Basidiobolus ranarum. The condition has been reported in children and adults presenting with abdominal pain, weight loss, abdominal distension, vomiting, diarrhea, fever, and an abdominal mass. We report a case of a previously healthy 2.5 years old male who presented to the ER complaining of abdominal pain and distension for two weeks together with significant weight loss. He looked ill and cachectic. He had tachycardia but was afebrile. His abdominal examination showed a right-sided abdominal mass. His initial abdominal ultrasound (US) suggested an abdominal tumor. The patient was referred to a tertiary center where he had an ultrasound-guided biopsy that showed fungal hyphae consistent with basidiobolomycosis.Basidiobolomycosis is a rare fungal infection caused by  Basidiobolus ranarum, an environmental saprophyte found worldwide, common in soil, decaying vegetable matter, and dungs of amphibians, reptiles including geckos, fish, and insectivorous bats [Basidiobolus haptosporus-like fungus has been described as a potential causative agent for gastrointestinal basidiobolomycosis in a recent report [Basidiobolomycosis is a rare fungal infection caused by ous bats -3. Basidt report . The cont report ,6. The pt report . The pret report . The most report ,10. The t report .B. ranarum was in 1956 [The first recorded human infection caused by  in 1956 . Gastroi in 1956 , and the in 1956 . In fact in 1956 ,14,15.A previously healthy two-and-a-half-year-old male presented to the ER complaining of abdominal pain, abdominal distension, and weight loss for the previous two weeks. The disease started with a documented fever of 38°C (at home) and vomiting for a day with decreased oral intake and activity. The abdominal pain and distension started immediately afterward. The pain was generalized all over the abdomen. The pain started suddenly, was steady, and woke him up. He had abdominal distention and constipation, which was only relieved by enema or glycerin suppositories. The patient suffered significant weight loss from 15 kg to 9.5 kg and a decrease in activity through the disease course with a loss of appetite to the extent that he could only tolerate milk or feeding by syringe. His past medical and surgical history was unremarkable. His family history was irrelevant. Upon physical examination, the patient was conscious, cachectic, and pale and looked ill. His vital signs upon admission were as follows: a pulse rate of 109 beats per minute, blood pressure of 105/66 mmHg, respiratory rate of 25 per minute, and temperature of 36.8°C. Abdominal examination showed an obvious asymmetrical distention on the right side of the abdomen. The umbilicus was everted. When palpated, there was a generalized tenderness over the abdomen, more on the right side, with a palpable mass in the right lumbar region under the costal margin crossing the midline at the umbilicus, which was circumscribed, firm, tender, and dull on percussion. There were no palpable enlarged lymph nodes.The initial laboratory workup revealed a white blood cell (WBC) count of 19.8 k/uL, 58% neutrophils (NE), hemoglobin (HB) of 10.1 g/dL, platelets (PLT) of 787 k/uL, C-reactive protein (CRP) of 30.41 mg/dL, erythrocyte sedimentation rate (ESR) of 70 mm/hour, and albumin of 2.7 g/dL  was suggestive of a tumor Figure .The patient was initially admitted to the ward. He received an IV antibiotic (cefotaxime 50 mg/kg q8 hours) as well as IV D5NS. He underwent an abdominal CT with oral and intravenous contrast in a triphasic manner, which showed a large well-defined soft tissue mass measuring about 8.5 × 7.5 cm) and occupying most of the right hypochondriac and right iliac regions Figures -7..5 cm andThe initial differential diagnosis at our hospital was intra-abdominal neoplasia, such as neuroblastoma, Wilms' tumor, rhabdomyosarcoma, and lymphoma. We did not do a PPD test as the provisional diagnosis was a neoplastic lesion rather than abdominal tuberculosis. The patient was referred to a tertiary center for further investigation, and workup at the interventional radiology service was unavailable at that time at our hospital. The patient underwent a US-guided biopsy from the abdominal mass. The result showed granulomatous inflammation with fungal hyphae consistent with basidiobolomycosis. Unfortunately, further data about the patient's treatment course and outcome in the tertiary center could not be obtained.Colonic involvement in gastrointestinal basidiobolomycosis is commonly misdiagnosed as malignant mass commonly in the cecal or ascending colon with local invasion and, at times, involvement of distant sites ,16. DissThe definitive diagnosis is a fungal culture obtained from the infected tissue, but histopathology can diagnose the condition in many cases. PCR is a new accurate method . For ourThe optimal treatment is a combined medical and surgical one. All the affected bowel segments should be surgically resected, followed by antifungal treatment for at least three months . ItraconGastrointestinal basidiobolomycosis is a rare, difficultly diagnosed disease due to its nonspecific presentation that often masquerades as invasive malignancy. Increased awareness among physicians is needed for proper diagnosis and treatment.


Findings of ectopic hepatocellular carcinoma (EHCC) have been rarely documented. Complicated clinical features and unpredictable medical prognosis make diagnosis and treatment difficult.in toto. Meanwhile, a 1 cm × 1 cm mass in the body of the stomach was found that was removed simultaneously. Histopathology showed that the pancreatic tumor was ectopic hepatocellular carcinoma (EHCC), and that the gastric nodule was gastrointestinal stromal tumor (GIST). The patient had an uneventful postoperative recovery. He has been living without recurrence for over 7 years since surgery. Owing to our knowledge, this is the second-longest disease-free survival time for EHCC in the literature.We reported a 59-year-old male patient who came to the hospital with epigastric discomfort and regurgitation of gastric acid. An enhanced CT scan revealed a 1.8 cm × 1.4 cm mass in the tail of pancreas without any positive finding in the liver. Postoperative MRI scan was performed but did not reveal any evidence of hepatic tumor. The tumor was resected Here, we present a rare case of EHCC in the pancreas, and review the current literature on EHCC. Operation was an effective treatment for patients with curable EHCC. EHCC with metastasis still needs more practice to improve the poor prognosis. The finding of ectopic liver accidentally happens in abdominal surgery and autopsy. It develops in various locations such as the gallbladder, intra-abdominal ligaments, omentum, peritoneum, retroperitoneum, and thorax –3. NeverThe diagnosis of EHCC before a pathological result is complicated because of various clinical features. Blood tests and imaging cannot give a significant clue. At the same time, treatment for EHCC does not have a gold standard, and it still needs more practice. In this study, we report a rare case of a combination of ECHH and GIST, which were both successfully treated with tumor resection and 7 years follow-up without recurrence. After the case presentation section, a detailed literature review of EHCC was performed.A 59-year-old man visited our hospital with epigastric discomfort and regurgitation of gastric acid in April 2014. There were no remarkable findings in the past medical history. He denied alcohol and drug abuse history. The abdomen was soft and without palpable mass. Tests for hepatitis B virus and hepatitis C virus were negative. Other laboratory examinations were regular, including low levels of CEA, CA19-9, and AFP . No significant indication was observed in hepatic function and routine blood examination. The contrast-enhanced computed tomography (CT) demonstrated a slight oval mass with irregular enhancement, which measured ~1.8 cm × 1.4 cm in the tail of pancreas. Moreover, impression of pancreatic duct dilation or stenosis was not detected by magnetic resonance imaging (MRI). By careful evaluation with the radiologist, there was no noticeable abnormality in the liver shown on CT. The postoperative contrast-enhanced magnetic resonance imaging (MRI) also confirmed the speculation on the hepatic condition .Traditional laparotomy was performed, which revealed nothing but a tumor in the pancreatic space that was mentioned in previous CT. The surface of the tumor was yellow and well-demarcated, and had a focal hemorrhagic appearance . The proConsent for publication was signed by our patient and approved by the Ethics Committee of the Fifth People's Hospital of Shanghai.We searched MEDLINE and EMBASE in February 2022 and the search strategy was “ectopic” and “hepatocellular” and “carcinoma” in title, abstract, and key-words. Included cases must provide confirmed pathological images, follow-up examination, and treatment methods. In the end, 27 cases were available for the criteria (including our case) , 5–27. AAs it is known, ectopic liver tissue and development of cancer from ectopic liver tissue is a rare condition . The ectin vitro . Two of three cases were diagnosed with EHCC before treatment or operation , 16. TheTwenty-six patients underwent operations in our review, and radical resection was performed on 24 patients. Majority of these patients who underwent a radical operation recovered well. At the same time, six of the 24 patients had recurrence after radical resection , 18, 22.The recommendation for diagnosis of EHCC is biopsy before operation. The AFP of blood test and hepatocyte-paraffin-1 of IHC are valuable for a definitive diagnosis of EHCC. Radical operation is necessary for a curable case. TACE, chemotherapy, and targeted therapy (like Sorafenib) are optional for patients with metastasis or multiple nodules. More cases of EHCC still need to be recorded to evaluate the prognosis and option for different treatments, especially long-time surveillance.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.The studies involving human participants were reviewed and approved by Ethics Committee of The Fifth People's Hospital of Shanghai. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.BG and JL collected the data. QL analyzed the data and wrote the manuscript. BG, XZ, YP, and JL revised the important intellectual content and helped in the final approval of the article. All authors read and approved the final version of the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Myxomas are rare benign mesenchymal tumors, made up of undifferentiated star-shaped cells in mucoid matrixThis neoplasia is more frequent among young patients, those between 10 and 29 years, being rarely found in individuals below 10 years of ageDifferential diagnosis must be made between: odontogenic fibroma, ameloblastoma, dentigerous cyst, fibrous dysplasia, giant cell central granuloma, osteosarcoma and chondrosarcomaMyxomas have a mean recurrence rate of about 25% and, the greater the surgical aggressiveness, the lower the recurrence rateA male, 1-year old patient, born in Salvador/BA, with a history of a progressive mass increase in the right mandible and left maxilla, since 15 days of life, already evolving with facial deformity.Upon physical examination, the oral mucosa was intact; however, with extensive enlargement of the mandible on the right side, extending all the way to the subcondylar portion to the height of the right lateral incisive.CT scan showed a multilocular-type of radiolucent honey comb-like area in the body of the right mandible, extending all the way to the paraphysial region in the mandible ramus, causing expansion and destruction of the vestibular and lingual bone cortical areas. Such area involved the condylar and coronoid processes of the mandible and shifted the ipsilateral tooth germs. There was still a hypodense area with mineralized formations in the left maxilla alveolar process.We carried out a previous biopsy, which diagnosis was fibroma. Since the lesion continued to expand, already involving the eruption of the first ipsi and contralateral teeth, we then chose surgical treatment. This was made up of a surgical excision of the entire mandible and the maxillary tumor, with a margin .The histopathology exam of the specimen showed a tumor mass made up of a slightly acidophil myxoid mass and rare spindle-shaped cells, or cells mildly star-shaped, picnotic, with areas of typical osteogenesis, extra-tumoral and normal hematopoietic marrow. Matching signs and symptoms of myxoma of uncertain biological behavior and neoplasia-free surgical margins.The hemifacial reconstruction is planned for a second procedure, with associated osteogenic distraction. Figure 1MConservative treatment of myxoma  is indicated only in proximal lesions and vital structures; however, with high recurrence rates1. Resection with proper margins is the treatment of choice to avoid recurrences1. Craniofacial reconstructions with osteogenic distraction enable a more aggressive approach and, consequently, more curative for these lesions, with the advantage of enabling an adequate oncologic control, since they reduce the need for locoregional grafts.


Cutaneous Rosai-Dorfman disease (CRDD) is a rare variant of benign histiocytic proliferative disorder limited to the skin. The underlying etiology is still unclear, but it had been claimed that infections, immunodeficiencies, and autoimmune disorders might have a role in the etiology of this disorder. The characteristic presentation of RDD is lymphadenopathy due to abnormal production and accumulation of histiocytes in lymph nodes; however, the extra-nodal areas could also be affected, such as cutaneous. Herein, we presented a 45-year-old Iranian woman presented with an atypical pure cutaneous Rosai Dorfman disease, in addition to a summarized list of atypical cases of RDD that are reported as pure cutaneous RDD with atypical presentation.Herein, we presented a 45-year-old woman who referred to us with an ulcerative nodule with a size of 5×5 cm on her buttock, gradually growing over one year. After the primary evaluations, a biopsy specimen was obtained, and histologic studies revealed a dense cellular infiltrate involving the dermis and the subcutis, which was composed of abundant sheets of large histiocytes with admixtures of lymphocytes, plasma cells, neutrophils, and eosinophils within their cytoplasm -known as the emperipolesis phenomenon. The immunohistochemistry staining was positive for S100 and CD68 and negative for CD1a.The diagnosis of CRDD was confirmed based on these histopathological findings. Rosai-Dorfman disease (RDD) is a rare disorder first described in 1965 by Destombes, and later in 1969, Rosai and Dorfman recognized it as a distinct entity coined as sinus histiocytosis with massive lymphadenopathy.RDD is clA thorough history taking and physical examination, then more evaluations such as excisional biopsy, can help to reach the diagnosis , 6. The Ethical disclosure: After describing the rareness of the patient’s condition to her, she orally consented to the authors to use her medical records for publication.A 45-year-old woman was referred to our hospital presented with an ulcerative indurated lesion located on her buttock. The lesion started to appear almost a year ago as a single popular lesion which gradually enlarged to a round erythematous nodule with a progressive growth over the last two months. She denied any history of pain, itchy sensations, and secretion from the lesion; also, patient did not experience any constitutional symptom such as malaise, weight loss, and fever over the past year. The patient was in good health and had no significant past medical history or family history of malignancies. The physical examination revealed a round reddish-yellow mass approximately 5 cm in diameter located above the right buttock's gluteal fold, and the ulceration was without any evidence of necrosis or bleeding; the rest of her physical examination and her laboratory evaluations were unremarkable. Before this admission, she was treated with antibiotics under the impression of the abscess by another clinician, which did not have any significant effect on her situation. We obtain a biopsy specimen from the lesion, and a histopathological study followed by immunohistochemical (IHC) staining for the patient. The histopathologic analysis reported a dense cellular infiltration involving the dermis and the subcutis with associated sclerosis. The infiltrate is composed of predominantly of large epithelioid histiocytes with pale eosinophilic cytoplasm. Admixed with these histiocytes are small lymphocytes, plasma cells, neutrophils, and eosinophils . Some hiThe most typical presentation of Rosai Dorfman disease (RDD) is lymphadenopathy; however, extra-nodal sites were also reported to be affected in less than half of the cases.Skin as tFrom an epidemiological point of view, this disease affects all age groups, sexes, and races, but the demographic pattern and ethnicity distribution differ between CRDD and systemic RDD cases. Systematic RDD is more common in younger patients (mean age of onset 20.6 years) predominantly in men (4:1 ratio) with African ethnicity; on the contrary, CRDD usually affects older individuals (mean age of onset 43.5 years) with a female predominance (2:1 ratio) and is mainly reported in patients with Asian and Caucasian ethnicity , 14. ComAs mentioned, CRDD has a favorable prognosis, but careful evaluations must carry on to distinguish it from its differential diagnoses especially Langerhans cell histiocytosis which is a rare and lethal disease, cutaneous lymphoma and other neoplastic histiocytosis . It is e All these characteristic features, in correlation with clinical presentations, help to distinguish between RDD and other diagnoses, for instance, Langerhans cell histiocytosis, as the most important differential diagnosis for CRDD is positive for CD1a and CD207, has eosinophilic infiltrate, and characteristic features like elongated grooved nuclei and Birbeck granules . Other dIn conclusion We presented a patient with an isolated ulcerative dermal-based lesion that had typical cytomorphologic and immunohistochemical features for pure CRDD without any systematic presentation. Thus, the diagnosis of CRDD was confirmed for her condition.


Infected cephalhaematomas are rare and can lead to complications such as sepsis, meningitis and osteomyelitis. We present an infected cephalhaematoma in a neonate with resultant underlying osteomyelitis and a review of the literature. Our patient presented 6 days following birth with a fever and a swelling consistent with cephalhaematoma. He was managed with intravenous antibiotics and early surgical intervention. Imaging demonstrated underlying osteomyelitis. The patient made a full recovery and was discharged home on completing his antibiotic course. On reviewing the literature, it is clear that early diagnosis and treatment with surgical intervention and antibiotic therapy are associated with improved outcome and can reduce the possibility of osteomyelitis developing. Escherichia coli  in addition to a swelling on his head, which had been present since birth. The mother had been induced at 38 weeks due to maternal diabetes. The child was delivered by forceps after an unsuccessful attempt at vacuum extraction but was in good condition at birth . A large cephalhaematoma was apparent on the left side of the head confined to the parietal bone with an overlying abrasion. The child was otherwise well and mother and child were discharged home after delivery.On assessment in the Emergency Department a septic screen revealed a raised C-reactive protein (CRP) of 291 and normal urine dip, chest X-ray and lumbar puncture. He was admitted and started on Benzylpenicillin and Gentamicin. A computed tomography (CT) was performed demonstrating a large collection over the left parietal bone with a moth-eaten appearance of the underlying skull suspicious of osteomyelitis .Escherichia coli was cultured from both pus and bone samples and S. epidermidis was cultured from the blood. Following the procedure, the patient improved with no further fevers and with a progressive decrease in CRP. He received 3 weeks of intravenous antibiotics followed by oral ciprofloxacin for a week. He was discharged home 20 days after surgery. Repeat CT and magnetic resonance imaging (MRI) of the head revealing no complications  and systemic (meningitis and sepsis) complications, as disease progression has been reported on antibiotics alone .None declared.


Burkitt's lymphoma is a poorly differentiated rare and aggressive type of non-Hodgkin's lymphoma. This article reports the case of a male child aged seven years, who was examined at the Odontopediatric Clinic of the UFRN Dentistry Department. The patient presented a tumor in the premolar region of the mandible; teeth were mobile in this region. Radiology revealed a diffuse radioluscent area which was diagnosed histopathologically as Burkitt's lymphoma. The patient was treated with polychemotherapy; complete remission of the disease was attained. Burkitt's lymphoma is a highly aggressive non-Hodgkin lymphoma that has the highest cell proliferation rate among human neoplasms.Burkitt's lymphoma is a rare poorly differentiated lymphocytic lymphoma characterized by monoclonal proliferation of B-lymphocytes.7Various studies have strongly suggested an association between the Epstein-Barr virus (EBV) and the pathogenesis of Burkitt's lymphoma. DNA sequences of this virus may be found in B cells, and elevated anti-EBV antibodies are found in patients with Burkitt's lymphoma.Clinically, this disease occurs mostly in children. The incidence peaks between ages 3 and 8 years, and males are affected about twice as frequently as females. Lesions involve mostly the maxilla, the mandible and the abdomen. The most frequent signs of this disease in the mouth are local tumors and altered tooth mobility. Symptoms are sparse, consisting of local pain, tenderness and parestesia.5Ardekian et al.Radiographic findings in Burkitt's lymphoma include radiolucent images of bone destruction with poorly defined and irregular margins.7Burkitt's lymphoma is treated preferentially with intensive chemotherapy; 5-year survival rates range between 75 and 95%, depending on the stage of the lesion at the time of diagnosis.4The differential diagnosis should be made with the following conditions: per apical lesions, ameloblastoma, other non-Hodgkin's lymphomas, undifferentiated carcinomas and sarcomas, and leukemia.5J.M.M.S., a white male patient aged 7 years, presented at the Pediatric Dentistry Clinic of the UFRN Dental School. His mother reported that the right region of the mandible body was increased in size. She also stated that the patient had been seen by a dental surgeon, who had suggested the possibility of a dentoalveolar abscess, and had started antibiotic therapy; the clinical picture remained unchanged 17 days later, after which the dental surgeon removed dental elements 84 and 85, which were mobile. The extra-oral physical examination showed that the right mandible was in fact increased in size. The intra-oral physical examination revealed an asymptomatic tumor-like mass located in the vestibular portion of the right aspect of the mandible body. On radiology, a diffuse radiolucent area was seen in the region of the abovementioned teeth. An incision biopsy was done, leading to a histopathological diagnosis of Burkitt's lymphoma. The patient was referred to the Oncology Unit of the Varela Santiago Children's Hospital ; polychemotherapy was undertaken and was successful. Seven years later, the patient is disease free and shows no signs of recurrence of metastasis.Burkitt's lymphoma is a rare and rapidly progressive tumor that occurs in an early differentiation stage of B cells.In this case, Burkitt's lymphoma occurred in the mandible of a child aged 7 years. The mandible is one of the most common sites for this disease;Burkitt's lymphoma responds well to chemotherapy.Burkitt's lymphoma is a rare neoplasm that has affinity for the maxillary bones, especially in patients within the first decade of life. This disease should be considered in the diagnosis of rapidly growing lesions located in the maxilla or the mandible, which progress to sizeable tumor-like masses, associated with tooth mobility and poorly defined borders on radiographic exams. Histopathology provides the conclusive diagnosis.


Uro-originated epidermoid cysts, especially located in the upper urinary tract are rare and only 4 cases of epidermoid cyst occurring in the upper urinary tract have been reported worldwide so far. In the previous cases, the cysts were diagnosed as tumors and organs were removed.We report a case of epidermoid cyst in ureter in a 48-year-old female patient admitted to the local hospital suffering from paroxysmal pain in the right hypochondriac for 8 years.She underwent right ureteroscopy in order to rule out the possibility of urinary epithelial carcinoma. The tumor was pathological diagnosed as a benign ureterocyst epidermoid. Postoperatively, the patient showed good recovery. During the 24-month follow-up period, the patient remained well and free of complications.This case illustrates that benign epidermoid cysts can appear in the ureter, although it is extremely rare. It also indicates that perioperative examinations must be exhaustive to avoid the further injury to the patients. Epidermoid cysts of genitourinary system are rare, with occurrences in the testis being the most reported, but they are extremely rare in the upper urinary tract such as in the kidney and ureter. Here we present a unique case of an epidermoid cyst in the middle section of the ureter, while providing ideas for the diagnosis and treatment of ureteral epidermoid cysts.An epidermoid cyst is a benign slow-growing epithelium tumor originated from the dermis or subcutaneous. The most common locations are the head and body cadres, limbs, retroperitoneal and pelvic cavities.A 48-year-old woman was admitted to our hospital with paroxysmal pain in the right hypochondriac for 8 years without other concomitant symptoms. She had a history of diabetes and hypertension. During the incubation period, she was suspected to suffer from ureteral calculus and underwent extracorporeal shock wave (ESWL) more than once at the local hospital. The patient’s laboratory examination, such as renal biochemical parameters and urine analysis, were normal. Plain and contrast-enhanced computerized tomography (CT) of urinary system indicated a stenotic change in the middle segment of the right ureter (at about S1 level), and a tumor was detected in that site. The ureter above the obstructed site was dilated concurrently with the ureter wall significantly thickened Fig. . The pat some scholars think that an epidermoid cyst is formed when embryonic neural tube is closed with the ectoderm, gradually growing into tumor, namely the skin epidermal layer residues in the site occurring as a cyst. With the renewing and shedding of keratinized cells, the contents of cyst gradually increased and eventually lead to the tumor formation. Some experts also believe that epidermal cells are implanted in tissues or organs during trauma and grow into epidermoid cysts. Epidermoid cysts can occur at any age, more frequently in the head and body cadres than in the extremities, retroperitoneal and pelvic cavities. They can also present in the skull, finger bones, spleen, breasts and other parts of the body. Epidermoid cyst of the genitourinary system is rare. There are many cysts occurring in testicles, but those occurring in the upper urinary tract, such as the kidney and ureter, are extremely rare. Only 4 cases of epidermoid cyst occurring in the upper urinary tract have been reported worldwide to date  shows inhomogeneous hypointense T1 signal and hyperintense T2 signal. These cysts are often nonenhanced but may show minimal peripheral contrast enhancement. Given the narrow ureteral cavity and the nature of small lesions, CT diagnosis effect is inferior to MRI. In this present case, we finally decided to perform the ureteroscopy plus biopsy to clarify the nature of the pathological change for the absence of cytological evidence preoperatively.Grayscale ultrasonography shows a well-circumscribed hypoechoic nodule,There are many treatment available, including conservative observation, simple cystectomy, and radical resection. In this case, the patient suffered from the chronic urinary tract obstruction that eventually resulted in a slight impairment of the right renal function. In addition, the patient had a history of high blood pressure for many years and the left renal function was also mildly damaged, therefore relieving the obstruction, reserving the renal function and regular follow-ups might be more beneficial for patients with long-term survival.Although epidermoid cyst is a benign disease, there is a 2% probability of progression to squamous cell carcinoma and 3% chance of recurrence after surgery.Ureteral epidermoid cysts are extremely rare and easy to be misdiagnosed preoperatively, leading to improper treatment. Currently, the medical imaging examinations have no adequate specificity and sensitivity to diagnose this disease accurately. However, ultrasonography shows a well-circumscribed hypoechoic nodule, and seems to improve diagnostic performance. Moreover, ureteroscopy is feasible when necessary.www.editage.com) for English language editing.We thank Dr Zhang and Dr Yuan for performing the surgery. We would like to thank Editage (Writing—original draft: Qiang JingWriting—review & editing: Xin Wang and Fan Liu


The spectrum for gastrointestinal tract mesenchymal tumours includes leiomyomas, leiomyosarcomas, gastrointestinal stromal tumours (GISTs) and schwannomas. Schwannomas  are well-known slow-growing, benign neoplasms that originate from nerve plexuses within a Schwann cell sheath. They can arise anywhere along the course of the peripheral nerve and are frequently reported around the head and neck, brachial plexus and along the gastrointestinal tract. Usually, these tumours are detected as solitary; however, they can occur at multiple sites around the body. Schwannomatosis (multiple schwannomas) is usually associated with neurofibromatosis type 2; the pathogenesis is triggered by mutations of the neurofibromatosis 2 tumour suppressor gene resulting in a loss of its function. Solitary gastric schwannomas are rare lesions that arise from the nerve plexus of the gastric wall. Frequently they are detected incidentally or may present with nonspecific abdominal pain or bleeding. This paper reports the case of a 79-year-old patient diagnosed with gastric schwannoma after presenting with abdominal pain.Gastric schwannomas should be taken into consideration while making a differential diagnosis of lesions that are gastric mesenchymal tumours, which span a broad spectrum. Gastric schwannomas are typically benign, considerably less common than gastric GISTs, and have an excellent prognosis following excision. Gastrointestinal tract mesenchymal tumour subtypes include leiomyoma, leiomyosarcoma, gastrointestinal stromal tumours (GISTs) and schwannomas. GISTs form the largest group of gut mesenchymal tumours . Gut schA 79-year-old female presented with abdominal pain. Relevant past medical history included hypercholesterolemia and hypertension with a previous angioplasty. The patient had no known drug allergies and was taking aspirin, amlodipine, atorvastatin, bisoprolol, valsartan and lamotrigine. On clinical examination, the abdomen was soft and non-tender in all quadrants. A digital rectal examination did not reveal any concerning lesions. A computerised tomography (CT) scan showed a 3.2 x 2.3 cm exophytic isodense mass arising from the body of the stomach, likely representing a GIST. Gastroscopy demonstrated a 3-5 cm mass located in the greater curvature of the stomach and biopsies were obtained. The remainder of the gastroscopy and colonoscopy were unremarkable. Biopsies demonstrated mild chronic gastritis with no other abnormality, with a comment to ascertain if these biopsies were representative of the mass. The patient was brought in for laparoscopic sleeve gastrectomy and resection of the submucosal mass in the greater curvature. A gross examination of the pathological specimen revealed a soft, circumscribed submucosal mass extending to the serosa and measuring 3.0 x 2.8 x 2.0 cm. Microscopic examination showed a spindle cell tumour, surrounded by a lymphoid cuff Figures , 2 with   On immunohistochemistry, the tumour cells were strongly positive for Vimentin Figure , S100 F and GliaThe stomach may harbour different types of lesions, and their pathology may be consistent with benign epithelial tumours, stromal lesions or malignant epithelial tumours which are related to a cancer mortality rate almost similar to breast cancer with an incidence of 7%-8% . PeripheAntoni A pattern is highly cellular and exhibits palisades of Schwann cell nuclei surrounded by prominent extracellular matrix and laminin secretion . Laminin is a glycoprotein found in the basement protein of the Schwann cells and plays a major part in axon myelination and nerve injury regeneration. A typical Verocay body is composed of a stacked display of two chains of longitudinal palisading nuclei that alternate with acellular areas made up of the Schwann cells’ cytoplasmic processes Figure . Antoni These tumours usually are detected as solitary lesions; however, they can occur at multiple sites of the body. Schwannomatosis (multiple schwannomas) is usually associated with neurofibromatosis type 2 . NeurofiThey can present as mass lesions, but the most frequent symptoms are upper gastrointestinal bleeding, abdominal pain, non-specific abdominal discomfort, nausea and gastric outlet obstruction. Ischaemic changes of the mucosa at the tumour site and acid activity may result in mucosal ulceration, leading to bleeding. Endoscopically, the vast majority of tumours are covered by intact overlaying mucosa and chiefly affect the submucosa and muscularis propria, sparing neighbouring structures. Central ulceration is detected in a significant number of tumours. Imaging with CT scan, MRI or ultrasonography may reveal homogenous, strongly contrast-enhanced lesions but no signs of tissue necrosis, intra-lesional haemorrhage, cystic spaces or soft tissue calcification, in contrast to GISTs . Fine neCD117  is the gene encoding the receptor tyrosine kinase protein and is activated in GIST tumours but never expressed in gastric schwannomas . DOG-1 , 6A-6C. The recommended treatment for schwannomas is complete excision of the tumour with clear resection margins. Surgical options include partial gastrectomy, wide local excision or wedge resection, done either in an open procedure or laparoscopically . As schwThe gastric mesenchymal tumours include a wide spectrum and gastric schwannomas should be considered in the differential diagnosis of those lesions. The gastric schwannomas symptoms are non-specific abdominal pain as seen in our case; however, other symptoms such as fullness, nausea, vomiting, and change in bowel habits also had been reported. The immunohistochemistry panel is crucial for gastric schwannomas diagnosis as they are mostly benign, and the final diagnosis has been concluded only after tumour resection. Generally, they are much less frequent than gastric GISTs and have a good prognosis after resection.


Gastrointestinal tumor (GIT) is an uncommon gastrointestinal tumor most commonly arising in the stomach. Duodenum is an uncommon site accounting for only about 3–5% of cases.In this case report, we present a case of high-risk duodenal GIST and review its management strategies.An abdominal mass and gastrointestinal (GI) bleeding are its usual presentation, however it may be lost among the long list of differentials of an abdominal mass and GI bleeding, if a high index of suspicion is not maintained. Surgery, with or without tyrosine kinase inhibitors like imatinib mesylate, has been the cornerstone in management of GIST.This case underlined the importance of duodenal GIST as a cause of GI bleed and abdominal mass as well as shone light upon historical developments, current updates and managements of GISTs. •Gastrointestinal tumor (GIT) is an uncommon gastrointestinal tumor most commonly arising in the stomach.•Duodenal GIST as a cause of GI bleed and abdominal mass.•Surgery, with or without tyrosine kinase inhibitors like imatinib mesylate, has been the cornerstone in management of GIST.•Here, we presented a rare case of duodenal GIST which should be considered a differential when considering etiologies for GI bleed. In addition to this, he also had weakness and exertional dyspnea. There was no history of a significant loss of weight nor a history of change in his appetite. Physical examination revealed pallor and an ill-defined abdominal mass occupying the right hypochondriac and the right lumbar regions. Lymph nodes assessment were unremarkable during the physical examination. On further review, his blood investigations showed a hemoglobin level of 5.6 gm/dl. He received blood transfusion in the hospital and was admitted for further evaluation of his symptoms.An initial assessment via. an upper gastrointestinal endoscopy revealed an ulcer of 1*0.5 cm located on the lateral aspect of the second part of duodenum following which, a Contrast Enhanced Computed Tomography (CECT) scan of the abdomen was ordered. Report of the CT scan showed a well encapsulated lobulated mass measuring 11*9 cm arising from the second part of the duodenum compressing on the liver and the right kidney and abutting IVC as shown in 3In this case, the male presented with an abdominal mass and a history gastrointestinal bleed, both of which are common presentations of GISTs . But whetrans-membrane growth factor receptor also found in interstitial cells of Cajal. Along with this, CD 34 positivity [Historically, GISTs have perplexed physicians for decades. The inability to distinguish them from other subsets of mesenchymal tumor and delineating its origin had halted a better treatment plan. But, advancement in the understanding of its pathobiology and genetic events relating to its development has created a paradigm shift in understanding GISTs. GISTs are immunohistochemically KIT(CD 117) positive tumors which differentiates it from tumors arising from smooth muscle cells like leiomyoma . KIT, issitivity  and the sitivity . Imatinisitivity .For a locally resectable non metastatic tumor as ours, surgery, especially an en bloc resection is the treatment of choice. The goal is complete gross resection with an intact pseudocapsule and a negative microscopic margin .In additLiterature reveals that recurrence primarily depends on the size of tumor rather than negative margins. Such recurrences occur predominantly intra-abdominally and involve the original tumor site . The ris4GISTs present as a neglected and a rare cause of GI tumor, the true prevalence of which is estimated to be far greater than that is explored. Here, we presented a rare case of duodenal GIST which should be considered a differential when considering etiologies for GI bleed. Advances in histochemical, pathobiology, molecular genetics has considerably expanded our understanding of GIST and has aided the introduction of novel treatment options such as imatinib which demands further exploration into the subject.Not commissioned, externally peer-reviewed.None.None.SS, AR, and AS wrote the original manuscript, reviewed, and edited the original manuscript. SKY, HBB, AR, AS, SS, AS, BKY, AA, RK, and GK reviewed and edited the original manuscript.Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.Name of the registry: NoneUnique Identifying number or registration ID: NoneHyperlink to your specific registration (must be publicly accessible and will be checked):Dr. Himal Bikram Bhattarai.The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.


We describe a case of generalized, extreme, colicky abdominal pain status post laparoscopic sleeve gastrectomy where the patient formed thromboses in the portal vein, superior mesenteric vein, and splenic vein, which were visualized with computed tomography (CT) imaging. The case was managed using the standard of care, which is anticoagulation and/or surgical intervention, both of which were used in this case. Laparoscopic sleeve gastrectomy (LSG) involves removing the greater curvature and fundus of the stomach; the partial gastrectomy is oriented vertically, parallel to the lesser curvature of the stomach. The procedure causes weight loss in a restrictive manner . The porA 40-year-old male presented to the emergency department, with pain and vomiting, status post uncomplicated LSG two weeks prior. The patient endorsed severe mild epigastric abdominal pain, worsening over two days, inability to eat without immediately vomiting, and several bouts of non-bloody diarrhea. Vital signs were within normal limits and pain was rated to be 10/10. The patient appeared alert and oriented, visibly anxious, and in mild distress. His abdomen was diffusely tender, with severe epigastric tenderness and mild ascites.In this case, computed tomography (CT) abdomen and pelvis with IV and oral contrast  revealed complete portal vein thrombosis (PVT), partial splenic vein thrombosis, and superior mesenteric vein thrombosis Figure . The patAlthough it is rare after bariatric surgery, PVT is most common after LSG. In a study of over 5700 patients who participated in laparoscopic bariatric surgery, 17 had thrombosis, 16 of whom underwent a sleeve gastrectomy . In a study of almost 24,000 autopsies in Sweden performed from 1970 to 1982, the prevalence of PVT was 1% without LSG . PVT decThe primary management of acute PVT is anticoagulation and, when possible, treatment of predisposing conditions. Anticoagulation is recommended with LMWH. Several case reports have documented successful lysis of acute PVT using streptokinase or tissue plasminogen. Other successful modalities include thrombectomy via TIPS procedure . TIPS plAbdominal pain is one of the most common complaints in the emergency department. The threshold for obtaining a CT, in these patients, is often low. However, in the case of recent abdominal surgery, the threshold to obtain a CT scan should be even lower. Although rare, PVT as well as the involvement of the splenic and superior mesenteric veins may occur in patients without the aforementioned risk factors. It is prudent to obtain an accurate medical history and perform a physical examination in all patients to be able to render the best medical care possible.


Colorectal lymphomas of primary origin are rare neoplasms accounting for 3% of all lymphomas involving the gastrointestinal (GI) tract, and of that 3%, 0.1-0.5% involve the colorectal region. Among the types of non-Hodgkin's lymphomas involving the GI tract, diffuse large B-cell lymphoma (DLBCL) is the most common type. While extranodal involvement of DLBCL in the GI is common, DLBCL of the colon with Epstein-Barr virus positivity is a rare entity with only a few cases reported in the literature. Here, we present a rare case of a 53-year-old female with human immunodeficiency virus (HIV) who presented with generalized abdominal pain, weight loss, night sweats, and fevers. A computed tomography scan of the abdomen and pelvis showed a mass on the right side of the colon with associated retroperitoneal and right inguinal lymphadenopathy. She later underwent a colonoscopy with a biopsy. Histopathology showed DLBCL of the ascending colon and chemotherapy was initiated. Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin’s lymphoma (NHL) amounting to approximately 24% of all NHL cases in America annually . ColorecA 53-year-old African American female with a past medical history of well-controlled HIV with Symtuza and diabetes mellitus presented to the emergency department with complaints of diffuse abdominal pain, associated with bloody stools, fevers, night sweats, and weight loss. Her vitals were stable. On physical examination, there were right cervical and right inguinal lymphadenopathy. There was tenderness to palpation in all four quadrants without signs of guarding or rigidity and bowel sounds were normal.Laboratory studies were normal except for lactate dehydrogenase (LDH) of 1883. Human T-lymphotropic virus (HTLV) and hepatitis C antibodies were negative. CT scan of the abdomen and pelvis showed diffuse retroperitoneal and pelvic lymphadenopathy and a large eccentric mass measuring 5.4 x 2.8 cm in the right hemicolon Figure  and showBased on the International Prognostic Index for Diffuse Large B-cell Lymphoma score of 3, she was at high intermittent risk. She received 1 cycle consisting of rituximab, cyclophosphamide, hydroxydaunorubicin, Oncovin, and prednisone (R-CHOP). Approximately one week later, she presented to the ED with fevers, chills, generalized body pain, and abdominal pain. She was tachycardic and hypotensive. A complete blood count (CBC) showed an absolute neutrophil count of 0. Blood and urine cultures were obtained. She was admitted to the intensive care unit for febrile neutropenia with shock and was started on intravenous hydration, meropenem, Zosyn, and vancomycin. Chest X-ray and CT scan of the chest, abdomen, and pelvis were obtained. Bowel perforation was ruled out. She expired 18 hours later. Blood cultures eventually grew pan-sensitive pseudomonas bacteremia.NHL is a form of malignant neoplasm that originates from T lymphocytes, B lymphocytes, and natural killer cells . Of the In patients diagnosed with DLBCL, efforts should be made to obtain the EBV status of the patient, since it is the determining factor in treatment response -13. EBV-Patients with DLBCL typically express pan B cell markers like CD19, CD20, CD22, CD45, and CD79a, and BCL-6 protein is expressed in 70% of cases while CD10 is expressed in 30-60% of cases . In our CT is the initial diagnostic method that aids in the identification of any localized mass as well as associated lymphadenopathy. For diagnosing primary lymphoma of the colon, colonoscopy is the test of choice for evaluating the morphology as well as obtaining a biopsy . The golThe International Prognostic Index (IPI) score is the most common tool utilized in estimating the outcome in patients with DLBCL who are receiving treatment. It takes into account the patient’s age, Ann Arbor stage, performance status, serum LDH, and extranodal site involvement. The calculated IPI score in our patient was 3, which puts her at high intermittent risk. In recent times, a new evolving technique known as gene profiling has been used , but theManagement of DLBCL usually includes chemotherapy, surgery, radiotherapy, or combination therapy. However, the role of surgery is debatable . Cai et Lymphomas involving the colorectal region are rare, with the most common type being DLBCL. Immunohistopathology remains the key to the diagnosis. The mainstay of treatment involves surgery with combination chemotherapy consisting of CHOP with or without rituximab. Since treatment outcome is strongly based on EBV positivity, it is imperative to evaluate the EBV status in every patient diagnosed with DLBCL. More research into treatment options for this unique subtype of DLBCL is needed to improve overall survival.


The natural history of neurofibromatosis type 2 (NF2) is profound bilateral hearing loss. The decision to pursue microsurgery may be more complicated in NF2 than with sporadic tumors. Schwannomas in NF2 often occur with other skull base tumors. Treatment should be tailored to preserve auditory perception for as long as possible. The authors present the case of a man with NF2 and a vestibular schwannoma who has poor hearing on the same side as a large petrous apex meningioma, both opposite to a well-hearing ear. This case highlights surgical decision-making and technical nuances during resection of collision tumors in NF2.https://stream.cadmore.media/r10.3171/2021.7.FOCVID21130The video can be found here:  This video demonstrates a combined right translabyrinthine and anterior petrosal approach for resection of a petrous apex meningioma in collision with a vestibular schwannoma in a young male with NF2.The patient is a 44-year-old with a history of shunting in childhood. He had several years of bilateral sensorineuronal hearing loss and debilitating exertional headaches, suggesting an acquired Chiari malformation. He has a history of unilateral vestibular schwannoma in his father. His neurological examination showed mild papilledema but was otherwise normal. An audiogram was performed, showing sensorineuronal hearing loss bilaterally with worse PTA and speech discrimination on the right.Preoperative MRI shows a large petrous apex meningioma with a dural base lateral to Meckel’s cave. This meningioma has a component that enters the posterior fossa to the level of the IAC , where enhancement shows a 2.5 × 2–cm vestibular schwannoma. Red circles highlight a contralateral 2.0 × 1–cm schwannoma, the hallmark of NF2.This case highlights several management principles in NF2. This is a patient with a new diagnosis of NF2 with likely inheritance from his father, who carried either a very mild germline mutation or a mosaic form, which has been inherited as germline in the patient. This patient’s most pressing issue is the petrous apex meningioma. In our practice, recent worsening of Chiari headaches is a good indicator of tumor growth, and resection should be pursued.2:08 The natural history of NF2 is profound bilateral hearing loss, and surgery should be tailored to preserve hearing as long as possible. This patient had poor hearing on the right side and good hearing on the left, which made the recommendation to pursue resection of the right schwannoma straightforward. Resection of NF2 schwannoma in a good- or only-hearing ear makes this recommendation more challenging.2:33 Schwannomas in NF2 are often polyclonal, making functional and anatomical preservation of the cochlear nerve unfeasible. In this case, we routinely use auditory brainstem implants to restore auditory perception when the likelihood of durable hearing preservation in the contralateral ear is poor. This is typically done in the same sitting.2:59 With this in mind, we planned for a combined petrosal approach for resection. Meningioma resection is carried out after skull base exposure and aided by division of the tentorium. Resection of the vestibular schwannoma is then performed, followed by ABI.3:03 We begin with the translabyrinthine approach. A cortical mastoidectomy is performed. Here the mastoid antrum and the tegmen are identified, followed by the presigmoid and postsigmoid dura. This patient had a poorly pneumatized temporal bone.3:23 A diagram depicts the course of the facial nerve as well as the structures of the inner and middle ear. The labyrinth is opened, and the IAC is skeletonized, including the inferior and superior troughs. These should be carried as medially as possible to provide 270° of exposure around the IAC and tumor.3:59 With the translabyrinthine approach complete, we turn our attention to the middle fossa approach, beginning with peeling of the middle fossa dura from the posterior-to-anterior direction to protect greater superficial petrosal nerve. The diagram here depicts Kawase’s bone as well as its margins around the GSPN  and the IAC. The IAC is first decompressed with a diamond bit. A monopolar stimulator can be used to define the GSPN laterally, and Kawase’s bone is drilled away with a diamond bit.4:49 We perform our resections without retractors whenever possible, and this is aided by early CSF  release. In combined petrosal craniotomies, this should be done superior to the IAC tumor. Alternating internal debulking and extracapsular dissection helps define the meningioma in the posterior fossa. Fascicles of the fifth cranial nerve can be seen here alongside the pons.5:39 Further resection is possible through division of the tentorium.5:58 Here tumor is resected along the pons and where the meningioma enters Meckel’s cave. This is resected, and any remnant is cauterized.6:14 With meningioma resection complete, the dura of Trautman’s triangle is opened for resection of the vestibular schwannoma. The arachnoid plane between the tumor and the posterior fossa is developed with the monopolar stimulator, which allows for continuous monitoring of facial nerve EMG during the resection.6:42 Alternating extracapsular dissection and internal debulking allow for identification of the cochlear nerve, which should be divided sharply against the brainstem before cautery against the deeper parts of the tumor should be performed.7:01 In this case, the root entry zone of the facial nerve and the tumor had a poor plane, and we turned our attention to the lateral parts of the tumor at the fundus, where the plane between the tumor and facial nerve was better identified.7:47 The cochlear nerve is dissected alongside specs of tumor in the IAC, which can be lifted away with a nerve hook. Here is division of the cochlear nerve, followed by sharp dissection along the facial nerve, which allowed for identification of a remnant of the meningioma not seen in Kawase’s exposure.8:29 The last bits of the vestibular schwannoma are then resected using sharp dissection with microscissors in a lateral-to-medial direction.9:16 We achieved a gross-total resection of both the meningioma and vestibular schwannoma, and attention then turned to placement of the ABI. PICA and the choroid of the fourth ventricle can be seen here. The rhomboid lip of the fourth ventricle is identified; the ABI is prepared and inserted along the cochlear nucleus anterior and superior. This is supported with Teflon and fat. Fat is packed into the translabyrinthine approach and the wound is closed in layers.The patient awoke with a House-Brackmann grade IV facial palsy, which had improved to grade III at early follow-up. A CT is shown here demonstrating bone removal from the translabyrinthine and anterior petrosectomy approaches. The patient had refused MRI while inpatient and is awaiting an intubated examination as an outpatient.The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this publication.Primary surgeon: Schwartz, Friedman. Assistant surgeon: Khan. Editing and drafting the video and abstract: Khan. Critically revising the work: Schwartz, Khan. Reviewed submitted version of the work: Schwartz, Khan, Plonsker. Approved the final version of the work on behalf of all authors: Schwartz. Supervision: Schwartz.


Triphalangeal thumb (TPT) is a rare congenital malformation where the thumb has three phalanges instead of two. Syndactyly is a condition in which children are born with fused or webbed fingers. The combination of TPT, Syndactyly, and thumb duplication is extremely rare, especially when these deformities are combined in one hand.Hand abnormalities and polydactyl have been reported in a 1-year-old boy.A clinical examination reveals two thumb duplications, finger fusion (Syndactyly), and a thumb with three phalanges (TPT). The diagnosis was based on clinical findings and an X-ray image of the hand.The Z-plasty method was used to remove the adhesion between the thumb and forefinger, as well as the removal of the medial and distal phalanx of the thumb’s medial tip.The patient was followed for 2 months and found him in good health. To authors’ knowledge, we described an unusual case from Syria, considered the first in medical history.General and plastic surgeons should be aware about this unusual mix of the three abnormalities. The family history must also be carefully investigated to explore the occurrence of hereditary illnesses. Despite having an incidence of 1 in 25,000 neonates, TPT is an uncommon abnormality, but its diverse phenotypic characteristics are frequent. It is inherited autosomal dominantly and is connected to LMBR1 on chr7q36.3. Additional deformities include Syndactyly, Ulnar Polydactyly, Cleft Hand and Radial Dysplasia, Differences in the Lower Extremities, and as part of a syndrome involving abnormalities in one or more other systems. Aase syndrome, which is likely a subtype of Diamond-Blackfan anemia, is distinguished by having TPTs. TPT may be categorized according to the three various forms of the additional phalanx  as defined by Wood, or it can be classified according to Wassel when radial polydactyly is present. The Duplication thumb is another congenital abnormality.Transverse deficiencies, longitudinal deficiencies of the forearm, deficiencies of the hands and fingers, and other complicated abnormalities of the upper limbs are all caused by congenital malformations. Usually, they are identified during a 20-week anatomic ultrasound. Triphalangeal thumb (TPT), historically first recorded by Columbo in 1559,Given that it affects 1 in every 3000 newborns, it is one of the most prevalent congenital hand deformities. Polydactyly, including duplication thumb, may affect the hands or the feet. The fusing of neighboring digits is the last abnormality, known as Syndactyly. Of all congenital hand abnormalities, it is the most prevalent, occurring in around 1 in 2000 births. This case report shows a very rare correlation between 3 deformities:TPT, thumb duplication, and Syndactyly. The appearance is the main reason parents come to the outpatient clinic. Surgical treatment for the various anomalies improves the shape and makes it more functional.A 1-year-old male was admitted to our hospital complaining of the presence of hand deformities and polydactyly. There is no family, medical, surgical or allergic history. Two thumbs were observed (thumb duplication), a fusion of fingers with each other (Syndactyly), and a thumb containing three phalanges (TPT) Fig. . We did  In addition, the International Federation of Societies for Surgery of the Hand Committee recommended Swanson’s classification of Congenital cases as a proper system for use by hand and upper limb surgeons working in this field which presented an understanding of embryological limb development, and it has also distinguished effective and useful. On the other side, Syndactyly forms one of the most frequent inheritance limb deformities. The incidence rate of Syndactyly ranges from 1.1/10,000 in the northern Netherlands to 1.3/10,000 in New York state because of geographical and registry differences, and in China is 7.4/10,000 in 1998–2009. Thumb duplication is another congenital polydactyly disorder when a kid is born with more than five digits on their hands and feet. Both the hands and the feet may be affected.We present the condition of thumb duplication with the TPT with clinodactyly and Syndactyly. TPT is rare, and the incidence rate is 1/25,000 live births. It is a congenital malformation in which the thumb contains 3 phalanges instead of 2. TPT may be a part of a syndrome like Blackfan anemia and may be autosomal dominant in ratio 2/3. It is associated with more malformation like polydactyly syndactyly claw-like hand or foot. The majority of the abnormalities are found on chromosome 7q3b, along with the added phalanx, which may have a variety of forms, including wedge or rectangular, from the distal interphalangeal joint to the radiocarpal joint, as well as joints, ligaments, muscles, and tendons of the first ray that can be hypoplastic deformed or missing with variable degrees of stiffness or instability. Classifying TPT depends on wood and Buck Gramcko, which describe three different shapes of the extra phalanx, while Buck Gramcko describes different encountered shapes from small to large.Thumb duplication is the most frequent congenital upper limb abnormality. In addition, preaxial polydactyly is often classified under this heading. The importance of our case comes because it is the first case in medical literature and because we report the association of these three conditions together. The patient suffered from the TPT with clinodactyly and Syndactyly. The wood classification was 5, and Buck-Gramcko was 7. An X-ray confirmed the diagnosis. Surgical treatment was chosen to remove deformities, reduce the length of the thumb, and create a good function with the observation other limb is also triphalangeal. The condition has been followed up for two months, and the patient’s condition was good without complications after surgery.In this case report, we provide the first instance in the medical literature where three anomalies are present at the same time. This uncommon combination of these defects will give plastic surgeons a distinctive personality. When confronted with a situation like this, they need to ensure that an exact therapy, such as surgery fixing, is carried out and then monitor the results.All authors read and approved the final manuscript.Conceptualization: Sarya Swed.Writing – original draft: Sarya Swed, Abdulqadir J. Nashwan, Hiba Haj Saleh, Yamane Chawa, Alaa Baria, Aladdin Etr.Writing – review & editing: Sarya Swed, Abdulqadir J. Nashwan, Hiba Haj Saleh, Yamane Chawa, Alaa Baria, Aladdin Etr.We would like to thank the patient’s parents for helping us to report this rare case in the literature.


The reported incidence of liposarcomas in ~2,000 cases annually results in about 30% of myxoid liposarcomas. Cardiac myoxid liposarcomas are very rare; their presentation could be cardiac tamponade, due to direct compression of the tumor and/or pericardial effusion. In this report, we describe a patient who presented with pericardial effusion secondary to myoxid liposarcomas from the right atrium, an extremely rare presentation of liposarcomas in the heart. We also present non-invasive imaging through echocardiography, CECT thorax and FDG PET scans, followed by a CT-guided mass biopsy. Histopathology of the right atrial mass demonstrated myxoid liposarcoma positive for the S100 tumor marker. A 53-year-old woman, with a history of having been hypertensive for 8 years but displaying no prior record of cardiac illness, came to the hospital with complaints of shortness of breath (class IV) for 1 week. This was aggravated 2 days prior to her visit, associated with orthopnea, a dry cough, and a low-grade intermittent fever. On examination, Pulsus paradoxus and Kussmaul's signs were present.The ECG showed sinus tachycardia with non-specific ST-T changes. Moreover, the echocardiogram showed massive pericardial effusion with features suggestive of cardiac tamponade and homogenous mass adjacent to the right atrium , B. EmerCECT thorax , B reveaCT-guided biopsy from the right atrial mass was subjected to histopathological examination. The findings revealed the presence of myxoid liposarcoma . The hisAnti-tuberculous treatment was terminated. The case was discussed on the tumor board and a decision to obtain a biopsy from the mesenteric lymph node adjacent to the left iliac artery with laparoscopic assistance was made. However, the patient and her family were not in agreement; hence, she was discharged against medical advice.Primary cardiac tumors are rare –3, foundNon-invasive imaging plays a critical role in the diagnosis and surgical interventions of cardiac tamponade . AlthougEven though there are more innovations in diagnosis , the imaDiagnosing myxoid liposarcomas remains a challenge , 21. ImaThe raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by CSP-MED/20/FEB/59/53 DATED 07.03.2020. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.MTR and NSR contributed to the intellectual content and revised the manuscript. VK drafted the manuscript. VK and NB were responsible for acquisition and interpretation of the data. SSunn and AR reconstructed the images, prepared the legends, and updated the literature. SSund and PK reviewed the histology data and interpreted the results. JS was responsible for acquisition of CT biopsy. AM performed and interpreted PET scanning. All authors made substantial contribution to the preparation of the manuscript, as well as read and approved the final version of the manuscript.


Camelus dromedarius) are few in number and deal with small number of cases.Choke  is an important oesophageal disorder in large domestic animals. Published studies on choke in the dromedary camel  more than camels more than 1 year of age (15.62%) and complete obstruction more than partial. Most cases had obstruction involving the cervical oesophagus (96.87%). In the majority of obstructive masses, there were pieces of fabric (48.44%) and plastic bags (35.94%). Most obstructive masses were slightly radio‐opaque (62.5%). Surgical and non‐surgical managements were effective  in resolving the choke.Choke was most likely in animals less than 1 year of age with complete obstruction of the cervical oesophagus. Surgical and non‐surgical methods were effective in resolving the choke in the dromedary camels. It was not practical to use forceps extraction in all adult camels due to the limited length of the alligator forceps. Oesophageal obstruction has been described in cattle,The aim of this study was to describe choke in dromedary camels, including some observations on diagnostic methods, the nature of the obstructive masses; with some comments on the methods of management.Camelus dromedarius) with a diagnosis of choke were presented to the Veterinary Teaching Hospital of the College of Veterinary Medicine‐King Faisal University from 2009 to 2018. The history in all cases included regurgitation of food and/or milk. The breed , age, sex and duration of clinical signs were recorded. The age ranged from 10 days to 8 years; most cases were under 1 year old; consequently, age was designated as one of two groups (less than 1 year and more than 1 year old).Sixty‐four dromedary camels  based on the history, oesophageal radiography and endoscopy. With complete obstruction, the history usually included sudden onset of dysphagia, regurgitation of food, milk and fluids, salivation and restlessness. With partial obstruction, there was regurgitation only of coarse and hard food. The duration of clinical signs varied between 2–4 days (median 3 days) with complete obstruction and 1–5 months (median 3 months) with partial obstruction. The clinical examination included passing a flexible stomach tube in all cases.Plain oesophageal radiography was performed for all cases. An oesophagogram was carried out in 30 camels using 200–300 ml and 500–600 ml barium sulphate solution  in young and adult camels, respectively. The solution was administered orally with a dose syringe or by stomach tube.N = 54) using a flexible endoscope , 8 mm diameter, 110 cm long, supported with an inflation and irrigation system and light source. The camel was secured in sternal recumbence and sedated with xylazine 0.2 mg/kg intravenously (I/V) . The oral cavity of camel was kept open with a Gunther's mouth Gag . The endoscope was inserted in the oral cavity, pharynx and oesophagus. Oesophageal fluid was aspirated with a surgical suction unit . The oesophageal mucosa was examined and the lumen was inspected for the nature of obstruction. The obstructive area was washed through the channel of the endoscope using 50 ml NaCl 0.9% solution to visualise the foreign body.Endoscopy was conducted in all camels under 1 year of age  with 80 cm long arms were inserted into the oral cavity and oesophagus to grasp the end of obstructive mass to attempt to remove it Figure . The proAfter the removal of the obstruction, camels received penicillin and streptomycin  intramuscularly (I/M) as 8 mg/kg procaine penicillin with 10 mg/kg dihydrostreptomycin sulphate, equivalent to 1 ml per 25 kg bodyweight, for 5 days; together with flunixin meglumine  I/V, single daily dose of 1.1 mg/kg for 3 days. Camel calves were given access to suckle milk after 12 h.Cervical oesophagotomy was carried out in 36 camels under 1 year of age that had tightly impacted obstructive masses that could not resolved with endoscopy and in 10 camels over 1 year of age. The anaesthetic regimen comprised sedation with xylazine 0.2 mg/kg I/V, followed by general anaesthesia with ketamine hydrochloride 10%  2 mg/kg I/V. Each camel was placed on its right side in lateral recumbence and a stomach tube was introduced close to the obstruction. The distal third of the neck was prepared for surgery. A single incision (10 cm long) was made at the ventrolateral aspect at skin and fascia; then, the sternocephalicus and sternothyrohyoideus muscles were bluntly separated while preserving the jugular vein beneath the sternocephalicus muscle. The oesophagus was located dorsolateral to the trachea and under the jugular vein; it was held with two stay stitches. A longitudinal incision (5 cm long) was made in the dorsolateral aspect of the oesophagus through the outer fibrous and muscular layers, then through the inner submucosal and mucosal layers, to expose the lumen. Rochester‐Carmalt forceps were used to extract the obstructing foreign object Figure . The stoFood was withheld for 3 days and maintenance fluid therapy (Lactate Ringer's solution) was infused I/V at a rate of 70 ml/kg/24 h. After 3 days, a soft diet such as milk was advised. Camels received oxytetracycline  I/M, 20 mg/kg, every 72 h and flunixin meglumine I/V, once daily, 1.1 mg/kg, for 7 days. The skin sutures were removed 14 days postoperation. The cases were followed up for 6 months via telephone.N = 43) than the Magateer and Omani breeds and in camels less than 1 year of age  than camels more than 1 year  (see Table N = 54).Choke was more common in the Majaheem breed . In terms of radio‐opacity, the obstructive masses were radio‐opaque, slightly opaque or radiolucent. Some obstructive masses were radio‐opaque  such as phytobezoars  including pieces of fabric   Figure .In all 30 cases, contrast oesophagram revealed that the barium solution was retained at the site of obstruction in complete oesophageal obstruction, while in partial obstruction, incomplete filling of oesophageal lumen was observed Figure . MegaoesNon‐surgical management using the alligator forceps guided endoscope was successful in 17 camels under 1 year. These camels had obstructive masses that were not firmly impacted in the lumen of the oesophagus and were within the range of the forceps. Inflammation of the oesophageal mucosa was observed in seven cases. One camel calf had an oesophageal tear after removal of an obstructive mass and the owner advised to slaughter the animal. The tear was associated with an attempt to retrieve an impacted trichophytobezoar.N = 42; 91.30%). One adult camel had choke in the thoracic part of the oesophagus; this was resolved by oesophagotomy at the distal oesophagus and introduced long forceps and endoscope from the oesophagotomy incision. A further three camels developed complications with oesophageal fistula in the second week postoperatively at the oesophagotomy site. Food material discharged from the oesophagotomy incision with phlegmon to the surrounding tissues.Surgical management  was effective in resolving choke of adult camels and calves with tightly impacted foreign bodies located beyond the length of the forceps (The obstructive masses are listed in Table The primary goal of treatment for choke is to relieve the obstruction with minimal trauma to the oesophagus and to limit other complications. In keeping with previous reports, the majority of the oesophageal obstructions in our study occurred in camel calves.Both complete and partial oesophageal obstructions were recorded in this study, similar to ruminantsIn this study, the cervical part of the oesophagus was the most common site of obstruction, especially its distal third, cranial to the thoracic inlet. In a previous report on camel calves,Oesophageal radiography revealed that some obstructive masses were radio‐opaque or slightly opaque and could be detected easily with plain radiography. Barium oesophagram was useful for viewing radiolucent obstructive masses and evaluating the oesophageal condition. This is similar to horses where survey radiography of feed impaction or lodgment of metallic foreign bodies can be a valuable diagnostic method.Endoscopic removal of oesophageal foreign bodies in the camel calves was successful; similar to previous reports in Holstein bovine calvesCervical oesophagotomy via a ventrolateral approach provides access to the middle and distal cervical oesophagus and proved to be a convenient way for extraction of tightly impacted oesophageal foreign bodies. The cervical part of the camel oesophagus was most accessible to surgery given that it makes up over 60% of the total length of the oesophagus. In horses, the cervical oesophagus constitutes over 50% of the oesophageal length and a ventrolateral approach is more desirable than a ventral approach due to the heavily developed ventral cervical musculature.The obstructive masses were similar to those reported in previous studies of camels.Mohamed K. Zabady collected the clinical cases, recorded the history, performed the examination, radiography, oesophagotomy, wrote and revised the manuscript. Turke Shawaf completed the examination with endoscope, wrote and revised the manuscript.The authors declare that they have no conflicts of interest.The authors confirm that the ethical polices of the journal have been followed.Supporting InformationClick here for additional data file.


The ileocolic region is the most common site of intussusception. It occurs mostly in children but can also occur in adults. Ileal tumors and polyps can cause ileocolic intussusception. Inflammatory fibroid polyp (IFP) is one of the rarest benign tumors of the gastrointestinal tract. The most common sites of IFP are the stomach, ileum, colon, duodenum, and esophagus. Small IFPs can be managed endoscopically but larger IFPs and those with complications such as intussusception require surgical resection. We report a case of ileal IFP presenting with small bowel obstruction due to ileocolic intussusception. The patient was successfully treated by surgical excision. The diagnosis of IFP was made based on a histopathological examination of the resected specimen. Intussusception is common in children but rare in adults ,2. The mAn inflammatory fibroid polyp (IFP) is a rare benign tumor of the gastrointestinal tract. It is most frequently located in the stomach and responsible for 0.1% of all gastric polyps . Small iA 41-year-old male with a known case of type II diabetes mellitus presented to our emergency department with sudden onset of abdominal pain, nausea, vomiting, and obstipation for one day. His medical and family history was non-contributory. Physical examination revealed an ill-defined, tender lump in the right lumbar region. Routine blood investigations including complete hemogram, and liver and renal function tests were within normal limits. The differential diagnoses included intestinal obstruction due to appendicular or cecal mass. Hence, contrast-enhanced CT (CECT) of the abdomen was performed. CECT abdomen revealed an oval mass-like structure with a bowel within bowel concentric ring-like appearance in the ileocolic region suggestive of intussusception  followed by the small bowel (20%) ,7,12. Th0% followEpigastric pain and bleeding are the most common symptoms of gastric IFP while colicky abdominal pain with constipation and abdominal distension are the most common symptoms of intestinal IFP ,7,15. InAbout 70% to 90% of adult intussusceptions are due to benign or malignant neoplasms such as adenocarcinoma, lymphoma, IFP, lipoma, and adenoma. Small bowel lesions are not usually diagnosed pre-operatively because they present with vague symptoms of bowel obstruction due to intussusception. Laboratory investigations and abdominal radiographs are not helpful in making the diagnosis as they will demonstrate findings only in the presence of bowel obstruction ,16.Radiological diagnosis of intussusception is often made by ultrasound especially in the pediatric population ,3. In adThe diagnosis of IFP is most often established on histological and immunohistochemical examination of the endoscopic or surgical specimen. Usually, IFPs stain positive for CD34 and vimentin. Occasionally, IFPs may also stain positive for smooth muscle actin, calponin, CD35, and cyclin D1 ,18. CharAs IFP is a benign disease, patients with small IFP diagnosed with endoscopic biopsy can be left alone if asymptomatic. However, most IFPs are symptomatic or there is suspicion of malignancy requiring surgical excision. Most of the previous studies have reported excellent outcomes with no recurrence on follow-up ,15. Ileal IFP causing intussusception is rare and very few cases have been reported in literature ,17,19. AIFP in the ileocecal region is rare and can lead to intussusception causing acute intestinal obstruction. It should be included in differential diagnosis while treating adult patients with intussusception or bowel obstruction. IFP mimics other gastrointestinal tumors such as stromal tumors, neuroendocrine tumors, lymphoma, and adenocarcinoma on preoperative radiological imaging. The final diagnosis can be made only on histopathology.


A variety of non-neoplastic diseases and benign and malignant lesions may involve parotid glands. In clinical practice, effective diagnosis is crucial to ensure proper treatment and achieve a good therapeutic effect. Unclear anamnesis and short medical history are factors that make diagnosis difficult, especially when cancer should be excluded. We present a case series of four patients who reported to the outpatient clinic with a unilateral nodule in the parotid region. The clinical presentation prevented an unequivocal diagnosis. The suspicion of a neoplastic disease resulted in profound diagnostics, including repeated cytology, ultrasound and magnetic resonance examination. Combining all the acquired information and follow-up, or a histopathologic examination, facilitated the final diagnosis. In all cases, thrombosis was diagnosed. We then analysed the diagnostic process and the associated difficulties. When thrombosis in vascular malformation occurs in the parotid region, it may have an unclear clinical and radiological presentation. Such an image can imitate both benign and malignant tumours. Ambiguous imaging in conjunction with blood cells in cytology should result in the inclusion of thrombosis in vascular malformations in the differential diagnosis. Vascular malformations (VMs) belong to vascular abnormalities resulting from genetic mutations leading to atypical morphogenesis of the vascular tissue. VMs are composed of dysplastic vessels lined by an endothelial layer. Although present at birth, they may not be detected until later in life. Malformations never regress and grow proportionally with the individual. Abnormal tissue may expand due to trauma, hormonal changes or infection ,2,3.Pathological angiogenesis may also lead to vascular tumours such as benign haemangiomas and malignant angiosarcomas. Haemangiomas are mostly seen in infants. Endothelial cells are indistinguishable from normal human endothelium, but a local imbalance between angiogenic stimulators and inhibitors in the development may lead to higher morbidity and mortality through haemorrhage. Angiosarcomas’ clinical presentation can often imitate benign lesions; however, they have a high tendency to metastasize. Those tumours are poorly responsive to chemotherapy and radiation; therefore, early diagnosis is crucial to a good prognosis .VMs mainly occur in the upper part of the human body. Over 40% of VMs localise in the head and neck. The most common areas are the eyelid, lip, chin, buccal space, parapharyngeal space, submandibular space and neck. Clinical findings contain well-defined, soft and compressible masses without pulsation . They may also involve each body part and enlarge during the Valsalva manoeuvre .Venous malformations, similar to other VMs, are present at birth. They are the most common type of VMs , affecting 1–4% of individuals ,6. LymphIn the general ear, nose and throat (ENT) population, the incidence of venous thromboembolism ranges between 0.1% and 1.6%, which is still an uncommon site of this condition . It is eWe discuss a series of cases of thrombosis in the parotid region, initially mimicking parotid gland tumours, to enable others to conduct an accurate diagnostic process and help to choose the right treatment.The presented patients were diagnosed at the University Clinical Center in Gdansk, Poland, for the presence of a nodule in the parotid region. Because of the non-specific nature of symptoms and relatively short clinical history, prompt diagnostics were ordered due to the risk of neoplastic disease.A 57-year-old female was admitted to the ENT outpatient clinic because of a painless nodule of the left parotid region that was observed for two months. In physical examination, enlargement and increased firmness of the left parotid gland were noted. The patient was scheduled for an ultrasound (US) examination. The first US revealed a suspicious polycyclic hypoechoic focal lesion (38 mm × 14 mm) in the superficial lobe of the parotid gland a. A fine−3 mm2/s) in diffusion-weighted imaging (DWI) (Magnetic resonance imaging (MRI) was ordered for further differentiation of the lesion. MRI revealed a solitary lesion measuring 18 mm × 9 mm × 35 mm, with a bright hyperintense centre and a dark hypointense rim in T1-weighted images b, a mixeng (DWI) e,f.After reassessment of the MRI examination, a diagnosis of thrombosis was suggested. Additionally, a hyperintense, ovoid lesion in T2-weighted images was spotted in the proximity of the left temporomandibular joint d. FollowThe patient was placed under ultrasound surveillance. In the 6-month follow-up, there were no signs of the previously observed thrombus in the widened vein. The vein was compressible, with slower blood flow in the lateral portion of the LVM g,h.A 62-year-old female with a known history of LVMs of the submandibular space and floor of the oral cavity came to the clinic due to a newly spotted, painless nodule in the right parotid region. About forty years before, in the surrounding of the temporomandibular joint, an LVM was surgically partly removed.−3 mm2/s) in DWI (The patient underwent an US examination a. An ovo) in DWI d,e. AfteA year after diagnosis of thrombosis, the patient was qualified for percutaneous sclerotherapy of the malformation in the anterior part of the superficial lobe of the right parotid gland. In the 1-year follow-up MRI, the lesion’s size had decreased, and there were no signs of previously observed thrombus and diffusion restriction. In the gradient echo sequence (GRE), blood products were spotted.−3 mm2/s)  d,e. In a3 mm2/s) f. Due toA 41-year-old female nurse was admitted to the clinic due to a painful nodule in the left parotid region, near the angle of the mandible. US examination revealed a lesion localised on the left masseter. The lesion appeared three months earlier and presented as a subcutaneous firm nodule measuring about 1 cm. The lesion was oval, non-compressive and hypoechogenic (8 mm × 3 mm), with no flow in Doppler examination a. After A diagnosis of thrombosis in the masseter’s vein was made based on a performed examination. In a follow-up US examination 3 months later, the lesion had a stable picture.The parotid region is not a typical location for VMs, with about 50 cases reported . AchacheDue to the abnormal morphology of VMs, there is pathological turbulent blood or lymph flow. Localised intravascular coagulopathy is the primary characteristic of low-flow venous malformations. The risk group mainly includes people with extensive and more profound VMs . PhlebolWe presented a wide variety of different lesions with thrombosis in the parotid region. Clinical and radiological symptoms were ambiguous. In three of the four cases, there was no biased medical history. Only one patient had a history of LVM in the head and neck area, which did not affect the diagnostics. The remaining patients had a short medical history of symptoms.Based on the findings in US examinations, FNA was ordered. In all of the cases, cytology revealed blood cells only. The cytology results were interpreted as non-diagnostic—category I according to the Milan System for Reporting Salivary Gland Cytopathology—with a potential risk of malignancy of 25% . In our In the MRI, three of the four lesions presented with hyperintense foci in T1-weighted images, which might suggest blood products. However, this sign is non-specific and may represent lipids in Warthin tumours , high prIn one case, the change of echogenicity of the lesion in the US was noted—a typical sign of the evolution of thrombus.To properly diagnose pathology in the parotid region, the most accessible US with colour Doppler can be applied. VMs have a typical image of compressible lesions—mostly anechoic, with possible septa, with fast, low, or no-flow, depending on the type of lesion. Contrast-enhanced CT has limited effectiveness in the characterisation of parotid lesions and VMs. MRI ensures high soft-tissue resolution and allows the assessment of diffusion restriction, dynamic contrast-enhanced examination, and detection of blood degradation products in gradient echo sequences and DWI. VMs appear as hypointense on T1-weighted images, and hyperintense on T2-weighted images, and as lesions with lobulated margins, without diffusion restriction, often transspacial or multispatial. LMs and LVMs can have fluid–fluid levels in T2-weighted images. In the event of thrombosis, a high signal in T1-weighted images, diffusion restriction and a blooming artefact in the gradient echo sequence may appear within VM. Limitations of the gradient echo sequence include possible intratumoral haemorrhage, the presence of calcifications, and also vascular phleboliths forming from an old thrombus .Due to the lack of standards for treatment of thrombosis in VMs on the head and neck, choosing the appropriate strategy was challenging. The selected management in the presented cases was varied—one lesion was surgically removed because of clinical symptoms and size progression, and one patient was put under US surveillance due to stable clinical and radiological picture; in the last two cases, spontaneous regression of thrombosis was observed.The treatment for VMs thrombosis on the head and neck should be individualised, and an important factor affecting the decision is the existance of thrombosis elsewhere.Dompmartin et al. reported patients with localised intravascular coagulopathy, causing pain and thrombosis. The authors stated that elevated D-dimer levels were statistically insignificant to localised intravascular coagulopathy in VMs on the head and neck (31% with increased D-dimer level) . They poOn the other hand, Soudet et al. reported using antiplatelet and antithrombotic drugs in patients with venous thrombosis in facial and non-facial VMs. All of the patients noticed a reduction in symptoms and complete thrombosis resolution. However, the authors point out that this treatment was started despite the lack of recommendations for this type of thrombosis . MoreoveOther authors suggest that the use of dabigatran (compared with low-molecular-weight heparin)  or rivarNakano and Zeinati point out the need to create anticoagulation therapy initiation criteria. It can be based on commonly evaluated biochemical markers—such as D-dimer and fibrinogen levels—taking into account types of vessel ectasia and the clinical condition of the patient . AccordiFurthermore, patients with head and neck VMs may take precautions by keeping their heads slightly elevated during sleep.The most common localization of VMs is the head and neck region. Abnormal morphology of vessels increases the risk of forming a thrombus. Due to the often atypical clinical and radiological presentation of the lesions—mimicking both benign and malignant tumours—wide differential diagnosis is necessary. Ambiguous imaging in conjunction with purely blood cells in cytology should result in including thrombosis in VMs in the differential diagnosis. Treatment of thrombosis in VMs differs from management of malignant tumours. Therefore, including VMs’ thrombosis in differential diagnosis in the right moment may spare costly diagnostics, unnecessary operations and stress for the patient.