International Journal of Health Research and Medico Legal Practice

Lohit Kumar Kalita ¹, Chayanika Kalita ², Pabitra Kumar Gogoi ³, Umesh Chandra Sarma ⁴

Affiliations
1 Department of Oncology, Gauhati Medical College and Hospital, Guwahati, Assam, IN
2 Department of Dermatology, Gauhati Medical College and Hospital, Guwahati, Assam, IN
3 Department of Clinical Hematology, Gauhati Medical College and Hospital, Guwahati, Assam, IN
4 Srimanta Sankadeva University of Health Sciences, Narakasur Hill-Top, Guwahati, Assam, IN

Abstract

Multiple myeloma presenting as a pleural effusion is extremely rare. Generally, it is a late complication which is associated with a poor prognosis. A 58-year old male presented with severe weakness, palpitation on exertion, dyspnea and fever for last four months. Clinically he was diagnosed as pulmonary tuberculosis. Chest radiograph showed left sided pleural effusion. Pleural cytology revealed numerous plasma cells, consisting of mature and immature - binucleated and atypical types. Cytological differential diagnosis included myelomatous effusion and immunoblastic type non-Hodgkin's lymphoma. Bone marrow biopsy and serum protein electrophoresis confirmed the diagnosis as plasmoblastic type multiple myeloma. Although extremely rare, Myelomatous pleural effusion as an initial presentation should always be considered in presence of atypical plasma cells in body fluids irrespective of age.

Keywords

Cancer, Mediastinum, Cardiac, Infection.

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Chayanika Kalita ¹, Lohit Kumar Kalita ², Ali Ahmed ³, Umesh Chandra Sarma ⁴

Affiliations
1 Department of Dermatology, Gauhati Medical College and Hospital, Guwahati, Assam, IN
2 Department of Oncology, Gauhati Medical College and Hospital, Guwahati, Assam, IN
3 Department of Pathology, Gauhati Medical College, Guwahati, Assam, IN
4 Srimanta Sankaradeva University of Health sciences, Narakasur Hill Top, Guwahati, Assam, IN

Abstract

Liposarcoma is the most common soft tissue sarcoma accounting for 20% of all mesenchymal malignancies. Spindle cell liposarcoma is a rare histological variant of liposarcoma. Spindle Cell Liposarcoma presenting with ulceration is a rare entity in the history of literature. We report a case of spindle cell liposarcoma arising from the right forearm presenting with ulceration. A 14-yearold young boy presented with a slow growing ulcer over the right forearm. Histological examination of biopsy showed spindled and stellate shaped cells in a myxoid background and many curved vessels suggesting myxoid and round cell liposarcoma suggesting spindle cell liposarcoma. Based on this, a histological diagnosis of spindle cell liposarcoma was made. Spindle cell liposarcoma is a rare variant of well-differentiated liposarcoma characterized by prominent spindle cell component. In previously reported cases spindle cell liposarcoma was demonstrated in the subcutaneous tissues of limbs, trunk, shoulder girdle, buttock presenting a mass without ulceration. Main differential diagnoses include benign lesions such as spindle cell lipoma, diffuse neurofibroma as well as dermatofibrosarcoma protuberans and other malignancies such as sclerosingliposarcoma, myxofibrosarcoma, malignant peripheral nerve sheath tumor and fibromyxoid sarcoma. Spindle cell Liposarcomas tend to recur locally and may have a potential for metastasis. Wide excision and long term follow up looking for recurrence and metastasis is necessary. To our knowledge, Liposarcoma presenting with ulceration at forearm has not been observed in literature. So, our case is a rare variant of liposarcoma arising at forearm with ulceration.

Keywords

Spindle Cell Liposarcoma, Leg, Atypical Lipomatous Tumor, well Differentiated Liposarcomas, Spindle Cell.

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