Usually, a hydatidiform mole (HM) develops inside the uterus. The occurrence of HM in ruptured tubal pregnancy is exceptional. Cases reported in the literature are scarce. In this article, a case of haemoperitoneum secondary to a ruptured fallopian tube by a complete mole is reported. A 50-year-old gravida 2, para 1 was admitted to the emergency department for acute abdominal pain. After the clinical examination, an abdominal sonography and CT scan were done, revealing the presence of an adnexal left mass associated with an important haemoperitoneum. A urine pregnancy test was done and was positive, indicating an immediate laparoscopic exploration. The laparoscopy revealed a haemoperitoneum secondary to a ruptured tubal mass. The pathological exam concluded a complete hydatidiform mole (CHM) invading the wall of the fallopian tube. Any acute abdominal pain in a potentially pregnant woman imposes first the routine realization of a pregnancy test. The occurrence of CHM in a ruptured fallopian tube is particularly rare and has exceptionally been diagnosed before the laparoscopic exploration. Gestational trophoblastic diseases (GTD) belong to a group of both benign and malignant tumors that are formed from placental tissue and include the following four formations: Placental site trophoblastic tumor, choriocarcinoma, epithelioid trophoblastic tumor, and hydatidiform mole  . The hypEctopic molar pregnancy is rare and has been reported in the fallopian tube , in the A 50-year-old gravida 2, para 1 was brought by ambulance to the general emergency department of our hospital. She reported in her history a vaginal delivery and being followed for Crohn’s disease that did not require medication for the moment. She still had periods but they were irregular and she did not use any contraception.Clinical examination revealed a distended abdomen with rebound and a maximum site of pain in the left iliac fossa. There was no abdominal guarding or rigidity. The vaginal examination revealed mild endocervical non-active bleeding. The patient was unable to provide urine on admission, explaining why the routine urine human chorionic gonadotropin (Beta hCG) test was not done before the imaging examinations.Abdominal ultrasonography showed a left adnexal mass measuring 67 × 25 mm adjacent to the left ovary presenting a scarce colour doppler flow . An abunExplorative laparoscopy was immediately performed and found a ruptured left tubal mass measuring 6 × 4 cm with a 1.5 L haemoperitoneum. Observation of the surface of the mass revealed tiny glistening cysts . Left saOn histological examination, there were chorionic villi with circumferential trophoblastic proliferation, hydropic modification, scalloped villi and karyorrhexis . The immThe post-operative period was uneventful, with return home on the first post-operative day. Because of the risk of a persistent trophoblastic disease, she was followed up by weekly serum Beta hCG until obtaining three titres less than 5 U/L and then monthly for 1 year. She was advised to use contraception and decided to use barrier methods.We choose to present this case knowing that the support has not been optimal. Immediate unavailability of urine hCG likely led to an abdominal CT scan. A posteriori, we judge that this CT scan was performed unnecessarily and did not provide any additional information, leaving the final diagnosis of mole unsuspected.Ectopic gestation is a common phenomenon with an incidence rate of 4.5–16.8/1,000 pregnancies . HM can Risk factors that increase EP susceptibility are endometriosis, cesarean section, tubal surgery, pelvic inflammatory disease, smoking, fertility treatment, intrauterine devices and variant reproductive system anatomy . HoweverEctopic molar pregnancy is rather scarce and this has prevented the determination of definite risk factors. In molar pregnancy, the principal risk factors are a history of GTD and higher maternal age . A retroIf the patient is symptomatic, she will mostly present abdominal pain and/or vaginal bleeding. Before any complementary imagery exploration, the realization of a urine pregnancy test is fundamental to orient the diagnosis to involving a possible pregnancy. Ultrasonography by its availability and low cost is the first choice. Nevertheless, the characteristic Swiss cheese or snowstorm pattern is rarely encountered. In most cases, a specific heterogenous, hypoechoic solid mass with cystic spaces is observed. The diagnosis is sometimes suggested intraoperatively by the presence of glistening vesicles on the surface of the tumour.One experience of more than 1,000 cases from a regional referral centre suggests that ultrasonography identifies less than 50% of intra uterine HM ; but we HM is the consequence of a placental malformation due to genetic anomalies, producing cystic swelling and trophoblastic proliferation. In CHM, a diploid paternal genome is present after the fertilization of an empty ovum by a divided haploid spermatozoon. In a partial mole, a triploid genome is present after a dispermic fertilization of a haploid ovum. Beta hCG levels are not useful in differentiating between molar and non-molar ectopic pregnancies . HistopaSebire et al. compared molar products of conception from uterine curettage and fallopian tube pregnancies and described in some cases a greater degree of extra villous trophoblastic proliferation in ectopic gestation, inducing a risk of over-diagnosis .In a haemodynamically stable patient, laparoscopy is preferable to laparotomy in view of the shorter hospital stay and faster convalescence. For reasons specific to our centre, we prefer salpingostomy to salpingectomy, knowing that in terms of fertility there is no significant gain in keeping the tube. In our case, the rupture of the fallopian tube justified the salpingectomy. In the case of an occult and unruptured ectopic pregnancy, we would probably have opted for a salpingostomy, with the risk of leaving molar material in the fallopian tube. Reading the literature, we find a case of partial HM successfully managed solely by salpingostomy. The question of a possible need for a second intervention to perform a salpingectomy vs. expectation remains open. It is important to note that the reported rate of rupture and haemoperitoneum is 67% in cases of ectopic molar pregnancy in comparison to 25%–30% in cases of non-molar ectopic pregnancy .It is assumed that the malignant potential of an ectopic molar pregnancy is similar to that of an intrauterine molar pregnancy . The risRegarding future fertility, a meta-analysis by Capozzi et al., indicates that there is a significant difference in the rate of live births between complete and partial moles. Patients with complete moles had an increased live birth rate compared to patients after a partial mole pregnancy .However, the occurrence of stillbirths, ectopic pregnancies, preterm birth and miscarriages didn’t show any significant difference between the two groups . The afoClinical examination combined with ultrasound performs poorly in the preoperative detection of intrauterine or extrauterine moles. Histopathological examination remains the gold standard for making the diagnosis of mole for any product of conception.


A surgical endoclip in the cystic pedicle rarely migrates to the duodenum and is considered a rare complication of laparoscopic cholecystectomy. Duodenal adenocarcinoma endoscopically mimicking a foreign body granuloma in the background of postcholecystectomy endoclip migration has never been reported before.A 53-year-old Indian male presented with progressive weakness and melena for the last three months. He underwent laparoscopic cholecystectomy a year ago with an uneventful clinical course and post-operative recovery. A complete hemogram revealed hemoglobin of 4.5g/dL. Upper gastrointestinal endoscopy revealed a large necrotic polypoidal mass arising from the lateral wall of the first part of the duodenum. Contrast-enhanced computed tomography (CT) of the abdomen showed an impacted surgical clip into the lateral wall of the first part of the duodenum. Intraluminal extension of the surgical clip was not appreciated in the imaging. We suspected the diagnosis to be foreign body granuloma in the duodenal wall. He underwent open duodenal wedge resection. Microscopic evaluation of resected specimens revealed poorly differentiated adenocarcinoma. All the resection margins were free. He had an uneventful recovery and was discharged on the seventh post-op day. He was symptom-free and doing well on follow-up at 12 months.The purpose of reporting the case was to make the readers aware of the delayed massive upper gastrointestinal hemorrhage as a rare complication of endoclip migration (ECM) post laparoscopic cholecystectomy. In our case, the duodenal adenocarcinoma mimicked a foreign body granuloma endoscopically, and hence a possibility of duodenal adenocarcinoma as a potential delayed complication of ECM cannot be ruled out.Although rare, in case of upper gastrointestinal hemorrhage in the background of the previous history of laparoscopic cholecystectomy, endoclip migration should be kept as a differential diagnosis. Laparoscopic cholecystectomy (LC) is performed worldwide for symptomatic cholelithiasis. A surgical endoclip in the cystic pedicle rarely migrates to the duodenum and is considered a rare complication of LC. These endoclips can erode the duodenal wall giving rise to ulcers that cause upper gastrointestinal bleed . Herein,A 53-year-old Indian male presented with a progressive weakness for the last three months, which started with one episode of the passage of dark tarry stool, which was not associated with abdominal pain, jaundice, vomiting, fever, or weight loss. He did not have any history of alcohol abuse. He was diabetic and hypertensive for the last five years and took medication for the same. He underwent laparoscopic cholecystectomy for symptomatic gallstone disease a year ago with an uneventful clinical course and post-operative recovery. Further details of the procedure were not available.Physical examination revealed pallor, tachycardia (pulse rate: 110/min), and hypotension (100/60 mmHg). A complete hemogram revealed hemoglobin of 4.5g/dL. Other biochemical investigations such as liver function tests, serum electrolytes, serum amylase, and lipase were within normal limits. Initial resuscitation was done with 4 units of packed cells. Post-transfusion, hemoglobin was 10.2 g/dL. Ultrasonography of the abdomen was unremarkable. Esophagogastroduodenoscopy revealed a large necrotic polypoidal mass arising from the lateral wall of the first part of the duodenum, with no evidence of ulcer or active bleed Figure . EndoscoLaparoscopic cholecystectomy (LC) remains the gold standard and widely accepted treatment modality for symptomatic gallstone disease. Endoclips are used in LC for controlling the cystic duct and cystic artery and are reasonably safe and effective. On some rare occasions, they may migrate to cause several complications, such as choledocholithiasis, acute pancreatitis, cholangitis, choledochoduodenal fistula, hepatolithiasis, bile leak, biliary stricture, duodenal ulcer, clip embolism, and sepsis -5. This The purpose of reporting the case was to make the readers aware of duodenal adenocarcinoma endoscopically mimicking a foreign body granuloma in the background of postcholecystectomy endoclip migration. Hence, the possibility of duodenal adenocarcinoma as a potential delayed complication of ECM cannot be ruled out. Further studies are required to establish this.Moreover, we couldn't possibly be sure whether there was a coexisting duodenal adenocarcinoma at the time of evaluation. There was no way we could have preoperatively diagnosed this sinister pathology, given the clinical context. Having said that, a high index of clinical suspicion should be there to look for malignancy in the gastrointestinal tract when an adult/elderly patient presents with anemia. Although rare, in case of upper gastrointestinal hemorrhage in the background of the previous history of laparoscopic cholecystectomy, endoclip migration should be kept as a differential diagnosis. Moreover, malignancy should be ruled out by histopathological evaluation before labelling it as foreign body granuloma. A sinister pathology like this can be easily missed unless looked for extensively in all cases of anaemia in an adult or elderly patient.


Intralesional T1w hyperintensities were either homogenously distributed throughout the entire lesion (6/12) or had a rim-like peripheral distribution (6/12). The mean time between the recorded onset of clinical signs and MRI assessment was 3 days; however, the age range of lesions with T1w hyperintense signal observed was 1–21days, suggesting that such signal intensities can be observed in acute, subacute, or chronic stages of ischemic stroke. Follow-up was recorded for 7/12 cases, all of which showed evidence of neurological improvement while in hospital, and survived to discharge. Correlation of the age and MRI appearance of lesions in this study with similar lesions observed in human and experimental studies suggests that these T1w hyperintensities are likely caused by partial tissue infarction or selective neuronal necrosis, providing an alternative differential for these T1w hyperintensities observed.Magnetic resonance imaging (MRI) signal changes associated with ischemic stroke are typically described as T2w and FLAIR hyperintense, and T1w isointense lesions. Intralesional T1w hyperintensity is generally attributed to either a hemorrhagic stroke, or an ischemic stroke with hemorrhagic transition, and has an associated signal void on gradient echo (GE) sequences. Cases of ischemic stroke with T1w hyperintense signal in absence of associated signal void on GE sequences have been sporadically demonstrated in human stroke patients, as well as in dogs with experimentally induced ischemia of the middle cerebral artery. This multicenter retrospective descriptive study investigates the presence of T1w hyperintensity in canine stroke without associated signal void on GE sequences. High field (1.5 Tesla) MRI studies of 12 dogs with clinical presentation, MRI features, and cerebrospinal fluid results suggestive of non-hemorrhagic stroke were assessed. The time between the observed onset of clinical signs and MRI assessment was recorded. All 12 patients had an intralesional T1w hyperintense signal compared to gray and white matter, and absence of signal void on T2 Hemorrhagic strokes result from rupture of a vessel supplying the brain parenchyma, whereas ischemic strokes result from occlusion of these vessels –3. In isansition .*w gradient echo or susceptibility-weighted imaging sequences (SWI)  , 10–12.*w GE or susceptibility-weighted imaging (SWI) sequences have been sporadically demonstrated in human stroke patients , Ars Veterinaria Hospital , and Vet Oracle Teleradiology service. Due to the non-invasive and retrospective nature of this study, ethics approval was not necessary; however, consent for the use of data was obtained for all patients. Databases were searched for dogs undergoing MRI of the brain for a suspected stroke between 2013 and 2021, using keywords “stroke,” “cerebrovascular accident,” and “CVA.”*w gradient echo sequence such as T2*w FGE or SWI. In addition, analysis of T1w post-contrast images (IV injection of 0.1 mmol of gadolinomide/kg of body weight), fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging (DWI) were analyzed when available. The MRI diagnosis of presumed brain infarction was made on the basis of imaging criteria previously described in dogs , presenting clinical signs, and physical and neurological examination findings, as performed by the attending veterinary neurologists were recorded for each case.The onset of clinical signs was recorded from the clinical notes, and the time from the onset of clinical signs to MRI was documented where available. For the purpose of this study, lesions were dated according to the timings between the observed onset of clinical signs and the MRI assessment. Categories included early hyperacute 0 ≤ 6 h), late hyperacute (6 ≤ 24 h), acute (24 h ≤ 1 week), subacute (1 ≤ 3 weeks), and chronic (>3 weeks) , mentation , behavior , posture , gait  and limb(s) affected, proprioception , vision , presence of cranial nerve abnormalities  and side(s) affected, hyperesthesia (yes/no), and further vestibular anomalies .TM IDEXX Europe B.V., Hoofed drop, The Netherlands) results were assessed, and dogs with a positive result were excluded from the analysis.Cerebrospinal fluid (CSF) analysis and infectious disease analysis available were recorded. CSF findings suggestive of stroke included normal analysis results, or increased protein concentration, mild neutrophilic or mononuclear pleocytosis [30 cells/mL], xanthochromia, and hemosiderosis , 24. DogAnesthetic protocols were tailored to individual dogs by the attending anesthetist. MRI protocols and sequences varied between institutions, but all MRI examinations were completed with dogs under general anesthesia, using high-field-strength magnets: 1.5 Tesla .The MRI studies were reviewed by a European College of Veterinary Diagnostic Imaging board-certified veterinary radiologist (I.C.), and a third-year veterinary radiology resident (P.W.), on DICOM viewing software . Reviewers were aware of the history, patient signalment, clinical, and neurological examination findings. Images were reviewed individually followed by consensus evaluation.*w GE, sequences, (b) appearance of lesion on T1w and T2w (heterogenous/homogeneous), (c) lesion margination (poorly defined/moderate/well-defined), (d) presence of contrast enhancement (none/mild/moderate/severe), (e) pattern of contrast enhancement , (f) presence of perilesional edema [none/perilesional (<10 mm)/extensive (>10 mm)], (g) associated mass effect  , hydrocephalus, or (h) presence of parenchymal atrophy (none/mild/moderate/severe). Signal intensity on diffusion-weighted imaging (DWI) and ADC values was recorded where available. Imaging characteristics as described are summarized in On the basis of the MRI findings, infarcts were classified for each dog as (1) location within the brain  and (2) infarct type . Territorial infarcts were defined as infarcts occupying the vascular territory of one of the main arteries of the brain. Lacunar infarcts were defined as subcortical infarcts limited to the vascular territory of an intraparenchymal superficial or deep perforating artery, and watershed infarcts were defined as an infarct in the boundary zone between large artery territories . 3) Vas Vas3). FData regarding treatment protocols were recorded for each patient. Survival was defined as the time from imaging diagnosis (MRI scan). Follow-up assessment was obtained from medical records where available.*w GE or SWI sequences , generalized seizures (4/12), collapse (2), unilateral blindness (2), and gait abnormalities (1). As detailed in The exact time between the onset of clinical signs observed and the MRI assessment was recorded in 7/12 patients. All remaining (5/12) patients were scanned within 1 week of the onset of clinical signs. The mean time between the MRI scan and observed onset of clinical signs in this patient cohort was 3 days, with a range of 24 h to 21 days. As defined above, at the time of MRI scan, 9/12 patients had acute stroke, 2/12 had chronic stroke, and 1/12 had a subacute lesion. An example of the MRI sequence parameters used is provided in Upon MRI examination, all patients had a solitary lesion confined to the anatomical territory of a cerebral or cerebellar artery, and all lesions predominantly affected gray matter (12/12). These included 6/12 territorial lesions centered on territories of the middle cerebral (3), rostral cerebellar (2), and caudal cerebral arteries (1), alongside 6/12 lacunar infarcts centered on the irrigated region if the caudal perforating (3), lateral striate (2), and proximal perforating (1) arteries. Examples of such lesions are demonstrated in *w or SWI sequences. All lesions (12/12) were T1w hyperintense relative to both gray and white matter. When T1w signal hyperintensity was graded in comparison with the basal ganglia, 4/12 were described as mild, 6/12 moderate, and 2/12 severely T1w hyperintense. In terms of chronicity, the lesions with mild T1w hyperintensity were both acute (3) and subacute (1). Of the six (6/12) with a moderate T1w signal, 5/12 of these patients had acute lesions, and 1/12 had a chronic lesion. The severe T1w hyperintense signal noted in 2/12 was both acute (1) and chronic (1) in nature. In a large proportion of cases (6/12), the T1w hyperintense signal was distributed throughout the lesion, with a homogeneous (5/12) or heterogeneous pattern (1/12). Interestingly, in 6/12 cases, the observed T1w hyperintense signal had an almost linear, peripheral distribution, with a T1w hyperintense-isointense center. This was circumferential in three cases of lacunar infarction, located in the rostral thalamus, tegmentum, and caudate nucleus. In three cases of stroke of the middle cerebral artery, peripheral T1w hyperintensities were noted along the overlying cerebral cortices. In two of these cases, this most severely affected the outermost aspect of the cerebral cortex, in particular along the sylvian gyrus, marginal sulcus, and pseudosylvian fissure of the temporal and parietal lobes. In the third case, the peripheral T1w hyperintensity was most severe along the innermost cortex adjacent to the right pseudosylvian fissure, with a mild and heterogeneous T1w hyperintense signal throughout the remainder of the lesion.All lesions (12/12) were homogeneously T2w and FLAIR hyperintense relative to both gray and white matter, and none had appreciable signal void on T2DWI sequences and apparent diffusion coefficient (ADC) maps were acquired in 7/12 cases. In 3/7 cases, lesions were hyperintense on DWI and hypointense on ADC, suggestive of restrictive diffusion. All of these lesions were acute in nature, corresponding with predominant cytotoxic edema seen in acute stages of infarction. Three (3/7) cases had lesions that were DWI hyperintense and ADC isointense relative to the contralateral gray matter, and these lesions were defined as acute (<1 week), subacute (8 days), and chronic (20 days) which may suggest an early stage of pseudonormalization, which is typically observed from 4 to 10 days of the ischemic event, secondary to cell lysis and subsequent facilitative diffusion . One was poorly defined due to extensive perilesional edema which extended into the surrounding white matter of the corona radiata and internal capsule. The second poorly defined lesion was centered on the caudate nucleus and, again, had a moderate amount of perilesional edema noted on FLAIR sequences. Mild perilesional edema was affecting four further lesions. The majority of cases had no associated mass effect (9/12). Three (3/12) cases exhibited mild mass attributable to the presence of perilesional edema, resulting in midline shift of the falx cerebri and mesencephalic aqueduct (2), and mild ventral compression of the left lateral ventricle (1). Parenchymal atrophy was not observed in any case.*w GE or SWI sequences. One was in the territory of the left caudal perforating artery  and the other in the right caudate nucleus. Neither of these concurrent lesions documented clinical signs attributable to their location, hence were presumed to be incidental findings at the time of image evaluation and at the time of image review.Two cases had concomitant, likely chronic infarcts, appearing as small, discrete foci that were T2w hyperintense and T1w isointense to gray matter, with no contrast enhancement, perilesional edema, or signal void on T2Supportive treatment was provided to the majority of cases (7/12) which included aspirin (3) and clopidogrel (2), omeprazole (1), and anti-epileptic drugs, (1) while 5/12 had no treatment documented. The latter five cases showed initial neurological improvement while hospitalized, however, were subsequently lost to follow-up. The remaining 7/12 survived to discharge with clinical and neurological improvement documented in the medical records. Of these, further follow-up obtained in three cases showed resolution of neurological signs at 7 days (1), 1 month (1), and 1 year (1).*w GE or SWI sequences. This characteristic has been documented in human stroke patients , or a more linear T1w hyperintensity was observed at the periphery of the lesion (6/12). This variation was observed in both lacunar (3/6) and territorial (3/6) lesions. The distribution of T1w hyperintense signal may reflect the inherent tissue susceptibility to hypoxia, or perfusion dynamics observed in ischemic stroke lesions , and cortical laminar necrosis (CLN) , 29, 32.The age of the lesions in our study also reflects temporal changes reported in studies of partial infarction and SNN. Histopathological studies in rats have demonstrated partial infarction to occur within 12 h following brief 10–25 min) occlusion of the middle cerebral artery , whereas min occlOstensibly, the presence of CLN could explain the peripheral T1w hyperintense signal observed in 3/6 cortical lesions of this study. Cortical laminar necrosis is a more specific subtype of infarction seen after global or focal ischemia that affects the cerebral cortex. It is a selective polioencephalomalacia occurring in response to transient or partial hypoxia or hypoglycemia, leading to necrosis of more metabolically active regions throughout cortical layers 3 and 5 , 41, 42.*w MRI may oppose this theory of intralesional mineralization  can be found in the article/supplementary material.Ethical review and approval was not required for the animal study because this study is retrospective in nature, hence all procedures performed were for diagnostic or therapeutic purposes deemed necessary by the handling clinician at the time of presentation. Furthermore, consent was obtained from each owner for the use of the patients images and medical records in research studies upon admission of the patient. Written informed consent was obtained from the owners for the participation of their animals in this study.IC conceived of the presented idea. PW and IC performed the image evaluation. PW wrote the manuscript. All authors contributed to the article and approved the submitted version.Linnaeus Veterinary Limited supported the costs of the Open Access Publication Charges.Authors PW, SB, and IC were employed by Linnaeus Veterinary Ltd. The remaining 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.


Retroperitoneal fibrosis is a rare disease with a largely unknown aetiology, varying presentation, and is characterized by fibrous tissue formation in the retroperitoneal region. It causes entrapment and obstruction of retroperitoneal tubular structures, notably the ureters, and has been associated with autoimmune disorders.We report a 52-year-old male who was admitted to the emergency department with a seven-day history of lower abdominal pain, anorexia, and unintentional weight loss. Routine blood work revealed the patient to have acute kidney injury, and an unenhanced computed tomography scan of the abdomen showed bilateral hydronephrosis  caused by a soft tissue mass in the retroperitoneal region. This mass was investigated with further imaging and a core biopsy, which confirmed retroperitoneal fibrosis.He is currently being planned for ureterolysis after a poor response to steroid therapy under the nephrology team. Urinary diversion was achieved with bilateral nephrostomies following unsatisfactory drainage with bilateral ureteric stents. This case highlights some of the difficulties that may be encountered in the management of retroperitoneal fibrosis. Retroperitoneal fibrosis is a rare disease characterized by the formation of fibrous tissue in the retroperitoneal region, chiefly around the anterior fourth and fifth lumbar vertebrae . It is lFirst described in 1905 by Albarran , it causRetroperitoneal fibrosis has frequently been associated with autoimmune disorders, with a small percentage occurring in metastatic disease . This haHistory and examination findingsA 52-year-old male who was admitted to the emergency department with a seven-day history of lower abdominal pain, anorexia, and a two-month history of left hemiscrotal swelling and pain. The patient was previously in a steady state of health save for the left hemiscrotal swelling, for which his general practitioner had prescribed some antibiotics on suspicion of orchitis. He reported a noticeable reduction in scrotal size and pain; however, following completion of prescribed antibiotics, he noticed a rebound in the scrotal size with worsening lower abdominal pain.Lower abdominal pain was associated with anorexia and unintentional weight loss of about 3kg over three months. He reported normal bowel opening, albeit small volume. There was no history of fevers or vomiting. No dysuria, abnormal penile discharge, or haematuria, and he also reported no history of trauma to the abdomen.The patient had no significant past medical history. An ex-smoker with over 20 pack years and a World Health Organization (WHO) performance status of zero. A general exam revealed a middle-aged man in no apparent distress. An abdominal exam showed a flat abdomen, soft and non-tender to palpation, and hard stools in his rectum. A urogenital exam revealed a cystic, non-tender left hemiscrotal swelling.InvestigationsFull blood count and testicular tumor markers were unremarkable; however, ultrasound of the scrotum showed left-sided hydrocele, and kidney function revealed an estimated glomerular filtration rate (eGFR) of 12ml/min and creatinine of 465 umol/L.Following this finding of acute kidney injury, which wasn’t present in his previous blood tests less than a month ago, an urgent unenhanced computed tomography scan of the kidneys, ureters, and bladder (CT KUB) was performed, which showed a large lobulated soft tissue mass seen superiorly at about the level of the distal abdominal aortic bifurcation and extending inferiorly and posteriorly into the deep pelvis to below the sacroiliac joints Figure . The lefThese findings prompted urgent review and admission to the urology team.Further down his care, he had a core biopsy of the retroperitoneal mass which confirmed retroperitoneal fibrosis Figure . The IgGTreatmentThe patient was reviewed in the emergency department and informed of the investigation findings. This showed acute kidney injury with significant left-sided hydronephrosis (grade 3) due to obstruction from a retroperitoneal mass. He consented and underwent an urgent left ureteric double J stent insertion. Intra-operatively he was noted to have a very tight left ureter with a distended duplex collecting system. Multiple attempts at cannulating the ureter were unsuccessful with a 6.26Fr ureteric catheter; however, the superior duplex moiety was successfully cannulated with a 4.8Fr multi-length double J stent.The patient was discussed at the urology multi-disciplinary team (MDT) meeting on account of his poor kidney function despite left ureteric stent in situ and admitting scan findings. A review of previous unenhanced computed tomography scans of kidneys, ureters, and bladder showed bilateral hydronephrosis Figure , and thePost MDT recommendation, the patient consented to a right ureteric stent insertion and left ureteric stent exchange. Intra-operative findings showed a right duplex collecting system as well, and 6.26Fr ureteric double J stents were inserted bilaterally. Post insertion of bilateral ureteric stents, the patient’s kidney function was not improving significantly, and an ultrasound scan reaffirmed the presence of bilateral hydronephrosis, grades 1 and 3 on the right and left kidneys, respectively. He subsequently had a left nephrostomy inserted Figure  which leHe was discharged home and scheduled for a re-discussion at our MDT meeting, following which he would be informed of the outcome. The outcome of the discussion was for referral to a tertiary center for a CT-guided biopsy; however, he was soon hospitalized on account of worsening dyselectrolytemia  and poor urine output, which required continuous venovenous haemofiltration (CVVH) in the intensive care unit. He improved with CVVH and was transferred to a tertiary center, where he had a right nephrostomy inserted, and a biopsy of his retroperitoneal mass was done. The biopsy confirmed idiopathic retroperitoneal fibrosis Figure  with IgGOutcome and follow-upThe patient remains well and reports normal appetite and energy levels. Nonetheless, he is struggling with the care of the bilateral nephrostomies and is keen to get rid of them. Comparatively, the right nephrostomy has always drained more than the left and currently produces about 100mls/hr of urine on average, while the left produces about 200mls/24hrs. His eGFR seems to be plateauing around just over 30mls/min, which, albeit a significant improvement from his first presentation, leaves him rather disappointed as he had hoped for a return to pre-admission levels. A discussion of his biopsy result was had, which reassuringly did not show any IgG4-related disease, even though the levels were slightly above the normal range.He is planned for an interval removal of the nephrostomy catheters whilst retaining bilateral ureteric stents to improve his quality of life, and these ureteric stents will undergo routine exchange when due. He has also undergone steroid therapy but evidence has suggested poor response, and thus he is planned for ureterolysis.Retroperitoneal fibrosis is an uncommon disease condition with an estimated annual incidence of one per 200,000-500,000 population . It presents a unique diagnostic challenge and this is due to a handful of reasons. Firstly, its rarity puts it on the tail end of differentials; secondly, its clinical presentation is non-specific, thirdly, many cases occur as incidental findings on imaging and lastly, confirmation is invasive, requiring biopsy.The clinical presentation of retroperitoneal fibrosis ranges from flank or abdominal pain to constitutional symptoms like anorexia and weight loss, all of which the index patient presented with. It has also been described to coexist with other pathologies such as hydrocele , which tManagement of patients with retroperitoneal fibrosis is a multi-pronged endeavor, which is geared at relieving symptoms, preserving renal function, and exclusion of secondary causes, including malignancy. Treatment is dependent on the stage of disease at diagnosis, and could be medical or surgical. Because the common clinical presentation would include abdominal or flank pain, and often kidney injury from ureteric obstruction (obstructive uropathy), interventions targeted at these are often pursued early during treatment. Ureteric obstruction can be amenable to both medical and surgical therapy; however, the latter often results in quicker resolution of symptoms. Surgical therapy could be in the form of temporizing maneuvers such as percutaneous nephrostomy or ureteric stent insertion Figure , both ofThere is no consensus on medical therapy for retroperitoneal fibrosis as there is a lack of controlled therapeutic trials to reach that consensus; however, steroids and other immuno-modulators are used . FollowiLearning pointsThe justification for this paper hinged on the rarity of retroperitoneal fibrosis; however, we also sought to highlight some of the difficulties that may ensue in its management. To achieve adequate treatment of such a case, one must first diagnose the patient; however, due to its non-specific clinical presentation, there’s usually a low index of suspicion, which may lead to a delay in its diagnosis. Finally, we would like to highlight the different approaches in the management of retroperitoneal fibrosis, which include both medical and surgical interventions, as demonstrated in this paper.Managing retroperitoneal fibrosis can be very challenging for all parties involved, patients and clinicians alike. As has been demonstrated in the index case, it requires a multi-facet approach, including medical, surgical, and other interventional measures which may not be locally available. This may necessitate multiple visits to different hospitals with the attendant consequences therefrom.


Ectopic pancreas refers to the presence of pancreatic tissue in an unusual anatomical location that has neither anatomic nor vascular continuity with the pancreas. Adenocarcinoma of an ectopic pancreas is rare; only few cases have been described in the literature.We reported a 69-year-old man who was admitted to the emergency department with feculent vomiting lasting two days prior to presentation. Endoscopy revealed pyloric stenosis. Biopsies performed during gastroscopy were in keeping with duodenal cancer, while those performed during endoscopic ultrasound suggested a gastric tumor.A subtotal gastrectomy was done because of results of the extemporaneous analysis and the suspicion of a gastric cancer. The final histopathological report revealed adenocarcinoma of an ectopic pancreas.Malignant transformation of an ectopic pancreas is very rare, and often occurs as an adenocarcinoma. A differential diagnosis of a gastric adenocarcinoma and a gastrointestinal stromal tumor is essential before treatment.Outcome and a literature review of the pathology, prognosis, and treatment will be discussed.Despite adenocarcinoma of an ectopic pancreas being rare, it should be considered as a differential diagnosis of submucosal tumors. The standard treatment for ectopic pancreatic adenocarcinoma is surgery, with a higher survival rate of 5 years compared to pancreatic cancer. Frozen section analysis is essential because it will give an idea on the origin of the neoplasia and allow adaptation of the surgical procedure. •This case report describes a case of adenocarcinoma of ectopic pancreas.•Malignant transformation of the aberrant pancreas is very rare.•Partial gastrectomy and duodenectomy of D1 was performed and sample sent for extemporaneous analysis.•The standard treatment for ectopic pancreatic adenocarcinoma is surgery. This work has been reported in line with the SCARE 2020 criteria 1An ectopic or aberrant pancreas refers to the presence of pancreatic tissue in an unusual anatomical location that has neither anatomic nor vascular continuity with the pancreas. It was first described in 1729 by Jean Schultz and later studied in 1970 by Potet and Duclert Majority of patients are asymptomatic. The reported incidence of ectopic pancreas in autopsy studies was 1 to 14%; it is encountered in one out of 500 abdominal surgeries Malignant transformation of the aberrant pancreas is very rare. Its incidence is about 0.4% among all cases Herein, we discuss patient outcomes with a literature review of the pathology, prognosis, and management of ectopic pancreatic adenocarcinoma.This work has been reported in line with the SCARE 2020 criteria 2A 69-year-old man was rushed to the emergency department with feculent vomiting lasting two days. Past medical history included appendicular peritonitis, coronary bypass surgery (a couple of months before), hypertension, chronic renal failure, hypercholesterolemia, and insulin-dependent diabetes.Vomiting occurred day and night without abdominal pain, with several months of eructation and burping; surprisingly, appetite was preserved.Vital signs were normal; the patient's abdomen was soft and painless.Blood analysis showed impaired renal function with creatinine of 1.8 mg/dL and C-reactive protein of 19.1 mg/L.Due to chronic renal failure, a non-contrast abdominal CT was performed, which showed a distended stomach without any duodenal or intestinal abnormality. However, an infrarenal abdominal aortic aneurysm with a diameter > 3 cm was discovered.The patient was hospitalized to complete investigations. He was placed on nil-per-os with parenteral nutrition, rehydration, high-dose proton pump inhibitors (PPI), and a nasogastric tube.Upper gastrointestinal series showed severe pyloric stenosis with absent gastric emptying. We therefore decided to perform gastroscopy with biopsies. The pyloric stenosis was widened by passage of the endoscope. No lesion or ulcer was visualized. Biopsies were performed and analyzed at our hospital's laboratory; well-differentiated duodenal adenocarcinoma was considered. To complete the assessment, we decided to carry out an echo-endoscopy, and the biopsy highly indicated an antro-pyloric adenocarcinoma. At this stage, new biopsies were performed and analyzed in an external laboratory that suspected infiltration of the gastric wall by a large intestinal adenocarcinoma.The tumor markers, carcinoembryonic antigen (CEA) and carbohydrate antigen 19–9 (CA 19.9) were within normal range.A PET-CT performed to exclude any metastatic lesion showed a very suspicious abdominal mass in the pyloric region , withoutFollowing this assessment, the case was discussed in a multidisciplinary meeting and surgical exploration was thus decided upon.Intraoperatively, exploration of the abdominal cavity revealed no ascites, suspicious liver lesion, peritoneal carcinosis, invasion of the root of the mesentery, or suspicious adenopathy. However, we were immediately struck by the adhesions (which could be explained by the history of appendicular peritonitis) present at the level of the vesicular hilum, with palpation of a mass at this level. Due to the numerous adhesions, we decided to perform a partial gastrectomy and duodenectomy of D1 to resect and analyze the lesion described in the preoperative workup, and also facilitate visualization and subsequent curage of the celiac trunk and hepatic pedicle. This specimen was sent for extemporaneous analysis.However, we finally opted for a subtotal gastrectomy with a D2 lymphadenectomy without splenectomy following the extemporaneous results that described a probable gastric neoplasia . A seconThe final histopathological analysis described an adenocarcinoma arising in an ectopic pancreas within the stomach wall . ResectiTwenty-two months postoperatively, recurrence occurred in form of pulmonary metastases that were suspected on CT scan and confirmed by biopsy after endobronchial ultrasound. A new chemotherapy cycle was commenced with Gemcitabine and Abraxane (Protein-bound Paclitaxel). Four year later, the lung nodules were stable. Abraxane was stopped due to stable lesions and poor patient tolerance.3Ectopic or aberrant pancreas was first described in 1729 by Jean Schultz Patients diagnosed with pancreatic rest are mostly asymptomatic; however, they can present with abdominal pain, bloating, gastrointestinal bleeding, intestinal obstruction or even pancreatitis.Differential diagnosis is to be made between a gastric adenocarcinoma (because of its location) and a GIST  While ectopic pancreas may be detected with an enhanced CT scan, if a submucosal lesion is noted on upper endoscopy, an endoscopic ultrasound with biopsy is strongly recommended for further evaluation as small lesions can pass unnoticed on the CT scan Guillou et al. The prognosis of ectopic pancreatic adenocarcinoma is generally favorable; as seen in cases described in the literature, it seemed to show a slightly higher survival rate than orthotopic pancreatic adenocarcinoma. This could be explained by the fact that adenocarcinoma of an aberrant pancreas is more quickly symptomatic, especially when the lesion is greater than 1.5 cm The management strategy of pancreatic rest should be guided by symptomatology and suspicion of malignancy. While asymptomatic lesions can be followed up, even though some authors recommend resection [14]Endoscopic resection of submucosal lesions has risk of perforation and bleeding, and should be carefully performed only when the mass is accessible In ectopic pancreata, it would seem that limited resection with healthy margins is sufficient; however, no recommendations could be established due to the rarity of such cases.Given the very limited number of cases of ectopic pancreatic adenocarcinoma in the literature, it is very difficult to make recommendations regarding the benefit of adjuvant or systemic chemotherapy in these situations; however, it appears that management, not only surgical but also medical, is parallel to the management of adenocarcinoma of the pancreas In cases of resectable tumors, the first surgery seems to be the reference and is followed by chemotherapy, often with gemcitabine, in case of positive lymph node, as was the case in our patient. In case of metastatic tumors, gemcitabine remains the reference chemotherapy, based on studies which included patients with metastatic and locally advanced tumors. For benefit of neoadjuvant chemotherapy, randomized trials are underway to evaluate its value 4The incidence of ectopic pancreas is low and its diagnosis is difficult but should be considered as a differential diagnosis of upper gastrointestinal submucosal lesions.This clinical case illustrates the difficulty of establishing the diagnosis of such lesions.The standard treatment for ectopic pancreatic adenocarcinoma is surgery with a higher survival rate of 5 years compared to pancreas cancer. Frozen section analysis is essential for deciding extent of surgery.Not commissioned, externally peer-reviewed.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.N/AWritten informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.N/AMansvelt Baudouin.KM: Conceived, coordinated and designed of the study. Write the manuscript. Took care of the patient.MG: Took care of the patient in the emergency service and performed the surgery.DT: Took care of the patient in the emergency service until before surgery.MB: Took care of the patient in the emergency service and performed the surgery.All authors disclose no financial and personal relationships with other people or organizations that could inappropriately influence (bias) this work.The authors declare no conflict of interest.


In most cases, it is not difficult to differentiate common left ventricular (LV) cardiac myxomas from fibromas because they are different disease entities and have different imaging findings. Herein, we present a case of a tumor with histological characteristics of a LV cardiac myxoma even though its imaging and macroscopical views were similar to that of fibroma.A 65-year-old woman was admitted to the hospital with chest tightness and palpitations which persisted for 2 years. Transthoracic echocardiogram and transesophageal echocardiography revealed a 23 mm × 8 mm, polyp-like-shaped, homogeneous, firm, solitary, mobile and solitary LV mass, which protruded into the left atrium during systole, resulting in mild mitral regurgitation. LV contrast-enhanced echocardiography revealed that there was little contrast agent filling in the LV mass. To further clarify the nature of the mass, non-enhanced and contrast-enhanced coronary computed tomography (CT) angiograms showed a 19 mm × 8 mm relatively homogeneous low density with punctate calcifications mass and no significant enhancement. Thus, we preoperatively diagnosed her condition as a LV fibroma and performed excision of the tumor under cardiopulmonary by-pass by using port-access approach through right mini-thoracotomy. The postoperative pathological diagnosis of the tumor was in fact a LV myxoma.LV cardiac myxomas mimicking fibroma makes diagnosis difficult, and sonographers should be aware of this imaging changes. Myxomas are the most common benign tumor of the heart, about 72% to 92% of myxomas are located in the left atrium , 2. LeftTheir early diagnosis is difficult since the symptoms and signs may be nonspecific, and symptomatic patients may present with a wide range of symptoms, including chest pains, palpitations, episodes of syncope, or nonspecific discomfort .In general, there is little confusion in differentiation of LV cardiac myxomas and fibromas as they have different imaging manifestations , 7. In tA 65-year-old woman was admitted to the hospital with chest tightness and palpitations which persisted for 2 years. The patient had a free past medical history, and denied any other relevant personal or family history. In physical examination, there were no remarkable signs, and her vital signs were normal. And, there was no hematological and biochemical disorders. The levels of tumor biomarkers were normal.Transthoracic echocardiogram (TTE) revealed a 23 mm × 8 mm mass which was polyp-like-shaped, homogeneous, firm, mobile and solitary Fig. A. FurtheExcision of the tumor under cardiopulmonary bypass was performed adopting a port-access approach through the right mini-thoracotomy. After incision of the left atrium, no thrombosis was detected. Then the mitral valve was pulled open, and a mass of gray-white, firm, polyp-like, was seen. The tumor was connected to the posterior wall of the LV and did not invade the heart muscle, and was completely excised with an adequate margin of endocardium Fig. A. After After tumor removal, the patient was free of chest tightness and palpitations and recovered well. At 9-day after the surgery, TEE showed that the cardiac mass and mitral regurgitation resolved completely. In the 3-year follow-up period, this patient experienced no tumor recurrence.Cardiac myxoma is the most common primary cardiac tumor. Most cardiac myxomas are located in the left atrium, and LV myxomas are quite rare . Unlike Their early diagnosis is difficult since the symptoms and signs may be nonspecific, and symptomatic patients may present with a wide range of symptoms, which are determined by tumor location, size, and embolization tendency . Pain, pMyxomas are not typically detected during physical examinations or in laboratory tests. Echocardiography, CT and magnetic resonance imaging (MRI) are the imaging modality enabling an accurate myxoma diagnosis . The typIn non-enhanced and contrast-enhanced CT, myxoma usually present as a heterogeneously low attenuated mass in the heart chamber with a smooth, irregular or villous surface, and heterogeneous enhancement , 17. CarPathology is the gold standard for diagnosing heart tumors. Macroscopically, cardiac myxoma typically present as a single, pedunculated, fragile, and irregular shaped lesion with an intact capsule, whereas cardiac fibroma is solitary, circumscribed, firm, gray-white, partially calcified neoplasms without a capsule. HistoloSurgery is one of the most effective treatments for cardiac myxoma. And a complete surgical resection is highly recommended as the recurrence of cardiac myxoma may be caused by incomplete tumor removal . FurtherIn conclusion, LV cardiac myxomas mimicking fibroma makes diagnosis difficult, and sonographers should be aware of this imaging changes.


The aim of this paper is to report a case of odontogenic myxoma that affected the right maxilla and maxillary sinus. We have also reviewed the literature in regards of the clinical, radiographic, histological and treatment aspects of this pathology. Odontogenic myxomas of the maxillofacial region are benign lesions, without preference for gender, race or location, with extremely varied clinical and radiographic characteristics, thus increasing the number oral and maxillofacial region tumors with which we can make the differential diagnosis. Myxoma is a benign, slow-growth, mesenchimal-stemed and locally aggressive neoplasia. Virchow coined this term in 1863, because he believed that, as it happens with the umbilical chord, this disease had mucin. Myxomas may involve hard and soft tissue . Usually, when it involves bony tissue, it affects the facial bonesThe odontogenic myxoma is a rare, benign tumor that does not shed metastasis and involves the maxillo-mandibular complex. When involving the maxilla, odontogenic myxomas can expand to inside the maxillary sinus, and are then diagnosed later only after having grown to larger sizes. They may still involve the palate, orbit and nasal cavity, causing symptoms associated with these structuresThe odontogenic nature of the maxillary myxomas stemming from a tooth germ may be proven through the following facts: it rarely occurs in other bones if not on the face; it has a histological similarity with the dental mesenchyma; it is associated with unerupted or absent teeth; and there is a sporadic presence of epithelial islands or odontogenic tissue inside the myxomatous stromaAccording to the latest WHO's classification of odontogenic tumors, in 1992, the myxoma is considered a tumor of the odontogenic mesenchyma, with or without the presence of odontogenic epithelium. The rarity of this pathology may be seen in some publications, such as in a retrospective study of 30 years, carried out at the Oral Pathology Laboratory of the Dentistry School of the Federal University of Rio Grande do Norte, where they analyzed 127 cases of odontogenic tumors, and the odontogenic myxoma corresponded to 4.72% of the sample with 3 cases seen in men and in women alikeOdontogenic maxillary myxomas were first mentioned in the literature by Thoma and Goldman in 1947. They usually affect adolescents and young adults, between the second and third decades of life, very rarely affecting people before 10 years of age or after 50 years of age. There is no consensus in the literature regarding location predilection (maxilla or mandible) and gender , however, most researchers state that there is no racial predilectionJust as it happens to most odontogenic tumors, the odontogenic myxomas are asymptomatic, causing pain, paresthesia or asymmetries only when they take on larger sizes. Their growth is usually slow, however they are locally aggressive. They may cause divergence or root resorption, tooth shifting or movementIn a recent prospective study involving 33 cases of odontogenic myxomas, the most affected individuals were within the age range of 10 and 39 years, and they affected mostly the posterior portion of the mandible. Since most cases were advanced, the most common symptoms were pain and cortical bone perforation with invasion of soft tissue. The most commonly found radiographic characteristics were multilocularity and root resorptionAlthough the radiographic aspects of odontogenic myxomas are markedly variable, they are always radiolucent. They may present with the aspect of soap bubbles, tennis racket and honey combs; there have been reports of a sun ray aspect In a retrospective radiographic analysis of 21 cases, the mandible was more involved than the maxilla. We also noticed that the unilocular forms were usually located in the anterior maxilla, while the multilocular forms involved the posterior regionBoth conventional radiographs and CT scans must be used in the radiographic investigation in order to size the tumor, define its margins, establish bony septum aspects and investigate whether or not there is cortical perforationIn its histological aspect, the odontogenic myxoma has abundant mucosal intercellular substance, made up of eosinophilic lax connective tissue, immersed in this stroma there are spindle-like cells and star-shaped cells with elongated cytoplasm, with or without small masses of inactive odontogenic epithelium. We have seen recently myxoma cases with characteristics that had not been described before in the literature, among them we have the presence of round calcified bodies made up of bony-cement tissue and islands of active odontogenic epitheliumHistologically, differential diagnosis must be made with rabdomyosarcoma, myxoid liposarcoma, neurogenic sarcoma, neurofibroma, lipoma, fibroma, chondromyxoid and nodular faciitisClinical and radiographic differential diagnosis of odontogenic myxomas may include: intraosseous hemangioma, cherubism, aneurysmatic bony cyst, fibrous dysplasia, ameloblastoma, gigantic cells central lesion, traumatic bony cyst and odontogenic cysts Since odontogenic myxomas bear a high risk of recurrence, mainly due to its gelatinous aspect and having no capsule, it is necessary that the initial treatment be very efficient. One important aspect that should be taken into account is the possibility that the patients may skip control visits. Thus, a possible recurrence will be seen only later on and treatment will be impaired. For all these reasons, a resection with broad margins is the most indicated treatment. Post-operative proservation of patients with odontogenic myxomas is indefinite, especially in the first two years, period of the greatest recurrence rate.Female, Caucasian, 23 years old, coming from Recife-PE, came to our attention complaining of a bulging in her right maxillary region.During clinical exam we noticed an enlargement in that region where tooth 16 had been removed (right side first molar) 12 months before. The overlaying mucosa was normal. Panoramic x-ray of the maxillary bone and periapical x-ray of the area showed an osteolithic lesion in the edentulous region and root resorption in the regions of the 15th (2nd right superior pre-molar) and 17th (2nd right superior molar) teeth. Other preoperative exams were normal. Medical history, family history and life style were uneventful. We then carried out an incisional biopsy under local anesthesia and the histology showed it to be odontogenic myxoma. After being aware of such diagnosis, we ordered a CT scan with a window for hard and soft tissue, axial and coronal views, which showed a lesion invading the right maxillary sinus, extending throughout the entire wall of the maxillary sinus, extending all the way to the orbit floor .Figure 1New preoperative exams were ordered and they were all within normal parameters. We then operated her under inhaling anesthesia and nasotracheal intubation. Through a modified Neuman incision we exposed the anterior wall of the maxillary sinus and cut the bone, removing the entire tumor together with teeth numbers 15, 17 and 18, which were affected by the lesion that measured 5cm in its largest diameter . HistopaIn the 6th month of postoperative control we did not find clinical or radiographic signs of recurrence. This case will be under indefinite surveillance.We have reported a case of odontogenic myxoma involving the maxilla and the maxillary sinus. This disease's slow but aggressive growth rate, makes it reach large sizes and, when involving the maxilla, it can invade the entire maxillary sinus, as was the case hereSince we are unable to assign specific clinical and radiographic characteristics to odontogenic myxomas, all lesions that may be considered as such must undergo incisional biopsy, as it happened in our case. Thus, we can avoid transoperative surprises and a possible incomplete tumor removalBecause of the large size of the tumor hereby reported and the slow growth of myxomas, one can suspect that such tumor was already present when the first right superior molar was removed because of a carious lesion. Initial radiographic alterations in the bony tissues can pass unnoticed if a detailed analysis of the panoramic radiographies is not carefully done.Cases like this also show the need to order panoramic radiographs within an annual dental check-up, and also periapical x-rays in situations that require greater details. CT scans can be ordered whenever it is necessary to see detailed characteristics of the lesion associated with its size, internal configuration, and othersClinical and radiographic characteristics of the odontogenic myxoma are variable, thus it should be always considered in the differential diagnosis of mixed and radiolucent lesions in maxillas of all age ranges. One less common clinical characteristic found in our case was root resorptionSince it is an infiltrative, aggressive disease, with a high recurrence rate, treatment performed in this case hereby reported was bony resection, because besides allowing entire tumor enucleating, it removes bone tissue that could be microscopically involved, and then cause disease recurrenceClinical and radiological aspects of maxillary odontogenic myxomas are not conclusive, it is necessary to have a histopathological exam for the final diagnosis. Because of its high rate of recurrence, especially due to its gelatinous and mucous aspect, surgical treatment through bone resection is the most indicated treatment modality, and the patient must be followed up closely for years.


In 1942, StafneConsidering most of the cases, Stafne cavity is diagnosed incidentally in routine radiologic examinations in asymptomatic patients. In panoramic radiograms it appears to be a dense circumscribed radiolucency in mandibular angle, below mandibular canal, mostly in one focus. Stafne cysts are considered stable structural changes of the mandible and do not require surgical intervention. But in literature, there are reports of patients operated for this entity, with descriptions of cavities containing submandibular gland tissue, muscles, fibrous connective tissue, blood vessels, fat or lymphoid tissue.A 60-year-old male patient with complaint of pain in right side of floor of mouth, was referred to our otolaryngology clinic of a tertiary academic center, with a MRI study showing a solid mass of the right submandibular region diverging from surrounding structures, such as submandibular gland and muscles with regular borders. The lobulated mass showed diffuse contrast retention and intermediate density in T1A sections, hyperintensity in T2 images and did not suppressed in fat suppressed series. Also this mass was filling the space situated anteriorly to the right mandibular angle, formed as a well-bordered cortical depression with an intact inferior mandibular line .Figure 1The patient was having pain for 3 months and antibiotics and anti-inflammatory agents had been used, with no pain relief. A panoramic radiography demonstrated an oval shaped and well-bordered cystic lesion between the second molar and the mandibular angle, slightly above the inferior mandibular line. The third molar had been extracted many years ago, and the cyst was not involving the second molar roots. Surrounding borders of the cyst were more dense . Head anAn informed consent was obtained and surgical treatment took place. Intraoral incision was performed on the buccal mucosa near the gingivobuccal line. Periosteum of mandible was lifted trough the inferior mandibular line and a window was opened from the buccal side of mandible using a burr. The mass could be observed just behind the thin cortical outer plate and the cavity did not have any epithelial lining. It was non-capsulated, solid, fragile and easily detachable from the submandibular gland and muscles, but strictly attached inferiorly to lingual nerve . The masThe mass was glandular like shape macroscopically . HistopaAccessory parotid gland is a glandular tissue located on the masseter muscle, lying closely or craniolateral to the Stensen's duct, but separated from anterior border of the parotid gland. Accessory parotid gland has a specific ductal system which drains into the Stensen's duct.Ectopic salivary glands mostly arise from the anterior triangle along the medial edge of sternocleidomastoid muscle and the most common location is the base of the neck.Barbuscia et al.Our case of ectopic parotid gland was located in Stafne's cavity. When StafneContent of the pseudocyst is usually inflamed salivary gland which is the most common finding in operated or imaging studies of Stafne cavity. Muscles, fibrous tissue, fat, lymphoid tissue, vascular structures or devoid of content are reported in a minority of cases.The diagnosis of the classic appearing of Stafne cyst, in the posterior lingual aspect of the mandible, is easily made with a panoramic radiograph. Stafne cyst's differential diagnosis includes odontogenic or non-odontogenic cystic lesions, fibrous dysplasia, non-ossifying fibroma, brown tumor of hyperparathyroidism, osteoporotic bone marrow defect, ameloblastoma, giant cell tumor, benign salivary gland tumors, hemangioma, myxoma, multiple myeloma, eosinophilic granuloma and metastatic disease.All authors made an agreement that Stafne bone cyst does not require surgical treatment and radiologic follow-up should be recommended for the management of the bone depression, because it can be considered an anatomical condition rather than a pathological entity. Biopsy or surgical exploration should be thought only if the diagnosis is uncertain or unusual exceptional disease is suspected. In the present case we preferred surgical exploration based on MRI findings presenting with anatomic deficiency. Histopathologic outcome revealed a developmental pathology, ectopic parotid gland which according to our knowledge is the first case in the English literature.Stafne bone cyst is a rare, benign anatomic entity mostly seen as posterior lingual depression of mandible and in our case it is associated with aberrant but well organized parotid glandular tissue originating dislocation from the pharyngeal pouches. According to our case and previous reported cases, advanced imaging studies must be obtained in order to eliminate the possibility of potentially dangerous diseases.The authors declare no conflicts of interest.


Fibromatosis is a non-metastatic, however locally invasive tumor that may infiltrate muscle, fat, and bone. It may be fatal depending on its location. Tumors in the head and neck are particularly dangerousThese fibroblast tumors have poorly defined margins and are not encapsulatedThis paper aims to present a case of fibromatosis involving a child's tonsils and discuss issues related to treatment and prognosis.The patient is a 10-year-old male, brown, born in Maceió. In 2002, he came to our service with a history of snoring, mouth breathing, and repetition tonsillitis. He underwent an adenoidectomy at the age of four. In the examination he was seen to have grade IV tonsil hypertrophy and reduced air column in the rhinopharynx as seen in the radiography of the cavum, being thus referred to an adenotonsillectomy.During surgery it was verified that his tonsils were unusually hard, and adhesions between the tongue base and the uvula were observed. The adenotonsillectomy was performed and tonsil pathology tests were positive for a fibroblastic proliferation consistent with fibromatosis.A year later the patient began to lose weight and experience difficulty swallowing solid foods. Oroscopy revealed a tumor invading the soft palate and tonsillar pillars . Laryngoscopy did not show any involvement of the pharyngeal posterior wall. The MRI revealed a solid, well-limited lesion involving distal portions of the soft palate, measuring 3.0x2.5x2.5cm, with marginal enhancement after contrast uptake. Hard palate, tongue base, posterior pharyngeal wall, and skull base were not involved. He was referred to surgical resection of the lesion with a safety margin of 2.0 cm.Fibromatosis occurs in the head and neck in 10-35% of the cases1. Stout was the first to identify and describe the disease's aggressive manifestation in 1954Resection with broad safety margins is the treatment of choice, a challenging goal for head and neck tumor removal without leaving any sequelaeFowlerThere is no consensus as to the use of chemo or radiotherapy, but both have been used as adjuvant treatment in inoperable tumors. One of the downsides of radiotherapy is the high dosage required to treat the tumor, as it may damage bone epiphysis and thus impair the patient's growthChemotherapy alone does not seem to be a curative treatment, but may be effective in managing inoperable tumors and in reducing the size of the tumor before surgery. Some studies indicate that tumor growth may be impacted by estrogen, and that adjuvant therapy with tamoxifen might be useful. Others looked into non-steroidal anti-inflammatory drugs due to their impact in prostaglandin metabolizationIn the literature we found only one case of tonsil fibromatosis, also in a child, with invasion of the pterygopalatine fossa. Cure was only possible through broad tumor resectionThis paper illustrates the difficulties in treating a rare condition as head and neck fibromatosis in children. Despite the various treatments proposed for the disease, not all can be offered to children, thus turning it into a benign disease of challenging management.


Soft tissue sarcoma is a relatively rare entity that comprises heterogeneous types of tumors. Here we report the case of a 14-year-old girl with pelvic sarcoma with a YWHAE-NUTM2B fusion gene. This fusion transcript has been reported in endometrial stromal sarcomas and clear cell renal sarcomas, but its description in pelvic sarcomas is recent. To our knowledge, this is the first case report describing this translocation in an adolescent patient with soft tissue sarcoma. The patient underwent cytoreductive surgery, followed by systemic chemotherapy and targeted drug treatment. Surprisingly, the treatment was effective, and the young patient is being followed up in our department. Soft tissue sarcomas (STSs) are a heterogeneous group of malignant tumors arising from mesenchymal cells, which are proportionally more common in children and adolescents . The higIn general, treatment for sarcoma patients involves surgery, chemotherapy, radiotherapy, or a combination thereof. For metastatic or advanced STS patients, doxorubicin alone or combined with other cytotoxic drugs has been traditionally recommended as the first-line treatment in the last four decades . A deep This clinical case reports the discovery and management of an adolescent presenting abdominal and pelvic sarcoma with a YWHAE-NUTM2B fusion gene, which has been previously described in clear cell sarcoma of the kidney (CCSK) and high-grade endometrial stromal sarcoma (HGESS) , 6. It hReviewing the literature, we found very few cases of sarcoma with a YWHAE-NUTM2B fusion gene in adolescents, and we have not identified any clear treatment strategy. The aim of the case report is to draw attention to the diagnosis and clinical treatment of this rare but severe sarcoma entity. Our case is interesting for three reasons: the young age of the patient, the extremely progressive development of the tumor, and the effective treatment of combined chemotherapy of epirubicin with anlotinib.A 14-year-old girl was admitted on September 18, 2021, to the Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Soochow University, Changzhou, China, for moderate, persistent pelvic diffuse pain in order to establish therapeutic specialist conduct. She is a non-smoker and has no history of contraceptive use, has irregular and moderate menstrual cycles, has occasional dysmenorrhea, has no other significant diseases, and has no important medical family history. A huge mass was accessible, reaching the xiphoid process superiorly, and the uterine adnexa was poorly palpated by pelvic examination. Ultrasound suggested a huge abdominal mass. A CT scan of the whole abdomen suggested a huge space occupying the abdominopelvic cavity, blurred surrounding intestinal fat spaces, retroperitoneum multiple enlarged lymph nodes, and unclear double adnexal areas. The tumor marker carbohydrate antigen (CA) 125 was 920.20 U/ml. After informed consent was obtained, exploratory surgery through laparotomy was performed under general anesthesia in our hospital. Specifically, she had right adnexectomy, omentectomy, peritoneal lesion resection, mesenteric lesion resection, and pelvic adhesiolysis. The pelvic cavity was filled with lobulated sarcomatoid tissue, with no obvious envelope. A lobulated sarcomatoid tumor attachment measuring approximately 15 × 15 × 6 cm was seen on the left lateral peritoneal surface. The surface of the omentum was full of lobulated sarcomatoid tissue and measured about 30 × 20 × 20 cm in size. Lobulated sarcomatoid tissue, approximately 8 × 7 × 6 cm to 6 × 5 × 4 cm in size, was found on the intestinal surface and intraperitoneally on the right side of the pelvic cavity, respectively. The uterus was posteriorly positioned, of normal size, smooth, and mobile. The fallopian tube of the left ovary was of normal size and has a smooth surface. The right ovary was slightly enlarged, with edema of the surface and a sarcomatoid tissue attachment on the surface. During the operation, the right ovary was cut, and it was seen that the right ovary was full of sarcomatoid tissue, and the right fallopian tube showed no abnormalities. Scattered masses of about 6 × 5 × 5 cm to 4 × 3 × 3 cm in size were found in the uterine rectal fossa and rectal surface with irregular morphology. The liver surface was smooth, there were no masses in the stomach and diaphragm, and the retroperitoneal lymph nodes were widely enlarged. Postoperative pathology showed neoplastic lesions (right appendix), which tended to be malignant; the type was difficult to determine. No tumor involvement was seen in the ipsilateral fallopian tube. Abdominal wall nodule, intestinal surface nodule, pelvic nodule, greater omentum nodule, and pelvic mass were considered malignant tumors, while the specific type was difficult to determine.H&E shows these tumor cells are made of small round cells, with scanty eosinophilic cytoplasm and a hyperchromatic nucleus  showed abdominal and pelvic lesions, blurred surrounding intestinal fat space, and multiple enlarged lymph nodes behind the peritoneum, which were similar to previous findings . Abdominal and pelvic effusions were more advanced than before, and the chest CT scan showed right pleural effusion with atelectasis, right pulmonary nodule, and possible metastasis  count 2.84 × 10Considering the rapid progression of the malignancy, we decided to start the treatment immediately after the improvement of the patient’s general condition. On day 5, she was given antitumor therapy with the consent of her parents. The chemotherapy regimen was as follows: epirubicin 40 mg on days 1 and 2 combined with anlotinib  8 mg/day targeted therapy. The patient was concomitantly treated with suppression of vomiting. The patient’s symptoms of abdominal distension and chest tightness improved after comprehensive treatment. On day 13, the patient was discharged with a better general condition. On November 15, 2021; December 7 and 30, 2021; January 21, 2022; February 21, 2022; March 15, 2022; and April 13, 2022, the patient received epirubicin 40 mg on days 1 and 2 combined with anlotinib 8 mg orally per day. After only 2 courses, the tumor decreased dramatically. CA125, an important ovarian cancer-associated antigen, decreased significantly to 125.40 U/ml as compared to the previous value of 920.20 U/ml. The latest value of CA125 was already decreased to normal (16.0 U/ml) Figure 3In the current study, we presented a case of rare pelvic sarcoma harboring the YWHAE-NUTM2B/E fusion transcript in a 14-year-old patient. YWHAE gene belongs to the 14-3-3 family of proteins, which mediate various biological functions, including cell proliferation, differentiation, and metabolism . NUTM2B There are little data about stromal sarcoma’s origin and biology. Histopathological diagnosis is very important for prognosis. However, it is difficult by conventional pathologic means to definitively diagnose soft tissue tumors that require NGS testing. With the wide application of NGS, an increasing number of novel genetic abnormalities in undifferentiated round cell sarcomas have been identified, including BCOR-CCNB3/ZC3H7B/MAML3, CIC-DUX4/FOXO4, YWHAE-NUTM2B gene fusions, or BCOR internal tandem duplication . Both YWIn the present case, the main and only complaint was abdominopelvic pain; abnormal vaginal bleeding was not recorded. When the patient was admitted to our hospital, her condition was already advanced. Diagnosis of such cases adolescents is not a simple procedure. The tumor mass presented rapid growth, and 34 days after the surgery, the control CT scan showed a huge mass again in the abdominopelvic cavity with repression of the rectum. Due to the lack of knowledge of the fusion transcript, the young patient was diagnosed with “pelvic sarcoma with YWHAE-NUTM2B fusion gene” approximately 1 month after the surgery. It was difficult to confirm the origin of the tumor. There was an urgent need for systematic antitumor therapy due to the rapid growth of the tumor. We therefore developed a therapeutic strategy mainly based on the tumor histology and genetic diagnosis, despite the initial tumor origin.2 given on days 1 and 2 and anlotinib 8 mg once daily on days 1–14 of each 21-day cycle), the CT showed dramatic tumor regression.Due to the extreme rarity of YWHAE-NUTM2B fusion-positive STS in the clinic, currently, no standard therapeutic guidelines are available. The first-line treatment for STS is mainly based on anthracyclines and ifosfamide. Hopefully, there are gradually multiple targeted drugs showing therapeutic effects in STS, bringing clinical benefits to various histotypes of STS . Among tThis clinical report leads us to consider not only age and histology in adolescent sarcomas management but also the molecular analyses and genetic diagnosis to develop the therapeutic strategy. Due to the rarity of this pathology, it is difficult to complete randomized clinical trials to determine the optimal management of the tumor.STSs are a rare group of tumors that originate from connective tissues. The diagnosis is established by histopathology, extended IHC staining, and molecular tests such as NGS. Rapid diagnosis and timely surgical intervention must be a therapeutic standard in these cases. Traditional chemotherapy for STS is mainly based on anthracyclines and ifosfamide. In front of this complex and highly aggressive YWHAE-NUTM2B fusion-positive STS, we underline its clinical presentation . We propose the early combined therapy of epirubicin with anlotinib in case of such high-grade sarcomas with Eastern Cooperative Oncology Group (ECOG) scores greater than 2. A meta-analysis from large clinical trials is necessary to determine the prognosis and proper curable treatment of sarcoma with YWHAE-NUTM2B fusion.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.Written informed consent was obtained from the individual(s), and minor(s)’ legal guardian/next of kin, for the publication of any potentially identifiable images or data included in this article.JH analyzed the data and drafted the manuscript. JH, YX, and JZ contributed to the conception of the case report. JH and JZ contributed significantly to the analysis and manuscript preparation. DZ helped analyze the pathological data. XN and JZ assisted in drafting the manuscript and critically reviewed the manuscript with regard to oncological issues and constructive discussions. All authors had final approval of the submitted and published versions.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.


Tracheocele or tracheal diverticulum is an uncommon benign entity that can be congenital or acquired. It is usually diagnosed incidentally on cervicothoracic imaging. Our aim is to describe the etiopathogenic, clinical and paraclinical features of the tracheocele as well as its therapeutic modalities.We report 2 cases of asymptomatic congenital tracheocele occurred in a boy and a woman, incidentally found on cervical CT scan done for accidental ingestion of chicken bone and infected thyroid hematocele respectively. The tracheocele, in our 2 cases, was probably congenital: no risk factors were noted and the opening of the tracheocele was narrow. The tracheocele was located in the right posterolateral tracheal wall in the 2 cases. It communicated with the tracheal lumen in one case. The female patient underwent a right lobectomy and resection of the tracheocele. For the boy, our attitude was conservative. The evolution was uneventful in the 2 cases.The presence or absence of risk factors, CT scan, bronchoscopy and histologic exam may distinguish between congenital and acquired forms. Asymptomatic patients are managed conservatively. Surgical resection is the treatment of choice for symptomatic patients. Tracheocele or tracheal diverticulum is an air sac arising from the wall of the trachea ,2. It isThe purpose of this paper is to describe the etiopathogenic, clinical and paraclinical features of this condition as well as its therapeutic modalities.Case 1A 14-year-old boy with no past medical history presented with odynophagia lasting for 2 days after accidental ingestion of chicken bone. He gave no history of dyspnea or dysphagia. He had not a fever or chest pain. There was no history of chronic cough or repeated respiratory tract infections. Oropharynx examination was normal. There was no cervical subcutaneous emphysema. Indirect hypopharyngoscopy was normal. Chest X-ray was normal. A cervico-thoracic CT scan was performed and did not show a foreign body. However, it revealed incidentally a 11 mm air image located in the right posterolateral tracheal wall, at the thoracic inlet . It communicated with the tracheal lumen with a narrow opening. There was no pneumomediastinum or subcutaneous emphysema. After 2 days, he no longer complained of odynophagia that was related to the ingestion of chicken bone. Our attitude was to continue the follow-up of the tracheocele without surgical intervention. After 3 months of follow-up, the patient was asymptomatic and in the CT scan, the size of the tracheocele was stable.Case 2A 28-year-old woman consulted for anterior neck mass and fever lasting for 2 days. Physical exam showed a painful and inflammatory anterior neck mass moving on swallowing. She had no compressive symptoms. She gave no history of chronic cough or recurrent respiratory infections. The laboratory workup revealed a biological inflammatory syndrome. The CT scan showed a ring enhancing cystic lesion located in the right lobe of the thyroid. Furthermore, it revealed a 9,6 x 6,9 mm air image located in the right posterolateral tracheal wall without obvious communication with the lumen of the trachea .The barium contrast study did not show an esophageal communication. Ultrasound guided aspiration of the cystic lesion was performed: the fluid was brown and free of bacteria. An infected thyroid hematocele was suspected. A clinical and biological improvement was obtained after 10 days of intravenous antibiotic therapy. Three months later, she underwent a right lobectomy. Intraoperatively, a 1 cm outpouching derived from the right posterolateral wall of the trachea, opposite to the third tracheal ring. The resection of the tracheocele was performed. The postoperative course was uneventful. Histological exam confirmed the diagnosis of tracheocele. Histological exam of the thyroid gland revealed a benign nodule. After 3 years of follow-up, CT scan showed no recurrence of the tracheocele.with only few cases have been reported in the literature (A tracheocele is an air-filled outpouching arising from the tracheal wall ,4. It isterature ,5. Pharyterature ,6. Trachterature ,3. Trachterature ,3,4. Theterature ,4,7. Theterature ,4,5. Theterature . Tracheoterature –3. Thereterature ,4,6. It terature ,3,5. Theterature ,3,4. It terature ,3,4. Thuterature . It has terature ,2,4. So,terature ,2,7. Theterature ,2,4. Thuterature ,3. The tterature ,2,4,5. IThe common symptoms are chronic cough, stridor or recurrent respiratory infections . DysphagHigh-resolution cervicothoracic CT is the best noninvasive technique to detect the tracheocele and evaluate its size and site ,4,8. On Barium swallow contrast study can help to eliminate a communication with the esophagus, especially in cases of absence of tracheal communication on CT scan. Secondary infection is the main complication with the potential risk of a paratracheal abscess ,3. The aConservative treatment includes antibiotics, mucolytic agents, bronchodilators, and physiotherapy ,4. Due tTracheocele is a rare entity. It is frequently located in the right para-tracheal region. The presence or absence of risk factors, CT scan, bronchoscopy and histologic exam may distinguish between congenital and acquired form. Chronic cough is the most frequent cause of acquired tracheocele. It is often asymptomatic and usually discovered incidentally on radiological investigations. CT scan confirms the diagnosis. Tracheoscopy is not necessary for the diagnosis. Paratracheal abscess is the main complication. Asymptomatic patients are managed conservatively. Surgical resection is the treatment of choice for symptomatic patients.


Malignant lymphoma (ML) can involve the central nervous system either primarily or by secondary spread, which tends to occur late in the disease as part of widespread dissemination. Lymphoma presenting as primary tumors of the spinal cord is extremely uncommon. Primary spinal lymphoma if detected early can have a good prognosis with no relapse after effective treatment.A 32 years old male patient presented with the symptoms of impending cauda equina syndrome which was managed with surgery and chemotherapy. The patient was successfully treated without the relapse of his condition at his 6 months follow-up scan.Discussion: Primary spinal non-Hodgkin lymphoma is a rare entity among extranodal non-Hodgkin lymphoma. MRI is usually non-confirmatory and needs immunohistochemistry for the correct diagnosis. R–CHOP regimen is the standard chemotherapy regimen. Surgical decompression is required in cases of impending neurological injury along with radiotherapy.Primary spinal epidural diffuse large B‐cell lymphoma should be considered as a differential diagnosis in patients presenting with back pain and symptoms of impending cauda equina syndrome. It is important to early detect and treat the disease to prevent permanent neurological injury and metastasis. •Primary spinal epidural diffuse large B‐cell lymphoma should be considered as a differential diagnosis in patients presenting with back pain and symptoms of impending cauda equine syndrome.•Surgical decompression may be required in cases of impending neurological injury.•Early diagnosis and treatment is the key to have a better prognosis. A spinal location for lymphoma is observed in 0.1–6.5% of all lymphomas which is a rare condition . Spinal 2A 32 years old male initially presented to another center with complaints of pain in the lumbar region for the duration of 6 months. The pain was insidious in onset, gradually progressive radiating to the bilateral lower limbs. There was no associated fever, weight loss, chest pain, cough, shortness of breath, or loss of consciousness. He had no significant past history. There was no history of similar illnesses in the family. He was a nonsmoker and non-alcoholic.On further investigation, MRI was done which revealed a T1 intermediate signal intensity lesion in the epidural region of the L3 vertebral body along with diffuse low signal intensities within the vertebral body . A biopsContrast MRI was done which showed T2 low signal intensity lesions within the L3 vertebral body including the posterior elements along with circumferential soft tissue density showing T2 intermediate to high signal intensity soft tissue density in the epidural region causing severe narrowing of the central spinal canal and bilateral lateral recesses at L3 level , Fig. 4.Since he had symptoms of spinal cord compression, the next step of management was decompression. During the procedure, the soft tissues adhering around the dura mater were visible . FollowiThe gram stain and gene Xpert report did not show any significant findings. Finally, histopathological features revealed chronic osteomyelitis with focal lymphoid cell proliferation. The differential diagnosis at this time was osteomyelitis. However, the Non-Hodgkin Lymphoma panel was suggested to rule out lymphoma. The immunohistochemistry report finally revealed diffuse large B cell Lymphoma. The immunomarkers like CD20, Ki 67, BLC 2, MUM-1, CD-10, and BCL 6 were reactive. CT chest, neck, and abdomen were performed which showed no signs of lymphadenopathy. There was no other primary site hence the finding of primary lymphoma of the spine was made. He was started with the chemotherapy regimen R–CHOP , vincristine (Oncovin), and prednisone). A total of 6 cycles of the treatment were provided every 21 days for the duration of five months. Subsequently, he completed the cycles of chemotherapy. Post procedural CT scan of chest, neck and abdomen after 6 months showed no signs of recurrence or metastasis.Currently, the patient is asymptomatic and free of disease. He is performing his regular activities.3Epidural lymphomas form 9% of all spinal epidural tumors . It is dBecause bony involvement is not present, plain radiographs rarely provide clinically useful information. Myelography and computerized tomography (CT)-myelography, as well as magnetic resonance imaging (MRI), are useful for detecting epidural compression . MRI appMost primary spinal lymphomas are comprised of diffuse large B-cell lymphomas with a minority being follicular lymphoma, precursor B-lymphoblastic lymphoma, Ki-lymphoma, diffuse lymphoblastic lymphoma, small lymphocytic lymphoma, or T-cell lymphoma . In our All patients with a histological diagnosis of lymphoma need a complete systemic workup for lymphoma, without which a diagnosis of PSEL cannot be made. In the series by Monnard et al., whole-body CT scan, bone marrow assessment, cerebrospinal fluid examination, lactic dehydrogenase, and white blood cell count were measured . In our A study by Lyons et al. has concluded that primary spinal epidural non-Hodgkin's lymphoma can be associated with a favorable outcome if diagnosed and treated early . It's pr4Primary spinal epidural diffuse large B‐cell lymphoma should be considered as a differential diagnosis in patients presenting with back pain and symptoms of impending cauda equine syndrome. Early diagnosis and treatment are the keys to having a better prognosis. Surgical decompression may be required in cases of impending neurological injury.N/A.None.Author 1: concept of study, contributed in writing the case information.Author 2: Literature review, writing initial draft, revising, and editing the manuscript.Author 3: Literature review and writing case information.Author 4: Literature review, revising and editing the manuscript.Author 5: Literature review and editing the manuscript.Author 6: Literature review and editing the manuscript.Author 7: Literature review and revising the manuscript.All authors were involved in manuscript drafting and revising, and approved the final version.1.Name of the registry: N/A.2.Unique Identifying number or registration ID: N/A.3.Hyperlink to your specific registration (must be publicly accessible and will be checked): N/A.Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.@gmail.com, Phone: +977–9848559942.Sulochana Khadka, Nepalese Army Institute of Health Sciences – College of Medicine, Kathmandu, Nepal. Email: suloachankhadka1Not commissioned, externally peer-reviewed.None.