Benign metastasizing leiomyoma (BML) is a rare spindle cell neoplasm seen in middle-aged women who have a history of leiomyoma of the uterus. The most common sites of metastases are the lungs; however, other sites of spread have been documented. These tumors by definition have no malignant features on histology and tend to be estrogen and progesterone positive. We present a middle-aged woman who was incidentally found to have multiple pulmonary nodules and a mass on her sternum after she was involved in a motor vehicle accident. She had a history of uterine leiomyoma and had undergone a hysterectomy ten years prior to the accident. Biopsies were performed of the lung nodules and sternum mass and compared to her hysterectomy specimen, and they were identical, and hence, she was diagnosed with BML. Due to the growing tumor of her sternum, she was started on tamoxifen with stability of her tumors. These tumors, since they are benign, tend to have an indolent course. However, in the instances that treatment is warranted, options include surgery or antiestrogen therapy. We will be discussing the pathogenesis, histological findings, and treatment options of this rare condition. Our case is unique because BML in general do not tend to spread to multiple organs and tend to be limited to one site of disease. Benign metastasizing leiomyoma is a rare, benign, spindle cell neoplasm usually diagnosed in middle-aged women who have a history of uterine leiomyoma. The most common site of metastases is the lung although other sites such as the heart, bones, and lymph nodes have been reported. Although these tumors are metastatic deposits from the uterus, they have no malignant features morphologically or clinically and most have an indolent course. We present a young female with BML to the lungs and bones, and we will discuss about BML, its pathogenesis, and treatment options.We present a 47-year-old woman with no medical history, who presented to the hospital after a motor vehicle accident. She has a history of leiomyoma of the uterus and underwent a total abdominal hysterectomy at age 37. While undergoing routine X-rays and Computed Tomography (CT) scans of her chest, abdomen, and pelvis, she was found to have multiple pulmonary nodules in both lungs, largest in the right lower lobe measuring 1.2 cm . She is The lung biopsy revealed a smooth muscle neoplasm that was positive for smooth muscle actin, vimentin, calponin, and desmin. Ki67 was 1-2%. It was negative for AE1/AE3 and p63 and showed no atypia, increased mitoses, or necrosis going against a metastatic leiomyosarcoma. This was compared to her hysterectomy specimen and histologically was identical. A diagnosis of benign metastasizing leiomyoma (BML) was made. The sternum biopsy showed a similar spindle muscle neoplasm that was positive for smooth muscle markers. Ki67 was 5% and was histologically similar to the prior lung biopsy and hysterectomy specimen. Estrogen receptor (ER) and progesterone receptor (PR) staining was performed and was strongly positive on both the lung and sternum biopsies. After a second consultation, it was confirmed as BML with no evidence of malignant sarcoma .Although there was concern for sarcoma, we had no evidence histologically and hence, it was confirmed she had BML involving the bone and lungs. As she was symptomatic from the sternum mass, we decided to pursue with treatment. We reviewed case reports and discussed her case in our multidisciplinary tumor board after which we initiated endocrine therapy. She was initiated on tamoxifen, and after three months, a repeat chest CT showed stability of the size and number of the lung nodules as well as stability of her sternum mass . Given tBenign metastasizing leiomyoma (BML) is a rare entity with the first case being reported by Dr. Steiner in 1939, in which he reported a contradictory case of a young woman who had benign appearing multiple lung nodules suggestive of a benign metastasizing fibroleiomyoma –4. As meThe pathogenesis of BML is not truly known. One theory is that there is hematogenous spread of benign endometrium cells into organs during the time of hysterectomy for ULM. Another theory is that they are leiomyosarcomas with low-grade malignant potential; as more cases are being reported, it seems unlikely that they are primary leiomyomas of the lung given the similarity between the uterine tumor and the metastatic site . Patton Microscopic findings of BML demonstrate characteristics of smooth muscle proliferation and tend to stain positive for actin, desmin, or vimentin. They do not to have a high mitotic rate, high Ki67, atypia, high degree of cellularity, or poor differentiation suggesting that they are benign tumors . They teThere are no standard treatment guidelines for BML. Since most cases are asymptomatic and tend to be slow-growing, they can be observed unless symptoms develop. Surgical resection of metastatic site if feasible would be the preferred treatment modality . Given tBenign metastasizing leiomyoma is a rare condition usually seen in middle-aged perimenopausal women. Most women have a history of leiomyoma of the uterus with a median time to onset of BML approximately 10 years after definitive hysterectomy. Although these tumors by definition are metastatic deposits, they do not have any malignant features and tend to be slow-growing and asymptomatic. In our case, we presented a perimenopausal woman who developed BML ten years after undergoing a hysterectomy. She had a progressively growing sternum lesion, and biopsy showed BML, and no carcinoma was seen. These tumors tend to be estrogen and progesterone positive suggesting a gynecological origin. Treatments include observation, surgery, or antiestrogen therapy. In our case, we initiated the patient on tamoxifen and this has stopped the growth of her tumors and we plan to continue tamoxifen indefinitely for now.


Imperforate hymen is an uncommon congenital anomaly of the female genital tract and can lead to the collection of blood in the vagina and the uterus. Most patients are not diagnosed until menarche when they present with symptoms such as cyclic abdominal and pelvic pain, constipation, tenesmus, back pain, and difficulties with urination in association with lack of menses. We discuss the case of an adolescent female who presented with the complaint of an increasing abdominal swelling along with the urgency and a sense of incomplete urination. She had not attained menarche. A diagnosis of hematometrocolpos was made based on computed tomography findings. Subsequent perineal examination revealed a bulging imperforate hymen. Hymenotomy was performed with complete resolution of the symptoms. This case highlights the importance of keeping a high index of suspicion for this condition in patients presenting with these symptoms and the importance of appropriate gynecologic examination. The hymen is a thin membrane of epithelium separating the vaginal lumen from the urogenital sinus. Hymen usually perforates during the perinatal period due to degeneration of the central epithelial cells. Imperforate Hymen (IH) is referred to the persistence of intact hymenal membrane resulting from failed spontaneous rupture. IH is a rare congenital anomaly of the female genital tract with an estimated incidence of about 1 in 2,000 female births . SurgicaPatient Information: a 14-year-old girl presented to the surgical outpatient clinic with a history of gradually increasing abdominal swelling over one year. She also reported a recent history of urgency and the feeling of incomplete bladder emptying. She endorsed intermittent cyclic abdominal cramps in the preceding few months and denied having started menses. She denied fever, diarrhea, constipation, vomiting, or weight loss. Her past medical, surgical, and family history was unremarkable. She was seen by multiple health practitioners with no relief in the symptoms despite good compliance with the medical advice.Clinical findings: the abdominal examination revealed a large non-tender, non-pulsatile palpable mass extending from the pelvis to the xiphisternum  revealed a large cystic lesion with a thick echoic collection, extending from the epigastric region to the lower pelvis and posterior to the urinary bladder, filling almost the entire abdominal cavity. Computed Tomography (CT) revealed a hypodense, non-enhancing, fluid-filled mass in the vagina measuring 28.5 cm x 11.3 cm x 12 cm with a small collection in the uterine cavity (e cavity . The lesDiagnosis: a diagnosis of hematometrocolpos was made.Therapeutic interventions: the patient and her mother were counselled about the potential risks of surgery including the risk of losing virginity. After taking consent, hymenotomy was performed under anesthesia. Over 3,000 ml of dark-colored menstrual blood was drained ( drained .Follow-up and outcome of interventions: the postoperative recovery was uneventful and was discharged from the hospital on the third postoperative day. At the follow-up visit, she was relieved of all the symptoms and had a big smile on her face. Her first menstruation occurred 18 days after the surgery.Patient perspective: “I was so distressed by the illness that I stopped attending school. I underwent multiple evaluations and treatment with no relief before presenting to the surgical outpatient department. I was discharged from the hospital on the third postoperative day, and one week later, I started attending school. At the follow-up, I was relieved of all the symptoms. My menstruation began 18 days after the surgery”.Informed consent: written consent was obtained from the patient´s father to publish images and clinical information relating to the case. The patient was under the age of 18 but had a sufficient understanding of the consent process and its implications.The hymen is a membrane of tissue and represents the junction of the sinovaginal bulbs with the urogenital sinus. During late fetal development, the centrally located epithelial cells degenerate leading to central perforation of the membrane. Failure of the degeneration results in persistence of the septum which is termed as IH . IH is rAt the age of menarche, the females may present with recurrent cyclical and poorly localized abdominal and pelvic pain secondary to distension of the vagina and the uterus by accumulating menstrual blood. The compression of the urethra and bladder can lead to obstructive uropathy symptoms such as urinary retention and urinary frequency as reported in our case . ProlongThe diagnosis can be made clinically by identification of bluish bugling obstruction of the vagina on introital examination. However, low transverse vaginal septum and agenesis of the vagina can result in similar findings. TAUS is usually the first imaging modality. Pelvic MRI may be used to provide a demonstration of the anatomy in complicated cases and the extent of distension of the vagina, uterus, or fallopian tubes . HematocThis case highlights the importance of considering IH as one of the differentials in young females presenting with symptoms such as abdominal swelling, abdominal pain, obstructive urogenital symptoms, and primary amenorrhea. Gynecologic examination and appropriate imaging can lead to early diagnosis and prevent complications like infections, kidney disease, and infertility.


We present the case of an enterovesical fistula (EVF) caused by ischemic enteritis. Ischemic enteritis is caused either by mesenteric macrovasculature occlusion or any pathophysiologic vasospasm of the microvasculature. In other words, ischemic enteritis (IE) occurs when the inflow of blood to the small intestines is reduced. The frequency of ischemic enteritis is less as compared to ischemic colitis because of the vast blood supply to the small intestine. It is the first case to be reported in the medical literature to date. EVF is a rare entity. It is a pathological connection between the bowel loops and the urinary bladder. EVF is a result of an underlying disease or injury. EVF is mostly caused by diverticular diseases, carcinoma colon, Crohn's, and inflammatory bowel disease, iatrogenic, appendicitis, carcinoma cervix, etc. Due to the formation of this abnormal connection, contents of the intestines, including the air, food content, etc., are usually found in the urine. Patients usually present with the complaint of irritative urinary tract symptoms and recurrent urinary tract infection (UTI). Surgical management is the mainstay of treatment although medical management is tried for those who cannot bear to undergo surgery. Enterovesical fistula (EVF) represents an abnormal communication between the intestine and bladder. Causes of EVF are plenty, but they have been devised into five main classes: congenital, traumatic, tumor, inflammatory, and others. In the Western world, the main cause is diverticulitis 56.3%) and almost all the cases are associated with colonic or bladder fistula. The second most frequent cause in the Western world is malignant tumors, which are located mainly in the intestine 20.1 %). Other associated tumors include bladder, cervical, ovarian, and prostate cancers and non-Hodgkin's lymphoma of the small intestine. The third most prevalent cause is Crohn’s disease (9.1%), which occurs mainly in the ileum. Other causes include iatrogenic injury (3.2%); trauma; foreign bodies in the intestinal tract; radiotherapy; chronic appendicitis; tuberculosis; and syphilis. The male-to-female ratio is 3: 1. The lower prevalence in females is owing to the interposition of the uterus between the bladder and sigmoid colon, but higher rates of both colovesical and colovaginal fistula have been reported in females who have previously undergone a hysterectomy [ %. Other% and almA 34-year-old male, carpenter by occupation, presented to the hospital with complaints of yellowish discoloration and foul-smelling urine with debris, pneumaturia, and burning micturition for the last 10 days. He had a history of recurrent urinary tract infections (UTIs) for which he was treated previously at the rural health care center. He also had multiple episodes of pain in the right lower abdomen for which he used to take over-the-counter (OTC) drugs and had on-off episodes of constipation. Subsequently, he was diagnosed with abdominal tuberculosis, and it was treated with antitubercular drugs for a period of six months. He had no history of diverticulitis, inflammatory bowel disease (IBD), and any surgery. The only significant medical history was Koch's abdomen and a history of smoking for the last 10-12 years, which is a risk factor for ischemic enteritis. Cartridge-based nucleic acid amplification test (CB-NAAT) was done, which was negative for tuberculosis. Lab investigations were within the normal limit except for urine microscopy, which showed numerous WBCs and epithelial and pus cells. Urine culture had led to the growth of mixed organisms including Escherichia (E.) coli.Due to recurrent episodes of UTI, ultrasonography (USG) was advised, considering his economically weak background. USG was done, which suggested a heterogeneous wall lesion of the urinary bladder in the dome suspicious of a urachal mass. No calculi were seen on the USG.Considering the USG findings, a further CT scan was suggested, which showed an air bubble in the urinary bladder, and he was diagnosed with EVF Figure .To look out for any neoplastic masses in the urinary bladder, diagnostic cystoscopy was done. Cystoscopy was suggestive of fecal matter with an irregular area around 2 cm at the fundus, near the midline. Since no masses were seen, neoplasia was ruled out (Figure Due to the history of Koch's abdomen, it has been one of the major differentials for intravesical fistula. And since it is fairly widespread in India, it has been thought to be the cause of EVF.The radiologist confirmed the fistulous tract arising from the ileum. Considering the clinical symptoms and using radiological imaging, a diagnosis of EVF was made. Ileocolonoscopy was not performed because it was expensive for the patient to bear the cost of extra investigations and minimally informative since CB-NAAT for tuberculosis was already negative, and there was no history related to any bowel disorder. Hence, explorative laparotomy was planned and the findings were: Inflamed and thickened ileocecal junction, communication between urinary bladder and ileum, and enlarged lymph nodes. Limited resection of the ileocecal junction with ileo-ascending anastomosis and repair of the urinary bladder was done Figures -4. The pIn addition, the tissue of the exploratory laparotomy was sent for histopathologic examination. Since tuberculosis is highly prevalent in India, we expected it to be the cause of the fistula, with a granuloma with Langhans-type giant cells. Instead, the histopathology report showed ileocecal stricture. Section of the ileocecal segment reveals acute enteritis and mucosal ischemic necrosis. The appendix showed serositis, and lymph nodes showed extensive areas of hemorrhage. Histology showed areas of congestion, hemorrhage, and necrosis extending up to the mucosal layer. Loss of villi is also noted along with inflammatory cells, suggesting ischemic etiology Figure .EVF is a rare entity that has various causes. The most common cause is diverticulitis followed by malignant tumors, especially of the colon. The third most prevalent cause is Crohn’s disease, which mainly involves the ileum. Other less common causes of EVF included radiation exposure, iatrogenic injuries, especially in pelvic surgeries, and foreign bodies are rare causes. Gouverneur’s syndrome characterized by suprapubic pain, frequency, dysuria, and tenesmus is the main hallmark of EVF . Other cOn clinical suspicion of EVF, cystoscopy is used to initially diagnose fistulae in 30%-50% of cases. Prior to advances in radiology diagnostic techniques, cystoscopy was considered the most reliable method of diagnosis. On cystoscopy, a congested erythematous urothelium is observed, with a mucosal edematous lining in the center emitting mucus and gas. Cystoscopy is performed for identifying the defect and its position and for biopsy. Treatment is done according to etiology. Diagnostic CT accuracy for colovesical fistula detection can be up to 90-100% ,5-6. CT Nonoperative treatment is particularly useful in cases of Crohn's disease. Medical therapy usually includes bowel rest, total parenteral nutrition, steroids, antibiotics, and urethral catheter drainage. Nonsurgical management of the EVF is usually done for those patients who are unfit for extensive surgeries or have a malignant neoplasm with extensive spread. Currently, surgical treatment consists of single-stage resection of the diseased bowel with anastomosis, and primary closure of the bladder defect remains the mainstay of the treatment.Various risk factors that could be hampering the blood flow and leading to ischemia in the gut are atherosclerosis, hypertension, diabetes mellitus, increasing age, alcohol consumption, arterial embolus, hypercoagulable states, severe dehydration, smoking, etc.; they are also some of the risk factors associated with ischemic enteritis .In this case, the patient had an ileocecal fistula because of ischemic enteritis. This is a rare cause of this entity, which was treated with resection and ileo-ascending anastomosis.EVF, which is a rare entity, has even rarer causes for it. Due to the lack of randomized control trials and the rarity of the condition, no proper diagnostic and treatment guidelines exist. This ailment remains an area of interest for the doctors to devise proper protocols for the better prognosis and outcomes of this condition. The management of EVF is primarily dependent on the underlying pathology, the site of the intestinal lesion, and the patient's preoperative status. Single-stage surgery is the preferred option in most cases.


Glioma in the petroclival region is very rare. Also, very few cases of primary gliomas have been reported to have radiographic as well as intraoperative features of extra-axial lesions resulting in diagnostic dilemma in the literature. We present a rare case of petroclival glioma mimicking trigeminal schwannoma in a young female.We present a 21-years old female with a 3-month history of pain in the right eye with no visual impairment. Cranial nerves examination revealed mild deficits in the trigeminal nerve, facial nerve, auditory nerve, oculomotor as well as the trochlear nerve.Magnetic resonance imaging detected an extra-axial mass with mixed signal intensities in the right petroclivus area. Immunohistochemical established glioma with world health organization (WHO) grade II.The lesion was resected via 2 successive operations in 6 months interval. The patient was further treated with radiotherapy and post-radiotherapy temozolamide.Two years follow-up revealed no recurrence of the lesions and she is well. Nevertheless, he is still being followed diligently to uncover any recurrence.The extra-axial nature as well as petroclival location of the glioma makes our case very unique and very rare. The imaging characteristics were very extraordinary for a glioma which resulted in diagnostic dilemma. Thus, the definitive diagnosis was based on the histopathological evaluation of the excised tumor. They are typically detected in the cerebral hemispheres. Very few cases of primary gliomas have been reported to have radiographic as well as intraoperative features of extra-axial lesions resulting in diagnostic dilemma in the literature. The diagnosis of glioma is still very challenging notwithstanding the innovations in imaging modalities.,2 Thus, diagnosis is often based on the histopathologic confirmation of the excised tumor. We present a rare case of petroclival glioma mimicking trigeminal schwannoma in a young female.Glioma in the petroclival region is very rare and so far, only one case has been reported in literature.2A 21-years old female presented with a 3-month history of pain in the right eye with no visual impairment. She denied association of trauma of any kind. She also denied headaches, nausea and vomiting. She had open cholecystectomy when she was 8 years old. She had no history of hypertension or diabetics. General physical examination was unremarkable. Cranial nerves examination revealed mild deficits in the trigeminal nerve, facial nerve, auditory nerve, oculomotor as well as the trochlear nerve. Ophthalmic examination of both eyes was unremarkable. Routine laboratory investigations were grossly at normal rangers. Routine Chest X-ray and electrocardiogram did not show any abnormalities.Magnetic resonance imaging (MRI) detected an extra-axial mass with mixed signal intensities in the right middle and posterior cranial fossa (right petroclivus) measuring 5.6 × 2.8 × 4.7 cm Fig.  A–C. TheBased on the MRI findings above, we opted to resect the lesion with massive decompression and preservation of cranial nerves like the trigeminal nerve, facial nerve, auditory nerve, oculomotor as well as the trochlear nerve and repair of sinus defects. The lesion was resected via 2 successive operations in 6 months interval. Electromyographic and auditory brainstem responses were utilized to monitor the cranial nerves above in both operations. We first resected the posterior part of the lesion via the right retrosigmoid approach.After general anesthesia, the patient was put on the park bench position with her head fixed in Mayfield 3 keys’ head support system and a right retrosigmoid incision made. Intraoperatively, the tumor was located in the petroclival region, extending from the right tentorium, the upper, middle and lower clivus. The tumor was adhering and compressing the facial nerve, auditory nerve, oculomotor as well as the trochlear nerve. The tumor was carefully separated from these cranial nerves and peripheral vessels. The tumor was yellow in color with clear borders. Also, it was hard in consistency with rich blood supply. The lower clival part of the tumor was completed resected. Postoperative MRI done showed no tumor in the posterior part Fig. A–C. NeveImmunohistochemical staining of the resected lesion revealed positivity for tumor markers like glial fibrillary acidic protein (GFAP), oligodendrocyte transcription factor, progesterone receptor (PR), S100, vimentin (VIM) as well as Ki-67 labeling index of about 3%  at our hospital's oncology department. Two years follow-up revealed no recurrence of the lesions and she is well. Nevertheless, he is still being followed diligently to uncover any recurrence.3 Glioma with prime extra-axial features has rarely been described in the literature. Most gliomas are detected in the elderly compared to our patient who was relatively younger.,2 Our case is very unique and very rare because, the lesion was extra-axial and located at petroclivus. Furthermore, the imaging characteristics were very extraordinary for a glioma which resulted in diagnostic dilemma. The clinical presentation in our case is of sudden onset of pain in the right as well as mild neurological deficits in cranial nerves like trigeminal nerve, facial nerve, auditory nerve, oculomotor as well as the trochlear nerve.Glioma in the petroclaval region is very rare and so far, only Karthigeyan et al have reported a case. On MRI, they further observed an extra-axial lesion which was isointense to hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging with moderate postcontrast enhancement. Our MIR findings were analogous to Karthigeyan et al MRI findings. We resected the lesion via 2 successive operations in 6 months interval because of the diagnostic dilemma of the lesion on radiology. We first resected the posterior part of the lesion via the right retrosigmoid approach and pathological evaluation of the resected samples gave us a clue of the nature of the lesion. The second operation was carried out 6 months after the first operation via the right anterior transpetrosal approach.Karthigeyan et al who saw a similar case observed that, the lesion was extra-axial type in the left petroclival on computed tomography and was heterogeneously hypodense with chunky foci of calcification.,5 The retrosigmoid approach also referred to as retromastoid or lateral suboccipital approach is the most frequently used technique in resecting lesions at the cerebellopontine angle as well as the petroclival regions.–6 This approach involves bone removal angled on the asterion borders of the transverse as well as sigmoid sinuses and their junction.–6 The dura is often resected in an arch manner and reflected outward, concealing the exposed sinuses.–6 We utilized this approach in our first operation because the tumor was entirely extra-axial and more revealing at posterior fossa. Also, this exposure allowed for maximum preservation of the cranial nerves.Several surgical approaches have been used to resect lesions in the petroclival region.,7,8 This approach provides an ideal extradural view of the clival region while exposing the trigeminal nerve, the facial and vestibulocochlear nerve complexes.,7 This approach is often a completely extradural approach with very reduced retraction on the temporal lobe.,7,8 We utilized this approach in our second operation because the tumor was entirely extra-axial and this time round, more anterior after resecting the posterior part of the tumor. Furthermore, this exposure allowed for maximum preservation of the cranial nerves.Anterior transpetrosal approach or the “Shiobara-Kawase approach” is also used to access tumors at the petroclival region.,9,10 The transpetrosal approach is often utilized to resect tumors that invades the middle as well as upper third of petroclival area which mostly involve the petrous bone.,9,10 The craniectomy commence with a complete mastoidectomy so that the middle fossa as well as posterior fossa dura are well exposed.,9,10 This exposure permits visualization of the transverse-sigmoid junction as well as the exposure of the superior petrosal sinus.,9,10The transpetrosal approach with variants such as presigmoid, posterior petrosectomy, retrolabyrinthine, transcrusal as well as transcochlear approaches have been described.,11,12 This approach allows for the same or enhanced exposure with minimum morbidity for the patient.,11,12 Usually, this approach to the petroclival area necessitates a transpterygoid approach.,11,12 Treat of WHO grade II comprises of utmost safe resection of the tumor followed by radiotherapy with postradiotherapy TMZ chemotherapy.Most recently, endoscopic endonasal approaches to the petroclival region are substitutes for all ventral open approaches like facial degloving, transfacial, Le Fort osteotomies, as well as transbasal approaches.2 as an adjunct to radiotherapy of 30 × 2 Gy equivalent to 60 Gy at tumor bed followed by up to 6 cycles of temozolomide at 150 to 200 mg/m2 on 5 of out 28 days prolonged median overall survical compared to radiotherapy alone. Based in these studies, we further treated the patient with radiotherapy and postradiotherapy TMZ at our hospital's oncology department as per the retreatment regime above.Stupp et al indicated that daily simultaneous treatment with temozolomide at 75 mg/m The most crucial marker for detection of glial differentiation is GFAP.,16 Virtually all gliomas secret S-100 protein, making it a sensitive marker for these malignancies. Nevertheless, S-100 secretion is a relatively nonspecific glioma marker because a variety tumors secrete it. OLIG2 does not permit for obvious differentiation between oligodendrogliomas and diffuse or pilocytic astrocytomas. It is however very useful in the differential diagnosis of a diffuse glioma and a neuronal, ependymal, or nonglial tumor type because OLIG2 staining is characteristically restricted or deficient in the latter.,17Immunohistochemical analysis is very useful in differentiating the various types gliomas as well as their subtypes.,18 Initial, the WHO grade I encompass pilocytic astrocytoma's, grade II were low-grade astrocytoma's (astrocytoma grade I and II), grade III were anaplastic astrocytoma's (astrocytoma grade III) while grade IV were glioblastoma multiform (astrocytoma grade IV).There is usually an upsurge in the Ki-67 labeling index in diffuse gliomas with malignancy grade of about <5% in low-grade diffuse gliomas, 5% to 10% in anaplastic gliomas, as well as >10% in glioblastomas. The WHO grade II diffuse astrocytomas as well as WHO grade III anaplastic astrocytomas are now respectively separated into IDH-mutant, IDH-wildtype as well as NOS types. It is specified that, if immunohistochemistry for mutant R132H IDH-1 protein and sequencing for IDH-1 codon 132 as well as IDH-2 codon 172 gene mutations are both negative, or if sequencing for IDH-1 codon 132 as well as IDH-2 codon 172 gene mutations alone is negative, then the lesion can be identified as IDH wildtype. In our patient, inhibitor of differentiation protein 1-1/2 gene mutations were not detected. Also, no mutations were detected in telomerase reverse transcriptase gene and no methylation was detected in in the promoter regions.In the 2016 classification, the diffuse gliomas comprised of the WHO grade II and grade III astrocytic tumors, the grade II and III oligodendrogliomas, the grade IV glioblastomas, as well as the related diffuse gliomas of childhood.4The extra-axial nature as well as petroclival location of the glioma makes our case very unique and very rare. The imaging characteristics were very extraordinary for a glioma which resulted in diagnostic dilemma. Thus, the definitive diagnosis was based on the histopathological evaluation of the excised tumor. Treat of WHO grade II comprises of utmost safe resection of the tumor followed by radiotherapy with post-radiotherapy TMZ chemotherapy.Conceptualization: Hui-Min Xie, Seidu A Richard, Zhigang Lan.Data curation: Hui-Min Xie, Seidu A Richard, Zhigang Lan.Formal analysis: Hui-Min Xie, Seidu A Richard, Zhigang Lan.Funding acquisition: Zhigang Lan.Investigation: Hui-Min Xie, Seidu A Richard, Zhigang Lan.Methodology: Hui-Min Xie, Seidu A Richard, Zhigang Lan.Resources: Zhigang Lan.Supervision: Zhigang Lan.Writing – original draft: Seidu A Richard.Writing – review & editing: Hui-Min Xie, Seidu A Richard, Zhigang Lan.


Plasmablastic lymphoma, an acquired immunodeficiency syndrome defining malignancy, is a subtype of diffuse large B-cell lymphoma. It is classically described in the oral cavity, the extraoral presentation being rare. Owing to its rarity and aggressiveness, plasmablastic lymphoma poses a diagnostic and therapeutic challenge to the treating physician. A 40-year-old male, recently diagnosed with HIV infection, presented with bleeding per rectum and spurious diarrhea. Examination revealed proliferative growth in the anal canal. Biopsy of the lesion was diagnostic of plasmablastic lymphoma. Computed tomography and magnetic resonance imaging were done to stage the lesion and assess the local extent, respectively. A multidisciplinary board discussion was done, and the patient was instituted on antiretroviral therapy and chemoradiotherapy. Following six cycles of chemotherapy and 25 fractions of radiotherapy, he achieved complete remission. Plasmablastic lymphoma (PBL), classified as a subtype of diffuse large B-cell lymphoma (DLBCL) by the World Health Organization (WHO), is a rare and aggressive malignancy, commonly seen in patients with human immunodeficiency virus (HIV) infection . It is c3.A 40-year-old male, known case of HIV, presented to the surgical emergency with complaints of bleeding per rectum for the past 15 days, containing both fresh blood and clots, associated with the painful passage of stools and spurious diarrhea. On examination, he was pale and moderately built. Vitals were normal. Per abdominal examination revealed no significant findings. Per rectal examination revealed a polypoidal growth from 1 o'clock to 3 o'clock starting from the anal verge, upper margin not palpable Figure . There wAfter the initial investigations, a colonoscopy was done which showed a growth in the distal rectum and anal canal for a length of 5 cm from 1 o'clock to 3 o'clock position Figure . Rest ofContrast-enhanced computed tomography (CECT) showed a heterogeneously enhancing soft-tissue density lesion measuring 9.1 x 5.4 x 7.8 cm involving the anal canal with loss of fat plane with levator ani bilaterally, extending till the root of the penis and posterior urethra anteriorly, puborectalis posteriorly, anorectal junction superiorly, and inferiorly till the subcutaneous tissue in the perianal region Figure . SeveralBiopsy from the lesion showed a monomorphic population of large round cells with areas of tumor necrosis and hemorrhage Figure -3F.The cells were positive for CD38 and CD138 and negative for CD20 and CD79a. Based on morphological and immunohistochemistry (IHC) features, the biopsy was consistent with PBL. The Ki67 score was >90%.The patient was started on highly active antiretroviral therapy (HAART) after discussion with the antiretroviral therapy clinic. After a multidisciplinary tumor board discussion, he was planned for a dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin (DA-EPOCH) regimen followed by radiotherapy. He received six cycles of DA-EPOCH chemotherapy with granulocyte colony-stimulating factor (G-CSF) support followed by 45Gy radiotherapy over 25 fractions. Following chemoradiation, he was assessed for response. Sigmoidoscopy showed indurated area at the previous tumor site with no residual mass; multiple biopsies were reported to be fibrotic tissue with no evidence of tumor. Repeat cross-sectional imaging  after the chemoradiotherapy also showed clinically complete response Figure -4C. He iAcquired immunodeficiency syndrome (AIDS) is known for an increased incidence of lymphoproliferative disorders due to the interplay of HIV-associated poor immune response and infection by oncologic viruses . Non-Hod3, mean duration of the disease is eight years, and average viral load is over 2,50,000 copies/ml [The usual presentation of PBL is around 40 years of age with male preponderance (4:1) . Howeveropies/ml . PBL of opies/ml . MoreoveThe staging system used for PBL is the Ann-Arbor classification, and most of the patients belonged to either stage 1 or stage 4 disease ,9. MoreoHistopathology remains the gold standard in the diagnosis of PBL. Under microscopy, they show a monomorphic proliferation of plasmacytoid cells  in a starry sky background which again reiterates the aggressive nature of these tumors . The keyIn cases of HIV-positive PBL, HAART initiation has been shown to have better outcomes. Cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) regimen has been tried extensively in the past. However, it has been abandoned due to poor survival outcomes in HIV-associated PBL . Given iAlthough rare, PBL should be a differential diagnosis for immunocompromised patients presenting with a suspicious neoplastic lesion of the anal canal. Given the aggressive biological behavior of the tumor, the aim is to have an early diagnosis of the condition. Timely initiation of appropriate therapy can have good treatment results.


Retroperitoneal Schwannoma is unlikely to be considered in the differential diagnosis of a young patient with unexplained abdominal discomfort with no previous medical history. Tissue sampling is required for a definitive diagnosis.A young male presented to the emergency room with abdominal pain. Imaging study and histopathological examination confirmed the diagnosis of retroperitoneal Schwannoma. Retrograde ejaculation has been discovered as a surgical complication in follow-ups.This case is reported because of its rare clinical presentation and subsequent autonomic nerve dysfunction.Schwannomas are tumors of neurological origin that can grow in any location where neurons exist, and complications related to the neighboring nervous plexus should always be expected. Although uncommon, retrograde ejaculation can occur after the surgery. It is essential to inform the patient about the possibility of these complications. •Retroperitoneal schwannomas are uncommon tumors with a difficult pre-operative diagnosis.•Patients may present with nonspecific symptoms such as vague abdominal pain or genitourinary symptoms•The treatment of choice is complete surgical excision.•Prognosis is good but further follow up is necessary for further neurological complications Vital signs were stable. There were no typical neurofibromatosis type 1 clinical manifestations such as café-au-lait spots, short stature, or Lisch nodules. Laboratory studies, including complete blood count, coagulative panel, SGPT, SGOT, ALK, were within normal range. A large well-defined retroperitoneal hypodense mass was discovered on the CT scan, causing a mass effect on the bladder wall, preventing the bladder from fully being enhanced after contrast administration a & b. ThThe patient was taken up for exploratory laparotomy. The operation was performed in a general hospital by the primary attending surgeon (with over 20 years of trainee). A well-circumstance lesion with a diameter of 8 cm was discovered anterior to aortic bifurcation and Pelvic splanchnic nerves, applying pressure on the left posterior side of the bladder, inverting into the sigmoid mesentery. Although the tumor adhered closely to the bladder and nerves (hypogastric plexus), it was encapsulated without invading the surrounding tissue allowing easy excision a & b. OnGross examination revealed a sharply circumscribed creamy and soft mass with a smooth external surface, measuring 8 cm in diameter. The cut section was predominantly cystic, filled by clear yellow fluid with an area of the solid component. (4 blocks).Histopathological examination revealed a benign-appearing neoplastic lesion composed of bundles of cells having band-looking spindle nuclei without any atypical or mitotic activity. Cells bundles were arranged differently, creating palisading patterns in some regions. IHC study by S100 showed diffuse positivity. CD34, SMA-Desmin, CD117, H-caldesmon are negative. Ki-67 showed a low growth rate.After a two-month follow-up, the patient unexpectedly complained of a sensation of ejaculation without any release of semen. Urine analysis revealed the presence of sperm. Ephedrine and pseudoephedrine were prescribed to the patient. In a three-year follow-up, the patient reported an increase in semen volume.3Schwannomas  are benign tumors of peripheral glial cells that are most typically found in head and neck regions In Conclusion, Retroperitoneal schwannomas are challenging to diagnose before surgery and require pathologic examination to confirm the diagnosis. They are prone to misdiagnose as malignant tumors The patient had a positive perspective toward his surgery at the time of discharge, and he only experienced bearable pain at the surgical site. However, in follow-up sessions, The patient became dissatisfied with the side effect of retrograde ejaculation and was concerned about his sterility. After undergoing medical therapy, the patient stated that his condition had improved.Not commissioned, externally peer-reviewed.The authors received no specific funding for this work.The ethical committee of Shahid Beheshti University approved the case-report.Written informed consent was obtained from the patient to publish this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.: N/A.Jalaluddin Khoshnevis is the Guarantor of this study.SI, SB, MR, EP, and JK were involved in the study concept or design.MR, EP, and JK were involved in data collection.SI and SB were involved in data interpretation.SI, EP, MR were involved in writing the paper under the supervision of JK.The authors declare that there are no conflicts of interests.


We report a rare case of orbital subperiosteal hematoma associated with frontal and ethmoidal sinusitis. Common concerns involving the orbital subperiosteal space include abscess, hematoma and tumor.A patient presented to our clinic with periorbital swelling and limited extraocular muscle movement in her left eye. Computed tomography revealed a superior subperiosteal mass with frontal and ethmoidal sinusitis. We diagnosed the patient with subperiosteal hematoma and surgical evacuation was performed via superior orbitotomy. Brown serous discharge was drained and biopsy demonstrated fibrin clots. The final diagnosis was orbital subperiosteal hematoma and the patient was discharged with symptoms resolved.Orbital subperiosteal hematoma is difficult to distinguish from abscess owing to its rarity and similar presentation. Computed tomography is helpful in diagnosis, and surgical evacuation during the early stages is essential to achieving a good outcome. The orbital subperiosteal space is a space between the periorbita and orbit that is susceptible to a variety of pathologies including abscess, hematoma and tumor . AlthougCompared with other causes, orbital subperiosteal hematoma is very rarely reported in association with sinusitis. Patients with trauma and venous congestion generally have a relevant history and bleeding tendency can be determined from blood tests. However, clinicians should consider sinusitis when presented with patients with unknown causes of orbital subperiosteal hematoma.We report one rare case of orbital subperiosteal hematoma associated with frontal and ethmoidal sinusitis and describe the characteristics, diagnostic tools and treatment of this disease.A 70-year-old woman visited our clinic due to periorbital swelling with mild ocular pain of the left eye for 4 days Fig. . She hadComputed tomography(CT) revealed a well-demarcated biconvex non-enhancing soft tissue density lesion in the left superior subperiosteal area Fig. . There wOn postoperative day 3, there were no limitations on left eye movement Fig. . Visual This study was approved by the institutional review board of Korea University in Seoul, Korea. The research and data collection were conducted in accordance with the tenets of the Declaration of Helsinki from the Word Medical Association.Orbital subperiosteal lesions are most commonly abscesses associated with sinusitis, but should be differentiated from other causes such as subperiosteal hematoma, mucocele or malignancy. In one study of subperiosteal masqueraders and abscesses, the abscess group was younger than the masquerader group . The mosSinus and orbital CT is the imaging modality of choice. When comparing hematoma with abscess, coagulated blood is typically seen as hyperdense, while abscesses have a relatively low density. Smooth, well-defined lesions with no periorbital fat stranding suggest a diagnosis of subperiosteal hematoma rather than abscess . MagnetiIn our case, the patient had no history of trauma or recent upper respiratory infection, no fever, no leukocytosis and slightly elevated ESR. CT suggested that frontal and ethmoidal sinusitis with bone thinning. Intraoperative findings and biopsy revealed the lesion to be a hematoma. Fortunately, hematoma was not re-occurred for 3 years of follow up. She was referred to local ophthalmological clinic due to long distance of our hospital from her house.Most orbital subperiosteal hematomas are post-traumatic, although some can be associated with non-traumatic causes. In traumatic cases, damage to the small vessels under the periosteum creates the hematoma .However,In most reported subperiosteal hematoma cases, sudden onset of proptosis and diplopia and ocular pain are common . With seThe treatment of orbital subperiosteal hematoma depends on the severity of orbital compression. There are three treatment options: observation for spontaneous resolution, needle aspiration and surgical evacuation . Some reIn conclusion, orbital subperiosteal hematomas are difficult to distinguish from abscesses owing to their rarity and similar presentations. We describe a rare case of orbital subperiosteal hematoma associated with frontal and ethmoidal sinusitis.


Benign proliferations of smooth muscle cells are known as leiomyomas; these proliferations can occur in the colon and are typically found incidentally. Colonic leiomyomas are very rare and are most commonly found in the descending or sigmoid colon. A 59-year-old Hispanic female presented to the gastroenterology clinic for surveillance colonoscopy. The biopsy showed a submucosal microscopic leiomyoma in the transverse colon. The treatment of choice for most colonic leiomyomas is surgical excision. This rare case favors the notion that endoscopic polypectomy may be superior to surgical excision, ultimately providing a less-invasive and less-costly procedure without complications or recurrence. Colonic leiomyomas are benign proliferations of smooth muscle cells, arising most often from the muscularis mucosa or muscularis propria layer of the colon. They typically present as incidental findings on colonoscopy and are benign as they rarely exhibit cellular atypia or malignant potential . ColonicA 59-year-old Hispanic female with a medical history of hypothyroidism, dyslipidemia, moderate persistent asthma, gastroesophageal reflux disease (GERD), constipation, colonic polyps presented to the gastroenterology clinic for surveillance colonoscopy. Three years prior, the patient was found to have a 1.3cm serrated tubular adenoma in the sigmoid colon. At the time of presentation, the patient was endorsing GERD-like symptoms that had been improving with omeprazole. She denied any melena, hematochezia, weight changes, weakness, and changes in stool caliber. A repeat colonoscopy was performed, which showed a 7mm sessile polyp Figure  and sentA study by Miettinen et al., which evaluated 88 tumors of the muscularis mucosae of the colon and rectum, exhibited that these tumors have a significantly higher incidence in males with a median age of 62 years and are located predominantly in the rectum and sigmoid colon . Upon hiThere is little known about the genetics of colonic leiomyomas; however, in some esophageal leiomyomas, deletions in collagen type IV alpha 5 and alpha 6 genes COL4A5/COL4A6) on the X-chromosome have been identified and may be tied to the proliferation of smooth muscle in these cases [A5/COL4A6Clinical manifestations of colonic leiomyoma are rare, as it is most often found incidentally on routine colonoscopy screening with performed polypectomy. However, they can produce bulk symptoms such as abdominal pain, constipation, bleeding, or luminal obstruction if it grows too large or develops in specific locations . LeiomyoAlthough colonic leiomyomas seldom have malignant potential, tumors containing high mitotic count, cellular atypia, and large size should be suspicious for possible metastasis . If signOn endoscopy, leiomyomas of the colon can look like ordinary mucosal adenomas, thus requiring biopsy and histological analysis to confirm the diagnosis . Small sA wide array of operative methods have been used to treat colonic leiomyomas, from simple endoscopic excision for small leiomyomas to subtotal colectomy for extensive, larger ones. The treatment of choice for most colonic leiomyomas is surgical excision . Most paTumor size appears to be the most accurate prognostic predictor for colorectal smooth-muscle tumors . Tumor sThis rare case presentation strengthens the notion that endoscopic polypectomy may be superior to the current treatment choice for removal of most colonic leiomyomas, which is surgical excision. It also encourages further investigation towards the approach to remove colonic leiomyomas. Current practice guidelines recommend surgical intervention for colonic leiomyomas measuring more than 5cm due to the potential for malignant transformation. In this case, a leiomyoma in the transverse colon was removed via colonic polypectomy, which ultimately provided a less-invasive and less-costly procedure without complications or recurrence after five years.


Masses of the inferior vena cava (IVC) are very diverse, most of which are thrombus and tumor thrombus, whereas heterotopic ossification of IVC has never been reported. Heterotopic ossification (HO) is the formation of mature lamellar bone outside normal bones and in soft tissues. Some researchers believe that HO is a manifestation of vascular calcification. Here we present a case of HO of the inferior vena cava (IVC) wall. A 68 year old female patient complaining hypertension and palpitation and diagnosed with a retroperitoneal mass was found to have a primary mass of the inferior vena cava wall during surgery. Histopathological examination after surgical resection revealed that the mass was mainly composed of mature bone tissues and hematopoietic tissues of bone marrow, there was no recurrence and the patient was symptom-free 15 months after the surgery. HO of the inferior vena cava wall is very rare, with large volume it can affect the circulation, and this case remind us that it can be cured by surgical resection. Inferior vena cava (IVC) mass is a rare disease with a wide variety of histology and sources. Based on previous literature, IVC masses include thrombus, secondary tumor thrombus, and intravenous leiomyomatosis, primary IVC leiomyosarcoma, IVC phleboliths. The primary lesions of tumor thrombus can be from kidney, liver, and adrenal glands –5. Heter2. A CT scan of the abdomen during hospitalization revealed irregular hyperintensity shadows in the inferior vena cava area and it was diagnosed as a retroperitoneal mass. The patient came to Wuhan Tongji Hospital in December 2019. Abdominal CT enhancement scan showed a mixed density image of about 22*28 mm in the IVC area and below the right renal vein, contained calcification and fatty density  is the formation of mature lamellar bone outside normal bones. At present, HO is generally considered as a complication after trauma, burns and nerve injury. The incidence of HO is 0.2–4% after burns, 10–53% after injury of the cord spine, and jumped to 90% after certain types of hip replacement or acetabular fractures –8. It isin vivo .The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Brainstem schwannomas are very rare, only 11 cases have been reported in the literature so far. We report a small intraparenchymal brainstem schwannoma of the pons, in a 37-year-old female patient who presented with a four-day history of numbness at the mandibular division of the trigeminal nerve on the left side of her face. Trigeminal neuralgia was diagnosed, and magnetic resonance imaging (MRI) showed a small intraparenchymal lesion at the level of the nuclei of the left trigeminal nerve present at the junction between the pons and left brachium pontis. A biopsy wasn’t feasible in this small lesion. We discuss the keen radiological features that helped in the presumptive diagnosis of an intrinsic brainstem schwannoma, with both intra- and extra-axial components. Our case had the earliest presentation and the smallest probable brainstem schwannoma reported so far, as well as its unique symptomatology of trigeminal neuralgia related to both the nucleus and the nerve of the fifth cranial nerve (CN V). Schwannomas are tumors derived from the schwann cells that form the myelin sheath of the peripheral nerves . They acIntra-axial schwannomas are relatively rare. Less than 1% of schwannomas occur within the brain parenchyma , and onlWe present the case of a 37-year-old female patient who harbored a probable intraparenchymal schwannoma of the pons and describe its neuroradiological characteristics. In addition, we briefly review the main theories of the origin of brainstem schwannomas, along with its common radiological features. A 37-year-old woman previously healthy presented with four days history of numbness at the mandibular division (V3) of the trigeminal nerve on the left side of her face. Physical exam revealed an alert, calm well-oriented patient and demonstrated that binocular vision was normal, bilateral pupils were of the same size, eyes were sensitive to light reflection and eyeballs moved freely in all directions. The fundoscopic exam was normal and facial sensation was also normal except for numbness and sensory loss at the mandibular division of the trigeminal nerve CN V on the left side of her face. The findings were solely unilateral. There was no nystagmus, no mouth deviation, and no sensorineural hearing problems. Otherwise, cranial nerve examination was normal. No cutaneous stigmata of neurofibromatosis type 1 were observed. She was diagnosed with trigeminal neuropathy and magnetic resonance imaging (MRI) of the brain was ordered.The MRI of the brain was performed on a 3T Ingenia Philips . It showed a small intraparenchymal lesion at the level of the nuclei of the left trigeminal nerve at the junction between the pons and left brachium pontis with low signal in T1 , or ganglioglioma ,2. UsualOur case has unique and interesting features compared with other cases. One, the symptoms in our patient developed four days before presentation; in other described cases, brainstem schwannomas symptoms developed between two weeks to three years ,7, thus Intrinsic brainstem schwannomas are exceptionally rare. Preoperative radiological diagnosis is exceedingly difficult since there is no clear consensus on neuroimaging features of schwannomas. Our unique case of pons schwannoma involving the trigeminal nucleus and nerve has the earliest presentation, the smallest size, and both intra and extraparenchymal components.


After the outbreak of COVID-19, many families equip with 75% ethanol to inactivate the SARS-CoV-2, which increases the risk of exposure to ethanol.We reported a 25-day-old newborn who was diagnosed with neonatal acute ethanol intoxication with a presenting complaint of accidental consumption about 15 ml formula milk containing 75% ethanol. His main clinical manifestations were irritability, flushed skin, tachycardia, tachypnea, and toxicology analysis detected ethanol. After timely gastric lavage and intravenous fluid replacement, he was cured and discharged.During the COVID-19 epidemic, high concentration ethanol used for inactivating SARS-COV-2 should be placed reasonably and neonatal feeding safety should be emphasized. Timely diagnosis and symptomatic treatment are essential for the prevention and management of acute ethanol intoxication in newborns. The major epidemic of COVID-19 has emerged as a serious global public health threat, especially after the emergence of the more infectious Delta strain . SARS-COA 25-day-old male newborn was admitted to Tianjin children’s hospital two hours after accidental consumption of about 15 ml formula milk containing 75% ethanol. According to his mother, two hours before admission, the boy ingested about 15 ml formula milk, which was mistakenly mixed with 75% ethanol instead of water. He immediately developed flushing around his eyes, which gradually spread to his face and the whole body, accompanied by crying and irritability. We reported the incident to the Child Guidance Centre, who conducted a thorough investigation and careful questioning, and ultimately determined that the incident was an unintentional injury.2 was 98%. Besides, his anterior fontanelle was flat and soft, and the examinations of lungs, cardiac, abdominal, nervous system, musculoskeletal, and extremity were normal. His toxicology analysis showed that 4.65 mol/L (21.4 mg/dl) of ethanol was detected in the blood and ethanol was also detected in the gastric juice. The remainder of the examination was normal.The boy was delivered by cesarean section at 40 weeks, with the birth weight of 3550 g. His birth history was normal. When he was admitted to the hospital, he was irritated, responsive, cried loudly, and could smell a faint but definite odor of ethanol presenting on the breath. His face and body were flushed. A physical examination showed his body temperature was 37.1 °C, a respiratory rate was 50breaths/min, heart rate was 185beats/min, blood pressure was 83/40 mmHg, and TcSOThe diagnosis of neonatal acute ethanol intoxication in this child was clear, according to a consensus on the management of acute ethanol intoxication . As a reEthanol intoxication is uncommon in children, especially neonates . Accordisake (Japanese wine prepared from fermented rice) was mixed in a 15-day-old newborn girl’s formula. The clinical features of the girl were flushed skin, tachycardia and low blood pressure indicating circulatory failure, somnolence and metabolic acidosis.In this report, we reported an acute ethanol intoxication incident in a 25-day-old newborn who was accidental consumption about 15 ml formula milk containing 75% ethanol during the COVID-19. Unintentional mixing of alcohol in formula is another way for neonates to consume ethanol. In Japan, a case  was repoThe main manifestations of the case we reported were irritability, flushing of facial and trunk skin, fast heart rate, breathing fast. These phenomena may involve multiple mechanisms, such as opioid peptides, prostaglandins, histamine, kinin, and catecholamines, which are related to acetaldehyde-activated vasodilation .Although the symptoms of the boy we reported were mild, there are also apparent life-threatening acute ethanol intoxication events. For example, Chang-Teng Wu  reportedAn important reason for the treatment failure of this 3-day-old newborn is that he was not found in time. Consequently, the timely discovery of ethanol intoxication in a neonate is very important for ensuring his health and safety. Fortunately, the neonate in our case was taken to hospital shortly after being found to have accidentally consumed ethanol.Because the child we reported had a history of ethanol consumption, we immediately gave normal saline gastric lavage until clear fluid was extracted, and diuretic and defecation, in order to promote ethanol excretion, as well as intravenous infusion of naloxone. Naloxone is considered to be an " amethystic agent " , which cTo sum up, in the grim situation of the global COVID-19 pandemic, the feeding safety of newborns should be taken seriously. The combination of medical history, physical examination, and ethanol poison detection is essential for the timely diagnosis and management of neonatal acute ethanol intoxication. In addition, high concentration ethanol used for inactivating SARS-COV-2 should also be placed reasonably and prominently marked during the COVID-19 epidemic.


The aim of this paper is to present and discuss a case of a solid pseudopapillary tumor of the pancreas occurring in a 19-year-old female.A 19-year-old girl presented to our department with epigastric pain for two months, she had no clinical findings on physical examination. Abdominal Computed tomography scan (CT scan) showed the presence of a well-defined tumor arising from the pancreatic head measuring 9,1 × 8.1 × 8.5 cm, heterogeneous and with solid and necrosis components. The patient was subjected to surgery and histopathological examination confirmed the diagnosis of a pseudopapillary tumor of the pancreas.This is an interesting case report of a rare tumor, in so far as without any adjuvant chemotherapy Prognosis of the tumor is better than other pancreatic tumors. surgical resection seems to be the best strategy in the management of SPT.Close follow up is necessary for early detection of the recurrence and metastasis. •Solid pseudopapillary tumor of the pancreas is a rare tumor of low malignant potential.•The prognosis is favorable even in the presence of distant metastasis.•Surgical resection is the treatment of choice.•Close follow up is necessary to early detection of the recurrence and metastasis. It di2A 19-years-old female, a university student, and resident in central Morocco were referred to our department due to epigastric pain for 2 months. The pain was progressive and persistent, not radiating without relief factors. There was no history of vomiting, fever, jaundice, or weight loss. The patient had no medical or surgical history and no history of alcohol or drug abuse. The Patient had no significant family history. On general examination vitals were stable, there was no tenderness or palpable mass on examination of the abdomen.Abdominal Computed tomography (CT) scan showed the presence of a well-defined tumor arising from the pancreatic head measuring 9.1 × 8.1 × 8.5 cm, heterogeneous and with solid and necrosis components, with no pancreatic or ductal dilatation. No metastases were observed in adjacent organs . Tumor mDuring laparotomy under general anesthesia, a mass involving the head of the pancreas, measuring 9 cm, was noted . The LivPostoperatively, the patient had a pancreatic fistula and subcutaneous somatostatin analogs were administered at a dose of 100 μg three times a day for 7 days. The patient recovered from surgery and was discharged on postoperative day 20 in good condition. The patient was reviewed after 1 month, 3 months, and 6 months and continues to do well.3SPN is classically described as an epithelial tumor with a macroscopic appearance of pseudo-papillary features and cystic microscopic appearance. The tumor has been identified with several synonyms, such as solid and papillary epithelial neoplasia, solid and cystic tumor, papillary cystic neoplasia, papillary cystic epithelial neoplasia, cystic papillary epithelial neoplasia tumor, and Franz tumor. In 1996, the World Health Organization (WHO) renamed this tumor SPT for the international histologic classification of tumors of the exocrine pancreas ,6.The common localization of solid pseudopapillary tumors is the tail of the pancreas, followed by the head and the body. More rarely it can stand as a multicentric tumor of the pancreas .Its clinical presentation is nonspecific. The patients often are asymptomatic for a long time, until the tumor reaches a considerable size, because of symptoms associated with tumor compression of adjacent organs. Sometimes the patient may have mild abdominal pain, nausea, poor appetite, loss of weight, or palpable abdominal mass . JaundicIn the CT scan, the mass appears to be heterogeneous and hypodense. It is possible to search for calcifications. After injection, there is a peripheral capsular enhancement. The limits of the CT-scan remain the lack of tissue resolution . MagnetiThe problem of the differential diagnosis is above all raised with neuroendocrine tumors of the pancreas and mucinous cystadenocarcinomas where the prognosis is less favorable .Histologically, macroscopically, the lesion is separated from the healthy parenchyma by a thin fibrous capsule. Microscopically, the cystic zones are surrounded by solid tumoral tissue presenting characteristic pseudopapillary structures, with the progression of the tumor necrotic and hemorrhagic zones developing .The tumors show immunohistochemical stains for vimentin, alpha 1- antitrypsin, neuron-specific enolase, CD56, and CD10 . PositivThe genetic pathway for NPS formation is well known, and NPS is characterized by the presence of mutations in the bêta-catenin activating gene that interfere with the phosphorylation of the protein product .Surgical resection is the treatment of choice for SPN and organ preservation is advocated if feasible. According to the location of the tumor, distal pancreatectomy with or without splenectomy, pylorus-preserving pancreatoduodenectomy, Whipple operation can be performed . EnucleaLong-term survival and cure for SPN are achieved through surgical resection, The overall five-year survival rate of patients with SPN is about 95% . MalignaCriteria that distinguish potentially malignant tumors and which are classified as SPC carcinoma are angioinvasion, perineural invasion, and deep invasion of the surrounding pancreatic parenchyma. Other histological features, such as extensive necrosis, nuclear atypia, high mitotic rate, Ki-67 proliferative index, and sarcomatoid areas may be associated with aggressive behavior ,16.4SPT of the pancreas is a rare tumor with low malignant potential, but the incidence is increasing. Large tumors of the pancreas among young women with solid and cystic areas should be highly suspected as SPT. The prognosis is favorable even in the presence of distant metastasis. Although surgical resection with clear margins seems to be the best surgical strategy in the management of SPT. The postoperative follow-up strategy should be personalized based on the presence of risk factors to diagnose a local recurrence or distant metastasis.Not commissioned, externally peer-reviewed.I declare on my honor that the ethical approval has been exempted by my establishment.None.Driss Erguibi: written the paper and operating surgeon. Yassine El Berni: written the paper. Aziz Moufakkir: written the paper. Rachid Boufettal: study concept. Rifki Jai Saad: study concept. Farid Chehab: correction of the paper.Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.None.Yassine El Berni.The authors declare having no conflicts of interest for this article.


Sciatic hernias are rare pelvic floor hernias that occur through the sciatic foramen and often present as abdominal or pelvic pain, particularly in women. Historically, they were repaired using an open approach, with limited reports on their laparoscopic treatment.Here we present the case of an 85-year-old woman who had repeated abdominal pain and was referred to our hospital for sciatic hernia surgery after conservative treatment. We laparoscopically observed the deep pelvis and identified the right sciatic hernia. When an extraperitoneal space was dissected, an ureterohypogastric nerve fascia (UNF) and a vesicohypogastric fascia (VF) were identified. Moreover, the maneuver to mobilize the fasciae inside from the pelvic wall made it possible to separate the ureter and urinary bladder, which might have otherwise incarcerated in the hernia. We repaired the defect of the sciatic foramen with a mesh plug and patch. The patient had an uneventful recovery, and the absence of sciatic herniation recurrence was confirmed 1 year after surgery.A laparoscopic repair of a sciatic hernia could permit detailed non-invasive observations of the deep pelvis and be performed effectively by recognizing an UNF and a VF located near the sciatic foramen. Sciatic hernia is one of the rarest forms of pelvic hernia, with only about 100 cases reported to date  and is mFour years ago, an 85-year-old woman experienced abdominal pain and consulted another hospital. She was diagnosed with bowel obstruction and hospitalized; her symptoms were relieved by conservative treatment. When the patient again experienced fever and abdominal pain, she consulted other hospitals and was hospitalized for bowel obstruction. CT demonstrated small intestine incarceration to the right sciatic hernia, which was thought to be the cause of the intestinal obstruction. After her symptoms were alleviated through conservative treatment, she was referred to our hospital. Physical examination revealed the following: height, 142 cm; weight, 38.5 kg (body mass index: 19.1). CT revealed that the small intestine had herniated into the sciatic foramen and the oral side of the small intestine had dilated (Fig. The patient was treated laparoscopically using three trocars and was positioned in a head-down position. The hernia was clearly evident in the suprapiriformis position of the greater sciatic foramen. Hernia orifice, 2.5 cm in diameter, was confirmed inside the right external iliac artery and outside the right ureter (Fig. Sciatic hernias are extremely rare; however, their reported incidence has increased in recent years due to the frequent use of radiological examination , 5. SciaRegardless of the incarceration, the treatment of sciatic hernias is surgical reduction and repair due to the high risk of strangulation. Although a bilateral symptomatic sciatic hernia threated by robotic approach was reported , bilaterIn conclusion, a laparoscopic repair of a sciatic hernia could permit detailed non-invasive observations. Furthermore, we recommend a laparoscopic repair recognizing the fasciae, such as a UNF and a VF.


Congenital granular cell tumor (CGCT) is a rare benign lesion and presents as a fibrous mass arising from the alveolus in the newborn. The prenatal screening of lesions can help in parent counseling, determining the complications, as larger size lesions may interfere with normal delivery and require a cesarean section. Congenital granular cell tumor (CGCT) is a rare benign lesion and presents as a fibrous mass arising from the alveolus in the newborn. The prenatal screening of lesions can help in parent counseling, determining the complications, as larger size lesions may interfere with normal delivery and require a cesarean section. It was first described by Ernst Christian Neumann in 1871 as “Congenital Epulis.”The congenital granular cell tumor is seen twice as commonly involving maxillary alveolar ridge to mandibular ridge with the incisor canine region being the most prevalent site.We here report a case of congenital granular cell tumor (CGCT) in the incisor region of the lower alveolar ridge. This case report is unique, owing to the size of the tumor, which is relatively rare, along with it we tried to highlight the differential diagnosis of this particular entity in a separate table which will guide the clinicians to arrive at a correct diagnosis when they encounter with such a lesion.2A newborn female patient was referred to the faculty of dentistry, National Medical College and teaching hospital, Birgunj, Nepal. The child had a normal delivery in the maternity department of the same institution and was referred to us 5 h post‐delivery for evaluation and management of mass in the mouth. On clinical examination, the lesion presented with a pedunculated, smooth‐surfaced mass, which was pink in color, size about 2.5 cm in diameter on the anterior part of the mandibular alveolus Figure . The tum2.1Pediatric consultation was done for the child and routine blood investigations like complete blood count, bleeding time, clotting time, the international normalized ratio was done. The reports were found to be within the normal limits. A single dose of 1‐mg vitamin K injection was administered intravenously to prevent vitamin K deficiency bleeding.2.2The surgery was performed under intravenous anesthesia Local anesthetic (2% lignocaine) was infiltrated at the base of the lesion to decrease intra‐operative bleeding and post‐operative pain. The lesion was excised with electrocautery. The excised mass (2.3 × 1.8 × 1.3) cm Figure  was fixe2.3The multiple sections of hematoxylin and eosin‐stained tissues revealed stratified squamous epithelium lining the lesion showing atrophy of rete ridges and the underlying stroma bears unencapsulated tumor composed of sheets of large, polygonal, round, and oval cells with indistinct cell border, granular, eosinophilic cytoplasm, and round to oval lightly basophilic nuclei Figure . The mic2.4The child was observed postoperatively for 3 h. Feeding was done with the spoon, which she tolerated well. A pediatric review was done, and then, the child was discharged. As the patient resided far from the hospital, the patient was never brought to the hospital for the follow‐up. However, the child's father reported to the department 15 days post‐surgery, stating that the child is doing well. As there is no concrete follow‐up data, the authors consider it as a limitation of this case report.3The clinical course of CGCT is not clear but still, it is considered as a benign lesion and does not grow postpartum. It was suggested that trauma due to finger sucking in utero could be a possible cause for the CGCT but it had little evidence so the concept was discarded. The most recent concept about CGCT is it is either a reactive lesion. Mostly it presents as an isolated lesion but there are reports of it presenting simultaneously with other entities, chiefly neurofibromatosis, transverse facial cleft, and blinder syndrome.The clinical diagnosis of CGCT can be made by the presence of a fibrous mass in the alveolar mucosa of the mandible or maxilla at the time of birth.Prenatal diagnosis of CGCT can be done by ultrasonography as early as 26 weeks of pregnancy.A wide range of immunohistochemical (IHC) markers could be used in CGCT including S100, CD 68, CD 105, podoplanin, and vascular endothelial growth factor (VEGF). But all cases of CGCT do not show positivity for all these IHC markers speaks for its enigmatic tissue of origin.The differential diagnosis for this particular entity includes granular cell tumor, congenital hemangioma, melanotic neuroectodermal tumor of infancy (MNTI), embryonal rhabdomyosarcoma, infantile myofibroma, and peripheral odontogenic fibroma.4Congenital granular cell tumor is a distinctive entity rarely encountered mostly in infants. The exact tissue of origin, course, and progression of this entity is obscure, which invokes further research. The take‐home message from this case report is prenatal diagnosis is important for treatment planning and depending on the size and location of the lesion to prevent any further complications. Although recurrence is rare, and malignant transformation has not been reported, periodic follow‐up of the patient should be performed.None.Snehashish Ghosh drafted the manuscript, revised, and edited it. Arpita Singh has done the literature review, edited the figures. Anuja Panthee has revised the manuscript. Anjani Kumar Yadav has assisted in literature review and editing of the manuscript. All the authors have reviewed the paper and approved the final version of the manuscript.Ethics approval was not required from the institution, in accordance with our country's law, as this was a case report.Written informed consent was obtained from the father of the patient (as the patient was a neonate) to publish this report in accordance with the journal's patient consent policy.


Gastric varices can be present in up to 20% of patients with portal hypertension. However, a varix of the left gastroepiploic vein (LGV) is extremely rare. Surgery is required if bleeding occurs; thus, precise diagnosis is crucial. We present a successful case of preoperative diagnosis intraabdominal varix of the LGV using three-dimensional-computed tomography angiography (3D-CTA) followed by laparoscopic resection. This is the first report of a case with variant LGV. Our study demonstrates the efficacies of 3D-CTA and laparoscopic surgery for the diagnosis and safe resection of the intraabdominal varix, respectively.A 74-year-old woman was referred to our department with a tumor in the abdominal cavity. On physical examination, no lumps were palpable in the upper abdomen.The enhanced CT was revealed that the tumor was not enhanced in the early phase, but in the equilibrium phase. Moreover, 3D-CTA clearly revealed that the tumor was being supplied by the LGV. Thus, it was diagnosed as a variant of the LGV.Surgical resection was performed laparoscopically as per the guidance of preoperative 3D-CTA findings. During surgery, a dark tumor was found along the gastroepiploic vessels, supplied by the LGV. The tumor was resected safely based on the preoperative information.Histopathological examination of the tumor showed accumulation of various vessels, but no malignant cells. Therefore, we made a final diagnosis of the tumor as an LGV varix. For follow-up, an annual CT examination was performed and after 3 years postoperation, no recurrence was observed.In the present case, we have achieved a successful preoperative diagnosis using 3D-CTA, and resection was safely accomplished using laparoscopy guided by preoperative anatomical information. This is the first report of an LGV variant. Appropriate management is crucial because bleeding is a catastrophic event. Therefore, imaging procedures such as 3D-CTA for diagnosis, followed by safe resection by laparoscopic surgery, are effective tools for the treatment of epiploic vein varices. However, there are currently no reports of varices of the left gastroepiploic vein (LGV), and it is not yet understood how these varices may occur and what they interact with. Moreover, surgical treatment is required once the varix is ruptured; thus, it is important to diagnose it appropriately and resect it safely before rupture occurs.Gastric varices may be present in up to 20% of patients with portal hypertension and have a 65% risk of bleeding due to the high intravariceal pressure.Here, we report a diagnosis of a varix of the LGV using preoperative 3D-CTA, followed by safe resection using laparoscopic surgery.2An asymptomatic 74-year-old woman was referred to our department with a tumor in the abdominal cavity. The tumor was more than 20 mm in size and was initially suspected to be an aneurysm of the epiploic artery, as suggested by enhanced CT findings. On physical examination, no lumps were palpable in the upper abdomen, while laboratory investigations showed slight anemia , no liver dysfunction, and normal levels of tumor markers .Upper gastrointestinal endoscopy could not detect any tumors or varices in the esophagus or stomach Fig. A and B. During surgery, a dark tumor was found along the gastroepiploic vessels. The tumor had mobility without any adhesion to or invasion of adjacent organs Fig. A. The LGThe tumor was 20 mm in size and the surface was macroscopically smooth and soft Fig. A. HistopIn this case, we accurately diagnosed a LGV varix using preoperative 3D-CTA, and subsequently performed safety resection by laparoscopic surgery. For follow-up, an annual CT examination was performed and after 3 years postoperation, there was no sign of any recurrence.3,4 Once bleeding occurs, it is considered an emergency event with a high mortality rate. Therefore, preventing any hemorrhage is crucial to avoid the need for endoscopic or surgical treatment. The diagnosis and handling of gastroepiploic vein varices are poorly understood, as they are extremely rare entities.Although their etiology is unclear, gastric varices mainly occur due to portal hypertension and abnormal shunts. Indeed, in the present case, once we suspected an abdominal tumor, we investigated it initially using abdominal CT. Then, we attempted to diagnose it more specifically by using 3D-CTA. As shown in Figure Preoperative 3D-CTA is a useful tool to diagnose and detect the pattern of blood supply to a tumor. We previously reported that we could diagnose the giant gastrointestinal stromal tumors (GISTs) nourished by the right epiploic artery by using 3D-CTA.,8 Moreover, the varix must be removed to prevent critical events and surgery. In this case, laparoscopic surgery was performed, and it was possible to determine the location and condition of the tumor without the need for a large incision. The patient had a good postoperative course; thus, laparoscopic treatment is an additional option in the case of an abdominal tumor that is difficult to diagnose preoperatively.Laparoscopic examination is a useful technique because it is possible to observe the tumor directly and treat it with minimal invasion, regardless of the difficulty of preoperative diagnosis.In conclusion, this is the first report on a variant of LGV. Effective management of LGV varices is crucial because bleeding is considered a critical event. Therefore, making full use of an imaging procedure such as 3D-CTA and safety resection by laparoscopic surgery are effective tools for epiploic vein varix.www.editage.com) for English language editing.We would like to thank Editage (KM, RT, YI, KH, and SL provided care to the patient, including the surgery. KY created the 3D-CTA. KM and SL designed and drafted the manuscript. KU reviewed and revised the manuscript. All authors have read and approved the final manuscript.Data curation: Kentaro Matsuo, Sang-Woong Lee, Ryo Tanaka, Yoshiro Imai, Kotaro Honda, Kazuhiro Yamamoto.Investigation: Kazuhiro Yamamoto.Supervision: Sang-Woong Lee, Kazuhisa Uchiyama.Writing – original draft: Kentaro Matsuo.Writing – review & editing: Sang-Woong Lee, Kazuhisa Uchiyama.


The parotid gland is a very rare location of Ewing's sarcoma. Its clinical and radiological manifestations are atypical. Its management is based on a multidisciplinary approach to improve prognosis and survival.The diagnosis of parotid Ewing's sarcoma is determined by a combination of genetic and histological criteria. Its local aggressiveness and high metastatic potential require prompt and appropriate management. Many prognostic features affect its management, the most important is the TNM staging.Limited cases of parotid Ewing's sarcoma have been published in the literature. This small number of reported cases is the only way to study its characteristics. •The parotid gland is a very rare location of Ewing's sarcoma.•The diagnosis of parotid Ewing's sarcoma is determined by a combination of genetic and histological criteria.•Many prognosis features affect its management, the most important is the TNM staging. ParotidThis case has been reported in line with the SCARE criteria .243-year-old female patient who had surgery for right breast cancer in 2015 and underwent a right mastectomy followed by 5 sessions of radiotherapy and 6 sessions of chemotherapy stopped in August 2016, and on hormonal therapy (Tamoxifen 1cp/d), presented to our department of maxillofacial surgery in November 2020 for left parotid swelling that had been progressing for 3 months. The patient was reported to our department by a regional referral hospital.The clinical examination revealed a parotid mass of 4 cm long axis with skin that appeared to be normal in appearance, firm on palpation, painless, mobile to the superficial and deep plane, without facial palsy, with moderate trismus and mobile high homolateral jugulo-carotid cervical adenopathy with no visible inflammatory signs, an examination of the orifice of the Stenon's duct shows no inflammation or bloody outflow, and otoscopic examination finds no signs of invasion of the external ear duct.Facial MRI revealed a slightly limited tissue process in the left parotid gland with polylobed contours in the T1 isosignal and T2 isosignal, which was heterogeneously enhanced after injection of the contrast agent , with thThe extension survey did not reveal any distant metastasis. The patient underwent exotic parotidectomy with extemporaneous examination revealing carcinoma, followed by full parotidectomy with facial nerve preservation and homolateral supra-digastric adenectomy . SurgicaThe anatomopathological outcome of the specimen concluded at parotid Ewing's sarcoma with the positivity of CD99, cytokeratin AE1AE3, and synaptophysin. The patient was sent to oncology for adjuvant radiotherapy then was followed after her discharge in the outpatient department by a rhythm of twice a month for two first months and then once per month for a year.3Extra-skeletal Ewing's sarcoma is a rare malignant tumor of mesenchymal cellular origin with histological characteristics similar to those of bony Ewing's sarcoma ,6. It caEwing's sarcoma occurs mainly among adolescents and young adults aged 10–30 years without gender predominance . EtiopatThe clinical manifestations of Ewing's sarcoma of the parotid gland are non-specific and include swelling in the rapidly developing parotid region, trismus, locoregional pain, peripheral facial paralysis, and homolateral cervical lymphadenopathy ,7. ImagiThe definitive diagnosis of parotid Ewing's sarcoma is histological due to its specific clinical and radiological characteristics. Histologically it is a small round cell tumor with a positive marker CD99/MIC2 in immunohistochemistry , in our The management of parotid Ewing's sarcoma is multidisciplinary, including surgeons and oncologists . SurgicaThe most important prognostic factors are represented by tumor size and the presence of distant metastases at the time of diagnosis, which influences the modalities and results of treatment .4Parotid Ewing's sarcoma is a rare entity of this kind of tumor which is characterized by its locoregional aggressiveness and high metastatic potential. Its therapeutic management can present a challenge to the treating physician, but a multidisciplinary approach including surgery, radiotherapy, and chemotherapy when indicated can lead to better long-term results.Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.The authors declared that this study has received no financial support.Ayoub Sabr: Corresponding author writing the paper.Rachid Aloua: writing the paper.Ouassime kerdoud: writing the paper.Faiçal Slimani: Correction of the paper.1. Name of the registry:2. Unique Identifying number or registration ID:3. Hyperlink to your specific registration (must be publicly accessible and will be checked):Ayoub Sabr.Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.Not commissioned, externally peer reviewed.Authors of this article have no conflict or competing interests. All of the authors approved the final version of the manuscript.


This article aims to explain the use of a variety of noninvasive of minimally invasive examinations to obtain reliable diagnostic clues. The choice of treatment methods and repair techniques for wound defects are also critical in terms of the prognosis. Here, we describe the case of a 53-year-old male patient who visited our dermatology clinic due to a red plaque on the inner side of his left nipple without any symptoms for more than 30 years. He was given dermoscopy, high-frequency ultrasound (HFUS), Color Doppler flow imaging (CDFI), and contrast-enhanced ultrasound (CEUS) examinations. Currently, there are no literatures on these auxiliary examinations for this disease. Dermoscopy revealed that there were abundant blood vessels on the periphery of the skin lesion with obvious dilation. HFUS revealed an inhomegeneous hypoechoic solid mass in the dermis with clear borders and irregular shape. CDFI indicated that there are abundant blood flow signals in the periphery and central of the tumor. CEUS showed a mixed inhomogeneous, grid-like high-enhancement pattern. Based on the above auxiliary findings, the possibility of malignant lesion was suspected. Therefore, the patient was given a pathological examination, which showed that many luminal structures of the dermis layer were embedded in the hyperplastic fibrous tissue. The atypical cells were not obvious but showed an infiltrating growth pattern. Immunohistochemistry showed positive reaction for cytokeratin 7 (CK7), epithelial membrane antigen (EMA), and carcinoembryonic antigen (CEA) and a weak positive results was obtained for S-100. There was also a negative result for CK20, gross cystic disease fluid protein 15 (GCDFP-15), and P63. As a result, the patient was diagnosed with “syringoid eccrine carcinoma.” The treatment was surgical excision. Mohs microsurgery was combined with the looped, broad, and deep-buried suturing technique (LBD tension-reduced suturing technique). This technique directly sutures the wound instead of carrying out traditional skin grafting or flap transfer. The postoperative follow-up results were satisfactory as no obvious keloid formed on the wound during the follow-ups. In conclusion, ultrasound is greatly advantageous in tumor morphology and hemodynamics. It orients the therapeutic management and assesses the therapeutic efficacy and the tumoral prognosis. In surgical treatments, a less-traumatic operation should be selected to reduce the patient’s pain. Syringoid eccrine carcinoma (SEC) is an infiltrative, low-grade malignant tumor derived from the eccrine glands, and it is rarely encountered in the clinic. This study describes a patient with SEC in the chest area from the aspects of pathology, dermoscopy, high-frequency ultrasound (HFUS), contrast-enhanced ultrasound (CEUS), and color Doppler flow imaging (CDFI), as well as its unique treatment. The manifestations of HFUS and CEUS of this disease have never been described in any literature, and we shall be able to learn more through this case study.The patient was a 53-year-old man. Thirty years ago, the patient had a mung bean-sized red papule on the inner side of his left nipple without obvious inducement. The papule gradually increased in size, but there were no conscious symptoms. In the past year, the patient experienced erosion and a scab appeared in the center of the lesion. As a result, he visited our clinic  began to enter the lesion within 15 s, and the intensity peaked at 22 s, displaying a mixed inhomogeneous, grid-like high-enhancement pattern. The baseline intensity and peak intensity were 6.60 and 18.38 dB, respectively , primary cutaneous adenoid cystic carcinoma (PCACC), microcystic adnexal carcinoma (MAC), and skin metastases of visceral adenocarcinoma. The distinction could be done mainly based on pathological manifestations, because their HFUS, CDFI, and CEUS manifestations have not been described in any literatures. The pathological feature of SEC is the tadpole-like and trabecular epithelial components that are embedded in the collagen fibrous matrix; this is similar to syringoma, but the slight atypia and infiltrating growth pattern of the cells can be distinguished between both. SEC lacks horn cyst, hair follicle differentiations, and pleomorphic mesh-like structure, which makes it distinguishable from MAC and PCACC. However, it is sometimes difficult to distinguish sclerosing eccrine carcinoma from PCACC. Positive results were obtained for tumor EMA and CEA, but the cells around the mass were not arranged in a fence-like manner and there were no contraction gap, which makes it distinguishable from BCC. The skin metastasis of visceral adenocarcinoma, combined with clinical manifestations, laboratory examinations, imaging examinations, negative CK20 and GCDFP-15 ruled out this possibility .The pathological and auxiliary examinations did not indicate the possibility of metastasis, thus, the patient was treated with a wide local excision; Mohs microsurgical resection was planned Figure 5The patient experienced a slight pain in the postoperative wound that disappeared after 1 month. The sutures were removed 2 weeks after surgery. Postoperative follow-up was performed during the 1st month and 3rd month, and no space-occupying lesions were found during HFUS examinations. No keloid was found Figure 5SEC is a rare malignant skin adnexal tumor accounting for less than 0.01% of all malignant skin tumors and lacks a clear pathogenesis –6. The tPresently, most patients undergo Mohs microsurgery, and skin flap repair or skin grafting is used to repair the wound defect . The patThe original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding author.Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.JZ and WX carried out the operation and collected data. JZ drafted the manuscript. XL conducted ultrasound examination and diagnosis. MZ and JY were responsible for pathological section, staining, and diagnosis. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.