Primary Hydatid Disease Of Chest Wall.

Hydatid disease-a parasitic medical condition caused by echinococcus, is one of the oldest diseases known to mankind. Primary hydatid disease of the chest wall is very rare and only nine cases have been reported so far in the literature. This study presents a case of primary hydatid chest wall in a patient with right infraclavicular swelling that increased in size suddenly. A 35 year-old lady presented to the Surgical Unit of Khyber Teaching Hospital with a two and a half year history of right infraclavicular chest wall lump which increased in size abruptly Upon investigation the Computed tomographic (CT) scan of the chest showed a complex multiseptated hypodense lesion in the right pectoralis muscle with no involvement of underlying clavicle or rib. She was booked for exploration under general anaesthesia electively. The lump revealed multiple daughter cysts with the characteristics of germinal layers and ecto cysts of hydatid cysts. The patient had a stable recovery in the postoperative period and was sent home on medical treatment. On follow up she was fine; the wound had healed and there was no swelling in the surgical site. Primary hydatid disease of the chest wall is a very rare disease, so this case is a piece of good evidence to consider hydatid cyst in the differential diagnosis of any cystic mass in any part of the body, especially in endemic areas. Radical peri-cystectomy followed by chemotherapy with albendazole is all that is needed for the treatment.

Plasma Cell Leukaemia: A Rare Yet Aggressive Plasma Cell Dyscrasia With A Very Poor Response To Conventional Therapy.

Plasma cell leukaemia (PCL) is a very rare plasma cell dyscrasia with a significant number of monoclonal plasma cells in the peripheral blood. It is diagnosed by the presence of ≥ 2x109 /L plasma cells in the blood or by plasma cells making up ≥20% of the leukocyte count. It can arise from a leukemic transformation of multiple myeloma, or more commonly it can be primary. Regardless of its origin, it carries a very dire prognosis. It responds very poorly to the traditional chemotherapy regimens used for multiple myeloma. We present the case of a 50 years old female who presented to our hospital with a complicated UTI and severe generalized body aches. She was diagnosed as a case of plasma cell leukaemia and was treated with cyclophosphamide and dexamethasone, however she failed to go into remission. Her condition deteriorated and she ultimately passed away 1.5 months after diagnosis. The recommended treatment for PCL is aggressive combination chemotherapy followed by stem cell transplantation. However, there is no consensus regarding the treatment of plasma cell leukaemia, and treatment should be individualized based on the patient profile. Once diagnosed, the prognosis is poor.

Metastatic Cardiac Melanoma With T-Wave Inversions.

A woman in her 70's with a background of ocular malignant melanoma treated more than a decade ago was admitted to hospital with symptoms of dysphagia and exertional shortness of breath. Routine ECG showed a grossly abnormal ECG with T wave inversion in inferolateral leads and some anterior leads. Consequently, echocardiography and CT demonstrated the presence of a large pericardial tumour which on biopsy was found to be metastatic melanoma. Patient was treated with palliative radiotherapy with only temporary initial benefit.