Ewing sarcomas/primitive neuroectodermal tumors (ES/PNET) of the kidney are rarely found high-grade malignant tumors, offering poor prognosis. Although established treatment guidelines for ES of kidney are scarce, a multi-modality treatment approached is typically implemented. Herein, we report a 14-year-old female patient with ES of right kidney. Post-nephrectomy disease recurrence was treated with chemotherapy (i.e., vincristine, doxorubicin and cyclophosphamide); marked reduction in tumor size (i.e., from 18.5 × 11.3 cm2 to 3.7 × 2.2 cm2; ~96% reduction in size) as per computed tomography images was observed. We present our treatment experience and review from the available literature.

Penicillium marneffei is a rare deep tissue fungal infection causing an endemic in Southeast Asia. This infection causes penicilliosis disease and is more common in patients who are immunocompromised. To date, no cases of P. marneffei infection relapse following treatment have been reported. A 36-year-old patient attended our hospital as a result of intermittent fever, cough, shortness of breath and multiple soft lesions located on the face, arms, neck and trunk. The medical radiological examination of the lung revealed multiple patchy exudative shadows, thick-walled hollow inner part of the visible lesions, bilateral pleural and pericardial effusion. Assessing the skull and right collarbone, bilateral thoracic ribs and a plurality revealed numeorus lesions with reduced bone destruction and revealed that the patient was positive for P. marneffei infection. After 6 months of antifungal therapy, pulmonary symptoms and the surface lesions of the patient rapidly disappearance and the physical condition markedly improved. The patient did not attend a follow-up and stopped antifungal treatment. In February 2016, the patient presented with left breast and subcutaneous soft tissue mass of the head and neck. Fungal culture results revealed that the patient was again positive for P. marneffei infection. The present case suggested that clinical doctors and patients must pay more attention to regular treatment of the disseminated P. marneffei. It also highlighted the requirement for awareness of penicilliosis in non-acquired immune deficiency syndrome patients, who are not immunocompromised, who are living in or traveling to P. marneffei-endemic areas.

BACKGROUND: Colorectal cancer commonly metastasises to the liver, peritoneum and lungs. Bony metastases are uncommon in colorectal cancer and in particular metastases to the hands or feet (acrometastasis) are an extremely rare occurrence.
METHODS: A 65-year-old male with a colonic malignancy underwent elective anterior resection. Intra-operatively he was found to have a pelvic collection necessitating an end colostomy. Histology confirmed complete Dukes B tumour excision with no evidence of lymph node metastases. The patient underwent chemo-radiotherapy but was unsuitable for reversal of Hartmann\'s due to elevated CEA levels and asymmetrical thickening of the rectal stump with a solitary lung nodule identified at a one-year surveillance CT. The lung nodule was resected revealing metastatic adenocarcinoma and biopsies from the rectal stump showed chronic inflammatory changes. The patient was offered further chemotherapy. However, six years after his original surgery the patient presented with an acutely painful left foot with radiographic appearances of an infiltrative sclerotic and lucent lesion confirmed as a calcaneal acrometastasis on Magnetic Resonance Imaging (MRI).
CONCLUSIONS: Diagnosis of acrometastasis is challenging and generally constitutes a wider metastatic process with poor prognosis. Patients are often asymptomatic or present with symptoms mimicking benign lesions such as arthritis, infection or ligamentous sprains of the hands or feet. Therefore, there should be a high index of suspicion and prompt radiological investigation is warranted in order to exclude disease recurrence.
CONCLUSIONS: Although acrometastasis may indicate a poor prognosis, timely diagnosis and intervention may facilitate improvement of long-term survival and symptomatic management.

BACKGROUND: Endometrial stromal sarcoma (ESS) is a term used to define a rare neoplasm that accounts for approximately 0.2%-1% of all uterine malignancies; it is, however, implicated in an estimated 10%-15% of those malignancies with a mesenchymal component. Recent evidence suggests that while the preservation of the ovaries may be considered appropriate in premenopausal women, hysterectomy and bilateral salpingo-oophorectomy remains the recommended treatment in postmenopausal women. Currently, only a few case series reporting the treatment of ESS in young women with a desire to preserve fertility and thus subjected to a fertility-sparing surgery are available in the literature.
METHODS: We report a peculiar case of early stage ESS treated by laparoscopic fertility-sparing surgery and a strict follow-up program (every 3 months) of imaging and clinical evaluation. The patient remained disease free 1 year after primary treatment. Three months after completing oncological follow-up, the patient conceived spontaneously and is, to date, pregnant at 11 weeks of gestation without evidence of recurrent disease or obstetric complications.
CONCLUSIONS: Based on our case report and in accordance with the data available, we suggest that in young patients affected by early stage ESS who wish to preserve reproductive function, fertility-sparing surgery could represent a valid option, though strict oncological follow-up remains mandatory.