Adrenal myelolipomas are benign adrenal tumours containing adipose and haematopoietic tissue. Although rare, they are significantly more common in patients with poorly controlled classical congenital adrenal hyperplasia (CAH) due to chronic adrenocorticotropic hormone (ACTH) overstimulation. This case describes a male patient in his 40s with longstanding CAH (21-hydroxylase deficiency) who presented with symptomatic bilateral giant adrenal myelolipomas and testicular adrenal rest tumours (TARTs). He presented acutely to hospital with abdominal pain, nausea and vomiting. Urgent imaging demonstrated giant bilateral adrenal masses with benign appearances in keeping with myelolipomas. Subsequently, he underwent open bilateral adrenalectomy. Postoperatively, his quality of life improved markedly and his steroid requirements reduced. This case illustrates the importance of increased awareness of myelolipomas in patients with poorly controlled CAH and highlights the need for vigilant endocrine management and a multidisciplinary approach to prevent other long-term complications such as TARTs.

What injury makes an isolated small coronoid fracture? Morphological analysis using 3D CT reconstruction.

Introduction: The Buschke-Löwenstein tumor, also known as giant condyloma acuminatum, is a rare sexually transmitted lesion associated with human papillomavirus (HPV), most commonly types 6 and 11. It is characterized by a slow but aggressive local growth that can cause significant tissue destruction while maintaining a benign histological appearance. Due to its rarity and resemblance to malignant lesions, the diagnosis and management of this entity represent a clinical and therapeutic challenge. Early recognition and appropriate treatment are essential to prevent recurrence and malignant transformation. Clinical Case: We present the case of a 63-year-old woman with a history of diabetes and hypertension, who presented with multiple exophytic lesions in the vulvar and perineal regions. Clinical examination revealed a cauliflower-like mass approximately 10 cm in diameter involving the labia majora, clitoris, and perineum. Histopathological biopsy confirmed the diagnosis of Buschke-Löwenstein tumor (giant condyloma acuminatum). The patient underwent surgical management with electrofulguration under regional anesthesia, achieving complete ablation of the lesion and satisfactory hemostasis. Postoperative recovery was uneventful, and follow-up at six month showed adequate healing without recurrence. Discussion: Female presentation of BLT, such as in this case, is exceedingly rare, with vulvar involvement reported only in isolated cases. The clinical course and histopathological findings were consistent with literature descriptions of locally invasive but non-metastatic behavior. Early biopsy and histopathological confirmation are crucial for distinguishing BLT from squamous cell carcinoma and other verrucous lesions. Among treatment options, electrofulguration represents an effective and safe approach for extensive vulvar disease, providing local control with minimal morbidity. Conclusion: This case highlights the importance of considering BLT in the differential diagnosis of large exophytic vulvar lesions. Early diagnosis and prompt surgical intervention are key to preventing recurrence and malignant transformation. Awareness of this rare presentation among gynecologists can improve clinical recognition and optimize multidisciplinary management of HPV-related anogenital disease.

Background: Giant congenital melanocytic nevus (GCMN) is a rare condition present at birth, with an estimated incidence of fewer than 1 in 20,000 live births. While smaller congenital melanocytic nevi are common, GCMN poses significant clinical concerns due to its potential malignant transformation into melanoma. Early recognition and long-term monitoring are crucial to mitigate risks. Objective: This case report aims to highlight the clinical presentation, diagnostic approach, and management challenges of GCMN to emphasize the importance of timely intervention. Case Presentation: A 24-year-old male presented with a progressively enlarging blackish facial lump that bled upon scratching. Laboratory tests indicated leukocytosis, and histopathology confirmed tumor growth in the epidermis with papillomatous architecture and hyperkeratosis, leading to a diagnosis of GCMN in the fronto-nasal region. Result: The histopathological findings confirmed GCMN, underscoring the need to its malignant potential. Despite its benign appearance, the lesion’s progressive growth and bleeding tendency warranted close monitoring. Conclusion: GCMN, though rare, requires early detection, appropriate treatment, and lifelong surveillance to prevent malignant transformation. Delayed intervention, often due to cosmetic concerns, may increase complications. Thus, a multidisciplinary approach involving regular follow-ups is essential for optimal patient outcomes.

Soft tissue sarcomas (STS) of the hand are rare, representing only 2% of all STS. The small size and benign appearance of these tumors often lead to unplanned excisions and diagnostic delay. This systematic review sought to characterize the clinical presentation, histology, treatment modalities, and oncological outcomes of hand STS. A systematic review of PubMed and Embase was conducted following PRISMA guidelines. The protocol was registered on PROSPERO. We included studies with ≥10 patients with STS that provided data on treatment options and oncologic outcomes. Data was extracted regarding demographics, tumor features, treatment modalities, and survival metrics. Eighteen studies comprising 570 patients were included. Most tumors were <5 cm, and 56.8% were deep (subfascial). Epithelioid and synovial sarcomas were the most common histologies, accounting for 27% and 17% of cases, respectively. UEs were seen in 57% of cases, and 26% of patients required amputation. Positive surgical margins were reported in 16% of patients. Radiation therapy and chemotherapy were used in 40% and 17% of patients, respectively. Twelve and 15% of patients developed regional lymph node and distant metastases, respectively. Local recurrence occurred in 20% of cases. Five- and ten-year overall survival were 80% and 77%, respectively. Disease-free survival at those time points were 77% and 74%, respectively. Hand STSs are challenging due to their rarity, small size, and high rates of UEs. Despite favorable survival rates, local recurrence and metastases remain a concern. Early referral to specialized centers and individualized treatment strategies are essential for improving outcomes.

Verrucous carcinoma of the vulva is a rare, well-differentiated variant of squamous cell carcinoma, characterized by slow growth, local invasiveness, and a low risk of metastasis. It most commonly affects postmenopausal women and is seldom reported in younger individuals. We report a rare case of a 37-year-old Asian woman who presented with a 6-month history of a progressively enlarging exophytic vulvar lesion, associated with foul-smelling discharge and urinary retention. The lesion’s deceptively benign appearance initially mimicked common vulvar conditions, creating a diagnostic dilemma and contributing to delayed diagnosis. Clinical examination revealed a large, friable, cauliflower-like growth on the left vulvar region. Imaging studies, including contrast-enhanced computed tomography and magnetic resonance imaging, confirmed a locally advanced vulvar mass involving adjacent structures. Histopathological examination diagnosed it as verrucous carcinoma, without lymphovascular or perineural invasion. The patient underwent a radical vulvectomy with myocutaneous flap reconstruction. The postoperative recovery was uneventful; however, the patient failed to return for follow-up. This case highlights an uncommon presentation of verrucous vulvar carcinoma in a young woman, emphasizing the importance of early diagnosis and aggressive surgical management to prevent morbidity.

Background: Pleomorphic adenoma (PA) is the most common benign salivary gland tumor. Despite its benign histological appearance, rare cases demonstrate metastatic potential without malignant transformation, termed metastasizing pleomorphic adenoma (MPA). Case Presentation: Here in we report a case of a 32-year-old female with no comorbidities, presenting with a left parapharyngeal mass. MRI revealed a well-circumscribed, lobulated lesion inseparable from the deep lobe of the parotid, with heterogeneous enhancement and cystic/necrotic components. Histo pathological examination of the resected mass revealed pleomorphic adenoma. Interestingly, metastatic deposits with identical histology were identified within the excised cervical lymph node. Conclusion: This case highlights the paradoxical behavior of pleomorphic adenoma, which, although histologically benign, may metastasize. Awareness of MPA is crucial for clinicians to ensure long-term surveillance following the excision of pleomorphic adenomas.

Rationale:Epithelioid hemangioendothelioma (EHE) is a rare vascular malignancy which poses significant diagnostic and therapeutic challenges due to its variable course and lack of standardized treatment protocols. In this case, the lesion’s benign appearance and ambiguous histology delayed definitive diagnosis.Patient concerns:A 46-year-old woman presented with a recurrent soft tissue mass in the left buttock. Initial impression with partial biopsy favored a benign neoplasm, complicating the diagnosis.Diagnoses:Histopathological examination confirmed EHE, characterized by epithelioid endothelial cells and positive immunohistochemical staining for vascular markers.Interventions:Complete surgical resection was performed, with no adjuvant therapy administered postoperatively.Outcomes:Surveillance over 24 months revealed no evidence of local recurrence or distant metastasis. Follow-up computed tomography on 18 month revealed no evidence of recurrence.Lessons:Comprehensive histopathological evaluation are critical for proper diagnosis of EHE. Surgical resection is the first line treatment for localized EHE. Long-term monitoring is essential due to the unpredictable metastatic potential.

In the emergency radiology setting, ectopic air can frequently be a cause for alarm, such as with pneumothorax, pneumomediastinum, and portal venous gas. Ectopic air can often serve as a harbinger of serious injury, which can prompt the radiologist to notify clinicians so patients can receive appropriate care. However, there are many benign conditions which may present radiographically with air in unusual locations. It is critical to be able to recognize these benign entities, as inaccurate identification could lead to unnecessary procedures or imaging. We present numerous benign conditions which can produce air in unusual locations that we have encountered in our practice. For each condition, we will describe its etiology and will also provide key imaging findings that help to distinguish it from pathology.

When Air is a Red Herring: Benign Appearances of Air in Unusual Locations

Soft tissue sarcomas (STS) occur in 2-5 patients per 100,000 people, as a rare heterogeneous group of tumors arising in connective tissues, embryologically derived from mesenchyme. These tumors comprise &lt;1% of all neoplasms with a 4:1 male preponderance. Prognosis depends on size, grade, depth and metastasis. Even in STS classified as low-grade, the risk of local recurrence requiring further intervention remains high, therefore emphasizing the importance of long-term follow-up. While nodal metastasis is rare, the tumor immediately becomes stage III when this occurs, regardless of size or depth. More than 50 subtypes exist and originate from cartilage, muscle, blood vessels, nerves, fat, tendons and deep skin tissues. Low-grade fibromyxoid sarcoma (LGFMS), one rare subtype with a relatively benign histologic appearance, has a high recurrence rate, late metastatic spread, and chemotherapy and radiotherapy insensitivity. We present the case of a 57-year-old male with a right chest wall mass diagnosed as a recurrent low-grade fibromyxoid sarcoma (LGFMS) 8 years after index excision. We emphasize the importance of early detection and management given the value of early surgical intervention due to the limited response of adjuvant therapy in this low-grade yet aggressive tumor.

Low-grade fibromyxoid sarcoma (LGFMS) is a rare fibroblastic neoplasm with an indolent clinical course. It is a distinctive subclass of soft tissue sarcoma with metastasizing potential and sometimes a long interval between tumor presentation and metastasis. This case report describes a 60-year-old female with an unresectable pleural LGFMS initially misdiagnosed as malignant mesothelioma. Pleural LGFMS remains exceedingly rare, with only four prior cases reported. Given its histologically benign appearance, LGFMS poses diagnostic challenges and risks of local recurrence or metastasis. This case underscores the importance of accurate diagnosis using MUC4 and it explores endocrine therapy as a promising palliative option for unresectable LGFMS, contributing valuable insights into management strategies for this rare entity.

Abstract Aim NICE guidelines suggest patients undergoing initial TURBTs should receive a single-instillation of Mitomycin-C at the same time as TURBT. EAU guidelines say Mitomycin should be given within 2 hours. Some in-vitro evidence suggests that bladder tumours can reimplant in the bladder lining and can even become covered within extracellular matrix within 2 hours. In 2023, the Trust changed its policy to start giving Mitomycin in theatre following TURBTs where appropriate rather than on the ward. This audit aims to assess the impact this change had on the timing of Mitomycin and determine if there are any issues reducing the number of patients receiving Mitomycin. Method A retrospective review was undertaken of patients undergoing their first TURBT between September and December 2022, at which time Mitomycin was given on the ward, and compared against initial TURBT patients from September to December 2023. Results 108 patients underwent TURBT from September-December 2022 with 50% receiving Mitomycin post-operatively. 123 patients had TURBTs from September-December 2023 with 43% receiving Mitomycin. The mean time until Mitomycin in the 2022 group was 241 minutes compared to just 121 minutes in 2023. The number receiving Mitomycin within 2 hours increased from 26% in 2022 to 67% in 2023. Reasons for not giving Mitomycin post-operatively included deep resection, solid tumour, incomplete resection, benign appearance, obturator kick, and ongoing haematuria. Conclusions Giving Mitomycin in theatre following TURBTs rather than on the ward reduced the time to Mitomycin and significantly increased the proportion receiving Mitomycin within 2 hours which may reduce tumour recurrence rate.

Nodular hidradenoma is a rare benign sweat gland tumor arising from the apocrine glands. This tumor has a low incidence of neoplastic transformation and metastasis. The differential diagnosis of the malignant form of the tumor is extremely difficult not only because of their benign appearance but also because of their similarity to other cutaneous lesions. Some of the excised lesions initially diagnosed as a benign tumor may be proved to be a malignant transformation once reexamined after the recurrences and the metastasis have been occurred. Here, a case of a nodular hidradenoma with atypical demonstration on the face of an old male is presented.

To appraise the inclusion of CEUS resection site evaluation in LI-RADS CEUS Nonradiation Treatment Response Assessment (TRA) v2024, currently applied for ablative therapy. We highlight the specific benefits afforded by CEUS in this effort. Retrospective chart review was performed for 102 patients following surgical resection of HCC and ICC with post-operative CEUS at our center. Demographic data, surgical history, CT/MR findings, and resection site appearances on greyscale and CEUS were documented. The resection site where the tumor was originally positioned was designated as the treatment site and the resection margin as the perilesional tissue to establish equal assessment to TRA for ablative therapy. The morphology of the resection site was assigned one of three appearances, using novel descriptors: EDGE, VOID, or SURFACE DIVOT. Resection sites were evaluated for benign appearances, post-surgical changes, and tumor recurrence, and then categorized with a CEUS LI-RADS TRA score. 102 patients had 120 resection sites following 115 operations for 94 HCC and 8 ICC. On CEUS, 59 (49%) were characterized as EDGE, 46 (38%) as VOID, and 15 (13%) as SURFACE DIVOT, n = 120. 23 (19%) of resection sites were LR-TR VIABLE for recurrence, 91 (76%) LR-TR NONVIABLE, and 6 (5%) EQUIVOCAL, n = 120. Benign post-surgical changes developed in 23 (19%) resection sites, n = 120. 63/115 surgeries (55%) had post-operative recurrence, 40 De Novo, 17 Perilesional, and 6 Intralesional. Our conclusions are in two categories: the first assessing the success of CEUS in the assessment of post-surgical treatment sites following liver resections. CEUS can successfully distinguish between unique post-operative appearances such as benign tissue migration, resection VOIDs resembling an intrinsic mass, and true recurrence. CEUS is thus strongly recommended for secondary surveillance following HCC and ICC resection. The second conclusion evaluates the inclusion of resection sites into the CEUS LI-RADS TRA algorithm for ablative therapies. In this regard, we believe that our study was highly successful, improving the perspective of all our staff as to what is important in the assessment of the post-surgical liver on CEUS and the method whereby this information is communicated to our referring clinicians.

Polymorphous Adenocarcinoma of the upper lip: Challenges in diagnosing a malignant lesion presenting benign clinical appearance

Molecular pathological insights into tumorigenesis and progression of giant cell tumor of bone.

There are numerous guidelines offering varying advice on the management of adrenal incidentalomas. The American College of Radiology (ACR) white paper recommends no follow-up for lesions with benign appearances. Our aim was to audit the indications for adrenal CT in the context of the ACR recommendations and to assess the long-term follow-up and outcome of these incidental lesions. A retrospective cohort study was performed identifying patients who had undergone adrenal CT from 1 January 2016 to 31 December 2018. Patients with symptoms of adrenal hypersecretion and malignancy were excluded. Radiology reports were analysed, with collected data also including patient demographics, referring team, lesion characteristics, radiologist recommendations, biochemical tests and histology. A total of 168 adrenal CTs were performed in 130 patients during the study period. 88 CTs (52%) were not in accordance with the ACR recommendations, as they were for the evaluation of adrenal incidentalomas previously characterised as benign. 93% of lesions had benign imaging appearances, none of which demonstrated evidence of malignant transformation. 70% of patients with benign-appearing lesions had excess imaging deemed not required as per the ACR recommendations. A large proportion of adrenal CTs are performed to evaluate incidental lesions previously characterised as benign. The ACR white paper recommends that these do not require further imaging; however, in most cases, this is not being followed. Radiologists should be encouraged to recommend no follow-up for benign-appearing adrenal lesions in accordance with the ACR recommendations and have confidence that it is reasonable and safe to do so.

Annual review of false-negative (FN) mammograms is a mandatory and critical component of the Mammography Quality Standards Act (MQSA) annual mammography audit. FN review can help hone reading skills and improve the ability to detect cancers at mammography. Subtle architectural distortion, asymmetries (seen only on one view), small lesions, lesions with probably benign appearance (circumscribed regular borders), isolated microcalcifications, and skin thickening are the most common mammographic findings when the malignancy is visible at retrospective review of FN mammograms. Most FN mammograms are not due to radiologist error. There are common and predictable settings in which FN mammograms occur. Patient factors associated with elevated FN mammograms include dense breasts, elevated lifetime risk of breast cancer, and personal history of breast cancer treated with lumpectomy and radiation therapy. About half of FN cancers are detected by supplemental screening examinations and half manifest clinically. The most common manifesting symptoms for interval cancers are a palpable abnormality, nipple discharge, and skin changes. Interval cancers can have more aggressive pathologic features and higher rates of node positivity. The FN review includes Breast Imaging Reporting and Data System (BI-RADS) 3 cases that develop a cancer diagnosis during surveillance. Nonbreast malignancies diagnosed as interval cancers (most commonly lymphoma and metastatic disease) do not need to be counted as FNs for audit purposes. The FN review and annual audit are confidential processes that protect patient and radiologist information while allowing meaningful quality control and improvement. Although FN mammograms are rare, review of these cases is a valuable educational tool. The slide presentation from the RSNA Annual Meeting is available for this article. ©RSNA, 2025.

Background/Aim: Peripheral ossifying fibroma (POF) constitutes a common reactive lesion of the gingiva, most commonly localized in the anterior maxillary region. Non-neoplastic, originates from the periodontal ligament in response to chronically injurious factors related to periodontal tissues, such as dental calculus, plaque, and orthodontic appliances. The aim of this case report is to illustrate the emergence of the POF in a 46-year-old female patient with severe generalized periodontitis. Case Report: A 46-year-old female patient came to our clinic, complaining of the presence of a rubbery mass in the upper jaw. The clinical examination revealed a pedunculated tumor, with normal color, slightly hard in palpation and with slightly whitish borders. The attachment of this mass to the underlying oral mucosa was relatively stiff but, with some effort, it was observed that the base of this mass is in direct association with the pocket of the tooth #26. At the site of the tumor, the submarginal incision was made with a No. 15C blade at the mesial papilla of tooth #24 following the gingival contour to the distal papilla of #26. It was an alveolar bone-deep incision and planned to remove the entire lesion. The biopsy confirmed the clinical diagnosis of the POF. Conclusions: The diagnosis of the POF may be proven difficult due to its clinical and histological features, resembling other clinical entities, both benign and malignant. Regardless of the possible benign clinical appearance, the tissue should always be examined histologically to confirm the diagnosis. In our case, the absence of medical problems in addition to the presence of periodontitis rendered the diagnostic process simpler. POF commonly originates from the periodontal ligament. The periodontal treatment removes the calculus and the inflammatory stimulus to the periodontal ligament, from the equation. Subsequently, periodontal treatment prevents the recurrence of POF.