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Introduction: 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., Case Report: 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., Discussion: 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., Conclusion: 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., (Copyright © 2022. Published by Elsevier Ltd.)

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., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

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., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

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., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

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., (© 2021 The Author(s).)

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., Competing Interests: Declaration of Competing Interest There is no conflict to be declared., (Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

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., Competing Interests: Declaration of Competing Interest There is no conflict to be declared., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

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., (Copyright © 2020. Published by Elsevier Ltd.)