Concurrent Subcutaneous Panniculitis-like T-Cell Lymphoma and B-Cell Acute Lymphoblastic Leukemia in 2 Pediatric Patients.

Subcutaneous panniculitis-like T-cell lymphoma is a cutaneous lymphoma characterized by CD8+ T-cell infiltrate in the subcutis that is rare in children. Acute lymphoblastic lymphoma is the most common pediatric malignancy and often presents with fevers and pancytopenia. Herein, we report 2 pediatric patients presenting with subcutaneous panniculitis-like T-cell lymphoma and B-cell acute lymphoblastic lymphoma, distinct hematologic malignancies arising from different lymphoid lineages, with no identifiable germline cancer predisposition.

The Impact of Repeating Endosonography with Confocal Endomicroscopy for the Diagnosis of Cystic Neuroendocrine Tumor.

Cystic pancreatic neuroendocrine tumors represent around 13% of all neuroendocrine tumors (Hurtado-Pardo 2017). There has been an increase in the incidence of cases due to improvement in imaging modalities. This is a case of a 68-year-old male with the incidental finding of a pancreatic cyst on CT. Initial Endoscopic Ultrasound with Fine Needle Aspiration (EUS-FNA) showed sonographic and cytology features suggestive of a pancreatic pseudocyst. However the cyst persisted with no change in size after aspiration leading to a follow-up EUS- FNA, which was combined with needle based confocal laser endomicroscopy (nCLE). The nCLE features were consistent with a cystic pancreatic neuroendocrine tumor, which was later confirmed on histology after surgical resection.

A Review of Extrapulmonary Tuberculosis.

Mycobacterium tuberculosis is an aerobic, non-spore-forming, non-motile bacillus that causes tuberculosis of both pulmonary and extrapulmonary sites. Though nationwide 66 percent of reported tuberculosis cases occur in foreign-born individuals, these individuals only contributed to 29 percent of the cases in South Dakota in 2015, whereas most of our cases were found in citizens born in the U.S.1 The South Dakota Department of Health also reported 317 cases of latent tuberculosis in South Dakota in 20151, making reactivation tuberculosis a major concern for U.S.-born residents. During the five years spanning 2011-2015, we have seen varying presentations of tuberculosis in South Dakota, many of which included extrapulmonary sites. We report a recent case involving of a 62-year-old Native American female with extrapulmonary tuberculosis cystitis.

Progressive Multifocal Leukoencephalopathy versus Brain Metastasis in a Patient with Locally-Advanced Non-Small Cell Lung Cancer.

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease affecting the white matter of the brain. This condition is caused by the John Cunningham virus and leads to progressive neuropsychological deficits. Though the infection is typically seen in association with HIV or AIDS, other immune-compromised states may predispose patients as well. This report discusses a patient who developed PML following standard chemo-radiotherapy for non-small cell lung cancer in whom presentation was initially more convincing for brain metastasis; thus, highlighting the importance of accurate diagnosis of new brain lesions in this setting.

Atypical Presentations of Tularemia.

Francisella tularensis is a gram-negative coccobacillus that causes a condition commonly referred to as tularemia. There has been a dramatic increase in tularemia cases reported in South Dakota, many of which were challenging to diagnose due to atypical clinical manifestations. We describe an interesting case of pneumonic tularemia and summarize six similar cases, several of which presented with lung nodules suggestive of malignancy. According to the literature, this is only the third outbreak of pneumonic tularemia reported in the U.S. We believe it is important for clinicians to be aware of the increased incidence of tularemia in the area and to be vigilant in the diagnosis and management of these atypically presenting cases.