Hi stiocytic sarcoma (HS) is a rare neoplasm composed of tumor cells derived from the monocyte/macrophage lineage. Involvement of the central nervous system in HS is rare and usually aggressive, 1 and it can be difficult to diagnose. There are several reports of HS in association with hematological malignancies. Here we present a unique case of a man with histiocytic sarcoma in the brain, refractory to systemic and radiation therapies, that developed 16 years after treatment for T-cell acute lymphoblastic leukemia (T-ALL). Case PresentationA male patient, age 44 years, presented to the emergency room with unsteadiness, loss of balance, and left-sided weakness of 2 weeks duration. The patient had been evaluated in the emergency room for confusion a few days earlier, which was attributed to excessive use of lorazepam for panic attacks. He was subsequently seen by his primary care physician who obtained a computerized tomography (CT) scan and magnetic resonance imaging (MRI) of the brain that showed two intra-axial enhancing lesions: one in the corpus callosum of 3.5 cm, and the other adjacent to the right lateral ventricle of 2.6 cm, both associated with vasogenic edema (figure 1).The patient had been diagnosed with T-ALL with cerebrospinal fluid (CSF) involvement 16 years prior and had received craniospinal irradiation and intrathecal chemotherapy for approximately 26 months. After completion of T-ALL treatment, he had no significant health problems other than anxiety and panic attacks for which he took buspirone, paroxetine, and lorazepam. The Histiocytic sarcoma (HS) is a very rare hematopoietic neoplasm that has been reported in association with other hematological malignancies. Presentation of HS in the central nervous system is even less common. Diagnosis of HS requires the presence of histiocytic markers and the systematic exclusion of markers of other cell lineages. Primary HS central nervous system tumors are aggressive and generally have poor outcomes. There are no standard treatment guidelines due to lack of clinical trials and a limited number of case reports. Here we present a unique case with two primary histiocytic lesions in the brain, refractory to systemic and radiation therapies, that developed after being treated for T-cell acute lymphoblastic leukemia 16 years prior.

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Adr enal cortical carcinoma (ACC) is a relatively rare malignancy (0.2% of all cancers and incidence of 2 per 1 million population) 1 that presents a significant clinical challenge for optimal treatment. Successful treatment depends on appropriate identification of the lesion, accurate staging, surgical resectability and response to subsequent mitotane, as well as cancer chemotherapy for residual or microscopic disease. We report a case of a 57-year-old woman diagnosed with right ACC with metastasis to the lungs and liver. She underwent right radical nephroadrenalectomy and liver nodule biopsy and received mitotane monotherapy for approximately 5 months, developing a complete response. She was followed regularly with physical assessment, laboratory testing, X-rays, and computed tomography (CT) scans and remained disease-free during the following 25 years. Case ReportA 57-year-old white woman was found to have abnormal liver function test results on routine medical evaluation in December 1983. She reported a 22-pound weight loss over the previous 2 years and abnormal hair growth on her abdomen.Physical examination revealed normal vital signs. Hair growth was present in the face without temporal balding and on the abdomen with male-type distribution. The liver was palpable 5 cm below the right costal margin, soft and non-tender. Lymph nodes and systemic examinations were negative. Pelvic examination revealed no enlargement of the clitoris or adnexal abnormalities.

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