Extra-skeletal plasmablastic myeloma presenting as palatal growth - An unusual entity.

INTRODUCTION: Multiple myeloma (MM) is characterized by malignant proliferation of plasma cells, monoclonal bone marrow plasmacytosis, the presence of M-protein in serum and/or in urine and osteolytic bone lesions. PRESENTATION OF CASE: We report a case of a 28-years old female, who was diagnosed to have relapsing extra-skeletal and extra-nodal plasmablastic myeloma, an atypical variant of MM with a poor prognosis. In addition to bone marrow plasmacytosis and the presence of M protein in the serum, the patient had an extramedullary lesion affecting the hard palate. DISCUSSION: There is a strong correlation with age. The peak incidence is seen in 6th-7th decade. The clinical course in adolescents and young individuals is generally indolent and the survival is longer. Extramedullary myelomas are rare tumors accounting for 0.4% of all head and neck malignancies. CONCLUSION: A case of extraskeletal plasmablastic myeloma presenting as a hard palate growth and that too in young female patient is an extremely rare and requires a multidisciplinary approach for management.

Primary Non Hodgkin's Lymphoma of Left Adrenal Gland - A Rare Presentation.

Primary adrenal lymphoma is rare and constitutes for 3% of extranodal lymphoma cases. Approximately 70% of patients present with bilateral disease and have adrenal insufficiency. Prognosis of primary adrenal lymphoma (PAL) is poor, most of patient die within one year of diagnosis. Moreover, there are no standard treatment protocols on such cases. Patients are generally treated with regimens similar to other nonhodgkin lymphoma which includes surgery, combination chemotherapy and or radiotherapy. We are presenting a successfully treated case of primary diffuse large B cell non Hodgkin lymphoma of adrenal gland in a 57-year-old patient. The patient had unilateral adrenal involvement (left adrenal gland), without adrenal insufficiency and normal Serum lactate dehyrogenase level. The patient was treated with left adrenalectomy followed by combination chemotherapy. Two years after diagnosis and treatment the patient is disease free on clinical and imaging studies.

Adenoid cystic carcinoma of cervix: treatment strategy.

Adenoid Cystic Carcinoma (ACC) of cervix behaves aggressively and it has a propensity for local infiltration, invasion in lymphatic vessels as well as perineural spaces, with subsequent haematogenous spread. In advanced disease (Stage III and IV), outcome is invariably poor. Moreover, these cases have a high tendency to recur locally and also to metastasize to distant sites. There are no standard treatment protocols because of rarity of disease. The guidelines for its management are established similarly as for staged squamous cell carcinoma of cervix. Therefore, recommended treatment in advanced disease is aggressive multimodality treatment, which includes chemotherapy and radiotherapy. We are presenting a case of adenoid cystic carcinoma of cervix in 55 years old patient, staged as III B. The patient was treated with concomitant radiotherapy and chemotherapy. The patient responded well to treatment and is disease free, three years after treatment.

Giant neurilemmoma of the vagus nerve: a case report and review of literature.

Cervical vagal neurilemmomas are rare, usually asymptomatic, slow-growing tumours and defined as a benign, encapsulated neoplasm that arises in the nerve fibre. Magnetic resonant imaging (MRI) plays a central role in diagnosing vagal nerve neoplasm and in fact, provides important pre-operative information useful in planning optimal surgical treatment. A rare case of giant neurilemmoma is presented with a large swelling in the right side of the neck associated with breathlessness and paroxysmal cough. X-ray chest revealed large homogenous opacity in apical area of the right lung extending into the lower neck. MRI revealed a large 6 x 8 x 13 cm soft tissue, well defined mass with lobulated contours on the right side of the neck. The mass was pushing sternomastoid muscle anteriorly and carotid artery was pushed anteromedially. The mass was abutting the brachial plexus and compressing internal jugular vein. The mass was extending into the mediastinum up to the level of carina. The mass was also pushing the vessels in superior mediastinum towards left and was compressing the veins. Tumour was extending posterior to trachea and pushing trachea anteriorly and towards left and also compressing it. There was also erosion of adjacent anterior aspect of the right upper ribs. Subclavian artery was also encased by the mass. Multiple enlarged lymph nodes were seen in right cervical area. A provisional diagnosis of malignant schwannoma of right vagus nerve was made. Cytology from the fine needle aspirate of the right lower Cervical region of the swelling revealed features of neurilemmoma. Complete surgical resection is the treatment of choice with excellent prognosis, as the tumour was benign, and recurrence is nearly unknown, so it is possible and indeed recommended to preserve nerve integrity with careful dissection.

Primary tuberculosis of the thyroid gland: a case report.

Tuberculosis of the thyroid gland is an uncommon disease and primary involvement of thyroid is even more rare. It is a rare disease even in countries in which tuberculosis is endemic. The diagnosis is often difficult as the clinical presentation has no distinct characteristics. Clinical course of the disease may resemble toxic goiter or acute thyroiditis or may follow a subacute or chronic growth pattern without specific symptomatology. Histologically presence of necrotizing epithelioid cell granulomas along with langhans type giant cells are the hallmark of thyroid tuberculosis. Demonstration of acid fast bacilli by ZN staining confirms the diagnosis, but this stain is frequently negative in tissue sections.