Primary Epitheloid Angiosarcoma (EA) of liver is an aggressive malignant tumour with poor prognosis irrespective of aggressive surgical resection with or without adjuvant therapy. It constitutes for 0.1-2% of primary malignant tumours of liver and is seen commonly in sixth or seventh decade of life, with male preponderance. It can be asymptomatic or may present with nonspecific symptoms. Lack of pathognomonic features on serological, biochemical and radiological tests, makes it even difficult for an early diagnosis. Despite early surgical removal, EA has very high recurrence rate. Chemotherapy agents (paclitaxel, bevacizumab) and immunomodulators (mTOR inhibitors) have shown some survival benefit and reduction in recurrence rates in recent years as adjuvant therapy. To the best of our knowledge, a hanging morphological variant of EA of liver has not been reported yet in literature. Author here by report a case of 37-years-old male incidentally diagnosed with aggressive, hanging variant of EA of liver. Despite early surgical resection and adjuvant, after chemotherapy patient had survival of less than eight months since first presentation.
Introduction: Thorn prick is commonly seen in people that are involved in gardening. In some cases, they are unaware of the precedent thorn prick or present for medical attention quite late and forget about the history of thorn prick. In such cases, it is challenging for the clinicians and the radiologist to rule out the cause of the osteomyelitis caused by an unrecognized foreign body. Case Report: A 14-year-old girl presented with a swelling of the hand and discharging sinuses with a radiographic picture of osteomyelitis of the 5th metacarpal. The CT and MRI showed features consistent with osteomyelitis as well, possibly tuberculous in etiology. Even after the completion of AKT (anti-tubercular treatment), the patient continued to have discharging sinuses out of which a plant thorn spontaneously egressed, and subsequently, the patient was completely relieved of her symptoms. Retrospective evaluation of the MRI showed the presence of a foreign body that was hyperdense on CT and was initially thought to be a sequestrum. Conclusion: Hence, even though a definite history of trauma/thorn prick is not given (although highly unusual in the case of hand), an organic foreign body should be considered in the etiologic differential diagnosis of non-responding chronic osteomyelitis and discharging sinuses. Keywords: Thorn, osteomyelitis, hand.
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