Allergic broncho-pulmonary aspergillosis presenting as flitting opacities on chest radiograph.

Allergic broncho-pulmonary aspergillosis (ABPA) is hypersensitivity reaction to Aspergillus fumigatus in the bronchial tree of young asthmatic patients. A 28 years old female patient presented with one year history of fever with generalised body aches and pains and had already received treatment for pulmonary tuberculosis. Her chest radiograph showed flitting opacities in both lung fields with a TLC of 13.2 x 109/L having 25% eosinophils and ESR of 87 mm at first hour. Her serum IgE were markedly raised and CT scan of the chest showed dilated large and medium sized bronchi forming mucocoeles, finger in glove appearance and nodular shadowing in the lung parenchyma. Sputum also showed fungal hyphae by direct microscopy. All the findings were consistent with the diagnosis of ABPA, which responded to oral Itraconazole and Prednisolone. ABPA is a potentially destructive lung disease requiring high index of suspicion for an early diagnosis to prevent irreversible lung damage.

Primary perisplenic hydatid cyst.

Splenic parasitic cysts due to flat worm Echinococci resulting in hydatid disease are a rare presentation as primary site even in the endemic regions. Primary splenic parasitic cysts have an incidence of 0.5-4%. A 21-year-old male with pet dogs at home, presented with 3 months history of gradually increasing discomfort in the left hypochondrium and tender splenomegaly. He had marked eosinophilia with normal liver function tests and positive serum IgM Echinococcus antibodies. Ultrasonography showed a cyst in the hilar region of spleen having septations with internal echos. An upper midline laparotomy was performed and a perisplenic cyst was removed along with spleen from the sub-diaphragmatic location. Histopathological examination confirmed acellular fibrous wall of hydatid cyst with germinal layer and scolices in the centre. Postoperatively, patient was continued on oral Albendazole for one month.

Biphasic synovial sarcoma of oral cavity.

Synovial sarcoma is a mesenchymal spindle cell tumour, which is unrelated to synovium and shows variable epithelial differentiation. Typically, synovial sarcoma arises in the soft tissues of the extremities but cases in the head and neck region are less common and oral cavity involvement is extremely rare. A 17-year-old girl presented with a gradually increasing swelling on the right cheek for 2 years, which on biopsy, revealed a biphasic tumour comprising fascicles of spindle shaped cells with gland formation by epithelial cells and scattered masts cells. Histological diagnosis of biphasic synovial sarcoma was confirmed on immunohistochemistry by strong positivity for EMA, S-100 and CD-99 in both epithelial as well as spindle cell areas.