We report two cases of the rare complication of a colonoscope incarcerated in an inguinal hernia. The first patient was a 73‐year‐old man in whom a colonoscope was incarcerated in a left inguinal hernia on attempted withdrawal. The incarcerated colonoscope was successfully reduced manually under fluoroscopic guidance. The hernia was subsequently repaired using an extraperitoneal approach followed by a successful colonoscopy. The second patient was a 74‐year‐old man in whom the colonoscope became incarcerated in a left inguinal hernia on insertion. Similar to the first case, the colonoscope was manually reduced under fluoroscopy and the entire colonoscopy was then uneventfully performed. An advanced sigmoid cancer was identified and treated with sigmoidectomy. The hernia resolved after this operation. When a colonoscope becomes incarcerated in an inguinal hernia, the manual reduction should be attempted. Subsequent colonoscopy can be safely performed under certain circumstances. Only a few cases of incarceration of a colonoscope in a hernia have been reported.A 73‐year‐old man underwent screening colonoscopy after several colonoscopic examinations with/without polypectomy. He had a history of hypertension, diabetes, hyperlipemia, cerebral contusion, chronic hepatitis B, and smoking. His Brinkman index was 1,800. He had not recognized the inguinal hernia before the latest colonoscopy. The procedure was initiated under mild sedation with 10 mg of diazepam and 15 mg of pentazocine administered intravenously. A PCF‐H290ZI (Olympus) colonoscope was used. After uneventful insertion to the ileocecal region and observation on the way back, the scope could not be withdrawn. Fifty centimeters of the colonoscope were left in the bowel. During the maneuver, the colonic lumen could be clearly observed. Palpation around the left inguinal region suggested the incarceration of the scope into the inguinal hernia. The patient was moved to the fluoroscopy room and sedated with 5 mg of diazepam and 15 mg of pentazocine, which were added intravenously. A loop of the colonoscope was seen in the left inguinal hernia Figure . Under dA 74‐year‐old man underwent a colonoscopy for occult blood in the stool. He had a history of hypertension, diabetes, femoral neck fracture, chronic pulmonary emphysema, chronic hepatitis C, and alcoholic liver disease. He had undergone two colonoscopies. He had a history of smoking, and his Brinkman index was 800. Before the colonoscopy, he had a known left inguinal hernia, with computed tomography demonstrating the sigmoid colon in the hernia. Colonoscopy was completed under mild sedation using 4 mg of midazolam and 22.5 mg of pentazocine intravenously, and the bowel was not palpated in the inguinal region. A PCF‐H290TI (Olympus) colonoscope was used. On initial insertion to 60 cm, it became impossible to either advance the endoscope or withdraw it, although the lumen was clearly patent. A physical exam revealed bulging of the inguinal region. Incarceration of the scope was suspected, and the patient was moved to the fluoroscopy room. A loop of colonoscopes was demonstrated in the left inguinal hernia Figure . The incIn both cases, the inguinal hernia was on the left side, as in many cases reported previously.Inguinal hernia is a common disease for surgeons but not for gastroenterologists, and the incarceration of a colonoscope is very rare. Obtaining a careful history and physical examination before colonoscopy is important in identifying the possibility of this complication. If a hernia is present, postponement of colonoscopy after inguinal hernia repair should be considered. In the event the colonoscopy must be performed prior to hernia repair, fluoroscopic guidance is recommended to prevent the incarceration of a colonoscope. External manual pressure during colonoscopy may be possible and effective. If the colonoscope cannot be inserted or removed with the lumen visible during the examination, incarceration of a colonoscope should be suspected and confirmed on examination. Continued manipulation may worsen the incarceration or cause perforation. Safe reduction under fluoroscopic guidance should be performed as soon as possible with surgical consultation.As in our two patients, past uneventful colonoscopy could not completely exclude the possibility of inguinal hernia. Older age, male sex, smoking, protease inhibitors, chronic emphysema, and so forth, are known risk factors for inguinal hernia.In conclusion, when a colonoscope cannot be inserted or removed with the lumen visible during colonoscopy, incarceration of a colonoscope into an inguinal hernia should be suspected. Palpation and fluoroscopic examination of the inguinal region should be performed to establish the diagnosis and prevent perforation or other complications. Subsequent colonoscopy after manual reduction may be acceptable in selected patients.The authors declare no conflict of interest.None.


With the advancement in technologies and the development of a vast variety of tests, diagnosing diseases has become relatively easy. However, certain diseases are challenging to diagnose due to their similarities with other disease processes. Primary peritoneal carcinoma (PPC) is one of the infrequent tumors that has a resemblance to an ovarian tumor, often making it hard to diagnose. The symptoms are non-specific, and by the time primary peritoneal cancer is diagnosed, the patient is usually at an advanced stage. Although diagnosis might be suspected based on presenting symptoms, it is rarely confirmed with symptomatology alone, requiring additional tumor markers or radiological studies. Sometimes it is diagnosed after surgical removal of the lesion. Several similarities have been described between PPC and ovarian cancer, with some studies explaining the differences as well. We highlight the importance of careful interpretation of imaging studies for the timely diagnosis of PPC. However, several factors can interfere with the analysis of test results leading to delays in diagnosis and management. Interpretation of imaging becomes difficult, especially in patients with significant ascites. Primary peritoneal carcinoma (PPC) is a rare and aggressive tumor that ordinates from the lining of the peritoneum. The most common presenting symptoms include abdominal distension, abdominal pain, a sense of fullness, nausea, emesis, constipation, increased urinary frequency, dyspnea, fatigue, and weight loss. Diagnosis and treatment of PPC are time-sensitive due to the rapidly progressive nature of the disease. Identification of PPC may be difficult due to its resemblance to ovarian cancer. For an expeditious and definitive diagnosis, extensive studies are required, including specific tumor markers, imaging in the form of computed tomography (CT), ascitic fluid analysis including cytology, and immunohistochemistry. The Gynecologic Oncology Group has established the following diagnostic criteria for PPC: 1) Both ovaries are normal in size or enlarged due to a benign process; (2) the involvement in extraovarian sites is greater than the involvement on the surface of either ovary; (3) microscopically, the ovaries are not involved by the tumor or exhibit only serosal or cortical invasion with dimensions smaller than 5.0 × 5.0 mm; (4) the histopathological characteristics of the tumor are predominantly of the serous type [ Both ovaA 58-year-old African American woman presented to the emergency department of our institution with a chief complaint of diffuse abdominal pain with abdominal distension associated with constipation of one month’s duration and unintentional weight loss of 10 pounds over the course of two months. Her medical history was significant for chronic hepatitis B infection, human immunodeficiency virus (HIV) (absolute CD4 count 398/µL), type II diabetes mellitus, hypertension, and asthma. Vital signs on admission were as follows: heart rate of 128 beats/minute, blood pressure of 125/75 mmHg, temperature of 97.2°F, respiratory rate of 18 breaths/minute, and oxygen saturation of 92% on room air. Initial laboratory investigations were remarkable for acute kidney injury with a creatinine of 2.1 mg/dL (baseline 1.0 mg/dL) and blood urea nitrogen elevated at 33 mg/dL. Human chorionic gonadotropin in serum was elevated at 7 mIU/mL . Laboratory investigations are presented in Table CT of the abdomen and pelvis revealed large ascites, presence of fluid between the layers of the mesentery, increased soft tissue density with an 8 mm focal calcification and distortion in the omentum, mild prominence, heterogeneous enhancement of the posterior body of the myometrium, and prominent endometrial complex measuring 9 mm in thickness Figures , 2. The Serum tumor markers revealed cancer antigen 125 (CA-125) elevated at 214 U/mL, and cancer antigen 19-9 (CA 19-9) was elevated at 53 U/mL. The patient underwent an ultrasound-guided diagnostic and therapeutic paracentesis with the removal of 8.8 L of serosanguinous fluid. Calculated serum ascites albumin gradient (SAAG) was 0, and ascitic fluid and serum lactate dehydrogenase (LDH) ratio was 3.2, suggesting infectious or malignant etiology. Cytologic analysis of ascitic fluid showed multiple clusters of adenocarcinoma cells, favoring Müllerian origin. A preliminary diagnosis of cancer of Müllerian origin was made and the patient was transferred to a tertiary center for an advanced level of care. At the tertiary center, she underwent a repeat CT of the abdomen and pelvis, which revealed moderate ascites, mild peritoneal thickening, and scattered peritoneal calcifications. However, adnexa and endometrium were normal. Again, therapeutic and diagnostic paracentesis was performed with the removal of 350 mL of straw-colored ascitic fluid. Pathology and immunohistochemical studies revealed adenocarcinoma tumor cells that were focally positive for estrogen receptors. Findings were favorable for Müllerian origin and primary peritoneal carcinomatosis. In the absence of an ovarian mass, as outlined in the GOC criteria, a final diagnosis of primary peritoneal carcinomatosis of Müllerian origin was made. Upon symptomatic improvement, the patient was discharged from the hospital with follow-up appointments with hematology/oncology for chemotherapy and continuation of care. Unfortunately, the patient was lost to follow-up with no further electronic records available.TP53, KRAS, EPHB1, BRCA2, or BCOR genes [BRCA1 and BRCA2 mutations being associated with an increased lifetime risk of developing PPC [PPC is a rare tumor that arises from the peritoneal lining and mostly involves the omentum . The exaping PPC . Most paping PPC . This hiGeneral presenting symptoms include abdominal pain and ascites. A study analyzing patients from 1976 to 1988 showed that abdominal pain was seen in 68% of patients, with 52% of patients presenting with ascites [Some studies have described the differentiating points between PPC and ovarian carcinoma. A study by Barda et al. concluded that a higher rate of abdominal distension, ascites volume, and malignant cells were found in ascitic fluid in PPC compared to ovarian cancer . A compaOur patient had ascitic fluid findings compatible with PPC, with tumor cells favoring Müllerian origin. Although initially at our hospital an ovarian lesion was suspected, imaging studies were limited due to extensive ascitic fluid. Further workup and imaging studies performed after repeat paracentesis were consistent with PPC without any evidence of an ovarian mass. Unfortunately, no further information regarding management is available for our patient as she was lost to follow-up.PPC is a rare and aggressive tumor with a female predominance that often leads to a diagnostic challenge due to its similarity with ovarian cancer in clinical presentation. Imaging studies and analysis of ascitic fluid are imperative to help differentiate PPC. Therefore, meticulous analysis and interpretation of the extensive workup are necessary to aid in timely diagnosis and expeditious therapeutics.


Subcutaneous metastasis of colorectal cancer is extremely rare. It is typically associated with a poor prognosis. Herein, we present a case of a 38-year-old young woman, diagnosed with stage III of rectal adenocarcinoma. She received neoadjuvant chemoradiation and was scheduled for total mesorectal excision after eight weeks of delay. During the week preceding surgery, she complained of the occurrence of two subcutaneous nodules, the first one in the abdominal wall, at the left hypochondrium, and the second in the low part of the chest wall. The physical examination showed well-defined, mobile, tender subcutaneous nodules without epidermal changes. The thoracoabdominal-pelvic computed tomography (CT) scan showed two enhanced nodules localized in the abdomen (A) and in the chest walls (B), measuring respectively 10 mm and 8 mm. Given the young age of the patient, it has been decided to perform mesorectal total excision associated with biopsy excision of subcutaneous nodules (C). The histological study of the rectal specimen showed a complete pathological response and safe margins (PT0N0). However, results in nodule specimens revealed poorly differentiated adenocarcinoma that was cytokeratin CK-20 and CDX2 positive (D). These results suggested a metastasis from the lower gastrointestinal tract. Unfortunately, the patient's general condition deteriorated rapidly in the first postoperative month. New subcutaneous nodules appear in the abdominal wall, the chin, and the cuisse. Besides, body CT and 18-Fluorodeoxyglucose positron emission tomography scans revealed disseminated disease including pancreas, adrenal, and peritoneum. The patient started chemotherapy but died after two cycles from a widely disseminated disease.


Abdominal wall endometriosis is the development of endometrial tissue in the anterior abdomen usually due to an operation in which the uterus is manipulated. We herein delineate the presentation, clinical investigation, and surgical treatment of an abdominal wall endometriosis case. A 42-year-old female presented with acute abdominal pain in the lower quadrants in the margins of an old cesarean scar. Two masses in the abdominal wall highly suspected of consisting of endometrial tissue were found during the investigation of the patient. These ones were removed in surgery and endometrial tissue secondary to previous cesarean section was confirmed after histological analysis. Consequently, although rare, if a painful mass in a surgical scar, such as a Pfannenstiel incision, is found in women of reproductive age with a history of obstetric surgery, the differential diagnosis shall include endometriosis. There is a portion of cases in which endometriosis recurs within five years following conservative surgery. Endometriosis is defined as the presence of ectopic endometrial tissue that can respond to ovarian hormonal stimulation . EndometPatient information: a 42-year-old female presented at the surgical emergency department complaining of a painful swelling in her lower abdomen. The pain in the swelling was a dull ache which would aggravate during menstruation. The patient´s medical history included two cesarean procedures via a pfannenstiel incision.Clinical findings: the vital signs were normal and she was afebrile. During clinical examination, the palpation of the abdomen revealed two lumps. The one lump was in the right lower quadrant and the other one in the left lower quadrant, while both of them were near the midline.Diagnostic assessment: the abdominal USG showed a 42mm round, solid mass, with poor blood flow in the anterior abdominal wall (nal wall . She alsnal wall .Therapeutic interventions: the patient, under general anesthesia, underwent wide local resection of the masses. In the operating room, the mass and the local abdominal wall removed en bloc, because endometrial tissue was developed at the rectus abdominus muscle sheath too (eath too . The abdeath too .Diagnosis: the histologic examination evinced the presence of endometrioma -more specific: multiple endometrial glands with variable focal cystic dilatation, surrounding specialized stroma and dense fibrosis between the endometriotic foci. There were no signs of cellular atypia in the histopathological examination of the tissue.Follow-up and outcome of interventions: there were no complications postoperatively and the patient discharged five days later. The woman was disease- free for endometriosis after 1 year at her scheduled follow up appointment.Patient perspective: the patient was satisfied with the diagnostic and the proposed care.Informed consent: the patient gave permission for her images and other clinical information to be reported in the journal. It has been known to the patient that her name and initials will not be published.Endometriosis is the presence of functioning endometrial tissue outside the uterine cavity. Endometriosis of the abdominal wall is a rare entity and difficult to diagnose as the symptoms may be non-specific . The cliThe average age at presentation is 31 years . The incRisk factors for endometriosis include early menarche, shorter than 27-day menstrual cycles, small number of childbirths, age 25-29, Caucasian race, daily consumption of ample amount of alcohol, excessive red meat consumption, and smoking ,14. The Medical treatment with the use of oral contraceptive pills, progestogens, and danazol is not efficacious to cure the patient and gives only incomplete relief in symptoms  and, simGood surgical techniques and proper care during cesarean section might prevent scar endometriosis . It has Scar endometriosis is a rare entity and often elusive that can result to frustration. A high level of suspicion should be maintained in any woman presenting with pain and swelling at an incisional site. History and physical examination are always helpful and every surgeon should consider endometriosis in their differential diagnosis. Wide excision is the treatment of choice whereas follow-up is required due to the possibility of recurrence.


Acute abscess is a common manifestation and needs urgent care. In its advanced stage, it may drain spontaneously through a fistula; it may be extra-oral, depending on the causing tooth, root site, bone thickness and muscle insertionsAn 89 year old male patient was referred because of a 30 year old fistula. During exam we noticed skin attachments in the alveolar border.Periapical and occlusal radiographs were taken and they revealed bone loss. We surgically removed the fistula in order to improve mouth conditions and also to cosmetically improve his face.At the microscope we noticed hair follicles, sebaceous and sweat glands. The diagnosis was of fistula in a regression stage.In the literature, authors recommend endodontic treatment as the first option in fistula treatmentsIn this case, since the causing tooth had been removed some thirty years ago, we chose to remove the fistula.There are not many literature reports on extra-oral fistulas, nor on the presence of skin attachments in the mouth. The single case reported was done by Mitchel6, however this author related it to periodontal disease and a pseudofolliculitis of the beard.Despite being a bizarre case, treatment was simple and we achieved full intra and extra-oral repair.Understanding the etiopathogenesis of lesions is extremely important for proper diagnosis and treatment, and cases reported with unusual characteristics may help in the diagnosis.


Pituitary apoplexy often occurs in patients with previously undiagnosed pituitary adenomas and no predisposing factors. Among patients with precipitating events, there are very few cases of pituitary apoplexy occurring in the setting of systemic chemotherapy treatment. A 31-year-old man with newly diagnosed metastatic testicular cancer developed headaches, nausea, and a right-sided visual field deficit one week after initiation of bleomycin, etoposide, and cisplatin chemotherapy. Computed tomography and magnetic resonance imaging revealed hemorrhage within a pituitary macroadenoma consistent with pituitary apoplexy, and he underwent urgent transnasal resection. We also review the four prior cases of pituitary apoplexy temporally associated with the administration of systemic chemotherapy. Pituitary apoplexy (PA) is a rare but emergent medical condition in which a patient experiences infarction or hemorrhage within the pituitary gland. Common clinical manifestations of PA include endocrine dysfunction, nausea, headache, ophthalmoplegia, and visual disturbances, with the condition confirmed through magnetic resonance imaging (MRI) or computed tomography (CT) imaging . AlthougTo the best of our knowledge, there have been only four prior case reports of PA temporally associated with the administration of systemic chemotherapy -7. We adA 31-year-old man with a recent diagnosis of seminomatous germ cell testicular cancer with metastases to the pelvis and retroperitoneum  presented to the emergency department with several days of severe, progressive bifrontal headaches, nausea, and right-sided blurry vision one week after initiating bleomycin, etoposide, and cisplatin chemotherapy. On examination, he was neurologically intact except for decreased right temporal visual acuity. Head CT and MRI demonstrated a 2.0×2.8×2.1-cm, expansile, heterogeneously enhancing sellar and suprasellar mass displacing the optic chiasm with evidence of internal hemorrhage concerning for apoplexy , elevated insulin-like growth factor-1 (554 ng/mL preoperatively and 423 ng/mL postoperatively) with a normal GH level, and low thyroid-stimulating hormone (0.33 mU/L) with a normal free T4. He was discharged home on postoperative Day 4, neurologically stable on maintenance hydrocortisone.The patient resumed his chemotherapy two weeks postoperatively and underwent a radical orchiectomy two months later. At one-month neurosurgical follow-up, his visual fields were full, and he remained otherwise neurologically intact. Endocrinologic follow-up is ongoing.We discuss a case of PA in a young patient with a previously undiagnosed pituitary adenoma that occurred after the initiation of systemic chemotherapy in relation to prior literature.Pituitary adenomas are relatively common, comprising approximately 15% of all intracranial tumors and occurring in more than 20% of the population -11. AlthBecause only a minority of PA cases have an identifiable predisposing factor, the exact pathophysiology of PA remains unclear ,14. AmonTo our knowledge, there are only four other cases of PA associated with the administration of systemic chemotherapies -7 Table. ConsistGiven the limited prior reports, the mechanism behind chemotherapy-associated PA has not been explored. Some chemotherapy regimens are known to cause hematologic and coagulopathic abnormalities, which can independently increase the risk of PA. This was seen in two of the four previously reported patients ,6, both Given the complex array of side effects that often accompany chemotherapy treatment and the potential for PA to present insidiously rather than acutely -18, the Systemic chemotherapy can rarely precipitate PA in patients with pituitary adenomas, with a total of five reported cases in the literature. Mechanistically, this is likely related to chemotherapy-induced coagulopathies and/or the cytotoxic or ischemic effects of chemotherapy on the tumor. Treatment of chemotherapy-related PA follows standard treatment algorithms, with initial medical stabilization and surgery for patients with visual/neurologic defects. In patients with larger macroadenomas, prophylactic resection may be reasonable before the initiation of systemic chemotherapies.


Colonic diverticulitis is one of the most common gastrointestinal diseases. There are several complications in colonic diverticulitis, such as stenosis, perforation, and abscess. Stenosis is a rare complication and can cause bowel obstruction. We report a case of colonic diverticulitis complicated by stenosis causing bowel obstruction.A 66-year-old Japanese man was referred to our hospital for abdominal pain. Computed tomography (CT) scans showed the presence of diverticula, concentric wall thickening, and pericolic fat stranding in the descending colon. He was diagnosed with descending colon diverticulitis. His abdominal pain improved with fasting and intravenous antibiotics. However, after three months, diverticulitis complicated by stenosis occurred in the descending colon. The stenosis was severe and was treated with left hemicolectomy. Histologic examination revealed diverticula, chronic inflammation, and fibrosis in the stenosis, with no malignancy.Stenosis caused by colonic diverticulitis can cause bowel obstruction. Conservative treatment may lead to recurrence, and surgical treatment is preferable. Colonic diverticulitis is a common gastrointestinal disease and its incidence increases with age. It occurs when the diverticulum becomes inflamed, with the lifelong risk of diverticulitis reported to range from 10% to 25% in people with diverticula [A 66-year-old Japanese man was referred to our hospital for abdominal pain that lasted a day. He had a past medical history of cecal perforation caused by diverticulitis and took no significant medication. Upon examination, his vital signs were normal. Abdominal examination revealed left lower quadrant pain. A blood test showed an elevated C-reactive protein (CRP) of 18.42 mg/dL. Computed tomography (CT) scans showed the presence of diverticula, concentric wall thickening, and pericolic fat stranding in the descending colon Figures , 1B.He was consequently diagnosed with descending colon diverticulitis and was admitted to our hospital on the same day. He was kept nil by mouth and treated with appropriate antibiotics, cefmetazole sodium, and analgesia. His abdominal pain improved and a blood test showed a decrease in CRP levels. After starting oral intake, he had no recurrent symptoms. On the tenth hospital day, he was discharged from the hospital. After discharge, he underwent a colonoscopy to rule out colorectal cancer. The colonoscopy revealed diverticulum and wall edema in the descending colon but no tumor Figures , 2B.A tumor was not found during routine follow-up. But suddenly, he developed abdominal pain and came to our emergency room (ER) after three months. CT revealed a relapse of diverticulitis complicated by bowel obstruction in the descending colon Figures , 3B, andA Gastrografin enema study showed a 6 cm-long segmental stenosis in the descending colon Figure .During evaluation and close follow-up, he was diagnosed with diverticulitis complicated by stenosis in the descending colon. Fasting and antibiotics improved bowel obstruction but after two months, bowel obstruction caused by diverticulitis relapsed Figures , 5B.He was treated with a transanal ileus tube. Following this course, to improve bowel obstruction, a descending colectomy was performed. Histologic examination revealed diverticula, chronic inflammation, and fibrosis in the stenosis, with no malignancy Figure .After surgery, the bowel obstruction and symptoms improved, and the patient was able to resume oral intake. At present, he has no recurrence of bowel obstruction and diverticulitis.A colonic diverticulum is an outpouching of the wall of the colon, which forms a sac. According to modern studies, the risk of developing colonic diverticulitis is less than 5% . The ratStenosis can cause severe distension of the colon, resulting in continuous ischemia of all bowel wall layers and necrosis of the colon . TherefoAs our case showed, once bowel obstruction caused by diverticulitis occurs, it may occur again, even if conservative treatment improves it. In addition, Tehranian et al. reported that the incidence of colorectal cancer and advanced adenoma was higher in patients with diverticulitis as compared with subjects undergoing screening colonoscopy . Hence, In summary, we have presented a case of colonic diverticulitis complicated by stenosis. Stenosis caused by colonic diverticulitis can cause large bowel obstruction and impending rupture. Conservative treatment may lead to recurrence, and early surgical treatment is the preferable basis to prevent further complications.


Left-sided appendicitis is a rare condition, and we report a patient with left abdominal heterotopia of the right colon complicated by acute appendicitis in the left lower quadrant.A 39-year-old male was admitted to hospital following left lower abdominal pain for 1 day. Imaging examination by abdominal CT showed that the appendix was not clearly seen, and a mass was found in the left lower abdomen. Because the patient's abdominal pain was severe and the current diagnosis was not clear, after soliciting the patient's consent, we performed laparoscopic exploration. This exploration revealed that the cecum and ascending colon were located in the left iliac fossa, the appendix was swollen, the length of the appendix was approximately 6 cm, the diameter of the appendix was approximately 1 cm, and there was pus moss attached to the surface. We performed a laparoscopic appendectomy; the procedure was uneventful and the patient was discharged 3 days after the procedure.Left-sided appendicitis is a rare condition and is therefore easy to misdiagnose. Wrong diagnosis can lead to serious complications and endanger the patient's life. Therefore, a full combination of laboratory tests and CT scan is required. If still no diagnosis can be made correctly, a laparoscopic exploration needs to be performed in a timely manner. This case teaches us that when we encounter a patient with severe left abdominal pain that cannot be definitely diagnosed, we need to be vigilant and perform timely laparoscopic exploration when necessary. Intestinal malrotation is attributed to an abnormal development of the midgut during the embryonic period. When the ascending colon rotates in the opposite direction, the appendix is ectopic in the left lower quadrant. When the appendix has inflammation, and if it is not treated on time, the appendix suppurates and perforates, which easily causes periappendiceal abscess, peritonitis, and septic shock, and becomes life-threatening in severe cases . Ectopic9/L, neutrophils was 91.4%, lymphocytes (%) 6.0%, and C-reactive protein 301.2 mg/L. Imaging examination by abdominal CT showed that the appendix was not clearly visible, and a mass was found in the left lower abdomen (9/L, NEU: 61%, LYM: 6.0%, CRP: 3.0 mg/L. Since the patient's blood routine examination was normal on the third day without fever, we stopped using antibiotics and the patient was discharged. Postoperative pathology revealed acute gangrenous appendicitis with periappendicitis (A 39-year-old male patient was admitted to hospital due to “left lower abdominal pain for 1 day.” On physical examination, T was 37.3°C, P 78 beats per minute, R 18 breaths per minute, and BP 115/61 mmHg. There were no obvious abdominal bulge, tenderness, and rebound pain in the left lower abdomen, bowel sounds were 4 times/min, and there was no shifting dullness. Laboratory tests showed that the white blood cell count was 10.2 × 10 abdomen . Because abdomen . Laparos abdomen , and int abdomen . Subsequndicitis , and on Left-sided appendicitis is a rare digestive system disease requiring emergency surgery, is classified according to congenital anatomical abnormalities, mainly situs inversus and intestinal malrotation, and accounts for approximately 93.6% of cases . Due to Congenital abdominal heterotaxy, with the ascending colon located in the left abdomen and the descending and sigmoid colon located in the right abdomen, is often accompanied by heterotopia of other organs such as the heart and liver, and the cecum is also located in the left lower abdomen . HoweverThe symptoms and signs of ectopic appendicitis can vary due to the variation of location, which often brings considerable difficulties to clinical diagnosis and treatment. Ectopic appendix in the left lower quadrant is rare, acute appendicitis is easily misdiagnosed as a sigmoid colon, and urinary system diseases and gynecological diseases occur in female patients . TherefoTo make a correct diagnosis of ectopic appendicitis at an early stage requires surgeons to have rich clinical experience and be familiar with the type and clinical characteristics of ectopic appendicitis. Physicians need to correctly understand the characteristics of severe abdominal pain in appendicitis and its diagnostic value in appendicitis. If necessary, severe pain, combined with imaging examinations and white blood cell count and C-reactive protein test results, to the exclusion of other diseases, can suggest the diagnosis and facilitate improvement in the correct diagnosis rate and reduce misdiagnosis . In partOnce ectopic appendicitis is diagnosed, surgical treatment should be given actively, and for a small number of patients with suspected appendicitis, it is indeed difficult to confirm the diagnosis, and if available, laparoscopic exploration is feasible. Under the laparoscope, the abdominal cavity and pelvic cavity can be explored to determine the diagnosis of ectopic appendicitis and exclude acute abdomen caused by other diseases. Laparoscopic appendectomy can reduce the incidence of incision infection and abdominal abscess. It has the advantages of less trauma, faster postoperative recovery, and fewer complications . TherefoLeft-sided appendicitis is a rare condition and is therefore easy to misdiagnose. Wrong diagnosis can lead to serious complications and endanger the patient's life. Therefore, a full combination of laboratory tests and CT scan is required. If still no diagnosis can be made, a laparoscopic exploration needs to be performed in a timely manner. This case teaches us that when we encounter a patient with severe left abdominal pain that cannot be definitely diagnosed, we need to be vigilant and perform timely laparoscopic exploration when necessary.


Benign lymphoid hyperplasia uncommonly involves the larynx. Involvement of glottis and subglottis is even rare, considering sparse lymphatic supply compared to supraglottis. A young female presented to emergency with worsening breathing difficulty. After securing the airway, she had found to have circumferential glottis and subglottic mucosa covered firm swelling. Histopathological evaluation of the swelling showed it to be benign lymphoid hyperplasia. Coblation assisted excision of the lesion was done, and the patient became asymptomatic without any recurrence. Idiopathic lymphoid hyperplasia is a very rare entity to present as glottis and subglottic lesions. Probably, it's the first case to be reported in the literature as laryngeal involvement sparing the supraglottis.  Benign lymphoid hyperplasia or ectopically placed tonsillar tissue is not rare in sites other than waldeyer’s ring. It usually presents as lymphoid aggregate and may be found in ventral surface of the tongue, floor of the mouth, soft palate, and even in the larynx . In the A 14-year-old female presented with progressively worsening difficulty in breathing over five months. She had associated change in voice for the same duration. The patient had a foreign body sensation in her throat with mild odynophagia. She did not have any cough during oral intake. She did not have any associated co-morbidities or any relevant family history. On initial evaluation with a chest and neck skiagram, significant upper airway narrowing was found. Due to the worsening stridor, the patient underwent an emergency tracheostomy. Direct laryngoscopy and evaluation was also done in the same setting under general anaesthesia. The findings revealed a circumferential smooth mucosa-covered bulge arising from the under-surface of bilateral true vocal cords extending up to 15 mm below its level, causing a near-complete subglottic obstruction . Biopsy was taken from the subglottic mass and sent for histopathological examination. The supraglottic larynx was normal. Vocal cords mobility couldn't be assessed because of the near-complete stenosis. Contrast-enhanced computer tomography Neck and thorax was done, which showed an asymmetrical circumferential wall thickening with mild enhancement involving the subglottic larynx causing severe airway compromise. The histopathological evaluation of the mass reported lymphoid hyperplasia. The patient was then evaluated further to rule out lymphoma or other lymphoproliferative disorders. Any granulomatous condition or auto-immune disorders were ruled out. The nasal endoscopic evaluation showed adenoid hyperplasia, and the rest of the systemic examination was normal. The patient was given a course of oral and inhalation steroid therapy for six weeks. She responded well initially, with subsequent laryngeal endoscopies showing a 30-40% reduction in the size of the mass. Keeping in mind the patient's young age, a decision to taper and eventually stop the steroid therapy was taken. However, over the next few weeks, the mass was found to again increase in size. As medical treatment didn't help, surgical intervention was planned. Coblation assisted removal of the glottis-subglottic lesion was done circumferentially preserving bilateral vocal cords. A Montgomery T- tube was placed as a stent to maintain the subglottic lumen and to prevent restenosis . The excised mass was again analyzed histopathologically by two independent pathologists. The microscopic analysis shows fragments of mucosa lined by squamous epithelium, and sub-epithelium shows multiple foci of lymphoid infiltration with entrapment of mucosal glands . The infiltrate was composed of both lymphocytes and plasma cells. There was no evidence of granuloma or malignancy seen. Thus, a diagnosis of ‘Idiopathic lymphoid hyperplasia’ was made. Twelve weeks later, she was evaluated, and the glottic and subglottic airway seems normal on X-ray. Montgomery tube was removed, and tracheostomy tube was placed, and corking was done. On follow-up, the glottic and subglottic lumen were found adequate, and she was decannulated . She is The larynx has a huge lymphatic supply, especially the supraglottic part. Thus, various lymphatic disorders also can involve the larynx either primarily or a part of systemic involvement. Primary lymphatic disorders of the larynx are very uncommon, which include mucosa-associated lymphoid tissue lymphoma (MALT-type lymphoma), a form of Non-Hodgkin lymphoma, or maybe a presentation of true lymphoma. The presence of benign focal nodular hyperplasia in the larynx has been reported infrequently in the literature. It may present with some foreign body sensation, change in the voice, or breathing difficulty. In our case, focal lymphoid hyperplasia involved the glottis and subglottis, which is very rare considering very sparse lymphatic circulation. Also, presentation at 14-year age is very uncommon for this age. Regarding laryngeal lymphoid hyperplasia, probably the first case was reported by Climie ARW, Waggoner LG, and Krabbenhoft KL in 1964 as lymphoid hamartoma of the larynx . The casAirway obstruction is an emergency and more often needs urgent intervention and expertise, especially in pediatric age group. The various causes in the young populations are inflammatory, auto-immune, traumatic, or maybe neoplastic. Idiopathic lymphoid hyperplasia is a rare cause of airway stenosis, which needs to be addressed by surgical excision. It should be differentiated from other lymphoid disorders like Lymphoma or MALT-type lymphoma. With Strong clinical suspicion and proper histopathological evaluation only, we can reach the diagnosis.


Bronchopulmonary sequestration is a rare disease in which a non-functional region of pulmonary tissue receives an aberrant vascular supply and lacks normal communication with the tracheobronchial tree. We present the case of a 30-year-old female with a primary complaint of unexplained weight loss and no other additional signs or symptoms. In view of this, computed tomography imaging was ordered, showing a 33HU mass in the right upper lobe. A specialist radiologist reviewed the images and concluded that the most likely differentials were mediastinal lymphoma or thymic malignancy. Video-assisted thoracoscopic surgery was performed, when it was seen that no malignancy was present, but rather a bronchopulmonary sequestration. Histology confirmed the diagnosis; the patient fared well post-operatively. Bronchopulmonary sequestration is a rare pathology, with most cases occurring in the lower lung lobes. This case is highly atypical, due to the lack of clinical features and the lesion radiologically mimicking the appearance of malignancy. Discovered by Rokitanski and Rektorzik in 1861, bronchopulmonary sequestration (BPS) is an isolated mass of non-functioning lung tissue, complete with alveoli and bronchi. The bronchial tree does not communicate with the mass, and sequestrations are typically classified as: extralobar, when encased by its own pleural investment, or intralobar, if lacking a membrane. BPS often occurs in the lower left lobe but may occur in posterior lung segments and in or below the diaphragm. Arterial supply is aberrant, usually arising as branches from the aorta, subclavian, intercostal or diaphragmatic arteries [We report a rare case of right upper lobe (RUL) BPS mimicking a malignancy, and its successful removal by video-assisted thoracoscopic surgery (VATS).A 30-year-old female presented to her general practitioner with a chief complaint of unexplained weight loss over several months. The patient was otherwise well, denying any other symptoms, including B symptoms. Physical examination was unremarkable.Computed tomography (CT) scans demonstrated a well-demarcated right-sided 5.5 × 2.6 cm paramediastinal solid mass, with associated atelectasis of the RUL  and 2. TThe top differential diagnoses suggested at this stage were mediastinal lymphoma or thymic malignancy. The mass had an average attenuation of 33HU, in keeping with such differentials. It was noted that the thymus was separate to the lesion. The specialist radiologist from the referring centre was confident that this was a solid mass, based upon the radiological findings.A single-port access in the fifth intercostal space along the mid-axillary line was used for VATS. Multiple adhesions from the RUL were released with diathermy, at which point it became evident that no paramediastinal mass was present, but rather, the pathology was located within the lung parenchyma itself. The azygous vein was distended, and the texture of the RUL lung tissue differed from the other lobes. The impression of the surgical team was that this was a rare case of RUL BPS .Upon mobilizing the lesion from the mediastinum, the systemic arterial feeding vessels were ligated and divided. The proximal extent of the lesion lied close to the segmental pulmonary artery branches, and there was concern that the staple would fail if the vessels were stapled en masse. Thus, these branches were divided individually. The staple line encompassed segmental lung parenchyma and some sub-segmental bronchi. In essence, the operation was not a classical anatomical segmentectomy, but was necessary to resect the BPS in its entirety. After resection, the lower, middle and remaining segments of the upper lobe inflated well with no atelectasis. A single chest drain to the apex was inserted, and the VATS port site was closed in layers with Vicryl.Histology of the specimen was undertaken to confirm the diagnosis. On sectioning, the lung parenchyma was extensively pneumonitic, and areas of fibrosis were identified surrounding blind and dilated bronchial spaces . HaemorrThe post-operative course was unremarkable. The chest drain was removed on Day 2, and the patient was discharged on Day 3. The patient has since been reviewed in clinic and is well. Follow-up radiographs demonstrated absence of any remaining pathology .et al. found that 97.75% of 400 BPS cases occurred in the lower lobes, with only eight cases of upper lobe pathology [BPS is a rare anomaly, characterized by non-functional pulmonary tissue receiving an aberrant vascular supply and lacking communication with the tracheobronchial tree. Savic athology . Here, wEmbryologically, such lesions are classified as foregut malformations and diagnosed via prenatal ultrasound or CT. Although rare, communicating bronchopulmonary foregut malformations can lead to sequestration, accounting for <6% of congenital lung malformations . It is tAlthough benign, a prompt diagnosis is important in facilitating timely treatment to prevent malignant changes, abscess formation, bronchiectasis, torsion and other serious sequelae. Nonetheless, diagnosis is difficult, and most cases are diagnosed post-operatively via histology .Literature states that misdiagnosis of BPS is common, with an average incorrect pre-operative diagnosis rate of 58.63% . PreviouTreatment of BPS is often curative via surgical resection, especially in those who are symptomatic. Some authors argue that a ‘wait-and-watch’ approach may be used for asymptomatic patients; however, this is an area of contention , 9. CertThe atypicality of our case conveys an important message to clinicians. A lack of clinical clues makes even the suspicion of BPS difficult, let alone a diagnosis. No specific arterial branch was seen to supply the lesion, except for a few branches from the pulmonary artery. Perhaps when diagnostic uncertainty exists with a lung mass, further investigations such as magnetic resonance angiography or DSA should be performed to accurately ascertain a diagnosis, allowing for tailored management.To conclude, BPS is a rare thoracic abnormality that may mimic sinister malignancies, both in terms of clinical and radiological features. A high index of suspicion is pivotal in making the diagnosis. Clinicians must consider BPS as a differential diagnosis if patients lack typical cancer symptoms and have a lung lesion with aberrant vascular connections upon imaging.None declared.None.


Background: Congenital mesoblastic nephroma (CMN) is the most common renal tumor among fetuses and infants before the age of 6 months. It usually behaves as a benign tumor. The prenatal features and outcomes of pregnancies with fetal CMN have never been systematically reviewed and analyzed, whereas neonatal or pediatric series have been published several times. The aims of this study are to (1) describe the prenatal natural course and prenatal sonographic char-acteristics of CMN; (2) determine the outcomes of pregnancies with fetal CMN; and (3) demonstrate typical sonographic images together with video clips of prenatal CMN, as an educational example based on our index case presented here. Methods: Studies focused on fetal CMN, including those consecutively published on PubMed from 1980 to June 2022 as well as the index case presented here, were identified and validated to perform a systematic review. The data of fetal imaging and the prenatal course of pregnancies were extracted for analysis. Results: The findings derived from 41 cases of review are as follows: (1) No single case has been diagnosed in the first half of pregnancy. No cases were detected during routine anomaly screening at mid-pregnancy. All cases were de-tected in the third trimester or late second trimester. (2) Polyhydramnios is very common and is the first clinical manifestation in most cases, leading to detailed ultrasound in the second half of pregnancy. (3) Preterm birth and low birth weight are the most common adverse pregnancy out-comes, resulting in neonatal morbidity. (4) Hydrops fetalis, though relatively rare, can be associated with CMN and is a grave sign. (5) Prenatal diagnosis is essential since it is critical for the antenatal plan, comprising either referral to a tertiary care center or proper surveillance to prevent serious obstetric complications, especially preterm birth. (6) Ultrasound is the primary tool for prenatal diagnosis of CMN, whereas MRI can be used as an adjunct if some other tumors are suspicious or sonographic features are not typical for CMN. Conclusion: In contrast to CMN in neonates, fetal CMN is much more serious since it significantly impacts adverse pregnancy outcomes and perinatal morbidity and mortality. The typical prenatal course and the sonographic features of CMN are described. Congenital renal tumors are relatively rare, including the most common types, with a decreasing order of the prevalence as follows: congenital mesoblastic nephroma (CMN), nephroblastoma (Wilms tumor), rhabdoid tumor, clear cell sarcoma, hamartomas, and ossifying tumor of infancy . CMN is Article selection and data extraction: A comprehensive literature review focused on CMN that was prenatally diagnosed was conducted. The review involved studies published on PubMed from 1980 to June 2022. The following search terms were used:  OR fetus [ti] AND mesoblastic nephroma [ti]. The non-English articles were also included, although some important details could not be extracted. Of all the consecutively searched results, the abstracts and titles were firstly scanned to determine if they matched the selection criteria. The full-text papers of all the selected articles were identified and retrieved for a comprehensive review to extract the data of fetal imaging and the prenatal course of pregnancies. The extracted data from each article were entered into a predefined database form, as presented in Statistical analysis: All statistical procedures were performed using the statistical package for the social sciences (SPSS) software, version 26.0 . The baseline and clinical characteristics were presented as means ± SD for continuous data and percentages for categorical data.A 23-year-old pregnant woman, G2 P1001, was referred to our hospital at 30 + 2 weeks of gestation for detailed ultrasound because of an abnormal mass in the fetal abdomen, suspected to be a gastrointestinal tumor. Her first pregnancy was uneventful, and she gave birth to a term healthy baby weighing 3600 g. The first child was healthy and had normal development. Her current pregnancy course prior to this visit was unremarkable. All basic laboratory tests of antenatal care were within normal limits. At her first antenatal visit, at 20 weeks of gestation, the ultrasound examination performed for fetal anomaly screening revealed no structural abnormalities and normal fetal growth. At 26 weeks of gestation, slightly large-for-date uterine height was suspected by clinical examination. Ultrasound examination showed appropriate fetal size and growth rate. Polyhydramnios with an amniotic fluid index (AFI) of 21 was demonstrated, but no structural abnormality was noted. The follow-up ultrasound scans at 30 weeks of gestation showed progressive polyhydramnios with an AFI of 26 and a solid mass in the fetal abdomen, suspected to be a gastrointestinal tumor. Fetal ultrasound examination at our center demonstrated a live male fetus with appropriate growth, a large left renal tumor, and polyhydramnios with an AFI of 27. The tumor had the following characteristics : locatedComments on the case: (1) The images are informative and typical of CMN in terms of a well-demarcated and well-circumscribed solid mass with relatively homogeneous echogenicity and moderate to strong vascularization. (2) It is possible that the tumor had already developed and, with very careful inspection, could have been visualized at 26 weeks of gestation when polyhydramnios had developed. (3) Because of its late occurrence, routine anomaly screening at mid-pregnancy could not detect this type of tumor in this case, as also reported in all previous reports. (4) Large-for-date uterine size or unexplained polyhydramnios in the second half of pregnancy should warrant the possibility of CMN and very careful detailed ultrasound examination of the fetal kidneys must be performed.A total of 37 publications were identified. Seven were excluded from the analysis because no data were available ,34,35,36The prenatal sonographic features of CMN are presented in Polyhydramnios was the first clinical manifestation in most cases, leading to detailed ultrasound in the second half of pregnancy. Hydrops fetalis, defined as fluid collection in at least two body spaces of the fetus, was noted in three cases ,41,42. TPerinatal death was found in 12.2% of the cases and was associated with hydrops fetalis and immaturity. However, CMN among the fetuses without serious obstetric complications had a favorable prognosis. All the neonates with live birth who underwent surgical management survived and were healthy without adjuvant therapy. Ultrasound is the primary tool for prenatal diagnosis of CMN, whereas MRI was performed prenatally in 26.8% (11/41 cases) and all confirmed the ultrasound findings. New insights gained from this study are as follows: (1) Although CMN in neonates has a natural course of a very good prognosis after surgical removal, it is much more serious in intrauterine life, since fetal CMN significantly impacts adverse pregnancy outcomes and perinatal morbidity and mortality. (2) No single case has been diagnosed in the first half of pregnancy. No cases were detected during routine anomaly screening at mid-pregnancy. All cases were detected in the third trimester or late second trimester. (3) Polyhydramnios is very common and is the first clinical manifestation in most cases, leading to detailed ultrasound in the second half of pregnancy. (4) Preterm birth and low birth weight are the most common adverse pregnancy outcomes, resulting in neonatal morbidity. (5) Hydrops fetalis, though relatively rare, can be associated with CMN and is a grave sign. (6) Prenatal diagnosis is essential since it is critical for the antenatal plan, comprising either referral to a tertiary care center or proper surveillance to prevent serious obstetric complications, especially preterm birth. (7) Ultrasound is the primary tool for prenatal diagnosis of CMN, whereas MRI should not be routinely performed prenatally.Natural course of fetal CMN: In this review, nearly all the cases of CMN in the prenatal series were detected in the third trimester, although a minority of cases were diagnosed in the late second trimester. None were diagnosed in the first half of pregnancy. It is noteworthy that in most cases, including our index case, the tumor mass size was relatively large at the time of diagnosis. It is possible that a small tumor has similar echogenicity to that of the normal renal pyramid, making it difficult to differentiate it from normal kidneys. Some fetuses, including our case, showed polyhydramnios without a renal mass a few weeks before the diagnosis, implying that detection of the tumor was missed in the early stage. Nevertheless, it is reasonable to conclude that CMN preferentially occurs in late pregnancy, with a rapid increase in tumor size.It is noteworthy that most cases were conceived naturally. However, two out of the 41 pregnancies (4.9%) of this prenatal series were conceived by IVF, using the transfer of a cryopreserved embryo ,41. AddiEffects on pregnancy outcomes: (1) Polyhydramnios is identified in about 66% of cases. The pathogenesis of polyhydramnios is unclear. Several mechanisms have been proposed, including the following: (a) Polyuria caused by an increase in renal perfusion and hypercalcemia induced polyuria of the fetus induced by prostaglandins secreted by the renal tumor [al tumor ,45. (b) Sonographic features: Prenatal sonographic features are as follows: (1) tumor characteristics: solid, well-demarcated, heterogeneous echogenicity in most cases, homogeneous mixed with some relatively low-level echoes in some cases, and similarity with the echogenicity of the normal renal parenchyma; (2) unilateral; (3) relatively large size at the time of diagnosis, often with displacement of the great vessels to the contralateral side; (4) typically appearing in the late second trimester or third trimester; (5) polyhydramnios in most cases; (6) hydrops fetalis in rare cases, representing 7.3% of cases and considered as a grave sign; (7) high vascularization (moderate to strong). Color Doppler flow can be used to highlight a vascular ring running along the tumor border. Additionally, three- and four-dimensional ultrasound can be used as an adjunct to demonstrate the origin of the tumor, to confirm its renal nativity [nativity .Note that polyhydramnios is the first clue, in most cases, leading to prenatal detection of the tumor. Nevertheless, polyhydramnios, commonly found together with a large tumor, is theoretically not a sign of the tumor in the early stage. It is possible that a small tumor which develops early in the second half of pregnancy is subtle and asymptomatic, and not associated with polyhydramnios, resulting in no clinical clues for ultrasound examination.Careful inspection of the renal parenchyma echogenicity may be helpful in differentiating the tumor mass from normal kidneys. In the early stage, it may be difficult to outline the tumor on prenatal ultrasound because it is contiguous with the normal parenchyma, does not have a well-demarcated capsule as seen in a large mass, and blends with the remaining normal kidney.In cases of abnormally enlarged kidneys or asymmetrical shape, much more attention must be paid to visualize the normal renal pyramids, which align with the typical renal vessel tree. In early developing tumor, the loss of typical pyramid features and disorganized vascularization on color Doppler flow may be helpful to facilitate early diagnosis or close ultrasound follow-up. Since CMN tends to have a rapid growth, the typical sonographic features are likely to be more obvious on follow-up scans. Additionally, both the adrenal glands and contralateral kidney should be meticulously visualized. If highly suspected, MRI can be helpful to evaluate the origin and morphological characteristics of a fetal abdominal mass ,10,19.Differential diagnosis: On prenatal ultrasound, fetal renal tumors typically appear as a solid mass in the renal fossa or paraspinal region. The main differential diagnoses of a solid renal mass are as follows: (1) Congenital mesoblastic nephroma (CMN): the prenatal ultrasound characteristics are as mentioned above. (2) Wilms tumor (nephroblastoma) [lastoma) ,47,48,49lastoma) ,50,51,52lastoma) ,54,55,56lastoma) : this isClinical impact: This review provides important information to help physicians taking care of women when counseling couples in cases undiagnosed in prenatal periods, in spite of huge renal masses. This is due to the fact that CMN is a late occurring disorder, whose diagnosis is simply missed at the time of anomaly screening at mid-pregnancy (18–22 weeks of gestation). Accordingly, it should be emphasized that although fetal anatomical survey for anomaly screening is usually performed once at mid-pregnancy, if ultrasound examination is indicated in late pregnancy for any reasons, a re-evaluation of fetal anatomy for late occurring anomalies that may not have appeared on the prior scans should be performed.Prenatal diagnosis can impact on the plan of management. Couples should be counseled on early detection of preterm labor, which may result in early labor inhibition as well as steroid administration, leading to higher success than inhibition in advanced labor. Because of the very high rate of preterm birth associated with CMN, a plan of birth in a center with the availability of a neonatal intensive care unit should be strongly considered. Early detection also allows parents to prepare for a child who will need more than standard postnatal care, probably resulting in better care management and survival.Detailed prenatal ultrasound is a single essential tool for the diagnosis of CMN. MRI may be useful as a confirmatory investigation, but it is not necessary in most cases, although some authors recommend it in all cases . We noteRecommendations: (1) If ultrasound examination is not performed routinely in late pregnancy whenever indicated, a re-evaluation of the anatomical survey should be conducted, even in cases with normal scans at mid-pregnancy. (2) In all cases with enlarged kidneys, the possibility of CMN must be kept in mind. A high level of precaution must be exercised because of its similar texture to the normal renal parenchyma, especially in the early development of the tumor. (3) Detailed ultrasound must be performed in all cases of polyhydramnios. (4) Pregnancy with fetal CMN should be monitored for rapid growth, amniotic fluid volume, the early detection of preterm labor and preterm birth, and notification of neonatologists as well as pediatric surgeons. (5) Expectant management is recommended in most cases diagnosed prenatally. However, CMN associated with hydrops fetalis should be strongly considered for delivery for postnatal definitive treatment. (6) The perinatal management plan should be focused on: (a) reliable maternal transportation; (b) effective monitoring of fetal well-being; (c) control of polyhydramnios to prevent preterm labor; (d) early detection of preterm labor and early management; and (e) elective newborn surgery at a stable condition.


Myopericytoma (MPC) is a benign soft tissue tumor that develops from perivascular myoid cells and is part of the perivascular tumor group. MPC most commonly occurs in the subcutaneous soft tissues of the extremities, while intracranial MPC is remarkably rare. Herein, we report the case of a 45-year-old woman with myopericytoma who had a 2-week history of recurrent dizziness. Magnetic resonance imaging (MRI) revealed an irregular mass in the pons, with nodular enhancement of the mass on contrast-enhanced scans. The mass was considered a vascular lesion and was highly suspected to be a hemangioblastoma, prompting surgical intervention for the patient. The postoperative pathological report corrected the initial diagnosis, hemangioblastoma, to MPC. Intracranial MPC is extremely rare and there are no detailed imaging sources for this condition; furthermore, MPC occurrence in the pons has not been reported previously. This report presents the etiological characteristics intracranial MPC as visualized through MRI data alongside a comparative discussion on other reported diagnoses that resemble MPC. The case findings will provide a more widespread understanding for radiologists regarding the differential diagnosis of intracranial blood-rich supply lesions. We present the case of a 45-year-old female with history of suffered dizziness that lasted several seconds two weeks ago. She has no other physical or laboratorial exams alteration; however, brain magnetic resonance imaging (MRI) revealed an aberrant lamellar signal shadow in the pons. The tumor mass was well-defined and measured approximately 1.0 cm×1.2 cm (Myopericytoma (MPC) was first reported by Granter et al. in 1998 –4. MPC oAlthough most MPCs are benign, there are some instances of malignant MPC . They arMost studies on MPC are case reports due to the rarity of MPC manifestation, especially in the central nervous system. The imaging performance of MPC is summarized with the following features after studying the relevant literature at home and abroad and combining it with the imaging performance of this case. MPC tumor imaging through CT illustrates well-defined tumor boundaries that are typically isodense or hypodense, though calcification can be detected in a few tumors. On T1-weighted imaging, tumors have a low or slightly low signal, whereas on T2-weighted imaging, they have an inhomogeneous high signal. When the tumor is small, the enhancement is generally uniform or heterogeneous; however, when the tumor is large, necrosis and cystic alterations are common in the center of the lesion, resulting in no enhancement in the center of the tumor and considerable enhancement around it on contrast-enhanced scans –16. The Histopathologically, a MPC is primarily composed of large blood vessels and mucus, both of which are coated with spindle-shaped or oval endothelial cells. It is well known that the histological traits of neoplasms frequently disclose their imaging properties. Consequently, the following tumors are usually included in the differential diagnosis: meningioma, solitary fibrous tumor/hemangiopericytoma, hemangioblastoma, and angioleiomyoma . 1) MeniSurgical resection is the most effective treatment for MPC. Most patients with MPC have better postoperative recovery and less local recurrence . After sIn conclusion, MPC is an uncommon benign soft tissue tumor that most often occurs in the extremities. To our knowledge, MPC of the central nervous system is rare. Moreover, patients with pontine MPC have not been previously reported, suggesting that such cases are extremely rare. Histopathologically, the tumor consists of abundant vascular components, indicating that it has an abundant blood supply. Accordingly, its imaging findings have certain characteristics that can provide a differential diagnosis for benign tumors with plentiful intracranial blood supply. We report this meaningful case, along with a review of the relevant literature, to improve the diagnostic process for intracranial MPC in clinical radiology.The original contributions presented in the study are included in the article/Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.MG and XC, manuscript writing. GZ, manuscript revision. YW, conception and critical review. 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.


Large bowel obstruction (LBO) is a life-threatening condition seen most often in the geriatric population. LBO can present with nonspecific abdominal pain that can overlap with other pathologies, such as abdominal infection, acute aortic disease, intestinal perforation, and atypical acute coronary syndrome in the geriatric population. Delays in diagnosis of colonic obstruction result in significant mortality due to complications involving bowel necrosis, perforation, and sepsis. In the emergency department (ED), abdominal point-of-care ultrasound (POCUS) can diagnose LBO and facilitate the assessment of the wide differential inherent to elderly abdominal pain. The authors report a rare ED application of abdominal POCUS to facilitate rapid diagnosis of an LBO secondary to rectal cancer.  Large bowel obstruction (LBO) in the emergency department (ED) is a life-threatening pathology encountered most commonly in the geriatric population that accounts for about 2-4% of all surgical admissions -2. The mIn the ED, the primary focus of a geriatric patient presenting with undifferentiated abdominal pain is expeditious diagnosis and stabilization of life-threatening pathologies. In addition to an often-nonspecific examination and unreliable vital signs, geriatric abdominal pain is complicated by a wide differential that includes dangerous etiologies, such as atypical acute coronary syndrome, gastrointestinal perforation, aortic pathology, peritonitis, and bowel obstruction -5. In adAn 82-year-old male with a history of hypertension, prior smoking, coronary artery disease, and remote history of prostate cancer status post chemotherapy and radiation presented to the ED with progressively worsening abdominal pain. He stated that the pain was nonspecific in location, without radiation, and present for several weeks before acutely worsening in the last four days. He reported nausea without vomiting and stated that he was obstipated over the last four days. He reported previously having episodes of diarrhea and some recent weight loss. He denied rectal bleeding, fevers, chest pain, dyspnea, and genitourinary symptoms. He was unsure when he had his last colonoscopy but stated that it was a long time ago. He denied the use of beta blockers and anticoagulants. On his initial vital signs, he had a heart rate of 107 beats per minute, respiratory rate of 16 breaths per minute, and blood pressure of 212/103 mmHg. He was afebrile with a normal oxygen saturation on room air. He appeared frail and distressed. His abdomen was softly distended with nonperitoneal tenderness to palpation. His labs were remarkable for a lactic acid of 3.3 mmol/L. White blood cell counts, renal and hepatic function tests, lipase, and electrolytes were unremarkable. His troponin and electrocardiogram were unremarkable. Intravenous fluids were administered. POCUS was performed on the patient and was remarkable for findings of a bowel obstructing rectal mass (Figures Intra-abdominal free fluid was also identified in the setting of possible metastatic cancer Figure .Findings were confirmed on CT of the abdomen and pelvis with contrast, which was also significant for numerous enlarged retroperitoneal and periaortic lymph nodes, a moderate amount of perihepatic fluid, and multiple masses on the liver, diaphragm, and the peritoneum Figures -5.After evaluation by the surgical team, the patient was admitted for medical management. A sigmoidoscopy with biopsy was performed and found a large obstructive lesion involving the entire rectum and rectosigmoid area. Ultimately, the patient was diagnosed with Stage 4 rectal cancer. Given the deconditioned state of the patient, he was not a candidate for chemotherapy. He deferred palliative colostomy and was ultimately scheduled for rectal stent placement and placement into palliative care.We present a case of metastatic rectal cancer presenting with an LBO and diagnosed with abdominal POCUS using both suprapubic and standard abdominal quadrant views. Obstruction complicates up to 29% of colorectal cancers, accounting for about 80% of emergency presentations of colorectal cancer . In the The utilization of abdominal POCUS has been well-established in ED resuscitation and abdominal pain -8. AdditManagement of LBO in the ED centers on stabilization and risk stratification. Symptomatic control and supportive treatment with antiemetics, bowel rest, as-needed nasogastric decompression, and intravenous hydration should be administered with consideration for avoiding iatrogenic fluid overload in patients with renal or cardiac insufficiency . ApproprDelays in diagnosis of colonic obstruction can result in significant mortality and morbidity due to complications involving bowel necrosis, perforation, and sepsis. In the ED, POCUS possesses potential utility in both expeditiously diagnosing LBOs as well as assessing for complications of obstruction.


Subdural anaplastic large-cell lymphoma (SALCL) is an extremely rare subtype of primary central nervous system (CNS) lymphoma. Here, we report a very rare subdural lymphoma case, which was misdiagnosed as a subacute epidural hematoma based on the radiological examination.We present the case of an 82-year-old patient who presented with a 2-day history of headache and consciousness disorder following head injury. Computed tomography of the head revealed a fusiform isodense/slightly dense shadow under the right temporoparietal occipital cranial plate, suggesting a subacute epidural hematoma. It was initially misdiagnosed as a right traumatic subacute epidural hematoma with hemiplegia of the left limb. According to the patient’s condition, an emergency craniotomy was performed to remove the hematoma. However, it was found that the lesion was located under the dura mater and was yellowish-brown with yellowish-brown liquid inside. The appearance of the lesion looked like bean curd residue. Histopathological examination diagnosed ALCL.SALCL presenting as a subacute epidural hematoma on imaging.Operation.The patient died 1 month after being discharged automatically.This report shows a rare radiography presentation of SALCL. SALCL can mimic the appearance of an epidural hematoma and should be regarded as a differential diagnosis even in patients with a history of craniocerebral injury and the “typical” imaging appearance of an epidural hematoma. The report is hoped to provide a scientific reference for the clinical diagnosis of subdural lymphoma. ALCL often occurs in lymph nodes and extranodal lymphoid tissues, commonly in the skin, bone, soft tissues, and other parts outside the node, and rarely in the brain, bronchi, and other parts.Central nervous system (CNS) lymphomas include primary CNS lymphomas and systemic lymphomas that invade the CNS as secondary lymphomas, accounting for 1% to 3% of CNS tumors. Subdural lymphoma is rarer, and the cause of the disease is unknown. Lymphoma of the CNS has been reported to be common in the cerebral parenchyma and partly involves the meninges. In primary CNS lymphomas, diffuse large B-cell lymphomas account for >90% of primary CNS lymphomas, and T-cell lymphomas account for <5%.ALCL is rarely reported, and the imaging manifestations are nonspecific, clinically easy to misdiagnose, and the exact diagnosis of this disease depends on pathological histology. Until now, the understanding of this lymphoma is not profound enough. Herein, a clinically rare case of subdural ALCL whose imaging appearance resembles an epidural hematoma is reported. The report is as follows.An 82-year-old man presented to the hospital with “headache and consciousness disorder for 2 days after head injury.” He has a history of hypertension. The patient’s family complained that the patient fell and hurt his head 2 days ago, and then the patient appeared to have unclear speech, unable to answer questions correctly, accompanied by blurred consciousness, accompanied by weakness of the left limb activity, unconscious disorder, limb convulsion, no nausea, vomiting, no incontinence, no systematic diagnosis and treatment, and the degree of consciousness disorder increased and came to the hospital. Physical examination on admission included temperature: 36.7°C, pulse: 66 times/min, respiratory rate: 19 times/min, blood pressure: 76/92 mm Hg, Glasgow Coma Score (E2-V4-M4) 10 points, blurred consciousness, incomplete mixed aphasias, no malformation of skull appearance, no swelling, tenderness, and no skull depression touched. Bilateral pupils were equal in size and circle, with a diameter of 2 mm. Bilateral pupils are insensitive to light. The muscle strength of the left limb was level 0, with slightly higher muscle tension, and the right limb had involuntary activity. The muscle strength was level 3, the muscle tension was normal, and the bilateral Babinski sign was positive. The breath sounds of both lungs were coarse, and a few moist rales could be heard at the bottom of the lungs. Emergency head computed tomography (CT) scan showed fusiform density under the right temporoparietal occipital cranial plate, obvious midline deviation, and ventricle compression. The subacute epidural hematoma was considered  from less common lesions (tumors) poses significant challenges for clinical management. Fusiform masses at the cranial top can be associated with a range of neurological deficits and can be easily identified by routine plain CT. In theory, any subdural/extradural mass can attenuate the X-ray and reproduce the image associated with the hematoma. A mass with a high attenuation coefficient can simulate an acute blood clot, while a mass with a low attenuation coefficient can simulate a liquefied clot. It has been reported that the imaging characteristics of dural lymphoma are similar to those of subdural hematoma. However, in this case, subdural lymphoma mimics subacute epidural hematoma on head CT imaging features. In this case, the following aspects are special. The first is the location of the lymphoma. Head noncontrast CT scan imaging features of subdural lymphoma are similar to the subacute epidural hematoma in this case. A search of the literature revealed that dural lymphoma often mimics the clinical presentation of a subdural hematoma. The second is the type of lymphoma. At present, there are mainly the following types reported: lymphoplasmacytic lymphoma, marginal zone lymphoma,–13 diffuse B-cell lymphoma, and Burkitt lymphoma. However, large-cell lymphoma (T-cell and ALK are positive) is rare.In 1985, Stein et al,12,13 However, due to the lack of reliable data for ALCL/T-cell lymphoma and the difficulty of clinical trials for CNS ALCL/T-cell lymphoma, there is still a lack of standardized treatment for CNS ALCL/T-cell lymphoma, the treatment strategy commonly used for B-cell lymphoma. At present, high-dose methotrexate (>3 g/m2) and rituximab should be part of any induction therapy, which can improve the response rate and overall survival rate of primary CNS diffuse large B-cell lymphoma patients. Current protocols for induction include procarbazine, temozolomide, rituximab and high-dose methotrexate/cytarabine, or prednisone, depending on geographic area and physician preference. The recurrence rate is close to 50%, and 10% to 15% of patients had primary drug resistance. Patients with recurrent refractory primary CNS diffuse large B-cell lymphoma have a very poor prognosis. It has become a research hotspot in recent years to apply new targeted drugs to improve the prognosis of patients with recurrent refractory type CNS lymphoma by studying gene mutations and signal transduction pathways to find new therapeutic targets, such as Bruton tyrosine kinase, mammalian target of rapamycin, immune checkpoint, and phosphatidylinositol 3-kinase inhibitors, and immunomodulators, have been used in the treatment of recurrent, refractory primary CNS diffuse large B-cell lymphoma.Since the dura does not contain any lymphoid tissue, the pathogenesis of primary subdural lymphoma remains unclear. Surgery, radiation, and chemotherapy can be recommended, but there are no standard treatment guidelines. At present, the treatment of subdural lymphoma mainly includes surgical resection combined with chemotherapy or radiotherapy, which has been reported to achieve significant results.In summary, when the patient’s complete nervous system examination, head trauma history, and head CT imaging characteristics are inconsistent, if conditions permit, further imaging examination can be carried out to help diagnose. Emergency surgery is a choice when the patient’s condition does not allow it. If the imaging manifestation is considered to be epidural/subdural hematoma, but the clinical data and further imaging examination do not support it, if the space-occupying effect of the lesion is not obvious and the clinical symptoms are mild, it can be observed based on dynamic imaging examination. Make the best treatment plan according to the observation results. If the patient has the indication of emergency operation at admission, surgical treatment should be taken based on other imaging examinations at night. If necessary, an intraoperative pathological examination can be performed.In this report, we present an extremely rare and atypical case of a patient with subdural ALCL presenting as a subacute epidural hematoma on imaging. The reason for such misdiagnosis is that primary lymphoma of the CNS is rare and prone to misdiagnosis. To some extent, the clinical examination is not comprehensive and careful, and the clinical analysis is not deep enough and thorough. In the future clinical diagnosis of primary CNS lymphoma, it is necessary to further clinical examination and diagnosis to avoid misdiagnosis.All authors contributed to the execution of this work and the preparation of this manuscript. All authors have read and agreed to the published version of the manuscript.


Rete ovarii giving rise to cysts, and benign and malignant tumors is a rare entity. Radiological and histopathological examinations can be used to make the diagnosis of rete cyst and differentiate it from cystic tumor of ovarian origin, with surgery being the treatment of choice. Cyst of rete ovarii is a rare phenomenon which has to be distinguished from cystic ovarian tumor. The treatment of choice is surgery for these cysts.  The abdominal pain had no relation to the food intake. There was no history of heartburn, acidic reflux to mouth, fever, jaundice, vomiting, lower limbs swelling, and weight loss. There was no change in the menstrual cycle. There was no family/personal history of malignancy. Past medical history was unremarkable.On abdominal palpation around 16 weeks size, cystic, non‐tender mass was felt over suprapubic region extending to bilateral iliac fossa with smooth surface, regular margin, freely mobile, could get below the mass and no associated other organomegaly. Per‐vaginal examination was not done. Examination of all other systems was unremarkable.Ultrasonography of abdomen and pelvis showed thin‐walled abdomino‐pelvic cystic mass of 16.1 cm × 4.7 cm from left adnexa with floating echogenic debris, and no solid component and papillary projection as shown in Figure The patient underwent laparotomy and left salpingo‐oophorectomy with a preoperative diagnosis of left serous cystadenoma. Pre‐operatively, there was a single cystic mass arising from the left ovary and twisted once on its pedicle as shown in Figure The postoperative period was unvaried and was discharged on the third postoperative day. During follow‐up examinations, she is doing well and no cyst formation in the contralateral ovary is observed in the 12‐month period after surgery.3Many researchers contemplate RO to be of mesonephric origin, while residue of primordial sex cords in the basal portion of the ovary giving rise to the rete has also been expounded.Cysts and tumors of RO proper have been reported only rarely. The relative rarity of benign and malignant tumors arising from RO as contrast to other sites in the female genital tract (FGT) has been attributed to reduced levels of estrogen receptor and progesterone receptor in the rete leading to lesser degree of receptiveness to hormone stimulation in this structure and consequently low proliferation rate in the RO.The appreciably comprehensive details about these cysts were presented by Rutgers and Scully, describing 16 cases of rete cysts in patients ranging from 23 to 80 years (mean age: 59 years), and the cysts ranged from 1 to 24 cm (mean diameter: 8.7 cm).As we noticed in our case, rete cysts can grow to large sizes. This can sometimes increase the risk of torsion. Large cyst can also lead to atrophy of the ovary. The patient ignoring the early symptoms and signs led to development of remarkably large size of cyst in our case. These cysts can be misinterpreted as a cystic tumor of ovarian origin; hence, findings from clinical, radiological, histopathological, and immunohistochemical  assessment should be integrated to find the exact origin.Recognition of RO and its lesions is foremost as they can lead to dubiety with other conditions like endometriosis.4Cyst of RO can pose a diagnostic challenge owing to its extreme rarity. The cysts of RO can outreach to large sizes that can lead to various complications, which can be prevented by early accurate diagnosis and treatment.Kritika Jha (KJ), Bishal Khaniya (BK), Suvana Maskey (SM), and Neebha Ojha (NO) involved in study concept and provided counseling and surgical therapy to the patient. Kritika Jha (KJ) and Roshan Aryal (RA) collected all the required case information, images, slides, and reports, reviewed the literature, and contributed in both writing and editing the manuscript. BK, SM, and NO served as a senior author and manuscript reviewer. All the authors read and approved the manuscript.None to declare.Not required.Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the editor in chief of this journal on request.


Cavernous hemangioma is a rare benign tumor which can sometimes mimic the clinical presentation and radiological findings of malignant tumors. Here we present a rare presentation of cavernous hemangioma in the mediastinum (CHM), along with a literature review among the main databases.We present a 48-year-old male who had suffered from persistent cough as the sole symptom of an anterior CHM. Computed tomography scan demonstrated a 12.5 × 10.8 cm mass in the anterior mediastinum. The mass was surgically resected, and histopathological evaluation established the diagnosis of CHM. The patient was discharged in good condition, in which during his four-month follow-up period, no recurrence of the tumor has been observed.Although cavernous hemangioma rarely present in the mediastinum, it should be considered in the differential diagnosis of mediastinal tumors. However, our review of literature demonstrated a female dominance and average age of 40 years, with a 52% mortality rate based on previous reports. Cavernous hemangioma (CH) is a common benign tumor with vascular origin. It can grow in many locations and its occurrence in some organs, like the liver, is so frequent that it is considered the most common primary tumor of the liver . NeverthWhile there have been reports of CH in the middle mediastinum, the majority of hemangiomas tend to present in the anterior mediastinum , 4. A prA 48-year-old man was referred to our center after dealing with a persistent severe cough for more than a month. Past medical history was positive for hypertension. He also had a recent episode of syncope which had been resolved spontaneously. Vital signs were within the normal range with an arterial oxygen saturation of 97%. Physical examinations were unremarkable including heart and lung examination. Laboratory findings were also unremarkable.In order to evaluate his persistent cough, spiral chest computed tomography (CT) scan with intravenous contrast was performed which revealed a heterogeneous lobulated mass in the anterior superior mediastinum measuring 125 × 77 × 99 mm in size, with pressure over the aortic arch, and mild pericardial effusion  and a fragment of fibro-fatty tissue (7.5 × 4 × 3 cm)  is a rare benign tumor originating from vascular endothelial cells. It is mainly an internally endothelium lined multilocular mass consisted from cavernous sinusoids of varying size , 7. A raBased on the mentioned cases in Table A paper by Cohen et al. published in 1987 was the first comprehensive case series regarding CHMs. They presented 15 cases of CHM with 8 of them being asymptomatic . This isCHM’s imaging finding usually indicates a round to oval-shaped mass with a well-defined border, but it can also invade adjacent organs and this renders the tumor border to be hazy to an extent that it can be confused with a malignant lesion , 65. TheJust like our case, a CHM diagnosis is usually established after surgery and examination of the excised tumor, and preoperative diagnosis is seldomly reached . This waWhile it has been proposed that a subtotal resection would suffice without any increase in morbidity and mortality , we perfThere have been reports of additional treatments alongside surgery. Radiotherapy and extracorporeal membrane oxygenation has been used in cases of CHMs with low platelet counts (i.e. Kasabach–Merritt syndrome) and massive hemoptysis, respectively , 71.Cavernous Hemangioma, a rare cause of mediastinal mass, should be considered in the differential diagnosis of mediastinal tumors. Our review of literature demonstrated a female dominance and average age of 40 years, with a 52% mortality rate based on previous reports. While imaging study can be helpful in diagnosing these benign lesions, it often needs surgery for both definite diagnosis and treatment.


Schwannomas can occur in the body where nerve sheaths are present. Genitourinary schwannomas are very rare, especially primary bladder schwannomas. They account for only 0.1% of bladder tumours. The literature reports that simple surgical resection has a good effect and prognosis.A 39-year-old man had no significant improvement in symptoms due to frequent urination and urgency for 1 month following the treatment of prostatitis for 2 weeks. Ultrasound and computed tomography (CT) showed a mass in the left side wall of the bladder (size approximately 2.0 × 1.9 cm) that had clear boundaries and protruded outward from the bladder. After the extraperitoneal space was dilated with a balloon, a minimally invasive laparoscopic partial cystectomy was performed in this space to remove the tumour. The pathological diagnosis was bladder schwannoma. Immunohistochemical staining showed that it was strongly S100 protein positive. There was no recurrence after 2 years follow-up by cystoscopy and CT.Bladder schwannomas are clinically rare benign bladder lesions and no specific clinical manifestations. Laparoscopic partial cystectomy through the extraperitoneal space is a safe and feasible treatment option. Worldwide, the incidence of bladder cancer ranks 11th among malignant tumours. In Europe and the United States, the incidence of bladder cancer ranks 4th among male malignancies . BladderThe patient, a 39-year-old man with frequent urination, urgency and pain in the bladder area while holding back the urine for 1 month was in good health before. There was no abnormality in the urine routine. The examination of the prostatic fluid showed elevated white blood cells and decreased lecithin bodies. Prostatitis was initially diagnosed. After two weeks of treatment with cephalosporin and M receptor blocker, the symptoms of frequent urination and urgency were partially improved. Review the prostatic fluid indicated that the white blood cells were normal, and the lecithin bodies increased by 20% compared to 2 weeks ago, but the pain in the bladder area was not significantly relieved when the urine was held. Further examination of the urinary system color Doppler ultrasound suggest that the bladder had occupying space. An approximately 2.0 cm solid lesion in the left upper part of the pelvic cavity was seen by ultrasound (Fig. With the results of the imaging examination, a benign tumour was considered. Based on the tumour being convex to the outside of the bladder, a laparoscopic partial cystectomy through the extraperitoneal space was performed Fig. . After gSchwannomas are derived from Schwann cells, which are often associated with von Recklinghausen disease, but the relationship between bladder schwannomas and this disease is not clear . BladderThis article describes an extremely rare case of bladder schwannoma, which is a clinically rare benign bladder lesion. Its clinical manifestations are non-specific. Bladder schwannoma can not be diagnosed initially through clinical symptoms, but requires cystoscopy, color Doppler ultrasound and CT. Determining diagnosis base on histopathology, and S100 positive expression is a specific marker. Active surgical intervention is recommended, and its effect is satisfactory. Laparoscopic partial cystectomy through the extraperitoneal space is safe and feasible when the tumour is in the anterior wall and side wall of the bladder and protruding out of the bladder. Its long-term prognosis needs further follow-up study.