Leukemia as a second malignancy.

To study the occurrence of leukemia as a second malignancy following various primary solid and hematological malignancies. Total 11 cases of leukemia presenting as a second malignancy were studied over a period of 15 years from 1990 to 2005. The primary malignancies included carcinoma breast (4), multiple myeloma (3) and one each of Hodgkin's lymphoma, mediastinal germ cell tumor, papillary carcinoma thyroid and myxopapillary ependymoma. Ten patients had received chemotherapy with combination radiotherapy in six patients. The commonest type of leukemia was AML-M2. The cyogenetic test results were available in three cases. The secondary leukemia showed aggressive behaviour and all patients on follow-up died within a period of one month. The risk benefit ratio of chemotherapy and radiotherapy should be considered before starting the patients on treatment. A high degree of suspicion and follow up with hematological parameters is required for therapy related complications.

Extramedullary myeloid cell tumours--the NIMS experience.

Extramedullary myeloid cell tumours are rare clinical entities, which often pose diagnostic problems. From the pathology record files of Nizam's Institute of Medical Sciences, Hyderabad, 16 cases of EMCTs were traced, over a period of 14 years. The clinical details, follow-up were noted and morphology re-evaluated, and immunohistochemistry with LCA was performed. Of the 16 cases, the distribution was as follows--skin and subcutaneous nodules, lymph nodes, extradural masses presenting with cord compression and one case each with eyelid, orbital and breast masses. The problems in diagnosis are presented and a panel of immunohistochemical markers suggested for proper diagnosis and treatment.

Hodgkin's lymphoma presenting as extradural spinal cord compression.

OBJECTIVES: Hodgkin's lymphoma presenting with spinal cord compression is rare. Reports estimate that only 5% of patients with Hodgkin's lymphoma have spinal cord compression. The objectives of this study were:- (1) To review the histology of all cases of Hodgkin's lymphoma causing spinal cord compression. (2) To correlate the findings with the clinical details- lymphadenopathy, hepatosplenomegaly, and marrow involvement. METHOD: This was a retrospective study, the period of study being between 1987-2002. All cases were taken from the histopathology record files, pathology department, NIMS, Hyderabad. The clinical profile of each case was noted and the histology reviewed. When necessary, immunohistochemistry with the necessary markers was performed. RESULT: There were 12 cases, of which 11 were males, and one was a female. The patients ranged from 8-62 years of age, with a median age of 32 years. The cord involvement was at different levels- thoracic(8), lumbar(2) and cervical(2). CONCLUSIONS: The histologic diagnosis of Hodgkin's lymphoma presenting as cord compression requires awareness of the condition. The close differential diagnoses include non-specific inflammation, non-Hodgkin's lymphoma, tuberculosis and eosinophilic granuloma. Detailed clinical evaluation is essential for interpreting the histology.