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Background: Adrenal malignancy is a rare entity of diseases that has a low incidence, vague symptoms, and variable prognosis. Due to its rarity, case series studies from around the world can contribute to a better understanding of the disease.
Aims and Objectives: To analyze the similarities and differences in this adrenal malignancy spectrum within the Middle East.
Settings: This retrospective case series was conducted at the Royal Hospital, Muscat, Oman.
Methods: The medical records of the patients diagnosed with primary adrenal malignancies were reviewed from January 2014 to December 2023.
Results: A total of 15 patients with a mean age of 52 years were included, with a male-to-female ratio of 1:2.7. The majority of patients (80%) had a personal medical history, and the most common condition was hypertension. Four patients (26.6%) presented with abdominal pain that required computed tomography imaging to determine the cause. Left-sided malignancy was predominant (60%); however, the majority of male patients had right-sided tumors (75%) (p-value = 0.235). The largest tumor measured 169 mm, with no statistically significant difference in tumor size between males and females: 87.3 ± 10.6 mm in males
versus 91.8 ± 47.4 mm in females (p-value = 0.77). Laboratory investigations revealed that 53% of the patients had elevated hormone levels, including aldosterone, cortisol, testosterone, and metanephrines.
Conclusion: With the rarity of this spectrum of diseases, more studies are needed for a better evaluation of its impact on the community. Hopefully, more advanced technology, especially at the molecular level, can allow a better understanding of its
behavior.

Background: Thrombophagocytosis refers to the phagocytosis of platelets by neutrophils or monocytes and is an uncommon finding, most often reported in bacterial infections. It may be linked to ethylenediaminetetraacetic acid (EDTA)-induced conformational changes in platelet membrane glycoproteins, which expose cryptantigens and promote immune-mediated interactions, resulting in platelet clumping, satellitism, and phagocytosis. If unrecognized, these in vitro artifacts can cause falsely low platelet counts, leading to pseudothrombocytopenia.

Case presentation: A 1-day-old neonate, born to a mother with a history of liver transplant on long-term immunosuppression, presented with normal initial blood values. However, the automated hematology analyzer flagged the sample, prompting microscopic review, which revealed thrombophagocytosis by neutrophils and, to a lesser extent, monocytes along with platelet satellitism. Repeat analysis of the same sample after 4 hours showed a marked decrease in platelet levels (160 × 10⁹/l to 88 × 10⁹/l), consistent with ongoing in vitro thrombophagocytosis. Maternal blood showed no abnormalities, and neither mother nor
neonate had signs of infection.

Conclusion: This case illustrates neonatal thrombophagocytosis in the absence of infection, suggesting the phenomenon is not exclusively infection-related. Our findings illustrate that delayed sample analysis can significantly lower platelet counts, risking misdiagnosis of thrombocytopenia. Awareness of EDTA-related artifacts is therefore essential for accurate laboratory interpretation and clinical decision-making.