Internal Septations Research Articles

Characterizing Theta-Emitter Generation for Use in Microdroplet Reactions.

Theta emitters are useful for generating microdroplets for rapid-mixing reactions. Theta emitters are glass tips containing an internal septum that separates two channels. When used for mixing, the solutions from each channel are sprayed with mixing occurring during electrospray ionization (ESI) with reaction times on the order of microseconds to milliseconds. Theta emitters of increasing size cause the formation of ESI droplets of increasing size, which require longer times for desolvation and increase droplet lifetimes. Droplets with longer lifetimes provide more time for mixing and allow for increased reaction times prior to desolvation. Because theta emitters are typically produced in-house, there is a need to consistently pull tips with a variety of sizes. Herein, we characterize the effect of pull parameters on the generation of distinct-sized theta emitters using a P-1000 tip puller. Of the examined parameters, the velocity value had the largest impact on the channel diameter. This work also compares the effect of pulling parameters between single-channel and theta capillaries to examine how the internal septum in theta capillaries affects tip pulling. We demonstrate the utility of using theta emitters with different sizes for establishing distinct reaction times. Finally, we offer suggestions on producing theta emitters of various sizes while maintaining high repeatability. Through this work, we provide resources to establish a versatile and inexpensive rapid-mixing system for probing biologically relevant systems and performing rapid derivatizations.

Equine Sarcocystosis in the Northern Region of the Republic of Kazakhstan.

A total of 396 samples were taken from the hearts, oesophagi, and diaphragms of 132 horses slaughtered at slaughterhouses in 2023 for subsequent examination. The histological method revealed pathomorphological changes in the muscle tissue. The molecular method identified the pathogen species. Histological examination revealed thick-walled cysts with internal septa and numerous bradyzoites, and mononuclear inflammatory cells with pericyst infiltrates. Microcyst samples were amplified by polymerase chain reaction. Molecular genetic analysis allowed for the identification of 18 sarcocysts. Phylogenetic analysis of Sarcocystis isolates revealed three separate clades of Sarcocystis bertrami and two separate clades of Sarcocystis fayeri. Comparison and phylogenetic analysis revealed a very close relationship between the identified Sarcocystis species and other equine Sarcocystis DNA sequences from China and Japan. Based on the results obtained, the epizootic situation and the parasitic level of sarcocystosis contamination of horses in the northern Kazakhstan were determined. This is the first histological and molecular study to identify Sarcocystis spp. isolated from microscopic forms of equine sarcocysts in the northern Kazakhstan. This research will contribute to the fight against the spread of sarcocystosis in the Republic of Kazakhstan and will allow us to develop proposals for improving the mechanisms of sarcocystosis control.

Painful Enlarging Cervical Mass in Young Male.

A 32-year-old male who recently immigrated from Kenya presented to the emergency department (ED) with a painful, enlarging, right-sided neck mass for eight weeks duration. Point-of-care ultrasound was used to reveal a large cystic mass with internal septations and numerous hypoechoic round lesions. Initial tuberculosis blood test ordered in the ED was positive with cultures ultimately growing Mycobaceterium tuberculosis. Scrofula should be considered in the differential in patients presenting with enlarging neck masses who have epidemiological risk factors for tuberculosis.

Uterine hydatidosis: casuistry is possible

Introduction. Hydatidosis is a severe parasitic disease caused by tapeworm Echinococcus granulosus widely spread in some endemic areas all over the world that primarily targets liver, lung, bones, muscles well as pelvis in casuistic cases. Due to the lack of pathognomonic signs as well as low prevalence rate of hydatid cysts in such anatomic sites, a differential diagnosis for relevant gynecological pathologies may be substantially complicated. Compared with common gynecological disease such as uterine fibroids, ovarian cyst and malignancies uterine hydatidosis may be identified only in 0.16 % cases.Aim: to present a clinical case of uterine hydatid cyst in order to optimize algorithms for differential diagnosis of primary pelvic echinococcosis and gynecological pathology, which is necessary for successfully conducted timely surgical treatment.Clinical case. In 2023, patient K. complained of dysuric phenomena and a feeling of heaviness in the pelvic area. Based on the anamnesis, clinical picture, laboratory and instrumental research methods, it was decided to perform surgical treatment. The patient underwent laparoscopic hysterectomy and removal of ¾ hydatid cyst. The obtained material was used for histological examination to verify the diagnosis.Results. Differential diagnosis of uterine echinococcosis is most often carried out with cystic or dysembryogenetic tumors, purulent or tuberculous abscesses, ovarian cysts, ovarian tumors, and uterine fibroids. Features of the MR picture, such as a thick compacted wall, the lack of internal septa, parietal and papillary outgrowths, as well as a solid component, allowed to suspect parasitic genesis of the neoplasm.Conclusion. While treating patients with cystic neoplasms of the pelvic area referred from endemic areas, echinococcosis should be included in the list of differential diagnostic searches.

Inguinal lymphangioma in an adult patient mimicking an irreducible inguinal hernia: A case report

IntroductionLymphangiomas are rare benign vascular malformations of the lymphatic system. They are usually located in the head, neck, and axilla and are typically present during the first two years of life. A few cases of inguinal lymphangioma have been reported in adults. Case presentationWe report a 35-year-old male who presented with left groin swelling for a one-year duration associated with on and off pain. On examination, he had soft, irreducible left inguinal swelling with positive cough impulse and no tenderness on palpation. Ultrasound (US) and magnetic resonance imaging (MRI) were done for him, showing a well-defined lobulated cystic lesion located between subcutaneous and deep fascia measuring around 6.5 × 4.2 × 8.1 cm with multiple internal septations. The lesion shows Low signal intensity in the T1 weighted image and high signal intensity in the T2 weighted image. 97 % alcohol was injected under US guidance and aspirated after 30 min. The swelling significantly decreased in size clinically and radiologically during the follow-up. Clinical discussionLymphangioma rarely occurs in the inguinal region, presenting a diagnostic challenge as it mimics various inguinal conditions. Differential diagnoses include inguinal hernia, hydrocele of the cord, lymphadenopathy, or hematoma. Imaging is used to determine the size, invasion, relation to surrounding structures, and extension to the abdominal cavity. MRI is the diagnostic modality of choice in non-emergency settings. Complete surgical excision is the gold standard for the management with the lowest risk of recurrence. Alternative non-surgical treatment options have been used successfully in poor surgical candidates. Different sclerosing agents have been used with low complications and rates of recurrence. Ethanol is a widely available sclerosing agent, and it was used with no recurrence or side effects during the follow-up period. ConclusionSurgeons should have a high index of suspicion when investigating any inguinal mass, considering such a rare presentation as part of the differential. Sclerotherapy is an effective treatment for lymphangioma and should be considered as an alternative modality in non-surgical candidates.

Encysted Odyssey: A Clinical and Pictorial Analysis of Hydatid Cysts From Head to Toe.

Cystic echinococcosis, a zoonotic disease caused by the larval form of Echinococcus granulosus, predominantly affects the liver and lungs, with humans acting as accidental hosts. Our retrospective study at the Department of Radiology and Imageology, Nizam's Institute of Medical Sciences, included 187 histopathologically or serologically proven cases. The mean age of presentation was 49.4 years. Liver involvement was most prevalent, accounting for 83.4% (n=156) of cases, followed by sporadic involvement of other organs such as the mesentery, spleen, pancreas, thalamus, kidney, lung, spine, and omentum. Characteristic diagnostic features observed on imaging included peripheral calcifications in 33% of cases, internal septations in 25% (n=47), dense calcifications in 15% (n=29), daughter cysts in 6% (n=11), and floating membranes in 5% (n=10). Among hepatic lesions, 90% (n=141) were showing involvement of a single lobe. Notably, 78% (n=110) of lesions were limited to the right lobe, 21% (n=30) to the left lobe, and 1% (n=1) to the caudate lobe. The most affected hepatic segment was segment VIII, while the least common was segment I (caudate lobe). Complications were identified in 13% (n=25) of cases of hepatic hydatidosis. The findings of our study emphasize the systemic nature of E. granulosusinfection which can affect various organs in the body. It also illustrates the invaluable insights imaging provides for timely and accurate diagnosis of hydatid disease.

A case of phyllodes tumor with rapid growth during pregnancy and lactation period: a case report

BackgroundThe age of onset of the phyllodes tumor is generally in the late 40 s, and diagnosis and treatment during pregnancy and lactation are rare. We herein present a case of a phyllodes tumor that rapidly increased in size during the pregnancy and lactation period.Case presentationA 39-year-old woman was referred to our hospital with a mass in the right breast that increased in size during the pregnancy and lactation period. On ultrasound (5 week postpartum), a well-defined lobulated mass with internal septations and fluid retention was observed. Magnetic resonance imaging of the breast at 8 week postpartum revealed a 70-mm-sized smooth-margin mass with multilocular cystic components. Marked proliferation of stromal cells with high cell density was observed in a biopsy specimen taken at the previous hospital. We diagnosed the mass as a phyllodes tumor of borderline malignancy and excised it at 13 week postpartum. The excised tumor was 85 mm in diameter and its interior was filled with a milk-like substance. Histologically, there was only a mild increase in stromal cell density but fibrosis with associated degeneration was prominent. The final diagnosis was benign phyllodes tumor with degeneration.ConclusionsWe report a case of a phyllodes tumor that rapidly increased in size during pregnancy and the lactation period. The accumulation of a milk-like substance was thought to be responsible for the rapid growth of the tumor.

A methodological approach to evaluate the dynamic response of internal septa and pillars in soft rock underground cavities

A large amount of underground cavities nowadays exists throughout the Apulian region (south-eastern Italy) as a result of mining processes of soft calcarenite, which frequently followed the “room and pillar” technique. In these cave systems, pillars and septa are critical structures, whose failure can lead to a significant increment of the sinkhole hazard. The behaviour of these rocky structures in the dynamic field is poorly studied in literature, and the present study aims to investigate their dynamic stability, according to regional seismicity data. For this purpose, ideal pillar geometries were considered, for which the evolution of the stress–strain field under dynamic inputs was observed in both 2D and 3- configurations by means of parametrical finite element analysis. For shallow cavities, slender septa were found to be the most affected by the influence of seismic loading. For deep cavities, dynamic instability is observed only for rather squat septa, with the cavity width also influencing the dynamic behaviour. To quantitatively assess the septum stability, a stability index was also proposed in 2D models. Moreover, three-dimensional analyses showed a stabilizing effect in the pillar exerted by the stress component perpendicular to the earthquake.

Radiological images of retroperitoneal dedifferentiated liposarcoma: a rare case report

Background: Retroperitoneal liposarcoma is a rare tumor with an incidence of 2.5 per 1 million individuals. This tumor usually occurs at the age of 50-70 years, although incidents in children have been reported. Imaging techniques such as Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) play an important role in the diagnosis and follow-up of retroperitoneal liposarcoma. To date, only a few cases of differentiated retroperitoneal liposarcoma have been reported. Therefore, the author wants to explain cases of differentiated retroperitoneal liposarcoma, in this case accompanied by recurrence. Case Report: A male 64-year-old patient complained of a lump appearing in his stomach. The lump in the stomach has appeared since the beginning of 2019. The first CT-Scan of the Abdomen without and with Contrast showed a left retroperitoneal mass with a cystic-solid-fat complex component, with internal septation, suspicious for microcalcification, which was attached to the nearby fascia and was pushing the left retroperitoneum organ to the right midline. The patient has undergone tumor resection, where in this patient the histopathological examination results showed a Malignant Mesenchymal Tumor, tending to Dedifferentiated Liposarcoma. A recurrence was reported after the surgery. The patient underwent another laparotomy surgery to resect the tumor. From the results of the last control, the patient's condition is still stable and from the results of abdominal MRI with the results there is no visible residive nor residual mass in the retroperitoneum or intraperitoneum. Conclusion: Retroperitoneal liposarcoma is usually asymptomatic until the liposarcoma is large enough to press on the surrounding organs. It is often misdiagnosed due to its rarity and absence of symptoms. However, imaging techniques such as MRI and CT play an important role in the diagnosis and follow-up of retroperitoneal liposarcoma.

Cross-Sectional Imaging Characteristics of Pancreatic Intraductal Oncocytic Papillary Neoplasms.

Pancreatic intraductal oncocytic papillary neoplasms (IOPN) are rare precursors to pancreatic ductal adenocarcinoma. We report cross-sectional computed tomography and magnetic resonance imaging (where available) findings of pancreatic IOPNs. Consecutive cases of pancreatic IOPNs identified on pathology between 2008 and 2020 at University of Pittsburgh and Johns Hopkins University were included in the study. Cross-sectional imaging of all patients was reviewed by two subspecialty trained abdominal radiologists. Patient demographics, cross-sectional imaging appearances and growth characteristics were evaluated. In this dual-center study, 14 patients with IOPNs were included. Median age was 64 years, and 64% were male. The median size of the lesions was 5.4 cm (range, 1.4-12.3 cm). All patients had either an enhancing mural nodule (93% of patients) and/or thick internal septations (29%). Thin/imperceptible outer wall was seen in 93%. Main duct was involved in 64% of the cases. Only 14% of the cases did not demonstrate abutment of the main duct. Histologic evaluation of surgical specimen showed high-grade dysplasia without invasive carcinoma in 57% and invasive carcinoma in 43% of cases. Lesions with invasive carcinoma were larger (7.1 cm vs 4.3 cm, P = 0.05) and tended to have larger mural nodule (3.7 cm vs 1.8 cm) compared with those without invasive carcinoma. Pancreatic IOPNs are rare cystic premalignant lesions, which among resected cases, are predominantly seen in middle aged men, are often large, have enhancing mural nodules and frequently harbor invasive carcinoma.

Evaluation of molecular subtypes of breast cancer using MRI BI-RADS Lexicon

BackgroundMolecular subtyping of breast cancer is one of the prognostic factors which play a very important role in managing patient’s treatment plan. The MRI BI-RADS Lexicon is initially used to categorize breast lesions but recent attempts were employed to differentiate breast lesions based on their molecular subtypes using this lexicon. The study aimed to evaluate of the role of the MRI BI-RADS Lexicon in classifying different molecular subtypes of breast cancer especially after coupling with Kaiser scoring system.MethodsThis retrospective study was conducted on 147 patients with 170 malignant breast lesions. They underwent Pre-contrast and a Dynamic contrast MRI study. Retrospective interpretation of the morphological and dynamic criteria of the breast lesions based on the MRI BI-RADS criteria was carried out followed by reassessment of the same lesions by Kaiser scoring. Resulting data were correlated with histopathological and immunological characterization.ResultsLuminal subtypes were more frequently encountered as mass lesions, contrary to the Non-Luminal lesions which showed a more frequent non-mass presentation value (P 0.002). The shape, margin, internal enhancement pattern of the mass lesions showed significant variability between different molecular subtypes (P < 0.001, < 0.001, < 0.001) respectively. On Dynamic study, Plateau curve was a more evident pattern with Luminal lesions contrasting with their Non-Luminal counterparts which showed a washout pattern more frequently (P 0.0004). Most of luminal A cancers were presented as mass lesions with rim enhancement and categorized as BIRADS 4 while most of Her2neu positive cancers (including luminal B entity) were presented as non-mass lesions with irregular shape and dark internal septations and categorized as BIRADS 5 with statistically significant values (P < 0.001). Coupling with Kaiser scoring system improved the categorization of non-luminal tumors as BIRADS 5 lesions especially the aggressive TN cancers.ConclusionsMRI-BIRADS lexicon can be of great value in the non-invasive molecular characterization of breast cancer. Kaiser score improved the categorization of TN cancers which were upgraded to BIRADS 5 category.

A rare case of fibrous dysplasia in the mandible: a case report

Background: Fibrous dysplasia (FD) is a benign fibro-osseous lesion of the bone which can be monostotic FD and the polyostotic form. Polyostotic FD with café-au-lait spots of the skin and hormonal imbalances is called McCune–Albright syndrome. Besides, Mazabraud syndrome is characterized by polyostotic FD and intramuscular myxomas. FD has its onset during childhood or early adolescence and usually occurs within the first or second decade of life.&#x0D; The mode of presentation of the FD of the jaw ranges from asymptomatic to dental anomalies, pain, and facial asymmetry. Given the clinical history and radiological assessment, cystic lesions have some important differential diagnoses which range from cystic ameloblastoma, fibrous dysplasia, aneurysmal bone cyst, and odontogenic keratocyst.&#x0D; Case report: This presents a 19-year-old female who presented to the maxillofacial surgeons’ clinic with a referral from a peripheral hospital. Her major complaint was right-sided facial swelling which was noticed 4 years before the presentation. A plain radiograph revealed an expansile lesion of the mid-right mandible appearing as a well-outlined, fairly oval multiloculated cystic radiolucent mass with multiple internal septations. A preliminary diagnosis of a complex cystic right jaw mass with benign features was made with possible differential diagnoses such as ameloblastoma, fibrous dysplasia, aneurysmal bone cyst, and odontogenic keratocyst were suggested as possible differential diagnoses. Finally, she had an excision biopsy with a histological diagnosis of fibrous dysplasia. The outcome of the surgery was satisfactory at one year review.&#x0D; &#x0D;

Intra-axial Hepatic Cerebrospinal Fluid Pseudocyst: An Unusual Complication of Ventriculoperitoneal Shunt Placement

Intra-abdominal Cerebrospinal Fluid (CSF) pseudocysts are a well-known and potentially serious complication of Ventriculoperitoneal (VP) shunt placement. These cysts are often found within the peritoneal cavity or along the serosal surface of solid organs. Here, we present an unusual case of an intrahepatic CSF pseudocyst in a 14-year-old female patient with a VP shunt placed three years ago, following the excision of a cerebellar pilocytic astrocytoma. The child presented with complaints of right hypochondriac pain and tenderness for one month. On ultrasound of the abdomen, the right lobe of the liver showed a complex anechoic cystic collection with multiple thick internal septations. A Contrast-enhanced Computed Tomography (CECT) examination revealed a well-defined hypodense collection in segments IV and V of the liver with a VP shunt tube within. Based on clinical and imaging features, differentials of intra-axial intrahepatic CSF pseudocyst, complex hepatic cyst, peri-shunt hemorrhagic cyst, and biliary cystadenoma were considered. Aspiration of the cyst revealed clear, colourless, non purulent, non sanguineous fluid which tested positive for beta-2-transferrin, confirming the collection to be a CSF pseudocyst. An elective laparoscopic cyst excision with shunt revision was performed with no recurrence on follow-up. The present case highlights the uncommon occurrence of intrahepatic CSF pseudocysts post-VP shunt, necessitating meticulous diagnostic evaluation. Successful laparoscopic excision and shunt revision underscore the efficacy of tailored interventions. This contribution enhances the understanding of atypical complications in VP shunt recipients, guiding clinicians and radiologists in both diagnosis and management.

A Large Recurrent Retroperitoneal Lymphangioma in a Previously Healthy Adolescent Male: A Case Report

Lymphangiomas are uncommon benign lymphatic vessel tumors that can affect any area of the body served with the lymphatic system. Intra-abdominal lymphangiomas are considered rare, accounting for less than 5 percent of all lymphangioma cases. In this case report, we present a recurrent large retroperitoneal lymphangioma in a previously healthy 15-year-old boy. The patient presented to the Emergency Department with abdominal pain lasting for one week. The pain, described as diffuse, crampy, and non-radiating, gradually increased with time and was aggravated by movement. A large retroperitoneal fluid collection was found on the Computed Tomography (CT) scan. Subsequently, the patient underwent CT-guided drainage, at which 700ml of bloody fluid was extracted. After three months, the patient was readmitted to the hospital for a similar presentation of abdominal fullness and pain. Complete blood count analysis indicated an unremarkable profile, except for a left shift of 82.2% neutrophils and a white blood cell count of 11,300/mcl. A CT scan of the abdomen reported a large, thin-walled cystic lesion in the right hemi-abdomen with minimal thin internal septations, resulting in moderate right hydronephrosis/hydroureter.

Recurrent Endometriotic Cyst with High Ca-125 Level Mimicking Malignancy

Gynecologists who treat endometriosis, a chronic, disabling disease, face difficulties diagnosing and treating the condition. Endometriotic cyst, with internal septations and opacities sonologically, mimics malignancy. Increased levels of CA 125 Are used as a tumor marker in epithelial ovarian malignancies. It is also an important prognostic indicator and follow-up tool in managing ovarian malignancies. A moderate increase in CA125 levels is observed in physiological conditions like ovulation and benign conditions like endometriosis and PID. We present here a case of extremely elevated serum CA 125 level in a patient who presented with recurrent ovarian endometriosis. Mrs. X, 46 years old, presented with a complex ovarian cyst with CA 125 level- 1021 iu/ml. With a history of laparotomy for endometriotic cysts in the past. Intraoperatively bilateral complex ovarian cysts were identified, which were densely adherent to the lateral pelvic wall and rectum posteriorly. The ovarian cysts were excised with a hysterectomy. The Patient developed dribbling of urine on the third postoperative day. CT urogram revealed a right ureterovaginal fistula. Laparotomy done. Uretero ureteral anastomosis done by a urologist. The Postoperative patient remained dry. Histopathological evaluation revealed benign endometriosis. Extensive and aggressive surgeries are usually done for ovarian malignancies to provide optimal reduction. However, in our patient, risk assessment for malignancy based on radiological factors and tumor markers was highly suggestive of malignancy. Yet, the histopathology turned out to be benign endometriosis. Therefore, to avoid invasive investigations and surgeries associated with high morbidity, emphasis must be made on the possibility of raised CA 125 levels in benign conditions such as endometriosis.

The hypoglycemic effects of Juglans regia L. internal septum in type 2 diabetic patients: A double-blind, randomized, placebo-controlled clinical trial.

The internal septum of J.regia is traditionally used to control diabetes, and its effectiveness has been shown in animal studies. Accordingly, human clinical trials are needed to confirm its effectiveness on hemoglobin A1c (HbA1c), fasting blood sugar (FBS), blood insulin level, and insulin resistance as a complementary for better control of type 2 diabetes. This study was a randomized, double-blinded, controlled trial. The lyophilized powder of extract of the internal septum of J.regia was used to fill the capsules. Sixty type 2 diabetic patients were randomly divided into two groups. 500 mg capsules three times daily before meal was added to their routine drug regimen, and HbA1c, FBS, and blood insulin level were checked at the baseline and after three months. Sixty patients completed the study. The mean(±SD) age of patients was 49.1(10.2) and 50.9(12.7) years in the placebo and J.regia groups, respectively. We observed that J.regia internal septum increases the level of HbA1c by about 0.02 units, but this effect was not significant (MD=0.02,95%CI=-0.36 to 0.40, P=0.93). Regarding the impact of capsules on insulin level, it seems that J.regia-containing capsules can raise insulin level by one unit. However, it was not significant (MD=1.01,95%CI=-0.86 to 2.88, P=0.28). As for FBS, it can cause a decrease of four units, but this effect is also not significant (MD=-3.98,95%CI=-18.33 to 10.37, P=0.58). Based on our study, the internal septum of J.regia has no significant effect on HbA1c, FBS, and insulin resistance. Moreover, no specific adverse reaction was observed in any of the patients.

An unusual radiological manifestation of a mandibular central giant cell granuloma

Central giant cell granuloma (CGCG) is an uncommon benign osseous lesion of the jaw. We present the case of an aggressive CGCG in a 16-year-old boy with a 5-month history of facial swelling and nasal obstruction. He was referred for a radiology consult for multiple expanding swellings on the right hemi-face. The swellings were reported to have an insidious onset, slow progression and no association with paresthesia, nasal discharge, or systemic symptoms. Extra oral examination revealed a diffuse swelling on the right side of the face which obliterated the nasolabial fold causing facial asymmetry. A face and neck computed tomography (CT) showed expansile multi loculated lytic lesions of the right mandibular ramus which involved the condyle and hard palate. Similar lesions were also found in the skull base. Scans showed fine internal septations and internal ground glass haze. It also revealed involvement of several teeth roots and surrounding soft tissues. A pre-operative intra-oral biopsy of the lesion revealed multinucleated giant cells, comprising of both spindle-shaped and round cells. Differential diagnosis helped determine the lesions as CGCG. This case helps to demonstrate the wide variation in the clinical, radiological, and histopathological features of CGCG and the importance of thorough investigation for timely diagnosis.

A Cervical Thymic Cyst in an Adult Female; A Case Report and Comprehensive Literature Review.

Introduction: Cervical thymic cyst accounts for (0.3-1) % of cervical cysts in children and are usually present during the first decade of life with few reported cases in adults. Herein, we present a 34-year-old female with a cervical thymic cyst. We conducted a review of all the previously reported cases as well. Case presentation: The patient complained of an anterolateral neck swelling that was noticed one year ago. It was a soft, fluctuant, mobile, non-tender swelling in the midline and the right side of the lower neck. Neck ultrasonography revealed a large thin-walled cyst, with no internal septa, echoes, or solid parts. Post-contrast MRI of the neck showed a well-defined, oblong-shaped, lobulated cystic lesion just beneath the strap muscle. The cyst extended caudally to the superior border of the anterior mediastinum at the level of the upper border of the manubrium sterni. The patient underwent excision of the swelling under general anesthesia via Kocher's collar neck incision. Connection with the thymus gland was detected behind the manubrium sterni which was separated. Pathological examination showed prominent thymic tissue confirming the diagnosis of a cervical thymic cyst. Conclusion: Adult cervical thymic cyst is very rare with a few cases reported in the literature. Surgical excision in symptomatic patients is the treatment of choice. Paper's main novel aspects: • A rare presentation of a cervical thymic cyst in an adult. • A comprehensive literature review including all the previously reported cases in one table.

Primary aneurysmal bone cyst of hands and feet: A series of 14 cases

Aneurysmal bone cyst (ABC) is a relatively rare, benign bone tumor that occurs exceptionally in the hands and feet. The objective of this article is to present clinical, radiological, histopathological features and management of a series of 14 primary ABC cases in these unusual locations. Eight cases occurred in hands and six in feet. We present the first reported subungual case to occur in the hand. The average age of the patients was 26 years (range 7 to 49), with half being over the age of twenty at diagnosis. The male to female ration was 9:5. In radiological terms, ABC appeared as an expansive lesion with internal septa and without cortical disruption. Twelve cases displayed the classic multicystic morphology and two cases were of the solid variant. “Blue bone” was detected in 50 % of the specimens. Treatment consisted of curettage, excision, or amputation in all cases. Recurrence rate was observed in 35 % of the cases, with the similar ABC morphology as the original samples. New therapeutic options have been proposed on their own or in combination with surgery to reduce local recurrence rates.

Spontaneous biloma manifesting with massive upper gastrointestinal bleed: case report

Spontaneous biloma is a rare non-traumatic lesion in whi­ch the extrahepatic or intrahepatic bile duct perforates spontaneously with no discernable cause. We present a case of spontaneous biloma in a 68 years old male patient with cholelithiasis and concurrent choledocholithiasis, who presented with acute severe cholangitis. There was no history of abdominal surgery, instrumentation, or trauma in the past. Initial ultrasonography (USG) abdomen showed central intrahepatic dilation, cholelithiasis, and choledocholithiasis. A sizeable hypoechoic lesion with few internal septations was present adjacent to the left lobe of the liver, with USG suspicion of a hydatid cyst. The lesion was abutting and displacing the stomach anteromedially. The patient had an acute renal failure with hemodynamic instability at presentation. The patient was managed with emergency endoscopic drainage under ultrasound guidance and improved after that. On the fourth day, after endoscopic drainage, the patient had a massive upper gastrointestinal (UGI) bleed due to erosion and pressure necrosis of the gastric wall due to biloma. The patient was managed successfully with sleeve gastrectomy and de-roofing of the cyst.