Mast Cell Leukemia (MCL), a rare subtype of systemic mastocytosis is defined by bone marrow involvement as atypical and aleukemic mast cells, if more than 20% and less than 10% of peripheral WBCs are mast cells, respectively. We met a case of aleukemic MCL presenting with anemia and ASCITES for 2 years, referred for BM evaluation, suspicious of leukemia. Our findings included BM involvement by diffused aggregates of oval-and spindle-shaped atypical mast cells, lacking mature mast cells and other hematopoietic cells. The mast cells were absent in peripheral blood smear. Further assessments showed positive reaction of mast cells metachromatic granules with Tryptase, Giemsa and Toluidine blue stains, the expression of CD117/KIT and CD45 by immunohistochemistery, and elevated level of serum Tryptase. Radiologic investigations revealed generalized lymphadenopathy, and massive hepatosplenomegaly, followed by the cervical lymphadenectomy, and liver wedge biopsy. Suspicious peritoneal lesions were identified and underwent excisional biopsy. Microscopic evaluations showed lymph nodes and liver involvement by cancer cells and the same features in peritoneal seeding. Multiple organs damage progressed in few months and the patient died despite surgery and chemotherapy. In conclusion, we report an extremely rare case of aleukemic MCL with multiple organs damage such as liver, peritoneum, spleen, gastrointestinal tract and BM, presenting by ASCITES. According to this case and previous parallel studies, we suggest some clinicopathologic features in favor of poor prognosis, including the presence of multiple organs damage, hepatomegaly, ASCITES, peritoneal seeding, the absence of mature mast cells and other hematopoietic cells in the BM, and elevated serum Tryptase level.

Objective: A urogenital sinus is a common channel into which both the urethra and genital tracts open. Occasionally there might be transverse obstructing membrane leading to hydrometrocolpos from either uterine secretions or urine. Although the presentation is varied, a neonatal presentation of a large hydrometrocolpos mimicking gross ASCITES is rare. Case Presentation: A 3-day-old female infant was referred to us from periphery as a case of gross ASCITES of unknown cause. Patient was having rapid and shallow breathing and had gross ASCITES. The patient was evaluated and was diagnosed to have large hydrometrocolpos.Conclusion: To avoid unnecessary delay in diagnosis and proper treatment the possibility of hydrometrocolpos secondary to urogenital sinus presenting as generalized abdominal distension should be kept in mind. A focused genital examination can help achieve the diagnosis.

Anthrax has been developed as a biologic warfare agent. One millionth of a gram of anthrax spores constitutes a lethal inhalation dose, and a kilogram of it, has the potential to kill hundreds of thousands of people. Anthrax is a relatively common zoonosis in developing countries. The etiologic agent is Bacillus anthracis. Transmission to human is usually by contamination of skin abrasions with the bacilli or spores. The most common presentation is a black necrotic skin wound (95%). Fulminant sepsis, acute abdominal pain, and ASCITES are among rare forms of the disease, and it is especially very rare if all of them occur in one patient. Extracutaneous forms of anthrax are generally very dangerous and life-threatening. Therefore, early recognition and prompt treatment are the most crucial steps to save the life of patients.

Omental and mesenteric cysts are both rare pathologies in children. Children who have omental cysts usually display symptoms of abdominal distension, with or without a palpable mass. The mass can simulate ASCITES on clinical observation, or tuberculosis on radiological images. The optimal treatment for this condition is complete resection. The presenting symptoms of abdominal distension and the simulation of septated ASCITES and abdominal tuberculosis are unusual. Reported cases in the literature usually display symptoms of abdominal distension, abdominal pain, painless mass or possible ASCITES.We describe the clinical presentation of a five-and-a-half-year-old boy who was treated for a diagnosis of abdominal tuberculosis and ASCITES at another hospital. After three years, he underwent abdominal surgery, and an omental cyst was found intraoperatively. The diagnosis was confirmed by pathological examination.