Plasma cell myeloma associated with Epstein-Barr virus infection in an 11-year-old girl.

Multiple myeloma is extremely rare in children and represents fewer than 1% of all patients with myeloma. We report a case of multiple myeloma in an 11-year-old girl, who presented with a well-differentiated immunoglobulin A/kappa plasmacytoma at the base of the skull at 9 years of age; at that time, the bone marrow biopsy was negative. Two years later, the patient experienced generalized bone pain with multiple lytic bone lesions that affected the skull, long bones, ribs, and clavicle. The bone marrow biopsy showed a well-differentiated (Marschalko-type) multiple myeloma that was positive for CD138 and immunoglobulin A, with kappa light chain restriction. Interestingly, the Epstein-Barr virus (EBV) was detected by in situ hybridization for EBV-encoded RNA (EBER) in the majority of the neoplastic cells from both biopsy specimens. The patient responded favorably to treatment with dexamethasone, thalidomide, and zoledronic acid and is scheduled for bone marrow transplantation.

[Cystic neoplasm of the pancreas: a ten years experience]. / Tumores quísticos de páncreas. Informe de 10 años.

BACKGROUND: Pancreatic cystic lesions (PCL) are identified in 1 % of patients who undergo abdominal computed tomography scans, because it is difficult to discriminate clinically between benign and malignant PCL. The PCL must be distinguished from inflammatory pseudocysts, which can have a similar radiographic appearance. The aim of this study was to review the incidence of PCL during 10 years. METHODS: Nineteen consecutive patients who underwent surgical resection of a cystic lesion of the pancreas during a 10-year period were reviewed. RESULTS: From 1998, 434 patients underwent to pancreatic surgery, 103 (25.75%) resulted with neoplasm of the pancreas and a PCL was diagnosed in 19 of them (18.44%). They were more common in women (n=15, 79%). The pathologic diagnosis was mucinous cystadenoma (n=6, 31.5%) followed by serous cystadenoma and solid cystic papilar tumor (n=4, 21%). Mucinous cystadenocarcinoma was diagnosed in a 77 year-old man and a serous cystadenocarcinoma was diagnosed in a 53 years-old woman; cystic degeneration of two insulinomas were diagnosed in a 71 year-old woman and a 32 year-old man (5.26%). CONCLUSIONS: PCLs represent a spectrum of associated diseases. The incidence of serous cystadenoma is lower in our experience.

Leiomyosarcoma of the kidney: case report.

BACKGROUND: Renal sarcomas represent 1-2% of malignant kidney tumors in adults; 50% of renal sarcomas are composed of leiomyosarcomas. These tumors generally arise from the renal capsule, smooth muscle tissue of the renal pelvis and intrarenal vessels. They are indistinguishable from other renal masses prior to surgery and are associated with an adverse prognosis. CLINICAL CASE: We report the case of a 58-year-old female with a clinical course characterized by asthenia, weakness, generalized attack to her health status and pain in the left renal fossa. Computed axial tomography was performed where a left retroperitoneal tumor was diagnosed. Left radical nephrectomy was performed. The histopathology report demonstrated leiomyosarcoma originating from the renal sinus vessels. The patient was successfully treated with adjuvant radiotherapy. CONCLUSIONS: Renal leiomyosarcomas usually have an aggressive biological behavior with poor prognosis, accounting for surgical treatment with wide resection associated with adjuvant chemotherapy and radiotherapy as the only therapeutic option.

[Tuberculosis of the pancreas: an unsuspected cause of abdominal pain and fever]. / Tuberculosis pancreática: una causa insospechada de dolor abdominal y fiebre.

BACKGROUND: Tuberculosis is frequently the form of presentation of human immunodeficiency virus (HIV) infection even in patients who have not developed acquired immune deficiency syndrome (AIDS). Nevertheless, pancreatic affection is uncommon. Tuberculosis of the pancreas (TBP) is a clinical rarity and mimics pancreatic carcinoma both clinically and radiologically. CLINICAL CASE: We present the case of a 42-year-old man with a 5-day evolution of moderate abdominal pain in the right lower quadrant and fever and vomiting without diarrhea. The patient had no history of abdominal surgery. CT scan revealed a heterogeneously enhancing, multicystic structure in the pancreatic head. Due to suspicion of malignancy, a pancreatoduodenectomy was performed with pathological result of pancreatic tuberculosis. The patient was discharged on the 10th postoperative day without surgical complications. He died 10 months later of Pneumocystis jirovecii pneumonia. By that time he had a positive serum HIV antibodies test. CONCLUSIONS: TBP diagnosis can be missed or significantly delayed because it is often not suspected prior to laparotomy unless there is evidence of pulmonary tuberculosis. TBP should be considered in the differential diagnosis of a mass in the head of the pancreas. The response to early antituberculosis treatment is very effective.