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Gliosarcoma (GS) is an extraordinarily rare variant of glioblastoma, which is differentiated by its distinct biphasic histopathological morphology consisting of both glial and mesenchymal elements. Although GS has a predilection for the cortical hemispheres, rare occurrences of intraventricular gliosarcoma (IVGS) have been documented in the literature. In this report, we present a 68-year-old female patient with a primary IVGS arising from the frontal horn of the left ventricle with corresponding left ventricular entrapment. The clinical course as well as associated tumor features as observed on computed tomography (CT), magnetic resonance imaging (MRI), and immunohistochemical studies are presented along with a relevant review of the current literature., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Mirchia et al.)

Calcium pyrophosphate deposition disease is not an uncommon cause of polyarthritis, especially in the elderly. This disease typically affects the appendicular skeleton but may rarely affect the axial skeleton as well. When the axial skeleton is involved, it can lead to numerous neurological signs and can be disabling. We describe a case in which a 68-year-old male presented with on-and-off myelopathy and was thought to have chronic inflammatory demyelinating polyneuropathy. Magnetic resonance imaging of the spine suggested an inflammatory or infectious lesion at the thoracic level. However, after a surgical biopsy, pathologists concluded that calcium pyrophosphate deposition, or pseudogout, was the cause of this patient's neurological symptoms. Pseudogout in the spine, especially the thoracic spine, is exceptionally rare. There are very few additional cases reported. In this report, we review the current literature on existing similar cases, radiological findings, risk factors, and treatments for this condition in hopes of increasing knowledge and awareness of this rare differential., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Carpenter et al.)

Craniopharyngiomas represent a rare group of intracranial tumors that often arise in the sellar/suprasellar region of the brain. Adamantinomatous craniopharyngioma is significantly more common than papillary craniopharyngioma. The former most often arises in children whereas the papillary craniopharyngioma is mainly limited to adults. We present the case of a 34-year-old female with visual disturbances and other vague complaints who was found to have a large lobulated sellar mass on neuroimaging studies. She was subsequently diagnosed with an adamantinomatous craniopharyngioma after undergoing transsphenoidal resection. We discuss the patient's clinical, radiological, and pathological findings in correlation with the current literature and recommendations regarding this type of tumor. Given that adamantinomatous craniopharyngioma rarely presents in adulthood, especially in middle-aged adults, this case is considered rare, and we hope to increase awareness to include adamantinomatous craniopharyngioma in the differential diagnosis for sellar lesions in this age group., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Carpenter et al.)

Primary intracranial germ cell tumors are rare, occurring more frequently in children and young adults in midline locations of the brain. Teratomas are an uncommon variant of germ cell neoplasm, although they account for a high proportion of fetal brain tumors. Here, we report a 27-year-old male who presented with a heterogeneously enhancing lesion in the left thalamus, without evidence of systemic disease. Histologic and immunohistochemical analysis were consistent with immature teratoma; next-generation sequencing was negative for targetable molecular alterations. The patient received chemotherapy and radiotherapy post-excision. Following the initial resection, ventriculoperitoneal shunt placement was performed due to left temporal horn entrapment. Nine months later, imaging revealed mediastinal and hilar adenopathy as well as pleural disease, with encasement and compression of pulmonary vasculature, and multiple, bilateral pulmonary nodules. Fine needle aspiration showed malignant cells with an immunohistochemical profile similar to the original tumor, consistent with metastases. Though germ cell tumors are known to spread via cerebrospinal fluid or blood, metastasis outside of the CNS from a primary intracranial germ cell tumor is a rare complication. Spread via ventriculoperitoneal shunt, which may have occurred in the present case, has also rarely been observed., (© 2022 The Authors.)

Minimally invasive vertebroplasty has arisen as a viable alternative treatment for pathologic vertebral body fractures. Vertebroplasty is well documented in the thoracic and lumbar spine from the posterolateral approach, but is rarely employed in the cervical spine in consideration of numerous critical neural and vascular structures that must be avoided. Careful technique and usage of imaging is necessary to maneuver crucial structures and minimize risk of complication. In the posterolateral approach, the lesion has to lie in the trajectory of a straight needle, in the lateral aspect of the C2 vertebra. This approach may limit adequate treatment of lesions that are located more medially. We describe a unique case report of successful and safe posterolateral approach treatment of a destructive medial C2 vertebra metastatic lesion using a curved needle., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Swarnkar et al.)

We present a unique case of diffusely extensive Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). Typically affecting the peripheral nervous system and manifesting with muscle weakness, breakdown or paresthesia, we present a case that additionally demonstrates; cranial nerve involvement, central nervous system parenchymal lesions, and chronic osseous remodeling of the nerve tracts. Cranial nerve involvement to this extent has only been described in one other case report to our knowledge. Central nervous system parenchymal lesions are extremely rare in CIDP and no discrete discussion about osseous remodeling has been presented, thus far, in the literature. The findings illustrated in this case may spur further understanding of imaging characteristics most associated with chronic CIDP disease and care measures that could help stratify patients most at risk for severe symptomologies., (Published by Elsevier Inc. on behalf of University of Washington.)

Neurological and psychiatric symptoms are highly prevalent in the initial manifestation of systemic lupus erythematosus (SLE) and is classified as neuropsychiatric systemic lupus erythematosus (NPSLE). Despite the high prevalence rate of this condition, it is still very poorly understood and often delayed in its diagnosis due to its variety in clinical manifestations. For our case, an eighteen-year-old male who was recently diagnosed with SLE presented with progressive confusion, visual and auditory hallucinations, in addition to high fevers, diarrhea, abdominal and flank pain. Upon initial presentation, he was treated for sepsis while trying to identify a source of infection. However, with the help of laboratory tests like CSF analysis and autoantibody serum studies as well as neuroradiologic imaging, we were able to rule out infectious causes and diagnose our patient with lupus induced striatal encephalitis. We present the first case of striatal encephalitis with vessel wall imaging to ultimately rule out lupus associated vasculitis. The importance of MRI imaging and identification of specific patterns associated with autoimmune encephalitis allowed rapid diagnosis and initiated immediate treatment in the hopes of reducing long term affects from neuroinflammation in our young patient., (© 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

A wide variety of benign and malignant tumors can arise from different structures in the orbital and peri-orbital area, affecting the eye and the optic nerve. This spectrum of tumors includes primary and metastatic carcinomas, lymphomas, melanomas, soft tissue tumors, and primary tumors of the retina, optic disc, and optic nerve. These also extend to relatively rare entities such as solitary fibrous tumor and meningioma of the orbit and optic nerve, which can present with very similar clinical and radiologic features, although the tumor grades, treatment plans, and outcomes can vary widely. In this report, we present two clinical cases of solitary fibrous tumor [central nervous system (CNS) World Health Organization (WHO) grade 2 and 3) and compare their clinical presentation, radiologic and histologic features, treatment, and clinical outcomes to a group of three orbital meningiomas (CNS WHO grade 1 and 2). In the context of these five cases of orbital lesions, we review the current clinical, pathologic, and radiologic literature on orbital tumors, focusing primarily on solitary fibrous tumors and meningiomas, along with an expanded discussion on the diagnostic criteria of both entities, as well as the treatment and prognosis of these lesions., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Williams et al.)

Neuroendocrine tumors (NETs) are unusual neoplasms with a diverse spectrum of clinical presentations. There is a lack of literature on cases of 2 primary histologically distinct NETs. We report a case of a 40-year-old man who presented with chronic diarrhea. A colonoscopy was performed which discovered a rectal polyp, with pathology showing a well-differentiated NET. A subsequent somatostatin scan revealed a pancreatic tail mass. Biopsy showed a histologically distinct well-differentiated vasoactive intestinal peptide-producing NET. Given that pancreatic and rectal NETs come from different embryonic origins, the diagnosis of 2 primary NETs presents a unique case., (© 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)

Fibrocartilaginous embolic infarction of the spinal cord is a rare cause of acute back pain and motor weakness. Most symptoms start after minor trauma that is often considered harmless and forgotten, however these minor injuries can result in lethal consequences. It is quite rare to diagnose fibrocartilaginous embolism in a timely manner and start treatment to prevent poor outcomes. We present the case of a previously healthy eight-year-old female with sudden onset neck pain and progressive bilateral upper extremity weakness following an injury while playing with her younger sister. Magnetic resonance imaging of the cervical spinal cord without contrast revealed a posterior disc protrusion suggestive of post-traumatic spinal cord infarction due to fibrocartilaginous embolism. In young, otherwise healthy, patients with acute motor deficits, radiographic imaging can help identify rare presentations like fibrocartilaginous embolism in order to rapidly diagnose and efficiently treat such patients., (© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

COVID-19 has been noted to present with neurological symptoms in nearly 30% of patients. While children are more likely to be asymptomatic, neurological involvement has been observed. We present the case of a 23-month-old previously healthy female who was brought to the emergency room for a new-onset facial droop. The patient tested positive for COVID-19 but was otherwise asymptomatic. Magnetic resonance imaging of the brain with and without contrast revealed abnormal enhancement along the canalicular segment of the right cranial VII extending to the first genu suggestive of cranial nerve neuritis. Given that our case involves a pediatric patient with no significant comorbidities presenting with facial drop, COVID-19 should be considered on the differential when evaluating causes of new onset peripheral nerve palsies., (© 2021 The Authors.)

Malignant triton tumors are an extremely aggressive form of malignant peripheral nerve sheath tumor that display rhabdomyosarcomatous features. While these tumors are extremely rare, they have a much higher incidence in patients with neurofibromatosis-1. We present a case of a 64-year-old male with neurofibromatosis-1 who presented to the hospital with sudden worsening of shortness of breath and dysphagia to solids. Radiological examination revealed a large mass in the anterior mediastinum causing significant narrowing and displacement of the upper trachea and esophagus. Biopsy of the mass, done by interventional radiology, demonstrated features of an MTT. The mass was subsequently resected but without confirmation of tumor-free margins and the patient underwent adjuvant radiation therapy. Repeat radiological examination approximately four months later revealed growing malignancy and new metastases, which eventually contributed to the patient's death seven months after his presentation to the hospital., (© 2021 The Authors.)

Chronic lymphocytic leukemia (CLL) is the second most common hematologic malignancy, and it is characterized by lymphocytic leukocytosis and secondary hematologic deficiencies. While it most commonly presents as a systemic disease, extramedullary involvement may rarely occur. The literature surrounding CLL metastatic disease to the gallbladder is particularly sparse. Interestingly, we describe a case of a 67-year-old female who presented with painless jaundice and was found to have a rapidly growing gallbladder wall mass which was determined to be CLL metastatic disease after extensive surgical resection. It is important for radiologists to recognize the possibility of CLL metastatic disease to the gallbladder when evaluating potential cases of cholecystitis due to the overlapping spectrum of imaging findings. Cognizant radiologists can potentially save patients from surgical intervention as CLL is classically treated with chemotherapy., (© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Despite the overall decrease in incidence and mortality rates for older adults, colorectal cancer in young adults is increasing. We present a case of a 15-year-old male who presented with 1.5 weeks of intermittent, sharp, severe right-sided abdominal pain. Abdominal radiograph demonstrated an air-fluid level within the right hemiabdomen. Computed tomography demonstrated marked wall thickening and a mass at the junction of the ascending colon and hepatic flexure causing obliteration of the lumen with a fluid-filled, dilated ascending colon. Follow-up ultrasonography demonstrated a 5.9 × 3.9 cm targetoid lesion in the right upper quadrant concerning for intussusception. Contrast enema revealed failure of contrast filling beyond the hepatic flexure due to a lobulated central filling defect surrounded by a claw-like contrast extension. Pathology of the polypoid lesion revealed poorly differentiated signet ring cell adenocarcinoma of the colon at the hepatic flexure. Despite its rarity, this case elucidates the need to consider colorectal carcinoma in adolescent and young adult patients who present with recurrent abdominal signs and symptoms., (© 2021 Published by Elsevier Inc. on behalf of University of Washington.)

A 37-year-old female was admitted with worsening neurologic function. On arrival from an outside hospital, the patient was obtunded and intubated. Magnetic resonance imaging of the brain revealed nodular enhancement of the leptomeninges, intracranial osteolytic lesions, and diffuse vasogenic edema causing mass effect. Imaging of the thoracic spine revealed pathologic compression fractures of 4 thoracic vertebrae. On review of the patient's electronic medical record, the patient had previously received treatment for secondary syphilis with intramuscular benzathine penicillin G. Surgical biopsies of the frontal bone and dura showed diffuse, chronic inflammation while a biopsy of the adjacent brain parenchyma revealed replicating spirochetes. The patient was subsequently prescribed dexamethasone and benzathine penicillin G. She regained neurologic function but later signed out against medical advice without completing her treatment regimen., (© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Urothelial carcinoma and nephrolithiasis are a common cause of obstructive uropathy which can be relieved by percutaneous nephrostomy catheter placement. A rare, but known complication of this procedure is iatrogenic seeding of tumor cells along the nephrostomy tract. We describe a case of 68-year-old-female with cutaneous metastasis of high-grade urothelial carcinoma with seeding of tumor cells along the percutaneous nephrostomy catheter tract 8 months after the removal of the catheter. Given its severity, interventional radiologists should be mindful of the number of percutaneous access attempts, exchanges, and catheter manipulations in patients with urothelial carcinoma due to the risk of metastatic seeding along the percutaneous tract or to nearby tissues., (© 2020 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

The transjugular intrahepatic portosystemic shunt (TIPS) procedure is performed to create an intrahepatic tract between the hepatic and portal veins which helps to shunt blood away from the hepatic sinusoids. This shunt decreases the portal venous pressure and secondary morbidities, including variceal bleeding and recurrent ascites. However, stent migration is a known complication of TIPS stent placement which may occur both during the procedure or postprocedural. We present a case of a 58-year-old male with history of liver cirrhosis in the setting of alcohol abuse and chronic hepatitis C infection who presented with melena and hematemesis. Esophagogastroduodenoscopy showed 4 columns of large grade IV esophageal varices with stigmata of recent bleeding. Despite endoscopic variceal banding, the patient had persistent episodes of hematemesis and became hemodynamically unstable requiring pressor support. The decision was made to proceed with emergent transjugular intrahepatic portosystemic shunt placement. After obtaining transhepatic portal access and initial stent deployment, the stent migrated from the TIPS tract into the main portal vein. While maintaining through-and-through wire access, the stent was successfully mechanically retracted using an angioplasty balloon and it was appropriately repositioned within the original TIPS tract. The stent was then further secured in place with a slightly larger stent which was deployed within the hepatic portion of the initially migrated stent. This technique was successful and obviated complete removal of the stent and follow-up imaging demonstrated patent flow and adequate positioning several months after the procedure., (© 2020 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Pulmonary epithelioid hemangioendothelioma is a rare vascular tumor and infrequently described in medical literature as case reports and case series. Diagnosis is often incidental with high index of histopathological suspicion from clinical pathologist. The pathological pattern is quite unique with distinct immunohistochemical stains. Up to this day, there is no established standard treatment owing to the scarcity of this tumor. In this case report, we describe a case of pulmonary epithelioid hemangioendothelioma unexpectedly diagnosed with transthoracic needle biopsy, along with a review of the current literature., Competing Interests: All authors in this article have no conflict of interest to disclose., (Copyright © 2020 Thu Thu Aung et al.)

Necrobiotic pulmonary nodules are an exceptionally rare extraintestinal manifestation of inflammatory bowel disease. Recognition is imperative because it may mimic other autoimmune pathologies such as granulomatosis with polyangiitis or sarcoidosis. We describe a 19-year-old man with a known history of ulcerative colitis who was found to possess bilateral pulmonary nodules on computed tomography imaging. Investigations that included an extensive autoimmune and infectious workup were inconclusive. Biopsy of the nodules revealed fibrinous exudate and palisading histiocytes that confirmed the diagnosis. He was started on prednisone therapy. A follow-up computed tomography a month later revealed near complete resolution., (© 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)

Alcoholic hepatitis results from excessive alcohol consumption in patients with or without underlying chronic liver disease. Leukemoid reactions have been associated with poor outcomes in severe alcoholic hepatitis. There are only a handful of reported cases describing this relationship, and the striking similarity in these cases was a high short-term mortality rate. We believe that these patients represent a unique subgroup of patients with alcoholic hepatitis and that leukemoid reaction is a poor prognostic indicator in this condition. Here, we describe a case of 55-year-old male with severe alcoholic hepatitis with superimposed candida esophagitis who was found to have leukemoid reaction during diagnostic workup., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Achufusi et al.)

We describe two cases of young adult men presenting with diffuse petechial rash and gastrointestinal disturbances. They were found to have leukocytoclastic vasculitis without immunoglobulin A findings under direct immunofluorescence on skin biopsy histopathology performed over a week after the appearance of lesions. Henoch Schönlein purpura (HSP) was diagnosed based upon the clinical presentation as well as the leukocytoclastic vasculitis biopsy findings., (Copyright © 2020 Baylor University Medical Center.)

A 31-year-old woman presented with acute alcoholic hepatitis, jaundice, anemia, and hypertriglyceridemia following ethylene glycol poisoning. She had no previous history of anemia or gastrointestinal bleeding. Laboratory findings were consistent with acute hemolytic anemia. She was diagnosed with Zieve syndrome and was managed with supportive measures. Zieve syndrome is a rare occurrence with only a handful of published case reports. Although rare, the diagnosis should be on the differential in this subgroup of patients to avoid unnecessary and invasive diagnostic interventions., (Copyright © 2020 Baylor University Medical Center.)

Purpose: To report an unusual presentation of commercial cannabidiol (CBD) oil-induced Stevens-Johnson Syndrome/toxic epidermal necrolysis (SJS-TEN)., Methods: A 56-year-old woman presented with acute onset of a diffuse, blistering, maculopapular rash with over 30% total body surface area (BSA) involvement two days after taking CBD oil sublingually for chronic pain. Biopsy confirmed SJS-TEN. Ophthalmology was consulted and mild eye involvement was found. She was started on topical cyclosporine, prednisone, moxifloxacin, and erythromycin ointment to prevent progression, which was successful. She was otherwise treated with supportive therapy in the intensive care burn unit and ultimately passed away from septic shock., Conclusion: In this case, we described an unusual drug-induced SJS from a commercial, non-FDA-regulated cannabis product. The use of a commercial CBD product should be cautioned due to potential for series of drug reactions to the cannabis product and the risk for reaction to other unregulated other pharmacological components., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Han Y. Yin et al.)

Carcinoma ex pleomorphic adenoma (Ca ex PA) is a rare malignant transformation of a benign primary pleomorphic adenoma (PA). We report the case of a 62-year-old male who presented with a swelling over his left temple. Imaging revealed a lytic lesion over the left orbital wall with soft tissue extension suggestive of malignancy. He underwent an en bloc resection of the mass with orbital exenteration, craniotomy, and reconstruction. Pathology demonstrated a lacrimal gland ductal adenocarcinoma arising from a PA which led to the diagnosis of ductal adenoCa ex PA. Postoperatively, he received chemotherapy with 6 cycles of cisplatin and concurrent radiation therapy (RT), but his course was complicated by recurrent bacterial meningitis and abscesses and he ultimately opted for comfort measures. Patients with PA of the lacrimal gland experience an insidiously enlarging painless swelling of the orbit with transformation to Ca ex PA highlighted by a rapid onset of bulbar enlargement, displacement, and often proptosis. Ductal adenoCa ex PA is aggressive with a poor prognosis and has no established standard of care. This case highlights the rarity of this condition and the need for more literature to help direct treatment., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2020 Prashanth Ashok Kumar et al.)

Hamartomas are considered a mixture of nonneoplastic tissue, which may be indigenous to a different location in the body. As such, they may be epithelial, mesenchymal, or mixed. In the sinonasal region, the following hamartomatous lesions are considered to lie on a spectrum and include respiratory epithelial adenomatoid hamartoma (REAH), chondro-osseous respiratory epithelial adenomatoid hamartoma (COREAH), and nasal chondromesenchymal hamartoma (NCMH). To our knowledge, less than 50 cases of sinonasal hamartomas have been reported in the English literature so far with NCMH being very rare and primarily a tumor in infancy, with only 2 cases reported in individuals older than 16 years of age. We report a highly unusual case of a NCMH in the right maxillary sinus of a 70-year-old female.

Foreign body aspiration occurs in all age groups, especially in children and the elderly. The aspiration of an organic foreign body such as iron sulfate can cause significant bronchial destruction via oxidizing necrosis. When iron comes into contact with bronchial mucosa, it gets oxidized from ferrous ions into a ferric form which is highly toxic to the mucosa causing severe inflammation, mucosal damage, and fibrosis. Physicians should be very prudent with prescribing iron sulfate or any other pills in individuals who are at high risk of aspiration. Diagnosis is based on the history of iron aspiration, intense airway inflammation or necrosis on bronchoscopic examination, and iron particles observed on pathology. Prompt diagnosis and management should take place to prevent further morbidities. We report a case of 61-year-old female who was admitted to the hospital with a four-week history of aspirating iron pill. Computed tomography (CT) of the thorax showed ground glass infiltrates in the right lower lobe. She underwent flexible bronchoscopy which showed distal right bronchus intermedius (RBI) necrosis and stenosis with near-complete obstruction of distal RBI. She underwent multiple advanced bronchoscopic interventions with minimal improvement of the obliterated bronchus., Competing Interests: The authors have declared that no competing interests exist.