Histiocytic sarcoma with acute lymphoblastic leukemia a rare association: case report and literature review.

Definition and diagnostic criteria for histiocytic sarcoma (HS) have changed over last two decades due to available new immunohistochemical markers, as well as better understanding of the biology of disease. We report here a case of 4 years old boy diagnosed as acute lymphoblastic leukemia (ALL), who later developed HS of pleura, when he was on maintenance phase of ALL protocol. HS constitutes less than 1 % of the haematolymphoid neoplasm, even more rare is association of HS with ALL. Thus reporting here a rare association of HS with ALL, will help in knowing the actual incidence of HS as well as association with ALL.

Granulocytic sarcoma with compressive myelopathy: a rare presentation of chronic myelogenous leukemia.

Granulocytic sarcoma occurs most commonly in acute myelogenous leukemia. The appearance of granulocytic sarcoma in chronic myelogenous leukemia signals accelerated phase/ blast transformation. This is a rare case of undiagnosed chronic myelogenous leukemia with granulocytic sarcoma causing cord compression, which went into tumour lysis syndrome requiring dialysis after starting of steroids and radiotherapy. A 43-year-old male presented in emergency department with acute onset of flaccid paralysis. On clinical examination, there was hepatosplenomegaly and lower motor neuron paralysis in the lower limbs. The peripheral smear was consistent with chronic myelogenous leukemia in chronic phase. The MRI spine revealed para-spinal and epidural masses causing cord compression and the biopsy from the paraspinal mass was consistent with granulocytic sarcoma.

Amphotericin B cement beads: A good adjunctive treatment for musculoskeletal mucormycosis.

Mucormycosis is one among the aggressive, invasive fungal infections usually seen in immunocompromised patients. Mucormycosis osteomyelitis is very rare. We present a patient with acute myeloid leukemia who complained of pain over the right proximal thigh. Plain radiograph revealed ill defined osteolytic lesion of proximal femur. MRI showed altered signal in proximal femur with focal collection and cortical breach. Biopsy and tissue culture diagnosed mucormycosis both histologically and microbiologically. He was treated with aggressive debridement, skeletal stabilization, and amphotericin antifungal cement beads. He recovered with no residual pain, minimal limb shortening, and no clinical or radiological evidence of recurrence at 3 years followup. The high index of suspicion, early diagnosis, aggressive surgical debridement, and adequate antifungal therapy play a significant role in the treatment of musculoskeletal mucormycosis.