An unusual pain in the hip.

A 68-year-old previously healthy man presented with increasing right hip pain of 6 months duration. On examination he was found to have a hard mass in the right hip arising from the pelvic bone. Imaging studies were in keeping with a sarcoma arising from the right iliac bone. However, biopsy of this bony lesion confirmed this to be a metastatic adenocarcinoma rather than a primary bone malignancy. Further imaging and a subsequent colonoscopy revealed the primary to be a colonic adenocarcinoma. The unique and unusual nature of this case was the presentation as a solitary bony metastasis from a colonic primary. There is no previously documented report in the literature of such a rare presentation of a colonic adenocarcinoma as a solitary bony lesion mimicking a primary sarcoma in the absence of other signs or symptoms.

Primary pituitary abscess with coexisting pyogenic meningitis: an unexpected diagnosis.

Primary pituitary abscess is a very rare disease most likely associated with pyogenic infection. A 27-year-old woman was initially diagnosed and treated as a case of acute pyogenic meningitis. In view of persistent headache, impaired visual fields, galactorrhea and menstrual irregularities, she underwent evaluation of pituitary mass lesion. Magnetic resonance imaging of the pituitary reported the mass as pituitary macroadenoma. However, transsphenoidal surgery revealed copious collection of purulent materials confirmed as pyogenic pituitary abscess. A follow-up magnetic resonance imaging of the pituitary 2 years later confirmed secondary empty sella. She has developed panhypopituitarism; she remains on appropriate anterior pituitary hormone replacement.