Burkitt's lymphoma is an aggressive type of non-Hodgkin lymphoma that represents approximately 30% of pediatric lymphomas and less than 5% of all pediatric malignancies. Although the involvement of the gastrointestinal tract is a common finding in sporadic Burkitt's lymphoma, primary intestinal lymphomas still represent a rare entity.We are reporting the case of an 11-year-old Syrian male who presented to our hospital with complaints of abdominal pain, distention, and tenderness. Clinical and radiologic examinations demonstrated moderate ascites with an abdominal mass. Interestingly, the cytological study of the ascites revealed the diagnosis of Burkitt's lymphoma which was later confirmed by histopathological and immunohistochemical examinations.Pleural effusions are a common finding in extranodal lymphomas, whereas ascites is considered a rare initial presentation constituting less than 2% of lymphoma cases.We aimed to present an extremely rare case of a primary intestinal Burkitt's lymphoma initially presenting with ascites, highlighting the major role of the cytological study of ascites in the primary diagnosis, and the essential role of histological and immunohistochemical examinations in confirming the diagnosis in challenging cases. Primary intestinal lymphomas constitute less than 2% of small intestinal malignancies.Ascites represents an extremely rare initial presentation of non-Hodgkin lymphomas.Cytological study of ascites represented a hard challenge in diagnosing Burkitt's lymphoma. BL:Burkitt's lymphomaNHL:Non-Hodgkin lymphomaEBVEpstein-Barr virusHIV-1human immunodeficiency virusUS:UltrasonographyCTComputed TomographyPETPositron Emission TomographyCDCluster of differentiationH&EHematoxylin and EosinIHCImmunohistochemistryTdTTerminal deoxynucleotidyl transferaseBCL6B-Cell Lymphoma-6BCL2B-Cell Lymphoma-2WBCWhite Blood CellsCRPC-Reactive ProteinLDHLactate dehydrogenase1Burkitt's lymphoma (BL) is an aggressive type of B-cell non-Hodgkin lymphoma (NHL) that was first defined by Dr. Dennis Burkitt in 1958 as a sarcoma of the jaw in Ugandan children ,3. Never2We report the case of an 11-year-old Syrian male who presented to our hospital with complaints of intermittent generalized abdominal pain for 45 days accompanied by abdominal distention, tenderness, loss of appetite, and a rapid weight loss (15 Kgs in 6 weeks). No fever, jaundice, vomiting, or night sweats were reported. Medical, psychological, and family history were unremarkable.9/L, hemoglobin value 10.8 g/dl, hematocrit value 30.3%, LDH value 4299 U/L, and CRP value 8.8 mg/L. Other tests were within normal limits. Full-body computed tomography (CT) scan demonstrated moderate ascites accompanied by a poorly defined heterogeneous mass  group. Thus treatment regimen consisted of alternating courses of Cyclophosphamide, Vincristine, Prednisone, Adriamycin, and Methotrexate (COPADM), followed by consolidation courses of Cytarabine and Methotrexate (CYM). A Positron Emission Tomography/Computed Tomography (PET/CT) scan was performed six months later and revealed a complete metabolic response with no residual uptake (deauville1). The patient is currently in a good state and is being monitored regularly with CT scan to detect any recurrence. Our work was reported according to the SCARE 2020 criteria [3Although the involvement of the gastrointestinal tract is a common finding in sporadic cases of Burkitt's lymphoma, primary gastrointestinal lymphomas represent a rare entity that constitutes less than 20% of extranodal non-Hodgkin lymphomas and less than 2% of small intestinal malignancies .Sporadic BL usually affects pediatric populations with disparities in age distributions. In a study by Mbulaiteye S et al., sporadic BL was more predominant in younger ages (3–5) years old ,6, wherePleural effusions are a common finding in extranodal lymphomas, whereas ascites is considered a rare initial presentation . In a stAmong lymphoma subtypes, T-cell lymphomas were more associated with serous effusions than B-cell malignancies. Furthermore, lymphoblastic lymphoma appeared to be the most common B-cell NHL associated with serous effusions . Our manRadiologic techniques could be helpful in the diagnosis and management of gastrointestinal neoplasms. In pediatric populations, ultrasonography (US) is preferable as a preliminary imaging technique due to the absence of ionizing radiation risk in addition to its role in evaluating peripheral lymph nodes and superficial lesions structures. Nevertheless, computed tomography (CT) scan with intravenous contrast provides a better evaluation of tumor infiltration in addition to its major role in whole-body evaluation. Furthermore, positron emission tomography (PET) scan combines anatomic detection with metabolic and functional information, which makes it a preferable method to predict treatment response ,11,12. IAnother interesting point in our manuscript is highlighting the role of cytology in the preliminary diagnosis. Due to the rapid proliferation of tumor cells and the risk of tumor lysis syndrome in aggressive neoplasms including BL, the cytologic study of serous effusions might play a critical role in the rapid diagnosis of BL. In our case, the ascitic fluid study revealed the proliferation of monotonous non-cohesive cells with moderate basophilic vacuolated cytoplasm, non-cleaved nuclei, and multiple prominent nucleoli, similar to the results of a study by Haddad et al. on cytologic smears in Burkitt lymphoma ,13.Nevertheless, histopathologic examination of the neoplasm is essential to confirm the diagnosis. Microscopically, BL is characterized by a high proliferation fraction of monotonous, intermediate-sized cells with basophilic vacuolated cytoplasm, round nuclei, multiple nucleoli, and a high mitotic rate with the “classic starry sky pattern”. Furthermore, ancillary techniques are crucial to establish the final diagnosis. BL is derived from germinal and post-germinal center B-cells. Therefore, the neoplastic cells demonstrate positivity for B-cell markers including CD20, CD19, CD79a, and CD22, in addition to the positive expression of germinal center-associated antigens including CD10 and BCL6, with negative expression of TdT and BCL2 as in our case .Regarding molecular genetics studies, all cases of BL harbor MYC translocation involving distinct locations. In approximately 80% of cases, this translocation involves the Myc gene on the long arm of chromosome 8 and the immunoglobulin heavy chain locus on chromosome 14. This translocation results in a high expression of c-Myc protein that regulates cell proliferation and apoptosis, which is responsible for the rapid tumor cell proliferation and subsequently, the high aggressiveness and the rapid doubling time (approximately 25 hours) of BL. Furthermore, sporadic BL cases are characterized by mutations in TCF3 gene and its negative regulator ID3 in approximately 70% of cases, in addition to a mutation in CCND3 in 38% of cases . NeverthTreatment of BL depends on brief-duration dose-intensive systemic chemotherapy regimens with multiple factors to be considered including the high proliferation rate of the tumor, age of the patient, and the risk of tumor lysis syndrome. In our case, the patient was treated based on the LMB protocol developed by The Societe Francaise d’Oncologie Pediatrique (SOFP) group which consists of alternating courses of Cyclophosphamide, Vincristine, Prednisone, Adriamycin, and Methotrexate. This protocol demonstrated a well-tolerance and improvement in survival rates among pediatric populations compared to adult groups. In our case, radiologic monitoring demonstrated a complete metabolic response to treatment and a marked improvement in our patient's status. On the other side, a large randomized trial performed by Ribrag et al. revealed an improvement in overall survival among adult and older populations upon adding Rituximab to the short intensive aforementioned regimen. Other treatment regimens include the Magrath protocol developed by Magrath et al. at the National Cancer Institute in the USA. This protocol consists of cyclophosphamide, vincristine, doxorubicin, high-dose Methotrexate (CODOX-M) alternating with ifosfamide, etoposide, and high-dose cytarabine (IVAC). In their original series, Magrath et al. reported similar prognosis rates among pediatric and adult populations. However, higher toxicity and myelosuppression-related deaths were reported. Nevertheless, the optimal chemotherapy regimen is still controversial due to the paucity of clinical trials ,21.4In our case, we aimed to present a unique case that highlights several challenging features including the rare symptoms of gastrointestinal lymphomas, the major role of cytological study of ascites in the primary diagnosis, and the essential role of histological and immunohistochemical examinations in confirming the diagnosis in the absence of molecular techniques.Research studies involving patients require ethical approval. Please state whether approval has been given, name the relevant ethics committee and the state the reference number for their judgement.Not applicable. It's a case report.All sources of funding should be declared as an acknowledgement at the end of the text. Authors should declare the role of study sponsors, if any, in the collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication. If the study sponsors had no such involvement, the authors should so state.None declared. The research didn't receive any funding.Authors' contributions: SI: Drafted the manuscript. SA and IM: Collected the patient's data and participated in revising the article. AG: The pediatric oncologist: was in charge of the patient's treatment and status, provided the data and participated in drafting the manuscript. AD: Participated in the pathologic examination and revising the manuscript. ZA: The guarantor and supervisor, performed and confirmed the pathological diagnosis and critically revised the article. All authors have read and approved the manuscript.Not applicable. It's a case report.Dr. Zuheir Alshehabi.Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.The following information is required for submission. Please note that failure to respond to these questions/statements will mean your submission will be returned. If you have nothing to declare in any of these categories then this should be stated.All authors must disclose any financial and personal relationships with other people or organisations that could inappropriately influence (bias) their work. Examples of potential conflicts of interest include employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and grants or other funding.None declared.


Chondrosarcomas are rare malignant cartilaginous tumor affecting adult and elderly patient. Pelvic and long bones are the most common location. We differentiate conventional chondrosarcoma which arises do novo from preexisting normal bone (primary chondrosarcoma) or within a preexisting lesion such as enchondromas or osteochondromas (secondary chondrosarcoma), Other rare subtypes of chondrosarcoma include clear cell chondrosarcoma, dedifferentiated chondrosarcoma, and mesenchymal chondrosarcoma, which will be considered separately. Although there are diverse clinical presentations depending on the anatomic extend, radiographic features of chondrosarcoma are very characteristic comprising frequently a combination of bone expansion and heterogeneous calcifications. We report a case of a 56-year-old male suffering from fixed mass adhering to the right pubic bone. MRI views showed a lytic lesion of right superior pubic rami, surgical biopsy was in favor of chondrosarcomas, then an en bloc resection was performed following a Pfannenstiel approach without any recurrence after three years of follow-up. •Chondrosarcomas are rare bone tumor of adult above the fourth decades.•They affect principally pelvis, proximal femur and proximal humerus.•Symptoms are essentially pain, rarely palpable mass; However pelvic location can cause gynecological, bowel or bladder problems.•Treatment involves radical resection because of chondrosarcomas resistance to chemotherapy and radiotherapy. Surgical resection has been considered the only curative treatment because of non-response to the chemotherapy and radiotherapy; however, pubic location is very difficult to remove because of depth and complicated anatomy of this region. Survival in chondrosarcoma has remained unchanged over the last years .The aim of this article is to describe the particularity of chondrosarcoma in the Enneking type III location, its symptomatology and surgical management through Pfannenstiel approach.This work was reported in line with the SCARE criteria .2The case involved a 56-year-old male without any personal or familial diseases, was worried by swelling around his right pubic region progressing during one-year, clinical exam noted a painful fixed mass adhering to the pubic bone measuring about 3 cm long and 2 cm wide without any inflammatory signs. Pelvic x-ray  and CT-sMRI images showed the lytic lesion of right pecten pubis with a low intensity in T1, and heterogeneous characteristics in T2-weighted sequences, exerting a mass effect on the bladder which was by elsewhere homogeneous and with thin wall. On the other hand, adjacent acetabular bone and hip joint were not affected .Fig. 2MRSurgical biopsy was performed through direct anterior approach under fluoroscopic control, macroscopic view of the tumor revealed a white cartilaginous constituent and histopathologic study was in favor of chondrosarcoma grade I.On the way to analyze tumor extension, we realized thoracoabdominal CT-scan and a whole-body scintigraphy without any pathological findings. Therefore, an en bloc resection of pubic rami and ischiatic branch was completed through a Pfannenstiel approach with careful soft tissue dissection, hemostasis and pulling laterally of femoral neurovascular bundle. Bone resection was started at the level of the contralateral pubic symphysis, followed by right pecten pubis osteotomy in a propre periacetabular zone cheeked with fluoroscopy, then homolateral ischial tuberosity that was the last osteotomy allowing total tumor removal. Finally surgical mesh was implanted to avoid herniation . Post-opTotal weight bearing was started after three months, and patient was regularly checked clinically and by imaging based on multiple X-rays at 3, 6 months and every year associated with annual pelvic CT-scan. All these exams were normal without detection of any recurrence after three-year follow-up.3Chondrosarcomas are the third most common primary bone tumor after myeloma and osteosarcoma. They occur particularly after 50 years old, with an identical gender distribution, their estimated incidence in the United States population is 1 in 200,000 per year [Chondrosarcomas originate frequently from pelvic girdles and metaphyseal surface of long bones, particularly proximal femur and humerus; however, they can arise at any skeletal site. Conventional chondrosarcomas comprise the largest group, representing 90% of all chondrosarcomas, they can arises do novo from preexisting normal bone (primary chondrosarcoma) or within a preexisting lesion (secondary chondrosarcoma). These secondary tumors are very rare, they have many predisposing factors and diseases like Maffuci syndrome, Ollier's disease in which malignant transformation occurs in 5% of osteochondromas either in multiple or solitary forms ,4. OtherConventional chondrosarcomas are also subclassified by their location in central (intraosseous), periosteal, or peripheral chondrosarcomas .Histologically, chondrosarcomas are made of pure hyaline cartilage differentiation, but they may have myxoid and calcification component. Microscopic appearance varies depending on the histologic grade of the neoplasm which is an important predictor factor of local recurrence and metastasis; therefore, chondrosarcomas are divided into three grades based upon their histopathology findings; grade I define a low-grade with moderate hyperchromatic nuclei, uniform similar to enchondroma, followed by grade II characterized by greater nuclear atypia, then grade III in which tumors are more pleomorphic and atypical than grade II. The fourth group of chondrosarcomas, considered as grade IV; called dedifferentiated chondrosarcoma is a pleomorphic tumor without significant cartilaginous matrix and makes up 10% of all chondrosarcomas .Low grade chondrosarcomas are often surgically cured because are poorly vascularized and there is no tumor cells dissemination. Therefore, in late grades the presence of blood vessels represents a potential risk for pulmonary micrometastases but also for the poor response to chemotherapy .Chondrosarcomas are often asymptomatic but becomes symptomatic when are of large size or in case of anterior pelvis location, they are often manifested by atypical signs, vascular compression, urethral or bladder compression and gynecological disturbances or sciatica in cases of ischium location . Plain xSurgical biopsy and histopathologic analyze confirm the diagnosis of chondrosarcoma, they have usually a typical macroscopic appearance composed of white hyaline cartilage with gritty white calcification. After malignancy finding, a complementary of biologic and radiologic assessment must be completed to evaluate metastatic extension such as bone scintigraphy, chest and abdominal CT-scan.The en bloc resection of pelvic tumors has been classified into 3 types according to Enneking and Dunham; type I represents resection of the ilium; type II involves resection of the acetabulum and type III involves resection of the ilio and ischiopubic branch .A number of surgical approaches to the anterior pelvis allowing Enneking type III resection exist, the most used is ilioinguinal approach, as published in a similar case by RĂZVAN ENE and col . In addiChemotherapy is normally not efficient in conventional chondrosarcoma, but may have a role in dedifferentiated grade, on the other hand, radiotherapy is used for tumors where surgical resection is impossible or limited. Also, there is a new therapeutic method with microwave-induced hyperthermia (MWA) that is still in evaluation and improvement, this procedure helps to reduce tumor proper margins and economize skeletal resection .4Chondrosarcoma of the pubic ramus have many challenging facts, such as complex dissection procedure, because of its specific location neighboring major neurovascular structures and pelvic organs, also limited reconstruction options after ischiopubic bone resection that must be strengthened by surgical mesh. On the other hand, tumors are often asymptomatic and diagnosis is always late making complete surgical resection very hazardous.The study is exempt from ethnical approval in our institution.This is a case report and the patient give us informed consent for publication.All authors disclose that this manuscript didn't received no specific grant from any funding agency.Abderrahim Zaizi and Abdelhay Rabah make substantial contributions to acquisition of data, conception and design, and analysis and interpretation of data.AS. Bouabid and Mostapha Boussouga participate in revising it critically for important intellectual content and give final approval of the version to be submitted.This case report doesn't need to be registered because is not first-in-man.This case report doesn’t need to be registered because is not first-in-man.Abderrahim Zaizi and Abdelhay Rabah are the guarantor of this publication.Patient give us informed consent for publication.Written informed consent was obtained from the patient for publication of this case report and accompanying images.Not commissioned, externally peer reviewed.All authors report no conflicts of interest.


Chondromyxoid fibroma (CMF) is a rare benign bone tumor that typically affects long bones, only 2% of CMFs involved facial bones or skull, zygomatic localization is extremely rare with only 8 cases reported in literature so far.We report a case of 88 old years patient with painful swelling in the right zygomatic around 1 year, progressively increasing in volume, Computed tomography (CT) scan showed an osteolytic lesion in the right zygomatic bone with cortical destruction. Surgical management consisted of bone curettage using intra oral approach, the histopahological findings were in favor of the diagnosis of CMF.CF is a rare bone tumor and represents less than 1% of all bone tumors, the maxillofacial bones are rarely affected, with the mandible as a site of predilection, the zygomatic location is extremely rare. The clinical presentation is not typical, radiologically, the lesion is usually osteolytic with well defined margins.En bloc resection is the gold standard, some authors recommand conservative approach to avoid esthetic and functional sequels.We reported a very rare presentation of CF involving zygomatic bone treated by conservative approach. Chondromyxoid fibroma involving an extragnathic bone in facial skeleton is very rareClinical and radiological presentations are not specificThe classic histological finding of chondromyxoid fibroma is stellate or spindle-shaped cells arranged in lobules with a myxoid backgroundThe surgical managment consisted of en bloc resection or conservative curettage Long bones are the most affected, but occurrence in facial bones or the skull is rare with only 2% of cases [CMF is generally misdiagnosed due to clinical and radiological non specificity .En bloc resection is the gold standard, however some authors recommand conservative curettage with regular follow-up .In this case we report a rare presentation of chondromyxoid fibroma involving the zygomatic bone, to our knowledge only 8 cases of zygomatic CMF have been reported in the literature .This case report has been reported in line with the SCARE Criteria .2A 88 years old patient was admitted to our department of oral and maxillofacial surgery with a painful swelling in the right zygomatic region around 1 year, progressively increasing in volume, there was no clear history of personal or family history of any chronic disease, clinical examination finds a painful, fixe and firm mass of the right zygomatic bone, without skin abnormalities, intraoral examination finds an edentulous patient with a good mouth opening, without intraoral expression of the tumor.The general blood test was normal.Computed tomography (CT) scan revealed an osteolytic lesion involving the right zygomatic bone with cortical destruction, extended to the zygomatic arch .Fig. 1CoFacial MRI with and without contrast was indicated and showed hypointense lobulated lesion of right zygoma on T1 sequence , and hypThe surgical management was performed by a qualified professor with the aid of medical residents, it consisted of bone curettage by intra oral approach under general anaesthesia, the lesion was approached through an upper right vestibular incision.Fig. 3SuThe histopahological examination of the resected specimen showed multiples lobules , with arThe post operative period was uneventful and the patient was discharged from the hospital at the 4th post operative day.The patient is under regular follow-up with no sign of recurrence to date (5th post-operative month).3CF is a rare bone tumor and represents less than 1% of all bone tumors, the tibia and distal femur are the most frequent locations, the maxillofacial bones are rarely affected, with the mandible as a site of predilection .The clinical presentation is not specific, it is characterized by an insidious pain or a progressively growing swelling, occasionally the tumor can be asymptomatic and fortuitously discovered on radiological exams, our case was admitted for local painful swelling.Radiologic findings of CMF are not characteristic, the tumor usually appears as an osteolytic lobulated lesion with well defined margins which confirm the benign nature of the tumor, partial or complete cortical erosion is generally seen. Intralesional calcifications are punctiform and rarely found .Only one case in the literature provide the MRI characterization of zygomatic CMF, the same findings are identified in our case .MRI signal is generally heterogeneous. The lesion, with a non-specific signal, appears in iso- or hypointense T1, in hypersignal T2 and is enhanced heterogeneously after injection. Calcifications and bone trabeculations are hypointense on all sequences. Soft tissue extension is not frequent but possible.a benign tumor characterized by lobules of spindle-shaped or stellate cells with abundant myxoid or chondroid intercellular material separated by zones of more cellular tissue rich in spindle-shaped or round cells with varying number of multinucleated giant cells of different sizes” [Histologically, this tumor is defined by the World Health Organization (WHO) as “t sizes” .CMF is characterized by its lobulated architecture, there are variable presentations, a proportion of myxoid, chondroid and fibrous tissue is arranged in a lobular pattern made with stellate or spindle-shaped cells distributed in a myxoid background.The lobules tend to be hypercellular in the periphery and hypocellular in the center, and are separated by abundant blood vessels, only few tumors show calcifications or mineralization.The differential diagnosis includes chondrosarcoma and chondroblastoma, CMF must be distinguished from this tumors especially from chondrosarcoma because the management of this aggressive tumor is totally different and the resection must be large including free bone rims.In chondrosarcoma the lobules are irregular, calcifications and malignant hyaline cartilage are easly identified. The distinction between chondroblastoma and CMF is not always easy, chondroblastoma is characterized by the presence of chondroblast-like cells and osteoclast-like giant cells with areas of focal calcification .The surgical managment varied from conservative curettage to en bloc resection which constitutes the gold standard, conservative treatment with regular follow-up is recommended by many authors to avoid esthetic sequel of total tumor resection, especially when the lesion is localized in the facial skeleton, however recurrence rate of 25% has been reported after conservative approach .4CMF involving an extragnathic bone in facial skeleton is very rare, this tumor is generally misdiagnosed due to clinical and radiological non specificity, the diagnosis of certitude is histologic, the surgical resection is the gold standard, conservative treatment with regular monitoring is recommended by many authors to avoid esthetic sequel of total tumor resection, especially when the lesion is located in the facial skeleton.Not commissioned, externally peer-reviewed.We have any financial sources.Not required.Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.Dr. Zainab Elzouiti and Dr. Achraf Sbai wrote the manuscript and analysed the literature research, Pr. Adil Eabdenbi tsen, Pr. Fahd Elayoubi supervised the writing of manuscript and performed the scientific validation. Pr Amal Bennani provided the histopathological analysis. All authors read and approved the manuscript.Not required.We have any financial sources.Dr. Zainab Elzouiti and Dr. Achraf Sbai wrote the manuscript and analysed the literature research, Pr. Adil Eabdenbi tsen, Pr. Fahd Elayoubi supervised the writing of manuscript and performed the scientific validation. Pr Amal Bennani provided the histopathological analysis. All authors read and approved the manuscript.The authors have no conflicts of interest to declare.Name of the registry:Unique Identifying number or registration IDHyperlink to your specific registration (must be publicly accessible and will be checked):Dr zainab elzouiti.The authors have no conflicts of interest to declare.


Lipoma is a benign soft tissue tumor that is mostly found in the trunk, however, lipomas of the thumb are rarely reported, around 1% of cases. We report a case of a Saudi male aged 32-year-old who presented with a progressive left thumb swelling for a long time. The aim is to add more cases to the literature and to consider it as a differential. As its name suggests, a lipoma is a benign adipocytic neoplasm that accounts for approximately 16% of soft tissue mesenchymal tumors . It is uA Saudi male patient aged 32-year-old right-handed government employee by profession presented with a progressive left thumb swelling that started 6 years ago. There were no other associated symptoms such as pain nor muscular atrophy. He was diagnosed with a multilocular soft-tissue lipoma on the volar aspect of the left thumb based on magnetic resonance imagining (MRI) findings, he is otherwise healthy and medically stable . He doesFor more investigations, the patient underwent several imaging workups. An MRI of the left thumb was ordered to confirm the findings, which showed a multilocular soft-tissue lesion along the volar aspect of the left thumb. The lesion extends from the level of the mid-distal phalanx to the first metacarpophalangeal joint. The lesion measures 2.2 × 2.8 × 4.3 cm in anteroposterior, transverse, and cranio-caudal diameters respectively. The lesion is surrounding the anterior, medial, and lateral borders of the flexor pollicis longus tendon with no deep extension to the tendon. After contrast administration, there is no definite enhancement. While the tendon of the flexor pollicis longus demonstrates a nonspecific abnormal signal intensity 1 cm above the base of the proximal phalanx. The remaining part of the tendon demonstrates normal signal intensity and thickness Lipomas are benign tumors that account for approximately 16% of soft tissue mesenchymal tumors . They usAttached below is a table summarizing the previous similar cases.The aim of this case report is to add more to the literature by reporting more lipoma cases of the fingers, specifically the thumbs even if it is a rare entity and to consider it as a differential diagnosis, which eases ruling out malignant causes . This ar


A 33-year-old Caucasian woman presented to our attention with generalized abdominal tenderness, abdominal distension, and vomiting. Her last bowel movement was 3 days before admission to the emergency room. Past medical and surgical history was unremarkable. On physical examination, abdominal distension with diffuse tenderness on palpation and a reduction of bowel sounds on auscultation were present. Laboratory studies were normal. An abdominal CT scan showed a closed-loop image in the right iliac fossa lateral to the uterine body, dilated small bowel loops containing air-fluid levels, and a fluid collection posterior to the closed loop Fig. .Fig. 1CTExploratory laparoscopy was performed, identifying the herniation of the penultimate ileal loop through a congenital defect of the right mesosalpinx Figs.  and 3. A2The broad ligament of the uterus is a double-layer fold of peritoneum that attaches the lateral portions of the uterus to the lateral pelvic sidewalls; it is divided into mesometrium, mesosalpinx , and mesovarium. The presence of a defect on the broad ligament can cause chronic pelvic pain, also known as the Allen-Masters syndrome. This type of hernia is very rare, accounting for 7% of all internal hernias and for 0.9% of all small bowel obstructions (SBO).2The pathogenesis of the defects on the mesosalpinx is unknown; it can be congenital or secondary to surgery, pelvic inflammatory disease, or delivery trauma. Clinical presentation may vary from an acute onset with intense abdominal pain due to obstruction and strangulation of the small bowel to a chronic pelvic pain caused by intermittent herniation of the bowel through the defect.3Preoperative diagnosis of internal hernia through a mesosalpinx defect can be very difficult, and even though the usefulness of a CT scan has been reported, it does not always make an accurate preoperative diagnosis .3 Even though laparoscopy has become a standard of treatment in various surgical procedures, its application remains somewhat unclear in the treatment of SBO.Historically the gold standard for treatment of SBO has been open surgery. The first case of internal hernia through the broad ligament treated with laparoscopic surgery was reported by Guillem et al. in 2003 .Internal hernias through the broad ligament defects should be taken into consideration as a differential diagnosis in SBO of mechanical nature, particularly in multiparas women with no previous surgical procedures.Exploratory laparoscopy ought to be kept in mind as a valid tool for treatment and in some cases as a diagnostic tool as well, especially in young women with SBO. During surgery the contralateral broad ligament should always be explored for defects and when present repaired.


Diffuse large B-cell lymphoma (DLBCL) can arise in both lymph nodes and extranodal sites. DLBCLs rarely present in the soft tissue of the upper extremity. We report a case of a 64-year-old woman who presented with a large left upper arm mass and underwent surgical resection under the presumptive diagnosis of sarcoma but the final pathology showed DLBCL. Sarcomas are common malignant tumors of the soft tissue of the extremities, but lymphomas also occasionally present as a soft tissue mass. It is important to keep lymphomas in mind in order to avoid unnecessary surgical excisions. Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL) and accounts for 31% of all cases of NHL in the world . DLBCLs A 64-year-old woman presented to the emergency room with a five-month history of an enlarging mass in the left arm and associated pain and redness for two weeks. The patient had a history of scleroderma for 15 years with five years of interstitial lung disease, calcified nodules and anemia of chronic disease. She experienced six months of increased fatigue, anorexia and unintentional weight loss of 20 pounds without any fevers or night sweats. Physical examination showed a tender, non-fluctuant, 5 cm x 5 cm immobile subcutaneous mass with overlying skin excoriations and minimal surrounding erythema. Multiple old raised calcified skin nodules on the wrist, forearm, elbow and thigh were noted. No cervical, axillary or inguinal lymphadenopathy noted. MRI of the left upper extremity with contrast showed a 4.7 cm x 3.4 cm x 3.6 cm mass in the middle-upper arm deep soft tissue between the biceps and triceps muscle and a second 4.9 cm x 4 cm x 4.5 cm mass in the subcutaneous tissue of the distal posterior part of the arm (Figure DLBCL is extremely uncommon in the soft tissue of the upper extremity and a few cases have been reported in the literature, where they were initially mistaken to be sarcomas and ultimately diagnosed as DLBCL only after biopsy. Mamorska-Dyga et al. reported a case of right arm violaceous fleshy tumor above the antecubital fossa that was initially thought to be a sarcoma based on physical examination and imaging results but after biopsy was diagnosed to be DLBCL . Mayo etSmall blue cell neoplasms encompass a broad spectrum of neoplasms such as lymphoma, mesenchymal chondrosarcoma, rhabdomyosarcoma, small cell osteosarcoma, Ewing sarcoma/primitive neuroectodermal tumor, melanoma, squamous cell carcinoma, olfactory neuroblastoma, pituitary adenoma or plasmacytoma and often pose diagnostic challenges to surgical pathologists. These tumors often share histological and immunophenotypical features and the clinician must depend on tumor site of origin, clinical findings and imaging studies for accurate diagnosis . SarcomaWe present the case of a small blue neoplasm of the upper extremity that clinically appeared to be sarcoma but then was found to be diffuse large B cell lymphoma. Small blue round neoplasm on core biopsy may be seen in many solid tumors and hematological malignancies, and warrants a thorough immunohistochemical and clinical workup to establish the correct diagnosis. On core biopsy, lymphoma may be missed if there is a low index of suspicion. Lymphoma should always be considered in extremity tumors thought to be sarcoma.


Introduction: Primary pulmonary paraganglioma is a rare tumor with few cases reported in literature and unspecific clinical presentation.Case Presentation: A 49-year-old woman presented to our department with an incidental finding of a pulmonary mass at chest X-ray and no associated clinical symptom. The CT scan and the FDG-PET showed mild uptake of contrast, but a definitive diagnosis was only possible after surgery through histopathological examination.Conclusion: Paragangliomas originating in the pulmonary tissue are generally non-functioning masses discovered incidentally in otherwise asymptomatic patients. Surgery appears to be the best treatment option, with only radiologic follow-up necessary afterwards. Primary pulmonary paragangliomas are rare neuroendocrine tumors with few cases reported in the literature. Generally, affected patients show no symptoms and usually discover the mass incidentally during unrelated medical examinations. We report a case of primary pulmonary paraganglioma in an asymptomatic 49-year-old woman.A 49-year-old Caucasian woman, an active smoker (15 packs/year) with an otherwise silent past medical history, presented with a dry cough that worsened in the supine position. While the cough resolved with proton-pump inhibitor (PPI) therapy, suggesting a gastrointestinal nature of the symptom, the patient also underwent a routine chest radiograph. The imaging showed a nodule with a diameter of 3.5 cm in the right lower lobe. Thus, a chest CT scan was performed, which confirmed the presence of a solid lesion with well-defined margins, mild contrast enhancement, and a diameter of 34 × 26 mm in the anterior basal segment of the inferior right pulmonary lobe. The exam also revealed an enlarged axillary lymph node that was later confirmed to be inflammatory in nature. To further characterize the lesion, a PET-CT scan with an injection of 18F-fluorodeoxyglucose (FDG) was done; the images showed mild uptake at the level of the nodule in the right lower lobe (with a maximum SUV of 2.8) , 2, suggParagangliomas are rare neuroendocrine tumors that arise from the chromaffin cells of the extra-adrenal autonomic paraganglia . Their iMost paragangliomas appear to be sporadic , with thExtra-adrenal paragangliomas are more commonly silent, and if they do present symptoms, these are mostly related to the mass effect at the site of the tumor. Primary pulmonary paragangliomas are rare even among the extra-adrenal paragangliomas, with <30 cases reported in literature . The majThe differential diagnosis of primary pulmonary paraganglioma should include many different conditions, including pulmonary carcinoma, pulmonary tuberculosis, pulmonary mycosis, either round or organizing pneumonia, inflammatory pseudo-tumors, and metastatic lung cancer .Paragangliomas are best evaluated at a contrast-enhanced CT scan, where they show enhancement in the arterial phase . HoweverThese tumors are slow growing and usually benign; however, because they do have a tendency for expansive growth and there are cases reported of low-grade malignant lesions , 9, surgIn regard to the primary pulmonary paraganglioma, patients have mostly been treated surgically, with either local excision or a lobectomy, depending on the extension of the lesion. No recurrence or metastatic disease has been reported in any of the known cases even though no chemo or radiotherapy was performed afterwards , 7. It aThis report presents a case of a primary pulmonary paraganglioma, a rare tumor with only a few cases reported in the literature , 7, 8. AThe original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.All authors participated equally in the case and in the writing of the manuscript.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.


Tongue hemangioma is a rare case of vascular tumors that causes symptoms such as pain, bleeding, difficulty in chewing, speaking, and breathing. We report a case of an oral lobular capillary hemangioma on the dorsal surface of the tongue treated with surgical excision and postoperative application of propolis extract. The difficulty in diagnosing oral lobular capillary hemangiomas may potentially arise due to the confusion with other similar conditions. Histopathological assessment is still the most accurate and satisfactory means of diagnosis. They commonly occur in the head and neck region. In the oral cavity, hemangiomas can cause several symptoms such as pain and bleeding, and in more serious cases, can negatively impact the quality of life by hampering the ability to chew, speak, and breathe. Hemangiomas are histologically categorized into three types, namely capillary, cavernous, or mixed, where about 80% occur as single lesions and 20% as bilateral lesions. The occurrence in male‐to‐female patient ratio is approximately 1–3. They are mostly found on the cheeks, upper lip, and eyelids, and rarely in the oral cavity, especially on the tongue.Propolis is a beehive‐derived natural product that has been shown to have anti‐inflammatory, anti‐nociceptive, and wound‐healing properties.The present case report describes a case of a female patient who had a growth on her left dorsal surface of the tongue which was subsequently diagnosed as an oral lobular capillary hemangioma based on the International Society for the Study of Vascular Anomalies (ISSVA) Classification of Vascular Anomalies.2A 63‐year‐old female patient in Medan, Indonesia, came to a dental clinic with a primary complaint of a lesion on the left dorsal surface of the tongue, which caused the difficulty in chewing and speaking. The lesion was of the size of a pea when the patient first noticed it but had grown to attain the size of 8 × 7 × 3 mm over a period of 2 weeks. The lesion had started to bleed when she was presented to the clinic. The patient's medical history was unremarkable. She mentioned that she previously went to a general practitioner and was prescribed amoxicillin, dexamethasone, and mefenamic acid. She consumed the medications for 5 days and reported no improvement. Intraoral examination revealed a single, spherical‐shaped, and reddish pink lesion. The lesion had a distinct border and irregular surface Figure . The surThe management of the lesion was a surgical excision, which was carried out under local anesthesia. A thread was tied around the base of the lesion. The lesion was then stretched upward to facilitate accessibility. It was subsequently excised out, and interrupted sutures were placed Figure . During The histopathological section of the specimen showed the characteristics of an ill‐defined intramuscular nodule with a pattern that was consistent with increased vascularity and inflammation. It was dominated by the appearance of epithelioid cells where the nuclei were in normal form. The predominant sub‐epithelium consisted of tubular, proliferating blood vessels where the lumen was partially filled with red blood cells. The stroma was composed of fibrous connective tissue within the normal range which had a moderate amount of inflammatory white blood cells infiltrate. No signs of malignancy were found in the specimen. The histopathological diagnosis was given as lobular capillary hemangioma by a qualified pathologist Figure .3The difficulty in diagnosing oral hemangiomas may potentially arise due to confusion with other similar conditions, such as other benign, pre‐malignant, and malignant tumors. Additionally, vascular anomalies of head and neck have historically confused clinicians due to the inconsistent nomenclature.The oral lobular capillary hemangioma lesion in the present case appeared to be relatively benign and non‐life threatening. However, the patient complained about bleeding and having difficulties in chewing and speaking. Therefore, simple excision was ordered under necessary precautions. Where possible, laser and cold surgeries can also be considered as these surgical methods have been shown to be effective and result in less postoperative complications such as less bleeding.Propolis was considered as an adjunctive treatment in the present case because of its antimicrobial, anti‐inflammatory, anti‐nociceptive, and wound‐healing properties. The application of propolis was well‐suited to the present case. Propolis has been demonstrated to be useful in treating many oral diseases and disorders in various clinical trials. Several blinded, randomized, placebo‐controlled studies demonstrated the efficacy of propolis in preventing and reducing the severity of oral mucositis.More importantly, propolis has also been shown to promote faster surgical wound healing in oral cavities. Lisbona‐Gonzales et al.In the present case, the patient was ordered to apply the commercially available hydroglyceric extract of Indonesian stingless bee propolis on the surgical wound three times a day. She noted the lack of pain in the surgical wound to the point that she opted to not consume the prescribed mefenamic acid. She also had a noticeable improvement in terms of wound healing within a week after the surgery. Propolis appears to be a suitable adjunctive treatment for oral application in the postoperative recovery. The present case was followed up for 6 months after the surgery. The wound healing was complete, and no recurrence was noted. Caution must always be applied in utilizing any bee product as an adjunctive therapy as allergic reactions might occur.4Capillary hemangiomas are infrequently seen on the tongue mucosa and can easily be confused with other lesions such as malignant tumors. Therefore, appropriate diagnoses and management by oral maxillofacial and dental surgeons are critical. Histopathological assessment remains the most accurate and satisfactory means to resolve ambiguity. In addition, propolis has been shown to have potent antimicrobial, anti‐inflammatory, analgesic, and wound‐healing properties. The present case demonstrates the potential use of propolis as an adjunctive treatment for postoperative application in the oral cavity.All other authors declare no competing financial interests and no conflict of interest.S.S. and F.Z. investigated the study and wrote original draft. M.R. involved in review and editing. All authors approved the final manuscript.Written patient consent has been signed and obtained from the patient.


If unrecognized, this delayed hematoma can lead to devastating consequences.A 30-year-old patient with no past medical history, was brought to the emergency after a severe brain injury secondary to an aggression, Glasgow coma scale was 6 (E1V1 M4) with a left anisocoria. The CT scan revealed a left acute subdural hematoma with midline shift superior than 10 mm, and a non-surgical contralateral EDH was also identified. The patient was operated on urgently. Post-operatively, the pupils became equal sized and reactive. A right anisocoria was noticed 12 h later, with a large contralateral EDH on CT scan associated to a gross midline shift. A second operation was performed immediately with a good recovery and the patient was extubated one week post-operatively.., however it's rare with only 100 cases, including the present one reportedThe most common surgical complications after a decompressive craniectomy for an acute subdural hematoma noted in literature are surgical site herniation, post-operative infections, epilepsy, and subdural effusions with or without hydrocephalus. Contralateral epidural hematoma (EDH) after decompressive craniectomy is also documented  Delayed contralateral EDH after decompressive surgery should be anticipated in the presence of contralateral skull fracture and/or intraoperative brain swelling and immediate postoperative scan is indicated. Early detection of this fatal complication and prompt treatment may improve the poor outcome in this group of patients. •This paper presents an A 30-year-old patient, was brought to the emergency after a severe brain injury secondary to an aggression, Glasgow coma scale was 6 with a left anisocoria. The CT scan revealed a left acute subdural hematoma with midline shift superior than 10 mm, and a non-surgical contralateral EDH was also identified. The patient was operated on urgently.•Post-operatively, the pupils became equal sized and reactive. A right anisocoria was noticed 12 h later, with a large contralateral EDH on CT scan associated to a gross midline shift. A second operation was performed immediately with a good recovery and the patient was extubated one week post-operatively.•The most common surgical complications after a decompressive craniectomy for an acute subdural hematoma noted in literature are surgical site herniation, post-operative infections, epilepsy, and subdural effusions with or without hydrocephalus. Contralateral epidural hematoma (EDH) after decompressive craniectomy is also documented, however it's a rare with only 100 cases, including the present one reported.•Ninety-nine cases of contralateral epidural hematoma after decompressive craniectomy have been reported, which have been reviewed and summarized in this article.•Delayed contralateral EDH after decompressive surgery should be anticipated in the presence of contralateral skull fracture, and intraoperative brain swelling. In the presence of this condition, immediate postoperative scan is indicated so that early detection of this fatal complication can be made allowing for prompt treatment, which may improve the poor outcome in this group of patients. Contralateral epidural hematoma after decompressive craniectomy due to traumatic brain injury is an uncommon event. Only few cases are reported in literature. Spontaneous evolution can be fatal .Finally, we discussed this rare condition considering the previously reported cases in order to establish a therapeutic management.We report the case of a patient operated on for a contralateral epidural hematoma after decompressive craniectomy (EHADC). We conducted a systematic literature review to aggregate all previously reported EHADC. 22.1clinicaltrials.gov databases were searched using the following search algorithm: “contralateral epidural hematoma” and “decompressive craniectomy” taking into consideration all articles up to June 2021. During the review process we searched for all reported cases with epidural hematoma after contralateral decompressive craniectomy whether the epidural hematoma was surgical or not, instead of the search for “surgical epidural hematoma” which could have reduced the field of research with possible loss of cases. The inclusion criteria considered all studies reporting single or multiple cases of epidural hematoma after contralateral decompressive craniectomy in adult patients. All titles and abstracts were double-checked by two neurosurgeons (AL and AR) to exclude all non-pertinent studies: those reporting subdural contralateral to decompressive craniectomy, those reporting pediatric patients, articles without full text available, articles not in English. The references of the selected studies were checked to find all possible related articles.The PubMed/Medline, Google Scholar, Cochrane library and This case has been reported in line with the 2020 SCARE guidelines [idelines 3drug history, personal or family, no surgery or psychosocial history, was brought to the emergency after a severe brain injury secondary to an aggression, Glasgow coma scale (GCS) on arrival was 6 (E1V1 M4) with a left anisocoria. CT scan revealed a left acute subdural hematoma (ASDH) with midline shift superior than 10 mm. A small parieto-temporal epidural hematoma and linear fracture of the contralateral side were also identified . The origin of bleeding was a cortical vein and cortical contusions. The bone flap was sacrificed because of the brain swollen. Post-operatively, the patient was ventilated overnight and was assessed. Pupils became equal and reacting to light. After twelve hours right anisocoria was noticed. CT scan showed a large contralateral EDH with gross midline shift . In admission the initial GCS was less than 8 in 82 patients, between 9 and 12 in 15 patients and only 2 patients above 13. CT scan revealed an acute SDH in all cases associated with non-surgical contralateral EDH in 8% (8cases).Intraoperative brain swelling after contralateral hematoma evacuation was noted in 88% of cases. CT scan was performed immediately in 40% because of the immediate postoperative worsening or intraoperative swelling, less than 6 hours in 16% of cases, between 6 and 12 hours in 19%, between 12 and 36 hours in 14.7%, and above 36 hours in 11% of cases. The mean hours of the lucid interval were 16.67 hours.All patients were operated urgently, evacuation of the hematoma and hemostasis was performed, skull fracture was noted in 92% of cases.Concerning the prognosis, we observed 28% of deaths GOS 1 , and 72% of survivors among them 35% of patients with good outcome (GOS4 and GOS5) while poor outcome (GOS 3 and GOS 2) was observed in 37% of patients.4The most common surgical complications after a decompressive craniectomy for an acute subdural hematoma noted in literature are surgical site herniation, post-operative infections, epilepsy, and subdural effusions with or without hydrocephalus. Contralateral epidural hematoma (EDH) after decompressive craniectomy is also documented ,15, howeIn literature, the longest period for an occurrence of the enlargement of a delayed contralateral EDH following the initial surgery is 14 days, as reported by C.-H. Su et al. . The meaVarious hypotheses have been proposed to explain the mechanism of delayed contralateral EDH, one of them being the loss of the tamponade effect on the bleeding source. Mass effect from the contrecoup acute subdural hematoma and contusions probably increases the intracranial pressure and produces a tamponade effect on the contralateral EDH, this would prevent the development of the EDH until performing decompressive craniectomy on the contralateral side, which would reduce the intracranial pressure and relieve the hemostatic tamponade allowing the development of the epidural hematoma . Doubts In many reported cases as was also seen in our case, patients presented with delayed neurological deterioration with intraoperative brain swelling. It may be the early warning sign of this devastating condition. This brain swelling may not represent cerebral edema or hyperemia that is often associated with diffuse traumatic brain injury but it might reflect the shifting of brain in response to the mass effect of the evolving contralateral EDH. Brain swelling was noted in 88% of the reported cases. Therefore 12% of reported cases of contralateral EDH had no brain swelling . A skullPatients with severe head injury (GCS <8) had poor outcome. However, we think that EDH evacuation still has its potential value in improving the prognosis in these patients, unless they have expressed signs of brain stem failure. EDH should be evacuated promptly if it causes significant mass effect and give these patients the chance to improve .5The most important limitations of this study is the retrospective nature, and the lack of clinical details for statistical analysis. No causal conclusion can be directly made and further confirmatory analyses are required.6Delayed contralateral EDH after decompressive surgery should be anticipated in the presence of contralateral skull fracture, and intraoperative brain swelling. In the presence of this condition, immediate postoperative scan is indicated so that early detection of this fatal complication can be made allowing for prompt treatment, which may improve the poor outcome in this group of patients.The authors declared that this study has received no financial support.Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient.Ethical approval has been exempted by our institution.None.Please specify the contribution of each author to the paper, e.g. study design, data collections, data analysis, writing. Others, who have contributed in other ways should be listed as contributors.Abdelkouddous Laaidi: writing the paper.Abderrahmane Rafiq: Corresponding author and writing the paper.Yassine Tahrir: study concept.Said Hilmani: Correcting the paper.Abdelhakim LAKHDAR: Correcting the paper.None.None.RAFIQ ABDERRAHMANE.Not commissioned, externally peer-reviewed.The authors declare having no conflicts of interest for this article.


A 17-year-old female presented to our hospital complaining of bloody diarrhea 4-6 times per day for the past month. She was a known case of inflammatory bowel disease noncompliant to her medications. Abdominal computed tomography revealed an unusually dilated mass in the retroperitoneum at L2 vertebral level connecting the lumbar and left renal veins. The renal artery was visualized separately, and a diagnosis of communicating vein varicosity was made. This lesion can be misleading on imaging, hence our aim to disseminate our findings to practicing radiologists. The differential diagnosis of these lesions include retroperitoneal lymphadenopathy, renal artery aneurysms, and testicular cancers causing retroperitoneal lymphadenopathy. To our knowledge, this is the first case to be reported in association with inflammatory bowel disease, perhaps providing a novel insight into the pathogenesis of this lesion that has not been considered in the contemporary literature. Inflammatory bowel disease (IBD) is characterized by an idiopathic chronic inflammatory state of the gastrointestinal (GI) tract and encompasses 2 distinct disease states: ulcerative colitis (UC) and Crohn's disease (CD). The clinical presentation of UC and CD overlap, the major difference between the 2 being the lack of small bowel involvement in UC Numerous studies have confirmed the elevated risk of venous thromboembolism (VTE) in IBD patients. The risk of thrombosis in IBD patients is 1.7 times higher compared to controls Here, we describe the radiologic detection of varicosity in the communicating vein between the left renal vein (LRV) and left ascending lumbar vein (LALV) in an inflammatory bowel disease patient, a novel association with IBD. This finding is important both radiologically and surgically, and we hope these specialties themselves with this finding.An 17-year-old female, known case of IBD, presented with the chief complaint of bloody diarrhea 4-6 times per day for the past month. Oral steroids and 5-aminosalicylic acid had previously been prescribed for the UC, and the patient was asymptomatic until independently discontinuing both medications, which caused symptoms to flare up.She was referred for radiologic assessment of her IBD. However, contrast-enhanced computed tomography (CT) scan of abdomen and pelvis also revealed an unusual aneurysmal dilatation of a vascular channel, measuring 13 × 15 × 15 in the transverse, anteroposterior, and craniocaudal dimensions, respectively, in the left paravertebral gutter at L2 vertebral level . On sagiWe continued our patient on conservative management with 5-aminosalicylic acid for the IBD and advised her for regular follow-ups.The left ascending lumbar vein (LALV) courses between the psoas major muscle and lumbar vertebrae, connecting the common iliac vein, 4 lumbar veins, vertebral venous plexus, and iliolumbar veins before draining into the azygos/hemiazygos venous system. The LALV has also been found to communicate with the left renal vein (LRV) with an estimated prevalence of 30%-46.4% on cadaver studies Although rare, this finding is of utmost importance to surgeons performing renal, aortoiliac, and other retroperitoneal surgeries, as unawareness could lead to accidental injury and life-threatening retroperitoneal hemorrhage ,10. ThisThe first reported case was a 34-year-old man who underwent orchiectomy for testicular cancer, making para-aortic lymphadenopathy a pitfall in diagnosis since testicular carcinomas exhibit lymphatic spread to the para-aortic nodes Since varicosities, by definition, evolve secondary to valve incompetency or increased backflow following obstruction, potential causes in our case might include pathologies such as thrombi within the LRV or inferior vena cava, leading to valvular incompetency and consequent retrograde flow into the communicating vein. The nutcracker syndrome, characterized by compression of the LRV between the superior mesenteric artery and abdominal aorta, obstructs the LRV. These more untoward etiologies must be excluded when evaluating such lesions. In the case presented here, the LALV-LRV varicosity might have developed as a consequence of IBD, but these postulations are purely theoretical. Theoretically, IBD, like other chronic inflammatory conditions, raises the possibility of systemic thrombotic events by precipitating a hypercoagulable state. Indeed, IBD is an independent risk factor for venous thromboembolic events No objective direction currently exists on the management of this finding. Since these varices are predominantly asymptomatic, a conservative approach is recommended, with definitive treatment aimed at resolving the underlying cause – likely IBD in this case. With the aforementioned hypothesis that LALV-LRV varicosities are a manifestation of underlying inflammatory states, clinical and radiologic evaluation for such conditions should include these etiologies. Also, treating the inflammatory state may constitute a valid therapeutic strategy.We reported varicosity in the LRV-LALV communicating vein in an IBD patient, which from our literature search has not been reported previously. We encourage practicing radiologists to acquaint themselves with the imaging approach to these lesions to prevent the potentially disastrous complications of misdiagnosis. The differential diagnosis of these lesions includes testicular carcinomas, renal artery aneurysms, and other retroperitoneal mass lesions, such as lymphadenopathy. All previous cases reporting an LRV-LALV communicant vein varicosity suggested an idiopathic etiology, but our case may provide a clue to the underlying pathogenesis of this finding.


Amyand's hernia (AH) is a form of inguinal hernia which is consider as very rare and this type of hernia occurred up to 1% of all inguinal hernia cases. In this type of inguinal hernia, the content of hernia sac is appendix. Most patient with AH often remains asymptomatic and diagnosed intraoperatively. The diagnosis is challenging, since needs a high index of suspicion and imaging is key. Surgery is the mainstay management. We report a case of Amyand's hernia that was managed operatively in our medium complex public institution.A 28 year's old man with normal body mass index (BMI) who had a history of right-side reducible linguino-scrotal swelling for 8 years, was admitted for elective right inguinal hernia repair. Two weeks back before admission, he noticed that swelling was slightly painful. Ultrasound of the abdomen reported normal findings. There was no history of abdominal pain and vomiting. Laboratory parameters were within normal limit. So, with a diagnosis of right sided partially reducible, incomplete, and indirect inguinal hernia, patient was operated for open hernia repair surgery, intra operatively we found dense adhesions within the sac, adhesions were released which revealed herniation of appendix into the inguinal canal. Appendix was mildly congested without gross evidence of inflammation. Hence, in view of noninflamed appendix, preperitoneal mesh (polypropylene) hernioplasty from Lichtenstein tension-free mesh repair was performed with appendicectomy. Postoperative period was uneventful, patient discharged at second day.Amyand's hernia is very uncommon and characterized by the presence of the appendix in the hernia sac and it is 0.4–1% of all inguinal hernia cases, literature review also showed that incidence of Amyand's hernia is very rare, whereas only 0.1% of cases complicate into acute appendicitis due to late presentation and missed diagnosis.Amyand's hernia (AH) makes up only a small proportion of most inguinal hernia cases, and its diagnosis is usually based on incidental finding intra-operatively. This condition may remain asymptomatic and behave like a normal inguinal hernia. Management of this type of hernia should be individualized according to appendix's inflammation stage, presence of abdominal sepsis and co-morbidity. With this approach it enables surgeons to manage more variations of Amyand's hernia. Laparoscopy for dealing Amyand's hernia is frequently diagnostic as well as therapeutic. Inguinal hernia sac contains any abdominal organ including small or large bowel. Amyand's hernia is a very rare and uncommon form of inguinal hernia where the vermiform appendix is present in hernia sac. The incidence of having abnormal appendix within the hernia sac varies from 0.5% to 1% The entity of Amyand's hernia has an incidence of 1% and is complicated by acute appendicitis in 0.8to 0.13% of case, whereas only 0.1%of cases complicate into acute appendicitis Incarcerated bowel containing hernias are the leading cause of mechanical bowel obstruction. Prompt surgical intervention is indicated due to increased changes of strangulation It affects both adults and kids along with also the contents of the gut sac might change from Cecum, liver, uterus, fallopian tube, omentum, or some Meckel's diverticulum along with an appendix. It received its name since the first man to report that the existence of perforated appendix was Claudius Amyand in 1735 The surgeon might encounter unusual signs, like a Vermiform appendix partially or fully found in the hernia sac, inflamed or non-inflamed or adherent into the sac walls. An inguinal hernia does not specific for age sex or group; as reported in literature, cases of Amyand's hernia found in the neonatal period for 9-2 decades, although left-sided Amyand's hernia is reported as well Losanoff along with the Bass-on classification System which clarifies the advocated surgical treatment selections for different kinds of Amyand's hernia. This approach will enable surgeons to recognize and manage more variations of Amyand's hernia 22.1A 28-year-old male with normal BMI presented to a surgical department clinic with complaint of a pain and swelling in the right inguinal region for the past two weeks initially it was small and gradually increase in size and associated with pain. This swelling was present for the last 8 years causing no symptoms, so the patient did not seek any medical advice for it. There was no history of abdominal pain and vomiting. The patient is an engineer by profession, suffering from Hepatitis C, for which he took treatment.2.2On examination, there was an indirect right inguinal hernia incomplete, and reducible type with positive cough impulse.2.3Patient was diagnosed clinically as indirect inguinal hernia. Hematological workup was within normal limits.2.4A Preoperative diagnosis of right inguinal hernia was made and was planned for hernia mesh repair, during surgery under spinal anesthesia, the hernia sac was found to contain an appendix. The appendix was slightly congested, not inflamed but there were dense adhesions within the sac and so adhesiolysis and appendectomy along with excision of the sac and Lichtenstein mesh hernioplasty was done. The postoperative period was uneventful. The patient postoperatively received fluid therapy, Oral fluids were administrated after 6 h along with soft diet and was discharged on postoperative day 2.2.5The patient was discharged on second post-operative day with complications on oral anti-biotics and followed up after one week of surgery , Fig. 3.3Amyand's hernia (AH), the disease has been originally clarified and handled in 1735 in Claudius The Choice to keep or remove the appendix relies upon the individual's era, endurance, and hazards of expanding acute appendicitis. The young people include a much greater chance of afflicted by acute appendicitis in contrast for this middle era or elderly men and women In terms of inguinal hernia detection, the initial use of ultrasound possibly followed by CT, represents a sensitive and cost-effective progression for the evaluation of the patient with a clinical history suggestive of a hernia, enables the possibility of differentiating affiliated intra-abdominal organs Therefore, an appendectomy had to be performed to enable structural reduction of the hernia despite the absence of visible signs of acute appendicitis Considering ultrasound imaging in a large-sized inguinal hernia even if it is reducible may be beneficial in reducing the complications. Early analytical imaging use may confound an instant pre-operative identification of AH. Right-sided Amyand's hernias occur more often than left due to the anatomical location of the appendix on the right. Left-sided Amyand's hernias are very rare The mainstay management is the open surgery, but in recent years the laparoscopy approach is summing cases; giving benefits of shorter hospital stay, faster recovery, less postoperative pain, among others The underlying mechanisms that cause acute appendicitis within an Amyand's hernia include decrease blood supply of the appendix due to adhesions that may cause non-reducibility of the hernia and compression in the external ring originating from increases in intra-abdominal pressure The Losanoff and Basson's classification presented above offer satisfactory guidance system for management of Amyand's hernia Definitive preoperative diagnosis poses a challenge due to indistinct clinical signs and symptoms. We report a case that was managed by open surgery in our medium complex public institution with review of the literature. This case report is in line with SCARE 2021 guidelines.4Amyand's hernia is a rare presentation of inguinal hernias. In the clinical setting of an incarcerated complicated or strangulated inguinal hernia, the initial approach should consider imaging studies; USG or CT can guide the surgical plan, and enables the possibility of identifying involved intra-abdominal organs. Literature review recommends reducing the hernia content and perform no tension hernia repair, In the cases where an inflamed, suppurative or perforated appendicitis were encountered, no prosthetics material should be used because of the increased risk of surgical site infection.in case of clinical suspicion of Amyand hernia is diagnostic laparoscopy which is useful approach in all forms of incarcerated hernias to assess contents and avoid unnecessary laparotomy We are still conservative about the application of mesh in hernia sac with acute appendicitis, which requires additional large-scale study to determine whether mesh repair will increase the risk of infection or not.No ethical approval is required. Our institution does not demand ethical approval for case reports, as these projects are not investigational.None declared.Hina Khalid, conceptualization, data curation, writing – original draft.Naveed Ali khan, review & editing.Munira Abdul Aziz, review & editing.Hina KhalidWritten informed consent was obtained from the patient.Not commissioned, externally peer reviewed.There are no conflicts of interest.


The subcutaneous localization of the hydatid cyst in the abdominal wall is rarely encountered particularly in the pediatric population and is sometimes difficult to diagnose preoperatively. Here, we report the case of a 6-year-old boy who presented with two isolated episodes of low abundant hemoptysis and in whom a mass on the right lumbar region already considered as a lipoma was studied. Laboratory and radiological examinations were requested and the parietal cyst was surgically managed. The macroscopic and the pathological examination confirmed the diagnosis of the hydatid disease and helped in identifying the nature of the thoracic lesion that disappeared spontaneously after two episodes of hydatid vomiting. Hydatid cyst should be considered as a diagnosis for any masses of the abdominal wall. Moreover, biopsy and partial resection of the mass must be avoided. Echinococcus cestodeworms are the causative agents.Echinococcus granulosusand is the most common presentation.Echinococcosis or hydatid disease is defined as a parasitic zoonosis in which theWe report a rare case of a child with subcutaneous hydatid cyst located in the lumbar region of the abdominal wall that its diagnosis was challenging in our clinical setting. The patient was successfully managed in our tertiary academic care center.A 6-year-old boy from a rural region was referred to our department of pediatric surgery by the family physician because of two isolated episodes of low abundant hemoptysis with an interval of 6 months. The child was apyretic and in a good general condition. There was no history of surgery, abdominal trauma, vomiting, abdominal or thoracic pain, hematologic disorders, or infectious diseases. Moreover, the patient had no family history of similar cases. Pulmonary vesicular sounds were decreased during auscultation of the right apical thoracic region. On the abdominal examination, a mass on the right lumbar region of 3*1.5 cm (cm) in diameter, firm in consistency, painless, and not fixed to the deeper tissue or to the overlying skin was found that was normal . It hasHydatid disease remains endemic in Africa as well as in other regions worldwide particularly in South America, Mediterranean countries, Central Asia, and China.The liver is the most affected organ since it is the first and the largest filter of parasitic embryos coming from the intestine through the portal system.The hydatid cyst is generally asymptomatic or minimally symptomatic.Serological testing can confirm the diagnosis, but its accuracy is not high.Chest X-ray, ultrasound, CT, and magnetic resonance imaging may be necessary depending on the organ affected and the stage of the disease to confirm the diagnosis.Lipoma, which was the diagnosis considered before the presentation of the patient to our department, the sebaceous cyst, and abscess might mimic a hydatid cyst of soft tissues.The available therapeutic options to clinicians in term of soft tissue hydatid disease include surgery, chemotherapy, and puncture/aspiration/injection/reaspiration (PAIR).The diagnosis of hydatid cyst with unusual localization remains challenging even in endemic areas of the disease, but it should be kept in mind to avoid any biopsy or partial resection. A total surgical resection of the cyst is the treatment of choice, which should be combined to benzimidazole drugs to prevent possible recurrence. Other localizations particularly in the liver and lungs should be systematically searched.


A 7-year-old castrated male Labrador retriever was referred for evaluation of progressive hind limb paresis of 4 weeks’ duration. On computed tomography and magnetic resonance imaging examination, masses were found in several regions including the lung, right kidney, and peritoneum. Additionally, an extradural mass at the region of T13–L1 was identified, which is assumed to related to the chief complaint, progressive hind limb paresis. With the consent of the owner, a dorsal laminectomy was performed to remove the mass and surrounding tissues for the palliation of the hind limb paresis. Hematoxylin and eosin staining and immunohistochemical examination revealed the mass to be consistent with an undifferentiated (high-grade) pleomorphic sarcoma. The patient presented with recurrence of the hind limb paresis, respiratory discomfort, and urinary incontinence. The owner declined treatment and the dog was euthanized. Systemic metastasis was confirmed on postmortem microscopic examination. To the authors’ knowledge, this is the first report describing multiple undifferentiated high-grade pleomorphic sarcoma with extradural involvement developing into the vertebral canal through the intervertebral space, resulting in spinal damage, in a dog. Undifferentiated pleomorphic sarcomas (UPSs), previously known as “malignant fibrous histiocytomas” (MFHs) are a group of soft tissue sarcomas reported in several species including humans, dogs, and cats ,2,3,4. AAccording to the human literature, UPSs are known as an expansile tumor, usually found at the retroperitoneum or extremities. They may infiltrate to surrounding tissues. Metastasis to lung, liver, lymph node, and bone has been also reported . In veteAlthough extradural UPSs have rarely been reported in the human literature, to the best of our knowledge, they have not been reported in veterinary medicine to date. This case report describes multiple UPS with extradural involvement and the surgical management of an extradural UPS, which was differentiated from other malignant sarcomas using immunohistochemical (IHC) staining, affecting the spinal cord in a dog. Furthermore, the current study reports on the systematic metastasis identified on postmortem microscopic examination. A 7-year-old castrated male Labrador retriever dog presented with progressive ataxia and hind limb paresis of 1 month duration. On physical examination, the dog was bright, alert, and responsive but had an inability to climb stairs, bilateral hindlimb lameness, and mild bilaterally symmetric muscle atrophy of the gluteal, quadriceps, and caudal thigh muscles. Neurologic examination indicated that the forelimbs were normal, but postural reactions of the hindlimbs, including the proprioception position, hopping, hemistanding, hemiwalking, and extensor postural thrust, were decreased . Spinal Thoracic radiography revealed a small, round soft tissue opacity in the right middle lung lobe A and a lMagnetic resonance imaging  was performed before and after intravenous administration of a contrast medium . The mass was identified at the bone lysis region on a transverse T1-weighted image A and on The dog was premedicated with butorphanol  and midazolam  before anesthetic induction with propofol . After intubation, general anesthesia was maintained with isoflurane  with oxygen. With the patient positioned in sternal recumbency, a dorsal midline incision was made under C-arm guidance to accurately expose T13 and L1. A dorsal laminectomy was performed for tumor resection. A rongeur was used for removal of the dorsal lamina, a portion of T13, the L1 spinous process, and the mass surrounding the spinal cord. The remaining dorsal fragment of the vertebral arch was removed with a pneumatic high-speed drill  and 3 mm round bur  for exposure of the spinal cord. The removal of the mass with surrounding tissue was continued until the spinal cord was exposed. Skin and soft tissue were closed in a routine manner. Recovery from anesthesia was uneventful. A constant rate infusion of butorphanol  was administered after surgery. Postoperative rehabilitation included passive joint ROM exercises of the hindlimbs (starting day 4 and performed 3 to 4 times per day.).The tumor was identified within paravertebral soft tissue and extending into the vertebral canal. The mass was directly attached to the dura mater. The surgically removed tissue samples were fixed in 10% neutral formalin and then routinary processed for histology. From samples paraffin blocks, 4 micron thick were obtained and stained with hematoxylin and eosin (H&E). Microscopic examination revealed the extradural mass invading adjacent tissue structures, causing necrosis. Multifocal areas of mineralization also present within the mass. A haphazard, storiform, and fascicular arrangement of the pleomorphic sarcoma was identified. A. The ma2O2. Each marker was visualized using vectastain ABC kit . The signal was visualized with vector SG  and counterstained with nuclear fast red solution . Tumor cells showed strong positive staining for vimentin  as a mesenchymal cell marker, desmin  as a smooth and striated muscle cell marker, alkaline phosphatase  as an osteosarcoma marker, cytokeratin 7  as an epithelial marker, S-100  as a perineural cell marker, and nestin  as a neural cell marker. Sectioned slides were hydrated through gradient alcohols. Heat-mediated antigen retrieval was performed using microwave in citrate buffer (pH 6.0). Endogenous peroxidase was blocked using 3% Hvimentin C, while vimentin D. Based Proprioception of the left hindlimb returned to normal on the third day after surgery. Gait improvement was identified 4 days after surgery. Chemotherapy was strongly recommended. However, the owner declined additional treatment. The dog was discharged 4 days after surgery and stitches were removed 14 days after surgery. By 6 weeks postoperatively, proprioception of the right hindlimb was improved. Three months after surgery, hind limb paresis recurred, and the patient had difficulty in in breathing and urinary incontinence. Thoracic radiography revealed an enlarged nodule at the right middle lung lobe compared to initial presentation. The dog was euthanized and a complete postmortem examination was performed with the consent of the owner. Recurrence of the mass was identified between the T13 and L1 A. Among Systemic masses including the lung, kidney, hilar lymph nodes, skin, urinary bladder, and peritoneum were confirmed as UPC through H&E and IHC staining, using vimentin antibody. Tumor growth was intensive. The surrounding lung parenchyma was severely inflamed and congested A. In theThe term MFH has been used since the early 1960s to describe a group of tumors with a mixed histiocytic and fibroblastic phenotype. However, with the advent of IHC staining and electron microscopy, as well as cytogenetic and molecular diagnostic studies, MFH is no longer the correct term ,3 becausUPS in animals has been reported previously in various species including dogs, cats, pigs, cattle, and horses. The lesions involved were of the spleen, head, skin, subcutaneous tissues, ileum, and digits ,16,17,18In human medicine, UPSs are classified into five subtypes: undifferentiated high-grade pleomorphic sarcoma, myxofibrosarcoma, undifferentiated pleomorphic sarcoma with giant cells, undifferentiated pleomorphic sarcoma with prominent inflammation, and angiomatoid fibrous histiocytoma. These have been characterized by their specific cytologic and histologic characteristics. In H&E staining, the storiform pattern of pleomorphic spindle cells may indicate UPS . HoweverIt is known that the histologic subtypes of UPS are associated with prognosis in human UPS . In humaIn the current case, total excision was impossible due to the location of the tumor, and the owner refused further adjuvant therapy. Although there are few similar cases, it would seem that an aggressive surgical approach to these tumors, such as vertebrectomy with chemotherapy, should be considered whenever possible. In human medicine, radiation therapy with or without decompressive surgical therapy showed improvements in pain, motor function and urinary continence .In conclusion, in the case reported here, an extradural UPS was invading the vertebral canal resulting in spinal cord damage. Due to the location of the tumor, complete removal was impossible despite a dorsal laminectomy. The dog was euthanized three months postoperatively, and systemic metastasis was confirmed postmortem. To the best of the authors’ knowledge, this is the first case reported of multiple UPS involving extradural mass extending into the spinal cord through a vertebral bone, resulting in damage to the spinal cord, in a dog.