Saadiya Haque

Hepatosplenic T-cell lymphoma (HSTL) is rare, being derived from cytotoxic T-cells, and manifests as an extranodal systemic lymphoma. We present an unusual case of a seventeen-year-old female, with no significant prior medical history, presenting with a hepato­splenic T-cell lymphoma. The diagnosis was confirmed by histological examination, immunohistochemisty, and flow cytometry. A staging work-up demonstrated bone marrow involvement by HSTL with concomitant intranuclear parvoviral inclusions.

Post-transplant lymphoproliferative disorder (PTLD) represents an abnormal lymphoid proliferation that occurs in recipients of solid organ or bone marrow allograft

Primary lymphoma of the bone (PLB) accounts for 2% of all non-Hodgkin’s lymphomas, and until recently it had not been well characterized in literature. Most cases present in adulthood (average age 50), with localized painful lesions in the long bones, cranium, or axial skeleton. We describe a case of multifocal PLB in an adolescent female. In this case, the initial presentation, with migratory large joint polyarthralgias and bone pain, mimicked chronic recurrent multifocal osteomyelitis (CRMO). Had a biopsy not been performed the diagnosis would have been missed.

Background : The relationship between Hodgkin′s lymphoma (HL) and plasma cell-type Castleman′s disease (PCD) has been well documented. There have been over 20 cases reported in the literature and nearly all of them were either diagnosed concurrently, or were initially diagnosed as PCD and upon review were found to have interfollicular HL. Human herpes virus type 8 (HHV-8) is present in about 40% of cases with PCD. It predisposes patients to a much higher risk of other malignancies, including Kaposi′s sarcoma and non-Hodgkin′s lymphoma. Cases linked to HHV-8 are associated with a different morphology than cases that are not linked to HHV-8. It has been proposed that patients with both HL and CD will have lymph nodes with HHV-8-negative morphology.Materials and Methods : We present a series of three cases in a retrospective study where patients had both HL and PCD. Surgical pathology reports, clinical histories, and H and E and various immunohistochemical stains on initial work-up were examined and subsequent immunohistochemical stains for HHV-8 were obtained from the Methodist Hospital.Results:Patient 1 was diagnosed with PCD and interfollicular HL in the same lymph node. Patient 2 was first diagnosed with classic HL and 2 years later returned with enlarged lymph nodes clinically suspected to be recurrent HL. Histology showed angiofollicular hyperplasia and interfollicular plasmacytosis without Reed-Sternberg cells and a diagnosis of PCD was rendered. Patient 3, a male in his third decade, was diagnosed with nodular sclerosing HL in the thymus, and concurrently PCD in the mediastinal lymph nodes. All three cases had architectural features consistent with an HHV-8-negative morphology. Immunohistochemical stains for HHV-8 were done retrospectively and were negative.Conclusion:All three of our patients with both HL and CD had HHV-8-negative lymph node morphology and absence of HHV-8 by immunohistochemistry. These patients, therefore, are not at an increased risk for the development of subsequent malignancies, when compared to HHV-8-positive patients. Included in our series is one unique case where the diagnosis of HL preceded CD by 2 years.

Bariatric surgery is the only solution for morbidly obese individuals who desire to lose weight and maintain it and have failed to do so by non-surgical means. As the incidence of morbid obesity rises, laparoscopic Roux-en-Y gastric bypass (LRYGBP) is increasingly performed. With the increase in bariatrics, the chances of discovering aberrant anatomy at the operating-table also increase. We present two cases of LRYGBP in patients with intestinal malrotation, which is a congenital anomaly caused by failure of the intestines to rotate and fixate at 270° during embryonic development. It occurs in one out of every 500 births in the United States, accounting for 5% of all intestinal obstructions. To this date, only three reports have been published describing the incidental finding of congenital malrotation during the initial laparoscopic exploration for gastric bypass. We found that the operation can still be performed laparoscopically in such patients, with some modifications to the standard technique.