Pilomatrixoma is a benign and rare neoplasm derived from the cortex of the hair follicle. The head and neck region's involvement is relatively common and occurs in the upper extremity, trunk, and lower extremity in decreasing tendency. It is usually encountered in younger age groups, usually in children and adolescents. Management of the pilomatrixoma involves surgical excision of the mass. A 15-year-old male presented with a history of an isolated left scapular mass. The lesion had appeared two weeks before the presentation. His parents brought him to the emergency department due to continued bleeding from the mass. He denied any pain, fever, night sweats, weight loss, chills, appetite changes, and numbness to the area. Physical examination revealed a bleeding non-tender mass measuring about 2.5 x 3 cm, with the fluctuant inferior surface. Baseline investigations were normal. Cyst, abscess, and neoplasm were the initial differentials. Ultrasound findings were suggestive of neoplasm, and contrast-enhanced MRI was highly suspicious for progressive neoplasm. The surgical team was consulted, and surgical excision of the mass was carried out. Biopsy results confirmed pilomatrixoma. In conclusion, the pre-surgical diagnosis of pilomatrixoma is difficult. Hence, this case report's main objective is to raise awareness among clinicians about this rare diagnosis and its clinical features. Furthermore, our case highlights the need to consider pilomatrixoma in the differentials of the head, neck, and back masses in children and adolescents. Pilomatrixoma is a benign, slow-growing rare tumor arising from the hair follicle matrix cells . Mostly Clinical suspicion must remain high, and physicians should use appropriate biopsy techniques to avoid misdiagnosis of pilomatrixoma . LiteratThis case report was previously presented as a poster at APA Region 5 Conference-Pediatrics Post 2020-Looking Back & Looking Forward on March 5, 2021.A 15-year-old previously healthy male with no significant past medical history presented to the emergency department for bleeding left scapular mass. He initially noticed the lesion two weeks before the presentation. The mass ruptured due to leaning against the wall. He was brought to the hospital by his parents due to continued bleeding. He denied any pain from the area except shortly after it ruptured. There was no history of fever, night sweats, weight loss, chills, appetite changes, and numbness to the site. Clinical examination revealed a non-purulent, solitary, and well-circumscribed mass located on the skin overlying the lateral side of the left scapula, measuring about 2.5 x 3 cm. On palpation, the mass was firm and non-tender with a fluctuant inferior surface. Excoriations and scabs were also noticed on the mass Figure -5. On onPilomatrixoma is a slow-growing subcutaneous tumor arising from the cortex of the hair follicle . Mostly,The lesion is usually encountered in younger age groups, usually in children and adolescents . HoweverPilomatrixoma is usually less than 3 cm in size. However, giant lesions of a size greater than 5 cm have been found. It is asymptomatic, firm, solitary, mobile, and well-circumscribed spherical to ovoid . Pre-surPilomatrixoma is usually diagnosed on history and physical examination . They arPilomatrixoma is a rare subcutaneous neoplasm with a low recurrence rate, ranging from 0%-3%. The preoperative diagnosis of pilomatrixoma is difficult due to a lack of knowledge, and therefore, it is mostly misdiagnosed. The main objective of this case report is to raise awareness among clinicians about this diagnosis and highlight its clinical and radiological features. Pilomatrixoma is usually a benign tumor, but in sporadic cases, malignant transformation has been reported. The definitive treatment is the complete surgical excision of the mass. The clinicians may improve the presurgical diagnosis of pilomatrixoma by considering it in the differentials of the head, neck, and back masses in the pediatric population.


Lung malignancies have become increasingly prevalent. Occasionally, an unusual tumour is diagnosed, or a common tumour type presentsunusually. This case report reviews 3 cases of thoracic neoplasm, including two cases of uncommon cancers  and an atypical presentation of malignant mesothelioma. Her chestradiograph and computed tomography (CT) scan revealed aninhomogeneous mass occupying nearly the whole right hemithorax,with an associated small pleural effusion Mr MG is a 65-year-old man who presented with left-sided chestpain. He was a non-smoker, and also reported profound weightloss. His chest radiograph showed a white-out of the left hemithoraxwith mediastinal shift. A CT scan revealed the presence of a leftmain bronchus mass with associated left lung atelactasis andcomplex collections extending to the chest wall consistent with aleft empyema neccesitans. A pigtail catheter was placed to drain thefluid. The purulent fluid aspirated did not yield any organisms onculture. A bronchoscopy was performed which revealed a left upperlobe bronchus that was partially occluded by the tumour. The biopsyconfirmed an adenoid cystic carcinoma (ACC) Mrs AM is a 53-year-old woman from the Democratic Republic ofCongo who presented with a 3-month history of generalised bodypain. On examination, she had many subcutaneous soft tissue masses. Her chest radiograph and CT chest showed a large roundedmass in the right hemithorax as well as a rounded lesion in the lefthemithorax. An ultrasound guided biopsy established a diagnosis ofa desmoplastic small round-cell high-grade sarcoma 6] The common presentationincludes marked chest wall pain and pleural effusions often with associated pleural thickening and volume loss. The patient presenteduncharacteristically, with pulmonary mass lesions with no identifiablerisk factors. The mortality is unfortunately still unacceptably higheven with chemotherapy, radiation and surgeryMMs are aggressive neoplasms arising from mesothelial surfacesof the pleura, peritoneal surfaces and tunica vaginalis. Eightypercent will arise from pleural surfaces where 70% of patients willreport exposure to asbestos. Other risk factors include radiation,carbon nanotube exposure and genetic factors such as mutations inBRCA1 associated protein 1(BAP1).[7] They are considered slowgrowing tumours, usually arising from the proximal tracheobronchialtree. The solid histological pattern has been associated with a moreaggressive clinical course and early distant metastases, in contrastto the cribriform type which shows a more benign behaviour.[8] The mainstay of therapy is surgery. Our patient probably had postobstructive pneumonia and an empyema as a result of the tumour inthe left upper lobe.Primary adenoid cystic lung cancers are rare salivary gland neoplasmsmaking up 0.04 - 0.2% of all lung cancers.[9] They are characterised histologicallyby nests of small tumour cells surrounded by cellular and vascularcollagenous stroma.11] Mostly arising in the abdominal and pelviccavity, these tumours can also originate in other sites, such as thelung and pleura.[12] DSRCTs are rare and aggressive malignanciescommonly affecting young males with only a few hundred cases reported in the literature. The prognosis is poor and therapy is stillnot well defined.Desmoplastic small round cell tumours (DSRCTs) are mesenchymaltumours arising from cells with multi-lineage potential. Firstdescribed in 1989 by Gerald and Rosai, these tumours have distinctmolecular and immunohistochemical characteristics. The molecularhallmark of DSRCT is the Erwing sarcoma and Wilms tumour gene(EWS-WT1) fusion protein.Unfortunately, all 3 patients presented with advanced disease andwere referred for oncological assessment and palliative care. This series serves as a reminder of the wide spectrum of presentations ofthoracic neoplasms.


Echinocococcus genus. It can be classified as either alveolar or cystic echinococcosis. Although the two forms differ significantly in terms of imaging findings, they share similarities in terms of management and treatment. In parallel to medical treatment with albendazole (ABZ), and surgery, historically used in these diseases, various imaging-guided interventional procedures have recently emerged ). These options open up a new range of therapeutic options. As in oncology, multidisciplinary consultation meetings now play a major role in adapted management and patient care in hepatic echinococcosis. Consequently, diagnostic imaging and interventional expertise have brought radiologists to the fore as important members of these multidisciplinary team. The radiologist will need to evaluate parasite activity in both forms of the disease, to guide the choice of the appropriate therapy from among medical treatment, interventional radiology procedures and/or surgical treatment. Knowledge of the specific complications of the two forms of echinococcosis will also help radiologists to discuss the appropriate treatment and management. The aim of this review is to describe the core knowledge that what a radiologist should possess to actively participate in multidisciplinary meetings about hepatic echinococcosis. We discuss the role of imaging, from diagnosis to treatment, in alveolar (AE) and cystic echinococcosis (CE), respectively.Echinococcosis is a parasitic disease caused by two zoonotic tapeworms (cestodes) of the  Imaging has a central role in the positive diagnosis of alveolar and cystic echinococcosis.Assessment of parasitic activity is crucial in both forms of echinococcosis and requires specific imaging techniques.Percutaneous interventional procedures are used in case of complications of alveolar echinococcosis and to treat some forms of cystic echinococcosis.Echinococcus (family Taeniidae). It refers principally to two severe zoonotic tapeworm (cestodes) diseases, namely alveolar echinococcosis, caused by Echinococcus multilocularis, and cystic echinococcosis, caused by Echinococcus granulosus sensu lato ., 3.EchinIn addition to evaluating parasitic activity, imaging plays a significant role in the evaluation of resectability. While magnetic resonance imaging (MRI) and Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography (FDG-PET)/CT scan remain the techniques of choice for the assessment of parasite activity, abdominal CT is the modality of choice for pre-operative evaluation . After ingestion, the eggs hatch and spread oncospheres in the intestine, which pass through the intestinal wall to the portal and lymphatic vessels, and consequently reach the liver. Extrahepatic primary involvement is rare and mainly involves the lung [AE endemic areas are located exclusively in the northern hemisphere, mainly China, North America and Central Europe . In the life cycle of the lung , 2, 5, 6Secondarily, in the liver, the larval (metacestode) proliferation leads to the growth of a liver mass. Lesions are infiltrative, can be isolated or multiple, and can be voluminous (up to 15–20 cm), with no clear margin between the lesion and healthy parenchyma. Lesions are composed of aggregated vesicles, calcifications, necrotic areas, and are often surrounded by fibrosis and a granulomatous reaction due to the host immune response .The aggregated vesicles  give the lesion its multilocular aspect  within the granulomatous structure, composed of macrophages, lymphocytes, fibroblasts, and neo-vessels. The natural course of the disease consists of approximately 5–15 years of asymptomatic incubation followed by a chronic period .The rarity of this infection makes it difficult to diagnose. The diagnosis depends on accurate history-taking, imaging, serology, and sometimes, histopathological analysis. The diagnosis of AE, usually made by imaging, can be fortuitous, or revealed by complications such as abdominal pain or jaundice , 6. ImagThe typical finding on B-mode ultrasound is a heterogeneous echogenic mass with irregular borders, composed of cystic vesicles due to necrotic areas, calcifications, and surrounded by a ring-like zone of hyperechogenicity that corresponds to fibrosis Fig. .Fig. 4InLess common findings include a mass with multiple hyperechogenic solid lesions, described as a “hailstorm pattern,” which can be confused with hemangioma of the liver, which is much more common  and alsoCT yields better characterization of lesions, in terms of their location, number and size Fig. . An infiMRI provides more precise information concerning the characterization of the lesion, with a heterogeneous infiltrative hypovascular mass that is a mix of solid and cystic tissue. T2-weighted imaging is the most specific sequence, since it enables visualization of metacestodal vesicles (microcysts) and liquefaction necrosis areas (large cysts) in high signal, while granuloma tissue, coagulative necrosis and calcification appear in low signal. Multivesicular lesions on T2-weighted imaging are described as a “bunch of grapes” or “honeycomb”  Fig. 5)5).In 2003, Kodama et al.  proposedMR cholangiopancreatography (MRCP) is useful for analyzing the potential invasion or compression of the biliary tree by the lesion, in order to guide curative  or palliative care  Fig. .Fig. 6LaE. granulosus hydatid fluid) that yields a primary immunodiagnosis for both AE and CE, with a diagnostic sensitivity of 95% for AE. For subsequent specification of the anti-Echinococcus antibody response, E. multilocularis-specific ELISA, using the E.m crude antigens (95% specificity) are used. In combination with the Em2-and rec-Em18-ELISA, this immunoblot method makes it possible to diagnose both clinical and sub-clinical (including abortive) AE, with a sensitivity of nearly 100%.AE serology is efficient and is performed either to confirm the diagnosis, when it is suspected on imaging, or to rule out the diagnosis, if there is diagnostic uncertainty . CurrentAlthough the diagnosis of AE relies on a combination of the history, serology and imaging, the role of imaging in establishing a positive diagnosis is preponderant Table . If an eIn case of doubt between an infiltrative mass and an AE lesion, the radiologist should look for microcysts on T2-weighted imaging, which is the pathognomonic elementary lesion of AE. In addition, MRI may show additional features with diffusion-weighted imaging that will help in differentiating AE from cholangiocarcinoma. Increased ADC values will be found in AE lesions, and may be a valuable tool for the differential diagnosis  Fig. 7)7). CT wiThe global increase observed in AE cases in endemic areas may be at least partially attributable to the growing number of immunosuppressed human hosts. The rise in cases worldwide has led to increasing reports of atypical imaging findings  , 12 Fig. RadioloAssessment of parasitic activity is crucial to evaluate possible treatment, but also to monitor the efficacy of antiparasitic treatment. FDG-PET remains the imaging technique of choice for assessment of parasitic activity, since in vitro experimentation in AE lesions has demonstrated high uptake of FDG by immune cells and low uptake by parasitic cells in the vesicles . ConsequOn MRI, AE activity in the lesions is evaluated by microcyst visualization  and by DWI. There is a lack of literature data reporting the association between Kodama’s classification and prognosis [Recent studies , 17 haveBiliary involvement is the leading complication of AE, and is mainly revealed by jaundice or cholangitis Figs. , 10. AE As AE is infiltrative, it can invade the major hepatic veins and retro-hepatic inferior vena cava Fig. , which iExtra-hepatic involvement remains rare in AE, and seems to be more frequent in China than in Europe , probablWhatever the situation, benzimidazole (mainly ABZ) is the common denominator for all the therapeutic options in AE, either to support curative surgical treatment or in the long term, if surgical treatment is not possible.Curative liver resection remains the gold standard treatment in AE, and the only one that may lead to definitive cure. However, since AE lesions are most often located in the right lobe of the liver, and in advanced cases, may have invaded the major bile ducts and vessels , major hepatic surgery is often required. Consequently, preoperative imaging is crucial. Triple phase CT scan  remains the imaging technique of choice for preoperative hepatic AE because of the spatial resolution it provide. This assessment should focus on identifying the slightest contact with structures such as hepatic venous confluence, inferior vena cava or diaphragm and hilar infiltration should be suspected when parasitic infiltration is close . In the For patients not amenable to surgery, long-term ABZ therapy should be prescribed. Massively calcified or metabolically inactive AE lesions are generally only monitored (“watch and wait” strategy) . Liver aInterventional radiology may be involved in preoperative management of AE lesions with portal embolization to enlarge future remnant liver volume, or in the management of complications . Percutaneous drainage to evacuate an infected necrotic cavity, and percutaneous transhepatic biliary drainage to treat bile duct obstruction may be necessary in rare situations Fig. . Contrar.For patients treated by curative surgery, long-term follow-up by US at shorter intervals and CT and/or MRI at intervals of 2–3 years should be planned due to the risk of recurrence, even after several years of remission . The comEchinococcus granulosus tapeworm. CE is responsible for a wide spectrum of manifestations, ranging from asymptomatic cases to fatal infection. Unlike AE, CE is mostly represented by one large cyst, from which complications arise, predominantly spontaneous rupture.Cystic echinococcosis (CE), also known as hydatidosis or hydatid disease, is a widely endemic disease caused by metacestode of the Echinococcus granulosus is present on every continent except the Antarctic and is endemic in South America, Eastern and Southern Europe, Russia, the Middle East, Africa and China. Humans are accidentally contaminated by dogs in livestock-raising areas. Just as in AE, the parasite reaches the liver by the same pathophysiological mechanism [echanism . Unlike echanism .The diagnosis is based on history, clinical examination, serology and imaging. The imaging diagnosis will be easy when evidence of the internal membrane or daughter cyst is visualized, but challenging in case of a simple cyst with parietal calcifications.US remains the imaging technique of choice for stage diagnosis of CE lesions. It makes it possible visualize the matrix within the cyst, and enables detection of calcifications. US of CE shows a liver cyst with an echogenic component. Visualization of an internal detached membrane, and internal anechogenic cysts will be the key point for the CE diagnosis. The World Health Organization Working Group on Echinococcosis (WHO-IWGE) international classification is based on US imaging Table , wherebyMRI, especially with T2-weighted images, provides good diagnostic performance for internal matrix visualization but can have shortcomings in identifying details of the cyst wall . It remaCT is not the first line imaging modality, but is frequently the means by which CE is discovered. It can be challenging in CE1 to CE4 lesions, as it does not enable precise visualization of the cyst matrix , but is Contrary to AE, specific serology suffers from a lack of sensitivity and plays only a secondary role in the diagnosis of CE. The first line tests available are the same as for AE . These first-line serology tests can be negative in 30–58% of cases for CE1 cysts, and in more than half of cases for inactive cysts CE4/CE5 . The higRadiologists will frequently be involved in ascertaining the CE diagnosis. In endemic countries, US is considered as the first line imaging approach, as it is widely available and enables good visualization of the matrix cyst. In case of a fortuitous discovery on US imaging, the radiologist must discuss the CE lesion in case of a cystic liver lesion showing heterogenous contents, including a detached membrane or internal anechogenic cysts. Radiologists will have to discuss the CE diagnosis more largely, in case of patients coming from endemic areas. Therefore, the radiologist must have good knowledge of the markers of parasitic activity  and must be aware that incomplete exploration on ultrasound will have to be combined with MRI findings, and vice versa. This is all the more important since, in CE, the serology can be negative in up to 58% of cases with CE1 cysts, in more than half of cases for inactive CE4/CE5 cysts, and in 5–20% of CE2 and CE3 cysts .The main differential diagnosis of CE will be a liver cystic lesion associated with calcifications Table , Fig. 14Activity assessment of CE lesions is simpler than in AE. The WHO-IWGE classification is correlated to parasitic activity  and imagCE is often asymptomatic, but symptoms occur largely when complications develop. The three main complications of CE are mechanical complications (rupture of the cyst or compression), secondary infection and anaphylactic reaction. Risk factors for complications are difficult to evaluate since a large proportion of cysts are asymptomatic and undiagnosed. Nevertheless seem to be more frequent in younger patients, whereas the link with cyst size is not clear .Macroscopic rupture in CE and secondary fistula are reported as the main complications of CE , 42. RupThe main US feature for diagnosing intrabiliary rupture of a hydatid cyst  is a losIntraperitoneal rupture can occur when CE is peripheral or located in the left liver lobe Fig. . It shouCE lesions can also compress the bile ducts, portal veins, hepatic veins and inferior vena cava and can cause portal hypertension  and BuddThe development of biliary cystic communication leads to small amount of hydatid fluid within the biliary tree, which is a prerequisite for bacterial contamination. Bacterial contamination leads to the formation of abscesses with the same US appearance as other types of liver abscess: poor delimitation, heterogeneous echostructure and intracystic air-fluid, or fluid–fluid levels . A peripContrary to AE, CE is frequently characterized by extrahepatic involvement. The other organs affected are mainly the lung (25–40% of cases –48), whiAs in AE, the role of imaging is essential in the therapeutic management of hydatid cyst, and depends on the WHO-IWGE classification, location, size and the presence of complications.Anti-infectious treatment is based on continuous administration of ABZ. It may sometimes be given life-long in multiple, inoperable cysts or for a fixed duration in association with potentially curative surgical or instrumental therapeutic options. The only curative treatment is complete surgical removal of the cyst. Total cystectomy, which avoids opening the cyst, is the technique of choice , 29.Percutaneous treatment by Puncture-Aspiration of cyst contents-Injection of protoscolecidal agents-Reaspiration (PAIR) has been largely developed in endemic countries . A more For inactive cysts (CE4 and CE5), a “Watch and Wait” approach is recommended (20). ABZ alone may be efficient for small CE1 and CE3a cysts (< 5 cm). Large CE1 and CE3a cysts (> 5 cm) can be treated either with PAIR or with surgery, depending on their location in the liver, and local expertise. Currently, the preferred option for CE2 and CE3b lesions is surgery, but the MoCAT technique is still under evaluation for these stages.It is widely accepted that close biological and imaging follow-up for at least 5 years is necessary in CE because of the risk of recurrence after surgical treatment and the uncertain results of other techniques. In addition, biological follow-up (liver enzymes and blood cell count) during the first 6 months is necessary to check for possible ABZ toxicity [In conclusion, the two tapeworms of the Echinococcus genus cause liver diseases that share some similarities in terms of diagnostic approach and treatment, but each associated with specific imaging findings. Radiologists should be aware of these two forms of parasitic liver infection, as it will be necessary to discuss imaging findings in patients with echinococcosis, and they will have to be referred for specific examinations for the assessment of parasitic activity. Radiologists should also be aware of the role of interventional radiology in these affections, as it may be useful for the treatment of certain complications in AE or for treating certain forms of CE. Multidisciplinary teams are crucial for echinococcosis management, and radiologists have an important role to play in these teams, given the central role of imaging in these two diseases.


Gastric schwannomas are rare peripheral nerve sheath tumors which are usually found incidentally while undergoing workup for other conditions. Despite their benign nature, they require surgical resection with negative margins. It is important to differentiate gastric schwannomas from gastrointestinal stromal tumors prior to surgical excision, as this can alter the recommended surgical plan. This can be achieved with endoscopic ultrasound and fine needle aspiration with analysis of the sampled tissue using immunohistochemical stains. We present the case of a 68-year-old female patient with an incidental finding of a gastric fundus schwannoma. Laparoscopic gastric wedge resection was performed with complete excision of the tumor and negative margins. Pathology was confirmed with immunohistochemical stains positive for S-100 and negative for CD117 and DOG1. Post-operative recovery was uneventful without tumor recurrence. A schwannoma is a benign tumor arising from Schwann cells, which are found in peripheral nerve sheaths. The most common locations of this tumor include the head, neck and extremities. Although uncommon, they have been reported in the gastrointestinal (GI) tract, with the stomach being the most common location (60–70% of cases) , 2. GastWe present the case of a 68-year-old female patient with a history of hypertension and hypothyroidism who was being evaluated at the surgery clinics due to complains of a left inguinal bulging concerning for a hernia. She denied abdominal pain, nausea, vomiting or any other symptoms related to the GI tract. Abdominopelvic computed tomography (CT) scan with oral contrast was ordered for further evaluation. Imaging results were remarkable for a well-circumscribed soft tissue submucosal mass in the gastric body, measuring 4.4 × 4.3 × 3.2 cm . There wThe patient was scheduled to undergo laparoscopic resection of the mass. During surgery, the previously tattooed lesion was identified at the gastric fundus and a wedge resection of that segment was performed, achieving complete resection of the tumor. Pathology confirmed the diagnosis of a schwannoma . ImmunohGastric schwannomas are rare benign stomach tumors arising from Scwhann cells in the nerve sheath of Auerbach’s or Meissner’s plexus , 6. As iGastric schwannomas can be mistaken for other neoplasms based on imaging and endoscopic findings. They are commonly misdiagnosed for GIST tumors, which can be malignant in 10–30% of cases . GastricEUS with FNA is used for pre-operative diagnosis of submucosal gastric tumors and surgical planning. FNA is a low-risk procedure that has been shown to have a diagnostic accuracy of 62–93% for subepithelial lesions of the GI tract . Both scGastric schwannomas are rarely malignant. Most of them can be managed with excision of the part of the stomach containing the tumor without lymph node sampling because they rarely metastasize to the lymph nodes . They arCT scan follow-up is not recommended due to the benign nature of the neoplasm. There are reports of a disease-free survival of >36 months after undergoing surgery with negative margins . Once thNone declared.The authors state that there are no sources of funding to disclose.


Laparoscopic approaches to inguinal hernia repair are becoming increasingly more popular as they offer many advantages to open techniques including faster recovery and lower rates of wound infection. However, it is important to recognize complications associated with newer techniques which only become apparent with increased volume and experience. In this report, we describe a rare case of small bowel obstruction (SBO) secondary to peritoneal defect herniation post-transabdominal preperitoneal repair (TAPP). This is an uncommon complication that is sparsely reported in the literature but may have devastating consequences for the patient if unrecognized or mistakenly attributed to adhesional SBO. A high index of suspicion for internal herniation and a low index for reoperation are important with SBO in the early postoperative phase post-TAPP. Inguinal hernia (IH) repair is one of the most commonly performed surgical procedures, with more than 20 million cases annually worldwide . Over thHowever, no operation is without risk, and it is important to recognize and document complications associated with newer techniques which may only become apparent with increased volume and experience. In this report, we describe a rare case of small bowel herniation through a peritoneal defect post-TAPP resulting in intestinal obstruction.A 75-year-old man presented to the emergency department 3 weeks post-TAPP for bilateral IH with a 2-day history of crampy abdominal pain, vomiting and constipation. His abdomen was soft but diffusely tender and grossly distended on examination, with abdominal X-ray showing dilated small bowel loops. Routine laboratory investigations were unremarkable. A wide bore nasogastric tube (NGT) was placed which immediately aspirated 1350 ml of bilious fluid. Computed tomography (CT) of the abdomen was performed which diagnosed small bowel obstruction (SBO) with a transition point in the right iliac fossa of unclear aetiology. Initially suspecting an adhesional SBO, a trial of conservative management was commenced. However, this was unsuccessful, with 1700-ml draining from the NGT over the next 24 hours. Given the lack of clinical improvement, surgical exploration was warranted. As the patient had been adequately decompressed by NGT, a laparoscopic approach was used.Laparoscopy utilized the same access points as prior TAPP, a 10-mm infraumbilical port and two 5-mm ports in the left and right upper abdomen. This revealed that a loop of distal ileum had herniated into a small defect in the peritoneal flap overlying the right sided hernia repair site  and 2. TThe past two decades have seen an evolutionary change in the surgical management of IH, with the unambiguous advantages of minimally invasive surgery transforming a procedure traditionally associated with considerable postoperative pain and slow recovery . Laparoset al. [et al. [Less than 20 cases of PDH secondary to TAPP have been reported . Kapiris [et al.  report t [et al. . The aut [et al. .PDH is not exclusive to TAPP. A small number of cases of PDH secondary to laparoscopic trocar insertion have been reported with ports as small as 5 mm . As withOur case highlights three important learning points. Firstly, SBO secondary to PDH post-TAPP is a highly uncommon complication that was not previously encountered in our high-volume practice and is sparsely reported in the literature. However, an awareness of this is important as TAPP becomes more frequent, as a delay in diagnosis can have serious consequences. Secondly, diagnosis is challenging, as CT appearances may mimic adhesional SBO; therefore, a high index of suspicion and low index to re-operate in this scenario are essential. Finally, this complication can be managed laparoscopically should the patient condition allow it, maintaining the post-operative benefits of minimally invasive surgery.


Two cases of Sporadic Burkitt’s lymphoma in children aged 11 and 8 years with primary symptoms in the oral cavity are reported. The first symptoms of the disease appeared in the oral cavity and were initially misdiagnosed as an inflammatory condition in one case and incidental findings not associated with the primary reason for visiting the dentist’s office in the second case. Biopsies of the lesions revealed the actual cause of the observed changes and contributed to the prompt initiation of polychemotherapy treatment. A review of current literature presents the known symptoms of Burkitt’s Lymphoma in the oral cavity and the available diagnostic methods. The role of the primary care physicians—the pedodontist and paediatrician—in the diagnostic and therapeutic process is discussed. Sporadic Burkitt’s lymphoma, also called American or idiopathic lymphoma, is a malignant tumour of B-cell lymphocytes classified as a subgroup of non-Hodgkin’s lymphoma. The African or endemic and HIV-associated types are the other two clinical variants of the disease. Initially, the disease was delineated in the early 20th century by Albert Cook in eastern Africa, and later, in 1958, it was presented and published by Denis Burkitt. He described it as a sarcoma involving the jaws  in well-2, Cyclophosamide, Doxorubicin, and Encorton) and two cycles of R-CYM  treatments. The patient responded well to treatment, and remission was achieved. Now, five years after initial diagnosis, he is undergoing regular check-ups, including dental examinations. The intraoral lesion resolved completely because of chemotherapy, and no surgical treatment was performed .The 11-year-old patient was referred to the Children’s Dental Clinic with suspected inflammation of the periapical tissues of the region of the left premolar of the mandible. Clinical evaluation revealed hypermobility of teeth 34 and 35 (FDI) with enlargement and redness of gingival tissue of both the vestibular and lingual side of the alveolus with pain symptoms. Teeth with no signs of caries lesions were not tender to percussion, the vitality tests were inconclusive, and no palpable lymphadenopathy was noticed. A cone beam computed tomography (CBCT) examination  revealed root resorption of tooth 35 and an area of extensive demineralisation in the region of 33–36 with loss of trabecular bone pattern, destruction of buccal, and thinning of the lingual cortical plates . On the The 8-year-old patient was referred to the Children’s Dental Clinic because of trauma of front upper central incisors. Hypermobility of the left upper incisor with swelling and bloody petechiae of the upper lip were noticed. Because the periapical X-ray was inconclusive, a CBCT examination  of the maxilla was performed to evaluate the possible presence of a fracture of either the root or the alveolar bone. CBCT ruled out the presence of a fracture in the front upper region but revealed the presence of a soft-tissue mass covering the area of the hard palate and extending into a maxillary sinus and a nasal cavity, which had dimensions of 25 × 25 × 20 mm . ClinicaSporadic Burkitt’s lymphoma is a poorly differentiated lymphocytic lymphoma that appears worldwide without a geographic or climate predilection . It affeA variety of signs and symptoms of SBL in the craniofacial region should be underlined when the dentist’s and paediatrician’s roles in the diagnosis of SBL are considered. Some more commonly seen conditions for this group age, such as acute periapical abscess, periodontal inflammation, and the presence of foreign bodies in the oral cavity, are usually considered the initial diagnosis when some enlarging of the soft or hard tissue mass is noticed. In such circumstances, the clinical and radiological examination should confirm the initial diagnosis. During examination, attention should be paid to the absence or contradiction of the typically associated disease features. Signs of a periapical inflammation-like condition in the absence of a caries lesion on a tooth is a good example. Another is the mobility of the tooth in the absence of periodontitis. Atypical tooth morphology with shorter-than-expected and widened roots should arouse interest and provoke a search for the causes of this state. The doctor conducting the examination should also be alert to the sudden onset of symptoms, such as regional paresthesia, and be aware that regional lymphadenopathy is only observed in approximately 25% of cases of SBL . When thThe dentist’s role is primarily to be vigilant in situations that do not correspond to the typical course of disease in the oral cavity. In case of suspicion, the dentist should act quickly, which means, above all, immediate referral of the patient for further diagnostic tests performed in specialised medical institutions. In most cases, the lesion in the oral cavity does not require dental treatment and resolves in the course of combined treatment with polychemotherapy. Because of very high replicative activity, SBL is particularly sensitive to some polychemotherapy schemes. The prognosis of SBL in children depends on the extent of the disease, age, and time of diagnosis. In children, the prognosis is very good, with a survival rate of 90–100% for the early stages ,9,18.


The most common peripheral nerve sheath and vascular tumors are schwannomas and hemangiomas, respectively. These tumors can affect any organ system and usually occur as separate morphologic and diagnostic entities. Herein, we describe the case of a 24-year-old woman with a tumor demonstrating composite differentiation to both cavernous hemangioma and schwannoma in the scalp. The patient had a slow-growing subcutaneous scalp tumor in the occipital region with an insidious onset and progression. The patient underwent wide local excision for treatment and based on follow-up evaluations has remained asymptomatic with no signs of recurrence. Synchronous development with cavernous malformation and nerve sheath tumor coexistence can occur in the same lesion as a rare entity. Based on previously documented studies, they can be characterized into two distinct types. The first type is known as a conjoined association wherein the cavernous malformation and nerve sheath tumor coexist as a single lesion. The cavernous malformation and tumor occur at separate locations in the second variant which is known as a discreet association -2. Such A 24-year-old female patient presented to the surgical outpatient department with an insidious onset of swelling in the occipital region of the scalp. The plane of swelling was subcutaneous and measured 6 cm × 4 cm × 4 cm. The mass was firm and immobile. MRI of the swelling was performed with the following sequence: T1, T2, axial, Cor Flair, and PD Sag. A well-defined thin-walled lesion measuring approximately 4.5 cm × 4.3 cm × 3.3 cm was observed on the right side beneath the occipital bone. The lesion was observed in the subcutaneous plane abutting the muscle. It showed a heterogeneous signal on T2-weighted imaging with cystic changes and heterogeneous enhancement in postcontrast study. No abnormalities of the intracranial structures were noted. A clinical diagnosis of neurofibroma was made and a wide local excision was performed. Grossly, the surgical specimen consisted of skin with a subcutaneous mass together measuring 6.5 cm × 3.5 cm × 1 cm. The mass alone measured 4.5 cm × 4 cm × 3 cm. The cut surface of the mass was grayish white with numerous interspersed large, ecstatic, hemorrhagic, and cystic areas. Microscopic examination of the hematoxylin-eosin (H&E) stained sections showed the histomorphology of a composite tumor showing biphasic differentiation to schwannoma and cavernous hemangioma Figure -D.The schwannoma component showed tumor architecture in the form of interlacing bundles, nests, and fascicles of cells. The cells were spindle-shaped, elongated, and wavy with tapered ends. They had spindle-shaped wavy nuclei, eosinophilic fibrillary cytoplasm, and indistinct cytoplasmic borders. Biphasic compact areas of hypercellular (Antoni A) and hypocellular (Antoni B) areas were noted. The cytoplasmic fibrillary processes of the cells showed prominent palisading of the nuclei around them (Verocay bodies) Figure -D. The hThe cavernous hemangioma component was interspersed throughout the hemangiomatous component. The hemangiomatous component showed numerous lobular proliferations of ecstatically dilated vascular channels Figure ,B. The vThe studied sections of the lesion were negative for a definitive evidence of atypia or malignancy. Immunohistochemistry revealed that the schwannoma component was positive for S100  are most commonly found in the upper extremities. Schwannoma, which is one of the most common PNSTs, affects the upper extremities and involves both sensory and motor nerves. Schwannoma is an encapsulated tumor that shows Antoni A and Antoni B regions on histology. Antoni A region is composed of spindle-shaped Schwann cells and is cellular. Nuclear palisading and Verocay bodies are frequently observed in cells within the Antoni A region. Antoni B region is also composed of Schwann cells, but their cytoplasm is hidden and their nuclei are surrounded by a thick myxoid matrix. Schwannomas show high levels of S100 on immunohistochemical analysis. If benign PNSTs of the extremities are stable in size and asymptomatic, they are treated conservatively. Excision is the surgical technique employed for the treatment of benign PNSTs. Because schwannomas in the extremities are encapsulated, they can be treated with enucleation or intraneural dissection, thereby saving the accompanying nerve .The most frequently diagnosed soft tissue tumor of infancy and childhood is hemangioma, which affects 12% of all babies. They are more prevalent in females, Caucasians preterm children, twins, and mothers with more advanced maternal age . HemangiWeakly constricted and abnormally dilated blood vessels are called cavernous hemangiomas, which have a flat endothelium lining. Categorization is based on distinct histological characteristics. The symptomaticity of cavernous hemangiomas is dependent on the tumor’s location. Larger lesions (>5 cm) are more likely to be symptomatic and vulnerable to consequences, including bleeding and rupture .A total of 22 cases (including the present case) has documented the synchronous and conjoined occurrence of schwannomas and hemangiomas  pathway, the phosphatidyl inositol 3 kinase/mammalian target of rapamycin (PI3K/mTOR) signaling, and the phospholipase second messenger system pathways. Angiopoietin-tie 2 interactions and schwannoma-secreted vascular endothelial growth factor (VEGF) act as the preliminary mechanisms in initiating and maintaining the above-described complex gesticulating reactions between Schwann and endothelial cells, resulting in the simultaneous growth of schwannoma and hemangioma in the same tumor [Furthermore, certain researchers attribute embryogenetic pathways to the neurilemmoma and angioma component co-occurrence in the same tumor due to their shared ectomesenchymal origin . In contPrevious studies have shown that these are conjoined lesions having a significant risk of bleeding, particularly when occurring at vestibular locations. It has been hypothesized that tumor cytokines can induce high expression levels of matrix metalloproteinase-2 and -9. This in turn can lead to vascular instability and increased predisposition to thrombosis and bleeding of the aberrant arteries. Subarachnoid hemorrhage can be a serious complication if these tumors occur in the central nervous system (CNS). Further vascular malformations and PNSTs can exhibit confounding and overlapping imaging characteristics. PNSTs are hypointense on T1-weighted imagining and hyperintense on T2-weighted imaging, with the features improving at higher contrast. Hence they can be misinterpreted as vascular malformations; radiologists can be misled into false diagnosing one for the other .Common tumorigenic molecular pathways might be involved in the conjoined development of schwannoma and hemangiomas. The frequent documentation of these cases implies the inclusion of a separate morphologic entity of 'Angiomatous Variant of Schwannoma' with the existing morphological classification of schwannomas. Vascular malformations and PNSTs can appear similar upon imaging, and PNSTs might be mistaken for vascular malformations. Massive acute/chronic intratumoral hemorrhage and necrosis are common in these tumors, which can clinically and radiologically mimic a malignancy. Hence, awareness of the morphological characteristics of such tumors and documentation of this particular variant may avoid radiological misdiagnoses and surgical mismanagement in the future.


Giant cell tumor (GCT) is an aggressive osteolytic lesion mostly affecting the meta-epiphyses of long bones at skeletal maturity. Occurrence of the GCT in diaphysis is a rare entity in adult and exceptionally rare in pediatric population. This is the only third diaphyseal case reported in pediatric population. We report a case of recurrent diaphyseal GCT in a skeletally immature patient of 15-year-old male at the right radius after previous resection with plate and screw fixation. Upon optimal investigations, en-bloc resection of the tumor with radial resection and ulna centralization with wrist arthrodesis was done for a campanacci stage III GCT. The patient had an uneventful recovery without recurrence for 2 years and 2 months following surgery. The main challenge relies on accurate diagnosis due to uncommon location that hinders adequate treatment plan, therefore diagnosis should be solely based on histopathology findings. Giant cell tumor (GCT) of the bone is a benign tumor locally aggressive with osteolytic lesions affecting the meta-epiphysis at skeletal maturity, typically in the second to fourth decade of life ,2. GCT aThe standard management options include appropriate curettage and use of bone cement, with local or systemic adjuvant therapy as adjunct ,2. RecurClinical findings and timeline of current episode: a 15 year-old-male patient from a low socio-economic background presented to our tertiary hospital with right forearm multiple recurrent masses for the past 6 months. The child originates from the Southern Province of Rwanda and has been consulting different public health facilities and traditional healers without significant outcome. Upon consultation, he was complaining of multiple right forearm, moderately painful swellings with progressive increase in size. Fifteen months´ prior consultation he underwent tumor excision together with open reduction and internal fixation (ORIF) with plate and screws at a teaching hospital in his province of origin, after a tissue biopsy had confirmed the tumor as GCT. The surgery was done by an expatriate surgeon from a missionary campaign. Later after 3 months the tumor progressively relapsed and the parents re-consulted and were transferred to our tertiary hospital. His initial exhaustive clinical examination was done and revealed multiple right forearm swelling closer to previous right radial and volar incision  score of 27.Informed consent: we appreciate the parents of our patient who willingly gave us their permission and consent to publish this report.et al. [Apropos of pediatric group, diaphyseal giant cell tumor has only been described twice in the literature and one of them was made by Patel et al.  and probet al.  and the et al. ,8. The cProgressive pattern of pain with quite soft swelling has been similarly described in literature and the tumor fit the campanacci type III description referring to tumor invasion, cortical break through and soft tissues involvement ,2. The oet al. [et al. study found copious curettage while avoiding soft tissue contamination was a sufficient measure to prevent recurrence compared to inter-lesional curettage, with recurrence rate of 41.9% and 19% respectively [et al. although limited hand function [The present case was a relapsed bone GCT which correlates with the available literature findings reporting the incidence of recurrence amongst pediatric age group to be around 20% as reported by Puri et al. . The foret al. . Interesectively . Advanceectively . Use of ectively , albeit ectively . Recurreectively . Our afoEpi-metaphyseal GCT in adults is aggressive in nature with high recurrence rate. Sporadic incidence of diaphyseal GCT in skeletally immature population group can potentially alter early adequate treatment plan. Appropriate tissue biopsy is therefore primordial. Our case presented noteworthy traits: tumor appearance at such a tender age and diaphyseal location with multiple relapses. Long term evaluation of our patient will allow us to have a timely clinical assessment to depict any potential recurrence.


Radiation Recall Dermatitis (RRD) is an inflammatory process in the site of irradiation, induced by physical and medical agents. Few cases of RRD in the skin and lung have been reported after COVID‐19 vaccination. Here, we report radiation recall dermatitis after both doses of inactivated SARS‐CoV‐2 vaccine . Radiation recall dermatitis should be considered among the differential diagnoses of skin eruptions, in the appropriate clinical settings, after several kinds of COVID‐19 vaccinations, including inactivated SARS‐CoV‐2 vaccine . Few cases of RRD in the skin and lung have been reported after COVID‐19 vaccination. Here, we report radiation recall dermatitis after both doses of inactivated SARS‐CoV‐2 vaccine .Radiation recall dermatitis (RRD) is an inflammatory disorder triggered by some medications and physical agents at the site of previous irradiation. This reaction is reported in the skin and other organs, like lung, muscle, and intestine, and is mainly precipitated by anti‐cancer medications; however, other drugs can also induce RRD . Recently, a few cases of RRD have been reported after different types of COVID‐19 vaccine in the skin and lung.Here, we report a case of radiation recall dermatitis after inactivated SARS‐CoV‐2 vaccine , repeated after rechallenge in the second dose of vaccine.2A 50‐year‐old woman presented to our outpatient dermatology clinic with an erythematous, pruritic skin rash over the upper chest and neck one month before referral. The lesions started one week after the second dose of the SARS‐CoV‐2 vaccine . Similar lesions (less extensive and less symptomatic) had developed after the first dose of vaccine, injected three weeks before the second dose.The patient is a known case of breast cancer  of the left breast that had undergone radical mastectomy and post‐operation chemotherapy and radiotherapy 15 years ago. Since then, she has had a routine follow‐up without any relapse of breast cancer.On examination of the skin, relatively ill‐defined erythematous plaque with focal scaling and mild lichenification was observed on the upper chest, on the irradiation window area marked by tattoo Figure . A skin The differential diagnosis included erysipelas, carcinoma erysipeloides, and contact dermatitis. Erysipelas and carcinoma erysipeloides were excluded by lack of characteristic histological features. Contact dermatitis was a less relevant clinical diagnosis, due to the recurrence of rash at the previous radiotherapy site, and absence of recent exposure to any topical medication at the site of dermatitis or new systemic agent or medication.According to the clinical and histopathological features, diagnosis of radiation recall dermatitis was made, and she was treated with oral prednisolone (15 mg daily) for three days, once‐daily application of mometasone furoate ointment, and frequent daily application of emollient. The signs and symptoms improved in a 10‐day follow‐up Figure .The patient experienced no dermatitis after injection of the third dose of COVID‐19 vaccine, without pre‐ or post‐medication with steroids.The patient signed written informed consent to permit the publication of the case report without identifying data and to use the photography for publication. The researchers committed to maintaining the patient confidentiality. Institutional ethics committee approved the case report (ethics code: IR.sums.med.rec.1400.325).3The radiation recall dermatitis represents an inflammatory process triggered by different agents in the previously irradiated body area. The most common triggering agents are drugs, especially anti‐tumor ones. However, other medications have also been discussed as causes of RRD, including antibiotics,The radiation recall dermatitis had not been reported after any vaccination before the COVID‐19 vaccination was started. Few reports of RRD after COVID‐19 vaccination have been recently published.The previous cases of radiation recall dermatitis after COVID‐19 vaccination presented with well‐demarcated, erythematous, and indurated plaquesAlthough only some of the previous cases of radiation recall dermatitis have undergone skin biopsy, some common features are described in the reported cases, including vacuolar changes in the dermo‐epidermal junction, apoptotic epidermal cells, vascular dilatation, and dermal infiltration of lymphocytes and eosinophils.Ristić hypothesized the role of mast cells in the pathogenesis of RRD.The time lapse between radiation and RRD in our patient (15 years) was among the most prolonged periods presented in the literature,The recurrence of RRD on re‐exposure with the causative agent is controversial.The radiation recall dermatitis has been treated with oral and/or topical corticosteroids, antibiotics, emollients, and analgesics,4There may be an increasing incidence of RRD after the COVID‐19 vaccination. So, the physicians should be cautious about this diagnosis in patients previously treated with radiation and after the COVID‐19 vaccine injection to recognize and treat it promptly.The authors declare no conflict of interest.Mozhdeh Sepaskhah involved in clinical diagnosis of the case, treatment planning, writing the manuscript draft, and final version approval. Fatemeh Ansari Asl involved in data acquisition, patient follow‐up, critical review of the draft, and final version approval. Mehrnoosh Taheri involved in clinical diagnosis of the case, critical review of the draft, and final version approval. Mojgan Akbarzadeh Jahromi involved in pathological confirmation of the diagnosis, critical review of the draft, and final version approval.The researchers committed to maintaining the patient confidentiality. Institutional ethics committee approved the case report (ethics code: IR.sums.med.rec.1400.325).The patient signed written informed consent to permit the publication of the case report without identifying data and to use the photography for publication. The researchers committed to maintaining the patient confidentiality. Institutional ethics committee approved the case report (ethics code: IR.sums.med.rec.1400.325).


Emphysematous osteomyelitis (EO) is a rare condition characterized by the appearance of gas locules within the bone on imaging, usually as a result of anaerobic bacterial infection. We present the case of a 46-year-old known intravenous (IV) drug user who was admitted to the emergency department with intractable pain in the right groin. He was febrile with elevated white cell count and C-reactive protein. He underwent an X-ray and CT of the pelvis which demonstrated intraosseous gas in the proximal right femur. A diagnosis of EO was made radiologically, allowing for prompt antibiotic treatment and a plan for surgical debridement. There are only a handful of published cases of EO in the literature, only one of which has described IV drug use as the underlying factor. Emphysematous osteomyelitis (EO) is a rare form of infection characterized by gas locules within the bone. It is potentially life-threatening if not diagnosed and treated in time. Imaging plays a vital role in establishing the diagnosis and a CT scan is often required to guide timely management.A 46-year-old male presented to the Emergency Department with a history of fever and intractable pain in the right groin. The patient was a known IV drug user without any other underlying medical condition. He had multiple past hospital admissions for various reasons. The inflammatory markers including C-reactive protein and white cell count were elevated.He was referred to the Radiology Department for CT angiography of the lower limb arteries to exclude pseudoaneurysm because of frequent needle usage for drug administration. On CT, multiple air locules were noted within the proximal femur Figures , b, the The femoral vessels were intact. Linear metallic foreign objects were noted in the soft tissue of the groin on both sides, consistent with embedded needles Figure .An X-ray pelvis was performed on the same day as a baseline for future follow-ups, which showed multiple radiolucent areas in the soft tissue around the right hip Figure . A preliThe patient was subsequently transferred to a tertiary care hospital for surgical debridement. The culture of the debrided tissue grew anaerobic organisms, namely Finegoldia magna, a Gram-positive coccus and Actinomyces europaeus, a Gram-positive bacillus on enriched medium. He was treated with a long course of Clindamycin.On follow-up after eight weeks, the patient was afebrile and the inflammatory markers were within normal limits. On X-ray, the intraosseous gas had resolved, though subtle cortical changes from osteomyelitis were evident Figure .In 1981, intraosseous gas was first described as a sign of osteomyelitis by Ram et al. [Sulyma et al.  reviewedInvolvement of both axial and appendicular skeleton by EO have been reported, including lumbar vertebrae, femur , pelvic Imaging plays a crucial role in diagnosis, notably as the clinical differential for groin pain are wide. Plain radiographs are the mainstay of imaging in acute setting; however, diagnosis of intraosseous gas is challenging in them. CT, on the other hand, is highly sensitive in demonstration of the gas locules and is supported by the review of published case reports . MRI is Escherichia coli, Klebsiella pneumoniae, Enterobacter aerogenes, Clostridium spp and anaerobes such as Anaerococcus, Peptostreptoccocus, Fusobacterium [A wide range of causative organisms have been isolated in pneumatic osteomyelitis including acterium  etc. Botacterium .The spread of infection is usually hematogenous, though contiguous spread from skin or soft tissue, or following orthopedic or intraabdominal surgery  have alsEO is associated with significant morbidity and mortality, calculated at 34% in a review of available data from 41 cases . The manEO is a rare infection that can be associated with a poor prognosis, especially in patients with underlying comorbidities. Outcomes in the past have often been fatal despite multiple serial surgical debridement procedures. Imaging plays a significant role in early diagnosis prompting physicians to initiate appropriate lifesaving management plan, including broad-spectrum antibiotics to cover anaerobes and surgical treatment where needed.


Pyogenic granuloma (PG) is an uncommon lesion of unknown etiology. It may be formed following a minor injury. They result from a reactive or inflammatory process consisting of proliferating vascular channels, immature fibroblastic connective tissue, and scattered inflammatory cells rather than neoplastic process. Bleeding is the most common symptom of the lesion. They may be seen in all age groups, and there is no clear predominance of a gender. Vulvar PGs can be confused with other polypoid or sessile lesions of the genital site. There are only a few cases of female genital PGs reported in the literature. Herein, we describe the first case of vulvar  PG in an Iranian patient and a brief review of the literature in this regard. Lobular capillary hemangioma or pyogenic granuloma (PG) is a common acquired benign vascular lesion of the skin and mucous membranes. –3 PG is A 54-year-old married woman complained of an easy bleeding, nontender, relatively fast growing clitoral lesion since 6 months ago. She did not mention any genital injury or trauma lately. In past medical history, we did not find anything contributory. Physical examination revealed a 2.5 × 0.5 cm, pedunculated, erythematous, granulation tissue-like appearance lesion beneath the clitoral hood . VaginalPG results from a reactive or inflammatory process, and it consists of proliferating vascular channels, immature fibroblastic connective tissue, and scattered inflammatory cells rather than neoplastic process. The exact etiology and pathogenesis of these lesions are not fully understood. However, it is assumed that minor trauma (in 50% of patients), chronic local irritation, hormonal influences, viral oncogenes, underlying microscopic arteriovenous malformation, and production of angiogenic factors may play a role in formation of them . BleedinThese lesions may be seen in all age groups, and according to our literature review, there is no clear predominance of a gender . Based oPGs are considered to be benign. However, vulvar PGs can cause confusion with some benign and malignant genital lesions including warts, giant condylomas, Kaposi's sarcoma, basal cell carcinoma, malignant melanoma, lymphomas, bowenoid papulosis, verrucous carcinoma, acquired tufted angioma, epithelioid hemangioendothelioma and bacillary angiomatosis , 13. AppInvasive and minimally invasive treatments of PGs include surgical excision, curettage followed by electrocauterization, cryotherapy with liquid nitrogen, sclerotherapy, radiosurgery, silver nitrate cautery, microembolization, and lasers. Photodynamic therapy with 5-aminolevulinic acid has been used for single PG either , 13. SevThe current patient did not have an underlying cutaneous or systemic disease. She did not mention any trauma or minor surgeries at the vulvar region. Since the lesion was located just beneath the clitoral hood, we preferred not to use electrocautery in order to avoid probable thermal injury of clitoral neurovascular bundle. In the 6-month follow-up of the patient, tactile and sexual sensation of the clitoris was preserved and there was no recurrence at the surgical site. To our best knowledge, this is the first published report of vulvar PG in Iran. Due to the special role of the clitoris in female sexual function, we believe that in the management of the clitoral lesions, special care should be given to preserving dorsal clitoral nerve and associated vascular content. Meticulous dissection and minimizing electrocautery usage should be considered.Complete surgical excision and primary closure are the most advised and acceptable treatment of vulvar PGs . Since tAlthough the vulva is a rare location of PG formation, it should be considered as a differential diagnosis of any polypoid or sessile lesion at this site. Since it sometimes may occur with underlying diseases or malignant conditions, taking medical history and performing physical examination are recommended. Complete surgical excision and primary closure of the lesion are the medical treatment of choice with very low recurrence rate. In clitoral PGs, in order to avoid compromising the neurovascular bundle of the clitoris, meticulous dissection and preventing usage of electrocauterization are highly suggested.


Intramuscular hemangioma (IH) is rare, accounting for only 0.8% of all hemangioma cases. In particular, IH of the foot has only been reported a few times. In such cases, the symptoms typically include tenderness and swelling, often in relation to physical activity, but tingling or impaired function may also be present. Here, we report a patient who presented with a significant IH in the plantar area treated surgically. A 25-year-old female visited our hospital with pain in the plantar aspect of the right foot. She had noticed a mass about 10 years prior. She had previously experienced pain only when pressing the mass, but the pain subsequently became more regular pain and was exacerbated by exercise. In fact, the pain became so intense that she could not sleep well. Upon physical examination, mild swelling and tenderness of the plantar area were noted in the second to the fourth metatarsal. Sensation and motor reflexes were normal and the results of Tinel’s test were negative. Plain radiographs of the right foot revealed phleboliths scattered throughout the first to third intermetatarsal spaces. Magnetic resonance imaging revealed a space-occupying multilobulated mass (5.6 × 2.8 × 2.5 cm) located in the flexor digitorum brevis (FDB) muscle, which penetrated the plantar fascia and spread to the subcutaneous layer. In T2-weighted images, the lesion displayed a hyperintense signal compared to the surrounding skeletal muscle. Based on radiological findings, we suspected IH. The mass surrounded by the FDB muscle was exposed and completely removed via wide excision. IH consisting of cavernous-like vascular structures was diagnosed on pathology. At 1-year follow-up, the patient was almost asymptomatic and had recovered almost full range of motion in the plantar area. Histological analysis and surgery are recommended to remove intramuscular hemangiomas in the plantar area, but if the patient is not suitable for surgery, sclerotherapy or combination treatment should also be considered. Hemangioma is a common benign soft tissue tumor that accounts for 7–10% of all soft tissue tumors . The lowHere, we report a patient who presented with a huge IH in the plantar area that was treated surgically. This case report demonstrates a unique presentation of IH due to its rare localization of the foot.This case report was approved by the Institutional Review Board and Human Research Ethics Committee of Soonchunhyang University Cheonan Hospital (IRB No. 2020–03–004). The patient gave written informed consent for publication of this report and the accompanying images.A 25-year-old female visited our hospital with pain in the plantar aspect of the right foot. About 10 years prior, she had noticed a mass but ignored it, as she only felt pain on pressing the mass. However, over time, the pain became persistent and was also exacerbated by exercise. She could not sleep well due to the pain.The patient had a normal foot structure and no history of trauma. She did not have rheumatoid arthritis or other systemic diseases, did not take any medication, and did not have a history of steroid injections into the affected foot. The patient visited a local clinic and plain X-ray revealed calcification. Her pain continued to worsen and she was transferred to our hospital for further evaluation.Upon physical examination, mild swelling and tenderness were observed in the plantar area, from about the second to the fourth metatarsal. Though not visible, the mass was palpable. Sensation and motor reflexes were normal and the results of Tinel’s test were negative. Plain radiographs of the right foot revealed phleboliths scattered throughout the first to third intermetatarsal spaces . MRI revThe authors explained the sclerotherapy or surgery to the patient, but the patient requested surgery because the severe pain interfered with her daily life and was negative about multiple treatments. The preoperative visual analog scale (VAS) pain score and American Orthopedic Foot and Ankle Society (AOFAS) midfoot scale score were 7 and 87, respectively. We planned elective general surgery and explained the basic procedures to the patient. The patient was prepared in the prone position under spinal anesthesia. A longitudinal incision was made on the second plantar metatarsal shaft A. When wPostoperatively, the foot and ankle were immobilized for two weeks. The patient was allowed to perform light partial weight-bearing exercise within two weeks. After two weeks, full weight-bearing exercise was permitted. The patient reported no intermittent pain in the plantar midfoot after surgery. Histologic examination of the excised mass revealed cavernous-like vascular structures within skeletal muscle and adipose tissue, suggesting IH . At the IHs are benign vascular neoplasms of the skeletal muscle and the most common type of deep soft tissue tumor . IHs accThe pathogenesis of IH remains unclear. Several authors have suggested a congenital origin ,17, wherClinical findings of IHs are often similar to those of other soft tissue masses. A palpable mass is typically seen, and it may be asymptomatic or symptomatic, with symptoms including a progressive increase in mass size, persistent pain, functional disability, swelling, increased local temperature, and discoloration of the overlying skin by dilated veins, among others. Although rare, IH can also cause acute compartment syndrome .Various radiological imaging modalities can be used to diagnose IH . Plain rThere is still debate over the best treatment for these vascular tumors. Intramuscular sclerotherapy, a kind of radiotherapy, is one well-known option. Uslu et al.  reportedSurgical intervention is the treatment of choice for IH that allows a histopathologic study and reduces recurrence. However, incomplete resection carries a risk of recurrence  ,12,25. TBecause IH in the plantar area is so rare, there is currently no definitive treatment of choice. More study is needed on the pathogenesis, risk factors, recurrence rate, and complications of IH in the plantar area.We describe a case of IH in the plantar area. We extracted the tumor through surgery, and the patient had recovered almost completely within a few weeks of the operation. There is debate regarding the treatment of plantar hemangioma. When a patient is not a suitable candidate for surgery, sclerotherapy or combination treatment could also be considered.


To our knowledge, no studies have reported the use of anlotinib in the treatment of locally cancerous nasopharyngeal inverted papillomas that cannot be operated on or treated with radiotherapy. Here, we report a case of a 53-year-old woman diagnosed with recurrent local canceration of nasopharynx papilloma. Magnetic resonance imaging (MRI) showed that the right parapharyngeal space, nasopharynx, and ethmoid sinus were changed, and recurrence was considered. There was no indication for surgery or radiotherapy. Imaging showed that the tumor had obvious enhancement and abundant blood vessels. Immunohistochemistry showed that vascular endothelial growth factor receptor (VEGFR) 2 expression was positive in papilloma tissue and in local canceration tissue of the papilloma. After the patient’s consent was obtained, anlotinib treatment was started in May and ended in November 2019. Then, the patient was treated with intensity-modulated radiotherapy (IMRT) with planning gross tumor volume (PGTV) 66 Gy, planning clinical tumor volume 1 (PCTV1) 60 Gy, and planning clinical tumor volume 2 (PCTV2) 54 Gy in 33 fractions. No disease recurrence was reported at 4 months after radiotherapy. Inverted papilloma (IP) is a benign epithelial tumor of the nasal cavities and paranasal sinuses, and IP of the nasopharynx is rare. IP rates for sinonasal cavity tumors range from 0.4 to 7%. However, three main characteristics make it distinguishable from other sinonasal tumors: its strong invasiveness, high rate of recurrence, and association with carcinoma . StudiesThe reason for recurrent papilloma relapse is unknown. Radiotherapy and surgical resection are the main treatments. However, there is no good method for refractory IP. The early symptoms of NIP malignancy are not typical, and some patients do not pay enough attention to the symptoms. Most of the cases diagnosed as malignant lesions are diagnosed too late. When NIP invades the orbit, the base of the skull, brain tissue, and other parts, radiotherapy and surgical procedures become very difficult, resulting in tumors that are not easy to control. Therefore, it is urgent to develop effective and safe treatments for NIP region cancer patients who cannot undergo surgery or radiotherapy. Anlotinib hydrochloride is a new oral tyrosine kinase inhibitor independently developed in China that has the dual effects of inhibiting tumor angiogenesis and tumor growth , 4. To tA 53-year-old Chinese woman was admitted to the local hospital for repeated right ear pus with hearing loss in November 2016. The examination showed a new growth in the right external auditory meatus and left nasopharyngeal region. However, the patient did not have obvious nasal congestion, dizziness, headache, or other discomfort. Pathology revealed IPs in the nasopharynx and squamous papillary hyperplasia in the external auditory meatus with focal high-grade intraepithelial neoplasia. No distant metastasis was found on chest abdominal computed tomography (CT) or brain MRI. Surgical resection was performed. Since then, due to recurrence of the lesions in the nasopharynx and right ear, the patient underwent three operations in our hospital, and the postoperative pathology showed IP of the nose and papilloma of the middle ear. During this period, there was sometimes pus or bloody secretion in the right ear. On March 21, 2019, the patient went to our hospital again because of nasal obstruction, headache, and dizziness. MRI of the nasopharynx showed that the right parapharyngeal space, nasopharynx, and ethmoid sinus were changed, and the possibility of recurrence was considered  (vs 6.3 months) and PFS (5.4 months vs 1.4 months) were significantly prolonged by the single agent. The incidence of adverse events was similar to that of the control group, and the main adverse reactions were hypertension (64.6%), fatigue (46.3%), increased thyrotropin (44.6%), and hand-foot skin reactions (43.2%).Anlotinib is a new small molecule and multitarget tyrosine kinase inhibitor independently developed in China. It can strongly inhibit angiogenesis-related downstream pathways mediated by VEGFR, fibroblast growth factor receptor (FGFR), and platelet-derived growth factor receptor (PDGFR) and interfere with the proliferation and migration of endothelial cells to form lumen, thereby inhibiting the formation of microvessels, and can interfere with multiple biological processes of tumor cells through inhibition of mast/stem cell growth factor receptor (c-kit) . The inh(c-kit) . At pres(c-kit) , colorec(c-kit) , thyroid(c-kit) , renal c(c-kit) , soft ti(c-kit) , and othIn this case, the local canceration of nasopharynx IP occurred after multiple operations. The recurrence period was short (1–6 months), but there was no viral inclusion body, and HPV infection was not detected by gene sequencing.The patient’s primary tumor invaded the skull base, leading to side effects caused by the large target volume of radiotherapy. Chemotherapy was refused. We analyzed the genes in the tissue and found no common sensitive mutation. The immunohistochemistry results showed that the papilloma tissue and papilloma local canceration tissue were positive for VEGFR2 and that the expression intensities were the same (P < 0.05).VEGFR is highly expressed in many kinds of malignant tumors. However, there are few reports of the high expression of VEGFR2 in papillomas . In factThis case shows that anlotinib provides a new treatment option for locally cancerous nasopharyngeal IP patients who are unable to undergo surgery or radiotherapy. Future clinical research is needed to determine the proportion of patients with NIP malignant transformation and how extensively this kind of patient is represented among those who are treated with anlotinib.The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding author.Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. 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.PY: writing the article and analyzing the experimental results. GM, YD: pathological results analysis and image collection. QS, CL, and YL: Follow-up of medical records and immunohistochemical test. JL: plan making, publishing funds, article revision. All authors contributed to the article and approved the submitted version.Author YL was employed by company Genecast Biotechnology Co., Ltd.The remaining 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.


Melanoma in childhood is rare and its diagnosis is more difficult than in adults, as it often presents histologic features overlapping with the Spitz nevus. The authors report the case of a 17-year old boy who was first diagnosed with Spitz nevus, however, the final diagnosis made after the excision of the tumor arising in the scar was changed to melanoma. The case in this present study emphasizes the importance of the differential diagnosis of skin tumors in young patients. Spitz nevi are benign tumors usually arising during childhood as rapidly growing non-pigmented -pink or red papules or nodules most often of the lower extremities or on the face.A 17-year-old boy presented to the Specialist Medical Practice in Tychy, Poland, with a tumor increasing in the scar on the left thigh six months after surgical excision of a nevus in this site. The excised, pink 5-mm rapidly growing tumor had been subjected to histopathological examination and Spitz nevus had been diagnosed. The patient denied preceding trauma and a family history of melanoma. There had been no dermoscopy before the surgical procedure.Clinical examination of the red scar revealed the presence of the shining nodule in its lower segment. In dermoscopy, the polymorphic pattern was present with a predominance of linear irregular vessels . ConsideIn the 3-month dermoscopic follow-up of the scar, the polymorphous vascular pattern consisting of dotted and linear vessels was present. Moreover, in the lower segment of the scar, there was a pinkish structure so-called the “milky red area” . BecauseThe distinction of melanoma even from a clinically typical Spitz nevus is still challenging, mainly because their dermoscopic and even histopathological features can overlap. The lower extremities are the most common anatomic region for both Spitz nevi and Spitzoid melanomas.2The studied patient’s young age and negative family history raised the suspicion of Spitz nevus, however, the evolution of the scar, especially after the second excision was highly dubious, because the Spitz nevi have a low recurrence rate, even after incomplete excision.The histopathological examination still remains as the gold standard for Spitz nevus diagnosis although in some cases, even with the use of immunohistochemical markers, an entirely safe diagnosis cannot be made.This case highlighted that the pink, rapidly growing nodular lesions in a patient older than 12-years of age should be excised but with a mandatory preceding dermoscopy.None declared.Joanna Pogorzelska-Dyrbuś: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature.Beata Bergler-Czop: Approval of the final version of the manuscript; design and planning of the study; critical review of the literature; critical review of the manuscript.Maciej Kajor: Approval of the final version of the manuscript; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript.None declared.


Guidelines of rare synchronous tumours treatment are often unavailable due to lack of wide prospective studies. Additionally, their management is not just a simple sum of coexisting tumours management and has to regard many circumstances like symptoms, age, comorbidities, advancement.Herein, we report a case of an 81-year-old woman who presented with bleeding from the prolapsed uterus.Based on physical examination, that is, speculum examination, bimanual, and per rectum, followed by rectoscopy and histopathology, the diagnosis of cervical squamous cell carcinoma FIGO IIA2 in prolapsed uterus with anal canal adenocarcinoma cT1N0M0 was made.Dominating complaint of bleeding from prolapsed cervix was managed with radical vaginal hysterectomy in conjunction with wide colpectomy preceded by laparoscopic pelvic and paraaortic lymphadenectomy. Due to the lack of consent for removal of the anus, only radiotherapy was applied instead.The patient underwent magnetic resonance image follow-up. No recurrence was found at 18 months.Imaging is useful method of synchronous cancers diagnostics. These cancers may vary in aetiology and stage. Cervical cancer may be co-existing with another anogenital cancer. Therapy of synchronous cancers should be individualized taking into account patient's consent, age, physical condition, and comorbidities. The synchronous one occurs when the second primary tumour is diagnosed in less than 6 months of the primary cancer. In case this period is more than 6 months, they are referred to as metachronous tumours.Multiple primary tumours (MPT) are diagnosed when more than 1 tumour in the same or a different organ appears in 1 patient. The frequency of MPT ranges from 1% to 16% depending on primary localisation. According the Cancer Statistic, which estimated new cancer occurrence after primary one, patients suffering from cervical cancer (CC) have an increased risk of anal canal cancer (ACC), whereas those suffering from ACC have increased risk of CC. Despite the above data, studies on the coexistence of these neoplasms are rare. According to the authors of this study, there is only 1 report on the incidence of the synchronous CC in a patient with the ACC. The latter author emphasizes the difficulties in diagnosis and the lack of generally accepted guidelines for these synchronous neoplasms.One tumour increases the risk of another. Standardized incidence ratio (SIR) defines how many times the risk of another cancer is increased after the first neoplasm occurrence. Some etiological factors are responsible for this phenomenon and they include, although not exclusively, human papilloma virus (HPV) infections. In HPV-related cancer patients pooled SIRs for second primary cancers amounts to 1.75 . Correction of this pathology may be a part of the surgical treatment of this tumour.–9An additional factor that hinders treatment is the coexistence of cancer with other pathologies. Pelvic organ prolapse is a pathology that rarely coexists with CC. However, due to prolonged irritation of prolapsed organs, it may be involved in the etiopathogenesis of CC.2An eighty year-old female presented with bleeding from the prolapsed uterus. The patient was admitted to the department of Gynaecology/Obstetrics and Gynaecological Oncology of Hospital in Dębica, Poland. In an obstetric history, she reported 3 vaginal births, the last one at the age of 30. Last menstruation was at the age of 52. She did not complain of any past diseases or current chronic diseases, she did not report any addictions and remained in 1 relationship. On admission, a large part of the vagina containing the cervix and a part of the uterine body was found below the vaginal introits . Examination revealed an exophytic infiltrating lesions covering entire surface of hypertrophic cervix spreading to the vaginal fornices  of the rectal and anal canal wall. High signal on B-value diffusion-weighted MRI (B) with corresponding low signal on apparent diffusion coefficient (ADC) map (C) confirmed water diffusion restriction – a sign of malignancy , with clear peripheral margins. The perineural and vascular space involvement was identified. Out of 13 regional lymph nodes examined, 2 showed metastasis (2/13).Due to the refusal of both anal extirpation and adjuvant chemotherapy, after a multidisciplinary consultation, the patient was qualified for radiotherapy (RT). She was transferred to the Radiotherapy Department at the Regional Hospital in Tarnow. The RT was dedicated as definitive treatment for ACC and adjuvant therapy for CC. RT was delivered via a two-step 3D conformal technique. The lymph nodes affected by SCACC and regional lymph nodes of anal cancer were included in step 1 and the dose of 50.4 Gy in 28 fractions was delivered. In step 2, boost of 3.6 Gy in 2 fractions to the primary anal canal was added. As the patient did not want to undergo resection of the anus, we planned brachytherapy in the third stage, as a way of dose escalation. The prescribed dose was defined as 98% of the planning target volume that should receive 98% of the dose. organ and risks were contoured, including the peritoneal space (bowel bag), bladder and bilateral femoral head. All constrains of tolerance doses for organ and risks were maintained. The treatment was tolerated well, however, Common Terminology Criteria for Adverse Events (v4.0), including grade 2 diarrhoea and anal canal colitis, were demonstrated. RT was completed without discontinuation through treatment.MRI performed on 45 postoperative days after radical vaginal hysterectomy and RT demonstrated a complete response. No sign of previous-seen mass-like thickening of the rectal wall on T2-weighted images Fig. . DiffusiThe duration of follow-up was 6 months.Informed written consent was obtained from the patient for publication of this case report and accompanying images.3 It was worth noting, the case reported in this study was contrary to the one described by us, since the more advanced of synchronous tumours was ACC.To the best of the authors’ knowledge, no report on synchronous CC with prolapse and ACC is available in the literature. Only 1 study was found dealing with the abovementioned 2 synchronous neoplasms but without pelvic organ prolapse. On the other hand, the incidence of CC among patients with uterine prolapse is 0.14% to 1%.–12Coexistence of CC with pelvic organ prolapse is rare. It is estimated that 1% of CC patients develop uterine prolapse.The incidence of ACC is very low reaching 1.5:100,000 but rising, due to spreading of HPV and HIV, autoimmune disorders and cigarette smoking. In the presented case, HPV HR was identified only in 1 neoplasm – cervical SCC, not in the anal adenocarcinoma. Meanwhile, Saleem et al observed that women with HPV infection have a higher SIR of anal cancer. Several other studies have found HPV infection as an etiological agent of ACC.–19Synchronous neoplasms may have a common etiological factors, HPV infection being a well recognized one. A good example is HPV-associated synchronous neoplasms of the uterine cervix and the throat. On the one hand, it is associated with the lack of contact with vaginal secretions and such a “protective” role against carcinogenesis is suggested by some of the authors.Uterine prolapse may have an ambiguous impact on the aetiology of CC. CC occurs in the elderly women, in whom a prolapsed cervix is exposed to injuries that predispose to the process of carcinogenesis. more advanced cases are characterized by pain, hardening, ulceration, bleeding, fistulas, and weight loss.The presence of CC was evident and only needed to be confirmed with a biopsy. The diagnosis of cancer of the anal canal was more challenging because the patient described herein did not report any symptoms. This was due to the fact that in our case we were dealing with the early stage of this tumour. According to Durot et al, other useful diagnostic methods may be rectal endoscopic ultrasound, CT of the chest and abdominal cavity for the assessment of metastases and positron emission tomography. MRI will also determine the clinical advancement of CC. It should be noted that imaging methods, including MRI, were not approved by FIGO until the 2018 classification.The diagnosis of ACC was based on the obligatory per rectum examination to assess the CC stage and on the rectoscopic image with histopathology. Additionally, the diagnosis was confirmed with MRI. In our case, this examination allowed for an accurate diagnosis, staging and follow-up. According to Ferrer Marquez et al, In our case, the evidence of synchronous nonmetastatic character of the tumours was based on different histological forms of the neoplasms: squamous cell carcinoma and adenocarcinoma. According to Song et al, in the case of uncertain histology, further molecular tests  and cytogenetic analyses  are often required. In our case, the diagnosis of synchronous cancers based on clinical findings and histopathology was obvious.It is important to distinguish synchronous neoplasms from metastatic ones because synchronous neoplasms have a better prognosis and a different regimen treatment. In the case presented herein, the choice of the cancer that was treated first was conditioned by the presence of bothersome symptoms, that is, bleeding.Available literature lacks uniform guidelines regarding the treatment of synchronous cases of cervical and anal cancer. However, some general guidelines concerning the treatment of synchronous neoplasms are available in the literature. One of them suggests the second cancer to be treated in the shortest possible time.According to the current literature, a second primary tumor should be resected as early as possible, and its treatment should be similar to that of a single tumor. recommendations, we took into account the tumour stage, the patient's age and life expectancy, and decided to apply nonoperative methods.In our case, the patient refused to undergo surgical treatment of the second tumour, that is, the cancer of the anal canal. In line with Song et al4Most synchronous neoplasms do not have generally accepted management algorithms. First of all, it results from lack of wide prospective randomized trials. Additionally, it was due to different patient characteristics, comorbidities, patients’ therapeutic decisions, and the different stages of coexisting tumours.In the presented case, we have the coexistence of 2 rare cancers of the cervix with prolapse and cancer of the anal canal. An additional factor was the patient's refusal to consent to the removal of the anus. Due to the lack of treatment algorithms, the presented case may serve as an example of individualized treatment of neoplasms found in this study and an urgent call for robust study on personalized treatment in all synchronous tumours.Conceptualization: Andrzej Skręt.Data curation: Andrzej Skręt, Joanna Trawińska, Joanna Bielatowicz, Mariusz Książek, Andrzej Radkowski, Jaromir Kargol, Bogusław Gawlik.Formal analysis: Andrzej Skręt, Joanna Bielatowicz, Mariusz Książek, Beata Niewęgłowska- Guzik.Funding acquisition: Bogusław Gawlik.Project administration: Joanna Skręt- Magierło.Supervision: Joanna Trawińska.Visualization: Andrzej Skręt.Writing – original draft: Andrzej Skręt, Joanna Trawińska, Mariusz Książek, Andrzej Radkowski, Jaromir Kargol.Writing – review & editing: Andrzej Skręt, Joanna Trawińska, Joanna Bielatowicz, Mariusz Książek, Edyta Barnaś.


Sclerochoroidal calcifications is a rare condition corresponding to senile plaques due to the deposition of calcium and phosphate in the sclera and choroid. It is an elderly patient's pathology. In most cases, it is idiopathic. However, some patients have systemic disorders leading to disturbances in phosphocalcic metabolism, which are at the origin of this disorder. A check-up is therefore necessary to detect them.We report the case of a 65 year old patient admitted to the ophthalmology department for a renewal of optical correction. The patient is known to have articular chondrocalcinosis on anti-inflammatory medication. Fundus examination revealed multiple white supra macular choroidal lesions with tumour-like appearance in both eyes. The ultrasound perfomed showed the calcic nature of the lesions. Fluorescein and indocyanine green angiograms showed no sign of activity or presence of neovessels.A complete metabolic work-up, mainly phosphocalcic, was ordered again and the systemic diagnosis of articular chondrocalcinosis was retained.Shields et al. first described, in 1997, a case of sclerochoroidal calcification in a patient with chondrocalcinosis and a normal metabolic profile. Few more have been added to the literature. It is generally considered to be predominantly bilateral and is most often seen as yellowish lesions. Two types of calcifications have been described to date, the plaque type and the pseudotumor type. Given the asymptomatic presentation, a fundus examination should be performed in patients with chondrocalcinosis. Generally, no treatment is necessary.Sclerochoroidal calcifications usually manifests as multiple discrete yellow placoid lesions in elderly asymptomatic patients. Visual prognosis for sclerochoroidal classification is good since the lesions tend to be away from the macula. They should not be confused with choroidal metastasis or achromic melanoma which require more extensive treatment. The slit lamp examination showed a non-disturbing bilateral nascent cortical cataract and normal eye tone in both eyes. Fundus examination revealed multiple white supra macular choroidal lesions with tumour-like appearance in both eyes  Fig. 2]Fig. 2].FAn ultrasound scan was performed confirming the calcified nature of the lesions with a posterior shadow cone appearance .Fig. 3UlOn fluorescein angiography, the lesions spared the macular area in both eyes.They showed a hypofluorescent edge in the early sequence, but the choriocapillaris soaked normally and took on a normal dappled appearance, even slightly hyperfluorescent at the end of the sequence. No diffusion or pinpoint phenomena are visible at later sequences  Fig. 5]Fig. 5].FThe lesion is slightly hypofluorescent on indocyanine green angiography, but the choroidal vascularity is normal at early, middle and late stages  Fig. 7]Fig. 7].FOptical coherence tomography showed a normal retina and pigment epithelium but elevated especially on the right .Fig. 8OpA complete metabolic work-up, mainly phosphocalcic, was ordered again and the systemic diagnosis of articular chondrocalcinosis was retained.A family screening of the children and siblings was carried out but no ocular involvement was found.3In 1997, Shields et al.  describeIn this report we describe an isolated case of sclerochoroidal calcifications associated with articular chondrocalcinosis. The inheritance of sclerochoroidal calcifications has never been described; however, hereditary forms of chondrocalcinosis have already been reported.In our case, the patient had a 12-month follow-up showing no growth of calcifications and no progression to the macular area.Two types of calcifications have been described to date, the plaque type and the pseudotumor type .No study has shown the progression from plaque lesions to tumour-like lesions.In 1992, Schachat et al.  reportedIn contrast, in 2004, S. Boutboul et al.  describeWe suggest that every patient with articular chondrocalcinosis should have an ophthalmic fundus examination to look for sclerochoroid calcification. These lesions may progress over time with possible macular involvement, thus affecting the visual prognosis. Choroidal neovascularisation is also a vision-threatening complication of sclerochoroidal calcifications that should be investigated by requesting an angiography .4Sclerochoroidal calcifications usually manifests as multiple discrete yellow placoid lesions in the midperipheral fundus of asymptomatic elderly individuals. Although they do not require treatment apart from monitoring, they should not be confused with choroidal metastasis or achromic melanoma which require more extensive treatment. Visual prognosis for sclerochoroidal classification is good, as the lesions are typically located away from the macula and foveal encroachment is rare.This type of study does not require any ethical approval by our institution.This study did not receive any sources of funding.O.Nabih: drafting the article, study concept, writing the article. H.Hamdani: acquisition of data. L.El maaloum: study design. B.Allali: revising the article. A. El kettani: final approval.Patient provided written, retrospective consent for publication following detailed explanation of the purpose of manuscript and understanding that no identifiable information was going to be released.Name of the registry:Unique identifying number or registration ID:Hyperlink to your specific registration (must be publicly accessible and will be checked):O.Nabih.Not commissioned, externally peer-reviewed.The authors declare no conflict of interest.