Solid Pseudopapillary Epithelial Neoplasm of the Pancreas: A Rare Entity with Diagnostic Dilemma

The solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas is a relatively uncommon entity. The aim of the present study was to summarize our experiences with regard to diagnostic dilemma, surgery, postoperative follow-up, and management. This retrospective data were collected during the period from January 1, 2018 to December 31, 2020. A total of four patients (three females and one male) were identified within an age range of 13 to 25 years. All the patients were presented with nonspecific symptoms such as abdomen lumps, swelling in the abdomen, and abdominal pain. To reach a definite diagnosis, imaging studies were conducted along with endoscopic ultrasound fine-needle aspiration (EUS-FNA) and biopsy. After confirmation of SPEN on biopsy, all the patients underwent surgery without any complications. Patients are on follow-up, and to date, no metastasis has been detected. SPEN is a rare pancreatic tumor with unusual pathological features leading to a diagnostic dilemma. The pathologist should be familiar with SPEN and its salient histological characteristics that differentiate it from other look-alike pancreatic tumors and can help in timely surgery and management.

Pheochromocytoma: The Great Masquerader

Catecholamine-secreting tumors occur with equal frequency in men and women, primarily in the fourth and fifth decades. The associated hypertension may be sustained or paroxysmal, and patients who are diagnosed in the presymptomatic stage may have normal blood pressure. These tumors can be lethal unless they are diagnosed early and treated appropriately. Numerous disorders can mimic pheochromocytoma, leading to diagnostic dilemma. Described here is a case which was misdiagnosed for 5 years as anxiety, panic attacks, cervical spondylosis, vasomotor symptoms of menopause, arrhythmia and even acute coronary syndrome. Therefore, enhanced adrenal awareness is the need of the hour, to catch this “great masquerade”.

Bleeding per rectum during induction chemotherapy: Looking beyond the leukaemia – 2 case reports and review of literature

Synchronous malignancies involving acute leukemia and a solid organ are rare. Bleeding per rectum is a common manifestation of acute leukemia during induction chemotherapy and might mask the presence of synchronous colorectal adenocarcinoma (CRC). Here we present two rare cases of acute leukemia with synchronous CRC. We also review previously reported synchronous malignancies to investigate demographics, diagnosis, and treatment modalities. Management of these cases requires a multispecialty approach

A case of paraneoplastic hyperleukocytosis closely mimicking chronic neutrophilic leukemia

Leukemoid reaction and myeloproliferative syndrome are close mimickers and frequently pose a diagnostic dilemma, particularly when the leukocyte count is very high. Leukocyte alkaline phosphatase score frequently aids in diagnosis but may or may not be contributory, especially in differentiating chronic neutrophilic leukemia. Herein, we document a case of leukemoid reaction with extensive hyperleukocytosis in a 46-year-old female with poorly differentiated carcinoma. The tumor itself as well as the associated leukocytosis portends a poor prognosis

Dengue Encephalitis - A Diagnostic Dilemma

Introduction: Dengue is most important arthropod-borneviral disease worldwide, with approximately 390 millioninfection occurung per year, of which approximately 96 milliocause sign of disease. Dengue virus is single stranded RNAvirus belonging to flaviviridae family having four serotypes.Case report: We are thus reporting a case of Dengue feverwhich presented as encephalitis. Very few cases of dengueencephalitis has been reported worldwide and the literatureavailable on the illness is limited.Conclusion: Dengue is classically thought to be a nonneurotropic virus. Most common dengue serotype causingneurological complication are DEN 2 and DEN 3. Neurologicalcomplication are rare in dengue.

Case Report of Diagnostic Dilemma – Fibrous Dysplasia/Osteosarcoma

Among bone tumours of head neck region, benign tumours of bone are common, while malignant tumours are very rare. These benign tumours constitute about 75% of all bone tumours. Most of these bone tumours present clinically with pain, swelling and symptoms of compression of vascular and neural structures. Surgery is not required for these bone tumours unless patient experiences any discomfort as diagnosis is made on plain radiographs. Only 2% of all benign tumours may undergo malignancy[1]. Fibrous dysplasia (FD) is a less common skeletal developmental anomaly of the bone, which is often misdiagnosed as malignant bone tumour. It manifests as defect in osteoblastic differentiation and maturation and affects a single bone or may involve multiple bones2. Osteosarcoma is a malignant mesenchymal tumour, predominantly affecting the long bones and occasionally seen affecting the maxillofacial region. It accounts for 15–35% of all primary bone tumours and 4–8% of sarcomas of jaw[4]. In osteosarcoma, males are more commonly affected than females. The aim of this article is to represent a rare case of bone tumour of the upper jaw in 10-year-old boy, which was initially suspected as osteosarcoma and later confirmed as FD.

Conventional renal cell carcinoma with renal capsular leiomyoma: A diagnostic dilemma.

Primary renal leiomyomas are very rare benign tumors of the kidney, arising from smooth muscle cells of the renal capsule, pelvis or blood vessels. Simultaneous occurrence of a leiomyoma with conventional renal cell carcinoma (RCC) in the same kidney is an extremely rare incidence. Herein we describe a case, which to the best of our knowledge is the second reported case in the English literature. This 70-year-old female presented in surgical out-patient department with the complaints of hematuria and abdominal pain. Subsequently, on computed tomography a multifocal mass was noted in the right kidney, measuring 4.5 cm × 3 cm × 2 cm and 1 cm × 0.5 cm × 0.5 cm respectively. A radical nephrectomy was performed with the clinical diagnosis of a multifocal RCC. Histopathological examination revealed a conventional RCC in the larger nodule, whereas the smaller nodule showed a sub capsular leiomyoma, which was immune-positive for smooth muscle actin and HMB45. In the index case, radiology could not differentiate between the RCC and leiomyoma. Apart from being a radiological diagnostic dilemma, rare HMB45 immunostain positivity in capsular leiomyoma may create diagnostic dilemma for histopathologists too. Sole HMB45 positivity should not distract one to diagnose this lesion as an angiomyolipoma, unless the other components are seen.