Background and Objectives: The uterine smooth muscle tumors of uncertain malignant potential (STUMP) are tumors with pathological characteristics similar to leiomyosarcoma, but that do not satisfy histological criteria for leiomyoma. These are problematic lesions with intermediate morphologic features; thus, diagnosis and treatment are difficult. This narrative review aims to review data in the literature about STUMPs, particularly focusing on management and therapeutic options and strategies for women who desire to preserve fertility. Material and Methods: authors searched for “uterine smooth muscle tumor of uncertain malignant potential” in PubMed and Scopus databases, from 2000 to March 2023. Pertinent articles were obtained in full-text format and screened for additional references. Only articles in English language were included. Studies including full case description of patients with histopathological diagnosis of STUMP in accordance with Stanford criteria were included. Results: The median age was 43 years old. Symptoms are similar to those of leiomyomas, with a mean diameter of 8.0 cm. Total hysterectomy with or without bilateral salpingo-oophorectomy is the standard care for women if fertility desire is satisfied. Myomectomy alone can be considered for young patients. Although these tumors have not a high malignant potential, several studies described recurrence and metastases. Conclusions: STUMPs are complex uterine smooth muscle tumors, with a rare but reasoned clinical–diagnostic management. Considering the high clinical and histological complexity of these tumors, high level of expertise is mandatory. In 1973, Langley was the first to speak about “smooth muscle tumor of uncertain malignant potential”; he was the first to describe what we nowadays call STUMP . A STUMPThe present study aims to review data in the literature about STUMPs, particularly focused on management and therapeutic options and strategies for women who desire to preserve fertility. Authors searched for “uterine smooth muscle tumor of uncertain malignant potential” in PubMed and Scopus databases, from 2000 to March 2023. Pertinent articles were obtained in full-text format and screened for additional references. We led a first screening using, in the research database, the keyword “STUMP”; more than 20,000 abstracts appeared. That is why we decided to increase the specificity of our first screening using two keywords: “UTERINE STUMP”, reducing the abstract pool to 8000 manuscripts. The articles not in English language have been excluded. Some manuscripts show repetition or not useful information; we excluded them too. Studies including full case descriptions of patients with histopathological diagnosis of STUMP in accordance with the Stanford criteria were included. Finally, 52 manuscripts were included.Macroscopically, STUMPs resemble fibroids and, thus, have a well-circumscribed and non-encapsulated appearance ; howeverSTUMPs are basically tumors that fell short of unequivocal diagnosis of leiomyosarcoma, of which follow the FIGO classification .2).smooth muscle tumors with focal/multifocal or diffuse cytological atypia (moderate-to-severe), lacking coagulative tumor necrosis and 6–9 mitoses per 10 HPFs  but lacking coagulative tumor necrosis or cytological atypia.Tumors with elevated mitotic count .Therefore, one of the four following criteria should be present for a diagnosis of STUMP ,10,11:smThe histological criteria for epithelioid and myxoid STUMPs vary considerably. Epithelioid smooth muscle tumors are characterized by round or polygonal cells with eosinophilic granular-to-clear cytoplasm. Epithelioid smooth muscle tumors with 2–3 mitoses/10 HPFs in the absence of coagulative tumor necrosis or atypia are classified as epithelioid STUMPs . AlternaOn a molecular level, STUMPs show genomic heterogeneity ranging from rare chromosomal alterations to high chromosomal instability, including chromosomal gains and copy number gains  However,The preoperative diagnosis is quite difficult and only the histological examination is diriment. In more than half of the cases, the diagnosis is incidental and is often post-operative, because MRI and pelvic ultrasounds are methods not able to pre-operatively differentiate benign from malignant tumors. The median age of diagnosis is 43 years . GadduccThere are not specific ultrasound characteristics for STUMP compared with leiomyoma or leiomyosarcoma. However, ultrasound features of malignancy like highly vascularized mass, irregular outline, irregular pattern due to necrotic areas, can be present that they are indistinguishable from leiomyosarcoma . A recenp < 0.05) [The use of ultrasound and diffusion-weighted (DW)-magnetic resonance imaging (MRI) to accurately diagnose STUMP is limited too. For accurate differentiation between leiomyoma and STUMP, contrast-enhanced (CE) magnetic resonance imaging (MRI) seems to be more specific compared with DW  . The use < 0.05) . The use < 0.05) . The STU < 0.05)  The role < 0.05) ,29.No practical guidelines are currently available for STUMP management, treatment, and follow-up. Surgery is the standard therapy ; howeverIf the STUMP is diagnosed at preoperative histological examination (hysteroscopy or myomectomy specimen), hysterectomy is the gold standard treatment for women with children ,26. The Hence, it is essential to consider the patient’s age and the desire of future pregnancy. If a fertility program is completed, the gold standard is total hysterectomy with or without bilateral salpingo-oophorectomy in a biopsy-proven STUMP case. Different approaches for total hysterectomy can be considered: abdominal, vaginal, or mini-invasive approach ,15,27,30The choice of the surgical technique depends primarily on the type of the lesion, the characteristics of the patient, fragility index of women, and the skills of the surgeon ,32,33. Sassessed the consequences of inadvertent morcellation of STUMPs, concluding that surgical re-exploration procedures after morcellation have a high likelihood of detecting peritoneal implants, which can be benign or malignant [The laparoscopic approach, when performed by expert operators, is considered the best choice. In young patients who desire to preserve childbearing, myomectomy alone should be considered, followed by hysterectomy after childbearing ,27,28. Nalignant . A recenalignant . Therefoalignant ,36. Nowaalignant .Annual surveillance with imaging  and has been suggested after hysterectomy. Ip et al. suggested a follow-up visit every 6 months for the first 5 years followed by annual control for additional 5 years ,28,38.The risk of recurrence of these tumors exists, despite the low malignant potential . GuntupaA review of the literature by Vilos et al. reported that 71 patients with STUMP treated with myomectomy alone experienced no recurrent disease after 1 to 216 months, and that residual tumor was found in 2 (14.3%) of the 14 patients in whom initial myomectomy was followed by hysterectomy .Metastases of STUMP are rare . A retroThe patient’s disease-free survival is conditioned not by the surgical approach (laparotomic/laparoscopic), but only by unprotected morcellation that is just related to minimally invasive surgery. Furthermore, other specific characteristics are related to worse prognosis, identifying a category of patients who should undergo closer follow-up: low progesterone receptor (PR) (<83%), diffuse p16 expression, high proliferation activity . The samStandard guidelines for recurrence treatment are not available, but surgical treatment seems to be the best option. Data about the role of adjuvant therapy and/or radiotherapy are lacking: four cases of recurrence were described, and they were treated with surgery and chemotherapy (doxorubicin and cisplatin are the most commonly used agent). An alternative therapeutic option is represented by endocrine therapy based on progesterone, aromatase inhibitors, or gonadotropin-releasing hormone analogues ,15.After conservative surgery for STUMPs, few cases of successful pregnancy have been described. Campbell et al. conducted a review of the literature, including five case reports, concluding that good clinical outcomes for both mother and baby are possible after a fertility-sparing myomectomy and successful pregnancy, in a patient diagnosed with a STUMP . In thesA single-center retrospective experience demonstrated that two of six patients who underwent myomectomy for STUMP wished to retain their fertility and both of them had delivered full-term live babies by cesarean section, without complications .Concerning in vitro fertilization, the literature showed an interesting case report on a Caucasian patient with endocrinal disorders and poor ovarian reserve . Fertility of the partner was tested and detected in normal range. Beyond the hormonal examination the woman received a TUS  which guided macroscopical anatomical control. The TUS did not show any pathological feature. After the conclusion of the preliminary examination, they started the IVF treatment, with cycles of COS (controlled ovarian stimulation) and ICSI (Intracytoplasmic Sperm injection). A mass in the uterine cervical area was discovered during the TUS’s interval sonographic check; this mass was unrelated to their pre-treatment. An MRI confirmed the cervical mass, which, after the laparoscopic removal, revealed itself as a STUMP. The mentioned study is the first manuscript correlating COS to STUMP .The recent retrospective study of Zhang et al. tried to investigate treatment, management, and prognosis of patients with STUMP during a period of 13 years. Thirty-one patients were enrolled, and the most common symptom of clinical presentation was menstrual disorder. Most representative immunohistochemical markers in tumors were ER, PR, and p16. Two cases of relapse were described, within 36 months . An inteFrom what has been said, it is clear that STUMPs are complex uterine smooth muscle tumors, with a rare but reasoned clinical–diagnostic management. Moreover, the numbers of cases of assessed STUMPs reported are limited in the scientific panorama. There are no National Comprehensive Cancer Network Clinical Practice Guidelines established for STUMP.If the diagnosis of STUMP is confirmed by histological examination, hysterectomy is the gold standard treatment for those women who have completed their childbearing planning. For women who want to preserve their fertility, a conservative approach with an accurate surveillance protocol is recommended. Considering the high clinical and histological complexity of these tumors, a high level of expertise in the field of soft tissue gynecological neoplasms is mandatory (including a gynecologic oncologist with high-level expertise in soft tissue sarcoma).


This is a case of a 68-year-old female with spontaneous and rare periduodenal hematoma of unknown origin without any signs or symptoms of duodenal stenosis. All causes of known precipitating factors, such as trauma, intervention, anticoagulation, pancreatitis or malignant processes, were ruled out. She was managed conservatively, with a series of radiological investigations performed throughout her 7-day admission to further define stability and investigate the possible cause for the periduodenal hemorrhage. A repeat magnetic resonance imaging 4 weeks later showed near resolution of the hematoma. The underlying cause in this case remains unclear. Periduodenal hematoma without precipitating trauma is a rare entity. Trauma, including various intervention-related injuries of the duodenum causing intramural or periduodenal hematoma has been presented multiple times in the literature. Spontaneous intramural hematoma is reported more frequently as a complication of anticoagulation therapy since its introduction and wide usage. Another common trigger is pancreatitis. There are, however, other causes, including congenital, inflammatory, vascular or ischemic often with a presenting symptom of duodenal stenosis.A 68-year-old female presented to the emergency department with a 3-day history of severe epigastric pain radiating to the back and the right shoulder with associated nausea, without vomiting. She had no preceding trauma. Previous surgeries of total abdominal hysterectomy, bilateral oophorectomy were confined to the lower abdomen. Her only medical issue was hypertension, not well controlled despite four antihypertensive agents with high systolic blood pressure during her stay. She was also on aspirin.9/L, normal lipase, lactate, liver and renal function tests, except a new Hgb drop of 103 g/L (5 months ago documented 144 g/L). Coagulation profile was normal.She was hemodynamically stable with no fever. On her initial assessment, she had a soft abdomen with RUQ tenderness, no obvious palpable mass. Bloods were unremarkable including WCC: 10.3 10Since the initial working diagnosis was cholecystitis, she had an abdominal ultrasound examination, which showed a normal gallbladder and pancreas, and long-standing liver hemangiomas (compared with previous images). There was a small amount of nonspecific perinephric, subhepatic fluid.The radiologist suggested a computer tomography (CT) scan to further explore the potential causes for this fluid. The CT abdomen and pelvis revealed extensive oedema and induration surrounding the duodenum with a complex hyperdense fluid, extending from this site to the paracolic gutters and into the pelvis. While these findings are suspicious of a paraduodenal hemorrhage from a ruptured duodenal ulcer and hemoperitoneum, they were not typical for perforated duodenal ulcer or erosion into the blood vessels. Differentials were an infiltrating mass either fibrotic or of a lymphoproliferative origin. However, this could not explain the complex fluid in the abdomen  and 2.After further discussion with the reporting radiologist, a magnetic resonance imaging (MRI) was performed, which confirmed the presence of an acute periduodenal hematoma surrounding D2 and D3, lying in the retroperitoneal space, anterior to the right perirenal space. Etiology was uncertain. No abnormal enhancement within the bowel to suggest a bowel wall lesion or infiltrating mass  and 4.She was admitted under the surgical team for observation. Patient kept nil by mouth, IV fluids were given, as well as IV pantoprazole. She had ongoing pain, worsening with movement, and therefore, the pain management team was involved. There was a significant drop of Hgb from 103 to 88 g/L the next day, without hemodynamical instability, hence an urgent CT angiography was requested to rule out active bleeding.It showed stabile appearance of the periduodenal collection surrounding D2 and D3 with retroperitoneal hemorrhage extending into the pelvis. Normal contrast opacification of the coeliac axis, SMA renal arteries and IMA  and 6.Continued observation, analgesia and fasting. On Day 2 post-admission, the patient had an urgent upper gastrointestinal endoscopy, which showed no abnormality. No ulcer, compression or inflammation was found. After the gastroscopy, the patient was started on a normal diet, which she tolerated well, and her pain had also improved. A progress CT was performed on Day 5, which showed a mild increase of the periduodenal collection with mass effect on the duodenum and evidence of mild biliary tree dilatation with the common bile duct measuring 11 mm. There was no sign of gastric outlet obstruction  and 8.The patient recovered well and was discharged on Day 7 with a stable Hgb of 110.She was reviewed in the surgical outpatient clinic 4 weeks later. She was still experiencing mild epigastric, right upper quadrant pain. The repeat Hgb was 133. Progress MRI abdomen and pancreas showed resolving hematoma, slight prominence of D2 and D3 of the duodenal wall with no discrete mass seen. No evidence of duodenal obstruction, prominent CBD of 8 mm  and 10.et al. [The first autopsy confirmed intramural intestinal hematoma published by James McLauchlan . In the et al. .Duodenal hematoma can be intramural or periduodenal, frequently caused by trauma.There are various causes of duodenal hematoma, such as trauma including intervention-related injuries; pancreatitis and its sequels; malignancy, vascular anomalies, with subsequent aneurysmal rupture; vasculitis, coagulopathy, duodenitis associated with Crohn’s disease, duodenal ulcer and perforation; congenital causes, for example: duplication cyst, duodenal diverticulum and its complications. Most of these cases are associated with duodenal stenosis .The rare, nontraumatic intramural hematoma, however, can be associated with anticoagulation and coagulopathy causing duodenal obstruction , 7.This case of periduodenal hematoma demonstrates a rare entity, which, with appropriate imaging investigation, can be confidently managed conservatively. The underlying cause in this case, however, remains unclear.None declared.None.The documents used during the current study are available from the corresponding author on reasonable request.Informed consent was obtained from the patient for publication of this case report and accompanying figures.


A few cases of primary liposarcoma of pleura have been reported worldwide. We report a young gentleman who was admitted with what was initially thought as coronavirus disease 2019 (COVID-19)-related pulmonary symptoms. His chest CT showed a large pleural effusion causing a mediastinal shift and compressing vital structures. He did not respond to conservative drainage intervention and subsequently underwent a left thoracotomy for his worsening clinical picture. He was found to have a large left pleural mass that was incompletely resected. Histopathology examination showed low-grade soft tissue sarcoma with lipogenic differentiation suggestive of myxoid liposarcoma. He was subsequently given adjuvant chemotherapy but succumbed and died because of the progression of the disease. Liposarcoma is a malignant mesenchymal tumor that accounts for 15% to 20% of all malignant mesenchymal tumors ,4. The mA 24-year-old male presented to the emergency department at our hospital with a two-week history of shortness of breath (SOB) and left-sided pleuritic chest pain. He had an expectorant cough but no hemoptysis, fever, chills, or rigor. He was a non-smoker with no significant past medical history, weight loss, or identifiable occupational exposure. He tested positive for coronavirus disease 2019 (COVID-19), and his chest X-ray (CXR) showed a large left-sided opacity with a right-sided mediastinal shift suggestive of a massive pleural effusion. A computed tomography (CT) showed a huge left-sided hemothorax/pleural effusion with numerous enhancing septations that depressed the hemidiaphragm and caused a significant rightwards mediastinal shift. In addition, the heart and great vessels were compressed, and the left lung was consolidated with some sparing of the left upper lobe, as shown in Figures Adjuvant treatment modalities were considered as the patient had incomplete tumor resection. Complete resection was not considered as the tumor was invading vital mediastinal structures. Radiotherapy (XRT) was also not feasible because of the large radiation field and anticipated toxicity of mediastinal structures. Thus, the patient was given chemotherapy. At mid-cycle of chemotherapy, a new CT scan was performed, which showed rapid progression of the disease. The findings were explained to the patient, and he understood the severity of his condition. The treatment from then onwards was palliative to improve the quality of life (QOL). He passed away four months later.About 24% of all pleural effusions are caused by malignant illness . The mosEven though there are various minimally invasive techniques for histologic identification of mediastinal tumors and cysts, open surgical access is occasionally required. Traditional methods for diagnosing mediastinal tumors include mediastinoscopy, thoracoscopy, and exploratory thoracotomy. These operations require general anesthesia and hospitalization .PPLs with myxoid and well-differentiated subtypes had a five-year survival rate of 71%, compared to 12.5% for the other subtypes in Wong et al.'s series . For PPLThe currently available literature shows that survival varies between seven months and eight years. Wong et al. published a similar report to our case with the patient alive five months following resection and adjuvant treatment . In our Myxoid pleural liposarcomas are very rare entities. They are slow growing with an expansile rather than infiltrative behavior. They may present late with compression symptoms on adjacent structures, as in our case. There is no common consensus on the treatment options for such cancer, but complete surgical resection remains the mainstay for better outcomes.


Spinal epidermoid tumors are rare tumors with typical symptoms including low back pain, radiculopathy, weakness, sensory disturbances, and bowel/bladder dysfunction. Here we present a rare case of a spinal epidermoid tumor in a 44-year-old female patient with a previous surgical history of epidural anesthesia with two cesarean sections. Our report aims to highlight the rare development of this type of tumor following epidural anesthesia, a routine part of labor management. Spinal epidermoid tumors, which make up less than 1% of intraspinal tumors, are composed of epidermal cells implanted in the spinal canal . Here weInitial presentationA 44-year-old right-handed female with a past medical history of low back pain and left leg numbness presented for evaluation. She reported back pain that began five years ago but experienced new onset left leg numbness and paresthesia six months ago. She described the back pain as intermittent and worse with prolonged sitting, bending, or lifting. She also reported occasional shocking sensations down the left posterior leg, as well as weakness of the left leg. She denied bowel/bladder incontinence or balance difficulties. However, she did endorse a distance-limited gait due to her left leg pain. Analgesics previously improved her back pain, but lately she found no improvement. Her surgical history was significant for a previous right axilla cyst removal for hidradenitis, laparoscopic fulguration for endometriosis, and two previous cesarean sections. Of note, the patient reported the development of a spinal headache after her second C-section requiring bedrest and an epidural blood patch. These complaints were suggestive of a dural injury. Her physical examination was unremarkable, with a full range of motion of the cervical and lumbar spine with no pain elicited on movement. She had full strength in both legs with slightly diminished sensation to light touch in the left leg and foot in a non-dermatomal distribution. Reflexes were elevated at the lower extremities bilaterally, but no clonus or Babinski sign was detected. MRIs were obtained, and she was found to have an intradural extramedullary lesion at the T12-L1 level with severe deformation of the spinal cord  and spinal somatosensory evoked potentials (SSEPs) were used throughout the surgery. A laminectomy was performed, including complete removal of T12 and L1. The dura was inspected and immediately caudal to the L1 lamina (L1-2 interspace) a small outpouching on the dura was noted Figure . This poSpinal epidermoid tumors are rare and are more commonly seen in children . Based oEpidural injections are commonly used in labor for pain management. In a review studying labor pain treatment options by Koyyalamudi et al., they reported approximately 61% of women in the USA received neuraxial analgesia for labor pain management . SimilarOur case exhibits the development of a rare complication from dural injury related to an epidural injection, an epidermoid tumor developing years after the procedure. Such a complication is not likely to be considered when performing this procedure. This inciting event may be overlooked as a spinal intervention, as it is a routine part of labor or pain management. In a case series evaluated by Mortia et al., they found that three out of four patients who developed an epidermoid tumor had prior lumbar punctures performed . In addiSpinal epidermoid tumors are rare and sparsely reported on in the current literature. We present a case of an epidermoid tumor in a female patient with a history of epidural injection associated with a spinal fluid leak. We show an abnormality on the dura likely associated with the site of prior intervention and in close proximity to the epidermoid tumor.


Gradenigo’s syndrome (GS) is a rare but life-threatening complication of acute otitis media (AOM). It is classically defined as a clinical triad of acute otitis media, ipsilateral sixth (abducens) nerve palsy, and pain in the distribution of the first and second branches of the trigeminal nerve. Another rare but serious complication of AOM is venous sinus thrombosis, which is often associated with GS. The diagnosis of these conditions requires clinical suspicion, sound interpretation of signs and symptoms, and the use of the correct imaging techniques.Here, we present the case of an 81-year-old man with a previous history of recurrent otitis media, who presented with GS and septic lateral sinus thrombosis. The clinical presentation, physiopathology, and management of these conditions are discussed. Gradenigo’s syndrome (GS) is a clinical triad of acute otitis media (AOM), ipsilateral sixth (abducens) nerve palsy, and pain in the distribution of the first and second branches of the trigeminal nerve, first described by Professor Giuseppe Gradenigo in 1904 . After tGS can be associated with other complications, such as meningitis and venous sinus thrombosis . Septic An 81-year-old man with a previous history of hypertension, cerebrovascular disease, and type 2 diabetes was admitted to the emergency department for a three-week course of nausea, vomiting, headache, and ataxia. The headache was described as affecting mainly the left parietal and temporal regions, with mention to left retro-orbital pain. Investigation of clinical history revealed recurring otitis media infections with previous complaints of headache, vertigo, and ataxia along with left imbalance for the last six months.On physical examination, he presented with left hearing loss, peripheral vertigo, left gait ataxia, and left external oculomotor ophthalmoplegia, with no meningeal signs. A slightly elevated C-reactive protein (CRP)  was the only relevant finding on blood tests. Diabetes was reasonably controlled HbA1c 7.6%). Head CT showed only ischemic lesion sequelae and left middle ear and mastoid filling  ceftriaxone 2 g every 12 hours. Further investigation with ear CT revealed skull base osteomyelitis and left otomastoiditis Figure .Pseudomonas aeruginosa.Additional findings of infectious collections in the cerebellopontine angle and retropharyngeal space were also documented. Antibiotherapy was then changed to meropenem (2 g every eight hours) to improve antibiotic penetration and add coverage to Neurology and neurosurgery opted for a conservative approach and discarded surgical control of the cerebellopontine and retropharyngeal collections.The case was then discussed with the otolaryngology department and surgical intervention was decided. Prior to the surgery, a head MRI confirmed left otomastoiditis, labyrinthitis, and documented septic left lateral sinus thrombosis with pachymeningeal inflammation Figures , 5.It was decided not to start anticoagulation at this point, considering that it could increase hemorrhagic risk and hematogenous infection dissemination.The patient was then submitted to exploratory tympanostomy, closed technique mastoidectomy, and myringotomy with Shepard tympanostomy tube insertion in the left ear. During the procedure, samples were collected for cytochemical, bacterial, mycobacterial, and anatomopathological studies. Samples were also collected for 16s rRNA gene sequencing. No microorganism was isolated or identified in any of the samples.The patient then began a long recovery process adjuvanted by physical therapy. At this point, anticoagulation with enoxaparin in a prophylactic dose was started. Only partial symptomatic recovery was achieved, with persistent sixth nerve palsy two months after the surgery. Subsequent MRI studies revealed the persistence of the infectious cerebellopontine and retropharyngeal collections and lateral sinus thrombosis. The need for long-term IV antibiotics (at least six months) conditioned discharge, but the patient was eventually able to go back home under a domestic hospitalization protocol. Three months later, he suffered a fatal ischemic stroke, affecting the right precentral gyrus. Although the lesion was consistent with an embolic etiology, the relationship of this event with lateral sinus thrombosis remains unclear.Septic lateral sinus thrombosis is a rare complication of otitis media, and GS is an exceedingly rare presentation of otitis media complications. The time interval between the onset of otitis media and the clinical presentation of Gradenigo’s triad of symptoms is variable. Despite sharing otitis media as the common etiology, each symptom results from different physiopathological processes. In a 40-year review of apical petrositis cases, only 13.6% presented all the GS triad’s symptoms .In general, the petrous apex is composed of dense bone and bone marrow. In only one-third of the cases, petrous apexes are well pneumatized and communicate with the middle ear cleft , making The petrous apex is located at the central part of the temporal bone. A fold of medial dura mater of the petrous apex forms Dorello’s canal, in which the sixth nerve rises toward the cavernous sinus . The proIn the present case, ear CT revealed skull base osteomyelitis and left otomastoiditis, triggering further investigation with MRI. Although CT scans are adequate for describing bone anatomy and bone destruction, other methods are preferred for diagnosing central nervous system pathologies and the composition of the lesion in the bone. In a series of 49 patients, head CT failed to identify 14% of the patients with central venous thrombosis, whereas venous CT or MRI venography could provide positive identification of abnormalities in all cases . ClinicaStreptococcus pneumonia and Haemophilus influenza, common pathogens in otitis media and mastoiditis [Identification of infectious agents was not possible in the presented case, but recent reviews found the microbiology of the AOM infections leading to GS surprising, for the preponderance of aerobic gram-positive cocci, and the relative paucity of toiditis . Infectitoiditis .Many cases of successful conservative treatment with IV antibiotics have been reported. However, if the patient deteriorates, or in the absence of rapid improvement, immediate surgery is indicated ,14. ThisThe benefit of anticoagulation treatment in this condition is debatable and remains controversial. In a series of five cases involving septic lateral sinus thrombosis under long-term anticoagulation with low-molecular-weight heparin, there was only one reported complication of a non-life-threatening intracranial hemorrhage . A CochrGS and lateral sinus thrombosis are rare but life-threatening complications of acute and chronic otitis media. Clinical interpretation of the signs and symptoms can be challenging as the time interval between the onset of otitis media and the clinical presentation of Gradenigo’s triad of symptoms is variable, and not all patients present with the classical syndrome.Imaging studies should include venous CT or MRI venography to exclude cerebral venous thrombosis. The use of anticoagulation treatment remains controversial but is probably safe and may be beneficial. Prompt treatment with large-spectrum IV antibiotics is paramount, and in the absence of rapid improvement, immediate surgery is indicated.The presented case highlights the pivotal role of internal medicine in the management of a complex condition that required continuous consultation with several surgical and non-surgical specialties .


Gestational trophoblastic neoplasia (GTN) located in the cesarean scar is a rare disease that has imaging appearances similar to those of an exogenous scar incision pregnancy and is often misdiagnosed due to insufficient clinical experience.We report 2 cases of uterine cesarean scar mass. Two patients with different diagnoses had similar clinical complaints as abnormal vaginal bleeding, enlargement of uterus isthmus by physical examination, and mixed echo mass in uterine low segment by ultrasound examination; however, their magnetic resonance imaging images showed very different features.One patient was diagnosed with cesarean scar pregnancy (CSP) and one patient was diagnosed with cesarean scar GTN.The CSP patient underwent surgery by laparoscopy combined with hysteroscopy after uterine artery embolism and obtained pathological confirmation. The GTN patient received chemotherapy.For the CSP patient, her serum β-human chorionic gonadotropin (hCG) concentration returned to normal 2 weeks later, and B-ultrasound showed that the niche was completely repaired 3 months after the operation. The intrauterine lesions of the GTN patient disappeared completely 3 months after serum β-hCG normalization. And her β-hCG was normal at all follow-up visits until now.Clinicians should consider GTN when identifying masses at scar incision sites. Magnetic resonance imaging images improve the understanding of the imaging features in patients suspected of having CSP/GTN. This disease is an extremely rare entity, as a gestational trophoblastic disease in the cesarean scar is reported to have an incidence of only 1.5 per million pregnancies. Due to this very low incidence, few cesarean scar GTN patients can obtain a clinical diagnosis before pathological examination, especially GTNs following nonmolar pregnancy, and this delay often leads to heavy bleeding or hysterectomy.,3 Here, we share our experience in the diagnosis and treatment of 2 patients with uterine cesarean scar mass: the first patient was diagnosed with CSP, and the second was diagnosed with cesarean scar GTN. Medical history, beta-human chorionic gonadotropin (hCG) measurements, and magnetic resonance imaging (MRI) helped us make the correct preoperative diagnosis.Gestational trophoblastic neoplasia (GTN) is the only solid tumor that does not require pathological confirmation. It is also a highly chemosensitive tumor type that has a very good prognosis, even in the advanced stages. Due to the increase in cesarean rates worldwide, the incidence of cesarean section scar pregnancy (CSP) has increased gradually. In 2014, Qian et al reported the first case of cesarean scar choriocarcinoma that was initially misdiagnosed as CSP.Case 1: A 36-year-old female patient, gravida 2, para 1, abortus 1, was admitted to our department in June 2017. She had delivered her first baby by cesarean section 6 years ago. In the 6th week of her current pregnancy, a B-ultrasound examination at the local hospital showed a gestational sac-like structure in the lower part of the uterus without fetal cardiac activity. The patient came to our hospital complaining of mild uterine hemorrhage lasting for 2 days presented at 8 weeks of gestation. She underwent transvaginal ultrasonography first which showed a mixed echo mass with a rich blood supply in the lower segment of the anterior uterine wall. Bimanual examination revealed a mildly enlarged uterus, the isthmus of the uterus was significantly enlarged, and the cervix was closed. The serum β-hCG concentration was 603 mIU/mL. MRI showed hemorrhage and tissue necrosis in the mass, which was surrounded by peritrophoblastic vasculature as the blood flow signal was abundant  at the region of the patient’s cesarean section scar that was indistinguishable from the uterine myometrium, and a moderately rich blood flow spectrum was observed around the mass. Bimanual examination revealed a mildly enlarged uterus, marked enlargement of the left isthmus of the uterus, and closure of the cervix. The serum β-hCG concentration was 164501.66 mIU/mL, which increased to 195671.8 mIU/mL 3 days later. MRI showed a mixed mass in the lower uterus, and the periphery of the lesion was significantly enhanced under the contrast agent  cases were GTN located in the cesarean scar. reported the first case of cesarean scar choriocarcinoma had been misdiagnosed by ultrasound as CSP. Zhou et al reported 2 cases: a case of cesarean scar GTN and a case of CSP; both cases were misdiagnosed by ultrasound at first, but MRI led to the correct diagnosis. Gromi made the GTD diagnosis by ultrasound at the first examination because the mass showed the typical snowstorm sign.Both patients underwent ultrasound as the first examination. Their ultrasounds were similar: a mixed-echo mass was observed at the cesarean section scar, which was indistinct from the myometrium of the uterine cavity and had a rich peripheral blood supply. GTN was not considered. Ultrasound is usually the initial diagnostic imaging test for CSP and GTN because of its convenience and repeatability. However, we think the primary diagnosis of GTN in a cesarean scar by ultrasound is very difficult. Qian et al The completely different MRI images of the 2 patients provided an important basis for our diagnosis. In Case 1, the MRI image showed substantial scattered anechoic lacunae in the chorion, named blood sinuses, the chorionic villi were degenerated and formed hydropic villi, appearing as vesicles or part of a heterogeneous mass. In Case 2, the MRI image showed nodular and well-defined tumor margins, absent or minimal intratumoral vascularity due to severe central necrosis and hemorrhage, and no tiny cystic lesions in or around the mass; these features were similar to those of other choriocarcinoma cases.,9,10 Because choriocarcinoma usually invades the myometrium through the venous sinus, the tumor margin is nodular, and the boundary is usually clear, which is more obvious after chemotherapy. At the same time, an invasive mole often shows a poorly defined infiltrating mass with tiny cysts as the molar tissue always directly invades the myometrium and blood vessels. We did not find obvious differences in the ultrasound diagnosis of our 2 patients, which differed from the MRI conclusions. This may be related to poor clinical experience for disease and limited ultrasound images for retrospective observation. Real-time dynamic scanning and more clinical experience will be helpful for diagnosis.MRI imaging has been recommended as a promising tool for noninvasive morphological analysis for CSP and for differentiating invasive mole from choriocarcinoma. The chest CT image of our GTN patient showed several tiny rounded pulmonary nodules that had clear boundaries and a uniform density, which were considered indicative of distant metastasis.,12 Our patient’s pulmonary nodules disappeared after 5 courses of chemotherapy, which confirmed the diagnosis.The lungs are the most likely site of metastasis in GTN patients with a probability of 80%. and histopathological diagnosis is not mandatory for GTN patients.There was no pathology diagnosis for the patient’s tissue collected by hysteroscopic curettage, which led to difficulties in our diagnosis and staging. The rate of pathological diagnosis after abortion is low for a country with a large population like China where pathologists are limited. Some medical centers recommended doing curettage or hysteroscopy after UAE for patients suspected of GTN to obtain a histopathological diagnosis. However, surgery was highly dangerous as the lesion had extremely abundant vascularization and was mainly bulging toward the serosa, with almost no overlying myometrium layer. The patient in Case 1 showed heavy bleeding during the operation even after UAE and preventive ligation of the uterine artery. There was also a report that a patient who was misdiagnosed as CSP received laparoscopic hysterectomy at the initial treatment. However, the patient had a temporary recurrence and died of tumor progression 39 months later after the surgery, as the final diagnosis was GTN in the caseation scar. For the patient in Case 2, we believed chemotherapy was acceptable to preserve her fertility as Tambe et al had done,In summary, early diagnosis of GTN in a cesarean scar is difficult because of its low incidence and nonspecific symptoms. Medical history, dynamic β- hCG monitoring, imaging examination, especially MRI, and metastasis assessment may be helpful in differential diagnosis. Making a correct clinical diagnosis by imaging but not pathology is undoubtedly useful for preserving patient fertility. We believe our experience in the diagnosis and treatment of patients with masses at the scar incision is helpful for the early diagnosis of scar incision GTN. Pathological diagnosis is recommended for every patient undergoing curettage or abortion.Clinicians should consider GTN when identifying masses at scar incision sites. MRI is a useful tool for the diagnosis of CSP and GTN.Thanks to Dr Yanni Xiang and Dr Jie Lin of the Ultrasound Department of Taizhou First People’s Hospital for their assistance in the diagnosis of these diseases.Data curation: Danjiang Huang, Dewen Yan, Xingxing Dai.Supervision: Liping Wang.Writing – original draft: Xiumin Zhao.


Gastrointestinal neuroectodermal tumors (GNETs) are extremely rare and intriguing malignancies originating from neural crest cells in the digestive tract. The digestive tract's neural crest cells can give rise to incredibly unusual and interesting gastrointestinal neuroectodermal tumors (GNETs). GNETs present considerable hurdles in diagnosis and management because of their rarity and varied expression. In this case report, a 45-year-old male patient is described who had signs of GNET, such as exhaustion, weight loss, and abdominal pain. A 7-cm jejunum tumor and related thickening of the gut wall were discovered using imaging investigations. The diagnosis of malignant GNET was confirmed by surgical resection, and adjuvant treatment was given. A recurring tumor required a second surgical procedure despite an initial disease-free period. The report emphasizes the difficulties involved in the diagnosis, treatment, and long-term effects of GNETs. The rarity of GNETs necessitates the development of standardized treatment protocols as well as additional research to enhance diagnostic precision and explore novel therapeutic approaches for this aggressive malignancy. Malignant gastrointestinal neuroectodermal tumors (GNETs) are exceedingly rare and highly intriguing neoplasms that arise from neural crest cells within the digestive tract. These tumors, characterized by their neuroectodermal origin, present a complex clinical and pathological challenge due to their scarcity and the inherent heterogeneity in their presentation. Although the precise etiology of GNETs remains elusive, their classification as a distinct entity is founded upon their unique histological features and molecular characteristics .GNETs primarily affect adults, with the age at diagnosis typically ranging from the second to the seventh decade of life. Clinical manifestations vary widely and are often nonspecific, encompassing symptoms such as abdominal pain, weight loss, fatigue, and gastrointestinal bleeding. The lack of specific clinical features further complicates the early diagnosis and recognition of GNETs, frequently resulting in delayed or missed diagnoses .Imaging studies play a pivotal role in the evaluation and initial identification of GNETs. Radiologically, these tumors present as intraluminal masses with associated features such as bowel wall thickening, ulceration, and mesenteric lymphadenopathy. However, it is important to note that the radiological appearance of GNETs may mimic other gastrointestinal malignancies, making accurate diagnosis challenging and warranting histopathological confirmation .Histologically, GNETs exhibit a diverse range of patterns, including solid, nested, trabecular, and glandular formations. Immunohistochemistry plays a critical role in establishing the diagnosis, with GNETs typically showing positivity for markers such as S100, neuron-specific enolase (NSE), synaptophysin, and CD56. The expression of these neuroendocrine markers supports the neural crest origin of GNETs and helps distinguish them from other gastrointestinal tumors .Due to their rarity, the management and treatment protocols for GNETs are not well established. The majority of treatment is surgical resection, which aims to completely remove the tumor and may improve patient outcomes. Although its efficacy in GNETs is unknown, adjuvant chemotherapy is frequently used to lower the risk of local recurrence or distant metastasis.This case study describes a 45-year-old male with GNET symptoms, including the clinical presentation, radiological findings, results of the histological examination, and course of treatment. After surgery and chemotherapy, the patient experienced periods without having any symptoms, but a tumor recurrence necessitated a second surgery. The complexity of detecting, treating, and foreseeing the long-term effects of GNETs is brought home by this instance.We present the case of a 45-year-old male who sought medical attention due to a six-month history of abdominal pain, weight loss, and fatigue. The patient reported a significant weight loss of 10 pounds during this period and described the abdominal pain as progressively worsening. He had no notable medical or surgical history and no family history of cancer.A physical examination revealed a pale and fatigued appearance. Abdominal palpation revealed a soft abdomen without tenderness, palpable masses, or hepatosplenomegaly. Laboratory investigations revealed anemia, with a hemoglobin level of 8.5 g/dL and elevated lactate dehydrogenase (LDH) levels. Other laboratory parameters were within normal ranges. We considered several possible diagnoses, including colon cancer, gastrointestinal neuroendocrine tumor (GNET), gastrointestinal stromal tumor (GIST), and synovial sarcoma.To further evaluate the patient's condition, a contrast-enhanced computed tomography (CT) scan of the abdomen was performed Figure , which rAdditionally, the CT scan revealed bowel wall thickening and mesenteric lymphadenopathy, but no evidence of distant metastases was observed. Upper gastrointestinal endoscopy and colonoscopy were subsequently performed, ruling out the presence of any additional lesions.Considering the clinical and radiological findings, the decision was made to proceed with surgical intervention. The patient underwent surgical resection, which involved an extended bowel resection to completely excise the identified mass. Histopathological examination of the resected specimen established the diagnosis of a malignant GNET Figure .Immunohistochemical staining demonstrated positivity for the S100 protein Figure , while mAdditionally, CD56 markers exhibited positive expression Figure , furtherTo reduce the risk of disease recurrence, the patient received adjuvant chemotherapy consisting of a combination of doxorubicin and ifosfamide. Regular follow-up CT scans performed at three-month intervals demonstrated no evidence of disease recurrence. However, at the 12-month follow-up, the patient presented with symptoms indicative of intestinal obstruction, prompting a CT scan that revealed the presence of a recurrent tumor in the small intestine. Subsequently, a second surgical resection was performed to remove the recurrent tumor, followed by adjuvant chemotherapy involving etoposide and cisplatin. Remarkably, the patient remained free from disease during the subsequent 24 months of follow-up.Malignant gastrointestinal neuroectodermal tumors (GNETs) are exceptionally rare neoplasms that originate from neural crest cells within the gastrointestinal tract. These tumors exhibit distinct histological and immunohistochemical characteristics, making them a unique entity within the spectrum of gastrointestinal malignancies.The diagnosis of GNET poses considerable challenges due to its rarity and variability in its clinical presentation. Nonspecific symptoms such as abdominal pain, weight loss, and fatigue are commonly reported by patients. These symptoms, although suggestive, do not provide definitive evidence for GNET and can overlap with other gastrointestinal tumors, including gastrointestinal stromal tumors (GISTs), leiomyosarcomas, and carcinoid tumors.Imaging studies, such as computed tomography (CT) scans and magnetic resonance imaging (MRI), play a crucial role in the diagnosis of GNET. These modalities aid in determining the location, size, and extent of the tumor. CT scans can reveal intraluminal masses with associated features such as bowel wall thickening and mesenteric lymphadenopathy. MRI can provide additional information regarding the relationship of the tumor with adjacent structures. These imaging techniques, while helpful, cannot definitively confirm the diagnosis and must be complemented with histopathological examination .Histopathological examination, usually obtained through endoscopic biopsies or surgical resection, is essential for confirming the diagnosis of GNET. Microscopically, GNETs display a diverse range of histological patterns, including solid, nested, trabecular, and glandular formations. Immunohistochemical analysis is crucial in establishing the diagnosis, with GNETs typically exhibiting positivity for S100 protein and negativity for melanocytic markers. Additional markers, such as CD56 and synaptophysin, can further support the neural crest origin of these tumors [The treatment of GNET remains challenging due to its rarity and the lack of established standard treatment guidelines. Surgical resection is considered the mainstay of treatment, with the extent of resection dependent on the tumor's location and size. Complete excision of the tumor is crucial to minimize the risk of local recurrence and improve patient outcomes. However, due to the aggressive nature of GNETs, they often infiltrate surrounding structures, making complete resection challenging .Adjuvant chemotherapy has been explored as a potential treatment option for GNETs, but the optimal regimen and duration of treatment remain unclear. Some studies have suggested a benefit from adjuvant chemotherapy with ifosfamide and doxorubicin, but further research is needed to establish its efficacy .The role of targeted therapies, such as tyrosine kinase inhibitors, in the treatment of GNETs is also being investigated, although limited data are available.The prognosis of malignant GNETs is generally poor, with a high risk of recurrence and metastasis . The rarA malignant gastrointestinal neuroectodermal tumor (GNET) is a rare tumor of the gastrointestinal tract that arises from the neural crest cells. The diagnosis of GNET is challenging due to its rarity and variable clinical presentation. Imaging studies and endoscopic biopsies can help in the diagnosis, and surgical resection is the mainstay of treatment. Adjuvant chemotherapy with ifosfamide and doxorubicin has shown some benefit, but the optimal regimen and duration of treatment are not well established. The prognosis of malignant GNET is generally poor, and there is a need for more research to establish standardized treatment guidelines for this rare tumor.


Few cases of diffuse pigmented villonodular synovitis have been reported in pediatric patients, especially in uncommon locations such as the hand. This case presents pathology-confirmed diffuse pigmented villonodular synovitis in the hand of a pediatric patient with multiple recurrences despite adequate surgical margins. The patient underwent mass excision with adjuvant radiation treatment after his last recurrence, with excellent functional outcomes and no recurrence at the five-year follow-up.Diffuse pigmented villonodular synovitis is characterized by synovial inflammation and hemosiderin deposition. It mainly occurs in adults, with the hip and knees being the most common sites of involvement. It is associated with high recurrence rates, with open synovectomy being the most common treatment method to avoid recurrence As reported in 1941 by Jaffe et al,Pigmented villonodular synovitis was first introduced in 1852 as a neoplastic process because of its unrelenting growth pattern, capacity to erode surrounding bone and joint tissue, and high recurrence rate after resection.The most common sites of involvement are the knee; hip; and, to a lesser degree, the wrist, hand, and spine.There are a variety of surgical options to treat this condition. Open versus total arthroscopic synovectomy tends to be the most popular surgical approach. However, studies report that total open synovectomy is a more reasonable option when dealing with DPVNS.This is the case of a 14-year-old boy who presented to our clinic with a chief complaint of a left hand mass. Physical examination of the left hand noted a distal tip mass of the left fifth finger. Radiographs of the fifth digit showed a soft tissue bulge lateral to the distal phalanx’s radial aspect, correlating with clinical findings.High-resolution sonography of the left hand demonstrated a soft tissue heterogeneously hypoechoic mass at the tip of the fifth digit with peripheral increased vascularity. The mass involved the DIP joint synovium, flexor, and extensor tendons. The patient underwent mass excision and flexor tenolysis. The mass in the left fifth finger was located at the distal, volar, and radial aspect and was adherent to the flexor digitorum profundus and radial digital nerve. The mass was hard, multilobulated, tan-yellow, and rubbery, suggesting DPVNS. After surgery, the patient regained full ROM with no loss of sensation.However, 2 years after this initial mass excision, the patient returned to the clinic with a recurrence of the mass. The patient returned to the operating room for excision of the mass recurrence and again, the diagnosis of DPVNS was pathologically confirmed . The masThe patient presented with a more proximal, aggressive mass in the ulnar, palmar side of the hand. On this occasion, the oncology service was consulted, adjuvant radiation was given, and surgery was performed to remove soft tissue mass . In this,Giant cell tumors of the synovial and tendon sheaths can be classified into two forms: localized (giant cell tumors of the tendon sheath or nodular tenosynovitis) and diffuse (diffuse-type giant cell tumors or PVNS). Tumors of localized form are confined to a distinct area of the synovium, whereas tumors of the diffuse form demonstrate extensive involvement of the whole synovial membrane and capsule.,s, radiotherapy was included in the patient’s management. Potential adverse effects from radiotherapy that must be considered include toxicity, skin changes, joint stiffness, and radiation-induced sarcoma. However, the patient history suggested that the benefits outweighed the potential complications. Recurrence is due to incomplete excision of the tumor or the presence of an unidentified satellite lesion and may be predictable on the basis of specific patterns of tissue involvement. Given the excellent outcomes following excision with the addition of radiotherapy, we recommend radiation therapy early, especially in extensive, aggressive masses. This may prevent repeat surgical procedures in a pediatric patient’s hand that may contribute to excess scarring and flexor contractures. Factors related to the degree of recurrence include involvement of the joint capsule, extensor tendon, and flexor tendon.Clinical differences between DPVNS and GCTTS lesions are also noted. Their symptoms vary depending on the location and size of the lesion, associated diseases, and history of trauma.There are multiple described cases of both GCTTS and PVNS in adults. However, only a few cases have been reported in the pediatric population and they are limited to the knee and lower extremities. The hand and wrist were the least likely locations for its appearance in pediatric patients, and none had the multiple recurrences observed in this case. Kay et alWritten informed consent was obtained from the patient for the publication of this case report and accompanying images according to the CARE guidelines.


Mycobacterium avium complex. Fewer than 10 cases of cutaneous MSPs have been published, and most have occurred in immunocompromised patients, either due to human immunodeficiency virus (HIV) infection or immunosuppressive medications. The differential diagnosis includes Kaposi’s sarcoma and other spindle cell neoplasms, which can be distinguished based on histology and special stains. We present the case of a 76-year-old man with HIV infection who presented with a diffuse rash on his arms and legs. A pretibial biopsy was performed and revealed tubercular MSP.Mycobacterial spindle cell pseudotumor (MSP) is a rare proliferation of spindle-shaped histiocytes that occurs most frequently in lymph nodes but has also been documented in the skin, soft tissue, abdomen, and other sites. These lesions contain acid-fast mycobacteria, most commonly  Mycobacterial spindle cell pseudotumor (MSP) is a rare condition characterized by the proliferation of spindle-shaped histiocytes containing numerous mycobacterial organisms. It has been reported most commonly in lymph nodes but has also been seen in the skin, soft tissue, abdomen, lungs, nasal septum, brain, and bone marrow. It presents most frequently in immunocompromised hosts, particularly those with human immunodeficiency virus (HIV) infection . To our The patient is a 76-year-old male with dementia and HIV infection (CD4 count of 80 cells/μL) who presented to the dermatology clinic with a two-week history of a new rash over his legs and arms. He was first diagnosed with HIV 15 years prior to presentation. He was prescribed bictegravir, tenofovir, alafenamide, and emtricitabine. He lived in an assisted living facility and his caretaker reported poor patient compliance with these medications. On physical exam, he was noted to have a 2 cm erythematous tender nodule with a hyperkeratotic scale over his right distal pretibial region , followed by Mycobacterium tuberculosis complex (16%). It has been suggested that MSP is due to a dysregulated immune response, leading to a proliferation of spindle cells, which is why immunocompromising medical conditions, including HIV infection, are risk factors [Mycobacterial spindle cell pseudotumor is a rare disease that is believed to develop in response to mycobacterial infection. A review of MSPs of the skin and other organs between 1950 and 2017 noted that 84% of affected patients were male, and nearly 50% of affected patients had HIV infection [Cutaneous MSP was first reported in 1985 by Wood et al., documenting a 54-year-old cardiac transplant patient who developed progressive swelling of his hand with nodules and linear lymph node enlargement. Hematoxylin and eosin (H&E) staining of skin abscesses suggested a spindle cell neoplasm [We report a case of cutaneous MSP in a male patient with HIV, contributing to a very limited body of literature as fewer than 10 such cases have been published. Antimycobacterial therapy with or without surgery is the best treatment for this condition, though this patient unfortunately deceased before he was able to be treated. The differential diagnosis of MSP includes Kaposi sarcoma and other spindle cell neoplasms. Tissue biopsy and special stains are required for differentiation and determination of the definitive diagnosis.


Vulvar leiomyomas are rare benign tumors originating from smooth muscle cells of the vulvar tissue. We present the case of a 44-year-old female patient complaining of a painless vulval mass for 12 years, gradually increasing from 1x1 cm to 5x4 cm. Clinical assessment initially suggested a Bartholin cyst because of its non-tender and non-fluctuant nature. However, surgical intervention revealed an unexpected diagnosis of vulvar leiomyoma, measuring 5x5x4 cm. The patient underwent successful excision and repair under spinal anesthesia. This case underscores the significance of meticulous clinical evaluation and accurate histopathological examination in distinguishing vulvar masses. Accurate diagnosis guides appropriate management, and long-term follow-up prevents complications and recurrence. This report highlights the diagnostic challenges of rare vulvar lesions and the importance of a comprehensive approach to their evaluation and treatment. Vulvar leiomyomas are notably rare among gynecologic neoplasms and vulvar tumors, originating from the smooth muscle cells within the vulvar tissue . While tIn contrast, clinicians often encounter more prevalent vulvar conditions, such as Bartholin cysts. Bartholin cysts, characterized by localized vulvar swelling, exhibit a significantly higher incidence compared to vulvar leiomyomas . The cliBartholin cysts are typically painless, subcutaneous swellings located near the posterior aspect of the labia majora . Their eAccurate diagnosis is crucial for guiding appropriate treatment decisions. Vulvar leiomyomas, albeit rare, require a distinct approach, often involving surgical excision . The surIn this case report, we present a patient who initially presented with a painless vulval mass clinically diagnosed as a Bartholin cyst because of its non-tender and non-fluctuant nature. Subsequent surgical exploration revealed a surprising histopathological diagnosis of vulvar leiomyoma. This report emphasizes the importance of accurate clinical assessment, histopathological evaluation, and appropriate surgical intervention for managing vulvar lesions. Through this case, we highlight the complexities of diagnosing rare vulvar conditions and underscore the need for a comprehensive approach to their assessment and treatment.We present the case of a 44-year-old female patient who presented with a longstanding complaint of a painless vulval mass. The mass had been present for 12 years and had gradually increased from an initial measurement of 1x1 cm to the current dimensions of 5x4 cm  staining revealed a distinctive tissue architecture. The specimen exhibited a pattern of benign-appearing spindle cells organized into interacting bundles. These spindle cells displayed oval to spindle-shaped nuclei and eosinophilic cytoplasm, consistent with the characteristic features of leiomyoma cells. Furthermore, intervening fibrous septa and dilated, congested vessels within the tissue were noted. Notably, no evidence of malignancy was observed in the sections examined, which confirms the benign nature of the vulvar leiomyoma. These histopathological findings align with the clinical diagnosis and concord with the immunohistochemical results, collectively supporting accurately characterizing the lesion as a benign vulvar leiomyoma Figure .An immunohistochemistry analysis of the excised vulvar leiomyoma revealed notable findings. Desmin staining exhibited diffuse and strong positivity Figure , confirmRoutine investigations, including coagulation profile, liver and renal function tests, chest X-ray, and ECG were all within normal limits. Furthermore, an abdominal and pelvic ultrasound showed no abnormalities. This case underscores the importance of accurate clinical evaluation and histopathological diagnosis in managing vulvar masses. Vulvar leiomyomas are relatively uncommon, and their presentation can mimic other vulvar conditions, as evidenced by the initial clinical diagnosis of a Bartholin cyst. Long-term follow-up may be recommended to monitor the patient's condition and detect potential recurrences or complications.The presented case of a 44-year-old female patient with a longstanding painless vulval mass highlights the challenges in diagnosing and managing rare vulvar lesions. Based on the patient's history and physical examination, the initial clinical diagnosis of a Bartholin cyst underscores the importance of considering a broad differential diagnosis for vulvar masses. Moreover, this case report emphasizes the significance of accurate clinical evaluation and histopathological diagnosis in guiding appropriate management strategies. Vulvar masses encompass a wide range of benign and malignant conditions, each with distinct clinical and histopathological characteristics . Accurate clinical assessment and histopathological diagnosis guide appropriate management and prevent misdiagnosis. This case serves as a reminder of the diverse differential diagnoses for vulvar masses and underscores the importance of a multidisciplinary approach to patient care. Further research and long-term follow-up are needed to enhance our understanding of these uncommon vulvar neoplasms and optimize their management strategies.The presented case highlights the diagnostic intricacies associated with rare vulvar conditions, precisely the challenge of distinguishing between vulvar leiomyomas and Bartholin cysts. Accurate clinical evaluation is paramount, as these lesions share standard features, including painless presentation and localized swelling. The case underscores histopathological confirmation's significance in preventing misdiagnosis and ensuring appropriate management. The management of vulvar lesions demands tailored approaches to achieve optimal outcomes. Surgically excising vulvar leiomyomas requires careful planning because of their location and potential impact on cosmetic and functional aspects. A misdiagnosis of these lesions can lead to unnecessary interventions or inadequate treatment. This report highlights the importance of a comprehensive diagnostic approach involving clinical assessment and histopathological examination to differentiate between similar vulvar presentations. This distinction has crucial implications for patient management, emphasizing the significance of accurate diagnosis in providing effective and patient-centered care. The case underscores clinicians' need for ongoing vigilance and awareness when encountering rare vulvar lesions, ensuring that patients receive the most appropriate interventions.


NF1 mutation have a better prognosis for sporadic gliomas. Diagnosis includes radiological imaging methods/MRI/ophthalmology/OCT and visual acuity log MAR assessment. The basis of treatment is clinical observation. In the case of disease progression, surgical treatment, chemotherapy and targeted therapy are used. Conclusion: Further research into novel techniques for detecting gliomas would allow for early monitoring of the disease. In this paper, the authors present a clinical picture of the diagnosis and current treatment regimens of optic pathway glioma in the pediatric population, with an emphasis on the role of an ophthalmic diagnosis in the differentiation and monitoring of lesions. Glioma is the most common optic nerve tumor in children. Material: Articles in PubMed, Scholar and Website were reviewed, taking into account current standards of management related to sporadic or NF1-related optic glioma, epidemiology, location, course of the disease, clinical manifestations, histological types of the tumor, genetic predisposition, diagnostic ophthalmic tests currently applicable in therapeutic monitoring of the tumor, neurological diagnosis, therapeutic management and prognosis. The importance of current screening recommendations, in line with standards, was emphasized. Results: Glioma occurs in children most often in the first decade of life. Initially, they may be asymptomatic, and clinically ophthalmic changes are associated with the organ of vision or with systemic changes. Gliomas associated with the  NF1, located on chromosome 17q, are linked to the loss of neurofibromin, resulting in the activation of the RAS signaling pathway [KIAA1549) [BRAFv600E point mutation and a tandem duplication resulting in a KIAA1549-BRAF fusion. This fusion results in a transcript in which the kinase domain of the BRAF gene is fused to a gene of unknown function (KIAA1549) [BRAF v600e mutation may be protective [Gliomas are a type of brain tumor that develops from neuroglial progenitor cells.  Gliomas  pathway . OPGs oc pathway . Surviva pathway ,22,23,24IAA1549) ,16,25. TIAA1549) , leadingIAA1549) ,28,29,30otective ; other gotective ,33,34. Totective ,35,36,37NF1 mutations [Pilocytic astrocytoma (PCA) is the most common childhood brain tumor ,39 and tutations .NF1 mutation were analyzed. The study showed that 37% of tumors were located behind the optic chiasm, and 76% of gliomas occurred bilaterally. In contrast, the sporadic form is most often located behind the optic nerve junction, mainly in the cerebellum ,41. The Gliomas of the optic nerve are far more common in the pediatric population. According to the available literature, gliomas develop in 75% of patients in the first decade of life, and in 90% in the first two decades of life . GliomasBRAFv600E mutations are larger and have a tendency toward infiltration, greater progression and tumor recurrence [BRAF V600E mutation in the pediatric group show positive overall survival (OS) outcomes, while such a correlation is not confirmed in the adult population [OPGs are slow-growing tumors. They can present with accelerated and stunted growth, as well as spontaneous regression. These tumors usually spread along the optic nerve, and distant metastasis are rarely described ,23,37,43currence ,48,49. Apulation . The propulation . NF1 mutation) show more aggressive histopathological features compared to gliomas associated with this mutation [The most common histologic types found in children with OPGs are low-grade gliomas (WHO grade I and II), with the most common being pilocytic astrocytoma (PCA) and the rarer pleomorphic xanthoastrocytoma (PXA). We include pilocytic astrocytoma, subependymal giant cell astrocytoma (SEGA), diffuse astrocytoma, pilomyxoid astrocytoma and Pleomorphic xanthoastrocytoma in the group of tumors classified as astrocytic tumors within the low-grade glioma (LGG) category ,37,41,52mutation ,35,47.As previously mentioned, OPGs can either occur sporadically  or be asNF1 is a tumor suppressor gene that controls cell proliferation, survival and differentiation, and it is inactivated in Recklinghausen disease. The mechanism works through the mitogen-activated kinase (MEK) and mTOR pathways [pathways ,58. The pathways . In patipathways ,15,16,17NF1 in the tumor without any other recurrent oncogenic alterations [NF1-associated OPGs contain a bi-allelic inactivation of the NF1 tumor suppressor gene . Consequently, patients with NF1 are born with one mutated copy of the NF1 gene, and tumors develop after acquired loss of the remaining erations ,33. The erations . NF1 mutations is also important in the dynamics of symptoms—sporadic optic nerve gliomas are generally detected in the first decade of life and carry a higher risk of vision loss [The symptoms of OPGs depend primarily on their location: in the orbit or in the CNS. For orbital tumors, the most common symptom is exophthalmos, often with strabismus (94%) and early vision loss 88%). Other common symptoms include abnormal pupillary response, dyschromatopsia, optic atrophy, swelling of the optic disc, nystagmus and elevated intraocular pressure 8%. Other. Patiention loss . In contion loss . An analion loss  52% of pion loss . Clinicaion loss ,62. Accoion loss , glioma The key diagnostic investigations of OPGs include a neurological clinical examination, visual acuity (VA), assessment by logMAR arrays and OCT , and magnetic resonance imaging (MRI). It is important to correlate the symptoms presented with supplementary gadolinium-enhanced MRI images. MRI provides a distinct advantage over CT ,12,64. MAccording to an analysis by Heidary et al. , at the Laboratory investigations should include tumor markers (AFP and B-HCG) for suprasellar lesions detected on imaging to exclude germ cell tumors ,78. CurrRecommendations for screening patients with optic nerve glioma in NF1 include annual testing of visual acuity on logMAR boards in all children under the age of 8 and at least every 2 years until the age of 18 . A meta-According to the current guidelines, in the observation group without residual tumor or with stable residue, physical and neurologic examination and ophthalmology (mandatory in VPG) should be performed every 3 months, audiometry (for brain stem LGG) should be performed every 6 months, and MRI should be performed every 3–6 months during the first year. In the second year, physical and neurologic examination, MRI and ophthalmology should be performed every 3–6 months. In the 3rd–5th years, physical and neurologic examination should be performed every 6 months, while MRI and ophthalmology (mandatory in VPG) should be performed every 6–12 months. In 6th–10th years, physical and neurologic examination should be performed annually, and MRI should also be performed annually, although optionally every 6 months in the case of VPG. Ophthalmology (mandatory in VPG) should be performed every 6–12 months. In the 1st–10th years, neuro-cognitive follow-up is according to institutional policy. In the 2nd–10th years, audiometry is not indicated if the results were previously normal, but there should be regular assessments if hearing is impaired. In the chemotherapy group with stable residue after termination of treatment, physical and neurologic examination with auxology, MRI  and ophthalmology (mandatory in VPG) should be commissioned every 3 months; audiometry (following carboplatin and for brain stem LGG) and assessment of renal function should be performed 6 months after chemotherapy.In the second year, physical and neurologic examination, MRI and ophthalmology should be performed every 3–6 months. In the 3rd–5th years, physical and neurologic examination, MRI and ophthalmology should be performed every 6 months. In 6th–10th years, physical and neurologic examination should be performed annually, and MRI should also be performed annually, although every 6 months in the case of VPG. Ophthalmology (mandatory in VPG) should be performed every 6–12 months. In the 1st–10th years, neuro-cognitive follow-up is according to institutional policy.In the 2nd–10th years, audiometry is not indicated if the results were previously normal, but there should be regular assessments if hearing is impaired. Renal function should be performed yearly, if not otherwise indicated; this assessment may not be required if the results are repetitively normal.In the radiotherapy group with stable residue after termination of treatment, physical and neurologic examination with auxology, MRI  and ophthalmology (mandatory in VPG) should be commissioned every 3 months, while audiometry (following irradiation of the inner ear and for brain stem LGG) should be performed every 6 months. In the second year, physical and neurologic examination, MRI and ophthalmology should be performed every 3–6 months, and audiometry (following irradiation of the inner ear and for brain stem LGG) should be performed every 6–12 months. In the 3rd–5th years, physical and neurologic examination with auxology should be performed every 6 months, MRI and ophthalmology (mandatory in VPG) should be performed every 6–12 months, and audiometry (following irradiation of the inner ear and for brain stem LGG) should be performed annually. In the 6th-10th years, physical and neurologic examination should be performed annually, and MRI should also be performed annually, although every 6 months in the case of VPG. Ophthalmology (mandatory in VPG) should be performed every 6–12 months. Audiometry is not indicated if the results were previously normal, but there should be regular assessments if hearing is impaired.In the 1st–10th years, neuro-cognitive follow-up is according to institutional policy .NF1/BRAF gene. The main goal of therapy is directed at reducing the risk of permanent, clinically significant visual dysfunction. In clinical practice, observation is the most common approach. The decision to treat or observe may not be straightforward. The best indication for treatment with chemotherapy is evidence of progressive, clinically significant vision loss. There are currently two distinct criteria for transitioning from observation to treatment. The first criterion includes patients diagnosed with significant symptoms, such as diencephalic syndrome, and all infants under the age of 1 diagnosed with chiasmatic/hypothalamic glioma with remaining tumors, regardless of symptoms. The second criterion encompasses cases where there is substantial radiological progression of a residual tumor or the appearance of new lesions on MRI imaging that cannot be addressed surgically, as well as significant worsening of neurological or visual symptoms after the initial observation period. In the case of surgical treatment, the method of choice is complete resection while maintaining a microscopic disease-free margin. Due to the risk of vision loss, often, full radicality of the procedure may not be possible. This creates a significant clinical dilemma; whether a patient should be included in treatment or remain under observation after a partial resection is a crucial decision. Performing surgery in OPGs provides valuable information for both histopathological and molecular diagnoses [The SIOP-E-BTG and GPOH Guidelines for Diagnosis and Treatment of Children and Adolescents with Low-Grade Glioma include recommendations for the management of patients with OPGs. The management approach depends on the patient’s age, tumor location, histopathological, especially molecular diagnosis, associated cancer predisposition syndrome and other co-morbidities carrying a mutation in the iagnoses . Surgical treatment is not recommended upfront, but according to the literature, it may be considered when there are symptoms such as tumor pressure on the visual pathway, causing severe visual disturbances; pain; ocular exophthalmos; and infiltration of the hypothalamus by the glioma, causing endocrine disruption and affecting surrounding structures ,5,89. ThSecond-line chemotherapy may be required in the face of a hypersensitivity reaction to carboplatin or upon progression during treatment or early relapse after the completion of first-line chemotherapy. The following are alternative therapies: vincristine/cisplatin/cyclophosphamide, monotherapy with vinblastine, irinotecan/bevacizumab, and thioguanine/procarbazine/cisplatin/vincristine (TPCV) ,90,91,92In gliomas, there is a significant increase in angiogenesis, with the growth factor VEGF inducing angiogenesis. Bevacizumab is a type of targeted therapy called an angiogenesis inhibitor. It is a monoclonal antibody that binds to a protein called VEGF, which is produced by some cancer cells and has been used in various pediatric tumors over the last 15 years with only limited benefit confined to selected groups, such as PLGG ,95. As aInteresting research results came from a multicenter study presented by Green et al. about standardized neuro-radiological (RANO-LGG) and visual  criteria which were used to assess the clinical–radiological correlation and survival outcomes in examined group of patients. Bevacizumab provides effective short-term control of PLGG and delays further progression, providing better visual benefits than imaging methods. Bevacizumab is a safe and effective treatment for low-grade glioma in children, including the stabilization or improvement of visual acuity, which correlates best with MRI responses . Although radiotherapy (RT) may provide favorable long-term outcomes in for either an adjuvant or salvage aim, chemotherapy is the preferred treatment approach due to the late effects of RT and impact on the optic pathway. RT induces apoptosis of local cells, and in the case of optic pathway gliomas (OPGs), it can lead to the worsening of vision. Proton beam radiotherapy may allow normal tissue sparing of radiation exposure compared to conventional photon therapy (references). Radiation therapy can be considered in cases where chemotherapy is not effective in the treatment of OPGs. However, the impact of radiation therapy, especially on patients with NF-1, should be taken into account, as it significantly increases the risk of secondary tumors. Therefore, it should not be the treatment of choice for NF-1 children with pediatric OPGs. In older children diagnosed with low-grade glioma outside of the optic pathway, radiotherapy may be considered as the first line of treatment .As mentioned earlier, pilocytic astrocytoma is the most common type of childhood cancer. It is characterized by the presence of changes in the MAPK pathway. The mutation leads to the activation of and changes in cell modulation and proliferation. Mutation in the MAPK pathway makes it possible for MAPK inhibitor therapy to be used in the course of pilocytic astrocytoma. This allows for targeted therapy, which is very promising, but further research and analysis of the impact of this treatment on glioma is still ongoing ,35,58. TThe optimal duration of targeted therapy is still unknown. Therefore, in many cases, treatment is continued without interruption if it does not cause adverse effects. There are reports that the discontinuation of therapy can cause relapse or progression of the disease . CurrentMost gliomas are considered to have a low risk of malignant transformation ,35. The  Due to the potential for a wide range of ophthalmic and general clinical symptoms in patients with optic pathway gliomas, multidisciplinary collaboration between ophthalmologists, oncologists, neurosurgeons, neuroradiologist, radiotherapists, endocrinologists, psychologists and geneticists, who have a significant impact on the early well-being of the patient and their caregivers, is extremely important. Isolated optic pathway gliomas are highly active tumors that tend to progress radiologically and cause visual deterioration in a significant percentage of patients compared to other OPG locations. Surgical treatment should be a last resort in the present day, and the main surgical intervention that is gaining in significance is biopsy, as it allows for the selection of appropriate targeted therapy, which currently remains in clinical trials. Chemotherapy deserves further pharmacological research, with perhaps new drugs, as it can help inhibit vision loss and is currently the most widely used and best-studied treatment, with the best long-term effects. The mainstay of OPG management today is observation and assessment of progression in correlation with clinical symptoms. Clinical signs and symptoms, optic nerve atrophy and history as predictive factors in children with NF1-OPG are of utmost importance. Therefore, eligibility criteria for future studies should include the timing of symptom onset, with a particular focus on visual deterioration, if identifiable. Further research into new techniques for the early detection of gliomas would allow for accurate monitoring of the disease, providing a chance for earlier treatment and longer survival for affected children.


Intrathoracic gastric duplication has rarely been reported. A 5-year-old child with gastric duplication located in the left thorax was diagnosed and treated successfully using laparoscopy combined with gastroscopy. Preoperative computed tomography, upper gastrointestinal contrast study, ultrasound, and other imaging methods were insufficient for accurate diagnosis in this case. Laparoscopy combined with gastroscopy is more suitable for the diagnosis and treatment of gastric duplication. Several cases of gastric duplication have been reported in the abdominal cavity, but fewer are noted in the thoracic cavity. We report a case of gastric duplication in the left thoracic cavity, connected to the stomach. Gastric duplicates account for 2%–8% of all gastrointestinal duplicates, with an incidence of approximately 17 case/1 million . Diagnos2.The patient was a 5-year-old boy. Seven days before this admission, he was admitted to the hospital due to pneumonia and was incidentally found to have a mass occupying the left mediastinum during computed tomography (CT) examination. This was initially thought to be either an esophageal foramen hernia or pulmonary isolation syndrome. He had no chest tightness, pain, dyspnea, cough, hemoptysis, or other clinical symptoms. Physical examination demonstrated a normal thoracic cavity, regular respiratory rhythm, symmetrical respiratory movements, and normal intercostal spaces. Respiratory sounds were coarse in both lungs, no rales were heard, and no prolonged expiratory phase was observed. Laboratory examination revealed normal routine blood markers, including liver and kidney function, electrolytes, coagulation indexes, and amylase levels. Preoperative upper gastrointestinal tract contrast study showed an irregular posterior esophageal lumen shadow and an esophagogenic cyst.As seen in After preoperative discussion, the possibility of an esophageal cyst was considered high, but other digestive tract malformations could not be ruled out. The presence of lesions and the parents' concerns about the progression of the disease spurred the decision to perform a surgical exploration. After successful anesthesia. Gastroscopy revealed an abnormal opening in the gastric fundus paracardia, as shown in After the surgery, antibiotics, fluid replacement, and other supportive treatments were administered. Diet was resumed 7 days after the operation, and the abdominal drainage tube was removed 10 days after the operation. Most of the submitted pathological samples were lined with gastric mucosa, and a small part of the lining epithelium was shed, with slight hyperplasia of granulation and fibrous tissues . Upper g3.Gastrointestinal duplication is a rare congenital malformation that can occur anywhere in the gastrointestinal tract (from the mouth to the anus). Almost half of the malformations occur in the small intestine, especially in the ileum, and rarely in other sections. Gastric duplicates account for 2%–8% of all gastrointestinal duplicates , with anThe manifestations of gastric duplication in children of different ages vary. Patients may experience abdominal pain, vomiting, bloody stools, difficulty eating, or other non-specific gastrointestinal symptoms –6. GastrSome studies have found that cases of gastric duplication may undergo malignant transformation –11. For Gastric duplication deformity, which can communicate with the stomach cavity, is rare . RowlingIn this case, the lesion shared the muscle layer with the gastric digestive tract and was located in the smooth muscle layer, and pathological examination showed gastric mucosa. The above are in line with the pathological diagnostic criteria of gastric duplication. No protruding masses were found on the surface of the stomach during laparoscopy, which is inconsistent with the bulge of a gastric diverticulum outside the stomach wall. A multilocular traffic cyst was found; hence, our case is multi-chamber gastric duplication with gastric contact extending into the thoracic cavity.Gastric duplication with an intrathoracic connection to the stomach is rare and difficult to diagnose. The combination of laparoscopy and gastroscopy in the treatment of intrathoracic and gastric-connected gastric duplicates is of great clinical significance. The case that we encountered in our surgical practice is extremely unique, and no other similar cases could be found in the published literature. This study can raise awareness of the differential diagnosis and treatment among clinicians who might encounter similar cases in the future. Finally, the patient had a good prognosis and recovered well after the review.


Chondrocutaneous branchial remnants (CCBRs) are rare congenital heterotopic tissue formations originating from the first or second embryonic branchial arches. Clinically, CCBRs are characterized predominantly by unilateral and solitary cartilaginous nodules found on the lower neck region. Herein, we present a case of CCBRs in a 9-year-old male patient who presented with horn-shaped projecting masses on either side of the anterior border of the sternocleidomastoid muscle. The pathological report following surgical resection revealed that the lesion was located in the dermis and consisted primarily of hyaline cartilage tissue enclosed by a fibrous capsule, with few local vascular proliferations. Based on the clinical and pathological features, the patient was ultimately diagnosed with congenital bilateral cervical chondrocutaneous branchial remnants. Chondrocutaneous branchial remnants are uncommon congenital cervical masses that typically manifest as unilateral, solitary hemispherical, horn-like, or papillary nodules. While first reported by Birkett in 1858 , 3. ChonExamination of a 9-year-old male patient at our outpatient department revealed painless masses that were protruding bilaterally on the anterior border of the sternocleidomastoid muscle in the neck, with no signs of infection or exudate detected upon palpation . AccordiThe physical examination of the patient did not reveal any significant findings. Besides, the chest X-ray showed no anomalies in the heart, lungs, or diaphragm. The child had not had any cardiac problems since childhood and the chest X-ray did not show any abnormalities in the size, shape, or position of the heart. Therefore, no further echocardiography was performed. A preoperative ultrasound examination of the neck revealed bilateral hypoechoic nodules in the subcutaneous region of the anterior cervical area. The left lesions were approximately 7 mm × 4 mm × 4 mm in size, while the right nodules were around 5 mm × 3 mm × 3 mm in size. They exhibited clear borders and irregular morphology, and no internal blood flow signal was detected.Eventually, the child underwent surgery under general anesthesia. The bilateral horn-like masses were meticulously separated and excised, as shown in Histopathological examination revealed that the lesion was located in the dermis and consisted primarily of hyaline cartilage tissue enclosed by a fibrous capsule with few local vascular proliferations .Considering the patient's history and clinical presentation, he was diagnosed with congenital bilateral cervical chondrocutaneous branchial remnants. No further treatment was thus given, and the patient was followed up regularly. To date, no signs of recurrence or hyperplasia have been observed.The nomenclature, differential diagnosis, etiology, possible genetic and molecular mechanisms, histopathology, comorbidities, investigative approach, treatment, and management recommendations for CCBRs are further discussed as follows.Birkett was the first to report a benign nodule formation in the neck that resembled an accessory auricle back in 1858. Since then, the terminology used to describe similar features has varied significantly, with various terms such as cutaneous appendages, malformations, papillomas, fibromas, warts, neck remnants, accessory tragus, and accessory auricle being utilized . In 1997The lesion was located at the anterior border of the sternocleidomastoid muscle in the neck and was consistent with the clinical presentation and histopathology of the chondrocutaneous branchial remnants, which was finally diagnosed in this child.As a result of clinicians' failure to identify the histological characteristics of patients and their subjective diagnosis, chondrocutaneous branchial remnants have previously been referred to under a variety of terms.The differential diagnosis of CCBRs for skin protruding formations includes warts, fibroids, polyps, epidermal-like cysts, and cervical follicular nevi . MeanwhiIn 1997, Atlan et al. first proposed a mechanism for chondrocutaneous branchial remnants occurrence during external ear development. He hypothesized that the auricle is formed by the migration of the six auricular hillocks of the first and second branchial arches along the sternocleidomastoid muscle from the cervical to the facial region. During migration, part of the malleoli may be left behind, remaining in the neck and developing into a chondrocutaneous branchial remnant. As a result, CCBRs tend to be found around the sternocleidomastoid muscle and contain cartilaginous tissue similar to that found in the auricle. The authors further proposed that CCBRs are most likely to form in the neck's middle and lower third sections and that the cartilaginous remnants most likely originate from the second or posterior branchial arch . On the Herein, the histological analysis of our patient revealed that the excised specimen consisted of hyaline cartilage, pointing towards a second branchial arch or inferior branchial arch origin. Nonetheless, further in-depth studies are warranted to substantiate and clarify the intricate etiology of CCBRs.Pham Dang et al. previously reported on five individuals with familial chondrocutaneous branchial remnants over three generations, indicating that this condition might also be hereditary in an autosomal dominant manner and is not significantly related to gender . HoweverChondrocutaneous branchial remnants are typically characterized by a core of elastic or hyaline cartilage located in the deep dermis or subcutaneous fat layer, surrounded by a fibrous capsule , 9, 15. In 1997, Atlan et al. reported that chondrocutaneous branchial remnants were associated with several abnormalities that could affect the auditory , respiratory , orogastric , genitourinary , cardiovascular , musculoskeletal , and visual systems (strabismus), as well as induce Parkinson's disease . Among tChondrocutaneous branchial remnants can lead to various systemic diseases and complications. These reports highlight the importance of systematic physical examination and ancillary tests during patient consultation to identify comorbidities that may impact treatment decisions and outcomes.Investigations are crucial for the timely detection and management of CCBRs. Gilboa et al. identified chondrocutaneous branchial remnants in three of 51,343 fetuses during early routine ultrasound examinations of pregnant women. In the first case, termination was chosen by the parents, while the second patient underwent postnatal surgical excision. The third fetus had cardiac abnormalities, and after careful consideration, termination was performed [In addition, it is important for patients with CCBRs to undergo a thorough physical examination. For CCBRs identified after birth, it is essential to monitor their growth and development. Moreover, neuropsychiatric, vision, hearing, maxillofacial, genitourinary, respiratory, and cardiac examinations must be conducted regularly. In addition, renal function, ECG, chest and abdominal ultrasounds, X-rays, and electroencephalograms must also be performed. Importantly, an ultrasound examination of the mass is necessary to prepare the patient for surgery and avoid intraoperative injury to surrounding blood vessels, nerves, tissues, and organs.When the diagnosis of chondrocutaneous branchial remnants is straightforward, surgical removal under anesthesia is typically the treatment of choice. However, in cases with additional complications or comorbidities, symptomatic management may be necessary prior to surgery to reduce the risk of damage to surrounding tissues and organs. The type of anesthesia used will typically depend on the patient's compliance.Since chondrocutaneous branchial remnants are often present at birth, it is important for families to seek medical attention promptly to avoid complications and psychological distress later on. Notably, early intervention before the child is enrolled at school can help reduce the risk of surgical complications and prevent social or psychological issues.The diagnosis and treatment of chondrocutaneous branchial remnants are of utmost importance to prevent complications and improve patient outcomes. While a small proportion of patients may present with comorbidities or complications, most patients are asymptomatic. Therefore, a comprehensive history, physical examination, and appropriate ancillary tests are crucial in making an accurate diagnosis. Early intervention through surgical excision is recommended to avoid any potential psychological effects on the child. In addition, conducting renal function, ECG, echocardiography, audiology, and imaging can help identify any associated abnormalities and enable effective treatment planning. Taking a proactive approach and providing timely and appropriate care can significantly improve the quality of life for patients with chondrocutaneous branchial remnants.