This is a case of a male child who presented with a progressively enlarging oropharyngeal mass, hyponasal voice, and symptoms of obstructive sleep apnea. Computed tomography imaging of the head and neck revealed a well-circumscribed low-density area of polypoid morphology arising from the left lateral pharyngeal wall, filling most of the posterior oropharynx and extending to a pedicle at the lateral nasopharynx. Histopathological evaluation following surgical excision revealed Antoni A tissue and S100 immunoreactivity. The presentation and diagnosis of benign schwannoma neoplasms are discussed. Schwannomas are a type of benign tumor of the nervous system. They grow from Schwann cells in the peripheral nerve sheath and often present as a well-circumscribed mass . ApproxiA 14-year-old male with no significant past medical or surgical history presented with a mass in his throat. He had a negative streptococcus test at an urgent care center and was then referred to the emergency department. He complained of two days of sore throat, nasal congestion, and an expanding mass in the back of the mouth. He reported voice changes and odynophagia. He denied difficulty breathing, difficulty opening his mouth, fevers, or referred otalgia. He was tolerating a normal diet. Oral examination showed a swelling in the midline of the posterior oropharynx. A viral panel was positive for respiratory syncytial virus (RSV), but no other laboratory values were obtained. He was diagnosed with bacterial pharyngitis with peritonsillar involvement by the emergency department providers, prescribed antibiotics, and discharged that same day to home. The otolaryngology service was not consulted and did not evaluate the patient during this visit.The patient presented three months later to the pediatric otolaryngology clinic with complaints of recent voice change and symptoms of obstructive sleep apnea. He denied sore throat, dysphagia, odynophagia, otalgia, dyspnea, neck pain, or trismus. He had been maintaining a normal diet. On a physical exam, the patient was noted to be afebrile, in no acute distress, and breathing comfortably on room air. He had a hyponasal voice. Oral examination revealed moist mucosa, normal healthy dentition, and normal mouth opening. His tongue was midline with normal movement, and there was no asymmetry to the natural arch of the palate. The tonsils were 2+ on the Brodsky scale , and theIn the emergency department, labs did not reveal any abnormal values. Computed tomography (CT) of the neck with intravenous (IV) contrast Figure  was obtaThat same day, the patient was taken to the operating room for excision of the oropharyngeal mass. Under general anesthesia, the patient was placed in the Rose position. Exposure was achieved using a Crowe-Davis mouth gag  and a red rubber catheter passed through the left nasal cavity and out the oral cavity to retract the soft palate. An obvious tumor was visible obstructing the entire oropharynx extending toward the nasopharynx Figure . The masThe gross specimen pathology report revealed a pharyngeal mass described as an oval tan-pink solid mass encased in a thin translucent fibrous capsule, weighing 40 grams and measuring 5.5 x 4 x 3.3 cm  staining Figure . The neoThe following day after surgery the patient was noted to be recovering well and tolerating a regular diet. He was breathing comfortably, and his pain was controlled with Tylenol and ibuprofen. Physical examination showed the posterior oropharynx was clear without evidence of bleeding and minimal erythema over the left anterior tonsillar pillar. He was discharged home in stable condition.Typically, 25%-45% of schwannomas occur in the head and neck region and are most common between the second and fifth decade of life . The majSchwannomas of the head and neck region often present as asymptomatic grossly visible masses or with localized obstructive symptoms such as dysphagia, globus sensation, voice changes, or difficulty breathing -16. PatiMany clinicians report that schwannoma is not in their initial differential diagnosis when they evaluate an intraoral or pharyngeal tumor ,17. IntrSurgical excision is the standard treatment for schwannomas, and there is typically a low rate of recurrence or complications . AlthougThis case presentation is unique due to the young age of the patient and size of the tumor, which led to near-total obstruction of the posterior oropharynx. The diagnosis of schwannoma should be considered in a pediatric patient presenting with an enlarging mass in the oral cavity and complaints of voice changes, dysphagia, or obstructive symptoms. Early CT imaging of the head and neck will aid in a more timely diagnosis, and referral to an otolaryngologist should be made for definitive surgical management.


Following the "rule of 2", Meckel's Diverticulum (MD) is 2 inches or 5cm long. However, we report the case of an extremely large MD. To the best of our elucidated literature search, it is the first case of Giant Meckel's Diverticulum (GMD) from Pakistan presenting with post-traumatic hemoperitoneum.A 25-year-old Pakistani male presented to a surgical emergency with a two-hour history of generalized abdominal pain after blunt abdominal trauma. An exploratory laparotomy was carried out due to the deranged hemodynamic parameters and free fluid in the abdominopelvic cavity, revealing a 35 centimeters long MD with a bleeding vessel on its tip. Diverticulectomy with the repair of a small intestinal defect was performed after the evacuation of 2.5 liters of clotted blood. Histologic evaluation revealed ectopic gastric tissue. He had an uneventful post-operative stay and was discharged home.The current English scientific literature has adequate case reports documenting the complications of perforation, intestinal obstruction, and diverticulitis of Meckel's Diverticulum (MD) of normal length. However, this case report highlights the significance of an MD with an abnormal length which put the patient's life at risk of death in the setting of normal intra-operative anatomy of all other abdominal organs.  The most common congenital anomaly of the human gastrointestinal tract is the presence of Meckel's diverticulum (MD) . MD is aMost individuals with MD remain asymptomatic throughout their lifetime. However, the most common symptoms include fever, vomiting, and abdominal pain . The cliAn MD over 5 cm long is classified as a Giant Meckel's Diverticulum (GMD) . The repAfter a comprehensive literature search on PubMed, Scopus, and Google Scholar, we deduce that this case is the first to be reported from Pakistan describing Giant Meckel's Diverticulum (GMD). Many cases have been reported of the complications mentioned above of GMD worldwide. However, a case report showing GMD as a cause of major post-traumatic hemorrhage and a size of 35cm has not been documented.2, presented to the surgical emergency of Lahore General Hospital, Lahore, Pakistan, in January 2021 with a complaint of generalized abdominal pain for the past 2 hours. He underwent blunt abdominal trauma in a road traffic accident. The abdominal pain was sudden in onset without any aggravating or relieving factors. It was associated with nausea and a single episode of food-stained vomitus. There was no significant past medical or surgical history. The presenting vitals were a pulse rate (PR) of 120 beats per minute, blood pressure (BP) of 90/60 mmHg, respiratory rate (RR) of 16 per minute, and oxygen saturation of 96% at room temperature and pressure. Upon examination, the abdomen was distended and tender, with sluggish bowel sounds. Clinical examination for other systems was unremarkable. All baseline investigations were normal, except complete blood count (CBC) showing a neutrophilic leukocytosis of 18.8 ×109/L. Our provisional diagnosis was peritonitis secondary to enteric perforation. Ultrasound abdomen and pelvis showed a "moderate amount of fluid in the abdominopelvic cavity". The consultant on call decided to explore the patient owing to the deranging hemodynamic parameters of the patient and ultrasound findings. A midline exploratory laparotomy was performed. Per-operatively, 2.5 liters of clotted blood in the abdominopelvic cavity was evacuated. Bowel contents were explored for the source of bleeding. A large Meckel's diverticulum was located approximately 76cm proximal to the ileocecal junction, and a bleeding vessel was present at the tip of Meckel's diverticulum. The length of MD was 35cm  of 22.5 kg/mAll abdominal and pelvic organs were normal. The bleeding vessel present on the apex of MD was ligated, and diverticulectomy with the repair of the defect in the small bowel was done with absorbable sutures. The Giant Meckel's Diverticulum (GMD) was incised to view its gross intra-luminal appearance, which resembled gastric rugae Figure .A closed-drain system was placed in the pelvic cavity. There were no intra-operative complications, recovery from general anesthesia was smooth, and the patient was shifted to a stable male bay. The patient had an in-hospital stay of eight days due to post-operative fever complaints. We found basal atelectasis as the cause of fever after clinical examination and chest X-ray (CXR), which was managed via prophylactic antibiotic cover, incentive spirometry, and chest physiotherapy. Meanwhile, his drain output decreased gradually and was removed after 48 hours. His oral feed was started with liquids on the sixth post-operative day, followed by semi-solids on the day of discharge. He was discharged home smoothly. The histopathology report confirmed Giant Meckel's Diverticulum (GMD) with the gastric mucosa. We followed the patient on two different visits. There were two visits in the first month, followed by one per month for the next five months. Each follow-up visit included the patient's clinical examination and wound healing and care instructions. The patient is living a healthy life these days.Less than 0.5% of vitelline anomalies can be classified formally as Giant Meckel's Diverticula (GMD). Of the cases, 80% are asymptomatic, and the lifetime risk of developing a complication is 6.4% [We document a unique case of hemorrhagic GMD. MD is preponderant among males; our patient was also a young male in his third decade. A case report presented by Srilankan authors reported a 20-year-old male laborer with spontaneous axial torsion of GMD . On the Ultrasound abdomen is usually the first diagnostic tool showing small bowel obstruction with air-fluid levels . Our patKhan et al. propose that diverticulectomy, wedge resection, or surgical resection, whether via laparoscopy or laparotomy, are the currently available management options. Various factors, i.e., the presence or absence of ectopic tissue, its location, and the integrity of the diverticular base, govern the optimum approach used . DivertiMDs are lined by heterotopic mucosa in 60% of cases, with the gastric type being the most common (62%), followed by pancreatic type among 6% of affected individuals. The remaining cases combine the above two and intestinal-type mucosa 5% [Much is known about Meckel's Diverticulum, but we have attempted to ascertain the most common differential diagnosis, types, resected structures, radiographic findings, and possible complications of a Giant Meckel's Diverticulum Figure .Post-traumatic hemoperitoneum secondary to Giant Meckel's Diverticulum (GMD) is a rare clinical phenomenon. Operative intervention remains the mainstay of management in symptomatic patients. Existing literature highlights the diagnostic limitation of ultrasound and computerized tomography scans in diagnosing this clinical entity. These investigatory modalities are insignificant until there are signs of associated complications, and a 99m-labeled-technetium pertechnetate scan does not help diagnose if MD is without ectopic mucosa.We emphasize that though the occurrence of Meckel's Diverticulum (MD) is rare and Giant Meckel's Diverticulum (GMD) is even rarer, it must be considered as an important differential diagnosis in patients who do not follow the "rule of 2's" for their age but present with abdominal pain. Despite lacking diagnostic modalities and rare findings, the spotlight must be put on Meckel's Diverticulum to reduce the morbidity and mortality associated with it or its complications.


Fast-paced trauma imaging can result in misses relating to the nonosseous structures included in the field of view. We report a case of a Bosniak type III renal cyst, later found to be clear cell renal cell carcinoma, incidentally noted on post-traumatic CT of the thoracic and lumbar spine. This case includes a discussion of the circumstances which could result in a radiologist missing this finding, the idea of satisfaction of search, the importance of maintaining a thorough search pattern, and the management and communication of incidental findings. A 77-year-old male presented with severe back pain after a mechanical fall. He denied lower extremity weakness and loss of sensation. Physical examination demonstrated midthoracic point tenderness.Computed tomography (CT) of the thoracic and lumbar spine without contrast was performed as part of the patient's initial workup. Initial CT thoracolumbar spine revealed fractures through the superior vertebral body A and lefThe Bosniak classification system stratifies cystic renal masses into 5 categories according to characteristics on CT and/or magnetic resonance imaging (MRI) In our case, the renal cyst was noted on a CT of the thoracic and lumbar spine ordered due to back pain secondary to a mechanical fall. It is therefore classified as an incidental finding and, without the benefit of hindsight, could have been missed if one focused solely on the osseous structures. One of the many pitfalls that could contribute to this is “the satisfaction of search”.In the context of radiology, a satisfaction of search error occurs when a radiologist prematurely ends their search for other abnormalities after an initial finding, which satisfies the goal of the search, has been identified. Multiple contributory factors play a role in the satisfaction of search. For example, “resource depletion” which refers to reduced attention and memory when processing multiple findings One of the secondary effects of a thorough search pattern and resistance to satisfaction of search is an increase in the number of incidental findings. Incidental findings are those that are discovered in the context of imaging ordered for a different reason, such as the renal lesion in our case. A subset of this group, described by the term “incidentaloma,” encompasses masses found unintentionally within the context of the original study ordered Informed consent was obtained from the patient for publication of this report and accompanying images.


An 86-year-old man presented with bilateral lower limb edema and was found to have hydropneumothorax on chest radiography. CT revealed a substantial pleural effusion and plaques. The patient had a history of working in a stone workshop, but the extent of asbestos exposure remained unknown. Thoracic drainage and subsequent thoracoscopic surgery confirmed the presence of biphasic malignant mesothelioma through pathological examination. Hydropneumothorax as a presentation of malignant pleural mesothelioma (MPM) is rare, with only a few similar cases reported. Remarkably, despite the coexistence of plural effusion and pneumothorax, the patient did not experience dyspnea. The examination also revealed tumor rupture and disruption of the pleura. Considering the possibility of MPM in patients with asymptomatic hydropneumothorax is essential for early diagnosis and appropriate management. Malignant pleural mesothelioma (MPM) is an aggressive tumor originating from the mesothelial cells lining the pleural cavity and is commonly associated with asbestos exposure . TypicalAn 86-year-old man with a history of hypertension presented to a local clinic with bilateral lower limb edema. Chest radiography revealed a suspected right-sided hydropneumothorax, which prompted a referral to our department. The patient exhibited a body temperature of 36.8°C, and their SpO2 in ambient air was 96%. Chest radiography revealed reduced translucency and a pneumothorax in the right lung field Figure . The echIntraoperatively, we observed thickening of the parietal pleura with plaque formation, whereas the visceral pleura appeared fragile, susceptible to damage, and prone to bleeding. Artificial lung inflation revealed several lung fistulas on the surface of the visceral pleura. The identified leakage sites were excised and covered with a polyglycolic acid sheet and fibrin glue Figure . PartialConsidering the patient's advanced age and their inability to tolerate highly invasive surgeries, such as extrapleural pneumonectomy, or aggressive cytotoxic chemotherapy, treatment with immune checkpoint inhibitors  was continued. To date, the patient remains alive and has maintained stability for eight months following treatment with ICIs.Malignant pleural mesothelioma is a challenging-to-treat tumor originating from the pleural mesothelial cells and is often associated with asbestos exposure . Since MFurthermore, despite the coexistence of pleural effusion and pneumothorax, the patient did not complain of dyspnea. Kono et al. reported a case of MPM with hydropneumothorax in which the patient remained asymptomatic and was diagnosed during a routine medical checkup. They speculated that the slow accumulation of pleural effusion might have contributed to the lack of respiratory distress awareness and that lung collapse due to preexisting pleural effusion could account for the absence of symptoms even when pneumothorax occurred . Our casMannes et al. described the pathogenesis of pneumothorax in MPM as the rupture of a necrotic tumor or disruption of the bra and brevis due to the tumor's obstruction of peripheral bronchi . AlthougInitially, when encountering hydropneumothorax, the differential diagnosis primarily focused on diseases involving lung parenchymal dysfunction, such as pneumonia, pulmonary tuberculosis, and lung cancer, rather than malignant pleural diseases. However, surgery was performed both for treating pneumothorax and for diagnostic purposes, leading to the identification of MPM. In cases of asymptomatic hydropneumothorax, the possibility of MPM should be considered, necessitating thorough investigations.This case report highlights a rare presentation of MPM as hydropneumothorax. Despite the presence of hydropneumothorax, the patient remained asymptomatic due to the preexisting pleural effusion and resultant lung collapse. Microscopic examination revealed tumor extension to the pleural surface, indicating MPM. Early diagnosis and comprehensive investigation of MPM are essential in cases of asymptomatic hydropneumothorax.


A 27-year-old male with insidious right arm swelling was diagnosed with a hematoma secondary to a partial biceps tear, later identified as a rhabdomyosarcoma. Soft tissue sarcomas (STS) may present with misleading patient histories and nonspecific symptoms, resulting in misdiagnosis and delayed treatment. One of the classic masqueraders of soft tissue sarcomas is hematomas secondary to trauma. Obtaining a prudent history with careful scrutiny of appropriate imaging often helps establish the correct diagnosis. Ultimately, tissue biopsy can resolve any ambiguous cases and prevent delays in diagnosis and treatment. Soft tissue sarcomas (STS) are mesenchymal-derived malignancies with varying clinical behavior, anatomic location, and histologic/molecular characteristics. These tumors are generally rare, accounting for less than 1% of all adult cancers and 7-10% of pediatric cancers [Previous reports of soft tissue sarcomas being misdiagnosed as hematomas -5 and viA 27-year-old male presented to the emergency department with right upper extremity swelling that had been waxing and waning. He stated that the swelling began after carrying heavy boxes during a move approximately one month prior. However, he denied any known trauma to his arm. The patient thought that he had sustained a bicep strain or had torn another muscle, but given the lack of ecchymosis, he did not seek medical attention. However, after a month of continued swelling, he presented for further evaluation. His primary concern was that his range of motion was becoming limited and he was having difficulty performing activities of daily living due to the tension in his arm. He denied pain or paresthesia. He worked in construction, was not on any medications, and denied any illicit drug use. On clinical examination, there was no ecchymosis present, and he had limited terminal elbow flexion. The involved brachium was appreciably larger than the contralateral side, but otherwise, there were no significant findings.He underwent an ultrasound examination Figure  and a coHe was first admitted by the general surgery service but discharged without an MRI evaluation. Due to the over-filled hospital capacity, the admitting team felt that the MRI could be obtained as an outpatient with routine follow-up in the orthopedic clinic. The following day, he was called back into the ER by the orthopedic surgery service, subsequently readmitted, and underwent an MRI evaluation Figure . The MRIHistological sections showed an overtly malignant pleomorphic, spindled, epithelioid, and rhabdoid sarcoma growing within an admixture of hyalinized stromal collagen and abundant extravasated blood. On medium-power evaluation, the tumor showed hyperchromatic and pleomorphic cells, with occasional multinucleated giant cells displaying variable nuclear-to-cytoplasmic ratios Figure . MitosesHis final diagnosis was stage III pleomorphic (adult-type) rhabdomyosarcoma. The patient underwent five cycles of neoadjuvant chemotherapy over the next two months with doxorubicin, ifosfamide, and sodium 2-mercaptoethane sulfonate (mesna). While on chemotherapy, however, the patient had continued enlargement of the tumor with fungating skin breakdown Figure , secondaSoft tissue sarcomas can present as insidious, benign masses and are often misdiagnosed as other masquerading conditions -15. In tThe first step in evaluation is obtaining a thorough patient history and physical examination. The mass history of when it was identified, if it is growing, and at what rate may provide an early clinical assumption. A small mass that has been present for years is likely benign, as opposed to a rapidly enlarging mass. The anatomic location , mass size, and palpable consistency (soft vs. firm) should be noted and correlated to the patient’s history. Generally, larger masses (>3 cm) that are deep in the fascia and/or enlarging in size warrant urgent advanced imaging evaluation. There is a general lack of experience in the evaluation of soft tissue masses among generalist providers with ambiguity in presentation. Fortunately, the Musculoskeletal Tumor Society (MSTS) recognizes these limitations and provides clinical practice guidelines on its website for public use and clinical decision assistance. They recommend that all soft tissue masses that are appreciably enlarging or are baseline larger than 5 cm have a significant likelihood of being malignant and should be promptly referred to a sarcoma specialist . They fuAdvanced imaging can often help differentiate between hematoma and STS; however, results may be inconclusive . MRI andIt is imperative that a biopsy be performed by a trained sarcoma specialist. There are significant potential morbidities ,20, and The confirmation of diagnoses by pathology may require a combination of modalities to examine the tissue. After obtaining an adequate biopsy specimen, evaluation of tumor morphology will guide the selection of subsequent ancillary testing . AncillaCase reports and series have demonstrated similar presentations to this article. Kontogeorgakos et al. performed a retrospective review of 15 patients who were initially diagnosed with hematomas and later diagnosed with STS  publisheDifferentiating a hematoma from a soft tissue sarcoma is appreciably difficult, with biopsy remaining the gold standard diagnostic modality. Advanced imaging using MRI with and without contrast should be obtained. Watchful waiting is appropriate in smaller (<5 cm) masses that do not continue to grow so long as the patient is adherent to interval follow-up appointments. Any growing soft tissue masses or those initially >5 cm in size should be promptly referred to a sarcoma specialist for diagnostic biopsy and definitive treatment.


Desmoplastic infantile tumors (DITs) are rare benign intracranial tumors in infants with benign biological behavior and rare malignant transformation characteristics. We present a DIT case that underwent malignant transformation and metastasis. A 6-year-old girl presented with DITs and underwent surgical resection. 12 years later, the tumor recurred and underwent surgical resection again. The pathology report confirmed the lesion to be a glioblastoma multiforme. She received adjuvant treatment. A year after the surgical operation of the lesions, she had intraspinal metastasis and underwent surgical resection again. Multiple spinal cord metastases were subsequently identified in the patient. The patient’s condition exhibited severe deterioration during the follow-up period. This case report focuses on the occurrence of DITs and their potential malignant transformation, as assessed through computed tomography and magnetic resonance imaging. The tumor is usually located on the surface of the brain. It mainly comprises cystic components with larger volumes and often involves multiple lobes, especially the frontal–parietal lobe. Although this tumor has malignant features on imaging, it was benign and classified as grade I by WHO , collect2A 6-year-old female patient complained of persistent headaches for 1 year and vomiting for 1 day. The brain computed tomography (CT) scan showed an irregular mass with distinct boundaries in the right thalamus, measuring 54 mm × 43 mm. This mass caused compression and deformation of the right lateral ventricle and the third ventricle, resulting in a shift of the midline structure to the left. Magnetic resonance imaging (MRI) of the brain revealed an irregular mass in the right thalamus, measuring 55 mm × 45 mm × 44 mm, with mixed signals and significant enhancement. Additionally, multiple cystic lesions and a liquid–liquid plane were observed. Immature teratoma or pineal blastoma was diagnosed on the image. Subsequently, she underwent a left temporo-occipital craniotomy with a near-total resection of the tumor. Postoperative pathological showed the mass as a DIG/DIA Figure 112 years later, she complained of head and neck pain for 2 weeks, vomiting for 2 days, and dizziness for 2 h. MRI results of the brain revealed some abnormal signals of the medial area of the right temporal lobe, right cerebral foot, cisterna annulus, cerebellopontine angle (CPA), and pontine arm. Tumor recurrence with apoplexy was considered. Subsequently, she underwent right CPA area approach tumor resection. The pathological diagnosis was glioblastoma , and metastasis was considered. Then, she underwent intraspinal tumor resection. Subsequently, an MRI of the cervical vertebra revealed multiple spinal cord spread. The patient’s condition was terrible with follow-up.3DIA was first reported by Taratuto et al.  in 1984.Primary glioblastoma is common, and secondary glioblastoma is rare in children. So far, a few literatures have reported malignant transformation of DITs in infants after tumor resection –13, and Differential diagnoses based on imaging include primitive neuroectodermal tumor (PNET), supratentorial ependymoma, ganglioglioma, and pleomorphic xanthoastrocytoma . PNET isSurgical complete resection is the preferred treatment for the benign biological manifestation of DITs, and the prognosis is usually good without radiotherapy and chemotherapy. Some tumors cannot be resected entirely due to their deep location, and the clinical efficacy of partial resections is poor. Such as our case, the tumor was located in the thalamus and cisterna annulus, the brain’s deep part. It is difficult to complete resection, and the patient underwent a left temporo-occipital craniotomy with a near-total resection of the tumor. 12 years later, the tumor underwent recurrence, malignant transformation, and metastasis. It has been reported that deep tumor location is a factor of increased mortality and an independent predictor of reduced time of tumor recurrence . TherefoIn conclusion, although DITs are benign tumors, their biological behavior is diverse, with recurrence, metastasis, and malignant transformation characteristics. Therefore, postoperative patients must follow up, especially those with deep tumor and partial tumor resection. Once the tumor progresses during follow-up, a second surgery is required and radiation and chemotherapy may be given optionally.The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding author.Written informed consent was obtained from the individual(s), and minor(s)’ legal guardian/next of kin, for the publication of any potentially identifiable images or data included in this article.YY: Resources, Writing – original draft, Investigation. BT: Data curation, Methodology, Writing – original draft. XC: Formal Analysis, Validation, Writing – review & editing. XL: Supervision, Writing – review & editing. SL: Supervision, Writing – review & editing.


Here, we report the occurrence of a malignant PEcoma in the colon using 18F-FDG PET/CT imaging showed a large hypermetabolic nodule and mass in the right mid-upper abdomen with heterogeneous density and a further increase in metabolism on the delayed scan.A 55-year-old woman was admitted to the hospital with abdominal pain for 10 days and a self-induced abdominal mass for 3 days. PEComa of the colon.Tumor resection was performed.The patient is well after 2 months of treatment, pending further follow-up.18F-FDG gastrointestinal malignancies. Additionally, 18F-FDG PET/CT may play a key role in the staging and extent of lesions in intestinal malignancies.Malignant perivascular epithelioid cell tumors originating in the colon are extremely rare, and our report suggests that PEComa should be considered as a differential diagnosis for  To date, this sporadic perivascular epithelioid cell tumor has been reported to occur in different anatomical locations, such as the lungs, uterus, bone, retroperitoneum, ovaries, and liver.–8 Most PEComas are benign, and malignant PEComas often show local recurrence, distant metastases, and poor prognosis.,10 Here, we report a rare case of a malignant PEComa in the colon on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT).The World Health Organization defines neoplasms with perivascular epithelioid cell differentiation (PEComa) as “a mesenchymal tumor comprising of histologically and immunohistochemically distinct perivascular epithelioid cells.” Typical PEComas include several solid types, such as vascular smooth muscle lipoma, lymphangioleiomyomatosis, and pulmonary clear cell “glycosarcoma.”A 55-year-old woman was admitted to the hospital with abdominal pain for 10 days and a self-induced abdominal mass for 3 days. The patient had abdominal pain, with no obvious cause 10 days prior, mainly in the right upper abdomen, with paroxysmal vague pain of variable duration, unrelated to body position and eating, with pain radiating to the lower back, accompanied by diarrhea and yellow dilute water, approximately 3 to 4 times/day. The patient abdomen was soft, with a slight bulge visible in the right upper abdomen. Abdominal breathing, no abdominal wall changes, and no intestinal pattern or intestinal peristaltic waves were observed. A tough mass of approximately 10 × 8 cm with fair borders was observed in the right upper middle abdomen, with mild localized pressure pain and no pressure or rebound pain. Laboratory tests showed glycogen 125:38.3 μ/mL, gamma-glutamyl transpeptidase 102 U/L, and alkaline phosphatase 223 U/L.18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) . PET/CT findings (Fig. The patient underwent a whole-body examination using  CT and magnetic resonance imaging examinations are not sensitive enough for the diagnosis and differentiation of benign and malignant PEComas owing to their nonspecific imaging features but can help detect suspicious lymphovascular invasion and metastatic lesions. 18F-FDG PET/CT is valuable in differentiating malignant from benign PEComas and detecting metastases.,13 FDG uptake values are usually not increased or are mildly increased in benign PEComas, whereas FDG uptake values are significantly increased in malignant PEComas and its metastases, with SUVmax up to 72.4. In this case, the main clinical manifestations were abdominal pain and weight loss. Abdominal pain may be caused by compression, embolism, or tumor bleeding. In this case, the lesion was mainly located in the right upper abdomen, poorly demarcated from the ascending colon, and the mass was growing outwards, and was large in size, with inhomogeneous density within it. Adjacent tissues were shifted by compression, and SUV uptake showed a heterogeneous increase, with SUVmax of 5.4 on the first scan of some lesions and a further increase of 7.7 on the delayed scan. This is consistent with the malignant tumor manifestations and pathological findings. A radiological defect at the center of the lesion might be associated with hemorrhagic necrosis.The main clinical manifestations of PEComas in the gastrointestinal tract are abdominal pain, black stools, rectal bleeding, obstruction, weight loss, anemia, and in some cases no symptoms, with abdominal pain being the most common clinical manifestation. Most PEComas appear as well-defined, uniformly dense masses on plain CT, which may have mixed internal density due to the presence of fat, necrotic cystic lesions, hemorrhage, and rarely, calcifications. In magnetic resonance imaging, lesions usually show low or isosignals on T1-weighted images and inhomogeneous high signals on T2-weighted images.In addition, this tumor should be differentiated from extragastric mesenchymal tumors, mesenteric lymphomas, peritoneal mesotheliomas, and other tumors on CT. Extragastric mesenchymal tumors are mostly solitary and large in size, most of which do not communicate with the intestine; the tumor border is clear and may be irregular in shape. Mesenteric lymphomas are primarily characterized by mesenteric lymph node involvement, with multiple enlarged mesenteric lymph nodes fusing to form irregularly shaped masses. Peritoneal mesotheliomas are diffuse in nature, showing irregular thickening of the peritoneum, greater omentum and mesentery in the form of “omental pancake,” mostly as a cystic solid mass. However, some tumors are difficult to identify using imaging and often require pathology and immunohistochemistry to confirm the diagnosis.18F-FDG PET/CT findings of the colon. 18F-FDG PET/CT is valuable in determining the malignancy of PEComas.In conclusion, this is a rare report of Conceptualization: Peiqi Wang.Investigation: Peiqi Wang, Xiao Zhang.Writing – original draft: Qianqian Chen, Xiao Zhang.Writing – review & editing: Jinhe Zhang.


Neural tube defects are a group of birth defects that affect the development of the spinal cord and brain. Myelomeningocele is a type of neural tube defect that results in the protrusion of the spinal cord and meninges through a defect in the vertebral column. While myelomeningocele is a relatively rare condition, cervical myelomeningocele is extremely uncommon. The condition can lead to various neurological problems and atrophies and is typically diagnosed in the first trimester of pregnancy using an ultrasound examination. Surgical intervention is typically recommended to repair the affected vertebral column. In this report, we describe the case of a four-month-old baby boy who was diagnosed with a cervical myelocystocele and successfully treated surgically. The patient had an excellent postoperative status, and this case highlights the importance of early diagnosis and intervention in the management of this rare condition. Neural tube defects are a type of birth defect that include cranial conditions and open or firm spinal dysraphism . They arAt the primary phase of gastrulation, the neural plate is formed, which unfolds when the endoderm and the ectoderm complete the embryonic bilaminar circle and are then displaced, forming the mesoderm. Finally, the notochord with the ectoderm organizes the neuroectoderm. Spina bifida is a neural tube defect that occurs when the spinal column doesn't close properly during fetal development. It can present in different types, including spina bifida occulta, which is often asymptomatic, and myelomeningocele, which is the most severe form. If only the meninges herniate, it is called spina bifida cystica, while neural tissue devoid of any meningeal or skin covering is myeloschisis. Failure of the rostral neuropore to close leads to anencephaly .Myelomeningioceles cause different neurological problems and various atrophies. Neurogenic bladder in children results from myelomeningocele. Patients may have paraplegia, sphincter disease, and sexual abnormalities with cardiotonic, nephritic, and pulmonary complications, reducing the survival rate ,7. ChildMyelomeningocele is identified in the first trimester of gestation. For at-risk patients, amniocentesis is recommended . UltrasoSurgical intervention of the affected vertebral column is recommended . PrenataThis report presents the case of a four-month-old male baby boy who was referred to the neurological surgery department for a posterior cervical mass that was ultimately treated surgically and diagnosed as a cervical myelocystocele.Our patient was a four-month-old baby boy born with a small posterior cervical mass. The volume of the cervical mass kept increasing. The baby was playful and showed normal growth for his age with normal upper and lower limb, urinary, and gastrointestinal activity. The parents were concerned about the increase in the volume of the mass. No previous prenatal or postnatal examination was made. The baby was born in a rural hospital, and the parents refused medical intervention at his birth.Physical examination revealed a pedunculated, egg-shaped mass connected by a stalk on top of the posterior cervical midline. The mass was enveloped by friable, purple-colored skin. The mass was compressible, moveable, warm to the touch, and translucent Figure . The patA cranial and cervical magnetic resonance imaging (MRI) with gadolinium revealed a pedunculated sac-like mass resembling a myelomeningocele at the level of the second cervical vertebra. Details of the MRI are depicted in Figure The patient was scheduled for surgery. Under general anesthesia and in the prone position, the mass was thoroughly opened to identify neural tissue. None were identified. The dural layer was closed in a water-tight fashion. The skin was sutured using 5-0 Vicryl and 5-0 nylon interrupted sutures Figure .Physical examination after surgery revealed normal upper and lower urinary and gastrointestinal activity. The specimen was sent to the pathology laboratory, which reported meningeal and skin samples devoid of any neural tissue.Valeur et al. reported on the extreme rarity of cystic dysraphism of the cervical and upper thoracic spine and the better prognosis versus lumbosacral dysraphism given the lack of functional neurological tissue in the dysraphic sac . ClassifOur case report adheres to the definition by Maclone et al. . AccordiMyelocystoceles are rare types of neural tube defects that involve the protrusion of the spinal cord and meninges through a defect in the vertebral column . These dCranial and cervical MRIs are indispensable in diagnosis and surgical planning . Mainly,We have presented a rare case of cervical myelocystocele and reviewed the classifications of this condition within the literature. Early diagnosis and surgical intervention are crucial for the successful management of this rare condition, as it can lead to various neurological problems and complications such as tethered cord syndrome and hydrocephalus. Our case report highlights the importance of increased awareness and surveillance for myelomeningocele, particularly the rare cervical subtype. Overall, this report underscores the need for continued research to improve the prevention, diagnosis, and treatment of myelocystocele and other types of neural tube defects.


Acquired haemophilia-A, although uncommon in elderly patients, poses significant clinical challenges, especially when associated with profound musculoskeletal complications. The potential mimicry of hematomas as tumors further complicates the diagnostic process.An 85-year-old male, with a remote history of hypertension, benign prostatic hyperplasia, and right inguinal hernia, presented with acute pain in the left lower limb, functional limitation, and deep hematomas in the ileopsoas and axillary region. Initial suspicions of a sarcomatous lesion in the ileopsoas, based on radiological findings, were refuted following histopathological examinations, which confirmed the presence of necrotic hemorrhagic tissue. The patient underwent a one-month physical therapy regimen, targeting lower extremity muscles, especially around the hip joint.The severity of the presentation and the involvement of vital muscles like the ileopsoas and quadriceps underscored the importance of comprehensive rehabilitation. Consistent therapeutic interventions, targeting muscle strength and joint function, demonstrated marked improvement as evidenced by the HJHS, HAL, and FISH scores. The multidisciplinary approach, entailing hematological, rehabilitative, and supportive measures, was paramount in ensuring holistic patient recovery.Acquired haemophilia-A in the elderly necessitates an integrative care approach, encompassing accurate diagnosis and tailored therapeutic interventions. This case emphasizes the transformative potential of dedicated physiotherapy in managing the musculoskeletal implications of this bleeding disorder, underscoring the value of early intervention and comprehensive care. •Elderly patient with Acquired Haemophilia-A: a diagnostic challenge.•Ileopsoas hematoma: An uncommon complication of haemophilia.•MRI & TC imaging essential for diagnosis and treatment planning.•Focused physiotherapy regimen aids in functional recovery.•Rehabilitation critical for independence and quality of life in elderly. Traditionally identified as a condition manifesting from birth, haemophilia A emerges through an X-linked inheritance pattern, affecting approximately 1 in 5000 male births .The typi2An 85-year-old patient, living with his wife, was functionally independent before being diagnosed with acute acquired haemophilia A. He was complicated by deep hematomas in the right axillary cavity and the left ileopsoas muscle, both cutaneous and subcutaneous. The hematoma of the ileopsoas on the axial plane measured 10 × 7 cm at the time of hospital admission, which reduced to 9 × 5 cm at discharge. Remote medical history includes systemic arterial hypertension, benign prostatic hyperplasia, and a right inguinal hernia. Recent medical history: the patient reported lumbar pain extending to the left leg and upon recommendation from a Physical Medicine and Rehabilitation specialist, he began treatment with anti-inflammatory and intramuscular steroids, suspecting lumbar sciatica. A week later, he was hospitalized due to worsening pain symptoms associated with numbness on the anterior thigh surface and resulting functional limitations. He also reported hematomas on the left thigh and beneath the right axillary cavity. Several instrumental investigations, including lumbosacral Magnetic Resonance Imaging (MRI) and a total body Tomography Computed (TC) scan, were conducted. The CT scan of the patient revealed a well-circumscribed, non-enhancing lesion in the left ileopsoas region, consistent with a hematoma. The dimensions were suggestive of its considerable size, pressing against adjacent structures and likely contributing to the patient's pain and mobility limitations. These findings were instrumental in ruling out other differential diagnoses, particularly given the initial suspicion of a sarcomatous lesion compromising vascular and nerve structures. Additionally, a large right subfascial hematoma was identified without signs of active bleeding. Histopathological examinations were subsequently conducted with excisional biopsy, showing no neoplastic lesions but multiple fragments of necrotic hemorrhagic tissue. Further diagnostic refinement found a complete absence of factor VIII. After seven days of specific therapy (factor VIII), he required high-dose, long-term steroid therapy and was also advised to take vitamin D. During hospitalization, he underwent physiotherapy to regain ambulation. At discharge, he was using a 2-wheel walker with crutches and required caregiver assistance. He was evaluated at home the day after discharge. A general pain scale administered showed an Numeric Pain Rating Scale (NPRS) , and Fun3•Subjective Reports:•Lumbar pain extending to the left leg•Numbness on the anterior thigh surface•Functional limitations in mobility•Pain at the left hip joint (NPRS 2/10)•Physical Examination:•Hematomas: Observed on the left thigh and beneath the right axillary cavity.•oPassive mobility maintained in all joint planes and foci.oActive mobility limited in the left limb, with flexion-extension deficits from a supine position. Inability to flex the left hip against gravity with an extended knee without assistance.Mobility:•Strength: Deficient in the area innervated by the left femoral nerve (MRC 2/5) for the ileopsoas muscle and femoral quadriceps.•Sensitivity: Tactile and kinesthetic sensitivity preserved.•Station: Upright position maintained with significant aid; requires walker for hand support and assistance for walking.•Instrumental Investigations:•Lumbosacral MRI and Total Body TC: Suspected sarcomatous lesion in the left ileopsoas, compromising vascular and nerve structures. Voluminous right subfascial hematoma without signs of active bleeding observed.•Histopathological Examination: Absence of neoplastic lesions; presence of multiple fragments of necrotic hemorrhagic tissue.•Coagulation Factors Assay: Complete absence of factor VIII detectedThe HJHS score is a tool specifically designed to assess joint health in people with haemophilia. Joint bleeds are a common complication in people with haemophilia, and over time, repeated bleeds can lead to joint damage, pain, and decreased function. The HJHS was developed to provide a standardized and objective way to assess and monitor joint health in this population.The HAL is a self-report questionnaire developed to measure health-related functional status specifically in adult patients with haemophilia. The questionnaire takes into consideration the physical limitations and social issues that are unique to this patient group. It is an essential tool for gauging how haemophilia impacts the daily life of patients, and its outcomes are useful for both clinical and research purposes.The FISH is a performance-based tool developed to assess functional independence in daily activities specifically for people with haemophilia. Unlike some self-reported measures, FISH evaluates actual performance in certain tasks. It provides insights into how haemophilia and its associated complications impact a person's functional ability in daily life.3.1Active Exercise Regimen:1.Tibio-tarsal Flexion and Extension (while lying supine)oDuration: 4 minoRecovery: 1 min2.Hip Flexion/Extension oDuration: 4 minoRecovery: 1 min3.Hip Flexion oDuration: 4 minoRecovery: 1 min4.Hip Abduction and Return oDuration: 4 minoRecovery: 1 min5.Bridge Exercise (hip lift while lying supine)oDuration: 4 minoRecovery: 1 min6.Abdominals (bringing knee to chest while lying supine)oDuration: 4 minoRecovery: 1 min7.Knee Flexion and Extension (while sitting)oDuration: 4 minoRecovery: 1 min8.Sit to Stand (repeatedly rising from and sitting down on a chair)oDuration: 4 minoRecovery: 1 min9.Alternating Forward and Backward Stepping (in an upright/orthostatic position)oDuration: 4 minoRecovery: 1 min10.Walking with a 4-wheeled walkeroDuration: 4 minThis exercise regimen should be performed at least once daily for a span of one month .4After One Month of Treatment:•Pain Assessment:oNumerical Pain Rating Scale (NPRS) for the left hip: 0/10 - Indicating no reported pain related to the left hip.•Muscle Strength Assessment:oMedical Research Council (MRC) scale for the left ileopsoas: Scored 3 - Indicating moderate muscle strength.oMRC scale for the left quadriceps: Scored 4 - Indicating good muscle strength, just below normal.•Functional and Activity Measures:oHaemophilia Joint Health Score (HJHS): 5/124 - Demonstrating a substantial improvement in joint health and function.oHaemophilia Activity List (HAL): 75/100 - Indicating an improved ability to perform daily activities.oFunctional Independence Score for Haemophilia (FISH): 22/32 - Reflecting better functional independence in daily tasks.•Clinical Observations:oSignificant reduction in all hematomas.oThe patient can walk within a domestic environment without the support of walking aids such as a walker.5Haemophilia-A is a renowned congenital bleeding disorder, but its acquired variant is less frequently seen, especially in the elderly . The pecThe deep hematomas, particularly that of the ileopsoas region measuring 10 × 7 cm at admission and reducing to 9 × 5 cm at discharge, presented a unique set of challenges. Their presence accounted for the patient's pain and limited mobility. These hematomas also introduced diagnostic dilemmas, manifested by the initial sarcomatous lesion suspicion in the ileopsoas. Hematomas in those with bleeding disorders can clinically and radiologically mimic tumors, underscoring a meticulous differential diagnosis.Given the patient's total absence of factor VIII , surgicaConsidering the bleeding risks of any surgical procedure in a hemophilic patient, physiotherapy emerged as a safer, less invasive approach compared to surgical drainage ,19. BefoThe introduction of a tailored physiotherapy regimen, beyond basic physiotherapy, was essential. It focused not just on mobility but primarily on muscle strength enhancement, especially of the ileopsoas and quadriceps. The progress in MRC scores and the positive shifts in HJHS, HAL, and FISH scores confirmed this approach's efficacy.A follow-up MRI is scheduled two months post-discharge to evaluate hematoma resolution further, and the findings will be pivotal for future action planning.In conclusion, this case accentuates the need for early recognition, precise diagnosis, and comprehensive management for acquired haemophilia-A in non-traditional demographics. The symbiosis of tailored physiotherapy with medical interventions can significantly bolster quality of life and functional independence. Future research involving more extensive cohorts could solidify best practices for such challenging presentations.Ethical approval is not a requirement at our institution for reporting individual cases or case series.Authors state no funding involved.RT contributed to conception and design of the study; RT to data acquisition, RT to data analysis and interpretation; RT contributed to draft the manuscript; RT contributed to the critical revision for important intellectual content. All authors read and approved the final version of the manuscript.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.Roberto Tedeschi.None.Informed consent has been obtained from all individuals included in this study.Authors state no conflict of interest.


Angiosarcoma, also known as malignant hemangioendothelioma, is a rare vasogenic malignant tumor, commonly found on the skin of the head and neck, rarely occurring in the intracranial region. As for intracranial meningeal angiosarcoma, only 8 cases have been reported before and there is no clinical study with large sample size. We report here a case of parasagittal meningeal angiosarcoma.A 48-year-old Chinese male patient was admitted to our hospital due to headache accompanied by bilateral lower limb weakness. On admission, CT showed a high-density mass on both sides of the sagittal sinus at the top of the frontal lobe. We performed exploratory surgical resection of the tumor. During the operation, it was found that the tumor originated from the dura mater and extensively invaded the surrounding brain tissue and skull, and the surrounding hemosiderin deposition was observed. Postoperative pathology suggested angiosarcoma.Intracranial meningeal angiosarcoma is difficult to accurately diagnose before surgery, so radiologists and neurosurgeons need to strengthen their understanding of this disease. The presence of extensive superficial hemosiderin deposition during operation may contribute to the diagnosis, and immunohistochemistry is very important for the diagnosis of intracranial angiosarcoma. Angiosarcoma is a highly malignant tumor originating in vascular endothelial cells, accounting for approximately 1% of all sarcomas, can occur in any part of the body, most commonly in the head and neck, and usually has a poor prognosis . At presA 48-year-old Chinese male patient was admitted to our hospital with headache and bilateral lower limb weakness for 1 month. He had no previous history of specific diseases, no family history of diseases, and no history of radiation exposure. On admission, CT scan of the head revealed uneven high-density mass at bilateral frontal parietal lobe. The T1—and T2-weighted images of the head MRI showed mixed and uneven mass signals with insignificant surrounding edema. MRI enhancement showed uneven and obvious enhancement of the lesion, involving bilateral parasagittal dura and sagittal sinus, and local brain tissue compression . Primary meningeal angiosarcoma is very rare. At present, only 8 cases of primary meningeal angiosarcoma have been reported  hemorrhage in the subarachnoid space , 11. ThiThe histopathological feature of this case is angiosarcoma, with pleomorphic spindle cells and epithelial cells organizing into abnormal new vessels. In poorly differentiated tumors, endothelial lineages must be determined by immunohistochemistry . angiosaThe imaging appearance of intracranial angiosarcoma depends on the extent of intratumor hemorrhage . Common The tumor in this case is closely related to the meninges and is easily misdiagnosed as haemangiopericytoma before surgery. The CT scan of haemangiopericytoma usually shows slightly higher density and no calcification within the lesion. The MRI imaging of haemangiopericytoma is complex, with equal or low signal intensity on T1WI and mixed signal intensity on T2WI. The tumor area of meningeal hemangiopericytoma has abundant blood supply, and some can see vascular flow void signals; The enhanced MRI scan showed significant uneven enhancement of the tumor, with no significant enhancement of necrotic cystic lesions within it . In addiRegarding the treatment of intracranial angiosarcoma, all the previously published literatures are retrospective case reports without evidence based on clinical trials. Total resection is generally recommended for primary and metastatic CNS angiosarcomas , 18. Adj2·d) and bevacizumab (10 mg/kg) for 2 weeks, and given temozolomide and bevacizumab for maintenance treatment [In addition, chemotherapy is a common treatment. However, the effectiveness of chemotherapy is generally poor, which makes chemotherapy only play a role of palliative treatment . PaclitaPrognosis of intracranial angiosarcoma varies greatly among individuals, with some reports of long-term survivals . CharactWe report a rare case of primary intracranial parasagittal meningeal angiosarcoma and describe its clinical presentation, imaging features, and clinical course. Although accurate preoperative diagnosis is difficult, radiologists and neurosurgeons need to be aware of this rare tumor. The presence of extensive superficial hemosiderin deposition during surgery may be helpful in diagnosis, and immunohistochemistry is very important for the diagnosis of the tumor.


Intraligamental leiomyomas of the uterus are rare. Extremely rare are the huge intraligamental fibroids (>20 cm), whose pre-operative diagnosis and surgical management poses a challenge to everyday clinical practice. The present study describes the case of patient who was subjected to surgical treatment for a huge intraligamental leiomyoma of the uterus, which weighed 3,370 g. A 48-year-old patient, without menstrual disorders and with a medical history of atypical symptoms from the digestive tract, was referred for a gynecological examination. Upon a physical examination, the abdomen was found to be bloated and distended, with no signs of peritoneal irritation. An intra-abdominal mass was suspected, the upper margin of which was palpable at about the level of the xiphoid process. The findings of computed tomography and magnetic resonance imaging confirmed the presence of a huge intra-abdominal mass, which probably originated from the internal genital organs. Following consultation with the patient, surgical treatment with laparotomy was decided. Intraoperatively, a large pedunculated subserosal leiomyoma was found, arising from the right lateral wall of the uterus with retroperitoneal extension within the leaves of broad ligament. Following the resection of the intraligamental leiomyoma, which had significant surgical challenges, a total hysterectomy with bilateral adnexectomy was performed. The post-operative course was smooth. In addition, in the present study, a brief review of intraligamental leiomyomas of the uterus is presented, emphasizing the significant diagnostic and surgical challenges and potential intraoperative complications that may arise in the management of patients with this condition. The term fibroid was first introduced into everyday clinical practice in the 1860s. Fibroids or leiomyomas are benign neoplasms that grow on the uterine wall in women of reproductive age and are currently the most common gynecological tumors worldwide . Among tIntraligamental leiomyomas are pedunculated tumors, which originate from the lateral wall of the uterus corpus and grow within the broad ligaments. Intraligamental leiomyomas are rare. They are estimated to account for 6 to 10% of all uterine fibroids . Huge inThe present study describes the case of patient who was subjected to surgical treatment for a huge intraligamental leiomyoma of the uterus. It is pointed out that, despite the rarity of the nosological entity concerning tumors >3 kg and the serious difficulties in differential diagnosis it presents from other intra-abdominal tumors, the adequate pre-operative preparation of the patient is considered necessary in order to ensure the optimal intraoperative and post-operative outcomes. At the same time, the significant surgical challenges and potential intraoperative complications that may arise in the treatment of huge intraligamental leiomyomas of uterus are highlighted.The present study describes the case of a 48-year-old patient, who visited the Gynecological Outpatient Clinic of the General Hospital of Trikala  for an examination. The patient presented an abdominal ultrasound, which was performed upon the recommendation of the general practitioner. To the family physician, the patient complained of abdominal distension with atypical abdominal pain, dyspepsia and anorexia. Ultrasound imaging revealed the presence of a space-occupying lesion of mixed echogenicity and an enormous size, which occupied most of the peritoneal cavity and was most likely originating from the right ovary. Furthermore, after obtaining a comprehensive medical history, it was revealed that the aforementioned symptoms first appeared ~20 months ago, during which time the patient had not requested medical care until she visited her family physician. In addition, from her personal medical history, hypothyroidism was reported, although it was well regulated with medication. Her menstrual cycle was normal. The patient had given birth to a child by vaginal delivery 15 years prior.Upon a physical examination, the abdomen was found to be bloated and rigid, with no signs of peritoneal irritation. The upper margins of the tumor were palpable at approximately the level of the xiphoid process. A Visual inspection of the cervix was difficult due to its displacement by the intra-abdominal mass. The transvaginal ultrasound was not diagnostic. A computed tomography scan revealed the presence of a large mass (28.5x23x11 cm), with well-defined margins, which occupied most of the peritoneal cavity and probably of adnexal origin. The intra-abdominal mass had a multilobulated shape and was of mixed consistency, with marked post-contrast enhancement of solid elements . The fin™ Dewax solution,100% alcohol, BOND™ wash solution; ii) antigen retrieval: for CD10, BOND™ Epitope Retrieval ER2 Solution, HIER, was used for 20 min at 100˚C, while for smooth muscle actin (SMA), estrogen receptor (ER) and Ki67 antibodies used ER1 solution (pH 7) for 20 min; iii) the block peroxide kit (BOND) was used for 5 min; iv) only for CD10 antibody: Protein block solution was used for 20 min; v) primary antibody: dilution for CD10 (MENARINI) ready-to-use antibody (cat. no. 44 217 CD10 RTU), SMA (ZYTOMED) ready-to-use (cat. no. 1A4 A00002-IFU-IVD-0002), ER (DAKO) 1:40 (cat. no. M3643), Ki67 (Skytec) 1:150 for duration 30 min , and post primary kit for duration 10 min at an incubation temperature of 100˚C; vi) secondary detection kit polymer for duration 10 min (no secondary antibodies were used herein); vii) DAB kit for duration 10 min, visualization; viii) counterstain: hematoxylin kit for duration 5 min at room temperature; ix) dehydration, mount section. The study of the slides was carried out using an optical microscope . The following results were obtained: Ki67, 7%; SMA (+), weakly positive for ER, and negative for CD10  and the proper pre-operative, intraoperative and post-operative management of these patients is critical for an optimal surgical outcome and for the prevention of potential intraoperative complications. Intraoperative hemorrhage is a common complication, which may be more prevalent during laparoscopic myomectomy, compared to myomectomy by laparotomy ,5. Recenet al  demonstret al .Additionally, the scientific competence and skills of the surgical team that will be called to treat patients with large intraligamental fibroids are among the necessary requirements for the safe and successful outcome of myomectomy or hysterectomy with larapotomy or laparoscopy . In the In conclusion, huge intraligamental fibroids of the uterus  are extremely rare. A pre-operative diagnosis is difficult. Surgical treatment (myomectomy or hysterectomy) is challenging and requires well-organized medical centers and an experienced surgical team. The supplementary ligation of the suspensory ligament, in combination with the established ligation of the round ligament as a typical procedure for access to the retroperitoneal space, is estimated to further facilitate the resection of intraligamental fibroid and can greatly contribute to an optimal surgical outcome. However, it requires the resection of the ipsilateral ovary and for this reason, it should be avoided in patients who wish to preserve fertility and achieve future pregnancy. Finally, the present study highlights that the use of an electrothermal bipolar vessel sealing device appears to greatly contribute to reducing the risk of intraoperative blood loss.


Left atrial appendage aneurysm (LAAA) is an extremely rare congenital heart abnormality, with varying degrees of symptoms, ranging from asymptomatic to arrhythmia, thromboembolic event or airway obstruction. Most infantile cases were incidentally found by echocardiography. Contrast-enhanced chest tomography can confirm the diagnosis and inform surgical plan. We describe an asymptomatic young female infant who had a unique extreme cardiomegaly on a chest x-ray and received surgical aneurysmectomy. Her heart was restored to a normal cardiac size after the heart surgery. When significant cardiomegaly is observed on chest radiography in young infants, several potential etiologies may be considered, including the extremely rare left atrial appendage aneurysm (LAAA) . LAAA isP wave axis with right axis deviation and absent R wave progression in the precordial leads were noted in the preoperative electrocardiography, which may be a clue for dextroposition of the heart. The surgical approach involved a median sternotomy and a cardiopulmonary bypass, without hypothermia. The left atrial appendage was opened, and the contained blood was aspirated, causing the aneurysm to deflate. The LAAA was then resected through the opening. The lymph node over the neck was removed. The surgery was successful without any complications. The patient was discharged 7 days after the heart surgery. The pathology of the aneurysm revealed a 3.5 cm × 2.0 cm × 1.0 cm cystic mass containing fibrous and smooth muscle tissue  vaccine after birth. At approximately 1.5 months of age, the presence of a neck mass prompted a visit to the pediatric outpatient department. The chest x-ray incidentally revealed significant cardiac enlargement . Physicae tissue . A post-e tissue . The patLAAA in infants pose unique challenges in terms of diagnosis and management. In contrast to adult LAAA case, which may be presented with greatly enlarged left heart border in chest x-ray . Our babWhile the exact etiology of LAAA remains unclear, congenital dysplasia of the musculi pectinati is believed to play a significant role . DiagnosThis case highlights the rarity of LAAAs in infants and emphasizes the importance of a multidisciplinary approach involving pediatric cardiology, radiology, and cardiothoracic surgery in the diagnosis and management. Early identification and timely surgical intervention are crucial in preventing potential complications associated with LAAAs, particularly in young infants. Further research is needed to understand the underlying etiology and long-term outcomes of this condition in the pediatric population.


Subchondroplasty is a novel and minimally invasive technique used to treat large subchondral talar cysts. It avoids soft tissue scarring, the need for osteotomies, bone grafting and its associated complications as seen with conventional approaches. Subchondroplasty involves arthroscopically approaching the cyst and injecting it with calcium phosphate paste injection, which undergoes an endothermic process and crystallizes in a manner that resembles cancellous bone to fill the defect. This case series presents two patients who underwent subchondroplasty: a 44-year-old female nurse with atraumatic right ankle pain of 2 years with a CT scan revealing a large subchondral cyst over the medial talar dome and a 55-year-old male chemical plant worker with left ankle pain following a biking accident 6 years ago whose CT scan too showed a large subchondral cyst in the medial talus. Both tolerated the surgery well, with significant reductions noted in MOXFQ scores at the 1-year follow-up. Subchondral talar cysts are osteochondral defects in the talus and are a source of chronic ankle pain . These l2) [Surgical treatment of these lesions depends on the lesion’s stage, location and size. Conventional open surgical techniques carry approach-related morbidity, and arthroscopic techniques are restricted to repairing small lesions (i.e. those <150 mm2) .2) of the talus with calcium phosphate injection leading to good clinical patient outcomes.Here, we present a novel arthroscopic technique for managing large subchondral cysts , to treat large subchondral cysts, which avoided the aforementioned complications. Furthermore, patients reported little to no pain post-operatively and returned home on the same day of the procedure.These outcomes were possible because of the availability of injectable calcium phosphate mineral compound, which crystallizes and hardens quickly in an endothermic reaction at 37 degrees Celsius to form nanocrystalline microporous scaffolds. These compounds are engineered mineral compound bone graft substitutes that mimic cancellous bone properties. They are eventually resorbed and replaced with new bone during the healing process through cell-mediated remodelling , 7. Thiset al., the authors used Calcium phosphate paste to fill a bone defect in a total knee arthroplasty procedure and noted the material’s stiffness as 80 Mpa after 10 days. Their patients could bear weight on the operated knee 10 days after surgery [In the study conducted by Sato  surgery . We adviet al. [Our patients reported complete resolution of symptoms following the procedure with significant reduction in MOXFQ scores. We observed no evidence of avascular necrosis in the most recent imaging of either patient. Similarly, Rona W. Law et al.  recordedThis study presented a novel arthroscopic treatment strategy for large subchondral talar cysts in a case series. This approach is minimally invasive and guided by fluoroscopy to fill the sub-chondral cyst with calcium phosphate paste to confer structural support and prevent articular surface collapse. Our patients reported complete resolution of all symptoms at a recent clinic follow-up.None declared.rohan7@doctors.net.uk.The data that support the findings of this case report are available upon reasonable request to the corresponding author. All required links or identifiers for the data are present in the manuscript as described. Any requests for data should be directed to the corresponding author at


Plasmacytomas are a rare spectrum of plasma cell neoplasms that are single localized tumours, lacking the clinical features of plasma cell myeloma with no radiographical evidence of additional plasma cell tumours. Two clinical variants of plasmacytomas can be distinguished: solitary plasmacytoma of bone and extramedullary (or extraosseous) plasmacytoma. The latter is rare, representing 1% of all plasma cell neoplasms, occurring most frequently in the upper airways. Ovarian localization is exceptional, with only a few cases being reported in the literature. We herein report a case of an ovarian extramedullary plasmacytoma occurring in a 56-year-old woman who consulted for abdominal pain and abdominal mass, while highlighting the main histological and immunohistochemical features of this rare malignancy, along with a thorough review of literature gathering all cases of ovarian plasmacytomas reported to date. Extramedullary plasmacytomas are a group of neoplasms resulting from the clonal expansion of mature plasma cells, located in tissues other than bone. They represent 1% of plasma cell neoplasms and occur most often in the upper airways. Ovarian plasmacytomas are an exceptional presentation, with only rare cases reported in the literature. We herein present a case of ovarian plasmacytoma, while highlighting the main histological and immunohistochemical features along with a thorough review of literature, regarding presentation and diagnostic workup.Patient information: a 56-year-old woman with a history of breast neoplasia for which she had a mastectomy, consulted for abdominal pain.Clinical findings: physical examination revealed abdominal tenderness and an abdominal mass.Timeline of the current episode: on October 2021, an abdominal-pelvic computed tomography (CT) scan was performed revealing a right ovarian mass, along with a normal biological workup. A few days after, the patient underwent a right adnexectomy.Diagnostic assessment: the abdominal-pelvic CT scan revealed a right ovarian mass, displaying a prevailing cystic component and a solid component enhanced after injection of contrast agent  plasmacytoma . ExtrameThe age of presentation is quite variable, ranging from 30 to 84 years old, with a mean age of 46 years. Only one case affecting a 12-year-old child was described . ClinicaOvarian plasmacytoma generally presents as a mass with a smooth outer surface, usually with a thick capsule, which may focally be calcified. At incision, the ovarian parenchyma can be partially or completely replaced by a lobulated solid mass of soft consistency, ranging in colors from tan to yellow, to white or gray, brown. It can also be exclusively cystic with thick walls, or have a dual component, with both solid and cystic areas. Hemorrhagic, necrotic, and myxoid areas may also occur . In our The histological appearance of the tumoral proliferation was broadly consistent in all cases reported in literature, with tumor cells displaying a plasmacytoid morphology with an eccentric nucleus and abundant cytoplasm. The main issue remains to think of a plasmacytoma at first glance. Since ovarian localization of this tumor is relatively rare, pathologists may be reluctant to make this diagnosis based on morphology alone and would be more tempted to rule out the most common diagnoses first, such as a granulosa tumor. Therefore, the definitive diagnosis of ovarian plasmacytoma has always been made after immunochemistry, along with a correlation of clinical, radiological, and biological findings.Plasma cell differentiation can be evaluated by the expression of CD138, CD38, CD79a and MUM1. A further characteristic is the strong expression of restricted cytoplasmic light chains (kappa or lambda) in almost all cases, which can be useful in distinguishing a monotypic plasmacytoma from polytypic reactive plasma cell infiltrates. Usually, mature neoplastic plasma cells will not express pan-B-cell markers, such as CD20, PAX5. However, CD20 can be expressed in 20% of plasma cell myeloma, and Cyclin D1 is positive in cases that harbors t  and in some case with hyperdiploidy . Unlike Since extramedullary plasmacytomas share with multiple myeloma the same morphological appearance of the tumor cells, and their immunohistochemical profile is relatively similar, the distinction requires a variety of additional clinical, biological, and radiological arguments. Diagnostic criteria for extramedullary plasmacytoma include histologic confirmation of plasma cell proliferation, bone marrow plasmacytosis of less than 5% on bone marrow biopsy specimens, the absence of clinical features of multiple myeloma, and normal bone imaging . The disExtramedullary plasmacytomas in the ovary remain rare but possible neoplasms, justifying a meticulous morphological examination in the quest for plasmacytoid differentiation, particularly when confronted with a monomorphic tumoral proliferation with eccentric nuclei. The incorporation of plasma cell markers along with the immunoglobulin light chain in the immunohistochemistry panel for such ovarian proliferations can be of great help in challenging cases. It is of utmost importance to eliminate bone marrow plasmacytosis and bone involvement that may be part of multiple myeloma, given the therapeutic and prognostic disparity implied.


Direct communication between dysmorphic arteries and veins without an interceding capillary segment is known as arteriovenous malformation (AVM). Its etiology is still unknown; however, it is commonly acknowledged that it could be related to trauma or is congenital in origin. Often, AVMs are found in the central nervous system or other sites such as under the skin or in the deep solid organs. They can be encountered as a solitary abnormality or associated with another pathology. If they are large enough, they can deprive the neighboring tissue of oxygen, eventually leading to tissue damage and compressing the surrounding organs, causing potentially more serious consequences. AVM in parathyroid adenoma is an unusual entity in the medical reports and known clinical practice. We herein report a unique case of a 49-year-old female patient who presented with a neck mass and associated symptoms of hyperparathyroidism (HPT) with no history of previous trauma or surgery. The imaging and laboratory tests were consistent with parathyroid neoplasm. Parathyroidectomy was performed and revealed parathyroid adenoma with AVM. Parathyroid adenomas are usually functional and manifest clinically with hypercalcemia; however, they may be detected as a non-functional lesion . They arWe report a case of a 49-year-old woman who presented with symptoms of hyperparathyroidism (HPT) and a neck mass. The patient’s technetium (99mTc) sestamibi report showed uptake of the right inferior parathyroid. Her blood work revealed elevated parathyroid hormone (PTH) of 36.7 pmol/L, high total calcium of 2.55 mmol/L, and ionized calcium of 1.49 mmol/L. The patient had a normal thyroid-stimulating hormone (TSH) of 2.15 mIU/L and a low vitamin D level of 36.7 nmol/L. The CT scan of the neck showed an ovoid right inferior parathyroid mass measuring 2.2 x 1.0 x 0.8 cm just inferior to the right thyroid lobe at the neck base, extending caudally to the level of the jugulum. The mass demonstrated central cystic changes. The CT scan did not reveal cervical lymphadenopathy or lytic or sclerotic bony lesions. Overall, this was compatible with a right inferior parathyroid adenoma. Subsequently, the patient underwent a parathyroidectomy of her enlarged left inferior parathyroid adenoma. Postoperatively, the patient’s calcium was normal, and her PTH lowered to 6.2 pmol/L; therefore, she was discharged without complications. On gross pathology, the specimen was a single brown, firm nodule measuring 2.8 x 1.5 x 1.3 cm and weighing 2.0 g. Histologically, the lesion was diagnosed as a hypercellular parathyroid gland in keeping with parathyroid adenoma, with numerous prominent vessels showing different wall thicknesses suggestive of arteriovenous malformation  . In our The other issue related to this abnormality is that arteriovenous malformations encountered unexpectedly during surgery may result in remarkable intraoperative bleeding. AVMs are by far the most challenging vascular anomaly to deal with due to the replacement of normal tissue by abnormal vasculature and their very high recurrence rate. Treatment options include minimally invasive surgery with endovascular or percutaneous embolization or open surgical excision. However, a combined approach using both methods is the gold standard approach for treating AVM. Total obliteration of the AVM nidus using an embolization technique results in a better outcome, as this helps reduce the risk of massive bleeding during surgery. In addition to bleeding, the other risk associated with AVM surgery is damage to the host organ. After surgical excision of AVM, local recurrence, especially in the pediatric age group, is not uncommon due to difficulties in achieving radical resection of the lesion or due to the development of a new AVM .An arteriovenous malformation may be encountered anywhere in the body, and it can alter the function of the hosting organ. We present a unique case of parathyroid adenoma with arteriovenous malformation. This article illustrates the possibility of facing such an unexpected diagnosis and the need to remain vigilant during the management of such a condition.


Recurrent tumors commonly appeared with well-defined borders (75%) as well as nodular appearance (98%), hyperintensity on T2WI (85%) and FS-T2WI (95%), isointensity on T1WI (65%), impeded water diffusion (55%), and intense (50%) or moderate (45%) enhancement. Postoperative changes showed ill-defined borders (75%), nodular appearance (56%), facilitated water diffusion (69%), and moderate (86%) enhancement, which were significantly different from those of recurrent tumors (p ≤ 0.020). Conclusions: Common and partitioning MRI features of locoregional recurrence were well-defined borders, nodular shape, impeded water diffusion, and intense enhancement. Peripheral margins on transplanted tissue were common sites in both recurrent tumors and postoperative changes.Purpose: Magnetic resonance imaging (MRI) is useful in the diagnosis of local recurrence, but few studies have explored recurrence in MRI in patients after reconstructive surgery. The purpose of this study was to analyze MRI findings of locoregional recurrence following reconstructive surgery after malignant soft tissue tumor resection. Method: Fifty-three postoperative MRIs from 37 patients who underwent reconstructive surgery after malignant soft tissue tumor resection were retrospectively reviewed. A total of 76 enhancing lesions, including 40 locoregional recurrences and 36 postoperative changes, were analyzed regarding morphology  and the signals on T1- and T2-weighted imaging , fat-suppressed (FS) T2WI, and contrast-enhanced FS T1WI. Diffusion-weighted imaging with an apparent diffusion coefficient was assessed. A chi-squared test and Fisher’s exact test were used for statistical analysis. Results: The most common site of recurrent tumors and postoperative changes was the peripheral margin on transplanted tissue (63% and 61%, respectively  Malignant soft tissue tumors of the trunk and extremities include soft tissue sarcomas, melanoma, non-melanoma skin cancers, and metastases . Skin caBecause of the wide spread of soft tissue defects and the associated functional impairments, reconstructive surgery is often needed. Reconstructive surgery provides stable soft tissue coverage and restores the contours and functioning of the limb. Flaps with strong vascularization offer speedier wound healing and improve the oncologic outcome of sarcoma resection . In addiLocal recurrence has been reported in up to 10% of patients with cutaneous melanoma  and 7–15However, diagnosing local recurrence using MRI is often difficult, because postoperative inflammation and fibrosis may show similar characteristics with local recurrence, such as T2 hyperintensity, architectural distortion, and enhancing nodules in the surgical bed ,14. In pTherefore, the purpose of our study was to analyze MRI findings of benign postoperative changes and locoregional recurrence following reconstructive surgery after tumor resection. We also hypothesized that some characteristic MRI features can be used to differentiate recurrence from postoperative changes in patients who undergo tumor resection and reconstructive surgery. Furthermore, we sought to identify distinguishing MRI features of local recurrence.This retrospective study was approved and informed consent was waived by the institutional review board . We retrospectively compared postoperative MRI findings of patients who had undergone soft tissue sarcoma resection and reconstructive surgery after dividing them into two groups—those with and without recurrence. The definition of the group with recurrence was patients who had undergone biopsy to confirm recurrence for focal abnormal findings in postoperative MRI. The definition of the group without recurrence was patients who had pathologically or clinically confirmed benign lesions that had appeared as focal abnormal findings in postoperative MRI.To divide patients into the two study groups (with and without recurrence), we reviewed medical records including operation records, pathology reports, and multidisciplinary case conference records. Postoperative MR images after tumor excision and reconstructive surgery were also reviewed. Postoperative MRI findings refer to follow-up MRI scans taken on a set schedule after reconstructive surgery, usually every 3–6 months during the first 1–2 years, depending on the histologic type and grade. We selected patients and lesions using the following inclusion and exclusion criteria. Inclusion criteria were: ① adult (≥17 years) patients who had undergone malignant soft tissue tumor resection followed by soft tissue reconstruction between 1 January 2010 to 31 October 2021 in our institution; ② focal enhancing lesion in any location of the scanned surgical site in postoperative MRI; and ③ lesion met either (a) or (b)–(a) pathologically confirmed lesion using excisional or incisional biopsy or image-guided core needle biopsy, (b) clinically confirmed benign lesion defined as a lesion with a >30% decrease in longest axis measurement during follow-up MRI after at least 1 year without adjuvant chemotherapy or radiation therapy. Exclusion criteria were: ① patients without histological results regarding resected malignant soft tissue tumor; ② too small (<1 cm) or inconspicuous enhancing lesions in postoperative MRI that were defined as not clearly visible due to the weak degree of contrast enhancement and thus not described in the MRI report; ③ subtle linear enhancing lesions along the surgical scar presumed to be postoperative changes, observed clinically or radiologically; and ④ pathologically unidentified lesion that had undergone adjuvant chemotherapy or radiation therapy. When the patient underwent several MRI exams without additional operation, only the exam on which the lesion(s) were seen foremost was selected. Follow-up MRI after additional reconstructed surgery was separately included. For example, one patient underwent MRI 3, 6, 9, 12, and 18 months after reconstructive surgery. This patient underwent re-operation at 13 months to resect a recurrent tumor and also underwent a new reconstructive operation. In this case, the study included one 12th month MRI with the most distinct lesions among the 3rd month, 6th month, and 12th month MRIs. In the case of the 18th month MRI, an 18th month MRI is also included in this study, considering that it is a new case because a new reconstructive operation was performed. Selecting MRI in this way involves newly detected or enlarged lesions during follow-up in an actual clinical setting. When there were multiple enhancing lesions in one MRI, the lesions were separately included as recurrence or postoperative changes according to each pathology result. Included enhancing lesions were classified as a recurrent tumor or benign postoperative change such as inflammation or fibrosis. Finally, 40 local recurrences and 36 postoperative changes were included based on the inclusion and exclusion criteria .max) of the lesions.We extracted patient demographic data from medical records, including age, sex, anatomic localization of tumor, type of reconstructed surgery , and history of previous radiation therapy. Histologic tumor types of primary tumors and recurred tumors and the presence of tumor cell infiltration in the surgical margins of excised primary tumors were also obtained from pathologic reports. We calculated the time span between reconstructive surgery and the postoperative MRI. We also calculated the time span between the postoperative MRI and reoperation. If the patients underwent fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) examination, we collected the maximum standardized uptake values  maps were made using commercial software and a workstation  ; ② ; ② 16]; ADC maps ; and ⑧ ct-test for continuous variables and chi-square test and Fisher’s exact test for categorical variables. p ≤ 0.05 was considered indicative of a statistically significant difference. The sensitivity, specificity, accuracy, and positive and negative predictive values were calculated using pathologic and clinical results as the gold standard. Statistical analyses were performed using commercially available software ). Stratified statistical analysis was performed after controlling for potential confounders with the Mantel–Haenszel test using another commercially available software .MRI parameters were compared between recurrence and postoperative changes using an independent n = 11 patients) followed by myxofibrosarcoma (n = 6 patients) (n = 42), local flap (n = 21), and skin graft (n = 13). Forty-one lesions were in a post-radiated state. There were 41 lesions that had matching lesions on 18FDG-PET/CT. The mean SUVmax was 8.57 ± 9.22 for 22 recurrent lesions and 2.00 ± 2.12 for 19 postoperative lesions.Our study included 37 patients with 19 male patients and 18 female patients. The mean patient age was 60.1 years . The most common histopathology of tumors diagnosed via excision before reconstructive surgery was cutaneous melanoma (atients) . The meaatients)  were fouatients)  were fouatients) . Twenty-n = 25) followed by the deep margin (n = 11) on transplanted soft tissue, which was not significantly different from those with postoperative changes . Seven regional recurrences were seen apart from transplanted tissue. The borders of the lesions were frequently well-defined  in recurrent tumors but were ill-defined  in postoperative changes (p < 0.001). Of recurrent tumors, 98 percent (39/40) were nodular in appearance, whereas of postoperative changes, 56 percent (20/36) were nodular in appearance (p < 0.001). One recurrent tumor (undifferentiated pleomorphic sarcoma) showed a band-like appearance. Sixteen postoperative changes showed a non-nodular appearance, including band-like (n = 8), diffuse (n = 4), and spiculated appearances (n = 4). The mean size of the tumors in the recurrence group was 2.6 cm ± 2.2, whereas that of the postoperative change group was 1.7 cm ± 1.0 (p = 0.020)  .2/s ± 590.9 vs. 1634.6 μm2/s ± 462.7, p = 0.008). Recurrent tumors more commonly showed impeded water diffusion than postoperative changes .The signal intensity of both local recurrence and postoperative changes were significantly different in each sequence . Local rThe nodular shape showed high sensitivity and a negative predictive value of 97.5% and 94.1%, respectively. Strong enhancement and impeded water diffusion showed high specificity  and positive predictive values  .n = 3), myxoid liposarcoma (n = 2), and melanoma (n = 2). Twelve recurrent tumors with hyperintense signal on T1WI of 11 patients were also varied in pathology: myxoid liposarcoma (n = 4), myxofibrosarcoma (n = 2), melanoma (n = 2), undifferentiated pleomorphic sarcoma (n = 2), dedifferentiated liposarcoma (n = 1), and squamous cell carcinoma (n = 1). Hyperintensity on T1WI was observed significantly more frequently in recurrent tumors than postoperative changes after adjustment for whether or not it was melanoma (p = 0.019). Hyperintensity on T2WI was observed significantly more frequently in recurrent tumors than in postoperative changes after adjustment for whether or not it was myxoid-containing tumor (p = 0.001). Hyperintensity on FS-T2WI was not significantly different between recurrent tumors and postoperative changes after adjustment for whether or not it was a myxoid-containing tumor (p = 0.052). The locations of enhancing lesions were not different between recurrent tumors and postoperative changes after adjustment for soft tissue reconstruction type . Signal intensity on T2WI was observed significantly more frequently in recurrent tumors than in postoperative changes after adjustment for whether or not it was a myxoid-containing tumor (p = 0.001). Signal intensity on T1WI, T2WI, FS-T2WI, CE, and diffusion restriction were significantly different between recurrent tumors and postoperative changes after adjustment for whether or not they were post-radiation tissues (p ≤ 0.047). Well-defined borders and nodular shapes were observed significantly more frequently in recurrent tumors than in postoperative changes after adjustment for whether or not they were post-radiation tissues (p ≤ 0.002). Histologically confirmed benign lesions (n = 10) were comprised of chronic inflammation and fibrosis with (n = 2) and without (n = 6) foreign body reaction and fragments of benign nerve bundles (n = 2).Seven regional recurrent tumors of seven patients were varied in pathology: myxofibrosarcoma (This study analyzed MR imaging findings of locoregional recurrence as well as common benign postoperative findings in patients undergoing reconstructive surgery after tumor resection. Since little is known about postoperative MRI findings in such patients, we believe that our results in incidence, shape, and location of postoperative changes can help to increase such knowledge. The principal MRI features of locoregional recurrence were well-defined borders, nodular shape, impeded water diffusion, and intense enhancement. The MRI features suggestive of benign postoperative changes were ill-defined borders, non-nodular shape, and free water diffusion.Local tumor recurrence was most commonly seen in the peripheral margin of the transplanted tissue followed by the deep margin, regardless of the type of reconstructive surgery in our study. Little is known about locations of local tumor recurrence in patients undergoing reconstructive surgery after tumor resection. Kotnis et al. reported postoperative MRI findings of myocutaneous flap reconstruction following hindquarter amputation for pelvic musculoskeletal malignancy . They shOur study newly revealed partitioning MRI features of locoregional recurrence, defined as well-defined borders, a nodular shape, impeded water diffusion, and intense enhancement in patients with reconstructive surgery after tumor resection. These results are not different from those of previous studies of postoperative MRI of soft tissue sarcoma resection regardless of soft tissue reconstructive surgery ,13,19. ALocal recurrences showed common hyperintensity in T2WI and FS-T2WI and isointensity in T1WI. The signal intensities of recurrences and postoperative changes were different in incidences. The subcutaneous fat, skin, and muscles that made up the flap were well distinguished using MRI, so the composition of the transplanted tissue could easily be estimated. Muscles may show alteration in signal intensity due to postoperative edema and changes due to radiation therapy. Signal intensity of the transplanted flap tissue also varies over time ,21. SignOur study had several limitations. First, this was a retrospective study, and therefore there may be selection bias. Particularly, pathologically unidentified lesions that had undergone adjuvant chemotherapy or radiation therapy were not included because they could not be determined as benign or malignant. Second, multiple lesions were selected per person, although such lesions might be related and introduce error. However, we believe that it would be useful to include all individually identified lesions rather than analysis including an arbitrarily selected lesion. Third, the number of lesions analyzed was small, and the histologic types of tumors included were diverse, preventing analysis of the characteristics of tumor histologic type. Results may also be affected by the histologic type of tumor included. Fourth, due to the small number of cases and tumor type variability, we did not present the diagnostic performance of each imaging feature that distinguishes between groups with and without recurrent tumors, as measured with variables such as odds ratio or accuracy. However, the purpose of this study was achieved by comparing and presenting the frequency of normal imaging findings that may appear after reconstructive surgery with the frequency that may appear in recurrent tumors. Finally, patients had undergone various treatment combinations including radiation therapy and chemotherapy with various time intervals between treatment and MRI.In conclusion, common and partitioning MRI features of patients with local recurrence who underwent reconstructive surgery after sarcoma resection tended to be a nodular shape, well-defined margin, moderate or intense enhancement, and low ADC. Peripheral margin of flap or skin graft and hyperintensity on DWI were commonly seen in both local recurrence and postoperative changes.