Primary Parotid Non-Hodgkin's B-Cell Lymphoma in an Elderly Woman on Pembrolizumab for Metastatic Invasive Papillary Urothelial Cell Carcinoma of the Bladder.

Primary lymphomas of the parotid are rare (4-5%) and seldom appear in patients with pre-existing metastatic cancer from other primary sources. We present a primary marginal zone B-cell lymphoma of the mucosaassociated lymphoid tissue (MALT) in an 84-year-old female with preexisting metastatic bladder cancer. A PET scan that identified positive pelvic/cervical lymphadenopathy and bilateral parotid masses. She underwent transurethral resection of a bladder tumor and started on pembrolizumab chemotherapy. After two years, the left parotid mass decreased in size but the right increased to 3.9cm. Right superficial parotidectomy diagnosed B-Cell Marginal zone lymphoma, staining positive for CD20, PAX5, and Bcl2. pembrolizumab was held and the patient was started on 4 weekly rituximab infusions. A PET scan done 3 months after completion of rituximab showed a good response to chemotherapy. This is the first reported case of a primary parotid gland lymphoma in a patient with active metastatic bladder cancer.

Delayed Hematogenous Metastasis Versus Second Primary Squamous Cell Carcinoma of the Neck in a Patient With Previous Cancer of the Cervix.

Squamous cell carcinoma (SCC) of the uterine cervix commonly spreads through direct infiltration and disseminates by lymphatic or hematogenous pathways. The most frequent locations for metastasis are lungs, liver, and bone. Other distant metastatic sites are rare, with only 1 reported case of neck metastasis. We present here a 73-year-old female with a prior human papillomavirus (HPV) + SCC of the cervix that had metastasized to her peri-aortic lymph nodes. Eight years after diagnosis and treatment, she returned with a hypermetabolic supraclavicular lymph node and new left-sided neck mass. Biopsy of the neck mass revealed invasive SCC positive for high-risk HPV genotype. The presence of high-risk HPV genotypes in both the cervix and supraclavicular lymph node, without evidence of second primary tumor, implies that the neck mass is a delayed metastasis of the patient's previous cervical cancer. This marks the second recorded case of neck metastasis from a SCC of the cervix.

Giant adrenal myelolipoma masquerading as heart failure.

Adrenal myelolipomas are rare benign tumors of the adrenal cortex composed of adipose and hematopoietic cells. They have been postulated to arise from repeated stimulation by stress, inflammation and ACTH oversecretion. Myelolipomas are usually detected incidentally on imaging and do not require any active intervention besides regular follow-up by imaging. However, myelolipomas may insidiously grow to large sizes and cause mass effects and hemorrhage. Timely diagnosis and surgical resection are curative and lifesaving.