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Li Lin,1,* Zeyu Huang,2,* Bangsheng Xi,3,* Xiaoming Qin,1 Kongchao Yang,1 Ruzhi Zhang1 1Department of Dermatology, The Second Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of China; 2Department of Dermatology, The Third Affiliated Hospital of Soochow University, Changzhou, People’s Republic of China; 3Department of Clinical Laboratory, The First Affiliated Hospital of Wannan Medical college, Wuhu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ruzhi Zhang, Email zhangruzhi628@163.comAbstract: Cutaneous squamous cell carcinoma (SCC) is a common non-melanoma skin cancer (NMSC). Although most cutaneous SCC in people with lighter skin pigmentation as a result of sun damage, patients with underlying conditions such as skin ulcers and chronic inflammation-including conditions such as lupus vulgaris (LV) and chronic discoid lupus erythematosus—are also predisposed to developing SCC. Here we report a case of secondary SCC diagnosed in a 54-year-old patient with 20 years of lupus vulgaris without prior formal systemic treatment, a rarity in clinical practice. Two months ago, the patient developed papules on the right cheek that ulcerated and discharged purulent fluid. Laboratory tests revealed a positive TSPOT result and histopathological examination confirmed granulomatous lesions, supporting the diagnosis of SLE. However, a tissue biopsy unexpectedly revealed a moderately differentiated SCC of the keratinizing type. In this case, we performed surgical excision of the lesion followed by cosmetic closure and adjuvant photodynamic therapy (PDT). Concurrently, the patient underwent systemic anti-tuberculosis treatment. At 6 months post-treatment, no tumour recurrence was observed and the rash associated with lupus erythematosus had also resolved. The patient was satisfied with the treatment outcome.Keywords: lupus vulgaris, squamous cell carcinoma, surgical excision, photodynamic therapy

Nasopharyngeal angiofibroma (NA) is a relatively rare, noncancerous, extremely vascular tumor, and it is only found in males. NA receives blood supply from various sources and can lead to major blood loss after surgical excision. Nowadays, endovascular embolization has the potential to reduce intraoperative bleeding and lower the recurrence rate. This case series aimed to describe the preoperative endovascular embolization of nasopharyngeal angiofibroma. In this study, we reported 3 cases of adolescents with NA diagnosed using CT angiography. All subjects had a successful embolization, which led to minimal postoperative bleeding and good outcome.

Peripheral cemento-ossifying fibroma is an unusual, localized reactive, benign lesion of the oral cavity that shows various degrees of fibrous maturation and calcification in the histopathology. The lesion is often misdiagnosed, hence appropriate radiographs and histopathological examination are crucial for its correct diagnosis and management. The lesion has a high recurrence rate. The present report highlights a case of peripheral cement-ossifying fibroma in a 24-year-old female patient who was surgically excised. The growth, however, recurred after 4 months which was then managed by scalpel excision as well as aggressive curettage and root planing.

Rationale: Pyogenic granuloma (PG) is a commonly observed reactive soft-tissue lesion, often arising due to prolonged mild irritation or hormonal fluctuations in the oral cavity. Clinically, PG presents as a lesion with a smooth or lobulated appearance, which can be either sessile or pedunculated, and typically exhibits an hemorrhagic tendency. Very few cases of calcification in a PG have been reported in the past as these rarely exhibit ossification when viewed under a microscope. Patient Concerns: The following report is a case of a PG, that presented as a growth with occasional pain in the right upper back region of a 54 year old female. The patient reported no other concerns. Diagnosis: A provisional diagnosis of PG was given following thorough clinical and radiographic investigations. This was confirmed by a histopathological examination following an excisional biopsy. Intervention: The patient was treated with surgical excision as a part of the excisional biopsy of the lesion. Follow-up for the patient was done after 6 months, and there were no signs or indications of recurrence. Outcomes: The histopathological examination revealed regions of calcification, which are uncommon in PG, in addition to the characteristic hallmarks of proliferating endothelial cells, blood vessels, and inflammatory cells.

Calcifying pseudoneoplasms of the neuraxis (CAPNON) are rare, non-neoplastic, slow-growing tumors that can present anywhere throughout the central nervous system. While the etiology of these lesions remains unknown, the mainstay of treatment is surgical excision. We describe a case of CAPNON at our institution in a 66 year-old female patient who presented with 5 months of pain and burning sensation in her thigh. On MRI, an intradural extramedullary lesion was identified at the level of T11-T12. The mass was surgically excised and the patient reported resolution of her symptoms by her six week follow-up appointment. We reviewed 79 spinal CAPNON cases, covering all cases reported in the literature thus far. In summary, we find that spinal CAPNON are most commonly lumbar and extradural in location, with pain as the most common presenting symptom. Lesions are well-defined and hypointense on T1 and T2 MRI sequence. The majority of cases had favorable surgical outcomes with near complete resolution of pain and associated symptoms.

Abstract Background Angiosarcoma is an extremely rare malignant tumor. So far, only about 42 cases of angiosarcoma involving the eyelids have been reported. Eyelid angiosarcoma occurs more frequently in elderly Caucasian males and is prone to misdiagnosis. We present a case report in a young Asian male patient with eyelid angiosarcoma that was misdiagnosed as a chalazion. Case presentation A 46-year-old South Korean male with no underlying disease had a right lower lid mass. The lesion was initially misdiagnosed as a chalazion at a local clinic, but a diagnosis of eyelid angiosarcoma was made after the first biopsy trial. PET-CT was performed to ensure that there was no metastasis in the whole body. Surgical excision with enough surgical margin was used alone for treatment and reconstruction was performed with a tarsoconjunctival advancement flap (modified Hughes procedure), which helped ensure good cosmesis. No recurrence was observed 4 years and 5 months after the surgery. Conclusions The current study presents the first case of chalazion-mimicked eyelid angiosarcoma in a young Asian male aged under 50 years. This case shows that even if a benign eyelid disease is suspected in a young patient, an incisional biopsy must be performed to confirm whether the lesion is malignant. Since the prognosis is good for the case of eyelid angiosarcoma, if there is no clear evidence of distal metastasis, surgical resection should be performed with an enough safety margin.

Abstract Schwannomas are benign neurogenic encapsulated peripheral nerve tumors of Schwann cells that rarely occur in the retroperitoneum. We present a case of a 22-year-old man who presented with right flank pain and was initially diagnosed as hydatid cyst based on the imaging and borderline results of anti-echinococcus (IgG). Albendazole was prescribed and taken for 4 months with no response and later underwent surgical excision of the mass. The diagnosis and morphology confirmed the nature of the schwannoma. Complete surgical excision remains the gold standard for the management of these tumors. The preoperative diagnosis is usually difficult; however, the definitive diagnosis is made upon histopathological examination.Author name: Please confirm if the author name are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 4 Given name: Asad Shahzad, Last name: Hasan.correct

Introduction: Arteriovenous (AV) malformations (AVMs) are rare vascular developmental orders containing an arterial network draining directly into one or more veins without a capillary bed, accounting for 1.5% of total vascular anomalies. Clinical presentations include pulsating mass, pain, ulceration, bleeding, tissue necrosis, enlargement of draining vein, and venous hypertension and/or cardiac failure. Treatment modalities include surgical excision, coil embolization, and sclerotherapy. Surgical excision offers an opportunity for cure but is associated with a risk of injury to vital structures, causing permanent impairment. Due to the high-risk nature of the lesion, it is important to study the clinical presentation and management of peripheral AVM for better management of these patients. Objectives: The objective was to study the presentation, management, and postoperative outcomes in terms of recurrence and functional status of the limb after surgical management of AVMs. Patients and Methods: It was a retrospective study done for 5 years (2018–2023). Thirteen patients who underwent surgical excision of peripheral AVM were included. Recurrence and functional status were assessed by clinical evaluation during follow-up outpatient department visits. Conclusion: The mean age of presentation is 33 years, with male preponderance (70%). Seven patients had upper limb AVMs (four had forearm involvement, while the rest had elbow region involvement). Six patients had lower limb AVMs, out of which four patients had involvement of the thigh region, one had in the knee, and the other in the calf. All patients complained of difficulty in performing daily activities due to the lesion. Nine patients underwent direct surgical excision, and four patients underwent AVM embolization before surgery (three patients had coil embolization, and one had onyx embolization). The mean duration of stay in the hospital was 5 days. Three patients were advised body contour stockings at follow-up. Two patients had recurrence (one after 6 months of surgical excision and the other had prior coil embolization), and one patient (had preembolization) had continued difficulty in walking postprocedure. The rest of the patients did not develop recurrence/functional impairment. There was no postoperative mortality. Thus, surgical excision offers a chance at cure with durable, functional outcomes in patients with peripheral AVMs.

A mucocele is a prevalent benign oral lesion distinguished by the extravasation or retention of mucous within submucosal tissue originating from minor salivary glands. Mucoceles predominantly manifest on the lower lip, followed by occurrences on the floor of the mouth and the buccal mucosa. Trauma and lip biting habits are one of the main causes of lesions. Mucoceles are rarely observed in infants. This paper highlights an atypical case of mucocele located within the floor of the mouth in the first year of life (9 months old) in a child who was treated successfully with complete surgical excision, and the patient is on regular postoperative follow-up.

Objective To compare the recurrence rates between 755 nm Q-switched alexandrite laser (QSAL) treatment and surgical excision of oral melanotic macules (OMM). Methods This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. A retrospective cohort study was designed to collect demographic and clinical characteristics and follow-up data from patients with OMM. Patients who received QSAL or surgical excision in the Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2019 to August 2021 were included. The one-year recurrence rate was investigated as the primary outcome. Long-term adverse reaction rates were investigated as safety indicators. Kaplan-Meier analyses were performed to analyze the recurrence-free rates between the groups. Results A total of 57 patients were enrolled in this study. 16 patients underwent surgical excision, and 41 underwent QSAL. The baseline demographic and clinical characteristics between the groups were not significantly different. No recurrence (0%) of OMM was observed in the surgical excision group, while in the QSAL group, the macule recurred in 12 patients (29.27%). The average duration of recurrence was 6.08 months after treatment. Recurrence was not found to be associated with smoking (P = 1.000), gastrointestinal polyps (P = 1.000), longitudinal melanonychia (P = 0.187), family history (P = 0.552), treatment sessions (P = 0.567) or multiple macule lesions (P = 0.497). Compared with treatment with surgical excision, the odds ratio of recurrence for treatment with QSAL was 4.41, with a 95% confidence interval of 1.27-15.24 (P = 0.020). In the surgical excision group, 3 patients (18.75%) reported depressions and scars on the lesion, while no long-term adverse reactions (0%) were reported in the QSAL group (P = 0.019). Conclusion Compared with surgical excision, the advantage of QSAL is the low long-term adverse reaction rate, while the disadvantage is the relatively high one-year recurrence rate. It is necessary to communicate the advantages and disadvantages of the two methods with OMM patients to assist in clinical decision-making.

No prospective data have been described to inform guidelines on antibiotic prophylaxis for partial vulvectomies. Thus, we conducted a single-center, pilot, double-blind randomized controlled trial to assess the effectiveness of prophylactic antibiotics to prevent wound complications after partial vulvectomies. Patients were randomly assigned 1:1 to preoperative antibiotics or no preoperative antibiotics. The primary outcome of 30-day postoperative wound complications occurred in 31 (62 %) of all patients, with no differences between groups. The most common wound complications were superficial separation (54.2 % antibiotic prophylaxis vs. 65.3 % no prophylaxis, p = 0.37) and surgical site infection (0 % antibiotic prophylaxis vs 7.7 % no prophylaxis, p = 0.49). However, this study was limited by differences in patient characteristics between the groups. This study provides data to perform power calculations for a trial examining the effect of preoperative antibiotics on surgical site infection.

In dermatology, a keloid is one of the most common skin morphological abnormalities caused by excessive proliferation of fibroblasts. Keloids that are large or occur near important joint sites often cause varying degrees of physiological dysfunction in patients, therefore requiring medical treatment. A boy with congenital syndactyly developed huge keloids at the surgical site after undergoing surgical correction treatment. After treatment using trepanation combined with superficial radiotherapy (SRT-100) in our hospital, most of the boy’s keloids shrank and flattened. The affected foot returned to its normal appearance, and the boy could wear shoes normally. The boy did not complain of pain, numbness, or any other distinctive discomfort after completing the treatment. This suggested that the combination of trepanation and SRT-100 may be one of the options for treating hypertrophic keloids that cannot be treated by surgical excision.

Key Clinical Message The combined approach of surgical resection along with superficial x‐ray radiotherapy emerges as a superior treatment option for individuals with keloids, which hold huge potential for enhancing aesthetic outcomes and preventing keloid recurrence.

Key Clinical Message Osteoblastoma of the frontal sinus, although rare, can manifest with seizures and pneumocephalus, underscoring the importance of thorough evaluation and complete surgical excision to prevent serious complications and ensure optimal patient outcomes. Abstract Osteoblastoma is an infrequent bone tumor, with origins typically in the vertebrae and long bones. While craniofacial involvement is rare, it may occur in regions such as the paranasal sinuses. We present a case of osteoblastoma located in the frontal sinus, an exceptionally uncommon site, resulting in seizures secondary to pneumocephalus. A 21‐year‐old male presented with a generalized tonic–clonic seizure and postictal confusion. Imaging studies revealed a well‐defined lesion in the left frontal sinus causing cortical breach, destruction of the posterior wall, and pneumocephalus. A total surgical excision was performed through bifrontal craniotomy. Histopathological analysis confirmed the diagnosis of osteoblastoma. Postoperative recovery was uneventful, with a follow‐up CT scan showing complete lesion excision. Osteoblastomas, especially in the cranial sinuses, are rare entities that may present asymptomatically but can lead to severe complications. The risk of recurrence underscores the importance of complete surgical resection for optimal patient outcomes.

Introduction: The commonest benign bone tumours, Osteochondromas, which can be solitary or multiple involving the metaphyseal region of long bones, rarely presents in the axial skeleton such as pelvic girdle which warrants surgical excision in case of symptoms arising out of pressure effects. Case report: In this study we are herewith reporting unusual case of pubic tubercle osteochondroma which is solitary and pedunculated in a 37-year-old female. She had the swelling for the past 15 years which is asymptomatic except for mild hydroureteronephrosis which was an incidental diagnosis, however we managed the patient with surgical excision of the tumour with elaborate preoperative radiological imaging using both X-ray and CT. Histopathological examination was confirming the diagnosis of osteochondroma. Conclusion: Asymptomatic pelvic osteochondroma should be borne in mind in patients with incidental swelling in the groin region especially females who may be reluctant to seek medical attention due to social stigma. Keywords: Osteochondroma, Pubic tubercle, surgical excision, solitary

Introduction: Sebaceous gland hyperplasia of the eyelids, known as adenomatoid or pseudoadenomatous hyperplasia, is a rare benign condition. Optimal management strategies for this specific type of eyelid tumor require further investigation. Case presentation: The patient presented with a 21-year history of a progressively enlarged mass in the right lower eyelid. Previous treatments, including laser photocoagulation and surgical excision, have failed to prevent recurrence. The mass, characterized by a firm texture and low mobility, has raised concerns regarding malignancy. However, histopathological examination following surgical excision identified the mass as sebaceous gland hyperplasia. The patient's medical history was notable for benign gastrointestinal and intestinal polyps with no evidence of malignancy. Conclusions: A final diagnosis of eyelid sebaceous gland hyperplasia was established after surgical excision and comprehensive histopathological analyses. The patient's successful recovery without recurrence over a three-month follow-up period post-surgery highlights the efficacy of the surgical approach and the use of intraoperative frozen section pathological examination.

Verruciform Xanthoma (VX) is an uncommon, benign, asymptomatic lesion of the oral cavity. The incidence rate of VX is 0.025%, with the most common location reported to be the gingival margin, followed by the tongue, hard palate, buccal and labial mucosa. It may also present on the skin and genitals. VX can manifest as a solitary or multiple lesion with well-defined margins. It appears as a papule or plaque with verrucous or papillary growth, exhibiting variable colours ranging from reddish-pink and yellow to grey. While the lesion typically appears verruciform, it may also have a polypoid, papillomatous, or sessile nature. In the present case report, the authors present a 45-year-old male patient with a history of tobacco use, who exhibited a reddish-pink papillomatous growth on his labial mucosa for a duration of three months. The growth was surgically excised, and histopathological evaluation confirmed the characteristic features of VX. The lesion healed without complications, and no recurrence was observed. Clinically, VX may be mistaken for various malignant or premalignant lesions such as papilloma, verrucous carcinoma, or proliferative verrucous leukoplakia. Therefore, it is crucial to differentiate VX from these conditions to avoid inappropriate intervention. Histopathological evaluation is necessary for the definitive diagnosis of the lesion, which reveals the pathognomonic presence of foamy histiocytes within the elongated dermal papillae. The present case report highlighted the diverse clinical features of VX and discusses its histological findings along with the differential diagnosis.

Gastric teratomas are very rare tumours. They present with upper abdomen distension which can easily be confused with other common conditions with mass per abdomen in the paediatric age group. Surgical excision is curative for gastric teratomas. The diagnosis is confirmed by radiological evaluation followed by histopathological analysis of excised specimen. We are reporting two such cases of gastric teratomas who presented with complaints of upper abdomen distension. They were evaluated with radiological imaging and successfully managed by surgical excision.

The carotid body, which is located bilaterally on the medial side of the carotid bifurcation, is the largest group of paraganglia in the head and neck. Chemoreceptor cells in the carotid bulb give rise to uncommon tumours known as Carotid Body Tumours (CBTs). The authors describe a case of a CBT in a 40-year-old woman who had a painful, pulsatile, lateral neck enlargement on the right side that had been developing over time. Due to the numerous difficulties and problems brought on by their high vascularity and close proximity to cranial nerves in the neck near the carotid bifurcation, they pose a surgical challenge. Based on the patient's medical history, the results of clinical and radiological examinations, and the successful surgical removal of the tumour, the diagnosis was suspected. The results of histological analysis supported the diagnosis of a CBT.

A giant intermuscular lipoma, an exceedingly rare occurrence, constitutes a non-malignant neoplasm originating from the mesodermal germ cell layer, with dimensions surpassing 10 cm. Its differentiation from liposarcoma and other malignant tumours is imperative. We present a case involving a 75-year-old woman who initially raised suspicions of liposarcoma due to pronounced enlargement and fullness in the upper quadrants of the left breast. After comprehensive imaging evaluations, the identification of a sizable BI-RADS 4a lesion positioned between the major and minor pectoral muscles of the left breast was found. The definitive diagnosis of an exceedingly rare giant intramuscular lipoma was validated solely subsequent to the surgical excision of the lipoma, through histological analysis.

Summary: Background: There are no current studies concerning gender-specific impact on the treatment of BCCs. We performed a retrospective analysis with the aim of showing that selection of treatment by physician and patients’ evaluation concerning quality of life and aesthetic outcome has a gender-specific impact. Methods: Overall, 47 patients treated by excision of BCC from the head and neck region at our department from 2015 to 2020 were included. Defects were closed via flap, split-thickness skin graft. or primary closure. Pain, scar quality, patient satisfaction and quality of life were ascertained by the Skin Cancer Index (SCI), the Basal and Squamous Cell Carcinoma Quality of Life (BaSQoL) questionnaire, Patient and Observer Scar Assessment Scale (POSASv2.0EN) and Vancouver Scar Scale (VSS). Results: Women received significantly more flaps than split-thickness skin grafts (p = 0.025). The coverage method was independent of surgeons’ gender.Patient's POSAS were higher in women (p = 0.087), and observer's POSAS (p = 0.229) and VSS (p = 0.7) showed no significant difference between genders.SCI and BaSQoL scores showed that women are significantly more critical than men after BCC treatment (SCI p = 0; BaSQoL p = 0.022). Furthermore, dermatological follow-up frequency was significantly higher in women (p = 0.035). Conclusion: We determined the gender-specific impacts on the treatment of patients with BCCs regarding methods of closure, post-interventional dermatological follow-ups, quality of life, scar quality, and overall patient satisfaction. No difference in scar quality was found when assessed by physicians.

Abstract Background Pilocytic astrocytoma (PA) is a central nervous system (CNS) World Health Organization (WHO) grade 1 glial tumor that is highly prevalent in children and young adults. The main aim of the study was to assess the frequency, clinicopathological features, and treatment of PAs along with their immunohistochemical and molecular analyses in patients from Northeast India. About 144 glial tumors were diagnosed in patients from 3 to 75 yrs of age from January 2015 to March 2022. Nine pediatric PA patients were identified and their clinical data were analyzed. Immunohistochemistry (IHC), fluorescence in-situ hybridization (FISH), and molecular analysis using the real-time polymerase chain reaction (RT-PCR) were performed. Data analysis was performed using the SPSS software. Results The mean age of the glioma patients was 41.7 yrs ± 18.2 with a male/female ratio of 1.3:1. The most common form of the glial tumor was found to be astrocytoma CNS WHO grade 2 (31.9%). The frequency of PA CNS WHO grade 1 was 6.9%. The pediatric PA cohort had a mean age of 9.2 yrs ± 4.9 with a male/female ratio of 2:1. Glial fibrillary acidic protein (GFAP) positive immunostaining and retention of transcriptional regulator alpha-thalassemia mental retardation X-linked protein (ATRX) expression was seen in all the tested PAs. The KIAA1459-BRAF fusion was detected in four PAs. Surgical intervention with total or radical tumor excision was performed for the PA patients. Eight PA patients exhibited improved condition post-surgery. Conclusion With the advent of healthcare and newer diagnostic facilities there is an increased incidence of glial tumors in developing countries. A combination of histological, immunohistochemical, and molecular analysis is very important for the diagnosis, accurate treatment, and prognosis of PA patients.

Background: We present a detailed description and the preliminary results of our original technique for non-invasive three-dimensional tumor localization in the breast, which was created as an alternative to standard invasive tumor marking before neoadjuvant systemic therapy (NAST), aiming to enable adequate surgery after complete tumor regression. Methods: A detailed description of the technique is provided in the main text. The technique’s feasibility and precision were assessed in a single-arm, prospective study based on the histological parameters of the adequacy and rationality of the excision of completely regressed tumor beds. Results: Out of 94 recruited patients, 15 (16%) were deemed unsuitable, mainly due to the tumors’ inadequate ultrasound visibility. Among the 79 processed patients, 31 (39%) had complete clinical regression after NAST and were operated on using our technique. The histological parameters of surgical precision (signs of tumor regression: 24/31; microscopic cancer residues: 7/31) were verified in all excised specimens (100% precision). There were no positive margins in seven cases with microscopic residues, indicating our technique’s capacity to enable oncologically safe post-NAST surgery. Conclusions: The proposed technique is feasible and satisfactorily accurate in determining the location of regressed tumors, thus representing an alternative to invasive tumor marking, especially in surgical centers lacking trained staff and equipment for invasive marking. The technique’s limitations are mainly related to the inadequate ultrasound visibility of the tumor.

Key Clinical Message The mainstays of treatment for granuloma pyogenicum include careful evaluation of any penile growth, thorough excision of the polypoid, histological examination, and close monitoring to check relapse and management. Abstract Pyogenic granuloma is an acquired noncancerous vascular proliferation that arises from the mucosa and skin, seldom subcutaneously or intravascularly. It is also referred to as telangiectasis granuloma or lobular capillary haemangioma. The risk factors include vascular abnormalities, medicines, hormones, and microtrauma. We discussed the case of a 24‐year‐old man who had a poorly managed ventral distal penile polypoid lesion at a peripheral hospital. Upon further histopathological examination, the diagnosis of pyogenic granuloma was made. Histopathologically speaking, the term “pyogenic granuloma” is misleading because the illness is not linked to the production of granulomas. Pyogenic granuloma's etiopathogenesis is still unknown; true hemangioma is thought to be a reactive hyperproliferative of the vasculature brought on by a variety of stimuli; pyogenic granuloma may be caused by uneven angiogenic factor production in response to minor local trauma or cutaneous disease. Histopathological analysis and surgical excision are the methods used for diagnosis and treatment. The mainstay of treatment for granuloma pyogenic granuloma includes careful evaluation of any penile growth, thorough excision of the polypoid, histological examination, close follow‐up to check for relapse, and early management.

Background: Petrous apex cholesterol granulomas (PACGs) are benign inflammatory cystic lesions of the temporal bone. Usually, asymptomatic patients may develop symptoms as the lesions expand. The diagnosis is based on both CT and MRI scans and the management relies on “wait and scan” or surgery. This paper aims at evaluating surgical outcomes and proposing a CT-based classification and a management algorithm. Methods: Patients with PACGs who were surgically treated between 2014 and 2024 were included. Symptoms, imaging, approach type and complications were considered. CT scans were classified as Type A (preserved apex cellularity), Type B (erosion of the apex cellularity), and Type C (involvement of the noble structures bone boundaries). The possible connection of the lesion with the infracochlear, perilabyrinthine and sphenoidal cellularity was assessed. Results: Nineteen patients with symptoms like diplopia, headache and sensorineural hearing loss were included. According to our classification, 1/19 patients was Type A, 4/19 were Type B and 14/19 were Type C. Five patients underwent a total resection, seven a subtotal and seven a surgical drainage. Only two complications were recorded, and 17/19 patients showed symptom regression and stability during follow-up. Conclusions: While the management of PACGs is still controversial, according to our classification and surgical outcomes, Type A, being mostly asymptomatic, should be managed with “wait and scan”, Type B should undergo surgery when symptoms are present, while Type C should always undergo surgery because of their invasiveness and potential complications. When possible, a drainage should be attempted; otherwise, a surgical resection is chosen, and its completeness depends on the preoperative general and hearing status.

Abstract Background Endometriosis affects 190 million women and those assigned female at birth worldwide. For some, it is associated with debilitating chronic pelvic pain. Diagnosis of endometriosis is often achieved through diagnostic laparoscopy. However, when isolated superficial peritoneal endometriosis (SPE), the most common endometriosis subtype, is identified during laparoscopy, limited evidence exists to support the common decision to surgically remove it via excision or ablation. Improved understanding of the impact of surgical removal of isolated SPE for the management of chronic pelvic pain in women is required. Here, we describe our protocol for a multi-centre trial to determine the effectiveness of surgical removal of isolated SPE for the management of endometriosis-associated pain. Methods We plan to undertake a multi-centre participant-blind parallel-group randomised controlled clinical and cost-effectiveness trial with internal pilot. We plan to randomise 400 participants from up to 70 National Health Service Hospitals in the UK. Participants with chronic pelvic pain awaiting diagnostic laparoscopy for suspected endometriosis will be consented by the clinical research team. If isolated SPE is identified at laparoscopy, and deep or ovarian endometriosis is not seen, participants will be randomised intraoperatively (1:1) to surgical removal (by excision or ablation or both, according to surgeons’ preference) versus diagnostic laparoscopy alone. Randomisation with block-stratification will be used. Participants will be given a diagnosis but will not be informed of the procedure they received until 12 months post-randomisation, unless required. Post-operative medical treatment will be according to participants’ preference. Participants will be asked to complete validated pain and quality of life questionnaires at 3, 6 and 12 months after randomisation. Our primary outcome is the pain domain of the Endometriosis Health Profile-30 (EHP-30), via a between randomised group comparison of adjusted means at 12 months. Assuming a standard deviation of 22 points around the pain score, 90% power, 5% significance and 20% missing data, 400 participants are required to be randomised to detect an 8-point pain score difference. Discussion This trial aims to provide high quality evidence of the clinical and cost-effectiveness of surgical removal of isolated SPE. Trial registration ISRCTN registry ISRCTN27244948. Registered 6 April 2021.

Abstract Background Spinal osteoblastoma needs surgical intervention, and over a decade with advancing technologies, different radiological aids have been utilized in the form of CT scan, fluoroscopy and O arm, but no study has compared its efficacy and outcomes. Here, in this case report of three cases, we have compared the intra- and post-operative course and effectiveness of three radiological modalities. Case presentation We reviewed three surgically treated cases of spinal osteoblastoma with aid of different generation radiological modalities like C arm, CT scan and O arm navigation treated over a span of more than 10 years in single institute by same surgeon. These 3 cases were assessed and compared in terms of intraoperative parameters (image acquisition type, image display, scan time, bone image quality, real-time imaging, radiation exposure, surgical time, blood loss, complications and others) and post-operative parameters (recovery, recurrence and follow-up). First case managed with aid of C arm showed fluoroscopically acquired two-dimensional images, poor bone image quality; higher scan time-surgical time and blood loss with higher radiation exposure and no real-time imaging. Second case managed with aid of CT scan provided three-dimensional images, better bone image quality; lower surgical time and blood loss but increased transport time with minimum radiological exposure to surgeon and OT personnel with no real-time imaging. Third case managed with O arm navigation provided 3-dimensional images, best bone image quality; less surgical time and blood loss with minimum radiological exposure to surgeon and OT personnel with real-time imaging. Additionally, O arm navigation improved accuracy of tumor localization and intraoperative confirmation of complete tumor excision. Whereas all three cases showed no clinico-radiological signs of recurrence on subsequent follow-ups. Conclusion O arm navigation in terms of best bone image quality, accuracy, intraoperative confirmation of tumor excision, surgical time, blood loss and post-operative recovery makes it superior to others.

Retroperitoneal liposarcomas are rare malignant tumours that often grow rapidly in size and become symptomatic late in the disease course, posing diagnostic and therapeutic challenges. Although abdominal imaging can reliably diagnose the tumour, definitive diagnosis is only possible through biopsy after surgical excision, which remains the primary treatment modality for these tumours. Long-term survival is primarily determined through histologic grade and post-resection tumour margins. We report the case of a 43-year-old male patient, seen at Dr Ruth KM Pfau Hospital Karachi, who underwent successful surgical excision for a well-differentiated retroperitoneal liposarcoma and had no radiographic evidence of local recurrence at both 3 and 12-month follow-ups. Keywords: Retroperitoneal liposarcoma, surgical excision, tumour recurrence, tumour grade.

Introduction: Osteochondroma is a common benign bone tumour characterized by a bony projection covered by cartilage. Osteochondromas typically occur in long bones, and scapular lesions account for a small percentage of reported cases. Scapular osteochondromas can present with unusual manifestations and pose diagnostic challenges. Case presentation: We present a case of a 7-year-old child with ventral scapular osteochondroma causing rib compression and chest pain. Diagnosis was done based upon clinical features and imaging modalities such as CT scan and MRI. The child underwent surgical excision of the tumour, resulting in complete resolution of symptoms and restoration of normal function. Conclusion: Early recognition and intervention are crucial for effective management. Surgical excision is the recommended treatment, offering a favourable prognosis, although incomplete excision can lead to recurrence. Long-term follow-up is necessary to monitor for recurrence or complications.

The paradoxical reaction (PR) is a transient worsening following tuberculosis treatment and it is not uncommon in lymph node tuberculosis (LNTB). PR in LNTB maybe wrongly considered as treatment failure or relapse. This review was undertaken to address various aspects of PR associated with lymph node tuberculosis prevalence, underlying mechanism, clinical pattern, predictors, and possible treatment in an immunocompetent individual. A literature review was performed using various databases (PubMed, Scopus, Science Direct, and Google Scholar) to identify relevant articles for review. The prevalence of paradoxical reactions associated with LNTB varies from as low as 13.3% to as high as 35.3% PR may occur during antitubercular treatment or be reported even after completion of treatment called post-therapy PR. An onset of PR may occur within a month of therapy to even 12 months from the initiation of an anti-tubercular drug. Delayed hypersensitivity reaction and reduction in immune suppression is believed to be possible mechanism leading to a paradoxical reaction. PR in LNTB is characterized by either progression of pre-existing nodal enlargement or formation of abscess, sinus formation, or appearance of new nodal enlargement or rarely extra-nodal involvement. PR is a diagnosis of exclusion and may show granuloma, positive AFB smear, or positive GeneXpert but AFB culture is always negative. Younger age, lymph node size of equal to or more than 3 cm, female gender, unilateral lymphadenopathy, and those with positive AFB on initial examination are predictors for PR in peripheral LNTB. The majority of PR in LNTB have a mild course and are generally self-limited.

Verrucous Haemangioma (VH) is a rare, congenital vascular malformation of cutaneous and subcutaneous tissue. It usually presents as macular lesion at birth which progresses with age, and may become bluish papules, nodules, and warty plaques. Linear presentation of this disease is even rarer. Here the present case report presents a case of a 30-year-old male patient with multiple raised erythematous hyperkeratotic papules and plaques over right forearm since birth which was arranged in a linear pattern.The patient also had asymptomatic papules on right thigh and lower back region, associated with sensory loss and peripheral nerve thickening. Dermoscopy of forearm showed reddish-blue lacunae, alveolar pattern, and whitish veils. Colour Doppler showed intradermal dilated venous channels with thrombosis which was suggestive of haemangioma. Histopathological examination confirmed the diagnosis of linear VH on forearm and slit skin Ziehl-Neelsen staining was suggestive of histoid leprosy. Linear VH is a rare congenital venous malformation, progresses proportionately with age. Dermoscopy can help in early diagnosis of vascular lesions. Complete surgical excision is the treatment of choice.

Background: Giant papillary conjunctivitis [GPC] is a type of inflammatory disease of the eye formed of "giant" papillae in the superior tarsal conjunctiva.Aim of the work: We have compared the effect of refractory giant papillary conjunctivitis management surgically with excision with and without conjunctival autograft or amniotic membrane transplantation.Patients and Methods: This was a randomized controlled trial conducted in the Ophthalmology Department, Al-Azhar University Hospitals, Egypt in the period from January 2022 to January 2023 included 45 patients presenting with giant papillary conjunctivitis who were treated surgically by one of the following techniques divided into 3 groups: group [1]; included 15 patients had undergone simple surgical excision of giant conjunctival papillae only, group [2]; included 15 patients had undergone surgical excision with conjunctival autograft and group [3]; included 15 patients had undergone surgical excision with amniotic membrane transplantation [AMT].Results: Results of this study reported that recurrence occurred higher in simple excision [10.7%] with a significant difference between groups [p value=0.021], also dry eye was higher in the same group [17.9%] with no significant difference. Conjunctival inflammation was higher in excision with AMT [10%] with no significant difference. Scar had been formed in one eye of simple excision patients only while vascularization was in one eye of excision with autologous conjunctival graft only.Conclusion: AMT or autologous conjunctival graft following excision of giant conjunctival papillae may reduce the chances of recurrence; also, surgical outcomes are better than that reported with the simple excision.

Introduction: Spinal osteochondroma is rare. The purpose of this study is to examine the clinical characteristics and surgical treatment outcomes of 11 patients with spinal osteochondroma. Materials and methods: The study included 11 patients with spinal osteochondroma. In these patients, we examined the onset level, onset site, initial symptoms, surgical procedure, outcomes and complications. Results: Of the 11 patients, 9 presented with solitary tumours, and 2 had multiple. The mean post-operative observation period was six years and two months. The onset level was the cervical spine in eight patients, thoracic in two, and lumbar in one. The most common onset site was the posterior elements. The initial presentation was myelopathy in seven patients, radiculopathy in two, neck pain in one and feeling of mass in one. All patients underwent excision of the tumour, and depending on the tumour onset site, additional posterior or anterior decompression with or without fusion was performed. There was no recurrence in all patients. Intra-operative complications included dura tear and oesophageal injury in one patient with cervical onset, while post-operative complications included C5 palsy in one patient. Conclusions: In this study, surgical excision for osteochondroma of the spine were excellent with no recurrence of the tumour.

A 17-day-old crossbred male bovine calf was presented with an additional and atypical limb-like structure on the dorsal thorax, just caudal to the hump.. Physical examination indicated that the ectopic appendage was similar to a supernumerary limb but much shorter in size and incom¬plete in structural details, with the characteristic appearance of a half-butterfly wing. This acces¬sory structure was attached to the middle of the back with muscles, fibrous tissues, and carti¬lage in a flexible condition resembling a limb-bud. It was likely to be composed of soft internal bones surrounded by layers of tissues and outer skin. Clinically, the case was diagnosed as an atypical notomelia, and surgical excision of the aberrant structure was done to handle the case. Postoperatively, the calf was treated with supportive medications, including proper management, and subsequently recovered within 2 weeks after surgery. [Vet. Res. Notes 2023; 3(2.000): 6-10]

The mediastinal teratomas can grow to a large size before becoming symptomatic. The symptoms are usually due to the compression of adjacent structures. A computed tomographic scan of the chest is the investigation of choice for making a provisional diagnosis and planning for further management. Removal of large mediastinal/thoracic teratoma can be associated with various intraoperative and postoperative complications, which can be life-threatening sometimes. We operated on a patient with a large mediastinal mass extending into the right thoracic cavity up to the costo-phrenic angle. The postoperative period was eventful and required judicious intensive care. The patient eventually recovered with conservative treatment. A literature search was done on PubMed using the keywords benign mediastinal teratoma. Case series/original articles published in the last two decades, that is, after the year 2000, were evaluated. As per the review of the literature, the prevalence of benign mediastinal teratoma may be higher in eastern countries. Thoracoscopic surgery is the preferred modality except for cases with adhesions or infiltration into surrounding structures.

An adult male variable kingsnake (Lampropeltis mexicana) was presented for examination due to a three-week history of anorexia and obvious body deformities. On objective examination the animal was in poor condition, and on palpation, an intracoelomic mass was noted approximately in the distal third of the body, cranial to the cloaca. In agreement with the owner, an exploratory celiotomy was planned and performed and the mass was surgically removed. Modified Wright–Giemsa stain impression smears were taken, which were consistent with an undifferentiated tumour. Histological examination revealed the presence of a solid proliferation composed of highly tubular anaplastic cells and abundant multinucleated cells. The neoplastic cells were positive for cytokeratin (AE1/AE3), but not for vimentin. Periodic acid–Schiff (PAS) staining revealed the presence of large granular cells, which can be identified as the characteristic cells of the efferent ducts. Based on the morphological and immunohistochemical findings, the diagnosis of extratesticular anaplastic carcinoma was made. To the authors’ knowledge, this type of neoplasm has never been reported in the male genital apparatus of snakes.

Orbital lipomas are uncommon benign tumors with only a few reported cases in literature. They are usually asymptomatic and exhibit gradual growth. We rendered such a rare case of primary lipoma in the orbital region with interpreted symptoms of ocular pain, reduced vision, and mild proptosis. Right fronto-orbital craniotomy with gross total excision of the tumor was done. Histological examination suggested a final diagnosis of lipoma. Post-operatively, the patient developed mild ptosis. During follow-up, ptosis completely subsided and significant improvement in vision was noted.

Uremic tumoral calcinosis (UTC) is an uncommon and severe complication of hemodialysis therapy. The most important pathogenic factor involved in UTC is an increase in calcium-phosphorus products. We report here a patient undergoing hemodialysis for renal failure caused by hypertensive nephropathy who presented multiple UTCs in the right shoulder, left elbow and wrist. After surgical excision, they all recurred, with a similar UTC in the left shoulder. By observing the imaging features of various imaging examinations during the whole period of this case, including X-ray, computed tomography (CT), magnetic resonance imaging (MRI), and single-photon emission computed tomography (SPECT), we highlight the importance of imaging for evaluating the state of UTC regarding treatment options, further deepening our understanding of the imaging manifestations for this disease and their clinical significance.

Key Clinical Message Benign mixed salivary gland tumor is comprised of epithelial and myoepithelial cells and represents up to 80% of tumors of the parotid gland. It is relatively rare in the soft palate and in other minor salivary glands. Surgery is the standard care. Abstract Salivary gland tumors are relatively rare and morphologically diverse group of lesions. Pleomorphic adenoma (PA) is the most common salivary gland tumor, accounting for approximately 80% of all major and minor salivary gland tumors. PA usually affects the parotid gland. Huge PA occurring in soft palate is extremely rare. Patients with these tumors are usually between at the age of 40 and 60 years. The tumors exhibit pleomorphic nature microscopically that may pose diagnostic challenges to pathologists as may confuse PA histopathologically with other salivary gland tumors. Surgery is the standard treatment. The purpose of writing this case study is to describe unusual case of a giant PA of the soft palate found in a 44‐year‐old male successfully managed at our facility.

Objective: To compare the clinical diagnostic accuracy of dermatologists and non-dermatologists in the diagnosis of dermatological diseases. Method: The descriptive, cross-sectional study was conducted at the Dermatopathology department of a tertiary healthcare hospital in the Punjab province of Pakistan from January 1 to December 31, 2019, and comprised biopsy specimens of patients with diseases of the skin and subcutaneous tissue. The clinical diagnoses of general surgeons, otolaryngologists, dental/maxillofacial surgeons, plastic surgeons and gynaecologists were noted and compared with those of dermatologists in the light of histopathological findings. Data was analysed using SPSS 16. Results: Of the 386 specimens submitted, 113(29.3%) were sent by dermatologists and 273(70.7%) by non-dermatologists. Clinical diagnostic accuracy of dermatologists 92(81.4%) compared to non-dermatologists 137(50.2%) (p0.05). In the neoplastic category, no significant difference was found in the clinical accuracy of dermatologists and plastic surgeons (p=0.347). Conclusions: The specialised skills of dermatologists could not be matched by any other group of physicians. Key Words: Diagnostic accuracy, Dermatologist, Surgical excision, Dermatological diseases, Histopathological diagnosis.

Adult orbital xanthogranulomatous disease (AOXGD) is a group of rare syndromes, involving the periorbital and ocular tissues. We present details of a case of adult-onset xanthogranuloma (AOX) and the management strategy employed in a positive outcome. AOX is the least common variant of AOXGD without any significant systemic involvement. The significance of this entity is that it is often self-limited and is localised to the eye (anterior orbit), with good prognosis. We have kept surgery as our viable primary option in patients presenting late with functional problems and severe cosmetic deformity. In cases with disfiguring lesions and late presentation, the best therapeutic approach is complete excision biopsy and reconstruction with local flaps and full-thickness skin graft. Level of Evidence: Level V, Case report.

Objective:Skin cancers occur most commonly in the head and neck region where the nose is the most commonly affected unit. The nose is the part of the face that is most exposed to trauma, sunlight, and other environmental factors. From the aesthetic and functional point of view, reconstruction of the defects occurring after skin cancer removal creates a great challenge for the surgeon. In this retrospective study, we present the success rates achieved in the past 20 years with paramedian forehead flaps used for repairing large defects of the nose.Methods:The study included 62 patients who underwent paramedian forehead flap due to nasal skin tumor [basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)] in Ege University Faculty of Medicine Otolaryngology Department between 2000 and 2020. Data on follow-up time, patients’ age and gender, defect sizes, and tumor types were obtained retrospectively from patient files, histopathologic examination results and patient photographs. Additional diseases such as diabetes, hypertension, and coronary artery disease that could affect flap success, were noted.Results:Out of 62 patients 29 (46.8%) were female and 33 (53.2%) were male. Their mean age was 61.4 (range: 46–88) years. Mean follow-up period was 125.6 (8–244) months. Of the 62 patients 33 (53.2%) were operated on for BCC and 29 (46.8%) for SCC. Four patients (6.5%) had recurrences during their follow-up. There was no loss of the paramedian forehead flap.Conclusion:Paramedian forehead flap is a reliable option in the reconstruction of larger defects of the nose even in smokers and elderly patients who have comorbid diseases.

Aim of the study Kaposi's sarcoma (KS) is a low-grade angioproliferative tumor arising from endothelial cells and associated with Human Herpes Virus 8 infection. Although there are considerable number of patients referred for surgical excision, the plastic surgery literature on KS is exceptionally scarce. In this study, it was aimed to emphasize the differences in the management of Kaposi's Sarcoma and help to understand the importance of a multidisciplinary approach, accordingly the sake of choosing the ideal treatment method for each lesion. Materials and methods Thirty patients who were operated with the diagnosis of KS between March 2015 and January 2020 were included. Preoperative HIV tests and detailed whole-body examinations of the patients were performed. As a surgical method, for lesions with sizes ranging from 0.5 * 1 cm to 2 * 3 cm, excisions were made over the deep skin fascia by placing a margin between 0.5-1 cm, considering the anatomical location and elasticity of the skin. Results Primary repair was performed in 23 patients (40 lesions) and 12 lesions of 8 patients were repaired with a skin graft. In four patients the repair was performed with local skin flaps. In a patient with a lesion on the finger, the defect that occurred after the excision of the lesion was repaired with a pedicled regional flap. Conclusions One-stage surgical excision of the lesions provides remarkable advantages, compared to the therapies such as radiotherapy, laser, or chemotherapy which require several administrations.

Background: Despite being an uncommon tumor, sacrococcygeal teratoma (SCT) is the most prevalent among newborns. SCT comprises tissue generated from many germ layers. It develops from Hensen's node's totipotent cells. The objective of our study was to determine the epidemiology and management of neonatal sacrococcygeal teratoma in the tertiary care center of Nepal in a resource-limited setting. Methods: It is a retrospective cross-sectional study that includes all cases of neonatal SCT admitted and treated in the department of Pediatrics and Neurosurgery, B. P. Koirala Institute of Health Sciences, over the period from July 2017 to December 2021. The primary endpoint was to determine the epidemiological profile of neonates with SCT, their surgical management, and their complications. Results: Our investigation included a total of 15 patients. Nine of the fifteen cases were female (60%) and six were male (40%). Six newborns (40%) were diagnosed with SCT antenatally and were referred to our tertiary care institution for delivery. The size of the SCT varied ranging from less than 8 cm to greater than 11 cm. Surgical excision was performed. Only 1 case (6.6 %) expired due to complications. Conclusions: In our context, SCT is the most prevalent tumor in babies. Even with limited resources, great surgical results with a high level of satisfaction in patients and caregivers may be accomplished with sound clinical judgment and competency of the surgeons and clinicians. Prenatal diagnosis should be encouraged.

Photobiomodulation (PBM), also known as low level laser therapy (LLLT) or cold laser therapy uses light energy to elicit biological responses from the cell and help regulate cell function. From a clinical point of view PBM offers dental practitioners a non-invasive treatment modality that can be used as an adjunct to the traditional therapies or as a therapeutic tool on its own. This is a case of surgical excision of a fluctuant mass using a scalpel and diode laser 980nm wavelength.