Ischaemic stroke as the first presentation of occult squamous cell cancer

A 39 years old female presented with sudden onset of left sided weakness and CT scan brain confirmed an ischaemic stroke. Extensive investigations looking for the underlying cause were un-rewarding. She presented few days later with confusion and fever and was found to have multiple new cerebral infarcts, disseminated intravascular coagulation, rectal mass and liver metastases. Biopsy of metastatic liver lesion identified the primary tumour to be of squamous cell origin. Such a rare presentation as ischaemic stroke of a very rare squamous cell carcinoma of rectum has not been reported before

Spontaneous hepatic subcapsular hematoma

A 47-year-old male presented with right hypochondrial pain radiating to the right shoulder associated with nausea and vomiting along with fever. Primary investigations showed significant neutrophilic leukocytosis. Initial impression was liver abscess. Further evaluation suggested the presence of liver cirrhosis complicated by hepatic subcapsular hematoma. Patient was managed conservatively at the beginning but he continued to deteriorate and hematoma increased in size. Hepatic artery angiography showed no signs of active bleeding. Later on his condition deteriorated further due to sudden intraperitoneal hemorrhage, which did not respond to emergency surgery or resuscitative measures. Operative finding and histopathology findings were consistent with hepatocellular carcinoma