A mucinous tubular and spindle cell carcinoma (MTSCC) is a rare and recently described kidney neoplasm with distal nephron differentiation. It can affect patients of all ages and is more prevalent among women. In this case report, we present a 50-year-old woman who had a renal mass, which was accidently discovered during an investigation for chronic anemia. The final diagnosis of MTSCC was made after the lesion was removed and a pathology work-up was performed. The clinical, pathological and imaging findings of this rare neoplasm are described in this report. Mucinous tubular and spindle cell carcinoma (MTSCC) of the kidney is a rare renal cancer, which was first described in 1998  in the WThe tumor is considered to be a low-grade carcinoma with a favorable prognosis. Its origin has been debated and some pathologists believe that it is derived from the epithelial cells of the loop of Henle, whereas others have credited its origin to the cells of the collecting duct .There are few reports of MTSCC in medical literature and only two focus on the imaging features of the tumor ,6. The oA 50-year-old Caucasianwoman was referred for ultrasound (US) examination during the course of an investigation for hypochromic/microcytic anemia, which was refractory to treatment for 4 years. The patient had no urinary complaints, hypertension or diabetes, and had no history of smoking. The pre-operative serum creatinine and hemoglobin levels were 0.8 mg/dl and 9.1 g/dl (hematocrit 30%), respectively.Abdominal ultrasonography revealed a round, solid, circumscribed mass, located in the upper pole of the left kidney. The mass was predominantly hypoechoic with echogenic areas in the central portion of the lesion Figure A and meaThe patient underwent a left-sided total nephrectomy and adrenalectomy. The macroscopic examination revealed a single, solid, circumscribed mass, which was primarily white but with yellowish and hemorrhagic areas, and a visible central scar. The longest axis measured about 10.5 cm  AE1/AE3, 7, 19 and vimentin, and was negative for CD10 and CD15. The immunostaining for epithelial membrane antigen (EMA) was focally positive. Immunostaining for neuron-specific enolase (NSE), chromogranin, synaptophysin, sarcomeric actin and desmin did not show neuroendocrine or muscle differentiation . The age at presentation varies from 17 to 82 years mean 53 years) [:1. The a years :,8-10.The size of MTSCC is variable. It ranges from less than 1.0 cm in diameter to more than 18.0 cm, with most tumors measuring 2.0 to 4.0 cm in the longest axis . The hisIn the absence of typical morphologic features, a nonclassic MTSCC pattern may be characterized by areas of papillary changes, neuroendocrine differentiation and sarcomatoid changes in the lesion. Immunohistochemistry may be valuable in limiting the potential differential diagnoses, as in this case. MTSCC is generally positive for low molecular weight cytokeratins . The epithelial membrane antigen is usually present and vimentin is occasionally detected .Imaging descriptions of MTSCCs are very rare. In Table In conclusion, there are still no specific imaging criteria for the diagnosis of MTSCC, which can only be confirmed by tissue sampling. The imaging features may resemble other variants of RCC, such as chromophobe or papillary types, which have a less favorable prognosis. However, a renal MTSCC should be suspected when a large, circumscribed, poorly enhancing lesion with low to intermediate signal on T2-weighted imaging is discovered, especially if in association with renal lithiasis ,4.Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.CK: Cytokeratin; EMA: Epithelial membrane antigen; IV: Intravenous; MR: Magnetic resonance; MTSCC: Mucinous tubular and spindle cell carcinoma; NSE: Neuron-specific enolase; RCC: Renal cell carcinoma; US: Ultrasound; WHO: World Health Organization.The authors declare that they have no competing interests.GEBS and VFM act as guarantors of integrity of the entire study. GEBS, RSC and VFM provided study concepts and design. MSL, GEBS, VFM and RCR provided literature research. MSL, RAP and ST performed the clinical studies. MSL, RAP, RSC and RCR prepared the manuscript. GEBS and VFM edited the manuscript. ST provided photographic documentation. All authors read and approved the final manuscript.


Primary pulmonary neoplasms rarely occur in children, but the majority of those that do are malignant. Mucoepidermoid carcinoma (MEC) represents ~10% of all primary pulmonary malignant tumors. However, MEC is not usually considered in the clinical differential diagnosis in pediatric practice. The present study presents the case of a seven-year-old female with a one-year history of recurrent hemoptysis. Computerized tomography (CT) scans revealed a tumor originating in the right lower lobe bronchus. The patient did not receive any radiation and chemotherapy following a lobectomy on the right lower lung. The tumor was histopathologically determined to be an MEC of the tracheobronchial tree. Subsequent to a six-year follow-up, the MEC was undetectable in this patient, according to the clinical and radiological evidence. The literature with regard to pediatric MEC is also reviewed in this study. Mucoepidermoid carcinoma (MEC) is the most common type of salivary gland malignancy in adults. It is also found in other areas, including bronchi, lacrimal sac and thyroid. MEC is not common in the lungs, particularly in children, accounting for only 0.1–0.2% of primary lung cancers. Generally, pulmonary MEC presents as a painless, slow-growing mass that is firm or hard, which may block bronchial tubes and cause obstructive pneumonia. Although the tumor is not encapsulated, the tumor usually has a low malignant potential . MEC is A seven-year-old female presented with a one-year history of recurrent hemoptysis with no evident cause. A sudden onset of hemoptysis had compelled the patient to seek treatment at the Renji Hospital . An initial diagnosis indicated that the patient was apyrexial, experiencing bronchiectasis and producing diminished breath sounds in the right inferior zone. Upon further examination, a computed tomography (CT) scan revealed atelectasis of the right lower lobe associated with local partial pulmonary tissue collapse and a consolidation of the right middle and lower lobes . The remBased on the previous diagnosis and information, the patient underwent surgery in the Renji Hospital. During surgery, congestion-like changes to the bronchial tissues were discovered in the lower lobe of the right lung, and several bleeding sites were identified in the airway. A granulomatous mass was located at the site of the middle lobar bronchial opening. In addition, a right lower and middle lobectomy was performed, followed by lymph node dissection.3 in size. Although histopathology revealed that the majority of the carcinoma was localized within the epidermis of the bronchus, certain sections had invaded the bronchial wall. An immunohistochemical examination revealed that the carcinoma cells were positive for high-molecular weight cytokeratin (HCK), also known as 34βE12 (+++), CK5 (++), CK7 (+++), Ki67 (+) and p63 /CT imaging (Since CT is the most sensitive technique for detecting and characterizing parenchymal disease, it has become the procedure of choice for further investigation. CT may be useful in assessing the extent of the disease. Familiarity with the appearance of these lesions on CT may assure an accurate diagnosis and optimize the management of the condition of the patient . In the  imaging –22, may Generally, when an endobronchial mass is present in a child, the clinical consideration typically includes the aspiration of exogenous objects, respiratory tract papillomatosis, an inflammatory pseudotumor and, rarely, a metastatic or primary tumor. Whether the mass is benign or malignant may be determined based on the clinical signs or symptoms alone. The total removal of the lesion, with the sacrifice of as little normal lung tissue as possible, is required. When technically possible, a sleeve resection of the involved bronchus is recommended. However, in the majority of cases, the location of the lesions requires a lobectomy for complete removal ,24. In tThe pathological diagnosis is indispensable . HistoloIn children, mucoepidermoid tumors should be considered potentially malignant. Since these tumors are relatively slow growing, a prompt diagnosis and early surgical treatment offer the best chance of a cure in this type of patient . ThoracoIn the present study, the patient was normal with no clinical or radiological evidence of disease recurrence during a six-year follow-up period following the surgery and lymph node dissection.In summary, childhood MEC is relatively rare and exhibits symptoms that are similar to those of other lung diseases, which may therefore delay a precise diagnosis. A timely examination and appropriate treatment may cure or at least markedly improve the outcome of children with MEC. More attention should be paid to increasing environmental pollution, as it may be a cause of the increase in childhood lung cancer ,32.


Carcinoid tumours of the common bile duct represent an extremely rare entity. Similarly, primary follicular lymphomas of the ampulla of Vater constitute an infrequent neoplasia. Herein, we report the first case of a synchronous development of a carcinoid tumour of the common bile duct and an ampullary follicular lymphoma that was treated surgically with a Whipple's procedure, due to inability to establish definitive preoperative diagnosis despite the extensive diagnostic investigation. Carcinoid tumours of the extrahepatic bile duct (EHBD) represent extremely rare lesions. These neoplasms account for 0.1% to 0.3% of all gastrointestinal carcinoid tumours . AltogetA 43-year old Caucasian male with no remarkable medical history, was referred to our clinic with intermittent jaundice and a 1-month history of nausea, vomiting, pruritus, dark urine, clay-colored stools and weight loss of 5 kg. The patient did not report abdominal pain or decreased appetite.On admission, the patient's liver function tests (LFTs) were abnormal; aspartate aminotransferase (AST) 78 IU/L , alanine aminotransferase (ALT) 109 IU/L , alkaline phosphatase (ALP) 226 IU/L , γ-glutamyl transpeptidase (γGT) 932 IU/L , total bilirubin 1.3 mg/dl  and direct bilirubin 0.9 mg/dl , while the tumour markers CEA, CA 19-9 and AFP were within normal range.Contrast enhanced computed tomography (CT) of the abdomen revealed dilatation of the biliary tree, with the hepatic duct measuring a diameter of 1.8 cm. Neither lymph node enlargement nor splenomegaly was demonstrated. Magnetic resonance cholangiopancreatography (MRCP) showed dilated intrahepatic and extrahepatic bile ducts including the cystic duct and the gallbladder. The common bile duct (CBD) measured 1.4 cm in diameter with an abrupt concentric stenosis in its lower third and a cut-off point located 1 cm distally to the duodenal ampulla. The pancreatic duct was depicted as normal  demonstrated the duodenal ampulla of Vater thickened and the CBD dilated with the presence of thick content.The patient underwent an endoscopic retrograde cholangiopancreatography (ERCP). The ampulla of Vater was depicted as being infiltrated by the neoplasm. An endoscopic sphincterotomy was carried out, thus letting us better view and sample the region, and the biopsies taken revealed the presence of an undifferentiated neoplasm, but no definitive diagnosis was made.Taking into consideration the aforementioned findings, our decision was to operate on the patient, and we performed a pylorus-preserving pancreaticoduodenectomy with the en bloc resection of the area in question and surrounding structures, including the regional lymph nodes.Histopathological and immunohistochemical study of the surgical specimen revealed infiltration of the duodenum by a non-Hodgkin B cell lymphoma, predominantly of nodular type, with characteristics of grade I follicular lymphoma [World Health Organization (WHO) classification] with G(λ)+ clonicity and indicative immunohistochemical examination  Figure .Postoperatively, the patient was further staged. Regarding the lymphoma, we conducted a CT scan of the neck and chest as well as a bone marrow biopsy to exclude extra-enteric lesions, and we proceeded with a video capsule endoscopy in order to exclude multifocal involvement of the small intestine . All theThe follow-up of the patient includes a complete blood count, routine biochemical exams and an abdominal CT scan every six months after surgery, supported with an annual evaluation of CgA levels ,7. EightCarcinoid tumours arise from enterochromaffin cells, also known as argentaffin or Kulchitsky cells. The term enterochromaffin refers to the ability to stain with potassium chromate (chromaffin), a feature of cells that contain serotonin. These cells are located in the gastrointestinal tract   or at vaThe term 'carcinoid tumour' has been replaced by the term 'well-differentiated endocrine tumour' in the latest WHO classification of tumours . The malignancy of neuroendocrine tumours is well described, ranging from well-differentiated tumours to malignant neoplasms ,12.The WHO staging system is based on the criteria such as tumour size, histological differentiation, Ki-67 immunostaining, invasion of adjacent tissues, and vascular and perineural invasion.Available data extrapolated from the existing literature suggest that carcinoid tumours of the extrahepatic biliary tree are of low malignancy . HoweverPrimary gastrointestinal non-Hodgkin lymphomas (NHL) constitute more than one-third of all extranodal lymphomas. The stomach is the most common site, followed by the colorectal region and the terminal ileum . The duoCompared to other biliary malignancies, lymphomas are more sensitive to chemotherapy and radiotherapy. However, NHLs represent a rare cause of malignant biliary obstruction, accounting for 1-2% of all cases , thus maWe present a patient harbouring a periampullary neoplasm, causing obstructive jaundice. We proceeded with a pancreaticoduodenectomy based on the preoperative finding of a poorly undifferentiated periampullary neoplasm. However, the final diagnosis revealed a follicular lymphoma of the duodenum and a carcinoid tumour of the CBD. No adjuvant therapy was judged appropriate after thorough staging and the patient is doing well eighteen months after surgery.Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.The authors declare that they have no competing interests.PA carried out the surgical procedure, designed the study, gathered the data and wrote the manuscript. NA finally revised the manuscript for submission. VSt participated in drafting and revising the manuscript. AT participated in gathering the data and drafted the manuscript. EK performed the appropriate histological analysis of the surgical specimens and provided histological sections as figures for the manuscript. CRL revised the language of the manuscript as a native English speaker. VS carried out the surgical procedure, participated in designing the study and revised the manuscript for submission. All authors have read and approved the final manuscript.


Actinomyces, with positive reaction with periodic acid Schiff. Right tubo-ovarian abscess was present. Abdominalpelvic actinomycosis should always be considered in patients with a pelvic mass especially in ones using intrauterine device.Abdominal-pelvic actinomycosis is often mistaken for other conditions, presenting a preoperative diagnostic challenge. In a 46-year-old female, computed tomography showed an abdominal-pelvic retroperitoneal mass extending from the lower pole of the right kidney to the lower pelvis. The patient had a 3-year history of intrauterine device. The mass appeared to involve the ascending colon, cecum, distal ileum, right Fallopian tube and ovary, and ureter anteriorly and the psoas muscle posteriorly. The resection of retroperitoneal mass, distal ileum appendicectomy, right hemicolectomy, and right salpingo-oophorectomy was performed. The postoperative period was uneventful. Penicillin therapy was given for six months without any complication. The retroperitoneal mass measured 4.5 × 3.5 × 3 cm, surrounded adjacent organs and histologically showed inflammatory granulomatous tissue, agglomeration of filaments, and sulfur granules of  Actinomyces israelii. Actinomyces israelii is an anaerobic, gram-positive organism that is normally present in oral cavity, throughout the gastrointestinal tract, female genital tract, and the bronchus. Actinomycosis occurs most frequently in the cervical facial (50%–65%), abdominal (20%), and thoracic (15%) regions. The overall incidence of registered cases of actinomycosis is decreasing. Abdominalpelvic actinomycosis, however, are increasing in frequency and is associated with abdominal surgery (such as appendectomy), bowel perforation, or trauma [In developed countries, actinomycosis is a relatively rare disease that is mainly caused by thoracic 5% regionbdominal 0%, and tIn the majority of cases, the indolent clinical course together with the malignant like tumour appearance at imaging investigations make a delay in diagnosis the rule rather than the exception. Preoperative diagnosis is usually difficult with the majority of cases being diagnosed after the histological and bacteriological examination of the resected specimen. The present paper discusses the case of an abdominalpelvic actinomycosis mimicking a malignant retroperitoneal tumour in a young insulin-dependent diabetic Italian woman with 3-year history of IUD.A 46-year-old female was referred to our unit following a computed tomography (CT) scan which demonstrated an abdominalpelvic retroperitoneal mass. The patient had came to emergency department complaining of a three-day history of a lump on the right lower limb preceded by fever and continuous right lower abdominal pain irradiated to the back for the previous 3 weeks. Past medical history was unremarkable except for insulin-dependent diabetes mellitus since 11 years of age. The patient had a 3-year history of IUD which had recently been removed. Physical examination demonstrated mild oedema of the right leg, with no abdominal abnormal findings. Doppler ultrasonography of the lower limbs was carried out and ruled deep venous thrombosis and superficial thrombophlebitis. The patient was discharged and she was investigated as an outpatient. Biochemical and haematological investigations demonstrated a raised CRP and ESR, normal white blood count, mild macrocytic anemia , and thrombocytosis PLT 626.000/uL). The CT scan showed a retroperitoneal mass with abscess areas and necrosis extending from the lower pole of the right kidney to the lower pelvis. The mass appeared to involve the ascending colon, cecum, distal ileum, right Fallopian tube and ovary, and ureter anteriorly and the psoas muscle posteriorly  or eccentric (n = 3) bowel wall thickening, with a mean thickness of 1.2 cm and a mean length of 8.3 cm. The thickened bowel enhanced homogeneously in nine patients and heterogeneously in the other nine. Inflammatory infiltration was mostly diffuse and severe. In 17 patients, a peritoneal or pelvic mass  was seen adjacent to the involved bowel and appeared to be heterogeneously enhanced in most cases; infiltration into the abdominal wall was seen in four patients.Preoperative radiologic diagnosis is rarely performed. Ha et al.  analyzedActinomycosis should be included in the differential diagnosis when CT scans show bowel wall thickening and regional pelvic or peritoneal mass with extensive infiltration, especially in patients with abdominal pain, fever, leukocytosis, or long-term use of intrauterine contraceptive devices.Neoplasms and other inflammatory diseases, especially tuberculosis or Crohn's disease, may be confused with actinomycosis. In actinomycosis, solid masses with focal low-attenuation areas were more frequently found than cystic masses with thickened walls. In conclusion, imaging investigations  confirm the presence of a mass with collections but they are not able to distinguish between actinomycosis and malignancy, Crohn's disease, diverticulitis, appendicitis, pelvic peritonitis, or tubercolosis . The infiltrative mass with unusual aggressiveness is the one of important radiological findings. In our case the CT scan showed an infiltrative mass with unusual aggressiveness. The lymph node enlargement, ascites and involvement of the whole peritoneal cavity were absent. These findings could be supported by the diagnosis of Actinomycosis in our case.Actinomyces granules regularly show a positive reaction with periodic acid Schiff and Grocott's dye, but the Kossa reaction is negative. Pseudoactinomyces granules formed by Nocardia and Streptomyces spp. show the opposite reactions [Similarly to our case, in the great majority of cases, diagnosis is reached by histopathological examination of the specimen obtained by surgical exploration and resection. Histopathologic examination of the infected tissue should include a search for characteristic, but not pathognomonic, appearances of sulphur granules. The granules measure 0.4–4 mm and stain Gram-positive with a mycelium-like structure . The difeactions . Becauseeactions . In our The primary diagnosis of abdominalpelvic actinomycosis is difficult. The clinical picture has changed in the last ten years. Women with IUDs are especially at risk. All organs and anatomic structures of the abdomen can be involved. Even with extensive infection, combined operative and antibiotic therapy allows cure in most cases.


Plasmablastic lymphoma (PBL) is a relatively new entity, classified by WHO as a rare variant of diffuse large B cell lymphoma. The present case report introduces a 17 year old girl with chronic diarrhea, abdominal pain, intra-abdominal venous thromboses, ascites, mesenteric lymphadenopathies and small intestinal polyposis, the pathologic and immunohistochemistric examinations of the polypoid lesions were in favor of PBL. Numerous cases of PBL have been reported, but to our knowledge, this is the first report of PBL presenting as small intestinal polyposis.Among lymphomas, only mantle cell lymphoma and follicular cell lymphoma have been previously reported to cause intestinal polyposis. This report introduces Plasmablastic lymphoma, a rare variant of diffuse large B cell lymphoma, as a possible cause of small intestinal polyposis. A 17 year old girl with a history of 8-year diarrhea presented with abdominal pain and distention. Her bowel movements had been loose and large in volume, occurring 4-5 times a day, containing no blood or mucus and sometimes making her to wake up for defecation at midnight.Three months before admission in our hospital, but she referred to another hospital due to abdominal pain and distention, but was self-discharged very soon, without reaching to diagnosis. The only documentations which she brought to us, were a report of an abdominopelvic ultrasonography showing normal liver, biliary tract, spleen, kidneys, ovaries and uterus, but accumulation of ascitic fluid and a suspicious intra-abdominal mass, maximally measuring 24mm in diameter and also, a report of a doppler ultrasonography indicating portal vein and superior mesenteric vein thromboses.When she referred to our hospital, she was still complaining of abdominal pain and diarrhea. She had lost her appetite but mentioned no weight loss due to edema. She sometimes felt low grade fever without chills or night sweat.She also complained of amenorrhea. Her first menstrual cycle was at the age of 11 years and then she experienced just 2 other menstrual cycles, the last one being 1 year ago.She was the 5th child in a family of 6 and was uneducated and single. No other member of her family had a history of chronic diarrhea or any significant disease. She mentioned no close contact to a person with tuberculosis. She did not smoke or use alcohol. Her only medication had been warfarin since 2 months before.On physical examination, her vital signs were stable. She was conscious, but seemed ill. There were multiple freckles on her tanned face skin but not around her lips or on her buccal mucosa. Also, no aphtous lesion was found in her oral cavity.Her conjunctiva was pale. There was no temporal wasting. She did not have thyromegaly or distended jugular veins. Also no peripheral lymphadenopathy was found. Her breasts were retarded in growth and she had just breast buds. There was no axillary hair. Her heart and lungs were normal on examination. Her abdomen seemed distended. There was no caput medusa or spider angioma. Her bowel sounds were hyperactive.She had shifting dullness in her abdomen, suggesting the presence of ascitic fluid, but no mass or hepato/splenomegaly was detected. She had no pubic hair. Her extremities were mildly edematous and clubbing was obvious on her fingers. Laboratory data are shown in She went under upper endoscopy and biopsy from the 2nd part of the duodenum. It grossly revealed hypertensive gastropathy without varix formation, but pathologic examination of the biopsy specimen showed villous atrophy with crypt hyperplasia and severe lymphocytic infiltration. Tests for anti-endomysial IgA, anti-gliadin IgG and anti tissue transglutaminase (anti tTG) IgA and IgG had negative results.Colonoscopy was also performed, revealing normal macroscopic appearance of mucosa, but no biopsy was taken. An abdominopelvic spiral CT-scan was also performed, showing multiple mesenteric lymphadenopathies and multiple pedunculated polypoid lesions in her small intestine. There was also an oval shaped mass in ileo-jejunal area measuring 60x40mm, causing a non-obstructing intussusception .At this time, she underwent laparatomy for excisional biopsy of the lymph nodes and resection of the mentioned masses. During the operation, multiple polypoid lesions were found in the small intestinal lumen by touching. One of these polypoid lesions had caused a non-obstructing intussusception at about 100 cm distance from the beginning of the jejunum. Multiple mesenteric lymphadenopathies were also found, but there was no retroperitoneal mass. The intussuscepting mass with 2 adjacent polyps and some lymph nodes were excised for evaluation. Histopathologic examination showed polypoid lesions with ulcerated surface epithelium and destroyed glandular architecture due to diffuse infiltration of discohesive medium to large sized lympho-plasmacytoid neoplastic cells. The tumoral cells had large vesicular nuclei, prominent nucleoli and scant to moderate eosinophilic cytoplasm. Mitotic figures with atypical forms were numerous . All of All together, the histologic and IHC results were in favor of plasmablastic lymphoma (PBL), but before starting chemotherapy, unfortunately the patient died.In our patient, the presence of chronic diarrhea accompanied by anemia, hypoalbuminemia, delayed puberty and amenorrhea were suggestive of malabsorption.Iron deficiency anemia in the absence of menstrual cycles necessitated the evaluation of GI tract. Although duodenal biopsy showed lymphocytic infiltration with villous atrophy, these findings were not specific and could be seen in celiac sprue, bacterial overgrowth, crohn s disease, cow s milk protein intolerance (in children), eosinophilic gastroenteritis, giardiasis, lymphoma, peptic duodenitis, tropical sprue, common variable immunodeficiency, autoimmune enteropathy and other immunodeficiency states.Negative antiendomysial and antigliadin and anti-tTG tests ruled out celiac sprue. In order to search for the other mentioned causes, colonoscopy and evaluation of small intestine were needed.On the other hand, the presence of high gradient ascites in the absence of heart failure, nephrose or thyroid disease led to ultrasonographic evaluation of the liver and spleen, which subsequently showed intra-abdominal venous thromboses. So, the high gradient ascites seemed to be due to portal hypertension caused by the thromboses. Here, the explanation for the companion of malabsorption and thrombosis could be hyperhomocysteinemia due to folic acid deficiency,  extraintAll together, the etiology of malabsorption had been still undiagnosed until the observation of intraabdominal lymphadenopathies and small intestinal polypoid lesions led to laparatomy and final diagnosis of lymphoma.The unique feature of our case was presentation of PBL as small intestinal polyposis. The common small intestinal polyposis syndromes include juvenile polyposis, Peutz-JePBL is a relatively new entity, classified by WHO as a rare variant of diffuse large B cell lymphoma,-12 initiNumerous cases of PBL presenting as buccal mass, cervical lymph node, lung tumor, isolated cutaneous mass, nasopharyngeal lesion, gastric tumor or even after therapy for inflammatory bowel disease, post solid organ transplantation or as a variant of Richter's syndrome have been reported,-25 but tAccording to the pathologic and IHC evaluation, the most important differential diagnoses to be ruled out were anaplastic plasmacytoma/multiple myeloma and anaplastic large cell lymphoma. The immunophenotype of anaplastic plasmacytoma/ multiple myeloma may be similar to that of PBL, but bone marrow involvement is a common finding. Furthermore, the neoplastic cells tend to have a larger cytoplasm and eccentrically located nuclei NegativeHowever, due to the aggressive behavior of PBL, the patient's chronic diarrhea could not be explained. Since PBL commonly occurs in immunodeficient patients, especially in association with HIV infection, immunodeficiency could have been the underlying reason for her long lasting diarrhea, but the patient died before the diagnosis of PBL was made. There fore, no test for HIV infection could be performed. It is also possible that another underlying cause, which we could not find, had been responsible for her long lasting diarrhea.In conclusion, lymphoma should be kept in mind as a cause of small intestinal polyposis. Also, beside mantle cell and follicular lymphomas, this report introduces PBL as a rare but possible cause of small intestinal polyposis.


Duplications of esophagus are rare congenital anomalies and the second most common duplications of the gastrointestinal tract. This form of bronchopulmonary foregut malformation may appear as a cystic mediastinal mass. On chest radiographs they may be visible as middle or posterior masses. On CT they are well marginated and oppose the esophagus. Usually they are asymptomatic, unless they become infected or cause obstruction. We report a case of thoracic tubular duplication cyst in a 10-month-old boy who presented with persistent wheezing that was unsuccessfully treated in out-patient services. Embryonal foregut duplication cysts are uncommon lesions that constitute 15% of all mediastinal masses, commonly found in the posterior mediastinum. Some 10%–20% of these anomalies are esophageal duplications . There aThe aim of this report is to present an infant with this anomaly and persistent wheezing as a marked clinical sign, unrecognized as a problem in out-patient practice.A 10-month-old male infant was referred to hospital because of prolonged, rough and intensive cough and persistent wheezing refractory to inhaled bronchodilators and corticosteroid therapy. He was unsuccessfully treated 8 weeks before admission. The boy was previously healthy. Because of the broncho-obstruction, as well as positive family history for atopic diseases (mother's asthma), the out-patient pediatrician had already carried out prick test to nutritive allergens (negative), eosinophil count in nasal secretions (negative), and eosinophils in blood . Acute episodes of marked broncho-obstruction occurred 2–3 times per month, with continuously present coughing and mild wheezing in the ‘symptom-free’ periods.2 was 96% (by pulse oximetry). Rough and irritable cough was notable, as well as marked persistent wheezing with signs of dyspnea .The child was in a good condition. He had no swallowing difficulties or cyanosis. He was normothermic, respiratory rate was 36/min, heart rate was 120/min, SatOAll additional examinations were normal: C-reactive protein (CRP), total leukocyte count, and differential white blood cell count, along with other biochemical findings , ECG and echocardiography findings, chloride in sweat(sweat test), and plain chest X-ray (CXR).During the first 6 days after admission, the patient was treated with beta-2 agonists and corticosteroids systemically, but wheezing and respiratory distress persisted.On the third day of hospitalization esophageal fluoroscopy was performed, showing impression at the middle third of the esophagus, its significant narrowing and shifting to the right. Nevertheless, its wall remained smooth. Diameters of the proximal and distal thirds of esophagus were normal .Lateral radiography  showed aFollowing these findings, contrast-enhanced computed tomography (CECT) was performed. It showed a hypodense, well circumscribed, oval-shaped mass with a thin rim located in upper and middle-posterior mediastinum. Its greatest diameter was around 5 cm. The lesion was displacing the esophagus to the right and aorta to the left. The distal third of the trachea was compressed and shifted to the right. There has not been any communication of the mass with the surrounding mediastinal structures seen. In the lungs and the rest of the mediastinum the CT findings were normal. Based on this finding the radiologist raised a suspicion of the tubular form of an esophageal duplication cyst. A bronchogenic cyst was also considered as differential diagnosis .The decision about surgical treatment was made after consultations including pediatrician, radiologist, and surgeons. Bronchoscopy was performed under general anesthesia, before surgical intervention. Endoscopy revealed marked signs of posterior wall compression in the left principal bronchus with a slit-like bronchial lumen.The patient underwent a left thoracotomy which revealed a large cystic mass in the posterior mediastinum. Next to the esophagus, a tubular duplication cyst with thin walls was found. Its size and position matched completely the CT and endoscopic findings. The cyst wall was excised in total, except the part which was in direct contact with the esophagus and had a joint wall (unroofing). Integrity of the entire length of the esophagus was checked by palpitation with probe. Biopsy findings were consistent with esophageal tubular duplication cyst.After the intervention, the respiratory symptoms disappeared. Unfortunately, the patient had a complication of the surgical intervention, and as a result of intraoperative lesion of ductus thoracicus he developed chylothorax.The child was discharged 6 weeks after surgical treatment, with normal CXR, without symptoms of respiratory or gastrointestinal disease, and normal physical findings.After 18 months the child is still well and regularly followed up.Esophageal duplication cysts are benign, asymptomatic bronchopulmonary foregut malformations. Most of them are found by accident, in children evaluated for other medical problems. Estimated incidence of congenital esophageal cyst is 1:8200, with male sex predominance (2:1) . DependiEsophageal duplication can be associated with other congenital anomalies, such as small intestine duplications, esophageal atresias distal to the duplication, tracheoesophageal fistulas, and spinal abnormalities .Our patient did not have any associated anomalies. This infant presented with severe wheezing refractory to all standard modalities of treatment. Usual conditions leading to wheezing were considered as differential diagnosis; the child was fully examined, and a cystic mass that could belong to the esophageal duplication cyst was discovered in the posterior mediastinum. Usually, these cysts are found accidentally on the CXRs in asymptomatic patients .However, when they become symptomatic with different features, mostly respiratory, it is often a sign of development of complications  . In our Non-invasive radiological methods can be helpful in the diagnosis. In these cases barium esophagogram is useful, revealing compression of the esophagus. CT has the advantage over conventional diagnostic procedures because it demonstrates the exact anatomic position of the cyst, nature of the mass, its relationship to the adjacent structures, and also influences the decision-making about resectability ,12.A symptomatic cyst is an indication to immediate resection. Surgical excision is recommended at the time of discovery to prevent the development of complications and to avoid the potential malignant transformation .Duplication cysts are rare but should be included in the differential diagnosis of persistent wheezing. A high index of suspicion is key to early diagnosis and treatment, because cyst progression in children can rapidly lead to obstruction and severe respiratory failure.


Osteoid osteoma (OO) is a common benign tumor of the bone and is typically treated by thermal ablation with computed tomography (CT) guidance. Only a few cases of multicentric OO have been described. We here report the case of an 11-year-old boy with multicentric OO of the right femur treated with laser ablation under open high-field MRI guidance. The steps of the interventional MRI procedure are described, discussing the benefits and disadvantages of MRI versus CT guidance especially with regard to younger patients. Osteoid osteoma (OO) is a benign neoplasm of the bone that makes up about 12% of all benign bone tumors [The main treatment options for OO include en bloc resection and curettage of the nidus. Since the extent of surgical resection is often disproportional to the actual tumor size,  thermal An 11-year-old boy was referred to our department with a more than one-year history of local pain in the right leg which worsened at night. He explained that the pain had started after a minor accident in which he had fallen on his knee. A radiograph of the knee had not revealed any abnormality (not shown). The patient did not tolerate salicylates and thus had been treated with acetaminophen, which had only given him minor relief. A second X-ray, which included not only the knee but also the distal femur, identified thickened cortical bone and a suspected nidus in the diaphysis of the femur . An MRI Before the procedure, prophylactic antibiosis was administered intravenously . The whole intervention was performed under general anesthesia. To reduce postoperative pain, subcutaneous and periperiosteal local anesthesia  was administered. A fast T1-weighted turbo spin echo (T1w TSE) sequence  was used for instrument guidance during the intervention . An MRI-The two nidi were successfully localized, targeted, and treated under MRI guidance. The laser effect was depicted online as previously described . No compThe whole procedure was performed in 97 min. A total of 6 pulse sequences were acquired, including a survey, T2w SPIR TSE for planning, PDw TSE for interactive drilling and needle/laser positioning, T1w GRE for MR thermometry, and finally pre- and postcontrast T1w TSE for computing subtraction images.At 6-month followup, the patient remains asymptomatic, without the need for oral anti-inflammatory agents. MRI showed complete resolution of femoral bone marrow edema, consistent with the relief of symptoms . Traditional surgical treatment methods include open “en bloc” resection, curettage, and percutaneous drill excision of OO. The problem of open resection techniques is that the amount of tissue removed is often much larger than the tumor mass, mainly due to the difficulty of proper intraoperative nidus localization . PercutaNewer, less invasive percutaneous techniques, including chemical destruction and thermal ablation, have higher success rates and fewer complications. With thermal laser ablation (LA), for instance, the insertion of an 18-G needle is usually sufficient to destroy the entire nidus. Among the percutaneous modalities, CT-guided hyperthermal ablation using radiofrequency (RFA) or LA is currently the treatment of choice with success rates of more than 90% , 11, 12.However, open MRI has features that may be advantageous for interventional guidance compared with CT, including superior soft tissue resolution and multiplanar navigation capabilities. The better resolution enables more reliable identification of critical tissue structures such as vessels, nerves, and cartilage in areas near the joints. Finally, the absence of ionizing radiation in MRI is advantageous especially in younger patients but also for the interventionist. MR-guided ablation is especially beneficial in the case of multicentric OO since the time needed for the intervention is longer than the time needed for eliminating a single nidus. On the other hand, MR guidance is more susceptible to instrument-induced artifacts, which may degrade the precision of the intervention. The occurrence of artifacts depends on the field strength used as well as the material the instruments are made of and their position relative to the main magnetic field B0. A major drawback of MRI guidance is that the size of the needle is usually overestimated due to artifact, which is most disturbing in critical regions such the periarticular region, the spine, and the small bones of the hands and feet , where CThermal monitoring of LA was reported to be unsuccessful in an open low-field scanner (0.23 T) . HoweverAs shown in the direct postinterventional control, subtraction images are useful to check whether ablation has been successful. Unfortunately, our patient refused the administration of contrast agent in the follow-up MRI, due to an extreme fear of needles, though the disappearance of femoral bone marrow edema was found to be consistent with the relief of symptoms.No tissue was sampled for histological confirmation of the diagnosis since the clinical and imaging findings suggested the diagnosis of OO. However, even specimens from surgical resection enable histological confirmation of OO in only 57–79% of the cases .A recent study has shown that MR-guided LA is less expensive than CT-guided RFA, mainly due to the higher costs of the disposable RF ablation probes used in CT-guided interventions .To our knowledge, this report presents the first case of multicentric osteoid osteoma treated with laser ablation under open high-field MRI guidance. In the reported case, LA under open MRI guidance was safe and effective. The avoidance of ionizing radiation when MRI guidance is used is advantageous, especially when the patient is young and two nidi have to be removed, as in our case. Still, further studies are needed to determine whether the theoretical advantages of open MRI-guided laser ablation can also be confirmed in larger patient collectives.


A 56-years-old woman was referred to our unit for partially treated acromegaly. She had a high level of insulin growth factor. She did not complain of any pulmonary symptoms and was a non-smoker. Physical examination revealed clinical features of acromegaly. She had a 13 mm pituitary adenoma and was proposed for surgical intervention. Her chest X-ray showed a right paracardiac tumor. Computed tomography scan revealed a large right-sided fowler tumor. Pituitary surgery was cancelled and lobectomy after biopsy with lymph nodes excision was performed through thoracotomy. Histological study of the tumor revealed a medium differentiated epidermoid carcinoma with positive lymph nodes and extension to pleura. She was referred to chemotherapy protocol. Association between carcinoma and acromegaly has previously been reported. Most common tumors are colorectal and thyroid neoplasia. As we see in this case report, we need to consider other carcinomas in acromegalic patients like pulmonary carcinoma, despite their rarity in women. Acromegaly is a chronic disease caused usually by a pituitary adenoma secreting excess growth hormone (GH). Untreated acromegaly is associated with a high morbidity and two -fold mortality risk , 2. AcroWe report the case of a 56-years-old non-smoking female patient diagnosed with acromegaly seven years ago and treated by transphenoidal surgery and radiotherapy. She was referred to our unit for persistent acromegaly. She had evident signs of acromegaly on clinical examination. Laboratory investigation demonstrated increase IGF1 at 429 ng/ml and pituitary 13 mm macro-adenoma. She didn't have metabolic complications. Our decision was surgery, because of non availability of medical treatment. She was referred to the neurosurgeon and proposed a trans-sphenoidal adenoma removal. A routine chest-X-ray, done in the pre-operative workout, revealed a right sided paracardiac opacity . A thoraAcromegaly is a rare disease with a prevalence of 40 cases/1 million population and 3 new cases/1 million population per year due to excess growth hormone (GH) secreted usually by a pituitary adenoma , 15. MajLung cancer is the most frequent cancer inducing deaths in women and men according to the American Cancer Society . Lung caActive disease may precede for several years the diagnosis of acromegaly because of indolence. Highl levels of IGF1 contribute to progression of malignant tumors. In acromegalic patients, screening is fundamental, and chest X-ray with CT may be necessary. During follow-up, more attention should be given in partially treated acromegalic patients because of persistent increase of IGF1 levels. Screening of neoplasias should be done in these high risk patients.


Mesothelioma of tunica vaginalis is a rare neoplasm, typically demonstrating frankly malignant morphology and aggressive behavior. Rare cases of well-differentiated papillary mesotheliomas have also been reported, which, in contrast, demonstrate indolent behavior. There are, however, cases which do not fit into the well-differentiated or diffuse malignant mesothelioma categories and can be considered mesothelioma of tunica vaginalis of "uncertain malignant potential", which is an emerging diagnostic category. A 57-year-old man presented with a neoplasm in a hydrocele sac. The neoplasm was non-invasive, but showed focal complex and solid growth and it was difficult to categorize either as well-differentiated papillary mesotheliomas or malignant mesothelioma. After the initial limited resection, the patient underwent radical orchiectomy with hemiscrotectomy and is alive and without disease progression after 6 years. Documentation of these rare tumors will allow their distinction from true malignant mesotheliomas and will facilitate the development of specific treatment recommendations. Mesothelioma of tunica vaginalis is a rare neoplasm comprising less than 1% of all mesotheliomas, with over 200 cases documented in the literature ,4. By deWe present a case which highlights the difficulty of clearly categorizing a case either as WDPM or malignant mesothelioma, which reiterates the need of introducing a diagnostic category of mesothelioma of tunica vaginalis of "uncertain malignant potential". Currently, there are no specific treatment recommendations for WDPM or mesotheliomas of "uncertain malignant potential" and it is important that these uncommon tumors are well characterized and their long-term behavior documented, which will enable establishing evidence-based treatment guidelines.A 57-year-old patient presented with asymptomatic hydrocele for 6 months prior to routine surgery. No prior history of local trauma or asbestos exposure was documented. Two small paratesticular nodular masses were found during the surgery, originating from the tunica vaginalis above the head of the epididymis, which measured 1.5 cm and 0.5 cm in diameter. The nodules were pedunculated and there was no gross evidence of invasion, resulting in limited local resection. Both masses had uniform yellow/tan cut surfaces on gross examination. Although a preliminary diagnosis of WDPM of tunica vaginalis was considered initially, the presence of some problematic morphologic features prompted an extramural consultation which acknowledged the difficulty in classifying the neoplasm. A close patient follow-up was recommended because of the inability to completely rule out the diagnosis of malignant mesothelioma. Therefore, a subsequent radical orchiectomy with hemiscrotectomy was performed five months after the initial resection, which included wide resection of the paratesticular and inguinal skin and soft tissue. The specimen showed no residual neoplasm and only three surface micronodules  of reactive mesothelial hyperplasia were found. After a 6-year follow-up, the patient had no disease progression and no evidence of local recurrence or metastatic disease.The specimen was fixed in neutral buffered formalin and was embedded routinely for histologic evaluation. Four-micrometer-thick sections were stained with hematoxylin and eosin. On light microscopy, both nodules resected initially were circumscribed and comprised mostly of variably sized papillary formations with fibrovascular cores, lined by flat to cuboidal and focally columnar cells with bland nuclei, showing no more than mild cytologic atypia Figure . The fibOn immunohistochemistry, the cells lining the papillae, as well as the cells in the areas of the more complex and solid growth, were uniformly immunoreactive for cytokeratin , calretinin, D2-40, WT-1 and vimentin, and were focally reactive for EMA and p53 (in approximately 10-20% of the tumor cells). Ki-67 was positive in less than 1% of the cells. Negative immunostains included: CEA, cytokeratin 5/6, Leu-M1 (CD15), Ber-Ep4 and MOC-31.Mesothelioma of tunica vaginalis with dominant papillary architecture and focal complex morphology, but without other adverse findings, raises the dilemma whether it can still be considered as WDPM or whether it represents a predominantly papillary malignant mesothelioma. The neoplasm presented herein consisted of two small solitary tumors with mostly papillary architecture and bland cytology, but with no invasion into the surrounding tissue or infiltrative growth. The presence of some potentially adverse features, such as areas of complex and solid growth, a microfocus of coagulative necrosis and a mitotic figure, introduced the differential diagnosis of malignant mesothelioma with predominant papillary growth. The patient had an uneventful clinical course after a more radical surgery with no evidence of local disease recurrence or progression with distant metastases. It can be argued that a favorable outcome was achieved because of the radical treatment for a low-grade papillary malignant mesothelioma. Another option of resolving this diagnostic conundrum would be to consider this case a mesothelioma of "uncertain malignant potential", because it neither completely fits into the WDPM nor in the diffuse malignant mesothelioma category. This approach highlights the diagnostic uncertainty in these types of cases, particularly during the initial sign-out, when the invasive growth cannot be completely ruled out, particularly when dealing with a limited specimen or a limited excision.WDPM of tunica vaginalis is considered "benign mesothelioma" in the World Health Organization fascicle on the tumors of the urinary system and male genital organs, primarily due to their indolent behavior . A critiThe definition of WDPM has been somewhat controversial, but most experts currently restrict the term WDPM only to localized, solitary and exophytic tumors composed exclusively of delicate papillae lined by bland cuboidal cells ,7,16. SeThe differential diagnosis of WDPM or mesotheliomas of uncertain malignant potential of tunica vaginalis includes primarily other mesothelial proliferations of tunica vaginalis, such as malignant mesothelioma, benign nodular mesothelial hyperplasia, adenomatoid tumor, and also some uncommon testicular or paratesticular neoplasms. However, it is crucial that they are distinguished from the malignant mesotheliomas, which typically present with multiple nodules of larger size, irregular nodules on the hydrocele surface or with diffuse and irregular thickening within a hydrocele. Less often, malignant mesotheliomas form solitary tumors or tumors with an exophytic, partially papillary growth, mimicking WDPM. Malignant mesotheliomas are often found to have hemorrhagic hydrocele fluid intraoperatively. On microscopy, they can be either epithelial, sarcomatoid or biphasic and they typically show frank invasion into the adjacent tissue including the testis, epididymis or the spermatic cord. Although the nuclei may demonstrate atypia and the nuclear size and shape may vary, many cases exhibit bland cytology. The mitotic figures are readily found and psammoma bodies may also be frequently seen. Local recurrences occur in 60% of the patients during the first two years after the initial treatment and in more than 90% of the patients within 5 years after the treatment . In a coThe benign end of the spectrum of mesothelial proliferations is represented by nodular or reactive mesothelial hyperplasia which occurs most likely as a result of local irritation or injury, and is usually discovered incidentally in hernia sacs in children or in hydrocele sacs in adults. These are typically microscopic nodules or flat lesions on the surface of tunica vaginalis with bland appearance. They lack the distinctive papillary architecture seen in WDPM. Mesothelial reactions in hydroceles can sometimes exhibit diffuse and layered "zonal" distribution with entrapment of the mesothelial cells in a background of an organizing hematocele. These superficial extensions of mesothelial cells, glands and entrapped mesothelial cells are usually organized in parallel and linear arrays, which should not be confused with mesothelioma invasion ,19.Other rare paratesticular and testicular neoplasms should also be considered in the broader differential diagnosis of the mesothelial proliferations of tunica vaginalis and were previously reviewed comprehensively by Amin MB and Algaba and the collaborators ,20. ThesWe describe a mesothelial neoplasm which can be considered a mesothelioma of tunica vaginalis of uncertain malignant potential, an emerging diagnostic category, which can be applied to rare cases that do not fit into the categories of WDPM or diffuse malignant mesothelioma. The neoplasm was detected in a hydrocele and exhibited mostly papillary architecture with focal complex morphology, but did not show stromal invasion. Although no disease progression was documented on follow-up of 6 years after more extensive surgery, the appropriate treatment for these cases is uncertain, which highlights the necessity of their documentation with long term follow-up.Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.WDPM: well-differentiated papillary mesotheliomaThe authors declare that they have no competing interests.KT conceived and designed the case report and drafted the manuscript. RB supplied clinical data and contributed to the revisions and editing of the manuscript. AK and AY participated in its design, contributed to the revisions and editing of the manuscript and provided images. All authors have read and approved the final manuscript.


Due to a lack of early symptoms, pancreatic cancers of the body and tail are discovered mostly at advanced stages. These locally advanced cancers often involve the celiac axis or the common hepatic artery and are therefore declared unresectable. The extended distal pancreatectomy with en bloc resection of the celiac artery may offer a chance of complete resection. We present the case of a 48-year-old female with pancreatic body cancer invading the celiac axis. The patient underwent laparoscopy to exclude hepatic and peritoneal metastasis. Subsequently, a selective embolization of the common hepatic artery was performed to enlarge arterial flow to the hepatobiliary system and the stomach via the pancreatoduodenal arcades from the superior mesenteric artery. Fifteen days after embolization, the extended distal pancreatectomy with splenectomy and en bloc resection of the celiac axis was carried out. The postoperative course was uneventful, and complete tumor resection was achieved. This case report and a review of the literature show the feasibility and safety of the extended distal pancreatectomy with en bloc resection of the celiac axis. A preoperative embolization of the celiac axis may avoid ischemia-related complications of the stomach or the liver. Pancreatic adenocarcinoma is still a tumor entity with a poor prognosis and an overall long-term survival of 1–5% . A majorThe standard resection for tumors of the body and tail of the pancreas is a distal pancreatectomy with concomitant splenectomy . Distal A 48-year-old otherwise healthy woman had suffered epigastric and back pain for 4 weeks. At first, gastroscopy was performed showing no pathological findings. Subsequent contrast-enhanced computed tomography depicted a 3.3 cm lesion in the body of the pancreas with invasion of the celiac axis . TherefoFifteen days after embolization of the celiac axis, the extended distal pancreatectomy with splenectomy and en bloc resection of the celiac axis was carried out. We favour an upper abdominal transverse incision with extension to the xiphoid to ensure maximum visibility and access to the pancreas. After confirming the absence of hepatic and peritoneal metastasis, the superior mesenteric artery was exposed at its origin from the aorta to exclude tumor infiltration. The patient underwent a prophylactic cholecystectomy to avoid postoperative ischemic cholecystitis. The hepatoduodenal ligament was dissected, and the proper hepatic artery, the common hepatic artery, and the gastroduodenal artery were exposed. After the common hepatic artery was divided proximally to the origin of the gastroduodenal artery, an excellent pulsation of the left and right hepatic artery was still assessed. The pancreas was transected at the level of the portal vein. The dissection of the portal vein revealed a potential tumor infiltration at the splenic vein confluence; thus, a concomitant portal vein wedge resection was performed. Then the origin of the celiac artery was identified above the superior mesenteric artery, and the celiac artery and the left gastric artery were divided. The body and tail of the pancreas, the spleen, the celiac axis, and the surrounding lymph nodes and nerve plexus were removed en bloc . FinallyStreptococcus pneumoniae, Haemophilus influenzae type B, and Neisseria meningitidis was administered during, the hospital stay.The postoperative course went uneventful, and the patient was discharged after 20 days stay in the hospital. A postoperative CT scan revealed sufficient arterial flow of the hepatic arteries via the pancreatoduodenal arcades . A moder2 for 3 weeks of a 4-week cycle for 6 months) was carried out. After treatment completion no local recurrence and distant metastasis occurred as evaluated by CT scan.The histopathologic findings showed an invasive ductal adenocarcinoma of the pancreas (pT3) with a size of 6 cm and clear histologically surgical margins (R0). The histopathologic grading was G2 (moderately differentiated), and two regional lymph node metastases were detected (2/17). A notable perineural infiltration extending to the celiac plexus was present. On the recommendation of the interdisciplinary gastrointestinal tumor board, a postoperative chemotherapy with gemcitabine . However, estimated 5-year survival rates of 42% as reported by Hirano et al. [Since Nimura implemented the distal pancreatectomy with en bloc resection of the celiac axis in 1976, a few authors have performed this procedure successfully . Due to o et al.  must be o et al. . It is wAdditionally, this operation not only increases the resectability but also improves quality of life due to long-lasting pain relief , 17. AdvDespite these advantages the high morbidity rate of the distal pancreatectomy with en bloc resection of the celiac axis must be considered. Hirano et al. report a morbidity rate of 48% in a series with 23 patients . The maiDuring surgery the key vessel of the distal pancreatectomy with en bloc resection of the celiac axis is the inferior pancreatoduodenal artery from the superior mesenteric artery, and surgeons should identify this artery to avoid an accidental injury. If an arterial reconstruction is needed, a middle colic artery-gastroepiploic artery bypass can be used . The splThis case report and the cited studies display the feasibility and safety of the operation. The encouraging results of Hirano et al. , who repThe extended distal pancreatectomy with en bloc resection of the celiac axis following a preoperative embolization provides a high resectability rate and a long-lasting pain relief. These results justify further evaluation of the long-term survival benefits. However, this procedure should always be considered in patients with locally advanced cancer of the pancreatic body or tail involving the celiac axis or the common hepatic artery. The presentation of these patients to a high volume center of pancreatic surgery may avoid premature palliative chemotherapy.


Osteochondrolipoma is an extremely rare histological variant of lipoma with osseous and cartilaginous differentiation. The present study reports an unusual case of an osteochondrolipoma occurring in the left scapular region of a 49-year-old male. The physical examination revealed a 3-cm, hard, non-tender and minimally mobile mass. Plain radiography revealed a faintly ossified soft-tissue mass without evidence of bone erosion. Computed tomography (CT) confirmed the presence of a lesion and the normal appearance of the scapula. Magnetic resonance imaging (MRI) showed a well-circumscribed subcutaneous mass with an almost homogeneous high signal intensity on the T1- and T2-weighted sequences. Contrast-enhanced fat-suppressed T1-weighted sequences demonstrated a faint peripheral and septal enhancement of the mass. A marginal excision of the tumor was performed. Histologically, the tumor was predominantly composed of mature adipocytes mixed with thin trabeculae of mature bone. In addition, small amounts of mature hyaline cartilage and osteoid were identified in the periphery of the lesion. Based on these findings, the tumor was diagnosed as an osteochondrolipoma. The patient demonstrated no evidence of local recurrence within six months of follow-up. Although rare, osteochondrolipoma should be considered as a differential diagnosis of a well-defined, calcified/ossified, subcutaneous mass in the scapular region. Lipoma is the most common mesenchymal neoplasm in humans and may appear in any location of the body . The conA 49-year-old male was referred to Fukuoka University Hospital with a one-month history of a painless, palpable mass in the left scapular region. There was no history of antecedent trauma. A physical examination revealed a hard, non-tender and minimally mobile mass, measuring ~3.0×3.0 cm. The range of motion of the left shoulder was normal. The neurological and vascular examinations were unremarkable. The patient's medical history was non-contributory.Plain radiographs revealed a faintly ossified, soft-tissue mass without evidence of bone erosion . ComputeThe excised specimen consisted of a well-circumscribed mass with a smooth surface. The cut sections of the mass revealed a predominantly yellow, fatty appearance with small white to gray areas . MicroscThe post-operative course was uneventful. At the six-month follow-up appointment, the patient was doing well without evidence of local recurrence.Osteochondrolipoma is one of the less common histological subtypes of lipoma. The condition may occur at almost any site of the body, notably in the oral cavity . Unlike et al(The pathogenesis of osteochondrolipomas remains uncertain. Lin et al reportedet al,5,7,9.CT is of great value in the evaluation of osteochondrolipoma . The proThe differential diagnosis for osteochondrolipoma includes soft-tissue chondromas, extraskeletal osteochondromas, myositis ossificans, ossifying fibromyxoid tumors, chondroid lipomas and well-differentiated liposarcomas.Soft-tissue chondromas, also known as extraskeletal chondromas, are relatively rare, benign cartilaginous tumors that usually occur in middle-aged adults, with a slight male predominance . These cMyositis ossificans is a benign, self-limiting condition that predominantly affects active adolescents and young adults, with a slight male predominance. It usually presents as a rapidly-growing, painful mass that expands for six-eight weeks in the extremities, particularly in the anterior thigh. Palin radiographs and CT scans are used to examine this condition and demonstrate the zoning phenomenon, with a peripheral rim of ossification that represents mature bone. MRI usually shows an intermediate signal intensity on T1-weighted sequences and a high signal intensity on T2-weighted sequences ,17. Histet al in 1989 (Ossifying fibromyxoid tumors, first described by Enzinger  in 1989 , are rar in 1989 . HistoloChondroid lipomas are rare variants of lipomas that usually occur in young and middle-aged adults, with a female predominance. These lipomas typically present as slow-growing, painless masses in the proximal extremities and limb girdles . ChondroWell-differentiated liposarcomas are the most common form of liposarcoma that are encountered in late adult life. The condition typically presents as a slow-growing, painless mass in the lower extremities, particularly the thigh. The presence of ossification within a well-differentiated liposarcoma is a rare occurrence . MRI usuIn summary, the imaging features of an osteochondrolipoma with a clinicopathological correlation have been described. Clinicians should consider osteochondrolipoma as a possible diagnosis for a well-defined, calcified/ossified, subcutaneous mass in the scapular region.


Turcot syndrome (TS) is a rare hereditary disorder clinically characterized by the occurrence of primary tumors of the colon and the central nervous system (CNS). Here we present the case of an 11-year-old boy with a synchronous clinical presentation of both glioblastoma multiforme (GBM) and colonic adenocarcinoma. A molecular genetic study revealed microsatellite instability in the DNA mismatch repair (MMR) gene. This patient ultimately survived for 13 months after clinical presentation. Based on this case study, the synchronous presentation of glioblastoma multiforme and adenocarcinoma of the colon might suggest a shorter survival rate for patients with Turcot syndrome. A literature review complements this paper. Turcot syndrome (TS) was originally described by Turcot in 1959 . It is cSince the time when this syndrome was first identified, there have only been isolated case reports or case series with a limited number of patients being discussed in the literature. The synchronous clinical presentation of CNS tumors and colonic adenocarcinoma in this syndrome is extremely rare. In this paper, we present a case of TS with simultaneous clinical presentation of GBM and colonic adenocarcinoma.An 11-year-old boy presented with headache for the past 5 days, vomiting, and history of a single tonic clonic seizure. He had no history of weakness, loss of consciousness, or memory disturbance. He was also suffering from vague abdominal pain and loose motion over a period of one month prior to presentation. He had positive family history of colonic cancer. His sister had multiple café-au-lait spots and multiple colonic polyps.During clinical examination, he was fully awake and oriented with a Glasgow coma scale (GCS) score of 15. His pupils were bilaterally equal and reacting; no motor or sensory deficit was noticed. His gait and posture were normal. On his skin there were multiple café-au-lait spots and areas of hypopigmentation . Brain CHe continued to have abdominal pain and diarrhea and developed melena and intermittent frank bleeding from the rectum. His blood cell count, platelets, and renal and coagulation profiles were within the normal range. Upper GI endoscopy was normal; however, colonoscopy showed multiple colonic polyps of various sizes with ulceration and active bleeding . Punch bNine months later, he presented with headache and was found to have mild right hemiparesis with an overall Karnofsky performance score of over 90. CT and MRI of the brain showed a left temporal ring-enhancing lesion about 4 × 5 cm in size with uncal herniation . He alsoTurcot syndrome is also known as brain-tumor polyposis and is characterized by the occurrence of primary tumors of the CNS and multiple colorectal adenomas and/or colonic adenocarcinoma , 11. FroThe pathological differentiation between sporadic GBM and TS-associated GBM has not been adequately addressed in the literature. Recently, Lusis and colleagues reported on three cases involving patients with TS-associated GBM . The hisMost of the reported TS cases in the literature are characterized by different time intervals between the clinical presentation of CNS tumors and the colonic adenocarcinoma , 22. TheSimultaneous clinical presentation of CNS GBM and adenocarcinoma of the colon in TS might be an indicator of a shorter survival rate. Moreover, the presence of GBM may also negatively affect the survival rate in contrast to other types of TS-associated CNS tumors.


Periocular tumors are common in infancy. The most common periocular tumors are capillary hemangiomas, which are present in 1-2% of newborns and develop in 10%–12% of children by the age of 1 year old. Deep capillary hemangiomas may be more challenging to diagnose than superficial capillary hemangiomas and can be confused with other orbital lesions. Deep orbital hemangiomas can mimic teratoma, lymphangioma, rhabdomyosarcoma, metastatic neuroblastoma, and granulocytic sarcoma. In this paper, we describe 2 pediatric cases where previously diagnosed dermoid cyst and dacrocystocele were found to be capillary hemangiomas upon biopsy. Approaches to distinguish capillary hemangiomas from other periocular tumors are further discussed. To our knowledge, this is the first case report of periocular hemangiomas imitating a dermoid cyst and a dacrocystocele. These cases emphasize the importance of including infantile hemangiomas in the differential diagnosis of subcutaneous periocular abnormalities. Periocular tumors are common in infancy, the most prevalent being infantile hemangiomas, which occur on any part of the body in 1-2% of newborns [ An otherwise healthy three-month-old female presented to our department for a six-week history of a right temporal brow mass. Her vision and ocular examination were unremarkable except for a 1.5 × 1.0 cm firm, rubbery mass along the right temporal brow Figures . The palIn the surgical suite, the patient was noted to have a capillary hemangioma on the right shoulder and a smaller one on the right neck . BecauseA four-month-old male born at 27 weeks gestation was examined in the neonatal intensive care unit for a several-day history of a nontender, bluish subcutaneous 1.5 × 1.0 cm mass located below the left medial canthus Figures . There wA nasal canthus duct exploration was undertaken with otolaryngology assistance. The right nasal cavity was patent and had no evidence of cyst or purulent secretion, while the left nasal cavity had some mucoid crusting. No purulent debris was expressed with palpation of the mass, and there was no cystic component noted intranasally. The mass on the cheek and lateral nose was determined to have no communication with the nasal canthus passage and was thought to be more consistent with an infantile hemangioma. The child was started on systemic propanolol, after which a decrease in size was observed.Capillary hemangiomas occur in approximately 1-2% of neonates and up to 10–12% of infants within the first year of life [Capillary hemangiomas are sometimes seen at birth but appear more commonly within the first few weeks of life and may enlarge quickly over the first year, after which the tumor begins to involute. Depending on the depth and location of the tumor, the clinical appearance may vary. Superficial hemangiomas produce an elevated strawberry-colored nodule, while deep orbital hemangiomas typically present as a fluctuant, compressible bluish mass . InfantiDermoid cysts manifest as a round, firm, smooth, and nontender mass that may be mobile or fixed to the underlying periosteum. The mass will typically be a slowly enlarging and painless subcutaneous cyst located superonasally or superotemporally to the eye . DermoidThe diagnosis of periocular disorders is generally made on clinical examination alone. A careful history that includes age of onset, color, and location, along with physical examination findings is generally sufficient in determining the pathological condition . In case In this paper, two distinct patients with periocular lesions, initially diagnosed as a dermoid cyst and dacryocystocele, were later found to have infantile hemangiomas. The prevalent occurrence and widespread distribution of infantile hemangiomas can simulate other periocular disorders. It is important to obtain a complete history and appropriate imaging to help make an accurate diagnosis. Infantile hemangiomas should be considered in the differential diagnosis of any subcutaneous periocular abnormalities.


Midline destructive lesions of the face have multiple possible etiologies. The majority of these cases are found to be due to an extranodal lymphoma of natural killer/T-cell-type non-Hodgkins lymphoma (NKTL). Unfortunately, diagnosis is often delayed. With variable presenting complaints, including nonspecific issues like chronic rhinosinusitis or nasal congestion, initial treatments are aimed at these presumed diagnoses. Only as the lesion progresses do overt signs of destruction occur. As with our patient, who was initially treated for presumed infection and abscess, final diagnosis often does not occur until several months, and several antibiotic courses, from initial presentation. As such, it is important for this rare entity to remain in the clinician's differential diagnosis for nasal lesion. Midline destructive lesions (MDLs) of the face were first reported in the late nineteenth century. These later became known as lethal midline granulomas. Other monikers such as idiopathic midline granuloma, idiopathic midline destructive disease, midline nonhealing granuloma, polymorphic reticulosis, and Stewart syndrome have also been used to describe this destructive process of the nose. Regardless of the name used, an ulcerative process, characterized by loss of both epithelium and cartilage with associated nasal crusting, occurs. Ultimately, there is loss of nasal structure and support, leading to nasal deformity . After tThough rare, NKTL is the most common form of sinonasal lymphoma and, thus, should be included in the differential for destructive lesions of the nasal cavity or midline face. There is a strong association with Epstein-Barr virus (EBV) and other epidemiologic risk factors including Asian or Central and South American descent, male gender, and age 50 to 55 –4. In thA 75-year-old Hispanic female presented with an 8-week history of a progressively enlarging nasal lesion involving the right nasal sidewall and ala, despite antibiotic treatment for presumed infection—and, later, abscess—given in multiple courses over two months. The patient denied history of trauma. In addition to obvious cosmetic deformity, she reported progressive nasal crusting, pain, intermittent right-sided epistaxis, and nasal dyspnea. She was admitted to the Otolaryngology service for intravenous antibiotics for what was thought to be a nasal abscess.Physical examination revealed an exophytic mass involving the entirety of the right nasal ala with extension onto the nasal sidewall. The skin overlying the lesion was erythematous with central crusting suggestive of ulceration. The lesion was firm and fixed to the surrounding soft tissue and underlying alar cartilage. Nasal endoscopy revealed extensive right-sided nasal crusting and friable tissue along the undersurface of the nasal ala and nasal sidewall. Fine needle aspiration was attempted but nondiagnostic. A biopsy of the right nasal alar lesion was obtained and sent for formal histopathologic examination.Maxillofacial computed tomography (CT) revealed an extensive nonenhancing submucosal lesion of soft tissue density involving the entirety of the right nasal ala, with associated distortion of the columella due to mass effect. The lesion appeared to be in a subcutaneous plane. The mucosal surface also appeared to be preserved. There was an incidental finding of benign-appearing mucosal thickening seen within the right maxillary and ethmoid sinuses Figures , and 3.Histologic findings demonstrated pseudoepitheliomatous hyperplasia and ulceration overlying a diffuse mixed inflammatory infiltrate consisting predominantly of histiocytes and lymphocytes. Epstein Barr virus encoded ribonucleic acid (EBER) in situ hybridization showed strong nuclear staining in the majority of cells .Much of the dilemma with midline destructive lesions of the face is in diagnosis. However, establishing the diagnosis quickly is imperative so that proper therapy can be initiated without delay. As seen with our patient who was initially treated with multiple courses of antibiotics, the diagnostic approach tends to be difficult as symptoms are nonspecific and the differential diagnosis is extensive, including infectious, autoimmune, neoplastic, and inflammatory etiologies. The initial laboratory workup includes a complete blood count with differential. Further testing for specific disease and autoimmune entities may include classic antineutrophil cytoplasmic antibodies (cANCAs), perinuclear antineutrophil antibodies (pANCAs), proteinase 3 (PR3), myeloperoidase (MPO), angiotensin converting enzyme (ACE), rapid plasma reagin (RPR), anti-Sjogren A and B antibodies, rheumatoid factor (RF), coccidioidomycosis, and human immunodeficiency virus (HIV) testing .Classic histologic features include angiocentric and angiodestructive growth with zonal necrosis. Immunohistochemistry (IHC) can then differentiate NKTL from other lymphoproliferative malignancies. The expression of CD3 and CD56 differentiates NK/T-cell lesions from other T-cell lymphomas , 5. CoexThe radiologic findings of extensive soft tissue and sinonasal involvement yield a differential diagnosis that includes granulomatosis with polyangiitis (formerly Wegener's granulomatosis), other granulomatous infections, other non-Hodgkins lymphoma, adenoid cystic carcinoma, olfactory neuroblastoma, melanoma, and squamous cell carcinoma , 7. OverThe clinical course is aggressive with five year survival rates ranging from 38 to 45 percent , 8, 9. TThe current mainstay of treatment is radiotherapy for all patients with localized disease with the optional addition of an anthracycline-based chemotherapy, such as CHOP  or CHOP-like regimen. Unfortunately, due to the relative rarity of NKTL, there is a lack of consensus on radiation field, optimal dose, and chemotherapy regimen , 12. TheMDLs are most often attributed to NKTL. As mentioned in the literature, and demonstrated by our patient, there is often a delay in diagnosis. This is largely due to the lack of specificity in presenting symptoms and the overall diagnostic difficulty MDL's present. A thorough evaluation, including appropriate imaging, laboratory studies, and biopsy specimens, is warranted for midline lesions that do not respond to conventional medical therapy. IHC is key in establishing the diagnosis. Prompt initiation of treatment in the form of radiotherapy and/or chemotherapy is critical for optimization of patient outcome.


Synovial cysts of the temporomandibular joint (TMJ) are very rare, and to date, only 12 cases of a synovial cyst in the TMJ region have been reported in the literature. In this paper, we present the clinicopathological and immunohistochemical characteristics of one such lesion affecting a 48-year-old woman, presented with a mass in the left preauricular region. We describe the usefulness of immunohistochemical analysis for recognizing the synovial lining, which allowed for clear differentiation between ganglion and synovial cysts. Immunohistochemical analyses can be used to diagnose synovial cysts with certainty; however, using at least two markers is advisable to distinguish the two existing synovial cell subtypes. Our findings indicate that synovial cysts of TMJ possess an internal lining dominated by type B (fibroblast-like) synoviocytes. Ganglion and synovial cysts are expansile, fluid-filled lesions of the joints, located mainly in periarticular areas of wrists, knees, and feet . Such leSynovial cysts are true synovial-lined cysts that may arise from displacement and/or herniation of the synovial lining, possibly because of increased intra-articular pressure . GanglioTo date, only 12 cases of a synovial cyst in the TMJ region have been reported in the literature –15. In tA 48-year-old woman visited the oral and maxillofacial surgery clinic of our university hospital complaining of a mass in the left preauricular region, located anterior to the tragus, which was about 2 cm in diameter. The patient indicated that the mass had been growing slowly for approximately 6 months. She reported occasional dull pain, which was sometimes aggravated by opening of the jaw and chewing. The patient denied any recent trauma to the ear or mandible. Her past medical and surgical history included essential hypertension and a hysterectomy for multiple myoma. She was currently taking enalapril, amitriptyline, and tetrazepam. No history of allergic phenomena or adverse drug reactions was noted, and the patient denied tobacco, alcohol, or drug use.A physical examination revealed a soft, nonerythematous, preauricular swelling (2 cm in size) in the left preauricular area lateral to the TMJ. The patient exhibited normal mouth opening, without deviation, and the mandibular range of motion was normal in all directions. No facial nerve paralysis or paresis was observed, and the rest of the head and neck examination was unremarkable. A routine panoramic radiograph showed no abnormalities. A computed tomography (CT) scan was then obtained, which revealed a hypodense mass of soft tissue of 18 × 17 × 14 cm in the left temporomandibular region , which did not show apparent degenerative or inflammatory changes. Likewise, magnetic resonance imaging (MRI) revealed a well-delimitated preauricular cystic lesion , with the pedicle in relation to the left TMJ capsule. The position of the articular disk and mandibular condyle displacement after mouth opening was normal, and the mandibular condyle showed no morphological changes. The imaging-based diagnosis was a TMJ cyst  was found to be the most useful for highlighting the synovial lining of the cyst; it clearly marked the entire inner contour of the cyst, excluding the possible existence of a ganglion cyst . The synβ-catenin expression.Taken together, our immunohistochemical findings indicate that the synovial cyst had a clear predominance of elongated type B (fibroblast-like) synoviocytes, which were clearly immunoreactive to D2-40, compared with type A (macrophage-like) synoviocytes, which were few in number and displayed a rounded appearance and CD68, lysozyme, and HLA-DR positivity. Likewise, the type B synoviocytes, which predominated at the intimal and subintimal synovial levels, showed clear reactivity against heat shock protein (HSP) 70 and metallothionein together with weak cytoplasmic The TMJ is a synovial joint that plays a crucial role in complex jaw movements. Mass lesions that can occur in the TMJ include some rare pseudotumor cystic lesions such as synovial and ganglion cysts, which are most commonly seen in other periarticular locations of the body , 5.Synovial and ganglion cysts of the TMJ are rare; therefore, we could only find 12 cases of synovial cysts in the TMJ in the literature  and onlyA synovial cyst is a true cyst lined by synovial cells (synoviocytes) that may or may not communicate with the joint cavity , unlike  Prior to our study, reported cases of synovial cysts of the TMJ usually not used immunohistochemical tools, raising sometimes doubts about the accuracy of histological diagnosis. Recently, Spincia et al.  illustraThe synovium is lined by a layer of cells, variously called lining cells, intimal cells, or synoviocytes, which have historically been subdivided into type A and B cells . UltrastIn the last decade, different immunohistochemical markers have been proposed for the identification of synoviocytes in the normal state and in various pathologies , 20–23; Of the eight markers used in our study, D2-40 (podoplanin) was revealed to be the most useful and powerful marker for highlighting the synovial lining of the cyst and excluding the possible existence of a ganglion cyst. D2-40 is a mouse monoclonal antibody specific for human podoplanin that is often used to highlight the lymphatic endothelium. However, D2-40 reactivity has also been described in a variety of normal tissues, including the mesothelium  and synoβ-catenin), we showed a clear predominance of type B (fibroblast-like) synoviocytes compared with type A (macrophage-like) synoviocytes, which were CD68-, lysozyme-, and HLA-DR-positive, in a synovial cyst. From a practical perspective, immunohistochemical analysis established with certainty the diagnosis of a synovial cyst; thus, using at least two different markers is advisable to distinguish the two synovial cell subtypes.Using other immunohistochemical markers (HSP-70, metallothionein, and Finally, increased reactivity against HSP-70 and metallothionein was found in the synovial cyst. The HSP family protects cells under stressful conditions and is a useful marker for type B synovial cells , 23. Som


Aim. Cemento-osseous dysplasia (COD) represents a rare group of benign fibroosseous disorders, while osteogenic sarcoma (OS) on the hand, is a malignant tumour of ominous prognosis. A combination of COD and OS is rare and sparsely reported in literature. There are only four reported cases known to the authors. The aim of this paper is to report additional cases of COD occurring concurrently with OS. Materials and Methods. The clinicoradiologic findings and histological analysis of mandibular lesions in two patients who reported at the Dental Centre of the University College Hospital, Ibadan, Nigeria, are presented. Results. The two patients were diagnosed of mandible osteosarcoma occurring concurrently with bilateral mandibular focal cemento-osseous dysplasia. Conclusion. The simultaneous occurrence of osteosarcoma and cemento-osseous dysplasia raises the question of whether COD has transformed into OS or a collision tumour has occurred and their simultaneous occurrence is just a coincidence.  Cemento-osseous dysplasia (COD) represents a rare group of benign fibroosseous disorders in which bone is resorbed and replaced with a cementum-like material in a background of fibrous stroma , 2. It iA 65-year-old Nigerian female reported at the oral and maxillofacial surgery clinic of Dental Centre, University College Hospital, Ibadan, Nigeria, with a six-month history of a left-sided mandibular swelling which was of spontaneous origin and painful intermittently. The swelling extended from the left ramus to the left parasymphyseal region of the mandible. The overlying skin was intact, appeared clinically normal, and not attached to the underlying tumour. The associated teeth were mobile, and both the lingual and buccal sulci were obliterated by the tumour mass . There wA 45-year-old Nigerian female reported at our clinic with a 3-month history of a right mandibular swelling of spontaneous origin which was otherwise not symptomatic but was increasing progressively in size. An orthopantomogram revealed a significant bone destruction of the right mandible extending from the lower right lateral incisor to a region just short of the mandibular angle. The radiolucency also encompasses the irregular mass of radio-opacity just apical to 16. The radiograph shows a similar irregularly shaped radio-opacity within the body of the left mandible . An inciCOD is a nonneoplastic fibroosseous lesion that is believed to run a relatively benign course. It is commonly asymptomatic and usually discovered on routine radiographs. This lesion typically affects middle-aged women of African and Asian descent, but it can occur in Caucasians as well . COD hasOsteogenic sarcoma (OS) is a highly malignant tumour of bone that is associated with a poor prognosis. Its aetiology is unknown but a few cases have been known to occur in irradiated or previously diseased bone , 5. OS oCOD and OS are two independent disease processes that run entirely different courses with varying treatment options and differing prognosis. These two distinctively different lesions occurring simultaneously in the same jaw are a rarity and therefore sparsely reported in literature. There are only four reported cases of a sarcoma occurring simultaneously with COD known to the authors.Schneider et al., in 1999, reported a case of a 54-year-old black woman seen in 1979 with mandibular “malignant spindle cell tumour” occurring in florid osseous dysplasia [Cheng et al., in 2002, reported a case of a 72-year-old black female with a week history of left mandibular swelling and numbness of the lower lip . The patMelrose and Handlers in 2003 reported a case of a 36-year-old black woman with an increasing, painful, mandibular swelling who had radiographic evidence of FCOD as a bignathic presentation on previous radiographs taken three years before presentation at their hospital . The bioLopes et al, in 2010, reported a similar case to that of Melrose and Handlersin a clinic-pathologic conference as a 44-year-old black female who presented with a painful swelling of the right mandible which was diagnosed as osteosarcoma in a background of FCOD .All the above previous cases have been associated with the florid subtype of cemento-osseous dysplasia which is said to be similar to Paget' disease of bone except that FCOD is localized to the jaws in the tooth-bearing portion. Based on this comparability, FCOD has been referred to as the “Paget 's disease of the mandible” , 9. The The simultaneous occurrence of osteosarcoma and cemento-osseous dysplasia, though rare, raises the question of whether a transition can occur from COD to OS or these cases simply represent collision tumours and their simultaneous occurrence is just a coincidence. The “transition zone” observed in this paper is not to state that a definite evidence of OS arising from COD has been found but that the two lesions are in close proximity with each other even microscopically. Further investigation will therefore be required to establish a transition, if any exists, from COD to OS. Nevertheless, patients with COD especially the florid and focal subtypes may benefit from long-term followup.


Testicular cancer is a rare disease. The incidence of testicular cancer in undescended testicles is of 3 to 48 times greater than in the general population. In the developed countries, the existence of undescended testicles in the adult population is rare, due to systematic practice of elective orchidopexy before the second year of life and orchiectomy in post adolescent males with undescended testicles. Despite these prevention measures, there are still some isolated cases of intra-abdominal testicular tumors in adults. We report a case of testicular cancer in cryptorchid testis revealed by supraclavicular lymphadenopathy.We report a case of a 46 year old fertile man with a history of unilateral cryptorchidism who presented with a palpable left supraclavicular mass and absence of the right testicle. On investigations an intrapelvic testis tumor was diagnosed. Laparotomy and complete excision was carried out. The possible association between the undescended testis and cancer transformations is briefly discussed.Testicular cancer in undescended testicles should not be ignored. Only early diagnosis and lower of testis in scrotumprevent such clinical forms. Cryptorchidism , the most common congenital anomaly of the genitourinary tract in males, is encountered in 1% of boys. The incidence increases in subjects with deficiencies of androgen function [A 46 year old man, father of three children, without significant previous medical history, consulted for the gradual emergence of an isolated left supraclavicular mass. On physical examination, the patient was afebrile, in good general condition, pleuropulmonary and abdominal examination was normal. The genital examination found an empty right purse, the left testicle was normal. The inguinal examination found no palpable mass but a suspect induration was reported. The ORL examination revealed no abnormalities. Chest radiography showed a normal pulmonary transparency. On ultrasonographic scanning of supraclavicular fossa and whole abdomen showed a supraclavicular lymphadenopathy measuring 31 × 23 mm and an heterogeneous mass in the right iliac fossa with irregular contours. The laboratory investigations were all normal; apart from a slightly elevated serum beta- human chorionic gonadotropin (β-HCG) 428 mmol/L. The serum alpha- fetoprotein (α-FP) was within normal limits, and lactate dehydrogenase (LDH) at 308 U/l. The thoracoabdominopelvien computed tomography (CT) scan revealed a right pelvic mass measuring 100 × 80 mm (Figure The testicular cancer represents 1-2% of all male malignant tumors and 4% of the urogenital ones. It is the more frequent solid neoplasia in young men between 20-35 years meaning the 1-2% of total tumors [Cryptorchid affects 0, 4% of male. The non-palpable testicles correspond to a 20% of the cryptorchidic testicles. Of the non-palpable testicles, only in 20% of the cases it is absent, the rest is in the abdomen or the inguinal canal. Between undescended testicles, abdominal testicles present a higher rate of malignity than the ones located in the groin inguinal .The tumors in undescendent testicles are rare. The histopathology of the undescendent testicle tumors in the adult depends on location, being the proportion of pure seminoma of 93% when it is in intra-abdominal situation, 63% if it is inguinal and 28% in normotopic testes . The proIn the developed countries, the existence of undescended testicles in the adult population is rare, due to systematic practice of elective orchidopexy before the second year of life, to prevent cancer and infertility. Orchidopexy does not eliminate cancer risk but allows an early diagnosis being testicle accessible to exploration ,9.There are many studies published on cryptorchidism and cancer in undescendent testicles. There is no long series of intra-abdominal testicular tumors in the literature. The majority of them corresponds to a case reports. Searching in PubMed, they are approximately 42 clinical cases of seminomas in intra-abdominal testicles published. In a 1930 article, a 8% incidence of Supra-calavicular lymphnodular metastasis have been recorded. In an article from Kenyata, an incidence of 17.91% has been recorded . The greThe abdominal variant of cryptorchid testis is rare and carries a high risk of malignant transformation. Very rarely they can be revealed by a supra-calavicular node. Early diagnosis and treatment of cryptorchidism can dramatically reduce the risk of testicular cancer and probably preserve the fertility, as well as, the virility of the patient.Written informed consent was obtained from the patient for publication of this manuscript and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.Authors declare that they have no competing interests.MFT, OR, MA: the principal authors, major contributions in writing the manuscript. YA, AK, MJE, and MHF: analysed and interpreted the patient data and the reviews of the literature. All authors read and approved the final manuscript.