Chondroblastoma is a locally destructive, cartilaginous bone tumor that accounts for a small percentage of cases of primary bone tumors. Although considered a benign tumor, chondroblastoma can locally recur and can rarely metastasize. Here, we report a rare presentation of a locally recurrent chondroblastoma with pulmonary metastases. A 13-year-old female presented with palpitations, dry cough, difficulty breathing, and chest tightness four years after her original surgical resection of tibial chondroblastoma. On chest CT, multiple pulmonary soft tissue nodules with confluent punctate areas of calcification were seen. The patient underwent robotic-assisted bilateral pulmonary wedge resections. She is now undergoing denosumab therapy. This case underlined the importance of suspecting metastatic disease in patients with a history of chondroblastoma when pulmonary nodules are detected on imaging. Chondroblastoma is a locally destructive, rare cartilaginous bone tumor that accounts for about 1% of cases of primary bone tumors. It is most commonly found in patients aged 10-20 years with a male to female ratio of 2:1. The primary tumor arises from the epiphysis of a long bone, with the most common locations being the proximal femur, proximal tibia, distal femur, and proximal humerus [A nine-year-old Caucasian female presented to our institute with a history of pain in right knee for five months. The patient’s past medical history was significant for frequent upper respiratory tract infections, asthma, gastroesophageal reflux disease (GERD), and neonatal abstinence syndrome. The patient had no prior surgical history upon presentation. Plain radiograph of the right knee revealed a focal lytic lesion in the proximal right tibial epiphysis Figures , 1B.MRI of the right knee demonstrated a focal lesion centered in the right tibial epiphysis and revealed extension into the central and posterolateral proximal tibial physis and proximal tibial metaphysis with diffuse heterogeneous enhancement Figures -2D. ThesOne month later, the patient underwent surgery and bone grafting. The microscopic description of the excised tissue described a tumor composed of mononuclear cells with grooved nuclei, “chicken wire calcifications” surrounding the cells, foci with chondroid appearing matrix, scattered multinucleated giant cells, and focal necrosis. The final diagnosis of chondroblastoma was made based on pathology.Six months after the original tumor resection, a follow-up MRI of the knee revealed a suspicious mass involving the proximal right tibial epiphysis, physis, and metaphysis. Imaging was also suggestive of edema in the adjacent proximal tibial epiphysis and diaphysis Figures , 3B. ThiNegative tumor margins were not achieved; five months later, the patient was again diagnosed with recurrent chondroblastoma on a surveillance MRI Figures , 4B. A rThree years after radical resection and arthroplasty of the right knee, the patient presented for evaluation of palpitations with reported symptoms of dry cough, difficulty breathing, and chest tightness. Electrocardiogram and echocardiogram were insignificant on evaluation. On chest radiograph, a well-defined round nodule was seen over the left lower lobe, as well as a dome shaped opacity in the left paraspinal region of the lung Figure . On chest CT, multiple pulmonary soft tissue nodules were seen Figures , 6B. TheOne month after detection of metastases on CT, the patient underwent robotic-assisted bilateral pulmonary wedge resections of seven nodules in the right lung and two nodules in the left lung. Microscopic review of the excised nodules demonstrated extensive peripheral ossification confirmed in all the foci of the tumor tissue. No significant atypia, atypical mitoses, or necrosis was identified. Immunohistochemical stain of the excised nodules for the H3K36M mutation found in chondroblastoma showed diffuse and strong immunoreactivity by mononuclear cells. Histology of the resected nodules resembled that of the primary tibial tumor. Therefore, final diagnosis of all resected lung nodules was consistent with chondroblastoma. Subsequently, the patient was started on denosumab 120 mg injection once a week for three weeks, then monthly for one year, then every three months indefinitely to prevent chondroblastoma recurrence. Most recent CT chest with IV contrast 14 months status post robotic-assisted bilateral pulmonary wedge resections showed no evidence of recurrent tumor Figures , 7B. No Metastatic chondroblastomas are very rare. The benign nature of chondroblastoma has been an issue of discussion. In their fifth edition of classification of bone and soft tissue tumors in 2020, the World Health Organization (WHO) re-classified chondroblastoma as a benign tumor, citing the prevalence of cases with metastases is less than 1% and therefore it should be considered benign. In the preceding fourth and third editions of the WHO classification of bone and soft tissue tumors, chondroblastoma was regarded as a neoplasm of intermediate malignancy, solely based on its ability to metastasize .The mechanism of pulmonary metastases is hypothesized to be vascular invasion, possibly due to tumor embolization during surgical manipulation. However, there are cases of pulmonary metastasis of chondroblastoma before surgery discrediting this theory . There iRadiographically, cases of pulmonary chondroblastoma are described to have variable presentation. They are reported to present on chest CT as nodules without calcification, as well as cystic, cavitary nodules ,7. The pIn most cases of metastases of chondroblastoma, histological properties of the metastatic tumor are the same as those of the primary tumor. Pulmonary metastases have not been described to undergo malignant transformation and have not demonstrated histologic features of malignancy, such as hyperchromasia, atypia, or atypical mitoses . PulmonaChondroblastoma is a tumor of cartilage origin classified as a benign tumor by the WHO. Metastases of chondroblastoma, although rare, have been reported in literature, with the commonest site of metastatic involvement being the lung. There is no clear explanation in literature regarding the pathogenesis of metastatic disease in chondroblastoma. This case underlined the importance of suspecting metastatic disease in patients with a history of chondroblastoma when pulmonary nodules are detected on imaging. Practitioners should use this case as an example of small yet significant percentage of chondroblastoma cases that exhibit behavior that is not completely benign. The authors believe this would best be addressed by radiographic surveillance in select chondroblastoma cases, especially in those with known clinically aggressive behavior, such as our case. This would ensure optimal patient management in such cases.


Diffuse midline glioma with H3-K27M mutation is an infiltrative high-grade glioma, with predominantly astrocytic differentiation.A 54-year-old Chinese woman presented with memory loss for a month and walking instability for 15 days.Magnetic resonance imaging showed a mass shadow of isometric T1 and slightly longer T2 with mild mixed signals in the third ventricle of the suprasellar region. Histologically, the tumor was primarily sheet-like, with many “anucleate areas” composed of long and thin fibrillary processes of the bipolar cells, which formed “whorls.” The neoplastic nuclei were ovoid and moderate in size. The tumor showed brisk mitotic activity and vascular proliferation, with no necrosis. In addition to histone H3K27M mutation, immunohistochemical staining showed that the tumor cells were positive for glial fibrillary acidic protein, oligodendrocyte transcription factor 2, alpha-thalassemia/mental retardation syndrome X, S-100 and Vimentin. The “anucleate areas” were positive for glial fibrillary acidic protein and negative for synaptophysin. The Ki-67 proliferation index was about 10%. Molecular genetic analyses detected H3F3A K27M mutation, but no mutations in IDH1 or IDH2, TERT promoter mutations, MGMT promoter methylation, KIAA1549-BRAF fusion or deletion of 1p/19q were found. Based on these findings, the patient was diagnosed as diffuse midline glioma with H3-K27M mutation in the third ventricle, corresponding to WHO grade 4.A craniotomy with total excision of the tumor was performed.After surgery, she was routinely treated with temozolomide for chemotherapy and synchronous radiotherapy. It has been 11 months now, and the patient is living well.This case report provides information on the microscopic morphological features of diffuse midline glioma with H3K27M mutation, which can help pathologists to make a definitive diagnosis of this tumor. It occurs at the midline –7 of the CNS. It is mainly found in children, and adult cases are relatively rare.,8Diffuse midline glioma with H3-K27M mutation is a new tumor type in the 2016 WHO classification of tumors of the central nervous system (CNS),Although its histopathological features have been widely described, glial fibrillary acidic protein (GFAP)-positive anucleate whorled patterns have not been reported to the best of our knowledge. Hence, we have reported this unusual case.2A 54-year-old Chinese female developed memory loss for half a month, which was characterized by intermittent short-term memory loss, but her long-term memory remained normal. After 15 days, the patient's memory loss obviously worsened, and both long-term memory and short-term memory were poor. Concurrently, she also developed walking instability. Magnetic resonance imaging showed a mass shadow of isometric T1 and slightly longer T2 with mild mixed signals in the third ventricle of the suprasellar region, about 3.4 × 2.5 × 3.4 cm in size. The enhanced scan showed that the lesion was irregular and annular, with a clear edge. The lesion had spread to the right lateral ventricle, which dilated the ventricular system, especially the right lateral ventricle. Furthermore, the lamellar long T2 signal was seen in bilateral paraventricular white matter, the midline structure had shifted to the left, and the corpus callosum was thinner , neuronal nuclear antigen (NeuN), oligodendrocyte transcription factor 2, S-100, synaptophysin (Syn), Vimentin and Ki-67 . All samples were midly counterstained with hematoxylin, dehydrated and mounted. The negative controls were incubated with PBS instead of the primary antibody, using the same procedure.Fluorescent in situ hybridization was performed to check for deletions of chromosomes 1p and 19q. Dual color-probe hybridization was performed with Vysis 1p36/1q25 and 19q13/19p13 fluorescent in situ hybridization probe kit  according to the manufacturer's instructions. At least 100 non-overlapping nuclei were counted; samples were considered to be 1p- or 19q-deleted when >30% of counted nuclei presented one target (red) signal and two reference (green) signals. Sanger sequencing was used to detect the IDH 1/2 mutation and TERT promoter mutations. K27M mutation and KIAA1549-BRAF fusion were performed by Sinomdgene company  and Kanglu company , respectively.4H3F3A K27M mutation  after surgery. To date, she has not had a recurrence for 11 months. The association between prognosis and histological grade of diffuse midline glioma needs further validation.Poor prognosis of most H3K27M mutant gliomas has been confirmed in many studies,Herein, we described an extremely rare case of diffuse midline glioma, H3-K27M mutation with GFAP-positive anucleate whorled patterns. This case report provides information on the microscopic morphological features of diffuse midline glioma with H3K27M mutation, which can help pathologists to make a definitive diagnosis of this tumor.The authors thank the technical assistance in genetic analysis from Beijing Sino MD gene Technology Co., Ltd and Wuhan Kanglu Medical Laboratory Co., LtdInvestigation: Qing-Chang Li.Methodology: Jian Gu.Resources: Lin Fu.Software: Xue-Shan Qiu.Supervision: En-Hua Wang.Writing – original draft: Yi-Hua Wang.Writing – review & editing: Juanhan Yu.


This study is the first to use an autologous pericardial patch combined with a 3D carbon fiber stent for the plastic repair of a large trachea defect. Radical surgery is the optimal therapy for primary malignant tracheal tumors. Tracheoplasty or repair is required to guarantee trachea integrity and normal ventilation function after tracheal tumor resection. Here, we present a case of plastic repair of the trachea using an autologous pericardial patch and a 3D custom-made carbon fiber stent. A 4 cm trachea defect was successfully repaired after resecting a malignant schwannoma. The postoperative ventilatory function was normal without obvious symptoms of discomfort. Fiberoptic bronchoscopy showed a smooth mucosal surface of the endotracheal wall and patency of the airway. CT scans performed 3 years after surgery showed no recurrence. Therefore, we can conclude that a 3D carbon fiber stent is feasible for abolishing patch floating and preventing tracheal stenosis. Malignant peripheral nerve sheath tumor (MPNST) or malignant schwannoma is a malignant tumor emanating from the peripheral nerve sheath, which is most often seen in the lower extremities but rarely reported in the trachea . RadicalA 55-year-old male presented with a 3.5 cm × 2.8 cm tracheal tumor revealed by computed tomography scan during a medical examination for 2 months but showed no symptoms such as cough or chest tightness. CT showed that the tumor was located in the right lateral wall of both the trachea and the right main bronchus . A fiberFirst, a 3D model of the trachea and tumor was created by using MIMICS software  with CT data . Then, tPrimary tracheal malignant neoplasm rarely occurs in the upper airway, accounting for less than 0.4% of all newly diagnosed tumors, and it is usually misdiagnosed . CT scanResection of tracheal tumors inevitably leads to trachea interruption or trachea defect. An end-to-end anastomosis is often considered a tracheal interruption that occurs within 4 cm. For large defects of the trachea, trachea repair or tracheoplasty can be considered. A pericardial patch is the best material for repairing trachea defects. It has a smooth surface, tenacity, and is sufficiently air proof. Carter et al.  reportedIn our case, because of the defect involving both the trachea and the right main bronchus, direct shaping without a patch would have complicated the operation. Patch floating would have occurred if we had performed trachea repair with an autologous pericardial patch alone because of the large-sized defect, and tracheal stenosis and obstruction can easily occur in the late postoperative period. Therefore, combining the results of Aria's study with our own experience with 3D carbon fiber reconstruction implants –8, we deIn conclusion, this is the first report of a successful trachea repair using an autologous pericardial patch combined with a 3D carbon fiber stent. This was a novel individual treatment procedure that not only produced a satisfactory result but also provided new ideas and a rich experience for us to further explore the clinical application of artificial trachea.The patient completed a questionnaire 3 years after the operation, entitled The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). The EORTC QLQ-C30 score 3 years after the surgery showed that all the functional domain scores were above 100%, the symptom domain score was 0%, and the overall health status score was 91.7%. The patient reported that they only had a mild cough and wound pain in the early days after surgery and that there was a gradual improvement in their condition thereafter.


Sphenoid sinus mucocele (SSM) caused by obstruction of sinus ostium while sphenoid sinus retention cyst (SSRC) is due to obstruction of mucinous gland ostium which could enlarge to obstruct the sinus ostium and lead to acute sinusitis or mucocele,Incidence of isolated SSM is about 2% out of paranasal sinus (PNS) mucocele, but there is no specifically occurrence rate regarding SSRcWe herein describe one case of SSM and two cases of SSRC with sudden unilateral visual loss that recovered following endonasal endoscopic sinus surgery.A 25-year-old man with left-sided vision loss (light perception (LP), afferent pupillary defect (APD)) occurred within 24 hours, was referred after 10 days of the attack.Magnetic resonance imaging (MRI) showed a mass with rim enhancement obstructing the sphenoid sinus ostium . ComputeA 12-year-old boy with a history of gradual visual loss of left eye over 2 month-period was referred because of left sphenoid sinus mass in MRI with no Gadolinium uptake that was compatible with SSRC. There was no obvious compression of the optic nerve in the CTS or MRI .(28-year-old woman) showed up with total visual loss (LP and APD) of the right eye over 34 day period and retro-orbital pain. She had a similar attack 4 years earlier treated with 2-week administration of Dexamethasone. MRI showed an RC in the sphenoid sinus  touchingAll patients were referred by ophthalmologist with the first diagnosis of retrobulbar optic neuritis (RON) following incomplete recovery with administration of glucocorticoids. The patients underwent endoscopic endonasal approach and the cysts were removed. Total vision and visual field recovery were achieved in case 1 and 3 and partial recovery in second case.Isolated inflammatory diseases of SS are infrequent comparing to other paranasal sinuses. However neglected sphenoiditis could lead to critical complications by affecting adjacent vital structures such as cranial nerves II, III, IV, VIVisual loss and blindness often occur following circulatory disorders of the optic nerve caused by prolonged mucocele pressure that erode the bone and put the nerve in jeopardyMucocele could show four patterns of MRI signal intensity according to the protein concentration revealing its chronicityA high index of suspicion is needed for proper diagnosis of this entity especially for neurologists and ophthalmologists who are usually first physicians visiting sudden visual loss cases.


Aerococcus urinae is a gram-positive organism frequently found in the urinary tract. It is often mistaken for Streptococcus and Enterococcus based on its appearance. It commonly causes urinary tract infections but has rarely been associated with fatal infective endocarditis and sepsis. We present a case of Aerococcus urinae infective endocarditis and discuss echocardiographic imaging findings and management approach.  Aerococcus urinae (A. urinae) is a gram-positive catalase-negative alpha-hemolytic coccus that grows in clusters and is commonly found in the urinary tract [A. urinae may resemble an alpha-hemolytic streptococcus or enterococci at 24-48 hours. Once thought of as a rare human pathogen, A. urinae is now increasingly identified as a human pathogen with the advancements in species determination methodologies, such as matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) [ry tract . It is c-TOF MS) .TM  implantation, complete heart block with a dual-chamber pacemaker in situ, ischemic stroke, end-stage renal disease on hemodialysis, hypertension, and diabetes mellitus type 2, presented with shortness of breath, left hip pain, non-bloody diarrhea, and a productive cough. He denied chest pain, fever, chills, lower extremity edema, orthopnea, or abdominal pain. He had a former history of tobacco use but no alcohol or illicit substance abuse disorders.A 79-year-old male with a history of atrial fibrillation with WATCHMANA. urinae , a 1.2 x 0.4 centimeter density on the aortic valve suggestive of vegetation  is often an effective option. Another suitable alternative is vancomycin or ceftriaxone. Antibiotics choice should then be further guided by variable species susceptibility patterns . ManagemA. urinae infective endocarditis, which likely carries a high mortality, especially in the elderly population. Prompt diagnosis and initiation of antibiotic therapy is believed to be imperative for treatment and improving patient outcomes. Transthoracic and transesophageal echocardiography aid in the diagnosis and evaluation of structural and valvular abnormalities. Once the diagnosis is confirmed, source control needs to be achieved when feasible and multidisciplinary assessment is necessary for determining optimal treatment.This case highlights a rare case of


Paraovarian or paratubal cysts both define cysts located between the ovary and the fallopian tube. They are usually benign and frequently occur in the third and fourth decade of life. Paratubal cysts are defined as giant when they exceed the threshold of 150 mm.We report the case of a 15-year-old girl who complained about diffuse abdominal pain since 2 years that was diagnosed with a 196 mm × 90 mm × 267 mm giant paratubal cyst. We furthermore reviewed all the data published on 13 articles, published between 2006 and 2021, concerning giant paraovarian cyst (POC) in pediatric patients.The giant mass of our 15-year-old patient was removed through a fertility-sparing laparoscopic surgery. Histopathological diagnosis of cystadenofibroma was made up, with no cytologic report of neoplastic cells. The incidence of POC in the pediatric and adolescent population attests around 4%. However, only 12.96% of them are defined giant (larger than 15 cm). Indeed, to the best of our knowledge, only 13 cases of giant paratubal cysts have been reported in adolescents. To accomplish diagnosis and differential diagnosis, accurate history and physical examination are mandatory. In all cases reported in the literature, further instrumental analyses were performed, including ultrasound, CT, and/or MRI scan. International Ovarian Tumor Analysis (IOTA) rules have not yet been validated in the pediatric population. Because of the advantages of the laparoscopic procedures, it is often preferred in pediatric population, also to help preserve as much ovarian parenchyma and salpinx if thought possible. The incidence of malignant adnexal masses in the pediatric population is reported to range from 4% to 9%, accounting for 1% of all pediatric cancers.Giant paratubal cysts in adolescent females are extremely rare and usually benign. A fertility-sparing laparoscopic surgery should be the preferable option whenever possible. Considering the rarity of these conditions, further investigations are needed to exclude the possibility of a malignant evolution. Paraovarian or paratubal cysts are terms that can be used interchangeably: they both define cysts located between the ovary and the fallopian tube and they make up about 10% of all adnexal masses . These cOnly a few cases of giant paratubal cysts have been published, particularly as far as the pediatric population is concerned. Moreover, all these cases had different surgical approaches. Therefore, our aim is to report our case of a giant paratubal cyst  in a 15-year-old patient that was managed by minimally invasive surgery and to report a review of the literature on giant paratubal cysts in the pediatric population.A 15-year-old girl came to our attention because of diffuse abdominal pain. She was virgo, her medical history was uneventful, and she reported regular menstrual cycles. Family history and medical history were irrelevant. The patient complained about abdominal distension for 2 years. No other symptoms were reported apart from vomiting that started in the last few days. At physical examination, a firm and painless abdominal mass extending from the pubis to 2–3 cm above the umbilicus was evident. We performed a transabdominal ultrasound examination that showed a unilocular mass occupying the whole abdomen until the epigastrium. The mass was 300 mm × 240 mm × 120 mm in size, with regular walls and anechoic content and no vascularization at Color Doppler examination was observed. Free fluid was present in the Pouch of Douglas. Serum levels of oncological markers were all negative: Ca125: 12.2 U/ml, Ca19.9: 5.7 U/ml, and Ca15.3: 19.6 U/ml. In order to better characterize the mass, the patient underwent abdominal computed tomography (CT) scan that reported a voluminous endoabdominal lesion of 196 mm × 90 mm × 267 mm coming from the pelvis and occupying all the four abdominal quadrants . The cysThe patient's parents provided consent for publication of this case report.Paratubal cysts make up about 10% of all adnexal masses . The incThe management of the cysts should be based on the imaging characteristics and the clinical appearance. Traditionally, giant paratubal cysts have been managed with midline laparotomy . HoweverP = 0.001)  . This fu= 0.001) .Regarding the final histology of the removed cyst, the final histology report of the reviewed cases was of serous cystadenoma in 13/13 cases. Final diagnosis of our cyst was cystadenofibroma with cuboidal monostratified walls. It is important to emphasize that, even if in the general population paratubal cysts have almost always a benign nature, an unexpected high percent (25.9%) of borderline giant paratubal cysts has been found . MoreoveIn conclusion, giant paratubal cysts in adolescent females are extremely rare, and they usually have an excellent prognosis. However, because of the complexity and rarity of these conditions, for proper management, patients should be treated at a tertiary referral center by an experienced multidisciplinary team. Laparoscopy should be preferred when performed by an experienced surgeon, and a fertility-sparing surgery should be the preferable option whenever possible. Better knowledge on the possibility of a borderline or malignant histology in giant paratubal cysts is required.


Pseudomyogenic hemangioendothelioma (PMH), also known as epithelioid sarcoma-like hemangioendothelioma, is a rare epithelioid vascular neoplasm predominantly affecting young adult males at an average age of approximately 30 years. This tumor is rare; therefore, detailed information regarding this tumor is still lacking.Here, we report a case of a man in his 20s presenting with left foot pain for about one year. Imaging showed a 2-cm ovoid, cortically based lesion with a lytic defect of the cortex at the fifth metatarsal proximal shaft. Histologically, the lesion presented as an infiltrating proliferation of distinctly myoid-appearing spindled cells with eosinophilic cytoplasm and mildly atypical vesicular nuclei. Scant mitoses were identified with no areas of necrosis. Tumor cells exhibited strong, diffuse cytokeratin expression as well as CD31 and ERG. CD34 was positive in a few tumor cells, and integrase interactor 1 (INI1) retained nuclear expression. No reactivity for S100, desmin, smooth muscle actin (SMA), epithelial membrane antigen (EMA), and CD1a was present.Over half of the patients with PMH develop multifocal lesions, often involving several tissue planes; however, distant metastasis is very infrequent. This patient underwent curettage and internal fixation of the left fifth metatarsal and had no evidence of recurrence or distant metastasis after seven years of follow-up. Our case contributes to the growing knowledge of PMH and sheds light on the prognosis of these lesions. Pseudomyogenic hemangioendothelioma (PMH) is an endothelial neoplasm, mostly indolent and with low-grade malignancy, having several different classifications. The current nomenclature was originally described by Hornick and Fletcher 2011), in which its myoid and epithelioid-like histologic pattern is defined as "pseudomyogenic" 1, in whi. This tuA male in his 20s presented with increasing pain in his left foot for the past year. He had a history of hypertension but had no other medical problems or trauma. A physical exam revealed tenderness over the fifth metatarsal, particularly at the proximal shaft. There was no warmth, erythema, or lymphadenopathy, and a reassuring distal neurovascular exam. Plain X-rays revealed a 2-cm ovoid lytic lesion in the fifth metatarsal, with a saucer-like deformity and significant scalloping, favoring reparative granuloma, chondroma, periosteal desmoid, or other neoplasms Figure . The lesHistopathological examination of the biopsied specimen revealed infiltrating proliferation of distinctly myoid-appearing spindled cells with eosinophilic cytoplasm and mildly atypical vesicular nuclei Figure .Scant mitoses were identified with no areas of necrosis. Tumor cells exhibited strong, diffuse cytokeratin AE1&3 expression, as well as CD31 and ERG  panel with 58 gene fusions (Cleveland Clinic Foundation panel) was performed and no gene fusion was detected. These findings are consistent with an epithelioid sarcoma-like epithelioid hemangioendothelioma (EHE), with a differential diagnosis including epithelioid vascular neoplasm and epithelioid sarcoma. The retention of INI1 expression, strong CD31 positivity, and lack of diffuse CD34 argue against epithelioid sarcoma, which was described as PMH.The decision was made to treat the lesion with debridement, curettage, grafting, and internal fixation. Post-surgical follow-up positron emission tomography (PET) scans were negative, and CT scans have shown progressive healing of the pathologic fracture and the cavitating cortical lesion Figure . There wPMH is a rare tumor, mainly occurring in males with an average age of 31 years . It mostHistologic morphology of PMH consists of neoplastic cells that are enlarged, spindled, and with bright eosinophilic cytoplasm that can mimic rhabdomyoblasts. They contain mild nuclear atypia and infrequent mitotic activity ,6.PMH has an inclusive differential diagnosis of epithelioid sarcoma, rhabdomyosarcoma, osteoblastoma, and vascular tumors . PMH hasAnother useful tool in the diagnosis of PMH is the use of FOSB immunohistochemistry. The FOSB expression for PMH is strongly positive . The SERPMH is a rare neoplasm, particularly with the involvement of the bone. It is characterized as a multifocal, male-predominant tumor with predominantly spindled epithelioid morphology and positive keratin markers. We presented a patient who underwent curettage and internal fixation of the left fifth metatarsal and had no evidence of recurrence or distant metastasis after seven years of follow-up. Our case contributes to the growing knowledge of PMH and sheds light on the importance of the identification of these lesions and their effects on treatment and prognosis.


Reduction en masse (REM) is a rare condition following manual inguinal hernia (IH) reduction in which a hernia sac is reduced back into the preperitoneal space with a loop of the bowel incarcerated at the neck of the sac. It resembles successful manual reduction and may thus be overlooked easily. We herein report an infantile case of REM of an IH that was successfully treated laparoscopically.A 10-month-old boy with a surgical history of bilateral open IH repair at 4 months old presented with a bulge in his left groin and vomiting. A left incarcerated recurrent IH was suspected, and manual reduction was performed. The hernia was apparently reduced successfully, but abdominal distention and vomiting persisted. He was admitted for further observation due to the symptoms. On day 2 after admission, abdominal X-ray showed extensive small bowel obstruction (SBO). Enhanced computed tomography (CT) revealed protrusion of the small bowel with a closed-loop in the left groin. A closed-loop SBO due to postoperative adhesion or an internal hernia was suspected. To assess the etiology of SBO, emergent laparoscopic exploration with hernia repair was planned. Laparoscopy revealed REM of the left incarcerated IH with a thickened peritoneum at the neck of the sac. Laparoscopic reduction was performed, and the incarcerated small bowel showed no signs of ischemia. The hernia sac was not associated with the previously ligated processes vaginalis, which had been closed by a previous Potts’ procedure. It was located at the inside of the processes vaginalis. The sac was successfully closed by laparoscopic percutaneous extraperitoneal closure procedures, and iliopubic tract repair was also performed via the previous inguinal incision. The postoperative course was uneventful.Pediatric IH is due to the patent processes vaginalis, and REM is extremely rare. Laparoscopic surgery for REM is a relatively common and useful approach for the diagnosis and treatment of adults. In our infantile case, the laparoscopic approach was similarly effective for both investigating the cause of SBO and performing high ligation of the sac for this rare condition with IH.The online version contains supplementary material available at 10.1186/s40792-022-01535-1. Reduction en masse (REM) is a rare condition following manual inguinal hernia (IH) reduction in which a hernia sac is reduced back into the preperitoneal space with a loop of the bowel incarcerated at the neck of the sac . It is nWe herein report an infantile case of REM of IH that was successfully treated by laparoscopic procedures.The case was a 10-month-old boy who had a surgical history of bilateral open inguinal hernia repair at 4 months of age at our institution. He presented with a bulge on his left groin and vomiting . Laparoscopy revealed a small amount of ascites, small bowel dilatation and a loop of small remained trapped in the hernia with a thickened peritoneum at the neck of the sac in the left inguinal lesion  was applied. Two 5-mm trocars  were inserted through a multichannel port device  to attach to the wound retractor, and pneumoperitoneum was established  the hernia sac must have a narrow neck, making it difficult for the bowel to move back out of the sac; (2) the hernia sac must be mobile within the inguinal canal; and (3) there must be enough laxity in the peritoneal cavity without displacing the bowel loops from the sac . In someRegarding the mechanism underlying recurrent IH after the Potts procedure at four months old in our present case, it was not associated with the recurrence of patent PV. The laparoscopic findings showed the incarcerated small bowel located inside the previously ligated PV. Retrospectivity, enhanced CT revealed that hernia sac and trapped small bowel had not been inside of the inferior gastric artery, and they appeared that they had headed into internal inguinal ring through outside of the inferior gastric artery Fig. . The mecIn cases of SBO after manual reduction of IH, the potential involvement of REM should be considered. Laparoscopic procedures for REM are effective for the diagnosis and treatment of REM in infantile cases of this extremely rare condition.Additional file 1.


Due to the rarity of osteolipoma, current knowledge and understanding of its’ clinical presentation, management, radiological features, histological characteristics, and prognosis are lacking and can present a clinical conundrum to clinicians and histopathologist alike, given wide range of differential diagnoses. This paper aims to compile, analyse and present details to augment the available literature on osteolipoma in the head and neck.A comprehensive literature search on PUBMED/MEDLINE, EMBASE, CINAHL and Science Citation Index, Google scholar and Cochrane database for osteolipoma in head and neck was performed up to the 1st May 2021. Reference lists from the relevant articles were then inspected and cross-referenced and any other pertinent publications were added to the review.A total of 38 cases were identified from the literature. The commonest sites of involvement within the head and neck region were the oral cavity in 21 (56.8%) patients, followed by the neck in 7 (19.0%) patients. 29 (78.4%) patients presented with soft tissue swelling or mass making it the most common presenting feature. All patients had the tumour excised surgically; of which 18 (48.6%) were excised via transoral approach and 6 (16.2%) via open transcervical approach including 1 lateral pharyngotomy. 12 papers documented long-term follow-ups (median 12 months) with no recurrence. Only 1 regrowth was reported after 5-years.Osteolipoma is a rare soft tissue neoplasm which has a wide range differential diagnosis including malignant processes. Recognising this benign tumour through an awareness of presenting sign and symptoms, radiological features and histopathology findings is important for patient reassurance as well as avoiding unnecessary radical treatment. Osteolipoma was first described by Plaut et al. in 1959.According to the World Health Organisation (WHO) classification of soft tissue tumours, osteolipoma is a variant of lipoma. It is an extremely rare variant, accounting for less than one percent of all lipomas found in the human body.4It is even rarer within the head and neck region, with only 37 cases described in the English literature. Owing to the rarity, comprehensive details about its clinical presentation, management, radiological features, histological characteristics and prognosis are lacking and presents a clinical conundrum to clinicians.In this review, we aim to examine the cases in the literature and present a complete updated review on this rare tumour.A comprehensive literature search on PUBMED/MEDLINE, EMBASE, CINAHL and Science Citation Index, Google scholar and Cochrane database for osteolipoma in head and neck was performed up to the 1st May 2021. Key words used were osteolipoma, ossifying lipoma, ossified lipoma, lipoma with osseous metaplasia and head and neck. The search was further extended MeSH words like oropharynx; tonsil; tongue base; palate; larynx; pharynx; hypopharynx; pyriform fossa; postcricoid region; lateral pharyngeal wall; neck; parotid; submandibular; oral cavity; external auditory canal; internal auditory canal; temporal bone; paranasal sinus; tongue; and mandible. All articles including non-English papers were considered, and if included, non-English papers were translated.Publications on osteolipoma arising only from the head and neck sub-sites were included. Reference lists from the relevant articles were then inspected and cross-referenced and any other pertinent publications were added to the review. Detailed search strategy is shown in A total of 38 cases were identified and included from the literature . All theThe commonest sites of involvement within the head and neck region was the oral cavity in 21 (56.8%) patients, followed by the neck in 7 (19.0%) patients. Other reported sites included the salivary gland, paranasal sinuses, nasopharynx, pharynx, orbit, and tympanomastoid region. The smallest recorded lesion was 8-mm in size within the tongue and the largest lesion measured 7 × 6 cm on the floor of mouth.30 (78.4%) patients presented with soft tissue swelling or mass making it the most common presenting feature. Other common presenting features include dysphagia (5.4%), paraesthesia in the trigeminal distribution (5.4%), nasal obstruction (5.4%) and middle ear effusion (5.4%).All patients had the tumour excised surgically; of which 18 (48.6%) were excised via transoral approach and 6 (16.2%) via open transcervical approach including 1 lateral pharyngotomy. Other patients required combined transoral and transcervical approaches (5.4%), parotidectomies (5.4%) and transnasal endoscopic approach (5.4%) respectively.13 papers documented follow-up ranging from 1-month to 5-years (median 12-months) with no recurrence. Only 1 regrowth was reported after 5-years.The terminologies used for adipocytic tumour/lipoma with osseous component can be confusing. Terms such as ossifying lipoma, osseous lipoma, and lipoma with osseous metaplasia have been used interchangeably with osteolipoma. Consequently, many prior reports of “osteolipoma” included tumours which in actual fact are parosteal lipomas and intraosseous lipomas.41,Parosteal lipomas are neoplasms of mature adipose tissues that are contiguous with underlying periosteal bones, commonly associated with reactive changes or hyperostosis in the underlying cortex whereas intraosseous lipomas are lipomas that arises within the medullary cavity and occasionally within the cortex of a bone.32Hence, “true” osteolipomas, based on the current review are adipocytic neoplasms with osseous tissue which are independent or not attached to any bone.Osteolipoma however, can be classified according to the composition of its tissue content. It is called ossifying lipoma if the adipose component is the predominant tissue type, while the term osteolipoma is used if it contains more bony element.Osteolipoma is rare and only featured in case series and case reports to date. Its’ precise incidence is therefore unknown. However, it is thought to account for less than 1% of all lipoma cases.43It has near-equal gender ratio and is pre-dominantly found in adulthood. Gokul et al. reported a congenital case in a patient aged 6, of the hard palate. It remains the only paediatric case reported in the literature to date.Classically, osteolipoma and majority of the head and neck osteolipoma presents as a painless swelling or mass located in the submucosa or soft tissue . The texAdditionally, when arising from the head and neck region, the signs and symptoms can be variable depending on the site of origin and size of the tumor. Lesions arising from the nasopharynx and paranasal sinuses tend to present with nasal obstruction.30The child with the congenital osteolipoma of the palate presented with a cleft palate, nasal regurgitation and recurrent middle ear infections.Given the wide range differential diagnoses of soft tissue tumours, characteristic radiological features are vital in aiding the diagnosis of osteolipoma, as well as assessing the exact site, delineate the extent of disease and help decide treatment approaches.Computed Tomography (CT) with or without contrast is the most frequently used cross-sectional imaging to investigate osteolipoma. Radiologically, it is a well-defined, heterogenous mass with mixed density.10More importantly, osteolipoma does not erode into the underlying bone, nor does it invade into the surrounding structures which would suggest a more aggressive and sinister disease process.30Although Magnetic Resonance Imaging (MRI) is the imaging modality of choice to characterize soft tissue neoplasm, it was only utilized in 7-cases, most likely due to limited availability. On MRI, osteolipoma is a well circumscribed tumour with high signal intensity on T1  and Shor40Occlusal radiograph or orthopantomography is useful as first line investigation for tumour arising within the oral cavity. Typically, oesteolipoma would appear as a well-defined radiopaque mass with an irregular pattern of trabeculae or occasional flecks of calcification within. Given the nature of soft tissue tumour, no cortical abnormality should be found.39Ultrasonography was only used in a handful of cases. It would characterize the lesion as hyperechoic with focal areas of calcification.38Histologically, osteolipoma consists of mature adipose tissue interspersed with multi-focal areas of bony tissue.32Microscopically, the adipocytes are regular in size and shape, and the nuclei are uniform with no hyperchromasia.No nuclear atypia, cellular pleomorphism, mitosis or necrosis was ever reported in any of the cases.The pathogenesis of osteolipoma is still unclear. Several hypotheses have been proposed to explain its’ pathogenesis.It is thought that osteolipomas may arise from the proliferation of mesenchymal stem cells (characterizing a “mesenchymoma”), either directly from multipotent stem cells, or cells from a different lineage which subsequently differentiates into lipoblasts, chondroblasts or osteoblasts, and fibroblasts.Another hypothesis is that osteolipoma forms from fibroblast metaplasia within a pre-existing lipoma, which is usually large and long-standing.Other alternative hypothesis includes the transformation of fibroblasts into osteoblasts induced by growth factors released from monocytes or due to the ossification of an inadequately nutritional supplied tissue within the core the lipoma.31The differential diagnoses for a well-defined, extraosseous soft-tissue mass containing both adipose and osseous components is dependent on the location of the lesion. Nonetheless, the differential diagnoses are wide and includes both benign and malignant processes as outlined in In the paranasal sinuses, the differential diagnosis includes inverted papilloma due to its’ appearance on endoscopy. However, the lack of adjacent inflammatory mucosa on CT is unusual for this entity. Instead, the ground-glass appearance of the lesion on CT suggests that fibrous dysplasia should be considered as a differential diagnosis.One of the main differential diagnoses of osteolipoma within the oral cavity is osteocartilaginous choristoma. It has a marked predilection for the tongue, but diagnosis can only be confirmed through histopathology. In contrast to osteolipoma, the histology of osteocartilaginous choristoma shows mass of dense lamellar bone with Haversian canals and haematopoietic marrow which is absent in osteolipoma.Other differential diagnoses within the oral cavity include dermoid cyst, teratoma, myositis ossificans and liposarcoma. Dermoid cyst and teratoma tend to be more heterogenous and cystic on CT. Myositis ossificans has a typical appearance on CT – a well circumscribed intramuscular lesion with a distinct zoning/ossification pattern which progresses from an immature, central, non-ossified cellular focus, to osteoid, and then to a peripheral rim of mature bone over days to weeks. It is separated from the underlying bone by a radiolucent zone. In the head and neck, MO is often found in the pterygoid muscles but can be seen in the masseter, temporalis, buccinators, sternocleidomastoid, and platysma.46Osteolipoma can mimic or be difficult to differentiate from well-differentiated liposarcoma based on imaging alone. However, features such as thickened or nodular septi (>2 mm thick), prominent foci of high T2 signal and prominent areas of enhancement are suspicious for liposarcoma.As a benign, indolent and slow growing neoplasm, osteolipoma can potentially be managed conservatively. Majority of the lesions reported were long-standing, with duration since detection ranging from 4-months to 30-years (median – 4-years). However, most of these patients presented due to the enlarging lesion or symptoms secondary to the compressive or obstructive effect requiring surgical intervention.The only treatment of choice is therefore a complete surgical excision. The surgical approach differs based on the location of the osteolipoma. 17 of the 21 cases of the oral cavity lesions were excised successfully via a transoral approach. The remaining 4 cases did not describe their approaches.Parotid salivary gland lesions were managed using a parotidectomy approach. Diom performed a total parotidectomy as the lesion was located between the deep lobe of parotid gland and the parapharyngeal space.Endoscopic approaches were used for lesions within the paranasal sinuses and nasopharynx. Durmaz employed a combination of transnasal and transpalatal approach to excise the lesion attached to the posterior surface of nasal septum and posterior wall of nasopharynx.Most osteolipoma within the neck were excised using a transcervical approach. One lesion within the parapharyngeal space extending into the infratemporal fossa required a mandibulotomy.Osteolipoma has a particularly good prognosis similar to that of a conventional lipoma. Of the 12 cases which documented their long-term follow-ups, no recurrences were reported in the 11 lesions which were completed excised. No malignant transformation had been reported to date. Abdalla et al. reported a regrowth and not recurrence of the lesion 5-years after the initial surgery, where the mass was only partially excised due to the extension into frontal sinus.There is currently no consensus regarding the duration of follow-up for head and neck osteolipoma. In this review, the longest documented follow up was up to 5-years. Some authors suggested close monitoring and long-term follow-up given the paucity of knowledge about this rare entity.Osteolipoma is a rare soft tissue neoplasm which has a wide range differential diagnosis including malignant processes. Recognising this benign tumour through an awareness of presenting sign and symptoms, radiological features and histopathology findings is important for patient reassurance as well as avoiding unnecessary radical treatment.The authors declare no have conflicts of interest.


Aims: This case demonstrates the adverse sequelae that can follow a traumatic dental injury at a young age. It also highlights the importance of taking a full history and undertaking a thorough exam, independent of the information in the referral. Case presentation: A 9-year-old boy was referred for treatment of “an extra tooth” and “hypoplastic and non-vital” maxillary left permanent incisors. Examination revealed a sinus tract labial to these incisors  with increased probing depth. However, the teeth were otherwise normal. The child sustained a fall as a baby and lost one of his primary teeth that was never recovered. Information collected suggested the most likely diagnosis was an undiagnosed complete intrusion of a primary incisor, with subsequent hypoplasia and malalignment in the developing teeth. Management included the removal of the intruded primary tooth and monitoring of the hypoplastic permanent incisors until complete eruption and root maturation. Aesthetic restorations were then provided. The patient was referred for orthodontic correction of the malalignment. Conclusion: Misdiagnosis and inappropriate management of dental trauma can cause additional damage. In this case, endodontic therapy in the permanent incisors was avoided by correct diagnosis. Clinicians have to correctly assess and justify their decisions on each individual case. Traumatic dental injuries are common in both primary and permanent dentitions. Recently, it has been estimated that more than one billion living people have had traumatic dental injuries . In chilInjuries to the primary dentition are often overlooked, mainly due to the perception that they will eventually be replaced by permanent teeth and the limited cooperation for examination and management in young children . NeverthCareful clinical and radiographic examination of dental injuries along with early diagnosis, timely intervention, and regular follow-up are essential to prevent and minimize complications. In general, the International Association of Dental Traumatology (IADT) guidelines  recommenA 9-year-old Nigerian boy was referred by his general dentist for “root canal treatment of hypoplastic and necrotic upper left incisors” and removal of “a supernumerary tooth” in the region. The chief complaint was concern about “discolored and rotated top front teeth with pus discharge in the area”. No history of recent trauma was reported. The child was otherwise physically well and with clear medical background. Clinical examination revealed hypoplastic enamel defects and malalignment of the upper left permanent incisors (teeth # 21&22) with a labial sinus tract between the two teeth A. An incUsing the horizontal parallax technique, the “extra tooth” appeared to be in a labial position . In the Detailed questioning of the child’s parents revealed a traumatic dental injury at the age of 18 months. The mother reported that the child had fallen off his bed at home and “lost” one of his “baby” teeth that was never found at the time of injury. The mother sought assessment at the Accident and Emergency service, however, the missing tooth was erroneously diagnosed as an avulsion by the attending physician. No further intervention was provided. A full history and thorough clinical examination, independent of the information in the referral letter, revealed that these permanent incisors were not necrotic and had no sign of pulp degeneration. The ‘extra’ tooth in the radiograph was assumed to be a completely intruded primary incisor and not a supernumerary tooth. Extraction of the abscessed primary tooth was planned and completed under general anesthesia due to potential behavior management problems and the complicated access to the intruded tooth . Closer At the postoperative review (2 weeks after the surgery), there was a satisfactory healing with a complete resolution of the sinus tract. The periodontal examination showed resolution of the increased probing depths. The patient was then placed on a 3-monthly recall interval to monitor the development and eruption of the upper left incisors. Owing to the hypoplastic enamel defects, intermittent sensitivity later developed in the upper left permanent incisors, and desensitizing agents  were used and oral hygiene instructions were reinforced. Nevertheless, a normal eruption rate of these incisors with appropriate root formation and satisfactory apical closure was evident on subsequent follow-up visits, confirming pulp vitality and favorable outcomes in these teeth  Figure . Following complete eruption of the affected permanent incisors, aesthetic restorations were provided with light-cured composite , using a minimally invasive cavity preparation . The aesInjuries in the primary dentition, particularly the severe forms, require careful examination and monitoring, not only for the tissue damage and complications in the traumatized primary tooth but also for the possible sequelae in the permanent dentition ,15,16.The current IADT guidelines highlight the need to follow severe injuries, especially intrusion and avulsion of primary teeth up until the eruption of the permanent teeth, for early diagnosis and timely management of any complications . ParentsThis report represents an unusual case of the complete intrusion of a primary incisor that had failed to re-erupt and remained undiagnosed for years until it developed necrosis and infection. Based on the clinical presentation only, tooth loss (avulsion) was mistakenly assumed in the first place, following the injury. Merkle reported a case of complete intrusion of a primary incisor that was erroneously diagnosed as an avulsion injury by the attending emergency room physician, and later discovered by the dental team during routine care . This ilA report in the literature was located where an intruded primary incisor remained undiagnosed for 15 years . It was It is worth mentioning that the provisional diagnosis that was made by the referring dentist (the presence of a supernumerary tooth rather than a completely intruded tooth) was included in the differential diagnoses and could not be initially ruled out. However, the trauma history  and the quite localized enamel defects of the developing incisors in the area, in addition to their rotation in an otherwise perfectly aligned dentition, all increased the suspicion of dental trauma. That said, this preliminary diagnosis was not proved until the tooth was surgically removed and inspected closely to confirm the morphology of a primary incisor. Furthermore, the tooth was located buccal to the cortical plate in a subperiosteal position and was not incorporated in the growing maxilla.Dental injuries in young children can have a significant negative impact on oral health with esthetic, functional, and psychological consequences. Careful clinical and radiographic examination, along with regular follow-up, is essential in all traumatic injuries. Organization of a proper emergency service and first aid for dental trauma is paramount at all pediatric hospitals, with the presence of a dental professional at initial assessment. Onward referral to a dentist after the acute emergency should be an essential component in the management of traumatic dental injuries. Inaccurate or incomplete diagnosis and subsequent inappropriate treatment protocol can cause additional damage and an unsatisfactory outcome. Clinicians must always make their own decision on each individual case, independent of the information or preliminary diagnosis from the referring dentist.


Prenatally identified suprarenal masses are most often found to be adrenal hemorrhage. The most common tumor in this situation is neuroblastoma.We report the case of a rare adrenocortical tumor found prenatally on ultrasound. While most patients with adrenocortical tumors present with virilizing symptoms, our patient did not have evidence of virilization and was presumed to have neuroblastoma.Following a period of observation, our patient underwent surgical resection due to tumor growth revealing the unexpected diagnosis. She was born at 39 weeks via repeat Cesarean section. Pregnancy was complicated by maternal preeclampsia and hyperglycemia. Additionally, a right adrenal mass was found on a routine ultrasound 2 weeks prior to delivery. She subsequently had two follow up ultrasounds, one prior to birth and another shortly after birth, which again demonstrated the presence of the right adrenal mass. The abdominal ultrasound showed a 4.8 × 3.9 × 3.3 cm mass that appears confluent to and/or abutting the posterior right kidney. This was followed by a CT abdomen which showed a 4.6 × 3.3 × 3.2 cm right adrenal mass Figure  and the On exam, the infant was well appearing without any signs of virilization. There was also no evidence of Cushing's syndrome. Her family history was positive only for maternal hypertension; there was no reported history of benign or malignant tumors within the family. Urine catecholamine metabolites were normal: homovanillic acid (HVA) was 13 and vanillylmandelic acid (VMA) was 7. Evaluation for additional adrenocortical hormones was not performed. Metaiodobenzylguanidine (MIBG) scan was negative. She was diagnosed with presumed neuroblastoma without any clinical or radiological evidence of metastatic disease. We followed Children's Oncology Group clinical trial ANBL1232 (off study) of which she was categorized as Group A1 per International Neuroblastoma Risk Group classification  since she was ineligible for the clinical trial. She was observed every 6 weeks with abdominal ultrasounds and urine catecholamines. At the first 6 week interval, the abdominal ultrasound was unchanged and the urine catecholamine metabolites were slightly increased compared to the initial values though still normal .At 12 weeks, the adrenal mass increased in size by greater than 50%, measuring at 5.6 × 4.2 × 4.7 cm  Program.Adrenocortical tumors, while rare, are frequently associated with cancer predisposition syndromes. Germline mutations have been identified in the TP53 gene on chromosome 17 in up to 82% of patients with adrenocortical tumors.In summary, our patient presented with a solid adrenal mass in utero. Her clinical presentation was atypical for prenatally diagnosed adrenocortical tumor and more consistent with prenatal neuroblastoma, despite having a negative MIBG and normal urine catecholamines. She underwent a complete resection at 3½ months of age due to tumor growth revealing an adrenocortical tumor with predicted benign activity. This case exemplifies the importance of maintaining a broad differential diagnosis and close observation when there is not a definitive diagnosis.Jeffrey H. Schwartz: Conceptualization (lead); investigation (supporting); methodology ; writing – original draft (lead); writing – review and editing . Erlyn Smith: Conceptualization (supporting); investigation (lead); methodology ; writing – original draft (supporting); writing – review and editing .The authors have stated explicitly that there are no conflicts of interest in connection with this article.Institutional approval was not required for this single patient case report. Informed consent for publication was obtained from the patient's parents for the publication of case details and use of images.


Postoperative small bowel obstruction is a rare complication. One of its less frequent causes is port site hernia. We report a case of Richter's port site hernia in a patient who underwent robot‐assisted radical prostatectomy.A 73‐year‐old man who underwent robot‐assisted radical prostatectomy noted acute abdominal pain and nausea on the 11th postoperative day. Computed tomography scans revealed dilated small bowel loops. Adhesive ileus was initially suspected, which was relieved with conservative management, including ileus tube insertion. However, his symptoms worsened. Thus, a laparotomy was performed. The camera port wound was reopened, and the repaired fascia and small intestine were found incarcerated into the peritoneal defects. These findings were consistent with Richter's hernia.Port site hernia was not detected on computed tomography scans. Patients presenting with small bowel obstruction following laparoscopic surgery should be evaluated for port site hernia, and surgical management should be considered. Port site hernia is one of the causes of postoperative bowel obstruction. An accurate diagnosis is key to early surgical intervention. In particular, Richter's hernias are difficult to diagnose. In cases where the area of strangulation is not apparent, conservative treatment may be given; however, surgery should still be considered.CTcomputed tomographyRARProbot‐assisted radical prostatectomyPSHport site herniaRARP is the standard surgical procedure for localized prostate cancer. Postoperative small bowel obstruction is a rare surgical complication primarily caused by adhesions.PSH is a less common cause, which results in serious complications, such as intestinal necrosis. Thus, an accurate diagnosis of PSH confirmed on CT scans is important. We report a case of Richter's PSH in a patient who underwent RARP. The hernia was not confirmed on CT scans and was only diagnosed postoperatively.2 and initial serum prostate‐specific antigen level of 4.3 ng/mL. Prostate biopsy revealed an adenocarcinoma, Gleason score 3 + 4 in three out of 10 sites. Metastasis was not detected on CT scans and bone scintigraphy. The patient was diagnosed with cT2aN0M0 prostate cancer.A 73‐year‐old man with an unremarkable medical history underwent RARP for prostate cancer. He had a body mass index of 22.2 kg/mRARP was performed via the trans‐peritoneal approach. The surgical trocars were placed as shown in Figure The patient had an uneventful postoperative course and was discharged 9 days after RARP. However, 11 days postoperatively, he reported abdominal pain, nausea, and vomiting. The CT scan revealed dilated small bowel loops proximal to the camera port Fig. . An ileuTen days after ileus tube insertion (postoperative day 21), the patient's abdominal pain and nausea were relieved. The ileus tube was removed; however, the patient noted recurrence of nausea and vomiting. A plain abdominal radiograph showed dilated bowel loops.Twenty‐two days postoperatively, laparotomy was performed considering the possible need for bowel resection due to adhesion. The wound of the camera port was reopened, and a portion of the small intestine was found incarcerated into the peritoneal defect despite repaired fascia Fig. . These fet al. reported that Richter's hernias frequently occur in the early postoperative period.Early postoperative small bowel obstruction occurs in 1–12% of abdominal operations, including laparoscopic and open surgeries.Richter's hernia is a herniation of the anti‐mesenteric portion of the intestine. This condition does not always lead to complete intestinal obstruction. Thus, patients often complain of subclinical symptoms.CT scans are the most commonly used diagnostic modality for PSH. However, it was ineffective in establishing the diagnosis of PSH in the present case. Several patients have been postoperatively diagnosed with Richter's hernia.Water‐soluble contrast is used to differentiate partial small bowel obstruction from complete obstruction and to hasten the resolution of adhesive obstruction.In cases where the strangulation is not apparent, conservative treatment may be provided; however, surgery should still be considered. In early postoperative small bowel obstruction, the rate of improvement without surgery is reported to be 73–96% within 2 weeks.We experienced a case of port site Richter's hernia in a patient who underwent RARP. Richter's hernia is difficult to diagnose on CT, and surgical intervention is necessary to treat the disease. This type of PSH should be considered in patients presenting with small bowel obstruction after laparoscopic surgery.Taisuke Tobe: Conceptualization; writing – original draft. Keiji Yuen: Writing – review and editing. Tomihiko Yasufuku: Supervision. Riku Uematsu: Supervision. Akira Miyazaki: Supervision. Masuo Yamashita: Supervision.The authors declare no conflict of interest.N/A.Informed consent was obtained from the patients for publication of this case report.N/A.


We describe the clinical presentation, radiological findings, treatment and outcomes of three patients with delayed leukoencephalopathy occurring after endovascular treatment (EVT) for cerebral aneurysms—a rare, albeit recurring, complication. The symptoms occurred 6 to 12 months following the EVT of the cerebral aneurysm. Characteristic imaging findings included high-signal changes on T2 images in the white matter without diffusion restriction predominantly at the distribution of the vascular territory of the catheterized arteries, coupled with patchy gadolinium enhancement or low susceptibility weighted imaging (SWI) signals within the white-matter lesions. Steroid pulse therapy is the treatment of choice and promptly improves clinical and imaging findings. Tapering or cessation of steroids may result in clinical and imaging relapses; close- and long-term follow-up for patients presenting this complication is warranted. Endovascular treatment (EVT), performed with coils, stents, and flow diverters, is considered an evolving therapy for cerebral aneurysms . The mosIn view of these considerations, we describe three consecutive cases presenting at our tertiary care stroke center with delayed non ischemic cerebral enhancing (NICE) lesions after EVT of cerebral aneurysms during the last three years . We alsoA 64-year-old woman presented to the emergency department with subacute-onset headache, auditory hallucinations, paresthesias and weakness of the left upper limb with an initial National Institutes of Health Stroke Scale (NIHSS) score of 3 points. Her past medical history included non-traumatic subarachnoid hemorrhage (SAH) one year ago, due to aneurysm rupture of the right posterior communicating artery (PCom), which was uneventfully treated with endovascular coil embolization . Computed tomography (CT) of the brain revealed right temporoparietal hypodense lesions. Magnetic resonance imaging (MRI) of the brain confirmed right temporoparietal subcortical lesions, surrounded by vasogenic edema without diffusion restriction. Additionally, susceptibility-weighted imaging (SWI) showed low-signal spots within the lesions, suggesting deposition of paramagnetic material and slight gadolinium enhancement in the post-gadolinium T1-weighted sequences A,B. ExteTwo years after a slow attempt in tapering steroid treatment, the patient presented with a clinical relapse with headache, dysarthria and left upper arm weakness (NIHSS score 2). Brain MRI also revealed a radiological relapse with enhancing lesions and low-signal spots on SWI along with extensive vasogenic edema, and a second steroid pulse treatment was initiated resulting in clinical and radiological recession D.A 62-year-old woman presented in our outpatient clinic with gradual left-sided hemiparesis, auditory hallucinations and seizures over the last six months (NIHSS score 3). Her medical history included non-traumatic SAH three years ago due to aneurysm rupture of the right posterior communicating artery (PCom), successfully treated with EVT and a surgical aneurysmal clipping of unruptured aneurysm in the anterior communicating artery (Acom). Six months after the EVT, the patient developed left homonymous hemianopsia and brain CT revealed right occipital hypodense lesion. Unfortunately, the patient declined further evaluation at that time. Brain MRI at the time of admission in our department revealed right occipitoparietal and occipitotemporal white matter lesions with radiological characteristics of vasogenic edema. SWI showed low-signal spots within the lesions, while post-gadolinium T1-weighted sequences demonstrated slight gadolinium-enhancement of the lesions A,B. BlooA 49-year-old woman was referred to our neurologic department due to gait disorders, right-sided hemiparesis, partial seizures of the right upper limb and mild cognitive and concentration difficulties, gradually deteriorating over the last 6 months (NIHSS score 4). A remarkable piece of information from her medical history was the application of a flow diverter stent (P 64-MW-HPC-450-15 FD) in a non-ruptured aneurysm of the supraclinoid segment of left internal cerebral artery (ICA) one year ago. The microcatheter that was used, had a hydrophilic coat (Rebar 18 105-5081-153). The patient was admitted to another hospital 5 months ago and brain MRI revealed multiple white-mater lesions in the left frontoparietal region with parenchymal enhancement as well as leptomeningeal enhancement after intravenous contrast administration A,B. A thOver the last few years, delayed non ischemic cerebral enhancing lesions suggesting immune-mediated leukoencephalopathy have been recognized as an increasing complication after aneurysm EVT, including coils, stents, and flow diverters with an estimated incidence between 0.05% and 2.3% mostly observed in women aged 41–65 years with median time of weeks up to 12 months after the procedure ,8. ConsiBrain MRIs of all similar cases reported so far in the literature have distinctive features: T2-fluid-attenuated inversion recovery hyperintensities predominantly in the subcortical white matter and at the grey–white matter border, predominantly at the distribution of the vascular territory of the catheterized arteries as well as perilesional edema, which varies in extent. Gadolinium enhancement is either solid or rim-shaped. Partially, low signals in SWI in the fluid-attenuated inversion recovery (FLAIR) hyperintensities are reported, probably due to deposition of microembolic paramagnetic coil-related materials ,15,16,17Brain biopsy was performed in few cases demonstrating granulomas, angiitis, periadventitial foreign-body giant cell response, and microabscesses encasing foreign material, neutrophilic granulocytes, and multinucleated macrophages ,9,11. BrIn terms of treatment, steroid pulse therapy followed by oral prednisone is considered the first treatment option, leading to significant resolution of neurological symptoms along with improvement of MR findings ,14,15,16In conclusion, delayed leucencephalopathy is a rare complication after EVT treatment of cerebral aneurysms. Approximately a hundred cases have been published so far over the last 14 years . The maiNevertheless, it is remarkable that in the three largest cohort studies ,6,7 16,


Annular elastolytic giant cell granuloma is an uncommon granulomatous cutaneous disease that usually affects sun-exposed skin. Non-scarring alopecia is a possible presentation. Although histopathology is mandatory for the diagnosis, dermoscopy may help to narrow down the clinical differential diagnosis. The authors report a case of annular elastolytic giant cell granuloma in the scalp of a female adult patient, showing multiple yellowish/orange follicular dots in a diffuse erythemato-whitish background in the dermoscopy. A 46-year-old female patient presented with a 2-month history of an enlarging frontal alopecic plaque. She denied any pain or pruritus. During the physical examination there were two confluent non-scaly pink alopecic plaques with an erythematous border, at the frontal implantation hair line, with 35 × 70 mm and 40 × 60 mm . The oveDermoscopy revealed empty follicular ostia, with a diffuse erythemato-whitish background, with fine unfocused linear branching vessels. It was also evident multiple yellowish to orange follicular dots in the center of the alopecic patch, with some pigmented thin hairs . When apClinical and histopathological findings were consistent with annular elastolytic giant cell granuloma. The patient was initially treated with a medium potency topical corticosteroid in combination with tacrolimus 0.1% ointment, with mild benefit. At 6-month follow-up, the authors performed one treatment of intralesional steroids at the border of the lesions, with some improvement in the erythema and stability of the size of the lesions.Annular elastolytic giant cell granuloma (AEGCG) is an uncommon granulomatous cutaneous disease that usually affects sun-exposed skin but may also occur in sun-protected areas.Diagnosis may be difficult due to the similar clinical features to other granulomatous dermatoses, such as sarcoidosis, classic granuloma annulare and necrobiosis lipoidica.Dermoscopy of the lesions may help to narrow down the clinical differential diagnosis. The dermoscopic hallmark of granulomatous skin diseases consists of a structureless yellowish-orange area, distributed in a focal or diffuse pattern, due to the presence of a granulomatous infiltrate in the dermis.This dermoscopy report of AEGCG involving the implantation hair line widens the differential diagnosis of scalp dermatosis with yellowish-orangish dots. The authors believe that it may present a clue to the diagnosis of this entity. More observational reports are needed to confirm the present observations.None declared.Tiago Fernandes Gomes: Data collection, analysis, and interpretation; critical literature review; preparation and writing of the manuscriptJosé Carlos Cardoso: Approval of the final version of the manuscript; data collection, analysis, and interpretation; Manuscript critical review.Victoria Guiote: Approval of the final version of the manuscript; data collection, analysis, and interpretation; intellectual participation in propaedeutic and/or therapeutic management of studied cases; manuscript critical review.None declared.


Total anomalous pulmonary venous connection is a rare congenital anomaly and has four anatomical subtypes of which the mixed type represents diagnostic and therapeutic challenge. When associated with obstruction, however, urgent surgical repair is needed. Herein, we present a rare case of obstructed mixed type total anomalous pulmonary venous connection with successful surgical repair. Total anomalous pulmonary venous connection has four main anatomical types. When associated with obstruction, however, it needs urgent surgical repair. Accurate preoperative evaluation is critical for achieving favorable outcomes. CTA was performed and confirmed the diagnosis of a mixed type TAPVC  with an obstruction. The obstruction level was at the connection of the vertical vein with the left innominate vein. On the 10th day of life, the neonate developed a sudden cardiac arrest and underwent cardiopulmonary resuscitation with rapid response without the need for mechanical ventilation. The patient was scheduled for urgent surgical repair. The operation was performed through median sternotomy. A large vertical vein was seen on the left side outside the pericardium and connecting with a very small vein to the left innominate vein (representing the site of obstruction) (Figure 0 mm, a l3The diagnosis of mixed type TAPVC and its surgical repair are challenging; however, it is the least common type of TAPVC, accounting for about 5% of cases.4Mixed type TAPVC represents diagnostic and therapeutic challenge in the field of congenital heart surgery. The best surgical outcomes in obstructed TAPVC cases need accurate preoperative evaluation and prompt intervention.Reem Shammout: Participated in writing the report and approved the final version. Doaa Alkhadraa: wrote and reviewed the successive versions and participated in their revisions. Sidra Alkadi: wrote and reviewed the successive versions and participated in their revisions. Alwaleed Al‐Dairy: Planned and performed the work leading to the report. Wrote and reviewed successive versions and participated in their revisions.There are no funding resources for writing this manuscript.The authors have no conflict of interest.The manuscript was approved by ethics committee at Damascus University..Written informed consent was obtained from the patient's parents to publish this report in accordance with the journal's patient‐consent policyNone of the authors listed in the manuscript are employed by a government agency that has a primary function other than research and/or education. Moreover, none of the authors are submitting this manuscript as an official representative or on behalf of the government.


This article reports 2 cases of symptomatic postoperative discal pseudocysts (PDP), a rare complication of percutaneous endoscopic transforaminal lumbar discectomy (PELD). In this report, we propose a possible mechanism of PDP and introduce an effective therapeutic strategy. To our knowledge, there have been no reports of the use of indwelling drainage techniques for the PDP treatment after PELD.Herein, we report 2 cases of PDP after PELD in our hospital. Both patients had disc herniation at the L4/5 level, and the symptoms of low back pain and radiculopathy were significantly relieved after PELD. However, the signs in both 2 cases recurred 20 days after surgery. MRI indicated PDP in both 2 patients with high intensity on T1- and T2-weighted imaging in the primary surgical area.Given the progressive symptoms in both cases, PELD was performed again and 3-lumen drainage catheters were placed at the surgical site for adequate drainage.The patient’s symptoms were significantly relieved after adequate drainage and disappeared 3 months after surgery. There was no clinical or MRI recurrence at the 6-month follow-up.According to operative findings, we found that PDP symptoms may not be attributable mainly to cyst compression but to the excessive accumulation of local inflammatory factors. Treatment of PELD combined with indwelling drainage is feasible and effective in treating PDP. In recent years, postoperative discal pseudocysts (PDP), a rare complication of PELD, have been reported in several cases. PDP mainly occurs in the short term after the operation, primarily manifesting as low back pain and radiating pain in the lower extremity and other symptoms similar to lumbar disc herniation.Percutaneous endoscopic lumbar discectomy (PELD) is rapidly gaining popularity worldwide owing to its advantages, such as minor trauma, short operation time, safe and controllable operation, and quick recovery. However, this technique is inevitably accompanied with complications.In these 2 PDP reports, we demonstrated a novel strategy for PDP treatment, PELD combined with indwelling drainage, with satisfactory short-term efficacy. In addition, based on systematically reviewing the related literature on PDP and summarizing the clinical data of this group of patients, we propose new possible pathogenesis of PDP. We also presented the strategy of PELD combined with indwelling drainage to be feasible and effective. This report provides a reference for the prevention and treatment of PDP.Case 1: A 24-year-old male presented with chronic low back pain for 1 year, aggravated and accompanied by radiating pain and numbness in the left lower extremity for half a year. Specialist physical examination revealed lameness and limited flexion and extension of the lumbar spine. At the same time, there was tenderness and percussion pain in the spinous process and between the spinous processes of the lower lumbar vertebrae and radiated to the left buttock and left lower extremity. The VAS score was 6 points. Right lower extremity muscle strength and sensation were normal. The skin of the left calf showed superficial hypesthesia on the outer side. The muscle strength of the left extensor dorsi muscle was grade 4, and the muscle strength of the rest of the left lower limb was normal. The left straight leg raise test was positive at 30°. At the same time, the left Achilles tendon reflex was weakened, but bilateral Barthel sign was negative. The lumbar spine’s frontal and lateral radiographs showed the L4/5 intervertebral space narrowing. Hyperflexion and hyperextension of the lumbar spine showed that the lumbar spine was unstable. CT findings showed posterior left L4/5 disc herniation, compression of the anterior edge of the dural sac, and narrowing of the left lateral recess. MRI showed L4/5 disc herniation to the left posteriorly with nerve root compression  Complete hemostasis during surgery and reduce coagulation and burning; (2) Absolute bed rest on the first day after surgery; (3) Wear waist circumference for 2–3 months after surgery active, moderate physical exercise.In addition to revision surgery, conservative treatment is possible when patients present with complete asymptomatic or mild tolerable symptoms. However, Chung et alThrough the intraoperative findings and postoperative management of 2 cases, we propose that the possible mechanism of PDP formation is the use of large-scale radiofrequency cautery of the surgical area to trigger a solid local inflammatory response and the cause of radiculopathy is more from the Stimulation of inflammatory factors rather than compression. For patients with ineffective conservative treatment of pseudocysts, PELD revision surgery combined with indwelling drainage is a feasible and effective new strategy for PDP treatment.ZQ.C and XC.Y. designed this study. S.W. and Y.Y. were responsible for gathering and writing the manuscript. ZQ.C and XC.Y. provided the valuable case, performed the operation, and contributed to revising the manuscript for important intellectual content. The final version of the text has been reviewed and approved by all authors.There was no funding for this study. The authors would like to thank Jianhua Li and Yun Bai for editing the English text for a draft of this manuscript. We thank Professor Jingming Wang for critically reviewing the manuscript.


Malignant neoplasms of the salivary glands are relatively uncommon; they account for less than 7% of head and neck cancers. Of these, about 10% have been diagnosed as the cystic adenoid carcinoma (CAC)A brown male patient aged 48 years reported moderate pain in the left lower molar region for the past two months. The physical examination of the face revealed no facial asymmetry and enlarged local lymph nodes. On the intraoral examination, the vestibular mucosa along the left lower molars was normal and there was no mass. The oropharynx was hyperemic, and the mucosa was blackened along the lateral portion of the tongue; this area was somewhat hardened and painful upon palpation. Orthopantomography revealed a radiolucent image in the periapical areas of the left lower second and third molars involving the mandibulary canal. Cone beam computed tomography revealed unclear borders, cortical tongue erosion, root resorption of the teeth in question, and involvement of the mandibulary canal . SurgeryThe incidence of CAC varies according to the site. It comprises about 1.6% to 2.2% of all tumors and 16% of malignant tumors of the parotid glands. In the submandibular gland this percentage is 12% to 17%; and in the sublingual gland this percentage is 40% of all tumorsThe CAC may present as a slowly growing asymptomatic tumor, although in most cases there are palpation-induced painful events due in theory to the fact that this tumor is markedly neurotropic. In the present case the patient had moderate pain in the lower molar region, especially upon palpation. Perineural invasion is a common finding in this disease, but is not a pathognomonic factor, as it arises in other salivary gland neoplasms such as in low grade polymorphic adenocarcinomaRadical surgery combined with postoperative radiotherapy has been the treatment of choice according to some authors; this approach appears to reduce recurrence rates significantly compared with surgery aloneThe CAC is a slow growing neoplasm that generally manifests as an enlarged mass covered by intact mucosa; it is painful upon palpation and metastasizes late in the progression of the disease. Radical surgery is recommended, as this approach reduces the likelihood of metastases.


Lymphoepithelioma was described in 1921 separately by Regaud and Schmincke as nests of non-keratinizing squamous cells embedded in a lymphoid stroma (Regaud) and isolated transitional cells scattered in lymphoid tissue resembling sarcoma (Schmincke). Lymphoepithelial tumors are the most common lesions of the nasopharynx, although they have also been reported in other localizations, such as the nasal cavity, maxillary sinus, the base of the tongue, parapharyngeal area, tonsils and thymus. Lymphoepithelioma of the larynx is extremely rare. We present a case of a 55-year-old patient treated due to this type of lesion to share our experience in the management of this type of malignancy and contribute to the field of rare laryngeal tumors diagnosis and treatment. Lymphoepithelial carcinoma (LEC) is the most common lesions of the nasopharynx, although they have also been reported in other localizations, such as the nasal cavity, maxillary sinus, the base of the tongue, parapharyngeal area, tonsils and thymus . LymphoeCompilation of LEC cases was performed by Faisal et al. with the distribution of the clinical and anatomic pathology variables in 46 patients with this type of tumor in the larynx and hypopharynx . Three mWe present a case of a 55-year-old patient with Schmincke's tumor of the larynx.A 55-year-old caucasian male patient was admitted to the laryngology ward due to the suspicion of a tumor involving the larynx. The patient had hoarseness lasting for 2 months prior to the admision, without other symptoms. He was a heavy smoker , suffering from hypertension and psoriasis. The laryngological examination revealed the smooth tumor of the left side of the larynx involving the left vocal fold, left vestibular fold and the petiole of the epiglottis. The surgical procedures were scheduled- the patient underwent two microlaryngoscopies with the sampling of the tumor tissue resulting with the diagnosis of malignant lesion, then the patient was referred to transoral laser-microsurgical resection . Final hThe computed tomography (CT) scans made before surgical resection with the use of CO2-laser showed the presence of a tumor measuring 19 × 12 mm and height 21 mm, within the pedicle of the epiglottis on the left side and the anterior 2/3 of the left vestibular fold, invading the anterior commissure and reaching the vocal fold without any obvious features of vocal fold infiltration. In addition, the correct CT image of the entrance to the larynx, epiglottis, subglottic area of the larynx and the part of the trachea included in the examination , 4.After the surgical resection the Oncological Board referred the patient for adjuvant radiotherapy. He received a full cycle of radiotherapy as planned- 60 Gy. The patient stays under the care of an outpatient clinic. No signs of tumor recurrence were observed in over 18 months of observation. The patient has a socially efficient voice, but he's dealing with the side-effects after radiotherapy  on a manageable level.Lymphoepithelioma was described in 1921 separately by Regaud and Schmincke as nests of non-keratinizing squamous cells embedded in a lymphoid stroma (Regaud) and isolated transitional cells scattered in lymphoid tissue resembling sarcoma (Schmincke) , 7.The non-differentiated tumor  is more prevalent in the African and Chinese populations , 6. TherThe tumor is rarely located outside of the nasopharynx. In 75% of cases lymph node invasion at the time of diagnosis is present and metastatic disease is described in almost 30% of the cases. The most common sites of metastasis are bones, lungs, and liver , 9. No sThe lymphoepithelioma of the larynx may arise from lymphatic tissue in the laryngeal ventricle. The microscopic studies on the origin and biology of the tumor showed the presence of single or double laryngocele in 70% of cases of laryngeal and parapharyngeal carcinomas in surgical specimens , 10. CylThe lymphomas and lymphoepitheliomas of the larynx are very difficult to distinguish clinically, usually presenting as smooth supraglottic masses involving the epiglottic area or aryepiglottic fold . CytokerDue to the rarity of LEC in the larynx and hypopharynx the current literature provides only recommendations and there are no available treatment guidelines.Treatment options include surgery and radiotherapy (primary and adjuvant) . Due to Our patient received a full cycle of planned adjuvant radiotherapy. Chemotherapy was not scheduled in our patient's case.Concluding, we have presented a case of a rare laryngeal malignancy treated with success by the surgical excision and adjuvant radiotherapy.


Dysembryoplastic neuroepithelial tumors (DNTs) are rare neoplastic entries of the central nervous system. Conventionally DNTs are with cortical location and predominantly occur in the temporal lobe associated with epilepsy. Subtentorial DNTs are rare entries. Herein we report a case of a two-year-old female with a DNT located in the cerebellum. The patient presented clinically with new onset gait instability, headaches and strabismus. Neuroradiology revealed a heterogenous, predominantly cystic lesion in the cerebellar vermis and left cerebellar hemisphere, which was interpreted as possible medulloblastoma based on the patient profile. Frozen section neuropathology was more suggestive of a low-grade glial tumor, with conventional histology and immunohistochemistry showing an admixture of glial and neuronal cells - a complex variety of DNT. Due to the histological appearance, differential diagnosis was required with other neuroglial tumors native to the posterior fossa, such as Lhermitte-Duclos disease. There have been several such published case reports, which, although of older patients, present with similar symptoms and neuropathological findings. The complexity of the neuropathological finding in posterior fossa DNTs can lead to future separation of this entry from conventional DNT, as was seen in the past with septum pellucidum DNT, now referred to as myxoid glioneuronal tumor. Dysembryoplastic neuroepithelial tumor (DNT) is a rare central nervous system (CNS) tumor with a predominant cortical location, diagnosed almost exclusively in the pediatric population, with a male and Caucasian predominance -3. The WClinically the main presenting feature is that of epileptic seizures, with around 6% of epilepsy cases being associated with DNT. The diagnostic criteria for the tumor include neuroimaging of a cortical mass without mass effect and peritumoral edema, sharply demarcated from the surrounding parenchyma, lobulated and a magnetic resonance imaging (MRI) fluid-attenuated inversion recovery (FLAIR) longitudinal relaxation time (T1) iso- or hypointensity and transverse relaxation time T2) hyperintensity, with some tumor showing cystic and multicystic transformation . Neuropa hyperintDNTs are most often located in the temporal lobe, in nearly 70% of cases, with other CNS locations being rare . So far,The patient, a two-year-old female, presented to our institution with new onset gait instability, headaches, and strabismus steadily developing over the past two months. Pregnancy, delivery, neonatal, and early developmental period were uneventful, with no significant medication use. Pediatric neurology revealed only gait instability without any additional findings. A CNS MRI revealed a posterior fossa multicystic tumor involving the cerebellar vermis and left cerebellar hemisphere, with a T1 hypointensity and T2 hyperintensity, without significant peritumoral edema and a largest diameter of 48mm, compressing the fourth ventricle and leading to dilation of the ventricular system   from the tumor revealed parts of the cerebellar cortex with a tumor proliferation involving both the cortex and white matter of the cerebellum comprising of a myxoid stroma with admixed glioneuronal components with small oligodendroglioma-like cells, pyloid astrocytes, and floating neurons. Areas of microcystic degeneration, myxoidisation, and malformative blood vessels were also noted throughout the specimen Figures -3C.Immunohistochemistry revealed S100 protein expression in the oligodendroglioma-like cellular component, glial fibrillary acidic protein (GFAP) in the astrocytic components, synaptophysin positivity neuron-specific enolase and neurofilament expression in the floating neurons, Ki-67 proliferative index was high in regard to tumor cellularity Figures , 5A-5C. One and a half years after the operation, the patient is stable, with improved neurological status and good neuropsychiatric development. Regular neuroradiology shows no recurrence of the disease and resolution of the hydrocephalus Figures , 6B.The principal differential diagnosis in our case is neoplasms native to the posterior cranial fossa, mainly medulloblastoma . Within As per the 2021 WHO classification of nervous system tumors, MGT is a newly defined entry, previously identified as a DNT-like neoplasm, most commonly diagnosed in the pediatric population and with an identical neuroradiological finding; however, despite classically being located in periventricular areas, most often it is not associated with the cortex, but with the septum pellucidum ,14.Furthermore, in our case, as seen in Figure To date, there have been only a few reported cases of DNT with cerebellar location, with Yuan et al. reporting a case that is virtually identical to ours, both in the patient profile and the presenting symptoms . Other sBased on the previous separation in the classification of DNT and DNT-like tumors of the septum pellucidum, it is likely that based on the complex morphology of cerebellar DNT tumors, that they would also be separated from this group in the future as a unique entry.DNT is a rare glioneuronal tumor classically located in the temporal lobe and associated with the cerebral cortex, clinically manifesting with epileptic seizures in both the pediatric and adult populations. The presented case enriches the spectrum of DNT with cerebellar locations, which as exceedingly rare entries, necessitate a broad set of differential diagnoses both on their clinical manifestation, and neuroradiological and neuropathological findings.Unlike DNTs with a classical location and furthermore, in a pediatric patient, our case presented with new onset gait instability and strabismus, which, based on the few similar cases published so far, can be considered a classical feature of the tumor in this location.