A 24-year-old male, presented to the oncology outpatient department of Saifee hospital with the complaints of abdominal distention, pain and significant weight loss since 2 months. Clinical examination revealed a mass in the left inferior quadrant of abdomen and lumbar region.Multiple Detector Computed Tomography (MD-CT) of abdomen [Table/ Fig-1] revealed a large heterogeneously enhancing mass in the left half of abdomen measuring 16 x 12 x 18.8 cm in dimensions, and extending from left hypochondrium to the lower lumbar region displacing the kidney. A 99mTc-HYNIC TOC scan [Table/ Fig-2] revealed a heterogeneous mass with diffusely increased tracer uptake along with a small focus of increased uptake in the left supraclavicular region suggestive of solitary metastatic disease.

Introduction Renal infiltration by leukemia causing massive bilateral nephromegaly is an extremely rare presentation of T-cell acute lymphoblastic leukemia(T-ALL). Case report 18-month-old female toddler presented with fever and progressive abdominal distension of 4–6 weeks duration. Imaging revealed bilateral massively enlarged kidneys with normal excretion. Peripheral blood counts and smear examination was unremarkable and immunophenotypic evaluation of marrow was consistent with T-ALL. Chest imaging was unremarkable. She was started on modified Indian Childhood Collaborative Leukemia Group (ICiCLe) ALL protocol. Even with the best anti-tumor lysis syndrome (TLS) prophylaxis the child required two sessions of hemodialysis. An end-induction morphological remission & end-consolidation negative minimal residual disease (MRD) could be achieved. Conclusion Bilateral massive nephromegaly is an extremely rare presentation of T-ALL. This case emphasizes the unusual presentation, need for prompt remediation of TLS, and most importantly the use of early intensification with four drug anthracycline & dexamethasone-based therapy for the treatment of T-ALL in children.

Metastatic deposits from primary ovarian malignancy can manifest as cystic masses in the liver. In endemic areas, hydatid disease is an important differential in all cases of cystic hepatic masses. We report a case of a 55-year-old lady who presented with progressive abdominal distension and was diagnosed with primary ovarian high-grade serous carcinoma. Imaging revealed concurrent lesions in the liver that were thought to be metastatic deposits but was later diagnosed as hydatid cyst based on radiologic features and serology. We report this rare case to highlight the importance of suspecting a hydatid cyst in endemic areas and its varied manifestations.

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