Huge osteoma in the frontoparietal bone caused by trauma from 18 years ago: a case report.

BACKGROUND: Osteomas are asymptomatic, benign tumors and are diagnosed accidentally by radiological investigations conducted for other reasons. In some cases, they may cause aesthetic or functional symptoms by affecting nearby organs. The cause of osteoma is still dialectical. Many theories suggest that inflammation, trauma, or congenital causes are behind its formation. In our case, the patient presented with a symptomatic and huge osteoma in the frontoparietal bone caused by trauma from 18 years ago. CASE PRESENTATION: A 24-year-old Syrian woman came to our hospital complaining of headaches, syncope episodes, blurred vision, and tumor formation in the frontoparietal region. The medical and surgical histories of the patient revealed appendectomy and head trauma when she was 6 years old in a traffic accident. Radiological investigations showed thickness in the space between the two bone plates in the left frontoparietal region, which reached the orbital roof without cortical destruction or periosteum reaction; the tumor size was 5 cm × 5 cm. A surgical excision was indicated. Under general anesthesia, the surgery was done for the tumor excision. The histopathology examination emphasized the diagnosis of osteoma. The follow-up for 7 months was uneventful. CONCLUSION: This paper highlights the importance of focusing on the medical history of patients with osteoma in an attempt to explain the reasons for its occurrence. It stresses the need to put osteoma within the differential diagnoses of skull tumors.

Langerhans cell histiocytosis of the frontal bone with unexpected manifestations: Rare case report.

INTRODUCTION: Langerhans cell histiocytosis (LCH) is a disease caused by clonal expansion of myeloid precursors that differentiate into specialized dendritic cells. PRESENTATION OF CASE: A 21-year-old female came to our hospital complaining of tachycardia, high temperature, and tumor formation in the frontal region with a fistula. The examination of the thyroid gland and other systems was normal. The radiological investigations showed a severe lytic osseous lesion with aggressive destruction of the bone. The ultrasound imaging of the thyroid gland revealed that the thyroid was generally hypoechoic and heterogeneous because of many small hypoechoic focuses. In addition, the blood perfusion increased in the gland. The laboratory investigations were within normal expect C-reactive protein, free T4, and TSH. The surgery was indicated. The patient underwent an excision of the mass by a specialist in neurosurgery. The histopathological examination of the excised mass revealed LCH (eosinophilic granuloma). After 6 months, the patient underwent cranioplasty. The follow-up was uneventful for 3 months until the patient suffered from hyperthyroidism. DISCUSSION: LCH can form in any part of the body, and cause many symptoms depending on its location. Even though hyperthyroidism is a rare and unexpected symptom of LCH. CONCLUSION: LCH is a disease with broad-spectrum manifestations, so it should be a differential diagnosis in bone, thyroid, skin, and other organ lesions. In addition, thyroid ultrasonography and laboratory investigations are important methods to estimate thyroid functions and determine the clinical classification of the disease.

Caustic ingestion leads to pneumonectomy and right colonic interposition, a unique case report.

INTRODUCTION: Corrosive ingestion forms serious problem, with various outcomes depending on the time of diagnosis and treatment. We report here a case with rare and dangerous complications. PRESENTATION OF CASE: A two-year-old girl came to our hospital, complaining of solids' dysphagia. Retrieving her medical history showed that she had ingested a corrosive liquid accidentally. Without knowing the nature of the ingested agent, the local doctor removed it, using nasal gastric tube. This procedure induced vomiting, which in turn led to more damage. She stayed in the area's hospital for 40 days with just supportive treatment. The radiological investigations suggested severe stenosis. The dilation was done, but the patient did not respond after three months of treatment. Therefore, a gastrostomy was done. The esophagus replacement was inevitable, but the parents refused the surgical approach. Three months later, she returned to our hospital complaining of a productive cough. The radiological investigations suggested destruction in the left lung with a high suspicion of tracheoesophageal fistula. The treatment was through a surgical approach by removing the damaged lung tissue and closing the tracheoesophageal fistula. The patient got better after a month of the surgery, which allowed us to replace the esophagus and close the tracheoesophageal fistula. DISCUSSION: corrosive treatment varies a lot, depending on the patient's situation. Accurate treatment prevents severe and unexpected complications. CONCLUSION: More stringent instructions should be enacted among medical providers, corrosive agents' producers, and the public to be more careful when dealing with corrosive chemicals.

Exophthalmos and hemiheadache caused by osteoma in the greater wing of sphenoid bone: an extremely rare case report.

Osteoma is the most common benign tumor of the nose and paranasal sinuses. It is usually asymptomatic and diagnosed accidentally. In our case, the tumor formed in an unusual location and led to unexpected symptoms, which created a big challenge in diagnosis and treatment. Case presentation: A 53-year-old woman complained of hemiheadache, exophthalmos in the right eye, and limitation in lateral eye movements progressing to diplopia in the past 2 months. The physical examination of the rest systems was unremarkable. The radiological investigations revealed a hyperdense lesion arising from the right greater wing of the sphenoid bone and compressed on the orbit's components and eye muscles, which caused proptosis. The radiological findings suggested osteoma and the tumor was excised by craniotomy. The patient gets rid of the symptoms and the follow-up for 6 months was uneventful. Clinical discussion: Even hemiheadache, exophthalmos, limitation in eye movements, and diplopia are unfamiliar findings in osteoma, they may be its manifestations. Also, MRI is used as a diagnostic method with computed tomography scan in intracranial osteoma. These cases are treated by craniotomy. Conclusions: Even though osteoma is a benign tumor, it may form in unusual locations and cause unexpected symptoms. So, it should be a differential diagnosis in skull bony tumors. Also, it should be treated when exists in sensitive places to avoid irreversible outcomes.

A challenging diagnosis and management of Herlyn-Werner-Wunderlich Syndrome in low-resource Settings: A case report complicated with hydronephrosis.

INTRODUCTION: Herlyn-Werner-Wunderlich syndrome is a rare congenital disorder that consists of a didelphic uterus, hemivaginal septum, and unilateral renal agenesis. Both diagnosis and management can be challenging in low-income countries. CASE PRESENTATION: a 13-year-old female who experienced recurrent pelvic pain, dysmenorrhea, and abdominal mass for one month. We could not obtain the MRI as it was unavailable in our hospital, and the patient cannot afford its expensive cost in a private center. Instead, US showed an absent right kidney and doubled uterus with a heterogeneous cystic formation. A pelvic CT scan revealed an absent right kidney, an enlarged left kidney, a double uterus, and a left hematocolpos. We established the diagnosis of Herlyn-Werner-Wunderlich syndrome and started planning for correcting the anomalies via laparotomy. DISCUSSION: ultrasound detects uterus didelphys, hematocolpos, hematometrocolpos, and renal agenesis but cannot identify the vaginal septum and the type of müllerian defect. The MRI is more convenient for a thorough assessment, but it is a high-priced diagnostic method. CONCLUSION: although MRI is the gold standard for establishing the diagnosis and preoperative planning, ultrasound and CT scan can be an alternative, less expensive, and reliable approach. In addition, Laparoscopy or vaginoscopy may not be available in these countries. Therefore, correcting the anomalies can be achieved with laparotomy, which results in acceptable outcomes without any complications.