Pulmonary Metastases From Primary Thigh Leiomyosarcoma: A Case Report and Review of the Literature.

Leiomyosarcoma is a rare type of tumor of smooth muscle cells that can occur anywhere in the body. However, it typically occurs in the retroperitoneum, intra-abdominal sites, and uterus in people over 65. Here is a case of a 71-year-old male with a history of melanoma of the skin who presented with a rapidly enlarging, non-tender lump at his left lateral thigh area that was later diagnosed as pleomorphic dedifferentiated leiomyosarcoma. The patient underwent radical resection of the tumor and the attached vastus lateralis muscle and partial lateral collateral ligament, followed by radiation therapy to the resected site. He had no evidence of tumor recurrence on follow-up imaging for several months until he was found to have metastatic disease to the lungs on a surveillance CT one year later. A biopsy confirmed that the lung nodules were leiomyosarcoma metastases, and the patient was started on chemotherapy and stereotactic body radiation therapy (SBRT). Upon reviewing the literature, a few cases of leiomyosarcoma arising from the thigh muscles were found.

Synchronous Liver Abscess With Cholecystitis: A Rare Case of Initial Presentation of Gallbladder Cancer Posing a Diagnosis Challenge.

Gallbladder carcinoma (GBC) is the most common of all biliary tract cancers. GBC is a multifactorial disease. Gallbladder dysplasia from any gallbladder inflammatory condition is one of the main risk factors for GBC. The late diagnosis of GBC is a major problem in its treatment. It is treated by radical resection and the prognosis is improved by adjuvant chemoradiation. We present a rare case of gall bladder cancer presenting as hepatic abscesses with severe sepsis. An 83-year-old male presented with progressive symptoms of shakiness, general weakness, vomiting, and profuse diarrhea. Lab work revealed deranged liver enzymes. Computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) abdomen revealed intrahepatic abscesses contiguous with the gallbladder lumen through a gallbladder wall defect and cholecystitis of unknown chronicity. Subsequently, he underwent central hepatectomy and the pathology report of the sample as well as endoscopic retrograde cholangiopancreatography (ERCP) brushings revealed gallbladder adenocarcinoma. The case was complicated by biloma, acute renal failure, and the development of malignant ascites, and the patient died almost four months after the diagnosis of gallbladder cancer.

Hemophagocytic Lymphohistiocytosis in a Patient With Post-acute COVID-19 Infection.

Hemophagocytic lymphohistiocytosis (HLH) is characterized by immune dysregulation with extensive inflammation and tissue destruction due to abnormal immune activation. Post-COVID-19 patients who have recovered with negative serologic tests may also present with secondary HLH, an unusual finding that our case demonstrates. A 73-year-old male with a notable past medical history of fall COVID-19 infection approximately 11 months prior presented initially to emergency services with a chief complaint of high fevers, lethargy, and progressive changes in mentation gradually progressive over the last 5 months' duration. This presentation was concerning for HLH in view of the patient's high H score and clinical suspicion for HLH, and he was initiated on dexamethasone 20 mg daily. intravenous immune globulin (IVIG) protocol was also trialed, despite which the patient continued to deteriorate before expiring during the course of the hospitalization. sHLH following COVID-19 infection remains a poorly understood phenomenon. The severity of the COVID-19 infection does not appear to be related to one's predisposition to develop sHLH. The mortality of HLH remains high even with appropriate therapy.