Deep Soft Tissue Research Articles

Myopericytoma of the Finger: Case Report and Literature Review

Myopericytoma is an uncommon type of soft tissue tumor characterized by a well-circumscribed, non-encapsulated nodular proliferation with thin-walled blood vessels and a concentric, perivascular arrangement of ovoid spindle-shaped myopericytes. Clinically, most myopericytomas present as painless, slow-growing tumors in superficial or deep soft tissues. They most commonly affect the lower extremities and are rarely found in the fingers. This report describes the case of a patient with a myopericytoma located on the left fifth finger.

Clinicopathological features, treatment outcomes, and prognostic factors of angiosarcoma: a 21-year experience at one center

BackgroundAngiosarcoma is a rare, aggressive soft tissue sarcoma characterized by poor prognosis and limited treatment consensus. Our aim was to clarify the clinicopathological features, treatment outcomes, and prognostic factors of these patients to inform improved management and follow-up strategies.MethodsWe retrospectively analyzed the clinical, pathological, treatment, and survival data of patients with angiosarcoma treated from 2003 to 2024 at Zhejiang Cancer Hospital.ResultsA total of 128 angiosarcoma patients were included, categorized as cutaneous (n = 49), visceral (n = 35), deep soft tissue (n = 31), breast (n = 10), and bone (n = 3). The median progression-free survival (PFS) and overall survival (OS) were 7 and 20 months, respectively, with 2-year PFS of 21.4% and 5-year OS of 29.6%. Superficial cases had better outcomes compared to deep-seated cases, larger tumors (> 5 cm) and distant metastases predicted worse prognosis. Primary surgery improved survival in localized disease, with adjuvant radiotherapy enhancing local control but not OS. In metastatic cases, first-line systemic therapies showed that paclitaxel-based regimens were less effective than doxorubicin-based chemotherapy, and the addition of anti-angiogenic therapy did not improve outcomes.ConclusionThis study underscores the heterogeneity of angiosarcoma across different sites, emphasizing the role of surgery for localized AS, and chemotherapy remains the mainstay for advanced cases. Targeted therapies and immunotherapies offer novel promise, especially the combination strategies.

Evaluation of Prognostic Factors in Myxoid Liposarcoma Treated with Combined Neoadjuvant Radiotherapy and Surgical Excision: Systematic Review.

Myxoid liposarcoma (MLPS) is a malignant tumor that occurs predominantly in the deep soft tissues of the extremities. Preoperative radiotherapy (RT) is used to reduce tumor volume to achieve adequate surgical margins. This systematic review aims to evaluate the impact of preoperative RT on surgical margins, local recurrence (LR) rates, metastasis development, and overall survival in patients with MLPS and associated prognostic factors. A systematic literature search was conducted by two reviewers following PRISMA guidelines on PubMed, Scopus, and the Cochrane Library on 30 November 2024. We included prospective and retrospective cohort studies published in English that evaluate surgical margin status, LR and metastasis rates, and survival outcomes in patients undergoing surgical excision of MLPS following neoadjuvant radiotherapy. Two authors extracted tumor characteristics, percentage of round cells (RCs), change in tumor volume post-RT, surgical margins, postoperative complications, LR and metastasis rates, survival rates, and related prognostic factors. The twelve studies included in this review involved 1483 patients with a mean age of 44.8 years. Tumors were mostly located in the lower limbs, deeply localized, and larger than 5 cm in most cases. The average LR and metastasis rates were 5.2% and 17%, respectively. The mean 5-year and 10-year overall survival rates were 87% and 74%, respectively. Poor prognosis was associated with >5% RC components, tumors larger than 15 cm, deep localization, and inadequate surgical margins. The management of MLPS requires a multidisciplinary approach. Preoperative radiotherapy offers several advantages in reducing tumor volume and facilitating the achievement of adequate surgical margins, finally improving local control and long-term outcomes.

Metastatic Breast Cancer to a Dedifferentiated Solitary Fibrous Tumor Arising from a PTEN Hamartoma of Soft Tissue.

Germline mutations or postzygotic mosaicism in PTEN cause PTEN hamartoma tumor syndrome. The hamartomas can occur at the mucocutaneous sites and superficial or deep soft tissue. PTEN hamartomas of soft tissue were initially described in the pediatric population, and therefore, they were considered pediatric lesions. Breast cancer is one of the major diagnostic criteria for Cowden syndrome. We report a 67-year-old female patient with a germline pathogenic variant of PTEN and a remote history of breast cancer who developed metastatic breast carcinoma into a dedifferentiated solitary fibrous tumor (SFT) that arose within a long-standing intramuscular PTEN hamartoma of soft tissue. Clinically, the dedifferentiated SFT was painful and grew rapidly within the hamartoma. Grossly, the fatty hamartoma partially encircled the fleshy dedifferentiated SFT. Upon light microscopy examination, the SFT was largely the conventional type, showing variably cellular bland fibroblasts randomly arranged in fibrous to myxoid background (patternless pattern) with branching thin-walled vessels. Within the conventional SFT, there were minute foci of metastatic ductal carcinoma of the breast, as well as distinct areas of dedifferentiated SFT consisting of mitotically active, hypercellular epithelioid and plump spindle cells with necrosis. In the surrounding fibrofatty tissue, there were increased numbers of vessels, including malformed arteries and veins, and lymphoid follicles, features described in PTEN hamartoma of soft tissue in children. Our report demonstrates that PTEN hamartoma of soft tissue in adult patients can be asymptomatic, detected incidentally, and associated with other neoplasms. Awareness of this rare phenomenon assists in arriving at a correct diagnosis.

Efficacy of pharmacological interventions in alveolar soft part sarcoma: A network meta-analysis.

e23563 Background: Alveolar soft part sarcoma (ASPS) is a very rare sarcoma of uncertain histogenesis, first described in 1952 by Christopherson, then a fellow in surgical pathology, as a ‘malignant myoblastoma’ or ‘granular-cell myoblastoma’. It is histologically characterized by uniform, organoid cell nests arranged in an alveolar pattern, separated by fibrovascular septa containing sinusoidal vascular channels lined by flattened endothelium with characteristic intracytoplasmic rod-shaped crystals. It accounts for < 1% of all soft-tissue sarcomas and belongs to a newly defined category of ultra-rare. It is most commonly seen in patients 15-35 years of age, with a well-documented female predominance. It primarily affects the deep soft tissues of the lower limbs but can also involve the buttocks, trunk, internal organs, and head and neck regions. Initial course of ASPS may seem indolent, but the overall prognosis is poor, characterized by late metastases, which often occur ten years after diagnosis. Although refractory to conventional cytotoxic chemotherapy, recent reports have discussed the possible benefits of targeted therapy, such as antiangiogenic drugs and immune-stimulating therapy. This network meta-analysis (NMA) aims to systematically evaluate the comparative efficacy of various such pharmacotherapies. Methods: A systematic search of PubMed/ MEDLINE, Cochrane, EMBASE, Scopus, and ClinicalTrials.gov identified clinical trials that evaluated the efficacy of pharmacological interventions in ASPS up to October 2024. A frequentist network meta-analysis was conducted to compare treatments for Progression Free Survival (PFS) in ASPS using odds ratios (ORs) and 95% confidence intervals. Results: The analysis included 3 studies involving 156 patients, 10 pairwise comparisons, and 6 treatments. For PFS in ASPS, none of the treatments demonstrated a significant advantage compared to placebo. Cediranib (1.20, 0.34–4.21) and Cediranib followed by Sunitinib (1.20, 0.13–11.29) showed modest trends toward improved PFS but with wide confidence intervals. Crizotinib (0.46, 0.13–1.65), Sunitinib (0.72, 0.12–4.24), and Sunitinib followed by Cediranib (0.72, 0.09–5.85) indicated non-significant reductions in PFS. Heterogeneity was minimal (I² = 0%), with no inconsistency observed across designs. Conclusions: Cediranib and Cediranib followed by Sunitinib showed modest trends toward improved PFS, but wide confidence intervals limit certainty. Minimal heterogeneity (I² = 0%) and consistent study designs support the robustness of findings. In conclusion, this NMA showed no significant PFS benefit for any treatment compared to placebo. Future clinical trials with larger sample sizes need to be conducted to warrant better evaluation of these interventions in ASPS.

CIC-rearranged sarcoma in the breast: A series of 3 rare cases with literature review.

CIC-rearranged sarcoma in the breast: A series of 3 rare cases with literature review.

Abstract 7173: Comprehensive genomic profiling reveals novel insights into the genomic landscape of extraskeletal myxoid chondrosarcomas

Abstract Background: Extraskeletal myxoid chondrosarcomas (EMCs) are rare mesenchymal neoplasms comprising less than 3% of all soft tissue tumors. EMCs arise mainly from the deep soft tissues of the extremities, accompanied by high rates of recurrence and metastases. The molecular hallmarks of EMCs are cytogenetic NR4A3 rearrangements, generating chimeric NR4A3 fusion oncoproteins. The most common reciprocal translocation t(9;22)(q22;q12) results in a fusion of the EWS RNA-binding protein 1 gene (EWSR1) to the nuclear receptor subfamily 4 group A member 3 gene (NR4A3 or TEC; approximately 75% of cases). Although the oncogenic NR4A3 fusion transcripts appear to play a crucial role in EMC tumorigenesis and progression, the specific biological function and the mechanism of action remains to be defined. Comprehensive genomic profiling (CGP) and reliable molecular characterization of solid tumors using Next-Generation-Sequencing (NGS) technology has become a key tool to facilitate biomarker-matched therapy selection. With a broad spectrum of therapies already approved or currently tested in clinical trials, rapid and scalable detection of an evolving number of therapeutically relevant genomic alterations and complex biomarkers is required. Methods: This study combined NGS-based CGP and fusion gene analysis of 69 paraffin-embedded EMC tissue samples to systematically map the genomic landscape of EMC. We used the all-in-one OncoDEEP® in-house kit, integrating both (i) an DNA NGS panel larger than 1MB powered by Twist Bioscience hybrid capture technology in combination with (ii) OncoDNA’s bioinformatic data analysis and clinical interpretation software suite (OncoKDM) resulting in an integrated theranostic report. The CE-IVD approved assay covers single-nucleotide variants (SNVs), copy number variants (CNVs), deletions and insertions (indels) and loss of heterozygosity (LOH) in 638 genes and facilitates the assessment of key complex biomarkers / signatures such as homologous recombination deficiency (HRD), tumor mutational burden (TMB), or microsatellite instability (MSI). Results: Overall, more than 13, 600 variants have been identified, categorized as: pathogenic (0.1%), likely pathogenic (1.9%), variant of unknown significance (VUS; 13.3%), likely benign (6.3%) and benign (78.3%). TMB, HRD and MSI status were successfully assessed in more than 88% of all EMC samples. Furthermore, a novel NR4A3 fusion rearrangement was identified with the majority of EMC samples expressing the chimeric t(9;22) EWSR1::NR4A3 fusion transcript. Conclusions: This study provides a comprehensive genomic profile of EMC and uncovers novel genetic alterations, enhancing our understanding of its underlying pathogenesis. Gained genomic insights are anticipated to inform and refine future diagnostic criteria, potentially leading to more precise targeted therapies. Citation Format: Carl Philipp Schmitthenner, Franziska Evelt, Lucas Sebastian Scholl, Jessica Janke, Anna Kuntze, Santina Kirmse, Kim Falkenberg, Ilka Isfort, Ruth Berthold, Kornelius Kerl, Inga Grünewald, Eva Wardelmann, Wolfgang Hartmann, Marcel Trautmann. Comprehensive genomic profiling reveals novel insights into the genomic landscape of extraskeletal myxoid chondrosarcomas [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 7173.

Factors associated with positive findings of deep infection on computed tomography among patients with extremity cellulitis.

Cellulitis shares several clinical features with fulminant deep soft tissue infections, creating a diagnostic dilemma for which clinicians are increasingly using cross-sectional diagnostic imaging to resolve. However, the role of imaging in apparent cellulitis is poorly defined. In particular, the clinical utility of CT in extremity cellulitis is underexplored. The purpose of this study was to determine patient and clinical factors that increase likelihood for finding of deep infection on CT among patients with extremity cellulitis. A retrospective observational study was performed of patients with cellulitis of the extremities who were examined with computed tomography from January 1, 2012 to December 31, 2021. Demographics, medical history, and clinical and laboratory characteristics were collected. The presence of positive findings on CT report was recorded. Repeated measures logistic regression was used to evaluate significant predictors of positiveCT. There were 496 eligible patient encounters, and CT was positive for deep infection in 39 cases (7.9 %). Median patient age was 56years of age, 58.1 % were male, and most patients had a history of diabetes mellitus, history of tobacco use, and/or obesity. Significant predictors for positive CT on multivariable analysis included gas on pre-CT radiographs, febrile leukopenic state, injection drug use, purulence on exam, and white blood cell count extremes. Elevated CRP was also a significant positive predictor on bivariate analysis. Finding a deep infection on CT in a patient with extremity cellulitis is uncommon and is predominantly associated with a high-risk clinical picture, and/or with high index of suspicion based on pre-CT plain films. In the absence of these patient factors or compelling findings on radiographs, CT does not typically provide clinically actionable information for extremity cellulitis and should not be used as part of standard evaluation.

Unusual encounter: Isolation of Carnobacterium divergens in an immunocompetent patient with a meat grinder Injury. Case report

The genus Carnobacterium belongs to lactic acid bacteria, this group are composed by 12 species. These microorganisms are associated with mucosal surface, present in food-related habitats including plant, wine, milk, and meat environments. In humans, evidence of Carnobacterium spp., about the disease spectrum remains unknown. Current work is about a 25-year-old male, was admitted to the emergency room for transmetacarpal traumatic amputation of his left hand caused by a meat grinder. In deep soft tissue samples obtained from surgery, Carnobacterium divergens was isolated. He was treated with piperacillin-tazobactam and was switched to amoxicillin-clavulanate for five more days with clinical success. Written informed consent was obtained from the participating patient for publication of this case report and any accompanying images. Therefore, the pathogenic role of Carnobacterium spp., remains unknown and classically is not considered pathogenic to humans. However, in previous cases where was associated with infection, the described outcomes were good. The misidentification showed that conventional identification methods are not accurate.

Complicated and deep bacterial skin and soft tissue infections.

Complicated erysipelas, cellulitis, and necrotizing soft tissue infections belong to the spectrum of bacterial infections affecting the skin and underlying soft tissues. Their frequency as well as risk of recurrence and complicated disease course pose a significant health burden. The latter is further impacted by global travel activity, associated variations in the prevalence of microbes, the emergence of multi-resistant bacteria, demographically driven aging with an increase in critical comorbidities, immunosuppressive therapies, and excessive (including non-medical) use of antibiotics. Against this background, early and accurate diagnosis and promptly initiated therapeutic measures are major determinants in prognosis and clinical outcome. Diagnostic evaluation involves clinical, laboratory, microbiological, and radiographic findings, which are assessed in the context of patient-specific risk factors and comorbidities. First and foremost, given the indication, exploratory incisions of lesional tissue should be performed, allowing rapid assessment of the extent of tissue necrosis and providing guidance on the scope and extent of further (surgical and non-surgical) treatment modalities. Thus, delayed or inadequate interventions can be avoided, which reduces the duration of treatment, health expenses, the risk of recurrent hospitalizations, and mortality rates.

Rectum Perforation Complicated Necrotizing Fasciitis Present as Lumbar Disc Herniation: Case Report.

Necrotizing fasciitis (NF) is an infection of the deep soft tissues that results in progressive destruction of the muscle fascia and overlying subcutaneous fat. These infections can be sudden, vicious, and fast-spreading. If not treated quickly with antibiotics and debridement of the infected tissue, the patient may develop septic shock, which may lead to multiple organ failure and death. NF is difficult to early diagnose due to the overlying tissue can appear unaffected initially. We report an unusual case of NF of the buttock and left thigh that clinically mimics lumbar disc herniation. This patient was successfully treated with emergent fasciotomy and intensive care. We recommend that patients with low back pain and unilateral leg pain should be diagnosed carefully especially keeping NF in differential diagnosis.

Ematoma, infezione e difetto della coagulazione

Febrile limp in paediatric patients is often associated with septic arthritis, but alternative diagnoses must be considered. The paper reports the case of a 10-year-old boy with intermittent fever and persistent coxalgia. Imaging revealed multiple abscess-like collections in the gluteal and thigh muscles. An improperly disinfected knee wound and factor VII deficiency contributed to infected hematoma formation. The isolation of MRSA producing Panton-Valentine leukocidin required targeted antibiotic therapy and surgical drainage. This case highlights the importance of careful differential diagnosis and a multidisciplinary approach in managing deep soft tissue infections.

P-403. Incidence of Surgical Site Infections in Selected Tertiary Care Hospitals in Bangladesh: Findings From A Pilot Surveillance Project

Abstract Background Surgical site infections (SSI) are the most frequent type of healthcare-associated infections (HAI) and SSIs have substantial healthcare ramifications. In Bangladesh, most hospitals lack surveillance systems for HAIs, including SSI. We conducted this SSI surveillance to assess the rate and determine measures of SSI burden in Bangladesh Common Organisms for Surgical Site Infections in Bangladesh Common Organisms for Surgical Site Infections in Bangladesh Methods From January to August 2021, we piloted SSI surveillance in four tertiary care hospitals. Participants included undergoing cesarean section (C-section) or abdominal surgery. We enrolled SSI cases if any infection occurred within 30 days of the surgery and contained the skin, subcutaneous tissue and/or deep soft tissue, in or on any part of the anatomy. We also collected data on symptoms, antibiotic consumption, diagnosis, and treatment Results We enrolled 1,760 patients, with a majority (75.7%) undergoing C-sections. Within 30 days of surgery, 33.2% (585) of patients developed SSI symptoms. Abdominal surgery patients had a higher rate of SSI (40.9%, 175/426) compared to C-section patients (30.7%, 410/1334). Most patients (90.9%, 532/585) acquired SSI symptoms during hospital stay. Two-thirds (66.4%) of patients were prescribed antibiotics on admission, and 70.1% were given surgical antibiotic prophylaxis. Rates of SSI did not differ between those who received antibiotics or not. The most frequently prescribed antibiotics were ceftriaxone 57.5%, on admission and the combination of ceftriaxone and metronidazole (84.1%) in postoperative patients. Only 10. 7% (63/585) of participants performed wound cultures, of which 76.2% (48/63) demonstrated growth. The most frequently reported organisms were Escherichia coli (37.2%), Staphylococcus aureus (30.2%), and Klebsiella pneumoniae (20.9%). Conclusion Further study of the factors contributing to this high incidence and timing for surgical antibiotic prophylaxis administration is needed. The high rate of antibiotic consumption also suggests a need for examination of whether appropriate treatment is being administered and/or if antibiotic prophylaxis is targeting the correct organisms. Additionally, strengthening IPC practices, establishing antimicrobial stewardship programs, and updating antibiotic guidelines could help prevent SSIs and AMR in Bangladeshi hospitals Disclosures All Authors: No reported disclosures

Primary Carcinomas of the Episiotomy Scar Site: A Systematic Literature Review.

Episiotomy is a perineal incision enlarging the vaginal opening during labor, preventing severe perineal/vaginal/ano-rectal lacerations. We performed a systematic literature review (PRISMA guidelines; Pubmed, Scopus and Web of Science databases) of primary malignant tumors arising from the episiotomy site. Thirteen primary carcinomas were reported, mainly endometriosis-related histotypes (77%) (nine clear cell, CCC; one endometrioid, EC) with only two vulvar invasive squamous cell carcinomas and one adenoid cystic carcinoma of Bartholin's gland. No sarcomas, melanomas or malignant trophoblastic tumors were described. Endometriosis was associated with tumors or reported in history (62%). Malignant transformation occurred 3 to 27 (mean 16) years after diagnosis of endometriosis. Patients were usually post-/peri-menopausal (eight cases, 61%) (age range: 31-70 years, mean 50). Imaging should exclude distant (0% in our series) or lymph node metastases (three cases, 23%), looking for potential invasion of vagina (five cases, 39%), anus (including sphincter) (four cases, 31%) and/or other deep pelvic soft tissues (five cases, 39%). All patients underwent surgery, except for a CCC-patient (only chemoradiation) subsequently progressing and dying of disease. Adjuvant chemotherapy and/or radiotherapy were administered to five (39%) cases, neoadjuvant therapy to four cases (31%). Globally, three (23%) cases recurred or progressed, and two-thirds (15%) died of disease (1 CCC, 1 EC). Radical surgery with lymph node status evaluation and eventual excision should be performed when possible. Chemotherapy and/or radiotherapy can be considered in an adjuvant and/or neoadjuvant setting (or as only treatment in inoperable patients). However, the role of different treatments should be studied in further larger multicenter series.

Association between epidural catheter tip malposition and anesthesiologists' experience after graduation: A cross-sectional study using postoperative CT images.

This study aimed to examine the incidence of epidural catheter tip malposition using postoperative CT images, and investigated its relationship with anesthesiologist and patient characteristics. Patients who had undergone epidural anesthesia at our hospital during the previous 18 years, and who had a thorax and abdominal CT scan within 5 days after surgery were included. Malposition was defined if the tip of the catheter did not penetrate the ligamentum flavum in postoperative CT images. Among 189 eligible patients (median age 71 years, range 15-89), 78 (41%) were female. The median number of years of postgraduate experience of the physicians inserting the epidural catheter was 5.7 years (range 2.0-35.4). All epidural catheters were inserted using the paramedian approach in the left lateral decubitus position. The puncture site was the middle (48%) or lower (49%) thoracic spine. Epidural catheter malposition was observed in 24 patients (12.7%, 95% confidence interval [CI] 8.3-18.3). Among these cases, catheter tips were located at the vertebrae (vertebral arches: 9, transverse processes: 2, spinous process: 1), in superficial soft tissue (erector spinae: 5, subcutaneous: 4), and in deep soft tissue (intervertebral foramina: 2, subpleural space: 1). Anesthesiologists in the malposition group had significantly more experience since graduation (median 10.1 years vs. 5.6 years, P = 0.010). No other characteristics showed an association with catheter malposition. Analysis of postoperative CT images revealed that the epidural catheter tip did not penetrate the ligamentum flavum in approximately 13% of cases. Our results suggest that even experienced anesthesiologists should be vigilant regarding proper catheter tip positioning.

Invasive group A streptococcal infections as a consequence of coexisting or previous viral infection in the post-COVID-19 pandemic period.

Invasive group A streptococcal infections as a consequence of coexisting or previous viral infection in the post-COVID-19 pandemic period.

Experience with extracorporeal radiotherapy in intermediate-grade vascular neoplasm of bone tumour: a case report

Abstract Background: This report discusses a 28-year-old male patient diagnosed with an intermediate-grade vascular neoplasm in the distal diaphysis of the right femur. The tumour was excised, irradiated extracorporeally and re-implanted, demonstrating the procedure’s feasibility and effectiveness of this approach. Case Presentation: A 28-year-old male patient presented with complaints of claudication. Magnetic resonance imaging revealed a lytic lesion measuring 65 × 40 × 91 mm in the distal diaphysis of the right femur. Positron emission tomography-computed tomography evaluation identified a malignant lytic lesion in the right femur without evidence of distant metastasis. Preoperative imaging suggested malignancy. The bone segment was excised, irradiated with 50 Gy in a single fraction and re-implanted. The patient underwent open reduction, internal fixation and deep soft tissue tumour excision. Histopathology confirmed intermediate-grade vascular neoplasm without angio invasion or perineural invasion. Immunohistochemistry was positive for Pansitokeratin, Vimentin, Cytokeratin-7, D2-40 and CD31 and negative for CD34. Results: Postoperatively, the bone segment was successfully re-implanted and fixed with metal hardware. Follow-up imaging over thirty months showed successful integration with no local recurrence or metastasis. The patient recovered well without significant complications. Recommendations: Extracorporeal radiotherapy is a viable technique for treating intermediate-grade vascular bone neoplasms, providing effective tumour control and preserving limb function. This approach could be considered for broader clinical application.

Exposure of orthodontically Maxillary impacted canine by diode laser (810_980)Nm(comparative study between palatal and buccal position)

Background: Diode lasers(810+980) provide deep soft tissue penetration and have minimal interaction with tooth-hard tissues and excellent coagulation/haemostasis.Objective: The aim of the current research was the exposure of maxillary buccally impacted canines by diode laser(810+980)nm in comparing palatally impacted canines depending on these parameters (pain, oedema, healing time).Materials and methods: All patients with an impaction of the maxillary canines, such as buccal or palatal impaction, were required to be exposed. They were separated into two groups: one with seven patients in the buccal position and another with seven patients in the palatal position. Systemically healthy patients in two groups had treatment with diode lasers (980+810)mn. This study did not allow the inclusion of patients who were pregnant or in any other medically compromised patients. Pain, edema, and healing were recorded using follow-up scores on the first, second, and fifth days as well as the first and second week following surgery and statistically examined.Results: The age mean in this study five male and nine female was 26.2. P ≤ 0.05 was designated as the significant level..patients with buccally impacted canines exposure experience less pain, less swelling, and healing more quickly than patients with palatally impacted canines.Conclusion: Patients with buccally impacted canines had less pain and swelling and faster wound healing than patients with palatally impacted canines when exposed.

Alveolar soft part sarcoma with neural differentiation and aberrant TLE1 expression: A case report

Alveolar soft part sarcoma (ASPS) is a rare soft tissue tumor of uncertain histogenesis. It occurs most commonly in deep soft tissues of the lower extremities. Relevant histomorphology and diffuse and strong immunoreactivity of TFE3 has been included in essential diagnostic criteria by WHO Soft tissue and Bone tumors, 5th edition.A 35 years female presented with recurrent painless posterior right thigh mass which progressed to a size of 15x15cm in 6 months. MRI of the swelling showed T1 isointense and T2 hetrointense lesion with multiple flow voids and few non enhancing areas suggestive of necrosis. Fine needle aspiration cytology showed tight clusters of round to oval tumor cells with moderate cytoplasm. Sections from the cell block revealed tumor cells arranged in an organoid pattern. Individual cells showed a round to oval nucleus with powdery chromatin and abundant eosinophilic to clear cytoplasm. Diagnosis of undifferentiated sarcoma was made. Histopathological examination of the excised lesion showed round to oval shaped cells arranged in nests and alveolar pattern. Individual cells showed mild degree of atypia with a vesicular nucleus, moderate eosinophilic cytoplasm and distinct cell borders. Increased mitoses, prominent vascularity, extensive areas of necrosis and hemorrhage were seen. Immunohistochemistry (IHC) for TFE3, TLE1, synaptophysin and BCL2 was positive and it was negative for pan cytokeratin and S100. Periodic acid‐Schiff stain for intracytoplasmic crystalline structures was negative. Based on the histomorphology and IHC, diagnosis of ASPS was made showing neural differentiation and abberent TLE1 expression. Further studies were suggested for confirmation of the diagnosis.Accurate diagnosis of ASPS requires trained pathologists and molecular testing to lead the treatment accordingly. This case is presented owing to its overlapping histomorphological and immunohistochemical findings.

Benign Glomus Tumor of the Urinary Bladder: A Case Report and Literature Review.

Glomus tumor is a rare neoplasm, typically found in superficial soft tissues and extremities, particularly in the subungual region. However, it can also occasionally affect deep soft tissue or viscera, such as the bladder, albeit infrequently. Our patient was a 51-year-old man presenting with recurrent hematuria of unknown etiology, accompanied by a blood clot that resolved spontaneously after 1 day. Abdominal computed tomography revealed multiple calculi in the right kidney, whereas cystoscopy showed mucosal edema on the left side of the bladder. A magnetic resonance image of the bladder identified an ovoid mass on the left side, measuring approximately 3.1 cm × 2.7 cm × 2.1 cm. This mass demonstrated a slightly increased signal intensity on T2-weighted images and an intermediate signal intensity on T1-weighted images. These findings suggested a malignant tumor in the urinary bladder with a nonfunctional right kidney. The patient underwent laparoscopic surgery to remove the right kidney and part of the bladder. Histologically, the tumor primarily consisted of round cells and abundant eosinophilic or pale cytoplasm. Immunohistochemical staining demonstrated diffuse positivity for smooth muscle actin and vimentin, and focal positivity for synaptophysin. The final pathological diagnosis was a bladder glomus tumor. At 15 months after resection, the patient was in good health with no recurrence or metastasis. The clinical manifestations and imaging features of bladder glomus tumors can pose diagnostic challenges for urologists. Therefore, it is imperative to consider this tumor in the differential diagnosis of bladder tumors and to enhance the understanding among urologists and pathologists regarding this entity.