Intraosseous hibernoma is a rare benign bone tumor derived from brown fat. It is typically found in the axial skeleton and is more commonly observed in women. It can manifest as a painful lesion or may be incidentally discovered. Intraosseous hibernoma often presents as a sclerotic lesion, although it can also manifest as a lytic lesion. Due to its varied radiographic appearance, it should be considered in the differential diagnosis of bone lesions as it can mimic metastatic lesions as well as other sclerotic and lytic bone lesions. Therefore, obtaining a biopsy of the lesion is crucial for an accurate diagnosis. In this report, we present the clinical, radiological, and histopathological findings of two cases of intraosseous hibernoma and provide a concise overview based on a review of the literature. Hibernoma is an uncommon benign neoplasm composed of adipocytic cells containing brown fat, typically manifesting as a painless, indolent mass occurring in the soft tissues. The tumor primarily occurs in the thigh, followed by the trunk and upper limb, with no apparent gender predisposition. Its incidence peaks during the third and fourth decades of life . HistopaRecently, intraosseous hibernoma (IOH) has been reported. Thorn initially reported this entity in 2008 . SubsequCase 1A 49-year-old female patient with no significant medical history was recently diagnosed with bilateral breast cancer. During the staging process, an incidental sternal bony lesion was identified, raising concerns about possible bone metastasis. Radiological evaluation using single-photon emission computed tomography (SPECT) revealed a 13-mm sclerotic lesion in the sternal manubrium, exhibiting hyperfixation without evidence of cortical erosion or visible periosteal apposition Figure . AdditioMicroscopic examination revealed a sclerotic trabecular bone structure, along with clear areas resembling medullary spaces. These clear areas consisted of large cells displaying cytoplasmic microvacuolations reminiscent of brown fat cells. Immunophenotyping analysis demonstrated the clear cells to be positive for the S100 protein Figure , while tCase 2A 63-year-old woman with no prior medical history was referred by her family physician due to an incidental bony lesion identified on MRI during the evaluation of chronic back pain and left sciatica Figure . The patThe histological examination of the biopsy specimen demonstrated similar characteristics to the first case, including abnormal bone tissue composed of thick interconnected trabeculae separated by clear spaces containing numerous capillaries and clear cells with multivacuolated pale cytoplasm and a central or paracentral nucleus. Immunohistochemical analysis revealed positive expression of the S100 protein in the clear cells, while epithelial, histiocytic, and brachyury markers showed negative staining Figure .Brown fat cells are characterized by their high vascularity and abundance of mitochondria, giving them the appearance of a brown color. Typically found in newborns, they gradually diminish with age and transform into white fat cells. However, remnants of brown fat tissue can persist in adults, predominantly in the upper trunk and paravertebral regions. Brown fat plays a significant role in thermoregulation in newborns and has emerged as a potential target for addressing obesity and diabetes in adults .Hibernoma is a benign tumor composed of brown adipocytes that primarily occurs in soft tissues. Intraosseous hibernoma (IOH) is extremely rare and has only recently been described. The first report of IOH was documented by Thorn et al. in 2008, and subsequent cases have been reported in the literature -25.To the best of our knowledge, including the two cases presented in this study, a total of 39 cases of IOH have been reported. IOH is typically observed in adults between the ages of 36 and 85, with an average age of 59.4 years. It occurs more frequently in women 69.2%) than in men (30.8%), with a female-to-male ratio of 2.1:1. In contrast, soft tissue hibernomas are more commonly found in men [% than inIOH is most commonly found in the axial skeleton and pelvis, with the sacrum being the most common site (33.3%), followed by the hip bone (27.0%) and vertebral bodies 23.1%). Other locations, such as the femur, ribs, and sternum, are less frequently involved. The majority of IOH cases (66.6%) are incidentally discovered, often during bone marrow aspiration for hematologic evaluations or through imaging investigations for cancer staging or unrelated back pain. However, 14 patients (37.8%) among the available clinical data presented with pain . On the other hand, all vertebral, hip, and sternal lesions were sclerotic. These findings suggest that sacral lesions may exhibit distinct radiological presentations compared to other common sites. However, due to the rarity of this condition and the limited published data, this hypothesis cannot be confirmed. Table There are no pathognomonic radiological features specific to intraosseous hibernoma (IOH). Therefore, a biopsy of the lesion is crucial for making an accurate diagnosis. Among the cases with available radiological data (34 cases), IOH most commonly appears as a nonspecific sclerotic lesion  on CT scans, mimicking conditions such as osteomyelitis, metastasis, lymphoma, and other benign sclerotic bone lesions like benign non-ossifying fibroma, bone island, hemangioma, and fibrous dysplasia. However, IOH can also present as an occult lesion  or an osteolytic lesion , with or without thin sclerotic margins. Cortical erosion or periosteal reaction was not observed in any of the reported cases.On MRI, IOH exhibits T1 hypointensity relative to subcutaneous fat and hyperintensity relative to muscles, heterogeneous hyperintensity on T2-weighted images, and variable enhancement on post-contrast fat-saturated T1-weighted images. Additionally, IOH may demonstrate minimal to prominent uptake on bone scans ,9,18,22 In our cases, the radiological evaluations were consistent with previously reported cases. Both cases exhibited sclerotic lesions on CT scans and T1 hypointense and T2 heterogeneous hyperintense lesions on MRI. Additionally, only one patient underwent FDG-PET, which was performed during breast cancer staging, revealing minimal uptake (SUV 3.2) in the IOH lesion.Histologically, intraosseous hibernoma (IOH) is characterized by a varying number of eosinophilic to clear vacuolated granular cells called physaliferous-like cells, which have central or paracentral nuclei resembling brown fat cells. These cells can occasionally be mixed with uni-vacuolated adipocytes. However, it is important to consider interosseous lipoma as a potential differential diagnosis during histopathological examination. Immunohistochemical studies are useful in ruling out other differential diagnoses, including metastasis from renal cell carcinoma , histiocytosis (positive for histiocytic markers such as CD68 and CD163), and chordoma (positive for brachyury). Our patients exhibited similar histological findings to those previously reported.The majority of IOH lesions do not require treatment, as they are often found incidentally. Among the available data for symptomatic reported cases (14 cases), most patients showed improvement in pain with medical management ,7,16,18.Additionally, there is a reported case where RFA and kyphoplasty were performed simultaneously with a biopsy for an incidental lesion during ovarian cancer staging, which initially mimicked metastasis. Interventional procedures may be considered in cases of persistent disabling pain, regardless of medical management. Currently, there is limited data available to determine the optimal interventional treatment. However, percutaneous ablation appears to offer good pain improvement with less aggressiveness compared to surgical treatment. More reported cases in the future may help clarify the most effective treatment approach.The question of whether intraosseous hibernoma is a neoplastic or physiological phenomenon remains unclear. Some authors suggest that these lesions could represent retained brown fat in adults rather than neoplastic lesions ,6,9. HowIntraosseous hibernoma is a rare benign lesion that has been recently described and should be considered as a potential differential diagnosis for sclerotic lesions, particularly in the axial skeleton. It is crucial to perform a biopsy to establish a definitive diagnosis and avoid unnecessary treatment, especially in cases where the lesion is discovered incidentally. This report contributes two additional cases that exhibit findings consistent with previously reported cases.


Congenital mesoblastic nephroma is a common benign renal tumor that mainly affects infants below the age of six months . Identifying the pathology type is crucial for determining the appropriate plan of action and predicting the patient's prognosis.A one-day-old Hispanic neonate was referred for surgical evaluation after detecting a LUQ mass. Ultrasound imaging revealed a heterogenous solid mass that infiltrated the hilum of the left kidney. The patient underwent a left radical nephrectomy, and the pathology results indicated that the mass was consistent with the classic type of congenital mesoblastic nephroma. The patient will be closely monitored by nephrology with frequent abdominal ultrasounds.The case describes a one-day-old female baby with an asymptomatic LUQ abdominal mass, which was diagnosed as mesoblastic nephroma. The baby was born full-term with no significant medical history, and after experiencing hypertensive episodes, she underwent a left radical nephrectomy to remove the tumor. Pathology confirmed mesoblastic nephroma, classic type, and the patient was diagnosed with stage I disease since the tumor was entirely resected with no renal vessel involvement. Follow-up ultrasounds were recommended to monitor for recurrence, and chemotherapy may be considered if recurrence occurs . Calcium and renin levels should also be monitored .Although congenital mesoblastic nephroma is typically benign, patients require ongoing monitoring for potential paraneoplastic syndromes. Furthermore, certain types of mesoblastic nephroma can progress to malignancy, necessitating close follow-up during the first few years of life. •A case of congenital mesoblastic nephroma presenting with hypertensive episodes•A left upper quadrant mass in a neonate should be further investigated.•High levels of renin and parathyroid hormone can be indicators of mesoblastic nephromas in neonates. The baby was born at 39 weeks and two days via repeat C/S (two) to a 39-year-old G5P3 F with negative prenatals. The mother and father denied any alcohol, tobacco, or drug use. The mother, father, and siblings had no known past medical history. Her birth weight was 3.3 kg (7 lb 4 oz), and her length was 49 cm (1 ft 7 in). Apgar at 1 min and 5 min were 8 and 9, respectively.A prenatal scan revealed that the left kidney appeared enlarged, measuring 56 × 32 × 43 mm and with a heterogeneous texture. The baby was breastfeeding well, with no reports of hematuria or vomiting—normal bowel movements. Since birth, the baby has experienced multiple hypertensive episodes and was placed on Isradipine 0.15 mg every 8 h when systolic blood pressure was over 105. BMP, electrolytes, and blood pressure were monitored until a radical nephrectomy was performed. BUN and creatine levels were within normal limits. Calcium levels were noted to be elevated at 10.7.Ultrasound findings revealed that the left kidney measured 6.8 cm with a large heterogeneous solid mass infiltrating the hilum of the left kidney, demonstrating intrinsic flow and causing some dilatation of the renal collecting system. The tumor measures 5.8 × 3.6 × 5.3 cm. There is a normal-appearing adrenal gland superior to the left kidney. The MRI of the abdomen and pelvis w/ & w/o contrast in After a discussion with the patient's parents, a left radical nephrectomy was planned. The procedure was performed in the operating room under general anesthesia and lasted 68 min. Complete exposure to the lesion's anterior, lateral, and posterior surfaces was performed. The lesion was well-circumscribed without extending into the adjacent adrenal or retroperitoneal structures. The capsule appeared to be completely intact. The lesion was excised without any leakage or disruption of the tumor capsule. The lesion was mobilized upwards, and careful blunt cautery and sharp dissection on all lesion surfaces allowed it to be fully mobilized out of the retroperitoneum. The vascular pedicle was readily identified, as was the ureter. The artery and vein were carefully divided between clamps and tied off with #0 silk ties. The ureter was traced down to its entry into the bladder and excised, suture ligating the ureter at its entry into the bladder with 3-0 Vicryl suture.The lesion was submitted to Pathology as a fresh specimen. After a discussion with the pathologist, the frozen section diagnosis was confirmed to be mesoblastic nephroma. Further attention to the retroperitoneum for the presence of grossly abnormal lymph nodes revealed none. There were very few lymph nodes in the paraaortic region. These were all normal. The retroperitoneum was irrigated copiously with warm irrigation fluid. There was no bleeding of the tumor bed. The incision was then closed in several layers.Final pathology, seen in 3Once a neonate presents with an asymptomatic left upper quadrant abdominal mass, it is imperative to perform imaging to begin the differential diagnosis. Usually, an abdominal ultrasound is performed; CMN usually appears as a solid cyst with a homogenous appearance. 4Identifying and diagnosing congenital mesoblastic nephroma should be performed in an expedited manner. Neonates with CMN are at risk for paraneoplastic syndromes such as hypercalcemia and secondary hypertension Written informed consent was obtained from the patient to publish this case report and accompanying images. A copy of the written permission is available for review by the Editor-in-Chief of this journal at request.Not applicable.None.Kristen De Wilde.None.Kristen De Wilde, MS: Study concept, data interpretation, writing the paperJamshed Zuberi, MD: Data interpretation, writing the paper.None.


Ectopic hepatocellular carcinoma (EHCC) originates from the ectopic liver, which refers to a liver organ or tissue unrelated to surrounding tissues. EHCC is a rare disease that lacks specific clinical signs, and preoperative diagnosis is often difficult. In a 61-year-old male patient with positive hepatitis B virus antibody, abdominal contrast-enhanced computed tomography scan showed a large heterogenously enhancing mass both on arterial and portal venous phase imaging arising from the right adrenal gland. Similar enhancement features were seen on magnetic resonance imaging. Serum potassium, aldosterone, cortisol, and plasma metanephrines were normal. The tumor markers of serum alpha-fetoprotein and alpha-fetoprotein-L3% were increased to 23.69 ng/mL and 82.1%, respectively. Exploratory laparotomy was performed and operative findings showed that the retroperitoneal tumor was disconnected from the right kidney and the liver, but invaded the right adrenal gland. Immunohistochemical examination showed that Arginase-1 was positive expression, and the retroperitoneal tumor was finally diagnosed as EHCC. We report a rare EHCC with adrenal infiltration that is difficult to diagnose preoperatively and mimics a retroperitoneal tumor or adrenal tumor, and we present a review of the literature on EHCC case reports. Ectopic hepatocellular carcinoma (EHCC) is defined as hepatocellular carcinoma arising from the hepatic parenchyma located in an extrahepatic organ or tissue . It is r2), and he presented with abdominal distention and hyporexia for one week. Due to abdominal distension and hyporexia, the patient went to a nearby outpatient clinic, and abdominal ultrasound examination showed a large solid mass with mixed echogenicity. The patient had no history of hypertension, diabetes, cardiovascular and cerebrovascular diseases, and no history of surgery. His abdomen was soft and flat. There was mild tenderness in the right upper quadrant, but Murphy’s sign was negative. The liver was palpable 2 cm below the costal margin due to the push of the mass. The patient lost 5 kg in weight last month. (Eastern Cooperative Oncology Group: 0).The case was a 61-year-old male patient with positive hepatitis B virus antibody  scan showed that the retroperitoneal tumor (11.8 × 11.0 × 8.3 cm) located in the right adrenal region, with obvious enhancement in arterial phase and continuous enhancement in venous phase  for the publication of this case report.Manuscript writing: YY and YL; Clinical case diagnosis and treatment: YY, QL, and YL; Data collection and literature resarch: YY, ZL, and CW; Manuscript review and revision: YY and QL. All authors contributed to the article and approved the submitted version.


Ossifying hemangioma is an exceptionally uncommon condition and has been infrequently documented in clinical practice. In 1974, Natali et al.A female patient was admitted to the hospital due to a mass on the left forehead for half a year. Six months ago, the patient noticed a mass on the left forehead, roughly the size of a “rice grain”, with no apparent cause. Intermittently, the mass exhibited slight tenderness and gradual enlargement, while the left eye showed no signs of epiphora, heightened secretion, blurred vision, or diminished visual acuity. Physical examination demonstrated a 2 × 3 cm mass on the left forehead near the upper edge of the eyebrow arch, with a clear boundary, poor mobility, as well as hard texture. Besides, the movement of the left eye in all directions was normal, and no bulge or discharge was observed. Nasopharyngeal fiberoptic laryngoscopy revealed no anomalies in the nasal cavity or pharynx. Following the comprehensive overall assessment and the elimination of surgical contraindications, surgical intervention was carried out under general anesthesia.Sinus Computerized Tomography (CT) demonstrated local bone destruction and soft tissue nodules in the anterior wall of the left frontal sinus. Moreover, the density was uneven, the size was 14 × 10 mm, and the CT value was 130 HU. Furthermore, an MRI of paranasal sinuses plain scan + enhancement: a round equal/slightly long T1 and long T2 nodule with a size of approximately 11 × 14 mm were found in the left part of the frontal bone, which grew into the frontal sinus, with a clear boundary. Following the enhanced scan, it was a moderately heterogeneous enhancement, and no conspicuous swelling of the surrounding soft tissue of the scalp was observed .Fig. 1CTFor aesthetic consideration, a transverse skin incision measuring 2 cm in length was created in the vicinity of the left eyebrow arch, adjacent to the mass. The skin, subcutaneous tissue, and muscle were separated to expose the frontal bone mass. Furthermore, the surface membrane of the frontal bone mass was detached using an orthopedic peeling instrument, revealing both the mass and the neighboring healthy bone in their entirety. Subsequently, the bone mass was fully isolated. Examination illustrated that the mucous membrane of the frontal sinus cavity was intact, the sinus cavity was not broken, and no remnants of the bone mass were evident. Following the operation, the group layer was pressurized and sutured, and the skin was sutured .Fig. 2PrHistopathological examination indicated an ossifying hemangioma with a small amount of surrounding bone tissue, and microscopically, mature trabecular bone, as well as multiple small vascular Spaces, were demonstrated  imaging or other neuroimaging modalities in planning surgery due to the fact that it indicates the site and extent of the tumor better in bone windows. TI and T2-weighted MR Imaging showed long signals, and the lesions showed different degrees of heterogeneous enhancement. Furthermore, the display of this imaging reflects the low-fat content of ossified hemangiomas accompanied by varying degrees of blood flow signals. Hence, the slightly prolonged T1 and T2 signals observed in this particular case are indicative of the lesion's comparatively diminished fat content. The high signal intensity on T2-weighted MRI may be induced by blood pooling or slow flow, and enhanced MRI scans suggest moderately heterogeneous enhancement.The ossifying haemangioma of the frontal sinus did not exhibit any indications of deleterious attributes and phenotypically appeared as an osteoma. It is frequently identified at an early stage by the appearance of raised features on the surface. Nonetheless, numerous types of intraosseous tumors grow slowly. At times, in the early stages, it may manifest without discernible clinical symptoms or signs, which is challenging to diagnose. Consequently, they are typically observed conservatively until the late stage, when relevant symptoms and signs appear and are eventually confirmed by surgical resection and pathological examination.For ossifying hemangioma of the frontal bone, complete resection is widely regarded as a benign tumor, and recurrence can be avoided. Follow-up CT scans should be performed 6–12 months after surgery to assess recurrence, to detect late adverse reactions related to treatment. In summary, based on the information available to us, this represents a comprehensive account of a characteristic and exceedingly uncommon instance of ossifying hemangioma within the frontal sinus.Ossifying hemangioma of the frontal sinus is extremely rare in clinical practice. It grows slowly and has no clinical-related symptoms in the early stage. The size, location, and surrounding tissue of the tumor can be preliminarily judged by imaging examination. Surgical excision stands as the singular efficacious approach for addressing ossifying hemangioma within the frontal sinus, with no instances of reoccurrence after the surgical intervention. Both otolaryngologists and neurosurgeons should maintain a heightened vigilance regarding the clinical indicators and manifestations of this condition, thereby facilitating informed and prudent decision-making.All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Book consent has been obtained from the patient for publication of all relevant data.The authors received no financial support for this article’s research, authorship, or publication.The authors declare no conflicts of interest.


Urethral caruncle is a rare condition. Although relatively common in postmenopausal women, its occurrence after a urological endoscopic procedure is unusual. Here, we report the case of a postmenopausal woman who presented with a symptomatic urethral caruncle two weeks after a ureteroscopy for a right ureteral calculus. Treatment consisted of surgical excision of the mass after the failure of local estrogen application, and the postoperative aesthetic and functional result was satisfactory. Through a review of the literature, the etiological, diagnostic, and therapeutic aspects of this pathology will be discussed. Urethral caruncle is a benign lesion with a significantly high incidence in postmenopausal women ; howeverHere, we report the case of a postmenopausal woman who presented with a symptomatic urethral caruncle two weeks after a ureteroscopy for right ureteral calculus. The underlying etiologies, diagnosis, and treatment of this uncommon condition are briefly discussed.A 63-year-old postmenopausal woman with a history of bilateral deafness was treated with cochlear prostheses. She presented with hyperalgesic right renal colic due to an obstructive 10 mm pelvic ureteral calculus. She underwent minimally invasive semi-rigid ureteroscopy with complete fragmentation of the stone using the holmium laser.Two weeks later, she presented with intermittent bleeding and dysuria. Clinical examination revealed a 2.5 cm bulging mass externalized through the urethral meatus, bleeding on contact Figure . After tHistopathological analysis showed an angiomatous urethral caruncle with no evidence of malignancy Figure . At the First described by Samuel Sharp, urethral caruncle is a benign lesion that is relatively frequent in postmenopausal women . Its occMacroscopically, it presents as a sessile polypoid lesion with a hemorrhagic surface and a crumbly consistency. Contrary to circumferential urethral prolapse, the base of the lesion is generally located on the mucosa of the posterior lip of the distal urethra. Histologically, it is lined with hyperplastic epithelium with clusters of capillaries in an inflammatory stroma . In our The exact cause of urethral caruncle is unclear, and several nosological hypotheses have been put forward, including  (1) estrAll these theories suggest that irritation of the urethra is often associated with the presence of hemorrhagic and inflammatory plaques on pathological examination. In our case, trauma of the urethra during the use of endoscopic equipment, as well as contact of the mucosa with fragments of the calculus, could be incriminated as an etiological factor.The clinical manifestations are dominated by the following symptoms: vaginal or even perineal pain (37%), hemorrhage in the form of metrorrhagia or haematuria (27%), and dysuria (20%) . There aIn the case of an atypical or suspicious mass, high-frequency vaginal ultrasound, CT, and MRI can be performed to better characterize the lesion and assess its stage of locoregional extension, while urethrocystoscopy can be used to look for intravesical invasion and obtain biopsies .The first-line treatment is medical based on local estrogens, venotonics, and anti-inflammatories . In the Acquired angiomatous urethral caruncle is a rare complication after ureteroscopy, particularly in postmenopausal women. Information about the benign nature of this pathological entity helps to reduce patient anxiety, which, in turn, improves treatment outcomes.


Idiopathic spontaneous intraperitoneal haemorrhage is a rare and life-threatening condition that results from non-traumatic visceral artery rupture in the latter half of pregnancy and within the postpartum period [1–3].A 32 -year-old woman presented to emergency department, 14 weeks post-partum, with sharp left sided abdominal pain, nausea, and vomiting. Initial computed tomography (CT) was suggestive of non-specific colitis from transverse to descending colon of unclear cause. Six hours into admission she became haemodynamically unstable with abdominal peritonism resulting in emergency laparotomy. Intra-operative findings showed large volume haemoperitoneum with an active bleed from the middle colic artery.Symptoms and clinical presentation of Idiopathic spontaneous intraperitoneal haemorrhage is variable and ranges from vague abdominal pain to haemorrhagic shock. A latent period of several hours may be followed by a rapid progression of symptoms owing to rapidity of extravasation[3]. Pathogenesis has been suggested to arise from the increased physiologic demands during the intrapartum period, wherein repeated distension of vessels and increased tortuosity leads to a predisposition for rupture [4].Diagnosis of Idiopathic spontaneous intraperitoneal haemorrhage is difficult but should be a differential in those who are post-partum presenting with abdominal pain. Patients should be assessed with CT angiography and treatment focused around aggressive resuscitation, surgical exploration, and ligation [3]. •Idiopathic spontaneous intraperitoneal haemorrhage is a rare and life-threatening condition.•Pathogenesis is of non-traumatic visceral artery rupture, with 30 % of cases having no identifiable cause.•Unprovoked peritoneal haemorrhage can occur within latter half of pregnancy and the postpartum period.•Treatment is centred around aggressive resuscitation, surgical exploration, and ligation. The pUnprovoked peritoneal haemorrhage is reported as an entity in the latter half of pregnancy and within the postpartum period . Whilst Due to recent advances in anaesthetic, resuscitative, and surgical technique, the mortality rate has been ameliorated to approximately 3.6 % . Reporte2A 32-year-old woman, 14 weeks postpartum, presented to an emergency department after 3 days of sharp left sided abdominal pain, nausea, and vomiting. The patient had no other past medical or surgical history, was G6P6, and had otherwise experienced an uneventful pregnancy.9/L and a haemoglobin of 150 × 109/L. Initial computed tomography showed a segmental bowel wall thickening from transverse to descending colon, suggestive of colitis.Initial examination revealed normal vital signs, left abdominal palpation tenderness, and no signs of peritonism. Blood work demonstrated a white cell count of 13.9 × 109/L, resulted in the decision to proceed to laparotomy.Six hours into admission, the patient rapidly deteriorated into hypovolaemic shock, with hypotension, tachycardia of 150 bpm, cool peripheries, localised left sided peritonism, and a lactic acidosis . Unsuccessful fluid resuscitation, increasing abdominal pain and a repeat haemoglobin of 121 × 10Early instability noted under anaesthesia necessitated supra-coeliac aortic clamping to allow for transfusion and inotrope commencement. Intraoperative findings were of large volume haemoperitoneum due to active haemorrhage from a branch of the middle colic artery . The vesA CT angiogram performed the next day demonstrated a 5 mm pseudoaneurysm in continuation with an irregular branch of the middle colic artery, potentially representing the site of previous haemorrhage . Re-look3Idiopathic spontaneous intraperitoneal haemorrhage is a rare and life-threatening condition that refers to the spontaneous rupture of the abdominal splanchnic vasculature . It is aClinical presentation is variable leading to difficulty in the diagnosis unless there is a high index of suspicion. Symptoms range from vague abdominal discomfort to sudden onset pain and hypovolaemic shock ,2. A latDue to the severe and abrupt deterioration treatment is thus centered around aggressive resuscitation, surgical exploration, and ligation ,7. Any pSuccessful surgical ligation reduces mortality to 8.6 % from 40 to 66 % with non-therapeutic exploratory laparotomy ,6. Initi4Although a rare entity, Idiopathic spontaneous intraperitoneal haemorrhage should be considered when assessing the post-partum patients presenting with unexplained abdominal pain and haemodynamic instability. If clinical status permits, CT angiogram scan provide a sensitive and specific tool diagnosing and identifying sites of haemorrhage or pseudoaneurysm. Management of these patients relies on early recognition, aggressive resuscitation, surgical exploration and ligation.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.Ethical approval not applicable.N/A.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Dr Danniel Badri – study design, writing the paper.Dr Callie Killoran – editing the paper.Dr Ratna Aseervatham – study concept/design, editing the paper.Dr Danniel Badri accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.N/A.


Blunt trauma to the urinary bladder is common with penetrating injury being a rare occasion. Most common entry pint for penetrating injuries includes buttock, abdomen and perineum with thigh being rare. There are a number of complications that may develop as a result of penetrating injury with vesicocutanous fistula being a rare occurrence that usually presents with typical sign and symptoms.We present a rare case of penetrating bladder injury through medial upper thigh as an entry point that had complicated into vesicocutaneous fistula with atypical presentation of long-standing pus discharge that had been managed by incision and drainage several times with no success. MRI demonstrated a presence of fistula tract and a foreign body (piece of wood) in-situ confirmed the diagnosis.Fistulas are a rare complication of bladder injuries and can cause negative impact on the quality of life of patients. Delayed urinary tract fistulations and secondary thigh abscesses are uncommon therefore a high index of suspicion is needed for early diagnosis. This case emphasizes the importance of radiological tests in aiding the diagnosis and ultimately proper management. Bladder injuries can be classified as blunt or penetrating. Generally the bladder is protected but as it fills up, it rises up into the lower abdomen making it more susceptible to injury . Blunt bThigh abscess can be a sign of intra-abdominal pathologies like diverticulitis or colorectal cancer, however less frequently this can arise from the urinary bladder . A fistuA 16-year-old female patient presented to our centre with a non-healing wound on her right inner thigh for a year and half. She reported that she sustained injury to that area after a fall off a double-decked wooden bed at her boarding school and sustaining injury on her right inner thigh on hitting its corner with minimal bleeding and the wound healed initially within some days. She did not sustain any other injuries and was attending her school normally. She then subsequently had on and off pus discharge with occasional swelling on her right inner thigh that had been incised and drained on two occasions at a nearby health centre with little relief and recurrence. Throughout that period she reported normal urinary habit, normal bowel habit, occasional low-grade fevers, and good appetite with no history of body weight loss. Neither history of diabetes mellitus nor hypertension were reported and no known history of malignancy in the family.On examination she was fully conscious, afebrile, not pale, not jaundiced, not dehydrated, nutritionally sound with stable vitals. Local examination revealed a right upper medial thigh pus-discharging sinus, 1х1 cm with exophytic granulomatous margins with scar tissue around. Chronic sinus was then suspected and a pelvic X-ray was ordered that revealed normal osseous outlines. An MRI was requested and reported a fistulous tract measuring about 10 cm in length with a foreign body originating from right lateral wall of the urinary bladder passing through pectineus, adductor longus, adductor brevis, adductor magnus and gracilis muscles exiting through medial aspect of right thigh; in keeping with vesico-cutaneous fistula with a foreign body in-situ (Fig. Laboratory work up showed hemoglobin of 11.5 g/dL, serum creatinine of 43 mmol/l, BUN of 1.95 mmol/l and serum potassium and sodium within range. She was scheduled for cystoscopy, exploration and fistulectomy. On examination under anesthesia she was noted to have normal appearing external female genitalia, and a 1 by 1 cm sinus on her upper thigh in the inner aspect, with exophytic edge, discharging pus and surrounded by firm scar tissue Fig. . CystoscOn exploration of the sinus, incision was made around the fistula, externally, few centimeters from the center and extended upwards about 2 cm. A foreign body was felt with forceps that seemed to project in the direction of right lateral wall of the urinary bladder through muscle layers. On controlled division and layered dissection a round old piece of wood measuring about 7 cm long with an estimated diameter of 6 mm was extracted out with no calcifications around Fig. . The fisPost operatively she was kept on Sitz-baths, a course of antibiotics and analgesics with no leakage of clear fluid/urine from the fistula tract or any adverse event noted. On day 21st post operatively the urethral catheter was removed and she continued to fair well Fig. .Urinary bladder trauma can be broadly classified as blunt or penetrating with blunt injury being the most common type. Penetrating injury to the bladder is relatively rare and accounts for 14–49%. Clinical presentation of bladder injury includes suprapubic pain, inability to pass urine, hematuria and peritoneal sign and symptoms in case of intraperitoneal injury . The indPort of entry can either be abdomen, perineum, rectum, buttocks or pelvis with upper inner thigh as the port of entry being a very rare presentation , 6. Our Diagnostic modalities for urinary bladder injuries can be X-ray cystography but CT-cystography is recommended if there is suspicion for other viscera injuries, provides a 3D image for evaluation, whereas on the contrary has exposure to more radiation . Acute bThigh abscess associated with a fistula due to abdominal pathology has been reported in literature. VCF presenting as a thigh abscess can have various aetiologies such as extensive pelvic fracture, pelvic abscess, post pelvic radiation giant bladder calculus, IBD and post operative cases such as hip arthroplasty . It is eVesicocutaneous fistulas rarely communicate to the thigh but commonly exit the perineum, scrotum, buttocks or hypogastrium . The timManagement depends on the presenting symptoms, the complexity of the fistula and the underlying cause . UrinaryPhysician should always remember the possibility of having bladder injury and associated complications including fistula in a patient with history of penetrating trauma on the inner aspect of the upper thigh. A delayed presentation of the urinary tract fistula can occur hence a high index of suspicion is required for early diagnosis and prompt management. This case report highlights the uncommon cause and the aid of radiology imaging in yielding the diagnosis.


A lymphoepithelial cyst of the pancreas is a rare benign lesion that is difficult to diagnose preoperatively and challenging in distinguishing from potentially malignant cystic pancreatic neoplasms. A diagnostic step-up approach is recommended to clarify the lesion’s dignity and specify a treatment plan.Here, we describe a case of a 51-year-old male European with a lymphoepithelial cyst of the pancreas mimicking malignant features in a mid-age male patient with abdominal pain and unintended weight loss.Patients with indeterminate cystic pancreatic lesions should be examined by a multidisciplinary diagnostic team in a step-up approach to clarify the lesion’s entity. In the case of incidentally found lymphoepithelial cysts of the pancreas, a watchful waiting strategy might be clinically reasonable if the diagnosis is proven. Pancreatic cystic lesions are a heterogenous group of pancreas-related entities with a rising detection rate due to recent imaging improvements , 2. The Preoperative workflow including several imaging modalities and fine needle aspiration (FNA) focuses on the specific diagnosis with subsequent treatment options. Some cases remain unclear with inconsistent results in histology, imaging and clinical presentation. In these patients, surgical resection of the lesion remains state of the art. In the following case, we report of an extremely rare entity of a lymphoepithelial cyst of the pancreas mimicking malignant preoperative features.A 51-year-old male European patient presented with undetermined epigastric pain and recurrent postprandial nausea. A history of recurrent mild episodes of pancreatitis treated by the general practitioner without the need of hospital admissions was notified during the last 4 years. The patient reported of unintended weight loss of 7 kg within 3 months. Proton-pump inhibitors were taken in double standard dosage without changing symptoms. A diabetes mellitus type II was first diagnosed 10 years ago with a need of insulin therapy for the last 3 years. Arterial hypertension, hypothyroidism and hyperlipidemia were sufficiently treated. The patient was smoker with a cumulative value of 30 pack years. Alcohol consumption was negated and exocrine pancreas function was not impaired. Family history of malignant neoplasm was unremarkable.Due to the unintended weight loss an esophago-gastro-duodenoscopy and colonoscopy were performed displaying mild esophagitis I° and Helicobacter pylori-negative gastritis as well as sigma diverticulosis and an isolated colon polyp without any pathologic sign. Alterations of the duodenum were not recorded. As a step-up approach, the patient underwent an epigastric magnetic resonance imaging (MRI) revealing a 5 × 6 cm inhomogeneous, polycystic mass in the pancreatic head with a dilated pancreatic duct and a partly compression of the duodenum Fig. . A furthAnalysis of the blood displayed no pathologic parameter except for a minimally elevated CA 19–9 of 93.3 U/ml (cut off: < 34.0 U/ml), CEA was in normal range, pancreatic enzymes were not deflected.Due to the young age and the minimal elevated tumor markers in the serum, an endoscopic ultrasound with fine needle aspiration (FNA) biopsy of the mass was performed. Ultrasound analysis supported the suspected malignant entity. Histology results showed necrotic tissue and normal small intestine mucosa without atypical cells.Although FNA revealed no malignant cells, considering the infiltrative growth of the mass according to CT scan, a surgical resection (Whipple’s procedure) was performed. Intraoperatively, the peripancreatic region showed a massive inflammatory process and surgical dissection was highly challenging. The cystic mass was removed completely and fresh frozen section analysis revealed no tumor infiltration into the margin regions.The final histological analysis reported a lymphoepithelial cyst of the pancreas with exophytic growth regions. Macroscopically, a 6.5 × 5 × 3.5 cm cystic mass with white, crumbly, sebum-like content associated with several minor similar, multi-cystic lesions with the same content adjacent to the pancreas was seen, completely surrounded by a capsule-like border Fig.  and 5. LThe postoperative course of the patient was characterized by a lymphatic fistula sufficiently managed by prolonged intravenous nutrition in combination with subcutaneous sandostatin therapy . Pain management was performed according to standard protocol without any excessive pain episodes. On postoperative day 16, the patient was discharged well-conditioned, pain-free with normal oral nutrition on pancreatic enzyme substitution. The foreknown insulin-dependent diabetes mellitus was managed equally compared to preoperative conditions. The one-year postoperative follow-up revealed no changes in the patient’s health condition.Lymphoepithelial cyst of the pancreas is a rare, non-malignant diagnosis first described in 1985 by Lüchtrath and Schriefers . The detAs in the present case, lymphoepithelial cysts of the pancreas are often mimicking criteria of malignancy in imaging such as dilatation and/or discontinuation of the pancreatic duct, infiltration of surrounding structures or vessels. Thus, potentially malignant cystic lesions of the pancreas, such as intraductal papillary mucinous neoplasms or mucinous cystic neoplasms, may be misdiagnosed. Due to the difficulties in reaching an accurate diagnosis preoperatively, most cases are surgically resected.Management of cystic pancreatic lesions requires a patient-oriented selective approach to fulfill the diagnostic and therapeutic criteria . Recent If high risk stigmata are present  and the patient is in good clinical shape, an upfront surgery is recommended. In surgically unfit patients, ablation methods should be considered in these cases. Apart from high-risk stigmata, there are worrisome features requiring further evaluation by endosonographic ultrasound and FNA. These features consist of a lesion diameter of more than 3 cm, pancreatic duct dilation of 5–9 mm, enhancing cystic wall, non-enhancing mural nodule and a suspicious lymphadenopathy. If neither high-risk stigmata nor worrisome features are present on imaging, a conventional follow-up is recommended after 6 months to 2 years depending on the current lesion size. The authors favor an initial re-imaging (CT) after 6 months to exclude misdiagnosed malignant lesions. Hereafter, an expansion of imaging surveillance may be reasonable. Unfortunately, there are no liquid biopsy markers for a better monitoring yet.However, the present case shows the remaining striking difficulty in finding a sufficient preoperative diagnosis of cystic pancreatic lesions.In conclusion, patients with indeterminate cystic pancreatic lesions should be examined by a multidisciplinary diagnostic team. If the results of the diagnostic step-up approach remain unclear and the entity cannot be clarified, surgery should be favored. In the case of incidentally found small lymphoepithelial cysts of the pancreas in asymptomatic patients, a watchful waiting strategy might be clinically reasonable if the diagnosis is proven.


Low-grade gangliogliomas (GGs) are typically epileptogenic intracranial neoplasms. Yet, the presentation of simplex vertiginous experience and spontaneous downbeat nystagmus (DBN) has not been reported to date.We present the case of a 26-year-old male with focal onset impaired awareness seizures, characterized by vertigo due to right temporal lobe epilepsy caused by ganglioglioma. As rare presentations, a spontaneous, consistent DBN in the absence of vertiginous experience was noticed. MRI suggested lesion in the right temporal pole. Twenty-four-hour continuous electroencephalogram (EEG) monitoring recorded periodic sharp and slow waves, originating from the right temporal lobe. The patient was completely relieved of the symptoms after surgical removal of the tumor, which was histologically confirmed as Grade I Ganglioglioma.Asides from the cortical pathogenesis of epileptic vertigo, this case also provides insight into the DBN secondary to tumor of the temporal lobe. Moreover, the 24-h EEG is advantageous to recognize vestibular seizures and localize the ictal onset areas.The online version contains supplementary material available at 10.1186/s12883-023-03311-6. Vestibular epilepsy is defined as recurrent simple complex or partial seizures that cause vertigo as the predominant symptom . Based oGangliogliomas (GGs) are rare (1%) intracranial neoplasms, frequently identified with BRAF-6000E mutations 18–30%). Though reported throughout the central nervous system, GGs are typically found within the temporal lobe of children and young adults, as benign, low-grade tumors. GGs are amongst the most common histopathological diagnoses in epilepsy surgical series, accounting for 10% of the cases 0%. Thoug–6. To ouThe patient, a 26-year-old right-handed man , was referred to the otolaryngologist complaining about recurrent rotatory vertigo followed by nausea and palpitation. The repetitive experience occurred three to four times a day without any circadian rhythm. The initial attack lasted for about 10 min, while the subsequent attacks were shortened to 10 to 15 s. Onset of the seizure was not related to changes in head position.Before this visit, these symptoms had repetitive for half a year, responsive to neither physical therapy nor Lorazepam. Orthopedist had ruled out the cervical origin by finding an almost natural curve of the cervical spine. Although brain magnetic resonance (MR) scanning revealed an irregularly shaped lesion in the right temporal lobe, measuring 2.0 × 2.4 cm Fig. , no causAt our clinic, we noticed a consistent, spontaneous DBN Video , which iAfter only four days of administration of Oxcarbazepine 300 mg bid), the onset frequency reduced to once per day or less while duration shortened into 2 s. At Day 10 of the treatment, DBN became feeble, yet remained detectable (Video 00 mg bidAlthough epilepsy are the most common presenting signs of GG, this tumor has rarely been reported as cause for vestibular seizures. This case, to our knowledge, is the first documented temporal-based GG resulting in epileptic vertigo coupled with spontaneous DBN.The episodic vestibular presentations can be attributed to focal discharge of vestibular cortex secondary to the neoplasm. Increased cortical excitability due to edematous peritumoral brain tissue, elevated intracranial pressure, metabolic derangement etc., might account for the tumor-associated epileptogenicity . Such spUnusual findings also include the spontaneous DBN, whilst epileptic nystagmus is predominantly horizontal or, less commonly, upbeat . Two chaSecondly, after epileptic attacks were resolved by Oxcarbazepine on Day 10, DBN turned feeble but remained detectable via video-goggles. Oxcarbazepine blocked the voltage-gated sodium channel to inhibit repetitive neuronal firing and spreading . MeanwhiFinally, this report highlighted the importance of 24 h-EEG, without which the temporal lobe epileptic discharge might have escaped detection. Clusters of onsets, subjective description of déjà vu, and intracranial structural abnormality were evidence that should invite the clinicians to associate the symptoms and signs with seizures. Regardless of the rarity of intracranial lesions as causes of vestibular epilepsy, it should be included in the differential diagnosis of isolated, recurrent, spontaneous vertigo. To establish the diagnosis, thorough investigations should involve not only the examinations depending on real-time recording, but also the ambulatory EEG that enables 24-h continuous monitoring of the electrical activity.In conclusion, cerebral tumors can be rare etiology of isolated vertigo. Primary vertical nystagmus suggests central vestibular disorders, and déjà vu experience indicates potential lesions in the temporal lobe. Twenty-four-hour continuous EEG monitoring provided essential evidence for identification of the causative lesion, which have been occasionally missed by other traditional investigations.Additional file 1.Additional file 2.


The size and anatomical complexity make giant intracranial aneurysms challenging surgical lesions. There is limited literature available for those arising from distal branches. The cases that have been reported in the literature have all presented with symptoms from a rupture leading to an intracranial haemorrhage. In this case report, the authors present a case of a giant aneurysm arising from a cortical branch of the middle cerebral artery presenting as an extra-axial tumour. A 76-year-old gentleman presented with a 2-day history of subjective left arm numbness. Imaging revealed a large conical right-sided parietal lesion. Intraoperatively, it was found that the lesion was being supplied by a single vascular pedicle. Histology was consistent with an aneurysm. In this case, that patient did not have any evidence of a rupture unlike all reported cases of cortical giant aneurysms. This case highlights the myriad location and presentation of giant intracranial aneurysms.  Intracranial giant aneurysms are defined as aneurysms with at least a diameter of 25 mm , 2. WithOur patient is a 76-year-old gentleman with medical history of hypertension and lumbar spondylosis. He did not have any previous history of trauma or systemic infections. He had presented to his local hospital with a 2-day history of left arm numbness. He did not report any headaches or giddiness. On clinical assessment, he did not have any neurological deficits. A CT brain and MRI brain –5 with cIntraoperatively, a small area of dehiscence in the bone overlying the lesion was noted. The lesion was found to be adherent to the bone but was easily dissected off the dura. There was a small dural defect at the deepest aspect of the lesion through which a vascular pedicle was noted to be supplying the lesion. The vessel was coagulated, and lesion was removed  and 7. Tet al. [Intracranial giant aneurysms are surgical challenging entities which can be present in both anterior and posterior circulation , 3, 6, 7et al.  recentlyIn our case, the patient was relatively asymptomatic with no evidence of ICH or SAH. We postulate this his subjective symptoms of numbness were a result of mass effect from the aneurysm on the somatosensory cortex. Recurrent thrombosis within the aneurysm would have led to progressive growth and increasing mass effect. The presence of bony remodelling and bony dehiscence further points to the chronicity of this aneurysm. The authors evaluated the reported cases of 14 giant cortical aneurysms  in the let al. [et al. [The authors expanded the literature review to find evidence of aneurysms presenting as extra-axial masses. Katayama et al.  reported [et al.  reportedHistologically, the aneurysm showed presence of endothelial cells and smooth muscle cells in the wall. The presence of bone remodelling around the aneurysm indicates that this aneurysm has gradually increased in size over a period. Various factors have been previously attributed to the growth of giant aneurysms , 13, 14.Treatment of ruptured giant artery aneurysm remains tricky. Clipping, bypass and trapping, and endovascular treatment can be used for occlusion. In our case, surgical treatment was relatively easy with a single vascular pedicle that was easily coagulated.This case highlights the myriad location and presentation of giant intracranial aneurysms. Further research is required to understand the pathophysiology of these aneurysms.


Meningeal tumors represent the most common primary central nervous system tumors. The term “multiple meningiomas” or “meningiomatosis” refers to the occurrence of 2 or more spatially separated meningiomas without the features of neurofibromatosis. Meningiomatosis accounts for only less than 10% of all cases and is more prevalent in women. We report a rare case of a 53-year-old female patient complaining of a headache characterized by a throbbing pain in the right side of the head. Neurological examination was largely normal, with the exception of a slight weakening of the right extremity. Multiple brain masses, due to meningiomatosis, were revealed upon CT scan and MRI. Subsequent tissue biopsy confirmed the diagnosis of meningothelial meningiomas. Meningeal tumors are the most common primary central nervous system tumors. They consist of both meningiomas and nonmeningeal mesenchymal tumors. Although most are attached to the dura mater, they can occur in other locations, such as the choroid plexus A 53-year-old female presented with a history of progressively worsening headaches for approximately 3 months, which had intensified markedly 2 days before her admission to the hospital. The headaches were characterized by a throbbing sensation on the right side of her head. Patient had neither experienced seizures nor reported any weakness in her limbs. Throughout this period, the patient remained conscious, could understand speech, and could follow commands. The patient had a 2-year history of hypertension, which had been well-managed. Physical examination, including assessment of vital signs, presented normal results.The neurological examination was largely unremarkable, except for a slight weakness in the motor function of her right extremity. Her laboratory tests showed an elevated leukocyte count. Computed tomography (CT) scans, performed both with and without contrast, revealed multiple solid, noncalcified masses in the suprasellar region and the right frontotemporal parietal region. These masses had extended to the subcortical cortical part of the right frontotemporal parietal region and were accompanied by edema. Hyperostosis of the calvaria os frontotemporoparietalis sinistra and dextra was also observed. A mass was present in the right frontotemporal parietal region , applying pressure and causing constriction of the surrounding sulcus gyrus, fissure sylvii dextra, ventricle lateralis dextra and leading to a midline shift towards sinistra .Fig. 1He-3 mm2/s and blooming artifacts in susceptibility weighted imaging. Magnetic resonance spectroscopy (MRS) displayed levels of increased glutamine, choline, along with levels of decreased N-acetyl aspartate and creatinine, consistent with the presence of meningiomas.Magnetic resonance imaging (MRI) examination of the head revealed multiple masses with a “dural tail” sign , fillingA postsurgical assessment revealed hyperostosis of the bone, tumor-infiltrated duramater, and a greyish white, easily bleeding mass . ApproxiMeningiomas, originating from arachnoid cap and meningothelial cells, are typically found within the arachnoid layer of the meninges or pacchionian granulations and typically demonstrate dural attachment According to a study by Cai et al., the main symptom of meningiomas was seizures reported in 65.8% or 25 patients. Other reported symptoms included headache  and hemiparesis . Less frequent early symptoms included visual disturbances , incidental , and dizziness . The incidence of seizures in patients with meningiomas located at the Sylvian fissure (65.8%) was significantly higher than in patients with generalized supratentorial meningiomas (29.2%). Generally, the frequency of seizures appears to be related to the tumor's location, with the temporal and limbic lobes having the lowest threshold for seizure generation. Moreover, hypoxia and metabolic imbalances caused by tumor invasion and extrusion are considered influential etiological mechanisms As the brain tumor grows, it progressively replaces healthy tissues, leading to vascular abnormalities and blood-brain barrier disruption. This results in substantial blood plasma leakage into the tumor tissue, causing cerebral edema and abnormal swelling of the cerebral parenchyma. Given that the skull is a closed compartment, any growth of the tumor and its associated cerebral edema can induce increased intracranial pressure (ICP) and create a space-occupying lesion. An space-occupying lesion refers to the occupation of intracranial space due to an increase in volume. Elevated ICP is responsible for many adverse symptoms associated with brain cancer, such as headaches, nausea, and seizures Meningiomas are classified by the World Health Organization (WHO) into 3 categories: benign (WHO Grade I), atypical (WHO Grade II), and malignant (WHO Grade III). This classification is based on criteria such as the number of mitoses, the degree of anaplasia, and the presence of necrosis Plain radiographic findings of brain tumors may reveal signs of increased ICP , tumor calcification, or enlargement of the middle artery indentation in meningiomas MRI is the gold standard for advanced imaging of meningiomas. The size of meningiomas is typically evaluated using a T1 sequence complemented by a gadolinium injection Fluid-attenuated inversion recovery sequences are particularly valuable for depicting peritumoral edema, with meningiomas typically displaying signal intensities ranging from isointense to hyperintense relative to the brain on fluid-attenuated inversion recovery imaging. T2* sequences (such as gradient echo and SWI) help illustrate intratumoral calcification. The phenomenon of “blooming,” secondary to intratumoral hemorrhage, is infrequent. Most meningiomas do not show restricted diffusion on diffusion-weighted imaging. T1-weighted postcontrast imaging reveals heterogeneous enhancement with a “dural tail sign” and extension into adjacent hyperostosis. Contrast administration is particularly beneficial in delineating “en plaque” meningiomas, which typically manifest as asymmetrically thickened sheets of enhancing duramater Magnetic Resonance Spectroscopy is a gold standard for advanced imaging diagnosing meningiomas. The characteristic features of these tumors include an increased choline peak (3.2 ppm), decreased creatine (3.0 ppm), and decreased N-acetyl aspartate. In some studies, lactate has been found more frequently in nonbenign meningiomas—those of WHO Grades II and III—but it is not a consistent marker of aggressive meningiomas. Lipids  are typically regarded as markers of aggressive meningiomas The recent development of magnetic resonance elastography (MRE) provides an alternative to traditional MRI. MRE is an MRI-based technique that quantifies intratumoral stiffness by measuring the propagation of vibration-induced displacement and viscoelastic mechanical properties in targeted tissues. However, while MRE represents a promising development, it cannot be considered completely noninvasive due to the necessity of delivering shear force to the patient's brain The therapeutic approach for treating meningiomatosis encompasses surgery, radiation therapy, and stereotactic radiosurgery. Surgery is the preferred treatment for meningiomatosis. Chemotherapy is a treatment option for patients with inoperable or higher-grade tumors, particularly when disease recurrence is a concern postsurgery and radiation therapy. To date, chemotherapy has played only a minimal role in meningioma treatment In this case report, a 53-year-old female patient presented with complaints of a headache. CT and MRI examinations revealed multiple brain lesions due to meningiomatosis. Subsequent tissue biopsy identified these as meningothelial meningiomas, which is considered a rare occurrence in line with existing literature and our current understanding. This case displayed the possibility of meningiomatosis presenting as multiple brain lesions, particularly in elderly patients.Meningiomatosis represents a rare manifestation of meningiomas, with a higher incidence in women. Imaging is critical in confirming the diagnosis and describing the extent and mass effect on crucial cranial structures, which is vital for determining the appropriate therapies.A written consent was obtained from the patient for publication of this case and any accompanying images.


Distant renal cell carcinoma (RCC) metastatic disease is mostly seen in the lungs, bones, and lymph nodes. The incidence of local recurrences within the ipsilateral retroperitoneum (RFR) is very low. We report a case of a 79-year-old male with recurrent left renal fossa RCC with pancreatic tail invasion who presented with large bowel obstruction. To the best of our knowledge, no cases have been reported of recurrent left renal fossa RCC initially presenting as extrinsic large bowel obstruction. Approximately 85% of all primary renal neoplasms are secondary to renal cell carcinomas (RCCs) originating in the renal cortex . Tumors A 79-year-old male with a past medical history of end-stage renal disease on hemodialysis, hypertension, atrial fibrillation, PT3C-Gleason 4+5 adenocarcinoma of the prostate  with biochemical recurrence, and left RCC T3AN0M0  presented to the ER with complaints of abdominal pain for two days. The pain was associated with constipation, nausea, bilious vomiting, loss of appetite, and small, hard stools with reduced caliber. The patient was afebrile and hemodynamically stable and looked uncomfortable. The abdominal exam showed a healed midline scar, left lateral flank incision, and left lower quadrant transverse incision. The abdomen was distended but non-tender. The rest of the exam was negative. Laboratory evaluation showed a white blood cell (WBC) count of 11.9 x 103/uL, hemoglobin of 10 g/dL, blood urea nitrogen of 38 mg/dl, creatinine of 9.6 mg/dl, and potassium of 4.2 mmol/l (Table Prostate-specific antigen (PSA) was elevated to 9.5 ng/ml, consistent with previously elevated PSA. Lactate dehydrogenase was within normal limits at 364 U/l. CT angiogram revealed an 8 cm constricting lobular soft tissue mass in the proximal descending colon resulting in a high-grade obstruction of the proximal large bowel. The mass invaded the tail of the pancreas Figure . The patThe case was presented on the tumor board. Imaging and pathology were reviewed in detail. Systemic chemotherapy was planned to be started outpatient after chemo port placement for local recurrence of ccRCC. Radiation oncology will follow the patient to see the role of radiation therapy after at least three months of systemic treatment and the patient will be started on androgen deprivation therapy (ADT) as an outpatient.RCC is the most common kidney malignancy, accounting for 85% to 90% of these tumors. More than 50% of patients who undergo primary tumor resection have a remote recurrence. RCC can metastasize to any site in the body; however, metastases to the gastrointestinal (GI) tract are extremely rare, with an incidence as low as 0.7% . A lack Local recurrence following nephrectomy is a rare event. A study from the Mayo Clinic reported a local recurrence rate of only 1.8% in 1737 patients who had undergone nephrectomy with localized RCC . Our patIt is important to identify, standardize, and employ surveillance strategies following the treatment of localized RCC. A better characterization of clinical, histopathological, and CT findings can aid in the prediction of tumor recurrence and therefore time management. Incorporation of these factors in the stage-based stratification may play an important role in the identification of ccRCC tumor recurrences and treatment strategies ,11. T1 (Treatment strategies for RCC are evolving and the combination of immunotherapy and radiation therapy may be considered a part of treatment regimens. This combined strategy may result in a phenomenon known as the abscopal effect, which is a systemic antitumor effect achieved distant to a radiation treatment site . The absRCC has a myriad of clinical presentations. Intrinsic and extrinsic intestinal obstruction should be considered as an initial presentation of recurrent RCC, as seen in our case. Operating with a high degree of suspicion in patients with a history of RCC is important in identifying recurrence. Surveillance strategies following the treatment of localized RCC need to be identified and standardized and must be employed to identify recurrences. Treatment strategies for RCC are evolving and radiation therapy in combination with immunotherapy plays an important role in addition to surgery in the management of these patients.


Clostridium septicum infection is an uncommon complication associated with malignancies, particular colonic adenocarcinoma. The organism appears to preferentially colonize large masses in rare individuals and subsequently seed the blood via mucosal ulceration. This has rarely been reported to lead to central nervous system infection and, in several cases, rapidly progressive pneumocephalus. In the few cases reported, this was a universally fatal condition. The current case adds to the reports of this extremely rare complication and provides a unique and complete clinicopathologic characterization with autopsy examination, microscopy, and molecular testing.Disseminated Clostridium septicum was identified on blood cultures and was confirmed in paraffin embedded tissue from the brain by 16 S ribosomal sequencing and from the colon by C. septicum specific PCR.A 60-year-old man with no known past medical history was discovered having seizure-like activity and stroke-like symptoms. Blood cultures turned positive after six hours. Imaging revealed a large, irregular cecal mass as well as 1.4 cm collection of air in the left parietal lobe that progressed to over 7 cm within 8 h. By the following morning, the patient had lost all neurologic reflexes and died. Post-mortem examination revealed brain tissue with multiple grossly evident cystic spaces and intraparenchymal hemorrhage, while microscopic exam showed diffuse hypoxic-ischemic injury and gram-positive rods. C. septicum is an anaerobic, gram-positive rod that can become invasive and is strongly associated with gastrointestinal pathology including colonic adenocarcinomas. Central nervous system infection with rapidly progressive pneumocephalus is a rarely reported and universally fatal complication of disseminated C. septicum infection. C. septicum is an obligate anaerobic, gram-positive rod that produces endospores as well as four major exotoxins  that have strong necrotizing properties [C. septicum are strongly associated with malignancy, especially colorectal neoplasms [C. septicum CNS infection, 13 had pneumocephalus and three had both pneumocephalus and colorectal cancer. These pneumocephalus cases were universally fatal. Here we report an autopsy case of rapidly progressive pneumocephalus secondary to a disseminated C. septicum infection in the setting of an occult colonic adenocarcinoma. The diagnosis was confirmed by positive pre-mortem blood cultures as well as brain tissue demonstrating gram positive rods and C. septicum positivity on 16s ribosomal sequencing [operties . Systemieoplasms . The orgClostridium septicum after six hours. The patient was started on broad spectrum antibiotics. Computed tomography (CT) head, CT angiography (CTA), and CT perfusion scan were completed per the stroke protocol. Imaging revealed a 1.4 cm collection of air in the left parietal lobe  while mortality in the cases with pneumocephalus was 100% (13/13).1 Moreover, most patients with pneumocephalus died within 48 h . Our patient was found to have rapidly progressive pneumocephalus causing severe global hypoxic injury within 24 h and death within 36 h of presentation. The mechanism of blood-brain-barrier penetration by C. septicum is unclear and may simply be related to vascular damage secondary to sepsis; however, it is worth noting that on further review by us, six of the previously noted 21 cases reported varying degrees of intraparenchymal hemorrhage/hemorrhagic stroke, which was also noted in our case. A plausible mechanism for CNS penetration by C. septicum could be microvascular damage due to a combination of severe sepsis and alpha toxin production resulting in intracerebral hemorrhage and organism dissemination within the brain parenchyma.Rapid recognition and treatment is vital in order to have any chance of patient survival. Diagnosis rests on recognizing potential sepsis in the setting of colon cancer, having a high index of suspicion for infection with fections , 8, no c


Myositis ossificans circumscripta (MOC) is a rare disorder that causes heterotopic bone formation in soft tissues. It usually occurs after trauma and affects large muscles of the extremities. MOC of the pectineus muscle is extremely rare and has not been reported to be treated surgically.A 52-year-old woman presented with left hip pain and dysfunction 4 months after a traffic accident that caused pelvic and humeral fractures and cerebral hemorrhage.Radiological imaging revealed isolated ossification of the left pectineus muscle. The patient was diagnosed with MOC.The patient underwent surgical resection of the ossified pectineus muscle followed by local radiation and medical therapy.At 12 months postoperatively, she was asymptomatic and had normal hip function. No recurrence was observed on radiography.MOC of the pectineus muscle is a rare condition that can cause severe hip dysfunction. Surgical resection combined with radiation and anti-inflammatory drugs can be an effective treatment option for patients who do not respond to conservative management. MO circumscripta (MOC), characterized by the ossification of a single muscle, is one of the 3 types of MO. Most MOC cases have been reported with a history of trauma, with few exceptions. More than 80% of lesions occur within the large muscles of the extremities, especially in the girdles and thighs. The affected muscles in published cases included: iliopsoas, triceps brachii, quadriceps femoris,–6 biceps femoris,,8 tibialis anterior, paravertebral, buccinators, masseter,,13 etc. To the best of our knowledge, cases of MOC involving the pectineus muscle are rare, and no reported cases have been treated surgically.Myositis ossificans (MO) is a rare disorder characterized by heterotopic bone formation in soft tissues and skeletal muscles.We present the case of a 52-year-old woman with consistent and progressive pain in the unilateral groin and hip dysfunction after traffic trauma. Radiographs and computed tomography (CT) revealed ossification of the left pectineus muscle. After resection of the ossified muscle and postoperative radiation, as well as administration of anti-inflammatory drugs, she was in good condition and showed complete recovery of hip function.A 52-year-old woman was admitted to our hospital because of hip dysfunction and consistent and progressive pain in the left groin for 4 months after a traffic accident. In the accident, she suffered a coma for 2 days, and a minor cerebral hemorrhage was identified by a brain CT scan. She recovered without surgical intervention. She also sustained pelvic and left humeral diaphyseal fractures. Her left arm was immobilized for 2 months, and the displaced fracture of the humeral diaphysis healed with acceptable deformity and good function. However, she complained of persistent isolated pain in her left groin that worsened, and she could not move her left hip freely; consequently, she was unable to sit, stand, and walk 4 months after the accident. She had undergone a total hysterectomy and bilateral adnexectomy due to uterine prolapse when she was 49 years old and had no other significant medical history.Physical examination and imaging data analysis after admission suggested MOC. Physical examination revealed the following: she was immobilized on the bed; there was a bony mass in her functional left mid arm; her left lower extremity was externally rotated and slightly abducted; tenderness was observed at her left groin; the range of the hip was reduced, and the passive range of motion was 30° of flexion, 0° of extension, 30° of abduction, and 0° of adduction. The radiograph of the left arm Fig.  revealedThe patient underwent ossified lesion resection. Although MOC is a self-limiting disease, her symptoms did not resolve spontaneously, and surgery was indicated. During the procedure, the pectineus muscle was exposed through an incision in the left groin Fig. A; the teAfter the surgery, the patient received 5 sessions of localized radiation therapy at a prescribed dose of 20 Gy; meanwhile, she received oral loxoprofen sodium (60 mg 3 times a day) for 4 weeks postoperatively.At the 12-month follow-up, the patient had returned to normal life and work. The function of her left hip was good, and her Harris score was 90. No recurrence or new ossified lesions were identified on radiological examination Fig. . The pat,14 According to the hereditary, severity of diffuse heterotopic ossification, and underlying causes, MO can be divided into 3 types: MOC, MO progressiva (fibrodysplasia ossificans progressive), and MO without a history of trauma or pseudo-malignant MO (non-traumatic MO). The last one includes cases associated with burns, polio, paraplegia, hemophilia, or infections.MO is a rare disease characterized by heterotopic bone formation in soft tissues, mostly in skeletal muscle. Traumatic MO accounts for approximately 75% of cases, while the other 25% consists of neurogenic, congenital, and idiopathic MO. MOC can be observed in any age group but predominantly occurs in adolescents and young adults and is more common in men. MOC may develop from fracture, dislocation, or even minor soft tissue trauma. Inflammation induced by trauma may activate an osteogenic response, which initiates the release of periosteal cells and growth factors into the muscle, resulting in localized ossification.MOC is the most common form of MO with a history of trauma. It mainly affects the extremities and occasionally involves other sites, such as the temporal, abdominal, or paravertebral muscles.; her traumatic cerebral hemorrhage may have aggravated the ossification process. neurogenic heterotopic ossification may involve systemic inflammatory changes in response to CNS injury, but the exact mechanism is still unknown.In the present case, multiple factors may have contributed to the ossification of the pectineus muscle. The patient injured the pelvis, arm, and head; fractures of both pelvic and left humerus were treated conservatively, which made the immobilization on the bed stricter and longer. Immobilization is recognized as an important risk factor for heterotopic ossification or MO. It is known that after damage to the central nervous system, such as traumatic brain injury, stroke, or spinal cord injury, neurogenic heterotopic ossification may occur in periarticular muscles In the present case, the ossified lesion confined to the unilateral pectineus muscle may be explained by a coincidental broken site and minor limited fracture. The pectineus muscle was attached to the superior ramus of the pubis, where the patient’s pelvic fracture occurred, resulting in the formation of heterotopic bone in the pectineus muscle. Extensive ossification was avoided because the undisplaced superior ramus fractures had limited local trauma.No surgical case of MOC of the isolated pectineus muscle has been reported previously. Most published cases involve the thigh, girdle, arm, knee, and shoulder; the lesions develop from large muscles, and the calcification is usually extensive. One case of MOC that involved the pectineus muscle was treated conservatively. The patient was referred to our hospital 4 months after the traffic accident, while it takes only 3 to 4 weeks for the muscle calcification to begin and become radiographically apparent. Her pelvic radiographs showed calcified lesions running parallel to the long axis of the pectineus muscle, which is a typical manifestation of mature MOC. However, in the early stages of MOC, because of the lack of ossified tissue, it may be difficult to diagnose this rare disorder. Occasionally, the periosteal reaction can be identified on plain radiography; soft tissue sarcomas associated with calcifications and extraskeletal osteosarcomas should be differentiated from the absence of a clinical presentation. CT can diagnose the condition earlier than radiography because it is more sensitive to soft tissue mass and calcifications. It can also delineate the zonal pattern of ossified muscle to determine MO and guide surgical resection. For difficult cases, additional imaging evaluations such as magnetic resonance imaging and bone scintigraphy may be necessary.Imaging plays an important role in the diagnosis of MOC, especially when the lesion is calcified into the mature phase. Surgical excision is indicated for intractable pain, dysfunction of the involved joint, and neurovascular structure compression caused by lesions. In our case, the lesion was present in front of the hip due to which the patient was unable to live a normal life. The ossified pectineus muscle was removed during the surgery. The pectineus muscle functions to flex and adduct the hip and internally rotate the thigh; however, these functions can be performed with other muscles such as the iliopsoas, adductor magnus, brevis, and longus. Removal of the pectineus muscle may have little effect on hip function, which was confirmed by the follow-up results of the case. For MOC, marginal excision is adequate; however, recurrence of the lesion has been reported. Radiation therapy can inhibit heterotopic ossification because of the sensitivity of osteogenic progenitors to radiation; in order to reduce the chance of recurrence, local radiation with a low dose is recommended in the early postoperative stage. Our patient underwent local radiation therapy 2 weeks after surgery, after the incision healed. Although bisphosphonates have been reported for MOC, the main medical therapy is nonsteroidal anti-inflammatory drugs (NSAIDs). Indomethacin is the most commonly used NSAIDs, and the recommended dose is 75 to 100 mg/d for 7 to 14 days postoperatively; other NSAIDs are also effective. Because of its ease of availability and administration, loxoprofen sodium is the prescription option in our hospital.MOC is a benign, self-limiting, and self-resolving disease, and conservative treatment is preferred for the vast majority of cases.In summary, even minor pelvic fractures may result in the MOC of adjacent muscles, especially in patients with heterotopic ossification risks, such as head injury, multiple fractures, and long-term bedrest. To our knowledge, MOC of the pectineus muscle is rare, and resection of the ossified pectineus muscle has not been previously reported. According to our experience, lesion resection combined with radiation therapy followed by oral NSAIDs may yield good results in symptomatic cases.Conceptualization: Yu Fan, Baozhong Zhang, Xiao Chang.Data curation: Qiushi Bai, Xiongfei Zou, Gang Yang, Yu Fan, Wenze Wang.Methodology: Xiao Chang.Resources: Xiongfei Zou, Xiao Chang.Supervision: Baozhong Zhang.Writing – original draft: Qiushi Bai, Wenze Wang.Writing – review & editing: Baozhong Zhang, Xiao Chang.


Sertoli-Leydig cell tumor (SLCT) is a rare tumor of the ovary.Cushing's syndrome (CS), on the other hand, is a clinical picture formed by the long-term high levels of glucocorticoids in the blood for any reason and the resulting symptoms. Exceptionally in some of cases, a tumor far from the adrenal region synthesizes adrenocortical hormones. Among such ectopic neoplasms, CS Tumors of the ovary that secrete cortisol as a cause of the disease is an exceptional case. In other words, in this case, we argue that the tumor in the ovary causes Cushing's syndrome by secreting cortisol and ACTH-like peptides. There are 5 cases reported in the literature. In this case report we present a case in which SCLT of the ovary was detected by histopathological examination in a patient who underwent laparoscopic surgery due to Cushing's syndrome and bilateral adnexal mass. Complaints of the patient when he applied to our hospital from the emergency department; There were swelling, weakness, acne, increased hair growth, purple spots on the abdomen, arms and legs, decreased speech, inability to walk, increased thirst, and frequent urination.Clinical findings in the internal medicine consultation requested from the emergency department; edema of the face and neck region, papulopustular lesions on the chest, virilization around the navel and aerola, distended abdomen, purple striae on the chest and upper extremity.Laboratoryresults;Cortisol:54.8ug/dL. ACTH:209 pg/mL .TSH:0.7 uIU/mL PTH(Parathormone):27.9 pg/mL Potassium: 1.78 mmol/L.A preliminary diagnosis of 'Cushing's syndrome' was reached with the examinations and clinical findings.. Dexamethasone suppression test was applied to confirm. Results are presented in Hypokalemia on admission was detected (1.78) and appropriately replaced. To diagnose the cause of the patient’s paraplegia Lomber MR was performed with the recommendation of Orthopedics and Traumatology. MR revealed compression fractures on T8-9 and L2-4. Due to the normal size of the adrenal glands, absence of skin hyperpigmentation, and higher than expected plasma ACTH levels, KS originating from an ectopic focus was considered to be the cause of the clinical picturenormal-sized. Brain CT was performed as a result of the neurosurgery consultation requested due to the microadenoma detected in the pituitary; there was no pathology observed. In other imaging, both adrenal glands were normal size and did not contain any mass or tumors, so pelvic tumor-induced ectopic glucocorticoid production was suspected. To evaluate ectopic Cushing syndrome and to identify the source PET-CT imaging was done. Due to PET-CT pointing to primary ovarian cancer, the patient was consulted to Gynecologic Oncology. Surgical excision of the mass was decided and the patient was then transferred to our clinic.)  Pathologic lymph nodes were not detected in the pelvic or paraaortic region. Bloodwork showed the tumor markers as CEA:8U/mL, CA 125: 64U/mL, CA15-3:25U/mL.Preop gastroscopy and colonoscopy were performed because the patient had bilateral ovarian masses. However, the results were not significant and did not point to another primary cancer or metastasis. In the lower abdomen CT, a nodular tumoral mass was observed to fill both adnexal lobes, with a lobulated configuration of 95x85 mm on the right with the largest of the solid nodules reaching 6 cm in diameter on the right tumoral mass, and a lobulated mass of 83x72 mm on the left adnexa   PathologThe surgery was planned as Diagnostic Laparoscopy, and if required followed by Total Abdominal Hysterectomy + Bilateral Salpingo Oophorectomy + Frozen. After the required preoperative preparations, the patient was operated on;The frozen response received at the surgery was 'Granulosa Cell Tumor'. Therefore, hysterectomy + bilateral salpingo-oophorectomy was performed.Both adnexa were sent for frozen study. In the macroscopic examination of the right and left adnexa; A lobulated contoured, encapsulated, yellow-pink colored mass with soft elastic consistency was observed. The cross-sectional surface of the masses was observed as yellow-pink colored and occasionally dirty yellow necrotic nodules. In addition, in the sections of the hysterectomy sent later, the endometrium was 0.1 cm; Myometrium is 1.5 cm thick and no feature is observed. In the microscopic examination of the samples taken from the masses; In the fibrohyalinized stroma, cells with lobular pattern, solid islands and vesicular chromatin forming an open glandular structure, irregular membrane nuclei, large eosinophil cytoplasm, and some bizarre-looking atypia were observed. Calcification areas were observed in the middle of the gland structures and in the stroma in places. In the tumor, there were 3–4 mitosis, tumor necrosis and widespread lymphatic invasion in 10 high magnification fields (3–4/hpf). The residual ovarian cortex around the tumor and the adjacent 'Adrenal Rest' area were noted., Inhibin, Calretinin, Chromogranin, Synaptophysin, CD56, EMA, PIT-1, ACTH, MUC5AC ; Cytokeratin7, Cytokeratin20, OCT-4, CD30, PLAP, TAG-72, CA125, WT-1, Melan-A, CD117, were negative with PR. Ki67 proliferation index was detected at the rate of 70–80% in the densest area. .Fig. 2LoThe patient was transferred to the Intensive Care Unit for post-op follow-up. The patient, whose follow-up and treatment were carried out; upon the improvement of the patient was transferred to our clinic 2 days later. The cushingoid appearance of the patient improved rapidly, and the edema on his face and body, along with the rashes and the striae regressed. Laboratory values improved to normal values. Her electrolytes have reached normal levels.  The patiIn the laboratory tests performed in the endocrine service, cortisol checked at night was 8 µg / dL, and basal cortisol level was 13 ug / dL. As the cortisol level decreased and improvement was observed in the patient's clinical table, the patient was discharged by the Department of Endocrinology after planning the outpatient follow-up care of the patient.3SLCTs are typically unilateral tumors. Only 1.5% of them occur bilaterally, as seen in our case. Most tumors are limited to the ovaries and 97.5% are stage I at the time of diagnosis. .SLCTs are characterized by the presence of testicular structures (Sertoli and Leydig cells) capable of producing androgens. SCLTs can simply cause virilization, or it may progress to aggressive metabolic activity that is enough to cause Cushing syndrome.The prognosis is linked to the degree of cell differentiation and the presence of heterologous elements. Histologically, SLCTs are divided into good, moderate, and poorly differentiated tumor subgroups based on cytological atypicality, mitotic activity, presence or absence of sarcomatous growth pattern. Heterologous elements  usually accompany moderately and poorly differentiated subtypes, however are also rarely seen in well-differentiated tumors. .. (Diagnostic accuracy is postoperative histological and, despite strong clinical assumptions, there are no specific ultrasound findings. SLCT's ultrasound images can vary. On ultrasound, Sertoli-Leydig cell tumors appear as heterogeneous masses of vascularized tissue containing solid areas; in SLCT forms consist of pure Sertoli cells, they are readily localized in relation to dense fluid regions; their sizes are variable, reaching around twenty centimeters.  Demidov . .. The mentioned cases are presented in .Cushing's syndrome is rarely associated with ovarian neoplasms. Although the incidence of Cushing syndrome due to ovarian neoplasms is not known, in case reports, they defined the mechanisms of ACTH secretion as the ectopic production of ACTH-like peptides and the release of corticotropin release factor and cortisol. In these Since SLCT can cause metabolic disorders such as severe hypokalemia and ketoacidosis, the prognosis may be poor. However, the most important causes of mortality are metastatic disease and thromboembolic events. Five cas4In conclusion, SCLT with Heterologous Elements is a rare histological subtype of ovarian SCLTs manifested by hormone-related symptoms or non-hormonal symptoms. As in our case, ACTH-independent Cushing syndrome can be seen as an ectopic tumor that produces glucocorticoids and sex hormones. The treatment is surgical resection and fertility-sparing conservative surgeries may be preferred for young patients with stage 1 disease. However, the picture due to endocrine causes is often malignant and complete resection is required.In the patient we presented in our case, ovarian tumors detected in abdominal CT scans were confirmed by histological and immunohistochemical staining and normalization of metabolic and endocrine activity immediately after ovarian tumor resection showed that ovarian tumors may cause CS.Gynecological surgeon Dr. Tuba OFLI, gynecological oncologist Dr. He performed the surgery with Gurkan KIRAN. Dr Atilla KUNT provided 3rd assistance to the surgery. Dr. Tuba wrote the draft. Dr. Tuba, Dr. Gurkan and Dr. Arilla edited the draft. Dr. Gurkan approved the draft. All authors have read, revised and approved the article.The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.