A case report of bilateral benign Ovarian Fibrothecoma coincidental with ascites: an unconventional co-occurrence.

Ovarian fibrothecoma are a mostly benign and profoundly rare type of gonadal stromal cell tumor. It makes up 3-4% of all kinds of ovarian neoplasia. They are predominantly unilateral in origin and mostly present in women during the postmenopausal phase. Our case is especially important because the tumors occurred bilaterally and were associated with ascites. This seldom happens in patients with ovarian fibrothecoma. Early identification and treatment are key components to avoid the subsequent complications of this tumor. Case presentation: We present the case of a 54-year-old female who presented complaining only of a slow progressive increase in the abdominal contour associated with vague abdominal pain. Our preoperative radiological imaging revealed multiple ovarian and uterine masses. Clinical discussion: Surgical intervention in the form of a hysterectomy with bilateral salpingo-oophorectomy was achieved. Histopathological analysis revealed bilateral benign ovarian fibrothecoma with benign uterine leiomyomas. The patient underwent an uneventful postoperative recovery. Conclusion: Ovarian Fibrothecoma is a rare gynecological pathology. The uniqueness of our case stems from the rarity of its bilateral occurrence and in rare occasions, their occurrence is accompanied by ascites. This kind of co-occurrence should be differentiated from other rare presentations, such as Meigs Syndrome. Therefore, documentation is necessary to circumvent misdiagnoses and to abate the resulting patient morbidity. To further highlight the value of our case, it is to the best of our knowledge, the first documented case of this pathology from our country.

A rare case of a male Choledochal Cyst with an ambiguous distal end incidentally discovered in adolescence.

INTRODUCTION AND IMPORTANCE: A choledochal cyst is a rare congenital biliary tract pathology. It displays an evident dilation that could arise in any part along the biliary tree. Its incidence rate reflects its rarity when it takes place in 1 per 100,000-to-150,000 newborns. 75 % of them are detected in early childhood, whereas around 20 % are identified and diagnosed in adulthood. The gender-specific predominance favors females over males with an almost 4:1 ratio. Our case is of an adolescent male, and this constitutes a rare variant of the previous criteria. Furthermore, the distal end of the common bile duct could not be identified. CASE PRESENTATION: We present the case of a 15-year-old previously healthy male, who presented to our surgical clinic complaining of chronic dull aching pain in the right hypochondrium. Preoperative radiological analysis revealed a choledochal cyst. CLINICAL DISCUSSION: Surgical intervention was achieved to excise the lesion and comprehensive histopathological analysis was a key element to establish a definitive diagnosis. CONCLUSION: Choledochal cysts are rare biliary anomalies. Its non-specific symptoms lead to misdiagnosis. Consequently, suitable clinical evaluation escorted by comprehensive radiological imaging is essential to suspect this pathology and swiftly treat it. This anomaly predominantly occurs in females and is chiefly discovered during childhood. Our case is a prime exception to this norm. To the best of our knowledge, this is the first documented case from Syria of an adolescent male affected by a Type I choledochal cyst with an ambiguous end of the distal common bile duct.

Case report: A unique case of benign teratoma in the posterior mediastinum associated with anterior meningomyelocele in a one-year-old child.

INTRODUCTION AND IMPORTANCE: Benign cystic teratoma considered an extragonadal germ cell tumor that can present at any age and mostly located in the anterior mediastinum, only 3 %-8 % are in the posterior mediastinum. Meningomyelocele is an abnormal herniation of the meninges that located in most cases posteriorly in lumbosacral spine. Cervicothoracic meningomyelocele are rare entities resemble only 1 %-5 % of all neural tube defects. The presence of both anterior meningomyelocele (MMC) an benign teratoma is very rare and this association in the thoracic column has never been mentioned before in the medical literature. CASE PRESENTATION: We present the case of a one-year-old child, who was admitted to our hospital with a complaint recurrent vomiting episode, and respiratory distress, with no improvement in symptoms after conservative treatment. Computed tomography showed an anterior heterogeneous meningomyelocele that extend posteriorly to the upper lobe of right lung tissue. MRI confirmed the presence of the meningomyelocele in addition to a heterogenous cystic structure within. Thoracotomy was indicated and the meningomyelocele was carefully resected and sent to histopathology analysis which showed the presence of a benign teratoma accompanying the meningomyelocele. CLINICAL DISCUSSION: Meningomyeloceles and teratoma are rarely associated, especially in the thoracic spine. Mediastinal tumors should be taken into consideration when a mass is found. A thorough imaging investigations is crucial in establishing the diagnosis along with histopathology after complete resection. CONCLUSION: In the presence of posterior mediastinal meningomyelocele with heterogeneity, a histopathological examination of the specimen should be performed to exclude the mediastinal tumors.

Progressive Acral Lentiginous Melanoma diagnosed via histopathology and surgically eradicated in a fingernail in a 69-year-old male - A Case Report.

INTRODUCTION AND IMPORTANCE: Acral Lentiginous Melanoma (ALM) transpires in a profoundly scarce percentage of the population and is intercalated with a low survival rate. This is partly because such tumors are chiefly diagnosed at an advanced stage. Diagnosis is delayed largely due to the difficulties in recognizing the early histopathological signs and clinical presentations of Acral Melanoma. CASE PRESENTATION: We demonstrate the case of a previously healthy 69-year-old Middle Eastern male patient, who presented to our university hospital's Dermatology clinic with a papule under the right ring fingernail with spontaneous Onycholysis of the entire nail, suggesting a spontaneous malformation in his finger. CLINICAL DISCUSSION: ALM is an abundantly rare subtype of melanoma that chiefly originates from the skin of the acral tissues. In this case it arose on the fingernail of a 69-year-old male, who has undergone 2 surgeries to eradicate the tumor with safe margins and as a ramification of successful follow-up for 6 months, has been deemed free of tumor recurrence or metastasis. CONCLUSION: The aim of this article is to highlight the vitality of early detection, diagnosis, prognosis, and treatment of malignant Acral Lentiginous Melanoma in patients of all ages, especially with older patient populations.

Case report: A rare case of congenital non-metastatic low-grade fibrosarcoma of the pleura in a 6-month-old infant manifested as pneumonia.

INTRODUCTION AND IMPORTANCE: Congenital Infantile fibrosarcoma is a rare tumor in children and accounts for only 10 % of various malignant tumors in this age group. Manifestations vary according to the site of occurrence. Symptoms of the tumor located in unusual places can be misleading and obscure the actual diagnosis, which in turn may waste precious effort and time until the correct diagnosis is established. Infant malignancies should be considered to reduce the morbidity and mortality associated with this pathology. CASE PRESENTATION: We present the case of a 6-month-old infant, who was admitted to our hospital with a one-month history of high fever and dry cough, with no improvement in symptoms after treatment with antibiotics. Computed tomography showed a heterogeneous mass in the pleural cavity compressing the lung tissue, in addition to bilateral mild pleural effusion. Thoracotomy was indicated and the tumor was completely resected. CLINICAL DISCUSSION: Histopathological and Immunohistochemical approach is crucial because this type of tumor can overlap with many soft tissue sarcomas. After searching in medical literature, no published evidence of a similar case was found, and thus we managed the patient empirically, depending on the usual approach for congenital fibrosarcoma. Complete surgical resection is the golden standard of treatment, followed by chemotherapy depending on pathological findings. CONCLUSION: Clinical awareness is important in any unresponsive pneumonia and malignancies should be taken into consideration.

A rare case of a Low Grade Appendiceal Mucinous Neoplasm in a 46-year-old Middle Eastern female - A case report.

INTRODUCTION AND IMPORTANCE: Mucinous cell neoplasia are rare and conceivably fatal causes of surgical abdomen. Adult manifestations can be obscure and ill-defined, yielding misdiagnoses and wasting precious time and effort to reach the correct one. Clinical awareness ought to be present once presented with a surgical abdomen in such a patient because this neoplasm may present with misleading presentations which mask the actual diagnosis and masquerade as a different one, and in turn, may result in performing a dissimilar treatment intervention. Rapid learnt surgical judgments must be taken and put into action to diminish the morbidity and mortality consequential to this pathology. CASE PRESENTATION: Our case is of a 46-year-old female, who was admitted into our hospital with a 2-month-history of general fatigue. Colicky abdominal pain and discomfort developed shortly prior to admission. Multi-Slice Computed Tomography (MSCT) scan exposed cystic formation in the terminal ileum. Exploratory laparotomy was warranted, in addition to performing a right hemicolectomy. CLINICAL DISCUSSION: We treated our patient via open surgery and performing an appendectomy with right hemicolectomy in addition to the excision of several surrounding lymph nodes. Diagnosis is traditionally reached intraoperatively relying on gross morphology and postoperatively through histopathological analysis of the excised specimens. CONCLUSION: Low Grade Appendiceal Mucinous Neoplasm is a scarce entity and varies critically in its manifestations, hence, it is existential to thoroughly study this kind of neoplasia, document it, and consider it, so that we can construct precise decisions to reach ideal results for patients who suffer from this neoplasm.

A rare case of primary non-metastatic Non-Hodgkin's diffuse large B-cell lymphoma in the ileum in a 19-year-old male manifested as intestinal obstruction- A case report.

INTRODUCTION AND IMPORTANCE: The gastrointestinal system is the most common site for extra-nodal NHL. Adolescent population are among the rarest of compromised groups, especially males. The gastrointestinal system is more involved by secondary metastasis rather than by primary lymphomas. Cardinal B-Symptoms and obstipation constituted the presentation of our patient who was diagnosed postoperatively as a case primary non-metastatic NHL. NHL can have misleading presentations which result in the implementation of different treatment modalities. We ought to have high clinical suspicion when presented with a patient suffering from B-Symptoms and obstipation to make timely judgements which help in performing effective therapeutic interventions to limit the morbidity and mortality which result from this pathology. CASE PRESENTATION: We present the case of a 19-year-old male, who presented with obstipation and B-Symptoms. CT scan indicated loop dilation, a lobulated mass, and what radiologically seemed to be intussusception. Surgery was done and the resected specimens were DLBCL. CLINICAL DISCUSSION: We treated him by surgical excision of the affected ileal segments. Histopathology indicated a primary Non-Hodgkin's DLBCL of the ileum. Afterwards, we referred him for adjuvant chemotherapy. Treatment modalities for this malignancy are mainly surgical in addition to Chemotherapy. CONCLUSION: Intestinal extranodal NHL presents with an array of vague symptoms. As a result, this type of tumors can be clinically indistinguishable from other gastrointestinal malignancies. It is vital to keep this type of malignancy in mind as a differential diagnosis when presented with a surgical abdomen in a patient with B-Symptoms.

A distinctive case of congenital midgut malrotation with volvulus in an adolescent female managed by Ladd's procedure - A case report.

INTRODUCTION AND IMPORTANCE: Midgut Malrotation (MM) is a potentially fatal and rare congenital anomaly that results from an incomplete rotation of the bowel 270 degrees around the Superior Mesenteric Axis. Newborns are the most affected age group, nevertheless, adult malrotation can manifest, but in a much rarer incidence rate. Clinical awareness must be present when faced with a surgical abdomen in an adolescent patient because this pathology can have several misleading signs and symptoms which may eclipse the true preoperative diagnosis and masquerade as another, and this could result in implementing a different therapeutic approach. Swift clinical informed judgments must be made and acted upon to limit the morbidity and mortality resultant from this pathology. CASE PRESENTATION: We present the case of a 15-year-old female, who was brought to our Emergency Department (ED) with a 5-day-history of biliary emesis which evolved into obstipation with continuous and excruciating abdominal pain. Computed Tomography (CT) scan indicated gastric and duodenal dilation in addition to a "Whirlpool sign". Exploratory laparotomy was done, and a Ladd's procedure was performed. CLINICAL DISCUSSION: We treated our patient by performing Ladd's procedure and adhesiolysis. Diagnosis is conventionally established pre-/intraoperatively based on radiological imaging and clinical suspicion. Therapeutic methods for this pathology are primarily surgical in nature. CONCLUSION: Midgut Malrotation is a rare entity, thus, it is crucial to further study this type of clinical presentation and keep it in mind to be able to make an accurate diagnosis to reach the optimal outcome for patients who present with acute surgical abdomen.

Spindle Cell Sarcoma (SCS); a case of primary leiomyosarcoma (LMS) of the sigmoid colon presented as intestinal obstruction.

Leiomyosarcoma (LMS) is a common form of soft tissue sarcoma. Primary colonic LMS is an extremely rare entity, comprising 1-2% of gastrointestinal malignancies. Primary mesenchymal sarcomas of the gastrointestinal system are rare and constitute just 0.1-3% of all gastrointestinal tumours. LMS is the most common variant of such tumours and represents just 0.12% of colorectal malignancies. We present a case of a 65-year-old female, who presented to the emergency department with 3 days history of obstipation and generalized abdominal pain. Radiology (X-ray and ultrasound) indicated a large pelvic mass compressing the sigmoid colon and its surrounding structures. Histopathological analysis indicated a primary LMS of the sigmoid colon. Diagnosis is established mostly postoperatively after histopathological evaluation. Prognosis and treatment modalities for this aggressive malignancy remain insufficient. LMS is relatively impervious to chemotherapy/radiotherapy. Our patient was treated by surgical excision of the tumour and referred postoperatively for adjuvant chemotherapy.

Spontaneously perforated Meckel's diverticulum due to diverticulitis with histopathological finding of gastric mucosa in an adult female - A case report.

INTRODUCTION AND IMPORTANCE: Meckel's Diverticulum (MD) is the most occurring congenital anomaly of the gastrointestinal tract. It characterizes a patent remnant of the omphalomesenteric duct. Despite remaining asymptomatic most of the time, the rarity of its occurrence is reflected by the scarcity of data involving it in the literature. Gastrointestinal bleeding, bowel obstruction, and inflammation are the most prevalent complications of MD. Perforation of MD is very rare. CASE PRESENTATION: We present the case of a previously healthy 32-year-old female, who presented to the emergency department with a 2-day-history of generalized abdominal pain. Radiological analysis suggested a perforated viscus and an inflamed Appendix. CLINICAL DISCUSSION: Our patient was diagnosed preoperatively with perforated hollow viscus and an exploratory laparotomy was indicated. Intraoperatively, a perforated MD was found and treated by surgical excision of the affected loop of bowel with end-to-end anastomosis and the specimens were sent for histopathological analysis. Histopathology revealed a perforated MD containing gastric mucosa. The patient had successful recovery. CONCLUSION: Early recognition with swift surgical intervention must take place to provide therapeutic outcome for patients and to limit the resulting morbidity. This case highlights the necessity of considering MD as core differential diagnosis in patients with acute abdomen. Due to the scarcity of data on perforated MDs in adult females, it's worthy of studying to highlight its incidence. Due to the rarity of a perforated MD in an adult female, it's worthy to consider such cases to explore preoperative assessment techniques, surgical interventions options, and postoperative complications.