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The authors describe a case of a 83 years old patient affected with Waldenström disease whose shift in chronic myelogenous leukaemia is surprising because the quickness of the fact and, even more, because the following very fast appearance of quickly fatal paravertebral granulocytic sarcoma, as extramedullary blast crisis expression. This feature appears unusual in old subject.

Sarcomatous degeneration is the most dreaded complication of Paget's disease of bone: this case report offers an opportunity for underlining the difficulties of differential diagnosis in a case of pulmonary metastatization in the presence of osteitis deformans. Immunohistochemical assay applied to the cytology of pulmonary needle-aspiration and surgical biopsy targeted to the suspected neoplastic lesion allowed correct diagnosis. This case confirms the very poor prognosis of this kind of neoplasm: the rapidity of the fatal outcome was not significantly influenced even by the most aggressive polychemotherapy. This poor prognosis appears to be related to a more aggressive growth of the neoplasm and to the reduced immunologic resistance of the elderly.

The authors present a case of syndrome of the orbital apex subsequent to a fibrous dysplasia in malignant evolution; they underline the usefulness of T.A.C. in the case, generally extremely rare, of such transformation.