A 25-year-old female presented with complaints of pain and discharge from her left thigh since 5 years. She had a history of fall ten years back at her home and sustained fracture of the left femur. She was operated elsewhere and a plate was implanted. Six months after the surgery, she developed pain, swelling and discharging sinus from the wound site. She was treated with empirical anti-tuberculous treatment. Due to persistence of symptoms, the plate was removed one year later. Since then she has been complaining of discharging sinus on and off. On examination, she was found to have puckered scars and sinuses over the posterolateral aspect of distal third of left thigh. Plain X-ray revealed areas of cortical thickening and sclerosis with intervening cystic lucencies in the diaphysis. Mild periosteal reaction with contour deformity of the bone was also seen [Table/ Fig-1a&b].Debridement, sequesterectomy and saucerisation were done and the specimen was sent to Department of Pathology for histopathological examination. Gross examination revealed multiple cysts folded like a membrane with a glistening grey white cut surface and many bony fragments.Histopathological examination revealed viable and necrotic bone with parts of a cyst wall composed of acellular eosinophilic lamellated material surrounded by fibrosis and dense chronic inflammation with foreign body type of multi-nucleate giant cells [Table/ Fig-2a&b]. A few protoscolices of Echinococcus granulosus with a chain of hooklets were seen in the germinal layer [Table/ Fig-2c&d]. Hence a diagnosis of Hydatid disease was made and the patient was started on co-trimoxazole, praziquantel and albendazole. After 7 months, she presented to us with complaints of discharge from the wound site. Debridement from the left femur revealed necrotic spicules of bone, inflammatory granulation tissue and scolices of Echinococcus granulosus, suggestive of residual disease. Magnetic Resonance Imaging (MRI) of femur showed a few small pockets of T2 hyperintense lesions along the anterior, lateral and posterior aspects of mid and distal femur. A re-debridement was done with hypertonic saline wash and antibiotic laden cement was filled in the cortical window. Two strings of antibiotic beads, one in the soft tissue and one in the medullary canal was also inserted [Table /Fig-3 Hydatid disease caused by the larval form of the parasitic tapeworm, Echinococcus granulosus, commonly affects the liver and lungs. Bone involvement by Hydatid is extremely uncommon and is reported in 1-3% of cases. It is often a dormant disease, presenting at a late stage with non-specific clinical and radiological findings. Usually they occur as an isolated entity without liver/lung involvement and a clinical suspicion of this disease is not possible. We report a rare case of Hydatid cyst of femur in a 25-year-old female, with unresolving non-union of fracture for five years. The occurrence of this disease in atypical locations and lack of a specific radiological sign makes the diagnosis challenging and it is ...
Very few cases of placental site trophoblastic tumor (PSTT) primarily involving extrauterine sites have been reported to date. We report a case of a 29-year-old female who presented with a vaginal nodule 9 months after delivery at an outside hospital which was initially diagnosed as a poorly differentiated squamous cell carcinoma. Subsequently she was referred to our institute, and on the basis of histology, mildly elevated serum β-HCG level, and immunohistochemistry, PSTT was diagnosed. After the completion of chemotherapy, the vaginal nodule completely regressed and serum β-hCG returned to baseline. Her follow-up has been unremarkable. This case highlights the importance of the fact that PSTT can be easily misdiagnosed at extrauterine sites in the absence of proper clinical, histologic, and immunohistochemical correlation.
Acute myeloid leukemia (AML) is a malignant hematopoietic stem cell disorder which is sub-classified based on bone marrow morphology and the presence of specific genetic abnormalities. One such cytogenetic abnormality is the pericentric inversion (inv) of chromosome 16 which is typically seen in AML M4 with eosinophilia and is associated with a favorable prognosis. We report the inv (16) in a young woman with AML M5 and abnormal eosinophils. This is a rare entity with only about 20 cases being reported till date.
A diagnosis of MHA could be made based on a thorough peripheral blood smear examination, which also helps to avoid a misdiagnosis of immune thrombocytopenia.
Phosphaturic mesenchymal tumour is a tumour that can involve bone or soft tissue. This is a rare tumour and is known to be associated with osteomalasia. This is caused by tumour induced expression of fibroblastic growth factor (FGF23). We present a case of PMT in a 72 year old female patient who was diagnosed with osteomalasia due to nutritional deficiency of vitamin D and was appropriately treated but later presented with a mass in her foot.
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