Plasmacytoma as a Mimicker of Colonic Carcinoma in an Elderly Man.

Multiple myeloma is a neoplastic proliferation of monoclonal plasma cells. Although it is usually restricted to the bone marrow, extraskeletal spread in the form of localised extramedullary collections of malignant plasma cells (plasmacytomas) can occur. However, gastrointestinal tract involvement in multiple myeloma is rare and overt gastrointestinal bleeding from plasmacytoma is uncommon. We report a case of colonic plasmacytoma which presented with bleeding per rectum and was initially misdiagnosed as colonic neuroendocrine carcinoma. Later the patient presented with recurrence of the colonic mass along with multiple lytic bone lesions. The diagnosis of colonic plasmacytoma with progression into multiple myeloma was given. We also discuss here the diagnostic difficulty of plasma cell neoplasms in small biopsies of the colon.

Vascular hamartoma of the parotid gland.

Hamartomas of the parotid gland are highly unusual. We present a case of a vascular hamartoma of the parotid gland arising as a 1.5 cm mass in a 5-year-old girl. As far as we are aware, no other case with the same features has been reported. We present this case to generate greater consideration of hamartomas as part of the differential diagnosis of parotid lesions, and to reflect over the criteria used to identify a hamartoma from other parotid lesions, as there appears to be some confusion in the literature.

Role of sequential biopsy study in the evaluation of renal transplant.

Renal biopsy is indicated in all cases of renal transplants showing renal dysfunction. This not only helps in the diagnosis but also in the institution of proper management. Study of sequential biopsies is essential for establishing the cause of renal dysfunction, evaluation of the effect of treatment and the progress of the disease. This report is based on the study of 14 samples (including three nephrectomy specimens) belonging to six patients who underwent two or more sequential renal transplant biopsies at the Salmaniya Medical Centre, Bahrain, between 1995-2000 because of deteriorating renal functions. Based on the sequential biopsies, the graft dysfunction was attributed to rejection in four cases and recurrence of primary glomerular disease in two. An important finding in this series is one case of type I membranoproliferative glomerulonephritis due to hepatitis C noticed five years after transplant and two cases of acute vascular rejection superimposed upon chronic rejection.