Draining cutaneous sinus tract in chin area may be caused by chronic periapical dental infections. Misdiagnosis of these lesions usually leads to destructive invasive treatment of the sinus tract that is not correct and curative.A 31-year-old male patient referred to us with a chronically draining lesion on his chin. The lesion previously was misdiagnosed by medical doctors and had undergone two times surgery with a focus on the skin lesion and had received antibiotic therapy for a prolonged period of time. After clinical and radiologic examination the dental origin of the lesion was evident and proper endodontic and surgical treatment was performed. Three months later, after the treatment, the lesion showed total healing and reoccurrence occurred.The key to successful treatment of cutaneous sinus tract of dental origin must be in appropriate communication between the dentist and the physician in order to achieve correct diagnosis and therapy in such cases. The successful treatment of cutaneous sinus tract of dental origin depends on the diagnosis of the source which may be very challenging. These lesions present a diagnostic problem and misdiagnosis leads to incorrect and unsuccessful treatment. Very often the possibility of an odontogenic origin is overlooked because most of the patients do not experience any dental symptoms.Treatment with systemic antibiotics results in temporary cessation of the drainage which returns immediately after antibiotic treatment is over. The diagnosis may be challenging for several reasons:The cutaneous lesions do not always arise in close proximity to the underlying infection and only half of all patients ever recall having had a toothache.The sinus tract appears most commonly on the chin or jaw line but they also can appear elsewhere on the face and neck , 2.Lesions have been reported to occur as far away from oral cavity as the chest, tight or sacrum -5.Because cutaneous lesions can mimic other disorders, several inappropriate surgeries and courses of antibiotics are commonly used before definite therapy is instituted , 6, 7.Patients with extraoral drainage from periapical pathosis may be unaware of any dental problem and tend to seek treatment from physicians, who may not give high priority to chronic dental infections.The differential diagnosis should include:Infected pylar or epidermal cystCarbunclePyogenic granulomaSuppurative lymphadenitisForeign body reactionThyroglossal tract fistulaBranchial cleft fistulaActinomycosisBasal cell and squamous cell carcinoma -11Dental etiology of these lesions can be confirmed by:Tracing the sinus tract to its origin with gutta percha or other radioopaque materialPulp vitality testingPeriapical filmsPanoramic filmsA 31-year-old male patient referred to our clinic with a chronically draining lesion on his chin. His history revealed that he had this lesion for more than 5 months and had undergone two times surgery and received antibiotics for prolonged period of time.Dental history revealed no pain or any dental symptoms but he recalls to a direct blunt trauma to the anterior mandibular region. The periapical radiograph showed a large radiolucent area around lower right first incisor. There was no electric or thermal pulp testing performed on the same tooth. Neither percussion nor palpation revealed any abnormality.The tooth was treated with calcium hydroxide and glycerine and antibiotics for 14 days. After the initial filling of the root canal, an apicoectomy and sinus excision was performed. Three months postoperative control revealed no sinus fistula or exudates from chin or from the mucosa.If correctly diagnosed and treated the tract is expected to disappear within 7 to 14 days. Systemic antibiotic therapy will result in a temporary reduction of the drainage and apparent healing . This trExtraoral cutaneous sinus tracts are usually lined with granulomatous tissue with a lumen containing a purulent exudate. The exudate is composed mainly of PMNL , 14. UnlEighty of reported cases of odontogenic origin are associated with mandibular teeth . The sinThe majority of sinuses arisen are intraoral , 20. A rJohnson et al. believe that the application to heat to the face may contribute to the cutaneous exit of these sinus tracts since it is well known that the heat causes vasodilatation and increase blood flow to the local area . CaliskaConventional root canal therapy and sometimes extraction of the tooth are effective in achieving healing of cutaneous sinus tracts in a few weeks. In general, it is not necessary to treat the skin lesion, except for esthetic reason . Al-KandIn this case, the skin lesion was treated surgically because the patient had undergone two times surgical intervention with the focus on the skin lesion and had a bigger defect on his chin. Also, the time of healing is shortened with additional surgical removal and apical resection.In conclusion, the key to successful treatment of cutaneous sinus tract of dental origin must be in appropriate communication between the dentist and the physician in order to achieve correct diagnosis and therapy in such cases. Basic principles of root canal treatment should be used judiciously to create a favourable environment while effectively eliminating the pathogens and giving the body’s immune, healing and repair mechanism a chance for the desired result.


We discuss our case using a comparative literature review to the few other known case reports.Sarcomas represent less than 1% of all malignant tumors found in the thyroid. Of these, primary extraosseoussarcoma has been reported only a few times in the past decade. We present the case of a 34-year-old male who had a fast-growing hard mass in the lower left neck. FNA was inconclusive. Core needle biopsy revealed the diagnosis of an Ewing sarcoma/primitive neuroectodermal tumor. Mutation of EWSR1 was confirmed using the FISH method. Following treatment by neoadjuvant chemotherapy, we observed clinical, radiological, and finally histopathological remission. This was followed by a left-sided isthmolobectomy with unilateral cervical lymph node dissection by lateral lymphadenectomy, which revealed no residual disease. Posttreatment radiotherapy was administered but discontinued upon the patient’s request. After 18 months of observation, the patient had no recurrence or metastasis and required  Sarcomas represent only a few percent of all neoplasms found in the thyroid, appearing in less than 1% of all patients treated for malignant thyroid tumors .Ewing sarcoma is most often found in children, being the second most common malignant bone tumor in this age group. However, its extraskeletal localization is found in approximately 20% of patients, most often in the thorax and abdomen 43%), with only 8% of these tumors being located in the head and neck region , most were adult males , 9–67 years, and all displayed growing neck masses without coexisting lymphadenopathy. All patients underwent surgical treatment. Standard chemotherapy regimen for Ewing sarcoma was administered to three of the seven patients, both pre- and postoperatively. One patient did not receive systematic treatment because of significant comorbidities. Information regarding chemotherapy for two of the patients was not available.Of the reviewed cases  method.The patient was referred to the Department of Surgical Oncology, Medical University of Gdansk for further evaluation. A contrast-enhanced computed-tomography (CT) of the neck, thorax, and abdomen revealed a mass in the left lobe of the thyroid 58 mm × 58 mm × 60 mm, causing tracheal deviation Figure . A numbe2, cyclophosphamide 1,200 mg/m2, vincristine 2 mg, iphosphamide 3.6 g, etoposide 200 mg, and mesna. After six cycles of chemotherapy, a complete, clinical response was observed and the patient was referred for surgery. Left-sided isthmolobectomy with unilateral cervical lymph node dissection of groups II, III, IV, and V was performed, confirming clinical response to treatment  we started supplementation of Ewing sarcoma/primitive neuroectodermal tumors are a group of small-, round-celled tumors, with different degrees of neuroectodermal differentiation . These nDiagnosis of thyroid Ewing sarcoma based on its clinical and radiological features or even fine needle biopsy seems to be challenging. The clinical manifestation of malignancy can be a rapidly growing mass, sometimes described as swelling on the neck , 6, 9. TBecause of the scarcity of such cases, no guidelines regarding optimal treatment options are available. All the reviewed cases where detailed information of treatment was available underwent the typical treatment regimen for Ewing sarcoma; however, the timing of chemotherapy differed. According to NCCN guidelines for treatment of Ewing sarcoma, neoadjuvant multi-agent chemotherapy should be administered prior to local therapy (surgery or radiotherapy) . As expeStandard surgical treatment of Ewing sarcoma does not cover lymphatic resection . From thExtraosseous Ewing sarcoma of the thyroid is an extremely rare tumor. Neoadjuvant therapy can provide total histopathological remission before surgery. Because very few literature cases are described, it is difficult to establish a set standard of care. Our case seems to be a confirmation that the standard suggested treatment regimens for Ewing sarcoma can be safely applied for such patients.PK, SK-J, MS, and WK managed the case. PK and SK-J drafted the manuscript. PK, SK-J, MS, KS, and JJ reviewed the manuscript. JL and WB prepared histopathological results.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.


Epithelioid leiomyoma of the vagina is extremely rare. Smooth muscle tumors of the vagina usually present with a submucosal growth pattern or a pedunculated growth pattern from the anterior vaginal wall into the vaginal cavity. Here we report a case of a 43-year-old woman with a solid epithelioid leiomyoma and a palpable mass in the pouch of Douglas. Transvaginal biopsy and angiography showed the epithelioid leiomyoma feeding from the vaginal artery behind the posterior vagina. An abdominal wide excision of the tumor with a partial vaginectomy was performed. Our use of ultrasound-guided needle biopsy and angiography was useful for preoperative diagnosis of a vaginal epithelioid leiomyoma exhibiting a pelvic mass. Epithelioid leiomyomas of the vagina are extremely rare benign smooth muscle tumors. Usually, smooth muscle tumors of the vagina present with a submucosal growth pattern or a pedunculated growth pattern from the anterior vaginal wall into vaginal cavity  Figure . Preoper primigravida female was admitted to our hospital for a Pap smear test. As an incidental finding, an ultrasonography and transvaginal physical examination combined with a bimanual rectal exam revealed a solid rubbery mass of approximately 8 × 6 cm between the posterior wall of vagina and anterior wall of the rectum with no obvious limits. Laboratory findings revealed that lactate dehydrogenase, CA-125, carcinoembryonic antigen (CEA), and CA19-9 were within normal limits. Radiological analysis with an echography and contrast enhanced computed tomography (CT) and contrast enhanced magnetic resonance imaging (MRI) revealed multiple leiomyoma in the uterus a solid-cystic mass (8 × 6 cm) in the pelvic area. The mass did not extend from the uterus corpus, but the findings were insufficient to determine its origin  can allRadiologic (CT or MRI) analysis is mandatory to evaluate a vaginal mass and its relationship to adjacent structures . AlthougDetermination of the primary organ and a benign or malignant diagnosis are desirable to inform the choice of the surgical approach. In our case, the pathological findings were based on an ultrasound-guided transvaginal needle biopsy, which can be safely performed. In addition, we could determine the tumor origin using an angiography.Histopathologically, benign and malignant vaginal smooth muscle tumors are difficult to distinguish. The criteria used for diagnosing uterine and soft tissue smooth muscle tumors are markedly different. Tavassoli and Norris established diagnostic criteria for smooth muscle tumors of the vagina that indicate that any tumor with greater than 5 mitoses per 10 high power fields and moderate to marked atypism should be considered as a leiomyosarcoma . When thComplete excision of a tumor with its capsule and a surrounding rim of normal tissue are recommended for patients with a vaginal leiomyoma . DhaliwaIn Zhao's series, most epithelioid vulvar leiomyoma patients did not show recurrence at 2 years after excision, but three patients showed recurrence 11 months and 1 year and 10 years later . Thus, lIn conclusion, angiography is useful for determining the origin of a pelvic mass. An ultrasound-guided needle biopsy is a useful and safe method for preoperative diagnosis of an epithelioid leiomyoma of the vagina.


MRI of the cervical spine established the final diagnosis of Hirayama disease (HD). HD is a rare disease with benign progress. Neurologists and radiologists should be aware of the specific neuroimaging signs of this rare clinical entity.A 22‐year‐old male presented with progressive muscular weakness of the upper extremities.  A 22 years old male patient presented with deteriorating bilateral muscular atrophy and tremor of the distal upper extremities with insidious onset 5 years ago. Cold exposure worsened the symptomatology. Clinical examination revealed symmetrical muscular atrophy of the hands and forearms and reduced muscular strength during flexion, extension, and abduction of the fingers and flexion, extension of the wrist, as well as reduced tendon reflexes from the affected neurotomes. Electroneurophysiology and electromyography showed signs of chronic motor neuron lesion at C7, C8, and T1 myelotomes, bilaterally. Magnetic resonance images (MRI) acquired in neutral position showed loss of cervical lordosis and focal cord atrophy at C5‐C6 level. MRI acquired in flexion revealed widening of the posterior epidural space. On postcontrast images, uniform enhancement of the epidural space was observed. The enhancement was reduced in the neutral position. According to the aforementioned findings described also in Figure HD is a rare clinical entity, first described by Hirayama in 1959 KS: designed and drafted the manuscript, CD and TA: acquired all MRI images and other pertinent patient data, GN: contributed to the analysis of the existing data, GE: designed and supervised the study.The authors declare that they have no competing interests.


Pelvic lymphoceles are an infrequent complication after pelvic surgery and develop shortly after the surgery in most cases. We experienced a case of delayed infection of a lymphocele 6 months after robot-assisted radical prostatectomy (RARP) and pelvic lymphadenectomy. In this case, antimicrobial chemotherapy and percutaneous drainage were effective, and there was no recurrence of the disease. Most urologists do not recognize that infected lymphoceles can develop a long time after surgery; thus, infected lymphoceles should be kept in mind in patients with nonspecific infectious symptoms, regardless of the length of time after surgery. Staphylococcus aureus, 1 case with S. agalactiae, and 3 cases in which the pathogenic bacteria are not mentioned [Lymphocele development is known as an infrequent complication after radical prostatectomy and pelvic lymphadenectomy . Most lyentioned .μg/ml presented to our department. He was diagnosed as having localized adenocarcinoma of the prostate, Gleason 3+3, cT2c N0 M0. He underwent transperitoneal non-nerve-sparing robot-assisted laparoscopic radical prostatectomy (RARP) with pelvic lymph node dissection, and a pelvic drain was placed for 3 days. The pathologic examination revealed that the tumor was pT2c with Gleason 3+5, and none of the dissected lymph nodes were malignant. On the 7th day after surgery, he was discharged from hospital with no complications. Six months after the operation, he visited a primary care doctor complaining of fever and fatigue. For a week, his symptoms continued. He was referred to the general medicine department in our hospital. A pelvic computed tomography (CT) scan showed a pelvic cyst, and a blood test revealed an abnormally high inflammatory reaction; he was then sent to our department and admitted.A 79-year-old Japanese man with a prostate-specific antigen level of 6.5 μl. A urine test showed no abnormal findings. Abdominal ultrasonography (US) and pelvic CT scan revealed an 80 mm cystic lesion displacing the urinary bladder (On admission, his body temperature was 39.3°C. On physical examination, any specific findings, excluding right lower abdominal pain, were not observed. Laboratory data revealed a CRP of 22.38 mg/dl and WBC of 12600/ bladder . S. aureus was detected in the culture of the fluid. Seven days after drainage, his drainage gradually decreased to 10 ml, so we clamped the drainage tube. A few days after clamping, a CT scan showed reduction of the lymphocele (The treatment course is shown in mphocele , and theNaselli et al. showed a 30% incidence of asymptomatic lymphocele after prostatectomy regardless of surgical procedures, open surgery, or laparoscopic surgery .The present case did not have risk factors already known for lymphocele, such as diabetes, number of lymph nodes removed, extraperitoneal approach, and the use of low molecular weight heparin, which were previously reported as factors predictive of lymphocele formation by Raheem et al. . In addiKeskin et al.  reportedAs many cases of prostatectomy are performed with RARP, the number of the delayed infections of lymphoceles would be increasing. Therefore, we should be aware of such a rare complication when a patient that underwent RARP with lymph node dissection presents with fever or other nonspecific symptoms.


Intestinal intussusception in adults is a rare medical condition accounting for less than 5% of all intussusceptions. Herein we present a 45-year-old patient with a history of abdominal pain and loss of weight. CT scan revealed jejunojejunal intussusceptions. The patient was subjected to exploratory operation and small intestine resection due to a mass causing intestinal intussusception. Pathology confirmed suspected diagnosis of metastatic melanoma to small intestine secondary to melanoma, 7 years after the initial manifestation. Postoperative evaluation with 18FDG-PET/CT revealed increased uptake in the thyroid gland. Subsequent total thyroidectomy revealed severe Hashimoto thyroiditis and no signs of metastasis. The patient received adjuvant immunotherapy and is healthy with no signs of recurrence 3 years after the initial diagnosis and treatment.  Intussusception is a rare condition in the adult population accounting for less than 5% of all intussusceptions , 2. DiagA 45-year-old female presented to our clinic with abdominal pain for the last month. In addition the patient presented abdominal fullness, constipation, and loss of weight the last month. On physical examination abdominal discomfort was present. Medical history revealed a prior operation in the left arm for melanoma and axillary lymph node dissection 7 years ago with initial stage unknown and she received adjuvant high-dose interferon (Kirkwood regimen). In May 2014 she developed symptomatic iron-deficiency anemia and diffuse abdominal pain. Imaging exams revealed an obstructing abdominal mass originating from the small bowel and causing intussusception . LaboratHistological examination of the tumor showed a malignant neoplasm consisting of large epithelioid atypical cells in solid arrangement which invades the mucosa, submucosa, and part of the muscularis propria. Immunohistochemistry revealed positivity of the tumor cells for HMB45 and Melan A . One monIntussusception in adults is a rare medical condition appearing in 5% of the total incidents of intussusceptions and represents the cause for 1% of intestinal obstructions . The usu


Esophageal rupture is an extremely rare condition to occur to a pregnant or postnatal woman. Esophageal ruptures have been previously described in the literature; however, they are most common in the setting of hyperemesis gravidarum.This case report describes a 27-year-old white woman who began complaining of central chest pain and shortness of breath 3 hours after a normal vaginal delivery, with no history of vomiting antenatally or intrapartum. A chest X-ray and computed tomography pulmonary angiogram confirmed surgical emphysema and pneumomediastinum, and a diagnosis of esophageal rupture was made based on these findings. She was stable and conservative management was initiated; she improved over 4 days. Resolution of surgical emphysema was demonstrated on serial chest X-rays without requiring contrast swallow or surgical intervention.This case exemplifies the importance of a timely diagnosis of esophageal rupture in ensuring a positive outcome for the patient. Delay in diagnosis can lead to an increase in morbidity and mortality. Esophageal rupture, especially in the absence of hyperemesis gravidarum, is extremely rare in pregnant women. In 1724, Dr Boerhaave first described a fatal esophageal rupture and it is thought to occur during or after persistent vomiting .A 27-year-old white woman, primigravida, presented at 36 weeks and 6 days’ gestation in spontaneous labor. Her antenatal course was uncomplicated.She was fit and well with a body mass index (BMI) of 20. She did not smoke tobacco and identified as a Jehovah’s Witness. She had arranged a documented advanced health care directive in the event of an emergency. She had no episodes of vomiting antenatally. Her medical history included being investigated for palpitations for which she had previously had blood tests, including thyroid function and a Holter monitor, all of which were normal. She had been reviewed by the cardiology team who had arranged for a transthoracic echocardiogram to be performed postnatally.On the day of delivery, she ruptured her membranes and went into spontaneous labor 1.5 hours later, taking 13 hours and 40 minutes of active labor to reach full dilation ; however, all other observations were normal with a stable blood pressure of 130/75 mmHg, oxygen saturations of 98% on room air, respiratory rate of 18 breaths per minute, afebrile, with no evidence of cyanosis or calf swelling. On examination, subcutaneous emphysema was palpable over her clavicles and into her neck, with good air entry bilaterally.2) 47 mmHg, lactate 4.59 mmol/L, and bicarbonate (HCO3) 19.6 mmol/L. The chest X-ray . The ECG showed sinus tachycardia. An arterial blood gas was attempted, although, unfortunately, it was found to be a venous blood sample with a pH of 7.416, partial pressure of oxygen . The mechanism of pushing causes straining against a closed cricopharyngeus muscle, and increased abdominal pressure then causes an acute rise in esophageal and intra-alveolar pressure . The ValThe successful outcome of the case was directly related to the early diagnosis of the surgical emphysema and pneumomediastinum with a chest X-ray. Findings diagnostic of a spontaneous esophageal rupture are seen in 97% of cases. Abnormalities on the chest X-ray can include subcutaneous emphysema, pneumothorax, hydropneumothorax, basal consolidation, or pneumomediastinum effusion , 6. The The prompt diagnosis and correct management of the esophageal perforation played a pivotal role in the successful outcome for this patient. The principles of management remain controversial and can be either conservative or surgical. In deciding between conservative and surgical approaches the site/size of the rupture, degree of mediastinal contamination, and time from diagnosis should all be considered . ConservEsophageal perforation during labor is an extremely rare but life-threatening condition. This case exemplifies how early diagnosis and prompt correct management is the key to a successful outcome. Most esophageal perforations can be diagnosed based on the clinical history, clinical examination, and chest X-ray findings. It is important to understand that if further investigations are conducted they should not delay treatment.


Dermatofibrosarcoma protuberans (DFSP) has been described as a rare, locally invasive, malignant fibroblastic tumor with a high rate of recurrence that usually affects middle-aged patients. Herein, we describe a rare case of a pedunculated dermatofibrosarcoma protuberans of the right thumb in an 80-year-old woman treated with excision through the base of the pedicle. We also make a brief literature review concerning this tumor. Dermatofibrosarcoma protuberans (DFSP) has been described as a rare, slowly growing, low-grade malignancy that is locally aggressive and has a high rate of recurrence and low metastatic potential . Its incHerein, we present a rare case of a pedunculated DFSP of the thumb in an 80-year-old woman.An 80-year-old Caucasian woman presented to the University Hospital of Orthopaedics with a formation in her right thumb with a duration of more than 10 years. A few months prior to presentation, the formation had gradually ulcerated with no bleeding, secretion, or pain. A physical examination revealed a non-tender, rounded, pedunculated soft-tissue mass measuring about one centimeter in diameter on the dorsal aspect of the interphalangeal joint of the thumb. The skin over the distal third of the mass was completely missing, revealing the underlying, slightly exsiccated, homogeneous yellowish tumor surface  in blood vessel walls and single cells. The tumor cells were negative for epithelial membrane antigen (EMA) Figure .No local recurrence was detected during a follow-up of two years. Later, the patient died of an unrelated condition.DFSP has been described as the most common dermal sarcoma. Morphologically, DFSP is composed of spindle-shaped cells with a diffuse CD34 expression. These cells arise in the dermis and could also disseminate in the subcutaneous fat. At the ultrastructural level, these cells resemble fibroblasts and are similar to dermal dendrocytes [This malignant fibroblastic tumor is characterized by a specific chromosomal translocation t17;22)q22;q13) in 90% of cases, which leads to fusion of the platelet-derived growth factor beta (PDGFbeta) gene with the collagen type 1 alpha 1  gene [2, malignant melanoma, and morpheaform basal cell carcinoma . It shouDFSPs usually appear as nodules, plaques, or papules and could affect any part of the body . The colAfter an extensive review of the PubMed database, we identified four similar cases published in the literature, but not in an elderly patient. Campos, et al.  presenteTo the best of our knowledge, this is the first report of a pedunculated DFSP of the hand.Although nonspecific, imaging studies, such as magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound, are essential for the preoperative evaluation of this tumor -3.The gold standard for the treatment of DFSP is adequate surgical removal. Inadequate treatment leads to high recurrence rates 20% to 50%) ,5. The m0% ,5. ThIn the current literature data, there are different strategies considering the width of the surgical margin and the excision techniques. Some authors prefer Mohs micrographic surgery (MMS) or slow MMS, but others recommend wide excision. In the latter, the surgical margins should be at least three centimeters wide to reduce the recurrence rate . HoweverIt is well-established that chemotherapy has a palliative effect. Target therapy with Imatinib has mixed results . RadiothIn conclusion, we described an extremely rare case of a pedunculated DFSP of the thumb in an 80-year-old lady. Commonly, the finger localization of DFSP is associated with a high rate of recurrence. Therefore, it is essential for patients with DFSP of the hand to be evaluated by a multidisciplinary team, including a hand surgeon and an experienced pathologist, in order to achieve recurrence-free outcomes and good hand function.


Polymorphous low grade adenocarcinoma (PLGA) is a rare salivary gland neoplasm with an indolent course. It occurs primarily in the minor salivary glands but can rarely occur in the major salivary glands. It usually occurs in the fifth to seventh decades of life with female preponderance. A 16-year-old male presented with recurrent painless swelling in the right preauricular region and with a history of surgical intervention at the same site in the past. His histopathology report was suggestive of pleomorphic adenoma. The swelling recurred after one year of excision and a superficial parotidectomy was performed. The detailed histopathological examination was suggestive of Polymorphous low grade adenocarcinoma. In view of close margins, the patient was given adjuvant radiotherapy. Thirty-three months post-surgery, he is alive and disease-free. We describe a rare case of PLGA of the parotid gland in a teenager with its clinical characteristics, histopathological features, and treatment.The occurrence of PLGA in the parotid gland is rare with only a few cases reported in literature. The diagnosis of PLGA is challenging due to morphological diversity. Polymorphous low grade adenocarcinoma (PLGA) was described as terminal duct carcinoma by Batsakis et al  and lobuA 16-year-old-boy came to our clinic with a 3-year history of painless swelling in the preauricular region. He underwent surgical excision one year ago and the histopathological examination was suggestive of pleomorphic adenoma. The complete details were not available as it was performed in another institution. The swelling recurred one year post excision at the same site. During the examination, a firm swelling of 3 cm x 3 cm was palpable in the right preauricular region. Haematological, biochemical renal and liver function tests were within normal limits. Chest X-ray and ultrasound of abdomen and pelvis were normal. Contrast enhanced computed tomography (CECT) was suggestive of a bulky right parotid with iso to hyperdense lesion in the superficial lobe. Fine needle aspiration cytology from the parotid swelling was suggestive of pleomorphic adenoma. The patient underwent right superficial parotidectomy. Gross examination of the specimen revealed a grey white infiltrating tumor measuring 2.5 cm x 2 cm x 2 cm with focal grey brown areas. Microscopically, a diffusely infiltrating tumor in the salivary parenchyma and adjoining fibroadipose tissue was observed. This tumor was arranged in lobules, papillary-cystic, tubular and focally in cribriform pattern .The tumor cells showed mild anaplasia with vesicular chromatin, pin-point nucleoli clear to eosinophilic cytoplasm, and few mucin filled cystic spaces. There were no areas of atypical mitosis or necrosis. Intervening areas showed fibrosis and mild lymphomononuclear cell infiltrate. The tumor cells showed positivity for S-100 . The patient received postoperative radiotherapy in view of close margins for a total dose of 50.4 Gy in 28 fractions. The patient is doing well 33 months post surgery without any clinical or radiological evidence of recurrence.PLGA is a low-grade neoplasm of minor salivary glands with an indolent nature, which usually presents as a painless slow growing mass. It mainly affects female patients and the female to male ratio is 2:1 ,6. It ocPLGA is characterized by a triad of infiltrative growth pattern, cytological uniformity and architectural diversity . GrosslyComplete surgical excision with adequate margins is the treatment of choice for PLGA. Recurrence may occur after years, hence long term follow-up is recommended. Vincent et al.  reportedPLGA arising from the parotid gland is a rare occurrence. The diagnosis of PLGA is difficult and challenging due to its morphological diversity. Wide local excision with negative margins is the treatment of choice. The role of adjuvant radiotherapy is still not defined due to the rarity of this disease and limited literature. The present case is unique because of the younger age of presentation and rare location.


Primary mucosa-associated lymphoid tissue (MALT) lymphoma is a rare malignancy. We found only 8 cases of MALT lymphoma in literature.We report here another case of primary prostatic MALT lymphoma which is presented by hematuria and diagnosed primarily as BPH. Immunohistochemistry studies demonstrate the diagnosis and MALT lymphoma. Six months after starting the treatment the patient was alive and well.Prostatic MALTomas are mainly presented with urinary obstruction or hematuria and have an indolent growth with a good prognosis. Although primary mucosa-associated lymphoid tissues (MALTs) of the prostate are very rare tumors, it could be considered as a potential pathology underlying of unjustified urinary obstruction, or hematuria..Prostate lymphomas and especially primary mucosa-associated lymphoid tissue (MALT) lymphoma is a rare malignancy. To date, only 8 cases of primary MALT lymphoma are reported all over the world. The first case of MALT lymphoma of the prostate was reported in 1992 by Franco et al  and biopsy was done for him, but pathologic results showed the evidence of BPH. After 28 days, the patient was admitted again due to gross hematuria. Rectal examination was normal. Pelvic CT-scan revealed a big clot in bladder without any lymphadenopathy. There was a significant heterogeneity in prostate. In second TURP, clot evacuation and biopsy were performed on more than 15 different areas of prostate. During the next 2 weeks, the patient underwent 3 other trans-urethral coagulation and clot evacuations due to hematuria.However, laboratory tests such as prothrombin time (PT) , partial thromboplastin time (PTT), clotting time (CT), bleeding time (BT) and platelet count were normal. After 15 days hematuria was stopped and was not repeated. Sections from prostate show foci of hemorrhage, The first transfusion was 2 units of PC during the second surgery. The second transfusion was 2 units of PC and 2 FFP, two days later. The consecutive third and fourth transfusions were done two days later during which the patient received 3 units of FFP, and 3 units of whole blood.Immunohistochemistry studies demonstrate CD20-positive in 90% of lymphoid cells and in the lymphoepithelial lesions , CD5-posIn the last fallow up, around eight months after discharging, the patient was alive and asymptomatic. Moreover, there is no evidence of other organ involvement.According to the Revised European-American Lymphoma (REAL) classification MALT lymphomas were categorized as extra nodal marginal zone lymphomas of MALT-type. These groups of lymphomas are composed of mature B cells that are CD20, CD21, CD35 and IgM positive, and CD5, CD10 and IgD negative. Low-grade marginal zone lymphomas are composed of multifocal proliferations of polymorphous lymphoid cells including small lymphocytes with dark round nuclei, small lymphocytes with irregular nuclear contours and pale cytoplasm. For distinguishing reactive follicles from follicles invaded by lymphoma, immunhistochemical determination of the number and distribution of CD20-positive B cells and CD3-positive T cells may be useful (Helicobacter pylori gastritis. The frequency of primary prostatic lymphoma is about 0.1% of non-Hodgkin’s lymphomas and 0.09% of all prostatic malignancies (The stomach is the most common site for MALT lymphomas . Histolognancies . Some ofgnancies . There ignancies . Primarygnancies .As mentioned before these kinds of tumors are very rare and the 10 previously reported cases in the literature are not enough to certainly discuss about the best treatment option and prognosis. But it seems that these prostatic MALTomas have an indolent growth with a good prognosis ,10. AccoSH; study design, preparation of manuscript, final approval. FF; study design, data gathering, and final revision. AH and KG; study design, manuscript edition, final approval. HA; study design, data interpretation and manuscript preparation and final approval.The authors declared no competing interests.No special source of funding.


Amyloidomas of the head and neck region are uncommon and generally considered a benign localized form of amyloidosis. Here, we describe “the unusual case of a young man” with a nasopharyngeal mass and osteolytic lesions caused by systemic light‐chain amyloidosis treated successfully with a combined surgical and chemotherapy approach. A 44‐year‐old African‐American male presented to our emergency room after having experienced a syncopal episode and cervical pain after a jump from a 10′ wall. The patient reported nasal congestion, anosmia, several episodes of sinusitis in last six of months, and weight loss of more than 100 lb over the last 18 months. He further reported a longstanding history of cocaine, alcohol, and tobacco use. The physical examination was significant for a deviated septum and a visible mass inside the left nasal cavity resulting in a pronounced nasal voice with limited protrusion and lateral movement of the tongue. The laboratory work‐up was unremarkable, except for mildly elevated serum kappa free light chains (FLC) (13.9 mg/dL) and kappa/lambda ratio (11.0) and a urine immunofixation positive for kappa FLC.A nasopharyngolaryngoscopy showed a large polypoid mass blocking most of the left nasal cavity causing nasal septum deviation and complete occlusion of the right nasal cavity. The CT showed a 9 cm large , expansile, heterogeneous mass in the left nasal cavity with posterior extension to the nasopharynx and superior extension to the sphenoid sinus. The MRI confirmed a 7 × 5 cm mass in the nasal cavity extending into the left maxillary sinus and compressing the nasal septum to the right side Fig. .The patient had several lytic bone lesions involving the clivus, calvarium, and cervical, thoracic, and lumbar vertebral bodies on CT and MRI studies. The largest expansile bone lesion was at the C2 level measuring 3.0 × 1.1 cm completely replacing the dens and posterior elements of C2 vertebral body  amyloidosis. The patient underwent extensive excision of the nasopharyngeal amyloidoma. Hereafter, he underwent induction chemotherapy with stem cell collection. In near future, he is planned for high‐dose chemotherapy and autologous stem cell transplantation.Amyloidosis of the nasopharyngeal region is uncommon and represents <5% of the cases of amyloidosis of the head and neck region The main goal of this case was to create awareness that amyloidoma of head and neck region can present in rare cases as the initial manifestation of primary, systemic AL amyloidosis. Therefore, a comprehensive and interdisciplinary work‐up is necessary to look for other organ involvements and coexistence of plasma cell dyscrasia SSA, PM, CH, and ST: were involved in the clinical care of the patient. SSA and PM: did the literature review and manuscript preparation. RHL, DA, and MK: contributed to the acquisition and analysis of the data. CH and ST: critically reviewed the manuscript. All authors read and approved the final manuscript.None declared.


A wide variety of complications due to the extrauterine migration of intrauterine contraceptive devices have been reported in the literature. Here we describe the case of a large bladder stone formed around a migrated Copper T380A device that was neglected and detected 15 years after insertion.A 48-year-old Sri Lankan woman underwent a workup for lower urinary tract symptoms and recurrent urinary tract infections over the previous 6 months. The radiographs showed a large bladder stone with an imprint of an intrauterine contraceptive device in the center of it. The device had been inserted 15 years previously. Two years after the insertion, it was considered to be missing, but our patient did not comply with the recommended follow-up. She had been completely asymptomatic until she developed lower urinary tract symptoms. After confirming the location of the stone via ultrasonography, a vesicolithotomy was performed, revealing a stone with three limbs corresponding to the shape of the Copper T380A device. The device and the threads were fully covered with the stone material. Our patient was asymptomatic following the surgery.A migrated intrauterine contraceptive device can act as the nidus for the formation of a secondary bladder stone. The detailed imprint of the device inside the stone and the laminated appearance of the stone material were characteristic of a secondary bladder stone formed around an intrauterine contraceptive device. Radiography and ultrasonography are adequate for the diagnosis of intravesical migration of intrauterine contraceptive devices. Vesicolithiasis is a rare condition in an otherwise normal bladder that can be caused by outflow obstruction, chronic or recurrent infections, and intravesical foreign bodies . A rare Here we have described the asymptomatic migration of an IUCD, previously considered to be missing, resulting in the formation of a large secondary bladder stone detected 15 years after the insertion. A plain X-ray was characteristic in showing the layers of stone material laid down around the limbs of the IUCD and an ultrasound scan was useful in confirming the location of the stone. Even though computed tomography is recommended for the localization of a missing IUCD, a plain radiograph and ultrasound scan was adequate in this case. The prolonged asymptomatic period observed in this case has resulted in the formation of a large stone and delayed the seeking of medical care.Proteus each time. She was managed with orally administered co-amoxiclav, according to the antibacterial sensitivity report, for 1 week during each episode. She was put on nitrofurantoin as a urinary antiseptic after the third episode of urinary tract infection. On presentation for the complicated, fourth urinary tract infection, this case underwent further investigation. She was found to be septic with a heart rate of 110 beats/minute, blood pressure of 130/90 mmHg, temperature of 38.9 °C (102 °F), and respiratory rate of 20/minute. She had neutrophil leukocytosis (18 × 109/ml), but her liver and renal function tests were normal. The radiographs of her kidney, ureter, and bladder showed a large bladder stone with three limbs and an imprint of a typical Copper T380A IUCD  in the middle of the stone (Fig. Proteus. She was managed with intravenously administered cefotaxime according to the antibacterial sensitivity report for 1 week and was continued on the nitrofurantoin until she underwent surgery.A 48-year-old Sri Lankan woman was referred to our general surgical clinic for the management of a bladder stone following successful treatment for a urinary tract infection complicated with upper tract involvement. She complained of intermittent nonspecific lower abdominal pain, dysuria, and hematuria over the previous 6 months. During the same period of time she had three uncomplicated urinary tract infections that were managed by her general practitioner. The urine culture grew a pure growth of On further inquiry, our patient indicated that she had an IUCD inserted 15 years previously, after the delivery of her third child. Two years later, the threads of the IUCD could not be found during a routine visit to a Well Woman Clinic, and it was documented as a missing IUCD. A further workup was not conducted since she did not return for a follow-up. She had forgotten about the missing IUCD and only mentioned it after being questioned. She denied having any urinary or lower abdominal symptoms until the last 6 months. She did not have any previous medical conditions. She was a housewife and had no other risk factor for urolithiasis. She had no family history of urolithiasis. Her general and abdominal examinations were otherwise unremarkable.The diagnosis of a bladder stone formed around a migrated IUCD was made and an open vesicolithotomy was scheduled for 4 weeks later due to the large size of the stone. The vesicolithotomy was uncomplicated, and the interior of her bladder was normal. A large bladder stone with three limbs measuring 6 × 5 cm was removed, the stone was broken, and the IUCD was found inside. The three limbs of the stone were shaped to cover the three limbs of the IUCD, with the threads of the device also completely covered by the stone material Fig. . Her posThe transmigration of an IUCD occurs due to traumatic primary perforation of the uterus or due to a long-term inflammatory process, the exact mechanism of which is not fully understood. The copper contained in some IUCDs can mount an inflammatory reaction that results in the contraceptive effect, but it can also be involved in the process of long-term uterine perforation and transmigration . In thiset al. reported a case of a sigmoid colocolic fistula due to an intraperitoneal IUCD [The nature of the complications from a migrated IUCD depends mainly on its destination. Cases of both intraperitoneal and extraperitoneal migration locations have been reported. The omentum is the most common lodging site after intraperitoneal migration. A wide variety of complications have been reported due to such intraperitoneal IUCDs; for example, Weerasekera eal IUCD . Moreoveeal IUCD , 6, 8–11eal IUCD  and ureteal IUCD  caused bin situ or missing IUCDs complaining of bladder symptoms. Moreover, this highlights the importance of arranging proper workups for all patients with missing IUCDs. The removal of a migrated IUCD after proper localization is advisable because of the unpredictability of the natural history.In this case, the complex etiology of our patient’s bladder symptoms became clear only after performing the relevant imaging and taking a thorough history. Bladder symptoms due to an IUCD can also arise from the partial invasion of the bladder wall without transmigration . Thus, aA migrated IUCD can act as the nidus for the formation of a secondary bladder stone. A high index of suspicion should be kept in mind when managing patients with missing IUCDs complaining of bladder symptoms. The detailed imprint of the device inside the stone and the laminated appearance of the stone material were characteristic of a secondary bladder stone formed around an IUCD. Radiography and ultrasonography are adequate for the diagnosis of intravesical migration of IUCDs.


This case describes an intraoperative incidental finding and surgical removal of ectopic liver tissue attached to the gallbladder during a standard laparoscopic cholecystectomy for acute cholecystitis. These anomalies are rare, with interesting associations and possible clinically relevant complications. The details of the case, along with a brief literature review of embryology, common ectopic sites, and associations/complications, are presented in this paper. Since laparoscopic cholecystectomy is a very common procedure, it is important to increase vigilance of ectopic liver tissues during surgeries to minimize complications and provide optimal management. Ectopic liver is a rare finding with a known incidence of 0.24–0.48% and a prevalence rate of 0.47% . It is iA 56-year-old Hispanic male presented to the emergency department with acute onset of epigastric pain associated with meals and had similar episodes in the past with vomiting, 9/10 sharp localized pain to the epigastric region without radiation, and absent associated symptoms. Patient had no significant past medical history except for removal of a cyst from his upper chest. TA vitals were 163/98 mmhg, 97.3 F. The laboratory evaluation of patient sera indicated elevated leukocyte count and altered liver enzymes. Computed tomography scan of abdomen demonstrated distended gallbladder with thickening of the wall and presence of stones; however there was no evidence of pancreatitis and inflammatory changes. Fatty liver was also noted.2 insufflated to 15 mmhg. Four additional ports were created: one port 11 mm to the right of falciform ligament, one 10 mm port in the subxiphoid region, and two 5 mm ports in the right upper quadrant and flank, respectively.Patient was taken for a standard laparoscopic cholecystectomy, prepped, and draped in the universal standard sterile fashion. The abdominal cavity was entered using Hasson's technique, COThe gallbladder was retracted cephalad while Hartmann's pouch was retracted laterally. It was then noted that an ectopic tissue was present on the gallbladder wall . First tEctopic liver is a rare entity with less than 100 reported cases in the literature . FurtherEctopic liver is a rare incidental finding on radiologic imaging, but due to its compressive effect on the gall bladder it can present as a case of acute cholecystitis, as evident in our case . The comArakawa et al. report in their review of the literature that there were 21 HCC cases related to ectopic liver. Patients who had ectopic liver tissue on the gall bladder were less susceptible to HCC development as comparable to other localizations outside the gall bladder. This study also revealed that only 1 out of 42 ectopic liver tissues localized on the gallbladder was diagnosed as malignant . The malIn conclusion we would like to emphasize the importance of being vigilant of ectopic livers, their complications, and the potential surgical risks as described above, including increased operative time and the need to follow up on such patients to rule out any possible associations. With the limited literature available ectopic livers can be missed on radiological exam, as in our case.Since cholecystectomy is a routinely performed surgery, surgeon awareness will help combat any potential intraoperative complications. Case reports such as ours are an addition to the knowledge base and would help the surgical community recognize and anticipate anomalies of liver, ultimately providing patients with optimal medical care.


Lipoma rarely involves parotid gland especially in children. An 11-year-old boy presented with right parotid swelling. Preoperative workup including CT scan and FNAC gave suspicion of parotid gland lipoma. The diagnosis was confirmed on histopathology after complete excision of the mass. An 11-year-old boy presented with a slowly progressive painless swelling in the right parotid region for the last 10 years . Physical examination revealed firm well defined non tender swelling measuring 3.5 cm × 3.5cm in the right parotid region. The overlying skin was normal and there was no cervical lymphadenopathy. Facial nerve function was also intact. A high frequency ultrasonography visualized hyperechoic lesion (2.8cm × 1.1cm) in the subcutaneous plane. CT scan showed a fat density lesion measuring approximately 3.3cm × 2.4cm × 4cm, in right parotid gland. Fine needle aspiration cytology (FNAC) was conclusive for the presence of mature fibroadipose tissue fragments consistent with lipoma. At surgery, the mass was encapsulated, soft, yellow and fatty, located in the superficial lobe of right parotid gland . Superficial parotidectomy with lipoma excision was done without injury of any major neurovascular structures . The drain was kept insitu for 48 hours. The specimen was sent for histopathological examination and the diagnosis was confirmed as fibrolipoma, a histological variant of lipoma . Postoperatively, neuropraxia of facial nerve was noticed from which the patient is improving and is doing well in follow up.Lipoma of parotid gland is quite rare in children with an incidence of 4.4%.[1] Parotid lipomas usually develop in the fifth and sixth decades with a definite male predominance.[2] Only few case reports of pediatric parotid gland lipoma have been published in literature. The etiology of pediatric parotid lipoma remains unclear. In 75% of cases, parotid lipomas occur in the superficial lobe while the deep lobe is involved in only 8.5% of cases and both the lobes are involved in 16.5% of cases.[4] Lipomas can be single or multiple. But the majority of children usually have a single lesion as found in our case. Lipomas exhibit morphological variants which include fibrolipoma, myxolipoma, etc. In the index case it was fibrolipoma on histopathological examination.Clinically, the parotid lipoma appears as soft, slow growing, painless and well defined mass. In our case too, it was noted for 10 years by parents before the child presented to us. Preoperative imaging, like CT scan and MRI, plays an important role in diagnosis.[1] FNAC can also give clue however, excision biopsy with histopathological examination remains gold standard for ultimate diagnosis. Histologically, lipomas exhibit resemblance to normal mature adipose tissue. They are distinguished from normal simple fat aggregation by the presence of a fibrous capsule.[6] Surgical excision with facial nerve preservation remains the mainstay of treatment but is quite challenging and should be done by experienced surgeons. In our case despite meticulous dissection and preservation of facial nerve, neuropraxia of facial nerve was observed postoperatively which improved on conservative measures.In conclusion, being a rare neoplasm, parotid lipoma is seldom considered in the initial differential diagnosis of parotid mass. Its possibility should be kept in mind when dealing with slow growing painless parotid masses in pediatric age group.Source of Support: NilConflict of Interest: None declared


Lipomas are benign neoplasms arising from adipose tissue. Oral lipomas have been reported in the buccal mucosa, tongue, floor of the mouth and lips; however, the case of a lipoma occurring as an antecedent lesion to recurrent sialadenitis is hitherto unreported in the English literature.We report the case of an intraoral lipoma occurring with signs and symptoms of recurrent sialadenitis in a 15-year-old Kenyan girl of Kikuyu descent. The lipoma was antecedent leading to partial obstruction and stasis related to the right Stensen’s duct culminating in recurrent sialadenitis of the ipsilateral parotid gland. Due to the slow growth, softness, diffuse nature and lack of pain, lipomas may exist below the diagnostic radar, hence, the need to have a high index of suspicion and utilize diagnostic aids as necessary. In this case magnetic resonance imaging was key in establishing the existence of the lipoma. The lipoma was excised with resolution of the recurrent sialadenitis.The purpose of this report is to present the diagnostic challenge emanating from the pressure effects of an intraoral soft tissue lipoma masquerading as recurrent sialadenitis with a view to improving on patient care through sensitization. Lipomas are benign neoplasms arising from adipose tissue. Though common elsewhere, lipomas are an uncommon neoplasm in the oral cavity. Lipomas stand out from normal body fat because their lipids are not subject to metabolism that normal body fat undergoes; in addition, they undergo uncontrolled proliferation. Intraoral lipomas are soft, slow-growing, mobile, and painless lesions that have been reported in the buccal mucosa, tongue, floor of the mouth, and lips , 2. IntrThis is the case of a 15-year-old Kenyan girl of Kikuyu descent who presented with a diffuse, painful, slight cheek swelling on the right side of her face. The pain and swelling consistently increased in size just before and during meals. The painful area was well defined and the pain confined with no radiation. Her medical and dental histories were unremarkable except for treatment for otitis media 3 months before her presentation.On examination her chronologic age was commensurate with her physique. The right parotid area was tender with no obvious change in the skin color. Intraorally, she had unerupted 8 s, missing 12, and a peg lateral in place of 22. The intraoral soft tissue was normal in color, texture, and consistency except around the right Stensen’s duct opening, which was inflamed. A small amount of pus was expressed from the right duct when slight pressure was applied on the papilla.A diagnosis of acute suppurative sialadenitis was made and treatment executed in the form of copious fluid intake, amoxicillin and clavulanic acid (500 mg/12 5 mg) twice a day for 5 days, paracetamol 1000 mg three times a day for 5 days and povidone-iodine (Betadine) gargle for 7 days. The infection resolved completely until about a year later when she presented with signs and symptoms as those initially observed. A similar treatment regimen was prescribed and, after elimination of the infection, the patency of the right Stensen’s duct was checked by cannulation with no indication of obstruction.About 2 years following her initial submission she presented with a recurrence of the initial signs and symptoms. It was immediately decided to perform a magnetic resonance imaging (MRI) scan Fig. . This shThe case presented is rare in the way the lipoma caused obstruction of the right Stensen’s duct resulting in recurrent infections of the ipsilateral parotid gland as the presenting pathology. This phenomenon stands hitherto undocumented in the English literature. Any attempts to treat the parotid gland in isolation would have been futile. Imaging in the form of an MRI scan in combination with the clinical findings resulted in the appropriate diagnosis and management of the condition. The location of the lesion, medial to the buccinator with almost no obvious external swelling while impinging on the Stensen’s duct, permitted the lesion to masquerade as sialadenitis of the right parotid gland and thus avoid immediate detection. It is therefore imperative to rule out external causes of stasis or blockage of the Stensen’s duct in the management of recurrent sialadenitis. It may be sometimes difficult to discern the lipoma from the surrounding soft tissue; hence, imaging is an important diagnostic tool when a lipoma is suspected. Some of the useful imaging modalities include ultrasound, computed tomography, and MRI. The intraoral approach guaranteed no external scarring and reduced the probability of injury to the facial nerve .The possibility of ductal obstruction by soft tissue lesions like lipomas is an important consideration in the management of sialadenitis. A high index of suspicion is required in making such a diagnosis, with the correct diagnostic imaging leading to more comprehensive patient care.


Incidental gastrointestinal findings are commonly detected on MDCT exams performed for various medical indications. This review describes the radiological MDCT spectrum of appearances already present in the past literature and in today's experience of several gastrointestinal acute conditions such as abdominal hernia, giant colon diverticulum, GIST, intestinal pneumatosis, colon ischemia, cold intussusception, gallstone ileus, and foreign bodies which can require medical and surgical intervention or clinical follow-up. The clinical presentation of this illness is frequently nonspecific: abdominal pain, distension, nausea, fever, rectal bleeding, vomiting, constipation, or a palpable mass, depending on the disease. A proper differential diagnosis is essential in the assessment of treatment and in this case MDCT exam plays a central rule. We wish that this article will familiarize the radiologist in the diagnosis of this kind of incidental MDCT findings for better orientation of the therapy. A large number of incidental gastrointestinal findings can be observed during abdominal MDCT exam; they can be divided into benign, indeterminate, and worrisome ; even ifAbdominal herniation is a condition characterized by different etiology, types, symptomatology, and treatment. It can be classified into congenital and acquired based on its etiology and into internal and external types ; some auAbdominal hernias can be asymptomatic or symptomless and although in many cases the treatment of choice is a surgery intervention, the therapy should be personalized and because of that it is important to take into account complications and recurrences .Internal hernias are the protrusion of the intestine through a mesenteric or peritoneal gap within the border of the peritoneal cavity. They can be congenital or acquired; in this second category we can include postinflammatory and traumatic postsurgical herniation, such as after liver transplantation or gastric bypass in bariatric surgery.Despite the lack of incidence, they can be often misdiagnosed with a 50% mortality in case of strangulation . In relaIn left-sided paraduodenal hernia, MDCT can evidence encapsulated bowel loops at duodenojejunal junction between the stomach and pancreas to the left of the ligament of Treitz or between the transverse colon and left adrenal gland; often there is a small bowel obstruction with dilated loops and air-fluid levels; mesenteric vessels can be enlarged, stretched, and displaced; the posterior stomach wall can move anteriorly, the duodenojejunal junction inferomedially, and the transverse colon inferiorly .In right-sided paraduodenal hernia MDCT can show encapsulated loops laterally and inferiorly to the descending duodenum associated with a small bowel nonrotation; superior mesenteric vessels supply the herniated loops  Figure .External hernias are the prolapse of intestinal loops through congenital or acquired weakness, defects, or holes of the abdominal or pelvic wall. They include inguinal hernia, umbilical hernia, and femoral hernia. These can be asymptomatic but in some cases a sudden increase in intra-abdominal pressure can lead to a common surgical emergency known as incarcerated hernia.At CT incarcerated hernia appears with bowel dilation and mesangial thickening. A CT scan, followed by oral iodinated contrast administration, is the best method to determine whether the sac content is intestinal and in this case to identify the intestinal type. MDCT scans can help in the detection of bowel strangulation  Figure .Based on our experience in the preoperative assessment, in fact, the identification of a saclike mass or a cluster of dilated small bowel loops located in an abnormal anatomic point is fundamental. At the same time the detection of stretched and displaced mesenteric vascular pedicle and converging vessels at the hernial orifice is vital.Diaphragmatic hernias (DH) are defect or hole in the diaphragm that allows herniation of abdominal contents into the chest cavity. DH are defined as congenital or acquired defect in the diaphragm  is a rare and severe condition. These defects can range from small subcentimetric defects to complete diaphragmatic agenesis.Three different types of CDH have been described, which include a posterolateral Bochdalek-type, an anterior Morgagni-type, and a central septum transversum-type or hiatal hernia.The complications associated with CDH are pulmonary hypoplasia, gastric volvulus, rotational abnormalities, midgut volvulus, hypoplasia of the left ventricle with a left-sided hernia or pleural effusions caused by right-sided involvement, and bilateral renal hypertrophy .In our personal cases (15 patients) during the prenatal period we detected that US has a high sensitivity in the detection of CDH. In the neonatal and infantile periods, a chest radiograph permits an accurate diagnosis. The classic radiographic appearance is a left hemithorax filled with bowel loops with a right-sided mediastinal shifting and no bowel gas is evident in the abdomen .Acquired diaphragmatic hernias can occur for traumatic or iatrogenic causes. Depending on the location and size of the defect, retroperitoneal or intra-abdominal organs and tissues can prolapse into thoracic cavity due to the negative intrathoracic pressure.CT has been reported to have a sensitivity of 14–82%, with a specificity of 87%. Spiral CT has increased sensitivity, 71–100%, with higher sensitivity on the left than on the right. CT findings indicative of rupture include direct visualization of injury, segmental diaphragm nonvisualization, intrathoracic herniation of viscera, “collar sign,” and peridiaphragmatic active contrast extravasation –13.Giant colon diverticulum (GCD) is a rare manifestation of diverticular diseases and is characterized by a large diverticular mass (4 cm in size or larger), in communication with colonic lumen, usually filled with stool and gas. The majority (>90%) arises from the sigmoid colon but it can occur in any part of the colon .Different theories have been proposed to explain the development of GCD but the exact etiology remains unknown. One hypothesis is that it can be caused by a unidirectional ball-valve mechanism through a tiny communicating diverticular neck, which causes air entrapment and gradual enlargement of the diverticulum. Another hypothesis is that GCD is secondary to the action of gas-forming organisms or a true congenital duplication during an anomalous embryologic development .GCD can be divided into three types, based on their histopathological pattern: Type 1: pseudodiverticula (22%); Type 2: inflammatory diverticula (66%); Type 3: true diverticula (12%) .Our patients present with not common symptoms like fever, nausea, vomiting, and rectal bleeding. Other symptoms include constipation and abdominal palpable masses.The most common complication is peritonitis, caused by the perforation of the GCD, followed by abscess formation, intestinal obstruction, volvulus, and infarction. Rarely, a carcinoma might develop from the diverticular mucosa.At CT, the diverticulum appears as a cavity filled with gas, fluid, or stool, with a thin regular wall and no contrast enhancement except in the presence of inflammation. The wall may contain calcifications in case of chronic inflammation .The definitive treatment for a GCD is surgery through resection of the involved segment with primary anastomosis.Gastrointestinal stromal tumors (GIST) are uncommon mesenchymal tumors arising from the interstitial cells of Cajal, which express KIT protein-CD117 on immunohistochemistry.GIST occur not only anywhere along the gastrointestinal tract (GIT), but also in the mesentery, omentum, and retroperitoneum.The clinical findings are usually site-specific. Lesions in the stomach, small bowel, or colon may present with gastrointestinal bleed in the form of hematemesis, melena, or occult blood in stools; lesions in the esophageal tract presents with dysphagia, but many patients present with vague symptoms, such as nausea, vomiting, abdominal discomfort, weight loss, or early satiety .Although abdominal US is often the primary imaging technique used in the investigation of a patient with abdominal pain or mass we use CT as the modality of choice. It is used to characterize the lesion, to evaluate the extension, and to assess the presence or absence of metastasis. Contrast enhanced CT is also used for monitoring the response to therapy and performing follow-up in case of recurrence .Tumors are usually of varying density and show patchy enhancement after intravenous contrast. Typically the mass has a soft-tissue density with central areas of lower density if necrosis is present and occasionally appears as fluid-fluid levels. Enhancement is typically peripherical and calcification is uncommon. A deep crescent-shaped ulceration demonstrating an internal air-fluid level may be referred to as the Torricelli-Bernoulli sign. This sign can be used to identify ulcerating neoplasms of the GI. Lymph node enlargement is not a feature. Metastases or direct invasion into adjacent organs may be seen in more aggressive lesions.GIST are positron emission tomography (PET) avid tumors because the receptor tyrosine kinase increases the glucose transport protein signaling. PET is useful in revealing small metastases which would not otherwise be seen on CT . GIST isIntestinal pneumatosis (IP), also referred to as intestinal emphysema, pneumatosis coli, or pneumatosis cystoides intestinalis, is a rare radiological finding, characterized by gas tracks along the bowel wall, appearing as either linear  or rounded cystic collections  that occurs in wide spectrum of clinical disorder . The smaPrimary IP (15% of cases) is a benign idiopathic condition in which multiple thin-walled cysts develop in the submucosa or subserosa of the colon. Usually, this form has no associated symptoms, and it is often called pneumatosis cystoides intestinalis .The secondary group (85% of cases) is associated with obstructive and necrotic gastrointestinal disease or with obstructive pulmonary disease.The pathophysiology of IP has been debated and two main theories have been proposed in the literature. A mechanical theory hypothesizes that gas dissects into the bowel wall from either the intestinal lumen or the lungs via the mediastinum due to some mechanism causing increased pressure or direct trauma. A bacterial theory suggests that gas-forming bacilli enter the submucosa through mucosal rents or increased mucosal permeability and produce gas within the bowel wall.Computed tomography (CT) is more sensitive than conventional abdominal radiography in the detection of this condition and in the evaluation of extension and complications. The radiological characteristic of IP at CT scan using a lung window is a low-density linear or bubbly pattern or combination of both and gas in the bowel wall. Abdominal CT scanning with or without contrast enhancement can show the morphology, distension, and thickness of bowel loops. CT scans depict additional details, such as morphologic changes, including mural wall thickening, dilatation, abnormal or absent wall enhancement, mesenteric stranding, edema or hemorrhage, vascular engorgement, ascites, and portomesenteric gas, and are helpful in determining the cause of IP .Colon ischemia (CI) is a clinical condition that results when blood flow to the colon is reduced to a level insufficient to maintain cellular metabolic function. This process implicates that colonocytes become acidotic and dysfunctional, lose their integrity, and, ultimately, die .The initial and most intense ischemic changes are always in the colonic mucosa. Ischemic change will subsequently extend from the mucosa to the serosa.The diagnosis of CI is usually established in the presence of symptoms including sudden cramping, mild, and abdominal pain; an urgent desire to defecate; and passage within 24 h of bright red or maroon blood or bloody diarrhea.CI is often classified according to the underlying cause. Nonocclusive ischemia develops because of low blood pressure or constriction of the vessels feeding the colon; occlusive ischemia indicates that a blood clot or other blockage has cutoff blood flow to the colon.CT with intravenous and oral contrast is the most helpful in the initial assessment of the patient with abdominal pain to assess the distribution and phase of colitis. It can exclude other causes of abdominal pain, suggest a location and source of ischemia, and identify complications associated with more-advanced disease . The diaMost cases of CI resolve spontaneously and do not require specific therapy, and surgical intervention should be considered in the presence of CI accompanied by hypotension, tachycardia, and abdominal pain without rectal bleeding; for pan-colonic CI; and in the presence of gangrene .Intussusception is the prolapse of a bowel loop with its mesenteric fold into the lumen of a contiguous segment causing intestinal obstruction. Majority of the intussusceptions are ileocolic, while the remaining are of the ileoileal or the colocolic types .Based on canalization and his consequence, intussusception is classified into three different types: cold intussusception; incomplete and reversible hot intussusception; and complete and irreversible hot intussusception.Cold intussusception is incidental and asymptomatic with no sign of bowel obstruction such as abdominal pain and obstructive symptoms.Abdominal CT with mdc with bowel distension by enteroclysis is the most sensitive radiological technique to identify intussusception. CT scans defines the presence (bowel-within-bowel) and intestinal origin of underlying masses, the site and the intestinal tract involved, mesenteric vascular impairment, involvement of perivisceral fat, surrounding tissue, and locoregional lymph nodes.There are three patterns of intussusception that are expression of different stages of the same disease: the target-like pattern ; the reniform-pattern ; and the sausage-shape pattern   Figure .Gallstone ileus is an uncommon cause of a mechanical small bowel obstruction (SBO) due to impaction of one or more large gallstones within the GI tract. Biliary-enteric fistula is the major pathologic mechanism of gallstone ileus. The gallstone enters the GI tract through a fistula between a gangrenous gallbladder and the GI tract. Occasionally a stone may enter the intestine through a fistulous communication between the common bile duct and the GI tract . It is aThe clinical manifestations of gallstone ileus are variable and depend on the site of obstruction but are frequently nonspecific with intermittent symptoms of nausea, vomiting, abdominal distension, and abdominal pain.SBO;ectopic gallstone; either rim-calcified; or total-calcified;abnormal gall bladder with complete air collection, presence of air-fluid level, or fluid accumulation with irregular wall .CT also has the capability to estimate size of ectopic gallstone, which renders decision-making in management strategy.Classically the findings on abdominal radiographs are mechanical bowel obstruction, pneumobilia, and an ectopic gallstone within bowel lumen (Rigler's triad). Contrast enhanced CT evaluation of acute SBO offers prompt and rapid diagnosis of gallstone ileus before operation. The diagnostic criteria of gallstone ileus on CT are as follows:The main therapeutic goal is relief of intestinal obstruction by extraction of the offending gallstone  Figure .Foreign bodies are any object that originates outside of the human body. Foreign bodies may be ingested, inserted into a body cavity, or deposited into the body by a traumatic or iatrogenic injury. The majority of foreign body ingestions occur in pediatric population .Most true foreign bodies can be identified radiographically; however, radiography does not always reliably detect radiolucent foreign bodies, especially fish bones. Even when fish bones are sufficiently radiopaque to be visualized on radiographs, large soft-tissue masses and fluid can obscure the minimal calcium content of the bone, particularly in obese patients. The use of a barium swallow is not recommended because of the risk of aspiration and because coating of the foreign body and esophageal mucosa with contrast interferes with endoscopic visualization.CT scan is significantly superior to radiography, with a sensitivity from 90% to 100% and a specificity of 93.7% to 100%. With CT, the shape, size, location, and depth of the impacted foreign body and the surrounding tissue can be visualized .The use of IV contrast agent has been long established for the diagnosis of foreign body related complication such as abscess, peritonitis, or fistula formation. Knowledge of these parameters is very important in the management of ingested foreign bodies. The majority of foreign objects pass without intervention and endoscopic removal and surgery are reserved for long, sharp, toxic, or pointed object .


To our knowledge this is the first systematic review of tracheal chondrosarcoma treatment outcomes. Management insights are thoroughly discussed. Men constitute 93.8% of cases, and most of these occur in the distal trachea. The most common symptom, dyspnea, occurs in virtually all patients. Extratracheal extension had occurred in 78.6% of patients. Definitive treatment with tracheal resection showed no recurrences in 10 patients with mean follow-up of 3.1 years. Adjuvant radiotherapy may be utilized for improving local control when open complete resection cannot be performed, but only after endoscopic excision of gross tumor. Tracheal chondrosarcomas are exceptionally rare, with only 17 cases having been reported in the English literature, to date. Moreover, the whole body of literature for different subsites of chondrosarcoma is also underwhelming in its discussion of advanced treatment decisions in high risk or surgically difficult areas to address, specifically multimodality treatment options. A systematic review of the current English-language literature was performed in an effort to further characterize these rare tumors and to determine treatment outcomes with different management techniques—namely, surgical excision with negative margins. Additionally, we include our own case of a 61-year-old male patient with tracheal chondrosarcoma treated with open tracheal resection and end-to-end anastomosis, without adjuvant therapy.A systematic literature review of all cases of tracheal chondrosarcoma reported in English literature was performed independently by two authors . The PubMed database, Cochrane Library, Web of Science, and Google Scholar were searched, using the medical subject heading terms of “tracheal chondrosarcoma,” “trachea chondrosarcoma”, “chondrosarcoma”, “cartilaginous tumor trachea”, “trachea”, and “tracheal” to accumulate cases reported during the time period of 1966  to January 4, 2016. We limited the search to include only cases published in the English-language literature. Inclusion criteria required a diagnosis of primary tracheal chondrosarcoma. The references included in these cases as well as those included in additional relevant articles were incorporated as references in this review. Two additional cases, one with an English abstract listed on PubMed and one referenced in several other case reports, were published in Japanese and were excluded from this study , 4. Two The description of our experience with a unique case of tracheal chondrosarcoma is detailed below, and our specific patient details are outlined in A 61-year-old morbidly obese male patient with a 4-year history of stable obstructive sleep apnea (OSA) presented to Loma Linda University Medical Center Emergency Department with a 2-day history of acute dyspnea. The patient had been experiencing progressively worsening dyspnea over the course of approximately 2 months.A neck computed tomography (CT) scan demonstrated an intraluminal tracheal mass, 2.2 × 2.1 × 1.3 cm in size, obstructing approximately 75% of the tracheal lumen . The tumInitially, the patient underwent endoscopic debulking of tumor to restore the airway and obtain pathology specimens. Approximately 75% of the gross tumor was removed at that time. Based on the final pathology report from these specimens, the patient was diagnosed with grade 1 chondrosarcoma of the trachea.Definitive treatment for this patient was open tracheal resection. Transcervical exposure with mini-sternotomy was performed and endotracheal endoscopic video-assisted methylene blue was injected transtracheally to identify the margins of the tracheal resection. Once the tracheal margins were marked and visualized externally, the innominate artery was retracted while a 4 cm tracheal sleeve, including the tumor, was resected. On gross appearance, the tumor was firm, mucosalized, and cartilaginous. Margins were clear by 1.2 cm superiorly and 1.4 cm inferiorly. The free ends of the trachea were approximated by primary anastomosis, using 2-0 and 4-0 polydioxanone sutures, placed externally submucosally in standard fashion. Grillo stitches were placed to remove tension from the trachea in case of excessive patient movement.The postoperative course was uneventful. The patient remained on a ventilator with the endotracheal tube balloon positioned distal to the tracheal anastomosis for 48 hours. He then underwent flexible bronchoscopy, which confirmed that the mucosa of the anastomosis appeared “sealed.” The patient was then weaned off the ventilator, extubated, and placed on prophylactic proton-pump inhibitor and Valsalva/anticoughing precautions with head of bed elevation. A swallow study the following day was normal, a diet was begun, and the patient was discharged on postoperative day four. The patient was alive without disease recurrence 1 year after surgery, based on follow-up CT  and in oChondrosarcomas are rare, accounting for only 0.2% of malignancies of the head and neck . These cPatients with tracheal chondrosarcoma are often asymptomatic until the tumor occludes greater than 75% of the tracheal lumen , 17. TheComputed tomography (CT) is the imaging method of choice for tracheal chondrosarcomas . CT alloBronchoscopy is the gold standard for diagnosis, as it allows for collection of pathology specimens as well as for symptomatic treatment of airway compromise via endoscopic resection or laser debulking of the tumor .Unlike chondrosarcomas of the bone and lung, chondrosarcomas of the head and neck tend to be low-grade and slow-growing, with low risk of metastasis , 24. LymThere is one reported case of tracheal chondrosarcoma, which developed distant metastases following malignant transformation of an incompletely resected tracheal chondroma into a grade 3 chondrosarcoma—a case which proved fatal even after multiple resections, 14 years following diagnosis and initial therapy .Definitive treatment for the majority of the patients in this review 11/16) was open surgical resection, with negative margins, of the involved portion of the trachea. No recurrences have been reported in this group of patients, to date. Contrastingly, recurrent disease has been reported in both of the patients (100%) who underwent endoscopic resection as definitive treatment of the tumor  was open. ExternaAs chondrosarcomas of the trachea are exceedingly rare, a review of other head and neck chondrosarcoma subsites and whole body sites with treatment analysis should also be considered when discussing treatment options. In the head and neck, one of the most common subsites for chondrosarcomas to originate is the larynx. Achieving adequate resection of these tumors while sparing laryngeal function is ideal. Endoscopic removal, thyrotomy, laryngofissure, are partial laryngectomy are laryngeal function-sparing techniques that can achieve wide excision of the tumor along with a sufficient margin of uninvolved cartilage . UnfortuAs there are no evidence-based recommendations for margin control in head and neck chondrosarcomas, broadening our discussion to include the optimal treatment for whole body chondrosarcomas warrants consideration. Recent studies of low-grade chondrosarcomas in the extremities have found that aggressive intralesional curettage, with or without cryosurgery at the margin, may be an acceptable alternative to wide excision of these lesions , 37. TheTraditionally, chondrosarcomas have been thought to be relatively radioresistant, due, in part, to their low-grade nature , 24. HowCurrently, no evidence exists to support the use of chemotherapy in the treatment of chondrosarcomas, although it is used by some in the treatment of high-grade tumors with a greater risk for metastases and should be considered in those with lymph node metastasis , 41.


Secondary or metastatic cardiac tumors are much more common than primary benign or malignant cardiac tumors. Any tumor can cause myocardial or pericardial metastasis, although isolated or combined tumor invasion of the pericardium is more common. Types of neoplasia with the highest rates of cardiac or pericardial involvement are melanoma, lung cancer, and breast and mediastinal carcinomas. Acute myeloid leukemia (AML) is the most common type of acute leukemia in adults. Initial treatment involves chemotherapy followed by consolidation treatment to reduce the risk of relapse. In high-risk patients, the treatment of choice for consolidation is hematopoietic stem cell transplantation (HSCT). Relapse of AML is the most common cause of HSCT failure. Extramedullary relapse is rare. The organs most frequently affected, called “sanctuaries,” are the testes, ovaries, and central nervous system. We present a case with extramedullary relapse in the form of a solid cardiac mass. Secondary or metastatic cardiac tumors are much more common than primary benign or malignant cardiac tumors. They usually appear after the age of 50 years in patients of either sex . MetastaAcute myeloid leukemia (AML) is a hematologic malignancy caused by the clonal transformation of a cell of myeloid lineage which proliferates abnormally, leading to the accumulation of immature myeloid cells in bone marrow (BM) and blood. AML is the most common type of acute leukemia in adults and its incidence increases with age . In younRecurrence of AML is the most common cause of HSCT treatment failure, occurring in up to 40% of patients who are refractory to first-line treatment. Extramedullary relapse is considered rare although its reported incidence varies from 0.65% to more than 20% .We report the case of a 61-year-old woman diagnosed with AML without maturation in September 2013. Conventional cytogenetic analysis revealed 46,XX. PCR analyses did not reveal NPM1 or FLT3/ITD mutation. She received induction chemotherapy with daunorubicin and cytarabine with primary refractoriness and reinduction chemotherapy with fludarabine, cytarabine, and idarubicin (FLAG-IDA) with which complete remission was achieved. Consolidation was performed with allogeneic matched-sibling HSCT in January 2014, with thiotepa, fludarabine, and busulfan conditioning. Posttransplant complications presented as cytomegalovirus infection and acute gastric graft versus host disease (GVHD). One year after HSCT, immunosuppression (IS) was withdrawn, after which the patient presented chronic GVHD of the liver and eyes, which required the reintroduction of IS with sirolimus and corticosteroids. As part of follow-up, TTE performed in October 2014 showed no evidence of structural or valvular heart disease.In August 2015 the patient was admitted to the emergency department with symptoms of malaise, fever, and pain characteristic of pericarditis. Physical examination revealed a blood pressure of 120/60 mmHg and mild 45-degree jugular venous distension. Cardiopulmonary auscultation showed decreased vesicular murmur in bases with symptoms of pleural effusion, no added noise and arrhythmic low-pitched heart sounds, and slight lower limb edemas. The electrocardiogram showed atrial fibrillation with controlled ventricular voltages and low generalized response. TTE showed left cavities of normal size and function and a dilated right ventricle (RV) with a mass of maximum diameter of 30 mm in the right atrium (RA) that hindered blood flow from the RA to the RV (mean tricuspid gradient of 8 mmHg). TTE with contrast (SonoVue) showed thickened, rigid RA walls and an anchored mass measuring 30 × 33 mm, seemingly dependent on the interatrial septum, extending to the lateral side of the RV, and moderate pericardial effusion  without evidence of hemodynamic compromise Figures . CardiacAtrial mass biopsy Figures  showed fPrevious publications have reported that leukemia can metastasize to the heart , 8, usuaThe present case once again illustrates the importance of imaging techniques and biopsy to confirm the diagnosis of any cardiac mass, taking into account neoplasms in the differential diagnosis. It also illustrates that extramedullary relapse after BM transplant for AML can, exceptionally, take the form of a solid cardiac tumor. To our knowledge, this has not been previously reported.


Lobular capillary hemangioma, or pyogenic granuloma, is an acquired hemorrhagic benign vascular lesion of the skin and mucous membranes. The pyogenic granuloma of the vulva is a rare finding and a limited number of case reports are available in the literature. To the best of our knowledge this is the first case described as a single pyogenic granuloma on the vulva. Lobular capillary hemangioma or pyogenic granuloma, as it is usually known, is an acquired hemorrhagic benign vascular lesion of the skin and mucous membranes –3. This The pyogenic granuloma (PG) of the vulva is a rare finding and a limited number of case reports are available in the literature , 4–6.A 51-year-old woman, G3P3, was sent by her attending doctor to our hospital due to an abnormal lesion on the vulvar surface. The patient reported a lesion that initially looked like a small wart but continued growing for 10 months that in the end looked like a small cauliflower. She did not complain of pain but reported that the lesion was uncomfortable and sometimes bled.On her medical history we notice hypertension and hyperthyroidism, controlled with medication. The gynecologic exam revealed a lobulated reddish malformation, ulcerated on the distal end which was located parallel to the clitoris, on the upper part of the right labia majora. The lesion was about 2 centimeters long . Her vagDuring the office visit we decided to do a wide excision under local anesthesia, and the whole lesion was removed . The speOn the follow-up appointment, one month later, the scar was well healed and the patient had no complaints. The histopathological features ruled out vulvar neoplasia and were consistent with ulcerated lobular capillary hemangioma .The term “pyogenic granuloma” was first introduced by Hartzell in 1904, and only almost eighty years later was the histological term “lobular capillary hemangioma” introduced by Mills et al. . The etin = 46), followed by the upper limb , trunk , and lower limbs  [PG is a lesion of the skin and mucous membranes and it can be seen in various locations of the body. A 10-year retrospective analysis of 86 cases from Akamatsu et al. showed that the head and neck area, including the oral cavity and nasal mucosa, were the most commonly affected sites (56%, The vulva is both a dermatologic and a gynecologic organ and, as such, may develop conditions more familiar to dermatologists than to gynecologists . UnfamilThere are various treatment options for PG: surgical excision, cryotherapy, sclerotherapy, curettage followed by electrocauterization, lasers, 5% imiquimod cream, and microembolization , 3. ReceSurgical excision and primary closure are associated with low recurrence rates among surgical treatments, being the most advised one. Besides that, it has some additional advantages, considering it is a single step treatment and the lesion can be sent to pathological evaluation . CryotheFrom the very few pyogenic granulomas of the vulva reported in the literature we only found cases of multiple PGs. So, to the best of our knowledge, ours is the first case described as a single pyogenic granuloma on the vulva.


We report a case of spontaneous superior pole renal artery dissection in a healthy forty-one year old man. Spontaneous renal artery dissection is a rare event occurring in patients with hypertension or renovascular disease such as fibromuscular dysplasia. This case demonstrates the importance of maintaining renovascular accidents as part of the differential diagnosis of abdominal pain.


The primary gastrointestinal non-Hodgkin’s lymphoma is a rare entity. Burkitt’s lymphoma (BL) is an aggressive form of B-cell lymphoma which is endemic in Africa, while in rest of the world non-endemic cases has been reported. Primary gastric BL is extremely rare and only around 53 cases have been reported till now. Here we present the case of a middle-aged male, immunocompetent who presented with anorexia weight loss and diarrhea. His upper gastrointestinal endoscopy and biopsy revealed a large primary gastric Burkitt lymphoma. After chemotherapy, he remains in remission. Burkitt’s lymphoma, a disease frequently found in children of Tropical Africa, was first described by an Irish surgeon “Denis Burkitt” in Kampala, Central Africa in the mid-1900s. It was initially believed to be a sarcoma, frequent in children of Tropical Africa.3According to the classification given by the World Health Organization, there are three types of Burkitt’s lymphoma based on clinical grounds; Endemic, sporadic and immunodeficiency associated. Nearly all cases are caused by EBV. Endemic Burkitt’s affects children between 4-7 years of age, affect males more with a 2:1 male to female ratio. Sites affected include; the bones of the jaw and face, the gastrointestinal tract, the kidneys, the ovaries, breasts, and other extra nodal sites.5Sporadic Burkitt’s lymphoma occurs globally. It accounts for 1-2% of all adult lymphomas and 40% of all childhood lymphomas in the U.S and western Europe.5A 45 years old male presented with a one-month history of anorexia, weight loss, generalized abdominal pain, dysphagia, and watery diarrhea. There were no associated comorbidities. On physical examination, there was pallor, abdominal examination revealed a vague mass which was firm and tender.9/L (4-11), neutrophils 60% (40-75), lymphocytes 22.0% (20-45%), monocytes 14.2% (2-10%), eosinophils 3.2 % (1-6), basophils 0.1% (0.1-1%), platelet count 809 x109/L (150-400). Other results included Erythrocyte Sedimentation Rate (ESR) 35mm (<25), creatinine 0.90mg/dl (0.7-1.2), LDH 436 IU (<225).Baseline full blood count revealed hemoglobin 13.0 g/dl (13.5-17.5), white cell count 7.48 x10The upper gastrointestinal endoscopy revealed a large area of mucosal growth with central ulceration. Another area of mucosal growth over lesser curvature in distal stomach.  CarbohydTwo specimens were taken for biopsy. Specimens showed High-grade Non-Hodgkin B-cell Lymphoma, Morphological and immunohistochemistry feature favors Burkitt’s lymphoma.  and 2B IPatient was treated using a third-generation chemotherapy protocol for NHL using Cyclophosphamide, Ifosfamide, Doxorubicin, Etoposide, Ara-C, Methotrexate, and Vincristine with prophylactic intrathecal Methotrexate. Complete remission after 4 cycles was documented on repeat UGIE, CT scan.Burkitt’s lymphoma being one of the most aggressive forms of B-cell NHL, with replication approaching 100% has three clinical forms; endemic, sporadic and immunodeficiency associated. The endemic variant is common in Africa, the sporadic variant is present in the U.S and Western Europe, and immunocompromised variant occurs mainly in HIV patients. The sporadic variant comprises 30% of pediatric lymphomas and less than 1% of adult NHL.6The most frequently affected site outside of lymph node involvement is the gastrointestinal tract (30-50%).The primary involvement of BL or a small non-cleaved cell lymphoma in the GI tract, although rare, has been reported in the literature. Despite gastric lymphomas being more common than intestinal lymphomas, the primary gastric involvement is extremely rare in BL. For non-endemic Burkitt’s lymphoma, the gastrointestinal tract is the most common site, followed by retro peritoneal, kidney, ovary, and testes respectively.3, which may suggest that immunity does not have a role in the matter, however, in our case study it was not the case.The exact mechanism leading to formation of Burkitt’s lymphoma is not yet known. The Epstein-Barr virus has been implicated to have involvement as it can be found in 25-40% immunodeficiency variant cases of Burkit’s lymphoma. Normal gene expression and translation process of cellular microRNA has been shown to be interfered with by Epstein-Barr virus interaction with the cellular microRNA.Burkitt’s lymphoma is a very aggressive malignancy and one of the fastest growing amongst human malignancies.Gastric Burkitt’s lymphoma is an aggressive tumor with high proliferation; we are yet to find the optimal treatment to this disease to help its poor prognosis. We have been able to hold it at bay by aggressive chemotherapy, mainly derived from pediatric treatment regiments, unspecific to Burkitt’s. Chemotherapy, rituximab and prophylactic CNS treatment should be included as part of the treatment regimens. Early diagnosis with aggressive and early treatment can give very good long term survival rates for the patients, reaching around 70-80%. However, letting the disease advance and get into older age groups can be very rapidly lethal for the patients. It is a disease which deserve great attention and as we are at the edge of breaking through into its treatment. An effort made into early detection can make a vast difference in outcome for the patient.


Polyarteritis nodosa (PAN) is a primary systemic necrotizing vasculitis with diffuse organ involvements, resulting in a high mortality rate due to multiple organ failure. Although the small bowel is the frequently targeted organ of PAN-associated vasculitis, rectal involvement is very rare, and only one case of rectal bleeding has been previously reported. The mortality rate of PAN with gastrointestinal (GI) perforation is reportedly much higher than that of without severe GI involvement. We herein report the first case of rectal perforation due to PAN, successfully managed with an adequate surgical intervention.A 66-year-old woman with PAN had abdominal pain and melena with guarding. Computed tomography scan showed abdominal free air and bubbles in the rectal hematoma. We diagnosed it acute peritonitis, and emergency surgery was performed. After removing rectal hematoma and necrotic tissue, a huge lack of rectal wall spreading to the pelvirectal space was observed. In order to totally remove the necrotic tissue, abdominoperineal resection was needed. Together with histopathological examinations which showed neutrophils and fibrinous necrosis, we finally diagnosed rectal perforation due to PAN. At 19-month follow-up after surgery, she was still healthy with a stable disease of PAN.We herein reported the first case of successfully managed rectal perforation due to PAN. Early adequate surgical resection may be important for the case with rectal perforation. Polyarteritis nodosa (PAN) is a primary systemic necrotizing vasculitis that predominantly targets medium-sized arteries defined as the main visceral arteries and their branches . DiseaseAround 40% of the patients with PAN has gastrointestinal (GI) involvements . Severe 4/uL and C-reactive protein of 7.31 mg/dL, and serum creatinine of 240 kmol/L. We diagnosed it acute peritonitis, and emergency surgery was performed. Bloody ascites and rectal hematoma with partial lack of rectal serosa were observed  had been administered, followed by 1 mg/kg/day prednisolone (PSL). Four days after the pulse steroid therapy started, she had abdominal pain and melena without guarding. Computed tomography (CT) scan showed high-density areas around the rectal wall Fig. . We diagved Fig. . Becauseved Fig. . Thus, wHistopathological examinations revealed that hematoma and abscess were observed in the rectal wall Fig. , b. In aPAN is a medium-sized vessel vasculitis disease, involving multiple organs such as the skin, heart, kidneys, and nervous system . GI invop < 0.01), though the sites of perforation were not specified. Therefore, prediction of bowel perforation may be clinically important in the management of PAN [Pagnoux and his colleagues showed six cases  presented bowel perforation, which was one of the significant prognostic factor of PAN (HR = 5.7, t of PAN . Five-Fat of PAN . Bourgart of PAN . DespiteWe herein reported the first case of successfully managed rectal perforation due to PAN. Early adequate surgical resection may be important for the case with rectal perforation.