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Background: The most frequent type of non-Hodgkin lymphoma (NHL) is diffuse large B-cell lymphoma (DLBCL). Although lymph nodes are the most commonly affected organs compromising 70% of DLBCLs, only 5% of extranodal lymphomas represent skeletal muscle involvement. Specifically, abdominal wall muscle involvement is rare and there are only a few reported cases of DLBCL with this type of muscle involvement. Painful abdominal mass was the main presenting symptom in these reported cases., Case: We are reporting a relapsed DLBCL with abdominal wall muscle involvement in a 65-year-old male, presenting with a discomfort and heaviness sensation in the right iliac region with no associated pain., Conclusion: A rare case of DLBCL with recurrence in the abdominal wall muscles as painless masses was reported in this case report. To our knowledge, it is considered the fourth reported in the medical literature. It shows the importance of the diagnostic process that combines imaging with histological examination and immune stains for accurate diagnosis., (© 2025 The Author(s). Cancer Reports published by Wiley Periodicals LLC.)

Key Clinical Message: Mature mediastinal teratoma (MMT) is a benign tumor that is composed of well-differentiated tissues from all three germ cell layers. Malignant tumors have a distinct feature of adhering to the surrounding organs. Therefore, adhesion of MMT to the adjacent tissues, as a benign tumor, is rare and considered a surgical challenge. It leads to incomplete tumor resection to avoid damage to the surrounding tissues., Abstract: MMT is a germ cell tumor that contains well-differentiated tissues from ectodermal, mesodermal, and endodermal germ cell layers. MMT comprises approximately 3%-12% of mediastinal tumors in adults and 60%-70% of mediastinal germ cell tumors. Complete surgical resection is the standard treatment. When adhesion to the surrounding tissues is present, residual tissues could be retained to reduce the injury of the peripheral blood vessels and nerves. We are reporting a rare case of MMT with adhesions to the pericardium and discussing the diagnostic and surgical challenges., Competing Interests: The authors declare that they have no competing interests., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

Background: Lung cancer has the highest mortality rate among malignancies globally. In addition, due to the growing number of smokers there is considerable concern over its growth. Early detection is an essential step towards reducing complications in this regard and helps to ensure the most effective treatment, reduce health care costs, and increase survival rates., Aims: To define the most efficient and cost-effective method of early detection in clinical practice., Materials and Methods: We collected the Information used to write this review by searching papers through PUBMED that were published from 2021 to 2024, mainly systematic reviews, meta-analyses and clinical-trials. We also included other older but notable papers that we found essential and valuable for understanding., Results: EB-OCT has a varied sensitivity and specificity-an average of 94.3% and 89.9 for each. On the other hand, detecting biomarkers via liquid biopsy carries an average sensitivity of 91.4% for RNA molecules detection, and 97% for combined methylated DNA panels. Moreover, CTCs detection did not prove to have a significant role as a screening method due to the rarity of CTCs in the bloodstream thus the need for more blood samples and for enrichment techniques., Discussion: Although low-dose CT scan (LDCT) is the current golden standard screening procedure, it is accompanied by a highly false positive rate. In comparison to other radiological screening methods, Endobronchial optical coherence tomography (EB-OCT) has shown a noticeable advantage with a significant degree of accuracy in distinguishing between subtypes of non-small cell lung cancer. Moreover, numerous biomarkers, including RNA molecules, circulating tumor cells, CTCs, and methylated DNA, have been studied in the literature. Many of these biomarkers have a specific high sensitivity and specificity, making them potential candidates for future early detection approaches., Conclusion: LDCT is still the golden standard and the only recommended screening procedure for its high sensitivity and specificity and proven cost-effectiveness. Nevertheless, the notable false positive results acquired during the LDCT examination caused a presumed concern, which drives researchers to investigate better screening procedures and approaches, particularly with the rise of the AI era or by combining two methods in a well-studied screening program like LDCT and liquid biopsy. we suggest conducting more clinical studies on larger populations with a clear demographical target and adopting approaches for combining one of these new methods with LDCT to decrease false-positive cases in early detection., (© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)

Introduction: Urachal carcinomas are uncommon malignant neoplasms comprising only 0.01% of all adult cancers. Most patients were aged from 58 to 64 years at diagnosis with 60 years being the median. It usually metastasizes to the lungs (22%), bones (22%), and liver (16%)., Presentation: We report a case of a 71-year-old female patient who initially presented with two large liver masses and a small nodule on the anterior side of the bladder. The symptoms were nonspecific with abdominal discomfort. The final diagnosis of urachal adenocarcinoma was finalized with a biopsy of the bladder mass. The patient initially received six doses of FOLFOX6 without improvement and then Gem-Carbo, showing improvement after six doses. Finally, the patient received two doses of FOLFIRI-B with no response and kept deteriorating and died after 19 months of treatment., Discussion: About 90% of patients are symptomatic and hematuria is the most typical presenting symptom at diagnosis. The low incidence and the histopathologic similarities to adenocarcinoma from various sources pose a difficulty in recognizing the tumor. Our study presents the only case of a urachal carcinoma first manifesting with abdominal mass resulting from liver metastasis with no prior symptoms of urological origins. Also, our study presents the first attempt of using FLOFIRI-B to treat metastatic UraC., Conclusion: This case highlights the necessity for clinicopathological correlation to make the correct diagnosis and the challenges in the treatment which urges the need for further research to identify more effective treatment strategies for this rare cancer., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Rationale: Desmoid-type fibromatosis (DTF), also known as aggressive fibromatosis, is a rare neoplasm originating from the fascial or musculoaponeurotic tissues. While benign and characterized by slow growth, it exhibits local aggressiveness and lacks specific clinical characteristics. However, in a considerable percentage of patients, it could be asymptomatic and discovered by accident during routine clinical examinations. Only a few cases of DTF arising from the psoas major muscle have been reported in the medical literature., Patient Concerns: A 24-year-old male, asymptomatic and without significant personal or family medical history, was diagnosed with grade 2 hydronephrosis by abdominal ultrasonography during a routine physical examination. This diagnosis was made 15 days after undergoing uncomplicated open-heart surgery to repair an atrial septal defect., Diagnosis: Intravenous pyelogram revealed hydronephrosis with dilation of the pelvicalyceal system. Ureteroscopy ruled out any intrinsic lesions of the ureter. Contrast-enhanced computed tomography identified a 3.5 × 2 × 5.2 cm mass in the retroperitoneum, closely associated with the psoas muscle and enveloping the ureter adjacent to the iliac artery. Postoperative pathological analysis confirmed a definitive diagnosis of sporadic DTF., Interventions: The patient underwent exploratory abdominal surgery, during which the tumor was resected without any intraoperative complications., Results: After close monitoring over a 5-year follow-up period, which included periodic physical examinations, magnetic resonance imaging, and ultrasonography, no local recurrence was detected., Lessons: Achieving an accurate preoperative diagnosis presents a challenge in cases involving retroperitoneal tumors originating from the psoas major muscle and encasing the ureter. However, the insertion of a double J stent is deemed a crucial step in the surgical process, facilitating the dissection and isolation of the ureter from the tumor while preserving kidney function., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Hydatidosis is a zoonotic parasitic disease caused by the cystic stage of Echinococcus species. Intrathoracic extrapulmonary hydatid cysts causing eventration are very rare. Here, we report a case of a 62-year-old female who presented with chest pain, intermittent coughing, general weakness, and fever. On auscultation, there were diminished respiratory sounds at the base of the left lung. A computed tomography scan showed a cystic formation with an ambiguous location involving the left lower thorax and the left hypochondrium. Complete surgical resection is the standard treatment for intrathoracic extrapulmonary hydatid cysts. Due to the direct bordering of the cyst with the pericardium in the left cadiophrenic angle, a cystotomy and evacuation of the cystic cavity were performed, followed by washing it with povidone and hyperosmolar saline. The location of the hydatid cyst has an important role in determining the surgical approach, as the unusual location could affect the possibility of radically removing the cyst., Competing Interests: None declared., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2024.)

Introduction: Primary spinal cord oligodendrogliomas (PSO) are sporadic tumors that arise from oligodendrocytes in the central nervous system (CNS). They can affect adults and children and make up about 2% of all intramedullary (IM) spinal tumors. Here, the authors present the second case in the literature of a primary spinal oligodendroglioma with intracranial extension., Presentation: A 28-year-old right-handed female presented to our emergency room severely malaised with left-sided hemiparesis, numbness, tingling, and urinary retention with positive Babinski and negative Hoffmann. MRI showed a widespread heterogeneous mass extending from the medulla to C7 with syringomyelia inferior to the mass. The mass was removed surgically, and her neurological condition improved rapidly. The gross, pathological exams, and immunohistochemistry confirmed the diagnosis of oligodendroglioma., Discussion: Up until 2017, there have been 60 documented cases of PSO in the literature and we have found two more cases in our search between 2017 and 2023. Also, there has been only one case recorded with an intracranial extension, making our case the 63rd PSO case and the second one with cranial extension., Conclusion: The golden standard for imaging is MRI. Surgical excision is the main treatment in the literature. Single-stage laminectomy showed promising results and surgical resection was the critical intervention to which the patient responded. This matches what was stated in the literature that surgery is the primary mode of treatment in PSO patients., Competing Interests: The authors declares no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Krukenberg tumors account for 9 % of metastatic ovarian tumors, they usually originate from the stomach and colon and are microscopically characterized by the presence of mucus-filled signet-ring cells. Krukenberg tumor originating from the gastroesophageal junction is extremely rare, which limits establishing proper diagnosis and management., Presentation of Case: A 34-year-old women presented with a complaint of amenorrhea, ultrasonography showed bilateral ovarian masses, pathological studies revealed Krukenberg tumor, immunohistochemistry of the tumor was positive for (CK1, and CK20). Upper GI endoscopy revealed the primary lesion located at the inferior esophagus and extending to the cardia. Despite marked improvement after introducing a chemotherapy regimen of oxaliplatin, calcium folinate and fluorouracil, the patient refused to complete her therapeutic course and died 5 months after discontinuation., Discussion: Krukenberg tumor may be asymptomatic but may also manifest as pelvic pain, bloating, and menstrual cycle abnormalities. Immunohistochemistry of Krukenberg tumor is mandatory to determine the primary tumor. Positivity of CK1, CK20 and negativity of CK7 indicates the gastrointestinal origin of the tumor. Different choices are available for the management of Krukenberg tumor but it still has a poor prognosis with an average survival rate of 14 months., Conclusion: Krukenberg tumor from the esophagus is rare and still enigmatic in terms of management. In this article, we aim to draw attention into possible presentations of the tumor by providing the first case in Syria of Krukenberg tumor originating from the esophagus and presenting as secondary amenorrhea and bilateral adnexal masses., Competing Interests: Conflict of interest statement The authors declare that they have no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Atypical Teratoid/Rhabdoid Tumor (AT/RT) is a rare aggressive neoplasm that mainly affects the pediatric population with a peak incidence in the first two years of life and a slight male predominance, whereas presentation of this neoplasm in older ages is extremely rare., Case Presentation: Herein, we present two cases of AT/RT. In the first case, a 9-year-old female presented with diplopia, dizziness, headache, and morning vomiting. CT Scan of the head demonstrated a heterogeneous mass in the left frontal-parietal region with vasogenic edema and midline deviation. In the second case, a 57-year-old female presented with severe generalized headache, numbness, and tingling in the right hand. MRI revealed a lobulated cystic mass in the right occipitotemporal region, with surrounding edema compressing the left lateral ventricle and causing a midline shift to the left, and enlargement of the right lateral ventricle. In both case, histopathological and immunohistochemical examinations revealed the diagnosis of Atypical teratoid/Rhabdoid tumors., Clinical Discussion: Microscopic examination demonstrated the proliferation of medium-sized to large cells with abundant eosinophilic cytoplasm, large vesicular eccentric nuclei, and conspicuous nucleoli with areas of necrosis and hemorrhage, thus confirming the diagnosis with adequate immunohistochemical staining. The first patient developed signs of recurrence and passed away six months later, whereas in the second case, the 57-year-old female received radiotherapy for 6 weeks before being put on chemotherapy., Conclusion: Despite the challenges facing the diagnosis of this aggressive neoplasm, we managed to present our cases with detailed histopathological and immunohistochemical examinations., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction and Importance: Poorly differentiated thyroid carcinomas represent a rare heterogeneous group of malignant tumors that constitute ~2-4% of all thyroid neoplasms. Substernal goiter (SG) is defined as an enlargement of the thyroid gland that is located below the thoracic inlet. Malignant neoplasms arising from a SG were reported in only 2-3% of cases.This case report has been reported in line with the Surgical CAse REport (SCARE) Criteria. 21 ., Case Presentation: This article presents a 54-year-old Syrian female who presented at our institution due to dysphagia, dyspnea, cervical swelling, and loss of appetite. Following clinical and radiological examinations, total thyroidectomy with lymph node dissection was performed. Microscopic examination revealed an infiltrative growth pattern of insular, trabecular, and solid formations of epithelial cells with scant eosinophilic cytoplasm, hyperchromatic nuclei, and bizarre mitotic figures with areas of necrosis. Subsequently, the final diagnosis was confirmed as a multifocal poorly differentiated thyroid carcinoma arising from a SG., Clinical Discussion: The heterogeneity of histologic features of poorly differentiated thyroid carcinoma represents a diagnostic challenge. Diagnosis of poorly differentiated thyroid carcinomas is based on the Turin Criteria, which highlights histopathological features. Computed tomography plays a major role in SG for further evaluation., Conclusion: In this manuscript, the authors aimed to present a unique case report with challenging diagnostic features including the rapid development of an infiltrative poorly differentiated thyroid carcinoma from a SG highlighting the importance of a detailed histopathological examination of thyroid nodules in the absence of significant medical history., Competing Interests: The authors declares that they have no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Cancer of unknown primary (CUP) is a tumour metastasis with no detectable primary origin. A secondary neoplasm (SN) is defined as a tumour secondary to a prior tumour treatment and has no histological relation to that primary tumour., Case Presentation: The authors report a case of a 72-year-old female patient who presented with back pain and had a history of non-Hodgkin lymphoma (NHL) treated with RCHOP 12 years ago. MRI showed a compression fracture in T5 and T7 vertebrae, while the PET/computed tomography (CT) only showed hypermetabolic lytic bone lesions in these vertebrae. Pathological examination of a biopsy of these lesions suggested metastatic breast cancer, but the mammography was normal. The above clinical description indicates that our case is a SN to RCHOP treatment manifested as a cancer of unknown origin., Discussion: CUP is diagnosed when all screening procedures fail to find the original tumour. On the other hand, the literature showed that RCHOP treatment of non-Hodgkin lymphoma has a 0.68% chance of causing a SN. After an extensive literature search, we found that our case, which has the combination of both CUP and SN, is the first documented case., Conclusion: This case suggests that cancer patients who received chemical or radiological treatment should be screened more carefully on the long term as it is possible to developed secondary neoplasms without a primary tumour in areas difficult to diagnose with traditional screening tools., Competing Interests: The authors declare no conflict of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Chordomas are rare malignant neoplasms that can originate anywhere along the cerebrospinal axis. However, they are most commonly found in the spine, cranium, and sacrococcygeal region. Chordomas can manifest differently depending on their location and most symptoms are a result of local invasion. We present a rare case of intracranial clival chordoma that manifested as isolated unilateral cranial nerve XII (CN XII) palsy., Presentation: A 53-year-old male presented to the neurosurgical clinic with headaches, dysarthria, and pharyngeal pain. Neurological examination showed left-sided atrophy of the tongue. MRI scan showed an infiltrative lesion in the clivus which was hypointense on T1 and hyperintense on T2. The lesion was treated surgically however full resection was not achieved. Pathological examination and subsequent immunohistochemical staining confirmed the diagnosis of chordoma., Discussion: To our knowledge, there have been only two reported cases of clival chordoma that presented with isolated CN XII palsy which manifested clinically as dysarthria and unilateral atrophy of the tongue. This makes our case the third reported case of clival chordoma that presented with isolated CN XII palsy., Conclusion: We report a rare case of clival chordoma that presented with isolated left CN XII palsy. Physicians should consider clival chordomas in their differential diagnoses when faced with isolated unilateral CN XII palsy. Surgical resection combined with adjuvant radiotherapy remains the preferred treatment protocol., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Breast cancer affects one in eight women during their lifetime; it may coincide with other diseases due to its high prevalence. Different pathologies that occur simultaneously with breast cancer, or later during its course, lead to multiple interactions with cancer and have a significant impact on its management., Presentation of Case: A 58-year-old Syrian female was admitted to our hospital for compliant of abdominal distension. Following complete examination, obtained biopsies confirmed the diagnosis of peritoneal tuberculosis. At a subsequent time, she suffered back pain and the computed tomography showed vertebral lesion with breast mass that was diagnosed as invasive lobular carcinoma (ILC) of the left breast. Vertebral lesion that appeared on radiologic assessment was diagnosed as cancer metastasis. However, the interaction of this metastasis with the proposed management diverted the attention towards its non-cancerous entity. Five months after completing the chemotherapy, biopsies revealed the recurrence of triple-negative (ER-, PR-, HER2- neu-) ILC of the breast. Ultimately, the patient was followed up for an overall duration of 4 years., Discussion: Latent tuberculosis infections may be activated by chemotherapy regimens that suppress immunity. Therefore, initial management of tuberculous infection is preferred when it coexists with cancer., Conclusion: Breast cancer is common and may co-present with other diseases, which, in some cases, produce mimicking lesions that alter its diagnosis. Pott's disease, albeit a rare entity, has shown a resurgence in developed countries and should be considered in the differential diagnosis of vertebral lesions in patients with breast cancer., Competing Interests: The authors declare that they have no competing interests.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

The gastrointestinal tract is embedded with microorganisms of numerous genera, referred to as gut microbiota. Gut microbiota has multiple effects on many body organs, including the brain. There is a bidirectional connection between the gut and brain called the gut-brain-axis, and these connections are formed through immunological, neuronal, and neuroendocrine pathways. In addition, gut microbiota modulates the synthesis and functioning of neurotransmitters. Therefore, the disruption of the gut microbiota in the composition or function, which is known as dysbiosis, is associated with the pathogenesis of many mental disorders, such as schizophrenia, depression, and other psychiatric disorders. This review aims to summarize the modulation role of the gut microbiota in 4 prominent neurotransmitters (tryptophan and serotonergic system, dopamine, gamma-aminobutyric acid, and glutamate), as well as its association with 4 psychiatric disorders (schizophrenia, depression, anxiety disorders, and autism spectrum disorder). More future research is required to develop efficient gut-microbiota-based therapies for these illnesses., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Cavernomas are rare vascular lesions that can occur anywhere along the neuraxis. However, they are most commonly found in the cerebral hemispheres. Spinal cavernomas are more uncommon and intradural extramedullary cavernomas are the most uncommon as they constitute only 3 % of spinal cavernomas., Presentation: A 36-year-old female presented to our neurosurgical clinic with a history of back pain radiating to the left side of the chest with left lower extremity paresthesia and ataxia without urinary disturbance. Neurological exam showed left-sided hypoesthesia below the T9 dermatome in addition to increased patellar and Achilles reflexes on the left side. MRI showed a homogeneous intradural extramedullary mass which was hyperintense on T1 and hypointense on T2 and it was surgically resected. Pathological examination confirmed the diagnosis of intradural extramedullary cavernoma., Discussion: Intradural extramedullary cavernomas are extremely rare lesions that arise within the area located between the inner surface of the dura and the pial surface of the spinal cord. Up until 2022 only 40 cases of intradural extramedullary cavernomas were reported in the literature. MRI is the preferred imaging modality and pathology is the golden standard for diagnosis. Surgical resection showed very promising results and it is considered the golden standard for treating this condition. However, surgery should be performed urgently to give an optimal outcome., Conclusion: Clinicians should consider this condition in their differential diagnoses when faced with progressive spinal root compression symptoms, sudden onset myelopathy, or progressive subarachnoid hemorrhage., Competing Interests: Conflict of interest statement The authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: High-risk non-muscle-invasive bladder cancer (HR-NMIBC) presents a challenge to many physicians due to its ability to resist Bacillus Calmette-Guérin (BCG) intravesical therapy and the substantial rate of progression into muscle-invasive bladder cancer (MIBC). Patients who are BCG-unresponsive have worse prognosis and thus require further management including radical cystectomy (RC), which significantly impacts quality of life. Moreover, the ongoing worldwide shortage of BCG warrants the need for policies that prioritize drug use and utilize alternative treatment strategies. Hence, there is a significant unmet need for bladder preserving therapy in this subset of patients., Methods: To address this issue, we searched the relevant literature in PUBMED for articles published from 2019 through May of 2023 using appropriate keywords. All clinical trials of patients with HR-NMIBC treated with immune-related agents were retrieved from clinicaltrials.gov., Findings and Future Perspectives: Exploratory treatments for BCG-Unresponsive HR-NMIBC included immune checkpoint inhibitors (ICI), oncolytic viral therapy, cytokine agonists, and other immunomodulators targeting TLR, EpCaM, FGFR, MetAP2, and IDO1. Some combination therapies have been found to work synergistically and are preferred therapeutically over monotherapy. Three drugs-pembrolizumab, valrubicin, and most recently, nadofaragene firadenovec-vncg-have been FDA approved for the treatment of BCG-unresponsive NMIBC in patients who are ineligible for or decline RC. However, all explored treatment options tend to postpone RC rather than provide long-term disease control. Additional combination strategies need to be studied to enhance the effects of immunotherapy. Despite the challenges faced in finding effective therapies, many potential treatments are currently under investigation. Addressing the landscape of biomarkers, mechanisms of progression, BCG resistance, and trial design challenges in HR-NMIBC is essential for the discovery of new targets and the development of effective treatments., (© 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Cow milk protein intolerance is a common gastrointestinal condition in the first year of life. It is mainly manifested as gastrointestinal and dermatology symptoms. It rarely presents as a respiratory manifestation only without other accompanying symptoms. We report a case of a 5-month-old Syrian boy who presented with a history of recurrent acute bronchitis symptoms (cough, wheezing, tachypnea) for 3 months with no significant personal or family history. Hematological and radiographic investigations were normal. The diagnosis of cow milk intolerance was confirmed by clinical, endoscopically, and histological findings. The child was placed on amino acid hydrolysate milk with restricted cow products. The child improved significantly, and chest symptoms improved within a week of the treatment. Despite the rarity of cow milk intolerance in children with only respiratory symptoms, it should be kept in mind when the patient has recurrent pulmonary infections that are not improving on appropriate therapy., Competing Interests: None declared., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Cholera is an acute type of diarrheal disease caused by intestinal infection with the toxin-producing bacteria Vibrio cholerae. The disease is still endemic in almost 69 countries, accounting for around 2.86 million cases and 95,000 deaths annually. Cholera is associated with poor infrastructure, and lack of access to sanitation and clean drinking water. The current cholera outbreak in Syria is associated with more than 10 years of conflict, which has devastated infrastructures and health services. There were 132,782 suspected cases reported between August 25, 2022 and May 20, 2023 in all 14 governorates, including 104 associated deaths. The recent earthquake in the region has complicated the situation, with an increase in cholera cases, and hindrance to a response to the disease. Climate change has driven a number of large cholera outbreaks around the world this year. The World Health Organization prequalifies three oral cholera vaccines. Cholera treatment mainly depends on rehydration, with the use of antibiotics in more severe infections. This review gives an overview of cholera bacteriology, pathogenesis, epidemiology, clinical manifestations, diagnosis, management, and prevention in light of global climate change and the ongoing outbreak in Syria, which poses a significant public health threat that requires urgent attention., Competing Interests: Conflict of Interest None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).)

Breast cancer is the most common malignancy in women and represents a leading cause of cancer-related mortalities. Females' awareness toward breast cancer is essential for the early diagnosis and detection especially in low and middle-income countries. This study aims to assess the awareness of breast cancer risk factors among females in the Syrian Coast., Methodology: An online cross-sectional survey was conducted among Syrian females during the COVID-19 pandemic. The questionnaire used in the study was derived from the Cancer Research UK questionnaire and modified to fit the perspective of the study. Statistical Package for Social Sciences (SPSS) was used for data analysis. The independent samples t -test and the one-way analysis of variance (ANOVA) were applied to determine whether there is statistical evidence or any statistically significant differences between the variables., Results: A total of 1305 females participated in the study. The majority aged between 18 and 25, (28.8%) of the participants obtained their information related to breast cancer from internet, (36.7%) of were smokers and (82.8%) had a family member with breast cancer. These results suggested a significant correlation between smoking, family history of cancer, marital status, and breast cancer awareness., Conclusion: This study showed which factors are significantly related to women's awareness of breast cancer risk factors. These results can contribute in the implementation of awareness programs and campaigns, thus raising the level of awareness among women., Competing Interests: NA., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Burkitt's lymphoma (BL), an aggressive kind of non-Hodgkin's B-cell lymphoma. On the other hand, appendiceal carcinoid tumors are uncommon neuroendocrine neoplasms., Case Presentation: The authors report a case of a 15-year-old Syrian adolescent who was admitted to our hospital due to a persistent, severe generalized abdomen pain accompanied by nausea, vomiting, loss of appetite, and inability to pass stool or gas. An abdominal radiograph revealed dilated intestinal loops with air-fluid levels. The patient underwent emergency surgery through which a retroperitoneal mass was removed as well as part of the ileum and the appendix. The final diagnosis was consistent with intestinal BL associated with an appendiceal carcinoid tumor., Discussion: The correlation between gastrointestinal carcinoids and other types of tumors was frequently reported. However, there have been few reports of carcinoid tumors being associated with lymphoreticular system cancers. BLs were classified into three variants: endemic, sporadic, and acquired immunodeficiency-associated BL while appendiceal neuroendocrine tumors were classified as the following: well-differentiated neuroendocrine tumors with benign or uncertain malignant potential; well-differentiated neuroendocrine carcinoma with low malignant potential; and mixed exocrine-neuroendocrine carcinoma., Conclusion: Our article demonstrates an unusual association between BL and an appendiceal carcinoid tumor that highlights the significant role of histological and immunohistochemical staining in confirming the diagnosis, as well as the role of surgery in treating the complications of intestinal BLs., Competing Interests: The authors declares that they have no conflicts of interest., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Xanthogranulomatous pyelonephritis (XGPN) is a rare, serious, and chronic inflammatory disorder of the kidney characterized by a destructive process that invades the renal parenchyma, which is most commonly associated with urinary tract obstruction and infection. It affects women more often than men., Case Presentation: Herein, the authors report a case of a 48-year-old male presented to their hospital with complaints of malaise, fever, chills, left flank pain, and a history of a staghorn calculus in the renal pelvis, which was removed by surgery 7 years ago. Ultrasonography and computed tomography scans showed an enlarged left kidney with cystic formation and pelvicalyceal system dilation with the presence of multiple large stones. The renogram showed a dysfunctioning left kidney. An open radical left nephrectomy was performed. Renal cell carcinoma (RCC) was suspected in both the gross and microscopic examinations. The immunohistochemistry was the decisive factor in confirming the diagnosis of XGPN., Clinical Discussion: Preoperative and postoperative diagnosis of XGPN can sometimes be difficult due to diverse differential diagnoses. The misinterpretation of 'foam cells' as 'clear cells' consistent with RCC is the most important diagnostic challenge for pathologists., Conclusion: The unusual findings of this case report suggest a careful evaluation of patients with a renal cystic mass, that can be misdiagnosed as a RCC. A combined computed tomography scan evaluation together with histopathology and immunohistochemistry are essential for a correct diagnosis of this rare renal entity., Competing Interests: The authors declare no conflict of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

The coexistence of a benign Brenner tumour and a mucinous cystadenoma is rare, and their relationship and origin are still enigmatic and challenging., Case Presentation: In this manuscript, the authors report a case of a 62-year-old nulliparous Syrian woman who presented with severe abdominal distension, which was followed by laparotomy and the excision of a 25×20 cm-cyst; its pathological examination confirmed a benign Brenner's tumour and mucinous cystadenoma., Clinical Discussion: Ovarian Brenner and mucinous are usually benign and can rarely grow asymptomatically to very big sizes. Herein, the authors aim to emphasize the importance of excluding malignancy by pathology examination., Conclusion: Walthard cell nests undergo metaplasia to give rise to different kinds of Brenner and mucinous neoplasm formations according to their genetic alterations. This paper adds to the available literature, which is still poor, by providing evidence of the first case of this rare combination from Syria with a review of different theories of origin and differential diagnoses. More studies directed towards exploring this combination's genetic origin are needed to boost our understanding of ovarian tumours in general., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Neurological disorders are an important cause of disability and death globally. Recently, a large body of research shows that the gut microbiome affects the brain and its conditions, through the gut-brain axis. The purpose of this mini-review is to provide a brief overview of the relationship between the microbiota-gut-brain axis in three neurological disorders: epilepsy, Parkinson's disease, and migraine. The authors chose these three disorders because of their burdensome and great effect on health care. We live on a microbial planet. Before humans, microorganisms existed for a hundred million years. Today, there are trillions of these microbes living in our bodies, it is called human microbiota. These organisms have a crucial role in our homeostasis and survival. Most of the human microbiota live in the gut. The number of gut microbiota is much more than the number of body cells. Gut microbiota has been regarded as a crucial regulator of the gut-brain axis. The discovery of the microbiota-gut-brain axis is described as a major advancement in neuroscience because it influences the pathophysiology of several neurological and psychiatric disorders. From this, more studies of the microbiota-gut-brain axis are needed in the future, to provide a better understanding of brain disorders and so that better treatment and prognosis., Competing Interests: The authors declare that there is no conflict of interest., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Primary anorectal melanoma is an extremely rare malignancy of the gastrointestinal tract with a very poor prognosis. Due to the late presentation, most patients with primary anorectal melanoma are diagnosed at advanced stages. Scleroderma is an autoimmune disease characterized by fibrosis of the skin and visceral organs. There is an increased risk of developing cancer in scleroderma patients., Case Presentation: A 57-year-old Syrian female diagnosed with localized scleroderma complained of a sensation of a mass in her anal area. She was diagnosed with primary rectal melanoma and was put on neoadjuvant radiotherapy. Following the radiotherapy, the endoscopy revealed several black lesions in her anal canal, and thus abdominoperineal resection was conducted., Discussion and Conclusion: Malignant melanoma can occur in unsuspected locations such as the anal canal. Novel therapies like anti-CTLA4 drugs have proven efficient in controlling the disease. The lack of data in the literature on this malignancy and the absence of guidelines make it challenging for an optimal approach., Competing Interests: The authors declare that they have no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Granulomatosis with polyangiitis (GPA) is a rare, immunologically mediated systemic vasculitis that presents as an aseptic necrotizing granulomatous inflammation of the small and medium vessels., Case Presentation: The authors report the case of a 47-year-old Syrian female smoker who was admitted to the hospital due to painless palpable masses in her left cheek and left upper lip. Her medical and family histories were unremarkable. Physical examination demonstrated facial asymmetry and bulging in the left cheek and left suborbital region, with marked limitation of the mouth opening and notable oozing from the maxillary sinus seen within the area of the extracted second premolar, in addition to swelling in the parotid gland region, which caused facial nerve weakness. Lab findings were significant for an elevated neutrophil count (16 400/mm 3 ) and positivity of Cytoplasmic- Antineutrophil Cytoplasmic Autoantibody (c-ANCA). Microscopic examination revealed noncaseating necrotizing granulomas surrounded by histocytes and multinucleated giant cells. The disease kept its local invasion going despite the treatment with cyclophosphamide. Thus, surgical debridement was considered a notable improvement., Discussion: GPA is a systemic disease that usually affects multiple organs, especially the kidneys and the upper and lower respiratory tracts. The diagnosis of GPA is made based on a biopsy and the presence of c-ANCA. The treatment of GPA is patient-adjusted, and it usually consists of two major phases: induction and maintenance. However, surgery is preferred for patients who do not respond to pharmacotherapy., Conclusion: This article demonstrates a rare case of GPA in the head and neck region; that highlights the significant role of c-ANCA and histological exam in confirming the diagnosis as well as the importance of surgery when the disease is intractable., Competing Interests: No conflict of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

In 2020, renal cell carcinoma (RCC) had an incidence of 73 750 new cases. This cancer is well known for its ability to give early and late metastases to some usual and unusual sites. The term 'late recurrence' is widely used to indicate a period exceeding 10 years from curative nephrectomy. This not-understood behaviour is almost specific to RCC, and it happens in a range between 4.3 and 11% of cases of RCC., Case Presentation: We report a case of a 67-year-old nonalcoholic smoker Syrian male presented with a 2-month painful mass located at the left upper posterolateral abdominal wall's region. He has had a history of left chromophobe cell RCC treated with radical nephrectomy with adjuvant radiotherapy for 12 years. In light of computed tomography's findings, a surgical biopsy was performed, and a pathological and immunohistochemical examination confirmed the diagnosis of chromophobe RCC., Clinical Discussion: Malignant cells seeding the surgical cut path and staying dormant for 12 years is the best theory of many to explain our case., Conclusion: We reported evidence for the potential of a relatively indolent histologic type of RCC (i.e. chromophobe cell carcinoma) to cause late recurrence after 12 years to a very rare site (i.e. abdominal wall's superficial muscles). Research should focus on addressing late recurrence to determine the best surveillance protocols; investigating malignant cells seeding during surgery to improve surgical oncology's outcomes; and studying late recurrence's genetics to boost our targeted therapy options., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Pleomorphic xanthoastrocytoma (PXA) is a rare glioma. It accounts for less than 1% of all astrocytomas. About 98% of PXAs originate supratentorially with the temporal lobe being the most common location. Cases of infratentorial PXAs are rarely reported in the medical literature. The tumor presents with a wide variation of symptoms based on the neuroanatomy involved with the location and size of the tumor, with seizures being the most reported symptom. The diagnosis depends on histological and clinical features along with radiologic features. We searched the keywords "Pleomorphic xanthastrocytoma, PXA, cerebellum, infratentorium, astrocytoma, gliomas" in the PubMed database; from 1979 to the current date, 28 cases were found in the medical literature featuring PXA in the infratentorium. We present the 29th case in the literature and the first in Syria. Our patient had a lesion in the right cerebellum and presented with a history of intermittent headache for 5 months followed by progressive gait disturbances and blurry vision and was misdiagnosed at the time of presentation with a high-grade glioma which is a common confusion because of the histological and clinical similarities. The patient underwent a suboccipital craniotomy, and adjuvant therapy with a combination of radiotherapy and chemotherapy with temozolomide was initiated at first. Then, the patient presented with a relapse of symptoms and went through another surgery where frozen sections suggested the diagnosis of PXA; further histopathological and immunohistochemical studies confirmed the diagnosis. Alongside highlighting the diagnostic challenge of this rare tumor, we did a brief review of the literature., Competing Interests: The authors declare no conflict of interest., (© 2023 The Author(s). Published by S. Karger AG, Basel.)

Pseudoaneurysms of the external carotid artery of nontraumatic causes are very rare; those of infectious causes in adults are also quite unusual and are often preceded by bacteremia. Infection-related cases such as the one described here are scarce in the literature since the complication is not often calculated or expected. We present a case report of an elderly female patient who, after dental treatment and parotitis, noticed a mass behind the right mandible. After examination, the case was diagnosed as a pseudoaneurysm of the external carotid artery of an infectious cause. Management could be by surgical intervention, but the high positioning of the pseudoaneurysm and the age of the patient were contraindications. The choice was made to avoid surgery and keep the patient under long-term follow-up; no increase in its mass was observed after 3 years of follow-up., Competing Interests: The authors have no conflicts of interest to declare., (© 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Endobronchial Metastasis from extrathoracic tumors is a rare neoplasm that accounts for approximately 1.1% of total endobronchial malignancies. The most common primary tumors associated with EBM are from the colorectal, breast, and kidney regions. Although it represents a late manifestation in the context of tumor progression, it can rarely antedate the diagnosis of the primary tumor., Case Presentation: A 67-years-old male was referred from another city hospital to our thoracic surgery department due to a 4-months history of hemoptysis and productive cough. A chest X-ray and computed tomography scan showed a soft-tissue mass within the left main bronchus and atelectasis of the anterior segment of the left upper lobe. Furthermore, a flexible bronchoscopy revealed a hypervascular lesion occluding completely the left upper lobe bronchus. The patient underwent lobectomy and pathological examination suggested endobronchial metastasis from clear cell renal cell carcinoma. A second computed tomography scan of the abdomen and pelvis showed a well-defined mass arising from the lateral aspect of the right kidney; therefore, the patient underwent right radical nephrectomy three weeks later and pathology confirmed the diagnosis of clear renal cell carcinoma with endobronchial metastasis., Conclusion: Despite its rarity, physicians should consider the possibility of endobronchial metastases in the setting of endobronchial lesions. Proper diagnostic approaches should also be considered to rule out the potential of asymptomatic extrathoracic neoplasms. In this manuscript, we aimed to report a rare case -the first from Syria to our knowledge- of an endobronchial metastasis that preceded the diagnosis of renal cell carcinoma. Importantly, we reviewed the existing literature and discussed the diagnostic and treatment approaches., (© 2023. The Author(s).)

Melanoma is a malignancy that develops from pigment-producing cells known as melanocytes. Although it is considered one of the most fatal tumors in the world, its early diagnosis is associated with a better prognosis and overall survival. A 49-year-old man was admitted to the dermatology department with a 15 cm lesion on the left arm. It was growing on a congenital nevus to reach an enormous size. Surgical excision was not possible and the treatment was controversial as the patient showed unpredicted resistance to immunotherapy. Further evaluations revealed false-negative BRAF mutation, which completely changed the course of treatment. Cutaneous melanoma is a rare malignancy, accounting only for 1% of skin cancer cases, and having it arising on a pre-existing congenital nevus is even much rarer. Although there is no decisive definition of giant melanoma, some authors define it as a lesion of more than 10 cm in diameter. Through the literature, only a few cases of giant melanoma on the arm have been reported. Through our paper, we are revealing the importance of early diagnosis and treatment of melanoma and confirming the significant role of regular follow-up for patients with a congenital melanocytic nevus. Moreover, we are showing the importance of having alternative methods for detecting BRAF mutations to avoid false-negative results and have better outcomes., (© The Author(s) 2022. Published by Oxford University Press.)

The Objective: this study aims to investigate the relationship between folic acid and colorectal cancer (CRC)., Methods: google scholar, Pubmed, Pubmed central were searched from 1994 to 2022 for articles on the association between folic acid and CRC using the combinations: folic acid and colorectal cancer risk, folic acid and colorectal cancer survival, folic acid and colorectal cancer recurrence., Main Message: to describe and discuss the effect that folic acid might play on colorectal cancer (CRC) risk, recurrence and survivals, taking into account the possible differences between the men and women., Conclusion: Our article supports the idea that says: vit-B9 has a dual-modulator effect on CRC carcinogenesis. However, its role in preventing recurrence and improving survival rates remains unresolved with a possible potential role of folate metabolism genotype variations. Therefore, more evidence from clinical studies is needed., Competing Interests: No conflict of interest., (© 2022 The Author(s).)

Introduction: Sarcoidosis is a chronic systematic inflammatory disorder of unknown etiology. Marginal zone lymphoma is a well-varied family of lymphomas that makes up to 10% of the overall non-Hodgkin's lymphomas. The relationship between sarcoidosis and multiple diseases was mentioned repeatedly in the literature, whereas the relationship between sarcoidosis and marginal zone lymphoma was found rare. This case presents a 56-years-old man who was diagnosed with sarcoidosis after treatment of marginal zone lymphoma., Case Presentation: A 56-year-old male presented to Tishreen University Hospital (TUH) Gastrointestinal department with abdominal pain, vomiting, loss of apetite, fever, and unintentional weight loss. Computerized tomography scan of the chest and abdomen, in addition to the excisional biopsy of the cervical nodes, were both highly suggestive of marginal zone lymphoma. After completing a course of chemotherapy, the patient returned with generalized abdominal discomfort, anorexia, and fatigue. Computerized tomography illustrated enlarged mediastinal lymph nodes in the chest and the abdomen. Microscopic examination of an abdominal lymph node revealed granulomatous lymphadenitis with sarcoidosis. Thereafter, the patient was managed with nonsteroidal anti-inflammatory drugs and corticosteroids., Conclusion: We describe the occurrence of sarcoidosis after the treatment of marginal zone lymphoma. In most cases, sarcoidosis precedes lymphomas. This case emphasizes the evidence on the possible relationship between lymphomas and sarcoidosis, and attention should be sought towards any new manifestations throughout the follow-up of patients diagnosed with lymphomas toward sarcoidosis as part of our differential diagnosis., Competing Interests: The authors deny any conflict of interest in any terms or by any means during the study., (© 2022 The Authors.)

Introduction and Importance: Anaplastic Large-cell Lymphoma (ALCL) is a rare but aggressive type of NHL that develop from mature post-thymic T-cells. ALCL constitutes approximately 2% of all lymphoid neoplasm. It is typically found among children and young adults, accounting for 10-15% of pediatric NHL, compared to 2% of adult NHL., Case Presentation: A 12-year-old Syrian boy was admitted to our hospital due to epistaxis, anorexia, weight loss and night sweats. The physical examination revealed preauricular, postauricular and submandibular lymphadenopathy. Pathological examination of the biopsy suggested Classical Hodgkin Lymphoma. Later on, Immunohistochemistry staining confirmed the diagnosis of ALK-negative Anaplastic Large Cell Lymphoma., Clinical Discussion: Systemic ALCL can be categorized into two major groups based on the expression of Anaplastic Lymphoma Kinase (ALK) protein: Systemic ALK + positive and Systemic ALK-negative. The majority of pediatric cases show an overexpression of (ALK), however, pediatric ALK-negative ALCL can occur in rare cases., Conclusion: The aim of this article is to report a rare case of pediatric ALK-negative anaplastic large cell lymphoma that developed a rapid & aggressive growth within a few months despite the chemotherapy treatment and unfortunately led to the patient's death., Competing Interests: None declared., (© 2022 The Authors.)

On May 6, 2022 an outbreak of monkeypox (MPX) was confirmed in the United Kingdom, originating from a British resident who had travelled to Nigeria. As of May 21, 2022, 92 cases have been confirmed worldwide, from 13 countries where monkeypox virus (MPXV) is not endemic. Reported cases thus far have mainly but not exclusively been identified among gay and bisexual men aged 20-50. MPXV is a viral zoonosis transmitted to humans via contacting or eating an infected animal, and direct connect with natural host's blood and body fluids. In addition to contacting with a patient's respiratory droplets, lesions, body fluids and polluted personal objects. Symptoms including shivers, headaches, fainting, backaches, and myodynia do not have any specific characteristics making it difficult to establish a proper diagnosis. Nevertheless, lymphatic hyperplasia, one of the most common symptoms of monkeypox, can be useful for diagnosing the disease. Clinical symptoms help establish the suspicion of monkeypox. However, in the absence of confirmed diagnostic tests it is very difficult to verify the disease and determine its cause based on clinical symptoms alone. There are numerous methods for detecting MPX, involving genetic, phenotypic, immunological methods, and electron microscopy. These tests require modern equipment and expert hands, which may not be available in developing countries where this disease is prevalent. Currently, there is no definite treatment for MPX. CDC recommends administering the smallpox vaccine within 4 days of exposure which may prevent the disease from happening, and within 2 weeks to reduce symptoms severity. To promptly identify patients and prevent further spreading, physicians should be aware of the travel or contact history of the patient with compatible symptoms., Competing Interests: The Authors declare that there is no conflict of interest., (© 2022 The Authors.)

Introduction: Retinoblastoma (Rb), the most common intraocular malignancy of children, typically presents with leukocoria or strabismus, and in later stages, the most common sign may be proptosis. Radiological techniques show calcification as an important finding for the diagnoses. This neoplasm can mimic any orbital or ocular disease in its atypical clinical/radiological presentations, which delay the diagnosis leading to high mortality rates., Case Presentation: Here we report a case of a 4-year-old male child who presented to our hospital with ocular pain, edema, and inflammatory signs in the right eye, with no calcification. Clinical examination and radiological techniques suggested a broad spectrum of differential diagnoses, including orbital Inflammatory pseudotumor. The patient received intravenous fluids and antibiotic therapy, while awaiting further investigations. He was kept under observation status for days and discharged home with a stable condition. After 6 months, He developed severe painful proptosis with a large extraocular mass. Orbital magnetic resonance imaging showed an orbital mass extending outside the orbit in a non-functional eye. Therefore, right eye exenteration was performed, and pathologic examination revealed the diagnosis of Rb. Adjuvant chemotherapy was applied postoperatively. After 3 months of progressive decline because of distant multiple metastases, the patient died., Clinical Discussion & Conclusion: Rb must be considered in the differential diagnosis for any intraocular disease, due to the importance of early diagnosis and management. In this manuscript, we aimed to present a case of Rb with atypical symptoms including ocular pain, edema, inflammatory signs, then proptosis, with no finding of calcification in a Syrian child, highlighting a bunch of educational lessons for healthcare workers in developing countries., Competing Interests: The Authors declare that there is no conflict of interest., (© 2022 The Authors.)

Background: Non-Hodgkin lymphoma represents a heterogeneous group of tumors that constitute the seventh most common malignancy. Immunohistochemistry plays a major role in the detection of specific cell receptors. Transcription factors are a heterogeneous group of genes that play a critical role in the commitment, differentiation, and proliferation of specific cell types., Methods: Paraffin-embedded tissue sections of non-Hodgkin lymphoma cases were selected, classified, and evaluated before staining with immunohistochemical markers (PAX5, OCT2, BCL6, and P53). Expression of the aforementioned markers was compared with histological subtypes and grades of lymphoma cases. Means of expression were also compared among histological subtypes., Results: A total of 55 cases of NHL including 26 cases of low-grade lymphomas and 29 cases of high-grade lymphomas were included in the study. DLBCL and FL were the most common subtypes of high-grade and low-grade lymphomas respectively. Both PAX5 and OCT2 were positive in 44 cases of NHL (80%) including all cases of B-cell lymphomas. BCL6 and P53 demonstrated positive expression in 29.1% and 67.3% respectively. Interestingly, we found a significant association between the histological subtypes and the aforementioned markers (P-value<0.05)., Discussion: Expression of PAX5, OCT2, BCL, and P53 played a major role in the diagnosis and grading of non-Hodgkin lymphomas in our study. Both PAX5 and OCT2 provided more accuracy and specificity in the diagnosis of B-cell neoplasms compared to the classical B-cell markers. BCL6 expression reflected its role in germinal center formation in normal and malignant lymphoid tissues, and expression of P53 mirrored the accumulation of gene mutations in more aggressive lymphoma subtypes., Conclusion: In this manuscript, we aimed to present a unique study that highlights the immunohistochemical expression of all the aforementioned factors among various histological subtypes of non-Hodgkin lymphomas with disparities in histological aggressiveness, highlighting a promising diagnostic and prognostic panel for non-Hodgkin lymphomas., (© 2022 The Authors.)

Introduction: primary neuroendocrine cancer of the breast (NECB) is a very rare entity, comprising less than 0,1% of all breast tumors. It was first reported in 1977 by cubilla et al., Case Presentation: we report the case of a 60-year-old rural Syrian female who admitted to our hospital due to a painless lump in her right breast. Radiological & clinical findings were highly indicative of breast carcinoma. Therefore, a partial biopsy was performed and microscopic examination suggested the diagnosis of neuroendocrine carcinoma of the breast, which was confirmed by immunohistochemical staining. Lab findings were also indicative for anemia & thrombocytosis., Clinical Discussion: neuroendocrine tumors are usually seen in the intestine & lungs. However, their presence as primary tumors in the breast is extremely rare., Conclusion: our article demonstrates a challenging case of primary neuroendocrine breast carcinoma with paraneoplastic thrombocytosis, which clarifies the major diagnostic & therapeutic approaches used in its management., Competing Interests: No conflict of interest., (© 2022 The Authors.)

Introduction and Importance: Neoplasms arising from vesical diverticula are rare clinical entities known as intradiverticular bladder tumors. The bladder diverticulum harboring these tumors can be congenital or acquired. Congenital diverticula are predominantly found in children and are extremely rare in adults., Case Presentation: A 56-year-old male admitted to our hospital with a 10-days history of painless gross hematuria and blood clots. Physical examination and vital signs were unremarkable. Radiologic examination revealed a bladder diverticulum with a mass inside it. Pathological examination confirmed the diagnosis of TCC tumor arising from congenital bladder diverticula., Clinical Discussion: While intradiverticular bladder tumors account for only 1% of all bladder tumors، and the finding of a congenital bladder diverticulum is a rare anomaly in adults, the concurrence of a tumor arising within a congenital bladder diverticulum is almost non-existent in adults., Conclusion: We aimed to present a rare case of urothelial carcinoma arising from a congenital diverticulum in an adult while highlighting the diagnostic and therapeutic options used in managing such tumors., Competing Interests: None., (© 2022 The Authors.)

Objective: to determine the clinical presentations and histopathological findings of idiopathic granulomatous mastitis, and to evaluate clinical outcomes after management., Methods: between 2007 and 2021, the files and histopathology reports of 17 patients with idiopathic granulomatous mastitis at Tishreen University Hospital, Latakia, Syria were reviewed. The data were analyzed and a scan through relevant literature was carried out to review related cases., Results: the age of patients ranged from 23 years to 57 years, and the mean age was 37.2 ± 9.57 years. All patients were female. The most common clinical presentation was breast lumps and the most common mammographic finding was ill-defined masses, which mimics breast carcinoma. Multinucleated giant cells, polymorphonuclear leukocytes, lipogranuloma-like changes and lobulocentric abscesses were the most common histopathological findings. Treatment options include: drainage of abscess along with antibiotics, steroid administration, and surgical excision. Antibiotic treatment was associated with a higher rate of complications, while use of steroids showed complete remission of the disease., Conclusion: idiopathic granulomatous mastitis is a spectrum of entities that should be differentiated from breast carcinoma and other mastitis conditions, the infectious or the non-infectious ones. The clinical and radiological features resemble those of breast carcinoma and infectious mastitis. The histopathological study is considered as the most crucial element in the multidisciplinary approach to diagnose idiopathic granulomatous mastitis (IGM) and determine the optimal management to be administered., Competing Interests: None., (© 2022 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Metaplastic breast carcinoma (MBC) is a diverse group of invasive breast carcinoma, in which the neoplastic epithelium differentiates toward squamous cells or mesenchymal looking elements, including but not restricted to spindle, osseous and chondroid cells. MBC was formally considered a distinct pathological pattern by WHO classification of breast tumors in 2000. We report the case of a 49-year-old Syrian female who presented to our hospital due to a painful huge mass in her right breast. Radiographic and clinical findings were highly indicative of breast carcinoma. Therefore, a core needle biopsy was performed, and surprisingly, microscopic examination suggested the diagnosis of soft tissue sarcoma, whereas immune stains confirmed the diagnosis of metaplastic carcinoma. We aim to introduce a challenging case that clarifies the rarity of this tumor, and the methods we used in diagnosing, examining and treating this malignancy., (© The Author(s) 2022. Published by Oxford University Press.)

Introduction: Burkitt's lymphoma is an aggressive type of non-Hodgkin lymphoma that represents approximately 30% of pediatric lymphomas and less than 5% of all pediatric malignancies. Although the involvement of the gastrointestinal tract is a common finding in sporadic Burkitt's lymphoma, primary intestinal lymphomas still represent a rare entity., Case Presentation: We are reporting the case of an 11-year-old Syrian male who presented to our hospital with complaints of abdominal pain, distention, and tenderness. Clinical and radiologic examinations demonstrated moderate ascites with an abdominal mass. Interestingly, the cytological study of the ascites revealed the diagnosis of Burkitt's lymphoma which was later confirmed by histopathological and immunohistochemical examinations., Discussion: Pleural effusions are a common finding in extranodal lymphomas, whereas ascites is considered a rare initial presentation constituting less than 2% of lymphoma cases., Conclusion: We aimed to present an extremely rare case of a primary intestinal Burkitt's lymphoma initially presenting with ascites, highlighting the major role of the cytological study of ascites in the primary diagnosis, and the essential role of histological and immunohistochemical examinations in confirming the diagnosis in challenging cases., Competing Interests: All authors must disclose any financial and personal relationships with other people or organisations that could inappropriately influence (bias) their work. Examples of potential conflicts of interest include employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and grants or other funding. None declared., (© 2022 The Authors.)

Background: Apocrine carcinoma is a rare tumor that constitutes < 4% of all breast malignancies, characterized by the proliferation of large atypical cells with strictly defined borders, abundant eosinophilic cytoplasm, large nuclei, and prominent nucleoli in more than 90% of tumor cells. Triple-negative apocrine carcinoma is a rare molecular subtype that constitutes less than 1% of triple-negative breast cancers and is characterized by negative expression of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor, with positive expression of androgen receptor., Case Presentation: We report a case of a 45-year-old Syrian female who presented to our hospital due to a painless palpable mass in her left breast. Following physical and radiological examinations, an excisional biopsy was performed. Microscopic examination of the specimen followed by immunohistochemical staining revealed the diagnosis of a triple-negative apocrine carcinoma., Conclusion: Triple-negative apocrine carcinoma is an extremely rare neoplasm that must be considered in the differential diagnoses of breast lesions through detailed clinical, histological, and immunohistochemical correlations. In our manuscript, we aimed to present the first case report of a Syrian female who was diagnosed with a triple-negative apocrine carcinoma, aiming to highlight the importance of detailed clinical, histological and immunohistochemical correlations with a detailed review of diagnostic criteria, molecular characteristics, and treatment recommendations., (© 2021. The Author(s).)

Intestinal diffuse ganglioneuromatosis is a rare, benign, neoplastic condition characterized by disseminated proliferation of neural elements. It has an established association with several systemic disorders including: multiple endocrine neoplasia IIB (MEN IIB) and von Recklinghausen's disease. However, isolated GNs are very rare and sporadic. We report a case of a 6-year-old patient was referred to the emergency department due to a colon perforation during endoscopy. He then underwent sigmoidectomy and the pathologic studies revealed prominent signs of diffuse ganglioneuromatosis. Unfortunately, the patient died the day after because of the late diagnosis and treatment. Such presentation emphasizes the importance of considering diffuse ganglioneuromatosis, among other causes, in patients with intractable GI symptoms despite medical treatment., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Background: Non-Hodgkin lymphoma is the fourth most common malignancy in children, and it is not considered to be a hereditary disorder. However, it could affect members from the same family., Case Presentation: We are presenting two cases of Caucasian female siblings who were diagnosed with mediastinal lymphoblastic lymphoma in the same year. The two young females were presented to the emergency department with respiratory symptoms. After doing radiological investigations and biopsies, they were diagnosed with lymphoblastic lymphoma. The elder sister died before confirming the diagnosis, and the other is on chemotherapy now, with good treatment outcomes., Conclusions: This case emphasizes the crucial role of precursor genetics in lymphoblastic lymphomas and suggests a strong relation between these genetics and age at symptom presentation. This is the first report of non-Hodgkin lymphoma in a pair of siblings in the pediatric population., (© 2021. The Author(s).)

Endometrial stromal sarcoma (ESS) is a rare and challenging type of endometrial tumor, constituting only about 0.2% of all uterine malignancies and occurring in women 42-58 years of age. ESS is usually misdiagnosed as leiomyoma. They both have nonspecific symptoms, which makes the diagnosis of ESS difficult to achieve. As the ESS is infrequently encountered, optimal management is quite debatable. Here, we report a rare case of a 22-year-old Syrian female who presented with abnormal uterine bleeding; the preoperative diagnosis suggested leiomyoma while histopathological and immunohistochemical studies confirmed the diagnosis of LG-ESS stage IIA. Therefore, the treatment plan was shifted from a conservative myomectomy to a total hysterectomy with both adnexa. The aim of this case report is to draw attention to this uncommon tumor at young age of patients as well as to have awareness of the necessity to suspect this diagnosis especially with the presentation of rapid enlargement of uterine leiomyoma., Competing Interests: The authors have no conflict of interest to declare., (Copyright © 2021 Lana Nseir et al.)

A primary spinal Ewing sarcoma is extremely rare to be found. To the best of our knowledge, it is the first reported case for bilateral foot drop as a prodromal symptom of sacral Ewing sarcoma. The case, we are presenting, is of an 18-year-old athletic female, who was presented to the emergency department suffering from sudden severe low back pain radiated to the lower limbs, associated with bilateral foot drop and later urinary incontinence. Following the indicated surgery and subsequent histopathology study, we diagnosed this rare type of tumors. In the following article, we are describing the clinical presenting features of this tumor and discussing the clinical aspects., Competing Interests: All authors confirm that there are no conflicts of interest to declare., (© 2021 The Authors.)

Background: Primary splenic lymphoma represents a rare entity that constitutes less than 1% of non-Hodgkin lymphomas, and less than 2% of all lymphomas. Diffuse large B-cell lymphoma (DLBCL) is the most common histological subtype of primary splenic lymphomas. DLBCL encompasses a heterogeneous entity with distinct morphological variants. The anaplastic variant of DLBCL was first defined in the 2017 World Health Organization classification as a rare histological subtype that constitutes less than 3.4% of DLBCL cases., Case Presentation: A 65-year-old Syrian man presented to our hospital with constant dull localized left upper quadrant abdominal pain for about 20 days accompanied by general weakness, loss of appetite, and rapid weight loss. Clinical examination revealed isolated splenomegaly and left upper abdominal tenderness. Following physical, laboratory, and radiologic examinations, the patient underwent splenectomy. Interestingly, pathological and immunohistochemical examinations of the resected spleen confirmed the diagnosis of a primary anaplastic variant of DLBCL., Conclusions: Herein, we aimed to present an unusual combination of a rare splenic neoplasm and a unique lymphoma subtype. Furthermore, we aimed to highlight the difficulties in differential diagnosis and the importance of histological and immunohistochemical examinations with clinical correlation.

Background: Composite lymphoma is a rare entity where two or more distinct subtypes of lymphoma coexist within a single organ or tissue., Case Presentation: We report a new case of a 67-year-old Caucasian male patient, who presented with fatigue, weakness, weight loss, and polyuria. He also had epigastric and left lumbar pain, enlarged spleen, and enlarged left axillary lymph node on examination, with no relevant medical or familial history. A biopsy from the node showed an appearance of T-cell rich, histiocyte-rich diffuse large B-cell lymphoma and nodular lymphocyte predominant Hodgkin lymphoma. The patient was initially treated with adriamycin (doxorubicin), bleomycin, vinblastine, dacarbazine chemotherapy regimen, then switched to rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone regimen. During the therapy, some regression was noticed, especially in the size of the splenic enlargement; however, the patient died 2 months after completing the regimen., Conclusion: Composite lymphomas should continue to be studied. Also, treatment is still debatable in type, efficacy, and outcomes.

Background: Ovarian steroid cell tumors represent a rare category of sex cord-stromal tumors that constitute less than 0.1% of all ovarian tumors. These neoplasms are classified into three main subtypes according to the cell of origin: Leidyg cell tumors, stromal luteomas, and steroid cell tumors not otherwise specified (SCTs-NOS). The latter subtype is defined as a neoplasm of an uncertain lineage that mostly affects middle-aged women, whereas it's rare in younger ages., Case Presentation: We report a case of a 21-year-old virgin female who presented to our hospital with complaints of mild abdominal pain, hirsutism, and oligomenorrhea for more than a year. Before her current admission, the patient had attended an external gynecologic clinic where she had been prescribed oral contraceptives to regulate her periods. Nevertheless, on presentation to our institution, physical examination revealed abdominal tenderness with a palpable pelvic mass and mild hirsutism in the thigh. Ultrasonography demonstrated a large left ovarian mass measuring 154 × 104 mm, and compressing the uterus. Therefore, a unilateral salpingo-oophorectomy was performed, and interestingly, pathologic examination of the large aforementioned mass alongside with immunohistochemical correlation revealed the diagnosis of a large ovarian steroid cell tumor-not otherwise specified with a unique combination of benign and malignant features., Conclusions: Although ovarian steroid cell tumors represent a rare category, they must be considered in the differential diagnosis for mild virilization symptoms in young females due to the importance of early diagnosis and management. In this manuscript, we aimed to present the first case report from Syria that highlights the crucial role of detailed morphological examination for challenging cases despite the difficulties in differential diagnosis, and the absence of ancillary techniques. Furthermore, we managed to discuss a brief review of diagnostic methods, histological characteristics, and treatment recommendations.

The diagnosis of indolent systemic mastocytosis can be quite a challenge due to its wide spectrum of clinical manifestations. We are reporting a case of misdiagnosed indolent systemic mastocytosis in a 41-year-old male that has been wrongly treated first as a Non-Hodgkin lymphoma. The patient had generalized lymphadenopathy and eosinophilia, which are rare manifestations of indolent systemic mastocytosis. The chronic neglected pruritus and elevated tryptase levels along with histological findings were the main clues that have led us to the final diagnosis of indolent systemic mastocytosis. Later during the coronavirus disease 2019 pandemic, the patient presented with symptoms that are common between coronavirus disease 2019 and mast cell activation syndrome. Coronavirus disease 2019 was confirmed with a polymerase chain reaction test. There were no clear guidelines for managing a case like ours, so our management plan was based on the latest recommendations published at that time., Competing Interests: We have no conflict of interest., (© 2021 The Authors.)