Acute Acalculous Cholecystitis due to primary acute Epstein-Barr virus infection treated with laparoscopic cholecystectomy; a case report.

INTRODUCTION: Epstein Barr virus (EBV) is a human herpes virus 4, transmitted through intimate contact between susceptible persons and asymptomatic EBV shedders. It usually presents with fever, pharyngitis and lymphadenopathy. Majority of individuals with primary EBV infection recover uneventfully. Acute Acalculous Cholecystitis (AAC) is usually seen in hospitalized and critically ill patients with major trauma, shock, severe sepsis, total parenteral nutrition and mechanical ventilation. CASE PRESENTATION: We report a 25-year- old woman presented with acute Epstein-Barr Virus (EBV)infection and hepatobiliary iminodiacetic acid (HIDA) scan confirmed presence of Acute Acalculous Cholecystitis (AAC). Conservative management was advised initially, but she had a laparoscopic cholecystectomy due to intolerable abdominal pain. CONCLUSION: AAC is a rare complication of acute EBV infection and it is usually managed conservatively, although our patient had laparoscopic cholecystectomy due to intolerable abdominal pain.

Pancytopenia in a 70-year-old african-american male: an unusual presentation of a rare disease.

Hairy cell leukemia is a rare lymphoid neoplasm arising from mature B-lymphocytes. Clinically, the disease presents with splenomegaly and abdominal discomfort, frequent infections, fatigue and bleeding because of related cytopenias. Bone marrow biopsy is essential for diagnosis. Below we describe a case of a 70-year-old African-American male who presented to our hematology clinic complaining of fatigue. Clinical exam and computed tomography imaging did not reveal splenic enlargement. Blood work-up revealed pancytopenia and bone marrow was diagnostic for hairy cell leukemia.The patient was started on cladribine, with gradual improvement of his symptoms and blood count abnormalities. Therefore, it is essential to keep hairy cell leukemia in the differential of pancytopenia even in the absence of a splenomegaly.

Spontaneous tumor lysis syndrome in a patient with cholangiocarcinoma.

Tumor lysis syndrome (TLS) is a potentially deadly complication of tumors or their treatment. This syndrome consists of a constellation of laboratory parameters such as hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia and clinical complications such as seizures, acute renal insult, cardiac dysrhythmias and death. TLS is especially common in patients with hematological malignancies with rapid cellular turnover rates such as acute lymphocytic leukemia and Burkitt lymphoma, but is very rare in patients with solid tumors. However, it is essential to keep in mind that solid tumors can also lead to TLS. We present a case of a 66-year-old African American male with metastatic cholangiocarcinoma complicated by the development of spontaneous TLS. TLS has never been reported in a patient with cholangiocarcinoma.

Breast osteosarcoma 29 years after radiation therapy for epithelial breast cancer.

Radiation therapy has a solid role in the management of breast adenocarcinoma. It significantly reduces the rates of disease recurrence. Nevertheless, radiation therapy is not without side effects and patients who have undergone breast irradiation are at increased risk for lung disease, sarcomas, acute leukemia and esophageal cancer. We present a case of radiation-induced breast osteosarcoma 29 years after radiation therapy and lumpectomy for breast adenocarcinoma. The patient had several disease recurrences after surgical resection and was found to have pulmonary metastases.

Primary diffuse large B-cell lymphoma of the ascending colon.

Primary colorectal lymphoma is a rare malignancy accounting for 3% of all gastrointestinal lymphomas and 0.1-0.5% of all colorectal malignancies. Among primary colorectal lymphomas, the most common histological subtype of colorectal lymphoma is diffuse large B-cell lymphoma. We report a case of an 84-year old Caucasian female who was admitted to the hospital because of a 2 days history of altered mental status. In the emergency department the patient was found to have acute kidney injury and hypercalcemia. On physical examination a large lower quadrant abdominal mass was palpated. Computed tomography scan of abdomen confirmed the presence of a mass along the cecum and proximal ascending colon. Colonoscopy showed a large ulcerated mass and biopsy was consistent with diffuse large B-cell lymphoma. The patient underwent colectomy but refused to receive chemotherapy.

Subcutaneous diffuse large B-cell lymphoma with intraocular involvement.

Here, we present an observational case report of choroidal involvement of subcutaneous diffuse large B-cell lymphoma (DLBCL). An 85-year-old female presented with a growing mass on her left abdominal wall that had been gradually growing over 2 months, which was diagnosed as subcutaneous DLBCL. A total of 1.5 months after her initial diagnosis, she presented with decreased peripheral vision of her right eye with intermittent pain for 1 month, and nausea and dizziness for 3 days. A large choroidal mass with vitreous seeding was found and vitreous aspiration with flow cytometry established the diagnosis of intraocular DLBCL. No tumorous lesions were detected anywhere else. Therefore, the patient was diagnosed as stage IV subcutaneous DLBCL with solely intraocular involvement, and was subsequently treated with systemic and intravitreal chemotherapy. A total of 9 months later, she achieved complete remission. It was concluded that subcutaneous extranodal DLBCL is a very rare form of non-Hodgkin lymphoma that can involve only the choroid.

Thymic lymphoepithelioma-like carcinoma mimicking primary tumor of the lung.

Thymic lymphoepithelioma-like carcinoma is a rare subtype of thymic cancer with a poor prognosis; a few cases have been reported in the English literature. Strong clinical suspicion should be pursued in patient management decision making despite initial diagnostic studies, which sometimes mcould islead clinicians, as in our case.