The diagnostic value of CT window width technique in primary omentum infarction was evaluated by this study.  The abdominal CT data of 32 patients with clinically diagnosed abdominal omentum infarction were retrospectively selected and analyzed. The fixed window position was 50 HU, and the window width was 135 HU, 250 HU (abdomen), 350 HU (mediastinum), and 500 HU, respectively. The detection rate of lesions was analyzed and compared.  Window widths of 135 HU, 250 HU (abdomen), 350 HU (mediastinum), and 500 HU have a detection rate of 12.5% (4 cases), 62.5% (20 cases), 100% (32 cases), 100% (32 cases) for abdominal omental lesions, respectively. However, 500 HU showed worse abdominal bowel and parenchymal organs than 350 HU.  According to the comprehensive image quality, the ideal window width for diagnosis of primary omentum infarction is 350HU  window width. According to the etiology, it is divided into primary and secondary omental infarction , 2. AmonRetrospective analysis included 32 patients with primary omental infarction diagnosed by abdominal pain in our hospital from March 2017 to February 2022. Among the 32 cases, 28 males and 4 female, aged 21-95 years, the average age of 39 ± 17 years. Lesion location: 14 cases of descending colon, 12 cases of sigmoid colon, and 6 cases of ascending colon. No injury and recent-operation history, due to short-term abdominal pain as the main symptoms of the diagnosis, abdominal pain lasted about 1-3 days. There was no nausea, vomiting, diarrhea, and fever. Only 6 patients showed a slight increase in inflammatory markers such as white blood cells, neutrophil counts, and C-reactive protein in laboratory tests. All the 32 cases disappeared after clinically conservative treatment of symptoms.Scanning using Aquilion/TSX-101A spiral CT machine, parameters were as follows: 120KV/154 mA, layer thickness according to need to use 5.0/1.0 mm, pitch is 1, because they are acute abdomen treatment, so only 1 case performed an enhanced CT examination. Three senior professional doctors, proficient in abdominal imaging diagnosis, diagnosed and analyzed the abdominal CT images of 32 patients with window width 135HU, 250HU, 350HU, 500HU, and window level fixed to 50HU.P less than 0.05 denoted as statistically significant difference.Statistical analysis was performed using the SPSS20.0 software package, the measurement data were expressed as mean ± standard deviation (x̄ ± S), the diagnostic rate of primary greater omental infarction was analyzed by one-way ANOVA with different window width. When comparing the two groups, Duncan's test was used, with P > 0.05), and there was no significant difference between 350HU and 500HU. Typical image data are shown in Clinicians' understanding can be improved by understanding the types of common and rare omental tumors. The differential diagnosis of intraperitoneal tumor and omental tumor depends on the imaging and pathological features of soft tissue sarcoma. Combining the relationship between tumor and adjacent organs and carefully judging the source of tumor blood supply can enable doctors to make more perfect treatment decisions. Clinical and imaging doctors should pay attention to the clinical research of rare tumors, accumulate experience, understand the occurrence, development rules and characteristics of omental tumors, improve the accuracy of clinical diagnosis, timely treat patients, and make treatment more standardized and comprehensive. Primary omental infarction is rare, and it is an unexplained retinal acute vascular disease  17]. Du. Du17]. After the necrotic omentum is reset, a large number of toxins can return into human blood through the vein of the omentum, aggravating the toxic symptoms such as postoperative high fever. Therefore, it is not suitable to reset the necrotic omentum before resection. Laparoscopic resection of the greater omentum with torsion necrosis, using ultrasonic scalpel or electrocoagulation, electric hook separation, and silk thread ligation, in order to prevent too much ligated tissue or insufficient ligation and postoperative bleeding of the stump. Although laparoscopic surgery requires certain surgical skills, compared with traditional open surgery, the trauma is small and the recovery is fast. All patients in this group were discharged after surgery and were followed up for half a year without discomfort. Ultrasound-guided percutaneous biopsy has been a common diagnostic method for intraperitoneal lesions, such as liver, kidney, pancreas, and other solid organs, but it is not often used in peritoneal and omental lesions. Most diagnoses are based on fine needle aspiration cytology, with low diagnostic rate and poor accuracy. Only a few diagnoses are based on small samples of histopathology. However, ultrasound-guided percutaneous biopsy is easy to be carried out in the outpatient department, with little damage, good safety, no serious complications, and high diagnostic accuracy. In the early stage, local omental vein thrombosis, adipose tissue congestion, and occasionally a small amount of bleeding can be seen. In the middle stage, the lesions developed further, and the inflammatory cells infiltrated in the local omental adipose tissue. In the late stage, inflammatory exudate, necrotic tissue lysis and absorption, infarction omental adipose tissue fibrosis, hyperplastic changes, and small punctured calcification can be seen. The infarcted omentum is shaped “pie-like”, often accompanied by exudative changes. When the spread is wide, it can be extended to adjacent tissues and parietal peritoneum, and adhesion occurs but generally does not cause thickening of the intestinal wall , 23. AccPrimary omental infarction is a diagnosis of exclusion, which can be diagnosed according to the following –26: (1) The omentum is a double membrane made up of peritoneum and adipose tissue, which includes blood vessels, nerves, lymphatics, and connective tissue. The omentum is connected with the greater curvature of the stomach and the transverse colon, covering the abdominal organs in a skirt shape. When infection, tumor, or other pathological changes occur in the abdominal cavity, the omentum needs to be formed by wrapping and adhesion to limit the spread of the disease. The omentum consists of fat pads and special tissue entities called macula. Microscopically, the macula is an aggregate of white blood cells, mainly macrophages and lymphocytes. The omentum is a thin structure containing a large number of adipose tissue and macrophages, which is represented as fat density on CT . Early oThe CT window technique includes window width and window level. Increasing the window width increases the range of tissue density that can be observed, but the image contrast is reduced; while the window width reduction results in the opposite result, and the low-density portion of the tissue is not displayed –30.There are three theories about the occurrence of omental teratoma: (1) during embryonic development, the migrated germ cells are captured by the omentum, and the primary teratoma of the omentum comes from the displaced germ cells; (2) ovarian teratoma in normal position fell off due to torsion or rupture, and it was implanted with omentum; and (3) there is extra ovarian tissue in omentum. The observation range of the conventional abdominal window width (135HU) is small, when the tissue around the organ such as omentum and mesentery is not ideally displayed. When the window width is appropriately increased to 350HU and 500HU, the changes of omentum tissue can be clearly displayed. In our group, the lesion display effect is poor and easy to miss diagnosis with 135HU and 250HU window width, and there is no case of missed diagnosis with 350HU and 500HU window width. The window width of 350HU showed clear changes in the parenchymal organs, the intestines, and the wall of the colon wall, and the window width of 500HU showed poor performance. Therefore, the use of window width 350HU as the ideal window width for the diagnosis of primary omental infarction and reduce misdiagnosis and missed diagnosis. The etiology of omental torsion can be divided into primary and secondary. Secondary omental torsion is a common peritonitis or postoperative spinal cord adhesion that causes torsion during exercise. The contents of the inguinal hernia are omentum, which is attached to the hernia sac and forms torsion in the process of autonomic reinnervation of the hernia. Cysts or tumors on the omentum make the free margin of the omentum asymmetric and easy to twist.Mesenteric and omental lipomas are rare benign solid tumors. Omental lipoma grows slowly, is liquid, soft in texture, and does not infiltrate the surrounding organs. Lipomatous lesions, which occur primarily in children and adolescents, can easily be mistaken for normal omental fat. Whether patients develop different nonspecific symptoms will be determined by the size and location of the tumor. Omental lipomas are usually asymptomatic or have progressive abdominal distension, anorexia, abdominal pain, constipation, abdominal distension, and weight loss. The clinical symptoms of primary omental infarction lack specificity. In addition to the need to distinguish it from other acute abdomen, the rational application of CT window width technique is also very important. The best image performance can be obtained by appropriate retinal tissue window width technology, which can significantly reduce the missed diagnosis rate of primary omental infarction, provide help for clinical diagnosis and selection of reasonable treatment plan, and avoid delayed disease and unnecessary surgery. Preoperative diagnosis can be made according to imaging characteristics. Omental lipomas often appear as a polyechoic mass with an envelope on ultrasonography. Liposarcoma can be distinguished from lipoma by heterologous echogenicity on B-ultrasound, tumor size, or abundant Doppler flow signals. Omental lipoma can be misdiagnosed as normal mesenteric fat. Based on the above reasons, 350HU window width is considered to be the ideal window width for diagnosing primary omental infarction and reducing misdiagnosis and missed diagnosis. However, in daily work, conventional window width is required for diagnosis, which is mainly supplemented by special window width.


Hepatic myopericytoma (MPC) is an extremely rare pathological entity in the liver. Conversely, cystic hepatic lesions are a group of heterogeneous lesions encountered commonly in daily practice. Here, we report a unique case of the coexistence of primary hepatic MPC and multiple cystic hepatic lesions along with our perceptions on its diagnosis and treatment.A 56-year-old female patient was found to have a left liver mass during a routine physical examination. Computer tomography (CT) and magnetic resonance imaging (MRI) confirmed the existence of a left hepatic neoplasm along with multiple hepatic cysts but could not exclude the possible malignant nature of the neoplasm. Computer tomography (CT) also identified an enlarged mediastinal lymph node with a maximum diameter of 4.3 cm, which further underwent core needle biopsy under CT guidance. A histopathological examination was performed to rule out malignancy. Afterwards, the patient underwent left hemihepatectomy to resect a solid tumor of 5.5 cm × 5 cm × 4.7 cm with multiple cystic lesions which were histopathologically examined to establish the diagnosis of myopericytoma with hepatic cysts. Postoperatively, the patient recovered from the surgery quickly without significant adverse events and was not found to have a reoccurrence of the primary pathological entity.This is the first reported case of a patient with the co-existence of primary hepatic myopericytoma and multiple cystic hepatic lesions undergoing surgical treatment with eventual recovery. Myopericytoma (MPC) is a rare type of perivascular benign neoplasm characterized by spindle cells with contractile features and varied arrangements around the blood vessels . MyoperiRoutine ultrasound found a left hepatic mass with multiple hepatic cysts.A 56-year-old female was admitted to our hospital after a mass in the liver was detected by routine ultrasonographic examination a month prior, with a chief complaint of occasional abdominal distension.The patient was diagnosed with hypertension at 51 years old and reported no history of hepatitis, tuberculosis, or AIDS.The patient reported no family history of liver malignancy or hepatitis.The patient exhibited stable vital signs, and no issues were detected following a physical examination.Tumor marker tests used can be seen in Table An abdominal CT scan showed a slightly low-density mass at the junction of the left and right lobes of the liver, existing behind multiple scattered, hypoattenuating, and round lesions with clear boundaries. Portal venous phase CT showed the lesion with progressive heterogeneous enhancement Fig. A, B. An The primary diagnoses are primary hepatic neoplasm and simple hepatic cysts.The patient underwent a left hemihepatectomy to remove the tumorous lesion in segment 4 of the liver, without any other unique perioperative treatments.The hepatic specimen from the resection was 17 cm × 12.5 cm × 7 cm in size and contained a tumorous lesion of the size of 5.5 cm × 5 cm × 4.7 cm. The cut surface of the specimen showed a hard gray-reddish tumorous lesion within the soft gray-yellowish hepatic tissues. Additionally, numerous cystic cavities were observed in the liver, with the largest one being 2 cm × 1.8 cm × 1.5 cm in size with clear fluid inside.Routine pathological examination of H&E tissue staining showed that the hepatic tumor cells were oval and spindle and were distributed around the hepatic blood vessels in concentric circles, without degenerative stromal changes, such as fibrosis, hyalinization, or myxoid changes; mitotic figures; tumor necrosis; or vascular invasion being observed Fig. A. The blPDGFRB mutations but not of SRF-RELA gene fusions. Overall, the gene fusion RNA examination did not unveil any common gene mutations or arrangements on the genes, including common mutations in genes related to malignancy or myopericytoma, such as PRKCSH, SEC63, LRP5, ALG8, and SEC61, or common germline mutations associated with autosomal dominant polycystic liver disease (ADPLD) [Gene + OncoFusion tumor gene-fusion RNA examination with 555 gene fusions revealed the presence of  (ADPLD) .No recurrence or metastasis was observed, and the enlarged mediastinal lymph node remained unchanged within the subsequent 29 months of follow-up.Requena et al.  reportedClinically, MPC can develop at any age, but it is most commonly found in middle-aged males. The clinical presentation and histological features of MPC are overall benign although 14 cases of malignant MPC have been reported . Some caThe diagnosis of MPC and differentiation of benign from malignant MPC are based on morphological and immunological characteristics in histopathological examinations . In our Another unique aspect of our case rested in the coexistence of hepatic MPC with multiple hepatic cysts. Hepatic cyst or cystic liver disease includes a heterogeneous group of fluid-filled lesions within the liver parenchyma and can be categorized into simple and complex cysts. Simple hepatic cysts have been defined as lesions with thinly smooth walls lined with bile-like fluid-secreting cuboidal epithelium ranging in size from < 1 to 30 cm in diameter. Furthermore, simple cysts encompass congenital cysts, biliary hamartomas, Caroli disease, and polycystic liver disease (PCLD) , 24. OurIn the aspect of clinical management, our surgical team could not diagnose the patient as having hepatic MPC preoperatively; thus, they proceeded with the left hepatectomy with the working diagnosis of hepatic malignancy as a precaution. A postoperative pathological exam verified the benign nature of the lesion, and no further treatment was offered to the patient, except for the scheduled follow-up. After 29 months, there was no sign of recurrence or metastasis, further verifying the benign nature of hepatic MPC in our patient. In summary, we presented an extremely rare case of primary hepatic MPC coexisting with hepatic cysts. Our results showed that inpatients with MPC occurring in the deep viscera, which are complicated by other pathological entities such as multiple hepatic cysts, hepatectomy can be the treatment of choice with eventual full recovery.


Pseudoaneurysm is a rare complication of laparoscopic cholecystectomy (LC). In most cases, the patient presents with gastrointestinal bleeding or hemoperitoneum. Here, we present a case with a post-cholecystectomy right hepatic artery pseudoaneurysm (PSA) induced by a generalized seizure. A 39-year-old male was sent to the emergency room with a generalized seizure and a loss of consciousness for approximately 5 min. Diffuse abdominal pain was complained of after consciousness returned. The surgical history of LC 13 days prior was mentioned. Abdominal computer tomography (CT) revealed a lobulated fluid accumulation in the gallbladder fossa with prominent fatty stranding and suspected biloma formation. After admission for one week, sharp abdominal pain was observed. Abdominal CT angiography revealed a right hepatic artery pseudoaneurysm. Transcatheter arterial embolization was performed with a total of seven platinum coils. In conclusion, it is important for doctors to take pseudoaneurysm into consideration in the patient who presents with seizure attack after receiving LC. Late discovery of PSA when it is ruptured can lead to fatal conditions, such as severe hemoperitoneum. Laparoscopic cholecystectomy (LC) is the standard surgery for symptomatic cholelithiasis. Injury to the vascular wall can occur during the procedure. According to previous studies, the incidence of bile duct injuries and bowel injuries during LC were reported to be approximately 0.6%  and 0.2%A 39-year-old male without systemic disease was sent to the emergency room with generalized seizure and conscious loss for approximately 5 min. It was his first episode of seizure attack, according to his family. After recovery of consciousness, diffuse abdominal pain was observed. The surgical history of LC 13 days ago was mentioned. The decision to perform laparoscopic cholecystectomy was under the diagnosis of gallstones with chronic cholecystitis to wall off a perforation and abscess formation. The preoperative abdominal CT revealed a gallbladder with a stone (size: 4.5 cm) with wall thickening and peri-cholecystic fatty stranding. No abnormal findings in the liver, biliary system, pancreas, and spleen were noted. The laparoscopic cholecystectomy was performed smoothly, and the patient tolerated the whole process well. After the surgery, a fever episode was noted on the first postoperative day, and atelectasis was suspected because the patient did not have abdominal pain or abdominal tenderness. Under empiric antibiotics treatment, the fever subsided, and the patient was discharged on the fourth postoperative day. At the emergency department, the patient presented with hypotension and sinus tachycardia, which responded to fluid resuscitation. Physical examination revealed tenderness of the whole abdomen with muscle guarding. Blood examinations showed leukocytosis , hemoglobin level of 9.3 g/dL (dropped from 13.7 g/dL in two weeks), normal total bilirubin (0.4 mg/dL), elevated C-reactive protein (2.17 mg/dL), and lactate level (3.3 mmol/L). No intracranial hemorrhage was discovered from computer tomography (CT) of the brain. Abdominal CT revealed lobulated fluid accumulation in the gallbladder fossa with prominent fatty stranding and suspected biloma formation induced by a generalized seizure.  The patiA review of 14,243 patients who underwent different standard laparoscopic procedures showed an overall hemorrhage rate of 4.1%, with bleeding rates of 2.3% intraoperatively and 1.8% postoperatively .The pathophysiology of right hepatic/cystic artery aneurysm varies from vascular laceration during the surgery, thermal injury, or clip application. Mechanical injury can easily occur when dissecting Calot’s triangle, especially if the adhesion is severe. If an inadvertent thermal injury is caused by cautery or indirectly via a clip during the procedure, it may cause scarring of the vessel, causing a PSA after detachment ,7. The dIn conclusion, PSA is a rare condition after LC. It is important for doctors to take pseudoaneurysm into consideration in patients who present with seizure attack after receiving LC. Late discovery of PSA when it is ruptured can lead to fatal conditions. TAE can be performed securely in most early cases.


The authors present the case of a 40-year-old male who visited the emergency department with left-sided flank pain. He was found to have a 12 mm ureteropelvic stone and was provided parenteral analgesia before being admitted to the hospital for urology consultation. The presentation and diagnosis of his case along with treatment options against a backdrop of related studies are discussed. Renal calculi (kidney stones) are hard deposits of minerals and salts that cluster within the kidneys. Patients with symptomatic nephrolithiasis typically experience severe flank pain that may be associated with hematuria, nausea, vomiting, fever, and chills. The severity of these symptoms increases proportionally with the size of the calculus due to distention of the ureter. Calcium stones are the most common, comprising 80% of renal calculi. Calcium oxalate (CaOx) and calcium phosphate (CaP) or a combination of both constitute the bulk of these renal calculi, and their formation is dependent on urinary pH. A pH between 5.0 and 6.5 favors CaOx, whereas a urinary pH greater than 7.5 is more likely to yield CaP stones. Calcium stones are linked with the greatest recurrence . Uric acA 40-year-old man arrived at the emergency department with left-sided flank pain, which had begun one day earlier. The pain was described as throbbing and radiated to his left upper quadrant. His vital signs were as follows: temperature of 98.3°F, a pulse of 86 beats per minute, a respiratory rate of 18 breaths per minute, a blood pressure of 168/113 mmHg, and oxygen saturation of 94% on room air. His medical history was significant for nephrolithiasis one year prior. The presentation was similar. At that time, it was an 18 mm stone that required a nephrostomy tube for resolution. His other medical history included chronic low back pain. His surgical history was only significant for myringotomy tubes as a child. He denied any recreational drug use. He was a non-smoker. He did drink alcohol, two beers per day. He worked as a driver. The most prominent finding on physical examination was the exquisite left costovertebral angle tenderness. Examination revealed a well-developed, well-nourished man in moderate distress secondary to pain. Heart, lung, and neurologic examinations were normal. A non-contrast computed tomography (CT) scan revealed a 12 mm stone in the left upper ureteropelvic junction. The patient was treated with 4 mg morphine, 15 mg ketorolac, 2 L intravenous saline solution, and 4 mg ondansetron. He was admitted to the hospital for a urology consultation for the removal of the stone (Figure Laboratory evaluation was essentially unremarkable; the results are shown in Table In the management of uncomplicated urolithiasis, the first approach is to evaluate whether the patient is likely to pass the stone on their own. In general, 75-90% of all stones pass without intervention . In thisThere are options for treating large kidney stones that are unlikely to pass. SWL is a noninvasive technique that uses high-intensity pulses to fractionate stones into fragments. These pieces will ideally be small enough to urinate out. Another method is PCNL, which involves surgical removal of the stone. An algorithmic approach can be adopted, depending on the size and location. For lower pole stones <1 cm, either SWL or ureteroscopic retrieval can be employed. Stones measuring 1-1.5 cm likely would need the latter. For stones measuring >1.5 cm, PCNL would be indicated. For upper pole stones, the preferred strategy is usually PCNL .A study examining 383 patients, in which 221 underwent SWL and 144 had PCNL, compared outcomes in kidney stones measuring between 1 cm and 2 cm. While 94% of PCNL candidates were successful, only 76% of SWL patients had success. Although PCNL was the more effective technique in this study, it is the more invasive option as well ,11. ThisRenal calculi can be very painful and require immediate attention. Those that are greater than 6 mm in width, regardless of location, are much less likely to be passed without intervention. In this case, the patient had a 12 mm stone that required urologic consultation. While PCNL is a more effective surgical option to remove the stone, SWL should be considered due to its noninvasive nature. We advise that stone location and width should be evaluated before deciding if PCNL or SWL is necessary and which option is the most suitable for the patient.


Gangliogliomas are extremely rare tumors of the nervous system that contain a mixture of neoplastic glial and neuronal cells. The aim of the present paper is to describe the clinical presentation, magnetic resonance imaging findings and histopathological and immunophenotypical characteristics of a cerebral cortex ganglioglioma in a 7-year-old Border Collie. The dog presented an acute onset of tonic-clonic epileptic seizures. Magnetic resonance imaging revealed a well-defined large intra-axial mass located on the left forebrain, mainly affecting the frontal cortex. The histopathological examination of the mass revealed a diffuse proliferation of neoplastic glial cells mixed with anomalous neuronal bodies. Immunohistochemical analyses confirmed the presence of two different populations of neoplastic cells. Most neoplastic glial cells were immunoreactive to glial fibrillary acidic protein and the other subset of neoplastic cells were positive to neuronal markers such as PGP 9.5, synaptophysin and neuron-specific enolase, suggestive of neuronal cells. These findings confirmed the diagnosis of a cerebrocortical ganglioglioma. To the authors’ knowledge, this is the first description of a cerebral cortex ganglioglioma in a dog.Gangliogliomas are extremely rare tumors of the nervous system composed of neoplastic glial and neuronal cells. The aim of the present paper is to describe the clinical presentation, magnetic resonance imaging (MRI) findings and histopathological and immunophenotypical characteristics of a cerebral cortex ganglioglioma in a 7-year-old Border Collie. The dog presented an acute onset of tonic-clonic epileptic seizures. MRI revealed a well-defined large intra-axial mass located on the left forebrain, mainly affecting the frontal cortex. Following humane euthanasia, the histopathological examination of the mass revealed a diffuse proliferation of neoplastic glial cells mixed with anomalous neuronal bodies. Immunohistochemical analyses confirmed the presence of two different populations of neoplastic cells. Most neoplastic glial cells were immunoreactive to glial fibrillary acidic protein (GFAP) and the other subset of neoplastic cells were positive to neuronal markers such as PGP 9.5, synaptophysin (SYN) and neuron-specific enolase (NSE), suggestive of neuronal cells. These findings confirmed the diagnosis of a cerebrocortical ganglioglioma. To the authors knowledge, this is the first description of a ganglioglioma of the cerebral cortex in a dog. Gangliogliomas are slow-growing tumors characterized by a combination of dysplastic neurons and neoplastic glial cells ,2. TheseIn veterinary literature, gangliogliomas have been anecdotally described in horses, dogs, hedgehog, rodents and calf ,11,12,13Centro Clínico Veterinario Indautxu following an acute onset of cluster seizures. The dog was 2 month old when acquired, and the owners did not report any relevant diseases since then. Very subtle generalized incoordination and difficulty to climb stairs were noted by the owners a few months earlier, but no additional investigations were performed.A 7-year-old entire female Border Collie was referred to the Neurology service of A physical exam did not show any relevant abnormalities. A neurological examination revealed an abnormal mental status and non-ambulatory tetraparesis, with decreased postural reactions in all four limbs. A cranial nerve examination showed absent menace response on the right eye. Based on this, neuroanatomical localization for an underlying lesion was the left prosencephalon.The main differential diagnosis included neoplasia, inflammatory/infectious diseases and vascular conditions. Complete blood count, serum chemistry and urinalysis were unremarkable and thoracic radiographs did not reveal any significant abnormalities. MRI of the brain was performed under general anesthesia.®; Guerbet, Roissy CdG cedex, France]). The study revealed a large, solid, well-defined, lobulated oval-shaped and intra-axial mass affecting the left forebrain. The lesion measured approximately 4.9 cm rostrocaudal, 2 cm mediolaterally and 3.4 cm dorsoventrally, and extended caudally from the left olfactory bulb along the medial aspect of the left frontal cortical area and cingulum reaching the level of the parietal cortical area, medial to the left lateral ventricle. The mass showed a marked hyperintense signal on T2W, mixed heterogenous hyper to isointense signal on FLAIR and marked hypointense signal on T1W, compared to the gray matter; no evident contrast enhancement was identified. The mass severely compressed the surrounding brain parenchyma; it caused ventral displacement of the corpus callosum, partial collapse of the rostral aspect of the left lateral ventricle, attenuation of the cerebral sulci, midline shift to the right with subfalcine herniation and transtentorial herniation . T1-weighted (T1W) and T2-weighted (T2W) images were obtained in transverse, sagittal and dorsal planes. Additionally, T2-weighted fluid attenuation inversion recovery (FLAIR) images were obtained in a transverse plane. T1W images in transverse and sagittal planes were also acquired after intra-venous contrast administration  were considered unlikely. Inflammatory  or infectious diseases were also considered less likely. Cerebrospinal fluid tape was not performed due to the increased intracranial pressure and the associated risks.Given the presumptive diagnosis of a brain tumor and the poor prognosis, the dog was humanely euthanized. A complete necropsy was performed and the brain was submitted for a histopathological analysis, previously fixed in 10% buffered formalin for more than 24 h. Immunohistochemistry (IHC) was performed to characterize all cell types and in Corona radiata and Corpus callosum).Grossly, the brain showed an enlarged and softer left cerebral hemisphere compared with the right one. On transverse section A, a focaOn microscopic examination, the mass corresponded to a diffuse neoplastic proliferation originated on the grey and white matter transition zone, showing a marked lax growth pattern, and infiltrating diffusely the adjacent nervous parenchyma B. The prMost neoplastic cells were immunoreactive to GFAP A,B. The These findings confirmed a mixture of atypic astrocytic glioma, including immature dystrophic neuronal cells being consistent with a grade II cerebral ganglioglioma, a rare type of primary nervous system mixed tumor.According to the World Health Organization (WHO) Classification of human tumors of the Central Nervous System, gangliogliomas are classified in the group of the glioneuronal and neuronal tumors . No key Gangliogliomas are extremely rare tumors in dogs; only a few focal cases have been reported in the thalamus of a puppy , in the The tumor’s predilection site in humans is the temporal and frontal lobes, resulting in intractable seizures in the majority of patients ,4,5,6. DMRI findings of human gangliogliomas are not well established due to the wide variety of signals, probably due to the cell heterogenicity of these tumors. Gangliogliomas appearance have been described as hypo or isointense on T1W sequences, hyper or hypointense on T2W sequences and with variable contrast enhancement. Quite frequently, this type of tumor shows cystic (hypointense areas on T1W and FLAIR in addition to hyperintense on T2W) and mineralized areas, but can also be found as a solid, poorly defined mass mainly in the temporal lobes ,6. In huMost of the gangliogliomas in humans are well differentiated and classified as grade I, however, anaplastic cases (grade III) have been also described ,2. The gImmunohistochemical techniques are essential to establish the diagnosis of ganglioglioma. In the present case, we identified both cellular components of the tumor: astrocytes (immunopositives for GFAP) and neuronal cell bodies . In the present case, few cells resulted immunopositives for Olig-2, a marker for neural progenitors and oligodendrocytes, and no immunopositivity was observed against NeuN, a marker of mature neurons . These rTo the authors knowledge, this is the first report of intracranial ganglioglioma located in the cerebral cortex in a dog. Despite ganglioglioma is a rare neoplasia, it must be considered in the differential diagnosis of a solitary solid mass on the cerebral cortex of young or adult dogs. Biopsy or postmortem histopathology and immunohistochemical evaluation remain essential to achieve the correct diagnosis and must be crucial to give accurate prognosis.


Pulmonary sequestration is a congenital disease formed by embryogenic separation of the lung parenchyma, halting development and function. It has an aberrant blood supply and can provide a nidus for infection and respiratory compromise. It can be diagnosed prenatally with surgical resection after delivery reserved as the best mode of treatment. In literature, six to twelve months is the most optimal time for elective surgical repair giving time for some maturation to withstand single lung ventilation and operation before the risk of infection heightens after 12 months. We present a case of an infant that had an elective repair at four months of age with no postoperative sequelae highlighting that surgeons can perform elective repair sooner than six months of age and that surgical decision-making should be on a case-by-case basis. Pulmonary sequestration (PS) is a rare congenital disease representing 0.16% of all structural lung diseases and 1.5% of all congenital pulmonary malformations . ILPS shThe patient is a four-month-old female with a left lower lobe congenital pulmonary airway malformation (CPAM) diagnosed prenatally on ultrasound imaging who underwent interval imaging three months after birth with computed tomography (CT) angiography of the chest, which confirmed a persistent, left lower lobe lesion Figures , 2 with Pulmonary sequestration (PS) is a rare congenital pulmonary malformation characterized by a non-functioning lung tissue mass that does not communicate with the rest of the tracheobronchial tree . It recePulmonary sequestrations occur primarily in the left lower lobe . IntraloIn literature, bilateral pulmonary sequestration, co-existing intralobar and extralobar, and pulmonary sequestration connecting with the digestive tract exist in addition to intralobar and extralobar presentations ,8,14,18.Surgical resection is recommended for treatment and is best performed at six to twelve months of age if elective ,16. ChilWe present this rare case of a left extralobar extrapleural pulmonary sequestration which only has visceral pleural covering without a parietal pleural. Despite this atypical presentation, elective management remains the same as an ELPS. Timing for surgery should be on a case-by-case basis.


The diagnosis and treatment of maxillofacial cystic lesions requires careful evaluation and correlation of the clinical presentation and radiological studies. The Pindborg tumor, also known as the calcifying epithelial odontogenic tumor, is a locally invasive benign neoplasm, with only around 300 cases being published to date. This study presents a new case of this already uncommon neoplasm, not associated with an impacted tooth, and describes the clinicopathological features of this rare entity, along with a review of other reported cases. Despite surgery having been recognized as the treatment of choice for the Pindborg tumor, no firm consensus exists concerning the extension of surgical resection. The calcifying epithelial odontogenic tumor was first described as a distinct odontogenic tumor by the oral pathologist Jens Pindborg in an abstract in 1955 and again in an article in 1958 . The oriA 52-year-old female was referred to our department for the evaluation of a facial pain located in the left preauricular area with two years of evolution. The main symptoms were impaired mouth opening, loss of more than 5% of her weight in the last 6 months, and intense continuous pain in the affected region with extension to the left ear that led to the diagnosis of temporo–mandibular disorder. Clinical history relating to the condition showed no response to conservative treatment with medication, physiotherapy, and occlusal splint. The left lower first and second molars were extracted in a dental clinic one year ago. The patient’s medical history included arterial hypertension and degenerative arthropathy, with shoulder and neck involvement. She had no history of maxillofacial trauma, and she denied a history of smoking, alcohol, or the use of any other drugs.A physical examination revealed discrete swelling in the left mandibular side, and movement was severely limited, with a maximum jaw opening of 18 mm. Facial nerve function was intact, no symptoms indicating the involvement of the inferior alveolar nerve were detected, and there was no evidence of cervical lymphadenopathy. During an intraoral examination, a hard nodule in the left retromolar trigone was observed. The remainder of the head and neck exploration was normal.The usual diagnostic imaging study with a panoramic radiograph showed a well-defined mixed radiolucent–radiopaque lesion with peripheral enhancement in the left mandibular ramus occupying almost its entire thickness . ComputeA preoperative study was carried out that did not contraindicate surgical intervention. Under general nasotracheal anesthesia, an intraoral vestibular incision was used to approach the tumor resection. An initially intraoperative biopsy was taken of the lesion, which was diagnosed as suggestive of a myxoid lesion. During surgery, the lesion proved to be primarily cystic in nature and could be removed with marginal resection from the surrounding mandible with preservation of bone continuity. No other action was deemed necessary to ensure bone stability. The surgically excised lesion was 5 × 4 cm in size. The specimen was examined by the Department of Pathology and revealed islands of polyhedric epithelial cells with nuclear pleomorphism, prominent intercellular bridges, and eosinophilic acellular plaques resembling amyloid and Liesegang rings calcifications. Immunohistochemical analysis revealed strong positivity for cytokeratin CK5/6 and p63. The resection margins appeared clear of tumor presence, and on that basis, the authors concluded that the tumoral lesion had been successfully removed. The final diagnosis of a primary intraosseous Pindborg tumor was established .There were no postoperative complications. The patient was discharged on the fourth postoperative day and followed up at the outpatient clinic. A pureed diet was advised for the first month and a normal diet thereafter. Clinical and radiological imaging studies showed excellent long-term stability of the mandible. The maximum jaw opening was stable at 40 mm with no evidence of mandible deviation. There was no evidence of recurrence after a follow-up of one and a half years.Odontogenic tumors represent between 2% and 5% of all the neoplasms of the maxillofacial area. In the fourth edition of the World Health Organization Classification of Head and Neck Tumors, twenty-four odontogenic tumors were listed, and the Pindborg tumor, also known as the calcifying epithelial odontogenic tumor, remains a benign odontogenic subtype without significant modifications and is considered a rare pathological entity representing less than 1% of all odontogenic tumors .The clinical behavior is variable and usually presents as an intraosseous or central lesion, as in this case report. Extraosseous or peripheral lesions account for less than 5% of cases. The literature reports that the Pindborg tumor usually starts as painless intumescences that cause a slow bone expansion. It can show up at any age, but is more common in middle age, with a peak incidence in the fifth decade of life, and there is no sex predilection . It usuaA review of the current scientific literature revealed some similarities between our case and those of previous authors. In our patient, a diagnosis was not made preoperatively. A malignant tumor was suspected, given the clinical characteristics of the lesion . Misinterpretation of benign and malignant odontogenic tumors has been documented, and malignant transformation has also been reported, although it is exceptionally rare and could be a source of diagnostic confusion that suggests an erroneous diagnosis of a metastatic carcinoma of unknown origin ,9,10. InThe surgical treatment of odontogenic tumors continues to be a subject of discussion. Simple conservative enucleation and curettage have a high rate of recurrence and can be followed by persistence or recurrence of the tumor, which frequently leads to the need for later surgical excision. Radical resection including mandibular margins, using either marginal or segmental resection, is also controversial, although there appears to be a high success rate and it could be justified for aggressive lesions, as in our case, where the preservation of surrounding anatomical structures, including the dental nerve and basal mandibular cortex, was taken into account for rehabilitation in a second stage with an implant-supported prosthesis to improve the patient’s mandibular function . TargeteMandibular radiolucencies are very common and are difficult to diagnose. When considering the surgical risks involved in the removal of the lesion, the differential diagnoses of benign and malignant tumors are of great importance. The Pindborg tumor is a benign, locally invasive odontogenic tumor, not always associated with an impacted tooth, with a high recurrence rate. In extremely rare cases, it may show aggressive growth and signs of malignancy. Lesions should be treated as soon as possible because these neoplasms usually develop and invade nearby structures. The definitive diagnosis of this case report aims to reinforce the importance of accurate radiographic analysis as well as clinical correlation to arrive at a diagnosis and determine the optimal treatment planning of apparently aggressive lesions of the mandible. Surgical options include appropriate marginal resections with tumor-free margins in order to reduce the probability of local recurrence. After surgery, patients need periodic clinical and radiographic follow-ups.


Uterine artery pseudoaneurysm (UAP) is a rare and potentially life-threatening vascular anomaly caused by inadequate sealing of a ruptured wall of a uterine artery. It mainly occurs after a traumatic lesion and can lead to delayed postpartum hemorrhage. We report a rare case of UAP after an uncomplicated vaginal delivery in a patient with a history of deep-infiltrating endometriosis. Selective coil embolization was successfully performed. UAPs should always be considered in cases of unexplained abdominal pain after surgery or childbirth with or without vaginal bleeding. Uterine artery pseudoaneurysm (UAP) is a rare and potentially life-threatening vascular anomaly caused by inadequate sealing of a ruptured wall of a uterine artery. The pain can vary from mild to acute abdominal. Thus, it may mimic and mask other entities, such as adnexal masses, septic miscarriage or endometritis. UAPs mainly occur after traumatic delivery, including caesarean section or surgical procedures such as hysterectomy, myomectomy, curettage or conization. It can be a rare cause of delayed postpartum hemorrhage, and occurs in approximately in 2–3/1000 births [A 30-year-old woman, gravida 1, para 1, was readmitted to our clinic because of increasing right lower abdominal pain that had started the previous day. She had an uncomplicated vaginal delivery 7 days ago with an estimated blood loss of 500 mL. Eighteen months ago, the patient had undergone laparoscopic endometriosis remediation for deep infiltrating endometriosis  with adhesiolysis and excision of a right-sided ovarian cyst. During this operation, a chromopertubation was also performed due to a desire to have children. In the postoperative course, she initially had no pain.When presenting in our clinic, there were no signs of circulatory compromise , no fever and no vaginal bleeding. Hemoglobin was 10.4 g/dL on the day of the new admission, and leucocyte levels were 7.3 G/l and 12.5 G/l, respectively. There was no free fluid in the abdominal cavity on transabdominal ultrasound. There was a pressure pain over the lower right abdomen with discrete guarding. An acute abdomen was ruled out. Upon transvaginal ultrasound, however, there was an echogenic mass of 8.6 cm in diameter on the right side, adjacent to the uterus, with a double-headed anechoic structure in the center, each cavity of approximately 3–4 cm in diameter. Color Doppler revealed a swirl of colors (Yin–Yang sign) and a pulse-synchronous blood flow from one cavity to the other as in arterial perfusion a–c.® (900 μm)), the pseudoaneurysm was excluded from the circulation by coil embolization   a–c.Subsequently, neither further sources of bleeding nor collateralization of the pseudoaneurysm from the contralateral side could be detected. After short-term monitoring in the intensive care unit, the patient was transferred to the peripheral ward. Sonographic scans subsequently showed no blood flow in the area of the pseudoaneurysm. The day after the intervention, the patient reported pain in the right flank area and exhibited an elevated temperature up to 38.1 °C. Laboratory testing showed increased inflammatory parameters . The right renal pelvis was still mildly dilated. Suspecting a right-sided pyelonephritis, a calculated antibiotic therapy was initiated. The further inpatient course was uneventful. After a total of 10 days, the patient was discharged from the hospital. Four months later, a control MRI showed a regressive finding, now 5.2 cm in diameter, with no evidence of contrast and a clear diffusion restriction of the switched-off UAP. Even after 18 months, the patient is doing well. She has breastfed her child and has a normal menstrual period.UAP is a rare cause of delayed postpartum hemorrhage, it occurs in approximately in 2–3/1000 births ,5.UAPs can be difficult to detect, especially in cases without a history of operative trauma. There is a high risk of rupture; the exact time of this incident is not reliably predictable. Early detection is therefore mandatory, as rupture can lead to massive, potentially life-threatening intra-abdominal hemorrhage.UAPs mainly occur after traumatic delivery including caesarean section ,7 or othUsually UAPs can be detected by transabdominal and transvaginal ultrasound. Supplementary imaging, such as CT, can support the diagnosis and serve as a guidance for the interventional or surgical treatment strategy. In the past, most UPAs were treated by laparotomy or laparoscopy and arterial ligation. This was associated with surgical risks, including peritonitis, wound infection, postoperative adhesions, pain, scar discomfort, scar herniation and thrombosis . AngiogrIn our case, the patient had undergone laparoscopy 18 months before the event due to infertility and an ovarian cyst. Deep infiltrating endometriosis was found during surgery. Whether endometriosis itself or the operation 18 months prior to delivery was a causing factor in the development of this UAP remains elusive. However, cases of UAP with endometriosis have already been described ,16. DuriUAPs are potentially life-threatening, and must always be considered in cases of unexplained abdominal pain after surgery or after childbirth with or without vaginal bleeding.


Ectopic adrenocortical tissues and neoplasms are rare and usually found in the genitourinary system and abdominal cavity. The thorax is an extremely rare ectopic site. Here, we report the first case of nonfunctional ectopic adrenocortical carcinoma (ACC) in the lung.+, melan-A+, Syn+) indicated that the tumor had an adrenocortical origin. The patient showed no symptoms of hormonal hypersecretion. The final pathological diagnosis was non-functional ectopic ACC. The patient was disease-free for 22 months and is still under follow-up.A 71-year-old Chinese man presented with vague left-sided chest pain and irritable cough for 1 month. Thoracic computed tomography revealed a heterogeneously enhancing 5.3 × 5.8 × 6.0-cm solitary mass in the left lung. Radiological findings suggested a benign tumor. The tumor was surgically excised upon detection. Histopathological examination using hematoxylin and eosin staining showed that the cytoplasm of the tumor cells was rich and eosinophilic. Immunohistochemical profiles (inhibin-aNonfunctional ectopic ACC in the lung is an extremely rare neoplasm that can be easily misdiagnosed as primary lung cancer or lung metastasis, both preoperatively and on postoperative pathological examination. This report may provide clues to clinicians and pathologists regarding the diagnosis and treatment of nonfunctional ectopic ACC. Adrenocortical carcinoma (ACC) is a rare malignancy with an incidence of 1–2 cases/million persons/year and often has a poor prognosis . Most caA 71-year-old man with complaints of vague left-sided chest pain and irritable cough for 1 month was admitted to our hospital in March 2021. He had no chills, fever, hemoptysis, wheezing, or abdominal pain. He was healthy with no relevant medical or family history of diseases, such as hypertension or diabetes, and no history of smoking or alcohol consumption. The laboratory findings showed that only the prograstin-releasing peptide (ProGRP) level was elevated (198.7 pg/mL), other tests showed no abnormalities. Thoracic computed tomography (CT) revealed a 5.3 × 5.8 × 6.0-cm heterogeneously enhancing globose mass in the posterior segment of the left upper lung lobe with a smooth margin without obvious lobulation or burr Figure 118F-fluorodeoxyglucose positron emission tomography was recommended to assess the condition of the whole body for invisible lesions. However, the patient refused.Postoperatively, the pathological diagnosis was suspected to be of an extrapulmonary and adrenocortical origin. Abdominal CT showed that the bilateral adrenal glands and kidneys were normal in size and shape without abnormal mass Figure 1Repeated laboratory examination revealed that the ProGRP level reduced from 198.7 to 78.5 pg/mL without any other abnormalities. We performed the Cortisol, ACTH, DHEA-S and Aldosterone tests, They’re all in the normal range. As the patient had no relevant clinical symptoms of hormonal hypersecretion, estradiol or other hormone tests were not performed.Gross inspection of the lobectomy specimen revealed a mass lesion measuring 16×9×4 cm. The surface of the mass was mostly smooth, covered by the visceral pleura, and ruptured through the smooth inner capsule in an area measuring 6.7×6.5×4 cm. Capsular tissues had prolapsed at multiple sites. Sectioning revealed well-circumscribed, multilocular, tan-brown to tan-yellow cut surfaces.Light microscopic examination of the hematoxylin and eosin-stained specimen revealed that the cytoplasm of the tumor cells was rich and eosinophilic. The tumor cells were pleomorphic and arranged in varying round blunt cell cords and cord-like structures, with transparent bodies in some cells. Interstitial blood vessels were abundant in the tumor tissue Figure 2According to the staging criteria of ectopic ACC by the American Joint Committee on Cancer and European Network for the Study of Adrenal Tumors, the final pathologic stage was pT2N0M0, i.e., stage II.Since ectopic ACC is a rare neoplasm, no consensus has been reached for treatment recommendations . After mThe patient was followed-up every 3 months after chemotherapy for 2 years, with the latest follow-up on August 25, 2022. The patient did not complain of discomfort, and physical examination, thoracic and abdominal CT, and laboratory examination showed no obvious abnormalities. The patient had a disease-free survival (DFS) of 22 months and is still under follow-up.Ethics approval was obtained from Caoxian People’s Hospital. Data was collected following patient’s concent. Informed consent has been obtained from the patient for publication of the case report and accompanying images.ACC is a rare malignancy with an incidence of 1–2 cases/million population and often has a poor prognosis , 17 and +, Melan-A+, Syn+) indicated that the tumor had an adrenocortical but extrapulmonary origin. The Weiss score was 5, as the cells were pleomorphic and distributed in various round blunt cell cords, with extensive necrosis, and irregular karyotype, and capsular invasion , melan-A (+), Syn (+), CK (+), CgA (+), TTF-1 (-), PAX8 (-), hepatocyte (-), and arginase-1 (-). Immunohistochemical profiles  for the publication of any potentially identifiable images or data included in this article.LN collected information, wrote the manuscript and literature review; Z-FF and ZW provided figures and pathology review. AG, SW, QD, YL and YS supervised the project and reviewed the manuscript.


Ectopic adrenal tissue is rare in adults, with an incidence of only about 1%. We report a rare case of ectopic adrenocortical adenoma in the left renal sinus.A 57-year-old woman was admitted to the Department of Urology due to “a left kidney tumor” on physical examination. Multislice helical computed tomography (CT) showed the left kidney with an anterior lip mass near the hilum, approximately 2.3 cm × 2.2 cm in size. Preoperative renal artery CT angiography (CTA) showed no obvious abnormality. Laparoscopic resection of the left renal sinus mass was performed, and postoperative pathological findings showed ectopic adrenocortical adenoma. The tumor was a nonfunctional adenoma.Renal ectopic adrenal cortical adenoma is rare. Most of them are nonfunctional adenomas, which cannot be clearly diagnosed by preoperative imaging examination and can often be diagnosed by postoperative pathology. Ectopic adrenal tissue is rare in adults, with an incidence of only about 1% , broad lThe 51-year-old female patient was admitted to the Department of Urology on 3 November 2021 after physical examination found “a left kidney tumor”. The patient did not have the common concomitant symptoms of renal tumors such as gross hematuria and lumbago. The patient’s body mass index (BMI) was 27.8 . She was not observed to be concentrically obese, and her blood pressure (BP) was in the normal range (BP 133/84 mmHg). The physical exam was normal. No masculine features were observed. Blood routine, routine urine examination, blood sugar, blood lipid, serum electrolytes, liver function, and renal function were normal. Serum cortisol and plasma adrenocorticotropic hormone (ACTH) were not measured. MRI showed an approximately circular signal of slightly short T1 and short T2 near the renal sinus of the upper left kidney. Diffusion-weighted imaging (DWI) showed a slightly higher signal with a diameter of about 1.5 cm. Enhanced scan showed mild enhancement. Multislice spiral computed tomography (CT) demonstrates a lobulated soft tissue density nodule above the hilum in the medial upper pole of the left kidney. The density was uniform, and the size was about 2.3 cm × 2.2 cm. Moderate enhancement was observed in the arterial phase on the enhanced scan, and the CT value was slightly of lower density in the delayed phase  is extremely rare . FunctioThis case was a nonfunctional renal ectopic adrenal adenoma. Due to the absence of abnormal laboratory studies, this case was not diagnosed before surgery. Masses that are adjacent to the renal sinus can be difficult to precisely localize and diagnose preoperatively. Biopsy may be helpful, but surgical resection of the lesions may still be necessary for a definitive pathological diagnosis.The immunoprofile  supported the diagnosis of adrenal cortical adenoma. The cells of adrenal cortical adenomas are immunoreactive for several proteins, including SF-1, Syn, Melan-A, and HMB45, as shown in this case. CK expression is usually weak or absent. In contrast to medullary tumors, CgA is negative. Lack of EMA, CA IX, and CD10 expression excludes clear cell renal cell carcinoma. Renal oncocytic tumors can also be excluded by SF-1 positivity. The Ki-67 proliferation is quite low (about 3%), consistent with lack of mitosis and necrosis and further arguing against the diagnosis of adrenal cortical carcinoma.Management of ectopic adrenal tumors includes conservative treatment and surgical resection . Some ectopic adrenal tumors are easy to find because of endocrine function and clinical symptoms. In such cases, early treatment should be given. If the tumor is small and has no endocrine function, conservative observation can be selected. The vast majority of adrenal neoplasms are benign, but preoperatively identifying the mass as ectopic adrenal is a challenge.Malignant tumor could not be ruled out before surgery in this case. Renal angiomyolipoma was a consideration intraoperatively, but intraoperative pathological diagnosis was not performed due to surgical considerations. Intraoperatively, the tumor did not invade surrounding tissues and was enucleated. Pathologically, there was no evidence of malignancy.In this case, the patient was diagnosed with a renal tumor preoperatively. Due to the absence of endocrine dysfunction, the tumor was not accurately diagnosed before surgery. Postoperative pathologic diagnosis was adrenal cortical adenoma. Since the patient had no history of adrenal surgery, the combined findings were those of an ectopic adrenal cortical adenoma, presumably a result of abnormal migration of mesothelial cells during embryology. In addition, combined with literature reports, we found that ectopic adrenal tumors in the kidney were mostly located in the soft tissue of the renal sinus. Therefore, it is suggested that ectopic adrenocortical adenoma should be considered in the differential diagnosis of renal sinus masses. CT can be used to observe whether adrenal atrophied, and serum cortisol and plasma ACTH levels can be measured by laboratory tests, or a preoperative biopsy of the tumor, if possible, should be performed to confirm the diagnosis of ectopic adrenocortical adenoma, so as to provide better support for surgical decisions.The original contributions presented in the study are included in the article/Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.TL and RL provided patient information and wrote the manuscript. XH conceived the manuscript. KL and QR collected the data. YZ and LM prepared histopathological examination and illustrations. ZL consulted the treatment plan. ZG reviewed the topic presentation, structure of the manuscript, illustrations and photographs. YC obtained resources, reviewed and edited the writing. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Regenerative endodontic management is a feasible treatment for immature teeth with periapical radiolucency and necrotic pulp that simplifies continued root creation. Among the most prevalent health problems in an immature root is dental pulp necrosis, which is caused by caries, improper endodontic treatments, and trauma. Necrosis of the dental pulp can affect long-term tooth survival and preservation and serve as a source of bacteria infecting the periapical tissue and the maxillofacial space. Here, we report on the application of advanced platelet-rich fibrin plus (A-PRF+) therapy, as a regenerative endodontic treatment (RET), in a 12-year-old with necrotic pulp and asymptomatic apical periodontitis. Over a 24-month follow-up post-treatment, we observed resolving of symptoms and a complete root formation with considerable periapical healing. Pulp necrosis in immature teeth leads to the incomplete development of roots, consisting of thin walls and open apices, making endodontic management challenging . The pulImmature teeth with apical periodontitis and pulp necrosis make challenges for endodontic management owing to the incomplete development of roots, thin root walls, and open apices . For theSeveral case studies have been published on immature necrotic teeth, indicating the potential of RET in stimulating the continuous formation of root length and width and preserving their structural integrity –6. UsingMore recently, studies have been performed on an autogenous material, platelet-rich fibrin (PRF), which serves as an osteoconductive scaffold with integrated growth factors for stimulating the cells for a regenerative response. While this technique has been utilized in dentistry for repairing different lesions and regeneration of dental and oral tissues, it can also be employed as a scaffold for pulp regeneration in an immature necrotic tooth .The present case report describes the management of a non-vital immature premolar tooth causing symptomatic apical periodontitis and necrosis of the pulp.The patient was an 11-year-old boy referred to the Department of Endodontic Dentistry of Tehran University of Medical Science, Tehran, Iran, with a complaint of spontaneous pain in the lower left premolar (tooth #20).General dental, medical, and traumatic histories were obtained, and no systemic disease was noted. Extensive caries was revealed by clinical examination on the occlusal surface as well as sensitivity to palpation and percussion and dens evagination addressed as a differential diagnosis for this case. A negative response was obtained by the vitality test with electric pulp testing (EPT)  and Endo-Frost cold spray , which represented no mobility. In the radiographic examination, an immature root was found along with deep caries, open apex, and periapical radiolucency. Additional caries was not found in the other teeth .Necrotic pulp was diagnosed with symptomatic apical periodontitis. REP was proposed as the best feasible option for treatment. A full explanation was provided to the patient and his family about the risks and benefits of REP, and informed consent for the procedure was obtained.An inferior alveolar nerve block was given with 2% lidocaine and 1 : 100,000 epinephrine  on the first visit. Caries removal and access cavity were conducted with diamond burs  followed by rubber dam isolation. An apex locator  along with radiography  was used to verify the working length. To irrigate the canals, 20 ml of 1.5% sodium hypochlorite (NaOCl) with ultrasonic passive activation was used. This was followed by irrigation with normal saline and drying by paper point . After applying CaOH into the canal, the access cavity was sealed temporarily with RMGI .The second session was appointed after 3 weeks. The patient did not have any complications. Using 3% mepivacaine, the tooth was anesthetized without a vasoconstrictor . The temporary restorative material was removed after isolation with a rubber dam. Normal saline was used to wash Triple antibiotic paste (TAP) out of the canal. The canal was irrigated thoroughly with 20 ml of 17% Ethylenediamide tetraacetic acid (EDTA). PRF was prepared by drawing 10 ml of whole blood and centrifugation at 1300 rpm for 8 minutes. After drying the canals, a 40-K file was inserted 2 mm beyond the apex in the canal to initiate bleeding . The advanced platelet-rich fibrin plus (A-PRF+) was injected into the root canal to a level of 3 mm under the cementoenamel junction (CEJ). To reduce the discoloration effect of MTA, a dentin bonding agent was placed on the dentinal walls. Ortho MTA  was placed as a coronal barrier. A moist cotton pellet was placed over the MTA in the pulp chamber, and the access cavity was temporized again with GC1 filling .A week later, during the third appointment, the glass ionomer and cotton pellet were removed. By setting MTA, restoration of the tooth was performed with composite .During follow-ups at months 3, 6, 12, and 24, the tooth remained asymptomatic with no sign of resorption, clinically or radiographically. Healing of the periapical lesion was illustrated through a radiographic assessment, which showed incremented root thickness, length, and width, indicating the apical closure  and PRF (85.2%). The same value for root lengthening was 64.2% (PRP) and 74.1.2% (PRF). The periapical lesion healing response as well as dentinal wall thickening rates was 100% for both PRP and PRF . HoweverThe tooth was deemed clinically asymptomatic, and there was a complete root formation with considerable periapical healing radiographically and a successful outcome. In addition to the limitation of case report in term of its essence, it should be mentioned that it was not possible to confirm the vitality of the pulp after regeneration due to the lack of access to laser Doppler flowmetry and pulse oximeter.Regenerative endodontic treatment with A-PRF+ was effective in the treatment of apical periodontitis and immature permanent premolar with pulp necrosis. For 24 months, follow-up appointments were conducted, in which the tooth was deemed clinically asymptomatic with a complete root formation and considerable periapical healing, demonstrated radiographically.


Dental tumors are lesions that stem from the epithelial and mesenchymal elements which are tooth components. For this very reason, they involve the maxilla and must make up the differential diagnosis of the lesions associated with this structure. The odontogenic myxoma is an uncommon benign neoplasia of slow and infiltrative growth, usually assymptomaticALNM, a 38-year-old female, African-American, came to de dentistry department of the hospital with a posterior mass in her left maxilla, without knowing for certain the time of evolution, and reporting that she had been submitted to surgery to correct the alveolar border with a histopathology diagnosis of myxofibroma. Panoramic x-ray showed an imaging suggesting a multilocular bone destruction of ill-defined margins. A CT-scan showed involvement of the left maxillary sinus, with evidence of lesion infiltration . The patIn the aforementioned case, the patient came to us complaining of an asymptomatic growth in the oral region of the maxilla, which is in accordance with most of the authors who state that this is a slow growth, invasive, asymptomatic lesion with bone cortical expansion. The mandible is the most involved regionOdontogenic myxoma is a rare lesion, with characteristics that are similar to those of other oral lesions, and this requires knowledge on the lesion, a detailed exam and histopathology in order to establish an early diagnosis and to offer a safe and risk-free treatment to the patient, avoiding sequelae and extensive mutilations which are common in the treatment of invasive lesions.


In recent years, it has been determined that primitive myxoid mesenchymal tumors of infancy (PMMTI) are solid tumors. To date, very few cases of PMMTI have been reported, and there is no consensus regarding treatment. To provide additional references, it is necessary to collect and report the diagnoses and treatment outcomes of related cases. We report the case of a 38-day-old girl who presented with a 5-cm purple tumor in the right shoulder. Upon hospital admission, the patient received an intratumoral injection of bleomycin after diagnosis of a possible lymphangioma. 10 days after the treatment, the tumor began to develop inflammation and necrosis, resulting in a clear demarcation between the tumor and surrounding tissue. Hence, during the second hospitalization, we performed a successful tumor resection. Postoperatively, the tumor was pathologically diagnosed as PMMTI. 3 months after excision, the patient showed no local recurrence on re-examination. To the best of our knowledge, this is the first report of a PMMTI in which bleomycin, or other similar chemotherapeutic drugs, have been injected into tumors. This result offers novel insights into the treatment of PMMTI. Injection therapy with bleomycin and similar chemotherapeutics may result in specific responses to PMMTI, which may help in developing better surgical conditions or improving outcomes in non-surgical patients. Primitive myxoid mesenchymal tumor of infancy (PMMTI) was first reported by Alaggio et al. . It is dIn this study, we report the case of a 38-day-old girl with a PMMTI in the right shoulder, who was intratumorally injected with bleomycin. To the best of our knowledge, this is the first report of a PMMTI in which bleomycin, or other similar chemotherapeutic drugs, have been injected into tumors.The patient was a 38-day-old girl with a normal vaginal birth at 40 weeks of gestation. Her birth weight was 2,800 g. Her parents were healthy and unrelated. Her mother denied any use of teratogenic drugs, smoking, alcohol consumption, or a history of chronic disease during pregnancy. The patient had a sister who was in good health. Her parents discovered a 5-cm purple tumor on the patient's right shoulder 1 week after receiving the Bacillus Calmette-Guérin (BCG) vaccine; however, there was an absence of pain, swelling, fever, dyspnea, vomiting, and other symptoms. The tumor persisted for 1 week; the texture became slightly more rigid, although its size remained essentially unchanged. The patient was admitted to the local hospital for treatment, and magnetic resonance imaging (MRI) revealed a possible lymphangioma. Subsequently, they visited our hospital's outpatient department where B-ultrasound revealed lymphatic malformation in the right shoulder with bleeding. Routine blood tests, coagulation spectrum, liver and kidney function, preoperative immunity, and necessary preoperative tests, including chest X-ray and electrocardiogram, revealed no obvious abnormalities following admission. On the 2nd day of admission, ~3 mg of bleomycin was administered through multiple injections, and no obvious fluid was removed. Normally, bleomycin would be injected at a dose of 0.3–0.6mg/kg, and the maximum dose should be no more than 10 mg per injection . TherefoThe diagnosis of PMMTI was proposed by Alaggio et al. . They reBCOR gene in undifferentiated round cell sarcoma and PMMTI in infants. Of the seven PMMTI cases reported, six showed BCOR-ITD, which was gradually recognized in later case reports as a diagnostic basis for PMMTI . Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin. Written informed consent was obtained from the minor(s)' legal guardian/next of kin for the publication of any potentially identifiable images or data included in this article.BY, QC, and YQ analyzed the data and wrote the manuscript. YZ, JW, AD, YC, WG, XH, and ZG contributed to clinical and instrumental data. All authors contributed to the article and approved the submitted version.This study was supported by the Natural Science Foundation of Zhejiang Province (Grant No. LY19H190005).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Giant cell tumors (GCTs) are a category of benign but locally aggressive tumors that are challenging to treat. GCT topography most often affects the epiphyseal and metaphyseal regions of long bones but rarely flat bones. We report the case of a 35-year-old woman with an aggressive GCT of the right scapula. Unfortunately, the late presentation of this case to the emergency department makes the scapulectomy more difficult to carry out effectively. As this case highlights, the lack of access to primary care and the lack of available family physicians in the community remains detrimental to good medical care in systems with limited resources. Giant cell tumors (GCTs) are a category of benign but locally aggressive tumors. Although benign, GCTs show a tendency for significant bone destruction, local recurrence, and occasionally metastasis ,2. TheirPain is the most common symptom of GCTs. Swelling and deformity are associated with larger lesions, and spreading to the surrounding soft tissue is common. The incidence of pathological fractures on presentation is 11% to 37% . Bone GCA 35-year-old woman was presented with apparent dyspnea. She reported pain in the right shoulder lasting five years, followed by the appearance of a mass on the inferior angle of the scapula, rapidly progressing, leading to dyspnea on exertion and causing the patient to seek consultation. On admission, her blood pressure was 140/90 mmHg, her oxygen saturation was 98%, she was afebrile, her heart rate was 77 beats per minute, and her respiration rate was 26 breaths per minute. On questioning, she reported dyspnea on exertion associated with right shoulder pain.The physical examination revealed diffuse swelling of the scapular region and the right shoulder Figure . On palpA shoulder X-ray revealed an increase in the volume of the scapula, cortical thinning, and a range of multiple lacunar osteolytic lesions with a classic soap bubble appearance, eccentric, expansile, well-defined, and involving the entire bone without intralesional matrix Figure . ComputeThe bone biopsy results were consistent with the radiological findings and showed many multinucleated giant cells averaging more than 70 nuclei. Round and oval uniform mononuclear cells were intermingled. The nuclei of the giant cells resemble those of mononuclear cells. We revised her diagnosis to Enneking Stage IIa aggressive GCT of the right scapula.A total right scapulectomy would be the ideal treatment. However, after an informed discussion, the patient did not wish to proceed with this line of treatment. Instead, we opted for palliative treatment (based on chemotherapy and radiotherapy) to limit the expansion of the tumor with strict monitoring of the patient through frequent follow-up appointments.Bone GCTs tend to occur in the distal femur and proximal tibia. Reports of GCT involvement in the scapula are rare in the literature . The disVarious surgical options for scapular tumors have been described. Total scapular prostheses after scapula tumor resection are available, but long-term outcomes are unknown . SimilarIn June 2013, the United States Food and Drug Administration approved denosumab as an alternative treatment for unresectable cases in adults and skeletally mature adolescents. In fact, denosumab provides favourable and consistent clinical and radiographic responses, which facilitates less aggressive surgical treatment, especially joint preservation. However, the local recurrence rate for GCTs of bone following resection does not seem to be affected by denosumab and remains a concern ,15.Indeed, despite the aggressive character of the tumor and its grading and staging, less than 25% of these cases carry a risk of metastasis , and theGCTs are relatively common bone tumors and are generally benign. They usually originate from the metaphysis of long bones, extend to the adjacent epiphysis on the articular surface, and have a narrow transition area. Although rare, this case describes an aggressive form of the tumor located on the scapula of a 35-year-old woman. The late presentation of this case to the emergency department makes the scapulectomy more difficult to carry out effectively. As this rare case highlights, the lack of access to primary care and a lack of available family physicians in the community remains a detriment to good medical care in systems with limited resources.


A full-term female baby presented at 24 hours of life at the emergency department with occipital encephalocele, bilateral cleft lip, and cleft palate. She was born to a second gravida mother with no consanguinity between the parents. On examination, encephalocele was 10centimeters x 7centimeters in size with bilateral cleft lip and palate. It presents the opportunity for healthcare professionals to learn about a group of congenital neurological disorders in the content of a rare case presentation and highlights the importance of ultrasonography in the antenatal period for the detection of neural tube defects in the early stage for proper counselling and management. A compulsory prenatal diagnosis of the suspected family should be done by the intervention of the public sector of any country so that we can prevent and avoid abnormal birth. Encephaloceles represent 15%-20% of all NTDs. The incidence of congenital encephalocele is estimated at 1 in 10,000 live births.2 The incidence is still high in developing countries.4 The prevalence of selected NTDs is 4.0  per 10,000 children in Nepal.5Encephalocele is a congenital malformation characterized by a protrusion of the brain tissue and/or meninges through a skull defect; classified into primary which is present at birth while secondary encephalocele is acquired and commonly due to trauma or post-surgical defect.A female baby presented at 24hrs of life at the emergency department of Lumbini Medical College and Teaching Hospital Palpa, Nepal after a spontaneous vaginal delivery at home. She was born full-term with a birth weight of 2.8kgs to a 27years old second gravida mother with one live baby at home. Birth events were uneventful; the baby cried immediately after birth. Upon arrival to hospital, paediatrician on the call noted a bulging occipital mass with 10cm x 7cm in size  with bilth percentile), Anterior fontanel was open and at the level. There was no murmur, the baby had passed meconium within 24hours after birth. There were two umbilical arteries and one umbilical vein. Limbs were normal. Regarding the antenatal history, the mother attended her Antenatal Care visits two times with ultrasonography (USG) done twice without any significant anomalies in USG. She did not take any iron, calcium, or folic acid supplementation during pregnancy. Her past obstetrical history was insignificant without any diseases or medication history during pregnancy. Her other child is healthy with no evidential defect. There was no history of consanguinity among the parents.The baby was then shifted to the Neonatal Intensive Care Unit (NICU) where she was kept under an overhead warmer in the left lateral position and was kept nil per oral. Nasogastric feeding was started as she had difficulty in sucking due to the cleft lip and palate. Detailed examination revealed an active baby moving all four limbs normally with no neurological deficit. Head circumference was 28.5cm  scan  which shA provisional diagnosis of Encephalocele with Bilateral cleft lip and palate was made. The neurosurgeon advised interval excision of encephalocele along with calvarium reconstruction. The parents were counselled but they did not give the consent immediately. Instead, the subject was discharged on request from the hospital assuring us that the parents would return soon after arranging the personal work at home. They were taught spoon-feeding as the special spoon for the cleft palate was not available in our area. But we lost the patient on follow-up.5 They are often associated with other midline anomalies such as hypertelorism, broad nasal root, cleft lip, and cleft palate.6 This is similar to our case reported showing occipital encephalocele with cleft lip and palate. Other associations include microcephaly, microphthalmia, cleft lip and palate, polydactyly, polycystic kidneys, and ambiguous genitalia.7 Occipital encephaloceles occur due to a defect in the fusion of occipital bone. The occipital bone develops from two sources. The failure of fusion of these two parts of occipital bone has resulted in the defect in this case. Such midline defects are associated with other midline lesions.8 This fetus presented with bilateral cleft lip and cleft palate. Such variable association of midline defects with occipital encephalocele can be attributed to multifactorial aetiology. More than 80% of encephalocele cases are not associated with certain genetic or chromosomal abnormalities.9 The incidence is between 1 in 3000 to 1 in 10,000 live births; approximately 90% of them involve the midline. Magnetic resonance imaging is the method of choice in diagnosis and surgery is the best option for the treatment of Occipital Encephalocele. The prognosis of patients born with occipital encephalocele depends on the size of the defect and the amount of brain tissue herniated into the encephalocele. Overall morbidity and mortality are high despite advanced surgical management but have been significantly improved in recent years thanks to sophisticated high-resolution imaging, adequate and proper surgical treatment, and decent post-operative care.10 Factors that determine the prognosis of patients diagnosed with occipital encephaloceles include the size of the sac, the contents of the neural tissue, the presence of hydrocephalus, infections, and pathologies that accompany the condition.11Occipital encephalocele presents as a mass in the occipital region usually covered by skin. They are the most common type of encephalocele. It is more frequent in females than males.12 In some patients with gliotic tissue can be completely excised without postoperative neurological deficit. Whereas, Occipital Encephalocele associated with hydrocephalus needs a ventriculoperitoneal shunting.11 But with associated anomalies, the patients' prognosis becomes rather poor. Hence there is a need for early prenatal diagnosis of such congenital defects. Limited literature regarding the aetiology and risk factors associated with occipital encephaloceles warrants additional prospective studies with larger populations. There is a need for the development of a good surveillance program with a full-proof reporting system. In fact, in the surveillance manual for congenital anomalies developed by WHO, ICBDSR, and CDC encephalocele, cleft lip and cleft palate have been included not only because of their ease of diagnosis but also because there is a potential for prevention, early diagnosis, and treatment.13The aim of surgery is resection of the sac, maximum preservation of herniated brain tissue, and closure of the defect, and surgery should be performed as early as possible. In a technical note mentioned by Bozinov, et al. for the surgical closure and reconstruction of a large occipital encephalocele without parenchymal excision, initially, the cystic portion is removed so that a partial reduction of the encephalocele is achieved. Six months later, the surgical closure of the defect is performed, with preservation of the occipital and cerebellar parenchyma, by incising the tentorium and retracting the cortex to the newly created infratentorial space. The bony defect is covered with autologous osseous graft harvested from parietal bone and reconstructed.


The coexistence of meningioma and pituitary adenoma is very rare, especially in the same location after meningioma surgery. Here, we reported a case of coexisting meningioma and pituitary adenoma secondary to postoperative meningioma in the sellar region in a patient who had not received radiation therapy before the second surgery. A 61-year-old woman underwent craniotomy for tumor resection for sellar meningioma in 2017, and postoperative imaging showed no residual in the surgical area. In 2022, the patient had a history of decreased vision again. MRI showed the possibility of postoperative pituitary adenoma in the sellar region. The patient underwent endoscopic resection of the skull base lesion again. After surgery, the patient's visual symptoms improved. Histology of the sellar tumor showed both meningioma  and pituitary adenoma in the same section. The coexistence of meningioma and pituitary adenoma is a very rare surgical entity. This report provides a theoretical basis for the selection of intracerebral tumor surgery and provides a diagnostic basis and treatment reference for patients diagnosed with meningioma and pituitary adenoma at the same time. The sellar region is located in the central portion of the skull base, behind the posterior wall of the sphenoid sinus and between both cavernous sinuses, and is one of the locations with a high incidence of intracranial tumors. The sellar area is adjacent to the internal carotid artery, optic nerve, pituitary gland, hypothalamus, and other vital structures . A spaceAs one of the most common intracranial tumors, meningioma originates from the intracranial meninges, with an incidence of about 15–25% . Among tThis study reported a rare vision loss 4 years after meningioma surgery. MRI examination revealed tissue lesions in the sellar region. The patient underwent minimally invasive neurosurgery. The postoperative tumor pathology results showed meningiomas and pituitary adenomas in the intracranial sellar region. The pathological results suggest that the tumors in the sellar tissue are also diverse, not as simple as a single tumor. Therefore, when dealing with this type of disease, it is necessary to comprehensively consider and combine neuroendoscopy, neuronavigation technology, and microsurgery technology to select the optimal treatment plan, so as to accurately locate the tumor location and meet the requirements of total tumor resection and subtotal tumor resection. This further reduces the incidence of postoperative complications.A 61-year-old female patient underwent an MRI examination in 2017 due to the progressive decline of binocular vision, which showed intracranial sellar space-occupying lesions, and underwent craniotomy for tumor resection. The postoperative pathological results showed meningioma, meningeal epithelial type, and WHO I type ,B. SymptThis patient's clinical manifestation of the adenoma was a non-functional adenoma, which only shows that the tumor compresses the optic nerve and causes vision loss. The detection of hormone level in patients before the second operation, thyroid-stimulating hormone (TSH): 2.03 mIU/L (reference range: 0.56–5.91 mIU/L); Free T3 (FT3): 4.63 pmol/L (reference range: 3.8–6.47 pmol/L); Free T4 (FT4): 6.45 pmol/L (reference range: 7.9–17 pmol/L); T3: 1.52 nmol/L (reference range: 1.34–2.73 nmol/L); T4: 83.24 nmol/L (reference range: 78.4–157.4 nmol/L); luteinizing hormone (LH): 6.82 mIU/ml (reference range: 10.87–58.64 mIU/ml); follicle-stimulating hormone (FSH): 26.97 mIU/ml ; pituitary prolactin (PRL): 34.29 ng/ml ; growth hormone (GH): 0.07 ng/ml (reference range: 0.01–3.607 ng/ml); and cortisol (Cor): 97.830 μg/L (reference range: 60.2–184 μg/L).The patient has a clear mind, good mental state, equal and equal round pupils on both sides, with a diameter of about 3 mm, sensitivity to light reflex, normal eye movement, and poor vision in both eyes, the results of Octopus visual field examination showed that the peripheral visual field of the left eye was significantly defective, and the temporal visual field of the right eye was slightly defective. The visual acuity of the right eye was 0.6, the visual acuity of the left eye was 0.3, and the visual acuity of the left eye decreased significantly, and no abnormality in the nasal cavity and external auditory canal. The forehead lines, nose, and lip grooves were symmetrical, and the tongue was in the middle. The forehead and face feel was normal, and the mouth feel was strong, the Weber test was in the middle, and the corneal reflex, pharyngeal reflex, and head–eye reflex were normal. The shoulders were symmetrical on both sides. The neck was soft, without resistance. The muscle strength of both limbs was Grade V, the muscle tension was normal, the deep and shallow senses of the limbs were normal, the superficial reflex was normal, and the tendon reflex was not hyperfunction. Bilateral pathological signs were not elicited.On 27 March 2017, the preoperative enhanced MRI scan of the patient's head showed that a 2.99 × 1.75 cm enhanced focus was found in the pituitary fossa, with blood vessels running inside and optic nerve compression .On 3 April 2017, postoperative CT of the patient showed that the part of the frontal bone was absent, no obvious abnormality was found in the brain parenchyma and ventricular system, and the midline structure of the brain was in the middle .On 19 April 2022, a plain scan and enhanced MRI of the patient's head before the operation showed that after the operation in the sellar region, the size of the tumor was about 2.8 × 4.0 cm, lumps and other T1–T2 signal mass shadows could be seen in the operation area. The tumor body wrapped around the internal carotid artery on enhanced scan and pushed upward to press the optic chiasma .On 21 April 2022, there was a slightly high-density strip shadow under the skull plate, no obvious abnormality was found in the ventricular system, and the midline structure of the brain was in the middle .The patients should complete preoperative vital signs, laboratory, imaging-related examinations, and determine the tumor location and operation mode. Selected a 30-degree endoscope to place into the nasal cavity, exposed the opening of the sphenoid sinus, and cut the nasal septum mucosa at the middle turbinate to fully expose the surgical field. The surgical area showed the tumor was flesh red, hard, and rich in blood supply. The tumor should be removed in blocks. The tumor removal sequence was first at the saddle bottom, then at both sides, and then at the middle. The tumor showed invasive growth. The tumor near the internal carotid artery was tightly adhered and was retained in a minimal amount.After the operation, both internal carotid arteries were well-protected, and the artificial meninges at the sellar floor were completely repaired. The patient was discharged from the hospital, the patient had a clear mind, no apparent blood exudation in the nasal cavity slightly decreased sense of smell, equal large and equal round pupils on both sides, light sensitivity, no apparent decline in vision, and no apparent neurological impairment symptoms left.After discharge, we regularly went to the outpatient department of our hospital for reexamination. Furthermore, the patient's vision does not continue to decline, his olfactory sense returns to normal, and no tumor growth is found in the postoperative reexamination imaging. Considering the relatively short recurrence interval of the tumor and the minimal amount of residual tumor near the carotid artery during the operation, we were now receiving gamma knife intracranial directional radiotherapy.Whether pituitary adenomas and meningiomas can interact and transform is unclear. The preferred diagnosis of single sellar lesions is a pituitary adenoma. Studies have found that 10–15% of patients with intracranial tumors were diagnosed with pituitary adenomas by autopsy, and 23% were diagnosed with meningiomas by MRI . The sinHowever, other scholars believe pituitary tumors, as endocrine tumors, are closely related to their clinical manifestations and hormone secretion. The increase in endogenous hormones that can cause tumors of different tissue types to interact with each other is unknown. Wiemels et al.  explaineThe pathogenesis of meningioma may be closely related to gene mutation. The mutation or deletion of the tumor suppressor factor (NF2) gene, which most often occurs on chromosome 22, can be found in more than 50% of sporadic meningioma patients. With the rapid development of new sequencing technology, some mutation genes commonly found in meningiomas, such as SMO, AKT1, PIK3CA, KLF4, BAP1, POLR2, SMARCE1, and TRAF7. SMO, AKT1, and PIK3CA mutations are specific mutations in anterior skull base meningiomas, while KLF4 mutations are highly expressed in secretory meningiomas, and BAP1 mutations are common in rhabdomyoma meningiomas . The priConsidering the high recurrence rate and initial location of the tumor at the same site as the patient, “SMO mutation” may exist in this case. SMO mutation is mainly found in anterior skull base meningioma, which is obviously abnormal with the normal meningioma-prone site. It is a vital signal converter in the sonic hedgehog (SHH) signal pathway and is inseparable from embryonic development and tumor occurrence. It plays a vital role in the process of intracranial lesions in patients with aggressive, unresectable, and highly recurrent meningioma. Unfortunately, due to the immaturity of advanced theoretical knowledge and the lack of detection technology, the patient failed to carry out relevant gene detection to determine the existence of SMO gene mutation in the patient's cells , 14.With the incidence of pituitary tumors, there is still no effective drug treatment. Therefore, surgery is the best choice for treatment. Despite this, the recurrence rate of patients within 10 years is still as high as 7–12% , and theMRI is commonly used in the diagnosis of sellar tumors, but in the process of clinical diagnosis, it is found that the imaging manifestations of pituitary adenomas and intrasellar meningiomas are very similar, and MRI cannot differentiate them before surgery. Therefore, intraoperative histopathological examination is an essential step in identifying tumor attributes. The MRI examination of the patient reported in this study showed the state of the sellar region, and the operation area showed a mass shadow with T1 and other T2 signals. The enhanced scan showed uniform enhancement, which seemed to be a single tumor. However, intraoperative histopathological examination confirmed the coexistence of pituitary adenoma and meningioma, and the pathological indicators provided a theoretical basis for postoperative treatment.After meningioma surgery, pituitary adenoma and meningioma coexist in the same sellar region, making the operation more difficult. According to the experience of senior doctors, when the pituitary adenoma and meningioma are adjacent to each other, a single pterional approach or endoscopic single intranasal transsphenoidal approach can be used for one-time surgical resection. Compared with conventional surgery, this approach significantly increases the risk of surgery and poor prognosis. Therefore, perfect preoperative examinations, a complete understanding of the specific conditions of the location and function of intracranial tumors, and an assessment of the patient's general condition are essential prerequisites for formulating appropriate surgical approaches and avoiding severe complications.The imaging manifestations of sellar tumors are similar, and a definitive diagnosis cannot be made preoperatively. Therefore, intraoperative histopathological examination is crucial, which can provide a theoretical basis for the subsequent treatment.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding authors.The studies involving human participants were reviewed and approved by Affiliated Lianyungang Hospital of Xuzhou Medical University. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.WL, YShe, and WY: data analysis and interpretation. WL, YShe, WY, and LA: drafting of the manuscript. LA: acquisition of data. YShi: critical revision of the manuscript. XK and YShi: study concept and design. XK: study supervision. All authors read and approved the final manuscript.This study was supported by the Organization Department of Jiangsu Province and Jiangsu Provincial Health Commission (ZDA2020018).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.