Cancer secondary to dermatomyositis (DM) is defined as paraneoplastic dermatomyositis, which is one of the major subtypes of DM. However, cases of DM with intrahepatic cholangiocarcinoma (ICC) are rarely reported. In the course of our clinical work, we encountered a case of a middle-aged female patient who was diagnosed with DM for 7 years and then diagnosed with ICC, and we would like to share this case. In addition, in order to further investigate the deeper mechanism of ICC associated with DM, we also analyzed the dataset related to DM and ICC in the Gene Expression Omnibus (GEO) database based on the machine learning methods and found that poly(ADP-ribose) polymerase family member 12 (PARP12) and metallothionein 1M (MT1M) were closely associated with ICC secondary to DM. They are potentially important biomarkers for predicting the occurrence of ICC in patients with DM.  HowevDermatomyositis (DM) is a main subtype of idiopathic inflammatory myopathy (IIM), which is characterized by multi-system involvement of the skin and muscles, which is more common in women and can develop in both adults and children . Studies2Here, we will share a case of ICC associated with DM that we encountered in our clinical work. The patient was a 55-year-old woman who presented to the clinic with “right upper abdominal distension for 2 weeks”. Physical examination revealed no jaundice, flat abdomen, no gastrointestinal type, no peristaltic waves, and no abdominal wall varices. The bowel sounds were three times every minute. The whole abdomen is soft, with no pressure pain and rebound pain, no muscle tension, and no palpable abdominal mass. Her Murphy’s sign was negative. Past medical history indicated that the patient had a previous history of dermatomyositis for 7 years, and the rest was not specific.33.1The abdominal computed tomography (CT) axial scan and enhancement suggested hypodense foci in the right posterior lobe of the liver and multiple cysts in the liver (3.2Magnetic resonance imaging (MRI) of the abdomen suggests that abnormal signal foci were seen in the right lobe of the liver with a low signal in T1-weighted imaging (T1WI) (3.3Carbohydrate antigen 199 (CA19-9) was 1,000.00 U/ml. Carbohydrate antigen (CEA) assay was 7.02 ng/ml. Carbohydrate antigen 125 (CA12-5) was 183.20 U/ml. Alpha-fetoprotein (AFP) was normal.4Combined with the patient’s medical history, imaging presentation, and tumor marker levels, the patient was diagnosed with liver-occupying lesions and dermatomyositis. After evaluation, the patient was eligible for surgical resection, and the patient was subsequently treated surgically. The surgical procedure was as follows.Tracheal intubation was performed after general anesthesia was administered to the patient. The skin, muscle, and peritoneum were incised layer by layer along the right subcostal margin, and the incision was approximately 20 cm long. Exploration of the abdominal cavity did not show any foci of the abdominal cavity, omentum, or abdominal wall displacement. The liver was normal in morphology and soft in texture and showed no sclerosis. The adhesions around the gallbladder were lax, and after the separation of the adhesions, a space-occupying lesion was seen in the right hepatic lobe, which was cystic and soft when it protruded toward the diaphragmatic plane. The lesion protruding to the visceral surface showed solid changes and protruded from the liver surface, partly located behind the gallbladder; the rest of the liver showed no abnormality. Considering that part of the tumor is located behind the gallbladder, the gallbladder cannot be preserved, so we performed “partial hepatectomy and cholecystectomy” on the patient: the right half of the liver was fully freed, the gallbladder triangle was anatomized, and the gallbladder was regularly resected. The hepatoduodenal ligament was dissected; the right and left hepatic ducts, the right and left hepatic arteries, and the right and left branches of the portal vein were isolated; the right branch of the portal vein and the right hepatic artery were blocked. The tumor was completely resected with an ultrasonic knife 2 cm from the edge of the tumor, and the bile ducts and blood vessels encountered in the cross-section were exactly ligated or sutured and blocked for approximately 20 minutes. The patient bled approximately 300 ml during the operation.55.1First evaluation: (liver) pathological examination of the sample sampling suggested that no cancerous tissue was seen. Second delivery: moderately differentiated adenocarcinoma of intrahepatic bile duct with vascular and nerve invasion was seen , CK7 (+), CK20 (−), CDX-2 (−), Ki67 (index 80%), Vimentin (−), TTF-1 (−), Tg (−), CA125 (+), Pax-8 (−), CA199 (+), GATA-3 (−), Villin (+) CR (+), MC (−), D2-40 (−), and CEA (+).6Combined with the pathological diagnosis and immunohistochemical results, the patient was finally diagnosed with ICC intermediate differentiated adenocarcinoma. The patient made a good overall recovery after surgery and expressed satisfaction with the surgical treatment. After surgery, she was transferred to the Department of Medical Oncology to continue chemotherapy and DM-related treatment. Up to our last follow-up visit, the patient showed no signs of cancer recurrence.Based on this case report, the deep-seated association between the two diseases was of deep interest to us, so we further explored the relationship between the two diseases at the genetic level. We searched the Gene Expression Omnibus (GEO) database and found DM datasets GSE46239/GSE1551 and the ICC dataset GSE32225. Then, based on machine learning methods, we explored the three datasets to identify the causes of ICC associated with DM.77.1Based on the DM and ICC dataset, the differentially expressed genes in the two diseases were screened with the screening condition of |LogFC| ≥ 1, p < 0.05. The results showed that there were 635 differentially expressed genes in ICC and 80 differentially expressed genes in DM, and the heat map  level. The molecular function (MF) level is mainly enriched in double-stranded RNA binding, chemokine receptor binding, and chemokine activity and mainly enriched in coronavirus disease–COVID-19, influenza A, hepatitis C, and other pathways  positron emission tomography–computed tomography (PET-CT) scan. Because cancer cells are generally more metabolically active than normal tissues, they require more energy and therefore absorb and retain more energy than non-cancerous cells. Cancer cells take up and retain more glucose. This case presents a patient with DM showing intense proximal muscle diffuse FDG uptake on whole-body PET-CT scans before the development of any muscle symptoms  family , which uin vitro, reduce MT1M expression, and promote tumor cell proliferation and migration , MT1M expression levels were found to be downregulated, and MT1M was found to inhibit esophageal carcinoma cell carcinogenesis through the inhibition of epithelial–mesenchymal transition and SOD1/PI3K axis . In lungigration . In anotigration , 28.Next, based on machine learning, we found that PARP12 was significantly upregulated in both DM and ICC, and PARP12 was also found to be a risk factor for ICC in the nomogram risk model, thus inferring that PARP12 may play a role in promoting the development of ICC in DM, while MT1M was upregulated in DM and significantly downregulated in ICC. It is suggested that MT1M expression is a risk factor for ICC, suggesting that we can largely predict the occurrence of ICC by measuring the expression level of MT1M in DM patients, which has a predictive effect on the development of ICC in DM patients. Both of them are potential predictive targets for ICC in DM.9PARP12 and MT1M are important predictive targets for ICC associated with DM.The original contributions presented in the study are included in the article/Written informed consent was obtained from the individual(s), and minor(s)’ legal guardian/next of kin, for the publication of any potentially identifiable images or data included in this article.Two authors contributed equally to this report, sharing the first authorship. The data collection and analysis were performed jointly. XZ wrote the article, and BC reviewed and revised it. All authors contributed to the article and approved the submitted version.


Hemolymphangioma is an uncommon benign tumor type that commonly occurs in the head and neck. Primary spermatic cord hemolymphangioma (SCH) with only several reported, however, is extremely rare. Clinical diagnosis can be challenging because of its rarity. Although spermatic cord hemolymphangiomas are benign tumors, there is still a high recurrence rate in postoperative. A 15-year-old boy presented to our hospital with complaints of scrotal for 15 days and did not have other associated symptoms. The male genital color Doppler ultrasound revealed that a cystic echo in the left spermatic cord region and above the testes was about 32 mm × 20 mm × 14 mm. He underwent left en bloc scrotum tumor resection under general anesthesia, and pathologic examination showed SCH. He was discharged from the hospital in the second postoperative day. After 1-month follow-up, the patient recovered well without recurrence. The patient is currently in follow-up phase. Up to date, only a few cases have been reported in the literature about SCH. So, we hope to raise the awareness of the diagnosis of SCH in clinical practice although this case. Hemolymphangioma, also known as angioma lymphaticum, is a congenital benign tumor of malformed blood and lymphatic vessels, not a true neoplasm that shows a mixture of blood vessels and lymphatics . It is chttp://www.ncbi.nlm.nih.gov/pubmed; accessed on 13 May 2023).Hemolymphangioma occurs mostly in children, and its incidence rate was 1.2–2.8 per 1000 newborn infants . HemolymSCH is extremely rare, which could readily misdiagnose with other diseases such as spermatic cord tuberculosis, spermatic cord cyst, and spermatic cord hydrocele. There are no standard treatments for SCH. SCH is rarely a benign disorder, which may invade the surrounding organs, and it has a high rate of local recurrence.Therefore, in this paper, we describe the first complete en bloc surgical tumor resection for SCH and show favorable results. In this case report, we aim to increase awareness of this rare condition and share our experience with diagnosis.A 15-year-old boy presented to our hospital with complaints of scrotal for 15 days and did not have other associated symptoms on 28 March 2023. The male genital color Doppler ultrasound revealed that the root of the scrotum on the left side and inguinal area was anechoic before 4 days admission in other hospital. Physical examination is as follows: T 36.0 °C. There was a round mass about 25 mm × 20 mm, with a smooth surface and good elasticity, arising from the root of the scrotum on the left side. Alpha‐fetoprotein (AFP): 1.13 ng/mL, carcinoembryonic antigen (CEA): 3.15 ng/mL, human chorionic gonadotropin (β-hCG): 0.10 mIU/ml, lactate dehydrogenase (LDH): 142.80 U/L, and erythrocyte sedimentation rate (ESR): 3 mm/h. Tuberculoid-specific cellular immune responses and tuberculosis antibody test were negative. The male genital color Doppler ultrasound revealed that a cystic echo in the left spermatic cord region and above the testes was about 32 mm × 20 mm × 14 mm  that was elastic, soft, and homogeneous with a light black area, with an irregular shape and irregular margins. Postoperative patient underwent anti-infection, detumescence, and other drug treatments. In order to define the tumor was removed completely, scrotal ultrasonography was performed again, and no obvious abnormalities were observed. The pathological result indicated that most luminal tissues were dilated in the tumor tissue submitted (Fig. The patient was discharged from the hospital in the second postoperative day, with no complications. After 1-month follow-up, the patient recovered well without recurrence. Due to the high recurrence rate, 6-month assessment is advised after post-operative and then annually thereafter until 3 years after the operation. Shortening the interval of follow-up time should be emphasized after partial surgical resection of the tumor. The patient is currently in follow-up phase.Our case seems to be the first reported case of complete en bloc surgical tumor resection for SCH to the best of our knowledge.Hemolymphangioma is a rarely benign neoplasm arising from the mesenchymal tissue, which could most commonly arise in the oral and maxillofacial head and neck regions . HoweverUsing PubMed, we searched by “hemangiolymphangioma [All Fields]” OR “hemolymphangioma [All Fields]” and “Spermatic Cord [MH]” OR “Cord, Spermatic [All Fields]” OR “Cords, Spermatic [All Fields]” OR “Spermatic Cords [All Fields]” OR “Funiculus Spermaticus [All Fields]” the literature published through May 2023. Only one case report of SCH was found . The patThe onset of SCH can be insidious and requires high clinical suspicion. Color Doppler ultrasound, CT, and MRI are useful imaging modalities in the diagnosis of this disease. The color Doppler ultrasound can be effectively found in a cystic echo pattern. Cysts have an irregular shape, smooth surface, and unclear boundaries within the tubular anechoic region. The CT scan and MRI are both universal imaging techniques used to determine tumor extent and the invasion of the tumor. Hemolymphangiomas are usually cystic solid or solid tumors. Solid tissue may represent remnants and compressed vascular tissue, while cystic tissue results from ruptured and fused lymphatic vessels, of which depend on the composition of the blood vessels and whether co-infection or bleeding . The useIn spite of hemolymphangioma’s benign nature, recurrence and invasion of adjacent organs have been reported . To dateSCH is an extremely rare benign tumor. The spermatic vein was kept intact, and the tumor was completely resected in our case. Hence, as of now, there are almost no cases of complete excision of the tumor in patients with SCH. In our patient, provide new insights into SCH prognosis and complete excision of the tumor for SCH cases.


Frequently misdiagnosed, the clinical condition of soft tissue hematoma typically emerges following blunt abdominal trauma and/or anticoagulant medication usage, with spontaneous occurrences being infrequent. In this case report, we present a spontaneous rectus sheath and iliopsoas hematomas without obvious classical risk factors. The purpose of presenting this case is to bring attention to this unusual clinical condition and emphasize the role of thorough history and physical examination in determining the suitable course of treatment.A 50-year-old woman with no medical history presented at the emergency room due to sudden asthenia and abdominal pain. Physical examination revealed a painful 20 cm hypogastric mass and left lumbar swelling causing leg bending. Lab tests indicated anemia and normal coagulation. CT scans showed significant hematomas in the left rectus and psoas muscles. Intensive monitoring and supportive measures stabilized her condition without resorting to surgery.Soft tissue hematomas, notably in the rectus sheath or iliopsoas muscle, are rare but potentially severe conditions. Their pathophysiology is not fully understood, and risk factors include age, anticoagulant use, and comorbidities. Diagnosis involves abdominal examination, anemia, and CT findings. Management varies based on symptom severity and blood loss, ranging from conservative approaches to surgery or embolization.Swift identification and effective handling of soft tissue hematomas hold utmost importance. The thorough history-taking and comprehensive physical examination play pivotal roles within this protocol. While supportive care constitutes the primary mode of management, instances arise where surgical intervention or vascular embolization becomes imperative for hematomas unresponsive to treatment and presenting hemodynamic instability. •Uncommon Spontaneous Hematomas: An uncommon occurrence of spontaneous rectus sheath and iliopsoas hematomas.•Diagnostic Challenges and Multidisciplinary Approach: The article highlights the diagnostic challenges posed by soft tissue hematomas.•Successful Conservative Management: The study showcases a successful conservative management strategy for spontaneous hematomas. In thThis work has been reported in line with the SCARE 2020 criteria .2A 55-year-old female, a homemaker with no prior medical or surgical history, and no history of antiplatelet or anticoagulant use, presented at the Mahmoud El Matri Hospital in Ariana, Tunisia, at the emergency care clinic with asthenia and abdominal pain of one-day duration. She reported the sudden onset of a hypogastric swelling that had been evolving for the past two days. The thorough history did not uncover fever, nausea, vomiting, changes in bowel habits, cough, trauma, or minor concussion. Symptoms appeared suddenly and acutely after lifting a heavy object.Upon physical examination, an elevated heart rate of 105 beats per minute and stable blood pressure of 120/75 mmHg were observed. The respiratory rate was normal. Cutaneous pallor of the mucous membranes was also noted. During the abdominal examination, a hypogastric mass measuring 20 cm in its largest dimension was palpated , and it Laboratory data revealed acute anemia with a hemoglobin level of 5 g/dL and hematocrit levels at 17.5 %. Blood group was A positive. Hemostasis assessment fell within the normal range. Serum electrolyte and kidney function test results showed no abnormalities.Regarding the patient's hemoglobin level, it's important to consider whether bleeding occurred at other sites that might have contributed to the hemoglobin level reaching 5 g/dL. We thoroughly explored potential sources of bleeding, including transrectal, vaginal, and upper gastrointestinal bleeding, and found no abnormal findings.An emergency computed tomography (CT) scan was performed, revealing a large hematoma in the left rectus muscle that communicated with the preperitoneal space and the ipsilateral para-rectal fossa. The hematoma measured 185 mm by 93 mm in axial dimensions and 220 mm in sagittal dimensions. Its density was heterogeneous with areas of spontaneous hyperdensity not enhanced and hypodense zones. The pelvic organs were displaced to the right side . AdditioThe patient received transfusions of packed red blood cells and fresh frozen plasma with a positive transfusion response. The course was marked by stable hemodynamic status, and the post-transfusion hemoglobin level reached 10 g/dL (after 10 units of packed red blood cells and 5 units of plasma). It was decided to proceed with observation.The patient was discharged following a gradual recovery of leg function with the assistance of physical therapy. In the one-month follow-up, there were no unfavorable outcomes. Additionally, upon discharge, the patient was referred for further hematological evaluation to eliminate the possibility of an underlying cause for this hematoma, particularly a rare coagulopathy. The hematological assessment, however, did not identify any coagulopathy or other factors that could explain the occurrence of this hematoma.3We presented a successful case of conservative management for spontaneous iliopsoas and rectus sheath hematomas resulting in acute anemia. The primary highlight of our study lies in the prompt diagnosis and effective conservative approach, facilitating the patient's recovery without resorting to surgery. However, a notable limitation is the relatively short duration of follow-up.Soft tissue hematomas can manifest in various locations, although they are most commonly observed within the rectus sheath or iliopsoas muscle .Spontaneous iliopsoas hematoma is an uncommon condition, with an estimated prevalence ranging from 0.6 % to 6.6 % . The incRectus sheath hematoma (RSH) is typically seen in the context of blunt abdominal trauma and/or anticoagulation therapy, rarely occurring spontaneously ,3,6. ThiCoagulopathy caused by hemophilia or the increasing utilization of anticoagulant and antiplatelet treatments could potentially contribute to the higher incidence of reported cases of soft tissue hematomas . The preClinical symptoms are nonspecific ,3. The pThe treatment approach depends on the extent of hemorrhaging, the patient's hemodynamic status, and the presence or absence of neurological deficits ,6. ThereSurgical intervention is linked to notable morbidity given the advanced age and presence of multiple comorbidities in these individuals . Coil orFor patients with mild symptoms, conservative management involving bed rest, blood transfusion, and potentially administering anticoagulant antagonist medications is usually adequate ,3. Spont4We present this case due to its uncommon occurrence among spontaneous hematomas. Its uniqueness lies in the absence of typical factors like anticoagulants and trauma. The presentation with atypical acute anemia underscores the importance of early diagnosis, and the effective conservative management highlights minimally invasive approaches.Spontaneous soft tissue hematomas are a potentially life-threatening condition . Given tWritten informed consent was obtained from the patient for the publication of this case report and its accompanying images. A copy of the written consent is available for the Editor-in-Chief of this journal to review upon request.The author(s) declared that no grants were involved in supporting this work.AI tools were not used for the elaboration of the manuscript.Ethical approval is not applicable/waived at our institution.This research did not receive funding from any specific grant provided by public, commercial, or not-for-profit organizations.Med dheker touati and Sana landolsi contributed to manuscript writing andediting, and data collection; Med raouf ben othmane and ahmed omry contributed to data analysis;Fahd Khefacha and Faouzi chebbi contributed to conceptualization and supervision;All authors have read and approved the final manuscript.Dr. Med Dheker Touati.1.Name of the registry: N/A.2.Unique identifying number or registration ID: N/A.3.Hyperlink to your specific registration (must be publicly accessible and will be checked): N/A.No conflicts of interest.


The aim was to present a 35-year-old female patient with diagnosis of monophasic primary pericardial synovial sarcoma (PSS) with cytopathological findings.The case with back pain, palpitation and weakness, was diagnosed with pericardial effusion and suspicious mass adjacent to right heart in ultrasonography. Computerized tomography showed mass 12 × 11 × 6.5 cm in size, located in right mid-anterior pericardial area, with heterogeneous internal structure, heterogeneously contrasting right heart and prominent pressure on superior vena cava. Cytopathology of pericardial effusion showed monotonous cells with oval-spindle vesicular nuclei, less amphophilic cytoplasm, evenly distributed chromatin and inconspicuous nucleoli. The pericardial mass was resected incompletely, spindle cell mesenchymal tumor with hypercellular fascicular structure and with infiltrative margins, containing a small amount of loose myxoid stroma, occasionally necrotic areas was observed histopathologically. Immunohistochemical positive reaction was for vimentin, Bcl-2, TLE-1. Accordingly, the case was diagnosed with monophasic PSS.This case of monophasic primary PSS was an extremely rare malignancy diagnosed with the cytopathological findings. Synovial sarcoma accounts for 5–10% of all soft tissue sarcomas. The lesion is often observed as a soft tissue tumor in the extremities of young adults. Localization of synovial sarcoma in the pericardium has rarely been reported in the literature –4. AmongA 35-year-old female patient arrived at our department complaining of back pain, heart palpitations, and fatigue due to the large size of pericardial mass causing a pressure symptom. No symptoms of hypertension, fever, extrasystoles were found on physical examination, and no arrhythmia or rhythm disturbances were found on the electrocardiography. No previous medical and family history was declared by the patient. A chest X-ray showed that the patient’s cardiothoracic ratio was enlarged and that her cardiophrenic sinus was obscured on the right side see Fig. . A transA contrasted CT scan of the chest showed a heterogeneously enhanced lesion measuring 12 cm x 11 cm x 6.5 cm located in the right mid-anterior of the pericardial area see Fig. . The masAfter the radiological examinations, the pericardial mass was decided to be resected. During thoracotomy, the pericardial mass was found to invade the ventricular wall and main vascular structures, therefore, the mass was resected incompletely. Due to the location, extent and nature of the tumor, debulking surgery was performed and R0 surgery could not be performed. Macroscopically, any palpable lymph node was not detected during the surgery.Histopathologically, a spindle cell mesenchymal tumor with infiltrative limited hypercellular fascicular structure containing a small amount of loose myxoid stroma hyalinized, and necrotic areas showing mild to moderate pleomorphism were observed in fragmented mass samples see Fig. a. A nuclPostoperative radiotherapy and chemotherapy were advised but refused by the patient at first place. On postoperative 4th month, the patient decided to undergo the oncological therapies, however, a six-week pregnancy was detected, therefore, only radiotherapy was applied due to the enlargement of pericardial mass. The chemotherapy was postponed for one year. After the term delivery, the patient suffered from the respiratory distress due to enlargement of the mass in the pericardial region to 14 cm in diameter, therefore, six cycles of doxorubicin and ifosfamide combination were administered. An emboli in the left main pulmonary artery, a pleural effusion in the right hemithorax, and a metastatic mass in the liver were detected. The patient whose respiratory parameters deteriorated was followed up in the intensive care unit. During this follow-up, the patient, who had myocardial infarction 21 months after the operation, died.Primary pericardial sarcomas are a group of extremely rare malignancies that constitute approximately 10–15% of all primary cardiac sarcomas. These aggressive sarcomas are classified into histopathological subtypes, including fibrosarcoma, angiosarcoma, undifferentiated sarcoma, leiomyosarcoma and, synovial sarcoma , 7.Examinations involving PSS include a chest X-ray that may reveal the presence of a pericardiac mass in a widened mediastinum . EchocarMalignant pericardial effusions represent an advanced stage of malignancy and are less common than pleural or peritoneal effusions. Therefore, the clinical and cytopathologic features of these cases have rarely been reported. Studies conducted on pericardial effusions are relatively rare and have been limited to case reports and small series. Occasionally, a cytology examination cannot help to differentiate reactive mesothelial cells from malignant mesothelial or metastatic cells . If a cyThe biphasic type of PSS that is composed of an epithelial component and a spindle-cell component is more common than the monophasic type composed of only spindle-cells and poorly differentiated small round cells clustered in a fascicular pattern , 13. ConThe differential diagnosis of PSS includes various other mediastinal and pericardial tumors, including mesothelioma, fibrosarcoma, thymoma, metastatic carcinoma, and other soft tissue sarcoma. Tumor histology may show a similar appearance to PSS, so to differentiate PSS from other sarcomas, the immunohistochemistry for vimentin, BCL-2, CD99, and TLE1 are common positive markers . The samThis case of PSS is an extremely rare malignancy, and it appears that it would be the first case with cytopathological findings to be published in the international literature. Because the progression of PSS is very rapid and because the morbidity and mortality rates of young people with PSS are relatively high, an aggressive surgical resection should be performed as soon as a patient is diagnosed. It should also be noted that FNAB is a helpful diagnostic method if it can be supported by molecular pathology.


Colorectal small cell carcinomas are very rare neuroendocrine malignancies of the colon or rectum. They have poor prognosis due to the aggressive and highly recurrent nature of the disease. It is a malignancy that is also poorly understood with limited literature, and thus there is no consensus in management. This case report presents the clinical features and radiological images of an otherwise healthy 74-year-old gentleman with a rare and aggressive 112-mm rectosigmoid small cell carcinoma with evidence of metastatic disease. This report will also discuss the most current and pertinent diagnostic and therapeutic recommendations from the literature. Colorectal small cell carcinomas (CSCCs) are very rare, aggressive, and highly recurrent neuroendocrine malignancies of the colon or rectum . CSCCs aA 74-year-old man was referred to the colorectal clinical by his general practitioner with a six-month history of lower abdominal pain, loose bowel motions, bleeding per rectum, and unintentional weight loss. He underwent a computer topography (CT) one month prior to clinic review, which showed a focal 89-mm partially necrotic pelvic mass. The patient had no past medical history. The only surgical history was a bilateral laparoscopic inguinal hernia repair with mesh. There was no family history of colorectal cancer, and he has had no colonoscopies in the past. He was an active smoker of 40 pack-years. The only pertinent finding on physical examination was suprapubic abdominal tenderness. Hematological investigations showed a carcinoembryonic antigen (CEA) of <1.0 mg/mL (<5.0 mg/mL) and chromogranin A of 454 ug/L (20-102 ug/L). An urgent colonoscopy demonstrated a 9-cm fungating, circumferential, and partially obstructing mass approximately 8 cm from the anal verge  demonstrated the same rectosigmoid tumor with direct invasion of the presacral fascia above the anterior peritoneal reflection, direct invasion of the inferior mesenteric vein, and a 5-mm left obturator lymph node (Figure A multidisciplinary approach was taken, and the patient was consequently referred to medical oncology for neoadjuvant chemotherapy and planned anterior resection of the rectum with creation of loop ileostomy. However, due to the rapid deterioration of health in the context of the ICU admission for uroseptic shock, the patient and his family later decided against radical surgical resection and opted for palliative transition instead. He was discharged home to comfort care. No palliative radiotherapy or chemotherapy was undertaken.CSCCs are very rare and poorly understood extrapulmonary neuroendocrine carcinomas of the colon or rectum . They reCSCCs usually manifest asymptomatically; however, non-specific abdominal features such as abdominal pain, per rectum bleeding, changes in bowel movements, and constitutional symptoms have been reported ,4. FeatuCurrently, there is no consensus on the optimal treatment for CSCCs due to poor prognosis and high recurrence of disease. Most therapeutic suggestions are extrapolated, due to limited evidence, from the more common pulmonary variation of SCC ,3. ThereIn conclusion, CSCCs are very rare, difficult to clinically diagnose, and aggressive colorectal malignancies with no prognostically significant treatment. There is no consensus on management. Available literature on CSCCs is also heterogenous and mostly in the form of case reports. This case report highlights the importance of early diagnosis and a multidisciplinary approach to holistic and patient-centered treatment. Given the rarity of the disease and limited research, an international registry should be created to collect data on cases of CSCCs with the aim to improve diagnostic and therapeutic outcomes.


During our practice as clinical surgeons, we have encountered situations in which exploratory abdominal laparotomies have yielded unexpected outcomes, despite conducting thorough and rigorous preoperative studies. A rare condition called sclerosing encapsulating peritonitis (SEP), in which a fibrocollagenous membrane encircles the intestine and other abdominal organs, surprised us in a case of an acute abdomen. Persistent descending mesocolon is another unusual condition in which the descending colon is transferred downward and to the right abdominal region because its mesocolon is unable to merge with the posterior abdominal wall. Those two different conditions are extremely rare and were never been described in a single case. We present a case of an 80-year-old male who presented in the emergency department with an acute abdomen and puzzled us. Despite meticulous preoperative investigation, exploratory abdominal laparotomy may present with unexpected findings, as several reported surgical cases indicate. Sclerosing encapsulating peritonitis (SEP) is one of the rare conditions in which a fibrocollagenous membrane forms in the abdomen, wrapping around parts of the bowel and other organs. This anatomical disorganization may eventually cause intestinal obstruction and present with signs and symptoms of acute abdomen . counter-clockwise rotate around the superior mesenteric pedicle, during embryologic development. After assuming the normal position, the colon surrounds the small intestine and inhibits its escape to other anatomical positions.Persistent descending mesocolon is another extraordinary disorder, the descending colon fails to fuse with the posterior abdominal wall and is transposed down and to the right abdominal area. It remains suspended by the mesocolon, but lies beneath the small intestine, along with parts of the drifted-away distal transverse colon. This is clearly due to the colon’s failure to normally 270°We report a case, which greatly puzzled us during exploratory laparotomy for acute abdomen, of the coexistence of these two rare pathologies - sclerosis encapsulating peritonitis (SEP) and persistent descending mesocolon. Both are uncommon developmental abnormalities of the lower gastrointestinal tract and, to our knowledge, they have not previously been reported to occur simultaneously.An 80-year-old male was brought to the emergency department with epigastric pain of acute onset, gradually worsening for two days, accompanied by nausea, vomiting, and subfebrile temperature (38°C). The patient’s medical record included hypertension, rheumatoid arthritis, and hyperlipidemia, but he had no history of abdominal pathology or prior surgery.Physical examination revealed upper abdominal distension, tenderness to palpation, and tympanic sound on percussion, but no signs of general peritonitis. Laboratory analysis demonstrated a white blood count (WBC) of 21.200 K/μL, c-reactive protein (CRP) value of 28.72 mg/dL, and mild hypoalbuminemia (2.7 mg/dL). Chest and abdominal x-ray and abdominal ultrasound showed no specific findings.The CT scan showed a large, circumscribed mass, occupying the epigastrium and most of the left hypochondrium and lumbar region. It consisted of a membrane-encased cluster of thickened and dilated small bowel loops, with interloop ascites. The mass displaced the transverse colon to the right and lower abdominal area, giving the unusual impression of small intestine lying over the third and fourth portion of the colon Figures -1F.The treatment of choice was emergency exploratory laparotomy, due to the patient’s gradually deteriorating status and abnormal CT findings. As soon as we entered the peritoneal cavity, we faced a large translucent, highly vascularized sac approximately 20 cm in diameter, projecting through the incision and containing several intestinal loops , the spleen (to the left), and the transverse and descending colon and mesocolon (to the right and below). The cecum with the ileocolic junction and the right colon  were greatly distended but remained in their anatomic location. The rest of the transverse colon and the distal parts of the large intestine appeared collapsed, yet the transition point was free of obstruction signs .To unravel the enigma, we followed the course of the terminal ileum from the ileocolic junction up. We could only measure approximately 10 cm of terminal ileum, before losing it through an opening of the transverse mesocolon. This opening seemed to connect the greater sac of the peritoneum with the interior of the abnormal sac. The sac’s content comprised the rest of the ileum and all the jejunum, up to the ligament of Treitz. All the loops were markedly distended. On thorough examination, we noticed a necrotic section, about 20 cm proximal to the entrance point of the intestine through the mesocolic opening, which we resected and closed the mesocolic opening Figure . Before Cytology of a sample of ascetic fluid and pathological evaluation of the resected ileum and a sample of the sac did not show evidence of neoplastic disease. The patient remained in the ICU for 41 days, during which he presented multiple atrial fibrillation episodes and was mostly nourished via a nasogastric tube. On the 36th day, the patient went back to automatic breathing. On the 41st day, he was transferred to our surgical department and 15 days later he was dismissed. The one-year follow-up was complication-free. He died after eight years due to an ischemic stroke attack.Sclerosing encapsulating peritonitis (SEP) has been given various names since it was introduced by Owtschinnikow in 1907 as “peritonitis chronica fibrosa incapsulata.” In 1978, Foo et al. introduced the term "abdominal cocoon syndrome" to describe its idiopathic form. Various names have been used over the years to describe it, such as icing sugar bowel, fibroplastic peritonitis, and peritoneal encapsulation. Apparently, the most appropriate term is encapsulating peritoneal sclerosis, because it excludes the word peritonitis, as it implies inflammation -4.SEP presents with two entities as follows: secondary, which is the most common type, correlated with other chronic fibrosing inflammatory conditions, such as tuberculosis, sarcoidosis, peritoneal dialysis, pelvic inflammatory disease, autoimmune disease, and hepatitis C virus infection -4. IdiopThe clinical diagnosis is difficult, because of the non-specific manifestations. Most of the patients present with symptoms of subacute intestinal obstruction, such as abdominal pain or distention, and in fewer cases with acute abdomen . PreoperThe typical radiological sign of SEP in a computer tomography (CT) scan is the image of a bunch of intestinal loops enclosed in a thickened sheath with continuous enhancement, whereas the normal peritoneum is barely visible and appears with discontinuous enhancement. Signs of obstruction may be present. The CT scan is additionally valuable for investigating the cause of a suspected secondary SEP. Abdominal ultrasonography and MRI can provide important clues as well .Differential diagnosis includes internal hernias into the lesser sac, that can occur through the foramen of Winslow, through a defect in the lesser or greater omentum, or through a defect in the transverse mesocolon. The latter is usually secondary to abdominal trauma or previous surgery . The sacSurgical treatment remains the gold standard for symptomatic patients. The therapeutic approach is surgical excision of the membrane and adhesiolysis . If the Several reports have suggested the correlation of idiopathic SEP with congenital anomalies, such as the absence of the greater omentum and gastrocolic ligament. Less commonly associated with it are hernia, accessory sac, and cryptorchidism . NotablyIn our patient, as is usually the case, the diagnosis of SEP was made when he presented with paroxysmal abdominal pain, due to obstruction. What was remarkable is that it brought to light an even rarer simultaneous congenital variant of the gastrointestinal tract, that has never been reported to accompany SEP.The sac containing the small bowel was found adjacent to the left abdominal wall, displacing the transverse and descending colon lower and to the right. This location of the sac could only be possible due to an aberrant positioning of the distal half of the transverse and the descending colon, in combination with the lowering of the left colic flexure (it was found right below the lower pole of the left kidney) Figure .The condition indicated persistent descending mesocolon, which represents the failure of the mesentery of the left colon to fuse with the posterior abdominal wall during fetal development, in the fifth month of gestation. As a result, the descending colon remains suspended by its mesocolon, and its location varies greatly. It commonly repositions medially, carrying away the left colic flexure and the distal transverse colon. This rearrangement of the colon leaves an area of the left abdomen free of viscera (the paracolic fossa) into which the small bowel may migrate. The ileocecal junction rests in the right iliac fossa, and the small intestine finds its way to it, passing right in front of the descending colon or, as in our case, through an opening in the mesocolon ,7.The condition is usually asymptomatic, because of the short height of the mesocolon and is accidentally diagnosed during routine examinations or an investigation of another pathology. Rarely, intestinal obstruction may be caused by colon twisting or internal hernia, when a long mesocolon is present .The obvious question is if the lower transposed splenic flexure of our patient fits the diagnosis of persistent descending mesocolon or if it is just a malrotation of the gastrointestinal tract that ended up with the small bowel pushing the left colon in a lower position. The latter possibility means that the intestinal migration and its peritoneal encapsulation occurred before the fifth gestational month and that he had lived with it, free of symptoms, for 80 years. Nevertheless, it is still a rare developmental deformity of the gastrointestinal tract, exceptionally associated with idiopathic SEP Figure .In any case, as it is important for clinical doctors, especially for surgeons to raise awareness of the existence of SEP, it is equally imperative to know that it can be associated with other, mostly innate, anatomical deviations. The preoperative suspicion can help determine the diagnosis, define the correct management, and most importantly protect the surgeon from clearly unpleasant surprises on the operating table.Sclerosing encapsulating peritonitis (SEP) and persistent descending mesocolon, two uncommon and separate pathological diseases, coexist in the case presented in this report, creating a unique and difficult therapeutic setting. The simultaneous presence of both of these uncommon lower gastrointestinal tract conditions is unheard of in the medical literature. The presence of SEP and its potential relationships with other congenital anatomical anomalies must be understood in therapeutic practice.


Myopericytomas usually occur in the extremities of older individuals; however, they also rarely occur in the penis. We report a case of myopericytoma in the corpus cavernosum of the penis and review the relevant literature.A 76‐year‐old man presented with a slow‐growing painless nodule on the left side of the penis. On physical examination, a non‐tender, 7‐mm mass was palpable. This tumor showed inhomogeneous low signal intensity on T2‐weighted magnetic resonance imaging. The mass was excised and a myopericytoma diagnosed by pathological examination of the operative specimen.We here report a rare case of myopericytoma in the corpus cavernosum of the penis. To the best of our knowledge, this is the second reported case of a myopericytoma in the penis and the first in the corpus cavernosum of the penis. Clinicians should keep this rare possibility in mind when investigating a mass in the penis. We here present a rare case of a myopericytoma in the corpus cavernosum of the penis. Clinicians should keep this possibility in mind when investigating a mass in the penis.MRImagnetic resonance imagingTUR‐BTtransurethral resection of bladder tumorMyopericytomas are composed of oval‐to‐spindle‐shaped myoid cells with a tendency to grow concentrically around vessels. They usually occur in the skin and superficial soft tissues of the extremities.A 76‐year‐old man presented with a small, elastic nodule on the left side of his penis. The mass had been growing for a year and had begun to cause discomfort. On physical examinations, a non‐tender 7‐mm mass was palpable. Ultrasound showed a hypervascular, hyperechoic, well‐circumscribed, solid mass. Magnetic resonance imaging showed a smooth marginated mass with peripheral low signal intensity on T2‐weighted images Fig. . Computeet al. in 1998et al. reported that metastases occur in approximately half of patients with malignant myopericytomas.Myopericytomas were first described by Granter Most primary penile tumors arise from penile skin, rarely from the corpus cavernosum.We here present a rare case of a myopericytoma in the corpus cavernosum of the penis. To the best of our knowledge, this is the second reported case of myopericytoma in the penis and the first in the corpus cavernosum. Clinicians should keep this rare possibility in mind.Hiroki Oshiro: Writing – original draft. Yousuke Shimizu: Supervision. Ryota Nakayasu: Supervision. Noriaki Utsunomiya: Supervision. Satsuki Asai: Supervision. Misa Ishihara: Supervision. Kimio Hashimoto: Supervision. Hiroki Katsushima: Supervision. Sojun Kanamaru: Supervision.The authors declare no conflicts of interest.N/A.We obtained written informed consent for the publication of details of his case from the patient.N/A.


Liposarcoma (LPS) is a common soft-tissue sarcoma predominantly diagnosed in adults, arising from malignant adipose cells. Among its various subtypes, myxoid LPS (MLPS) stands out as the second most frequent, accounting for ~30% of all LPS cases. This particular subtype typically manifests in males between the ages of 40 and 50 and is commonly found in the lower extremities. Although rare, MLPS may also occur in the head, neck, and infrequently in the back. Chest wall LPS cases are also sparsely reported.In this report, we present a case of MLPS in a 69-year-old male patient who presented with a complaint of firm swelling on the right posterior chest wall, which was progressively increasing in size over the past 10 years. The tumour was located in the posterior chest wall on the left side, and further diagnostic evaluation using computed tomography (CT) and MRI was conducted to identify its characteristics and extent.The use of CT scanning plays a crucial role in differentiating between various lipomatous tumour types, aiding in the identification and classification of MLPS. However, MRI emerges as a more effective technique for detecting microscopic fat compared to CT or ultrasonography, providing valuable insights for accurate diagnosis and treatment planning.Surgery remains the primary therapeutic approach for managing LPSs, including MLPS. Adjuvant preoperative radiation is recommended due to its significant sensitivity and potential for improved outcomes. Given the rarity of this presentation and the varied anatomical locations, a multidisciplinary approach is paramount in effectively managing such cases. Medical practitioners should collaborate closely, considering the unique challenges posed by MLPS to ensure optimal patient care and treatment outcomes. HighlightsThe study presents a rare case of myxoid liposarcoma (MLPS), which is extremely unusual for this subtype of liposarcoma (LPS) to occur in the posterior chest wall.A 69-year-old male with a decade-long history of hypertension and diabetes mellitus presented with a gradually enlarging firm swelling on the right posterior chest wall.The differential diagnosis for the firm swelling on the posterior chest wall that led to suspicion of a neoplastic lesion on ultrasonography is LPS or myxofibrosarcoma.Preoperative assessment of lipomatous and myxoid tumours often involves computed tomography scanning and MRI, with MRI being better at identifying microscopic fat and distinguishing LPS from other soft-tissue lesions.Surgery is the mainstay treatment for LPSs, with wide and deep surgical excision recommended for high-grade lesions. Preoperative radiotherapy is commonly used, while chemotherapy may have limited impact, especially for larger tumours.The exceptional rarity of this presentation underscores the imperative for a multidisciplinary approach among medical professionals to effectively manage such cases.1. Soft-tissue tumours comprise 50% of benign lipomas and around 1% of malignant sarcomas of soft tissue. These rare LPSs occurring in the adult population report a frequency of less than 1% and an incidence of less than 30 cases per million people. The location of the tumour, and more specifically, its histological pattern, has a significant impact on the tumour’s prognosis2.The most prevalent soft-tissue sarcoma in adults is liposarcoma (LPS), which is often a cancer of adipose cells. In a middle-aged individual, LPS often presents as a slowly growing, painless, non-ulcerated submucosal lump. Nevertheless, some lesions grow quickly and develop ulcers before others do3. MLPS is the second most prevalent type of LPS, contributing to around 30% of all LPS cases and is usually seen in the fourth and fifth decades of life, commonly manifesting in males5. This particular subtype frequently develops in the lower extremities6. They are occasionally found in the head and neck and seldom in the back7.LPS is classified into four main groups: Well-differentiated LPS , dedifferentiated LPS (DDLPS), myxoid LPS (MLPS), and pleomorphic LPS8.In the case presented, a MLPS was identified, which on computed tomography (CT) scan reporting was classified as a pseudocystic LPS. This case is particularly remarkable due to the location of the LPS, which is very unusual as it is uncommon to find this tumour in the back. The present case was reported in line with the SCARE 2020 criteriaA 69-year-old male with a known case of hypertension and diabetes mellitus presented to the outpatient department with a complaint of firm swelling on the right posterior chest wall, which has been progressively increasing in size for the past 10 years. The patient reported that the swelling was not painful but occasionally caused discomfort while lying down.On examination, the swelling was soft, non-mobile, and non-tender. Fluctuation and transillumination tests were negative. The overlying skin was unremarkable. Further evaluation revealed that the swelling had a well-defined border and was ~8 cm in diameter. The patient denied any history of trauma or previous surgeries in the area.The patient was advised an ultrasound of soft tissue, which revealed a well-defined hypoechoic lesion in the subcutaneous tissue of the left side of the back, showing arterial and venous flow on colour Doppler imaging, it approximately measured 9.3×7.0 cm, and raised suspicion of neoplastic lesion likely LPS. A CT scan of the back with contrast was advised, along with a biopsy for further evaluation.CT scan revealed a fluid density cystic area measuring about 9.8×8.8×3.8 cm (LS×TS×AP)  involving the subcutaneous tissue of the right posterior chest wall extending up to the midline. There was also mild adjacent fat streaking. It appeared inseparable from underlying posterior spinal muscles. A lymph node measuring 1.0×0.5 cm was seen in the paratracheal region. Included sections from the upper abdomen showed a calcified area in segment VIII of the right lobe of the liver, likely representing an old healed abscess or hydatid cyst. Furthermore, a trucut biopsy was taken and cores were sent to histopathology for a conclusive diagnosis.Multiple greyish-white liner cores measuring 0.5 cm in aggregate.Sections examined revealed neoplastic lesions composed of atypical spindle cells with mild to moderate nuclear pleomorphism set against a loose myxoid background. Few atypical lipoblasts-like cells were also appreciated with hyperchromatic indented nuclei and clear multi-vacuolated cytoplasm.Malignant neoplasm (sarcoma). Differential diagnosis includes LPS and myxofibrosarcoma in order of preference.The patient underwent surgical excision of the tumour, which revealed a large multi-lobulated cystic tumour arising from the muscles of the posterior chest wall, post-operative histopathological examination confirmed a MLPS. The patient continues to do well to date, with regular 6 monthly follow-ups scheduled to monitor the patient.Figures A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.9. It varies from highly cellular or pleomorphic malignant neoplasms to well-differentiated lipoma-like and myxoid tumours. The diverse microscopic image is reflected in the variable clinical behaviour10.One of the most prevalent malignant soft-tissue sarcomas in adulthood is the LPS, with around 13–60% originating in the thighs and less frequently in the retroperitoneum with no specific gender predisposition. This fat tumour, which is localised everywhere, typically presents as a slowly growing lump with a deceptively innocuous look11. The symptoms of pain typically arise when the tumour becomes large enough to have an impact on surrounding structures. Many patients present with oedema, loss of sensations, and tenderness due to nerve impingement12. In more than 90% of instances, MLPS is linked to a chromosomal translocation, most frequently t  , which causes the DDIT3 and FUS genes to fuse, leading to the production of the FUS-DDIT3 fusion protein13. Extrapulmonary areas, notably soft tissue and skeletal locations like the mediastinum and the retroperitoneum, are where MLPS tends to metastasize. Hence, it is crucial to make an early diagnosis and offer the best treatment choices since the disease has the potential to spread to distant places4. The chest wall LPS has been documented in a very small number of instances. These included two cases covered in subcutaneous tissue, one with a partly extended latissimus dorsi flap and one in the intermuscular area. Since LPSs often form in the intermuscular fascia, they frequently manifest on or underneath muscles7.LPS often manifests clinically as a painless soft-tissue tumour, similar to other kinds of soft-tissue sarcomas. Meanwhile, 10–15% of instances of LPS are painful14. On a CT scan, the LPS can have a pure fat, mixed, or pure fluid density, as seen in our case, which is very rare to find. Compared to CT or ultrasound, MRI is better capable of identifying microscopic fat15. By identifying an adipose component frequently found in these tumours, MRI with fat-saturated T1-weighted images and gadolinium-enhanced sequences is a useful tool for differentiating LPS from other kinds of soft-tissue lesions11. However, in some cases, chest X-rays, CT scans, or even PET scans, which have been shown effective in other soft-tissue sarcomas, may not be able to detect metastatic malignancy in MLPS16. To this date, the mainstay treatment of LPSs remains surgery. For high-grade lesions, wide and deep surgical excision, concomitant radiation, and/or chemotherapy may be required12. Due to its excellent sensitivity, adjuvant preoperative radiotherapy is recommended. Nonetheless, chemotherapy may have little impact, particularly in tumours bigger than 10 cm17.Preoperative assessment of soft-tissue lipomatous and myxoid tumours often entails the use of CT scanning. In addition to offering useful morphologic details, CT scanning aids in the distinction between various varieties of lipomatous tumoursRadiologists frequently have the challenge of identifying a deep soft-tissue mass. It is imperative for radiologists to provide a precise and timely preoperative diagnosis and determine the tumour’s extent in order to treat the sarcoma effectively. The very uncommon nature of this presentation highlights the need for medical professionals to address instances like this in a multidisciplinary manner.Ethics approval was not required for this case report as it does not constitute research according to the policies and guidelines of our institution. Institute: Liaquat National Hospital and Medical College, Karachi, Pakistan.Written informed consent was obtained from the patient for publication and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.Not applicable/nothing to declare.S.S. and S.E.A.: literature search and writing of manuscript introduction and discussion; M.Z. and R.A.: study design and writing of case report body and also reviewed the article; A.K.A., R.R., A.A., and T.A.: reviewed and supervised the article.Not applicable/nothing to declare.Not applicable.Talal Almas, MD.Not applicable to this article.Not commissioned, externally peer-reviewed.Not applicable.


Testicular ascent to the inguinal region after hernia repair has been previously reported as a rare complication of this surgery in pediatric patients. This article presents two cases of adult patients with ascending testicles after inguinal hernia repair that was performed in childhood. Both men underwent orchidopexy through a combined inguinal and scrotal approach, the latter for the creation of a sub-dartos pouch. In both cases, this intervention was completed successfully without complication and resulted in a satisfactory post-operative position of the testicles in the scrotal sac. This surgical approach appears to be a safe management option for adult men with ascending testicles after inguinal hernia repair. The development of ascending testicles after inguinal hernia repair has been reported in children ,2. SeparAscending testis has been reported to be a rare occurrence after repair of an inguinal hernia in children, ranging from 0.058% to 0.43% ,2. WhileThis article presents two cases of adult patients who underwent surgical intervention for ascending testicles, describes the surgical technique that was used, and provides the surgical outcomes.Case 1The first patient is a 26-year-old male, who presented to our clinic regarding a left undescended testicle. He underwent bilateral hernia surgery in infancy. He then had an orchiopexy 11 years ago in another country, as his left testicle ascended to the inguinal region following the hernia repair. The patient never felt the testicle in the scrotum after that attempt at orchiopexy but felt it in the inguinal area. He has not felt any masses. He reported occasional pain in the left inguinal region and up into the left lower abdomen, for which he requested treatment. He had no chronic illnesses. Physical examination revealed the left testicle to be palpable in the inguinal region; the right testicle was descended into the scrotum, of normal size, and without palpable masses.Ultrasound performed five years ago confirmed left testicle positioned in the left inguinal canal, mildly atrophic without masses. Repeat ultrasound two years ago demonstrated an asymmetric small size and mildly hypoechoic left testicle; the right testicle was descended and normal Figure .After counseling, the patient elected to proceed with left orchidopexy, which was performed under general anesthesia. The left testicle was then brought down to the scrotum and anchored in a sub-dartos pouch that was created in the left hemiscrotum. The patient tolerated the procedure well and was transferred to the recovery unit in stable condition.The patient recovered well from surgery with no complication. At follow-up 17 months after surgery, he reported complete resolution of pre-operative symptoms. His left testicle was palpable within the upper left hemiscrotum with no palpable masses.Case 2The second patient is a 37-year-old male, who initially presented to our clinic seven years ago regarding infertility. His past medical history was unremarkable. He reported a history of left inguinal hernia repair when he was three years old.Physical examination revealed descended right testicle of normal size and consistency and no varicocele. The left testicle was noted in the inguinal canal, which limited its evaluation. He had three semen analyses seven years ago, which showed severe oligospermia (sperm concentration ranged from 0.008 to 0.03 million/mL [reference range: 15 million/mL and above]) and necrospermia. Hormonal evaluation revealed serum levels of follicle-stimulating hormone (FSH) level at 9.5 mIU/mL (reference range: 1.4-18.1 mIU/mL), luteinizing hormone (LH) at 4.3 mIU/mL (reference range: 1.5-9.3 mIU/mL), prolactin at 4.0 ng/mL (reference range: 2.1-17.7 ng/mL), and testosterone at 330 ng/dL (reference range: 249-836 ng/dL). Karyotype was 46,XY, and Y chromosome microdeletion assay was negative. Scrotal ultrasound seven years ago showed a normal right testicle in the scrotum, with the left testicle in the inguinal canal.The patient was started on clomiphene citrate, and his serum testosterone increased to 480 ng/dL. However, semen analysis three months later showed normal volume azoospermia. He underwent right testicular sperm extraction seven years ago, during which mature and viable sperm was successfully retrieved and was cryopreserved. He returned to our clinic a year ago regarding his left undescended testicle. He then reported that he and his wife have a 10-month-old boy, who was conceived through in vitro fertilization.No surveillance has been performed since he was last seen in our clinic six years ago. He denied any pain in the left testicle. While he was able to bring the testicle down into the very high scrotum, this was difficult to do and did not allow for a reliable examination of the left testicle. Repeat scrotal ultrasound a year ago showed normal size (4.5 x 2.7 x 1.7 cm), shape, and echotexture of the right testicle, with scattered microliths; the left testicle was located in the left groin, smaller in size (3.6 x 2.0 x 1.5 cm), and normal in shape and echotexture, with no focal lesions. Color Doppler was normal in both testicles  of the patients, who were 1-3 years old [This article presents two cases of adult patients with unilateral undescended testicles that developed after inguinal hernia repair earlier in life. The first patient had a failed attempt at orchidopexy 11 years ago. Ascending testicle after an inguinal orchidopexy was reported to range from 0.2% to 13% [In both cases, patients’ decision to proceed with surgical repair of this condition was driven by their desire to have the testicle in a position that would allow for routine self-examinations, taking into consideration that extra-scrotal testicular location is associated with a considerable risk for the development of testicular cancer ,5. The fBoth men underwent orchidopexy through a combined inguinal and scrotal approach, with the latter for the creation of a sub-dartos pouch. Of note, the first patient underwent a failed attempt at an orchiopexy 11 years ago in another country. The patient never felt the testicle in the scrotum after that surgery but felt it in the inguinal area. In both cases, this intervention was performed on an outpatient basis, was completed successfully without complication and resulted in a satisfactory post-operative position of the testicles in the scrotal sac.This surgical approach appears to be a safe and feasible management option for adult men with undescended testicles that developed after previous inguinal hernia repair. This procedure would allow future self-testicular examinations and may lead to resolution of discomfort if present and associated with the extra-scrotal location of the testicle.Testicular ascent to the inguinal region after hernia repair is a rare occurrence, which thus far has been reported only in pediatric patients. This article presents two cases of adult patients with ascending testicles after inguinal hernia repair. Ascending testicles in adult patients who underwent inguinal hernia repair could be successfully managed by orchidopexy, performed through a combined inguinal and scrotal approach, with the latter for the creation of a sub-dartos pouch.


Schwannoma, which clinicians sometimes struggle to diagnose, is a tumor arising from Schwann cells of peripheral nerves, often in the soft tissues and rarely in the gastrointestinal tract. Pancreatic neuroendocrine tumor (PNET) is rare among pancreatic tumors, and recurrence can occur long after resection. Here, we were presented with a case where a sigmoid colon schwannoma was difficult to distinguish from a postoperative recurrence of PNET and was diagnosed after laparoscopic resection.A 51-year-old man was diagnosed with PNET (NET G2) after a distal pancreatectomy (DP) 13 years ago. The patient underwent hepatectomy due to liver metastasis 12 years after initial radical surgery. The follow-up magnetic resonance imaging (MRI) after hepatectomy showed pelvic nodules, and laparoscopic surgery was performed for both diagnosis and treatment because peritoneal dissemination of PNET could not be ruled out. Since the tumor was in the sigmoid colon, a partial colon resection was performed. The histopathological diagnosis was a schwannoma, and the patient was discharged on the seventh postoperative day.We experienced a case of sigmoid colon schwannoma that was difficult to differentiate from peritoneal dissemination of PNET and was later diagnosed after laparoscopic resection. In addition, this case involved a long-term postoperative recurrence of PNET that was amenable to radical resection, further establishing the importance of long-term imaging follow-up. Schwannoma is a tumor arising from Schwann cells of peripheral nerves, mostly occurring in soft tissues and less commonly in the gastrointestinal tract. Gastrointestinal schwannomas (GIS) arise from the Meissner or Auerbach plexus. GIS accounts for 2–6% of all stromal tumors in the gastrointestinal tract  and is mPancreatic neuroendocrine tumors (PNETs), also known as islet cell tumors, are relatively rare among pancreatic tumors, with a 5-year overall survival rate of 53% . The bas18F-fluorodeoxyglucose (FDG)-positron-emission tomography (PET)/CT showed low FDG accumulation in the nodule  for PNET 13 years ago, with a histopathological diagnosis of NET G2. Lymph node metastasis was positive in 1/14 (near the pancreas); endocrine function was insulin negative, glucagon negative, and somatostatin negative; and Ki67 was 4%. A computed tomography (CT) scan showed indications of liver metastasis 6 months after surgery  and pancreas  being the primary sites of recurrence [PNETs account for less than 5% of all pancreatic tumors, and although resection is the treatment of choice in principle, PNETs are known to recur frequently after surgery. Dong et al. reported that 154 (15.1%) of 1,020 postoperative patients with PNET experienced recurrence, with the liver (reas n = 5, 22.7% Careful follow-up is important to avoid missing the optimal timing of resection. Tumor markers should be measured every 3 months, and imaging studies should be performed every 6 months during the first 2 years, and then every year thereafter . It has When the development of schwannoma is observed during the postoperative follow-up of a malignant tumor, a definitive diagnosis is difficult. Although differential diagnoses for GIS include GIST, NET, leiomyoma, leiomyosarcoma, and adenocarcinoma, it is difficult to confirm these diagnoses through imaging studies alone. GIS appear as well-defined homogenous tumors with low enhancement on CT compared to the heterogeneous appearance of GIST or the obscure characteristics of adenocarcinoma. However, these features are not highly specific . CT has A histopathological diagnosis of GIS can be made by endoscopy or surgery. Although endoscopic identification is possible in some cases, surgery may be required in cases where endoscopic lesions are not seen or a biopsy is difficult to diagnose . In the We report a case of sigmoid colon schwannoma that was difficult to distinguish from peritoneal dissemination of PNET. Laparoscopic surgery was considered useful as a diagnostic and therapeutic approach as it was minimally invasive. In addition, this case showed that radical surgery was possible for the recurrence of liver metastasis 12 years after the initial surgery for PNET. Long-term follow-up with imaging studies is, therefore, important in such cases.


This review focuses on the role of magnetic resonance imaging (MRI) in the evaluation of the gastrointestinal tract (GI MRI), analyzing the major technical advances achieved in this field, such as diffusion-weighted imaging, molecular imaging, motility studies, and artificial intelligence. Today, MRI performed with the more advanced imaging techniques allows accurate assessment of many bowel diseases, particularly inflammatory bowel disease and rectal cancer; in most of these diseases, MRI is invaluable for diagnosis, staging, and disease monitoring under treatment. Several MRI parameters are currently considered activity biomarkers for inflammation and neoplastic disease. Furthermore, in younger patients with acute or chronic GI disease, MRI can be safely used for short-term follow-up studies in many critical clinical situations because it is radiation-free. MRI assessment of functional gastro-esophageal and small bowel disorders is still in its infancy but very promising, while it is well established and widely used for dynamic assessment of anorectal and pelvic floor dysfunction; MRI motility biomarkers have also been described. There are still some limitations to GI MRI related to high cost and limited accessibility. However, technical advances are expected, such as faster sequences, more specific intestinal contrast agents, AI analysis of MRI data, and possibly increased accessibility to GI MRI studies. Clinical interest in the evaluation of bowel disease using MRI is already very high, but is expected to increase significantly in the coming years. Magnetic resonance imaging (MRI) is the most advanced cross-sectional imaging technique which currently allows the evaluation of several, if not all, intestinal segments. Compared to other imaging methods, it has several important advantages. First of all, it does not require ionizing radiation, and thus can be used in young patients, and it is repeatable and useful in the follow-up and monitoring of many benign and malignant diseases. Second, MRI has a good-to-excellent spatial resolution and an excellent tissue contrast, higher than any other imaging tool; furthermore, it is able to analyze the tissues with multiple imaging parameters, differently from any other imaging method.MRI was firstly introduced for bowel evaluation in the late 90s ,2, when Over the past two decades, MRI techniques for bowel evaluation  have progressively improved and today, nearly 30 years after its introduction, the clinical value of MRI in the assessment of several intestinal diseases of the small and large bowels has grown significantly. To date, relevant information can be obtained in both benign and malignant intestinal diseases in a relatively short examination time, using the multiple imaging parameters currently available, such as diffusion-weighted imaging, motility imaging, and dynamic contrast enhancement  . RecentlGI MRI is nowadays the most accurate imaging tool for the diagnosis and monitoring of Crohn’s Disease (CD), for the preoperative evaluation of rectal cancer, and for its follow-up during treatment, as well as for the functional evaluation of pelvic floor disorders.MRI is also able to study the motility of the esophagous, stomach, and small and large bowels, as well as of the ano-rectum, thanks to real-time dynamic fast sequences.Some limitations, however, still exist. For example, to evaluate the gastrointestinal tract, at any site, oral contrast agents are crucial to distend the intestinal lumen and highlight the intestinal wall . DisappoLimitations and contraindications to MRI also include the presence of metallic medical implants or pacemakers, although it is not frequent, thanks to the technical evolution that has produced numerous MRI-compatible devices. Claustrophobia is rarer and rarer due to larger gantries, and it can be overcome using anxiolytic drugs, but still can be a limitation. Furthermore, GI MRI requires a longer examination time than other imaging tools, thus a high compliance of the patient to follow instruction, to stay still, and to hold breaths, which is often problematic for children or older patients, or patients with severe, painful conditions. In addition, because MRI requires a longer examination time, it is less accessible than CT and in general more expensive than other imaging techniques. Finally, longer examination time and higher costs determine a low accessibility to MRI, particularly for abdominal and gastrointestinal disorders.The goal of this review Is to analyze the current role of MRI for the evaluation of gastrointestinal tract disorders, the pros and cons, and future perspectives.MRI is a precious diagnostic tool in the evaluation of inflammation and inflammatory disorders. MR Enterography (MRE) is nowadays considered a fundamental exam in the evaluation ofCrohn’s disease (CD) , both foTo fully display the small bowel, the patient is invited to drink approximately 1500–2000 mL of iso-osmotic solution (macrogol or mannitol solutions), approximately 45 min before the examination. To reduce motion artifacts due to intestinal peristalsis, the use of an antispasmodic drug intravenously administered is suggested, before intravenous contrast injection. Distended bowel loops may be best evaluated in the prone position when possible.Basic MRE protocol for IBD includes the use of fast T2-weighted spin-echo and balanced steady-state sequences on axial and coronal planes in breath-hold or breath-hold free acquisition. Additional T2-weighted sequences may include the T2 weighted breath-hold HASTE fat-saturated thick slab in coronal acquisition c, or theMRE is able to recognize intestinal Crohn’s disease inflammation with several inflammatory biomarkers, some of them well known and described for over three decades, such as mural thickening, wall edema on T2 weighted images, perivisceral edema, and post-contrast enhancement on T1-weighted images ,10,11,12The most recent joint guidelines of the ECCO (European Crohn’s and Colitis Organization) and ESGAR  scientific societies for diagnostic assessment in IBD ,13 stateMultiple CD activity scores based on MR Enterography have been proposed to stage the severity of the disease , such asDue to its favorable characteristics, MRI is increasingly used in evaluation of pediatric IBD. In children affected by CD, MRI provides a safe and accurate evaluation of CD lesions in the small and large bowels, in the anorectal region, thus allowing the characterization of different CD morphological phenotypes. Furthermore, fast sequences in breath-hold free acquisition are very useful in uncooperative younger patients ,19,20. IMRI is also useful in assessing most of the inflammatory disorders involving the gastrointestinal tract, not only Crohn’s Disease, such as ulcerative colitis, diverticulitis, appendicitis, and infectious colitis.Even though colonoscopy is usually adequate to diagnose and to assess the extent and severity of ulcerative colitis, there are cases in which cross-sectional imaging, such as MRI, is fundamental, like for a difficult differential diagnosis between Crohn’s disease and ulcerative colitis or whenever endoscopy is incomplete or contraindicated .In the diagnosis of diverticulitis, thanks to its superior soft tissue contrast resolution, MRI allows a very precise identification of pathological changes: the presence of pericolonic fat inflammation, thickening and inflammation of the intestinal wall, mesenteric infiltration, stenosis of colonic segments, and size of diverticula; moreover, contrast-enhanced MRI may be helpful in the differentiation of colonic diverticulitis from primary colonic carcinoma ,23,24.MRI can be helpful in the diagnosis of appendicitis, which can be difficult and erroneous if based on clinical-laboratory data only. MRI, providing a complete evaluation of the abdomen and pelvis, allows a correct diagnosis in up to 20% of patients with uncertain diagnosis; the most frequent differential diagnoses are adnexal disease (including ovarian torsion and hemorrhagic cysts), enterocolitis, and mesenteric adenitis, all detectable with MRI. Typical MRI features of appendicitis are a diameter greater than 7 mm, periappendiceal fat infiltration, and thickening of the appendicular wall. MRI, using a rapid, noncontrast protocol, is highly sensitive and specific in the evaluation of appendicitis, particularly in children; compared with CT, it does not use contrast or ionizing radiation and can replace it completely. However, its poor accessibility and its high cost limit its use. The fastest and least expensive MRI technique is based on a combination of T2-weighted multiplanar imaging, with and without fat suppression, and DWI. The use of intravenous gadolinium is not essential, but it increases the diagnostic accuracy .Most of the imaging studies on infectious colitis focus on the role of CT. One of the most common infectious colitis types is the clostridium difficile colitis, where both CT and MRI can recognize several specific imaging parameters, such as the pancolic extension, the thickening of the intestinal wall, hyperemia, severe submucosal edema determining the typical “accordion sign”, ascites, and edema of the pericolonic fat ,27.Another gastrointestinal inflammatory disease recently investigated with MRI is the intestinal graft-versus-host-disease (GVHD), a severe acute or chronic complication of hematopoietic stem cell transplantation, difficult to diagnose. Multiparametric MRI can be useful for both diagnosis and staging of acute and chronic GVHD, being able to identify many specific intestinal and extraintestinal signs (biomarkers), such as predominant and continuous small bowel involvement, edema of the intestinal wall, stratified “target” wall appearance on both T2-weighted and post contrast T1-weighted images, subcutaneous fat tissue edema, and mesenteric and retroperitoneal edema ,29.MRI is currently considered the gold standard to diagnose and stage perianal fistulas ,13. MRI The MAGNIFI-CD score, recently developed, is an index of perianal fistula activity, and can be used as a predictive tool . The MAGIn recent years, MRI has been frequently used in the diagnosis of gastric cancer, due to the development of fast, high-resolution imaging sequences that allow correct localization of parietal lesions and local staging without radiation risk. To reduce motion artifacts due to gastric peristalsis and patient breathing, the gastric cavity is distended with 500–800 cc of water with the use of an antispasmodic drug intravenously administered, similarly to CT.Basic MRI protocols for gastric cancer include the use of fast T1- and T2-weighted spin-echo or gradient echo sequences, diffusion-weighted imaging (DWI), and intravoxel incoherent MRI (IVIM); dynamic contrast-enhanced MRI (DCE-MRI) also provides considerable contrast between the parietal lesion and the healthy wall.Some recently developed techniques, such as the free-breathing, radial, three-dimensional (3D) sequence with star-stacked gradient echo (GRE), have a higher signal-to-noise ratio, higher contrast-to-noise ratio, and fewer artifacts, and are potentially effective in the evaluation of gastric cancer.MRI can play a crucial role in preoperative staging, with accuracy ranging from 71.4% to 88% for T staging, and 52% to 55% for lymph node involvement; the overall accuracy of T2-weighted + DCE + DWI in T staging was significantly higher than T2-weighted + CE and T2-weighted + DWI ,34,35,36The ADC value can be used for quantitative analysis as an imaging biomarker; in particular, lower ADC values were associated with higher TNM classification. Intestinal type tumors, according to Lauren’s classification, have significantly higher ADC values than diffuse type tumors, due to the presence of more distorted and narrower intercellular spaces in the diffuse type ,34,35,36Small bowel tumors are rare and account for about 3% of all gastrointestinal cancers. The average interval between symptoms and diagnosis is about three years for benign tumors and about two years for malignant tumors.The frequency of small bowel tumors decreases from proximal to distal bowel.In addition, each histological subtype of tumor has a predilection for a different segment of the small intestine: adenocarcinoma is more frequent in the duodenum and jejunum, and carcinoid in the ileum. Small bowel tumors are generally solitary but can be multiple. Both benign and malignant tumors can cause complications, such as intussusception, obstruction, or perforation. The larger the tumor, the more likely it is to cause intestinal obstruction ,38.Although conventional Enteroclysis and capsule endoscopy are the most common procedures to visualize mucosal abnormalities of the small intestine, they are unable to assess the mural and extra-mural extent of small bowel neoplasms and thus to stage the tumor. Magnetic resonance Enterography has 96.6% accuracy in the diagnosis of small bowel neoplasms, it offers an excellent soft tissue contrast and multiplanar imaging, without ionizing radiations. In addition, the acquisition can be repeated over time for functional assessment of small bowel mobility, which is useful for diagnosing low-grade stenosis and determining the level of obstruction. . FinallyMRE, if performed with the best technical conditions  is highly accurate in the evaluation of patients with familiar intestinal polyposis, such as the Peutz-Jeghers syndrome . In thesNeuroendocrine tumors (NETs) are rare neoplasms which originate from cells of the diffuse neuroendocrine system and can occur in any body district, most frequently in the gastroenteropancreatic tract and the lung.NETs are usually diagnosed in the metastatic phase, and the liver is the most commonly involved organ, followed by bones and lungs. Gastroenteropancreatic (GEP) NETs may exhibit unpredictable behavior ranging from indolent to highly aggressive forms .Many studies have highlighted the usefulness of MRI in the study of NETs, most of them focusing on pancreatic NETs, in which the routine morphological T2-weighted and T1-weighted sequences are implemented with contrast injection and multiple post-Gadolionium scans, including arterial, venous, and delayed (>5 min), and the use of diffusion-weighted sequences. Currently, MRI is considered the best imaging technique to detect hepatic metastases; DWI sequences and T1-weighted images acquired after the injection of an hepato-biliary contrast agent (Gadolinium BOPTA or DTPA) are extremely sensitive to detect hepatic metastases, even smaller than 5 mm ,44 Figu.Only a few studies have compared MRI to PET/CT in the diagnosis and staging of NET, with similar results: MRI was the method of choice in assessing local tumor extension and liver metastases, while PET/CT is preferred for assessing distant metastatic involvement; they concluded that the integration of the two methods provided the best results. ,45,46,47Over the past 100 years, rectal cancer staging systems have undergone significant changes. One of the best-known staging classifications was developed by Sir Cuthbert Dukes in 1958, which can be traced to the current UICC/AJCC tumor-node-metastasis (TNM) staging system which classifies rectal cancers into five prognostic groups based on combinations of tumor invasion, lymph node involvement, and metastasis.AJCC staging manuals today consider T3 tumors as a single group characterized by tumor invasion through the muscularis propria. In 1993, a subclassification of T3 tumors into four groups was proposed: T3a (<1 mm), T3b (1–5 mm), T3c (5–15 mm), and T3d (>15 mm). The degree of invasion beyond the musculature is the most sensitive way to assess tumor stage compared with lymph node status, with a significant correlation to survival . High-reIn a recent 2022 article, Lambregts et al.  provide If MRI is undoubtedly the method of choice for loco-regional staging of rectal cancer, to date its role in the local staging of colonic cancer is instead poorly investigated, since MRI of the colon is impaired by peristalsis and motion artifacts. However, 3 Tesla MRI has shown a significantly higher sensitivity compared with CT in discriminating between pT1-T3b and pT3c-T4 colon tumors. Low primary tumor ADC values have been shown to predict the risk of lymph node and/or distant metastases. Recent studies also showed that whole body MRI (WB) has similar accuracy to CT in local and distant staging. . TherefoPelvic floor dysfunctions are responsible for many pelvic disorders and symptoms, not only anorectal dysfunctions, but also urological and gynecological discomforts. For a long time, such disorders were investigated using evacuation proctography, or defecography, which is a fluoroscopic radiological technique capable of studying the pelvic floor prolapse, thanks to the opacification of the rectum and optionally also of the vagina and the small bowel. Defecography allows the real time visualization of ano-rectal movements during straining and defecation, and quantification of anorectal angles.Nowadays, MR defecography allows a real-time visualization of the same parameters, by using a rectal contrast agent  to distend and visualize the rectum; dynamic images are taken during straining, squeezing, and defecation, similarly to conventional defecography ,52,53 F.MRI defecography offers additional advantages compared to conventional defecography: it can carefully measure the prolapse and anorectal angles without the need for radiation exposure and allows an accurate evaluation of all pelvic floor organs, muscles, and soft tissues; moreover, functional manouvres can be repeated several times, since the patient is not exposed to radiations. The main MRI disadvantage is the obliged supine position of the patient, which is required required by most high field (1.5–3 Tesla) MRI equipment. Therefore, MR defecography evaluates pelvic floor movements in a non-physiological position, differently from conventional defecography. However, several early and more recent studies provided a good correlation between findings observed in supine and sitting positions, justifying the increasing use of MRI in the evaluation of pelvic floor disorders ,55. NowaThe gastrointestinal tract is a moving organ whose peristaltic movement is critical to facilitate digestion and progression of food along the gastrointestinal tract, expelling waste and maximizing the action of digestive acids and enzymes on nutrients. Abnormalities of intestinal transit are frequent causes of functional disorders and abdominal pain, not associated with organic lesions. Imaging techniques that rely on static images and diagnostic tools may miss these functional alterations.MRI, thanks to fast and cine sequences, is capable of studying the motion of the bowel and internal organs. Cine-MRI is currently widely used to study the heart; the dynamic study of the gastrointestinal tract, however, offers more difficulties than the heart, since it is wider, and bowel movements, although slower, are not periodic ,57.The radiological study of the esophageal movement has been for a long time a prerogative of conventional radiography, with fluoroscopy and barium swallow, but lately a few studies on the dynamic MRI assessment of esophageal dysfunctions, such as achalasia, have been published. The main limitation is the position of the patient, since in most MRI equipment the patient can perform the examination only in a supine position, while in fluoroscopy the patient can swallow the barium while standing, in a physiological position. A recent study by Biggermann et al.  comparedManometry is the gold standard for the evaluation of gastric motility, but it is a long and invasive study, causing discomfort to the patient; moreover, it can quantify only the motility of the gastric fundus. Another important parameter in the study of gastric function is gastric emptying, which is often studied with nuclear medicine (gastric scintigraphy). Fluoroscopy with barium swallow is still used to study gastric motility, like for the esophagus, being easy and accessible.Until now, gastric motility has not been extensively studied with MRI; there exist only a few articles focusing on it. The study by Heissam et al. , based oSmall bowel motility is often studied in Crohn’s disease patients, as reduced motility (fixity) of inflamed loops has long been considered a hallmark of the disease . To corrThe analysis of small bowel movements could also be crucial in the investigation of functional diseases, such as chronic pseudo-obstruction of the intestine; thus far, only a few studies have focused on the potential diagnostic role of cine-MRI in this pathology ,64. One The evaluation of colonic motility can be crucial in patients with functional constipation, a very common problem which should be accurately investigated when standard therapies fail. In clinical practice, the radiological study of colonic transit time using radiopaque markers is widely used, although it involves a moderate radiation exposure. Other radiological exams focus on the colon, such as virtual colonoscopy and colon double contrast enema, but provide only static information.The current gold standard exams to investigate functional neuromuscular colonic disorders are colonic manometry and barostat, which are both invasive, uncomfortable for the patient, and costly, requiring anesthesia or sedation and long examination times. On the other hand, MRI is not invasive, more comfortable, and requires a shorter examination time and no anesthesia or sedation, unless in the case of claustrophobia, and also has lower costs.One of the most important studies focused on cine-MRI of colon motility, by Kirchhoff et al. , evaluatAnother recent study, by Vriesman et al. , was lesDiffusion-weighted magnetic resonance imaging (DWI) provides qualitative and quantitative data on tissue cellularity based on the random diffusion of water molecules. MR-DWI improves tumour detection by providing a quantitative assessment through measurement of the apparent diffusion coefficient (ADC).DWI has an established diagnostic value in the diagnosis, staging, and follow-up of rectal cancer .2. Lower b-values are always associated with T2-shinethrough effects. DWI with ultra-high b-values (above 1000 s/mm2) may allow better visualization of rectal tumours due to highly effective suppression of the background signal.The most commonly used DWI b-values for rectal cancer detection are 800 and 1000 s/mm2 in rectal cancer helps to assess the primary rectal tumour and its response to chemoradiation therapy (CRT). fluoro-d-glucose (FDG) is widely used for initial staging and treatment response assessment of numerous gastrointestinal malignancies. Hybrid PET/MRI scanners, which acquire PET data and MRI data simultaneously, have the potential to provide accurate whole-body staging in a single examination. Furthermore, in addition to FDG, many new PET tracers have been developed to evaluate specific aspects of tumor biology and inflammatory disorders ,71. CrohArtificial intelligence (AI) is a revolutionary and still-unexplored diagnostic tool. Its application in the medical field, and in particular in radiological imaging, is becoming increasingly popular, allowing, for example, image classification, reconstruction, and resolution enhancement ,73. The Two of the most developed techniques that helped to speed up image acquisition are parallel imaging and compressed sensing. With these techniques, it is possible to collect basic information from multiple coils and then reconstruct images from a smaller sample of data . It is tMany new AI tools can recognise complex patterns in data, information, and images, allowing both qualitative and quantitative assessments of radiological features.Among the most promising methods are deep learning methods, which are able to recognise undersampled data and also allow the conversion of low-resolution data into high-resolution data . PrelimiMagnetic resonance enterography (MRE) is an essential companion to endoscopy for the diagnosis and longitudinal monitoring of CD disease phenotype, complications, and disease activity. Crohn’s disease activity is associated with increased mural thickness and T2 signal intensity, but also with increased contrast-enhanced mural signal intensity, reflecting underlying angiogenesis within the bowel wall. Examining this signal beyond simple mean intensity may therefore provide new insights into the underlying vasculopathy in CD ,78,79.The texture analysis (TA) is a post-processing technique that can be applied to cross-sectional data to facilitate the analysis of heterogeneity within selected image regions. The derived image series contains features highlighted at different spatial scales, ranging from fine to coarse textures. Histogram quantification then generates the following parameters: mean of pixels within the ROI, standard deviation, symmetry of distribution, mean of positive pixels, kurtosis (distribution “accuracy” or “sharpness”), and entropy .Artificial intelligence (AI) is set to transform the practice of medicine and the management of inflammatory bowel disease (IBD) by replicating the judgement of expert clinicians and uncovering powerful insights by analyzing volumes of data too large and complex for humans to perceive. Intelligence requires the ability to acquire, store, and logically organize information.The emergence of artificial intelligence in IBD has been made possible by the availability of large volumes of digitized medical data and the computational methods required to analyze complex data analysis models, collectively referred to as machine learning (ML). In ML, input data is annotated, labelled, or classified, and can be clinical outcomes, expert measurements, or even physiological processes. ML methods quantify the relationships between the input data and the outcome as a model; this process is called training.Recently, it has been possible to apply AI to improve MRI diagnoses of tumours such as rectal, breast, or even prostate cancer. Specifically for rectal cancer, we can mention the application of AI models based on “faster R-CNN”  to detect metastatic lymph nodes in the pelvises of rectal cancer patients. The study shows how multiparametric MRI (mpMRI) combined with the Mask R-CNN data processing system was able to correctly identify 80% of metastatic lymph nodes in patients with rectal cancer. The AI detection system can make the detection of lymph nodes >3 mm more efficient .Other promising AI MRI models have been developed to improve the loco-regional assessment of advanced rectal cancer. These models aim to improve the accuracy of MRI in loco-regional staging, detection of metastatic lymph nodes, and assessment of response to neoadjuvant chemotherapy. With continued improvements in deep learning algorithms and the combination of MRI with deep learning image recognition, it will be possible to more accurately predict patient prognosis and response to therapy. Recently, the texture analysis of contrast-enhanced T1-weighted images was correlated to the presence or absence of histological parameters of hypoxia or angiogenesis in Crohn’s disease lesions . Recent In the near future, all these developing models and algorithms will certainly make AI-MRI crucial for the diagnostic approach and in-process evaluation of several GI diseases, not only rectal cancer. AI systems are proving capable of reproducing complex measurements and judgements, showing the promise of accurate and less biased measurement of disease, predicting future clinical outcomes, and enabling us to discover new insights into the pathophysiology of disease.Recent advances in MRI technology open up many possibilities for the future. It is not unreasonable to expect new techniques that may revolutionize the study of the gastrointestinal tract, such as the possibility of “magnetic resonance colonography” or “follow through MRI for dynamic evaluation of small bowel dysmotility”. The recent development of ‘Upright High Field MRI’, which allows the patient to stand or sit, may facilitate the study of gastrointestinal motility as it is performed in a physiological position. As MRI is radiation-free, new applications of this method in various bowel diseases are being sought, particularly in pediatric settings and younger adults. According to preliminary studies, magnetic resonance transfer imaging is promising in detecting and distinguishing different degrees of intestinal fibrosis in CD ,83.The expanded use of artificial intelligence in the evaluation of the gastrointestinal tract has not yet been as fully developed as in other systems and organs, but it seems likely to expect a real revolution in a few years.MRI has a high diagnostic power in the evaluation of the bowel, from the oesophagus to the anorectum, in the assessment of functional, inflammatory, and neoplastic intestinal disorders.In the evaluation of most functional and inflammatory gastrointestinal diseases, especially in young patients, MRI should be considered the primary diagnostic tool, being highly accurate and radiation free.In recent years, we have witnessed the evolution of MRI techniques, which are now multiparametric and capable of providing different tissue information. The development of artificial intelligence is the new frontier that is constantly evolving to improve the diagnostic power of MRI, with ever-increasing levels of sensitivity and specificity.Of course, there are still some limitations to the use of MRI: firstly, it requires longer examination times than CT; secondly, its cost is higher than any other imaging techniques, making it less available.However, whenever possible, it should be considered as a reliable and primary diagnostic tool for the evaluation of most gastrointestinal diseases, as it provides an in-depth multiparametric assessment of morphological, pathological, or functional changes in both inflammatory and neoplastic diseases like no other diagnostic modality.