Various authors have recommended adjuvant chemotherapy, but outcomes have so far been uniformly poor, with survival extended by months rather than years. We present two cases of this rare condition, which were diagnosed four months apart within our histopathology laboratory andconfirmed the very late presentation of the disease in one and the poor survival of both patients.Primary extraskeletal osteosarcoma is an uncommon disease and has been reported to affect the uterus only rarely. Less than 20 cases have so far been reported in the English literature. The common clinical presentation is heavy bleeding None declared Uterine sarcomas make up less than 1% of all gynaecologicalneoplasms.A 60-year-old Ghanaian woman (para 8), 20 years postmenopausal presented to a district hospital in Ghana with a three-month history of progressively worsening, unprovoked post-menopausal bleeding with associated weight loss. Chest X-ray and other laboratory examinations were normal. Speculum examination revealed blood at the posterior fornix and a necrotic cord-like tissue extending from the endocervical. The uterus was bulky and parametria were free. A pelvic ultrasound showed a bulky anteverted uterus with thickened endometrium.The endometrial cavity showed a fluid collection with echogenic material seen with the fluid. Pouch of Douglas was free and right and left ovaries were not visualised. Endometrial curettage for histopathological evaluation showed mostly necrotic tumour with small viable areas showing spindle and bizarre-shaped giant malignant cells. An initial pathological diagnosis of malignant mixed Mullerian tumour was suggested, and hysterectomy advised.The patient underwent total abdominal hysterectomy, bilateral salphingo-oopherectomy, and pelvic and para-aortic lymphadenectomy.Intra-operative findings: The uterus was 16 weeks, globular, soft with serosa broken antero-fundally by the tumour. Ovaries appeared atrophic with normal-looking fallopian tubes. Few enlarged pelvic and para-aortic lymph nodes were seen. The liver, spleen, gall bladder, appendix and small and large bowels all looked and felt normal on palpation. No gross tumour was seen on the omentum or within the peritoneal cavity.Pathology: A deformed uterus, cervix and both adnexae together weighing 500g. The body of the uterus measured 14x11x10cm, with the cervix measuring 2x2cm. Both left and right ovaries and fallopian tubes were grossly normal. The cut surface of the uterus showed a partly necrotic tan-brown endometrial mass filling the cavity and measuring 10.5cm in maximum dimension  and smooth muscle actin (SMA) . Both ovDiagnosis: Primary osteosarcoma of the uterus (Stage IC).After surgery, she was referred for adjuvant chemotherapy at the Centre for Radiation and Nuclear Medicine, Korle Bu Teaching Hospital, but she defaulted due to financial constraints. Review nine months after surgery revealed bilateral opacities in the lung fields. She subsequently developed bilateral pleural effusion and palpable abdominal masses. Twelve months after surgery, an abdominal ultrasound scan showed a complex solid and cystic mass in the mid-abdomen  measuring 8.17cm x 7.34cm. She died on April 14, 2020, fourteen months after the surgery. No autopsy was done.A 42-year-old woman first presented in 2009 with lower abdominal pain and was diagnosed as multiple uterine fibroids. Teen year later, she presented with prolonged menstrual flow. Abdominal ultrasound showed an enlarged uterus containing fluid. An abdominal CT scan also showed a left adnexal mass with mild to moderate ascites, hepatomegaly, and left lower anterior abdominal wall mass. She was given Goserelin (Zoladex) for three months to shrink the uterus. CT scan of chest showed nodules in the lung. Laparotomy was done in May 2019.Intra-operative findings: Uterus was 18 week-size, with bilateral cystic ovaries. Ascites was 1.2 litres, and there was a tumour attached to the sigmoid colon, extending to the upper rectum. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, resection of the sigmoid colon and upper rectum with the construction of colostomy, appendicectomy and adhesiolysis.Pathology Grossly deformed, multinodular uterus, with the cervix and both adnexa, together weighed 2.1kg. Both right and left ovaries contained tiny cysts but were otherwise unremarkable. Cut surface of uterus showed multiple greyish-white, haemorrhagic subserous, intramural and submucosal nodules, the largest 11cm in diameter  and smooth muscle actin (SMA) .Diagnosis: Primary osteosarcoma of the uterus (Stage IVB)Post-operatively, she developed pulmonary embolism, chest infection, hypertension, and anaemia, which were managed conservatively. She was discharged on postoperative Day 16. She was re-admitted a month later with severe anaemia and urinary tract infection for which she received appropriate treatment. CT scan of chest showed multiple pleural and pulmonary metastases, nodular deposits in anterior epicardial fat, mediastinal and extrathoracic lymphadenopathy, but no pleural or pericardial effusion and no thoracic bony lesions. Pelvic and abdominal CT-scan showed complex solid/cystic lobulated mass arising from the pelvis and multiple metastases involving retroperitoneum, anterior abdominal wall, and along the colostomy site subcutaneously. No osseous metastatic deposits or pathological fracture was noted. The bladder was encased in the tumour, with moderate left obstructive uropathy.The patient received five cycles of radiotherapy during which she developed intestinal obstruction, with large left paracolic gutter and right lumbar intra-abdominal masses causing mass effect on adjacent structures. Chemotherapy was recommended, but she went rapidly downhill and died four months after the initial surgical intervention. No autopsy was done.Primary osteosarcoma of the uterus is a rare tumour. The earliest report of a case in English literature was by Stier and Lyman in 1936.The most reliable diagnostic tool is the microscopic examination of H&E-stained sections of the tumour. Histological parameters include features of a malignant mesenchymal neoplasm, with osteoid formation, lacking an epithelial component,14These two cases satisfy the three criteria specified for diagnosis of primary osteosarcoma of the uterus, namely: exclusion of primary bone lesion, presence of neoplastic osteoid and absence of epithelial or other specific homologous uterine elements.9Metastasis from a skeletal osteosarcoma was also excluded in our two patients by absence of skeletal lesions on imaging studies.Successive reports have indicated that chemotherapy is the most useful adjuvant therapy. Trial of radiotherapy in the second patient with advanced disease proved disappointing, as she demonstrated rapid spread of the tumour within a short time. Unfortunately, the first patient with a relatively early stage of the disease could not afford the chemotherapy treatment recommended. Although suggested as the most appropriate adjuvant therapy, the ideal chemotherapy regimen for primary osteosarcoma of the uterus remains unsettled. Most recommended chemotherapeutic agents are derived from protocols used for the much commoner skeletal osteosarcomas or other soft tissue sarcomas. Despite chemotherapy, the disease has been reported to pursue a rapid course, leading to death within months. The longest surviving patient in the literature lived to 37 months.9Patients diagnosed with primary osteosarcoma of the uterus in the literature were aged over 40 years, as in our two aged 60 and 42 years, respectively. Our 60-year-old patient also gives us an insight into the possible natural progression of the disease without the benefit of adjuvant chemotherapy, from a relatively early stage into a rapidly progressive disease leading to death ten months after diagnosis. Our second patient presented with a more advanced stage of the disease, went rapidly downhill despite radiotherapy and died within four months. These two cases confirme that the disease pursues an aggressive course despite adjuvant therapy.per vaginam. The diagnosis was based on histological examination of the tumour and the establishment of its primary nature in the uterus, through absence of homologous uterine components in the tumour. Our two cases further emphasise the rapid progression of the disease, resulting in death within months. This paper also highlights in the 60-year-old subject the difficulty cancer patients face in accessing quality health care in poorer countries such as Ghana.Two cases of primary osteosarcoma have been presented, essentially to raise awareness of the condition in older women, as a cause of prolonged bleeding


An intradural extramedullary myxopapillary ependymoma is a rare spinal cord tumor found in the thoracolumbar region of the spine. In this case report, we describe this case and review the various aspects of ependymomas. There are different types of ependymomas based on their location and histopathological appearance. Myxopapillary ependymoma is a non-invasive, slow-growing benign tumor that can present as a simple complaint of lower back pain to a severe stage like paraplegia. Ependymoma is a benign tumor of ependymal cells of the spinal cord and central nervous system ,2. EpendHistory of present illnessA 67-year-old female presented with complaints of pain in the lower back for two years, and weakness in both lower limbs due to which she was unable to walk. She lost her bladder and bowel control and developed dribbling of urine. The pain was insidious in onset and gradually progressed. Severity had increased in the last month. It was hindering her daily activities. Pain radiated to both feet. The pain was constant throughout the day, aggravated by movements, and reduced by medications and rest. The pain was also associated with a tingling sensation in both lower limbs. There was no diurnal variation. There was no history of heavy weight lifting or trauma. The bladder and bowel involvement was present.ExaminationThe patient was lying on a bed. Spinal curvature was normal, and the local temperature was not raised. Bony tenderness was present over T11-L1, and paraspinal muscle spasm was present. On the Straight leg raising test, the patient felt pain on the left side at 20° and on the right side at 30°. The Lasegue sign was positive. Sensations were intact. All the deep tendon reflexes were elicited. Higher functions and cranial nerves were intact. Muscles were hypotonic. Planters were non-responsive. Wasting of muscles of lower limbs was present. Table InvestigationsThe patient underwent an MRI (Magnetic Resonance Imaging) of the spine, where a well defined longitudinally oriented, altered signal intensity lesion was noted in the intradural, extramedullary compartment extending from the upper border of D12 to the lower border of the L1 vertebra (in front of conus medularis), showing hyperintensity on T2 weighted (T2W) MRI and showing post-contrast enhancement. The lesion was displacing the cord posteriorly. Figure DiagnosisA myxopapillary ependymoma (WHO grade I) over T12-L1 with paraplegia was diagnosed.Treatment Posterior decompression and excision of tumor at T12-L1 level for space-occupying lesion over T12 -L1 done under general anesthesia. The patient was advised post-operative radiotherapy to prevent a recurrence. Further, antibiotic coverage and pain relief were managed. Figures Histopathological findingsAfter the surgery, the patient's sample was sent for histopathological examination to confirm the diagnosis. The section shown in Figures Post-operative advice and follow-upThe power improved to grade III/V in the foot, ankle, knee flexors and extensors, hip flexors, extensors, abductors, adductors, and rotators of both sides. Urinary catheter clamping was started 48 hours after the operation. The patient started getting a bladder-filling sensation on day 5 of the surgery. She went home with the catheter. At the time of discharge, bladder training and catheter care were given to the patient and her attendants. The patient was discharged with the advice of back extension exercises, deep breathing exercises, vitamin B complex supplements, and plenty of fluid intake. On day 15 of surgery, on examination, the power had improved to grade IV/V in all lower limb muscles on both sides. The catheter was changed. After one month, the catheter was removed as the bladder and bowel control was restored and power was grade IV/V + in all the muscles of the lower limb on both sides.Ependymomas are benign tumors of ependymal cells lining the central canal of the spinal cord and the brain parenchyma . They caThe myxopapillary ependymomas show myxoid background with round to oval nuclei that form rosette-like structures around the vessels with some hemorrhagic focus and some collagen accumulation. Sub-ependymomas show hypocellular clusters of cells in an abundant glial matrix. Classic ependymoma shows a papillary pattern, clear cells regularly arranged in a true rosette; tanycytic is a rare variety with elongated spindle-shaped cells with eosinophilic fibrillary processes arranged in bundles. Anaplastic ependymomas show hypercellular, hyperchromatic cells in a pseudo-palisading pattern with microvascular proliferation without any rosettes. RELA fusion-positive ependymomas include sub-tentorial ependymomas in the pediatric and adult populations ,4. HOX family genes, and other genetic aberrations may be analyzed for ependymomas. For example, spinal ependymomas are more related to the NF2 mutation. Also, the MDM2 overexpression or mutation may be responsible for the dysfunction of the p53 gene, thus leading to the uncontrolled growth of the cells. The exact etiology is not yet clear, though [As far as the etiology is concerned, it varies with the age the tumor presents and the location of the tumor. The grade of the tumor also varies with the genetic aberrations. Few studies point towards the Warburg Effect, and other metabolic pathway alterations may lead to tumor growth. Upregulation of HIF1 alpha increased expression of , though .Clinical features of myxopapillary ependymoma are very vague. They can range from lower back pain to any neurological symptoms due to compression or irritation of any nerve root. In this case, the patient had paraparesis and a positive Lasigue straight leg raising sign. It may also present with vertigo, any ophthalmic symptoms due to papilloedema , vomiting, etc. ,9.Differential diagnoses of myxopapillary ependymomas can be schwannoma, paraganglioma, fibrous meningioma, chordoma, giant cell tumor, or meningioma . TreatmeThe prognosis depends upon the grade, location, and invasion of the tumor ,4. Also,This case report describes the rare spinal cord tumor, Myxopapillary Ependymoma (WHO grade I), that presented with lower back pain and paraplegia. This case is rare in this age group, and the tumor's location is different from the conventional one, which is expected to happen in the cauda equina and filum terminale. Treatment and prognosis depend upon the grade, location, and various patient factors.


Hemangiopericytoma is a rare type of tumor, which was first described in 1942 by Stout & MurrayA 34-year old male patient with a lesion on the right tongue border, with two months of onset, with slow and progressive growth . He had The hemangiopericytoma is uncommon in the head and neck2.Angiographic characteristics may help differentiate hemangiopericytomas from other types of hypervascularized tumors. Image studies, such as radiographies, CT scans and angiography are not specific. MRI reveals a solid mass with isodense contrast in T1The differential diagnosis of highly vascularized tumors in the head and neck is a challenge, especially because of the difficulty in differentiating hemangiopericytomas from other tumors which have a prominent vascularizationThe treatment of choice is complete surgical resection of the lesion. Adjuvant radiotherapy and chemotherapy may be indicated in cases in which there is only a partial resectionRecurrences and distant metastases are rare in patients treated with complete surgical excision; nonetheless, most of the patients who had metastases or recurrences were diagnosed after over 40 months of follow up; suggesting a long standing postoperative follow-up for all the patients


Adrenocortical carcinoma is a rare malignancy (0.5–2 cases/million/year) with a poor prognosis. Hypercortisolism, virilization, and compressive features are among the common presentations of adrenocortical carcinoma. Hematuria is one of the rare initial presentations of adrenocortical carcinoma reported in the literature. We report a case of adrenal carcinoma presenting with microscopic hematuria.A 67-year-old Sri Lankan patient with diabetes, hypertension, and ischemic heart disease presented with an acute coronary event. During the routine evaluation, microscopic hematuria was detected without proteinuria or active sediments. She denied any painful micturition, previous similar episodes, or abdominal pain. Further evaluation revealed a hypokalemia with biochemical evidence of hypercortisolism and high testosterone levels with suppressed adrenocorticotropic hormone levels. On imaging, there was evidence of a right suprarenal mass 7 cm × 3 cm × 6 cm in size that was hypoechoic and lobulated and suggestive of a lipid-poor tumor. She underwent adrenalectomy. By the time of surgery 3 weeks later, significant weight gain with features of Cushing syndrome, including hirsutism, skin atrophy, easy bruising without virilization, and proximal myopathy, were noted. Histology identified a right-sided adrenal tumor with capsular and vascular invasion. Hypercortisolism and hematuria disappeared after surgery. The patient was referred for further oncological management.This case illustrates a rare presentation of adrenal carcinoma. Awareness of this presentation may facilitate early evaluation and management. Adrenocortical carcinoma (ACC) is a rare malignancy (0.5–2 cases/million/year) with a poor prognosis . Hyperco2. Gradually she developed hirsutism, thin skin, and easy bruising. However, there were no features of virilization or proximal muscle weakness. During the investigation, she developed hypertensive heart failure with recurrent non-ST-elevation myocardial infarctions, which was treated in the intensive care unit. With greatest precautions, adrenalectomy was performed. Histology revealed right-sided adrenal carcinoma with vascular and capsular invasion. Following the surgery, her cushinoid features were abated. Latest 9 am cortisol was 485 (166–507) nmol/l, serum free testosterone was 1.1(0.1–1.7) pg/ml, and low-dose dexamethasone suppression test was suppressed to 46 (50) nmol/l. Hematuria settled. She was referred for further specialized oncological care with the histology report.A 67-year-old Sri Lankan lady with a history of diabetes and hypertension and ischemic heart disease presented to the National Hospital of Sri Lanka (NHSL) with a history suggestive of ischemic chest pain. While she was being treated for an acute coronary event, microscopic hematuria with 50–60 red cells without proteinuria or casts was noted. She denied any painful episodes of micturition, abdominal pain, or previous similar episodes. Abdominal examination was unremarkable. Urine for dysmorphic cells was negative. She also had hypokalemia (serum potassium 3.1 mEq/l). Her cardiac function was satisfactory. Renal, liver, and thyroid functions were normal. Ultrasound scan revealed a right-sided, 7 cm × 3 cm × 6 cm, suprarenal mass that was hypoechoic and lobulated. Contrast-enhanced computed tomography (CT) scan of abdomen was done and revealed a well-defined oval-shaped, soft-tissue-density lesion in the right suprarenal region suggestive of a lipid-poor adenoma. Her 9 am cortisol was 628 (166–507) nmol/l, serum free testosterone was 14.3 (0.1–1.7) pg/ml, and dehydroepiandrosterone (DHES) was 3.91 (0.03–5.8) μg/ml. Cortisol was not suppressed with high-dose dexamethasone. Adrenocorticotropic hormone (ACTH) level was < 5 (10–50) pg/ml. Renin–aldosterone ratio and urine vanillylmandelic acid were normal. While awaiting surgery for adrenal carcinoma, in 3 weeks’ time, significant weight gain was noted with an increase in body mass index (BMI) from 26.5 to 30 kg/mAdrenocortical carcinoma (ACC) is a rare malignancy with an incidence of 0.5–2 cases/million/year . ACC canAdvanced adrenal carcinomas present with vascular invasion mainly into renal vein and inferior vena cava (IVC). Since this patient had histologically proven vascular invasion, this is the most likely explanation for the hematuria. Right-sided ACC may grow into the IVC more frequently than left-sided tumors. Left-sided ACC extends into the IVC through the renal vein . There iHowever, hematuria being the initial presentation of the ACC before the onset of features of hyper functioning adrenal gland is an unusual presentation.Definitive cure requires adrenalectomy with intra- and postoperative glucocorticoid replacement in all patients with autonomous cortisol secretion followed by mitotane treatment if indicated . To dateThis case illustrates a rare presentation of a case of adrenal carcinoma. Our patient had a right-sided ACC with histologically proven local vascular invasion that may have caused the hematuria with possible micrometastasis. Since this is a rare condition with poor overall prognosis, awareness of this rare presentation may facilitate early evaluation and management.


Bronchopulmonary sequestration is a rare congenital lung dysplasia. An intralobar sequestration (ILS) is a nonfunctional mass within the lung parenchyma without bronchial communication and with aberrant systemic arterial blood supply. Surgical resection or close observation can be proposed in the management of asymptomatic and low-risk ILS, but there is a lack of consensus. Endovascular embolization before thoracoscopic resection of ILS has been described to limit perioperative bleeding. Another technique previously reported is the injection of methylene blue in the feeding artery to macroscopically mark the sequestration from the healthy lung. In that way, a nonanatomical resection can be performed instead of a lobectomy without the risk of leaving abnormal lung tissue in place. We describe the first two cases of these two techniques combined: a 3-year-old girl with an ILS in the right lower lobe with an artery originating from the abdominal aorta, and a 14-month-old girl with an ILS in the right lower lobe with an artery coming from the celiac trunk.The combination of embolization and injection of methylene blue in the aberrant artery leads to a clear macroscopic demarcation of the blue-colored ILS from the healthy lung parenchyma and allowed safe nonanatomical resection of the ILS without risk of bleeding or compromising normal lung tissue. Bronchopulmonary sequestration (BPS) is a rare congenital lung dysplasia which can exist as extra- or intralobar sequestration (ILS). ILS consists of nonfunctional lung parenchyma without bronchial communication and with an aberrant systemic arterial blood supply. Unlike the extralobar sequestration, an ILS shares the same pleura with the rest of the lung.Since ILS is known to cause recurrent pulmonary infection and hemoptysis, early and prophylactic surgery is offered especially for symptomatic or high-risk ILS. A high-risk ILS consists of a large sequestration with possible mass effect, or if another diagnosis is suspected (pleuropulmonary blastoma).Minimal invasive surgery such as video-assisted thoracoscopic surgery (VATS) for ILS is safe, and few long-term comorbidities are associated.New techniques have emerged in the treatment of ILS, such as endovascular embolization of the feeding artery before the actual removal of the mass, which decreases the perioperative risk of bleeding.In this article, we describe the combination of embolization and methylene blue injection of the aberrant feeding artery followed by VATS resection of ILS in two patients.A 3-year-old 12.5 kg) and a 14-month-old (10 kg) female patients were referred to our hospital for management of ILS. Both cases had been diagnosed prenatally, and both patients had been asymptomatic since birth. A contrast-enhanced computed tomography scan of the chest was performed to complete the work-up. The mass localization in the lower lobe and its radiologic characteristics confirmed diagnosis of an ILS in both cases. The feeding artery was identified as originating from the abdominal aorta in the 3-year-old girl and from the celiac trunk in the 1-year-old girl and2..5 kg andThe procedure and risks were explained to the parents and an informed consent for this combined technique  was signed preoperatively. Both patients underwent the same surgical procedure, which was executed in a hybrid theater room. Conventional endotracheal intubation was used in both cases. Standard intraoperative monitoring included electrocardiogram, direct measurement of arterial and central venous pressure, pulse oximetry, continuous monitoring of temperature, and arterial and central venous blood gases.First, our interventional radiologist performed an embolization of the aberrant artery by endovascular coiling via the right femoral artery. Once the coils had been introduced, 10 mL of diluted methylene blue (1 ampoule of 10 mg/1 mL methylene blue diluted with physiologic serum) was injected within the artery and2. After the endovascular step, we positioned the patient in left lateral decubitus and proceeded to resection of the mass by VATS, using the 3 mm Bolder sealer and2, The pathological analysis of the ILS resection confirmed diagnosis in both patients. Postoperative evolution was favorable for both children. The 1-year-old girl was discharged on the first postoperative day and the 3-year-old girl on the fourth postoperative day. The older girl had a longer stay because of the thoracic drain with secondary pain, and she also had ongoing difficulties with weight gain warranting longer surveillance of her food intake after surgery. Postoperative follow-up (FU) at 10 days and 3 and 12 months revealed no complications and both patients had a normal chest radiography.Prophylactic surgery for ILS management is still recommended in most centers to prevent infection or hemoptysis and to confirm the diagnosis on histopathology, especially since thoracoscopy is safe and without long-term comorbidities.Once surgery is proposed, a minimal invasive approach is nowadays preferred because of reduced postoperative pain and shorter hospital stay, and prevention of long-term musculoskeletal consequences of a thoracotomy.Methylene blue is a dye used in different settings such as oncologic and intestinal surgeries.Methylene blue injection in the aberrant artery provides a macroscopic clear distinction between healthy and abnormal tissues to perform a targeted resection of the mass. We recommend marking the mass by electrocoagulation after the methylene blue injection because the discoloration disappears after a few minutes because of the remaining venous drainage.The embolization takes away the risk of intraoperative bleeding, making it possible to undertake safe and complete resection sparing normal tissue. The most important limit of this technique is the availability of an interventional radiologist and a hybrid operating theater. Ideally, this operation should be performed in a hybrid operating room to avoid moving the patient under general anesthesia from the radiology department to the operating theater.This is, to our knowledge, the first report of two cases of ILS managed with a hybrid technique using endovascular embolization and methylene blue coloration before minimally invasive lung-sparing surgery. Both patients are in perfect health and no complications occurred at 1 year FU. This combined technique leads to a safer resection with less risk of bleeding and healthy lung tissue preservation without compromising resection margins.


Streptococcus sanguinis.A 68-year-old man with a known history of pulmonary tuberculosis (TB) was admitted to our hospital following sudden onset of left hemiplegia. Cranial magnetic resonance imaging (MRI) showed multiple hyperintense lesions on T2-weighted images with surrounding vasogenic edema  and ringS. sanguinis is a facultative anaerobic commensal bacterium found in the oral cavity. Central nervous system infectiondue to S. sanguinis has rarely been reported in the literature. Facilitating conditions included infective endocarditis, pulmonary arteriovenous fistulas, and history of craniotomy in previously reported cases-S. sanguinis. Moreover, the diagnostic challenge posed by the patient’s history of pulmonary TB is noteworthy. Awareness of this pathogen as a rare cause of brain abscess will help clinicians determine the accurate diagnosis.To our knowledge, this is the most severe case of brain abscess caused by


Dyke-Davidoff-Masson syndrome (DDMS) is a rare disease affecting the brain with almost 100 cases previously reported, with only 21 cases among adults. Due to the intricacy of clinical manifestations and radiological findings, it is difficult to reach the diagnosis. It usually includes atrophy of the cerebral hemisphere, dilation of the lateral ventricle, hypertrophy of skull bones, and hyperpneumatization of air sinuses. Herein, we present a case of a 55-year-old female patient who presented with a new-onset seizure. This case emphasizes the importance of considering DDMS in the differential diagnosis of adult-onset seizures, especially in patients with a previous history of brain insult, and demonstrates the possibility of developing this condition despite the lack of childhood symptoms. To our knowledge, this is the first case reported in Jordan. Dyke-Davidoff-Masson syndrome (DDMS) is a rare neurological condition with the main characteristic of cerebral hemiatrophy on brain imaging . Since 1A 55-year-old female patient presented to the emergency department following a generalized tonic-clonic seizure for the first time. After ensuring the stability of the patient, a thorough history was taken from her and her family. She had an unremarkable childhood with normal developmental milestones, until the age of 23 when she had a stroke. Workup for vasculitis, thrombophilias, and vascular embolisms was unremarkable at the time of the stroke, and no clear cause was established. On physical examination, she had facial asymmetry and hemiparesis. Muscle strength on the right upper limb and lower limb was 3/5, while the left upper and lower limbs had a score of 5/5. Upper and lower limbs’ sensation and proprioception were normal. Additionally, she scored 27 out of 30 on the Mini-Mental State Examination (MMSE). Laboratory tests and a septic workup were ordered in which normal results were found.On magnetic resonance image (MRI), axial T2 image showed extensive encephalomalacia changes in the left frontotemporoparietal lobes, indicating left cerebral hemiatrophy corresponding to a previous infarction of the left middle cerebral artery (MCA) territory, and associated skull vault thickening Figure .On the axial flair image, gliosis of the frontotemporal lobe as a result of the previous insult was evident Figure .An ex vacuo dilatation of the left occipital horn of the lateral ventricle was also found on the axial T2 image Figure .Enlargement of the left frontal sinus and left mastoid air cells were found as well Figure .There is also an elevation of the petrous ridge Figure .All of the previous findings are classical characteristics of DDMS, which along with the clinical presentation were enough to make the diagnosis. The patient was started on valproic acid to prevent seizure recurrence.Dyke-Davidoff-Masson syndrome (DDMS) is a rare neurological condition named after the three physicians who first described it in 1933 with nine patients presenting with hemiparesis, facial asymmetry, seizures, intellectual disability, and skull radiography findings of pneumatoencephalographic changes . The patDDMS presents clinically with a variety of possible features that may differ in severity depending on the degree of injury. Seizures , facial asymmetry, contralateral hemiparesis, and intellectual disability are some of the more prominent features . AssociaIn addition to the clinical presentation, radiological findings of CT scans and MRI play a core role in establishing the diagnosis and assessing the severity of the condition. These findings vary from one patient to another and typically include atrophy of the cerebral hemisphere at the side of the lesion, along with lateral ventricular dilation and prominent sulci. Other prominent changes include compensatory hypertrophy of skull bones and hyperpneumatization of air sinuses such as the frontal sinus . It has The management approach of DDMS is centered on symptomatic improvement. Anticonvulsant medications for seizure control, physiotherapy for neurological improvement, and speech therapy are some of the modalities used, depending on patients’ needs. In cases of hemiplegia with intractable disabling seizures, hemispherectomy is indicated with a reported 85% success rate . PatientDyke-Davidoff-Masson syndrome (DDMS) is a neurological condition that presents with a constellation of symptoms with various severities that can include seizures, hemiparesis, and intellectual disability with characteristic cerebral hemiatrophy, skull hypertrophy, and sinus hyperpneumatization. Despite being regarded as a childhood condition, adult presentation is possible even without a suggestive pediatric history. Symptomatic management is the mainstay of treatment, although surgical intervention is indicated as a last resort in certain cases.


Even though the histology is fearsome, these are probably the patients who will benefit from upfront surgery. Chemotherapy seemed to behave as surgery, and there is no statistical difference between chemotherapy only, surgery, or adjuvant treatments, even though adjuvant treatments tend to be more successful. New chemotherapies have been reported with notable results in recent years, such as Tyrosine Kinase Inhibitors and monoclonal antibodies. In this complicated picture, new cases are needed to further build shared evidence in terms of diagnosis, treatments, and survival opportunities.In a Surgical Thoracic Center, two females and a man were unexpectedly diagnosed with hepatoid adenocarcinoma of the lung (HAL) in a single year. HAL is a rare lung cancer with pathological features of hepatocellular carcinoma with no evidence of liver tumor or other primitive sites of neoplasms. As of today, a comprehensive treatment is still not written. We reviewed the most updated literature on HAL, aiming to highlight the proposed treatments available, and comparing them in terms of survival. General hallmarks of HAL are confirmed: it typically affects middle-aged, heavy-smoker males with a median of 5 cm bulky right upper lobe mass. Overall survival remains poor (13 months), with a longer but non-significant survival in females. Treatments are still unsatisfactory today: surgery guarantees a small benefit compared to non-operated HALs, and only N0 patients demonstrated improved survival ( Lung cancer is the second most frequent neoplasm in both sexes and the first cause of tumor-related death . BecauseIn addition to the pathological details, the tumor microenvironment has also been little studied. It is a complicated net of signal pathways and molecular interactions that promote cancer development and protect the neoplasm. In HAL, this is still today underexplored: EGFR, ALK, RAS, ROS, MET, and PDL-1 are routinely processed to discover any therapeutical opportunities in lung adenocarcinomas (ADCs), and this also happens in HALs . RecentlThe first description of HAL is dated 1981 and appeared in a scientific report of a patient presenting with lung cancer, high levels of alpha-fetoprotein (aFP), and no evidence of liver disease . In 1990Since 1990, the published case series and case reports have fixed almost three landmarks in HAL. First, a strong male predominance. To date, HAL is found to have a low overall incidence, but in females, it is extremely rare. Male predominance amounts to approximately 80% of cases ,17,18. HSecondly, in pathological reports, HAL is commonly diagnosed with panels showing positivity for HepPar1, aFP, CK7, and pancytokeratin. TTF1, napsin, and CK20 are commonly negative. Immunohistochemical stains and microscopic features of HAL have been previously largely discussed ,10,20,21Finally, patients usually receive a diagnosis of advanced oncological disease, and their expected overall survival is poor. According to previous studies, HAL demonstrates a median overall survival of almost 14–16 months, a 5-year survival rate of 8.0%, and a 2-year survival of 35.3% ,15,22.Therefore, rare cancers suffer from a scarcity of background literature and an absence of a general shared consensus treatment. This unfortunately makes the therapy of these patients unhelpful, thus resulting in an oncological behavior still unclear today. In order to increase knowledge on HAL, we summarized and discussed treatments described in the literature as of today, and we reported three cases of HAL . Increasing the number of rare tumors reported encourages further understanding of the pathological mechanisms behind this cancer in the hope of improving better outcomes and treatment agreements in the future.We interrogated Scopus, EMBASE, MEDLINE, and Cochrane Library online databases, and it was updated to the end of 31 December 2022. To include all the publications dealing with our topic, the query string was composed as (Hepatoid Adenocarcinoma) AND (Lung). We conducted our research according to the updated guidelines for systematic reviews (PRISMA 2020 statement) . Duplicap < 0.05.We conducted descriptive and survival statistics in Jamovi software (v2.3.21)  and R stAnatomopathological reports collected the following issues. The macroscopical examination described: size, site, and height of the neoplasm and the number and size of the resected lymph nodes. The microscopical examination reported: lymph nodes involvement, microscopical aspect of cells organization, and immunophenotypical results that we reported in a dedicated table . Our thoA 67-year-old non-smoker female presented to our Thoracic Surgery Department in October 2021, with an advanced oncological status, for which she was being treated in another hospital.In September 2020, she was admitted to the Emergency Department for left chest pain. A CT scan revealed a 68 mm mass in the upper lobe of the left lung and multiple suspected metastases in both the iliac bones and in the subcutaneous fat of the right buttock. Subsequently, she underwent positron emission tomography (PET) studies which confirmed an increased metabolic activity in the above-mentioned lesions with a maximum standard uptake value (SUV) of 23.2 in the left lung. No other uptake sites emerged, especially in the stomach or ovary. A percutaneous computed tomography-guided biopsy was performed, sampling a lesion in the right ilium. The microscopical examination suggested a poorly differentiated adenocarcinoma with unclear immunohistochemical stain . She underwent chemotherapy with platinum and gemcitabine for 6 cycles. Unfortunately, a CT scan in May 2021 revealed signs of progression. Therefore, the patient was advised to undergo a second-line therapy with Atezolizumab, which had to be interrupted after one cycle due to toxicity presented by asthenia, amaurosis, drowsiness, and arterial hypotension.The patient came to our department in poor general health and with dyspnea. An additional CT scan was performed, showing the further progression of the disease, left pleural effusion with pulmonary atelectasis, multiple bone metastases, and the bilateral involvement of mediastinal and hilar lymph nodes (cT4N3M1). We proceeded to investigate by biopsying a 46 mm diameter left axillary lymphadenopathy, which demonstrated a poorly differentiated epitheliomorphic neoplasm with a solid and micro-acinar pattern. This is compatible with HAL (HepPar1+).Respiratory symptoms were palliated by the placement of a 20Ch pleural drainage and by performing talc pleurodesis . The pat2 mass in the right upper lobe of the lung. The neoplasm highlighted by the CT scan demonstrated a chest wall infiltration between the third and the fifth ribs. It was investigated with a needle biopsy resulting in an initial diagnosis of non-small cell lung cancer not otherwise specified (NSCLC NOS) type. Furthermore, the patient underwent a PET study illustrating an SUV of 16.67 and 6.97 in the mass and in the right paratracheal lymph node station, respectively (cT3N1M0), with no other sites of active glucose metabolism.In January 2022, a 61-year-old female presented with chest pain and shoulder discomfort. A chest X-Ray and a chest CT scan reported a 65 × 57 mm2) with increased necrotic findings. Given these outcomes, we performed a right upper lobectomy with the removal of the second to the fifth ribs using thoracotomy access and a further wall reconstruction with a Prolene patch  dose of 50.4 Gy in 28 fractions. At the end of the therapies, restaging images reported the growth of the lung mass  with a HepPar1+ and a CK7- stain. Moreover, NGS revealed a mutation of exon 11 in the KIT gene (p. N564Y). We returned the patient to our Oncologist for a clinical and radiological follow-up. The patient is still alive 5 months after surgery.2 nodule to the left lower lung that remained substantially unmodified until 2022, when he performed a chest X-ray and a CT scan due to a thoracic trauma, which demonstrated a 33 mm nodule to the left lower lobe. He underwent a bronchoscopy that evidenced a red lesion to the first part of the apical segmental branch. Pulmonologists performed multiple biopsies  with morphologic and immunohistochemical suspects of adenocarcinoma. A further total body CT scan confirmed the lung as a single site of neoplasm. Moreover, the PET scan did not evidence any significative uptake value. According to this unclear diagnosis, the patient underwent left lower lobectomy and loco-regional lymphadenectomy in Video-Assisted Thoracoscopic Surgery (VATS)  . The patAccording to the PRISMA 2020 flow diagram, we identified 50 studies available, with 63 cases of HAL . In thisConsidering our experience and the other 48 cases in which authors reported the proposed treatments, HAL was managed as follows: surgery (25 cases—50.0%), chemotherapy (32 cases—64.0% including 7 cases of adjuvant chemotherapy–13.8%) . FurtherPlatinum was adopted in 21 cases .Paclitaxel (10 cases) and Docetaxel (3 cases) were the most common drugs used in combination with platinum. Pemetrexed was employed five times. Other drugs combined with the platinum-based regimen were Etoposide, Gemcitabine, Uracil, or Vinorelbine.Other drugs combined into a first platinum-based scheme were Pembrolizumab (4 cases), Durvalumab, and Bevacizumab (2 cases). Tyrosine Kinase Inhibitors (TKIs) available as first regimen treatments were Anlotinib, Crizotinib, Erlotinib, and Sorafenib.Some authors also reported a second line or a savage therapy (15 cases—28.3% of treated patients). In six cases, another platinum-based scheme was administrated. Monoclonal antibodies were used in five cases . As concerns TKIs, Anlotinib, Sorafenib, Erlotinib, and Sorafenib were administrated.p = 0.04) especially one year after surgery  A. Surger surgery C. Adjuva surgery D.In 1990, HAL was defined for the first time as an independent and extremely rare primitive tumor of the lung . As of tIshikura and Colleagues reported the differential diagnoses that need to be kept in mind when approaching the diagnosis of HAL . CliniciThe main hallmarks in HAL remain confirmed. It commonly affects middle-aged men (more than 80%) with a heavy tobacco smoke history. The right upper lung is the main affected field, and it is usually diagnosed in an advanced stage as a bulky mass, and pain is a well-reported alarming symptom ,15.Despite the general male predominance of this malignancy, we surprisingly registered two female cases in a single tertiary Center in almost one year, being, to our knowledge, the eighth and ninth cases of female HAL reports. According to Grossman et al. and Hou et al., the patient of Case 2 appeared to be adherent to previous usual HAL features as presenting a right upper lobe mass in a middle-aged smoker with a non-responsive disease after doublet therapy (platinum and paclitaxel) ,15. In tAs we confirmed, survival in HAL remains scarce. Despite this, it appears to be longer in females compared to males. On this point, a clear statistical significance has not been demonstrated yet. Recently, it has been reported that females exhibit general protection against HAL in comparison to males. However, a clear explanation is unknown . In the As concerns treatments, surgery is adopted in about half of HAL cases, but a unique consensus treatment is yet to be outlined. Probably, early stages and N0 HALs demonstrated an interesting, improved survival after surgical treatment because this aggressive histology does not affect cancer development immediately. On this point, the importance of radical surgery in improving outcomes in HAL patients’ survival has already been discussed ,52. In CAs of today, a double or triple regimen of platinum-based chemotherapy is the gold standard medical treatment in NSCLC despite cases of resistance to chemotherapy being registered . This apAt the basis of resistance to conventional therapies, in addition to acquired resistance mechanisms, a still uncertain role is played by cancer stem cells . In thisAnother crucial point is related to the rarity of HAL: it is possible that this rare histology induces pathologists first to consider the neoplasm as NOS, prolonging the time to diagnosis and treatment decision-making (Case 2). Otherwise, it is possible to suspect a diagnosis (as the carcinoid in Case 3), finding HAL in the operative specimens. On this view, when feasible, surgery probably remains an interesting upfront choice in the early stages, and N0 patients will probably benefit from surgical treatment, despite the extremely malignant histology.An emerging and interesting point is reserved for new therapies administrated in HAL. Anlotinib and Osimertinib, the latest novelties in TKI therapy, are ameliorating outcomes in advanced lung tumors . As is wAs we summarized, HAL remains an unclear malignancy with a poor prognosis, and a multidisciplinary approach is mandatory. Free nodes at the early stages (N0) have a greater chance of surviving in HAL compared to N+. Although surgery does not always guarantee a better outcome, it remains an interesting and competitive option when it is feasible. Few promising experiences of monoclonal antibodies and TKIs are going to delineate a wider range of therapies in HAL that must be considered in the future.As a main conclusion, we must consider suspect of HAL any patient presenting with a right upper lobe mass  with a diameter of around 5 cm having no response to routine chemotherapy and an unclear preoperative diagnosis (NOS), especially in men. These cases must be carefully investigated because the scarce prognosis and an unshared consensus treatment make the time to diagnosis extremely valuable.


Osseous metaplasia is rarely detected in benign and malignant lesions in the gastrointestinal tract, especially in the pediatric population under the age of six. Here, we report the case of a four-year-old boy with a history of constipation associated with painless bleeding per rectum for six months which was excised successfully. Microscopically, there was osseous metaplasia with no malignant changes. Further reporting is needed due to the limited cases of osseous metaplasia in colorectal polyps, with unknown mechanisms of pathogenesis and prognostic factors, specifically in the pediatric population. Benign gastrointestinal polyps are the most common type of polyps in children. They are benign masses of normal tissue that may occur sporadically or are inheritable with other syndromes ,2. OsseoA four-year-old boy presented to the Emergency Department (ED) with a history of constipation for two months, followed by painless bleeding per rectum with a protruding anal mass Figure .He was diagnosed with an anal fissure and managed conservatively with pediatric gastroenterology with no improvement. There was no history of fever, rash, joint pain, vomiting, or weight loss. There was a family history of celiac disease with no other significant chronic illnesses. He was referred to a pediatric surgery clinic for further management. Upon physical examination, the patient was afebrile and vitals were within normal limits. A digital rectal examination revealed a pedunculated posterior rectal polyp at 6 o’clock. The remainder of the physical examination was unremarkable. Laboratory tests were all within the normal range. The parents were counseled for surgical polypectomy under general anesthesia.The polyp was then excised successfully, with no other polypoid lesions detected. The polyp was located around 8-10 cm above the dentate line and was carefully excised. On gross examination, a white-tan, soft, polypoidal tissue measuring 1.0 × 0.8 × 0.5 cm and 0.4 × 0.3 × 0.3 cm was noted. Microscopically, a hamartomatous polyp with ulcerations and osseous metaplasia was noted. The tissue showed histological changes that were discussed with the pathologist Figures -4.The patient tolerated the procedure well, with no immediate or delayed complications. He was discharged with instructions, medical management for constipation, and regular follow-up.Osseous metaplasia is a well-known phenomenon found in various organs, such as the nasopharynx and endocervix; however, the rectal polyp is rarely reported, with limited previously reported cases in the literature . Benign Interestingly, almost all pediatric cases are inflammatory polyps with an equal male-to-female ratio -6. The cTable We reported a rare and incidental histopathological finding of osseous metaplasia in a young boy with a prolapsed rectal polyp associated with painless bleeding. Cases of osseous metaplasia in colorectal polyps are few, with unknown mechanisms of pathogenesis and prognostic factors, specifically in the pediatric population. Benign osseous metaplasia should be considered in all colorectal lesions as a differential diagnosis; however, malignant lesions must be investigated and ruled out. We believe this is the second case reported in the literature in Saudi Arabia, and only 21 cases have been reported worldwide. Reporting such findings and understanding the underlying mechanisms would help in determining its outcomes.


Conjunctival lymphangiectasia is a rare pathology that represents the enlargement of the lymphatic vessels localized in the conjunctiva. Patients may be asymptomatic or experience symptoms such as foreign body sensation, congestion, irritation, dryness, and blurry vision.There are various methods of therapy for patients with severe and symptomatic conjunctival lymphangiectasia. Surgical excision has the lowest rates of recurrence.We present a case of a 24-year-old woman with conjunctival lymphangiectasia and a history of left lower limb enlargement and bilaterally enlarged submandibular and upper jugular lymph nodes without an identifiable cause, who presented to the ophthalmology clinic accusing ocular discomfort, foreign body sensation and transparent conjunctival cystic lesions in the left eye for the last five months.Abbreviations: OD = right eye, OS = left eye, OCT = optical coherence tomography, VEGF = vascular endothelial growth factor  The eye’s lymphatic system is present at the conjunctiva, lacrimal glands, and optic nerve level. Therefore, any disruption of its function will automatically lead to eye changes.1].Lymphangiectasia is a rare condition defined as the pathological dilation of the lymphatic ducts, with secondary fluid retention in the interstitial space. The disease can be primary or secondary. The former appears due to the congenital developmental disorder and is associated with various systemic pathologies such as Fabry disease, Turner syndrome, and Nonne-Milroy-Miege disease. The latter is most likely caused by the obstruction of the lymphatic vessel due to various motives: irradiation, trauma, inflammation, and ocular surgery .Most of the time, conjunctival lymphangiectasia resolves spontaneously without treatment. Severe or symptomatic cases may need treatment. Various therapy types are available, such as liquid nitrogen cryotherapy, carbon dioxide (CO2) laser, or surgical excision. Although surgical excision is more invasive, it has a much lower recurrence rate [Fig. 1) and no changes in the right eye (OD). We observed that the conjunctival lesions were immobile and transparent (the sclera could be seen clearly), and there was no chemosis or conjunctival congestion. A 24-year-old woman presented to the ophthalmology clinic accusing a 5-month history of ocular discomfort, foreign body sensation, and transparent conjunctival cystic lesions in the left eye. The initial diagnosis was conjunctivitis with the initiation of the topical treatment (steroids and antibiotics), but without a favorable response. However, several months later, due to the localized aspect of the conjunctival changes, a subconjunctival worm was suspected, and the patient was referred to our clinic. The visual acuity measured with the Snellen chart was 1 in both eyes without the need for correction. The slit lamp examination revealed sausage-like conjunctival cystic lesions in the left eye (OS) .We decided to perform an anterior segment optical coherence tomography (OCT), which revealed cystic fluid-filled lesions of different caliber in the sub-conjunctival space, suggestive of dilated lymphatic vessels  subconjunctival injections. The resection of the lesion and the suturing of the remaining tissue with an 8.0 Vicryl is the option presented by Seven et al. in a case report published in 2018 [In our case, the patient refused the mentioned treatment options for the current moment and is kept under observation.Conjunctival lymphangiectasia is often misdiagnosed because it is confused with other causes of conjunctival swelling. Precise anamnesis and examinations are necessary for an accurate diagnosis and effective treatment.


Primary glioblastoma of the spinal cord (sGB) is a rare and challenging diagnosis. In the diagnostic algorithm, reversible causes should be considered while the diagnosis of sGB is under evaluation. We present a case of cervical sGB mimicking neuroschistosomiasis.A 21-year-old Somali man presented with neck pain, sensory disturbances, and spastic tetraplegia. Cervical spine magnetic resonance imaging with contrast showed a heterogeneously enhancing intramedullary mass spanning from the level of the C1 to T3 vertebrae. Cerebrospinal fluid analysis showed a lymphocytic predominance and elevated protein. Due to the patient’s history of poorly treated schistosomiasis, praziquantel and dexamethasone were initiated while the diagnostic work-up was completed. Three days after the patient was discharged to a rehabilitation facility where he experienced worsened motor function with radiographic progression of the lesion and increased cord edema. The patient underwent a surgical biopsy which confirmed a diagnosis of primary sGB.sGB is an unusual diagnosis that can masquerade as a non-neoplastic lesion. However, the diagnosis of sGB should be considered in patients with an intramedullary spinal cord lesion who exhibit rapid radiographic and clinical progression. Primary glioblastoma of the spinal cord (sGB) is a rare and challenging diagnosis, as it accounts for only 1%-3% of all primary spinal cord tumors -6. EarlyA 21-year-old Somalian male with a recent history of incompletely treated bladder schistosomiasis presented to the emergency department with a three-month history of neck pain associated with paresthesias of both hands and feet, bilateral lower extremity weakness, and gait imbalance causing recurrent falls. The patient’s bladder schistosomiasis was diagnosed six months before the presentation, and he did not complete a full treatment course due to medication non-compliance. Neurological examination revealed spastic tetraplegia, a cape-like sensory loss in the upper extremities, and a stocking-distribution sensory loss to light touch, pain, and temperature.Contrast-enhanced magnetic resonance imaging (MRI) of the brain and the cervical spine showed a centrally located intramedullary expansile mass with heterogeneous enhancement. The lesion was associated with adjacent hyperintensity on T2-weighted sequences and punctate foci of gradient echo blooming, superiorly at the level of the obex and inferiorly extending to the T10 vertebral level  analysis revealed yellowish fluid, a cell count of 28 nucleated cells with 90% lymphocytic predominance and no red blood cells, normal glucose, and elevated protein with a level >300 mg/dL. We made a putative diagnosis of neuroschistosomiasis, and the patient was started on praziquantel and dexamethasone. The patient’s symptoms improved, and he was discharged to an acute inpatient rehabilitation center. Three days later, the patient’s upper and lower extremity motor strength significantly deteriorated. Repeat cervical spine MRI showed significant rostral extension of the lesion into the medulla with increased fluid attenuated inversion recovery (FLAIR) hyperintensity. Repeat lumbar puncture showed an unchanged CSF analysis. The initial diagnosis of neuroschistosomiasis was questioned at this time, and a spinal cord biopsy was performed. Histopathological analysis of the lesional tissue was consistent with sGB, including findings of pleomorphism, high cellularity, vascular proliferation, and central necrosis. The tumor cell populations were bimodal, such that some cells had small cytoplasms with hyperchromatic nuclei, whereas others had large cytoplasms with pleomorphic nuclei and gemistocyte features Figure .Immunohistochemistry showed MIB-1 and p53 labeling indices of 17.1% and 65%, respectively. Despite the best medical therapy, the patient’s neurological symptoms progressed and involved his respiratory muscles, thereby causing cardiorespiratory failure within 48 hours of the biopsy.sGB represents only 1%-3% of all primary spinal tumors . The medSchistosoma haematobium and S. mansoni are the most common parasitic infections of the spinal cord, and they can cause acute and chronic spinal complications. Schistosomaiasis can be curatively treated with a course of praziquantel. Spinal schistosomiasis usually affects the lower thoracic region or cauda equina [It remains challenging to establish a diagnosis of sGB. CSF and serological testing are useful adjuncts to distinguish among the various etiologies of an intramedullary lesion . The difa equina . Given ta equina . Since tFor cervical sGB, no therapeutic intervention has shown any survival advantage to date, and early treatment is not as essential as for an infectious etiology. Currently, sGB remains an aggressive pathology with a dismal prognosis. Clinicians managing a patient with an intramedullary spinal cord lesion should have an appropriate level of suspicion for this neoplastic entity. The risk-to-benefit profile of spinal cord biopsy must be carefully weighed, and surgery should be performed on carefully selected patients after an appropriate evaluation.sGB is a very rare diagnosis that can mimic non-neoplastic processes. One should consider the diagnosis of sGB in patients with an intramedullary spinal cord lesion who develop precipitous radiographic and clinical progression.


Teaching point: Attention to the urethra is essential when looking for urinary tract stones or etiology for hematuria. A 66-year-old male presented to the emergency department complaining of left flank pain increasing with time despite analgesics. The patient was treated for an obstructive lithiasis with a diameter of 12.5 mm at the level of left vesicoureteral junction.ESWL was unsuccessful, and a ureterorenoscopy was performed. During this procedure, a urethral stricture was found, and an retrograde urethrogram showed a large urethral stone which was missed during the last radiological examinations (X-ray and CT).A previous abdominal X-ray showed multiple opacities in the area of the lower pole of the left kidney , arrow. A previously performed CT confirmed the right renal stone , arrow, The retrograde urethrogram showed a filling defect in the bulbous urethra and , arrow aUrinary tract stones are most commonly located in the upper urinary tract. In rare cases (0.3–2%) they can be located in the urethra . UrethraImpaction of the stone usually occurs at the level of the prostatic urethra, although some authors reported higher occurrence in the anterior urethra or equal occurrence in the anterior and posterior urethra.Urethral stones can be primary as they develop in or proximal to a urethral stricture, a diverticulum or a neurogenic bladder, or secondary, descending from the upper urinary system. Acute urinary retention is the usual clinical presentation of a urethral stone. However, urethral stones can cause pain and obstructive symptoms without urinary retention, depending on the size and location. Misdiagnosing urethral stones may lead to urethral damage, urethro-cutanous fistula, incontinence, hydronephrosis and obstructive kidney damage.In conclusion, imaging has an important role in diagnosing a urethral stone, especially when patients present with non-specific complaints such as dysuria of various severity, hematuria or interruption of the urinary stream during micturition.


Given its novelty, there is currently no standard of care. We describe the diagnostic challenges, molecular characteristics, prospective management, and outcome of a pediatric patient with a DGONC, with the aim to increase awareness of this entity and describe clinical behavior and diagnostic uncertainties.Diffuse glioneuronal tumors with oligodendroglioma-like features and nuclear clusters (DGONC) are rare tumors of the central nervous system, having been added as a provisional diagnosis in the 2021 World Health Organization (WHO) Classification of Tumors of the central nervous system (CNS).A 6-year-old male presented with a 2-year history of intermittent vomiting that increased in frequency over the preceding 3 months. Additionally, there was an approximate 18-month history of episodes consisting of breath-holding, shaking of hands, vacant staring, and non-sensical speech each lasting about 20–45 s before resolution, and though initially responsive during the episodes, he became progressively less responsive as time went on. The patient presented to their local emergency department after what was determined to be a focal seizure lasting less than 40 seconds. He had 3 to 4 similar seizures over the following 2 days and was started on antiepileptics. Shortly after, he developed an ataxic gait which prompted neuroimaging demonstrating a right hemispheric tumor with midline shift and mass effect.Initial MRI showed a large, well-defined intraparenchymal mass lesion involving the right frontal and temporal lobes. There was complete encasement of the right middle cerebral artery (MCA). There was no peritumoral edema, no enhancement, and no restricted diffusion. There were no findings of distant or regional metastases. The MRI features suggested a low-grade lesion .The patient underwent a frontotemporal craniotomy with a resultant subtotal resection limited due to the MCA . PostopeBRAF V600E and IDH1 R132 were negative. Mismatch repair proteins were retained. The Ki67 proliferation rate approached 25% focally.The histopathology of the initial surgical resection was initially thought to be consistent with a high-grade glioma. Histology sections showed a moderately cellular, diffusely infiltrating tumor composed of round cells with variable perinuclear halos . Scatter1p/19q co-deletion and no 7q34 duplication with breakpoints in KIAA1549 and BRAF. Additional molecular analysis, including a RNA-derived NGS panel as well as whole genome and RNA sequencing, showed no known pathogenic rearrangements. It was subsequently sent for a DNA methylation array at Universitats Klinikum Heidelberg in Germany. DNA methylation using the brain tumor classifier version 12.5 returned showing a calibrated score of 0.93 for a DGONC , atypical extraventricular neurocytoma (17%), glioblastoma (14%), anaplastic oligodendroglioma (14%), and low-grade glioma (10%).3 Calcification, ganglion cells, apoptosis, and foamy cells have also been seen.3 Strong MAP2, NeuN, OLIG2, and synaptophysin positivity with predominant GFAP negativity has been noted.3 The mitotic index has ranged from 0.42 to 3.38 per mm2, and focal positivity for Ki67 of up to 30% have been observed in prior studies.3 Our case exhibited many of the same features worrisome for aggressive behavior commonly observed in other diffusely infiltrating gliomas. The focal Ki67 rate of up to 30% along with a mitotic count of approximately 9 per 10 high power fields, generated significant discussion about the need for aggressive therapy in the context of a high-grade lesion. Single-cell and confluent apoptosis and microvascular proliferation were also frequent. In retrospect, however, these findings were more evident adjacent to areas of mucinous degeneration and thus may reflect that process rather than an increased tumor grade.In terms of histology, DGONCs have been described as having a clear cell appearance, perinuclear haloes, vascular proliferation, and nuclear clusters.2 In the 3 cases described by Pickles et al., monosomy of chromosome 14 was found in addition to a common focal loss of chromosome 1p and loss of chromosome 3p on the copy number plots.3 Our case also demonstrated a loss of chromosome 14 in addition to a gain of chromosome 17 and a mosaic loss of chromosome 19, with no BRAF alterations, thus showing similar cytogenetic changes to previously described DGONCs. Few studies have shown the presence of tumor suppressor genes located on chromosome 14q.6 Though the loss of such genes may be involved in the pathogenesis of DGONCs, we cannot confirm this based on our case and future research is needed.Deng et al. described monosomy of chromosome 14 as a uniting feature in 30 of 31 tumors; other genetic findings included gain of 17q (58%) and 1q (26%), and loss of 19q (35%).3 The tumors studied by Pickles et al. were well-circumscribed cortical or subcortical supratentorial masses with no lobar predilection.3 Each of these 3 tumors had no perilesional edema, were hyperintense compared to the cortex on T2 and FLAIR weighted sequences and were poorly enhanced with contrast. The tumors also showed calcification of the internal matrix, with a heterogenous signal on diffusion-weighted images and a small focus of low central apparent diffusion coefficient (ADC)3 Our patient’s tumor similarly demonstrated no surrounding edema, heterogenous low T1 and high T2 and FLAIR signal intensity, no diffusion restriction, and no significant post-contrast enhancement. This tumor was predominately solid with multiple small cystic spaces and coarse central calcifications. The lack of perilesional edema, and no diffusion restriction at presentation is unusual for most high-grade tumors, which made our team question the concerning high-grade features noted above and consider a low-grade lesion. The lack of growth between the 2 surgeries further supported this impression.Radiologic features of DGONC are not well described. Deng et al. described their tumors as being within the cerebral hemispheres, stemming mainly from the temporal lobes, and did not exhibit tumor dissemination at first presentation.2 All 3 patients described by Pickles et al. are alive and had favorable outcomes; all patients underwent total gross resection and craniospinal radiation in addition to chemotherapy and are considered to be in complete remission.3 Despite these positive outcomes, we recognize the overall lack of treatment and outcome data for this population, making it difficult to draw definitive conclusions on prognosis. Though our patient is younger in age than those previously described, he has done exceptionally well through close follow-up. He has not undergone any chemotherapy or radiotherapy, and though there is residual tumor, this has exhibited no growth over the 17 months since initial diagnosis.Clinically, Deng et al. found that patients with DGONC had a median age of 9 years with no sex predilection. Though many initial histological diagnoses were high-grade, available follow-up data showed a favorable clinical course with disease progression in only 3 patients. With 2 of these patients had delayed mortality at 25 and 96 months which suggests prolonged follow-up should be considered. However, no therapeutic data were discussed, and availability of follow-up data was limited.Our case was unusual as the symptom interval was prolonged and imaging features were not consistent with a typical high-grade glioma, presenting a diagnostic dilemma that was clarified with the assistance of DNA methylation. Symptom interval for DGONC has not been previously discussed, and there are no studies discussing the optimal treatment of DGONCs. This is the first case in the literature to date that demonstrates prospective follow-up of a DGONC after subtotal surgical resection with no adjuvant therapies; our patient has done well without progression of residual disease. Given the current literature as well as our findings, DGONC is a rare entity that is frequently misdiagnosed and potentially over-treated. At present, classic histopathology and imaging features along with the presence of monosomy 14 strongly suggest a diagnosis of DGONC, especially in cases where methylation profiling is not readily available. The clinical course of our case is encouraging and while wide applicability needs to be cautioned with a single case, close observation following surgical resection of DGONCs may be a consideration in the context of multidisciplinary team review with the possibility to reduce short- and long-term complications associated with chemotherapy and radiotherapy.Neuro-Oncology Advances online.Supplementary material is available online at Supplementary Figure 1. Timeline of diagnostic events. Magnetic Resonance Imaging (MRI), subtotal resection (STR). Immunohistochemistry (IHC), single-nucleotide polymorphism (SNP), Diffuse Glioneuronal Tumor with Oligodendroglioma-like features and Nuclear Clusters (DGONC)vdac170_suppl_Supplementary_Figure_S1Click here for additional data file.


Omental infarction is a rare cause of acute abdomen that can present in both the pediatric and adult populations causing adhesions or abscesses. Presentation may mimic appendicitis; however, ultrasonography may not be sufficient. We discuss the importance of CT imaging for the pre‐surgical diagnosis to avoid serious port‐site injuries. Omental infarction is a rare cause of acute abdomen that may mimic appendicitis. Complications such as adhesions may occur, and hence, CT imaging should be considered for the pre‐surgical diagnosis to avoid serious port‐site injuries. The need for awareness about the condition and preoperative imaging is emphasized.2A 6‐year‐old patient presented to the hospital with acute abdominal pain and constipation, having passed dry, hard motions every 3 days. He was given analgesia and Daflon  in hopes of relieving the symptoms and was discharged. Having severely deteriorated, he then re‐presented to the hospital a week later with a surgical abdomen (rigid and tender with guarding). The patient had a BMI of 22.22, putting him in the 99th centile for age, and classed as “very overweight.” The patient has no surgical history. Differentials that were considered included a small bowel obstruction; however, the patient had no emesis. Further, the absence of fever and a loss of appetite also discouraged a diagnosis of appendicitis.39/L and neutrophilia with 85.7% neutrophils. CRP was also elevated at 35.Routine bloods were acquired prior to surgery showing an elevated white blood cell count (WBC) of 17.8 × 10An ultrasound was requested on suspect of appendicitis; however, it was deemed inconclusive. Further, an abdominal X‐ray was requested which showed fecal and gaseous distension of the large bowel with no evidence of free air under the diaphragms. There was no radio‐opaque calculus or abnormal calcification, which did not lead to any conclusive pathology Figure . Prior t4The patient was then taken for laparoscopic surgery where port sites were carefully chosen to avoid an umbilical insertion as to not pierce the adherent omentum. Open technique was used to enter the peritoneal cavity. The laparoscope was then inserted into the abdomen under direct vision, and a 10 mm port was inserted. Subsequently, the following ports were inserted under direct visualization along with local anesthetic in the typical fashion: a left lower quadrant 5 mm port and a 5 mm right lower quadrant port.After a general inspection of the organs and the abdomen, the omental adhesion was carefully released from the umbilicus Figure . It was 5Omental infarction is a serious condition that can be easily misdiagnosed, as the clinical presentation is similar to other causes of acute abdomen such as appendicitis. Although it is a rare condition, the importance lies in the need of adequate imaging and diagnosis prior to surgery, as we have shown how omental infarction may lead to, or be concomitant with anterior abdominal wall adhesions.9/L were predictive of conservative treatment failure—which our case has reaffirmed.Though it is believed that conservative management may be sufficient in some cases, our case showed that it resulted in deterioration of the patient's state, and hence, surgical intervention was necessary. Moreover, it has been shown that both a younger age and an elevated white blood count ≥12 × 10Some literature suggests ultrasound as the modality of choice in the diagnosis and management of omental infarction6In conclusion, while there have been previous case reports on omental infarction mispresenting as appendicitis, our case indicates the importance of the consideration of surgical intervention in the pediatric population, as well as the necessity for preoperative diagnosis prior to laparoscopic laparotomy to ensure port‐site injury and heavy omental bleeding is avoided.Kareem Omran (First author): Write up of the manuscript as well as literature review. Dr. Wissam Jamal Al Tamr (Senior author) served as a senior physician who operated the case and supervised the write up.No sources of support or external funding.We disclose no conflict of interest.Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.


Capillary hemangioma is a common benign tumor in children. Its presence in the kidney is rare, and there have been only case reports in the English literature. Herein, we report a special case of capillary hemangioma located in the renal hilum, which was suspected to be a paraganglioma.A 44-year-old woman had an irregular mass in the right hilar region. She had a history of hypertension for 3 years, and her 24-hour urinary norepinephrine was slightly high . Abdominal MRI revealed a mass in the renal hilum measuring approximately 4.8×4.0×3.2 cm, slightly low signal intensity on T1WI, and very high signal intensity on both T2WI and DWI. The multiphase enhanced scan showed that the tumor had obvious enhancement with a central hypointense area. Therefore, paraganglioma was initially diagnosed. Phenoxybenzamine was administered over the next 2 weeks. She performed laparoscopic right hilar area tumor resection, and the kidney was preserved. Unexpectedly, the final pathology report was capillary hemangioma.Capillary hemangioma in the renal hilum is extremely rare. Surgery is the first choice to reduce the risk of compression symptoms and to rule out malignancy with respect to an undefined growing retroperitoneal mass. In addition, renal-sparing surgery should be preferred. Capillary hemangioma is the most common benign tumor in infancy and early childhood and is also known as infantile hemangioma. It is a congenital tumor or vascular malformation commonly found in the skin and soft tissues and is caused by the proliferation of vasculogenic cells during the embryonic period , 2. Its In this report, we describe our experience with a 44-year-old woman who underwent surgery due to a suspected paraganglioma, but a histopathological study of the specimen showed capillary hemangioma.A 44-year-old woman was admitted to our hospital with a mass that was found by physical examination and was present in the right renal hilar region. Ultrasonography showed a solid mass in the renal hilum measuring 4.2×3.1 cm. She had no complaints of paroxysmal headache, dizziness, heart palpitations, lumbago, gross hematuria, or other discomfort, but she had a history of hypertension for 3 years. The physical examination at admission showed that her weight was 50 kg, her heart rate was 80 beats per minute, her blood pressure was 143/95 mmHg (1 mmHg=0.133 kPa), and there was no tenderness or percussion pain in either of her kidneys. The preoperative laboratory tests showed a 24-hour urinary free cortisol level of 25.06 µg , a 24-hour urinary norepinephrine level of 41.53 µg , a 24-hour urinary adrenaline level of 2.5 µg , and a 24-hour urinary dopamine level of 168.9 µg . Other hormones, including adrenocorticotropic hormones, renin, potassium, aldosterone, and sex hormone levels, were normal. Additionally, a blood test showed a hemoglobin concentration of 142 g/L and a hematocrit level of 40% . She underwent abdominal MRI, which revealed an irregular mass in the right hilar region measuring approximately 4.8×4.0×3.2 cm, slightly low signal intensity on T1WI similar to the abdominal aorta, and very high signal intensity on both T2WI and DWI. The multiphase enhanced scan showed that the tumor had obvious enhancement with a central hypointense area, and the filling of the contrast agent from the edge to the center was delayed. The mass compressed the right renal pelvis and ureter, and the right renal arteriovenous and inferior vena cava were also slightly compressed Figure 1After 2 weeks, the patient had a blood pressure of 100/68 mmHg, a body weight of 52 kg and hematocrit was 33.1%; she also complained of mild nasal congestion. Therefore, she underwent transperitoneal laparoscopic surgery in a 60° lateral position. The kidney was preserved, and the surgery was successfully performed in 2 hours. During the surgery, the tumor was carefully separated from the kidney, renal hilar vessels, and inferior vena cava. The patient’s blood pressure remained stable throughout surgery. The estimated blood loss was approximately 400 ml. The source of blood loss was primarily the blood vessels around the tumor. Several hem-o-locks were used to control bleeding. We also tried to block the renal artery temporarily (within 15 minutes), which was partly effective. The specimen received in the pathology department showed that the mass was nodular, and its greatest diameter was measured to be approximately 4 cm. The mass was mostly solid and was white and brown in color. The cut surface was slightly jelly like with a medium texture, and the boundary was still clear Figure 2Capillary hemangiomas are most commonly found in children and can occur throughout the body. Hemangiomas that occur in the oral and maxillofacial area account for 60% of systemic hemangiomas, and the next most common locations are the trunk and extremities . Most ofCapillary hemangiomas are benign tumors that commonly do not affect normal life. However, the specific site of hemangioma is prone to serious complications, such as an intracranial hemangioma rupture causing intracerebral hemorrhage and an intestinal hemangioma rupture causing gastrointestinal hemorrhage. According to the published literature, there have been less than 40 cases of renal capillary hemangioma reported . There hThe patient in this study had a special case—capillary hemangioma at the hilar site of the kidney was different from the other reported cases. First, this patient had a larger tumor diameter. Second, this patient had a history of hypertension before surgery, mildly abnormal findings on her endocrine tests, and high enhancement on enhanced MRI. Considering the safety of the operation, we first prepared the patient by administering medications for 2 weeks. Then, we performed tumor resection and preserved the right kidney. The mass was accidentally diagnosed as a capillary hemangioma after surgery. Postoperatively, all imaging was reviewed to assess whether a preoperative diagnosis could have been made. Several subdivided bifurcated vessels could barely be observed during the enhanced scan phase of MRI. However, paraganglioma or malignancies are also hypervascular. This evidence was insufficient to draw conclusions. Enhanced CT may show the presence of little enhancement which has been sustained into the delayed phase . RegretfThe growth rate of renal capillary hemangioma is still not clear because only cases have been reported. However, we insist that they must not be ignored in this case. First, surgical excision is often performed for all cases of renal capillary hemangioma, as the imaging appearance is similar to that of malignant lesions. Second, possible rupture of hemangioma could be dangerous. Finally, surgery could reduce the risk of compression symptoms in the future, especially in this case.Capillary hemangioma in the renal hilum is extremely rare and is difficult to accurately diagnose preoperatively. However, excision is appropriate in highly vascular tumors to reduce the risk of compression symptoms in the future and to rule out malignancy with respect to an undefined growing retroperitoneal mass. In addition, treatment options that include renal-sparing surgery should be preferred.The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding author.The studies involving human participants were reviewed and approved by Cancer Hospital Chinese Academy of Medical Sciences (ID:20/245-2441). The patients/participants provided their written informed consent to participate in this study.All authors listed in this manuscript contributed significantly to the study. WJ contributed to writing the manuscript. XL contributed to the pathological diagnosis. LW contributed to reviewing the manuscript for critical revisions. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Cystic hygromas (lymphangiomas) are rarely reported in various animal species, humans included. A hygroma is a benign congenital malformation of the lymphatic drainage system, presenting itself as a mass consisting of multiple cysts of various sizes with a watery content.This report describes clinical, ultrasonographic, and post-mortem findings of a cystic hygroma in a suckling pig. The mass was characterized by a few thin-walled cysts, containing clear yellow serous fluid. Histologically, the central cavity was lined by a single layer of squamous cells, supported by a thick fibrous stroma. On immunohistochemistry, scattered lining cells were weakly positive for Factor-VIII, suggesting their possible endothelial origin.This case report contributes to raising awareness on this condition in pigs allowing early identification in life so that appropriate care can be provided. The case report attributes to science on hygromas in general, as better understanding of pathologic features, the aetiology and appropriate treatment are needed. A cystic hygroma is a benign congenital malformation of the lymphatic drainage system, presenting itself as a mass consisting of multiple cysts of various sizes with a serous content . AlthougAlthough the exact embryonic origin of cystic hygroma is not clarified, it is hypothesized that they result from developmental defects or a cystic malformation of dilated lymphatic channels . In humaIn October 2021, a 3.5-week-old, farm-bred, female crossbred piglet (Landrace × Yorkshire × Terra (sow) × Large White (boar)) weighing approximately 4 kg was presented with a mass cranial to the right femur  was seen Fig. B few aggThe authors present the findings of clinical and post-mortem examination of a case of cystic hygroma (lymphangioma) in a young female piglet. The diagnosis was made on the typical clinical presentation and the macroscopic and microscopic findings. This case greatly resembles the cases mentioned in the only previous study in pigs, by Letko et al. , both inRegarding the pathogenesis of this lesion, based on the age of the animals affected in our and in the previously published studies (piglets) , on the Further research into this topic could be valuable for a better understanding of cystic hygromas and lymphangiomas in general, not only in swine but also in other species, including humans. More understanding with regard to the underlying pathological processes and likely causes could provide a basis for developing advanced treatment and prevention options in such cases in any of the species.Although this case study provides an interesting insight into a rare and under-documented condition, there are limitations. As the rarity and value of the case was not yet appreciated at that time quality and extent of ultrasonographic examinations were limited. For future cases, use of ultrasound or MRI is recommended to visualize the extent and potential communication with other structures of fluid filled cavities in vivo in more detail. In addition, although the fluid content of the mass was not further investigated in this case, cytology or microscopic examination of sediment in addition to protein analyses of the content can provide information about the nature of the content, exudate or transudate, to further narrow down the differential diagnosis. Based on the morphologic and immunohistochemical features, a reactive hygroma developing in the subcutaneous groin region could still not be fully excluded and should be still considered in the list of differential diagnoses. In particular, in the absence of fluid examination additionally supporting the lymphatic origin, a differential might be a trauma-induced damage to the subcutis with necrosis and panniculitis and fluid accumulation forming a reactive fluid-filled cavity (hygroma) surrounded by thick fibrous tissue and sprouting of new blood vessels . In prenEuthanizing the piglet gave valuable insight into the structure and makeup of the lesion, however, it limited our ability to assess changes in the lesion over time and during growth and development of the piglet. Spontaneous resolution of cystic hygromas  as well As hygromas may occur in body cavities without any external signs, and as infected hygromas can be difficult to differentiate from pure abscesses , awarene


Only 5% of pleural neoplasms are fibrous tumors of the pleura, which typically develop from sub-mesothelial mesenchymal tissue of the visceral pleura. These tumors often behave clinically benignly, and when they are larger than 15 cm or occupy more than 40% of the hemithorax, they are referred to as “giant” tumors. Surgical excision is the gold standard treatment, although intra-operative bleeding is one of the major complications.In this case report, we discuss a 39-year-old female patient with a large homogeneous enhancing mass of soft tissue density in the right lower hemithorax with systemic arterial supply from the right inferior phrenic artery. Angiography and embolization were valuable adjuncts in preoperative management. Via thoracotomy, the mass was successfully removed completely with minimal blood loss.Giant SFTP is a rare neoplasm of the pleura. Intraoperative bleeding is one of the main complications during surgical resection, which is the gold standard of its treatment. Angiography and embolization are valuable complements in the preoperative treatment of this type of tumors to reduce intraoperative blood loss and operative times. Only 5% of pleural neoplasms are solitary fibrous tumors of the pleura (SFTP), an uncommon neoplasm that develops from sub-mesothelial mesenchymal tissue of the pleura ,2. DiagnA 39-year-old female presented to the emergency services with complaints of the right lower side of the chest. Her medical history was non-contributory. Upon inspection, it was discovered that her right infra-axillary and infrascapular regions lacked breath sounds. After looking into it, an x-ray of the chest showed signs of a loculated pleural effusion on the right side. A massive homogeneous enhancing mass of soft tissue density of around 14.7 x 15.4 x 13.5 cm was seen in the right lower hemithorax on a contrast-enhanced computed tomogram of the chest. There was no suggestion of a major concomitant mediastinal shift, invasion of the chest wall, or mediastinal lobulation, and the mass was smooth, well-defined, and lobulated. There was no mediastinal adenopathy or pleural effusion that was associated. Additionally, neither necrosis nor calcification was visible Figures , 1B.Preoperative transarterial embolization was performed to facilitate surgical removal of the tumor and to reduce intraoperative blood loss and operative times. Selective angiography with a Simmons 2 diagnostic catheter was performed after common femoral artery access. The right inferior phrenic artery, the unique systemic arterial tumor supply, was embolized by detachable embolization coils (2-3 mm diameters) and 300-500 μm nonspherical polyvinyl alcohol particles  through a microcatheter 2.7 Fr. Subsequently, the mass was successfully resected via thoracotomy two days later with minimal blood loss (100 mL) Figures , 2B.Macroscopic examination of the resected tumor showed a large, smooth-surfaced, nodular tumor, which on the cut section was solid with areas of necrosis Figure . Light mAccording to the morphology and cellular immunophenotype, the diagnosis of benign giant SFTP was signed out. The patient made an uneventful postoperative recovery and was discharged home on the sixth postoperative day.SFTP is a mesenchymal tumor that tends to affect the pleura, which was initially described by Wagner in 1870 and characterized in 1931 by Kempler ,5. The SAt the time of diagnosis, most patients are usually asymptomatic and are usually detected as an incidental finding on a routine chest x-ray. Patients who do have symptoms, it is due to the mass effect on adjacent structures, but these tend to be nonspecific chest symptoms such as chest pain, dyspnea, cough, and, rarely, hemoptysis ,9. A cutA well-circumscribed lobular homogeneous mass with obvious heterogeneity and necrosis, as well as atelectasis and displacement of other structures, is frequently how an SFTP appears on a CT scan. Although no specific computed tomographic characteristics for the diagnosis of SFTP have been documented, the tumors often show up in contact with the pleural surface . On T1-wIn 38%-50% of cases, the tumor is joined to the pleura by a highly vascular pedicle ,10. CollComplete surgical excision is the mainstay of therapy and is curative in almost all benign lesions. The considerable bronchial and systemic vascular supply frequently makes surgical excision difficult. Transcatheter arterial embolization may be useful in circumstances where the tumor has a systemic arterial supply to reduce the blood supply and the risk of perioperative bleeding .Authors' search of Pubmed and Google Scholar revealed 82 cases of giant SFTP reported between 1980 and 2014 . SurgicaGiant SFTP is a rare neoplasm of the pleura, around 50% of cases have a highly vascularized pedicle from which the tumor adheres to the pleura, which makes intraoperative bleeding one of the main complications during surgical resection, the gold standard of its therapy. As seen in our case, preoperative treatment of this type of tumor with transcatheter arterial embolization helps to minimize intraoperative blood loss and surgical time.