Several reports have documented that the pulmonary sequestration is in communication with the gastrointestinal tract and the concept of bronchopulmonary foregut malformation (BPFM) has become more widespread. However, there are few reports of the sequestration associated with the pancreas derived from the foregut. We describe the history and pathophysiology of BPFM including pancreatic tissue in a male infant with respiratory distress.A male patient was born at 38 weeks of gestation and weighed 2752 g at birth. He developed pneumonia and was hospitalized at 3 months of age. Chest radiographs and CT scans led to the diagnosis of a lung abscess in the left lower intralobar pulmonary sequestration with aberrant arteries from the abdominal cavity. At 4 months of age, when the abscess had resolved, left lower lobectomy and the resection of the intralobar sequestration were performed. The pulmonary sequestration was conjoined with the esophagus. A fistula was found between the lower esophageal wall and the pulmonary sequestration. An additional small segment of the esophageal wall was excised. Histologically, the mediastinal surface of the sequestration tissue contained pancreatic tissue. Furthermore, esophageal and gastric tissue, cartilage tissue, and ciliated epithelium were confirmed. A definitive diagnosis of BPFM was made.We postulated the rare case of a communicating BPFM with intrapulmonary sequestration on one end and the esophagus on the other forming a mass lesion, which included ectopic pancreatic tissue in a male infant. Bronchopulmonary foregut malformation (BPFM) refers to a very rare spectrum of congenital defects that are due to abnormal differentiation of the respiratory and upper gastrointestinal tracts during early embryonic development .Common embryologic pathogenesis causes a wide range of malformations in BPFM, including pulmonary sequestration with partial or complete communication to esophagus or stomach, esophageal or gastric diverticulum, and esophageal or bronchogenic duplication cysts .Although several reports have documented that the pulmonary sequestration is in communication with the gastrointestinal tract, there are few reports of the sequestration associated with the ectopic pancreas derived from the foregut.We describe the history and pathophysiology of BPFM including ectopic pancreatic tissue in a male infant with respiratory distress.The male patient was born at 38 weeks gestation and weighed 2752 g at birth. The patient had a history of bloody vomiting from 2 months of age and was initially diagnosed with gastroesophageal reflux disease. The patient developed pneumonia and was hospitalized at 3 months of age. A chest radiograph showed a ring-shaped infiltration 2 cm in diameter in the lower left lung field and contrast-enhanced computerized tomography (CT) scans demonstrated a lung abscess in the left lower intralobar pulmonary sequestration forming a tumor-like lesion with aberrant arteries from the celiac trunk Fig. . Review At 4 months of age, when the abscess had resolved with antibiotics, left lower lobectomy including intralobar sequestration was performed. The pulmonary sequestration and surrounding tissues in the mediastinum were strongly adherent and became a mass lesion. Moreover, the mediastinal surface of the sequestration merged into the esophagus. Left lower lobectomy including the mass lesion was considered unavoidable because no boundaries were defined between them. The lower lobe of the left lung, including intralobar isolation (S10) with a 1 cm length of the esophageal wall, was resected. A fistula of 3 mm diameter was found between the lower esophageal wall and the pulmonary sequestration (Fig. Histologically, a mass lesions attached to the esophagus and the intrapulmonary sequestration contained ectopic pancreatic tissue, which were scattered within the fibrovascular connective tissue and the morphology was similar to H&E stained pacreatic tissue reported by Ballouhey  includinAfter the operation, the patient is doing well and has no respiratory or swallowing problems.Pulmonary sequestration which communicates with the esophagus has previously been reported as a form of BPFM, and various pathological conditions associated with BPFM have been reported, such as communication with the esophagus and lung sequestration in the abdominal cavity , 2, 4. TIn this case, surgery was performed after the formation of an abscess. The esophagus and sequestrated lungs fused fibrously, forming a mass lesion containing a fistula and this condition has been reported in a small number of patients with BPFM , 6. The Bloody vomiting in infancy is a typical sign of gastroesophageal reflux disease. Our case was initially diagnosed with gastroesophageal reflux, but eventually was accompanied by hemoptysis. Hemoptysis is rare in infancy and BPFM is one of the differential diagnoses. Therefore, CT scans and esophagography are required as imaging studies, leading to an early diagnosis. Attention should be paid to the structure of the esophageal wall when obtaining an upper gastrointestinal series.We described here the rare case of a communicating BPFM with intrapulmonary sequestration on one end and the esophagus on the other, including ectopic pancreatic tissue in a male infant. Although the concept of BPFM has become more widespread, the effects of ectopic pancreatic tissue in BPFM are unclear. The accumulation and analysis of additional cases is needed.


The peritoneal cavity is the second most common location for mesothelioma with only 10.5% of 10,589 mesothelioma cases reported in the United States between 1973 until 2005 and known with poor prognosis. Diagnosing malignant peritoneal mesothelioma is a challenge for many clinicians because the symptoms are often non-specific. Therefore, the emergence of computer tomography (CT) features knowledge and another finding is an essential aspect in establishing the diagnosis. We present a case 43-years-old man with no history of malignancy presented with abdominal distention, weight loss, and decreased appetite for 2 months. To pursue the proper diagnosis an abdominal CT was performed and revealed diffuse, irregular thickening of the parietal peritoneum with multiple nodules, and the chest CT revealed a left-sided pleural effusion with multiple nodules in both lungs. Concomitant with the imaging result, histopathological examination and immunohistochemical analysis of a core biopsy of the peritoneal nodule showed a malignant round cell tumor indicating the source of the mesothelioma. It has been reported that only 10.5% of 10,589 mesothelioma cases reported in the United States between 1973 and 2005 originated from the peritoneum; moreover, in industrialized countries, the occurrence rate of this disease ranges from 0.5-3.0 cases per million in men, and from 0.2-2.0 cases per million in women A 43-years-old man with no history of malignancy presented with abdominal distention, weight loss, and decreased appetite for 2 months. A physical examination was carried out and ascites permagna was noted. The tumor markers, serum alpha-fetoprotein, CA-125, and CA-19.9 were within normal limits. Abdominal CT revealed diffuse, irregular thickening of the parietal peritoneum with multiple nodules. The thickening was up to 1.8 cm on visceral peritoneal surfaces  and 2. AMalignant peritoneal mesothelioma (MPM) is the second most common type of mesothelioma; it accounts for around 30% of all cases of malignant mesothelioma, with an overall incidence of 2-2.6 cases per million per year. The development of peritoneal mesothelioma is associated with a history of asbestos exposure; some patients have no history of asbestos exposure, as in this case. According to the literature, exposure to mica, talc, thorium, and simian virus 40 (SV40) infection could be a risk factor for mesothelioma Clinical features of MPM are non-specific in early stages and thus most cases are diagnosed at an advanced stage. The clinical presentation of the tumor's spread within the abdominal cavity may vary and is associated with the accumulation of ascites and the presence of mass growth leading to the primary symptom of abdominal distension. MPM is generally divided into 2 types: diffuse and local. Most patients exhibit the diffuse peritoneal type. Those with diffuse malignant peritoneal mesothelioma (DMPM) usually present with abdominal pain or distension •Dry type: the presence of a large peritoneal mass or multiple, diffuse, small peritoneal nodules with little or no ascites.•Wet type: a predominant presence of ascites with or without multiple nodules or small plaques.•Mixed type: the combination of dry and wet type In general, according to Sudhantiram et al. (2012), CT images of mesothelioma cases are categorized into 3 types:MPM has several manifestations on CT: thickening of the peritoneum, mesentery, and pleura; multiple nodules of various sizes and shapes; the presence of mesenteric or omental infiltration; ascites; adenopathy; and bone destruction.Irregular peritoneal thickening of >1 mm was found in some MPM patients Tumor growths may spread to the parietal and visceral peritoneum of intra-abdominal organs. MPM presents with involvement of the omentum, diaphragm, liver, small and large intestines, and mesentery Ascites is radiologically defined as the presence of high fluid density (>20 HU) or low fluid density (<10 HU).In cases where ascites has spread through the entire abdominal cavity and to pelvic cavity, it is referred as extensive ascites. In moderate ascites, fluid is localized around the liver and spleen. In mild ascites, there is only a small amount of fluid present In some patients with MPM, pleural manifestations are commonly found as pleural calcifications and recurrent pleural effusions In this case, multiple nodules of up to 1.8 cm in thickness on the parietal and visceral peritoneal surfaces were visualized using abdominal CT, which also revealed the mixed type with diffuse, irregular thickening. A large volume of ascitic fluid was present in the abdominal cavity extending to the pelvic cavity. Furthermore, chest CT revealed a left-sided pleural effusion with multiple nodules in both lungs. The CT images demonstrated features of MPM, though they could have been features of peritoneal carcinomatosis as well. Nevertheless, the immunohistochemical examination revealed a mesothelioma of the peritoneum.The recommended treatment since the 1990s is cytoreduction combined with hyperthermic intraperitoneal chemotherapy (HIPEC) which has been considered in patients with peritoneal mesothelioma. This treatment is a promising treatment for patients with long-term survival of 5 years increasing to 50% in these patients. Despite these advances in treatment, globally most patients with MPM receive palliative care or systemic chemotherapy. This incident has been noted in previous studies, in which most patients were treated with palliative therapy or diagnosed during autopsy Malignant peritoneal mesothelioma (MPM) is a rare occurrence; despite this, these diagnoses could easily lead to misdiagnosis. CT images can diagnose and categorize the type of MPM, even though the gold standard is through immunohistochemical examination. In addition, the awareness and knowledge of imaging and other investigations is therefore essential in establishing the diagnosis.Written consent has been obtained from the patient as there is no patient identifiable data included in this case report. This study has met the ethical principle and already got approval from Research Ethics Committee from Dr. Soetomo General Hospital, Surabaya.Written informed consent was obtained from the patient for the publication of this case report.None


A duodenal duplication cyst (DDC) is a rare congenital anomaly. Gastrointestinal duplication cysts are traditionally treated by complete surgical resection due to the potential precancerous conditions. Here, we describe an asymptomatic DDC that was successfully treated using endoscopic resection. A submucosal tumor in the descending portion of the duodenum was detected in a 71‐year‐old female during a regular checkup at our hospital. Upper gastrointestinal endoscopy showed a 10‐mm pedunculated submucosal tumor. Endoscopic ultrasonography revealed a 10‐mm cystic tumor of low echogenicity that included nodules and debris. Endoscopic resection with hot snare polypectomy was performed for diagnosis and treatment. The postoperative course was uneventful. Histologic examination revealed that the cystic tumor was a DDC. Endoscopic resection is a safe, effective, and minimally invasive alternative to surgical resection for small DDCs with malignant potential. A duodenal duplication cyst (DDC) is a rare congenital anomaly usually encountered during infancy or early childhood.A 71‐year‐old female visited our hospital for a regular checkup, whereupon a submucosal tumor (SMT) in the descending portion of the duodenum was detected. She had a medical history of hypertension and dyslipidemia. Her family and social history were unremarkable. Physical examination revealed no palpable mass, and all clinical laboratory data were normal. Upper gastrointestinal (GI) endoscopy showed a soft pedunculated 10‐mm SMT, which was easily movable by the bioptome. The SMT was located in the descending portion of the duodenum, next to the papilla of Vater  revealed a 10‐mm tumor with low echogenicity that included nodules and debris. The first layer of the cyst lumen was hyperechoic, the second layer was hypoechoic, the third layer was hyperechoic, the fourth layer was hypoechoic, and the fifth layer was hyperechoic, appearing to continue from the duodenal mucosa. The tumor did not communicate with the common bile duct or the pancreatic duct Figure . An enhaHistologically, the lesion had a cystic structure. The cystic space was lined by columnar epithelial mucosa and had a muscle layer. The inner and outer surfaces of the cyst were formed by normal duodenal mucosa. Moreover, the cystic wall was highly infiltrated by lymphocytes, which led to the pathological diagnosis of DDC. The tumor was p53(−) and Ki76(+) by immunohistochemistry, indicating the presence of atypical regenerative epithelium in the inner layer. There was no sign of malignancy Figure .A duplication cyst is a rare congenital anomaly formed during embryonic development of the alimentary tract. Duplication cysts are characterized by spherical or tubular structures which possess a well‐developed smooth muscle layer and are lined with a mucous membrane.The diagnosis of malignant GIDCs is rare; only a small number of cases have been reported.Complete surgical resection is considered the optimal treatment for DDCs; however, pancreaticoduodenectomy is sometimes necessary. This procedure has high complication and mortality rates and should be carefully considered. A recent study suggested that DDCs could be safely resected endoscopically.In our case, the patient was an adult and asymptomatic. EUS was used to perform a close visual inspection; although the findings were insufficient for diagnosis, the differential diagnosis included a simple cyst, lipoma, lymphangioma, and duodenal hamartomatous protrusion. The tumor included nodules; thus, the possibility of malignancy could not be ruled out. Because the EUS image confirmed that the tumor had a long stem and was situated sufficiently far from the papilla of Vater, hot snare polypectomy was deemed appropriate. Furthermore, we had not definitively diagnosed the tumor as a DDC; thus, marsupialization was not an appropriate choice at that time. Furthermore, endoscopic resection allowed for detailed pathologic evaluation, which is an important advantage over marsupialization. Therefore, we decided that the DDC could be easily and safely treated by endoscopic resection, and a hot snare polypectomy was performed. The outcome was favorable, and no complications, including perforation, occurred.Endoscopic resection is a safe, effective, and minimally invasive alternative to surgical resection for small DDCs with malignant potential.The authors declare no conflict of interest.None.Not applicable.Written informed consent was obtained from the patient for publication of this case report and any accompanying images.


Central nervous system germ cell tumors (CNS GCTs) represent a class of rare tumors that exhibit region-specific prevalence in some Asian areas (15.3%), higher than that in North America (3.6%), and age-specific prevalence in children and adolescents. According to the 2016 World Health Organization (WHO) classification, CNS GCTs can be categorized into germinomas and non-germinomatous GCTs (NGGCTs). Owing to the compression of the interventricular foramen by enlarged GCTs in the pineal gland, the resultant obstructive hydrocephalus may result in high intracranial pressure (HIP) at an alarming pace, which urgently requires a ventriculoperitoneal shunt for the relief of severe HIP. Although CNS GCT cells tend to migrate through the cerebrospinal fluid (CSF) starting from the subependymal lining, metastasis along the ventriculoperitoneal shunt tube is extremely rare.In this study, we reported two cases of iGCTs with intraperitoneal metastasis. Both patients underwent ventriculoperitoneal shunt placement to alleviate HIP, and both received standard radiotherapy and chemotherapy, but they still developed abdominal metastasis, and all the abdominal masses were pathologically confirmed to be iGCTs.We performed a literature study and found that from 1979 to 2020, a total of 18 cases of iGCTs were metastasized outside the nervous system. We also found a shift of the median of 13.5 months and that the most common primary site was the pineal region (83.3%); moreover, nearly half of the patients (44%) died within 1 year of metastasis, indicating a poor prognosis after celiac metastasis.The online version contains supplementary material available at 10.1186/s41016-021-00246-0. Central nervous system germ cell tumors (CNS GCTs) represent a class of rare tumors that exhibit region-specific prevalence in some Asian areas 15.3%), higher than that in North America (3.6%), and age-specific prevalence in children and adolescents 5.3%, hig. Owing tA 13-year-old Asian male presented with unsteady gait for 4 months and complained of headache, nausea, a drooping left eyelid, blurred vision for 11 days, and convulsions for 3 days. The magnetic resonance imaging (MRI) scan Fig. . The patA 17-year-old Asian male presented with a long-standing history of generalized headache, diabetes insipidus, and intermittent fever without obvious inducement. An MRI examination Fig.  revealedWhile iGCTs in the pineal gland are more prevalent in the pediatric population, they are still relatively rare, with a low incidence rate of less than 1% of all intracranial tumors . NeverthAlthough abdominal metastasis is a low-probability event, the two patients described above were treated with total central radiotherapy, which poses a challenge for subsequent treatment after abdominal metastasis. We believe that chemotherapy alone is far from sufficient for germ cell tumors. Radiotherapy is an important way to improve prognosis under the premise of inoperability. However, since patients undergo whole-CNS radiotherapy, the spinal cord and bilateral kidneys are irradiated with different doses; therefore, whether there is an opportunity for whole-abdominal radiotherapy needs to be assessed according to the first radiotherapy plan. Given the pathogenetic process, history, and clinical and imaging manifestations, which are entirely in line with the primary diagnosis and standard treatment, their diagnoses were highly likely to be GCTs. Patients receiving the standard regimen (a VP shunt followed by chemoradiotherapy) rarely develop EIM after treatment, but the two patients developed extensive peritoneal metastasis 8 and 32 months after placement of VP shunts. Therefore, we aimed to determine whether tumor cells can be metastasized through a shunt. Unfortunately, cytological analysis of the CSF specimen of the first case was not performed after surgery, but the pathological report of the second case revealed metastatic GCTs. Through previous studies reported in the literature, we found that although the placement of a VP shunt is a classic surgical procedure for the emergency relief of hydrocephalus, it still has a risk of metastasis. Therefore, for tumors with a high risk of dissipating, the third ventricle fistula may be a better choice, which not only relieves hydrocephalus but also avoids the maintenance of the shunt tube and the risk of abdominal dissemination in the later stage. Moreover, if conditions permit, neurosurgeons have an opportunity to perform a biopsy to obtain a clear pathology.Intracranial GCTs are rare and rarely progress to distant metastases; however, peritoneal implant metastasis occurred in two cases 8 and 32 months after placement of VP shunts. As Devkota et al.  stated tRegarding the metastatic pathway of the two cases reported herein, we believe that GCTs are likely to metastasize through the CSF and have a high possibility of developing distant metastasis along the VP shunt pathway.Additional file 1: Fig. S1. MRI of the central nervous system showed no evidence of tumor recurrence in the second patient.Additional file 2: Fig. S2. Intraoperative resection of the lesion confirmed the diagnosis of mixed germ cell tumor.


The arcuate line is the inferior margin of the posterior layer of rectus abdominis sheath. An arcuate line hernia is a parietal interstitial hernia consisting of ascending protrusion of intraperitoneal contents above the arcuate line. Arcuate line hernias are rare, and fewer than 20 cases undergoing surgical repair have been reported. Various surgical approaches were used in previous cases, and there is no consensus regarding the ideal repair method. We report the first case of an arcuate line hernia repaired using single-incision laparoscopic surgery.The patient was a 78-year-old man who presented with a history of intermittent lower abdominal quadrant pain of more than 2 month’s duration. He had not previously undergone abdominal surgery, but had a history of mycobacterial lung disease and asthma. His vital signs were normal on presentation, and he experienced no vomiting or nausea. On palpation, his abdomen was flat and soft, and no mass was palpable. However, there was slight tenderness in the right lower quadrant. Blood laboratory test results were within normal ranges. Computed tomography revealed small bowel protrusion between the rectus abdominis and the posterior rectus sheath, and an arcuate line hernia was suspected and subsequently confirmed intraoperatively. The patient underwent single-incision laparoscopic repair with the intraperitoneal onlay mesh technique with tacks and with care to avoid the inferior epigastric vessels. The operation time was 30 min, and no intra- or post-operative complications occurred. Surgery relieved his symptoms, with no recurrence within 1 year postoperatively.Single-incision laparoscopic surgery was performed easily and successfully in this rare patient with arcuate line hernia. Arcuate line hernia should be considered in patients presenting with abdominal symptoms, and single-incision laparoscopic repair should be considered for repair. The arcuate line (AL), also called the linea arcuata, linea semicircularis, and the semicircular line of Douglas, marks an anatomical transition point inferior to which all the aponeurotic layers of the abdominal muscles, except the transversalis fascia, pass simultaneously anterior to the rectus abdominis muscle , 2. The 2. His abdomen was soft and flat, no parietal mass was palpated, and slight tenderness was present in the right lower quadrant. Blood test results were within normal limits. Abdominal contrast-enhanced computed tomography (CT) revealed protrusion of a small bowel loop between the rectus muscle and the PRS  was 27.4 kg/mWith the patient in the supine position under general anesthesia, a 2-cm-long muscle-splitting incision was made at contralateral McBurney’s point. A Lap Protector™  was attached to the wound, and an EZaccess™ (Hakko) with three inserted 5-mm trocars was added Fig. a. LaparoIn the supraumbilical and part of the infraumbilical abdominal wall, the rectus abdominis muscle is covered on the dorsal side by the PRS, a plate of aponeurotic tissue that is formed by the fascia transversalis and posterior lamina of the internal oblique muscle. Somewhere between the umbilicus and pubic bone, the posterior lamina of the internal oblique muscle joins the anterior lamina on the ventral side of the rectus muscle, leaving only the transversus fascia on the dorsal side as areolar tissue . This leIn some cases, the preoperative diagnosis of ALH was mistaken for Spigelian hernia , 12. SpiThe prevalence of ALH is unclear, and the underlying reason is that most ALHs are asymptomatic and remain unclassified, and the diagnosis is often incidental or could be misclassified as another abdominal hernia. To investigate the incidence of ALH, two retrospective large cohort studies using CT have been reported , 21. CouThere have been 19 reported cases of surgery for AL , and extended-view totally extraperitoneal repair (eTEP). There have been no reports of recurrence. It is difficult to determine the best method because each technique has advantages and disadvantages. It is best to use the method that the surgeon is comfortable with. In any method, care must be taken to avoid damaging the inferior epigastric vessels that branch from the external iliac vessels and cross the AL into the rectus abdominis. In our case, we performed SILS using the IPOM technique. The procedure was relatively simple, and we were able to close the hernia orifice safely and securely. The advantages of SILS are reduced associated morbidity, namely wound infection, pain, bleeding, visceral injury, and port-site herniation . In lighWe reported the first case of SILS for ALH. Although ALH is a rare disease, its possibility should be considered in patients with abdominal complaints. Laparoscopy is recommended for symptomatic ALH, and SILS should be considered.


Mucinous cystic neoplasms of the pancreas are uncommon and especially their occurrence during pregnancy is an extremely rare event which necessitates an individualized and interdisciplinary management. A 33-year old woman was referred to our department during her third trimester of pregnancy (34th week of gestation) with severe anemia and tarry stools. Based on gastroscopic findings, our interdisciplinary team suspected a gastrointestinal stromal tumor and therefore indicated a prompt delivery via cesarean section completed with an oncological resection of the neoplasm. Histological examination subsequently showed a mucinous cystic neoplasm of the pancreas with no evidence of malignancy. To review the prevalence of mucinous cystic neoplasms and to discuss diagnosis and treatment during pregnancy. Moreover, we critically value the indication of preterm delivery and the oncological procedure in the perspective of outcome for mother and infant. A bleeding gastrointestinal tumor during pregnancy represents a life-threatening risk for mother and infant and requires an immediate interdisciplinary treatment. The urgency and radicality of the therapy should be adapted according to individual findings. As our patient’s tumor was suspected of having a malignant progression, an extensive surgical intervention was necessary. According to the World Health Organization, anemia can be found in about 40% of all pregnancies worldwide. In Germany, providing a well-established health care system with regular prenatal check-ups, the prevalence was reported at a much lower rate, 23%, respectively . In abouRarely, a benign neoplasia can also be the cause of anemia. One of these rare tumor entities is the mucinous cystic neoplasm (MCN) of the pancreas. Especially its occurrence in pregnant women represents a rare event . The majHistologically, MCNs consist of two definite components: a mucin-producing columnar epithelial layer and a unique ovarian-type subepithelial stroma , which cWe present a primigravid, 33-year old European woman, who was admitted to the emergency department for obstetrics in her 34th week of pregnancy, due to a symptomatic but compensated anemia, which clinically has been manifesting in a 3-week history of fatigue, mild circulatory insufficiency and a hemoglobin level of 4.8 g/dL. The patient negated vaginal or rectal bleedings but mentioned a blackening of stool during the last three weeks, which she attributed to the intake of iron supplements. There were no abnormal findings considering the pregnancy. After transfusion of three packed red blood cells, only a marginal increase in hemoglobin level (5.9 g/dL) was recorded. Considering the symptoms and insufficient increase in hemoglobin levels, a gastrointestinal bleeding was assumed and gastrointestinal endoscopy was advised. Gastroscopy revealed a posterior wall-sided mobile conglomerate tumor in the corpus and antrum with an ulcerated and hypervascularized surface leading to severe hemorrhage. Proximal to the tumor, the posterior wall of the gastric corpus was impressed extraluminally. According to its endoscopic appearance, the tumorous mass was assumed as a highly suspicious finding with the suggestion of an ulcerated malignant gastric tumor or gastrointestinal stromal tumor (GIST) of the stomach. Biopsy or intervention measures were not performed due to the risk of further uncontrollable bleeding. The extent of the tumor was additionally determined by transabdominal ultrasound, which showed an 11 cm mostly cystic tumor mass presumably arising from the pancreatic tissue. At this point, the entity was still not clear. An interdisciplinary team of gynecologists, visceral surgeons and gastroenterologists evaluated these clinical findings with regard to the gestational age and decided to refrain from further diagnostics (magnetic resonance imaging (MRI)/computed tomography (CT)/biopsy/blood tests) and conservative therapy because of the urgent need of maternal treatment. A preterm delivery via cesarean section was indicated and followed by visceral surgery in the same session. Intraoperatively, a differentiation between a conglomerate tumor arising from the gastric posterior wall or the pancreas was impossible . A tumorPathology confirmed a 12.5 cm × 11 cm × 10.5 cm measuring, mostly cystic, partly necrotic, knotty pre-bulged tumor, which was located on the posterior gastric wall and was removed with tumor-free resection margins . The splPancreatic mucinous cystic neoplasms represent highly rare findings. Especially their occurrence in pregnant women has only been published in a few reports . MCNs usThe present case showed exceptional displacing tumor growth causing a compression of the posterior gastric wall with consecutive erosion of the mucosa and severe gastric bleeding.≥ 40mm should undergo a surgical resection, as well as MCNs which are symptomatic or show risk factors for malignant transformation, regardless of their overall size  [MCNs in pregnant women have been described to exhibit a greater size (14.5 cm) if compared to MCNs in the non-pregnant population  (6.5 cm) ,25. Thisreement) ,23,26,30reement) . In ordereement) . A folloreement) .Pancreatic mucinous cystic neoplasms are a rarity and their occurrence in pregnant women requires careful interdisciplinary management. The rapid tumor growth during pregnancy is associated with an increased risk for malignant transformation and associated complications like tumor rupture, pancreatitis, fetal intrauterine growth restriction or in this case severe anemia. The risk of disease progression in pregnancy should be weighed against an observative strategy in order to ensure fetal maturity. Close cooperation between different medical disciplines  is vital in order to properly manage MCNs in pregnant women.


Although there is no established treatment strategy for liver metastasis of leiomyosarcoma, liver resection has been reported to be effective in some cases. However, almost all liver resections performed for liver metastasis of primary leiomyosarcoma are reported to be open resections, and there are few reports of liver resection performed by laparoscopy. Here, we report a case of laparoscopic liver resection for liver metastasis of a leiomyosarcoma in the right thigh.An 80-year-old man was diagnosed with leiomyosarcoma of the right thigh with liver metastasis. The primary tumor was first resected, and he was discharged on the 25th postoperative day. Four months after primary tumor resection, a laparoscopic right posterior sectionectomy was performed. There were no postoperative complications, and the patient was discharged on the 11th postoperative day with a histopathological diagnosis of liver metastasis of leiomyosarcoma and negative resection margins. Currently, 9 months have passed since the resection of the primary tumor, and 5 months have passed since the laparoscopic liver resection; there is no recurrence.The liver metastasis of leiomyosarcoma was successfully removed, with good short-term outcomes after the laparoscopic liver resection. Laparoscopic liver resection seems to be effective for liver metastasis of leiomyosarcoma, which is characterized by a high recurrence rate after surgery. However, more case studies may be necessary to examine the effectiveness and long-term results of laparoscopic liver resection for the treatment of liver metastasis of leiomyosarcoma. Leiomyosarcoma is one of the most common histological types of soft-tissue sarcomas, accounting for 5–10% of all cases , 3. It hThere is no established treatment for liver metastasis of leiomyosarcoma, but liver resection has been reported to be effective –9. The rth postoperative day, antibiotics were administered owing to wound redness and elevated levels of inflammatory markers. Thereafter, the patient’s condition progressed without any problems, and he was discharged on the 25th postoperative day. A histopathological diagnosis of leiomyosarcoma was made based on the presence of atypical spindle cells with numerous mitotic figures [42 mitoses/10 high-power fields]  of 0.535 and receptor index  of 0.933, indicating good liver function. Whole-body computed tomography (CT) revealed a 25-mm mass with heterogeneous contrast effect in the right thigh and a low-density mass in segment 7 of the liver (S7). T2-weighted magnetic resonance imaging (MRI) revealed a 25-mm solid tumor with a high-intensity signal at the right medial thigh, which was suggestive of a soft-tissue sarcoma. A gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (EOB) MRI revealed decreased EOB uptake in the liver S7. Moreover, 18F-fluorodeoxyglucose-positron emission tomography CT revealed fluorodeoxyglucose accumulation with a maximal standardized uptake value of 12.3 in the liver S7, which was suggestive of synchronous metastasis  of 12–51.8% and a median survival time (MST) of 11–77 months , 11–15 (In the present case, the patient had simultaneous liver metastases, and went through two-staged surgeries, with liver resection performed 4 months after resection of primary tumor. According to Marudanayagam et al., there was no significant difference in survival outcome after liver resection between patients with synchronous versus metachronous liver metastases from soft-tissue sarcomas , 27.According to previous reports regarding liver resection for liver metastases of leiomyosarcomas, in almost all cases, only open liver resection performed –13, 28, Leiomyosarcoma liver metastasis is characterized by a high recurrence rate of approximately 43.7–88% after surgery , 28. RehIn conclusion, we present the case of a patient in whom the liver metastasis of a leiomyosarcoma was successfully removed by laparoscopic liver resection with good short-term outcomes. Our findings suggest that laparoscopic liver resection is an effective treatment approach for liver metastasis of leiomyosarcoma, which have a high recurrence rate but are effectively treated by re-liver resection. However, because this case had a postoperative observation period of only 7 months, more case studies are warranted to examine the long-term effectiveness of laparoscopic liver resection for the treatment of liver metastasis of leiomyosarcoma.


Left-sided colonic diverticulitis is a common condition with significant morbidity and health care costs in Western countries. Acute uncomplicated diverticulitis which is characterized by the absence of organ dysfunction, abscesses, fistula, or perforations accounts for around 80% of the cases. In the last decades, several traditional paradigms in the management of acute uncomplicated diverticulitis have been replaced by evidence-based routines. This review provides a comprehensive evidence-based and clinical-oriented overview of up-to-date diagnostics with computer tomography, non-antibiotic treatment, outpatient treatment, and surgical strategies as well as follow-up of patients with acute uncomplicated diverticulitis. Diverticular disease was first described during the 19th century by anatomists who described the development of the disease with inflammation and its complications including the formation of abscesses and fistulae 1. The disColonic diverticulosis is a common condition affecting up to 70% of the population in Western countries by the age of 80 7. However10The most common presentation of patients with diverticulitis is pain in the left lower abdominal quadrant and changes in bowel habits (constipation or diarrhea) with or without fever. These symptoms are non-specific, and the clinical diagnosis of diverticulitis has a sensitivity of only 45%–72% –20; howeTo confirm the diagnosis and to differentiate uncomplicated from complicated disease, radiological examination is needed. Since the introduction of computed tomography (CT) during the latter part of the 20th century, this modality has taken over as the primary examination method as it has excellent sensitivity for acute diverticulitis, and is rapid and relatively inexpensive to carry out ,19,23. HEven though CT is the most common examination tool used for suspected diverticulitis, CT examination protocols (exposure and choice of contrast) differ between countries and hospitals. In most Nordic countries, full-dose CT with intravenous contrast is used . The useIn the pre-antibiotic era, treatment of diverticulitis consisted of bed rest and no or low residual diet. These treatments had a rather high symptomatic success rate . DespiteA long-term follow-up of the AVOD trail with data on 556 patients of the 623 originally included with a mean follow-up time of 11 years showed that antibiotics omittance was safe in the long-term . The lonStrict patient selection in randomized studies is a drawback, and further studies in a population-based setting are necessary for external validity. Following the findings from RCTs, several retrospective population-based observational studies have shown the implementation and the safety of a non-antibiotics policy for AUD ,40,41. I42In recent years, outpatient treatment has gained much attention. In a systematic review, outpatient treatment in selected groups was shown to be safe, reduced healthcare costs considerably, and did not increase the risk of complications, revealing a pooled readmission rate of 7% and very low rates of surgical intervention ,51. The British Journal of Surgery that the treatment of diverticula and diverticulitis “comprised in one word—Surgery” . Fortunately, two RCTs comparing conservative treatment to elective sigmoid resection for recurrent or persistent painful diverticulitis have been published: DIRECT and LASER trials ,71. The –69. FortAny decision on sigmoid resection in patients with AUD should be individualized, and the advantages of elective sigmoid resection, namely superior HRQoL, lower pain, and fewer recurrences, need to be balanced against the significant risk of major complications of surgery.Although evidence is limited, currently elective sigmoid resection with primary anastomoses is usually performed with minimal invasive techniques . HartmanThere is no consensus in the literature with regards to the need for a routine colonic examination after an episode of AUD. Meta-analyses of studies on cancer prevalence after an episode of acute diverticulitis have shown varying results with a prevalence of malignancy of 0.5%–2% for uncomplicated diverticulitis and 7.9%–10.8% for complicated diverticulitis ,82. Give83In our opinion, omission of a routine follow-up colonoscopy could be considered in patients with CT-verified uncomplicated diverticulitis, where the CT scans have been re-evaluated by a gastrointestinal radiologist, the patient has no sign of colorectal cancer such as anemia, haematochezia, or change in bowel habit and where the symptoms of diverticulitis have diminished at a 4-week follow-up.


Lymphangioma circumscriptum is a rare benign disorder of lymphatic channels in deep dermal and subcutaneous layers. It can occur either as a congenital abnormality or as acquired damage to previously normal lymphatic channels. It occurs in different parts of the body, and the vulva is one of the parts which is commonly affected. Here, we presented a 39 years old para 2 who presented with vulvar swelling. She was diagnosed with acquired lymphangioma circumscriptum of the vulva and superficial vulvectomy was done. Lymphangioma circumscriptum is a benign disorder of lymphatic origin that can be either congenital or acquired, involving the skin and subcutaneous tissues. Acquired vulvar lymphangioma circumscriptum is a rare disease known to occur after radical hysterectomy with or without adjuvant radiation therapy for cervical cancer, chronic lymphedema of the lower extremity, or infections like Tuberculosis. It is caused by damage to previously normal lymphatic channels ,2,3.The clinical presentation of lymphangioma circumscriptum is highly variable, ranging from being asymptomatic to a highly disabling condition. Discomfort, itching, rubbing, and lymph oozing are the most frequent symptoms. Clinically, it usually presents as multiple nodular lesions, verruciform or polypoid, with variable size and with intervening normal skin ,5.It may pose diagnostic difficulties both clinically and histopathologically. It is frequently confused with warts or condyloma acuminate. The main differential diagnosis is genital warts ,4,5. TheHere, we present a 39 years old para 2 woman who presented with vulval swelling. She was diagnosed with acquired lymphangioma circumscriptum and for whom superficial vulvectomy was done. There was no recurrence over 9 months of follow-up.A 39 years old para 2, both vaginal deliveries, who had regular menstrual cycle presented with vulval swelling of two years duration with swelling. The patient reported a progressive increment of the swelling, oozing and itching sensations. She also reported swelling of her right leg of 2 years duration. Five years back, she underwent laparotomy for an unspecified gynecologic disorder which looked benign condition.On physical examination, she had an old infra umbilical midline scar, but there was no other finding on abdominal examination. On genital examination, bilaterally swollen labia with multiple popular and vesicular lesions with some oozing of watery discharge from the mass, the vulvar skin over the mass was shiny. Other genital examinations were none reviling. On musculoskeletal examination, she had non-pitting edema of the right extremity upto the thigh.For her condition, after repetitive visits to different OPDs, she was diagnosed with lymphangioma circumscriptum at a dermatology clinic, and she was linked to the gynecology department for management. Before her final diagnosis, she was diagnosed with vulval eczema, genital wart. Vulvar cancer was considered and treated for eczema and genital wart, but no improvement and biopsy were made before her final diagnosis.Her basic investigations were nonrevealing; pelvic ultrasonography was normal. After evaluation at the gynecology department, she was counseled on options of management and potential recurrence of the lesion. Even after surgical management, she was admitted for elective surgery after written consent and bilateral superficial vulvectomy was done with primary skin closure done under spinal anesthesia.After surgery, she was followed at gynecology and dermatology OPDs. She had small oozing from the wound site at 9 O clock until 27th postoperative day with some swelling of the clitoris, but the itching and pain had subsided and on her 40th day of postoperative follow-up day, the wound had healed well with no recurrence of the lesion and no discharge. She was linked to the internal medicine side for follow-up of lower extremity lymphedema. At the 9th month follow-up, she did not have recurrence on the vulva, and she was wearing elastic bandages on the lower extremity. She also reported that she was having sexual intercourse without difficulty.Pathologic examination described scattered arteriolar size dermal and subcutis vessel, exocrine and apocrine ducts involved (cuffed) by intense mononuclear infiltrate noted. A few dilated lymphatic lumens filled with lymphatic fluid were noted. For the above description, the pathologist concluded vulva; nonspecific chronic inflammation with minimal dermal lymphedema accumulation.Vulvar lymphangioma circumscriptum sometimes accompanies lower extremity edema or genital lymphedema. It may pose diagnostic difficulties both clinically and histopathologically. It is frequently confounded with warts or condyloma acuminate. The most common dermoscopic pattern associated with lymphangioma circumscriptum is the presence of lacunae and vascular structures ,5.This patient had a risk factor of lower limb lymphedema, but her diagnosis was challenging. She had visited different OPDs to reach a final diagnosis and she had taken different medications for her condition, but the final diagnosis was reached at the dermatology clinic. Her pathology report description of few dilated lymphatic lumens filled with lymphatic fluid which favors diagnosis of vulvar lymphangioma circumscriptum.Acquired lymphangioma occurs more commonly in the vulvar region compared to the other regions of the body, which can be frequently associated with surgery, radiation therapy, infection , Crohn's disease, congenital dysplastic angiopathy, and congenital lymphedema ,2,4,5. IEven though this patient did not have the commonest risk factor of pelvic radical surgery or radiation to her pelvis or treatment history for tuberculosis, she presented with a typical clinical picture. For this case, the only risk factor was the presence of lower limb lymphedema. Her previous pelvic surgery was for benign pathology, which evidences do not mention as it increases the risk of having lymph angioma circumscriptum of vulva.There is no standard management for vulvar lymphangioma circumscriptum. The various treat-ments range from conservative treatment with decon-gestive physiotherapies, such as manual lymph drainage, exercise, and compression, to abrasive therapy, sclero-therapy, electrocoagulation, laser-therapy with CO2, and surgical excision depending on the patients' condi-tions. While lesion recurrence is frequent, out of various treatment modalities, surgical excisions were preferred. The recurrence rate after surgical management was 23.1% on a follow-up ranging from 6–81 months. The recurrence rate might be twice as high in lymphangioma circumscrip-tum without surgical management. The recurrence rate after radical excision was high when the initial lesions were greater than 7 cm diameter as compared with lesions of less than 7 cm diameter for which a local excision was performed ,5.In our case management, we choose superficial vulvectomy for the reason of lack of other management modalities and the extensive nature of the lesion. She was symptomatic which made her not an ideal candidate for conservative management. For nine months of follow-up, she had no recurrence of the lesion. Due to the rarity of vulvar lymphangioma circumscriptum, it is common to misdiagnose the condition timely which will force patients to get treatment for the misdiagnosed condition, which will make delay in giving timely and appropriate management of the condition. Therefore, high index of suspicion is mandatory for better management.


Renal pelvic rupture (RPR) is a rare condition, that is most usually caused by obstructive calculi.In another hand, primal ureteral tumors are also uncommon, with only a few cases reporting their involvement in a RPR.We report a case with a multimodality discussion of an ureteral tumor, with a spontaneous renal pelvic rupture (RPR) forming a large retrorenal urohematoma.Only few series reported the subject of RPR in the English literature. Only some single cases reported the causality of urinary tract tumors in RPR.RPR is an imaging based diagnosis. Herein, upper urinary tract tumors show a variable appearances at imaging.By reporting this case, we highlight the role of both computed tomography (CT) and magnetic resonance (MR) imaging in the diagnosis of the RPR and their accuracy in the detection of the ureteral tumor. We also consolidate the effectiveness of the conservative attitude in the management of the RPR. •An ureteral tumor can lead to a renal pelvic rupture.•Both CT and MR imaging are accurate in the detection of the ureteral tumors.•Non-surgical management of renal pelvic ruptures is efficient. It is most usually caused by obstructive calculi. Other causes include ureteral extrinsic compression by both malignant or benign neoplasms, pregnancy, iatrogenicity or traumas.In another hand, primal ureteral tumors are uncommon, representing less than 5% of all urothelial carcinomas. However, there's only a few cases reporting their involvement in a RPR We report a case of a multimodality discussion of a rare presentation of an ureteral tumor, with a spontaneous rupture of the renal pelvis forming a large retrorenal urohematoma.The case reported was managed by the authors in an academic hospital and written in line with the SCARE criteria 2A. K., a 48 y.o. male presented by himself to the emergency department with a history of macroscopic hematuria and lower back pain evolving for 2 months. The patient was a chronic smoker with a history of 20 pack-years. He reported an estimated weight loss of 10 kg in 6 months and denied any history of trauma, previous surgery, urolithiasis or past illnesses. He was pale, eupneic, afebrile with a tachycardia at 90 bpm. No other evidence was revealed on the physical examination. A blood sample was taken and the blood count showed an hypochromic microcytic anaemia with an heamoglobin level at 8,7 g/dL. The serum renal tests were at normal values .The patient was hospitalized and a contrasted CT-Urogram  was requAn MR-Urogram was performed for a further characterization. The signal on the retrorenal collection was both liquid and hemorrhagic . The renThe patient benefited from a flexible ureteroscopic examination confirming the ureteral lesion and guiding biopsies. Herein, the pathological examination confirmed the diagnosis of a papillary urothelial carcinoma, grade 2.We discussed the management options for this patient, while no evidence of lymph node enlargement or metastatic lesions were noted on previous imaging. The patient elected to undergo a laparoscopic radical nephroureterectomy with a bladder cuff excision. He was operated by our team, 3 weeks after his first presentation. With the final pathological evaluation, the disease was staged pT2N0M0.As an adjuvent therapy, a 21-day cycles of cisplatin and gemcitabin based chemotherapy were managed after three months from the surgical procedure. The patient had no further hematuria. Furthermore, serial follow-ups during one year, using cystoscopy and CTs showed no evidence of a disease recurrence.3Renal pelvic rupture (RPR) is an imaging based diagnosis with a perirenal urine extravasation. Causes are mainly obstructive and are dominated by obstructive calculi, which are reported in around 80% of cases. Only few series reported the subject in the English literature. Morgan et al. listed malignancies as the second most common cause of RPR. However, they didn't define as if it concerns only urinary tract malignancies or even extrinsic malignancies causing compression on the urinary tract. In another series by Gershman et al., they didn't cite any case of primal urinary tract tumor, while extrinsic ureteral compressions were listed as the second cause of RPR In another hand, tumors in the upper urinary tract  are dominated by urothelial carcinomas (UC). Upper tract urothelial carcinomas (UTUC) are rare, accounting for only 5–10% of all UC, while the bladder accounts for 90–95%. We should say that UC is an urothelial disease with a great association between UTUC and bladder tumors UTUC may be incidentally found on imaging. Otherwise, haematuria is the most common appealing symptom. Other symptoms include flank pain, or systemic symptoms, as fatigue, weight loss… The latter should raise the attention for an advanced/metastatic disease At imaging, CT-Urography (CTU) is the most accurate technique in the diagnosis and staging of UTUC. Its rapid acquisition of a thin slices, offering an isotropic resolution, allows an accurate visualisation of the tumor in multiple planes. MR-Urography is less accurate, and is used mainly in cases of contraindications to CT Otherwise, ureteral tumors may appear as a sessile or polypoid filling defect, a focal eccentric or circumferential wall thickening or an infiltrative ureteral and periureteral mass There's no consensus about how to manage RPR. Treatment may be non-surgical with or without antibiotics administration; or surgical using ureteral stenting or nephrostomy. Morgan et al. argued that non-surgical management should be privileged. Herein, they suggested that the place of antibiotic therapy and surgery should be ruled by arguments on infection. These latter include fever, leukocytosis, positive urinalysis, or elevated creatinine Finally, in a context of UTUC, hydronephrosis, which is the mechanism that leads to RPR, places the patient at a “high-risk” group, making him a bad candidate to kidney-sparing surgery 4Besides its rarity and the usual association with urolithiasis, a renal pelvic rupture can unmask an upper urinary tract malignancy. We should say that imaging is accurate in the determination of UTUC, with a variable appearances. The non-surgical attitude of RPR is effective to save time for a carcinologic planning and management.The authors didn't receive any funding.Ethics approval was given.The consent to participate was given by the patient included in the article.This article does not concern a “First in Man” study.Jaafar Fouimtizi M.D.All authors contributed equally to this work. All authors read and approved the final manuscript.No conflict of interest.


Appendicitis is a common cause of right lower quadrant pain. However, appropriate diagnostic evaluation and a high clinical suspicion can reveal alternative etiologies that are not so commonly encountered. In this report, we present a rare case of an appendiceal collision tumor involving two distinct neoplasms as the source of the patient's pain and describe how thoughtful clinical maneuvering led to its diagnosis and treatment. Appendiceal neoplasms are a rare group of neoplasms that account for less than 1% of all gastrointestinal (GI) malignancies . NotablyIn addition to this uncommon entity, there also exists an even rarer presentation of appendiceal tumors known as collision tumors. It is so rare that our literature search yielded only four reported cases in the literature. Collision tumors are characterized by a bi-clonal derivation resulting from two distinct but adjacent neoplasms . We presThe patient was a 54-year-old Hispanic male who presented with a one-day history of sudden onset of severe right flank and right lower quadrant abdominal pain with radiation to the right inguinal area accompanied by nausea and vomiting. The patient denied any fever or chills and no significant family history was reported. On examination, the abdomen was soft with minimal tenderness on deep palpation of the right lower quadrant without guarding or any distention. Laboratory workup revealed evidence of elevated creatinine, but leukocyte count was within normal limits. A contrast-enhanced CT of the abdomen and pelvis revealed an obstructing stone at the right ureterovesical junction Figures -1C. The The patient’s clinical picture was initially attributed to ureterolithiasis and was treated accordingly. However, the cystic structure on the appendix was concerning for a mucocele. Consequentially, the decision was made to take the patient to the operating room for a diagnostic laparoscopy with a possible appendectomy. Intraoperative findings were significant for an enlarged appendix (measuring approximately 8 x 1.3 cm) with a thickened partially calcified wall, without evidence of inflammation. An enlarged and elongated cystic structure was noted in the mid-appendix. The rest of the abdominal cavity was unremarkable, without mucin or free fluid noted. A laparoscopic appendectomy was performed in the usual fashion. However, given the intraoperative findings, the decision was made to include a distal segment of the cecum in the resection. No surgical complications were encountered during the procedure.The patient's postoperative course was uneventful and final pathology was obtained three days after surgical intervention Figures -3D, repoPrimary appendiceal neoplasms are a rare entity, accounting for less than 1% of all GI malignancies. Clinically, the presentation may range from asymptomatic to acute appendicitis. Often, the diagnosis is made intraoperatively or during the postoperative period via histologic evaluation. Depending on which subtype of tumor we encounter, the majority of cases occur in patients during the third decade of life. Therefore, it is imperative to suspect these neoplasms, especially when it occurs in middle-aged patients. The surgical management of appendiceal tumors varies depending upon several factors, including size, location, invasion, and subtype, and can range from a simple appendectomy to a right hemicolectomy. Hence, knowing the type of appendiceal tumor is important as it guides the subsequent management. The most common appendiceal tumors are epithelial neoplasms and NETs.Although a rare malignancy accounting for only up to 0.2% of all appendectomies and up to 6% of all appendix malignancies, epithelial adenocarcinomas are the most common type . EpithelIt is of key importance in the treatment to consider the presence of pseudomyxoma peritonei in patients with a mucinous neoplasm. Pseudomyxoma peritonei is classically described as the presence of mucin within the peritoneal cavity; however, it is typically only described when the condition is widespread, as opposed to cases where only a small pull of mucin surrounds the appendix and in which the epithelial tumor cell is microscopically identified . As descNeuroendocrine carcinomas, classically referred to as “appendiceal carcinoid,” are tumors that originate from the serotonin-producing enterchromaffin-like cells located in the bowel wall . AppendiSurgery is the only curative treatment for NETs . Tumor sIn addition to the previously mentioned conditions, there also exists an even rarer presentation of appendiceal tumors, known as collision tumors. These tumors are defined as two histologically distinct neoplasms of different clonal origins coexisting within the same organ. Our literature review has revealed only a few documented cases. Singh et al. in 2011 presented a case of a collision tumor where both adenocarcinoma and carcinoid were present; however, in their case, the adenocarcinomatous component displayed omental deposit and metastasis to the regional lymph nodes at the time of presentation . In our The clinical presentation in the present case was concordant with the published literature regarding the highly variable clinical presentation of this tumor, highlighting the importance of maintaining a high level of suspicion when treating middle-aged patients with atypical presentations. Following intra and postoperative diagnosis, the management of our case was considered to be appropriate. Optimal management of both histologically different tumors was taken into account independently. Both tumors were defined as low-grade, non-aggressive, and confined to the appendix, and a simple appendectomy with clear margins was all that was required to appropriately treat our patient.


Solitary fibrous tumors (SFTs) usually occur in the pleura and account for two-thirds of all cases; however, SFTs occurring in the prostate are extremely rare. Approximately 25 cases have been reported in the literature to date. This study reports the case of a 43-year-old man referred to our hospital with the chief complaint of a pelvic tumor after careful examination. The tumor marker levels were within normal limits. T2-weighted magnetic resonance imaging revealed a tumor, demonstrating primarily low signal intensity. It showed a capsule-like rim at the left lobe of the prostate, suggesting that the tumor was partially invading the rectal wall. Histopathological examination of needle-core biopsies showed spindle cell neoplasm with small and fusiform cells, strongly expressing signal transducer and activator of transcription 6 (STAT6) with a ramifying vascular network. Therefore, the clinical diagnosis of the patient was SFT of the prostate and robot-assisted radical prostatectomy was performed. Histopathological examination revealed that the tumor was composed of spindle cells with patternless and staghorn patterns. Immunohistochemical analysis showed a strong expression of STAT6. Furthermore, the tumor was partially positive for CD34. Therefore, the patient was diagnosed with SFT of the prostate. Two years after the initial diagnosis, the patient was alive with normal erectile function, continence status, and no evidence of the disease. A solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm of myofibroblastic origin  and was Here, we report a case of a 43-year-old man diagnosed with a prostatic tumor during a medical checkup and later with prostate SFT.A 43-year-old man was referred to our hospital with a chief complaint of pelvic tumor after careful examination. The tumor was identified during a medical checkup; however, the patient had no symptoms of urinary tract obstruction. On digital rectal examination, a large, soft, and movable mass without tenderness was palpable in the left lobe of the prostate. Tumor markers, including prostate-specific antigen , carcinoembryonic antigen, and carbohydrate antigen 19-9 levels, were found to be within normal limits.T2-weighted magnetic resonance imaging revealed a tumor of 30 × 34 mm in size, demonstrating primarily low signal intensity, with a capsule-like rim at the left lobe of the prostate, suggesting that the tumor was partially invading the rectal wall .Histopathological examination of ultrasound-guided needle core biopsies showed a spindle cell neoplasm with small and fusiform cells, strongly expressing signal transducers and activators of transcription 6 (STAT6) with a ramifying vascular network. Radiographic examination of the whole body revealed no lymphadenopathy or distant metastases. Therefore, the clinical diagnosis of the patient was SFT in the prostate.Robot-assisted radical prostatectomy was performed to predict the risk of recurrence or metastasis based on clinically aggressive features ,10. AnteMacroscopic examination revealed a solid, yellowish-white tumor measuring 3 × 3.4 cm on the left side of the resected prostate .Histopathological examination revealed a well-circumscribed mass composed of spindle cells arranged without any particular architecture (patternless), associated with variable amounts of collagen and distinctive vascularization (staghorn pattern) A,B.Immunohistochemical (IHC) analysis showed a strong expression of STAT6 in the tumor cells, which were partially positive for CD34 A,B. TherThe patient progressed favorably, and there were no obvious complications after surgery. Two years after the initial diagnosis, the patient was alive with normal erectile function, continence status, and no evidence of the disease.Mesenchymal neoplasms comprise <1% of tumors occurring in the prostate . AlthougIn particular, the distinction between the SFTs and prostatic stromal tumors of uncertain malignant potential may be problematic and will be facilitated by additional specific IHC markers .Recent genomic studies on SFTs have identified a novel fusion transcript, NAB2-STAT6  as an SFT-specific chimeric fusion gene ,15. CurrAlthough most SFTs usually follow a benign clinical course, a small number of SFTs may transform into more aggressive forms and have more adverse clinical outcomes ,17,18,19We observed that SFT in the prostate could be removed with complete resection-negative surgical margins. However, 10% of SFTs with histological features of malignancy may be unpredictable, exhibiting aggressive behavior with local recurrence or distant metastasis. Therefore, a long-term follow-up is recommended for all patients with SFTs, including our case.


Primitive neuroectodermal tumors are extremely rare and highly aggressive malignant small round cell tumors that arise from the primitive nerve cells of the nervous system or outside it. These tumors share similar histology, immunohistologic characteristics, and cytogenetics with Ewing’s sarcoma. Peripheral primitive neuroectodermal tumors of the chest wall are rare malignant tumors seen in children and young adults.We report a rare case of peripheral primitive neuroectodermal tumor in a 4-year-old Albanian girl with a mediastinal tumor and an unusual clinical presentation. She was initially treated for acute polyradiculoneuritis (Guillain–Barré syndrome) owing to pain, weakness in the lower limbs, and walking difficulty, as well as severe irritability. During the second week of treatment, the child began to experience dry cough, chest discomfort, and worsening dyspnea. Chest radiography, chest computed tomography, and contrast-enhanced computed tomography demonstrated a large mass in the right hemithorax that was derived from the posterior mediastinum with expansive growth in all directions and that shifted the mediastinal structures in the anterolateral left direction. Consequently, histopathology and immunohistochemical examination of the markers S-100, CD99, and Ki-67 showed that the tumor cells stained positively for S-100 and CD99. The proliferative index measured by Ki-67 was approximately 20%, which suggested primitive neuroectodermal tumor.Even though other diseases, including leukemia, lymphoma, and neuroblastoma, may be accompanied by musculoskeletal manifestations in children, other solid tumors, such as peripheral primitive neuroectodermal tumors, should be considered in the differential diagnosis in any child presenting with musculoskeletal symptoms. Primitive neuroectodermal tumors (PNETs) are rare, highly aggressive, malignant small round cell tumors that arise from the primitive nerve cells of the nervous system; these are termed CNS PNETs or central PNETs (cPNETs), which occur in the form of medulloblastoma . They caA 4-year-old Albanian girl from a rural area was referred to the Department of Neurology of the University Clinical Centre of Kosovo because of abdominal pain, progressive weakness in the lower limbs, and walking difficulty. Prenatal and postnatal history: She was the fourth child in the family and was born as a result of a full-term pregnancy that was not well controlled. No history of drug use or exposure to radiation during pregnancy was reported. Delivery was completed at a regional hospital; she had a birth weight (BW) of 3500 g. Treatment with retinol and cholecalciferol (AD3) for prevention of vitamin D deficiency and vaccinations were irregular. She was breastfed for 1 year, and supplementary food was introduced at 5 months. Her growth and development were normal, and this was her first hospitalization. Family history: Her aunt died from breast cancer at 35 years of age.Disease history: The first symptoms appeared 2 months before admission and consisted of profuse sweating of the head, neck, and upper part of the body, mostly at night, followed by progressive abdominal pain. Therefore, she sought medical attention and was treated with analgesic and antiparasitic therapy. Despite treatment, the abdominal pain persisted, became more progressive, and was followed by musculoskeletal manifestations in the lower limbs. In general, the physical examination at admission revealed a relatively good general condition; she weighed 15 kg and was conscious, alert and communicative. Moreover, a physical examination of the musculoskeletal system revealed no erythema or swelling, but a reduced range of motion in the lower limbs with no weight- bearing tolerance was observed. In addition, muscle tonus was decreased in the lower limbs, whereas it was within the normal range with intact sensory perception in the upper limbs. The abdomen was slightly distended, soft upon palpation, and not painful. Furthermore, the patient’s blood pressure was within the normal range for her age; likewise, clinical findings in other systems were within normal limits.3. The erythrocyte sedimentation rate was 40 mm per hour, and C-reactive protein was negative . Furthermore, liver enzymes, coagulogram, urea and creatinine, and acid–base status of the blood were normal. However, her lactate dehydrogenase (LDH) level of 536 U/l at admission continued to increase to 3520 U/l (NR 160–450 U/l). In addition, a progressive decrease in total serum proteins from 6.0 to 2.9 g/dl (6.3–8.0 g/dl) was observed. Other investigations, including urinalysis and urine and blood culture, were negative; abdominal ultrasound was also unremarkable.Initially, the results of routine blood tests showed a normal blood cell count; hemoglobin (Hgb) was 11.2 g/dl, and platelet count was 249,000/mmOwing to progressive weakness in the lower limbs and walking difficulties, this patient was initially suspected to have acute polyradiculoneuritis (Guillain–Barré syndrome), and thus, lumbar puncture was performed. Cytology and biochemical analysis of cerebrospinal fluid (CSF) revealed white cells 10 cells/mm (100% monocytes) and proteins 44.1 g/dl (NR 15–40 g/dl), while the CSF glucose level was normal compared with the plasma values. Moreover, electromyoneurography (EMNG) revealed a reduced amplitude and velocity of the M wave for the peroneus and tibial nerve on both sides.Therefore, she was suspected to have polyradiculoneuritis and was treated with corticosteroids and immunoglobulins. However, this medication did not improve her clinical condition. Instead, during the second week of treatment, the child began to experience dry cough, chest discomfort, and worsening dyspnea. Therefore, she was transferred to the intensive care unit. Chest radiography revealed a hyperdense homogeneous shadow occupying almost the entire right hemithorax with a slight mediastinal shift to the left, which suggested a massive right-sided mass, while no pleural effusion was noted Fig. .Fig. 1FrSubsequently, chest computed tomography (CT) was performed, which revealed a large mass of homogeneous density that may have originated in the posterior mediastinum; this mass occupied the entire right hemithorax. A left mediastinal displacement was described with compression of the principle bronchus and minimal pleural leakage (effusion) Fig. .Fig. 2A Moreover, since tumors such as neuroblastoma were suspected, the levels of homovanillic acid (HVA) and vanillylmandelic acid (VMA) in urine were determined and were found to be negative. Furthermore, echocardiography revealed that the heart had shifted down and to the left without pericardial effusion. On the right side of the hemithorax, pleural effusion was noted around the homogeneous mass; however, when thoracentesis was performed, only 90 ml hemorrhagic fluid could be aspirated from the right infrascapular area after repeated attempts. A pleural fluid study yielded fluid with a reddish color, and cytological examination predominantly showed elements of peripheral blood, while the microbiological culture was negative.Furthermore, contrast CT of the thorax and abdomen revealed a large heterogeneously enhancing mass 95 × 75 × 70 mm in size in the right hemithorax, with central necrotic areas that likely originated from the outlet roots of spinal nerves of the spinal canal, which shifted the right lung and mediastinal organs. Minimal pleural effusion was observed in the phrenicocostal right sinus (hemorrhagic), with the drain located around the mass that was functional. Moreover, no adenopathy was detected in the mediastinum or axillary regions, and abdominal CT scans were unremarkable Fig. .Fig. 3AxFor the histopathological diagnosis, during CT, a percutaneous needle biopsy of the right mass was performed. Consequently, the histopathology of the examined tissue cylinders identified tumor tissue composed of poorly differentiated malignant small round cells with dark staining, cells with round nuclei , and a confluence of necrotic foci, which suggests the tumor type of blastoma Fig. . ConclusPNET is a malignant neoplasm included in the Ewing’s sarcoma (ES) family of tumors owing to its biological similarities with osseous and extraosseous tumors arising from germinal matrix cells of the primitive neural tube . Peripheet al. [Additionally, only a few case reports have described peripheral PNETs in the posterior mediastinum in adults –25, as tet al. . To the In general, the clinical presentation of this disease is not pathognomonic and depends on the affected site, the degree of tumor invasion and the involved structures . MoreoveIn our case, the clinical manifestations were initially atypical with profuse sweating, mostly at night, and abdominal pain, which progressed during the following 2 months with pain onset prior to weakness in both lower limbs and walking difficulty progressing up to an inability to walk. Moreover, cough, chest discomfort, and worsening dyspnea due to chest wall extension of the mediastinal lesion were observed almost 3 months after the onset of the first signs and symptoms, as the tumor had grown to a large size and compromised the structures of the surrounding organs. Although the histogenesis of this tumor remained uncertain, based on CT scans, it is suspected that the tumor arose from the outlet roots of spinal nerves, which may explain the musculoskeletal manifestations.For diagnostic purposes, imaging studies should include magnetic resonance imaging (MRI) and CT. However, radiologic findings are nonspecific for the differentiation of PNETs from other types of bone and soft tissue tumors. Nevertheless, in general, their typical appearance resembles large noncalcified, soft tissue masses containing cystic or necrotic areas with heterogeneous contrast enhancement .Importantly, a definitive diagnosis requires histopathology and immunohistochemistry. Generally, the classic histological pattern of ES/PNET consists of solid sheets of small uniform “primitive” cells, which have round nuclei and scant cytoplasm and lack significant differentiation . FurtherMIC2 gene; in this regard, staining is very helpful for diagnosing these tumors. Likewise, immunoreactivity for synaptophysin, NSE, PGP9.5, vimentin, S100, and neurofilament, which indicates neuroectodermal differentiation, may also be observed and supports the diagnosis of pPNET [In particular, by immunohistochemical analysis, PNETs are positive for the surface antigens CD99, 12E7, E2, 013, and HBA71, which are all products of the of pPNET . Tumor cof pPNET .The differential diagnosis for a posterior mediastinal mass in children and adolescents should include sympathetic ganglion tumors  and nerve sheath tumors . Likewise, rhabdomyosarcoma, non-Hodgkin lymphoma, and Langerhans cell histiocytosis should also be considered in the differential diagnosis . ConcernUnfortunately, the clinical status of our patient worsened during her hospital stay, and she developed respiratory distress and died before starting the specific treatment.3, axial location, increased LDH levels, low serum albumin levels, metastasis, older age, and neural differentiation [Generally, pPNETs are aggressive, and significant prognostic factors include tumor site, tumor volume, and presence of metastasis . Some fantiation .Our case is a rare example of a childhood malignancy with onset of atypical manifestations and progression of musculoskeletal symptoms. Even though other diseases, including leukemia, lymphoma, and neuroblastoma, can be accompanied by musculoskeletal manifestations in children, other solid tumors, such as pPNETs, should be considered in the differential diagnosis in any child presenting with musculoskeletal symptoms.


Histopathology study revealed pelvic abscess with no evidence of malignancy and a central calcification which corresponded to a faecolith identified on pre-appendicectomy imaging. We contributed this rare presentation to the limited existing literature about complications of retained appendicoliths. As laparoscopic appendicectomies are performed commonly as the standard of care of appendicitis, care should be taken to extract appendicoliths completely to prevent complications.Dropped or retained appendicoliths are uncommon complication of laparoscopic appendicectomies, and rarely they have been reported to cause complications such as pelvic abscesses or enterocutaneous fistulas. We reported on a rare presentation of a pelvic abscess masquerading as urachal malignancy in a 41-year-old male, 2 years after his laparoscopic appendicectomy. As urachal malignancy could not be unequivocally excluded on imaging findings alone,  Dropped appendicoliths are known complications following laparoscopic appendicectomies. Although the true natural history of this complication remains unclear, the existing literature has described a range of complications from pelvic abscess to enterocutaneous fistula. In this report, we describe an interesting presentation of an abdominopelvic abscess masquerading as a urachal mass secondary to a retained appendicolith.A 41-year-old, previously well, male presented to the emergency department with lower abdominal pain, pyrexia with a temperature of 38.2°C and a palpable suprapubic mass. His relevant background history included an uneventful laparoscopic appendicectomy 2 years prior for acute appendicitis, insulin independent type 2 diabetes and hypertension. He presented with raised inflammatory markers and computed tomography (CT) showing a well circumscribed central pelvis lesion that appeared concerning for a urachal malignancy . This leen bloc resection of the lesion with partial cystectomy was performed for complete excision of the lesion. Histology found a 15 × 15 mm abscess cavity with small calculus involving anterior bladder wall, which showed chronic inflammation and mucosal ulceration but no evidence of malignancy.Intraoperatively, frozen section study of the specimen suggested chronic inflammatory changes without obvious malignant features. Therefore, an open The patient had an uneventful recovery post operation. A retrospective review of the patient’s previous imaging revealed evidence of an appendicolith at the time of appendicitis diagnosis . DespiteAcute appendicitis is a common surgical presentation. It affects up to 7% of the general population and about one-third of these patients may have appendicoliths . They arManagement of retained appendicoliths involves sepsis control and eventual removal of the appendicolith. Sepsis control can be achieved with antibiotics and percutaneous drainage of the collection. However, recurrence of infection is likely if appendicolith is not removed . RemovalIn conclusion, we report a rare presentation of pelvic abscess associated with retained appendicolith masquerading as urachal mass. Although laparoscopic appendicectomy is a simple, quick operation that is widely performed, care needs to be taken to ensure the appendicolith is retrieved, particularly if evident on preoperative imaging. In patients who present with an abscess following appendicectomy, a comparison of pre- and post-operative imaging, particularly with CT, can provide invaluable help in diagnosing retained appendicoliths.None declared.


Sternal clefts are rare congenital chest-wall deformities, which can be complete or incomplete; therefore, reconstruction with autologous tissue is essential to protect the heart and prevent respiratory infection. In this report, we present the case of a 16-month-old baby girl from a preterm, twin pregnancy with a partial superior sternal cleft. A moist dressing for promoting wound healing was used until cutaneous layer complete epithelialization at which time we performed reconstruction with autologous tissue. After surgery the patient recovered with close-to-natural chest wall contour and adequate heart and lung function. A sternal cleft is a rare congenital disease, with a reported incidence of 1:100 000 cases per live birth and <1% of chest wall congenital defects . SternalAn early diagnosis, such as during the intrauterine stage with ultrasound and early correction, provides benefits for the thoracic cage’s elasticity and a cosmetic outcome . The surA 16-month-old baby girl with a birth weight of 1060 g and uneventful antenatal care, was referred from rural hospital to our institution. Our initial examination showed cyanosis with a sternal defect with only a thin cutaneous covering over the heart. Her history was significant for mild hypoplastic arch, with aberrant RSCA from CTA and ECC with a mean normal, her condition could be controlled with antihypertensive drugs. She had other malformations, notably scoliosis without surgical correction and parotid hemangioma, which was treated with propranolol. After managing all associated anomalies, a CT scan revealed a partial superior sternal cleft with a thin skin covering the heart; all other physical examinations were normal. First, we placed a dressing with a moist gel until cutaneous layer complete epithelialization, which we maintained for 6 months with regular dressing changes. When she was deemed ready for the next step, operative reconstruction of the defect was then performed. First, the skin was marked at the costal margin  and 2, tThe patient had an uneventful postoperative course and was discharged home on the fifth day postoperatively. The child was doing well and had an excellent cosmetic result with no complications at the 3-month follow-up .Sternal clefts are a rare congenital defect that involve the anterior chest wall, with an incidence of <1% of all chest wall congenital deformities . Early dReconstruction of a sternal cleft is a challenging situation, as many complications can occur including pneumothorax, massive blood loss, cardiac injury and arrhythmia. Therefore, advanced monitoring and advanced anesthetist are essential. Increasing the thickness of the skin prior surgery is essential so we used a moist dressing to allow a healing process until the skin reached adequate thickness. And autologous cartilages from the resected inferior part of the sternum were used to obliterate space at superior part of sternal defect as it can decrease tension between the costal ridge during closure. In addition, autologous cartilage has better wound healing properties than others. A near-perfect reconstruction result can be achieved by careful preoperative planning with a multidisciplinary team, advanced monitoring and proper anesthesia surgical techniques.The sternal cleft is a rare congenital disease. The management began during intrauterine diagnosis followed by post-delivery planning with a multidisciplinary team to screen for associated anomalies, and surgical planning. Early treatment of other malformations was done before surgical correction of the sternal cleft including a facial hemangioma. Sternal cleft repairs should be done earlier, and autologous tissue reconstruction could be suitable and safe for sternal cleft repair.


The plexiform fibrohistiocytic tumor (PFHT) is an infrequent soft-tissue neoplasm with uncertain biological behavior. We report a rare congenital PFHT case in a 4-year-old boy, treated with wide excision and skin grafting. After a 52-month follow-up, no recurrence, regional or distant metastases were documented. A literature review on the management of PFHTs is reported. Fibrohistiocytic tumors of the skin comprise a heterogeneous group of dermal and subcutaneous tumors of mesenchymal origin which show fibroblastic and myofibroblastic differentiation . PlexifoIn this article, we describe a very rare case of a congenital PFHT in a 4-year-old child, which is one of the very few cases of congenital PFHTs that have been reported in the literature so far . Our aimA 4-year-old boy presented with his parents at the Outpatient Clinics of our Department, following resection of a congenital nodule from the arch of his right foot two months earlier, elsewhere. According to the history, this skin lesion was present since birth as a macroscopically solid, asymptomatic and painless nodule that slowly increased in size, measuring –before excision- about 0.8 mm in diameter .The histopathological evaluation of the specimen revealed a dermal and subcutaneous spindle cell neoplasm with moderate cellularity. The majority of the cells were elongated, with eosinophilic cytoplasm and ovoid nuclei with minimal pleomorphism, arranged in interconnected fascicles with a plexiform pattern. Intermixed with these cells, there was a small subset of medium-sized, ovoid or round cells. Their cytoplasm was eosinophilic and the nuclei were ovoid, with mild pleomorphism and distinct nucleoli. These cells were arranged in clusters along with a few osteoclast-like giant cells and hemosiderin deposition . There wDue to positive margins, a wider excision was performed under general anesthesia, with 2 cm excisional margins around the existing scar and down to the underlying muscle fascia. The defect was covered with a full-thickness skin graft harvested from the left groin area. The immediate postoperative period and wound healing of both operated areas on the foot and the donor site was uneventful . The patApproximately four months later, the patient presented with palpable lymph nodes in both groin areas. An ultrasound scan of both inguinal sites was performed reporting enlarged lymph nodes, which showed reactive features and were negative for tumor. On follow-up, seven months postoperatively, the clinically palpable groin lymph nodes subsided and a computed tomography scan of the thorax, abdomen, and pelvis showed no pathology. On 52 months’ follow-up, there was no evidence of local recurrence, regional lymphadenopathy or distant metastases .Plexiform fibrohistiocytic tumor (PFHT) is a rare mesenchymal tumor that exhibits fibroblastic/myofibroblastic differentiation, mainly affecting children and young adults, with 87% of patients under the age of 37 years . This tuPFHT is typically located in the deep dermis with extension into the adjacent subcutis; however, it can extend into the deeper subcutaneous tissue or underlying muscle ; therefoThe congenital form of this tumor is extremely rare, with very few cases being reported in the literature so far . Table 1According to the literature, both acquired and congenital PFHTs are histologically composed of two main components: histiocyte-like and spindled fibroblast-like cells arranged in a plexiform pattern. Hemosiderin deposition is also a characteristic feature ,5. NucleOccasionally, PFHT may demonstrate aggressive behavior with local recurrence and, rarely, regional lymph node involvement and distant lung metastases ,17–19; nRegarding the surgical approach, complete excision is the primary treatment, while the role of radiation and chemotherapy appears to be limited ,20. AlthIn our case, following the first incomplete resection, we decided to perform a 2 cm-margin wide excision around the existing scar extending deep to the underlying fascia, in order to avoid recurrence; a full-thickness skin graft was used to cover the surgical defect and provided stable coverage of the operated site over the foot instep. Indeed, after a 52 month-follow-up, no evidence of local recurrence or distant metastases was recorded. Our patient’s follow-up is still ongoing with yearly clinical examination of both the operated zone and regional lymph nodes, and chest x-ray performed once a year.In conclusion, PFHT should be included in the differential diagnosis of an enlarging skin and subcutaneous tumor in children. Despite the absence of local recurrence and metastases in the reported congenital PFHT cases, and although the prognosis is generally favorable, this tumor shares the same histological features with the acquired form and thus, its clinical behavior is presently considered unpredictable. Therefore, wide local excision is recommended and high clinical vigilance is required on follow-up.


Splenic abscesses are rare, difficult to diagnose, difficult to treat and usually appear in immunosuppressed patients. We present the case of a 64-year-old patient with left pleuritic chest pain, anorexia and fever with rigors diagnosed with splenic abscess due to splenic flexure colon cancer. The abscess spontaneously ruptured and the patient was operated on for acute abdomen. Splenectomy and Hartmann’s hemicolectomy were performed. The patient was discharged from the hospital and referred to the oncologic department. Continuous spread of infection and especially initiating from a cancer lesion is a usual mechanism of splenic abscess formation. Although computed tomography-guided percutaneous drainage is the treatment of choice, an exploratory laparotomy was necessary in this case because of the rupture of the abscess. It is important for the clinicians to include splenic abscesses and their complications in the differential diagnosis of acute abdomen. A patient with a rare spontaneous rupture of a splenic abscess causing acute abdomen as the first indication of splenic flexure cancer was managed successfully by emergency excision. Splenic abscesses are extremely rare entities, with a reported incidence in 0.14–0.70% autopsies . Common A 64-year-old man presented to the emergency department with left pleuritic chest pain, anorexia and fever with rigors. His vital signs included a pulse of 130 beats/min, blood pressure of 108/51 mmHg, respiratory rate of 18 breaths/min, oxygen saturation of 95% and body temperature of 36.1°C. He had no relevant medical history. The patient was admitted to the hospital with the diagnosis of pneumonia based on his chest X-ray findings. The patient remained hemodynamically stable through the next day but developed a temperature of 39.2°C. A CT scan revealed a tumor of the splenic flexure that had invaded the spleen and pancreas via the transcoelomic route and created a subcapsular splenic abscess . The CT et al. [et al. reported a case of splenic abscess rupture in an immunocompromised individual. It was diagnosed during an exploratory laparotomy performed after pneumoperitoneum was seen on simple radiographic exams. There were no signs of malignancy [Splenic abscesses are uncommon and are usually arise from the systemic spread of infection. Splenic flexure cancer is also uncommon, accounting for 4% of all colon cancers, and it has a relatively poor prognosis . Both paet al.  describelignancy .The relative high mortality rate of splenic abscesses can be attributed to the fact that they are frequently misdiagnosed. CT-guided percutaneous drainage is the preferred treatment for uncomplicated splenic abscesses, considering that it ensures the preservation of the spleen and its immunological functions. Post-splenectomy infections are difficult to treat and have high mortality. Surgical management is preferred in complicated cases with intrabdominal rupture of the abscess. In our patient, it was necessary to thoroughly clean the peritoneal cavity and to perform postoperative drainage.In conclusion, splenic abscess is a rare condition that is associated with high mortality because it is often misdiagnosed. Direct invasion of the spleen by cancer of the splenic flexure is not a common occurrence and its spontaneous rupture is even rarer. Furthermore, this pathology is difficult to diagnose owing to the absence of specific symptoms. It is important for surgeons to include splenic abscess in the differential diagnosis of acute abdomen.None declared.None.


A 9-year-old male child was brought by his father to the emergency department of the hospital with chief complaints of swelling on the left half of the abdomen since birth. The father of the child told that he had swelling of small size at birth which started gradually increasing in size for 18 months and then it was static up to 6 years of age. Later it again started increasing in size and now it has occupied the entire left abdomen. On clinical examination, the swelling was soft in consistency, non-tender with mild reddish-blue discolouration of overlying skin and no local rise of temperature. There was no pus discharge and itching over the swelling. For further investigation child was referred to the department of radiodiagnosis for contrast-enhanced computed tomography and ultrasonography of the abdomen. On computed tomography multiple varied size hypodense areas, most of them communicating with each other seen in the subcutaneous plane of anterior abdominal wall more on left side extending from left hypochondrium to left lumbar region inferiorly and crossing midline reaching right hypochondrium laterally on the posterolateral aspect of the abdominal wall. Few areas showed hyperdense content within with no significant enhancement on all post-contrast phases. On ultrasound, multiple cystic anechoic areas with internal debris independent part and showing no vascularity were noted.