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Thrombotic thrombocytopenic purpura (TTP) is a potentially fatal consumptive coagulopathy that requires prompt diagnosis and treatment. It is characterized by microangiopathic hemolytic anemia and thrombocytopenia, with microthrombosis. COVID-19 vaccination is proven to reduce disease morbidity and mortality. Vaccines have been hypothesized to link to certain autoimmune diseases. We present the case of a 43-year-old man with no personal or family history of hematologic diseases who admitted with a chief complaint of fever and icterus 15 days after vaccination with the second dose of COVID_19 AstraZeneca (ChAdOx1-S). Clinical and Laboratory data (increased LDH, decreased haptoglobin, and indirect hyperbilirubinemia) was suspicious of TTP. We confirm the diagnosis of TTP With low ADAMTS13. To our knowledge, this is the first Iranian case of vaccine-induced TTP that has been reported. In conclusion, for accurate diagnosis of patients with clinical symptoms of thrombocytopenia after COVID-19 vaccination, clinicians should be alert to the possibility of acquired TTP.

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Background: Multiple Endocrine Neoplasia type 2B (MEN2B) is an autosomal dominant disorder characterized by Medullary Thyroid Carcinoma (MTC) and pheochromocytoma. MTC occurs in almost all MEN2B patients. The tumor develops at an earlier age and is aggressive. Surgery is often not curative for this condition. Death from MTC occurred in 50% of patients with MEN2B. Thus, early diagnosis and prevention are crucial in this regard. Thyroidectomy, as early as the neonatal period, may be indicated in patients with MEN2B identified by genetic screening. Case Presentation: We reported a 24-year-old male presented to the emergency department with dyspnea for the past 3 months. There was a nodule 3*3 cm in the Right Lower Lobe (RLL) of the thyroid gland. Non-contrast Computer Tomography (CT) scan of the lung revealed multiple nodular lesions compatible with metastasis. The Fine Needle Aspiration (FNA)cytology of the thyroid nodule indicated that the features of medullary thyroid carcinoma were positive stains in Immunohistochemistry (IHC) for calcitonin. A diagnosis of pulmonarymetastatic medullary thyroid carcinoma, as a presenting feature of MEN2B, was made. The patient was treated with Vandetanib. Conclusion: In the reported MEN2B patient, MTC occurred in the early stages of life and was multifocal. Thus, it is crucial to diagnose medullary thyroid cancer at the early stages of the disease.

: Histiocytic sarcoma (HS) is a very rare neoplasm of hematopoietic origin characterized by the proliferation of malignant cells that have the morphological and immunohistochemical features of mature tissue histiocytes, with only a few cases reported. Most patients with symptoms of the unilateral or multichannel disease are more involved with the intestines, skin, and soft tissues, palpable mass lesions, and compressions of adjacent organs, such as intestinal obstruction, or constitutional symptoms (e.g., fever and weight loss). In this study, we reported a 56-year-old man with a six-month history of a cutaneous plaque lesion on the left arm’s posterior surface. He underwent skin lesion biopsy, histopathologic examination, and immunohistochemistry that was compatible with histiocytic sarcoma. Since surgical resection not deemed appropriate, our patient underwent aggressive multiagent chemotherapy with six cycles of ICE (ifosfamide, mesna, carboplatin, and etoposide) regimen and radiotherapy. After the completion of chemoradiotherapy, the skin lesion was completely disappeared. The patient is currently coming to us for the follow-up without any recurrence of the disease.