Composite tumors of the adrenal medulla consisting of pheochromocytoma and ganglioneuroma are rare tumors accounting for less than 3% of all sympathoadrenal tumors. These tumors display more than one line of differentiation in which normal and neoplastic chromaffin cells are capable of differentiating into ganglion cells under the influence of nerve growth factors. To the best of our knowledge, we report the second case with a composite tumor of the adrenal medulla in a normotensive patient from India.
Background:In Acute Myeloid Leukemia (AML), malignant clones of immature myeloid cells (primarily blasts) proliferate, replace bone marrow, circulate in blood and invade other tissues. The unique presentation of bilateral proptosis and bilateral temporal swelling in AML is being reported.Case Report:A 6-year-old girl presented with low-grade fever, progressively increasing bitemporal swelling and bilateral proptosis. Contrast Enhanced Computed Tomographic (CECT) images revealed enhancing infiltrates occupying the lateral orbital wall, causing proptosis. The infiltrate extended toward the bilateral temporal fossae beneath the temporalis muscle and extradurally beneath the frontal and temporal bones. A high total leucocytic count with immature and deformed cells and, Fine Needle Aspiration Cytology (FNAC) from the temporal swelling, the bone marrow aspirate and biopsy showing leukemic blast cells confirmed the diagnosis of AML. Chemotherapy brought about remission of the disease.Conclusions:To the best of the authors’ knowledge, simultaneous presence of both bilateral proptosis and bitemporal swellings have not been previously reported in AML. A peripheral blood smear with bone marrow aspirate and biopsy help in the early detection of AML. Institution of early intervention in this potentially fatal disease is often associated with gratifying survival rates.
Parvovirus B19 is the etiologic agent of erythema infectiosum (fifth disease), a fever-rash illness
occurring in childhood. We present a 10 month old child with high grade fever for 10 days,
generalized tonic-clonic seizure, bilateral cervical lymphadenopathy, generalized maculopapular
rash, hematemesis and malena. Bone marrow aspiration and liver biopsy were done. EBV
serology and parvovirus PCR were also performed. Bone marrow aspiration and biopsy showed
giant pro-erythroblast consistent with parvovirus infection. PCR showed amplification of
parvovirus genomic sequences. Present case highlights an atypical presentation of Parvovirus
B19 infection as fever, rash and hepatosplenomegaly.
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