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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.

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

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.

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.

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.

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.

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.

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: To compare the frequency of recurrence after surgical excision versus aspiration and injection of Steroids of wrist ganglion Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of General Surgery at Combined Military Hospital, Kohat Pakistan, from Sep 2018 to Aug 2019. Methodology: Seventy patients reported to the Outpatient Department, Combined Military Hospital, Kohat Pakistan, with complaints of ganglion and wanted treatment. Patients were randomly allocated into two Study Groups 1 and 2, by lottery method. Group-1 was treated by aspiration of the cyst contents followed by Steroid injection, while Group-2 was by excisionof the ganglion surgically under a local anaesthetic agent. The patient was followed up after three months to look for recurrence in both groups. Results: The frequency of recurrence was 34.29% in Group-1 and 5.71% in Group-2, (p-value was less than 0.001). Conclusion: Surgical excision results in lesser recurrence when compared with simple aspiration and Steroid injection for ganglion of the wrist.

Background: Umbilical granuloma (UG) and umbilical polyps (UPs) are the most common umbilical abnormalities in neonates, causing inflammation and drainage. Aims: The aim of this study was to compare the effectiveness of the technique of silver nitrate cauterization and surgical excision on both UG and UP in pediatric patients. Settings and Design: A prospective study on UG and UP was carried out in a high-volume tertiary care teaching institute from January 2015 to December 2020. Materials and Methods: The patients were randomly distributed by chit method into two groups: Group A treated with surgical excision and Group B treated with silver nitrate cauterization. Statistical Analysis: The unpaired Student's t-test was used to find the existence of any statistical significance between the parameters of the two groups. Results: There were 105 patients with 59 males and 46 females. There were 70 patients in Group A and 35 in Group B. Most of the patients in both Group A and Group B were between >1 and 3 months of age group. Blood mixed umbilical discharge was the most common complaint. There was complete resolution of symptoms in 100% of patients in Group A. In Group B, success with first attempt with cauterization was achieved in 20 (57.14%) patients and 12 (34.29%) patients after the second attempt. In Group B, successful management was achieved in 2 (5.71%) patients after the third attempt combined with double ligation. In 1 (2.86%) patient, there was an incomplete response to cauterization. Minimal perilesional burn (in the umbilicus) was observed in four cases, two each in the UG and UP groups. Conclusions: The technique of silver nitrate cauterization for both UG and UP is a simple, less expensive, and safe procedure in experienced hands. Most patients show complete responses at the first attempt. In others, complete resolution is accomplished at the second or third attempt. Surgical excision should be performed in cases with an incomplete response and larger lesions.

(1) Background: Osteochondromas are the most common benign bone tumors, primarily found in long bones, while scapular osteochondromas are rare and account for less than 1% of all osteochondromas. (2) Methods: We present a case of a young female patient with a unique presentation of scapular osteochondroma. The patient exhibited superomedial scapula angle osteochondroma with winging, a rare manifestation of scapular osteochondroma. The patient had a slow-growing mass on the left scapula for several years. Physical examination revealed a visible deformity with significant winging of the scapula. Imaging studies demonstrated a large osteochondroma arising from the superomedial angle of the left scapula, with a bony stalk. (3) Results: Surgical excision was performed, and histopathological analysis confirmed the diagnosis of osteochondroma. Following the surgery, the patient experienced a significant improvement in scapular winging. A comprehensive literature review revealed only a limited number of reported cases of scapular osteochondroma with winging, underscoring the significance of this case report as a valuable addition to the existing literature. The diagnosis of scapular osteochondroma should be considered in the differential diagnosis of patients presenting with a scapular mass, particularly when associated with winging. Surgical excision is the recommended treatment, and complete excision is crucial to prevent recurrence. (4) Conclusions: This case report highlights a rare presentation of scapular osteochondroma with winging and emphasizes the importance of considering this diagnosis in patients with scapular masses accompanied by winging. The successful surgical intervention in our case resulted in significant improvement. Clinicians should be aware of this entity and consider prompt surgical intervention for complete excision, ensuring optimal patient outcomes and preventing recurrence. Further research and additional case reports are necessary to enhance our understanding of scapular osteochondroma and its varied clinical presentations. Furthermore, comprehensive studies involving larger patient cohorts are necessary to explore the full spectrum of clinical presentations of scapular osteochondromas. By documenting and analyzing a wider range of cases, including variations in tumor location, size, and associated symptoms, researchers can identify patterns and establish more accurate diagnostic criteria. This will facilitate early detection and appropriate management of scapular osteochondromas, ultimately improving patient outcomes.

Introduction. Pyogenic granuloma (PG) is a vascular inflammatory hyperplasia involving the skin and oral mucosa, often associated with local irritation or trauma, or with pregnancy. Intraoral location usually affects the gingiva, but tumoral aspect can be misleading, especially in extra-gingival locations. A thorough assessment and diagnosis are therefore important for ensuring the proper treatment. Case presentation. We report the case of a 12-year-old boy who presented for a growing and bleeding tumour of his lower lip mucosa. The tumour was labeled as “hemangioma”. It was growing for several weeks and associated with minor, but repeated mucosal trauma. Although the anatomic location was not common, the patient history suggested a diagnosis of PG. After a dermatologic assessment, which proposed a differential diagnosis with oral papilloma, a soft tissue ultrasound sustained the clinical diagnosis. The tumour was surgically excised and the defect was closed directly with absorbable sutures. Three weeks later the mucosa had a healthy appearance, without signs of impaired healing or tumour recurrence. The histopathological exam confirmed the clinical diagnosis. Conclusions. There are several types of soft tissue solid or vascular tumours that can be mislabeled and the diagnosis of hemangioma is commonly used for various vascular anomalies. In our case, the clinical aspect, together with the tumoral growing pattern and the history of repeated trauma, led us to the correct diagnosis and treatment. Surgical excision completely removes the PG and ensures rapid and esthetically convenient healing, without complication or tumour regrowth.

Basal cell carcinoma (BCC) is a common disease of the skin caused principally by prolonged solar radiation exposure. It is normally a malignancy with favorable prognostic features and is potentially curable by standard excision. In White populations with high disease incidence, general practitioners (GPs) play a vital role in diagnosing and managing BCC, including surgical excision. Dedicated care at the primary care level by adequately trained GPs is conceivably cost effective for the health system and more convenient for the patient. In Asia and other parts of the world with low incidence, this valuable role of GPs may appear to be inconsequential. In this regard, any justification for the involvement of local GPs in BCC surgery is debatable. This article aims to provide a clinical update on essential information relevant to BCC surgery and advance understanding of the intricate issues of making a treatment decision at the primary care level. Case Report: Madam Tan, a 71-year-old Malaysian Chinese lady, otherwise healthy, presented to her local GP with a complaint of a nodule over the left cheek that had been there for more than a decade. Her concern was that the lesion was growing and had become conspicuous. She had spent most of her life as a farmer working in her orchard. Upon examination, she had an obvious dome-shaped nodule over the left cheek measuring approximately 1.8 cm in diameter. The lesion was firm, pigmented, well-demarcated, and slightly ulcerated at the top. Clinically, she was diagnosed with a pigmented nodular basal cell carcinoma of the left cheek. Examination of the systems was unremarkable. She requested that the consulting GP remove the growth. The cost for specialist treatment and waiting time at the local hospital were her concerns. Clinical Questions: Can the basal cell skin cancer be excised safely and effectively in the local primary care setting? What are the crucial preoperative concerns?

Abstract Giant Multilocular Prostatic Cystadenoma (GMPC) is one of the rare benign tumors of the prostate. This report presents a case of a young man who has been recently diagnosed with GMPC. Our report highlights the importance of timely diagnosis and treatment, considering the overlapping symptoms with other common urinary conditions.

Abstract Background Endometriosis is the presence of endometrial tissue outside the uterine cavity. The lesions are typically found in the pelvic cavity but can occur in other extrapelvic areas. Umbilical endometriosis, also known as Villar’s node, is a rare disease comprising 0.5–1% of all extrapelvic disease. It commonly presents with cyclical pain and bleeding from an umbilical nodule. Case series We present a retrospective case series of five African patients with umbilical endometriosis diagnosed and treated between July 2015 and February 2019 at a tertiary health facility. The patients were aged between 31 and 47 years, and all presented with an umbilical swelling and pain. They had lesions with diameters ranging from 1.6 cm to 4 cm. The duration of symptoms ranged between 3 and 60 months. Their diagnoses were made on the basis of clinical presentation followed by surgical excision. In all the cases, diagnosis was confirmed by histopathology with no malignancy detected. Conclusion Umbilical endometriosis is a rare condition that should be considered as a differential diagnosis in women with umbilical lesions. Diagnosis is mostly clinical; most patients present with umbilical swelling, cyclical pain, and bleeding or discharge. Imaging has a limited role. Surgical excision is the treatment of choice with low risk of malignancy or recurrence.

Abstract Splenosis is a condition that occurs after splenic rupture. A 29‐year‐old male patient with a history of splenectomy was admitted due to multiple vomiting episodes. The diagnostic workup was unable to differentiate between gastric GIST and splenosis. Laparoscopic surgical resection was performed leading to the diagnosis of splenosis.

We report the case of a histologically confirmed primary cutaneous marginal zone B-cell lymphoma (PCMZL), which was treated by surgical excision. PCMZL is the second-most common type of primary cutaneous lymphoma, including cells of the marginal zone, lymphoplasmacytic cells, and plasma cells. Treatment options include surgery, radiotherapy, topical therapy, corticosteroids, chemotherapy, rituximab, and antibiotics. After treatment, local recurrence may occur but metastasis is extremely rare. Tumor prognosis shows an indolent course with a 5-year disease-free survival rate approaching 97%–99%. We present the case of a woman aged 69 who was diagnosed with PCMZL for a pruritic, erythematous lesion with an undefined border on the upper left leg.

Endometriosis is a common disorder in women of reproductive age. Scar endometriosis is an infrequent type of extrapelvic endometriosis associated with obstetrical and gynecological surgeries but is rarely observed in abdominal scar after cesarean section. We are reporting here a case of scar endometriosis in a 30-year-old woman involving subcutaneous and muscular planes following cesarean section. Preoperative diagnosis of cesarean scar endometriosis was made by clinical examination, radiological imaging, fine-needle aspiration cytology, and confirmed histologically after surgical excision.

Abstract Although myxoma represents the most frequent non‐malignant cardiac primary tumor; it is extremely rare met in the left ventricle. Clinical features of the neoplasm extend from symptomless to critical signs of either ischemia or embolism. We describe here an unusual case of a huge left ventricular myxoma in a 68‐year‐old man, presented with clinical and ECG findings of an inferior wall myocardial infarction. The patient was primarily referred to our institution for coronary angiography, which showed no coronary artery disease. Further examinations revealed a left ventricular mass as the possible source of embolization, thus the patient underwent surgery for tumor excision. The postoperative course was unremarkable. A bibliographical analysis demonstrated that those tumors are rare but treatable causes of embolic myocardial infarction, thus profound clinical intuition, proper utilization of imaging modalities, administration of anticoagulants preoperatively, as well immediate surgical removal are justified.

Glomus tumour is a rare small benign lesion which is typically located at fingertip. Most patients with glomus tumour have delayed diagnosis. Recognition of the classical triad of glomus tumour which include paroxysmal pain, exquisite tenderness to touch and cold intolerance; and advanced imaging like MRI and biopsy would help in making the diagnosis. Here, a case of an elderly patient is reported with painful right forearm swelling for three years which progressively increased in size. The size of the swelling was unusually large for glomus tumour. Unfortunately, during the same time period he suffered from acute coronary event. MRI revealed subcutaneously located lobulated soft tissue mass. Surgical biopsy with marginal excision was done. Histopathological examination revealed small uniform rounded cells surrounding capillary vessels, consistent with the diagnosis of glomus tumour. There was no recurrence up to 2 year of follow-up and his cardiac symptoms also stabilised.

Abstract Background Midline cervical cleft is a very rare congenital anomaly. According to a literature search, until 2014 only 205 cases were reported. Case presentation We present a classic case of congenital midline cervical cleft. This was a case of a 3-year-old Middle Eastern boy. The lesion was excised and the defect was closed via multiple Z-plasties. Conclusions Midline cervical cleft, although a rarity, when presented needs surgical treatment, which comprises surgical excision and closure that lessens the possibility of scar visibility and contracture.

An epidermoid cyst is a benign cyst resulting of implantation of superficial epidermal tissue into the dermis or subcutaneous tissue. They are commonly found on the scalp, face, neck, trunk and extremities; and rarely seen in the clitoral or vulvar region, most often associated with prior trauma or surgery to the area, particularly female genital mutilation. Epidermoid cyst of the clitoris is a very uncommon pathological entity, it can be spontaneous present at birth or develop later in life, or often secondary to surgery or trauma at the clitoral region. Herein, we report a case of 33-year-old multiparous woman, without past medical history of vulvar trauma or genital surgery, presented to the emergency department with a history of slowly growing clitoral mass over 11 months, which recently became responsible of sexual discomfort and difficulty in urination, without fever, vaginal discharge or other complaints. On perineal examination a painless midline cystic mass of 5 × 3 cm was noted; it extended from the clitoral region up to the labia minora; the mass was mobile, nontender, well-circumscribed and with a smooth surface (A, B). The labia minora and majora were normal, and both the urethral and vaginal openings were normal in position and shape (B). There was no associated bleeding or discharge. The remainder of the physical examination was otherwise unremarkable. Ultrasound testing revealed normal internal genital and urinary tract without communication between the cystic structure and the urethra. The patient underwent a complete surgical excision of clitoral cyst under spinal anesthesia, without compromising the clitoral neurovascular bundle or hood. Histopathological examination revealed an epidermoid cyst lined with stratified squamous epithelium and filled with keratinous material. The final pathologic diagnosis was of a spontaneous nontraumatic epidermoid cyst of the clitoris. The patient´s postoperative course was completely uneventful and she was discharged from the hospital on the 2nd postoperative day without any complication. No recurrence of the cyst was noted 6 months later at a follow-up visit, and she had a normal cosmetic appearance of the external genitalia, with complete disappearance of genital and urinary complaints.

We report here the case of a patient admitted for management of posterior fossa cerebral hemangioblastoma. A 16-year-old male patient with a history of intracranial hypertension syndrome consisting of progressively worsening headache, vomiting, especially morning and jet vomiting, and decreased visual acuity. The patient´s symptomatology worsened a few days later with the appearance of a disturbance of balance with enlargement of the sustentation polygon. The patient initially benefited from a brain CT scan that objectified a solidocystic process of the posterior brain fossa. The patient then underwent a surgical excision that was considered partial and the diagnosis of hemangioblastoma was made on the surgical specimen. Since the surgical removal was partial the patient was referred to our training where he received external radiotherapy on his hemangioblastoma of the posterior brain fossa. The patient was examined one month after the end of irradiation; he presented a spectacular improvement in his neurological symptomatology with a clear regression of balance disorders. The standard treatment for cerebellar hemangioblastoma is complete microsurgical removal, but our results show a high level of efficacy for fractional photon radiotherapy after partial surgery of this benign tumour.

A 32-year-old male patient reported with a painless swelling over right cheek and is slowly growing in size for the past 2 years. Incisional biopsy revealed the lesion as Ossifying fibroma (OF), which is not very common in the maxilla. Surgical excision and primary closure was successfully carried out with no postoperative complications. The case was followed for a period of 3 years with no evidence of recurrence.

Intrapericardial teratoma is a germ-cell tumor that typically arises from the base of the heart and usually diagnosed in the fetal or neonatal period. Although benign, these tumors can be massive in size causing direct compression of the heart. Life-threatening complications such as fetal hydrops, cardiac failure, superior vena cava syndrome, and cardiac tamponade caused by these teratomas have been reported. Early surgical excision is curative. We present the images of a mature intrapericardial teratoma diagnosed in an asymptomatic neonate. The neonate was managed successfully by elective surgical excision.

Abstract Osteochondromas are benign tumors that can be responsible for angular deformities, limb‐length discrepancy, and impending fractures of the neighboring bones. The risk of future fractures and joint malalignment is an indication for surgical intervention.

Swellings of the hand are commonly encountered in a general practice setting and include a multitude of diagnoses. Although majority of these lesions are benign, a specific diagnosis should be achieved for an appropriate treatment. We present a case of a very unusual rheumatoid nodule on the palmar aspect of the hand, but without any rheumatological disease, which was initially misdiagnosed as a tendon sheath tumor. The nodule was successfully treated by surgical excision. The patient made an uneventful recovery, did not experience progression to rheumatoid arthritis (RA), and showed no recurrence during the one-year follow-up. We suggest that when dealing with patients with a hand mass, a rheumatoid nodule should be considered as a differential diagnosis. Understanding the cutaneous expressions of RA can enable early diagnosis, prompt treatment, and lower morbidity and mortality for the affected persons.

Objective: Classic Kaposi’s sarcoma is an indolent, angioproliferative tumor that is usually observed in the lower extremities of elderly men. Depending on their stages, skin lesions are maculonodular or vegetative ulcerated masses. Visceral organ or lymph node involvement may rarely occur. There is no gold standard treatment for local diseases. Surgical excision, radiotherapy, chemotherapy, and cryotherapy can be performed. This retrospective study aimed to evaluate the long-term results of surgical excision and skin graft repair of stage I and II classic Kaposi’s sarcoma skin lesions around the foot and ankle. Material and Methods: Eleven patients were included. The patients’ age and gender, location of lesion, surgical treatment, follow-up period, and recurrence were evaluated by retrospectively examining patient records. For the surgical treatment, the lesion was excised with a 0.5-cm safe skin margin. The defect area was repaired with full-thickness skin grafts that were obtained from the inguinal region in all patients. Results: Eight of the patients were male and three were female. The average age of the patients was 69 (54–84) years. All patients were completely cured. The average follow-up period was 1.8 (1–3) years. No recurrence was observed in any of the patients at the end of the follow-up period. Conclusion: Classic Kaposi’s sarcoma skin lesions in the lower extremity can be completely cured by surgical excision, with no recurrence risk. After surgical excision, using a full-thickness skin graft for repairing primary cutaneous defects, particularly those in the soles, is a simple and reliable method.

We read the “test your knowledge” article by Ishak et al. with great interest. We commend the authors for their educative discussion about the case of a 26-year-old woman with bilateral xanthelasma palpebrarum (XP). We frequently encounter patients with XP in our plastic surgery clinic and feel that it is important to add several points regarding the treatment of this condition.

Haemangiomas are very common benign vascular lesions. However, haemangioma of cervix is very rare. They are more common in 2nd and 3rd decades of life. Most of them are asymptomatic and discovered incidentally. Surgical excision remains the treatment of choice in most of the cases and alternatively conservative treatment can also be considered which is helpful in preserving fertility in the young females. We present a case of cervical haemangioma in a 38-year-old female which was diagnosed incidentally.