Portal hypertension, often stemming from liver cirrhosis or vascular anomalies, can result in cavernous transformation of the portal vein, a rare condition associated with biliary obstruction, variceal hemorrhage, and splenomegaly. This case report details a unique occurrence of portal hypertension, splenomegaly, and cavernous transformation of the portal vein successfully managed through splenectomy and spleno-renal shunt. A 30-year-old female with a history of portal hypertension, portal gastropathy, and splenomegaly presented with left upper quadrant abdominal pain. She had previously undergone esophageal variceal ligation and required intermittent blood transfusions. Additional complications included easy bruising, heavy menstrual bleeding, and a prior episode of hematemesis. Clinical assessment confirmed splenomegaly, while a CT scan confirmed the diagnosis. A tailored surgical approach was chosen, leading to splenectomy and spleno-renal shunt.  Portal hypertension, a complex condition characterized by increased blood pressure within the portal venous system, often can result from liver cirrhosis, portal vein thrombosis, or vascular abnormalities . One maiHerein, we report a rare case of portal hypertension, splenomegaly, and cavernous transformation of the portal vein treated with a splenectomy and spleno-renal shunt. This case report has been reported in line with the SCARE Criteria .A 30-year-old female with a history of portal hypertension, portal gastropathy, and splenomegaly presented to the outpatient department with pain and a dragging sensation in the left upper quadrant of her abdomen. She had previously undergone multiple sessions of endoscopic band ligation for esophageal varices and occasionally required transfusions for red blood cells and platelets. The patient also reported easy bruising and heavy menstrual bleeding. She had a history of melena and a single episode of hematemesis in the past. Notably, she had umbilical sepsis in infancy, which may have been a risk factor for her current diagnosis. Apart from this, her family history, drug history, and psychosocial history was unremarkable.On examination, she appeared pale and lethargic but was alert and oriented. Abdominal examination revealed an enlarged and tense spleen extending 19 cm beyond the costal margin, while the liver was non-tender and palpable. The percussion note was tympanic, with no signs of fluid accumulation. Cardiovascular and respiratory exams were unremarkable.The CT scan exhibited features consistent with portal hypertension and associated changes in the pre-portal venous system, liver, and spleen  and 2.The patient’s complete blood count indicated pancytopenia, while liver function tests showed no significant abnormalities. Upper gastrointestinal endoscopy showed the presence of small esophageal varices and severe portal hypertensive gastropathy .Based on the patient’s clinical history, examination findings, and imaging studies, the working diagnosis of cavernous transformation of the portal vein  was decided upon. The patient was informed about her condition and consented to a high-risk surgical procedure involving splenectomy and spleno-renal shunt. She underwent pre-splenectomy vaccination.The surgical procedure involved a Chevron incision. During the operation, an enlarged and firm spleen was encountered. Multiple dilated and tortuous varices were found around the spleen involving the splenocolic, phrenicocolic, and gastrocolic ligaments. The splenic vein was also dilated and tortuous. Splenic vein dissection was affected proximal to the splenic hilum to preserve maximum length for the subsequent shunt. Following removal of the spleen, an end-to-side, central (non-selective) spleno-renal shunt was performed with polydioxanone 5/0.The patient was monitored for vital signs, pain, and fluid balance during the immediate post-operative period. She had an uneventful recovery and was discharged on the third day after surgery .Post-operative follow-ups were conducted two and four weeks after surgery. She has remained well and stable. Her quality of life has improved significantly, as has her functional class. Hematological tests done reveal a reversal of counts to normal levels. A repeated upper GI scope performed after a month showed complete resolution of gastric varices. She has been taking meat regularly, but there are no alarming signs of encephalopathy. She has been kept on regular surveillance at 3-month intervals.Extra Hepatic Portal Vein Obstruction (EHPVO) is a rare condition with an uncertain prevalence. In India, it affects 0.84–13.6 individuals per 100 000, while in Western countries, portal venous thrombosis accounts for two to five percent of all variceal bleeds. EHPVO predominantly affects young adults, primarily between the ages of 10 and 30, and men are more commonly affected, with a male-to-female ratio of 2:1 [et al., who conducted two randomized controlled trials on emergency portocaval shunts. Their findings indicated that this procedure effectively stopped variceal bleeding with almost no chance of re-occlusion [Historically, EHPVO has been treated with surgical shunts, the largest series of which was conducted by Orloff cclusion .Predisposing factors for EHPVO include intra-abdominal infections, peritonitis, hypercoagulability, and portal venous stenosis or atresia. EHPVO and non-cirrhotic portal fibrosis are the leading causes of non-cirrhotic portal hypertension . It is eDue to its vast range of clinical manifestations, early EHPVO diagnosis is challenging. Common symptoms include abdominal pain, splenomegaly, recurrent variceal bleeding, and ascites. Splenomegaly causing hypersplenism is an important finding seen in patients with EHPVO. Even Though medical and endoscopic management is recommended for EHPVO, shunt surgery is indicated in rare cases such as portal biliopathy, hypersplenism, massive splenomegaly affecting the quality of life, growth retardation, and rare blood group .Our patient had been undergoing endoscopic band ligation due to esophageal variceal bleeding. Although endoscopic management has temporarily alleviated variceal bleeding, it is not treating the underlying cause, making it unsuitable as a long-term treatment. Despite potential hazards due to collaterals, direct surgical procedures on the biliary system are often performed for EHPVO, providing a one-time solution for young patients with long life expectancies with almost no recurrence changes .Therefore, our patient underwent a splenectomy and an end-to-side proximal spleno-renal anastomosis. The patient remained stable during follow-ups, and GI scope showed no changes related to portal hypertension. Overall, she showed signs of improvement at every flow-up.This case report highlights the importance of a comprehensive approach to managing Noncirrotic portal hypertension, especially concurrent with splenomegaly and recurrent variceal bleeding. Although surgical interventions such as a splenectomy and a spleno-renal shunt can improve outcomes such as seen with this case, due to the rarity of this condition, data on it is scanty.Treatment plans tailored to each and close follow-up are necessary to achieve positive long-term outcomes and prevent complications. Further research and larger studies are needed to evaluate these surgical procedures’ long-term effectiveness and safety in patients.


Mammary analogue secretory carcinoma (MASC) is a new disease among tumours affecting the salivary glands. It was first reported in 2010, and few cases have been reported worldwide. MASC is often incorrectly diagnosed as salivary gland acinic cell carcinoma. We present here the case of a patient with an asymptomatic parotid tumour who underwent a parotidectomy of the superficial lobe.A 78-year-old female patient came to the clinic for a tumour of approximately 2.5 × 2.5 cm and a hard, elastic consistency that had grown insidiously in the right preauricular region. Magnetic resonance imaging of the head and neck showed a heterogeneous ovoid lesion located in the lower part of the superficial lobe of the right parotid gland, measuring 29 × 27 × 27 mm. A superficial parotidectomy was performed with the facial nerve identified and preserved. Immunohistochemistry was positive for S100, mammaglobin, periodic acid Schiff (PAS) and GATA-3. Fluorescence in situ hybridisation analysis was subsequently performed and Translocation-ETS-Leukemia Virus (ETV6) gene rearrangement observed. These findings were consistent with diagnosis of a MASC. The patient then required no new interventions or adjuvant therapy. At publication, she was free of disease and continues in clinical follow-up.MASC is a tumour of the saliva glands that is recently described and rare. There are no studies that describe its biological behaviour or prognosis precisely. This vaet al  first deet al –3. Most et al –5.It is associated with a chromosome translocation, t12;15) p13;q25), that results in Translocation-ETS-Leukemia Virus ETV6) - Neurotrophic Tyrosine Receptor Kinase (NTRK3) gene fusion [;15  and did not report alcohol consumption. Physical examination found a mobile, elastic, hard, ovoid lesion in the right preauricular region. Magnetic resonance imaging (MRI) showed a right superficial parotid nodule with well-defined edges and a fibrous capsule that was hypointense in nearly all sequences, but with a mainly hyperintense, heterogeneous signal in T2 sequences. This nodule showed enhancement with intravenous contrast and papillary-like projections inside. It measured 29 × 27 × 27 mm and was first interpreted as a primary neoformative process  and 2.Fine needle aspiration (FNA) was performed on the lesion. Neoplastic cells were observed with moderate atypia, macrokaryosis, occasional nucleoli and scant cytoplasm arranged in three-dimensional strips, with nuclear superimposition in a haematic background in which few lymphocytes were identified (Milan Classification V) .A right superficial parotidectomy was performed, with the facial nerve identified and preserved . IntraopMicroscopic study of the surgical specimen identified a lesion measuring 27 × 22 mm. It was characterised by proliferation of neoplastic cells, with moderate atypia, macrokaryosis, occasional nucleoli and abundant cytoplasm with a vacuolated appearance arranged in a predominantly microcystic and follicular pattern, and with fine fibroconnective septa . There wPostoperative adjuvant therapy was not considered necessary after surgical resection. The patient had regular clinical follow-ups , local and regional ultrasound every 6 months and annual CT scans with intravenous contrast. The patient is currently free of disease (disease-free period: 36 months) and has experienced no sequelae from surgery.MASC is a recently described tumour of the salivary glands, with a distinctive, characteristic t  ETV6-NTK3 chromosomal translocation, which leads to fusion of the ETV6 gene on chromosome 12 and the NTRK3 gene on chromosome 15 . ETV6-NTSince the work of Skálova et al , MASC haMASC mainly affects the parotid gland but can affect the submaxillary and minor salivary glands, mainly in the oral cavity. Lesion size varies, lesion growth is slow and insidious, and the most common presentation is a palpable tumour. MASC generally appears as a low-grade, malignant lesion with a low rate of regional lymph node metastases and a low mortality rate. .The most common differential diagnoses of these tumours are acinic cell carcinoma, mucoepidermoid carcinoma and adenocarcinoma , 10. MASLike secretory mammary carcinoma, MASC has a recurrent chromosomal translocation, t12;15) p13;q25), that results in the fusion of the ETV6 gene on chromosome 12 and the NTRK3 gene on chromosome 15. The biological consequence of this translocation is the fusion of the transcriptional regulator ETV6 with the membrane receptor NTRK3. Fusion triggers activation of this kinase, which promotes cell proliferation. ETV6-NTRK3 gene fusion has not been shown in any other salivary gland neoplasm [;15  or metastatic disease . Howeveret al [Most MASC cases involve low-grade malignant neoplasms with effective surgical management, but there are case reports of high-grade, more aggressive cases with higher rates of recurrence . Some MAet al  identifiet al .More research is required to gather accurate data on the clinical behaviour and long-term prognosis of MASC. Standardised guidelines are also required for surgical treatment, the role of radiotherapy and chemotherapy, the time and manner of follow-up, regional lymph node involvement, distant metastases, recurrence and mortality associated with MASC , 10.MASC is a recently described and rare salivary gland tumour. Few cases have been reported worldwide and there are no definitive studies that make it possible to establish the prognosis and behaviour of MASC. Resection with adequate oncological margins is the basis of treatment, but more information is needed to establish evidence-based treatment guidelines.The patient’s prior informed consent was obtained for this case report.There are no conflicts of interest to declare in this publication.The listed authors did not receive funding for preparing this manuscript.


Renal cell carcinoma (RCC) is rarely diagnosed during pregnancy and its management represents a challenge as it necessitates considerations for the well-being of both the mother and the developing fetus. Diagnosis can be challenging and is often an incidental finding during routine imaging, which can lead to difficult decision-making. The choice of the ideal imaging study in these cases is a matter of debate. When the tumor is detected at an early stage, radical nephrectomy is indicated. However, there is still controversy regarding whether it should be performed conventionally or laparoscopically, as both techniques have their risks and benefits. In this context, our primary objective was to provide adequate surgical treatment for the patient, while safeguarding fetal health. Here, we present a patient with a history of recurrent miscarriages, in whom a renal tumor was incidentally diagnosed during pregnancy. Adding to the uniqueness of this case, the patient was diagnosed with an eosinophilic variant of chromophobe RCC through histopathological analysis. Our aim is to highlight the controversies surrounding diagnostic and treatment methodologies and to present the surgical techniques employed in this unique situation. This case underscores the importance and need for a multidisciplinary approach, which, in our instance, resulted in favorable outcomes for both maternal and neonatal health. Urological cancers are a highly uncommon phenomenon during gestation, with an incidence rate of approximately 13 cases per 1,000,000 pregnancies and renal cell carcinoma (RCC) emerging as the most frequently reported renal tumor in pregnancy, followed by angiomyolipoma and blastoma . RCC mayWhen a renal tumor is detected in the first trimester, it is essential to address its integral management. The dilemma in treatment should be communicated to the patient, emphasizing the risks to pregnancy outcomes and discussing the option of pregnancy termination. When the renal mass is diagnosed in the second or third trimester, surgical intervention can be conducted. By contrast, postponing surgery after birth is considered a viable option by some authors as a favorable approach, although there are no robust data to support treatment decisions in these cases ,4. WithiThis is the case of a 36-year-old female patient with a history of spontaneous abortions. An incidental renal mass was discovered during a routine ultrasonographic evaluation, which was subsequently diagnosed as a rare variant of RCC during pregnancy. This case underscores the importance of a multidisciplinary approach, with a primary focus on ensuring optimal management for both the mother and her fetus.We present a case of a 36-year-old female patient with a past obstetric history of G3P0A2, which includes two intrauterine curettages in 2016 and early 2018 due to spontaneous abortions during the first trimester. Her gynecological and obstetric history revealed that she was diagnosed as pregnant at six weeks of gestation due to a delayed period, without exhibiting any other pregnancy-related symptoms, and at that time, her last menstrual period date was May 26, 2019. After the second curettage, a routine pelvic and abdominal ultrasound was performed, which demonstrated a right renal cyst without any other specifications. According to the patient's account, she was informed that her renal cyst was congenital in nature and did not require continuous follow-up.In June 2019, she was referred to our urology department by her gynecologist due to her history of intrauterine curettages following spontaneous miscarriages. During the evaluation, the obstetrician requested a series of tests, including an abdominal ultrasound, which once again revealed the previously mentioned renal mass. On this occasion, the tumor exhibited characteristics indicative of malignancy, as rapid growth was evidenced when compared to previous imaging studies. Therefore, the radiologist recommended complementing these findings with a contrast-enhanced computed tomography (CT), despite her pregnancy status.The CT scan was performed on June 15, 2019 and revealed a heterogeneous mass in the middle portion of the right kidney. The tumor measured approximately 4.5 x 4.2 x 4.6 cm , hematuria (47%), and hypertension (18%), while the classical triad of back pain, mass, and hematuria is observed in 26% of pregnant patients. The typical symptoms of RCC differ when presenting in a pregnant patient due to the potential overlap between them, such as abdominal pain, abdominal distension, and increased abdominal circumference. The aforementioned factors can mask the clinical picture and lead to diagnostic delays [Although our patient exhibited no symptoms, we believe that a significant factor that contributed in the management outcome of this case was the early-stage detection of the tumor, despite previous imaging studies showing a renal mass. Furthermore, we hold the perspective that the patient's presentation during the first trimester afforded the opportunity to judiciously formulate the management strategy.In accordance with current guidelines, the preferred initial imaging modality for pregnant patients should generally not involve the use of a CT scan, except in cases where urgent diagnostic information is deemed essential. Given the efficacy of ultrasound and magnetic resonance imaging (MRI) in pregnant individuals, CT scans should be reserved for emergency situations or instances when MRI is not readily available . HoweverHistorically, pregnancy was regarded as an absolute contraindication to surgical intervention, primarily due to concerns regarding the risk of preterm labor and miscarriage. In addition, previous studies have revealed that women who underwent non-obstetric open surgical procedures while pregnant gave birth to infants with reduced birth weights, which carried an increased mortality rate during the first week following birth . This no2 utilized for insufflation can give rise to fetal acidosis. Moreover, the pneumoperitoneum possesses the potential to exert pressure on blood vessels, resulting in a decrease in the uterine blood flow. In addition, performing laparoscopy can introduce heightened technical complexities during pregnancy. Nevertheless, recent literature underscores laparoscopic radical nephrectomy as a favored approach for management during pregnancy, especially when deemed feasible [Nevertheless, conducting laparoscopic procedures during pregnancy entails inherent risks. There exists a potential for injury to the gravid uterus. The occurrence of vena cava compression, attributed to heightened insufflation pressures and table positioning, can result in decreased maternal cardiac output, subsequently inducing fetal hypotension and hypoxia. The absorption of COfeasible ,10.Managing renal masses during pregnancy presents a multifaceted challenge. There is a lack of consensus regarding the optimal timing of interventions and appropriate patient positioning during surgery. It is crucial to approach all solid renal tumors during pregnancy as potential RCC until proven otherwise. To mitigate this possibility, prompt nephrectomy, whether partial or radical, should be undertaken to establish a definitive diagnosis .In instances where surgical intervention is deemed necessary during pregnancy, a collaborative approach involving obstetricians and anesthesiologists becomes essential. In terms of anesthesia, meticulous monitoring is vital to avert hypoxia, hypotension, and the use of nonsteroidal anti-inflammatory drugs. It is important to highlight that prolonged hypoxia and hypotension can lead to fetal demise. On the obstetric front, proactive preparations should be in place for potential emergent fetal delivery, depending on the outcome of the surgical procedure .This case underscores the unique characteristics and intricacies of managing RCC in pregnant patients. It presents an exceptional situation where both the patient's condition and fetal safety must be carefully considered. While the classic symptoms of this tumor strongly suggest its diagnosis, our case highlights the importance of prenatal counseling, as the incidental finding of a renal tumor during a screening ultrasound is not an uncommon form of diagnosis. Given the absence of standardized diagnostic or treatment criteria, a multidisciplinary approach is essential for optimal management, and each case should be revised individually. Our case report advocates for laparoscopic radical nephrectomy as surgical treatment whenever feasible and when the required equipment is available, based on the results obtained in this patient. Nonetheless, we also acknowledge that the use of ionizing radiation in a pregnant patient is a weakness of this case. Nevertheless, our outcomes were successful for both the patient, who remains disease-free, and fetal development, which progressed optimally.


Phytobezoars constitute conglomerates of indigested plant fibers and are a rare cause of acute mechanical ileus. They exhibit an increased prevalence in the elderly population and people with specific predisposing conditions. Radiological imaging can often set a definitive diagnosis and dictate the optimal therapeutic approach, combined with the patient’s clinical status. An 81-year-old male presented with deteriorating clinical symptoms of intestinal obstruction, and an exploratory laparotomy was performed following inconclusive radiological findings; multiple phytobezoars and incipient intussusception were revealed intraoperatively. A patient’s medical history can often raise clinical suspicion of phytobezoars. However, a careful etiological investigation is imperative in all cases of mechanical ileus in advanced ages; early detection and dissolution of phytobezoars, when applicable, can reduce the need for surgical interventions. The term “bezoar” was officially introduced in the medical literature in 1854 by Dr. Richard Quain to describe a mass of unknown origin and consistency incidentally discovered during autopsy . PhytobeAn 81-year-old male presented to the emergency department with intense colicky pain in the right lower quadrant, which had initially appeared the previous day and had since intensified. He also complained of anorexia and bouts of nausea, often followed by bilious vomiting. His temperature was normal, and he did not report diarrhea or constipation. Bowel sounds appeared hyperactive and high-pitched upon auscultation. Physical examination of the abdomen revealed marked sensitivity in the right lower quadrant and hypogastric region, without rebound or guarding. Digital rectal examination was normal. Upon suspicion of a possible intestinal ileus, the patient was admitted to the hospital and started on intravenous (IV) antibiotics while laboratory and imaging tests were ordered. Nil per os was instructed, and a nasogastric (NG) tube was placed in order to decompress the upper GI tract.Regarding his past medical history, the patient had suffered an acute myocardial infarction (AMI) 15 years prior, for which he had undergone percutaneous coronary intervention (PCI). Ever since, he has been under medication with acetylsalicylic acid and simvastatin, the former of which was discontinued in light of the patient undergoing endoscopy the day after his hospital admission; accordingly, the patient received subcutaneous bemiparin injections once daily for the duration of his hospital stay. He was also under medication with metoprolol in order to regulate his blood pressure. He had undergone laparoscopic cholecystectomy 4 years prior, as well as surgical repair of bilateral inguinal hernias with mesh placement. Owing to the aforementioned previous surgeries, the ileus was attributed to possible postoperative adhesions in the abdominal cavity.Laboratory tests revealed normal inflammatory markers; white blood cell (WBC) count was 8.44 K/μL : 4–11 K/μL), and C-reactive protein (CRP) was 0.1 mg/dL (nr: <0.5 mg/dL). Hemoglobin (Hb) was 14.4 g/dL (nr: 13.0–18.0 g/dL) and platelet count was 263 K/μL (nr: 150–400 K/μL). Regarding his renal function, serum urea was 33 mg/dL (nr: 10–50 mg/dL), and serum creatinine was 0.8 mg/dL (nr: 0.7–1.2 mg/dL). Liver enzyme levels were also normal. The patient’s electrolyte count was also examined; serum potassium was 4.5 mmol/L (nr: 3.5–5.1 mmol/L), serum sodium was 141 mmol/L (nr: 136–145 mmol/L), and serum calcium was 10.2 mg/dL (nr: 8.6–10.2 mg/dL). Additionally, INR was 1.18.Initial imaging included chest and abdominal X-rays; the former was normal, while the latter revealed the presence of air-fluid levels in dilated loops of the small intestine, therefore confirming the initial diagnosis of an ileus a. The foBased on the aforementioned radiological imaging, as well as the deterioration of the patient’s clinical status, an emergency laparotomy was performed. Under general anesthesia and through a midline incision, the entirety of the peritoneal cavity was surveyed. Careful investigation of the small bowel revealed multiple palpable, slightly mobile masses approximately 40 cm from the ileocecal junction; the proximal part of the small intestine was visibly distended and intussuscepted. The intraluminal formations were of hard consistency, with an abnormal shape, imitating feces.In the distended segment of the small bowel, visible ulcerations and hypertrophy of the mesenteric fat were also observed. Notably, the thickening and extension of the fat around the circumference of the intestine were similar to “creeping fat”, which is associated with Crohn’s disease a. Owing An incision on the antimesenteric border of the surgical specimen revealed the presence of multiple bezoars. Additionally, at the sites of the bezoar’s lodging, the intraluminal wall exhibited prominent ulcerations and strictures b. The enCombined with the aforementioned endoscopy results, it was suspected that our patient’s phytobezoars had formed primarily in the small intestine, owing to alterations in the intraluminal anatomy. The patient’s postoperative recovery period was uneventful; the NG tube was removed on the first postoperative day, and per os diet was initiated. Bowel sounds were normal upon auscultation. He was discharged 6 days postoperatively.Bezoars constitute a rare medical entity; they exhibit an increased prevalence in advanced ages and tend to affect both genders equally . BezoarsBezoars can be located in any part of the gastrointestinal (GI) tract, yet the stomach is the most common site ,7,8. BezMany studies have been conducted in order to determine predisposing factors for bezoar formation. Generally, it appears that bezoars are usually identified in elderly people and people with reduced gastric or intestinal motility. The most consistent finding in people with phytobezoars is previous gastric surgery, such as vagotomy or partial gastrectomy, which results in decreased gastric motility and hypoacidity ,13,14,15Systemic conditions and pharmacological agents also have a crucial role in bezoar formation. Hypothyroidism, diabetes mellitus, inflammatory bowel diseases (IBD), malignancies of the GI tract, and neurologic conditions, namely scleroderma and myotonic dystrophy, can also be the instigators of the aforementioned physiological dysfunctions. Moreover, medications such as cholestyramine, anti-acids, anticholinergics, and tricyclic antidepressants can cause gastroparesis ,6,15. A The increased prevalence of phytobezoars in the elderly population can sometimes be attributed to dental problems, which lead to improper mastication and, therefore, non-fragmented food boluses being ingested ,17. TheiClinical manifestation varies according to the bezoar’s location in the GI tract, its composition, and the overall condition of the patient. Asymptomatic cases have been reported, yet in most cases, these medical entities manifest through gastric or intestinal obstruction. Common symptoms include abdominal pain and distension, nausea and vomiting, anorexia and dysphagia, or even constipation ,14,18. EImaging tests are essential for diagnosing and differentiating cases of intestinal obstruction. CT appears to be the most advantageous test, especially in setting an early diagnosis of a phytobezoar, with the characteristic “mottled gas pattern” of an intraluminal mass ,20,21. WBezoar-induced intestinal obstruction may lead to serious complications if left untreated. Gastric or intestinal perforation can be a life-threatening complication, and it requires immediate surgery. Gastric bleeding, intussusception, and strangulation can lead to local ischemia/necrosis ,13. Fist® has also proved to be a reliable first-line treatment for gastric phytobezoars [® on persimmon bezoar fragments was studied, the well-known beverage achieved significantly better results compared to the enzymatic methods [Many treatment methods have been utilized in order to treat phytobezoars. If the patient’s clinical status and the phytobezoar’s location do not dictate immediate surgical intervention, conservative methods can primarily be attempted. Gastric phytobezoars are more accessible; metoclopramide can facilitate gastric emptying ,6. Dissoobezoars . Notably methods . Neverth methods ,4. Recent research articles have also highlighted the efficacy of new methods, such as the transnasal ileus tube (TIT). Compared to a nasogastric (NG) tube, TIT can decompress the entirety of the small intestine proximally to the obstruction and aid in administering enzymes or liquids to dissolve phytobezoars. A research analysis conducted by Lin et al. concluded that conservative methods when combined with TIT, can achieve optimal results and ultimately decrease the need for a surgical approach .Invasive techniques to treat obstruction due to phytobezoars include endoscopic and surgical interventions. Gastric phytobezoars allow for endoscopic fragmentation or removal, which can be highly effective ,4,13,22.It is important to note that time is of the essence if any of the above interventions are to be applied. In cases of complete bowel obstruction that result in ischemia, strangulation, or necrosis, segmental bowel resection is the method of choice ,8,21,26.Phytobezoars constitute a rare cause of acute intestinal obstruction, and their pathogenesis is multicausal, involving systemic conditions, local factors, as well as dietary customs. Cases of mechanical ileus in the elderly should be viewed carefully; phytobezoar-induced obstruction exhibits an increased prevalence in advanced ages, and early, accurate diagnosis can reduce the need for surgical interventions. CT is the gold standard approach, yet in rare instances, it can produce inconclusive findings; in these cases diagnosis can be set intraoperatively.


Granular cell tumors (GCTs) are uncommon soft tissue tumors, predominantly benign lesions. Approximately 50% occur in the tongue, with a peak incidence in the fifth and sixth decades of life. However, in this case, a rare presentation of GCTs on the cheek of a 16-year-old young female, including a review of the literature.The medical records and histopathological slides of the case were retrospectively reviewed. This work has been reported based on Surgical CAse REport (SCARE) criteria.A 16-year-old female presented with a non-painful exophytic and pigmented cheek lesion that is rapidly growing. A primary concern was expressed as cosmetic in nature, a biopsy of the mass was taken, and histopathological findings showed a malignant tumor, mostly consistent with GCTs. She was recommended to have a total excision of the mass. During follow-up, facial MRI findings indicate granulation tissue versus recurrent/residual tumor at the site of surgery, without any evidence of cancer metastasis or spread.GCT is a tumor of Schwann cells, which is mostly benign with a 2% risk of malignant transformation. The peak incidence of this tumor is around the age of 50, and it is uncommon in young individuals. Clinically, GCT presents as a single, asymptomatic dermal or subcutaneous, brown-red nodule or papule, which grows slowly with diameter ranging from 0.5 to 3 cm. The definitive treatment for both benign and malignant GCTs is sufficient local excision with safe margins.GCT is an extremely rare tumor, with a peak incidence of fifth and sixth decay of age, which usually appear in the tongue (50% of cases); however, in this case, we present a 16-year-old female with a cheek mass diagnosed as GCT. In short, we think that GCT should be considered as one of the differential diagnoses of solitary facial masses at young ages. HighlightsPresentation of primary granular cell tumor (GCT) in young patients is extremely rare.GCT mostly comes as the mass tongue (50% of cases).GCT could be considered in the differential diagnosis of a solitary lesion on the cheek of a young patient.6.Granular cell tumors (GCTs) are relatively uncommon soft tissue tumors, predominantly benign lesions. Most GCTs occur in the head and neck region, with ~50% of cases affecting the tongue. Other sites of occurrence include the oral cavity, larynx, bronchus, gastrointestinal tract, and breast. GCT can affect both sexes and individuals of any age, although it is most commonly found in females and dark-skinned populations. The majority of GCTs occur during the fourth to sixth decades of life, with congenital cases being extremely rare. Malignant GCTs are exceptionally uncommon, accounting for only 1–2% of cases, while multiple GCTs are observed in up to 10% of cases. In children, there have been only 20 reported cases in the literature. The gold standard for diagnosing GCT is histopathology. This report presents a rare case of a 16-year-old female who presented to the hospital with a rapidly growing, painless, red mass on her left cheek, which was diagnosed as a malignant GCT. The paper discusses the clinical presentation, histopathological findings, and the patient’s clinical progress following the surgical removal of the tumorThe patient’s main complaint is cosmetic in nature. Her medical and surgical history is unremarkable, and have no known drug allergies or significant medication use. She is a non-smoker with a good socioeconomic status. Family history is negative for malformations or genetic abnormalities.A 16-year-old female with a free past medical and surgical history has complained of a red, painless mass on her left cheek since May 2021. She described that the mass would appear and disappear intermittently over the past year. However, she noticed that recently the mass had grown rapidly and became more prominent, accompanied by increased skin discoloration compared to previous episodes. The patient’s sole concern was cosmetic.During the examination, a pink, shiny mass with a yellowish area in the central part was observed. The patient was referred for an excisional biopsy of the lesion with a 0.1 cm margin. The resulting defect was closed primarily, and the excised tissue was sent for histopathological evaluation. The macroscopic description indicated a non-oriented ellipse of skin and underlying soft tissue, measuring 2×1.5×1.5 cm. Upon sectioning, a tan, firm lesion measuring 2×1.4×1.2 cm was identified in the subcutaneous tissue, pushing up against the epidermis.Microscopic examination has revealed dermal-based neoplasm, composed of nests of monomorphic population of ovoid cells with round to oval nuclei, open nuclear chromatin, prominent eosinophilic nucleoli and moderate amount eosinophilic cytoplasm with little fibrocollagenous stroma, high mitotic activity, including atypical forms (>12/HPF) and foci of tumor necrosis. Lympho-vascular invasion is also noted. The tumor cells were positive for SOX10, S100, and CD68 immunostains and negative for MART1, Melan-A, HMB45 (excluding melanocytic lesion). Myoepithelial markers including P63, CK5/6 and GFAP were also negative . Pan-CK, Actin, TFE3, Androgen receptor, and CD10 were also negative. Molecular and cytogenetic studies for ESWR1 gene rearrangement is performed and was negative (excluded the possibility of melanoma of soft part) (clear cell sarcoma).See Figure The mass was successfully excised with a safety margin by a plastic surgeon and their team at a local hospital. The patient underwent the surgery without any complications and remained stable with normal vital signs. There were no signs of fever or vomiting, and her pain was effectively controlled. The patient was able to ambulate, void, and tolerate her diet. She was discharged home and will be followed up at the outpatient clinic.Panadol (500 mg two tablets/6 h PO) and Fucidine ointment .The patient had a pet-CT scan and MRI, and findings indicate no evidence of metastatic disease or cancer spread.The patient has been advised to undergo a follow-up examination at 6-month intervals to monitor for the presence of recurrence, wound care, and medication usage. This proactive approach aims to ensure early detection and appropriate management of any potential complication related to surgery or recurrence of the lesion. The patient demonstrated high levels of intervention adherence by following the postoperative instructions and exhibited excellent tolerability, as evidenced by the absence of significant complications or any adverse effects during the recovery period.As of June 2023, the patient’s condition remains favorable, exhibiting no indications of recurrence. The absence of any signs of recurrence in the patient’s current state suggests a positive outcome following the treatment.9. The majority of cases present as benign tumors, with less than 2% being malignant8. GCT is rare in children while it is more common in adults aged 30–60, with a peak of incidence at the age of 50, and more common in women and people of African-American ethnicity8. About 40–60% of GCT cases occur in the head and neck, with approximately half of them in the tongue9. It is also possible to occur in the breast, GI tract, respiratory tract, extremities, pituitary and parotid glands, skeletal muscles, and eyes9.GCT, also known as granular cell myoblastoma, is a rare tumor that arises from Schwann cells. This tumor was first described by Abrikosoff in 19268. The presentation of multiple lesions of GCTs is rarely reported, and when it occurs, it is associated with neurofibromatosis and Noonan syndrome, cardiovascular and musculoskeletal abnormalities, especially in children7.Clinically, GCT presents as a single, asymptomatic dermal or subcutaneous, brown-red nodule or papule, which grows slowly with a diameter range from 0.5 to 3 cm8. The cells are arranged in sheets or fascicles with variable stroma7. The granular appearance of the cytoplasm is due to the presence of large lysosomes that stain positively with periodic acid-Schiff stain6.Histologically, the boundaries of the cells are usually indistinct and appear syncytial. The tumor cells have abundant granular eosinophilic cytoplasm with small, vesicular, or pyknotic nuclei, which may be centrally or eccentrically located9.There are three possible histological results of the biopsy: benign, atypical, and malignant. Six histological criteria are used to distinguish between them, including spindling, vesicular nuclei with large nucleoli, necrosis, increased mitotic activity (>2 mitoses in 10 high-power fields at 200× magnification), pleomorphism, and high nuclear to cytoplasmic ratio. If three or more of these criteria are met, the diagnosis is malignant; if one or two are met, the diagnosis is atypical; and if none of the criteria are met, the diagnosis is a benign GCT. However, these histological criteria alone are not sufficient to distinguish between them10. However, they are negative for GFAP, CK, NF, EMA, HMB45, chromogranin, synaptophysin, and desmin5. There is an association between the expression of p53 and the Ki-67 proliferation index with the aggressiveness of tumor growth in some cases. Positive p53 and high Ki-67 proliferation index are shown with malignant GCTs, while negative p53 and low Ki-67 proliferation index are shown with benign GCTs6.In immunochemistry, typically, both benign and malignant GCTs are positive for S100, CD68, CD57, inhibin, neuron-specific, calretinin, CD56, TFE3, SOX10, PGP9.5, and vimentin8.The diagnosis of GCTs is based on histopathology and immunochemistry. There are many differential diagnoses of this tumor that include myofibroma, dermatofibroma, xanthogranuloma, adnexal tumor, and melanocytic nevus4. If thelesion is malignant, the sentinel lymph node biopsy is recommended4. In case of palpable lymph node or biopsy-proven metastatic disease, lymph node dissection is recommended; rare cases of benign GCTs are reported with local recurrence, which is noted to associate with incomplete resection9. However, in the malignant GCTs, the local recurrence rate is up to 41% after surgical excision, and up to 62% of them develop distant metastasis, so long-term follow-up is necessary9.The definitive treatment for both benign and malignant GCTs is sufficient local excision, which can also serve as a diagnostic procedure. Surgical excision with a safe and clean margin is recommended when there is no surrounding capsule5. The primary treatment modality for these tumors is surgical removal. Due to their potential for infiltration into surrounding tissues, intervention is crucial to effectively address the tumor and prevent further complications.According to existing literature, GCTs typically are not responsive to radiotherapy and chemotherapy6. The recurrence rate varies between 2 and 8%, with histological control of the safety margin playing a crucial role; in cases where the excisional margin is affected, the recurrence rate can increase up to 20%6.Complete excision with a free margin of 1 cm is regarded as the sole curative treatment for benign GCTs with the aim of preventing recurrenceOverall, the prognosis for most cases of benign GCT is considered excellent.For this case, a total excision was performed with a free margin of 1 cm; see Figure During the follow-up, the facial MRI findings indicated granulation tissue versus recurrent or residual tumor at the site of surgery. There is focal skin thickening seen in the left cheek with underlying irregular subcutaneous fat stranding at the site of surgery, which measures around 15 mm in the maximal craniocaudal and anteroposterior dimension and around 9 mm in depth, and no associated muscular or bone marrow infiltration.Before the surgery, I felt really self-conscious about the growing mass on the left side of my face. I worried about complications and whether the surgery would actually remove the mass without any negative effects on how I looked or my health. I was also afraid that the mass might be connected to something more serious.On the day I was getting ready for the surgery, my doctor explained everything to me in detail and patiently answered all my questions. The surgical team made sure I was comfortable and took good care of me.When the day of the surgery came, I felt a mix of excitement and nervousness. But the surgical team and the anesthesiologist were very supportive, which helped calm my fears.After the surgery, I felt a huge sense of relief when I found out that they successfully removed the facial mass. I did have some discomfort during the recovery period, but it was manageable with the pain medication they gave me.During my recovery, I followed all the instructions from my doctor. I kept the surgical site clean and took all the prescribed medications. As time went on, the swelling went down, and I noticed a big improvement in how my face looked. This made me feel more confident and better about myself.In conclusion, going through the facial mass surgery was a journey of feeling self-conscious and worried at first, but with the explanations from my doctor and the support from the surgical team, I was able to go through with it. The successful removal of the mass, along with taking good care of myself during recovery, made a big difference in how my face looked and how I felt about myself. Oh, and I was really happy when the PET-CT scan showed no signs of the mass spreading anywhere else in my body.GCTs are a rare neoplasm that can occur in various anatomical locations within the human body, with a notable predilection for the tongue (found in ~50% of cases). Typically, this condition manifests in older individuals, with the highest incidence observed in the fifth to sixth decades of life. However, the presented case deviates from the norm as it involves a 16-year-old patient with a lesion located on the left cheek. This occurrence represents an exceptionally uncommon presentation in this particular age group and anatomical site.None.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.No funding or grant support.M.S.: supervision; H.A.S., L.K.D., and S.I.H.: writing original draft and writing – review and editing; T.M.E.: data curation; A.N.A.: methodology; S.B.W.: resources.There are no conflicts of interest.None.Husein Sarahneh.Not commissioned, externally peer-reviewed.The data in the current case are available from the corresponding author on request. The corresponding author has full access to all data and takes responsibility for its integrity and accuracy.


Lumbar hernias are rare, with only 200–300 published cases listed in the literature. Two areas are described to have weakness points: the inferior lumbar triangle (Jean-Louis Petit triangle) and the superior lumbar triangle (Grynfeltt–Lesshaft triangle). Clinical diagnosis is confirmed by computed tomography and possibly by ultrasound or radiography. The surgeon must refine the clinical detection of this condition, as most patients do not have sufficient means to have a computed tomography scan performed, which remains the gold standard for diagnosis. Despite the different techniques recommended, the open route remains the most affordable in our environment.This case presents an 84-year-old black congolese patient consulted for bilateral swellings of the lumbar regions. The patient was married and in the farming profession for several years. The patient had no notion of trauma or fever and no notion of vomiting or stopping of materials and gases. The lumbar region presented with swellings that were ovoid, soft, painless, impulsive and expansive on coughing or hyperpressure, and non-pulsatile, measuring 9 × 7 cm in diameter (right) and 6 × 5 cm in diameter (left). Ultrasound performed of the upper costolumbal region revealed two lipomatous masses facing Grynfeltt’s quadrilateral with a 1.5 cm hole on either side. The diagnosis of bilateral Grynfeltt hernia was made, and herniorrhaphy was indicated.Grynfeltt–Lesshaft hernia is a rare surgical condition caused by congenital or acquired etiology. A lower back pain or a pain point localized on the hernia in addition to a lumbar mass that reduces when lying down suggests the diagnosis of lumbar hernia. Lumbar hernias are rare surgical conditions; only 200–300 published cases are listed in literature . The supThis case presents an 84-year-old black congolese patient consulted for bilateral painful swellings of the lumbar regions, who was married and in the farming profession for several years. There was no notion of vomiting or stopping of materials and gases, trauma, and fever.2]. He had a surgical history of right inguinoscrotal hernia repair 3 years ago.On physical examination, the patient expressed discomfort through means of facial expression and presented with grade 3 malnutrition [calculated body mass index (BMI) 14.2 kg/mThe right lumbar region presented with swelling that was ovoid, soft, painless, impulsive and expansive on coughing or hyperpressure, and non-pulsatile, measuring 9 × 7 cm in diameter.The left lumbar region presented with swelling that was ovoid, soft, painless, impulsive and expansive on coughing or hyperpressure, and non-pulsatile, measuring 6 × 5 cm in diameter.The patient had noticed a mass in the Grynfeltt area for 3 years without any notion of pain nor vomiting in the beginning, and was first followed up in a health center where he had received medical treatment without success.A few months later, he consulted a traditional practitioner for the same symptomatology where he benefited from scarification without amendment, which motivated his consultation in our hospital for better care.Ultrasound performed of the upper costolumbal region revealed two lipomatous masses facing Grynfeltt’s quadrilateral with a 1.5 cm hole on either side. Due to a lack of means, computed tomography (CT) scan had not been carried out. On the basis of the clinical examination and ultrasound, the diagnosis of bilateral Grynfeltt hernia was made. Bilateral herniorrhaphy was indicated  and proposes therapeutic options for each of the four types retained . ClinicaWhen the patient consulted a local medical center 1  year ago for swelling in the lumbar region, a diagnosis of lipoma was made. This is in accordance with the literature, which supports the clinical similarity between lipoma and lumbar hernia and additionally draws the attention of the clinician to the differential diagnosis of lumbar tumefactions. This diagnosis, apart from hernia, can include lipoma, abscess, hematoma, or tumor of the soft tissues . When thSurgery aims to correct the defect and reconstruct an abdominal wall that is sufficiently elastic but resistant to daily physical stress. In the case of intestinal content, the risk of strangulation should always be indicated . SurgicaMany operative techniques have been described, but there is no recommendation for any of these techniques or approaches. Open surgical technique has proved effective 1 year after surgery. Younger patients have increased levels of gut tissue formation ; but youGrynfeltt–Lesshaft hernia is a rare surgical condition caused by congenital or acquired etiology. Lower back pain or a pain point localized on the hernia in addition to a lumbar mass that reduces when lying down suggests the diagnosis of lumbar hernia. In our low-resource settings, the surgeon must refine the clinical detection of this condition, as most patients do not have sufficient means to have a CT scan performed, which remains the gold standard for diagnosis. Despite the different techniques recommended, the open route remains the most affordable in our environment.


Juvenile xanthogranuloma (JXG) is an uncommon benign skin disorder of infants and young children characterized by dermal proliferation and infiltration of dendrocytes. We present a unique case of giant congenital JXG with a mixed presentation of macules, papules, nodules, and ulcerations in a neonatal male who was observed until the age of 23 months, by which time all lesions had spontaneously self-involuted. Prior to complete resolution, some lesions took the form of pedunculated protrusions. To our knowledge, this is the first of this atypical case to be presented in the literature. Juvenile xanthogranuloma (JXG) is a benign proliferative disorder of dermal dendrocytes and is the most common of the non-Langerhans cells histio-cytosis . While eJXG typically presents in early childhood as a solitary lesion on the head, neck, and upper trunk that spontaneously resolves on its own after a few years . Rarely,An infant boy was born at term via an uncomplicated vaginal delivery. Physical exam at birth revealed an alert neonate with right-sided scalp swelling and rash. Vital signs were stable and the remainder of the physical exam was non-contributory. The patient was transferred to the neonatal intensive care unit (NICU) with the admitting diagnosis of encephalocele. Head ultrasound and MRI demonstrated hemorrhage into deep subcutaneous tissues without evidence of an underlying cystic hygroma, consistent with a subgaleal hematoma. Abdominal ultrasound showed a normal liver and spleen while ophthalmology consult revealed no ocular involvement.Dermatology consult on day four revealed multiple firm, mobile, non-tender papules and subcutaneous nodules with overlying erythema and central erosions on the occiput of the scalp Figure  with fewOver the course of 23 months, new lesions appeared, grew, shrunk, and self-involuted leaving flat, yellow lesions Figures -6. From JXG is a benign proliferative disorder of dermal histiocytes that typically presents in early childhood and spontaneously resolves in approximately one to five years . It typiAlgorithms and classifications have been proposed and used to assist with diagnosing and categorizing JXG ,7. Such With the background of the current literature, we present a rare case of giant congenital JXG with a mixture of giant and micronodular lesions. This case is also unique in its combination of macules, papules, nodules and ulcerations, some of which were present at birth while others erupted or were acquired throughout infancy until self-involution was complete by 23 months. Additionally, our case documents symptomatic, pale tan-colored pedunculated JXG lesions at seven months of life, the largest of which measured 2 cm.To our knowledge, this mixed picture of giant, congenital JXG is the first case of this atypical presentation to be reported and as such, we encourage pediatricians and dermatologists to consider JXG in the differential diagnosis of multiple ulcerated and non-ulcerated macular, papular, and nodular lesions at birth.


Webbed neck deformity is a congenital anomaly that exists in several syndromes. Various techniques for surgically correcting the webbed neck deformity have been described in the literature, each comes with its own advantages and disadvantages. The aim of surgery is to achieve normal neck contour and symmetrical hairline, avoid excessive scarring over the anterior and lateral neck, and limit recurrence. In this report, we described our experience in managing a case of Turner syndrome with bilateral webbed neck deformity using the modified five-flap Z-plasty technique. Turner syndrome is a rare congenital anomaly affecting one in every 2000 live-born female infants. Affected children genotypically lack one of the X chromosomes - commonly referred to as XO - resulting in characteristic findings such as webbed neck deformity, low nuchal hairline, short stature, high arched palate, lymphedema of both hands and feet, broad chest with widely spaced nipples, scoliosis, hypothyroidism, cardiac and renal anomalies, coarctation of the aorta, ovarian dysgenesis, and cutis laxa. It was first described by Turner in 1938 based on a series of female patients presented in the classic triad of webbed neck, sexual infantilism, and cubitus valgus [Webbed neck deformity, also known as ‘pterygium colli’, consists of a subcutaneous band of thickened fascia superficial to the trapezius muscle typically extends from the mastoid to the acromion process -4. ApartThe main concern in dealing with the deformity is mainly aesthetic, as many children with Turner syndrome or their parents seek surgical correction of the webbed neck deformity to avoid being teased by peers especially when they reach school age, which may negatively impact their emotional and psychosocial development. The aim of surgery is to achieve normal neck contour and symmetrical hairline, avoid excessive scarring over the anterior and lateral neck, and limit recurrence. Various surgical techniques have been described in the literature to achieve the above objectives -6. In thThis is a five-year-old Malay girl who was referred to our department for a bilateral webbed neck and bifid nose. She was diagnosed with Turner syndrome and congenital hypothyroidism. Antenatal history was unremarkable. Her developmental milestones were generally up to her age. Clinically she has prominent webbing of the bilateral lateral neck extending from the mastoid to the acromion process Figure . Apart fA formal workup and medical clearance were done before she was electively admitted for surgery. The correction of the bilateral webbed neck was done under the same setting. The patient was placed in a supine position under general anesthesia with the patient’s head slightly tilted to the contralateral side of the corrected lateral neck. The lateral approach, the five-flap Z-plasty technique was selected as the mode of surgical correction Figure . The maiThe patient had an uneventful postoperative period. Upon follow-up, we noticed a mild recurrence of the left lateral neck web compared to the right side. The scar was slightly hypertrophic but managed conservatively Figure . OtherwiSince its first description by Kobylanski in 1883 , there hIn 1937, Chandler described the lateral approach using traditional Z-plasty to lengthen and break up the web, which satisfactorily addresses the neck contour deformity . It alsoMenick et al. 1984) described another technique of lateral approach using a cervical advancement flap [84 descriThe posterior approach was first reported by Foucar in 1948, in which two lateral flaps were undermined through a midline incision followed by a T shape closure with a vertical limb on the posterior midline of the neck . ShearinA combination of techniques has been proposed by Reichenberger et al., in which a series of 11 patients who underwent three different techniques - including Z-plasties, advancement flaps, or a combination of both - has been reviewed ,12. The To the author's knowledge, this is the first case encountered in our center for surgical correction of webbed neck deformity using the lateral approached five-flap Z-plasty technique. The five-flap Z-plasty is a variation of the classical Z-plasty technique that combined a double opposing Z-plasty in series with the addition of a Y-V advancement flap between the two . TheoretVarious technique for surgical correction of webbed neck deformity has been described in the literature over the past century - each carries its own pro and cons. The selection of technique should be based on the patient’s characteristic, which includes the laxity of web skin and the extension of the posterior hairline. Our technique is technically easy to perform and provides reasonable advantages in improving the lateral neck contour, achieving a more natural hairline, low chance of recurrence, and providing cosmesis.


Sarcoidosis is a disease characterised primarily by lung tissue involvement. Extrapulmonary involvement, particularly in the genitourinary tract, is extremely rare, particularly when it comes to primary disease detection in this location. The gold standard in establishing a definitive diagnosis of sarcoidosis is a combination of the clinical picture, the results of imaging methods, and histopathological examination from the biopsy taken (thus ruling out other causes of granulomatous inflammation). However, it is common for the biopsy to be infeasible or for the patient to refuse such an examination, resulting in the neglect of this critical verification. We introduce the case of a young 29-year-old man of Czech nationality who had been complaining for some time about non-specific pain above the pubic bone and in the lower abdomen, which was combined with a painless enlargement of the right half of the scrotum. Due to suspected malignancy, it was, after considering clinical, imaging, and laboratory findings, decided to perform a radical orchiectomy as a treatment option. The histological examination revealed that it was not cancer, but rather a rare genitourinary form of extrapulmonary sarcoidosis. In this case, radical resection had been, therefore, unnecessary. We also present a review of the literature on published extrapulmonary, genitourinary, and testicular sarcoidosis cases. All the above demonstrates the importance of considering a possible atypical sarcoidosis manifestation and histological confirmation before pursuing radical solutions. Multiple non-caseating granulomas formed mostly by an accumulation of fibroblasts, lymphocytes, and transformed macrophages are a typical morphological picture –4. The eIt is primarily a disease of younger and middle-aged individuals, most frequently between the ages of 20 and 40. The diagnostic process is usually lengthy and complicated since the disease’s symptoms are often non-specific and can mimic other illnesses , particularly in atypical locations. The testicular form of sarcoidosis is extremely rare (less than 50 cases had been reported in the literature since the year 2000). This rare condition, however, bears a high risk of performing an unnecessary orchiectomy and/or epididymectomy due to a suspicion of malignancy, especially where diagnostic biopsy is not performed –9.Here, we would like to introduce the case of a patient whose first sarcoidosis manifestation was a painless mass in the right half of the scrotum. To provide a more comprehensive view of this problem, this paper also includes a review of published literature on atypical extrapulmonary manifestation of sarcoidosis – testicular sarcoidosis. The primary objective of this publication is to emphasise that this disease should not be overlooked in the differential diagnosis and that preoperative biopsy can be extremely beneficial in certain cases. The case report itself was created using the CARE checklist  painless enlargement of the right half of the scrotum. The patient denied having any other problems, he had no loss of appetite or weight loss, and there had been no previous genital trauma that could have caused the enlargement. In the past, an orchidopexy was performed due to the undescended right testicle. The patient also underwent inguinal hernia surgery in his childhood. The patient had essential hypertension, which was controlled with medication. Clinically, the patient’s family history was insignificant. Other information that could explain the patient’s problems or be relevant to the given case has not been discovered.The patient’s physical clinical examination revealed a significantly hard testicle on the right, as well as an infiltrated and firmer spermatic cord. The findings on the left side were normal. Based on the results of the subsequent ultrasound examination, a diagnosis of a tumour arising from the testicular tissue with simultaneous induration  of the epididymis on the right was made Figure 2A radical right-sided orchiectomy was chosen as the solution. No preoperative or perioperative biopsy was performed since the diagnosis of malignancy was considered certain. The possible risk of malignant cells spreading and thus worsening the prognosis of a patient with the suspected testicular tumour was the main reason for the surgery. Given the seriousness of the presumed diagnosis, the quickest possible intervention was preferred and inguinal exploration with radical orchiectomy was performed.A complex of the testis, epididymis and spermatic cord (right side) with a total weight of 55 g and a size of 6.5 × 4 × 4 cm was sent to the Institute of Pathology for histological examination. The seminal cord was 1 cm long and had a normal macroscopic structure. The testicle was 3 × 3 × 3.5 cm in size, with light brown parenchyma and no macroscopically visible focal changes. The testis sheaths had been slightly thickened. The epididymis was 2.5 × 0.7 × 1 cm in size, and a well-circumscribed solid whitish lesion was visible macroscopically. There were no other significant macroscopic findings Figure 3Microscopic histopathologic examination of all the mentioned structures did not confirm the initial clinical diagnosis of a malignant tumour. Non-caseating epithelioid cell granulomas with multinucleated giant cells were the most dominant finding in all specimens. Asteroid inclusions were also visible in the giant cells, as well as an optically active material with a foreign appearance and a morphology that was suggestively crystalline or fibrous. Granulomas were found to express CD68 diffusely using immunohistochemical techniques. CKAE1/AE3 expression, on the other hand, was not observed Figure 3Following the surgery, a full-body CT (computed tomography) scan revealed extensive lymphadenopathy, particularly in the mediastinal, paratracheal, and hilar nodes. The lung parenchyma also demonstrated focal involvement. Additionally, there were enlarged nodes in the supraclavicular sheath and retroperitoneum. Based on these findings, the clinicians suspected a progressive tumour process. The fact that the oncological markers were negative while the testicle was obviously affected with a pathological growth, led the clinicians to suspect lymphoma. A mediastinoscopy with subcarinal lymph nodes sampling for histopathological examination was performed; similar to the scrotal contents, histopathology revealed the presence of typical sarcoidosis signs.Tumour markers were assessed on Day 3 day after the surgery. Both the human chorionic gonadotropin level and alpha fetoprotein level were within the normal range.9/l and lymphopenia with a level of lymphocytes 0.7 × 109/l. Blood lymphocyte immunophenotyping by flow cytometry wasn´t performed.The laboratory evaluation on Day 10 after the orchiectomy showed physiological liver transaminases, alkaline phosphatase, lactate dehydrogenase, glutamyltrasferase, creatinine, urea, albumin, total serum protein, C-reactive protein and immunoglobulins  results. Serum protein electrophoresis showed a polyclonal increase in gamma globulin. Further laboratory testing showed a decreased haemoglobin level of 12.6 g/dl, elevated platelet count of 489 × 10As a result, the patient’s condition was concluded by the multidisciplinary team as stage II sarcoidosis. Specific examinations were also performed to detect associated eye and heart impairment. The findings were normal, with the exception of a 24-hour urine collection test, showing increased calcium excretion and serum angiotensin-converting enzyme (SACE), which was below the normal range at 13 (reference range: 20-70). The patient was then prescribed corticosteroid therapy. Prednisone was administered at a dose of 40 mg/day per os for the first three weeks, then at a dose of 30 mg for two weeks, and finally at a dose of 20 mg long-term. Corticotherapy was administered for a total of two years. Discontinuation of corticotherapy was preceded by a follow-up CT examination, which showed practically complete regression of lymphadenopathy and focal lung involvement.The patient is now free of clinical issues and attends individual specialised follow-ups on a regular basis, with the last one having taken place in June of this year (2023).3Sarcoidosis, as mentioned in the Introduction, is a disease characterised mostly by the involvement of lung tissue and related lymph nodes (mainly hilar). Only approximately one-tenth of all sarcoidosis cases primarily manifest as extrapulmonary . Extrapulmonary manifestations primarily occur in the skin, eyes, spleen, liver, or, in some cases, the central nervous system. Primary sarcoidosis in the genitourinary tract is extremely rare, especially when it comes to the primary detection of the disease in this location. As a consequence, sarcoidosis is rarely considered as a possible cause of pathological findings in these unusual locations, putting patients at risk of unnecessary procedures and surgical interventions that can negatively impact their quality of life , 10, 11.The genitourinary manifestation of sarcoidosis affects less than 0.2% of all patients. It’s worth noting that this statistic increases to 5% when autopsies are included – genitourinary involvement is frequently underdiagnosed , 12, 13.Clinical symptoms of testicular involvement are numerous and differ from case to case. It can be a sharp pain that appears suddenly or a long-term silent mass in the scrotum (as in our case). However, it is necessary not to forget that the scrotal enlargement can be caused by a wide range of diseases that must be ruled out before a definitive diagnosis can be made. It may be a hernia, an abscess, a localised form of tuberculosis or syphilis, or even a malignant tumour . Sarcoidosis is typically diagnosed by exclusion , 28, 29.A combination of the clinical picture, the results of imaging methods, and the conclusion of histopathological examination from the biopsy taken  is the gold standard in establishing a definitive diagnosis of sarcoidosis. However, this is a procedure reserved for cases of lung tissue or lymph node abnormality. Exact guidelines for cases of primary manifestation in unusual locations are still lacking. Moreover, biopsy is relatively often not completely feasible or the patient refuses such examination, resulting in the omission of this critical verification. In such cases, the final decision is based solely on clinical examination and imaging modalities, which do not provide an accurate picture of the disease at hand. Sarcoidosis can also mimic other lesions, the most serious of which is a malignant tumour, which cannot be ruled out without a confirmative biopsy , 19, 20.Malignancy is the most serious possible diagnosis, which is further complicated by the fact that both sarcoidosis and malignant testicular tumours have a similar age of onset. Even though histopathological evaluation is the most sensitive and accurate method, clinical practice relies largely on imaging results, particularly on the ultrasound, which was also performed in our case. It can reliably identify a pathological lesion, but it is unable to distinguish between “mere” extrapulmonary sarcoidosis and a malignant tumour. The use of MR (magnetic resonance) imaging is an option, but it is a much more expensive examination with several limiting criteria, and the data obtained may not be strictly specific , 9, 15. As a result, it is appropriate to highlight the indispensable role of histopathological examination, which can determine the final diagnosis with high accuracy. Even so, since biopsy is an invasive method that is associated with several complications in the genital area, this examination is performed less frequently and reluctantly. When a malignant tumour is suspected, a large number of clinicians consider performing a probatory biopsy very carefully because there is a risk of spreading malignant cells to other locations. It is also worth noting that some studies suggest a link between testicular sarcoidosis and testicular cancer, but this remains a contentious issue. That is why we continue to face the fact that when a unilateral scrotal mass is discovered, the most common treatment is an often-unnecessary radical orchiectomy, as was the scenario in our case , 35, 36.As a result, some recommendations can be summarized in the following points. In younger individuals with a bilateral scrotal mass involving several scrotal structures, a known family or personal history of sarcoidosis and negative oncological markers, we should first consider a possible benign nature of the lesion and proceed with further verification. First and foremost, high-quality imaging of the chest, abdomen, and pelvis should be performed, and a biopsy with histological evaluation or perioperative biopsy should be seriously considered. Perioperative biopsy with immediate fresh-frozen section evaluation can be performed even if the clinical picture is unclear and the risk of malignancy is intermediate. This will allow, if the malignancy is indeed confirmed, to proceed with the radical procedure immediately while minimizing the risk of spreading of potential malignant cells; on the other hand, this approach will prevent unnecessary orchiectomy if the finding is benign , 32, 35.However, it is clear that this is an issue that requires more research and a deeper understanding by professional societies in order to effect change and create precisely defined diagnostic and therapeutic procedures.4To summarise, the diagnosis of sarcoidosis, particularly when it comes to atypical localizations, remains a very complicated process, owing to the variability and non-specificity of the syndromes. Genitourinary sarcoidosis is a very rare manifestation of this systemic disease, and it frequently mimics other diseases (including cancer), making the correct diagnosis difficult. Hence, when an atypical scrotal mass is discovered, physicians should consider the atypical manifestation of sarcoidosis among the possible diagnoses. The presented case shows the importance of chest examination using imaging methods and of histopathological confirmation of the diagnosis in such unclear cases, in which sarcoidosis can be suspected, before performing a radical surgical procedure.5The patient agreed to the course of treatment and had no objections to the chosen procedures. The patient also consented to the publication of his case with anonymized data, as he believes that this may help to raise awareness of the issue.The original contributions presented in the study are included in the article/The studies involving humans were approved by The Ethics Committee of FN Ostava, University Hospital Ostrava, 17. listopadu 1790/5, 708 52 Ostrava, Czech Republic (Reference number 430/2023). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.


Primary sternal chondrosarcoma, although rare, is the most common malignant tumor of the sternum. The gold standard treatment is complete surgical excision, which frequently causes the instability of the thorax necessitating future reconstruction. Local recurrence is common increasing the risk of distant metastasis.A 60-year-old male patient was diagnosed with primary sternum chondrosarcoma and underwent surgical excision with negative resection margins. Later, he was found to have two local recurrences at 11 months and 37 months post initial excision. The two recurrences were surgically removed followed by local adjuvant radiation.The seeding theories have been reported more frequently with relation to diagnostic biopsy procedures, tumor manipulation and self-seeding tumors. The patient developed two local recurrences despite total resection with negative margins, without concerns regarding seeding in distant metastasis. The thorax consists of bone and soft tissue, protects the internal organs and supports the process of respiration. The tumors found most often in the chest wall are usually metastases from other organs such as breast, kidney or lung. In contrast, primary tumors of the chest wall constitute an average of 0.2–2% .The histSternal chondrosarcoma is usually resistant to chemotherapy and radiotheraphy, the only valid alternative being the surgical treatment . The surIn case of high-grade tumors, inadequately resected margins or surgical intervention performed in hospitals that are not experienced with tumors, local metastases occur in up to 50% of patients who undergo curative surgery , 4.Local recurrence is an indicator of systemic metastasis and a poor outcome. The specialty literature has reported that 29% of patients who have local recurrence will develop distant metastasis . Thus, aA 60-year-old male was diagnosed with primary sternal chondrosarcoma and underwent surgical treatment, removing completely the tumor, but two local metastases were discovered four years after the primary intervention without systemic metastases.In the current specialized literature no such case has been presented.A 60-year-old male patient, known to have hypertension, diabetes mellitus, and a history of cardiac catheterization and cholecystectomy, was referred to the hospital with painful enlarging swelling of the anterior chest. The patient also developed at that time progressive shortness of breath and a productive cough. He denied any history of relevant trauma to the area. The physical examination revealed a hard anterior chest mass measuring 8 × 8 × 8 cm. The abdomen was soft and lax with no palpable organomegaly. Chest computed tomography (CT) showed an extensive, destructive lesion involving the whole manubrium with a soft tissue component of 8 × 8 × 6 cm. The destructive osseous lesion with internal calcification in the sternum was associated with an anterior parasternal soft tissue component and another posterior intrathoracic state intermediate soft tissue component, which was abutting with the left brachiocephalic vein Fig. . There wFollowing the conclusion of the multidisciplinary team, the surgical treatment was decided. Resection included the upper half of the sternum en bloc with medial parts of both clavicles and the central portion of the first and second ribs bilaterally. The defect was reconstructed with a non-absorbable mesh which is the most important and strongest part of the reconstruction; one titanium plate was added to connect the right and left clavicles together in order to avoid their retraction and to maintain the anterior superior chest wall convexity shape Fig. . The plaIntra-operative histopathology showed a completely resected 7.5 × 5 × 4 cm tumor with 2–3 cm free margin—a grade II chondrosarcoma with 30% necrosis.At three weeks post-operatively, the patient presented to the emergency department with pain where the surgical intervention was. It was found a fracture of the titanium plate between the clavicles due to excessive hard work and was admitted for plate revision and fixation with stainless steel wires.The patient remained asymptomatic with non-remarkable CT images during all follow-up visits, until eleven months later when he presented with swelling of the left chest. CT showed a mass in the left chest wall in the subcutaneous area, no recurrence in the sternum, and no lung lesions. Biopsy confirmed recurrent grade II chondrosarcoma with positive S-100, negative Pan-Ck immunostain, and inconclusive IDH-1. The patient then underwent left chest wall mass wide local resection. The post-operative course was favorable and the patient was discharged on the third day. Histopathology exam confirmed a recurrent well defined grade II chondrosarcoma measuring 11 × 10.5 × 7 cm with up to 2 cm free, but close margin due to the recurrence location near the lateral aspect of the clavicle.So post-operative radiation followed.After twenty-six months after resection of the first recurrence, a CT scan showed a new lobulated mildly enhancing mass in the right upper anterior chest wal, just above the medial end of the right clavicle suspicious of recurrent disease (confirmed by biopsy). A whole-body CT scan showed no distant metastases. Surgery was the next step with right upper chest wall mass resection en bloc with skin and major pectoralis muscle beside foreign body titanium plate removal. The post-operative course was uneventful. Pathological examination confirmed grade II chondrosarcoma, measuring 4.5 × 3 × 2 cm, mitotic rate 1/10, and necrosis with up to 2 cm completefree margin at the lateral aspect. Random biopsies lateral to the resected tumor were obtained, despite no masses encountered there and then sent to histopathology, which proved positive for chondrosarcoma. The patient was discussed in the sarcoma multidisciplinary team for adjuvant radiotherapy.Chondrosarcoma is the most common primary malignant bone tumor of the chest wall . It has Imaging evaluation for any suspected chest wall mass is the chest CT with contrast in setting up a therapeutic plan since the bone and soft tissue window outline tumor characteristics and invasion, while pulmonary window help evaluates lung metastasis . The CT Non-excisional biopsy increases the risk of tumor implantation along the needle track after aspiration biopsy and in the soft tissue after open biopsy thus it is discouraged , 11.Surgery is the treatment of choice, aiming for wide aggressive free margin radical en bloc excision with chest wall reconstruction . Completp = 0.004) [Chest wall chondrosarcoma shows aggressiveness due to it is high risk of local recurrence and metastasis despite negative mergines resection . Rascoe = 0.004) .In some cases, it is hard to establish whether the local recurrence is due to spontaneous tumor spreading, needle tract seeding or due to tumor manipulation .Needle tract seeding is defined as tumor cell implantation by a needle while biopsy or examine the tumor, the risk of this iatrogenic phenomenon has increasingly been reported in the last few decades, some believe that needle tract implantation may change the tumor grade and the operability of the tumor . The preAfter all, Local recurrence decrease survival rates to 45% at 5 and 10 years compared to 89% and 81% at 5 and 10 years in patients without recurrence .In our case, the patient had two separate local recurrences despite previous resection with free margins in the primary tumor surgical resection and the first recurrence resection. Last surgery revealed the presence of tumor cells in random biopsies lateral to the tumor whose margin was free of tumor upon microscopic examination despite no apparent masses which may indicate seeding of the tumor either with self-seeding or during manipulation of the tumor in the previous surgeries.Chest wall chondrosarcoma can relapses locally. Local recurrence is usually accompanied by distant metastasis. Controlling primary tumors with free resection margins is the main factor to prevent a recurrence but not definite. In this case, two instance of local recurrences have been demonstrated in four years despite free margins resection and the lack of systemic metastasis, which raise a concern of tumor seeding, and most likely due to tumor manipulation or self seeding tumors. Seeding is a raw theory and we encourage more studies and experments in this field to help understand the definite mechanism and approaching treatment manners.


Solitary fibrous tumors (SFTs) are rare neoplasms arising from submesothelial connective tissue. Typically affecting elderly individuals, SFTs can exhibit malignant characteristics despite most cases being benign. Diagnosis often occurs incidentally on routine chest radiographs, and patients are usually asymptomatic unless the tumor causes compression of adjacent structures. While imaging studies aid in identification, confirmation of the diagnosis requires bronchoscopy with tissue sampling and immunohistochemistry. Surgical excision remains the primary treatment for SFTs, with complete resection being associated with a better prognosis. Our case highlights the successful management of a massive SFT using uniportal video-assisted thoracoscopic surgery (VATS). Regular chest computed tomography (CT) follow-up is important for monitoring SFTs and ensuring timely intervention when necessary.We present the case of a 54-year-old female with a massive SFT presenting as a pleural tumor in the right lower lobe. The patient was initially asymptomatic, and the diagnosis was made incidentally during routine chest CT follow-up. Uniportal VATS was successfully performed for the excision of the tumor measuring 10x9x6 cm. Our case highlights the successful application of uniportal VATS for the thoracoscopic removal of a huge pleural solitary fibrous tumor. Primary pleural tumors are rare neoplasms that can be divided into two main categories: diffuse and solitary tumors . They acSFTs typically manifest in individuals between the ages of 50 and 60, with no significant gender differences in incidence and age distribution . AlthougIn this report, we present the case of a 54-year-old patient who was incidentally found to have a large benign neoplasm arising from the pleural surface on a chest computed tomography (CT) scan during breast cancer surveillance. The patient was closely monitored over time, and the tumor was eventually excised due to rapid growth. Histopathological analysis confirmed the diagnosis of a benign solitary fibrous tumor, which was managed successfully with uniportal video-assisted thoracoscopic surgery (VATS) excision.A 54-year-old patient was diagnosed with breast cancer in 2013 and was referred to the surgical ward for a left breast lumpectomy. At that time, the patient had an incidental finding of a localized swelling in the left breast without nipple discharge, lymphadenopathy, or noticeable changes in the skin. Mammography and breast ultrasound (U/S) were performed and confirmed findings consistent with a malignant lesion in the left breast. Fine needle aspiration (FNA) and tru-cut biopsy revealed moderately differentiated invasive ductal mammary carcinoma. Subsequently, a whole-body CT scan was performed to check for metastatic disease, which was unremarkable except for an incidental right-sided pleural mass measuring 4.8x1.3 cm. A CT-guided biopsy of the pleural mass revealed fibrofatty tissue infiltrated by reactive lymphocytes and histiocytes with extensive fibrosis, suggestive of an SFT. The patient's breast carcinoma was treated with chemotherapy, surgical resection, and biological treatment, while the fibrous tumor was managed with observation and close follow-up.In 2017, the patient returned to the clinic complaining of right-sided chest pain. A chest x-ray was done and showed an oval-shaped solid mass with well-defined borders in the right lower lung zone. A subsequent CT scan confirmed an increase in the size of the right-sided pleural mass, measuring 6.2x2 cm. At that time, the patient refused surgical intervention and was treated with nonsteroidal anti-inflammatory drugs (NSAIDs) with marked improvement in her pain.Four years later, the patient's symptoms worsened and became nonresponsive to NSAIDs. A contrast-enhanced CT of the chest revealed an enlargement of the right pleural mass measuring 10x9x6 cm, along with passive atelectasis in the base of the right lung, left lung apical fibrotic changes consistent with postradiation fibrosis, and left adrenal thickening Figure . The tumPostoperatively, the patient was transferred to the surgical intensive care unit (ICU) for observation and was initiated on intravenous analgesics, fluids, and prophylactic antibiotics. The patient was transferred to the surgical ward as her condition continued to improve. Additionally, a chest x-ray was performed and showed no evidence of pneumothorax or pleural effusion; thus, the chest tube was removed. Four days postoperatively, the patient was discharged home with no complications. She was counseled to follow-up at an outpatient surgical clinic two weeks postdischarge. Three months later, she underwent a chest CT scan to assess for tumor recurrence, which was unremarkable.SFTs are rare neoplasms of the pleura and comprise less than 5% of primary pleural tumors. They originate from the mesenchymal cells of the submesothelial layer of the pleura and have an indolent clinical course. The etiology of SFTs still remains unknown without clearly established risk factors. There is no current evidence linking SFTs to environmental exposures like smoking, asbestos, and radiation [SFTs, previously described as “benign mesotheliomas”, equally affect men and women, presenting in the 6th and 7th decades of life with an estimated frequency of 2.8 per 100,000 individuals . The neoSFTs of the pleura are usually found as single masses with a size ranging from 1 to 39 cm and an average weight varying from 100 to 400 mg . The domFurthermore, immunohistochemical testing is an invaluable tool for making a definitive diagnosis given the patternless histological pattern of this tumor, which helps distinguish SFTs from mesotheliomas ,8. SFTs The preferred treatment for SFTs of the pleura is surgical resection with 1-2 cm clear margins by either thoracotomy or VATS . InteresComplete surgical removal of the tumor with microscopically clear surgical margins is the best prognostic indicator . The recFattahi et al. studied 13 patients diagnosed with benign SFTs of the pleura, with a mean age of 50.46 years . Among tSFTs of the pleura are rare mesenchymal neoplasms characterized by haphazard proliferation of spindle-shaped cells surrounded by fibrous stroma of collagen fibers. Surgical resection with microscopically clear margins either through thoracotomy or VATS is the curative treatment of choice. Our case highlights the successful application of uniportal VATS for the thoracoscopic removal of a huge pleural SFT. Using a minimally invasive approach for the resection of large pleural SFTs is feasible, given the availability of skilled surgeons, adequate experience, and appropriate facilities. Long-term surveillance is recommended due to the possibility of late recurrence. However, further studies are warranted to evaluate the efficacy and outcomes of uniportal VATS in a broader cohort of patients with large pleural SFTs.


Pleuropulmonary blastoma (PPB) is an extremely rare and malignant pediatric lung tumor. Purely cystic PPB has a more favorable prognosis than solid PPB, but may be difficult to distinguish from a certain type of “benign” congenital pulmonary airway malformation before and during surgery. The influence of tumor rupture on long life prognosis has not been clarified in detail.A 5-month-old boy underwent emergency transfer from another hospital due to a left thoracic cystic lesion and left pneumothorax detected on chest radiography performed for persistent wheeze and cough. Contrast-enhanced computed tomography of the chest revealed marked deviation of the mediastinum to the right due to a giant cystic lesion and pneumothorax. Thoracotomy was performed on hospital day 2. A cystic lesion had developed from the distal alveolar region of lower lobe of the left lung and the tumor showed a tiny adhesion to the left diaphragm and a tiny rupture near the adhesion. Partial lung excision including the cyst and scraping of the adhesion were performed. Histopathological investigations revealed immature blast cell-like mesenchymal cells and differentiated striated muscle cells in a dense cambium layer were found under the epithelium of the cystic lesion. Type I PPB was diagnosed.Surgery should be performed with the possibility of type I PPB in mind when an extrapulmonary cystic lung lesion is found. Since issues such as the pathogenesis and long-term prognosis of ruptured cases remain unclear, continued careful follow-up of this case will be required. Pleuropulmonary blastoma (PPB) is an extremely rare and malignant pediatric lung tumor . The proA 5-month-old boy with no other medical history underwent emergency transfer from another hospital due to a left thoracic cystic lesion and left pneumothorax detected on chest radiography, which had been taken because of a 2-week history of persistent wheeze and cough Fig. .Fig. 1ChChest contrast-enhanced computed tomography taken after insertion of a chest drainage tube revealed marked deviation of the mediastinum to the right Fig. .Fig. 2CoSurgery was performed on hospital day 2 because retractive breathing was unimproved with oxygen administration through a nasal cannula while under sedation with Dexmedetomidine. Thoracotomy was done by the left fifth postero-lateral intercostal incision in the lateral position under general anesthesia. A cystic lesion was seen to have developed from the distal alveolar region of the left lower lobe Fig. . The tumHistopathological investigations revealed immature blast cell-like mesenchymal cells and differentiated striated muscle cells present in a dense cambium layer under the epithelium of the cystic lesion Fig. . ImmunosBecause the respiratory condition quickly improved and an atelectasis in the right upper lung field disappeared after surgery, the patient was transferred to another hospital and received 5 courses of VAC  chemotherapy. About a year since surgical treatment and chemotherapy, the patient is doing well without recurrence.DICER1 gene.Genetic testing revealed that both the patient and his mother had the hereditary mutation in PPB is a rare pediatric pulmonary malignancy . In 1994Type I PPB is understood to show better prognosis than type II or III , 3. HoweThe similarities of PPB and between CPAM have been discussed –6. In 20The patient in this case presented with respiratory failure due to compression of the mediastinum by a space-occupying tumor rather than pneumothorax, so resection through thoracotomy was performed. Feinberg et al. proposed a therapeutic algorithm for cystic lung disease, suggesting that surgical treatment be performed if symptoms are present , while kIn this case, 5 courses of VAC chemotherapy were administered because rupture had occurred and tumor cells were also found at the diaphragm adhesion site. Pneumothorax due to tumor rupture is one of the problems with cystic PPB lesions , 10, butDICER1 gene was identified as the gene responsible for the onset of familial PPB [DICER1 cause abnormalities in proteins that produce micro ribonucleic acids (RNAs) involved in cell proliferation, apoptosis, and cell differentiation, leading to the development of various malignant tumors such as PPB, rhabdomyosarcoma, cystic nephroma, and thyroid tumors. These related malignancies are collectively referred to as DICER1 syndrome [DICER1 gene is speculated to be associated with malignant transformation, although no mechanisms have been elucidated [DICER1 gene have been confirmed in approximately 60% of PPB patients and the presence or absence of mutations may not affect differences in PPB disease type or survival rate [DICER1 gene.In 2009, lial PPB . Mutatiosyndrome . A potensyndrome , 13, 14 ucidated , 16. MutDICER1 gene.We should perform surgery with suspicion of malignant type I PPB when an extrapulmonary cystic lung lesion is found. Since problems such as the pathogenesis and long-term prognosis in ruptured cases remain unsolved clearly, further accumulation of surgical cases is required to better understand this disease in the future. Careful follow-up is required because the patient had ruptured lesion and has the mutation of


Peritoneal cystic echinococcosis happens usually after traumatic rupture or after surgical treatment. Primary peritoneal cystic echinococcosis is a very rare case that constitutes a diagnostic and therapeutic challenge.A 30-year-old Tunisian man was admitted for hypogastric pain since 4 months. He has a 10 cm hypogastric mass. Biological-tests were normal. A computed tomography Scan showed a cystic mass on the pelvis measuring 13 × 17 cm without echinococcosis cyst in the liver.The patient was operated and we found a cystic mass of 17 cm located on the Douglas cul-de-sac that suggest a pelvic hydatid cyst. We have performed an aspiration of the cyst confirms the diagnosis followed by injection of hypertonic solution, extarction of the germinal layer and a maximal reduction of the pericyst. The postoperative course was uneventful.Trough our case, we try to focus on the diagnosis and therapeutic options of this rare entity that we should think of in front of a patient with isolated peritoneal cyst especially in endemic country. The liver is the most common organ to be concerned by Echinococcus granulosus infestation but other organs can be affected at the same time or as a primary target organs. Peritoneal hydatidosis is rare  but primary one are more rare (less than 2%) and should be raised in case of a cystic lesion found on computed tomography (CT) in a patient from an endemic country that represents a diagnostic and therapeutic challenge. It can be asymptomatic or can present with symptoms caused by the cyst compression effect.A 30-year-old Tunisian man was admitted for hypogastric pain since 4 months without known medical/surgical diseases. On examination, he was afebrile and an hypogastric, 10 cm, tender and hard mass without signs of rectal or bladder compression, no more abnormality were found. White blood cells, ionogram, urea and C-Reactive protein were normal. Hydatid serology was not done.A CT Scan showed a 13 × 17 cm cystic mass on the pelvis with its own wall, slightly enhanced after contrast-product injection, with homogeneous liquid content, which did not communicate with the digestive lumen and pushed the bladder forward and the colon posteriorly suggesting an ileal duplication, cystic lymphangioma or a primary peritoneal cystic echinococcosis despite the absence of daughter cysts (regarding we are an endemic country of hydatid cyst)  and lung 13%) [3% [1]. P0% and luClinical symptoms are not specific. Patients may suffer from signs of urinary, digestive or vascular compression. The diagnosis is based on radiological findings and serologic tests . UltrasoSurgery is the optimal treatment; the type of intervention depends on the location of the peritoneal cyst, its size and other organs involvment. Total surgical excision is the best treatment but it can not always be performed . It is iPrimary cystic echinococcosis of the peritoneum is a rare diagnosis that we should suspect in endemic country. Without considering its size, total surgical excision is the Gold standard treatment when there is no organ envasion  otherwise, a part of pericyst should be left.