Primary cardiac osteosarcoma: A rare cause of chest pain in a young man.

Although primary cardiac osteosarcoma is uncommon, cardiac neoplasms should be in the differential diagnosis of cardiac complaints. We present a case of a 35 year old man with recurrent episodes of exertional chest pain and who was diagnosed with primary cardiac osteosarcoma. Cardiac osteosarcomas are rare but must be suspected.

A Lateral Neck Myeloid Sarcoma Presenting as Acute Otitis Externa.

Myeloid sarcoma (MS) is a solid extra-medullary tumor of immature myeloid cells which could occur before, during or after remission of acute leukemia at any site on the body. Owing to variation in differential diagnosis, pathologic evaluation and immunohistochemical staining are essential for definitive diagnosis. Rarely, MS has been shown as an isolated extramedullary relapse (iEMR) after allogeneic stem cell transplantation (allo-SCT), which often does not necessarily result in bone marrow involvement. It seems that despite chemotherapy and graft-versus-leukemia (GVL) effects on bone marrow, leukemic cells could remain alive in the extra-medullary region. However, in order to achieve longer survival, timely diagnosis as well as combined systemic, local, and cellular therapeutic modalities should be considered in any patient with iEMR after allo-SCT. We report a left lateral neck isolated MS presented as acute otitis externa in a patient with prior allo-SCT due to acute myeloid leukemia (AML). Therefore, MS should be considered in patients with any history of acute leukemia even if the patient presents with signs and symptoms of an infectious disease.

Well-tolerated oral cyclosporine in a case of hypersensitivity to parenteral cyclosporine in postallogeneic bone marrow transplantation.

Cyclosporine is one of the main drugs used for the prophylaxis of graft versus host disease in bone marrow transplanted patients. Hypersensitivity reaction to intravenous cyclosporine is rare and might be due to its vehicle polyoxyethylated castor oil, Cremophor EL. The exact mechanism is unknown, but IgE and IgG antibodies, complement, and histamine release have been considered to play a role in the development of this reaction. Here, we describe a case of anaphylaxis to intravenous cyclosporine, which was developed in a 19-year-old Iranian female with acute myeloid leukemia who underwent allogeneic bone marrow transplantation from her sister. The corn oil-based soft gelatin capsule (Sandimmune®) was substituted with no reaction. Our observation along with the previous reports confirms the role of Cremophor EL in hypersensitivity reaction to cyclosporine, according to which, modifying the formulation of the intravenous (IV) form could be the solution for this problem.