A Rare Case of Eccrine Carcinoma Demonstrating Intracranial Invasion in a Patient With Advanced Hepatocellular Carcinoma.

Eccrine carcinoma (EC) is a rare intraepidermal carcinoma of the eccrine sweat glands. Even more rare are instances of EC exhibiting intracranial invasion. Here, we describe the case of a metachronous EC mass demonstrating intracranial invasion in a patient with advanced-stage hepatocellular carcinoma (HCC), reporting CT head findings of a left frontal skull expansile destructive mass with soft tissue density and immunostain findings of the following: CEA: positive, granular, EMA: positive, AE1/AE3: positive, CK7: strongly positive, CK20: negative, GCDFP: negative, and HEPAR: negative. The only recommended treatment for EC is surgical excision with tumor-free margins, and no chemotherapy protocols currently exist. Due to socioeconomic factors, our patient was unable to receive adequate treatment for her HCC, nor surgical excision for her EC. However, the unique presentation of a rare intracranial EC tumor causing no neurological deficits in a patient with untreated HCC merits the need for a more thorough identification of secondary tumors via biopsy in patients with HCC to identify possible associations between these two tumors in future patients.

Pernicious Anemia and Vitamin B12 Deficiency Presenting As Pseudothrombotic Microangiopathy and Developing Secondary Thrombocytopenia After Treatment: A Case Report.

Pernicious anemia (PA) is an autoimmune disease secondary to chronic atrophic gastritis leading to vitamin B12 deficiency. Rarely, some patients may develop advanced hematological complications that mimic those of thrombotic thrombocytopenic purpura (TTP). Differentiating these conditions is crucial because they require different management. We present a case of a 68-year-old male who presented with generalized weakness, fatigue, and shortness of breath. This patient had anemia, thrombocytopenia, and a markedly deficient serum level of vitamin B12. The symptoms initially mimicked those associated with TTP, but the activity of ADAMTS 13 was normal. A diagnosis of pseudo-TTP has been made due to vitamin B12 deficiency resulting from PA with reactive thrombocytosis. Ultimately, vitamin B12 deficiency pseudo-TTP should be considered a differential diagnosis for therapy refractory TTP because of its different management strategies ranging from parenteral Vitamin B12 in PA patients with highly favorable outcomes to more advanced treatment with less favorable outcomes in TTP patients.