Ossifying fibromyxoid tumor in the lower extremity mimicking a sebaceous cyst. Case report and literature review

IntroductionOssifying fibromyxoid tumor (OFMT) is an uncommon soft tissue neoplasm, with malignant potential and unclear histogenesis. OFMT exhibits a spectrum of histopathologic features including benign (typical), atypical and malignant subtypes. To the best of our knowledge, about 300 cases have been reported worldwide. We present the first reported case from Qatar.Presentation of caseA 36-year old Egyptian male, with no comorbidities was admitted electively as a day case for excision of left thigh suspected sebaceous cyst under local anesthesia. History, physical examination and soft tissue ultrasound imaging were unremarkable. Intraoperatively, the patient was found to have a hard-calcified mass adhering to the surrounding fascia which was excised en bloc. The histopathology result was of ossifying fibromyxoid tumor. The post-operative course along with 40 months follow-up were uneventful in terms of surgical complications and recurrence.DiscussionOFMT has marked features in terms of cytology. Though it is difficult to diagnose preoperatively, it should be considered in tumors involving soft tissue that demonstrate prominent ossification and calcification.ConclusionOFMT is a rare soft tissue neoplasm, and should be considered as a differential diagnosis in any subcutaneous swelling with a bony component. All OFMT patients should undergo a long course of follow-up to rule out and assess any recurrence or metastasis in the malignant variants.     

Mediastinal hemangioma mimicking an invasive tumor growth: A case report

Introduction and importanceMediastinal hemangiomas are a rare entity frequently developing in the anterior mediastinum. They may exhibit an infiltrating appearance into the surrounding tissue, and extensive surgery is often required despite its benign nature. We report a case of a mediastinal hemangioma mimicking an invasive tumor growth requiring a combined resection of the lung and diaphragm.Case presentationAn asymptomatic 73 year-old-man presented with a 50 mm-sized mass on his chest radiography. A combined resection of the mediastinal mass with the part of the lower lobe of left lung and diaphragm not necessitating a patch repair was performed. The pathological findings were compatible with a diagnosis of a mediastinal hemangioma. Only fibrous adhesions were observed between the tumor and resected lung and diaphragm without any histological invasion.Clinical discussionWhile imaging examinations play a key role in determining a preoperative diagnosis, mediastinal hemangiomas may pose a diagnostic challenge mainly due to its rarity. With a clinical suspicion of a hemangioma during the diagnostic work up, a dynamic CT might be helpful.ConclusionsIn mediastinal hemangiomas, a preoperative diagnosis is essential in order to avoid extensive surgery. A hemangioma should be raised as a differential diagnosis for anterior mediastinal tumors, especially in cases with an infiltrative appearance that suggests the necessity for a combined resection of the surrounding organs.     

Primary hydatid cyst of the rib mimicking chest wall tumor: a case report

Hydatidosis, caused by Echinococcus granulosus, is still an endemic parasitic disease in the Mediterranean area, South America, North Africa, and Australia. The most common anatomic location of hydatid disease is the liver, followed by the lung. Hydatidosis is located in the bones in 0.5% to 2% of all cases. A hydatid cyst can be seen in any part of the body. However, primary hydatid cyst of the rib in childhood is exceedingly rare. We report the first case of a pediatric hydatid cyst of the rib mimicking chest wall tumor.     

An arcane case report of primary intramuscular hydatid cyst of thigh

IntroductionHydatid diseases are a cystic parasitic infestation caused by Echinococci which are endemic to parts of India and commonly occur in agricultural workers. Primary intramuscular hydatidosis is a rare manifestation of hydatid disease.Presentation of caseOur case report describes a rare case of primary intramuscular hydatidosis in an agricultural worker with no involvement of any other viscera. This was diagnosed with clinical evaluation, radiological modalities and managed surgically.DiscussionHydatid disease is endemic in parts of India. Primary intramuscular hydatidosis is uncommon because the lactic acid in the muscle and muscle contractility hinders the development of cysts making it improbable diagnosis on first presentation. Hydatid cyst demonstrates a wide variety of imaging features, which can vary according to growth stage, associated complications and affected tissue. The treatment of choice is complete surgical excision of the cyst along with thorough irrigation of the surrounding soft tissues combined with the use of systemic antiparasitic drugs after surgery.ConclusionIn a patient of an agricultural background of cattle rearing living in an endemic region and presenting with a swelling in the musculoskeletal system, a suspicion of hydatidosis should always be kept in the clinicians mind, so that it can be diagnosed using a multimodal approach and managed properly in a timely manner.     

Echinococcosis mimicking liver malignancy: A case report

IntroductionHuman Alveolar Echinococcosis – Alveolar Hydatid disease (AE) is an omitted zoonotic infection presenting with focal liver lesions. Cause of AE is a larval stage of Echinococcus multilocularis tapeworms.Case presentationIn this report an extraordinary case of a 38 year-old female examined due to 2 liver tumors and 2 pulmonary nodules is described. The patient underwent pulmonary and liver surgery for suspected advanced cholangiocellular carcinoma and surprisingly AE was found.DiscussionDistinguishing intrahepatic AE from other focal liver lesion can be complicated and in many cases is diagnosed incorrectly as intrahepatic cholangiocarcinoma or other liver malignancy.ConclusionAE is a rare but potentially fatal parasitic infection primarily affecting liver, although it can metastasise to lung, brain and other organs. The diagnosis and treatment can be difficult and clinical misinterpretation as malignancy is not rare. The principal treatment of AE is surgery accompanied with chemotherapy.     

Low-grade fibromyxoid sarcoma of the hand: a case report

We report a case of low-grade fibromyxoid sarcoma with giant collagen rosettes in the hand of a 21-year-old female. This is a clinically and radiological benign appearing tumor that has a high rate of recurrence and metastasis.     

Extragenital malignant mixed mesodermal tumor: A case report

IntroductionPrimary malignant mixed mesodermal tumor (MMMt, also called malignant mixed Mullerian tumor and designated in the WHO classification of female genital tract neoplasms as carcinosarcoma) is an infrequent tumor that develops usually in the uterus and more rarely in the ovary. Extragenital tumor, including primary peritoneal MMMt, is an extremely rare and aggressive neoplasm with only few case reported in the literature.Presentation of caseWe report a case of a 70-year’s old female who presented with nausea and abdominal discomfort for 6 months. Workup revealed an abdominal mass. Patient was treated with surgical removal in a general hospital.DiscussionMost peritoneal carcinosarcomas originate in the pelvic peritoneum, followed by decreasing frequency in the serosal surface of the colon, retroperitoneum, anterolateral abdominal peritoneum, and omentum. Surgical excision is the most effective treatment in carcinosarcomas. A complete cytoreduction, with resection of cancer to a status of no evidence of disease by the surgeon’s unaided eye should be attempted.ConclusionOwing to the rarity of the disease, limited data regarding the management of peritoneal MMMT exists. Recommendations for the treatment of MMMT are based on individual cases only. In our case, the patient is alive with a follow-up of 15 months and she did not receive any cycle of chemotherapy.     

Primary hydatid cyst of pancreas: Case report and review of literature

IntroductionHydatid disease is caused by the larval stage of Echinococcus granulosus. It most commonly affects the liver and lung. Pancreatic hydatid cyst (PHC) is very rare with incidence of 0.14%–2%.Presentation of caseA 40 year old lady presented with epigastric pain for last 3 months. A 5 × 5 cm abdominal lump occupying the epigastric and left hypochondrial region was noted on physical examination. Ultrasonography (USG) and Contrast enhanced Computed Tomogrpahy (CT) revealed a 55 × 57 mm cystic structure in the pancreatic body. Endoscopic ultrasound guided fluid aspiration cytology revealed normal Carcinoembryonic antigen and Amylase levels. Cytological examination was noncontributory. During open surgical exploration, it was found to be a hydatid cyst. After irrigation with scolicidal agent and evacuation of cystic contents, Partial cystectomy with external drainage was done. Histopathological biopsy revealed Hydatid cyst. Post-operative ELISA (Enzyme linked immunosorbent assay) for Echinococcal antigen was positive.DiscussionPHC is a rare entity. Most common mode of spread is hematogenous. Cysts in pancreatic head can present as obstructive jaundice. Cysts in body and tail are usually asymptomatic. USG, CT and Hydaitd serology can help in diagnosis and monitoring recurrence. Surgical exploration is treatment of choice. Options include pericystectomy, partial cystectomy +/− external drainage/omentopexy, marsupialization or cysto-enterostomy. Preoperative and Post-operative anti helminthic (Albendazole) is recommended.ConclusionPHC can masquerade as pseudocyst or cystic neoplasm of pancreas. It should always be considered in the differential diagnosis of cystic pancreatic lesion in patients from endemic regions.     

Neuroendocrine tumor of the small intestine diagnosed with trans-abdominal ultrasonography: A case report

IntroductionTumors of the small intestine are rare. In addition, clinical symptoms are nonspecific and neoplasm-related symptoms occur late. We report a case of neuroendocrine tumor (NET) of the small intestine that was diagnosed early with trans-abdominal ultrasonography (US).Presentation of caseThe patient was a 61-year-old man. Abdominal contrast-enhanced computed tomography (CT) was performed because the patient complained of abdominal pain. The CT showed a tumor lesion in the mesentery. Trans-abdominal US was undertaken to evaluate this tumor lesion, and a tumor lesion of the small intestine was found nearby. A diagnosis of lymph-node metastasis of a small-intestine tumor was made as a preoperative diagnosis. A laparotomy was performed with partial resection of the ileum, together with the small-intestine mesentery including an enlarged lymph node. Histological examination revealed NET of the ileum and lymph-node metastasis.DiscussionWith the application of trans-abdominal US, we could diagnose lymph-node metastasis of a small-intestine tumor relatively early and before surgery.ConclusionTrans-abdominal US is useful in the diagnosis of small-intestine NET.     

A rare case report of an adenomatoid odontogenic tumor associated with odontoma in the maxilla

IntroductionThe adenomatoid odontogenic tumor (AOT) associated with odontoma has been described as a new entity with overlapping features of adenomatoid-like structures and odontoma. Presentation of the case: We report the second case of AOT associated with odontoma in the posterior maxillary region. A 22-year-old patient presented expansion of the vestibular and palatine cortical wall of maxilla. Radiographic examination and computed tomography confirmed erosion of maxillary walls, root resorption, displacement of a neighboring tooth and radiopacities within the lesion. Histopathological analysis showed a cystic cavity lined by odontogenic epithelium, organized as duct like structures and tubular dentin. The diagnosis established was AOT associated with odontoma.DiscussionAs fewer cases have been described, the aim of this study is to report clinical behavior and evolution of adenomatoid odontogenic tumor associated with odontoma, as it have not yet been described and its origin is not completely established. The hamartomatous or neoplastic origin of this tumor is under debate.ConclusionsTherefore, it is necessary similar cases to be published to increase the knowledge about the clinical behavior and evolution of this tumor, to enable such lesions to be more clearly defined in the next classification of odontogenic tumors.     

Bronchial carcinoid tumor in the era of covid-19 pandemic: A case report

IntroductionBronchial carcinoid tumors are rare, slow growing, malignant neuroendocrine tumors which arise from Enterochromaffin (Kulchitsky) cells. Early diagnosis is extremely important as the main stay of treatment is surgical excision.Presentation of caseWe present a rare case of bronchial typical carcinoid tumor in a 27-year-old male who presented with a complaint of intermittent dry cough of 2 weeks’ duration associated with shortness of breath and low grade fever. He was initially misdiagnosed as covid-19 pneumonia and was admitted to covid-19 treatment center. Right lung bi-lobectomy with regional lymph node resection was done and he was discharged home in good condition.DiscussionMajority of typical carcinoids are located in the central airways leading to bronchial obstruction with recurrent pneumonia, chest pain and wheezing. In the era of covid-19 pandemic, lung cancer patients are at higher risk of being affected by covid-19 and, early identification and differential diagnosis is extremely difficult in the absence of comprehensive evaluation and work up as the clinical and imaging findings of covid-19 may resemble lung cancer. Although hilar and mediastinal lymph nodes are the most common metastatic sites for typical carcinoids most lymphadenopathies are caused by a reactive inflammatory reaction.ConclusionBronchial carcinoids are rare, malignant neuroendocrine tumors with complete surgical resection being the only curative management. During the Covid-19 pandemic crisis, diagnosing rare lung diseases like carcinoid tumor is real challenge especially in resource limited set up and needs high index of suspicion with meticulous diagnostic work up. The outcome of typical carcinoids with lymph node metastasis is excellent with complete resection.     

Pediatric intrahepatic bile duct adenoma-rare liver tumor: A case report

BACKGROUND Intrahepatic bile duct adenoma(BDA) is one of the rarest of the rare benign tumors of the liver in the pediatric age group. It arises from the epithelial lining of intrahepatic bile ducts. The overall incidence of BDA is 1.3% of all primary benign liver tumors. Few case reports of this rare tumor occurring in adult population are present in the literature and to date, only one pediatric case has been reported worldwide.CASE SUMMARY An 18-month-old male child presented with chief complaints of mass per abdomen for 8 mo. Computerized tomography abdomen revealed a well-defined exophytic solid tumor arising from the posteroinferior margin of the right lobe of the liver with heterogenous enhancement and cystic changes, suggesting a suspicion of hepatoblastoma. Non-anatomical liver resection was done and a tumor of 10 cm × 9.5 cm was excised. Histopathology of the specimen was conclusive with the diagnosis of intrahepatic bile duct adenoma, which was further supported by immunohistochemistry panel testing. The post-operative period was uneventful. On follow-up, the child was doing well and had no postoperative complication.CONCLUSION Intrahepatic bile duct adenoma in children is very rare and to date only one case has been reported. This is the second pediatric case of intrahepatic bile duct adenoma in the world. Additionally this is the first ever case of such a large tumor presenting in a child.     

Pulmonary sclerosing haemangioma mimicking hydatid cyst: a case report

We report the case of a pulmonary sclerosing haemangioma radiologically presenting as a cystic lesion. The patient was found to have specific anti-echinococcus immunoglobulin E and therefore the preoperative diagnosis was that of pulmonary hydatid cyst. A surgical resection was performed. Although rarely encountered, pulmonary sclerosing haemangioma may show radiological and serological similarities to a pulmonary hydatid cyst. Both entities necessitate complete removal of the lesion without parenchymal resection.     

Giant cell tumor of soft tissues: A case report of extra-articular diffuse-type giant cell tumor of the quadriceps

IntroductionGiant cell tumors of soft tissue (GCTs) are a relatively rare entity. It is a distinct but uncommon group of neoplasms morphologically identical to osseous giant cell tumor. The diffuse type of extra-articular GCT arising within muscle is a rare benign soft tissue tumor with a wide spectrum of clinical presentation.Presentation of caseThis article reports a rare case of a 44-year-old woman with a mass arising from her right thigh. MRI showed only a few areas of low T2 signal in a mass that was hyper intense to muscle. Histopathology of this lesion located within the right quadriceps muscle revealed admixture of multinucleated giant cell with mononuclear cells. This patient was treated by surgical resection and followed up for recurrence.DiscussionDiffuse-type GCTs are commonly located in the periarticular soft tissues, but on rare occasions these lesions can be purely intramuscular or subcutaneous and can be challenging to diagnose. Characteristic findings include gradient echo secondary to hemosiderin deposition, and the low signal on T2.ConclusionBecause extra-articular diffuse-type GCTs are rare, the differential diagnosis is challenging. The clinical outcomes of diffuse-type GCTs are unclear because of their rarity. Benign clinical course is expected if the lesion is excised adequately.     

A recurrent solitary fibrous tumor of the thigh with malignant transformation: A case report

IntroductionWe describe an unusual case of a uniformly high-grade malignant solitary fibrous tumor (SFT) of the thigh with recurrence after wide resection in a 31-year-old man.Presentation of caseOur current case showed a long-term benign course before the operation, although the subcutaneous tumor was larger than 10 cm at presentation. The SFT was diagnosed by needle biopsy, and wide resection was performed. Histological findings showed proliferation of capillaries surrounded by masses of spindle-shaped cells without any cytologic atypia, and the percentage of MIB-1-positive nuclei was 2.1%. However, a rapidly enlarging recurrent tumor was observed 11 months after the operation. A second wide resection for the recurrent tumor was performed. Histologically, the tumor cells uniformly displayed significant cytologic atypia and pleomorphism, and had 40–50 mitoses per 10 high-power fields. The proportion of MIB-1-positive nuclei was 48%. Consequently, the tumor was diagnosed as a SFT with malignant transformation.DiscussionThe malignant transformation described in past studies showed high-grade areas within benign, low-grade, or intermediate-grade SFTs. Therefore, in contrast to our case, uniformly high-grade malignant histological findings at recurrence were not described.ConclusionEven if a tumor is non-malignant during the clinical course, as confirmed by tissue biopsy, the possibility of tumor progression to high-grade sarcoma at recurrence should be considered, and the treatment strategy should be determined carefully.     

软骨样脂肪瘤1例

正患者,女,28岁,因右前臂内侧软组织肿物2年入院。患者自述2年前无明显诱因出现右前臂内侧软组织肿物,当时肿物大小约4 cm×3 cm×2 cm,肿物呈进行性生长,且生长较慢。患者未予重视,也未行任何治疗。1个月前因右上肢剧烈活动后,出现肿物部位疼痛,疼痛为隐痛,休息后疼痛稍有缓解。现为进一步治疗,至我院就诊。入院查体:右前臂中1/3内侧处肿胀明显,皮肤无黄染、无瘢痕、肤色正常,右前臂内侧局部可触及肌间软组织包块,大小约5 cm×3 cm×2 cm,质韧,边界清晰,活动度较差,无压痛,桡动脉搏动良好,末梢血运良好,无肢体感觉及运动障碍。辅助检查:术前完善各项常规检查,前臂X线片未见骨质异常。超声提示前臂肌层内可见5.0 cm×2.4 cm低回声肿物,边界清,内部回声欠均     

Ossifying fibromyxoid tumor of soft parts in a child: a case report.

Ossifying fibromyxoid tumor (OFMT) is a relatively rare tumor, most of which occur in adults with preferential localization in subcutis or muscles of the extremeties. Although Schwannian or cartilage origin has been suggested, histogenesis of this tumor still is unclear. The authors present a 6-year-old girl with retroperitoneal OFMT showing paraspinal extension, who is alive and tumor free 9 years after excision. The current case is the youngest reported patient showing unusual deep trunk site with surgically identified association with the spinal nerve. Both the clinical and histopathologic features strongly suggested Schwannian origin of this tumor.