We report a case of retroperitoneal intra-abdominal primary monophasic synovial sarcoma (SS) with hemangiopericytomatous (HPC) pattern in a 25-year-old male arising from the triangular ligament on the superior surface of liver encasing the inferior vena cava (IVC) and masquerading as a hepatic tumor. A large heterogeneously enhancing, well defined, lobulated, exophytic lesion was seen involving segment VIII of the liver with foci of calcification in the periphery. A biopsy, followed by total resection of the tumor, showed a spindle cell sarcoma with HPC pattern, which was consistent with monophasic SS on histology and immunohistochemistry. The unusual clinical presentation, radiology, pathology, and differential diagnosis will be discussed in detail.
BackgroundBone marrow metastasis is a significant presentation of many non-hematological malignancies. The present study was conducted with the aim of analysing the clinical, hematological and biochemical parameters of the patients with bone marrow metastases and to determine the parameters which could be possible indicators of bone marrow metastases.Material and methodsBone marrow aspirate, imprint and biopsy slides of 22 cases with bone marrow metastases were reviewed and the hematological and biochemical data of all these cases was compared with that of 20 controls who had no evidence of metastases.ResultsThe mean values of mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR) and serum lactate dehydrogenase (LDH) were found to be significantly different (p<0.001) between the cases and controls. A MPV<8.1 fL, NLR>3.5 and LDH>452 U/L showed high likelihood ratio in predicting bone marrow metastases.ConclusionParameters such as MPV, NLR and LDH can be used as efficient and easily available means to predict bone marrow metastasis for an early diagnosis.
Hepatitis B Virus (HBV) infection can present with varied multisystem manifestations involving the skin, kidneys, blood, and nervous system. We report a 57-year-old man with HBV-related mononeuritis multiplex who had symptoms of multiple sensory-motor axonal polyneuropathies. He was evaluated for his neuropathy with nerve conduction studies and a sural nerve biopsy that revealed necrotizing small-vessel vasculitis. He also had an acute liver injury. He was started on direct-acting oral antiviral therapy followed by steroid therapy and this treatment led to the resolution of his symptoms and normalization of transaminases without significant changes in nerve conduction studies at a one-year follow-up.
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