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Collision tumors are two histologically distinct types of malignancies within the same mass and organ. The aim of this study is to present a case series of thyroid collisions.This was a multicenter retrospective case series study. The participants were consecutive in order. Socio-demographic and clinical data were obtained from hospital records.The study included eight cases comprising six (75%) females and two (25%) males. The patients had different presentations, including neck swelling, dyspnea, and dizziness. The pathology was successfully determined through fine-needle aspiration. Four patients (50%) underwent lobectomy, whereas the other half (four patients) underwent total thyroidectomy.Collision tumors of papillary thyroid cancer (PTC) and follicular thyroid carcinoma (FTA) or medullary thyroid carcinoma (MTC) and FTA are exceedingly rare phenomena that most commonly affect females. Complete or partial thyroidectomy is the ideal management of choice for these cases and is associated with good survival.

Introduction Hurthle cell carcinoma (HCC) is a rare type of thyroid cancer while Hodgkin's lymphoma (HL) is an uncommon cancer of the lymphocytes. The synchronous occurrence of HCC and HL in a single person has not been described in the literature. This report aims to present the first case of synchronous HCC and HL. Case report A 31-year-old male presented with a right side neck swelling for three months. Laboratory findings revealed elevated thyroglobulin (286.7 ng/ml). Ultrasound (US) examination showed several enlarged lymph nodes (, Highlights • Hurthle cell carcinoma is a rare, well-differentiated, and aggressive thyroid cancer. • Hodgkin's lymphoma is a cancer of the lymphocytes, associated with good prognosis. • This report presents the first case of synchronous Hurthle cell carcinoma and Hodgkin lymphoma.

Highlights • There is a considerable debate regarding implant or autologous reconstruction of breast. • Single session reduction mammoplasty with contralateral autologous reconstruction is feasible. • A novel procedure has been presented. • Dividing the contralateral breast and creating a myocutaneous flap for reconstruction., Introduction The aim of this paper is to introduce a novel procedure for concomitant contralateral reduction and ipsilateral reconstruction mammoplasty by dividing the contralateral breast and creating a pectoralis myocutaneous flap for reconstruction. Presentation of case A 34-year-old female, with a history of left side mastectomy presented for reconstruction. Under general anesthesia, the scar of the previous operation was resected in an elliptical shaped incision, the right breast was divided in middle, leaving the flap (pectoralis myocutaneous flap) with pectoralis branch of thoracoacromial artery. The superiomedial part of right breast (the flap) was rotated under the bridge of intermammary skin into the left incision. Ten days after the operation, the flap was viable and healthy. Discussion The aim of breast reconstruction is to provide psychosocial support and improve quality of life in the long term by restoring the shape of the breast surgically. New techniques have emerged constantly, and each comes with its list of advantages and risks. The benefits of reconstruction are clear, yet often it is not found as a part of breast cancer treatment routinely. Conclusion In single session reduction mammoplasty in one breast and using the resected piece as a flap to reconstruct the contralateral breast is possible whenever indication.

Highlights • Total thyroidectomy represents one of the commonest procedures performed for thyroid diseases. • Ischemic tracheal necrosis an extremely rare complication of thyroidectomy. • In this paper is to report a rare case of trachea-cutaneous fistula after total thyroidectomy., Introduction Total thyroidectomy represents one of the commonest procedures performed for thyroid diseases. The aim of this paper is to report a rare case of tracheocutaneous fistula after total thyroidectomy. Case report A 44-year-age female presented with left side neck swelling for 2 month duration. Neck ultrasound showed a well-defined left thyroid nodule (25 × 15 × 14 mm) with features highly suggestive of malignancy, under general anesthesia total thyroidectomy was performed. On the third postoperative day, the patient came back with neck swelling especially during speaking, there was subcutaneous emphysema, wound opened with residual air leak. Under local anesthesia, the wound opened, there was 10 × 10 mm opening in the anterior aspect of trachea, a tracheostomy was inserted, the patient was sent home after decannulation with an opening in the anterior neck. Twenty days later the tracheal opening closed spontaneously. Discussion The possibility of a tracheal wall ischemic necrosis is plausible due to cautery use. Some autopsy studies have demonstrated that small branches of inferior thyroid artery form the main blood supply of the upper segment of trachea. These fragile branches have a lateral entry point that can be damaged readily leading to ischemia and necrosis. Conclusion Ischemic tracheal necrosis, although very rare, is possible after total thyroidectomy, minimal use of electro-cautery is advised whenever possible.

Highlights • Sacrococcygeal area is the commonest site of PNS. • However, it could be found in other regions like hand, intermammary, suprapubic, umbilicus, nose etc. • Breast pilonidal sinus is an extremely rare variant of PNS. • The aim of this report is to present a case of pilonidal sinus occurring in breast., Introduction Breast pilonidal sinus is an extremely rare variant of the condition, the report aims to present a case of pilonidal sinus occurring in the breast. Case presentation A 35-year-old female presented with a left breast discharging lesion for a 5-month duration. There was a local redness with multiple discharging sinuses on her left breast at 3–5 o’clock, 3–4 cm away from the nipple. The discharge was serosanguinous in appearance. The lesion was excised totally with primary closure under general anesthesia. Histopathological examination was consistent with pilonidal sinus. Discussion For atypical pilonidal sinus disease, surgery is the modality of choice but regarding sacrococcygeal pilonidal sinus, non-operative treatment begins to grow. The cardinal risk factors for recurrence and complications are male gender, family history, tobacco smoking, obesity, size of sinus, poor personal hygiene and surgical methods. Conclusion Breast pilonidal sinus is an extremely rare variant of the condition. It should be suspected on clinical examination. Surgical excision is the definitive treatment strategy.

Introduction and importance The thymus is a primary lymphatic organ within the mediastinum that plays an essential role in developing and maintaining cell-mediated immunity. The current study aims to report a case of intra-tumoral osseous metaplasia of the thymus gland, which is an infrequent phenomenon. Case presentation A 43-year-old male presented with weakness and easy fatigability for 2 months. The patient had an elevated anti-acetylcholinesterase antibody (19.5 nmole/L). Magnetic resonance imaging showed a round, capsulated, enhanced mass in the anterior mediastinum measuring 5.5 × 3.5 cm, suspecting thymoma. The patient underwent plasmapheresis three times in one week, under general anesthesia, in a supine position, sternotomy was performed, and the thymoma was totally resected. Discussion Thymomas are known to occur in all age groups with the peak of nearly between 35 and 70 years with the median age of 54 years. The sex distribution of thymoma is approximately equal with slight predilection of women in old age groups. However, among all reported cases of thymomas with osseous metaplasia, the majorities are female. The significance of this ossification is still to be clarified. Conclusion Although it is rare, secondary changes in thymoma may occur including calcification and ossification., Highlights • The thymus is dedicated to the growth of the immunocompetent T-cells. • Thymoma is an uncommon tumor of the thymic epithelium. • Thymoma with osseous metaplasia is a sporadic condition.

Introduction Intrathyroidal parathyroid is a parathyroid completely embedded within the thyroid parenchyma. The aim of this study is to present a case with co-occurring bilateral normal intrathyroidal parathyroid glands and papillary thyroid carcinoma (PTC). Case presentation A 35-year-old female presented with anterior neck swelling for a duration of a week. The patient was generally asymptomatic. Ultrasound showed mild enlargement of the thyroid gland, and a well-defined solid nodule measuring 9 ∗ 8 ∗ 7 mm in the left lobe with malignant characteristics. Laboratory findings were within normal limits. Fine needle aspiration of the nodule resulted in the diagnosis of PTC. The patient underwent total thyroidectomy. Histological examination confirmed the diagnosis of well differentiated multifocal bilateral PTC alongside two bilaterally located intrathyroidal parathyroid glands. Discussion The occurrence of normal ITP is exceedingly rare, and even rarer when simultaneous with other thyroidal lesions. It is theorized that inferior parathyroid glands arise from the third pharyngeal pouch, and during embryogenesis they might migrate to other anatomic locations. In this case, two bilateral normal ITP were present with PTC. Conclusion Normal ITP presents a diagnostic challenge due to their high insensitivity to current preoperative diagnostic techniques; hence, surgeons are required to carefully examine thyroid tissue during thyroidectomy when missing parathyroid glands are observed., Highlights • Intrathyroidal parathyroid is completely embedded parathyroid gland within the thyroid parenchyma. • The ectopic localization of parathyroid inside the thyroid is uncommon. • It is even rarer when synchronous with another thyroidal tumor. • In this study, a case of co-occurring bilateral normal ITP and papillary thyroid carcinoma is discussed.

Introduction and importance Lymph node metastasis is the most prominent prognostic factor in breast cancer. The aim of this paper is to report a case of contralateral axillary lymph node metastasis (CAM) which look like metachronous initially, but histopathologicaly confirmed as synchronous CAM. Case presentation A-44-year old female was a known case of left breast cancer five years prior to this presentation (T2,N2,M0, grade III, Triple negative, multifocal invasive ductal carcinoma). On follow up, multiple contralateral axillary suspicious lymph nodes were discovered. Fine Needle Aspiration Cytology from the lesion revealed grade III, Triple negative, invasive ductal carcinoma consistent with metastasis from the left invasive ductal carcinoma. Bilateral mastectomy and right axillary dissection were performed. The histopathological examination and immunohistochemistry showed left breast recurrent 0.5 cm grade III, Triple negative invasive ductal carcinoma. Discussion If a cancer is found in the contralateral axilla, three main potential sources should be considered: contralateral spread from the original breast tumor, metastasis from an occult primary in the ipsilateral breast, and metastasis from an extramammary site. Conclusion Although CAM in patients with breast cancer is an uncommon condition, it is still possible to occur. There is a controversy regarding the appropriate management., Highlights • Lymph node metastasis is the most prominent prognostic factor in breast cancer. • Ipsilateral axillary lymphnode metastasis is the most common site of involvement. • Contralateral axillary lymphnode metastasis is an unusual finding. • In this paper, a case of synchronous contralateral axillary lymph node metastasis has been discussed.

Bronchogenic cysts are congenital lesions found in the mediastinum, particularly the posterior-superior area. The current study aims to report a rare case of a subcutaneous bronchogenic cyst in the chest wall.A 41-year-old patient presented with a swelling of the chest wall. The mass had been present since birth. On examination, there was a large soft, round mass over the sternum subcutaneously. It was a fixed, non-flatulence, non-pulsatile, and non-tender mass.Usually, the condition develops between the fifth and sixteenth weeks of gestation, when the primordial intestine separates into two parts: dorsal, which gives rise to the esophagus, and ventral, which gives rise to the pulmonary bud and tracheobronchial tree. As a result, the cyst is an ectopic lung bud that may or may not be connected to the tracheobronchial tree but lacks mesenchymal tissue.Although chest wall bronchogenic cysts are uncommon, they should be considered in the differential diagnosis of cystic and soft tissue lesions in adults with chest wall swelling.

Background Pilonidal sinus disease (PNS) is a disorder of the young population. The aim of this study is to analyze the risk factors associated with development of PNS in the secondary school students. Methods This case control study enrolled 189 participants, (Control group: 95 cases, case group: 94 cases). The inclusion criterion for the trial group was those secondary school students with PNS and age ranged between 16 and 20 years without the known risk factors of PNS. Result About 80 (42.3%) patients were male and 109 (57.7%) were female. Each group included 95 patients. There was no significant difference in both groups regarding basic features. Among the control group 36 (37.9%) participants were used to study while sitting on a hard place whereas among the case group 62 (66%) cases were used to study while sitting on a hard place, the difference was statistically significant (, Highlights • Pilonidal sinus disease is a disorder of the young population. • Several risk factors have been recognized like job, being hairy …. etc. • Studying for prolonged time has never being studied to cause PNS. • In this study, factors have been assessed to cause PNS in preparatory students.

During the past decades, several methods to measure and rank journal impact were explored. To best of our knowledge, no ranking or evaluating approach for papers has been addressed in the literature. To encourage authors and create a national field for competition and challenge, we suggested and performed a method for paper evaluation denoted as source normalized annual paper ranking (SNAPR). It measures a paper's contextual impact, taking into account several of its characteristics like type of the study, the state of the publishing journal, the contextual citation and affiliation. The details with example of SNAPR have been discussed. SNAPR is a measure of contextual impact of papers, designed to be used in developing countries to evaluate articles and induce competition among the researchers.

The trend through which academia finances scientific publication has been changed into open access publishing, the latter is exploited by predatory journals and publishers. The aim of this paper is to review the current situation of predatory publishing and introduce Kscien's list of predatory journals and publishers. Kscien has recruited a special committee consisting of 23 young researchers. They are working unceasingly to keep the list refurbished, expose current tricks invented by the predators and guide authors. The list is designed to be updated daily. Currently, the criteria used to recognize predatory journals and publishers basically depend on the journal's misconduct, fabrication and inadequate peer review. Researches are ongoing to recapitulate more solid criteria with objective evidence to overcome the critics faced by Beall. Kscien's list has been proposed to replace the vanished Beall's list from the interior of the drawn region in fake journals and publishers.

Introduction and importance Although Corona virus primarily infects respiratory system, several complications have been reported. The aim of this paper is to report a strange case of corona virus disease presented with death on arrival and survived after rigorous cardiopulmonary resuscitation. Case presentation A 35-year-old male present as a sudden loss of consciousness 10 min before admission. The patient was unconscious, pulseless, there was no sign of breathing, the pupils fixed, did not react to light. Blood sugar was 112 mg/dl. Cardiopulmonary resuscitation (CPR) commenced with insertion of two wide bore cannulas. The patient developed ventricular fibrillation. Later, he reverted to pulseless ventricular tachycardia. After several minutes of CPR, the patient returned back to sinus rhythm. He underwent percutaneous coronary intervention and became healthy one month after the intervention. Clinical discussion Cardiac involvement in case of COVID-19 might be explained by the presence of the angiotensin-converting enzyme 2 (ACE2) receptor which is a transmembrane soluble protein regulating the local actions of the renin-angiotensin apparatus in cardio-vascular system. Conclusion death on arrival could be the first presentation of COVID-19. Aggressive CPR is necessary to revive the victim.

Background Pilonidal sinus disease is a common perianal inflammatory condition. Currently, operative therapy is the standard management strategy. The aim of this study is to investigate the efficacy of a preparation with antimicrobial, sclerosing, and wound-enhancing properties in the nonoperative management of pilonidal sinus disease. Methods A parallel randomized controlled trial was conducted between January 2013 and January 2017 to investigate the effect of a mixture of sclerosing agent and herbal product (Lawsonia inermis powder) in the management of sacrococcygeal pilonidal sinus disease. The patients were allocated randomly into the study group (group receiving injection of the mixture into the sinus track) and the control group (group receiving the classic technique of operative excision and primary closure). Results This study was conducted among 400 patients, 316 (79%) male, 84 (21%) female. The age range was 18 to 40 years with a mean age of 27.1 years (standard deviation, ±2.4); each group included 200 patients. None of the patients had an abscess or complicated pilonidal disease. Cure rate, defined as complete healing of the sinus, was high among both groups after the first intervention (94% for control group and 89% for the test group, respectively; P = .051). In the study group, there was a statistically significant decrease in hospital stay, cost, perioperative pain, duration of absence from work, and duration of the procedure. Conclusion According to this trial, the injection of this mixture appears to be better than the other therapeutic options for pilonidal sinus disease in terms of cost effectiveness, time off work, rate of complication, and perioperative pain.

Background porocarcinoma is a rare sort of skin cancer developing from sweat glands. Its clinical course and management are not well understood. Objectives the current meta-analysis is to address the presentation and management of porocarcinoma. Data sources Web of Science, PubMed, MEDLINE on OVID and Google scholar were searched for English-language studies published before December 1, 2016. Results The review of literature revealed 453 cases. From which 222 (49%) cases were male and female were 231 (51%). The mean age was 67.57 years. The mean duration of presentation was 5.57 years ranging from 4 days to 60 years of age. The most common site of affection is the head and neck (39.9%) followed by lower extremity (33.9%). Mass and nodule are the most common modes of presentation. Metastasis occurred at presentation in 110 (31%) cases. The most common organ to which porocarcinoma metastizes is the nearby lymph node (57.7%). Conclusions Porocarcinoma is an aggressive skin cancer. Surgery is the main modality of treatment. Systematic review registration number reviewregistry233., Highlights • Porocarcinoma is a rare sort of skin cancer developing from sweat glands. • Because of rarity of the problem, there is controversy regarding both presentation and management. • The aim of the current meta-analysis is to summarize all data regarding the disease.