Hallucal sesamoiditis on a bipartite sesamoid bone: An uncommon cause of chronic great toe pain

The pathologies and lesions affecting the sesamoid bones of the hallux are uncommon and can be easily overlooked. Among them, sesamoiditis is a relatively rare condition known to cause severe great toe pain; lack of awareness of this particular entity leads to misdiagnosis, delayed treatment, and contributes to significant morbidity. Herein, we present a chronic sesamoiditis case occurring on a medial bipartite sesamoid bone, presenting as chronic great toe pain. The main purpose of this work is to discuss the role of magnetic resonance imaging and X-rays in the diagnosis process. To the best of our knowledge, no cases of great toe sesamoiditis occurring on a bipartite bone in no-athletic patients have yet been reported.

Hydatid cyst of the uterus: Very rare location

The involvement of the genital tract of a hydatid cyst is rare and the occurrence in the uterus is an extreme rarity. The diagnosis of this localization is difficult because the clinical and radiological findings are often misleading and the diagnosis is often worn during surgery and after histopathological examination of the surgical specimen. We report the case of a patient who consulted for primary infertility, with a clinical finding as the only anomaly significantly large uterus, and imaging pointing strongly toward an ovarian multilocular cyst, and in which the discovery of hydatid cyst was accidental intraoperative with double localization uterine and omental. Radical treatment cannot be discussed in this young patient of 32 years and gravid 0. The removal of the cyst wall completely and excision of the mass epiploic seemed reasonable. The patient was placed under Mebendazol and is always under the supervision of a possible recurrence.

Renal artery pseudoaneurysms post percutaneous nephrolithotomy: A case report

Percutaneous Nephrolithotomy (PCNL) is a standard, safe and efficient method for removing large renal calculi. This pathology is associated with a risk of life-threatening Iatrogenic Renal Vascular Injuries, such as pseudoaneurysm (1%-3%). We report the case of a 49 old year male patient with Hematuria post PCNL for renal calculi. Computed tomography renal angiography was indicated which showed a pseudoaneurysm in the lower pole of the left kidney confirmed by digital subtraction angiography. Super selective endovascular embolization was successfully performed with conservation of the left-over vascularization of the kidney. No postoperative complications were seen. We aimed to report this case and to review the literature regarding endovascular management of kidney pseudoaneurysms after PCNL.

Cerebral fat embolism syndrome after long bone fracture: A case report

Cerebral fat embolism is a rare and potentially fatal condition that may occur following a long bone fracture. Its characterized by respiratory, neurological, and mucocutaneous signs. Isolated severe brain syndrome remains exceptional. We report a 21-year-old male patient admitted for the cerebral manifestation of a fat embolism syndrome due to a fracture of long bone after a traffic accident injury. Neurological deterioration after a free interval was seen with generalized tonic-clonic seizures. MRI of the brain was indicated which showed numerous multifocal hyperintensities involving the deep white matter of both hemispheres producing a "starfield" appearance. This pattern of cytotoxic cerebral edema, with lesions in the white matter rather than the grey matter, is indicative of the subacute stage of fat embolism. The patient was treated with comprehensive support in the intensive care unit, he returned to normal neurological function and was discharged after 3 weeks of hospitalization.

Metastatic rectal gastrointestinal stromal tumor with intestinal obstruction: A rare case report

Gastrointestinal stromal tumors (GISTs) arising from the rectum are rare. We report the case of an aggressive rectal gastrointestinal stromal tumor (GIST) in a 60-year-old female that presented for symptoms of constipation and lower gastrointestinal bleeding. Upon rectal examination, a hard mass was found at 6cm from the anal marge. An MRI was indicated that shows a well-demarcated lesion originates from the distal rectum with exophytic growth and central necrosis. The diagnosis of rectal gist was confirmed by colonoscopy with biopsy and immunohistochemical analyses of bioptic material. Liver metastases were seen on computerized tomography (CT). She was referred for palliative chemotherapy. The patient had suffered from intestinal obstruction three weeks after his initial presentation and passed away shortly thereafter. We aimed to report this case as an aggressive and rare GIST localization.

Renal angiomyolipoma with renal vein extension

Renal angiomyolipomas are uncommon benign tumors containing fatty tissue. Only a few cases of infiltrating angiomyolipomas have been reported. We aimed to describe a case of a 65-year-old woman presenting a peripheral angiomyolipoma of the left kidney with CT evidence of involvement of the renal vein. The lesion has been found incidentally during abdominal CT for an unrelated reason. The patient underwent surgical treatment considering the vascular extension of the lesion and the risk of thromboembolic complications. The pathological analysis confirmed the diagnosis of renal AML in the upper pole of the left kidney invading the renal vein without malignancy.No post-operative complications and the evolution was favorable.

Anal Cancer with Atypical Brain and Cranial Bones Metastasis: About 2 Cases and Literature Review

Canal anal cancer is a rare tumor that accounts for 2% of all colorectal neoplasms, with a low propensity for metastasis. The spread of anal squamous cell carcinoma to the brain is exceedingly rare and has been previously reported only 5 times in the medical literature. However, the first and only case of cranial bone metastasis from anal canal carcinoma was described in 2019. The purpose of this article is to add our cases to the limited literature for the management of metastatic anal cancer. The current study presents 2 cases of patients diagnosed with squamous cell carcinoma of the anal canal how underwent chemo and radiotherapy. Despite the treatment our patients developed neurological symptoms, cerebral magnetic resonance imaging showed brain lesions for the first case, and cranial bones metastasis for the second one, histopathology confirmed these lesions to be a poorly differentiated squamous cell carcinoma, consistent with the known primary tumor of the anal canal. Unfortunately, both patients succumbed quickly to systemic complications of the disease during these treatments. Despite its rarity, brain metastasis should be considered in any patient with a history of anal cancer presented neurological symptoms.

Recurrent costovertebral hydatidosis with epidural extension

Osseous echinococcosis is a relatively rare entity and that of the rib is even rare. Few cases of costal echinococcosis have been reported in the literature so far. We report a case of a recurrent costovertebral hydatidosis with epidural extension in a 49-year-old man who presented with paraparesis and back pain. MRI of the dorsal spine was performed. The imaging features were suggestive of echinococcosis involving the rib and vertebrae with epidural extension. This diagnosis was confirmed histopathologically after surgical treatment. The evolution was marked by the reappearance of the same symptoms due to recurrence. The prognosis of costovertebral hydatidosis is gloomy despite radical surgical treatment due to the frequency of recurrences.

This case highlights the role of MRI for the diagnosis and follow-up of patients after treatment.

[Hydrocele of the canal of Nuck detected during infertility evaluation: an atypical case report]

L´hydrocèle du canal de Nuck est une pathologie rare de la femme, souvent découverte durant l´enfance. Cette présentation rapporte un cas rare d´hydrocèle découverte à l´âge adulte au cours d´un bilan d´infertilité. A l´admission au service, la patiente a rapporté une tuméfaction inguinale droite chronique non douloureuse. L´imagerie a été typique d´une hydrocèle du canal de Nuck. L´échographie a retrouvé une formation kystique avec quelques fin septas et l´'imagerie par résonance magnétique (IRM) n´a pas retrouvé de communication avec le péritoine. Avec les mêmes moyens d´imagerie, un utérus bicorne non cloisonné a été découvert pouvant rentrer dans le cadre de son bilan d´infertilité. Le but principal de ce travail est de faire connaitre l´imagerie typique de l´hydrocèle du canal de Nuck un diagnostic peu connu et de le faire intégrer parmi les diagnostics différentiels des tuméfactions inguinales chez la femme.

Chondrosarcoma of the parapharyngeal space: Case report and literature review of an extremely rare location

Chondrosarcoma of the head and neck region is a rare disease, representing approximately 0.1% of all head and neck neoplasms. Parapharyngeal location is extremely rare and low-grade ones are even rarer. Surgery alone or followed by adjuvant radiotherapy is the treatment of choice. In this article, we report a case of a 67-year-old male with low-grade parapharyngeal chondrosarcoma who presented with a 3-month history of dysphagia. A cervical magnetic resonance imaging was performed that shows a well-defined mass located at the right parapharyngeal space, causing medial deviation of the mucosal space. Surgical resection of the tumor without neck dissection followed by adjuvant radiotherapy was undertaken with a favorable response. The purpose of this article is to add our case to the limited literature for good management of parapharyngeal chondrosarcomas.

Ansa pancreatica: a rare cause of acute recurrent episode in chronic pancreatitis

Ansa pancreatica is a rare anatomic variation of pancreatic ducts. It is a predisposing factor of recurrent pancreatitis. In this case report, we describe a case of a 24-year-old male suffering from an ansa pancreatica with a non-patent major papilla, diagnosed on magnetic resonance cholangiopancreatography (MRCP).The ansa pancreatica was revealed by an episode of acute pancreatitis attacks in chronic pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) confirmed important abrupt dilation in the main pancreatic duct with an ansa loop in the pancreatic duct in the head of the pancreas, and a sphincterotomy of the minor papilla was performed. The procedure was difficult and the placement of a long-term pancreatic stent during the ERCP was impossible, thus a surgical pancreatico-jejunostomy was proposed as a treatment of an ansa pancreatica with a non-patent major papilla.

Curvilinear pericallosal lipomas diagnosed incidentally during evaluation following trauma with corpus callosum abnormalities in two patients

Pericallosal lipomas are the most habitual location for an intracranial lipoma. They are fat-containing lesions arising from the interhemispheric fissure intimately related to the corpus callosum, which is often abnormal. They originate from aberrant differentiation of the persistent primitive meninx. Most Pericallosal lipomas are asymptomatic and come into clinical attention during neuroradiological investigations for other conditions. MRI is the modality of choice to characterize not only the extent of the lipoma but also the frequently associated agenesis/dysgenesis of the corpus callosum. Pericallosal lipomas can be divided into two groups: The Tubulonodular type and The curvilinear type. Curvilinear lipomas are less common than Tubulonodular. We report the clinical and radiological findings of curvilinear Pericallosal lipoma in two patients with corpus callosum abnormalities revealed incidentally during evaluation following trauma.

Clinical and radiological resolution of vertebral sarcoidosis mimicking metastatic disease

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Vertebral sarcoidosis cannot be certainly differentiated from metastatic disease based on imaging only.

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Vertebral sarcoidosis lesions are mostly focal osteolytic, sclerotic, or combined.

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Osseous sarcoidosis may have an increased uptake on 18F-FDG-PETand may guide to false-positive results.

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Accurate diagnosis is only attainable by histopathological verification of the lesions.

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Corticosteroids are the first line of treatment.

Sarcoidosis is a disease that exhibits extreme heterogeneous clinical manifestations. Bone involvement in sarcoidosis is rare (1%-13%), and involvement of the vertebrae is even rarer. Usually, it is a diagnosis of exclusion with nonspecific characteristics in imaging.

A 35-year-old male, who has no significant medical history£. He came to clinical examination for lower back and associated bilateral lower extremity pain. Magnetic resonance imaging (MRI) was performed to exclude disc-related pathology. It demonstrates left paramedian lumbar disc herniation at L4–L5 level. Multiple small enhancing lesions throughout the lumbar vertebrae were discovered as an incidental finding.

An 18F-labeled fluorodeoxyglucose was performed to evaluate for metastatic disease that shows hypermetabolic apical right nodule of the lung parenchyma with multiple mediastinal and right iliac external adenopathy. Increased uptake throughout the lumbar vertebral lesions was also seen. A CT-guided biopsy of the right apical lung nodule and one of the vertebral lesions (L3) revealed noncaseating granulomas consistent with sarcoidosis. We introduce steroid treatment with favorable evolution of vertebral lesions.

Vertebral sarcoidosis cannot be certainly differentiated from metastatic disease based on imaging only. Accurate diagnosis is only attainable by histopathological verification of the lesions.