Primary neuroendocrine tumors of the gallbladder (GB-NETs) are rare, accounting for 0.5% of all NETs and 2.1% of all gallbladder cancers. Among GB-NETs, mixed neuroendocrine–non-neuroendocrine neoplasms of the gallbladder (GB-MiNENs) are extremely rare.We present the case of a 66-year-old woman who was referred to us for the management of a gallbladder tumor . The patient had no history of abdominal pain or fever, and the findings on a physical examination were unremarkable. Blood tests showed normal levels of tumor markers. Imaging studies revealed a mass of approximately 10 mm in diameter  located at the fundus of the gallbladder. A gallbladder cancer was suspected. Therefore, an open whole-layer cholecystectomy with regional lymph nodes dissection was performed. The postoperative course was uneventful, and she was discharged on postoperative day 6. Pathological findings showed GB-MiNENs with invasion of the subserosal layer and no lymph node invasion . Analysis of the neuroendocrine markers revealed positive chromogranin A and synaptophysin, and a Ki-67 index above 95%. Fourteen months after the operation, a local recurrence was detected, and she was referred to another hospital for chemotherapy. GB-MiNENs are extremely aggressive tumors despite their tumor size. Optimal therapy should be chosen for each patient. Primary neuroendocrine tumors of the gallbladder (GB-NETs) are rare, accounting for 0.5% of all NETs and 2.1% of all gallbladder caners. Among GB-NETs, mixed neuroendocrine–non-neuroendocrine neoplasms of the gallbladder (GB-MiNENs) are extremely rare.We present the case of a 66-year-old woman referred for management of a gallbladder tumor, which was incidentally found during an abdominal ultrasonography indicated for gallbladder stones. The patient had no history of abdominal pain or fever, and the findings on physical examination were unremarkable. The blood tests showed normal levels of tumor markers . Contrast-enhanced computed tomography (CT) showed wide-based mass of approximately 10 mm in diameter contrasted in arterial phase at the fundus of the gallbladder. MRI showed a nodule in the fundus of gallbladder with high signal in diffusion-weighted imaging and low in apparent diffusion coefficient. Since there was no Rokitansky–Aschoff sinus in the nodule, the possibility of gallbladder adenomyomatosis was considered low. The tumor was limited within gallbladder; it was hard to predict precise depth of tumor even by radiologist  was positive for chromogranin A, synaptophysin, and CD56 Fig. . The Ki-While there was venous infiltration in the adenocarcinoma area, there was no vascular involvement in the neuroendocrine area.The exocrine (adenocarcinoma) and neuroendocrine components were each present in more than 30% of the tumor mass. Therefore, the tumor was diagnosed as a GB-MiNENs with invasion of the subserosal layer and with no lymph node invasion classified T2aN0M0 pStage IIA .After the operation, she received oral adjuvant chemotherapy (tegafur/gimeracil/oteracil potassium combination) for 5 months. She later discontinued the chemotherapy due to loss of appetite and diarrhea. However, 14 months after the operation, a local recurrence was detected. She was referred to another hospital for chemotherapy.According to the 2019 WHO Classification of Tumors of the Digestive System, MiNENs are defined as tumors consisting of two components, a non-neuroendocrine tumor, and a neuroendocrine tumor, each of which host at least 30% of the total cellular population on pathological examination . The oriStudies have shown that in most MiNEN, the adenocarcinoma component is located on the mucosal surface, meanwhile the neuroendocrine component invades the deeper areas . In our Just as in other gallbladder tumors, no specific symptoms and changes in image findings occur in GB-NET, making its diagnosis difficult. The most common presenting symptom is vague abdominal pain or discomfort and the GB-NET is usually associated with cholelithiasis . A studyImaging studies like ultrasound, computed tomography, magnetic resonance imaging, positron emission tomography–CT, and somatostatin receptor scintigraphy, reveals useful information about GB-NETs. However, the imaging findings of GB-NETs are non-specific and it is extremely difficult use imaging findings to differentiate between GB-NETs and gallbladder adenocarcinoma. While neuroendocrine tumor is hypervascular tumor strongly enhanced on CT, neuroendocrine carcinoma (NEC) is hypovascular tumor like adenocarcinoma. It is difficult to differentiate NEC from adenocarcinoma. Iwamoto et al. reported that since in the case of NEC of the gallbladder, the progression is more rapid than in the case of gallbladder cancer, and the pathology is less fibrosis and more necrotic changes, tumor showed images with poor contrast effect on late phase of contrast enhanced CT . MurawakIn this patient, a local recurrence was detected 14 months after the operation, prompting referral to another hospital for chemotherapy.We encountered GB-MiNENs at an early stage, and because they are asymptomatic at this stage, it was difficult to detect them when they were still resectable. GB-NETs are malignant tumors that still have a poor prognosis. More cases need to be studied to help establish a standardized optimal treatment.


Hibernoma is a rare benign neoplasm of brown adipose tissue most frequently involving the thigh, shoulder, back, and neck. Differentiating this benign entity from other lipomatous tumors such as well-differentiated liposarcoma is essential, given the different surgical approaches and prognosis associated with each diagnosis. It is helpful for the radiologist to recognize the uncommon locations of hibernoma, as well as characteristic imaging features, in order to properly include it in the differential considerations. Here we present a rare case of symptomatic vulvar hibernoma in a 25-year-old woman treated with surgical excision.  Hibernoma is a rare benign neoplasm of brown adipose tissue accounting for <2% of benign lipomatous tumors and 1% of all adipocytic tumors . In a coA 25-year-old G2P1 woman with a history of hernia repair presented with a slowly enlarging left labial mass, first noticed approximately eight years ago when she felt intermittent sharp and burning pain in the region aggravated by wearing tight pants. The mass was visible on the physical exam and measured up to 5 cm in size. Sporadic exacerbation of pain was frequently noted without exacerbating factors; however, it was also occasionally noted when wearing tight pants. Follow-up pelvic MRI showed a circumscribed, lipomatous mass in the subcutaneous soft tissues of the left labia measuring 4.9 cm x 2.1 cm x 1.6 cm  without malignant features, which are characteristic of typical hibernoma Figure . Hibernoma is a rare benign neoplasm composed of brown lipomatous tissues without the potential for malignant transformation. The term “hibernoma” was coined in 1914 by Gery and came from the relatively common occurrence of brown fat in hibernating animals . The majHibernomas are composed of various proportions of brown fat cells with eosinophilic granular cytoplasm and microvacuolation (hibernoma cells), multivacuolated adipocytes, and mature univacuolated adipocytes. Four morphologic variants of hibernomas have been described: typical 82%), myxoid (8%), lipoma-like (7%), and spindle cell (2%) [%, myxoidIt is important to be aware of these rarer subtypes of hibernoma as the lipoma-like subtype of hibernoma could be mistaken for atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDLS) due to the presence of scattered multivacuolated adipocytes mimicking lipoblasts . The intHibernomas classically appear as a circumscribed, lobulated, lipomatous mass on MRI, demonstrating mild T1 hypointensity to subcutaneous fat, incomplete fat suppression on short TI inversion-recovery (STIR) sequences, and heterogeneous enhancement. There may be enhancing internal septations and vascularity within the lesion: in fact, branching flow voids in non-contrasted studies and enhancing vascular structures are considered a distinguishing feature that favors hibernoma over WDLS . DiffereDifferentiating hibernoma from ALT/WDLS by imaging before tissue diagnosis can be a diagnostic dilemma. Both entities can be well circumscribed and show T1 hypointensity to the surrounding fat and incomplete fat saturation; both may contain thickened >3 mm) and enhancing septation. Individual hibernoma of certain subtype may exhibit unique imaging characteristics. For example, the lipoma-like and spindle-cell subtypes may show internal serpiginous vascular structures, while the myxoid subtype may have non-specific high T2 signals due to its high water content [ mm and eOther modalities including positron emission tomography (PET) have also been utilized to characterize hibernomas. Several studies have attempted to use standardized uptake values (SUV) in 18-fluoro-2-deoxy-D-glucose (18FDG)-PET to differentiate between hibernoma and other ALTs. For example, hibernoma was shown to have intense FDG uptake greater than 7.9, while liposarcomas have low to intermediate uptake values between 0.8 and 6.0 depending on the tumor grade; simple lipomas usually have low uptake values less than 2.0 -15. HoweThe definitive and curative treatment of hibernoma is surgical excision. No recurrence of hibernoma after excision has been reported in the literature. For patients who cannot tolerate surgery, routine surveillance may be considered. When an ALT is encountered in daily practice, the imaging features outlined above can be used to distinguish hibernomas from more suspicious entities such as WDLS. FDG-PET may offer additional information to characterize the brown fat content of the tumor, but the SUVs are often non-specific for the diagnosis of hibernoma and histopathologic diagnosis remains the gold standard.Hibernomas are rare benign neoplasms of brown adipose tissue. The primary differential diagnosis of a hibernoma on imaging is a liposarcoma due to their shared hypervascularity. We report a hibernoma of the vulva which is an exceedingly rare location for this lesion with only one other reported case in the literature. Although MRI plays an important role in establishing a differential diagnosis, surgical resection remains the gold standard in order to definitively exclude a liposarcoma.


Gastrointestinal perforation due to foreign body intake is rare and often secondary to unintentional intake; hence, a misdiagnosis is likely. Herein, we report a case of perforation of the ileum due to fish bone.A 57-year-old woman presented with right lower abdominal pain. She did not provide any information about having a history of swallowing foreign bodies. Surgery for uterine fibroids and subtotal gastrectomy was performed 6 years ago.Laboratory tests and imaging examination showed normal results. During laparotomy, a fish bone was found at the end of the ileum. Two senior radiologists re-evaluated the computed tomography scan, and confirmed the presence of the suspected foreign body.Partial intestinal resection and manual ileum end anastomosis were performed.The patient recovered well after surgery and recalled that she had eaten fish the night before experiencing abdominal pain.An accurate diagnosis of complications due to fish bone intake, often secondary to the unintentional intake, is quite challenging. Detailed history-taking about the patient's diet and eating habits is therefore important. Clinical manifestations are mainly determined by the location of perforation, which typically occurs at the junction of the ileum and rectal sigmoid colon. Imaging examination and surgery are often used for definite diagnosis. Pathological examination of surgical specimens showed acute inflammation, and the patient was discharged normally on the 7th day.A 57-year-old woman was admitted to the general surgery department with complaints of right lower abdominal pain that started 3 days ago. The patient showed no symptoms of peritonitis, fever, and other inflammatory aspects. Her white blood cell count, blood urea nitrogen level, and defecation were normal. Surgery for uterine fibroids and subtotal gastrectomy was performed 6 years ago. Contrast-enhanced abdominal computed tomography (CT) did not show any obvious abnormalities. As the patient had a history of multiple surgeries, we wondered whether the pain was due to postoperative intestinal adhesion. However, on the third day after hospital admission, we decided to perform a laparoscopic exploration. There was a small amount of yellow exudate in the pelvic cavity. Given the patient's history of multiple abdominal surgeries, part of the intestinal showed adhesion, and the laparoscopy could not provide a comprehensive exploration. We surgically opened the abdomen and found a sharp, hard foreign body measuring 1.7 cm at the end of the ileum. It was coated in some fibrinous exudates around the puncture point (Fig. 3Although most foreign bodies can be extruded within one week after entering the digestive tract,Most foreign bodies leading to perforation of the gastrointestinal tract are caused by eating foods such as sharp broken bones and fish bones. In one study, fish bones were found to be the most common foreign bodies that lead to perforation of the gastrointestinal tract. In certain countries or regions that prefer to eat fish, gastric perforation or other complications caused by fish bone intake are very common.Although perforation caused by fish bones can affect any part, it is most often seen occurring in areas of physiological stenosis or intestinal transitions such as the ileum or rectosigmoid junction.Ingestion of fish bones leading to perforation is often secondary to accidental intake. Therefore, doctors rarely obtain a history of fish-bone ingestion. It is often only found during an imaging examination or surgical exploration.Imaging examination is usually unreliable in the diagnosis of perforation caused by fish bone. High-density shadow, free gas, and abscess formation are often used to determine the presence of inflammatory changes or perforation.This patient had previously undergone resection of uterine fibroids and subtotal gastrectomy. She had only abdominal spasm pain and no other abnormalities on imaging or laboratory test results. Hence, the symptoms were very similar to the pain caused by postoperative intestinal adhesion. Imaging examination did not show high-density shadow or presence of liquid or free gas. This likely caused a misdiagnosis of abdominal pain due to intestinal adhesion prior to preoperative consideration.Most gastrointestinal foreign bodies can be removed by gastroscopy or enteroscopy, only 1% of cases need surgical excision. According to the perforation site and clinical manifestations, treatment is usually chosen through suture perforation site, bowel resection or Hartman procedure.In this case, the patient had a misdiagnosis because of the mild presenting symptoms, multiple abdominal surgery history, and negative imaging results. Fortunately, the fish bone did not cause significant damage. Because of the lack of a clear diagnosis before surgery, we preferred laparoscopic surgery. During the operation, we found a small amount of effusion in the pelvic cavity. Given that the intestinal adhesion was present at the upper abdomen, laparoscopy could not provide a comprehensive exploration. Therefore, we opted for open surgery and eventually found the fish bone lodged at the end of the ileum. We chose bowel resection instead of simple suture, because the perforated site was visible with minor fibrinous exudates. The patient recovered well after surgery. The woman recalled that she had eaten fish on the night before the abdominal pain started.4Accurate diagnosis of complications due to fish bone intake is still difficult, as it is often secondary to the unintentional intake. Therefore, a detailed history of the patient's diet and eating habits is important. Clinical manifestations are mainly determined by the location of perforation which usually occurs at the junction of the ileum and rectal sigmoid colon. Imaging examination and surgery are often used for definite diagnosis.The authors would like to thank all participants who contributed to this study.JCS and WJY reviewed the medical records and scientific literature and wrote the manuscript. YWZ, YW, and CL critically reviewed the manuscript. JSQ and YCF interpreted the CT images. LL, WHW, JDQ, and CWY contributed to the interpretation of data and critically reviewed the manuscript. All authors approved the final version of the manuscript.Conceptualization: Yu Wang.Data curation: Junchuan Song, Weijin Yang, Jiandong Qiu, Jianshen Qiu.Formal analysis: Junchuan Song, Weijin Yang, Nan Lin.Funding acquisition: Yu Wang.Investigation: Nan Lin.Software: Jianshen Qiu.Supervision: Chen Lin.Validation: Weihang Wu, Chen Lin.Writing – original draft: Junchuan Song, Weijin Yang.Writing – review & editing: Junchuan Song, Chen Lin.


Solitary fibrous tumour (SFT), as are benign neoplasms of fibroblastic cells. Nasosinusal localisation is exremely rare, difficult to diagnose and to manage.We report a rare case of Solitary fibrous tumour in the nasal cavity in a 47-year-old- woman, with complete surgical resection.SFTs are of mesenchymal origin, mainly from serous membranes. The head and neck region is affected with a percentage ranging from 5 to 27%. On the other hand, LTS unusually affects the nasal tract (NTS). Because of this rarity and its variable morphological appearance, it is difficult to distinguish TNS from other mesenchymal lesions.Although there are no standard clinical guidelines, the preferred treatment for FLS is radical surgical resection. •Solitary fibrous tumour is an uncommon fusion neoplasm of spindled fibroblastic cells set in a branching vasculature with an unclear biologic behavior.•Nasosinusal localisation is exremely rare, difficult to diagnose and to manage.•Complete resecability is the most important prognostic factor in the treatment of SFT.•Advantages of the endoscopic approach include a panoramic and large view without external incision, low postoperative morbidity and a shorter hospital stay. She has reported anosmia and intermittent epistaxis for the past six months with hemicranial headaches. Ophthalmological examination was normal. His medical history and family history are otherwise unremarkable.Examination of the left nasal cavity found a lobulated mass bleeding on contact, above of left medial turbinate , the rigTo better assess the extent and origin of the mass, a MRI with injection of gadolinium was performed, showing a tumor process of the ethmoidal cells, intensely enhanced after injection.The histopathological analysis showed a spindle cell with minimal pleomorphism, no atypia, no mitosis .Fig. 3asAn immunohistochemical study has been carried out, it shows a diffuse expression of CD34 . Exclusi3The first description of SFT was in 1931 by Klemperer and Rabin . It is aGenerally occur in adults in their third to fourth decade of life; with extemes ranging from 9 to 86 years with no significant difference between males and females . ClinicaHistopathologically, the important feature of this tumor is it composition of bland spindle cells set in a collagenous stroma with typical variation in cellularity with both hypo- and hyper-cellular areas are objectified. The presence of areas of hyalinization adjacent to collagen deposits is also a characteristic of SFT. Another characteristic feature is the presence of a prominent vascular network with dilated, stellate, branching or staghorn shaped vessels. Mature adipose tissue within SFT and pseudovascular spaces lined with multinucleated stromal giant cells are histologic variant ,16. Typi4SFT is a rare soft tissue spindle cell tumour that can occur in any area of the body. It rarely involves the nasal or paranasal cavities. Most often FTS are benign neoplasms. Complete resecability is the most important prognostic factor in the treatment of SFT. Advantages of the endoscopic approach include a panoramic and large view without external incision, low postoperative morbidity and a shorter hospital stay.I declare on my honor that the ethical approval has been exempted by my establishment.None.Chaker Kaoutar: Corresponding author writing the paper. Ahmed Brahim Ahmedou: writing the paper. Youssef Oukessou: study concept. Sami Rouadi:study concept. Reda Abada: study concept. Mohammed Roubal :correction of the paper.Researchregistry5198.DR AHMED BRAHIM AHMEDOU.Written informed consent was obtained from the patient for publication of this case report and accompanying images.Not commissioned, externally peer reviewed.The authors declare having no conflicts of interest for this article.


Thoracic endometriosis syndrome (TES) is an extremely rare disorder, and it is defined as the presence of functional endometrial tissue in pleura, airways, and lung parenchyma. We describe a rare case of a 29-year-old nulliparous female who presented with abdominal pain, dyspareunia, and shortness of breath. She complained of worsening of symptoms around the menstrual cycle. Initial workup showed markedly elevated CA-125 levels. A chest radiograph and CT of the chest, abdomen, and pelvis demonstrated large tension hydrothorax, ascites, and bilateral ovarian cysts. A chest tube was placed to decompress the tension hydrothorax, which drained copious amounts of blood. In view of the unexplained etiology of large hemothorax and elevated CA-125 levels, an MRI of the abdomen and pelvis was performed. This revealed advanced pelvic endometriosis, a right pleural nodule, and ipsilateral hydropneumothorax. Based on these findings, a diagnosis of TES was presumed. The patient was then referred to video-assisted thoracoscopy (VATS) and continuous estrogen suppression for optimal treatment. On early follow-up, she presented with recurrent hydropneumothorax, which was successfully managed with CT-guided chest tube placement and remained stable on further follow-ups. TES diagnosis is often challenging and delayed, demanding a high index of suspicion in patients with risk factors and characteristic clinical presentation. Radiologists should be aware of key imaging findings to help in early diagnosis for timely clinical and surgical management. Endometriosis is defined as the presence of functional endometrial tissue outside of the uterine cavity . It is cA 29 years-old nulliparous African-American female presented to the emergency department with abdominal pain and bloating for a week, which had progressively worsened, without any relief from over-the-counter medications. The patient also developed shortness of breath while lying on her right side, which progressed to both sides. She denied dysmenorrhea, but reported dyspareunia and worsening of symptoms around the menstrual cycle.Initial chest radiograph performed during admission demonstrated a large right-sided pleural effusion, a leftward shift of the mediastinum, and inversion of the diaphragm, compatible with tension hydrothorax Figure . This waMRI of the abdomen and pelvis was recommended for further evaluation in view of elevated levels of serum CA-125, unexplained etiology of massive right hemorrhagic pleural effusion, and ovarian cysts. MRI demonstrated a right pleural hemorrhagic/cystic non-enhancing 2-cm nodule Figure , moderatBased on the spectrum of these multiple chest-abdominal-pelvic findings associated with recurrent hemorrhagic right pleural effusion and a pleural hemorrhagic/cystic nodule, a diagnosis of TES was suggested. The patient underwent video-assisted thoracoscopy (VATS), with wash-out of the hemorrhagic pleural effusion, pleurodesis, and chest tube placement. No solid nodules or masses were appreciated on VATS. The chest tubes were subsequently removed with uneventful postoperative recovery. The patient received Lupron 11.25 mg intramuscular (IM) injection  for ovarian suppression upon discharge and followed up with gynecology and surgical specialties.The patient was readmitted 10 days after discharge, in view of recurrent multi-loculated right-sided hydropneumothorax Figure . A CT-guEndometriosis is a common disorder, affecting 6-10% of women in reproductive age . It is dTES is a rare disorder, and it is defined as the presence of functional endometrial tissue in pleura, lung parenchyma, or tracheobronchial system . TES affThere are different mechanisms suggested for the pathogenesis of TES, such as the trans-diaphragmatic migration, which comprises the following: 1) tissue migration through pelvic vessels; 2) reflux of endometrial tissue through fallopian tubes into the peritoneal cavity; and 3) progression into the thoracic cavity through diaphragmatic fenestrations/defects. This mechanism explains the right-side asymmetry in the distribution of TES, believed to occur due to the pooling of leaked endometrial cells by the falciform ligament. Metaplasia of coelomic epithelium is also a discussed mechanism for the pleural type thoracic endometriosis .Symptomatic patients with TES usually present with symptoms of chest pain, followed by dyspnea, hemoptysis, and cough (rare) within 24-48 hours of the onset of menses ,8. In the initial assessment of patients presenting with chest symptoms, radiographic and chest CT scan studies usually demonstrate pleural effusion, pneumothorax, ground-glass infiltrates, thin wall cavities, nodules, and bullous formation. Abdomen and dedicated pelvic MRI can corroborate the diagnosis of endometriosis, as pelvic endometriosis is highly associated with TES ,7,8.MRI is currently the preferred imaging method to assess endometriosis with high sensitivity and specificity ,9. Its aEndometriosis can have different presentations on MRI, depending on the location, degree of fibrosis, and the condition of hemorrhage (acute or chronic). Fibrous and compact smooth muscle tissue present with intermediate signal intensity on T1 images and low signal intensity on T2 images. However, deep pelvic endometriotic foci present as irregular nodules, with a hyperintense signal on T1 images and hypointense signal on T2 images. Pelvic adhesions, tubal blockage, and ovarian endometriomas can result in tubo-ovarian complex masses. The presence of dilated ectopic endometrial glands may result in a blended appearance of high-intensity signal areas on T2 images with a variable signal on T1 images, depending on the stage and degree of hemorrhage . The hemTreatment modalities include clinical and/or surgical management. Medical therapy consists of hormonal suppression of ovarian estrogen secretion that can be achieved with oral contraceptives, progesterone agonists, gonadotropin-releasing hormone agonists, and danazol. A combination of medical and surgical management is associated with low recurrence in a long-term follow-up ,9,12.TES is an extremely rare condition. Consequently, its diagnosis is often challenging and delayed, demanding a high index of clinical suspicion in patients with risk factors and characteristic clinical presentation. Radiologists should be aware of the key imaging findings to help guide early and proper clinical and surgical management.


Summary. Stump appendicitis is an uncommon complication after appendectomy and may lead to serious complications. Management of low-grade appendiceal mucinous neoplasm (LAMN) is controversial, and we discuss the importance of the case.  We describe a case of a young male with a history of appendectomy one year ago, who developed symptoms of stump appendicitis, and after removing this stump, histopathology showed low grade neoplasm.  The case of young male post stump appendectomy with histopathology showing LAMN in the stump of the appendix, which to our knowledge, is the first in the medical literature and, discuss the stump appendicitis and incomplete appendectomy concerning malignancy, mucinous neoplasm, and adenocarcinoma. Stump appendicitis, the remnant of appendiceal tissue after surgical removal of an inflamed organ, is one of the rare complications after appendectomy  whether A 36-year-old male with no chronic disease admitted for laparoscopic exploration for intermittent abdominal pain after an open appendectomy that was performed 11 months ago. On previous admission, he was operated for clinical and radiological diagnosis of acute appendicitis. Initial CT scan showed distended appendix measuring 8-9 mm in diameter, showing abnormally thickened enhancing the wall, with surrounding fat stranding, free fluid, and adjacent pocket of pus collection measuring 2 × 4 cm. Open appendectomy was performed with findings of the gangrenous appendix, where the base was healthy and appropriately secured with Vicryl suture. He was discharged in good condition two days postsurgery. Pathology of the specimen showed 4.5 cm long appendix and 0.7 cm in diameter with a diagnosis of acute appendicitis and periappendicitis. After almost a year, he was seen in the clinic as he complained of recurrent abdominal pain for one month and a slight decrease in appetite. His ultrasound abdomen showed a complex heterogeneous collection with internal echoes in the right iliac fossa measuring 5.5 × 2.7 × 6.4 cm, corresponding to a volume of 50 ml. His CT abdomen showed a well-defined mass-like lesion about 5 × 5 cm in diameter of fluid density (22 HU) suggesting thick fluid in the right iliac fossa; the stump of the removed appendix is well demonstrated and about 4 cm in length and closely related to the lower part of this collection . The pat2Cytology of the gelatinous fluid was negative for malignant cells. At the same time, the histopathology of the stump showed appendix measuring 4 cm in length and 0.6 cm in diameter with low-grade appendiceal mucinous neoplasm (LAMN) Figures –7. The tStump appendicitis is the inflammation of the residual appendiceal tissue after an appendectomy. It is a rare complication with a frequency that is underreported as well as underestimated. Its incidence was reported to be 1 in 50,000 cases . Most ofAppendiceal malignancies are uncommon and include carcinoids, cystadenocarcinoma, and adenocarcinomas . They usLAMNs is low-grade and shows uncertain malignant potential. It is a well-differentiated adenoma that can proliferate outside the appendix in malignant fashion . LAMN coThe goal of management of LAMN includes the prevention of rupture, seeding, and development of pseudomyxoma peritonei (PMP) . Low-graAs far as the appendiceal stump carcinoma is concerned, it was first reported by de Ruyter in 1903 at autopsy, in which a carcinoma was found in the stump of an appendix. The appendix was removed six years back . This waLow-grade mucinous neoplasm is very rare in stump appendectomy with no reported cases previously. Treatment varies based on the cellularity of mucin ranging from hemicolectomy to close follow-up as advised in case of noncellular mucin such as in our case. Further studies and prolonged follow-up will add to the management of LAMN. Patient education about the case and the follow-up plan is crucial in high-risk patients for pseudomyxoma peritonei.


Multiple gallbladders represent a rare congenital disorder, and coexistence with carcinoma is extremely rare, leading to a high possibility of misdiagnosis and surgical complications. In this study, a case was reported and the literature was reviewed.18F-fluoro-2-deoxy-D-glucose positron emission tomography, gallbladder carcinoma was pathologically diagnosed as stage 0 mucosal cancer. Seven days after the operation, portal thrombosis of the posterior branch was revealed, and conservative therapy was indicated; satisfactory results were achieved. The patient was discharged 65 days after surgery. No recurrence was observed for 1 year after surgery.An 80-year-old woman was diagnosed with acute cholecystitis via ultrasonography and was successfully treated with antibiotics. After the patient’s biliary colic relapsed, she was referred to our hospital. Multiple imaging modalities revealed duplication of her gallbladder (H-type) and suggested coexistence with carcinoma. According to preoperative evaluations, we assumed the patient had stage IIIA disease, and cholecystectomy, cholangiography using a near-infrared ray vision system, and sectionectomy of segments 4a and 5 were performed. Contrary to the high standardized uptake values obtained by An extremely rare case of malignancy in a duplicated gallbladder was reported, and the literature was reviewed. Accurate estimations are feasible for diagnoses of multiple gallbladders, where correct evaluations are vital, especially in malignant cases. Because of the possibility of malignancy, resected accessory gallbladders should be scrutinized pathologically. Multiple gallbladders (MGs) represent a rare congenital disorder, and coexistence with carcinoma is even more rare, resulting in a high risk of misdiagnosis and surgical complications. Although cases of MGs have been reported in 1 per 4000 autopsies –6; littlAn 80-year-old woman was admitted to her home doctor’s practice with abdominal pain and fever. She was diagnosed with acute cholecystitis via ultrasonography (US) and was successfully treated with antibiotics. When biliary colic relapsed, the patient was referred to our hospital. She had suffered from hypertension for 10 years. There were no special notes in her family history or from her relevant physical examination, nor were there any other significant clinical findings.18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) was revealed as 5.97 at the accessory gallbladder. No other metastases were identified in any of the images , and the volume for the limited resection of segments 4a and 5 was estimated to be 93 mL, which was equivalent to 11.2% of the TLV. A double gallbladder was clearly identified macroscopically after laparotomy (Fig. First, images obtained by US showed gallbladder duplication and an elevated lesion with a diameter of 1 cm in the proximal portion, which was identified as an accessory gallbladder Fig. . Magnetiomy Fig. . IntraopCases of MGs are reported in 1 per 4000 autopsies . They foRaymond and Thrift reported the first case in 1956 , and onlRecently, diagnostic precision has been improved by EUS, which has been suggested to be accurate for the clinical staging of gallbladder carcinoma –14. HoweThe SUV max evaluated by FDG-PET was 5.97 in our case, which was supposed to be indicative of malignancy; the patient’s past history of cholecystitis was taken into account because an experimental animal model indicated that the SUV max would be normalized within 1 week of the onset of acute inflammation . HoweverIn the extremely rare case of malignancy, correct cancer staging is critical. This case presented as stage 0 pathologically but was overdiagnosed as clinical stage IIIA based on an incorrect interpretation of the EUS findings and an equivocal SUV max that was probably affected by previous inflammation. In cases of MGs with malignancy, attention should be paid to accurate staging in cholecystitis patients. However, few reports are available on this issue, so further studies are needed to assess the coexistence of gallbladder duplication and carcinoma.We reported an extremely rare case of malignancy in a duplicated gallbladder. Accurate estimation is feasible for the diagnosis of MGs. In cases of malignancy, especially in cases with inflammation, correct cancer staging is vital. Because of the possibility of malignancy, resected accessory gallbladders should be scrutinized pathologically.


Trans-anal evisceration of small bowel is a rare surgical presentation. The first case ever reported was in 1827. The exact mechanism of how this develops remains poorly understood.A 70-year-old lady presented with multiple small bowel loops eviscerated through the anus. Abdominal exploration was done. The bowel was carefully reduced. There was a longitudinal defect on the anterior wall of the rectum at the recto-sigmoid junction and a large mesenteric defect and thrombosed mesenteric vessels compromising blood supply to part of the bowel. Resection of 50 cm of ileum, jejunostomy and a mucous fistula were performed.Several preexisting pathologies such as rectal prolapse can result in thinning out of the wall of the rectum. That combined with increased intra-abdominal pressure can explain trans-anal evisceration of the bowel. This condition is managed by surgical intervention. The operation will depend on the extent of viability, contamination and patient’s general condition. Trans-anal evisceration of small bowel is a very rare surgical presentation. The first case ever reported was in the early 19th century, and up until 2007 only 65 have been recorded [A 70-year-old, bed-bound female patient with a history of multiple strokes, presented to A + E with multiple loops of small bowel, eviscerated through the anus . When asThe patient was hemodynamically stable. When examined, there was an associated uterine prolapse. The bowel loops were covered with warm saline soaked packs and the patient was immediately transferred to theater.Abdominal exploration through an infra-umbilical incision was done; the bowel loops were carefully reduced through the anal canal. It appeared that there was a longitudinal defect on the anterior wall of the rectum at the recto-sigmoid junction. There was also a large mesenteric defect, possibly ensued from prolonged traction, and thrombosed mesenteric vessels compromising blood supply to part of the bowel, so resection of 50 cm of ileum with a jejunostomy and a mucous fistula were performed. The postoperative recovery was uneventful and the patient was discharged 16 days after surgery.We do not know for sure how many cases of small bowel evisceration have been reported. Brodie, in 1827, reported the first ever case. The exact mechanism remains unclear. A number of factors leading to increased abdominal pressure such as straining to defecate, vomiting, heavy lifting and labor can precipitate it .Excluding trauma, several preexisting surgical conditions have been suggested to preexist such as rectal prolapse, diverticular disease, uterine prolapse or solitary rectal ulcer all of which can result in thinning out of the wall of the rectum or sigmoid . A largeet al. [Initial management involves adequate fluid resuscitation and reducing contamination by cleaning of the eviscerated bowels with normal saline. The treatment for this condition is typically surgical with laparotomy aiming at of reducing the small bowel, resection if indicated and repair of the rectal tear. A covering stoma is usually formed if deemed necessary, depending on bowel viability and overall state of contamination of the bowel , 5. Howeet al.  reportedSeveral preexisting pathologies such as like diverticular disease, rectal prolapse, uterine prolapse or solitary rectal ulcer can result in thinning out of the wall of the rectum or sigmoid. That combined with increased intra-abdominal pressure can explain trans-anal evisceration of the bowel. This condition is typically managed by surgical intervention. The operation itself will depend on the extent of tissue contamination and viability along with the patient’s general condition.None declared.None.


Second branchial cleft cysts (BCCs) are common congenital causes of neck swellings; however, isolated parapharyngeal space presentation is extremely rare, with only sporadic cases reported. Our objectives in this report are to describe a case and review different diagnostic and management strategies adopted in the current world literature. The case presented is a 26-year-old female with a large isolated parapharyngeal BCC extending to skull base in which first presenting symptoms were referred otalgia and painful side-to-side head rotation for months followed by odynophagia. A previously ordered computed tomography (CT) scan suspected a parapharyngeal abscess. Correct diagnosis was preoperatively achieved using magnetic resonance imaging (MRI) showing a 3.1 × 3.4 × 5.4 cm parapharyngeal BCC. Cyst was completely surgically excised transoral without complications. No evidence of recurrence has been noted after 24-month follow-up. A comprehensive world literature search for all reported cases in the last 30-years revealed thirty cases in 23 separate case reports with different diagnostic and surgical modalities adopted. Presentation and management strategies in such rare cases are discussed in detail. Our study shows that although rare, BCC diagnosis should be kept in mind while dealing with isolated parapharyngeal space swellings with MRI being key for successful preoperative diagnosis. If encountered, the transoral route can be a safe, aesthetically pleasing and effective way for complete surgical excision in contrast to most other parapharyngeal swellings, which are usually better excised via a transcervical approach. Branchial cleft cysts (BCCs) are congenital malformations arising from incomplete involution of branchial remnants. Around 90%–95% represent second branchial cleft anomalies that usually become clinically evident at ages 20 to 40 years –4.Type-I cysts are situated along anterior border of sternocleidomastoid muscle beneath superficial cervical fascia. Type-II ones are the commonest and lie just laterally to great vessels beneath enveloping fascia of the neck. Type-III ones pass between internal and external carotid arteries. Type-IV cysts are situated in the pharyngeal mucosal space just deep to palatine tonsil and medial to great neck vessels, often extending upward towards skull base. Most second BCCs comprise the first three types, while type-IV cysts are extremely rare [Second BCCs are classified into four types according to Bailey-Proctor classification , 6. Typeely rare , 7, 8.This report documents a large type-IV second BCC located in the parapharyngeal space presenting as a submucosal oropharyngeal swelling completely medial to great neck vessels. All reported cases in the world literature are reviewed, and different diagnostic and therapeutic modalities are discussed.A 26-year-old female presented with a 3-month history of right referred otalgia and pain on side-to-side head rotation. Sensation of throat fullness and odynophagia started later. Oropharyngeal examination showed a significant right smooth lateral pharyngeal wall submucosal swelling just behind the palatopharyngeal fold with normal overlying mucosa. Neck examination demonstrated no palpable neck swelling except two small tender right upper deep cervical lymph nodes (largest 2 × 1 cm). There was no fever or other signs of acute inflammation. Neurological symptoms were absent, and cranial nerve examination was normal. She had received broad-spectrum antibiotic and anti-inflammatory treatment for one week. Blood picture was normal with no leukocytosis.The patient came with previously ordered contrast-enhanced computed tomography (CT) scan that showed a large right parapharyngeal cystic lesion with thin walls and mild mural enhancement. It averaged 3.1 × 3.4 × 5.4 cm in maximum anteroposterior, side-to-side, and craniocaudal dimensions, respectively. The lesion exerted a mass effect with indentation of nasopharyngeal/oropharyngeal walls and posterolateral displacement of right carotid sheath vessels with upper extension reaching skull base. Her preliminary imaging diagnosis of suspected right parapharyngeal space abscess was not entirely consistent with her clinical presentation; thus, we additionally ordered a neck magnetic resonance imaging (MRI). It revealed a well-defined right parapharyngeal cystic lesion with nearly same dimensions, slightly T1 hyperintense with contents showing no contrast enhancement and heterogeneously T2 hyperintense with fluid-fluid level, demonstrating restricted diffusion of contents  but not in cyst wall, suggesting a rare second BCC location .Being a young female, the patient's request was to avoid any external approach if possible. After patient counseling, a decision of transoral surgical excision was taken with consent for transcervical incision if needed.®  were applied to protect and obliterate the surgical cavity. Simple 4-0 Vicryl sutures were taken for pharyngeal incision closure  usually manifest in adulthood after gradually increasing in size following upper respiratory tract infections. Nevertheless, presentation age extremes were reported with Thaler et al. having aCross-sectional imaging has become the mainstay diagnosis for BCCs. Radiologically, they can be distinguished from other lesions by their solitary, ovoid, sharply outlined, fluid-containing features . CT withAfter clinical and radiological diagnosis suspicion, BCC is confirmed histologically by a cystic cavity lined by epithelium and underlying connective tissue showing germinal centers. The lining is generally stratified squamous epithelium, and the germinal centers are contained within abundant lymphoid tissue. The connective tissue stroma underlying the epithelium contains areas of lymphoid tissue with reactive germinal centers but lacking true lymph node architecture as demonstrated in our case. –35.Several conservative methods have been used in treatment of BCCs including repeated aspiration, incision and drainage, marsupialization and injection of sclerosant agents. All give only temporary relief and carry high incidence of recurrence , 28. ConThe transcervical route is considered the traditional approach for parapharyngeal masses . Its obvTransoral excision of a type-IV BCC was first described by Takimoto et al.  with theIsolated parapharyngeal BCC is extremely rare and hence is often misdiagnosed and treated as a deep neck abscess. Although congenital in origin, it mainly presents in adults with nonspecific symptoms. MRI is mandatory to differentiate from other more common parapharyngeal lesions. Complete surgical excision is the main line of treatment and most could be safely and effectively excised transoral unlike other parapharyngeal masses.


Choroid plexus tumors (CPTs) are rare intraventricular neoplasms that primarily occur in children and are rare in adults. Of the CPT subtypes, choroid plexus carcinomas (CPC) are highly aggressive and malignant and of World Health Organization (WHO) Grade III. Dissemination through the cerebrospinal fluid space is the inevitable natural course of the disease.In this case report, we present a 33-year-old female with a past medical history notable for schizophrenia and bipolar disease who suffered from left-sided acute vision loss and hearing loss. Magnetic resonance imaging (MRI) demonstrated multiple enhancing masses found in the left cerebellopontine angle (CPA), right internal auditory canal, the atrium of the left ventricle, and the left foramen of Monroe. After surgical decompression of the CPA tumor, the permanent final pathology was consistent with CPC.To our knowledge, this is the first reported case of a primary CPC occurring within the CPA in an adult. The unique presentation and progression of this rare adult-onset CPC provide insight for the diagnosis and treatment of other rare instances of CPTs. Choroid plexus tumors (CPT) are rare and account for 0.3%-0.6% of all brain tumors . CPTs inAdditionally, we conducted a literature review of adult CPC to investigate tumor location, clinical features, symptom duration, surgical outcomes, and adjuvant therapy. A comprehensive search of the literature was performed using Google Scholar and PubMed without date restrictions. During the search, a variety of terms were used in Boolean logic, to include: (1) CPC; (2) adult; (3) CPA; and (4) CPTs. Peer-reviewed studies that focused on CPCs primarily in adult populations were included in the literature review.Preoperative courseThe patient is a 33-year-old woman who presented to the emergency department with decreased left visual acuity, hearing loss in her left ear, and paresthesia on the left side of her face. Her past medical history was notable for schizophrenia, bipolar disorder, intravenous (IV) drug use, and a 30 pack-year smoking history. On physical exam, she had diminished vision in her left eye, hearing loss in her left ear, and mild aphasia; otherwise, she had a normal neurologic exam. Magnetic resonance imaging (MRI) revealed four lobulated heterogeneous enhancing masses in the left CPA, right internal auditory canal, the atrium of the left ventricle, and the left foramen of Monroe Figure . The larOperative descriptionThe patient was positioned in the lateral position with the left side up. Cranial nerves 7-12 were monitored. An intraoperative lumbar puncture was performed for brain relaxation, and CSF was sent for cytological analysis. A 10 cm curvilinear incision was placed just below an imaginary line between the inion and external auditory canal. A single burr hole was made at the transverse-sigmoid junction, followed by a small retromastoid craniotomy. The craniotomy edges were burred until the edge of the transverse and sigmoid sinuses were visualized. The dura was opened in a C fashion along the transverse sigmoid junction. Using the interoperative microscope, we removed a large section of the tumor and sent it for frozen and permanent pathological specimen. The tumor was debulked utilizing the ultrasonic aspirator while frequently checking the tumor capsule for cranial nerve function using the monopolar Prass probe . There was significant tumor adherence to surrounding vessels and cranial nerves. The intraoperative frozen pathology report was consistent with metastatic adenocarcinoma. Given the significant adherence of the tumor to the cerebellum and cranial nerves, we decided to leave the remaining tumor to avoid cranial nerve deficit. The bone flap was replaced at the end of the procedure. Routine postoperative CT was performed , followed by those with chemotherapy alone (45%), radiotherapy alone (32%), and those without further therapy (15%) . VariousChoroid plexus carcinoma presenting in the CPA is extremely rare. Gross total surgical resection was limited due to cranial nerve invasion. This is the first reported case of a primary CPC occurring within the CPA in an adult. The unique presentation and progression of this rare adult-onset CPC provide insight for the diagnosis and treatment of other rare instances of CPTs.


Oral granular cell tumor (GCT) is a relatively rare, benign lesion that can easily be misdiagnosed. Particularly, the presence of pseudoepitheliomatous hyperplasia might, in some cases, lead to the hypothesis of squamous cell carcinoma. Surgical excision is the treatment of choice. Recurrence has been reported in up to 15% of cases treated with conventional surgery. Here, we reported a case of GCT of the tongue in a young female patient, which was successfully treated through 445 nm diode laser excision. Laser surgery might reduce bleeding and postoperative pain and may be associated with more rapid healing. Particularly, the vaporization effect on remnant tissues could eliminate GCT cells on the surgical bed, thus hypothetically leading to a lower rate of recurrence. In the present case, complete healing occurred in 1 week, and no recurrence was observed after 6 months. Laser surgery also allows the possibility to obtain second intention healing. Possible laser-induced histopathological artifacts should be carefully considered. Granular cell tumor (GCT), also called the Abrikosoff tumor, is a relatively rare benign lesion, presumptively originating from Schwann cells. GCT has been described for the first time by Abrikosoff in 1926 and named “myoblastic tumor”, based on its supposed origin from muscle cells [The estimated incidence of oral GCT is approximately 1:1,000,000 population per year . The tumGCT can be found in any part of the body. Common locations are skin, respiratory tract, breast, gastrointestinal tract. Up to 50% of lesions have been reported to arise in the head and neck region, with a peculiar predilection for the tongue. Other oral sites of occurrence are the lips, the retrocomissural area, and buccal mucosa, followed by the palate, uvula, and parotid gland .Oral GCT typically appears as a single, sessile, asymptomatic whitish nodule that gradually increases in size. Cases of multiple lesions have been reported . Tumor sMalignant transformation has rarely been reported, and only 2% of cases have documented to metastasize to distant sites .Very few cases of GCT, successfully managed through different types of laser, have been reported in the literature, but no one of these using diode laser.The first application of diode laser in dentistry dates back in the mid-90s. Common ranges of wavelengths cover 810, 940 and 980 nm. Many advantages have been described in association with the use of diode laser: definite cutting edge, hemostasis, no need for suturing, reduction in surgical time, less post-surgical pain, and ease of use. Disadvantages reported in the literature include delayed wound healing and possible carbonized borders of the surgical field .Here, we reported a case of GCT of the tongue in a young female patient, which was successfully treated through 445 nm diode laser excision.A 35-year-old white woman was referred by her dentist to the section of Oral Medicine and Oral Surgery of the University of Parma, Italy, because of the presence of a painless, solitary nodule on the dorsum of the tongue.The patient reported that the swelling was initially small, and it gradually increased in size over the last few months.At the clinical evaluation, it was noticeable a well-defined, non-tender, and non-fluctuant whitish lesion, with smooth borders, on the left side of the dorsum of the tongue. The lesion measured approximately 1 cm. The days before, the patient reported small ulceration, which could not be seen on the day of surgery .Differential diagnosis included pyogenic granuloma, GCT, lipoma, and traumatic fibroma of unknown cause.The patient reported no history of smoking and alcohol consumption, and the anamnesis was negative for systemic disorders.©, Eltech K-Laser s.r.l., Treviso, Italy, 3.5 W, continuous wave, 445 nm) under local anesthesia, including 0.2 cm of surrounding clinically healthy tissue  was used in both cases; such device induced effective hemostasis, which allowed to avoid sutures. According to the experience of these authors, post-surgical pain was lower than that observed after intervention performed through the cold blade. Besides, the surgical excision was faster and easier than the traditional one [Romeo et al. described the surgical treatment of two cases on the dorsum and margins of the tongue; KTP laser  photocoagulation for the treatment of GCT of the esophagus; these authors also highlighted an apparent lower post-surgical discomfort .2 laser excision, highlighting the possibility to work in a bloodless surgical field and to ensure a precise and safe resection of the tumor [The other four cases of bronchial GCT were conservatively treated through Nd:YAG laser by van der Maten et al. All patients underwent complete recovery, and they did not develop recurrences during follow-up . Piazza he tumor .With regard to lasers that have a possible application in oral soft tissue surgery, Er:YAG laser  penetrates up to 0.1 mm and has no effect of carbonization. Such laser is absorbed by hydroxyapatite and water, and it is, therefore, primarily indicated for hard tissue surgery. Nevertheless, several authors have used Er:YAG laser for cutting and ablating soft tissue with satisfying results. The surgery performed with such laser has proved to be efficient and provides clean and high precision cut with minimal injury to the adjacent hard and soft tissue. It has also the advantage of inducing a lower increase in temperature of surrounding tissues when compared to traditional burs . The hemKTP laser (wavelength: 532 nm) can produce stromal changes and vascular damages if not used correctly. The affinity for hemoglobin allows, in most cases, to use lower power and fluence .2 laser (wavelength: 10.600 nm) has, to some extent, a low versatility and can lead to an excessive scaring retraction and a higher post-surgical discomfort.COTo the best of our knowledge, this is the first case report of a GCT of the tongue treated with 445 nm diode laser.The choice of 445 nm diode laser, also called “blue laser”, was based upon recent evidence in literature; a study of Reichelt et al. evaluated the effects of such laser on a cellular level. They described a large wound due to the high temperature, but fast healing. This wavelength seems not associated with particular side effects on cells, tissues, cytoskeleton, and DNA .The 445 nm diode laser demonstrates photoangiolytic properties comparable with KTP laser, power of carbonization, and coagulation. It combines cutting properties of diode laser with the coagulation vessel capability of KTP. Other advantages listed by Hess et al. are the portability of the shoe-box, the versatility of such laser in many surgery fields, the possibility to work with continuous-wave for less than a millisecond, a better cutting than KTP .Treatment of GCT consists of surgical excision, possibly with disease-free margins. Recurrence can occur many years after primary tumor resection, and it is most probably related to not radical excision. Besides, late occurrence in other parts of the body has been documented (metachronous lesions) .Benign granular cell tumors have a recurrence rate of 2 to 8% when resection margins are deemed clear of tumor infiltration and are increased to 20% when the resection margins of a benign granular cell tumor are positive for tumor infiltration [We hypothesize that the use of diode laser for surgical excision of GCT may reduce the risk of recurrence. In fact, such laser has the ability to penetrate within the oral soft tissues from 0.27 mm up to 3.94 cm, and such effect might contribute to ablate possible cellular remnants of the tumor, which are believed to be the potential cause of recurrence . HoweverA reduction in the risk of recurrence was confirmed also by Rai et al. in the treatment of pyogenic granuloma (recurrence rate: 16%). The authors used a diode laser  with 808 nm wavelength, 7 W power, in continuous/interrupted pulse mode. No recurrence was observed after such treatment .Andreadis et al. also highlighted no recurrences for pyogenic granuloma radically treated with diode laser .The risk of recurrence has also been reduced after laser treatment of oral leukoplakia, which, in general, is regarded as a lesion with a high tendency to recur .However, it is very important to carefully consider the extension of the incision within the surrounding tissues, in order to avoid laser-induced artifacts on tumor margins, which are possibly associated with histopathological misdiagnosis. A disadvantage of a diode laser, indeed, is the increase in temperature, described also by Fornaini et al.; lower temperatures are described for Er:YAG and KTP laser in contrast to Nd:YAG and diode laser ,26.This may lead to problems in excision margins. Common artifacts that may influence the histopathological diagnosis include epithelial modifications  . On the 2 laser, Er:YAG laser, and the scalpel; nevertheless, the histopathological readability of specimens was not compromised in any case [Monteiro et al. demonstrated that the highest tissue damage was found on the tissue excised with the electrosurgical scalpel, followed by a diode laser, Nd:YAG laser, COany case .Because of its wavelengths, the diode laser is poorly absorbed in hard tissues, and it could not be used for bone and dental lesions .An important advantage of diode laser surgery on oral soft tissue is the possibility to achieve effective hemostasis, which allows avoiding sutures in most cases, thus leading to second intention healing .Pain and post-surgical discomfort are usually lower for interventions performed with lasers than for those with a cold blade. The biophysical mechanisms underlying such differences are believed to depend on the antimicrobial and photobiomodulative effects of laser beams .The diode laser is a very versatile device; as Al-Mohaya et al. stated, such laser can be used for surgery in uncontrolled diabetic patients, in which a bloodless surgical site and excellent post-operative healing are important .The diode laser can also be very useful in patients with hemostasis disorders or in therapy with oral anticoagulants, in order to enhance coagulation, or in patients with hypertension .Other methods of use of diode laser include the photocoagulation of vascular lesions and bleaching of pigmentations. Such effects are based on the high affinity of laser wavelength for melanin and hemoglobin.Other possible uses include the so-called photobiomodulation, also known as low-level laser therapy (LLLT).For example, in a study by Akbulut et al., diode laser LLLT was used for oral lichen planus lesions, not responding to conventional steroid treatment, and for mucous membrane pemphigoid .Monteiro et al. also reported that diode laser reduced recurrence and malignant transformation of oral leukoplakia .Diode laser finds application also in the case of physiologic gingival pigmentation; the high affinity for hemoglobin and melanin makes such laser the best device for depigmentation of gingiva .In conclusion, the present case gives support to the hypothesis that 445 nm laser is a reliable tool for the surgical excision of GCT and similar benign lesions of the oral mucosa. Such a device is probably associated with the possibility of reducing the risk of recurrences. Moreover, laser surgery has a well-established utility in reducing post-surgical pain and increasing the clinician comfort, eliminating, in most cases, the intraoperative bleeding . It is i


Fetal congenital mesoblastic nephroma (CMN) is a rare renal tumor, characterized by polyhydramnios, premature birth, and neonatal hypertension. In the prenatal stage, it is particularly difficult to diagnose CMN either by ultrasonography or magnetic resonance imaging (MRI). Thus, CMN is frequently detected in the third trimester in the clinical scenario.A 29-year-old G2P0 pregnant woman took routine prenatal examinations in our hospital. The fetal right kidney abnormality was not observed after 2 systematical ultrasonic examinations (at 24 and 31 weeks of gestation respectively), and only an increase was noticed in the amniotic fluid index (from 19.3 to 20.8 cm).CMN was detected by antenatal ultrasonography and MRI as a fetal right renal mass at 35 weeks of gestation in our hospital.The pregnant woman was admitted at a gestational age of 38 weeks and 5 days due to alterations in renal function. Further, the pregnant woman was administered with “oxytocin” to promote delivery, and the neonate underwent a right nephrectomy on the 9th day after birth.The pathological examination confirmed a cellular type of right CMN. The neonate recovered well after operation without adjuvant treatment. During 6 months of follow-up, the neonate grew well and showed no signs of recurrence or metastasis.Polyhydramnios detected during prenatal examination required attention due to the risk of malformation of fetal urinary system. Prenatal ultrasonography combined with MRI could not only clearly identify the origin of the tumor, but also distinguish the correlation between the tumor and adjacent structures, thereby leading to early diagnosis and favorable prognosis. CMN was initially described by Bolande et al. in 1967 as a benign renal tumor different from other types of renal tumors. It is also known as mesenchymal hamartoma, leiomyomatous hamartoma and fetal renal hamartoma. Due to the similarity between the images of CMN and Wilm's tumor, prenatal diagnosis rate of CMN is extremely low.,8 Interestingly, accumulating data have revealed that the combination of ultrasonography and magnetic resonance imaging (MRI) enables antenatal detection of CMN.–14 Herein, we report a case study of CMN diagnosed by prenatal ultrasonography combined with MRI, in an attempt to offer novel references for early diagnosis of CMN.Neonatal renal tumors account for 7% of all neonatal tumors,2This case report has been approved by the Medical Ethics Committee of First Hospital of Jilin University (2020-371) and written informed consent was obtained from the patient and caregiver prior to the study.A 29-year-old pregnant woman (G2P0) with natural pregnancy this time was recruited in this study. She had no unhealthy life history and denied the previous exposure to radioactive materials, chemical raw materials or pesticides. The results of Down's screening and oral glucose tolerance test showed no abnormality. Her spouse was healthy and had no bad habits.In 2019, the woman underwent 2 systematic ultrasonic examinations respectively at 24 and 31 weeks of gestation. No abnormality was found in the right kidney of the fetus, and only an increase was identified in the amniotic fluid index .The woman was diagnosed with CMN through prenatal routine ultrasonography, which identified a fetal right renal mass at 35 weeks of gestation in the Center for Reproductive Medicine and Center for Prenatal Diagnosis in our hospital. The tumor was about 3.3 × 3.0 × 2.7 cm, which was solid, well-defined, and hyperechoic with uniform internal echo Fig. . MoreoveThe mother was admitted at a gestational age of 38 weeks and 5 days due to alterations in renal functions and the obstetrician used “oxytocin” to promote delivery. A female baby weighing 3.25 kg was born vaginally and had an Apgar score of 5 at 1 minute. Subsequently, the conditions of the neonate were improved after 10 minutes of tracheal intubation resuscitation. Postnatal ultrasonography showed a solid, well-defined, heterogeneous mass of 3.9 × 3.0 × 3.8 cm in the posterior upper part of the right kidney of the neonate. Right nephrectomy was performed on the 9th day of birth . Intraoperative findings indicated that the tumor was located on the outside of the right kidney and fused with the kidney. The blood supply of the tumor was abundant, the capsule of the tumor was intact, and the tumor did not protrude out of the kidney. No tumor thrombus was observed in the renal vein and inferior vena cava, and no obvious enlarged lymph nodes were found around the kidney.According to macroscopic observations Fig. , the volThe mother received no postoperative chemotherapy nor radiotherapy. The neonate recovered well after operation and was discharged 5 days later. No signs of recurrence or metastasis were observed during the 6-month follow-up and the neonate was well developed without any adverse effects.3 Although rarely seen, CMN is the most common benign tumor of the kidney in the infants. Owing to the similarity between the imaging findings of the CMN and Wilm's tumor, it is difficult to prenatally diagnose CMN.,8 Meanwhile, almost all fetal CMN cases were found in the third trimester, when a rapid increase occurred in tumor size. In terms of epidemiology, it has been suggested that CMN is more likely to occur in males and in the right kidney. The conditions of the case reported in this study are basically consistent with findings provided in these literatures.CMN is a rare renal benign tumor associated with polyhydramnios, prematurity, and neonatal hypertension. In ultrasound detection, classic CMN can be a homogeneous or heterogeneous, solid, hypoechoic renal mass with an echogenic rim (‘ring sign’), and color Doppler analysis may show a ring of venous and arterial waveforms with/without low vascularity. Commonly, CMN presents as a large, unilateral renal mass, where occasionally emerging in cystic areas.,11 In our case, prenatal ultrasonography showed a 3.3 × 3.0 × 2.7 cm uniform internal echo, solid, well-defined, hyperechoic mass in the fetal right kidney. Moreover, color Doppler ultrasound result indicated a large nutrient vessel entering the inside of the tumor; and the signals of circular blood flow were detected around the tumor, consistent with previous literature report. Wilm's tumor was highly similar to CMN, commonly appearing as an unencapsulated tumor with a clearly defined capsule, characteristically invading the normal renal parenchyma. Areas of hemorrhage and necrosis may be detected within the mass. Prenatal ultrasonographic examination of CMN and Wilms’ tumor are similar and absolute distinction can solely be identified pathologically. Further, previous studies have indicated that a considerable number of masses initially considered as Wilms’ tumor were ultimately diagnosed as CMN in the postnatal period.,18 Considering the particular difficulty in differentiating Wilm's tumor and CMN, a previous study suggested that fetal renal tumors found in the prenatal stage should be considered as CMN. Moreover, congenital adrenal neuroblastoma distinguishes itself from CMN for being separated from the kidney with obvious margin and a mixed echo structure of solid and cystic components. Prenatal diagnosis mainly depends on the observation of the asynchronous movement between lesion and kidney during fetal breathing.In spite of the considerable advancement in ultrasonography technology, only 15% of fetal renal tumors are prenatally identified. which makes it particularly useful in the case of oligohydramnios. Further, MRI has some advantages as compared with ultrasound, especially in the identification of urogenital and encephalic malformations. In fetal MRI, CMN is well defined, homogeneously solid, and tends to be isointense to normal renal parenchyma on T2-weighted imaging. Moreover, normal renal parenchyma and circulation system may be distorted by compression of the masses.,22,23 In our report, the signals of TIWI, T2-haste and T2-trufi were similar to those of the renal parenchyma, while the signals of diffusion weighted imaging were slightly higher than those of the renal parenchyma, which were in agreement with evidences reported in previous literatures. In the MRI, the boundary between the lesion and the adjacent structures was clear, which provided a reference for postnatal surgery. In addition, MRI can also be used for the evaluation of metastases or recurrence.Currently, the fetal MRI technology is preferred by obstetricians since MRI can provide a better tissue contrast and a variety of imaging planes regardless of the fetal orientation, In the process of antenatal examination, doctors often pay attention to the malformation of fetal digestive system rather than fetal urinary system when polyhydramnios was observed. Polyhydramnios could be detected in approximately 70% of CMN cases. The cause of polyhydramnios is not clear so far, whereas 2 speculations have been proposed:,17,25,26 a reduction in the absorption of amniotic fluid by fetal gastrointestinal tract, or an increase in the production of fetal urine. The former is mainly due to the compression and physical stimulation of the tumor, which results in the slowing down of fetal gastrointestinal peristalsis and the hindrance of the fetal swallowing amniotic fluid. The latter is mainly a result of the presence of fetal renal tumor, which leads to polyuria due to increased renal perfusion, and the consequence of hypercalcemia could induce polyuria. In our case, polyhydramnios was also witnessed (AFI 25.3 cm). However, there was also a rare case where CMN was associated with oligohydramnios. In this case, the neonate was diagnosed as CMN based on the detection of anuria, hypotension, hyperkalemia, and disseminated intravascular coagulopathy after birth. As expected, babies with oligohydramnios present a poorer prognosis than those with polyhydramnios.Polyhydramnios serves as a clue for the prenatal diagnosis of fetal congenital obstruction of the gastrointestinal tract. If CMN was prenatally diagnosed and suitable treatment was adopted after birth, the 5-year survival and overall survival rates of infants could reach 94% and 96%, respectively. Apart from the correlation between CMN and prematurity as well as neonatal hypertension, recurrence and metastases have also been reported after nephrectomy. However, in our case, there was no premature labor, and the neonate recovered well after operation. Moreover, there was no sign of hypertension, recurrence, or metastasis during the 6 months of follow-up visit, and the neonate was well developed without any side effects. We will continue to follow up and observe closely.Nephrectomy is the major therapeutic method for CMN.4During prenatal examination, we should not only pay attention to the malformation of fetal digestive system, but also the fetal urinary system, especially in the presence of polyhydramnios. CMN should be considered firstly upon the occurrence of fetal renal tumor. Further, prenatal ultrasonography combined with MRI could not only identify the origin of the tumor more clearly, but also better distinguish the tumor from adjacent structures, providing valuable information for postnatal surgery. In this sense, the combination of ultrasonography and MRI could, to a large extent, facilitate early diagnosis, appropriate treatment, and satisfactory prognosis.Data curation: Meiling Che, Cong Han.Investigation: Huilin Huang.Supervision: Hongyang Zhang.Writing – original draft: Fan Yang.Writing – review & editing: Nao Sun.


We highlight an interesting case of post-cesarean section abdominal wall endometrioma implantation and describe the patient’s clinical course and disease management. The radiographic features of the mass are described and proposed mechanisms for the development of an abdominal wall endometrioma following a C-section is discussed.A 30-year-old female with a history of multiple cesarean sections presents to the emergency department with several months of right lower quadrant abdominal pain only associated with her menstrual cycles. CT abdomen and pelvis with contrast was remarkable for an abdominal wall mass that likely represented an endometrioma, and she was subsequently discharged with pain medications and conservative treatment. However, three months later, she returned to the ED, because her pain was unbearable and refractory to medical management. Interventional radiology was consulted for percutaneous biopsy of the soft tissue mass located in her rectus abdominus muscle. Following the procedure, the patient was started on ORILISSA Endometriosis is estrogen-sensitive endometrial tissue, such as endometrial glands and stroma, that develops outside of the uterine cavity. A more localized form of endometriosis is an endometrioma or “chocolate cyst”, which classically occurs in women of reproductive age. The most common location for an endometrioma is the ovary, followed by the anterior/posterior cul-de-sac and posterior broad ligament . Other rA 30-year-old G4P3013 African American female with past medical history of morbid obesity, three cesarean sections, and bilateral tubal ligation presents to the emergency department with right lower quadrant abdominal pain, nausea, and vomiting. The patient reports that her pain has been periodically occurring over the last several months and interestingly is only associated with her menstrual cycles. The abdominal pain is cramping in nature without radiation and localized to her right lower abdomen. She states that she feels a “bulge and bump” in this region. On physical exam, there was tenderness to superficial palpation in the right periumbilical region, without rebound tenderness, guarding, or any other signs of acute abdomen, in addition to an absent Rovsing’s sign. Due to her large body habitus and abdominal pannus, the mass was unable to be palpated.The patient was given NSAID and anti-nausea medication, and a CT abdomen and pelvis with contrast was ordered to determine the etiology of the abdominal pain. CT showed an irregular, ill-defined 5 x 4 cm soft tissue mass in the inferior right rectus abdominus muscle at the right lower abdominal wall that was consistent with an endometrioma based on the patient’s past medical history Figures , 2. Afte® (elagolix), a gonadotropin-releasing hormone (GnRH) antagonist used to treat severe pain associated with endometriosis.After three months, the patient returned back to the ED with complaints of severe dysmenorrhea that was not alleviated with NSAIDs. OBGYN was consulted, but significant weight loss was recommended prior to surgical management due to the risk of wound healing complication and potential hernia development. Instead, interventional radiology (IR) was consulted for ultrasound-guided percutaneous biopsy of soft tissue mass in the rectus abdominus muscle. There were no postoperative complications on postprocedure ultrasound. Following the IR procedure, pathologic examination of three core biopsy soft tissue specimens confirmed the diagnosis of endometrioma due to the presence of ectopic endometrial stroma. The patient continued to follow-up with OBGYN and was placed on ORILISSAEndometriosis is defined as endometrial glands and stroma located at extrauterine sites that implant most commonly in the pelvis, such as the ovaries and fallopian tubes. These estrogen-sensitive ectopic implants can develop nearly anywhere in the body including infrequent locations such as the gastrointestinal tract, respiratory tract, or abdominal wall. A more localized form of endometriosis is an endometrioma or “chocolate cyst” that classically occurs in women of reproductive age. While the etiology and pathophysiology are not entirely understood, the most commonly accepted mechanism is due to retrograde menstruation, where endometrial cells flow in reverse through the fallopian tubes and into the pelvic cavity causing cyclical lower abdominal pain . This prInterestingly, surgical operations, such as a C-section, can induce endometrial seeding of the abdominal wall, which is enhanced by chronic inflammation and impaired immunity. The development of an abdominal wall endometrioma likely is due to a combination of endocrine, immune, and inflammatory pathways rather than retrograde menses. Abdominal wall endometrioma is a relatively rare condition with a reported incidence of 0.03%-0.45% in women with previous C-section with a mean age at diagnosis of 35 years [It is important to have a thorough review of a patient's prior surgical history when assessing an anterior abdominal wall mass that may be an endometrioma. When evaluating an abdominal mass, although much less likely, the differential diagnosis should include desmoid tumors, hematomas, and soft tissue sarcomas ,4. In ouPatients may initially present with chronic pain that is cyclical in nature with the menstrual cycle at the cesarean scar or incision site of the abdominal wall. Occasionally, an endometrioma located superficially under the skin may be visualized and appear blue, purple, or brown . UltrasoCT commonly demonstrates non-specific findings of a solid, enhancing mass. Compared to CT, MRI is often preferred to suggest the diagnosis of endometrioma due to enhanced definition of soft tissues. There will be hyperintense, heterogeneous signal intensity of the affected area, often with high internal punctate signal intensity on both T1 and T2-weighted images, indicative of hemorrhage from the endometrial glands . AnotherWe highlight an interesting case of an abdominal wall endometrioma status post C-section. The diagnosis requires heavily on a combination of history, presentation, and imaging for confirmation. This case emphasizes the need to have a high index of clinical suspicion when evaluating women with a prior surgical history of C-section who present with cyclical pain and an abdominal wall mass on imaging. Definitive treatment is via operative resection; however, oral medications are preferred for patients with certain comorbidities where surgery is unfavorable.


Ameloblastic carcinoma (AC) is a rare malignant odontogenic tumor in pediatric patients, only 22 cases have been reported in literature since 1932. We present an extremely rare case in which AC occurred in a 2-year-old girl, who had a tumor in the right mandible. Radiographic findings showed a multilocular, poorly defined, and mixed radiolucent-radiopaque lesion in the region of teeth #84 to #85, with bone and tooth root resorption. Computed tomography revealed buccal cortex destruction, tumor infiltration of soft tissue, and enlarged nodes. Incisional biopsy showed histomorphological features of AC. Immunohistochemical analysis exhibited a positive result for Cytokeratin (CK) 19 and overexpression of p53 and Ki67. The patient underwent right hemimandibulectomy and neck dissection. The final pathology was consistent with the initial diagnosis of AC. The patient did not exhibit signs of recurrence or metastasis within 2 years postoperatively. Given the rarity of this disease and the age of the patient, this report constitutes a valuable contribution to the current literature. Ameloblastic carcinoma, first described by Elzay in 1982, is a rare, malignant type of odontogenic tumor –5.AC involves the mandible more frequently than the maxilla. It most frequently affects adult men. However, a few pediatric cases have been reported, with a minimum age of 4 , 7. In tWritten informed consent of the patient's mother was obtained prior to this paper's publication.A 2-year-old girl presented with a painful mass in the right mandible, which had appeared 1 month prior. Her first examination was performed in a local hospital, and the initial diagnosis was gingivitis. Oral hygiene instruction and antibiotics were prescribed. One week later, the mass continued to increase in size and caused pain and fever; thus, the girl was admitted to the Department of Maxillofacial Surgery at Hanoi National Hospital of Odonto-Stomatology, Hanoi, Vietnam.Clinical examination revealed a mass in the right body of the mandible that extended from the commissure of the lip to the angle of the mandible. It was approximately 1 × 1 cm in size and painful on palpation. No sign of lip paresthesia related to the mass was detected, and the overlying skin was normal in color and texture. The submandibular lymph nodes were palpable, tender but painless, and movable. Mouth opening was normal. Intraoral examination showed a swelling in the region of teeth #83 to #85, which obliterated the right buccal sulcus. Mobility and displacement of teeth #84 and #85 were detected. The lesion was soft in consistency and painful on intraoral palpation. The overlying mucosa exhibited overgrowth (covering the crown of #85), red color, and an ulcerated appearance.Orthopantomography showed a multilocular, mixed radiolucent, and radiopaque lesion with a poorly defined border affecting the region of teeth #84 and #85. The lamina dura, roots of #84 and #85, and furcation of #84 were resorbed . Axial aIncisional biopsy was performed at the intraoral vestibule, where the lesion had penetrated. Histologic examination revealed sheets and nests of odontogenic epithelium separated by fibrous tissue with inflammatory infiltration and stellate reticulum-like structure. The peripheral cells of the nests resembled preameloblasts with cuboid shape and nuclei polarization . DediffeImmunohistochemical stains were performed using CK19, Ki67, and p53. The ameloblastic epithelium showed a positive reactivity for CK19 . High prBased on these findings, the final diagnosis was ameloblastic carcinoma.The patient underwent right hemimandibulectomy, extending from the distal aspect of #71 to the angle of the right mandible, with safe osseous margins of 2 cm on each side of the tumor. The surrounding tissue was also excised. Complete supraomohyoid neck dissection was performed on the right side, combined with excision of the right submandibular gland. The patient recovered uneventfully, and the wound healed well after surgery. The histopathological examination of the resection specimens was performed, and the diagnosis of the primary tumor was consistent with the initial diagnosis of AC. The positive submandibular lymph nodes were identified, and the microscopic examination of the lymph nodes showed diffuse infiltration of neoplastic cells . The subThe patient returned regularly for follow-up. Clinical and radiographic examination at 2 years postoperatively showed no sign of recurrence or metastasis .AC is considered a rare, malignant neoplasm of odontogenic origin. Patients of various ages can be affected, but the disease most commonly occurs during the fourth decade of life. Moreover, it appears more frequently in men than in women, and the mandible is affected more frequently than the maxilla .AC shares some common clinical features with ameloblastoma, such as a mass in the jaw, resorption of bone, and mobility of teeth. However, its behavior is more aggressive, including rapid growth, pain, perforation of the cortical plate, soft tissue infiltration, and/or lower lip paresthesia . Lymph nHistologic features, such as cytologic atypia and increased mitotic figures, are important criteria for distinguishing AC from ameloblastoma . When asSome immunohistochemical markers correlating with the diagnosis of AC have been identified. In our report, immunohistochemistry is employed for interpreting the tumor origin and biological behaviors. CK19 expression is detected in the epithelium of the dental germ, so it has been a good marker for odontogenic cysts and tumors, such as ameloblastoma. Ki67 is a nuclear protein which is presented in cellular proliferation. The immunoexpression of Ki67 has been considered as a prognostic tool to distinguish among benign and malignant tumor. p53, known as tumor suppressor gene, plays an important role in DNA repair and apoptosis initiation. The accumulation of p53 has been associated with increased cellular proliferation and malignant transformation. In Martínez et al.'s study comparing histological and immunohistochemical features of ameloblastoma and AC, they suggested that both Ki67 and p53 could be good markers of malignancy .Little information regarding AC in pediatric patients is available. A review of the literature from 1932 to 2019 revealed 22 cases in pediatric patients, for whom age, sex, location, clinical signs, treatment, follow-up, recurrence, and metastasis status were collected . HoweverThe management of AC remains controversial, but surgical resection is always recommended. En bloc removal of the jaw with 2 cm of normal bone margin is indicated to assure a disease-free status. This approach results in a recurrence rate below 15% .This report appears to describe the youngest patient with AC reported in the literature to date. The child had a rapidly growing and aggressive lesion, with bone destruction and suspected lymph node metastasis. The diagnosis was based on histopathologic and immunohistochemical features, including ameloblastic differentiation, nuclear pleomorphism, mitotic figures, and positive reactivities with specific immunomarkers. The treatments were segmental mandibulectomy (with safe bony margins of 2 cm) and neck dissection. No adjuvant therapy was applied. Regular check-ups were performed every 3 months, and the long-term prognosis for this patient is expected to be good.To date, AC is still a rare, highly malignant odontogenic tumor, with a 5-year survival rate below 70%. Metastases to the lung, liver, lymph nodes, bone, and brain are the causes of death and may appear at 0.5 to 14 years postoperatively. Thus, radical treatment and meticulous long-term follow-up are essential, and sufficient time should be considered before reconstruction due to the potential for tumor recurrence.


Case Presentation. We report a case of a 74-year-old farmer with a cutaneous projection measuring ∼8 × 5 × 3 cm3 over the medial surface of the right pinna for 1 year. It started as a small projection which was progressively enlarging. The primary reason behind him presenting to us was cosmetic reason since it resembled an animal horn. The projection was not associated with pain or similar lesions anywhere else in body. Understanding the malignancy risks and the cosmetic benefits, he was planned for excision biopsy of the horn. He had no systemic signs of malignancy. Histopathological reports were consistent with malignancy.  A cutaneous horn is a common clinical entity which usually presents as a cutaneous lesion. Because of its subtle nature, patients usually tend to present late unless the lesion is big or complications develop. Because of its resemblance to animal horn, it has been given the term “horn.” Cutaneous horn seems to have a remarkable history. Though cutaneous horn is benign most of the times, chances of malignancy (20–25%) should be kept in mind. Old age, giant cutaneous horn carries more chances of transformation into malignancy like in our case. Thus, early diagnosis and treatment is required in all cases.  Cutaneous horns are usually benign lesions and mostly found in the head and neck region. Because of the chances of malignancy, cutaneous horns should undergo surgical removal and biopsy for early and definitive diagnosis and management. A cutaneous horn is a hard, conical, dense, hyperkeratotic cutaneous lesion. There were accounts of giant cutaneous horns in the sixteenth and seventeenth centuries which might have been due to lack of knowledge and lack of health facilities. Numerous natural and supernatural theories have been discussed in history regarding their etiology. The late eighteenth century marks the characterization of the disease as a medical disorder by surgeons Everard Home and his brother-in-law John Hunter in London , 2. Thou3 over the medial surface of right pinna (A 74-year-old farmer presented with a cutaneous projection over medial surface of his right pinna for 1 year. It started as a small cutaneous projection which was progressively enlarging. He denied any history of pain but had discomfort over the pinna. There was no history of discharge from the projection. There was no history of hearing loss, tinnitus. There was no history of similar lesions or any other mass in other parts of his body. He did not give any history of weight loss and loss of appetite. There was no history of significant medical illness, trauma to ear or surgery in the past. He was a nonsmoker and did not drink alcohol. He did not give history of similar lesions in any of his family members. On examination, his vitals were within normal limits. Systemic examination revealed no abnormality. On examination of the lesion, there was a woody hard, nontender cutaneous projection, measuring ∼8 × 5 × 3cmht pinna . Skin suht pinna  with negCutaneous horn, also known as cornu cutaneum, is a form of hypertrophic senile keratosis in which the horny layer accumulates and adheres resulting to horn. In around 20% to 25% of cases malignant transformation into squamous cell carcinoma has been found . The earEarly diagnosis and treatment is mandatory to prevent the risk of transformation to malignancy and the psychosocial stress owing to the bizarre presentation. Surgical excision remains the treatment of choice in most cases . SurgicaGiant cutaneous horns might present as small asymptomatic lesions. Despite the fact that majority of lesions are benign, the risk of malignant transformation should not be ignored. The standard treatment should be excision biopsy with adequate margins. We have reported our case owing to its typical presentation, a close resemblance of an animal horn and its association with malignancy. Very few cases of “giant cutaneous horn” have been found in literature. We have tried to keep our focus over the unavoidable risk of malignancy which should be addressed on time to avoid physical and psychosocial stress to the patient and the attending family members.