GIANT ADRENAL GANGLIONEUROMA AND MYELOLIPOMA: A RARE CASE OF COLLISION TUMOR.

Background: An adrenal collision tumor is a rare entity. We present a rare combination of giant adrenal ganglioneuroma (GN) and myelolipoma. GN is a rare benign tumor of the adrenal medulla that originates from primitive neural crest cells, while myelolipoma is a benign tumor of the adrenal cortex comprising of mature adipose tissue and blood components. Case Report: We present a case of a 52-year-old male who presented with generalized body swelling with episodes of vomiting and diarrhea. There was no history of abdominal pain or any significant history. Routine laboratory investigations and endocrine workup were within normal limits. MRI was performed for unexplained symptoms, and which revealed a solid homogeneous mass measuring 9x7x4.5cm arising from the adrenal gland. A diagnosis of myxoid adrenocortical neoplasm was suggested, and laparoscopic left adrenalectomy was performed based on imaging findings. The final diagnosis of coexisting giant adrenal GN with myelolipoma was made on histopathological examination, which was further confirmed by immunohistochemistry. Conclusion: Ganglioneuroma coexistence with myelolipoma is a rare finding in the adrenal gland. Therefore, histopathology is imperative in such cases for a definitive diagnosis.

Cysticercosis presenting as cervical lymphadenopathy: a rare presentation in two cases with review of literature.

Lymphadenopathy is a rare mode of presentation of cysticercus infestation. Hence, in endemic areas, cysticercosis must be included in the differential diagnosis of superficial palpable swellings in the neck region. We report two cases of cervical lymphadenopathy which were clinically suspected to be of tuberculous etiology. However, fine-needle aspiration cytology (FNAC) revealed features of parasitic lymphadenitis consistent with cysticercosis. Our cases highlight the importance of FNAC as an initial and rapid diagnostic modality for detecting parasitic lesions manifesting as lymphadenitis. Diagnosis by the minimally invasive FNA technique prompted an early therapeutic intervention with good response in our patients.

Acquired hemolytic anemia after minor ABO incompatible renal transplantation.

Passenger lymphocytes in grafted kidney have been reported to result in autoimmune hemolytic anemia (AIHA) in minor ABO incompatible transplants. We followed up 15 cases of minor ABO incompatible transplants for one year. Two patients developed severe but self-limited auto-immune hemolytic anemia within two weeks of renal transplantation. Both were blood group A and had received a kidney from a group O donor. Preoperative cross-match and antibody screen was negative; however subsequent to the hemolytic episode, group-specific blood was incompatible and patients were transfused with group O, cross-match compatible blood. Serological tests showed positive direct anti-globulin test (DAT) and anti-A was eluted from both cases.

The prevalence of transfusion transmitted diseases in renal transplant recipients.

Majority of renal transplant patients have history of blood transfusion. Out of a total of 120 renal transplant patients, 20 (16.6%) patients showed raised alanine aminotransferase (ALT) levels (> 45 IU) on 2 or more occasions at 2 weeks interval. This study was undertaken to estimate the risk of transfusion transmitted diseases (TTD) in these 20 renal transplant patients. Another 200 voluntary blood donors were also included as control. Both subject groups were screened by ELISA for HBsAg, anti HBc (IgG & IgM), anti HCV, anti CMV (IgM), anti HIV and VDRL tests for syphilis. A total of 11 (55%) patients and 3 (1.5%) blood donors showed the evidence of HBsAg positivity (p < 0.01). Anti HBc antibody was present in 12 (60%) patients and 39 (19.5%) donors which was significantly (p < 0.01) different. Anti HCV antibody was detected in 5 patients and in one blood donor (p < 0.01). However, anti CMV antibody was present in 4 (20%) patients and 3 (1.5%) donors, respectively. There was no evidence of HIV and syphilis infection in both these groups. High incidence of hepatitis markers were observed in renal transplant patients.