Hydatidosis is a widespread anthropozoonosis. It can affect almost any part of the body, but it occurs most commonly in the liver (75%) and the lungs (15%). Its occurrence in female genital tract, especially the uterus, is very rare. Diagnosing hydatid disease at these unusual locations can be difficult. Hereby, we report two cases of primary hydatid cyst of the uterus. The first case is that of a 62-year-old woman, G7P5A2, who presented with an eight-month history of chronic pelvic pain. Clinical examination and radiological explorations revealed the presence of a uterine fibroid and a serous cystadenoma of the left ovary. She underwent a hysterectomy and a bilateral adnexectomy. Anatomopathological examination concluded that a serous cystadenoma of the left ovary was a calcified subserous hydatid cyst of the uterine fundus. The second case is that of a 69-year-old woman, G6P4A2, who consulted for chronic pelvic pain that had been evolving for 3 months. The clinical examination and radiological explorations doubted a hydatid cyst of the uterus, with a positive hydatid serology. She underwent a resection of the salient dome. The anatomopathological examination was in favor of a hydatid cyst of the uterus. Hydatid disease is endemic in Tunisia. The pelvic region is rarely affected with an incidence ranging from 0.3 to 0.9%, 80% of which involves the genitals. The uterus is more rarely affected than the ovaries. Most often, it is a contamination secondary to the intra-abdominal rupture of a hydatid cyst of the liver. However, primary uterine hydatid cysts have been reported. Surgery is the Gold Standard for the treatment of uterine hydatid cysts. Exploration of the abdominal cavity is essential in the search for other localizations, particularly hepatic. Postoperative medical treatment with Albendazole can be discussed. The ideal approach to deal with this public health concern is to emphasize the need for improved preventive measures. Modern imaging techniques have significantly improved the detection rates of hydatid cysts in atypical localizations. Indeed, the preoperative diagnosis of uterine hydatidosis requires a meticulous approach which is necessary to initiate an adequate treatment and thus guarantee a better management of the patient. Hydatidosis is a widespread anthropozoonosis worldwide. It is a real public health concern in countries where it is endemic. This zoonosis is caused by the larval form of a cestode of the Echinococcus granulosus species, a dog tapeworm for which man is an accidental intermediate host . HydatidThis is a 62-year-old woman, menopausal for 12 years, hypertensive, G7P5A2, with no previous history of abdominal surgery, who consulted for chronic pelvic pain evolving for 8 months.Abdominal examination did not reveal any abnormalities. Vaginal speculum examination revealed a macroscopically healthy cervix, a 1 cm polyp of the cervix. Vaginal touch revealed a small uterus, with the perception of a renitent left latero-uterine mass separated from the uterus by a groove. A pelvic ultrasound revealed a 4 cm uterine-fundal hypoechoic mass evoking a uterine fibroid. The left ovary was the site of a cystic mass measuring 10 cm in diameter with pure anechogenic content. A pelvic MRI scan was performed and concluded a 9 cm purely cystic mass of the left ovary classified as O-RADS 2 evocative of a serous cystadenoma, with a pedicle subserous FIGO type 7 myoma developed at the expense of the anterior wall of the uterine body lateralized on the right measuring 30∗27∗40 mm  .The patient was operated on, and an exploration of the abdominal cavity revealed a uterus was surmounted by a 4 cm cystic lesion with subserous development and a 12 cm cystic mass with no exocystic vegetations in the left ovary. Given the patient's age, the diagnosis of a malignant lesion has been evocated, so a total hysterectomy with bilateral adnexectomy was performed. The postoperative follow-up was unremarkable. The patient was discharged four days postoperatively.Anatomopathological examination concluded two ovarian serous cystadenomas measuring 12 cm on the left and 1.7 cm on the right and a subserous calcified hydatid cyst of the uterine fundus with a benign polyp of the endocervix .A chest X-ray and an abdominal ultrasound were subsequently performed and did not reveal any other hydatid localizations.2), G6P4A2, menopausal for 16 years, hypertensive, and diabetic, with no previous history of abdominal surgery, who consulted for chronic pelvic pain evolving for 3 months.This is a 69-year-old overweight woman  according to the ELISA technique (enzyme-linked immunosorbent assay). The patient was operated on medially, a hydatid cyst of the uterine fundus was found, but no hepatic lesions were noticed, and the protruding dome was resected (we opted for a conservative treatment since we operated the patient with a preoperative diagnosis of a benign cyst). The operation was uneventful, and the patient was discharged 4 days after the operation. The anatomopathological examination was in favor of a hydatid cyst of the uterus.Hydatid disease is endemic in Tunisia; it is concentrated in the northwest of the country. Globally, the endemic areas are the Mediterranean countries, the Middle East, the southern part of South America, Iceland, Australia, New Zealand, and southern parts of Africa; the latter five regions are intensive endemic areas. Central Asia, particularly China, is also an endemic area. Approximately 2 to 3 million cases of human echinococcosis are reported worldwide each year .Echinococcus granulosus induces a cystic, noninvasive, unilocular, and encapsulated lesion that evolves slowly (0.5 to 3 cm per year). It commonly affects only one organ, and 10 to 15% of cases have two organs affected .The pelvic region is rarely involved with an incidence ranging from 0.3 to 0.9%, of which 80% involve the genitals. The uterus is more rarely affected than the ovaries . The majThe rarity of uterine hydatidosis, the slow progression of this disease, and the heterogeneity of symptoms make preoperative diagnosis difficult. Differential diagnosis is made with cystic or mixed retroperitoneal tumors (dermoid cysts), pyogenic or tuberculous abscesses, cysts of the ovary or hydrosalpinx, ovarian tumors, or uterine fibroids .Surgery is the Gold Standard for the treatment of uterine hydatid cysts. Midline laparotomy under the umbilicus remains the best choice. The laparoscopic approach remains controversial because of the lack of experience in treating hydatid cysts by this route, the increased risk of dissemination, and the higher rate of recurrence. Sterilization of the cyst and protection of the surgical site are performed using hydrogen peroxide. A cystectomy must be performed for accessible cysts or for the partial or total surgical removal of organs invaded by hydatidosis . ExploraIn an endemic country such as ours where hydatidosis is a public health concern, the ideal is to focus on the implementation of preventive measures, notably the fight against infestation of the definitive host, the protection of the intermediate host, and the fight against human contamination.The detection of hydatid cyst in its atypical localizations has been facilitated by various modern imaging techniques. Indeed, the preoperative diagnosis of uterine hydatidosis requires a meticulous approach which is necessary to initiate an adequate treatment and thus guarantee a better management of the patient.


Valentino syndrome is one of the rare classical presentations of duodenal perforation, wherein the leaked contents collect at the right lower quadrant of the abdomen causing local peritonitis and mimicking appendicitis. Here we present a case profile of a 28-year-old gentleman, who presented with right lower quadrant abdominal pain and mass, which was clinically diagnosed as acute appendicular inflammatory mass. Later with laboratory reports and radiological imaging, he was confirmed to have acute pancreatitis, and actually the peripancreatic fluid collection has tracked down into the right iliac fossa and pelvis to present similar to Valentino syndrome. This article is reported to highlight acute pancreatitis as a cause of Valentino syndrome. The Valentino syndrome or Valentino’s appendix was originally named after an American actor, Rudolph Valentine 1895-1926). He had an appendectomy for his acute appendicitis-like presentation but later died due to peritonitis and multiorgan failure. His autopsy revealed a perforated gastric ulcer and the leaked contents were tracking through the paracolic gutters into the right iliac fossa causing peritoneal irritation in that area, mimicking appendicitis [895-1926.A 28-year-old gentleman presented in our surgical casualty with a four-day history of acute onset diffuse abdominal pain, which was now localized at the right lower quadrant of the abdomen. He had one episode of fever initially and had nausea with bilious vomiting for the same duration. He occasionally consumes alcohol and his last drink was one year ago. He did not have any relevant past medical and surgical history. On clinical examination, he was found to be afebrile, dehydrated, and had tachycardia (Pulse rate 140/min). The examination of the abdomen proper revealed a mild uniformly distended abdomen with right iliac fossa fullness and a localized tenderness over it. He was admitted with the provisional clinical diagnosis of appendicular inflammatory mass. His urgent ultrasonogram abdomen reported probe tenderness over the right iliac fossa region and could not document any bowel or visceral pathology due to excess gas shadows. The basic blood investigations suggested an inflammatory or infective pathology with total white cell counts of 13,270/cu mm (Neutrophils 78%) and C-reactive protein value of 252. The panel of blood tests also included an elevated serum amylase (177 U/L) and lipase (663 U/L), which prompted for an emergency contrast-enhanced computed tomography (CECT) of the abdomen and pelvis. The CECT abdomen gave an entirely different diagnosis of acute pancreatitis with a severity score of 6/10  and then he was put on lipid-lowering agents with a low-fat diet plan. The patient was discharged after a week and is on regular follow-up.Valentino syndrome was originally described as an eponym to impart caution to our surgical fraternity in handling cases of appendicitis-like clinical presentations . The litAcute pancreatitis with Valentino’s appendix-like presentation is probably the first time reported in the literature. Pancreas shares its neighbourhood with duodenum and stomach in the lesser sac and hence it can also present with similar findings in the presence of sufficient peripancreatic fluid collection. To understand the pathophysiology behind the Valentino’s appendix presentation, we require the knowledge of various retroperitoneal spaces and their communications with each other. To brief a little about it, retroperitoneal space is that space between parietal peritoneum and posterior fascia transversalis. It is divided into three compartments, that is, lateral, median (vascular) and posterior (muscular) compartments . The latThe presentation in our case was typical of a Valentino’s appendix and he even had a right iliac fossa fullness and rebound tenderness due to the local peritoneal collection and irritation. The presentation was acute with a clinical picture pushing for an emergency laparotomy in view of suspected appendicular perforation or abscess. Only with a detailed panel of blood investigations for acute abdomen, CT imaging and clinical follow-up, we were able to make the right diagnosis and management plan for him.Acute pancreatitis can also present as appendicitis and will be even more difficult to identify with clinical acumen alone. Awareness and a systematic approach of ruling out the other possible causes of a presentation will be helpful in identifying and treating these rare conditions. The eponym Valentino’s appendix is worth to be remembered and passed on to the upcoming surgical generations for the plight it can save us from.


Pancreatic leiomyosarcoma (PL) is a very rare, malignant neoplasm with a very poor prognosis. Here, we examine a novel case of PL with schistosomiasis hematobia. The patient had been initially misdiagnosed by the first magnetic resonance imaging (MRI). The second imaging examination demonstrated an enlarged heterogeneous tumor mass in the body-tail of pancreas. Following image analysis, the patient underwent a pancreatectomy, splenectomy and lymph node dissections. Sixteen months after the tumor resection, follow-up computed tomography (CT) and MRI revealed tumor metastasis in the liver and lung. PL has non-specific clinical manifestations and imaging characteristics, making early diagnosis very challenging. When it is difficult to distinguish between benign and malignant pancreatic lesions, short-term imaging follow-up is preferred. In this case report, we discuss the relationship between PL and schistosomiasis hematobia. Pancreatic leiomyosarcoma (PL) is a very rare, malignant neoplasm occurring in the pancreas, accounting for 0.1% of tumors primarily arising from pancreas . It is tSchistosoma eggs were found in the tumor tissues  (S. japonicum is a chronic infection where regulatory pathways accommodate host permissiveness to schistosome establishment of productive parasitism (Was PL induced by d IL-10) . S. japorasitism , 21. Assrasitism , 23. Whirasitism , 24. TheIn summary, PL has non-specific clinical manifestations and imaging characteristics, but shares similar imaging appearance with many other pancreatic neoplasms. When it is difficult to distinguish between benign and malignant pancreatic lesions, other examinations  and short-term imaging follow-up are preferred. The relationship between schistosomiasis and PL might be not relevant, but more clinical evidence is needed to confirm this assertion.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.QL and YZ took the lead in drafting the manuscript and provided magnetic resonance images and H&E staining. DS, YZ, and JC provided supervision and participated in the literature review and in drafting the manuscript. All authors contributed to the article and approved the submitted version.This work was supported by Public Welfare Technology Research Program of Zhejiang Natural Science Foundation (grant number: LGF20H180005 to QL), China Postdoctoral Science Foundation Funded Project (grant number: 2020T130584 to JC), and China Scholarship Council . This work was also supported by Wuhan University Training Program for Young Talents Abroad (grant number 2018-105 to YZ).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Wilms' tumor is childhood’s most common renal tumor, and its presentation in the adult age is extremely rare. Due to the low frequency in adults, no standard management guidelines are available for this population, also the natural history of the disease and management is unclear. We present a case report of a 31-year-old woman with metastatic Wilms' tumor, with lymph node, lung and liver involvement; systemic treatment with chemotherapy was started, with complete clinical response. Finally, a literature review is performed to showcase the differences in the clinical course, prognosis, and treatment alternatives, in adult disease compared to childhood. Wilms' tumor, also known as nephroblastoma, is the main cause of solid abdominal neoplasms in children younger than six years, with a reported annual incidence of 8-10 cases per million persons; hence, this tumor shows a clear predominance for pediatric age, with 90% of cases being diagnosed in patients younger than five years . Due to The standard pediatric treatment is proposed by two collaborative groups: the National Wilms Tumor Study (NWTS) and the International Society of Paediatric Oncology (SIOP). It implies a multimodal management with radical nephrectomy as the cornerstone of management, associated with exclusive chemotherapy or with concomitant radiotherapy in most patients . By compWe present a case report of a 31-year-old woman treated in the Instituto Nacional de Cancerología in Bogotá, Colombia. The patient presented with a Wilms' tumor with metastatic disease and high tumor burden, which presented a complete clinical response to a pediatric chemotherapy scheme. Afterwards, we perform a literature review where the clinical course, prognosis, and treatment of Wilms' tumor are compared between children and adults.A 31-year-old female patient had a personal history of radical nephrectomy and adrenalectomy due to left renal mass in 2010, performed outside the Instituto Nacional de Cancerología, apparently with a complete resection and an unknown initial pathology report. The patient didn’t receive any additional management and remained under follow-up. In 2016, she consulted to the Instituto Nacional de Cancerología. In imaging studies, hepatic lesions with metastatic appearance were observed. Biopsy reported a morphology compatible with Wilms' tumor, and immunohistochemistry was positive for CK (AE1/AE3), WT1, BCL2, CD56, and negative for synaptophysin, chromogranin, CD99, S100, FLY-1, and estrogen receptor. Due to its morphology, a differential diagnosis of synovial sarcoma was proposed; hence, a fluorescence in situ hybridization (FISH) study for the SS18 gene was performed, which was negative.The patient underwent right hepatectomy in February 2018, where multiple lesions with metastatic aspect were found in the right lobule and no lesions were observed in the left hepatic lobule. The pathology report confirmed the diagnostic suspicion of Wilms' tumor due to the tri-phasic pattern and the immunohistochemistry pattern , dyspnea, cough, chest pain, and supraclavicular masses. Imaging studies were performed: in a thoracic and abdominal computed tomography (CT), pulmonary and lymph nodes progression was observed . The NWTS treatment scheme for stage IV was started, with a DDA4 scheme  from 29 august 2018, with overt clinical response since the second week of treatment and with no toxicity associated. No concomitant radiotherapy was offered due to the lack of evidence in adult patients and the risk of severe toxicity in this population.The patient finalized the chemotherapy protocol in February 2019, when imaging studies found a nearly complete response, only with a non-specific right hilum lymph node of 8mm and a 4mm nodule in the left inferior lung lobule. A multidisciplinary board meeting with clinical oncologists and oncologic radiotherapists was performed, leading to the recommendation of a lung bath in a 2GY fractioning for a total dose of 12GY. The patient completed such treatment without any toxicity in May 2019. Furthermore, she underwent total abdominal radiotherapy in a 1.8GY fractioning up to a total dose of 10.8GY, completing the radiotherapy treatment in June 2019 without any toxicity.In the last follow-up with clinical oncology in September 2020, the patient was asymptomatic, with ECOG 0, and imaging studies revealing complete tumoral response (Figure Wilms' tumor is a renal embryonal neoplasm that occurs predominantly in the pediatric population, with around 95% of cases being diagnosed before 15 years . An inciThe prognosis in the pediatric population has been dramatically modified in the last few decades, from a global five-year survival of 20% in 1960 to over 90% after multimodal protocols, including high-intensity chemotherapy, have been implemented . The larAround 300 adult Wilms' tumor cases have been reported in the literature ; due to Two big observational studies have successfully specified clinical, therapeutic, and survival characteristics in adult patients with Wilms' tumor , 15. TheWilms' tumor has an extremely rare incidence in adults. The diagnosis is usually performed in later stages and the oncologic prognosis is considerably worse compared to children. Management based on pediatric protocols has shown improved survival outcomes. Therefore, even though no evidence of specific clinical studies performed in the adult population is available, it is reasonable to extrapolate pediatric protocols to adult patients.


Schwannomas are benign tumors of the nerve sheath, they do not typically present on the abdominal wall and cause symptoms. To the best of our knowledge, this is the second symptomatic case of schwannoma in upper abdominal wall reported according to the reviewed English medical literature.A 25-year-old man post renal transplant two year ago. He presented with left hypochondrial painfull swelling, and redness. On examination, local examination revealed a lesion located in the anterior abdominal wall swelling, 3 × 3 cm, tender with minimal erythema and hotness but no discharge. An ultrasound showed superficial oval shaped with thick wall and mildly increased peripheral vascularity without internal vascularity. He underwent surgical excision and the histopathology result was schwannoma.Usually, a patient presents asymptomatic with a slow growing mass. However, the symptoms can vary and depending on the location. Furthermore, a growing lump can start putting pressure on the nerves around the area, and patients can show symptoms accordingly. The likability of ultrasound to pick up a well-circumscribed mass and reaching a definitive diagnosis without histopathology is nearly impossible. Therefore, a complete excision and histopathology confirmed the presence of schwannoma.Upon the rarity of schwannomas presenting in atypical regions, such as the abdominal wall. A painful mass on the abdominal wall should raise the suspicion of benign schwannoma. The recurrence rate after the treatment of choice is unusual. Moreover, complete surgical excision of the mass is the definitive treatment. These t2A 25-year-old man post renal transplant two year ago. He presented to the emergency department with left hypochondrial swelling, that he noticed three months ago. It became painful for 2 weeks duration with no changes in the size or discharge from the lesion. He denied a history of trauma and fever. He is non-smoker, his psychosocial, drug and family history were unremarkable.On examination, the patient was vitally stable, looks well and not in pain. Abdominal examination revealed a lesion located in the anterior abdominal wall, the area between the left hypochondrial and lower chest. The swelling was about 3 × 3 cm, tender with minimal erythema and hotness but no discharge.The routine laboratory works up were unremarkable. An ultrasound was done while scanning the left anterior abdominal wall at the area of concern, it showed superficial oval shaped with thick wall and mildly increased peripheral vascularity without internal vascularity . In corrHe then presented to the clinic a week later with the same history given previously, a surgical excision proposed to the patient and was done under local anesthesia by general surgeon. During the procedure, the excised mass was found to be round in shape, soft tissue in character, adhesion to the surrounding tissue which was excised with healthy margins and sent for histopathology review.The histopathology findings of the lesion show a necrotic tissue with peripheral spindle cells with prominent nuclear pallisading (Verocay Bodies) . The spiThe patient had uneventful procedure with no complications and was discharged home in a good condition and followed regularly in the clinic, He experienced improvement in his symptoms, quality of life and the capability of coping with daily demands.3Schwan cells of the peripheral nerve sheath is the origin of the benign neurogenic tumors, they are usually encapsulated and slow growing, they can present with pain, paresthesia, or less commonly with neurologic deficits ,6. TransAs often known, schwannomas do not affect the conductivity of the nerve that arises from it. Usually, a patient presents asymptomatic with a slow growing mass. However, the symptoms can vary and depending on the location they present differently . FurtherAlthough imaging of superficial subcutaneous lesions is usually ultrasound , computeTo aid the diagnosis of these lesions, histopathology is strongly recommended. Typically, schwannomas react strongly with S100 protein and immunohistochemistry ,7. WhereHistologically, schwannoma is a well encapsulated mass, composed of typical dense cellular areas (Antoni type A) and myxoid areas (Antoni type B) ,4 Ancien4Upon the rarity of schwannomas presenting in atypical regions, such as the abdominal wall. A painful mass on the abdominal wall should raise the suspicion of benign schwannoma . The recThe authors report no declarations of interest.This study did not receive any funding from governmental or private organizations.st February 2021.Ethical approval was obtained from the Institutional Review Board (IRB) of the King Fahad Specialist Hospital, Dammam, Saudi Arabia. The ethical approval was signed on 01Not applicable.Abdullah G. Alsahwan, Jomana M. Felemban, Anas Al-Othman, Shahad Y. Assiri and Ali A. Alzahir: study concept or design, data collection, data interpretation, literature review, drafting of the paper, final review of the manuscript.Dr. Abdullah Ghazi AlSahwan.Not commissioned, externally peer-review.


Case presentation. The first case was a 34-year-old female with left inguinal pain and swelling which was clinically diagnosed as inguinal hernia. The second case was a 28-year-old female with inguinal pain and swelling, depicted with triplex ultrasonography and computed tomography, and was suspected to have inguinal hernia or enlarged inguinal lymph node. During the surgical exploration, both patients were found to have thrombosed aneurysm of the superficial epigastric vein. During the surgical exploration, both patients were found to have thrombosed aneurysm of the superficial epigastric vein. The superficial epigastric vein was ligated, and the venous aneurysms  were excised. Histological examination of the thrombosed aneurysm showed complete replacement of the vascular wall by fibrous tissue, thrombosis, and an inflammatory reaction. There were no postoperative complications, and both patients were discharged on the second postoperative day. The 3-month and 1-year follow-up examination, respectively, was uneventful.  Presentation of two cases of superficial epigastric vein aneurysm simulating inguinal hernia. To our knowledge, only one other case is reported in the literature.  Although venous aneurysms in the inguinal area are rare, they should be included in the differential diagnosis of a groin swelling. Venous aneurysms are usually uncommon. Venous aneurysms were first identified in autopsy studies by Osler in 1915 . SuperfiFirst case: a 34-year-old female patient was admitted for an extensive painful swelling along her left inguinal area during the past 6 months. She was a nonsmoker, there was no trauma, use of oral contraceptive pills, infection, inflammatory disease, and recent travel in her medical history while review of systems was unremarkable. The patient had a medical history of left saphenectomy 8 years ago. Physical examination revealed a nonpulsating, immobile, and painful swelling along her left groin. The results of electrocardiography, routine biochemistry, and blood analysis were normal. The patient was clinically diagnosed with a left inguinal hernia, while an ultrasonic scan, unfortunately, had not been previously performed.cm) was excised   and compcm) was excised (The differential diagnosis preoperatively was left inguinal hernia and inguinal lymph node enlargement. The patient was operated under spinal anesthesia, and a left oblique inguinal incision was performed. A large blue mass, due to a thrombosed saccular aneurysm of the superficial epigastric vein, was found . The sup excised .Histological examination of the thrombosed aneurysm showed complete replacement of the vascular wall by fibrous tissue, thrombosis, and an inflammatory reaction . There wVenous aneurysms are rare vascular malformations that occur throughout the body and vessels at various sites can be affected as in the internal jugular vein, superior vena cava, inferior vena cava, superior mesenteric vein, and also veins of the extremities , 7. PrimHistologically, there is replacement of three normal vascular wall layers by fibrous tissue with thrombosis and inflammatory infiltration . In bothThe causing symptoms are due to disfigurement, rupture, fistulation, or compression. Deep venous aneurysms present with pain or pulmonary embolism, while superficial venous aneurysms are usually asymptomatic; so, venous aneurysms located in the inguinal region,could be misdiagnosed as soft tissue lesions , 12 or aVenous aneurysms can generally be diagnosed mainly by color Doppler imaging , as wellThe anatomic position of the venous aneurysm defines the best surgical approach. The indication for surgical treatment of superficial, neck, and face venous aneurysms is usually cosmetic. Asymptomatic nonenlarging venous aneurysms can be safely followed up, due to their high surgical morbidity and mortality. Abdominal venous aneurysms are at high risk of becoming painful or bleeding, and thus surgery should be considered for low risk patients , 13. As We report two rare cases of a thrombosed venous aneurysm of the superficial epigastric vein, simulating an inguinal hernia. Although venous aneurysms in this region are rare, they should be included in the differential diagnosis of a groin swelling.


Diagnosis of small renal tumor from imaging analysis is limited. We report a case of juxtaglomerular cell tumor diagnosed preoperatively by renal tumor biopsy.A 17‐year‐old male was urgently hospitalized for acute‐onset congestive heart failure. Radiographic findings revealed a 2‐cm mass lesion, and on renal biopsy, a juxtaglomerular cell tumor was suspected. The juxtaglomerular cell tumor was resected by laparoscopic partial nephrectomy, on suspicion of causing the heart failure. The patient’s clinical symptoms improved drastically postoperatively.Biopsy may be a promising option for preoperative diagnosis of juxtaglomerular cell tumors. ALTalanine aminotransferaseASTaspartate aminotransferaseCKcytokeratinCTcomputed tomographyHHF35muscle actinJGCTjuxtaglomerular cell tumorMRImagnetic resonance imagingNanatriumPAXpaired boxSMAsmooth muscle actinSOXSRY‐related HMG boxT‐Biltotal bilirubinUAuric acidSome renal tumors may be difficult to diagnose based on radiographic findings. This case report provides valuable insight on the use of renal tumor biopsy for appropriate diagnosis. The JGCTs should be taken into consideration in diagnosis of renal tumors with characteristic symptoms such as hypertension and hypokalemia.With widespread utilization of CT for screening diseases of patients, frequency of incidental findings of small renal masses is getting higher recently.JGCT is one kind of the diseases which can present small renal mass.A 17‐year‐old male visited our hospital because of epigastric abdominal pain. His blood pressure was high (133/104 mmHg) and physical examination revealed leg edema. His laboratory results revealed the following values: T‐Bil: 2.97 mg/dL , AST: 576 U/L , ALT: 967 U/L , UA: 8.7 mg/dL , Na (sodium): 128 mEq/L , and kalium: 3.5 mEq/L . Cardiac ultrasound suggested acute‐onset congestive heart failure with a left ventricular ejection fraction of 19%, and the patient was urgently hospitalized for the heart failure treatment. Obstructive coronary artery disease was excluded as a cause by cardiac catheterization. The patient was diagnosed with dilated cardiomyopathy by a myocardial biopsy. A 2‐cm mass lesion with slight, uneven enhancement in the right kidney was incidentally found by enhanced CT Fig. . InterveThe final diagnosis of the patient was a JGCT based on the histological findings of the resected tissue. Postoperatively, the patient’s symptoms are improved (blood pressure: 123/180 mmHg) with decrease of plasma renin (0.4 ng/mL) and aldosterone (53.7 pg/mL). Other postoperative laboratory results were as follows: T‐Bil: 0.75 mg/dL, AST: 18 U/L, ALT: 15 U/L, UA: 6.7 mg/dL, Na: 139 mEq/L, and kalium: 3.6 mEq/L. Cardiac ultrasound suggested improved cardiac function with a left ventricular ejection fraction of 61.0%.JGCT is a rare disease which presents renal mass by CT, and about 100 cases have been reported until now.On dynamic CT, JGCT tumors are not enhanced or only slightly enhanced in the late phase. On MRI, JGCT tumors show isointense or hypointense lesion on T1‐weighed images, and hyperintense lesion on T2‐weighted image,Histologically, JGCT cells are composed of uniform polygonal cells with small round nuclei and eosinophilic cytoplasm, showing solid growth pattern.As described above, preoperative diagnosis of JGCT has been presumed by the clinical presentation, elevation of plasma renin, and radiographic findings in most of the previous cases. There were some cases in which the patients underwent surgery with a clinical diagnosis of renal cell carcinoma, but the pathological diagnosis was that of JGCT.The authors declare no conflict of interest.


Small intestine diverticula are rare findings that were mostly reported in the elderly population as asymptomatic findings. However, they can also present with a wide range of symptoms  or complications  which in turn warrant medical treatment or urgent surgical intervention.This is a case report of an 84-year-old female who presented with an acute surgical abdomen. An exploratory laparotomy revealed complicated small bowel diverticula with a jejunal diverticulum perforation, for which a diverticulectomy was performed.Throughout this paper, we are aiming to outweigh the consideration of the possibility of complicated small bowel diverticula as a differential in the evaluation of any acute abdomen, especially in the elderly, which warrants emergency surgical management. Excluding Meckel’s diverticulum, small bowel diverticula are rare findings that have been reported anywhere in the small bowel, with the duodenum being the most common site. This latter is followed to a much lesser extent by the jejunum or ileum, and lastly with the three locations simultaneously combined . Its preAn 84-year-old female was admitted to the Department of General Surgery complaining of severe, generalized abdominal pain with epigastric intensification. The pain started 24 h before admission and gradually increased. It was accompanied by nausea, but no reported vomiting. A medical history of epigastric pain that worsened one hour postprandial, which after investigations were attributed to gallstones, was observed. Thus, a cholecystectomy after which the pain was not completely relieved. Later on, the patient was diagnosed with a peptic ulcer and put on a proton pump inhibitor. However, the abdominal discomfort persisted. She was also previously diagnosed with atrial fibrillation, mitral valve regurgitation, constipation attributed to her old age, and external hemorrhoids treated conservatively. Medication history consisted of . On admission, the patient was alert with vital signs as follows: . Physical examination revealed a hernia in the epigastric region, marked tenderness in the right hypochondriac area with abdominal guarding. An abdominal Ultrasound was performed reporting a resected gallbladder, a heterogeneous mass in the epigastric area, and a 7 mm epigastric midline hernia  that contained intestinal loops Figs. . The lar. The clinical presentation in the cases of perforation is mostly acute with symptoms and signs similar to peritonitis such as fever and severe abdominal tenderness. Complications of diverticula can be managed conservatively or surgically, mainly in cases of perforation [JD is a disease of elderly people, and over 80% of affected individuals are in the 7th decade of life. The average age of presentation is 62 years, and its incidence is slightly more common in men. According to the literature containing 290 patients, the age of the patients ranged between 45 and 90 years old, with only one case in which the age of the patient was 36. The diverticula incidence in the colon simultaneously with the jejunoileal diverticulum is 20–70%, in the duodenum 10–40%, in the esophagus and stomach 2%. While some patients with complicated JD were asymptomatic , the resforation –34. The foration  (Table 2foration . Therefo


This case report illustrated the conservative management of an invaginated type II tooth with a large periapical lesion. This dental malformation is characterized by the complexity of root canal anatomy, which when associated with a periapical lesion complicates the performance of conventional endodontic treatment, hence resulting to the difficulty of obtaining the optimal disinfection of the root canal system, which is an essential element for the success of any endodontic treatment. In the present case report, clinical and radiographic examinations were supplemented by CBCT examination to identify the root canal configuration and the extension of the periapical lesion. Conservative orthograde endodontic treatment was performed by combining mechanical and chemical action. Additionally, active nonsurgical decompression was performed and the follow-up visits revealed a favorable outcome. Dens invaginatus (DI), also known as dens in dente, is a dental malformation found mostly in the permanent dentition and has been reported to affect 0.3% to 10% of the population . The maxThis case report showed the importance of the use of Cone Beam Computer Tomography (CBCT) evaluation to facilitate the exploration and accessibility of the complicated root canal system of the invaginated tooth. In addition, it demonstrated that the use of the orthograde conservative approach alone allowed the healing of the periapical lesion despite the complexity of the root canal anatomy and the wide extension of the periapical lesion.A 34-year-old male patient, with good general health, was referred for endodontic treatment of the maxillary lateral right incisor (tooth #12). The patient had priorly received an endodontic treatment by a general practitioner. The patient had been complaining of pain associated with recurrent palatal swelling on the right side of the palate for 6 months. There was no history of trauma.The extraoral examination revealed no abnormalities. The intraoral examination showed tooth #12 as a “rice-shaped tooth,” a palatal swelling on the right side , and a fThe radiographic examination showed the presence of DI; the invagination extended from the crown to the root apex, associated with a radiolucent lesion in the periapical area of tooth #12 . Cone Be2) paste was placed for 2 weeks. The access cavity was sealed with a temporary restorative material. Two weeks later, the tooth was asymptomatic. Since the intracanal serosities did not dry up, the intracanal medication was renewed. After a month, the tooth became asymptomatic and the canal dry. Then, root canal filling was performed by a lateral condensation technique associated with thermomechanical compaction using gutta-percha cones and the access cavity was restored using a laminate technique (glass ionomer cement-light-cured composite resin).After obtaining the patient's informed consent, a rubber dam was applied, the access cavity was modified, and the root canal and the invagination were located. The working length was measured using an apex locator and confirmed with an X-ray examination. Both the canal and the invagination were instrumented through a crown-down technique using manual instruments. In order to overcome the lack of mechanical instrumentation in the presence of complex root canal anatomy, all attention has been paid to chemical disinfection. Irrigation used was 2.5% Sodium Hypochlorite (NaOCl) for a total time of 30 minutes for the root canal and the invagination. NaOCl was conveyed into the canal using an irrigation syringe with a side outlet needle, the solution was renewed regularly. To improve disinfection, sonic activation was used with the EndoActivator sonic device (Dentsply Sirona) for 30 seconds. NaOCl irrigation was alternated with 17% Ethylene Diamine Tetra acetic Acid (EDTA) gel to dissolve inorganic substances. The active nonsurgical decompression with an irrigation syringe was performed with the objective of aspirating as much as possible the intracanal serosities. Then, the intracanal dressing with calcium hydroxide (Ca(OH)Clinical and radiographic control sessions were carried out at 6, 12, and 18 months after the treatment. During the follow-up period, no signs and symptoms related to the concerned tooth were reported by the patient and bone neoformation was noticed in the periapical area .Type I shows an invagination limited to the crownType II extends below the cementoenamel junction, ends as a blind sac, and may or may not have communication with the pulpType III extends through the root and perforates the apical (type IIIa) or lateral area (type IIIb), without any immediate communication with the dental pulp The endodontic management of DI is a challenge due to the complexity of the root canal anatomy. Several classifications of DI have been proposed; the most commonly used one was proposed by Oehlers . AccordiWhen this complicated canal configuration (type II or III) is associated with an extensive periapical lesion, nonsurgical endodontic treatment is difficult to perform, but it must be considered before any surgical treatment . The use2 medication [2 by remanence effect for at least two weeks, but its parietal elimination is difficult [Root canal can be instrumented with manual or rotary files while it is recommended to shape the invagination with manual instruments to prevent the occurrence of instrumental fractures with rotary files within the invagination since the surface is predominantly covered by enamel and has varying shapes . The usedication . Althougdication . Anotherifficult .The success of endodontic therapy can be judged clinically by the absence of symptoms  and radiographically by the decrease in bone lesion size, osteoformation, and reconstitution of the lamina dura . The preThe importance of combining mechanical action with chemical disinfection has been widely proven to eradicate endodontic infection and can be effective without resorting to endodontic surgery which is mutilating to periapical tissue even with complex anatomy.The presence of a complex root canal anatomy does not systematically justify the use of apical surgeryOrthograde endodontic treatment is the first-line treatment for the management of large extended periapical lesions. Only if this fails, other options should be consideredThe mechanical instrumental action is limited by the presence of a complex root canal anatomy. To compensate for this limitation of mechanical action, contact time of the chemical solution should be extended and more molecules should be addedIn the light of the findings of the present case report, three points need to be stressed:


A case of a mandibular acanthomatous ameloblastoma, with an admixed little component of follicular type, is reported. The epidemiological features of the present case agree with those reported in the international literature. Clinico-radiographic differential diagnostic difficulties existed with several other noncystic osteolytic lesions of the mandible. Recurrence was diagnosed early 1 year after the initial excisional biopsy, and a definitive rim resection was therefore performed. No further recurrence occurred in the following 4-year follow-up. Ameloblastoma belongs to the benign epithelial odontogenic tumor subgroup, and it is probably one of the most controversial and enigmatic tumors of the facial skeleton, due to both clinical behavior and histological features –10.The World Health Organization in 2005  defined Unlike unicystic, peripheral, and desmoplastic types, which show a good response to the lowly invasive local excision, the solid/multicystic variant are more infiltrative with a high rate of local recurrence, especially following nonaggressive procedures, such as enucleation and curettage , 4, 6, 7The term acanthomatous is used in the presence of extensive squamous metaplasia and variable keratinization of stellate reticulum-like cells; in addition, the formation of squamous edges, in the center of the neoplastic nests, and calcification may be present. Acanthomatous ameloblastoma (AA) also presents histological features very similar to those of the squamous odontogenic tumor from which it differs since the peripheral cells are columnar instead of flat . In an eA 78-year-old patient was first observed in December 2008 at the Complex Operative Unit of Oral Surgery at the Department of Odontostomatological and Maxillofacial Sciences of the “Sapienza” University of Rome due to a small, symptomless, localized swelling at the right inferior alveolar process, between the canine and the first premolar which appeared spaced several millimeters each other . The sweThe en bloc excision of the lesion was directly performed under local anesthesia and after antibiotic prophylactic regimen  involving the overlying keratinized tissue and the 2 contiguous teeth, with a few millimeters of lateral and apical clinically healthy tissue and about 2 mm of residual bone cavity curettage. A surgical dressing was finally placed to support a secondary intention healing. No medical treatment was prescribed after surgery but only the use of a 0,20% chlorexidine mouthwash and analgesics as needed.An acanthomatous ameloblastoma (AA), with a little component of follicular histo-type, was histologically diagnosed, and a microscopic amount of pathological tissue was identified at the deep edge of the surgical piece corresponding to the center of the residual bone cavity, while the lesion appeared completely removed from the contiguous soft and bone tissues.A close clinical radiographic follow-up was therefore performed until, after approximately 1 year, a 5 mm radiolucent area was detected in the middle of the mineralized bone tissue .A computed tomography (CT) with the Dentascan program was then performed  to betteComplete excision of the lesion was then performed by a rim resection involving a safety margin of about 7-8 mm of laterally and inferiorly radiographically healthy bone tissue, while preserving the integrity of the lingual cortical bone .Histological examination of the surgically excised tissue confirmed the tumor recurrence Figures –9.No recurrence was observed at the radiographic 4-year follow-up , and no The epidemiological features of the present case support those reported by the international literature regarding AA, despite the association of two different histo-types. Actually, the advanced age of the patient (78 years) is typical of the AA whose mean age at presentation 51 years) is more advanced than that of both the follicular (41 years) and the plexiform (39.1 years) subtypes  years is.Although ameloblastomas with more than one epithelial hysto-type are not infrequent, mixed cases with acanthomatous hysto-type are rarely reported in the literature –14, and,Pathogenesis of the coexistence of different hysto-types in the same tumor has not been explained yet. It is possible that it represents the different expression of the same neoformation process due to epithelial ameloblastic cells in different stages of maturation and morpho-differentiation—in relation to genetic mutations of their pathway of differentiation –17 or toThe clinical radiographic features of this case also support those described in the literature.Actually, bone swelling seems to be the most common clinical sign of all types of ameloblastoma.Other frequent events are pain, soft tissue ulceration, tooth eruption disorders, tooth mobility, and dislocation , 6, 8. DAll these clinical features, however, as well as the radiographic appearance, were not pathognomonic of ameloblastoma. Actually, differential diagnostic difficulties exist with several other noncystic osteolytic lesions of the mandible, since unilocular and multilocular aspects of the solid/multicystic forms seem to occur with approximately the same frequency , 5, 8.The decision to first perform an excisional rather than an incisional biopsy of the lesion was made based on the following aspects: the diagnostic assumption of a benign neoformation due to the limited extension to the canine region in a subedentulous mandible; the lack of involvement of the nervous and vascular surrounding structures ; the good radiographic peripheral demarcation, the radiographic appearance not pathognomonic of ameloblastoma; the hypothesis to resolve the pathological picture in a single surgical session, in view of the disability, with lack of mobility; the advanced age of the patient; and the notable distance of his home from the hospital. Actually, to the best of the authors' knowledge, there are no guidelines in the international literature on when to perform an excisional or incisional biopsy of jaw bone lesions. It therefore seems appropriate to obtain a precise histological diagnosis preoperatively using a preliminary incisional biopsy in the presence of an apparently benign osteolytic lesion of an uncertain nature, wide enough and/or involving important adjacent anatomical structures such as nerves, blood vessels, mucous membranes, and roots of many teeth, in order to perform a proper surgical planning, reducing the risk of recurrence caused by an incomplete intervention. Actually, the frequency of ameloblastoma recurrence, which may occur even many years after surgery, seems to depend on both the histological features of the tumor and the type of therapeutic approach used , 4, 6–8.The extensive 1995 literature review by Reichart et al. [However, the most recent study by Hong et al.  with 305Since the simple enucleation or curettage of solid/multicystic ameloblastoma has 60-80% recurrence rate, especially in the presence of high-risk histologic variants such as the follicular one, lesion excision with an adequate safety margin is necessary , 7.Histological sections showed tumor cells at a distance of 8 mm from the clinical and radiographic limit of the lesion, so the elimination of at least 1 cm of peripheral bone margin and the removal of at least 1 tissue plane surrounding the tumor when the soft tissues are involved seem to ensure the complete elimination of all possible peripheral tumor nuclei and may therefore significantly reduce the recurrence rates , 7.The close clinical radiographic follow-up of the patient was therefore essential for early detection of recurrence and for its rapid treatment. Its small size compared to that of the initial mass also allowed to perform a much less aggressive or radical surgery, compared to what could have been in the first instance. Such a procedure allowed the removal of about 7-8 mm of clinically and radiographically healthy bone tissue, laterally and inferiorly to the lesion, and the simultaneous preservation of the lingual cortical bone integrity, in order to reduce surgical invasiveness and promote better tissue healing. The decision to conservatively treat the recurrence with a rim resection took into account its small size, histological type, and the advanced age and the clinical conditions of the patient. Actually, although neoplastic projections are able to spread easily through the marrow spaces of the spongy bone, it is unusual that the tumor tissue infiltrates the compact bone as well as the neural structures such as the inferior alveolar nerve , 4.Finally, since the slow growth of these tumors can take many years (even 20 years) before a recurrence may be seen, although it most commonly appears 2-5 years later, the surgical site clinical radiographic follow-up is highly recommended for at least 10 years , 7, 9. IClinical and radiographic features of an early stage ameloblastoma can be not pathognomonic, so a preliminary histological diagnosis, through an incisional biopsy, seems highly indicated. During surgery, the preservation of the lingual cortical is advisable unless it is not clearly compromised by the tumor, in order to preserve bone continuity. Acanthomatous ameloblastoma is not frequent, but its complete excision, with adequate peripheral safety margin, is of paramount importance in reducing the risk of recurrence.


Hibernomas are rare lipomatous tumors derived from brown adipose tissue. Only two cases of hibernomas in the scrotum have been reported in the literature so far. Brown adipose tissue is responsible for thermogenesis in hibernating mammals and embryos. In adult humans, reminiscent brown tissue is most frequently located in the axial skeleton, scapular waist, and neck. This case report describes the finding of a testicular pouch hibernoma in a 34-year-old male who presented with a nodule in the scrotum, which was initially suspected to be a lipoma. The diagnosis was confirmed by histopathological analysis, and the patient was treated by surgical excision. Despite its rarity, hibernoma should be part of the differential diagnosis for lipoma, the most frequent benign mesenchymal neoplasm worldwide. Hibernomas are benign tumors derived from residual brown adipose tissue. Unlike lipomas, they are extremely rare, with less than 200 reported cases in the literature. Hibernomas most often occur proximally to the axial skeleton, where brown fat existed in the fetus and has persisted into adulthood . So far,A 34-year-old male from São José do Rio Preto  presented with a gradual increase of scrotal volume in the course of the last six years. There were no other associated signs or symptoms. He was taking escitalopram for anxiety. He had no history of previous surgeries. On physical examination, the right testicle showed a 2-cm nodule; it was superficial, mobile, fibroelastic, and painless.A Doppler ultrasound was requested for further evaluation of the nodule. The testicles and epididymis had normal echographic aspect; a subcutaneous nodular image with regular contours and imprecise limits, isoechogenic to adipose tissue, was seen in the right testicular pouch 2.6 x 2.1 x 1.0 cm)  and sent for anatomopathological study with hematoxylin and eosin staining Figure . The anaNon-germinative testicular tumors account for approximately 5% of all testicular tumors and thus are rare among urological neoplasms . In the In hibernating animals, brown adipose tissue is involved in the production of heat to maintain body temperature. It is highly vascularized, organized in clusters, and surrounded by white adipose tissue. It can be found in varying amounts among species and their lineages. In adult humans, reminiscent brown adipose tissue is generally located in the interscapular, intercostal, periaortic, perirenal, axillary, cervical, and ventral regions . The capIn adult humans, hibernomas are a rare brown adipose tissue-derived tumor. On physical examination, it presents as a superficial, mobile, fibroelastic subcutaneous mass. In the Doppler ultrasound exam, hibernomas manifest as solid, well-circumscribed hyperechoic masses with an increased central vascular flow .The definitive diagnosis is made through histopathological examination with hematoxylin and eosin staining. It demonstrates three cell types: cells with granular eosinophilic cytoplasm containing lipid vacuoles; large cells containing scarce granular eosinophilic cytoplasm and multiple lipid vacuoles; and large uni-vacuolated adipocytes .Fine needle aspiration biopsy is not recommended in suspected cases of hibernoma: due to its hypervascularity, there is a significant chance of bleeding. The treatment consists of complete excision of the lesion .Hibernoma is a rare benign tumor, with only two cases reported in the testicular pouch so far. Its growth is slow and painless, and previous cases have been mistaken for lipoma or liposarcoma. The definitive diagnosis is made with total excision of the lesion, followed by histopathological evaluation.


We present a series of three patients with large hepatocellular adenoma lesions showing a central location, for which the living donor liver transplantation strategy was used as a backup procedure.  Hepatocellular adenoma was confirmed by biopsy in all patients. Surgical resection was indicated because of the patients' symptoms and lesion size and growth. All patients had a lesion that was central or in close contact with major vessels. The final decision to proceed with the resection was made intraoperatively. A live donor was prepared for all three patients. Two patients underwent portal vein embolization associated with extended hepatectomy, and a total hepatectomy plus liver transplantation with a living donor was performed in one patient. All patients had good postoperative outcomes.  In the treatment of hepatocellular adenomas for which complex resections are necessary and resectability can only be confirmed intraoperatively, surgical safety can be improved through the use of a living donor backup. Center expertise with living donor liver transplantation is paramount for the success of this approach. A hepatocellular adenoma (HCA) is a benign tumor that typically develops in a healthy liver. This condition usually occurs in women between 15 and 45 years of age and is associated with the use of oral contraceptives . The mosLiver transplantation (LT) is an alternative for patients with HCA or liver adenomatosis deemed unresectable, or when other treatment strategies have failed. However, large or central tumors usually require complex hepatectomies, with the potential risk of damaging the future liver remnant (FLR). Having a back-up living donor for transplantation can inform the most appropriate strategy for extreme resections.We report a series of three patients with large HCA who were taken to the operating room with a living donor prepared for a backup procedure in case resectability was not possible.A 12-year-old girl, weighing 22 kg, presented with a 2-year history of pruritus and a right upper quadrant mass. The patient's history did not include the use of hormones, and she did not present with jaundice, fecal acholia, or coluria. All laboratory liver tests and alpha-fetoprotein (AFP) levels were normal. Underling liver disease was ruled out.3, representing 14% of the total liver volume (TLV), and 0.47% of the patient weight ratio.Magnetic resonance imaging (MRI) showed a large heterogeneous hypointense mass measuring 23 cm × 15.3 cm × 12.4 cm that compromised the right lobe (RL) of the liver, segments IV and I . AdditioA liver biopsy of the mass was performed and showed features compatible with HCA, and the immunohistochemical (IHQ) result showed the HNF1-mutated subtype.A right portal vein embolization (PVE) was performed to increase the FLR, thus allowing the extended hepatectomy.3, which corresponded to 40% of the TLV and 2.3% of the patient weight ratio.On the third day after PVE, the patient presented with abdominal pain, hypotension, and a drop in serum hemoglobin concentration. Computerized tomography (CT) suggested intralesional active arterial bleeding, and the patient underwent a transarterial embolization. A new CT scan was performed seven weeks later and showed an FLR of 504 cmDue to the close contact of the mass with major vessels, the assessment of potential living related donors for a backup procedure was performed. A 35-year-old female, a related family member who was ABO compatible, was selected as a living donor and prepared according to a previously published protocol [An extended right hepatectomy with caudate resection was performed in March/2016, and the entire tumor was removed with no need to proceed with the LT. Histopathological analysis confirmed the diagnosis and had no signs of malignant transformation. The patient has been followed for 5 years since surgery and is clinically well, with normal liver function tests. A follow-up CT scan showed no residual tumor.A 12-year-old girl, weighting 28 kg, presented with a six-month history of pain and abdominal growth associated with vomiting and progressive shortness of breath, featuring abdominal compartment syndrome.Liver function tests and serum AFP levels were normal. Underling liver disease was ruled out.3, which represented 28% of the TLV and 0.64% of the patient weight ratio.MRI showed a large heterogeneous lesion measuring 20 cm × 16 cm × 16 cm occupying the entire RL and preserving segments II, III, and inferior IV . The tumA liver biopsy was performed and showed features compatible with HCA, and the IHQ analysis identified an inflammatory subtype.3, which corresponded to 33% of the TLV and a graft to recipient weight ratio (GRWR) of 1.5%.Because of the close contact of the mass with major vessels, a back-up live donor was evaluated. The donor was a healthy 31-year-old female, ABO compatible. The estimated volume of the left liver was of 450 cmThe tumor mass occupied almost the entire liver, preserving only segments II, III, and IVb . The intA left liver graft was implanted with a cold and warm ischemia time of 55 and 25 minutes, respectively. The operation lasted 10 hours. Both the donor and recipient postoperative courses were uneventful, and the patients were discharged after 6 and 11 days, respectively. Histopathological analysis confirmed the diagnosis and did not demonstrate signs of malignant transformation. Currently, the recipient is in the tenth year of follow-up, clinically stable, and with normal liver tests.A 40-year-old female, weighting 95 kg, presented with an eight-month history of abdominal pain. Oral contraceptives had been used for 20 years.2. Liver function tests and serum AFP levels were normal. Underling liver disease was ruled out.On physical examination, the patient was overweight, with a body mass index of 32.5 kg/mAn abdominal MRI showed the absence of underlying chronic liver disease and a solitary lesion with HCA characteristics measuring 4.6 cm in the caudate lobe.3, corresponding to 12.5% of the TLV and 0.31% of the patient weight ratio. The patient underwent a percutaneous biopsy, which revealed an HCA-inflammatory subtype. PVE of the right and segment IV portal branches was performed through a percutaneous ipsilateral approach. No complications were observed after PVE. CT was performed 6 weeks later, with an FLR volume of 761 cm3, corresponding to 32.7% of the TLV and 0.82% of the patient weight ratio.The patient was instructed to discontinue oral contraceptives, lose weight, and repeat the imaging exams. After eight months, an abdominal MRI showed a solid hypervascularized lesion measuring 9.3 cm , with inDue to the close proximity of the tumor with the FLR left hepatic vein, an evaluation and work-up of a potential live donor occurred as part of a backup plan.A 19-year-old male who was ABO compatible was selected as a live donor (the patient's son). General tests used for donor preparation were normal.The patient underwent surgical resection in September/2015, and the remnant left liver was macroscopically normal. Intraoperative ultrasound showed no involvement of the left hepatic vein by the tumor. Extended hepatectomy with caudate resection was performed. Histopathological analysis confirmed the diagnosis and showed no signs of malignant transformation. Currently, 6 years after surgery, she is in good general condition with normal liver function tests. An abdominal MRI was performed fifteen months after the operation and showed a hypertrophied left liver without residual tumor.Recent advances in imaging as well as the acquisition of new tools in molecular biology to complement the diagnosis of HCA subtypes , 7 have β-catenin activated, increasing size or imaging features of malignant transformation, rising AFP, males, and glycogen storage disease [The surgical approach is recommended for asymptomatic patients with the following HCA conditions: larger than 5 cm, harboring hepatocellular carcinoma or dysplastic foci,  disease –10.Symptoms of pain and a large liver mass led to the decision to proceed with surgery in the patients described herein. The fact that the lesion was benign made the decision to proceed with surgery more difficult, because the central location of the tumors creates a technical challenge.The management of patients with HCA is a controversial topic. A few publications and small patient series report complications in the evolution of these patients. Hemorrhage is the most prevalent complication in published studies and shows a direct correlation with the size and the superficial location of these lesions , 4. TherIt was reported in the literature that patients who received LT for unresectable HCA typically showed a small FLR at the time of resection ; howeverCurrently, the clinical use of techniques that allow for compensatory hypertrophy of the FLR, such as PVE, has become pivotal in preparing for major liver resections –17, prevHowever, PVE is an invasive procedure that is not free of risks. The most common complication of percutaneous transhepatic procedures is hemorrhage, and its occurrence has been reported in 2-4% of patients. When there is massive bleeding, transarterial embolization is the most effective treatment, as occurred in patient 1 .All patients in this series were submitted to surgical treatment, and a living donor served as a backup strategy because of uncertainties regarding tumor resectability and the viability of the FLR. Although the patients who underwent PVE presented with a final increase in the size of the FLR sufficient for their metabolic demands after surgery, a living donor was used as a backup strategy because of the close proximity of the lesion to the vessels of the FLR. In both patients, complete lesion resection was achieved without the need to use the living donor.LDLT is more appropriate for this option because the procedure can be scheduled. In potentially resectable large tumors, this strategy adds a particular benefit because of potential technical difficulties that may arise during tumor resection, such as a delay or prolongation in cold ischemia time when grafts are used from deceased donors, which often precludes the success of the LT. In this series, only one of the patients actually underwent LT (patient 2), who presented evidence of unresectability because of vascular involvement of the FLR. The living donor backup procedure becomes viable only for medical groups with proven experience in complex liver resection and LDLT. Our group has extensive experience with LDLT, with no procedure-related mortality and a low incidence of severe complications .Thus, the use of the living donor backup procedure should be part of the treatment strategy in complex resections for benign lesions when the resectability is unclear, ensuring the safety of the liver resection.HCA is a benign disease, and there are challenging aspects to the surgical treatment strategy for patients with large and central HCAs that require complex liver resections. Extended hepatectomy linked to the donor backup procedure provides security in complex liver resections and should become part of the surgical treatment approach for these patients. Additionally, this approach should be performed in centers with personnel who have expertise in hepatobiliary surgery and liver transplantation using a living donor.


Malignant tumors of the seminal vesicles are rare; they may be of epithelial or mesenchymal origin. Carcinomas are the most common and pelvic sarcoma may be confused with a primary tumor of the seminal vesicles. Little is known of the prognosis and best sequence of treatment in such sarcoma. We report a rare case of extra-skeletal Ewing sarcoma/primitive neuroectodermal tumor of the seminal vesicles in a 54-year-old man who presented with chronic lower abdominal pain, urinary retention, and severe constipation. Pelvic CT scan and MRI confirmed the presence of a soft tissue mass lesion centered on seminal vesicles. A trans-gluteal Tru-cut biopsy confirmed the diagnosis. Three cycles of the preoperative chemotherapy VAC/IE  protocol achieved an excellent clinical response. Seminal vesicle primary malignant tumors are uncommon. They can arise from either epithelial or mesenchymal cells, with carcinomas being the most prevalent . Ewing'sThese tumors have a bad prognosis and require aggressive treatment. The secondary malignancy can frequently be seen either from the adjacent organs, the most common of which is the prostate, or as distant metastasis . There iA 54-year-old man presented with chronic lower abdominal pain, urine retention, and severe constipation. CT imaging revealed a lobulated, complex, heterogeneously enhanced soft tissue pelvis mass lesion with cystic changes/necrosis, measuring about 11 x 10.2 x 9.8 cm, predominantly located in the floor of the pelvis, between the urinary bladder and the sacrum, likely arising from the seminal vesicles, exerting focal mass effect on the adjacent structures and pelvic floor muscles, with no gross evidence of muscular invasion. The mass was compressing and displacing the adjacent part of the anal canal and rectum to the left side laterally, and the prostate to the left side anterolaterally. Additionally, mild surrounding fat stranding and subcentimetric regional lymph nodes were observed without distant metastasis  Figure  and not Histopathological examination revealed proliferated small monotonous round cells. These cells had round nuclei and scant clear cytoplasm and showed positive expression for vimentin, CD99, and Friend leukemia virus integration-1 (FLI-1) immunostains while being negative for cytokeratins, leukocyte common antigen (LCA), chromogranin, neurofilament, prostate-specific antigen (PSA), CD138, desmin, myogenin, CD34, EMA, DOG-1, inhibin, and human melanoma black-45 (HMB-45). Accordingly, immunohistochemical analysis confirmed the diagnosis of a PNET, as shown in Figure A follow-up in two months, after three cycles of induction chemotherapy, revealed almost 50% reduction in the tumor size (6.5 x 5 x 5 cm) and focal mass effect on the adjacent pelvic structures  every three weeks for 14 cycles. The final chemotherapy session was received in December 2020.PNETs, as a part of the Ewing family, are characterized by small, round blue cells characterized by balanced translocations in chromosome 22. PNETs of seminal vesicle origin are extremely rare, with a few cases documented; in addition, they are more common in children and adolescents, making the age of our patient unusual . The preThe primary localized seminal vesicle tumor is possibly curable; however, the secondary spread, mainly from the prostate, bladder, and rectum, is usually an advanced disease with poorer outcomes; therefore, differentiation between primary and secondary tumors is crucial. Negativity for both PSA and prostate-specific acid phosphatase immunostains is crucial for diagnosing the primary one . ImmunosPelvic seminal vesicle PNETs have a significantly poorer five-year survival than non-pelvic ones . Studies from UK that had used ifosfamide-based chemotherapy in Ewing's sarcoma showed that the survival benefit was limited to the non-pelvic cases (p<0.001) .We followed the standard road map in treating Ewing's sarcoma, starting with chemotherapy followed by radical surgery, taking into consideration that Ewing's family of tumors is systemic in nature, with most patients harboring subclinical metastasis upon diagnosis. Local therapy alone ends with a high relapse rate (80%-90%) . MultiagBased on our observation, we believe that a multimodality approach starting with preoperative induction chemotherapy is very helpful in the downstaging of the large seminal vesicle Ewing's sarcoma. The standard chemotherapy protocols used in the skeletal Ewing's sarcoma seem to be effective in the extra-skeletal ones. Optimal usage of the immunohistochemical stains can lead to the proper characterization of the tumor origin. Further confirmatory data is needed to support our conclusion.


Angiomyolipoma is a benign mesenchymal tumor that develops commonly in the kidney and rarely in other organs. The involvement of the spleen in angiomyolipoma is extremely rare, and only one such case has been reported in the English literature.A 27-year-old man presented with adenoid hyperplasia and bilateral palatal tonsillar hyperplasia. During the treatment for adenoid hyperplasia, a 15-cm tumor was detected in the spleen using abdominal ultrasonography and enhanced computed tomography. Partial resection of the spleen was successfully performed. A giant tumor of approximately 13 cm with a smooth surface was observed in the upper left quadrant of the abdomen. The tumor was confirmed to be continuous with the upper spleen, and there was no invasion of the other organs. The postoperative course was good, and the patient was discharged on the 7th postoperative day. The excised specimen was a smooth, extremely soft tumor measuring 123 × 120 × 82 mm. The cleaved surface of the tumor was reddish brown, and a distressing yellow color was observed. Pathological examination revealed a proliferation of mature adipocytes and an increase in the number of blood vessels of various sizes. Furthermore, spindle-shaped cell proliferation foci were visible between the adipocytes and the surrounding blood vessels. Profuse leakage of erythrocytes from the blood vessels, hemosiderin deposition, and small round cell infiltration were also noted. Immunostaining disclosed that the spindle-shaped cells were weakly positive for smooth muscle antibody and were identified as smooth muscle cells. The adipocytes and spindle cells were negative for HMB 45, Melan A, MDM, and CDK4. However, some parts of the cells were positive for estrogen and progesterone receptors. Besides, vascular endothelial cells were positive for CD31 and CD34 and negative for CD8. Based on these findings, the patient was diagnosed to have primary angiomyolipoma of the spleen.We have reported the surgical treatment for an extremely rare case of giant splenic angiomyolipoma in a young man. Globally, this is the second report on this condition. We believe that partial splenic resection is a feasible option for the management of giant tumors. Angiomyolipoma is a benign mixed mesenchymal tumor consisting of three elements, namely the blood vessels, smooth muscle cells, and adipocytes. These tumors often develop in the kidney and rarely in other organs such as the liver and uterus . However2) and did not have tuberous sclerosis (TS). His laboratory findings were within the normal range .A 27-year-old man presented with adenoid hyperplasia and bilateral palatal tonsillar hyperplasia. Bilateral tonsillectomy was performed for adenoid hyperplasia. Abdominal ultrasonography (AUS) and enhanced computed tomography (CT) performed as part of the preoperative examination revealed the presence of a 15-cm tumor in the spleen. The patient was obese  was used to perform a partial resection of the spleen, including the tumor (Fig. Partial resection of the spleen was performed. The abdomen was opened using an upper abdominal L-shaped incision. A giant tumor of approximately 13 cm with a smooth surface was observed in the upper left quadrant of the abdomen (Fig. The excised specimen was a smooth, extremely soft tumor measuring 123 × 120 × 82 mm. The cleaved surface of the tumor was reddish brown, and a distressing yellow color was observed Fig. a, b. ImmFour years postoperatively, the patient has not faced any hematological problems, including those involving the platelets, and no new tumors have been identified in the spleen or other organs.Angiomyolipoma is a mesenchymal benign tumor involving the smooth muscle tissue, mature adipocytes, as well as large and small blood vessels, the majority of which are present in the kidney . AlthougCT is the most commonly used imaging technique in investigating angiomyolipomas . As a tyTreatment strategies for angiomyolipoma include surgery and arterial embolization, but the latter is less invasive and appears to be useful in preventing bleeding and achieving hemostasis . The priMinja et al. have reported 16 cases of extrarenal MLs from 1982 to 2011 . Nine caWe have reported the surgical treatment for a rare case of giant splenic angiomyolipoma in a young man. For spleen tumors, radical surgical excision or embolization of the lesion can be opted; nonetheless, if malignancy cannot be ruled out, surgical excision is necessary. We considered that partial splenic resection might be a feasible option for the treatment of a giant tumor as long as complete excision can be achieved. Extrarenal angiomyolipoma seems to have a favorable prognosis after surgical resection. Further evaluation, including diagnostic imaging and prognosis, is urgently needed to characterize primary angiomyolipoma of the spleen in a better manner. Moreover, follow-up will be required, including surveillance for malignancy.


A dermoid cyst (DC) is a benign tumor caused by inclusion errors during embryogenesis. DC of the head and neck is a well-recognized entity both clinically and histologically; however, it rarely occurs in the Eustachian tube (ET). Due to its anatomical position, significant morbidity related to middle ear dysfunction may result from ET obstruction. In this report, we present a rare case of a girl child aged two years and nine months with persistent otorrhea, who was initially diagnosed with acute otitis media with mastoiditis, along with suspicion of congenital cholesteatoma. However, high-resolution CT (HRCT) temporal and MRI of the neck revealed a DC of the ET causing left chronic otitis media (COM) with mastoid abscess. The patient underwent mastoid exploration surgery and myringotomy with grommet insertion. Although complete excision is the standard treatment modality for DC, the treatment of poorly ventilated mastoid and middle ear takes precedence over it. MRI surveillance scan is recommended in such cases. Reports century ,3. Based century ,4,5. Typ century -8. OtoscThe patient was a girl child aged two years and nine months, who presented with persistent left otorrhea for one month. The otorrhea was foul-smelling and copious in nature, which was preceded by bouts of rhinorrhea, without fever or symptoms to suggest intracranial complications. There were no symptoms to suggest upper respiratory obstruction. She was diagnosed with acute otitis media with mastoiditis, with suspicion of congenital cholesteatoma. The child had been born full-term with a good birth weight of 3.5 kg. Both her antenatal and postnatal histories were unremarkable.On examination, the child was found to be active with no facial asymmetry. The external ear and neck examinations were unremarkable. On otoscopy, there was foul-smelling mucopus in the left external auditory canal (EAC) with a dull, bulging TM and a pinhole perforation seen at the posteroinferior quadrant of the TM. Neither posterior wall-sagging nor keratin debris was observed.Nasoendoscopy was not performed at the time of the initial examination. Play audiometry revealed left mild to moderate conductive hearing loss (CHL) with an average air-bone gap of 36 dB Figure .The high-resolution CT (HRCT) temporal bone Figures , 3 showeMRI of the neck showed a well-encapsulated lesion within the left parapharyngeal space with heterogenous hyperintensities on T1WI Figure  and T2WIThe patient underwent left canal wall up mastoid exploration and myringotomy and grommet insertion. Intraoperatively, the left mastoid was found sclerotic, with granulation tissues and pus in the mastoid cavity and middle ear. The dome of the lateral semicircular canal (SCC) was flattened. The DC was neither seen at the nasopharynx nor the middle ear. A final diagnosis of left COM with mastoid abscess secondary to DC of ET was made following pre and intraoperative evaluations.Mycobacterium tuberculosis infection. At the two-week follow-up after the operation, the patient was found to be doing well with no complications. Subsequently, she was lost to follow-up due to the coronavirus disease 2019 (COVID-19) pandemic. However, upon communication with her mother via phone, the child reportedly went on to develop recurrent left otorrhea three months after the operation. Her speech is normal with no obvious reduced hearing noted by the family. She is scheduled for a repeat MRI and hearing assessment at her next follow-up.Histopathological examination of the mastoid and middle ear lesion showed features of an acute on chronic inflammatory process. Pus culture grown did not show any bacterial growth, and tissue specimens were negative for DC of the head and neck accounts for 33.9% of all cases of DC, with 50% of them found to be located in the periorbital region, 25% in the oral cavity, 13% in nasal cavities, and around 12% in the neck, occipital, frontal, lip, and soft palate ,9. TempoDifferential diagnosis of benign lesions in ET includes DC, teratoma, hamartoma, and lipoblastoma. Dermoid or hairy polyps consist of only two germinal layers (mesoderm and ectoderm), which are foreign to the site. Teratoma is a true neoplasm, which consists of a mature and immature mixture of all three layers of germ cell , and hamartomas refer to focal disorganized overgrowth of cells and tissue found at the site of origin ,12, whilThe treatment for DC of ET is often surgical resection. However, based on a literature review, the surgical resection is usually performed in children presenting with airway obstruction caused by DC of ET extending into the nasopharynx. Other cases are managed in phases, with transmastoid and nasoendoscopy approaches including neck exploration depending on the size and extension of the DC -7. In thPatients with persistent refractory otorrhea require an urgent HRCT temporal to obtain a correct diagnosis. In cases of sequelae of poor middle ear ventilation like in our patient, a multidisciplinary discussion involving the neuro-otologist, radiologist, and pediatric teams is imperative in achieving the correct diagnosis and deciding on the proper management. Treatment of the poorly ventilated mastoid and middle ear takes precedence over complete surgical excision of the tumor. MRI surveillance and preservation of function are advisable in cases of localized DC of ET without extension to the nasopharynx or middle ear.


Primary cervical melanocytic schwannomas, arising from the sympathetic chain, are very rare pigmented neural sheath tumors that, both grossly and clinically, are often misdiagnosed with other more frequent lesions of the uterine cervix. Literature review accounts for seventeen published cases of schwannomas of the cervix, ten of which are malignant and seven benign. Pathological examination with immunostaining techniques is essential for the correct diagnosis of these tumors. We report a case of primary cervical schwannoma in a 32-year-old female who was referred to our department at 13 weeks of gestation with a diagnosis of malignant melanoma of the cervix. Pathological review detailed a neoplasm with a myxoid spindle cell component and a minority of small epithelioid cells, with a low-malignant potential proliferation index: morphological and immunocytochemical findings were compatible with the diagnosis of nerve sheath tumor, type schwannoma. The patient underwent a vaginal trachelectomy and a prophylactic Shirodkar's cerclage. Pregnancy was carried on without any negative event. The patient delivered by a caesarean section a healthy female newborn. Placental histology was negative. After 6 years from the first diagnosis, the patient is healthy and disease free. Schwannoma, otherwise known as neurinoma or neurilemmoma, is a particular type of neurogenic tumor. It is described as an encapsulating tumor, originating from the Schwann cell of the peripheral nervous system and first described by Verocay in 1908 , are ver+5 weeks of gestation, the patient was submitted to a loop electrosurgical excision procedure (LEEP) of the cervix which revealed an ulcerated tumor with spindle and epithelioid cells. Immunocytochemistry stained positive for vimentin and S100 protein and negative for desmin, anti-muscle actin antibody (HHF35), cytokeratins, Estrogen Receptor (ER), Progesterone Receptor (PR), Epithelial Membrane Antigen (EMA), synaptophysin, chromogranin, and smooth muscle actin; a low proliferative activity was detailed; surgical conization margins were positive. An additional pathological review was carried out and obtained at 11+2 gestational weeks: this revealed a morphological and immunocytochemical framework consistent with infiltrating melanoma of the cervix. Immune reactivity with antiprotein S100 and Melanoma Marker Antibody (anti-HMB45) was positive, while that with antityrosinase1 and anti-MITF was negative. With all this information, the patient, now at 13+6 weeks of her pregnancy, was referred to our department. On admission, she underwent chest X-ray, colposcopy, complete abdomen Magnetic Resonance Imaging (MRI), psychological counselling, gynaecological oncological ultrasound, obstetric ultrasound, and immunopathological review of the conization specimen. Colposcopy showed a normal cervix . After 6 years from the first diagnosis, the patient is healthy and her well-being is good without any evidence of cervical disease.We report a case of primary cervical schwannoma in a 32-year-old woman who was referred to our department with a diagnosis of malignant melanoma of the cervix in pregnancy. Before referral, she underwent a colposcopy with targeted biopsy because of a white, thick, and hardened round lesion of the left upper margin of the cervix detected by vaginal manual exploration. Biopsy pathological exam revealed a minimal fragment of mesenchymal proliferation with areas of myxoid degeneration together with regular round core elements, no apparent mitosis, no necrosis, and further excision recommendation for actual analysis. A pathological slide review was performed, and identification of a neoplastic lesion with spindle and epithelioid cells obtained was performed. In the meantime, the patient became pregnant. The immunophenotypic characterization was consistent with a diagnosis of malignant mucous melanoma. At 8l cervix , with arl cervix  did not l cervix . Accordiechnique . The patAs far as we know, this is the first described case in literature of a cervical schwannoma diagnosed and treated in pregnancy. Melanocytic schwannoma is a rare nerve sheath tumor that occurs in a wide variety of locations. Most commonly, it occurs in middle aged subjects, without a clear gender predilection . These tAlthough the uterine cervix is a rare site for schwannomas, it should be considered in the differential diagnosis of any unclear cervical mass. Because of their rarity, the diagnosis of these tumors remains a challenge for both clinicians and pathologists. Our reported case underlines the pivotal importance of the pathological differential diagnosis among several conditions sharing similar aspects with schwannomas and melanomas. Currently, complete surgical resection is the mainstay of treatment, and the goal of radicality should always guide the decision-making process. Nevertheless, in specific circumstances, especially when a comprehensive clinical and pathological workout does not confirm any evidence of malignancy or high-malignant potential in young patients, a conservative choice may, in our opinion, be safely considered. As our experience represents a single and isolated case, we do not have any supporting element to recommend such a choice and we advocate for the need of more similar reports to be published and shared within the scientific community.


Gastrointestinal hemangiomas are very rare and are even rarer in the mesorectum. It is not clear whether mesorectal hemangiomas originate in the bowel wall or in the mesorectum. For clinicians, to correctly identify the imaging features of mesorectal hemangiomas is important.We herein describe a case of a 31-year-old male that presented with hematochezia and sensation of rectal tenesmus. Both the rectal MRI and contrast-enhanced CT scan of the whole abdomen indicated rectal wall thickening, marked dilatation, and tortuous vessels around the rectum. In addition, a contrast-enhanced portal venous phase CT scan showed the dilation of portal vein, splenic vein and inferior mesenteric vein. The dilated inferior mesenteric vein extending down to the mesorectum, and became marked dilatation and tortuous vessels around the rectum. The patient underwent laparoscopic surgical resection of the mesorectal lesion and the involved portions of the rectum. The surgical samples underwent pathological analysis, and a diagnosis of cavernous hemangioma was confirmed. Seven days after surgery, the patient was discharged without postoperative complications.This case highlights the imaging features of mesorectal hemangiomas. In addition, in this current case, the mesorectal hemangioma more likely originated in the mesorectum. Hemangiomas are benign proliferating vascular malformations, characterized by abnormal proliferation of blood vessels and mesenchymal tissue. They may be congenital or appear soon after birth . HemangiBased on their pathology, hemangiomas are classified into three categories: capillary, cavernous, and mixed type, but the majority of hemangiomas in mesenteric regions reported thus far are of the cavernous type. No definite gender predominance has been identified. Patients can present at any age, but most present in young adults in the third decade of life .It is not clear whether mesorectal hemangiomas originate in the bowel wall or in the mesorectum. Some reported cases of mesenteric hemangiomas have been thought to originate in the bowel wall and extend into the mesentery , 5–11. IA 31-year-old male developed a sensation of rectal tenesmus one month before admission. He consulted the local hospital and proctitis was considered. The symptoms did not improve significantly after treatment. One week later, hematochezia suddenly occurred, resulting in blood loss of about 100 ml. The bleeding resolved without treatment. The patient was admitted to our hospital.His physical examination was unremarkable except for the digital rectal examination, which identified a soft mass in the right lateral wall of the rectum at 7 cm from the anal verge, about 3 cm × 3 cm in size, that grossly bled on exam. The complete blood count did not reveal anemia. A total colonoscopy revealed a discoid protuberance of mucosa at the rectum 7 cm from the anus, and erythema of the mucosal surface. The subsequent rectal biopsy indicated chronic inflammatory changes of the mucosa. A contrast-enhanced CT scan of the whole abdomen revealed rectal wall thickening, marked dilatation, and tortuous vessels around the rectum with scattered calcifications Fig. A. In addThree days after admission, the patient underwent laparoscopic surgical resection of the involved portions of the rectum and mesorectum, as well as a coloanal anastomosis. Surgical samples were taken and sent for pathological examination. The pathology viewings indicated a dark red area in the mesentery adjacent to the peritoneal reflection; the lesion was spongy and there was blood outflow from the incision. Histologically, the neoplasm was shown to be composed of dilated thin-walled blood-filled vascular spaces, and these spaces were lined by endothelial cells Fig. A. The imHemangiomas are a benign proliferative congenital vascular malformation that originate from the embryonic sequestrations of mesodermal tissue and can be found in any organ. They have an incidence of approximately 2–3% . While iClinical presentations and diagnoses of hemangiomas in mesenteric regions depend on their size, localization, and intestinal wall involvement. Smaller tumors are often asymptomatic whereas symptomatic masses tend to be large at the time of diagnosis. Larger hemangiomas located in mesenteric regions can cause intraperitoneal hemorrhage and can often result in life-threatening conditions. When hemangiomas involve the bowel wall, they may result in intraluminal bleeding. Therefore, the clinical manifestations are hematemesis or melena. Long-term chronic occult blood loss is an important cause of anemia , 12, 13.Currently, radiological evaluation plays an important role in the noninvasive examination of abdominal diseases, including mesorectal hemangioma. Imaging examinations, such as CT and MRI, cannot be used to unequivocally diagnose hemangiomas in mesenteric regions, but they do allow a more precise evaluation of the size, vascularization, and possible involvement of adjacent structures of the tumor . CalcifiA definitive diagnosis of cavernous hemangioma of the mesorectum depends on histopathological examination. Because of the high risk of hemorrhage, biopsy of clinically suspected hemangiomas is not recommended. Histologically, cavernous hemangiomas are composed of dilated vessels of varying sizes, which are lined with flattened endothelial cells with little fibrous connective tissue between the vascular channels. The vessel lumen often shows thrombosis and contains a large number of erythrocytes , 14, 15.The optimal treatment of hemangiomas in mesenteric regions is surgical resection of the lesion and the involved intestinal segments , 8. RecuMesorectal hemangiomas are extremely rare tumors, and it is not known whether they originate in the bowel wall or the mesorectum. Some studies have described mesenteric hemangiomas that originate in the bowel wall and extend into the mesentery. In this current case, the mesorectal hemangioma more likely originated in the mesorectum. We used CT imaging for diagnosis and to evaluate the size, vascularization and possible involvement of adjacent structures of the mesorectal hemangioma. We surgically resected the mesorectal lesions and affected intestinal segments. Recurrences after complete resection are rare, and we are confident that our patient will not experience a recurrence of this tumor.


A repeated contrast-enhanced MRI showed new, intense leptomeningeal enhancement of the cerebellar hemispheres, highly suspicious for leptomeningeal metastases. Leptomeningeal biopsy confirmed the diagnosis of leptomeningeal spread of the known meningioma, with rhabdoid transformation (WHO grade 3). Diffuse cerebellar cortical hypermetabolism on 18F-FDG-PET/CT is a rare phenomenon reported in a few cases with paraneoplastic cerebellar degeneration [18F-FDG-PET/CT can be an early imaging marker for leptomeningeal metastases in solid tumors, appearing even before contrast enhancement on MR imaging. Recognizing this phenomenon may prevent delayed diagnosis and treatment.A 20-year-old woman was referred to our center with a 3-month history of progressive nausea, headache, and meningismus. She had surgery followed by proton-therapy three years earlier for a right-sided parasagittal atypical meningioma. Extensive blood and CSF examinations were done, but cultures remained negative and no infectious agents or malignant cells were identified. An