Atypical Presentation of B-Cell Lymphoblastic Lymphoma: Solitary Scalp Mass in a Pediatric Patient.

B-cell lymphoblastic lymphoma (B-LBL) is a subtype of non-Hodgkin lymphoma characterized by the proliferation of abnormal B-cell lymphoblasts in lymphoid tissues. Typical presentations include lymphadenopathy, mediastinal mass, and involvement of organs such as the liver and spleen, but extranodal sites can also be affected. A previously healthy 20-month-old male child presented to the pediatric surgery clinic with a two-month history of a painless, progressively enlarging mass on the scalp as well as postauricular mass consistent with an enlarged lymph node. Ultrasound of the mass near the vertex demonstrated a hypoechoic complex cystic lesion for which excision was indicated. Preoperatively, acute enlargement of the entire postauricular lymphatic chain was noted. Intraoperatively, the scalp mass was noted to be firm with calcified tissue and no identifiable cystic or infectious components. The mass and part of the overlying skin were excised. Pathologic evaluation was consistent with B-LBL. The patient was therefore referred to a pediatric oncologist for further evaluation and management. Bone marrow examination revealed greater than 25% blasts in the clot section, consistent with B-ALL. He was promptly initiated on induction therapy with maintenance chemotherapy to ensure continued remission. This case highlights the atypical presentation of B-cell lymphoblastic leukemia/lymphoma (B-ALL/LBL) as a scalp mass in a 20-month-old male. It underscores the importance of considering malignancy in the differential diagnosis of unusual masses. Prompt collaboration between pediatric surgeons and oncologists facilitates timely diagnosis and initiation of appropriate treatments for optimal outcomes.

An Unexpected Giant: A Case of Massive Paratesticular Extra-mammary Myofibroblastoma.

Mammary-type myofibroblastomas (MFBs) are benign spindle cell tumors, typically presenting in common locations such as the breast, abdomen, and inguinal region. We present a case of a 66-year-old male with a four-year history of painless scrotal swelling. The preoperative diagnosis was challenging, with an initial suspicion of soft tissue sarcoma. A complete surgical excision was performed, revealing a well-circumscribed, encapsulated mass. The tumor measured 30 x 20 x 14 cm, weighing 5.28 kg. Histopathology confirmed an MFB. This exceptionally large paratesticular MFB emphasizes the diagnostic difficulty of such tumors. Surgical resection remains the treatment of choice, with an excellent prognosis. This case highlights the importance of considering MFB in the differential diagnosis of scrotal masses, even with atypical presentations.

Beneath the Surface: A Case Report Revealing a Rare Cystic Neoplasm Hidden Within a Pseudocyst in the Pancreas and a Scientific Literature Review.

Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare tumours with distinctive clinicopathological features. We present a case of a 51-year-old female with a large cystic neoplasm involving the entire pancreas, initially presenting with abdominal pain. Diagnostic imaging revealed a well-defined heterogeneously enhancing mixed solid cystic lesion in the pancreas. Surgical exploration confirmed a lesion in the entire pancreas, prompting total pancreatectomy with duodenectomy. Postoperative histopathology and immunohistochemistry supported the diagnosis of SPN. Herein, we discuss SPN's clinical presentation, diagnostic challenges, surgical management, and pathological characteristics.

A Symptomatic Mucinous Cystic Neoplasm of the Mesentery: A Case Report.

Mucinous cystic neoplasms (MCNs) are rare tumors primarily observed in the pancreas but occasionally found in other locations such as the retroperitoneum, ovary, liver, and spleen. These neoplasms are histologically classified based on the degree of dysplasia, with some associated with invasive carcinoma. Colorectal surgeons infrequently encounter MCNs. Mesenteric MCNs pose a diagnostic challenge secondary to their atypical location, subtle histology, and lack of specific biochemical markers. In this context, we present a case involving a 68-year-old female who initially presented with an assumed ovarian mass. Subsequent exploration revealed a 12 cm MCN situated in the sigmoid mesentery, a location seldom associated with these tumors. The patient underwent laparotomy with successful resection and recovery. Histopathological analysis confirmed the neoplasm's mucinous epithelium with a complex papillary architecture. Immunohistochemical staining supported the diagnosis, revealing positivity for CK7, SATB2, and CDX2.

Recurrent Achilles Tendon Rupture in Multiple Sites as a Primary Manifestation of Systemic Lupus Erythematosus in a 32-Year-Old Patient: A Case Report.

The Achilles tendon is vital for walking and running, but it's also the most frequently ruptured tendon. Ruptures often occur without direct trauma and present with acute posterior ankle/heel pain. Various factors like age, biomechanical properties, degeneration, and mechanical factors influence susceptibility to rupture. Mechanisms of injury vary, including weight-bearing forefoot pushing off and sudden dorsiflexion of the ankle. Management goals focus on minimizing morbidity, swift recovery, and preventing complications through tailored interventions. Systemic lupus erythematosus (SLE) can also contribute to tendon rupture, especially with prolonged corticosteroid use. A 32-year-old female presented to the ER after injuring her left foot during a basketball game. She was diagnosed with an Achilles tendon rupture and underwent surgery to repair it. However, she experienced delayed wound closure and needed a skin graft. Two months later, she suffered another rupture in a different location, requiring a tendon transfer surgery. She was finally diagnosed with SLE after tests by the Rheumatology Department. Treatment commenced, and she began rehabilitation four weeks post-surgery. Surgical management of ruptured Achilles tendon involves techniques like open repair, percutaneous repair, mini-open repair, and augmentative repair. Open repair involves a direct approach with a posteromedial incision to align tendon stumps using various stitching techniques. Conservative treatment involves immobilization and non-weight-bearing for at least four weeks post surgery. For rare cases of Achilles tendon rupture caused by lupus, treatment focuses on managing the underlying disease with medications like hydroxychloroquine and glucocorticosteroids. Comprehensive evaluation, including musculoskeletal assessment, is crucial for lupus patients. SLE needs to be considered as a potential cause, especially in cases of recurrent ruptures or additional musculoskeletal symptoms. Surgical management should be tailored to individual patient needs, while also considering surgeon proficiency and preferences.

A Case of Necrotic Colonic Volvulus in Cerebral Palsy With Severe Scoliosis.

Cerebral palsy (CP) is a neurodevelopmental disorder that affects motor function and is often accompanied by secondary musculoskeletal issues. Severe scoliosis, a lateral curvature of the spine over 40 degrees, poses a significant challenge for individuals with CP, impacting their mobility and overall well-being. While the association between scoliosis and gastrointestinal complications is acknowledged, the occurrence of colonic volvulus with necrosis in the context of CP and severe scoliosis is rare and complex. This case report emphasizes the importance of clinical awareness in managing gastrointestinal complications in patients with CP and severe scoliosis. An 11-year-old female presented with gastroenteritis and a concurrent viral upper respiratory tract infection. She experienced complications such as greenish vomiting, hematemesis, abdominal distention, and constipation. The patient has a medical history of epilepsy and was diagnosed with quadriplegic CP at four months old due to viral meningitis. She is currently on anti-epileptic medications and receives regular follow-ups with neurology. Severe lumbar scoliosis of more than 50 degrees Cobb angle is also noted. Physical examination revealed dehydration, bilious content in nasogastric tube (NGT) aspiration, tender abdomen, and an empty digital rectal examination. Some laboratory findings showed elevated levels of erythrocyte sedimentation rate (ESR), prothrombin time (PT), blood urea nitrogen (BUN), and sodium, while albumin levels were decreased, and white blood cell (WBC) count was mildly elevated. Abdominal computed tomography (CT) with contrast showed a distended ascending colon with air and swirling of the mesentery. The distal half of the large bowel was not dilated, and fecal matter was present. The small bowel appeared to be collapsed, and there was moderate free fluid in the peritoneal cavity, indicating colonic volvulus involving the proximal large bowel. The patient underwent surgery, which involved deflating and removing the distended colon, resecting the gangrenous colon, and performing an ilio-sigmoid anastomosis to restore gastrointestinal continuity. Postoperatively, the patient received close monitoring in the pediatric intensive care unit (PICU), received total parenteral nutrition (TPN) for five days, gradually progressed feeding, and showed overall improvement in her condition. In conclusion, this case report highlights a rare occurrence of colonic volvulus in a patient with CP and severe scoliosis. It emphasizes the complex relationship between neurological and musculoskeletal disorders in gastrointestinal complications. A multidisciplinary approach is important for optimal management. It shows the importance of musculoskeletal factors in patients with neurological conditions. Overall, it contributes to the medical literature and emphasizes tailored management strategies for gastrointestinal issues in such patients.

Epileptic Seizures in a Pediatric Patient With Vein of Galen Aneurysmal Malformation and Obstructive Hydrocephalus: A Rare Case Report.

The vein of Galen aneurysmal malformation (VGAM) is a rare congenital arteriovenous fistula of the embryonic median prosencephalic vein of Markowski, resulting in its pathological dilation. If left untreated, it can lead to multiple severe complications in the neonatal period, among which obstructive hydrocephalus. We present a case report of a six-year-old male patient with severe status epilepticus and a clinical history of VGAM and obstructive hydrocephalus, diagnosed via an MRI and an MR-angiography. The hydrocephalus was treated via a ventriculostomy at the age of six months, while the VGAM underwent a partial transarterial endovascular embolization when the patient was four years old. The procedures were successful, and there were no significant post-operative complications observed. The epileptic seizures began at a later point and were successfully medicated with valproate. However, they resumed due to a lowering of the medication dosage by the patient's parents. The patient was given a new valproic acid regimen with an appropriate dosage, and his parents reported no further seizures. This case report emphasizes the use of appropriate prenatal and neonatal diagnostic methods for VGAM and explores the nature of the multi-procedural therapy approach towards the pathology and its complications in relation to a possibly idiopathic co-pathology, namely epilepsy.

Presentation of Perforated Meckel's Diverticulum and Phlegmon: A Case Report.

One of the most frequently encountered congenital anomalies of the gastrointestinal tract is the Meckel's diverticulum. Perforation of the diverticulum, a rare complication, can significantly hinder accurate diagnosis of the condition. Other common complications associated with Meckel's diverticulum include intestinal obstruction, intussusception, volvulus, inflammation, and hemorrhage. The presentation is similar to the presentation of appendicitis at times. Formation of a phlegmon around a perforated Meckel's diverticulum can mask clinical signs and symptoms. We present a case of a 59-year-old man who presented with pain in the right upper and lower quadrants. After imaging, the patient underwent exploratory laparotomy, which revealed a perforated Meckel's diverticulum. This case highlights the importance of considering Meckel's diverticulum as a possible diagnosis in patients presenting with acute abdominal pain. A thorough approach to history and physical exam combined with imaging can help in the early diagnosis of a perforated Meckel's diverticulum.

Rare case of chondrosarcoma of the manubrium sterni: Management challenges and insights (a surgical case report).

INTRODUCTION AND IMPORTANCE: Chondrosarcoma of the manubrium sterni is an exceedingly rare localization of chondrosarcoma. Its treatment poses a significant therapeutic challenge due to the tumor's proximity to the mediastinal organs and the clavicles. This challenge is magnified when the inner ends need to be resected due to tumor contact with the sternoclavicular joints and, more critically, during the reconstruction of the thoracic wall. CASE PRESENTATION: We present the case of a 71-year-old female with a 45x42x51 mm chondrosarcoma of the manubrium sterni, extending to both sternoclavicular joints. The diagnosis was confirmed cytologically and histologically after an ultrasound-guided biopsy. A surgical strategy involving en bloc resection of the manubrium sterni, the internal ends of both clavicles, and the first two ribs, followed by sternal reconstruction using a synthetic manubrial plate and titanium costal staples without clavicular bridging, was indicated and executed. CLINICAL DISCUSSION: This case outlines the surgical considerations and techniques adopted for this complex procedure, emphasizing the operative planning and interdisciplinary collaboration required for a successful outcome. CONCLUSION: At 18 months post-surgery, the patient demonstrated favorable clinical and radiological progress, indicating a positive response to the treatment strategy employed.

Mechanical Bowel Obstruction Due to Secondary Sclerosing Peritonitis, Managed Conservatively: A Case Report.

An uncommon cause of intestinal obstruction is an abdominal cocoon, also known as sclerosing encapsulating peritonitis (SEP). We present the case of a 24-year-old female peritoneal dialysis patient who presented with a picture of complete intestinal obstruction. After reviewing the patient's medical history and acquiring relevant laboratory and imaging data, the decision was made to proceed with surgery. Intraoperatively, however, she had a picture of sclerosing peritonitis. The decision was to terminate the surgery and to take a conservative approach, including total parenteral nutrition. Her condition improved, obstruction was resolved, and she was discharged home in good clinical condition. Sclerosing peritonitis should be considered a possible etiology that can be managed conservatively in any peritoneal dialysis patient with intestinal obstruction.

Missed Diagnosis of a Rare Retropatellar Juxta-Articular Angioleiomyoma: A Case Report.

Angioleiomyomas are benign tumors that originate from smooth muscle cells and most commonly affect organs such as the uterus or gastrointestinal tract. This article presents a case of a rarely reported angioleiomyoma located in the retropatellar juxta-articular region of the knee. The patient is a 42-year-old female who experienced chronic anterior knee pain that led to two unsuccessful arthroscopic surgeries. Magnetic resonance imaging (MRI) revealed a well-defined lesion in the retropatellar area, prompting the decision to proceed with open surgery. The histopathological examination confirmed the diagnosis of angioleiomyoma. This case highlights the challenges in diagnosing angioleiomyomas in the knee and emphasizes the importance of comprehensive MRI evaluation for accurate diagnosis and appropriate surgical intervention. Prompt identification and excision of the soft tissue lesion can lead to the complete resolution of symptoms and effective management of this rare condition.

Closed Reduction and Percutaneous Pinning in Isolated Cuboid Dislocation Management: A Case Report.

Cuboid dislocations are a rare type of injury with few cases reported. A 41-year-old female came in for an assessment of her left foot, seeking evaluation 13 days post-injury. On inspection of the left lower extremity, we found swelling and ecchymosis throughout the midfoot. There was dimpling along the fourth/fifth tarsometatarsal (TMT) joint with palpable dorsal subluxation. A closed cuboid reduction with percutaneous pinning was performed 20 days after the initial injury. The cuboid was reduced with a combination of traction and direct pressure. One 1.6 mm Kirschner wire was passed from the fifth metatarsal across the TMT joint into the cuboid. At the 10-week follow-up appointment, she was ambulating with her boot and had successfully returned to work as a teacher. Radiographs demonstrated a maintained reduction of the dislocation and interval healing of the navicular and fourth metatarsal base fractures. Dislocations of the cuboid have only a handful of cases reported. They can occur in isolation or with other injuries of the midfoot. This patient was successfully treated with closed reduction and percutaneous pinning. Further studies are required to obtain a consensus on optimal treatment for these types of injuries.

Bilateral Frontoparietotemporal Craniectomy for Traumatic Brain Injury: A Case Report.

There is no conclusive agreement on the optimal approach to managing severe traumatic brain injury. This article details the methodology and outcomes of bilateral frontoparietotemporal decompression surgery performed on a three-year-old patient with severe traumatic brain injury. As the patient had fixed dilated pupils, GCS (Glasgow coma scale) 4, and marked edema in the frontal and parietal regions, the Kjellberg approach was modified, and decompression including part of the parietal bone was performed. The patient was intubated and sedated in the intensive care unit for one week postoperatively. After extubation, the patient had reactive pupils and a GCS of 13. The patient underwent a cranioplasty two months after the trauma, combining the bone grafts placed in the abdomen. The patient was followed for three days after cranioplasty and discharged with a GCS:15 and intact motor examination.

An Unexpected Cause of Abdominal Discomfort: Non-pancreatic Mesenteric Pseudocyst.

Mesenteric cysts (MCs), rare entities of embryologic origin, predominantly affect the small bowel's mesentery. The clinical manifestations of MCs often lack specificity, which complicates diagnosis. Given their rarity, detailed reporting of MC cases is essential to enhance understanding and improve treatment strategies. We present a case of a 45-year-old male who presented to the emergency department with a one-month history of abdominal pain in the umbilical region, postprandial fullness, progressive decrease in food intake, 12 kg weight loss, and increased abdominal girth. Computed tomography (CT) imaging revealed a well-defined mass in the jejunoileal area. During the exploratory laparotomy, we identified and excised a fibrotic mass on the mesentery of the ileal jejunum, which was not adherent to the intestines. We discharged the patient with no complications following an uneventful four-day observational period. Histopathological examination, including immunohistochemical staining, confirmed the lesion as a non-pancreatic mesenteric pseudocyst. On the follow-up visit, the patient reported no complications. This case report underscores the solitary, multilocular nature of the jejunoileal MC, distinct for its serosanguineous fluid content. In conclusion, this case highlights the diagnostic challenge of MCs and illustrates the potential for successful management with a timely and multidisciplinary approach.

Multiple Distal Femoral Osteochondromas Encasing Popliteal Neurovascular Bundle.

Multiple hereditary exostosis syndrome is a rare diagnosis with approximately 1:50000 incidence prevailing in males. The exostoses or osteochondromas are benign but have the potential for malignant transformation in 1-5%. There is a strong genetic component, with exostosis (EXT) signaling pathways being an underlying cause. They can be symptomatic, with pain and functional deficit as the main complaints. We present a case of a 17-year-old male who presented with pain and anatomical deformity in his left lower femur. Magnetic resonance imaging revealed multiple osteochondromas compressing the popliteal neurovascular bundle. Excision of the osteochondromas was performed to decompress the neurovascular bundle in a multidisciplinary approach. Histological examination demonstrated no evidence of malignancy. Currently, there is no consensus for patients diagnosed with multiple osteochondromas regarding further investigation and/or screening for malignant transformation.

Atypical Presentation of a Right Atrial Myxoma.

Primary cardiac tumors are exceptionally rare and predominantly located in the left atrium with occasional involvement on the right side of the heart. We present the case of a 52-year-old man who presented with chest pain, leading to suspicion of acute coronary syndrome. However, further investigation revealed a right atrial tumor measuring 6.3 cm. After surgical removal, the pathology analysis of the mass confirmed the histology of myxoma. Differential diagnoses for atrial myxomas include thrombus and other tumors, such as rhabdomyomas. More than half of these tumors arise in the left atrium and may be complicated by neurologic symptoms secondary to embolization. Right atrial myxomas are rare and described in the literature with a myriad of symptoms (signs of right heart failure [i.e., fatigue, peripheral edema, hepatomegaly, ascites], a diastolic murmur, and symptoms of pulmonary emboli). In other cases, they may be asymptomatic. Due to the low incidence and variety in their clinical picture, careful documentation of these cases is suggested for early recognition and directed management.

Aortic Valve Replacement and Tricuspid Valve Repair Five Years After Orthotopic Heart Transplantation in an Adult Patient.

In the current era of improved survival after orthotopic heart transplantation, post-transplant valve dysfunction is not an uncommon occurrence. The first treatment is medical management, but when it fails, surgery, possibly as retransplantation, may be needed. However, due to the scarcity of donor hearts, efforts are being made on the preservation of the cardiac allograft function by conventional operations in lieu of retransplantation. In this case report, we present a patient developing severe aortic valve insufficiency and moderate-to-severe functional tricuspid valve insufficiency five years after cardiac transplant, leading to progressive clinical deterioration and heart failure symptoms. The aortic valve was replaced with an Edwards Inspiris Resilia Nr. 23 biological prosthesis, and the tricuspid valve was repaired with a Medtronic Contour 3D Nr. 28 annuloplasty. The postoperative course was uneventful, and the patient remained well six months after her reintervention. In the literature, cases of patients undergoing valve operations following their heart transplants have already been described. However, to the best of our knowledge, this is the first case report describing a concomitant procedure of aortic valve replacement and tricuspid valve repair in an adult patient occurring five years after her cardiac transplant.

Reconstruction of a Giant Main Pulmonary Artery Aneurysm Using a Porcine Root in an Adult Patient.

Pulmonary artery aneurysm (PAA) is a rare disorder with a difficult diagnosis and debated management in literature due to the limited number of cases. Even if the definitive treatment of PAA is surgery, consistent guidelines still need to be developed to help surgeons determine when intervention is appropriate. We report a case of a 77-year-old female diagnosed with central PAA measuring 61 mm at contrast-enhanced computerized tomography scan which was treated surgically. The patient underwent a successful elective complete pulmonary root replacement with a Medtronic Freestyle (Medtronic Inc, Minneapolis, MN) porcine root. Postprocedural recovery and follow-up at 12 months were uneventful.

A Case of Primary Lymphoepithelioma-Like Carcinoma of the Bladder With Review.

Lymphoepithelioma-like carcinoma (LELC) was characterized by epithelial neoplastic cells developing in solid or incohesive sheets mixed with a noticeable lymphoid infiltration. Lymphoepithelioma-like carcinoma of the bladder (LELCB), which was first described by Zukerberg, is a rare variant of LELC. Here we reported a new case of LELCB occurring in a 70-year-old woman presenting with hematuria. Computed tomography (CT) and cystoscopy revealed a tumor on the left upper wall of the bladder. A partial cystectomy was finally performed. Pathological and immunohistochemical analysis revealed LELCB. After receiving systemic adjuvant chemotherapy, the patient conducted a 25-month follow-up without experiencing a recurrence.

Penetrating Neck Injury: Double Jeopardy of a Complex Aerodigestive Dilemma.

The neck is a critical region containing many essential structures. Before surgical intervention, it is crucial to assess the adequacy of the airway and circulation, as well as the presence of any skeletal or neurological damage. Here, we present a case of a 33-year-old male with a background of amphetamine abuse who presented to our emergency department with a penetrating neck injury just below the mandible at the hypopharynx level, resulting in an upper zone II neck injury with complete separation of the airway. The patient was taken immediately to the operating room for exploration. Airways were managed by direct intubation, hemostasis was maintained, and the open laryngeal injury was repaired. After the surgery, this patient was transferred to the intensive care unit for two days and discharged after a satisfactory full recovery. Penetrating neck injuries are rare but often fatal. Advanced trauma life support guidelines emphasize the importance of managing the airway as the first action. Providing multidisciplinary care before, during, and after trauma can help prevent and treat such incidents.