Mesenchymal stem cells differentiate into a plethora of cell types. These differentiated cell types include osteoblasts, chondrocytes, myocytes, and adipocytes. Sarcomas occur secondary to malignant transformation of these mesenchymal, pluripotent stem cells. Involuntary smooth muscle is responsible for the make up of hollow organs and vasculature in our body and is regulated by our autonomic nervous system, hormones, as well as chemical and local mediators. Cancer involving smooth muscle cells is designated as leiomyosarcoma (LMS). LMS can arise from any location in the body where smooth muscle is present and is frequently reported in the abdomen and pelvis, as well as the trunk, extremities, and throughout the retroperitoneum.
Lemierre’s syndrome is an oropharyngeal infection complicated by septic thrombophlebitis of the internal jugular vein, bacteremia, and septic emboli. It mainly occurs in immunocompetent individuals and was first reported in the early 1900s by physician Andre Lemierre. A 23-year-old male presented to our institution with sore throat, difficulty swallowing, left-sided ear pain, nausea, vomiting, subjective fevers, general malaise, right-sided rib pain, and anorexia. Complete blood cell count and metabolic panels revealed severe thrombocytopenia, mild anemia, acute kidney injury, and hyperbilirubinemia. Blood cultures grew
Fusobacterium necrophorum
. Ultrasound and computed tomography scan of the neck revealed thrombosis of the left internal jugular vein. ADAMTS13 activity was later reported to be markedly decreased at less than 2%, confirming a diagnosis of thrombotic thrombocytopenic purpura.
Pheochromocytomas (PCC) are rare neuroendocrine tumors of the adrenal medulla that arise from chromaffin cells. These cells are neural crest derivatives and are innervated by the splanchnic nerve of the sympathetic nervous system which releases acetylcholine that in turn binds to nicotinic acetylcholine receptors of the adrenal medulla causing the release of catecholamines. The dopamine, norepinephrine, and epinephrine released from these tumors are responsible for the episodic hyperadrenergic symptoms seen in these cases such as hypertension, palpitations, and headaches. This case report discusses the incidental finding of a unilateral PCC in a 58-year-old woman who initially presented to our emergency department complaining of intermittent chest pain and headaches for two days.
Aspergillus is a large group of spore-forming fungi in the phylum Ascomycota. Aspergillus infections more frequently occur in individuals with pre-existing lung conditions such as cystic fibrosis and asthma and immunosuppressed individuals, and less frequently in the immunocompetent population. Pulmonary aspergillosis can be subdivided into three categories: allergic bronchopulmonary aspergillosis, chronic pulmonary aspergillosis, and invasive pulmonary aspergillosis. We present a rare case of a 57-year-old male with a previously known diagnosis of pancreatic adenocarcinoma on chemotherapy who was found to have a co-infection of the respiratory tract by Aspergillus flavus and Mycobacterium avium intracellulare.
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