Density Shadow Research Articles

Hyalinizing clear cell carcinoma of the sublingual gland: A case report and literature review.

Hyalinizing clear cell carcinoma (HCCC) of the salivary glands is a rare low-grade malignant tumor. This type of tumor is particularly uncommon in the sublingual glands. A 57-year-old female with a mass on the left side of the floor of the mouth that had been present for 2 months. The computed tomography scan of the neck revealed a nodular abnormal density shadow in the left sublingual area, measuring approximately 2.6 cm × 1.9 cm. Primary HCCC of the sublingual gland. The patient underwent surgical treatment and reconstruction using a left anterolateral femoral free flap, which showed immunohistochemical positivity for CK 5/6, CK 7, CK (AE1/AE3), and Ki-67 (<5%), but negative for SMA and S-100. No recurrence was observed during the 12-month postoperative follow-up period. The absence of characteristic clinical manifestations makes HCCC highly susceptible to misdiagnoses. This case presents a rare instance of HCCC in the sublingual gland, providing a reference for the clinical diagnosis and treatment of the disease.

99mTc-Pertechnetate Scintigraphy Capturing Heterotopic Gastric Mucosa, Intestinal Duplication, and Heterotopic Pancreas in Imaging—A Rare Encounter

Abstract A 15-year-old adolescent boy was hospitalized because of abdominal pain. Blood tests indicated inflammation markers were elevated. Fecal occult blood test was weakly positive. CT revealed thickening and edema of the small bowel wall, accompanied by gas density shadows and blurring of fat interstitial spaces. Thus, intestinal perforation and gastrointestinal hemorrhage were suspected. In order to investigate the underlying cause, 99mTc-pertechnetate scintigraphy was performed. A tracer accumulated lesion was presented around the navel, suggestive of heterotopic gastric mucosa. Surprisingly, postoperative pathology confirmed coexistence of heterotopic gastric mucosa, intestinal duplication, and heterotopic pancreas, which was a rare condition.

Impact of Solar Shading on Façades’ Surface Temperatures under Summer and Winter Conditions by IR Thermography

In warm climates with high levels of solar irradiation, solar shading plays a determinant role on buildings’ envelope performance, both during summer and winter conditions. In this research, an evaluation of the solar shading effect on sunny façades through IR thermography non-destructive testing was performed. Sunny and shaded areas revealed temperature differences of 7.4 °C in summer conditions and up to 1.2 °C in wintertime. Moreover, solar shading was shown to be beneficial not only for decreasing surface temperature in summertime but also for reducing convective air flow in wintertime. In addition, it was found that the prevalence of dense shadows, especially with non-reflective materials in louvres, is favorable. External Thermal Insulation Constructive Systems (ETICS) must be shadowed and the use of clear colors is recommended to reinforce homogeneity in the surface in wintertime and reduce solar absorptance in summertime. Under steady-state calculations, thermal losses can be reduced up to 30% at night in wintertime and up to 50–60% at daytime in summertime because of the shadowing. However, another important finding lied in the confirmation of the performance gap that arises between using air temperature, sol-air temperature and the actual surface temperature data, in such a way that the two former implied high levels of inaccuracy and overestimated the performance of the buildings compared to the actual behavior. Some of the main conclusions can be extrapolated to other circumstances.

Clinical characteristics and removal approaches of tracheal and bronchial foreign bodies in elders

The symptoms of tracheobronchial foreign body in the elderly are not typical, so they are often missed or misdiagnosed. This study aims to depict the clinical characteristics of tracheobronchial foreign body inhalation in the elderly. We retrospectively analysed the clinical data of elder patients (age ≥ 65 years) diagnosed with tracheal and bronchial foreign bodies. The data included age, sex, clinical symptoms, type and location of foreign bodies, prehospital duration, Chest CT, bronchoscopic findings, and frequencies and tools for removing these elderly patients' tracheal and bronchial foreign bodies. All patients were followed up for a half year. Fifty-nine cases were included, of which only 32.2% had a definite aspiration history. Disease duration > 30 days accounted for 27.1% of the patients. 27.1% of the patients had a history of stroke, and 23.8% had Alzheimer's Disease. Regarding clinical symptoms, patients mainly experience cough and expectoration. The most common CT findings were abnormal density shadow (37.3%) and pulmonary infiltration (22.0%). Under bronchoscopy, purulent secretions were observed in 52.5% of patients, and granulation tissue hyperplasia was observed in 45.8%. Food (55.9%) was the most common foreign object, including seafood shells (5.1%), bones (20.3%), dentures (18.6%), and tablets (20.3%). The success rate of foreign body removal under a bronchoscope was 96.7%, 28.8% of the foreign bodies were on the left and 69.5% on the right. 5.1% of the elderly patients required rigid bronchoscopy, and 6.8% required two bronchoscopies. In elderly cohorts, tracheal foreign bodies are obscured by nonspecific clinical presentations and a paucity of aspiration history, challenging timely diagnosis. Predominantly constituted by food particles, with a notable predilection for the left bronchial tree, these cases demand skilled bronchoscopic management, occasionally requiring sophisticated approaches for successful extraction.

Translocation of a fish spike from the pharynx to the thyroid gland: A case report

BACKGROUND A fish spike stuck in the throat is a common ear, nose, and throat (ENT) emergency. However, it is very rare for a fish spike to reach the thyroid tissue through the throat, which is very dangerous and can lead to pharyngeal fistula, cervical abscess, mediastinal abscess, and thyroid abscess. Proper and timely management can help reduce complications, especially in elderly patients. CASE SUMMARY In the case presented here, the causative factor was dentures, but improper management aggravated the condition. In the case presented here, an elderly woman with a history of accidentally swallowing fish bones for 20 d had a sensation of foreign bodies in her throat. Eventually, computed tomography (CT) of the neck showed that the left side of the thyroid gland had a dense shadow in the form of a stripe. CONCLUSION If a fishbone foreign body is not visible during endoscopic examination but the patient has significant symptoms, the surgeon should be aware that the fishbone may be lodged in the thyroid. To avoid a misdiagnosis, ultrasound, CT, and other tests can be used to clarify the diagnosis. T The first step in treating a fish bone in the thyroid gland is to determine the position of the foreign body and the extent of the infection, and to develop a personalized surgical plan for its removal. At the same time, scientific information should be made available to the general public so that people know that if a fish bone is accidentally lodged, they should not force it to be swallowed or be spit out by inducing vomiting, which are incorrect methods and may aggravate the condition or even cause it to migrate outside the cavity, leading to serious complications, as in this reported case.

Novel KMT2B gene mutation in MUC4 positive low-grade fibromyxoid sarcoma

BackgroundLow-grade Fibromyxoid Sarcoma(LGFM)is a rare fibrosarcoma, which mainly occurs in young people and is mostly seen in the trunk and limbs. The tumor is usually FUS-CREB3L2 fusion caused by t(7;16)(q32-34;p11)chromosome translocation, and rarely FUS-CREB3L1 and EWSR1-CREB3L1 fusion. MUC4 diffuse strong positive can be used as a specific index of LGFM. LGFM is similar to Sclerosing Epithelioid Fibrosarcoma(SEF) and may have the same origin.Case presentationWe report a case of LGFM in the chest wall. A female who is 59 years old. In 2016, CT showed dense nodule shadow and focal thickening of the left pleura, the patient underwent surgery, Pathological report that low to moderate malignant fibrosarcoma(fibromyxoid type). The CT re-examination in 2021 showed that the tumors on the left chest wall were significantly larger than before. Pathological examination showed the disease is composed of alternating collagen like and mucinous areas. Under high-power microscope, the tumor cells are consistent in shape, spindle or short spindle, and the tumor cells are arranged in bundles. In local areas, the density of tumor cells is significantly increased, mixed with collagen fibers, and small focal SEF appear. The result of immunohistochemistry showed that SMA, Desmin, CD34, STAT6, S100, SOX10, HMB45 and Melan A were negative, EMA was weakly positive, MUC4 was diffuse and strongly positive, and Ki67 index was low (3%).ConclusionSequencing results showed that MET, EGFR, KMT2B and RET gene were mutated in LGFM, and KMT2B gene had cancer promoting effect, but there was no literature report in LGFM, which may be of certain significance for the diagnosis and treatment of LGFM.

A foreign body that has been left for 20 years causes a pseudoaneurysm of the middle cerebral artery: a case report

BackgroundWe report a patient with extensive subarachnoid hemorrhage caused by the rupture of a middle cerebral artery pseudoaneurysm from a foreign body that had been left for two decades.Case presentationA 74-year-old male patient from Han nationality was admitted to the emergency department of our hospital with impaired consciousness for 1 hour. Cranial computed tomography examination indicated a massive subarachnoid hemorrhage with intraventricular blood accumulation, and a high-density short strip dense shadow was seen in the M1 segment of the right middle cerebral artery, considering the possibility of a foreign body. Subsequently, a cerebral angiography was suggested; the foreign body was seen through the right middle cerebral artery, and the aneurysm was seen in the lower wall, so a pseudoaneurysm was considered. The emergent surgical intervention involved the clipping of the pseudoaneurysm and intracranial extraction of the foreign body. Unfortunately,the patient ultimately expired due to severe pulmonary infection.ConclusionIntracranial pseudoaneurysm caused by foreign body has been rarely reported previously, and microsurgical treatment of an intracranial pseudoaneurysm caused by a foreign body is a good choice.

Early antithrombotic therapy in patients with postinterventional cerebral hyperdensity reduces early neurological deterioration after mechanical thrombectomy

BackgroundInitiation of early antithrombotic therapy after acute ischemic stroke (AIS) is crucial. We aimed to investigate whether early antithrombotic therapy influences early neurological deterioration (END) in AIS patients with postinterventional cerebral hyperdensity (PCHD) immediately after mechanical thrombectomy (MT).MethodsWe retrospectively analyzed 108 consecutive anterior circulation AIS patients with PCHD immediately after MT. All patients were divided into END group and non-END group and END was defined as an increase of four points or more on the postinterventional National Institutes of Health Stroke Scale (NIHSS) score within the first 72 h after MT. Early antithrombotic therapy was defined as patients with PCHD who received antithrombotic therapy within 24 h after MT. Statistical analyses were performed to evaluate the association between early antithrombotic therapy and the risk of END.ResultsAmong 108 patients, 27 (25%) patients developed END. Multivariate regression analysis revealed that early use of antithrombotic therapy (OR = 0.229, 95%CI = 0.083–0.626, P = 0.004) was an independent protector of END and postinterventional low density shadow exceeding 1/3 of the vascular territory (OR = 4.000, 95%CI = 1.157–13.834, P = 0.029) was an independent risk factor for END.ConclusionAntithrombotic therapy within 24 h after MT maybe associated with the reduced risk of END in anterior circulation AIS patients with PCHD.

Medical image segmentation of gastric adenocarcinoma based on dense connection of residuals.

Accurate segmentation of gastric cancer based on CT images of gastric adenocarcinoma is crucial for physicians to screen gastric diseases, clinical diagnosis, preoperative prediction, and postoperative evaluation plans. To address the issue of the inability of the segmentation algorithm to depict the correct boundaries due to unclear gastric contours in the lesion area and the visible irregular band-like dense shadow extending to the perigastric region, a 3D medical image segmentation model 3D UNet based on residual dense jumping method is proposed. In the method we proposed, Residual Dense Block, which is applied to the image super-resolution module to remove CT artifacts, and Residual Block in ResNet are further fused. The quality of CT images is improved by Residual Dense Skip Block, which removes banded dense shadows, preserves image details and edge information, captures features, and improves the segmentation performance of gastric adenocarcinoma. The Instance Normalization layer position is modified to select the best result. Different loss functions are also combined in order to obtain the best gastric adenocarcinoma segmentation performance. We tested the model on a hospital-provided gastric adenocarcinoma dataset. The experimental results show that our model outperforms the existing methods in CT gastric adenocarcinoma segmentation, in which the method combining the hybrid loss function of Dice and CE obtains an average dice score of 82.3%, which is improved by 5.3% and 3.8% compared to TransUNet and Hiformer, respectively, and improves the cross-merge rate to 70.8%, compared to nnFormer, nnUNet by 1% and 0.9%, respectively. The residual jump connection structure indeed improves segmentation performance. The proposed method has the potential to be used as a screen for gastric diseases and to assist physicians in diagnosis.

Dermoid Cyst of the Mesentery of the Jejunum Following Appendectomy: A Clinical Case

Mesenteric cysts and cystic mesenteric tumors are very rare abdominal growths. They may be localized all over the mesentery, from the duodenum to the rectum, however, they are mostly found in the ileum and right colon mesentery. There are several classifications of these formations, among which the one based on histopathologic features including 6 groups has been most commonly used: 1) cysts of lymphatic origin--lymphatic (hilar cysts) and lymphangiomas; 2) cysts of mesothelial origin--benign or malignant mesothelial cysts; 3) enteric cysts; 4) cysts of urogenital origin; 5) dermoid cysts; and 6) pseudocysts-infectious or traumatic etiology. A dermoid cyst is a benign, epithelial-lined cavitary lesion composed of ectoderm and mesoderm that can arise anywhere in the body, with a tendency to develop in midline structures. In 20% - 45% of cases, accompanying diseases that were not previously clinically manifested can be diagnosed during emergency interventions, requiring additional surgical interventions for their correction. The aim of the study is to demonstrate the successful treatment experience of a dermoid cyst of the mesentery of the jejunum, detected after traditional appendectomy. Clinical case: A mother brought her 9-year-old son, V., to the emergency department of the Kursk Regional Children’s Clinical Hospital with complaints of moderate-intensity pain in the right iliac region, multiple episodes of vomiting, and fever. Ultrasound features indicative of destructive appendicitis and peritonitis. In an emergency situation, after preoperative preparation, a traditional appendectomy was performed under intravenous anesthesia, using the Volkovich-Dyakonov approach. The postoperative period was uneventful. Moderate infiltration was observed on the control abdominal ultrasound examination, in the intestine (presumably the small intestine) in the right half of the abdominal cavity, with a solid formation measuring 27*33 mm, producing a dense acoustic shadow. On the 7th day after the initial intervention, a revision of the abdominal organs was performed. The loop of the jejunum with the formation was brought out into the wound. The capsule above the formation was dissected: the formation of bone density, when the capsule is separated, resembles a fecal stone in structure, considering the localization - a dermoid cyst. Step-by-step enucleation of the cyst was performed. The postoperative wound was tightly sutured in layers.

DIFFERENTIAL DIAGNOSIS OF COMMUNITY-ACQUIRED PNEUMONIA FROM COVID-19 BY COMPUTED TOMOGRAPHY

The retrospective study was conducted on data collected from tertiary Care Hospitals from January 2020 to May 2021 to compare CT manifestations and clinical features of COVID-19 with CAP and evaluate the diagnostic accuracy of CT in patients with COVID-19 and CAP. The study included one hundred sixty patients with COVID-19 and 115 with CAP diagnosed during the same time. Clinical data and CT images of the participants were collected. Results showed that 134 (84.3%) patients in the COVID-19 group had ground glass opacities on CT scans. In the COVID-19 group, the typical early presentation was single or multiple small round lesions. 51 (31.8%) patients had small lesions, and 83 (51.8%) had large patches, areas of fusion, or density shadows with spots. In the CAP group, 69 (60%) patients had consolidation, and 45 (39.1%) had ground glass shadows. There was a significant difference in density between both groups (P &lt;.001). Of observed imaging and clinical manifestations, ground glass shadows, number of leukocytes, and age factor are clinically significant in diagnosing COVID-19. In the CAP group, major characteristics were the thickening of the bronchial wall, accumulation of textures and fibrous cords, and consolidated lung lesions. In COVID-19, common imaging manifestations of GGO and consolidation. Clinically, a CT scan should be used along with history and examination for early and accurate diagnosis of COVID-19.

Pathology-based CT Imaging Performance Contrast Study of Osteosarcoma and Chondrosarcoma

This paper aims to compare the CT imaging features of osteosarcoma and chondrosarcoma based on pathology evidence. 27 patients with osteosarcoma or chondrosarcoma confirmed by surgical pathology in our hospital from October 2018 to February 2023 were retrospectively selected. Among them, 15 cases of osteosarcoma and 12 cases of chondrosarcoma underwent conventional CT scanning. The CT findings and diagnostic efficacy of each measurement parameter of the two types of patients were compared. Compared with osteosarcoma, the incidence of chondrosarcoma was significantly increased (P&lt;0.05). Of the 15 cases of osteosarcoma, 9 cases (60.00%) developed in the long tubular bone. Of the 12 cases of chondrosarcoma, 7 cases (58.33%) occurred in axial bone, and the difference between them was significant (P&lt;0.05). The appearance of periosteal reactions, Codman's triangle, and radial bone needles indicates a higher incidence of osteosarcoma, while the appearance of type IV calcium density shadow indicates a higher incidence of chondrosarcoma.

Clinical features and outcome of eight patients with Chlamydia psittaci pneumonia diagnosed by targeted next generation sequencing.

The clinical symptoms of Chlamydia psittaci pneumonia are still poorly understood. This study was designed to summarize the clinical features and outcome of eight C. psittaci pneumonia patients diagnosed by targeted next generation sequencing (tNGS). We included eight C. psittaci pneumonia patients admitted to our hospital from January 2021 to July 2022. The tNGS was performed to the samples collected from bronchoalveolar lavage fluid of each patient. Their clinical data were analysed, including baseline features, clinical symptoms, chest radiographic findings and laboratory examinations. The tNGS sequence number for C. psittaci was in a range of 10 to 1722. The radiographic characteristics were mainly featured by patchy consolidation shadows, ground-glass density shadows, air bronchogram and slight pleural effusion. Within 1-3days after hospitalization, most patients showed increased neutrophil ratio, C-reactive protein and erythrocyte sedimentation rate, and decreased lymphocyte count, total protein, albumin and prealbumin. Some patients showed increased glutamic-pyruvic transaminase, glutamic-oxaloacetic transaminase and lactate dehydrogenase levels. Three critically ill patients showed increased creatine kinase, creatine kinase isoenzyme and high-sensitivity troponin T (hs-TnT) levels. A poultry or bird contact history, typical flu-like symptoms, patchy consolidation, ground-glass density shadow and air bronchogram may contribute to the diagnosis and treatment of C. psittaci pneumonia. Increase in creatine kinase, creatine kinase isoenzyme and hs-TnT may indicate a severe condition. Moxifloxacin and minocycline were effective in the management of C. psittaci pneumonia.

Clinical analysis of nodular fasciitis in the head and neck

Objective: To analyze the clinical features, diagnosis, treatment and prognosis of nodular fasciitis (NF) in the head and neck. Methods: Seven cases of primary NF in the head and neck admitted to Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from 1990 to 2022 were retrospectively analyzed, including 3 males and 4 females, aged from 2 to 67 years, and the location, course of disease, clinical manifestations, imaging findings, and treatment results of the disease were summarized. Results: Of the 7 patients, the primary sites were respectively nasal vestibule, paranasal sinus, nasal dorsum, sella turcica and clivus, neck, subglottis, and tonsil. Three cases presented with rapidly growing subcutaneous painless masses within 2 months, 1 case presented with hemoptysis, hoarseness and asthma for 28 days, 1 case presented with blood in the nasal discharge for 2 months, 1 case presented with headache for 1 month, and 1 case was found to have tonsillar neoplasms on physical examination for 3 days. CT was performed in 5 patients and the lesions showed soft tissue density shadows, and MRI was also performed in 2 of them, which showed T1 isointensity or T2 slightly long abnormal signal shadows. All patients underwent simple surgical resection of the mass. The patients were followed up for 13 months to 10 years, and none had recurrence. Conclusion: Primary NF in the head and neck is rare, with atypical clinical symptoms and imaging findings. Surgery is the mainstay of treatment for NF with good results.

Evaluation of computed tomography images under deep learning in the diagnosis of severe pulmonary infection.

This work aimed to explore the diagnostic value of a deep convolutional neural network (CNN) combined with computed tomography (CT) images in patients with severe pneumonia complicated with pulmonary infection. A total of 120 patients with severe pneumonia complicated by pulmonary infection admitted to the hospital were selected as research subjects and underwent CT imaging scans. The empty convolution (EC) and U-net phase were combined to construct an EC-U-net, which was applied to process the CT images. The results showed that the learning rate of the EC-U-net model decreased substantially with increasing training times until it stabilized and reached zero after 40 training times. The segmentation result of the EC-U-net model for the CT image was very similar to that of the mask image, except for some deviations in edge segmentation. The EC-U-net model exhibited a significantly smaller cross-entropy loss function (CELF) and a higher Dice coefficient than the CNN algorithm. The diagnostic accuracy of CT images based on the EC-U-net model for severe pneumonia complicated with pulmonary infection was substantially higher than that of CT images alone, while the false negative rate (FNR) and false positive rate (FPR) were substantially lower (P < 0.05). Moreover, the true positive rates (TPRs) of CT images based on the EC-U-net model for patchy high-density shadows, diffuse ground glass density shadows, pleural effusion, and lung consolidation were obviously higher than those of the original CT images (P < 0.05). In short, the EC-U-net model was superior to the traditional algorithm regarding the overall performance of CT image segmentation, which can be clinically applied. CT images based on the EC-U-net model can clearly display pulmonary infection lesions, improve the clinical diagnosis of severe pneumonia complicated with pulmonary infection, and help to screen early pulmonary infection and carry out symptomatic treatment.

Post-dural puncture headache combined with pneumocephalus secondary to vaginal delivery following epidural anesthesia: a case report

BackgroundPneumocephalus is rare in vaginal deliveries. Pneumocephalus may be asymptomatic or present with signs of increased intracranial pressure. However, parturients who received epidural anesthesia with air in their brains may experience low intracranial pressure headaches after giving birth, causing the diagnosis of pneumocephalus to be delayed. We report a case of a parturient who developed post-dural puncture headache combined with pneumocephalus secondary to vaginal delivery following epidural anesthesia.Case presentationA 24-year-old G1P0 Chinese woman at 38 weeks gestation was in labor and received epidural anesthesia using the loss of resistance to air technique and had a negative prior medical history.She presented with postural headache, neck stiffness and auditory changes 2 h after vaginal delivery. The head non-contrast computed tomography revealed distributed gas density shadows in the brain, indicating pneumocephalus. Her headache was relieved by bed rest, rehydration, analgesia, and oxygen therapy and completely disappeared after 2 weeks of postpartum bed rest.ConclusionsThis is the first report that positional headaches after epidural anesthesia may not indicate low intracranial pressure alone; it may combine with pneumocephalus, particularly when using the loss of resistance to air technique. At this moment, head computed tomography is essential to discover other conditions like pneumocephalus.

AHF: An Automatic and Universal Image Preprocessing Algorithm for Circular-Coded Targets Identification in Close-Range Photogrammetry under Complex Illumination Conditions

In close-range photogrammetry, circular-coded targets (CCTs) are a reliable method to solve the issue of image correspondence. Currently, the identification methods for CCTs are very mature, but complex illumination conditions are still a key factor restricting identification. This article proposes an adaptive homomorphic filtering (AHF) algorithm to solve this issue, utilizing homomorphic filtering (HF) to eliminate the influence of uneven illumination. However, HF parameters vary with different lighting types. We use a genetic algorithm (GA) to carry out global optimization and take the identification result as the objective function to realize automatic parameter adjustment. This is different from the optimization strategy of traditional adaptive image enhancement methods, so the most significant advantage of the proposed algorithm lies in its automation and universality, i.e., users only need to input photos without considering the type of lighting conditions. As a preprocessing algorithm, we conducted experiments combining advanced commercial photogrammetric software and traditional identification methods, respectively. We cast stripe- and lattice-structured light to create complex lighting conditions, including uneven lighting, dense shadow areas, and elliptical light spots. Experiments showed that our algorithm significantly improves the robustness and accuracy of CCT identification methods under complex lighting conditions. Given the perfect performance under stripe-structured light, this algorithm can provide a new idea for the fusion of close-range photogrammetry and structured light. This algorithm helps to improve the quality and accuracy of photogrammetry and even helps to improve the decision making and planning process of photogrammetry.

Nasal Alar and Scalp Metastases From Lung Carcinoma: A Case Report and Literature Review.

Both nasal alar and scalp metastases from lung carcinoma are exceedingly rare. Herein, we report a case of an elderly male smoker who had left lung carcinoma and underwent radical resection. Seven months later, masses began to appear on his nasal alar and parietal scalp which gradually increased in size. The nasal computed tomography and head magnetic resonance imaging scan revealed a dense soft tissue shadow in the right nasal alar and nasal cavity, as well as a soft tissue nodule in the middle of the parietal scalp. A biopsy was performed and immunohistochemistry suggested poorly differentiated metastatic carcinoma that was consistent with the characteristics of primary lung carcinoma and supported the diagnosis of nasal alar and scalp metastases. Then, he received a combined treatment of Albumin paclitaxel and Xindirizumab. However, he passed away 3 months later. In addition to this case, we also review the clinical features of nose and/or scalp metastases from lung carcinoma based on previously reported cases as well as this case.

Eosinophilic solid and cystic renal cell carcinoma with TSC2 mutation: a case report and literature review

BackgroundEosinophilic solid and cystic renal cell carcinoma (ESC-RCC) is an under-recognized, emerging new entity of sporadic renal neoplasms, which is listed as a rare type of renal cell carcinoma in the 2022 WHO renal tumor classification. It is easily misdiagnosed because its characteristics are insufficiently understood.Case presentationWe report one case of ESC-RCC, a 53-year-old female patient with a right kidney mass found during clinical examination. The patient experienced no discomforting symptoms. Computer-tomography imaging at our urinary department showed a round soft tissue density shadow around the right kidney. Microscopic examination revealed a tumor displaying a solid-cystic composition of eosinophilic cells with unique features, revealed by characteristic immunohistochemical markers (CK20-positive/CK7-negative), and a nonsense mutation in TSC2. Ten months after the renal tumor resection, the patient presented in good condition with no recurrence or metastasis.ConclusionsThe distinct morphological, immunophenotypic, and molecular characteristics of ESC-RCC we describe here, based on our case and the relevant literature, highlight the key points of the pathological and differential diagnosis of this novel renal neoplasm. Our findings will therefore deepen our understanding of this novel renal neoplasm and help reduce misdiagnosis.

A case of metallosis mimicking cutaneous malignant melanoma following total elbow arthroplasty

AbstractMetallosis manifests as an abnormal dark macroscopic staining of periprosthetic tissues by metallic particles from the prosthesis. This complication is uncommon in non‐weight‐bearing joints such as the elbow. We describe a rare case of metallosis mimicking cutaneous malignant melanoma following total elbow arthroplasty (TEA). A 77‐year‐old Japanese woman presented to our clinic with a black nodule within a blue‐greyish pigmentation on the left elbow. She had undergone a left TEA 8 years before presentation. X‐ray showed an amorphous increased density shadow accompanied by high‐density substances in the periprosthetic tissues, consistent with the features of metallosis. Surgical debridement and prosthetic removal were performed. Histopathological examination of the pigmented skin around the nodule revealed a dense infiltration of histiocytes with brownish to blackish granular particles in the dermis. The black‐stained periprosthetic tissues exhibited many multinucleated giant cells and histiocytes with similar particles. Additionally, analysis of the paraffin sections containing particles and the scanning electron microscope‐energy dispersive X‐ray spectroscopy (SEM‐EDX) revealed that the metal was composed of titanium and aluminium, which were components of the prosthesis. At the patient's first visit to our clinic, cutaneous malignant melanoma was considered as a possible differential diagnosis based on the clinical appearance. To the best of our knowledge, previous cases of metallosis with this clinical presentation have not been reported.