Preoperative differentiation between pulmonary fractionation and solitary fibrous tumors (SFTs) is challenging. Diaphragmatic primary tumors are relatively rare among SFTs, with limited reports of abnormal vascularity.A 28-year-old male patient was referred to our department for surgical resection of a tumor near the right diaphragm, Thoracoabdominal contrast-enhanced computed tomography (CT) scan revealed a 10 × 8 cm mass lesion at the base of the right lung. The inflow artery to the mass was an anomalous vessel in which the left gastric artery bifurcated from the abdominal aorta, and its origin was the common trunk and right inferior transverse artery.The tumor was diagnosed as right pulmonary fractionation disease based on the clinical findings. The postoperative pathological examination determined a diagnosis of SFT.The pulmonary vein was used to irrigate the mass. The patient was diagnosed with pulmonary fractionation and underwent surgical resection. Intraoperative findings revealed a stalked, web-like venous hyperplasia anterior to the diaphragm, contiguous with the lesion. An inflow artery was found at the same site. The patient was subsequently treated using a double ligation technique. The mass was partially contiguous with S10 in the right lower lung and stalked. An outflow vein was identified at the same site, and the mass was removed using an automatic suture machine.The patient received follow-up examinations that involved a chest CT scan every 6 months, and no tumor recurrence was reported during 1 year of postoperative follow-up.Differentiating between SFT and pulmonary fractionation disease may be challenging during preoperative diagnosis; therefore, aggressive surgical resection should be considered as SFTs may be malignant. Identification of abnormal vessels using contrast-enhanced CT scans may be effective in reducing surgical time and improving the safety of the surgical procedure. Conversely, solitary fibrous tumors (SFTs), particularly those of diaphragmatic origin, are relatively rare mesenchymal tumors with a predilection for the pleura. It is reportedly difficult to differentiate between the 2 conditions, and the identification of abnormal blood vessels is often difficult. In the present case, abnormal blood vessels were identified preoperatively using contrast-enhanced computed tomography (CT) scans, and the patient was diagnosed with pulmonary fractionation disease. However, histopathological examination following surgical resection revealed a SFT. We report a case in which preoperative identification of abnormal blood vessels in the lung tissue allowed us to perform a safe and rapid surgical tumor resection.Pulmonary fractionation disease is an abnormal lung tissue that is vascularized from abnormal vessels of the major circulatory system and has no traffic with normal bronchi.The patient was a 28-year-old male diagnosed with an abnormal chest shadow during a medical checkup in 2022. No abnormalities were noted in past physical examinations. A chest CT scan revealed a tumor near the right diaphragm, which was diagnosed as right lung fractionation disease, and the patient was referred to our department for surgical resection of the tumor.The patient had no significant family history of disease, including no family history or diagnosis of cardiac disease. The patient had a history of allergic rhinitis but reported no previous history of smoking or alcohol consumption. The patient characteristics at admission were as follows: The patient was 176 cm tall, weighed 58 kg, and had a body mass index of 18.7. No abnormal respiratory sounds were noted in the chest. No cervical lymph node enlargement was observed. Laboratory findings at admission reported no abnormal findings in blood count, biochemistry, or coagulation. The tumor markers, CEA (1.3 mg/mL) and CA19-9 (8.5 U/mL) were not elevated. There were no abnormal findings on respiratory function or electrocardiography.Chest radiography images revealed a mass on the right side of the diaphragm Fig. . A contrThe intraoperative findings were recorded for the surgical resection procedure. A small thoracoscopically assisted right fifth intercostal chest incision was made. Intrathoracic examination revealed no obvious adhesions to the diaphragm. Web-like venous hyperplasia was observed anterior to the diaphragm, which was contiguous with the lesion and stem-like Fig. A. The maThe resected specimen was 11 × 9 × 5 cm in size, and the pleura covered the entire specimen except for the vasectomy at the base of the lung Fig. A. The cu Pulmonary fractionation disease can be categorized as intralobular lung fractionation syndrome, in which the fractionated lung is covered by a common pleura with the normal lung, and extrapulmonary lung fractionation syndrome, in which the fractionated lung is not covered by a common pleura. The diagnosis of pulmonary fractionation requires the identification of abnormal arteries, which is often difficult owing to their small diameters. Moreover, it is difficult to distinguish pulmonary fractionation from mediastinal tumors or SFTs. Previous reports have indicated that a preoperative diagnosis of pulmonary fractionation disease favors a more conservative treatment approach due to the risk of damaging abnormal blood vessels during surgical intervention. Nevertheless, surgical resection is frequently performed to differentiate SFT from other diseases, as described earlier.Pulmonary fractionation disease is defined as an abnormal lung tissue that exists in isolation from the normal lung and is vascularized by an abnormal blood supply from the general circulation system. SFTs with hypoglycemia have also been reported.,10 Histopathologically, SFTs comprise spindle-shaped cells with fibroblast-like round or oval nuclei that grow in an unstructured and disorganized manner.,12 Immunohistological features include strong expression of CD34, CD99, and BCL-2 in > 90% of cases.,14 The genetic hallmark of SFT is the NAB2:: STAT6 gene fusion and immunostaining with anti-STAT6 antibodies have been reported to be useful for the diagnosis of SFT. STAT6 immunostaining is the most sensitive and specific marker currently available in several studies. England et al defined the criteria for a malignant SFT as mitotic figures of 4/10 HPF or more; increased cell density; nuclear hyperplasia; or the presence of hemorrhage or necrosis. Although several studies have been conducted using other criteria, most reports to date have relied on this definition.An SFT is a rare tumor of mesenchymal origin which typically originates within the thoracic cavity, predominantly from the pleura; however, other extrathoracic origin sites have also been identified, including the head and neck, abdomen, pelvis, extremities, meninges, and scrotum. In the present case, the left gastric artery branched directly from the abdominal aorta, and the right diaphragmatic artery branched from its common trunk and was further identified as the inflow artery. The perfusion vein was identified as the pulmonary vein. Therefore, abnormal blood vessels were determined using contrast-enhanced CT imaging preoperatively, and a final diagnosis of pulmonary fractionation disease was determined. Although the patient had no subjective symptoms, surgical resection was performed upon request. The inflow artery was noted as a web-like vascular-transected area at the base of the lung; however, the outflow vein could not be clearly identified.In the present case, the inflow artery was identified as the left diaphragmatic artery and the perfusion vein was identified as the pulmonary vein by 3D reconstruction using a preoperative contrast-enhanced CT scan. An angiography is performed in cases where it is difficult to identify the abnormal blood vessels but is not always conducted due to the cost of medical care and the widespread use of contrast-enhanced CT scans. Therefore, SFTs should be considered in the preoperative evaluation of tumors with abnormal vascularity.Intraoperative vascular treatment was straightforward as the preoperative contrast-enhanced CT images revealed abnormal vasculature. The inflow and right diaphragmatic arteries were dissected using a double ligation technique. The pulmonary vein, thought to be the perfusion vein, was partially severed as a single lump with the lung using an automatic suture machine. This case was diagnosed postoperatively as an SFT on histopathological examination. We believe that this case of SFT with such abnormal vascular motion is very rare in the literature and is therefore a valuable case study for both researchers and clinical professionals. However, it has already been suggested that postoperative histopathological examination of SFTs may show abnormal vascular motion. Therefore, the indication for biopsy should be carefully considered. Therefore, aggressive surgical resection should be prioritized in all cases.In this case, pulmonary fractionation was diagnosed preoperatively, and surgical resection was performed. As mentioned previously, pulmonary fractionation can be difficult to distinguish from other diseases, including SFTs. In this case, the SFT was diagnosed as benign; however, a malignant SFT should have been considered. A biopsy may be beneficial for a definitive preoperative diagnosis. However, in the case of malignant SFTs, needle tract seeding has been previously reported and is known to cause tumor recurrence in the puncture route.We report a relatively rare case, wherein anomalous vessels were identified preoperatively, and a diagnosis of pulmonary fractionation was determined. However, histopathological examination revealed an SFT. This case showed abnormal vascular distribution in the right diaphragmatic artery and pulmonary vein as a perfusion vein. Preoperative contrast-enhanced CT imaging enabled us to identify the vascular architecture and perform surgical resection of the tumor safely and promptly. Pulmonary fractionation disease is often difficult to diagnose preoperatively, and surgery is a useful alternative for obtaining a definitive diagnosis.Conceptualization: Ryusei Yoshino.Supervision: Ryusei Yoshino, Nana Yoshida, Akane Ito, Masaki Nakatsubo, Sayaka Yuzawa, Masahiro Kitada.Validation: Ryusei Yoshino, Nana Yoshida, Akane Ito, Masaki Nakatsubo, Sayaka Yuzawa, Masahiro Kitada.Visualization: Ryusei Yoshino, Nana Yoshida, Akane Ito, Masaki Nakatsubo, Sayaka Yuzawa, Masahiro Kitada.Writing – original draft: Ryusei Yoshino.Writing – review & editing: Ryusei Yoshino, Sayaka Yuzawa, Masahiro Kitada.


Urachal tumors are exceedingly rare, and adenocarcinoma is the most common malignant urachal neoplasm. Here, an especially rare patient of primary urachal leiomyosarcoma from our hospital was reported, and only five patients have been reported thus far since 1981.A 24-year-old man was admitted due to urinary tract symptoms. Both urogenital ultrasonography and contrast-enhanced computed tomography showed a mass at the dome of the urinary bladder. Laparoscopic surgical resection was performed, and histopathologic examination of the mass confirmed the diagnosis of urachal leiomyosarcoma. No recurrence was noted after one and a half years.Because the leiomyosarcoma located in the extraperitoneal space of Retzius and may manifest with nonspecific abdominal or urinary symptoms, early and definitive preoperative diagnosis is challenging. Partial cystectomy with complete excision of the urachus is recommended. Because only a few patients have been recorded, clinical outcomes and recurrence risks are difficult to assess. The urachus is a ductal remnant that arises embryologically, originating from the involution of the allantois and cloaca and extending between the bladder dome and the umbilicus . The tubA 24-year-old man manifested the symptoms of dysuria, urinary frequency, and urgency for more than a week. Urogenital ultrasonography (US) revealed a hypoechoic mass at the dome of the bladder. The patient was treated with anti-inflammatory therapy and discharged from the local hospital after improvement. Thereafter, the patient sought consultation at our hospital for further evaluation. Contrast-enhanced abdominal computed tomography (CT) showed a heterogeneous 2.7 cm × 2.1 cm × 2.1 cm mass at the dome of the bladder Figure 1The urachus is a 3.0 - 10.0 cm tubular structure extending from the allantois to the early fetal bladder. During embryonic development, the upper part of the allantois will be reduced gradually. After birth, it is replaced by fibromuscular tissue, also known as the median umbilical ligament. In patient of partial obliteration of the urachus, various diseases including fistula, diverticulum, or tumor may occur. The tumor primarily occurs in males and is usually localized in the bladder dome or anterior wall. Urachal adenocarcinoma is the most common pathological type (up to 80%), with an occasional occurrence of squamous cell carcinoma , 11. ProLeiomyosarcoma is a malignant neoplasm characterized by smooth muscle differentiation. The World Health Organization (WHO) proposed a histological classification of leiomyosarcoma which is divided into myxoid and epithelioid leiomyosarcoma . LeiomyoUS is the preferred method in the detection of urachal leiomyosarcoma. US can show the urachal tract between the bladder dome and the umbilicus allowing localization of the tumor. The CT appearance of a leiomyosarcoma is not specific; necrotic or cystic change is usually observed and reveals no enhancement; therefore, it shows an uneven and avid enhancement on contrast-enhanced CT. On MRI, the urachal leiomyosarcoma is reported to be isointense on T1-weighted imaging (T1WI) and heterogeneously hyperintense on T2-weighted imaging (T2WI). A high signal intensity on T2WI is associated with fluid, necrosis, or mucin. The contrast-enhanced MRI findings are similar to that of the contrast-enhanced CT.18F-fluorodeoxyglucose (FDG) PET/CT may be helpful for diagnosing primary and recurrent urachal adenocarcinoma . In identifying the primary focus, FDG PET/CT does not seem to yield additional information compared with CT or MR. However, it may detect metastatic lesions not seen on other imaging modalities, causing changes in tumor stage and patient management  for urachal cancer, but none of them have been fully validated. The Sheldon staging system is complex and has eight categories, while the Mayo system is simpler and more proportional for patient distribution. Based on the Mayo system, urachal cancer is classified into four stages: Stage I, tumor confined to urachus and/or bladder; Stage II, tumor extending beyond the muscular layer of urachus and/or bladder; Stage III, tumor infiltrating the regional lymph node; and Stage IV, tumor infiltrating non-regional lymph nodes or distant sites . TherefoCompared with other modalities for staging of urachal cancer, MRI has more advantages in soft tissue resolution and multi-plane imaging capabilities. For primary UrC, MRI can provide the tumors’ location, size, morphology, extent of peritoneal tissue, and/or local structures beyond bladder invasion. For recurrent UrC, it can accurately evaluate recurrence and metastatic patterns. Studies have shown Mayo stage at MRI is highly consistent with pathology .18F-FDG uptake due to hypocellularity of tumors which may limit the sensitivity of 18F-FDG PET/CT . For chemotherapy, we suggest that it should not be recommended on a routine basis, as types of treatment used are heterogeneous and the benefits are unclear. Postoperative chemotherapy may be considered due to positive margins, lymph node or peritoneal involvement, or unresected umbilicus and a high likelihood of relapse . FinallyAs a result of the lack of data on urachal leiomyosarcomas, follow-up scheme of this entity is not clear in the literature . For theLeiomyosarcoma is a type of soft-tissue sarcoma usually occurring in the soft tissues of the extremities and trunk. It is aggressive and spreads hematogenously which are characteristics of a malignant neoplasm. Primary leiomyosarcoma of the urachus is extremely rare, and it tends to be easily misdiagnosed. Understanding the embryological basis of these urachal disorders and their imaging features coupled with histopathological, examination is crucial for the correct diagnosis and management.Our patient reported the following about his disease: “Throughout my clinical care, I have been concerned that my disease would come back. I now have an abdominal ultrasonography every three months to keep track of my disease. Fortunately, I am now in good health. Thanks are given to the doctors and nurses who have taken care of me and helped me.”The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding author.The studies involving human participants were reviewed and approved by Institutional Ethics Committee of the Suining Central Hospital. The patients/participants provided their written informed consent to participate in this study.JY, QD, and GY participated in the study design and writing of the manuscript. JY, QD, GY, CT, HL, and YL participated in clinical data collection and analysis, and carried out the interpretation of the CT images. LY performed the pathological and immunohistochemical examinations. GY, MM, AB, RL, GT and BF all revised the paper critically for intellectual content. All authors contributed to the article and approved the submitted version.


Candida bezoar is a rare pathologic entity characterized by the colonization of a cavity by an aggregate or mass of mycelia due to local or systemic infections with Candida spp. Candida bezoar is commonly seen in immunocompromised individuals and can often present in the context of symptomatic urinary tract infection or urosepsis. The implicated risk factors for the development of Candida bezoars are anatomical urinary tract abnormalities, diabetes mellitus, indwelling urinary catheters, increased use of broad-spectrum antibiotics, and corticosteroids. Early clinical suspicion is essential for diagnosis to prevent the dissemination of disease and for a favorable prognosis. We report a case of a 49-year-old diabetic male who presents with hematuria, abnormal urinary flow, and left-sided flank pain for four days caused by a Candida bezoar of the urinary bladder resulting in unilateral obstructive uropathy despite the appropriate placement of a ureteral stent. Treatment with left nephrostomy tube, oral fluconazole, and amphotericin bladder irrigation for three days was successful. The patient’s condition improved, and he was discharged on fluconazole and was recommended to follow up with urology as an outpatient. Candida bezoars are a colonization of a cavity by an aggregate or mass of Candida mycelia. While candiduria can be seen in approximately 20% of hospitalized patients, the development of Candida bezoars is very rare [Candida bezoars are largely seen in immunocompromised individuals, hospitalized patients with multiple comorbidities, and those with severe illnesses requiring admission to intensive care units [Candida bezoars are unknown. However, Candida bezoars are commonly seen in neonatal and elderly populations [Candida bezoars are anatomical urinary tract abnormalities, diabetes mellitus, indwelling urinary catheters, increased use of broad-spectrum antibiotics, and corticosteroids [Candida bezoars usually presents in the context of symptomatic urinary tract infection or urosepsis. Bezoars are not typically symptomatic themselves until they cause urinary tract obstruction. Obstructing bezoars may cause renal colic pain and the development of post-renal kidney injury [Candida bezoar of the urinary bladder resulting in unilateral obstructive uropathy despite the appropriate placement of a ureteral stent.ery rare . Candidaulations . The impsteroids . The cliy injury . We presA 49-year-old male with a past medical history of chronic hidradenitis suppurativa involving the axillary region bilaterally, uncontrolled type II diabetes mellitus with glycosylated hemoglobin HbA1c) of 10.2, recurrent kidney stones, and left hydronephrosis due to ureteral stricture presented for hematuria, abnormal urinary flow, and left-sided flank pain for four days. His physical examination was significant for tenderness in the left upper quadrant, left lower quadrant, suprapubic region, and left costovertebral angle (CVA). During his initial assessment, his laboratory workup was notable for an elevated creatinine of 1.7 mg/dL (baseline: 1.1 mg/dL), mild hyperkalemia (5.3), hyperglycemia 320 mg/dL, and a leukocytosis of 12.8 k/uL. Urinalysis results were notable for glucosuria, hematuria, proteinuria with positive leukocyte esterase, and pyuria. A CT of the abdomen and pelvis demonstrated marked left hydronephrosis despite an appropriately positioned ureteral stent, a heterogenous filling defect containing gas within the urinary bladder, and an additional gas-containing filling defect present at the proximal end of the ureteral stent (Figure c of 10.2Candida albicans. The broad-spectrum antibiotics were then switch to oral fluconazole 400 mg daily for a two-week duration, and the patient underwent amphotericin bladder irrigation for three days. Bladder irrigation resulted in the expulsion of thick tan-white fungal aggregate measuring 1.5 × 1.4 × 0.4 cm. Pathology demonstrated innumerable fungal hyphae with associated inflammation. A repeat CT scan revealed no further filling defects in the bladder or kidney (Figure Subsequently, the patient was started on intravenous piperacillin/tazobactam, and bladder irrigation was performed by urology to remove debris. Interventional radiology-guided left nephrostomy tube was placed, which drained 110 mL of purulent fluid from the ureteral collecting system. Purulent fluid later speciated y Figure . Blood cCandida albicans bezoar in the urinary bladder resulting in unilateral obstructive uropathy, with the evidence of candiduria given the positive culture for Candida from the urinary collecting system and multiple fungal aggregates in the bladder irrigation fluid. The risk factors for Candida bezoars include an immunocompromised state, increased use of antibiotics and corticosteroids, diabetes mellitus, and indwelling urinary catheters [This case illustrates an unusual presentation of a atheters . SeveralCandida albicans is the most common fungal species causing fungal bezoars; however, other fungal isolates have been reported in the literature including other Candida spp., Aspergillus spp., Rhizopus oryzae, and Geotrichum candidum [Candida bezoar infections of the bladder and upper urinary tract are a very rare phenomenon with unknown exact epidemiology. A high clinical index of suspicion with prompt medical and surgical treatment is necessary for treating Candida bezoar infections in immunocompromised patients. Although our case demonstrates a complication of localized Candida infection rather than dissemination, the mortality rate of disseminated Candida infections has been reported as high as 44% [candidum -5. Candih as 44% . DiagnosCandida bezoars are seen as mobile, rounded, and heterogeneously hypoechoic masses with no evidence of vascularity seen in Doppler studies. Several morphological features can be appreciated on abdominal CT/MRI scans, including rounded heterogeneous soft-tissue densities not attached to the urinary tract wall, with or without regions of gas or calcification. MRI signal characteristics of Candida bezoars have been rarely illustrated but include T1 scans being isointense to renal parenchyma while T2 scans being hyperintense to renal parenchyma [When utilizing ultrasound, renchyma . The mosrenchyma . Our patCandida bezoars are a rare entity and should be considered in the differential of immunocompromised patients presenting with candiduria. Early diagnosis and treatment are important to prevent the dissemination of disease and for a favorable prognosis.


Paratubal cyst torsion accompanied by secondary isolated fallopian tube torsion without involvement of the ipsilateral ovary is rare. A similar case occurring in the postpartum period has not been reported to date in the English literature. Our case report concerns a pregnant multiparous woman in the 40th gestational week, without regular antenatal care attendance, who was urgently admitted to the maternity ward with pushing labour pains and gave birth with vaginal delivery. A few hours later, puerperant complained of worsening severe lower abdominal pain, accompanied by nausea, dizziness and vomiting, unresponsive to analgesic medication. Based on the clinical and ultrasound findings, the diagnosis of an ovarian cyst torsion was established, and it was decided to treat the patient with surgery and in particular with laparotomy. Intraoperatively, in the left parametrium, the presence of an ovoid mass with a brownish-red hue and a smooth outer surface was detected, along which the ipsilateral fallopian tube ran, without the involvement of the ovary. Histological examination of the surgical specimen confirmed the diagnosis of isolated fallopian tubal torsion with paratubal cyst. The postoperative course was uneventful. In this paper, based on modern data, a brief literature review of this rare nosological entity is attempted, regarding the diagnostic and therapeutic approach, the immediate application of which can ensure the best prognosis. The paratubal or paraovarian cyst, as otherwise referred to in the literature is of fetal origin, is estimated to originate from the Wolffian duct and was first described as a separate pathological entity by Kariminejad and Scully in 1973 . In apprTorsion of the paratubal cyst after vaginal delivery during the immediate postpartum period has not been described in the English literature to date. Therefore, on the occasion of our patient, it is useful to emphasize the significant preoperative difficulties and the inclusion of this extremely rare nosological entity in the differential diagnosis of acute abdomen during the postpartum period.The case report concerns a 42-year-old multiparous pregnant woman, with three vaginal deliveries in her obstetric history, who, in the 40th gestational week, was urgently admitted to the maternity ward of our hospital with advanced cervical dilatation (9 cm) and pushing labour pains. She gave birth 10 minutes later by vaginal delivery to a live, full-term, male newborn weighing 3100 grams. Administration of ergometrine (0.2 mg bolus followed by 0.2 mg in drip infusion over two hours) was deemed necessary to treat postpartum hemorrhage. Obstetric history revealed incomplete antenatal care attendance of the current pregnancy. Only two visits to a gynecologist were reported, no prenatal screening was provided, nor ultrasound assessment of fetal growth during pregnancy. The personal medical history was unremarkable. Hereditary history was of no pathological significance.After the birth of the newborn, the urgent laboratory test revealed: hematocrit (Ht) 41.9%, hemoglobin (Hb) 13.4gr/dl, platelets (PLT) 211x103/ml, white blood cells (WBC) 16.9x103/ml, and neutrophils (NEUT) 89%. Coagulation tests were within normal range. The biochemical analysis and the urinalysis were without pathological findings. In the early hours of the morning, approximately eight hours after delivery, puerperant complained of worsening abdominal pain. She complained of severe pain in the lower abdomen, accompanied by nausea, dizziness and vomiting. The administration of analgesic drugs had no effect. From the clinical examination, no obstetric pathology was found. The peritoneal irritation signs during palpation of the left abdomen, and especially in the hypogastrium, were intense. During imaging study with the transabdominal ultrasound in the anatomical location of the left adnexa, an unilocular, thin-walled cystic mass with a regular and well-demarcated outline, with a maximum diameter of approximately 100 mm, was found , due to pressure on the lower abdominal cavity or due to torsion of the paratubal cyst, respectively . In our In many cases, abdominal pain of variable intensity can be accompanied by other symptoms related to fallopian tube torsion. Dizziness, nausea, and signs of peritoneal irritation on palpation of the abdominal wall suggest isolated fallopian tube torsion accompanied by a paratubal cyst . HoweverIn contrast to clinical findings, imaging can sometimes be useful in the diagnosis of paratubal cysts. Abdominal ultrasound as a first-line test, computed tomography and magnetic resonance imaging are now considered to be of great help in the diagnostic approach to paratubal cysts, but in most cases the exact diagnosis is made during surgery . On ultrPreoperative differential diagnosis between ovarian cysts and paratubal cysts remains very difficult. The incomplete description of the specific pathognomonic features on imaging when examining paraovarian cysts, especially when involved in emergency clinical situations characterized by torsion, significantly increases the risk of misdiagnosing paratubal cysts as ovarian cystic masses ,15. It iThe diagnosis of paratubal cysts is easily made intraoperatively. Intraoperatively, the non-involvement of the ipsilateral ovary in the neoplasia and the characteristic running of the fallopian tube on the outer surface of the cyst are evident Figure . In addiSecondary isolated fallopian tube torsion accompanied by a paratubal cyst during the postpartum period is an extremely rare pathological entity. Preoperative diagnosis is a challenge in modern medical practice. Despite its uniqueness, fallopian tube torsion secondary to torsion of a paratubal cyst without ovarian involvement should be considered in the differential diagnosis of puerperal lower abdominal pain and adnexal cystic masses. During the postpartum period, abdominal pain accompanied by vomiting, before being attributed to obstetric causes, must be differentiated from adnexal torsion. Its timely treatment contributes to the preservation of the affected fallopian tube.


Spermatocytic tumors are a rare type of testicular cancer, comprising <1% of all testicular malignancies. This type of cancer typically affects males in their 60s and 70s and rarely metastasizes; however, it poses a threat to the health of affected individuals if left untreated. The present study describes the case of a 68-year-old male patient with this type of tumor, including a presentation of his initial symptoms, treatment and subsequent monitoring. A male patient, aged 68 years, visited the authors' clinic with an asymptomatic mass in the right testicle. The mass had been progressively increasing in size for a duration of 5 years following a history of blunt injury. During the examination, a noticeable, painless enlargement was detected in the right testis, whereas the left testis appeared to be in a normal state. Tumor markers were within normal limits. Imaging revealed a complex mass (11x8x7 cm) almost replacing the right testis, with no detectable lymph nodes. A right radical orchidectomy was performed under spinal anesthesia. A histopathological examination revealed a spermatocytic tumor. The post-operative period was uneventful, with no metastasis detected in the CT scans. The patient was discharged with instructions for regular follow-up appointments. The case presented herein highlights a rare spermatocytic tumor in a 68-year-old male. The early detection and treatment of testicular tumors, regardless of age, are crucial for a good prognosis. Testicular cancer is an uncommon neoplasm, contributing to 1.5% of all malignancies in the male population ,3. TumorThe present study describes a rare case of a spermatocytic tumor in an elderly male, including presentation, investigations, management and follow-up. The present study aimed to avoid citing predatory publications based on a well-known predatory list .A 68-year-old male patient presented to the Urology Clinic at Smart Health Tower, reporting a gradually enlarging, painless right testicular mass for a period of 5 years. The case had a history of right testicular blunt trauma 5 years prior. He had ignored his condition until the mass grew to a size that began to concern him.Upon a physical examination, it was found that he had an enlarged, non-tender right testicular mass with no associated palpable inguinal lymph nodes, and the left testis appeared normal.The levels of tumor markers, including alpha-fetoprotein  and human chorionic gonadotropin  were within normal limits, while those of lactate dehydrogenase were elevated to 400.3 U/l . Scrotal ultrasound (US) imaging revealed a complex heterogeneous mass almost replacing the right testis and measuring 11x8x7 cm , while tUnder spinal anesthesia, a right radical orchidectomy was performed. Histopathological and immunohistochemical analysis revealed the presence of a spermatocytic tumor in the testis .The histopathological examination was performed by the authors' laboratory as follows: The sections (5-µm-thick) were paraffin-embedded and fixed with 10% neutral buffered formalin at room temperature for 24 h. They were then stained with hematoxylin and eosin (Bio Optica Co.) for 1-2 min at room temperature, and examined under a light microscope (Leica Microsystems GmbH).For immunohistochemistry, the sections (4-6-µm-thick) were cut from the paraffin blocks and transferred onto glass slides with an electric charge. These slides were then placed in an oven at 60˚C overnight. Antigen retrieval was carried out using the Dako PT Link  by immersing the sections in boiling water at 100˚C for 5 to 10 min. Depending on the target antibody, a solution with either pH 6.0 or 9.0 was used. Following antigen retrieval, the slides were washed for 15 min with a 20 ml buffer solution  at room temperature. To facilitate this process, the slides were marked using the Dako Pen . Endogenous peroxidase activity was blocked by applying a 3% hydrogen peroxide solution. Subsequently, primary antibodies were applied at room temperature followed by incubation at room temperature (25˚C) for 80 min. Afterward, the secondary antibody, which was horseradish peroxidase, was applied, along with the chromogen (diaminobenzidine), both at room temperature for 15 min. To achieve counterstaining, hematoxylin Gill II was applied at room temperature for 30 sec. Finally, the slides were allowed to dry, and coverslips were affixed.The post-operative period was uneventful, and the metastatic workup, including chest and abdominal computed tomography scans, revealed no evidence of metastasis. The patient was discharged the day after the surgery and ws instructed to return for regular follow-up appointments.Continual discussions exist regarding the theory that suggests precursor cells of ScTs arise during embryogenesis . Certainet al (et al (ScTs are rare, accounting for <1% of all testicular cancers. These type of tumors predominantly affect older males, typically in their 60s and 70s (et al , it was et al . They alet al . In the et al ,7. It isl (et al  reportedl (et al . A clinil (et al ,4,7,8. Tl (et al . It shoul (et al .In the case presented herein, scrotal US imaging revealed a complex heterogeneous mass almost replacing the right testis, confirming the presence of a sizable tumor. The absence of para-aortic lymph nodes on abdominal ultrasound scan suggested localized disease without metastasis ,14. AnotIn conclusion, the present case report underscores the rarity and slow-growing nature of testicular ScTs, emphasizing the significance of prompt identification and treatment. Clinical examination, tumor markers, and imaging techniques are vital for accurate diagnosis. Radical orchidectomy is crucial for ensuring favorable outcomes, and long-term monitoring is necessary to detect any potential recurrence or spread.


Cardiac malignancies in children are extremely rare and they with hypereosinophilia are rather relatively uncommon. The majority of individuals may survive over the long term even with heart tumors provided they don't have any significant symptoms and their hemodynamics are unaffected. But we should nevertheless be aware of them, especially when they are coupled with persistent hypereosinophilia and the development of a hemodynamic anomaly. The case of a malignant heart tumor with hypereosinophilia in a 13-year-old girl is presented in this paper. She exhibited an echocardiographic deficit and a heart murmur. Additionally, it was difficult to treat her hypereosinophilia. Nevertheless, it was resolved the day after the operation. We presume that there is a certain relationship between them. This study gives clinicians a wide range of options for analyzing the connections between malignancy and hypereosinophilia. A 13-year-old girl was admitted to our hospital with intermittent coughing for a month that had no apparent explanation and no other symptoms.3 , with 24 percent of those cells being eosinophilic granulocytes . Her eosinophils did not resolve the following therapy with allopurinol and methylprednisolone [She was diagnosed with pneumonia, four days earlier, at the Tianjin Children's Hospital. After being admitted, the patient received anti-infection, and anti-virus treatments. The white blood cell (WBC) count from the peripheral blood analysis was 43,900/mm3 with an absolute eosinophil count of 12,590/mm3(27.6% eosinophils). Tachycardia was seen on the electrocardiogram (ECG), and RV5 = RV6 and some leads had a notched P wave. And An 8.2 × 4.9 cm space-occupying lesion in the LA, which occupied around 80% of the LA, was detected by echocardiography  and the WBC count was 18,820/mm3 . The pathologic diagnosis was rhabdomyosarcoma. Four weeks following the surgery, he had a cutaneous metastasis to the right temple and metastatic involvement of the retroperitoneum.There are several different causes of hypereosinophilia, which are often categorized into four broad groups: familial, secondary (reactive), primary, and idiopathic –9. It haWei et al. reported two patients, who were diagnosed with a renal tumor, had persistent eosinophilia of pre-operation and normal eosinophilic granulocytes following surgery . And a cThere are a variety of mechanisms of eosinophils to promote the development of tumors : (1)ImmuIn conclusion, Cardiac malignancy in children is extremely rare, and the symptoms may not be immediately apparent, but we should nevertheless be aware of them, especially when they are coupled with persistent eosinophilia and echocardiogram indicates space-occupying lesions. Additionally, this study gives clinicians a wide range of options for analyzing the connections between malignancy and hypereosinophilia.


Cases Description. A 5-year-old boy has been admitted with a rake embedded in his head. That occurred during a violent play with a neighbor. At presentation, the child was alert; there was no neurological deficit. The rake was embedded in the parietal regions on each side of the midline. The head Computed Tomography (CT) scan performed showed a biparietal hyperdensity from either side of the midline with a metal artifact. In the operating room, after a transversal incision joining the 2 tips of the object, we performed successively bone flaps; object extraction; debridement; duraplasty; and closing. The outcome was uneventful.  A penetrating head injury (PHI) refers to a situation where a projectile has breached the cranium but does not exit it. It constitutes about 0.4% of all head injuries. Several nonmissile materials inserting the skull have been reported. But to our knowledge, never before has any case of PHI caused by a hit of rake been reported. We report a first case of PHI caused by a rake in a child; then, we relate our experience with its management and discuss the relevant literature.  This is the first case of PHI by a rake. The surgical management constitutes the main challenging point. Based on the mechanism, head injuries are classified into nonpenetrating or penetrating types . The latHead CT scan constitutes the imaging of choice for evaluating any penetrating cerebral trauma , 12. It So far, the initial management of patients with PHI remains so diverse , certainIn this article, we report a case of PHI caused by a hit of rake in a 5-year-old boy treated in the neurosurgical department of the National Hospital of Niamey. Through this report, we aimed to relate our experience with the management of this kind of PHI and discuss the relevant literature about it.A 5-year-old boy was admitted with a rake embedded in the head . That ocIn the operating room, under general anesthesia with a cuffed endotracheal tube in situ and a strict and sterile condition, we performed a transversal incision joining the 2 penetrating tips of the rake and extended it exteriorly. Then, we proceeded with subcutaneous dissection with parietal bones exposition. A bone flap was performed followed by a bony filing at the base of the 2 tips . And thePostoperatively, antibiotics  were continued for 14 days. No postoperative complications such as seizure, neurological deficit, visual disturbance, and epistaxis leakage were noted. Wound stitches were removed on day 10, and he was discharged home. Seen successively 1 and 3 months later, he was still in good condition.PHIs account for a rare condition with an incidence reported to be 0.4% of all brain injuries . Among tIn some reported case series, most patients with nonmissile PHIs have a good clinical condition with clear consciousness state at admission , 9. But Initial examination includes a plain skull X-ray which can show the penetrating object, the existence of skull fractures, and the advantage of being free of metallic artifacts , 14. TheBecause of a number of factors such as the object type and its entry site and trajectory through the skull, patient characteristics, and brain injury mechanism , 14, a sThe initial admission Glasgow Coma Scale(GCS) score, pupil size, and initial CT scan findings , 20 condPediatric nonmissile PHIs are rarer compared to adults and furthermore, this case due to a rake is very unusual and constitutes the first reported in the literature to our knowledge. Regarding the surgical technique, by filing the bone at the base of the 2 penetrating tips of the rake before removing these, we ensure ourselves to avoid any undesirable movement which could trigger more secondary intracranial damages. We think that surgical technique could help in the future if a similar case occurs.


Double inferior vena cava (DIVC) is rare and usually detected incidentally. DIVC may be associated with several anatomical variants of the retroperitoneal and pelvic veins. These variants can pose a clinical problem during colorectal surgery. We present two patients with lower rectal cancer who also had a DIVC.Case 1 was a 72-year-old man with advanced lower rectal cancer (T3N0M0) who underwent robot-assisted low anterior resection after neoadjuvant therapy. A DIVC was detected on preoperative computed tomography (CT). During the operation, a presacral vein was injured while mobilizing the rectum and hemostasis could not be achieved. We converted to open surgery and packed the pelvic cavity for hemostasis. Retrospective analysis suggested the injured vein arose from an interiliac vein of the presacral pelvic venous plexus. Case 2 was a 50-year-old woman with lower rectal cancer (T3N0M0), immune thrombocytopenic purpura, and a DIVC. Although preoperative three-dimensional CT angiography showed no obvious pelvic vein abnormalities, a short course of preoperative radiotherapy was delivered to avoid lateral pelvic lymph node dissection. Chemotherapy was deferred owing to her thrombocytopenic disease. Laparoscopic abdominoperineal resection was performed meticulously to minimize bleeding and achieve rapid hemostasis. No intraoperative complications occurred.DIVC is often accompanied by venous malformations that may pose a problem when mobilizing the mesorectum from the retroperitoneum. Preoperative assessment of pelvic vessel anatomy using three-dimensional CT is essential in patients with a DIVC who undergo rectal surgery. Congenital malformations of the inferior vena cava (IVC) are rare. Double IVC (DIVC) is a type of malformation which is usually found incidentally in healthy individuals during diagnostic imaging for unrelated disease –3. ReporA 72-year-old man with advanced lower rectal cancer was referred to our department. Digital rectal examination revealed a tumor located in the anterior wall approximately 5 cm from the anal verge. Colonoscopy showed a type 2 tumor. Biopsy findings were consistent with well differentiated adenocarcinoma. CT showed several swollen lymph nodes in the mesorectum; no significant lateral pelvic lymph nodes were visualized. We also appreciated a DIVC but did not recognize any other anatomical abnormalities Fig. . ComplemIn retrospect, the patient had a connecting vein between the left and right internal iliac veins which coursed anterior to the sacrum and formed a distended venous network. Also, venous anomaly was also seen in this case as follows; left IVC originated from the confluence of the left common iliac vein and a branch of the right internal iliac vein. Right IVC was mainly connected to the right external iliac vein, partially jointed to right internal vein Fig. . This wa4/µL. On colonoscopic examination, her rectal cancer was located mainly in the lower rectum proximal to the dentate line. CT and MRI showed a DIVC and no enlarged lymph nodes or distant metastasis. Positron emission tomography/CT demonstrated no significant fluorodeoxyglucose accumulation outside of the primary tumor. Stage II lower rectal cancer (cT3N0M0) was diagnosed. Because of the DIVC, 3D CT angiography was performed for more detailed assessment ; therefore, the rectum was mobilized from the sacrum, pelvic splanchnic nerve, uterus, and vagina. After completing total mesorectal excision, the colon was transected intracorporeally using a laparoscopic stapler and the rectum was resected from the perineal side. The surgery was completed without complications. Duration of surgery was 270 min. Blood loss was minimal. The patient was discharged uneventfully.DIVC is one of the most well-described IVC abnormalities. Most cases are detected incidentally because it rarely causes symptoms , 7. DIVCSeveral studies have classified the complex anomalies that may occur during IVC development , 10, 11.DIVC can pose a clinical problem in retroperitoneal and pelvic surgeries. Mao et al. reported a case of iatrogenic DIVC injury during radical nephroureterectomy and cystectomy in a patient in whom it was misdiagnosed . When IVAnterior resection of upper rectal cancer in patients with a DIVC has been previously reported , 16; howIn case 1, although DIVC was identified before surgery, we were not aware of the various risks that this anomaly poses. Difficulty in recognizing and mobilizing tissue layers owing to preoperative CRT might also have served as a risk factor. However, in case 2, detailed preoperative imaging was performed . As a result, we avoided serious complications related to the DIVC and pelvic venous abnormalities. To avoid these serious complications, DIVC and any associated anatomical abnormalities must be recognized before surgery to enable careful surgical planning.Patients with DIVC frequently also have other venous malformations that may become a problem when mobilizing the mesorectum from the retroperitoneum. In rectal cancer patients with a DIVC, preoperative assessment of pelvic vessel anatomy using 3D CT angiography is essential. Tumor stage guides the selection of appropriate neoadjuvant therapy and surgical procedure. Meticulous technique and surgical manipulation will contribute to safe performance of the operation, regardless of the surgical approach.


A 25-year-old primigravida presented at 26 weeks of gestation by dates, the first time for the routine antenatal checkup. No histories were suggestive of pregnancy-induced hypertension (PIH) and edema. On physical examination, pallor was present with microcytic hypochromic anemia. Raised beta-human chorionic gonadotropin (HCG) and alpha-fetoprotein (AFP) levels were present. Ultrasonography revealed triples with two thin echogenic intertwining membranes. Anomaly scan did not reveal any abnormality in fetuses. The placenta showed a large oval hypoechoic mass arising from its edge and bulge into the amniotic fluid. A central feeding vessel with a branching pattern and pulsatile color flow like that of the umbilical artery is noted on the color Doppler. She was spontaneously preterm delivered vaginally at 28 weeks of gestation. All three fetuses were stillborn. Histopathological diagnosis of angiomatous chorioangioma was confirmed. This case classically represents a grave complication of the large chorioangioma.  A placental chorioangioma is a benign vascular tumor of placental origin. It is the most common tumor of the placenta, with an estimated incidence of 0.6% of all pregnancies . The risA 25-year-old primigravida presented at 26 weeks of gestation for the first time for a routine antenatal checkup. No histories were suggestive of pregnancy-induced hypertension or edema. Her vitals were within normal range . Except for pallor, the rest of the physical examination was unremarkable. The patient’s height was 156 cm, and her weight was 58 kg. Her hemoglobin (Hb) was 8.0 g/dL with a peripheral smear suggestive of microcytic hypochromic anemia. Her serum β-human chorionic gonadotropin (HCG) and alpha-fetoprotein (AFP) levels were elevated . A urine examination for albumin and glucose was negative. HIV and venereal disease research laboratory (VDRL) tests for syphilis were negative. The patient was then referred to the Department of Radiology for a routine antenatal ultrasound.All ultrasound examinations were performed using a color Doppler duplex ultrasound system equipped with a 3.75-15 MHz transducer. Ultrasonography revealed triples (three fetuses) with USG parametric measurements, as illustrated in Table The fetal fundic bubble, kidneys, bladder, four-chamber view of the heart, spine, and cranial sonography of all fetuses were normal. There was no pleural effusion or ascites in any of the fetuses. Three vessels of the umbilical cord were present. Polyhydramnios was present in all three fetuses. Two thin echogenic intertwining membranes were present between the fetuses. There were three placentas, and a well-defined oval hypoechoic mass measuring 10.3 × 5.8 cm was seen at the edge of the placenta, causing a lobulated bulge into the amniotic fluid. On application of the color Doppler imaging, a central feeding vessel with a branching pattern was seen, and on the pulsed Doppler, it showed a pulsatile flow similar to that of the umbilical artery.The diagnosis of chorioangioma in the triplets was postulated based on the ultrasonographic and color Doppler findings Figures , 2. The A placental chorioangioma is a benign vascular tumor of placental origin and is the most common tumor of the placenta. It was first described by Clarke in 1798 . The estThere are three histological patterns of chorioangiomas: angiomatous, cellular, and degenerative . AngiomaIn most cases, chorioangiomas are asymptomatic and are diagnosed as incidental. However, poor outcomes for both the fetus and the mother are seen with multiple and large chorioangiomas. Complications for the fetus include developing high cardiac output failure and hydrops fetalis due to arterio-venous shunting , and fetChorioangiomas occur near the insertion site of the umbilical cord and protrude into the amniotic cavity. On grayscale ultrasonography, chorioangiomas are rounded hypoechoic masses seen near the chorionic plate or at the insertion site of the umbilical cord. Anechoic cystic areas may be seen within. Heterogeneous areas within it represent degenerative changes and internal hemorrhage. A pedunculated appearance is rarely seen. Pulsatile color flow within the anechoic cystic area on color Doppler images represents enlarged vascular channels. Spontaneous infarction is sometimes noted in large chorioangiomas as decreased tumor volume, decreased echogenicity, and decreased blood flow on color Doppler images . On T1-wChorioangiomas should be differentiated from partial hydatidiform moles, degenerated uterine fibroids, placental teratomas, and blood clots on USG and color Doppler images, as illustrated in Table Small chorioangiomas are often monitored with ultrasound every six to eight weeks, whereas large chorioangiomas require weekly USG examinations. Chorioangiomas may regress spontaneously during pregnancy. However, complicated chorioangiomas appearing before fetal viability require intervention. Various techniques, such as serial fetal transfusions and fetoscopy laser coagulation of vessels supplying the tumor, may be effective ,10. In oA placental chorioangioma is the most common benign vascular tumor of placental origin. The risk is increased after multiple pregnancies and in female babies. Antenatal diagnosis is achieved by ultrasound, and Doppler is the investigation method of choice for diagnosing chorioangiomas and ruling out other causes of placental masses. Large chorioangiomas are associated with high perinatal morbidity and mortality as well as poor prognoses, which warrants institutional and timely delivery. This case with classical ultrasound findings will raise awareness in the reader about rare entity.


Abdominal cystic lymphangiomas are a rare pathology of childhood. They are lymphatic malformations that develop in the retroperitoneum or mesenteric spaceWe report the case of a 17-year-old patient with no medical history referred for abdominal pain and fever. Biologically, we only found inflammatory syndrome. The abdominal computed tomography (CT) scan showed a collection under the stomach and above the pancreatic tail. There was a fatty infiltration suggesting inflammatory involvement. Magnetic resonance imaging of the abdomen revealed a lesion measuring 64 × 39 mm of retro-gastric topography. This lesion presented regular sharp contours. There was intense and homogeneous contrast of the shell, with a heterogeneous upper portion that appeared almost adherent to the gastric wall . We perVideo 1 Endoscopic ultrasound confirming the diagnosis of cystic lymphangioma with argument for infection leading to its surgical resection.Most symptomatic cystic lymphangiomas are revealed by abdominal pain, but no case of infection has ever been described. EUS, in addition to other imaging techniques, allows the diagnosis, especially if the latter are insufficient for diagnosis. Surgical treatment remains the reference for this type of condition.Endoscopy_UCTN_Code_CCL_1AB_2AG_3AC


Local resection is the standard treatment for gastrointestinal stromal tumors (GISTs). Laparoscopic and endoscopic cooperative surgery (LECS) is a minimally invasive surgery used to resect GISTs. Herein, we report an extremely rare case of a gastric GIST that grossly vanished during LECS.A 50-year-old Japanese female was referred to our hospital after an abnormality was detected during an esophagogastroduodenoscopy (EGD) at her annual health checkup. Based on EGD, endoscopic ultrasound (EUS), and computer tomography (CT) findings, the patient was diagnosed with a 50-mm submucosal tumor (SMT) with intraluminal growth on the anterior wall of the lesser curvature of the upper body of the stomach. We routinely use LECS to treat the intraluminal growth type of GISTs. During the intraoperative endoscopy, the intraluminal submucosal tumor, which was detected preoperatively, had vanished. A red-white scar was observed in the regressed tumor region. LECS was performed by resecting at a distance away from the scar tissue and closing the gastric wall with intracavitary sutures. In the evaluation from the tumor section view of the original resected specimen, a 22 × 14 × 8 mm lobular neoplasm was observed that was predominantly located in the gastric submucosa to the muscularis propia. Pathological findings confirmed the diagnosis of GIST with intermediate risk indicated by the Fletcher classification. The patient continued postoperative adjuvant chemotherapy with imatinib and no recurrence was detected over 12 months after surgery.LECS was performed on the vanished gastric GIST, providing the best surgical treatment and leading to an accurate diagnosis and optimal postoperative care. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, yet they account for only 1–3% of all gastrointestinal tumors . LECS, aA 50-year-old Japanese female with a past medical history of chronic obstructive pulmonary disease and bronchial asthma was referred to our hospital following the detection of an abnormality on esophagogastroduodenoscopy (EGD) at her annual health checkup. EGD revealed a submucosal tumor of over 50 mm with central ulceration on the anterior wall of the lesser curvature of the upper body of the stomach Fig. . EndoscoLECS were performed. Under general anesthesia, 5 trocars were inserted, including a 12-mm umbilical trocar, a 12-mm trocar at the left subcostal, and 3 5-mm ports inserted to form a shallow trapezoidal shape. During the intraoperative endoscopy, the previously detected intraluminal growth submucosal tumor was no longer visible. A red and white scar was observed in the regressed tumor region Fig. . BecauseNo previous reports described spontaneously vanishing GISTs, and this was an extremely rare case. The tumor, which grossly disappeared intraoperatively, was resected without excess or deficiency by LECS, leading to an accurate diagnosis and optimal postoperative treatment.The terms spontaneous remission and spontaneous regression (SR) exist in the field of oncology . SR of aEndoscopy, EUS, and CT are commonly used to diagnose GISTs . In our The objective of surgery for localized GISTs is to achieve R0 resection to the greatest extent possible. Lymph node dissection is not recommended, except when lymph node metastasis is clinically suspected. Therefore, wedge or segmental resection with preservation of organ function to maintain quality of life is recommended . PreviouLECS is the standard surgical procedure for GIST treatment because it is minimally invasive and adequate resection can be achieved , 10, 11.The presumed causes of tumor morphology changes, as in the present case, include hemorrhage, infection, necrosis, penetration, and perforation. Several reports described such conditions in patients with GISTs, but all of these conditions caused acute abdominal symptoms requiring emergency treatment, 14. FurSurprisingly, no obvious mass could be observed during the intraoperative endoscopy. The surgical team had to make a very difficult decision as to whether to resect or to stop the surgery and follow up. The decision about what area to resect was also challenging. Considering the possibility of a tumor remnant, the decision was reached to resect the tumor scar. Although no previous reports describe the extent of resection, we performed full-thickness resection with a margin of 2–3 cm from the probable tumor scar by LECS. As a result, the histopathological diagnosis of GIST was confirmed, the resection margin distance was not excessive, and the best surgical treatment was provided. Even after attentive observation of the resected specimen, it was incapable of noting the presence of the tumor from the mucosal surface grossly, and a 22 mm mass was identified histologically in the gastric submucosa to the muscularis propia. A retrospective review suggested that the tumor could not have been identified by conventional endoscopy at the time the LECS was performed, although its presence could have been confirmed by EUS. Additionally, the EUS findings would have been very useful in deciding to resect and determining the extent of the resection. Performing EUS routinely during LECS is not practical due to the need for special equipment and scopes. Nonetheless, in situations similar to this case during LECS, EUS can be a valuable strategy.We experienced a very rare case of a vanished gastric GIST. LECS enabled the best surgical treatment, leading to an accurate diagnosis and optimal postoperative care.


Although pleomorphic adenoma is the most common type of parotid gland tumor, its occurrence in the trachea is rare. Here, we describe a successfully resected pleomorphic adenoma of the trachea in a woman with severe respiratory failure that had been preoperatively misdiagnosed as asthma.A 69-year-old woman presented to the emergency department with symptoms of worsening dyspnea and subsequent loss of consciousness. She had a history of progressively worsening wheezing and stridor over the course of 2-years and had been diagnosed with asthma. Arterial blood gas sample analysis indicated type II respiratory failure. A chest computed tomographic scan revealed a tumor in the trachea, which was almost completely obstructing the lower tracheal lumen. The tumor was located just above the carina. To alleviate airway constriction and achieve complete resection, carinal resection with reconstruction was performed. The postoperative diagnosis was pleomorphic adenoma of the trachea.Pleomorphic adenoma is a rare tracheal tumor that may present with obstructive airway symptoms that mimic asthma.Tracheal tumors should be considered in patients with chronic respiratory symptoms that do not improve with medication. •We describe a successfully resected case of the pleomorphic adenoma of the trachea in a woman with severe respiratory failure.•Tracheal tumors should be considered when encountering a patient who has chronic respiratory symptoms that do not improve by medication. The patient was immediately intubated with a single-lumen endotracheal tube, but arterial carbon dioxide levels remained elevated . Chest roentgenography indicated a round mass shadow at the lower tracheal level above the carina (A 69-year-old woman presented to the emergency department due to worsening dyspnea and subsequent loss of consciousness. She had a 2-year history of progressively worsening wheezing and stridor, and had been diagnosed with asthma. However, treatment with bronchodilators and steroid inhalers failed to resolve the symptoms. An arterial blood gas sample on 15 L/min of oxygen demonstrated type II respiratory failure (pH 6.87, PaOe carina . An emere carina  scan reve carina A-B. Brone carina .Fig. 1ChBecause complete excision of the tracheal tumor was considered possible, surgery was performed for complete excision of the tumor to relieve airway constriction. The patient was initially placed in a supine position, and venovenous  extracorThere were no postoperative complications, and the patient was discharged 11 days later. Postoperative CT performed 2 months after surgery demonstrated no evidence of stenosis at the site of the anastomosis .Fig. 5PoMacroscopic findings showed a 15 mm-sized, well-demarcated heterogeneous tumor A. Histol3Primary tumors of the trachea correspond to 0.2 % of all airway neoplasms, affecting 0.1/100,000 individuals per year ,4. In adPleomorphic adenomas are benign neoplasms characterized by mixed epithelial and mesenchymal components . The epiTracheal tumors have nonspecific clinical manifestations. The most common symptoms of benign tracheal tumors are dyspnea, cough, hemoptysis, wheezing, and stridor . Except The biological behavior and clinical course of pleomorphic tracheal adenomas have yet to be fully described. Complete excision of the tumor with sufficient margins is the definitive treatment for pleomorphic adenocarcinoma of the salivary gland because inadequate surgical procedures are associated with the risk of recurrence . In addiOne case of pleomorphic adenoma of the trachea recurred 10 years after surgical resection . Metasta4Pleomorphic adenomas are rare tracheal tumors that may present with obstructive airway symptoms mimicking asthma. Tracheal tumors should be suspected in patients with chronic respiratory symptoms that do not improve with medication. Although complete resection may be the best treatment for pleomorphic adenoma of the trachea, careful follow-up of the postoperative course is important because distant metastasis to other organs has been reported on rare occasions.CTComputed tomographyVVVeno-venousECMOextracorporeal membrane oxygenationAs it is a case report, ethical approval is exempted by University of Miyazaki Hospital.The authors have no competing interests to declare.Dr. Mayu Inomata is the main author and she has designed this report.Nobuyuki Oguri and Yuichiro Sato have provided us with the histological diagnosis and photos of the slides, and have reviewed.Shoei Kuroki and Fumiya Kawano have reviewed.Dr. Ryo Maeda is the writer of this article and corresponding author.Dr. Ryo Maeda accepts all responsibility of this article.Not applicable.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.All author declare that they have no conflicts of interest.


Inferior vena cava leiomyosarcoma is a rare malignant mesenchymal tumor that originates from the smooth muscle cells of the venous media and is more frequent in females in the V-VI decade of life. Due to scarce and specific symptoms, diagnosis is not simple, and often metastases to the liver, lungs, and/or lymph nodes are already present. A 44-year-old male patient arrives at our institution presenting diffuse abdominal pain and a sense of weight associated with lumbar pain. He showed nothing relevant except for a moderate consumption of alcohol. Ultrasound examination of the abdomen revealed liver enlargement with hyperechoic nodularity and clear margins. Furthermore, the presence of a voluminous solid nodular formation was found, with an inhomogeneous echostructure and moderate vascularization on Doppler. Inferior vena cava leiomyosarcoma is a rare malignancy. The diagnosis is usually established after surgery, however, recurrences are common and the role of chemoradiation therapy remains to be defined. The only potential treatment is surgical resection with possible vessel reconstruction and en bloc removal of adjacent structures with 5 and 10-year survival rates of 49% and 29%, respectively. Leiomyosarcoma of the inferior vena cava (VCI) is a very rare mesenchymal tumor associated with an extremely poor prognosis. It accounts for less than 1 in 100,000 of all malignancies and about 0.5% of adult soft tissue sarcomas. Fewer than 450 cases are reported in the literature These lesions are classified according to the segment involved: inferior , medium , and superior  We present the case of a leiomyosarcoma of the VCI found in a 44-year-old male patient who came to our observation to perform an abdominal ultrasound following repeated widespread abdominal pain and a sense of weight associated with lumbar pain; in his anamnesis, he does not show anything relevant except for a discreet consumption of beer. On ultrasound examination, despite marked intestinal meteorism, it was possible to detect: an increase in the volume of the liver with a nodularity of 3 cm at the border between VI and VII segment, hyperechoic in structure and with clear margins, compatible with an angioma; beyond a substantial negativity of the remaining abdominal organs we found in the subhepatic area, a conspiucous solid nodular formation, of an expansive nature, whose maximum dimensions were 14 × 11.6 cm and which appeared echostructurally inhomogeneous with an iso-hypo-hyperechoic appearance and a discrete vascularization on color Doppler . This fiDuring hospitalization the patient underwent 2 transfusions; empiric antibiotic therapy + urine-blood culture and a chest X-ray for the onset of fever; and anticoagulant therapy; Abdominal CT with and without administration of contrast medium, the latter showed the presence of a fluid-superfluid collection with predominantly blood density at the level of the IVC  with a cranio-caudal extension of 13.4 cm of which we have no images. The patient was discharged with anticoagulant therapy performed with Fondaparinux for 6 months and an abdominal CT with and without administration of contrast medium was prescribed to be performed at our hospital. The latter showed a clear reduction of the postsurgical hematoma along the anterior surface of the IVC, however the aforementioned collection has an extension of 9 cm that goes from the iliac bifurcation (where the IVC assumes a threadlike appearance) up to the confluence of the veins upstream of which the cava configuration is normal . FinallyThe leiomyosarcoma of the VCI is a rare mesenchymal tumor that originates from the smooth muscle cells of the venous media, represents 2% of all leiomyosarcomas, it is more frequent in females in the V-VI decade of life and at the time of diagnosis in 35%-50% of cases there are metastases to the liver, lung and/or lymph nodes; it can affect the lower, middle (as in the case described) or upper venous tract and, based on growth, can be extraluminal (as in the case described), intraluminal or combined. It is often asymptomatic as it has slow growth or may present nonspecific symptoms such as pain, Budd-Chiari syndrome if infrarenal, nephrotic syndrome if of the middle segment, and lower limb edema if of the lower tract, intraluminal and middle segment have a better prognosis for early diagnosis. Ultrasound is often the first-level examination, but derived findings are usually nonspecific since the echo structural heterogeneity can also evoke masses of a different nature such as retroperitoneal sarcomas; moreover, since these are often voluminous masses, it is difficult to topographically locate the form in a precise manner. More particularly in ultrasound, the tumor is heterogeneously hypoechoic; color Doppler may show absent or abnormal IVC flow when an intraluminal form is detected, however, discrete intratumoral vascularization may also be present. When the tumor is exclusively extraluminal, its solid components are generally isoechoic with respect to the liver and may contain internal cystic spaces With this item we state that informed consent was acquired from our patient for inclusion in the associated study.


Mammary-type myofibroblastoma (MTMF) is an unusual and rare benign tumor that typically presents in older men or post-menopausal females. A 53-year-old female presented with a 6-month history of an asymptomatic pink/white submucosal nodule involving the left lateral tongue. Clinical examination showed a 5 mm × 5 mm × 5 mm firm submucosal nodule with intact overlying mucosa. Differential diagnoses focused on benign nodular connective tissue tumors. An excisional biopsy was performed and submitted for histopathological examination. The patient underwent conservative local excision. Histopathology and immunocytochemistry revealed a lipomatous variant of MTMF. Hematoxylin and eosin sections revealed an unencapsulated soft tissue lesion with a lobular growth pattern. The neoplasm was biphasic, comprising adipose tissue and cellular fibrous components. By immunohistochemistry, tumor cells were positive for desmin, estrogen receptor, and CD34. In summary, we presented an unusual case of a lipomatous variant of myofibroblastoma on the tongue. MTMF rarely occurs in the head and neck and its accurate diagnosis necessitates awareness of its histomorphological spectrum and application of appropriate immunohistochemical stains. Mammary-type myofibroblastoma (MTMF) is an unusual benign mesenchymal tumor first described by Wargotz et al. in 1987 as a benign neoplasm of the breast contained in a pseudocapsule composed of spindle cells and abundant collagen , 3. HowiA 53-year-old woman was evaluated for an asymptomatic 5 mm × 5 mm × 5 mm pink/white submucosal nodule involving the left lateral border of the tongue. The overlying mucosa was intact. The lesion had first been noticed by the patient six months before consulting her dentist, who referred her to our clinic for further evaluation.The patient's past medical history was only remarkable for hypothyroidism and gastroesophageal reflux disease. Her current medications were Synthroid and occasional pantoprazole. She denied any allergy or history of smoking and consumed alcohol socially (2–3 glasses of wine/week). Her family history was unremarkable. Concerning her tongue lesion, she denied any history of trauma or parafunctional habits, such as grinding or clenching, nor did she notice any other similar lesions at other body sites. There was also no history of gastrointestinal or dermatological issues. Clinical examination of the tongue lesion showed a 5 mm × 5 mm × 5 mm firm submucosal nodule with intact overlying mucosa . Based oBased on the clinical presentation and stability of the lesion, differential diagnoses focused on benign nodular connective tissue tumors that are more frequently known to affect the tongue. These include fibroma, neurofibroma, hemangioma, schwannoma, granular cell tumor (GCT), leiomyoma, rhabdomyoma, and lipoma. A possible submucosal mucocele was also considered. Nevertheless, a malignant process could not be entirely excluded.Irritation fibroma and giant cell fibroma were most suspected initially. Irritation fibroma, reactive proliferation of submucosal fibrous tissue, is the most common soft tissue lesion of the oral cavity. It presents as a smooth-surfaced pink nodule similar in colour to the adjacent mucosa, but can often become superficially ulcerated due to localized trauma or chronic irritation . Most fiGiant cell fibroma presents as an asymptomatic sessile or pedunculated nodule, typically less than 1 cm in diameter. Compared with irritation fibroma, giant cell fibroma typically occurs at a younger age. Furthermore, around 55% of cases occur on the gingiva, with the mandibular gingiva affected twice as often as the maxillary gingiva , 14. TheIn the same category of nodular mesenchymal lesions, lipoma is the most common benign neoplasm. However, lipoma of the tongue represents only 0.3% of tongue tumors . ClinicaConsidering the presentation as a submucosal swelling, the diagnosis of a mucocele was also reflected in the differential diagnosis. Mucocele is a common lesion of the oral mucosa that results from the rupture of a salivary gland duct and spillage of mucin into the surrounding soft tissues, most often following trauma. Clinically, a mucocele presents as a dome-shaped mucosal swelling ranging from 1 to 2 mm to several centimetres in diameter, occurring primarily in children and young adults. The lesion itself is typically fluctuant but can be firm to palpation. The most commonly affected site is the lower lip, typically lateral to the midline although less commonly, mucoceles can be found in the floor of the mouth, anterior ventral tongue, buccal mucosa, and retromolar pad. Seeing as a mucocele must develop in the area of the oral cavity with minor salivary glands, whereas also considering the firm consistency of our lesion, the diagnosis of mucocele was eliminated from the differential diagnosis.A neurofibroma and a neurilemmoma  belong to the category of benign peripheral nerve sheath tumors and can present clinically as a submucosal nodule of the tongue. Neurofibroma is the most common type of peripheral nerve neoplasm and occurs as a reactive soft tissue enlargement of Schwann cells and perineural fibroblasts. It is typically solitary but can be present as numerous lesions in neurofibromatosis. Similarly, a schwannoma is a benign neural neoplasm of Schwann cell origin and typically occurs in association with a nerve trunk. Clinically, both neurofibroma and neurilemmoma present as soft, slow-growing, and asymptomatic masses of varying sizes, ranging in size from a few millimetres to centimetres in diameter. When located intraorally, both lesions are most commonly identified on the tongue, mainly the dorsal and ventral surfaces, and disproportionately affect young to middle-aged adults with a slight female predilection. Occasionally, both neurofibroma and schwannoma can occur centrally in the bone and produce bony expansion. In neurofibroma, this typically occurs in the area of the posterior mandible, whereas in the case of schwannoma, the tumor can occur almost anywhere in the oral cavity. In both instances, the central form of the tumor may produce a well-demarcated or poorly defined unilocular or multilocular radiolucency , 17.A traumatic neuroma is a benign reactive proliferation of nervous tissue occurring in response to injury to a nerve bundle. When repair is interrupted, the proximal area of the nerve supports the disorganized proliferation of Schwann cells leading to a tumor-like mass neuroma. Traumatic neuromas are classically smooth-surfaced, non-ulcerated, and sometimes painful nodules most commonly observed in the area of the mental foramen, tongue, and lower lip. A history of trauma can often be elicited or a recent history of invasive surgical procedures in the affected area. Traumatic neuromas can develop at any age but are most commonly diagnosed in middle-aged adults with a slight predilection for women.Considering the clinical presentation of our lesion, this category of lesions was considered the most likely diagnosis.Similar in origin to neurofibroma and neurilemmoma, GCT is a benign soft tissue neoplasm of Schwann cell origin with a predilection for the oral cavity, and more specifically the tongue. Clinically, GCT presents as a solitary, asymptomatic, sessile nodule of less than 2 cm in diameter that is covered by normal pink-coloured mucosa, although it may sometimes appear yellow. GCTs are most often identified in individuals in their fourth to sixth decade of life and the lesion holds a 2 : 1 predilection for females , 19. ThePyogenic granuloma (PG) is a vascular growth of granulation-like tissue that occurs as a response to local irritation or trauma. This lesion is typically smooth or lobulated, pedunculated, and asymptomatic, and the surface is characteristically ulcerated and ranges in colour  depending on the age of the lesion. The size varies from a few millimetres to several centimetres in diameter. Oral PG demonstrates a significant predilection for the maxillary gingiva; however, it can also exist on the lips, tongue, and buccal mucosa in rarer circumstances. In extra-gingival sites, a history of trauma can often be elucidated. PG is most common in children and young adults and has a predilection for females, especially in pregnant women. Our patient denied any history of trauma and our clinical examinations failed to show any erythema or bleeding from the lesion site. As a result, the diagnosis of PG was less probable.For comprehensiveness, other mesenchymal pathologies, such as hemangioma, leiomyoma, and rhabdomyoma, were also considered in our differential.Hemangioma occurs as a result of excessive proliferation of endothelial cells lining blood vessels and remains the most common benign tumor of infancy, occurring in 4–5% of 1-year-old children. Clinically, superficial hemangiomas are firm and rubbery to palpation, slightly raised, and bright red due to their blood content. These lesions are typically noted at birth and occur more frequently in whites and show a 3 : 1 female predilection .Leiomyoma is a benign neoplasm of smooth muscle and is extremely rare in the oral cavity. When intraoral, leiomyomas tend to localize on the tongue, lips, cheek, and palate. Extremely rarely, leiomyoma can present intraosseous as a unilocular radiolucency of the jaw. Clinically, this lesion presents as a solitary mucosal nodule of usually less than 2 cm in diameter, asymptomatic, slow-growing, firm, and rubbery on palpation .Rhabdomyoma is an exceptionally rare benign neoplasm of skeletal muscle. Clinically, rhabdomyoma presents most commonly as an asymptomatic, well-delineated, submucosal mass with normal overlying mucosa that can grow to several centimetres before its discovery. When observed intraorally, lesions are typically found in the floor of the mouth, soft palate, and base of the tongue. Rhabdomyoma is most commonly seen in middle to old-age individuals with a slight predilection for men.Although the clinical presentation of our case suggested benign pathology, ruling out a malignant process is critical. Of particular importance is squamous cell carcinoma (SCC), which constitutes more than 90% of oral malignancies. The development of SCC is related to both intrinsic and extrinsic factors and can often be preceded by a precancerous lesion, presenting in the form of leukoplakia or erythroplakia. SCC has varied clinical presentations, including exophytic or endophytic lesions, leukoplakia, erythroplakia, and erythroleukoplakia. An exophytic lesion typically has a surface that can be irregular, fungating, papillary, or verruciform with colour that varies from normal to white or red, dependent on the quantity of keratin and vascularity in the lesion. The surface is often ulcerated, and the tumor feels hard on palpation. SCC typically presents in older men who have been aware of the oral lesion for months before seeking professional help, mostly because the early growth phase of the lesion is asymptomatic. SCC was considered less likely in this case given our lesion presented submucosally and lacked epithelial changes. However, the possibility of metastasis or submucosal invasion from adjacent tissues could not be ruled out.None of the lesions discussed here as differential diagnoses cannot be ruled out clinically. Hence, an excisional biopsy specimen under local anaesthesia was taken and sent for histopathological examination.Macroscopically, the lesion consisted of a nodular fragment measuring 0.3 cm × 0.3 cm × 0.3 cm. Hematoxylin and eosin histological sections revealed an unencapsulated soft tissue lesion with a lobular growth pattern . The neoAdipocytes were uniform in size and shape and lacked nuclear pleomorphism . This liThese cells demonstrated slightly differing morphologies individually, with variable amounts of amphophilic cytoplasm and indistinct cell borders . Most tuBy immunohistochemistry, tumor cells of interest (within the fibrous component) were positive for desmin, estrogen receptor, and CD34 ; they were negative for cytokeratin AE1/AE3, SOX-10 (mast cells are immunoreactive), P63, smooth muscle actin, S100 (adipose tissue is immunoreactive), PR, MDM-2, ERG, and HHV-8 Figures , and 8.Together, the histological and immunohistochemical features were consistent with the diagnosis of a lipomatous variant of myofibroblastoma.Accurate diagnosis of MTMF as a benign condition is of extreme importance to prevent radical surgical intervention. There is no evidence of any significant recurrence risk for MTMF, even in the presence of positive resection margins , 22. TheIn summary, we presented an unusual case of a lipomatous variant of myofibroblastoma of the tongue, a benign soft tissue lesion. Myofibroblastoma rarely occurs in the head and neck and the accurate diagnosis of this benign lesion necessitates awareness of its histomorphological spectrum and application of appropriate immunohistochemical stains to confirm the diagnosis. We recommend the inclusion of MTMF in the clinical differential diagnosis of soft tissue tumors of the oral cavity.


Tonsillar synovial sarcoma is an extremely rare entity and only 9 adult patients have been reported up to now. Here, we describe the first pediatric tonsillar synovial sarcoma of the literature in a patient who presented with a 2-month history of dysphagia and snoring. Clinical and radiological examinations showed that the tumor arose from the right palatine tonsil and narrowed the parapharyngeal space. An incisional biopsy from the palatine tonsil revealed the diagnosis of synovial sarcoma. The patient has underwent total tonsillectomy and received radiotherapy and chemotherapy because of the positive surgical margins. The patient is clinically in good condition and free of tumor 30 months after the initial diagnosis. We achieved a long-term complete remission with a combination of surgery, radiotherapy and chemotherapy in our case. Tonsillar synovial sarcoma should be kept in mind while dealing with tonsillar masses. We can conclude that a multidisciplinary approach is warranted while treating synovial sarcoma with this localization. Synovial sarcoma (SS) is the most common soft tissue sarcoma after rhabdomyosarcoma in the pediatric population. The annual incidence rate is 0.5-07 /million in children and adolescents younger than 20 years of age ,2. SynovA 13-year-old boy presented with a 2-month history of dysphagia and snoring. His physical examination revealed an ulcerative, green colored mass in the right tonsil which narrowed the oropharynx. Contrast-enhanced magnetic resonance imaging (MRI) revealed a 50x47x45 mm solitary mass originating from the right lateral oropharynx, extending to the hypopharynx and narrowing the oropharyngeal lumen irregularly Figure 2The patient was staged according to IRS staging as clinical group 3 and chemotherapy was initiated with vincristine , ifosfamide , and doxorubicin  according to the treatment schema for the Pediatric Oncology Group trial 9553 . The tumSynovial sarcoma is often associated with joints such as knee, but it can also arise from pluripotential mesenchymal stromal cells anywhere in the body . HistoloPrimary SS of the tonsil is extremely rare and only nine cases have been reported in the English literature up to now  Table 1Table 1. More than 90% of all SS show a reciprocal translocation, t (X: 18) (p11:q11), with a resultant fusion gene of SYT and one of three SSX genes. It is considered a molecular hallmark for the diagnosis of SS in difficult cases . Three oComplete surgical excision with a wide margin is the mainstay of the treatment in SS. In cases with positive surgical margins, a high incidence of local recurrence (60%-90%) within 2 years has been reported . RadiothIt has been shown that a large tumor size (≥5 cm in diameter), presence of distant metastasis, gross residual disease, and omission of radiotherapy are all significantly associated with poor survival . Age is Head and neck localization of SS is rare and the treatment approach to tonsillar SS is based on case reports. There are nine case reports in the literature . All of Although there are limited data about tonsillar synovial sarcoma in the literature, it is obvious that total tumor excision is the most crucial part of the treatment. Neoadjuvant chemotherapy is recommended for all patients with SS with a head and neck localization who have tumors > 5 cm in size, extensive or recurrent disease, and high risk localization, such as the skull base or paraspinal area ,14,15,23In conclusion, a review of the literature shows that surgery could be sufficient for low risk and totally excisable tonsillar SS cases. However, we believe that high risk patients such as our case deserve multimodal therapy. The treatment approach should include a multidisciplinary team consisting of a head and neck surgeon, radiation oncologist and pediatric oncologist to ensure full recovery in these patients.This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.The authors declare no conflict of interest.


Female genital mutilation/cutting (FGM/C) is a major public health problem, particularly in developing countries.The authors reported a case of 48-year old multiparous woman presented to Kassala Hospital, east Sudan, with recurrent urine retention resulting from urethral obstruction, which was caused by large vulval inclusion cyst. A traditional birth attendant circumcised her when she was 5 year old. Five years before her presentation the patient observed a painless swelling in her vulva, which was gradually increasing in size. She presented to the hospital with urine retention seeking medical care. Local examination showed a large cystic swelling originating in the circumcision line and covering the introitus. A diagnosis of inclusion cyst at the site of circumcision was made. The cyst was large enough causing bladder outlet obstruction and when the patient advised to tilt it away from the urethral orifice she passed urine without difficulties. The cyst was surgically removed by dissection along the lines of cleavage, which measured 10 × 9.2 cm and weighed 1.2 kg.This case report indicates that FGM is a serious public health problem and there should an urgent intervention such as planned health education campaigns to end FGM practice. Female genital mutilation/cutting (FGM/C) is a major public health problem, particularly in developing countries . The praThe authors reported a case of 48-year old multiparous woman presented to Kassala Hospital, east Sudan, with recurrent urine retention resulting from urethral obstruction, which was caused by large vulval inclusion cyst. She had obstetric history of spontaneous home vaginal deliveries, the last one seven year back. A traditional birth attendant circumcised her when she was 5 year old. De-infibulation, re-infibulation and episiotomy were performed after each delivery. Five years before her presentation our patient observed a painless swelling in her vulva, which was gradually increasing in size. She neglected it since a relative midwife had re assured her. The swelling enlarged to extent that made the sexual intercourse very difficult. In the last month prior to her presentation, she suffered urine retention three times for which the nearby health care provider relieved her symptom by temporary catheterization of her urinary bladder without further investigation and treatment. She presented to the hospital with the fourth time of urine retention seeking medical care and asking for the cause. Local examination showed a large cystic swelling originating in the circumcision line and covering the introitus Fig. . A diagnRamart reported BOO in 50 years old woman presented with a huge introitus mass [Dirie and Lindmark reported urinary retention, urinary tract infection, and urinary problems as immediate urological complications resulting from FGM [Dirie and Lindmark explained the urological symptoms in FGM patients ‘’ urine retention occurred because the meatus usually is covered by the infundibulum, causing the vaginal discharge to accumulate and favor the growth of bacteria. In this case, the patient’s midwife just have re- assured her, thus, it is important that health professionals should be aware of the complications of FGM and recognize its seriousness.Female genital mutilation is a common procedure in developing countries that causes early and late complications. This case indicates the seriousness of FGM and it is severe enough to cause urine retention. In women, this condition, bladder outlet obstruction (BOO), remains a poorly understood condition and is much rarer in comparison with male. This cyst enlarged until it created re angulation of the urethra in the urinary bladder and thus a blockage at its base. In consistent with our report, tus mass . Urethratus mass , 9. Thertus mass . Female tus mass . Immediatus mass . In Sudatus mass . Dirie afrom FGM . Urine rThis case report indicates that FGM is a serious public health problem and there should an urgent intervention such as planned health education campaigns to end FGM practice.


This case report highlights the exceptional rarity of appendix duplication in adults, a condition that closely mimics appendiceal tumors, posing diagnostic challenges. The novelty of this case lies in its presentation of a Type A duplication, emphasizing the diagnostic intricacies involved in distinguishing it from other pathologies.We present the case of a 69-year-old male with a history of hypertension, hyperuricemia, and duodenal gastric ulcer, who presented with a positive occult blood test. Lower gastrointestinal endoscopy revealed an appendiceal orifice with atypical hyperemia and edema. Subsequent imaging and biopsy results suggested an appendiceal tumor, prompting laparoscopic ileocecal resection. Intraoperative findings revealed an unremarkable appendix, but histopathological analysis unveiled appendiceal duplication, characterized by bifurcation into two lumens within a thick serosal wall. The patient was discharged without complications.This case underscores the importance of recognizing appendix duplication as a rare differential diagnosis for appendiceal tumors. Surgeons should remain vigilant, especially in cases of Type A duplication, where preoperative diagnosis remains challenging. Early identification can avert potential complications and missed congenital anomalies. Duplication within the digestive tract is exceedingly rare in adults, as more than 80% of cases manifest as acute abdominal distress or bowel obstruction before the age of two . Among tDiagnosing appendiceal tumors can be a challenging endeavor due to their clinical and anatomical characteristics. In pursuit of a definitive pathological diagnosis and to mitigate the potential for malignant progression, laparoscopic ileocecal resection emerges as a viable procedure.Within this report, we present a case detailing the duplication of the appendix, which presented a striking resemblance to an appendiceal tumor. The primary objective of this report is to heighten awareness regarding this congenital anomaly and to underscore the repercussions of overlooking a second appendix.A 69-year-old male sought medical attention following a positive occult blood test result. His medical history encompassed hypertension, hyperuricemia, and duodenum gastric ulcer, which had required partial gastric resection. The patient was also a former smoker with a history of daily alcohol consumption. Physical examination yielded no noteworthy findings. Initial laboratory results indicated a serum hemoglobin level of 13.5 g/dL, a serum carcinoembryonic antigen level of 3.3 ng/dL (reference range: 0–5.0 ng/mL), and a carbohydrate antigen 19–9 level of 11.9 ng/dL (reference range: 0–37 U/mL). Lower gastrointestinal endoscopy unveiled a protruding, hyperemic, and edematous appendiceal orifice Fig. . Given aIn this case report, we document an instance of appendix duplication that strikingly mimicked an appendiceal tumor. To the best of our knowledge, this represents a truly rare case of suspected appendiceal tumor associated with appendix duplication. The case holds instructive value for two significant reasons. First, appendix duplication can effectively mimic appendiceal tumors. Second, attaining a preoperative diagnosis is not always attainable through radiographic imaging or gross intraoperative observations.A.Characterized by a single cecum housing a normally localized appendix exhibiting partial duplication, which may manifest in varying degrees of incomplete duplication.B.Symmetrical placement on either side of the ileocecal valve.Localization along the taenia coli.Originating in the hepatic fixture.Originating in the splenic flexure.Comprises two complete appendices originating from a single cecum. Subdivisions within this category include:C.Encompasses two appendices, each emerging from its respective cecum.D.Refers to the horseshoe appendix, which constitutes a single appendix featuring two openings in the cecum.Duplication within the gastrointestinal tract is a relatively uncommon phenomenon, with appendix duplication itself being a rarity. Although its precise incidence remains challenging to ascertain, a comprehensive analysis of 50,000 appendiceal specimens yielded only two instances of duplication . DespiteType A and Type B2 duplications, which exhibit higher incidence rates (18% and 37% amongst reported cases), are typically diagnosed incidentally or when an otherwise normal or anomalous appendix presents as acute abdominal pain, with the median age of symptom are 19 or 25 years, respectively . AlthougIn light of the suspicion of an appendiceal tumor, our patient underwent planned laparoscopic ileocecal resection. Conducting a diagnostic appendectomy followed by further resection based on pathology findings is a feasible approach. However, patients suspected of having appendiceal tumors often remain asymptomatic or exhibit nonspecific symptoms. Since appendiceal lesions typically present as submucosal tumors during endoscopy, colonoscopy rarely detects appendiceal abnormalities and seldom provides a diagnostic biopsy . RecogniIt is paramount for any surgeon performing appendectomy to possess a comprehensive understanding of the potential etiologies. Familiarity with anatomic variations and anomalies proves invaluable in ensuring the delivery of appropriate surgical treatment and facilitating discussions with colleagues and patients. In most reported cases, discovery occurs during surgery with a presumed diagnosis of acute appendicitis. The preoperative detection of appendiceal duplication remains challenging, particularly in cases mirroring Type A duplication, such as our own.This report highlights a case of appendix duplication that strikingly resembled an appendiceal tumor. Although exceedingly rare, the recognition of appendix duplication holds critical significance for surgeons. Failure to identify such anomalies may yield unexpected outcomes, including the oversight of a second appendix and associated congenital anomalies. Preoperative radiographic and ultrasonographic imaging, along with gross intraoperative findings, do not consistently yield a definitive diagnosis. Therefore, surgeons should remain vigilant regarding this anomaly to mitigate potential confusion with intra-abdominal structures.