Ovary involvement of non-Hodgkin lymphoma (NHL) is rare. We report a rare case of ovarian NHL during adolescence revealed by bone metastasis. The diagnosis of malignant lymphoma was established after adnexectomy and histological study of the excised tissue. The tumor was classified as a diffuse large B-cell lymphoma. The patient has been treated according to the LMB French protocol with good outcome after two years. Although NHL is a rare ovarian neoplasm, it is essential to establish an accurate diagnosis as early as possible for therapeutic purposes. Ovarian infiltration in pediatric non-Hodgkin lymphoma (NHL) is rare, and information on outcome is scarce and mainly based on case reports and small series. Ovarian involvement by NHL is usually secondary, occurring as a part of systemic disease. Localized presumably primary NHL of the ovary (PONHL) is rare, accounting for 0.5% of all NHL and 1.5% of all ovarian tumors [We report a case of 12-year-old girl diagnosed with diffuse large B-cell lymphoma (DLBCL) revealed by bone metastasis with a good outcome.A 12-year-old girl (no puberty) presented with localized pain of the left shoulder evolving for 9 months, and plain radiography done in the emergency showed osteolytic lesions without rupture of the cortex of the upper end of the left humerus  confirmeLymphomas of the ovary may occur at any age, but mostly women in their 40s are affected . PediatrOvarian involvement by lymphoma can be primary or secondary. The secondary involvement is either as an early metastasis in occult extraovarian neoplasms or as a generalized metastatic disease . PrimaryThe consensus surrounding whether some ovarian lymphomas can be considered truly primary and not merely a localized initial manifestation of a generalized disease remains controversial . Fox et Most pediatric cases showed a B-cell NHL immunophenotype, of which the majority had a Burkitt type, which may be a reflection of the most common lymphoma found in children , 8. In rSpecific clinical characteristics are difficult to describe. All pediatric cases presented with abdominal pain and/or abdominal mass , 9, whicChemotherapy regimens are considered the most appropriate therapeutic option for patients with NHL . SurgicaPrognosis of ovarian lymphomas is often poorer than nodal lymphomas due to inaccurate or delayed diagnosis . POL hasThis article presents a unique case of ovarian DLBCL with bone metastasis in a 12-year-old girl with good outcome. Unfortunately, ovarian malignancies during childhood and adolescence present several difficulties, mostly caused by late diagnosis. The best treatment option seems to be chemotherapy. Physicians should be aware of this rare presentation to avoid radical surgery, which is unnecessary.


Introduction: There are still no guidelines about pediatric cardiac cancers. The purpose of this work is to provide new scientific data facilitating the differential diagnosis of a rare cardiac tumor with an unusual presentation, such as the cardiac inflammatory myofibroblastic tumor (IMT).Case Presentation: A 3-year-old male child presented with several symptoms including unconsciousness, vomiting, and drowsiness. A clinical and neurological examination revealed a unilateral (right) motor delay and positive unilateral Babinski sign. Electrocardiogram (ECG) was normal.Diagnostic Assessment: The total body computed tomography (CT) scans showed hypodensity in the left temporal–parietal lobe, a large hypodense area in the right frontal lobe, and a second area in the left frontal lobe were found with head CT. A magnetic resonance (MR) also noted cerebral areas of hypointensity. The echocardiographic images revealed an ovoid mass, adherent to the anterolateral papillary muscle. The histological exams, performed with hematoxylin–eosin, Masson's trichrome, Alcian blue PAS, Weigert and Van-Gieson stain, allowed observing the microscopic structure of the neoplastic mass. The immunohistochemical analysis was performed through subsequent antibodies: anti-vimentin, anti-actina, anti-ALK, anti-CD8, anti-CD3, anti-CD20, anti-kappa and lambda chains, and anti CD68 antibodies. The healthcare professionals diagnosed a cardiac IMT with brain embolism.Differential Diagnosis: The ventricular localization, observed through radiological exams, required a differential diagnosis with fibroma and rhabdomyoma, the presence of brain embolism with sarcoma, and its morphology with fibroma. Neurological symptoms might be attributed to encephalitis, primitive cerebral cancer, such as astrocytoma or neuroblastoma, cerebral metastases due to any malignancy, or embolic stroke.Conclusion: New studies are encouraged to better define IMT behavior and draw up guidelines confirming the crucial role of multidisciplinary approach and treatment protocol selected on the basis of the characteristics of the tumors, in the case of this rare type of cancer. The cardiac inflammatory myofibroblastic tumor (IMT) represents a rare form of parenchymal organs and/or soft tissue sarcoma, originating from the lining of the airways, gastrointestinal tract, and reproductive system, as well as from the central nervous system. It can also involve the mesentery , 2.As the name suggests, this tumor originates from mesenchymal cells, especially from myofibroblasts. The adjective “inflammatory” refers to the histopathological characterization of this tumor, marked by the presence of immune cells, among which plasma cells, lymphocytes, and eosinophils surrounding elongated myofibroblasts . The infThis disease affects most children and young adults with regard to the age of involved patients, although some cases relate to elderly subjects.Heart involvement is quite rare: ventricular chambers represent the most affected site, and there was no different prevalence between the two ventricles .Macroscopically, the tumor appears as a single or multilobulated mass, ranging in size from 1.0 to 22 cm .Signs and symptoms are initially unspecified: fever, weight loss, and asthenia are associated with laboratory abnormalities, especially hypochromic and microcytic anemia, thrombocytosis, increased erythrocyte sedimentation rate, and elevated C-reactive protein , 8.The clinical picture of heart involvement includes dyspnea, tachycardia, and heart failure; signs and symptoms vary based on the organ affected. The mortality of the IMT, like other cardiac tumors, is secondary to onset of arrhythmic cardiac events, thromboembolism, and outflow or inflow tract ventricular obstruction .We introduce an unusual clinical presentation of a cardiac inflammatory myofibroblastic tumor (IMT) in a child. There are still no guidelines about pediatric cardiac cancers. The purpose of this work is to provide new scientific data facilitating the differential diagnosis of a rare cardiac neoplasm with an unusual presentation, such as the cardiac inflammatory myofibroblastic tumor (IMT). This study encourages the drafting of guidelines about the multidisciplinary approach in the differential diagnosis of cardiac tumors and treatment protocol selected on the basis of the characteristics of the tumors.A well-being infant of 3 years old, without a relevant past medical history, was admitted to the pediatric emergency department with several symptoms, such as unconsciousness, vomiting, and drowsiness. Right motor delay and positive Babinski sign developed after a few hours; healthcare workers, assuming a form of encephalitis, treated the infant with antibiotic, antiviral, and antiedema therapy, after an infectious disease counseling. Electrocardiogram (ECG) was normal; a brain CT (computed tomography) showed a region of hypodensity in the left parietal–temporal area. A brain magnetic resonance (MR) raised the suspicion of a cerebral embolism. There was a radiological worsening, characterized by an extent of hypodensity at the left frontal–temporal lobe and homolateral lenticular–capsular region, and associated with a clinical worsening, denoted by onset of aphasia, miosis, deviation of the eyes, and upper limb hypertonia, on the third day. The echocardiographic images showed an abnormal mass inside the left ventricular chamber, on the 5th day; thus, an endocavitary thrombus was supposed, and healthcare workers administered a heparin treatment and transferred the child to the pediatric cardiac surgery department. The chest CT revealed an expansive neoformation, on the following day; the clinical picture worsened further, with onset of a comatose state, generalized tonic–clonic seizures, upper limb dystonia, requiring an intubation and mechanical ventilation, on the same day. The following brain CT showed multifocal cerebral ischemia involving also the right frontal lobe in association with periencephalic liquor space flattening, on the 9th day. The cardiac tumoral mass was surgically excised, on the 10th day. The infant, presenting persistent clinical symptoms of the previous brain embolism, such as aphasia, conjugate eye left deviation, facio-brachio-crural right hemiparesis, and upper limb ipsilateral hypertonia, was transferred from the surgical ward to a rehabilitation center 12 days after the surgery.The following histological exams revealed the presence of a cardiac inflammatory myofibroblastic tumor (IMT). The resection of the tumor was complete. The healthcare workers avoided chemotherapy or radiotherapy according to the benign nature of the tumor and disputes in the literature concerning the adjuvant treatment with chemotherapy or radiotherapy. The anticoagulation therapy allowed the resolution of brain embolism.The 2-year follow-up includes echocardiography, chest and brain CT, and neurological examinations. The surgical approach was sufficient in this case; in fact, the last follow-up excluded a cardiac tumor recurrence and revealed a complete resolution of brain embolism. Rehabilitation improved upper limb motility and aphasia. Conjugate eye left deviation is unchanged.The brain CT scans showed hypodensity in the left temporal–parietal lobe. The follow-up, which performed head CT, highlighted a significant increase in brain damage after 3 days of hospitalization, with the involvement of unilateral basal ganglia and internal capsule. The healthcare professionals suspected an encephalitis; a further diagnostic in-depth investigation run with magnetic resonance (MR) also noted cerebral areas of hypointensity. The suspected diagnosis was brain embolism. A further brain CT highlighted a large hypodense area in the right frontal lobe and a second area in the left frontal lobe, secondary to the multi-infarct vascular lesions, with an alteration in the volume of liquor spaces. The echocardiographic images  revealedA surgical exploration revealed the presence of a polypoid, non-encapsulated, and lobulated neoplasm measuring 4 × 0.3 × 0.2 cm , with haCytokeratin was negative. These findings corresponded to the literature data based on macroscopic examination of the mass, distribution, conformation, and type of cells, as well as positivity for anti-vimentin and anti-muscle-specific actin antibodies , 10.The healthcare professionals diagnosed a cardiac IMT with cerebral embolism.The location of the uncommon tumor in the heart made clinical and histopathological diagnosis difficult secondary to its clinical and morphological analogies with other cancerous masses. In this case, the ventricular localization, observed through radiological exams, required a differential diagnosis with fibroma and rhabdomyoma, the presence of brain embolism with sarcoma, and its morphology with fibroma. The histological exams are fundamental in the differential diagnosis from fibroma: this last, in fact, consists of monomorphic spindle cells, characterized by nuclei devoid of nucleoli and pale cytoplasm with entrapped myocytes, undulated elastic fibers, and rare lymphocytes; IMT, on the contrary, consists of large spindle cells with nuclei endowed of nucleoli, numerous acute and chronic inflammatory cells, and a dense vascular network.The immunohistochemical analysis facilitated its diagnosis secondary to the positivity of IMT cells for the expression of high muscle-specific actin and negativity for the expression of cytokeratin, CD34, S100, and p53 proteins. It has been difficult to get to a true diagnosis in our clinical case. Clinical manifestation, in fact, only consisted of neurological symptoms: right motor delay, state of slumber and positive Babinski sign, aphasia, right upper limb hypertonus, miosis, and generalized tonic–clonic seizures. No alterations in hemodynamic parameters were highlighted; electrocardiogram showed the electrical activity of the heart within normal limits. Microbiological exams became necessary, since the clinical presentation mimicked the symptoms and signs of encephalitis. Neurological symptoms of this clinical case might be attributed also to a primitive cerebral cancer, such as astrocytoma or embolic stroke. In these last cases, radiographic imaging allowed performing an accurate differential diagnosis.The cardiac tumors are subdivided into two categories: primary and secondary malignancies. The primary tumors  are very rare , 12: theThe inflammatory myofibroblastic tumor represents a rare neoplasm with a not entirely determined anatomopathological identity and uncertain biological behavior. It affects predominantly children and young adults, with localization in soft tissues and various organs. Histologically, this type of neoplasm consists of myofibroblasts, inflammatory cells, namely, plasma cells, lymphocytes, eosinophils, and fibromyxoid stroma. In our case, the IMT localization was at the level of the heart ventricular chamber. It may originate from atrial or ventricular walls, valves, or coronary vessels, at the heart level.Escherichia coli, Gram-positive cocci, Klebsiella pneumoniae, mycetes, or Epstein–Barr virus. Many classes of IMT, associated with chromosomal abnormalities, present an aggressive behavior, although this is a benign neoplasm. An important characteristic of IMT is the high tumor recurrence rate (about 25%), infiltration of adjacent structures, and distant metastases. The genetic and immunohistochemical studies allow discovering genetic modification, such as the 2p23 locus clonal rearrangements of the ALK gene, ALK gene fusion with specific proto-oncogenes  and clathrin heavy chain (CTLC) gene, and ALK gene overexpression. ALK-1 positivity was associated with a better prognosis in our case according to some studies (The cardiac IMT etiology is still unknown; there are many theories about it, such as fibroblastic inflammatory reaction due to traumatic or iatrogenic events; autoimmune disease, especially in cases of its association with vasculitis or venous thrombosis with antifibrinogen and anti-C3 antibody deposits in blood vessel walls; infections caused by  studies ; other a studies . At leas studies , 16. Cyte about 2%, infiltThe American Academy of Pediatrics provided guidelines for overall pediatric cancer recommending a multidisciplinary approach .There are no specific guidelines about IMT; the European Society of Cardiology suggests a radiological diagnostic approach with echocardiography or real-time three-dimensional echocardiography to get information about the tumor blood supply or composition, relationship to nearby structures, and complementary imaging exams, such as CT, CMR, and PET, to detect its extension and resectability.The echocardiography, CT, and CMR performed in our clinical case provided a valid aid in the diagnosis, but nevertheless, the histopathological examination resulted, clearly, fundamental to a definite diagnosis.Regarding the therapeutic strategy, the National Cancer Institute summarizes five types of approach: watchful waiting, chemotherapy, surgery, radiation therapy, and target therapy . In caseThe therapeutic protocol remains uncertain because of the lack of clinical trials concerning this rare neoplasm .New studies are encouraged to better define IMT behavior and draw up guidelines confirming the crucial role of multidisciplinary approach and treatment protocol, selected on the basis of the characteristics of the tumors, in the case of this rare type of cancer.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. Written informed consent from the participants' legal guardian/next of kin was not required to participate in this study in accordance with the national legislation and the institutional requirements.CB, GP, PD, EP, AA, and SZ performed the literature research and comparing literature data with case report clinical funding. EM and GD performed the immunohistological analysis. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Parenchymal extinction is characterized by the irreversible loss of hepatocytes and their eventual replacement by fibrous tissue, along with the alteration of the sinusoidal architecture and the obstruction of the small portal and hepatic veins. In clinical practice, radiologic modalities are not sufficient for differentiating between parenchymal extinction and hepatocellular carcinoma in patients with advanced fibrosis or cirrhosis. Herein, we present a case of parenchymal extinction mimicking hepatocellular carcinoma in a patient with chronic hepatitis B-related liver cirrhosis. Parenchymal extinction is defined as the loss of contiguous hepatocytes in a pathologic examination . Conside3/μL; prothrombin time (PT), 14.8 s; and AFP level, 585.2 ng/mL . After confirming viral breakthrough with the presence of 2.8 × 107 IU/mL hepatitis B virus (HBV) DNA, and the drug-resistant mutations L180M and M204I, we switched the antiviral treatment to tenofovir disoproxil fumarate monotherapy.A 47-year-old man, who was a farmer, with chronic hepatitis B infection and Child-Pugh class A cirrhosis, was referred to the Department of Internal Medicine with a markedly elevated alpha-fetoprotein (AFP) level and a hypoechoic hepatic lesion with a diameter of approximately 3 cm, observed with abdominal ultrasonography. He had been treated with entecavir and adefovir for 5 years at a local clinic but had voluntarily stopped taking antiviral agents a year ago. His initial laboratory findings were as follows: aspartate aminotransferase (AST) level, 170 IU/L; alanine aminotransferase (ALT) level, 278 IU/L; total bilirubin level, 1.2 mg/dL; albumin level, 3.69 g/dL; platelet count, 103 × 10Dynamic T1-weighted MRI revealed a 3-cm-sized, lobulated mass at segment 6, demonstrating hyperintensity in the arterial phase, isointensity in the delayed phase, and hypointensity in the hepatobiliary phase, suggesting the possibility of HCC . Due to Histological examination of the resected mass revealed the loss of focal hepatocytes with increased capillary-sized vessels and fibrotic tissue in the cirrhotic liver, consistent with findings of parenchymal extinction . Some bl3/μL; PT, 11.2 s; and AFP level, 5.1 ng/mL. The repeat HBV DNA was undetectable.After approximately 1 year, the patient’s laboratory and radiological findings were normalized . His folWe presented a case of parenchymal extinction mimicking HCC in a patient with chronic hepatitis B-related liver cirrhosis. Wanless et al. defined parenchymal extinction as the irreversible loss of hepatocytes and their replacement by fibrous tissue ,7. The pThe limitations of our case are as follows. First, we could not perform another radiologic technique, such as contrast-enhanced ultrasonography (CEUS), for the diagnosis of HCC. On CEUS, arterial phase hyper-enhancement with mild late-onset (>60 s) washout is pathognomonic of HCC ,13. In aSecond, we could not perform a biopsy of the suspected HCC lesion because of the possibility of needle track seeding. Instead, wedge resection was performed to simultaneously diagnose and treat the peripheral lesion. In previous studies, needle track seeding is shown as manageable by excision or radiation therapy and does not affect the clinical outcome or overall survival ,16. TherA target biopsy is required for the diagnosis of the lesion suspected to be HCC.Parenchymal extinction can be difficult to differentiate from HCC in patients with cirrhosis.When the diagnosis of HCC is uncertain using one radiologic modality, alternative modalities should be considered.Diagnostic liver biopsy of suspected lesions should be considered prior to surgery, when feasible.


Primary abdominal wall actinomycosis is rare, but even rarer when it comes to intestinal infiltration; it is usually misdiagnosed as a neoplasm in computed tomography till proved otherwise with pathological examination.We report a 59-year-old diabetic male presented with a year-old abdominal wall mass, diagnosed by pathology after surgical excisional biopsy, and treated with penicillin for 6 months. We recommend consideration of actinomycosis in cases of abdominal wall mass, especially in immunocompromised patients, as a differential diagnosis of neoplastic lesions. Actinomyces species, which colonizes the oral cavity, gastrointestinal tract and vagina [Actinomycosis is a rare, slowly progressive and granulomatous disease caused by d vagina . ExtensiIt presents with weight loss, malaise, change in bowel habits, abdominal pain and palpable abdominal mass, which might lead altogether to a misdiagnosis of neoplasia . Its mimPathological features include classical sulfur granule arrangement with extensive fibrosis and granulomatous tissue formation .We present a case of a 59-year-old male patient with a record of 15 years of diabetes and hypertension, who developed primary actinomycosis in the abdominal wall with intestinal infiltration.A 59-year-old male patient presented with moderate, intermittent pain at the periumbilical region for 1 month. It was accompanied with a gradually increasing mass over a year time. His bowel habits were altered, and abdominal pain was relieved after defecation. There were no other symptoms concerning nausea, vomiting or weight loss. The patient denied any history of abdominal trauma, surgery or injection at that region. On the other hand, his medical history was eventful. He had type 2 diabetes and hypertension for 15 years. He was treated with oral antidiabetics and angiotensin converting enzyme inhibitors (ACEIs). The patient neither smokes nor drinks alcohol.Upon his first visit, his pulse and blood pressure were normal. His physical examination revealed 10 cm distention in the right upper quadrant of the abdomen that crossed the midline. Its size did not change upon increased intra-abdominal pressure. The patient was afebrile with no signs of local inflammation.The mass was firm, non-pulsatile, painless, with no clear borders and could not be detached from the innards, still it moved with breathing movements. The overlying skin was moveable as well.The radiologist performed ‘Focused Assessment Sonography Test’ to rule out any existence of free fluid in the abdomen corresponding with trauma or any systemic disease. The test showed neither presence of free fluid nor detected any abdominal mass, which was irrelevant to the fact of the visual bulge.Computed tomography (CT) scan depicted a solid irregular density 15 × 11.5 × 6 cm sized, occupying bilaterally musculus rectus in the umbilical area. The lesion was projecting through anterior abdominal wall lipoid tissue and posterior mesenteric lipoid tissue. The mass had a heterogeneous characteristic; 2 cm of the bowel was infiltrated within the mass. It also showed no enlargement of lymph nodes or other organs .With respect to previous results, we suspected neoplastic origin of the mass and decision was made for excisional biopsy with regards to safety borders .Microscopic examination showed benign stratified squamous epithelium, surrounded by skin with wide area of fat necrosis and abscess formation, composed of massively acute inflammatory infiltrate of neutrophils, eosinophils, foamy cells, histocytes and plasma cells with many ‘sulfur’ granules, which contain irregular round clusters of bacteria rimmed by eosinophilic, club-like projections of proteinaceous material  . Colon aAll above was suggestive of actinomycosis.Treatment consisted of parenteral crystalline penicillin 24 million units/day for 1 month, followed by oral penicillin V for 6 months.Actinomyces species are members of normal flora in immunocompetent individuals. However, they might act as pathogens whenever an impaired state of immunity is detected. So the majority of cases are seen in immunocompromised statuses also in intestinal necrosis, abdominal operations and implementation of intra-abdominal devices such as intrauterine contraceptive device [e device , 5, 6. WThe infection involves cervicofacial 50%), abdominopelvic (20%) and thoracic (15%) regions 0%, abdom. HoweverAbdominal mass accompanied with unspecific digestive symptoms and CT findings oriented the decision to make an excisional biopsy. Pathology results denied any malignancy while confirming the inflammatory nature of it.Actinomycosis is an infectious disease treated with antibiotics, mainly penicillin G , 9. TreaDue to the suspicion of the neoplastic origin, decision was made to remove the lesion. The histopathological study revealed actinomycotic infection. Antibiotic treatment was prescribed as mentioned by the previous regimen.


Poroid hidradenomas are a rare subtype of hidradenoma. A Veteran’s Administration patient presented with a mobile, cystic scalp lesion. Intraoperatively the mass spontaneously ruptured. We hope clinicians will consider this entity on their differential when treating patients presenting with similar scalp lesions and intraoperative findings. Poroid hidradenomas (PH) are a rare type of adnexal tumor. It is said that Abenoza and Ackerman were the first to describe them in 1990 . Poroid A patient was seen and evaluated at the VA Memphis plastic surgery clinic. After signing informed consent, he underwent surgical excision of a scalp lesion. A VA photo consent and release of information were obtained at his post-operative visit. The Memphis VAMC IRB determined this as a case study. The pathology slides were processed and were embedded in paraffin wax, sectioned, stained with hematoxylin and eosin, and examined and photographed under microscope magnification.A fifty-eight-year-old male with a history of hypertension, anxiety, depression, and chronic low back pain presented with a one-year history of a right parietal scalp mass. He believed that the mass first appeared after he bumped his head, but he was not sure. The patient denied any drainage, pain, numbness, tingling, fever, or redness. Medications included acetaminophen, bacitracin, ranitidine, ketotifen fumarate, ammonium lactate, castellani colorless topical paint, urea 20% cream, celecoxib, and cyclobenzaprine. The patient denied any smoking, alcohol, or drug use. Family history was non-contributory, and he had no known drug allergies. On physical exam, he was found to have a mobile and cystic appearing right parietal scalp mass with a punctum. The differential diagnosis included an epidermal inclusion cyst, pilar cyst, or lipoma.The patient underwent operative excision five days later under monitored anesthesia care. An elliptical incision was made around the lesion, including the punctum. The cyst was circumferentially dissected. It spontaneously ruptured and the specimen was passed off to pathology. The patient returned for a post-operative visit nine days later. He complained of right scalp incisional pain that was slowly improving but did not have any other issues. His staples were removed at that visit. Post-operative photos are displayed in We add to the literature by describing a case of poroid hidradenoma in a United States veteran with a scalp lesion. Most clinicians do not consider this entity on their differential for scalp lesions. Poroid hidradenomas are an uncommon subtype of hidradenomas, which themselves are rare. Patients presenting with this condition range from ages 13 to 91 with the disease being more common in the sixth and seventh decades of life . Some auvs. other entities like lipomas, which are homogenous—most lesions were excised without any pre-operative imaging or another workup other than clinical exam [Given the rarity of this entity, not much is known about the prognosis or treatment options. The prognosis is thought to be good as poroid hidradenomas are not known to progress to malignancy. Patients present for removal of this lesion secondary to pain, discomfort, aesthetic concerns, or concerns for malignancy . A systecal exam ,4,6,7. Dcal exam .On histology, poroid hidradenomas are lobular, circumscribed, non-encapsulated, solid, or partially cystic dermal tumors consisting of poroid and cuticular cells . Poroid Reports state that these lesions present as red or blue papules, nodules, or plaques, 1–2 cm in diameter, almost anywhere in the body—abdomen, trunk, neck, thigh, axilla, and limbs . The tumMost of these lesions do not require reconstruction as they are typically 1–2 cm in diameter . The scavia the mentioned methods [Iblher et al. suggested a simple algorithm for reconstruction of scalp defects after oncologic defects that may be applied here: defects <3–4 cm may be closed primarily; defects <6–8 cm and <4–5 cm from the hair border may be reconstructed with some of the local flaps listed above . Wounds Some studies suggest that these lesions are more common in immunosuppressed patients, such as liver transplant recipients and hematopoietic stem cell transplant recipients ,16. Thervia surgical excision with low rates of long-term recurrence.With this case report, we hope to alert clinicians to the possibility of their patients having a poroid hidradenoma, especially if their patients have similar clinical histories and medical co-morbidities. As not much is known about these lesions, it is important that every poroid hidradenoma is noted and more data is obtained so that questions about prognosis, treatment, surveillance, and recurrence can be better addressed. Our case report is consistent with what others have found: poroid hidradenomas appear to be benign lesions with a good prognosis and are curable


Spinal infections are very commonly encountered by radiologists in their routine clinical practice. In case of typical MRI features, the diagnosis is relatively easy to interpret, all the more so if the clinical and laboratory findings are in agreement with the radiological findings. In many cases, the radiologist is able to make the right diagnosis, thereby avoiding a disco-vertebral biopsy, which is technically challenging and associated with a risk of negative results. However, several diseases mimic similar patterns, such as degenerative changes (Modic) and crystal-induced discopathy. Differentiation between these diagnoses relies on imaging changes in endplate contours as well as in disc signal. This review sought to illustrate the imaging pattern of spinal diseases mimicking an infection and to define characteristic MRI and CT patterns allowing to distinguish between these different disco-vertebral disorders. The contribution of advanced techniques, such as DWI and dual-energy CT (DECT) is also discussed. Spondylodiscitis in elderly patients is challenging in presence of inflammatory Modic changes.Features of Anteroposterior inflammatory spine is suggestive of metabolic disease.Approach of destructive spondylodiscitis should be integrated in clinical context.CT is complementary to MRI to assess osseous changes and detect calcifications.5-Disco-vertebral biopsy could be avoided by systematic analysis of vertebral endplates signal.Spondylodiscitis represents 2–7% of all osteomyelitis cases, with an annual incidence of 1/100,000 to 1/250,000 . Disco-v−3 mm2/s depending on b-value [MRI is the technique of choice in the acute phase of spondylodiscitis, with a sensitivity of up to 92% (increased to 95% when using a contrast agent) and a specificity of up to 96% . No diff b-value , 14, 15.However, the choice of b-value is an important point to consider when analyzing these results. Several authors –17 conclCT is used to guide percutaneous biopsy, permitting to identify the causative microbiological agent and to exclude malignancy and mimicking diagnoses . In addi18F-FDG) being the radiotracer of choice [18F-FDG is a reliable technique to monitor response to treatment with high sensitivity and specificity [Dual-energy CT (DECT) is a technique enabling tissue quantification based on energy dependence at different X-ray spectra . It is uf choice , 23. R1 cificity , 25. X-rcificity  and the cificity . Nowaday−3 mm2/s) than for the control group, but higher than in patients with degenerative discitis [−3 mm2/s when using a b-value of 800 s/mm2 [The typical MRI pattern in the acute stage consists of inflammatory endplates that appear hyperintense on T2 and STIR and hypointense on T1, along with disc hypersignal (in mirror) . Hyperindiscitis . For oth00 s/mm2 –17. Pate00 s/mm2 . Sequenc00 s/mm2 . Spondyl00 s/mm2 . Besides00 s/mm2 . CT rema00 s/mm2 .R1 Point 2 On the other hand, differentiation between pyogenic and tuberculosis spondylodiscitis based only on imaging remains challenging. The presence of an intact meningo-vertebral ligament  , thoraciFinally, imaging criteria could be integrated in a scoring system for the diagnosis and to monitor progression following treatment .The typical MRI characteristics are summarized in Table −3 mm2/s) in degenerative diseases [Degenerative spinal disorders in the inflammatory stage Modic 1) can mimic infection particularly due to an overlapping clinical presentation . The vertebral endplate changes are related to inflammation-mediated active disc degeneration , 38. On  can mimidiseases . Furtherdiseases , are sugdiseases .Fig. 168The Andersson lesion, which was first described by Andersson in 1937, is a rare but well-known destructive disco-vertebral complication of ankylosing spondylitis . Though Crystal deposition in the disc may mimic osteomyelitis in case of acute inflammatory presentation. Pathogenically, crystals form in the pericellular matrix of cartilage, thereby inducing inflammation and catabolic effects on chondrocytes and synoviocytes and resulting in pericellular matrix destruction; besides, metabolic deposits may accelerate joint damage . The reaAlso known as Charcot spine, this condition is characterized by a rapid destruction of disco-vertebral and facet joints due to several neuropathic disorders . The undSpinal involvement is the second most frequent manifestation of the synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome , with thVertebral compression fractures may mimic spondylodiscitis, mostly tuberculous spondylitis, if the endplate is poorly defined in the absence of an obvious trauma history . MRI shoSchmorl nodes represent an extrusion of a disc through an endplate around the cartilaginous node. They manifest as high signal intensity on T2WI and STIR and low signal intensity on T1WI and contrast enhancement, with a correlation with pain in some cases. The concentric ring feature and involvement of an endplate without signal intensity abnormalities allow ruling out the diagnosis of spondylodiscitis .Although MRI features of disco-vertebral infections are usually quite typical, there are a variety of degenerative, post-traumatic, metabolic, and non-infectious inflammatory conditions that may present with similar features. Awareness of the differential diagnoses described above and knowledge of the specific pattern on MRI may help the radiologist to avoid these pitfalls and an unnecessary disco-vertebral biopsy.


Nowadays, virtual reality (VR) is increasingly more used for enhancing diagnosis and for preoperative planning of surgical procedures. With VR, the surgeon can interact, before any surgery, with a virtual environment that is completely generated by a computer, offering them a real experience inside a virtual 3D model. (2) Methods and Results: The aim of the present paper was to present a case of surgically removal of a schwannoma, which originated from the fibers of the superior laryngeal nerve, in a predictable and minimally invasive fashion, upon using VR for diagnosis and surgical procedure planning. (3) Conclusions: The current clinical report attracted the attention of including schwannoma in the possible differential diagnosis of a swelling in the anterior cervical region, mainly when a nonspecific radiological appearance is noticed, even with the use of multiple imaging modalities. Virtual reality can increase the predictability and success rate of the surgical procedure, being in the meantime a good tool for communication with the patient. Schwannomas, which were first described by Verocay in 1910 as peripheral nerve tumors , are mesHead and neck schwannomas routinely involve cranial nerves V, VII, IX, X, XI, and XII; sympathetic chain ; and braUsually schwannoma is a benign tumor, occurring at any age, but malignant change in head and neck has an incidence varying between 8 and 13.9% ,13.Diagnosis of this peripheral nerve tumor is challenging, due to the non-specific medical history and clinical examination. The common differential diagnoses for a swelling in the anterior and lateral cervical region include carotid body tumor, carotid aneurysm, schwannoma, branchial cyst, thyroid cyst, laryngocoele, pulsatile secondary lymph nodal swelling, and lipoma .Malignant epithelial and nonepithelial neoplasms such as squamous cell carcinoma , melanomComputed tomography (CT), magnetic resonance imaging (MRI), and fine needle aspiration (FNA) are mainly used to avoid misdiagnosis ,21. Nowadays, virtual reality (VR) is increasingly more used in diagnosis and preoperative planning of surgical procedures; some examples come from orthopedic surgery ,23, but With VR, the surgeon can interact, before any surgery, with a virtual environment that is completely generated by a computer, offering them a real experience inside virtual 3D model, and the patient can be aware of the type of surgery, the uneventful complications, and the treatment’s alternatives or intra/postoperative reconstructions .The collaboration between medical professionals, engineers, and software developers has facilitated the implementation of VR in clinical practice. The aim of this paper was to present case of surgically removal of a schwannoma, which originated from the fibers of the superior laryngeal nerve, in a predictable and minimally invasive fashion, upon using virtual reality for diagnosis and surgical procedure planning.We report a case of a 67-year-old woman who presented to the Maxillofacial Outpatient Department of Military Hospital Brasov, Romania, complaining of a neck “lump” and feeling a slight discomfort at manual compression for the past 7 months. Clinical examination revealed an elastic, tender, and mobile tumor, located on the left side of the neck. The rest of the head and neck examination was normal. During anamnesis, the patient had no complaints of odynophagia, dysphagia, or hoarseness. The patient was non-smoker and there was no family history of any genetic diseases or malignancy. The patient’s medical history included arterial hypertension and age-related cataracts, and her body mass index (BMI) was 34. Before the admission, the patient underwent diagnostic panendoscopic evaluation in another medical center. The findings of a fiberoptic laryngoscopy, bronchoscopy, and esophagoscopy revealed no abnormal masses.A neck ultrasonography revealed a 3 cm × 2.06 cm well-defined, hypoechoic mass , and no A computer tomography (CT) scan of the head and neck region  unveiledAn ultrasonography-guided fine needle aspiration biopsy was performed in order to establish a pathologic diagnosis, but the result was non-diagnostic.www.3dslicer.org (accessed on 4 October 2021)) [® GeForce® GTX 1650 Ti 4GB). From the extension manager, Slicer Virtual Reality was installed, enabling the user to interact with the 3D scene using virtual reality [Thus, for avoiding misdiagnosis, Digital Imaging and Communication files (DICOM) from the CT scan were imported in an open-access multi-platform software, 3D Slicer (r 2021)) , install reality . The extThe Segment Editor module in 3D slicer software was used to manually segment the tumor for VR surgical removal .All the information regarding the shape and position of the tumor as well as the closest vicinity with the superior laryngeal nerve, involving the risk of nerve resection with subsequent hoarseness, were presented to the patient. The informed decision was to perform surgical resection under general anesthesia, and the patient signed the consent form.Before surgery, routine preoperative tests were performed according to National Institute for Health and Care Excellence (NICE) guidelines . Blood tThe anesthetic, 3 × 1.7 mL cartridges of Ubistesin™ Forte 1/100,000  solution, diluted with 4.9 mL of saline solution, was injected with a spinal needle (25-gauge × 3.5 inches) in a tumescent fashion, infiltrating the subcutaneous area. A 7 cm horizontal incision was made along a cervical skin crease into the lateral neck region. A subplatysmal sharp and blunt dissection was performed to dissect the over- lying soft tissue; the dissection was extended both cranially and caudally, taking care not to injure the internal jugular vein (IJV), carotid artery (CA), and vagus (X) nerve .The carotid artery and the internal jugular vein were displaced laterally but not compressed. The sternocleidomastoid muscle was retracted laterally and a yellowish-white ovoid mass (4.5 cm × 3 cm) was identified; both the inferior and superior ends of the mass appeared in continuity with superior laryngeal nerve. A microsurgical approach was initiated in order to perform an intracapsular ablative procedure a,b. SincThe distance between the proximal and the cranial nerve stump of the superior laryngeal nerve was approximately 5.0 cm; direct coaptation could not be performed without significant tension and as such, a nerve cable graft was the only option to bridge the defect. Considering the fact that the patient did not consent to any course of action involving a nerve harvest procedure , the decision was not to perform any immediate nerve reconstructive procedure. However, both superior laryngeal nerve stumps were sutured to the lateral surface of sternocleidomastoid muscle, with a non-resorbable 5/0 suture .Postoperative recovery was uneventful. Due to minimally invasive procedure, the patient was discharged on the second postoperative day.The pathological examination confirmed the diagnosis of benign schwannoma of the superior laryngeal nerve.The patient developed a mild hoarseness following surgery and was diagnosed with vocal cord palsy by an ear, nose, and throat (ENT) specialist. She was informed, prior to surgery, both of the cause and the therapeutical options to treat the hoarseness. However, she expressed high satisfaction with the final outcome, without a personal significant decrease of her quality of life, and as such, did not request any further treatment. At the 12-month follow-up visit, there was no recurrent disease.Schwannomas, neurilemomas, neurolemmomas, or neurinomas are encapsulated nerve sheath tumors composed of proliferated Schwann cells, encompassing motor and sensory peripheral nerves. Their preoperative diagnosis is always a brain-teaser for both the surgeon and the radiologist.18F-fludeoxyglucose (FDG) positron emission tomography (PET) was proposed, in association to MRI, for assessing tumor extension [Imaging examinations of schwannoma include ultrasound, CT, and magnetic resonant imaging (MRI). Recently, xtension . A precixtension ,32.Fine needle aspiration is a simple and safe procedure that can guide the clinician towards the optimal therapeutical approach. The major problem in this diagnostic procedure is to obtain enough and characteristic material for a good cytological examination . HoweverDiagnosis certainty is achieved only with histological examination and immunohistochemical staining of a surgically resected specimen.When different pathologies need to be taken into consideration, the evaluation of surrounding anatomical tissues is crucial. Three-dimensional evaluation of the surgical site, offered by the VR, improved the overall performance of the operation, particularly in terms of assessing the relations with vital neighboring structures.Virtual reality is a popular technique, used nowadays in many areas of medicine and healthcare. Bartella et al. described the use, for the first time in the field of oral and maxillofacial surgery (OMFS), of VR glasses for evaluating three-dimensional imaging dataset (DICOM set taken from CT/cone-beamCT scans) . The sofThe novelty in our case was the use of VR with an open and continuous developing software, 3D Slicer. In our case, VR navigation through registered anatomy and tumor segmentation was a very helpful tool for the evaluation of the extent of the tumor.Virtual planning of surgery using VR and augmented reality is constantly developing . Moreta-The present case report highlighted the use of VR as aid for assisting in diagnosis of a swelling localized in the carotid triangle region. In spite of the clear limits of the tumoral mass with no intratumorally vascularity as diagnosis on Doppler imaging, the differential preoperative diagnosis in the absence of a cytological biopsy is impossible, due to several pathological entities located in this area. Thus, the choice for the present case was surgical ablation. The current report surveyed the clinical and imaging features of the tumor in order to spotlight possible diagnostic and management methods for this rare pathological entity. Due to the paucity of schwannomas, the degree of suspicion for this diagnosis is low. Not surprisingly, such tumors are subject to frequent misdiagnosis. Most of the scientific literature regarding laryngeal nerve schwannoma is represented by case reports  or case Cervical vagal schwannomas represent about 2–5% of neurogenic tumors . AccordiTypically, a schwannoma comes from a single fascicle within the main nerve and dislocates outward from the rest of the nerve. Because the tumor arises within the nerve stealth, it is surrounded by a true capsule. Intracapsular dissection is recommended in order to keep the integrity of the affected nerve. For preventing recurrence, some authors suggested that the tumor capsule should be removed simultaneously . NeverthIn our case, the ablative procedure was not possible without sacrificing the nerve. Hoarseness is the most common complication in our case of resection, as a result of injury of vagus nerve branches during surgery. The same approach was described by Synková et al., and the vocal cord palsy was treated by a phoniatrist, but with no expectation for reversal of the condition .The 3D visual communication process between clinician and patient made possible with the VR was highly important. For the patient, it is crucial to understand the necessity of any additive surgical procedure  or the possible consequences for not doing it, and it is the clinician’s responsibility to inform the patient about possible diagnosis, treatment options, and complication risks. In the meantime, regarding the postoperative mild hoarseness installed, in our presented case report, the patient became used to it and did not accept the neuroplasty. However, vocal fold atrophy is one of the more common reported findings in elderly patients, with no tumoral pathology, also leading to dysphonia in older individuals .Virtual reality represents a novelty in the oral and maxillofacial surgery and otolaryngology fields for diagnostic purpose and surgical planning; however, for extensive and predictable use, further investigations are needed.The VR offered the users a real experience inside virtual 3D model, and it is a useful tool for diagnostic and comprehensive communication with the patient.The current clinical report attracted the attention of including schwannoma in the possible differential diagnosis of a swelling in the anterior cervical region, mainly when a nonspecific radiological appearance is noticed, even with the use of multiple imaging modalities.


Central neurocytoma (CN) is slow-growing rare intraventricular tumor that represents 0.25-0.5% of all intracranial tumors in adults. Typically, it is seen in young adults, yet with surgical resection, it has excellent prognosis. Due to CN rarity and its feature similarities with other common tumors, misdiagnosis can be an issue. With no pathognomonic clinical features of CN, a proper diagnosis can be achieved by radiological imaging, magnetic resonance spectroscopy, histopathology assessment, and immunohistochemistry. Therefore, this is a case report of a 17-year-old male who presented with right lateral ventricular CN with intraventricular hemorrhage. Subtotal tumor resection was carried out via right transcortical approach. Subtle improvement for the patient condition was noted. Central neurocytoma (CN) is a benign tumor with an intraepithelial location arising from germinal matrix cells in the septum pellucidum (near foramina of Monro) or the periventricular region. It is one of the rarest central nervous system neoplasms compromising 0.25-0.5% of all primary brain tumors which was first described in the 1980s by Hassoun et al. and graded as WHO grade II .Young females are more prone to have CN than male , 4. HoweNo specific risk factors or geographic distribution were identified or reported except for a genetic component found in people of Asian descent than of other ethnic groups causing a larger proportion of CN to form .Surgical resection is the treatment of choice having a good prognosis with complete resection with different approaches such as transcallosal, transcortical, and endoscopic. An adjuvant treatment is indicated in cases where complete resection is not possible such as radiation therapy , 6. ThisThis is a 17-year-old young man unknown to have any medical illness transferred to our center from other hospital as a case of hydrocephalus and intraventricular hemorrhage (IVH). He had a complain of headache for 3days that subsided with paracetamol. On the day of his presentation in the initial hospital, the patient suffered from severe headache with persistence vomiting and decreased level of consciousness with GCS of 11/15. However, the physical examination upon arrival to our center was GCS 9/15 and pupils equal reactive bilaterally with spontaneous movement for both upper and lower limbs. Consequently, head computer tomography (CT) was performed, and it showed a well-defined, lobulated large mass measuring 6 cm × 5 cm × 3 cm expanding the frontal horn and body of right lateral ventricle that was mainly hyperdense with heterogeneous attenuations and areas of calcifications . The lesTherefore, the patient underwent an emergency EVD insertion to relief intracranial pressure secondary to hydrocephalus. Bloody CSF came out under high pressure. Thereafter, a preoperative MRI of the brain was done, and it showed a heterogeneous ventricular mass about 40 mm in diameter on the right lateral ventricle which is hypointense signal on both T1and T2 with no contrast enhancement  and 4 suAccordingly, the patient underwent craniotomy for subtotal tumor resection via right transcortical approach. Using the navigation system, the cortex was opened at right frontal site exactly above the mass. The white matter was dissected posteriorly and medially reaching right frontal horn. While opening the right frontal horn, multiple clots were identified and removed until the ependymal wall was recognized. An abnormal gray mass was seen and debulked; a sample was taken for histopathology. Further dissection was carried out anteriorly and medially until there was no obvious abnormal tissue. Moreover, the ventricular system was investigated using endoscope medially anteriorly and posteriorly to confirm a good resection. A ventricular catheter was left in the ventricle.Postoperatively, the patient was kept intubated and sedated for 10 days in the ICU. Postoperative examination while the patient was sedated revealed free movement of the limbs except for the left upper and lower limbs which showed motor power 1/5 and 2/5, respectively.After being whined off sedation, the patient was extubated and transferred to regular ward with his GCS improving. Later on, the patient started to follow orders and speak. However, he was returned to the operative room and underwent VP shunt insertion due to unresolving hydrocephalus and residual neoplasm Figures  and 6. AMicroscopically, the tumor was characterized by neuroepithelial tissue which was comprising of monotonous bland appearing cells showing fine chromatic nuclei and eosinophilic to clear modest cytoplasm, in a background of fibrillary matrix . These cCentral neurocytoma is a rare well-differentiated neoplasm with ectodermal neuronal origin , 8. It aCN is typically deeply seated in midline structures, most commonly in the frontal horn of the lateral ventricle adjacent to foramen of Monro and attached to septum pellucidum which might extend to the third ventricle , 13, 15.The initial clinical presentations of CN usually develop gradually within duration which varies from several hours to several years, but generally advance from 3 to 6 months , 17. TheHemorrhage is not typical feature to occur in CN , 19, 20.Radiologically, CN generally appears as well-demarcated lobulated mass in the lateral ventricle . Its attMoreover, CN usually presents as heterogenous isointense to hypointense mass in T1-weighted MRI while isointense to hyperintense with soap-bubble multicystic appearance in T2-weighted MRI , 15, 16.These neuroradiological characteristics were clearly observed in our patient and thus supporting the diagnosis of CN. The tumor appeared on CT as a well-defined hyperdense mass with heterogenous areas because of calcification which extended from the anterior portion of the right lateral ventricle with no contrast enhancement. Also, hyperdensities which filled the dependent portions of the ventricular system were observed indicating presence of IVH Figures  and 2. OBased on the radiological findings and taking the lesion exact location and the patients age into consideration, the preoperative differential diagnosis includes ependymoma, subependymal giant cell astrocytoma, central neurocytoma, and to a lesser extent oligodendroglioma, primary cerebral neuroblastoma, and choroid plexus papilloma. However, ependymoma and astrocytoma are characterized by the lack of intratumoral cysts and rarely have calcifications. Unlikely, intraventricular oligodendroglioma which is usually located within the body of the lateral ventricle can present with large intratumoral calcifications. Choroid plexus papilloma, on the other hand, is more common in supratentorial compartment in children and the posterior fossa in adults. It is located in the fourth ventricles in almost 70% of adults and the lateral ventricles in pediatrics. Unlike most other brain tumors, CNs are typically located in the supratentorial ventricular system extending to the third ventricle in 26% cases and rarely have extraventricular extensions . It is nThe mainstay treatment of CN is a total resection which can be performed directly via transcortical, transcallosal, or via endoscopic neurosurgery , 25. TotThe choice of surgical approach is largely dependent on the surgeon experience and personal practice and tumor location , 15. YetIn fact, avoidance of open resection surgery complications has prompted the usage of endoscopic tumor removal surgery . Cheng eFor accuracy and safety's purposes, neuronavigation system was deployed as image-guided for neurosurgical operations for localization and delineation of brain lesions, therefore, ensuing maximum safe resection. However, intraoperative brain shift can limit its accuracy . Thus, iBesides, adjunctive radiotherapies have been used to treat recurrent and residual tumor , 28. MahIn our patient, due to the large tetraventricular hemorrhage which played role in the onset of the postoperative hydrocephalus, the transcallosal route was unsuitable; therefore, transcortical approach was favored over transcallosal approach in our case, a subtotal tumor resection was accomplished via transcortical approach because of the high vascularity of the tumor. Postoperatively, the patient was managed accordingly, but no radiotherapy was performed. In addition, the only documented complications were hemiparesis grade 3 and unresolving hydrocephalus.The histopathological diagnosis of CN is challenging as many of its histopathological features resemble other neoplasms of CNS, thus resulting in misdiagnosis. Therefore, the definitive diagnosis of CN relies mainly on immunohistochemistry to determine the neuronal origin of the tumor. The most reliable diagnostic marker in immunohistochemistry is antibodies to synaptophysin which labels CN in both fibrillary and perivascular areas. Furthermore, positive neuron-specific enolase and negative for glial fibrillary acidic protein can be used as other features of immunohistochemistry for CN , 14. In CN is a slow-growing benign neoplasm of the central nervous system that has an excellent prognosis. Although the best long-term survival rates and local tumor control correlates with total resection which is the most preferable management, adjuvant radiotherapy is considered following subtotal resection with residual CN, large-sized CN, or deep-seated CNs.We describe here a rare case of central neurocytoma with atypical presentation and radiological finding; however, central neurocytoma should be considered as a differential diagnosis in slow growing neoplasms with hemorrhagic extension to the ventricles; a total safe resection should be carried out; if it cannot be achieved, a subtotal resection followed by adjuvant radiotherapy should be considered.


Testicular choriocarcinomas comprise less than 1% of all testicular tumors and are often highly vascular with early hematogenous metastasis. Choriocarcinoma syndrome (CS) is a rare entity distinguished by diffuse tumor burden and often fatal bleeding from metastatic sites. Most reported cases describe pulmonary hemorrhage secondary to initiation of chemotherapy. We present a fatal case of a young, previously healthy male with overwhelming gastrointestinal bleeding as the presenting sign of CS. Our case demonstrates that CS should be considered in the differential diagnosis for refractory anemia due to gastrointestinal hemorrhage in a young male with a testicular mass. Testicular choriocarcinoma is a rare, highly aggressive subtype of non-seminomatous germ cell tumors and comprises approximately 0.2% of all testicular tumors . HematogChoriocarcinoma syndrome (CS) is an exceedingly rare and often fatal manifestation of choriocarcinoma and is likely a reflection of massive tumor burden . The majHere, we describe an uncommon case of a young male who presented with overt gastrointestinal bleeding (GIB) as the solitary sign of CS.A 32-year-old previously healthy male was transferred from an outside facility after presenting with several weeks of progressively worsening fatigue, abdominal pain, non-bloody vomiting, and melena. Prior to transfer, he received two units of packed red blood cells due to a low initial hemoglobin of 4 g/dL (14-18 g/dL). He was hemodynamically stable. On physical examination, his abdomen was soft and lax. Admission labs were notable for a post-transfusion hemoglobin of 5.3 g/dL. The chemistry, coagulation, and liver panels were otherwise unremarkable.Esophagogastroduodenoscopy revealed a non-bleeding arteriovenous malformation (AVM) in the gastric body which was treated with hemostatic clips. Colonoscopy was unremarkable.A video capsule endoscopy showed a proximal jejunal lesion. Push enteroscopy revealed a 1.5 cm bleeding mass in the proximal jejunum, which was biopsied Figure . A CT ofDue to persistent bleeding from the mass, the patient underwent emergent exploratory laparotomy with resection of 50 cm of the proximal jejunum with primary two-layer, hand sewn jejuno-jejunal anastamosis. The excised surgical specimen of the jejunal mass confirmed metastatic choriocarcinoma Figure .Amidst the workup, the patient reported left testicular pain and had visible scrotal swelling. Testicular ultrasound revealed a 5 × 3 cm left intra-testicular mass and beta-human chorionic gonadotropin (hCG) was over 200,000 IU/L. He was considered a poor surgical candidate for orchiectomy given his overall poor clinical status with recent exploratory laparotomy. He was started on chemotherapy with cisplatin and concurrent reduced doses of ifosfamide and etoposide. Unfortunately, he developed complications related to septic shock with multiorgan failure and expired on day 36 of hospital admission.CS is an extremely rare clinical condition associated with high morbidity and mortality that was first described in 1984 . CS is dCS often manifests as massive tumor lysis secondary to initiation of chemotherapy. Rarely, it can present as primary spontaneous hemorrhage in metastatic choriocarcinoma ,12. MostDefinitive treatment options for choriocarcinoma-related GIB are rather limited. Hemorrhage is cited as the cause of death for 44% of patients with testicular choriocarcinoma . The 199Nonetheless, targeted treatment of choriocarcinoma is paramount to attaining control of the rapidly growing metastatic burden . IdeallyWe report a rare case of CS with jejunal metastasis causing overt GIB. Diagnosis and management can be difficult secondary to its nonspecific presentation and often delayed diagnosis at late stages of the disease. Early recognition and treatment with chemotherapy is a mainstay; however, most patients still are at high risk of fatal complications. Our case highlights the comprehensive workup for obscure overt GIB and the need to consider metastatic choriocarcinoma in the differential diagnosis in a young male with GIB and testicular mass.


Angiolipoma is a type of lipoma, a benign soft tissue tumor. It is distinguished by the excessive degree of vascular proliferation and the presence of mature adipocytes. It occurs commonly on the trunk and extremities. Angiolipomas larger than 4 cm are classified as “giant,” and due to their size, histological evaluation is necessary to exclude malignancy. We report a case of a male patient who suffered from a giant noninfiltrating intramuscular angiolipoma which formed after venipuncture in the antecubital fossa. Clinical examination showed a palpable painless soft mass. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a giant angiolipoma on the right forearm. Surgical removal of the mass was performed, and the biopsy was negative for malignancy. To the best of our knowledge, this is the first report in the literature of posttraumatic intramuscular angiolipoma. Physicians and orthopedic/general surgeons should be aware of the possibility of soft tissue masses in a posttrauma situation. Angiolipomas are benign soft tissue tumors of mesenchymal origin which are made of mature adipocytes with an excessive degree of vascular proliferation . They caThe authors present a case of a giant angiolipoma of the forearm in a male patient who reported a venipuncture in the affected area, 12 months before our clinical evaluation. To our knowledge and after reviewing the current literature, there are no confirmed cases of posttraumatic intramuscular angiolipoma.A 62-year-old male farmer presented in the outpatient clinic with a large mass on the volar surface of his right forearm (dominant arm). The patient reported that the mass started appearing right after a venipuncture in the region of the antecubital fossa, about 12 months ago. Since then, the mass gradually increased in size with a more rapid growth over the past 6 months. The patient complained of slight discomfort during flexion of the elbow. No history of previous trauma in the affected area was reported. Past medical history included arterial hypertension. In addition, he was a social drinker and a nonsmoker.Physical examination revealed a large, palpable, and painless soft solid mass on the upper half of the right forearm . No overA CT and MRI with contrast demonstrated a well-encapsulated, solid multilobular lesion with lipoid content and the presence of septa Figures  and 3. TA lazy-S incision was performed, and the mass was removed surgically. The lesion occupied almost the entire upper half of the forearm including the antecubital fossa. It was located subcutaneously above the radial artery near the bifurcation of the brachial artery and between the brachioradialis and pronator teres muscles . The marThe removed mass's dimensions were 5 × 5 × 8 cm, and its weight was 68 grams . Histolo12 months postoperatively, the patient was asymptomatic.Although Bowen in 1912 first described a case of angiolipoma as a different entity from the generic diagnostic term “lipoma” , it was At present, the WHO Classification of Soft Tissue Tumors classifies angiolipomas in the group of adipocytic tumors, the largest group of mesenchymal tumors  . It is dAngiolipomas are more common in young adults , they are equally distributed between sexes and occur mostly in the extremities (2/3 of the cases in the forearm), trunk, spinal axis, head, and neck, and their size almost never exceeds 4 cm , 10. MulThe diagnosis can be aided by ultrasonographic analysis (US), computed tomography (CT), or magnetic resonance imaging (MRI), but the microscopic examination is necessary for a conclusive diagnosis. US analysis is not very specific but can be useful for differentiating subcutaneous angiolipomas from ordinary lipomas by observing color Doppler flows . CT contMicroscopic examination of the surgical specimen is necessary for the conclusive diagnosis. The histopathologic characteristics were described by J. J. Lin and F. Lin as encapsulated (noninfiltrating angiolipomas) or nonencapsulated (infiltrating angiolipomas) lesions with, at least, 50% evidence of mature adipocytes and angiomatous proliferation in the tumor, in various ratios . The preThe differential diagnosis of angiolipomas include lipomas and other lipoma variants , hemangiomas, benign lesions affecting bone, joints, or tendons , and liposarcoma , 10.The treatment of noninfiltrating angiolipomas is simple surgical excision, and they show no tendency to recur. Fine-needle aspiration is rarely diagnostic. Treatment of infiltrating angiolipomas consists of wide surgical excision, but there is a recurrence rate of 50%. When it is not associated with pain or has a small size (under 5 cm), it can be followed up without surgical treatment , 14.The pathogenesis of this lesion remains unclear, and the origin of angiolipomas is still controversial. Increased familiar incidence has been reported (approximately 5%) but does not exceed that of ordinary lipomas , 2.The relationship between trauma and formation of posttraumatic “tumors” has been investigated since 1935, and Ewing suggested that repeated or acute trauma could, rarely, cause a soft-tissue tumor or aggravate a preexisting one . Since tIn their most recent study of 31 cases with posttraumatic lipomas and review of the literature, Aust et al. found an elevated PTT in their patients and reported a link between manifest or subclinical coagulation disorders and development of posttraumatic lipomas that are defined as adipose tissue tumors forming at the location of a precedent trauma, with a marked gender predominance towards women. They also reviewed precedent studies and possible theories on their formation . The firPosttraumatic angiolipomas are a very rare clinical diagnosis. With their case report and after review of the literature, Morgan et al. reported—in total—2 cases of cranial intraosseous angiolipomas, a very rare benign tumor of the bone, with a possible association with head trauma .Angiolipomas are benign tumors of soft tissue composed of mature adipocytes with an excessive degree of vascular proliferation. They occur more commonly on the extremities and trunk/head of young adults, and their size rarely exceeds 4 cm. Among imaging tools, MRI with contrast is the most sensitive imaging tool to better define the lesion. Histological analysis is necessary to define the diagnosis, and surgical excision is the treatment of choice, especially in the presence of giant lesions. In the past years, more studies suggest that trauma can induce the formation of lipomas and various mechanisms were presented trying to explain the formation of posttraumatic lipomas. Physicians and surgeons should be aware of the possibility and recognize the formation of soft tissue masses in a posttrauma situation. To our knowledge and after reviewing the current literature, there are no confirmed cases of posttraumatic intramuscular angiolipomas.


Case 2 was a 49-year-old man who presented with an incidentally detected 4th rib mass with calcification on computed tomography scan. Chondrosarcoma was suspected according to imaging features. An open biopsy was considered to have a risk of tumor seeding because the tumor was located behind the scapula. En bloc excision of the tumor without biopsy was performed. The pathological findings were consistent with hemangioma of bone.  Case 1 was a 58-year-old man who presented with an incidentally detected, slowly growing mass in the right hypochondrium area. An imaging study showed the mass arising from the 11th rib, with ill-defined margins and cortical destruction. Differential diagnoses included chondrosarcoma and metastatic malignant tumor. Open biopsy was associated with moderate bleeding (300 mL) despite small incision. Microscopic findings showed numerous irregular, dilated, and thin-walled vessels, consistent with the diagnosis of hemangioma of bone, and en bloc excision without biopsy can be a practical treatment option. We reported two cases of rare hemangioma arising from the rib, which mimicked chondrosarcoma. The preoperative diagnosis was challenging, both clinically and radiologically. Because biopsy for hemangioma of the rib is associated with a bleeding risk, the  Hemangioma of bone is a benign tumor composed of vascular channels of either small or large caliber , and theen bloc tumor excision, including the adjacent 11th rib, with no surgical complications. Pathological findings were consistent with the features of hemangioma of bone  Figures . He was  Figures . At the en bloc excision of the tumor, along with the adjacent 4th rib, was performed. The pathological findings were consistent with hemangioma of bone. No surgical complications were observed. At the 18-year postoperative follow-up visit, no local tumor recurrence was detected. Both patients were informed that the data from their cases would be submitted for publication, and they provided their informed consent.A 49-year-old man presented with a 4th rib mass that was incidentally detected on chest X-ray during a regular checkup. X-ray and CT imaging showed a mass with honeycomb-like calcifications in the 4th rib . MRI demThe majority of hemangiomas of bone involve vertebral bodies, followed by the craniofacial skeleton and long bones. Hemangioma of the rib is rare, with only 33 cases of rib hemangiomas, including our two cases, described in the English literature to date –9. In thOn CT, hemangioma of the rib presents as an expansile, lytic bone mass with a honeycomb appearance in the medullary cavity and a thin bony cortex either with or without cortical destruction . On MRI,en bloc tumor excision without biopsy represents a practical treatment option in cases with tumor seeding or bleeding risk to avoid the complications due to biopsy. Moreover, when the degree of dysfunction after en bloc excision is minimal and the probability of high-grade sarcoma or bone metastasis is low through clinical examination and systemic workup, the biopsy could be omitted. Curettage for vascular tumors also has the risk of large bleeding events during the surgical procedure. Therefore, en bloc excision is typically performed for rib hemangioma [en bloc excision with at least a 2 mm margin is advisable for obtaining optimal oncological outcomes in patients without biopsy because this margin was considered a safe margin for high-grade chondrosarcoma.For Case 1, the preoperative open biopsy was associated with moderate bleeding despite small incision, whereas the biopsy was avoided to reduce the risk of tumor seeding in Case 2. Some authors have stated that biopsy should be avoided due to the tumor-seeding risk through the biopsy tract and bleeding risk , 12, whemangioma . On the mangioma , en blocEn bloc excision without biopsy can be a practical treatment option to avoid bleeding or tumor seeding risks. Delayed-phase contrast-enhanced MRI may be helpful for differential diagnosis.In conclusion, we reported two rare cases of rib hemangioma mimicking chondrosarcoma.


Congenital mesoblastic nephromas mainly present as asymptomatic abdominal masses, but some present hematuria, hypertension or hypercalcemia. Neonatal dyspnea in an early-birth neonate due to rapid tumor growth is reported here for the first time.A renal tumor and polyhydramnios were detected by ultrasonography of a male fetus at 32 weeks and 3 days of gestation. The mother had abdominal distension due to the polyhydramnios and signs of imminent premature birth. Amniocentesis was performed and the signs of imminent preterm birth subsided, but growth of the renal tumor was noted as a potential cause of respiratory dysfunction. Cesarean section was performed at 36 weeks and 2 days of gestation. His birthweight was 2638 g and his 1 and 5 min APGAR scores were 2 and 4 points, respectively. There was no spontaneous breathing at birth and he had remarkable abdominal distention. He underwent cardiopulmonary resuscitation. After circulation stabilized, emergency surgery was performed because of progressive hypoxemia and respiratory acidosis. Laparotomy revealed a huge tumor arising from the right kidney and right nephrectomy was performed. Histopathological examination led to diagnosis of congenital mesoblastic nephroma. The respiratory condition and circulatory dynamics stabilized after the pressure on the thorax from the tumor was relieved by surgery. The postoperative course was uneventful. No recurrence or complications have been observed in the 36 months since the surgery.Congenital mesoblastic nephroma can rapidly increase in size from the fetal period and may cause respiratory oncologic emergency, although there is relatively good prognosis. Congenital mesoblastic nephroma (CMN), a rare benign renal stromal neoplasm, is the most common renal tumor in neonatal and early infancy periods . It main2 of 89%, blood pressure of 89/44 mmHg and body temperature of 36℃. He had a palpable mass on the right side of the abdomen. Blood tests at birth showed Hb of 9.5 mg/dL, and tumor markers such as HCGβ, AFP and NSE were within normal range. No occult blood was found on urinalysis at birth. Chest x-ray examination showed elevation of the diaphragm and compression of the thorax by renal tumor. Abdominal US showed a 79 × 98 mm tumor at the right kidney and exclusion of the liver to the cranial side. Abdominal computed tomography (CT) showed an 80 × 100 mm tumor that had an inhomogeneous contrast effect. The liver was excluded to the cranial side and the diaphragm was elevated by the renal tumor  detected a 67 × 67 mm retroperitoneal tumor in the fetus and showed polyhydramnios. Fetal magnetic resonance imaging (MRI) two days later showed polyhydramnios and a 69 × 70 mm mass, low signal on T1-weighted imaging and faint high signal on T2-weighted imaging at the right kidney . Emergency laparotomy was performed at one day after birth because exclusion of the diaphragm due to the right renal tumor may have been the cause of respiratory and circulatory insufficiency.High-frequency oscillation ventilation and circulatory agonists were administered to maintain respiratory and circulatory systems. Arterial blood gas analysis used the following ventilation settings: FiO2 = 0.5, stroke volume = 30 mL and mean airway pressure = 16 mmHg. The pH was 7.286, PaCOThe liver and ascending colon were excluded by a dark red mass covering the peritoneum. The ascending colon was mobilized from the retroperitoneum and the tumor was detached from the surrounding tissue. The right renal artery and vein and the right ureter were dissected, and the right kidney was resected. The right adrenal gland was preserved.The tumor was covered with a capsule, and a yellow solid component and a renal parenchymal component were found on the cut surface Fig. . The tum2 was 38.0 mmHg, PaO2 was 89.7 mmHg, HCO3 was 25.2 mmol/L and BE was 1.1 mmol/L. This suggested the improvement of hypoxemia and respiratory acidosis. Respiration and hemodynamics became stable after the operation. The circulatory agonist was discontinued on postoperative day (POD) 2 and the patient was extubated on POD 3. The postoperative course was uneventful, and the patient was discharged on POD 45. Thirty-six months have passed since the operation without adjuvant chemotherapy, and the infant has not had recurrence, metastasis or complications.Under arterial blood gas analysis  the pH was 7.431, PaCOCMN can often be diagnosed antenatally with US or MRI . On US, In the present case, US revealed a non-uniform hypoechoic region inside. MRI showed a low signal on the T1-weighted image and a faint high signal on the T2-weighted image. WT-1 was negative by immunohistochemical staining. US, MRI and immunostaining findings were consistent with CMN.The earliest reported detection of CMN was at 22 weeks of gestation . CMN is The standard treatment for CMN is surgical resection, and the 5-year survival rate is 93–96% . Tumor rIn conclusion, neonates can have respiratory oncologic emergency because of a rapid increase in size of CMN that leads to dyspnea by elevation of the diaphragm and exclusion of the thorax, although CMN has a relatively good prognosis.


Intraosseous schwannomas are rare benign tumors that most often occur at the mandible or sacrum. We present an unusual case of a bilobed schwannoma of the distal humerus with both intraosseous and extraosseous components. The extraosseous component was non-enhancing on initial MRI and enhanced on a subsequent MRI obtained after biopsy. We hypothesize that this change was attributable to decreased intra-tumoral pressure secondary to biopsy-related disruption of the tumor capsule. Schwannoma is the most common peripheral nerve sheath tumor. It is composed of Schwann cells which form the myelin sheath of peripheral nerves. Masson coined the term “schwannoma” in 1923 to describe peripheral nerve sheath tumors distinct from neuromas Most schwannomas are solitary and sporadic, although approximately 5% occur in the setting of syndromes such as neurofibromatosis type 2 or schwannomatosis, often as multiple lesions As peripheral nerve sheath tumors grow along the length of a nerve, they are typically fusiform Intraosseous schwannomas are very rare, accounting for 0.1%-0.2% of primary bone tumors ,13. A stAt gross pathology, schwannomas have a capsule derived from epineurium and are often seen growing along a parent nerve ,23. At mOn radiographs, intraosseous schwannomas have benign imaging features such as a narrow zone of transition and little to no periosteal reaction On MRI, schwannomas are typically well-defined solitary masses that have a fusiform appearance and can often be seen growing eccentrically along a parent nerve. A “split-fat” sign can be present, visible as a thin rim of fat surrounding the tumor, often most apparent at the ends of the lesion on long-axis images. However, this sign is not specific for schwannoma and can be seen in other soft tissue tumors such as myxomas and myxofibrosarcomas A 17-year-old woman presented with a painless mass in the distal right upper arm which she had noticed one week earlier. She denied prior trauma and had no significant past medical history. Physical examination was notable for a firm and immobile mass at the anteromedial distal upper arm. Laboratory evaluation inclusive of complete blood count, basic metabolic panel, and inflammatory markers was normal.Radiographs demonstrated a soft tissue mass anterior to the distal humerus A in addiSonography was subsequently performed and showed a deep soft tissue mass with circumscribed margins, peripheral decreased echogenicity, and somewhat greater echogenicity centrally . There wMRI was then performed, demonstrating a dumbbell-shaped mass with an intraosseous component measuring up to 2.5 cm located centrally in the distal humeral metaphysis and a larger extraosseous component extending anteromedially through a cortical defect and measuring up to 5.0 cm. The mass was isointense to muscle on T1-weighted images. On T2-weighted images, the mass was hyperintense with mild heterogeneity and higher signal intensity at the periphery of the extraosseous component A and B. Ultrasound-guided fine needle aspiration and core biopsy of the mass was then performed, with samples obtained from both the enhancing intraosseous component and the non-enhancing extraosseous component.Histologic specimens of both tumor components showed a proliferation of spindle cells with areas of variable cellularity and no evidence of malignancy. Verocay bodies, although poorly formed, were identified. Immunohistochemistry demonstrated diffuse, strong S100 positivity and scattered CD34 positivity, but neurofilament staining was negative for intra-tumoral axons. Based on these features, the biopsy was interpreted as consistent with benign peripheral nerve sheath tumor, favoring schwannoma with neurofibroma not entirely excluded.After discussion of the biopsy results, the patient elected observation with MRI follow-up. A repeat MRI was performed approximately 3 months after the initial MRI and biopsy. On this second MRI, the extraosseous component of the lesion enhanced heterogeneously D; findinAbout four and a half months after the initial MRI, the patient decided to proceed with surgical excision. The extraosseous component was freed after careful dissection (Histopathology of the surgical specimen demonstrated the presence of Verocay bodies, confirming the diagnosis of schwannoma A. The exPost-operatively, the patient experienced hyperesthesia in the median nerve distribution which improved over time.Of the three mechanisms previously described for osseous involvement by schwannomas, it seems most probable that the tumor in our case originated within a nutrient canal, with subsequent extra-osseous growth producing the dumbbell-shaped morphology. While the largest nutrient foramen of the humerus is located at the diaphysis, smaller nutrient foramina are present at the distal humerus ,31.The imaging appearance of the mass in the current case parallels the histopathologic findings, with the relatively T2-hyperintense and hypoenhancing periphery of the extraosseous component corresponding to areas of hypocellular Antoni B pattern tissue, and the less T2-hyperintense, and enhancing central region corresponding to cellular Antoni A pattern tissue  and 3.An unusual feature of this case is the lack of enhancement of the extraosseous component on the initial MRI and avid enhancement of the same portion of the tumor on the subsequent MRI. As the initial biopsy specimen and resection specimen were histologically similar and there was no other intervention between the two MRIs, we hypothesize that this change may have occurred due to a decrease of intra-tumoral pressure secondary to disruption of the tumor pseudocapsule by the biopsy. This theory is supported by the presence of capsular disruption noted at gross examination of the resection specimen. We estimate the scan delays to be similar for both MRIs. Furthermore, as there was no change in enhancement over the duration of the contrast-enhanced potions within either the initial or subsequent MRI, difference in scan delay is unlikely to account for difference in tumor enhancement.A similar phenomenon of increased post-biopsy enhancement has previously been reported in intramuscular myxomas by Wang et al. The concept of increased interstitial pressure in tumors impeding molecular transport was described by Jain in 1987 In conclusion, we present a rare case of intraosseous schwannoma of the distal humerus, likely arising within a nutrient canal. The histopathologic features noted after resection parallel the imaging findings, which in turn reflect the variable composition and cellularity of schwannomas. We hypothesize that increased enhancement of the extraosseous component following biopsy was secondary to disruption of the tumor capsule and associated decrease of intra-tumoral pressure. Although these lesions are rare, radiologist awareness of intraosseous schwannoma can facilitate efficient diagnosis and appropriate treatment of these benign tumors.Written informed consent was obtained from the patient's parents.


Chondromas rarely occur in the nasal area and are usually found in the metaphyseal area of the phalanges and metacarpals of the hands, as well as the pelvis, sternum and scapula. The authors present an unusual case of dysphagia induced by histologically confirmed chondroma arising from the nasal septum. Treatment is to completely remove the mass with adequate margins of normal tissues to prevent recurrence and malignancy. Intranasal endoscopic removal of tumor with an adequate margin of normal tissue. After one year of treatment, there was no evidence of recurrence. We present a case of nasal septal chondroma in 18-year-old male. Chondroma is a benign tumor usually arising from the femur, lung or breast; it rarely occurs in the head and neck region.4 We present a case of dysphagia induced by chondroma arising from the nasal septum removed by endoscopic operation.In patients with dysphagia, esophagitis or esophageal motility disorders may be common causes, but in rare cases, esophageal stricture, pharyngoesophageal diverticulum, neuromuscular disorder, cricopharyngeal spasm, gastroesophageal reflux disease may be the reason.A male patient aged 18-year-old visited our otorhinolaryngology outpatient clinic who was referred to our department from the division of gastroenterology complaining of lump sensation and intermittent dysphagia for the past six months who showed no specific findings in esophagogastroscopy. Dysphagia worsened after eating solid food rather than liquid food, but the patient did not complain of hoarseness, odynophagia and aspiration. The patient had nasal obstruction for two months, but did not complain of any other nasal symptoms. No pharmacologic treatment could lead to improvement of symptoms. The patient suffered facial trauma after falling down the stairs five years ago, but had not received treatment due to minor injuries. Other than that, there were no family history and operation records. On physical examination, the nasal septum was clearly deviated to the right with the right nasal cavity almost completely obstructed. The left nasal cavity was partially obstructed due to concha bullosa and hypertrophy of the uncinate process. Just posterior to these structures, there was a hard circular mass surrounded by normal mucosa completely obstructing the posterior nasal cavity extending to the nasopharynx in adhesion to the floor of the left nasal cavity. Upon swallowing, there was significant loss of mobility of the floor of the left nasal cavity compared to the right due to the adhesion with the mass. Computed tomography (CT) of the sinus showed a non-enhanced, round, homogeneous mass measuring 4.0 x 3.0 cm in the nasal cavity and the nasopharynx with partial bone destruction in the posterior nasal septum and the sphenoid sinus. Also, adhesion between a mass and soft palate was observed  and 1B. 4 It may affect all ages but usually occurs in middle-aged people of either gender.1 The etiology of chondroma is unclear; there are two suggested theories. One suggests abnormal enlargement due to localized inflammation caused by stimulation of infected chondrocytes.1 The other theory involves cartilaginous material interacting with fibrous material in a cyst caused by trauma to the cartilage or the bone.5 In this case, trauma seems to play a major role in the pathogenesis of the chondroma, but the etiology remains unclear.First reported by Morgan in 1842, chondroma was controversial in its pathogenesis and etiology. It is now categorized, however, as a benign bone tumor. It usually arises in the orthopedic area and rarely occurs in the head and neck area.5 In cases of chondromas occurring in the nasal cavity, the patient might suffer from nasal obstruction, rhinorrhea, or epistaxis as the size of the chondroma increases. Rarely, swelling of the buccal area and exophthalmosmay develop.6 Unfortunately, in this case, diagnosis was delayed since dysphagia was the main symptom rather than nasal symptoms. Diagnosis of chondromas is made with CT or MRI, but in cases arising from the nasal septum, detection may be difficult.6 First, since it presents as a painless mass, diagnosis is delayed until the mass is big enough to cause nasal symptoms. Second, chondromas are very rare compared to other diseases that cause dysphagia. Third, it is easy to misdiagnose it as osteoma, ossifying fibroma and fibrous dysplasia from the ground glass opacification found on CT. Lastly, MRI shows inconsistent enhancement with no specific findings. Differentiation should be made from mucous cyst, osteoma, ossifying fibroma, fibrous dysplasia and angiofibroma. Chondromas require long term follow up as these tumors may progress to chondrosarcomas.7 Diagnosis is confirmed by histology, and gross findings present with a mass that is smooth and rather firm, with a ripe pear consistency.4 Microscopic studies show well differentiated hyaline cartilage and evenly arranged chondrocytes that are similar to normal cartilaginous tissues with no anaplasia.1Clinical manifestations of chondromas are incidentally found, as it is usually a painless mass.8 If surgical approach is difficult, long term medication such as non-steroidal anti-inflammatory drugs is reported to be beneficial, but surgery is recommended due to risks of recurrence and malignancy such as chondrosarcoma.8 In the past, extensive excision of the nose or maxilla was done, but currently it is endoscopically removed. The advantages of endoscopic removal with such as the procedure in this case are prompt recovery, made possible due to minimal damage to the mucosa, the ability to correct deviated nasal septum, directly having access to the mass with normal tissues spared, and obtaining satisfactory cosmetic results.Treatment is to completely remove the mass with adequate margins of normal tissues to prevent recurrence and malignancy.9 Any loss of palate mobility will affect these functions of the soft palate, it eventually leads to allow pressure and bolus material to escape inappropriately.9 In light of the significant decrease in the movement of the patient's left nasal cavity base, it may be assumed that this would have affected the soft palate movement, resulting in dysphagia.In this case, we suppose that the mass was causing the patient's symptom because it was firmly attached to the soft palate. While the oral phase of swallowing, the soft palate separates the oral cavity and pharynx. Soft palate then rises, separates oropharynx and nasopharynx during the pharyngeal phase of swallowing.10 However, in this case, it was difficult to diagnose because dysphagia was caused by chondroma in the nose. We would like to present that dysphagia can be a symptom originating from the nose as well as the mouth or esophagus.In the presence of dysphagia symptoms, it is necessary to distinguish whether the symptom occurs after swallowing or initiating swallowing to distinguish whether oropharyngeal dysphagia or esophageal dysphagia. Also, to distinguish between neuromuscular disorders such as achalasia and esophageal spasm, as well as mechanical obstructions such as stricture and cancer, doctor should check whether the symptom occurs only in solid food or liquid diet.JNMA Case Report Consent Form was signed by the patient and the original is attached with the patient's chart.None.