Myeloid osseous metaplasia of the lung: A case report.

Pulmonary osseous metaplasia is a disease in which mature bone is found within the parenchyma of the lung. The current study presents a case of pulmonary osseous metaplasia in a 64-year-old female. The patient was previously diagnosed with transitional cell carcinoma (TCC) of the lower ureter. During a routine check-up, an enhancing basal lung nodule was found on chest computed tomography scan, which was suspected to be metastatic lung disease. The patient underwent a thoracoscopic resection of the nodule. The histopathological examination of the specimen confirmed it to be myeloid osseous metaplasia. The disease usually has no significant complications and can also be found in association with other pulmonary diseases. Very limited information is available on the phenomenon; therefore, there is no exact treatment guide for clinicians to follow. In conclusion, myeloid osseous metaplasia of the lung is a rare finding, and based on this report, it may be associated with TCC.

Sporadic neurofibroma of facial nerve presenting as parotid gland tumor: a rare case report.

Intraparotid gland neurofibroma is a rare benign tumor that arises from Schwann cells of the facial nerve within the parotid gland. This case report discusses a 41-year-old woman who experienced a painless preauricular swelling on her right side for over 5 years. Clinical examination and ultrasound revealed a well-defined mass in the parotid gland. The patient underwent total mass excision, resulting in transient facial nerve dysfunction but complete recovery. These tumors often manifest as solitary masses in the parotid region and may compress nearby structures, causing facial paralysis or numbness. Their diagnosis can be challenging due to similarities with other parotid gland tumors and possible associations with neurofibromatosis. Managing intraparotid tumors, including neurofibromas, involves a multidisciplinary approach with input from cytopathologists, radiologists, and surgeons.

Lingual osteoma presenting as a solitary painless lesion: Report of a rare case with review of the literature.

Lingual osteoma, a rare, benign bone tumor that primarily affects the posterior tongue, can be difficult to diagnose. This study aims to report a case of osteoma affecting the tongue in a 17-year-old female. The patient had a foreign body sensation and a progressively growing lesion for 3 years and underwent clinical examination and diagnostic procedures. A well-defined, smooth-surfaced, white mass was discovered in the posterior third of the tongue. The 1.5 × 1 × 0.4 cm mass was completely excised under local anesthesia and histopathologically confirmed as a benign lingual osteoma. The 2-month post-operative outcome was uneventful. The rarity of lingual osteoma, as well as the fact that it is often asymptomatic, makes diagnosis difficult. The diagnosis entails a proper clinical examination, imaging studies, and histopathological analysis. Surgical intervention, primarily aimed at complete excision while preserving tongue function, remains the primary treatment option. Successful excision entails educating healthcare professionals about this rare benign bony tumor to ensure the best possible patient outcomes.

Mediastinal parathyroid cyst: A case report and review of the literature.

Mediastinal parathyroid cysts (MPCs) are extremely rare, benign lesions arising from the parathyroid glands and residing within the thoracic cavity. This study aims to advance understanding of MPC, emphasizing accurate diagnosis and management approaches for this rare condition. A 46-year-old woman presented with dysphagia for one week. Blood tests revealed elevated parathyroid hormone (PTH) (112.8 pg/mL) and normal serum calcium (9.54 mg/dL). Ultrasonography identified a large, well-defined cystic nodule measuring 46 × 30 × 25 mm, extending retro-sternally in the right upper third of the chest. A subsequent high-resolution computed tomography scan of the chest revealed a large space-occupying lesion (47 × 43 × 31 mm) in the superior mediastinum, near the esophagus, suggesting an esophageal duplication cyst or, less likely, a bronchogenic cyst. Video-assisted thoracoscopic surgery (VATS) was performed, and the entire cyst was excised, confirmed histologically as a mediastinal parathyroid cyst. Mediastinal involvement of PCs poses diagnostic challenges due to their rarity and diverse clinical presentations. Surgical excision is necessary for symptomatic cases, with VATS emerging as a favorable approach.

Epidermal inclusion cyst in an axillary lymph node with breast cancer: A case report.

Epidermal inclusion cyst (EIC) is a benign lesion rarely discovered within lymph nodes. The present case report introduces an EIC incidentally discovered during an axillary lymph node biopsy in a patient with invasive ductal carcinoma of the breast. A 55-year-old woman presented with a breast mass. Ultrasound revealed a suspicious mass, and a core needle biopsy confirmed the diagnosis of invasive ductal carcinoma. Lumpectomy and sentinel lymph node biopsies were performed. Histopathological examination revealed tumor-free lymph nodes, with one of them harboring a keratinous EIC. EICs typically arise from entrapped epidermal cells. Their presence in lymph nodes is exceptionally rare. While the origin of such inclusions remains unclear, various theories exist, including anomalous embryonic development, implantation, and metaplasia. This report highlights the unique presentation of an EIC within an axillary lymph node. Recognizing this entity is crucial to avoid misdiagnosis of malignancy and unnecessary interventions.

Granulomatous mastitis masking ductal carcinoma in situ: A case report with literature review.

Granulomatous mastitis (GM) is a rare inflammatory disorder that infrequently occurs with synchronous breast carcinoma. The present study reports the case of a patient who was initially diagnosed with recurrent GM, which eventually proved to be masking an underlying ductal carcinoma in situ (DCIS). A 30-year-old female presented with left breast pain. On clinical examination, there was a large, palpable and painful lump in the left breast, with axillary lymphadenopathy. Initially, the diagnosis was GM and conservative treatment was applied. Surgical resection was decided upon for the condition after it became recurrent, and the histopathological examination revealed extensive DCIS with GM. Later on, the patient underwent a mastectomy with an axillary sentinel lymph node biopsy. The postoperative follow-up was uneventful. In conclusion, tissue diagnosis has a key role in detecting DCIS masked by GM, especially in young females who are not undergoing regular mammogram screening. The present study shows the challenge that the specialists in this field may face when dealing with recurrent GM of the breast, and warns them to search for a second pathology such as the DCIS presented in the current case.

Diagnosis of a pulmonary hydatid cyst by fine needle aspiration: a case report with literature review.

Introduction and importance: Hydatid cysts are seldom identified in cytologic smears and are often incidental. This report highlights a case where fine needle aspiration cytology was unintentionally utilized to diagnose a pulmonary hydatid cyst clinically mistaken for an abscess. Case presentation: A 29-year-old female presented with intermittent respiratory symptoms, including a mild cough and sputum, that she has been complaining of since 2020. A blood investigation revealed an elevated erythrocyte sedimentation rate (25 mm/h), C-reactive protein (>5 mg/dl), and white blood cells (>11×109/l). A high-resolution computed tomography scan of the chest revealed an irregular pulmonary opacity in the right lower lobe with central fluid attenuation, suspecting an abscess or, less likely, a pulmonary neoplasm. The patient underwent fine needle aspiration cytology, which was diagnosed as a hydatid cyst. A thoracotomy was performed, and the cyst was totally excised. Histopathological results of the specimen confirmed the previous diagnosis. Clinical discussion: Various diagnostic modalities have been discussed for diagnosing hydatid cysts, including radiology, serology tests, and fine needle aspiration. These modalities have been evaluated in terms of their respective advantages and drawbacks. Conclusion: Hydatid cysts can be challenging to diagnose based on imaging findings and may be misidentified as abscesses or masses. Despite the risk of anaphylaxis, fine needle aspiration cytology can be a reliable diagnostic method if performed meticulously by experienced radiologists.

Granulomatous mastitis in accessory breast tissue: A rare presentation and surgical management.

Granulomatous mastitis (GM) in accessory breast tissue is rare. The present study aimed to report a rare case of GM in accessory breast tissue. A 39-year-old female patient presented with right axillary discomfort and swelling for ~5 days. On clinical examination, a tender, firm lump was detected in the right axillary region. The ultrasound showed diffuse parenchymal heterogeneity and surrounding edema in the right accessory breast associated with reactive axillary lymph nodes. Following unresponsiveness to conservative treatment, a surgical procedure was performed in the form of an excisional biopsy and the lesion was diagnosed as GM. During the six-month follow-up, there were no recurrences. The exact cause of GM remains uncertain and the etiology within accessory breast tissue is even less understood. Proposed mechanisms suggest that it may result from an exaggerated immune response triggered by various factors, such as infection, autoimmunity or hormonal fluctuations. GM in accessory breast tissue is a rare and challenging clinical condition to be diagnosed. Due to the rarity of this condition, it highlights the importance of including GM in the differential diagnosis of axillary masses.

Carcinoma arising from thyroglossal duct remnants.

Thyroglossal duct cysts (TGDCs) are unusual remnants of the thyroid gland that are rarely observed in association with carcinoma. The present study aimed to showcase the clinical characteristics, diagnosis and management of patients with TGDC carcinoma. It was a single-center study conducted from February 2016 to February 2020. The study involved the retrospective analysis of a series of cases with TGDC carcinoma. A total of 10 patients were included in the study, of whom eight (80%) were females. Their age ranged from 25 to 48 years with a mean age of 39.1 years. A total of five cases (50%) underwent only Sistrunk's procedure, four patients (40%) underwent total thyroidectomy along with Sistrunk's procedure and one patient (10%) was treated by Sistrunk operation and lobectomy. In all of the cases (100%), histopathological examination confirmed papillary thyroid carcinoma in TGDCs. In addition, in the thyroid tissue, 2 cases (20%) also had papillary thyroid carcinoma and 3 cases (30%) had papillary thyroid microcarcinoma. Radioiodine was administered in one patient (10%) with suppressive thyroxine. A three-year follow-up with ultrasound revealed no suspicious lesions in any of the cases. Although rare, carcinoma may develop in the thyroglossal cysts. In this situation, both the thyroid gland and different lymph node compartments should be evaluated for malignancy. Surgical intervention is the cornerstone of management.

Penile calciphylaxis with penoscrotal necrosis: A case report with literature review.

Penile calciphylaxis, also known as calcific uremic arteriolopathy is an uncommon condition of the penile vessels due to its extensive vascular network. The aim of this report is to report a very rare case of penile calciphylaxis with penoscrotal necrosis. A 54-year-old male patient presented with progressive penoscrotal necrosis within a duration of one month. He had a history of diabetes mellitus and stage 5 chronic kidney disease. Under spinal anesthesia, partial penectomy and excision of the necrotic scrotum were performed. Histopathological examination was consistent with calciphylaxis. Despite it is a rare occurrence, penile calciphylaxis should be included in the different diagnosis of any diabetic and end stage kidney disease patients who presented with penile pain.

Biliary tree traumatic neuroma following laparoscopic cholecystectomy: A case report and literature review.

Laparoscopic cholecystectomy has been found to be associated with the development of traumatic neuromas on rare occasions. The present study reports a rare case of post-cholecystectomy biliary tree traumatic neuroma. Herein, a 47-year-old female with a history of laparoscopic cholecystectomy presented with upper abdominal pain and anorexia. Upon an examination, a yellow discoloration of the sclera was observed. Magnetic resonance cholangiopancreatography revealed a dilated proximal bile duct and mild dilatation of the intrahepatic biliary tree due to a stricture. Intraoperatively, a hard bile duct mass was observed with multiple enlarged lymph nodes in the peri-hepatic region. The patient was initially suspected to have bile duct cancer; however, a histopathological analysis of the resected mass revealed a bile duct traumatic neuroma. Biliary traumatic neuromas may be underestimated since they often remain asymptomatic. It is unfortunate that, as traumatic neuromas often lack distinguishing characteristics, no particular radiological findings for traumatic neuromas of the bile duct have been described to date, at least to the best of our knowledge. The rarity of this condition, combined with the absence of a standardized diagnostic modality, renders its diagnosis difficult and can even lead to misdiagnosis as biliary cancer.

Sarcoid­like granulomatous inflammation in a carotid body paraganglioma: A case report and mini­review of the literature.

Sarcoid-like granulomatous inflammation (SLGI) is defined as the development of non-necrotizing epithelioid granulomas in patients who do not meet the criteria for systemic sarcoidosis. Its occurrence is known to be linked to diverse conditions, including malignancies, infections, the use of certain drugs and inorganic substances. To the best of our knowledge, the available literature to date lacks any description regarding SLGI in a paraganglioma. The present study describes the first case of SLGI in a carotid body paraganglioma (CBP). A 54-year-old female patient presented with anterior neck swelling for 27 years without any other symptoms. An ultrasonography revealed a multinodular goiter with retrosternal extension and a solid lesion on the right side of the neck measuring 40x30x22 mm, which was suggestive of a CBP. The patient underwent a total thyroidectomy, and the right-side cervical mass was resected via another longitudinal incision. A histopathological examination of the thyroid specimen revealed findings of a multinodular goiter. Sections from the right-side cervical mass confirmed the diagnosis of CBP accompanied by multiple, well-formed, small-medium sized, non-necrotizing epithelioid granulomas associated with multinucleated giant cells, indicative of SLGI. Non-necrotizing epithelioid cell granulomas (as with SLGIs), identical to those observed in sarcoidosis, may rarely be observed in patients who do not meet the criteria of systemic sarcoidosis; however, they have been observed in association with various neoplasms. It is thus crucial to distinguish them from actual sarcoidosis, as misdiagnoses may lead to severe consequences. The presence of SLGIs accompanying a paraganglioma is an extremely rare phenomenon. Due to this, it is difficult to conclude if it confers a better prognosis or not.

Tuberculous granulomatous inflammation of parathyroid adenoma manifested as primary hyperparathyroidism: A case report and a review of the literature.

Tuberculosis of the thyroid gland is rare, and tuberculous granulomatous inflammation of the parathyroid glands is even rarer. The present study reports a rare case of primary hyperparathyroidism caused by tuberculous granulomatous inflammation. A 58-year-old female patient presented with generalized body pain persisting for 1 year. She had a history of recurrent renal stones (>20 times) and an incidental finding of multinodular goiter involving the parathyroid on neck ultrasound. A blood analysis revealed elevated levels of serum calcium (11.26 mg/dl) and parathyroid hormone (154.7 pg/ml). The patient underwent the resection of the affected left thyroid lobe under general anesthesia. A histopathological examination revealed parathyroid adenoma with caseating granulomatous inflammation involving the adenoma with focal lymphocytic thyroiditis of the left thyroid gland. Although granulomatous parathyroid disease with parathyroid adenoma causing hypercalcemia is an extremely rare event, it can occur. The treatment of choice is surgical resection.

Extra­abdominal recurrent aggressive fibromatosis: A case series and a literature review.

Aggressive fibromatosis is a rare clonal proliferative tumor arising from mesenchymal cells in the fascia and musculoaponeurotic structures. The aim of the present study was to describe several cases of extra-abdominal recurrent aggressive fibromatosis. The present study was a single-center retrospective case series of patients with recurrent aggressive fibromatosis. The cases were managed at a single private facility. A total of 9 patients with recurrent fibromatosis were included. The mean and median ages of the patients were 29 and 30 years, respectively. In total, two thirds (66.67%) of the cases were female. A negative previous medical history was reported in 7 cases (77.7%), and diabetes and hypertension were reported in 1 case (11.1%). Overall, only 1 case (11.1%) had a family history of breast fibromatosis. The time interval between primary tumor resection and recurrent presentation was 28 months. In 6 cases (66.7%), the tumor was located in the extremities. Pain was the most common presenting symptom in 6 cases (66.7%). All patients had their recurring tumor surgically removed, followed by radiation in 5 cases. The resection margin was positive in 4 cases (44.4%). Each patient was subjected to a careful three-month follow-up for recurrences. On the whole, the present study demonstrates that despite the fact that several therapeutic approaches for extra-abdominal recurrent aggressive fibromatosis have been described in the literature, there is a significant likelihood of recurrence following resection.

Spermatocytic tumor of the testis: A case report and mini­review of the literature.

Spermatocytic tumors are a rare type of testicular cancer, comprising <1% of all testicular malignancies. This type of cancer typically affects males in their 60s and 70s and rarely metastasizes; however, it poses a threat to the health of affected individuals if left untreated. The present study describes the case of a 68-year-old male patient with this type of tumor, including a presentation of his initial symptoms, treatment and subsequent monitoring. A male patient, aged 68 years, visited the authors' clinic with an asymptomatic mass in the right testicle. The mass had been progressively increasing in size for a duration of 5 years following a history of blunt injury. During the examination, a noticeable, painless enlargement was detected in the right testis, whereas the left testis appeared to be in a normal state. Tumor markers were within normal limits. Imaging revealed a complex mass (11x8x7 cm) almost replacing the right testis, with no detectable lymph nodes. A right radical orchidectomy was performed under spinal anesthesia. A histopathological examination revealed a spermatocytic tumor. The post-operative period was uneventful, with no metastasis detected in the CT scans. The patient was discharged with instructions for regular follow-up appointments. The case presented herein highlights a rare spermatocytic tumor in a 68-year-old male. The early detection and treatment of testicular tumors, regardless of age, are crucial for a good prognosis.

Thyroglossal duct diseases: presentation and outcomes.

OBJECTIVE: The incidence of thyroglossal duct diseases in the general population is about 7%. We aimed to demonstrate the clinical presentations and management of thyroglossal duct diseases. METHODS: We conducted a retrospective review of all patients who underwent surgery for histopathologically confirmed thyroglossal duct cyst, sinus, or fistula at a single center. RESULTS: A total of 151 cases were included in this study. There were more female patients (87, 58%) than male patients (64, 42%). The patients' ages ranged from 1 to 63 years old. The most prevalent complaint was painless upper midline neck swelling (93.3%). Most cases were diagnosed as thyroglossal duct cysts (137, 90.7%). Six cases (4%) were associated with carcinoma. All the cases were managed using the modified Sistrunk procedure. There were no procedure-related complications, and five cases of recurrence. CONCLUSIONS: Although thyroglossal duct cyst is the most common neck anomaly in children, it may also present with various characteristics later in life. This condition can be managed successfully without complications and with a low recurrence rate.

Management of Idiopathic Granulomatous Mastitis: A Single Institution Experience.

Introduction: There are multiple management modalities for idiopathic granulomatous mastitis, but the treatment of choice is still under debate. This study aims to evaluate the diagnosis and outcomes of different management modalities in patients with idiopathic granulomatous mastitis and to identify the risk factors associated with recurrence. Method: This is a single-group cohort study that included those patients who had idiopathic granulomatous mastitis. Ultrasonography was conducted for all of the cases using LOGIQ E9 with an ML6-15 transducer (5-15 MHz). A core needle biopsy was conducted to take samples from the cases for histopathological examination. The patients were put on steroid therapy. Whenever the cases did not respond to the steroid therapy, treatment with a combination of low-dose steroids and methotrexate was started. In the lack of response to conservative treatments, surgical interventions were started. Results: Sixty-three cases with a confirmed histopathological diagnosis of granulomatous mastitis were included. The mean age of patients was 35.7 years. The history of more than one childbirth was positive in a large portion of the cases (82.5%). The lesion side was unilateral in 58.7% of the cases. A large proportion of the lesions were classified as BIRADS category 2. The best treatment outcome was yielded by a combination of low-dose steroids and incision and drainage. The factors of age, lesion area (cm2), skin thickening, and white blood cell count enhanced the chance of recurrence. Conclusion: Incision and drainage in combination with a low dose of steroids can give an acceptable outcome with a low rate of recurrence.

Primary pancreatic synovial sarcoma: Report of a rare case and review of the literature.

Synovial sarcoma is a mesenchymal spindle cell tumor. Primary pancreatic sarcomas are extremely rare. The present study describes a rare case of synovial sarcoma in the head of the pancreas. A 35-year-old male presented with left upper quadrant abdominal pain. An endoscopic ultrasound examination revealed a complex solid-cystic lesion in the pancreatic head. He had undergone pancreaticoduodenectomy (Whipple procedure). A histological examination yielded negative results for AE1/AE3, CD10, S100, CD34, desmin, smooth muscle actin, ß-catenin, CD117, HMB45, chromogranin and synaptophysin. However, the results were positive for TLEI and vimentin, which is consistent with synovial sarcoma. Synovial sarcoma is a soft tissue malignant tumor. Primary pancreatic sarcomas frequently present as large, high-grade tumors in the pancreatic head. Histologically, there are several types of synovial sarcoma, such as monophasic, biphasic and poorly differentiated. A histological examination is necessary for the diagnosis as the imaging findings are not specifically suggestive of synovial sarcoma. The preferred course of treatment is complete resection with wide margins, followed by adjuvant chemotherapy and/or radiotherapy. Primary mesenchymal tumors of the pancreas are extremely uncommon. As a result, a diagnosis requires careful evaluation. Surgical resection is the main modality of treatment.

Papillary thyroid carcinoma associated with non­functioning parathyroid carcinoma with Warthin's tumor of the parotid gland: A case report and brief literature review.

Multiple neck pathologies occurring simultaneously are a rare condition. The present study describes an extremely rare case of papillary thyroid carcinoma, non-functioning parathyroid carcinoma (PC) and Warthin's tumor of the parotid gland. A 59-year-old male presented with a 3-month history of anterior neck swelling. The neck ultrasound revealed a left-sided thyroid nodule associated with pathological lymph nodes. There was a parotid gland mass. A fine-needle aspiration of the left parotid mass was not diagnostic, although the left thyroid nodule revealed a malignancy with metastasis to the left cervical group lymph nodes. The patient underwent total thyroidectomy, left central and left lateral cervical lymph node dissection. A superficial parotidectomy was also performed. A histopathological examination revealed three different pathologies: Papillary thyroid microcarcinoma, PC and Warthin's tumor. The simultaneous occurrence of a Warthin's tumor, papillary thyroid microcarcinoma and PC is an unusual condition. The concurrent findings of these three pathologies have not yet been reported in the literature, at least to the best of our knowledge. The synchronous findings of PTC, non-functioning PC and Warthin's tumor are extremely rare, yet possible. Surgical intervention remains the most appropriate treatment strategy.

Clinical, microbiological, immunological and hormonal profiles of patients with granulomatous mastitis.

Various studies on the etiology and other aspects of granulomatous mastitis (GM) have been performed; however, a lot of controversies have arisen. The present study aimed to present the clinicopathological findings and identify the sensitivity and resistance of isolated bacteria in patients with GM. In this cross-sectional study 63 female patients with a confirmed histopathological diagnosis of GM were included. A core needle biopsy was conducted for the patients to obtain a sample for histopathological examination and bacterial culture. In total, 46 types of antibiotics were used to determine the sensitivity and resistance of each isolated bacterial species. All the medical and clinical records of the patients were acquired through the completion of a questionnaire form in person or, if necessary, through the evaluation of their medical records in the database of the relevant center. The majority of the patients were in the premenopausal or perimenopausal period. GM was unilateral in 58.7% of the patients. The most common symptom was pain, followed by fever and chills. The mean ranges of the erythrocyte sedimentation rate, C-reactive protein, IL-6, IL-17, C5a, white blood count, neutrophil-to-lymphocyte ratio, and prolactin tests were significantly elevated in comparison to the normal ranges. In total, nine different bacterial species were isolated from the bacterial culture of the core biopsy samples, and 50% of the isolated bacterial species were sensitive to trimethoprim-sulfamethoxazole. Since there is no consensus on the etiology of GM, any additional studies related to this aspect expand the current understanding of this puzzling condition.