Primary and metastatic malignancies arising in the sinuses are rare and histologically diverse. The role of fine-needle aspiration cytology (FNAC) and the cytomorphologic characteristics of these tumors have not been specifically addressed. We described two cases of suspected malignant maxillary sinus tumors in 85- and 90-year-old patients with comorbid conditions, both of whom underwent tissue biopsies that failed to yield a definitive diagnosis. We performed FNAC after imaging confirmed that the malignant tumors were outside the maxillary sinus. The 85- and 90-year-old patients were diagnosed with squamous cell carcinoma (SCC) and adenocarcinoma, respectively. In the latter, the cell block method was used to prepare the specimen, rendering individual cells identifiable. Atypia of the histological structure was confirmed without the influence of cell duplication, a known weakness of FNAC. Thus, the diagnosis was made quickly. We believe that FNAC would be utilized more frequently for the definitive diagnosis of sinonasal tumors as the technique and diagnostic technology improve further. Primary and metastatic malignancies originating in the sinonasal tract are rare and histologically diverse.Fine-needle aspiration cytology (FNAC) is accurate, cost-effective, and has quick turnaround times . HoweverHere, we report two cases of maxillary sinus malignancies in which a definitive diagnosis was obtained using FNAC after repeated tissue biopsies failed to yield definitive diagnoses. Tumors were localized using sinus computed tomography (CT) and magnetic resonance imaging (MRI).Case 1An 85-year-old male patient complained of right nasal discharge with an associated transient hemorrhage of three weeks’ duration. An endoscopic examination of the nasal cavity revealed a polypoid mass in the right nasal cavity. CT of the sinus cavity revealed a soft neoplastic shadow filling the right maxillary sinus, with bony destruction of the orbital floor, and infiltration into the orbit, including the inferior rectus muscle Figure . He had The patient was referred to the Department of Otorhinolaryngology at the Aichi Medical University for further examination. Nasal endoscopy revealed a polyp filling the right nasal cavity and a hemorrhagic mass behind the polyp, which was the tumor itself. MRI of the sinus cavity revealed a large mass within the right maxillary sinus protruding into the nasal cavity. The sagittal image demonstrated the presence of a tumor just posterior to the polyp. A tissue biopsy was performed again in the outpatient department.Before the biopsy, the nasal cavity was superficially anesthetized with gauze, and lidocaine HCI (1%) and epinephrine  were injected topically into the nasal cavity.Transnasal endoscopic tissue biopsy was performed on the lesion behind the polyp. However, the bulk of the mass could not be biopsied because of excessive bleeding. Histopathological examination revealed an endogenous papilloma with dysplasia, and no atypia, which was cancerous. We considered whether the papilloma had degenerated into a malignant tumor such as a squamous cell carcinoma (SCC).A tissue biopsy was performed under general anesthesia. However, because the patient was elderly and had comorbidities, general anesthesia was considered risky. Instead, we performed an FNAC in the outpatient setting. Upon reviewing the sinus MRI, a T2-weighted image showed a high-signal area in the nasal cavity consistent with a polyp. Posterior to that was a slightly low-signal area consistent with a papilloma. Additionally, a low-intensity area bordered by the right orbital floor to the middle nasal meatus was suggestive of a malignant tumor Figure , 1C. TheFor the FNAC procedure, the nasal surface was anesthetized by applying gauze with adrenaline and 4% lidocaine for 10 min. The patient was seated in an examination chair and the nostrils were dilated using a nasal speculum. FNAC was performed using a device improvised from a 21G catheter needle and an extension tube for infusion connected to a 20 cc syringe Figure . The neePositron emission tomography (PET) and CT revealed no local or distant metastases. The disease was classified as stage IVa T4aN0M0) [aN0M0 [4]Case 2A 90-year-old man with a history of prostate cancer, cataract, hypertension, and cholecystectomy visited the neurosurgery department with a month-long history of right upper strabismus and diplopia. He was referred to the otorhinolaryngology department because of a mass in the right maxillary sinus. A CT scan of the sinus showed a soft shadow located in the right maxillary sinus, infiltrating into the orbit and the outer maxillary sinus Figure , 5B. NasThe tissue biopsy showed only inflammatory changes; no neoplastic lesions were detected.For further examination, the patient visited the outpatient clinic of the Department of Otorhinolaryngology, Aichi Medical University three days later. Sinonasal MRI showed a high-signal, iso- to low-signal mass on T1-weighted images and a low-signal mass on T2-weighted images. The mass had extended into the right orbit; a slightly high-signal shadow in the right middle nasal passage suggested a secondary inflammatory tissue Figure . The masHe underwent a PET/CT scan, which revealed multiple deposits in the prostate and bone. These were considered metastases from his preexisting prostate cancer. He did not complain of pain or other symptoms apart from diplopia, was elderly, and did not want aggressive treatment. He opted for palliative care. The patient was satisfied with how the definitive diagnosis was promptly established.The sinonasal tract encompasses the paranasal sinuses  and the nasal cavities. The paranasal sinuses are in contact with the orbit and the cranium. Primary and metastatic malignancies arising in the paranasal sinuses are rare and histologically diverse. These account for 0.2-0.8% of all malignant neoplasms and 3% of the malignant neoplasms occurring in the head and neck . PrimaryFNAC is an accurate and cost-effective diagnostic method, with high diagnostic accuracy and a short turnaround time. However, because the sinuses are surrounded by bone, tissue biopsy is the mainstay of conventional biopsy. Here, we describe two cases of sinonasal malignancies that were diagnosed using FNAC after tissue biopsies failed to yield a definitive diagnosis. When tumors arise in the nasal sinuses, they often obstruct sinus drainage holes, resulting in secondary sinusitis and inflammatory polyps. Therefore, when a nasal sinus tumor is encountered, imaging  should be performed prior to biopsy. Images should be reviewed in three planes.Sinus CT determines the extent of local invasion into the lamina papyracea, orbital floor, and cribriform and pterygoid plates, and also whether the tumor protrudes outside the sinus cavity into the nasal cavity or skin side. Areas of bone destruction detected on sinus CT are likely to be malignant .Sinus MRI demonstrates invasion of the orbital contents, dura, brain, and cavernous sinuses. It differentiates between normal mucosal thickening and inflammatory tissues such as polyps, which show high signal intensity on T2-weighted images, and neoplastic lesions, which show lower signal intensity on T2-weighted images. In addition, the image pattern of papillomas shows a convoluted cerebriform pattern with alternating high and low signals. Malignant tumors show a heterogeneous internal pattern, making it possible to distinguish areas where benign tumors, such as papillomas, have transformed into malignant tumors . This alWhen a malignant tumor is suspected in the sinus cavity, it is important to image the site of the tumor three-dimensionally by comparing the MRI T2-weighted image with the site of bone destruction on sinus CT.Combining the information from CT and MRI helps to localize the tumor, identify the biopsy site, and select the appropriate method of biopsy. By marking the site of the tumor on the three-dimensional (3D) CT image for sinus surgery navigation, the corresponding site can be shown on horizontal, sagittal, and coronal CT images on the same screen, making it easier to construct a 3D image of the tumor before biopsy Figure . The dirImaging with contrast, especially with contrast-enhanced CT, can confirm if a lesion is highly vascular . Tissue Potential puncture sites for FNAC include those where the tumor has invaded extraosseous structures  or those exposed from the membranous part of the maxillary sinus to the middle nasal passage. Furthermore, FNAC can be performed even for tumors located deep within the ethmoid sinus. Performing FNAC using an intramucosal approach, as in case 2, minimizes the risk of subcutaneous tumor seeding.Many factors affect the accuracy of FNAC. Experience in performing FNAC is the most important. Failure to obtain a representative sample leads to an erroneous diagnosis. This may be due to a needle positioned outside the target tissue or due to central necrosis, hemorrhage, or cystic change in the tumor .We have created a device composed of a needle, syringe, and an extension tube to facilitate the collection of sufficient samples during FNAC. We also use the same device for ultrasound-guided thyroid cytology; having an assistant apply constant negative pressure prevents needle tip blurring that occurs when the operator performs aspiration; releasing it slowly before removing the needle prevents blood from being aspirated into the needle. The operator should also be aware that when the needle is inserted, it should be rotated concentrically to collect tissue. The pathologist must confirm that enough cells have been collected by examining the fixed aspirated samples on a glass slide. The FNAC is repeated until a sufficient sample is obtained.According to multicenter reports and meta-analytic studies on FNAC in various organs in the last decade, the sensitivity, specificity, diagnostic accuracy, and area under the receiver operating characteristic curve (AUC) of FNAC for thyroid, lung, breast, and salivary gland tumors, depending on the anatomic site, have been reported to be 85.6%-97.4%, 71.4%-99.6%, and 86.1%-98.5%, respectively (Table However, there are few reports on the diagnostic accuracy of FNAC for primary nasal sinus malignancies. The following studies reported on FNAC performed on the main body of a nasal sinus malignancy matched with the final histological diagnosis, such as surgical specimens, although the types of cases differed. Helsel et al. performed FNAC on seven nasal sinus tumors and found matches in five cases . Gupta eAmong these, Dimitra et al. reported the highest diagnostic accuracy; they stated that the diagnostic rate of FNAC can be improved by improving the diagnostic methods, applying stricter protocols in tissue collection, carefully evaluating materials, minimizing procedural limitations, and improving the interpretation of cytological findings in FNAC .SCC is the most common sinonasal tumor, accounting for 40-50% of all nasal sinus malignancies, whereas ACA accounts for 13-19% of all cases -18. FNACAlthough cytology is suitable for detecting individual cellular atypia, it is sometimes difficult to determine structural atypia when cellular stacking is observed . TherefoAn improved diagnostic rate by combining cytological diagnosis and cell block preparations has been reported . The evaFNAC for deep sinus lesions has not been a common diagnostic method for sinonasal tumors because of the difficulty in palpating the tumor and inserting a needle due to the adjacent bone structures. In this paper, we described two cases in which cytology established definitive diagnoses where histopathology had previously failed. Based on these two cases and the literature review, it is important to determine whether FNAC is possible in the paranasal sinus region by performing a thorough imaging diagnosis in advance. If the tumor site can be 3D-reconstructed and cells can be collected from the tumor through FNAC, FNAC is a less invasive, rapid, highly sensitive, and specific test that may be an excellent adjunctive procedure for the diagnosis of nasal sinus tumors.


Cemento-ossifying fibroma is a benign fibro-osseous lesion arising from the periodontal ligament and has the potential to form cementum and bone in the periodontal ligament. Cemento-ossifying fibroma is a painless, pedunculated, or sessile, smooth exophytic growth arising attached to the gingival tissues. We present a case of cemento-ossifying fibroid epulis in the posterior maxilla attached to the interdental gingiva between the 26 and 27 region buccally in a 52-year-old female patient managed with surgical excision of the lesion, extraction of the involved teeth, curettage, and palatal obturator while under general anesthesia. The patient was followed up post-operatively, healing was satisfactory, there were no signs of infection, and no recurrence was noted in the six-month follow-up period. Cemento-ossifying fibroid epulis is a benign fibro-osseous lesion. It is defined as a well-demarcated and occasionally encapsulated lesion comprising fibrous tissue containing variable amounts of mineralized material resembling bone (ossifying fibroma), cementum (cementifying fibroma), or both -3. SubgiA 52-year-old female patient reported to the Department of Oral and Maxillofacial Surgery with the chief complaint of swelling in the upper back teeth region for one month. The patient gave a history of swelling for three years which gradually progressed to the current size. No history of pain or discharge from the swelling. Past medical history of the patient reveals that the patient has a known case of diabetes and has been under medication for the same for 15 years. On clinical examination, 3x2 cm solitary swelling was noted in the 26, 27 region buccally, which is oval in shape, pedunculated attached to the interdental gingiva between the 26 and 27 region and pink in color and has smooth texture; no discharge noted  and intraoral periapical radiography (IOPA) were taken which revealed a radiopaque rim surrounding the radiolucent region superimposed over 26, 27 and 28 region . The obturator was removed after the second post-operative week. Healing was satisfactory.Cemento-ossifying fibroid epulis is a benign fibro-osseous lesion. It is defined as a well-demarcated and occasionally encapsulated lesion comprising fibrous tissue containing variable amounts of mineralized material resembling bone (ossifying fibroma), cementum (cementifying fibroma), or both -3. ShephSome genetic conditions are associated with multiple peripheral ossifying fibromas like multiple endocrine neoplasia- type II, nevoid nasal cell carcinoma syndrome, neurofibromatosis, and Gardner syndrome . ClinicaHistopathological examination of the lesion reveals parakeratinized stratified squamous epithelium with long and slender rete ridges. There was fibrocellular connective tissue with calcifications. Cellular areas consist of fibroblasts with trabecular bone lined by osteoblasts. Multiple round-to-oval hematoxoyophilic calcified matrix is present resembling a cementum-like material . HistopaPeripheral ossifying fibroma needs to be differentiated from other reactive gingival lesions such as pyogenic granuloma, peripheral giant cell granuloma, and peripheral odontogenic fibroma. Pyogenic granuloma clinically appears as a red mass with an ulcerated surface and exhibits vascular proliferation resembling granulation tissue under a microscope. Peripheral giant cell granuloma shows giant cells scattered in fibrous stroma. Peripheral odontogenic fibroma contains prominent islands of odontogenic epithelium. Bony involvement is noted in few cases such as erosion of superficial bone, foci of calcifications, widening of periodontal ligament space, thickening of lamina dura, and teeth getting migrated with loss of interdental bone .Treatment comprised conservative surgical excision and scaling of adjacent teeth. The recurrence rate of peripheral cemento-ossifying fibroma is high and is probably due to incomplete removal of the lesion, repeated injury, or persistence of local irritants . ExcisioRecurrence was reported by many authors in the literature such as Cundiff observed 16%, Eversole and Robin reported 20%, and 8.9%-20% by Bhaskar and Jacoway ,12,13. RCemento-ossifying fibroid epulis is common in females. Local irritants like plaque and calculus are the main causative factors. The lesion is exophytic, firm in consistency, smooth textured, and asymptomatic in nature which delays the patient seeking treatment. Such a lesion must be identified and diagnosed during routine clinical examination of the oral cavity. Prompt diagnosis and surgical excision of the lesion with the pedicle and interdental gingiva and osteoplasty with removal of involved teeth might prevent recurrence of the lesion. Surgical excision with a scalpel gives good margins for histopathological examination but causes bleeding in the operating site, which may be avoided by using lasers. Osteoplasty might aid in reducing the recurrence rates. Long-term follow-up is needed to rule out any recurrence.


A solid pseudopapillary tumor (SPT) of the pancreas, which mainly occurs in young women, is an uncommon pancreatic tumor that often presents diagnostic and therapeutic dilemmas. This case study discusses the symptoms and treatment approach for a 34-year-old woman from Yemen diagnosed with SPT. The patient was diagnosed through abdominal and pelvis CT scan, followed by ultrasound-guided biopsy confirming the presence of SPPT. Management through the Whipple procedure and portal vein reconstruction proved successful, with no recurrence or metastasis noted in a year-long follow-up. The importance of comprehensive understanding and surgical expertise in handling SPT is emphasized. A solid pseudopapillary tumor (SPT) of the pancreas, sometimes referred to as pancreatic solid pseudopapillary neoplasm (SPN) or Frantz's tumor, represents a unique pancreatic tumor type, making up roughly 3% of all exocrine pancreatic tumors ,2. The dA 34-year-old Yemeni woman had been grappling with abdominal pain for five months, which initially led to her admission to the hospital. This pain was intermittent, non-radiating, gradual onset, had a severity of 5/10, and did not correlate with her eating or defecation patterns. Interestingly, it could be partially eased with analgesia. The patient didn't report any recent weight loss, night sweats, or changes in bowel habits. With no record of previous similar attacks, a family history of the same, chronic illness, history of surgery, or allergies, she was an otherwise healthy individual. Regarding her social history, she was a non-smoker and teetotaller, with no family history of malignancy.Upon admission, she was fully conscious, alert, and oriented. Her vital signs were stable, with a body temperature of 37.3°C, heart rate of 72 bpm, respiratory rate of 22 breaths/min, blood pressure reading 100/70 mmHg, and oxygen saturation at 98%. She showed no signs of jaundice, or pallor, and no palpable lymph nodes were noted. Her respiratory system was unremarkable. Regarding abdominal examination, a palpable firm-mild tender mass in the right upper quadrant (RUQ) was noted. The skin over the mass displayed no changes. Our initial laboratory tests Table  yielded A subsequent ultrasound-guided biopsy of the mass showcased a proliferation of monomorphic cells with ovoid nuclei arranged in small solid sheets. The immunohistochemistry results were positive for B-catenin, CD10, and progesterone receptors, which led us to a diagnosis of a solid pseudopapillary tumor (SPPT) of the pancreas Figure .In light of the biopsy findings and her persistent symptoms, a very challenging Whipple procedure with portal vein excision and reconstruction was performed on October 22, 2022. A large vascular mass, originating from the head of the pancreas, was discovered without evidence of metastatic disease Figure .Transfusion of four packed RBC cell units as well as two free frozen plasma and two platelets units in total was given intraoperatively. Post-operative analysis of the resected mass confirmed our preoperative diagnosis of SPPT. The tumor had infiltrated the adjacent pancreatic tissue and the portal vein wall, necessitating their urgent excision. However, there was no infiltration into the duodenal wall or the portal vein lumen Figure . The resFollowing the surgery, she was moved to the ICU for five days, where she was kept nil per oral (NPO) and placed on IV fluids. Her pain was managed with a patient-controlled analgesia (PCA) pump. On the third postoperative day, the patient exhibited severe chest pain accompanied by tachycardia, symptoms often associated with significant anxiety. Given the gravity of her symptoms, immediate steps were undertaken to rule out potential cardiac complications and pulmonary embolism (PE) through appropriate diagnostic procedures. These investigations confirmed that these were not the underlying causes of her distress. Consequently, a daily regimen of bisoprolol 2.5 mg was initiated, which resulted in a notable improvement in her condition. Her diet was gradually reintroduced with clear fluids, which she tolerated well. She had follow-up appointments at three- and six-month intervals which revealed no other symptoms. There was no recurrence of symptoms or signs of recurrence, metastasis, or any complications.Solid pseudopapillary neoplasm (SPN) of the pancreas, often referred to as Frantz's tumor, is a fascinating diagnostic entity. It was first described by Virginia Frantz in 1959 . Even thSPN was added to the WHO classification in 1996 . The tumThe symptoms range from nonspecific abdominal discomfort and pain to compression symptoms due to the expansive nature of the mass . PhysicaThe hallmark histological features of this condition are solid tissue sections that create pseudo-papillae, mixed with cystic regions showing signs of hemorrhage . It's thSurgical resection remains the cornerstone of SPN management. Most patients undergoing surgical excision find it curative -20. HoweThe prognosis for SPN is generally positive, with a few cases recording recurrence post-excision -23. FactSPN, with its challenging diagnosis, has seen an increase in reporting over the last two decades due to advancements in imaging techniques. Despite its generally favorable prognosis, a comprehensive understanding of its pathology, combined with surgical expertise, is essential to manage these neoplasms effectively. The need for further exploration into its histopathological features and potential markers cannot be understated, as they may offer insights into recurrence potential and overall prognosis -27.Solid pseudopapillary neoplasm (SPN) of the pancreas remains a diagnostic and therapeutic challenge, largely due to its rarity. This case underscores the significance of modern imaging techniques in diagnosing such neoplasms. Surgical resection stands as the most effective therapeutic strategy. Although SPN patients generally have a positive prognosis, long-term postoperative monitoring is crucial. The increasing reports of SPN in recent years highlight the importance of continued research to better understand its pathology, ensuring effective management and better patient outcomes.


YPEL3 pathogenic variant. This patient presented with growth failure, generalized abdominal pain and chronic diarrhea. She was confirmed to have mesenteric plexiform neurofibroma on histopathology and targeted sequencing on affected tissue confirmed that there were no neurofibromatosis type 1 variants present. Given that this patient’s mesenteric plexiform neurofibroma is associated with YPEL3 dysfunction, she is unlikely to benefit from MEK inhibitors, which are the newly approved treatment for inoperable plexiform neurofibroma in patients with neurofibromatosis type 1.Mesenteric plexiform neurofibroma is a subtype of plexiform neurofibroma that involves the mesentery and causes a variety of gastrointestinal complaints. Plexiform neurofibroma is classically found in patients with neurofibromatosis type 1, although genetic contributions to plexiform neurofibroma pathogenesis are heterogeneous. We report the first case of mesenteric plexiform neurofibroma in a patient with a  YPEL3 pathogenic variant with diarrhea and malnutrition associated with a solitary non-NF1-related MesPN. Informed consent was obtained before manuscript submission.Plexiform neurofibroma (PN) is a benign tumor that develops along nerve fascicles with potential for malignant transformation, classically described in patients with neurofibromatosis type 1 (NF1) . We repoYPEL3, hypomyelination and hypertrophic peripheral nerves, motor neuropathy with hyporeflexia and hypotonia, remote history of lymphedema, neuromuscular scoliosis, hip dysplasia, restrictive pulmonary disease, and gastroesophageal reflux requiring fundoplication and gastrostomy feeding presented with faltering growth, abdominal pain, and chronic diarrhea. Whole exome sequencing revealed that her baseline clinical features were associated with a novel frameshift mutation of YPEL3 resulting in loss of function , comprehensive metabolic panel, inflammatory markers, and thyroid studies. She had normal fecal elastase, stool alpha-1-antitrypsin, infectious stool studies, and serology for neuroendocrine tumors . Esophagogastroduodenoscopy was visually normal with mild chronic gastritis on histopathology. Colonoscopy was visually normal with patchy moderately active colitis on histopathology. Capsule endoscopy revealed normal intestinal mucosa. Findings were not consistent with inflammatory bowel disease (IBD) due to lack of chronic inflammation on histopathology, normal C-reactive protein, and CBC. She underwent a trial of steroid enemas with no symptomatic improvement. Gastric emptying study was normal. Abdominal computed tomography (CT) showed diffuse infiltrative soft tissue density around the superior mesenteric artery and inferior mesenteric artery (Fig. NF1 variants present. Our patient was started on parenteral nutrition, providing 90 kcal/kg/d with excellent weight gain. Diarrhea and pain resolved after minimizing oral intake.A laparotomy was performed to obtain tissue based on the abdominal CT findings. The entire mesentery was thickened with nodular cord–like structures Fig. . CompletYPEL3. PN is a benign peripheral nerve tumor that develops along nerve fascicles with an unpredictable growth pattern. It can involve any peripheral nerve, typically consisting of multiple nerve fascicles, and occurs in various locations including subcutaneous tissue, craniofacial, and retroperitoneum (This case demonstrates MesPN in a patient with malnutrition and diarrhea associated with pathogenic loss-of-function variant in ritoneum . When PNritoneum ,2. MesPNritoneum . PN can ritoneum .NF1, specifically in cases of craniofacial PN (NF1 in affected tissue, confirming that this was not the cause of her MesPN.PN had been thought to be pathognomonic for NF1. However, an estimated 10% of patients with PN were described without pathogenic variant in acial PN . This paYPEL3.Treatment for MesPN is limited. Complete surgical resection is advised, although often challenging due to infiltration of mesentery ,2. MEK iYPEL3 is involved in differentiation of myelinating cells, including perineurial glia and Schwann cells (YPEL3 silencing has been indirectly shown to disinhibit the Wnt pathway by stabilizing β-catenin, thus inducing epithelial-mesenchymal cell transition, leading to tumorigenesis (YPEL3 result in a lack of functional myelinating cells and improper intercellular binding during the compaction stage of myelination, leading to hypertrophied and hypomyelinated nerve fascicles (YPEL3 dysfunction (nn cells . YPEL3 sigenesis . Additiofunction . The mecfunction ,2. We spPatchy moderately active colitis on histopathology could be a result of MesPN or early IBD. Resolution of her abdominal pain and diarrhea with decreased oral intake, normal inflammatory markers, and CBC disfavors IBD. A repeat colonoscopy and fecal calprotectin would be warranted if she continues to have symptoms with oral introduction of feeds to assess for possible developing IBD.Given that our patient’s MesPN is likely driven by Wnt pathway, she would be unlikely to benefit from treatment with a MEK inhibitor. She is currently asymptomatic and gaining weight on parenteral nutrition over the past year.


Head and neck paragangliomas are rare neuroendocrine tumors arising from the autonomic nervous system. Imaging hallmarks of paragangliomas of the head and neck include an enhancing soft-tissue mass in the carotid space, jugular foramen, or tympanic cavity on computed tomography; a salt-and-pepper appearance on standard spin-echo magnetic resonance imaging; and an intense blush on angiography. Imaging studies depict the location and extent of tumor involvement, help determine the surgical approach, and predict operative morbidity and mortality. However, an atypical presentation of paragangliomas, especially when co-existing with other middle ear pathologies that have overlapping imaging findings, can often be misleading. Here, we report a case of simultaneous occurrence of paraganglioma, cholesteatoma, and otomastoiditis in a young adult female. Paragangliomas of the head and neck are rare neuroendocrine tumors arising from the extra-adrenal paraganglia of the autonomic nervous system. These tumors are commonly found near vascular structures and are typically named after their location of origin. The middle ear is the second most common site for head and neck paragangliomas after the carotid body. Jugular tumors located in the region of the jugular foramen often extend through the skull base, occurring both intra- and extra-cranially, as well as within the jugular vein. Jugulotympanic paragangliomas may exhibit a deeper red coloring when observed behind the overlying tympanic membrane .Diagnosis is typically made through a combination of clinical findings and radiographic studies. Magnetic resonance imaging (MRI) is the most important imaging modality for evaluating and characterizing suspected head and neck paragangliomas. Definitive management of these lesions should be carefully considered, taking into account both tumor and patient-oriented factors, especially in terms of potential treatment-related morbidity.Surgery and radiation therapy are the primary treatment modalities for paraganglioma. The choice of treatment depends on the tumor's size, location, biological activity, and the overall health of the patient. Although radiotherapy may effectively arrest the tumor's growth, complete elimination rarely occurs without surgical resection. Surgery, however, may be associated with significant morbidity, mainly due to the risk of major cranial nerve injury. Thus, patient selection, considering age and medical condition, should be thoroughly assessed before recommending aggressive surgery for head and neck paragangliomas, particularly for patients at risk of experiencing disabling surgical morbidity .Diagnostic imaging can be considered in two clinical situations: in patients who present with clinical symptoms suggestive of a paraganglioma and in individuals from families with hereditary paragangliomas. It is necessary not only to detect and characterize the lesion but also to study the presence of multiplicity. For these purposes, MRI, especially 3D time-of-flight magnetic resonance angiography (3D TOF MRA), is the modality of choice. On imaging, paragangliomas appear as highly vascular tumors showing intense post-contrast enhancement, which can resemble tumors of vascular origin, middle ear adenoma, schwannoma, meningioma, or even chronic otomastoiditis. CT scanning is useful in demonstrating destruction of the temporal bone. Angiography, in combination with embolization, is mainly used prior to surgical resection but can also be employed for diagnostic purposes when the diagnosis is not yet clear. Several parameters play a role in the decision to treat, of which multifocality and impairment of cranial nerves are the most important. The primary therapeutic option for paragangliomas is complete excision of the tumor with preservation of vital neurovascular structures. However, resection should be balanced against a more conservative "wait and scan" policy or palliative treatments such as radiotherapy .We report a patient with middle ear paraganglioma mimicking as well as concealed by chronic otomastoiditis and cholesteatoma, primarily focusing on radiological imaging.A 28-year-old was admitted to the Department of Otolaryngology with a one-year history of right-sided earache and hearing disturbance. The patient also complained of on-and-off pus discharge from the right ear during the same period. The hearing loss had progressively increased over the past year, and the earache had worsened in the past week. There was no history of facial deviation, dysphagia, or hoarseness of voice. Physical examination showed no palatal asymmetry or deviation of facial muscles, tongue, or uvula. Additionally, there was no significant cervical lymphadenopathy.Otoscopic examination showed a bulging right tympanic membrane with no definitive evidence of tympanic membrane perforation. However, the tympanic membrane was sub-optimally evaluated due to thick crusts within the external auditory canal (EAC). Indirect laryngoscopy was unremarkable and showed no evidence of vocal cord palsy. Audiometry revealed a conductive type of deafness. As the patient did not show improvement with conservative management, the treating team requested a high-resolution computed tomography (HRCT) of the temporal bone.On HRCT of the temporal bone, we observed soft tissue thickening that obliterates the right middle ear cavity, including Prussak's space, and extends to the right mastoid cavity via the aditus Figure . AdditioBased on the imaging findings on HRCT temporal bone, a provisional diagnosis of chronic otomastoiditis with cholesteatoma was made. However, due to the extensive soft tissue thickening and bony erosions, a contrast-enhanced MRI of the brain and skull base was suggested to look for intracranial, vascular, and other soft tissue extensions.MRI showed ill-defined, heterogeneously hyperintense foci on T2-weighted images in the right middle ear cavity and mastoid air cells Figure . CorrespA radiological diagnosis of chronic otomastoiditis with cholesteatoma was made in correlation with the contrast-enhanced MRI, HRCT, and clinical findings. However, a remote possibility of an underlying hyper-enhancing/vascular lesion was raised in view of a few hyper-enhancing areas in the middle ear and mass effect on the sigmoid sinus, internal jugular vein, and internal carotid artery on the right side.Given the atypical imaging findings, suspicion of a hyper-enhancing space-occupying lesion in the middle ear, and the lack of improvement with conservative management, the treating team decided to proceed with surgical exploration. Intraoperatively, they found an ill-defined, irregular, lobulated lesion with a tendency to bleed in the middle ear cavity, along with features of chronic otomastoiditis and cholesteatoma in the background. The lesion was surgically excised and sent for histological diagnosis.Histopathological examination of the lobulated lesion was performed using hematoxylin and eosin staining and reticulin staining techniques. It revealed cells arranged in an organoid pattern with numerous blood vessels lined by normal endothelial cells. The cells were round to oval, with a few spindled forms, vesicular nuclei, prominent nucleoli, and eosinophilic granular cytoplasm. Most of the stroma appeared focally hyalinized and myxoid. There was no evidence of necrosis or increased mitotic activity. These features were consistent with jugulotympanic paraganglioma Figure . No otheThe patient tolerated the surgery well and did not experience blood pressure fluctuations in the perioperative period. Postoperatively, the patient was monitored for complications in the ward until postoperative day 5 and was then discharged. On follow-up, the patient exhibited symptomatic improvement, with the right-sided earache resolved. Repeat audiometry three weeks after the surgery showed a significant improvement in the hearing ability of the right ear.Glomus jugulare tumors are the most common tumors of the middle ear, while jugulotympanic paragangliomas are the second most common tumors of the temporal bone. There is no clear racial predilection, but females are four to six times more commonly affected than males. Glomus tumors exhibit a familial tendency, with males being more commonly involved in this form. An autosomal dominant inheritance pattern has been suggested .In recent years, MRI has been used to detect and localize paragangliomas. These tumors are isointense to the surrounding structures on unenhanced T1-weighted images, making them difficult to recognize when small. On T2-weighted images, paragangliomas show increased signal intensity. Additionally, multiple punctate and serpentine areas of signal void caused by high-velocity flow in tumor vessels can be present.Intravenous administration of MR contrast media has been recommended to improve tumor detection in patients with paraganglioma. Some studies have suggested obtaining T1-weighted images with gadopentetate dimeglumine in suspicious patients when no paragangliomas are seen on unenhanced T1-weighted images, without the addition of T2-weighted series. Although relatively safe, intravenous administration of these contrast agents is invasive, and a number of side effects, including anaphylactic reactions, can occur. Furthermore, their use increases costs and can prolong examination time. Therefore, it is essential to assess whether paragangliomas are detected significantly better when gadopentetate dimeglumine is used .The overwhelming majority of head and neck paragangliomas are benign. Malignant behavior has been noted in approximately 4% of jugulotympanic tumors and 6% and 16% of carotid body and vagal paragangliomas, respectively. Histological criteria are not accepted as a definite sign of malignancy. The only acceptable criterion of malignancy is the presence of metastasis to the cervical lymph nodes or distant sites, such as the lung, liver, and skin. It is important to note that the aggressive behavior of a paraganglioma does not necessarily imply malignancy. Malignancy in paragangliomas is more common in sporadic, non-familial patients than in the hereditary form .The coexistence of paraganglioma and cholesteatoma is a rare entity in itself. A definitive radiological diagnosis becomes even more challenging when there is also a superimposed otomastoiditis. In this patient, the typical imaging features of paraganglioma, such as the 'light bulb' appearance on T2-weighted images or the 'salt and pepper' appearance on T2-weighted images or post-contrast T1-weighted images, were lacking ,9. AdditHRCT is an excellent technique for demonstrating even small abnormalities of the thin and complex bony structures of the middle ear. Established indications encompass complex conditions, such as the complications of acute and chronic otomastoiditis, the postoperative ear in chronic otomastoiditis, or the localization of prosthetic devices, and the assessment of congenital or vascular anomalies. High-resolution CT precisely shows the extent of bone erosion associated with cholesteatoma. On the other hand, MRI is indicated when complicated inflammatory lesions are suspected to extend into the inner ear or towards the sigmoid sinus or jugular vein. It is also valuable in cases where fistulization through the tegmen tympani or the posterior wall of the temporal bone is usually detectable by CT, but the actual involvement of meninges and veins requires better assessment.Neoplasms arising from or extending into the middle ear necessitate the use of both HRCT and MRI, as their combined data provide essential information for surgical planning, particularly regarding the destruction of thin bony structures and the relationships of the lesion with the dura and surrounding vessels. Furthermore, digital subtraction angiography and interventional vascular techniques play an essential role in the pre-surgical work-up and embolization of paragangliomas extended into the middle ear.Head and neck paragangliomas may not always present as intensely enhancing T2 hyperintense, polypoidal lesions with flow voids on MRI. Overlapping imaging features and atypical clinical presentations can be misleading, leading to diagnostic dilemmas. When there is even the slightest suspicion of a neoplastic lesion, especially a highly vascular one for which biopsy is contraindicated, the radiology team must forewarn the surgeons. Both radiologists and clinicians should be aware of atypical imaging findings and their confounding factors, and they should diligently look for possible co-existing pathologies and ancillary findings while evaluating middle ear pathologies, even if a diagnosis that explains the patient's symptomatology has already been obtained.


Mesocolic hernias are a rare cause of small bowel obstruction that occurs when a loop of small bowel herniates through a defect in the mesocolon. We present a case of a 35-year-old male with a mesocolic hernia causing small bowel obstruction, who was successfully treated with laparoscopic reduction and repair. The patient had an uneventful recovery and was discharged on postoperative day 3. Mesocolic hernias should be considered in the differential diagnosis of small bowel obstruction, and prompt diagnosis and surgical intervention are essential to prevent complications such as bowel ischemia and perforation. Laparoscopic treatment can be a safe and effective option for the management of mesocolic hernias. This case report highlights the clinical presentation, radiological features, and surgical management of mesocolic hernias, with a focus on the role of laparoscopy in the treatment of this rare condition. Internal hernias are a rare cause of small bowel obstruction. Mesocolic hernias are a subtype of internal hernias where the small bowel herniates through a defect in the mesocolon . The rigOur emergency department received a 35-year-old male patient who complained of upper abdominal pain, nausea, and constipation. He mentioned that the pain had begun 14 days prior to his admission and had intensified over the past 48 hours. Furthermore, the patient had been experiencing mild cramping pain following meals for the past year. There was no history of any prior abdominal surgery. During the abdominal examination, the patient showed voluntary defense in the epigastric area. The laboratory test showed leukocytosis (white blood cell (WBC) of 11,200/mL) with mildly elevated C-reactive protein (CRP) level . Upright abdominal X-ray showed air-fluid levels and distended small bowel loops. Next, the patient underwent a computed tomography (CT) scan of the abdomen with intravenous contrast (Video Mesocolic hernias are a rare subtype of internal hernias that occur when a loop of small bowel herniates through a defect in the mesocolon. The mesocolon is a double layer of peritoneum that attaches the colon to the posterior abdominal wall. Defects in the mesocolon can be congenital or acquired and may result from trauma, surgery, or inflammation . There aMesocolic hernias can present with symptoms of small bowel obstruction, such as abdominal pain, distention, and vomiting. Because the signs and symptoms are not specific, it needs a high index of clinical suspicion. Imaging studies, such as CT scans, can help identify the mesenteric defect and the herniated bowel loop .Treatment is directed at the intestine to prevent obstruction and strangulation, which may lead to life-threatening complications, gangrene, and perforation. Surgical treatment is necessary to reduce the herniated bowel and repair the mesenteric defect. The defect can be closed primarily with interrupted or continuous sutures. We preferred to close the defects one by one with interrupted silk sutures, whereas Villalona et al.  preferreMesocolic hernias are a rare cause of small bowel obstruction but should be considered in the differential diagnosis. Prompt diagnosis and surgical intervention are essential to prevent complications such as bowel ischemia and perforation. Laparoscopic treatment can be a safe and effective option for the management of mesocolic hernias.


A 59-year-old woman with right upper quadrant abdominal pain was admitted to the Department of Internal Medicine. Her ultrasonography revealed a hyperechoic liver lesion, while her laboratory test results were normal. Magnetic resonance imaging was performed, which revealed restricted diffusion in the lesion on diffusion-weighted images . We obse--Hepatic fascioliasis has nonspecific clinical symptomsIn this case, diffuse enhancement was observed instead of peripheral enhancement, and there was no tract extending into the subcapsular region. No clinical history was suggestive of parasitic infections.Misdiagnosing hepatic fascioliasis as metastasis may result in a dearth of treatment. It is necessary to report the imaging findings of hepatic fascioliasis. Noninvasive techniques must be used more frequently in the management of hepatic fascioliasis.


A cutaneous horn is a yellow or white-colored conical projection made up of complex keratin that arises from the surface of the skin. It is usually diagnosed clinically but requires histologic examination to rule out malignancy or determine the underlying lesion. Verruca vulgaris, a human papillomavirus-associated lesion, is a very common benign underlying lesion. We present a case of an 80-year-old female who presented with a cutaneous horn on a unique location, the proximal interphalangeal joint (PIP) of her left fourth digit. Post-excision biopsy revealed a diagnosis of a verruca vulgaris-associated cutaneous horn. A cutaneous horn (cornu cutaneum) is a hyperkeratotic projection above the surface of the skin. They are so named as they resemble an animal’s horn physically but differ histologically as they consist of cornified proliferative keratinocytes without a bony component . CutaneoAn 80-year-old female with a past medical history of dementia, hypertension, and bipolar disorder was evaluated for a growth on her left fourth finger. The growth had been present for a year and she denied any family history of similar lesions. On examination, her vitals were within normal limits, and a double-horned, yellow-tan hard keratotic lesion was present on the dorsal surface of the PIP of her left fourth finger. The patient denied numbness, tingling, or any sensory abnormality on all fingers. The lesion was mobile and mildly tender with movement. She retained a full range of motion in her fingers and there was no enlargement of the cubital lymph nodes. The patient consented to surgery, the entire mass was excised at its base under local anesthesia with an oval incision 3 cm long and 2 cm wide down to the subcutaneous tissue of the left fourth finger Figure . The patCornu cutaneum is an unusual hard conical projection made of compact keratin on the surface of the skin. They can arise from benign, premalignant, or malignant skin lesions . They arCutaneous horns usually arise due to an underlying epidermal lesion. The most common benign lesions are seborrheic keratosis, molluscum contagiosum, hypertrophic lichen planus, or verruca vulgaris. The most common premalignant lesions are actinic keratosis and keratoacanthoma, and squamous cell carcinoma is the most common malignant cause . Most paAccording to the post-excision histopathology report, verruca vulgaris was confirmed as our patient’s underlying epidermal lesion. Verruca vulgaris, a human papillomavirus (HPV)-associated lesion, is commonly observed to present as a papule but can rarely present as a cutaneous horn by developing hyperkeratosis . CutaneoThis case report adds to the current literature by describing an 80-year-old female presenting with a cutaneous horn on a unique location, the PIP of her left fourth digit, which was later diagnosed as a verruca vulgaris-associated lesion after a histologic examination. Cutaneous horns are usually diagnosed clinically but require a histologic examination to determine the underlying lesion and rule out malignancy. Cutaneous horns can arise from benign, premalignant, or malignant skin lesions. Management depends on the type of underlying lesion, with wide local excision with appropriate margins being the preferred standard of care for premalignant or malignant cases. For verruca vulgaris-associated cutaneous horns, biopsy after a complete excision can suffice, and most patients will require no additional therapy.


Congenital dermal sinus tract (DST) is a rare spinal dysraphism characterized by a persistent tract lined by epithelial cells, beginning at the epidermis and terminating in deeper tissue layers. With 1% of all congenital DST cases found in the cervical region, only 4% of all cases are diagnosed after the age of 20.In this case, a 65-year-old woman with a congenital DST at the cervical level presented with symptoms of neck and some arm pain, suboccipital headaches, and unique external characteristics. Neck Disability Index and visual analog scale were used to assess the patient’s preoperative and postoperative pain, and quality of life. Patient underwent an operative intervention, where the DST was surgically removed followed by interlaminar decompression at C1–C2, excision of the epidural component, and biopsy followed by plastic surgical repair. Pathology analysis indicated a squamous epithelial-lined sinus tract interacting with the dura. Most notably, a meningothelial proliferation with associated psammomatous calcifications was identified, similar to a meningioma.A review of literature was conducted to further discuss clinical and radiological presentation as well as to document the novel appearance of this congenital DST. As one of the oldest cases of DST, it demonstrated unusual pathological characteristics with a meningothelial proliferation, compatible with meningioma, reported at the epidural level. Congenital dermal sinus tract (DST) is a rare spinal dysraphism characterized by a persistent tract lined by epithelial cells, beginning at the epidermis and terminating in deeper tissue layers . With anA 65-year-old female presented to the clinic with complaints of chronic suboccipital headaches consistent with occipital neuralgia. The patient’s chief complaints were a pain in the neck and head and tingling on the left side of the body, including the scalp, arm, leg, and lip. Patient has a family history of headache disorders, but no history of spinal problems. To alleviate the pain, the patient regularly took tramadol and even steroids. Patient mentioned that she was born with a “hole” in her neck, the persistent DST in the posterior cervical area, which gave her significant personal discomfort in its appearance as shown in Fig. Preoperatively, the patient reported a Neck Disability Index Score (NDI) of 46, and visual analog scale (VAS) neck 9.8. Neurological examination indicated the range of motion as stiff but relatively intact, motorically intact at 5/5, normal sensory, gait, and reflexes. The patient’s congenital DST was unique in its physical appearance as it was a hypopigmented, contracted external sphincter-like outer boundary with hypotrichosis, and no signs of infection. She denied any pain in that area or drainage from the opening. Contrary to a typical case of congenital DST, there was an absence of associated neurological dysfunction, swelling, infection in the area, or associated hemangioma. The cervical MRI shows C1 bifid arch traversed by the congenital DST as shown in Fig. The surgical intervention was an excision of the posterior cervical pathologic lesion that extends from the skin to the spine along with a plastic surgical repair. A circular posterior cervical incision around the DST was made, and the dissection was taken down along the tract past the cervicodorsal fascia. An excision of the congenital sinus tract and associated fistula tissues along with interlaminar decompression of C1 and top of C2 with epidural micro-dissection and excision was performed. The sinus tract was followed all the way to the C1 arch and the C1–C2 interlaminar space via a minimalistic coned-down dissection under microscopic magnification Fig. . During At 3 months postoperatively, the patient was extremely satisfied and indicated resolution of her arm symptoms, C2 neuralgia, suboccipital headaches, and tingling on the left side of the body. The patient reported an NDI of 14 and VAS score of 0.1 (neck). Neurological exam remained stable. Five-month postoperative MRI indicates minimal dorsal nodularity without enhancement in Fig. Congenital DSTs are hypothesized to be the embryological result of an incomplete separation between the neural ectoderm and cutaneous surface ectoderm during the 3rd and 8th week of gestation . Less thOur case demonstrates unique appearance, and pathology including squamous epithelial-lined sinus tract that extended from the epidermis, through the dermis, into epidural space. Meningothelial proliferation was found along with psammomatous calcifications Figs.  and 8. TDiagnosed typically at birth or in early childhood, congenital DSTs are usually located in the lumbosacral region and rarely in the cervical region. Early diagnosis and treatment of congenital DST are important to prevent neurological deficits, infection and pain. To our knowledge, no previous reports of this type of DST with these unique external characteristics, spinal dysraphism with epidural meningioma, have ever been reported.CARE Checklist


The correct reconstructive technique following dermoid cyst removal is critical for treatment and aesthetics. This article will discuss the management of nasal dermoid sinus cysts. A mixture of “Turkish-delight” crushed cartilage with Fibrin-based tissue adhesives and non-crushed septal cartilage was used for the primary reconstruction of the nasal dorsum. Nasal dermoid cysts: Nasal dermoid sinus cysts are rare midline abnormalities that can occur on the nasal dorsum, typically between the glabella and the columella. Surgical intervention is usually necessary to prevent complications and ensure complete removal of the cyst.Surgical approaches: Various surgical approaches can be used for the treatment of nasal dermoid cysts, including excision with primary closure, midline vertical incision, transverse incision, lateral rhinotomy, inverted-U incision, and external rhinoplasty. The choice of approach depends on factors such as the size, location, and extent of the cyst, as well as the patient’s condition and the surgeon’s preference.Importance of complete excision: Complete excision of nasal dermoid cysts is crucial to prevent complications such as recurrence, nasal deformity, infection, meningitis, and intracranial abscesses. Proper surgical management aims to remove the cyst and associated sinus tracts while restoring normal nasal anatomy and function.Surgical technique: In a case study involving a 73-year-old male patient with a nasal dermoid cyst, an inverted T-shaped incision was made on the nasal dorsum. The entire cystic mass was carefully removed along the midline, and any eroded nasal dorsum bones were drilled to create a single common cavity. The defect on the nasal dorsum was repaired using a combination of crushed septal cartilage mixed with Fibrin-based tissue adhesives and small cartilaginous palisade grafts for aesthetic reconstruction.Successful outcome: The patient underwent successful surgery with no recurrence observed during the one-year follow-up. The wound site healed completely, and the patient maintained a pleasing profile. This case highlights the effectiveness of the surgical technique in managing nasal dermoid cysts while minimizing defects and achieving aesthetic and functional outcomes. These tComplete excision of NDSCs is crucial in order to prevent complications such as recurrence, nasal deformity, infection, meningitis, and the formation of intracranial abscesses. Several surgical approaches are utilized for the treatment of NDSCs. Proper surgical management aims to achieve complete removal of the cyst and its associated sinus tracts and restore normal nasal anatomy and function .Introducing this surgical technique into the existing literature aims to raise awareness about the potential occurrence of nasal dermoid cysts on the midline nasal dorsum, even in advanced age. Furthermore, it underscores that effective management of such cases with minimal defects is achievable through meticulous surgical strategizing. The primary objective is to present a successful case of managing a dermoid cyst in the middle nasal dermal sinus.The treatment strategy employed a combination of two materials: “Turkish-delight” crushed cartilage and Fibrin-based tissue adhesives, which were utilized as a matrix to fill the excised area. In addition, non-crushed septal cartilage was employed for the primary reconstruction of the nasal dorsum. This innovative approach is highlighted to showcase its positive outcome and to emphasize its potential for addressing similar cases in the future.2.Following radiological imaging, a 73-year-old male patient with a history of progressive swelling on the nasal dorsum for the past year was diagnosed with a nasal dermoid cyst. Nasal endoscopy findings were normal, and subsequent brain and paranasal sinus tomography and clinical examinations did not reveal any signs of intracranial extension. Consent to publish this case report has been obtained from the patient in writing.The patient underwent surgery under general anesthesia. The initial step involved deciding on the approach and the type of incision. An inverted T-shaped incision was made on the nasal dorsum, followed by skin and subcutaneous tissue dissection to access the cystic mass. Careful removal of the entire cystic mass was performed along the midline of the nasal dorsum. Erosion was observed in the lateral left nasal bone, middle ethmoid cells, and upper part of the septum. The eroded portion of the nasal dorsum bones was drilled to create a single common cavity (Additionally, the two small septal cartilage palisade grafts were placed over the nasal septal defect to cover the nasal dorsum defect and achieve a more aesthetically pleasing profile .3.Cystic masses are frequently found in the head and neck area due to various reasons like development, infection, tumors, and trauma. However, Epidermoid and Dermoid Cystes are rarely encountered, making up just 3.7% to 11% of congenital masses and less than 10% of head and neck tumors. Typically associated with the orbital region in about half of the cases, our patients showed a different pattern, with nearly equal distribution among the orbital, auricular, and neck regions, and around 20% of cases occurring in other locations . DiffereInfective cysts, on the other hand, could arise due to infections or inflammatory processes. Clinical features such as redness, warmth, and tenderness may be indicative of an infective origin. Neoplastic cysts, which could be benign or malignant, require careful evaluation for features suggesting malignancy, such as rapid growth, irregular borders, and associated pain. Traumatic cysts might form in response to physical trauma and could be filled with serous or blood-tinged fluid. The location of the cysts can also aid in differentiation. For example, the orbital region is often linked to epidermoid and dermoid cysts, while other regions such as the auricular and neck regions might also be affected, as noted in the study. Histopathological examination is a crucial tool for differentiation. The cyst’s content, cellular composition, and surrounding tissue characteristics can provide important diagnostic information. Molecular markers and imaging techniques could further contribute to accurate differentiation. The study by Al-Khateeb et al. emphasizes the importance of considering the diverse etiologies and clinical presentations of cutaneous cysts in the head and neck region. By carefully analyzing clinical features, location, histopathological findings, and possibly molecular markers, healthcare professionals can effectively differentiate between various types of cutaneous cysts and provide appropriate management strategies for each case .The definitive treatment of nasal dermoid cysts is surgery, and if there is an intracranial extension, excision with craniotomy should be performed. Recurrence was reported as 1–4% after treatment ,6–10. Th4.The purpose of introducing this technique in the literature is to increase recognition regarding the potential occurrence of nasal dermoid cysts on the midline nasal dorsum, even in later stages of life. It underscores the idea that these instances can be effectively addressed with minimized structural impact by means of meticulous surgical preparation.


The annular pancreas (AP) is an uncommon congenital anomaly, characterised by a circumferential envelope in the second portion of the duodenum. In recent years, some genetic component has been found in the etiology. A newborn full-term male, weighing at 1910 g at birth, had a history of intrauterine growth restriction and diagnosis of tetralogy of Fallot, Down syndrome and congenital hypothyroidism. Duodenal membrane is suspected after persistent postprandial vomiting and abdominal distension; his abdomen was distended, hyperresonant and soft. The gastroduodenal series showed data compatible with a duodenal membrane so exploratory laparotomy was performed, finding the pancreas completely wrapping the second portion of the duodenum, so a diamond-shaped-duodenoduodenostomy anastomosis was performed. The AP should be considered, especially in male neonates with postprandial vomiting, abdominal distension, who show some other congenital anomaly, and in the abdominal X-ray, the sign of the double bubble is observed. Annular pancreas (AP) is a rare congenital anomaly occurs in 1:20 000 live births. It is characterised by a circumferential envelope in the second portion of the duodenum, it is also described as a band of pancreatic tissue that conditions stenosis and obstruction, and its treatment is surgical [The AP was first recognised by Tiedman in 1818 and named as PA by Ecker in 1862 . Its etiA newborn full-term male, with a weight of 1910 g and height of 43 cm, had a history of intrauterine growth restriction and diagnosis of tetralogy of Fallot, Down syndrome and congenital hypothyroidism. He was hospitalised at the pediatric intensive care unit for suspected duodenal membrane after persistent postprandial vomiting and abdominal distension.Physical examination revealed a hypotonic newborn, normocephalic with phenotypic features of trisomy 21 and a systolic murmur. His abdomen was distended, hyperresonant and soft on palpation. The rest of the physical examination showed no abnormalities.The gastroduodenal series showed data compatible with a duodenal membrane between the second and third portions of the duodenum . Based oSome series report that AP is more frequent in males, up to a 2:1 ratio ; howeverAP has been reported to be commonly associated with other congenital anomalies 27–67.5%), mainly cardiac anomalies, but also with Down syndrome, duodenal atresia, esophageal atresia, duodenal membrane, intestinal malrotation, Meckel’s diverticulum, anal atresia, among others , 6, 7.7.5%, maiPrenatal ultrasound usually shows abnormalities in up to 64% of cases, in particular the sign of fetal abdominal double bubble, polyhydramnios or some malformation of the digestive tract is described , 3, 6. IThe clinical presentation varies according to the degree of obstruction, the main symptom is vomiting up to 59–94%, being mostly 2/3 parts) biliary and classically, postprandial. Abdominal distension, weight loss and, sometimes, hyperbilirubinemia are also described /3 parts .The diagnosis of duodenal obstruction is made with the clinical picture and the finding of the ‘double bubble’ sign on a plain abdominal X-ray, present in 90.9–100% of cases. It can be confirmed with a gastroduodenal series showing obstruction at the level of the duodenum. Some describe the use of computed tomography (CT) and magnetic resonance imaging (MRI). Despite the above, the gold standard is the complete examination of the duodenum and pancreatic head during surgery , 3, 8.The treatment is surgical, the objective is to relieve the duodenal obstruction by means of a surgical bypass that restores the alimentary transit, either by gastrojejunal anastomosis, laterolateral duodenojejunal bypass or diamond-shaped duodeno-duodenal anastomosis. The latter is the most frequently used, as it is more physiological and is considered the best, in addition to presenting fewer complications .Traditionally, this was performed by laparotomy, with a transverse supraumbilical incision; however, with the advent of laparoscopic surgery, it has become the gold standard, due to the shorter recovery and hospitalisation time, less pain, less risk of bleeding, and formation of adhesions and scarring. Its limitation is that it requires the skill of the surgeon and, even more, the availability of supplies , 9, 10.In one study, a mean of 7.8+/−2.7 d of fasting after the surgical procedure was described. Regarding potential postsurgical complications, surgical site infection 2.6%) and anastomotic leakage (1%) were described [% and ana


Osteoma is a benign, and usually asymptomatic bone tumor normally found in the skull and facial bones, although it can occasionally occur in the long bones and spine.In this article, we present a 49-year-old male patient who experienced progressive neck pain accompanied by left-sided radicular pain symptoms. Clinical investigation using various imaging techniques confirmed a bone-forming lesion located within the C1 vertebrae region. Treatment involved performing hemilaminectomy of C1 along with resection for complete removal of this extradural bone lesion, ultimately achieving symptom relief. Histopathological examination of the resected specimen leads to the diagnosis of osteoma. Along with reporting this case, we conducted a comprehensive literature review of the previously reported spinal osteoma cases.Histopathological examination confirmed the diagnosis of osteoma. A comprehensive literature review was conducted, revealing 16 previously reported cases of spinal osteoma. Among these, only one case involved the C1 vertebra and presented similar neurological symptoms. The review underscores the rarity of spinal osteomas and the importance of surgical intervention for symptom relief.Spinal osteomas are rare but should be considered in the differential diagnosis of patients presenting with neck pain and radicular symptoms. Surgical removal of the lesion is often necessary for symptom relief, as highlighted by our case and supported by the literature review. This case adds to the limited body of evidence on spinal osteomas and emphasizes the importance of a multidisciplinary approach for optimal patient outcomes. •Osteomas are benign bone lesions, mostly near sinuses, but infrequent in the upper cervical spine•Surgical intervention often necessary for symptomatic upper cervical spine osteomas•Case study: 49-year-old male with neck pain and left-sided radicular symptoms•Successful relief through hemilaminectomy and lesion resection•Rarity of upper cervical spine osteomas necessitates continuous reporting and analysis•Personalized management is essential considering diverse treatment modalities OsteomaHere, we present a case study involving a patient who experienced neck pain radiating to his left hand due to an osteoma in their C1 vertebra. Both complaints were successfully resolved without any complications through hemilaminectomy and resection of an extradural bone lesion. Moreover, we conducted a comprehensive literature review of the 14 reported cases of spinal osteomas in the literature, with only one located in the C1 vertebra. This highlights the rarity of our case and underscores the need for reporting and analyzing such unique occurrences to enhance our understanding of osteomas in the upper cervical spine.This work has been reported in line with the SCARE criteria to ensure standardized and high-quality reporting .2A 49-year-old man was referred to the neurosurgery department in Chamran Hospital, Fars, Shiraz, Iran, complaining of progressive neck pain and left-sided radicular pain persisting for a period of 6 months. Additionally, the patient experienced hypoesthesia and paresthesia in the left hand approximately two weeks before seeking medical attention. The patient denied any history of trauma prior to the onset of symptoms. Notably, the pain did not extend to the lower back or hips, and no numbness in the lower extremities was reported. Past medical and drug history was unremarkable, as was the patient's social history. The patient also reported no congenital abnormalities in the upper cervical spine. The patient exhibited normal cranial nerve function, muscle power, and gait.Computed tomography (CT) scan displayed a well-delineated ovoid bony mass on the left side of C1 pedicle that mildly extended into the spinal canal, with cortical density on bone window without evidence of significant cord compression . MagnetiHistopathological examination of the resected specimens revealed fragments of mature cortical type bone architecture with areas of endochondral ossification, showing no cellular atypia or necrosis. The diagnosis of the specimens and extradural bone lesion was suggestive of osteoma . The pat3In this article, a case of osteoma in the C1 region is presented with upper cervical canal stenosis. Hemilaminectomy of C1 and complete resection of the extradural bone lesion was performed. Accurate diagnosis of osteomas in this anatomical region poses significant challenges as they have radiologic and clinical overlap with other medical conditions, making them difficult to detect . Kanaya We conducted a literature review of all cases of spinal osteoma, listed in In conclusion, our case report and comprehensive literature review enhance the understanding of osteomas in the upper cervical spine. By presenting a rare case of osteoma in the atlas and analyzing existing studies, we contribute to the body of knowledge surrounding the accurate diagnosis and surgical management of these lesions.C1First cervical vertebraC2Second cervical vertebraC3third cervical vertebraCTComputed TomographyMRIMagnetic Resonance ImagingThe present study was approved by the Medical Ethics Committee of XXX University of Medical Sciences. The purpose of this report was completely explained to the patient and written inform consent was obtained from the patient.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.Data of the patient can be requested from authors. Please write to the corresponding author if you are interested in such data.No source of funding.SAN and SSN drafted the manuscript.MK collected the data and revised the manuscript. SHJ collected and reported the imaging data. DF proofread the manuscript and did the English language editing of the manuscript. AD revised the final version of the manuscript and supervised the study. All authors read and approved the final version of the manuscript.Seyed ali nabavi zadeh accept full responsibility for the work and/or the conduct of the study,had access to the data, and controlled the decision to publish.The authors declare that they have no competing interests.


Osseous metastasis (OM) in ovarian cancer (OC) are rare, with an incidence ranging from 0.8% to 2.6%, and are associated with poor prognosis. The available literature on their management and associated complications is scarce.We report a case of International Federation of Gynecology and Obstetrics (FIGO) stage IVB clear cell epithelial OC (EOC) who presented with neck pain. Imaging revealed multiple cervical spine metastases with left vertebral artery encasement and concurrent C1 lateral mass compression fracture, without neurological deficit, requiring occiput to C2 posterior instrumentation and fusion.Early OM may be associated with shorter overall survival, and survival after OM diagnosis is on the order of months. Management of OM should include a multidisciplinary team and may require surgical stabilization in addition to systemic chemotherapy, local radiotherapy, and osteoclast inhibitors. Ovarian cancer (OC) is the most common cause of gynecological cancer death . Direct A 59-year-old African American P0 (nulliparous) with a history of uterine leiomyoma presented with abdominal pain and bloating. A transabdominal sonogram demonstrated multiple large, complex adnexal masses. Staging computed tomography (CT) chest, abdomen and pelvis was suspicious for metastatic ovarian carcinoma, with bilateral complex adnexal masses, peritoneal carcinomatosis, omental caking, and pericardiac, abdominal, peripancreatic, mesenteric, retroperitoneal, and pelvic lymphadenopathy. No osseous lesions were identified at the time of the initial scan.An initial consult with gynecological oncology revealed an abdominal mass above the umbilicus, pelvic masses, and a palpable left supraclavicular node. Ca-125 was 6,773. Pathological examination of interventional radiology-guided peritoneal mass biopsies had an immunoprofile compatible with a high-grade adenocarcinoma of Mullerian origin, favoring clear cell carcinoma. The tumor showed preserved mismatch repair (MMR) proteins expression . Immunostain for human epidermal growth factor receptor 2 (HER-2) was equivocal and difficult to interpret on the scant cell block material with mostly cytoplasmic staining, no convincing membranous staining, score 0-1, and immunostaining for PD-L1 was limited by scant cellularity in the cell block, focal positivity with an estimated combined positive score (CPS) 3-4. Further genetic testing did not show any mutations for possible targeted therapy. The patient was diagnosed with FIGO stage IVB clear cell EOC. She received her first cycle of carboplatin, paclitaxel, and bevacizumab, with a plan for 3-4 cycles of neoadjuvant chemotherapy and interval debulking pending clinical response.After her first cycle of chemotherapy, the patient endorsed persistent neck pain of moderate severity. Magnetic resonance imaging (MRI) cervical spine revealed contrast-enhancing osseous lesions within the anterior arch and left lateral mass of C1, as well as in the C4 and C7 vertebral bodies, left articulating facet of C6 and T4 vertebral body extending into the left pedicle. There was lateral tumor extension with encasement of the vertebral artery at the C1 level. There was no evidence of epidural disease or spinal cord impingement Figure -1C. CT aThe patient was admitted to neurosurgery with gynecological oncology consultation, where she continued to endorse left-sided cervical pain radiating to the occiput which worsened with movement and improved with opioids, steroids and immobilization with a hard collar. There were no focal neurological deficits, paresthesias, anesthesia, gait difficulties, or bowel or bladder dysfunction. The patient had full strength in the upper and lower extremities and an intact gait. She had no signs of myelopathy and had a negative Hoffman’s sign.Given normal cervical alignment, with imaging demonstrating articular facet involvement and lateral mass fracture, this pain was considered to be caused by cervical spine instability Figure . Urgent surgery was not indicated without neurological deficits or compressive pathology. A multidisciplinary team discussed the case to determine if surgical decompression was required prior to local radiation, and surgical intervention with occiput to C2 instrumentation and fusion was decided upon. Surgery was performed two days after diagnosis. Intraoperatively, there was extensive tumor involvement of the C1 lateral mass and posterior arch, encasing the vertebral artery and extending towards the occipital condyle. A palliative C2 neurectomy was performed for pain control. A right C1 lateral mass screw, bilateral C2 pedicle screws, and occipital keel plate with three bicortical screws were placed. The fusion bed was prepared by decorticating the occiput and bilateral C1-2 joint spaces with the placement of allograft over the decorticated spaces. Intraoperative monitoring was stable throughout and the patient awoke at neurological baseline. Postoperatively, the patient endorsed significant improvement of her cervical pain. Incisional pain was controlled with methocarbamol, gabapentin and hydromorphone PCA . Radiographs demonstrated excellent instrumentation placement and alignment Figure .The patient ambulated without assistance on postoperative day (POD) 1 and was discharged in stable condition on POD3. Radiographs of the spine confirmed stable spinal fusion rods three weeks postoperatively Figure . There wThis report illustrates a unique complication of OM in EOC. Given the rare nature of these lesions, the literature is sparse. Four retrospective studies comment on OM in the context of other rare OC metastases , 10, 11.Additionally, four retrospective studies looked specifically at OM in OC , 5, 6, 7Ak et al.  examinedSehouli et al.  examinedBy far, the largest study on this topic, Zhang, C. et al. , examineLastly, Zhang, M. et al.  found OMThere is a paucity of data regarding the management of OM with or without SRE in OC, and the current management of lesions is based on that for other solid tumors. Diagnosis includes history and physical, and imaging options include radiographs, CT and MRI; MRI is the modality of choice for vertebral lesions. A multidisciplinary team approach is often needed for the management of such rare cases, including radiology, orthopedic surgery, neurosurgery, radiation oncology , gynecological oncology, palliative and pain medicine . All of In conclusion, we present a unique case of clear cell EOC with vertebral OM resulting in pathologic C1 fracture requiring surgical stabilization, further complicated by vertebral artery encasement and narrowing. OM secondary to OC are rare and often present with pain though rarely with neurologic deficit. The risk factors for the development of OM are poorly understood but may include clear cell EOC as in this case, and lesions are more commonly described in those with late-stage disease. Patients who present with OM at the time of diagnosis or early in their disease course may have shorter overall survival than those with later OM. However, survival after OM diagnosis is on the order of months. Surgery at the primary site and combination chemotherapy and RT may prolong survival. These findings are based on limited retrospective studies, and further examination of risk factors and prognostic implications of OM in OC is needed.


Careful history and examination revealed a swelling of the lower lip which had gradually increased in size but was static for the last three months. As the patient complained of cosmetic and social inconvenience, it was surgically managed. Any post-operative complications were ruled out and the patient was sent home in a good condition. Much research is warranted to know the exact etiopathogenesis and appropriate management of pleomorphic adenoma of the lower lip.Pleomorphic adenoma is a benign tumor of the salivary glands. It commonly occurs in the parotid gland, palate, upper lip and cheek. The authors present a rare case of a pleomorphic adenoma of the lower lip in a 30 years old female admitted on 20 The salivary glands are important components of the faciomaxillary area and are divided into major and minor glands. Tumors of the salivary glands make up 3-10% of all the head and neck tumors. Nearly 80% of these tumors are benign and involve the major salivary glands, whereas malignant tumors are seen typically in minor salivary glands. Thus, the potential of malignancy is inversely proportional to the size of the salivary glands.1Pleomorphic adenoma (PA) is one of the most common benign tumors of the salivary glands. It usually affects the major salivary glands, having an incidence of 84% in the parotid glands, 8% in the submandibular glands and 1% in the sublingual glands. Scarcely does it involve the minor salivary glands with an incidence of 6.4%.3History of smoking, intake of cholesterol-rich diet and exposure of the head and neck regions to radiation are signification risk factors for pleomorphic adenoma.5Labial pleomorphic adenomas account for 20-40% of the total intra-oral incidences. They usually involve the upper lip and rarely do they occur in the lower lip, i.e., ≤ 3% amongst all intraoral pleomorphic adenomas.The differential diagnosis of a localized mass in the lower lip includes mucocele, traumatic fibromas, or focal fibrous hyperplasia, pleomorphic adenoma, benign epithelial salivary gland tumor and basal cell adenoma.th of July, 2022 with a complaint of painless, slightly itchy swelling on the lower lip for the last four months. Careful history and examination revealed a swelling of the lower lip which had gradually increased in size but was static for the last three months. There was no associated history of fever, pain, bleeding or difficulty in chewing. History of diabetes, hypertension, smoking or tobacco chewing was not present. The patient was not on any past medications or treatment. Her family history was also insignificant.A 30 years old female presented to surgical outpatient department (OPD) of Akbar Niazi Teaching Hospital (ANTH), Islamabad on 20On local examination, the swelling was 1x1 cm, towards the left of the midline . Its surInvestigations included all the baseline tests and COVID-19 profile. CT scan face/ maxillofacial and neck showed a well-defined, benign appearing, soft-tissue subcutaneous mass on the lower lip, left to the midline. Fine needle aspiration cytology (FNAC) revealed presence of ductal epithelial cell clusters in the background of a chondromyxoid matrix with scattered myoepithelial cells. Anesthesia fitness test was done and the patient was prepared for surgery. Consent was taken and possible risks and complications were explained to the patient.The surgical procedure was conducted under general anesthesia. The surgical site was identified and elliptical incision around the swelling was made. The skin and underlying tissue were separated . The masWorldwide, cancer of the oral cavity is one of the top ten most malignant neoplasms. Southeast Asia is reported to have the highest incidence of these cancers, mainly owing to the habitual habit of the locals of smoking, alcohol consumption and chewing betel quid.6Study by Zaman et al found a ratio of 2.6:1:1.3:0.05 of the tumors in the parotid (51.6%), submandibular 19.7%), minor salivary glands (27.4%), and the sublingual gland (1%); in contrast to the traditional ratio of 1:0.1:0.1:0.01, thus showing a relatively higher incidence in the submandibular and minor salivary glands. It also concluded that pleomorphic adenoma; a benign lesion, was the most commonly diagnosed tumor (47.2%) in the study population, followed by adenoid cystic carcinoma (17.5%), mucoepidermoid carcinoma (16.4%) and basal cell adenoma (4.3%)..7%, minoA study conducted in Jammu Kashmir reinforces this statement. Histopathological evidence concluded that 51% of the samples collected were benign and amongst them, pleomorphic adenoma was the most frequent diagnosis on biopsy.The afore mentioned report is about a pleomorphic adenoma of the lower lip. A similar rare case was recorded in literature by Nourwali et al.Pleomorphic adenoma is a benign and common lesion amongst all the salivary gland tumors. However, its occurrence on the lower lip is quite rare and only a few cases have been reported over the years. Thus, much research is warranted to know its exact etiopathogenesis and appropriate management.MUA: provided concept/design, acquisition of data.NN & AR: did project management.HA & AR: did editing of manuscript and project management.MUA: takes the responsibility and are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


After resection of the retroperitoneal tumor, PET/CT further revealed multiple abdominal and pelvic metastases, with a SUVmax of 22.5. Therefore, the patient received a cycle of chemotherapy and follow-up PET/CT imaging showed the achievement of complete metabolic response after the treatment. In this case, PET/CT played a crucial role in detecting metastasis, compensating for the limitations of pathological sampling, thus establishing a definitive diagnosis and predicting prognosis. And it was evident that PET/CT also has the advantage of evaluating therapeutic efficacy.Postpubertal testicular teratoma exhibits malignant biological behavior and has metastatic potential. We report a case of a 17-year-old patient diagnosed with postpubertal testicular teratoma with massive retroperitoneal metastasis. The pathological examination revealed a mature teratoma without any other components. However, the patient had a significantly increased level of AFP, and  Mature teratomas have normal or slightly elevated FDG uptake, so if the tumor has a significantly elevated FDG uptake, it suggests that there are other components in the tumor  include embryonal carcinomas, yolk sac tumors, choriocarcinomas, and teratomas. Testicular teratomas can be further classified into prepubertal and postpubertal teratomas, and teratomas unrelated to germ cell neoplasia tal type , 2. Preptal type . The diatal type , 5. A sital type . Howeverhe tumor , 8. Combhe tumor .A 17-year-old boy accidentally found a left testicular swelling, which was hard and accompanied by pain. The patient went to the local hospital and was diagnosed as inflammation. The pain was relieved after antibiotic infusion, but there was no significant change in the size of the swelling, so he was consulted at our hospital. The patient was previously in good health and had no history of tumor, and had no familial history of hereditary diseases. Laboratory tests showed markedly increased level of AFP  whereas his HCG level was normal (<0.1 mIU/mL). The ultrasound showed that there was a cystic mass in the left testis, which tended to be benign. The pelvic contrast-enhanced MRI revealed that the left testicular mass contained both solid and cystic components, and it exhibited low signal intensity on T1WI and high signal intensity on T2WI. There were multiple reticular structures in the mass, which exhibited low signal intensity on T1WI and T2WI and high signal intensity on DWI. The solid components showed significant enhancement on enhancement scan. And there were no enlarged lymph nodes in the scanning range –D. Then,18F-FDG PET/CT was performed. PET/CT revealed increased FDG uptake at the edges of the tumor with a SUVmax of 15.9, while the central FDG uptake was low, indicating a large area of necrosis. These findings reflected the aggressive growth and high malignant potential of the tumor. In addition, there were no metastatic lesions with abnormal FDG uptake in other parts of the body , so further examinations were performed. Contrast-enhanced CT of urinary system showed there was an irregular soft tissue mass on the on the left side of abdominal aorta and below the left renal hilum, at the size of 8.4 × 10.0 cm. The mass had an incomplete capsule with unclear boundary. The internal density was heterogeneous and multiple patchy necrotic areas could be found. Also, the fatty space surrounding the lesion was unclear and the lesion demonstrated uneven enhancement –C. To futhe body –G. Then,One month after the second operation, the patient’s AFP was still higher than normal , so he underwent PET/CT examination again for re-staging. There were multiple soft tissue density nodules and masses around the abdominal aorta, spleen, left psoas major, left diaphragm foot and left pelvic cavity, some of which had unclear boundaries with adjacent intestines, left adrenal gland and psoas major muscle. The FDG uptake of these lesions increased unevenly, with a SUVmax of 22.5, indicating extensive recurrent metastasis of the tumor –C. Then,Although testicular tumors account for only about 1% of all solid tumors in men, it is the most common solid malignancy in men aged 15–35 years . The WorVarious imaging modalities such as ultrasound, MRI and CT are used for evaluating testicular teratomas. Ultrasound evaluation is often the first choice of imaging modality for testicular teratoma, which typically shows a cystic or solid cystic mass with heterogeneous echogenicity. The mass may contain calcifications and other elements, such as bone and hair. Immature teratomas are richly vascularized due to their predominantly solid component, while mature teratomas are mainly cystic and lack vascularity , 17. WheThe final diagnosis of testicular teratoma relies on pathological examination. Mature teratomas contain well-differentiated tissues, typically including three germ layers. Immature teratomas refer to tumors containing undifferentiated components, resembling tissues at embryonic developmental stage, characterized by immature neuroepithelial islands and varying degree of differentiation including skeletal muscle, cartilage, and stromal cells. For patients with testicular GCT, the distinction between mature and immature teratoma is not of great significance, because both are considered as malignant components and have metastatic potential. Approximately one-third of testicular GCTs are mixed, presenting with two or more different GCT types. Teratoma can coexist with embryonal carcinoma and yolk sac tumor , 22. A s18F-FDG PET/CT examination combined with morphological and metabolic information can be used as a favorable examination to detect metastasis. A literature search was performed on the PubMed and database from 1997 to 2022, using the keyword “retroperitoneal teratoma” and “PET/CT.” There were night cases of retroperitoneal teratoma with PET/CT findings. The basic information and metabolism of retroperitoneal teratoma are summarized in 18F-FDG, with a SUVmean of 1.38 ’ legal guardian/next of kin for the publication of any potentially identifiable images or data included in this article.HJ: Writing – original draft, Writing – review & editing. YQ: Writing – original draft, Writing – review & editing. WH: Writing – review & editing. YZ: Writing – review & editing. ZC: Writing – review & editing. AW: Writing – review & editing, Supervision. LK: Writing – review & editing, Supervision.The author(s) declare financial support was received for the research, authorship, and/or publication of this article.This work was supported by the National Natural Science Foundation of China (82171970), the Beijing Science Foundation for Distinguished Young Scholars (JQ21025), the Beijing Municipal Science & Technology Commission (Z221100007422027), National High Level Hospital Clinical Research Funding .The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Physical examination was remarkable for violaceous tender plaques on the bilateral ulnar aspects of the palms, third left proximal interphalangeal joint, right index pad, and left elbow (Figure A 65-year-old man with diabetes mellitus presented with hematochezia, a fever of 101.6°F, abdominal pain, and a new painful rash on his bilateral hands. Initial colonoscopy was suspicious for ulcerative colitis, but repeat colonoscopy revealed ulceration from the anal verge with skip lesions, making Crohn's disease more likely. Laboratory studies revealed a white blood cell count of 14.7 × 10Author contributions: All authors listed above have made substantial contributions to the conception of the work, drafting the work or revising it critically for important intellectual content, final approval of the version to be published, and agreement to be accountable for all aspects of the work. P. Tran is the article guarantor.Financial disclosure: None to report.Informed consent was obtained for this case report.


Lymphoma is a malignancy arising from lymphocytes or lymphoblasts. It affects the lymphoid system and may be expressed in a variety of ways and behave in different fashions. Depending on the organ involved, aggressiveness, and primary or secondary disease, the expression of lymphoma shows polymorphism and sometimes makes it difficult to diagnose from imaging. This article will describe the image findings of lymphoma in different organ systems of one patient. Lymphoma is a cancer that develops in the white blood cells of the lymphatic system. It can be restricted to the lymphatic system or arise as extranodal disease. The diagnosis of lymphoma is based on pathological histology and is distinguished on a morphological basis between classical Hodgkin’s lymphoma (HL), characterized by the presence of Reed-Sternberg cells, and non-Hodgkin’s lymphomas (NHL) . Non-HodHodgkin’s lymphoma is usually entirely confined to the lymph nodes and typically starts in the upper body. Extranodal HL, although uncommon, may be found in any organ system, either as a primary manifestation or as dissemination of systemic disease.In addition to lymphoma, numerous conditions, such as other malignancy with metastasis, infectious diseases, and autoimmune disorders, can also cause lymphadenopathy and present similar image findings to lymphoma. Since HL is considered a curable malignancy and the differential diagnosis is broad, it is clinically important to discriminate HL from other conditions for patient management. In this article, the image findings in different organ systems of Hodgkin’s lymphoma in a patient will be described.A 31-year-old woman initially presented in the emergency room for left upper chest tightness. Her vital signs, blood exam, and electrocardiogram (EKG) were normal while chest radiographs revealed a large anterior mediastinal mass lesion . On chesExcisional biopsy of right supraclavicular enlarged lymph node was performed, and the pathologic result turned out classical Hodgkin’s lymphoma, mixed cellularity subtype.For progressive back pain, bilateral lower-leg weakness, and urine retention noted during follow-up, enhanced magnetic resonance imaging (MRI) of the whole spine and the brain was performed. Enhanced brain MRI discovered homogeneous enhancing lesions in the left periventricular region and septum pellucidum, which had an isointense signal on T1 weighted image (T1WI) and hyperintense on T2 weighted image (T2WI) . The enhThere are other conditions that can mimic the image findings in different organ systems in lymphoma, such as other malignancy, infection, and metastases. However, some image findings in lymphoma have distinct characteristics and may provide some clues for correct diagnosis. For example, lymphoma in mediastinum usually demonstrates a soft tissue attenuating mass, with smooth or lobulated margins which conform to surrounding structures and cystic areas on CT; pancreatic lymphoma can appear as a well-circumscribed discrete mass or as infiltrative appearance with poor enhancement, and it rarely causes obstruction or dilatation of the pancreatic duct or surrounding blood vessels .Differentiating between lymphoma and other similar-appearing diseases is paramount for the correct management of patients. Despite the fact that multiple lesions in different organ systems make it a challenge to distinguish lymphoma from other primary cancers, infection, or metastasis, there are a number of common imaging characteristics bound to suggest the diagnosis.