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Introduction and Objectives. The most common cause for Congenital adrenal hyperplasia (CAH) is due to 21- hydroxylase deficiency which can produce disorders of sex development. 46,XX maleness is a rare syndrome with an incidence of 1 in 20000-25000 males, and they are defined by ambiguous genitalia or partially to fully mature male genitalia. Materials and Methods. We present the case of a 49-year-old patient (46,XX) with CAH resulting from 21-hydroxylase deficiency, diagnosed with penoscrotal hypospadias at the age of 3 and a half years for whom multiple corrective surgeries were performed and was referred to our hospital for evaluation of urethrocutaneous fistulas. Results. In 2021, the patient was diagnosed by the endocrinology department with 46,XX Karyotype, male phenotype and congenital adrenal hyperplasia due to 21 hydroxylase deficiency. The urological diagnosis established at "Prof. Dr. Theodor Burghele" Clinical Hospital was of multiple urethrocutaneous fistulas that occurred after penoscrotal hypospadias repair in childhood. The surgical indication consisted of urethroplasty with oral mucosa graft in two steps, the time between interventions being about four months. The surgical evolution was good, without complications. Complications after multiple times operated hypospadias are redoubtable, including strictures of the anterior urethra, urethral fistulas, urethritis, and recurrent urinary tract infections. The treatment of such cases is particularly difficult. Conclusions. The use of extragenital tissues for urethral reconstruction (oral mucosa graft) provides superior functional and aesthetic results compared to the techniques using skin flaps. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Percutaneous nephrolithotomy (PCNL) successfully replaced open surgery more than 30 years ago, and it still represents the gold standard in the treatment of large renal stones. Although nowadays, with advancing technology improving many technical aspects, it is considered a safe procedure with a low complication rate, close postoperative management is mandatory. Colon perforation is a rare but severe complication that can occur in specific cases. Materials and Methods. We analyzed 1146 cases, from June 2015 to May 2017, admitted in "Prof. Dr. Th. Burghele" Clinical Hospital based on medical records identified when searching procedure code. Data referring to risk factors such as age, sex, stone location and type, associated diseases, previous surgical history, and also intra and postoperative details were carefully analysed. All of the cases were primarily assessed with complete blood and urine tests. When diagnosed, urinary tract infections were treated with specific antibiotic agents. All available imagistic details were studied before and after the PCNL session for selected cases. Results. 7 cases met our criteria and were diagnosed with colonic injury after PCNL. All suspected cases were assessed imagistically with an abdominal CT scan and managed conservatively as the first intention. Sex distribution revealed five males and two females with a mean age of 52.3 years old. Colonic injuries were diagnosed intra or postoperatively and were most prevalent on the left side. Accessing the pylocaliceal system was performed by puncturing the lower calyx in 6 cases and the middle calyx for technical reasons in one case. When referring to risk factors, a retrorenal colon was diagnosed in two cases. In one case with previous open renal surgery, the right colon was injured. It was only one case of intraperitoneal lesion in which surgical management with temporary colostomy for three months was preferred. Conclusions. Colon perforation is a rare complication related to PCNL with management key being based on early diagnosis. According to other studies, our results reveal that extraperitoneal colon perforations can be successfully managed conservatively, but surgery with a temporary colostomy is the election treatment for intraperitoneal lesions. [ABSTRACT FROM AUTHOR]

Knowledge of lymph node metastases in patients with urologic tumors is important for clinical management and may help the urologic surgeon in choosing the best treatment for these patients. Accurate nodal staging helps to predict prognosis. Conventional magnetic resonance imaging (MRI) often fails to differentiate between benign and malignant changes in lymph nodes because this technique is reliant on nonspecific features such as size and morphologic criteria. Therefore, there is a need for more accurate non-invasive diagnostic technique to improve nodal assessment. Diffusion-weightedmagnetic resonance imaging (DW-MRI) is a non-invasive functional imaging technique that provides unique information related to tumor cellularity and the integrity of the cellular membrane. DW imaging has the potential to differentiate malignant from benign lymph nodes based on the mean ADC value. Metastatic nodes show, as most primary malignant tumors, lower ADC values due to their impeded diffusion caused by high cellularity. Improved diagnostic of lymph node metastases might guide the surgeon to remove positive nodes only. Although initial results are promising, larger-scale studies will be needed to improve detection and localization of lymph node metastases. Standardizing the technical parameters and improving the image analysis represent major challenges to the widespread adoption of DW imaging. [ABSTRACT FROM AUTHOR]

Introduction and objectives. The aim of this paper is to systematize and illustrate distinct imaging patterns and lesions distribution seen in renal lymphomas and to discuss the differential diagnosis with other renal tumors. Materials and methods. We realized a retrospective study over a period of 12 years from the cases investigated by CT or MRI in our hospital and diagnosed with a lymphoproliferative disease. Of the 3290 patients found, a total of 48 showed renal lymphoma. There was pathological confirmation for all patients, either node biopsy or after nephrectomy. All patients had at least two CT / MRI examinations. Indications for CT examination were: disease staging, follow-up at 6 or 12 months, clinical suspicion of recurrence and evaluation of renal or other organs lesions. Follow-up interval varied from four months to four years. MRI examination was performed only in two patients with iodinated contrast material allergy. Results. The most common imaging appearance of renal lymphomas is that of homogeneous, isodense (non-enhanced CT) and hypoattenuated (contrast-enhanced CT) masses compared with normal parenchyma. We found a wide variety of manifestation: multiple bilateral (52%) or unilateral masses (13%), a solitary nodular lesion (8%) or infiltrative lesions (13%), contiguous retroperitoneal extension (6%) or masses in the perirenal space (8%). Conclusions. Contrast enhanced CT is useful in: detection and characterization of renal involvements in patients with lymphoma, disease staging, follow-up and response after therapy and differential diagnosis with other renal masses. Histological confirmation of disease and the presence of bilateral renal nodular lesions associated with other extra-nodal involvements can establish the diagnosis of renal lymphoma. Otherwise renal biopsy is necessary. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Retroperitoneal mullerian cysts are very rare, usually asymptomatic and are considered to be a subtype of urogenital cysts. We present the clinical and pathological findings in a case of benign retroperitoneal cyst of mullerian type. Materials and Methods. A 50 years old female presented in our department left side abdominal pain and a left side abdominal mass discovered on clinical examination. Physical examination detected a 20x15 cm left side abdominal mass. The CT scan showed a large cyst like structure, 163/160/138 mm in dimensions situated in the left abdominal flank, with its upper pole under the caudal pancreatic region, unilocular with homogenous fluid density. It appears to be separated from the left kidney. Results. Surgery was performed – open laparotomy. We found a large cyst of 17/15 cm situated in the left retroperitoneum. Final histopathological exam described mullerian unilocular cyst, 17/17/13 cm in dimensions, with a thin firm wall, with serosal clear fluid, and the inner surface was without papillary projections. Conclusions. Retroperitoneal mullerian cysts are rare diseases, with a long period of asymptomatic evolution. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this paper is to present in a simple concise and clear manner the computer tomography (CT) perfusion technique using a 64-multi-slice CT (MSCT) and to discuss the main clinical applications. Materials and Methods: The CT protocol included: unenhanced CT scan to locate the prostate, intravenous administration of non-ionic iodinated contrast medium using a power injector (volume-100 ml, rate 5ml/s), scanning in CINE mode (cranio-caudal coverage - 40 mm, continuous exposure for 40 seconds) with a 10 seconds delay after beginning of injection, followed by ten additional 1-second scans in axial mode, with a 15-second interval to quantify the amount of contrast medium that filtered into the interstitial compartment. Perfusion CT examination was followed by a standard thoraco-abdomino-pelvic examination; a report was issued according to our daily clinical practice. The patients received doses (DLP - Dose Length Product) ranged between 1000 and 1500 mGy·cm, depending on their age and weight. Analysis of source images was performed on a workstation using a dedicated software. Results: Colored functional maps and quantitative measurements were obtained for the following parameters: Permeability Surface-area product (PS), Blood Volume (BV), Mean Transit Time (MTT), Blood Flow (BF), Contrast Arrival Delay (IRF T0), Time to Peak (TTP), Transit Time to Impulse Residue Function Peak (Tmax). Placing ROI's in femoral artery, normal and abnormal prostate tissue, we obtained graphs with contrast-enhancement curves and tables with specific CT perfusion parameters. Conclusions: Perfusion CT represent an imaging diagnostic tool that may be used in prostate cancer, allowing an easy and quick assessment of the functional changes, providing informations about in vivo tumor vascularity and guidance for histopathological correlation if biopsy is scheduled. Moreover, this technique may be performed in cases where MRI is contraindicated. [ABSTRACT FROM AUTHOR]

Von Hippel Lindau is an multisystem autosomal dominant disorder that causes tumors of the central nervous system (brain, retinal, and spinal cord hemangioblastomas), endolymphatic sac tumors, renal cell carcinomas, renal cysts, pheochromocytomas, pancreatic cysts and tumors, and epididymal cystadenomas. In this review we describe the major semiological computed tomography and magnetic resonance imaging findings of this pathological entity. [ABSTRACT FROM AUTHOR]

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: In Romania, the latest official report indicates that more than half of the births (80,890 cases, representing 52.88% of the total) are performed by cesarean, a rate significantly higher than the World Health Organization (WHO) recommendation of 15-20%. This study aims to identify the predictors associated with women's decisions to opt for cesarean in Romania., Materials and Methods:  An analytical cross-sectional observational study was conducted in the general population of Romania. The study was carried out over the course of 2023, with a total duration of four months. During this period, researchers targeted pregnant women from various regions of the country, regardless of their place of residence, age, or education level. The primary data collection tool was a self-administered online questionnaire, distributed via Google Forms, an accessible and efficient platform that allows for automatic response collection. The questionnaire was distributed online, particularly on social media platforms frequented by pregnant women, such as Facebook, Instagram, and TikTok., Results: A total of 1,301 participants were validated. Socio-demographic and clinical factors significantly influence women's decisions to give birth by cesarean. Among these participants, 435 expressed a preference for cesarean delivery. Key predictors include fear of pain and concern for the child's health. Fear of pain at birth is the first predictor in Romanian women to choose cesarean (OR=2.09; 95% CI: 1.62-2.68). Concerns about the child's health do not increase the likelihood of opting for a cesarean., Conclusion:  By utilizing valuable resources such as midwives and implementing strategies like birth plans, significant contributions can be made toward reducing the cesarean rate and improving the childbirth experience for women worldwide., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committee of the Emergency County Hospital issued approval 41482/09.08.2022. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Radu et al.)

Persistent Müllerian duct syndrome (PMDS) is a rare kind of internal male pseudohermaphroditism. The patient, who has a male karyotype and phenotypic characteristics, exhibits Müllerian duct derivatives such as the uterus, cervix, fallopian tubes, and upper two-thirds of the vagina. This article provides a comprehensive analysis of the CT and MRI characteristics of a case of PMDS in a 35-year-old male patient who sought medical attention at our clinic due to pain in the left inguinal region and the presence of undescended testes on both sides. The imaging results showed a pelvic mass with a bicornuate appearance, situated adjacent to the bladder on the left side. The diagnosis of compensated hypergonadotropic hypogonadism with a normal male karyotype is confirmed through biological and genetic studies. The final diagnosis was confirmed through histopathological examination following laparoscopic transperitoneal surgical removal. The examination revealed a left lateral vesical pelvic tumor with a firm-elastic, bicornuate appearance, along with a thickened endometrium. Microscopic findings included simple glandular hyperplasia with edema in the endometrium, a small adenomatous polyp at the uterine fundus, and bilateral rigid cords consistent with vas deferens histology. The primary issue with PMDS is in its rarity, which consequently limits the availability of comprehensive case series and prospective research. As a result, radiologists and surgeons must possess knowledge of this ailment, as there is a scarcity of defined treatment guidelines and long-term care strategies., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committee of Clinical Hospital "Prof. Dr. Theodor Burghele" issued approval 2/2021. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Bolocan et al.)

Background: Midwives are strong advocates for vaginal births. However, their visibility and accessibility are poorly perceived by women in Romania. Consequently, the women's options are limited to a single direction when pregnancy occurs, involving the family doctor, the obstetrician, and often an interventional technical approach at the time of birth. The aim of this research is to identify specific variables that affect the perceptions and attitudes of pregnant women towards the care provided by midwives. This knowledge could contribute to the development of more effective education and information strategies within maternal health services., Methods: A cross-sectional observational analytical survey was conducted in Romania among pregnant women from the general population. Data were collected through a self-administered questionnaire, with informed consent obtained from each participating pregnant woman. The questionnaire was administered online using the cloud-based Google Forms platform and was available on the internet for seven months, from January to July 2023. The questionnaire was distributed through various media channels, both individually and in communication groups, in the form of a link. All questions were mandatory, and the questionnaire could only be submitted after answering all questions., Results: A total of 1301 individual responses were collected. The analysis of the socio-demographic and obstetrical profile of the pregnant women revealed that approximately half, 689 (52.95%), of the participants were aged between 18-29 years, and 1060 (81.47%) of the participants were married. Among our group of 1301 pregnant women, 973 (74.78%) had higher education, and 987 (75.86%) had a regular job. A majority of the survey participants, 936 (71.94%), lived in an urban geographic area, while 476 (36.58%) had attended childbirth education courses, and 791 (60.79%) were in the third trimester of pregnancy. A total of 298 (22.9%) respondents did not want to give birth in a hospital, and one-third, 347 (26.67%), did not place significant importance on control over the childbirth process., Conclusions: The main factors influencing women's decisions regarding perinatal care and the importance of midwives as a component of the maternal-infant care team are modifiable, and thorough educational and psychological preparation would reduce the increasing predominance of preference for cesarean section, thereby promoting healthier and more woman- and child-centered perinatal care.

Diverse conditions comprise the spectrum of renal sinus pathologies, which have diagnostic and therapeutic implications for patients. Using CT imaging as a lens, this exhaustive review examines the representation of these pathologies. The article begins with a concise synopsis of renal anatomy and the specialized CT methodologies utilized to achieve excellent visualization. Transformational cell carcinoma, leiomyosarcoma, renal cell carcinoma, multilocular nephroma, and lymphoma are among the tumoral origins of the renal sinus pathologies that are investigated. Further, vascular pathologies including fistulas, hematomas, and aneurysms are included in the discourse, along with parapelvic and peripelvic cysts, and lipomatosis. In addition to urolithiasis and encrusted uretero-pyelitis, the review examines the consequences of metal toxicity and non-neoplastic conditions. With a focus on critical CT imaging findings that aid in the provision of an accurate diagnosis, every pathology is meticulously examined. With the intention of improving clinical decision-making and patient care, this article intends to function as a valuable resource for radiologists, clinicians, and researchers who are engaged in the interpretation and comprehension of renal sinus pathologies., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Bolocan et al.)

(1) Background: Computed tomography (CT) imaging challenges in diagnosing renal cell carcinoma (RCC) include distinguishing malignant from benign tissues and determining the likely subtype. The goal is to show the algorithm's ability to improve renal cell carcinoma identification and treatment, improving patient outcomes. (2) Methods: This study uses the European Deep-Health toolkit's Convolutional Neural Network with ECVL, (European Computer Vision Library), and EDDL, (European Distributed Deep Learning Library). Image segmentation utilized U-net architecture and classification with resnet101. The model's clinical efficiency was assessed utilizing kidney, tumor, Dice score, and renal cell carcinoma categorization quality. (3) Results: The raw dataset contains 457 healthy right kidneys, 456 healthy left kidneys, 76 pathological right kidneys, and 84 pathological left kidneys. Preparing raw data for analysis was crucial to algorithm implementation. Kidney segmentation performance was 0.84, and tumor segmentation mean Dice score was 0.675 for the suggested model. Renal cell carcinoma classification was 0.885 accurate. (4) Conclusion and key findings: The present study focused on analyzing data from both healthy patients and diseased renal patients, with a particular emphasis on data processing. The method achieved a kidney segmentation accuracy of 0.84 and mean Dice scores of 0.675 for tumor segmentation. The system performed well in classifying renal cell carcinoma, achieving an accuracy of 0.885, results which indicates that the technique has the potential to improve the diagnosis of kidney pathology.

During the last decades, male urogenital cancers (including prostate, renal, bladder and testicular cancers) have become one of the most frequently encountered malignancies affecting all ages. While their great variety has promoted the development of various diagnosis, treatment and monitoring strategies, some aspects such as the common involvement of epigenetic mechanisms are still not elucidated. Epigenetic processes have come into the spotlight in the past years as important players in the initiation and progression of tumors, leading to a plethora of studies highlighting their potential as biomarkers for diagnosis, staging, prognosis, and even as therapeutic targets. Thus, fostering research on the various epigenetic mechanisms and their roles in cancer remains a priority for the scientific community. This review focuses on one of the main epigenetic mechanisms, namely, the methylation of the histone H3 at various sites and its involvement in male urogenital cancers. This histone modification presents a great interest due to its modulatory effect on gene expression, leading either to activation (e.g., H3K4me3, H3K36me3) or repression (e.g., H3K27me3, H3K9me3). In the last few years, growing evidence has demonstrated the aberrant expression of enzymes that methylate/demethylate histone H3 in cancer and inflammatory diseases, that might contribute to the initiation and progression of such disorders. We highlight how these particular epigenetic modifications are emerging as potential diagnostic and prognostic biomarkers or targets for the treatment of urogenital cancers., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Burlibasa, Nicu, Chifiriuc, Medar, Petrescu, Jinga and Stoica.)

Beer is one of the most consumed drinks worldwide. It contains numerous categories of antioxidants, phenolic products, traces of group B vitamins, minerals (selenium, silicon, potassium), soluble fibers and microorganisms. Low or moderate beer consumption, with or without alcohol, showed positive effects on health by stimulating the development of a healthy microbiota. In the present review we focused on four components responsible with interaction with gut microbiota: microorganisms, polyphenols, fiber and melanoidins, their presence in usual beers and on perspectives of development of fortified beers with enhanced effects on gut microbiota. Though microorganisms rarely escape pasteurization of beer, there are new unpasteurized types that might bring strains with probiotic effects. The polyphenols from beer are active on the gut microbiota stimulating its development, with consequent local anti-inflammatory and antioxidant effects. Their degradation products have prebiotic action and may combat intestinal dysbiosis. Beer contains dietary fiber such as non-starchy, non-digestible carbohydrates (β-glucans, arabinoxylans, mannose, fructose polymers, etc.) that relate with gut microbiota through fermentation, serving as a nutrient substrate. Another type of substances that are often considered close to fiber because they have an extremely low digestibility, melanoidins (melanosaccharides), give beer antioxidant and antibacterial properties. Though there are not many research studies in this area, the conclusion of this review is that beer seems a good candidate for a future functional food and that there are many pathways by which its ingredients can influence in a positive manner the human gut microbiota. Of course, there are many technological hinderances to overcome. However, designing functional beers fortified with fiber, antioxidants and probiotics, with a very low or no alcoholic content, will counteract the negative perception of beer consumption, will nullify the negative effects of alcohol, while simultaneously exerting a positive action on the gut microbiota.

Testicular cancer is the most common solid tumor affecting young males. Most testicular cancers are testicular germ cell tumors (TGCTs), which are divided into seminomas (SGCTs) and non-seminomatous testicular germ cell tumors (NSGCTs). During their development, primordial germ cells (PGCs) undergo epigenetic modifications and any disturbances in their pattern might lead to cancer development. The present study provides a comprehensive review of the epigenetic mechanisms-DNA methylation, histone post-translational modifications, bivalent marks, non-coding RNA-associated with TGCT susceptibility, initiation, progression and response to chemotherapy. Another important purpose of this review is to highlight the recent investigations regarding the identification and development of epigenetic biomarkers as powerful tools for the diagnostic, prognostic and especially for epigenetic-based therapy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Nicu, Medar, Chifiriuc, Gradisteanu Pircalabioru and Burlibasa.)

Background: COVID-19 vaccination started in Romania in December 2020. Child vaccination started in 2021 with children aged 12-15 years in August. For children aged 5-11 years, vaccination started in January 2022. The aim of our study was to describe COVID-19 vaccination hesitancy in Romanian children and vaccine acceptability in the general population. As parental consent is required for child vaccination in Romania, these aspects have a significant association., Methods: An analytical cross-sectional survey was conducted in October and November 2021 during the peak of the 4th COVID-19 wave., Results: After validation, 1645 participants formed the main study group: median age 35 years, 72.83% women, and 35.44% from the medical domain. In total, 1311 (79.70%) participants were vaccinated against COVID-19 and 188 (11.42%) had vaccinated their 12-18-year-old children against COVID-19. Parents' level of education, geographic area of residence, and COVID-19 vaccination status were significantly associated with COVID-19 vaccination. The hesitancy factors of child vaccination included the novelty of COVID-19 vaccines (62, 47.32%), fear of adverse reactions (32, 24.42%), and anti-vaccinism in general (29, 22.13%). In the studied group, only 188 (11.42%) participants recommended vaccination of 5-11-year-old children. Vaccine acceptability was higher in the general population (1311, 79.70%) than in the medical domain (326 out of 583, 55.91%). General vaccine hesitancy was based mainly on beliefs regarding inefficiency (131, 39.22%) and fears about the side effects of the vaccine (76, 22.75%)., Conclusions: Overall, the acceptability of COVD-19 vaccines in the Romanian population was influenced by the level of education, area of residence, and being a COVID-19-vaccinated parent. Public health intervention programs are essential.

Leiomyosarcoma is a rare condition so there are relatively few and small case series and no prospective studies to provide clear guidelines regarding management. We report on a case that presents some particularities that further underline diagnostic and treatment difficulties posed by the affliction of such a rare tumor. This is the case of a 43-year-old woman who had a large tumor arising from the uterus, with a spectacular growth rate over a short period. The patient, with congenital spastic tetraparesis and hydrocephalus, came for belly enlargement with rapid increase in size over the previous two months. Physical exam and ultrasound lead to the conclusion of a large abdominal mass. A computed tomography scan showed a mass arising from the pelvis and a large amount of ascites. An exploratory laparotomy was performed and the histopathology report confirmed the diagnosis of uterine leiomyosarcoma. Leiomyosarcoma poses challenging problems regarding histological grading and, due to its rate of growth, real surgical difficulties. Final diagnosis is done by histopathological examination after surgical excision. Frequently, it is late diagnosed when complete removal of the tumor is often impossible.