Lipoleiomyomas are rare, fatty variants of leiomyomas (commonly referred to as fibroid), which are frequently found in the uterine corpus and cervix. Here, we present a case of a robotic inguinal hernia repair with resection of an incidental lipoleiomyoma.A 74-year-old woman presented to the office with complaints of pain and a palpable mass in the right inguinal region. Physical examination revealed tender, moderate-to-large bilateral inguinal hernias. Robotic bilateral inguinal hernia repair with mesh was performed. Intraoperatively, a mass measuring 4 × 3 cm was noted near the round ligament of the uterus. The mass was encapsulated without invading any surrounding structures. The mass was resected and sent to the histopathology department. The pathological evaluation identified a leiomyoma filled with mature adipocytes, compatible with the diagnosis of an extrauterine lipoleiomyoma.Lipoleiomyoma incidentally found in the inguinal canal is extremely rare. The medical literature regarding this incidental finding is limited. Resection of the mass was easily performed using the same robotic instruments as used for the inguinal hernia repair. Although uterine leiomyomas or fibroids can be found in 20-30% of women over 35 years of age , uterineA 74-year-old woman was referred to the surgical outpatient office for the evaluation of recurrent inguinal hernias. The general and systematic physical examinations revealed tense, moderate-to-large bilateral inguinal hernias on Valsalva approximately 3 cm in size which reduced on palpation. The diagnosis was purely clinical and no investigations were ordered. The patient had a previous surgical history of a hysterectomy, open appendectomy, abdominoplasty, and initial inguinal hernia repairs six years prior.A decision was made to perform a robotic bilateral inguinal hernia repair with mesh. Intraoperatively, a mass measuring 4 × 3 × 1.8 cm was noted in the right inguinal canal of Nuck, as the round ligament of the uterus exited the internal ring. The mass was encapsulated and did not invade any surrounding structures Figure . The hisLipoleiomyomas are rare, fatty variants of leiomyomas (or fibroids) and were first described by Meis in 1991 as a leiomyoma with an additional fatty component . InguinaLipoleiomyomas are known to be benign and can be treated conservatively . The surLipoleiomyomas are discovered incidentally during other procedures or when they cause discomfort . Unlike Inguinal swelling is typically attributed to inguinal hernias; however, other inguinal masses should also be in the differential diagnosis in women as recurrence and/or malignancies can arise from these rare tumors. There have been reports of other masses found incidentally during inguinal hernia repairs such as Meckel’s diverticulum and gastrointestinal stromal tumors ,11.This is a case of a lipoleiomyoma incidentally found in the inguinal canal during a bilateral inguinal hernia repair. To our knowledge, this is one of the few rare cases reported in the medical literature. Resection of the mass was easily performed using the same robotic instruments as those used for the inguinal hernia repair. However, we recommend broadening the scope of differential diagnosis when it comes to cases of inguinal masses in women.


StAR) gene. Patients classically present with adrenal crisis in early infancy and female external genitalia irrespective of chromosomal sex. We report 2 Chinese patients with normal female external genitalia presenting with salt wasting in the neonatal period. However, the diagnosis of CLAH was made only during pubertal years when they developed hypergonadotropic hypogonadism. One of them was subsequently found to have a 46XY karyotype and gonadectomy was performed at age 15 years. The other patient developed gonadal insufficiency and polycystic ovaries after menarche with hemorrhage into ovarian cysts requiring cystectomy. These 2 cases illustrate the importance of recognizing atypical features in neonates presenting with adrenal crisis. In managing the newborn with adrenal insufficiency and female-appearing external genitalia, the possibility of sex reversal and diagnosis of CLAH should be considered. Accurate delineation of internal pelvic organs using reliable imaging modalities or even laparoscopy, together with careful interpretation of clinical and laboratory findings, are crucial to accurate diagnosis and subsequent management.Congenital lipoid adrenal hyperplasia (CLAH) is a rare cause of adrenal insufficiency caused by mutations in the steroidogenic acute regulatory ( StAR) gene and is inherited in an autosomal recessive mode [Congenital lipoid adrenal hyperplasia (CLAH) is the most severe form of congenital adrenal hyperplasia (CAH), characterized by impaired synthesis of all gonadal and adrenal steroid hormones. It is caused by mutations in the steroidogenic acute regulatory  with no significant rise after synacthen stimulation (266 nmol/L at 30 and 249 nmol/L at 60 minutes) (9.6 μg/dL at 30 minutes and 9.0 μg/dL at 60 minutes). Paired adrenocorticotropin (ACTH) was elevated at 1635 pg/mL (360.0 pmol/L) . Plasma renin activity was greater than 20 ng/mL/hour  while plasma aldosterone was 900 pmol/L (32.4 ng/dL) . 17-hydroxyprogesterone (17-OHP) was 0.6 nmol/L (2 ng/mL). Ultrasound scan showed enlarged adrenal glands with indistinct corticomedullary differentiation. She was started on hydrocortisone and fludrocortisone for adrenal insufficiency. Repeated ultrasound scan at 8 months of life showed normal-sized adrenal glands, and she was thriving with normal growth parameters.At aged 12 years, she was noted to have no pubertal development and was later found to have primary gonadal failure . Ultrasound of the pelvis reported a very small uterus with both ovaries visualized, and the adrenal glands were noted as unremarkable. Karyotype subsequently came back to be 46, XY, with a repeated ultrasound of the pelvis showing similar findings. Laparoscopy was finally performed at age 15 years. Intraoperatively, no uterus was found and the gonads were normal in size with unremarkable pouch of Douglas. There was a 2.5-cm blind-ended vagina. Gonadectomy was performed and the pathology showed atrophic testes with no malignant changes. Testicular tissues with Sertoli cells and rare spermatogonia were seen within atrophic seminiferous tubules. Thick hyalinized basement membrane was observed around most of the tubules with no spermatogenesis seen. Epididymis and vas deferens were both present.StAR gene, confirming the diagnosis of CLAH. The family was counseled on the diagnosis and the patient was started on estrogen replacement therapy.Molecular analysis later revealed homozygous nonsense mutation (Q258x) in the A baby girl was born full term in the 1980s to a nonconsanguineous Chinese couple. There was an episode of hypoglycemia with jitteriness and a blood glucose of 1.1 mmol/L (19.8 mg/dL) in the first few hours of life, which was promptly treated with intravenous dextrose bolus. On the fourth day of life, hyponatremia (121 mmol/L) and hyperkalemia (5.7 mmol/L) were noted, which were corrected with intravenous fluid and sodium supplement.She developed recurrent vomiting with poor weight gain since the third week of life. Physical examination showed generalized hyperpigmentation but otherwise normal female external genitalia. Investigations showed a sodium level of 122 mmol/L and potassium level of 8.4 mmol/L with elevated paired urine sodium. Serum cortisol was low, whereas ACTH and plasma renin activity were elevated. She was treated for primary adrenal insufficiency with hydrocortisone, fludrocortisone, and sodium supplement. The condition stabilized and she had normal growth and development.The patient had breast development at age 11 years and menarche at age 13 years. Despite regular menstrual cycles initially, she developed oligomenorrhea 2 years after menarche.Gonadotrophins were elevated (LH 39 IU/L and FSH 8 IU/L) with low estradiol (41 pmol/L) (11.2 pg/mL), while 17-OHP and testosterone were both undetectable. Ultrasound of the pelvis showed enlarged ovaries up to 39.4 mL on the right side and 25.8 mL on the left side with multiple ovarian cysts of varying sizes measuring up to 2 cm in both ovaries.StAR gene, confirming the diagnosis of CLAH.She was started on cyclic medroxyprogesterone for regular withdrawal bleeding. LH level subsequently dropped from 39 IU/L to 19 IU/L in 5 years. FSH remained at the level of 5 to 6 IU/L while estradiol rose to 137 pmol/L (37.3 pg/mL). Repeated ultrasound scan showed gradual reduction in ovarian volume to 10 mL. Molecular analysis finally revealed homozygous nonsense mutation (Q258X) in the She presented with acute abdominal pain and fever at age 37 years. Pelvic ultrasonography showed a 4 × 4 × 4 cm multiloculated right ovarian cyst and a 6 ×6 × 6 cm left ovarian cyst.An urgent bilateral ovarian cystectomy was performed, with histopathology suggestive of follicular and endometriotic cyst, respectively. She was continued on medroxyprogesterone, and serial imaging 1 year post operation showed recurrence of a cystic lesion in the right ovary. The option of cystectomy was offered but the patient opted for conservative management and surveillance by ultrasound for the time being.StAR gene, which result in impaired cholesterol transport into the inner mitochondrial membrane and hence near absent or absent biosynthesis of all circulating adrenal and gonadal steroids [StAR mutations identified [StAR-mediated acute steroidogenic response as a result of the underlying mutation, with preservation of a low level of StAR-independent steroidogenesis. There is thus a compensatory increase in ACTH and LH levels, which causes accumulation of cholesterol and cholesterol esters in cells. This results in the second hit whereby the accumulated lipids and their autooxidation products damage cells and disrupt the StAR-independent steroidogenesis [We reported 2 Chinese girls with CLAH presenting with adrenal insufficiency and delayed puberty. CLAH is caused by autosomal recessive mutations in the steroids . It is aRetrospectively, there were several hints that could have led to earlier diagnosis. First, both girls presented with adrenal insufficiency in the neonatal period with normal female external genitalia. This is an unusual finding in the most common form of CAH caused by 21-hydroxylase deficiency, where excessive production of androgens leads to virilization of the female external genitalia . This atCYP11A1 mutations causing cholesterol side-chain cleavage enzyme (P450scc) deficiency and 3β-hydroxysteroid dehydrogenase 2 (3βHSD 2) deficiency also result in impaired production of glucocorticoid, mineralocorticoid, and sex steroid. Patients with deficient P450scc activity are clinically and biochemically indistinguishable from those with CLAH, but they typically lack the massively enlarged adrenals characteristic of CLAH [The abnormally low or even undetectable 17-OHP and testosterone levels in our patients, together with glucocorticoid and mineralocorticoid deficiency, suggested disorders in the first step in steroidogenesis with impaired biosynthesis of all 3 classes of adrenal steroids . Apart from CLAH,  of CLAH . As for The first patient was found to have enlarged adrenal glands initially. In fact, if further imaging, such as computed tomography or magnetic resonance imaging, was performed at that juncture, fat deposition in the adrenal cortex may have been identified and the diagnosis could have been made earlier. Similarly, accurate assessment of internal pelvic organs could provide more information on sex reversal. Limitation of ultrasound findings was demonstrated in our first case, where a repeated scan still showed “presence of uterus and ovaries,” and clinicians should recognize this in the evaluation and proceed to other imaging modalities or even laparoscopy when in doubt.As illustrated in our cases, accurate diagnosis is essential to guide subsequent management, including gender assignment and gonadectomy. Undoubtedly, in this era of genetics and genomics, with the advent of whole-exome sequencing and whole-genome sequencing technologies, there have been growing insights into the genetics of adrenal insufficiency and associated molecular mechanisms, and the diagnosis can often be easily made with molecular testing. However, clinical correlation, based on clinical, biochemical, and radiological features, is still essential.The phenomenon of multiple ovarian cysts with elevated LH/FSH ratio in our second patient has also been reported in other 46, XX girls affected by this disorder, although the underlying pathogenic mechanism has not been well studied . With acIn conclusion, a diagnosis of CLAH should be considered when newborns present with salt loss and normal-appearing female genitalia. Accurate delineation of internal pelvic organs using reliable imaging modalities or laparoscopy, together with careful interpretation of biochemical parameters, are crucial in reaching an accurate diagnosis and directing subsequent management.CLAH should be considered in newborns with adrenal insufficiency and normal-appearing female genitalia.Evaluation of glucocorticoid, mineralocorticoid, and sex steroid production is essential in one presenting with adrenal crisis.Limitations of ultrasound in the accurate delineation of internal pelvic organs should be recognized.Genetic analysis plays an increasingly important role in evaluation of adrenal insufficiency.Ovarian cysts and their associated complications should be monitored in CLAH.All authors made individual contributions to authorship: S.W.Y.P. prepared the manuscript and performed literature review on the topic; R.H.W.L. offered expert advice on gynecological management of the 2 patients; and J.Y.L.T. was involved in the clinical management of the index cases and supervised the manuscript submission.


A calcifying fibrous tumor (CFT) is a benign fibroblastic tumor of soft tissues occurring at all ages with no gender predilection. Earlier, it was called a pseudotumor. It may or may not present with symptoms. It can occur anywhere in the body - the most common sites are the stomach, pleura, and intestines. Our study is presented as a case of Intussusception in a young male with symptoms of pain, abdomen, and nausea. The patient underwent an excision of the tumor, and the tumor was examined histo-pathologically and immunohistochemically, showing spindle-shaped cells in dense collagenous tissue with mild inflammation. In this case, a study we are explaining the Clinical and morphological features of the CFT and how to differentiate it from other mesenchymal tumors. A calcifying fibrous tumor (CFT) is An uncommon benign mass lesion that was initially identified by Rosenthal  and AbduIt comprises abundant dense well-circumscribed hyalinized collagen with lymphoplasmacytic infiltrate, spindle cells, lymphoid aggregates, and psammomatous or dystrophic calcifications. Only 12 of the roughly 70 CFTs documented involve the gastrointestinal tract, making it uncommon . It is, A 26-year-old patient came to the emergency department complaining of pain in the abdomen for one month, complaints of constipation, and complaints of vomiting within 15- 30 minutes of food consumption for one month. Vomiting was non-projectile containing food particles as content, and which got aggravated for two days.The patient was evaluated clinically -and on examination, revealed diffuse abdominal tenderness; his dehydration was corrected, and an x-ray of the erect abdomen showed dilated bowel loops. Ultrasonography was done, which suggested an 11.0X3.7 cm oblong mass in the left iliac and hypo-gastric region consistent with small bowel intussusception. Routine clinical investigations were done, as shown in Table Contrast-enhanced computed tomography (CECT) of the abdomen suggested moderate to severe dilatation of the jejunum due to hypodense enhancing amorphous mass lesion arising from the jejunum with jejuno-jejunal intussusception, and the mass showed mild to moderate enhancement and likely polypoidal mass leading to intussusception Figure . The patDistal to the intussusception, the small bowel appears collapsed, intussusception was manually reduced, a 4x5cm firm mass noted intra luminally arising from the jejunal wall, resection, and anastomosis with a 2 cm margin was done, and the specimen was sent for histopathological examination . Plain abdominal radiographs are usually diagnostic of bowel obstruction in up to 86% of the cases, but in 20-30% of cases, further imaging (like CT or barium radiography) may be required. CECT aids in the identification of the location of the transition point, likely pathology.Based on the Clinical, Radiological, and Intra-operative Findings, we suspected the mass to be jejune-jejunal GIST leading to intussusception; hence R0 resection was done with a 1- to 2-cm macroscopic margin, which is sufficient to achieve microscopically negative margins . IntraluIn contrast to gastrointestinal CFTs, GIST cells are typically more cellular and have fibrillar stroma, whereas CFTs typically have hyaline in the stroma and lymphoplasmacytic infiltration. Spindle cells of GIST are positive for CD117, CD34, and DOG-1 and frequently display somatic KIT mutation .Shwannoma's paucicellularity, regions of hyalinization and calcification, and peripheral lymphoid aggregation can also make them look like CFT. However, schwannomas' spindle cells feature distinctive undulating nuclei and are S100-positive .IMT (Inflammatory Myofibroblastic Tumor) is histologically similar to CFT, but the fact that IMT uniformly stains smooth muscle actin differentiates it from CFT . TreatmeCFT has been predominantly considered a deep soft tissue tumor without malignant potential; its occurrence involving the GI tract is rare. Clinical and imaging findings are usually non-specific, and definitive diagnosis can only be made by histopathology and IHC.


Mycobacterium fortuitum is associated with skin and soft-tissue infections, yet isolated liver involvement is rare. A 67-year-old asymptomatic man was referred for endoscopic ultrasound (EUS) to evaluate a gastric lesion and an incidental liver mass. EUS revealed a heterogeneous liver mass that was sampled. Pathology revealed necrotic granulomatous inflammation and positive acid-fast bacilli stain with M. fortuitum deoxyribonucleic acid. Levofloxacin plus trimethoprim and sulfamethoxazole for 3 months were used for complete resolution of liver lesion. Isolated nontuberculous liver involvement is uncommon. We report the first case of a liver mass caused by M. fortuitum diagnosed by EUS-fine needle aspiration. Mycobacterium fortuitum is a type of nontuberculous mycobacteria belonging to a group classified as rapidly growing mycobacteria and Mycobacterium abscessus and Mycobacterium chelonae. These nontuberculous mycobacteria can be found in soil and aquatic environments. Mycobacterium fortuitum is an opportunistic pathogen characterized by biofilm formation as attributed to known antibiotic resistance.1M. fortuitum is predominantly associated with skin, soft-tissue, and surgical wound infections. Nosocomial infections such as catheter-related sepsis, prosthetic arthroplasty, and pacemaker infection have been fairly described. Disseminated diseases such as pneumonia, endocarditis, and meningitis can also occur.2 Isolated liver involvement by atypical mycobacterial infection is exceedingly rare. Here, we describe a case of M. fortuitum presenting as an asymptomatic liver mass.M. fortuitum deoxyribonucleic acid. The patient was treated with levofloxacin 750 mg daily plus trimethoprim and sulfamethoxazole (Septra Double Strength) 800–160 mg twice daily. Follow-up contrast-enhanced MRI revealed complete resolution of the liver lesion after 3 months of antibiotics  to evaluate a gastric body subepithelial lesion (SEL) and a 3 cm incidental liver mass described as a heterogenous enhancing liver lesion in the left liver lobe segment #2 and #3 Figures  and 2. H3 Initial percutaneous CT-guided liver biopsy was nondiagnostic and falsely negative in retrospect, either from sampling error or from insufficient tissue acquisition. Acid-fast staining is not included in routine histopathology workup unless infectious etiology is considered in the differential diagnosis. A study revealed a diagnostic accuracy of 86% CT-guided liver biopsy of small focal liver lesions: 3 cm.4 Percutaneous liver biopsy suffers shortcomings in diagnostic accuracy because of the requirements of a large sample, operator's skill, and sampling error.5 EUS findings showed a gastric mass extending to muscularis propria highly suggestive of a gastrointestinal stromal tumor or leiomyoma,3 the latter is at low risk for malignant transformation.6 Gastrointestinal stromal tumor has the potential to metastasize, but, in our case, the lesion was in the stomach, was small in size (less than 2 cm) with an asymptomatic presentation; therefore, this SEL was a low risk for malignancy and therefore managed with annual endoscopic surveillance.7Mycobacterium fortuitum has not been previously associated with liver involvement. By contrast, hepatic tuberculosis can emerge in a variety of presentations that include miliary tuberculosis, tuberculoma, pseudotumor, and abscess.The liver mass was initially believed to be evidence of a metastatic primary gastric tumor despite an isolated hepatic lesion found in the setting of a subepithelial lesion that is commonly found in routine examinations and usually benign in nature.8 EUS showed no well-defined fluid collections but rather a hyperechoic mass in favor of a hepatic tuberculoma. Like a hepatic tuberculoma, this hepatic mass resolved with antimicrobial agents and did not require drainage. Few publications describe isolated liver involvement by an atypical mycobacterial infection,10 but none are associated with M. fortuitum.Abdominal MRI showed hyperintensity on T2-weighted imaging sharing similarities with radiologic findings of a hepatic tuberculoma or abscess.M. fortuitum diagnosed by EUS-fine needle aspiration (FNA). Precise and accurate recognition by a minimally invasive technique such as EUS-FNA resulted in prompt treatment and resolution of the disease.Isolated liver involvement by nontuberculous mycobacteria is uncommon, usually asymptomatic, and its diagnosis can easily be missed or mistaken. We report the first case of a liver mass caused by Author contributions: Y-S. Jao: conceptualization, investigation, writing, review & editing, and project administration. L. Martinez and VJ Carlo: conceptualization, investigation, and validation. C. Micames: conceptualization, investigation, writing, review & editing, and supervision.Declaration of competing interest or financial support. Dr. Lemuel Martinez discloses being a speaker for Cubist Pharmaceuticals. Dr. Carlos G Micames has served as a consultant for Boston Scientific. The remaining authors have no financial interests disclosed related to this article.Notice of prior presentation of the case report at a professional meeting: The case report was presented on October 24, 2022, at the ACG national conference meeting in Charlotte, NC.Informed consent was obtained for this case report.


A 39-year-old man reported that he had experienced several short episodes of speech arrest and neologistic jargon aphasia in the last 6 months. He further described a noticeable limitation of his memory function. Convulsive seizures or loss of consciousness had not occurred. The patient presented without focal neurological deficits, speech disorders or apparent cognitive impairment. Cranial magnetic resonance imaging (MRI) revealed a left temporal lesion. Further epilepsy diagnostics were not performed in view of the clear causal relationship with the lesion.The multidisciplinary tumor committee recommended total resection of the left temporal lesion because a high-grade glioma was suspected. A temporal craniotomy was performed. The left temporopolar cortex overlying the tumor was removed. It was a well-demarcated and relatively solid tumor, and these features allowed uncomplicated circular resection along the anatomical tumor borders. Most importantly, dissection against the basal ganglia, usually the most challenging step in the resection of temporal gliomas due to the lack of clear anatomical boundaries, was simple given the clear tumor margins. In summary, the microscopic aspect of the tumor was atypical of a high-grade glioma and more closely resembled a brain metastasis. The intraoperative histopathology, however, suggested a malignant glioma.Postoperative MRI showed a complete resection of the contrast enhancing tumor. The patient recovered from surgery without new neurological deficits. An initial histological diagnosis of glioblastoma World Health Organization (WHO) grade IV, isocitrate dehydrogenase (IDH) wild type was made. Chemoradiotherapy with 54 Gy to the tumor region and six cycles of temozolomide were administered. The patient returned to full-time employment and reported no recurrence of speech disturbances or memory impairment.Ultimately, the diagnosis was reversed from a glioblastoma WHO grade IV glioma to the final histological diagnosis based on the molecular characteristics of the tumor. The therapy had been adapted accordingly, and the further course of the disease was monitored by MRI. No recurrence was observed at 6 months after surgery.arrow). Especially the lower part of the lesion showed no contrast enhancement . On diffusion-weighted MR images , the lesion showed signs of restricted diffusion . Note the central and well-demarcated signal loss . This area within the lesion  also appeared hypointense on T2*-weighted images . This area may correspond to either local calcification or intralesional hemorrhage. We could not reliably distinguish the two on the basis of the MR images. Unfortunately, we did not perform a preoperative computed tomography (CT) scan.Magnetic resonance imaging (MRI) showed a space-occupying intra-axial lesion of the left temporal lobe Figs. , 2 and 3Glioblastomas are high-grade, fast-growing, diffusely infiltrating astrocytomas, classified as CNS WHO grade IV neoplasms, with a poor prognosis , 2. GlioOligodendrogliomas are diffuse infiltrating gliomas classified as WHO CNS grade II–III neoplasms, with the molecular hallmark feature of IDH mutation and 1p19q codeletion , 6. OligGiven the age of the patient in the present case as well as the calcified alterations, an oligodendroglioma has to be considered as differential diagnosis, although the temporal and mostly subcortical location as well as the relatively well-circumscribed and enhancing appearance is not typical for an oligodendroglioma.Dysembryoplastic neuroepithelial tumors (DNET) are slowly growing, well-circumscribed, cortically based tumors, classified as CNS WHO grade I neoplasms , 7, 8. ODue to the calcification and inhomogeneous enhancement of the lesion in the present case as well as the missing “bubbly” or cystic component, the diagnosis of a DNET is less likely.Pleomorphic xanthoastrocytomas (PXA) are rare astrocytic tumors, classified as WHO CNS grade II–III tumors, depending on the histological features . UsuallyDue to the described imaging features of PXAs, the diagnosis is less likely in the present case, as a solid enhancing nodule with cystic component and leptomeningeal involvement are absent; however, due to the occurrence in the temporal lobe, the diagnosis of PXA must be considered.Gangliogliomas are rare tumors of the central nervous system (CNS), usually low grade, and reveal a combination of neuronal and glial cell elements with a variable morphological spectrum , 12, 13.In the present case the tumor is characterized by a solid mass in the temporal lobe with calcified alterations and inhomogeneous enhancement, thus, and due to the various appearance of gangliogliomas, this differential diagnosis has to be taken into account.An angiocentric glioma is a rare low-grade diffuse tumor entity with angiocentric pattern, usually affecting children and young adults . They tyDiffuse astrocytomas are low-grade diffusely growing neoplasms, MYB-altered or MYBL1-altered, and commonly arise within the cortex or subcortex of the temporal and frontal lobes , 16, 18.Polymorphous low-grade neuroepithelial tumors of the young (PLNTY) were firstly described in 2017 by Huse et al. . PLNTYs Hematoxylin and eosin staining of the formaldehyde-fixed and paraffin-embedded biopsy material revealed a pleomorphic glial tumor with necroses and microvascular proliferations Fig. a, scatteH3 G34 mutant, have mutations of the histone H3-3A gene and a characteristic methylation profile [Differential diagnoses included high-grade gliomas, astrocytoma, oligodendroglioma, diffuse pediatric-type high-grade glioma, H3-wildtype and IDH-wildtype, diffuse hemispheric glioma, H3 G34-mutant, and some rare neuroectodermal tumors with a diffuse growth pattern. These differential diagnoses are characterized by pleomorphic tumor cells with broad morphological overlaps. Therefore, additional molecular testing was required . Methyla profile . Diffuse profile . Additio profile . As the IDH and histone H3 genes. The copy number profile revealed signs of genomic instability with gains of genomic material on several chromosomes including chromosome 7 and chromothripsis on chromosome 10. A combined loss of the chromosome arms 1p/19q was not found. Next, an 850k methylation array analysis was performed. Classification with the Heidelberg brain tumor classifier version 12.5 failed to generate a match with the established methylation classes [Molecular testing showed a TP53 loss of function mutation, a common finding in high-grade gliomas. Wild-type alleles were found in the  classes . Unexpec classes .BRAF, FGFR2, FGFR3, and, rarely, NTRK genes [In 2016 Huse et al. reported a new type of epileptogenic tumor and named the entity as PLNTY . PLNTYs RK genes , 20, 28.RK genes . ConversTP53, ATRX, PTEN, and TEK genes [Due to a relative scarcity of reported cases, prognostic evidence on PLNTYs is limited to date. Accurate diagnosis is critical in predicting clinical behavior and developing a treatment plan. In a published case series the majority of PLNTYs showed a clinical behavior consistent with CNS WHO grade 1 tumors with rare recurrences after gross total resection . Given tEK genes .In summary, the present case is diagnosed as PLNTY, CNS WHO grade 1; however, the pleomorphic histopathology and the identified TP53 loss of function mutation suggest that the tumor has undergone a malignant transformation warranting frequent follow-up controls.


Haematospermia is a relatively uncommon condition that can be caused by a variety of factors, including infection, inflammation, trauma, and neoplastic disease. Bleeding from the seminal vesicle is considered to be a rare cause. We present a case of a 65-year-old man who had repeated episodes of haematospermia over the previous few years. Initial physical examination was unremarkable. Laboratory tests, including coagulation profile and prostate-specific antigen level, were within normal limits. A magnetic resonance imaging scan of his pelvis revealed a right seminal vesicle haemorrhage as the cause of his haematospermia. The patient was reassured and was managed conservatively. Haematospermia, which is the presence of blood in semen, can cause distress and anxiety in sexually active males and their partners. It is a relatively rare urological symptom, accounting for about 1% of cases .A 65-year-old man with no previous medical conditions and not taking anticoagulants presented to the urology clinic at Suez Canal University Hospitals with intermittent episodes of self-resolving haematospermia over several years. When the patient presented with daily persistent haematospermia for a week, he was referred on a two-week wait pathway. A detailed examination, including a digital rectal exam of the prostate, found no noteworthy issues, and bleeding from his female partner was eliminated as a possible cause. Prostate-specific antigen (PSA) blood test, urine culture, semen culture, and flexible cystoscopy were all performed, but no abnormalities were detected. As the patient continued to experience haematospermia even after masturbation, a pelvic MRI was performed to rule out any hidden intrapelvic conditions. The MRI revealed a subacute haemorrhage in the right seminal vesicle, with a high signal intensity on the T1-weighted sequence and a low signal intensity on the T2-weighted sequence. No focal enhancing lesion was found, and it was determined that this was the cause of the haematospermia (Figures Haematospermia commonly affects young males and is usually a benign and self-limited symptom that can be managed with basic investigations and simple treatments. However, in some cases, it may indicate urogenital malignancy, particularly in patients over 40 years of age or those with persistent or recurrent symptoms. Therefore, further investigations are required. Imaging and endoscopic examinations are necessary to make a definitive diagnosis and provide appropriate treatment. MRI of the pelvis is an excellent diagnostic tool for investigating the underlying cause of haematospermia .In this case, the MRI findings revealed subacute haemorrhage in the right seminal vesicle, with high signal intensity in T1-weighted sequence and low signal intensity in T2-weighted sequence, which is influenced by the magnetic properties of iron and the integrity of the red blood cell membrane. Iron is diamagnetic when oxygenated and paramagnetic when deoxygenated, and in its paramagnetic state, iron atoms shorten the T1 and T2 relaxation times, with a greater effect on T1-weighted images . The evaThe bleeding from the seminal vesicles can be caused by various factors, such as trauma, infection, inflammation, or tumours. Inflammation or infection of the seminal vesicles is known as vasculitis, which may result in pain in the groin, fever, and blood in semen. Studies have shown that vasculitis is an infrequent cause of haematospermia, accounting for only 2% to 5% of cases . TumoursThe potential for urological malignancy to cause haematospermia, especially in patients over 40 years of age, was also highlighted in studies by Zhao et al. and Suh et al., which found cases of prostate cancer, seminal vesicle cancer, and bladder cancer among patients with haematospermia, as well as common calcifications in the prostate, seminal vesicles, and ejaculatory ducts ,10. ThesSeminal vesicle bleeding is a rare cause of haematospermia, with vasculitis and tumours being the most common causes. MRI is a useful diagnostic tool for determining the underlying cause of haematospermia, and treatment depends on the cause. In most cases, conservative treatment is sufficient and includes antibiotics or anti-inflammatory medications. It is also important to consider the possibility of the female partner as the source of bleeding in sexually active patients and rule it out.


Inguinal hernia is the most commonly diagnosed hernia, with approximately one out of every three males eventually being diagnosed with an inguinal hernia. Amyand's hernia is a subtype of an inguinal hernia that occurs when the appendix is located within the hernia sac. It is an uncommon condition that is usually discovered as an incidental finding in less than 1% of all patients with inguinal hernia. The management options for this condition will vary depending on the presence or absence of appendicitis. This case report highlights a rare occurrence where a patient with a left-sided scrotal swelling was found to have a left-sided Amyand's hernia that was eventually managed without complications. Amyand's hernia is an uncommon variant of inguinal hernia where the appendix resides within the hernia sac. It is named after Claudius Amyand, the surgeon who first identified this condition . The incAn 81-year-old male patient known to have diabetes mellitus type 1 on insulin therapy and arterial hypertension with no history of prior abdominal surgeries presented with a scheduled appointment to the surgical outpatient clinic with a longstanding history of left-sided inguinal swelling and a history of pain that was progressively worsening in the last four days before presentation (Figure The patient underwent a Lichtenstein tension-free mesh hernia repair, during which a suction drain was placed and spinal anesthesia was administered. The intraoperative examination revealed a large, approximately 30 cm by 15 cm left-sided hernia containing a loop of the terminal ileum, cecum, and appendix Figure .The postoperative course was uneventful. The drain was removed on the second postoperative day and the patient was discharged without complications. The patient was followed up in the surgical clinic and remained asymptomatic six months postoperatively.Amyand's hernia is a rare form of inguinal hernia that was first described by Claudius Amyand in 1735. The appendix, which is normally located in the right lower quadrant of the abdomen, can herniate through the inguinal canal and be incarcerated within the hernia sac. The incidence of Amyand's hernia is estimated to be 1% of all inguinal hernias  though oThe clinical presentation of Amyand's hernia is highly variable and depends on whether the appendix is inflamed or not. An inflamed appendix within the hernia sac can cause acute appendicitis, which presents as acute abdominal pain, fever, nausea, vomiting, and leukocytosis; in some cases, it may lead to incarceration, strangulation, necrosis, perforation, or rupture. Early symptoms include tenderness and inguinal swelling, which may be misdiagnosed as a strangulated hernia. This condition can be difficult to diagnose clinically ,5.Imaging studies, such as ultrasound and CT scans, can aid in the diagnosis of Amyand's hernia. Ultrasound can detect the presence of an inguinal hernia and identify the appendix within the hernia sac. A CT scan can provide high-resolution images of the hernia sac and the appendix and can differentiate between an inflamed and non-inflamed appendix .The management of Amyand's hernia depends on the clinical presentation and whether the appendix is inflamed or not. In case of an inflamed appendix, early surgical intervention is recommended to prevent complications such as perforation, abscess, and sepsis. An appendectomy can be performed either through an open or laparoscopic approach, depending on the surgeon's preference and the patient's condition. The hernia can be repaired simultaneously with appendectomy using either a mesh or non-mesh technique, depending on the surgeon's preference and the patient's risk factors . The useAmyand's hernia is a rare form of inguinal hernia that can pose a diagnostic and therapeutic challenge. It usually occurs in the right inguinal region. A high degree of clinical suspicion and prompt radiological investigation can aid in the diagnosis of Amyand's hernia. However, as shown above, it may present on the left inguinal region in patients presenting with large inguinoscrotal hernias. Early surgical intervention is recommended, especially in cases of an inflamed appendix, to prevent complications and ensure a good outcome.


In this case report, we discuss the rare presentation of a 56-year-old-gentleman with a history of light chain amyloidosis (AL), causing colonic pseudo-obstruction and requiring open subtotal colectomy and end ileostomy. This should remain a differential diagnosis in patients with known light chain AL presenting with nonspecific gastrointestinal symptoms such as constipation and abdominal pain. This prompts early investigation, such as endoscopy and tissue biopsy, and surgical intervention may be warranted. Amyloidosis (AL) is an umbrella term used to describe a group of rare and complex diseases caused by the abnormal deposition of insoluble extracellular proteins in tissues . It can There are two main pathophysiological processes of AL which contribute to colonic stasis; alteration of the intrinsic nerve plexus, as well as damage to the mucosal vasculature, which can lead to reduced intestinal peristalsis , 4. ThisHere, we discuss the rare presentation of a 56-year-old-gentleman found to have acute colonic pseudo-obstruction secondary to light chain AL, requiring open subtotal colectomy and end ileostomy.A 56-year-old gentleman from home presented with a 1-day history of fever, nonproductive cough, shortness of breath, and constipation over the last few weeks. He had a complex past medical history, including AL and multiple myeloma, being treated with immunotherapy and chemotherapy , as well as recurrent right pleural effusion due to AL, thalassemia minor, atrial fibrillation, and obstructive sleep apnoea.He was initially admitted under the haematology team with consultation from infectious disease and respiratory teams for management of persistent right pleural effusion for which he required a right intercostal catheter and bronchoscopy.A week later, the patient reported new central abdominal pain with associated nausea and his last bowel action was almost 1 week prior. On examination, his abdomen was distended with generalized tenderness, but there was no peritonism. He was subsequently treated with regular oral laxatives, but with no improvement. A computed tomography (CT) abdomen and pelvis with oral and intravenous contrast was performed, which demonstrated marked faecal loading in the ascending and transverse colon with no convincing evidence of mechanical bowel obstruction .The colorectal team was consulted, and the patient received increased doses of aperients and suppositories as well as regular abdominal X-ray screening to monitor for colon dilatation. Despite this, the patient had minimal clinical improvement with ongoing abdominal bloating and pain and lack of bowel action, presenting a clinical dilemma of pseudo-obstruction, or AL with colonic involvement. A decision was made to proceed with flexible sigmoidoscopy, which found distended colon with faeces in the lumen, no mucosal changes to suggest ischaemia, and no obvious mechanical obstruction .A subsequent gastrograffin study was performed the next day with persistent contrast in nondilated small bowel at 8 hours and nil therapeutic clinical improvement .The patient was a high-risk surgical candidate, given his comorbidities, malnutrition, and sarcopenia. He was commenced on parenteral nutrition, and a consensus decision was made to trial neostigmine to help alleviate his pseudo-obstruction. He was transferred to intensive care for close monitoring and for administration of neostigmine. Despite the several doses of neostigmine, there was no real clinical improvement, and a decision was made to proceed to surgical intervention, with the hope of performing a decompressing loop ileostomy.Intraoperatively, there was massively dilated caecum and transverse colon, with a large caecum serosal tear and multiple transverse colon serosal tears as well as a contained perforation at the hepatic flexure. The small bowel was nondilated, and there was general tapering of the left colon. A subtotal colectomy with end ileostomy was performed. Histopathology confirmed ischaemic colitis with ulceration, perforation, and peritonitis as well as a positive Congo red stain consistent with extensive AL involving blood vessels, bowel wall, and fat .Postoperatively, the patient recovered well, with initially high stoma output which settled with titration of loperamide. Patient was discharged to a rehabilitation service for ongoing optimization of physical strength and mobility.Light chain AL is a systemic condition caused by haematologic malignancy, in which there is an abnormal high production of light chains produced by plasma cells in the bone marrow. It is also associated with multiple myeloma in ~15% of cases [The pathogenesis of AL and gut dysmotility is thought to be due to mucosal or neuromuscular involvement; however, this varies between different causes of AL , 6. In pThe gold standard for diagnosing AL requires tissue biopsy of the affected organ with Congo red staining, with a positive result confirming the diagnosis. This is typically referred to as the ‘apple green birefringence’ in polarized light, as demonstrated in Therefore, in patients with suspected GI AL, endoscopy can be performed to acquire tissue biopsy to confirm the diagnosis, given there may be limited mucosal changes visible to the endoscopist. Imaging modalities to assess for systemic AL with very high sensitivity include whole-body 123I-labelled serum amyloid P scintigraphy [AL with colonic involvement is a rare presentation, which can potentially progress to acute surgical abdomen, including bowel obstruction and perforation. Therefore, it should remain a differential diagnosis in patients with known AL presenting with nonspecific GI symptoms such as constipation and abdominal pain.All authors are in agreement with the contents of this submitted manuscript and that this manuscript is not being published or considered elsewhere. The authors are either in process of surgical training or have obtained FRACS in General Surgery. In addition, verbal consent was obtained from the patient and permission was gained for the use of images in this manuscript.The study is not funded.The data underlying this article are available in the article and in its online supplementary material.


Schwannomas are the most common type of benign peripheral nerve tumor in adults. Schwann cells assist in the conduction of nerve impulses and wrap around peripheral nerves to provide protection and support. Schwannomas typically arise from a single fascicle within the main nerve. Although they can occur anywhere in the body, nasal schwannomas are exceptionally rare.This case study presents a 65-year-old Caucasian female who had been experiencing obstructive nasal symptoms for three months. The in-office physical examination revealed a soft tissue expansile mass involving the submucosal tissues of the bilateral anterior nasal cavity, located just posterior to the columella. The mass was surgically excised in the operating room, and the diagnosis was confirmed through histopathology.With only 32 reported cases, nasal septal schwannomas are exceedingly rare. Diagnosis relies on histopathology for confirmation. However, their clinical presentation can mimic other sinonasal pathologies. A septal schwannoma should be considered as a differential diagnosis for a unilateral sinonasal mass. Complete excision is the definitive treatment and is associated with a low recurrence rate. The patient had no signs of reoccurrence on nasal endoscopy three months postoperatively. Surveillance MRI will be completed at one year. A schwannoma is a benign nerve sheath tumor that can arise from any myelinated nerve fiber. It affects fewer than 200,000 people, and the typical age range of affected individuals is between 50 and 60 years. There is no recognized sex or racial predilection . Head anA 65-year-old female was referred to the Ear, Nose, and Throat clinic by her primary care provider for evaluation of a sinonasal mass involving the anterior nasal cavity. The mass was first noticed four months prior and had been progressively enlarging, causing nasal obstruction. She denied any significant pain, rhinorrhea, numbness, epistaxis, anosmia, history of squamous or basal cell carcinoma, or any history of trauma to the area. Her past medical, family, and surgical histories were noncontributory.On examination, she was noted to have a soft expansile mass involving the submucosal tissues of the bilateral anterior nasal cavity, just posterior to the columella. Initially, the mass appeared to be a cystic lesion. The nasal septum was otherwise midline, with no appreciable mucosal edema or discharge observed during the examination.The mass moderately obstructed the nasal aperture bilaterally and was increasing in size. Fine-needle aspiration was performed, which yielded no significant fluid or blood. The specimen was sent for pathological cytological interpretation. The cytology report demonstrated rare, atypical cells. Based on the growth velocity observed over a four-month period and the pathological findings, a recommendation was made for intraoperative excision.The patient was taken to the operating room for excision of the anterior nasal cavity mass. There was prominent bulging soft tissue involving the anterior nasal cavity bilaterally, just posterior to the columella. The expansile lesion was moderately obstructing the nasal aperture. A pale-colored lobulated soft tissue mass, measuring approximately 2.5 × 1.5 cm in its greatest dimensions (Figure A gross examination of the anterior submucosal mass revealed a 2.1 × 1.7 × 1.1 cm brown-tan, rubbery, polypoid segment of soft tissue. Histological analysis was positive for S100, supporting the diagnosis of a schwannoma.One month postoperatively, the widening of the anterior septal mucosa had resolved after excision. The right-sided incision had healed, and there was no edema. The patient reported improved nasal obstruction and no cosmetic deformities. There was no evidence of recurrence on nasal endoscopy at her three-month follow-up.Schwannomas are the most common type of benign peripheral nerve tumors in adults. While 25%-40% of all schwannoma variants occur in the head and neck region, anterior nasal septal schwannomas are exceedingly rare, with only 32 reported cases [Clinically diagnosing a sinonasal schwannoma is difficult due to its vague presenting symptoms and broad differential diagnoses. The most common symptoms of nasal schwannomas include discharge, nasal obstruction, epistaxis, and anosmia . Given tDue to the wide variety of potential pathologies causing unilateral nasal obstruction, it is challenging to make a diagnosis based solely on imaging. However, MRI imaging sequences are used to aid in the diagnosis of schwannomas. On MRI, schwannomas typically appear as well-circumscribed masses that displace adjacent structures without direct invasion . Common The diagnosis of schwannomas can only be confirmed through histopathology . MacroscAs in this case, the treatment of choice for schwannomas is complete surgical excision. Depending on the tumor location, surgical excision can be achieved through endoscopic endonasal surgery or lateral rhinotomy. The endoscopic approach is considered the standard surgical approach due to its ability to visualize the mass and avoid external incisions. The need for intraoperative imaging depends on the location of the schwannoma .Recurrence of schwannomas is rare, but it is important to monitor patients in the short and long term. In this case, the patient did not experience recurrence at the three-month follow-up. An MRI is scheduled for one-year post-operation to evaluate for any signs of recurrence .Nasal schwannomas are very rare. Their presenting symptoms are common sinonasal complaints, making the differential diagnosis extensive. The office workup typically includes nasal endoscopy and/or fine-needle aspiration, depending on the location of the mass. A preoperative MRI can confirm whether the mass is of neurologic origin. Diagnosis requires surgical excision and histological evaluation. Endoscopic endonasal surgery is the standard treatment for nasal schwannomas. These tumors are benign masses with low recurrence rates following excision, and resection is considered curative. Surveillance with MRI at one, five, and ten years postoperatively is recommended for monitoring.


Surgery was not indicated due to the difficult transsphenoidal access and the absence of major clinical symptoms.Hypothalamic hamartomas are benign tumors composed of ectopic neural and glial tissue. They have a low prevalence and are usually associated with central precocious puberty or epilepsy with gelastic seizures. The presentation beyond childhood is rare, and the symptoms are not the same as in childhood. Here, we report the case of a woman who presented with secondary amenorrhea and headaches revealing a giant hamartoma of the tuber cinereum (TC). The hormonal assessment showed moderate hyperprolactinemia. Synacthen testing was normal. Magnetic resonance imaging revealed a suprasellar hamartoma on the TC measuring 20 mm with sellar extension. The optic chiasma and cavernous sinuses were clear. Hyperprolactinemia was explained by mechanical compression of the pituitary stalk. The patient started cabergoline orally (1 mg per week) Hamartomas are benign tumors consisting of tissue elements normally found at the same organ site, but growing in a disorganized manner . HamartoA 23-year-old woman presented to our department with secondary amenorrhea associated with a few headaches. The medical history revealed that the patient had her first period at the age of 19, her menstrual cycle was normal and presented one year after a spaniomenorrhea. Her medical history was significant for recurrent headaches. She had no polyuria or polydipsia.On examination, there was no hirsutism, no signs of hypothyroidism or hypogonadism with a strictly normal neurological exam. There was no evidence of galactorrhea or abdominal mass. Transvaginal ultrasound showed a normal anteverted uterus. Her blood pressure was 120/76 mmHg. Her weight was 75kg with a body mass index of 30 kg/m². Initial laboratory data revealed a negative human chorionic gonadotropin level.Biochemical investigations Table  showed nSynacthen testing showed a normal adrenal response (cortisol >180 ng/mL). A luteinizing hormone-releasing hormone (LHRH) test was made with 100 μg of LHRH injected intravenously, which showed a normal gonadotrophin response excluding the pituitary cause of the secondary amenorrhea Table . HyperprAn MRI revealed a homogenous suprasellar hamartoma of the TC measuring 20 mm, with sellar extension Figures -2. Both The patient was started on cabergoline with an improvement of the prolactin levels (20 ng/mL) and had a natural pregnancy six months later without incident. She had spontaneous labor and delivered vaginally a healthy boy weighing 3 Kg. No invasive monitoring was used. Transsphenoidal surgery was not indicated for her hamartoma due to the difficult surgical access and the absence of major clinical symptoms.Brain hamartomas are benign malformations composed essentially of neurons located in the brain or local cells originating from the site where they develop. They are usually small lesions, between 0.5 cm and 2 cm in diameter, located at the base of the brain on the floor of the third ventricle and in the mammillary bodies . In rareIn our case, the hamartoma was located in the TC and presented as secondary amenorrhexa. Usually, secondary amenorrhea can be attributed to polycystic ovary syndrome, hypothalamic amenorrhea, hyperprolactinemia, or primary ovarian insufficiency . A patiePituitary hormones can be disrupted by suprasellar tumors and macroadenomas compressing the pituitary stalk, leading to hyperprolactinemia and hypopituitarism. As a diagnostic tool, MRI is more accurate than CT . It can The pathophysiology of hamartomas as a cause of secondary amenorrhea, in this case, is due to mechanical pituitary compression. An LHRH test showed a normal gonadotrophin response, and even if this test were normal, the fact that the patient had a pregnancy after normalization of prolactin levels pleads in favor of a pituitary stalk disconnection. Regarding precocious puberty in children, the mechanism involves activation of the secretion of LHRH . Recent Treatment of TC hamartomas is surgical, mostly via the transsphenoidal approach. All cases pose possible surgical risks  . In our Tuber cinereum hamartoma is a rare, non-neoplastic, heterotopic mass of neural tissue that can be diagnosed incidentally during routine autopsy. In contrast, an early diagnosis is made when clinical symptoms such as precocious puberty and/or gelastic convulsions are present. The pathogenesis of these clinical features is still a matter of debate. In our case, the main symptom was secondary amenorrhea. The position of a hypothalamic hamartoma and involvement of the third ventricle are likely to be more predictive of clinical characteristics than size and shape. Surgery is not always needed, as in the case of our patient, especially with difficult transsphenoidal access and the absence of major clinical symptoms.


Nonspecific gastrointestinal symptoms remain a problem for pediatricians because, out of a thousand trivial cases, there are rare diseases that require in-depth diagnostics and extensive knowledge to identify them. These complaints may be caused by a neoplastic process. We present the case of a 5-year-old boy whose diagnostic pathway lasted about 3 months. He was admitted to hospital due to severe abdominal pain. Physical examination revealed a bloated, hard, and painful abdomen. In the standing X-ray, the features of intestinal obstruction were visualized. An ultrasound examination showed a possible malignant lesion in the location of the left adrenal gland. After the surgical removal of the pathological mass and histopathological examination, the diagnosis of ganglioneuroblastoma intermixed was made. This tumor, along with neuroblastoma, ganglioneuroma, and ganglioneuroblastoma nodular, belongs to neuroblastic tumors (NTs), which originate from primitive cells of the sympathetic nervous system. NTs are quite rare, but they are still the majority of extracranial solid tumors in children, and their symptoms often appear relatively late when the neoplastic process is already advanced. The purpose of this review is to present current information about ganglioneuroblastoma, with a special emphasis on nonspecific gastrointestinal symptoms as first sign of this tumor and its diagnostics. Ganglioneuroblastoma intermixed (GNBI) is, in addition to neuroblastoma (NB), ganglioneuroma (GN), and ganglioneuroblastoma nodular (GNBN), one of the four types of neuroblastic tumors (NTs) according to the International Neuroblastoma Pathology Committee (INPC). NTs are the most prevalent extracranial solid tumors in children and originate from primitive cells of the sympathetic nervous system . HoweverWe present a clinical case of a child with nonspecific gastrointestinal symptoms as the first sign of GNBI. The aim of this study is to illustrate similar cases, highlight the diagnostic challenges associated with nonspecific gastrointestinal symptoms in children, and present the current state of knowledge about GNBs—its morphology, diagnostic, and treatment options.The paper was created based on the PubMed and Google Scholar databases. The literature was reviewed using the following key words: ganglioneuroblastoma, high-risk neuroblastoma, abdominal pain, and rare tumors. We also reviewed similar case reports from the last 30 years, where gastrointestinal symptoms were the first sign of GNB in children.A five-year-old male patient presented to the Pediatric Emergency Department (ED) due to severe abdominal pain. Since three months prior to admission to the hospital, the patient had periodically been suffering from constipated stools, which were mostly passed daily, but with increased hardness. Over the past three months, there had been three episodes when the boy did not pass stool for a week. During these times, an increase in paroxysmal abdominal pain was observed. The boy was then treated with trimebutine prescribed by the general practitioner. Three days before his admission to the hospital, the child had passed stool for the last time, and abdominal pain had intensified. In primary care, trimebutine and macrogol therapy were ordered, but due to the lack of improvement, the mother took her child to the ED for the first time. During this visit, the child underwent an examination by a pediatrician and had an enema performed. At that time, the boy’s condition improved, and the child was discharged home. On the next day, the mother and the boy were again admitted to the ED, because the child had developed severe abdominal pain since the morning hours.The patient was in average general condition. Physical examination revealed that the abdomen on palpation was bloated, hard, and painful on the entire surface. A standing abdominal X-ray  was perfBased on imaging studies, a neuroblastoma-like lesion was suspected. The child was transferred to the Department of Surgery for the resection of the tumor and then to the Department of Pediatric Hematology and Oncology with the aim of further diagnostics and treatment. The additional laboratory tests  showed tDuring hospitalization, the boy complained of abdominal pain, accompanied by loose stools and pain in the lower limbs, which required opioid analgesics—nalbufine. Due to the boy’s deteriorating condition, pending the result of the histopathological examination, the decision was made to start chemotherapy. The diagnosis of neuroblastoma was suspected because of the location of the tumor ; the patient’s age; the presence of metastatic lesions in the bone marrow and in the T3 and T6; and high NSE, ferritin, and OB. Therefore, the patient was classified as being at high risk of neuroblastoma (HR-NBL), and chemotherapy was started according to the COJEC protocol. The tolerance to chemotherapy was generally good. There was a tendency towards thrombocytopenia and anemia, which required a transfusion of 1 unit of RBC concentrate. The following histopathological result was obtained: ganglioneuroblastoma intermixed with a partial tumor differentiation of paraganglioma with bone marrow, bone, and periaortic lymph node involvement. 131I-Metaiodobenzylguanide (131I-MIBG) scinthygraphy was performed, which showed two distinct foci of accumulation of 131I-MIBG within the T5 and T6 vertebrae. The patient continued chemotherapy and underwent autologous peripheral blood stem cell transplantation (auto-PBSCT). He was also treated with radiotherapy (21 Gy) and immunochemotherapy with 13-cis-retinoic acid and dinutuximab. In a follow-up scintigraphy study, the regression of previously identified lesions with residual tracer accumulation at T6 was visualized. The boy has been facing complications from intensive treatment: leukopenia (grade IV according to WHO), anemia (grade III according to WHO), toxic liver damage (grade II according to WHO), eating disorder, and infection requiring broad-spectrum antibiotic therapy.Abdominal pain is one of the most frequent complaints reported by children in pediatric healthcare units. While most of the complaints are relatively mild and are associated with functional gastrointestinal disorders, it is very important to always remember about organic causes of abdominal pain that may be life-threatening . The diaIn addition to the patient’s history and detailed physical examination, imaging studies are extremely valuable tools in the search for organic causes of abdominal pain. These tests can be helpful in finding a pathological mass, and their primary role is to confirm its presence and recognize prominent imaging characteristics that can narrow the range of differential diagnoses. The preferred initial modality to determine the origin of the mass is US . HoweverWe reviewed the case reports of GNB in children, where the primary complaints were those from the gastrointestinal system .In the nine case reports, the first sign of GNB was chronic watery diarrhea caused by excessive VIP secretion. All of these children were under 2 years of age, and all complaints were resolved after the surgical removal of the tumor. According to Soga et al., pediatric patients with VIP-secreting GNBs have a good survival rate of 90% . AlthougThe majority of extracranial solid tumors in children and adolescents, comprising 7–10% of all pediatric tumors, are NTs ,27,28. NThe histological characteristics of the GNBI subtype encompass small regions of neuroblastic cells at various levels of maturation, the presence of neuropil, and Schwannian stroma constituting more than half of the structure. In comparison to the nodular subtype, GNBIs usually lack hemorrhagic and/or necrotic nodules. Tumors in this category are classified into a Favorable Histology (FH) Group according to The International Neuroblastoma Pathology Classification (INPC) . ImmunohMultimodality imaging, including metabolic nuclear imaging, is required for diagnosis, staging, response assessment, and follow-up . US is nGNBs are easily misdiagnosed due to nonspecific symptoms in the early stages of the disease . The cliGNBI is widely seen as a malignant tumor that, depending on the stage, requires multimodal therapy ,52. The The International Society of Pediatric Oncology (SIOPEN) conducts trials on NB within Europe. In the current HR-NB protocol, cross-sectional imaging is mandatory for the response assessment of the primary tumor at staging, after induction chemotherapy, for preoperative planning and the evaluation of residual primary tumors after surgery and before radiation therapy, before maintenance, and at the end of treatment . The IntThe recurrence of GNB occurs mostly in the first 2 years after surgery, and it can be solved by subsequent surgery and chemotherapy ,56. OkamClinicians should be aware of classic manifestations of GNB, especially those caused by disseminated tumors, and must always pay particular attention to the possibility of a neoplastic cause of nonspecific gastrointestinal symptoms. In diagnosing functional gastrointestinal disorders, an organic cause should always be excluded. Imaging studies, such as CT, play a key role in the evaluation of children with nonspecific symptoms, enabling the detection of lesions that are rare and life-threatening. As a result, the likelihood of a timely diagnosis and the early implementation of effective therapeutic protocols increases, ultimately leading to improved survival rates and reducing permanent damage.


This 49-year-old man presented with headaches, diplopia, and elevated serum prolactin (> 2000 ng/mL). Brain MRI revealed a 4.6 cm enhancing mass in the pituitary fossa, with inferolateral invasion. He was treated medically with cabergoline with normalization of prolactin but no improvement in symptoms. He underwent tumor resection.Figure composites . No additional alterations were identified in the PitNET, but the sarcomatous component contained an activating missense mutation in PIK3CA, a truncating missense mutation in RECQL4, biallelic homozygous deletion of CDKN2A/CDKN2B, and TERT promoter rearrangement. Chromosomal copy number analysis revealed an aneuploid genome in both components but essentially no overlap in the copy number variants. While the possibility of contamination could not be entirely excluded, it was considered unlikely, as the other sarcoma-associated alterations were not identified in the PitNET sequencing.The tumor was further characterized by the UCSF500 Next-Generation Sequencing (NGS) cancer panel. Tumor-only sequencing was performed separately on the two components, revealing an overlapping common activating missense mutation in the PitNETs are generally well-differentiated NETs with a favorable prognosis, although a subset is associated with considerable morbidity and mortality. Sarcomatous transformation of PitNETs is exceedingly rare and is nearly always associated with prior irradiation , 2. We aPDGFRB-fusion positive neoplasms , may theoretically have clinical utility. Our patient experienced dramatic improvement to his headaches and partial improvement to his double vision after surgery. He was recommended to follow up with oncology and was subsequently evaluated for post-surgical radiotherapy.The genetic alterations identified in our sarcoma were not specific for a more distinct tumor type , 5. Howe


Osteochondromas are the most common benign tumors of the bone. Mainly these lesions affect the long-bone metaphysis and usually are asymptomatic. When complications develop from these lesions, then they become symptomatic and surgical resection may become indicated. Spontaneous resolution of osteochondroma is rare. There have been fewer case reports about this condition. We are reporting 16 years old, male, who sustained direct trauma to his shoulder and presented with fracture at the base of a solitary osteochondroma. Complete resolution of the lesion occurred without any surgical intervention 18 months following the fracture. Osteochondromas are the most common bone benign tumors. It is defined as a cartilage-capped bony projection on the bone external surface, secondary to a perichondral ring defect (ring of Ranvier) and mainly affecting long bone metaphysis .The vast majority of osteochondroma, are solitary with only around 15 % of them can be multiple in the context of hereditary osteochondromatosis. ,3 usuallTreatment of osteochondromas consists of close observation with routine clinical and radiological follow up, whereas surgical resection is indicated for symptomatic cases.  However Sixteen years old, healthy, active boy, with no known co-morbidities, and no family history of any inherited disease. He attended our Emergency room with history of left mid-arm localized pain and swelling over a 2 weeks duration following a direct trauma. During this period the arm was tender to touch with increasing swelling around the arm. There were no constitutional symptoms, and he did not have any symptoms in the same arm prior to the trauma.On examination the boy was conscious and oriented, with stable vital signs. Local examination of the left arm showed proximal arm diffused swelling with soft compartments, while on palpation he had tender, fixed, non-mobile, firm mass at the lateral aspect of the left proximal humerus just above the deltoid muscle insertion. The overlying skin was normal and there were no signs of any ongoing infection. However, the patient had full active and passive range of motion of the shoulder with no signs of any shoulder instability and intact distal neurovascular examination. No other sites were involved with similar mass or swelling.Radiographic examination reviled solitary pedunculated osteochondroma at the proximal third of the humerus with features of callus formation over the fracture stump.  The pati14 months following the injury he remained asymptomatic, and a new X-ray showed almost complete regression of the lesion with only a small bony remnant and scalloping of the posterolateral cortex at the site of the lesion.  subsequeOsteochondromas are slow growing benign tumors that are usually asymptomatic. However, spontaneous regression of such tumor is a rare entity and there have been only few reported cases. Most of the reported cases were sessile and predominantly reported in young males . RadiogrThe humerus was the most common sit of involvement followed by the distal femur and proximal tibia was the third most common site.  The exacHowever, it has been hypothesized that a combination of vascular compromise followed by bony repair secondary to fracture is the mechanism by which resorption occurs, as trauma can interrupt the growth of the lesion's cartilaginous cap and incorporating it as part of bone healing process, . In the Although rare, spontaneous regression of solitary osteochondromas in a skeletally immature patient may occur. It has been reported that an exostosis base fracture can lead to complete resorption of the tumor during fracture healing. Therefore, a period of conservative treatment should be considered in such cases. However, surgical resection should be reserved for the significantly symptomatic lesion.This article was Approved by the local Medical Research Center. Hamad Medical Corporation, Orthopedics Department, Doha, Qatar.Open access funding was provided by the Qatar National Library.Written informed consent was obtained from the patient for publication of this case report and accompanying images.The authors have no competing interests to declare.


Dysphagia is a common clinical manifestation with a wide range of underlying medical conditions. Here, we present a case of a 52-year-old man with dysphagia, found to have a pleomorphic adenoma in the right parotid gland causing significant pharyngeal wall distortion. The patient underwent a successful total parotidectomy with facial nerve preservation using a transparotid-transcervical approach. A histological examination confirmed the diagnosis. While the patient experienced temporary facial weakness post-surgery, he had a successful recovery with no further issues during the 2-year follow-up. This case highlights the importance of considering parotid gland tumors as a potential cause of dysphagia when a mass is present in the oropharynx. Additionally, it demonstrates the feasibility of using a transparotid-transcervical approach for total parotidectomy with facial nerve preservation. Dysphagia is a common symptom encountered in primary care, with a broad differential diagnosis ranging from benign to life-threatening conditions . Among tPleomorphic adenoma is the most common benign neoplasm of the salivary gland, accounting for approximately 60% of all salivary gland tumors . The majA 52-year-old male patient from Far East Asia has reported difficulty swallowing, especially with solid food. He has been experiencing this problem for the past year, and the symptoms have gradually worsened, leading him to seek medical attention. In addition to the difficulty in swallowing, he also experiences an abnormal foreign body sensation in the pharynx.The patient had a significant medical history of poorly controlled hypertension and asthma. He had a history of gastroesophageal reflux disease and was on proton pump inhibitor therapy for 6 years. He had no significant surgical history but had a 20-pack-year smoking history. He had no family history of cancer or other significant medical conditions. He was married and worked as a construction worker.On examination of the oral cavity, there was a firm mass seen in the right tonsillar area that was covered by normal mucosa and occupying a significant portion of the oropharynx. The mass was causing distortion of the oropharynx and displacing the uvula. The patient had no other abnormal physical findings, and no cervical lymphadenopathy was noted. Examination of the cranial nerves, particularly the facial nerves, revealed normal findings.Laboratory studies, including hematological and biochemical investigations, were unremarkable. An MRI scan of the neck was performed, which revealed a well-circumscribed, lobulated mass in the right parotid gland measuring approximately 4.2 cm x 2.8 cm x 3.5 cm. Imaging studies showed a well-defined, encapsulated, and lobulated lesion involving the deep lobe of the right parotid gland. This lesion displayed low signal intensity on T1-weighted images and predominantly high signal intensity on T2-weighted images, with discrete foci of low signal intensity observed within it. On post-contrast imaging, the lesion exhibited heterogeneous enhancement. Notably, there was no radiographic evidence of extra-parotid extension, and the surrounding fat planes appeared unremarkable. No cervical lymphadenopathy or other significant abnormalities were seen (Figures Fine-needle aspiration was performed using a trans-oral approach, which showed cells consistent with a pleomorphic adenoma. The patient was referred to an otolaryngologist for further evaluation. The surgery team discussed the diagnosis of a parotid gland tumor with the patient and explained the potential risks and benefits of surgery. After considering all options, the patient agreed to proceed with a total parotidectomy with facial nerve preservation.The surgery was performed under general anesthesia and employed a transparotid-transcervical approach, wherein a vertical incision was made in the skin to create a flap for exposing the gland. Identification of the external jugular vein and auriculotemporal nerve was done, and an incision was made in the medial portion of the sternocleidomastoid muscle to locate the facial nerve. Separation of the parotid gland from the cartilage of the external auditory canal was performed, and removal of the tumor was accomplished without mandibular osteotomy. Throughout the procedure, the facial nerve was carefully monitored by the surgeon to avoid any harm to its function.During the surgery, the mass was observed to be well-circumscribed, with a smooth capsule. The mass measured 4.0 cm x 3.4 cm x 3.9 cm and had a rubbery consistency. Histological examination confirmed that it was a pleomorphic adenoma of the parotid gland, without any signs of malignancy. The histological features showed a combination of epithelial and mesenchymal elements, with areas of hyaline and myxoid degeneration (Figure Post-operatively, the patient experienced temporary weakness on the right side of their face, which resolved after a week. The patient was discharged on the second day after the surgery and had a follow-up visit with the otolaryngologist a week later. The surgical site was healing well, and the patient had no complaints. They were followed up for two years without any issues. The patient remained on regular annual follow-ups with their primary-care physician to monitor their overall health status and ensure timely intervention if any new health concerns arise.Pleomorphic adenoma is the most prevalent benign tumor of the salivary glands, accounting for roughly 60% of all salivary gland tumors . It typiThe primary symptom of parotid gland pleomorphic adenoma is typically a painless, slow-growing mass. However, other symptoms, including facial nerve weakness, pain, and paresthesia, have been reported . AlthougThe diagnosis of parotid gland masses typically involves imaging studies, such as MIR, which provide information about the size, location, and proximity of the mass to adjacent structures. Fine-needle aspiration or core needle biopsy is then performed to obtain a definitive diagnosis and assist in treatment planning. In this case, fine-needle aspiration revealed cells consistent with pleomorphic adenoma, confirming the diagnosis ,5.The treatment of parotid gland pleomorphic adenoma usually involves surgical resection while preserving the facial nerve. The objective of surgery is the complete removal of the mass while minimizing the risk of facial nerve injury and preserving salivary gland function . SuperfiAlthough pleomorphic adenoma is considered a benign tumor, it has the potential for local recurrence and rare malignant transformation. The recurrence rate varies from 2% to 45%, depending on the extent of surgical resection, the duration of follow-up, and the criteria used to define recurrence [The described case highlights the importance of properly evaluating and managing patients who present with symptoms of difficulty swallowing and a foreign body sensation in the pharynx. It also emphasizes the significance of considering parotid gland tumors as a possible cause of these symptoms. The case also demonstrates the benefits of using fine-needle aspiration for diagnosing pleomorphic adenoma and a transparotid-transcervical approach as a viable surgical option.


Malignant degeneration on remnants of the thyroglossal tract is a very rare phenomenon. In our practice setting, we report the management of papillary carcinoma on a thyroglossal tract cyst. This was a 44-year-old female patient with a postoperative diagnosis of papillary carcinoma of the thyroglossal tract with an atypical clinical and ultrasound presentation. She subsequently underwent total thyroidectomy and bilateral recurrent lymph node dissection, with resection of fibrous scar tissue in the previously operated hyoid region. We have discussed our therapeutic attitude to this rare pathology, the management of which is the subject of controversy. It can et al.  in Togo.et al. . We repoThis was a 44-year-old female patient, with no specific pathological history, who consulted for a painless, median, anterior cervical swelling that had been progressively evolving for 2 and a half years. There was no evidence of dysphonia, dysphagia or cough. Physical examination revealed a median tumefaction, in contact with the sub-hyoid bone, oval in shape with a transverse major axis of about 6 cm, rising on swallowing and tongue protraction, painless, firm to palpation, regular in outline, with no inflammatory signs . We suggIn view of the close relationship with the hyoid bone, the frequency of TTCs in the anterior high cervical region and the presence of a cystic contingent within the lesion on ultrasound, the diagnosis of atypical TTC was retained.The patient was operated on using the Sistrunk procedure. Intraoperatively, the sub-hyoid muscles had adhered to the firm formation, with a thick wall connected to the hyoid bone by its upper pole and to the thyroid isthmus by a lower cord. The formation was removed as a monobloc, removing the body of the hyoid bone and adherent sub-hyoid muscles . PostopeThe postoperative diagnosis of papillary carcinoma on TTC was accepted. Six weeks later, the patient underwent total thyroidectomy and bilateral recurrent lymph node dissection, with resection of scar tissue in the hyoid region. The postoperative course was simple. Corrected serum calcium levels were normal, and the patient was treated with levothyroxine 125 ug/day, with a TSH target of 0.5 mIU/l. Anatomopathological examination of the thyroid gland, lymph node removal product and fibrous scar tissue revealed no carcinomatous lesions. Clinical, radiological and ultrasound follow-up was decided every 6 months. To date, after more than 3 years, no tumor recurrence has been noted.The first case described in our country, malignant degeneration of the TTC is rare. Its prevalence varies from 1 to 1.5% of cysts . As in tMany authors believe that these carcinomas develop de novo within the TTC. The origin would be normal thyroid tissue present both in the cyst wall and along the entire path of the tract. Others suggest that the thyroglossal duct is a natural pathway for the spread of carcinomas from the thyroid gland , 8. ThesThe Sistrunk procedure remains the gold standard for surgical excision of TTC, which is associated with a relatively low rate of cystic recurrence. The role of total thyroidectomy is controversial, and there is no consensus on the subject in cases of TTC malignancy. Some teams are satisfied with the total removal of the cyst using the Sistrunk procedure, and see no point in performing a total thyroidectomy, whereas others recommend completing the initial surgical procedure with a total thyroidectomy; still, others perform both procedures in a single operation if the preoperative diagnosis has been established by fine needle aspiration cytology, or if there is an associated thyroid nodule. The reasons given for the maximalist attitude are the frequency of association of degenerated TTCs with primary thyroid carcinomas, which varies from 11 to 40%, and the guarantee of better follow-up , 9. AuthMalignant degeneration of a TTC is rare and is often papillary carcinoma. Its clinical and paraclinical presentation is never specific. The diagnosis is most often made after an anatomopathological study of the surgical specimen. Management is comparable to that of differentiated thyroid cancer but remains controversial. The context of developing countries, with all the follow-up difficulties that medical staff is confronted with in relation to patients, justifies the broadness of the surgical gesture in the present case.


Uterine leiomyosarcoma (ULC) is an uncommon neoplasm characterized by poor prognosis, it can predispose to distant metastasis, causing various symptomatic presentations. We present a unique case of a large heterogeneous mass in the lung cavity arising from a ULC, with complete absence of pulmonary symptoms and with concurrent coronavirus disease 2019 (COVID-19) infection. A high degree of clinical suspicion is required for ULC with accompanying metastasis. Effective screening methods are currently lacking for many cancers. Given the aggressive nature of some cancers, symptoms may indicate a certain diagnosis. However, in the absence of symptoms, cancers may be detected incidentally at an advanced stage. Here, we present the case of a patient with asymptomatic pulmonary metastasis of uterine leiomyosarcoma (ULMS).A 52-year-old woman with a medical history of hypertension, hyperthyroidism, and fibroids presented with a one-month history of vaginal bleeding. The patient was admitted to the gynecology service for symptomatic anemia with an initial hemoglobin of 5.7 g/dL and was transfused two units of packed red blood cells. Transvaginal ultrasonography revealed a markedly enlarged heterogeneous uterus with presumed fibroids, the largest lesion possibly related to the malignancy. Follow-up computed tomography of the abdomen and pelvis with intravenous contrast revealed a markedly enlarged, irregular, and heterogeneous leiomyomatous uterus. Chest computed tomography performed to evaluate the metastasis showed a 21-cm mass in the right upper lung lobe with mediastinal and right hilar invasion as seen in Figures Leiomyosarcoma is a type of uterine sarcoma much rarer than common leiomyomas. It most commonly presents as pre- or postmenopausal bleeding. Other common symptoms of leiomyosarcomas include abdominal distention, abdominal pain, vaginal bleeding, and associated urinary symptoms . If metaAt our institution, the hematology-oncology department was consulted, and a biopsy was performed. The biopsy revealed caldesmon, smooth muscle actin, CD10, and p16 positivity, whereas immunohistochemistry was negative for estrogen and progesterone receptors. P16 is overexpressed in uterine leiomyosarcoma and can be used as a diagnostic marker. The typical histological pattern of leiomyosarcoma of any origin involves intersecting sharply marginated fascicles of spindle cells with abundant eosinophilic cytoplasm and elongated hyperchromatic nuclei ,6. LeiomIn our case, chemotherapy could not be attempted because of the underlying COVID-19 infection. Dexamethasone therapy was recommended for COVID-19 with lung metastasis, whereas chemotherapy was not administered. The mass enlarged and compressed the airways, and the patient was readmitted two weeks later requiring intubation. Ultimately, she was terminally extubated. This case emphasizes the importance of clinical suspicion and workup for distant metastases to the lungs in cases of ULMS despite the absence of clinical symptoms. If suspected, a full workup should be performed to evaluate the patient for the earliest possible intervention, whether surgical, adjuvant, or palliative.Leiomyosarcoma is a rare aggressive cancer that grows in the smooth muscles and requires a quick and comprehensive workup to aid in its diagnosis and treatment. Leiomyosarcoma is usually found incidentally when symptoms manifest in the patient at the most common metastatic sites such as the lung, peritoneum, bones, and liver. This case report illustrates an incidental finding of a lung mass in a patient in COVID-positive patient with no pulmonary symptoms who was later diagnosed with uterine leiomyosarcoma. Further research on ULMS in the absence or presence of minimal symptoms is required.


Vocal cord nodules are benign laryngeal lesions seen in professional voice users. They are usually bilateral and are thought to occur due to submucosal edema and hemorrhage, with resultant fibrosis. False cord occurrences are very rare; hence we report a unique case of unilateral right false cord nodule. A healthy 16-year-old female student presented with persistent hoarseness for two years without any history of voice abuse, trauma, infection, or endotracheal intubation. Endoscopic examination showed a mass occupying the right false cord. Subsequent direct laryngoscopy revealed a friable mass on the right false cord without any true cord involvement. Complete excision was done. Post-operatively her symptoms completely resolved, and flexible endoscopic examination seven months post-op showed no recurrence. Histopathological examination revealed fragments of fibro collagenous tissue covered by benign respiratory epithelium, favoring the diagnosis of a benign nodule. False cord benign lesions are rare. In a symptomatic case, endolaryngeal microsurgery gives a good outcome.  Benign vocal cord lesions include nodules, polyps, and cysts. Nodules commonly occur at the mid-membranous vocal cord, where maximal impact stress happens during phonation . Voice aThis article was previously presented as a poster at the 11TH Malaysian International ORL-HNS Congress & 39th Annual General Meeting of the MSO-HNS on June 20, 2019.A healthy 16-year-old female student presented to the otorhinolaryngology clinic with a two-year history of hoarseness. There was no fever or weight loss, and her symptom was not associated with any breathing or swallowing difficulty. There was no history of preceding dental trauma, infection, or foreign body ingestion, and she had never been hospitalized prior to this. She was not a professional voice user, nor was there any history of preceding voice abuse. Perceptual voice evaluation showed overall dysphonia grade three with main components strain and rough voice.Examination of the neck revealed no lymphadenopathy, and flexible endoscopic nasopharyngolaryngoscopy showed a mass at the right false cord, obscuring the view of the right true cord.Subsequent direct laryngoscopy confirms a friable right false cord mass Figure ; howeverThe patient recovered uneventfully in the postoperative period, with marked improvement in her voice. Postoperative endoscopic examination in the clinic showed some granulation on the right false cord, which healed well seven months after, with only a mild bulge at the operated site.The histopathological section of the mass shows multiple fragments of fibro collagenous tissue partly covered by benign respiratory-type epithelium Figure .Actinomyces spp colony was seen, and Congo Red stain was negative for amyloid deposition.The tissue was eosinophilic and hypocellular with mild lymphoplasmacytic cell infiltrate. A cluster of Benign vocal cord lesions are thought to result from mechanical stress, in which voice abuse, overuse, and misuse lead to repeated mechanical trauma to this area, resulting in wound formation. Wound healing results in the remodeling of the superficial lamina propria, encompassing hyalinization and fibrosis, leading to increased stiffness with resultant hoarseness. Diagnosis of such lesions involves thorough medical and voice history, examination of the head and neck, perceptual assessment of the voice, and detailed imaging of the vocal cords. Laryngeal videostroboscopy remains the most practical and clinically useful tool in assessing vocal cord vibratory characteristics and glottal configuration, in which nodules tend to appear as white to opaque, symmetric, fusiform, and firm. They result in an hourglass closure glottal configuration and will affect the vocal cord mucosal wave and vibration variably .On the contrary, false cord benign lesions are rare, in most part due to the obscurity of their precise anatomy and function. To the author's knowledge, there has only been one published case report on false cord nodules; unfortunately, the original author of the report was uncontactable for further details and comparisons .While the vocal cords are known to directly contribute to phonation and protection of the lower airways, the anatomy nor the role of the false cords on phonation has not been clear in the literature, whereby their primary function was thought to take the role of a "valve" regulating the pressure between thoracic and intraabdominal cavity . HoweverFirst-line treatment for benign vocal cord lesions involves speaking and singing therapy to maximize the efficiency of the voice mechanism and reduce vibratory trauma to the cord. Additionally, treatment of poor vocal hygiene and laryngopharyngeal reflux also contributes to a positive outcome, especially in terms of perceptual improvement . SurgicaActinomyces spp, of which Actinomyces israelii is the most prevalent in humans [Actinomyces spp usually possess low pathogenicity as they are saprophytes and are thought to only cause infection in the event of antecedent tissue injury by way of mucosa breach [In this patient's specimen, a cluster of actinomyces colonies was observed Figure . Actinomn humans . While ta breach ,6. As aca breach . LaryngeThis case report describes a rare occurrence of a unilateral right false cord nodule in a young patient presenting with persistent hoarseness. The diagnosis of vocal cord nodules is typically associated with professional voice users and bilateral involvement. However, this case report highlights the importance of considering false cord nodules in the differential diagnosis of hoarseness, even in the absence of voice abuse or other contributing factors. The increasing discovery of the false cord's role in normal phonation may explain the possible etiology of this condition.


The purpose of this report is to provide a comprehensive account of an exceptional case involving the presentation of congenital rubella syndrome (CRS) in a newborn. Furthermore, it aims to document the successful regression of CRS through medical treatment alone. We present the case of a five-day-old infant who was referred to our facility as a CRS case. The patient presented with bilateral white corneal opacity, which was observed shortly after birth. The mother was diagnosed as rubella-positive during pregnancy. Upon the initial examination under anesthesia, both eyes exhibited central white corneal opacity accompanied by large intrastromal cysts. Although a few breaks in Descemet's membrane were observed in both eyes, there were no signs of vascularization or the presence of iridocorneal or lenticular-corneal adhesions. After undergoing medical treatment consisting of topical sodium chloride and steroids, the cysts in both eyes completely regressed. Subsequently, the patient underwent penetrating keratoplasty to further address the dense scar. This case enhances our comprehension of ophthalmological complications associated with CRS and provides valuable insights into alternative therapeutic approaches for corneal stromal cysts. Congenital rubella syndrome (CRS) is a prevalent congenital infection known for its wide range of severe ophthalmic and systemic complications . It typiA five-day-old male infant with a confirmed diagnosis of CRS was referred to our facility for examination due to the presence of white corneal opacification in both eyes. The patient's mother also had a confirmed diagnosis of reactive rubella during pregnancy. Upon the initial examination under anesthesia, both eyes exhibited central white corneal opacity along with large intrastromal cysts. Although a few breaks in the Descemet membrane were identified in both eyes, no signs of neovascularization or iridocorneal or lenticular-corneal adhesions were observed Figure . UltrasoCRS is a prevalent congenital infection characterized by various clinical manifestations, including heart defects, hearing impairments, and ophthalmological abnormalities . The mosIn conclusion, this case study brings attention to the infrequent presentation of corneal stromal cysts in a newborn with CRS, emphasizing the importance of identifying uncommon ophthalmological manifestations associated with CRS. The effective nonsurgical management of corneal stromal cysts demonstrates a noninvasive treatment option. This case contributes to a broader understanding of ophthalmological complications and provides valuable insights into alternative therapeutic approaches for corneal stromal cysts.