Intramuscular myxoma is a rare benign soft tissue tumor which may be mistaken for other benign and low-grade malignant myxoid neoplasms. We present the case of a 63-year-old woman with an asymptomatic intramuscular myxoma discovered incidentally on a whole-body F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography. PET images showed a mild FDG uptake  in the left gluteus maximus. Subsequent magnetic resonance (MR) imaging revealed a well-defined ovoid mass with homogenous low signal intensity on T1-weighted sequences and markedly high signal intensity on T2-weighted sequences. Contrast-enhanced MR images showed heterogeneous enhancement throughout the mass. The diagnosis of intramuscular myxoma was confirmed on histopathology after surgical excision of the tumor. The patient had no local recurrence at one year follow-up. Our case suggests that intramuscular myxoma should be considered in the differential diagnosis of an oval-shaped intramuscular soft tissue mass with a mild FDG uptake. Intramuscular myxoma is a rare benign soft tissue tumor of unknown origin. It usually occurs as an isolated lesion. The coexistence of intramuscular myxoma and skeletal fibrous dysplasia is known as Mazabraud’s syndrome . To the A 63-year-old previously healthy woman underwent whole body FDG PET/CT for cancer screening. FDG PET images demonstrated an increased uptake in the left buttock. The maximum standardized uptake value (SUV) was 1.78. CT showed a 3.5 cm hypodense mass, with corresponding tracer uptake Figure A and marAn open biopsy was performed. The tumor was composed of bland spindle and stellate shaped cells that were widely separated by myxoid stroma Figure . No mitoGNAS1 mutations have been identified in intramuscular myxoma with and without fibrous dysplasia [et al. [GNAS1 mutation analysis can be helpful to distinguish intramuscular myxoma from low-grade myxofibrosarcoma in selected cases.Intramuscular myxoma has a peak incidence in the fourth to sixth decades of life with a female predominance. It typically presents as a slowly growing, painless mass in the large muscles of the thigh, shoulder, buttock, and upper arm ,4. Margiysplasia ,7. Inter [et al.  reportedThe gross appearance is characteristic and the tumor has a mucoid, gelatinous cut surface with thin fibrous septa. Histologically, intramuscular myxoma is composed of bland spindle and stellate shaped cells in an abundant myxoid stroma. Fluid-filled cystic spaces are seen occasionally. Mitotic activity and cellular pleomorphism are usually absent or minimal. Some intramuscular myxomas show focal areas of hypercellularity and hypervascularity, which may be confused with several myxoid soft tissue sarcomas such as myxoid liposarcoma, low-grade myxofibrosarcoma, and low-grade fibromyxoid sarcoma . ImmunohIntramuscular myxoma is shown as a homogeneous low-attenuating mass on CT . MRI revFDG PET is increasingly used for the detection and management of soft tissue tumor. In the present case, PET revealed an increased uptake of FDG with a maximum SUV of 1.78. Only one case of a positive FDG PET in intramuscular myxoma has been reported so far . In thatWe report the second case describing FDG PET/CT imaging of intramuscular myxoma. This tumor should be considered in the differential diagnosis of an oval-shaped intramuscular soft tissue mass with a mild FDG uptake.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.CT, Computed tomography; FDG, Fluorodeoxyglucose; MRI, Magnetic resonance imaging; PET, Positron emission tomography; SUV, Standardized uptake value.The authors declare that they have no competing interests.JN managed the patient and drafted the manuscript. MN helped to draft the manuscript. Both authors read and approved the final manuscript.


Omental lipomas are extremely rare tumors of childhood. We report a case of solitary giant lipoma of the omentum in a child, successfully managed by complete excision, without any recurrence on follow-up study. Omental lipomas are rare benign tumors of infants and children that can be accurately diagnosed preoperatively by ultrasound and abdominal computed tomography (CT). Complete surgical excision is the treatment of choice. We report a case of giant omental lipoma in a 2.5-year-old boy, successfully managed by complete excision without any recurrence on follow-up study.A 2.5-year-old boy was admitted for evaluation of an abdominal mass. He was a well-developed, well-nourished boy who presented with complaints of gradual abdominal distention, intermittent abdominal pain and diarrhea of two months duration. Palpation of the abdomen revealed a large, elastic mass extending in all the quadrants. Plain X-ray of the abdomen demonstrated gross abdominal distension and centrally positioned bowel loops . UltrasoPrimary tumors of the omentum are very rare. Stout and Cassel described the first reported case of a primary omental tumor in 1942 [Common presenting symptoms of a solid omental tumor include abdominal discomfort (45.5%), abdominal lump (34.9%) and abdominal distention 15.2%). Nausea and weight loss may occur occasionally. Abdominal pain is usually exacerbated in the supine position but relieved in the upright position [5.2%. NauIn 1980, Giubilei et al. reported a solitary giant lipoma of the omentum and gastrocolic ligament in an 8-year-old boy . In 2005In conclusion, omental lipoma as other solid abdominal tumors is easily diagnosed by ultrasound (US), but for more precise localization and characterization of the lesion, CT should always be performed.


Intracerebral schwannomas are rare tumors of the CNS. We report a rare case of intracerebral schwannoma, presenting as a cystic and solid frontoparietal mass, arising in a 16-year-old girl. The patient presented seizures and headache. Neuroradiologic findings showed a left frontoparietal lesion with cystic and tissular components. The tumor was removed through a left frontoparietal craniotomy. Histological features confirmed the diagnosis of intracerebral schwannoma. Intracerebral schwannomas, unrelated to cranial nerves, are rare. The Schwann cells are not indigenous to brain substance, and hence histogenesis of these tumours has attracted a lot of speculation, but because most reported cases have involved young patients, a developmental origin has been suggested. The theories and literature related to this case are reviewed. Intraparenchymatous schwannomas of the central nervous system are rare. A literature survey revealed reports of 65 such cases . The pre A 16-year-old female was admitted with headache and one episode of seizure. Neurological examination was unremarkable, and cognitive functions were normal. MRI brain showed intracerebral space occupying lesion in the left frontoparietal lobe . Preoper Schwannomas are benign tumors accounting for approximately 8% of all intracranial lesions . Intracr Schwannomas commonly arise from the nerve sheaths of peripheral and cranial nerves. Thus, since the central nervous system is devoid of the Schwann cells present in nerves, the pathogenesis of intracerebral schwannomas is unclear. Several theories have been proposed for their intracerebral occurrence. These theories can broadly be considered in two groups, the developmental and nondevelopmental. According to the developmental theory, aberrant Schwann cells in the brain parenchyma may occur due to the transformation of the mesenchymal pial cells  or from  Intraparenchymal schwannomas are detected either in the first two decades, when they present with an indolent, slow-growing course, or in the elderly, when their symptoms evolve rapidly . Males aHistopathologically, the detection of Antoni A and Antoni B structures, Verocay bodies, infiltration by foamy macrophages, and vascular hyalinization usually suffice for the recognition of schwannomas.  Surgery remains the main therapeutic modality, and due to the benign nature of the tumor, complete excision is associated with cure, and the long-term outcome after excision is generally good. The patient was discharged from our hospital with no neurological deficit. This case is reported here because of the rarity of the lesion, and schwannoma should be considered as differential diagnosis in young patients presenting with solid and cystic intracranial space occupying lesions. Long-term outcome after excision is generally good.


Staphylococcus infections of the abdominal wall. We present 3 cases of patients with morbid obesity who presented to our hospital with abdominal wall swelling, thickening, erythema, and pain. The abdominal wall and legs were edematous, with cobblestone-like, thickened, hyperpigmented, and fissured plaques on the abdomen. Two patients had localised areas of skin erythema, tenderness, and increased warmth. There was purulent drainage from the abdominal wall in one patient. They were managed with antibiotics with some initial improvement. Meticulous skin care and local keratolytic treatment for the lesions were initiated with limited success due to their late presentation. All three patients refused surgical therapy. Conclusion. Early diagnosis is important for the treatment of abdominal elephantiasis and prevention of complications.Abdominal elephantiasis is a rare entity. Abdominal elephantiasis is an uncommon, but deformative and progressive cutaneous disease caused by chronic lymphedema and recurrent streptococcal or  Lymphedema refers to excessive lymphatic accumulation in the interstitial space and occurs as a result of inadequate drainage. This may result from intraluminal or extraluminal obstruction, and rarely from congenital hypoplasia of the lymph vessels. When the lymphedema persists, there is often fibrous tissue proliferation and the affected area becomes hard and no longer pits on pressure. Elephantiasis is localised lymphedema with superadded bacterial infection leading to chronic skin changes. It is characterized by chronic edematous and thickened skin resulting from the repeated inflammation of the skin and subcutaneous tissue. We present three cases of abdominal elephantiasis in morbidly obese patients. Staphylococcus, Corynebacterium, and Streptococcus viridians. The polymicrobial growth was likely from colonization/contamination from normal skin flora. A 53-year-old, morbidly obese gentleman, with a weight of 725 pounds and BMI of 115, who had been homebound for the past 4 years, presented with worsening abdominal swelling and abdominal wall pain. He noticed progressive increases in the thickness of the abdominal skin over the preceding 2 years. His past medical history was significant for type 2 diabetes mellitus, hypothyroidism, recurrent leg cellulitis, and obstructive sleep apnoea. He had no history of congestive heart failure, cancer, liver, or renal disease. He has had no prior surgery or radiation therapy. His physical exams were significant for diffuse, edematous abdominal wall, and legs. The abdominal skin was thickened, fissured, erythematous, and cobblestone-like in appearance . It was A 60-year-old woman with past medical history of multiple sclerosis, depression, and morbid obesity (with a BMI of 94), presented with abdominal pain and purulent discharge from the abdominal wall. The abdomen was markedly distended and sagging. The abdominal wall was edematous, thickened, hyperpigmented, and excoriated at many sites . There wA 80-year-old Caucasian female with morbid obesity (BMI of 55) was admitted with worsening shortness of breath and progressive abdominal and leg swelling. Her past medical history was significant for congestive heart failure, hypertension, chronic kidney disease, and morbid obesity. Her outpatient medications included Lasix, aspirin, and statin. Clinical examination was remarkable for thickened skin of the abdominal wall, fissuring, and nonpitting edema of the abdominal wall. Her legs were visiblly swollen and puffy but were nonpitting. Her lungs were clear of auscultation. Her cardiac echo revealed markedly enlarged right atrium and right ventricle systolic pressure with pulmonary artery hypertension . She was started on dobutamine drip, intravenous Nesiritide, and Lasix. Despite the aggressive diuresis, there was only very minimal decrease in the leg swelling. Abdominal elephantiasis is relatively uncommon in the general population. It is relatively more common in the morbidly obese patients .Lymphedema may be classified as primary or secondary. Primary lymphedema results from congenital abnormality or dysfunction of the lymphatic vessels. Secondary lymphedema develops as a consequence of destruction or obstruction of the lymphatic channels. This may result from obesity, infection, trauma, surgery, tumor obstruction, radiation therapy, or Kaposi sarcoma , 3.Morbid obesity can be associated with massive localized lymphedema . It causStaphylooccus infections [Elephantiasis is an uncommon, but deformative and progressive cutaneous disease caused by chronic lymphedema and recurrent streptococcal or fections . The micAbdominal elephantiasis is a rare entity. There are only few reported cases of this abnormality in the medical literature. Thyroid dermopathy, venous stasis dermatitis, and filariasis must be considered in the differential diagnosis. The possibility of filariasis is unlikely in the United States (US) . FilariaDistinguishing pure abdominal wall cellulitis from abdominal wall elephantiasis in obese patients can be challenging. Often the two coexist as abdominal wall elephantiasis predisposes the patient to recurrent cellulitis. A long standing, slowo-l progression course and a history of unsuccessful treatment with antibiotics may suggest underlying lymphedema. The diagnosis can be difficult to confirm. Surgery (exeresis/plasty) may confirm the presence of dilated lymph vessels. The management of this chronic and deformative disease includes antibiotics to treat cellulitis, topical keratolytics, mechanical massages, oral retinoid, topical benzopyrones , and surAll the 3 patients refused surgical intervention and preferred conservative management; so they were started on antibiotic treatment in Cases We have presented three cases of presumed abdominal elephantiasis and reviewed the current literature on the subject. Massive, chronic lymphoedema in obese patients can cause extreme disfigurement and physical disability affecting them on both social and physical levels. Management of the morbidly obese patient with lymphedema requires that the obesity be addressed in a frank and supportive way. Treatment of lymphedema must be linked to the treatment of obesity if long-term success is to be achieved. Physicians should be aware of the great risk and complications of chronic lymphoedema, strive to develop a collaborative approach to care, and be prepared to educate and closely monitor these patients. Management in advanced stages is usually unsuccessful. The initial stages of this condition can be treated more easily with topical therapies. Early diagnosis is important for the treatment and prevention of complication.


We report a case of perivascular epithelioid cell tumor arising in the rectum of a 55-year-old woman. The tumor was treated by transanal endoscopic microsurgery. After 1 year follow-up, the patient is alive with no radiologic or endoscopic evidence of recurrence. Perivascular epithelioid cell tumor is a rare mesenchymal tumor characterized by co-expression of melanocytic and smooth muscle markers. This rare tumor can arise in various organs, including the falciform ligament, uterus, uterine cervix, liver, kidney, lung, breast, cardiac septum, pancreas, prostate, thigh, and gastrointestinal tract. Perivascular epithelioid cell tumor of the gastrointestinal tract is very rare, with only 23 previously reported cases. We review the literature on perivascular epithelioid cell tumors arising in the gastrointestinal tract. Perivascular epithelioid cell tumors (PEComas) were defined as “mesenchymal tumours composed of histologically and immunohistochemically distinctive perivascular epithelioid cells” by the World Health Organization . PEComasGastrointestinal PEComa-NOS are very rare. To our knowledge, 23 cases have been reported in the literature -22; consA 55-year-old woman was referred to our hospital because of a rectal submucosal tumor detected on a colonoscopic examination. She had undergone a sigmoidectomy for sigmoid colon carcinoma 2 years previously in our hospital. Postoperatively, the final disease stage was T1N0M0 (Stage I) according to the TNM classification. The histological subtype of the sigmoid colon cancer was moderately differentiated adenocarcinoma. There had been no evidence of recurrence or metastasis during 2 years follow-up. The patient showed no signs of tuberous sclerosis complex.On digital rectal examination, a hard mass was palpated on the posterior wall of the rectum. The results of other physical examinations of the abdomen and other organs were normal. Laboratory data showed no marked abnormalities, including tumor markers such as carcinoembryonic antigen and carbohydrate antigen 19-9. Colonoscopic examination in our hospital revealed a submucosal tumor 3 cm in diameter arising in the posterior rectal wall, 10 cm from the anal verge , neuron-specific enolase, CD68, and transcription factor E3 (TFE-3), but negative for AE1/AE3, CAM5.2, epithelial membrane antigen, smooth muscle actin, Desmin, MyoD1, Caldesmon, Calponin, Synaptophysin, Chromogranin A, NCAM, Vimetin, CD34, S-100, Melan-A, CD99, CD10, D2-40, CD138, P-ALP, and multiple myeloma oncogene-1 (Figure PEComas are part of a group of very rare mesenchymal neoplasms. Bonetti and colleagues  were theIn this study, we focused on gastrointestinal PEComa-NOS and did not include classic AML and LAM of the gastrointestinal tract in our review. The clinicopathological features of the PEComa-NOS included in this study are summarized in Table Although the treatment of choice for gastrointestinal PEComa is surgical resection, the overall management strategy for gastrointestinal PEComa remains to be established. Furthermore, potential benefits of adjuvant chemotherapy have not been investigated. In a recent study of PEComa of soft tissue and gynecologic origin, Folpe and colleagues  suggesteGiven the present situation, close follow-up, including imaging studies and colonoscopy, is mandatory after surgical resection of gastrointestinal PEComa, especially in patients with high-grade malignancy. Because the outcomes of gastrointestinal PEComa remain unclear, further long-term studies in larger number of patients are needed.We reported a rare case of rectal PEComa and reviewed the clinicopathological characteristics of gastrointestinal PEComa-NOS. At the present time, the most effective treatment for gastrointestinal PEComa is surgical resection. But the postoperative management including adjuvant chemotherapy still has not been established. So patients with postoperative PEComa-NOS should be carefully followed up.Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.AML: Angiomyolipoma; CCST: Clear-cell “sugar” tumors; HMB-45: Melanoma-associated antigen; LAM: Lymphangioleiomyomatosis; PEComa: Perivascular epithelioid cell tumor; PEComa-NOS: PEComa-not otherwise specified; TFE3: Transcription factor E3.The authors declare that they have no competing interests.AK, SF, TG, AI, TO, and TF performed the surgical treatment. AK and SF drafted the manuscript. TI and AN performed the pathological studies. NY, YR, TI and MM revised this manuscript. CK critically reviewed the manuscript and gave final approval for publication. All authors have read and approval the final manuscript.


Purpose. The aim of this paper is to report a case in which the cone beam computed tomography (CBCT) was important for the confirmation of the presence of maxillary sinus septum and, therefore, the absence of a suspected pathologic process. Case Description. A 27-year-old male patient was referred for the assessment of a panoramic radiograph displaying a radiolucent area with radiopaque border located in the apical region of the left upper premolars. The provisional diagnosis was either anatomical variation of the maxillary sinuses or a bony lesion. Conclusion. The CBCT was important for an accurate assessment and further confirmation of the presence of maxillary septum, avoiding unnecessary surgical explorations. Maxillary sinuses (MS) are facial pyramidal cavities with thin walls corresponding to the orbital, alveolar, facial, and infratemporal aspects of the maxilla. The size, shape, and wall thickness of this anatomic structure vary from one individual to another . Some maA 27-year-old male patient was referred to our institution for the assessment of a radiolucent area surrounded by radiopaque border located in the periapical regions of upper left first and second premolars .The intraoral examination showed integrity of the mucosa and no bone expansion was noticed. Pulp vitality test was positive for all teeth in the region. The provisional diagnosis was an anatomic variation of the MS or a bony lesion.Dolphin software . Coronal, sagittal, and axial images showed the presence of maxillary sinus septum and associated with palatine extension of maxillary sinus. 3D reconstructions allowed the volumetric visualization of the anatomic condition , using FOV of 6 cm, 20 seconds, and 0.3 mm voxel. The images were reformatted using ondition .These tomographic images confirmed the provisional diagnosis of anatomical variation of the MS and the absence of any related pathologic process. The CBCT showed the location and size of the septum as well as its association with a palatine sinus extension. The patient has been informed about the anatomical variation.Many authors have reported the presence of MS septa and their relevance to surgical procedures. This anatomic variation was first described by Underwood in 1910  found thIn the present case, the first analysis of the panoramic radiograph led to a concern about the possibility of the radiolucent image to represent a cystic lesion. The image could be suggestive of a maxillary cystic process of odontogenic origin, since the radiolucent area was close to the apical region of the teeth and it presented a surrounding radiopaque border. The clinical examination proved that the teeth were vital and the patient had no pain or swelling. Nevertheless, the radiolucent image as seen on the panoramic radiograph could still represent an odontogenic lesion at an early stage. The CBCT scan was important for the accurate assessment of the region and identification of the sinus septum and palatine extension.As a conclusion, this paper highlights the importance of an accurate imaging assessment of the maxillary sinus and its variations, in order to properly differentiate pathologic lesions from an anatomic variation, avoiding unnecessary surgical explorations.


Supraglottic laryngeal cysts are benign, uncommon lesions that have the potential to cause airway compromise.We present a case of a 46-year-old Caucasian woman who was scheduled for excision of a large neck growth (saccular cyst) and was managed successfully. There was thorough consideration regarding anesthetic and surgical management. Steps taken led to a successful excision with no recurrence during follow up.This case was an opportunity to consider the challenges in the airway management associated with such cysts and provided reassurance that excision of these cysts is associated with a good post-operative outcome. The presence of a large neck growth can potentially cause difficulty during intubation in theatre as well as in the emergency department. Supraglottic laryngeal cysts such as saccular ones may be benign, and uncommon, lesions. On rare occasions, they have been reported to cause life-threatening events through acute airway obstruction. However, when proper assessment has taken place in the pre-operative stage and the anesthetic and surgical management have been well planned, complications and morbidity can be avoided. In our case, our patient was assessed pre-operatively, and both her anesthetic and surgical management ensured her well-being.A 46-year-old Caucasian woman was referred to our clinic with a 12-month history of hoarseness and progressive difficulty in breathing. Weeks prior to surgery she developed minor dysphagia which, in combination with the earlier symptoms, convinced her to seek medical advice and treatment. Past medical history included smoking (20 cigarettes per day), with no other significant co-morbidity.On examination, she had an easily recognized right neck mass, which in palpation felt soft, mobile and non-pulsatile. There were no lymph nodes or other masses nearby. She also had a noticeable breathy dysphonia. On flexible nasendoscopy, there was a large well-defined supraglottic lesion partially obstructing her vocal cords, which were anatomically and functionally intact. An urgent neck computed tomography (CT) scan was ordered, which revealed an extensive cystic supraglottic mass with no further anomalies of the larynx Figures  and 2. SOn the day of the operation, our patient had no premedication. The plan was to induce our patient and test the ability to bag-mask ventilate before administration of a muscle relaxant. The option of awake intubation and gaseous induction was offered, however our patient refused it. An emergency tracheotomy kit was readily available as a last option. Following pre-oxygenation, midazolam 2 mg, fentanyl 100 μg and propofol 200 mg were administered and manual ventilation ability was assessed. It proved to be feasible and subsequently suxamethonium 100 mg was given. Conventional laryngoscopy was attempted at that stage that showed a Cormack and Lehane view Grade IV. Due to the readily available equipment we proceeded down the fiberoptic intubation route. The oral route was chosen to avoid extra tissue trauma that could affect visibility. The initial view was that of a mass obstructing all the structures in the supraglottic area. There was a need for manipulation with the tip of the scope to bypass it as non-traumatically as possible in order to get a view of the vocal cords. Insertion of the tube (flexible size 7.0id) was uneventful. As a result, her airway was secured and we proceeded to the operation. Maintenance of anesthesia was achieved with an oxygen and nitrous oxide mix (65% to 35% respectively) and sevoflurane 1.9%.The mass was excised with an external approach Figure . This meInspection of the lesion revealed a brownish soft mucosal lined sac sized 5.5 × 2.9 × 4 cm which contained mucus. A histopathology report confirmed the diagnosis of a cyst lined with pseudostratified columnar respiratory epithelium and focal presence of intracellular and extracellular mucus production . No evidence of cancer cells in the specimen was found. At follow-up eight months later there was no recurrence.Supraglottic laryngeal cysts are benign and relatively rare formations that originate from the laryngeal saccule and can mimic other types of more common laryngeal anomalies . This saDetailed history prior to any anesthetic intervention is vital. Signs and symptoms such as hoarseness, neck swelling, stridor, dysphagia, globus, sore throat, snoring and cough can alert the anesthetist to potential difficulties with intubation and ventilation, especially after the administration of muscle relaxants. Imaging studies may contribute by revealing the size of the lesion and its anatomical relations. If there is cause for concern, preparation should be made for management of a difficult airway. A person skilled in fiberoptic intubation should be immediately available. Maintenance of oxygenation via cricothyrotomy, tracheotomy or even cardio-pulmonary bypass may be required in extreme situations . In the As far as surgical management is concerned, these entities can be efficiently managed with endoscopy when they are diagnosed at the early stages of the disease . HoweverA useful tool for selecting the ideal approach is the preoperative CT scan as it allows for proper mapping and surgical planning. Magnetic resonance imaging (MRI) can also be helpful in distinguishing between inflammation and malignancy as well as allowing better visualization of soft tissue structures . The information gathered provides guidance with regards to the extra care needed to avoid damage to neighboring structures .After successful excision, anesthetic problems are extremely rare. The remainder of the management involves recovery and ruling out neoplastic lesions. The association between laryngeal saccular cyst and carcinoma means that histopathology studies are vital in excluding such tumors .Huge laryngeal saccular cysts demand proper anesthetic and surgical management planned in advance. Above all, the anesthetic part includes preparation for difficult airway and skills to deal with what otherwise would be unexpected. For the surgical part, the approach must be considered carefully as it is directly related to the optimal visualization and thorough mobilization of the cyst. Once these two areas are secured, post-operative airway problems are negligible.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.The authors declare that they have no competing interests.IA and AS faced the clinical situation, made notes of it and gathered the data presented. All the authors contributed to the literature search and writing and reading of the manuscript. All authors read and approved the final manuscript.


Following long-course chemoradiotherapy repeat staging did not identify any metastatic disease. She underwent a laparoscopic cylindrical abdominoperineal excision with en bloc resection of the coccyx and posterior wall of the vagina with a negative circumferential resection margin. The perineal defect was reconstructed with Permacol  mesh. She had no clinical evidence of a perineal hernia at serial followup. Dynamic MRI images of the pelvic floor obtained during valsalva at 10 months revealed an intact pelvic floor. A control case that had undergone a conventional abdominoperineal excision with primary perineal closure without clinical evidence of herniation was also imaged. This confirmed subclinical perineal herniation with significant downward migration of the bowel and bladder below the pubococcygeal line. We eagerly await further evidence supporting a role for dynamic MR imaging in assessing the integrity of a reconstructed pelvic floor following cylindrical abdominoperineal excision.A 72-year-old female presented with a six-month history of increased frequency of defecation, rectal bleeding, and severe rectal pain. Digital rectal examination and endoscopy revealed a low rectal lesion lying anteriorly. This was confirmed histologically as adenocarcinoma. Radiological staging was consistent with a T National and international data on abdominoperineal excision (APER) reveal high-margin positivity rates and a high incidence of intraoperative perforation –3. Endea3N2 tumor with enlarged inguinal nodes. However, fine needle aspiration of the latter was negative. Following discussion at the multidisciplinary meeting the patient was referred and underwent a six-week course of chemoradiotherapy. Following a subsequent 6-week interval the patient was admitted electively for laparoscopic abdominoperineal excision . The abdominal component was performed supine. Ports were placed to facilitate a medial-to-lateral approach to the left colon. The inferior mesenteric artery was isolated and divided using an endovascular stapler (Ethicon) with prior identification of the left ureter. The medial dissection was completed separating the mesocolic fascia from Gerota's fascia. The lateral peritoneal attachments were divided in a cephalad direction with adequate mobilisation to facilitate adequate length to form an end sigmoid colostomy. This ladies' body habitus required proximal mobilisation to facilitate colostomy formation. The pelvic dissection was commenced along the plane of the mesorectal envelope. The anterior landmark for cessation of abdominal dissection was the point at which the vagina was initially encountered. The posterior dissection ended at the corresponding posterior level at the upper border of the coccyx to ensure that the mesorectum was not fully mobilised off the pelvic, thereby avoiding “coning”. The sigmoid colon was divided laparoscopically, and an end colostomy was constructed in the left iliac fossa.A 72-year-old female was referred with a 6-month history of faecal urgency, rectal bleeding, and severe rectal pain. Colonoscopy revealed an anterior rectal mass. The lower border of the rectal lesion was palpable at 3 centimeters from the anal verge and encroached on the rectovaginal septum. Histopathological examination of biopsy specimens confirmed rectal adenocarcinoma. Computerised tomography of the abdomen and pelvis did not reveal distant metastases. MRI pelvis staging reported a Ten bloc resection of the posterior vaginal wall as the tumor had initially encroached on the rectovaginal septum.The perineal component was undertaken in the prone “jack-knife” position. The anal orifice was closed using a purse-string suture. The anus and sphincter complex was widely excised with cephalad extension of the incision to facilitate access to the coccyx. The sacrococcygeal joint was disarticulated, and the pelvic peritoneum was breached posteriorly. Lateral dissection across the ischiorectal fossae was then performed with wide division of the levators to meet the abdominal dissection. Finally the specimen was delivered, and the anterior component was completed with The vaginal wall was closed, and the pelvic floor defect was reconstructed using a Permacol Biologic Implant  which was fixed to the pelvic floor defect circumferentially using interrupted 2/0 polypropylene sutures. Initial suture placement was laterally along the fascial line of attachment of the pelvic floor muscle. Posteriorly it was sutured to the fascia posterior to the sacrococcygeal junction. Anteriorly it was sutured either side of the midline so that it did not cause further distortion of the posterior vaginal wall. The perineal wound was closed in three layers with interrupted absorbable sutures. A closed suction drain was left in situ. The patient made a favourable postoperative recovery and was discharged home on the 13th postoperative day. She lived alone, and at the time of discharge she was fully independent in her stoma care. Her perineal wound was fully healed. Final histology revealed residual poorly differentiated adenocarcinoma with associated cytological changes characteristic of neoadjuvant therapy. Extensive fibrosis was noted indicative of favourable regression in response to neoadjuvant therapy. Extramural venous invasion was observed. All 14 lymph nodes retrieved showed no evidence of malignancy, and the circumferential resection margin was 3 mms with no evidence of invasion into the vaginal wall.2-weighted sagittal and coronal views were obtained , and 5-millimeter Tobtained . It was obtained . This deThis paper illustrates the feasibility of using dynamic MRI scanning to image perineal integrity following extralevator abdominoperineal excision and subsequent porcine mesh reconstruction. Ideally, the abdominoperineal resection technique must serve the oncological requirement to satisfactorily clear malignant disease with minimal morbidity. Much of the morbidity that commonly follows this procedure arises from the perineum which has typically undergone radiotherapy. Intuitively the larger defect created will yield higher perineal morbidity, and initial experiences support this hypothesis , 8. OptiSir Ernest Miles described many operative procedures but he had a particular interest in the area of rectal cancer . Early iOne potential drawback to cylindrical excision is that the pelvic defect that follows the procedure could be associated with greater perineal morbidity than the conventional operation if not coupled with suitable perineal reconstruction. Several authors have utilised muscle flaps to close the perineal defect following cylindrical excision with favourable outcomes in individual personal series. Some surgeons report using vertical rectus abdominis myocutaneous (VRAM) and inferior gluteal artery perforator flaps (iGAP) –15. HolmThe advent of biological meshes provides a novel approach to reconstructing the pelvic floor. The xenograph composed of acellular porcine dermis has yielded positive postoperative outcomes across multiple surgical disciplines during its preclinical trials and subsequent decade of clinical applications. Clinical data has revealed its safety profile in direct contact with small intestine while clinically evident infections can be safely treated with antimicrobial therapy and typically do not require removal in the setting of infection –21. Thesversus 43%: P = 0.24 [Conventional APE involves a sutured closure of the pelvic defect with subsequent closure of the overlying fat and perineal skin. The classical procedure is however associated with significant perineal wound-related problems –25. SpecP = 0.24 . IdentifThe current case highlights some of the challenges faced with attempts to improve outcome in low rectal cancer surgery. The large perineal defect that follows extralevator APE is likely to benefit from reconstruction. The clinical superiority of a single reconstructive technique that leads to reduced perineal morbidity has not been established. The functional integrity of the reconstructed pelvic floor can be clearly imaged using dynamic magnetic resonance imaging. This radiological approach could support an evaluation of outcome following differing types of perineal reconstruction in a larger series.


Acute gastric dilatation can have multiple etiologies which may lead to ischemia of the stomach. Without proper timely diagnosis and treatment, potentially fatal events such as gastric perforation, haemorrhage, and other serious complications can occur. Here we present a 36-year-old man who came to the casualty with pain abdomen and distension for 2 days. Clinically, abdomen was asymmetrically distended more in the left hypochondrium and epigastrium region. Straight X-ray abdomen showed opacified left hypochondrium with nonspecific gaseous distension of bowel. Exploratory laparotomy revealed dilated stomach with patchy gangrene over lesser curvature and fundic area. About 4 litres of brownish fluid along with semisolid undigested food particles was sucked out (mainly undigested pieces of meat). Limited resection of gangrenous areas and primary repair were done along with feeding jejunostomy. Necrosis of the stomach was confirmed on histopathology. The patient recovered well and was discharged on the tenth postoperative day. Acute gastric dilatation can have multiple etiologies which may lead to ischemia of the stomach. The etiologies are lifestyle habits, underlying morbidities, acute necrotizing inflammation, acute vascular insufficiency, and postoperative complications. Without proper timely diagnosis and treatment, potentially fatal events such as gastric perforation, haemorrhage, and other serious complications can occur. We here present a rare case of gastric dilatation leading to patchy gangrenes on the surface of stomach and how timely intervention was carried out.A 36-year-old male patient, referred from periphery hospital with nasogastric tube in place, presented to the casualty with pain abdomen and abdominal distension for two days which was not relieved with conservative treatment. Two days ago he had taken nonvegetarian meal twice, in increased quantity than usual, within a short gap of 3 hours between those two meals. Then he had two episodes of vomiting 6 hours later. His past history was not significant. He was not suffering from any psychiatric illness or any co-morbidity like diabetes and had not undergone any surgeries. His vital parameters were within normal limits. Abdominal examination showed more asymmetrical distension in left hypochondrium and epigastrium with tympanicity all over the abdomen without signs of peritonitis. Straight X-ray abdomen showed opacified left hypochondrium with nonspecific gaseous distension of bowel . Even afIn 1833, Duplay first described acute gastric dilatation . The impIschemia is caused presumably due to venous insufficiency when massive dilatation occurs , 12. To Several theories have been postulated to explain the pathogenesis of acute gastric dilatation. Morris et al. claimed that anaesthesia and debilitation may be predisposing factor as it is a very frequent postoperative complication. Relaxation of the upper oesophageal sphincter with aerophagia may be a factor leading to gastric distention , 4, 10. In more than 90% of cases of acute gastric dilatation, vomiting is an important and common symptom . AnotherPlain abdominal films and CT scan can demonstrate gastric distension and free air and are useful in the diagnosis. In our case, since the distension was increasing and huge, we just planned to explore the patient with just abdominal X-ray showing opacification in left hpochondrium with gaseous distension of bowel. Treatment focuses on early diagnosis and decompression of the stomach, thus halting the vascular congestion and thus ischemia . Decompr


Testicular cancer is the most common malignancy in men 15- to 35-years-old. The North American standard classification divides testicular cancers into germ cell tumors and non-germ cell tumors. The lymphatic spread of germ cell tumors usually involves the retroperitoneal lymph nodes. However, this spread to the retroperitoneum rarely involves the hepatic hilum. We describe an unusual case of metastatic choriocarcinoma of the testis that was clinically mimicked by a cholestatic jaundice. This is an unusual presentation of testicular cancer and, to the best of our knowledge, the first report of this kind in the literature.A 28-year-old Moroccan man presented with a four-week history of progressive obstructive jaundice, and weight loss to our emergency department. Abdominal ultrasound showed a dilatation of the biliary ducts due to pathologically enlarged lymph nodes of the hepatic hilum. A complete clinical and radiologic assessment to discover the primary tumor was negative except for pulmonary metastasis. In the laboratory findings at admission there were signs of cholestasis with an abnormal increase in the rate of testicular tumor markers , which subsequently led to the suspicion of a testicular tumor. Further evaluation included testicular palpation and ultrasound which revealed a testicular nodule. The patient underwent an inguinal orchidectomy of the right testis and histopathological examination confirmed a pure choriocarcinoma. The prognosis was poor due to lymph node involvement at the hepatic hilum. He died one month later, despite general chemotherapy.The clinical presentation of the disease and the rarity of this entity are two remarkable characteristics described in this case report which are rarely reported in literature. Despite general chemotherapy, he died due to lymph node metastasis at the hepatic hilum.A 28-year-old man who was a native of Morocco without prior medical history presented with a four-week history of progressive obstructive jaundice and weight loss to our emergency department. On physical examination he looked tired, his temperature was normal (37.5C), and he displayed conjunctival icterus. His abdominal examination was normal and a rectal examination found no tenderness or blood.Laboratory findings at admission showed: leukocytes 12.5G/L , hemoglobin 12.5g/dL , lactic dehydrogenase 416U/L , glutamic oxalacetic transaminase (GOT) 107U/L , glutamic pyruvic transaminase (GPT) 210U/L , γ-glutamyltransferase 110U/L , alkaline phosphatase 592U/L , bilirubin 40.19μmol/L , and C-reactive protein (CRP) 102mg/L .Abdominal ultrasound Figure  revealedBecause of his young age, we performed a complete serum analysis with testicular tumor markers. His serum beta-human chorionic gonadotrophin (HCG) level was 11,000IU/ml , serum alpha-fetal protein was 0.426IU/ml , serum lactate dehydrogenase was 438U/L , carbohydrate antigen (CA19-9) and carcinoembryonic antigen (CEA) were in the normal range.The diagnosis of testicular tumor was suspected. Further exploration included testicular palpation and ultrasound which revealed a right testicular nodule that was 2cm in its largest diameter, at the lower pole of the testis with low echogenicity and heterogeneity.He underwent right inguinal orchidectomy and histopathological examination showed choriocarcinoma of the right testis Figures , 4. ImmuChoriocarcinomas are rare, accounting for less than 1% to 3% of all the testicular neoplasms. They can also be found in combination with other germ cell tumor elements in 8% of testicular germ cell tumors . Tumors et al. [Patients often have symptoms of metastasis before the primary lesion is detected. Sahraoui et al.  report iTo the best of our knowledge, this is the first case report where jaundice is the first symptom due to larger and compressive lymph nodes of the hepatic hilum. Therefore, our patient was at first evaluated by the gastroenterology team at presentation. His young age in combination with undiagnosed abdominal or chest masses led to the measurement of tumor markers of the testis before he was referred to our institution.On histopathological examination, the diagnosis of choriocarcinoma is based on morphologic features with the finding of cytotrophoblasts and syncytiotrophoblasts; positive staining for HCG and cytokeratin are also important. The syncytiotrophoblastic cells are usually multinucleated with deeply staining, eosinophilic to amphophilic cytoplasm, and the cytotrophoblastic cells have pale to clear cytoplasm with a single, irregularly shaped nucleus with one or two prominent nucleoli . HoweverThe origin of the histopathological appearance is due to the strain cell of embryonal carcinomas. They grow through imitation of the trophoblastic tissue of the placenta .et al. [Orchidectomy followed by chemotherapy in germ cell tumors associated with retroperitoneal lymphadenectomy is mandatory. After orchidectomy the patient underwent a protocol of four cycles of bleomycin, etoposide, and cisplatin (BEP) as recommended in the poor prognosis group with survival rates of 45% and 50% . Ismailiet al.  report aet al. [The prognosis of a choriocarcinoma is worse than others due to its early hematogenous metastasis. Sahraoui et al.  reportedThis case is rare in being pure choriocarcinoma of the testis, which accounts for less than 3% of the testicular neoplasms with an unusual clinical presentation. Investigation for primary testicular germ cell tumors is essential in young men with unidentified tumor metastasis. The detection of the testicular tumor markers may provide an important clue to the diagnosis.Written informed consent was obtained from the patient’s next-of-kin for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.The authors declare that they have no competing interests.MA was the principal author and major contributor in writing the manuscript. MFT, SM, JA, AK and HF analyzed and interpreted the patient data and reviewed the literature. RSW, MJE, MHF and AA read and corrected the manuscript. All authors read and approved the final manuscript.


Hepatic mesenchymal hamartoma is a rare benign tumor. We present an unusual case of a fetal abdominal cyst, later diagnosed histopathologically to be mesenchymal hamartoma of liver. The organ of origin was indeterminate on both prenatal and postnatal ultrasounds. As there are no specific sonological findings, whenever a large multicystic fetal abdominal cyst is seen, mesenchymal hamartoma should be considered as a possibility.  Increase use of antenatal ultrasound has resulted in greater incidence of prenatal diagnosis of congenital malformations. Many anomalies which manifest in the third trimester are diagnosed, as serial growth of fetus is monitored by ultrasound. Fetal abdominal cyst with normal kidneys and liquor in the third trimester is probably ovarian cyst, mesenteric cyst, or rarely mesenchymal hamartoma of liver as reported in this case. Mesenchymal hamartoma is a cystic benign tumor, but rapid growth to enormous size can lead to fetal hydrops and demise. Case report with management and review of the literature of congenital mesenchymal hamartoma of liver is presented.A 25-year-old primigravida was referred to us at 38 weeks for management of cardiac disease complicating pregnancy. Incidentally, during antenatal ultrasound, an intra-abdominal anechoic cyst, just above the level of kidneys, measuring 7 × 8 cm was noted . BladderHowever, laparotomy was performed at 2 months for persistence of cyst. Liver function, renal function tests, and electrolytes were preoperatively normal. At laparotomy, a cystic lesion arising from 5th segment of liver was noted and the same was excised . HistopaPostoperative period was uneventful. After 2 months of surgery, a small cystic lesion (4 × 1 cm) was seen arising from the inferior part of right lobe of liver. It was decided to followup, the cyst. At the end of 2 months of postoperative follow up the cystic lesion reduced in size to 5 mm and baby was asymptomatic with good catch up growth. Hepatic tumors are rare and comprise of 5% of the total neoplasms in fetal and neonatal period . After hIn the largest series by Isaacs Jr, 45 cases of mesenchymal tumors are reported over a period of 35 years (1970–2005) . A totalEarly onset of presentation, rapidly progressing tumor, and polyhydramnios compression of arteries are poor prognostic factors which were seen in cases reported by Dickinson et al., Tsao et al., and Laberge et al. –6 Table. Thus, tCesarean delivery is not per se indicated unless it is a big tumor anticipating abdominal dystocia as can be inferred from


Undifferentiated embryonal sarcomas (UESs) are uncommon tumours that are seen predominantly in late childhood. Cases in adults are rare and generally present once a large mass develops and may be mistaken for other tumours. A case of an UES of the liver with an isolated peritoneal metastasis is described. The patient presented with a palpable mass with imaging findings suggestive of a cystic tumour. She had complete surgical resection of the liver mass and isolated peritoneal metastasis. She was tumour-free on imaging at 6 months without adjuvant chemotherapy. An UES should be considered in the differential of large cystic hepatic lesions, with aggressive surgical resection considered when possible. Undifferentiated embryonal sarcoma (UES) is an extremely rare entity in adulthood, with less than 60 cases reported in the literature –4. EmbryThe behavior of UES is generally highly aggressive in children and is considered to be the same in adults. Preoperative diagnosis of UES is rarely entertained for adults. Surgical resection does offer a chance of possible cure and should be considered in all cases. A case of UES in an adult patient treated by aggressive surgery is presented, and the features of UES and outcomes are discussed.A 78-year-old female presented with asymptomatic upper abdominal mass. Computed tomography (CT) was performed and demonstrated an encapsulated solid and cystic tumour involving the right lobe of the liver, measuring 16 cm in maximum diameter . PositroAt the time of surgery a large, a well-circumscribed, partially haemorrhagic cystic lesion was noted . This wa1-antitrypsin, vimentin, and desmin. Variably sized eosinophilic, intracytoplasmic, PAS-positive, diastase resistant globules were also noted within occasional tumour cells (Histology of the tumour revealed variable morphology. Prominent intratumoral necrosis was seen, and there was moderate mitotic activity. The morphological and immunohistochemical profile was consistent with undifferentiated embryonal sarcoma. The tumour was comprised of densely cellular areas of rounded and pleomorphic cells and myxoid more paucicellular areas with stellate and spindled cells . Tumour ur cells . In addiur cells  and staiThe patient declined adjuvant chemotherapy. Repeat CT imaging 6 months postoperatively showed no evidence of recurrent disease. Embryonal sarcoma is a primitive mesenchymal tumour of unknown aetiology associated with multiple genetic mutations . Also knUES most commonly arises in the right lobe of the liver; however cases located within the left lobe and bilateral lobes simultaneously have been documented , 7. VariPreoperative diagnosis is confounded by the absence and/or nonspecific symptoms. Embryonal sarcoma may present with abdominal pain or palpable mass or represent an incidental radiological finding as in our case. Tumoral rupture may rarely result in intraperitoneal haemorrhage . ConstitRadiologically, UES presents as a solid, cystic, or complicated circumscribed mass with or without septations . CT may 1-antitrypsin immunohistochemical stains, with variable cytokeratin expression.Macroscopic examination of UES reveals a well-circumscribed, soft mass showing cystic degeneration, haemorrhagic, and necrotic areas. Microscopically the tumour is surrounded by a pseudocapsule often with foci of extracapsular infiltration. UES is typically composed of stellate and spindled cells, set within a myxoid matrix and areas of higher cellularity. Moderate nuclear hyperchromasia and pleomorphism are seen. Occasional bizarre giant cells and PAS-positive, diastase-resistant eosinophilic globules are typically within the cytoplasm . ExtrameUES is a highly aggressive neoplasm with a guarded prognosis. Complete surgical resection offers the only chance of long-term survival, further improved by adjuvant chemotherapy plus or minus radiotherapy. While patients have been documented as disease-free for greater than 10 years, the median survival is reported as 29 months . Poor prIn summary, UES of liver in the adult population is a very rare entity with limited cases reported. When tumours are asymptomatic and the radiological features nonspecific, the diagnosis of embryonal sarcoma preoperatively is speculative and many other differentials are feasible. Surgical resection is necessary for histological assessment and complete tumour removal. Embryonal sarcomas have generally poor prognosis; however surgical resection and adjuvant chemoradiation offer the best chance for long-term survival.


Acute thromboembolic occlusion of the superior mesenteric artery is a condition with an unfavorable prognosis. Treatment of this condition is focused on early diagnosis, surgical or intravascular restoration of blood flow to the ischemic intestine, surgical resection of the necrotic bowel and supportive intensive care. In this report, we describe a case of a 39-year-old woman who developed a small bowel infarct because of an acute thrombotic occlusion of the superior mesenteric artery, also involving the splenic artery.A 39-year-old Caucasian woman presented with acute abdominal pain and signs of intestinal occlusion. The patient was given an abdominal computed tomography scan and ultrasonography in association with Doppler ultrasonography, highlighting a thrombosis of the celiac trunk, of the superior mesenteric artery, and of the splenic artery. She immediately underwent an explorative laparotomy, and revascularization was performed by thromboendarterectomy with a Fogarty catheter. In the following postoperative days, she was given a scheduled second and third look, evidencing necrotic jejunal and ileal handles. During all the surgical procedures, we performed intraoperative Doppler ultrasound of the superior mesenteric artery and celiac trunk to control the arterial flow without evidence of a new thrombosis.Acute mesenteric ischemia is a rare abdominal emergency that is characterized by a high mortality rate. Generally, acute mesenteric ischemia is due to an impaired blood supply to the intestine caused by thromboembolic phenomena. These phenomena may be associated with a variety of congenital prothrombotic disorders. A prompt diagnosis is a prerequisite for successful treatment. The treatment of choice remains laparotomy and thromboendarterectomy, although some prefer an endovascular approach. A second-look laparotomy could be required to evaluate viable intestinal handles. Some authors support a laparoscopic second-look. The possibility of evaluating the arteriotomy, during a repeated laparotomy with a Doppler ultrasound, is crucial to show a new thrombosis. Although the prognosis of acute mesenteric ischemia due to an acute arterial mesenteric thrombosis remains poor, a prompt diagnosis, aggressive surgical treatment and supportive intensive care unit could improve the outcome for patients with this condition. Acute thromboembolic occlusion of the superior mesenteric artery (SMA) is a condition with a serious prognosis . Acute mOne aspect that influences survival is the cause of the bowel ischemia, which can be classified as a non-thrombotic or a thrombotic event . Conditi6/L) and normal levels of the coagulation parameters. She was given abdominal ultrasonography in association with Doppler ultrasonography (Esaote Megas GPX 7.5-MHz convex probe), highlighting a thrombosis of the SMA. As a result of this clinical picture, she underwent an abdominal CT scan  scan that demonstrated only the presence of free fluid localized in the pouch of Douglas and the perihepatic region. In relation to these signs, she was given an emergency, explorative laparotomy, with lavage of the abdomen. The laparotomy demonstrated only hyperemic jejunal and ileal handles. She was discharged after nine days without any complications. Two weeks after the patient was readmitted to the same hospital with similar symptoms, and she was treated with corticosteroids, mesalazine, and metronidazole with a complete resolution of the symptoms. Five days later, the patient was admitted to our unit. At admission, she had leukocytosis . Moreover, the second-look and other laparotomies suggest the performance of an intraoperatory Doppler ultrasound to evaluate the artery flow. According to Ottinger , a new tWritten informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.The authors declare that they have no competing interests.NR wrote the article. VP researched and retrieved the bibliography. GB was the language supervisor. LL analyzed and interpreted the abdominal ultrasound data. VG acquired and interpreted the Doppler ultrasound data. RL contributed to writing the manuscript, controlling and correcting the general surgery portion. GB interpreted the hematology. OG supervised and was the chief of the team. All authors read and approved the final version of the manuscript.


Introduction. Sinusoidal hemangioma is a rare variant of acquired cavernous hemangioma predominantly occurring in females. Very few case reports have been described in the literature. Case Report. We present a case of a 46-year-old woman who noticed a slowly growing, cutaneous nodule on the left breast. Local excision of the lesion was performed and histology allowed to find a sinusoidal hemangioma. No recurrence was noticed. Conclusion. The very few reports of such a lesion in the literature reflect either rarity of such lesions or unfamiliarity of this subset among the pathologists. Sinusoidal hemangioma (SH) was first described by Calonje and Fletcher  in 1991.A 46-year-old woman had a painless, slowly growing, cutaneous nodule on the left breast with a duration of 6 months. Clinical examination showed a nontender, firm, slightly raised 1 cm cutaneous nodule with purplish discoloration of the overlying skin . There wIn 1991, Calonje and Fletcher –7. It apThe sinusoidal hemangioma is cured by simple local excision. Evolution of sinusoidal hemangiomas is different in different reports. Most authors, including Calonje and Fletcher , both foSH is a variant of acquired cavernous hemangioma that occurs mostly in women. Very few reports of such a lesion are described in the literature. The present case that we have reported appears to be a typical sinusoidal hemangioma clinically and histologically as described by the original authors. Local excision is the accepted therapy.


Vulvar cancer represents approximately 3%–5% of all gynecological malignancies. Squamous cell carcinoma is the most frequent histotype, whereas melanomas, adenocarcinomas, basal cell carcinomas, and sarcomas are much less common. Intestinal-type adenocarcinoma is a rare variant of vulvar carcinoma with only few cases found in the literature. The origin of this neoplasia is still much debated, but the most reliable hypothesis is the origin from cloacal remnants that may persist in the adult in different organs. Because of its extremely low incidence, the optimal management of this kind of vulvar cancer is still debated. We report the case of a woman affected by advanced intestinal-type vulvar adenocarcinoma, who achieved a complete clinical and pathological response after neoadjuvant chemotherapeutic treatment with platinum and paclitaxel. Vulvar cancer (VC) represents approximately 3%–5% of all gynecological malignancies . It affeHereby, we report the case of a woman affected by advanced intestinal-type vulvar adenocarcinoma, who achieved a complete clinical and pathological response after neoadjuvant chemotherapeutic treatment with platinum and paclitaxel.2 plus cisplatin 100 mg/m2 were administrated every 3 weeks. Neither adverse events nor high-grade chemotherapeutic toxicity was reported. On physical examination, performed after the third cycle of chemotherapy, the vulvar lesion was markedly reduced and this finding was confirmed at abdomen-pelvic CT scan, which showed no evidence of the disease . Multiple biopsies of the lesion and nearer tissues were performed with histological finding of a moderately differentiated invasive adenocarcinoma of the vulva ulcerating the surface epithelium. The neoplastic glands showed a colorectal morphology. The immunohistochemical pattern was strongly positive for cytokeratin 20, CEA, CDX2, and p16, with weak and focal positivity for cytokeratin 7, while vimentin and estrogen receptors were negative . These f disease , with re disease . The tum“Intestinal-type” vulvar adenocarcinoma is a very uncommon neoplasia and, consequently, its clinical behavior and prognosis are poorly understood and studied. Only few cases of this variant of vulvar adenocarcinoma have been previously described  2–11]. –11. 2–11Interestingly, the positivity of the present tumor for p16 suggests that vulvar intestinal-type adenocarcinoma could be associated with high-risk HPV. Furthermore, as described earlier, no increased serum tumoral markers  have been found in our case, consistently with reports previously described in the literature –6, 8–10.The clinical behavior of this rare malignant cancer seems to be rather indolent, with progression-free interval ranging from 12 to 120 months . GeneralAccording to our experience and the good response to chemotherapy reported until now for this setting of tumors, we could consider neoadjuvant platinum/paclitaxel chemotherapy followed by surgery as a valuable option for advanced vulvar intestinal-type adenocarcinoma not susceptible to primary surgical treatment. Both pathologists and gynecologic oncologists should be aware of the existence of this rare tumor. However, more cases with longer follow-up period are needed to fully understand its origin and better establish the biomolecular pattern of the disease, to elucidate the best therapeutic management and its long-term prognosis.


Candida albicans is a ubiquitous fungus and infection of urinary tract by C. albicans can be originated from blood or retrograde infection. We reported a case of localized candidiasis in the kidney presenting as a mass. The patient was a 61-year-old male with a history of type 2 diabetes mellitus and urinary bladder urothelial carcinoma status post radical cystoprostatectomy with a neobladder three years ago. Pathology at that time also showed a prostatic adenocarcinoma (Gleason score 3 + 4) in addition to the high-grade urothelial carcinoma. Three month ago the patient presented with flank pain, chill, and increased white cell counts. Imaging study showed a large renal mass suspicious for a renal cell carcinoma. Radical nephrectomy was performed and found that there was a large pocket of pus in the retroperitoneum around the right kidney during the surgery. Intraoperative abscess cultures were positive for C. albicans. Pathology showed a 13.5 cm necrotic renal mass extending to the perinephric fat. Histologically the tumor showed necrotic granulomatous inflammation. Grocott stain in the surgical specimen was positive for pseudohyphae and yeast forms. The patient was initiated a course of fluconazole postoperatively and was feeling well. Candida albicans is a ubiquitous fungus and can be detected in approximately 32–55% of health individuals [C. Candida can be from blood or retrograde infection [ividuals . Infectinfection . Localiznfection , or rarenfection , 10. In The patient was a 61-year-old male with a history of lynch syndrome, dyslipidemia, hypertension, and type II diabetes mellitus and coronary disease and underwent 4-vessel coronary artery bypass graft surgery 17 years ago. He had a smoking history of 1 PPT for 25 years and quitted 18 years ago. Three years ago, he was diagnosed with high-grade urothelial carcinoma in the urinary bladder and underwent cystoprostatectomy with a Studer pouch urinary diversion. Pathologic examination also found an prostatic adenocarcinoma (Gleason score 3 + 4) in addition to the high-grade urothelial carcinoma. Three months ago, the patient presented with right flank pain, chills, and increased white blood cell counts of 23,000. Imaging study showed a complex soft tissue mass of the posterior lower pole of the right kidney and posterior pararenal space. In its entirety, this mass measured 10.7 × 9.6 × 11.9 cm Figures . A portiCandida spp. Gram and acid fast stains were negative.The specimen was processed routinely. The specimen consisted of right kidney and perinephric adipose tissue measuring 24.6 × 14 × 6.5 cm and weighed 783.7 grams. On the posterior surface there was a large, necrotic defect mass measuring 13.5 cm in greatest dimension. On cut surface, it showed a large, poorly circumscribed, heterogeneous, and necrotic mass in the lower pole of the kidney measuring 13.0 × 5.0 × 6.0 cm  and exteC. Albicans is greatly advanced though the study of animal model. It has been shown that this fungus can be detected in all main organs, especially in the brain or kidneys [Our understanding of renal infection by  kidneys  shortly  kidneys , 12. In  Candida cause diseases in human when the body defense is compromised such as diabetes mellitus, human immunodeficiency virus infection, cancers, neutropenia, or immunosuppression due to organ transplantation, or when the patients undergo certain procedures such as bladder catheterization or urologic procedure . PatientC. Albicans infection can present as a mass lesion and have been reported in stomach [C. glabrata does not produce true hyphae and cannot produce pseudohyphae except under special cultural conditions. This hyphaeless fungus rarely produces renal mass in the renal pelvis [ stomach , pancrea stomach , liver [ stomach , and han stomach . Couple  stomach , 10. Masl pelvis .C. Albicans infection in the urinary system can occur through two ways, one is through the blood to spread into the renal parenchyma, and the other is retrograde through the urinary tract [ry tract .Escherichia coli and Proteus mirabilis [In our case, the mass is composed of granulomatous inflammation, necrosis, and abscess consistent with xanthogranulomatous pyelonephritis (XGP) . No tumoirabilis –24. Candirabilis , 10. Comirabilis . In our  All in all, in our case, patient's previous history of bladder cancer status after bladder resection in combination of type 2 diabetic mellitus and smoking may all contribute the infection.C. Albicans is a rare cause for xanthogranulomatous pyelonephritis, which can mimic various benign and malignant conditions. Treatments include nephrectomy and antifungal medications. In summary,


We present the case of a 79-year-old male who, due to hematuria, underwent cystoscopy that showed a lesion in the bladder dome. Transurethral resection was attempted, but access to the tumor by this route was impossible. Given the findings, a body CT scan was performed showing an inguinoscrotal hernia with vesical carcinoma contained. Open surgical treatment of the vesical carcinoma contained within the inguinoscrotal hernia was performed in conjunction with the hernia repair. The anatomical pathology report confirmed a high-grade urothelial carcinoma (stage pT2b) with a free resection margin of <1 mm. Adjuvant radiotherapy was selected for subsequent treatment. The presence of bladder tumor in an inguinoscrotal hernia is an uncommon finding and a diagnostic delay can be assumed. The initial therapeutic plan may need to be changed from the usual approaches due to the atypical presentation. The presence of the bladder wall is an infrequent finding in inguinal hernias, occurring in fewer than 4% of cases, according to published series , 2. The We present the case of a 79-year-old male with type II diabetes, hypertension, dyslipidemia, a history of transient ischemic attacks, and chronic renal insufficiency due to vascular nephropathy. He had been followed by the urology service for the previous 2 years due to irritative voiding symptoms with normal PSA and physical examination. Due to an episode of macroscopic hematuria, imaging studies—ultrasound and computer-aided tomography (CT)—were performed without significant findings. Therefore, urethroscopy was chosen to aid the etiological diagnosis. A 1.5 cm multilobulated lesion, with a solid appearance suggestive of bladder cancer and positive cytology for malignant cells was appreciated at the dome of the bladder.Excision of the lesion via TUR was attempted during the surgery, but it was impossible to access the tumor using the resector due to access difficulties. The tumor was visualized in the dome and anterior wall adjacent to an apparent diverticular region that could not be passed by the resectoscope. Given the findings, a body CT scan was performed showing a bladder tumor located in an inguinovesical herniation  associated with inguinal hernias; it is linked to crural hernias in 23% of cases and to other types  in 2% . Classic% associaOur case was a right-sided paraperitoneal hernia, which is the most prevalent 60%) type . Vesical0% type .Voiding urethrocistoscopy has been considered to be the test of choice due to its higher sensitivity for diagnosing bladder hernias , 6. SomeThe presence of malignant neoplasms in inguinal hernias is an infrequent finding, occurring in less than 0.5% of the herniorrhaphies described in the literature , 9.The most frequent etiology is metastatic tumors, the vast majority of which originate in the gastrointestinal tract. Other possibilities include aggressive mesothelial, ovarian, hematological and vesical sarcomas and angiomyxomas, melanomas, endometrial cancer and tumors of the thymus, kidney, and pericardium. According to the literature, urothelial carcinoma of the herniated bladder account for 5.34% of hernia sac tumors .Some authors have described a poor survival rate (caused by diagnostic delay) in patients with tumor of the herniated portion of the bladder . Studies


Intracranial schwannomas unrelated to the cranial nerves are uncommon. We report a new case of tentorial schwannoma unrelated to the cranial nerves, with extension into the pons. A literature review with discussion of the most relevant pathogenetic aspects is also performed.A 42-year-old Caucasian man was admitted with right-sided paresthesias and weakness of his upper and lower extremities. The neurological examination revealed right hemiparesis and hemi-hypoesthesia. A brain magnetic resonance imaging scan revealed a cerebellopontine lesion, arising from the left free edge of the tentorium, and extending into his pons. A piecemeal removal was performed through a retrosigmoid approach. The lesion was not found to be associated with any cranial nerves. The histological examination revealed a schwannoma Antoni type A. His postoperative course was uneventful. At one year follow-up, the patient was neurologically intact and the magnetic resonance imaging of his brain performed at that time showed complete removal without signs of recurrence.Tentorial schwannomas are rare clinical entities. Knowledge of their clinical, radiological and anatomical characteristics is very important for the correct diagnosis and management. Schwannomas constitute about 8% of primary intracranial tumors and account for almost 80% to 90% of cerebellopontine angle tumors. Most cases are related to the eighth cranial nerve, and less commonly to other cranial nerves. Intracranial schwannomas not associated with cranial nerves are uncommon ,2. To daWe report a new case of a tentorial schwannoma unrelated to the cranial nerves, with extension into the pons. A literature review with the discussion of the most relevant pathogenetic aspects has also been performed.A 42 year-old Caucasian man was admitted to our institution with a recent history of paresthesias and weakness of his right upper and lower extremities. The neurological examination revealed right hemiparesis and hemi-hypoesthesia. His cranial nerve functions were normal as was his brainstem auditory evoked response test. His personal and family histories were negative for neurofibromatosis. A brain magnetic resonance imaging (MRI) scan revealed a left cerebellopontine lesion, hypointense in T1-weighted images and hyperintense in T2-weighted images. A homogeneous contrast enhancement of the lesion was observed after gadolinium injection; the tumor appeared to be implanted on the left free edge of the tentorium, with extension into the pons. A 'dural tail' connecting the lesion to the tentorial edge was also present (Figure Surgery was performed using a retrosigmoid approach. After retraction of the hemispheric cerebellar lobe, a yellowish extra-axial lesion of the cerebellopontine angle was discovered. The tumor was strongly attached to the superior surface and the free edge of the tentorium, extending into the pons parenchyma. An endocapsular piecemeal removal was performed by means of an ultrasonic aspirator; the lesion appeared friable and vascularized. The cranial nerve complexes V, VII, VIII, IX, × and XI were all identified and preserved, and the mass was not found to be associated with these cranial nerves. The intraparenchymal portion was carefully dissected by the brain stem. After dissection from the surrounding structures, the lesion was mobilized and its implantation on the left free edge and superior surface of the tentorium exposed and resected. After tumor removal, the IV cranial nerve was exposed in its arachnoid cistern. At the end of the procedure, coagulation and resection of the implantation were achieved.His postoperative course was uneventful and our patient fully recovered from his preoperative deficits.Histological examination of the resected tumor revealed schwannoma Antoni type A Figure . A brainIntracranial schwannomas unrelated to the cranial nerves are uncommon, since the central nervous system is devoid of Schwann cells. In 1966, Gibson published the first case of intracerebral Schwann cell tumor in the temporal lobe of a six-year-old boy . Since tTypically, tentorial-based schwannomas appear on radiology as a heterogeneous enhancing cystic lesion, occasionally encased in the surrounding brain parenchyma, but without peritumoral edema; as in our case, a dural tail sign is often present .Several surgical approaches have been reported to remove this kind of tumor Table . In our There are several hypotheses about the origin of intracranial schwannomas unrelated to the cranial nerves . InteresAlthough the absence of postoperative cranial nerves deficits has been advocated as proof that these lesions do not arise from cranial nerves, this observation has been questioned by some authors, since a lack of postoperative symptoms could be related to the compensative mechanism of ocular movements .Tentorial schwannomas are rare clinical entities, but the knowledge of their clinical, radiological and anatomical characteristics is very important for a correct diagnosis and management.Written informed consent was obtained from the patient for publication of this manuscript and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.The authors declare that they have no competing interests.DPI analyzed and interpreted the patient data, and was the major contributor in writing the manuscript. MM performed the surgical procedure. DBA performed the histological examination. MCF analyzed and interpreted radiological data. DCP analyzed and interpreted clinical data. CG performed the surgical procedure and critically reviewed the manuscript. All authors read and approved the final manuscript.


Primary squamous cell carcinoma (SCC) may originate elsewhere in the body, including the head, neck, lung, bronchus, cervix uteri, esophagus and cardia, and metastasize to the stomach. In the present report, a case is presented of an SCC, which arose from an unknown primary site and metastasized to the stomach of a 59-year-old male. The tumor was located in the interspace between the liver and the stomach. It involved the placenta percreta, lamina muscularis and submucosa, however, had already metastasized to a regional lymph node at the time of surgery. No SCC was observed in other organs on physical examination, which included positron emission tomography-computed tomography. In the follow-up period, there was no evidence of additional malignant tumors in the patient; therefore, the origin of the tumor was speculative. To the best of our knowledge, this is the first case report regarding a tumor of this type. Primary squamous cell carcinoma (SCC) arising from an unknown primary site and metastasizing to the stomach is extremely rare –9. Due tA 59-year-old male was admitted to Subei People’s Hospital of Jiangsu Province on June 21, 2012, complaining of upper abdominal pain with no evident inducible factor, which had persisted for one month; the pain was discontinuous and dull. The patient’s past medical history was unremarkable, with the exception of mild weight loss. The patient had smoked one pack of cigarettes per day for 25 years. A physical examination revealed no abdominal mass; however, there was tenderness in the right upper quadrant of the abdomen.Laboratory studies revealed that the complete blood count and blood chemistry were within the normal range. No abnormal tumor markers were detected: Cancer antigen (CA)125, 3.15 KU/l (<35.00 KU/l); CA15-3, 2.16 KU/l (<35.00 KU/l); CA19-9, 3.57 KU/l (<35.00 KU/l); CA242, 2.58 KU/l (<20.00 KU/l); α-fetoprotein, 6.57 ng/ml (<20.00 ng/ml); carcinoembryonic antigen, 2.25 ng/ml (<5.00 ng/ml); neuron-specific enolase, <1.0 ng/ml (<13.00 ng/ml); ferritin, 19.70 ng/ml ; human growth hormone, 2.20 ng/ml (<7.50 ng/ml); or β-human chorionic gonadotropin, <0.03 mIU/ml (<3.00 mIU/ml). Axial positron emission tomography (PET), computed tomography (CT), PET/CT and maximum intensity projection images are shown in Histopathology revealed that the SCC infiltrated into the serosal fibrous tissue, lamina muscularis and submucosa of the gastric wall ; howeverPrimary SCC of the stomach was first described in 1895  and remaTo reach a diagnosis of primary SCC of the stomach, alternative sources of malignant squamous cells must be excluded. For example, islands of squamous cells originating from the esophagus may exist in the cardia and may be a potential source for the development of SCC. SCCs that originate in the esophagus itself may extend into the stomach by direct invasion. Primary SCC may originate elsewhere in the body  and metastasize to the stomach. Metastatic disease from such sites may be ruled out by clinical examination, particularly PET/CT.Usually, primary SCC of the stomach initially invade the mucosa; those limited to outside the area of the mucous membrane are extremely rare. Histologically, the tumor tissues were located outside the area of the mucous membrane without adenoid tumor tissue structures or tumor mucosal lesions; therefore, it may be considered that the tumor tissues were not associated with the mucosal epithelium and glands. Therefore, the present case is neither primary SCC nor adenoacanthoma of the stomach. Furthermore, gross and pathological examinations eliminated direct invasion of the esophageal SCC into the stomach. No tumors were determined in other organs during the physical examination that included PET/CT. Therefore, the tumor was identified as a metastatic gastric tumor or an SCC arising from an unknown primary site and metastasizing to the stomach.In a previous study, immunohistochemical staining showed strong staining for high molecular weight CK5/6 and p63 in the SCC . The immet al  resection remains the mainstay of the treatment and is well supported by adjuvant therapies as reported in the present study. Regardless of undergoing only four chemotherapy sessions, the patient in the present study did not exhibit recurrence or metastasis; therefore, paclitaxel and platinum-based agents are recommended. A good response to chemoradiotherapy, with respect to recurrence, following surgical resection was reported by Michalet et al . Adjuvanet al . Good loet al . HoweverIn conclusion, a rare case of SCC from an unknown primary site metastasizing to the stomach is presented. To the best of our knowledge, this is the first case report to have investigated this tumor type. The pathogenesis, diagnosis and treatment of an SCC of this type has generally been considered poor, thus, additional cases require investigation to confirm this.


Ameloblastomas are locally aggressive jaw tumours with a high propensity for recurrence and are believed to arise from remnants of dental lamina or odontogenic epithelium. Extragnathic ameloblastomas are unusual, and primary sinonasal tract origin is very uncommon with few cases reported in the literature. We herein report a case of primary sinonasal ameloblastoma presented in a 74-year-old male with nasal obstruction, rhinorrhoea, and sinusitis. Nasal endoscopy showed the right nasal cavity completely obstructed by a polypoid lesion attached to the lateral nasal wall. A preoperative CT scan was performed showing a solid lesion, measuring 2 cm in the maximum diameter, extending from the nasopharynx area with obstruction of the ostiomeatal unit and sphenoethmoidal recess into the lateral pharyngeal space, laterally to the parotid, without continuity with maxillary alveola and antrum. The tumour was completely excised endoscopically, and a final diagnosis of ameloblastoma was rendered. At the 12-month followup, there was no evidence of recurrence. Ameloblastoma (AM) is a common odontogenic epithelial tumor, usually arising in the maxilla or mandible , 2. It pA 74-year-old man presented to our hospital with a 2-month history of progressive right-sided nasal obstruction, associated with rhinorrhoea and sinusitis. He had no associated history of epistaxis, pain, or anosmia and was otherwise healthy, with no previous sinonasal disease. Nasal endoscopy showed the right nasal cavity completely obstructed by an exophytic, polypoid, firm lesion, with irregularly shaped borders, attached to the lateral nasal wall. A preoperative CT scan was performed showing a lytic expansile, solid lesion, measuring 2 cm in the maximum diameter extending from the nasopharynx area into the lateral pharyngeal space, laterally to the parotid, without continuity with maxillary alveola and antrum . NeoplasAM is a slow growing, locally aggressive tumor, usually arising in the jaws and frequently associated with an unerupted tooth –10. It mPrimary sinonasal AMs are rare and have a predilection for men of older ages , 9, 20, As far as histogenetic considerations about sinonasal AM origin is concerned, some studies have indicated a close relation of the embryological derivation of the sinonasal tract and odontogenic apparatus –16, 22. From a pathological viewpoint, AM has been divided into solid and (multi)cystic types , 2, 5, bSinonasal AMs are often indistinguishable from benign nasal polyps or chronic sinusitis both clinically and on CT scan. Although the presence of unilateral involvement and bony erosion on CT should raise suspicion for a neoplasm, because of the lack of pathognomonic radiologic characteristics, a definitive diagnosis of sinonasal AM requires biopsy. However, the differential diagnosis may remain a challenge in small biopsies if tissue fragments obtained for diagnosis are superficial, and the typical histology of the tumor is not well represented in them.The overwhelming majority of cases affecting the sinonasal cavity are tumors that grow in the maxilla and secondarily extend through the nasal and paranasal cavities. Therefore, of primary importance is to exclude extension into the sinonasal tract from a primary gnathic AM.  AM histologic features are pathognomonic; therefore, the differential diagnosis is limited. It comprises acute and chronic sinusitis, inverted papilloma, carcinoma, adenocarcinoma, angiofibroma nasopharyngeal, and basal cell adenoma, a rare salivary gland-type tumour primitive of sinonasal tract –4, 23. TAM is a lesion of low-grade malignant potential, histologically benign but locally aggressive with a marked tendency for recurrence. So, AM requires complete excision with adequate margins to minimize recurrence. Surgical excision is the treatment of choice in all cases. Recently, endoscopic management of AMs has resulted in less radical surgical approach with decreased morbidity and better tumor control , 16–19.


Hepatoblastoma, an embryonal tumor, is one of the most common primary liver tumors in childhood. It secretes human chorionic gonadotropin (hCG), which can cause precocious puberty (PP). Herein, we present a case with PP who had enlarged penile size noticed during a diagnosis of hepatoblastoma. Laboratory examination revealed increased testosterone, alpha-fetoprotein (AFP), and hCG levels. Serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were within prepubertal ranges. The diagnosis of hepatoblastoma was made by liver biopsy. Chemotherapy was administered, and the patient was referred to surgery. Ten months later, testis volumes were below 4 ml bilaterally, and penile length was 5.5 cm. Serum testosterone, AFP, and hCG levels decreased. Resection of the tumor and chemotherapy are essential for the treatment of hepatoblastoma and they can eliminate the symptoms of PP.Conflict of interest:None declared. Precocious puberty (PP) is a term that defines the onset of signs of puberty before age 8 in girls and age 9 in boys. Sex steroid production in these children can stem from hypothalamic-pituitary-gonadal axis activation (GnRH-dependent PP), or may be due to a nonhypothalamic-mediated increase in sex steroid production (GnRH-independent PP). In patients presenting with precocious puberty, more than 90% of girls and about half of boys have GnRH-dependent PP .Hepatoblastoma, embryonal tumor, is one of the most common primary liver tumors in childhood. It secretes human chorionic gonadotropin (hCG), which can cause GnRH-independent PP. It is more common in males. Mean age at presentation of this liver tumor, occurring predominantly in childhood, is 18 months. It may be seen in newborn babies which suggests that its origin may be prenatal , 3. So f3, a platelet count of 83 500/mm3, normal transaminase levels, increased testosterone , alpha-fetoprotein (AFP)  and hCG  levels. Serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were in the prepubertal ranges. Ultrasonographic examination showed a heterogenic liver tissue and abdominal free fluid. The diagnosis of hepatoblastoma was made by liver biopsy. Chemotherapy (the PLADO protocol) was administered, and the patient was referred to surgery. Ten months later, testis volumes were below 4 ml bilaterally, and penile length was 5.5 cm. Serum testosterone, AFP, and hCG levels decreased  to normal ranges.A three-year-old boy was presented to the hospital because of abdominal distention, hair on the scrotal area, and enlarged penile size, noticed 2 months prior to the presentation. Ultrasonography demonstrated a liver mass, and the patient was referred to the Department of Pediatric Oncology. Protuberant abdomen, hepatomegaly , scrotal hair, enlarged testes (volume 6 ml/6 ml), and enlarged penile size (8 cm) were noted on physical examination  and 2. LLiver tumors account for one percent of all malignancies in childhood, and 1.4 in one billion children under 16 years is re ported to be diagnosed with liver tumor every year. The incidence of hepatoblastoma is increased by 15 fold in babies with birth weights less than 1000 grams. The tumor is rare after the age of 3 years.Liver tumor risk increases in some diseases, such as Beckwith-Wiedemann syndrome, familial adenomatous polyposis, trisomy 18, glycogen storage diseases, hereditary tyrosinemia type 1, and Alagille syndrome increase the risk of liver tumor. Most cases are admitted to hospital because of abdominal mass, abdominal pain, weight loss, anorexia, nausea and vomiting. Serum AFP and hCG levels are increased in most patients and  are important both for diagnosis and follow up. The-five year survival rate of patients with hepatoblastoma is between 65-75% after resection of the tumor and chemotherapy .  The first case with PP due to hepatoblastoma was reported in 1963 . ApproxiPP due to liver tumor in childhood is not a frequently encountered condition. Giacomantonio  presenteIn conclusion, we want once again to draw attention to hepatoblastoma, which should be kept in mind as a cause of PP by the clinicians in gastroenterology, oncology, and endocrinology.


Paraesophageal bronchogenic cyst was one of common mediastinal congenital cystic lesions of foregut origin. Because of an intimate embryologic relationship with the esophagus, they were usually found intramural  with the local esophageal mucosa being intact and the paraesophageal bronchogenic cysts were rarely communicated with esophageal lumen. We report a case of para-esophageal bronchogenic cyst communicating to the esophageal lumen thorough a pedicle of canal, which looked liked a diverticulum on X-ray. During the operation, a communication of paraesophageal bronchogenic cyst with esophageal was found and the pathology diagnosis were made then. The symptoms of chest pain and dysphagia were relieved immediately after operation. The follow-up was well 2 years after the surgery. Bronchogenic cysts were congenital lesions derived from the primitive foregut, and were the most common primary cysts of the mediastinum,2. They A 56 years old woman was admitted into our hospital with symptoms of intermittent and reprieved chest pain and dysphagia over 3 years as well as a rapid weight loss of 10 kg in two months. She has no fever, cough, and shortness of breath. And there was no significant positive finding in physical examination. A barium swallow revealed a huge para-esophageal cyst compressed to esophagus, and also communicated with esophagus through a canal Figure. So, difBronchogenic cysts were the most common congenital cystic lesions of mediastinum, originated from the primitive foregut. The dorsal segment of the foregut formed the esophagus, while the ventral component formed the trachea,2. The mFor pare-esophageal bronchogenic cysts, the extramural pare-esophageal bronchogenic cyst was the most common type. They were always found anotomic closed to esophagus, with clearly borderline or with only a mind adhesion to gastrointestinal tract, which made the operative procedure difficult. Some cystic lesions tend to located in the wall of esophagus, but with lumen mucosa intact. This type of bronchogenic cysts had been recognized well as intramural esophageal bronchogenic cysts in the literatures,5. Even 2 zone was found and a fistula of the bronchogenic cyst into the esophagus was revealed in video-assisted thoracoscopic surgery in emergency revealed[In our case, here we emphasized a more rare type of para-esophageal bronchogenic cyst, in which the cystic lesion communicated to esophageal lumen through a prepared canal. To our knowledge, only five similar case of bronchogenic cyst had ever been reported, but the nation of the communication remained unclear-9. The mThe clinical symptoms of patients with bronchogenic cysts were varied according to the lesions' size, location and communication. For the Pare-esophageal cysts, the patient more likely present symptoms of dysphagia and chest pain due to compression and pleural irritation,3,4. ButFor a pare-esophageal cyst, an accurate pre-operative diagnosis was difficult. Classic imaging features clould only infer the possible of lesion. Although accurate diagnosis must be provided by postoperative pathology, and per-operative differentiation should include other cystic lesions around esophagus, such as esophageal duplication cyst, esophageal malioloma or mediastinal tumor. In case of difficult preoperative diagnosis of a para-esophageal mass, endoscopic ultrasound was a safe and very useful procedure to clearly distinguish cystic from solid masses as well as defining the intraextramural extent of the lesion. In our All suspected bronchogenic cysts were suggested to be removed in operable candidates. Because complete surgical resection would contribute to establish diagnosis, alleviate symptoms, and prevent complications. We consIn conclusion, the lumen communicated para-esophageal bronchogenic cyst may be a rare congenital cystic lesion of mediastinum. More cases should be reported to confirm the nature of the communication.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.The authors declare that they have no competing interests.WW, study concept and design; YN, acquisition of data; analysis and interpretation of data; LWZ and CK, critical revision of the manuscript for important intellectual content and material support; XL, technical, or material support; QL, drafting of the manuscript; QC, drafting of the manuscript. All authors read and approved the final manuscript.Wuping Wang, bachelor's degree, Superintendent of the institution, surgeon; Yunfeng Ni, doctor's degree, surgeon; Changkang Ke, master's degree, surgeon; Xiaofei Li, doctor's degree, surgeon; Qiang Lu, doctor's degree, surgeon; Qingshu Cheng, doctor's degree, surgeon;


Primary non-Hodgkin’s lymphoma of the cranial vault is extremely rare. This case report presents a 42-year-old man with a painless subcutaneous scalp mass which extended intracranially associated with recent mild headache. Initial computed tomography and magnetic resonance imaging revealed two lesions emanating from the skull. Biopsy revealed a diagnosis of diffuse large B cell lymphoma (DLBCL). A thorough work-up revealed no other point of involvement. This case is concerned about considering lymphoma in the differential diagnosis of calvarial lesions with both intra- and extra cranial extensions but without obvious intervening bony destruction. Although malignant lymphoma of the central nervous system has become common due to progressively increasing immunosuppressive conditions, a primary malignant lymphoma particularly diffuse large B cell lymphoma (DLBCL) of the dura and/or cranial vault is a rare occurrence and has been described as case reports. The overall rate for diffuse large cell lymphomas (DLCLs) is approximately 4.68 cases per 100,000 people per year , 3, 4. TA 42-year-old man with a left frontal head lump which had been largening progressively during the past 4 months came to our hospital. He also complained of a recent headache. There was no significant medical history including trauma or seizure. Local examination revealed a non-tender soft 5 × 10 cm sized swelling over the left frontal region, fixed to the underlying skull. There was no sign of inflammation or tenderness over the lesion. In general examination, no focal neurological deficit, lymphadenopathy or organomegaly was noted.Skull radiographs showed a relatively well-defined soft tissue density over the left frontal bone, without evidence of calcification, or obvious bone erosion or sclerosis . NoncontThe histological examination of the surgical specimen showed lymphoid infiltration of the skull bone and adjacent dura, with tumor cells demonstrating large vesicular nuclei and extremely large reddish nucleoli as well as scattered mitotic figures . ImmunohCranial vault lymphoma is more often associated with intra- and extracranial extension and intervening skull bone destruction -8. In ouRegarding gender and the involved region, our case is similar to other cases reported in the literature , 11, 12.