Sclerosing mesenteritis (SM) is a rare fibroinflammatory disorder that involves mesenteric adipose tissue, more frequently localized in the small intestine, with an insidious clinical presentation having symptoms related to mass effect, usually resulting in bowel obstruction, mesenteric ischemia, as well as rapid weight loss. We report a case of a 23-year-old male presenting with palpable abdominal mass, mesogastric pain, and a history of rapid weight loss, who underwent exploratory laparoscopy. A hemorrhagic and gelatinous nodular tumor mass of the mesentery was identified and the surgical procedure was converted to a laparotomic approach. Histologically, the mass was composed of a proliferation of bland-looking spindle cells with slightly eosinophilic cytoplasm and elongated normochromatic nuclei with mild nuclear atypia, haphazardly set in a collagenized stroma; fat necrosis and inflammatory cells  were also evident. The diagnosis of sclerosing mesenteritis was made. Our case emphasizes that histology remains pre-eminent for a correct diagnosis of SM, as pre-operative radiological-based diagnosis is non-specific. Sclerosing mesenteritis (SM) is a rare fibroinflammatory disorder that involves mesenteric adipose tissue, more frequently localized in the small intestine , 2.Although the etiopathogenesis is still to be elucidated and is based on the single cases reported in the literature, an association with abdominal trauma, surgery, autoimmune conditions such as IgG4 disease, infection, ischemia, and malignancy have been suggested –5.SM has an insidious clinical presentation with non-specific symptoms related to mass effect, usually resulting in bowel obstruction, mesenteric ischemia, as well as rapid weight loss –8.Based on the predominant histological component , a wide variety of terms, including mesenteric panniculitis (MP) , mesenteWe herein report on a case of a 23-year-old male presenting with palpable abdominal mass and mesogastric pain.A 23-year-old male was admitted to our institution with a history of mesogastric pain, fatigue, loss of appetite, and rapid weight loss (about 30 kg in 1 year with a BMI reduction from 25.8 to 16.2).Abdominal examination revealed distended abdomen with a large-sized, slightly mobile, non-tender mass in the periumbilical region. Gastroscopy and colonoscopy showed unspecific findings. Medical history was negative for previous neoplastic diseases or abdominal surgery.Laboratory tests showed blood count with hemoglobin of 12.70 g/dl, a white blood cell count of 13.920 mmc and platelet count at 606.000 mmc; CRP was 3 mg/dL while ESR was 42 mm/h.Given the rapid weight loss, a clinical sign indicating malignancy, a CT scan was performed. An oval-shaped mass measuring 8.5 × 8 × 6.5 cm, with evidence of a pseudo-capsule and locoregional lymph nodes of increased volume, were observed in the mesentery .Therefore, an exploratory laparoscopy was planned. A large-sized, solid mass arising from the small bowel mesentery, with multiple hemorrhagic spots, was seen; the wall of the small intestine appeared thinned and extensive intraperitoneal adhesions were present. Laparotomic excision of the mass, with small bowel resection and primary anastomosis were performed. Post-surgical days were uneventful (Class 0 on the Clavien-Dindo Classification) and patient was discharged on the sixth day post-intervention.Grossly, a hemorrhagic and gelatinous nodular tumor mass of the mesentery, measuring 8.5 cm in its greatest dimension, was identified. Histologically, it was composed of a proliferation of bland-looking spindle cells with slightly eosinophilic cytoplasm and elongated normochromatic nuclei with mild nuclear atypia, haphazardly set in a collagenized stroma; fat necrosis and inflammatory cells  were also evident. Mitoses, including atypical forms, and nuclear pleomorphism were absent. Muscolaris propria and subserosal of the small intestine showed vascular congestion, while the mucosa of the small intestine was unremarkable. Immunohistochemical analyses, showing a diffuse staining for vimentin and smooth muscle actin, revealed the myofibroblastic nature of the lesional spindle-shaped cells . Desmin,SM is a rare fibroinflammatory disorder that involves mesenteric adipose tissue, more frequently localized in the small intestine. Rarely, it may be localized in the retroperitoneum, the peri-pancreatic region or the pelvis , 10.retractile mesenteritis” by Jura et al. in 1924 ,,retractiThe epidemiology of SM is not well-defined; autopsy studies by Kuhrmeier estimate an incidence of 1% (9/712 autopsies) , 8. SM tThe etiology of SM remains unknown; the etiopathogenetic hypotheses derive from cases reported in the literature and include association with trauma, surgery , 11, autThe association between SM and malignancies still remains a matter of debate; in favor of the association are the studies of Ogden et al.  and of JSymptoms are highly non-specific and include: abdominal pain, weight loss, presence of palpable mass, as shown by our patient, as well as fever, nausea and vomiting . Our patThere are no specific laboratory tests for SM; in most of these patients there is an increase in inflammation indices, such as erythrocyte sedimentation (ESR) rate and c-reactive protein (CRP) ; values The advent of the CT scan has improved radiological diagnostics of SM, although the differential diagnosis with malignancy can be very difficult, especially when locoregional lymphadenopathies are present, as in our case. Signs of specificity are represented by the “fat ring sign” and by the presence of a pseudocapsule , 18–20.Coulier proposed criteria for diagnosing SM: a mesenteric mass (1) causing a mass effect without invasion of surrounding structures, (2) high attenuation , (3) mesenteric fat containing small (10 mm) soft tissue nodes with (4) hypo-attenuating fat surrounding the lymph nodes or mesenteric vessels  and (5) an over-attenuating pseudocapsule surrounding the absence of ascites or known neoplasm involving the mesentery . These cDespite the improvement in imaging methods, the histological evaluation of biopsy and surgical samples remains the gold standard for the diagnosis of SM. Grossly it may present as a single mass, multiple nodules, or as a diffuse mesenteric thickening .Histologically it is characterized by a variable admixture of fibrosis, chronic inflammation and fat necrosis.Kipfer proposed a classification of SM into three subgroups. Type I SM (diffuse mesenteric thickening): thickened mesentery up to 10 cm. The thickening typically ended within 3–5 cm of the mesenteric border. Type II SM (single discrete tumor): often localized in the jejunal mesentery. The mass can be smooth or multi-lobular, firm, or rubbery consistency. Type III SM: multiple nodules with the same consistency and features as describes in type II . Our patSome authors have emphasized the link between SM and IgG4 disease, by showing the presence of IgG4 positive plasma cells in the context of SM; histologically, in these cases there is also the presence of storiform fibrosis and obliterative phlebitis , 22, 23.The main differential diagnoses of SM revolve around GIST  and mesenteric fibromatosis. GIST, the most common mesenchymal tumor of the gastrointestinal tract, is more cellular than SM, and it is characteristically stained with CD117, CD34, and DOG-1, markers that were negative in our case. Unlike desmoid-type fibromatosis, SM lacks a fascicular arrangement with parallel aligned cells, as well as the expression of β-catenin , 25. MalNo consensus has been reached regarding the management of SM; as far as medical treatments are concerned, the use of corticosteroids, tamoxifen, thalidomide, colchicine, infliximab, azathioprine, and cyclophosphamide has been proposed with variable results . In caseThe prognosis of SM is generally excellent, with the painful symptoms subsiding and the mass reducing in size in most patients , 3. For Our case emphasizes that histology remains prominent for a correct diagnosis of SM, as preoperative radiological-based diagnosis is non-specific. When the radiologist is faced with a mesentery mass of the small bowel, SM should be included in the differential diagnosis, in view of its benign clinical behavior and different management, compared to the most common neoplasms arising in the same site.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. The patients/participants provided their written informed consent to participate in this study.EP drafted the manuscript. CD'A, MP, and CCa provided the clinical information of the patient. GM, CCo, and LM edited the manuscript. All authors were involved in the clinical care of the patient and approved the final version of the manuscript at the time of submission.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Malignant pheochromocytomas are rare endocrine tumors that develop within chromaffin tissue. The diagnosis of malignancy is based on neoplastic recurrence or the presence of metastasis in organs that lack chromaffin tissue. We report a series of four cases because of their diagnostic and therapeutic particularities.we describe four clinical cases of patients with malignant pheochromocytoma whose Menard triad “headache-palpitations-sweating” was present in three out of four patients, the methoxylated derivatives were measured in 4 patients, 3 of which had high values, all of our patients carried out a CT scan which objectified signs of malignancy, MRI was performed on a single patient; presenting with a neoplastic recurrence; looking for a locoregional invasion.Pheochromocytoma (PC) is a rare neuroendocrine tumor derived from the chromaffin cells of the adrenal medulla. Its annual incidence is 2 to 8 per million adults. A peak frequency is observed between 30 and 40 years of age. Approximately 10% of pheochromocytomas are malignant and in 10% of cases, bilateral localization is observed. Criteria for malignancy include the invasion of neighboring organs, a large tumor, the presence of lymphadenopathy on imaging, or fixation on scintigraphy. Surgery for MAP is not always curative. In the case of multiple liver metastases, treatment is based on adrenalectomy, which can be effectively combined with chemoembolization, cryoablation, or radiofrequency techniques.The main prognostic factors of the malignant pheochromocytomas are a large tumor volume, the existence or number of visceral metastases, and the presence of a mutation in the SDHB (Succinate dehydrogenase B) gene. •Malignant pheochromocytomas are rare endocrine tumors that develop within chromaffin tissue.•A very large part of pheochromocytomas are of genetic origin which can be part of hereditary syndromes.•Criteria for malignancy include the invasion of neighboring organs, a large tumor, the presence of lymphadenopathy on imaging, or fixation on scintigraphy.•Adequate management of this pathology requires a multidisciplinary consultation meeting The prevalence of malignant pheochromocytomas is estimated at 10%, this figure can vary between 5 and 26%, the malignancy of the tumor is judged at first diagnosis or recurrence ..17].The main prognostic factors are a large tumor volume, the existence or number of visceral metastases, and the presence of a mutation in the SDHB (Succinate dehydrogenase B) gene .Treatment is usually multimodal. It is based on excisional surgery , pharmacological (drug) control of hormonal symptoms, and systemic treatments.Preoperative pharmacological preparation aims to prevent the deleterious consequences of the inevitable catecholamine discharges during surgery. The reference treatment is based on alpha-blockers, administered 7 to 14 days before the operation .Surgery for MAP is not always curative. In the case of multiple liver metastases, treatment is based on adrenalectomy, which can be effectively combined with chemoembolization, cryoablation, or radiofrequency techniques.In cases of metastatic or unresectable MAP, surgical debulking may be discussed for symptomatic purposes, although it would not improve survival .Chemotherapy may be offered to treat metastatic or recurrent malignant pheochromocytoma. The most common combination of chemotherapy drugs used is the CVD protocol, which includes cyclophosphamide (Procytox), vincristine (Oncovin) and dacarbazine (DTIC) .Active monitoring or delayed treatment may be indicated for inoperable patients with a median survival greater than 10 years. This monitoring is based on clinical and radiological examination . Three arguments prohibit active surveillance, including hormonal disturbance, high tumor volume , or radiological progression .4Malignant pheochromocytoma is rare, the diagnosis of malignancy may be made preoperatively or immediately postoperatively, but sometimes it is made several years after the initial diagnosis, hence the need for life-long monitoring of patients operated on for pheochromocytoma.PCpheochromocytomaMAPmalign adrenal pheochromocytomaNEM2(multiple endocrine neoplasia 2)MNmetanephrineCTcomputed tomographyMIBGmétaiodobenzylguanidineVMAvanillylmandelic acidNot commissioned, externally peer-reviewed.Ethics and consent to participate to the Declarations: Not applicable.The consent to publish this information was obtained from study participants. We confirm that the proof of consent to publish from study participants are available when requested and at any time.The datasets in this article are available in the repository of the urology database, CHU Ibn Rochd Casablanca, upon request, from the corresponding author.Not applicable.Dr. IJ, Dr. AM, Dr. YL, Dr. GM analysed and performed the literature research, Pr. MD, Pr. AD, Pr. RA performed the examination and performed the scientific validation of the manuscript. IJ was the major contributors to the writing of the manuscript. All authors read and approved the manuscript.The authors state that they do not have competing interests.


Escherichia coli was confirmed in the lesion by immunohistochemistry and polymerase chain reaction. Only 12 cases of cervical malacoplakia have been reported to date. This condition should be included in the differential diagnosis of cervical tumors. Malacoplakia is an uncommon chronic granulomatous inflammation that rarely affects the female genital tract. A case of a 78-year-old woman with malacoplakia involving the uterine cervix and the vagina is described. The patient complained of vaginal bleeding. Clinically, a 13-mm mass was detected in the cervix, which was confirmed by ultrasound scan and magnetic resonance imaging. Histological examination showed a dense histiocytic infiltrate with abundant Michaelis–Gutmann bodies involving the uterine cervix and the upper vagina. The presence of  Escherichia coli. Although malacoplakia is usually subsequent to infections, it has been described in association with malignant tumors [Malacoplakia is an uncommon chronic granulomatous condition that usually affects the urinary tract. It was first described by Michaelis et al. in 1902 [Histologically, the lesion is characterized by the presence of large histiocytes, some of which contain pathognomonic Michaelis–Gutmann (MG) bodies. These structures are nucleus sized, basophilic bodies containing calcium, sometimes with a laminated structure and a bull’s-eye appearance. The histiocytic infiltrate is usually accompanied by a mixed inflammatory infiltrate composed of plasma cells and leukocytes.Malacoplakia of the female genital tract is a rare disorder with less than 40 cases having been described to date ,17,18,19A 78-year-old woman complained of vaginal bleeding that had persisted for one month that had not resulted in anemia (hemoglobin 122 g/L). The patient had a history of Sjögren’s syndrome treated with corticoids, a pulmonary thromboembolism 3 months before, and had cognitive deficit secondary to an episode of cerebral ischemia. The vaginal bleeding was confirmed by the caretakers.The gynecological examination was limited due to pain. The ultrasound examination showed a 14 × 7-mm mass located in the posterior lip of the uterine cervix, with no other pathologic findings. A Pap-smear test and biopsy samples from the cervix and vagina were taken. The Pap-smear showed abundant large histiocytes and glandular cells with mild, non-specific atypia . The cerA total hysterectomy was performed due to clinical suspicion of cervical cancer. Macroscopically, the cervix showed a yellowish and indurated lesion with poorly delimited margins, involving the whole uterine cervix and extending focally to the upper vagina .E. coli was detected using a mouse monoclonal antibody  following the manufacturer’s protocol. Immunohistochemistry was performed with the Autostainer Link 48 automated system  using the EnVision system (Dako) and magenta as chromogen.The specimen was fixed in 10% neutral buffered formalin and embedded in paraffin following routine procedures. Paraffin sections were stained with hematoxylin and eosin, periodic acid-Schiff (PAS), and von Kossa. E. coli was performed in paraffin-embedded tissue. For DNA extraction, 10 µm thick sections of formalin-fixed, paraffin-embedded tissue were incubated overnight in 20 μL of proteinase K solution (1 mg/mL) at 56 °C. Subsequently, proteinase K was heat inactivated by incubation of the sections at 95 °C for 10 min, and samples were spun and cooled down at −20 °C for 1–2 min. DNA was isolated using a commercially available kit . DNA yields were quantified spectrophotometrically using the NanoDrop ND–1000 . Detection of E. coli was performed using specific primers and probes . The LightMix® modular assay was run in a LightCycler® 480 II instrument . PCR cycle threshold values > 37 were considered negative.A polymerase chain reaction (PCR) for E. coli bacilli were identified . Immunohistochemically, abundant intracytoplasmic entified . AdditioThe patient was asymptomatic 13 months after surgery.Malacoplakia is an uncommon inflammatory process which usually involves the genitourinary tract. The presentation as a primary lesion in the female genital tract is rare, and less than 40 cases have been reported to date ,17,18,19E. coli, the microorganism most commonly identified as causing malacoplakia, was detected immunohistochemically and by PCR in the lesion, confirming the diagnosis. This is the first malacoplakia of the uterine cervix in which the responsible microorganism was identified by immunohistochemistry. In the previously reported cases, E. coli infection was confirmed in two patients by tissue and urine culture [The diagnosis is based on microscopic findings of macrophages with MG bodies, which can occasionally be identified in Pap smears ,6,16,17. culture ,18. In t culture .Due to the few cases reported, the clinical management remains unclear. In the present case, the decision of performing a hysterectomy in the absence of a histological diagnosis was based on the evidence of a cervical mass in the imaging exams , together with the serious limitations to the clinical evaluation and her advanced age. It was thus considered that the advantages of solving the clinical symptoms and excluding/confirming a malignant tumor exceeded the risks of possible overtreatment. In this respect, it is interesting to note that, as clearly shown in In summary, malacoplakia is an inflammatory alteration that can mimic or can be associated with a malignant tumor; in light of this, it is important remember that malacoplakia of female genital tract exists.


It is a rare cardiac malignant primary tumor that seems to derive from the same cellular line as myxomas, but the prognosis is very different. It is a rare cardiac malignant primary tumor that seems to derive from the same cellular line as myxomas, but the prognosis is very different. It is a rare cardiac malignant primary tumor that seems to derive from the same cellular line as myxomas, but the prognosis is very different. Cardiac myxosarcoma is a rare neoplasm that appears to rise from the same cellular source like myxoma. It is difficult to differentiate a myxoma tumor from a myxosarcoma tumor because of its appearance and pathology examination. Myxosercoma tumor requires surgery and chemoradiotherapy, but myxoma is treated only by surgery.We describe a case of a 58-year-old patient with a left atrium myxosarcoma, presenting with congestive heart failure. Transthoracic echocardiogram (TTE) showed a large polypoid and mobile mass in the left atrium, the patient underwent cardiac surgery and the tumor was successfully extracted, and histopathological result revealed typical features of myxoma. 15 days after surgery, he underwent explorative laparatomy because of progressive GI bleeding. Laparatomy revealed extensive metastatic masses in abdomen and the pathology diagnoses was myxosaroma. Unfortunately, in spite of supportive care, the patient expired on postoperative day one.It is difficult to differentiate a myxoma tumor from a myxosarcoma tumor because of its appearance and pathology examination. Maybe magnetic resonance imaging can help us to achieve more data suggesting malignancy. Primary cardiac tumors are extremely uncommon, with incidence of 0.001 to 0.3% . Most ofA 58-year-old man was admitted to our hospital who complained of progressive exertional dyspnea for one month, chest pain and lower GI bleeding in November 2018.The patient had past medical history of hypertension and GI bleeding. His vital signs were stable. On physical exam, conjunctiva was pale. Lungs auscultation was clear. Cardiovascular exam showed tumor plop sound at the apex. Abdominal exam was normal. Laboratory findings were as follows: WBC 11.3 K/ul, Hb 7.9g/dl, Hct 23.8 %, platelets 500K/ul. Electrolyte panel findings were as follows: Na 141 mmol/L, K 4.0 mmol/L, Urea 35 mg/dl, Cr 1.27 mg/dl. ECG showed sinus rhythm .Transthoracic echocardiogram (TTE) revealed EF 60%, mild mitral regurgitation and a large polypoid and mobile tumor (120 mm*30 mm with strand like particle on it) in the left atrium .The patient underwent median standard sternotomy and exploration. A large, 10 cm × 4 cm mass was located in left atrium, attached via to the pulmonary vein. The mass was extracted, and histopathological result revealed typical features of myxoma .After the operation, the patient was sent to intensive care unit. After ten days, the patient was discharged from the hospital. The control post operation echocardiography was normal.15 days later, the patient came to the emergency room with pleuritic chest pain, illness, fatigue and anemia (Hb=7.7). TEE disclosed moderate MR  and no pericardial effusion. Endoscopy showed small size sliding hiatal hernia and gastritis. However, the treatment for GI signs did not improve the patient's complaints. Abdominal pain and vomiting developed gradually. And GI bleeding occurred again. The patient underwent endoscopy and colonoscopy that was suspicious to obstruction. He underwent exploratory median laparatomy. Opening the abdomen, we could see extensive metastatic masses in liver and invagination was found because of a 5 cm mass, 10 cm to ligamentum teres. The pathology diagnosis was myxosaroma involving small intestine from serosal layer up to mucosa, lymphovascular invasion was present and margins were involved , 6.The mass and metastases specimen were removed and sent to pathology. Loss of consciousness, headache and blurred vision occurred 5 hours after surgery. The patient underwent brain scan computed tomography (CT) .Brain CT Scan showed multiple hemorrhagic mass like structure are seen in left frontal lobe and bilateral occipital lobes. Posterior shift of midline structures is seen at the level of third ventricle, about 1mm to the left side Possibility of hemorrhagic metastasis should be considered alongside primary hemorrhagic stroke. Unfortunately, in spite of supportive care the patient expired on postoperative day one.This case illustrates an uncommon, malignant case of a left atrial myxosarcoma with rapid progression of symptoms which proved fatal. Myxosarcoma is an uncommon type of primary cardiac malignant tumor -3. Only


Background: Coarctation of the aorta (CoA) is the congenital constriction or narrowing of the aortic lumen. These constrictions are primarily located in the descending aorta causing significant discrepancies in systolic blood pressures of the upper and lower extremities. Thus, a delay in diagnosis and treatment may lead to severe and adverse consequences.Case presentation: Herein, we present a 13-year-old boy with anterior cerebral rupture following a delayed diagnosis for descending CoA. Percutaneous transluminal balloon dilatation and endovascular stent implantation were urgently and successfully performed alongside cerebral clipping of the vascular aneurysm.Conclusion: An early diagnosis is crucial for CoA's successful treatment and management to prevent complications, including anterior cerebral rupture. Coarctation of the aorta (CoA) is one of the most common congenital heart disease malformations and represents a spectrum of aortic narrowing that varies from a discrete entity to tubular hypoplasia . NotablyClinically, CoA is a congenital cardiac malformation that is often misdiagnosed despite specific physical findings ; therefoWe present a 13-year-old boy with an anterior cerebral rupture following a delayed diagnosis for descending CoA. Percutaneous transluminal balloon dilatation and endovascular stent implantation were urgently and successfully performed alongside cerebral clipping of the vascular aneurysm.A 13-year-old boy was referred to the local hospital with a 6-month history of headache and dizziness with no obvious predisposing causes. He denied any familiar history of hypertension, psychosocial history including genetic information, or other cardiac health comorbidities. Nonetheless, the local physician prescribed Amlodipine  for hypertension treatment. The patient was eventually transferred to our center with an explosive onset of headache, vomiting, dyspnea, and fatigue. Physical examination showed normal body development. The upper and lower limbs' blood pressure was 200/130 and 98/78 mmHg, respectively. A heart rate of 85 bpm with significant pulsation in the suprasternal fossa was detected. A systolic murmur was audible at the paravertebral area. Radial pulse was palpable, whereas the dorsal pedal artery was not.Electrocardiogram results showed sinus rhythm, incomplete right bundle branch block, and potential ventricular hypertrophy. Chest X-ray showed no remarkable findings with a standard cardiothoracic index. However, transthoracic echocardiography showed a peak systolic gradient of 64 mmHg at the coarctation site of the descending aorta. A hypoplastic artery was also noted distally to the coarctation (13 mm). Cerebral computed tomography scan and angiography (CTA) were performed to detect the cause of headaches and dizziness. The results indicated an aneurysmal rupture of the anterior cerebral artery. A cardiac CT scan was further performed, and a 3 mm coarctated descending aorta , arrow, The postoperative outcomes were satisfactory. The blood pressure was also significantly alleviated on both upper and lower limbs. Systolic and diastolic blood pressures were at 116/77 and 123/79 mmHg, respectively. The constricted segment of descending aorta was dilated up to 16 mm, which was detected by the chest CTA 3 days after the endovascular procedure . The patCoA, a fundamental cause of secondary hypertension and discrepant upper and lower extremity pulse, is a treatable congenital malformation. Patients often complain of headaches, leg fatigue, or claudication . The preSevere discrepant hypertension, aortic dissection, stroke, and congestive heart failure are common complications in patients without timely therapeutic intervention or delayed therapy . OptionaIn addition, a prolonged afterload increase in the left ventricle would accelerate ventricular remodeling and heart failure. Thus, early diagnosis and CoA treatment are of the utmost importance. In the study by Rao , an expeThe patient in the case herein was diagnosed with CoA. The craniocerebral aneurysm might have resulted from the prolonged and recurrent hypertension secondary to the constricted descending aorta. It is pivotal to note that crucial aspects of the present study were limited, given that CoA patients are predisposed to intracranial aneurysms (IAs) and asymptomatic until rupture occurs, with an overall mortality rate of ≈45% . ApproxiHowever, if the patient was diagnosed early and prompt surgical therapeutic management of the descending aortic malformation was performed, aneurysmal formation and rupture detected in the present case could have been averted. Thus, we appeal to local healthcare authorities to organize related medical staff training to strengthen awareness and improve physician's diagnostic skills. Finally, professional and public medical education concerning CoA is undoubtfully essential and should be emphasized in developing countries.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by the Ethics Committee of the Second Xiangya Hospital of Central South University. Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin. Written informed consent was obtained from the participants' legal guardian(s) for the publication of this case report.KQ and CF drafted the manuscript. CF and JY designed the study. KQ, CI, CF, and JY revised the manuscript. KQ, MT, and JY were responsible for the collection of data or analysis. All authors read and approved the final manuscript.This work was supported by the Key Project of Science and Technology of Hunan Province (Grant No. 2020SK53420 to JY).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Objective: To describe the findings of an unusual splenic tumor in a kitten. Methods: A grossly multinodular mass arising from the splenic capsule of a 7-month-old male Havana kitten was echographically detected and surgically removed by splenectomy, then analyzed microscopically and ultrastructurally. Results: The mass showed features of an inflammatory myofibroblastic tumor. Treatment and Outcome: Two months after surgical excision, the mass recurred in the same intra-abdominal area but disappeared after 2 months of anti-inflammatory therapy. Follow-up at 18 months after surgery revealed resolution of the disease. Clinical Relevance: Inflammatory myofibroblastic tumor in cats have been rarely reported and are usually in the orbital region. In the present report, an unusual multinodular gross presentation, a recurrence over time, and a favorable clinical course, are described. This leosarcoma ,9. The cosarcoma , anemia,osarcoma . Primaryosarcoma  even of osarcoma . When suosarcoma . Histoloosarcoma , in an iosarcoma .In veterinary medicine, the disease has been diagnosed as IMT only in a few canine cases, and similar lesions have been described under the name of (inflammatory) pseudotumor in the dog, cat, horse, bushbaby, and brush-tailed porcupine ,11. MostIn this article, we report the clinical, microscopic, and ultrastructural description of a case of intra-abdominal multinodular recurrent myofibroblastic proliferation with an inflammatory component in a cat.Mycobaterium spp.A 7-month-old, cryptorchid male, FIV-FeLV-negative, Havana kitten was presented for mild weakness, inappetence, abdominal distention, and occasional vomit. Familiar history reported the death of a brother-mate for an abdominal mass of unknown origin. Physical examination evidenced a mass at abdominal palpation of the cranial abdomen. An abdominal ultrasonography revealed the presence of multiple, up to 5 cm in diameter, hypoechogenic nodules adjacent to and sharing the blood supply with the spleen. Thoracic radiograph and general blood tests (hematology and biochemistry for liver and kidney) were unremarkable. Cytology of the nodules detected the presence of a slightly atypical spindle cell population in a markedly hematic background and a mixed mainly eosinophilic infiltrate. After 1 week, the cat underwent exploratory laparotomy and subsequent splenectomy. Approximately 15 contiguous, variably-sized (1–5 cm), well-demarcated, soft, red nodules were attached to the splenic capsule on the parietal and visceral surfaces of the distal extremity of the spleen . GrosslySoon after surgery, the spleen was fixed with 10% neutral buffered formalin, paraffin embedded, and processed for routine histology and immunohistochemistry. Immunohistochemistry was performed on sections mounted on TOMO® Adhesion Microscope Slides  and dried at 37 °C for 30 minutes. All samples were tested with a semi-automated immunostainer , which included dewaxing and rehydration, antigen retrieval with CC1 , primary antibody incubation, antigen detection with an ultraView Universal diaminobenzidine (DAB) kit  for 8 minutes, and counterstaining with modified Gill hematoxylin for 8 minutes. Finally, slides were manually dehydrated through a graded series of alcohols and mounted . Primary antibody dilutions were performed using a commercial antibody diluent . The following antibodies were used: VWF , desmin , GFAP , calponin , vimentin , panCK , SMA , HLA-dr , and Iba1 . 2). The spindle cell component was multifocally associated with proliferation of small capillaries, wide cystic spaces filled with red blood cells, and occasional mild hemorrhages. Spindle cells were admixed with disseminated inflammatory cells represented by eosinophils and scattered mononuclear cells resembling histiocytes  , and desAt TEM, the atypical spindle cells showed cytoplasmic microfilaments referable to contractile filaments . EosinopAfter 2 months from surgery, the cat was submitted to a follow up visit, he was asymptomatic but a new abdominal nodule near the splenic area was detected via an ultrasound examination. The nodule appeared 13×14 mm in diameter and its architecture did not reveal any pre-existing structure. At the same time, a moderate lymphadenomegaly of the cranial mesenteric, and cranial and caudal colic lymph nodes was detected. Cytological examination of this neoformation confirmed the presence of the same spindle cell population  observedThe present article reports the unusual presentation and outcome of a myofibroblastic proliferation with an inflammatory component arising from the splenic capsule of a 7-month-old kitten, detected by abdominal ultrasonography, and treated by splenectomy and long-term medical therapy with steroids.Most splenic masses in cats are represented by primary and metastatic neoplasia, including mastocytoma, lymphoma, myeloproliferative disease, and hemangiosarcoma . SplenicFinally, despite local recurrence, medical treatment with long-term steroids after splenectomy appears to be able to control the disease, with an absence of peritoneal nodules on post-mortem examination after 18 months from the initial diagnosis.We described the clinical presentation, macroscopical, microscopical, and ultrastructural features of a recurrent, extra-orbital, extra-pulmonary IMT-like lesion in a cat unlikely to be associated with an infectious agent. The distinctive cell population in IMTs, both in humans and in animals, is represented by spindle cells of myofibroblastic origin mixed with an inflammatory population characterized mainly by eosinophils and histiocytes; the latter are typically diffusely disseminated throughout the mass and intermingled with the myofibroblastic cells, while eosinophils are usually also scattered but with variable density throughout the tumor. Compared to other cases described in veterinary medicine, the present case is peculiar for the unusual gross presentation with multiple concurrent nodules and for the recurrence.


Chordoid glioma is a rare intracranial tumour, which usually occurs in middle-aged female patients, mainly in the third ventricle, hypothalamus and suprasellar region. It can reportedly occur in the temporal–parietal lobe, occipital horn of the lateral ventricle and left thalamus. Here, we report a case of chordoid glioma in the thalamic region of a female child, which is different from the previously reported chordoid glioma in the left thalamus. Given its atypical location and imaging findings, it is often misdiagnosed as low-grade glioma before operation. Through the study of this case, we recognized the atypical imaging manifestations of chordoid glioma in a rare location. Here, we report the case of a 10-year-old child with chordoid glioma in the right thalamic region. CT and MRI findings are not consistent with the typical third ventricular chordoid glioma and the chordate gliomas of the left thalamus reported by Kim et al..7Chordoid glioma is a rare intracranial tumour. It was first proposed and named by Brat et al. in 1988. In 2016, it was listed under “other types of gliomas”, class II, in the latest World Health Organization (WHO) classification of tumours of the central nervous system.A 10-year-old female child was hospitalized on 2 September 2015 with a paroxysmal headache that had persisted for 2 weeks. The physical examination on admission showed that the patient was lucid and demonstrated language fluency, but was otherwise uncooperative during the physical examination. There was no hoarseness, choking when drinking water or difficulty swallowing. There was no atrophy or hypertrophy of the overall body muscle, the muscle tension of the extremities was normal, and the muscle strength of the extremities was Grade 5. The bilateral finger nose and calcaneal knee tibia tests were stable and accurate. The bilateral Babinski sign was negative, the neck was soft and the Kirschner sign was negative.CT revealed a low-density oval mass in the right thalamus . MRI exaThe patient underwent resection of the right thalamic space-occupying lesions via a transcortical, right lateral ventricle approach under general anesthesia on the morning of 8 September 2015. On the second day after surgery, CT showed that most of the tumour had been resected, and there was some bleeding in the surgical area .Postoperative pathology showed that the tumour cells were sparse, the arrangement was dense, the heterotype was not obvious, the blood vessels did not proliferate obviously, some of the tumour cells degenerated, and the interstitial myxoid was degenerated . ImmunohThe patient had recovered well by the 23rd day after the operation and mentioned no particular discomfort. Physical examination showed that the patient could speak clearly and cooperated with the physical examination. The head incision healed well. Pupil dilation occurred evenly across both eyes; the patient showed direct and indirect light reflex, and eye movement was normal. Muscle tension was normal, muscle strength in both limbs was Grade 5, and the bilateral pathological reflex was negative. The patient was discharged in a stable condition.8 as well as studies by other researchers have reported that the tumour is located in the third ventricle and has ependymal differentiation and an ultrastructure similar to that of secretory ependymal cells, so it may be a subtype of ependymoma. Romero-Rojas et al9 suggested that the positive expression of CD99 indicates that a given tumour originated from ependymal cell differentiation, which indirectly confirms Brat et al.’s report. However, Sato et al10 found that the ultrastructure of chordoid gliomas shares greater similarity to that of embryonic elongated cells, which suggests that notochordal glioma may originate from elongated cells, but genes related to tumourigenesis have not been identified.The origin of chordoid glioma is not clear. Brat et al,7 respectively. The principal cause of signal variability was that the tumour was composed of epithelial-like cells arranged in clusters and stripes buried in the mucus-rich matrix, such that the number of clusters and stripes also changed the signal. When the epithelioid cells were dominant, the T2W images were mainly isointense and featured a low signal. When the mucus-like matrix was dominant, T2W images were visibly high signal. The main enhancement scan showed readily visible enhancement. The MRI findings of this case differed from those of typical chordoid gliomas. The main manifestations were cystic solid mass, cystic degeneration, cystic central solid nodules and enhanced nodules. Pathology showed that some of the tumour cells had undergone degeneration and interstitial myxoid degeneration, which was consistent with the observations made via MRI.Typical chordoid gliomas are often solid masses that occupy the third ventricle, and a few of them may be complicated with cystic degeneration. The tumour signal is changeable. On MRI images, 63% of chordoid gliomas showed isointensity in T1W images, and the ratios of high signal, isointense signal, and low signal in T2W images were 42%, 37%, and 21%,Chordoid glioma in the thalamus is different from pilocytic astrocytoma. Pilocytic astrocytoma usually occurs in adolescents and children, and it most commonly occurs in the cerebellar hemisphere. The main manifestations of MRI are large cysts and small nodules, and the nodules are located in the cyst wall.11The ideal treatment of choroid glioma is gross total resection (GTR) of the tumour, but because of its deep location, it is difficult to remove the tumour and the incidence of postoperative complications is very high, so subtotal resection (STR) is often chosen. It has been suggested that adjuvant γ knife radiosurgery (GKRS) following planned STR may be a safe, effective and minimally invasive strategy for choroid glioma in patients at high risk for the GTR of tumours.We reported a case of chordoid glioma in a rare location in a child. The patient’s imaging findings differed from those of a typical chordoid glioma.Chordoid glioma is a rare intracranial tumour, which usually occurs in middle-aged female patients – mainly in the third ventricle, hypothalamus and suprasellar region.The reason for the observed signal variability is primarily due to the fact that the tumour is composed of epithelial-like cells arranged in clusters and stripes buried in the mucus-rich matrix; therefore, the number of the two components also leads to signal changes.Through the study of this case, we recognized the atypical imaging manifestations of a chordoid glioma in a rare location.Highlights:


A 20‐year‐old grey Warmblood gelding that had history of dermal melanomatosis.To report surgical treatment of a 6‐cm large malignant metastatic melanoma located in the cutaneous trunci muscle of the left lateral thorax of a horse.A 20‐year‐old grey Warmblood gelding was referred for evaluation of a large, rapidly growing, thoracic mass. Clinical examination revealed an ovoid, firm, non‐painful, movable mass, approximately 6 cm in diameter, located in the cutaneous trunci muscle of the left lateral thorax. Multiple melanocytic nodules were also found at the perianal region and ventral tail. Rectal examination, ultrasonography and endoscopy of the respiratory tract revealed no melanomas internally. Haematological and biochemical values were within normal limits. Surgical excision of both the thoracic mass and perianal nodules was the treatment of choice. Histopathology of the distant thoracic mass confirmed the diagnosis of malignant metastatic melanoma secondary to the perineal lesions that were confirmed as dermal melanomatosis.The horse recovered uneventfully. Up until 3 years post surgery there was no tumour regrowth at the excision sites.Surgical excision of the metastatic melanoma was performed and considered successful, with no gross evidence of tumour reoccurrence. Despite the fact that surgical excision is considered a treatment option regarding equine dermal melanomatosis, there is no previously published study proposing surgical removal of distant malignant metastatic melanocytic masses. This is the first report of a successful surgical excision of a large (6 cm) metastatic melanocytic tumour from the skeletal muscle of the lateral thorax of a horse. A 20‐year‐old grey Warmblood gelding was referred for evaluation of a large, rapidly growing, thoracic mass. Histopathology of the distant thoracic mass confirmed the diagnosis of malignant metastatic melanoma. Surgical excision of the metastatic melanoma was performed and considered successful, with no gross evidence of tumour reoccurrence.This report proposes surgical excision as a treatment option for distant malignant metastatic melanocytic masses in skeletal muscle. It affects over 80% of aged grey horses  metastatic malignant melanocytic tumour of stage four, located in the cutaneous trunci muscle of the left lateral thorax.2A 29‐year‐old grey Warmblood gelding (550 kg) was presented for evaluation and treatment of suspected melanocytic nodules at the perianal region and the ventral surface of the tail as well as for examination of a rapidly growing, 6 cm large mass at the lateral thorax.Three years prior to referral, the owner had noticed multiple nodular lesions around the horse's anus and the base of the tail, as well as signs of dyschezia. A definitive diagnosis of dermal melanomatosis had been histologically confirmed and tumour masses had been surgically removed with the horse in standing position. Post‐operatively, the gelding had been unsuccessfully treated with oral cimetidine (2.5 mg/kg bwt TID) for 4 months. New tumours had developed near the excision sites and two additional surgeries, with one‐year intervals, were necessary for the alleviation of clinical sings. Three weeks prior to presentation the owner had noticed a growing mass at the thoracic musculature.3Upon clinical presentation, the horse was bright, alert, responsive and in good condition (body condition score 7/9). Clinical and haematological parameters were within normal limits. An ovoid, firm, well‐circumscribed, non‐painful, movable mass, measuring 6 cm × 5 cm × 4 cm, was palpable in the musculature of the left lateral thorax, 10 cm dorsal to the olecranon and 5 cm caudal to the caudal border of the scapula  laser and were allowed to heal by second intention.Masses on the ventral tail were evaporated with the use of carbon dioxide , malignant, metastatic, melanocytic mass from a skeletal muscle of the lateral thorax. Equine melanomatosis commonly affects grey horses and many therapies have been suggested regarding the prevention and cure of this disease. Still, none is uniformly accepted. Treatment modalities concerning melanocytic tumours and in particular distant malignant metastatic masses need to be further studied and investigated. This report proposes surgical excision as a treatment option for distant malignant metastatic melanocytic masses in skeletal muscle.The client‐owned animal was treated by routine surgery after informing the client of inherent risks. The client consented to surgery and histopathological diagnosis of tissue recovered from the animal.No conflict of interests has been declared.N. Diakakis, P. Tyrnenopoulou, T. Billi and V. Karadima performed the surgery. G.D. Brellou and E. Apostolopoulou performed histopathological specimen interpretation. All authors contributed to the writing of the manuscript.Theodora Billi: Data curation; Investigation; Visualization; Writing‐original draft; Writing‐review & editing. Vasiliki Karadima: Data curation; Investigation; Visualization. Panagiota Tyrnenopoulou: Data curation. Emmanouela P. Apostolopoulou: Methodology. Georgia Brellou: Data curation; Methodology. NIKOLAOS DIAKAKIS: Conceptualization; Project administration; Supervision; Validation; Visualization.https://publons.com/publon/10.1002/vms3.366.The peer review history for this article is available at


Reminder essential clinical practice: Pericardial effusion is a rare fatal condition, however potentially reversible when grasped in time. It should always be thought out in neonate with a central line who develops unexplained cardiorespiratory failure. Reminder essential clinical practice: Pericardial effusion is a rare fatal condition, however potentially reversible when grasped in time. It should always be thought out in neonate with a central line who develops unexplained cardiorespiratory failure. However, it is known to be associated with complications ranging from infection to pericardial effusion and subsequent cardiac tamponade.Although pericardial effusion is a fatal condition in neonates, however potentially reversible when it is grasped in time. We report a case of early pericardial effusion as a complication from the umbilical venous catheterization diagnosed by urgent echocardiography and followed by immediate pericardiocentesis.2A 995‐g (10th centile) male baby was born at 27 weeks’ gestation by urgent cesarean section because of abruptio placentae to the 30 years old, gravida 2, para 1 mother.Pregnancy was complicated by episodes of vaginal bleeding during the first and third trimesters. Apgar scores were 5 and 7 at 1 and 5 minutes, respectively. The baby was intubated due to respiratory distress, connected to a conventional ventilator, and received Surfactant. Umbilical vein catheter (UVC) size 5 French was inserted at the age of 3 hours by the senior specialist. It was an uneventful procedure, and the position of the UVC tip was confirmed by chest radiograph before the start of parenteral nutrition and medications :79.5 mmHg, and base deficit: ‐ 7.3mEq.The baby was reintubated because of increasing oxygen requirement and worsening respiratory distress. The ventilatory setting was advanced with minimal improvement. Shortly after, the patient suddenly developed acute bradycardia and active cardiopulmonary resuscitation was performed with administration of intravenous adrenaline. Urgent echocardiography requested and was immediately performed due to the presence of cardiology staff in the unit at that time.Bedside 2D echocardiography revealed large amount of pericardial effusion Figure .Echocardiography‐guided pericardiocentesis was done through a subxiphoid route, and 8‐ml clear fluid was aspirated, resulting in the recovery of circulation. Repeated echocardiography after pericardial tapping revealed minimal pericardial effusion.Throughout the hospital course, the baby remained hemodynamically stable. Serial echocardiograms showed a gradual reduction of PCE with complete resolution within 3 days Figure .There was no evidence of reaccumulation thereafter. Currently, the patient is extubated to a high flow nasal cannula, saturating well on 30% FIO2, gaining weight, and on full parenteral feeding.3Central venous catheterization is widely used in the neonatal intensive care unit to provide parenteral nutrition and other solutions for critically ill neonates. Presence of the tip of the UVC in the cardiac chambers considered to be one of the main risk factors for PCE with cardiac tamponade (CT).PCE/CT is an uncommon and life‐threatening complication when not promptly diagnosed and expeditiously treated.Direct injury of myocardium wall, hyperosmotic damage that may be caused by infusion of total parenteral nutrition (TPN), and necrosis of myocardium wall due to frequent contact of the myocardium with the tip of the catheter may predispose to PCE.Most frequently, perforation has a delayed course, and several reports concluded that the average time between placing the catheter and the diagnosis of PCE with CT was 2.5 days.Furthermore, several retrospective studies reported the occurrence of PCE/CT in the presence of a satisfactory position of UVC tip where the occurrence of PCE with cardiac tamponade most probably happened because of the hyperosmolar parenteral nutrition infusion that caused endocardial injury and further penetration of this fluid into the pericardial sac.The acute clinical deterioration that occurred shortly (2 hours) after the insertion of UVC is unlikely related to the osmotic injury of TPN. Migration of the central line and subsequent perforation of the right atrium by UVC tip may be the most plausible explanation of PCE in the reported case where the tip of the catheter was visualized in the right atrium after initial correct positioning.The migration of the catheter tip is not rare. It was determined by chest radiograph that at 1‐hour post‐UVC insertion, 36% of UVC tip migrated into the cardiac silhouette.Causes of CVC migration include flushing of the umbilical line by the staff, manipulations, and movements of the extremities or head.In order to avoid these life‐threatening complications, some reports suggested verifying the position of the catheter tip by chest roentgenogram at least once in 2 days.P =.001).Most reported cases of PCE presented with cardiomegaly. Nowlen et al considered increased cardiothoracic ratio as statistically significant findings in PCE (Many cases of neonates with sudden and unexplained death were diagnosed to have PCE/CT only during the cadaverous examination.Timely diagnosis of PCE and appropriate intervention in the index case was done due to the availability of the cardiac team in the unit at the time of the sudden collapse of the patient that was lifesaving and prevented the possibility of sudden death.4High suspicion of pericardial effusion and cardiac tamponade must be considered in any infant with central line who developed sudden cardiorespiratory collapse. Echocardiography‐guided pericardiocentesis is a key procedure to prevent subsequent mortalities, which has been established by the recovery of the index case. As a result, it is imperative to acknowledge the pressing need for PCE targeted echocardiography training among neonatologists in order to diagnose and subsequently guide treatment in such life‐threatening condition.None to declare.RAH: collected the data, wrote the paper, and critically revised the final manuscript; LBM: prepared and critically revised the article; MFA: collected the data and prepared the primary draft; MSA: collected the data and prepared the primary draft; OIH: collected the data, prepared the primary draft, and critically revised the final manuscript; all authors approved the manuscript as submitted.Informed consent was obtained from parents for reporting this case.


A parastomal hernia is a type of incisional hernia that occurs in abdominal integuments in the proximity of a stoma. It is a frequent late complication following colostomy. Surgical repair is currently the only treatment option for parastomal hernia. Here we present the case of a 74-year-old patient with parastomal hernia and a history of open surgery treated with a totally extraperitoneal (TEP) endoscopic approach. There was no recurrence of the hernia at the 3-month follow-up. We discuss the feasibility and possible operative approaches for endoscopic repair of parastomal hernia with the TEP technique. Parastomal hernia, a frequent late complication following colostomy, involves protrusion of the abdominal viscera through a defect in the abdominal wall around the stoma; it has a high incidence rate 30–50%) –4 and is0% –4 andSurgical repair is the treatment of choice for parastomal hernia . SurgicaA 74-year-old male patient visited our hospital in October 2020 with a mass above the stoma that had persisted for 2 months. He had no history of abdominal pain, fever, or cough. In 2016, he underwent an abdominoperineal resection procedure for carcinoma located in the distal one-third of the rectum. He also had a history of open appendectomy. The patient was an active smoker, was on medication for diabetes, had no chronic obstructive pulmonary disease, and was not using any immunosuppressive drugs. He had also received chemotherapy (10 cycles of FOLFOX6) for carcinoma. There was no history of any other comorbidities. Family, psychosocial, and genetic histories were insignificant.2. Abdominal examination in the erect position revealed a mass with a diameter of ~5 cm protruding above the stoma. He had midline and gridiron incisional scars. There was a parastomal hernia at the outer edge of the rectus abdominis muscle. The hernia was soft and reducible to the abdominal cavity in the supine position.The patient's blood pressure was 140/90 mmHg, heart rate was 82 beats/min, respiratory rate was 20 breaths/min, and body temperature was 36.4°C during the examination. His body mass index was 27.5 kg/m9/l, hemoglobin concentration of 65 g/l, neutrophil percentage of 61.8%, and platelet count of 149 × 109/l. Glycosylated hemoglobin A1c (HbA1c) level was 6.5%. The renal function test showed that creatinine was 79.2 μmol/l and urea was 7.21 mmol/l. Electrolytes and coagulation function were normal. There were no abnormalities detected in the electrocardiogram, chest X-ray, and echocardiogram. The diagnosis at admission was post-operative rectal cancer with a parastomal hernia.Computed tomography (CT) examination revealed a parastomal hernia  with a dUnder general anesthesia, endotracheal intubation or a laryngeal mask and pre-operative indwelling urinary catheterization were applied to the patient, who was in a supine position. The surgeons were standing contralateral to the stoma with the monitor over the surgical site. The stoma was sealed with an adhesive incise drape. The surgical field was divided into right and left partitions using the sterilized surgical towel to prevent any potential contamination.2) for endoscope insertion.An incision of 1.2 cm through the skin and subcutaneous adipose tissue was made at the right iliac region. The incised subcutaneous tissue was separated using a pair of retractors to expose and dissect aponeurosis of the external oblique muscle. Hemostatic forceps were used to separate the internal oblique and transversus abdominis muscles. The primary extraperitoneal space was created using a finger. To create the preperitoneal space, 2 sets of 5-mm trocars were inserted at the site of surgical incision using the retrograde puncture technique ; the troThe further extraperitoneal space was created under direct endoscopic guidance down to the pubic floor and up to the bladder, where it was easier to create. We then moved to the contralateral side of the abdomen; as the long midline incision in the abdomen made it very difficult to separate the peritoneum, the membrane was cut while avoiding damage to the tissue at the middle of the incision, thus weakening the abdominal wall. When performing cephalad dissection, we targeted the space between the rectus abdominis and posterior sheath. To create the space, we opened the lateral edge of the posterior sheath to penetrate the extraperitoneal space between the lateral and mid-abdomen. The TEP technique was used for this separation. The dissecting plane of the lateral space was the extraperitoneal space between the peritoneum and parietal plane. During separation, the peritoneum was dissected and observed to avoid damage to the bowel around the stoma. Through the space that was created by separation, we enlarged the extraperitoneal space within a 15- to 20-cm radius around the stoma, providing a large field for mesh placement .At the end of the procedure, the abdominal wall defect was closed with a 2-0 non-absorbable suture . The perA 15 × 15-cm polypropylene mesh was cut in the middle and placed around the colostomy loop , then suThe total operation time was 240 min while the peritoneal separation time was 115 min. The patient was discharged 48 h after the operation. At the 3-month follow-up, the patient had a regular oral intake and defecation, no pain around the stoma, no seroma formation, and no infection at the incision site. The follow-up abdominal CT scan showed no recurrence of the hernia .An intraperitoneal approach is typically used in laparoscopic parastomal hernia repair surgery, which involves the placement of an anti-adhesion mesh with a special coating that is in contact with the bowel. However, there is a risk of intestinal adhesion or fistula, and it can be life-threatening . TEP tecWhile operating, it is critical to move along the abdominal wall. On the abdominal wall, there are several easily separated spaces . Area I Two kind of separations could be performed in Area I—i.e., the rectus abdominis and posterior sheath, and the posterior sheath and peritoneum. The peritoneum is usually extremely thin and adheres tightly to and could not be separated from the posterior sheath. However, we attempted to confirm that the space between the peritoneum and posterior sheath can be separated, thus laying a foundation for TEP repair of parastomal hernia. The long midline incision on the abdomen in patients with a history of abdominal surgery makes it difficult to separate the peritoneum, which must be opened for the operation. Additionally, an open peritoneum allows observation of the intestine within the abdominal cavity, which can reduce the risk of accidental injury. Most hospitals have been able to implement laparoscopic transperineal rectal cancer surgery to reduce the use of abdominal incisions; this facilitates the creation of the extraperitoneal space and reduces the difficulty of the operation.The mesh was placed after closing the defect at the end of the separation. We considered three ways to place the mesh, i.e., lap-TES-keyhole, lap-TES-sugarbaker, and lap-TES-sandwich –25. In oIn our case, the peritoneum separation time by laparoscopy was just 115 min, which was shorter than expected. With more patients and the accumulation of surgical experience, the operation time will decrease. The repair method of placing the mesh outside the peritoneum effectively avoids intestinal adhesion incidents and allows the use of ordinary mesh, thus reducing costs. At 48 h post-surgery, the patient was discharged with no post-operative complications such as pain, bleeding, or sepsis.Repair of parastomal hernia was previously performed around the stoma. In that situation, the mesh was easily contaminated during placement by intestinal contents with high concentrations of local bacteria, thereby increasing the risk of infection . HoweverStoma necrosis, bowel obstruction, and/or perforation were observed during long-term follow-up in a study that used the retromuscular sugarbaker technique to repair a parastomal hernia . In our Parastomal hernia repair using the TEP endoscopic approach is feasible, even in a patient who has previously undergone open rectal resection. Although long-term outcomes are unknown, this novel approach offers a new option for the surgical treatment of parastomal hernia.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Ethics committee of Northeast International Hospital. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.HJ and MW contributed to study conception and design and data acquisition and interpretation, and drafted the article. DT contributed to data analysis and interpretation, and drafted the article. CM and XC contributed to data acquisition and interpretation. All authors critically revised and approved the final version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Primary hepatocellular carcinoma (HCC) is one of the most frequently diagnosed cancers in adult men and a leading cause of cancer-related deaths worldwide. It also has an association with patients with hepatitis C-related cirrhosis. HCC usually metastasizes within the liver as well as to the lungs, regional lymph nodes, and adrenal glands, whereas the involvement of the chest wall and thoracic musculoskeletal system are more unusual.Herein, we report the case of a 58-year-old man who presented with swelling of the right anterolateral lower chest wall. The final diagnosis was primary HCC with distant metastases involving the right anterolateral ribs and left scapula. Such a presentation of extrahepatic HCC of this size and at this site is unique and has never before been reported in the literature. It reinforces the urgency and importance of screening all adults (18 years and above), particularly baby boomers, because three out of 100 have been infected with hepatitis C, at least once in their lifetime. It is also a wake-up call, as the incidence of primary HCC secondary to hepatitis C-associated cirrhosis has doubled, with a resultant increase in mortality.This HCC-related death might have been prevented if the patient had been screened for hepatitis C virus in his lifetime, as recommended by the American Association for the Study of Liver Diseases. We also discuss the latest developments in the diagnosis and management of HCC.  The incidence of hepatocellular carcinoma (HCC) has doubled and mortality rates have increased in recent decades . CirrhosData from the literature show that alcohol-related cirrhosis diagnoses and the associated age-adjusted mortality with subsequent development of HCC have declined. Thus, biologically credible culprits responsible for the rising incidence of HCC are hepatitis B and C, particularly in baby boomers, who account for about 75% of US hepatitis-C cases .A 58-year-old male patient presented with right-sided chest wall swelling that had been increasing in size for three months.He had no history of fever, night sweats, or jaundice. Patient history was significant for weight loss of about 20 pounds in the last six months. The patient was not even an alcoholic drinker or tobacco smoker. The patient was admitted for a workup of swelling and loss of weight and appetite. On examination, there was a 6 cm×10 cm oval swelling over the right anterolateral mid-chest wall with a smooth surface located lateral to the nipple. The swelling was firm, non-tender, well-defined, and fixed to the chest wall. The overlying skin was normal. No cervical, axillary, inguinal lymph nodes were palpable. Lungs clear to auscultation. S1, S2 heart sounds were heard in normal intensity and no murmurs were heard. Abdominal examination was soft, non-tender, and non-distended without hepatosplenomegaly.Preliminary labs, including complete blood picture and basic metabolic panel, were essentially normal but the hepatitis panel tested positive for hepatitis C antibody, which led us in the direction of hepatitis C workup, including liver imaging studies. Admission laboratory results also include a hepatitis C viral (HCV) load of 200,000 IU/L, and the remainder of the hepatitis panel was negative. Other results included alanine aminotransferase (ALT) of 52 units/L, aspartate aminotransferase (AST) of 64 units/L, alkaline phosphatase (ALP) of 120 units/L, platelet count of 170, and albumin of 3.3 g/dL.Chest X-ray Figure  showed aHCV accounts for 1% of morbidity and mortality globally . ApproxiThe incidence of HCC is 850,000 cases per year. It remains the second leading cause of cancer-related deaths globally, at approximately 800,000 per year. HCC is the most common primary liver tumor, accounting for 90% of patients . The risIn regard to screening, the American Association for the Study of Liver Diseases (AASLD) released practice guideline recommendations stating that every adult aged 18 years and above should be screened for HCV at least once in their lifetime [We have made remarkable progress in regard to the diagnosis and treatment of HCV with the invention of highly efficacious treatments, with a cure rate of > 95% using anti-HCV antiviral agents with minimal and condonable side effects .HCC metastasis occurs most commonly within the liver, and extrahepatic sites often include the lungs, abdominal lymph nodes, and bones . ExtraheEighty percent of HCC patients have preexisting cirrhosis, and chronic hepatitis C is the most common etiology after chronic hepatitis B . We beliWe can divide diagnosis and surveillance into two groups. First, cirrhotic hepatitis C patients do not require invasive procedures, such as liver biopsy, provided the liver lesion on four-phase CT imaging is greater than 2 cm with vascular features suggestive of HCC. These features include arterial phase hyperenhancement and washout, capsule appearance, and threshold growth on multiphase CT or MRI . AlternaWe did not have difficulty diagnosing HCC in our patient because of an easily accessible chest wall mass for cytopathological examination and characteristic HCC imaging findings. A liver biopsy is not indicated, as our metastatic site yielded the diagnosis of HCC.Treatment and prognosis of HCC with or without extrahepatic metastasis depend on intrahepatic liver tumor size. Patients can die of liver failure secondary to uncontrolled growth of the liver mass ; both prOur case report is of interest not only because of the involvement of the chest wall and left scapula but also due to the extent and size of the liver metastatic lesion on the chest wall. Our case report reminds us that one should consider extrahepatic HCC in the differentials during the evaluation of a chest wall swelling in chronic hepatitis patients.Our case report reinforces the necessity of the need for HCV screening in all adults aged 18 years and above at least once in their lifetime, with more emphasis particularly on baby boomers whose HCV prevalence is remarkably higher than in the normal population. This aims to reduce the risk of the hepatitis C virus associated with primary HCC and its resultant morbidity and mortality. This is achievable because of the remarkable progress we have made by inventing highly efficacious anti-HCV antiviral medications, which carry a cure rate of >95% with minimal and condonable side effects. Fortunately, we do not need invasive procedures such as a liver biopsy to diagnose primary HCC if the imaging studies show typical and characteristic findings on CT or MRI of the abdomen, with few exceptions. Liver biopsy is mandatory in non-cirrhotic patients, even if the imaging findings are suggestive of HCC. Our key clinical message relates to the importance of screening all adults aged 18 years and above, particularly baby boomers, for HCV at least once in their lifetime.


Sarcomas, tumors of mesenchymal origin, comprise a small percentage of all malignant tumors and are often challenging to diagnose. Leiomyosarcoma (LMS) is a rare form of cancer arising from smooth muscle cells. While a soft tissue sarcoma diagnosis is rare in and of itself, LMS diagnosis at an adolescent age is even more unique. Vulvar LMS can easily be misdiagnosed as a benign vaginal lesion, leading to a delay in proper treatment and poorer outcomes. In this case, we present a 14-year-old female who was diagnosed with a grade 2 vulvar LMS that clinically mimicked a Bartholin’s gland cyst. Sarcoma refers to a malignant neoplasm formed among mesenchymal tissue. Accounting for 1% of all malignancies, sarcomas are composed of neoplasms arising from bone, cartilage, fat, muscle, blood vessels, and fibrous and connective tissue . LeiomyoA 14-year-old Hispanic female presented to her pediatrician for a well-child check with concerns for a mass that could be felt in the vaginal area when sitting in certain positions and that has been growing over time. The patient had reports of rare mild pain in the vaginal area for approximately 10 months prior to the initial visit. Nearly four months later, the physical examination identified an approximately 3 × 2 cm palpable mass in the inferior aspect of the left labia and the edge of the introitus. No discomfort was felt with pressure to the mass. The patient does menstruate on a regular cycle and has never noticed or been diagnosed with any lesions or cysts elsewhere on her body. The mass did not have any open spontaneous drainage. The patient was recommended and scheduled to have surgical drainage and partial excision of the mass following this visit.Significant medical and surgical history includes the patient being a nonsmoker, not sexually active, not on any medications, and a diagnosis of pediatric obesity with a body mass index (BMI) in the 95th-98th percentile for her age at the time. The patient underwent an appendectomy at the age of eight due to perforated appendicitis, which gave rise to an intraabdominal septic infection with the development of abdominal abscesses, which was successfully treated after a prolonged hospitalization. Family medical history includes the patient’s mother being positive for purified protein derivative (PPD), but no other significant family medical history is reported. Upon examination at the well-child check, the patient’s pediatrician noted a 2 cm non-tender, round, mobile swelling at the left posterior opening of the vagina. This finding was believed to be an uncomplicated Bartholin’s cyst without abscess or infection, and the patient was referred to pediatric surgery for additional evaluation and management.Approximately one month following the pre-operation appointment, the patient underwent drainage and partial excision of the presumed left Bartholin’s cyst. The patient and her parents have continued to deny any change in medical history in the interim, including no reported fevers, night sweats, chills, cough, chest pain, shortness of breath, abdominal pain, nausea, vomiting, changes in bowel habits, dysuria, hematuria, urinary frequency, and urinary urgency. During the procedure, the mass was noted at 6 × 6 cm and thought to be a Bartholin’s cyst in the left labia, although it had suspicious solid components at the time of resection. As such, instead of marsupialization or drainage, the surgical team proceeded with the excision of the mass. There was minimal drainage from the mass, which appeared to have multiple lobulations. The mass outside the hymenal ring on the vaginal mucosa was excised using sharp and blunt dissection, and a biopsy was sent to both surgical and molecular pathology.The surgical pathology report of the biopsy taken during surgery confirmed a leiomyosarcoma of the vulva, grade 2 of 3. The tumor was found to be composed of plump spindle cells with abundant eosinophilic cytoplasm arranged in fascicles. The mitotic rate was reported to be variable but reached as high as 11 per 10 high-power fields (HPFs). The tumor cells stained strongly and diffusely positive for caldesmon and SMA with rare focal positivity for desmin and EMA. Negative stains were reported for MNF116, AE1.3, Cam5.2, ALK1, ROS1, S100, HMB45, MyoD1, and myogenin. An additional immunohistochemical stain for pan-TRK was negative in the tumor cells, while the expression of ATRX was retained. The molecular pathology report included a solid fusion assay, which is based on targeted ribonucleic acid (RNA). Next-generation sequencing (NGS) using anchored multiplex PCR (AMP) detected no reportable fusion transcripts from the biopsy taken. The patient was then scheduled for further imaging, including pelvic magnetic resonance imaging (MRI), positron emission tomography (PET), and computed tomography (CT) later in the week.Nearly two weeks later and following the cancer diagnosis, the case was presented at the pediatric sarcoma tumor board, and the patient was referred to gynecologic oncology, as well as plastic surgery. The patient was recommended for a radical hemivulvectomy with the possible need of a flap to close the defect. The patient and her parents were informed of the rationale behind this procedure, given the extremely rare nature and aggressiveness of this form of tumor in children, and they agreed to proceed with the surgery.The patient subsequently underwent the radical hemivulvectomy of the left vulvar leiomyosarcoma and reconstruction with an advancement flap. Biopsies were taken during this procedure, and final pathology revealed no evidence of malignancy on the left vulvar deep margin. Furthermore, there was no evidence of malignancy on the left vulva medial margin or the left vulvar inferior margin. Postoperative MRI, PET, and CT imaging revealed no evidence of metastatic disease. Following a successful tumor excision and reconstruction, the patient was again presented at the sarcoma tumor board in pediatrics, and the recommendation was made for close surveillance only. Following these procedures, the patient has been doing well as the pain is well controlled, and she is planning to be followed with future imaging and clinic visits on an as-needed basis.Sarcomas are rare neoplasms of mesenchymal origin that account for less than 1% of all adult cancers and approximately 20% of all pediatric malignant solid tumors . While uArising from smooth muscle, leiomyosarcomas (LMS) are known to be rare and aggressive malignancies associated with distressing clinical outcomes. While the uterus is the most common location for LMS occurrence, adolescent vulvar LMS are exceedingly rare and poorly understood. In this case, we presented a 14-year-old female who was diagnosed with a grade 2 vulvar LMS that clinically mimicked a Bartholin’s gland cyst. As such, raised suspicion is warranted for vulvar lesions with atypical features, given that benign assumptions of Bartholin’s gland masses are more plausible in this adolescent age group.


Benign multicystic peritoneal mesothelioma is a rare cystic neoplasm, characterized by subtle symptoms, that occurs predominantly in reproductive-aged women. The pathogenesis and etiology of the disease are yet to be determined. We herein present a 71-year-old woman presented to our clinic with persistent low back pain. The clinical examination showed a palpable mass in the abdominal area. The magnetic resonance imaging revealed multiple cystic lesions that occupy the largest part of the pelvis, posterior to the uterus. The patient underwent cyst excision, total hysterectomy with bilateral salpingo-oophorectomy, omentectomy and lymph node dissection. Postoperative course was uneventful and histopathology of the specimen revealed a benign multicystic peritoneal mesothelioma. Complete tumor resection is considered the optimal therapeutic approach of peritoneal mesothelioma. Histopathological analysis is required to confirm the diagnosis of multicystic peritoneal mesothelioma. Benign Multicystic Peritoneal Mesothelioma (BMPM) is an uncommon benign tumor that occurs predominantly in women of reproductive age . The repPatient information: a seventy-one-year-old woman presented to our outpatient department with a history of persistent low back pain. She had previously visited an orthopedic who suggested a lumbar spine computed tomography (CT). CT findings demonstrated abdominal cystic formations.Clinical findings: on clinical examination, a palpable mass and mild tenderness in the lower abdomen were elicited; therefore, she underwent an abdominal Magnetic Resonance Imaging (MRI).Timeline: after initial clinical assessment of the patient, the diagnosis was persumed to be a musculoskeletal condition. During evaluation, CT findings did not match with symptoms. Thus, an incidental finding of a multicystic intraperitoneal lesion was noticed and it was decided to perform an excision.Diagnostic assessment: MRI revealed multiple cystic lesions  with thin septations but no papillary projections occupying the largest part of the pelvis, mainly behind the uterus. Multiple small cysts coexist also in the perirectal fat, pericolically and the greater omentum. Another lesion with similar characteristics  was observed in the intraperitoneal subhepatic space (ic space .Therapeutic intervention: the patient was taken up for exploratory laparotomy after obtaining informed consent. Perioperative findings demonstrated free intraperitoneal clear fluid, a large left ovarian cyst as well as an accompanying ovarian cyst on the right side with smooth walls and multiple small cysts in the peritoneum, arranged in a grape-like form (ike form . Total hDiagnosis: histopathology of the specimen revealed multiple cysts without malignant transformation suggesting a diagnosis of benign multicystic peritoneal mesothelioma (thelioma .Follow-up and outcome of interventions: the patient´s postoperative course was uneventful and she was discharged on postoperative day 5 with advice of regular follow-up.Patient perspective: “I used to think that the low back pain was caused by a spinal problem. I felt really anxious when I heard about the CT findings. My doctor suggested to undergo a surgery. Since the histopathology revealed a benign neoplasm, I felt relief with the final diagnosis. My doctor reassured me and suggested annual follow-up. I hope everything will be fine”.Informed consent was obtained.Benign multicystic peritoneal mesothelioma was first described in 1928 by Plaut during an operation for uterine leiomyoma ,7. GivenThe majority of patients with BMPM are asymptomatic and are diagnosed during a routine medical examination or in some cases as an incidental operative finding . The mosThe differential diagnosis mainly includes lymphangioma, pseudomyxoma peritonei and malignant peritoneal mesothelioma . LymphanBenign multicystic peritoneal mesothelioma is a rare cystic benign neoplasm and definitive diagnosis requires histopathological analysis. In postmenopausal women, BMPM should be included in the differential diagnosis when cystic tumors are identified in the anatomical area of the adnexa or pelvis. Complete resection of the tumor is the ideal treatment and malignant transformation is uncommon. Further studies are needed to better understand its pathogenesis and biological behavior.


Schwannoma can be included in the list of differential diagnoses of tongue masses but seems to be a rare finding in the Iranian population. The current case was presented as an exophytic nodular sessile mass which was growing fast. Schwannoma can be included in the list of differential diagnoses of tongue masses but seems to be a rare finding in the Iranian population. The current case was presented as an exophytic nodular sessile mass which was growing fast. Intraoral schwannoma is a rare finding. Herein, we report the first case of schwannoma of the tongue in a 15‐year‐old Iranian male patient.Schwannoma, also referred to as neurilemmoma, is a benign, encapsulated tumor with a slow growth pattern, which is often single and originates from the Schwann cells wrapping around the axons of neurons in peripheral, cranial (except for the optic and olfactory nerves), spinal, and autonomic nerves. Around 25%‐40% of schwannomas occur in the head and neck region; of which, only 1%‐12% occur intraorally.1. The myelinating Schwann cells that produce the myelin sheath wrapping around the peripheral axons.2. The nonmyelinating Schwann cells that play a fundamental role in response to injury to the peripheral nervous system. They produce neurotropic factors and lead to regeneration of the injured neurons. They also guide the immune response in the peripheral nervous system.The current case is reported in line with the SCARE criteria.The patients were then classified into three groups of children, adolescents, and teenagers (≤20 years of age), middle‐aged individuals (>20 and ≤60 years), and the elderly (>60 years) based on their age range.2Our patient was a 15‐year‐old Iranian male who presented to the Oral and Maxillofacial Medicine Department of School of Dentistry, complaining of a painless swelling on his tongue from 1 month earlier, which was growing fast  of the tongue without contrast was requested for the patient, which revealed a tongue mass with well‐defined borders measuring 15 × 12 mm, which was hypersignal on T2‐weighted, and hyposignal on T1‐weighted images.Based on the clinical findings  and the information acquired from the MRI, benign mesenchymal tumors were considered in the list of differential diagnosis. The fast growth rate of the tumor in our case was concerning. After obtaining written informed consent from the patient and his parents, the patient underwent excisional biopsy under local anesthesia by an oral and maxillofacial surgeon. The mass was submucosal, and after elevating a mucosal flap, a pedunculated yellow‐color mass with a smooth surface appeared, which measured 1 × 1 cm, and was easily resected with blunt dissection Figure . The speMicroscopic examination revealed a benign neoplasm with a clear capsule composed of cells with spindle‐shaped nuclei, forming an Antoni A pattern. The tumoral cells did not show any cellular atypia or mitosis Figure .Because of the benign nature of the lesion, no additional treatment was indicated. After the postoperative period, the patient's complaints, including the swelling, were resolved. The patient had no signs of recurrence in the first follow‐up session scheduled 1 year postoperatively Figure .3Considering the electronic search for relevant articles published from 1954 to 2020, and by taking into account the current case, a total of 212 cases of oral schwannomas have been reported so far in the literature. The patients were classified into three groups of children, adolescents, and teenagers (≤20 years of age), middle‐aged individuals (>20 and ≤60 years), and the elderly (>60 years) based on their age range.A total of 63 patients were included in the age‐group of children, adolescents, and teenagers (≤20 years of age); among which, 34 were males, 26 were females, and the gender of 3 had not been specified. Also, three patients in this group had ancient schwannoma. Figure A total of 129 patients were in the middle‐age group (>20 and ≤60 years); out of which, 65 were males and 64 were females. Figure A total of 20 patients were in the elderly group (>60 years); of which, 9 were males and 11 were females. Figure Schwannoma or neurilemmoma is a benign tumor with slow growth, originating from the Schwann cells of the nerve sheath.The chief complaint of patients in this age‐group was widely variable and the most common are included painless, tender, or painful swelling, which was fast‐growing or slow‐growing, dull pain in the jaw, an asymptomatic lesion detected during routine radiographic examination (intraosseous lesion), and hoarseness.Microscopically, schwannomas are encapsulated tumors with two possible histological patterns of Antoni A and Antoni B. In the Antoni A pattern, the Schwann cells are spindle‐shaped and have elongated nuclei arranged in a palisading pattern around acellular areas (Verocay bodies). The Antoni B pattern has fewer cells with random orientation in a loose matrix.The current findings indicated that schwannoma may develop at a young age. Its prevalence was the highest in the middle‐aged individuals, and the lowest in the elderly. The tongue was the most common site of involvement in all age‐groups. The mandible was the second most common site of involvement in patients up to 60 years of age; while in the elderly, the floor of the mouth was the second most common site of involvement. Higher prevalence of schwannomas in the tongue may be due to the higher incidence of trauma to the tongue and the role of Schwann cells in repair of injured neurons.Regarding the prevalence of schwannoma in different age‐groups, it seems that it has a slightly higher prevalence in males up to 60 years of age. However, this pattern changes after 60 years of age and it becomes slightly more prevalent in females.Painless swelling with slow growth was the most common chief complaint of patients in all age‐groups.Unlike other reports showing that the tongue is the most common site of involvement, it is not a common site of involvement for schwannoma in the Iranian population according to the existing literature. To the best of the authors' knowledge, the current case is the first case of tongue schwannoma in a 15‐year‐old Iranian male patient according to the existing literature (Table Also, the chief complaint of our patient was a painless swelling with a fast growth, which was rare, compared with schwannomas reported in the literature. Since 1954, only six cases of oral schwannomas have been reported in the Iranian patients, including the current case.4In the Iranian population, Schwannoma is rarely included in the list of differential diagnosis of oral masses. Schwannoma can be considered as a differential diagnosis in a fast growth and painless swelling in an adolescent patient.None declared.All authors: contributed to the study conception. FA‐H, MY, and PA: performed data collections. MY and M‐SM: wrote the first draft of the manuscript. All authors: read and approved the final manuscript.Written informed consent was obtained from the patient and his parents.


Musculoskeletal lipomatous lesions are common in soft tissues. However, these are rarely associated with tendon sheaths or tendon compartments. Moreover, angiolipoma of the Achilles tendon is yet to be described. Here, we report an angiolipoma of an intact Achilles tendon, which has not been described previously. A 54-year-old woman presented with a two-year history of a palpable mass in the posterior aspect of the left ankle. The mass caused an intermittent localized pain while walking and a catching phenomenon induced by the plantar dorsiflexion movement of the ankle joint. Magnetic resonance imaging revealed a well-circumscribed, oval lesion on the lateral aspect of the Achilles tendon. The location and shape of the lesion had changed over time, suggesting that the lesion was moving in and out around the Achilles tendon. At the surgery, the tumor was confirmed under the crural fascia. Histopathological examination revealed that the tumor comprised mature adipocytes covered peripherally with a fibrovascular capsule. Based on these features, the tumor was diagnosed as an angiolipoma. Angiolipomas are typically treated surgically by simple excision, and lipomatous lesions of the tendon sheath are not different. From this case report, angiolipomas are rare but should be considered in the differential diagnosis and treatment of Achilles tendon tumors. Musculoskeletal lipomatous lesions are common in soft tissues. These can occur anywhere on the body and are typically localized in subcutaneous fat. Angiolipoma, one of the lipomatous lesions, represents a benign subcutaneous lesion as described by Howard and Helwig . This moA 54-year-old woman with a two-year history of a palpable mass in the posterior aspect of the left ankle was referred to our hospital. The mass caused intermittent localized pain while walking, and catching phenomenon was induced by plantar dorsiflexion of the ankle joint. The patient had no history of antecedent trauma, signs of infection, or abnormal lipid metabolism. Physical examination showed an elastic, soft, and smooth lesion on the lateral aspect of the Achilles tendon. The lesion moved with dorsiflexion and plantar flexion of the ankle, suggesting an anatomical relationship with the tendon. A plain radiograph showed a soft tissue shadow without calcification on the dorsal aspect of the Achilles tendon. Magnetic resonance imaging (MRI) revealed a well-circumscribed, oval lesion on the lateral aspect of the Achilles tendon . The lesAn angiolipoma represents as benign subcutaneous lesion most commonly affecting young male in the second to third decades of life . The mosSoft tissue lesions of the Achilles tendon have been reported including chondroma, angioleiomyoma, and chondrolipoma –7. MRI iA tendon sheath comprises fibrous connective tissue consisting of a fibrous layer and a synovial layer. The fibrous layer supports and protects the tendon, and the synovial layer lubricates the tendons and produces synovial fluid to prevent tendons from adhering to surrounding structures and from damage that could occur with repetitive movements .a paratenon throughout its length. The paratenon forms a thin space between the Achilles tendon and crural fascia. Although the paratenon is probably not a true tendon sheath, it still functions as an elastic sleeve [In contrast, the Achilles tendon is surrounded by c sleeve . Whether


Synovial Sarcoma is a rare malignancy that accounts between 8 and 10% of soft tissue neoplasms, with the highest presentation rate in extremities, an extremely uncommon condition in head and neck.We present a case of an 18-year-old male with synovial sarcoma situated at hypopharynx who underwent surgical resection and postoperative radiotherapy.Synovial Sarcoma represents a rare head and neck malignancy with challenging diagnostic approach due to its frequency and nonspecific clinical manifestations. Surgical treatment must assure good free margins. Adjuvant radiotherapy has a positive impact in local recurrence and survival. •Sinovial Sarcoma it's a rare and challenging entity, early diagnosis is related with better outcomes.•On time adjuvant therapy needs to be done in order to improve oncologic outcomes.•Multidisciplinary approach it's related to good postoperative outcomes and extended overall survival. Palpable IB lymph nodes were found during physical exam. Patient was admitted.A new neck Computed Tomography (CT) scan was obtained due to lack of report from the previous and showed a 91 × 27 × 50 mm mass located in pharynx's posterolateral wall and involving retro cricoid region, extending from the pyriform sinus to the oropharynx and causing an occlusion greater than 60% . After cThe patient was referred to our surgical oncology department where the case was discussed by specialists in oncology and head and neck surgery. Due to the frequent metastases and lymph node involvement of this pathology a Positron Emission Tomography (PET)/CT was obtained. The scan showed a malign infiltrative mass compromising the left oropharynx and hypopharynx. Additionally, laterocervical lymph nodes  with low FDG affinity were found. Bone scintigraphy was performed to rule out metastases with negative results. As well, PET Scan do not show any hypermetabolic capitation in distance places, ruling out metastatic disease.After the multidisciplinary discussion and analysis of the case the patient underwent an excision of the mass through a pharyngectomy with unilateral lymphadenectomy by an experienced head & neck surgeon . During Following surgery, the patient did not require management in the intensive care unit and had an uneventful immediate post-operative recovery, without nerve deficit. The patient was discharged home. Received Intensity Modulated Radiotherapy (IMRT) with a daily dose of 100 cGy in 25 fractions for a total dose of 6000 cGy.At 6 months post hypopharynx tumor resection the patient continues with uneventful follow up, no signs of local relapses. He has resumed his regular life.3Synovial Sarcoma (SS) is an uncommon soft tissue malignancy accounting for 8–10% of soft tissue neoplasms Head and neck synovial sarcomas usually present as a non-painful mass with slow progressive growth hence its vague clinical presentation. Consequently, symptoms will depend on mass effect over adjacent structures and may range from mild throat discomfort, hoarseness to dysphagia and dyspnea Preoperative diagnosis is challenging due to its rare occurrence and nonspecific clinical presentation, being images the most important tools in its identification and diagnosis Furthermore, translocation t between chromosomes 18 (SYT gene) and X (SSX gene) is associated with synovial sarcomas Overall, surgery is the election treatment and performing a wide local resection ensuring 2–5 cm free margins is fundamental Lastly, synovial sarcomas have poor prognosis with an average survival rate at 5 years of 25–62% and a 10-year survival rate of 11–30% 4Synovial Sarcoma represents a rare head and neck malignancy with a challenging diagnostic approach due to its frequency and nonspecific clinical manifestations. Surgical treatment must assure good free margins. Adjuvant radiotherapy has a positive impact in local recurrence and survival.Not commissioned, externally peer-reviewed.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Ethical approval of institutional committee was made previous publication.Written informed consent was obtained from the patient for publi-cation of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.Felipe Giron, MD, MSc: Make substantial contributions to concep-tion and design, acquisition of data,analysis and interpretation of data.Carlos Rey, MD: Participate in drafting the article and revising it critically for important intellectual content.Lina Marcela Rodriguez, MD: Participate in drafting the article and revising it critically for important intellectual content.Fernando Gutierrez, MD: Participate in drafting the article and revising it critically for important intellectual content.Andrés Álvarez, MD: Participate in drafting the article and revising critically for important intellectual content. Give final approval of the version to be submitted and any revised version.Marcela Estrada MD: Participate in drafting the article and revising critically for important intellectual content.None.Felipe Giron.Authors do not declare any conflict of interest.