The neoplastic, a rarer type, is usually located outside the heart, and it is further broken down into adult, fetal and genital. Hamartomas, the most common types, are further divided into cardiac hamartoma and skin rhabdomyomatous mesenchymal hamartoma,The adult-type rhabdomyomas are rare benign neoplasia, which affect predominantly men (70% of the cases) around 25-40 years of age. The majority involves the head and neck region (90% of the cases), and they may also involve the mouth, mouth floor, soft palate, pharynx and larynx. There are reports of it involving other sites, such as the orbit, bladder, esophagus, trunk and endsFollowing, we report the case of a male, 61-year old patient, with a tumor on his mouth floor, which first appeared 1 year ago.A male, 61-year-old patient, came to our ward in the year of 2010, because of a tumor on his mouth floor, which had appeared one year before. The patient had been a smoker for 30 years. Upon physical exam we found the following: enlarged submandibular gland with a mobile and well-outlined lesion, with clinical traits suggesting it was benign. Neck lymph nodes were not palpable.The patient was submitted to fine needly aspiration, which was not satisfactory (acellular), and posterior exeresis of the right-side submandibular gland, which yielded the following report: benign, well-outlined neoplasia, made up of polygonal cells with granular and eosinophilic cytoplasm . We alsoThe adult rhabdomyoma is a rare neoplasia which has a predilection for the head and neck region. The most frequently involved site is the mouth, mouth floor and parapharyngeal space,Clinically, rhabdomyomas grow slowly and painless, and symptoms vary according to the site affected,,The adult rhabdomyoma usually manifests as an encapsulated, uniform mass, represented by polygonal cells with granular and eosinophilic cytoplasm. There may be vacuoles underneath the cell membrane, providing a star or spider-web shape to it. We notice cells with cross-sectional striae in almost all the cases. There is fibrous stroma and the mitotic activity was very low. Some cases may, occasionally, show vacuolar degeneration or spaces between the neoplastic cells. The cross-sectional striae and the crystalline structures may be better identified with phosphotungstic acid hematoxylin. The neoplastic cells were immunoreactive to myoglobin (Myo D1), desmin and smooth muscle acid (α-AML)Among the differential diagnoses, we have hybernoma and granular cell tumors.Differently from the adult rhabdomyoma, the fetal type manifests as a pleomorphic, immature mass, represented by polygonal cells and spindle-shaped cells. Mitotic activity is minimum and the more pleomorphic types require careful diagnosis, in order to rule out rhabdomyosarcoma as differential diagnosis.Both rhabdomyoma variants are treated by surgical exeresis. There are reports of recurrence. There were not cases of malignant transformation cases.Because of the low extra-cardiac incidence of adult rhabdomyomas, it is fundamentally important to have knowledge about it so as to consider it among the differential diagnoses of neck neoplasia. With the association of clinical, radiological and histopathology data, it is possible to establish the diagnosis. Treatment is based on total lesion exeresis in order to avoid recurrence.


Choristomas are rare malformations consisting of normal mature tissue in an abnormal location. Neuroglial choristomas consist of heterotopic mature neural tissue and, in human medicine, they are predominantly reported in the head and in the neck, except for one recent case reported in a foot of a child. In domestic animals, neuroglial choristomas are exceedingly rare, reported only in the retina of a dog, in the pharynx and in the skin of two kittens, and within the oropharynx of a harbor seal. In this report we describe the first ovarian case of neuroglial choristoma in canine species. The lesion was present in a three-year-old intact female Jack Russell Terrier that, seven years after ovariectomy, is still clinically normal. Together with a recent case described in the foot of a child, this case confirms that neuroglial choristoma may also be found far from the skull or spine, supporting the hypothesis that they may arise from an early embryological migration defect.Neuroglial choristomas are rare malformations consisting of heterotopic mature neural tissue at a site isolated from the brain or spinal cord. In human medicine, neuroglial choristomas are predominantly reported in the head and in the neck, except for one recent case reported in a foot of a child. In domestic animals, neuroglial choristomas are exceedingly rare, reported only in the retina of a dog, in the pharynx and in the skin of two kittens, and within the oropharynx of a harbor seal. A three-year-old intact female Jack Russell Terrier presented for elective ovariectomy exhibited a cystic lesion 2 cm in diameter expanding in the right ovary. Histological examination of the lesion revealed a mass composed of well-organized neuroglial tissue. Immunohistochemistry with primary antibodies against GFAP, NSE, and IBA-1 confirmed the neuroglial origin of the mass. At the time of this writing, 7 years after ovariectomy, the dog was clinically normal. Together with a recent case described in the foot of a child, this case confirms that neuroglial choristoma may also be found far from the skull or spine, supporting the hypothesis that they may arise from an early embryological migration defect. Mature brain tissue at a site isolated from the cranium or spinal cord is termed neuroglial choristoma . Decade A three-year-old intact female Jack Russell Terrier was presented for ovariectomy to the Reproduction Unit of the Veterinary Teaching Hospital (Università degli Studi di Milano). The dog was regularly vaccinated, treated for both internal and external parasites, and fed with mono-protein commercial dry food for food-responsive enteropathy. Except for this enteric chronic disorder, diagnosed at one year of age and resulting in occasional episodes of vomit and inappetence, the bitch was deemed healthy based on physical examination and pre-anesthesiologic laboratory tests. Furthermore, no alteration of the reproductive cycle was reported.Elective ovariectomy was performed at the anestrous phase using a standard technique through median laparotomy access with the bitch supine . The remGrossly, the left ovary was normal, showing multiple yellowish corpora lutea in regression, whereas the right one was expanded by a 2 cm-diameter cystic lesion filled with clear fluid and lined by a solid gray tissue rim. Both ovaries were fixed in 10% buffered formalin for three days and then trimmed and routinely processed for histology. Briefly, samples were dehydrated through graded alcohols, clarified in xylene, and embedded in paraffin wax. From paraffin blocks, 5 μm-thick sections were obtained and stained with hematoxylin and eosin (HE).Histologically, the right ovary was expanded by a cystic lesion that was 2 cm in diameter, well-demarcated, not encapsulated, and consisting of well-organized neuroglial tissue characterized by multifocal degeneration and necrosis which partially replaced the ovarian cortex. Neuroglial tissue surrounded an optically empty cystic cavity that was internally lined by ependymal tissue organized to form a choroid plexus. The lesion was composed by fibrillary eosinophilic collagen bundles in which glial cells were present. Among the glial cells, three cell types were detectable. One type was represented by spindle cells with indistinct cell borders, small amounts of pale eosinophilic cytoplasm, round nuclei, vesicular chromatin, and inconspicuous nucleoli resembling astrocytes. The second cell type consisted of spindle to polygonal cells with a perinuclear halo and densely basophilic round nuclei resembling oligodendrocytes. The third cell type consisted of spindle cells with densely basophilic, elongated or cigar-shaped nuclei resembling microglial cells. Within glial cells, other stellate, large cells with distinct cell borders, abundant basophilic cytoplasm, and a central round nucleus with coarsely-stippled chromatin and one prominent nucleolus, namely, neuronal bodies, were visible. The elongated portion of the neurons (axons) variably wrapped in myelin sheath (myelinated fibers) were also detectable. Multifocally within the neuroglial tissue there were extensive coalescing areas of rarefaction and cavitation with the loss of neuroparenchyma and small focal areas of liquefactive necrosis with the replacement of the neuropil by granular eosinophilic necrotic debris, foamy reactive gitter cells multifocally containing intracytoplasmic granular red-brownish material (ceroid), fibrin, hemorrhages, and edema. Multifocally increased vacuolization defined as spongiosis, dilated myelin sheaths containing swollen and degenerate axons forming spheroids, dilated myelin sheaths containing necrotic debris and gitter cells (ellipsoids and digestion chambers), and slight gliosis were also visible. Scattered reactive, variably stellate cytoplasmic projections and multinucleated giant astrocytes with nuclei located at the periphery of the cell, often polarized to one side of the cytoplasm and defined as gemistocytic astrocytes, were also visible. Neurons were multifocally characterized by central chromatolysis , by peripheral chromatolysis (with the presence of the Nissl substance only around the nucleus and absence at the periphery), or by neuronal swelling or shrinkage (necrosis and degeneration). Occasional necrotic neurons with total loss of nucleus and the Nissl substance were also present. Scattered neurons showed small, optically empty peripheral vacuoles in their cytoplasm defined as vacuolar degeneration. Finally, the cystic cavity was internally lined by a single layer of ciliated polygonal to cubical cells resembling ependymal cells, often arranged in papillary structures projecting into the lumen and supported by lose connective tissue and capillaries, such as choroid plexus .To confirm the neuroglial origin of the cystic lesion, serial sections were further obtained and examined immunohistochemically by the avidin–biotin–peroxidase complex method  technique  with priTissue samples demonstrated a good immunohistochemical reactivity with the expected marker expression in positive controls. Glial fibrillary acidic protein (GFAP) and ionized calcium-binding adapter molecule 1 (IBA-1) labelling highlighted the astrocyte-type cell and microglial cell cytoplasm and cytoplasmatic branching processes, respectively b,d, wherAccording to the histological appearance and immunohistochemical results, the cystic lesion was diagnosed as neuroglial choristoma.Abdominal ultrasound examination performed about a month after ovariectomy revealed only a mild hyperechogenicity at the left and right ovarian sites. These findings were considered within the limits of normality after surgery. No abdominal visceral nor parietal lymphadenomegaly was detected. No lesions were detected in the liver, spleen, kidneys, adrenal glands, urinary bladder, or uterus peritoneum.No therapies were prescribed after histological diagnosis. Three years after ovariectomy, the dog underwent enterotomy to remove a foreign body ingested during an episodic pica secondary to the worsening of enteropathy. In that circumstance, no record referable to ovarian neuroglial choristoma emerged. Therefore, ovariectomy was considered curative.At the time of this writing, 7 years after ovariectomy, the dog is clinically normal based on communications with the owner. In human as in veterinary medicine, ovarian choristoma is extremely rare, except for ectopic adrenal glands which have been widely documented in humans, horses, and cats ,16,17,18Regarding the pathogenesis of neuroglial choristoma, many theories have been proposed in human medicine. The origin has been attributed to the herniation of a portion of fetal cerebral tissue, which can occur during embryonic development as in the development of encephaloceles with subsequent separation from the cranial cavity ,22,23. HThe presence of normal neuroglial tissue within the ovary of a bitch was previously described twice: in 2012 by Rota et al., and by Pires et al., 2019. In both these cases, the entity was diagnosed as ovarian mature monophasic teratoma ,28. HoweNeuroglial choristomas are exceedingly rare in domestic animals and they have been reported only in the retina of a dog and in the pharynx and in the skin of two kittens. In the present report we described, based on histological and immunohistochemical findings, the first case of ovarian neuroglial choristoma in canine species. This case confirms that neuroglial choristoma may also be found far from the skull or spine and suggests considering this lesion among canine ovarian pathologies.


Dyke-Davidoff-Masson syndrome (DDMS) is a rare condition that usually presents in early life with recurrent seizures. It can be congenital or can be acquired by perinatal hypoxia, infections, and intracranial hemorrhage. Its frequency remains unknown. It is usually diagnosed by neuroimaging. The classical neuroimaging features are unilateral cerebral hemiatrophy, volume loss, and hyperpneumatization of the sinus. We present the case of a 22-year-old male who presented with complex partial status epilepticus and had a history of recurrent seizures since he was six years old. The diagnosis of DDMS was made on neuroimaging. Dyke-Davidoff-Masson syndrome (DDMS), also known as cerebral hemiatrophy, is a rare neurological condition that is only described in case reports -3. AlthoIt was first described by Dyke, Davidoff, and Masson in nine patients who had hemiplegia. They described the neurologic features through changes seen in plain skull X-rays ,2. The cA 23-year-old male presented to the emergency department with complex partial status epilepticus. The seizure was sudden in onset and was associated with a confused state and motor automatisms. It was managed conventionally by intravenous lorazepam and intravenous phenytoin. According to his mother, he was a preterm baby and was managed in the neonatal intensive care unit for hypoxic insult. In addition, he had a seizure disorder since he was six years old. He also had developmental delays in attaining milestones. There was no history of seizures in the family. He had been prescribed tab. sodium valproate 200 mg twice a day. The patient was taking tab. sodium valproate 200 mg twice a day till 14 years of age. Subsequently, he went to the hospital for a follow-up where computed tomography (CT) of the brain was done (scans not available). His dose was escalated after eight years at 14 years of age to 500 mg twice a day. However, he was non-compliant for four days when he presented with a seizure. Examination revealed mild right-sided hemiparesis with a power of 4/5, hyperreflexia, and extensor right plantar reflex. There was no facial atrophy. Cranial nerve and sensory examination were unremarkable.His laboratory investigations were normal. Magnetic resonance imaging (MRI) of the brain showed cerebral atrophy of the frontal and temporal lobe Figure , calvariHe was discharged on sodium valproate 500 bid and was advised for regular follow-ups.Dyke, Davidoff, and Masson described DDMS in 1933 . Nine paThe clinical presentations of DDMS include seizures, mental retardation, contralateral hemiparesis, and facial asymmetry. Our patient had recurrent seizures since childhood and examination revealed hemiparesis. History revealed that he was a preterm baby with a hypoxic insult at birth. DDMS was diagnosed by MRI of the brain. Initially, he complained of headaches, followed by episodic complex partial seizures. This rare condition can be missed if not diligently sought for because these characteristic imaging findings become gradually evident with increasing age . EspeciaThe radiological results of CT scans and MRIs are crucial in making the diagnosis and determining the severity of the ailment, in addition to the clinical presentation. These results can differ from patient to patient, although they frequently include lateral ventricular enlargement, prominent sulci, and atrophy of the cerebral hemisphere next to the lesion. The differential diagnoses of DDMS include Rasmussen encephalitis and Sturge-Weber syndrome ,4. SturgThe DDMS management strategy focuses on symptom relief. Depending on the needs of the patient, various modalities may be used, including anticonvulsant drugs for seizure management, physical therapy for neurological rehabilitation, and speech therapy. Hemispherectomy is recommended in situations of hemiplegia with uncontrollable incapacitating seizures, with a reported 85% success rate . The proDDMS is a syndrome that is usually misdiagnosed. It presents with recurrent seizures since childhood along with focal neurologic deficits. Cerebral hemiatrophy is the classic imaging finding. Though cerebral hemiatrophy is also seen in conditions such as Rasmussen encephalitis and Sturge-Weber syndrome, the hallmark neuroimaging finding that differentiates it is calvarial thickening and hyperpneumatization of the frontal sinus. Thorough knowledge of the clinical presentation, associated risk factors, such as birth asphyxia, intracranial hemorrhage, infections, and imaging features are essential elements to suspect and diagnose DDMS.


Congenital and self-healing Hashimoto-Pritzker reticulohistiocytosis is the benign variant of the Langerhans cell histiocytosis (LCH) group. It is characterized by multiple skin lesions , without systemic manifestations and spontaneous resolution in days to months. The authors report the case of a boy with a single congenital leg skin lesion, a rare disease variant. Through histopathology, a dense skin infiltration of S100 protein-, CD1a-, CD207-immunomarked cells was found. KI67 index was high (62%). A complete spontaneous resolution occurred 07 days after the biopsy (25 days after birth). Monolesional disease, distal limb lesion, absence of lesions in the mucous membrane or seborrheic area, and less than 25 percent of LCs with Birbeck granules were said to be possible clues for a favorable prognosis in LCs histiocytosis. But, as a precautionary measure, the child will be followed up until at least 2 years of age. Langerhans cell histiocytosis (LCH) comprises four clinical variants: Hand-Schüller-Christian, eosinophilic granuloma, Letterer-Siwe, and Hashimoto-Pritzker.In common, they present proliferation of Langerhans cells, with Birbeck granules under electron microscopy and immunohistochemical positivity for S100 protein, CD1a, and CD207 (langerin).Congenital and self-healing Hashimoto-Pritzker reticulohistiocytosis is the benign variant of the Langerhans cell histiocytosis group. Multiple skin lesions, congenital or appearing in the first days after birth, without systemic manifestations, and spontaneous resolution in days to months, characterize the disease.A newborn otherwise healthy boy was noted to have a single skin lesion on his left leg. He was conceived by in vitro fertilization, from unrelated parents, all prenatal serological tests were normal, and the childbirth took place through cesarean section, without complications. At birth, BCG and Hepatitis B vaccines were administered.The dermatological examination revealed, on the left leg , a 1.2 cm papulo-nodular, erythematous-hyperchromic lesion, with an exulcerated center A. After At 18 days of age, a biopsy was obtained and, after 7 days, the lesion showed a complete resolution, being replaced by a 1 cm hyperchromic macule, with a central scar area, corresponding to the punch biopsy site B.On histologic examination, the dermis and hypodermis were densely infiltrated by cells with abundant eosinophilic cytoplasm, clear ovoid or kidney-shaped nuclei, with several mitotic figures, admixed with a slight and variable number of eosinophils and lymphocytes .Figure 2The cells were strongly positive for CD1a and S100 protein, and less for CD207; the Ki67 index was high (62%)  is characterized by multiple nodular dermatological lesions.To set up the diagnosis of LCH is necessary the support of clinical, histological, and immunohistochemical data. The differential diagnoses considered in the presence of a congenital papulo-nodular lesion are congenital mastocytoma, eosinophilic granuloma, juvenile xanthogranuloma, congenital Spitz nevus, hemangioma, the cutaneous form of leukemia, or lymphoma, congenital fibrosarcoma, infantile hamartoma, and infantile myofibroma.On immunohistochemical stain of 7 HPR patients’ samples, it was found immunoreactivity for S100 protein and CD1a. The LCs phenotype was confirmed by the specific presence of Birbeck granules, on electron microscopy, performed in half of the cases.It is difficult to predict the severity of the disease based on initial clinical and histological findings. There is an approximately 3% risk of mortality and a 10% chance of relapse in HPR.It is advisable to perform the biopsy as early as possible, to obtain elements that characterize the isolated cutaneous form of this histiocytosis. In this case, it is probable that self-healing was accelerated by biopsy, as its growth and infiltration since birth, regressed soon after the first days of the procedure. Besides Hashimoto-Pritzker, there are many other cases of spontaneous tumor regression reported in the literature and several pathogenetic hypotheses for regression proposed for different types of tumors. Some of these mechanisms include apoptosis, immune system effectiveness, tumor microenvironment,Regulatory T-lymphocyte density does not seem to be predictive of disease evolution in LCH. However, in reports on laryngeal cancerKi67 has a role in cell division and is usually used as a prognostic marker and predictor of recurrence. The proliferative index found in the present study’s patient (62%) was high and greater than that described in the literature for HPR; so, the role of hypoxia and apoptosis should be considered. The immunohistochemical results of Ki-67 in an 11 cases study were 38.50±19.61 (mean ± SD).The child had received BCG and Hepatitis B vaccines and their role should also be considered. It is attested the utility of BCG to induce tumor remissionNone declared.Luciana Prates Nogueira de Lima: Study concept; data collection; writing of the manuscript; approval of the final version of the manuscript.Carolina Viza Amorim: Data collection; approval of the final version of the manuscript.Rachel Martins Marinho: Data collection; approval of the final version of the manuscript.Maria Letícia Cintra: Data collection; writing of the manuscript; effective participation in the research guidance; approval of the final version of the manuscript.Elemir Macedo de Souza: Analysis and interpretation; critical review; research guidance; approval of the final version of the manuscript.None declared.


Cryptococcus neoformans is a fungus that may cause several CNS manifestations, especially in immunocompromised patients. Cryptococcal meningitis is the most common type of involvement. Mass-effect lesions are uncommon: they are described as cryptococcomas and their prevalence is even lower among immunocompetent patients. The aim here was to report an extremely rare case of cryptococcoma causing a mass effect and mimicking a brain tumor in an immunocompetent patient. The literature on CNS cryptococcal infections was reviewed with emphasis on cryptococcomas. Clinical, surgical and radiological data on a female patient with this rare presentation of cryptococcoma mimicking a brain tumor are described. Central nervous system (CNS) infectious diseases have high prevalence in developing countries and their proper diagnosis and treatment are very important for public health planning.  A 54-year-old female patient presented to the emergency department with a rapid-onset progressive history of confusion and completely dependency for basic activities. Neuroimaging showed a left occipital lesion and neurosurgical treatment was proposed. From histopathological evaluation, a diagnosis of cryptococcoma was established. She received clinical support with antifungals, but despite optimal clinical treatment, her condition evolved to death. Cryptococcal infections have several forms of presentation and, in immunocompetent patients, their manifestation may be even more different. Cryptococcoma is an extremely rare presentation in which proper surgical and clinical treatment should be instituted as quickly as possible, but even so, there is a high mortality rate. When this organism passes through the blood-brain barrier, it generally means that the host defenses are compromised. This may be due to human immunodeficiency virus (HIV) infection or to chronic conditions such as renal and vascular diseases.The lungs are the primary sites of infection. From there, Cryptococcus neoformans infection may be manifested as neurocryptococcoma, which is a granulomatous CNS lesion that may cause a mass effect.,In rarer cases, Here, we describe a rare case of a female patient who did not have any condition that reduced her immunity. The only relevant occurrence in her medical history was the presence of controlled arterial hypertension. She presented to the emergency department with a complaint of confusion that evolved very quickly to completely dependence for daily activities. Brain magnetic resonance imaging (MRI) showed mass-effect lesions in the left occipital lobe. She underwent neurosurgical intervention and meningitis treatment. Initially after surgery, she showed some neurological improvement. However, despite optimal treatment, her condition evolved to death.A 54-year-old female patient presented to the neurosurgical emergency department, brought by her family, who described a history of rapid and progressive mental confusion , leading to complete dependence for basic daily activities such as baths and eating. The only significant condition in her medical history was hypertension. One relevant social factor was that she had grown up on a farm and had had direct contact with several bird species including pigeons.General and neurological physical examinations revealed that the patient was normotensive but in a poor general condition, was only able to obey simple orders, was restricted to bed , seemed not to have any motor deficits and did not have any cranial nerves alterations or meningeal signs. It was difficult to perform a complete neurological examination because of her general condition. Based on her history and physical examination, she was categorized as having a score of 50 on the Karnofsky performance scale (KPS).An MRI scan  performeCryptococcus neoformans were observed in the samples, along with increased protein levels). Before the puncture, a brain CT scan was performed to rule out any signs of intracranial hypertension or any alteration that might make it impossible to perform this procedure. All punctures revealed increased intracranial pressure (ICP) that progressively worsened , but she did not present hydrocephalus.After the operation, the patient showed some neurological improvement and, after some days, a lumbar puncture was performed to evaluate the presence of meningitis. The presence of cerebrospinal fluid (CSF) infection was confirmed  and fluconazole was administered, in association with clinical support, because she presented renal failure due to use of many drugs and required hemodialysis. However, despite optimal clinical treatment in the intensive care unit (ICU), comprising antifungal drugs, broad-spectrum antibiotics against pneumonia, electrolyte replacement, hemodialysis and respiratory physiotherapy, the patient’s condition evolved to death due to various complications, including the initial disease, the toxicity of the various medications and bronchoaspiration leading to sepsis.,,,Cryptococcosis is the most common fungal disease of the central nervous systemTransmission occurs through inhalation of substances that are present in mammal and bird feces (pigeon feces have been described most frequently). Thus, the lungs constitute the entrance for the disease and pulmonary impairment is usually the first manifestation.,Central nervous system cryptococcal infections usually manifest as meningitis, meningoencephalitis, encephalitis or ventriculitis.The World Health Organization (WHO) recommends two weeks of induction treatment with amphotericin B deoxycholate (AmBd) and flucytosine or fluconazole, followed by eight weeks of consolidation treatment with oral fluconazole.Cryptococcus can inhibit the migration and function of leukocytes and promote survival and localized replication of the pathogen, thus facilitating chronic granulomatous inflammation and cryptococcoma formation.,,,,,,,,,,,Nevertheless, in rare cases, this chronic granulomatous process can lead to formation of a mass (cryptococcoma) that has a tumoral appearance.,,Surgical excision and debulking are indicated as adjunct therapies for lesions that are greater than or equal to 3 cm.Intraparenchymal cryptococcomas usually present with low signal intensity on T1-weighted MRI and high intensity on T2-weighted images. Solitary cryptococcomas are very rare lesions.The patient of this paper was extensively investigated but did not have any immunosuppressive condition or pulmonary impairment. The only data that might have helped us to think of the diagnosis of cryptococcoma was the patient’s previous contact with pigeons . Because the patient had a neurological dysfunction that developed quickly, which made us think initially that the cause was an aggressive brain tumor, it was decided to perform surgical removal. The histopathological analysis  confirmeDiagnosing the tumoral form of cryptococcosis (cryptococcoma) in immunocompetent patients is a challenge even in endemic regions. Primary and secondary brain tumors are usually the first hypotheses in these cases. Proper investigation through anamnesis and imaging can lead to consideration of this diagnosis before the histopathological analysis has been conducted. A neurosurgical approach should be considered in cases of this type of mass lesion, to reduce the compressive factor and thus the intracranial pressure. Despite optimal treatment, this is a condition with high mortality.


Mucinous cystadenomas are among the most common benign adnexal masses. The peak incidence of mucinous cystadenoma appears between the third and fifth decades of life, but rare cases in younger and older women have also been reported. Ovarian cystic formations are usually asymptomatic at early stages, until they grow in size and various compression symptoms appear, such as abdominal discomfort, distention, nausea, vomiting, and increased urination.This is a case of an 86-year-old woman with partial bowel obstruction due to a sizeable adnexal mass. The patient was submitted to exploratory laparotomy due to intestinal obstruction symptoms, the mass was removed and the final histopathological report indicated a benign mucinous cystadenoma (maximum diameter 25 cm). Physical examination was remarkable due to the large size of the mass. Computed tomography revealed the sizeable abdominal mass in contact with the uterus and the ovaries resulting in bowel compression. Exploratory laparotomy due to bowel obstruction symptoms confirmed the imaging results. The abdominal mass was removed without being ruptured, and total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy were done.Our case report highlights the clinical suspicion that is required for the diagnosis and appropriate treatment of this clinical entity. These tumors are uncommon in postmenopausal women, and when they do appear, they can be difficult to differentiate from cancer. Adnexal masses arising from the ovaries, fallopian tubes, or surrounding connective tissues are a common gynecologic problem. It is estimated that there is a 5–10% lifetime risk for a suspected ovarian neoplasm for women undergoing surgery .We record a case of an 86-year-old woman with no remarkable signs and symptoms, who was randomly diagnosed with a sizeable mucinous cystadenoma of the left ovary.An 86-year-old woman presented in the emergency room reporting anorexia, discomfort, flatulence, diffuse abdominal pain and vomiting for three days. Her medical history was free and she had never undergone surgery in the past. During physical examination, abdominal distention and a sizeable palpable mass were identified. Percussion notes were dull, the fluid thrill and shifting dullness was negative and bowel sounds were hard to appreciate due to the large size of the mass. The X-ray strengthened the suspicion of formation, demonstrating a large radiopaque lesion, as the intestine has been repelled laterally . LaboratComputed tomography (CT) scan showed a large abdominal mass (23 × 13 cm) in contact with the uterus and the ovaries, resulting in organ displacement. The findings were attributed to cystic density mass of the left ovary, with fattened diaphragms  and mostThe patient was submitted to exploratory laparotomy due to bowel obstruction symptoms. The procedure was performed under general anesthesia in a supine position with a midline laparotomy incision. The mass was removed without being ruptured, along with the left ovary . Total aThe final histopathological report indicated a benign mucinous cystadenoma (maximum diameter 25 cm); therefore, no staging was performed.The postoperative period was uneventful and the patient was discharged on the 6th postoperative day.Adnexal masses arising from the ovaries, fallopian tubes, or surrounding connective tissues are a common gynecologic problem. It is estimated that there is a 5–10% lifetime risk for a suspected ovarian neoplasm for women undergoing surgery. There are a wide variety of mass types and they may affect females of all ages, from fetuses to older adults. Pathology in this area may also arise from the uterus, bowel, retroperitoneum, or metastatic disease from another site, such as the gastrointestinal tract or breast [Ovarian masses include physiologic cysts (follicular or corpus luteum), benign neoplasms (such as endometriosis and cystic teratoma/dermoid cyst) and ovarian cancer or metastatic disease from a nonovarian primary tumor. Fallopian tube masses include ectopic pregnancy, hydrosalpinx, and fallopian tube cancer. Apart from these two categories, adnexal masses can derive from nearby structures, too  . AdnexalAdnexal masses may be asymptomatic for years and are incidentally diagnosed by ultrasonography for another cause. Especially ovarian cysts  disappear spontaneously without signs and symptoms. Abdominal discomfort may be present when they are large and increased urination in case of pressure on the bladder. Signs and symptoms may also include: pelvic pain, dysmenorrheal, dyspareunia, nausea, vomiting, fullness, and heaviness in the abdomen, and frequency and difficulty emptying the bladder. Acute, severe pain may be the first sign of a complicated ovarian cyst, hemorrhage, torsion, infarction, or rupture . When syIn postmenopausal patients ovaries are not normally palpated, so the identification of a palpable ovary during the physical examination should raise the suspicion of an ovarian or tubal tumor, and further examination with laboratory testing  and pelvic imaging are required. The physician should never forget the abdominal examination for distention and ascites and/or an abdominal mass. When these findings coexist the diagnosis of malignancy is almost certain .The first diagnostic instrument is pelvic ultrasound, as it is less expensive than other imaging techniques but its diagnostic accuracy is similar. In most patients, both a transvaginal (better resolution) and a transabdominal (better tolerated) approach should be applied. Magnetic resonance imaging (MRI) is secondarily used to determine if a surgical evaluation is needed and computed tomography (CT) is part of noninvasive staging . CA 125 To summarize according the ESGO/ISUOG/IOTA/ESGE Consensus Statement on preoperative diagnosis of ovarian tumors, ultrasonography is indicated as a first step in stratifying patients with symptoms that suggest an adnexal mass, as well as those who have an adnexal mass accidentally discovered on imaging. An experienced sonographer should perform any ultrasonographic examination in the case of a suspected ovarian mass. The Consensus also took further steps to distinguish the malignancy and the disease’s extent. The tumor marker profile  in combination with an expert’s ultrasound assessment can often reveal the precise subtype of malignancy. Diagnosis of the primary tumor can be assessed with MRI and before any scheduled surgery for suspected malignancy, a CT scan of the chest, abdomen, and pelvis is required to rule out secondary malignancies, thromboembolic events, and multifocal intraparenchymal distant metastases that would make resection impossible [Mucinous cystadenoma is a benign cystic ovarian tumor. It arises from the surface epithelium of the ovary and is lined by mucin-secreting epithelium . The peaOvarian cystic formations are usually asymptomatic at early stages, until they grow in size and various compression symptoms appear. They are usually detected incidentally during a routine gynecological examination or on imaging studies for another reason . BecauseWhen symptomatic, they may cause vague pelvic or abdominal pain, fullness, gastrointestinal symptoms, and progressive abdominal distention , 11. TheUltimately, surgical resection remains the elective treatment for a large ovarian mass. The laparoscopic approach is increasingly used because of the shorter recovery and decreased perioperative morbidity. This minimally invasive method is successfully used even in cases of sizeable adnexal formations , 4, 13. Mucinous cystadenoma is a benign cystic ovarian tumor that can reach a huge size. These tumors are rare in the postmenopausal age group, and when they do occur, they pose a diagnostic challenge to differentiate from malignancy. This case report highlights the clinical suspicion that is required, due to the extended asymptomatic period at the early stages.Supplementary MaterialClick here for additional data file.


Bronchogenic cysts (BCs) are generally detected in the mediastinum, along the tracheobronchial tree, or in the lung parenchyma. Subcutaneous BCs are rare, but, when found, are usually small (< 3 cm) and detected in children.In an unusual adult case, we treated a 52-year-old woman who presented with a mass in the left intergluteal cleft region. Ultrasonography showed a well-circumscribed hypoechoic lesion with posterior enhancement and internal echogenic foci within the mass. Color Doppler images showed no signals. Computed tomography showed the mass as a homogeneous, 6.8- × 6.3- × 5.1-cm soft tissue-attenuation lesion lodged in subcutaneous fatty tissue. Magnetic resonance imaging revealed a cystic lesion of similar dimensions with heterogeneous hyperintensity on both T1- and T2-weighted images. No contrast enhancement, solid components, or restricted diffusion foci were apparent. The cyst was completely excised, and histopathological evaluation indicated it was a BC. The patient’s recovery was uneventful.BCs should be considered in the differential diagnosis of all subcutaneous cystic masses, regardless of their location and size and the patient’s age. A bronchogenic cyst (BC) is a congenital pulmonary anomaly resulting from abnormal budding of the tracheobronchial tree during embryological development . Most BCA 52-year-old woman presented for evaluation of a painless mass in the left intergluteal cleft region. It had been present for 10 years but had enlarged significantly over the previous year. When the patient first noticed it a decade previously, the lesion had been the size of a peanut. The patient had no other relevant medical or trauma history. Physical examination revealed a 6-cm, partly compressible, superficial mass with no tenderness or associated skin changes. There was no visible fistulous opening or discharge from the lesion. Laboratory results—including complete blood count, biochemical blood tests, and tumor markers—were within their normal ranges.Ultrasonography showed a well-circumscribed hypoechoic lesion with posterior enhancement and internal echogenic foci. Color Doppler images showed no signal on the mass Fig. . SubsequMacroscopically, it was a well-defined, gray-tan cystic mass that contained brownish mucous material. Histopathological examination of the resected cyst showed that it was lined with pseudostratified ciliated columnar epithelium, which was consistent with it being a BC. Hemorrhage, inflammatory cells, and fibrosis were present but no signs of malignancy Fig. . The patBCs are congenital foregut malformations caused by abnormal budding of the tracheobronchial tree during embryological development . HistoloClinically, subcutaneous BCs have been found shortly after birth or during early childhood. More than 80 cutaneous or subcutaneous BCs have been reported in the English-language literature . SubcutaThe present report constitutes only the second reported case of a giant subcutaneous bronchogenic cyst (> 6 cm), and it is the first reported in an adult woman. The characteristics  of the detected and reported subcutaneous BCs in adults, including the present case, are shown in Table Although ultrasonography, CT, and MRI are helpful for detecting a BC , 9, 12, Pilonidal cysts occur predominantly in males. Sonographically, these cysts usually involve the dermis and hypodermis and appear as saclike or bandlike structures that communicated with the base of widened hair follicles. Pathologically, the sinus where the hair enters is lined by stratified squamous epithelium with slight cornification [Dermoid cysts are located around the hyoid bone and are echogenic owing to the presence of fat and osseo-dental structures [Epidermoid cysts usually appear as well-circumscribed masses confined to the subcutaneous layer, with a high T2 signal and sometimes with low-signal-intensity debris with thin rim enhancement on contrast-enhanced T1-weighted images. They may also show diffuse restriction in diffusion-weighted imaging sequences due to liquid contents or disturbance in the directional orientation of keratin, or both [Cystic hygromas usually show homogeneous watery density on CT scans [Because of their submucosal location and nonspecific imaging appearance, BCs are often misdiagnosed preoperatively as other subcutaneous cystic lesions. The most common growths in the differential diagnosis of subcutaneous BCs are pilonidal cysts, dermoid cysts, epidermoid cysts, and cystic hygromas , 11, 15.ructures . Epiderm or both , 17. Of  or both , as alsoCT scans . Thus, iAlthough BCs are asymptomatic and in many cases are discovered incidentally during medical checkups or workups for other diseases, complications associated with BCs—that is, infection, cyst rupture, bleeding, malignant transformation—have been reported , 20, 21.In summary, BCs should be considered in the differential diagnosis of all subcutaneous cystic masses, regardless of their location and size and the patient’s age.


Cortical vein thrombosis (CVT) is a rare subtype of cerebral venous thrombosis. Because CVT is rare and its clinical and imaging findings are atypical, the misdiagnosis of CVT may be extremely high. We report a case of cortical venous infarction (CVI) secondary to CVT. Due to the atypical symptoms, we were perplexed about confirming the diagnosis between CVI and glioma hemorrhage. Eventually, CVT was confirmed by pathology combined with imaging. A 20-year-old female patient was admitted to a hospital with complaints of headache for the past 4 days and numbness and weakness in her left limbs. The patient initially experienced headache and weakness and numbness in her left upper limb. Weakness and numbness in the left upper limb then progressed to the fingers and thumb of the left hand and gradually to the left lower limb. Neurological examination showed grade 1 muscle strength in the left upper limb, grade 3 muscle strength in the left lower limb, and hypoesthesia in the left limb. She had a cesarean section 5 days earlier. Non-enhanced computed tomography (NECT) revealed hypodense lesions, which enclosed hyperdense lesions, in the right frontal–parietal lobes . So, couAfter symptomatic treatment, the patient's consciousness gradually deteriorated (awake-somnolence-lethargy), presenting grade 0 left limb muscle strength and loss of sensation. Emergency computed tomography (CT) showed expanded edema and a significant shift in the midline, possibly leading to the development of a hernia . BecauseThe final diagnosis was CVI. Post-operatively, necrotic tissue was removed c the patThis was a rare case of CVI secondary to cortical venous thrombosis (CVT), which was illusory and difficult to diagnose considering the presence of glioma hemorrhage. As a result, the diagnosis could not be confirmed until the pathological results of surgical exploration were available. The process used to diagnose this case is shown in In this case, due to CVI secondary to venous thrombosis, hemorrhage, and edema after infarction can cause a massive effect. When a hernia is about to occur, some of the hemorrhagic and necrotic lesions should be removed, and the dura should be decompressed and sutured to reduce intracranial pressure. CVI was ultimately confirmed and low-molecular-weight heparin was recommended in the acute phase  for the publication of any potentially identifiable images or data included in this article.DF: conceptualization, methodology, and writing—original draft. LZ: writing—original draft. HQ: supervision. QC: writing—review and editing. All authors contributed to the article and approved the submitted version.


Segmental testicular infarction(STI) is a rare unknown condition. Clinical presentation is non-specific and management is unconsensual. We report clinical and surgical management of a segmental testicular infarction. A 18-years old adult presented to emergency with acute right testicular pain. The only triggering factor was a stressful situation. Examination revealed a slightly swollen, non-ascending testicle with no inflammatory signs. We suspected spermatic –cord torsion(SCT), we decided to explore it surgically. Exploration showed a well-demarcated infarcted inferior pole of right testicle. Partial orchiectomy was performed. STI is a rare entity often clinically confused with SCT. Diagnosis is based on intraoperative findings. The only triggering factor revealed an acute stressful situation preceding the onset of the pain. Examination found no fever. Examination of the testicles revealed a slightly swollen right testicle, not ascended, with no inflammatory signs. There was no palpable testicular mass. The spermatic cord was painless and free. The cremasteric reflex was present. Given the clinical suspicion of a torsion of the spermatic cord in a young adult, we decided to explore the testicles surgically. Intraoperative exploration showed a right testicle of normal consistency and size, with no suspicious mass. There was no spermatic cord torsion. There was a well-demarcated infarcted appearance of the lower pole of the right testiclea and b. 3,Segmental testicular infarction is a rare condition that has not enough been described in the literature.In our case, the infarction involved the lower pole of the testis. However, some authors have reported the superior pole of the testicle as the preferred site because of the poor supplementation of the anterior vascular network.,The described age of predilection is between 16 and 35 years.,The clinical presentation may simulate a testicular tumour with a clinically suspicious mass with negative testicular markers leading to inguinal orchiectomy.,Testicular Doppler ultrasonography is the first line of investigation, demonstrating an avascular area on Doppler.,Scrotal MRI may be indicated in difficult cases and atypical sonographic forms.In our patient, the fear of missing a torsion of the spermatic cord led us to perform an emergency surgical exploration without carrying out radiological examinations. It should be noted that none of these radiological methods can eliminate a testicular tumor.,For management, surgical exploration is the rule for some teams while others advocate pain management and clinical and ultrasound monitoring.,Surgical exploration is ideally performed through an inguinal approach with first vascular clamping.4Segmental testicular infarction is a rare entity often clinically confused with spermatic cord torsion. The diagnosis is based on intraoperative findings. Ultrasound and MRI are recommended to guide the diagnosis. Partial surgery may be proposed in the absence of malignant suspicion.Signed consent was obtained from the patient.The authors declare that there are no conflicts of interest regarding the publication of this article.


Collision tumor of the appendix is an extremely rare entity, defined as the coexistence of two independent tumors located in the same site without transitional changes. We describe in this report the case of a 75-year-old man who presented with an acute abdominal pain, nausea and vomiting. Physical examination revealed an abdominal distension with a hypogastric mass. Abdominal computed tomography showed colonic obstruction related to a sigmoid tumor. Therefore, a total colectomy was made. Macroscopic specimen examination showed a sigmoid tumor associated to a cystic dilatation of the appendix tip with mucoid content. Histological examination of the appendix showed the co-existence of two independent tumors located in the tip, without transitional changes: pTis low-grade appendiceal mucinous neoplasia and grade 1 neuroendocrine tumor. The latter was discovered incidentally during histological examination. We draw attention through our presentation to the importance of a thorough macroscopic and histological examination of the appendix. Primary tumors of the appendix are infrequent representing 1-2% of appendectomies . CollisiPatient information: a 75-year-old man without significant pathological history presented at the emergency room with a sudden onset of an acute abdominal pain, nausea and vomiting.Clinical findings: physical examination revealed an abdominal distension with a painful hypogastric mass.Timeline of current episode: May 2021: the patient presented at the emergency room of our institution for abdominal pain associated with nausea and vomiting. Therefore, abdominal computed tomography (CT) scan was made in urgency and the patient was referred to the operating room.Diagnostic assessment: computed tomography scan of the abdomen showed colonic occlusion related to a sigmoid tumor. Therefore, a total colectomy was made.Diagnosis: macroscopic specimen examination objectified a stenosing tumor of the sigmoid, measuring 6cm and located 11cm from the colonic resection margin. We also noted a cystic dilatation of the appendix tip with mucoid content, which extends over 1.5cm. Elsewhere, the appendix was of conserved morphology. Therefore, the appendix was included in its entirety. The sigmoid tumor corresponded to an invasive low-grade adenocarcinoma which invaded through the serosa. Lympho-vascular space invasion was present and there was no lymph node metastasis. Appendix examination objectified the co-existence of two independent tumors located in the tip, without transitional changes: the first tumor consisted of a LAMN classified as pTis ( as pTis . The sec as pTis . The Ki-Therapeutic interventions: total colectomy.Follow-up and outcome of interventions: the postoperative course was regular and the patient was discharged in good condition on the next postoperative day. The patient was then referred to the oncology department for possible adjuvant treatment.Patient perspective: “I will continue with the adjuvant treatment in order to cure of the cancer”.Informed consent: the patient expressed his absolute and informed consent.Appendiceal tumors are uncommon entities accounting for 1-2% of all appendectomy specimens. They are usually found incidentally during appendectomy for appendicitis. Their clinical presentation is similar to acute appendicitis making the pre-operative diagnosis of appendiceal neoplasm challenging . Our revet al. reported in 2011 a case of collision tumor of the appendix composed of an aggressive mucinous adenocarcinoma, with omental deposit and metastasis to the regional lymph nodes at the time of presentation, and a well differentiated NET [et al. in 2021; however, in this case the mucinous adenocarcinoma was confined to the appendix [et al. in 2016 describing a case of a 95-year-old woman with synchronous quadruple primary neoplasm. She was diagnosed with adenocarcinoma of the right colon, collision tumor of NET and Schwann cell hamartoma in the appendix and sessile serrated adenoma of the appendix. The collision tumor was discovered in the histological examination [Singh ated NET . Anotherappendix . In our LAMNs are uncommon in the appendix, accounting for 0.6% of all appendiceal lesions. They can present as appendicitis, mucocele or as pseudomyxoma peritonei. LAMNs usually have a good prognosis if confined to the appendix. NETs are the most frequent tumors of the appendix and are found in 0.3-0.9% of appendectomy specimens with small predominance in female patients. Patients mostly present with appendicitis, carcinoid syndrome is rarely observed. NET rarely metastasize and they usually have an excellent prognosis ,3.et al. and Gonzalez et al. found that there is no improved survival rates following right hemicolectomy compared with those following appendectomy [The management of the appendiceal collision tumors remains a matter of debate. For LAMN, the assessment depends on the grade of atypia, lymph node involvement and peritoneal extension. Simple appendectomy is a sufficient treatment for LAMN, even when ruptured. However, this condition may cause recurrence by the development of pseudomyxoma peritonei. Thus, surgical debulking or post-operative intraperitoneal chemotherapy would be necessary -3. The tndectomy ,11.In the present case, LAMN was diagnosed during macroscopic examination of the appendix and NET was discovered incidentally on histological examination. Therefore, we conclude that appropriate preoperative and postoperative examination of the appendix is the key to the diagnosis of appendiceal tumor.


Tailgut cyst, a type of retro‐rectal cyst, is a rare condition requiring evaluation for malignant transformation. We report a case of squamous cell carcinoma arising in the retro‐rectal cyst, in a 51‐year‐old female who underwent incomplete resection of the cyst and chemo‐radiotherapy, subsequently became locally recurred and metastatic. Malignant transformation of tailgut cysts should be detected. The treatments based on pathology include complete surgical excision with or without chemotherapy and radiotherapy. Our case had a poor outcome despite the multi‐modality treatments. Symptoms can range from asymptomatic to local effects on adjacent organs or infectious processes.Tailgut cysts may have a malignant transformation and present with different pathologies that can show different behavior and outcome. Malignant transformations are often adenocarcinomas and neuroendocrine forms. Squamous Cell Carcinoma, like what we will report in our case, is very rare and has been reported in only four patients so far.2A 51‐year‐old woman presented with pelvic pain, constipation, and fecal urgency complaints. She had no past medical history or any familial history.In rectal examination she had a palpable rectal mass in distal part with mild tenderness in touching. The rectal lumen was intact with flat mucosa on colonoscopy, but posteriorly, the rectum seemed under external pressure.The abdominopelvic computed tomography (CT) scan revealed a hypodense cystic lesion measuring 99*93 mm in the left retro‐rectal region without contrast enhancement, causing a rectal deviation to the right side Figure .She underwent surgical cystectomy drainage and incomplete resection of the cyst. Histopathologic examination showed a cyst wall containing smooth muscle bundles lined by squamous or columnar epithelium. The stroma was infiltrated by nests of neoplastic cells with vesicular nuclei and abundant eosinophilic cytoplasm with foci of keratin‐like material Figure . In immuA Post‐operative CT scan reveals no gross tumor residue. According to the multidisciplinary team's recommendation, the patient was decided to undergo radiation therapy similar to the anal canal radiation fields; 36 Gy in 20 fractions to the pelvic and inguinal lymph nodes and then up to 54 Gy to the surgical bed, concurrently with Capecitabine.Three months after the treatment was completed, she complained of continued pelvic pain. On the pelvic MRI, there was a 23*20*28 mm multi‐loculated cystic, solid lesion in the pre‐coccygeal space in the midline posterior cavity suspicious of residual disease or recurrence. These results were confirmed by FDG‐PET/CT scan; high SUVShe underwent CT guided biopsy from the per‐sacral mass, and it revealed poorly differentiated carcinoma.Due to the multiple recurrent lesions and the presence of metastasis, she was referred for chemotherapy. There was no treatment response despite the numerous chemotherapy courses, and the disease progressed. Her pelvic pain was difficult to control by the nerve block and palliative measures. Finally, one year after the diagnosis, she, unfortunately, passed away due to the progression of metastatic abdominopelvic lesions.3Tailgut cysts (TGCs), also known as retro‐rectal cystic hamartoma (RCH) or epidermoid cysts in presacral and retro‐rectal space, are cystic lesions that occur due to developmental abnormalities in the embryonic pathways and they are the remnants of the embryonic hindgut.Histologically, TGCs are multilocular cysts with squamous, mucinous, simple, pseudostratified ciliated, or transitional lining cells or may contain bundles of smooth muscle in the cyst's wall. Meningeal tissue, thyroid tissue, and glomus bodies have also been reported.The clinical manifestations of TGC can range from asymptomatic to atypical clinical symptoms because of compressive effects of mass, including constipation, rectal filling, dyschezia, infertility, dysuria, and abdominal pain. The infectious process like repeated urinary tract infection, abscess, and fistula formation may also occur with symptoms including high fever, pain, and frequent micturition.Differential diagnoses that should be considered for retro‐rectal masses include anal gland cyst, duplication cyst, endometriotic cyst, epidermal cyst, teratoma or dermoid cyst, sacral meningocele, pilonidal sinus, and rarely malignancies originated from colorectal or anal area or from genitourinary origins, however the location is uncommon.Although FNA or other cytological biopsies have been recommended in some older articles, tissue sampling has not been recommended in more recent data due to the risk of the tumor spreading into the abdominal cavity, and the role of imaging in preoperative diagnosis has become more prominent.CT and MRI are required to diagnose and characterize differential diagnosis and treatment strategies.Malignant transformation in TGCs can occur but are rare, and the clear pathogenesis remains unknown. The most frequent histological types include adenocarcinoma and neuroendocrine tumors. Others include carcinoid tumors, squamous cell carcinoma, endometrioid carcinoma, adenosquamous carcinoma, transitional cell carcinoma, and sarcoma were rarely reported.Generally, the reported incidence rate of malignant tumors arising from epidermoid cysts is 0.011% –2.2%.The treatment of choice for all TGCs is complete surgical excision. Additional chemotherapy or radiation therapy treatments are given if malignancy is detected based on the pathology report. The minimally invasive transanal or transrectal approach is indicated for small low‐lying, non‐infected cases because of the risk of pelvic infection in these surgical approaches.In the case of pre‐rectal cysts, of which Tailgut cysts can be one, the possibility of malignant transformation should be considered, and in this case, surgical resection and complete evacuation of the cyst with a suitable margins may be the best measure for potential diagnosis and treatment of these lesions. In our case, complete oncological surgery was not performed, leading to early disease progression and metastasis despite chemo‐radiation therapy. This case highlights the critical role of extensive surgery, and if it is not expected to be possible, neoadjuvant treatments may facilitate this goal. If surgery is done first, it would be logical to consider adjuvant therapies. Eventually, there is no conclusive guideline or standard policy on adjuvant treatment indications in malignant tailgut cysts. Further research is needed, so treating such patients in a multidisciplinary team is reasonable.Mahsa Moshtaghian: Data curation; investigation; methodology; resources; software; supervision; validation; visualization; writing – original draft; writing – review and editing. Reza Shahsiah: Data curation; investigation; resources; writing – review and editing. Fatemeh Jafari: Data curation; visualization; writing – review and editing. Mahdi Aghili: Conceptualization; data curation; methodology; supervision; validation; visualization; writing – review and editing.The authors declare no conflict of interest.Written informed consent was obtained from the patient's next of kin to publish this report in accordance with the journal's patient consent policy.None.


Mature teratomas are benign germ cell tumors. On rare occasions, they have been associated with somatic malignancies and are termed rare germ cell tumors with a somatic-type malignancy (GCTSM). Mature teratomas commonly comprise adenocarcinomas; only seven previous cases of mature teratomas with neuroendocrine tumors have been reported to date. Here, we report a patient with a neuroendocrine tumor whithin a mature teratoma.18F-fluorodeoxyglucose (18F-FDG) accumulation. He underwent complete tumor resection via the transsternal approach. Histopathological examination of the specimen indicated a neuroendocrine tumor contained within a mature teratoma.A 26-year-old man visited our department complaining of chest tightness. Contrast-enhanced computed tomography (CT) scans showed a strongly enhanced lesion within a 10-cm encapsulated cystic lesion in the anterior mediastinum. Positron emission tomography (PET) scans showed no areas of significant In this case, a neuroendocrine tumor was contained within a mature teratoma. Our patient had no specific symptoms and his serum markers were within the normal range. Although PET is beneficial for diagnosing other GCTSM, it is not useful in detecting a neuroendocrine tumor. Therefore, the preoperative diagnosis of neuroendocrine tumors contained within mature teratomas remains challenging. However, GCTSM should be suspected in patients exhibiting CT findings of a mediastinal tumor, measuring ≥ 6 cm, in addition to characteristic GCTSM findings. Moreover, surgery should be performed carefully in such cases. Mature teratomas are the most common benign germ cell tumors arising in the mediastinum . Mature Herein, we report the case of a 26-year-old man with a neuroendocrine tumor contained within a mature teratoma and discuss the relevant literature.18F-fluorodeoxyglucose (18F-FDG), showed no areas of significant 18F-FDG accumulation  scans showed a 10-cm encapsulated cystic lesion in the anterior mediastinum, along with a 1.5-cm nodular lesion on the capsule located inside the cystic lesion wall (Fig. The resected tumor specimen was soft and measured 13 cm × 9 cm × 5 cm Fig. a. A smalMature teratomas are primary germ cell neoplasms derived from more than one of the three embryonic germ cell layers and comprised of fully differentiated adult tissues. They account for 5–10% of all mediastinal tumors . Only 15To date, only eight cases of neuroendocrine tumors, arising from mediastinal mature teratomas, including the present case, have been reported in the English literature –11. In tCarcinoid tumors comprising 40% of primary neuroendocrine tumors of the ovary, have been reported to be associated with thyroid follicle ; however18F-FDG accumulation [18F-FDG accumulation in the neuroendocrine tumor, arising from a mature mediastinal teratoma. PET scans often fail to show 18F-FDG accumulation in small tumors < 1 cm, even when they are malignant [No known clinical characteristics are unique to the diagnosis of mediastinal GCTSM. Mediastinal GCTSM are generally observed to be large, measuring at least 6 cm. They are typically apparent on chest radiographs . On CT, mulation . Howeveralignant . One stualignant . TherefoTreatment options for GCTSM have not yet been established. Surgical resection is a viable treatment option for GCTSM in cases where a tumor has not invaded, metastasized, or disseminated . However18F-FDG accumulation on PET. Therefore, GCTSM should be suspected in cases exhibiting CT findings of a mediastinal tumor, and surgery should be performed more carefully in such cases.Here, we report a case of a neuroendocrine tumor, arising from an anterior mediastinal mature teratoma. In this case, the tumor was excised without complications and there was no recurrence. However, a preoperative diagnosis remains challenging because neuroendocrine tumors do not exhibit


A congenital cervical mass is a considerable health problem worldwide; however, accessory tragus (AT) in the neck is extremely rare. The cervical variant of AT or congenital cartilaginous rest of the neck (CCRN) is a rare anomaly related to the branchial arch located at the lateral of the neck that typically presents as an asymptomatic papule or nodule along the anterior border of sternocleidomastoid (SCM) muscle. It is detected since birth or in the first few years of life. Diagnosis is based on the clinical characteristics of the lesion, surgical findings, and histopathologic studies.A young man with no underlying diseases or known congenital anomaly was referred by a dermatologist for an asymptomatic pedunculated papule in the left mid-cervical area. Physical examination reveals a firm and mobile papule with a size of 1*1 cm on the anterior middle 1/3 border of the SCM. Radiologic findings illustrated a mass nearby the SCM with a long tract beneath it extending upward. The lesion was finally resected, and during surgery, a long tract was discovered, and histopathologic examination confirmed the diagnosis of a CCRN.Although rare, the cervical variant of AT or CCRN should be considered in a differential diagnosis of benign masses in the neck. Accessory tragus (AT) is the most prevalent external ear anomaly that was first described by Birkett in 1858 ,3. In thA 21-year-old male presented with a chief complaint of a left neck mass since childbirth. His history included an uneventful full-term pregnancy, normal vaginal delivery, and no other congenital defects. Family and medical histories had no remarkable findings. There were no other congenital deformities and no complaint of hearing loss. Routine head and neck region examination revealed a mass at the level of thyroid cartilage on the anterior middle 1/3 border of sternocleidomastoid (SCM) . The masIn palpation, it was mobile, firm in consistency with no tenderness or erythema, and also no discharge in compression. No regional lymphadenopathy was palpated. Spiral neck CT scan illustrated a 9*4-mm soft tissue density containing a sinus tract which was located on the left middle 1/3 of the neck extended through SCM at the level of the thyroid cartilage to the hyoid bone . The sonographic findings illustrated a mixed echo 4*8.5-mm lesion with small cystic particles, definite margins without vascular components superficial to SCM, with a 17-mm long tract beneath it. This tract arch was about 6 mm superiorly but did not penetrate underneath the muscle .It was completely resected by an adequate excision via an elliptical incision. There were cartilaginous fragments in the center of the lesion. Furthermore, there was a tract laid beneath the lesion which was extending upward. The tract was exposed as much as possible, and it terminated at the level of the hyoid bone next to the anterior belly of the left digastric muscle . The microscopic findings demonstrated a polypoid lesion covered by epidermal tissue with pilosebaceous follicles, sweat glands, and adipose tissue in the dermis, as well as a hyaline cartilage tissue just beneath the dermis. Straight muscle and neuron bundles were also observed in the depth of the lesion around the cartilage tissue . These fCCRN is a rare manifestation of AT and branchial arch maldevelopment ,3. MoreoIn addition, it is detected at birth or in the first few years of life but can be neglected for a long time as occurred in our case ,6. It isMukai et al. showed that preauricular and cheek AT was overall derived from the first branchial arch; otherwise, cervical AT or CCRN was a derivation of the second branchial arch. CCRN is usually presented in the lower one-third of SCM; however, in our case, it is presented in the middle one-third . ClinicaThe histological examination shows elastic cartilage surrounded by the eccrine gland, adipose tissue, pilosebaceous units, and hair follicles . The difCCRN is a benign and symptomless lesion, the chance of infection is low; therefore, no treatment is needed, reassurance is sufficient, and surgery is done just for cosmetic reasons, or if it is irritated ,8, it prAlthough incidence in the neck is rare, AT should be considered.


Central giant cell granulomas (CGCG) are not common in the mandibular condyle. In teenagers, the problem is more complex because of difficulties in diagnosis and treatment involving the potential growth of the mandibular process and development of the face. In this short communication a case is presented of an eleven-year-old female under diagnosis of central giant cell granuloma affecting the mandibular condyle treated surgically in two steps using a condylectomy and vertical ramus osteotomy at the first time and later orthognathic surgery, showing the clinical evolution after 13 years of follow-up. In addition, we performed a review of the scientific reports related to CGCG in the mandibular condyle to compare this treatment with others, in terms of follow-up and results. We concluded that the CGCG affecting the mandibular head can be properly treated with low condilectomy, vertical mandibular ramus sliding osteotomy, and discopexy. Central giant cell granuloma (CGCG) is an intraosseous lesion with three main features: the presence of fibrous connective tissue with multinucleated giant cells, hemorrhagic foci, and bone trabeculation ,2,3,4. IJaffe in 1957 first described this lesion in the maxillofacial region as a reparative intraosseous lesion secondary to trauma, inflammatory conditions, or hemorrhage [The aim of this short communication is to present a case of CGCG involving the mandibular condyle in a young patient, 11 years old, treated by surgery in a two-stage strategy with 13-year follow-up and to perform a review of the treatment and follow-up of published cases.A 11-year-old Caucasian female patient was referred to the Department of Oral and Maxillofacial Surgery by the orthodontist in 2008. In the initial exam was observed a well-defined radiolucency in the orthopantomography in the right mandibular condyle. Clinically, the patient showed a normal open mouth with no restriction in mandibular movement, without any increase in facial volume; however, she complained of mild pain in chewing. The symptoms started one year earlier, after a trauma on the chin with no fractures. Computer tomography (CT-scan) showed a well-defined hypodense area involving the right mandibular condyle, without cortical perforation . In the The initial diagnosis ranged from the simple bone cyst, aneurysmal bone cyst, CGCG, or intraosseous hemangioma. Laboratory tests for calcium, phosphate, alkaline phosphatase and parathyroid hormones were within a normal range.The treatment plan was assessed by a 3D model using a classic preauricular and retromandibular approaches under general anesthesia with nasotracheal intubation. Curettage of the lesion was performed, and an intraoperative frozen section was conducted, ruling out the presence of malignant cells. Thereafter, a low condylectomy was carefully performed; after that, a vertical ramus osteotomy from the sigmoid notch to inferior mandibular border was realized, with stability in the alveolar inferior bundle.The position of the mandibular ramus obtained from the vertical osteotomy was sliding and fixed in an upper level using a surgical guide, creating a “neo-condyle” to replace the condylar head. Osteotomy was fixed with two 2.0 mm L-shaped titanium plates and 8 mm long screws . A new cOne year after the first surgery, a new analysis was performed to confirm the dentofacial condition and on this occasion the orthognathic surgery was included. Dental occlusion was treated using orthodontics with dental extraction to create a class II dental occlusion . After 4The orthognathic surgery was realized to modify the maxillomandibular position and the skeletal class II malocclusion, using a bilateral mandibular sagittal split osteotomy for advancement movement and the Le Fort I osteotomy for upper movement. The chin was not included at this moment. After 13 years from the initial treatment, the patient remained asymptomatic, without functional disturbances, and disease-free ; the chiThe World Health Organization describes CGCG as a bone lesion ,9,10. ThThe first case published of peripheral CGCG in the head of the mandible was in a 44-year-old woman . Choung CGCG histologically it looks like an aneurysmatic bone cyst and the absence of blood-filled gaps in the CGCG is an important feature for diagnosis . In the Treatment strategies for the CGCG range from systemic to local treatment; systemic included the use of calcitonin, hypodermic interferon-alpha 2a, intralesional steroid injections  and subcThe medical treatment included for this lesion mainly involves pharmacology applied directly into the lesion; intralesional corticosteroid has been used as well, showing variability in the long-term follow up ,15,16. DIn the opinion of the authors, the side effects of pharmacological treatment, the location in the mandibular condyle, the involvement of facial condition and dental occlusion and the precision required for diagnosis suggest surgical treatment as the best course of action.Strategies for condylar reconstruction described in these situations include autogenous grafts  or alloplastic materials ,7. TeenaReconstructions including autogenous donors show differences in long-term results. Parmar et al.  reportedNowadays, TMJ reconstruction with alloplastic materials is safe for TMJ replacement, with patient-specific implant (PSI) strategies being recommended in some reports . MeurechThe age of the patient and the requirement for secondary or tertiary surgical treatment in this patient were the main reason for the use of an autogenous reconstructive surgery using the mandibular ramus as the donor site. In 2013, Sidebottom  reportedOrthognathic movement in an 11-year-old could show unexpected evolution ; for thaThough this is an isolated case which may not be applicable to patients in general, we showed that CGCG affecting the mandibular head can be properly treated with low condilectomy, vertical mandibular ramus sliding osteotomy, and discopexy. In addition, orthognathic surgery can be carried out later to treat remaining dentofacial deformities.


Invasion is more likely to occur in gastric cancer affecting larger areas. Poorly differentiated adenocarcinoma tends to invade deep. The cardiac region prefers submucosal invasion because the submucosa is coarser than the other regions.A 75-year-old man presented with a chief complaint of abdominal discomfort and weight loss. Esophagogastroduodenoscopy revealed an irregular ulcerative lesion with partial redness of the upper body and lesser curve of the stomach. A continuous shallow depressed lesion invaded the abdominal esophagus by approximately 40 mm. Poorly differentiated adenocarcinomas  were observed on biopsy. Grossly, the cancer appeared to extend into the muscle layer; however, we could not confirm invasion into the muscle layer in our biopsy tissue. We diagnosed the lesion as a superficial spreading type of advanced gastric cancer and performed a total gastrectomy, D2-lymph node dissection (spleen preservation), Roux-en-Y reconstruction, and cholecystectomy. Postoperative histopathological examination revealed extensive infiltration of poorly differentiated adenocarcinoma (90 mm × 55 mm), and all were intramucosal lesions. The final pathological diagnosis was T1a, N0, M0, and Stage IA. The postoperative course was uneventful and the patient was discharged on postoperative day (POD) 11. Five years have passed since the operation, and the patient is alive without recurrence.We encountered a case of gastric carcinoma in which poorly differentiated adenocarcinomas expanded extensively. All lesions were intramucosal. Generally, the likelihood of invasion in gastric cancer increases with the area affected , 2. PoorA 75-year-old man presented with a chief complaint of abdominal discomfort and weight loss. His medical history included hypertension, paroxysmal atrial fibrillation, and refractory pruritus. He had lost approximately 10 kg of weight in 2 months and was referred to our hospital because of abdominal discomfort. At the time of consultation, his height was 174.8 cm, body weight was 56.5 kg, body mass index was 18.49; his vital signs were as follows: body temperature 36.1 °C, blood pressure 128/79 mmHg, heart rate at 77/min, and oxygen saturation at 97 % (room air). Hematological investigations performed on admission revealed carcinoembryonic antigen at 5.1 ng/mL, carbohydrate antigen19-9 at 0.1 U/mL, and carbohydrate antigen − 125 at 7.7 U/mL, indicating no increase in tumor markers. No abnormalities were observed in the blood tests. Esophagogastroduodenoscopy showed a wide, shallow, depressed lesion from the cardia to the mid-body, with an ulcerated part, which we diagnosed as a type 3 tumor  was not performed in this case, but it can be used to improve the accuracy of diagnosing the depth of invasion . EndoscoThere are two theories of pathogenesis regarding the mechanism of development: monocentric, in which a single lesion spreads extensively, and polycentric, in which multiple lesions coalesce to form a broad lesion. No conclusion has yet been reached . In thisGastric cancer is widespread and often invasive. However, it is important to accurately diagnose the depth of invasion using multiple examinations, since the superficial spreading type of adenocarcinoma of the stomach also exists, although it is relatively rare. On the other hand, it requires careful diagnosis and treatment, considering that it is an early gastric cancer but has a worse prognosis than the usual early cancer.


The finding of splenic tissue within the pancreas, also known as splenosis or intrapancreatic accessory spleen (IPAS), is a relatively uncommon condition that presents as an intrapancreatic mass. The discovery of an intrapancreatic mass often prompts a thorough diagnostic workup for a primary pancreatic malignancy, often exposing patients to unnecessary risks associated with invasive testing and even surgery. The benign, asymptomatic nature of this finding places emphasis on utilizing non-invasive techniques for confirmation of the diagnosis, reducing risks of morbidity and mortality in this patient population. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) will display near-identical signal intensities (SI) between the spleen and the intrapancreatic mass, as well as identical contrast-enhancement patterns. Nuclear medicine evaluation with Tc-99m heat-damaged red blood cells (HDRBCs) is often used as a confirmatory test and allows for differentiation from malignancies. The presence of an accessory spleen is the result of the abnormal migration of mesenchymal cells in the dorsal mesogastrium . The majA 45-year-old male with a past medical history significant for hypertension and hyperlipidemia presented to the emergency department due to one-day history of right lower quadrant pain described as a dull intermittent ache that progressed to a constant stabbing pain in the right lower quadrant that woke him from sleep. He admitted to associated nausea and a single episode of vomiting at home before presenting to the emergency department (ED). At the time of conducting the history and physical, the patient stated that his pain had improved and was rated a 1/10. He also admitted to subjective fever and chills at the time of the interview. He denied any chest pain, shortness of breath, diarrhea, or constipation.3. Attention was turned toward the possibility of an acute inflammatory process such as appendicitis, cholecystitis, or colitis.On physical exam, the patient was afebrile and hemodynamically stable. The abdomen was soft but was notable for mild direct right lower quadrant tenderness with no guarding or rebound tenderness. The remainder of the physical exam was unremarkable. Labs drawn in the ED revealed a leukocytosis of 14,400/mmA CT of the abdomen and pelvis was performed and revealed a 1.9 cm soft tissue mass in the pancreatic tail  scan was performed using SPECT-CT and fusion imaging. Findings were significant for focal radiotracer uptake directly corresponding to the soft tissue mass in the pancreatic tail, which was similar in intensity to the spleen  on pre-contrast T1-weighted imaging and a relatively high SI on pre-contrast T2 imaging. This is similar to various hypervascular tumors found in the pancreas . A hallmNuclear medicine testing, using technetium 99m HDRBC followed by multiplanar and SPECT-CT imaging, is a highly specific method used in the detection of splenic tissue. Analogous to how naturally damaged red blood cells are taken up by the spleen and reticuloendothelial system, up to 90% of the injected Tc-99 labeled HDRBCs are taken up by splenic tissue . The relWhile ectopic splenic tissue presenting as an accessory spleen is not an uncommon phenomenon, the intrapancreatic location of such masses is seldom reported. They pose a diagnostic challenge when discovered on imaging, as they may be initially suspected to be an intrapancreatic malignancy. Careful consideration of the imaging characteristics of the mass, as well as the utilization of appropriate imaging modalities, can allow for confirmation of the IPAS without invasive procedures or surgical intervention. This is of great potential benefit to the patient, as IPAS is an inherently benign mass, and intervention is unnecessary in an overwhelming majority of circumstances.


More than 15% of all soft-tissue tumors arise in the hand. Because of the location of these tumors, even small abnormalities may be alarming to patients on presentation. Although the majority of lesions are benign and can be diagnosed solely by history and physical examination, additional imaging workup may be required to confirm a diagnosis or define anatomic extent of involvement. This paper aims to review the basic epidemiology, clinical presentation, imaging findings, and treatment options of the more common soft-tissue tumors of the hand. Of all soft-tissue tumors, more than 15%, surprisingly, arise in the hands, which comprise a total of only 2% of total body surface area . Wh. Wh28]. Glomus tumors are defined as perivascular neoplasms of the glomus body of the distal phalanx and subungual region. Most are benign, but some can be malignant and demonstrate aggressive behavior. The glomus body of the finger is a neuroarterial structure responsible for thermoregulation and is located underneath the nails or in the pulp of the finger. Accounting for about 1–5% of tumors in the hand, they generally present between the fourth and sixth decade of life . SolitarSubungual and phalangeal glomus tumors tend to be less than 1 cm in size and present with the classic triad of symptoms: local sensitivity, pain with cold exposure, and severe pain following minor trauma . BecausePlain radiographic imaging of a glomus tumor is usually unremarkable. Rarely, cortical scalloping of the underlying phalanx can be found in long-standing cases. Ultrasound studies typically show hypoechogenicity, internal vascularity on Doppler interrogation, and tenderness to direct sonographic palpation with the ultrasound prob ,36. On MLow-flow malformations include venous malformations (VMs), capillary malformations (CMs), and lymphatic or venolymphatic malformations (LMs or VLMs) . ArterioThe most common presentation of VMs is that of a soft-tissue mass that is painful with activity or cold weather. On examination, these soft-tissue masses usually have a bluish tint and increase in size with dependent positioning, while decompressing when the upper extremity is elevated due to changes in hydrostatic pressure. The lesions may cause compression of nearby nerves and corresponding paresthesia, pain, or weakness.LMs have a classic rubber texture on palpation and can have overlying skin dimpling. Distinction from VMs can be made because LMs do not change in size based on the position of the upper extremity. Radiologic distinction can be difficult, particularly as some entities contain components of both as a venolymphatic malformation. CMs present as red or pink cutaneous discolorations that are commonly referred to as port-wine stains. Finally, AVMs are often warm, pulsatile masses that have associated bruits and thrills on examination due to arterialized blood flow through engorged veins. A proximal AVM may result in symptoms of digital ischemia and finger discoloration. Similar to LMs and CMs, AVMs do not change in size based on the position of the upper extremityPlain radiographs of low-flow VMs may show phleboliths, pathognomonic calcifications within thrombosed veins, in the area of suspicion. These phleboliths will be hyperechoic on ultrasound, or can result in signal void on MRI . SonograFinally, ultrasound and color Doppler ultrasound can reliably assess the pulse flow characteristics of an AVM. CT angiography and venography is helpful in delineating the enlarged veins with arterialized flow . MRI imaSuperficial palmar fibromatosis of the hand, also known as Dupuytren’s disease, is a connective-tissue disorder that results in firm, subcutaneous nodules on the palmar surface of the hand that can cause debilitating flexion contractures. Known as the “Disease of the Vikings”, there is a strong predilection towards Caucasian males of northern European descent, with an incidence of roughly 30 per 100,000 annually . In geneCharacteristic nodules and cords along the palmar fascia are thought to result from dysregulated fibroblastic proliferation mediated by fibrogenic cytokines: fibroblast growth factor, wingless/integrated (Wnt), and transforming growth factor β have all been implicated ,40. DisePlain radiographs generally add little value in the imaging of palmar fibromatosis. On ultrasound, hypoechoic nodules that arise from the palmar fascia are characteristic. MRI reveals low-signal intensity both on T1W and T2W images, a common theme of lesions that are of composed of dense collagen. Intermediate signal intensity on T2W MRI suggests higher cellularity and a higher tendency towards recurrence . Recent Synovial chondromatosis is a rare benign neoplasm that generally affects patients in their fourth through sixth decades . The disSome 70–95% of synovial chondromatosis cases display multiple intra-articular calcifications . The “riTenosynovitis is the inflammation of the tendon sheath and is an orthopedic emergency when caused by infection . BecauseInfectious tenosynovitis can lead to irreversible disability and morbidity due to the resulting contracture of involved musculature. Common microorganisms in order of prevalence include Staphylococcus aureus, Pasteurella multocida (cat bites), Neisseria gonorrhoeae , Eikenella corrodens (human bites), and Mycobacteria tuberculosis . Due to its higher-contrast resolution, MRI is the most sensitive and specific imaging modality for the diagnosis of infectious tenosynovitis . Fluid aBecause hands are frequently used in daily activities, they are vulnerable to penetration and impalement injuries that result in foreign bodies in the hand. Foreign bodies may remain asymptomatic if initially overlooked, but over time may lead to inflammatory, allergic, and infectious complications . ComplicThe index of suspicion for a foreign body should be high in any penetrating hand injury and warrants imaging investigation especially given a suggestive history . Plain rOf all soft-tissue sarcomas (STS), only about 20% originate in the upper extremity [Epithelioid sarcomas, synovial sarcomas , and undIn the event of a diagnosis of a soft-tissue sarcoma, MRI is required to map anatomic involvement of the neuro-vasculature, tendons, and bone so that resectability can be determined, and appropriate reconstructive options can be planned. Typically, STS have low signal on T1W images and are heterogeneously high-signal intensity on T2 sequences. In higher-grade STS or carcinosarcoma, a non-enhancing necrotic center with peripheral enhancing zone of viable tumor may be observed , which cSTS of the hand and fingers present unique challenges as input from multiple surgical subspecialists may be required, including orthopaedic oncology, hand surgery, and plastic surgery, in discussions with patients for goals of care and outcome expectations. The need to achieve wide negative tumor margins often necessitates radical resection with reconstruction of tendon, bone, nerve, and skin in pursuit of complete tumor extirpation, although ray amputation may ultimately be required for limb salvage ,53. MultSoft-tissue tumors of the hand are relatively commonly encountered in clinical practice. Although the vast majority of these lesions are benign, they may generate a great deal of anxiety for patients. Knowledge of the more common hand soft-tissue tumors, understanding their presentations, and recognizing their imaging characteristics can help radiologists and clinicians appropriately treat and advise patients. In this review, the complexity of the various soft-tissue tumors of the hand was synthesized and discussed. The basic epidemiology, clinical presentation, imaging findings, and treatment options of each tumor were highlighted. The overarching goal of the paper is to educate trainees, provide a reference to practicing physicians, and spread awareness about this topic.


Osteoblastoma is quite rare in the oromaxillo-facial region, while the mandible is always the predilection. However, in our case, the lesion was located in the left temporal articular tubercle, involving the adjacent skull base, which is extremely rare in the literature.It had been diagnosed as the most common temporomandibular joint disorder in the local hospital before the patient came to our department, mainly due to the primary symptom, that was, the patient got pain in the left temporomandibular joint area while opening the mouth. However, we found a mass of bone lesions at the left temporal articular tubercle in MRI and cone beam CT, and it turned out to be an osteoblastoma after surgery. The patient's primary symptom disappeared after recovering from the surgery, and there have been no indications of complication or recurrence up to now.Osteoblastoma is very rare in the temporomandibular joint region. It could easily miss the possibility of a benign tumor due to its unusual location and confusing chief complaint in this case. Our report provides experience in the identification of osteoblastoma in rare sites. Osteoblastoma is a benign bone-forming tumor with a peak incidence in the second decade of life , 2, and The patient's clinical symptoms were quite similar to those of the most common temporomandibular joint disorders (TMD), and they may easily miss the possibility of a benign tumor. We therefore hope that this case report will provide experience in the identification of osteoblastoma in rare sites.A 26-year-old male patient came to our department with the chief complaint of pain in the left preauricular area while opening his mouth for the last 3 years. It was diagnosed as TMD after a physical and radiological examination at the local hospital over a year ago. Besides giving instructions about protecting the TMJ area, “glucosamine hydrochloride capsule” was also given at that time to reduce intra-articular inflammation and prevent damage to the articular cartilage. However, the symptoms did not receive effective relief. Physical examination showed that there was swelling and pain with palpation in the left TMJ area. The largest mouth opening range was normal but with pain and deviation to the left, while without joint noise or limitation during protrusive and lateral sliding movements. There were no ear complaints, such as ear pain or hearing impairment. Then further radiological examinations were performed, including cone beam CT (CBCT) and magnetic resonance imaging (MRI), which showed anterior displacement of the left disc, and local swelling was detected on the anterior and lateral sides of the left temporal articular tubercle, with interrupted continuity of the cortical bone . CBCT shDuring the operation, a pre-auricular incision was made, the tumor was resected , followeThe histopathological examination was conducted after 7 days of decalcification in a 10% EDTA solution. It showed that the tumor was composed of haphazardly mineralized trabeculae of bone, osteoid rimmed by osteoblasts, and acellular vascular fibrous stroma . There wAfter one-month follow-up, postoperatively showed that the mouth opening range was normal without any pain or limitation, and the incision was quite concealed. Radiological examination  also shoDue to the identical clinical and radiological features, it is hard to differentiate these bone lesions, including ossifying fibroma, osteoid osteoma, osteoblastoma, giant cell lesions of the jaws, and low-grade osteosarcoma.Ossifying fibroma is composed of hyper-cellular fibroblastic stroma containing variable amounts of calcified structures. It is usually less vascular, more fibrous, and has less osteoblastic activity compared with osteoblastoma . BesidesA more significant differentiation to be made is between osteoblastoma and low-grade osteosarcoma. First, the latter one can be more aggressive and may have more severe symptoms clinically. Second, they can be distinguished by histopathological methods that show that hyperchromatic nuclei, mitosis, pleomorphic cells, and poorly circumscribed margins with infiltration of the host bone are more common in osteosarcoma , 25. ImmTo our knowledge, there is only one case report of osteoblastoma at the temporal articular tubercle . And in As a matter of fact, gross total tumor resection is the standard treatment for osteoblastoma . Hence,


Endoscopy may make the diagnosis in up to 64% of patients and should be performed to rule out other causes of bleeding.4 Intermittent bleeding renders visualization difficult, although side-viewing endoscopy may significantly enhance diagnostic yields.4 Endoscopic ultrasound and endoscopic retrograde cholangiopancreatography may also aid in detecting filling defects of the pancreatic duct.4 Visceral angiography successfully treats over 79% of cases, although severe cases may require pancreaticoduodenectomy.5A 55-year-old man with chronic alcohol use presented with epigastric pain radiating backward, vomiting, and 1 day of decreased colostomy output (created 1 year earlier for an infected hernia-repair mesh). He had no history of pancreatitis. Computed tomography angiography of the abdomen revealed pancreatic fat stranding, peripancreatic head fluid collection, and a portal vein thrombus Figure . An emerAuthor contribution: S.L.—drafting and critical revisions to the article, literature review, provided images, and is the guarantor. M.G.—critical revisions and approval of the article.Financial disclosure: None to report.No Informed Consent was obtained for this report.