Rare Location Research Articles

Ultrasound diagnostics: assessment of tumor thickness and depth of invasion in squamous cell carcinoma of the oral cavity

Aim. To evaluate the capabilities of ultrasound using various approaches in determining the depth of invasion of squamous cell carcinoma of the oral cavity and to compare the results obtained with data obtained by the use of other diagnostic methods. Materials and methods. In our reserch, ultrasonography was performed on 193 patients with primary malignant tumors of the mobile part of the tongue, floor of the oral cavity and tumors of rare locations (mucous membranes of the lip, cheek, alveolar processes). The age of the patients ranged from 15 to 85 years. In all patients, tumors were squamous cell carcinoma. ultrasound was performed using submandibular, intraoral and transbuccal approaches. ultrasonic data were compared with the results of pathomorphological examination, as well as of X-ray computed tomography and of magnetic resonance imaging with contrast. Results. A statistically significantly high correlation was obtained for all ultrasound approaches (submandibular, intraoral and transbuccal) with the depth of invasion of the oral tumor determined pathomorphologically (r = 0.78; r = 0.89; r = 0.93; p <0.001). Ultrasound using all approaches shows statistically significantly better results in determining the thickness of tumorsof the tongue and mouth floor in comparison with X-ray computed tomography and magnetic resonance imaging (p <0.001). All diagnostic methods are characterized by an overestimation of the tumor invasion depth (overdiagnosis) as compared with pathomorphological examination. for exophytic tumors and oral cavity tumors of mixed growth with an exophytic component, the depth of invasion was less than the tumor thickness. Conclusion. Ultrasound is an accessible, easily reproducible, radiation-free method, the resolution of which makes it possible to accurately determine not only the depth of invasion of oral tumors, but also the distance from the tumor to the midline of the tongue, that represents an important information when choosing the extent of surgical intervention.

Multiple Disseminated Hydatidosis with Rare Locations: Mediastinal, Pancreatic and Pelvic (Case Report)

Hydatid disease is an anthropozoonosis due to the development of the larval form of Echinococcus granulosus in the human body, which constitutes a ‘dead-end’ host. It’s a common parasitosis in North African countries and constitutes a public health problem in Morocco. The liver and lung are the most affected while the mediastinum, pancreas and pelvis are rarely affected. We report the case of a 40-year-old patient operated 15 yearsago for cerebral and cervical hydatid cysts and who was hospitalized for generalized mucocutaneous jaundice. On exploration, we discover the presence of disseminated abdominal hydatidosis with association of 3 rare locations: mediastinal, pancreatic and pelvic. Indirect diagnostic tests were positive: indirect hemagglutination (IHA) and Elisa. The Western blot test also showed the presence of specific bands, thus making it possible to retain the diagnosis of hydatidosis. The hydatid cyst with mediastinal, pancreatic and pelvic location is rare and their association is very exceptional. It is essential to evoke the hydatid origin of any cystic lesion in a patient staying in an endemic area.

Особенности дерматоскопии в диагностике меланомы кожи. Обзор литературы

The incidence of melanoma of the skin is steadily increasing, and, undoubtedly, the need for its early detection is increasing. A universal tool for early diagnosis is dermatoscopy, a method of in vivo examination of skin neoplasms, which has proven its effectiveness in the course of numerous clinical studies. Knowledge of algorithms and dermatoscopic patterns of skin melanoma, depending on the anatomical localization of the tumor, can increase the effectiveness of early diagnosis and, as a result, affect the prognosis of the disease, especially melanomas of rare localizations

Isolated traumatic retroclival interdural hematoma causing craniocervical instability: A case report of pathology in a rare location and literature review

Introduction. Retroclival hematomas (RCH) are a rare entity primarily as a post-traumatic phenomenon in the pediatric population. We present a case of Retroclival interdural hematoma in a 12 y/o female with a previous record of craniocervical trauma. A RCH is identified initially by CT and easily overlooked. MRI cervical spine to evaluate the Tectorial membrane and other craniocervical ligaments integrity. Case report. A 12-year-old female presented with bilateral abducens nerve palsies and a Glasgow Coma Score (GCS) of 13 following a high-speed motor vehicle accident. Initial CT brain revealed an infra-tentorial extra-axial focal hyperdense collection (hemorrhage) along the retroclival region in the interdural space measuring approximately 9 × 29 × 58 mm. Subsequent imaging and evaluations suggested cranio-cervical instability, leading to surgical intervention. Conclusions. Prompt diagnosis of RCH with conservative or surgical management is essential to avoid neurological deficits and mortality. Despite the significant potential for morbidity and mortality, the majority of patients show a benign clinical course with conservative care, underscoring the importance of quick diagnosis and close observation.

Total resection of foramen magnum meningioma via a far-lateral approach – a case report

Introduction and aim. The foramen magnum is a rare location of meningioma development, accounting for 1.8 to 3.2% of all reported tumors of this type. Microsurgical resection, representing a gold standard in foramen magnum meningioma treat ment, may result in various neurological deficits or incomplete resection due to challenging anatomical conditions. Currently, even surgical resections of foramen magnum meningioma conducted by experienced neurosurgeons are burdened by a relatively high complication rate of 17.2% Description of the case. We report the case of a 25-year-old male who presented increasing headaches and decreasing activity for 5 months. In his medical history, the patient had been diagnosed with cerebral palsy, autism spectrum disorder, and suffered partial seizures. Magnetic resonance imaging revealed anterolateral foramen magnum meningioma. The tumor was resected via a far-lateral approach. After the surgery, the patient maintained a preoperative neurological state without additional neurological deficits. The post-operative magnetic resonance imaging demonstrated complete tumor removal. Histopatholog ical examination revealed transitional meningioma (WHO grade I). Conclusion. Our case demonstrates that the far-lateral approach can be efficient for the resection of anterolateral foramen magnum meningioma. In such cases, Simpson grade 1 can be achieved without complications, providing immediate relief of symptoms and minimizing the risk of recurrence.

Otorrhea revealing a neglected parapharyngeal foreign: A case report and a literature review

Foreign body removal is a common procedure in Otorhinolaryngological (ORL) practice. It may affect adults as well as children, the nature of the Foreign body varies depending on the situation , for adult it is generally swallowed Foreign Bodies seen in the palatine , piriform sinus and vallecula but for children its due to playground accidents multiple location are possible with varying symptoms depending on the location otorrhea being an unusual symptom. Nevertheless, the parapharyngeal space remains a rare location with the possibility of migration to deep neck spaces2, presenting a danger to the vascular and nervous structure in the region, which presents a challenge during the extraction procedure .

Sporadic Hybrid Nerve Sheath Tumour Arising from a Vestibulocochlear Nerve: A Rare Case Report

Hybrid Peripheral Nerve Sheath Tumors (HPNST) were first included in the 4th edition of the World Health Organization (WHO) Classification of Central Nervous System in 2016. These tumors are a combination of schwannoma and neurofibroma, and are typically found in the limbs, trunk, and soft tissues. In this case report, we present a rare intracranial localization of neurofibroma/schwannoma with histological examination. Our patient was a 36-year-old man without any tumor genetic syndromes. The tumor measured 1.6 × 1.1 cm and was completely excised. The pathology report showed no significant nuclear atypia, mitotic activity, or necrosis. At the time of writing, the patient is alive and well with no recurrence. It is important to note that HPNSTs are usually benign tumors, but can occur in various locations, including the intracranial region. Further studies with a larger number of cases are needed to determine the exact pathogenetic basis of these tumors.

Myocardial Infarction Seen Tardively Complicated by Ventricular Septal Rupture Extending to the Right Ventricule: A Dilemmatic Scenario

Ventricular septal rupture (VSR) is an uncommon but well-recognized mechanical complication of acute myocardial infarction (MI). Mortality without intervention is 70% in intrahospital at 30 days, and 90% at one year due to cardiogenic shock. Transthoracic echocardiography (TTE) is the choice tool in the diagnosis and evaluation of VSR. We report an original case of a 72-year-old patient diagnosed with myocardial infarction of the inferior wall of the left ventricle, complicated by the rupture of its basal segment aneurysm extending to the right ventricle. After which standard drug treatment was prescribed. Inferior wall myocardial infarction complicated with VSR at its basal segment is a rare mechanical complication of MI and this clinical case shows a rare location of VSR compared to forms described in the literatures. On the third day, the patient died from refractory cardiogenic shock, and neurological complications which could have been prevented by surgery. Treatment of VSR secondary to MI is an emergency based on either an open heart surgery or percutaneous intervention inorder to reduce morbi-mortality rate.

Twelve years after: The french national network on rare head and neck tumours (REFCOR)

BackgroundRare cancers constitute less than 10% of head and neck cancers and lack sufficient evidence for standardized care. The French Rare Head and Neck Cancer Expert Network (REFCOR) as established a national database to collect data on these rare cancers. This study aims to describe patient and tumour characteristics in this database. MethodsProspective data collection was conducted across multiple centers. Survival analyses were performed using Kaplan Meier method and Log Rank test. Odds ratios were used for comparing proportions. ResultsA total of 7208 patients were included over a period of 10 years. The most frequent histologies were: Not Otherwise Specified (NOS) adenocarcinoma 13 %, adenoid cystic carcinoma 12 %, squamous cell carcinoma of rare locations 10 %, mucoepidermoid carcinoma 9 %, intestinal-type adenocarcinoma (8 %). Tumours were located in sinonasal area (38 %); salivary glands (32 %); oral cavity / oropharynx / nasopharynx (16 %); larynx / hypopharynx (3 %); ears (1 %); others (3 %). Tumours were predominantly classified as T4 (23 %), N0 (54 %), and M0 (62 %). Primary treatment approach involved tumour resection (78 %) and / or radiotherapy (63 %). Patients with salivary gland cancers exhibited better 5-year overall survival (OS) rates (p < 0.05), and lower recurrence rates compared to patients with sinonasal, laryngeal/ hypopharyngeal cancers. No significant differences were observed in the other comparisons. Acinar cell carcinoma demonstrated the best OS while mucous melanoma had the poorest prognosis. ConclusionMelanoma, carcinoma NOS, and sinonasal undifferenciated carcinoma still have poor prognoses. Efforts are being made, including training and guidelines, to expand network coverage (REFCOR, EURACAN), improve data collection and contribute to personalized therapies.

Successfully treated osteomyelitis with 20 years of evolution, covering the whole humerus (case report)

Infections affecting the humerus are a serious therapeutic challenge, especially when they are spread along the entire length of the humerus and have a long evolution. Their origin can be both hematogenous and exogenous. Unsuccessfully treated osteomyelitis of the humerus can be the cause of severe disability, intoxication and even lead to amputation.&#x0D; The aim: To pay attention to the difficulties associated with the treatment of a rare localization of osteomyelitis affecting the entire humerus.&#x0D; Material and methods: One patient is presented, a 63-year-old man who underwent multiple operations for osteomyelitis of the humerus about 20 years ago.&#x0D; Results: The early postoperative period went smoothly. The surgical wound healed primarily, the bone infection was completely repaired, and the right upper extremity is in good functional condition, with no evidence of circulatory or neurological problems.&#x0D; Conclusion: The presented patient is a clear example that the key to the successful treatment of osteomyelitis is the correct choice of the main method, namely the method providing full revascularization of the bone or the replacement of the affected bone segment with autoosteoplastic material.&#x0D;

Different Ectopic Endocrine Tumors on Renal Hilum Detected by 68 Ga-DOTATATE PET.

Renal hilum is a very rare location for primary adrenocortical adenoma or pheochromocytoma. We report 68 Ga-DOTATATE PET/CT findings of primary renal hilar adrenocortical adenoma in one patient and 68 Ga-DOTATATE PET/MR findings of pheochromocytoma in another patient.

Xanthogranulomatous mastitis: a rare entity presenting with breast lump and mimicking fibroadenoma in a young female

Introduction and importance: Xanthogranulomatous mastitis is a rare chronic granulomatous inflammation of breast tissue, characterized by the presence of multinucleated giant cells, lipid-laden foamy macrophages, and cholesterol crystals. The breast is an extremely rare location for xanthogranulomatous inflammation. Case presentation: The authors describe a case of xanthogranulomatous mastitis in a 26-year-old female patient who presented with a 4×5 cm lump in her right breast. After ultrasonography (revealed a well-circumscribed hypoechoic lesion, with increased vascularity), and surgical consultation, an excisional biopsy was done, and sent for histopathologic examination, which showed features suggestive of xanthogranulomatous mastitis. Clinical discussion: Xanthogranulomatous mastitis, clinically as well as radiologically mimics some other conditions of breast like breast cancer, or fibroadenoma. Ultrasonography usually reveals a well-circumscribed hypoechoic lesion, with increased vascularity, and mammography usually shows BIRADs 3 to 5. Diagnosis is usually based on histopathologic findings of multinucleated giant cells, lipid-laden foamy macrophages, and cholesterol crystals. Treatment is usually surgical excision. Conclusion: Though xanthogranulomatous inflammations are rare in the breast, they must be considered a differential diagnosis in patients presenting with various breast symptoms like lump, pain, or features of breast malignancy.

A common tumour at an uncommon location: Lesser trochanter osteochondroma

Osteochondromas are benign osteocartilaginous tumours, which are developmental abnormalities rather than actual neoplasms. The lesser trochanter is an extremely rare location for a solitary osteochondroma, and depending on the tumour’s size, the patient can exhibit various symptoms, including a limited range of motion. This case study describes a rare instance of a benign solitary osteochondroma of the lesser trochanter identified and managed using an excisional biopsy following Ludloff’s approach. With intraoperative fluoroscopy, we could accurately outline and remove the entire tumour mass without endangering the nearby essential tissues.

A rare ectopic localization of pleomorphic adenoma of lip

This case report described a rare and unusual lesion found in a 68-year-old male, which was diagnosed as pleomorphic adenoma of the minor salivary glands in the upper lip. The tumor was a circumscribed, large firm mass, about 2 cm in diameter, characterized by slow growth. Complete excision was performed and the histopathologic analysis showed pleomorphic adenoma.

Intraneural ganglion of the media nerve at the wrist level: a rare clinical case report

Extraneural ganglia are the most common lesions in the wrist and hand. In contrast, intraneural ganglia on the upper extremity, particularly the wrist and hand, are extremely rare. The paper presents a clinical case of successful treatment of a patient with intraneural ganglion of a rare anatomical location – the median nerve at the level of the wrist.

Tuberculous Tenosynovitis of the Wrist: A Case Report

Tuberculous tenosynovitis is a rare localization of tuberculosis. Diagnosis is often delayed due to poor and chronic clinical manifestations. We report a case of tuberculous tenosynovitis of the left wrist with a favourable evolution under antituberculosis treatment.

Clinical manifestations, endoscopic findings and outcomes of tonsillar fossa foreign bodies in dogs: seven cases (2020-2023).

Clinical presentation and outcomes of dogs with tonsillar foreign bodies are not described in the literature. The objective of this case series is to describe the presence, clinical manifestations, endoscopic findings and outcomes of foreign bodies in the palatine tonsillar fossa of dogs. Medical records of dogs in which tonsillar fossa foreign bodies were removed by endoscopy between 2020 and 2023 at a referral centre were reviewed. Dogs were included if complete medical records were available. Seven dogs were included. Among all clinical signs reported, acute onset of throat clearing occurred in all dogs. Palatine tonsil enlargement and protrusion from the tonsillar fossa were observed in four of seven dogs. Foreign bodies were removed under endoscopic guidance in all dogs; a vegetal foreign body was found in all but one dog (6/7). Complete resolution of clinical signs was reported in the five dogs for which follow-up information was available. The tonsillar fossa is a rare but possible location for foreign bodies in dogs and should be explored even in the absence of macroscopic lesions of the tonsils, since some dogs could have a normal palatine tonsil appearance. Acute throat clearing should raise the suspicion of tonsillar fossa foreign bodies. The prognosis appears good after removal.

Extra-axial desmoplastic/nodular medulloblastoma in adult mimicking cerebellar metastasis: reappraisal of this rare presentation with literature review

Introduction and importance: Medulloblastomas are the most common malignant intra-axial brain tumour in paediatric patients and represent 35–40% of posterior fossa tumour types in children between 3 and 9 years of age. Medulloblastomas may also be found in adulthood. These tumours are classified into two groups according to its molecular characteristics and histological type. The desmoplastic/nodular subtype is the second common subtype after the classic one. Only three cases of desmoplastic/nodular extra-axial medelloblastoma have been previously reported in the literature originating from to the cerebellopontine angle. Case presentation: The authors report a new case of an extra-axial desmoplastic/nodular cerebellar medulloblastoma originating outside the cerebellopontine angle and mimicking a solitary cerebellar metastasis in a 49-year-old female patient who presented for a raised intracranial pressure and cerebellar syndrome. Clinical discussion: Medulloblastoma is a malignant embryonal intra-axial tumour of the cerebellum or posterior brain stem that occurs mainly in children. Medulloblastomas may also be found in adulthood. Desmoplastic/nodular medulloblastoma is the second most common type of all medulloblastomas. The intra-axial form is always predominant. Only three cases of extra-axial desmoplastic/nodular medulloblastoma have been reported in the literature. The authors will go through the literature to dissect this rare entity. Conclusion: Although considered a common paediatric intra-axial tumour, there are increasing numbers of solitary cases reporting an extra-axial presentation in different locations of the posterior cerebral fossa even in adulthood. These rare and unusual presentations and locations may mislead the correct diagnosis and delay treatment.

The communicating rudimentary horn of the unicornuate uterus as a rare localization of a partial hydatidiform mole and the diagnostic challenge

The communicating rudimentary horn of the unicornuate uterus as a rare localization of a partial hydatidiform mole and the diagnostic challenge

A rare case presentation of neurofibromatosis type 1 with multiple gastrointestinal stromal tumors: a case report

Neurofibromatosis type 1 (NF1), a hereditary cancer predisposing syndrome is an autosomal dominant disorder. Gastrointestinal stromal tumor (GIST) is the most prevalent non-neurological tumor in these individuals. In NF1-associated GIST, KIT and platelet-derived growth factor receptor α (PDGFRA) mutations might not be present, and Imatinib may not be effective. Surgical resection is the first-line treatment. The primary aim was to include the possibility of rare tumors including GIST in neurofibromatosis patients in the differential diagnosis of GIT pathology/presentation. A 50-year-old male with neurofibromatosis came with complaints of dull aching abdominal pain and on further investigation was found to have lesions in the distal small bowel, suspicious of nerve sheath tumors, in abdominal computed tomography. A laparotomy was performed and the jejunum containing nodular lesions was resected and pathologically diagnosed as GIST. The patient was then started on Imatinib. At the 6-month follow-up, no tumor recurrence was visible. The rare and unusual location of multiple GIST in neurofibromatosis patients underscores its importance in differential diagnosis, and our case report on the patient's therapy and the clinical outcome could aid in patient care.