Giant Pancreatic Lymphangioma Herniating Above the Diaphragm.

Lymphangiomas of pancreatic origin are rare and can often be found with abdominal symptoms or incidentally on imaging. A 46-years-old female presented with epigastric abdominal pain and vomiting, and twenty-pound weight loss over 3 months. Computed tomography of the abdomen showed a septated mass of the distal pancreas measuring 25.4 cm in largest diameter and extending superiorly into the mediastinum via a hiatal hernia. Endoscopic ultrasound demonstrated abutment but no invasion of the esophagus and stomach. She underwent an exploratory laparotomy with retroperitoneal mass excision, distal pancreatectomy, splenectomy, and hiatal hernia repair with Dor fundoplication. Pathology was consistent with a cystic lymphangioma. Patient was discharged on postoperative day 3 and remained recurrence free for over a year.

Transvaginal Resection of a Gastrointestinal Stromal Tumor (GIST) of the Rectum.

Gastrointestinal stromal tumors (GISTs) are connective tissue tumors representing a minority of gastrointestinal tumors. A 49-year-old woman was found to have a rectal mass in addition to uterine fibroids during work-up for abnormal uterine bleeding. A peri-rectal mass was again seen during hysterectomy, but definitive resection was deferred. A pelvic MRI suggested a posterior vaginal wall mass. A transvaginal approach was chosen for excision of a solid multi-lobulated mass from the rectovaginal septum space. Frozen section reported uterine leiomyoma, but final pathology confirmed a 10-cm high-risk GIST arising from the rectal muscularis propria, with microscopically positive margins. Patient was started on imatinib therapy. Abdominopelvic resection was offered to decrease the risk of recurrence but was declined. Repeat imaging has shown no obvious distant metastases or residual rectovaginal region mass. The simultaneous and similar presentation of uterine leiomyoma and rectal GIST draws attention to this case.

Anti-Coronavirus Disease 2019 Vaccines: Need for Informed Consent.

Vaccines are among some of the most efficacious medical and public health methods ever employed to contain a pandemic, in addition to providing protective and preventive measures. Evaluation of vaccineassociated adverse events through experimentation and empirical evidence is an integral part ofthoroughly assessing the safety of vaccines before authorization of their widespread use. History has highlighted the importance of continuous search for possible vaccine-related adverse effects and vaccine-induced immunogenicity long afterlicensure, suggesting that a primary concern with new vaccines is not only efficacy but also safety, particularly overthe long term. Many of the various anti-COVID-19 vaccines have used different types of technology, with some being introduced for the first time or rushed shortly into testing, bypassing animal experimentations. They have been adopted for use through emergency use authorizations, leading to a less than optimal collection of broad data on safety, immunogenicity, effectiveness, and time span of protection, as well as short follow-up of few months, despite many infectious disease experts arguing thatit takes 10 years to develop a vaccine. Given the valid concerns on well-recognized short-term and long-term safety issues, such as antibody-dependent enhancement and other processes like molecular mimicry and potential genomic transformation, the experimental nature of the vaccination process, the limited shortterm follow-up in the main trials, and the dismissal by law of pharma companies and health care providers from any medico-legal responsibilities, the application of an informed consent should become not only a necessity but also mandatory by law in accordance with all declarations on human rights. Such information should be provided to every potential recipient in the form of an official written digital consent prior to the registration for or the receipt of the vaccine.