A schwannoma is a benign, encapsulated tumour that is derived from neural sheath (Schwann) cells. Approximately 25–40% of schwannomas occur in the head and neck. The most common site is the parapharyngeal space of the neck; oropharyngeal occurrence is extremely rare. Among the various histological types of schwannomas reported to date, the ancient (degenerative) variant is the most rare. To our knowledge, this is the first report of an ancient schwannoma in the parapharynx with an extensive oropharyngeal component causing dysphagia. Dysphagia was the prominent symptom because of the location and volume of the lesion. The tumour was excised via a transcervical approach. Schwannoma (neurilemmoma) is a rare, benign, encapsulated tumour arising from neural sheath cells commonly seen in the extremities.To date, ancient schwannomas presenting as neck masses have been reported by various authors . In the A 46-year-old man presented to a multidisciplinary tertiary cancer centre having suffered from a painless and progressively increasing mass in the right side of the submandibular region for the last 2 years. There had been an accompanying change in voice and dysphagia for the last five months. On clinical examination, he had a diffuse soft cystic swelling, measuring approximately 6cm × 5cm, anterior to the right sternocleidomastoid. The overlying skin was free. Intraoral examination revealed a large smooth bulge in the right lateral pharyngeal wall pushing the tonsil medially and causing narrowing of the oropharyngeal airway . The patThe routine blood investigations were normal. Ultrasonography revealed a large oval anechoic lesion with multiple septa. On performing colour Doppler ultrasonography, there was no evidence of increased vascularity. Fine needle aspiration (FNA) was suggestive of a high grade pleomorphic malignant tumour but a formal biopsy was advised. T2 weighted magnetic resonance imaging (MRI) showed a 6.8cm × 6.3cm × 4.9cm hyperintense homogeneous cystic lesion in the right parapharyngeal space from the C1 to C4 levels that displaced the major vessels laterally . Planes The differential diagnoses included second branchial cleft cyst, retropharyngeal abscess and schwannoma. The patient underwent surgical removal of the mass through a cervical approach under general anaesthesia. The procedure was without incident, with the mass being dissected easily from the surrounding tissues. Post-operative recovery was uneventful with no evidence of neural damage.The specimen consisted of a 7.5cm × 3.5cm × 2.5cm well circumscribed lesion with multiple cystic yellowish areas. The cyst wall thickness varied from 0.2cm to 0.5cm. On microscopy, the tumour was composed of short fascicles of spindle cells with eosinophilic cytoplasm, giving a syncytial appearance. Focally, the spindle cells were arranged in a vague palisade pattern (Verocay bodies). Cholesterol clefts, inflammatory cells and haemosiderin laden macrophages were seen sprinkled among the tumour cells. On immunohistochemistry, the spindle cells were immunoreactive to S100 protein. Overall, the features were those of an ancient schwannoma .Figure A schwannoma is a tumour originating from the Schwann cell of the nerve sheath. These tumours are typically slow growing and cause minimal symptoms to be detected late in the disease progression. They are characteristically solitary, well encapsulated and originate along the course of peripheral, cranial or sympathetic nerves.These tumours present as a cystic mass in the neck region and therefore the differential diagnoses to be excluded are lymphadenitis (reactive/tuberculous/metastatic), lipoma, cystic hygroma, second branchial cleft cyst, carotid body tumour and laryngocoele. Inflammatory lymphadenitis will have a short disease history with tender neck swellings responsive to antibiotics. Tuberculous lymphadenitis will have classical matted swelling on palpation with the constitutional symptoms of fever and night sweats. Lipomas are superficial cystic swellings. Cystic hygromas are non-compressible cystic swellings with positive transillumination. Second branchial cleft cysts present usually as painless fluctuant masses in the lateral portion of the neck adjacent to the anteromedial border of the sternomastoid muscle, at the angle of the mandible. Carotid body tumours are firm, pulsatile neck masses.These tumours exhibit characteristic histological features of an encapsulated lesion showing degenerative ‘ancient’ changes including large cystic/myxoid areas with occasional bizarre spindle cells and even a few mitoses.In our case, the FNA was suggestive of a high grade pleomorphic malignant tumour. These features of nuclear atypia and hyperchromatism seen on FNA in ancient schwannomas suggest a regressive phenomenon and should not be considered a sign of malignancy.at al that evaluated 24 schwannomas of the extremities showed that MRI is the most useful technique in evaluating ancient schwannomas.To date, there have not been any major studies that have evaluated the role of radiological imaging in the diagnosis of ancient schwannomas. The single study done by Isobe As the ultrasonography did not reveal any useful diagnostic information, computed tomography (CT)/MRI was performed. Since the lesion was of a soft tissue, contrast enhanced MRI was chosen in view of its multiplanar capability and its better soft tissue contrast. In the literature, the CT appearance of a schwannoma has been described as a well circumscribed, inhomogeneous mass of low density, which can be explained by the following microscopic pattern: hypocellular areas (Antoni type B) adjacent to more cellular regions (Antoni type A) and cystic degeneration.Nowadays, MRI is considered to be the gold standard in the evaluation of ancient schwannomas. Schwannomas on T1 weighted MRI typically show a peripheral low signal intensity area and a high signal intensity area on T2 weighted images corresponding to the Antoni B areas.Surgical excision remains the mainstay of treating this benign condition although there is a lack of evidence to support this in view of the rarity of this disease entity.We have described a case of an ancient schwannoma originating in the parapharyngeal region. This type of tumour is uncommon in the head and neck region as well as in the parapharyngeal region. The diagnosis should be based on clinical findings of a longstanding painless cystic growth. MRI is the imaging modality to be relied on to clinch the diagnosis. FNA may be misleading histologically. Complete resection leads to complete cure of this benign disease.


Mesenteric lymphatic hygroma is a benign tumor of lymphatic origin that is rarely observed in adult patients. Congenital and developed non-specific symptoms, including abdominal distension, pain and ileus, develop at an early age in patients. This type of disease is usually reported by pediatric doctors, as referred to in the literature. The current study presents the case of a 23-year-old male in whom a polycystic mass in the mesentery was identified by computed tomography. The size of the tumor was measured to be 30×20×15 cm during surgery. The mass was excised completely with preservation of the intestine, duodenum, pancreas and other neighboring organs. Histopathological examination confirmed the diagnosis of lymphatic hygroma. The post-operative recovery was uneventful, with the exception of chylous leakage for one week, which was relieved spontaneously. In addition, the present study presents a review of the previous literature concerning mesenteric lymphatic hygroma. Lymphatic hygromas are rare lymphatic vessel malformations, which are localized in areas of abnormal development of the lymphatic system. Commonly, the disease is diagnosed during childhood, is located in the head and neck region and occurs in one out of every 2,000–4,000 live births ,2. Only A 23-year-old male was admitted to Huashan Hospital Affiliated to Fudan University  with the chief complaint of progressive dull pain in the upper abdominal region that had been present for seven years. This symptom worsened when the patient was lying down, particularly in a lateral position, and was slightly relieved by a horizontal position. In addition, the patient suffered from a change in bowel habits with an irregular alternation between diarrhea and constipation. The patient did not receive any related medical examinations until seven days prior to admission. A computed tomography (CT) scan indicated a huge cystic mass in the midabdomen, with an estimated maximum diameter of >15 cm . The topA laparotomy was performed with a median abdominal incision. Intraoperative exploration revealed a huge mass within the small bowel mesentery extending into the mesentery of the left colon. The size of the mass was measured to be ~30×20×15 cm. The appearance of the mass was found to be yellowish, cystic and lobulated. The capsule was almost complete, with the exception of an unclear section of the Toldt’s fascia, which was confused with the Gerota’s fascia of the left kidney. Tight adhesion was found near to the descending section of the duodenum. Following entrance to the potential space of the mesentery by peritoneal incision lateral to the descending colon, the mass was easily separated by blunt dissection. The trunk of the superior mesenteric vessels was carefully protected, and sharp and blunt dissection were practiced to control the tight adhesion in the duodenal region. Visible tumor-related lymph vessels were most concentrated in the superficial layer covering the head of the pancreas and drained towards the retroperitoneum. These lymph vessels were ligated carefully. The mass was removed completely without tumor perforation and intra-abdominal pollution . The duoInvestigation of the resected tumor identified that each lobule was filled with a milky white fluidic content. Following fixation with formalin, the size of the tumor was reduced to 29.5×16.5×3.0 cm. Multicystic structures were found with morphological observation, and the diameter of the cysts ranged between 0.3 and 2 cm. Caseous material remained inside the cysts following drainage of the milky white fluid. Microscopically, the cystic walls of the tumor were comprised of flat endothelial and smooth muscle cells . Lipid dThe patient’s first bowel movement occurred three days after surgery. Drainage tube 1 (in the left paracolic gutter) was removed without any adverse events on day 6. A milky chylous fluid appeared in tube 2 (placed at the descending section of the duodenum), since a fluid diet had been administered on day 4. A chyle test of the drainage indicated a positive result that confirmed the diagnosis of chylous leakage. Since the volume of the drainage was 30–50 ml each day, which is clinically acceptable, no special treatment was provided and a semi-fluid diet was initiated on day 7. The patient recovered well post-operatively and the drainage was removed on day 14 when the drainage volume had decreased to 2–3 ml per day. The patient provided written informed consent.Lymphangiomas are divided into the following three major histological types: Simple or capillary hemangioma, cavernous hemangioma and lymphatic hygroma ,6. The cet al (The etiology and pathogenesis of lymphatic hygroma are poorly understood. It has been indicated that its possible etiologies are attributed to chronic inflammation and fibrosis, trauma, lymph node atrophy and lymphatic endothelial disturbances . Geneticet al  showed tet al (A pre-operative diagnosis of lymphatic hygroma is often difficult, since it is difficult to distinguish lymphatic hygroma from other cystic masses due to its rarity. The radiographic characterizations are profitable for arranging treatments and predicting lower-stage lesion treatment outcomes. The sonographic characteristic of a multilocular lesion filled with clear fluid matches the diagnosis of lymphatic hygroma . Lymphatet al  previouset al ,24.et al (et al (et al (Multiple staging systems have been developed for lymphatic hygromas. According to histological results, lymphatic hygromas are divided into three categories ,6. Howevet al and Hamoil (et al  demonstrl (et al  categoriThe goal of lymphatic hygroma treatment is the restoration or preservation of functional integrity and the patients’ quality of life. Lymphatic hygromas do not only compress and infiltrate adjacent structures, but occur with complications, including intracystic hemorrhage, cyst rupture, volvulus or infection . As a reet al (The standard treatment of lymphatic hygroma is surgical excision . A complet al  showed tThe current study presents the case of a 23-year-old male patient diagnosed with mesenteric lymphatic hygroma, with the chief complaint of progressive dull pain in the upper abdominal region that had been present for seven years. A correct diagnosis was possible following combined analysis of a CT imaging examination and routine abdominal ultrasound. Treatment by complete resection was successful and no severe complications occurred. Large mesenteric lymphatic hygromas continue to pose a therapeutic challenge. In the majority of cases, the treatment planning for adults is primarily determined by the presence of functional compromise or associated symptoms. The mainstay of lymphatic hygroma treatment is surgical resection ,33. Inco


A 10-year-old boy presented with left-sided nasal obstruction and epistaxis. Endoscopic evaluation revealed a polypoid mass in the vestibule arising from the lateral wall of the nasal cavity anteroinferior to the left inferior turbinate. Computed tomography (CT) scan showed a soft tissue opacity in the vestibule of the left nasal cavity. After the endoscopic excision of the mass, postoperative and histopathological analyses confirmed the diagnosis of an angiofibroma. Angiofibromas are highly vascular, nonencapsulated, and histologically benign but locally aggressive tumors which most commonly arise in the nasopharynx of adolescent males. It is a unique fibrovascular tumor with the specific histopathological finding of irregularly configured endothelial-lined vascular spaces embedded in a fibrous stroma. They usually arise from the posterolateral wall of the nasal cavity, where the sphenoidal process of the palatine bone meets the horizontal ala of the vomer and the pterygoid process. Angiofibromas constitute about 0.5% of all head and neck neoplasms . These tA 10-year-old boy came to the outpatient department with a four month history of progressive left-sided nasal obstruction and intermittent epistaxis. He had history of fever 5 days back. The patient had no other health problems. The coagulation status was normal. Anterior rhinoscopy revealed a fragile, lobular, red-grayish-colored, smooth, and polypoidal mass, arising anteroinferiorly to the left inferior turbinate filling the vestibule . PosteriComputed tomography (CT) scan of the nose and paranasal sinuses demonstrated a soft tissue opacity that filled the vestibule of the left nasal cavity, without any sinus invasion and bony destruction. On postcontrast study, the soft tissue is showing intense enhancement Figures .The mass was later excised under general anaesthesia. It was lobular, smooth, red-grayish, about 12 mm long tumour, and with the diameter up to 8 mm. This was followed by profuse bleeding which was controlled with anterior intranasal packing. The mass was sent for histopathological analysis. The antibiotic therapy was used for ten days. The anterior nasal pack was removed on the fifth postoperative day and endoscopic nasal finding was good.Histopathological examination of the excised masses (hematoxylin-eosin stain) showed a metaplastic squamous epithelium with the respiratory epithelium remnants on the tumor surface. Under the epithelium, we found many irregular blood vessels ranging from capillaries and sinusoids to large vessels, lined with one layer of flat endothelial cells lying in a fibrous stroma. Several fields of proliferative fibrosis at the sites of repetitive haemorrhages were seen . This suAngiofibromas of the head and neck are benign nonencapsulated lesions occurring predominantly in the nasopharynx . The tumThere are number of theories have been put forward to explain the etiopathogenesis of angiofibromas. They can be developmental, hormonal, and genetic, but none of them found general acceptance. Currently juvenile angiofibromas are believed to be as vascular malformations, arising from discontinuous vascular basal laminae, focal lack of pericytes, and pronounced irregularity of the smooth muscle layers . AngiofiAccording to Brunner, these tumors originate in the tissue of the anterior margin of the atlas at the lower surface of the sphenoid bone, which is called fascia basalis. During its development, this tissue extends up to the posterior part of the vomer and the ethmoid bone. We suggested that our patient's tumor had arisen from the periosteum on the anteroinferior end of inferior turbinate. The presence of this tumor on the anterior portion of the inferior turbinate indicated that the origin may be from ectopic tissues located further away to its usual place . Primary extranasopharyngeal angiofibromas have been reported sporadically in the literature. They most commonly originate from the maxillary sinus. Other rare sites reported are the ethmoid and sphenoid sinuses, nasal septum, middle turbinate, inferior turbinates, conjunctiva, molar and retromolar region, tonsil, and larynx , 5, 6. UThe most frequent symptoms of nasopharyngeal angiofibromas are unilateral nasal obstruction, epistaxis, facial deformities, and pain. Extranasopharyngeal angiofibromas symptoms depends on the site of their occurrence .The management angiofibromas includes preoperative radiological examination and biopsy . ComputeThe various modalities for the treatment of angiofibromas include surgery, hormonal therapy, radiation, and systemic chemotherapy . HoweverThe differential diagnosis includes fibrosed antrochoanal and ethmoidal polyp and other fibrovascular tumors, such as capillary hemangioma, hemangiopericytoma, and solitary fibrous tumor .Extranasopharyngeal angiofibroma arising from the nasal cavity is an extremely rare tumour. The exact cause is not known. It probably comes from an ectopic tissue. Radiological and endoscopic examination along with histopathological analysis is necessary for its diagnosis. Surgical excision of the mass is the treatment of choice.


Introduction. Peritoneal mesothelioma is a rare tumor, presenting difficulties in diagnosis and treatment. Peritoneum is the second most common area of the mesothelioma after pleura, and even synchronous pleural and peritoneal mesotheliomas are observed in 30–45% of all cases. The diagnosis may be difficult due to lack of specific symptoms and clinical findings. In addition, a delay in the diagnosis is not rare especially in the absence of previous asbestos exposure. Here we report two cases of malignant peritoneal mesotheliomas. The diagnostic and therapeutic approaches for these rare neoplasms are discussed. Case Presentation. The cases were two men (one aged 54 years old and the other 40 years old). Prolonged abdominal pain and swelling were the primary presentation symptoms and findings. The mesotheliomas were developed in the right upper quadrant of abdomen in both of the cases. Both cases were treated with surgical resection. Final diagnosis were possible with histological and immunohistochemical documentation of tumor characteristics, which were consistent with dictating a mesothelial origin. No history of asbestos exposure was reported. Conclusion. Peritoneal mesotheliomas are rare clinical entities. However, patients with prolonged abdominal pain and abdominal masses should be considered to have atypical pathologies such as peritoneal mesotheliomas. Malignant peritoneal mesothelioma is an uncommon disease and has a very poor prognosis with an average survival time between 5 and 12 months [Case 1: a 54-year-old male patient was admitted with complaints of shortness of breath simultaneous abdominal pain, stiffness, and swelling. The patient was referred to specialist pulmonologist. Thorax CT scan revealed the presence of common pleural effusion on the right side of the patient and changes in the lung fields adjacent to the effusion revealed the presence of passive atelectasis. The presence of collapse and consolidation was revealed in the right lateral segment lung. Thoracic surgery consultation was requested for the patient because of the right pleural effusion. Thoracentesis was performed to the patient by the thoracic surgeon. Cytological examination of the material was reported to be compatible with malignant epithelial tumor. However, distinction of mesothelioma and carcinomatous adenocarcinoma could not be made as a result of cytopathology. He had no known previous exposure to asbestos. In abdominal examination, an abdominal mass was palpated in the right upper quadrant. Abdominal CT was also performed to the patient because of prolonged abdominal pain. In abdominal CT imaging, suspected invasion of omentum has been found in hepatic flexure and right transvers colon . In addiIn the second case, a 40-year-old male patient was admitted with abdominal pain that has continued for 2 months and abdominal swelling in the right upper quadrant. There was a palpable mass in the right hypochondrium in the physical examination. In the size of 7 × 5 cm, mass originating from the gallbladder was detected in the abdominal CT . The decMesothelioma is defined as neoplasm arising from the mesothelial cells which line the serous cavities such as pleura and peritoneum. Pleural mesothelioma is common and well known. However, isolated peritoneal mesothelioma is rare and presence of mesothelioma in atypical locations such as tunica vaginalis of the testis has been reported , 3. The Patients with mesotheliomas do not present with distinctive symptoms and this causes difficulties in diagnosis and treatment. Two types of symptoms are generally reported in the patients with mesotheliomas: (1) abdominal pain, which is usually localized and related to a dominant tumor mass with little or no ascites and (2) ascites and abdominal distention without abdominal pain. Patients with mesotheliomas have been reported to generally present with one of these two types of symptoms and signs .Imaging is important in diagnosis, and ultrasonography and CT scan of the abdomen are useful. However, pathological examination of biopsy or resection material is essential for confirmation of the definitive diagnosis. Open or laparoscopic surgery may be used to biopsy or with respective purposes for the suspicious lesions. Even laparoscopy may be very necessary in the diagnosis of some rare cases with ascites, such as primary mesothelioma. These clinical entities are usually overlooked by other diagnostic modalities, such as ultrasound and CT or ascitic fluid cytology. Laparoscopy may document the presence of the tumor fluid. However, there is controversies such as the potential that laparoscopy can facilitate tumor dissemination to port sites .Prognosis is determined by the clinical presentation, the completeness of cytoreduction, and gender of the patient. It has been reported that women survive longer than men with this condition. Prognosis appears to be improved with the use of intraperitoneal chemotherapy. Over the past decade, the management of these patients has evolved similarly to ovarian cancer treatment. Currently, cytoreductive surgery, heated intraoperative intraperitoneal chemotherapy with cisplatin and doxorubicin, and early postoperative intraperitoneal paclitaxel are used. Adjuvant intraperitoneal paclitaxel and second-look cytoreduction are recommended after these perioperative treatments. This multimodality treatment approach with cytoreductive surgery and intraperitoneal chemotherapy has been reported to result in a median survival of 50 to 60 months , 5.These cases indicate the importance of considering the rare clinical conditions such as peritoneal mesotheliomas in the patients with common clinical problems such as abdominal pain, mass, and ascites. Peritoneal mesothelioma is an uncommon disease, but should be considered in people presenting with abdominal mass, prolonged abdominal pain, and ascites, especially in those where the initial diagnosis is not clear. A history of asbestos exposure may not be present. Radiological investigations may overlook the diagnosis. Thus, a thorough clinical evaluation and a comprehensive approach are essential in order to diagnose and properly treat the potential patients with peritoneal mesotheliomas.


Leiomyosarcomas are neoplasms of smooth muscles that most commonly arise from the uterus, gastrointestinal tract, or soft tissue. Primary pleural leiomyosarcoma is extremely rare. To the best of our knowledge, only nine cases have been published to date. Because of the rarity of pleural leiomyosarcoma and its similarity  to other pleural neoplasms, particularly sarcomatous mesothelioma, diagnosis is often difficult.A 58-year-old North African man was admitted with complaints of dyspnea and chest pain to our hospital. Chest computed tomography revealed right pleural effusion and pleural thickening. A transthoracic needle biopsy yielded a diagnosis of leiomyosarcoma, and tumor cells were strongly and uniformly positive for vimentin, a smooth muscle actin at immunohistochemical analysis. A general examination did not show any metastatic lesions in other areas. One month after diagnosis, the tumor grew rapidly, with pulmonary invasion, and therefore he was treated only by palliative care. He died from respiratory failure one month later. Because no organ of origin of the leiomyosarcoma, other than the pleura, was detected, this case was diagnosed as a primary pleural leiomyosarcoma.Although leiomyosarcoma originating from the pleura is rare, this entity is increasingly described. The purpose of presenting this case report is to raise awareness among clinicians to consider this clinical entity as a differential diagnosis when a pleural mass is identified. Leiomyosarcomas are cancers of smooth muscle cells that can arise from any location but occur most often in the uterus, retroperitoneum, or intra-abdominal region. Primary pleural leiomyosarcomas are extremely rare ,2. ThereTo definitively establish the pleura as the primary site for leiomyosarcoma, all other possible sites of origin within the body must be excluded. Therefore, diagnosis is difficult and management is complete resection of the tumor if feasible ,6,7. In 3 (23% neutrophils and 71% lymphocytes), total protein concentration was 32 g/dL , lactate dehydrogenase level was 460 IU/L, and glucose level was 110 mg/dL. The pH of the pleural fluid was 7.30. These findings were consistent with exudative pleural effusion. The results of pleural fluid cytology were negative for malignant cells. The pleural fluid was cultured for bacteria (aerobic and anaerobic), fungi, and mycobacteria, and the results were negative. During a clinical examination, the breath sounds were decreased on the right side. A chest radiograph showed the presence of an opaque right hemithorax, and the mediastinum was pushed toward the right , physical signs, and radiology ,6. On raExtrathoracic primary tumors should be excluded by physical examination and CT. Most pleural leiomyosarcomas are metastatic from other sites, including the gastrointestinal tract, uterus, retroperitoneum, and lung -4. So exOn reviewing the literature on pleural leiomyosarcoma, we found that most of the cases were diagnosed by surgical biopsy at either thoracoscopy or thoracotomy ,3. OccasMicroscopically, leiomyosarcomas are characterized by malignant spindle cells with cigar-shaped nuclei and scant fibrillary cytoplasm. Variable mitotic activity is observed ,4,5. HowTherefore, the use of an antibody panel is recommended in order to confirm the diagnosis of pleural leiomyosarcoma and to rule out a commonly considered differential diagnosis. Immunohistochemically, leiomyosarcomas are nearly uniformly positive for smooth muscle actin, desmin, and vimentin and negative for calretinin, carcinoembryonic antigen, cytokeratin, leukocyte common antigen, neuroendocrine filament, CD-117, and S-100 protein ,5. In ouHistopathology and IHC staining have been supplemented by cytogenetic analyses, which can confirm the diagnosis of leiomyosarcoma . CytogenThe optimal treatment for pleural leiomyosarcoma has not been defined. Surgery is the mainstay of therapy for pleural sarcoma in limited disease, and even in some cases having local spread, resection was feasible ,6,7,9. MAs with leiomyosarcomas of other soft tissue sites, histological grade and clinical stage of the disease are the best prognostic factors. Patients with unresectable sarcoma or metastatic disease are treated with chemotherapy . LeiomyoThe addition of our case to the literature offers new clinicopathological data useful for better defining the diagnosis and biological behavior of pleural leiomyosarcoma. The purpose of presenting this case report is not only to report an uncommon pleural tumor but also to raise awareness among clinicians adding this clinical entity as a differential diagnosis when a pleural mass is identified.CT: computed tomography; IHC: immunohistochemistry.Written informed consent was obtained from the patient's next of kin for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.The authors declare that they have no competing interests.GR was involved in the analysis of the data and the literature search and wrote the manuscript. SR helped with the patient management and revision of the manuscript. H Mouzount and MA helped with the literature research. H Mrabti, SK, and FE helped with modifications and revision of the manuscript. AJ performed the histological examination. HE approved the treatment and analyzed the literature data. All authors read and approved the final manuscript.


Giant cystic lymphangioma is an uncommon mesenteric tumor which is usually reported in children. In this paper, we describe 3 cases, that was admitted in our department, two with abdominal distension, pain, and an abdominopelvic mass; the other present an acute abdomen. Preoperative studies including abdominal ultrasonography and computed tomography failed to determine the cause of the pain for the female patients. The laparotomy found a giant cystic tumor of the small bowel mesentery. The histological study showed a tumor that was diagnosed as a cystic lymphangioma. Based on those three cases a review of the literature is suggested. Cystic lymphangioma is an uncommon mesenteric tumor which is usually reported in children, it is a benign, slow growing tumor derived from of the lymphatic vessels; it is rarely found as intra-abdominal masses when occurring in the abdomen –3. The aA 12 year old female was referred to our hospital for a clinical profile characterized by nausea, vomiting and abdominal ballottement during eight previous days. This child has had a history of constipation, and the intermittent medical treatment administered for 2 years has failed. The examination has found a cachectic child with a very swollen abdomen, and a palpable abdominopelvic mass. The biological assessments investigated the blood cell count, the alpha-fetoprotein and the beta human chorionic gonadotrophin, and were found normal. The full abdominal X-ray showed a displaced bowel loop by the mass of soft tissue . The ult3. The ultrasonography revealed an abdominal multiloculated septated cystic mass measuring 14 cm. The CT-scan demonstrated a septated cystic mass of 17×11×4 cm. The patient was underwent surgery. A cystic mass of the small bowel mesentery, containing a serosanguinous fluid representing cyst hemorrhage (A 10 years old boy was admitted in the emergency for an acute abdomen in the last two days, with fever. The physical examination showed a very painful abdomen, with tenderness and muscle guarding in the left side of the abdomen. The blood cell count found a hyperleucocytosis 21000 E/mmmorrhage  was discmorrhage , and an An 11 year old girl was admitted to our department for abdominal pain, and increase volume during 7 months. She also has constipation. The examination has found a cachectic child with a palpable abdomino-pelvic mass. The biological assessments investigated the blood cell count, the alpha-fetoprotein and the beta human chorionic gonadotrophin, and were found normal. The full abdominal X-ray showed a displaced bowel loop by the mass of soft tissue. The ultrasonography revealed an abdominal cystic mass measuring 20 cm. The CT-scan demonstrated a cystic mass measuring 25/15/10, without visualization of the ovaries. The surgery was performed, and a huge mesenteric tumor containing 4 litters of clear fluid was discovered, the involved bowel and the mesenteric tumor were resected. A primary anastomosis was performed, and the diagnosis of the cystic lymphangioma was revealed by the histological study of the surgical piece. The surgical follow was simple, and the clinical evolution is simple within of 2 years recession.Cystic cavernous lymphangiomas are uncommon benign slow growing tumor derived from the lymphatic vessels . It etioThe final diagnosis is always based on the histological findings, since this examination shows extensive myofibroblastic areas and objectifies the lymphatic character of the lesion , 6.Where the underlying lesion could be discerned, the tumor was composed of cystically dilated lymphatic spaces, which were partially invested by a layer of smooth muscle and were associated to with occasional lymphoid aggregates. The lymphatic spaces contained either clear fluid or large numbers of foamy macrophages. The lymphatic endothelial cells lining the cystic spaces were generally attenuated without any cytological atypism , 7. The The cystic mesenteric lymphangioma is rare benign tumor. The clinical symptomatology is polymorphic and not specific. The diagnosis is suggested by the imaging modalities, but still requiring an histopathologic confirmation. The treatment of choice is surgical and consists of a full resection of the lesion. The intracystic sclerotherapy could be used for symptomatic tumors associating diffuse mesenteric lesion which are not resecable without extensive intestinal sacrifice.


Incipient odontogenic tumors often display intermediate features between two or more lesions leading to diagnosis dilemma. We report the onset of a peripheral ameloblastoma fortuitously found subjacent to a nondysplastic leukoplakia in the region of missing 38 teeth of a 52-year-old man. The aim of this paper is the discussion of the microscopical features observed in the case reported which allowed the establishment of the final diagnosis of an early peripheral ameloblastoma. The odontogenesis is a set of complex interactions between the oral epithelium and the ectomesenchyme which culminates with the formation of the tooth. After this process, residual odontogenic epithelial cells remain dormant in the tissue of the jaws indefinitely and may proliferate later, generating cysts and tumors . This prTherefore, the aim of this work is to present the onset of a peripheral ameloblastoma fortuitously found subjacent to a nondysplastic leukoplakia, discussing the microscopical findings which led us to its final diagnosis.A 52-year-old man sought for treatment of a white plaque in the gingiva. The lesion was asymptomatic and had been noticed by the patient two years before the consultation. He reported daily tobacco and alcohol consumption. Oral examination revealed an 8 mm diameter and ill-defined white plaque on the edentulous alveolar ridge, region corresponding to the 38 tooth. Radiographs showed normal bone appearance . The cliUnder local anaesthesia, the white plaque was excised. Microscopically, the oral squamous epithelium was hyperplastic and hyperkeratotic but without dysplastic alterations . A discrThe odontogenesis is an intricate process by which the formation of the tooth occurs. After its conclusion, residual epithelial cells remain scattered in the soft tissue adjacent to the tooth. In some cases, it stays dormant indefinitely but in others, it may proliferate and raise odontogenic cysts or tumors . NeverthThe presented case illustrates an uncommon occurrence: the onset of an odontogenic tumor. It is impossible to anticipate the development of this accidentally found tumor supposing no concomitant appearance of this with the leukoplakia, which motivated the patient to seek for treatment. However, details concerning the microscopical characteristics and radiographic images observed in the case allow us to reach some interesting conclusions. Vickers and Gorlin criteria, which is still largely utilized. Vickers and Gorlin criteria state that nuclear hyperchromatism, nuclear palisading with reverse polarization, and cytoplasmic vacuolization with intercellular spacing, when observed together, constitute histopathologic evidence of neoplasia [Vickers and Gorlin criteria to diagnosis of ameloblastoma, as reverse polarization could not been seen. However, it does not necessarily mean that the peripheral ameloblastoma is discarded from the list. An elegant discerning review of some controversial aspects of ameloblastoma performed by Gardner [Vickers and Gorlin criteria. Therefore, the cytoplasmic vacuolation and reverse polarity may not be present but the basal cells should be palisaded, columnar, and hyperchromatic [Vickers and Gorlin criteria were originally described to help diagnose early ameloblastomas in cysts, they are useful when examining other lesions that are suspected of being ameloblastomas [Vickers and Gorlin criteria are indeed helpful for differential diagnosis, but not enough to establish the diagnosis of ameloblastomas in very incipient lesions.The peripheral ameloblastoma is the extraosseous counterpart of the conventional ameloblastoma. Therefore, they share the same microscopical features defined by the World Health Organization , as folleoplasia . Our cas Gardner  drew atthromatic , as was hromatic  when he lastomas . In otheFurthermore, the bud projections mimicking the normal embryologic development of the tooth bud at the stage of enamel matrix production  and comm


Dermoid sinus, a congenital malformation of neural tube development, has been reported in humans and several animal species including dogs. It is typically found in the dorsal midline and commonly occurs in the Rhodesian Ridgeback breed. A case of multiple dermoid sinuses in the fronto-occipital region is described. An 11-month-old, intact female Saint Bernard dog was presented with a 2 day history of discharge from a large irregular subcutaneous mass in the fronto-occipital region. The dog was otherwise healthy. The dog had two circular skin lesions (approximately 4 × 4 and 4 × 2 cm diameter) surrounded by multiple irregular elevated masses. The masses had multiple small openings on the skin surface with tufts of hair protruding from the apertures. The masses were surgically removed, and the diagnosis of multiple dermoid sinuses was confirmed by histological examination. Histopathological examination showed multiple, variably sized, spherical to tubular cysts expanding the dermis and subcutis. Cysts were filled with hair shafts and lamellar keratin and were lined by a stratified squamous epithelium. Sebaceous and apocrine gland adnexal structures were also observed. To the best of our knowledge, this is the first reported case of multiple dermoid sinuses of two different types in the head of a Saint Bernard dog. Dermoid sinus (DS) is a congenital malformation caused by an incomplete separation of the skin and neural tube during embryonic development . This ab3/μL, normal range 5 to 13 × 103/μL) and biochemistry was unremarkable. Hair was clipped from the area, revealing abnormal skin which covered the area between the right supraorbital rim, the base of the right ear and nape, extending partially into the left fronto-occipital portion of the skull  at a dose of 5 mg/kg once daily per os starting 3 days before surgical removal of the abnormal tissue. General anaesthesia with the dog positioned in ventral recumbency were induced and the area aseptically prepared and draped. An incision allowing wide exposure of the tissue and blunt dissection was made. After complete excision of the lesion, two Penrose drains were placed and the wound was sutured. A small part of the incision overlying the right ear had to be left to heal by secondary intention to avoid excessive traction of sutures. Postoperative analgesia and antibiotic treatment were administered and a light bandage was applied for the first two weeks.An 11-month-old, 42 kg, intact female Saint Bernard dog was presented with a 2 day history of discharge from a large, irregular swelling in the fronto-occipital region. The owner reported that the dog had scratched the head on trees almost daily since it was a puppy. Palpation of the head elicited a marked pain reaction, but no other clinical signs were observed. The discharge was submitted for bacterial culture and antimicrobial sensitivity test, and a growth of coagulase positive staphylococci was obtained. Routine haematology revealed only a mild leucocytosis  in dogs ,26 and nHistopathology was necessary to confirm the clinical impression . The mosThe authors declare that they have no competing interests.AP and MBe conceived of the study and participated in its design and coordination and helped to draft the manuscript. MBu did the clinical investigation. SF and RR performed the histopathologic examination and interpretation. II made an intellectual contribution and reviewed the paper. RB has given final approval of the version to be published. All authors read and approved the final manuscript.


Prune belly syndrome is a rare congenital disorder of the urinary system, characterized by a triad of abnormalities. The aetiology is not known. Many infants are either stillborn or die within the first few weeks of life from severe lung or kidney problems, or a combination of congenital anomalies. Prune belly syndrome is a congenital abnormality of unknown aetiology with characteristic features: deficient development of abdominal muscles that causes the skin of the abdomen to wrinkle like a prune, cryptorchidism, abnormalities of the urinary tract. It is associated with other congenital anomalies and most commonly clinically presented with stillborn. The case is reported for its rare congenital abnormality.A 22-Year-old female Gravida II, Para I Live I with 6 months of pregnancy came to hospital with decreased foetal movements for 2 days. There was no history of bleeding or draining per vagina, and no history of hypertension, diabetes, tuberculosis, bronchial asthma, and epilepsy. Also there was no history of consanguinity. Her first pregnancy was full term, normal delivery.  Per abdominal examination showed 34 wks of gestation with breech presentation. Foetal heart sounds present. Ultrsonography were revealed a single viable foetus with breech presentation. Foetal head deformed. There was a well-circumscribed cystic mass in the foetal abdomen measuring 15.4 × 15.4 cm. Other investigations were within normal limits.Patient delivered a single dead foetus weighing 2.4 kg by breech presentation after aspiration of 700 mL of fluid from foetal abdomen on induction by prostaglandins. Placenta expelled out in toto. Dead foetus was subjected to pathological examination.Foetus of 2.4 kg weight showed potters facies consisting of ocular hypertelorism, low-set ears, receding chin, and flattening of the nose. There were absence of nipples, cystic dilatation of abdomen with deficient development of abdominal muscles, and defective insertion of umbilical cord in the anterior abdomen . The lowOn Opening the abdomen bladder measured 12 cm in diameter and was filled with straw-colored fluid. On cut section, the bladder cavity is abnormally dilated with variable thickness . Both in The lungs are grossly normal number of lobes. Heart is normal and no cardiac anomalies. Were found skull and thoracic organs were normal.Sections from the anterior abdominal wall show normal skin and absence of skeletal muscle . Both thPrune belly syndrome is a rare congenital disorder affecting about 1 in 30,000 births . In receThe pathogenesis of prune belly syndrome is not clearly known. The mesodermal defect theory suggests that a defect exists in the mesoderm of the anterior abdominal wall and urinary tract. Between 6 and 10 weeks of gestation, aberrant development of the derivatives of the first lumbar myotome leads to a patchy muscular deficiency or hypoplasia of the abdominal wall as well as to urinary tract abnormalities . The higAlthough many ethical questions are raised when innovative fetal therapy is discussed, the insults that result from urinary tract obstruction often lead to stillbirth or neonatal death. Many infants are either stillborn or die within the first few weeks of life from severe lung or kidney problems, or a combination of congenital anomalies. There are cases of prune belly syndrome who survived into adult life after abdominal reconstruction and urinary tract repair . There i


We report the case of a 61-year-old man with supratentorial extraventricular anaplastic ependymoma who presented with repeated intratumoral hemorrhage. The patient was admitted with headache. Computed tomography and magnetic resonance imaging showed an enhancing mass with intratumoral hemorrhage in the right temporal lobe. Gross total resection was performed. The tumor was well demarcated from the brain tissue, and showed no continuity with the ventricular system. Histopathological examination revealed the features of anaplastic ependymoma. Therefore, additional radiation therapy and adjuvant chemotherapy were administered. Ten months later, the tumor recurred with hemorrhage in the spinal canal. This case showed rapid malignant progression and repeated intratumoral hemorrhage within a short period of time, both of which are characteristics of anaplastic ependymomas. Close observation of the central nervous system and adjuvant radiotherapy are mandatory, even if the ependymoma presents with repeated intratumoral hemorrhage. Ependymomas are primary neoplasms of the central nervous system (CNS) that account for about 3–5 % of all adult intracranial gliomas , 2. EpenA 61-year-old man presented with severe headache on November 30, 2008. A more detailed history revealed that he had been suffering from severe headache of acute onset from 3 days beforehand. Head computed tomography (CT) demonstrated a high-density lesion in the right temporal lobe . After surgery, focal radiation therapy (60 Gy) and chemotherapy (temozolomide) were administered. The patient showed no neurological deficit after the treatment, and was discharged.The patient was admitted again with back pain and gait disturbance on November 8, 2009. MRI of the thoracic spine demonstrated a tumor with hematoma in the spinal canal Fig. . A seconEpendymomas usually arise from the cells lining the ventricular system and central canal of the spinal cord –6. The cThe case we have reported here presented with at least 5 episodes of intratumoral hemorrhage over a period of 40 days. Only one previously reported case of supratentorial extraventricular ependymoma presented with repeated intratumoral hemorrhage . In thatIn our present case, the tumor recurred in the spine between the lower thoracic and upper lumbar spinal cord, showing both intratumoral and extratumoral hemorrhage. According to the previous literature, anaplastic ependymomas are characterized by a higher proliferative rate and a greater tendency to disseminate into the cerebrospinal fluid, causing drop metastases. Saito et al.  mentioneIn conclusion, meticulous MRI follow-up of the CNS is mandatory in adult patients with intracranial anaplastic ependymomas, even after gross total removal of the tumor.Thus, our experience of this case indicates that supratentorial extraventricular ependymoma with repeated intratumoral hemorrhage should lead to a suspicion of an anaplastic tumor histology. Neurosurgeons should not hesitate to perform a radical initial surgery in such cases. Even after gross total removal of the tumor, adjuvant radiotherapy and close MRI follow-up of the central nervous system are mandatory.


White sponge nevus (WSN) is a rare hereditary dyskeratotic hyperplasia of mucous membranes. It is an autosomal dominant disorder with variable penetrance. We report a case of WSN in a healthy 21-year-old male with no history of familial involvement. A white smooth plaque with no erythema or other structural abnormalities was observed, which confirmed the diagnosis of WSN histopathologically. This condition is attributed to a defect in the normal keratinization .11 This keratotic mucosal alteration may be seen on vaginal and rectal mucosa but the great majority of cases involve the oral mucosa.1White sponge nevus (WSN) is a relatively rare cutaneous and mucosal lesion.12A search of dermatological and gynecological literature revealed very little about WSN in Iran. More information was available about this lesion in the oral cavity, which was retrieved from the dermatological and dental literature.14Lesions of WSN usually appear at birth or in early childhood, but sometimes the condition develops during adolescence. The lesions consist of symmetric, thickened, white, corrugated or velvety, diffuse plaques. Buccal mucosa is the most frequently affected, followed by the labial and gingival mucosa, and the floor of the mouth. Extra-oral mucosal sites, such as the nasal, esophageal, laryngeal, and anogenital mucosa, appear to be less commonly affected. Patients are usually asymptomatic. The white color does not diminish when the tissue is stretched in any mucosal site.5The recognition of this disorder is important in that it must be differentiated from other congenital or familial disorders of more widespread clinical significance. The clinical appearance is so distinctive that biopsy is usually unnecessary. The microscopic features of WSN are characteristic but not necessarily pathognomonic. Prominent hyperparakeratosis and marked acanthosis with clearing of the cytoplasm of the cells in the spinous layer are common features; however, similar microscopic findings may be associated with leukoedema and hereditary benign intraepithelial dyskeratosis. In some instances an eosinophilic condensation is noted in the perinuclear region of the cells in the superficial layers of the epithelium, a feature that is unique to WSN.In this paper, a case of WSN in a healthy white male with no history of familial involvement is described.The patient was a 21-year-old Iranian male referred to the Department of Oral Medicine at Tabriz University of Medical Sciences Faculty of Dentistry for diagnosis and management of a “white, itchy spot” on the buccal mucosa. White bilateral lesion in oral mucosa was the chief compliant of the patient. The patient complained of a white lesion which was present since birth.The patient’s general health was reportedly good. The patient denied presence of a similar condition in immediate family members or any similar lesions elsewhere on his body.In clinical examination, there were bilateral, symmetrical white plaques and patches on the buccal and labial mucosa, which could not be removed. The plaIn histopathologic evaluation, oral mucosa covered by stratified squamous epithelium revealed prominent hyperparakeratosis and marked acanthosis with clearing of the cytoplasm of cells in the spinous layer. In addition, eosinophilic condensation was noted in the perinuclear region of the cells in superficial layers. UnderlyBased on clinical data and histopathologic findings, the lesion was consistent with white sponge nevus. Because of benign nature of this lesion, no treatment is necessary and only biopsy and correct diagnosis is necessary to rule out other similar lesions. Six-month follow-up was recommended.5 WSN is an autosomal dominant disorder with variable penetrance and hence familial reports are not very common, similar to the present case. WSN has been listed as a rare disorder, with a prevalence rate below 1 in 200,000.13 Most commonly, lesions appear at birth or in early childhood. Neither gender nor racial predilection exists.14 A case of WSN, in which human papilloma virus type 16 was demonstrated, has been reported in the literature.4 Many different types of white lesions can occur in the oral mucosa and the appearance of WSN is not pathognomonic. There is a need for precise identification through prompt histopathologic examination to differentiate this condition from more serious, potentially premalignant lesions as well as other genodermatoses such as hereditary benign epithelial dyskeratosis, lichen planus, lichenoid drug reaction, lupus erythematosus, cheek chewing and possibly candidiasis. While some of these lesions are benign, others are pre-malignant or manifestations of some systemic diseases. Therefore, early diagnosis of this benign lesion isimportant,3 and often, these lesions need different treatment plans.21 In addition, these lesions reveal different epidemiological patterns and involve different societies and races. In Northwest Iran, this condition seems to be rare and no other similar documented cases are available. In this case, none of the family members had similar lesions. This lesion appeared early in life without any reported changes throughout the patient’s life, but diffuse spreading of the lesion seems to be an alarming factor. Biopsy in such cases is necessary for treatment planning and ruling out of other lesions.WSN is a rare hereditary dyskeratotic hyperplasia of mucous membranes. This entity is also known by other names, such as Cannon's disease, familial white folded hypertrophy of the mucous membranes, hereditary leukokeratosis, white gingivostomatitis, and exfoliative leukoedema.


Adenoid cystic carcinoma (ACC) is a relatively rare epithelial tumor of the salivary glands that accounts for approximately 5 to 10% of all salivary gland neoplasms. The typical clinical and pathological findings of this tumor include slow indolent growth, common local recurrence, and late distant metastasis to lung, brain, bone, liver, thyroid, and spleen. We report a 52-year-old female patient who presented a tongue ACC, 27 months after successful pulmonary ACC resection. Adenoid cystic carcinoma (ACC) is a malignant neoplasm that usually arises in the salivary glands , but canA 52-year-old woman was referred to Yeouido St. Mary’s Hospital, Republic of Korea for evaluation of an incidentally found right lower lobe lung mass. The patient had a history of hypertension and denied recent weight loss or smoking. The patient’s initial laboratory findings were unremarkable, and the results of a pulmonary function test were normal. A chest computed tomography (CT) scan revealed a relatively well-circumscribed and enhanced mass involving the visceral pleura in the right lower lobe, and no mediastinal lymphadenopathy Figure . The masDuring follow-up, the patient was diagnosed and treated for transitional cell cancer of the bladder. Recurrence of the bladder cancer was suspected at 27 months after the pulmonary operation, and a whole-body PET scan showed an enlarged and increased uptake pattern of both parotid nodules without recurrence in the lung Figure . The blaWe represent a case with the following unusual manifestations of ACC: 1) the initial presentation was a solitary peripheral lung mass; 2) the primary site of ACC was the tongue; and 3) the primary lesion was found 27 months after successful treatment of the metastatic lesion.ACC constitutes approximately 5 to 10% of all salivary gland tumors. It is particularly prevalent in the palate, but also in the submandibular and parotid glands, and the tongue . AlthougIn the lung, salivary gland-type tumors can occur as either primary tumors or metastatic tumors arising in the salivary glands. Most primary pulmonary ACCs arise in the submucosal glands of the trachea and main bronchus, and approximately 10% of ACCs are located peripherally. Multiple lesions usually indicate a pulmonary metastasis, while a solitary lesion may be an indication for metastasectomy in ACC of the salivary gland. Distinguishing primary from metastatic lung ACC based on histology is difficult , and hisTongue ACCs are rarely reported , and a rWhile we could not confirm by pathologic examination whether the lung lesion was a primary tumor or a metastasis, our patient was diagnosed with a primary peripheral pulmonary ACC after the initial surgery because no evidence of a tumor origin was found on whole-body PET scan and the otolaryngologic examination. We were surprised to observe the pathologic findings of tongue ACC, the cribriform and tubular pattern of which was identical to that observed in the specimen of pulmonary cancer removed 27 months earlier. There are three potential relationships between pulmonary ACC and tongue ACC: 1) subclinical tongue ACC with metastatic pulmonary ACC 27 months previously; 2) metastatic tongue ACC; and 3) primary pulmonary ACC followed by primary tongue ACC.Metastatic ACC of the salivary gland or tongue has not been reported previously. However, slow indolent growth and late distant metastasis are common findings of ACC in the salivary gland, and pulmonary metastasis is also frequent in tongue ACC . IdenticWe have presented herein a case of ACC with unusual clinical behaviors that remain to be fully defined. Although ACC is characteristically slow growing and associated with late distant metastasis, our case showed the reverse presentation pattern: early recognition of a metastasis and late presentation of the primary site. Therefore, peripheral pulmonary ACC should be carefully followed and considered in relation to head and neck ACC, even after successful management.Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.18F-FDG: 18F-Fluorodeoxyglucose; ACC: Adenoid cystic carcinoma; CT: Computed tomography; H &; E: Hematoxylin and eosin; PET: Positron emission tomography.The authors declare that they have no competing interests.YJS participated in the preparation of the manuscript, literature search, and drafted the manuscript. SBS provided assistance for the operation. SWM participated in the study design and coordination. TJK diagnosed the pathology of this case. CBP edited the manuscript for its scientific content and conceived of the study. All authors read and approved the final manuscript.


Pigmented villonodular synovitis is a rare, benign, but potentially locally aggressive disease that should be considered in younger patients who present with monoarticular joint symptoms and pathology. We present the case of a 33-year-old woman with a mass arising from her right hip joint that was examined using a multimodal radiological approach. Because her clinical presentation mimicked that of synovial osteochondromatosis of the hip, surgical dislocation was performed. Histopathological examination of the resected specimen confirmed the diagnosis of localized pigmented villonodular synovitis, with the mass consisting of proliferation of fibrohistiocytic cells, abundant hemosiderin, foamy histiocytes, and occasional giant cells. Because of the presence of tumor necrosis, we hypothesize that torsion of the tumor pedicle was the cause of acute presentation. Locace width –5. PVNS ce width . PVNS ofce width , 13. Her3, arising from the anteromedial synovium . Although the severe pain disappeared about 10 days after onset and only vague discomfort and pain in a specific posture had remained, she was referred to our hospital for a surgical treatment at 3 weeks after pain onset. The range of motion in the affected hip was 130° in flexion, 15° in extension, 30° in abduction, 20° in adduction, 45° in external rotation, and 15° in internal rotation. Findings on the Patrick test were positive, the anterior impingement sign was present, and she had mild tenderness of the Scarpa triangle. Preoperative blood tests revealed no evidence of diabetes, rheumatoid arthritis, infection, or abnormality in renal or liver function. Although initial radiographs, obtained 1 month after pain onset, revealed no significant findings, magnetic resonance images showed marginal enhancement of a mass located inferior to the hip joint . We perfsynovium . We assusynovium . Synovecsynovium .PVNS is a rare, benign, proliferative condition of the synovium involving a joint, bursa, or tendon sheath. Its etiology is unknown, although a neoplastic or inflammatory origin has been suggested , 15. It


Chondroid syringoma, or pleomorphic adenoma of the skin, is a rare, benign skin adnexal tumor. It is usually exhibited as a slowly growing intradermal or subcutaneous nodule, typically located in the head and neck region. Because of the unremarkable clinical symptomatology of this rare tumor, the diagnosis is exclusively made retrospectively based on histological confirmation of the surgically excised tumor. We present a rare case of a chondroid syringoma located in the left medial canthus of a 58-year-old man. The patient had no symptoms and decided to excise it for cosmetic reasons only. Local excision with a macroscopic wide cuff of normal tissue was done, without destroying the aesthetic and functional structures, since the defect was restored by a finger flap. One year postoperatively, the patient has remained disease-free. Chondroid syringoma usually appears in the face but the location in the medial canthus is not mentioned in the literature for the last twenty years. The chondroid syringoma, or mixed tumor of the skin, is a benign neoplasm of sweat gland origin and a rare clinical entity. Histologically, it could be described as a neoplasm consisting of epithelial and myoepithelial cell formations within a myxomatous, pseudochondromatous, or hyaline stroma that contains mucous secretions . It is uWe report a very rare case of chondroid syringoma located in the left medial canthus. This location has not been mentioned in the literature for the last twenty years.A 53-year-old male patient consulted our oral and maxillofacial surgery outpatient clinic for an asymptomatic exophytic lesion in the left medial canthus. The patient requested surgery for cosmetic reasons.According to the patient the lesion had first appeared six months before the clinical examination and it was growing very slowly. He did not complain of any symptoms except for the cosmetic problems.On examination the lesion diameter was 1 cm and located in his left medial canthus, without limiting his sight .Under local infiltration anesthesia the lesion was excised and sent for histopathological examination. Reconstruction was carried out with a classic glabellar flap .Healing was uneventful and the patient was satisfied with the cosmetic result. One year later there is no recurrence.The histological examination revealed a circumscribed, multinodular lesion , locatedNo atypia or unusual mitotic activity was observed. The diagnosis of pleomorphic adenoma (mixed tumor) was performed.Sweat gland tumors in the head and neck are uncommon. Chondroid syringoma, which was first described by Hirsch and Helwig in 1961 , is a raWe report a rare case of chondroid syringoma located in medial canthus, which has not been mentioned in the literature .The lesion is a slow-growing, painless, intradermal, or subcutaneous nodule and may be attached to the overlying skin with no fixation to deeper structures . The diaTreatment of choice is local surgical excision with a cuff of normal tissue, in order to prevent recurrence. If the tumor has been completely excised and is benign, long-term followup is not indicated. Followup is indicated only if the excision is incomplete or if there is indication of malignant change, which is rare but has been reported in the literature .Chondroid syringoma is an uncommon mixed tumor of the skin, which usually appears on the face. Maxillofacial surgeons must be aware of these tumors, as they can easily be misdiagnosed, because of the rare occurrence of them. However, it should be included in the differential diagnosis of any slowly growing nodule in the skin of the face. The treatment of choice is local excision. Recurrence is attributed to incomplete excision or malignant transformation, which, although being rare, has been reported.


Carcinoma of unknown primary site (CUP) is said to account for approximately 3 to 5% of all carcinomas. However, an isolated lesion in the abdominal cavity is rare, and there are no reports describing associated abscess formation.A 76-year-old woman had consulted a previous physician complaining of fever and right lower quadrant abdominal pain. Enhanced computed tomography (CT) showed an abscess formation around the cecum. She was treated conservatively with antibiotics, but the symptoms relapsed and she consulted our hospital. Enhanced CT showed a persistent abscess, a tumorous lesion in the mesentery and right hydronephrosis. Because malignancy could not be ruled out, surgical treatment was selected. At laparotomy, encapsulated abscesses were found on the mesenteric side and outside of the ileocecal region. When we raised the ileocecal region, a tumor was found to be fixed to the right ureter, and there was leakage of white, solid tumor content. This tumor content was submitted to intraoperative frozen section diagnosis which revealed a carcinoma. Ileocecal resection with D3 lymph node dissection and retroperitoneal tumor resection was thus performed. There were no abnormal findings in the uterus and adnexa, nor any evidence of peritoneal dissemination. We regarded this case as an incomplete resection and chemotherapy with paclitaxel and carboplatin was administered. The patient has remained alive and disease-free for almost one year since the primary operation.We described a case with mesenteric CUP discovered during surgery for an intra-abdominal abscess. It is necessary to pay attention to treatment-resistant intraperitoneal abscesses as they may accompany a tumor. Carcinoma of unknown primary site (CUP) is defined as the presence of metastatic cancer in the absence of an identifiable primary tumor site, even after thorough clinical examination and diagnostic studies. CUP accounts for approximately 3 to 5% of all malignancies, and is thus not particularly rare ,2. HowevThe patient was a 76-year-old woman who had a history of surgery for papillary thyroid cancer and cesarean section with uterus bicornis.She had consulted a previous physician complaining of fever and right lower quadrant abdominal pain. A marked inflammatory reaction was observed and enhanced computed tomography (CT) showed abscess formation around the cecum. An intra-abdominal abscess was diagnosed and the patient was treated conservatively with antibiotics, but her symptoms relapsed after discharge and she was referred to our hospital. The inflammatory reaction showed exacerbation and cancer antigen 125 (CA125) was mildly elevated (78 U/mL). Enhanced CT was performed again and showed a persistent abscess, a tumorous lesion in the mesentery and right hydronephrosis  and carboplatin  were administered at intervals of four weeks. The patient has remained well and disease-free for almost one year, to date, since the primary operation.CUP accounts for approximately 3 to 5% of all malignancies. Finding CUP as an isolated lesion in the abdominal cavity is rare and there are no reports, to our knowledge, of cases with abscess formation. This is thus the first report of CUP discovered during surgery for an intraperitoneal abscess.Histopathological examination, especially the immunohistochemical approach, is important for identifying the primary lesion in patients with CUP . In our Efforts were made to identify the primary tumor. The gastrointestinal tract was negative because CDX-2 was negative. The patient had a past history of papillary thyroid cancer but TTF-1 was negative and the nuclear findings were also inconsistent with thyroid cancer recurrence. Furthermore, the possibility of primary ovarian cancer was considered based on the CK7 positive, CK20 negative, calretinin negative, WT-1 positive, CEA nonspecific and ER nonspecific findings. However, intraoperative findings and postoperative gynecological examination, transvaginal US, and PET revealed no abnormalities and there were no findings indicating a primary ovarian tumor.CUPs are a heterogeneous group of malignant neoplasms with different biological characteristics. Our patient’s age and pelvic tumor with an increased CA125 value suggested so-called ‘serous papillary peritoneal carcinomatosis’ . HoweverIn addition, abscess formation was observed in this case. The tumor was in contact with the gastrointestinal tract, but did not penetrate the digestive tract. Culture of the pus yielded no infectious organisms. For these reasons, it was suggested that this tumor was not gastrointestinal in origin and that the abscesses had formed due to necrosis of the tumor. From the location of the abscesses, cecal diverticulitis had been suspected by the previous physician, and conservative treatment with antibiotics had been selected. However, the abscesses were unaffected by this treatment. When she consulted our department, re-examination by CT raised suspicion of a tumorous lesion and surgical management was chosen, finally providing a definitive diagnosis. It is necessary to pay attention to treatment-resistant intraperitoneal abscesses as they may accompany a tumor.With CUP, as its name suggests, a ‘metastatic’ carcinoma with an unknown primary site, the prognosis is generally poor and chemotherapy has been the basis of treatment. Platinum-based or platinum-taxane combination chemotherapy is common -6. DepenWe have presented a case with mesenteric poorly differentiated carcinoma of unknown primary site with abscess formation. It is necessary to pay attention to treatment-resistant intraperitoneal abscesses because of their possible association with malignant tumors.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.AB: Alcian blue; CA125: Cancer antigen 125; CBDCA: Carboplatin; CDX2: Caudal type homeobox 2; CEA: Carcinoembryonic antigen; CK: Cytokeratin; CT: Computed tomography; CUP: Carcinoma of unknown primary site; ER: Estrogen receptor; GCDFP-15: Gross cystic disease fluid protein-15; HE: Hematoxylin-eosin; PTX: Paclitaxel; TTF-1: Thyroid transcription factor 1; US: Ultrasonography; PET: Positron emission tomography; WT-1: Wilms tumor gene 1.The authors declare that they have no competing interests.All authors have been involved in the management of the patient and in the conception of the manuscript. YY, KM and YS have been involved in drafting the manuscript or revising it critically for important intellectual content. All authors read and approved the final manuscript.


Background. Although rare, visceral artery pseudoaneurysms often present as surgical emergencies with a specific mortality rate as high as 35% related to aneurysmal rupture. Risk factors for the development of iatrogenic pseudoaneurysms include anticoagulation, female gender, obesity, and vessel calcification. Case Report. We present a case of an elderly female who developed a dissecting pseudoaneurysm of the proper hepatic artery after undergoing routine surgery to resect a large duodenal adenoma. Surgical repair comprised of resection and primary anastomosis was employed resulting in a favourable outcome. Discussion/Conclusion. Surgical management reduces the risk of hepatic ischemia, biliary complications, and abscess formation. Although stenting, coil embolization, and thrombin injection are all plausible options for management, we propose that surgical reconstruction be considered seriously as a treatment for such spontaneous pseudoaneurysms. The occurrence of pseudoaneurysms in the splanchnic vasculature is very rare with only a few cases being reported in the literature , 2. We rPseudoaneurysms are defined as a defect through the wall of a blood vessel, including the adventitial layer, causing a localized dilatation , 4. The Splanchnic artery aneurysms are uncommon but important, as nearly 22% of these present as surgical emergencies . ApproxiBiliary tract operative trauma is a rare cause of iatrogenic hepatic artery pseudoaneurysms. Percutaneous intervention is more commonly the inciting event. Clinically, epigastric pain and obstructive jaundice have been reported in symptomatic patients .A 79-year-old female underwent a transduodenal resection of a large adenoma. Preoperative endoscopic biopsy was indeterminate for malignancy, with computed tomography (CT) scan showing a soft tissue mass centered on the second part of the duodenum. There was no evidence of extension to the soft tissue surrounding the duodenum. The hepatic vasculature was normal. She had a past history of intraductal papillary mucinous neoplasm and mild cognitive disease. There was no history of cardiovascular or connective tissue disease. Surgery was performed through a midline laparotomy. A longitudinal lateral duodenotomy was performed and the adenoma was isolated. The lesion was excised completely and the duodenum was closed transversely to maintain the lumen. The porta hepatis was not dissected and there was no obvious injury to any of the periduodenal tissue.The patient was stable during the immediate postoperative period. On the fourth postoperative day, the patient had increasing serosanguineous output from her Jackson-Pratt drain and a drop in haemoglobin from 128 to 75 g/L. A CT scan was performed which revealed a pseudoaneurysm that appeared to arise from either the gastroduodenal (GDA) or the proper hepatic artery (PHA) measuring 3.1 × 2.5 cm Figures . There wThe patient underwent emergency laparotomy. Proximal and distal control was achieved prior to dissection of the porta hepatis. The inflow to the aneurysm from the common hepatic artery (CHA) was controlled with a bulldog vascular clamp. By following the CHA, the GDA was identified and ligated and the aneurysm localized. A large defect in the adventitia was identified on the right lateral aspect of the PHA.Rather than simply ligating the PHA, the aneurysm was resected from the origin of the GDA until the bifurcation of the RHA and LHA. On inspection of these vessels, the extrahepatic RHA appeared normal and the LHA had an intimal dissection extending into the liver. The LHA was ligated and reconstruction to the origin of the RHA was performed using microvascular techniques. On release of the arterial clamps there was a good pulse and thrill in the RHA. Intraoperative Doppler ultrasound showed a normal triphasic signal in the anastomosis . Post-opThe patient was stable postoperatively, had no further complications and was discharged home on postoperative day 11.Pseudoaneurysm formation in the hepatic arteries is an extremely rare complication of manipulation of the hepatic vasculature during abdominal surgery . In our Hepatic artery aneurysms can present with dyspepsia, jaundice, or bleeding . In the Management of aneurysmal disease in the splanchnic vasculature is a relatively new phenomenon. Small asymptomatic pseudoaneurysms (less than 1.0 cm in diameter) can usually be observed. When treatment is warranted, there are several options. First, ultrasound-guided thrombin injection results in instant thrombosis of the pseudoaneurysm under direct visualization. It should be noted that such injections have been performed successfully in the femoral location but no data exists for the splanchnic circulation. Risks include arterial embolization or thrombosis of the parent blood vessel and rarely, anaphylaxis. This procedure is not recommended in unstable aneurysms –16. A second treatment modality is coil embolization which utilizes angiography to deploy flexible wires to directly obliterate the pseudoaneurysm. Its benefits include its use in regions where direct puncture percutaneous access is difficult and also in patients that cannot tolerate open surgery. Its disadvantages include contrast-induced nephropathy and significant radiation exposure , 17. ThiA third treatment option is stenting, whereby a stent graft is introduced using endovascular techniques. The stent effectively excludes the aneurysm from the circulation while maintaining distal flow. This method is preferred for wide-neck aneurysms, large diameter arteries, or vessels with minimal tortuosity . ComplicFinally, surgical repair of these pseudoaneurysms should be considered seriously depending on the context. Several modalities exist including ligation without arterial reconstruction, patch repair, and primary anastomosis , 19. SimAlthough a rare occurrence, it is important for both general and vascular surgeons to consider visceral artery pseudoaneurysm formation as a rare cause of postoperative hemorrhage in patients undergoing upper gastrointestinal surgery. This case demonstrates the feasibility of surgical reconstruction as a primary modality of treatment. We advocate that resection and primary anastomosis be considered as an important treatment option as it ensures optimal perfusion to the liver and likely improved patient outcomes.


Retained surgical sponge (RSS) is a rare surgical complication. The RSSs are mostly located intra-abdominally but they can also be left in the thorax, spine, extremity, cranium, and breast. RSS is often difficult to diagnose because of the nonspecific clinical symptoms and radiologic findings. Clinically, RSS may present as an exudative reaction in the early postoperative period or may also cause an aseptic fibrous tissue response. A foreign body may remain asymptomatically silent for a long time, and it may later present with obstruction, fistulization, or mass formation. In this report, we present a case in which an RSS has migrated through the abdominal wall and caused an anterior abdominal wall abscess. Retained surgical sponge (RSS) is a rare surgical complication. A foreign body may remain asymptomatically silent for a long time, and it may later present with obstruction, fistulization, or mass formation. In this report, we aimed to present a case in which an RSS has migrated through the abdominal wall and caused an anterior abdominal wall abscess and clinically sepsis.A 27-year-old woman was admitted to our surgical unit with a series of symptoms including left-sided abdominal colic lasting for a month and stiffness, increasing erythema, and purulent discharge which had developed in the past week. The patient was septic and her body temperature was 38.1 degrees centigrade. In the abdominal examination, a firm, mobile, and tender mass with purulent discharge was palpable on the left side of the umbilicus. Blood analysis showed a marked leukocytosis (WBC: 17000) and increased CRP: 15.4 . Contrast-enhanced abdominal CT revealed a mass formation located intra-abdominally, neighboring the small intestine, and extending to the skin through the abdominal wall . The patRSS is also known as gossypiboma, meaning a mass of cotton matrix retained within the human body  . It is aRSS results in a broad spectrum of clinical presentations depending on the location of the sponge and the type of reaction. The reported time to diagnosis ranges from 1 day to 40 years. They are inert materials and do not cause any specific biochemical reactions other than granulation reaction so that they can stay asymptomatic for a long time. They cause two different tissue reactions that shape the clinical presentation. The first one is the exudative pattern, usually present in the early postoperative period surgical site infection is the most important clinical finding in this period and can be complicated with wound infection, abscess, fistula formation, or intra-abdominal sepsis, causing high mortality. The second type of reaction is the fibrinous response. This type of reaction, observed in 25% of cases, is formed as a result of encapsulation of the retained foreign body by the scar tissue and granuloma formation. This aseptic reaction may mimic a pseudotumor form or cause intestinal obstruction and erosion of urinary or gastrointestinal tissues . ForeignThe diagnosis of a retained surgical foreign body is based upon imaging studies which demonstrate the object. Plain radiographs are the first used imaging methods but their accuracy is not very high. They are not favorable because of the impaired film quality, different radiopaque image, and a lack of awareness or fragmentation of the radio-opaque markers. Thus, computed tomography is preferred as the initial study. A low-density heterogeneous mass with a spongiform pattern that contains gas bubbles is the characteristic appearance of RSS on computed tomography. If necessary, gastrointestinal contrast studies, ultrasonography (for extremity surgery), magnetic resonance imaging , mammography (for breast surgery), or positron emission tomography are the other important radiologic modalities which can be helpful , 6.Removal of RSS is indicated to prevent potential complications. Especially long existing asymptomatic RSS cases can be followed after being informed about the potential complications but surgical removal of the sponge should be recommended. Although RSS can be excised laparoscopically, laparotomy is usually preferred due to the size of the foreign body and the adhesions surrounding it . TransmuThe recognition of risk factors for this undesirable complication would be of particular importance for the surgeons. Emergency surgical operation is the most important risk factor that increases the RSS risk 9 times. However, RSS often occurs after elective surgery (70%). High body mass index and an unplanned change in the type of surgery are the other important risk factors. Although prevention strategies such as standardized count protocols, radiographic screening in the operating room, counting devices such as bar codes or radiofrequency chips are used in several centers, this complication still exists .In conclusion, RSS must be remembered in the differential diagnosis of the patients presenting with intra-abdominal mass and declaring a past operation. Clinical suspicion and suitable imaging methods constitute the most important steps for the diagnosis. RSS cases may be asymptomatic for a long time but can also cause lethal complications which can be accompanied by serious medicolegal problems.


A 77-year-old male presented with chest pain in March 2012. The individual had undergone surgery for an anterior mediastinal tumor 24 years earlier and the pathological diagnosis was that of a thymoma. The patient underwent a medical check-up every 6 months for the next 20 years. However, ∼3 years following the final check-up, sudden chest pain was reported and the patient was referred again. Computed axial tomography revealed a mediastinal mass adjacent to the left lung, pericardium and sternum. There was no apparent invasion to the adjacent structures. The patient underwent surgical resection following a diagnosis of recurrent thymoma. A posterolateral thoracotomy was performed under video-assisted thoracoscopy. Severe adhesions were observed around the tumor, which appeared to invade the left lung and pericardium, but not the chest wall. The tumor was extirpated in combination with partial resection of the left lung and pericardium. The pathological diagnosis of the tumor was of a well-differentiated neuroendocrine carcinoma (NEC) of the thymus. The specimen that was excised 24 years earlier was re-examined by a pathologist and was reported to exhibit the same histology. Primary NECs of the thymus are rare among anterior mediastinal tumors and the 5-year survival rate is ∼30%. The present case study reports a case of a thymic NEC and describes the pathological and clinical features. Local a surgery  and recu surgery ,6. Howev18F-fluorodeoxyglucose uptake in the mass , although no abnormal uptake indicative of distant metastases was observed  type B3 thymoma classified as pathological stage I due to the absence of capsular invasion (Masaoka classification). Regular medical check-ups had been performed twice a year for 20 years after the surgery and had been completed without evidence of recurrence. However, ∼3 years after the final check-up, a sudden onset of left-sided chest pain was reported and the patient was referred again. Laboratory examinations revealed elevated C-reactive protein levels (3.53 mg/dl), but no other abnormal levels of any tumor markers, including neuron specific enolase. Computed tomography (CT) revealed an irregularly enhanced tumor in the anterior mediastinum with a maximum size of ∼3 cm . Positroobserved .Surgery was performed under the diagnosis of a suspected recurrent thymoma. A posterolateral thoracotomy was performed under video-assisted thoracoscopy. Severe adhesions were observed around the tumor, which appeared to have invaded the left upper lung and pericardium, while no pleural dissemination was observed. Therefore, the tumor was extirpated in combination with partial resection of the left upper lung and pericardium, and the excised pericardium was repaired using a polytetrafluoroethylene sheet. The tumor was found to be a yellowish-white solid mass invading the lung .Histopathologically, atypical carcinoid cells were observed to be arranged in sheets or small nested patterns accompanied by necrosis and lymphoid infiltration invading the surrounding adipose tissue and lungs, while extremely few mitotic cells were observed . An immuThere were no post-operative complications. Although the surgical margins were positive for cancer cells, no medical intervention was administered due to the patient’s age and the invasiveness of radiation and chemotherapy.Thymic NEC is a rare type of neoplasm arising in the thymus, accounting for 2–4% of all anterior mediastinal tumors . This foet al previously reported that local recurrence or distant metastasis developed 15–60 months after surgery in 4/5 (80%) patients. In these cases, the sites of relapse included the chest wall, regional lymph nodes, bones and lungs  of patients who underwent total tumor resection, despite the absence of local recurrence  (et al identified recurrence in one case 9 years after surgery (Local recurrence and distant metastasis develops frequently following surgical excision of thymic NECs –4. Wang nd lungs . In addiIn conclusion, this study presents a case of a surgically-excised thymic NEC recurring >20 years after the initial excision. Thoracic oncologists must be aware that thymic NECs may recur ≥20 years after surgical treatment.


Background. LCH is a benign vascular growth of the skin and mucous membranes commonly affecting the head and neck. Since it was first described in the nineteenth century, this entity has been variously known as “human botryomycosis” and “pyogenic granuloma.” The shifting nomenclature reflects an evolving understanding of the underlying pathogenesis. We review the histopathology of and current epidemiological data pertaining to LCH which suggests that the development of these lesions may involve a hyperactive inflammatory response influenced by endocrine factors. We report two new cases of pediatric lobular capillary hemangioma (LCH) of the nasal cavity and review current theories regarding the etiology, diagnosis, and treatment of nasal LCH. Methods. Retrospective case series. Case Series. Two adolescent females presented with symptoms of recurrent epistaxis, nasal obstruction, and epiphora. Both patients underwent computed tomography imaging and biopsy of their intranasal mass. The tumors were excised using image-guided transnasal endoscopic technique. Seven other cases of nasal LCH have been reported to date in the pediatric population. Conclusion. Nasal LCH is a rare cause of an intranasal mass and is associated with unilateral epistaxis, nasal obstruction, and epiphora. We advocate for image-guided endoscopic excision of LCH in the adolescent population.  Lobular capillary hemangioma (LCH) is a benign vascular growth of the skin and mucous membranes commonly affecting the head and neck , 2. The The etiology of LCH remains unknown, though there is some evidence to support both trauma and hormonal influences. The relative frequency of LCH developing at the anterior nasal septum and the anterior aspect of the inferior turbinate, as well as the increased incidence of LCH in recurrent nose pickers or those with a history of nasal packing lends credence, give to the belief that local trauma plays arole in the genesis of LCH , 6. ManyThere is a well-established relationship between LCH and pregnancy. LCH commonly occurs in women who are pregnant and those who use oral contraceptives , 10. TheThough LCH frequently presents in the head and neck, it rarely occurs in the nasal cavity , 11, 13.A 16-year-old female presented with four months of recurrent right-sided epistaxis, nasal obstruction, and epiphora.The patient's past medical history included asthma and mild eczema.She denied oral contraceptive use and prior sexual activity.On nasal endoscopy, a pedunculated, grossly vascular tumor was visualized arising from the lateral surface of the middle turbinate.A noncontrast head CT demonstrated a soft tissue mass extending from the right maxillary and ethmoid sinuses to the right nasal choana .There waBiopsy of the intranasal mass was performed in the office with no significant bleeding.The histopathology demonstrated a dense network of capillary-sized vessels consistent with LCH.The biopsy revealed acutely and dramatically inflamed granulation tissue.The presence of necrosis and squamous metaplasia was thought to suggest trauma with reactive changes.The patient was treated with image-guided endoscopic excision of the right nasal mass arising from the right middle meatus.Her surgery and recovery were uncomplicated and no recurrence has been noted six months postoperatively.The final pathology was read as lobular capillary hemangioma.A 12-year-old female presented with three months of recurrent, left-sided, epistaxis and nasal obstruction.On nasal endoscopy, the patient was noted to have a mass filling the left middle meatus.A head CT with contrast demonstrated a mass in the left nasal cavity .The massThe patient underwent an image-guided transnasal endoscopic resection of this mass .The massLCH occurs at any age, but most commonly develops in the third to fifth decade of life . In adulPatients with LCH of the nasal cavity commonly present with epistaxis, nasal obstruction, epiphora, or purulent rhinorrhea , 8. The Radiographic studies are frequently used to diagnose an intranasal mass.CT can be important in determining the presence of bony destruction by a rapidly growing intranasal mass or in evaluating intracranial extension of a mass originating on the roof of the nasal cavity , 13, 21.In this case series, each patient underwent an in-office biopsy of her intranasal lesion. In each case, suspicion for angiofibroma or a lesion that extended intracranially such as a meningocele or meningomyelocele was sufficiently low that we felt a biopsy could be performed safely. In both instances, the biopsy established a previously uncertain diagnosis and resulted in minimal bleeding that was easily controlled in the office.The recommended treatment of LCH in the nasal cavity is conservative local excision with cautery at the base of the tumor for hemostasis , 15.ThisNasal LCH is a rare cause of an intranasal mass and is associated with unilateral epistaxis, nasal obstruction, epiphora, and purulent rhinorrhea.We advocate for image-guided endoscopic excision ofLCH in the adolescent population.