Apocrine and clear cell metaplasia in the gallbladder: the first finding in the medical literature.

Apocrine metaplasia, specifically, involves the development of cells resembling those in apocrine glands, characterized by their distinctive cytoplasmic features. Apocrine metaplasia in the gallbladder represents a new and intriguing discovery, marking a significant milestone in medical literature. Furthermore, clear cell metaplasia is often observed in other organs like the cervix and has never been documented in the gallbladder. The coexistence of apocrine and clear metaplasia challenges existing paradigms surrounding gallbladder pathology, prompting a reevaluation of the underlying mechanisms that drive these cellular transformations.

Mucinous cystadenoma of the ovary with xanthogranulomatous oophoritis: the first case report in the literature.

This case report presents a unique and unprecedented occurrence of mucinous cystadenoma of the ovary accompanied by xanthogranulomatous oophoritis, a rare inflammatory condition. To the best of our knowledge, this is the first documented case of its kind in the medical literature. The patient, a 25-year-old woman, presented with abdominal pain, fever, and discomfort, prompting further investigation that led to the unexpected discovery of these coexisting pathologies.

Xanthomatous salpingo-oophoritis accompanied by hobnail cell and apocrine metaplasia: The first case report in the literature.

INTRODUCTION AND IMPORTANCE: Xanthomatous inflammation is a rare chronic inflammatory condition typically affecting organs such as the kidney and gallbladder. Its occurrence in the female genital tract, particularly in the ovaries and fallopian tubes, is exceptionally rare and sparsely documented. CASE PRESENTATION: We report a unique case of xanthomatous inflammation involving the fallopian tube and ovary, characterized by the presence of hobnail cells and apocrine metaplasia. This represents the first documented instance in medical literature. A 55-year-old woman presented with pelvic masses, initially raising suspicion of more common conditions such as ovarian neoplasms or tuberculosis. CLINICAL DISCUSSION: Xanthomatous salpingo-oophoritis (XSO) often presents with symptoms resembling ovarian tumors or infectious diseases, posing challenges in diagnosis. Accurate preoperative identification is essential to avoid unnecessary radical surgeries and optimize patient management. CONCLUSION: This case highlights the importance of considering xanthomatous inflammation in the differential diagnosis of ovarian and tubal lesions, especially when typical symptoms of pelvic masses are present. Recognizing this rare inflammatory condition can prevent overtreatment and guide appropriate therapeutic strategies.

Ectopic adrenal tissue in the mesosalpinx of an older female: the fourth case report in the literature.

Ectopic adrenal tissue is a rare finding often encountered incidentally during histopathological examinations. The most common site is the genitourinary tract and pelvis, and more frequently in males than females. Ectopic adrenal tissue is primarily found in neonates and is extremely rare in adults. Although it is an unexpected entity, pathologists should be aware of it because it may be confused with metastasis of clear cell renal carcinoma. To the best of our knowledge, only three cases of ectopic adrenal tissue in the mesosalpinx of the fallopian tube have been reported in the medical literature, making this case the fourth one. In our report, we discussed an ectopic adrenal tissue that was discovered incidentally in the mesosalpinx of an older female.

Extradigital glomus tumor: A rare case report.

INTRODUCTION AND IMPORTANCE: Glomus tumors are benign soft tissue tumors of the glomus body, most regularly found in the sublingual region of the digits, palms, and soles. Extra digital lesions are uncommon and might be difficult to diagnose. CASE PRESENTATION: We report a rare case of a 38-year-old man who presented with a painful nodule on his right upper arm. A definite diagnosis was made by histopathological study. A complete surgical excision was performed to avoid recurrence. CLINICAL DISCUSSION: Glomus tumors form less than 2 % of all soft tissue tumors. The tumor was first reported by Wood in 1812. It typically appears like a small blue-red solitary papule in the hand especially the digits, which are the most prevalent location for glomus tumors with an incidence rate of up to 75 %. The histopathology findings of glomus tumor, are three components: glomus cells, vasculature, and smooth muscle cells. The preferred method of treatment is total excision to prevent a recurrence. CONCLUSION: Eventually, the glomus tumor is fairly a rare benign tumor that physicians should keep in mind as a deferential diagnosis when facing a subcutaneous nodule and don't rule out when the tumor is extradigital.

Dyskeratosis congenita: a rare case report.

Dyskeratosis congenita (DKC) is a rare genetic disorder characterized by lacy reticular skin hyperpigmentation, bone marrow failure, nail dystrophy, and oral leukoplakia. To the best of our knowledge, only around 200 cases were reported in the medical literature, and in this report, we present another distinctive case from Syria. This case report describes a male patient with generalized reticular pigmentation and abnormal nails since childhood. The patient reported a history of recurrent urethral stenosis and corneal density. Dermoscopic examination revealed pigmented lines arranged in a netlike pattern. Histopathological findings were nonspecific. Hematological values were unremarkable. A contrast CT scan revealed changes in the bladder wall. The final diagnosis of Dyskeratosis Congenita was made based on the clinical criteria. This disorder can present with additional cutaneous manifestations and systemic complications. Treatment are generally prescribed to maintain bone marrow function, based on the fact that it is the major cause of death. Regular monitoring and screening for associated conditions are recommended.

Eccrine spiradenoma on the anterior forearm in a pediatric patient: A rare case report.

Spiradenoma is a rare benign adnexal tumor arising from eccrine sweat glands. It presents as a painful bluish nodular lesion which occurs rarely over the arms. This case report adds to a case where a recurrent spiradenoma occurred over the arm. The majority of reported cases involve young adults, making our pediatric case particularly unusual. Early diagnosis through excisional biopsy is crucial for optimal management and prevention of recurrence or malignant transformation. Eccrine spiradenoma is an uncommon tumor that should be kept in mind in case of a patient with a painful nodule. More genetic studies are needed for the best understanding of this rare tumor entity.

Amelanotic melanoma in a kidney transplant patient: a rare case report.

Immunosuppressed individuals face a significantly elevated risk of developing aggressive cutaneous malignancies, often surpassing the aggressiveness observed in immunocompetent counterparts. Our patient exhibited several risk factors associated with melanoma development in renal recipients, including skin type, sun exposure, and the duration of immunosuppression. The determination of staging holds paramount importance as it directly influences both prognosis and subsequent management. It is crucial to handle suspected lesions with caution in these patients to facilitate early melanoma detection and enhance overall prognosis.

Incidental ectopic adrenal cortical tissue in the descending mesocolon in an elderly female: a first case report in the literature.

Ectopic adrenal tissue (EAT) is an extremely unusual finding. The most common site is the genitourinary tract and pelvis, and more frequently in males than females. In our report, we discuss an ectopic adrenal cortical tissue detected in the descending mesocolon in an elderly female. To the best of our knowledge, this case is the first report in the English literature.

Primary squamous cell carcinoma of the renal pelvis presenting with severe hydronephrosis: A rare case report.

INTRODUCTION AND IMPORTANCE: Primary squamous cell carcinoma of the renal pelvis is a rare malignancy, accounting for fewer than 1 % of all kidney tumors. This form of cancer normally develops in the urinary tract's transitional epithelium, and its presence in the renal pelvis is extremely rare. CASE PRESENTATION: In this report, we discuss the clinical and pathological aspects of a patient with primary squamous cell carcinoma of the renal pelvis. The patient, a 58-year-old man, had flank discomfort associated with burning micturition. A right nephrectomy was done after imaging investigations indicated right kidney hydronephrosis. The diagnosis of primary squamous cell carcinoma was confirmed by pathological investigation of the specimen. The patient has received 4cycles of chemotherapy with cisplatin and gemcitabine. One month later, the patient was referred for a metastatic mass in the chest wall. CLINICAL DISCUSSION: Because of the tumor's rarity, diagnosis and therapy are difficult. This case report emphasizes the significance of including primary squamous cell carcinoma in the differential diagnosis of renal pelvic tumors, especially in individuals with risk factors such as smoking and chronic renal calculi. CONCLUSION: Renal pelvis squamous cell carcinoma is a rare, aggressive, high-grade tumor with a poor prognosis. Chronic irritation plays a substantial role in the process. Thus, patients with a history of urolithiasis should be monitored closely.

Metastatic squamous cell carcinoma of the lung to the thyroid gland presented as nodular goiter: a rare case report.

Metastasis of squamous cell lung carcinoma to the thyroid gland is an extremely rare event. It frequently metastasizes to lymph nodes, liver, adrenal glands, bone, brain, and pleura. Among the lung carcinomas metastasizing to the thyroid, adenocarcinomas are the most common followed by squamous cell carcinomas (SCCs). Case presentation: A 58-year-old male patient presented with bilateral neck swelling. Fine needle aspiration is performed and was undetermined. Ultrasonography of the neck demonstrated multiple hypoechoic nodules with thyroid enlargement. The patient was diagnosed with nodular goitre and he underwent a total thyroidectomy. Microscopically, the Hematoxylin and eosin-stained sections revealed thyroid follicles with sheets composed of polygonal cells with pleomorphic nuclei, prominent nucleoli, and a moderate amount of eosinophilic cytoplasm. Keratin pearls were present. Based on histopathological and clinical findings, the final diagnosis was metastatic SCC to the thyroid gland. Clinical discussion: Clinically, patients with thyroid metastasis presented with nonspecific symptoms such as thyroid nodule or goitre, cervical discomfort, dyspnoea, dysphagia, or dysphonia. Chemotherapy is used in the case of a poly metastatic tumour and radiotherapy as a palliative treatment whereas radioiodine treatment is not indicated for thyroid metastases. Conclusion: Diagnosis of SCC in the thyroid gland as a primary or metastatic neoplasm is a significant challenge. In the absence of specific clinical or radiological signs, pathological studies remain the gold standard for diagnosis.

Idiopathic eosinophilic cholecystitis with cholelithiasis: Two rare cases report.

INTRODUCTION AND IMPORTANCE: Eosinophilic cholecystitis is an unusual condition in which more than 90 % of the inflammatory infiltrate in the gallbladder wall is comprised of eosinophils. The pathogenesis of eosinophilic cholecystitis is still unknown, but in some cases, it is related to hyper-eosinophilic syndrome, parasitosis, infections, and drugs. CASE PRESENTATION: We described two cases in which a woman aged 27 years and a man aged 30 years presented with acute and chronic cholecystitis symptoms, respectively. The ultrasound revealed calculous cholecystitis. The cholecystectomy was performed, and the pathological examination of the surgical specimen revealed eosinophilic cholecystitis. CLINICAL DISCUSSION: Eosinophilic cholecystitis is a rare disease of the gallbladder. It accounts for 0.25 to 6.4 % of cholecystitis cases. It is characterized by eosinophils infiltration in the lamina propria and the muscle layer. There are no specific symptoms of this disease; it presents as typical cholecystitis. The histopathological investigation is the gold standard for diagnosing eosinophilic cholecystitis, and cholecystectomy is the ultimate treatment for it. CONCLUSION: Eosinophilic cholecystitis is a rare condition characterized by acute cholecystitis with eosinophilic infiltration of the gallbladder. In patients with eosinophilic cholecystitis, a comprehensive assessment of the underlying causes is recommended.

Appendiceal neuroma presented as acute appendicitis: A rare case report from Syria.

INTRODUCTION AND IMPORTANCE: Appendiceal neuroma, also known as fibrous obliteration, is an exceptional benign lesion discovered in the vermiform appendix removed for indications of acute appendicitis. CASE PRESENTATION: We report a case of a 76-year-old woman who presented with signs and symptoms of acute appendicitis. An abdominal ultrasound revealed a mildly distended appendix with a peri-appendiceal fluid collection. Gross examination of the excised appendix showed an obliterated lumen of the distal part on serial cuts. Microscopically, the lumen is replaced by the proliferation of spindle cells into fascicles embedded in fibrous tissue. The diagnosis of appendiceal neuroma was reported and supported by the result of the S-100 immunohistochemical staining. CLINICAL DISCUSSION: An appendiceal neuroma represents an incidental finding in appendices excised for other reasons. Clinically, there are no specific signs or symptoms, and it is discovered inadvertently. Occasionally, it can mimic acute appendicitis. This lesion is characterized by the proliferation of spindle cells that occlude the lumen of the appendix. CONCLUSION: A histopathological evaluation is essential to achieve a definitive diagnosis of an appendiceal neuroma.

Low-grade appendiceal mucinous neoplasm associated with Urothelial carcinoma: A rare case report from Syria.

Introduction: and importance: Low-grade appendiceal mucinous neoplasm is a rare neoplasm found in the appendix vermiform. Appendiceal mucinous neoplasms are usually seen by accident during investigations or surgeries for other reasons in the abdomen. Low-grade appendiceal mucinous tumors have no specific symptoms. Case presentation: We report an unusual case of a 72-year-old man with low-grade appendiceal mucinous neoplasm, which was found accidently during the investigation of the bladder tumor on a CT scan. Pathological examination of the specimen showed a cystic dilation at the distal tip of the appendix, filled with gelatinous mucus. Microscopically, we found mucinous epithelial proliferation with extracellular mucin. Clinical discussion: Low-grade appendiceal mucinous neoplasm is an uncommon tumor of the appendix. The incidence of low-grade appendiceal mucinous neoplasm is reported to be 1% of all tumors of the gastrointestinal tract and is found in less than 0.3% of appendectomy specimens. Appendiceal mucinous tumors are usually found with no specific symptoms. Conclusion: Low-grade appendiceal mucinous neoplasms are rare tumors of the gastrointestinal tract. The appropriate management for this tumor is appendectomy. The most feared complication of these tumors is seeding of mucin into the peritoneal cavity, leading to pseudomyxoma peritonei.

Heterotopic pancreatic tissue in the gall bladder neck and lymph node surrounding cystic duct identified during cholecystectomy for chronic calculous cholecystitis: a rare case report from Syria.

Heterotopic pancreas is a congenital anomaly defined as the presence of the pancreatic tissue outside its normal location, which is usually discovered incidentally. We describe a rare case of heterotopic pancreatic tissue in the neck and the node surrounding the cystic duct of the gallbladder. A 33-year-old female presented with right upper quadrant abdominal pain aggravated after fat meals. The diagnosis was made as chronic cholecystitis. Laparoscopic cholecystectomy was performed. Pathologic examination showed a lobulated nodule connected to the cystic duct. Microscopically, this node consisted of all components of pancreatic tissue. Localization of heterotopic pancreatic tissue in the gallbladder is exceedingly rare. Less than 40 cases of heterotopic pancreas in the gallbladder have been reported worldwide. The ectopic pancreas is an extraordinary congenital entity. Although pancreatic tissue in the lymph node is an exceptional finding, pathologists should be aware of it because it may be confused with tumor or metastasis.

Rapid onset and unpredicted findings of a giant nodular melanoma arising on a congenital nevus: a case report.

Melanoma is a malignancy that develops from pigment-producing cells known as melanocytes. Although it is considered one of the most fatal tumors in the world, its early diagnosis is associated with a better prognosis and overall survival. A 49-year-old man was admitted to the dermatology department with a 15 cm lesion on the left arm. It was growing on a congenital nevus to reach an enormous size. Surgical excision was not possible and the treatment was controversial as the patient showed unpredicted resistance to immunotherapy. Further evaluations revealed false-negative BRAF mutation, which completely changed the course of treatment. Cutaneous melanoma is a rare malignancy, accounting only for 1% of skin cancer cases, and having it arising on a pre-existing congenital nevus is even much rarer. Although there is no decisive definition of giant melanoma, some authors define it as a lesion of more than 10 cm in diameter. Through the literature, only a few cases of giant melanoma on the arm have been reported. Through our paper, we are revealing the importance of early diagnosis and treatment of melanoma and confirming the significant role of regular follow-up for patients with a congenital melanocytic nevus. Moreover, we are showing the importance of having alternative methods for detecting BRAF mutations to avoid false-negative results and have better outcomes.

Role of Magnetic Resonance Imaging (MRI) in grading gliomas comparable with pathology: A cross-sectional study from Syria.

Objective: Gliomas are one of the most common brain tumors in adults with a poor prognosis in most patients. Magnetic Resonance Imaging (MRI) plays a critical role in the diagnosis, management, and follow-up of gliomas. The aim of this study is to assess the sensitivity and specificity of MRI in the preoperative grading of supratentorial gliomas in comparison to histopathology. Methods: A cross-sectional study included 39 patients, aged between 40 and 75 years with histologically diagnosed supratentorial gliomas who underwent conventional MR imaging, which included T1, T2, and FLAIR sequences from November 2018-December 2019 in the Department of Neurosurgery, Tishreen University Hospital, Lattakia. The histopathological typing and grading of the tumor were done by using 2016 WHO classification. The sensitivity, specificity, predictive value, and accuracy of MRI in determining tumor grade were calculated. The comparison was done between MRI findings and WHO histopathological grading. Results: The overall sensitivity and specificity of MRI findings in the assessment of high-grade gliomas were 100% and 91% respectively. The positive predictive value (PPV) was 66.6%, and the negative predictive value (NPV) was 100%. The overall accuracy was 94.9%. The agreement between histopathological and MRI findings was 72%. Conclusions: MRI plays an essential role in the initial diagnosis and grading of supratentorial gliomas with high sensitivity and specificity. It is considered a non-invasive method and is useful in cases where the biopsy procedure is a contraindication or rejected by the patient.

Dropped gallstones mimicking intraabdominal implants or tumor: A report of two cases.

Introduction and importance: Dropped gallstones are an uncommon complication of laparoscopic cholecystectomy. Few reports have described dropped gallstones that were found accidently. Here, we encountered two cases of dropped gallstones that were unexpectedly found during surgery. Case presentation: Case 1 involved a 54-year-old woman who has undergone a total abdominal hysterectomy with bilateral salpingo-oophorectomy for endometrioid cancer in the right ovary which was confirmed by histology. During surgery, a small firm nodule was seen in the omentum. An omentectomy is done for histological evaluation. Case 2 involved a 29-year-old woman admitted for an elective Caesarean section. During surgery, a firm nodule in the vesicouterine pouch was found. The nodule was carefully removed and sent to the pathology department. Microscopically, both cases revealed a fibrous wall enclosing gallstone associated with a foreign body-type granulomatous reaction. Clinical discussion: Dropped gallstones (DGs), also referred to as spilled gallstones, into the peritoneal cavity are an uncommon complication of laparoscopic cholecystectomy. Clinically spilled gallstones usually remain silent for months or years after laparoscopic cholecystectomy and can be found during imaging or surgery. Conclusion: Clinicians should keep in mind that mass-forming lesions within the peritoneal cavity, due to dropped gallstones, may mimic neoplasia.