Localized biphasic MPeM is rare in clinical practice, we reviewed 8 cases of localized biphasic MPeM (including our present case), and summarized the clinical and imaging features of the disease.We reported a 79-year-old man with chief complaint of a narrowing in the caliber of the stool for one year. A soft tissue shadow was occasionally found by CT examination in the right pelvic wall, and it was diagnosed as localized biphasic malignant peritoneal mesothelioma (MPeM) by postoperative pathology. Radical excision was performed and no radio-chemotherapy was applied. Nearly six years after surgery, the mass was significantly enlarged, and the neighboring tissues including rectum, prostate, seminal vesicle, and right ischial ramus were all infiltrated. The patient was in the end stage of cancer with poor prognosis.The localized biphasic MPeM may show following characteristics: (1) with heterogeneous low-density and obscure margin; (2) with low incidence rate of ascites; (3) with few central hemorrhage and necrosis; (4) with few calcified structures; (5) with mild to moderate heterogeneous delayed enhancement on contrast-enhanced CT. The imaging characteristics can provide further information for the diagnosis of localized biphasic MPeM in the future. Mesothelioma is defined as the transformation of mesothelial cells from the lining of any human cavity into a tumor. The malignant mesothelioma (MM) is relatively rare in clinical practice, and has a highly invasive form. The most common site of MM was the pleura, and MM arising from the peritoneum of the pelvic wall was rarely reported . The disThe present study reported a localized epithelial and sarcomatoid mixed mesothelioma derived from pelvic wall, of which diagnostic and therapeutic experience remain limited. We reviewed the patient’s clinical, imaging, pathological, therapeutic and prognostic information in order to provide more clues for this disease.A 79-year-old man came to our gastrointestinal outpatient with complaint of a narrowing in the caliber of the stool without obvious cause for about 1 year. Otherwise, he had no history of asbestos exposure, hematochezia, diarrhea, constipation, abdominal pain and distention. He had a history of prostatectomy due to benign prostatic hyperplasia and he denied recent weight loss. Digital examination of rectum showed the lower boundary of a mass in the rectum was 2 cm from the anal margin, and the upper boundary could not be palpated. Therefore, the patient underwent colonoscopy endoscopic electrocoagulation resection.A soft tissue shadow was occasionally found by pelvis CT examination in the right pelvic wall. The mass had well-defined boundary and was oval shape with size of 7.3 × 5.3 cm. No calcification was found within the mass. On unenhanced CT images, the mass was heterogeneous with suspected necrotic area Fig. a. In artSix month after the discovery of the pelvic mass, the mass was slightly larger observed by CT examination Fig. a. The paThe postoperative pathological examination showed that the mass was biphasic differentiated to both epithelium and mesenchyma Fig. a-b. ImmuOne and a half years after surgery, the patient underwent pelvic CT reexamination and no sign of tumor recurrence was found. Four years after surgery, the patient attended a local hospital due to progressive dysuria and lower abdominal pain. Then pelvic CT showed a soft tissue mass in the preexisting position and the mass was measured as 7.89 × 10.41 cm with oval shape and well-defined boundary , WT1 (94%), and CK5/6 (89%) , which wTherefore, we collected radiological data from all the biphasic MPeM cases of restricted growth patterns available at present. Radiological studies play an important role in the diagnosis, staging and prognosis of biphasic MPeM. Among them, the contrast-enhanced CT is the major imaging modality for MM . CT has Currently, no standard treatment of malignant peritoneal mesothelioma had been established, and localized MPeM has been usually treated with radical resection. In Table At present, the diagnosis of MM is still difficult, and the diagnostic standards are usually pathological examination including immunohistochemistry. Although imaging examination has only made little progress in the diagnosis of MM, it can still show the spatial or temporal features of mass with a non-invasive way compared with pathology. The diagnostic efficacy of radiological examination for MM is improving by reviewing more cases of MM. Histology and immunohistochemistry also have limitations in the classification of subtypes of MM. The classification of subtypes of MM by imaging has been explored recently –23. For In summary, the present case and literature review suggest that the localized biphasic MPeM may show following characteristics: (1) with heterogeneous low-density and obscure margin; (2) with low incidence rate of ascites; (3) with few central hemorrhage and necrosis; (4) with few calcified structures; (5) with mild to moderate heterogeneous delayed enhancement on contrast-enhanced CT. We hope that our report on localized biphasic MPeM will provide further information for the diagnosis, classification and treatment of the disease in the future.


Dentists and physicians should include oral metastases originating from prostate adenocarcinoma as a rare differential diagnosis of jaw lesions that can produce periosteal reactions in the radiographic features such as osteosarcoma. Dentists and physicians should include oral metastases originating from prostate adenocarcinoma as a rare differential diagnosis of jaw lesions that can produce periosteal reactions in the radiographic features such as osteosarcoma. In addition, we have reviewed 10 case reports of metastatic prostate adenocarcinoma to mandible in the literature.2A 64‐year‐old man was referred to the department of oral and maxillofacial surgery complaining of a mass on the right side of mandible associated with paresthesia of the right side of lower lip.Intraoral examination revealed little expansion of right mandible with bony hard consistency measuring about 5 cm, which caused facial asymmetry. CT scan images showed a lesion with periosteal reaction along with bone destruction and bone formation in the ramus of right mandible without perforation of cortical table and mandibular canal destruction Figure . He has 3Prostate cancer typically metastasizes to bones, such as lumbar vertebrae, thoracic vertebrae, and the pelvis. Metastasis of prostate cancer to the maxillofacial region is relatively rare.Because metastatic lesions to the jaw mimic other oral lesions, diagnosis is a dilemma for dentists. These lesions may cause paresthesia, pain, ulcers, swelling, and pathologic fracture, and these symptoms may be mistaken with other oral lesions. Imaging, histopathologic examination, and patient's history of cancer would help the diagnosis. Also for the definitive diagnosis, scintigraphy and IHC panel may help the clinician.Metastases cases of mandible reported in the literature were mostly in angle and body region and rarely in condylar area. Most frequently, patients were in their 7th and 8th decades of life.Radiographic feature showing periosteal reactions can be classified as single layer, multilayered, solid, speculated, perpendicular, sloping, complex, Codman triangle, and sunburst.Table As seen in the table, common clinical features among most cases were pain, paresthesia, and swelling. Posterior of mandible from body to angle and condyle were the common sites for metastasis. In most of the cases reviewed, left side was involved.Differential diagnosis for this case can be osteosarcoma which can show “sunburst” periosteal reaction.In conclusion, dentists and general physicians should include oral metastases originating from prostate adenocarcinoma as a rare differential diagnosis of jaw lesions that can produce periosteal reactions. Metastases are more common in elderly people and more common in posterior of mandible. The patient's chief complaint is usually pain and swelling with paresthesia.None.MH: conceived of the presented data. AK: carried out the experiment; MKP and FK: contributed to sample preparation; AA: wrote the manuscript in consultation with other authors.


Type1 Neurofibromatosis (NF1) is an autosomal dominant disorder with a great variety of clinical features. Vascular manifestations appear in less than 7%, and venous complications are extremely rare.We report a case of an enormous cervical hematoma caused by bleeding from the internal jugular vein in a NF1 patient. As the patient refused surgery, natural evolution was marked by spontaneous fistulization and drainage of the mass.Several cases of fragility of both the vessel wall and the surrounding tissue are discussed and two jugular vein aneurysms were reported. Management of such cases remains unclear and some reports describe defective hemostatic control at surgery.Surgery in NF1 vascular involvement should be considered on a case by case basis especially when the risk of iatrogenesis is high. Surgeons need to be aware of hemorrhagic risks, which could occur because of vessel friability. It represents 95% of all neurofibromatosis with a prevalence of 1/4500 without sex distinction. Oto-laryngologic involvement occurs in 1–10% of cases . VasculaWe report a case of an enormous cervical hematoma caused by bleeding from the internal jugular vein and its spontaneous evolution. The work has been reported in line with the SCARE criteria .2We present a case of a 27 years old woman with a NF1 who presented to the emergency room for a left cervical mass evolving for 48 h and rapidly increasing in size. The condition caused her breathing difficulties and dysphagia due to limited mouth opening. Physical examination revealed a 20 cm soft, non-pulsatile mass of the neck extending anteriorly from the pinna to the left supra-clavicular region and shoulder and posteriorly to the back of the neck. There was no thrill or bruit. The skin over the mass was hyper pigmented and saggy in favor of plexiforme neurofibromas . PuncturDoppler ultrasound revealed a large heterogeneous hypoechoic mass with a slightly increased vascular flow without a clear visualization of the carotid artery and internal jugular vein.CT angiography showed a large mass of liquid density extending from the peri-auricular region to the left clavicle and shoulder compressing the oropharynx but the rest of the airway remained permeable. No arterial involvement was detected. The hematoma extended along the length of the internal jugular vein which was thrombosed. It measures approximately 22 × 16 × 11 cm .Fig. 2a:Surgery was indicated in consultation with cardiovascular surgeons. However, the patient refused surgery when the risks of uncontrolled bleeding were explained.Evolution was marked by a spontaneous fistulization of the mass after two weeks and spontaneous progressive drainage of the hematoma thus disappearance of the compressive signs without necessity of transfusion. The patient did not have any recurrence or local complication at her one year follow up.3Neurofibromatosis represents a heterogeneous group of seven diseases sharing the same cutaneous signs due to a common embryological origin .Neurofibromatosis Type 1 (NF1), or von Recklinghausen disease, is an autosomal dominant disorder affecting one in 4500 individuals. NF1 affect mainly connective and nerve tissues yet, any organ can be involved . Even thOn a review of the literature, several cases of fragility of both the vessel wall and the surrounding tissue are discussed ,9 and twYilmaz et al. confirmed by histology the vein wall infiltration by NF1 which was mainly responsible for difficulty in hemostasis thus led to severe intraoperative bleeding . VasculaRegarding management, some authors reported surgical resection of venous aneurysms in NF1 patients . HoweverThis case study describes a patient with NF1 who developed a venous bleeding causing a neck mass without aneurysm or arterial involvement. The natural evolution was marked by fistulization gradual decrease in mass’s size and without complications. This probably treated her condition better than surgery would. It avoided a serious threat of massive hemorrhage as major vessel thrombosis would enhance morbidity and mortality.4Surgery in NF1 vascular involvement should be considered on a case by case basis especially when the risk of iatrogenesis is higher. Surgeons need to be aware of haemorrhagic complications, which could occur because of vessel friability. More importantly, the patient should be informed of the risks and involved in therapeutic decisions.None.The study is exempt from ethical approval in our institution as it is a “Case report” and not a research study.Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.H. Ardhaoui: Investigation, Resources, Writing - original draft, Writing - Review & Editing, Visualization.S. Halily: Investigation, Resources, Writing - Review & Editing.M. Mahtar: Validation, Supervision.This is a Case report that does not require a research registry.H. Ardhaoui, S. Halily.Not commissioned, externally peer-reviewed.None.


Pulmonary imaging findings in e-cigarette and vaping use associated lung injury (EVALI) and coronavirus disease 2019 (COVID-19) may be similar. One such pulmonary radiographic finding is ground glass opacities (GGOs). These GGOs present a wide differential that is narrowed down through diagnostic testing, deliberation of past medical history as well as medication use, and social history. This case presents GGOs observed in a COVID rule-out admission clinically correlated with EVALI. The objective of this case report is to describe a case of suspected e-cigarette and vaping use associated lung injury (EVALI) in the setting of the coronavirus disease 2019 (COVID-19) pandemic. Testing for COVID-19 may be performed on the basis of clinical suspicion if not universally performed in the setting of a hospital admission. GGO’s (ground glass opacities) are nonspecific radiologic findings associated with both EVALI and COVID-19 [A 26-year-old female with a history significant for idiopathic chronic abdominal pain, diarrhea, cough, and daily marijuana vaping use presented to the emergency department with acute onset nausea, vomiting, and abdominal pain not controlled with her home medications of Prilosec and Compazine. She denied fever, chills, myalgias, or sore throat. She denied sick contacts, however, she did not follow the state-mandated stay at home order, social distancing recommendations, and frequently visited her close friends. Review of systems was pertinent for chronic non-productive cough unchanged with acute illness, abdominal pain, chronic unchanged diarrhea, nausea, vomiting, dizziness, and headache. She was afebrile with temperature of 36.7° Celsius, oxygen saturation of 99% on room air, blood pressure 145/95, heart rate at 105. Abdominal exam was remarkable for tenderness to palpation with voluntary guarding and the remainder of the physical exam, including pulmonary exam, was unremarkable. Associated lab findings included anion gap metabolic acidosis (19), elevated lactate (3.5), mild hyponatremia (133), leukocytosis (23.8), and lymphopenia (6). Dedicated chest imaging was not performed, but CT of the abdomen and pelvis was obtained. This imaging was negative for an acute inflammatory or obstructive process, but did show GGOs in bilateral lung bases  and cough (67.8%). Diarrhea was noted rarely (3%). Most common lab findings include lymphocytopenia (83.2%), thrombocytopenia (36.2%), and leukopenia (33.7%) [The most common radiologic finding on CT is GGOs present in 56.4% of patients with COVID-19 . The finSince COVID-19 pathology is variable and this patient had non-specific GGOs, precautions as COVID-19 under investigation were needed. The differential for ground glass opacities in COVID-19 settings must include EVALI should the patient give a correlating history. Most EVALI cases show basilar-predominant consolidation and GGOs . There aAmidst the cost of COVID-19 inpatient care and the number of rising EVALI cases since fall 2019, management attempts to promptly identify the disease process. Identification affects inpatient management, and treatment of these two disease processes may vary, especially with the accumulation of data derived from more cases and trials of pharmacotherapy. EVALI and COVID-19 are new disease processes that appear similarly and may each rapidly progress to acute hypoxic respiratory failure. Diagnostic uncertainty predicates detailed history taking for use of e-cigarettes or vaping instruments. Testing for COVID-19 is necessary to evaluate GGOs in the correct clinical setting, as implications for personal protective equipment (PPE) use and tailored discharge planning are paramount during a pandemic. This case highlights the dilemma created when alternate disease processes manifest in a similar clinical fashion to an ongoing pandemic. Successful management hinges on detailed history taking and systematic weighing of pre-test and post-test probability when approaching diagnostics.


This report presents a brief review of the current literature on primary ovarian solid pseudopapillary tumors, including a discussion of expected prognosis after surgical resection, as well as a discussion of the role of immunohistochemistry (IHC) in differentiating ovarian neoplasms in young premenopausal women.Solid pseudopapillary tumors are rare, with the majority of described cases originating in the pancreas. To date, there are only 10 documented reports of primary ovarian solid pseudopapillary tumors. Here, we describe the case of a 24-year-old woman who presented with worsening pelvic pain and dysmenorrhea. Workup demonstrated a right ovarian solid mass on ultrasound and an elevated serum LDH, which raised concerns for dysgerminoma due to her relatively young age. Therefore, she was taken to the operating room and underwent laparoscopic right salpingo-oophorectomy. On initial rapid frozen section, her ovarian cyst had a grossly hemorrhagic appearance with multiple hemosiderin deposits noted microscopically, which suggested a benign hemorrhagic cyst. However, the final pathology was reported as solid pseudopapillary tumor based on several defining histologic characteristics. Most importantly, immunostaining was positive for  SPTs arA 24-year-old African-American nulligravida female presented to a gynecologist with worsening pelvic pain and dysmenorrhea. She was otherwise healthy with regular monthly menses, no medical problems, no changes in weight, and no changes in bladder or bowel habits. Her family history was significant for a paternal grandmother with breast cancer at an unknown age. On physical exam, a palpable mass and tenderness were appreciated in the right adnexa. Pelvic ultrasound showed an enlarged right ovary measuring 5.24 cm × 5.52 cm × 3.22 cm with a solid heterogenous mass measuring 3.4 cm × 3.3 cm × 3.8 cm . This irUpon laparoscopic entry into the abdomen, findings included a 5 cm right ovary with a partly solid, partly cystic mass. Otherwise, abdominal and pelvic anatomy appeared normal with no evidence of ascites, carcinomatosis, or metastasis. A right salpingo-oophorectomy was performed without complications. The specimen was removed intact and sent to pathology. On initial rapid frozen section, the ovarian mass grossly appeared very hemorrhagic with multiple hemosiderin deposits microscopically, suggestive of a benign hemorrhagic cyst . Therefoβ-catenin and negativity for membranous E-cadherin (Upon further sampling of permanent sections of the specimen, a diffuse pseudopapillary growth pattern and prominent hyaline globules were noted Figures . IHC of cadherin , consistThe patient had an uncomplicated postoperative recovery. A postoperative CT scan of the abdomen was ordered to assess for intra-abdominal lesions, particularly in the pancreas. However, the patient became pregnant shortly thereafter and declined to have CT imaging until after delivery. She remains clinically well with resolution of her pelvic pain and continues to have close surveillance with her obstetrician/gynecologist.Solid pseudopapillary tumors usually arise in the pancreas as a low-grade, indolent neoplasm. In rare cases, pancreatic SPTs may be aggressive and metastasize to the liver or peritoneum, or even more rarely to the ovary . Less thThe exact origin of SPTs remains unclear. Some investigators hypothesize that SPTs develop from pluripotent embryonic cells of the pancreas with multipotential differentiation, whereas others suggest that SPTs originate from genital ridge cells which had been attached to pancreatic tissue during early embryogenesis , 10. Priβ-catenin (On initial rapid frozen section, the specimen had a grossly hemorrhagic appearance, possibly due to fragmentation within the laparoscopic retrieval bag. Microscopically, a predominance of hemosiderin pigmentation was noted , but not-catenin  and negaA comparison of our case to other reported cases of ovarian SPTs revealed several similarities. Ovarian SPTs most frequently occur in young premenopausal women, with an overall age range of 17-57 years. Typical presenting symptoms include abdominal pain, bloating, swelling, and fullness; decreased appetite and weight loss have also been reported. On gross examination, the tumors range in size from 3 cm to 25.5 cm and are usually well-circumscribed masses with both cystic and solid components, although some ovarian SPTs are cystic only. In terms of tumor site, there does not appear to be a predominance of the left ovary versus the right ovary. As with primary pancreatic SPTs, the majority of primary ovarian SPTs have an indolent course, and prognosis is usually very favorable after surgical resection . HoweverGiven the rarity of primary ovarian SPTs in the literature, optimal treatment and surveillance remain unclear. In our case, a thorough laparoscopic examination of the abdomen and pelvis revealed no evidence of ascites, carcinomatosis, or metastasis. A CT scan of the abdomen was recommended after surgery to complete evaluation for intraabdominal lesions, particularly in the pancreas. However, the patient conceived shortly after her surgery and declined a CT scan during her pregnancy. Regardless, she is expected to have an indolent course with good prognosis, given that her ovarian SPT histologically did not exhibit as much mitotic activity or necrosis compared to pancreatic SPTs.


Eruptive syringoma is a rare variant of syringoma presenting with skin-colored or slightly pigmented papules mostly before or during puberty. In this report, we presented a rare case of eruptive syringoma in a 30-year-old woman. She exhibited multiple skin lesions in dorsal areas of her both hands, developed from the age of 15. Syringomas are well known to be benign adnexal tumors detected most commonly in periorbital skin areas of middle-aged women . EruptivWe presented a 30-year-old woman with eruptive syringoma of about 15 years duration, who was referred to the dermatology clinic of Alzahra hospital, Isfahan, Iran. Lesions started from the dorsal side of the patient's right hand without presenting other symptoms such as pruritus, burning sensation, inflammation, or erythema. The number of lesions increased following the epilation of the area for several times and no improvement was observed with the use of local corticosteroids. As a result, she stopped the epilation of her dorsal hand area. The patient refused to do a skin biopsy upon the suggestion of a dermatologist.At the age of 26 the patient was visited by an expert dermatologist with complaints about the expansion of the lesions to the dorsal areas of her left hand and underwent trichloroacetic acid (TCA) therapy twice with one year gap with suspicion of plane warts. Physical examinations in our clinic showed multiple erythematous, flat-topped papules located on dorsal areas of her hands varying from 1 to 3 mm in size .Lesions were symmetrical, and Darier's sign was negative. The family history was unremarkable, and there was no previous history of skin disorders. Laboratory test results were normal, and the patient underwent biopsy of skin lesions. Finally, the diagnosis of eruptive syringoma was made based on both clinical and histological findings. In histological sections, multiple nests of cells were seen with pale cytoplasm positioned within sclerotic stroma. Many nests show central ductal differentiation with a compact eosinophilic cuticle. The epidermis is normal; however, numerous tubular structures are embedded in a dense stroma in dermis, and ducts are lined by two rows of epithelial cells. Some of them have comma-like tails (tadpoles) .After establishing the diagnosis, we recommended her some destructive modalities like cautery or radiofrequency for treating these disfiguring lesions, but the patient refused to undergo any treatment.Eruptive syringoma is known to be a rare variant of syringoma with nonspecific clinical findings. The diagnosis of eruptive syringoma usually is based on performing skin biopsies and histological examinations. Clinical diagnosis of the disease is almost difficult due to its similarity to other skin diseases such as acne vulgaris, sebaceous hyperplasia, lichen planus, urticaria pigmentosa, eruptive vellus hair cysts, sarcoidosis, warts, and lentigo –8. The sNo prolonged morbidity or mortality due to eruptive syringoma has been reported . HoweverAlthough eruptive syringoma commonly occurs before or during puberty, it could be diagnosed in any period of life. Our case developed skin lesions after puberty, but the definite diagnosis of the disease occurred at the age of 30. Similarly, Sakiyama et al. reported eruptive syringoma in two females aged 43 and 35 years old . The pos


Introduction: Renal cell carcinoma (RCC) found during pregnancy is rare. Treatment strategies and timing of surgeries are controversial. Retroperitoneal laparoscopic partial nephrectomy for T2 RCC during pregnancy has not been reported before.Patient Concerns and Diagnosis: Herein, we report a case of T2 RCC found in a 36-year-old woman during her 21st week of pregnancy. Both ultrasound and magnetic resonance imaging (MRI) suggested a malignancy, possibly renal cell carcinoma.Interventions and Outcomes: After discussion with a multidisciplinary team, the tumor was removed completely via retroperitoneal laparoscopic partial nephrectomy, and pathology result was clear cell RCC. A male infant was delivered full-term uneventful, and both the patient and the boy were in good health after a 46-month follow-up.Conclusion: Partial nephrectomy with retroperitoneal laparoscopic technique is feasible and recommended in some T2 RCC patients. Renal cell carcinoma (RCC) is one of the common malignant tumors in the urinary system. Its pathological types include clear cell carcinoma, papillary cell carcinoma, and chromophobe cell carcinoma. During the early stage, there are no obvious clinical symptoms, and the prognosis is good after treatment, while in the late stage, patients may present with hematuria, lumbago, and abdominal mass, and the prognosis is usually poor.Cancer diagnosis during pregnancy is a rare event. RCC diagnosed during gestation is extremely rare , which iA 36-year-old woman with 21 weeks of pregnancy was admitted to our hospital for a left renal tumor, which was incidentally detected by ultrasonography in a routine pregnancy examination. Ultrasound showed a confounding echo mass in the middle part of the left kidney, 7.9 cm in size, uneven internal echo, and clear blood flow signal inside. Computed tomography (CT) was not performed, as she was pregnant. Abdominal magnetic resonance imaging (MRI) showed a round mass in the middle part of the left kidney with a maximum diameter of 8.3 cm . The sigA multidisciplinary team including urologists, gynecologists, pediatrists, anesthesiologists, and radiologists was responsible for the decision making to help the patient and her baby. Considering that the patient is only 36 years old, her strong desire to remove the tumor as well as retain the kidney, and the relatively indolent nature of the RCC, retroperitoneal laparoscopic partial nephrectomy was performed by an experienced surgeon after the risk was explained and informed consent was signed.2 was monitored below 35 mmHg, pneumoperitoneum pressure was strictly controlled below 12 mmHg to reduce maternal hypercapnia and fetal acidosis throughout the surgery. The operation time was 100 min with a warm ischemia time of 28 min and an estimated blood loss of 150 ml. The patient recovered uneventfully after the operation and was discharged within a week after the surgery. Blood hemoglobin was decreased postoperatively  and back to normal on POD7 (121 g/L), while serum creatinine levels were normal throughout the perioperative period . Obstetrics and gynecology consultation monitored the fetus before and throughout the operation.During the procedure, the patient was placed in the lateral flank position and underwent general anesthesia with endotracheal intubation. The procedure was performed through a retroperitoneal approach, and the retroperitoneal cavity was formed by blunt dissection and balloon dilation from a small incision located 2 cm above the iliac crest of the midaxillary line. After the establishment of the retroperitoneal space, four trocars were inserted on the left waist between the superior edge of the iliac spine and the inferior border of the rib. The tumor was removed completely, and renal reconstruction was then achieved with a 1/0 self-retaining barbed suture (V-Loc). Although maternal hemodynamic parameters were maintained stable and end-tidal COThe pathology report revealed an 8.2-cm clear RCC, Fuhrman grade 2, with negative surgical margins . AccordiCancer diagnosis during pregnancy is rare. The estimated incidence of cancer diagnosed during pregnancy in developed countries is 1 per 1,000 pregnancies . The mosMost patients of this kind are asymptomatic, and renal tumors were found accidentally through routine ultrasound examination for antepartum care, which is the same as the case we reported. The most commonly reported symptoms include pain (50%), hematuria 47%), hypertension (18%), and the classical triad of hematuria, pain, and palpable mass (26%) 7%, hyper. Since t2 insufflation, which, in turn, jeopardized the blood flow and development of the fetus  are considered , RCC diaTo sum up, renal cancer in gestation is a rare clinical scenario. Most are found incidentally by routine pregnancy examination. Ultrasound and MRI are useful tools for identifying and staging the tumor. Though the timing is still controversial, nephrectomy remains a pivotal treatment for local RCC. Presently, partial nephrectomy is rarely applied, mostly through the transperitoneal approach, and only in pregnant patients with small tumors. This is the first presented retroperitoneal laparoscopic partial nephrectomy case in a pregnant patient with T2 RCC. Based on the multidisciplinary team's decision and surgeon's experience, partial nephrectomy can be performed retroperitoneally and securely in large-volume renal tumors in suitable pregnant patients.The patient has provided informed consent for publication of the case.All datasets generated for this study are included in the article/Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.JD, YZ, and WX collected clinical data. JD wrote the manuscript. WX revised the manuscript. All authors approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Hemolymphangioma is a benign tumor comprised of the newly-formed lymph spaces and blood vessels, which can usually be found in the head and neck of the affected children. There are few reports regarding cases with hemolymphangioma in small intestine, spleen, esophagus, and other organs.Herein, a 55-year-old woman was presented in this study, she had complained of discomfort in the right upper abdomen for 2 months, and was discovered with a space-occupying lesion in proximal jejunum on computed tomography (CT). Eventually, the lesions were confirmed through double-balloon enteroscopy (DBE) to be located in the jejunum 60 cm away from the Treitz ligament.Subsequently, the small intestine was partially resected, and postoperative pathology had confirmed the diagnosis of small intestinal hemolymphangioma.∗3 cm to 2∗2 cm when engorged the superficial vessels. No enlarged lymph nodes were seen at the root of the mesentery, and no obvious lesion was observed in the remaining small intestine.Excisional surgery of the lesion was planned. On surgery, the lesions were discovered to be about 3Follow-up for 6 months showed no recurrence.Hemolymphangioma lacks typical clinical symptoms, and the correct preoperative diagnosis of hemolymphangioma remains challenging. Due to the increasing use of endoscopic diagnostic techniques, it is expected that hemolymphangioma in gastrointestinal tract may be detected and endoluminal located before surgery more feasibly. This case report aimed to highlight the contributions of CT and DBE to an accurate preoperative diagnosis and surgical strategy planning. Hemolymphangioma is usually discovered in the head, axilla, and neck, but rarely in the gastrointestinal tract, especially in the small intestine. Only a limited number of hemolymphangioma cases have been reported in literature thus far due to its low morbidity, and the correct preoperative diagnosis of hemolymphangioma remains challenging. This paper had reported a case with jejunal hemolymphangioma discovered by computer tomography (CT), localized by double-balloon enteroscopy (DBE), and finally managed with surgical resection.Hemolymphangioma is a rather rare benign tumor in the vascular system, which is characterized by the cystically dilated lymphatics.2A 55-year-old women was admitted into the First Affiliated Hospital of Soochow University as a result of complaint of discomfort in the right upper abdomen for 2 months. The patient also had a history of abdominal fullness and weakness, but she denied the symptoms of nausea, vomiting and fever, and had no medical history of abdominal trauma or surgery, no family history of malignant tumor, and no weight loss. Physical examination revealed mild tenderness on the right upper abdominal quadrant, with no rebound tenderness, and no abdominal mass was detected. No abnormality was detected in laboratory examinations, including blood routine examination, biochemical examination, and tumor makers. CT in other hospital demonstrated a space-occupying lesion in proximal jejunum with calcium deposition, which had exhibited enhancement after contrast injection Fig. . Radiolo∗3 cm to 2∗2 cm when engorged the superficial vessels. No enlarged lymph nodes were seen at the root of the mesentery, and no obvious lesion was observed in the remaining small intestine. Subsequently, the small intestine was partially resected, and postoperative pathology had confirmed the diagnosis of small intestinal hemolymphangioma  and Endoscope. Specifically, CT and MRI are the useful tools to define the tumor extent and invasion, and to plan the surgical strategy. The recurrence rate varies depending on the complexity, anatomical location, and adequacy of the excision. According to literature reports, 10% to 27% of the completely excised lesions would recur, whereas 50% to 100% of the partly resected tumors may recur. Compared with surgical treatments, nonsurgical treatments, including cryotherapy, laser therapy, radiotherapy, and local injection of sclerotic agents, are not superior.Generally, complete excision can provide the best results with a lower recurrence rate; however, careful follow-up is necessary.In conclusion, the current case report has presented a hemolymphangioma lesion in the small intestinal of a female patient. Hemolymphangioma lacks typical clinical symptoms, and specific radiological findings such as CT and MRI are helpful in confirming the diagnosis and appropriating treatment selection. Endoscopic diagnostic techniques for small intestinal hemolyphangioma also contribute a lot to an accurate preoperative diagnosis and surgical strategy planning. Although the hemolymphangioma is a very rare benign tumor, especially involving the small intestine. The possibility of hemolymphangioma should be taken into account when patients have repeated and unexplained gastrointestinal symptoms. Radiology and endoscopy are very significant for its diagnosis and treatment.Resources: Qinhua Xi.Writing – original draft: Yajie Teng.Writing – review & editing: Jie Wang, Qinhua Xi.


Recurrent urinary tract infection (UTI) is uncommon in males, but it is a common complication of Crohn’s disease (CD). Patients with CD often present with abdominal pain, diarrhea, and systemic symptoms, such as weight loss, low-grade fever, and fatigue, and rarely it can cause serious complications, such as fistulas or abscesses. Some patients with CD remain asymptomatic, which can progress to severe complications and delayed treatment. We are presenting a 22-year-old male with recurrent UTIs and no established past medical history of CD. However, on subsequent investigations, an anatomical abnormality was discovered that helped us make the diagnosis of CD. The aim of this report is to emphasize the early detection of asymptomatic CD in atypical patients, to not only decrease the risk of complications such as UTIs but also allow for early treatment intervention and better outcomes. Urinary tract infection (UTI) is uncommon in male patients younger than 50 years. The causes of UTI include prostatitis, epididymitis, orchitis, pyelonephritis, cystitis, arthritis, and urinary catheters. Many experts believe that UTI in males is associated with anatomic abnormalities and might require surgical procedures to avoid further complications. Obtaining a urine culture in a suspected male UTI can help narrow down the diagnosis. In a majority of males with their first UTI, imaging adds little to supplement a careful history and physical exam. Men below 45 years of age with their first UTI who respond well to antibiotic treatment are not likely to have a urologic abnormality ,2.An estimated 1.3% of adults in the United States are diagnosed with inflammatory bowel disease (IBD) either with CD or ulcerative colitis (UC). The risk of CD slightly increases in women and an Ashkenazi Jewish compared to non-Jews . Age aboA 22-year-old male patient who came to the hospital with recurrent UTI and hematuria complains of nausea, vomiting, flank pain, increased frequency of urination, cloudy urine, dysuria, and intermittent blood in the stool. However, he denied fatigue, fever or chills, abdominal pain, weight loss, constipation, diarrhea, urethral discharge, and pain radiating to the groin. The patient had no known medical or family history. The patient is a non-smoker, is sexually active with intermittent protection usage, and drinks alcohol occasionally.On initial assessment, it appeared to be pyelonephritis and sexually transmitted infection (STI). However, STI was ruled out by history and lab tests. Imaging using CT and CT scan with contrast showed fistulas and the presence of an enterovesicular fistula. Axial CT scan revealed thickened pseudodiverticulum wall suggesting fistula Figure .Coronal scan of the abdomen shows thickened sigmoid colon suggesting chronic inflammation by bowel disease Figure . Fistulas between small and large bowel suggest colonic fistula on CT scan Figures , 4. Axial CT scan also showed the presence of a fistula between the bladder and the terminal ileum suggesting enterovesicular fistula Figure . Sagittal CT scan shows the presence of thickened sigmoid colon suggesting chronic inflammation Figure . The presence of hypodensity on a bilateral kidney CT scan is suggestive of pyelonephritis. Based on the CT findings and the presence of fistulas, the patient was diagnosed with CD Figure . An incidence of UTI in males is five to eight cases per year per 10,000 cases with ages between 21 and 50 years, and prevalence is about 14%. Patients diagnosed with first UTI, with high-risk factors such as immunocompromised status, uncircumcised, engaging in anal intercourse, greater than 65 years of age, bladder outlet obstruction, anatomical functional abnormalities, previous urinary tract surgery, cystoscopy, catheterization, or transrectal prostate biopsy, may not need further unnecessary evaluation. Limiting further evaluation of men with a first UTI to those at increased risk may reduce unnecessary radiological, endoscopic, or urodynamic investigation. There is minimal evidence to support routine imaging in low-risk men with a first UTI, whether with or without fever [Recurrent UTI in men warrants evaluation for structural abnormalities, colovesical fistulas associated with colonic malignancy or IBD, enlarged prostate, and unprotected sexual intercourse. Screening for immunologic disorders that might increase the risk of infection with the human immunodeficiency virus and hematologic malignancies is also recommended .Organisms causing UTI can suggest the etiology. Gram-negatives such as Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis are often found in anatomical obstruction. On the other hand, organisms such as Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, or Ureaplasma urealyticum are typically STIs. Yeast infections suggest underlying immunosuppression that occurs with diabetes or corticosteroid use .CD follows a bimodal age distribution, with the first peak between the ages 15 and 30 years. Clinically, CD presents with abdominal pain, reduced appetite, diarrhea with blood in the stool, and weight loss. In patients who present with recurrent UTIs and are asymptomatic, physicians should always keep CD in mind, imaging techniques like CT scan and MRI for the extent of fistulas should be used and they decrease the high morbidity associated with it .The European Crohn's and Colitis Organization (ECCO) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) published new imaging guidelines for CD. The diagnosis of CD and UC requires multiple steps, which include clinical evaluation, stool sampling, endoscopy, imaging study, and histological findings. Multiple imaging studies help to establish diagnoses such as MRI, CT scan, magnetic resonance enterography (MRE), endoscopy, and colonoscopy. MRI is the first line study used to diagnose and classify perianal CD and provide a more accurate assessment of abscess and pelvic fistula. Transrectal ultrasounds are better than clinical exam in providing better information. A combination of MRI and transrectal ultrasounds provides a more accurate assessment ,5Abdominal ultrasound, MRE, or a small bowel capsule endoscopy (SBCE) helps evaluate to newly diagnose a patient with CD and can be used in patients with negative endoscopy. Biopsies of both inflamed and non-inflamed segments are required to establish an accurate diagnosis. Patients with high clinical suspicion of CD and normal biopsy should be considered for SBCE or cross-sectional imaging. The presence of at least three small bowel ulcers on SBCE in a patient who has not used non-steroidal anti-inflammatory drugs for one month has a high chance of having CD ,6.The diagnostic studies, such as CT enterography and MRE, provide information that helps to treat a patient based on the severity and extent of CD and helps to evaluate its complications that cannot be observed by clinical exam or endoscopic evaluation of kids and adults. Based on the severity of the presentation, CD requires medical management or surgical intervention. For enterovesical fistula due to CD, medical therapy is the first choice. Zhang et al. reported long-term remission of enterovesical fistula in 13 of 37 patients with CD over a mean of 4.7 years through treatment with antibiotics, azathioprine, steroids, and infliximab .Antibiotic therapy should be based on the organism and sensitivities when available. Fluoroquinolone and trimethoprim-sulfamethoxazole are first-line agents. Ustekinumab is a monoclonal antibody to the p40 subunit of interleukin-12 and interleukin-23 used in a patient with moderate to severely active CD. Research by Feagan et al. found that ustekinumab provides systemic anti-inflammatory activity, better safety profile, and has a lack of immunogenicity . It is aDefinite treatment of enterovesical fistula is the surgical resection of the involved bowel. Gaglani et al. concluded that laparoscopic resection of IBD decreases hospital stays and operating time along with decreased complications . It can The initial workup for UTI consists of urine analysis and culture, but does not include imaging as it does not add diagnostic value. However, in atypical patients presenting with recurrent UTIs, after ruling out common etiologies, we recommend clinicians consider asymptomatic CD leading to an enterovesicular fistula. Extensive investigation using imaging techniques like X-ray, CT scan, MRI, MRE, and SBCE can be useful in establishing a diagnosis of CD. Pursuing early detection of asymptomatic CD in such atypical patients will allow for early intervention that can help reduce severe complications and improve outcomes.


We experienced an extremely rare case of gastric adenocarcinoma wrapped by leiomyoma.A 65-year-old man had an abnormality (filling defect) of the upper gastrointestinal series in his first medical checkup five years prior. Esophagogastroduodenoscopy detected a 10 mm submucosal tumor-like lesion in the greater curvature of the upper gastric remnant body. Despite repeated biopsy from the lesion, there was no sign of malignancy. A delle was observed on the top of the tumor at another visit five year after the first and a biopsy specimen revealed poorly differentiated adenocarcinoma. Therefore, laparoscopic gastrectomy was performed. Histological assessment revealed a 28 × 22 mm elevated lesion with a slight depression. Microscopically, papillary adenocarcinoma was observed at the submucosa with a solitary heterotopic gastric gland adjacent to the lesion. The final diagnosis was papillary adenocarcinoma arising from a solitary heterotopic gastric gland in the leiomyoma. No recurrence has occurred during a follow-up of two and a half years after surgery.This is the first report of gastric adenocarcinoma arising from a submucosal tumor. Gastric leiomyoma is a submucosal growth that accounts for 2.5 % of gastric tumors. Some cases are clinically evident because of bleeding from ulceration of the overlying gastric mucosa . This is2A 65-year-old man had an abnormality (filling defect) of the upper gastrointestinal series in his first medical checkup five years prior. The patient had undergone distal gastrectomy for a gastric ulcer at age forty. Esophagogastroduodenoscopy (EGD) revealed a 10 mm submucosal tumor-like lesion in the greater curvature of the upper gastric remnant body. Endoscopic ultrasonography (EUS) revealed a hypo-echoic tumor located in the third layer. Blood test findings revealed a carcinoembryonic antigen level of 3.8 ng/mL and carbohydrate antigen 19−9 level of 6 U/mL, indicating the tumor markers were within the normal range. Because there was no sign of malignancy, the gastric lesion was followed up by annual EGD . A delle3We experienced an extremely rare case of gastric adenocarcinoma wrapped by leiomyoma. However, it is impossible to explain that the adenocarcinoma arose from the leiomyoma. The SMT had been observed for 5 years. The tumor appearance including its mucosal surface had never changed for 4 years, and a delle appeared on top of the tumor. The pathological findings showed that carcinoma was not present at the surface mucosa, only at fundus of the ulcer. This finding indicated that the adenocarcinoma had arisen from the SMT. There is no previous report of adenocarcinoma arising from SMT.There are many reports about the adenocarcinoma from heterotopic gastric glands . The HGGIn summary, we first diagnosed heterotopic gastric glands within the leiomyoma, then adenocarcinoma arose from the heterotopic gastric glands. Supporting pathological evidence shows that there is no connection between adenocarcinoma and the normal mucosa lamina propria, and there is no finding of inversion of the mucous membrane. This is the first report of gastric adenocarcinoma appearance in leiomyoma.HGG is classified into 4 types based on their number and range of distribution: solitary type with 3 sites or less, localized type with 4–9 sites at the focal area, broad type with 4–9 sites in the broad area, and diffuse type with at least 10 sites which exist in the entire stomach . The dif4This is the first report that describes a case of gastric adenocarcinoma arising from leiomyoma.None of the authors has anything to disclose.None of the authors has anything to disclose.All procedures used in this research were approved by the Ethical Committee of National Hospital Organization, Kure Medical Center, Chugoku Cancer Center.Written informed consent was obtained from the patient for the publication of this case report and any accompanying images. A copy of the written consent form is available for review by the Editor-in-Chief of this journal.Hirofumi Tazawa is the corresponding author and carried out revision of the manuscript. Takashi Suzuki performed the surgery. Toshiaki Komo participated in the surgery. Kaoru Wada participated in the clinical treatments. Kazuya Kuraoka performed the pathological analysis. Hirotaka Tashiro and Takahisa Suzuki supervised the writing of the manuscript. All authors read and approved the final manuscript.This is not a research report, just a case report. So we do not need register this.Hirofumi Tazawa has accepted full responsibility for this work and the decision to publish it.Not commissioned, externally peer-reviewed.


Tattooing is a procedure where ink is inserted typically in the intraepidermal space of the skin. Multiple incidences of viral infections following tattooing which lead to warts have been reported in recent years. The aim of this report was to show a relatively rare adverse effect after tattooing – verruca plana.A 27-year-old female presented to our department with complains of multiple verrucous papules over her 2-year-old tattoo without itch.Pathological investigation confirmed the diagnosis as verruca plana.The patient was treated with 3 cycles of liquid nitrogen cryotherapy and 5% imiquimod cream for 5 months.A significant improvement in her lesions was observed after the combined treatment.Clinically, verruca plana post-tattooing is relatively less reported. We need to combine clinical manifestations with pathological results to arrive at a definitive diagnosis. Besides, there are a large numbers of post-tattoo complications and various routes of virus inoculation. Therefore, it is important for medical professionals to caution people before considering to have a tattoo. Recently, having a tattoo has become increasingly popular for it's artistic, beautifying and blemish-concealing features. However, in many cases the adverse reactions post-tattooing produce undesirable outcomes. The main side effects caused by tattooing include immunological, inflammatory, infectious, and neoplastic complications.2A 27-year-old female presented to our department with complains of multiple verrucous papules over her 2-year-old tattoo without itching. The tattooing had been performed to conceal a scalded scar on the left leg present for more than 1 year. At first the papules appeared above the tattooed area, eventually involving the lesions with larger numbers. On physical examination, she had 1- to 4-mm size of verrucous papules on her left dorsal foot and the anterolateral side of the left lower leg within and limited to her black tattoo , or Veregen 10% ointment, which lead to different outcomes.4To sum up, this case report presents a relatively rare virus-associated side effect of tattooing. Tattooing is considerably risky although it is beautifying. As a doctor, we have the obligation of warning people to be tattooed only in certified institutions. And immediate medical advice should be sought from dermatology professionals in case of a reaction or an undesirable condition post-tattooing.Supervision: Li LI.Writing – original draft: Yanjing Chen.Writing – review & editing: Yanjing Chen, Owais Nabi, Ping Diao, Ruoyu Wan.


Subcutaneous extraskeletal osteosarcoma (ESO) is a rare high grade malignant mesenchymal neoplasm consistent of approximately 1% of soft tissue sarcoma. Less than 10% of ESOs are superficial, originating in subcutis.We reported a 72 years old male with chief complain of a painless slowly growing soft tissue mass in his plantar aspect of right foot in the last 9 months before admission. The plain radiography showed a large subcutaneous soft tissue mass in plantar area and heel, Magnetic resonance images displayed an irregular subcutaneous soft tissue mass extending from posterior lower leg to ankle and involving calcaneus inferiorly. A percutaneous core biopsy of the mass, obtained. The histopathology examination confirmed an soft tissue osteosarcoma. Subsequent wide local excision of the mass performed. Final histopathological result was subcutaneous extraskeletal osteosarcoma.The patient has had no evidence of recurrence or/and distant metastasis at 25 months followed up. However, excising subcutaneous ESOs with a safe surgical margin is paramount for achieving the best outcome.A subcutaneous ESO is a rare malignant tumor. We recommended that along with clinicohistological findings, radiological correlation is necessary for ruling out other diagnoses. The mos2A 72-year-old healthy farmer man presented with a painless slowly growing mass in his plantar aspect of right foot in May 2018. At first, the small soft tissue mass grew in the foot plantar location for approximately 6 months ago and then slowly developed in his heel during nine months ago. He is a farmer in the north of Iran, sometimes he worked on his farm with hard shoes or even without shoes in paddy rice. He told a persistent history of previous trauma to his foot plantar for a long time. Additionally, no history of cancer elicited. On physical examination, an 11 × 4.5 × 3 cm firm and irregular mass palpated on his right foot plantar that extended to heel overlying with unremarkable skin. The plain radiography of foot showed a large subcutaneous soft tissue mass in plantar area and heel, possibly with peripheral chunky calcification . MagnetiThe patient did not receive postoperative chemotherapy or radiation. Six months later, a repeat MRI was performed which showed no resolution of the postoperative changes and no evidence of recurrent or residual tumor. The patient has had no evidence of recurrence or/and distant metastasis at 25 months followed up as verified with single-photon emission computed tomography/positron emission tomography (SPECT CT/PET).3Extraskeletal osteosarcomas most frequently occur in patients older than 40 years old. All the subtypes of osteosarcoma of bone have reported in ESOs. Osteoplastic ESO is the most common variant followed by fibroblastic ESO. Well-differentiated ESO is a rare variant . Several4A subcutaneous ESO is a rare malignant mesenchymal tumor of the soft tissue. We recommended that along with clinicohistological findings, radiological correlation is necessary for ruling out other diagnoses. However, pre-operative chemoradiotherapy associated with wide excision of subcutaneous ESOs is paramount for achieving the best outcome.The authors report no declarations of interest.No source of funding.Ethical approval was not required in the treatment of the patient in this report.Written informed consent was obtained from the patient forpublication of this case report and accompanying images. A copy of written consent is available for review by Editor-in-Chief of this journal on request.Keykhosro Maedanpour: writing the manuscript, study design, final review.Mahtab Rahbar: data collector, writing the manuscript.N/A.Mahtab Rahbar is the guarantor and accepts full responsibility.Not commissioned, externally peer-reviewed.


Cholesteatomas are benign tumors mainly composed of cholesterol crystals that rarely arise within the orbit. However, orbital cholesteatomas require a complete surgical resection due to their recidivating potential. Transcranial approaches offering a broad surgical exposure of the orbital cavity have been scarcely used for the management of these tumors. Here, we provide evidence of the benefits of the pterional craniotomy for the surgical resection of orbital tumors by sharing our experience in the surgical management of a cholesteatoma of the superotemporal orbital wall.A 45-year-old Hispanic man with a 2-year history of progressive proptosis of the left eye attended to our center complaining of diplopia and migraine. At his arrival, physical examination revealed ptosis, palpebral edema, and exophthalmos of the left eye, as well as the abolishment of the ipsilateral photomotor and consensual responses. Fundoscopy showed mild optic atrophy, whereas a T2-weighted magnetic resonance imaging (MRI) of the head showed a hyperintense mass arising at the superotemporal wall of the orbit that was displacing the eyeball. The tumor was resected using a pterional craniotomy without postoperative complications. The histopathological analysis of the tumor revealed a cholesteatoma. The patient recovered the functionality of the left eye with no visual sensitive deficits nor tumor recurrence 1 year after the surgery.Our results support the use of the pterional craniotomy as a safe procedure for the surgical resection of cholesteatomas arising at the superotemporal walls of the orbit, with low postoperative morbidity. Different inflammatory, vascular, cystic, and neoplastic lesions have their origin at the orbit. Among these, mesenchymal and lymphoproliferative tumors account for most cases of orbital lesions, although other neurogenic, lacrimal, and metastatic tumors can also affect this location , 2. CholDistinct approaches have been employed to access orbital tumors, most of them requiring extensive bony removal that hinders the total resection of complex masses without risk of postoperative complications and aesthetic consequences . ConversIn the current report, we provide evidence of the safety and advantages of the pterional approach for the surgical management of a patient with a cholesteatoma arising at the superolateral orbital wall. Our findings indicate that the pterional craniotomy is a suitable procedure for the surgical resection of orbital cholesteatomas with low operative morbidity.A 45-year-old Hispanic man with a 2-year history of progressive proptosis of the left eye attended to our center complaining of diplopia and hemicranial migraine. He was previously diagnosed with hyperthyroidism receiving thyrostatic treatment with thiamazole for 6 months without clinical improvement. His past medical history was not relevant, and he denied previous ocular trauma. At his arrival, physical examination revealed ptosis, palpebral edema, and exophthalmos of the left eye, as well as the abolishment of the ipsilateral photomotor and consensual responses, but conserving the corneal reflex. Furthermore, the patient presented an evident limitation for the abduction and supraduction of the affected eye, whereas fundoscopy showed mild optic atrophy. The exploration of the right eye did not reveal any abnormality, whereas the neurological examination showed normal cognitive function with no focal neurologic deficits. A T2-weighted magnetic resonance imaging (MRI) of the head showed a hyperintense mass arising at the superotemporal wall of the left orbit that was displacing the eyeball, invading the frontal bone, and causing inflammation of the adjacent dura mater Fig. a, c.Fig.Due to the extension of the tumor, we decided on its surgical resection using a pterional approach. The skin incision and dissection of the temporalis muscle fascia were performed as described before , 7, in oCholesteatomas and cholesterol granulomas are benign lesions of presumed inflammatory origin that rarely affect the orbit . HoweverThe pterional approach has been widely employed in neurosurgery since it's developed by Yasargil in 1975 . AlthougDespite such benefits, the pterional approach has been rarely used in the context of orbital tumors. Previous reports have demonstrated the low operative morbidity of this approach in the management of different types of orbital neoplasia, including lacrimal, neurogenic, and metastatic tumors . HoweverIn conclusion, our report demonstrates that the pterional craniotomy is a safe procedure that offers advantages over primary orbital approaches for the surgical resection of orbital cholesteatomas with a low postoperative morbidity and acceptable aesthetic outcomes.


Over the last 20 years, substantial knowledge has been developed in Veterinary oncology, and tumors previously reported only in humans have been identified in animals. Primary paragangliomas of the tongue are extremely rare tumors in human beings and have never been reported in animals. A Chow Chow dog showed an ulcerated nodule at the lingual body, deeply infiltrated, which extended to the base of the tongue. A full clinical and pathological investigation was conducted, and a post-surgical follow-up of 6 months did not detect recurrence. Cytological, histological, and immunohistochemical features are presented and support the diagnosis of lingual paraganglioma. The paraganglioma of the tongue reported in this Chow Chow dog shares many similarities with the human counterpart. Over the last 20 years, substantial knowledge has been developed in Veterinary oncology. Tumors previously reported only in humans have been identified in animals, and there is a considerable improvement in the diagnosis and treatment of neoplasms and an increase of survival. Neoplasms of the tongue accounted for 54% of lingual lesions, and 64% are malignant tumors, with a particularly high incidence in Chow Chows and Chinese Shar-Peis .Primary paragangliomas of the tongue are extremely rare tumors in human beings and have never been reported in animals. Paragangliomas of the head and neck usually have a parasympathetic origin and generally are non-secretory , 3. ExtrWe describe the occurrence of paraganglioma in the tongue of a Chow Chow dog that shares similarities with the human counterpart.An 11-year-old female Chow Chow dog was referred for clinical care with sialorrhea, oral bleeding during eating, fetid breath , and dysphagia for 20 days. The inspection of the oral cavity showed a nodule with an irregular surface, exophytic, and ulcerated at the right side of the lingual body, deeply infiltrated, which extended to the base of the tongue . RegionaSamples of tissues were fixed in 10% phosphate-buffered formalin (pH 7.0), embedded in paraffin, and sections of 4 μm stained with hematoxylin and eosin (H&E), periodic acid-Schiff (PAS) and reticulin silver stains. Tumoral samples were also submitted to immunohistochemistry using the biotin-peroxidase-streptavidin method  with primary antibodies incubated overnight . The priAdditionally, we made a review of manuscripts published on tongue paraganglioma in animals and humans. A PubMed query was conducted with the following keywords: paraganglioma, tongue, pharynx, dog, canine, animals, veterinary, head, and neck. Articles were selected based on the location of paragangliomas and scientific relevance and were used to compare features between the dog and the human counterpart.CT revealed a poorly delimited neoformation in the body of the tongue, isodense, heterogeneous at the proper lingual, styloglossus, hyoglossus, and genioglossus muscles. Thoracic x-ray and abdominal ultrasonography did not detect tumoral masses or other abnormalities. The pre-surgical evaluation showed an increase in serum activity of creatine phosphokinase . The CBC and the serum levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyl transferase, creatinine, urea nitrogen, total protein, albumin, cholesterol, triglycerides, calcium, and phosphorus were within the reference ranges .Fine needle biopsy aspiration of the tongue mass revealed round to polygonal cells arranged in groups or isolated, moderate anisocytosis and anisokaryosis, nuclei with finely granular chromatin, some naked nuclei, and the presence of one or two nucleoli. The tumor cells had a slightly basophilic cytoplasm and occasional acinar-like structures, and binucleated cells were also observed . The par2). The cytoplasm was eosinophilic and slightly granular, and PAS-negative stained. There were multifocal tumoral infiltrations to the muscular tissues and scarce surgical margins. Immunohistochemistry of tumor samples  evidenced by the reticulin stain . Neoplas samples  showed s samples  and Syna samples , and vim samples .The dog returned 1 month after partial glossectomy for clinical follow-up, and there was an improvement in food intake and weight gain. The tongue showed proper healing , and halThe paraganglioma of the tongue in the Chow Chow dog shares many similarities with the human counterpart. Difficulty swallowing associated with a partial tongue dysfunction owing to tumor infiltration and traumatic injuries enabled sialorrhea, difficulty feeding, bleeding, and halitosis in the dog. Hemorrhage during eating was also related to traumatic injuries of a tumoral mass on the base of the tongue in the first report of primary lingual paraganglioma in humans . BleedinPharyngeal paresthesia , pain anThe large ulcerated tumoral mass in the dog showed deep infiltration of the lingual muscles from the body of the tongue to the base. The high serum activity of creatine phosphokinase possibly demonstrates muscular damage related to tumor growth and infiltration. The location of paragangliomas in the tongue of humans is similar to that observed in the dog, and ulceration and serum biochemistry abnormalities have not been reported –17. The Cytological features of the ulcerated lingual lesion in the Chow Chow dog, such as acinar-like configuration or loose clusters of cells with round to oval nuclei within stippled chromatin, moderate anisocytosis and anisokaryosis, and some naked nuclei –21, provIn human patients, there are different cytological presentations of paragangliomas of the head , 20, incThe most relevant histological diagnostic feature detected in the tumor of the tongue was the “Zellballen” appearance composed by nests of round to polygonal neoplastic cells PAS-negative. Microscopically, tumoral infiltration to the lingual muscles was also a significant finding. Fibrovascular stroma dividing packets or nests of variable pleomorphic epithelioid to polygonal tumoral cells, and surrounded by thin trabeculae of fibrous tissue are remarkable in EPs of dogs , 6, 8, aParagangliomas of the tongue in human patients are histologically similar to those observed in other tissues –17, 19 aThe immunolabeling for Chromogranin A, Synaptophysin, Vimentin, and GFAP antibodies is a hallmark of extra-adrenal paragangliomas in dogs and humans –8, and aThe exclusive S100 protein positivity of sustentacular cells in the Chow Chow dog was also reported in paragangliomas of the tongue in humans –18, and The tongue is an unexpected anatomical site to arise paragangliomas, a hypothesis supported by the absence of cases reported in Veterinary literature and the rarity in human beings. Once the anatomical distribution of minor paraganglia is not entirely known, paragangliomas of the tongue may arise from parasympathetic paraganglia related to the branches of facial or glossopharyngeal nerves, or in the walls of arteries . AlthougGranular cell tumors (GCTs) in the tongue of dogs –26 are oDespite the rarity, paragangliomas of the tongue should also be included in the differential diagnosis of the most frequent lingual neoplasms in dogs such as melanomas, carcinomas, fibrosarcomas, hemangiosarcomas, and some benign tumors such as squamous papilloma, plasma cell tumors, and GCTs. Further investigations on the anatomic distribution of paraganglia in the oral cavity, and genetic analysis of SDH genes, may contribute to the knowledge on lingual paragangliomas in dogs.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.Ethical review and approval was not required for the animal study because it was an expontaneous disease. Written informed consent was obtained from the owners for the participation of their animals in this study.JS and LF performed clinical evaluations. FR, AP, DS, TW, BS-B, and MC performed pathological examinations. MC drafted the manuscript. All authors read and approved the final manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Patients with mixed neuroendocrine-nonneuroendocrine neoplasms (MiNENs) of the colon have poor prognosis. Herein, we report a patient with MiNEN of the colon with metastases to the liver and the thyroid gland, with long-term survival. A 45-year-old man presented with anterior neck swelling. Histopathological examination of the thyroid tumor revealed neuroendocrine carcinoma (NEC), suggesting that a primary NEC in another organ had metastasized to the thyroid gland. Computed tomography to identify a primary NEC revealed two tumors: one in the liver and one in the transverse colon. A biopsy revealed that the histopathology of the liver and colon tumors was NEC and adenocarcinoma, respectively. Thereafter, the patient underwent surgical resection of the colon tumor and was finally diagnosed as colon MiNEN with metastases to the thyroid and liver. The surgical resection of the metastatic liver tumor was performed after several courses of systemic chemotherapy, and the patient survives presently without any recurrence for approximately seven years after the diagnosis. Surgical resection of each metastatic lesion combined with systematic chemotherapy apparently improved the prognosis of MiNEN of the colon with distant metastases. Neuroendocrine neoplasms of the colon are a rare but life-threatening malignancy . The WorWe report a case of a 45-year-old man who had MiNEN of the colon with metastases to multiple organs, including the thyroid gland and the liver. The patient underwent surgical resection for each lesion, combined with systemic chemotherapy, resulting in ongoing disease-free survival for seven years. We should keep in mind that surgical extirpation of resectable tumors with systemic chemotherapy may yield long-term disease-free survival in patients with MiNEN of the colon metastasizing to multiple organs, although surgery alone has been reported to have no survival benefit for the majority of high-grade neuroendocrine neoplasms of the colon with metastatic disease [A 45-year-old man presented to our department with rapidly progressive swelling of the anterior neck. He had been a 40-pack-year smoker. Contrast-enhanced computed tomography (CT) showed a 4.5 cm tumor that was enhanced slightly in the left lobe of the thyroid . At firsChemotherapy was planned for the residual metastatic liver tumor based on a regimen for small-cell lung cancer: six cycles of chemotherapy with carboplatin and irinotecan as the first line, six cycles of chemotherapy with cisplatin and etoposide as the second line, and eight cycles of amrubicin as the third line. Disease progression was observed after the third line, which required an extensive right hepatic lobectomy and resection of the inferior vena cava. The elevated serum level of NSE and ProGRP  returned to normal after hepatic lobectomy. The patient showed no evidence of disease recurrence for 7 years of follow-up after the hepatic surgery.In 2017, the WHO classified high-grade colorectal tumors into three categories according to the proportions of neuroendocrine and exocrine components as follows: (1) NEC (>30% neuroendocrine component and <30% nonneuroendocrine component), (2) MiNEN (>30% of both components), and (3) adenocarcinoma with neuroendocrine differentiation (>30% adenocarcinoma and <30% neuroendocrine component) [Cisplatin-based , 7, 8 orSome studies regard the role of primary tumor resection at an early stage as important , 7; howeMetastasis to the thyroid gland from nonthyroid sites is uncommon; however, the most common site is the lung –17. In aFurther studies are needed to establish standard guidelines for a therapeutic strategy including surgery, chemotherapy, and target therapy for patients with MiNEN of the colon.


Ischemic colitis is a common disease; however, its pathophysiology remains unclear, especially in ischemic proctitis after sigmoidectomy. We present a rare case of ischemic proctitis 6 months after laparoscopic sigmoidectomy.The patient was a 60-year-old man with hypertension, type 2 diabetes, and hyperlipidemia. He was a smoker. He underwent laparoscopic sigmoidectomy for pathological stage I sigmoid colon cancer and was followed up without any adjuvant therapy. Six months after his surgery, he complained of lower abdominal discomfort, bloody stools, and tenesmus. Colonoscopy showed extensive rectal ulcers between the anastomotic site and the anal canal, which was particularly severe on the anal side several centimeters beyond the anastomosis. We provided non-surgical management, including hyperbaric oxygen therapy. The rectal ulcers had healed 48 days after the therapeutic intervention. He has not experienced any recurrence for 3.5 years.While performing sigmoidectomy, it is important to consider the blood backflow from the anal side of the bowel carefully, especially for patients with risk factors of ischemic proctitis. Ischemic colitis is a common disease, and ischemic proctitis after sigmoidectomy is rare. The pathophysiology and definitive management remain unclear. We present a case of ischemic proctitis that occurred 6 months after laparoscopic sigmoidectomy and treated by non-surgical management.A 60-year-old man underwent an occult bleeding test during his annual medical checkup, which showed positive results. Colonoscopy showed a type 1 tumor in the sigmoid colon Fig. . AbdominIschemic colitis is defined as a localized and reversible ischemic colonic lesion , 2 that The first-line treatment for ischemic colitis is non-surgical management, including withholding oral intake and administration of antibiotics. In severe cases, surgery including colostomy or abdominoperineal resection is indicated . In geneIschemic proctitis after sigmoidectomy might be related to underlying arteriosclerosis and anatomical blood flow insufficiency. It is important to carefully consider the blood backflow from the anal side, especially in patients with risk factors for ischemic proctitis.


Inflammatory myofibroblastic tumor (IMT) is a spindle cell neoplasm with low malignant potential, which may appear in different parts of the body. Uterine localization is rare, especially among children. Etiology is unclear, although some authors suggest underlying trauma or distress. A 3.5-year-old girl was treated at our institute for recurring vaginal bleeding without injury or known pathology. Physical examination and laboratory analysis revealed no specific findings, contrast-enhanced MRI found a 25 × 28 × 30 mm-sized inhomogeneous soft tissue mass in the uterus wall, which was excised in toto. Histological examination identified a spindle cell pattern, and the FISH test revealed ALK gene rearrangement, the lesion was defined as an IMT. Six cases were published to date, and their diagnostic methods are not equivocal, CT, and PET CT were preferred instead of MRI. Aggressive therapy seems to be exaggerated according to low recurrence and metastasis occurrence, and crizotinib is proved as good therapeutic agent in those cases. Biopsy and histology has important role in order to distinguish IMT from malignancies completed with FISH examination because ALK positivity strengthens the diagnosis. No lethal outcome was published among children, as our patient is also symptom-free after 3 years. ALK) gene, which encodes receptor tyrosine kinase  is a rare spindle cell neoplasm with low malignant potential, and it is composed of proliferative myofibroblasts and mixed inflammatory cell infiltrate. The appearance of IMT in childhood is extremely rare. Symptoms and treatment are heterogeneous, mainly depend on the localization of the tumor –4. Genete kinase –5. Here,A 3.5-year-old girl was referred to the surgical outpatient clinic complaining of recurring vaginal bleeding. There was no trauma or inflammatory symptoms in her clinical history. Regarding the family history, no malignant, or genetic disease was noted. On physical examination flat and non-tender abdomen was found without any palpable lumps, with negative rectal examination. Abdominal ultrasound scan showed a mildly enlarged uterus, while MRI examination identified a 25 × 28 × 30 mm sized inhomogeneous soft tissue mass in the uterus that compressed the entire endometrium . The lesAccording to the multidisciplinary team's decision, primary open surgery was chosen. Fine needle biopsy was excluded because of pelvic localization, small size, and the chance of inadequate sample size for a certain histologic opinion. Tumor spilling was also considered as risk factor during this procedure. Surgery was performed through suprapubic incision; and the well-circumscribed lesion seemed resectable, so instead of tumor biopsy the entire mass was removed from the posterior wall of the uterus. The myometrium was completely reconstructed. Lymph node metastasis was not found. The postoperative period was uneventful. After a 3-years follow-up period the child was complaint-free, and the abdominal US scans showed no recurrence. Histological examination revealed IMT with irregular borders composed of spindle cells with low cytological atypia. Also, an extensive inflammatory cell infiltrate with eosinophyl granulocytes and lymphocytes was observed in the tumor tissue. Immunohistochemistry was positive for h-caldesmon, smooth muscle actin, CD34, factor XIII and ALK. ALK FISH examination has found ALK translocation in 80% of the tumor cells.© database only 6 reports concern pediatric uterine IMT cases  . As someThe histological appearance of each varied from case to case. Immunohistochemistry revealed ALK-positivity in 4 cases as it was also seen in our presented case. The expression of ALK protein and the presence of ALK gene rearrangement are good diagnostic markers; however, they are only present in about 50% of the IMTs, but in 88–100% of uterine IMTs , 14. A vThe “wait-and-see” approach was also described as a safe treatment of IMTs in adults as well as in pediatric cases , 15, 16.In conclusion, the so far published youngest child with uterine IMT was treated successfully by our team. To date, no recurrence or metastasis has been observed. The authors would also like to stress the role of the uterus-sparing surgery to eliminate tumor or gain tissue specimen, and emphasize the importance of the prior MRI imaging instead of other reported methods in order to achieve recovery without harming the normal development of the female genital tract.All datasets generated for this study are included in the article/supplementary material.This study was carried out in accordance with the recommendations of the Declaration of Helsinki with written informed consent from the parents. The protocol was approved by the scientific ethic committee of University of Szeged.The study conception was performed and the manuscript was written by PE and TK. Data acquisition was by PE, LK, and TK. Revision was by LK and TK.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The patient is a 31-year-old woman with a history of prior resection of a presumed keloid scar around her Pfannenstiel incision found to be endometrial tissue on final pathology. She presented 5 years later with recurrence of pain and a mass associated with menses despite maximal medical therapy for endometriosis. Computed tomography of her abdomen and pelvis demonstrated an infiltrative soft tissue mass measuring 8.8 cm × 4.0 cm. Surgical oncology conducted an en bloc resection of the mass and obstetrics and gynecology performed a concomitant total abdominal hysterectomy and bilateral salpingo-oophorectomy. Plastic and reconstructive surgery completed the repair of the final 23 cm × 10 cm full-thickness abdominal wall defect with bridging biologic mesh, complex layered closure, and incisional negative-pressure wound therapy. Final pathology confirmed a diagnosis of endometriosis. Patient’s hospital course was uncomplicated, and follow-up at 6 months does not demonstrate clinical or radiographic evidence of bulge or hernia recurrence. Abdominal wall endometrioma is a well-documented occurrence in prior cesarean scars; plastic surgeons can contribute to a multidisciplinary approach in reconstruction when resection compromises abdominal wall integrity, necessitating expertise in complex repairs. Due to association with the abdomen and prior incision, the differential diagnosis includes incisional hernia, keloid scarring, desmoid tumor, suture granuloma, fat necrosis, or malignancy.The diagnosis of abdominal wall endometriosis (AWE) is made when endometrial tissue superficial to the peritoneum is confirmed by histopathology. The incidence of cesarean scar endometriosis is estimated between 0.03% and 0.45%, and patients most commonly present with a mass (96%) and pain .4 Although AWE is well documented in the literature as a late complication following cesarean section, the average reported size (2.7 cm) typically lends toward primary fascial closure following resection.3 In cases of large abdominal wall defects, options for closure include unilateral or bilateral component separation, bridging interposition mesh, or musculofasciocutaneous/fasciocutaneous free flap.The treatment of choice for AWE is wide local excision with at least 1 cm margins, and recurrence is estimated at 4.3%.A 31-year-old African American woman with a history of 2 low transverse cesarean sections and prior resection of abdominal scar endometrioma 5 years ago presented with a recurrent Pfannenstiel incision-associated mass and chronic, severe pain uncontrolled by maximal medical therapy. Computed tomography with contrast of the abdomen and pelvis demonstrated evidence of an infiltrative soft tissue mass involving the right lower quadrant ventral abdominal wall musculature and subcutaneous tissues measuring 8.8 cm × 4.0 cm , typically relies on a bridging mesh repair.7 Additionally, bridging mesh predisposes patients to risk of hernia recurrence (56% with biologic mesh used as an interposition bridge) and infection (25%).9 Therefore, a multidisciplinary approach, adequate patient counseling of expectations, and intraoperative flexibility are needed to address unique complications or scenarios following wide, deep excisions that significantly alter the structural integrity of the abdomen.10 Plastic and reconstructive surgeons well versed in complex abdominal wall repairs play an integral role in the treatment of these patients as they can best address current defects and hedge against future complications.This repair balanced patient-specific factors with plastic surgical principles to minimize morbidity. However, patients receiving abdominal wall reconstruction with use of ADM in the setting of oncologic extirpation have a high likelihood of hernia recurrence (odds ratio = 6.47).Resection and repair of infiltrative AWE require a multidisciplinary approach and intraoperative problem solving by plastic surgeons familiar with complex abdominal wall repairs. Additionally, likelihood of recurrence requires surgical foresight in case of future necessary repairs following additional resections.


In dogs, meningiomas mostly cause chronic progressive clinical signs due to slow tumor growth.In contrast, three dogs were presented with the history of chronic generalized tonic-clonic seizures and peracute deterioration with sudden onset of neurological deficits in accordance with an extensive unilateral forebrain lesion. Magnetic resonance imaging examinations of the dogs revealed a well-delineated extraaxial T2W hyperintense mass in the rostral forebrain with homogeneous contrast enhancement. Additionally, an intraaxial, well-demarcated, unilateral lesion was apparent in the parenchyma supplied by the middle cerebral artery. In two cases, necropsy revealed meningothelial meningioma in the rostral fossa and marked eosinophilic neuronal necrosis, a sign of ischemia, focal malacia, edema and gliosis in the temporal lobe and hippocampus because of a focal thrombosis of the middle cerebral artery. In the third case symptomatic treatment resulted in improvement of clinical signs enabling a good quality of life for the patient.In dogs with structural epilepsy caused by meningioma, acute deterioration of clinical signs can be associated with ischemic infarctions as a potential complication. Meningiomas are the most common primary intracranial tumors in dogs  and occuIn this report meningioma was diagnosed in three dogs. All three dogs suffered from an unusual acute worsening of neurological signs presumably because of associated ischemic cerebral infarction.All examinations were performed with written informed owner’s consent according to ethical guidelines of the University of Veterinary Medicine Hannover, Foundation. A resident of the European College of Veterinary Neurology performed the neurological examinations in every dog.Magnetic resonance imaging  and cerebrospinal fluid (CSF) sampling were obtained in general anesthesia (premedication: diazepam 0.5 mg/kg intravenously (i. v.), levomethadone with fenpipramide 0.2 mg/kg i. v. ; induction of anesthesia: propofol dose to effect 1–3 mg/kg i. v.; orotracheally intubation and connection to a semiclosed circle absorber system ; maintenance of anesthesia: isoflurane in an oxygen/air mixture ) in all dogs.If the dogs were euthanized (dog 1 and 2) pentobarbital  was administered i.v.Full post mortem examination of the dogs in case 1 and 2 have been done. Representative samples of parenchymal organs, including the whole brain, were fixed in 10% neutrally buffered formalin. The samples were trimmed and embedded in paraffin wax, cut at 3–5 μm and sections were stained with hematoxylin & eosin (HE). For further evaluation of the meningiomas, immunohistochemistry for vimentin , pan-cytokeratin , glial fibrillary acidic protein  or S-100 protein  using the avidin-biotin-peroxidase complex (ABC) method  was performed. In case 2, additionally immunohistochemistry detecting neuron specific enolase  and laminin  were applied .A client-owned 13-year-old Miniature Schnauzer, male intact, showed non-progressive generalized tonic-clonic seizures since 3 months without obvious interictal abnormalities. The animal was presented to the neurology service of the Department for Small Animal Medicine and Surgery of the University of Veterinary Medicine Hannover, Foundation, because of peracute worsening of clinical signs. The neurological examination revealed an ambulatory tetraparesis with proprioceptive deficits on all four limbs with a left sided accentuation and ongoing oro-facial seizures on the left side of the face. The dog was obtunded and disorientated, showed compulsive pacing and circling to the right. Menace response and vision were absent on both eyes, while pupillary light reflex (PLR) was normal. Nasal nociception was reduced in the left nostril. Other cranial nerves and spinal reflexes were unremarkable. Neuroanatomical localization was a forebrain lesion with a right-sided accentuation.General examination revealed a mild systolic heart murmur, a small tumor on the left upper eyelid and moderate dental callus.Escherichia coli. No signs of septicemia were present. Heart sonography revealed low-grade mitral valve endocardiosis.Blood examination revealed mildly to moderate increased liver enzymes  , glutamate dehydrogenase (GLDH) , alkaline phosphatase (ALP) ) and urea . Blood cell count, renal parameters, triglycerides, cholesterol, glucose, electrolytes and thyroid hormones were unremarkable. Non-invasive blood pressure measurements  were in the reference range . In radiographic examinations of thorax and abdomen multiple spondylarthrosis, hepatomegaly, mineralization in both kidneys and urolithiasis were seen. Renal calculi (up to 1 cm in diameter) and mineralization in both kidneys were also detected during abdominal sonography and furthermore minimal dilatation of the urethra were noted. Urine analysis and microbial testing revealed struvite uroliths and cystitis associated with MRI demonstrates a well-delineated extraaxial mass at the rostral part of the right olfactory bulb, hyperintense in T2weighted (T2W), fluid inversion recovery (FLAIR) and gradient echo (GE) images and isointense to surrounding tissue in T1W sequence. The mass displayed a marked homogeneous contrast enhancement and had a diameter of approximately 1 cm compressing the olfactory bulb  per os (p. o.)  by the referring veterinarian. At the day of presentation, the dog experienced peracute worsening of clinical signs. The dog was in lateral recumbency with reduced consciousness. The body temperature was 40.4 °C, mucous membranes were reddened with a capillary refill time of 2 s and the heart rate accounted 200 beats per minute. At the neurological examination the dogs was ambulatory tetraparetic, with severe ataxia on all limbs and reduced proprioception with a right sided accentuation. She was obtunded and disorientated, showed convulsive pacing, circling to the left, and a decreased menace response of the right eye. The neuroanatomical localization was left forebrain. Secondary to this a neurogenic shock and central hyperthermia was suspected, but at this time point septicemia could not be excluded.Blood cell count, renal and liver parameters, glucose, electrolytes, thyroid hormones and urine analysis were unremarkable, which made septicemia unlikely. Mild hepatomegaly was evident on abdominal radiographic examination.3. It produced a mild midline shift in the rostral brain region to the right. It appeared heterogeneous hyperintense in T2W, FLAIR, GE, hypointense in T1W with multifocal signal void in all sequences. Marked heterogeneous contrast enhancement was visible. Adjacent to this mass lesion an extended intraaxial lesion of the cortical grey matter and underlying white matter of the left cerebral hemisphere was visible. The area corresponded to brain tissue supplied by the left MCA. The intraaxial lesion was moderately to well-demarcated with a mildly inhomogeneous, hyperintense appearance in T2W, FLAIR, GE sequences and isointense in T1W  and radiotherapy of the brain tumor. Histopathological examination of the mammary tumors characterized them as complex carcinoma and multifocal simple, partly cystic adenomas.The dog recovered well, showed no neurological signs and no further seizures. Control MRI examination 3 months after radiation revealed that the mass was mildly decreased in size but otherwise unchanged.Six months after initial presentation the dog was presented in the emergency service due to peracute clinical deterioration. She was disorientated and agitated and showed a right sided head turn. She was non-ambulatory tetraparetic with proprioceptive deficits on all 4 limbs with a left sided accentuation. Her menace response was absent on both eyes with normal PLR and suspected decreased vision. Nociception on the left nostril was decreased. Additionally, continuously focal oro-facial seizures in the left face was observed. General examination and blood pressure measurements were unremarkable. Repeated abdominal sonography stayed unremarkable.The following MRI displayed the previously reported mass with decreased size but otherwise unchanged. However, an additional intraaxial lesion was visible Fig. e-h. It wSubsequent symptomatic therapy included additional antiepileptic medication , Levetiracetam 20 mg/kg p.o. TID ), hand feeding, and continuous rate infusion. After six days the dog’s clinical signs improved and she started to walk again with waxing and waning consciousness, compulsive circling to the right and decreased vision. She could be discharged from hospital at day nine after onset of the tetraparesis. At this time point she was alert, ambulatory and could follow commands. Only a visual deficit of the left eye with reduced menace response and normal PLR was noticeable. Further follow up information are available until time of writing (1.5 years after first presentation): The dog experienced generalized tonic-clonic or focal oro-facial seizures every 2–8 weeks despite treatment with phenobarbital 3.6 mg/kg BID p.o. and levetiracetam 20 mg/kg TID p.o. A control MRI 13 months after initial presentation showed multifocal cavitation of the right cerebral cortex, increased volume of the lateral ventricle due to loss of parenchyma and multifocal, T2W and FLAIR hyperintense intraaxial lesions in the right cerebral cortex without mass effect and without pathological contrast enhancement. These lesions were located at the location of the presumed infarction (Fig. Meningioma are the most common primary intracranial tumors in dogs  and mostIn the third case post mortem examination was not performed, since the dog recovered well and is still alive at the time of writing. Clinical and MRI features resembled the other two confirmed cases and the MRI diagnosis reinforces the suspected diagnosis of ischemic infarction of the MCA additional to a preexisting meningioma. In human medicine, ischemic infarctions in patients with brain tumors are a rare but well recognized phenomenon . SeveralIn the presented cases, an intensive work up was performed to exclude systemic causes for ischemic stroke as far as possible. In case one septic emboli due to bacterial cystitis might be a possible reason for stroke, but necropsy could not detect bacteria within the histopathologically diagnosed thrombus. In the third case, radiation-induced vasculopathy could have caused occurrence of stroke, but as radiation was not performed in the author’s clinic, radiation protocol was not available. In the second case, no underlying pathology could be found, but due to adrenal infarction a connection between similar changes in the brain could not be excluded. Interestingly, in all three described cases a very similar distribution of the meningioma and the affected vessel was seen: the tumor was located in the rostral forebrain and the occlusion occurred in the ipsilateral MCA. A direct obstruction of the vessel via compression by the tumor itself is unlikely due to its anatomic localization. However, the mass effect and an additional peritumoral edema increasing the intracranial pressure, could have caused the stroke by indirect compression of the MCA.In veterinary medicine, to the author’s knowledge this is the first case series reporting a concurrent presence of meningioma and cerebral infarction. An etiological association is feasible. In dogs with sudden deterioration of clinical signs and diagnostic imaging with suspicion of an intracranial infarction despite an extraaxial mass supportive treatment attempt might be worthwhile as demonstrated in case 3. Prognosis seems to be fair regarding the acutely occurring clinical signs caused by the infarction.