We present a case of a patient with juxtaarticular hemangiohamartoma with a synovial extension associated with hemorrhagic synovitis and recurrent spontaneous hemarthrosis.A 21-year-old Caucasian woman was admitted to our hospital complaining of pain and swelling at her knee for 6 months. In the magnetic resonance imaging, T2-weighted and fat-suppressed scans revealed a mass with high signal intensity just posterior to the patellar tendon. We performed an excisional biopsy of the mass through an anterior longitudinal incision. Excised material included arterial and venous vascular structures, which were found to be spread among the fat, connective and peripheral nerve tissues microscopically.Although hemangiohamartomas are not true neoplasms, they may cause knee pain, swelling and hemarthrosis that warrant surgical resection. This lesion, although rare, should be considered in the differential diagnosis, especially in teenagers and young adults. Synovial and subsynovial hemangiomas are very rare benign lesions that are classified by pathologists as hemangiohamartomas when admixed with fat, connective tissue and peripheral nerve structures ,2. The pRecurrent non-traumatic hemarthrosis with pain and palpable mass are among the common findings experienced by the patient . MagnetiComplete open excision decreases the potential for local recurrence, but localized lesions can be treated arthroscopically -8. In thA 21-year-old Caucasian woman was admitted to our hospital complaining of pain and swelling at her knee for the past 6 months. Her pain and swelling were especially aggravated by physical activities.Her physical examination revealed that she had mild quadriceps atrophy and pain during terminal flexion of her knee, with mild swelling just beneath the patellar tendon. Her conventional radiographies displayed no abnormalities. The T2-weighted and fat-suppressed MRI scans revealed a mass with high signal intensity just posterior to the patellar tendon Figure . Her labThe radiologists included synovial sarcoma in the differential diagnosis, and we performed an excisional biopsy of the mass through the anterior longitudinal incision. We decided to perform open surgery because of the unknown characteristics of the lesion. The lesion, which measured 3cm × 2cm, was excised fully.The excised material was soft and encapsulated macroscopically. Microscopically, arterial and venous vascular structures were found to be spread among the fat, connective and peripheral nerve tissues Figure ,3. The pSynovial hemangiomas and hemangiohamartomas are two entities that are both rare and similar in nature. Hemangiohamartomas involve the synovia with the fat and connective tissue. In addition to pain, swelling and palpable mass, they may cause hemarthrosis  and wereThe differential diagnosis for hemangiohamartoma should include pigmented villonodular synovitis, synovial sarcoma, rheumatoid arthritis, juvenile chronic and arthritis, hemophilic arthropathy and lipoma arborescens.Arthroscopic excision in cases of focal or pediculated and appropriate-size lesions may be an alternative to open surgical resection. In cases of pure synovial hemangioma, selective embolization of feeder vessels might also be an alternative to surgery -13.Plain radiographs are usually of poor diagnostic value. In less than 5% of patients, periosteal reaction, cortical destruction, discrepancy in leg length or even arthropathy simulating hemophilia may be seen ,13. MRI Although hemangiohamartomas are not true neoplasms, they may cause knee pain, swelling and hemarthrosis that warrant surgical resection. This lesion, although rare, should be considered as part of a differential diagnosis, especially in teenagers and young adults.Written informed consent was obtained from the patient for publication of this manuscript and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.The authors declare that they have no competing interests.SS, MSS and EU contributed to the conception and design of this case report and carried out the literature research, manuscript preparation and manuscript review. HC was involved with the case and the writing of the manuscript as well as the general management of the patient. KO revised the manuscript for important intellectual content. All authors read and approved the final manuscript.


Weir-McCall J, Shaw A, Arya A, Knight A, Howlett DC The use of pre-operative computed tomography in the assessment of the acute abdomen. Ann R Coll Surg Engl 2012; 94: 102–107 doi: 10.1308/003588412X13171221501663 The authors have presented a study correlating the reports of abdominal computed tomography (CT) in the acute abdomen with findings at laparotomy. The retrospective diagnostic ‘accuracy’ of CT scan reporting rises from 78% when reported by a registrar to 83% when additionally assessed by a consultant and finally to 93% after a further consultant review. In their conclusions, the authors state that this represents ‘a high degree of accuracy’. This mirrors our experience: we also feel that the correct diagnosis is missed by CT scan in approximately one to two patients in every ten presenting with an acute abdomen requiring surgery.However, we are concerned that the authors have totally ignored the impact that a full clinical assessment would have on correct diagnosis. We feel strongly that radiological techniques are an adjunct, albeit important, to clinical history taking and examination in the formulation of a working diagnosis. In this way, the majority of patients may be correctly diagnosed pre-operatively, which ought to be the minimum standard.


Background: Ectopic pregnancy is one of the main problems in women in reproductive age that needs special attention and appropriate strategy should be managed. In some cases expectant management seems good strategy without any medicine or surgery and their possible side effects. But are the outcomes always the same? Which outcomes should we expect?Case: We have reported 2 patients whose ectopic pregnancy had been managed conservatively and they had sustained pain for several months which needed surgery to resolve.Conclusion: In the case of ectopic pregnancy, it is important for the clinician to select the patient meticulously and be aware of common and rare consequences of her treatment. An ectopic pregnancy (EP) is a developing embryo in an area other than endometrial cavity. Although many of patients have the triad of pain, vaginal bleeding and retardation of the menses, this classic feature is absent in more than half of the patients . Even wiet al reported a series of successful conservative management of tubal pregnancy and Hill et al has shown two persistent trophoblastic tissues which were treated with metotroxate  and they suffered from unexpected aftermaths. We could not find the same report in literature searching. Although Atri reported surgical intervention in 5 cases of expectant management despite of declining βhCG because of the pain, that was an acute problem which was found in short term follow up . These cCase 1The patient was a 28-year old woman primipara with c/s 7 years ago. She came to our clinic with a history of abnormal uterine bleeding from 2 years before. She was pregnant two years ago and he had experienced an episode of vaginal bleeding in 6 weeks of pregnancy without any previous sonography. So, she was undergone curettage due to diagnosis of incomplete abortion. After that her menses were irregular and she had frequently a sustained annoying pain in her lower abdomen almost always. She had several negative pregnancy tests. Her βhCG level was less than 2 and in sonography the endometrial thickness was13 mm with a fine heterogenicity and one local hypoechogenicity with 7×4mm diameter, which was probably endometrial polyp. The left adnex was normal and there was a mix echo lesion in 17×24 mm diameters with an echolucency area around it with 14 mm diameter in right ovary . It had 1 low and T2 high signal. No fat signal is seen in the mass. There was also no evidence of aneurism. The patient was undergone laparoscopy and hysteroscopy due to pain and complex adnexal mass and abnormal uterine bleeding. In laparoscopy the left adnex was normal. In the right adnex it was an old tubal pregnancy that has involved almost half of the tube with significant calcification in the mass but there was not any rupture or hemorrhage evidences in the tube or any adhesion around it. In her MRI report there was an approximately 23×17 mm mass separable from right ovary with TThe salpangostomy was done and the calcificated mass was extracted completely. In hysteroscopy there was a little polyp and it was extracted. The pathology report of tubal mass was ghost of chorionic villi compatible with degenerated products of conception. Three months later the patient was good with no pain in her lower abdomen. We obtained informed written consent from this patient and the next one to use her data in our report.Case 2A 42-year old woman primipara with a c/s 9 years ago referred to our center. When she came to our clinic in October, she had suffered from mild pain in her lower abdomen from 2 months ago. She was hospitalized 3 months ago with a positive pregnancy test and vaginal bleeding in another center in order to rule out ectopic pregnancy. At that time she had a 32 mm mixecho mass in left adnex in vaginal sonography suspicious to EP or hemorrhagic cyst and her βhCG serum level had fallen from 693 to 46 IU/L during 10 days. Also, as she had reported cessation of bleeding. So, she was discharged with probable diagnosis of absorbed EP or abortion. After 3 months, the patient came to our clinic with sustained lower abdominal pain that was mild but had bothered her. In physical exam the abdomen was soft with mild tenderness in her right lower quadrant. In sonography report the endometrial thickness was 3.5mm and one solid mass in right adnex with 58×34mm diameter. The serum βhCG level was 20  and other tumor markers were normal. We chose laparascopy for patient because of pain and solid mass. In laparoscopy there was a tubal pregnancy in right tube that had contained two third of tube and there was organized clots in it without rupture or active hemorrhage. Because of the large size of the EP and complete distortion of tube, salpangectomy was done. After three months the patients was good without any pain.EP is one of the main problems for women in reproductive age. In past years it was accompanied with high mortality rate but nowadays as a result of modern methods, diagnosis is very earlier and then contemporary treatments are more conservative than in the past. One of those treatments is expectant management. It may end in tubal abortion, spontaneous regression or tubal rupture but the success rate has reported 50-70% , 9. Manyet al in their trials consider patients with βhCG levels up to 1500 IU/L for expectant management and their outcomes were similar to methotroxate group  <1 as indication for expectant management but it seems that other factors such as size of the mass are also important to predict complete absorption of EP , 11. Korte group , 8. Someh/hCG 0h te group -16 but t’t have the baseline βhCG, it seems that they had no acute, short term problem. Many of studies have focused on short term outcomes. For example Lui et al reported 100% success rate in their expectant management cases, but they considered negative βhCG test as a successful treatment but in our cases and also in some cases of Atri study, the consequences continued even after decline in βhCG level (et al reported in 1990, but this tissue may have other effects even if it is not alive, such as pressure due to adjacent hematoma and it is the probable explanation for our patient’s situation (Although a problem is that these cases had not been picked up intentionally, and they had not been followed until undetectable βhCG and in first case we didnCG level , 9. Retaituation . Also, situation . Additionally, the clinician should be aware of probable continuity of problems even after negative βhCG test. Furthermore, some mistakes are made in diagnosis of EP. These mistakes will reduce if meticulous attentions be paid on every person who has symptoms of abortion without any documented evidence of intrauterine pregnancy and it will eradicate some complications in next steps.It seems that in addition to a threshold of β-hCG level, some other factors should also be considered for expectant management of EP. It may be possible that precise patient selection beside long term follow up can improve outcomes.


Introduction. Liposarcoma is a rare pathological entity. By far it is the most common histological subtype of genitourinary sarcomas in adults. Approximately two hundred cases were reported in the literature. We are hereby presenting a case with a typical clinical scenario of paratesticular liposarcoma. Case report. A 75-year-old gentleman presented with a painless right hemiscrotal swelling that was progressively increasing in size over the last 6 years. Testicular tumour markers were negative. Imaging showed a heterogenous mass with fat component. Subsequently he underwent wide local excision that included the paratesticular mass along with the right testicle and all right inguinal canal contents up to the deep inguinal ring with the sparing of right illioinguinal nerve. Histopathological examination showed a well differentiated liposarcoma of the spermatic cord. He remained recurrence-free so far after 18 months of followup. Conclusion. Radical orchidectomy with wide local excision comprises the cornerstone of treatment of paratesticular liposarcoma. Due to the rarity of the disease there is no definite universal consensus of opinion as regards the role of radiotherapy and chemotherapy. A 75-year-old gentleman presented to our patient clinic with a history of right scrotal swelling for almost 6 years. It was painless and slowly increasing in size with no relation to the patient's posture. He also gave a history of mixed voiding and storage lower urinary tract symptoms. Physical examination revealed a nontender mass which was firm anteriorly with softer posterior aspect. The right testicle was felt distinct from the mass with normal size and consistency. The mass was neither reducible nor transilluminating. The left testis was also normal. Laboratory investigations including testicular tumor markers were normal. Scrotal ultrasound showed a large right scrotal heterogeneous mass, mainly hyperechoic in echotexture and measuring 8.5 × 5.4 cm. Both testicles were sonographically normal . CT scan with IV contrast revealed a right-sided scrotal sac multifocal fat-containing lesion extending deeply to right inguinal canal. No lymphadenopathy and no distant metastasis were detected .Consequently, a wide local excision that included the paratesticular mass along with the right testicle and all right inguinal canal contents up to the deep inguinal ring with the sparing of right illio-inguinal nerve was carried out through an inguinal incision. Histopathological examination revealed a well-differentiated liposarcoma of the spermatic cord with a normal testicle. The patient made a satisfactory postoperative recovery. On two subsequent clinic visits, there was no evidence of local recurrence clinically. Follow-up scrotal ultrasound and CT scan of the abdomen and pelvis with IV contrast  revealedPara-testicular liposarcoma is a rare entity making it difficult to have a universal consensus on the natural history and management even in large institutions. , 2 Less Spermatic cord is the most common site followed by testicular tunics and epididymis . Average age at presentation is 55 years (range 16.5 to 85). The above clinical scenario represents the typical mode of presentation. Occasionally, para-testicular liposarcoma presents as a rapid increase in the size of previously stable mass. In less than 6% of cases there is history of scrotal surgery or trauma. The presentation can be mistaken for inguinal hernias or hydrocele.  Few casePara-testicular liposarcoma appears as a nonhomogeneous mass with variable echoes consistent with fat. CT scan with IV contrast is an excellent radiological tool for diagnosis. It is used preoperatively and postoperatively for staging and followup, respectively. Based on histological appearance liposarcomas in general have been classified into myxoid , round cell, well differentiated , and pleomorphic.  LiposarcWith regards to treatment radical orchiectomy and en bloc removal of the tumor with wide local excision are the standard treatment. It has been reported that no therapeutic advantage could be attributed to superficial inguinal or retroperitoneal lymphadenectomy. Radiation therapy has been used for local control in liposarcoma in general. Liposarcomas are the most radiosensitive sarcoma and in some cases remission has been achieved with radiotherapy alone but the results in para-testicular liposarcoma are less clear. In some studies radiotherapy in 11 cases has been associated with recurrence in 5 cases. Recurrence after radiotherapy may have a higher-grade and more aggressive neoplasm with dedifferentiation. Radiation therapy is recommended in addition to surgery [There is a paucity of data regarding the results of chemotherapy in metastatic para-testicular liposarcoma but the results of chemotherapy for liposarcoma at other sites are poor. Adjuvant chemotherapy has been reported in 2 cases but followup has been short. Doxorubicin chemotherapy has been used occasionally. Para-testicular liposarcoma has a high propensity for local recurrence, the commonest reason for which is incomplete resection. The reported recurrence rate ranges between 46% and 57%. Prognosis and survival vary in relation to histopathological classification. Myxoid and well-differentiated have better prognosis than round cell and pleomorphic liposarcoma. Five-year survival rates are 80% and 20%, respectively.  Even in large institutions, it is difficult to accumulate sufficient cases to document the natural history for such a tumor and draw conclusions about treatment results because of rarity of the tumor. When diagnosed or suspected preoperatively, radical orchiectomy with wide local excision is the recommended treatment. Adequate local resection provides the best chance of eradicating this disease. Adjuvant radiation should be considered in tumors of intermediate or high grade and in recurrent liposarcoma after previous wide excision. The role of chemotherapy is not well defined. Regardless of initial therapy, the risk of local recurrence and subsequent increase in grade always necessitates long-term followup.


Chordomas are very rare low-grade malignant bone tumors that arise from the embryonic rests of the notochord. They are characterized by slow growth and long history with frequent local relapses, and sometimes metastases. While chemotherapy is not efficient, imatinib has shown antitumor activity.We report on a 76-year-old patient with EGFR-overexpressing advanced chordoma that progressed on imatinib and subsequently responded to erlotinib during 12 months.We report the fourth case of advanced chordoma treated with an EGFR inhibitor. We also review the literature concerning the rationale and potential of EGFR targeting in chordoma. Chordomas are very rare malignant bone tumors (approximate incidence rate 0.1/100.000/year), usually arising in the sacrum, skull base and spine. Median age at diagnosis is 60 years . ClassicAt first diagnosis, in 1999, the patient was a 65-year old man, Caucasian type, without any specific medical personal or familial history. His medical story began in January with chronic and rebel lumbar pain. In April 1999, pelvic magnetic resonance imaging (MRI) showed a sacral tumor. A distal sacral and coccygeal surgical resection was performed. Histological and immunohistochemical  analyses confirmed the diagnosis of chordoma obtained by pre-operative biopsy. Post-operative radiotherapy was delivered with a total dose of 60 Grays in 30 fractions.In April 2006, computed tomography (CT) revealed 3 subcutaneous lesions located behind the left scapula, below the right scapula, and next to the temporal bone. Two lesions  were surgically removed, and corresponded histologically to typical relapses of chordoma. Two months later, a new recurrence was observed with a right supraclavicular tumor of 2 cm, which was treated by radiotherapy (30 grays in 10 fractions).In July 2007, a CT scan revealed disease progression with appearance of a multilocular tumor under the left scapula, several infra- and supracentimetric lung nodules suggesting metastases, and an increase in size of the right supraclavicular lesion. Once again, the two soft tissue lesions were surgically removed. Their largest pathological diameters were 9 and 5 cm respectively. Histological analysis confirmed the diagnosis of chordoma. Owing to the positive margins of the peri-scapular lesion, adjuvant radiotherapy was delivered (30 grays in 10 fractions), followed in October 2007 by introduction of imatinib . Treatment was well tolerated. In February 2008, a slowly progressive subcutaneous tumor nodule located under the right scapula was surgically excised. Histological analysis again confirmed the diagnosis of chordoma. Imatinib was continued. Subsequent clinical examination and imaging monitored the stability of the disease until February 2009, at which time a CT scan showed progression at various sites: increase in size of the lung nodules, right cervical adenopathy, and two solid lesions located inside the right pectoralis minor muscle and the right paravertebral back muscle. In spite of an increased dose of imatinib (600 mg daily), the disease continued to progress slowly, even though the patient remained asymptomatic with good performance status.EGFR, KRAS, BRAF, KIT, and PDGFRA. Fluorescent in situ hybridization (FISH) did not indicate EGFR amplification, but showed chromosome 7 trisomy in 38% of the tumor cells. Given these results and the absence of any alternative therapeutic option, in February 2010, the 76-year-old patient was started on erlotinib 150 mg daily. After 4 weeks and no side effect, the patient reported a significant improvement of asthenia, and the thoracic pain had completely disappeared. In May 2010, after 3 months of erlotinib, the patient fared very well, the pectoral lesion had decreased, and the CT scan revealed a stabilization of the right cervical adenopathy (2 × 1.5 cm) and a regression by 53% of the pectoral lesion volume (7.6 × 2.3 cm). Lung nodules were stable in size and number. Treatment was continued. In September 2010, a CT scan  and the right pectoral lesion (8.5 × 4.2 cm)  inhibited proliferation of the U-CH1 cell line in vitro and diminished EGFR phosphorylation in a dose-dependant manner, a finding supported by inhibition of phosphorylated Erk1/2 and p-Akt. Altogether, these data clearly implicate aberrant EGFR signaling in the pathogenesis of chordoma. Biological analysis of our case confirmed these findings, with strong EGFR expression, and absence of gene mutation. FISH analysis revealed trisomy of chromosome 7 in 38% of tumor cells, an alteration already reported in chordomas and frequently associated with c-MET overexpression [The rationale for treating chordoma with EGFR inhibitors is inspired by recent reports. Weinberger hordomas . A Polishordomas . Activathordomas . The larhordomas . Phosphopression . In our Our case highlights the antitumor activity of EGFR inhibition in advanced chordoma, in agreement with three other clinical cases previously reported and pre-clinical data. The targeting of EGFR represents an attractive challenge in chordoma, which clearly calls for prospective assessment in multicentric clinical trials.Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.CT: computed tomography; EGFR: epidermal growth factor receptor; IHC: immunohistochemistry; MRI: magnetic resonance imaging; PDGFR: platelet-derived growth factor receptorThe authors declare that they have no competing interests.Conception and design: FB; Manuscript writing: SGL and FB; Final approval: FB, SGL, BC, FM, SN, DP, JG, LMZ; Pathological explorations: BC; Patient's management: FB, SN, FM, LMZThe pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2407/11/423/prepub


Bronchogenic cysts are developmental anomalies of the primitive foregut which mostly occur in the lung. Gastric bronchogenic cysts are extremely rare; few cases have been reported in the literature and the diagnosis was often made following surgical resection.A 40-year-old North African man was admitted to our hospital with a gastric submucosal mass. An endoscopic ultrasound revealed a unilocular cystic mass located in the muscular layer. Its content was echogenic suggestive of mucus. Magnetic resonance imaging confirmed the liquid nature of the cyst and showed a high ratio of proteins. Based on these observations, the diagnosis of bronchogenic cyst was confirmed. An endoscopic monitoring was decided rather than surgery because of the small size of the cyst and the absence of symptoms.Although gastric bronchogenic cysts are rare, they should be well known and considered in all differential diagnoses of gastric tumors. We report a new case of gastric bronchogenic cyst and highlight the contribution of morphological tests that currently allow a non-invasive diagnosis. Bronchogenic cysts are congenital anomalies evolving through the ventral foregut. They are the result of an autonomous and delayed development of a cell bud from the tracheobronchic tree. Bronchogenic cysts are divided into thoracic and abdominal cysts ,2. AbdomHelicobacter pylori gastritis. An endoscopic ultrasound (EUS) confirmed the submucosal location of the lesion. It showed an image of a unilocular cyst containing echoic spots suggestive of mucus. This lesion was located in the muscular layer 45cm from the dental arches and it measured 15×19mm  is not known in this location  whereas Although gastric bronchogenic cysts are rare, they should be well known and considered in all differential diagnoses of gastric tumors. We report a new case of gastric bronchogenic cyst and highlight the contribution of morphological tests that currently allow a non-invasive diagnosis.Written informed consent was obtained from the patient for publication of this manuscript and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.The authors declare that they have no competing interests.HS and TA evaluated the patient and were major contributors to the writing of the manuscript. AA and FE performed the gastroscopy. FR performed the EUS. MM analyzed and interpreted the data from the MRI. AB and AZ reviewed the manuscript. All authors read and approved the final manuscript.


Fibromyxoma represents a rare benign neoplasm that mostly affects the posterior region of the mandible. Here, we report the case of a 46-year-old male with a swelling of the right maxilla. After proper diagnosis, he was treated with enucleation and curettage of the tumor. The defect was filled with a pedicled buccal fat pad flap. The mesenchymal origin from the dental follicle of the fibromyxoma is the most plausible explanation. Radiological examination with MRI, CT, and conventional radiography contributes to the differential diagnosis from other benign tumors, such as the ameloblastoma. Its management is surgical and comprises enucleation and curettage or en bloc resection. Patients must be monitored for at least two years postoperatively in order to diagnose possible recurrence. According to the literature, the maxilla is a rare location of a fibromyxoma and, to our knowledge, our case is the 30th presented case of a fibromyxoma of the maxilla. Odontogenic fibromyxoma represents a rare slow-growing benign neoplasm, usually occurring in the 2nd and 3rd decades of life, rarely in children or adults over 50 years of age , 2. It iThe aim of this case report and review of the literature is to present the rarity of a fibromyxoma of the maxilla, the contribution of the radiological examination to the differential diagnosis, and the importance of a meticulous enucleation in order to prevent recurrence.A 46-year-old male was referred to the outpatient department of the Oral and Maxillofacial Surgery Clinic of the General Hospital “G. Papanikolaou” of Thessaloniki, with a swelling of the right maxilla. The swelling occurred 8 months prior to the consultation. Facial and mucosal numbness, pain, or tooth mobility was absent.The medical anamnesis of the patient did not reveal anything in relation to the pathological condition. Radiological investigation by means of a panoramic radiograph was not helpful in diagnosing the lesion. Waters' view revealed complete obstruction of the right maxillary sinus. A Computed Tomography (CT) imaging of the maxilla revealed a large radiolucent lesion extending from the area of the right canine to the area mesial to the first molar. Examination with Computed Tomography (CT) Scan showed expansion of the walls of the right maxillary sinus, obstruction with low density tissue of the whole cavity, and local erosion of the walls . The intThe lesion was approached by means of a lateral rhinotomy incision, with enucleation and curettage of the tumor. The lesion had a solid consistency and was totally resected Figures  and 3. TThe histopathological examination revealed randomly stellate, oval, and spindle-shaped cells in a myxoid stroma . Septa oTwo years postoperatively, the patient shows no signs of recurrence. His rehabilitation period was uneventful and he gained complete function soon after surgery.In order to prove evidence of the rarity of a fibromyxoma of the maxilla and the frequency of recurrence, a literature search was carried out using Pubmed. Search terms included ≪fibromyxoma≫ and ≪myxoma≫. Exclusion criteria were not relevant papers, interviews, books' and conferences' abstracts, comments, replies to author and to editor, and unsupported opinion of an expert. 43 articles met our criteria. In order to record only reports of fibromyxoma and not myxoma, the articles were further sorted, in order to include those reports of fibromyxomas that were mentioned under the general term myxoma. Finally, 19 articles met all criteria and were chosen for further evaluation  8–26].–26.8–26]Myxoma/fibromyxoma is a rare odontogenic neoplasm. Fibromyxoma is classified as a specific type of myxoma with a higher fibrous/myxoid tissue ratio than myxoma. There is a discrepancy regarding the reports of fibromyxoma, as many of them are classified under the general term “myxoma”, making the review of the literature difficult. According to Dutz and Stout, the term myxoma was first used by Virchow in 1863, but the term fibromyxoma was described by Marcove et al. in 1964 who reported extragnathic locations of fibromyxoma , 28. We Myxomas/fibromyxomas are usually located intraorally most often in the posterior regions of the mandible, its angle and ramus and rarely extraorally , 29. ThePrevious theories stress that the lesion derives from the neural sheath or is the result of degeneration of fibromas, lipomas and so forth, due to the chronic irritation and the degenerative processes following tissue anoxemia . Recent Histopathological characteristics of the myxoma/fibromyxoma are the hypocellularity, the presence of stellate, spindle-shaped cells into a loose myxoid extracellular matrix with cells presenting with thin, long cytoplasmic prolongations that give to the tissue characteristics of immature mesenchyma . The fibMyxomas are diagnosed with radiological, histological, and histochemical investigation. The radiological investigation reveals homogenous radiolucencies or sclerotic trabeculations with different appearances, like “honeycomb”, “soap bubble”, and “tennis racket” . In our Radiological examination plays a crucial role for the differential diagnosis of myxomas/fibromyxomas and also between benign myxomas and malignant neoplasms with myxomatous tissue. In Magnetic Resonance Imaging (MRI), the lesion shows low-signal intensity in T1 and high-signal intensity in T2 . In contDuring the process of differential diagnosis pathological conditions that should be included are ameloblastoma, central haemangioma, fibrous dysplasia, odontogenic cysts, aneurysmal cysts, central gigantocytic granuloma, metastatic neoplasms, well-differentiated liposarcoma, and other rare entities like desmoplastic fibroma , 33.The main pathological condition that may lead to difficulties in diagnosis is the ameloblastoma, especially when the bony septa are curviform . An impoThe treatment of the fibromyxoma is surgical and involves enucleation and curettage. The avoidance of recurrence is strongly related to the complete resection of the lesion. The patient should be monitored for at least two years after the surgical intervention due to the higher rate of recurrence during this period . Myxomas/fibromyxomas show a recurrence rate between 25% . This isIt is stressed that complete resection and peripheral osteotomy is the treatment of choice depending on the size and behaviour of the tumor and results in a lower rate of recurrence , 33, 37.In conclusion, the maxilla is a rare location of a fibromyxoma. The radiological examination by means of CT and MRI plays an important role in the diagnosis of a fibromyxoma and in the differential diagnosis from other pathological entities such as the ameloblastoma. Its management is surgical and ranges from enucleation and curettage to complete resection and peripheral osteotomy according to its size. Patients must be monitored for at least two years postoperatively in order to diagnose possible recurrence.


Intraperitoneal rupture of cystic ovarian teratoma is a rare complication. We report a case in a 29-year-old female, with increased abdominal circumference 2 months after vaginal delivery. MRI/CT raised this diagnosis associated to chemical peritonitis. A malignant ovarian mass with peritoneal carcinomatosis was excluded. Laparoscopic oophorectomy was performed and histologic analysis confirmed imaging findings. This case demonstrates the interest of imaging before surgery in pelvic masses to avoid misdiagnosing and to provide adequate treatment. Mature cystic teratoma of the ovary is the most common ovarian neoplasm, accounting for between 5 and 25% of all ovarian tumors. It occurs most commonly in young females and is bilateral in 8–15% of cases. It comprises a cyst lined by an epidermis-like epithelium and contains a variable admixture of elements of one or more of the three cell lines, meso-, endo-, and ectodermal derivatives including sebaceous secretions, hair, teeth, bone, or fat, and is asymptomatic in most of cases; however, it may represent serious complications including torsion (16%), followed by spontaneous rupture (1.3%) and infection (1.2%) and rarely malignant degeneration and hemolytic anemia.A 29-year-old female patient, gravid 2, para 2, was addressed to our radiological department by her gynecologist for investigation of a left ovarian mass and increased abdominal circumference 2 months after normal vaginal delivery.MRI was obtained and showed a large heterogenous left ovarian mass measuring 85 × 50 × 45 mm with fatty, solid, and liquid contents and a small calcification of 10 mm suggestive of cystic teratoma . AscitesA CT scan was also obtained to confirm the diagnosis of delivery induced intraperitoneal rupture of a cystic ovarian teratoma and associated chronic chemical peritonitis .The patient underwent laparoscopic oophorectomy. Lyses of the dense adhesions and the thick white to yellowish plaque-like lesion on the visceral peritoneum, especially on the surface of the uterus and rectum, were performed with copious saline washing of the chemical peritonitis and its sequelae .The patient had an uneventful recovery.The word teratoma is derived from the Greek word Terato meaning monster.Mature cystic teratomas are composed of well-differentiated derivations from at least two of the three germ cell layers . They therefore contain developmentally mature skin complete with hair follicles and sweat glands, sometimes luxuriant clumps of long hair, and often pockets of sebum, blood, fat, bone, nails, teeth, eyes, cartilage, and thyroid tissue. They are usually asymptomatic but can complicate and sometimes lead to fatal consequences if not adequately treated , 2.The adnexal torsion considered as the most common complication caused by rotation of the ovarian pedicle, resulting in arterial, venous, or lymphatic obstruction and involves the ovary and the fallopian tube rather than either alone. US is the first examination for diagnosing adnexal torsion in an emergency setting. If diagnosis and reduction of ovarian torsion are delayed, hemorrhagic infarction occurs and sometimes leads to severe peritonitis and even death.Malignant transformation occurs in 1%-2% of ovarian teratomas and accounts for 1% of all ovarian malignancies and occurs usually in patients of more than 45 years. It may occur in any of the three germ cell layers including the ectoderm, mesoderm, and endoderm. Squamous cell carcinoma arising from the squamous lining of the cyst is the most common type of malignant transformation, accounting for 80% of the reported cases.Rupture occurs in 1%–4% of ovarian teratomas and causes leakage of the liquefied sebaceous contents into the peritoneum, which irritates the peritoneum and leads to acute or chronic inflammation.Superimposed infection occurs in 1% with Coliform bacteria most commonly implicated.Autoimmune haemolytic anaemia occurs in <1% and may be due to cross-reactivity of tumor and red blood cell antigens, production of red blood cell autoantibodies by the tumor, and alteration of the red blood cell molecules by the tumor, which renders them antigenic to the host.Some of the complications are as follows –4.The adChemical peritonitis is a result of an intraperitoneal rupture of a dermoid cyst. First case described in 1843 by Barth was of a 40-year-old female presenting with fat globules adherent to the liver and associated with an ovarian tumor containing fat and hair. In 1952, Geist was the first to describe the X-ray findings of multiple abdominal calcified lesions and thus diagnosis of a ruptured intraperitoneal ovarian cyst. Spontaneous rupture is an extremely rare complication of mature cystic teratoma because of its usually thick capsule. The cause of rupture may be due to torsion with infarction of the tumor, infection, malignancy and rapid growth of the cyst, direct trauma, or prolonged pressure from pregnancy or delivery as in our case.It can occur in the peritoneal cavities or, less frequently, into the adjacent hollow viscus, such as the bladder, small bowel, rectum, sigmoid colon, vagina, and even through abdominal wall resulting in the following.Acute peritonitis due to rupture and sudden release of tumour contents rupture that may result in acute abdominal crisis, shock, or hemorrhage.Chronic granulomatous peritonitis, which is more common, is due to a chronically leaking dermoid from a tiny breach in the cyst wall, characterized by numerous nodules of mature glial tissue implant on a widespread area of the peritoneum and dense adhesions and variable ascites that simulate carcinomatosis or tuberculous peritonitis. Fluid collection can also occur in the bilateral, paracolic gutters and between the mesenteric leaflets.The symptoms and signs might be subtle and marginal in the early period; however, the patient would complain of progressive abdominal distention, low abdominal pain, and gastrointestinal disturbances such as anorexia, nausea, vomiting, and diarrhea. Plain Film. Plain film may show calcific and tooth components with the pelvis and in the abdomen in case of a ruptured cyst.  Ultrasound. Ultrasound is the most common imaging modality, with 58% sensitivity and 99% specificity in the diagnosis of a mature cystic teratoma, calcified structures, hair, echogenic sebaceous material, and fat contents. It confirms presence of mass, identifies organ of origin and internal structures, and uses Doppler to assess for flow; however, it is limited by abnormal pelvic anatomy and difficult to appreciate cystic quality of these tumors.  CT Imaging. CT imagining has 98% sensitivity and 100% specificity in the diagnosis of a mature cystic teratoma and fat detection (density less than 20 HU). It is diagnostic, gravity dependent layering with fat fluid line, palm tree like protrusion, and fat-fluid levels (10%).In case of a ruptured cyst and chemical peritonitis, ascites and floating areas of fat attenuation around the liver as well a mature cystic teratoma of the ovary are seen. Discontinuity of the cyst wall with surrounding infiltration is evident. The characteristic hypoattenuating fatty fluid can be found as antedependent pockets, typically below the right hemidiaphragm, a pathognomonic finding. The escaped cyst content also leads to a chemical peritonitis with ascites, diffuse, or focal omental infiltration and inflammatory masses involving the omentum and bowel, which may mimic peritoneal carcinomatosis. MRI Imaging. MRI imaging has excellent sensitivity for detecting fat and calcification and is useful for detecting organ of origin if ultrasound is nondiagnostic. T1 Weighted: sebum/fat has very high signal intensity; calcium bone and hair are low. T1 Weighted with fat saturation: suppression of high signal sebum/fat is diagnostic. Blood products in hemorrhagic cysts should not suppress. In case of a ruptured cyst, ascites and peritoneal thickening are detected with fat globules in the cul de sac and in the antedependent pockets with a deformed ovarian dermoid cyst.The treatment of choice, once rupture of an ovarian cystic teratoma is diagnosed, is surgical intervention. The cases of spontaneously ruptured ovarian cystic teratoma have a favorable prognosis if obvious intraoperative signs of peritonitis are not seen, because prompt removal of a spontaneously ruptured ovarian cyst with thorough peritoneal lavage is sufficient to prevent prolonged chemical peritonitis.Chemical peritonitis is a rare condition that occurs secondary to a spontaneous rupture of a dermoid cyst in the acute presentation, or secondary to a tiny perforation and leakage from a breach in the cyst wall in the chronic form. In the chronic phase, the diagnosis is usually incidental following abdominal discomfort or increase circumference. Intra-abdominal peritoneal seedlings, adhesions, and/or masses are frequent sequelae.The diagnosis should be raised in front of every case of unexplained chemical peritonitis especially when associated with dermoid cyst or fat globules and/or calcified hepatic or peritoneal deposits. Recognition of a dermoid tumour associated with glial seedling and a good understanding of the imaging findings and of the complications of ovarian teratomas are important to prevent misdiagnosis, to avoid unnecessary debulking surgery, and to achieve adequate treatment.


Osteochondroma, also known as osteocartilaginous exostosis is a benign cartilage forming tumor that usually develops in long bones and relatively uncommon in the craniofacial region. Both the condyle and coronoid tip being the most common sites of occurrence in the mandible, it rarely appears at the symphysis region. Here, we describe a case of osteochondroma arising from the left parasymphysis of mandible. Osteochondroma is an osseous protuberance with cartilaginous growth potential that usually appears near the growth plate at the ends of long bones such as knee, hip, shoulder, and joints. Only about 1% of these occur within the head and neck region , 3. HereA 9-year-old female child was referred to our maxillofacial unit because of a painless bony hard swelling in the left parasymphysis of mandible. The child's mother had noticed this swelling several years ago but did not seek any medical attention. Patient had no history of trauma. Bilateral submandibular lymph nodes were palpable. An extraoral swelling of 2 × 2 cm size was evident at the corner of the mouth. On clinical palpation, well-defined, irregular bony hard, nontender mass was felt which is fixed to the underlying buccal cortical plate. The overlying skin appears slightly fixed. Occlusal radiographic view revealed an irregular multiple foci of radiopacity merging with buccal cortex and extending into soft tissue shadow of buccal mucosa and lower lip . InternaThe clinical diagnosis that lurked in our minds was osteoma cutis, and the tumor excision was done under general anaesthesia. The mass was approached through labiobuccal vestibular incision. Intraoperatively, the bony mass was exposed and the dissection was limited to the base of the lesion. The irregular surface of the lesion was found to be grown into the buccal mucosa , which wHistopathological examination  revealedOsteochondroma forms as an exophytic growth from the surface of the affected bone . It commRadical excision including surrounding periosteum is strongly recommended and recurrence is rare . The resThough osteochondromas are rare to occur in craniofacial bones, these bony lesions should sometimes lurk in the surgeons mind. Clinically, the presence of stalk like cortex continuous with the cortical bone suggests a true osteochondroma. These have tendency to grow parallel to the growth of the underlying parent bone as the patient's age advances. These may be asymptomatic initially, but mechanical irritation and cosmetic deformity by an underlying exostosis frequently lead to surgical resection. Care is required to ensure that the resection neither violates normal host cortex by staying too deep nor leaves residual lesion by staying too shallow. The overlying bursa should be left intact, and the loose adhesive tissue should be dissected away, so that the bursa and the lesion are removed en bloc. As long as the entire cartilaginous cap or perichondrium is removed there should be no recurrence. Although the outcomes of treatment and prognosis are good, it is advisable to follow up these cases, as recurred cases have also been reported.  Recent genetic karyotyping studies suggest that they may represent a true neoplastic process and not a reactive one. Research is in early stage and further investigation is needed. As the bone length discrepancies are seen in some cases of long bone multiple osteochondromas, it is quite fair enough to keep a periodic record of length of the affected mandible mainly when it is seen in younger individuals.


Introduction. Peripheral de-differentiated chondrosarcomas are among the rarest malignant mesenchymal tumors. This tumor's descriptive radiographic characteristics are reported but objective quantification does not exist. This investigation surveyed imaging of peripheral de-differentiated chondrosarcomas to facilitate better recognition of these uncommon tumors. Methods. Database interrogation for peripheral de-differentiated chondrosarcomas was performed; 23 patients were identified and imaging for 18 was reviewed. A musculoskeletal radiologist reviewed all studies for mineralization characteristics; presence of pre-existing osteochondromas; preserved corticomedullary continuity; adjacent cortical obliteration; soft-tissue mass; tumor necrosis; and presence of a cartilage cap. Tumor luminance was measured with computer software. Results. Mineralization was present in 17 tumors. Pre-existing exostoses were evident in nine cases, corticomedullary continuity was preserved in three cases. There was no difference in mineralization or other characteristics based on tumor location. Mean tumor luminance was 94.9 candela/m2. Conclusions. The imaging characteristics described for central de-differentiated chondrosarcomas are similar to the peripheral form of this tumor. Peripheral mineralization with a bimorphic pattern on CT scan and the presence of a soft-tissue mass should be considered worrisome for a peripheral de-differentiated chondrosarcoma, particularly in the setting of multiple hereditary exostoses. Dedifferentiated chondrosarcoma is an uncommon tumor that is known to arise from preexisting, low-grade cartilage lesions –5. This  A consistent radiographic appearance of conventional, central dedifferentiated chondrosarcoma is recognized and described ; as a re Descriptive reporting of radiologic findings has been undertaken in some case reports and limited series; however, objective quantification of radiographic characteristics for peripheral dedifferentiated chondrosarcoma has not been performed. The varied descriptions of this tumor have included comparisons to a normal osteochondroma, a low-grade chondrosarcoma, and a conventional dedifferentiated chondrosarcoma , 20. The After Investigational Review Board and Ethics Committee approvals were obtained, the senior investigator's institutional database was queried for patients treated between 1980 and 2012 with a diagnosis of peripheral dedifferentiated chondrosarcoma; 23 patients were identified. Five patients were encountered only in consultation, and no imaging studies were available, leaving 18 patients for consideration.  The mean age of the patients at the time of operation was 46.4 years (range from 22.9 to 70.0 years). There were 13 men and five women. Nine patients' tumors arose from an exostosis in the setting of multiple hereditary exostoses (MHE), eight lesions arose from a preexisting solitary exostosis, and one lesion arose peripherally without an exostosis. The cartilaginous component of the tumors was chondrosarcoma in all patients. The histologic subtype of the dedifferentiated, noncartilaginous component was malignant fibrous histiocytoma-like (MFH) in 11 patients, osteosarcoma-like in five patients, and spindle-cell sarcoma-like in two patients. There was one lesion of the sternum, two of the scapula, three of the humerus, five of the pelvis, four of the femur, two of the tibia, and one of the fibula.  Preoperative imaging studies of the lesion included plain radiographs alone for five patients; a computed tomography (CT) scan alone for one patient; plain radiographs and CT for eight patients; and plain radiographs, CT, and magnetic resonance imaging (MRI) for four patients. An attending-level musculoskeletal radiologist evaluated all imaging studies. Plain radiographs were assessed for the presence of mineralization, whether mineralization appeared to encompass greater or less than 50% of the tumor area, a bimorphic pattern of mineralization, the presence of a soft-tissue mass, evidence of a preexisting exostosis, evidence of preserved corticomedullary continuity when an exostosis was present, extracompartmental extension, and erosion of the adjacent cortex. CT and MRI scans were assessed for the presence of mineralization, whether mineralization was central, peripheral, or both; a bimorphic pattern of mineralization; the presence of a soft-tissue mass; evidence of a preexisting exostosis; preserved corticomedullary continuity; extracompartmental extension; erosion of the adjacent cortex; the presence and thickness of a cartilage cap, and necrosis. t test.Tumor luminance was measured in an effort to objectively quantify tumor mineralization content on plain radiographs. Luminance is a measurement of brightness with units of candela per square meter; it is measured on a scale of zero, or completely black, to 255, or completely white. Luminance has been used in previous investigations to measure trabecular and soft-tissue density with both radiography and ultrasound , 22. Rad Plain radiographs revealed mineralization was seen in 16 of 17 cases; in eight cases it appeared to be bimorphic . Mineral Dedifferentiated, noncartilaginous histologic subtypes of patients in this series included 11 with MFH-like components, five with osteosarcoma-like components, and two patients with a spindle-cell sarcoma-like components. Mineralization was seen in 10 of 11 patients with MFH-like tumors, and in all patients with osteosarcoma-like and spindle-cell-like tumors, there was no statistical difference between groups .  There were eight axial lesions, seven of which demonstrated mineralization. All appendicular lesions showed mineralization. There was no difference in the occurrence of mineralization when results were divided by tumor location . Computed tomography demonstrated mineralization in 12 of 13 scans, it was thought to be bimorphic in 11 cases. The only CT to not demonstrate mineralization was the case which did not show mineralization on plain radiographs. Cross-sectional imaging showed the mineralization to be peripheral-only in four cases and central and peripheral in eight cases; there were no cases of central-only mineralization. A soft-tissue mass was identified in all 13 CT scans. A preexisting exostosis was seen in six CT scans; four of these exostoses were identified on the corresponding plain radiographs, and two were not identified on plain radiographs. Corticomedullary continuity was preserved in three cases with identifiable exostoses. Central necrosis was identified in three CT and MRI studies performed with contrast. A cartilage cap was identified in three lesions. There was no difference when results were divided by histologic subtype or tumor location Tables . 2 . Mean adjacent soft-tissue luminance was 43.8 candela/m2 (range from 11.1 to 140.0); therefore mean luminance for the tumors alone was 94.9 candela/m2 (range from 59.4 to 129.0), indicating that tumor opacity on radiographs was approximately 37%. When compared by histological subtype, MFH-like and OSA-like tumor luminance showed no statistical difference (P = 0.49). When spindle cell-like tumors were compared to MFH-like and OSA-like, the difference approached significance (P = 0.14), however, limited patient numbers precluded robust statistical analysis ( Tumor luminance was measured on plain radiographs in 14 cases. Mean tumor luminance without soft-tissue subtraction was 138.7 candela/manalysis . Anderson and coauthors reported the earliest description of a peripheral dedifferentiated chondrosarcoma and noted that its radiographic characteristics were consistent with osteochondroma . Since t The radiographic characteristics of conventional, central chondrosarcomas are known and include deep endosteal scalloping, cortical destruction, and a soft-tissue mass . Garriso Mercuri and coauthors reported that the imaging characteristics of central dedifferentiated chondrosarcoma depended on the preexisting cartilage tumor . They noSeveral case series of dedifferentiated chondrosarcoma have included mixed reporting of central and peripheral tumors. Discrete accounts of radiologic features for peripheral dedifferentiated chondrosarcoma include few case reports and limited case series. Cortical destruction was the first described harbinger of de-differentiation . BertoniThe current investigation confirms that the primary radiologic features of central dedifferentiated chondrosarcoma, soft-tissue mass, heterogeneous mineralization, and bimorphism are similar to the less common peripheral lesion morphology . SecondaOver one-half of the cases in the current series showed an MFH-like histologic morphology. This finding diverges from the largest reports of central dedifferentiated chondrosarcoma where MFH-like features comprised from 4% to 22% of the total cases, and osteosarcoma-like characteristics usually dominate , 16, 28.This investigation has limitations that warrant discussion. Our study details the radiologic findings of eighteen patients treated over a 33-year interval, during which imaging technology changed substantially, creating a heterogeneous mix of radiographic studies. While our case number is small and underpowered to truly ascertain statistical differences in the radiographic appearances of these rare lesions, this study represents the largest and only investigation dedicated to peripheral dedifferentiated chondrosarcoma imaging, and we believe that the results justify reporting. Measurement of tumor luminance in this investigation was an attempt to quantify tumor opacity, and therefore its mineralized content is relative to the surrounding soft tissues. Further investigations correlating this technique with quantitative CT are required to determine its usefulness and validate the results; however, the authors believe that it may prove a useful technique for quantitifying mineralization in the absence of advanced, three-dimensional imaging. The authors acknowledge that luminance in isolation does not provide radiologists and surgeons with objective criteria for ruling peripheral dedifferentiated chondrosarcoma in or out as a diagnosis; however, it does provide an objective starting point for comparison to other tumors that could lead to such parameters.  In general the imaging characteristics described for central dedifferentiated chondrosarcomas are applicable to the peripheral form of this tumor. Peripheral mineralization with a bimorphic pattern on CT scan and the presence of a soft-tissue mass should be considered worrisome for a peripheral dedifferentiated chondrosarcoma, particularly in the setting of multiple hereditary exostoses.


Squamous metaplasia presenting in noninvasive mucinous cystic neoplasm (MCN) of the pancreas is extremely rare. We described a case of 39-year-old Chinese female with a 5-year history of a slow growing mass in the left upper abdomen and an 18-month history of surgical incision exudation. The patient underwent cystojejunostomy, laparotomy and distal pancreatectomy consecutively because of the initial diagnosis of “pancreatic cyst”. The histological section showed columnar mucin-producing epithelium formed small papillary projections and extensively visible squamous metaplasia. Therefore the diagnosis of “noninvasive MCN with intermediate-grade dysplasia of the pancreas and extensive squamous metaplasia” was made finally. The squamous component of the pancreas may be derived from pluripotent stem cells, and may be in association with cystojejunostomy.http://www.diagnosticpathology.diagnomx.eu/vs/1322364365718540The virtual slide(s) for this article can be found here  Mucinous cystic neoplasm (MCN) is a rare exocrine pancreatic tumor that can be classified into four histopathological types : noninvaA 39-year-old Chinese female was referred to our hospital with a 5-year history of a slow growing mass in the left upper abdomen and an 18-month history of surgical incision exudation. The painless mass was found incidentally with an initial diagnosis of pancreatic cyst 5 years previously, and the palliative bypass procedure of cystojejunostomy was performed. However, due to the increasing size of the mass, the patient underwent a laparotomy 2 years later. This revealed a pancreatic tumor which was inoperable because of the major adhesion surrounding the neoplasm, stomach, greater omentum, mesentery and abdominal wall. Some of the anastomotic stoma tissue was excised for pathological examination, and a diagnosis of noninvasive MCN with intermediate-grade dysplasia was made. After 18 months, the surgical incision began to produce exudate. On admission to hospital, physical examination revealed a single, deep-seated, painless mass and two incisional sinuses with exudation in the left upper abdomen, without tenderness or muscular tension. Laboratory investigations were unremarkable, and serum levels of carbohydrate antigen 19–9 and carcinoembryonic antigen were within normal ranges. Abdominal ultrasonography and computer tomography scan revealed a 7.8 cm × 7.3 cm, heterogeneous hypoechoic or low-density mass with poorly defined margins in the tail region of the pancreas, compressing other adjacent organs. The mass was composed of several large loculi with an irregular thickening of the cyst wall and papillary excrescences projecting into the cystic cavity , the epithelial component with squamous differentiation was strongly immunoreactive with high molecular weight cytokeratin HCK, 34βE12) and CK5/6  theThe preoperative diagnosis of MCN is very important, since other types of pancreatic neoplasm may be treated differently and the grade of neoplasm does accurately predict the outcome ,5. The mAll MCNs should be resected to prevent malignant transformation but can be monitored for an appropriate time if the lesion is small without the presence of mural nodules -15. Our We have described a case of 39-year-old Chinese female with a 5-year history of a slow growing mass in the left upper abdomen and an 18-month history of surgical incision exudation. The patient underwent cystojejunostomy, laparotomy and distal pancreatectomy consecutively because of the initial diagnosis of “pancreatic cyst”. The histological section showed columnar mucin-producing epithelium formed small papillary projections and extensively visible squamous metaplasia. Therefore the diagnosis of “Noninvasive MCN with intermediate-grade dysplasia of the pancreas and extensive squamous metaplasia” was made finally. The squamous component of the pancreas may be derived from pluripotent stem cells, and may be in association with cystojejunostomy and the inflammation. More studies of series of patients with MCN and longer follow-up times are needed to explore whether extensive squamous metaplasia represents neoplasm progression and/or predicts a poor prognosis.HCK: High molecular weight cytokeratin; IHC: Immunohistochemistry; LCK: Low molecular weight cytokeratin; MCN: Mucinous cystic neoplasm; MEBMMSO: Mixed-epithelial papillary cystadenomas of borderline malignancy of mullerian type with squamous overgrowth; PR: Progesterone receptor.The authors declare that they have no competing interests.The research for this article was supported by grants from National Natural Science Foundation Of China (Nos. 30771120 and 81072103).PFL, YMW and ZW drafted the manuscript. QQZ was responsible for collecting the patient material. YXL and YL carried out the tissue staining, immunoassays, and electron microscopic examination. PFL and ZW conducted the analysis of the histological features and clinicopathological relations. All authors read and approved the final manuscript.Written informed consent was obtained from the patient for publication of this Case Report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.


Between 2 and 5% of malignant germ cell tumors in males arise at extragonadal sites. The origin of extragonadal retroperitoneal germ cell tumors remains controversial. Whether these develop primarily in the retroperitoneum or are metastases of a primary testicular tumor has long been debated. We report a 38-year-old male who presented with abdominal pain and was diagnosed with retroperitoneal seminoma. The patient gave a history of having undergone a right orchidectomy for an undescended testis via the inguinal route 10 years previously with a reported histology of benign inflammatory mass. The incidence of testicular cancer has doubled in the past 30 years and continues to increase –3. TestiWe report a 38-year-old male who was referred for abdominal pain to our surgical department. The study was approved by the Institutional Review Board of Catania University, Catania, Italy. Written informed consent was obtained from the patient. Physical examination revealed a well-nourished young male with a palpable mass on the right iliac fossa and the absence of the right testicle. The left spermatic cord and testis were palpable and normal on clinical examination. An incisional scar on the right groin was observed. The patient gave a history of having undergone a right orchidectomy for an undescended testis via the inguinal route 10 years previously. The patient, however, claimed that the histology report described a ‘benign inflammatory mass’. He had remained well until 3 months prior to presentation when he noticed the insidious onset of abdominal pain that progressively increased. No lower urinary or constitutional symptoms were reported and there was no history of trauma to the area. There was no palpable inguinal, axillary or supraclavicular lymphadenopathy. Laboratory studies upon admission revealed a normal blood cell count and chemistry profile. Serum α-fetoprotein (AFP) and β-human chorionic gonadotropin (HCG) were normal. The chest X-ray was also normal. Scrotal ultrasonography revealed the absence of the right testis and that the left testicle, kidney, spleen and liver were in normal condition. Abdominal ultrasonography revealed a heterogeneous mass suggestive of an encapsulated abscess. It was complemented by abdominal computerized tomography that revealed a solid mass located in the right iliac fossa . There wTesticular cancer represents 1–2% of all male malignant tumors and is the most frequent solid neoplasia in males aged 20–35 years . GonadalCryptorchidism is a frequent pathology that affects 2–5% of children. In only in 20% of the cases of cryptorchidism are the testicles non-palpable at clinical examination, in the remaining cases they are in the abdomen or the inguinal canal .Abdominal testicles present a higher rate of malignancy and develop cancer in 30% of cases. The high temperatures in the abdomen and inguinal canal and maternal risk factors appear to be responsible for the malignant degeneration . The tesThe histopathology of undescended testicle tumors in the adult depends on location; it is pure seminoma in more than 90% of the cases when it is intra-abdominal ,21–23. MNo cases of abdominal seminoma following orchidectomy have been reported in the surgical literature. As to whether the resected tumor in the present report was primary or a local recurrence, it would appear that the latter is the case as there are no known structures that may give rise to such a tumor following inguinal orchidectomy. It is possible that a microscopic deposit survived and gave rise to the mass in question, thus calling into question the accuracy of the first pathology report. Post-orchidectomy evaluation of the surgical pathology specimen and the definitive removal of the residual testicle tissue is established by an awareness of the histological spectrum exhibited by testicular remnants . AlthougAs a conclusion, and despite the elevated risk of testicular cancer in patients with intra-abdominal testicles, we considered retroperitoneal seminoma to be a disease of low incidence. This is due to the standard practice of orchidopexy in pre-adolescent patients and orchiectomy in post-adolescents with cryptorchidism. Nevertheless, tumors of intra-abdominal testicles occasionally appear that could be avoided by the adoption of adequate prevention strategies and a careful follow-up. If a patient presents with an abdominal mass following orchidectomy, the differential diagnosis of seminoma should be considered even if the prior histopathology report stated it to be benign. Extirpation of such tumors may be carried out safely by laparotomy. This will obviate the possible rupture and local seeding of tumor cells. We also wish to highlight the fact that a greater number of sections should be taken when preparing histopathological slides of post-orchidectomy testicles to reduce the risk of missing areas of the tumor.


Intussusception is one of the less common causes of intestinal obstruction among adults. It is usually covert  in its clinical presentation. The ileo-colic type with accompanying anal protrusion is extremely rare. The case at hand is that of both an ileo-colic intussusception with anal protrusion, in the presence of a persistence of both the ascending and descending mesocolons; a case possibly yet to be documented in literature.A 32 year-old African-Ugandan woman presented with complaints of a mass protruding per anus for 2 weeks. It was reducible and associated with colicky abdominal pain, loose stools, and bloody-mucoid discharge per anus. She had previously had a one and a half month’s history of abdominal pain; periodically continuous, while other times colicky in character. Examination and investigations revealed an intussusception with a partial intestinal obstruction. At laparotomy she was found to have an ileo-colic intussusception with a freely mobile colon throughout its length. There were persistent ascending and descending mesocolons, and absent hepatocolic and splenocolic ligaments. The intussusceptum was ‘milked’ but not completely reducible. A right hemicolectomy was done, with ileo-transverse colonic anastomosis. Histopathological examination revealed no preexisting pathologic lesion as a lead point.The persistence of the ascending and descending mesocolons (azygosis) best explains the anal protrusion of an ileo-colic intussusception with partial obstruction. In this case zygosis  failed embryologically. This experience is particularly beneficial to general surgeons, radiologists, gastroenterologists, colorectal surgeons and pathologists. Adult intussusception accounts for less than 5 per cent of intussusceptions with an incidence of 2 to 3 per 1,000,000 of the population per year [The protrusion  of the intussusceptum through the anal verge is rare, especially in adults. There are a number of documented cases in the literature, each tending to have some uniqueness about it ,4. Even During embryologic development the mesenteries of the ascending and descending parts of the colon blend with the posterior abdominal wall peritoneum by the process of zygosis . This coA 32 year-old African-Ugandan woman of nilo-hamitic ethnicity presented to her local hospital with complaints of abdominal pain and bloody diarrhea for 5 days in mid-August, 2012. She was admitted there and treated for amoebic dysentery, though no stool examination had been done. The abdominal pain was generalized and lasted for long periods prior to subsiding. Stools were mucoid and foul-smelling, though not copious in amount. She reportedly improved following empiric treatment with metronidazole, cotrimoxazole, analgesics and IV fluids, and generally felt better for a period of about 2 weeks. Subsequently, her abdominal symptoms changed in character. She felt an abdominal mass and the abdominal pain became colicky in nature, and was associated with vomiting. There was straining while defecating, tenesmus and a feeling of incomplete voiding of stool. A few days later she noticed what she described as "something protruded from the anus". It came as a result of straining to pass stool, and spontaneously reduced. Over the next one week she found that she had to manually reduce it, occasionally. She was consequently referred with a working diagnosis of rectal prolapse.The patient presented to our hospital on the 23rd September, 2012 with a chief complaint of abdominal pain and “a mass protruding from the anus”. She also complained of a swelling in the abdomen. The pain was colicky and she still passed bloody-mucoid stools, interspersed occasionally with semi-solid stools. This she did with straining and only passed very small quantities. She vomited once or twice daily, through not profusely, and passed flatus. Remarkable physical examination findings were per abdomen and per rectum. She had a firm, mobile mass in the umbilical region that measured 14 cm by 11 cm; located intra-abdominal and only slightly tender. The rest of the abdomen was of normal fullness. On rectal examination, the anal verge was normal. No protruding mass was visible (it had spontaneously reduced). A mobile mass was palpable 3 cm from the verge, and was free of the rectal mucosa all round. The examining digit could not get to its proximal limit; characteristic of intussusception. There was plenty of mucoid discharge and some dark blood. Significantly elsewhere, she was mildly dehydrated and afebrile. She had a blood pressure of 130/80 mmHg and a pulse rate of 80 beats/min. Examination of the mucoid, blood tinged material was negative for ova and cysts of any parasite.A diagnosis of a prolapsed intussusception with partial intestinal obstruction was made. An abdominal ultrasound scan confirmed this. Our patient was resuscitated and prepared for an exploratory laparotomy. This was performed through a midline incision. On opening the peritoneum, a large section of gut was revealed, ‘crammed’ and invaginated, but stretching from the distal ileum right up to the sigmoid colon, occupying the central aspect of the abdominal cavity Figure . This caThe intussusception was then manipulated. Its intussusceptum’s tip was felt in the sigmoid colon upon tagging on it. The intussusceptum was gently ‘milked’ proximally Figure  but coulThis case presents a scenario of chronicity of intussusception with partial intestinal obstruction. The symptoms found in adult patients with intussusception are often chronic and non-specific, such as abdominal pain, fever, nausea, vomiting, melena stools, weight loss, and constipation . PhysicaAn interesting aspect of this case is that she was initially clinically diagnosed with amoebic dysentery, a common condition in the tropics, presenting with abdominal pain , bloody-mucoid stools, diarrhea and vomiting. Amoebic dysentery is thus a top differential diagnosis in this patient. In chronic amoebic infestation with a resultant amoebic granuloma, intussusception may result as well. Relevant literature on this is expressed in a Sri Lankan study  where abAnal protrusion of the intussusceptum should not present a conundrum in the descriptive diagnosis of this case. She was referred with a new diagnosis of rectal prolapse, another differential diagnosis of intussusception. The two can usually be easily distinguished. In the event of a rectal prolapse, there is palpable continuity between the perianal/anal tissue and the protruding tissue. In contrast, in intussusception no palpable continuity may be felt; typically manifested in this case. Though ultrasonography (very specific for intussusception diagnosis) was done, it was not essential. The clinical features are sufficient to reach a definitive diagnosis of intussusception.The ability of the ileo-cecal lead point to ‘easily’ reach the anal verge and prolapse through is plausibly explained by the freedom of the colon made by the persistence of ascending and descending mesocolons. This is our hypothesis. Following normal embryonic zygosis, ascending and descending colons are firmly held in position  and would not allow for a relatively smooth invagination of an intususceptum all the way from the terminal ileum to the rectum and out. Right from the initiation of the invagination of the intussusceptum with its accompanying luminal and vascular obstruction, a vicious cycle will be offset. This will consist of: oedema, obstruction, and ischaemia; with subsequent accentuation of each of these with time. The result is more likely to be an intussusceptum with its lead point stopping within the ascending or transverse colon, and associated with total luminal obstruction. However, with failure of zygosis, as in our case, there is persistence of ascending and descending mesocolons, with more room for manouvreability of the intussusceptum. Further still, this mobile colon with ‘free’ hepatic and splenic flexures allows for only a partial intestinal obstruction with no gross abdominal distension, and the ability to pass flatus and stool, albeit still bloody and mucoid.Previous reports advocate for reduction of adult intussusception instead of resection  especialOur case, to the best of our knowledge, is the first documented one of its kind, at least in the East African region. It is an unusual presentation of a known, though rare, clinical disease  coexisting with a rare anatomical variation (persistent ascending and descending mesocolons). We draw lessons from the clinical features which generally give a mixed picture. There were both typical  and atypical features . Firstly, a mobile, abdominal mass in the umbilical region, with a protruding intussusception yet only a partial intestinal obstruction, should raise the suspicion of persistent mesocolons. Secondly, persistent mesocolons allow for only a partial intestinal obstruction even with such a sizeable intussusception in place.Clinicians ought to have a high index of suspicion for intussusception even when treating for amoebic dysentery. Either of the two can occur alone or contemporaneously. It is important to do stool analysis prior to initiation of antiparasitic/antibiotic agents so that we can ascertain or rule out amoebiasis. Radiological investigations  are important for early definite intussusception diagnosis.Written informed consent was obtained from the patient for publication of this Case Report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.The authors declare that they have no competing interests.OAP managed our patient peri-operatively, performed the operation, and wrote the manuscript. LRL prepared and analyzed the resected specimen and histopathological slides. He also edited the manuscript. JJ participated in the management of our patient and edited the manuscript. All authors read and approved the final manuscript.


To the EditorHere we present a case of multiple granulocytic sarcomas with monocytic differentiation involving the skin and retroperitoneal area. A 19-year-old man presented with the complaints of generalized arthralgia and fixed non-tender nodular lesions . PhysicaAbdominal and thorax computerized tomography (CT) was performed, which revealed a right retroperitoneal mass with blurred margins. A CT-guided biopsy was performed. The biopsy showed pleomorphic cell infiltration with large mononuclear and binuclear cells with clear nucleoli, which were CD163-positive, CD117-negative, and focal MPO-positive. These atypical pleomorphic, monocytic-histiocytic cells did not have blastic morphology. A high dose of cytosine-arabinoside and idarubicin was started. The nodular lesions disappeared 20 days after starting chemotherapy. Arthralgia, dyspnea, and respiratory distress developed consequently. Right pleural effusion was demonstrated in the chest X-ray. The cytological examination of the pleural fluid revealed blastic infiltration. Since the retroperitoneal mass persisted in follow-up abdominal CT, a new chemotherapy regimen containing fludarabine, cytosine arabinoside, and idarubicin was started. However, pleural effusion persisted and required Pleurocan evacuation. Methotrexate (Mtx) was given intrapleurally accompanied with systemic high-dose Mtx. Tumor lysis syndrome developed 28 days after this regimen and required intubation; the patient died due to cardiac arrest 3 days later. Granulocytic sarcoma (GS) is the tumoral infiltration of extramedullary sites with immature myeloid precursor cells; it is associated with 3%-8% of acute myeloid leukemia (AML) cases and rarely with chronic myeloproliferative disorders . MonocytThe prevalence of skin involvement in myeloid malignancies is approximately 3%, and it is usually associated with cases with monocytic differentiation. It is difficult to identify the origin of the tumor when it is not associated with bone marrow infiltration, namely “aleukemic leukemia cutis” . In a seIn conclusion, myeloid leukemias might present with granulocytic sarcomas, particularly in skin without bone marrow involvement. Multiple skin lesions of nodular pattern with violaceous color might suggest an underlying myeloid neoplasm. The positivity of monocytic markers such as CD68 and CD163 is typical for leukemia with a predilection to the skin. Patients with aleukemic granulocytic sarcoma might have a very aggressive course, with evolution to tumor lysis syndrome.Conflict of Interest StatementThe authors of this paper have no conflicts of interest, including specific financial interests, relationships, and/ or affiliations relevant to the subject matter or materials included.


A 7-year-old boy presented with a slightly raised, painless swelling on left lower quadrant of anterior abdominal wall. The swelling was slowly growing for 10 months. There was no history of preceding trauma and no relevant past medical and surgical history. General physical and systemic examination did not reveal any significant findings. On local examination, there was a non-tender, firm to hard nodular swelling of 2.0 cm x 1.5 cm in size over the anterior abdominal wall, free from overlying skin and underlying muscles. There were no other subcutaneous masses. His routine laboratory investigations were within reference range. The mass was excised and sent for histopathological examination. Grossly, the cut surface was firm, blue-white and glistening. Hematoxylin and eosin stained sections showed confluent lobules of hyaline cartilage with variable cellularity comprising of mature chondrocytes embedded in chondrocytic lacunae . There was no significant cytologic atypia, mitosis, or necrosis. No calcification/ ossification were present throughout the mass. Final diagnosis of extraskeletal chondroma (ESC) was made.ESCs are benign mesenchymal soft-tissue tumor composed mainly of hyaline cartilage without any bony or periosteal involvement. It constitutes only 1.5% of benign soft-tissue tumors. Most of ESCs were found between 30-60 year of age and have an equal sex distribution. It is very rarely seen in children.[2] ESC arise principally in extremities (96%) with 72% in the hands and 24% in the feet and only 4% in the rest of the body. In our case, it was located over the anterior abdomen wall.Clinically, they present as a slow-growing mass, occasionally causing pain or tenderness. They are usually less than 3 cm in size and firm or rubbery on palpation.[1] Soft-tissue masses of anterior abdominal wall in children encompass a wide variety of lesions including soft-tissue abscess, lipoma, posttraumatic hematoma, vascular malformation, desmoid tumor, and cysticercosis. The etiology of ESC is uncertain. It is believed that either these lesions develop from residual embryonal tissue in the area of preexisting fetal cartilage or pleuripotent mesenchymal cells undergo metaplasia, differentiating into cartilage.[2] Malignant transformation has not been reported in English literature.[3]On plain radiographs, ESC may appear as well-circumscribed, lobulated mass with dense central mineralization.[4] Calcification is usually ring-like punctate or granular. Sometimes, mineralization has an unusual configuration or is completely absent. The lesion should be differentiated from myositis ossificans, tumoral calcinosis, chondroid syringoma, low-grade extra-osseous chondrosarcoma and extraskeletal osteosarcoma. Wide local excision is the optimal treatment for ESC. Local recurrence has been seen in up to 18% cases and metastasis has not been documented.[5]Source of Support: NilConflict of Interest: None declared


The assessment of liver fibrosis is an important way for prediction of liver disease progression and patient’s prognosis. Liver stiffness measurement (LSM) is strongly associated with stage of liver diseases. overestimation of liver fibrosis in heart failure has been reported. We would like to introduce a new leading cause of liver fibrosis overestimation by presentation of two cases.one case with right lobe hemangioma has an overestimation of liver fibrosis. The result completely changed when Fibroscan was performed in patient’s left lobe. Interestingly, another case with left lobe hemangioma had overestimation of fibrosis in her left lobe but, right lob Fibroscan was normal.We found that liver hemangioma may leads to overestimation of liver stiffness and the correct inspection of liver echogenicity before any interpretation of high liver stiffness is recommended. We suggest that patient with higher level of Fibroscan score repeat it in other sides of the liver. Also, they should be evaluated by sonography for ruling out of possible confounders such as hepatic hemangioma. Hemangioma is a benign, asymptomatic, and suddenly founded hepatic tumor . PrevaleThe subject was a 34 years old female. She was known case of hepatic hemangioma from two years ago. Also, she had fatty liver and had come to our clinic for following up her problem by Fibroscan. The body mass index of patient was 23.7. In her first Fibroscan, median fibrosis score of her liver was 17.1 kilo Pascale (Kpa) which was compatible with F4 on Metavir histological index . Her capInterestingly, another patient came to our office for her fatty liver treatment follow up. We reviewed her medical documents for our new decision. We found that she is a known case of hepatic hemangioma. We demanded her to accept Fibroscan test. There was no problem for Fibroscan performance and patient’s BMI was 24.1. Then, Fibroscan was done. Her fibrosis assessment by standard approach (right lobe) was normal and stiffness score of her liver was 5.6 Kpa which was equal with F0-F1 . Also, hWe found that hepatic hemangioma is a leading cause of liver fibrosis overestimation. Overestimation of liver fibrosis has been reported in the presence of heart failure . Effect


Nodular fasciitis is described as a benign reactive proliferation of myofibroblasts. Due to its rapid-growing nature, a precise clinical diagnosis is difficult and the condition is frequently misdiagnosed as malignant lesions. In this study, we present the case of a young woman with an auricular nodular fasciitis as an example of one of the rarest sites of this tumor. The patient underwent an excision of the lesion under general anesthesia. The literature choices for treatment include complete excision, partial excision, or intralesional injection of steroids. Due to its associated local discomfort, and in order to exclude other differential diagnosis, we recommend a complete surgical excision.Auricular nodular fasciitis is a rare lesion. Due to its associated local discomfort, and in order to exclude other differential diagnosis, we recommend a complete surgical excision. Nodular fasciitis (NF) is described as a benign reactive proliferation of myofibroblasts. The exact etiology is still unknown, but a number of hypothesis regard a preceding trauma as an etiologic factor. However, an obvious history of trauma is not always evident among patients ,2. Due tNodular fasciitis is typically seen on the extremities of adults. A head and neck lesion is most commonly seen in children, whereas the auricular lesion is rarely seen. In a study by Thompson, auricular NF accounted for 1.5% of 3930 NF cases and just 1.9% of all auricular lesions  and tympanic membrane, but the lesion appeared to be discrete from the EAC. No cervical lymphadenopathies were detected. A thorough whole-body skin examination revealed no other lesions. With a pre-diagnosis of a pyogenic granuloma, and also to rule out the malignant lesions such as sarcoma, a punch biopsy was taken. At subsequent 1-week follow up, the lesion had grown to approximately 3 × 4.5 cm . Microscopic findings showed a proliferation of plump, mitotically active spindle-shaped cells with oval, pale-staining nuclei and short irregular bundles in a loosely mucoid matrix with extravasated red blood cells and multinucleated giant cells. An immunohisto- chemical (IHC) panel for cytokeratin (CK), S-100, epithelial membrane antigen (EMA), smooth muscle actin (SMA), and vimentin (Vim) was performed. On IHC study, CK, EMA, and S-100 were negative, and SMA and Vim were expressed, which confirms the diagnosis of NF . According to the pathologic diagnosis of nodular fasciitis, the patient underwent an excision of the lesion under general anesthesia. The basal skin of the lesion was completely excised and the surrounding skin was primarily repaired. There was no cartilage invasion. The permanent pathologic result was also compatible with nodular fasciitis. There was no recurrence after a year.Nodular fasciitis of the auricle is an uncommon lesion. It was first described by Konwaler et al in 1955 . In an aIn addition to its rapidly growing nature, the presence of high cellularity and considerable mitosis are the principal elements of a differential diagnosis . ThompsoThe pathologic characteristics are consistent with other studies. Only a few spindle sarcomas grow as rapidly as nodular fasciitis, but they show histologically a greater degree of pleomorphism and a greater area of necrosis. Fibromatosis is another differential diagnosis, but fibromatosis has larger infiltrative margins with collagenous stroma and scanty inflammatory cells, which differentiates it from NF.The treatment is also controversial. While complete excision is recommended by some authors ,4, otherAuricular nodular fasciitis is a rare lesion. Due to its associated local discomfort, and in order to exclude other differential diagnosis, we recommend a complete surgical excision.


A giant cell tumour (GCT) is a benign tumour that commonly arises in the distal end of the long bones. Extraosseous GCTs have been reported in a number of organs, but it is rare for a GCT to present in the parotid gland. Therefore, primary GCTs of the parotid gland (GCTPs) are extremely rare. Although GCTPs have been identified as benign soft-tissue tumours, they have a highly malignant potential and poor prognosis. In the present case, we report a 58-year-old male patient presenting with non-tender mass over the left preauricular area for 11 months. The final pathology report revealed a rare case of a GCTP that was treated by parotidectomy and adjuvant radiation therapy. The patient had no recurrence after 2 years of follow-up. Extraosseous giant cell tumours have been reported in a number of organs, including the temporomandibular joint , larynx 3) was occupying the deep lobe of the left parotid gland  with an 11-month history of a non-tender mass over the left preauricular area with no relevant medical history. A physical examination revealed a painless, hard, elastic mass (4×3 cm) over the left preauricular area. The results of a head and neck examination were within normal limits and facial nerve function was intact. A fine-needle aspiration was performed over the left parotid gland using a 22-gauge needle and the histopathological study was not able to exclude the presence of a malignancy. Subsequent observations by computed tomography showed that a mass (4×3×1.5 cmid gland .3) was observed to be occupying the deep lobe of the left parotid gland. Following removal of the tumour, the facial nerve trunk and its branches were preserved over the deep lobe of the left parotid gland.The patient received a total parotidectomy due to suspected malignancy. Following confirmation of all the facial nerve branches, the superficial lobe of the left parotid gland was resected and the tumour was exposed . The tumThe tumour was sent for histopathological examination by immunohistochemistry. The sections of the specimen were identified as that of a giant cell tumour, composed of uniformly distributed osteoclast-like giant cells, admixed with mononuclear cells and numerous brown hemosiderin-laden macrophages . The immFollowing surgery, the patient was referred to the Department of Radiation Oncology  for adjuvant radiation therapy since surgical margins were not achieved. Treatment consisted of surgical excision associated with adjuvant radiation therapy. No facial palsy was observed following surgery and radiation therapy , and the individual exhibited no recurrence of a neoplasm after 2 years of follow-up.et al in 1984 .For the treatment of malignant parotid tumours, parotidectomies and post-operative adjuvant radiation therapy have been used . A previThe basic treatment for a GCT is extensive resection of the tumour, allowing for a sufficient margin of the surrounding normal tissue . A GCT iIn summary, GCTPs are uncommon benign tumours with a malignant potential. The identification of a GCTP should warrant a diligent search for a carcinomatous component. Complete surgical removal of the tumour is the treatment of choice for a resectable GCTP. In addition, surgery alone has been justified for the management of a GCTP without a carcinomatous component. However, combined radiation therapy is recommended if surgery has been contraindicated, if surgical margins have not been achieved or if GCTP has been diagnosed with an associated carcinomatous component.