There are limited data about the cutaneous metastases of gynecological malignancies in the literature. Based on this limited number of studies, cutaneous metastases from gynecological malignancies are uncommon occurrences. Cutaneous metastases from the synchronous endometrioid carcinoma of the uterine corpus and bilateral ovaries arising from endometriosis are extremely rare. Herein, we report a 51-year-old woman with FIGO Stage 1A Grade 1 endometrial endometrioid-type adenocarcinoma and synchronous bilateral Stage 1B ovarian endometrioid-type adenocarcinoma who presented 34 months following total abdominal hysterectomy and bilateral salpingo-oophorectomy with skin metastases. After the patient underwent an excisional biopsy, we applied a palliative radiotherapy. The patient received the combination therapy with cisplatin and doxorubicin after the completion of radiotherapy but the disease evolution was rapidly fatal and the patient died 4 months after her admission to our department due to widely disseminated disease. Metastases to the skin from internal carcinoma are relatively rare, with a reported incidence of 0.7–10% –4. In thSynchronous primary endometrial and ovarian cancer arising from endometriosis is frequently encountered in daily clinical settings. The presence of simultaneous carcinomas involving both the ovary and uterine corpus represents a diagnostic challenge, particularly if the tumors have a similar histology. The classification of these lesions as either two separate primary tumors or as a single primary tumor with a metastasis has significant implications with respect to patient prognosis and recommendations for therapy. Although several morphologic criteria have been proposed as guidelines for the classification of these lesions, certain cases remain difficult to classify with accuracy.In this paper, we report a 51-year-old woman with FIGO Stage 1A Grade 1 endometrial endometrioid-type adenocarcinoma and synchronous FIGO Stage 1B bilateral ovarian endometrioid-type adenocarcinoma who presented 34 months following total abdominal hysterectomy and bilateral salpingo-oophorectomy with skin metastases. Similar cases in the literature are reviewed.A 51-year-old female, gravida 1 para 1, postmenopausal for 6 years, presented to her gynecologist with a new complaint of vaginal bleeding for 1 month. A systematic physical examination was negative. The patient had no significant past medical history and was not on medication. Since menopause, she had no previous episode of postmenopausal bleeding. Endometrial biopsy and endocervical curettage were performed. The pathologic report was the following: well-differentiated endometrioid-type endometrial adenocarcinoma.The patient was referred to the gynecologic oncology service and underwent an exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic and paraaortic lymph node sampling. Surgicopathologic assessment revealed FIGO Stage IA Grade 1 endometrial endometrioid-type adenocarcinoma and synchronous FIGO Stage 1B bilateral ovarian endometrioid-type adenocarcinoma arising from endometriosis. The patient received paclitaxel/carboplatin combination chemotherapy for 6 cycles after surgery. Then she received external pelvic irradiation (4500 cGy) in 25 fractions followed by intracavitary radiation therapy (3500 cGy).She was followed regularly with a physical examination every 3 months and a chest X-ray every 6 months and was clinically without evidence of disease. Twenty-two months after her initial therapy, scalene lymph node metastasis was seen and confirmed by biopsy. The disease continued to progress while the second-line chemotherapy was applied to the patient. She was referred to our department thirty months after her initial therapy with supraclavicular mass and cutaneous lesions on chest wall skin. Clinical examination revealed the presence of a right supraclavicular lymph node and cutaneous papulobullous lesions located on the right chest wall skin . A cerviCutaneous metastasis is a relatively uncommon manifestation of internal malignancies. It most often occurs late in the course of disease but may also be the first presentation of underlying cancers. The overall incidence of cutaneous metastases from visceral neoplasm is 5.3%, ranging from 0.7% to 10% , and 1.9Histopathological appearance is the most important feature in the diagnosis of cutaneous metastases, as it is similar to that of the primary tumor. In our study, histology of the sections showed pigmented skin overlying metastatic malignant tumors consistent with endometrioid-type adenocarcinoma from the endometrial and the synchronous bilateral ovarian cancer. Because of advances in cancer therapy, patients with cutaneous metastases may live longer than before. Nonetheless, cutaneous metastases are still a poor prognostic sign, especially in patients with cancer of the lung, ovary, upper respiratory tract, or upper digestive tract . Most caSynchronous primary endometrial and ovarian cancer is frequently encountered in daily clinical settings but cutaneous metastases following synchronous primary endometrial and ovarian cancer are extremely rare. This study is the first one that reported the cutaneous metastases from the synchronous endometrioid carcinoma of the uterine corpus and ovary arising from endometriosis. It is a clinical sign of a widely disseminated disease with a poor prognosis: once cutaneous lesions are diagnosed, survival approximates 4–6 months.


Uterine rupture is one of the most catastrophic complications during pregnancy. It is a rare complication in developed countries but a frequent cause of maternal and perinatal morbidity and mortality in Africa. Uterine rupture occurs in 1.6% of patients suffering blunt abdominal trauma. Here we report a unique case of complete fundal rupture of the unscarred uterus following fall from motorcycle in 39-week-pregnant mother who was managed with total abdominal hysterectomy and left salpingo-oophorectomy and survived, though fetus died before intervention. We also reviewed similar cases reported from different parts of Africa. This is a preventable complication had the woman been properly instructed on transportation safety during her antenatal care visits. Uterine rupture is a serious obstetric complication, with high morbidity and mortality, particularly in less and least developed countries. With ready access to obstetric care, including caesarean section for obstructed labor, rupture of the unscarred uterus should be rare . NeverthMotor vehicle accidents, domestic violence, and falls are the most common causes of blunt trauma during pregnancy , 5. MotoA 30-year-old patient, gravida 6 para 5 , at 39 weeks of gestation was admitted to our hospital 4 hours after she sustained motorcycle accident. She was a passenger on motorcycle sitting behind the driver. The driver suddenly changed direction as pedestrian got in their way; she lost balance and fell flat on the ground. Following the accident, she started to experience severe abdominal pain and faints on attempt to get up. There was no vaginal bleeding or passage of liquor. She had no other apparent injuries and was conscious without vomiting. She had antenatal care at the local health center. All previous deliveries were vaginally at home. She had no gynaecological surgery.On physical examination, she was confused with blood pressure of 80/40 mmHg, pulse rate of 132 beats per minute; she was pale and had cold extremities. She had a bruise of 4 by 5 centimeters over her abdomen just above umbilicus and the abdomen was tender all over. There were signs of intra-abdominal fluid collection with easily palpable fetal parts. Per vaginal examination the cervix was closed; she had no vaginal bleeding. Sonographic examination revealed peritoneal fluid collection and empty enlarged uterus and the fetus in abdominal cavity had no heart activity.Uterine rupture was diagnosed and resuscitation started with crystalloid. Blood was sent for cross match and laparotomy was done with the consultation of senior obstetrician. At operation, about 2500 mL blood was present in the peritoneal cavity and the fetus had apparently recently died. The placenta was in the peritoneal cavity and other abdominal organs were normal. Blood, fetus, placenta, and membranes were removed from peritoneal cavity.There was a complete transverse tear measuring 10 centimeters in the left upper segment of the uterus, extending laterally to involve the left uterine vessels. At the same side the round and infundibulopelvic ligaments were torn. Total abdominal hysterectomy and left salpingo-oophorectomy were done . She recSafety is critical in any transport system; this is specially an area of concern when it comes to transporting pregnant women. Trauma affects 6 to 7 percent of pregnancies in the United States and is the leading cause of nonobstetric maternal death . In deveAlthough motor vehicle crashes are responsible for most severe maternal injuries and fetal losses from trauma, pregnant women are less aware of measures to decreasing maternal and fetal injury and mortality after motor vehicle accidents . In thisThe fetal and neonatal outcomes in the pregnancies that are delivered during motor vehicle accident admissions were poor. About a third ended in a perinatal death . With utThere is no universal standard for management of uterine rupture. Total or subtotal abdominal hysterectomy, repair, or repair with tubal ligation can be considered depending on the location, hemodynamic status of the patient, future fertility desire , availabThere are case reports on uterine rupture in pregnancy following motor vehicle accidents involving motorcycle from other parts of Africa and are managed differently –9. We reIn conclusion, this is a preventable complication had the woman been properly instructed on transportation safety during her antenatal care visits. Pregnant women should be informed about safety of different options of transportation and instructed on precautions to avoid injury during motor vehicle accidents as part of birth preparedness and complication readiness advice during antenatal care. As mentioned above over 83% of hospitalization following motor vehicle accidents during pregnancy involved a motorcycle  and seri


Meningeal melanocytoma is a rare pigmented tumor of the leptomeningeal melanocytes. This rare entity results in diagnostic difficulty in imaging unless clinical and histopathology correlation is performed. In this case report, we describe a case of meningeal melanocytoma of the cervical region presenting with superficial siderosis. Extensive neuroradiological examination is necessary to locate the source of the bleeding in such patients. Usually, the patient will be cured by the complete surgical excision of the lesion. Meningeal melanocytoma is a rare tumour which arises from leptomeningeal melanocytes. They are considered to be the benign end of the neoplastic lesions of the leptomeningeal melanocytes. The preoperative diagnosis of the meningeal melanocytoma is often a diagnostic challenge as the clinical and neurological features are often nonspecific. These tumors have better prognosis than their malignant counterparts . They caA 62-year-old hypertensive, obese, diabetic, male patient with short neck presented with episodic falls, difficulty in walking, and brief loss of consciousness to our hospital. Weakness of both hands and progressive weakness of all four limbs were present since 1 week. The patient was diagnosed as complex partial seizures clinically. There was no history of trauma at the presentation or in the past. The patient had a history of subarachnoid haemorrhage 6 months back for which conservative management was done elsewhere. Magnetic resonance (MR) imaging of the brain showed mild effacement of the sulcal spaces on T1 weighted images (T1WI) and T2 weighted images (T2WI) Figures . There wCervical spinal magnetic resonance imaging (MRI) revealed an intradural extramedullary mass occupying the anterior intradural space which displayed hypointense signal on T2WI and hyperintense signal on T1WI Figures . ContrasMelanocytes are cells of neural crest origin and are normally found in the leptomeningeal layers. Melanocytes may cause primary melanocytic neoplasms which can be classified as melanocytoma (benign end of the spectrum), intermediate grade melanocytic neoplasms, and primary malignant melanoma. These neoplasms can be differentiated histologically based on the identification of mitotic activity, cytological atypia, necrosis, and invasion of the adjacent structures . MelanocOn computed tomography, these lesions present as well-defined, isodense to hyperdense, homogenous, and contrast enhancing mass lesions. The MRI appearance of meningeal melanocytoma is variable, depending on the amount of melanin content present. Signal characteristics include isointense or hyperintense on T1 weighted images and isointense or hypointense on T2 weighted images which give a heterogeneous enhancement on postcontrast images and show blooming of low signal on gradient images . The conComplete excision is the treatment of choice; however this is often not possible as intraoperative haemorrhage may be severe. Furthermore, local recurrence has been reported even after gross total removal. Risk of tumour recurrence is noted even after complete excision; hence, adjuvant radiation therapy is advised in cases of both complete and incomplete resection .Melanocytoma should be considered in the differential diagnosis of the pigmented tumors which include meningeal meningioma, melanotic schwannoma, and metastatic and primary malignant melanoma , 12. RadDue to abundant melanin production, meningeal melanocytomas appear dark brown to black on gross examination. They feature pigmented spindle cells growing in tight nests. Cytologically, tumor cells are bland with less pleomorphism and indistinct nucleoli. These must be distinguished from intermediate grade melanocytic neoplasms and malignant melanoma owing to the same cell of origin. Intermediate grade melanocytic neoplasms should be considered when bland cytology with some CNS invasion, mitotic activity (0–3 mitoses per 10 high power fields), and Ki-67 labelling index ranging from 1–4 (% of nuclei) is seen. Features in favour of malignant melanoma include high mitotic activity (2–15 mitoses per 10 high power fields), central nervous system invasion, tumor necrosis, Ki-67 labelling index ranging from 2–15 (% of nuclei), and cellular and nuclear atypia [In summary, although the imaging might not differentiate the pigmented lesions very well, it helps in early identification of the complications like diffuse benign spread and recurrence. Making a correct differential diagnosis and being alert to the unusual presentation of meningeal melanocytoma as superficial siderosis will result in appropriate therapy as well as identification of the complications in the follow-up.


Epidermoid cysts, dermoids, gliomas, and meningo-/encephaloceles are the most important differential diagnoses in congenital nasofrontal masses. Since they arise from an abnormal fusion during fetal development, intracranial extension of the lesion has to be ruled out radiologically before therapy. Dermoids are the most common entity. We report about a congenital epidermoid cyst of the glabella and nasion that had been growing over the last two years before presentation in a 24-year-old patient. We discuss radiological imaging and the different surgical approaches described in literature. Congenital midline masses of the face are uncommon, occurring in one out of 20.000–40.000 live births –3. A malA 24-year-old patient presented to the Department of ENT, Head and Neck Surgery of the Cantonal Hospital St. Gallen, Switzerland, complaining of a nasofrontal mass existing since birth but slowly growing for the last 2 years. Other symptoms included a nonspecific frontal headache. There was no history of trauma, visual impairment, rhinorrhea, epistaxis, or hyposmia.Clinical examination revealed a painless mass in glabellar area of approximately 2 cm in diameter . The masSurgical excision was performed under local anesthesia through an incision along the relaxed skin tension lines (RSTL) in the glabella; blunt dissection revealed a cystic mass that did not infiltrate surrounding tissues .Histological examination showed a cystic mass with an epithelial lining and macrophages consistent with a nasofrontal epidermoid cyst.The congenital manifestation of the mass and growth during an infection is indicative of a congenital nasofrontal cyst or dermoid. Among the cystic lesions, dermoids are more prevalent than epidermoid cysts in children (58.9% versus 13.3%) . An autoNasofrontal dermoid cysts typically present as a mass with a small pore along the dorsal surface of the nose . This isTrue dermoids and dermoid sinus or fistula, encephaloceles, meningoceles, and gliomas are the most important differential diagnoses of epidermoid cysts since they also present as a midline mass in the newborn . Other cRadiological imaging often entails a CT scan as the primary investigation although ultrasound has reportedly been used . Axial, In the patient presented here, a CT scan was available and sonography was indicative of a cystic lesion obviating the need for an additional MRI scan.When a dermoid, glioma, or encephalocele is suspected a biopsy may only be considered after an intracranial extension has been ruled out because of the risk of causing meningitis or CSF leak. An open biopsy of dermoid cysts is not recommended because of the increased risk of recurrence. Fine needle aspiration cytology is advocated by some for ruling out malignancy before any therapy is conducted, but the need for such investigation is controversial .Treatment of choice is the complete surgical excision preserving the cyst wall. Recurrence rates ranging from 50 to 100% have been described when the cyst wall had been damaged during surgery . DermoidSeveral surgical techniques have been described in the literature. Choosing the approach will mainly depend on the location, the size of the lesion, and the surgeon's preference and experience. The patient's cosmetic concerns must be taken into account when discussing treatment options. The external transfacial approach by means of a vertical or horizontal incision or a Lynch incision is a straightforward approach offering a good exposure and facilitating complete removal of the lesion.Transnasal approaches may offer superior cosmetic results but carry the risk of insufficient access to masses located cranially along the nasal bones or within the glabella. The transnasal approaches may be easier to perform in patients where skin laxity is favourable, such as the elder patient. However, it has been described in young patients as well . Other eEndoscopic techniques such as the endoscopic forehead approach allow good exposure of cranially located cysts while placing the incisions well camouflaged in the scalp. Drawbacks of this technique include wide undermining of the forehead and the risk of injury to neurovascular structures .When an intracranial extension is present, a combined approach with a craniotomy may be required. Recently, less invasive techniques such as the transorbital neuroendoscopic approach (TONES) have been described with the orbital cavity serving as a corridor to the anterior skull base , 21.The primary concern in the case presented here was a complete surgical excision given the high recurrence rates reported when the cyst capsule is disrupted . In spitIn conclusion epidermoid cysts or dermoids are rare but important differential diagnoses in a patient with a congenital nasofrontal mass. For radiological imaging a MRI scan is recommended in children or if the CT scan raises suspicion of an intracranial extension. Most authors would recommend both for assessing intracranial extension and planning the surgical approach. Surgery is the treatment of choice although not always necessary, especially if there is no history of infections, suspected malignancy, or evidence of intracranial extent. Recent articles advocate endoscopic approaches for superior cosmetic outcome. However, they do not appear to have gained wide popularity. We demonstrate that the external approach resulted in minimal scarring while offering superior exposure and a safe removal of the mass.


Objective: Hemangiomas are benign vascular lesions mostly arising from soft tissues. However, intraosseous hemangioma is a rare entity, comprising only 1% of benign bone tumors. We describe here the presentation, diagnosis, and treatment of a 42-year-old woman with a painless hard swelling—diagnosed to be intraosseous hemangioma via orbital magnetic resonance imaging—localized on the left infraorbital margin. Methods: After en bloc excision of the mass with safety margins through a subciliary incision, the defect was reconstructed via Medpor, which was fixed to the drilled bones with polypropylene sutures. Results: Histopathological diagnosis of the specimen revealed intraosseous cavernous hemangioma. There seems to be no recurrence or any cosmetic deformity 3 months postoperatively. Conclusion: Total surgical excision is the preferred method of treatment for intraosseous hemangiomas with reconstruction. In this patient, we used Medpor for reconstruction of orbital floor, the infraorbital orbital rim and anterior wall of maxillary sinus. We think that Medpor is a good option since a natural smooth malar contour and adequate orbital rim can be achieved and there is no any other scar. Intraosseous vascular anomalies are rare and account for less than 1% of all bony tumors. The sites most commonly involved are the vertebral column and the skull. Within the calvarium, the parietal bone is most commonly involved followed by the frontal bone. Within the facial skeleton, vascular anomalies occur in the mandible, maxilla, and nasal bones.2 was palpated on the left infraorbital margin. There were no signs in the eye and in particular any abnormality in vision, ocular movement, or position of the globe; there was no regional paresthesia. The overlying skin was mobile and normal in appearance. No other specific finding was observed in her head or neck region.A 42-year-old woman was referred to our clinic with a complaint of gradually enlarging mass on her left cheek that she had noted in the last 3 years. The mass was painless and did not produce any symptom except for a hint of cosmetic deformity. On physical examination, a bony, hard, painless mass measuring about 1.5 × 1 cmAn orbital magnetic resonance imaging (MRI) showed a 16-mm diameter, well-circumscribed mass originating from left maxilla in close proximity to the zygomatic bone . The masEn bloc excision was decided to be the right surgical approach. Preoperative routine blood investigations were within normal limits. Anesthesiology consultation was done and the patient was scheduled for surgery under general anesthesia.3. After irrigation of the left maxillary sinus and hemostasis by bone wax, the defect was reconstructed via Medpor, which was fixed to the drilled bones with polypropylene sutures. On gross examination, the mass was a characteristically purplish-red with honeycomb appearance (A subciliary incision was performed after local anesthesia infiltration. Periosteal flap was raised, and mass exposed . The maspearance . Histopapearance .,3Hemangiomas are benign vascular lesions that are typically identified during infancy and are known to regress by adolescence.2They are classified as cavernous or capillary type according to their vascular network histopathologically. The cavernous hemangioma is composed of large thin-walled vessels and sinusoids lined with a single layer of endothelium. However, a small fine vascular network filled with blood forms the capillary hemangioma. Capillary hemangiomas are usually present at birth. In contrast, most cavernous hemangiomas occur in adulthood. Almost all intraosseous hemangiomas of the facial skeleton are to be cavernous type.Women in the fourth and fifth decades of life are mostly affected.Computed tomography is considered the most useful imaging technique because of its unique characterization of trabecular and cortical details, showing the honeycomb appearance.The goal of the treatment in hemangioma is to remove the tumor completely without any functional deficit, cosmetic deformity, or significant tissue loss. Biopsy of the lesion in order to exclude malignancy should be done cautiously because of the risk of severe bleeding.6-10In the past, radiotherapy and sclerotherapy were the treatment of choice. But today radiotherapy may only be reserved for cases in which surgery is not feasible due to the adverse effects such as tissue necrosis, retardation of growth of bones and teeth, telangiectasia, and malignant degeneration, and sclerosing agents are used for soft-tissue hemangiomas of the head and neck. Other treatment modalities include angiography with embolization, curettage, and cryotherapy.7Total surgical excision is the preferred method of treatment for intraosseous hemangiomas with reconstruction. Depending on the size of the defect and the surgeon preferences, autologous or heterologous materials can be used. Some techniques include hydroxyapatite associated with titanium mesh for reconstruction,


The tumor was removed by marginal resection of the left mandible under general anesthesia. Histopathological findings revealed that the tumor stroma contained abundant thin-walled vessels. The postoperative course was uneventful, and we found no evidence of recurrence at the postoperative 34-month follow-up.Myofibroma is a benign tumor composed of myoid spindle cells. The prevalence of myofibroma in the oral cavity is very low, with the mandible being the most common site. This report describes an adult case of myofibroma that arose on the mandible and includes magnetic resonance imaging (MRI) and positron emission tomography (PET) findings. On the MRI T1-weighted images, the tumor appeared with signal iso-intensity and was highly and heterogeneously enhanced with contrast material. On the T2-weighted images, it appeared with increased signal intensity.  Myofibroma is a benign tumor composed of myoid spindle cells arranged around thin-walled blood vessels. Myofibromas are classified as either a solitary or multicentric type . The solSome cases of oral myofibroma have been misdiagnosed as various benign and malignant tumors -7 becausA 52-year-old woman was referred to the Department of Oral and Maxillofacial Surgery, Tsurumi University Dental Hospital  on 30 October 2010 for diagnosis and treatment of a mass on the left mandible. The patient had noticed the mass for 1 month. The mass grew rapidly from the extraction socket of the lower mandibular second molar. Past medical history revealed hypertension and hyperlipidemia, which were adequately controlled with medication. The patient’s family history was unremarkable. Physical examination revealed a rubbery sessile mass measuring 20 × 15 mm on the left mandible , using the post-injection transmission acquisition method. The image showed abnormal strong accumulation of FDG in the left mandibular region with a maximum standard uptake value of 8.5. There were no abnormal accumulations of FDG in the cervical lymph nodes nor was there any uptake in the other organs . On the T1-weighted axial images, the mass appeared isointense and was highly and heterogeneously enhanced with gadolinium in the left mandibular region. On the T2-weighted axial images, it appeared with increased signal intensity. On short-tau inversion recovery coronal imaging, the mass also showed high signal intensity Figure . The PETs Figure A. The PEs Figure B.In November 2010, the biopsy was performed under local anesthesia. The pathological diagnosis was myofibroblastic tumor, probably benign. However, the mass enlarged rapidly to 35 × 25 mm within 3 weeks after biopsy. According to the clinical findings, we could not completely deny the malignancy of the tumor. On 2 December 2010, it was removed by marginal resection of the left mandible under general anesthesia -stained sections revealed that the tumor was composed of interlacing bundles of spindle-shaped cells. The tumor cells had tapered blunt-ended nuclei with pale-staining eosinophilic cytoplasm. The spindle-shaped cells did not show either cellular atypism or polymegethism. Mitoses were sometimes observed. The stroma contained abundant thin-walled vessels Figure A,B. ImmuThe postoperative course was uneventful, and we found no evidence of recurrence at the postoperative 34-month follow-up.There are few reports of adult patients with myofibroma of the mandible . ClinicaIn the present case, the preoperative diagnosis based on the biopsy specimen findings was a myofibroblastic tumor, probably benign. However, the tumor grew rapidly in a few weeks. In the oral and maxillofacial region, approximately one-fourth of cases of myofibroma exhibit rapid enlargement, and some lesions show accelerated growth after incisional biopsy . SpindleTo the best of our knowledge, PET findings of myofibroma have been reported in only one case in the literature. In that case, strong accumulation of FDG in a myofibroma of the mandible was documented . The FDGIn the present case, gadolinium-enhanced T1-weighted MRI showed strong enhancement in the tumor. Strong enhancement on T1-weighted images by contrast material was also documented in some reported cases of myofibroma -15. In tIn this report, we described an adult case of myofibroma that arose on the mandible and discussed the diagnostic value of preoperative MRI and PET findings.Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.18 F-fluorodeoxyglucose; HE: Hematoxylin and eosin; MRI: Magnetic resonance imaging; PET: Positron emission tomography.CT: Computed tomography; FDG: The authors declare that they have no competing interests.YT and TS performed the operation. HF and TS were clinically responsible for the patient’s care. KM was responsible for the pathology. KK and KN reviewed the literature. YT and HY wrote the main manuscript. YH revised the manuscript for important intellectual content. All authors read and approved the final manuscript.


Acute portomesenteric venous thrombosis is a rare but life-threatening complication of laparoscopic surgery that has been described in literature. Prompt diagnosis and early initiation of treatment are vital to prevent life-threatening complications such as mesenteric ischemia and infarction. A 51-year-old lady had laparoscopic small bowel resection and primary anastomosis with ventral hernia repair 4 weeks earlier for partial small bowel obstruction. Her postoperative period was uneventful and she was discharged home. Four weeks after surgery she developed watery diarrhea and generalized abdominal pain for four-day duration. A computed tomography of the abdomen revealed portomesenteric venous thrombosis although a computed tomography of abdomen before surgery 4 weeks back did not show any portomesenteric venous thrombosis. We are reporting a case of acute portomesenteric venous thrombosis as a complication of laparoscopic surgery. Acute portomesenteric venous thrombosis is an uncommon complication of laparoscopic surgery that has been described more often after laparoscopic bariatric surgeries. The pathogenesis of portomesenteric venous thrombosis associated with laparoscopic procedures is multifactorial. The minimally invasive nature of laparoscopic surgeries has gained increased popularity among both patients and physicians in the recent decades. Hence knowledge on rare postoperative complications becomes vital for practicing physicians to avoid delay in appropriate treatment and life-threatening complications.μL and 75% of neutrophils. She also had normochromic normocytic anemia with hemoglobin of 10.2 g/dL and normal platelet count. Chemistry showed normal electrolytes and renal function. Aspartate aminotransferase (AST) was mildly elevated to 84 IU/L  and other liver enzymes were normal. Bilirubin, total protein, albumin, and coagulation profile was normal.A 51-year-old lady with recent history of laparoscopic abdominal surgery presented to our emergency department with watery diarrhea and generalized abdominal pain for four-day duration without vomiting, fever, or any other systemic complaints. She denied recent travel and was unable to relate any food that could have triggered her symptomatology. Four weeks earlier she was found to have small bowel obstruction secondary to incarcerated incisional hernia with trapped bowel loop in the hernial sac. She has a history of caesarean section with midline incision. Patient had laparoscopic small bowel resection and primary anastomosis with ventral incisional hernia repair. During her surgery there was no mechanical injury to the portal and mesenteric veins and standard pressure of pneumoperitoneum was utilized. She was perioperatively anticoagulated with prophylactic dose of heparin. Her postoperative period was uneventful with no abdominal sepsis and she was discharged home. Histology of the small bowel revealed submucosal congestion and serosal granulation. Her other medical problems were hypertension, diabetes mellitus, peripheral vascular disease, and meningioma, abnormal mammogram with BI-RADS score of 5 (Breast Imaging-Reporting and Data System) awaiting biopsy. There was no personal or family history of clotting disorders. Physical examination was positive for generalized abdominal tenderness without guarding or rigidity. All other system examination was unremarkable. Initial labs revealed mild neutrophil leukocytosis with a white blood cell count of 12 200/A computed tomography of the abdomen was done to rule out anastomotic leak or intra-abdominal abscess as a postoperative complication and incidentally revealed filling defect within the portal vein and a branch of the superior mesenteric vein compatible with thrombosis Figures  and 2 exDuring her hospital stay biopsy of the left breast for abnormal mammogram revealed invasive ductal carcinoma in situ which may have predisposed to systemic hypercoagulable state. Another workup for coagulopathy was unremarkable. She had normal protein C and protein S levels with no resistance to activated protein C. Her lupus anticoagulant, anti-cardiolipin antibody, and beta 2 glycoprotein antibody were negative. There was no prothrombin gene mutation and antithrombin 3 levels were normal. Flow cytometry for paroxysmal nocturnal hemoglobinuria was negative. Patient was started on enoxaparin and warfarin and her diarrhea and abdominal pain resolved.Portomesenteric venous thrombosis is being increasingly recognized due to the frequent use of ultrasonography. The commonest predisposing factor is primary hepatic parenchymal disease . In a heAcute portomesenteric venous thrombosis is a rare but serious life-threatening complication of laparoscopic surgery that has been described in literature. A systematic review by James et al. revealed 18 cases of portomesenteric venous thrombosis after laparoscopic surgery excluding splenectomy . Out of There have been no reported cases of portomesenteric thrombosis after laparoscopic small bowel resection and ventral incisional hernia repair. The etiology of portomesenteric thrombosis is usually associated with more than 1 risk factor. Our patient was diagnosed with invasive ductal carcinoma in situ of the breast during the hospital stay which could have predisposed for a systemic hypercoagulable state. Breast cancer is commonly associated with deep vein thrombosis and pulmonary embolism; however portal vein thrombosis has not been reported. Our patient is a unique case of portomesenteric thrombosis after laparoscopic small bowel resection and ventral incisional hernia repair with predisposing breast cancer.The pathogenesis of portomesenteric venous thrombosis in laparoscopic surgery is multifactorial and could be explained by Virchow's triad which includes vascular injury, hypercoagulability, and stagnation of blood flow. The increased intra-abdominal pressure as a consequence of carbon dioxide pneumoperitoneum during the laparoscopic surgery contributes to decrease in portal venous flow , 9. The Acute portomesenteric venous thrombosis can be asymptomatic or present nonspecifically with abdominal pain, dyspeptic symptoms, and diarrhea when the superior mesenteric vein is involved. The clinical syndrome may resemble gastroenteritis and the diagnosis can be missed, leading to life-threatening complications such as mesenteric ischemia and infarction. Early diagnosis and prompt initiation of anticoagulation therapy can prevent the sequela of chronic portomesenteric thrombosis and portal hypertension.The definitive diagnosis is made by imaging with the use of contrast enhanced computed tomography or color Doppler ultrasonography. Other imaging modalities that could be used are angiography or magnetic resonance imaging. The choice of treatment is decided based on the extent of thrombosis and the presence or absence of bowel ischemia. Mostly therapeutic anticoagulation is the treatment of choice. The goal is to prevent elongation of the thrombus and to facilitate recanalization and avoid the sequelae of intestinal infarction and portal hypertension. When a predisposing condition is identified treatment of it is recommended. The duration of treatment remains unclear. Treatment may be lifelong for patients with prothrombotic states and may continue for 6 months in other patients. Low molecular weight heparin or heparin infusion should be started immediately followed by warfarin with a target INR of 2-3. In patients with bowel infarction surgical exploration is necessary and delays can lead to increased mortality. Other modalities described in literature are endovascular thrombolysis and percutaneous thrombectomy which could be utilized in extensive thrombosis .We report the first case of portomesenteric venous thrombosis as a complication of laparoscopic small bowel resection and primary anastomosis with ventral incisional hernia repair with predisposing breast carcinoma induced thrombophilic state and knowledge on this rare complication becomes significant with the increasing number of laparoscopic procedures.


Treatment strategy to prevent perioperative cerebral infarction in patients with asymptomatic severe stenosis of the internal carotid artery is not fully established.2 rather than performing prophylactic vascular reconstruction surgery, and successful tumor removals were achieved without causing further neurological or radiological deficits.Two patients were treated for skull base tumor in the presence of severe stenosis of the internal carotid artery, unilateral in one patient and bilateral in the other patient. Both patients were asymptomatic but had reduced vascular reserve capacity. The extended transsphenoidal approach was planned avoiding the low perfusion pressure region, with only conventional methods of maintaining blood pressure and PaCOIf the surgical route is planned to avoid the distribution of stenotic vessels and low perfusion pressure, prophylactic vascular reconstruction surgery would be unnecessary. Although more experiences based on sub-classified etiology for internal carotid artery stenosis are required, various types of operations including intracranial-extracranial vascular surgery might be justified based on this principle. No protocol has been established to prevent perioperative cerebral infarction in patients with asymptomatic internal carotid artery (ICA) severe stenosis. Antiplatelet agents are sometimes administered in addition to management of any atherosclerotic disease including hypertension, diabetes mellitus, and hyperlipidemia-3. HowevWe report two surgical cases of skull base tumor with severe ICA stenosis. Both patients were asymptomatic but with reduced vascular reserve capacity, and successful tumor removals were performed without neurological or radiological deficits.Case 1: A 46-year-old female was introduced to our department with severe visual disturbance. She had only light perception in the right eye and temporal hemianopsia in the left eye. She had a history of hypertension since age 30 years, and medication for diabetes mellitus and epilepsy, which had been diagnosed 5 years previously at screening for moyamoya disease. She had since been treated with an antiplatelet agent and no ischemic symptom had occurred.Magnetic resonance (MR) imaging showed a well-demarcated skull base tumor extending from the planum sphenoidale to the diaphragm sellae. Abnormal mesh-like enhancement was seen in the right half of the tumor around the right ICA terminal, and also at the distal portion of the anterior cerebral artery (ACA) in the convexity Figure a, b. MR 2 was maintained over 40 mmHg, and hematocrit of peripheral blood over 35% (37.4% of preoperative state). Mean arterial pressure was maintained within the ranges between 75 and 95 mmHg. Minute feeding arteries around the tumor were selectively coagulated and devascularized one by one, and Simpson’s grade 2 removal was achieved. The patient recovered consciousness soon after the operation, and postoperative head MR imaging showed no ischemic lesions or evident tumor bulk [Figure Tuberculum sellae meningioma was suspected and surgery was planned through the extended transsphenoidal route, which could avoid the low perfusion pressure region. Somatosensory evoked potentials were monitored by left tibial and median nerve stimulation throughout the surgery. PaCOCase 2: A 19-year-old female was introduced to our hospital suffering from tumor re-enlargement. She had a history of initial treatment for craniopharyngioma, which had been detected at screening examination for low stature and moderate memory disturbance. Surgery through the transcranial basal interhemispheric approach resulted in subtotal tumor removal, and 50 Gy of fractionated irradiation to the remnant was given postoperatively. Four years later she suffered cerebral infarction in her right frontal lobe. MR angiography showed severe stenosis of the right ICA, and antiplatelet agent administration was started. No ischemic symptoms had occurred since then. Seven years after the initial treatment the tumor had re-grown, and she was introduced to our hospital.On admission, MR imaging showed a partially ossified solid tumor in the suprasellar cistern, which had compressed the optic chiasm upwards, and a large cyst with thin wall in the third ventricle Figure a, b. MR 2 was maintained over 40 mmHg, and hematocrit of peripheral blood over 35% (44.6% of preoperative state), and mean arterial pressure was maintained within the ranges between 74 and 100 mmHg. The atrophic pituitary stalk was cut just at the transitional region to the posterior lobe, and the solid and cystic portions were removed simultaneously en-bloc. The patient recovered consciousness soon after the operation, and postoperative head MR imaging showed no ischemic lesions or evident tumor bulk [Figure Surgery was planned through the extended transsphenoidal route to avoid the low perfusion pressure region. Somatosensory evoked potentials were monitored using left tibial and median nerve stimulation throughout the surgery. PaCOAlthough a few surgical cases of brain tumor with severe ICA stenosis have been reported involving brain stem glioma and other cerebellar hemispheric tumors,9, partiProphylactic carotid endarterectomy for the patients with severe stenosis of the ICA or extracranial-intracranial bypass for occlusion of the ICA may reduce the risk of cerebral infarction during coronary artery bypass grafting,6, or atWe successfully treated two cases of skull base tumor associated with severe stenosis of the ICA. Both patients were asymptomatic but had reduced vascular reserve capacity. If the surgical route can be planned to avoid the distribution of stenotic vessels and low perfusion pressure, prophylactic vascular reconstruction surgery would be unnecessary.Written informed consent was obtained from both patients for publication of this Case Report and any accompanying images. Copies of the written consents are available for review by the Editor-in-Chief of this journal.The authors declare that they have no competing interest.YO performed tumor removal and analyzed the patient data, and was a major contributor in writing the manuscript. TT gave an essential suggestion and supervised this manuscript. Both authors read and approved the final manuscript.


She underwent a left upper parathyroidectomy and her serum calcium and intact PTH concentration immediately decreased to normal levels. This report describes the usefulness of PTH–FNA for localizing and differentiating an atypical functional parathyroid lesion from nonfunctional tissue in primary hyperparathyroidism.Parathyroid cystic adenomas are often misdiagnosed as thyroid cysts and routine preoperative diagnostic tools, such as ultrasonography (US) or 99m technetium-sestamibi (99mTc-MIBI) scans, cannot clearly distinguish between these entities. We present a 67-year-old hypercalcemic woman with a cervical cystic lesion who had negative sestamibi scan results. Her laboratory data indicated primary hyperparathyroidism  concentration 239 pg/ml). The cervical US and computed tomography scans revealed a large and vertically long cystic mass (12×11×54 mm). A mass was located from the upper end of the left thyroid lobe to the submandibular region and was not clearly distinguishable from the thyroid. For preoperative definitive diagnosis, we carried out a parathyroid fine-needle aspiration (FNA) and PTH assay (PTH–FNA) of liquid aspirated from the cyst. The intact PTH–FNA concentration was 1.28×10Cystic parathyroid lesions, even in the case of elevated PTH levels, can produce negative results in 99mTc-MIBI scans.Preoperative diagnosis of parathyroid cysts detectable on US is possible by parathyroid FNA and PTH assay (PTH–FNA) of liquid aspirated from the cyst, if malignancy is not suspected. PTH–FNA could be helpful in the differential diagnosis of an equivocal cervical tumor. Parathyroid cysts causing primary hyperparathyroidism are uncommon A 67-year-old woman presented to our hospital for further examination of hypercalcemia. Her past medical history was unremarkable, and she had no family history of parathyroid or other endocrine disease. Physical examination revealed a normal blood pressure and a supple neck with no palpable masses or nodules.6 pg/ml and the thyroglobulin concentration was 4.0 ng/ml. It was diagnosed that primary parathyroidism was due to a cystic mass.Laboratory findings revealed an elevated calcium concentration , normal phosphate concentration , and elevated intact PTH concentration . Her other electrolyte values and kidney function were within normal limits. Her 24-h urinary calcium was 260 mg/day, urinary calcium-to-creatinine ratio was 0.51, and fractional excretion of calcium was 2.59%. These findings were compatible with primary hyperparathyroidism. A large and vertically long cystic mass located from the upper end of the left thyroid lobe to the submandibular region  was deteThe patient underwent a left upper parathyroidectomy and her serum calcium and PTH concentrations immediately decreased to normal levels . The histopathologic examination revealed an adenoma of the parathyroid gland with cystic transformation. No findings of malignancy were detected.The hypercalcemic patient had a cervical cystic lesion with negative sestamibi scan results. The cervical US and computed tomography scans revealed a large and vertically long cystic mass of size 12×11×54 mm diameter. A mass was located from the upper end of the left thyroid lobe to the submandibular region, which was not clearly distinguishable from the thyroid. The PTH–FNA assay was performed, and the patient was diagnosed with primary hyperparathyroidism due to a cystic mass. The patient underwent a left upper parathyroidectomy and her serum calcium and intact PTH concentration immediately decreased to normal levels. The usefulness of PTH–FNA for localizing and differentiating an atypical functional parathyroid lesion from nonfunctional tissue in primary hyperparathyroidism is thus evident from the report. The imaging studies reveal parathyroid cysts sometimes mimicking thyroid cysts; therefore, preoperative diagnosis of primary hyperparathyroidism due to such cystic lesions is generally difficult. The diagnostic modalities of choice include: US, 99mTc-MIBI scan, computed tomography, and magnetic resonance imaging Although the sensitivity of imaging studies to detect solitary functioning parathyroid adenomas is high, some negative results are inevitable. For solitary adenomas, the reported sensitivities of 99mTc-MIBI scans and US are 88.44 and 78.55% respectively A preoperative diagnosis of a parathyroid cyst is possible by FNA of the cyst fluid and PTH determination. PTH–FNA is an effective tool for distinguishing between parathyroid glands and other tissues The unique finding in this case was the nature of the cyst. The cyst extended upward rather than downward. Parathyroid adenomas generally develop downward. The location of the tumor also differed from that usually predicted for an enlarged parathyroid gland. Parathyroid adenomas tend to locate on the superior dorsal (77%) and inferior dorsal (42%) thyroid gland A written informed consent was obtained from the patient.S Kato evaluated the patients. S-T Kawashima and T Usui reviewed and performed further investigations on the patient. The ultrasonography-guided fine-needle aspiration was performed by Y Watanabe. Treatment decision was made by all of the authors. Surgery was performed by Y Watanabe and R Asato. The initial draft of the manuscript was prepared by S-T Kawashima. All authors contributed equally to writing the draft and preparing the final manuscript.


Intracranial tumors may rarely cause stroke. We report an epidermoid cyst causing stroke in a pediatric patient. We have also reviewed the literature and pathogenesis of stroke caused by intracranial tumors. Stroke as a presenting symptom of intracranial tumors is extremely rare. Epidermoids referred to as “an ordered disorder” usually produce symptoms of slowly progressive mass lesion . We repoA 12-year-old boy was brought by parents into a rural hospital with complaint of headache for the last 6 months. Computed tomography (CT) scan of brain revealed a hypodense lesion in right cerebellopontine angle and basal cistern . The proMagnetic resonance imaging (MRI) of the brain was done within one hour of arrival of the patient and approximately 12 hours after the onset of symptoms. It revealed the lesion with isointensity on T1 weighted imaging and hyperintensity on T2 weighted imaging in right cerebellopontine angle extending to basal cistern Figures . There wThe patient was operated on, on emergency basis via right retrosigmoid approach, and near-complete excision of epidermoid cyst was done leaving behind the capsular fragments densely adherent to vessels and nerves.The patient improved in sensorium with partial improvement of hemiparesis after the surgery. Magnetic resonance imaging (MRI), done one month after the surgery, was suggestive of complete resolution of the infarct Figures . HistopaSchnitker and Lehnert in 1952 described middle cerebral artery infarct in a case of pituitary apoplexy . There aEpidermoids account for approximately 1% of all intracranial tumors. Although these lesions are congenital, patients are usually symptomatic in their third to fifth decade . Two casIn all the cases reviewed, we found only one pediatric case described by Pozzati et al. . Our casT1 hyperintensity with no blooming on gradient echo as in our case may represent incomplete stroke as described by Baheti et al. and warrant urgent intervention .The two cases described before were treated medically for two weeks and the postoperative improvement in their deficits is not mentioned . In our Epidermoids may cause acute symptoms as brainstem infarct. The exact mechanism is unknown, but the stretching of the vessels may play an important role. Early surgery instead of medical treatment can reverse the insult. When primary cause of stroke is tumor or tumor-like lesion, the early surgery rather than antiplatelet treatment should be considered.


Case. This case report describes the operative management of 16-year-old male with a symptomatic chondroblastoma of the distal femur with breach of the chondral surface. Following appropriate imaging and core needle biopsy, the diagnosis was confirmed histologically. The patient then underwent intralesional curettage and osteochondral allograft reconstruction of the defect. At one-year follow-up the patient was pain-free and has obtained excellent range of motion. There is radiographic evidence of allograft incorporation and no evidence of local recurrence. Conclusion. Osteochondral allograft reconstruction is an effective option following marginal resection and curettage of chondroblastoma involving the chondral surface of the distal femur. Chondroblastoma was first described by Codman in 1928 as “epiphyseal chondromatous giant cell tumors of the proximal humerus” –6. SubchIn August of 2012 a 16-year-old male presented complaining of rest and activity pain worsening for the past year. He denied any history of trauma. The patient reported is worsening left knee pain and decreased range of motion were limiting his daily activities. Radiographs from an outside facility (not available for publication) showed a lobulated well-defined epiphyseal lesion with sclerotic margins and without stippled calcifications. Computerized tomography (CT) further defined a low-attenuation lesion in the medial femoral condyle measuring 13 mm by 16 mm with well-defined sclerotic margins and depression of the subchondral bone at the lesion border . DiffereThe patient underwent resection and allograft reconstruction in January of 2013. The posterior aspect of the medial femoral condyle was approached through a posterior medial approach to the knee using an extensile skin incision dissecting down through the interval between the medial head of the gastrocnemius and the semimembranosus tendon as described by Burks and Schaffer . The lesThe patient tolerated the procedure well without complication and was instructed to remain touch down weight bearing in a hinged knee brace locked in full extension for two weeks. He was seen two weeks postoperatively with minimal pain and swelling noted on exam. At this point the Bledsoe brace was unlocked and he was allowed to weight bear as tolerated. He then completed a full course of physical therapy and was seen in follow-up at the three- and five-month marks. At the five-month postoperative visit he denied any pain and reported ability to run and jump without pain or limitation. He demonstrated full active flexion and extension compared to the contralateral extremity . At his Chondroblastoma is a rare benign primary bone tumor commonly presenting in the knee of young patients , 5. GiveWe report a case of chondroblastoma involving the posterior surface of the medial femoral condyle in an otherwise healthy and active 18-year-old male. After obtaining appropriate imaging and a tissue diagnosis via core needle biopsy, marginal excision and osteochondral allograft reconstruction was performed in an attempt to prevent recurrence and maintain joint integrity. At the one-year mark there was no evidence of disease recurrence and the patient has achieved full painless, active range of motion. He has returned to school and sport and is very satisfied with the outcome of his treatment. At one year the osteochondral allograft has incorporated and remained stable and flush with the remaining articular surface, which should limit the progression of the degenerative process. At this point we will continue to follow up the patient for evidence of local recurrence, metastasis, and degenerative change with serial radiographs. We would expect our patient's risk of local recurrence and metastatic disease to be similar to rates reported in the literature as we treated the lesion with standard intralesional curettage and local adjuvant therapy. Our focus, as it relates to this case report, will be long-term follow-up of osteochondral allograft incorporation and progression of degenerative disease.Given our experience with this case we feel that intralesional curettage with osteochondral allograft reconstruction is a viable surgical option for chondroblastomas involving the articular surface of the knee. This reconstruction technique allows for painless weight bearing and full range of motion.


A 70-year-old male patient underwent an Fluorodeoxyglucose-positron emission tomography-computed tomography for staging of a left parahilar lung neoplasm found during work-up for fatigue and asthenia. The scan demonstrated a hypermetabolic lung tumor, a hypermetabolic pleural effusion and 4 hypermetabolic bilateral soft tissue lesions of the chest wall corresponding to 4 elastofibroma dorsi. Initially, the oncologic disease was classified as stage IV because of the hypermetabolic pleural effusion. A transbronchial biopsy showed squamous cell carcinoma and the cytology of the pleural effusion revealed no malignant cells. As the other 4 hypermetabolic thoracic wall lesions were correctly diagnosed as benign despite their unusual presentation, the patient underwent surgery by left pneumonectomy and mediastinal lymphadenectomy. The lymph node involvement required adjuvant chemotherapy.Diagnostic confidence of the benignity of the hypermetabolic chest wall lesions allowed a more aggressive treatment with a better outcome after a malignant pleural effusion was excluded. This atypical presentation must be recognized to avoid erroneous staging.Positron emission tomography/computed tomography (PET/CT) is used in daily practice, particularly for oncological staging. Hypermetabolic foci must be correctly interpreted for accurate staging. In our case, the hypermetabolic pleural effusion and the hypermetabolic chest wall lesions could modify staging, as these could translate secondary tumor locations. The chest wall lesions were atypical for elastofibroma dorsi because of their increased number and unusual Fluorodeoxyglucose , an associated hypermetabolic left pleural effusion (SUVmax 6) and 4 hypermetabolic bilateral soft tissue masses of the posterior chest wall with an increased 18F-FDG uptake up to SUVmax 4.7 for the most hypermetabolic mass measuring 5 × 1.6 cm and located under the right latissimus dorsi muscle  for intrapericardial left pneumonectomy. The pathological diagnosis confirmed the type of lung cancer, complete resection, and demonstrated intrapulmonary lymph node involvement. The hypermetabolic pleural effusion was not of carcinomatous origin and was probably linked to an infectious left lung base consolidation. The final Tumor Node Metastasis (TNM) classification was pT2a N1 M0 R0, stage IIa. The high risk of recurrence owing to lymph node involvement required adjuvant chemotherapy.18F-FDG-PET/CT showed an unchanged aspect of the 4 elastofibroma dorsi  scans is of 2% in the elderly population with a clear female preponderance (F:M ratio 13:1), although some recent studies reported a prevalence ranging from 13% to 17% and even up to 81% in some autopsy studies.6 Elastofibroma dorsi are frequently asymptomatic and unilateral but bilateral involvement is described in 10% to 66% of cases.7 Even though a case of 17 elastofibromas has been reported,3 multiple elastofibromas are rare. When symptomatic, patients report tumefaction, mild pain, and a clicking sensation.8 Surgical resection is the treatment of choice when elastofibromas are symptomatic or >5 cm in diameter.7 Correct diagnosis of this benign pseudotumor prevents excessive resection as the risk of recurrence is very low with marginal excision.4Elastofibroma is a benign poorly circumscribed soft tissue lesion classically located in the subscapular region, hence the denomination elastofibroma dorsi. This entity can also be found in other less frequent locations such as the olecranon,11 Magnetic resonance imaging (MRI) is often considered the modality of choice due to excellent soft tissue resolution; however, findings may remain nonspecific. Nonetheless, CT seems to be more accurate in determining the size of elastofibroma dorsi.6 These lesions may be difficult to detect based solely on their morphology, as in our case. The initial CT had not retained any chest wall lesions and it was their metabolic activity on the PET/CT that revealed them.Imaging features of elastofibroma dorsi include lack of a capsule, poor differentiation with surrounding muscles, soft tissue density, heterogeneity with strands of fat, and absence of bone abnormalities.max (±standard deviation) ranges from 1.4 to 3.212 or is measured at 2.0 ± 0.63 (range 0–5.1)11 or at 2.31 ± 0.61 (range 1.0–4.30) (10).According to different studies, the mean SUV8In an oncological context, the differential diagnosis includes metastases and other primary lesions such as fibromatosis, fibrolipoma, desmoid tumors, or sarcoma.18FDG uptake. However, the number of lesions and their slightly unusual uptake should not lower the diagnostic confidence based on the typical CT appearance and location.Our case is atypical owing to the sex of the patient, the number of lesions, and the slightly increased


The objective of this paper is to propose minilaparotomy hysterectomy as the suitable choice for large uterus on the basis of our experienced case of performed minilaparotomy hysterectomy to 4,500 g myoma uteri and review published cases about this clinical condition. We presented a 44-year-old woman  who consulted our hospital because of the chief complaints of abnormal genital bleeding and hypermenorrhea. Transabdominal ultrasonography revealed that abdominal solid tumor reached over the navel. Her tumor was an indication of surgery; to do minilaparotomy hysterectomy with laparoscope was decided because her informed consent was obtained. A 6 cm transverse incision (Maylard incision) was made to the skin above the pubic hairline. At the end of surgery, the length of abdominal wound was 8.5 cm, operating time was 128 min, weight of resected myoma uteri was 4,500 g, and intraoperative blood loss was 895 mL. Blood transfusion was not done; postsurgical course was not a problem without anemia. We propose that a large uterine case in which it is difficult to perform vaginal or laparoscopic hysterectomy should be considered in order to select minilaparotomy hysterectomy up to around 5 kg weight of uterus, and the length of skin incision in minilaparotomy hysterectomy is necessarily <9 cm particularly in large uterus. Currently, primary methods of hysterectomy are vaginal, abdominal, laparoscopic, and robotic hysterectomy. In March 2013, the president of Obstetrics and Gynecology Society of United States made the statement that robotic surgery takes a high cost in hysterectomy of benign disease except complex surgery such as cancer, but the improvement of patient outcomes is not observed, so vaginal hysterectomy is the first choice and the second choice is laparoscopic hysterectomy [A 44-year-old woman  consulted our hospital in May 2013 because of the chief complaints of abnormal genital bleeding and hypermenorrhea. Her past history and family history were with no particular event. The patient never had sexual intercourse and thus refused to undergo pelvic examination, rectal examination, and transvaginal ultrasonography. Transabdominal ultrasonography revealed that abdominal solid tumor reached over the navel, hard and movable . We consThe route of hysterectomy is determined by several factors, for example, weight of uterus, width of vagina, possibility of adhesion, movability of uterus, obesity, existence or not of ovarian tumor, and hope of patient. A weight of uterus is a main factor of preoperative assessment of hysterectomy, and several formulas of calculation of uterine weight are reported. To our knowledge, heaviest uterine weight of each surgical procedure is 2,421 g in vaginal hysterectomy , 3,200 gIn April 2014, US Food and Drug Administration recommended withdrawal of laparoscopic power morcellation . We prop


Malignant glomus tumor, or glomangiosarcoma, is a very rare mesenchymal neoplasm that, when seen, occurs in visceral organs. Despite having histologic features of malignancy, these tumors usually do not metastasize. However, when metastasis occurs, this disease is often fatal. Our report presents the case of a 59-year-old female patient with a highly aggressive and widely metastatic glomus tumor of the lung. Glomus tumors are uncommon benign neoplasms that customarily originate from glomus bodies in the dermis or subcutis of the extremities. Extracutaneous glomus tumors occur but are very rare, especially in visceral organs such as the stomach, mediastinum, trachea, lung, ileum, and kidney -5. A few9 /L. The computed tomography (CT) scan of the chest showed multiple masses in bilateral lungs with the largest measuring 25 mm in diameter in the left upper lobe  presented to our hospital complaining of an ongoing cough and hemoptysis for 4 months and melena for 1 week. The patient’s medical history was unremarkable. The auscultation revealed attenuated respiratory sound in bilateral lungs and no rales or wheezing were noted. There was no superficial node enlargement. Laboratory investigations showed normocytic anemia (hemoglobin level 58 g/L) and a platelet count of 294 × 10Glomus tumors typically present as solitary or multicentric lesions in the dermis or subcutis, with characteristic subungual location. Extracutaneous presentations occur but are rare, especially in the visceral organs, where glomus bodies are sparse or even absent, including the respiratory tract, gastrointestinal tract, and mediastinum. Within the respiratory tract, the trachea is the most frequent site of involvement. Primary glomus tumors of the lung, especially with metastasis, are extremely rare. To the best of our knowledge, only three cases have been reported in the English literature. The first case of a glomangiomyoma of the lung with widespread metastasis was reported by Gaertner et al.  in 2000,Folpe et al.  proposedSurgical resection is curative and remains the mainstay of treatment in reported cases of malignant glomus tumor diagnosed with or without local metastasis , and lonMalignant glomus tumor of the lung, particularly with multiple metastasis, is exceedingly rare. The cornerstone of diagnosis is pathological features and immunostaining. This case, combined with the other three cases mentioned above Table , indicatWritten informed consent was obtained for publication of this report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.


Synovial sarcoma of lung is a rare tumor with few case reports in literature. Though named synovial sarcoma due to its resemblance to synovium on light microscopy, it arises from mesenchymal tissue. Here, we present a case of synovial sarcoma of lung in a 7-year old boy, with main emphasis on difficulty faced in the management. A 7-year-old male child presented one year back with complaints of left sided chest pain. There was no associated history of cough, fever, respiratory distress or weight loss. On examination, there were diminished breath sounds on left hemithorax with basal crepitations. Chest radiograph showed homogenous opacity in left upper zone. CECT chest revealed ill-defined lesion in the left upper lobe compressing left main pulmonary artery and left sided pleural effusion causing collapse of underlying left lower lobe with mediastinal shift to right. CT guided biopsies were done twice, but each time it revealed necrotic material and tissue diagnosis could not be achieved.At surgery, a large tumor arising from the upper lobe and adherent to the 2ndrib was found. Left upper pulmonary lobectomy with gross total excision of tumor was done. Histopathological examination of resected specimen revealed cellular tumor with oval shaped cells, moderate nuclear pleomorphism, and high nucleus to cytoplasmic ratio, vesicular chromatin, and mitotic figure of 10-11/hpf . Tumor cells were positive for vimentin, EMA, Bcl2 and CD 99  and negative for calretinin, desmin, SMA, CD 34 and cytokeratin. The above features were consistent with synovial sarcoma.Postoperative PET-CT was negative with no tracer uptake. But as the histopathological margins were positive, the patient was planned for chemotherapy. He was started on ifosfamide, carboplatin, etoposide and epirubicin (ICE+ epirubicin). Three cycles of this chemotherapy regimen were administered, following which PET-CT was repeated. It revealed soft tissue density lesion in left 2nd intercostal space, with left sided pleural effusion suggestive of disease progression .He was then subjected for radiotherapy. Intensity modulated radiotherapy (IMRT) was given five days a week for a total dose of 50.4Gy (28 fractions). PET-CT was done for response assessment, which showed metabolically active pleural-based soft tissue density lesion involving almost entire left pleura, suggestive of disease progression.He was started on second line chemotherapy (docetaxel and gemcitabine) for total of 3 cycles. While on the third cycle, he developed swelling in the left back adjacent to the previous thoracotomy scar. Trucut biopsy from the swelling revealed the sheets of round to spindle tumor cells with moderate eosinophilic to clear cytoplasm, granular nuclear chromatin with inconspicuous nucleoli. Mitosis was 6-8/10 hpf. Findings were consistent with metastatic deposits.CECT thorax was done and it showed a large mass 15x12x12 cm occupying whole of the left hemithorax with shifting of mediastinum to opposite side. The child developed respiratory distress and he was taken up for tumor resection. Intraoperatively, the tumor was densely adhered to the surrounding structures. Only piece-meal tumor debulking was possible. There was significant blood loss during the procedure and he had cardiac arrest twice during surgery. He was revived and shifted to ICU where he succumbed after few hours.Synovial sarcoma is the most common pediatric non-rhabdomyosarcoma soft tissue sarcoma (NRSTS) commonly affecting lower extremity followed by upper extremity. Other sites include head, neck and trunk. Primary synovial sarcoma of lung is a very rare entity and commonly presents as chest pain. Though termed erroneously due to its resemblance to synovium on histology, it is thought to arise from primitive pluripotent mesenchymal cells rather than the synovium.[1] It is an aggressive tumor with propensity to invade the adjacent tissue.[2]Initial radiological investigations include chest X ray followed by CECT thorax. More than 75% of the cases show well-delineated border on initial CXR.[3] Ipsilateral pleural effusion is common, which was present in our case too. Management of such tumor is difficult as these tumors are poorly sensitive to chemotherapy. Surgical resection whenever feasible is the treatment of choice.On histopathological examination (HPE), it needs to be differentiated from fibrosarcoma. Immunohistochemistry (IHC) is needed to differentiate it from other sarcomas. Synovial sarcoma is positive for cytokeratin, ema, bcl-2, vimentin and negative for s-100, desmin.[4-6] In our case, it was positive for vimentin, ema, cd 99 and bcl2 and negative for calretinin, desmin, sma, cd 34 and cytokeratin. Prognosis depends on the size of tumor and the age of patient. Other factors are male gender, extensive tumor necrosis, high grade, large number of mitotic figures (>10/hpf) and syt-ssx1 variant. [9] SYT-SSX translocation is characteristic of synovial sarcoma, found in more than two third patients. SYT-SSX1 variant is associated with more aggressive phenotype and more tumor cell proliferation. It could not be done at our centre due to non availability of resources. Most of these poor prognostic factors including age, male gender, high grade, necrotic tissue and high mitotic rate were present in our case too. For children 0 to 16 year old and tumors less than 5 cm in size, 5-yearoverall survival (OS) is 71 to 88 %, and in this group, addition of chemotherapy did not improve survival. In patients with tumor greater than 5 cm that are deep and invasive and without metastasis, OS is 50 to 75 % and chemotherapy responsiveness is 50 to 60 %. Radiotherapy does have role in this disease and is recommended after marginal resection or before anticipated marginal resection. Standard protocol for adjunct chemotherapy is lacking due to its rarity and poor chemo-sensitivity.To conclude, primary synovial sarcoma of lung is a very rare tumor, which is highly aggressive with poor prognosis. Diagnosis needs combined efforts with radiology, histology, immunochemistry and molecular studies. The most appropriate management is surgical excision with negative margins, whenever feasible. Adjuvant chemotherapy and radiotherapy have limited role. Due to high rates of recurrence, a very close follow up is needed.Source of Support: NilConflict of Interest: None declared


The incidence of intussusception is low in adults, particularly in the descending colon, due to the anatomical attachment of the descending colon to the retroperitoneum. Signet ring cell histology represents ~1% of colon adenocarcinomas and is associated with young patients and a poor clinical outcome. The present study describes a case of descending colo-colonic intussusception caused by signet ring cell carcinoma in a 27-year-old male. The patient presented with a history of intermittent left upper-quadrant abdominal pain for more than six months without any evident etiology. A computed tomography scan of the abdomen revealed left-sided colo-colonic intussusception. Upon laparotomy, a left hemicolectomy was performed according to intraoperative frozen-section pathology. Post-operative pathological evaluation revealed signet ring cell carcinoma invasion of the serosa, and 31.8% (7/22) of the regional lymph nodes were positive for cancerous cells. The post-operative course was uneventful and the patient was discharged on the tenth post-operative day. The majority of cases of intussusception occur in infants and children, although ~5% of affected patients are adults . IntussuSignet ring cell carcinoma of the colon is a rare histological subtype and accounts for 0.5–1% of all colon adenocarcinomas. The neoplasm is characterized by a specific morphological appearance of abundant intracytoplasmic mucin, which pushes the nucleus to the periphery of the cell to give a signet ring appearance ,5. As thIn the present study, a young male with adult intussusception of the descending colon, caused by signet ring cell carcinoma, was pre-operatively diagnosed by a computed tomography (CT) scan. Written informed consent was obtained from the patient.A 27-year-old male who had experienced intermittent left upper-quadrant abdominal pain without hematochezia for more than six months was admitted to the Kunshan First People’s Hospital Affiliated to Jiangsu University . The patient did not complain of any other symptoms, such as vomiting, nausea or fever, had no relevant medical or surgical history, and denied smoking and alcohol consumption. A physical examination identified left upper quadrant tenderness, but no rebound tenderness. Upon palpation, no abdominal mass was identified and laboratory test results were all within normal ranges. The chest X-ray, plain abdominal X-ray and electrocardiography findings were non-specific. A CT scan showed the concentric-like structure of the descending colon, which was typical of left colonic intussusception, but no evidence of ischemic changes in the proximal colon were revealed .Upon examination, there was no evidence of intestinal obstruction. Elective surgery with a median laparotomy was performed, which confirmed the diagnosis of intestinal intussusception caused by a left colon carcinoma. Surgery revealed that the tumor had caused the descending colon to intussuscept into itself . To prevIntussusception is the telescoping of the proximal intestinal wall into the lumen of a distal intestinal segment ,7–9. WhiThe first described case of primary signet ring cell carcinoma of the colon and rectum was in 1951 . This paIn the present study, a rare case of descending colo-colonic intussusception caused by a primary signet ring cell carcinoma of the colon was described. Unlike cases of childhood intussusception, no attempt should be made to reduce a colonic intussusception in adults by a barium enema; adult intussusception is often accompanied with organic diseases and, in this case, barium enema is ineffective in reduction ,16. The In the present case, one month followng surgery, the patient received six cycles of standardized chemotherapy, with each cycle lasting for four weeks, at the Department of Oncology, Kunshan First People’s Hospital Affiliated to Jiangsu University. The latest CT scan, three months after the cyclo of chemotherapy, did not show any recurrence. In a previous study, a total of 60% of colonic intussusceptions were caused by malignant neoplasms, in patients with colonic intussusceptions . It may


Tuberous sclerosis is a rare genetic disorder resulting in benign tumor growth in various organs including the brain, heart, skin, eyes, kidney, and lung as well as systemic manifestations including seizures, cognitive impairment, and dermatologic abnormalities. This report shows the radiological findings and differentiation between a subependymal nodule and subependymal giant cell astrocytoma in a patient with tuberous sclerosis presenting with new onset seizures. Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disorder resulting from mutations in the TSC1 gene or the TSC2 gene . ClinicaA 26-year-old female with history of hypertension and dialysis-dependent ESRD with a GFR of 5 was admitted after having a seizure at work. Significant family history includes a father with tuberous sclerosis and brother with tuberous sclerosis and seizures. The patient stated she was at work the night before admission when she “felt hot” and started “shaking.” She described 1-2-second duration and serial, generalized myoclonic twitching lasting roughly 5 minutes prior to reported loss of consciousness. During EMS stabilization and transfer another generalized tonic-clonic convulsion occurred accompanied by postictal lethargy and confusion. The patient denied any prior history of seizures, cognitive impairment, or frequent headaches.On examination vital signs revealed the patient to be tachycardic (164 beats per minute) and hypertensive (249 mmHg/153 mmHg). Neurological examination was normal. Several facial and body hyperpigmented fibrous plaques and a posterior lumbar Shagreen patch were noted.A nonenhanced head computed tomography was performed to exclude ischemia or hemorrhage. This revealed a rounded, heterogeneous, soft tissue mass with central calcifications opposing the ependymal surface in the ventral body of the right lateral ventricle measuring approximately 12 mm × 18 m. No accompanying hydrocephalus or local neoplastic extension was evident.Subsequent contrast enhanced brain MRI demonstrated a 23 mm × 23 mm × 18 mm round, well-circumscribed mass in the right lateral ventricle and roof of the third ventricle. The mass was heterogeneous with several internal signal voids. There was mild mass effect (4 mm septum pellucidum leftward shift), with adjacent white matter mild edema and gliosis. Scattered cortical based T2 and FLAIR hyperintensities were seen throughout both cerebral hemispheres, suggestive of cortical tubers.Prior renal ultrasound and abdominal CT were obtained which demonstrated chronic cystic renal atrophy/chronic medical renal disease Figures  and 5.The majority of TSC patients present with neurologic symptoms, with approximately 90% of affected individuals experiencing seizures and roughly half experiencing cognitive impairment, autism, or other behavioral disorders . EpilepsThe main structural brain lesions include cortical tubers, subependymal nodules (SENs), and subependymal giant cell astrocytomas (SEGAs) , 5. CortSubependymal nodules are collections of abnormal, swollen glial cells and giant cells which cannot be differentiated as normal neural tissue. They have a tendency to calcify and can progress into subependymal giant cell astrocytomas, which are histologically indistinguishable from SENs but distinguishable based on their larger size, higher growth rate, and potential for mass effect compared to the relatively static course of SENs , 15. TheGenerally speaking, tumors greater than 3 cm carry significant risk for complications and should be medically managed. Surgical intervention of SEGA > 3 cm carries a 67% risk of surgery-related complications and surgery on tumors > 4 cm was associated with a 73% risk of complications , 22. BilThis case of a new onset seizure illustrated CNS manifestations of tuberous sclerosis. The patient presented with a new onset seizure and was found to have multiple cortical tubers and subependymal giant cell astrocytoma on brain imaging. The cortical tubers were the likely etiology of her seizure and the patient was placed on Keppra but more concerning was the astrocytoma mass in the body of the right lateral ventricle. The proximity to the right foramen of Monroe, its incomplete calcification, enhancement on MRI, and large size (>1 cm) make SEGA the likely diagnosis. A neurosurgery consult was recommended off-site, but surgery was not performed because of the patient's comorbidities and symptoms attributed to cortical tubers rather than symptomatic SEGA.


Antecubital fossa lesions are uncommon conditions that present to the orthopaedic clinic. Furthermore, the radius bone is an uncommonly reported location for an osteochondroma, especially when presenting with a concurrent reactive bicipitoradial bursitis. Osteochondromas are a type of developmental lesion rather than a true neoplasm. They constitute up to 15% of all bone tumours and up to 50% of benign bone tumours. They may occur as solitary or multiple lesions. Multiple lesions are usually associated with a syndrome known as hereditary multiple exostoses (HME). Malignant transformation is known to occur but is rare. Bicipitoradial bursitis is a condition which can occur as primary or secondary (reactive) pathology. In our case, the radius bone osteochondroma caused reactive bicipitoradial bursitis. The differential diagnosis of such antecubital fossa masses is vast but may be narrowed down through a targeted history, stepwise radiological investigations, and histological confirmation. Our aim is to ensure that orthopaedic clinicians keep a wide differential in mind when dealing with antecubital fossa mass lesions. Antecubital fossa mass lesions may be either benign or malignant in nature , 2. BeniOsteochondromas are a type of developmental lesion rather than a true neoplasm . They arOsteochondromas are known to exist in the forms of solitary and hereditary multiple osteochondromatosis , 8. SoliComplications of osteochondromas are vast. Frequently occurring examples include mechanical range of motion blocks, nerve impingement, tendon rupture, fracture and deformity, bursitis, extensive growth without malignant change, and malignant transformation of the cartilaginous cap , 6–8. SoBicipitoradial bursitis is a form of chronic bursitis with only a handful of cases documented in the current literature –15. It c61-year-old lady, right hand dominant homemaker, presented with a four-year history of right anterior elbow pains localised in the antecubital fossa associated with swelling and intermittent paraesthesia in the radial border of forearm extending towards the thumb limiting her thumb flexion at the distal interphalangeal joint. She denied any forms of trauma and symptoms of osteoarthritis and rheumatoid arthritis and was otherwise systemically healthy. She complained of pain on active elbow flexion and both pronation and supination. Prior to presentation to the orthopaedic outpatient clinic, she described a lengthy period of conservative management through simple analgesia including oral paracetamol, oral nonsteroidal anti-inflammatories, and physiotherapy.On examination, a palpable mass was felt in the right antecubital fossa measuring roughly 5 cm in diameter fixed to the underlying soft tissue structures. There was pain on active elbow flexion and pronation, with reduction of range of motion in both ranges. Elbow extension and supination were neither painful nor limited.Strength was equal to the contralateral side; however pain was elicited on all resisted movements. There was no vascular compromise, but reduced cutaneous sensation on the radial side of the thumb, corresponding to the distribution of the superficial radial nerve.A plain radiograph was performed  which shMRI before and after gadolinium confirmed the appearance of an 8 mm by 9 mm fluid collection compatible with bicipitoradial bursitis and ongoing synovitis between the biceps brachii tendon and the radial tuberosity Figures , and 3. An ultrasound guided aspiration was performed  with aspUnder tourniquet, a linear incision over the right antecubital fossa was performed distal and radial to the biceps brachii tendon. A combination of gentle blunt and sharp dissection through tissue layers was employed towards the direction of the biceps tendon insertion until exposure of the synovial bursa and biceps tendon Figures  and 6. TShe was followed up after one month and then six months with near complete pain cessation along with improvements in ranges of elbow flexion and pronation. Follow-up plain radiographs show disappearance of the lesion .Osteochondromas occurring at the elbow are uncommonly reported . Our casThe bicipitoradial bursa is located between the distal biceps tendon and the radial tuberosity. Its function is to allow free movement of biceps tendon during pronation and supination of the forearm. The anatomy of the bicipitoradial bursa was accurately described by Skaf et al. . HistoloRadiology is helpful in furthering the diagnostic process, our case report being a case in point. Sofka and Adler  propose CT scans sometimes detect a rim-enhancing mass adjacent to the radial insertion of biceps tendon. MR imaging findings are a high-signal-intensity material distending bicipitoradial bursa and a relationship between fluid and biceps tendon .For both osteochondromas and bicipitoradial bursitis as separate entities, surgery is a viable option. Liessi et al.  demonstrOsteochondromas and bicipitoradial bursitis are known causes of antecubital fossa masses and pain. When approaching cubital fossa masses, the initial focus is to exclude a malignancy. Our case report highlighted a diagnostic pathway which ultimately led to surgery following a trial of conservative treatment. To our knowledge there is only one other case report of an osteochondroma at the proximal radius with a secondary bicipital bursitis .


A PIT was confirmed histopathologically in the surgical specimens from both patients. In one case, the tumor consisted of a type A thymoma without abnormal FDG uptake. In the other case, the tumor consisted of a type B2 thymoma presenting with weak FDG uptake. This report thus documents two cases of PITs with different histopathologic and FDG-PET/CT findings. Thoracoscopic surgery is essential in the differential diagnosis between PITs and other lung tumors.Primary intrapulmonary thymomas (PITs), which are intrapulmonary tumors without an associated mediastinal component, are very rare. The diagnosis of a PIT can be difficult. Here, we report two cases of resected PITs that were difficult to differentiate from other lung tumors. The patients, of a 62-year-old man and a 64-year-old woman, had no significant symptoms and were both referred to our hospital due to the presence of an abnormal shadow on chest computed tomography (CT). The patients underwent  Herein, we report two patients with PIT, in whom a low-grade malignant pulmonary tumor or metastasis was suspected on diagnostic imaging, but PIT was ultimately diagnosed based on tumor specimens excised via video-assisted thoracoscopic surgery (VATS).Thymomas are tumors derived from thymic epithelial cells, reported to have an incidence of 0.15 per 100,000 person-years . PITs arA 62-year-old man was referred to our department for evaluation of an abnormal shadow on chest computed tomography (CT). A solitary, very small, round opacity in the left lung was incidentally detected on chest CT during a routine medical examination 2 years previously. The lesion was followed radiologically at regular intervals, and the size of the nodule had increased slightly. Chest CT revealed a 15 × 10 mm tumor in the left S10  3 years previously. Chest CT revealed a 9-mm tumor in the right S1 and an 11-mm tumor in the right S3 Fig. , b. TherMacroscopic examination found well-circumscribed, white nodules Fig. . HistopaPrimary intrapulmonary thymomas (PITs) are uncommon lung tumors. To the best of our knowledge, 32 cases of PITs have been reported in the English and Japanese literature since 1951, not counting our cases –11.Here, we present a summary of the clinicopathologic features of all 34 cases. The patients’ ages ranged from 14 to 79 years, and half the patients were females. The site of occurrence was the right pulmonary lobe in 21 cases, the left lobe in 12 cases, unknown in 1 case, the upper lobe in 22 cases, and the lower lobe in 11 cases. Three cases, including our second case 2, were multifocal within the same lung. The sizes of the lesions ranged from 9 to 128 mm in diameter. The presenting symptoms of PITs have included chest pain, cough, and hemoptysis, which also occur in patients with lung cancer, but most lesions were discovered incidentally on radiographic examination in asymptomatic individuals. Based on the WHO classification [PIT appears on CT as a well-circumscribed, heterogeneous mass, such as seen in our patients. The differential radiologic diagnosis of PIT includes low-grade malignant tumor, metastatic lung tumor, hamartoma, sclerosing hemangioma, lipoma, and angiolipoma. Performing a preoperative diagnosis is difficult, and most PITs are diagnosed postoperatively .Histological features of the tumor showed that the lesion was composed of dense proliferation of spindle cells with a minority arranged in pseudoglands and a cystic lesion in case 1, and there were lobulated lesions with vascular septa, consisted of epithelial cells palisading along the septa and centrally located small lymphocytes in case 2. The differential diagnosis of PIT includes a wide range lymphoma and primary or metastatic carcinoma of the lung. Immunohistochemical staining is helpful in this differentiation. Epithelial cells are stained by AE1/AE3 or EMA, and lymphocytes in thymomas are stained by T cell phenotypes . EpithelFDG-PET can be applied to the diagnosis of malignant neoplasms because it is designed to detect and assess the degree of carbohydrate metabolism in malignant tissue . The PITP = 0.039). Histologic subtype (WHO classification) and tumor size did not significantly affect survival. Myasthenia gravis and the Good syndrome significantly decreased survival . Because complete surgical resection was obtained for both of our cases, we believe that their postoperative outlook is good.Most case reports of PIT have described the tumors as slow-growing, indolent, and asymptomatic until large enough to cause localized effects such as pain and bronchial obstruction . The besPITs are very rare lesions that are difficult to diagnose. This report described two cases of PITs, which manifested different histopathologic and FDG-PET findings. If complete surgical resection of the tumor is possible, the postsurgical outlook is good.Written informed consent was obtained from the patients for publication of this case report and any accompanying images. A copy of written consent is available for review by the Editor-in-Chief of this journal.