Intrathoracic gossypiboma is a consequence of retained sponge/swap, gauzoma, muslinoma, textiloma, or cottonoid in the thoracic cavity during surgery. The thoracic cavity is of the rarest place for gossypiboma as these entities most occur after abdominal surgery.We report a case of intrathoracic gossypiboma that was missed for an extended period of time with no symptoms and was successfully treated with surgical intervention.The rarity of gossypiboma necessitates a high index of suspicion for correct diagnosis. Gossypiboma is often difficult to diagnose, leading to misdiagnosis and unnecessary interventions. It is important to consider this entity as a diagnosis in any case with an unexplained or unusual presentation during the postoperative period. Several factors contribute to patient morbidity and mortality during surgery. Retained sponge/swap, gauzoma, muslinoma, textiloma, or cottonoid are examples of these, and they all lead to gossypiboma , 2. GossA 62-year-old male patient was admitted to our department with a purulent fistula at the site of previous surgery in the right posterolateral thoracic area. The fistula was painful, warm, and erythematous with induration and continuous milky purulent drainage. He had a past medical history of diabetes mellitus from 20 years ago, which was treated with insulin injections. He also had two previous surgeries, the first was right posterolateral thoracotomy and pneumonectomy for the management of chronic tuberculosis about 47 years ago, and the other one was abdomino-pelvic resection for the management of colorectal cancer. The patient had developed a purulent lesion from two years ago, but mentioned no other symptoms. He also mentioned that his diabetes mellitus was severe in these 2 years. On physical examination, he had a 3*3 cm lesion with purulent secretion in the right posterolateral thoracic area. The surrounding tissue was red and tender.Chest X-ray showed opacities covering the whole right hemithorax and radiopaque strip Fig. . The patAlong with the sponge, a considerable amount of blood and suppuration was also removed from the thoracic cavity. A chest tube was inserted to drain the remnant purulent material. We used a chest tube and feeding tube catheter to irrigate the pleural space with warm normal saline (1000 cc) three times/day. The postoperative irrigation continued until the chest tube fluid became clear, lab examination became normal, and the patient did not have any signs of fever and infection. The chest tube was removed 3 days after surgery. The patient was then discharged with no symptoms or complications.Gossypiboma is a reaction to a foreign body within body cavities. It results from a reaction against the cotton matrix in a sponge and then the formation of a mass . TypicalRadiological examination, including X-ray and CT scan, are the main route of diagnosis. Well-circumscribed soft tissue density or calcification can be observed in chest X-rays. However, a CT scan is the preferred option . AbdominThe World Health Organization's (WHO) global challenge 'Safe Surgery Saves Lives' in 2007 drew on literature and clinical experience from around the world to produce a core set of surgical safety standards. The WHO's Surgical Safety Checklist was created to improve surgical care safety, and it has resulted in a significant decrease in both morbidity and mortality since its implementation. Nonetheless, in a previously operated patient, gossypiboma should be considered if no other differential diagnosis or source of infection can be identified. This is true even when there is no radiopaque line present, as in the cases reported by Dubois et al.  and BakaWe presented a case of intrathoracic gossypiboma that had been asymptomatic for a long period of time. The rarity of gossypiboma necessitates a high index of suspicion for correct diagnosis. Surgical intervention is the primary treatment of gossypiboma.


Paragangliomas are rare neuroendocrine tumors that could secret catecholamines. Hypertension and heart failure caused by the catecholamine crisis are fatal cardiovascular events. However, silent paragangliomas that lack typical symptoms of catecholamine pose a significant diagnostic challenge.A 45-year-old woman who presented with more than 1-year history of abdominal discomfort was suspected of having a gastrointestinal stromal tumor by a local hospital since a vast metastatic mass occupied her left abdomen. Thus, she was recommended to our hospital. After completing the gastroscopy, she unexpectedly developed acute heart failure and was transferred to the Intensive Care Unit (ICU) where the initial diagnosis of paraganglioma was considered through path. However, a second catecholamine crisis due to constipation led to acute heart failure again. After anti-heart failure therapy and rigorous preoperative preparation, surgery was arranged to remove the tumor. Postoperative pathology conﬁrmed the paraganglioma, and the patient was discharged from the hospital in good condition.We reported a rare case of huge retro-peritoneal paraganglioma with successive catecholamine crises and acute heart failure. This was probably the largest retro-peritoneal paraganglioma since the 1980s. Besides, we were the first to use surgical drawing to illustrate its complex anatomical adjacent relationship of retro-peritoneal paraganglioma. Our case emphasizes the inclusion of extra-adrenal paraganglioma in the differential diagnosis of retroperitoneal tumors. In suspected paragangliomas, catecholamine testing is preferable to invasive procedures including gastroscopy and biopsy to avoid triggering a catecholamine crisis. Surgical resection is the primary treatment. We highlight the priority of dealing with the venous reflux branches of the tumor to prevent the release of catecholamines into the blood. In particular, preoperative preparation plays a vital role in managing paraganglioma. Moreover, it is necessary to schedule genetic testing and clinical follow-up due to the metastatic potential of paragangliomas. Paragangliomas are rare neuroendocrine tumors arising from chromafﬁn cells of the parasympathetic or sympathetic paraganglia outside of the adrenal glands . ClinicaHerein, we described a rare and severe case of huge paraganglioma with two times catecholamine crises to underline the diagnosis and treatment of silent paragangliomas that lack typical manifestations.A 45-year-old woman was admitted to our hospital in February 2021, who presented with acid reflux in the past one month followed by more than a one-year history of abdominal discomfort after eating. She had normal menstruation without a history of hypertension, coronary heart disease, diabetes, or other diseases. There was no family history of illness. Suspected to be a gastrointestinal stromal tumor by the local hospital due to a vast mass occupying her abdomen through abdominal computed tomography (CT), she was recommended to our hospital for further diagnosis and treatment.Vital signs on presentation were blood pressure=120/60 mmHg, heart rate=82 beats/min, and respiratory rate=20 times/min. On examination, the left abdominal mass was palpable with poor activity and unclear border. In addition, there is no tenderness and rebound pain in the abdomen. Moreover, all laboratory tests including blood routine, liver function, coagulation function, biochemistry even tumor markers did not show significant abnormalities.However, after finishing the gastroscopy, she felt sudden pain and discomfort under the xiphoid accompanied by sweating, chest tightness, and shortness of breath that night. On examination, her heart rate was 110–127 beats/min, and respiratory rate was 20–24 times/min, and her blood pressure fluctuated from 117–179/78–91 mmHg (the maximum blood pressure was 179/91 mmHg), with blood oxygen was 90%–100% and her both lungs had no obvious rales on auscultation.A series of emergent measures were taken immediately. Subsequently, laboratory tests revealed a significant increase in biomedical markers of myocardial injury, including type B natriuretic peptide pro-N-terminal , cardiac troponin , myoglobin, alanine transaminase , lactate dehydrogenase , creatine kinase , and creatine kinase isoenzyme . The inﬂammatory markers were much higher than normal, such as the level of white blood cell count , and neutrophil ratio . Then, we asked the cardiologist for urgent consultation, and he considered differential diagnoses, including acute myocardial infarction and acute heart failure. Due to the rapid heart rate and the progressive decline in blood oxygen, the patient was transferred to ICU for further monitoring and treatment.The echocardiography in ICU showed moderate systolic dysfunction with the left ventricular ejection fraction of 35%. However, the coronary angiography did not see any sign of myocardial infarction. Furthermore, the thoracic CT showed considerable exudative lesions in both lungs. Meanwhile, abdominal CT  revealedLater, the laboratory test associated with paraganglioma was arranged. The result revealed a signiﬁcant increase in both urine catecholamine and Plasma catecholamine , CgA (+), Syn (+), CK (−), CD34 (+), SMA (−), CD10 (−), EMA (−), HMB45 (−), Inhibin-α (−), MelanA (−), NF (−), S-100 (−), and the Ki-67 index was 15% . Based oAfter being followed up for 5 months, the patient was free of abdominal discomfort, sweating, acid reflux, or symptoms of heart failure. Meanwhile, there were no signs of recurrence through CT evaluation .Paragangliomas are unusual neuroendocrine neoplasms originating from cells derived from the neural crest. This tumor is called pheochromocytoma in the adrenal medulla and is known as extra-adrenal pheochromocytoma elsewhere or simply as paraganglioma . The incBased on the presence or absence of typical clinical signs, retroperitoneal paragangliomas can be classified into three categories: non-functional, sub-clinical, and functional types. Patients with functional paragangliomas that overproduce catecholamines may experience the classic triad symptom including tachycardia, headache, and diaphoresis –10. In cIn differential diagnosis, paraganglioma located in the retro-peritoneum should be differentiated from nerve sheath tumor, liposarcoma, and giant lymph node hyperplasia. Diagnosis is made through laboratory and imaging tests . ConsequParaganglioma with tumor size larger than 5 cm has a metastatic tendency. It is advisable to perform surgical resection to improve survival . ResectiDuring the procedure, we found that the retro-peritoneal mass about 17 cm in diameter was adjacent to the peripheral vessels and organs like the abdominal aorta (AO), the left half colon, the middle colic artery (MCA), the inferior mesenteric artery (IMA), the left genital vessels as well as the left urinary system including the left side of kidney, ureter and renal vessels. Moreover, the tumor had a common blood supply with the left hemicolon . In caseA study showed that the 5-year likelihood of recurrence among those with an extra-adrenal paraganglioma was approximately 20% . Hence, We presented a rare case of retroperitoneal paraganglioma with successive catecholamine crises as well as acute heart failure. This is probably the largest retro-peritoneal paraganglioma since it was reported in the 1980s . Our cas


Leiomyosarcoma originating from the renal vein (RVLMS) is extremely rare. RVLMS lacks specific clinical manifestations and specific imaging features. This article discusses the epidemiological characteristics and diagnostic difficulties of RVLMS, as well as imaging features, differential diagnosis, treatment strategy, and prognostic factors of this disease.A case of RVLMS at our center, and 55 cases from the literature based on the PubMed search.Total operation time was 224 min, and total blood loss during the surgery was 200 ml. Resected tumor was irregular in shape, with negative margins. On the 6th day after the operation, the drainage tube was removed, and the patient was discharged from the hospital. Postoperative pathological results confirmed the renal vein leiomyosarcoma: spindle cell sarcoma, diffuse severe atypia, S-100 (-), SMA ( +), desmin ( +), CD34 (−), CD99 ( +).  Twenty-seven months after the surgery, the patient is alive, and without local recurrence or distant metastases.Unspecific clinical manifestations and imaging features make the diagnosis of RVLMS difficult. Most patients are diagnosed intra-operatively or following postoperative pathology. Differential diagnosis with paraganglioma (PG) and retroperitoneal sarcoma (RPS) should be made. Early and complete resection is considered as the first choice of treatment, and whether to preserve the kidney is based on the patient's condition. RVLMS is highly malignant, and may recur locally or metastasize to distant locations; therefore, adjuvant therapy and regular follow-up should be carried out after surgery. Angiogenic leiomyosarcoma is a rare soft tissue sarcoma, which mostly occurs in the inferior vena cava. A leiomyosarcoma arising from the renal vein is even more rare. To date, only 67 cases are reported in literature , 2. SimiA 61-year-old Chinese man with a history of grade 1 hypertension complained of right lower abdominal distention and intermittent pain in the upper abdomen for 4 months. Preoperative abdominal ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), serum creatinine (SCr), 24-h 3-methyl-4-hydroxymandelic acid (VMA), adrenocorticotropic hormone (ACTH), sex hormone screening, plasma cortisol rhythm and renin–angiotensin II–aldosterone system (RAAS) function in the upright and recumbent positions were performed. The preoperative contrast-enhanced ultrasonography, abdomen CT scan and MRI images are shown in Fig. Retroperitoneal laparoscopic surgery was performed under general anesthesia. The patient was placed in lateral position, and the pneumoperitoneum was established routinely. 12 mm, 12 mm and 11 mm trocars were placed under the 12th costal margin along the right psoas major muscle, under the anterior costal margin along the axillary line, and on the iliac crest along the middle axillary line, respectively. At the same time, 5-mm trocar was placed 5 cm above the anterior superior iliac spine. We dissected the posterior layer of the Gerota fascia on the dorsal side of the kidney to the hilum of the kidney along the surface of psoas major muscle, then cut off the lymphatic vessels around the renal pedicle, and then dissected one renal artery and one renal vein. At the same time, we carefully dissected the ureter and the vena cava located near the lower pole of the kidney. We found the retroperitoneal mass is located on the dorsal side of vena cava and renal vein. After completely freeing the lower pole, ventral and dorsal sides of the kidney, we lifted the kidney, and freed the tumor on the ventral side at the angle of intersection of the right renal vein and vena cava. It was found that the tumor was irregular in shape, and had clear boundaries with the surrounding tissues. The tumor originated from the wall of the renal vein and partially protruded into the right renal vein cavity , treatment strategy, surgical approach choice, and prognostic factors of this disease.. RVLMS predominantly occurs in women (82%), with a peak incidence in the fifth or sixth decades of life—the tumor is predominantly located on the left side (60%). In terms of clinical manifestations, RVLMS is characterized by abdominal pain (49%), presence of a mass on physical examination (15%), and weight loss (13%) [RVLMS is very rare. To date, only 67 cases have been reported in literature, and mostly in the form of a single case report . RVLMS pnal pain 9%, preseImaging findings are easily confused with, and are difficult to distinguish from those of retroperitoneal tumors and vascular invasion of renal cell carcinoma (RCC). According to Kaushik, the typical CT appearance of a RVLMS is a homogenous, well-circumscribed solid mass with minimal contrast enhancement in the region of the renal hilum . On MRI,Due to the similarities in the preoperative clinical manifestations, and imaging studies between RVLMS and paraganglioma (PG), a differential diagnosis should be made, especially in patients with a history of hypertension. PG originating from the retroperitoneum or mediastinum is an extra-adrenal pheochromocytoma, which can occur in any part of the abdominal chromaffin tissue, and can be found in the paravertebral ganglion and the bladder . AccordiAnother disease that needs to be differentiated from RVLMS is retroperitoneal sarcoma (RPS). According to literature, in order to distinguish RPS from other types of retroperitoneal masses, CT-guided core needle biopsy (CNB) is recommended . WilkinsWith regard to the pathological features of RVLMS, they tend to display bundles of spindle-shaped cells, with flat nuclei and fibrillary appearing cytoplasm. RVLMS originating from the retroperitoneum shows nuclear atypia with mitoses. However, it has been reported that the diagnosis cannot be ruled out in patients with inactive mitosis . ImmunohLeiomyosarcomas are highly malignant, and have the potential to metastasize to lymph nodes and distant sites. Therefore, early and complete resection of the tumor can improve the prognosis. Before the operation, thorough examination should be performed, and an MDT meeting should be held to fully analyze and make differential diagnoses.. reported that preservation of the kidney should always be considered when the tumor does not infiltrate the renal hilum [At present, many surgeons choose radical nephrectomy (RN) over local excision (LE) as the first treatment choice for the following the reasons: 1) owing to the high malignant potential of leiomyosarcoma, cancer cells may invade the inferior vena cava and the kidney. 2) Vascular reconstruction after tumor resection may potentially lead to complications, such as anastomotic leakage, anemia or hemorrhagic shock. (3) It is believed that the possibility of tumor recurrence is greater following tumor resection. However, there is a lack of systematic support regarding the best choice of surgical treatment. We looked at the 67 patients that have been reported in the past. Including our case, we only managed to find surgical approach and follow-up data of 55 cases [ owing to Vascularal hilum . In our . reported that the probability of local recurrence after operation is 40%, and that distant metastases can reach the lung, liver, skin and soft tissues [. analyzed 30 cases reported in the literature and found that 30% of patients (average follow-up 78 months) had no local recurrence or distant metastases, 23% had local recurrence and distant metastases but were still alive (average follow-up 48 months), and 37% died following local recurrence [. [According to the current literature, the risk of local recurrence and distant metastasis is significantly increased when the tumor is greater than 3 cm in diameter, and when the margins of the resected specimen are positive for tumor cells , 55. Gri tissues . Aguilarrence [.  reportedOur study is not without limitations. The number of patients that choose to remove the tumor and preserve the kidney is a lot smaller than that of patients that choose radical nephrectomy. The duration of follow-up in both groups is also inadequate. In addition, the reasons why a particular form of surgical treatment was chosen over another are not mentioned in most cases. Therefore, the best form of surgical treatment remains unknown. However, with our initial results, we believe that the form of surgical treatment may not be the most important factor in determining the OS for these patients. We hope that future studies with larger sample numbers will be carried out, to find out how best these patients can be managed.In this study, we shared our experience about the diagnosis and treatment of a patient with RVLMS at our center. RVLMS is very rare, and lacks specific clinical manifestations and features on imaging studies. Most patients are diagnosed intra-operatively or following postoperative pathology. Early and complete resection is considered the first choice of treatment, and whether or not to preserve the kidney depends on the patient's condition. RVLMS is highly malignant and it may recur locally or metastasize to distant locations, therefore, adjuvant therapy and regular follow-up should be carried out regularly after surgery.


Portomesenteric Vein Thrombosis (PMVT) following Laparoscopic Sleeve Gastrectomy (LSG) is an uncommon but potentially debilitating complication. Catheter-Directed Thrombolysis (CDT) has an evolving role in recanalizing the venous flow and preventing thrombus propagation. Therefore, it can be used as an alternative or in combination with systemic anticoagulants in selected patients. We report two trans-hepatic and trans-splenic CDT. The patient’s clinical details, radiological findings, safety, and efficacy are reported.Two patients presented to the Emergency Department (ED) within 14 days of surgery. The presenting complaints were generally nonspecific. The diagnosis of PMVT was established in both patients based on abdominal Contrast-Enhanced Computed Tomography (CECT). The two patients received a combined therapy of subcutaneous (SC) heparinization and CDT using a trans-hepatic approach in case 1 and a trans-splenic approach in case 2. Subsequent post-procedure venograms and CECT were performed and showed significant thrombus resolution. Both patients received oral anticoagulant therapy upon discharge with a successful overall recovery.PMVT is an infrequent and severe post LSG complication. Various approaches for re-establishing the portal venous flow have been described according to the severity of venous thrombosis. This article describes CDT therapy as a safe and effective option for treating PMVT in symptomatic patients. Worldwide, Laparoscopic Sleeve Gastrectomy (LSG) is currently a recognized dominant bariatric procedure . PortomeThe purpose of this study was to present cases that developed PMVT after LSG and precisely discuss the effectiveness of CDT in the treatment of acute and subacute cases.A 48-year-old female patient, unknown to have any previous remarkable medical history, presented to our hospital two weeks after LSG, indicated for morbid obesity, with abdominal pain without tenderness or vomiting. CECT revealed complete thrombosis of the superior mesenteric vein (SMV) extending to the main portal vein, thickened proximal jejunal loops with moderate enhancement, and mild adjacent mesenteric stranding. However, the visceral arteries were patent Fig. a. The paThe occlusion was then traversed using a 5F angiographic catheter with the same guidewire until reaching the SMV. The angiographic catheter was then replaced by a 5F multi-side-hole infusion catheter. The venogram showed SMV occlusion extended to the main portal vein Fig. b. A loadA 35-year-old male patient with ten-day history of LSG, unknown to have a previous remarkable medical history including thromboembolic events, presented in ED with diffuse abdominal pain and mild abdominal tenderness. Laboratory results demonstrated a raised white blood cell count. Abdominal ultrasound was performed, and it showed no evidence of flow in the portal vein, suggesting portal vein thrombosis. An abdominal CECT was performed, showing evidence of persistent SMV thrombosis extending to the intrahepatic portal veins with remarkable small bowel thickening Fig. a. A systPMVT has become a potentially severe reported complication of LSG despite its rare frequency , 10. In LSG and other laparoscopic bariatric procedures can have intraoperative factors using mechanical and thermal energy devices, potentially contributing to thrombus formation. Also, the liver’s prolonged retraction can result in venous stasis resulting in clot formation . In addiCECT is considered a gold standard in detecting PMVT and bowel ischemia, with a sensitivity reaching 90% . In our The management of PMVT depends on many factors such as the extension of thrombus, presence or not of bowel ischemia, and patient’s general condition. The primary goal is to recanalize the affected veins to prevent secondary complications and further thrombus extension.There is remarkable poverty in the studies comparing the various recanalization modes used in PMVT. This can be achieved through systemic anticoagulation, CDT, combination therapy, or surgical interventions . SystemiIn up to 80% of cases, it was found that long-term anticoagulation alone for a minimum of six months may also recanalize partial to complete thrombosis . While iCDT for the treatment of PMVT can be performed either by direct trans-venous approach which can be combined with mechanical thrombectomy, balloon angioplasty, and stenting or by indirect trans-arterial approach. The direct approach gives direct access to the portal system through portal, splenic or jugular veins. The percutaneous trans-hepatic technique, usually performed under ultrasound guidance, is a known option to access PMVT. However, it carries the risk of bleeding, primarily if large catheters or sheaths are used during thrombolysis or thrombectomy with hemodynamic instability rates of up to 60% . The ultThe trans-jugular intrahepatic portosystemic shunt (TIPS), although technically more challenging, is recommended in the presence of abnormal deranged coagulation, causing less intraperitoneal bleeding than the trans-hepatic or trans-splenic approaches .The second way to proceed with CDT is by an indirect approach using trans-femoral or trans-radial arterial accesses to insert a multi-side hole perfusion catheter into the proximal superior mesenteric artery (SMA), which allows for thrombolytic agents infusion , 21. NevFinally, surgical trans-ileocolic approaches were described, offering access to the portomesenteric vein. However, it is less suitable for mechanical techniques like thrombectomy, balloon angioplasty, or stenting .Both patients had regular follow-up by venogram, and the vital signs were continuously monitored during tPA infusion. The duration of tPA infusion was based on the results obtained by the venogram and CECT. The infusion was interrupted once partial recanalization of the portomesenteric vein was obtained to reduce the bleeding risk.In conclusion, PMVT is a relatively uncommon complication in patients undergoing LSG. However, early detection and treatment based on high clinical suspicion and awareness of clinical presentation and imaging results are necessary to prevent long-term complications. Among the various approaches for recanalizing the PMVT, including thrombolysis and thrombectomy techniques, CDT offers a safe and effective option to restore portal and mesenteric veins patency in symptomatic PMVT patients.


Synovial sarcoma of the head and neck is very rare, and sarcoma of the larynx and hypopharynx rarer still. As such, correct diagnosis and decision-making regarding surgery and adjuvant therapies pose clinical challenges to the otolaryngologist. We present a case of a synovial sarcoma arising from the hypopharynx, and a review of the literature.A 77-year-old woman presented with intermittent hoarse voice and episodes of choking when swallowing. Panendoscopy showed a smooth, cystic mass arising from the right posterior aryepiglottic fold . InitialThe case was reviewed at the head and neck oncology MDT, consisting of two Radiology consultants, two Oncology consultants and four head and neck surgeons, as well as speech therapy and cancer nurse specialists. For this case we also invited input from the thyroid surgeon. It was felt that the quality of the first CT made it difficult to establish the origin of the mass; therefore the patient underwent a repeat CT. In these images, a visible tissue plane separated the mass and the right thyroid lobe , indicatOur patient had a background of idiopathic pulmonary fibrosis, with progressive dyspnoea on minimal exertion. She was offered curative surgery; however she repeatedly declined any therapy. She explained that she wanted to spend what time she had with her family, preserving the quality of her life as long as possible. With support from the palliative care team, she died at home, nine months after the confirmation of her diagnosis.Synovial Sarcoma (SS) is a distinct malignant tumour of non-epithelial soft tissues. The name is a historical misnomer, as it is now recognised that they do not arise from joint synovia. It is most commonly seen as a slow-growing tumour in the extremities of adolescents and young adults; it is estimated that of approximately 200 presentations of SS per year in the U.K., 90% are in the extremities.On review of the English-language literature, we found 31 cases of laryngeal or hypopharyngeal SS  translocation in over 90% of SS.Prognosis and management of these tumours has a limited evidence base. Of the 22 cases with a year or more of follow-up, 82% were disease-free at one year. Of the cases followed for 3 years, 67% were disease-free, 25% had died and one patient had a recurrence. 46% of the cases received primary surgery alone, 46% received surgery and adjuvant radiotherapy, and 7% received primary chemo-radiotherapy. Differing lengths of follow-up prevent meaningful comparisons of patient outcomes from the different therapeutic strategies.Synovial sarcoma of the head and neck is a rare but significant pathology. The lack of specific clinical and radiological features, and the smooth well-circumscribed lesions, can delay diagnosis and even recognition of their malignant nature. This case highlighted the importance of multi-disciplinary collaboration, and of early suspicion of sarcoma. This case, with those previously reported; serve to further clinical recognition of these rare but devastating tumours.The authors declare no conflicts of interest.


Background and Objectives: Glomus tumors are rare benign tumors. The majority of them affect the skin the most and are rarer in the trachea, where the glomus bodies may not be present. Only scarce reports of tracheal glomus tumors have been reported solely with case reports of relevant articles. Materials and Methods: A 53-year-old man, with a free previous medial history, presented to our hospital with tracheal mass which was incidentally found. He did not complain of any specific symptoms associated with the tracheal tumor. The contrast-enhanced chest computed tomography (CT) revealed an avid enhancing nodular lesion, which is similar to blood vessels, in the trachea, 3 cm above the carina level without definite airway obstruction. Results: Successful tracheal resection and end-to-end anastomosis were performed on the patients; therefore, the final post-operative pathologic findings revealed a benign tracheal glomus tumor. The follow-up CT scan four months after operation showed complete removal of the tumor. Conclusion: Tracheal glomus tumors, even rare entities, could be considered as a differential diagnosis if a highly enhancing mass appears on CT images. A glomus tumor is a rare benign tumor that originates from modified smooth muscle cells of normal glomus bodies, which are formed at anastomoses of arteries and veins. They affect blood flow and control body temperature. The tumor can occur anywhere in the body, but for the most part, this tumor affects skin and is rare in the trachea, where normal glomus bodies may not be present. Although clinically, the symptoms range from asymptomatic to severe discomfort, symptoms related to airway irritation are common in bronchial and tracheal glomus tumor ,2. Due tA 53-year-old male was referred to our hospital with a diagnosis of a tracheal mass, which was found incidentally during a health-screening check. The patient had no specific clinical symptoms. He was previously healthy and had no relevant medial history. The clinical physical examination revealed no specific findings. His vital signs were stable, with blood pressure 110/70 mmHg, heart rate 78 bpm, respiratory rate 15 breaths per minute, and oxygen saturation in room air 98%. Laboratory findings, including complete blood cell count, liver and thyroid function tests, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and urine analysis results were normal. Electrocardiography and pulmonary function test results were also normal. As imaging examinations, chest radiography results at admission were normal (not shown). However, computed tomography (CT) revealed a highly enhancing mass lesion measuring 1.4 × 1.3 × 1.2 cm in the right posterior wall of the mid trachea and 3 cm above carina level without definite evidence of airway obstruction. The mass showed contrast enhancement similar to that of blood vessels . No defiGlomus tumors are composed of modified perivascular cells that resemble those of normal glomus bodies, which are involved in temperature control by regulating peripheral blood flow . While mGlomus tumors presenting in airways are extremely rare; the majority are benign ,5,6 and CT provides a useful means of diagnosing glomus tumor arising from the endobronchial tree. On CT images, these tumors are visualized as masses with avid contrast enhancement due to their abundant vascularity, as was observed in our case. When a glomus tumor arises from the respiratory tract, it mimics a variety of disease entities, which range from benign mucosal balls to malignant entities necessitating bronchoscopy . The leaAlthough several adequate methods are suitable for treating tracheal glomus tumors, such as tracheal stenting through bronchoscopy or laser resection with or without adjuvant radiotherapy, surgical resection is the definitive curative treatment of choice and requires no further treatment. The possibility of tumor recurrence after endoscopic removal is higher than that after complete surgical removal, even when tumors appear benign .Tracheal glomus tumor is an extremely rare entity, but when CT depicts a mass with an avid contrast enhancement pattern in the respiratory tract, this tumor should be considered in the differential diagnosis. Furthermore, CT imaging was found to be an appropriate guide for diagnosis and treatment.


Intrapericardial diaphragmatic hernia (IPDH) is rare and most often a sequela of blunt thoracic trauma. The trans-abdominal or thoracic repair approaches are based on the acuteness of presentation and the expectation of encountering intrapericardial adhesions. We present an acute IPDH in an 80-year-old female patient managed with a laparoscopic trans-abdominal repair. Misdiagnosis and complications from the delayed presentation can be avoided with careful attention to the initial exam, imaging, and early operative repair if the patient is a candidate for the trans-abdominal approach. An intrapericardial diaphragmatic hernia (IPDH) is the rarest type of non-diaphragmatic hernia in adults . In an IAn 80-year-old female with a past medical history of hypertension (HTN) and seasonal allergies and no significant past surgical history presented to Carle Foundation Hospital on 10/17/2022 after a MVC. The patient was leaving church when she was suddenly struck on the front driver’s side by a vehicle traveling at an approximate speed of 60 mph. The primary survey was significant for systolic blood pressure of 66 mmHg so she received 2 liters of crystalloids and a unit of blood to which she responded appropriately, and her blood pressure normalized. The secondary survey demonstrated small abrasions to the left dorsal hand and the right pretibial area. On presentation, the patient had a hemoglobin (Hgb) of 8.8 and otherwise unremarkable laboratory values. In addition, an electrocardiogram (EKG) was performed and it demonstrated a right bundle branch block (RBBB) without ST elevations or depressions. Chest x-ray (CXR), pelvic x-ray, and a computed tomography angiography (CTA) of the chest, abdomen, and pelvis demonstrated findings significant for an IPDH with small bowel emanating through the thoracic cavity and into the mediastinum  by the trauma team, she was taken to the operating room for laparoscopic primary repair of traumatic IPDH with the placement of a 19 French pericardial drain. After gaining intra-abdominal access via the open Hasson technique, an inspection of the diaphragm revealed a large 10-cm defect that allowed for direct visualization of the heart as there appeared to be a defect within the pericardial sac as well Figures  and 5. LShe was seen in the clinic 2 weeks postoperatively and was deemed to be doing well. At the time of this publication, the patient has resumed her baseline activities and is devoid of any symptomatic sequelae.This case illustrates a rare complication of blunt trauma sustained by a patient involved in an MVC: an IPDH. Post-traumatic IPDH is an extremely infrequent complication of blunt force to the chest or abdomen. According to a literature review published by Reina et al. in 2001, at that time only approximately one post-traumatic IPDH was reported yearly . AdditioThe treatment for an IPDH is surgery in the acute and in the delayed setting. In acute traumatic IPDH, a trans-abdominal approach is preferred because it allows for better visualization of the diaphragmatic defect that needs to be repaired. In cases of delayed IPDH, a thoracic approach is used due to the increased likelihood of pericardial adhesions that need to be addressed . Using tA common and feared complication of IPDH, especially in a delayed setting, is cardiac tamponade . CardiacWhile rare, IPDH should be promptly diagnosed given the increased morbidity associated with a misdiagnosis. Since the presentation can have an elusive constellation of symptoms, it can easily be overlooked on initial history and physical exam. However, if imaging confirms the diagnosis, prompt surgical intervention should be undertaken. In the acute setting, a trans-abdominal approach is preferred as it provides the ability to perform a diagnostic evaluation of intra-abdominal contents for any concomitant injury and it provides a better visualization of the diaphragmatic defect. In our case, a laparoscopic repair proved to be a viable option with quick recovery - an important consideration, especially in the elderly patient population.


Wilms’ tumor (WT) is a common type of primary renal tumor in the pediatric population that can equally affect both sides. Herein, we describe a case of bilateral Wilms’ tumor (BWT) in a three-year-old male with different responses to preoperative chemotherapy in the two kidneys. The left kidney mass responded poorly to chemotherapy than the right kidney, which raised the suspicion of coexisting benign disease or congenital anomaly. However, it was ruled out by preoperative nuclear scan and ultrasound-guided frozen section biopsy taken from the left kidney mass. The report of a frozen section on hematoxylin and eosin (H&E) stain was positive for the small blue cell tumor. The patient was managed successfully with a total nephrectomy of the right kidney and nephron-sparing surgery (NSS) on the left kidney. The postoperative period was uneventful and was managed successfully with radiotherapy. Despite many challenges faced in the management of bilateral Wilms’ tumor, surgery is the most preferable mode of therapy with chemotherapy and radiotherapy being effective in certain cases. The patient was followed up till no signs of recurrence or metastasis were observed. Wilms’ tumor (WT) is a common renal cancer in the pediatric age group that affects one in every 10,000 children . BilaterA three-year-old male with no significant clinical history presented with a complaint of painful abdominal lumps observed after an incidence of falling. Syndromic features such as aniridia and gigantism can be mentioned as examined/absent. Abdominal ultrasonography (USG) showed the presence of bilateral renal masses. There was no reported history of urinary tract infections and no family history of cancer and consanguinity.Routine blood investigations were within normal limits. Abdominal USG revealed a large tissue mass arising from the right kidney measuring 15.9 × 9.4 × 9.6 cm with adjacent septated fluid (likely to be hematoma). The inferior vena cava (IVC) was patent. The left tumor was observed using computed tomography (CT). Its dimensions were 0.9 × 1.6 × 1.4 cm.Thereafter, abdominal CT was performed, which showed BWT (stage V) with evidence of tumor rupture on the right side. A small mass with normal-looking parenchyma was observed on the left kidney. Other metastatic workups were negative Figure .USG-guided biopsy samples were taken from both tumors. Both samples confirmed the histology of Wilms’ tumor. Following confirmation, NACT was started for six weeks with vincristine, dactinomycin, and doxorubicin.Status post-chemotherapy for six weeks with a repeat CT showed marked interval reduction of the right kidney mass from 11.7 × 8.0 × 11.8 cm to 4.6 × 2.9 × 6.9 cm with no significant change in the left-sided mid-pole lesion from 0.9 × 1.6 × 1.4 cm to 0.9 × 1.5 × 1.2 cm  was performed with partial adrenalectomy, followed by retrocaval lymph node (LN) biopsy. Primary closure was done over oxidized cellulose impacted on the tumor bed on the left side. Warm ischemia time was nine minutes. Hemostasis was secured, and a left flank drain was inserted. Closure of the abdomen was done in layers, and the dressing was applied. The patient was shifted to the intensive care unit.Postoperative courseRecovery was uneventful, with normal renal function throughout the postoperative period, and the patient was discharged on the eighth day. Follow-up for 10 months (once every two months) in the clinic showed persistent improvement with no recurrence of the tumor as observed in ultrasound images.Histopathology results showed the presence of BWT with favorable histology, intermediate risk, negative margin, and negative lymph node. The patient started to receive postoperative radiotherapy after two weeks of surgery.As per the recommendations of the Children’s Oncology Group (COG), patients with BWT should start treatment with NACT, followed by repeat imaging at an interval of six weeks . If chemIn many of the cases of Wilms’ tumor, preoperative chemotherapy leads to a significant decrease in tumor size, thus allowing subsequent renal salvage surgery (NSS) ,9. In ouAfter 12 weeks, a long chemotherapy repeat CT scan revealed a marked interval reduction of the right kidney mass. However, the left kidney mass responded poorly to chemotherapy.A literature review revealed that the coexistence of Wilms’ tumor with other renal cancer, although rare, is not unheard of . In our BWT is considered an independent risk factor for renal failure . Hence, The rare pathological findings from the young patient with BWT showed varied responses to preoperative chemotherapy on either side of the kidneys, which followed another chemotherapy treatment even after performing NSS. Also, multiple pathologies of other kidney diseases such as a benign tumor or congenital condition along with BWT might affect the chemotherapy regimen. In our opinion, the differences observed throughout the treatment following preoperative chemotherapy in BWT patients should be explored thoroughly, keeping in mind the possibility of coexisting benign diseases or Wilms’ tumor with different immune histopathology, as found in our case.


Three-year follow-up CT imaging shows no evidence of tumor recurrence.A 64-year-old patient presented with shortness of breath and chest pressure. The initial examination was unremarkable, and a chest X-ray revealed a large mediastinal mass. Computed tomography (CT) scan demonstrated a lobulated mediastinal mass involving the great vessels and mass effect on the trachea, esophagus, and heart. A CT-guided biopsy showed a monotonous, evenly spaced population of mature, normal-appearing adipocytes consistent with a well-differentiated lipoma-like liposarcoma/atypical lipomatous tumor. The patient underwent a median sternotomy with  Mediastinal liposarcomas are rare and comprise less than 1% of all mediastinal tumors. The majority are found either in the lower extremities or the retroperitoneum . AMediastinal masses can present with various symptoms, including dyspnea, arrhythmias, and dysphagia. These masses usually have an insidious growth course and only become symptomatic once they exert a mass effect on local structures . They arLiposarcoma of the mediastinum with simultaneous involvement of anterior and posterior compartments is a rare entity that has seldom been described in the literature. The majority of currently described treatment algorithms involve peripherally involved tumors; however, when they are found in the mediastinum, the standard of care is elusive. Reviewing a compilation of the literature helps design the optimal treatment algorithm. Primary surgical resection may be curative for mediastinal liposarcomas, and locally advanced tumors may benefit from neoadjuvant chemoradiation . This caThis report documents a liposarcoma of the mediastinum that achieved a favorable surgical treatment outcome, albeit not without complications involving injury to surrounding structures. The lack of a standard of care for the treatment of this rare tumor necessitates the use of similar case reports and series to supplement clinical decision-making in designing optimal treatment strategies. Despite the involvement of major peri-mediastinal structures, aggressive en bloc resection may be considered in cases without distant metastasis and with anticipation and surgical management of possible resulting complications.


Upper lumber hernia is a rare entity which can cause obstruction and strangulation. Laparoscopic technique has been considered effective for such hernia repairs; however, there is no report of use of the self-expanding mesh.A 77-year-old woman visited to our hospital complaining of a bulge of about 5 cm in the left lumbar dorsal region while standing. Abdominal CT and MRI scans showed a fascial defect in the left lumbar abdominal wall and confirmed the presence of a hernia, in which retroperitoneal fatty tissue and the descending colon protruded. Transabdominal preperitoneal repair (TAPP) was performed and the operative findings revealed the hernia orifice, 3 × 2.5 cm in diameter, between two intercostal nerves. To avoid nerve injury or entrapment, the number of mesh fixation was desirable minimum; therefore, a self-expanding mesh with a memory-recoil ring was used. The mesh, 9.5 × 13 cm in diameter, was placed and tacked to the abdominal wall at two points, 1 cm ventral and dorsal to the hernia orifice. The postoperative course was uneventful and no pain or recurrence was observed with follow-up of 6 months.We herein present a case of upper lumber hernia successfully repaired by TAPP with a self-expanding mesh. Upper lumbar hernia is a rare disease that occurs in the upper hip triangle (Grynfeltt-Lesshaft's triangle) surrounded by the 12th subcostal, the posterior border of the internal oblique muscle, the inferior posterior serratus muscle, and erector spinae . Upper l2, presented at our department complaining of hen-egg-sized swelling in the left upper lumbar region with duration of a year. Physical examinations confirmed a reducible hen-egg-sized bulge on her left upper back and CT scan showed a fascial defect in the left lumbar abdominal wall, through which the retroperitoneal fatty tissue and the descending colon protruded to the subcutaneous layer  and Petit hernia (the inferior triangle) –17. The They are classified as either congenital or acquired. Congenital lumbar hernias represent 20%, are usually seen infancy. Acquired lumbar hernias are primary or spontaneous and secondary. Acquired lumbar hernias can be further classified as either primary or secondary. Most of them are primary and precipitated by conditions associated with aging, increased intra-abdominal pressure, chronic bronchitis and extreme thinness, etc. , 18. SecThe most common symptom is a posterior and regional protruding bulge in the lumbar region. Symptoms are variable and may be asymptomatic, associated with local and abdominal discomfort, or marked local tenderness. Tenderness is caused by distribution of the sciatic nerve or bowel obstruction due to intestinal fits , 7, 10.The best treatment option for lumbar hernia is a surgical repair because hernia orifice gradually is enlarged and become difficult to repair. Sometimes, intestine can be strangulated in hernia orifice, intestinal tract necrosis and patient's condition worsens.Surgery is the most common treatment for lumber hernia. Several surgical methods have been applied. For example, primary suture closure of the hernia orifice and reinforce the oblique muscle group and dorsal muscle group (Petit surgery) , 12, bonAs shown in Table The upper lumbar hernia is anatomically surrounded by the intercostal nerves. The intercostal nerves dominate the skeletal muscles that form the chest and abdominal wall and the skin of the chest and abdominal wall . They function not only as motor nerves for breathing, raising the arm, and flexing the upper body but also as sensory nerves for the body surface. Accidental entrapment of nerves can cause postoperative pain and should be avoided. A self-expanding mesh can be easily unrolled and fixed to the abdominal wall due to Pascal’s law in the preperitoneal space and thus requires no or less fixation . In termSimilarly, self-gripping mesh is a good option in that it requires little or no fixing. However, self-grip mesh can be difficult to deploy in the body cavity. In rare cases such as lumber hernias, the mesh with a memory ring is easier to use, because it is self-expanding and easy for anyone to use.One limitation of using a self-expanding mesh is that there are a very few variations in size. The maximum size of the mesh used in Japan is 9.5 × 13.0 cm. Considering sufficient overlap of this mesh, it should be used for a hernia with diameter of less than 5 cm.Concerns about mesh with non-absorbable memory-recoil ring may exist in regard to long-term safety. Some authors reported bowel complications related to self-expanding mesh in intraperitoneal only mesh ventral hernia repair; however, in extraperitoneal hernia repair, there have been no reports demonstrating complications due to ring breakage.TAPP using a mesh with a self-expanding mesh seems to be useful for upper lumbar hernia repair.


Schwannomas are benign and rare entities of peripheral nerve sheath origin. The clinical presentation depends the size of tumor, and they may cause symptoms of abdominal pain, urinary difficulties, anemia, hematuria, and abdominal mass as a result of the pressure of the tumor to the adjacent structures. The diagnosis can only be established by immunohistochemical study. Complete surgical clearance remains the mainstay of treatment.We report the case of a 35-year-old female patient consulted for chronic abdominal pain. Abdominal ultrasound and abdomino-pelvic CT scan identified a well-delineated, heterogenous retroperitoneal mass developed in anteraortocaval region measuring 55 × 65 × 88 mm. The lesion seemed to repress the inferior vena cava, and enhanced with contrast administration. The histopathological panel confirmed the diagnosis of retroperitoneal schwannoma. •Schwannomas are benign and rare entities of peripheral nerve sheath origin.•They do not lead to an invasion of the adjacent structures; however the compression and displacement of the retroperitoneal organs are marked as complications of increasing in size of these entities.•The total excision is the sole treatment for retroperitoneal schwannoma. These tumors contribute to 0.75–2.6% of all retroperitoneal neoplasms, and the majority of patients are between 20 and 50 years old with a female predominance ,2,6. TheThe diagnosis can only be established by histological and immunohistochemical study. The total excision is the sole treatment ,2. We re2We present a 39-year-old female  with no significant past medical or surgical history had presented in 2019 to our department chiefly complaining of chronic abdominal pain of five months duration with a severity of 5 in 10. The pain has been mainly located in the epigastrium and umbilical region. It has been radiating to the back and has been not associated with any aggravating or mitigating factors. Notably absent were symptoms of nausea, vomiting, fever, bloating, and change in bowel habit or weight loss. There has been no history of cancer in her family, without reference to using drugs, alcohol or tobacco. She had no psychological history.Computed tomography (CT) of the abdomen and pelvis has revealed a well-delineated, heterogenous retroperitoneal mass developed in anteraortocaval region measuring 55 × 65 × 88 mm. The lesion seemed to repress the inferior vena cava, and enhanced with contrast administration. No metastases were found. The level of serum tumor marker, were within the normal range.Based on the clinical and radiological findings, the patient underwent a midline laparotomy; intra-operative exploration has revealed a large retroperitoneal mass, difficult to access to the presence of several mesenteric lymphadenopathies. A lymph node dissection was performed.The Pathological examination has revealed that the lymph nodes were reactive without a specific element of malignancy. The patient was lost to follow-up.In September 2021, the patient presented herself in our department with complaints of distention and abdominal pain. Vital parameters and all laboratory investigations, including blood exam, kidney function and urinalysis, were within normal limits. Abdominal computed tomography scanning was performed, revealed an oval mass increased in size (68 × 74 x 98 compared to 55 × 65 x 88) . The casDue to the risk of bleeding and the unavailability of blood, a surgical biopsy of the mass with Tru-cut® was performed, and pathology report confirmed the diagnosis of a retroperitoneal Schwannoma.The surgery for the mass removal after obtaining the patient's consent was performed. The procedure was performed by a professor of surgery with over 15 years of surgical experience in an academic hospital. Under general anesthesia, the patient was placed in the supine position. The patient underwent laparotomy with midline abdominal incision where multiple adhesions were seen. After releasing the adhesions, the lesion was seen on anteraortocaval region b. We carPathological examination of the specimen has a benign tumor proliferation arranged essentially in a single area, ANTONI B where the cellularity is loose and made up of regular fusiform cells without atypia or mitosis. This proliferation arranged in a wavy fashion. Tumor cells express PS100 strongly, suggesting that the tumor was a schwannoma b.Fig. 3aAfter an uneventful postoperative course, the patient was discharged 4 days after surgery. Presently, the patient is doing well, without recurrence of the tumor during the five months follow-up examination.3Schwannomas are benign and rare entities of peripheral nerve sheath origin with predominance usually in young to middle-aged adults, rarely degenerate into a malignant form ,4. TheseThe most common symptoms associated with retroperitoneal schwannoma are vague because of the flexible feature of the retroperitoneum. Patients with RSs can present asymptomatically in the early stages of its development. The clinical presentation of these entities depends the size of tumor, and they may cause symptoms of abdominal pain, urinary difficulties, anemia, hematuria, and abdominal mass as a result of the pressure of the tumor to the adjacent structures ,4,8. RadThe immunohistochemical study is a valuable tool for validating the diagnosis of RSs based on positive immunostaining for S-100, vimentin and NSE, and negative labelling for desmin, SMA, HHF35, CD34 and CD117 .The best and optimal treatment for retroperitoneal schwannoma is a complete resection. This option is not always possible due to extend to neighboring anatomical vital structures ,2. In ouIn summary, the surgical resection is an effective treatment modality for retroperitoneal schwannomas, and should be performed by and an experienced surgeon to avoid intra-operative vascular lesions. The preoperative diagnosis remains a challenge for the clinician.No ethical approval necessary.The author(s) received no financial support for the research, authorship and/or publication of this article.Our paper is a case report; no registration was done for it.Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.Not commissioned, externally peer reviewed.The authors declare that they have no conflict of interest.This research has not been supported by any private or corporate financial institutions nor has any grant been received for this study.Harouachi Abdelhakim.Abdelhakim Harouachi: Have written the article, have consulted the patient, prescribed all of the tests and prepared the patient for surgery and participated in the surgery. Dr. Nabil Khomsi: have helped writing the article, data collection. Dr. Houssam Aabdi: have helped writing the article, data collection. Dr. Tariq Bouhout: (oncology surgery professor): supervised the writing of manuscript. Pr. Amal Bennani: (Pathology professor): confirm the histological diagnosis. Pr. Tijani EL. Harroudi: (oncology surgery professor): supervised the writing of manuscript. Pr. Badr Serji: (oncology surgery professor): have supervised the writing of the paper, and had been the leader surgeon of the case.The authors declared no potential conflicts of interests with respect to research, authorship and/or publication of the article.


Rituximab. Preoperative diagnosis of primary ovarian lymphoma is extremely difficult. Surgical exploration is often necessary in patients presenting with acute abdominal or pelvic pain; when the suspicion of primary ovarian lymphoma arises intraoperatively, every effort should be made to minimize invasive procedure in order to enhance post-operative recovery.Burkitt's lymphoma (BL) is defined as a highly invasive B-cell lymphoma, usually characterized by an excellent prognosis, more than 90% of children and adolescents being cured with highly dose-intensive multiagent chemotherapy. Primary ovarian localization without involvement of other organs is a rare manifestation of BL, especially in pediatric population. Symptoms at diagnosis are similar to other ovarian lesions and differential diagnosis may be challenging for clinicians. A 12-year-old girl was referred to our institution for abdominal pain and palpable mass observed by the pediatrician. Diagnostic work-up demonstrated a large mass arising from the right ovary, causing compression on abdominal aorta, inferior vena cava, ureters and bowel, with a second smaller lesion on the left ovary. At surgery, a 15 cm-large, ruptured mass arising from the right ovary was found, associated with a second lesion originating from the left ovary (8 cm) and multiple nodules of the greater omentum. Right salpingo-oophorectomy was performed, incisional biopsies were taken from the left ovary and omental nodules and peritoneal fluid samples were collected for cytology. Pathology revealed a Burkitt lymphoma and the patient underwent chemotherapy according to AIEOP LNH-97 Protocol, group R3 with  Ovarian neoplasms are rare in pediatric population, accounting for approximately 1% of all childhood malignancies; among these patients, more than half are affected by germ cell tumors, followed by epithelial neoplasms and sex cord stromal tumors . Rarely,Clinical presentations include abdominal or pelvic pain, dysuria and evidence of a palpable mass and, considering the overlap among the possible histotypes –5, diffeIn the present paper, the authors report a case of an adolescent affected by primary ovarian lymphoma and discuss the problems of differential diagnosis in girls affected by ovarian neoplasms.Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements, as well as written informed consent from the patients or participants' legal Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements, as well as written informed consent from the patients or participants' legal guardian.A 12-year-old girl was referred to our institution for abdominal pain and palpable mass observed by the pediatrician. After admission, a complete blood count (CBC) test was performed, showing normocytic anemia . High serum level of lactate dehydrogenase  and uric acid  were reported, while the results of liver and kidney function tests were normal. Tumor markers such as Beta-human chorionic gonadotropin (β-HCG), Alfa-fetoprotein (α-FP), CA 19-9 and CEA were negative; only CA-125 was higher than the reference value .After initial ultrasound, the patient underwent Computed Tomography (CT) scan: the results showed a voluminous hypogenic mass (size 20 cm × 13 cm × 10 cm) arising from the right ovary, causing compression on the contiguous structures, especially abdominal aorta, inferior vena cava, ureters and bowel ; anotherThe case was discussed in a multidisciplinary meeting with radiologists, oncologists and pathologists. Images were judged suggestive of primary right ovarian tumor with ischemic changes due to vascular compression in the contralateral ovary; surgical exploration was indicated in order to resect what was thought to be a right ovarian neoplasm and relieve compression on the left ovary.Pfannenstiel laparotomy was performed; intraoperatively, a 15 cm-large, ruptured mass arising from the right ovary was found, associated with a second lesion originating from the left ovary (8 cm) and multiple nodules of the greater omentum. Right ovary was completely distorted by the mass and was judged non-salvageable; right salpingo-oophorectomy was then performed and incisional biopsies were taken from the left ovary and omental nodules and peritoneal fluid samples were collected for cytology. No surgical complications were reported.c-myc gene rearrangement. Fluorescence in situ hybridization (FISH) confirmed the presence of the MYC(8q24)-IGH(14q32) rearrangement. In situ hybridization for Epstein-Barr virus (EBER) was negative. A final diagnosis of Burkitt lymphoma was given.Histological examination revealed a diffuse proliferation of monomorphic, medium size lymphoid cells, with high nucleus/cytoplasmic ratio, finely dispersed chromatin and multiple small nucleoli. There were abundant mitoses and apoptosis and many macrophages containing tingible-bodies (“starry sky” pattern). There were also areas of necrosis . The samThe patient underwent complete staging of the disease according to the International Pediatric Non-Hodgkin Lymphoma Staging System  by totalAt the time of writing, the patient is still under induction chemotherapy (V course), which has been, so far, well tolerated.Follow-up imaging shows reduction of the mass in the left ovary .The incidence of ovarian tumors in girls and adolescents increases with age, starting from 0.4 per 100,000 during infancy to 25–30 per 100,000 at the age of 18 , and maySymptoms at presentation are very similar across different histologic types and include abdominal distension, palpable pelvic masses or acute pain due to torsion or rupture –5, 11. AThe most prevalent ovarian lymphoma imaging characteristics on CT scan, ultrasonography, and MRI are described by Ferrozzi et al.  When comSerum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), alpha-fetoprotein (AFP), and β-HCG biomarkers usually remain normal in patients with ovarian lymphoma but may be helpful for the differential diagnosis of other ovarian tumors. Serum levels of LDH and uric acid are usually elevated in patients affected by Non-Hodgkin lymphomas  and highStaging is crucial in assessing the extent of the disease and enables the application of a standardized treatment strategy; in the pediatric population, the St. Jude staging system has largely been replaced with the International Pediatric Non-Hodgkin Lymphoma Staging System .Treatment of primary lymphoma of the ovary consists in multiagent chemotherapy , 7. SurgDifferentiating ovarian lymphoma from other ovarian neoplasms is essential, since ovarian lymphoma is treated by systemic chemotherapy , 6 whileDespite the limited role of surgery in ovarian lymphoma, the majority of reported patients underwent laparotomic or laparoscopic exploration on the basis of the acute clinical presentation and the suspicion of adnexal torsion , 21, 22;Although lymphomas have a rapid growth rate, the estimated survival rate in pediatric patients is greater than 90%, while lower values are reported in prospective clinical trials for adults, ranging 75%–85% –25. YounIn conclusion, preoperative diagnosis of primary ovarian lymphoma is extremely difficult. Laboratory tests including a complete blood count, comprehensive metabolic panels, measurement of LDH and uric acid levels can be helpful in the differential diagnosis of ovarian neoplasms.Surgical exploration is often necessary in patients presenting with acute abdominal or pelvic pain; when the suspicion of primary ovarian lymphoma arises intraoperatively, every effort should be made to minimize invasive procedure in order to enhance post-operative recovery.Timeframe of the relevant events


Paragangliomas could be localized from the skull base to the pelvic floor. Tympanic localization represents the most common benign tumor of the middle ear. Diagnosis is based on clinical signs with a great contribution of radiology. A 40-year-old male presented with isolated tinnitus of the right ear evolving for 18 months. Examination revealed a red bulging right-sided tympanic membrane and a conductive hearing loss. Tomodensitometry and Magnetic resonance imagery showed findings in favor of a right jugular tympanic paraganglioma. The tumor was classified type B according to FISCH classification. The patient underwent surgery consisting in tympanotomy using a retro auricular access route. The postoperative course was uneventful. There was no recurrence during the one-year follow-up. Jugular tympanic paraganglioma diagnosis is guided by a combination of epidemiological, clinical and radiological features. Treatment is still not consensual, but surgery still have its indications in localized forms of head and neck paragangliomas (HNP´s). Paragangliomas could be localized from the skull base to the pelvic floor. They are embryologically derived from the neural crest and arise from paraganglia cells within a highly vascular environment. They are classified by their location. Head and neck paragangliomas (HNPs) originate from the parasympathetic tissue, with the carotid body, vagal body and jugular tympanic region are the most common locations . TympaniWe report the case of a jugular tympanic paraganglioma, diagnosed and treated in our ENT department in 2019.Patient information: a forty-year-old male, smoker, presented in consultation with gradually increasing, unilateral, right tinnitus, evolving for 18 months, associated with hear loss. Tinnitus was swishing as reported by the patient, synchronous with pulse, and responsible of an important discomfort, causing concentration difficulties and insomnia. The patient did not report any otorrhea, otalgia or vertigo. He did not report any sign for the left ear. His past medical history was normal for any cerebrovascular accident, migraine, headaches, head and neck trauma, or radiation exposure. He had no family history of paragangliomas nor multiple endocrine neoplasia. He did not any past interventions.Clinical findings: otoscopic examination, using a rigid endoscope 0° , axial and coronal sections, without contrast, showed a nonspecific, well-defined, 7 mm right nodular mass of soft tissue, arising from the hypotympanum and overlying the cochlear promontory  they received.Informed consent: the patient was informed by the different modalities of treatments and was consenting for surgery.th, Xth and XIth cranial nerves. Associated XIIth palsy forms Collet-Sicard syndrome [Head and neck paragangliomas (HNPs) represent neuroendocrine tumors developed from chromaffin cells within paraganglionic tissues of the autonomic nervous system . They resyndrome . On audisyndrome . Screenisyndrome ,12. ThisImagery is necessary to diagnose HNP, classify the tumor and establish a treatment plan. Temporal bone CT and MRI are complementary . Small JRadiotherapy, used exclusively or postoperatively, could assure long-term tumor control. The recommended dose is 45-50 Gy fractioned over 5 weeks . A studyJugular tympanic paraganglioma are challenging rare lesions. Precise clinical assessment, preoperative imaging and interdisciplinary discussions are the basis of an adequate management of HNPs. Function-preserving therapy seems to be the most adapted approach, even if, to date, there are still no consensual recommendations in literature.


Osteochondroma usually arises from the metaphyseal region of growing bones. The occurrence of extraskeletal osteochondroma is rare with very few case reports. Para-articular osteochondroma is a type of extraskeletal osteochondroma. It frequently occurs around the knee, usually at infrapatellar Hoffa's fat pad. It is usually intracapsular but extrasynovial and arises from the capsule and connective tissues due to osteocartilaginous metaplasia. We present a case of 19-years male with anterior knee pain for 3 years, swelling, and deformity of the knee with flexion limitation for one year. Radiography revealed ovoid, corticated lesion free from adjoining bones. Mass interpreted as benign, so planned for excision. Well circumscribed nodule excised from the medial parapatellar approach. Histology revealed cartilaginous tissues surrounded by fibrous tissues with scattered enchondral ossification. Postoperatively and subsequent follow-up resulted in pain-free joint, complete recovery of range of motion with no clinicoradiological evidence of recurrence. It usually arises in the metaphyseal region of growing bones. Extraskeletal osteochondroma is very rare, manifestation is common in the knee particularly in the infrapatellar fat pad of Hoffa. It originates from the capsule or adjoining connective tissue as a result of osteocartilaginous metaplasia. It may be the sequel of Hoffa's disease which is the consequence of various traumatic events or repetitive microtrauma of the infrapatellar fat.A 19 years old male presented with gradually increasing swelling at the anterior aspect of the right knee with deformity, anterior knee pain for 3 years, and difficulty in flexing the knee for 1 year. The pain was primarily activity-related. No history of relevant trauma. There was no any mass in other parts of the body. On examination there was a non-tender, irregular, bony hard swelling prominent over the medial aspect of the patella tendon, flexion restricted beyond 90 degrees.Blood parameters were normal. Radiographs revealed a well-circumscribed, ovoid, corticated mass at the infrapatellar fat pad region. It was free from adjoining bones . FurtherClinico-radiologically, it was interpreted as benign and marginal excision was planned. Well circumscribed, intracapsular, and extrasynovial mass measuring about (6x4x3) cm excised through the medial parapatellar approach .Histology revealed cartilaginous tissue with scattered enchondral ossification within, surrounded by capsular fibrous tissue. There was no evidence of malignant features . The patPostoperatively knee mobilization and weight-bearing allowed as tolerated. Knee was pain-free, with complete recovery of range of motion on subsequent follow-up. There was no clinico-radiological evidence of recurrence at 1 year follow-up .3Extraskeletal osteochondroma is very rare. There are 3 different types of extraskeletal osteochondroma: a) synovial chondromatosis, b) soft tissue chondroma and c) para-articular osteochondroma. In synovial chondromatosis, multiple intrasynovial osteocartilaginous nodules are seen as loose bodies. Soft tissue chondromas are usually seen at hands and feet. According to Reith et al, a lesion is called paraarticular osteochondroma if: (a) the lesion presents as a single, dominant mass, both radiographically and grossly; (b) the mass consists histopathologically both bone and cartilage, organized in a manner similar to conventional osteochondromas; and (c) the lesion is not intra-articular, that is, it does not arise within the synovial lining of a joint.5 It may occur at any age, but most of them are reported at 3060 years.7 This is case of 19 years gentleman, with a solitary mass in the infrapatellar region lined by joint capsule externally and synovial membrane internally with no evidence of underlying bone continuity. Radiographs usually reveal a single, marginated bony mass with internal trabeculae. Histopathologically, mass is characterized by enchondral ossification surrounded by hyaline cartilage, fibrous and adipose tissue. So, the most appropriate term to define this lesion is "para-articular, extrasynovial osteochondroma". Similar clinico-radiological and histopathological findings are seen in other case reports on extraskeletal osteochondroma.10Para-articular osteochondroma usually manifests in joints with a potential capsular space, such as the patellofemoral joint or infrapatellar Hoff's fat pad, although they may occur in other regions too.fat pad.5The exact pathogenesis is still unknown, but it is supposed to be due to osteocartilaginous metaplasia of the articular or para-articular connective tissue, or metaplasia of Hoffa's fat pad due to trauma, or sequel of end-stage of Hoffa's disease (chronic impingement of Hoffa's fat pad). So, in this case, the pathogenesis is not relatable to a mechanical post-traumatic event or chronic impingement of Hoffa's fat pad but to primary osteocartilaginous metaplasia of infrapatellar 6 There is no known recurrence of the lesions after complete resection.11CT scan and MRI were not done due to financial constrain, which is the limitation of this case report. Clinically and radiographically, the tumor was interpreted as benign, so we planned marginal resection and sent for histopathological examination which confirmed our diagnosis. Marginal resection is the treatment of choice, especially for para-articular osteochondroma.Para-articular extrasynovial osteochondroma is an unusual lesion that commonly arises around the knee joint, particularly the infrapatellar Hoffa's fat pad due to the osteocartilaginous metaplasia of capsule and adjoining connective tissues. Clinico-radiological examinations are often diagnostic but integrated radio-pathological examination helps to distinguish it from other differentials. Marginal resection is the treatment of choice and these lesions are not known to recur.


Endometriosis is a common gynecological disease that mainly influences pelvic organs. However, extra-pelvic endometriosis is considered less prevalent. Here, we present a case study of umbilical endometriosis associated with an underlying hernia. It is known that the incidence of such a case is very rare and its diagnosis is challenging. Surgical excision of this type of lesion with a repair of the hernia is considered the preferred management approach. In this case, a 40-year-old female was admitted to the hospital with cyclical umbilical bleeding for one year. The bleeding would start with her menstruation and continue throughout the menstrual period. Initial diagnosis was made by physical examination and ultrasound imaging. Treatment options were discussed with her and she accepted to undergo surgical wide excision of the umbilical lesion with a repair of the hernia. Diagnosis was further confirmed by a histopathological study of the lesion tissue specimen. Also, a referral to a gynecologist did not report any abnormality or pelvic disease, and the patient was discharged well from the hospital. Endometriosis is a chronic and mostly benign gynecological condition that influences up to 22% of females. It is characterized by the presence of endometrial glands as well as stroma outside the uterine cavity and musculature ,2. GenerSeveral theories have been suggested to clarify the pathogenesis of endometriosis such as the embryonal rest theory, the coelomic metaplasia theory and the migratory pathogenesis theory. The first one, the embryonal rest theory, proposed that the remnants of the Wolffian duct or Müllerian duct are the precursors of ectopic uterine tissue while the coelomic metaplasia theory stated that certain inflammatory, hormonal or traumatic factors can stimulate the embryonic coelomic mesothelium to undergo transformation into endometrial tissue. But the most accepted theory is the migratory pathogenesis theory that assumed that the dissemination of endometrial tissue can take place by vascular and lymphatic channels, direct extension, and surgical manipulation . During The usual frequency of umbilical hernias ranges from 3% to 8.5% of all cases of abdominal wall hernias . HoweverA 40-year-old female patient presented to the hospital with a symptom of cyclical umbilical bleeding for one year Figure . This blA physical examination was carried out to assess the umbilical nodule and associated hernia. Diagnosis was further confirmed by ultrasound imaging that referred to evidence of subcutaneous, sub-umbilical, hypo-echoic and heterogenous mass lesion (28 mm × 22 mm) with vascularity suggesting an endometrioma. Also, the ultrasound image report pointed to evidence of umbilical hernia with a neck of 14 mm; it was reducible and containing bowel. After discussing the possible management options, the patient agreed to undergo a primary hernia repair with excision of the subcutaneous mass and umbilical reconstruction.During the operation, a vertical incision was created around the umbilicus and the wound was deepened down to the abdominal wall fascia by using electro-cautery. Then, the hernia sac was divided at the level of the fascia leaving it connected to the subcutaneous nodule. The umbilicus was later reversed and a purple endometrial tissue was observed implanted at its base Figures , 3. AfteThe hernia was repaired by using nylon 1, double layers. The first layer was continuous while the second was interrupted. Then, the subcutaneous tissue was sutured using 2-0 Vicryl and the umbilical skin was reconstructed using nylon 0 subcuticular. The patient underwent the surgical operation successfully. Later, she was referred to the gynecology department for further evaluation of any other endometriosis sites, through pelvic examination and ultrasound imaging; no abnormality was reported in this regard. Moreover, the histopathological assessment of the collected specimen confirmed the diagnosis of endometriosis. Finally, the patient was discharged well from the hospital. As a follow-up plan, the patient was informed about the risk of recurrence for both endometriosis and hernia. She was advised to maintain a high-fiber diet and to avoid heavy weight lifting and any other strenuous activity for at least four to six weeks after the surgery. Also, the patient was advised to follow up with a gynecologist within two to six weeks post-surgery and commence hormonal therapy.Primary umbilical endometriosis is a rare medical condition and when associated with an underlying hernia, its diagnosis becomes challenging. Indeed, the diagnosis of umbilical endometriosis can be mistaken for a cyst, abscess, melanoma, lipoma, suture granuloma or a deposit of systemic malignancy . EndometThe histopathological appearance of an endometriosis section is usually characterized by the irregular glandular lumina that is embedded in the stroma with an elevated vascular and cellular component similar to the stroma of the functional endometrium . Also, iSurgical resection and hernia repair are the preferred treatment options for umbilical endometriosis associated with an underlying hernia. Additionally, hormonal therapy like gonadotropin-releasing hormone (GnRH) analogues or danazol can be used in severe cases ,3,11. LaIn this case report, both clinical presentation and ultrasound imaging suggested that the patient had an umbilical nodule and an underlying hernia. The hernia defect was repaired primarily as its diameter was less than 2 cm. Mesh repair is recommended for recurrent or bigger hernias . SeveralEndometriosis is a common gynecological condition, but spontaneous umbilical endometriosis is very rare especially when associated with an underlying hernia. Moreover, the diagnosis of primary umbilical endometriosis associated with an underlying hernia is considered difficult. Therefore, the use of preoperative imaging is recommended for better preoperative planning. Surgical excision of the umbilical lesion with a hernia repair is considered the preferred treatment option.


When planning an operation, surgeons usually rely on traditional 2D imaging. Moreover, colon neoplastic lesions are not always easy to locate macroscopically, even during surgery. A 3D virtual model may allow surgeons to localize lesions with more precision and to better visualize the anatomy. In this study, we primary analyzed and discussed the clinical impact of using such 3D models in colorectal surgery. This is a monocentric prospective observational pilot study that includes 14 consecutive patients who presented colorectal lesions with indication for surgical therapy. A staging computed tomography (CT)/magnetic resonance imaging (MRI) scan and a colonoscopy were performed on each patient. The information gained from them was provided to obtain a 3D rendering. The 2D images were shown to the surgeon performing the operation, while the 3D reconstructions were shown to a second surgeon. Both of them had to locate the lesion and describe which procedure they would have performed; we then compared their answers with one another and with the intraoperative and histopathological findings. The lesion localizations based on the 3D models were accurate in 100% of cases, in contrast to conventional 2D CT scans, which could not detect the lesion in two patients . The 3D model reconstruction allowed an excellent concordance correlation between the estimated and the actual location of the lesion, allowing the surgeon to correctly plan the procedure with excellent results. Larger clinical studies are certainly required. Colorectal lesion resection is one of the most frequently performed surgical procedures. The anatomy, especially of the right-sided colon, varies considerably from patient to patient ,2. Neoplmagnetic endoscopic imaging studied by Miroslaw Szura et al. .Data are expressed as means and standard deviation or through frequency distribution. Cohen’s kappa coefficient was used to assess the inter-agreement between the data collected with the 3D System, with the CT and during surgery. Analysis was performed using STATA/SE14tm software .✓Limited number of cases;✓Limited number of surgeons who have tested the software;✓No specific training of surgeons in viewing radiological images;✓The prospective observational nature of the study.The study was conducted between July 2018 and July 2019 and involved 14 patients. All patients were Caucasian. The mean age was 74 ±11.5 years old; six patients were male and eight were female. There were no absolute contraindications for performing laparoscopic procedures. The postoperative histopathological findings revealed 12 malignant lesions and 2 benign lesions. The mean time that elapsed between surgery and preoperative staging was 9 days (STD 9.5). Among the 14 patients, 7 patients (50%) had a right-sided colon lesion , 3 (21.43%) had a rectal lesion, 2 (14.28%) left-sided (descending and sigmoid colon), and 2 (14.28%) had a transverse colon lesion  documented on the CT scan. Two patients (14.28%) had a suspected right-sided colon lesion shown only during colonoscopy but not evidenced by the CT scan. In order to reconstruct the 3D models for these patients, both colonoscopy and CT scan were used. Based on the pre-operative identification of the suspected lesion location, patients underwent the indicated surgical procedures according to standard clinical practice  , showingWhen comparing the lesion localizations identified on the 3D models and the histopathological findings, a 100% concordance correlation was found . This was not true, however, for the comparison between the conventional method based on the 2D CT scans and the visualization of the 3D models . The errors were related to the two patients (14.29%) for whom the lesion was not evidenced on the CT scan, and the colonoscopy findings had to be used to plan the procedure .A 65-year-old female patient. History: hypertension, hypothyroidism and previous appendectomy and hysterectomy for benign pathology.After multiple sub-occlusive episodes, she underwent colonoscopy, which revealed a sigmoid tumor that could not be crossed by the endoscopic instrument.The histological examination of the biopsies harvested during colonoscopy was positive for adenocarcinoma.The disease was staged T3N1M0 at the CT enema. The tumor was located in the proximal portion of the sigmoid colon.According to this evidence, left video laparoscopic (VL) hemicolectomy surgery was scheduled.-Substenosing neoplasm located in the distal portion of the sigma in a dolichosigma framework.-Vascularization of the neoplasm came from the sigmoid arterial branches, which individually originate below the outlet of the left colic artery. This one was of moderate length.-Suspicious lymph nodes were evident in the area surrounding the neoplasm only.The 3D reconstruction showed the following :-SubstenBecause of this evidence, the surgery designed on the basis of 3D reconstructions was left hemicolectomy with preservation of the left colic artery.During the surgery, the neoplasm was located in the distal sigma. Left hemicolectomy was then performed with left colic artery preservation and Knight–Griffen anastomosis without the need for splenic flexure mobilization.A 79-year-old female patient. No comorbidities. She came to our attention for SOF +, weight loss of about 10 kg in recent months and tenesmus. On colonoscopy imaging, a vegetative lesion was found about 17 cm from the anal rhyme involving the lumen circumferentially, not crossable by the endoscope. CT confirmed the presence of a large lesion in the sigma rectum, with thickening of the adjacent adipose tissue probably due to infiltration; multiple lymph nodes were noticed in the mesorectum, in the presacral adipose tissue, in the Douglas and in the iliac stations bilaterally. -A large lesion of the sigma rectum joint, occupying a large portion of the pelvic excavation and in close contact with the contiguous organs  and the iliac vessels, without signs of infiltration. -The vascular reconstruction highlighted the inferior mesenteric artery, while the left colic artery was not visible. -The presence of pathological lymph nodes in the Douglas and in the iliac area, especially on the left. The 3D reconstruction highlighted the following : -A largThe patient underwent surgery with a robotic approach, subsequently converted to median laparotomy due to unclear cleavage plans of the neoplasm with the uterus and bladder. A partial mesorectal excision was then performed, with ligation of the inferior mesenteric vessels at the origin. A left colostomy was created. The final histological evaluation of the neoplasm described a pT4b/G3/N0 lesion.A 73-year-old female patient.History: hypertension, treated with new oral anticoagulants (NOAs) for previous thrombophlebitis; previous appendectomy; and two caesarean sections.She was admitted to the hospital for asthenia and anemia. Esophagogastroduodenoscopy (EGDS) and colonoscopy were performed: the latter revealed an adenocarcinoma of the right colon. A CT scan for the staging of the neoplasm followed. The findings were a hyperemic thickening of the walls of the ascending colon, inhomogeneity of the adjacent adipose layers, edema and millimeter mesenteric lymph nodes with extraserous involvement.-A neoplastic lesion located between the proximal and middle third of the ascending colon.-Vascularization was ensured by the right ileocolic and colic arteries.-Multiple mesenteric lymph nodes were noticed.The 3D reconstructions showed the following :-A neoplThe patient underwent a right VL hemicolectomy with the ligation and section of the ileocolic vessels and of the middle colic artery right branch.The histological examination staged a pT2/G2/N0 lesion.A 79-year-old male patient.History: hypertension and previous ischemic heart disease: triple coronary artery bypass graft (CABG). He was investigated for severe anemia (6.9 g/L) and asthenia. He underwent endoscopic investigations; colonoscopy found a vegetative and stenosing lesion, not crossable by the endoscopic instrument and localized in the distal splenic flexure/distal transverse colon. Biopsies were collected. A CT scan was performed: it showed parietal thickening and a mass protruding the lumen with a large base causing substenosis of the lumen. -A heteroplastic lesion of the splenic flexure in the setting of a dolichocolon.-Vascularization by the middle colic artery.-Some mesenteric lymph nodes.The 3D reconstructions showed the following : -A heteThe patient underwent colic resection from the left colic angle to the proximal descending colon after the isolation and sectioning of the left colic and the left branch of the middle colic. Histological evaluation: pT4a/G2/N0 (for effracted and outdated serosa).An 80-year-old male patient.History: hypertension, Chronic obstructive pulmonary disease (COPD) and pulmonary emphysema, duodenitis and previous appendectomy. He came to attention for alternate alvus. Investigations revealed a substenosing cuff lesion of the rectum. He underwent neoadjuvant therapy. The abdominal CT showed thickening of the rectal wall projecting into the lumen and resulting in substenosis extending to the anal rim. A few perirectal lymph nodes were present.The lesion was reduced in size, extension and thickness on post-neoadjuvant MRI.Surgery performed with a robotic approach was therefore planned. Skeletonization of the sigmoid and rectum, and TME with NS, Knight–Griffen anastomosis and a protective ileostomy were performed.-Voluminous neoplastic mass of the middle rectum.-Vascularization by the inferior mesenteric artery.-Some locoregional lymph nodes.The 3D reconstruction displayed the following :-VoluminHistological evaluation: ypt3/Gx/N0.This study performed an evaluation of the efficacy of using patient-specific 3D model reconstruction during preoperative planning in colorectal lesion localization. As mentioned earlier, colonoscopy and conventional imaging have some limitations when used in preoperative planning. For example, the lesion can be too small to appear on a CT scan, or vascular structures may be misrepresented . Moreovemagnetic endoscopic imaging (MEI) [Miroslaw Szura et al. localized colon lesions before surgery using ng (MEI) , statingIn our study, the TC scan alone was not sufficient to localize two lesions because of their small dimensions, while colonoscopy correctly localized all the lesions. These two patients presented right-sided, malignant lesions. Such a situation can lead to risks, for example, the choice of an incorrect surgical approach or type of resection, leading to an incomplete excision.Using ‘Hyper Accuracy 3D™’ ’ software, which incorporates colonoscopy findings with CT abdominal scans, such lesions were not only evidenced but also studied more efficiently. Guerriero et al.  found anOther studies focused primarily on lesion vascularization, as well as the vessels of organs found in the proximity. Some researchers found utility in the implementation of 3D surface rendering, especially in undiagnosed vessel anomalies, such as undiagnosed short arterial trunks that could lead to improper surgical decisions with higher intraoperative and postoperative hemorrhage risks or anastomosis leakage. Moreover, one case report involving a patient with horseshoe kidney, who underwent an anterior resection of rectosigmoid cancer, states the importance of evaluating gonadal vessels, sacral arteries, branches of hypogastric arteries and inferior mesenteric arteries, which, in this particular case, were identified and preserved due to 3D model SR ,21,22. Although our study is one of the first to evaluate the impact of using 3D models in colorectal surgery, it presents some limitations, the most important being related to the number of patients enrolled. However, we believe that this number is enough considering that our results are comparable to those of other published studies that tested 3D software reconstruction, even though the parameters taken into consideration are different.This study provides a positive evaluation of the efficacy of high-resolution preoperative 3D reconstructions for the localization of colorectal lesions. The 3D models, built using both CT scans and colonoscopy data, were demonstrated to not be inferior to conventional 2D CT scans in tumor localization and pre-operative surgical planning. They could present good potential to improve lesion localization and help surgical planning, especially in difficult cases. We believe that this study will not only play a fundamental role in the pre-operative planning of surgery but also in 3D reconstructions’ application in intraoperative surgical guidance  . This st