Gliosarcoma (GS) is an extraordinarily rare variant of glioblastoma, which is differentiated by its distinct biphasic histopathological morphology consisting of both glial and mesenchymal elements. Although GS has a predilection for the cortical hemispheres, rare occurrences of intraventricular gliosarcoma (IVGS) have been documented in the literature. In this report, we present a 68-year-old female patient with a primary IVGS arising from the frontal horn of the left ventricle with corresponding left ventricular entrapment. The clinical course as well as associated tumor features as observed on computed tomography (CT), magnetic resonance imaging (MRI), and immunohistochemical studies are presented along with a relevant review of the current literature. Gliosarcoma (GS) is an exceedingly rare WHO grade 4 neoplasm, usually classified as an isocitrate dehydrogenase (IDH) wildtype genetic rare variant of glioblastoma (GBM), which comprises about 2% of glioblastomas ,2. GS isGS usually presents as a supratentorial intraparenchymal lesion abutting the meninges, which is not unlike the presentation of a meningioma and has a predilection for the temporal, frontal, parietal, and occipital lobes in order of preference -6. ExcepIn this report, we describe a novel case of a 68-year-old female with primary IDH-wildtype intraventricular gliosarcoma (IVGS) arising from the frontal horn of the left ventricle with resultant left ventricular entrapment, confirmed by histopathological evaluation. A review of the current IVGS literature was conducted, along with a comparison of associated tumor radiologic findings. A 68-year-old woman with no history of prolonged contraception use presented with a one-month history of subjectively reported "fogginess" with now acute and worsening confusion, aphasia, and subtle right-sided weakness over the past two days. The physical exam demonstrated right-sided hemiparesis, right facial droop, and pronator drift. The initial CT scan without contrast demonstrated a 2.1 x 0.7 x 1.3 cm (anterior-posterior (AP) x transverse (TV) x craniocaudal (CC)) heterogeneous left ventricular soft tissue nodule extending into the interventricular foramen, causing left ventricular entrapment, asymmetric dilation of the left lateral ventricle sparing the left frontal horn, and an 8 mm rightward midline shift . She reports short-term memory loss without additional neurological symptoms. All of the aforementioned initially presenting neurological symptoms, including hemiparesis and aphasia, have resolved on the most recent follow-up examination. Treatment is ongoing at the time of publication with adjuvant TMZ chemotherapy.Analogous to glioblastoma, GS occurs most commonly in the fifth to seventh decade of life with a male:female ratio of 1.4:1 . IVGS haThe differential diagnosis for an intraventricular tumor primarily includes low-grade glial or glioneuronal tumors, including neurocytomas, subependymomas, and ependymomas, as well as choroid plexus tumors, although astrocytic tumors may be seen as well ,15. AddiBecause of the variability of imaging findings and overlapping gross morphology, a histopathological examination of IVGS is still required for a definitive diagnosis. To be classified as a GS, histopathology must demonstrate biphasic morphology consisting of distinct or admixed glial and metaplastic components -5. ExamiAccording to current NCCN guidelines, the standard treatment for GS is maximal safe resection followed by adjuvant radiotherapy and temozolomide (TMZ) chemotherapy. This is the identical treatment protocol that our patient underwent. Even with treatment, the prognosis for GS remains dismal, with a mean overall survival of 17.3 months for primary GS and 10.2 months for secondary GS [GS displays an increased propensity for metastasis with an incidence of 11%, compared to GBM with an incidence of 0.2-1.2% . Both spDespite increasing reports of intraventricular gliosarcoma over the past decade, primary IVGS still remains an exceedingly rare entity. We report the novel finding of an IDH-wildtype IVGS in a 68-year-old female patient arising from the frontal horn of the left ventricle with corresponding left ventricular entrapment. Although exceptionally rare, IVGS has been well documented and should be considered in the differential diagnosis of intraventricular tumors. Further investigation of prognostic or predictive genetic markers for IVGS will enhance future patient care.


Pott’s puffy tumor (PPT) is a life-threatening complication of infectious sinusitis/osteomyelitis of the frontal bone. It occurs due to infection or trauma and is often seen in late childhood and adolescence. If left untreated for a protracted period, intracranial complications such as epidural abscess, subdural empyema, meningitis, and a cerebral abscess may occur. The diagnosis is often confirmed with CT. Prompt medical and surgical treatment is mandatory as there is the potential for significant morbidity if not quickly diagnosed and treated. This paper presents two cases of PPT manifested in patients with hemi pansinusitis. Pott’s puffy tumor (PPT) was first described by Sir Percivall Pott in 1760 ,3. The dCase report 1A 28-year-old man presented to the Department of Neuroradiology, UConn Health, with complaints of left-sided extremity numbness, altered mental status, and swelling of the forehead on the right side . CT demonstrated a large right frontal lobe mass with vasogenic edema consistent with a cerebral abscess. The mass and edema compressed the adjacent portion of the right lateral ventricle and caused an approximately two cm right-to-left midline shift. There was partial opacification of the right frontal sinus with erosion through the anterior wall of the sinus Figures -2. Also,Case report 2A 54-year-old man presented to the Department of Neuroradiology, UConn Health, with a history of sinusitis and a chief complaint of severe frontal headache with progressive swelling in the center of the forehead. CT scan revealed bony erosion of the anterior and posterior walls of the right frontal sinus Figure . HemipanPPT is a classical sign of frontal sinus osteomyelitis. Although considered rare in the post-antibiotic era, PPT is still a life-threatening complication due to frontal sinus infection. The pathogenesis is due to the spread of infection/sinusitis to the frontal bone. Percival Pott postulated that a puffy, circumscribed, indolent scalp tumor due to dural inflammation and spontaneous separation of pericranium from the skull occurs due to head injury . Later iIn both cases, untreated frontal sinusitis for a prolonged period led to intracranial complications. A radiographic examination of both patients revealed hemipansinusitis. Mittal MK et al. reported a case of pansinusitis progressing as meningitis with intracranial complications . This emIf a patient presents with swelling of the forehead, osteomyelitis of the frontal bone should be suspected, and CT and MRI imaging should be performed. Radiographic differential diagnosis of Potts puffy tumor is destructive metastasis to the frontal sinus and unilateral non-Hodgkin’s lymphoma. The presence of underlying frontal sinusitis and osteitis of sinus walls in scans helps differentiate PPT from the aforementioned conditions. In challenging cases, bone scintigraphy can be performed .In recent times, Cone-beam computed tomography (CBCT) has been widely employed for diagnosis and treatment planning in the oral and maxillofacial region. Some of the large field-of-view CBCT scans can capture all the paranasal sinuses, including the frontal sinus. Therefore, if signs of chronic pansinusitis or hemipansinusitis are evident, along with other bony changes, it warrants further investigation and referral to the concerned medical specialist.Once the diagnosis is established, depending on the severity of complications, treatment of PPT ranges from conservative broad-spectrum antibiotics to surgery. Antibiotics are prescribed to patients as soon as the diagnosis is made to prevent neurologic sequala. In some cases, culture is performed to determine the source of infection, and antibiotics are prescribed based on the micro-organism. Surgical intervention depends on the disease course progression. In some cases, frontal craniotomy is performed, followed by subdural empyema and subperiosteal abscess drainage. Functional endoscopic sinus surgery is performed in a few cases . Since bPott’s puffy tumor is a potentially life-threatening complication of chronic frontal sinusitis. This paper presents two cases of chronic frontal sinusitis with intracranial complications. Both cases were managed by surgical intervention. Periodic follow-up scans showed resolution in both patients. These reports highlight the utmost importance of early diagnosis and intervention for a seemingly benign infection like bacterial sinusitis. Oral and maxillofacial radiologists should be aware of this condition since the frontal sinus and bones are imaged in most of the large-volume CBCT scans. Early diagnosis and intervention of this condition help in avoiding fatal neurological complications.


Ephitelial salivary gland neoplasms are rare in children and adolescents: they represent only the 1%-5% of the total number of salivary gland tumoursIn the infancy, it has been reported that 35% of salivary gland tumours are malignant and between these mucoepidermoid carcinoma is the most frequent, while the occurrence of acinic cell carcinoma in children is very rareA 15-year-old boy was referred to the ENT Department at the University Hospital of Ferrara, for the assessment of a right, painless, firm, preauricolar mass, which was noticed six months before. The ecographic evaluation revealed the presence of an irregular surfaced, 2.5 cm maximum diameter, right parotid mass and a 1 cm reactive lymphoadenopathy located at the inferior parotid edge. A fine needle aspiration cytology (FNAC) was performed and revealed a possible epithelial salivary gland tumour containing acinic cells.Even if facial nerve function appeared normal, facial electromyography (EMG) was performed prior to surgery, and it proved a little action potential amplitude asimmetry in the inferior right area of the face.A total parotidectomy with preservation of the facial nerve was performed, under general anesthesia. The mass was hard, poorly circumscribed, not encapsulated and situated both in the superficial and deep portion of the gland with intimal involvement of the superior branches of the right facial nerve.Histologic examination revealed an infiltrating Acinic Cells Carcinoma with no metastasis in the six lymphnodes found inside the specimen .Fig 1TheOnly a mild weakness of right eye's orbicular muscle was noted in the first two postoperative days. The patient underwent a single cycle of radiotherapy .After 5 years of follow up, the patient is still disease free.Malignant epithelial salivary gland neoplasms are infrequent in adults and rare in children, as there only are few reports in the literature. Published data suggest a male preponderance; it is stimated a 1.4:1 male/female ratio. The major salivary glands, the parotid and submandibular, are the main site of occurrenceMucoepidermoid carcinoma is the most common malignant salivary tumour of the childhoodThe clinical evaluation of a parotid mass can be difficult in childrenUltrasonografy can be helpful for studying tumours topography and dimension. Computed tomography (CT) and magnetic resonance imaging (MRI) are also useful providing additional information regarding the local extensionFine-needle aspiration cytology (FNAC) can be considered a safe, rapid and helpful diagnostic test in determining the nature of a parotid mass. As it has been reported to have a specificity of 91% and a sensivity of 96% when sufficient cells are presentDifferential diagnosis includes neoplastic lesions, vascular malformations, acute and chronic cervical lymphadenopathies and cystic lesionsPatient history, physical examination, radiological studies, all are necessary for treatment planning. Surgery is the treatment of choice for epithelial salivary gland tumours in both adults and children.In children adjuvant radiotherapy should be considered only in selected cases for its possible complications; these include trismus, retarded growth of the facial bones, hemi-facial hypoplasia, pituitary insufficiency and X-ray induced cancerOur patient has shown no evidence of recurrence after 5 years of clinical and radiological follow-up.Malignant epithelial salivary gland neoplasms are infrequent in adults and very rare in children. We support the idea that the best treatment for parotid malignancies in children as in adult age is surgery and only in selected cases adjuvant radiation therapy is necessary.


Intravenous leiomyomatosis (IVL) is a distinct uterine leiomyoma, even rare when combined with intracardiac invasion. Although leiomyomas are histologically benign, intracardiac metastasis may cause circulatory failure and death. Herein, we report a 55-year-old woman with a tricuspid chordae mass on echocardiography. Subsequently, gynecological ultrasonography revealed that the patient had masses in the ovaries, internal iliac vein, and inferior vena cava. The patient successfully underwent resection of the tricuspid chordae tendinea mass and implantation of the tricuspid annuloplasty ring. The patient underwent inferior vena cava, common iliac vein, hysterectomy, and bilateral adnexectomy after 4 months. To our knowledge, the present study is the first reported case with such a rare combination. Intravenous leiomyomatosis (IVL) is a distinct uterine fibroids type, even rare when combined with intracardiac metastasis. Its primary feature, uterine benign leiomyoma formation, remains a characteristic hallmark for the disease. In addition, other typical IVL features include pelvic and intravenous masses. Notably, only 0.1% of cases become IVL disease . PresentThe study herein is a 55-year old female diagnosed with tricuspid chordal leiomyoma due to tricuspid valve regurgitation. The patient successfully underwent tricuspid chordectomy and valvuloplasty. Four months later, the inferior vena cava, common iliac vein, uterus, and bilateral appendages were removed. To our knowledge, this study is the first reported case with such a rare combination involving the tricuspid valve chordae tendineae.A 55-year-old female patient was admitted to the hospital given a tricuspid mass lesion was found following a routine physical examination. The patient’s medical history recorded no heart palpitations, breathing difficulties, or other symptoms. A tricuspid murmur was found on cardiac auscultation. Transthoracic echocardiography showed a small tumor beneath the tricuspid valve with moderate tricuspid regurgitation. Biochemical indicators, such as blood and tumor markers, were within the normal range.A median sternotomy with extracorporeal circulation (CPB) and mild hypothermia was used to perform intracardiac tumor resection. During the operation, an isolated 20 × 15 × 10 mm mushroom-like tumor was attached to the anterior leaflet chordae of the tricuspid valve . The tumGiven the intravenous leiomyomatosis possibilities, gynecological ultrasound was performed and found multiple uterine fibroids and ovarian tumors. Also, lumenal fluid and masses on the uterine fundus posterior wall, extending toward the bilateral internal iliac veins and the inferior vena cava, were found . In addiThe patient underwent surgical procedures on the right common iliac vein, inferior vena cava, uterus, and bilateral salpingo-oophorectomy four-month postoperatively . The hisEchocardiography is the preferred imaging method when the patient has clinical symptoms related to the heart. Echocardiography is non-invasive and has no known risks or side effects. Echocardiography can effectively describe the relationship between the tumor and the heart cavity, valve, and other cardiac apparatus. Echocardiography can also highlight the neoplastic attachment site(s). It is essential to assess the tumor’s impact on valve function .The patient’s heart color on the Doppler ultrasound showed a heterogeneous tricuspid valve echo. Thus, vegetation, thrombus, or cardiac tumor were suspected to be the diagnostic differentials. Given that the patient has no recent history of infection, fever, or drug use, the neoplastic chordae of the tricuspid valve was merely considered. Under ultrasound images, a thrombus can be seen throughout the cardiac cycle. The thrombus is usually close to the damaged myocardium and the congested area. Thrombus formation usually occurs with acute surgery cases, indwelling central catheters, or chronic diseases, particularly at the superior vena cava junction, and the right atrium . The patMyxoma is the most prevalent cardiac tumor. Myxomas are highly mobile, usually confined to the heart chambers, and often attached to the atrial septum . Thus, dInterestingly, IVL is a rare, benign, and smooth muscle tumor only seen in women. The pelvic and venous masses in a typical IVL are continuous. Though its pathogenesis is unclear, possible theories include its origin from blood vessel wall (smooth muscle) or uterine fibroids invasion into the uterine vein with significant widespread . The IVLvia the right atrium after a circulatory interruption to enable adequate tricuspid tendon exposure and replacement. Given that cardiovascular-gynecological combination therapy is highly invasive, with the bleeding risk associated with systemic heparinization, we opted for a two-stage surgical treatment strategy.Surgical treatment of IVL with intracardiac manifestations: In the case herein, the tumor was resected To our knowledge, this study is the first reported case with such a rare combination seen in an elderly female with no evidence of benign metastatic leiomyoma. A related report described an asymptomatic 24-year-old female who denied solitary genital leiomyoma or reproductive system surgery, presenting as an intracardiac space-occupying lesion . This caThe original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.XW and FL contributed equally to the work. GS, XW, and FL contributed to the conception and design of the study. GS, XW, FL, CI, and CF wrote sections of the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Stump appendicitis is an acute inflammation of the residual appendix and one of the rare complications after appendectomy. Stump appendicitis is an under-reported and poorly defined condition related to obstruction and inflammation of the residual appendix after an appendectomy, usually by a fecolith. It remains a clinical challenge because of delayed diagnosis and subsequent treatment with increased morbidity or mortality. Herein, we describe the case of a 42-year-old male who presented with periumbilical pain with progression to generalized abdominal pain and signs of peritonitis 14 months post appendectomy. An exploratory laparotomy revealed an inflamed, non-gangrenous perforated appendices stump. We discuss the challenges in the diagnosis and management thereof. Appendectomy is one of the most commonly performed surgical procedures involving resection of the vermiform appendix at its base, located at the confluence of the taenia coli, posteromedial to the cecal wall . In rarePatient information: a 42-year-old male presented to the emergency department with a chief complaint of a three-day history of severe periumbilical pain that was initially intermittent and localized, then gradually progressed to constant and generalized. In addition, the patient complained of constipation, bilious vomiting, and gradual abdominal distension that had started after the onset of the pain. However, there was no associated fever. His surgical history was significant for a previous emergency open appendectomy via a midline incision performed 14 months prior to his current presentation with intraoperative findings of a perforated appendix with four-quadrant pus contamination. In addition, his medical history was significant for hypertension diagnosed a year prior and fairly controlled on antihypertensive. His vital readings revealed a heart rate of 117 beats per minute and blood pressure of 140/104mmHg.Clinical findings: physical examination of the abdomen revealed generalized abdominal distension and a healed lower midline scar. Abdominal palpation revealed generalized tenderness, rebound tenderness, guarding, and rigidity. The rest of the systemic examination was unremarkable.Diagnostic assessment: routine laboratory investigations revealed a total white cell count (WCC) of 5.97 x 109/L , neutrophils of 75.5%, c-reactive protein (CRP) of 442.1 mg/l , urea of 13.8  and creatinine of 124umol/l . A plain abdominal X-ray demonstrated centrally located dilated bowel loops with valvulae coniventes and centrally located multiple air-fluid levels.Therapeutic intervention: the patient was kept nil per os. A nasogastric tube and urinary catheter were inserted. Intravenous fluids , parenteral antibiotics, and analgesia were initiated. Consent was obtained for an emergency exploratory laparotomy. The abdomen was entered via a lower midline incision with findings of dilated loops of bowel and pus in the right and left lower quadrants of the abdomen. Further exploration revealed an inflamed, non - gangrenous perforated appendices stump about 5 cm long  is the interval of repeated inflammation of remaining residual appendices tissue after an appendectomy. Incompletely removing an appendix leaves a stump behind, allowing for recurrent appendicitis . Stump andicitis . Stump andicitis . The symet al. reported three out of five patients with a subserosal appendix, while the other two had residual appendices tissue with a 5.9 cm remaining appendices stump length [et al. findings, which indicated an appendices stump range of 0.5 cm to 6.5 cm [et al. found that only 34% of the 36 cases they studied had an initial laparoscopic appendectomy [et al., who discovered that the first appendectomy was open in 65 percent of SA cases [The most common surgical error associated with stump appendicitis is the failure to detect the appendices base, resulting in a long appendices stump . Stump ap length . This iso 6.5 cm . The patndectomy . This isSA cases .Stump appendicitis presents a challenge for surgeons because it is rare, and delaying diagnosis results in considerable morbidity. Nevertheless, it should remain a differential diagnosis for patients who have had an appendectomy and are experiencing right lower quadrant pain.


A postmenopausal woman presented with a predominantly right-sided abdominal lump, insidious in onset and not associated with any aggravating or relieving factors. Physical examination revealed a soft cystic mass extending from the right hypochondrium to the right iliac fossa region crossing the midline. Ultrasonography of the abdomen and pelvis showed a large cystic anechoic area noted in the abdomen extending from the epigastric region to the pelvis. Contrast-enhanced CT of the abdomen and pelvis showed a large non-enhancing cystic lesion in the pelvis suggesting the possibility of a right ovarian cyst or mesenteric cyst. Laparotomy was performed and the excised specimen was sent for histopathological analysis, which confirmed it to be an endometrial cyst. Though endometriosis prevalence decreases to 2.55% in postmenopausal women , endometA 53-year-old P2L2 (para 2 live 2) postmenopausal female presented with swelling in the right side of the abdomen which was insidious in onset and progressive in nature and not associated with any aggravating or relieving factors. There were no bowel or bladder complaints, and no history of weight loss or loss of appetite. She had no significant history of taking OCP or any hormone replacement therapy. General physical examination revealed a soft cystic mass felt was extending from the right hypochondrium to right lumbar region and right flank. All routine lab investigations done were normal. Many differential diagnoses including a mesenteric cyst, abdominal wall lipoma, desmoid tumour, hepatoma, hernia and a large retroperitoneal tumour were kept in mind.Radiological findingsUltrasonography of the abdomen and pelvis showed a large cystic anechoic area noted in the abdominal cavity extending from the epigastric region up to the pelvis, possibly peritoneal. The right ovary was not visualized separately from the lesion. CECT of the abdomen and pelvis Figure  showed aThe patient's serum carcinoembryonic antigen (CEA) was found to be 1.4 ng/ml (0 to 2.5ng/ml) and cancer antigen 125 (CA125) was 12 units/ml (0 to 35 units/ml). Based on clinical and radiological findings with negative tumour marker levels, a benign cystic lesion of the ovary, ovarian cyst, or mesenteric cyst was considered. The patient was posted for exploratory laparotomy for excision of the cyst.Intra-operative findingsA vertical lower midline incision was taken extending from the umbilicus to the pubic symphysis and the abdomen was opened Figure . A bluisPost-procedure the resected cyst was sent for histopathology Figure  and confPost-operative care in the form of regular vital monitoring, IV antibiotics, antipyretics, analgesics, proton pump inhibitors, antiemetics, and a regular sterile dressing was given. The patient was discharged from the hospital once she was clinically and vitally stable with a healthy suture line with advice to follow-up in surgery OPD for further follow-up after one month or SOS (if needed) in case of emergency. Postmenopausal endometriosis Postmenopausal endometriosis though rare has special renewed interest due to its propensity for malignant transformation ,4. PostmAlso, there are no defined biomarkers for endometriosis. Hence, this indicates that thorough medical history, physical examination, and clinical evaluation can aid clinicians to determine postmenopausal endometriosis only to a limited extent. The differential diagnosis of vague abdominal lump includes a range of conditions such as lipoma, hernia, desmoid tumour, mesenteric cyst or primary or metastatic malignancy . AlthougHence, surgical removal of cysts and histopathological confirmation is the gold standard diagnostic method for endometrial cysts. In this case, transvaginal ultrasonography was performed initially to identify the cyst and later CT was conducted to rule out cystic lesion vs over distended stomach. Evidence of a large non-enhancing cystic lesion in the pelvis extending up to the liver measuring approximately 30cm x 13cm x 20 cm probably arising from the right ovary suggested the possibility of an endometrial cyst or a mesenteric cyst. We used histopathological analysis to confirm the diagnosis of the endometrial cysts. In a similar study by Chandra et al., premenopausal women admitted with pelvic mass underwent abdominal cystectomy and histopathological examination of excised section confirming the diagnosis of ovarian endometriosis . AlthougPharmacotherapyPharmacotherapy is considered to play a secondary role during the postoperative period in a few situations, for example, in women with incomplete resection of endometriotic foci or in patients with concomitant pain postoperatively . CommonlRisk of malignancy Sampson et al., 1925, first described the malignant transformation in endometriosis with an incidence of 1% . The risAlthough endometriosis is a rare condition in postmenopausal women, it can occur irrespective of age or location. Hence, a high degree of clinical suspicion is necessary to diagnose postmenopausal endometrial ovarian cysts before worsening potential complications or the chance of developing into a malignancy.


Venous malformations are the commonest vascular anomalies and can be found everywhere in the body. Those of the external genitalia are quite rare. Although they can be small, they may give rise to psychological discomfort and functional impairment and their management can be delicate and challenging. We present a case of a large and infiltrating venous malformation of the glans penis successfully treated with a combined strategy using sclerotherapy and Nd:YAG laser.  What is already known about this topic?Treatment of venous malformations of the glans is still controversial. Only case reports are available concerning the treatment of these malformations.What does this study add?Combining the available techniques could represent the key for good treatment results. We didn't find reports in the literature of clinical cases where this approach is described. This paper reports a good outcome with two techniques combined together in the treatment of a deep and extensive venous malformation of the glans penis.1Venous malformations (VMs) are constituted by enlarged, tortuous, dysplastic vascular chambers representing the commonest congenital vascular anomalies. They can either remain undetected if deeply located until a thrombotic event occurs or they can be visible early in life when superficial or large enough to cause deformity. Venous malformations usually slowly worsen over time and never regress spontaneously. They clinically appear as blueish soft vascular masses responding to gravity as for filling and emptying their blood content. They can be found all over the body and according to their location are responsible of symptoms like pain, heaviness, swelling, ulceration, bleeding, and thrombosis.VMs of the urogenital tract are very rare and those located in glans penis are the most uncommon.2A 45 year old patient presented to our referral centre of malformations and rare vascular diseases for evaluation of an irregular blue‐colored mass of the glans penis. The lesion, present at birth, became significant in size at the age of 10, but at that time no treatment was offered. No other abnormality of the genitourinary tract was found in the urological follow‐up.He denied dysuria, bleeding, hemospermia or haematuria. He did not complain of erectile dysfunction, but an important increasing in volume of the lesion during erection with evident functional impairment. We found an irregularly shaped, bluish, globular, soft vascular mass, reducible under compression, then slowly refilling in few seconds. There was no palpable thrill and the mass was not pulsatile. A colour‐Doppler ultrasound confirmed the purely venous nature of the malformation and the absence of thrombotic sequelae. Arterial and venous circulation were anatomically and functionally normal. The lesion was infiltrating the glans for 12 mm in depth, without involving the corpus spongiosum. Based on the history, physical findings and US, the diagnosis was consistent with a venous malformation, and no further imaging was performed.A surgical option was excluded because of the wide extension of the lesion. A Neodymium:yttrium aluminium garnet (Nd:YAG) laser was proposed as a first approach. This laser, at safe energy parameters can effectively cauterise vessels at a maximal depth of 4–6 mm. Therefore, after some treatments we decided to combine the photo‐thermal ablation with sclerotherapy in order to reach the deeper parts of the lesion.After a transdermal local anaesthesia with 5% lidocaine cream, a direct puncture of the lesion with a 23 gauges needle was performed. After slowly injecting some millilitres of 0.9% saline solution to confirm correct endoluminal positioning, we injected 1–2 ml of 3% foamed polidocanol (ratio polidocanol‐air of 1:4), under ultrasound guidance.After removal of the needle and compressive haemostasis the lesion was further treated with application of a 1064 nm wavelength Nd:YAG laser with this parameters: 70–95 J/cm2, pulses of 30–40 msec, spots of 6–8 mm of diameter. Between 12 and 30 shots were applied per session.All the procedures were well tolerated, without the need for further anaesthesia.We performed in total six treatments as described above, at an interval of 6–10 weeks, with a total amount of 97 laser shots and 8 ml of total foamed polidocanol. US control was performed prior to each treatment session, demonstrating progressive fibrosis and shrinkage of the lesion.We did not encounter any kind of complication. The outcome was very satisfying in terms of both aesthetic and functional result. US showed no thrombotic collateral damage and no residual malformation up to 24 months follow‐up Figure . The pat3Venous malformations are congenital vascular anomalies that may slowly worsen and never regress. Those of external genitalia are quite rare. They are mostly asymptomatic, with an important aesthetic impact.A recent study showed that there could be a significant association between external and internal genital vascular malformation, thus suggesting an MRI investigation of the pelvis in all cases.A review of the literature shows that current therapeutic options include surgery, sclerotherapy, cryotherapy, and laser ablation. Each technique has its indications, advantages, and possible complications.Surgical excision can bear good results especially for small lesions.There are no recent case reports about cryotherapy for penile lesions, probably due to technical limitations in such a small anatomic region.Nd:YAG laser treatment is better described and proved to be effective and safe; however, the available transcutaneous devices allow to only reach a depth of 4–6 mm. It should be used cautiously, to avoid mucosal necrosis.Sclerotherapy is a widely adopted technique for slow flow vascular malformation in every anatomical region and has proved good aesthetic and functional results even for genital lesions.The rationale for the association of Nd:YAG laser and sclerotherapy is to reduce as much as possible the dose of sclerosing agent and so minimise the risk of injury of the corpus cavernosum or spongiosum, that could affect the erectile function. Finally we believe that polidocanol provides a good balance between efficacy and inflammatory response, given its little impact on perivascular structures, and it is well suitable for this anatomic region, due to its low risk of ulceration and necrosis.In conclusion combined sclerotherapy and transdermal laser ablation is a promising technique for penile venous malformation. We recommend the use of cautious laser parameters and small amounts of sclerosing agent; even if the improvement after a single session may seem little, a very good final result can be obtained, without any dermal, mucosal or vascular complication.None to declare.Marco Fresa: Conceptualization (lead); Data curation (lead), Methodology (lead); Writing – original draft (lead); Writing – review & editing (lead). Lucia Mazzolai: Project administration (lead); Validation (lead); Writing – review & editing (supporting).


Encountering a young child with an enlarging painless facial swelling often raises concerns in the treating physician about the possibility of a congenital lesion or an unfavorable pediatric tumor. We discuss a case of a female child who presented with multiple craniofacial swellings, which turned out to be Langerhans cell histiocytosis (LCH). She was subsequently diagnosed with multisystem LCH (MS-LCH) with risk-organ involvement, which included the craniofacial bones, skin, hemopoietic system, and liver. We analyze the various presentations and systemic complications of this rare pediatric tumor, LCH, with an aim to address the diagnostic dilemma associated with this great masquerader. In the pediatric population, a rapidly progressing facial swelling may imply sinister diseases such as metastatic neuroblastoma, Ewing sarcoma, osteogenic sarcoma, rhabdomyosarcoma, as well as Langerhans cell histiocytosis (LCH) on the list of differentials . AlthougThe patient was a one-year-old Malay girl who presented with a right postauricular swelling, which had progressively increased in size over a period of three months. It was a painless, fluctuant, cystic-like swelling and measured 7 x 7 cm Figure .There was no associated ear pain, ear discharge, or reduced hearing. The patient had also developed left lower eyelid ecchymosis, which had progressed into a large maxillary swelling over a period of two weeks. The left maxillary swelling measured 4 x 4 cm and was firm in consistency Figure . She alsCT of the brain, orbit, and paranasal sinuses and the high-resolution image of the temporal bone showed a heterogeneous lesion on the right postauricular region measuring 6.9 x 5.1 x 7 cm, with bony erosion of the right temporal and right mastoid air cells. There was an intracranial extension of the mass into the right temporal region and right posterior fossa. The mass closely abutted the right tentorium cerebelli and the sigmoid sinus; however, the sinus remained patent. There was an extension of the mass into the external auditory canal and the middle ear but with intact ossicles. Another similar heterogeneous mass, measuring 4.6 x 3.4 x 4.1 cm, was noted at the left infraorbital region with infraorbital extension and associated bony erosion involving the orbital floor. There was evidence of bony erosion involving all walls of the left maxillary sinus and the left alveolar process. The mass completely obliterated the left maxillary sinus. The presence of a clear fat plane with the left orbit and left extraocular muscles and left optic nerve intact was also observed.The patient was scheduled for an MRI; however, she continued to have clinical deterioration with rapid enlargement of the mass. In view of the urgency to obtain a tissue biopsy, a multidisciplinary discussion involving otorhinolaryngology, neurosurgery, and pediatric oncology deemed the maxillary mass to be a safer option for biopsy and with less intraoperative risk. This was based on the CT imaging showing the postauricular mass with the presence of intracranial extension, and hence this surgical approach was not used in view of the risk of cerebrospinal leak and intracranial complications. The child underwent nasal examination under anesthesia and incisional biopsy of the left maxillary tumor via sublabial approach. Intraoperatively, it was noted that the sublabial mucosa was intact but the sulcus was obliterated. The capsulated tumor broke during sublabial incision and plenty of stale blood content was noted within the tumor. The tumor was dark red in color with a jelly-like consistency. There was tumor extension and erosion of the left alveolar process of the maxilla, and anterior, lateral, and medial maxillary walls.The patient then underwent an MRI of the brain, which demonstrated the skull base mass at the right temporal region arising from the bone. The lesion was heterogeneous hyperintense on T1W1 and iso-hypointense on T2W1. There was a presence of cystic components within, with the fluid level seen. The mass measured 5.7 x 7.0 x 7.5 cm. The mass was hypointense on gradient recalled echo (GRE) and there was a heterogeneous enhancement on post-gadolinium images. There was no intracranial extension. The sigmoid sinus was compressed by the mass; however, it remained patent. A similar appearance was noted at the left maxillary lesion measuring 2.7 x 3.5 cm, with mass effect onto the left orbital floor and stretching the left inferior rectus muscle. Differentials listed included metastasis , a less likely differential in lymphoma or rhabdomyosarcoma , CD3 (ruling out T-lining lymphoma), CD20 (ruling out B-lineage lymphoma), CD30 , EMA , and myogenin (ruling out rhabdomyosarcoma).The patient was started on six cycles of vinblastine and oral prednisolone. She, unfortunately, had a poor response after initial chemotherapy and has been reclassified as LCH with disease progression and multisystem involvement and is currently undergoing second-line treatment with a combination of oral prednisolone, cytarabine, and vincristine. She has shown a favorable response to the latest regime and continues to receive multidisciplinary care from the pediatric, oncology, otorhinolaryngology, and dermatology teams.LCH is a heterogeneous disease with a wide spectrum of clinical presentations, primarily depending on the organ or systems involved ,5. The cBone is the most common organ involved in LCH, with the skull vault most frequently involved in younger children, who usually present with a painless fluctuant lump -7. Our pCutaneous manifestations of LCH are diverse and represent the second most common presentation of LCH. They can manifest as scalp seborrheic dermatitis or a non-specific rash  over the scalp and trunk ,7. It is3 whereas severe thrombocytopenia means platelets below 20,000/mm3. Hepatomegaly or splenomegaly requires the ultrasound confirmation of the liver or spleen being palpable 3 cm below the costal margin at the mid-clavicular line. Liver involvement can also be shown by deranged parameters such as hyperbilirubinemia, hypoalbuminemia, and raised ALT (SGPT) and AST (SGOT) [Risk-organ involvement can be revealed by blood investigations showing cytopenia, liver dysfunction, and imaging-proven hepatosplenomegaly . Anemia T (SGOT) .CT scan is required to confirm the presence of the bony lesion and delineate the extent of osseous and cortical destruction as well as soft-tissue involvement . The rolAs LCH is essentially a histological diagnosis, one important step in the management involves obtaining a tissue biopsy . Our pat2/day orally for four weeks followed by tapering over two weeks) and vinblastine (6 mg/m2 weekly intravenous bolus). The maintenance phase of therapy depends on the response to initial therapy, which is an important prognostic marker. Non-intensive maintenance therapy, with a one-year regime of prednisolone, vinblastine, and oral mercaptopurine, is advocated for patients with complete disease resolution or minimal disease in non-risk organs. On the contrary, a second initial course (similar to the first one but with corticosteroids given for three days a week) is recommended for patients with a risk disease with evident but incomplete response in risk organs, as well as for patients with a low-risk disease without improvement after the first course. Risk-group patients with a lack of improvement in risk organs after 6-12 weeks of therapy are candidates for salvage options. The adverse prognostic markers include multisystem presentation, risk-organ involvement, and poor response to initial therapy [The mainstay of treatment of LCH is the use of chemotherapy and prednisolone. MS-LCH is treated with standard therapy involving an initial six-week course of prednisolone (40 mg/m therapy .LCH is a great masquerader, with presentations ranging from a simple isolated cutaneous lesion to a mistakenly diagnosed nonaccidental injury with periorbital ecchymosis to a possibly fatal multi-organ failure secondary to disseminated disease. When dealing with children with rapid progressive craniofacial swellings, a high index of suspicion is needed even for rare conditions such as LCH. There must be an emphasis on a careful head-to-toe evaluation of patients in order to tie up and correlate multisystem presentations, and appropriate early imaging is of paramount importance to prevent delayed diagnosis and treatment. This provides a better prognosis for these children and a glimmer of hope for the parents.


Idiopathic hypertrophic cranial pachymeningitis (IHCP) is a rare chronic inflammatory disease characterized by diffuse thickening of the dura mater. Although IHCP mostly presents as a diffuse lesion, it may also occur as focal tumour-like lesions. Here we present the first reported case of IHCP associated with a Chiari type I malformation (CMI). A 65-year-old man presented with a one-year history of chronic headache and vertigo exacerbated by standing and neck flexion. The neurological examination was unremarkable except for tongue wasting and fasciculations. MRI demonstrated features of CMI and findings suggestive of IHCP.Posterior fossa decompression resulted in significant symptomatic improvement and the diagnosis of IHCP was confirmed on histopathology. Though there is no consensus about the management of IHCP in this case, we advocate surgical decompression with prolonged steroid therapy. Idiopathic hypertrophic cranial pachymeningitis (IHCP) is a comparatively rare chronic inflammatory disorder associated with diffuse or localized thickening of the cranial dura mater and compression of adjacent structures with subsequent neurological deficits -2; it prA 65-year-old Caucasian male presented with a one-year history of progressive headache and vertigo associated with upright posturing and neck flexion that worsened with coughing and sneezing. He had no travel history, weight loss, or family history of any genetic or immunological disorders. Neurological examination was unremarkable except for fasciculations and wasting of the left side of his tongue. Inflammatory markers were very mildly elevated, and an autoimmune screen, syphilis and malignancy screen were negative. A lumbar puncture was done and CSF examination was inconclusive. A CT scan revealed a low-lying right cerebellar tonsil suggestive of a CMI without any evidence of hydrocephalus. An MRI examination of his whole neuraxis was subsequently performed, demonstrating prominent pachymeningeal thickening in the region of the foramen magnum as well as cerebellar tonsillar descent 6 mm below the foramen magnum, consistent with IHCP and an associated CMI Figures -3.A posterior fossa decompression was performed including excision of the posterior arch of C1 and augmentation duraplasty. The dura beneath the occiput at the foramen magnum was extremely thick and tough, but otherwise unremarkable in appearance, and specimens were sent for histopathological examination post operatively. Microscopically, in the post-operative sample, there was a non-specific, variable chronic inflammatory cell infiltrate, lymphoplasmacytic cell infiltrates, and hyaline degeneration. Duraplasty was completed with a commercially available dural substitute, and the patient made an unremarkable post-operative recovery with good resolution of his pre-operative symptomatology.A follow-up for 12 months showed complete recovery and relief of his symptoms.IHCP is a rare disorder of unknown etiology. The spinal form of idiopathic hypertrophic pachymeningitis was first described in 1869 by Charcot and Jaffrey while Nafziger and Stern described the first cranial case in 1949 . It is aThe most common anatomical location of thickened dura-mater is the posterior fossa in the cranium, in IHCP, hence it could cause non-communicating hydrocephalus .Headache is the most reported symptom and, in some cases, may remain the only presenting symptom for years . In a reIHCP is a diagnosis of exclusion . HoweverThe treatment of IHCP remains controversial. Despite a lack of consensus about the duration and the dose of steroid therapy, they are effective in alleviating the symptoms of IHCP . The comWe have reported a case of IHCP occurring in association with CMI. We advocate a heightened clinical suspicion for IHCP in patients with Chiari malformation. Diagnostic neuroimaging and laboratory evaluation should be performed for patients with suggestive neurological presentations. Ultimately, the definitive diagnosis of IHCP is confirmed by salient findings on histopathological evaluation of dural biopsy specimens. Posterior fossa decompression and treatment with steroids were rewarded with success in the management of our index patient and are hereby recommended. Long-term observation will be required to monitor the overall outcome of our index case.


Sarcomas are a diverse group of cancers of mesenchymal origin. Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is an uncommon and hardly reported neoplasm that is a malignant variant of the typically benign inflammatory myofibroblastic tumor (IMS). We discuss an exceedingly rare case of a 53-year-old patient with primary EIMS of the pericardium who presented in impending hemodynamic collapse. A transthoracic echocardiogram revealed a large circumferential pericardial effusion with tamponade physiology and an echogenic intrapericardial mass compressing the right ventricle to near obliteration. She underwent emergent sternotomy with resection and one cycle of chemotherapy with liposomal doxorubicin before having recurrent metastatic pericardial and pleural effusions, ultimately leading to her unfortunate passing. Sarcomas are a diverse group of cancers of mesenchymal origin that comprise approximately 11% of all cancers . SarcomaEIMS is distinguished by its morphological and histological elements, including a predominance of epithelioid cells with vesicular nuclei in a setting of myxoid stroma, inflammatory cell infiltrates, and the presence of spindle cells . In addiA 53-year-old woman with a past medical history of factor V Leiden mutation and multiple prior venous thromboembolisms with inferior vena cava filter placement presented with progressive fatigue and shortness of breath. On exam, she was in visible respiratory distress, hypoxic, and tachypneic. A computed tomography (CT) angiogram of the chest revealed bilateral pleural effusions and a large circumferential pericardial effusion Figure . A transOnly two months later, she was admitted to the medical intensive care unit for acute hypoxic respiratory failure requiring endotracheal intubation. CT of chest angiogram revealed multiple, large multi-loculated pleural effusions of the right hemithorax, causing complete opacification Figure . She undEIMS is a rare and recently defined entity that represents a more aggressive subtype of inflammatory myofibroblastic tumor (IMT). There have been several reports in recent years describing numerous cases of intra-abdominal EIMS, with a smaller number of cases being extra-abdominal, primarily in the thoracic or mediastinal spaces . The majThe diagnosis of EIMS can be difficult owing to its rarity and resemblance to other malignant diseases of mesenchymal or lymphoproliferative origins . In our Cardiac EIMS, specifically of pericardial origin, is exceedingly rare. The largest review of patients with cardiac IMT was of 57 patients performed by Eilers et al. . In theiClinician and pathologist familiarity with this disease can be crucial for diagnosis. It is important for clinicians to be aware of variations in the presentation of EIMS and for pathologists to be aware of the characteristic histological features as the course of the disease is often aggressive and rapidly fatal. In addition, proposed therapies that target specific markers typical of EIMS should consider variants that do not express the most common markers. Du et al. present one example of a proposed therapy that could target cases that express PD-L1 ; howeverEIMS is a rare and aggressive cancer that has conventionally been recognized by its intra-abdominal presence and distinctive histological and genetic characteristics. Our case demonstrates that pericardial manifestations and ALK-negative presentations are possible with EIMS. This sarcoma can be a challenge for both clinicians and pathologists to diagnose. Knowledge of more atypical presentations can aid in earlier diagnoses. In the future, targeted therapies should consider variants of EIMS that do not express the typical genetic markers as this may affect prognosis.


Angiomyomatous hamartoma of the lymph nodes (AMH-LNs) usually develops in the inguinal or femoral lymph nodes. Although its pathologic findings have been well described in the literature, there have been few reports on detailed clinical and imaging features of AMH-LNs. Moreover, most of these reported cases required excisional biopsy to make a precise diagnosis. Herein, we report a case of AMH-LNs with localized lymphedema manifesting as a subcutaneous mass. In this case, we also describe in detail the clinical and imaging findings to help dermatologists establish an accurate diagnosis without unnecessary surgical intervention.A) and slightly high heterogeneous signal intensity on T2-weighted imaging (B). Transverse fat-suppressed T2-weighted MRI (C) and an apparent diffusion coefficient map (D and E) showed slightly swollen lymph nodes surrounded by edema. Excisional biopsy of 1 of the lymph nodes from the mass demonstrated partial replacement of lymph node parenchyma by proliferated thick-walled vessels distributed in the hilum, extending into the lymph node cortex (A and B). Irregularly arranged smooth muscle cells were observed in the dense fibrocollagenous stroma. Immunohistochemical examination revealed that the stromal cells were positive for desmin (C). On the basis of these findings, we established a diagnosis of AMH-LNs with localized lymphedema. During the 4-month follow-up period after diagnosis and without any treatment, the mass was not enlarged.A 63-year-old woman without any remarkable medical or family health history was referred to our clinic with a complaint of a right femoral subcutaneous soft mass measuring 10 cm × 10 cm in size . Ultraso imaging , B. Tranhted MRI , C and aient map , D and Ee cortex , A and Br desmin , C. On tAngiomyomatous hamartoma is histologically characterized by the partial replacement of normal nodal parenchyma by disorganized blood vessels and smooth muscle cells, with or without adipose tissue within a fibrous stroma.To date, more than 60 cases of AMH-LNs have been reported.,,Most reported cases of AMH-LNs were presented by pathologists from a histopathologic point of view. In addition, few previous reports have provided a detailed clinical description of AMH-LNs with imaging findings. Of note, to our knowledge, although there has been only 1 report describing the clinical presentation of AMH-LNs,This report describes important clinical and imaging features of AMH-LNs and lymphedema. It is difficult to make a diagnosis of AMH-LNs before excisional biopsy because of its rarity and close appearance to other soft-tissue tumors, such as lipoma, lipomatosis, liposarcoma, angiosarcoma, and fibroblastic neoplasm. Furthermore, AMH-LNs needs to be differentiated from other diagnoses that cause localized lymphedema . Because unnecessary surgical treatment could be avoided if diagnosis of this rare benign entity could be made by other diagnostic criteria, an accumulation of reports that describe detailed clinical and imaging features of AMH-LNs is required to enable a precise nonsurgical diagnosis of AMH-LNs. AMH-LNs is still uncommon in dermatology. Thus, dermatologists should be aware of this rare disorder and recognize localized lymphedema, especially in the evaluation of soft subcutaneous masses, to avoid unnecessary surgical treatment.None disclosed.


Hepatic sarcomatoid carcinoma (HSC) is an extremely rare malignant tumor typically observed in clinical settings. HSC occurrence is predominantly noted in the right lobe and rarely in the left lobe of the liver. This report presents a case of sarcomatoid carcinoma that occurred in the left outer lobe of the liver, which was accompanied by gastrointestinal stromal tumors (GSTs) in the greater curvature of the stomach. In addition, the patient showed late-stage recurrence of HSC in gastric tissues.via imaging examinations. However, 3 months later, the patient presented with pain in the upper left abdomen, and examination revealed cancer recurrence in the stomach. The surgery was repeated, and the patient recovered favorably after the procedure. Unfortunately, the patient died owing to multiple metastatic diseases 4 months after the second surgical procedure.A 63-year-old man was concomitantly diagnosed with HSC and GST. The main clinical manifestation was fever. Abdominal computer tomography (CT) and ultrasound-guided percutaneous liver biopsy at the local hospital revealed the presence of malignant hepatic tumors. The patient approached our hospital for further treatment. The subsequent electronic gastroscopy showed multiple submucosal tumors (SMT) in the stomach. Owing to the absence of multiple metastases in other regions of the body, we performed left hepatic lobe resection with gastric partial resection. The postoperative pathological analysis confirmed the presence of HSC and GST. The patient reported feeling well 1 month after the surgery, and no obvious space-occupying lesions in other areas were noted HSC shows no characteristic clinical manifestations and is highly malignant. Surgical intervention is the first treatment of choice for patients with HSC. In cases of sarcomatoid cancer occurring in the left lobe of the liver, it is imperative to exercise strict vigilance against the tumor's invasion of the stomach tissue. This is particularly important when the tumor breaks through the capsule of the liver. Hepatic sarcomatoid carcinoma (HSC) is a particularly malignant tumor with unknown pathogenesis, and it accounts for 2% of surgically removed cases of hepatocellular carcinoma (HCC) and 3.9%–9.4% of autopsies , 2. HSC In the current report, we present the case of a 63-year-old man who showed fever as the main clinical manifestation and had a postoperative pathological diagnosis of HSC and gastrointestinal stromal tumors (GST). We performed left hepatic lobectomy combined with partial gastrectomy on the patient, and the patient recovered favorably after the operation. However, 3 months later, the patient presented with gastric recurrence and received surgical intervention for the second time. In this paper, we share the clinical characteristics of and the diagnosis and treatment process for this patient with the aim to assist colleagues in their associated work.At the time of hospital admission, the patient was a 63-year-old male and showed fever as the main clinical manifestation. His body temperature fluctuated in the range of 37.5°C–38°C. The patient did not have jaundice, the abdomen was flat and soft, and showed no tenderness or rebound pain. The liver and spleen were not palpable under the ribs, and no mobile dullness was identified. The patient did not have a history of chronic diseases such as hypertension and diabetes, a history of infectious diseases including hepatitis B and tuberculosis, or a family history of tumors.9/L). The blood biochemical examination revealed that alanine aminotransferase (37 U/L) and aspartate transferase (18 U/L) were within the normal range. We noted a decrease in the total protein content (62.8 g/L) and the white ball ratio (1.0); however, the C-reactive protein (215.70 mg/L) levels had increased abnormally. Immune screening detected no hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. Through the tumor marker screening, we determined that carcinoembryonic antigen (CEA) (1.24 ng/ml), alpha-fetoprotein (AFP) (4.47 ng/ml), prostate-specific antigen (2.98 ng/ml), carbohydrate antigen 19–9 (CA19–9) (6.32 IU/ml), and carbohydrate antigen 15–3 (CA15–3) (18.10 IU/ml) were within the normal range.Blood routine tests showed increased levels of white blood cells  of the upper abdomen indicated a liver abscess and multiple lymphadenopathies in the abdominal cavity. However, a subsequent (1 week later) ultrasound-guided percutaneous liver biopsy revealed a malignant tumor in the left lobe of the liver.Helicobacter pylori (HP) infection.To receive further treatment for liver tumors, the patient was admitted to the Department of Hepatobiliary Surgery at our hospital. The Color Doppler ultrasound  showed that the left outer lobe of the liver had a mixed echo of 103 × 112 × 110 cm. The tumor was mainly hypoechoic with an irregular shape and clear boundaries. The internal echo was uneven, the color revealed the presence of dots of blood flow signals in and around the tumor, and no abnormality in the portal vein was noted. Irregular masses of long T1  and longvia postoperative pathologic analysis. HCC, ICC, HSC, and other properties are not excluded. We performed left hepatic lobectomy combined with partial gastrectomy (wedge resection) with the patient's and his family's consent. We intraoperatively identified a mass of ∼10 cm in diameter in the left lobe of the liver, with off-white color and hard texture. The tumor had appeared to have broken through the liver capsule, the visceral surface densely adhered to the lesser curvature of the stomach, and enlarged lymph nodes were palpable in the suspensory ligament of the hepatoduodenum. Intraoperative biopsies were performed and all three enlarged lymph nodes tested negative upon pathologic examination. Two superficial tumors were observed on the greater curvature of the stomach wall. The right liver was normal in size and soft to the touch. The size of the gallbladder was approximately 7 × 4 × 3 cm. No tumor metastatic nodules were detected in the omentum, diaphragm, jejunum, or pelvis. Intraoperative examination revealed that the liver tumor had invaded the left gastric artery, which was removed from the root. The operation was relatively successful, lasted for approximately 6 h, and the bleeding volume was approximately 200 ml.The patient was febrile and showed no characteristic clinical presentation. Results of laboratory tests, including tumor markers, were unremarkable. A combination of imaging findings and liver puncture results of the patient in the local hospital assisted us in determining that the patient had a malignant tumor in the left lobe of the liver, accompanied by greater curvature GST, without obvious metastatic lesions. Owing to the fact that only a small amount of pathological tissue was acquired through the liver puncture, the nature of the tumor required further elucidation The postoperative specimens were subjected to pathological examination and immunohistochemistry (IHC). The liver tumor tissue specimen was diagnosed as a high-grade pleomorphic malignant tumor of the left lateral lobe of the liver with necrosis. The immunological markers were as follows: CK (+) , Vim (−)The patient recovered favorably and was discharged from our hospital on postoperative day 8. No adjuvant therapy was administered or prescribed. The patient was followed up in the outpatient clinic 1 month after discharge, and he presented no obvious symptoms or discomfort. The blood routine test and biochemical profile showed no abnormalities, and AFP (10.5 ng/ml) had no significant increase compared with the first measurement (4.47 ng/ml). The hepatobiliary, pancreatic and splenic ultrasound showed no obvious space-occupying lesions.However, 3 months later, the patient presented with persistent pain in the upper left abdomen, which worsened paroxysmally. Imaging examinations revealed the presence of an irregular and substantial mass in the area between the greater curvature of the stomach and the omental sac , and theCases of SC are extremely rare in clinical practice. SC may occur in multiple organs throughout the body and even occur concurrently. The lung and the bladder are the most common sites of occurrence , 5, wherSymptomatic HSC cases account for 68%–75% of cases. Abdominal pain is the most common symptom , followeOn an enhanced MRI image, HSC is typically manifested as peripheral enhancement, central necrosis, and different enhancements with and without a tumor envelope in the solid part . The varβE12, CAM 5.2, c-Kit, S-100 protein, HHF-35, kinesin-like protein-1, CD34, and HAM-56, which is helpful for the diagnosis of HSC (An accurate HSC diagnosis relies on a large number of pathological signs and IHC observations. HSC is composed of spindle cells and epithelial components that are identifiable in ultrastructure, IHC, and morphology . The IHCs of HSC . In the Reportedly, surgical resection has been an effective method for the treatment of HSC. Radical surgery can significantly prolong the overall survival of patients with HSC, and the associated survival period is significantly higher than that of palliative resection , 14. In HSC is highly malignant; thus, timely detection, accurate diagnosis, and personalized treatment are of paramount importance to positively impact disease prognosis. In cases presenting with SCs in the left lobe of the liver, clinicians should be vigilant regarding the possibility of gastric infiltration; this is a plausible outcome if the carcinoma breaks through the liver capsule. If available, gastric endoscopic ultrasonography should be used to evaluate the involvement of the gastric wall. In this report, we have shared our patient's clinical characteristics and the corresponding diagnosis and treatment process to provide a reliable reference for healthcare professionals in this field.


Misdiagnosing granuloma annulare (GA) for a malignant process can lead to unnecessary and costly treatment avenues for the patient. Thus, it is salient for surgeons to independently evaluate a patient’s clinical and histopathologic presentation before proceeding with surgery. We present a case of a 67-year-old male with a biopsy-proven squamous cell carcinoma (SCC) on the dorsal hand who presented for Mohs micrographic surgery (MMS). At this time, the surgeon noticed the histopathologic diagnosis did not match the patient’s clinical appearance. GA was diagnosed following a repeat biopsy of the lesion, which prevented an unnecessary Mohs procedure. We present this case primarily to highlight the importance of clinicopathologic correlation by the surgeon when a patient is referred for surgery. Many clinical and histopathological mimickers of squamous cell carcinoma (SCC) have been described in the literature including hypertrophic lichen planus, tophaceous gout, and keratoacanthomas -3. WhileGA is a benign cutaneous reaction pattern presenting with papules that group in an annular shape and affect patients of all ages and gender. The etiology of GA is unknown, though many potential disease associations and triggers have been described in the literature, including preceding infectious diseases and traumatic events. GA is often asymptomatic, self-limited, and requires little to no treatment when it is localized. However, when misdiagnosed for a malignant process such as SCC, patients may be referred for surgery. Dermatologic and Mohs micrographic surgeons often encounter lesions where the clinical presentation does not match the histopathological description or vice versa. Given there are histopathological and clinical mimickers in Mohs micrographic surgery (MMS) -3, surgeWe report a case of GA of the dorsal hand mimicking SCC, highlighting the importance of independent CPC evaluation of lesions referred for surgical treatment.A 67-year-old male with a history of basal cell carcinoma was referred for MMS for a biopsy-proven SCC on the left dorsal hand Figure . The lesSome clinicopathological mimickers of SCC that have been described are hypertrophic lichen planus , gouty tIn the present case, the original biopsy showed small nests of mildly atypical squamous epithelium that appeared to infiltrate into the dermis with surrounding fibrosis and inflammation, leading to an original diagnosis of well-differentiated SCC. In retrospect, while a small well-differentiated SCC could still be possible, it is more likely to represent a focus of a benign process such as a ruptured hair follicle or focus of trauma with reactive epithelial atypia. The diagnostic features of GA were more prominent on the second biopsy, indicating that, while this could represent a collision lesion, a more common explanation involves the importance of sampling error in larger lesions.The differential for cutaneous annular lesions in the elderly includes tinea corporis, sarcoidosis, keratoacanthoma centrifugum marginatum (KCM), actinic granuloma, and GA. Many believe KCM to be a low-grade SCC that can recur but not metastasize . FeatureGA has a classic histopathologic pattern of focal degeneration of collagen and elastic fibers, mucin deposition, and a lymphohistiocytic infiltrate in the upper and mid dermis. The clinical differential is broad and is dependent on its subtype. For example, for conventional GA, annular entities including actinic granuloma and annular sarcoidosis should be considered, whereas papular GA can simulate flat warts, and perforating GA can resemble perforating calcinosis cutis or molluscum contagiosum.As GA and reactive granulomatous dermatitis can be secondary to a systemic condition like diabetes or even cancers, diffuse or extensive involvement may lead to additional workup. Treatment of GA includes topical or intralesional corticosteroids as well as immunomodulators. Spontaneous resolution of GA occurs within two years in 50% of cases with a 40% recurrence rate .As MMS is a treatment for skin cancers, referrals sent for Mohs surgery are typically malignant. However, Mohs surgeons should be aware of clinical and histopathologic mimickers of benign lesions and independently evaluate each patient with a CPC to avoid unnecessary surgery and ensure timely and appropriate treatment for patients.Many cutaneous diseases, including but not limited to GA, mimic SCC and thus warrant referral to MMS. As with the patient in this report, many of these mimickers are benign and self-limiting processes that would otherwise resolve with supportive or no treatment. Similarities in both clinical and histopathologic presentation make distinguishing benign cutaneous diseases from SCC challenging. As Mohs surgeons are uniquely trained in the clinical and pathologic presentation of cutaneous disease, it is critical each patient is evaluated with respective disease correlation upon arrival for surgery. Recognizing SCC mimickers can save patients invaluable time, decrease financial burden, and mitigate the risk accompanying surgical procedures.


Bilateral multilocular huge epididymal cysts are a rare entity with few reports in the literature. Epididymal cysts are mostly found in middle-aged men with or without symptoms. We present the case of a 45-year-old man with asymptomatic bilateral scrotal swelling, which was clinically diagnosed as a right epididymal cyst with left hydrocele. However, an ultrasound of the scrotum revealed bilateral epididymal cysts with normal testes. Intraoperatively, it demonstrated bilateral huge epididymal cysts for which the patient underwent excision of bilateral epididymal cysts. Postoperatively, the patient is doing well on follow-up. Thus, it is concluded that when the epididymal cyst is larger than 10 mm or 1 cm and does not involute with time, surgery is indicated. In comparison, epididymal cysts smaller than 10 mm or 1 cm are managed conservatively. Epididymal cyst or spermatocele is a fluid-filled sac arising from epididymis containing serous fluid . It commA 45-year-old man presented to the surgical outpatient department (OPD) with complaints of bilateral scrotal swelling for eight months. The patient had no history of any trauma, pain, fever, urinary symptoms, or co-morbidities. Physical examination demonstrated non-reducible, non-tender, and bilateral scrotal swellings (left>right) Figure  adjacentClinical differential diagnosis included left-sided secondary hydrocele with right-sided epididymal cysts and bilateral hydroceles of the spermatic cord. In addition, scrotal ultrasound showed two large cystic swellings arising from both epididymal heads of size measuring 45 X 30 mm on the right and 100 X 70 mm on the left Figure .Both testes appeared normal in size, shape, and echogenicity with the normal color flow in the Doppler scan. Thus, the patient was taken for elective surgery. After tunica vaginalis exploration, a large thinned out translucent cyst was identified with multilocularity within, of size 10 X 7 X 2.5 cm on the left side Figure  and 4.5 An epididymal cyst is a fluid collection in either a single (unilocular) or more than one sac (multilocular) due to efferent epididymal tubules dilatation as a result of tubular obstruction ,8. They Furthermore, epididymal cysts can be symptomatic and can present with variable clinical presentations. A patient may narrate scrotal swellings as a third testicle. They may also present with testicular pain or orchialgia . On clinUltrasound helps determine the location, site of origin, the content of the cyst, size, shape, and vascularity of the testes. The head of the epididymis is identified as the most common site of origin of the cyst, while the body and tail of the epididymis are rare sites ,18. CystTreatment options for epididymal cysts depend on the patient’s presentation, symptoms, and clinical findings. Most of the epididymal cysts involute with time . ConservConservative management still remains the initial choice of treatment for asymptomatic epididymal cyst with a size measuring < 1 cm, while surgical modality is the only mainstay of treatment for patients with acute symptomatology like intractable scrotal pain, swelling, and redness and also when the size of the cyst does not regress on its own instead increases with time.From this rare case presentation, we would like to conclude that while dealing with the cases of small-to-medium scrotal swelling or small hydrocele, epididymal cysts should always be kept into consideration as a differential diagnosis.


Kernohan Woltman Notch Phenomenon (KWNP) is caused by a supratentorial lesion pressing the contralateral cerebral peduncle against the free edge of the tentorium of the cerebellum. It is manifested by neurological signs of ipsilateral localization; cerebral MRI is the most sensitive examination for KWNP. Our patient is a 50-year-old woman, operated in 2011 for aortic and mitral valve replacement by mechanical prosthesis, under oral anticoagulant, consults for headaches evolving for 20 days without any notion of head trauma with installation of a progressively worsening left hemibody deficit. Glasgow coma scale was 14 (E3 V5 M6) with left anisocoria 4mm left/2mm right with left hemiplegia. CT shows a chronic left hemispheric subdural hematoma 13.5mm thick with subfalcorial and ipsilateral temporal involvement of the deficit. The cardiovascular examination as well as the biological assessment was unremarkable. The patient was operated on with a total recovery in 12 days, the anticoagulant is resumed on day 20 postoperatively, with close monitoring. KWNP may contribute to misdiagnosis in patients with bilateral corticospinal tract lesions, and anticoagulation poses a problem in stopping and restarting treatment due to the risk of bleeding on one side and thrombosis on the other side. •This article presents a review of literature of Kernohan Woltman Notch Phenomenon due to a subdural chronic hematoma.•The clinical examination revealed a hemiplegic motor deficit associated with consciousness disorders and the CT scan confirmed the diagnosis.•The relationship between the hypersignal of the cerebral peduncle on MRI and the severity of the clinical picture as well as the delay in postoperative recovery. Is usuaSince their original description in 1929 , few patWe report the case of Kernohan's notch phenomenon in a patient with chronic subdural hematoma on anticoagulant treatment.We conducted a systematic literature review to aggregate all previously reported KWNP. Finally, we discuss the management of this rare phenomenon at the light of the previously reported cases.22.1clinicaltrials.gov, and clinicaltrialregister.eu databases were searched using the following search algorithm: “Kernohan-Woltman notch phenomenon” and “chronic subdural hematoma” taking into consideration all articles up to august 2021. All titles and abstracts were verified by two neurosurgeons (AL and SH) to exclude all non-pertinent studies. Articles reporting pediatric patients, patients with acute subdural hematoma, epidural hematoma and cerebral tumors were all excluded.The PubMed/Medline, Google Scholar, Cochrane library, Studies involving animals or without available full text were also excluded. The references of the selected studies were subsequently searched to identify any additional related articles.33.1We report the case of a 50-year-old woman with a past medical history of aortic and mitral replacement by mechanical prosthesis operated in 2011 with anticoagulant medication. And no history of fall. Presenting with tree weeks of headaches, and two days of the hemi-body heaviness.Neurological examination on admission demonstrated a Glasgow Coma Scale (GCS) score of 14 . Left pupil was of 4mm, and was nonreactive, right pupil was of 3mm. With left hemiplegia grade 2 on the Medical Research Council (MRC) grading system.The preoperative CT scan revealed a 13.5mm thick left hemispherical chronic subdural hematoma with falcor and ipsilateral temporal involvement of the deficit.The patient was operated on the same day. An emergency left trephination was performed to evacuate the chronic subdural hematoma. After the operation, the neurological signs, including deterioration of mental state, left-sided hemiplegia and unresponsive dilated left pupil immediately returned to normal. Third day evolution, motor function had improved to 4/5 on the MRC grading scale and she was discharged with GCS 15 and no cognitive deficits. The anticoagulant is resumed on day 20 postoperatively, with close monitoring. Complete recovery was noted one month after surgery.3.2Twelve cases of Kernohan-Woltman notch phenomenon due to subdural chronic hematoma have been reported including our case and have been reviewed and summarized in This case has been reported in line with the 2020 SCARE guidelines .44.1KWNP due to a chronic SDH are rare, with only 12 cases, including the present one, reported. They usually present after the sixth decades, with a slight male predominance. They present as a chronic subdural hematoma on MRI or CT scan. Complete surgical removal led to clinical recovery in most cases.4.2Kernohan's phenomenon is a rare and interesting complication secondary to intracranial mass effect. Since this first description, there have been many reports describing clinical and radiological features of this phenomenon. (1) Kernohan and Woltman have described in 1929 that any supratentorial-localized mass may compress the contralateral cerebral peduncles at the tentorial edge. (2) Petechial hemorrhages may be seen through gradient echo MRI, and cytotoxic edema could also be present. (1).In the classic ipsilateral brainstem compression by medial temporal lobe herniation from an ipsilateral compressive lesion, the Kernohan Woltman notch phenomenon occurs when brain displacement results in compression of the contralateral crus cerebri by the tentorial edge. (4) We are describing the occurrence of this phenomenon in association with a chronic subdural hematoma.Hemiparesis can be found in up to 58% of cases of CSDH and mostly the deficit is contralateral to the lesion . (10) In rare circumstances the focal neurological deficit can be ipsilateral to CSDH (7) which define the KWNP.As though, there is no comprehensive clinical trial concerned with the incidence of KWNP, nevertheless, there is limited number of cases of KWNP secondary to CSH . We haveWhen the mechanism of Kernohan-Woltman notch phenomenon was considered, we conclude that remarkable brain atrophy was a facilitating factor in development of KWNP secondary to wide subdural hematoma and it was noticeable also in our case. The clinical evaluation is the gold standard in diagnosis of Kernohan-Woltman notch phenomenon. (2).However, some authors believe that the pathophysiology of KWNP involves the mechanism of cytotoxic edema for which diffusion weighted imaging (DWI) could be more helpful in the initial assessment of KWNP. (4) It shows a hypersignal of the contralateral cerebral peduncle, which is an essential factor to analyze on the imaging and which allows to predict the clinical evolution of the patients. We noticed that the evolution of the patients with a hypersignal of the cerebral peduncles had a slower improvement than those who did not have, which is confirmed by the study of Itoyama and al (9). The signal change shown on MRI due to Kernohan's notch phenomenon causing a permanent tissue damage in the crus cerebri, predicts persistent motor deficit. However, with the gradual onset of a chronic subdural hematoma, Kernohan's notch phenomenon may develop with only transient compression of the crus cerebri. In this situation recovery is more complete than in those patients with signal changes in the crus cerebri identified by MRI. (5).5Kernohan's phenomenon is a rare false localizing sign, which can lead to diagnostic and clinical confusion. We have reviewed pathophysiology, neuroimaging features associated with this phenomenon due to subdural chronic hematoma and demonstrated that, whilst functional outcome is determined by the lesion of cerebral peduncle, motor function can be regained in most cases. Patients affected by KWNP should be counselled on the rehabilitation potential of the affected limbs, however, more data into the reversibility of KWNP can help to further understand rehabilitation potential.The authors declared that this study has received no financial support.Provenance and peer review Not commissioned, externally peer-reviewed.Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient.Ethical approval has been exempted by our institution.None.Abdelkouddous LAAIDI: writing the paper. Saad HMADA: Corresponding author. Abdelhakim LAKHDAR: Correcting the paper. Abdessamad NAJA: Correcting the paper.None.ResearchregistryXXXXSaad HMADA, Abdelkouddous LAAIDI.The authors declare having no conflicts of interest for this article.


Tuberous sclerosis (TS) is a genetic multisystem disorder associated with the development of benign tumors in many organs. Diffuse lipomatosis, which represents the overgrowth of fatty tissue in one part of the body, is a very rare finding reported in patients with tuberous sclerosis. We describe the case of a patient with diffuse lipomatosis in the right scapular, posterior cervical and perivertebral regions, associated with a space-occupying lesion adjacent to the odontoid process of C2 that appeared to be a pseudotumor, and discuss possible relation between these entities. Tuberous sclerosis (TS) is a genetic multisystem disorder, caused by a mutation in one of two different genes, TSC1 and TSC2, that encode for different tumor suppressor proteins known as hamartin and tuberin, respectively. In many cases, it occurs as a sporadic mutation, but it can also be inherited as autosomal dominant. Alterations in the TSC1 and TSC2 genes lead to exaggerated activity of the mammalian target of rapamycin (mTOR) pathway, causing the development of benign tumors in many organs including the skin, brain, eyes, kidneys, lungs, and heart. This disorder is clinically variable from one person to another, depending on the organs affected. Nearly all patients have skin abnormalities including hypomelanotic macule and angiofibromas. The central nervous system (CNS) is frequently involved with cortical/subcortical tubers, subependymal nodules, and subependymal giant astrocytoma (SEGA). Other major abnormalities include kidney angiomyolipomas, lymphangioleiomyomatosis of the lung, heart rhabdomyoma, and retinal hamartomas -6.We describe the case of a patient with diffuse lipomatosis in the right scapular and cervical regions associated with an incidental finding on MRI of a space-occupying lesion at the atlanto-axial joint similar to a pseudotumor, a previously unreported association, to the best of our knowledge.A 16-year-old patient was initially observed at a medical appointment because of a slowly growing lesion in the right scapular region over 4 years, composed of fatty tissue, as assessed by soft tissue ultrasound. He was diagnosed with tuberous sclerosis, with a mutation in the TSC1 gene.Brain magnetic resonance imaging (MRI) revealed cortical and subcortical tubers and radial migrating bands in both cerebral hemispheres and small subependymal hamartomas, related to tuberous sclerosis. A Chiari I malformation was also found, due to a short clivus, with a caudal descent of cerebellar tonsils, compressing the posterior surface of the medulla. As an incidental finding, a space-occupying lesion at the atlanto-axial joint was noted Figure .To better characterize this lesion, a cervical computed tomography (CT) was later performed. It demonstrated a diffuse lipomatous infiltration and enlargement of the right suboccipital, posterior paravertebral, and prevertebral muscles, and of the ipsilateral posterior cervical, submandibular, retropharyngeal, and carotid spaces. In addition, there was a periodontoid soft tissue mass, with bone remodeling of the right lateral mass of C2, the odontoid and the anterior arch of C1 and less pronounced remodeling of the clivus. These bone abnormalities were well delimited and exhibited cortical and subchondral sclerosis Figure . The lesThese imaging findings, namely the bone remodeling and sclerosis, and the stability of the changes through the different examinations suggested a process with slow growth and, therefore, a benign lesion. Its imaging features resembled those of a periodontoid pseudotumor. The patient had no symptoms related to this space-occupying lesion at the craniocervical junction, so a conservative expectant attitude was decided with clinical and imaging surveillance.Diffuse lipomatosis in one part of the body is a very rare finding in patients with tuberous sclerosis and has been previously reported only in six patients. It is observed on the lower limbs in most cases, and in the subcutaneous lumbar region and the thoracic region around the lungs -6. TheseWe hypothesized that this diffuse lipomatous infiltration of the muscles and neck spaces led to an atlanto-axial joint hypermobility with the development of a presumed periodontoid pseudotumor.Periodontoid pseudotumor reflects a non-neoplastic soft tissue mass adjacent to the odontoid process. It is caused by various mechanisms and etiologies such as rheumatoid arthritis, trauma, atlantoaxial hypermobility compensating for subaxial ankylosis, and deposition diseases . Some cases are idiopathic, but the underlying mechanism is believed to be a chronic subluxation of the atlanto-axial joint. The histology of the mass mainly reveals connective tissue and cartilage . SupportThough we do not have histologic confirmation in our case, we postulate that a periodontoid pseudotumor is the most plausible diagnosis, since it is a slowly growing extraosseous mass located around the odontoid process causing bone remodeling and sclerosis. The diffuse lipomatosis of the right neck spaces and muscles could explain an atlanto-axial subluxation and the development of an ipsilateral pseudotumor.Diffuse lipomatosis in one part of the body is a very rare finding in patients with tuberous sclerosis. Our patient was initially observed because of a slowly growing tumefaction in the right scapular region over 4 years. The first follow-up brain MRI of tuberous sclerosis revealed an incidental space-occupying lesion at the anterior atlanto-axial joint, the characteristics of which were of a periodontoid pseudotumor on both cervical CT and MRI. These imaging studies also revealed diffuse lipomatosis in the right cervical spaces and ipsilateral perivertebral muscles, leading to a probable association between these two entities.


We report a case of inflammatory myofibroblastic tumor of the bladder (IMTB) that arises from left posterior bladder wall. The IMTB usually demonstrates slight hypointensity on T1WI, heterogeneous bright hyperintensity on T2WI, hyperintensity on DWI, and no restricted diffusion on ADC map. IMTB exhibits irregular ring enhancement and scatters stripe-like enhancement in central area with progressive and persistent enhancement pattern on CE-MRI. High-contrast multisequence MRI may be a potential technique to distinguish IMTB from other bladder tumors. Although IMTs most commonly occur in the lung, they can also present in diverse extrapulmonary locations including head and neck, abdomen, pelvic cavity, retroperitoneum, trunk, and limbs. IMTs arising from the urinary system are relatively rare and mostly locate in the bladder. IMTs of the bladder (IMTB) are typically considered as benign; however, recurrences have been reported in the literatures. The diagnosis of IMTB may be delayed by non-specific clinical symptoms and laboratory tests. Therefore, preoperative identification of IMTB by imaging technique is very important for deploying the individually tailored therapies.Inflammatory myofibroblastic tumors (IMTs) are rare benign spindle cell tumors and characterized histologically by the myofibroblastic spindle cell proliferation accompanied by inflammatory cell infiltration.To our knowledge, there has been few reports focused on the correlation between imaging and pathological features. Herein, we present a case report regarding MRI characteristics of a rare IMTB and its relationship to pathological features.A 26-year-old female patient was admitted to the emergency department due to gross hematuria accompanied by urinary urgency and frequency for half a day. Routine ultrasound showed a pelvic mass. Physical examination on admission revealed no suprapubic pain or palpable abdominal mass. Routine blood examination indicated anemia and urinalysis showed an increased number of homogeneous red blood cells. Other laboratory results were unremarkable.T1-weighted images (T1WI) and mild hypointensity on T1WI with fat-suppression compared with muscle (T2-weighted images (T2WI) with fat-suppression and sagittal T2WI without fat-suppression  adhering to the left posterior bladder wall and protruding through the bladder lumen. The central area of the mass exhibited slight hyperintensity on axial h muscle , heterogpression . The maspression . The maspression . Apparen ADC map . On T1WI ADC map . The mas ADC map .The patient subsequently underwent the bladder mass resection. The specimens were collected for pathologic evaluation and results were shown in  Most IMTB patients are young adults and females are more susceptilbe than males (ratio 5:3). Hematuria is the most common clinical manifestation of IMTB that occurs in 81.3% of patients. IMTB commonly occurs in the superior wall or front wall of the bladder. IMTB usually exhibits the spindle cell proliferation and inflammatory cell infiltration, while lacks of significant necrosis, abnormal mitotic figures and cytologic atypia. The local tumor recurrence rate of IMTB after complete resection is only 4% and few distant metastases have been reported.IMTB is an extremely rare tumor and barely diagnosed in children. As previous studies reported that necrosis or cyst degeneration was rare in IMTB, there was no necrosis or cyst degeneration occurred in our case. Because the MRI features of IMTB are diverse depending on the pathological component, histopathology assessment may provide the good explanation for MRI findings of IMTB. Immunohistochemical positive findings including Vimentin, Desmin, SMA, S-100 protein and negative for CD-34 can confirm the definitive diagnosis of IMTs. Approximately 35–89% of IMTB presents with ALK-1 over-expression.IMTB can be large with a mean size of 5.5 cm due to their specific location and slow growth. MRI features of IMTB have diverse manifestations depending on the contents of mucus, fibrosis and cellular infiltration. In the central part of IMTB as our case, it may appear isointensity or slight hyperintensity on T1WI and heterogeneous bright hyperintensity on T2WI which correlates with a few spindle cells and inflammatory cells scattered in the abundant edematous mucus background. Isointensity on both T1WI and T2WI in the peripheral area can be interpreted as compact arranged spindle cells with scattered chronic inflammatory cells and many blood vessels which result in more obvious and progressive enhancement after contrast. However, IMTB most commonly occurs in young adults and most of them locate in the superior wall and front wall with no case in the bladder base. After contrast, bladder TCC usually demonstrates homogeneous or heterogeneous enhancement with peak appearing after a delay of approximately 60 sec on DCE-MRI. However, IMTB often displays ring enhancement type which may be a clue for diagnosing IMTB on DCE-MRI. Bladder TCC usually presents obvious restricted diffusion on DWI due to its high cellularity. However, no diffusion restriction occurs in IMTB because of its abundant edematous mucus background like our case. The hyperintensity of IMTB on DWI in our case can be interpreted as T2 “shine-through” effects. Bladder rhabdomyosarcomas are the most commonly-occurring solid neoplasms in children younger than 10 years. Bladder rhabdomyosarcomas most often locate in vesical trigone and bladder neck and appear as the large and nodular heterogeneous enhancement mass with evident necrosis on contrast-enhanced MRI. However, IMTB usually locates in the superior or front wall and appears as ring-shaped enhanced masses without evident necrosis. Bladder leiomyomas are rare benign tumors without risk of recurrence or metastasis. Their MR imaging features are very similar to uterine fibroids which demonstrate intermediate to low signal intensity on both T1WI and T2WI. Because IMTB has the potential of recurrence and about 60% of it has the invasion into the muscularis propria, transurethral resection of bladder tumor or partial cystectomy is recommended to prevent any recurrence. Therefore, it is important to differentiate IMTB from bladder leiomyomas before surgery to avoid inappropriate treatment. Different from bladder leiomyomas, IMTB usually demonstrates hypointensity on T1WI and heterogeneous bright hyperintensity on T2WI due to its abundant edematous mucus. Different MRI features can distinguish IMTB from bladder TCC, rhabdomyosarcoma, and leiomyomas.IMTB is generally considered to be benign with few distant metastases being reported to date. It is essential for urologist to get a correct diagnosis in order to avoid unnecessary radical surgery of bladder. Therefore, it is very important to differentiate IMTB from bladder malignant tumors such as transitional cell carcinoma (TCC) and rhabdomyosarcoma. Bladder TCC often occurs in male older than 65 years and usually occurs in the base of bladder.In conclusion, IMTB usually demonstrates hypointensity on T1WI, bright hyperintensity on T2WI, irregular ring-shaped progressive enhancement on contrast-enhanced MRI, and without diffusion restriction on ADC map. High-contrast multisequence MR imaging can accurately distinguish IMTB from other bladder tumors by identifying these MRI characteristic findings.IMTB usually appears slight hypointensity on T1WI, heterogeneous bright hyperintensity on T2WI with fat-suppression in the central area, and the mass exhibits isointensity to muscle on both T1WI and T2WI in the peripheral area.IMTB exhibits irregular ring enhancement with relatively well-defined margin and scattered stripe-like enhancement in the central area on contrast arterial phase image, and the mass exhibits progressive and persistent enhancement on venous and delayed phase images.IMTB exhibits hyperintensity on DWI due to T2 “shine-through” effects and no diffusion restriction on ADC map.