Numb Chin Syndrome as the Initial Manifestation of Breast Carcinoma.

Numb chin syndrome may be the manifestation of a local dental pathology or secondary to a systemic disease. A systematic physical examination with diagnostic workup is of utmost importance in patients presenting with numb chin syndrome. We report the case of a 58-year-old woman who presented with numb chin syndrome. An orthopantogram and computed tomography of the head revealed osteolytic lesion in the left molar region. Histopathological and immunohistochemical examination confirmed the lesion to be metastatic breast carcinoma. Breast ultrasound scan demonstrated a 1.5 × 1.5-cm lesion in the left breast and fine needle aspiration cytology from the lesion confirmed the diagnosis of breast carcinoma. Bone scan showed multiple bone metastases. She was diagnosed to have numb chin syndrome secondary to bone metastases from breast carcinoma. In view of her disseminated disease status, she was started on palliative hormone therapy (Letrozole) with zoledronic acid. We present this case to highlight the importance of careful evaluation of patients presenting with numb chin syndrome because this may be the only manifestation of a systemic malignancy.

Primary classical Hodgkin lymphoma of rectum: Report of an extremely rare case and review of the literature.

Hodgkin lymphoma (HL) commonly presents as nodal disease, but in a subset of cases, the disease primarily develops in extranodal sites. Primary classical HL of the gastrointestinal (GI) tract is an extremely rare occurrence. Primary nature of the disease is confirmed after a complete lymphoma work up including chest radiograph, computed tomography scan, peripheral blood, and bone marrow studies. Only a few cases of primary GI lymphomas with limited immunohistochemical or molecular confirmation have been reported in literature. We report the case of a 64-year-old immunocompetent woman with primary rectal HL. She presented with constipation, and on sigmoidoscopy examination, she was detected to have an ulceroproliferative circumferential growth in the rectum. Considering the possibility of rectal carcinoma, a low anterior resection was done. Histology was suggestive of mixed cellularity classical HL. She was started on combination chemotherapy, and she responded well to treatment. However, she developed pulmonary complication after the fourth cycle of chemotherapy and succumbed to the illness. Primary rectal HL is extremely rare, and to the best of our knowledge, only 16 cases have been reported previously. We believe that reporting this case will add to the scarce data about this unusual presentation in immunocompetent patients.

Acute myeloid leukemia presenting as galactorrhea.

Acute myeloid leukemia (AML) presents with symptoms related to pancytopenia (weakness, infections, bleeding diathesis) and organ infiltration with leukemic cells. Galactorrhea is an uncommon manifestation of AML. We report a case of AML presenting with galactorrhea.