Parapharyngeal lymph node as an isolated manifestation of follicular dendritic cell sarcoma: First report in Iran.

Follicular dendritic cell sarcoma (FDCS) is a rare type of sarcoma that originates from the stromal component of the germinal center of the B-follicle. Its presentation and prognosis vary, as it can be nodal or extranodal, localized or multifocal, and can be fatal in 20% of cases. Due to its rarity, FDCS diagnosis requires a high level of suspicion. Most cases have been reported in Europe or the United States, and no cases have been previously reported in individuals of Iranian descent. This case report describes a 33-year-old Iranian man with no significant medical history who presented with a palpable nodule in the neck and odynophagia. Magnetic resonance imaging revealed a mass with heterogeneous enhancement in the parapharyngeal space. Pathological examination confirmed FDCS, likely localized to a parapharyngeal lymph node with no extranodal involvement. The patient underwent radiation therapy and remained disease-free 28 months after diagnosis.

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.

Spontaneous Complete Remission in a Patient with Acute Myeloid Leukemia and Severe Sepsis.

Without treatment, acute myeloid leukemia (AML) is almost always fatal. Spontaneous remission of AML is a rare phenomenon and usually with a short duration. The exact mechanisms are unknown. However, its association with infection and blood transfusions has been described. We report a 53-year-old male who presented with severe sepsis and who was diagnosed with AML (M4). He has experienced complete spontaneous remission with relatively long duration. To the best of our knowledge, it is the first case of spontaneous remission described in Iran.

An inverse association between serum vitamin D levels with the presence and severity of impaired nerve conduction velocity and large fiber peripheral neuropathy in diabetic subjects.

Diabetic neuropathy (DN) is the most common complication of diabetes mellitus (DM) and also the major cause of morbidity and mortality in diabetic patients. There have been recent speculations that circulating 25-hydroxyvitamin D (25(OH)-D) could be involved in DN development and progression. This study explored the association between serum 25(OH)-D and DN in diabetic subjects by performing strict matching of possible confounders. Overall, 33 diabetic subjects with DN and 29 controls matched in terms of age, sex, BMI, height and disease duration entered this study. Nerve conduction velocity (NCV) was performed to determine the existence and severity of large fiber neuropathy. 25(OH)-D had significantly lower value in DN group (21.2 ± 11.5 vs. 13.5 ± 5.1 ng/mL, P = 0.001). None of the other observed variables showed a significant association with existence and severity of DN. After adjustment for all studied variables, serum vitamin D had an independent and inverse association with both DN presence and severity, as each 1 ng/mL increase in serum 25(OH)-D was correlated with 2.2 and 3.4 % decrease in the presence and severity of NCV impairment, respectively. While adjusted for demographic variables, comorbidities and treatment of DM, our results imply that decreased levels of circulating 25(OH)-D may contribute to increased risk of large fiber neuropathy in type 2 diabetic subjects.