ABSTRACTPrimary presacral clear cell carcinoma (CCC) of Müllerian origin is extremely rare. Malignant transformation of endometriosis is a known phenomenon, though typically involving the ovaries or pelvic peritoneum. Retroperitoneal presentation, especially decades after definitive surgery, is exceedingly uncommon. A 60‐year‐old woman presented with a large retroperitoneal/presacral pelvic mass leading to hydronephrosis, 20 years after total abdominal hysterectomy and bilateral salpingo‐oophorectomy for endometriosis. MRI showed a cystic‐solid mass with mural nodularity. Surgical exploration revealed dense retroperitoneal adhesions with involvement of the rectosigmoid and the appendix. En bloc resection was performed in posterior exenterative fashion. Histopathology confirmed clear cell carcinoma arising from endometriotic foci, fulfilling Sampson's criteria. Postoperative management included adjuvant paclitaxel‐carboplatin chemotherapy. The patient recovered uneventfully and was scheduled for ileostomy reversal. This case illustrates the potential late malignant transformation of endometriosis into Müllerian CCC even decades after hysterectomy and oophorectomy. Endometriosis‐associated carcinoma should be considered in the differential diagnosis of retroperitoneal pelvic masses, particularly in women with prior endometriosis.

ABSTRACTScrub typhus, an acute zoonotic disease from Orientia tsutsugamushi, is uncommon in newborns and presents atypical symptoms. Untimely diagnosis and treatment can lead to a prolonged and potentially fatal course. Early diagnosis and treatment are essential for better patient outcomes. Metagenomic next‐generation sequencing can rapidly and accurately diagnose pathogens, aiding precise treatment.

ABSTRACTWe report a rare case of fatal posterior atlantoaxial dislocation without odontoid fracture. Attention should be paid to the possibility of delayed or missed diagnosis of cervical spine injury in patients with disturbance of consciousness.

ABSTRACTOvarian Low Grade Serous Carcinoma (LGSC) is a rare gynecological cancer with limited representation in literature. Achieving R0 through maximal cytoreductive effort is indicated to provide the best outcome. Gynecological cancer surgery increases risk of pulmonary embolism—balancing this with bleeding risk complicates the post‐operative landscape.

ABSTRACTExtramedullary plasmacytoma (EMP) of the maxilla is a rare tumor to be in young patients. Accurate diagnosis requires histopathology, immunohistochemistry, and exclusion of systemic disease. This case highlights the need for early recognition and long‐term surveillance to prevent its progression to multiple myelomas, emphasizing a multidisciplinary approach in managing atypical plasma cell neoplasms.

ABSTRACTThe late onset of significant symptoms in this case provides valuable insight for future research on multiple neoplasia and endocrine syndromes, emphasizing the challenges of timely recognition. As syndromic features may regress over time, careful attention to detailed clinical history and subtle past manifestations remains essential for diagnosis and management.

ABSTRACTSister Mary Joseph's nodule represents a rare sign of advanced abdominal or pelvic malignancy, which indicates a poor prognosis for the patient. All clinicians should be aware of its significance and urgently refer the patient for further investigation and management.

ABSTRACT Fluoroscopic anatomy varies between patients and should be confirmed with echocardiography or angiography to avoid complications. Multipurpose A2 catheters risk cardiac perforation and must be advanced only over soft J‐tipped wires. If perforation is suspected, stabilize the catheter in place to reduce tamponade risk by wedging the site.

ABSTRACT Cardiac perforation associated with hemothorax represents an extremely rare complication following pacemaker implantation. We describe a case of right ventricular lead perforation through the pericardium resulting in a massive left‐sided hemothorax. Point‐of‐Care Ultrasound (POCUS) was key to diagnose the lead migration and pleural effusion. We performed emergent percutaneous drainage of the hemothorax, device removal and replacement.

ABSTRACTA 58‐year‐old male with a history of gout presented with new‐onset neck pain. Dual‐energy CT revealed extensive urate crystal deposition in his cervical part and sternoclavicular joints, an uncommon manifestation. Diagnosed with spinal de novo tophi formation, his symptoms have improved with conservative urate‐lowering therapy and pain management.