LEARNING OBJECTIVES: Diagnosis and Treatment of Pulmonary Blastoma. CASE INFORMATION: This patient is a twenty-seven year old black male who has a past medical history of asthma since eight years old. He is a non-smoker. He states that eight months ago he started to work at a police impound. Where he states he was exposed to a lot of dust. Six months later he started having shortness of breath, cough with whitish to yellowish sputum, and wheezing with associated left lateral chest pain. He then went to the hospital were he was treated for an asthma exacerbation with improvement and subsequently discharged. He then returned with chest pain, left sided rated 8/10 and admitted. On physical exam blood pressure was 90/43, pulse 97, respirations 20, and temperature 97.3 degrees Fahrenheit. Room air pulse oximetry was 97%. He has decreased breath sounds on the left hemithorax. Otherwise physical exam was normal. Chest x-ray showed left lung to be completely opacified by tumor mass or pleural effusion, with some cystic components. CT scan off chest showed a large soft tissue mass completely replacing the left lung of mixed density most likely representing a neoplastic process such as sarcoma, invading and obstructing the left main bronchus. The bronchoscopy showed the right lung to be patent and 3 cm below the carina going to the left main stem bronchus, the airway was completely occluded by a tumor mass in the lumen. Endo bronchial biopsy was performed at that time, which revealed pulmonary blastoma, monomorphic epithelial type (well differentiated fetal adenocarcinoma). IMPLICATIONS/DISCUSSION: Pulmonary blastoma is hard to be diagnosed before operation. The main symptoms can be cough, expectoration. This tumor is extremely rare and manifest's a mixture of epithelial and mesenchymal neoplastic cells. This is a low grade tumor that consists of immature embryonic epithelial elements forming tubules and glands and primitive lung structures, surrounded by a malignant-appearing mesenchymal stroma. Other tumors with better differentiated background mesenchymal elements or neuroendocrine cells in the stroma have also been reported and may represent part of this tumors spectrum. These tumors presents in children and adults and most commonly appear as parenchymal masses. Pulmonary blastoma is more common in women, and is usually diagnosed by surgical resection. This is usually curative, although if late relapses and metastasis occur they are usually not curable. For palliative treatment radiation therapy may be used, and a role for chemotherapy is not defined. LEARNING OBJECTIVES: Acute Myeloid Leukemia (AML) is an exceedingly rare diagnosis to find in association with Acute Intermittent Porphyria (AIP). Only one case report documents such an occurrence. CASE INFORMATION: We present the case of a 61-year-old man with a long-standing history of known Acute Intermittent Porphyria, (AIP) diagnosed in 1996, who was admitted to the internal medicine service for treatment of pharyngitis and severe dehydration. He had never undergone any chemotherapy and his AIP was fairly well controlled, with only four exacerbations noted including the sentinel episode. At presentation for his current admission the patient described fatigue and increasing retropharyngeal pain associated with deglutition, which had steadily progressed during the preceding three days. His CBC was significant for hemoglobin of 10.6 g/dl, WBC of 170.4/mm3, and a platelet count of 102,000/mm3. The differential was 24% segmented neutrophils, 0% bands, 3% lymphocytes, 57% monocytes, and 7% blasts. The patient had hepatosplenomegaly and a global petechial skin rash. Bone marrow studies were done to characterize the underlying etiology. Cellularity to fat ratio was 100:0 with normal bony spicules. Myelofibrosis was completely absent, and granulopoiesis was increased with an abnormal appearance. The blast estimate was greater than 20%. Over the subsequent week the patient experienced a rapid clinical decline with worsening coagulopathy. In accord with decisions made by the patient, his family, and consulting hematologists, chemotherapy was not instituted. AIP is the most common and most severe of the porphyrias.