Adenoid cystic carcinoma (ACC) is a relatively common malignant neoplasm which occurs in the head and neck region, particularly in the salivary glands. It is a slow growing, locally aggressive neoplasm with a unique feature of perineural spread. Intracranial extension can occur by direct extension, hematogenous metastases or by perineural spread. However, the occurrence of primary intracranial ACC with no evidence of a primary, is rare, with only ten cases reported in reviewed English literature until now. One such case is presented here with brief review of literature. This patient showed a good response to treatment with surgery followed by post-operative radiotherapy and has remained disease free, 32 months after the completion of treatment.
A 24-year-old man presented with radiating back pain and progressive neurological deficit. MRI revealed a spinal epidural tumor at thoracolumbar junction. He underwent decompression and excisional biopsy. Histopathology and immunohistochemistry identified it as diffuse large B-cell lymphoma. He received chemotherapy and is asymptomatic at 1-year follow-up. Primary spinal epidural lymphomas (PSELs) comprise a group of tumors, which are present only in the spinal epidural space, with a histopathological picture of lymphoma and negative diagnostic workup for lymphoma at other sites. 1 The epidural location of lymphomas, both Hodgkin's and non-Hodgkin's, is infrequent and challenging to diagnose. About 24%-48% of non-Hodgkin's lymphomas (NHLs) were found to have an extranodal origin. 2,3 However, PSEL accounts for only 0.9% of all extranodal NHLs. 4 There are many cell types of NHLs. Primary spinal epidural DLBCL is the most common form which accounts for only 1.8% all diffuse large B-cell lymphomas. 5 It is easily missed and maybe misdiagnosed leading to a lack of timely intervention and unhindered tumor progression. This report describes the clinical features, imaging characteristics, and histopathological features of the rare case of primary spinal epidural diffuse large B-cell lymphoma (DLBCL). To the best of our knowledge, this is the first reported case of primary spinal epidural DLBCL from Nepal. It also emphasizes the importance of a multidisciplinary approach for the successful treatment of this disease. 2 | CASE REPORT A 24-year-old man presented with a 3-month history of low back pain associated with the burning sensation of bilateral lower limbs. For the last 12 days, he was unable to walk due to gradually progressive weakness in bilateral lower limbs. These symptoms were not accompanied by fever, headache, and night sweats. He could not recall any history of trauma in the past. His past medical and surgical history was not significant. On examination, there was a localized tenderness over the thoracolumbar region. Lower limb motor power varied across muscle groups: hip flexors (2/5 bilaterally), knee extensors (2/5 bilaterally), ankle dorsiflexors (2/5 bilaterally), long toe
A 24-year-old male presented with radiating back pain and progressive neurological deficit. MRI revealed spinal epidural tumor at the thoracolumbar junction. He underwent decompression and excisional biopsy. Histopathology and immunohistochemistry identified it as diffuse large B-cell lymphoma. He received chemotherapy and is asymptomatic at one-year follow-up. Key clinical message Rarer diseases like primary spinal epidural diffuse large B-cell lymphomas should also be considered as the differential in those patients who complain of back pain with rapid neurological deterioration in lower limbs.
Melioidosis, also called Whitmore's disease, is an infectious disease caused by the bacterium Burkholderia pseudomallei. It is predominantly a disease of tropical climates, especially in Southeast Asia and northern Australia. Due to a wide range of signs and symptoms that can be mistaken for other diseases such as tuberculosis or common forms of pneumonia, patients can be frequently misdiagnosed, which can have adverse consequences and can make management more complicated. This case report elaborates on the clinical course of a middleaged nondiabetic male patient who presented to our hospital with fever for two months and painful swelling of the right proximal leg for 10 days, following a previous diagnosis of disseminated abdominal tuberculosis made at a different healthcare center. Preliminary investigations confirmed multiple diagnoses of acute osteomyelitis and septic arthritis complicated by multiple hepatic and splenic abscesses. Given the patient was in a state of septic shock at the time of presentation, he was managed as an emergency case and an arthrotomy of the knee joint was performed followed by decompression and drainage of the right proximal tibia. As per standard hospital protocol, the pus and synovial fluid were sent for microbial culture and sensitivity, at which point B. pseudomallei was isolated and the diagnosis was confirmed. Diagnosis of melioidosis requires a high degree of suspicion among clinicians and microbiologists, especially in individuals that have frequent exposure to contaminated soil and water and have a travel history to endemic countries.
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