Xanthogranulomatous pleuritis induced by recurrent biliothorax due to a biliopleural fistula: The first case report in the literature.

Xanthogranulomatous pleuritis is an extremely rare pathological entity, characterized by the infiltration of foamy cells and multinucleated giant cells within the pleural space. This condition often mimics infectious and neoplastic processes, presenting significant diagnostic challenges. This report details the first documented case of xanthogranulomatous pleuritis induced by recurrent biliothorax due to a biliopleural fistula, presenting a unique clinical scenario. We describe the clinical presentation, diagnostic hurdles, and both the surgical and medical management of this case. The discovery of biliothorax, evidenced by pleural fluid bilirubin levels that exceed serum bilirubin levels, underscores the importance of considering biliothorax in the differential diagnosis of recurrent pleural effusions, particularly in patients with a history of trauma. This case emphasizes the need for heightened awareness and a multidisciplinary approach in the diagnosis and treatment to effectively manage this complex condition and prevent recurrence.

Low-grade fibromyxoid sarcoma in laryngopharynx: the first case report in the literature.

Low-grade fibromyxoid sarcoma is a rare mesenchymal neoplasm with distinctive histopathological features. Although it typically arises in the deep soft tissues of the trunk and extremities, its occurrence in the head and neck region is exceedingly rare. We present the first documented case of low-grade fibromyxoid sarcoma in the laryngopharynx, expanding the spectrum of this rare tumor's anatomical localization. The clinical, radiological, and histopathological features of this unique case are discussed, highlighting the diagnostic challenges and therapeutic considerations associated with this uncommon presentation.

Optimization of tissue microarray technique for breast cancer patients: a short communication.

Background: Tissue microarray (TMA) is a novel technique for studying different types of cancer tissues in one block. TMA is not yet established in Syria, so we aimed in this project to apply and set the most optimal conditions of TMA creation of breast cancer tissues at the Pathology Department of our institute. Materials and Methods: Eighty-eight blocks of breast cancer tissues were selected, considering the inclusion criteria. The tissue specimens of breast cancer patients were manually placed in the block by punching a core from a paraffin block, which was then released into a recipient block using a small trocar. Three different conditions were tested on the constructed TMA block. Results: We determined the most effective parameters that proved high quality: incubating the newly constructed block at a temperature of 43°C for 24 h in the oven and then cutting it the next day after cooling it to room temperature; also, cutting with a 5 µm thickness created the preferable stained slides later. CD3 staining showed high expression of tumor-infiltrating lymphocytes among triple-negative breast cancer patients and high expression of CD3 in triple-negative cancer patients. Conclusion: The optimization of parameters presented in our study resulted in perfect TMA generation and successful immunohistochemistry staining for cancer research at our institution.

Rapidly progressive tumor stage mycosis fungoides: A case report from Syria.

Introduction and importance: Mycosis Fungoides, the most common type of cutaneous T-cell lymphomas (CTCLs), has typically an indolent course over years or decades. Patches grow into infiltrated plaques which may turn eventually into tumors. The tumor stage represents advanced lymphoma, but this occurs in a minority (∼10%) of cases. Case presentation: we present a rare case of mycosis fungoides in a 30-year-old woman showing rapid progression to tumor stage, unlike the indolent clinical course seen classically. Clinical discussion: Mycosis Fungoides (MF) is the most common primary cutaneous T-cell lymphoma, representing less than 1% of the total number of non-Hodgkin lymphoma. Patients with a classical type of MF progress from patch stage to plaque stage and finally to tumor stage disease, and they have a protracted clinical course over years or even decades. Conclusion: Although mycosis fungoides is a rare disease, it requires a high degree of suspicion clinically. The disease can have an excellent prognosis when identified and treated promptly.

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.

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.

A successful treatment of severe lupoid cutaneous leishmaniasis in an elderly man: a case report.

Lupoid cutaneous leishmaniasis (LCL) is a rare, atypical presentation of cutaneous leishmaniasis (CL). In this report, the authors present the case of a severe LCL in an elderly patient who presented to our dermatology department with severe, painful ulcerated lesion on his midface with cosmetic deformity to his nose. He had a history of CL 3 years ago at the same place. Histopathologic examination showed epidermal and dermal changes with chronic inflammatory infiltrate and no leishmaniasis bodies were detected. He was admitted and treated with systemic glucantime (60 mg/kg) for a month followed by hydroxychloroquine (200 mg twice a day) for another month with favorable outcome. Countries with endemic CL should consider LCL in patients with a history of leishmaniasis and a similar clinical presentation, especially that it could be misdiagnosed with other granulomatous cutaneous conditions, thus leading to cosmetic deformities that can be avoided with early adequate treatment.

Osteosarcoma of the frontal bone: a study of a rare case in a 17-year-old female.

Head and neck osteosarcomas are infrequent and usually present in the third-fourth decades of life. However, they are extremely rare in the pediatric population. Primary involvement of the cranial vault, excluding the mandible and maxilla, is an exceedingly rare phenomenon; thus, the number of clinical studies published in the literature is limited. Because of the anatomy of the head, complete resection may be difficult to achieve. Furthermore, an aggressive surgical approach can cause a significant functional impairment or cosmetic defect. We report the case of a 17-year-old patient with an aggressive recurrence of multiple tumors in the left side of the skull accompanied with a severe headache and complete left-sided vision loss with no metastases at presentation. The recurrence of the tumor was preceded by pregnancy and delivery, which raised the question of whether pregnancy hormones were a provoking factor in the recurrence of the tumor or not.

Recurrent giant fibroadenomas with transformation to cystosarcoma phyllodes in a 17-year-old girl: a rare case report from Syria.

BACKGROUND: Fibroadenoma is the most prevalent benign breast lesion that generally affects middle-aged women; it is rare in adolescents and younger children. The transformation into malignancy is not common. However, multiple recurrences of rapidly enlarging fibroadenomas suggest a high possibility of transforming into phyllodes tumors, which are uncommon fibroepithelial lesions that account for 0.3-0.5% of female breast tumors and typically present in premenopausal women. CASE PRESENTATION: We report a case of a 17-year-old Syrian girl who previously had three episodes of recurrence of multiple rapidly enlarging fibroadenomas in her left breast and underwent three operations for complete resection of the lesions. However, a few months later, she was readmitted with multiple large masses in the same breast, and pathological findings confirmed a surprising combination of multiple fibroadenomas for the fourth time with a malignant phyllodes tumor (cystosarcoma phyllodes). The patient underwent lumpectomies followed by adjuvant radiotherapy. Long-term follow-up was recommended. CONCLUSION: Our patient had an extraordinary number of episodes of recurrence at a young age and a rare combination of malignant and benign lesions in the same breast with multiple recurrences. We present her unique, very challenging case with the aim of highlighting the importance of clinical correlation, detailed diagnosis, and careful follow-up.

Pediatric mediastinal ALK- negative anaplastic large cell lymphoma (Hodgkin-like pattern) in a 13-year-old girl: a case report and review of literature.

Anaplastic large-cell Lymphoma (ALCL) is a rare type of non-Hodgkin lymphoma that is characterized by an entity of large neoplastic cells labeled by the Ki-1 antibody. It constitutes ~2% of all lymphoid neoplasms and is divided into two main categories: anaplastic large-cell kinase (ALK)+ALCL and ALK-ALCL that is recognized by the absence of ALK expression and mostly affects men at older ages. Thus, in this report we present a rare case of ALK-negative ALCL (ALK-ALCL) that was described and diagnosed in a 13-year-old girl in the mediastinum. Highlighting the rarity of manifestation at younger ages and the importance of using immunohistochemical staining in the differential diagnosis of this lymphoid neoplasm.

Clinicopathological study of primary gastric lymphoma.

OBJECTIVE: To present a histopathologic and immunohistochemical analysis of primary gastric lymphomas that was reclassified according to the new World Health Organization classification of lymphoid neoplasms. METHODS: We reviewed the morphological and immunohistochemical features of 28 patients with gastric lymphomas, diagnosed in the Department of Pathology at the University Hospital of Tishreen University, Lattakia, Syria, during the period 1994-2003. Specimens were obtained from endoscopic and surgical biopsies. The immunohistochemical study was performed to analyze the immunophenotype of these lymphomas. RESULTS: Patients were aged 17-71 years. There was a slight predominance of females (male to female ratio, 13:15). Seventeen of the patients had tumors mainly located in the gastric antrum. Histologically, the most common lymphoma was of mucosa-associated lymphoid tissue (MALT) type (20 patients), also with diffuse large B-cell lymphoma (7 patients), and anaplastic large cell lymphoma (one patient). CONCLUSION: Our study demonstrates the different patterns of gastric lymphomas in Lattakia, Syria during a 10-year period in 28 Syrian patients, and reveals that the most primary gastric lymphomas are B-cell MALT lymphomas.