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Introduction: Retroperitoneal localization is an extremely rare presentation of interdigitating dendritic cell sarcoma (IDCS), the primary neoplasm of the antigen-presenting interdigitating dendritic cells. Case Presentation: We report an incidentally found isolated retroperitoneal IDCS in a 59-year-old female patient with no prior symptoms. The patient was initially misdiagnosed since the tissue samples obtained by tru-cut biopsies were diffusely positive for S-100, and the radiological features were similar to neurogenic tumors. However, additional immunohistochemical staining in the excisional biopsy specimen revealed IDCS as the correct diagnosis. Conclusion: The correct diagnosis may not always be achieved with tru-cut biopsy evaluations in the retroperitoneal masses. Immunophenotyping and radiological features can occasionally be perplexing. In these cases, an accurate diagnosis can be achieved by excisional biopsy and additional immunohistochemical staining.

Introduction: Paragangliomas are tumors of neuroendocrine origin, may appear in different localizations, and are related to the autonomic nervous system. Paragangliomas are generally asymptomatic and may rarely appear with adrenergic symptoms, and clinical findings depend on the catecholamines they secrete. Extra-adrenal paragangliomas are mostly benign, like all paragangliomas. Malignancy criteria consist of local recurrence, metastasis after total resection, and presence of distant metastasis during primary diagnosis. Case Presentation: This report presents the case of a 31-year-old man with jugular paraganglioma, multiple skeletal metastases, and a long-segment tumor thrombus. Imaging procedures showed a continuous tumor thrombus extending from the posterior fossa to the right atrium and metastases in C2, T1, T6, T8, L5, and right humerus. Histopathological assessment of the metastasis in C2 identified malignant paraganglioma. Curative surgery was not an option for this patient, hence combined chemotherapy was given. Conclusion: In cases of malignant paraganglioma with multiple distant metastases, chemotherapy and radiotherapy are feasible treatment methods.

Purpose: To investigate the morphometric characteristics of the lacrimal sac fossa in Anatolian population using multidetector computed tomography (MDCT) images in surgical aspect.Methods: A total of 77 cranial MDCT scans were evaluated. Maximum thickness of the maxillary and lacrimal bones; midpoint thickness, and the distance between anterior and posterior lacrimal crests were measured at the upper, middle, and lower axial planes. The angle between the lacrimal bone and the sagittal plane was measured at the middle plane. The length of the lacrimal sac fossa was calculated.Results: The mean maximum thickness of the maxillary bone at the upper, middle and lower planes were: 3.58 mm, 4.27 mm, and 5.81 mm; the midpoint thickness at each plane were: 2.76 mm, 2.51 mm, and 1.48 mm; the lacrimal bone thickness at each plane were: 0.72 mm, 0.65 mm, and 0.66 mm; the distance between anterior and posterior lacrimal crests at each plane were: 5.96 mm, 8.1 mm, and 4.63 mm; the angle between the lacrimal bone and the sagittal plane in males and females at the middle plane were: 132.73° and 131.46°; the length of the lacrimal sac fossa in males and females were: 15.82 mm and 14.02 mm, respectively.Conclusion: In Anatolian population, bone thicknesses of the lacrimal sac fossa were higher in males, while the angle between the lacrimal bone and the sagittal plane was higher in females. This study indicates that osteotomies can be easily performed in DCR interventions in Anatolian population.

Purpose Ventriculoperitoneal shunt is preferred and widely applied method in patients who require shunt procedures. However in cases with abdominal complications, another body compartment should be used for the distal catheters and ventriculoatrial shunt is the preferred second-line treatment method. The purpose of this study is to evaluate the efficacy of percutaneous ventriculoatrial shunting as a salvage method in the pediatric patients with abdominal complications. Methods Data obtained from 9 patients with ventriculoperitoneal shunt dysfunctions due to abdominal complications, who underwent ventriculoatrial shunting as a salvage treatment at a single institution between January 2019 and September 2021 were retrospectively reviewed. All of the operations were performed under the guidance of intraoperative fluoroscopy and ultrasound. Results The mean age of the patients was 8.1 ± 1.2 years (2-15 years). Six patients (67%) were male and 3 patients (33%) were female. The mean number of the patients’ ventriculoperitoneal shunt revisions until atrial catheter placement was 7.5 times. Reasons for intraperitoneal catheter failure were; peritoneal adhesions in 4 patients (44.5%), pseudocyst formation in 3 patients (33.3%), and peritonitis in 2 patients (22.2%). Seven patients of the study cohort had no problem after ventriculoatrial shunt placement. Only 1 patient had shunt dysfunction related to ventricular catheter, and ventricular catheter and shunt valve revision was performed 26 months after ventriculoatrial shunt placement. Atrial catheter of the patient was intact. One patient died because of the progression of her primary disease (medulloblastoma in the 4th ventricle), not related to her ventriculoatrial shunt. Conclusion Percutaneous ventriculoatrial shunting under the guidance of intraoperative fluoroscopy and ultrasound provides a safe, effective and easy alternative in the patients with peritoneal complications and multiple operations history.

To investigate the reduction of elevated shunts after treatment with sorafenib in hepatocellular carcinoma (HCC) patients planned for transarterial radioembolization (TARE).Sixteen HCC patients treated with sorafenib were investigated. Shunts were evaluated by SPECT/CT after Technetium-99 m Tc-macroaggregated albumin injection.All patients had high LSF (median 43.5%, range 28-86), and two (12.5%) of them had widespread intrahepatic shunts with concomitants elevated (36%) and acceptable (18%) lung shunt fraction (LSF). The mean duration of the sorafenib use was 134.4 ± 59.2 days. While one patient (6.25%) developed hand-foot syndrome, minor side effects were seen in all patients. After sorafenib use, LSF fell below 20% in eight patients, and TARE was applied to all of them. There was strong negative correlation between the failure of shunt reduction and presence of macrovascular invasion (ρ = - 0.775) and infiltrative tumour type (ρ = - 0.775).Sorafenib use may be beneficial in some selected HCC patients with elevated shunts. Expected results may not be obtained in patients with infiltrative tumour type or macrovascular invasion, but patients with nodular tumour type with the absence of macrovascular invasion may be appropriate candidates for shunt reduction with ensuring subsequent TARE. Further investigations with sufficient patient population and standardized protocols of follow-up periods are needed to clarify the values for sorafenib use in HCC patients with evaluated shunts.

Herein, we present a case of systemic aspergillosis with a fatal outcome in a case with diffuse large B cell lymphoma (DLBCL) treated by ibrutinib. Aspergillosis was suspected clinically and proven microbiologically. Radiological findings were compatible with aspergillosis. We aim to review radiological findings in a case with DLBCL treated with ibrutinib, which is an important tyrosine kinase inhibitor used in lymphoid neoplasias.