Reports doi: 10.3390/reports9030289

Authors: Yong-Shun Thoo Mariana Fernandes Marie-Joe Dib Corinne Grandjean Ouanes Amine Ben Saad

Background and Clinical Significance: Horner’s syndrome is an uncommon but recognised complication of neuroaxial analgesia in obstetric procedures, with an incidence of 0.4–4%. Case Presentation: This case report describes a 28-year-old primigravida who developed unilateral Horner’s syndrome approximately one hour after lumbar epidural analgesia placement for labour pain relief. Upon examination the patient presented with left-sided ptosis, anisocoria, and unexpected sensory blockade extending to the T3–T4 level, accompanied by localised numbness in the left breast and transient upper limb paraesthesia. The pathophysiology of Horner’s syndrome involves cephalad spread of local anaesthetic toward the superior cervical sympathetic chain, disrupting sympathetic innervation to the ocular and facial areas. Primary and secondary damage to the sympathetic pathways in the central nervous offer a wide differential diagnosis. The management was conservative, including reduction in epidural bolus infusion rates and careful monitoring. The patient experienced complete resolution of all symptoms within five hours and delivered vaginally without complications. Conclusions: This case demonstrates the characteristically benign and self-limited nature of this complication, emphasising the importance of clinical awareness, proper reassurance of patients, and avoidance of unnecessary diagnostic testing.

Reports doi: 10.3390/reports9030288

Authors: Socratis Thomaidis

Background and Clinical Significance: Implant impressions can present inaccuracies, affected by many factors, such as impression technique, impression material, and parallelism or lack thereof among the implants. The use of a verification index can assess the accuracy of the mastercast and can be used in order to adjust the inaccuracy of the mastercast. This article presents a technical variation in established verification-index procedures, followed by implant analog repositioning, which can be used in case of an impression inaccuracy; Case Presentation: A patient with a moderate gag reflex received an implant. The impression of an implant and a prepared tooth was made. At the metal try-in, an inaccuracy of the mastercast was found, attributed to the final impression. A technique was illustrated, describing a polymethyl methacrylate (PMMA) verification index fabrication, followed by implant analog repositioning in the removable die of the master cast with the use of acrylic resin. This method may be used as an alternative to repeating the impression in selected clinical situations, but it is time-consuming, technique-sensitive, and needs meticulous handling; Conclusions: This is a viable technique and may represent an alternative to repeating the impression in selected clinical situations. Therefore, the clinical workflow can be reduced by one appointment. It can be helpful for patients with a moderate to severe gag reflex, since it can minimize the discomfort and stress for the patient and the dentist.

Reports doi: 10.3390/reports9030287

Authors: Rahaf A. Alghamdi Hind A. Alshankiti Adel F. Al-Marzouki Yara M. Daous

Background and Clinical Significance: Carbimazole is a widely used medication to treat Graves’ disease, although it can rarely cause acquired aplastic anemia, a complication that happens in less than 0.01% of people. Case Presentation: We report a 36-year-old woman treated with supratherapeutic dose carbimazole who, after approximately six months of treatment, developed high grade fever, severe menorrhagia, spontaneous epistaxis, and pancytopenia. Her bone marrow biopsy showed severe bone marrow failure with only 5% cellularity and trilineage hypoplasia. Other potential causes were ruled out. Immediate discontinuation of carbimazole was done, and supportive care, including blood transfusions, broad-spectrum antibiotics, G-CSF, and eltrombopag, was started. The patient deteriorated during her hospital stay, developed neutropenic sepsis and acute respiratory failure from diffuse alveolar hemorrhage, which required intubation and pulse steroid therapy. She was stabilized and discharged, with a referral to a tertiary medical center for starting antithymocyte globulin (ATG) immunosuppressive therapy, which she subsequently completed; two months after discharge she was transfusion independent with near-normalization of her blood counts. Conclusions: This case serves as a stark reminder of how lethal thionamide-induced bone marrow failure can be, highlighting the vital need for immediate drug cessation, swift intensive care, and thorough patient education on early warning signs.

Reports doi: 10.3390/reports9030286

Authors: Abdallah Shurrab Awad Dmour Mouaiad Abu Alika Muhammad Moosa Lucian-Cristian Bulat

Background and Clinical Significance: Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract and an uncommon cause of small bowel obstruction in adults, in which the diverticulum or a band arising from it typically constricts the adjacent bowel. Entrapment of the diverticulum itself within a pre-existing fibrous band is exceedingly rare; Case Presentation: A 42-year-old man with no previous abdominal surgery presented with colicky abdominal pain, distension and bilious vomiting. Contrast-enhanced computed tomography demonstrated small bowel loops dilated to 35.4 mm with a pelvic transition point of undetermined cause. At emergency laparotomy, a fibrous ileo-mesenteric band delimited a constricting orifice through which the Meckel’s diverticulum had herniated and become strangulated at its base, with secondary obstruction and ischemia of the adjacent ileum. Division of the band restored perfusion; the bowel remained viable and stapled diverticulectomy was performed without segmental resection. The patient recovered without complications. In most reported cases of Meckel’s diverticulum causing small bowel obstruction, the diverticulum or a band arising from it constricts the adjacent bowel. In this case the mechanism is reversed: the diverticulum was the entrapped structure itself, herniating through and strangulating within the orifice of a pre-existing ileo-mesenteric fibrous band. This configuration is exceptionally rare; Conclusions: Meckel’s diverticulum should be considered among the possible causes of small bowel obstruction in adults with no history of abdominal surgery. Recognition of this unusual anatomical configuration may facilitate intraoperative identification and appropriate assessment of bowel viability.

Reports doi: 10.3390/reports9030285

Authors: Bianca Varzaru Adina Emilia Croitoru Razvan Andrei Iacob Simona Olimpia Dima Cristian Gheorghe

Background and Clinical Significance: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with a poor prognosis, even in resectable disease. Molecular alterations in the four major driver genes (KRAS, SMAD4, CDKN2A, and TP53) have been associated with disease progression and patient outcomes. However, reliable prognostic biomarkers remain limited, particularly in resected PDAC, where recurrence rates remain high; Case presentation: We report the case of a 71-year-old woman incidentally diagnosed with PDAC carrying KRAS G12R with an ultra-low-variant allele frequency (VAF) SMAD4 mutation, with low baseline neutrophil-to-lymphocyte ratio (NLR) and circulating cell-free DNA (ccfDNA) levels. The patient underwent distal pancreatectomy with splenectomy and portal vein resection with multiple postoperative complications requiring re-intervention. The patient demonstrated excellent tolerance to the therapy, experiencing no significant adverse events and reaching an overall survival of 53 months. Conclusions: This case highlights the potential value of integrating molecular alterations with inflammatory and liquid biopsy biomarkers, including NLR and ccfDNA levels for improving risk stratification in PDAC. A focused review of the literature further supports the need for multimodal prognostic assessment in resected disease.

Reports doi: 10.3390/reports9030284

Authors: Vasileios Petrakis Maria Panopoulou Anastasia Grapsa Andreas G. Tsantes Periklis Panagopoulos

Background and Clinical Significance: People with HIV (PWH) experience an elevated risk of atherosclerotic cardiovascular disease (ASCVD), driven by chronic immune activation, metabolic toxicities of antiretroviral therapy (ART), and traditional risk factors. Achieving target low-density lipoprotein cholesterol (LDL-C) levels is frequently impeded by adherence barriers, pharmacokinetic drug interactions, or muscle-related symptoms. Inclisiran is a hepatocyte-targeted small interfering RNA that halts proprotein convertase subtilisin/kexin type 9 synthesis, providing a long-acting therapeutic alternative. Case Presentation: We present two PWH with severe hypercholesterolemia and elevated cardiovascular risk on stable ART. Case 1 describes a 54-year-old male with a history of myocardial infarction presenting with persistent, refractory hypercholesterolemia on rosuvastatin and ezetimibe (baseline LDL-C 142 mg/dL). Case 2 describes a 58-year-old male with verified statin intolerance and inadequate response to ezetimibe (baseline LDL-C 194 mg/dL). Following subcutaneous inclisiran administration at Day 1 and Day 90, Case 1 achieved an 80.2% LDL-C reduction to 28 mg/dL at Month 6, and Case 2 achieved a 54.6% reduction to 88 mg/dL at Month 6 as monotherapy. Both patients tolerated therapy well, with stable CD4+ counts and sustained virological suppression. Conclusions: These cases illustrate that inclisiran can effectively lower LDL-C levels across primary and secondary prevention settings in PWH facing oral therapy limitations or statin intolerance. Provider-administered dosing every 6 months overcomes adherence challenges, supporting the inclusion of PWH in broader clinical pathways pending ongoing cardiovascular outcome trials.

Reports doi: 10.3390/reports9030283

Authors: Ali Alamer Sajjad Alkadhem Osama Kattih Ahmed Al-Amoudi Aida Al Jabri Maali Alali Ahmed Soliman

Background and Clinical Significance: Diabetic ketoacidosis (DKA) is a common presentation of new-onset type 1 diabetes mellitus in children; however, severe DKA complicated by acute pancreatitis, dialysis-requiring acute kidney injury (AKI), severe hypertension, and neurological involvement is uncommon. Early recognition of these complications is essential because they may substantially increase morbidity and complicate standard DKA management; Case Presentation: An 11-year-old Saudi girl with morbid obesity (BMI 43 kg/m2), previously in good health, was brought to the emergency department after being found semi-conscious. She had experienced intermittent abdominal pain for five weeks and vomiting for four days. On presentation, she was critically ill, dehydrated, and confused (Glasgow Coma Scale 11/15) and exhibited Kussmaul breathing and abdominal tenderness. Laboratory investigations confirmed severe new-onset DKA, with a blood glucose level of 684 mg/dL, pH < 7.0, HbA1c 12.2% and an anion gap > 37 mEq/L. Despite standard DKA management, metabolic acidosis persisted and renal function progressively deteriorated, accompanied by oliguria and severe hypertension reaching 200 mmHg. By day 4, the patient developed anuria and marked creatinine elevation to 560 µmol/L. Brain magnetic resonance imaging demonstrated cerebral microhemorrhages in the setting of multifactorial encephalopathy. Continuous kidney replacement therapy was initiated for KDIGO stage 3 AKI with refractory metabolic acidosis. Autoimmune testing supported the diagnosis of type 1 diabetes mellitus, while renal biopsy demonstrated acute tubular injury; Conclusions: This case highlights a rare, severe multisystem presentation of pediatric DKA. Close monitoring for renal, neurological, pancreatic, and hypertensive complications is crucial, particularly when the clinical course does not improve as expected with standard therapy.

Reports doi: 10.3390/reports9030282

Authors: Enrica Filigheddu Luigi Sardellitti Manuela Astrid Chessa Edoardo Filigheddu Alessio Pirino Egle Patrizia Milia

Background and Clinical Significance: Facial aging is a multifactorial process involving the skin, subcutaneous tissues, facial fat compartments, muscles, ligaments, and skeletal structures. Integrated minimally invasive protocols are increasingly used to improve facial harmony and skin quality while preserving natural expression. The PATH (Profundity, Action, Timing, and Home care) protocol combines chemical peeling, hyaluronic acid–succinate filler, intradermal biorevitalization, and post-procedural homecare in a sequential and individualized approach to facial rejuvenation; Case Presentation: Three female patients aged 52–58 years with clinical signs of facial aging were treated according to the PATH protocol. Assessments were performed at baseline and after 60 days using standardized photography, OBSERV 520®, Antera 3D PRO®, and QuantifiCare LifeViz® Infinity Pro. No serious adverse events or systemic complications were reported during the 60-day follow-up period. Mild edema, erythema, and ecchymosis resolved spontaneously within 48–72 h. At 60 days, all patients showed natural improvement in facial appearance, with better midface and lower-face balance, increased skin brightness, improved texture, and no overcorrection or alteration of facial expression. Instrumental evaluations supported the clinical findings, showing improvements in skin regularity, chromatic uniformity, microrelief, and soft-tissue distribution; Conclusions: This preliminary case series suggests that the PATH protocol may represent a coherent multimodal strategy for integrated facial rejuvenation. The main clinical lesson is that a sequential, depth-oriented, and individualized approach may achieve natural aesthetic improvement. No serious adverse events were reported in the three patients during the 60-day follow-up period; however, the limited sample size and short follow-up do not allow definitive conclusions regarding safety. Further controlled studies with larger samples and longer follow-up are needed to confirm these exploratory findings.

Reports doi: 10.3390/reports9030281

Authors: Satoru Kusaka Tatsuya Akitomo Masashi Ogawa Yuto Shoji Jimei Zhao Ryota Nomura

Mucoceles are benign lesions caused by the accumulation of mucus such as saliva, and are common in children. Surgical intervention is effective but is not well tolerated by children because of its invasiveness, and alternative treatment methods are being explored. A boy aged 2 years and 5 months presented at our hospital with a chief complaint of mucocele. Considering the patient’s age, micro-marsupialization was initially selected to avoid surgical excision; however, the cyst did not resolve. We decided to apply the rubber band ligation method used for treatment of internal hemorrhoids, and ligated the mucocele using an orthodontic elastic separator. At the 3-week follow-up visit, the mucocele had disappeared. According to the patient’s guardian, the rubber band fell off after 1 week, and the mucocele subsequently detached and fell off spontaneously shortly thereafter. Although further studies are needed to establish the effectiveness of this treatment method, this report suggests that rubber band ligation may represent a novel, minimally invasive, and safe therapeutic option for the treatment of mucoceles.

Reports doi: 10.3390/reports9030280

Authors: Iris-Iuliana Adam Liliana Vecerzan Bogdan Moldovan Raluca-Gabriela Miulescu Alexandru-Petru Ciucu Alina-Bianca Iacob Alina Ormenișan

Background: Head and neck cutaneous squamous cell carcinoma (HNcSCC) presents intersecting oncologic, functional, and reconstructive challenges. Although numerous clinicopathologic factors have been associated with recurrence, metastasis, and survival, their relationship with reconstructive complexity and patient-centered outcomes remains insufficiently studied. This review aimed to examine how established oncologic risk factors might inform reconstructive planning while distinguishing measured reconstructive evidence from hypothesis-generating clinical inferences. Methods: A structured PubMed/MEDLINE search conducted through 15 July 2026 was used to identify the literature addressing clinicopathologic prognostic factors in HNcSCC. Twenty-nine prognostic publications were retained for structured charting. Additional reconstructive, functional, aesthetic, and patient-reported outcome sources were identified through reference-list screening and were used solely for narrative contextualization. Because no dedicated multi-database systematic search of reconstructive outcomes was performed, the article is presented as a structured narrative review and hypothesis-generating research framework rather than a systematic review of reconstructive evidence. Results: The prognostic literature reported associations between adverse oncologic outcomes and factors including tumor size and depth, perineural invasion, lymphovascular invasion, poor differentiation, immunosuppression, recurrent disease, positive margins, nodal involvement, and extranodal extension. However, most of these studies did not measure post-excision defect characteristics, reconstructive technique, wound complications, functional recovery, scar quality, aesthetic outcomes, or patient-reported outcomes. Direct reconstructive evidence was limited and predominantly derived from site-specific, mixed-histology, technical, or methodological publications. Consequently, clinicopathologic factors should be regarded as potential upstream variables for future investigation rather than validated predictors of reconstructive outcomes. Conclusions: Current evidence supports oncologic risk stratification more strongly than prediction of reconstructive difficulty or patient-centered outcomes in HNcSCC. Prospective studies should jointly measure patient, tumor, treatment-field, defect, reconstructive, functional, aesthetic, and patient-reported variables. The proposed framework is intended to guide such research and is not a validated clinical prediction model.

Reports doi: 10.3390/reports9030279

Authors: Nikolaos A. Stavropoulos Fotios Kantas Dimitrios V. Papadopoulos Rizos Tsaknis Vasileios S. Nikolaou George C. Babis

Fractures of the lateral process of the talus are uncommon injuries. We present a direct force trauma-induced talus lateral process fracture sustained in a 60-year-old male. The fracture was eventually diagnosed with computed tomography (CT) imaging and managed conservatively due to the patient’s co-morbidities and fracture type. The patient achieved an AOFAS Hindfoot Score of 90 at one year and remained asymptomatic at 78 months. Through this case, we aim to underscore the variability in clinical manifestations of the talus’ lateral process fractures as well as increase physician awareness for this type of fracture.

Reports doi: 10.3390/reports9030278

Authors: Márcio de Carvalho Formiga Jucielly Santos Lesnik de Souza Gustavo dos Santos Coura Sérgio Alexandre Gehrke

Background and Clinical Significance: Immediate implant placement in mandibular molars represents a clinical challenge due to lower trabecular bone density and anatomical limitations of the interradicular septum. Osseodensification has been proposed as an alternative to improve primary stability in sites with low bone quality. Case Presentation: This report describes the case of a 54-year-old female patient with a mesial root fracture in the lower right first molar, treated by atraumatic extraction followed by immediate implant placement using a densifying drilling protocol. After careful root removal, the interradicular septum was expanded using Versah burs at 1200 rpm, allowing placement of a 4.0 × 7 mm Implacil Duecone implant with a final insertion torque of 25 Ncm. The residual gap was filled with a xenogeneic bone substitute and covered with a dense polytetrafluorethylene membrane for alveolar preservation. Healing progressed uneventfully and, after four months, adequate bone formation was observed, enabling prosthetic rehabilitation with a single ceramic crown. After 4 postoperative years we could find peri-implant tissue stability. Conclusions: The clinical outcome supports current evidence indicating that osseodensification may enhance initial stability and predictability of immediate implants placed in posterior mandibular regions.

Reports doi: 10.3390/reports9030277

Authors: Konstantinos Poulopoulos Christina Charisi Filippos Fytros Asterios Katsagkolis Stefanos Zisis Maria Kalyva Nikolaos Spantidakis Petros Papadopoulos Athanasios Poulopoulos Vasileios Zisis

Background: Oral lichen planus (OLP) is a chronic inflammatory mucocutaneous disorder that is well documented in adults but remains relatively uncommon in the pediatric population. Due to its rarity, knowledge regarding its epidemiology, etiology, clinical behavior, diagnosis, and management in children remains limited. Objective: To review the current literature regarding epidemiology, pathogenesis, clinical presentation, diagnosis, histopathological characteristics, treatment, and outcomes of OLP in pediatric patients. Materials and Methods: An electronic search of the literature was conducted in the PubMed, Scopus, and Cochrane Library databases to identify OLP-associated case reports in the pediatric population. The search was limited to English-written publications of the past decade. The initial PubMed search yielded 228 publications. Following restriction to studies published between 2016 and 2026, 97 records remained. Limiting the search to English-language publications resulted in 95 studies. Screening for patients younger than 18 years identified 51 potentially relevant publications. After title, abstract, and full-text review, 10 studies fulfilled the inclusion criteria. To ensure comprehensive literature coverage, supplementary searches were subsequently conducted in the Scopus and Cochrane Library databases, identifying three additional eligible studies after excluding the duplicates. Consequently, a total of 13 studies were included in the final review. Results: Pediatric OLP is considerably less common than adult disease. The available evidence suggests an immune-mediated pathogenesis, although the exact mechanism remains unclear. Clinical presentations include reticular, erosive, plaque-like, linear, and severe mucocutaneous forms, with the reticular subtype being the most frequently reported. Histopathological findings consistently demonstrate basal cell degeneration and a dense subepithelial lymphocytic infiltrate. Topical corticosteroids remain the most commonly prescribed treatment and are generally associated with favorable clinical outcomes. Conclusions: Although relatively uncommon, OLP should be considered in the differential diagnosis of persistent oral white lesions in children. Early diagnosis and appropriate management are essential for symptom control and prevention of complications. Additional research is needed to better understand disease pathogenesis and establish evidence-based treatment protocols for pediatric patients.

Reports doi: 10.3390/reports9030276

Authors: Manabu Mogitate

Background: Chronic nasopharyngeal inflammation (chronic epipharyngitis) is associated with various upper airway and systemic symptoms. However, the relationship between endoscopic inflammatory findings and functional respiratory abnormalities remains unclear. This study aimed to evaluate respiratory oscillometry parameters measured by the MostGraph system in patients with chronic epipharyngitis and to investigate their changes following Epipharyngeal Abrasive Therapy (EAT). Methods: In this retrospective observational study, patients diagnosed with chronic epipharyngitis who underwent MostGraph examination were analyzed. Respiratory resistance and reactance parameters, including R5−R20, X5, inspiratory X5 (Xin5), resonant frequency (Fres), and low-frequency reactance area (ALX), were assessed. Endoscopic findings were scored using a standardized grading system. Comparisons were performed between patients and healthy controls, and pre- and post-EAT measurements were evaluated. Correlations between endoscopic severity and oscillometric parameters were analyzed using Spearman’s rank correlation coefficient. Results: Patients with chronic epipharyngitis demonstrated significant abnormalities in oscillometric reactance parameters compared with healthy controls. Following EAT, a significant change was observed in R5−R20, whereas other oscillometric parameters did not show significant changes. In addition, endoscopic severity scores showed no significant correlation with oscillometric measurements. These findings suggest that respiratory oscillometry may detect physiological abnormalities that are not directly reflected by endoscopic inflammatory severity. Conclusions: Patients with chronic epipharyngitis exhibited abnormalities in respiratory oscillometry parameters despite the absence of significant associations with endoscopic severity scores. The observed dissociation between endoscopic findings and oscillometric measurements suggests that morphological inflammation and physiological dysfunction may represent distinct dimensions of the disease. Respiratory oscillometry may therefore provide complementary information regarding the pathophysiology of chronic epipharyngitis beyond conventional endoscopic assessment.

Reports doi: 10.3390/reports9030275

Authors: Alfonso Lendínez-Jurado Ana García-Ruiz Viviane Ruiz-Dassy

Background and Clinical Significance: Eczema herpeticum (EH), or Kaposi’s varicelliform eruption, is a dermatologic emergency characterized by the abrupt onset of painful monomorphic vesiculopustules with potential for rapid dissemination. Atopic dermatitis (AD) is the main predisposing condition due to skin barrier dysfunction and impaired antiviral immunity. Early recognition is essential because delayed treatment may result in avoidable complications, including ocular involvement and systemic disease. Current recommendations emphasize immediate systemic acyclovir based on clinical suspicion, without awaiting laboratory confirmation. Case Presentation: A 4-year-old boy with moderate AD presented with a 6-day history of fever, malaise, and a rapidly progressive vesiculopustular eruption involving both eczematous and previously unaffected skin. The patient had a recent AD flare, molluscum contagiosum, and had initially received oral amoxicillin-clavulanate for presumed bacterial superinfection without improvement. Physical examination revealed widespread painful monomorphic umbilicated vesiculopustules with hemorrhagic crusts and mild bilateral conjunctival injection. Oral acyclovir was initiated within one hour of evaluation. Laboratory investigations showed mild inflammatory abnormalities without renal or hepatic involvement. Because lesional PCR was unavailable, complementary blood-based investigations were performed; HSV-1 IgM serology and blood PCR provided additional retrospective findings compatible with HSV-1 infection, while Gram stain and bacterial cultures were negative. Fever resolved within 24 h, no new lesions developed after day 3, and complete re-epithelialization was achieved after a 10-day course of acyclovir. Conclusions: This case highlights the importance of bedside recognition of eczema herpeticum in children with atopic dermatitis, particularly when painful monomorphic vesiculopustules are accompanied by fever and rapid dissemination. Early initiation of systemic acyclovir based on clinical suspicion remains the cornerstone of management. While PCR from vesicular lesions is the preferred diagnostic test when available, laboratory confirmation should not delay treatment. This report also illustrates common real-world challenges, including initial misdiagnosis as bacterial infection and limited access to optimal virological testing.

Reports doi: 10.3390/reports9030274

Authors: Justina Antonela Dragomir Alexandru Stoichiță Silviu Gabriel Vlăsceanu Radu Matache Beatrice Mahler

Background and Clinical Significance: Solitary fibrous tumor (SFT), historically termed hemangiopericytoma (HPC), is a rare fibroblastic mesenchymal neoplasm with variable biological behavior. Pulmonary involvement is uncommon and may represent either a primary thoracic tumor or metastatic disease from an extrapulmonary site. Its clinical course ranges from indolent, surgically curable disease to aggressive malignancy with local recurrence and distant dissemination. In this retrospective case, confirmatory STAT6 immunohistochemistry was unavailable; therefore, the tumor is described as a hemangiopericytoma/solitary fibrous tumor spectrum neoplasm. Case Presentation: We report the case of a 33-year-old woman who presented with sudden-onset hemoptysis and was found to have two large, well-defined bilateral pulmonary masses. Initial clinical and radiological evaluation raised suspicion of primary pulmonary tumors or other benign lesions. Because both lesions were considered resectable, staged pulmonary resections were performed. Subsequent reassessment of the patient’s medical history revealed previous surgeries for a poorly documented recurrent thigh tumor, later confirmed to represent the primary malignant hemangiopericytoma/solitary fibrous tumor spectrum neoplasm. Despite staged pulmonary resections, systemic chemotherapy, and further oncologic management, the disease progressed rapidly, with cerebral, bilateral pulmonary, mediastinal, and subcutaneous metastases. The patient died within 18 months of the initial pulmonary diagnosis. Conclusions: This case highlights the diagnostic difficulty of metastatic pulmonary hemangiopericytoma, particularly when the primary soft tissue tumor is inadequately documented. It emphasizes the importance of detailed clinical history, retrieval of previous histopathological reports, and long-term surveillance in patients with soft tissue tumors, even when initially considered benign.

Reports doi: 10.3390/reports9030273

Authors: Konstantinos Koutsoulas Evangelos Karagiannis Dimitrios Kouroupis Ioannis Vlachos Spyros Papadopoulos Panagiotis Pateinakis Athina Pyrpasopoulou Ioannis Vouros Ioannis Goulis

Background and Clinical Significance: Renal disease is the leading cause of secondary hypertension in children and adolescents. Among younger patients presenting with severe hypertension, renovascular and renal parenchymal disorders should be considered promptly; Case presentation: We describe the case of a 16-year-old male who presented with severe fatigue and was found to have resistant arterial hypertension (180/120 mmHg). His medical history was notable for blunt epigastric trauma sustained during football training approximately 6 months before presentation. Magnetic resonance imaging of the kidneys and retroperitoneum demonstrated a large right-sided perinephric hematoma compressing the kidney. Plasma renin activity and aldosterone levels were markedly elevated, establishing the diagnosis of Page kidney. Percutaneous drainage was performed by placement of a drainage catheter into the perinephric collection, resulting in evacuation of a substantial volume of liquefied hematoma. Following the procedure, arterial blood pressure gradually normalized, accompanied by resolution of the hormonal abnormalities; Conclusions: Page kidney is a rare but important cause of secondary hypertension resulting from activation of the renin-angiotensin-aldosterone system due to external renal compression and impaired intrarenal perfusion. Although its clinical presentation may be insidious, delayed recognition can lead to severe cardiovascular and renal complications. Management includes percutaneous drainage or surgical decortication of the affected kidney, together with antihypertensive treatment targeting the renin-angiotensin-aldosterone system. Early diagnosis and treatment are essential to optimize clinical outcomes and preserve renal function.

Reports doi: 10.3390/reports9030272

Authors: Tomohiro Kawasumi Takao Hamamoto Takashi Ishino Tsutomu Ueda Sachio Takeno

Background and Clinical Significance: Eosinophilic sialodochitis (ES), also known as sialodochitis fibrinosa, is a rare disorder characterized by recurrent salivary gland swelling caused by intraductal eosinophilic mucous plugs. Typical histopathological findings include eosinophils and Charcot–Leyden crystals within ductal secretions, and characteristic imaging findings include salivary duct dilatation and glandular swelling. Although rare cases associated with sialolithiasis or calcification have been reported, high-attenuation material within the salivary duct on computed tomography (CT) has not been clearly described in ES. Case Presentation: A 56-year-old woman with allergic rhinitis presented with recurrent swelling and pain in the right submandibular area. CT and ultrasonography revealed a large sialolith in the right submandibular gland and dilatation of Wharton’s duct. She underwent right submandibular gland excision for presumed chronic obstructive submandibular sialadenitis with a sialolith. Soon after surgery, she developed recurrent swelling of the right floor of the mouth, and CT showed persistent high-attenuation material along Wharton’s duct without residual sialolith. Ductal massage discharged a brownish gelatinous material. Histopathological examination revealed numerous eosinophils and Charcot–Leyden crystals in both the discharged mucous plug and decalcified sialolith, fulfilling Baer’s diagnostic criteria for ES. Physical extraction and anti-allergic medications were insufficient, whereas ductal irrigation with saline and triamcinolone acetonide markedly reduced mucous plug discharge. Symptoms were controlled during 18 months of follow-up. Conclusions: Retained eosinophilic mucin in ES may appear as high-attenuation ductal material on CT and contribute to salivary stasis and sialolith formation.

Reports doi: 10.3390/reports9030271

Authors: Catalin-Bogdan Satala Valerica Valentin Zaharia Alina-Mihaela Gurau Cristina-Mihaela Popescu Robert Daniel Ciortan Daniela Mihalache

Background and Clinical Significance: Proliferative fasciitis (PF) is an infrequent benign fibroblastic/myofibroblastic proliferation that may closely resemble a soft tissue sarcoma, creating a diagnostic dilemma out of proportion to its biological behaviour. Because no single clinical, histological or immunohistochemical feature is diagnostic, accurate classification depends on the integration of complementary findings. We describe a challenging case of PF involving the lower leg and present a practical clinicopathological approach to its evaluation. Case Presentation: A 34-year-old man presented with a painless subcutaneous nodule on the lateral aspect of the left lower leg, discovered incidentally. Clinical examination suggested a benign superficial soft-tissue lesion, and because no features raised suspicion for malignancy, complete excision was performed without preoperative imaging. Gross examination revealed a 1.9 × 1.6 × 0.7 cm fascial-based lesion composed of spindle cells and scattered ganglion-like cells within a variably myxoid stroma. Focal nuclear pleomorphism, typical mitotic activity (2 mitoses/10 high-power fields), and limited extension into adjacent adipose tissue broadened the differential diagnosis. Immunohistochemistry demonstrated focal SMA positivity, weak focal desmin and S100 expression, absence of CD31 and CD34 staining, and a low Ki-67 proliferative index (approximately 2–3%). Negative surgical margins, together with integration of the clinical presentation, gross findings, histomorphology, and immunophenotype, supported the diagnosis of proliferative fasciitis. The patient remains free of local recurrence four months after surgery. Conclusions: PF should be considered in the differential diagnosis of superficial spindle-cell proliferations showing deceptively aggressive histological features. Careful clinicopathological correlation remains the cornerstone of diagnosis and helps distinguish this benign entity from its malignant mimics. The clinicopathological framework proposed in this report may assist pathologists in the systematic evaluation of similar diagnostically challenging lesions.

Reports doi: 10.3390/reports9030270

Authors: Jakub Kwiatek Oskar Barczak Marcin Lenkowski Justyna Kaczewiak Mateusz Tarnowski

Background and Clinical Significance: Peri-implantitis is an inflammatory condition associated, among other factors, with biofilm accumulation, affecting peri-implant soft and hard tissues and potentially leading to implant loss. Its treatment remains challenging because no single decontamination or regenerative protocol has demonstrated clear superiority. This case report describes a comprehensive surgical and regenerative approach aimed at preserving an affected implant and restoring peri-implant tissue stability; Case Presentation: A systemically healthy 30-year-old patient presented with peri-implant bone loss around an implant in position 25, restored with a lithium disilicate crown and functioning for three years. Treatment included flap elevation, mechanical debridement and air-polishing of the implant surface, followed by thorough irrigation with sterile saline to remove residual abrasive particles and debris, photodynamic antimicrobial therapy, and laser therapy. Bone regeneration was performed using a bone substitute combined with injectable platelet-rich fibrin to produce sticky bone, which was covered with an advanced platelet-rich fibrin membrane. A provisional crown was placed without occlusal contact. After four months, a definitive crown with a modified emergence profile was delivered to improve hygienic access and reduce biofilm retention. Clinical and radiographic follow-up over five years demonstrated stable peri-implant tissues and maintained bone levels; Conclusions: The combined use of surgical decontamination, PRF-assisted regeneration, sticky bone, and prosthetic modification resulted in stable clinical and radiographic outcomes over five years. Identification and elimination of contributing factors were essential for long-term treatment success.

Reports doi: 10.3390/reports9030269

Authors: Fahad BaHammam

Background and Clinical Significance: Tooth surface loss is the irreversible loss of dental hard tissue caused by non-carious processes. Restoration of affected teeth can be challenging, especially on the palatal surfaces of maxillary anterior teeth when severe palatal hard-tissue loss is present without marked clinical crown shortening. In such cases, clinicians must preserve the remaining enamel for predictable adhesive bonding while ensuring accurate seating, complete adaptation, and controlled cementation of thin indirect restorations. To address these challenges, this case report describes a novel preparation-free approach in which two temporary incisal seating lugs were incorporated into the design of indirect resin-based composite palatal veneers; Case Presentation: A 35-year-old male patient was referred by his general dentist for management of extensive erosive tooth surface loss. Clinical examination revealed generalized tooth surface loss, with a distinctive pattern of severe palatal hard-tissue loss affecting the maxillary anterior teeth without marked clinical crown shortening. Restorative treatment was planned at a 2 mm increase in occlusal vertical dimension. The maxillary anterior teeth were restored with preparation-free indirect resin-based composite palatal veneers, each incorporating two temporary incisal seating lugs to provide a positive seating stop during cementation; the lugs were removed after cementation. Other affected teeth were restored using directly placed resin-based composite restorations. At six months, the veneers remained clinically acceptable, with stable occlusion, maintained pulp sensibility, no postoperative sensitivity, and high patient satisfaction; Conclusions: This technique may facilitate restoration positioning during cementation and may represent a useful clinical alternative when seating preparation-free palatal veneers is challenging.

Reports doi: 10.3390/reports9030268

Authors: Christina Velliou Anna Varouktsi Iraklis Leonidis Anastasia Sarvani Nikoleta Moutsou Theocharis Koufakis Dimitrios Patoulias

Background and Clinical Significance: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome characterized by uncontrolled activation of macrophages and cytotoxic lymphocytes. Secondary HLH is most commonly associated with infections, malignancies, and autoimmune disorders. Visceral leishmaniasis (VL) is an uncommon infectious trigger of HLH, and the considerable overlap in clinical manifestations frequently delays diagnosis. Early recognition of the infectious trigger is essential, because prompt targeted therapy may prevent the need for prolonged immunosuppressive treatment and substantially improve outcomes. Case Presentation: A 68-year-old livestock farmer from northern Greece presented with a one-month history of persistent fever, fatigue, and night sweats. Laboratory evaluation demonstrated pancytopenia, severe hyperferritinemia, hypertriglyceridemia, and elevated soluble interleukin-2 receptor (sCD25) levels. After extensive, relevant screening for other underlying etiologies, which proved to be negative, bone marrow examination revealed hemophagocytosis, while anti-Leishmania serology and polymerase chain reaction (PCR) analysis of bone marrow aspirate confirmed infection with Leishmania infantum. Treatment with liposomal amphotericin B along with intravenous dexamethasone resulted in rapid clinical and laboratory improvement. Serial ferritin and sCD25 measurements closely paralleled clinical recovery, supporting their potential usefulness as biomarkers of treatment response. The patient remained asymptomatic at one-month follow-up. Conclusions: Secondary HLH associated with VL is rare, but potentially fatal. Clinicians should maintain a high index of suspicion in patients presenting with prolonged fever, splenomegaly, cytopenia, and marked hyperferritinemia, particularly in endemic regions. Early diagnosis and prompt initiation of targeted therapy are associated with favorable outcomes.

Reports doi: 10.3390/reports9030267

Authors: Francesco Chiari Cecilia Dalmazzini Ludovica Borgia Claudio Donadio Caporale Pierre Guarino

Background and Clinical Significance: Oropharyngeal squamous cell carcinoma (OPSCC) and small-cell neuroendocrine carcinoma (SCNEC) are biologically distinct entities with markedly different prognostic and therapeutic implications. While HPV-negative OPSCC carries worse outcomes than HPV-positive disease, SCNEC is exceedingly rare, highly aggressive, and prone to early systemic dissemination. Their synchronous occurrence in the head and neck (HN) is exceptional and poses major diagnostic and therapeutic challenges. Case Presentation: A 54-year-old male, smoker and alcohol consumer, presented with a left tonsillar lesion and cervical lymphadenopathy. Biopsy confirmed p16-negative OPSCC. He underwent transoral robotic surgery with modified radical neck dissection. Histopathology unexpectedly revealed two distinct malignancies: keratinizing OPSCC in the tonsil and high-grade SCNEC in a cervical lymph node, confirmed by immunohistochemistry (synaptophysin, CD56, Ki-67 80%). Postoperative FDG-PET/CT performed within two months showed rapid systemic spread, including paravertebral, pulmonary, and pelvic nodal metastases. Despite recommendation for systemic therapy, the patient deteriorated quickly and died shortly thereafter. Conclusions: This study reports coexistence of p16-negative OPSCC and high-grade SCNEC in the HN. It highlights the diagnostic complexity, staging limitations, and therapeutic dilemmas of discordant histologies, while illustrating the fulminant clinical course typical of SCNEC of unknown origin. Early recognition, comprehensive pathology, and multidisciplinary management are essential, although prognosis remains dominated by the aggressive neuroendocrine component.

Reports doi: 10.3390/reports9030266

Authors: Cristina Valeria Tandara Alexandru Cristian Cindrea Adina Maria Mârza Lucian Adrian Tandara Ovidiu Alexandru Mederle

Background and Clinical Significance: Ruptured common iliac artery aneurysms may mimic urological disease, particularly when retroperitoneal bleeding causes ureteral compression and secondary hydronephrosis. This case is clinically relevant because the first symptom was acute stabbing testicular pain, followed by lumbar discomfort and ultrasound findings suggestive of obstructive uropathy. Case Presentation: A 73-year-old man with arterial hypertension and active smoking presented to the Emergency Department with sudden left lumbar pain that initially radiated to, or was perceived in, the left testicle. The testicular pain resolved spontaneously, but persistent poorly localized lumbar pain continued. He was afebrile and initially hemodynamically stable. Point-of-care ultrasound showed left hydronephrosis, while the abdominal aorta appeared unremarkable. Because the patient looked clinically unwell and the abrupt, stabbing onset was not fully explained by uncomplicated renal colic, contrast-enhanced abdominal and pelvic computed tomography was performed. CT revealed a fissured saccular aneurysm of the left common iliac artery with active contrast extravasation and a large retroperitoneal hematoma compressing the ipsilateral ureter, thereby causing secondary hydronephrosis. The patient underwent urgent endovascular treatment with percutaneous transluminal angioplasty and Bentley stent. Post-revascularization CT showed no further contrast extravasation, and the patient was discharged after seven days without complications. Conclusions: In older patients with cardiovascular risk factors, sudden testicular, flank, or lumbar pain may warrant consideration of retroperitoneal vascular emergencies, even when initial ultrasound suggests a urological diagnosis. In this patient, discordance between the clinical presentation and the initial ultrasound findings prompted contrast-enhanced CT, which enabled diagnosis and timely vascular management.

Reports doi: 10.3390/reports9030265

Authors: Ancuţa-Alina Constantin

Background and Clinical Significance: Pulmonary disease caused by nontuberculous mycobacteria (NTM) represents an important diagnostic challenge in tuberculosis-endemic settings because its clinical, radiological, and microbiological features may overlap with those of pulmonary tuberculosis (TB). Accurate distinction between these conditions is essential to avoid diagnostic delay and inappropriate treatment. Case Presentation: We present two cases that illustrate the heterogeneity of imaging patterns associated with NTM disease. The first case involved a 55-year-old woman with previously treated pulmonary tuberculosis who presented with chronic productive cough, recurrent mild hemoptysis, and progressive nodular-bronchiectatic and cavitary abnormalities. Mycobacterium avium was repeatedly isolated from independently collected respiratory specimens and identified using a line probe assay (LPA). The second case involved a 65-year-old man with severe chronic obstructive pulmonary disease (COPD), bronchiectasis, previous tuberculosis, and extensive bilateral fibrocavitary lung disease. Respiratory specimens were acid-fast bacilli-positive, whereas GeneXpert MTB/RIF repeatedly failed to detect the Mycobacterium tuberculosis complex. Repeated cultures identified Mycobacterium xenopi, including isolates from two sputum specimens and one bronchial aspirate. Treatment was subsequently adapted according to species identification and multidisciplinary assessment. These cases illustrate two major phenotypes of pulmonary NTM disease: nodular-bronchiectatic disease caused by M. avium and fibrocavitary disease caused by M. xenopi. They emphasize that persistent acid-fast bacilli (AFB) positivity with negative GeneXpert MTB/RIF results should prompt consideration of NTM alongside other differential diagnoses, followed by mycobacterial culture and species-level identification. Conclusions: The diagnosis of pulmonary NTM disease requires integration of clinical manifestations, radiological evolution, and repeated microbiological confirmation. Early species identification, multidisciplinary treatment selection, and close follow-up may reduce diagnostic delays and support appropriate individualized management.

Reports doi: 10.3390/reports9030264

Authors: Nusa Matijasic Stjepovic Izabela Kranjcec Aleksandra Bonevski

Background and Clinical Significance: Skin-limited Langerhans cell histiocytosis (LCH) is a clinically heterogeneous disease, ranging from self-healing forms to fulminant multi-organ failure, the latter being more often described in infants, especially preterm neonates. The optimal therapy for cutaneous LCH remains controversial; the possibilities vary from a watchful waiting approach to systemic chemotherapy. Case Presentation: This case report describes an exceptionally rare and clinically challenging course of skin-limited LCH in a prematurely born infant treated at the Department of Oncology and Hematology, Children’s Hospital Zagreb, Croatia. At presentation, the patient exhibited several features suggestive of aggressive disease biology. However, therapeutic decision-making was complicated by extreme prematurity and young age, both of which significantly increased vulnerability to treatment-related toxicity. Following failure of topical therapy, systemic treatment was initiated according to the LCH-IV trial, primarily due to concerns regarding potential evolution into multisystem LCH. During treatment, the patient developed multiple life-threatening complications, namely severe infections (Staphylococcus aureus endocarditis, Pneumocystis jirovecii pneumonia, and Enterobacter cloacae sepsis), aggravated by secondary hypogammaglobulinemia, neutropenia, and iatrogenic adrenal insufficiency. Conclusions: The varied nature of cutaneous LCH underscores the necessity for a tailored treatment approach. When deciding on the treatment modality, clinicians should weigh the benefits of aggressive therapies, ensuring better disease control, against the potential for severe adverse effects, particularly in young, fragile infants with immature immunity.

Reports doi: 10.3390/reports9030263

Authors: Ventseslav Ralev

Background/Objectives: The present investigation was designed and conducted with the aim to evaluate the statistical significance of the Comprehensive Facial Injury (CFI) score in relation to total surgical time (ST), length of hospital stay (LOS), and the presence of head injury in patients with fractures of the maxillofacial skeleton. Methods: The study includes 332 patients with maxillofacial fractures, a subset of whom also had associated head injuries. The CFI score was calculated for each patient. The Kolmogorov–Smirnov test was applied to assess the distribution of score values within the cohort. The Kruskal–Wallis H test was used to compare ST (minutes), LOS (days), and Glasgow Coma Scale (GCS) scores across different CFI score groups. Statistical significance was defined as p < 0.05. Results: The majority of the patients were male, at 77.1%, with 22.9% female. The mean age was 36.4 years, with a standard deviation of 19.3 years. Definitive surgical treatment was performed in 58.7% of patients, while the remaining 41.3% were managed conservatively (with closed reduction and external fixation) or received no surgical intervention. A statistically significant association was found between the CFI score and both ST and LOS (p < 0.001). Associated head injury was found in 33 patients or 9.9%. Furthermore, significant correlations were observed between CFI score values and Glasgow Coma Scale scores (p < 0.001) as well as the presence of head injury (p < 0.001). Conclusions: In conclusion, the CFI score provides a straightforward and comprehensive framework for assessing both operative duration and hospitalization length in patients with maxillofacial trauma. Moderate correlations between the CFI score and all investigated variables support its reliability in assessing trauma severity. The CFI score may therefore be useful in guiding treatment planning and developing standardized clinical protocols. However, its predictive capacity requires further validation in future studies.

Reports doi: 10.3390/reports9030262

Authors: Yueh-Cheng Tu Meng-Yu Wu Giou-Teng Yiang Yu-Long Chen

Background and Clinical Significance: Peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) substantially alters aortic flow dynamics, generating catastrophic false-positive pathology on standard imaging. We report a case of ECMO-induced artifacts mimicking a Stanford type A aortic dissection (TAAD), which led to an unnecessary exploratory sternotomy. Case Presentation: A 67-year-old man underwent extracorporeal cardiopulmonary resuscitation (ECPR) for a shockable out-of-hospital cardiac arrest. Post-resuscitation chest computed tomography angiography (CTA) and preoperative transesophageal echocardiography (TEE) demonstrated a prominent flap-like structure in the ascending aorta, prompting emergency sternotomy. Intraoperative exploration revealed no intimal tear. Subsequent evaluation confirmed an acute anterior myocardial infarction, managed with coronary intervention. Following a dismal neurological prognosis due to hypoxic encephalopathy, VA-ECMO was palliatively withdrawn on day 9, and the patient expired on day 19. The interaction between retrograde ECMO flow and varying levels of intrinsic cardiac function dictates the topology of flow disturbances. Absent native flow creates contrast layering within the aortic root, whereas preserved native flow creates a volatile downstream watershed zone. Based on these distinct phenotypes, we propose a novel conceptual framework for tailor-made imaging strategies titrated to native flow strength—such as temporary ECMO flow reduction for preserved native output, or circuit contrast injections for profound cardiac depression. Conclusions: ECMO-related artifacts present substantial diagnostic pitfalls. Clinicians should adopt a context-aware approach, integrating multi-modality imaging with hemodynamic status to implement individualized, physiologically guided imaging protocols.

Reports doi: 10.3390/reports9030261

Authors: Fabrizio Melfa Gabriele Ciranna

Background and Clinical Significance: Iatrogenic atrophy following intralesional corticosteroid injections represents a rare but potentially disfiguring complication, particularly when administered in the facial region for the treatment of inflammatory acne. Unlike conventional post-acne atrophic scarring, corticosteroid-induced tissue loss involves both dermal and subcutaneous compartments, resulting in a clinically distinct presentation that poses significant therapeutic challenges, with no established consensus on optimal management. Case Presentation: We report the case of a 26-year-old Caucasian female (Fitzpatrick phototype III) presenting with severe iatrogenic facial atrophy of the left cheek, resulting from multiple intralesional corticosteroid injections performed by a previous physician for papulo-pustular acne. The condition had been clinically stable for approximately two years at first evaluation. The patient underwent a stepwise multimodal protocol delivered over approximately 18 months (November 2023 to April 2025), combining non-ablative fractional laser remodelling (LightScan—Eufoton), Autologous Regenerative Therapy (ART, Seffiller technique, Seffiline srl), hyperdiluted calcium hydroxylapatite (CaHA—Radiesse, Merz Aesthetics) biostimulation, and additional non-ablative fractional photothermolysis sessions, supported by a topical cosmeceutical protocol. Documented follow-up extended to December 2024, 13 months after the initiation of treatment at our centre. Clinician-assessed severity of the post-acne atrophic scarring component improved from Goodman & Baron Grade 3 to Grade 2. Global aesthetic improvement of the treated area was rated as +2 (“much improved”) on the GAIS, with a patient satisfaction score of 5/5. No validated grading instrument was applied to the subcutaneous volume deficit itself, for which no such instrument is currently available. Conclusions: This case documents the clinical management and favourable outcome of a patient with severe iatrogenic steroid-induced facial atrophy treated with a personalised multimodal protocol. While the observed improvement is encouraging, the single-case design does not permit conclusions regarding the efficacy, reproducibility, or generalisability of this approach. Future controlled studies are needed to determine the therapeutic value of this multimodal strategy for this rare condition.

Reports doi: 10.3390/reports9030260

Authors: Nelli Arakelyan Denis Reshetov Sergey Yakovenko Inna Kosorukova Denis Islamgulov Tatiana Andreeva

Background and Clinical Significance: The oocyte zona pellucida (ZP) is an extracellular glycoprotein matrix with essential roles in oogenesis, fertilization, and early embryonic development. Abnormal ZP morphology is associated with female infertility and adverse outcomes after assisted reproductive technology (ART), but its molecular basis remains incompletely understood. Case Presentation: We present three patients with female infertility, abnormal oocyte ZP morphology, and adverse embryological outcomes, including fertilization failure and early developmental arrest. Whole-genome sequencing identified an extremely rare heterozygous missense variant in the ZP4 gene (rs1254095560) in one patient, resulting in the p.Leu342Pro substitution at a conserved amino acid position within the functionally important ZP-C subdomain of the protein. In silico modeling showed that the p.Leu342Pro substitution may alter the spatial folding of the ZP4 protein. Conclusions: These results and the known role of ZP4 in the organization of the zona pellucida allow this variant to be considered a candidate genetic factor potentially associated with disruption of the zona pellucida structure. The absence of comparable, apparently pathogenic coding variants in ZP genes in two other patients with a similar zona pellucida phenotype suggests genetic heterogeneity of this phenotype.

Reports doi: 10.3390/reports9030259

Authors: Hannah S. Foster Gregory W. Kirschen Sheri Bechard Kristin D. Gerson

Background and Clinical Significance: Budd–Chiari syndrome (BCS) is a rare disorder characterized by hepatic venous outflow obstruction, often associated with underlying hypercoagulable states. Pregnancy represents a physiologic prothrombotic condition that may precipitate disease onset. Case Presentation: We report a case of de novo BCS diagnosed in the second trimester in a previously healthy 36-year-old multiparous patient. Evaluation revealed cirrhotic liver morphology, portal hypertension, and bleeding esophageal varices requiring emergent treatment. The patient’s course included a transjugular intrahepatic portosystemic shunt (TIPS) procedure with complications, anticoagulation, multidisciplinary care, and a work-up revealing a JAK2 mutation consistent with an underlying myeloproliferative disorder. Despite apparent maternal stabilization and reassuring fetal growth, the pregnancy resulted in intrauterine fetal demise at 34 weeks’ due to placental abruption, followed by postpartum hemorrhage. Conclusions: This case highlights the diagnostic and therapeutic challenges of BCS in pregnancy, and demonstrates that favorable maternal stabilization does not preclude severe obstetric complications.

Reports doi: 10.3390/reports9030258

Authors: Marios Theologou Panagiotis Kyriakongonas Nikolaos Syrmos Theologos Theologou

Background and Clinical Significance: Encephalitis is a rare neurological complication associated with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. In rare cases, focal neuroinflammation can manifest as a mass-like parenchymal lesion, creating profound diagnostic and treatment dilemmas by mimicking primary central nervous system neoplasms. Case Presentation: A 34-year-old female presented with cephalalgia, nausea, confusion, facial palsy, and a new onset of focal impaired awareness seizures (FIAS). Brain magnetic resonance imaging (MRI) revealed a prominent hyperintense lesion within the left temporal lobe with associated vasogenic edema and focal leptomeningeal enhancement highly suspicious of a low-grade glial neoplasm. Although nasopharyngeal RT-PCT was negative, the presence of serum anti-SARS-CoV-2 IgM and IgG suggested recent subclinical SARS-CoV-2 infection. To resolve diagnostic ambiguity and avoid empiric oncological overtreatment, a stereotactic brain biopsy was performed. Histopathology revealed acute neuroinflammation characterized by reactive gliosis, microglial hyperplasia, and perivascular lymphatic cuffing, with no evidence of neoplastic presence. Quantitative tissue RT-PCR confirmed the presence of SARS-CoV-2 (Ct33). Follow-up imaging demonstrated complete resolution of the abnormalities following conservative treatment with corticosteroids and antiepileptics, though mild clinical symptoms persisted for 12 months thereafter. Conclusions: Encephalitis presents a rare yet critical manifestation of SARS-CoV-2. Establishing definitive etiology remains challenging. Stereotactic biopsy is a valuable tool to guide appropriate treatment in cases of ambiguous imaging and clinical findings. Radiographic resolution may precede complete clinical recovery.

Reports doi: 10.3390/reports9030257

Authors: Yan Vares Yarema Vares Łukasz Pałka Raphael Olszewski

Background and Clinical Significance: Implant rehabilitation of patients with acquired maxillofacial defects remains challenging, particularly following high-energy war-related trauma. Gunshot and mine blast injuries frequently result in extensive hard and soft tissue loss, often requiring complex reconstructive procedures. Although cortically anchored implants have been successfully used in patients with severe maxillary atrophy and selected traumatic defects, evidence supporting their use for the immediate rehabilitation of critical-size war-related maxillary defects remains limited. Cortically anchored single-piece implants used in conjunction with an immediate loading protocol may provide an alternative rehabilitation strategy for selected patients who decline, or are unsuitable for, conventional implants and bone-grafting procedures. Case Presentation: Two patients with critical-size maxillary defects (approximately 3 cm) resulting from gunshot and mine blast injuries are presented. Treatment consisted of extraction of non-restorable teeth, placement of cortically anchored single-piece implants, including tubero-pterygoid implants, followed by immediate loading with fixed hybrid metal–acrylic hybrid prostheses. Clinical and radiological evaluation was performed using panoramic radiography and cone-beam computed tomography. Conclusions: Successful implant-supported prosthetic rehabilitation was achieved in both patients. Cortically anchored implants engaging the basal bone of the maxilla provided stable support for immediately loaded fixed prostheses despite substantial hard and soft tissue loss. Functional and aesthetic outcomes were satisfactory. Immediate prosthetic rehabilitation was successfully completed in both patients. A 12-month clinical and radiographic follow-up was available for one patient and demonstrated stable implant function without biological or prosthetic complications. Long-term follow-up of the second patient was not available because of active military service. Cortically anchored implant-supported hybrid prostheses may represent a viable treatment option for selected patients with critical-size maxillary defects resulting from gunshot or mine blast injuries, enabling rapid restoration of oral function and facial aesthetics while avoiding extensive bone-grafting procedures.

Reports doi: 10.3390/reports9030256

Authors: Jan Naseer Kaur Parikshit Padhi Abhinav Dodeja

Background and Clinical Significance: The most common cause of liver toxicity with the use of immune checkpoint inhibitors (ICIs) is autoimmune hepatitis. As most patients with prior viral infections such as hepatitis B and hepatitis C were excluded in trials for the use of ICIs, the safety of ICIs in these patients with active or prior treated hepatitis is unknown. With expanded use of these medications in many malignancies, it is important to understand the risk of viral reactivation with these medications. There are only few case series and reports documenting hepatitis B reactivations with the use of ICIs. Case Presentation: We present a middle-aged woman with a history of treated hepatitis B who presented with metastatic gastric cancer. She was treated with two cycles of 5-FU, oxaliplatin and nivolumab followed by maintenance nivolumab. After 14 months of nivolumab, she developed marked transaminitis and was found to have reactivation of hepatitis B. As autoimmune hepatitis was the initial suspicion, the patient was initiated on prednisone 1 mg/kg with no improvement in transaminases. Due to the significant elevation of HBV DNA, she was diagnosed with hepatitis B reactivation. She was initiated on entecavir with normalization of transaminases and improvement in HBV DNA levels. She was successfully rechallenged with nivolumab with no evidence of recurrent transaminitis or worsening HBV DNA levels. Conclusions: There are case series of HBV reactivation with the use of ICIs. We believe that any patients with known history of HBV should get baseline viral titers prior to initiation of ICIs with serial monitoring of DNA levels. Prospective studies to evaluate risk of reactivation may need to be performed for us to get a better understanding of risks of viral reactivation and potential effects it may have on safety and efficacy of ICIs.

Reports doi: 10.3390/reports9030255

Authors: Alice Arduini Rita Polati Giulio Luigi Bonisoli Sokol Sina

Background and Clinical Significance: Metaplastic breast carcinoma (MBC) is a rare type of breast tumor with various subtypes. MBCs are typically high-grade and exhibit a particularly aggressive behavior, with a significant propensity for recurrence and specific chemoresistance, especially in neoadjuvant settings. One of its high-grade variants is the metaplastic carcinoma with heterologous mesenchymal differentiation (MCHMD). At present, the literature regarding the genetic predisposition of MBC and its connection with BRCA2 is limited. Hence, we present a rare case of a 51-year-old patient with a germline BRCA2 pathogenic variant affected by MCHMD. Case presentation: A 51-year-old Caucasian woman with a family history of breast cancer noticed a lump in her right breast. A needle biopsy of the mass resulted in a diagnosis of poorly differentiated (G3) invasive ductal carcinoma, associated with a dominant component of pleomorphic carcinoma with osteoclast-like cells. After surgery, the pathological report diagnosed a metaplastic carcinoma of the breast with heterologous mesenchymal differentiation (MCHMD) according to the WHO 2019 classification. Genetic testing revealed the presence of the pathogenic variant c.9676del of the BRCA2 gene. Conclusions: We report, to the best of our knowledge, the first case of a BRCA2 mutation in a woman with metaplastic carcinoma of the breast with heterologous mesenchymal differentiation.

Reports doi: 10.3390/reports9030254

Authors: Konstantina Salveridou Theodoros Tzamalis Sabine Haase Aristoteles Giagounidis

Background and Clinical Significance: The COVID-19 pandemic led to the rapid development of effective vaccination strategies. Although COVID-19 vaccines are generally safe, rare hematological adverse events have been reported, most prominently vaccine-induced immune thrombotic thrombocytopenia (VITT). Isolated cases of autoimmune cytopenias and bone marrow failure syndromes following COVID-19 vaccination have also been described. Case Presentation: We report the case of an 80-year-old male who developed subacute-onset severe normocytic anemia with reticulocytopenia and mild leukopenia following heterologous COVID-19 vaccination with ChAdOx1 nCoV-19 (AstraZeneca) and BNT162b2 (Pfizer–BioNTech). Seven days after the second vaccination, mild anemia was detected, progressing over the following weeks to symptomatic anemia requiring hospitalization. Extensive diagnostic evaluation revealed no evidence of hemolysis, nutritional deficiency, autoimmune disease, or viral infection, including SARS-CoV-2 and Parvovirus B19. Bone marrow examination demonstrated an erythroid maturation arrest at the proerythroblast stage, resembling a pure red cell aplasia (PRCA)-like pattern. Cytogenetic and molecular analyses excluded myelodysplastic syndromes. Treatment with erythropoietin resulted in complete hematologic recovery. Conclusions: This case suggests that, in rare instances, COVID-19 vaccination may be temporally associated with transient suppression of erythropoiesis. Further studies are required to elucidate underlying mechanisms and to guide diagnosis and management.

Reports doi: 10.3390/reports9030253

Authors: Grigorios Kastanis Mikela-Rafaella Siligardou Nikolaos Ritzakis Alexandros Tsioupros Constantinos Chaniotakis

Background and Clinical Significance: Dupuytren’s disease (DD) is characterized by abnormal myofibroblast proliferation and excessive collagen deposition, leading to the formation of pathological fibrous cords. It typically affects the palmar surface of the hand, where these contractile cords cause progressive flexion contractures of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. Lesions involving the proximal interphalangeal (PIP) joint without significant flexion contracture may be misdiagnosed as soft-tissue tumors or inflammatory lesions based on imaging findings, including magnetic resonance imaging (MRI) and ultrasound; Case Presentation: We present a case of a soft-tissue mass located on the volar aspect of the proximal phalanx of the little finger, associated with a mild PIP joint contracture. The initial MRI findings suggested a giant-cell tumor of the tendon sheath; however, the diagnosis of Dupuytren’s disease was established only after histopathological examination; Conclusions: This case highlights the importance of considering DD in the differential diagnosis of peripheral soft-tissue lesions of the finger, particularly when presenting with only mild PIP joint contracture and atypical imaging features.

Reports doi: 10.3390/reports9030252

Authors: Adnan Hussain Alrashed Abdullah Abdulhadi Alamer Mohammed Jassim Alhassan Abdullah Mansour Alkhars Fatimah Mustafa Althabit Mashael Abdulrahman Alhussain Abdullah Fahmi Alkhars

Background and Clinical Significance: Scaphoid fractures and nonunion are uncommon in skeletally immature patients. Pediatric nonunion most often follows a missed or delayed diagnosis or failure of conservative treatment. Inferior-pole nonunion is particularly uncommon, and evidence guiding graft selection in children is limited. We report a case in which preoperative and intraoperative assessment of fragment viability supported the use of a non-vascularized graft. Case presentation: A 12-year-old boy sustained a right inferior-pole scaphoid fracture after falling onto an outstretched hand. The fracture was missed at the initial emergency-department visit. Thumb-spica immobilization was subsequently prescribed, but the patient repeatedly removed the cast, missed appointments, and was lost to follow-up. At referral six months after injury, radiographs and multiplanar CT demonstrated established inferior-pole nonunion. MRI showed preserved marrow fat signal in both fragments without osteonecrosis. Open reduction and internal fixation were performed through a dorsal approach using a 2.4 mm headless compression screw and approximately 1 cc of cancellous iliac-crest autograft. Intraoperatively, both fragments appeared viable, without cystic or sclerotic change. At two months, the patient was pain-free and radiographs showed progressing union. The Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score improved from 25 preoperatively to 10 at two months. CT at six months confirmed complete osseous union, with a QuickDASH score of 0. At 1.5 years, he remained pain-free, had full flexion with a 5° terminal extension lag, and had returned to table tennis without functional limitation. Conclusions: In this inferior-pole scaphoid nonunion, open reduction and internal fixation with iliac-crest cancellous autograft achieved CT-confirmed union and sustained functional recovery. MRI and intraoperative confirmation of viable bone supported selection of a non-vascularized graft. At 1.5 years, the patient was pain-free, had returned to sport without functional limitation, and had a QuickDASH score of 0.

Reports doi: 10.3390/reports9030251

Authors: Konstantinos Gkialas Anna Papakonstantinou Evangelos Fragkiadis Napoleon Moulavasilis Panagiotis Mitsos

Background and Clinical Significance: Endoscopic ureterocele incision is the preferred initial treatment for ureteroceles associated with duplex collecting systems due to its capability for rapid decompression via a minimally invasive technique with generally favorable outcomes among pediatric patients. However, the postoperative trajectory in children with solitary functioning renal units remains inadequately characterized. We present a severe, yet reversible, case of postrenal acute kidney injury (AKI) following endoscopic ureterocele incision in an infant with a contralateral multicystic dysplastic kidney (MCDK). This case emphasizes the pathophysiological implications of failed ureterocele decompression and the vital importance of rigorous postoperative monitoring. Case Presentation: A female infant with a right MCDK and a left duplex collecting system featuring an upper pole ureterocele underwent transurethral endoscopic incision due to progressive hydronephrosis. Within 24 h following surgery, the patient exhibited oliguria, oedema, worsening hydronephrosis, hyponatremia (125 mmol/L), metabolic acidosis, and increasing serum creatinine levels, indicative of postrenal AKI. Arterial blood gas analyses indicated severe renal-driven metabolic acidosis with bicarbonate levels of 13.9 mmol/L, accompanied by respiratory compensation and normal lactate levels. Imaging studies revealed deteriorating hydronephrosis of the upper and lower poles of the left kidney. Emergency open nephrostomy placement in the lower pole, after failed jj insertion in the lower pole ureteral orifice, resulted in the immediate restoration of urinary drainage and progressive biochemical recovery. The patient required a brief period of intensive care monitoring, followed by hospitalization in pediatric and urological departments. Longitudinal imaging demonstrated persistent but stable upper pole dilatation with preserved parenchyma. Definitive management was later achieved through right nephrectomy of the non-functioning MCDK. Conclusions: In patients with solitary functioning renal units, the endoscopic ureterocele incision may result in postoperative local oedema, potentially leading to clinically significant obstructive AKI. This case underscores the necessity for intensified surveillance and individualized postoperative management strategies in anatomically complex pediatric patients.

Reports doi: 10.3390/reports9030250

Authors: Sahar Ahmed Abdalbary Sherif M. Amr Ahmed Al-Feeshawy Ehab A. A. El-Shaarawy Khaled Abdelghany Ahmed Abdel Moghny Mohamed Abdel-Wahed

Background and Clinical Significance: Clavicular fractures account for approximately 2.6% of all fractures, with 80% of clavicular fractures occurring in the middle-third of the bone. The middle-third of the clavicle lies directly under the skin without any protection from soft tissue or muscle attachments. The purposes of this case report are as follows: (1) to represent the prosthesis and its operative implantation and (2) to assess the radiological and clinical outcomes of using the prosthesis after a 2.5-year follow-up of the patient; Case Presentation: We present the case of a midshaft clavicle fracture in a 26-year-old, right-handed, male patient following a failure of conservative and open reduction and internal fixation of the fracture. A three-dimensional (3D) customized prosthesis with polyamide was designed for the patient. The patient presented 2.5 years after surgery with a VAS score of 2 and a DASH score of 21, and radiographic evaluation revealed good prosthesis position and no evidence of a stress fracture or unanticipated complications; Conclusions: This is a single case with successful polyamide prosthesis fixation in the treatment of a midshaft clavicle fracture after the failure of plate fixation.

Reports doi: 10.3390/reports9030248

Authors: Venera Berisha-Muharremi Alberta Humolli Jehona Telaku Fisnik Kurshumliu Reshat Mati

Background and Clinical Significance: The co-occurrence of Hashimoto thyroiditis (HT), Graves’ disease (GD), and papillary thyroid carcinoma (PTC) is an extremely rare event and offers a unique opportunity to examine how chronic autoimmune thyroid disease may interact with the process of thyroid cancer development. Case Presentation: We present the case of a 42-year-old female with long-standing autoimmune thyroid disorders who developed progressive Graves’-related orbitopathy that did not improve with corticosteroid therapy. Owing to persistent hyperthyroidism and worsening orbital symptoms, she underwent total thyroidectomy. A histopathological examination of the removed thyroid gland surprisingly found PTC developing within a background of chronic autoimmune inflammation. The patient’s postoperative course included stable thyroid hormone replacement, a significant decrease in serum levels of thyroid autoantibodies, and clinical improvement in her orbital symptoms following decompressive surgery, although partial visual impairment persisted. Conclusions: This case highlights how chronic thyroid autoimmunity may create a carcinogenic environment and emphasizes the importance of comprehensive histopathological assessment and multidisciplinary care for patients with complex autoimmune thyroid disease.

Reports doi: 10.3390/reports9030249

Authors: Ondrej Placek Tomas Krejci Radim Lipina Vaclav Prochazka

Background and Clinical Significance: Carotid-cavernous fistulas (CCFs) are pathological communications between the carotid artery and the cavernous sinus, most commonly traumatic when direct and high-flow (Barrow type A). Bilateral traumatic CCFs are rare, occurring in approximately 1–2% of cases. Case Presentation: We report a 45-year-old male with polytrauma after a road traffic accident who presented with right-sided chemosis, pulsatile exophthalmos, and ocular bruit. Digital subtraction angiography revealed bilateral direct CCFs. The right fistula was treated with transarterial coil embolization combined with flow-diverter stent placement in the intracavernous internal carotid artery. Subsequent imaging demonstrated left-hemispheric ischemia while the contralateral high-flow CCF remained untreated; the underlying mechanism was considered potentially hemodynamic or thromboembolic. The left fistula was managed using the same technique. Final angiography confirmed complete bilateral occlusion. Despite transient postoperative epistaxis, the patient showed neurological improvement. Conclusions: This case highlights the effectiveness of combined flow diversion and coiling in managing rare bilateral traumatic CCFs.

Reports doi: 10.3390/reports9030247

Authors: Nagi A. Massoud Mohamed Mahmoud Bakr Abdulrahman H. Alashkar Mohamed Ghazala

Background and Clinical Significance: Periorbital ecchymosis, or “raccoon eyes,” often indicates a basilar skull fracture. When trauma is absent, clinicians should consider other causes, such as Valsalva maneuvers, bleeding disorders, or systemic inflammation. Spontaneous orbital hemorrhage is rare, and its appearance as a mass causing a secondary orbital roof blow-out fracture is even more unusual. This report presents a unique case of primary spontaneous orbital hemorrhage (PSOH) leading to a secondary orbital blow-out fracture; Case Presentation: A 60-year-old man with a history of ulcerative colitis (UC) presented with acute-onset, non-traumatic, and bilateral periorbital bruising, swelling, and right-sided vision loss. Computed tomography (CT) showed a mass lesion in the right orbit with an associated orbital roof fracture. Following excision, histological examination showed extravasated blood. Additional laboratory work-up helped rule out possible hematologic and inflammatory etiologies, confirming a diagnosis of PSOH with a secondary orbital roof fracture; Conclusions: This case demonstrates that PSOH can generate sufficient intra-orbital pressure (IOP) to cause a secondary blow-out fracture, a phenomenon not previously reported in the literature. Furthermore, it emphasizes the need for a systematic diagnostic approach to exclude potential systemic etiologies in patients presenting with spontaneous periorbital ecchymosis. In addition, this case highlights the critical importance of rapid decompression in managing orbital compartment syndrome (OCS) to prevent permanent visual loss.

Reports doi: 10.3390/reports9030246

Authors: Misaki Inoue Akira Motoyasu Shogo Ema Joho Tokumine Kiyoshi Moriyama

Background and Clinical Significance: Spina bifida occulta may be associated with occult spinal dysraphism, including a low-lying conus medullaris or tethered cord, which can increase the risk of neurological injury during neuraxial anesthesia. We report a case in which preoperative magnetic resonance imaging (MRI) and lumbar ultrasonography supported individualized planning for spinal anesthesia for cesarean delivery. Case Presentation: A 31-year-old woman at 37 weeks of gestation was scheduled for elective cesarean delivery because of marginal placenta previa. She had chronic low back pain, and previous lumbar radiography and computed tomography had demonstrated radiographic spina bifida occulta. Preoperative lumbar MRI confirmed that the conus medullaris terminated normally at L1 and showed no evidence of tethered cord, filum terminale thickening, spinal lipoma, or abnormalities at the planned L3/4 puncture site. Based on these findings and discussion with the patient, spinal anesthesia was selected. Immediately before the procedure, lumbar ultrasonography was used to identify the L3/4 interspace, visualize the posterior complex, and estimate needle depth. Spinal anesthesia was successfully achieved with a 27-gauge pencil-point needle and intrathecal hyperbaric bupivacaine, morphine, and fentanyl. Cesarean delivery was completed without new neurological deficits or major anesthetic complications. Conclusions: Preprocedural MRI and lumbar ultrasonography supported individualized anatomical assessment and anesthetic planning in this patient.

Reports doi: 10.3390/reports9030245

Authors: Jimei Zhao Kaoru Shigeta Risa Yamamoto Sara Watanabe Ayako Chida-Nagai Hirokuni Yamazawa Tatsuya Akitomo Koichi Nakamura

In patients undergoing endotracheal intubation and mechanical ventilation, damage to the endotracheal tube or inflation line is a potential risk with life-threatening consequences. Although various devices and bite blocks have been developed to secure the endotracheal tube and prevent its dislodgement or damage, they are not suitable for children or newborns. We describe a 1-year-and-2-month-old girl who required long-term endotracheal intubation and mechanical ventilation. The eruption of the lower deciduous incisors caused damage to the inflation line. A mouthguard was not appropriate because her teeth had erupted only slightly, and the retention was insufficient. After collaborating with a dental technician to fabricate a protective device, we were able to provide the optimal treatment while minimizing invasiveness to the patient. It is necessary to collaborate with other professionals as a team to select the optimal medical care tailored to each patient.

Reports doi: 10.3390/reports9030244

Authors: Vasileios Petrakis Dimitrios Themelidis Maria Panopoulou Pelagia Kriki Pipitsa N. Valsamaki Dimitrios Papazoglou Periklis Panagopoulos

Background and Clinical Significance: Tenofovir disoproxil fumarate (TDF) is a widely prescribed nucleotide reverse transcriptase inhibitor (NtRTI) for HIV-1 infection. Though generally well-tolerated, proximal renal tubulopathy resulting in full-blown Fanconi syndrome remains a rare but severe complication (<0.1%). Case Presentation: We present the case of a 52-year-old female living with HIV-1 (diagnosed in 1999, CDC stage A3) who had been treated with a TDF-based antiretroviral regimen for 12 years. Upon admission, she complained of progressive bone pain and polyuria over the preceding six months. Laboratory investigations revealed profound hypokalemia, severe hypophosphatemia, hypouricemia, elevated alkaline phosphatase (ALP) and a decline in renal function (creatinine 1.3 mg/dL from a baseline of 0.7 mg/dL). Arterial blood gas (ABG) analysis showed a normal anion gap hyperchloremic metabolic acidosis alongside respiratory acidosis. Urinalysis demonstrated profound glycosuria in the setting of normal blood glucose levels, coupled with increased 24 h urinary excretion of potassium and phosphorus. A bone scintigraphy demonstrated a “super scan” pattern of metabolic etiology, establishing secondary osteomalacia driven by renal phosphate wasting. Secondary hyperparathyroidism and severe vitamin D3 deficiency were also recorded. The diagnosis of TDF-induced Fanconi syndrome was established. TDF was discontinued, and her antiretroviral regimen was modified to tenofovir alafenamide fumarate (TAF), emtricitabine (FTC), darunavir, and ritonavir, combined with vitamin D supplementation. Over a 6-month follow-up period, renal function normalized, electrolyte wasting resolved, and metabolic acidosis completely reversed. Conclusions: This case highlights that TDF-induced proximal tubulopathy can manifest even after a decade of uneventful therapy, particularly when co-administered with a boosted protease inhibitor.

Reports doi: 10.3390/reports9030243

Authors: Reports Editorial Office Reports Editorial Office

The Reports Editorial Office and the Editor-in-Chief would like to inform readers of concerns regarding potential scientific irregularities identified in this case report [...]

Reports doi: 10.3390/reports9030242

Authors: Jun Yamaguchi Joho Tokumine Kiyoshi Moriyama Harumasa Nakazawa

Background and Clinical Significance: Anti–myelin-associated glycoprotein (MAG) antibody polyneuropathy is a rare, chronic IgM-mediated demyelinating peripheral neuropathy predominantly affecting sensory nerves in older adults, commonly in association with monoclonal gammopathy of undetermined significance. Reports describing anesthetic management in patients with this condition remain extremely limited, and no specific guidelines currently exist regarding neuromuscular blocking agent (NMBA) use or neuromuscular monitoring in this population. Case Presentation: A 79-year-old man with anti-MAG antibody polyneuropathy (diagnosed in 2007) and IgM monoclonal gammopathy of undetermined significance developed disproportionate progressive lower-extremity weakness and became wheelchair-dependent following COVID-19 infection in 2020. Preoperative evaluation revealed mildly reduced left ventricular function (ejection fraction 49%), mild chronic kidney disease, and marked intrinsic hand muscle atrophy with absent deep tendon reflexes. He was scheduled for robot-assisted radical cystectomy with ileal conduit diversion under combined general and thoracic epidural anesthesia. Before NMBA administration, neuromuscular monitoring was systematically attempted at the ulnar nerve (electromyography and acceleromyography, up to 60 mA/300 μs) and the corrugator supercilii; despite visible muscle contractions following peripheral nerve stimulation, neither modality produced reliable responses at either site. Given the inability to establish reliable monitoring, the administration of NMBAs was considered to carry an unacceptable risk of a prolonged, undetectable blockade. Anesthesia was maintained with deep sevoflurane (2.0–2.5% end-tidal) and remifentanil infusion without NMBAs, titrated to a bispectral index of 40–60. Tracheal intubation was accomplished via video laryngoscopy without NMBA. The 7 h and 30 min surgery was completed without patient movement or surgical compromise. Postoperatively, the patient developed transient upper airway obstruction attributed to glossoptosis, managed successfully with head elevation and nasopharyngeal airway insertion; supplemental oxygen was required until postoperative day 3, and the patient was discharged from the high-dependency unit on postoperative day 5. Conclusions: No measurable quantitative neuromuscular response could be obtained in this patient with advanced anti-MAG antibody neuropathy, despite appropriate application of electromyography- and acceleromyography-based monitoring and the presence of visible muscle contractions following peripheral nerve stimulation. In such circumstances, avoiding NMBA administration in favor of deep volatile or intravenous anesthesia with opioid supplementation may represent a reasonable, hypothesis-generating approach in carefully selected patients; this observation does not establish the general superiority of an NMBA-free strategy, and caution is warranted before generalizing it to procedures such as robotic surgery, in which profound neuromuscular blockade is often considered desirable.

Reports doi: 10.3390/reports9030241

Authors: Ajlan Alajlani Nouf Almagushi Fahad Almuhaymizi Ruaa Alharithy

Background and Clinical Significance: Blistering distal dactylitis is a localized infection of the distal phalanx, most commonly affecting children and adolescents and typically caused by group A β-hemolytic Streptococcus. Infections due to atypical organisms are rare. Involvement of atypical organisms such as Acinetobacter lwoffii is extremely rare; Case Presentation: We report an 18-month-old boy presenting with hemorrhagic crustation over bilateral big toes for 2 weeks; wound culture swab revealed Acinetobacter lwoffii. Patient was managed with 5 mL of trimethoprim–sulfamethoxazole twice daily for a week; Conclusions: This case highlights the rare involvement of Acinetobacter lwoffii in blistering distal dactylitis and emphasizes the importance of culture-guided diagnosis and treatment.

Reports doi: 10.3390/reports9030240

Authors: Alban Landeros Cheryld Mutel Mauricio Soto Luis Quiñiñir

Background/Objectives: Cardiac implantable electronic device (CIED) infections are infrequent but clinically significant, and Latin American—particularly Chilean—data remain scarce. We aimed to describe the clinical and microbiological profile, complications, mortality, and local infection burden of CIED infections at a tertiary center in southern Chile. Methods: This was a retrospective descriptive cohort study of all patients treated for CIED infection at Hospital Dr. Hernán Henríquez Aravena between January 2015 and December 2021. Crude per-procedure infection proportions were calculated using locally implanted devices (primary implants, generator replacements, and upgrades) as the denominator; because annual implant volumes and individual follow-up times were not retrievable, only exploratory approximate rates per 100 patient-years were derived under strong assumptions and were not used for formal comparison. Results: Fifty-four patients were included (77.8% men; mean age 69 ± 14 years). Predominant comorbidities were arterial hypertension (79.6%), heart failure (40.7%), atrial fibrillation (27.8%), and type 2 diabetes mellitus (24.1%). Pacemakers accounted for 59.3% of infections, and late-onset cases predominated (48.2%). The overall per-procedure infection proportion was 1.4% (95% confidence interval [CI] 1.1–1.9%) and was numerically higher for implantable cardioverter-defibrillators (ICDs; 5.5%) and cardiac resynchronization therapy (CRT) devices (4.3%) than for pacemakers (1.1%). Coagulase-negative Staphylococcus (43.2%) and Staphylococcus aureus (24.3%) were the leading isolates, although microbiological sampling was incomplete (available in 68.5%). Complete system extraction was attempted in all patients and achieved in all but one case; recurrence occurred in 9.3% and in-hospital mortality in 1.9%. Conclusions: The clinical and microbiological profile of CIED infections in this single-center southern Chilean cohort was broadly consistent with international series. Per-procedure proportions for ICDs and CRT devices were numerically higher than those for pacemakers, but the retrospective design, a procedure-based denominator including replacements and upgrades, and incomplete echocardiographic and microbiological workup preclude formal comparison with time-to-event registries; these device-specific findings should be regarded as exploratory and hypothesis-generating. The findings identify concrete, locally actionable targets: more systematic microbiological sampling, broader pre-procedural and diagnostic echocardiography (including transesophageal studies), and strengthened long-term follow-up of CIED carriers.

Reports doi: 10.3390/reports9030239

Authors: Konstantina Dinaki Constantinos Papadopoulos Rafail Ioannidis Konstantinos Valsamidis Athanasia Printza

Background and Clinical Significance: Foreign body aspiration is an important cause of morbidity and mortality in children younger than three years of age. Although laryngeal foreign bodies are uncommon, they may be life-threatening and are frequently misdiagnosed because of their variable clinical presentation. Eggshell aspiration is exceptionally rare, with only a few cases reported in the literature. We report a case of delayed diagnosis of a glottic eggshell foreign body in a toddler presenting with persistent upper airway symptoms. Case Presentation: A 16-month-old previously healthy girl was referred to our hospital for evaluation of persistent hoarseness and barking cough following a witnessed choking episode while eating boiled egg. The choking episode had occurred 15 days before presentation during an episode of viral upper respiratory tract infection. Initial symptoms were attributed to laryngitis and persisted despite medical treatment. Flexible laryngoscopy revealed a foreign body impacted at the glottic level, while neck radiography demonstrated a radiopaque calcified lesion corresponding to the foreign body. Microlaryngoscopy under deep sedation was performed, and an approximately 10-mm eggshell fragment was successfully removed. A small amount of granulation tissue was observed at the posterior commissure, corresponding to the site of foreign body impaction. The postoperative course was uneventful, and repeat endoscopic examination on postoperative day three demonstrated satisfactory laryngeal healing with regression of the granulation tissue. Conclusions: This case highlights the importance of considering a retained laryngeal foreign body in young children with persistent hoarseness or barking cough following a choking episode, even in the presence of concomitant respiratory infection. Early endoscopic evaluation is essential to avoid diagnostic delay and facilitate prompt treatment. In addition, this report emphasizes the importance of food choking prevention and caregiver education in children younger than three years of age.

Reports doi: 10.3390/reports9030238

Authors: Tatsuya Akitomo Yuria Asao Nanako Kataoka Toshinori Ando Mikihito Kajiya Ryota Nomura

Odontoma is one of the most frequent odontogenic tumors, and most cases occur in pediatric patients. A panoramic examination of an 11-year-old boy presenting with a chief complaint of dental caries revealed delayed eruption of the maxillary right second molar and a radiolucency around the crown. In addition, cone-beam computed tomography revealed slight calcifications within a cystic lesion measuring 20 × 18 × 13 mm, and demonstrated root resorption of the first molar. Following root canal treatment of the first molar, the lesion was removed under general anesthesia. Histological findings of the resected lesion confirmed the diagnosis of a developing odontoma. This report highlights the importance of early detection of odontomas through radiographic examination.

Reports doi: 10.3390/reports9030237

Authors: Navanita Biswas Shoja Rahimian

Background and Clinical Significance: Enfortumab vedotin combined with pembrolizumab has emerged as an effective first-line therapy for advanced urothelial carcinoma. While immune checkpoint inhibitors are associated with digestive tract toxicities, upper gastrointestinal involvement such as esophagitis remains rare, and its presentation in combination with enfortumab vedotin is not well characterized. Case Presentation: A 72-year-old man with metastatic urothelial carcinoma presented with generalized weakness, poor oral intake, odynophagia, dysphagia, anemia, and systemic symptoms following the second cycle of combination therapy of enfortumab vedotin and pembrolizumab. Endoscopic evaluation revealed diffuse circumferential ulcerative esophagitis involving the entire esophagus, with associated duodenitis. Infectious workup, including Clostridioides difficile, cytomegalovirus, and human immunodeficiency virus testing, was negative, and HSV-1 IgG was positive, consistent with prior exposure rather than active infection; however, tissue-based testing for active HSV infection was not performed. Lower gastrointestinal evaluation demonstrated nonspecific rectal inflammation. The patient was treated with high-dose intravenous corticosteroids (intravenous methylprednisolone 1 mg/kg/day) with rapid clinical improvement within 48–72 h, followed by a steroid taper and supportive care. Conclusions: This case represents a severe and diffuse manifestation of esophagitis associated with enfortumab vedotin and pembrolizumab therapy. While immune-mediated esophagitis is rare, the combination of antibody–drug conjugate therapy with immune checkpoint inhibition may contribute to synergistic mucosal injury. Early recognition and prompt initiation of immunosuppressive therapy are critical for favorable outcomes. Clinicians should be aware of severe esophagitis as a potential complication of enfortumab vedotin and pembrolizumab therapy. Timely diagnosis and management with corticosteroids can lead to rapid symptom resolution and may prevent serious complications.

Reports doi: 10.3390/reports9030236

Authors: Christopher Stevens Eric Wallace Chaitanya Ahuja

Background and Clinical Significance: Intrahepatic portosystemic venous shunts (IPSVSs) are rare hepatic vascular malformations that occur when there is an abnormal communication between the hepatic and portal veins. IPSVSs can be acquired or congenital, with the latter being the most common. Case Presentation: In this manuscript, we report two cases of symptomatic IPSVSs that were likely congenital in etiology and varied in presentation. The shunts were diagnosed using ultrasound, CT, and MRI, followed by successful treatments with transcatheter embolization procedures. Conclusions: This report highlights the high degree of symptomatic variance that can be seen in patients with symptomatic IPSVSs, as each case presented with different symptomatic features, while also reinforcing the notion that the use of ultrasound, CT, and MRI is of high importance when trying to diagnose IPSVSs. In addition, this article also adds to the existing literature that transcatheter embolization is a valuable therapeutic approach for symptomatic IPSVSs.

Reports doi: 10.3390/reports9030235

Authors: Vincenzo Carfora Francesco Lanza Laura Vona Vittorio Ambrosini

Background and Clinical Significance: Iatrogenic aorto-ostial dissection is a rare but potentially life-threatening complication of percutaneous coronary intervention (PCI), most commonly involving the right coronary artery. Although ostial stenting is generally considered the standard bailout strategy, failure of initial sealing may occur in selected anatomical settings and remains poorly understood. A focused narrative review of the literature was conducted through PubMed/MEDLINE, Scopus and Web of Science to identify reports of PCI-related aorto-coronary dissection with particular attention to dissection morphology, propagation mechanisms, bailout strategies, and outcomes after ostial stenting; Case Presentation: A 76-year-old man presented with non-ST-elevation myocardial infarction. Coronary angiography showed severe ostial right coronary artery (RCA) disease and significant left anterior descending artery stenosis. Following drug-eluting stent implantation in the RCA, extensive aorto-ostial dissection with retrograde extension into the sinus of Valsalva occurred. Initial ostial stenting failed to seal the dissection and was complicated by hyperacute stent thrombosis. After successful rewiring of the true lumen, a second overlapping drug-eluting stent was implanted using a stent-in-stent technique, followed by prolonged balloon inflation, achieving complete sealing and stabilization. Serial computed tomography angiography confirmed stability, and staged PCI of the LAD was successfully performed five days later; Conclusions: Failure of primary sealing may depend not only on procedural factors but also on dissection morphology. Transverse dissections with wide entry tears may be less effectively sealed by a single ostial stent, whereas overlapping stenting with prolonged balloon inflation may represent a more effective bailout strategy.

Reports doi: 10.3390/reports9030234

Authors: Hussain Alessa Afnan Alshayeb Renad Aljasser Abdulaziz Ali Qahtani

Background and Clinical Significance: Gallstone ileus (GI) is a rare but serious complication of gallstone disease. This condition is characterized by migration of gallstones through a cholecystoenteric fistula, resulting in mechanical bowel obstruction. GI primarily affects older patients with multiple comorbidities. Case Presentation: Herein, we describe a case of 68-year-old Saudi woman with a history of end-stage renal disease, pulmonary hypertension, diabetes mellitus, bronchial asthma, and atrial fibrillation. She presented with acute calculous cholecystitis. Due to her condition, she was managed conservatively initially. The patient was recommended laparoscopic cholecystectomy but she declined due to fear of anesthesia-related complications. She re-presented after two months with abdominal pain, vomiting, distension, and constipation. Computed tomography (CT) scan showed a 3.2 cm ectopic gallstone impacted in the distal ileum with proximal bowel dilatation and segmental ischemia, confirming GI. Laparotomy showed bowel ischemia and localized perforation. The patient was managed with enterolithotomy, resection of 25 cm of distal ileum, and primary anastomosis. Post-surgery, the patient had favorable recovery. Conclusions: This case highlights need for early diagnosis and appropriate management of GI in patients with multiple comorbidities.

Reports doi: 10.3390/reports9030233

Authors: Ülkü Figen Demir Fatmanur Karakuş Dilbaz Nur Banu Memur

Background and Clinical Significance: Alien hand syndrome (AHS) is a rare disorder of agency and complex motor control characterized by involuntary, apparently purposeful limb movements experienced as outside voluntary control. Pontine hemorrhage is an uncommon substrate, and its manifestations may overlap with sensory ataxia and other post-stroke movement disorders. Case Presentation: An 86-year-old right-handed man developed right-sided alien hand phenomena after a left pontine hemorrhage. Examination showed dysarthria, limited left gaze, diplopia, preserved muscle strength, marked right-sided proprioceptive impairment, a thalamic-hand-like posture, impaired spatial control, involuntary levitation, intermanual conflict, and purposeful-appearing rubbing movements when distracted. The diagnosis was based on loss of agency and autonomous limb behavior that could not be explained by sensory ataxia alone. Serial CT demonstrated an interval reduction in the size of the pontine hemorrhage; a representative thalamic level CT showed no evident thalamic hemorrhage or gross structural lesion, although a small CT occult ischemic lesion could not be excluded. Repeat MRI was not completed because of severe claustrophobia and anesthesia risk. EEG, formal neuropsychological testing, and standardized functional scales were unavailable. The NIHSS, assessed 15 days after admission to our hospital, was 6 points. No specific pharmacological treatment was initiated. Cognitive-behavioral rehabilitation was recommended, but transportation difficulties prevented regular attendance. Approximately three months after discharge, physician relatives reported resolution of abnormal movements and improved independent gait; no formal post-discharge examination was performed. Conclusions: Pontine hemorrhage may rarely be associated with mixed AHS phenomenology. Disruption of ascending proprioceptive and sensorimotor pathways is plausible, but the absence of advanced imaging and neurophysiological assessment precludes definitive anatomical or causal conclusions.

Reports doi: 10.3390/reports9030232

Authors: Kei Nagasaki Manabu Mitsuhashi Taketoshi Seino Mizuki Toura Yoshifumi Kudo

Background and Clinical Significance: Patellar dislocation is considered uncommon in African populations, a finding often attributed to characteristically deeper femoral trochlear grooves that confer increased patellofemoral stability. Nevertheless, individual anatomical variations may predispose certain patients to instability despite population-based trends; Case Presentation: We report the case of a 12-year-old African pediatric patient who presented with a primary traumatic lateral patellar dislocation. Magnetic resonance imaging (MRI) demonstrated rupture of the medial patellofemoral ligament (MPFL) and a markedly increased sulcus angle of 159°, consistent with a shallow trochlear groove. The patient underwent MPFL reconstruction using a synthetic ligament to minimize the risk of physeal injury; Conclusions: This case shows the importance of individualized anatomical assessment in pediatric patellar instability. Even in populations generally considered to have lower anatomical risk, marked individual variation in trochlear morphology may influence treatment decisions. When surgical stabilization is selected in skeletally immature patients, physeal-sparing techniques should be carefully considered.

Reports doi: 10.3390/reports9030231

Authors: Akash Bharatbhai Patel David Zula Karan Varshney Daryl Thompson Vladamir Bolshinsky

Background and Clinical Significance: Cryptogenic multifocal ulcerating stenosing enteritis (CMUSE) is a rare idiopathic disorder of the small bowel which remains diagnostically challenging because it can closely mimic Crohn’s disease, celiac disease, and non-steroidal anti-inflammatory drug (NSAID)-induced enteropathy; Case Presentation: We report a 44-year-old man with Down syndrome, Hirschsprung’s disease, celiac disease, and multiple prior abdominal operations who developed recurrent small-bowel strictures of uncertain cause. Initial management involved endoscopic assessment and jejunal dilatation, but this became neither technically feasible nor durable as the disease progressed. He therefore underwent exploratory laparotomy with small-bowel resection to relieve obstruction and to obtain adequate tissue for diagnosis. On balance, the presence of multifocal ulceration, recurrent mucosa-predominant strictures, and non-transmural jejunitis supported a diagnosis of CMUSE; Conclusions: This case highlights the rarity and diagnostic difficulty of CMUSE, which may closely resemble Crohn’s disease in patients with recurrent small-bowel strictures and obstructive symptoms. Early and ongoing MDT coordination (surgery, gastroenterology, radiology, dietetics, and infectious diseases) supports anatomy definition, complication control, and coherent long-term management focused on function and quality of life.

Reports doi: 10.3390/reports9030230

Authors: Maryam Izadi Amir Mirnateghi Shiva Shafabakhsh

Background/Objectives: Helicobacter pylori infection is a major cause of chronic gastritis, peptic ulcer disease, and gastric cancer. Although accurate diagnostic tests are available, their cost, accessibility, and invasiveness may limit their routine use, particularly in resource-limited settings. Because dyspeptic symptoms are frequently used to guide testing decisions, identifying symptom patterns associated with H. pylori infection may improve patient selection for diagnostic testing. This study evaluated the association between gastrointestinal symptoms, particularly burning epigastric pain that worsens on an empty stomach, and H. pylori stool antigen positivity. Methods: This retrospective observational study included 589 adults who underwent H. pylori stool antigen testing at a private laboratory in Tehran, Iran, between May 2021 and June 2022. Patients were classified as H. pylori-positive (n = 353) or H. pylori-negative (n = 236) based on stool antigen test results. Gastrointestinal symptoms documented in patient records were compared between groups using chi-square analysis. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of burning epigastric pain were also calculated. Results: Burning epigastric pain that worsens on an empty stomach was significantly more common in H. pylori-positive than H. pylori-negative patients (76.2% vs. 4.2%; p < 0.00001). Significant associations were also observed for bloating, persistent vomiting, dysphagia, diarrhea, constipation, and melena. Burning epigastric pain demonstrated a sensitivity of 76.2%, specificity of 95.8%, PPV of 96.4%, and NPV of 72.9%. Overall, 99.7% of H. pylori-positive patients reported at least one gastrointestinal symptom compared with 35.2% of H. pylori-negative patients. Conclusions: Burning epigastric pain that worsens on an empty stomach was strongly associated with H. pylori stool antigen positivity and may help clinicians identify patients who are more likely to benefit from diagnostic testing. However, symptoms alone are insufficient for diagnosis and should complement, rather than replace, established diagnostic methods. Prospective studies using standardized symptom assessment and multiple diagnostic modalities are needed to validate these findings.

Reports doi: 10.3390/reports9030229

Authors: Alexandra Paraschiv Teodora-Oana Iordache Elena-Doina Magheran Vasile Grigorie Daniel Dumitru Dinescu Ioana-Mădălina Moșteanu Ana-Luiza Iorga

Background and Clinical Significance: Solitary fibrous tumors (SFTs) of the pleura are rare mesenchymal neoplasms accounting for less than 5% of pleuro-pulmonary tumors. Recurrence after complete resection of benign SFT is exceptional, with an estimated rate of approximately 3%. Case Presentation: We describe a 78-year-old woman who developed a late recurrence 10 years after resection of a giant benign pleural SFT. The new pleura-based mass was confirmed as SFT by CT-guided biopsy demonstrating spindle-cell morphology, patternless architecture, staghorn vasculature, and STAT6/CD34 positivity, consistent with intermediate-risk disease by Demicco scoring. Surgical tumorectomy was successfully performed. Conclusions: This case illustrates the unpredictable long-term behavior of pleural SFTs and reinforces the importance of extended imaging surveillance even in initially benign lesions. An updated review of contemporary classification systems, molecular mechanisms, and management strategies is included.

Reports doi: 10.3390/reports9030228

Authors: Raeshun T. Glover Robert W. Maitta Yi-Yuan Zhou

Background and Clinical Significance: Extracorporeal therapies such as hemodialysis, continuous renal replacement therapy (CRRT) or therapeutic plasma exchange (TPE) are mainstay treatments for acute toxins, venoms and poisonings. Ibuprofen is a common drug implicated in acute toxicity, with a major complication being acute kidney injury (AKI). As such, these patients often receive hemodialysis or CRRT, which do not remove substances with high protein binding (>80%) and low volumes of distribution (Vd) (<0.2 L/kg). The pharmacokinetics of ibuprofen have these characteristics. While hemodialysis or CRRT can clear the accumulated toxic metabolites, they do not remove the ibuprofen that causes renal injury. In contrast, TPE can remove protein-bound drugs such as ibuprofen. Case Presentation: We describe the case of a previously healthy young male who presented with AKI due to ibuprofen toxicity requiring concurrent continuous renal replacement therapy and plasma exchange. Conclusions: TPE in conjunction with hemodialysis or CRRT is an effective treatment modality for ibuprofen toxicity.

Reports doi: 10.3390/reports9030227

Authors: Ramona Celia Moisa Nicoleta Negrut Cezar Cristian Mihai Moisa Denisa Florina But Harrie Toms John Paula Marian

Background and Clinical Significance: Uterine atony is the most frequent cause of postpartum hemorrhage and remains a major contributor to maternal morbidity worldwide. Neuraxial opioids are routinely used as adjuvants for labor analgesia and cesarean delivery anesthesia; however, their possible influence on myometrial contractility remains incompletely clarified. We describe a severe case of refractory uterine atony after emergency cesarean delivery in a patient exposed sequentially to epidural fentanyl during labor and intrathecal morphine for cesarean anesthesia; Case Presentation: A 34-year-old primigravida at 39 weeks and 4 days of gestation presented with early labor that had begun less than one hour earlier. Epidural labor analgesia was provided with ropivacaine, and the total epidural fentanyl exposure was 100 mcg over an approximately 7 h catheter period. Labor was complicated by dysfunctional uterine activity and cervical dystocia despite 3 h and 30 min of oxytocin augmentation. Emergency cesarean delivery was performed under spinal anesthesia with hyperbaric bupivacaine and intrathecal morphine. After delivery of a healthy neonate and uncomplicated placental separation, the patient developed severe uterine atony with postpartum hemorrhage. Hemorrhage persisted despite uterotonic therapy, continuous uterine massage, hemostatic suturing, and B-Lynch compression suture. Blood loss, measured using the suction canister and estimated from surgical swabs, was approximately 3800 mL. Progressive hemodynamic instability required transfusion therapy, conversion to general anesthesia, norepinephrine support, and emergency total abdominal hysterectomy. The postoperative course was favorable, and the patient was discharged on the eighth postoperative day; Conclusions: This case illustrates the rapid progression and therapeutic complexity of refractory uterine atony after emergency cesarean delivery in the setting of dysfunctional labor, oxytocin augmentation, cesarean delivery, sequential neuraxial opioid exposure, and subsequent hemorrhagic instability. A possible contribution of sequential neuraxial opioid administration to impaired myometrial contractility cannot be excluded; however, causality cannot be established from a single case. Early recognition, structured escalation, transfusion support, and timely multidisciplinary surgical management remain essential in severe postpartum hemorrhage.

Reports doi: 10.3390/reports9030226

Authors: Nusret Bajrami Sidre Sahin-Uzuner Sylvia Stadlmann Michael Kostrzewa

Background and Clinical Significance: Intravascular large B-cell lymphoma (IVLBCL) is an exceedingly rare and aggressive malignancy characterized by the selective growth of lymphoma cells within blood vessel lumina. This malignancy often presents with non-specific systemic manifestations, making diagnosis challenging. Neurological symptoms and cutaneous findings are typical, whereas thrombotic events are uncommon at the initial presentation. We report a unique case of IVLBCL with MYC and BCL2 rearrangements (“double-hit” genetics), diagnosed following mechanical thrombectomy; Case Presentation: A 79-year-old woman presented with acute right-lower-limb swelling due to extensive iliofemoral deep vein thrombosis. Mechanical thrombectomy was performed, and the histopathological and genetic examination of the retrieved material revealed IVLBCL. Subsequent staging with positron emission tomography-computed tomography (PET-CT) demonstrated an FDG-avid tumor thrombus confined to the right internal iliac vein, without any lymphadenopathy or solid tumor mass. The patient was successfully treated with a combination of systemic chemoimmunotherapy and targeted radiotherapy and remained in complete remission for more than four years after diagnosis; Conclusions: We report a potentially unique case of double-hit IVLBCL diagnosed using endovascular thrombectomy. This underscores the therapeutic and diagnostic potential of mechanical thrombectomy systems in the detection of intravascular malignancies and the critical importance of the routine histopathological examination of all thrombectomy specimens. Despite negative thrombolysis data from the ATTRACT and CAVA trials, mechanical thrombectomy may improve venous hemodynamics and may reduce post-thrombotic syndrome (PTS) in pelvic thrombosis. Here, mechanical thrombectomy followed by right iliac vein stenting achieved excellent technical and clinical outcomes.

Reports doi: 10.3390/reports9030225

Authors: Khaled Abdulwahab Amer Nawaf Ibrahim Al Shuqayfah Mohammad Abdallah Alhakamy Abdullah Jaber Alasiri

Background and Clinical Significance: Heerfordt syndrome (uveoparotid fever) is an uncommon extrapulmonary expression of sarcoidosis defined by parotid enlargement, uveitis, low-grade fever, and facial nerve palsy. It is identified in fewer than 1% of patients with biopsy-confirmed sarcoidosis, and the co-occurrence of bilateral seventh-nerve palsy with calcitriol-driven obstructive kidney injury has been reported only sporadically. Recognizing this metabolic-renal phenotype is clinically important because it is readily reversible yet easily missed when the chest radiograph is normal. Case Presentation: A 30-year-old man presented with four months of progressive bilateral parotid swelling, sicca symptoms, and intermittent blurred vision, preceded by a self-limited episode of bilateral simultaneous peripheral facial weakness; renal colic developed one month before admission. Evaluation showed parathyroid-hormone-independent hypercalcemia (peak corrected calcium 13.1 mg/dL), a serum angiotensin-converting enzyme level above 100 U/L, and acute kidney injury (creatinine 2.1 mg/dL) caused by bilateral upper-ureteric calculi with hydronephrosis. Posterior uveitis was confirmed ophthalmologically. Chest radiography and high-resolution thoracic computed tomography were unremarkable, with no hilar lymphadenopathy. Parotid gland biopsy demonstrated non-caseating epithelioid granulomas. Bilateral ureteric stenting and oral prednisolone 40 mg daily produced rapid normalization of serum calcium, recovery of renal function, and regression of parotid enlargement. Conclusions: This report characterizes a phenotype that combines bilateral simultaneous facial-nerve involvement, calcitriol-mediated hypercalcemia, and obstructive nephrolithiasis without coexistent pulmonary disease. It argues for early consideration of sarcoidosis whenever hypercalcemia, parotid enlargement, and cranial neuropathy occur together, and reinforces the reversibility of sarcoidosis-related renal injury when corticosteroids are introduced promptly.

Reports doi: 10.3390/reports9030224

Authors: Luigi Di Lorenzo Hassan Zmerly Emiliano Agliaroro Alfonso Maria Forte Valeria Marinò

Background and Clinical Significance: Severe pediatric spastic equinovarus may significantly impair positioning, orthotic tolerance, hygiene management, caregiver-assisted mobilization, and assisted standing activities. In children with severe cerebral palsy, clinically meaningful outcomes frequently include reduction in caregiver burden and facilitation of daily care rather than restoration of autonomous gait. Ultrasound-guided cryoneurolysis has recently emerged as a minimally invasive option for focal spasticity management, although procedural workflow and tolerability remain challenging in severe deforming patterns. Case Presentation: We report a CARE-compliant same-patient bilateral technical comparison in a 9-year-old child with severe spastic cerebral palsy and bilateral dynamic equinovarus refractory to intensive rehabilitation and repeated botulinum toxin treatment. Baseline severity was consistent with GMFCS level IV. One lower limb was treated using the proposed posterior single-window ultrasound-guided cryoneurolysis approach through a single posterior proximal-calf window, whereas the contralateral limb underwent a conventional multi-point supine strategy. The posterior single-window approach enabled sequential targeting of multiple motor branches through a single posterior access corridor under continuous ultrasound guidance. The procedure required approximately 1 mL of 2% lidocaine without additional sedation and was completed in approximately 4 min, whereas the conventional supine strategy required multiple access points, repeated probe repositioning, minimal conscious sedation with midazolam, and approximately 20 min. At follow-up, lower-limb spasticity improved from approximately MAS 3 toward MAS 2, passive ankle angle, measured as the tibia–foot angle with 90° corresponding to the neutral ankle position, improved from approximately 80° to 95°, and semitendinosus-related hypertonia was reduced. Clinically meaningful improvement in positioning, hygiene management, assisted standing, and rehabilitation handling was observed. Caregiver-reported satisfaction and procedural tolerability were qualitatively perceived as better with the posterior single-window approach. Conclusions: The proposed posterior single-window cryoneurolysis strategy may represent a technically simplifying and clinically relevant minimally invasive approach for severe pediatric spastic equinovarus. Further prospective studies are required to confirm reproducibility, safety, and long-term outcomes.

Reports doi: 10.3390/reports9030223

Authors: Alawi M. Alkhadrawi Jawaher Saad Arwa Alsaleem Mohammed Al-Hariri Fayez Alzubair

Background and Clinical Significance: Marfan syndrome (MFS) is an autosomal-dominant connective-tissue disorder caused by pathogenic FBN1 variants. Aortic-root dilation and dissection are the canonical complications, whereas spontaneous vertebral artery dissection (VAD) is described only sporadically. Yet, cerebrovascular events are several-fold more common in MFS, and up to 74% of patients exhibit increased vertebral artery tortuosity, a validated predictor of dissection; Case Presentation: A 32-year-old African man with hypertension, type 2 diabetes mellitus, tobacco use, and headaches labelled as migraine presented with acute agitation, visual disturbance, vertigo, dysarthria, and right-sided weakness of two hours’ duration. Examination disclosed previously unrecognised marfanoid stigmata: arachnodactyly with positive wrist and thumb signs, reduced upper-to-lower segment ratio, increased arm-span-to-height ratio, dolichocephaly, pectus excavatum, and a high-arched palate. Non-contrast CT showed left occipital and posterior inferior cerebellar hypodensities. CT angiography demonstrated discontinuous intraluminal filling defects in the left vertebral artery at C4 and C2, and MR angiography confirmed long-segment occlusion/stenosis of the intracranial left vertebral artery. Echocardiography revealed mild aortic-root dilation (4.0 cm; Z-score +2.53) and a small patent foramen ovale (PFO) with a positive bubble study. The patient received intravenous thrombolysis followed by antiplatelet therapy, a high-intensity statin, antihypertensive therapy, and intensified glycaemic control. Because the infarct territory matched the dissected vessel and the small PFO carried no high-risk features (RoPE score 6; PASCAL category “unlikely”), VAD was designated the culprit lesion and the PFO incidental; Conclusions: Spontaneous VAD may be the inaugural manifestation of unrecognised MFS, antedating aortic complications. In young adults with cryptogenic posterior-circulation stroke and marfanoid features, early cervical imaging and Ghent assessment are warranted, and a coexistent PFO should not be assumed causal. Multidisciplinary evaluation supports accurate attribution and surveillance.

Reports doi: 10.3390/reports9030222

Authors: Satoko Minakawa Toshihide Higashino Daisuke Sawamura

Background and Clinical Significance: Varicella, caused by the varicella-zoster virus (VZV), is typically a childhood disease; however, adult cases carry substantially higher morbidity and mortality. Immunocompromised individuals are particularly vulnerable to severe outcomes. Many adults in Japan lack documented varicella vaccination, representing a missed opportunity for preventing primary VZV infection. None of the patients had documented prior varicella vaccination. Case Presentation: We conducted a retrospective review of varicella cases at Hirosaki University Hospital between April 2007 and March 2025. Ten patients (eight adults and two children) were identified. Among the eight adult patients, written informed consent for publication was obtained from five patients, whose clinical courses are described in detail in this report. Four patients had underlying conditions requiring immunosuppressive therapy, and two were undergoing cancer treatment. All immunocompromised patients exhibited hepatic dysfunction, with elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. All patients received antiviral therapy with valaciclovir or acyclovir, and some additionally received intravenous immunoglobulin. All five adult patients in this series recovered from varicella without long-term sequelae, although one later died from unrelated causes. We additionally note that one patient later died from cerebral embolism and pneumonia, unrelated to varicella. Conclusions: This retrospective case series illustrates the vulnerability of immunocompromised adults to severe varicella and aligns with current recommendations supporting the vaccination of susceptible high-risk adults. While antiviral therapy remains essential for clinical management, prevention through appropriate vaccination strategies—varicella vaccine for preventing primary infection in eligible individuals and RZV for preventing herpes zoster reactivation in immunocompromised adults—represent an important preventive strategy for reducing overall VZV-related morbidity and mortality. These findings reinforce the importance of preventive strategies, including vaccination and early recognition of varicella in high-risk adults.

Reports doi: 10.3390/reports9030221

Authors: Albara Dabroom Muhanad Alzahrani Mohammed Ayed M. Alshammari

Background/Objective: Adamantinoma is a rare, low-grade malignant primary bone tumour with a predilection for the tibial diaphysis. Despite decades of case series and institutional cohorts, the evidence base remains fragmented, and outcomes are inconsistently reported across studies. To synthesise the best available evidence on clinical outcomes, recurrence patterns, metastatic behaviour, and surgical management of skeletal adamantinoma and to appraise the methodological quality of the contributing literature. Methods: A structured narrative review was conducted searching PubMed (294 records) and Web of Science (397 records) from inception to April 2026, yielding approximately 532 unique records after deduplication. Case series of five or more patients with histologically confirmed skeletal adamantinoma were included. A risk-of-bias critique was applied across five domains to each included study. Results: In total, 17 studies, representing more than 900 reported patient entries with possible cohort overlap, formed the primary evidence base. Local recurrence rates for classic adamantinoma (AD) range from 15% to 31%, with metastatic rates from 10% to 27%, predominantly to the lung. The osteofibrous dysplasia-like subtype (OFD-AD) showed no metastases in any series that reports this subtype separately but carries a locally aggressive recurrence rate of 22–43%. Wide resection with uncontaminated margins is the most consistently protective surgical variable (hazard ratio 0.164; p < 0.001). Late recurrences beyond 15 years are documented in multiple series, supporting prolonged surveillance. An MRI-based model for metastatic risk stratification at diagnosis has been proposed but requires external validation. Conclusions: Adamantinoma is more dangerous over a longtime horizon than its low-grade designation implies. Subtype distinction, margin status, and lifelong surveillance are the cornerstones of management. The evidence base carries predominantly moderate to high risk of bias; all conclusions should be interpreted accordingly. A multinational prospective registry remains the most important unmet research need.

Reports doi: 10.3390/reports9030220

Authors: Mihai-Teodor Georgescu Andrada Maria Bărbuț

Background and Clinical Significance: Brain metastases in non-small cell lung cancer (NSCLC) carry a poor prognosis, particularly in patients lacking targetable driver mutations or significant programmed death-ligand 1 (PD-L1) expression. Durable intracranial control exceeding five years is uncommon in this population and the factors that determine exceptional therapeutic response remain incompletely understood; Case Presentation: We report a 59-year-old male with pathological stage pT3N1 solid-type pulmonary adenocarcinoma (EGFR wild-type, ALK wild-type, PD-L1 <1%) who developed two sequential brain metastases following right upper lobectomy and adjuvant pembrolizumab plus pemetrexed-carboplatin. The first lesion was treated with single-fraction stereotactic radiosurgery (SRS, 10 Gy); a second metastasis identified 18 months later was managed with focal radiotherapy (8 Gy, single fraction) followed by whole-brain radiotherapy (24 Gy in 12 fractions). Local progression of the second metastasis in 2024 prompted successful surgical resection via right occipital craniotomy. Over a follow-up exceeding five years, the patient achieved sustained intracranial disease control, preserved neurological function, and maintained quality of life. Notably, no clinically apparent neurocognitive deterioration was documented on routine clinical follow-up, despite whole-brain irradiation without hippocampal sparing; formal neuropsychological testing was not performed; Conclusions: This case demonstrates that durable intracranial control may be achievable through carefully sequenced multimodal therapy—including stereotactic radiosurgery, whole-brain radiotherapy, and neurosurgical resection—even in biologically unfavorable NSCLC. The absence of clinically apparent neurocognitive deterioration on routine follow-up after WBRT raises hypothesis-generating questions regarding interindividual variability in radiation tolerance; this observation must be interpreted in the absence of formal neuropsychological testing and prospective hippocampal dosimetry. A multidisciplinary, individualized approach integrating radiotherapy, systemic therapy, and neurosurgery remains essential in this setting.

Reports doi: 10.3390/reports9030219

Authors: Alexandra Caziuc Radu Alexandru Ilieș George Ionuț Golea Cristian-Florin Bibu-Monuș Andrada Larisa Deac George Călin Dindelegan

Background and Clinical Significance: Malignant melanoma with primary or metastatic intestinal involvement is a rare entity, often diagnosed late and associated with severe complications such as bowel obstruction and perforation. Differential diagnosis of primary intestinal lymphoma may be challenging in the absence of an identifiable primary lesion. Case Presentation: We report the case of a 35-year-old male with no significant medical history who was admitted for persistent abdominal symptoms. Contrast-enhanced abdominal CT revealed a giant circumferential jejunal mass (109/147/156 mm) causing marked luminal stenosis and mesenteric lymphadenopathy, initially raising suspicion of primary intestinal lymphoma. The patient subsequently developed upper intestinal obstruction and severe anemia (Hb 5.5 g/dL), requiring an emergency exploratory laparotomy. Intraoperatively, a voluminous unresectable tumor extending to the mesenteric root was identified, and a feeding jejunostomy was performed. The postoperative course was complicated by tumor perforation and generalized peritonitis, necessitating reoperation. Histopathological examination established the diagnosis of malignant melanoma, with no identifiable primary site, which is most consistent with metastatic melanoma (MUP). PET-CT staging demonstrated metastatic disease (mesenteric, retroperitoneal and supraclavicular lymph nodes, as well as subcutaneous nodules), consistent with a stage IV disease. Molecular analysis revealed a BRAF V600E mutation. Combined immunotherapy (Nivolumab + Ipilimumab) was initiated, resulting in a partial radiological response after three cycles. Conclusions: Intestinal involvement by malignant melanoma might mimic other gastrointestinal malignancies and be the cause of a delayed diagnosis and severe surgical complications. Multidisciplinary management is essential, and modern immunotherapy offers promising outcomes even in advanced-stage disease.

Reports doi: 10.3390/reports9030218

Authors: Narayan Dhimal Roberto Pili Joel B. Epstein Vipanchika Satheeshkumar Minu Ponnamma Mohan Kapil Meleveedu Poolakkad S. Satheeshkumar

Background: Neurological complications (NCs) are increasingly recognized as contributors to adverse outcomes in hospitalized cancer populations, yet their burden and associated disparities in patients with head and neck cancer (HNC) remain poorly characterized. This study evaluated the association between NCs and hospital outcomes in HNC and examined sociodemographic disparities. Methods: A retrospective cross-sectional study was conducted using the 2021 National Inpatient Sample, a nationally representative database of U.S. hospitalizations. Adult patients with a primary diagnosis of HNC were included. NCs were identified using ICD-10-CM codes. Survey-weighted multivariable regression models assessed associations with outcomes. Results: Among 57,615 weighted HNC hospitalizations, corresponding to 11,523 unweighted discharges, 6320 (unweighted n = 1328; 11%) had at least one NC. NCs were independently associated with higher hospital charges (adjusted geometric mean ratio [aGMR], 1.38, 95% CI 1.26–1.51), longer length of stay (aGMR, 1.25, 95% CI 1.17–1.34), and increased in-hospital mortality (aOR 2.42, 95% CI 1.96–2.98). NCs were also associated with higher odds of hospital-acquired complications (aOR 1.92), septicemia (1.90), fluid and electrolyte disorders (1.65), COVID-19 infection (1.66), and emergency department admission (1.33). Disparities were observed, with Hispanic and Other race patients incurring higher charges and Black and Hispanic patients experiencing longer hospital stays; Medicaid and self-pay patients had higher mortality compared with those on Medicare. Conclusions: NCs are associated with worse outcomes and increased healthcare utilization among hospitalized HNC patients; however, given NIS limitations, including lack of cancer stage, treatment history, performance status, and brain metastasis data, these findings should be interpreted as non-causal associations. Early NC recognition and disparity-focused interventions may improve inpatient cancer care.

Reports doi: 10.3390/reports9030217

Authors: Abdullah Addar Mishari Alanezi Nouf Alabdulkarim Razan Alshatwi Fahad Alshayhan Fahad Alhuzaimi

Background and Clinical Significance: Reconstruction of large segmental bone defects following oncologic resection in pediatric patients remains a major challenge. Although distraction osteogenesis with bone transport is a well-established biological reconstructive option, regenerate formation may be compromised in patients receiving chemotherapy. The accordion maneuver, consisting of alternating cycles of compression and distraction, has been described as a method to stimulate bone regeneration, primarily in association with external fixation systems. However, its use in internal bone transport systems using intramedullary lengthening nails following oncologic resection, particularly in the setting of perioperative chemotherapy, remains rarely reported. Case Presentation: We report a case of a 12-year-old boy with high-grade telangiectatic osteosarcoma of the distal femur who underwent neoadjuvant chemotherapy followed by limb-salvage surgery, resulting in a 14 cm segmental bone defect. Reconstruction was performed using plate-assisted bone transport with a motorized intramedullary magnetic nail. During distraction osteogenesis, delayed and asymmetric regenerate formation developed. An accordion maneuver was subsequently initiated, resulting in progressive improvement in regenerate density and corticalization without the need for revision surgery. Conclusions: This case highlights the successful application of the accordion maneuver using internal bone transport following oncologic resection. It represents a minimally invasive technique to stimulate bone healing and may reduce the need for revision surgery; however, larger series are needed to confirm this potential benefit, particularly in biologically compromised patients receiving chemotherapy.

Reports doi: 10.3390/reports9030216

Authors: Thomas Ferenc Darko Blašković Karolina Krstanac Mislav Rakić Mateja Vujica Ferenc Vinko Vidjak

Background and Clinical Significance: Abdominal wall endometriosis (AWE) is an ectopic endometrial tissue embedded into the anterior abdominal wall, mainly infiltrating the rectus abdominis or oblique muscles and subcutaneous tissue. In most cases, AWE is associated with surgical scars after obstetrical and gynecological, as well as non-gynecological surgeries. Case Presentation: A 51-year-old female patient presented to the ultrasound outpatient clinic with a non-cyclic painful, palpable nodular mass located in the postoperative scar in the right lower abdominal quadrant. She underwent an appendectomy at the age of 9 (premenarchal period). The patient had regular menstrual cycles, one cesarean section and two vaginal deliveries, denied any trauma to that abdominal region, and had no history of pelvic endometriosis. Her past medical history was also remarkable for left-sided breast cancer, and she was worried it could be metastasis. Following imaging evaluation, a preliminary diagnosis was a benign lesion in the post-appendectomy scar, most likely a suture granuloma, also known as Schloffer’s tumor. Fine-needle aspiration was performed, and findings were primarily suspicious for AWE. The patient was then referred to an abdominal surgeon for excision of the affected area, and subsequent histopathological analysis confirmed that the mass was AWE. Conclusions: Imaging findings of a mass in the abdominal wall are not pathognomonic for AWE; only histopathological examination can confirm the diagnosis. If a painful nodular mass is located adjacent to a surgical scar in a female patient, AWE should be a leading consideration in the differential diagnosis, along with suture granuloma in cases of old surgical scars.

Reports doi: 10.3390/reports9030215

Authors: Bartosz Stangiewicz Lukasz Korzep

Background and Clinical Significance: Streptococcus pyogenes (group A Streptococcus, GAS) can cause rapidly progressive invasive infections, including necrotizing soft tissue infection (NSTI) and streptococcal toxic shock syndrome (STSS). Although invasive GAS disease is often associated with skin barrier disruption, severe infection may also follow blunt trauma without visible skin injury. Case Presentation: A 22-year-old woman presented with persistent right hip and groin pain four days after a blunt fall during recreational sports activity, without disruption of skin integrity. On admission, she was hypotensive, tachycardic, and intermittently hypoxemic, with local hematoma, swelling, and inflammatory infiltration of the right groin. Laboratory tests showed marked inflammation, acidosis, acute kidney injury (AKI), elevated lactate, creatine kinase, and myoglobin levels. She was admitted to the intensive care unit with septic shock. Empirical antimicrobial therapy was initiated with piperacillin/tazobactam, clindamycin, and linezolid. Computed tomography showed inflammatory changes extending from the right groin to the thigh fascia. On day 3, the patient’s condition deteriorated with respiratory failure necessitating endotracheal intubation and mechanical ventilation. Surgical incision revealed inflamed and necrotic subcutaneous tissue with superficial muscle involvement. Deep tissue cultures yielded GAS, whereas blood and urine cultures remained negative; probable STSS was diagnosed. Therapy was de-escalated to penicillin plus clindamycin. Continuous renal replacement therapy with an adsorptive acrylonitrile 69 surface-treated (AN69ST) membrane was initiated for AKI. The patient gradually improved and was transferred to the surgical ward on day 16. Conclusions: Minor blunt trauma without skin disruption may precede life-threatening invasive GAS infection. Rapid recognition, surgical source control, antitoxin antimicrobial therapy, and intensive organ support are essential in suspected STSS.

Reports doi: 10.3390/reports9030214

Authors: Iva Prodanova Preslava Gatseva Hristiana Delvarska Todor Vasilev Victor Donev

Background and Clinical Significance: Lues remains a global health concern despite the well-known nature of its symptoms, the availability of diagnostic methods, and the existence of effective therapy. The recent increase in maternal syphilis has been accompanied by a rise in congenital infections, which are associated with stillbirth, prematurity, neonatal mortality, and severe multisystemic disorder. In newborns, it may present with highly variable clinical manifestations, making timely diagnosis and treatment essential. We report a case of severe early congenital syphilis in a premature newborn with extensive multiorgan involvement; Case Presentation: We present a case of a male infant born at 31 + 6 weeks of gestation to a 26-year-old mother with inadequate antenatal care and no documented screening or treatment for syphilis during pregnancy. Prenatal ultrasound revealed fetal ascites. At birth, the infant presented with severe respiratory failure requiring immediate resuscitation, endotracheal intubation, and intensive care support. Clinical findings included hepatosplenomegaly, generalized edema, ascites, petechial rash, palmoplantar desquamation, severe thrombocytopenia, anemia, coagulopathy, liver dysfunction, and hemorrhagic syndrome. Maternal and neonatal serologic testing confirmed syphilis infection. The clinical course was complicated by pneumonia with prolonged mechanical ventilation, cardiovascular involvement impairing cardiac function, and heart failure. Treatment consisted of intravenous penicillin G, broad-spectrum antimicrobial therapy, antifungal medication, respiratory support, transfusion therapy, cardiovascular management, and intensive multidisciplinary care; Conclusions: This report presents consequences of untreated maternal syphilis and underscores the importance of timely diagnosis, early initiation of penicillin therapy, and close multidisciplinary follow-up to optimize outcomes in neonates.

Reports doi: 10.3390/reports9030213

Authors: Margarida André Francisco Vara-Luiz Luísa Moreira João Paulo Rosa Miguel Carvalho

Metastatic involvement of the male genitourinary tract by lung cancer is exceedingly rare. We report a 56-year-old man with metastatic lung adenocarcinoma (initial stage T3N2M1b) under pembrolizumab, who presented with severe pelvic pain. Pelvic magnetic resonance imaging and computed tomography demonstrated a large mass with an imaging epicentre favouring the left seminal vesicle, involving the prostate and fistulising to the distal rectum, without pelvic ascites or peritoneal disease. A total PSA of 0.81 ng/mL and a previous negative prostate biopsy made a primary prostatic malignancy less likely. Biopsy of the rectal component revealed a poorly differentiated carcinoma with an immunophenotype (CK7+, TTF-1+, p40−, CDX2−, NKX3.1−, PAX8−) consistent with metastatic adenocarcinoma of pulmonary origin. The patient underwent palliative pelvic radiotherapy, with improvement of pelvic pain; he subsequently developed pneumaturia and faecaluria and died eight months later from disease progression. Seminal vesicle metastasis from lung carcinoma has been reported previously; to our knowledge, however, this is the first report presenting with rectal fistulisation. This case highlights a diagnostically challenging presentation and the need to consider metastatic disease when evaluating atypical seminal vesicle masses in oncological patients.

Reports doi: 10.3390/reports9030212

Authors: Konstantina Dinaki Rafail Ioannidis Panagiotis Theodorou Aristidis Delis Constantinos Papadopoulos

Background and Clinical Significance: To report an unusual case of a bilateral low-frequency air–bone gap consistent with an apparent conductive audiometric pattern following spinal anesthesia and discuss a possible underlying mechanism; Case Presentation: A 56-year-old man underwent elective inguinal hernia repair under spinal anesthesia. On the second postoperative day, he developed a severe postural headache followed by bilateral hearing loss. Otoscopic examination was normal. Tuning fork tests and pure-tone audiometry demonstrated a bilateral low-frequency air–bone gap consistent with an apparent conductive audiometric pattern. Laboratory findings were unremarkable. The patient was managed conservatively with bed rest, hydration and systemic corticosteroids, resulting in gradual clinical improvement; Conclusions: Hearing loss after spinal anesthesia is typically sensorineural and attributed to cerebrospinal fluid pressure alterations. This case highlights a rare apparent conductive audiometric pattern in the absence of clinically evident middle-ear pathology. A possible mechanism may involve altered inner-ear pressure dynamics leading to transient mechanical restriction of stapes mobility. Awareness of this atypical presentation may facilitate prompt recognition and appropriate management.

Reports doi: 10.3390/reports9030211

Authors: Oscar Arturo Benítez-Cárdenas Elhi Manuel Torres-Hernández Miguel Angel Noyola-Frías Ricardo Martínez-Rider Marlen Vitales-Noyola

Background and Clinical Significance: Odontogenic myxoma (OM) is a rare benign neoplasm of the jawbones characterized by spindle-shaped cells embedded in a myxoid stroma. Despite its benign histological nature, it demonstrates locally aggressive behavior, significant invasiveness, and a high risk of recurrence. OM ranks as the third most common odontogenic tumor after odontoma and ameloblastoma. It affects both sexes and occurs more frequently in the mandible than in the maxilla, typically during the second to fourth decades of life. Macroscopically, OM is non-encapsulated, whitish-gray, and gelatinous. Radiographically, it usually presents as a radiolucent lesion with fine bony trabeculae, producing a characteristic “tennis racket” appearance. Case Presentation: We report a case of a 27-year-old male diagnosed with maxillary odontogenic myxoma measuring 2.3 × 1.7 cm. Clinical, radiographic, and histopathological findings were evaluated, and the lesion was treated conservatively by surgical enucleation and curettage. Results: The surgical procedure was completed without complications. Histopathological analysis confirmed the diagnosis of odontogenic myxoma. The patient showed satisfactory postoperative healing, and no evidence of recurrence was observed during a 10-month follow-up period. Conclusions: Although odontogenic myxoma is benign, its locally aggressive nature and recurrence potential require accurate diagnosis and appropriate management. Conservative treatment by enucleation and curettage may be effective for small, well-defined lesions, provided that careful long-term follow-up is maintained to monitor for recurrence.

Reports doi: 10.3390/reports9030210

Authors: Seung Hwan Chung Hussein Ali-Ahmad Andrew Zwyghuizen Linda Qu

Background and Clinical Significance: Cutaneous squamous cell carcinoma (CSCC) is a common non-melanoma skin cancer, and while most cases are curable, a small proportion progresses to locally advanced or metastatic disease. As neoadjuvant immunotherapy with PD-1 inhibitors such as cemiplimab becomes more widely adopted, understanding real-world patterns of response remains essential. Case Presentation: We report a case of a man in his 50s with a large, locally advanced CSCC of the left hand in whom neoadjuvant cemiplimab was chosen to reduce tumor burden and preserve hand function when margin-negative resection was unlikely. The patient received four cycles of cemiplimab and demonstrated marked clinical improvement followed by complete pathological response at the primary site upon wide local excision. However, metastatic involvement of the epitrochlear and axillary lymph nodes was identified at surgery despite initial benign imaging. Postoperative PET/CT showed no additional disease, and the patient subsequently underwent axillary dissection and adjuvant cemiplimab with good functional recovery. Conclusions: This case highlights the potential for neoadjuvant cemiplimab to achieve substantial local tumor control and functional preservation while emphasizing the need for careful nodal assessment and ongoing surveillance in patients with very-high-risk CSCC. In cases where baseline cross-sectional staging is not performed, pre-existing occult nodal disease cannot be excluded.

Reports doi: 10.3390/reports9030209

Authors: Tomonori Kai Keiko Tominaga Atsumi Matsunaga Hiroshi Shimizu Kazuhiro Iwama Keisuke Ishizawa

Background and Clinical Significance: Beta-propeller protein–associated neurodegeneration (BPAN), also known as static encephalopathy of childhood with neurodegeneration in adulthood (SENDA), is a subtype of neurodegeneration with brain iron accumulation caused by pathogenic variants in WDR45. Although its clinical course and neuroimaging features are increasingly recognized, detailed neuropathological characterization, especially at its terminal stage, remains limited. Case presentation: We report a 68-year-old woman with a heterozygous WDR45 splice-site variant (NM_007075.4:c.830+1G>A), representing the longest-surviving case of SENDA/BPAN described to date. After static developmental delay in childhood, she rapidly developed progressive parkinsonism, dystonia, and cognitive decline in early adulthood, ultimately becoming bedridden with profound motor and autonomic dysfunction. Serial MRI demonstrated progressive cerebral and cerebellar atrophy with iron-related signal changes in the globus pallidus and substantia nigra. She died of sepsis at the age of 68 and was subjected to an autopsy including the brain. Neuropathological findings: Autopsy revealed severe, diffuse neuronal loss and gliosis throughout the central nervous system, with marked iron deposition and complete neuronal loss in the globus pallidus and substantia nigra. Immunohistochemistry demonstrated widespread tau pathology. Notably, neuronal tau inclusions contained both four-repeat (4R) and three-repeat (3R) isoforms, whereas glial tau was predominantly 4R-positive, indicating a mixed neuronal 4R/3R and glial 4R-dominant tauopathy. Perivascular and subpial 4R-tau–dominant deposits consistent with aging-related tau astrogliopathy were also present. LC3-positive and ferritin-positive cells suggested impaired autophagic flux, supporting the proposed autophagy-related pathogenesis of SENDA/BPAN. Conclusions: This case provides comprehensive clinicopathological insight into end-stage SENDA/BPAN, highlighting distinctive tau isoform patterns in neurons versus glia and pathological evidence of autophagy dysfunction. These findings expand the neuropathological spectrum of SENDA/BPAN and may inform future mechanistic and therapeutic research.

Reports doi: 10.3390/reports9030208

Authors: Lexi Frankel Courtney Marie VanderMeersch Jeffrey Morgan Denney

Background and Clinical Significance: Superficial postoperative wound dehiscence after cesarean delivery is insufficiently described in the literature, and evidence guiding management in high-risk patients remains limited. Case Presentation: We report a case of superficial wound dehiscence in a patient who underwent cesarean delivery following a motor vehicle accident with non-reassuring fetal heart tones and placental abruption. Her medical history included Hepatitis C infection, methadone dependence, endocarditis, and a prior episode of rapid wound dehiscence after laparoscopic surgery incisions closed with absorbable suture. Conclusions: Although many studies demonstrate no significant difference in dehiscence rates across closure methods, including suture, metal staples, and absorbable staples, clinicians should recognize that underlying medical conditions associated with inflammation or a history of prior wound dehiscence may increase the risk of complications when absorbable suture or absorbable staples are used. Careful assessment of patient-specific risk factors may help guide optimal closure technique in high-risk obstetric populations.

Reports doi: 10.3390/reports9030207

Authors: Gabriela Rybka Andrzej Boryczko Radosław Dziedzic Łukasz Chmura Joanna Kosałka-Węgiel

Background and Clinical Significance: Hyperviscosity syndrome (HVS) is a rare complication of primary Sjögren’s syndrome (pSS). While therapeutic plasma exchange (TPE) is the standard treatment to clear pathogenic immunoglobulins, its execution can trigger severe, atypical systemic risks. Case Presentation: A 60-year-old woman with pSS and extreme polyclonal hypergammaglobulinemia (total protein 100 g/L, IgM 41 g/L) presented with an acute hyperviscosity crisis, causing retinopathy, neurological deficits, and skin ischemia. Emergency TPE with 5% albumin replacement successfully reduced IgM by ~90% (to 6.39 g/L), resolving HVS symptoms. However, 20 min post-procedure, the patient suffered sudden hemodynamic collapse (BP 50/30 mmHg) and developed multiple massive, expanding soft-tissue hematomas. Laboratory tests revealed a coagulopathy consistent with plasma protein depletion following therapeutic plasma exchange, characterized by severe hypofibrinogenemia (1.35 g/L) and a 50% reduction in total serum protein. TPE was permanently discontinued. The patient was successfully stabilized using aggressive fluid resuscitation, vasopressors, and fresh frozen plasma (FFP) transfusions, followed by maintenance therapy with rituximab. Conclusions: In conclusion, clinicians should remain vigilant that severe hyperviscosity syndrome can be driven by a polyclonal increase in immunoglobulins rather than just monoclonal entities; furthermore, managing this condition requires careful balancing of TPE efficacy against its potential to trigger profound depletion coagulopathy.

Reports doi: 10.3390/reports9030206

Authors: Georgios-Eleftherios Anagnostopoulos Theodoros Spinos Vasileios Tatanis Angelis Peteinaris Evangelos Liatsikos Panagiotis Kallidonis

Background and Clinical Significance: Metallic stents represent a breakthrough in the treatment of ureteric obstruction, improving patient quality of life. Despite their advantages, management of encrustation remains a difficult complication to address. This case series highlights the rare occurrence of permanent ureteral Wallstents remaining indwelling for over 20 years. It emphasizes that the function of these older devices can be successfully preserved using minimally invasive techniques. Case Presentation: This case series details three patients, two males, aged 75 and 69 years, diagnosed with colon cancer, and one female, aged 67 years, with cervical cancer, who presented with obstructive uropathy due to extrinsic malignant compression. As a therapeutic strategy, permanent ureteral Wallstents were placed in all three patients. Over time, the stents developed significant encrustation, leading to secondary obstruction. Clinical manifestations of this complication varied, ranging from asymptomatic hydronephrosis to acute symptomatic uropathy characterized by fever and localized pain. All cases were treated endoscopically with Ho:YAG laser lithotripsy, and urine flow was successfully restored. During the follow-up period, one patient experienced two recurrences that were managed with the same technique, another remained completely symptom-free, and the third was lost to long-term follow-up. Remarkably, the stents have remained functional for over 20 years post-implantation. Conclusions: This is a rare report documenting permanent ureteral Wallstents with such prolonged indwelling time. Furthermore, our findings suggest that through minimally invasive techniques, the function of these devices can be successfully preserved.

Reports doi: 10.3390/reports9030205

Authors: Georgiana Ciobanu Daniel Pichler Benjamin Hutter Thomas Münzer

Background and Clinical Significance: When diverse clinical presentations coincide with complex laboratory findings, particularly in older adults, the diagnostic process can be especially challenging. Case Presentation: We report the case of a geriatric patient who was hospitalized with initial gastrointestinal and respiratory symptoms, followed by progressive chest pain and profound weakness, accompanied by elevated transaminases, troponin elevation, and hyponatremia, initially suggesting multiple competing diagnostic entities. During the clinical course, the patient developed neurological symptoms. Ultimately, careful history-taking, including detailed exposure assessment, raised suspicion for tick-borne encephalitis, which was subsequently confirmed by serological testing. Conclusions: This case highlights the diagnostic complexity of tick-borne encephalitis in older adults, where atypical and multisystem presentations may obscure the underlying etiology and delay recognition of a neuroinfectious disease.

Reports doi: 10.3390/reports9030204

Authors: Kunitaro Watanabe Chihiro Akizawa Ryuji Sawada Mieko Chinzei Kiyoshi Moriyama

Background and Clinical Significance: Proximal hamstring tendinopathy can occur not only in athletes but also in nonathletes when daily activities impose repetitive tensile or compressive loading at the ischial tuberosity. Because symptoms often resemble piriformis syndrome or lumbar pathology, diagnosis may be delayed; Case Presentation: A woman in her twenties developed buttock pain during desk work. Lumbar MRI was normal, and piriformis blocks provided only temporary relief. Localized tenderness at the ischial tuberosity, pain provocation during sitting, and positive provocation tests suggested proximal hamstring tendinopathy. Ultrasound showed a mildly hypoechoic area at the tendon insertion without definite thickening or tear. Ultrasound-guided injection of levobupivacaine and dexamethasone produced immediate but temporary relief. She continued receiving injections every two weeks, combined with stretching, hip-lift strengthening, and reduced sitting. After 18 injections, her pain improved from a numerical rating scale score of 10 to 0–1; Conclusions: This case demonstrates that proximal hamstring tendinopathy can develop in nonathletes due to lifestyle-related mechanical loading. Characteristic clinical findings and ultrasound evaluation are essential for diagnosis, and ultrasound-guided injection combined with exercise and activity modification provided sustained symptom improvement.

Reports doi: 10.3390/reports9030203

Authors: Lauryn Rudin Roberto Pili Joel B. Epstein Karrar Aljanahi Diggory Cordova Richa Rajesh Kapil Meleveedu Poolakkad S. Satheeshkumar

Background: Cancer treatment-induced ulcerative mucositis (UM) is a debilitating toxicity in patients with cancers of the lip, oral cavity, and pharynx (CLOP). This study evaluated the association of chemotherapy-induced (CT-UM) and radiotherapy-induced ulcerative mucositis (RT-UM) with burden of illness (BOI), focusing on hospital length of stay (LOS) and total charges, and examined disparities in outcomes. Methods: This retrospective cohort study analyzed 2019 National Inpatient Sample (NIS) data. Adult patients (≥18 years) hospitalized with CLOP (ICD-10-CM C00–C14) undergoing inpatient surgery, chemotherapy, or radiotherapy were included. CT-UM (K12.31) and RT-UM (K12.33) were identified as secondary diagnoses. Survey-weighted generalized linear models (negative binomial for LOS; gamma for charges) adjusted for demographics, comorbidities (Elixhauser score), insurance, income, and Diagnosis-Related Groups (DRG; surgical vs. medical) were used. Results: Among 59,710 weighted CLOP hospitalizations, 820 had CT-UM and 1010 had RT-UM. Patients with UM were younger and had varying comorbidity burdens. Unadjusted analyses showed prolonged geometric mean LOS for CT-UM (5.66 vs. 3.81 days, p < 0.001) and RT-UM (4.95 vs. 3.81 days, p = 0.001), with lower total charges ($48,645 and $42,938 vs. $56,267). Multivariable analyses confirmed RT-UM was associated with increased LOS (adjusted coefficient 1.33, 95% CI 1.14–1.55) but lower charges (0.67, 95% CI 0.56–0.81). In patients >50 years, CT-UM showed stronger effects (LOS 1.80, 95% CI 1.49–2.15; charges 0.79, 95% CI 0.65–0.98). Significant disparities were observed: females, Black and Hispanic patients, and Medicaid beneficiaries experienced greater BOI (prolonged LOS and/or higher charges in subgroups). Associations persisted in DRG- and procedure-stratified sensitivity analyses, suggesting treatment interruptions as a key driver. Conclusions: Ulcerative mucositis in hospitalized CLOP patients is associated with prolonged LOS but lower charges, likely due to treatment modifications, and disproportionately affects vulnerable populations. These findings highlight the need for proactive oral care protocols, multidisciplinary integration, and equity-focused interventions to reduce the burden of this toxicity and improve cancer treatment outcomes.

Reports doi: 10.3390/reports9030202

Authors: Ibrahim S. Alshaygy Mishari N. Alanezi Omar A. Aldosari Safana M. Alomar Hatim A. Khoja

Background and Clinical Significance: Malignant transformation of giant cell tumor of bone (GCTB) is a rare but clinically significant event, most commonly associated with radiotherapy, denosumab therapy, or recurrent disease. Secondary malignant transformation occurring in the absence of recognized risk factors is exceptionally uncommon. We report a rare case of high-grade sarcomatous transformation of proximal humeral GCTB after a prolonged latency period without prior radiotherapy, denosumab exposure, or documented recurrence; Case Presentation: A 27-year-old female initially presented with right shoulder pain and was diagnosed with proximal humeral GCTB. She underwent intralesional curettage and bone grafting, with histopathological confirmation of benign GCTB. Nine years later, she developed progressive shoulder pain, functional limitation, and systemic symptoms. Imaging demonstrated an aggressive lytic lesion with cortical destruction and soft-tissue extension involving the proximal humerus. Repeat curettage and histopathological evaluation revealed high-grade spindle cell sarcoma consistent with malignant transformation of GCTB. The patient received neoadjuvant chemotherapy followed by wide resection and endoprosthetic reconstruction of the proximal humerus, with additional adjuvant chemotherapy postoperatively. At two-year follow-up, she remained disease-free with excellent functional recovery and satisfactory quality of life; Conclusions: This case highlights the potential for delayed malignant transformation of GCTB even in the absence of established predisposing factors. Clinicians should maintain long-term vigilance in patients treated for GCTB, particularly when new pain, functional decline, or aggressive radiologic features develop years after initial treatment. Early recognition and multidisciplinary management are essential to optimize oncologic and functional outcomes.

Reports doi: 10.3390/reports9030201

Authors: Hasan Obeidat Mahyar Toofantabrizi Katie Li Sarah J. Silva Hibba Tul Rehman

Background and Clinical Significance: Cardiac and mediastinal angiosarcomas are rare, aggressive malignancies that often present with nonspecific symptoms and pose significant diagnostic challenges. Tumor heterogeneity and necrosis may lead to false-negative biopsy results; Case Presentation: We report a 64-year-old man who initially presented with cardiac tamponade of unclear etiology. Despite an extensive workup, the patient remained asymptomatic for five months before re-presenting with dyspnea and a large mediastinal mass compressing the right heart, along with a lytic rib lesion. Initial ultrasound-guided biopsy of the rib lesion demonstrated a benign vascular proliferation consistent with Masson tumor (intravascular papillary endothelial hyperplasia), which was discordant with aggressive imaging findings. Further evaluation with positron emission tomography–computed tomography (PET-CT) revealed peripheral metabolic activity, and cardiac magnetic resonance imaging (MRI) demonstrated a heterogeneous mass with central necrosis and peripheral enhancement. A repeat CT-guided biopsy targeting the metabolically active region confirmed angiosarcoma, with immunohistochemical staining demonstrating diffuse positivity for ERG, CD31, and CD34. The patient was treated with palliative radiation and paclitaxel-based chemotherapy but experienced rapid clinical decline and transitioned to comfort-focused care; Conclusions: This case highlights the importance of correlating imaging with pathology and emphasizes the risk of sampling error in necrotic tumors. PET-guided biopsy targeting viable tumor regions is essential in cases with discordant findings.

Reports doi: 10.3390/reports9030200

Authors: Athanasios Vlachodimitropoulos Nicholas S. Mastronikolis Gerasimos Danielides Foteini Tsapardoni Georgios Batsaouras Spyridon Lygeros

Background and Clinical Significance: Choanal atresia is a rare congenital obstruction of the posterior nasal aperture, with an estimated incidence of one in 5000 to one in 8000 live births. Bilateral disease typically presents as a neonatal emergency, whereas unilateral disease is more frequent and may remain undiagnosed for years or decades, presenting in adolescence or adulthood with chronic unilateral nasal obstruction and ipsilateral mucopurulent rhinorrhoea. Optimal surgical management remains debated, particularly with regard to mucosal-flap reconstruction and the choice of postoperative stent. Case Presentation: A 22-year-old male was referred for chronic left-sided nasal obstruction, persistent ipsilateral mucopurulent rhinorrhoea and reduced ipsilateral olfaction. Nasal endoscopy and high-resolution computed tomography demonstrated an isolated, non-syndromic, mixed bony–membranous left choanal atresia. The patient underwent transnasal endoscopic choanoplasty with posterior septectomy and removal of the atretic plate and posterior vomer. An ipsilateral superiorly based septal mucoperichondrial flap was raised first and later transposed over the sphenoid rostrum; following drilling, the contralateral septal mucosa was approached and incised horizontally to generate a superior and an inferior leaflet, which were rotated to cover the corresponding portions of the residual posterior septal ridge. A bioabsorbable mometasone-furoate-eluting sinus implant (PROPEL®, Medtronic) was deployed across the neo-choana. The follow-up endoscopy at two months demonstrated a widely patent, well-mucosalized neo-choana with complete resolution of symptoms. Conclusions: Transnasal endoscopic posterior septectomy combined with mucosal-flap reconstruction and a bioabsorbable steroid-eluting stent is a technically feasible and biologically rational approach to adult unilateral CA. To our knowledge, this is among the first reports describing the off-label intraoperative use of a PROPEL® stent in a young adult with isolated unilateral choanal atresia.

Reports doi: 10.3390/reports9030199

Authors: Yurena Rodríguez Francisco Montes de Oca Idaira Dorta Ricardo Reyes Aixa R. Bello

Uterine leiomyosarcoma (LMS) is a rare and aggressive malignancy with diagnostic challenges, particularly in cases with overlapping histological features with atypical leiomyoma or smooth muscle tumors of uncertain malignant potential. We report a comparative immunohistochemical analysis of LMS, leiomyoma, and adjacent myometrium obtained from a 40-year-old woman with discordant pathological diagnoses. LMS tissue showed increased Ki67 and NTS/NTSR1 immunoreactivity together with a distinctive cytoplasmic localization of estrogen receptor beta (ERβ), in contrast to the predominantly nuclear localization observed in leiomyoma and normal myometrium. Importantly, focal areas within adjacent morphologically non-neoplastic myometrium exhibited an immunophenotype resembling LMS, including cytoplasmic ERβ localization and increased Ki67 and NTS/NTSR1 expression. These observations suggest a potential association between ERβ subcellular localization, NTS/NTSR1 signaling, and molecular alterations occurring during uterine smooth muscle tumorigenesis. However, given the single-case nature of this report, these findings should be considered exploratory and require validation in larger studies. The diagnostic message conveyed by these images may assist in the interpretation of diagnostically challenging cases and provide a basis for future investigation.

Reports doi: 10.3390/reports9030198

Authors: Zlatko Zlatev Tanya Peshleevska-Vicheva Angel Angelov George Stoyanov Hristo Popov

Background and Clinical Significance: Osteonevi, originally described by Heidingsfeld in 1908 and later by Nanta in 1911, because of whom it is known as osteonevus of Nanta, is a rare condition with not yet fully established etiopathogenesis; Case Presentation: Herein, we report a case of a 33-year-old female patient who presented to our institution with a papilliform pigmented lesion located on the projection of the left mandibular angle, measuring 2 × 1.5 cm. The lesion had been present since childhood; however, it had increased in size by approximately 5 mm over the previous month and had become painful. Surgical excision was performed, which went uncomplicated. Histology of the resected specimen showed a dermally based, symmetrical melanocytic proliferation, without signs of dysplasia, and an underlying keratocyst with rupture, accompanied by a surrounding foreign-body-type granulomatous reaction around inert keratin flakes. A third component of the lesion was also noted, represented by foci of osteoid and myeloid metaplasia underneath the melanocytic proliferation, without direct relation to the ruptured keratocyst. Based on the morphological findings, the diagnosis of osteonevus of Nanta was established; Conclusions: Oseonevus of Nanta is an extremely rare, benign morphological finding. The etiopathogenesis of these rare lesions is not yet fully established, despite several proposed mechanisms. The differential diagnosis, while typically straightforward, is broad.

Reports doi: 10.3390/reports9030197

Authors: Gianluca Pagnoni Alberto Monello Luca Rossi Daniela Aschieri Marco Loffi

Background and Clinical Significance: The Coronary Sinus Reducer (CSR) is a percutaneous therapeutic option for patients with refractory angina who are unsuitable for further myocardial revascularization. The procedure has a generally favorable safety profile, with a low rate of reported procedural complications. To our knowledge, major atrioventricular (AV) conduction disturbances during CSR implantation have not been previously described. This case highlights a rare but clinically relevant intraprocedural complication; Case Presentation: A 71-year-old man with multivessel coronary artery disease and previous coronary artery bypass grafting was referred for CSR implantation because of refractory angina despite optimal medical therapy and lack of further revascularization options. The procedure was performed via a right jugular venous approach. Baseline electrocardiography showed right bundle branch block and findings consistent with previous inferior myocardial infarction, without definite criteria for left anterior fascicular block. During coronary sinus cannulation, the patient developed transient complete AV block, resulting in an approximately 8–10-second ventricular pause without a stable ventricular escape rhythm. The conduction disturbance resolved after catheter withdrawal and repositioning. Given the severity of the event, a temporary transvenous pacemaker was inserted via the right femoral vein, allowing safe completion of CSR implantation. At three-month follow-up, angina had improved from Canadian Cardiovascular Society class III to class I, and no recurrent advanced AV block was documented; Conclusions: Transient complete AV block may occur during CSR implantation, particularly during coronary sinus manipulation and possibly in patients with pre-existing conduction disease. Careful catheter handling, prompt recognition of conduction disturbances, and immediate availability of temporary pacing support should be considered in selected high-risk patients undergoing CSR implantation.

Reports doi: 10.3390/reports9030196

Authors: Bomonyo Fente Ahmad El-Said Hilda Yuson Gavin Galasko

Background and Clinical Significance: Ischaemia with non-obstructive coronary arteries (INOCA) has attained more recognition in recent decades. These patients may present with typical cardiac sounding chest pain but have no evidence of obstructed coronary arteries on coronary angiography. This presents a challenge to clinicians in terms of diagnosis and management. Coronary microvascular dysfunction (CMD), or coronary spasm (whether epicardial or microvascular) may be the cause of their presentation, and they usually require further invasive investigations of their coronary microvascular circulation to determine the cause. Case Presentation: This case involves a male patient in his 60s presenting with recurrent nocturnal chest pain, clinical and ECG evidence of ischaemia, and diagnostic findings from invasive coronary angiography and a microvascular study. These findings confirmed an absence of obstructive coronary artery disease (CAD) but demonstrated significant microvascular dysfunction, consistent with a diagnosis of microvascular angina according to the COVADIS criteria, as well as epicardial coronary artery spasm leading to complete vessel closure. This case highlights the clinical and diagnostic complexities of microvascular angina and coronary artery spasm. It also emphasises the importance of advanced diagnostic testing in confirming this challenging diagnosis. This case was interesting due to the patient having a final diagnosis of microvascular angina and coronary artery spasm at the same time. This case also demonstrates how 300 mcg of intracoronary nitrate was given to dilate a vessel in coronary spasm with positive effect. This finding was supportive of the final diagnosis given the clinical context of this patient. Conclusions: This case report demonstrates the diagnostic steps, from symptom assessment through to angiography and microvascular testing and would add to the existing knowledge of INOCA and aid in the understanding and management of these patients especially in centres where acetylcholine testing to confirm inducible epicardial coronary spasm is not available, like it was not in our centre (Blackpool Victoria Hospital).

Reports doi: 10.3390/reports9020195

Authors: Calin Romulus Fodor Marta Bieńkowska Bartosz Dalewski Łukasz Pałka

Background/Objectives: Advanced implant anchorage techniques are increasingly used to manage severe maxillary bone deficiency and to avoid extensive bone augmentation procedures. This case series report aimed to describe the canine bypass anchorage technique and to evaluate the short- to medium-term clinical outcomes and survival of implants placed using this approach. Materials and Methods: Thirteen patients presenting with missing maxillary premolars or posterior segments and insufficient alveolar bone height for conventional axial implant placement were treated using the canine bypass technique. A total of 19 long one-piece implants were inserted palatally to the canine root, engaging distant cortical bone of the nasal cavity and/or palatal alveolar process. Pre- and postoperative cone-beam computed tomography (CBCT) examinations were performed to assess implant positioning and anchorage. Patients were followed up to 3.5 years. Results: The mean follow-up period was 26.1 ± 10.8 months. Nasal cortical anchorage was achieved in 84.2% of implants, and palatal cortical anchorage in 73.7%; both anchorage types were obtained simultaneously in 57.9% of cases. The mean distance between the implant and canine root was 1.27 ± 1.4 mm (range: −1.0 to 4.5 mm), including cases of direct implant–tooth contact and periodontal ligament space transgression. All implants remained functional throughout the observation period, yielding a cumulative survival rate of 100%. Canine pulp vitality was preserved in all non-endodontically treated teeth. Conclusions: Within the limitations of this case series report, the canine bypass anchorage technique appears to be a feasible and minimally invasive treatment option for maxillary rehabilitation with implant-supported restoration in selected patients with severe bone deficiency, potentially allowing avoidance of sinus augmentation procedures. Further prospective studies with larger patient cohorts and longer follow-up periods are required to confirm the long-term safety, predictability, and clinical applicability of this approach.

Reports doi: 10.3390/reports9020194

Authors: Hiroshi Tanabe Mari Ogawa Mari Kita Takeshi Kotake

Background and Clinical Significance: Peristomal pyoderma gangrenosum (PPG) is a rare subtype of pyoderma gangrenosum, most commonly associated with inflammatory bowel disease or haematologic disorders. Its occurrence in patients with solid malignancies is uncommon. PPG in an oncologic setting poses diagnostic and therapeutic challenges because systemic immunosuppressive therapy, wound care, and ongoing chemotherapy must be carefully balanced; Case Presentation: We report the case of a Japanese man in his 50s with stage IVB rectal adenocarcinoma who developed rapidly progressive peristomal ulceration clinically consistent with PPG around a colostomy 12 weeks after initiation of panitumumab-containing systemic chemotherapy. The diagnosis was made on clinical grounds and was strongly supported by the clinical morphology, exclusion of major mimickers, and response to systemic corticosteroid therapy, although histopathological confirmation was not obtained. Because existing diagnostic criteria for pyoderma gangrenosum are not specifically designed for peristomal disease, they were used as supportive rather than definitive diagnostic tools. Skin biopsy was avoided due to the risk of pathergy at the peristomal site. Superficial cultures were not obtained because frequent cleansing and faecal contamination were likely to compromise diagnostic accuracy. To minimise mechanical pathergy, the stoma appliance was changed from a one-piece soft convex system to a two-piece flat system. Multidisciplinary management, including systemic corticosteroids, meticulous stoma care, and selective ultrasonic debridement, resulted in complete epithelialisation by Week 26. Chemotherapy was temporarily withheld during the active inflammatory phase and later resumed. Despite successful control of the peristomal ulceration, the patient died from progressive malignancy at Week 34; Conclusions: This case highlights the clinical challenge of balancing immunosuppressive therapy for clinically suspected PPG with ongoing oncologic treatment. Mechanical pathergy related to stoma appliance use was considered a more likely precipitating factor than chemotherapy alone, although panitumumab may have contributed to impaired cutaneous repair. Close collaboration among dermatologists, oncologists, surgeons, WOC nurses, and family caregivers is essential for multidisciplinary decision-making in complex oncologic settings.

Reports doi: 10.3390/reports9020193

Authors: Hala Jasim Orhan K. Öz Joseph Frankl

Background and Clinical Significance: Many diagnostic radiopharmaceuticals are excreted in the urine. This can pose a diagnostic challenge when urine-containing structures are in atypical locations, particularly in review of planar imaging without anatomical details from cross-sectional imaging. This case highlights a challenging 99mTc-methylene diphosphonate (99mTc-MDP) bone scan in a patient with an inguinal hernia containing a portion of the urinary bladder. Subsequently, we review diagnostic challenges on conventional and molecular imaging following surgical repair of the inguinal hernia. Case Presentation: A 79-year-old man with prostate cancer underwent initial staging prior to prostatectomy with 99mTc-MDP bone scintigraphy. Anterior and posterior images showed focal uptake overlying the pubic symphysis. Lateral views showed that the activity was extraosseous. Follow-up CT urography showed a bladder hernia as the cause of the abnormality on bone scan. Prostatectomy and inguinal hernia repair were performed as a combination case. Four years postoperatively, follow-up 68Ga-PSMA-11 positron emission tomography/computed tomography (PET/CT) showed no recurrence. The CT component of the exam showed an intermediate-density focus at the right inguinal hernia repair site, corresponding to a plugoma related to a polypropylene mesh plug, and a hyperattenuating Gore-Tex mesh repair of the left inguinal hernia. Conclusions: This case highlights the importance of lateral projections in resolving scintigraphic pitfalls and recognizing mesh-related imaging appearances to prevent misinterpretation.

Reports doi: 10.3390/reports9020192

Authors: Niall Leahy Sandra Quinn Derek Crinion

Background and Clinical Significance: Inflammatory myopericardial syndrome is an umbrella term recently introduced by the European Society of Cardiology, which encapsulates the overlap that exists in clinical practice between myocardial and pericardial disease. It has a heterogeneous aetiology and a broad spectrum of severity in terms of its clinical features. Toxoplasma gondii is a rare but recognised infectious cause of myopericarditis and is typically seen in immunocompromised individuals. Case Presentation: We present the case of a young, immunocompetent male, presenting with pleuritic chest pain following a recent flu-like illness. Investigations revealed an acute myocardial injury based on elevated troponin T levels, in the absence of ventricular dysfunction. Toxoplasma immunoserology was consistent with primary toxoplasma infection. The remainder of his viral panel was negative. There was prompt symptom improvement following commencement of treatment with colchicine and a non-steroidal anti-inflammatory agent. Cardiac magnetic resonance imaging post-discharge revealed findings consistent with prior myocarditis. Conclusions: This case is an example of the rare occurrence of toxoplasma myopericarditis in an immunocompetent individual. Cardiac MRI is an invaluable imaging modality used to evaluate myocardial function and tissue characteristics in patients presenting with inflammatory myopericardial syndrome.

Reports doi: 10.3390/reports9020191

Authors: Riana Tarabocchia Kiran Javaid Rahul Mittal Maria Balabanian Rory Ulloque

Background and Clinical Significance: Cerebral amyloid angiopathy (CAA) is a neurovascular disorder characterized by the deposition of amyloid beta (Aβ) peptides within the walls of small-to-medium-sized cerebral vessels, leading to vascular fragility and an increased risk of lobar intracerebral hemorrhage (ICH), cognitive decline, and recurrent stroke. CAA is an important cause of spontaneous ICH in elderly patients and may be underrecognized, particularly when presenting with acute neurologic symptoms that mimic ischemic stroke. Early identification has significant implications for management, prognosis, and secondary prevention. Case Presentation: An 80-year-old male presented to the emergency department with incoherent speech, rambling, and severe headache concerning for acute stroke. His medical history was notable for a prior cerebrovascular accident, hypertension, diabetes mellitus, benign prostatic hyperplasia, and recent evaluation for dementia-like symptoms. Initial neuroimaging revealed a 3.2 cm intraparenchymal hemorrhage in the left occipital lobe with surrounding edema. Subsequent MRI demonstrated a lobar hemorrhage pattern suggestive of CAA based on imaging findings and clinical context. The patient was admitted to the intensive care unit (ICU) for close neurologic monitoring. He remained hemodynamically stable with no new motor or sensory deficits. Over a three-day hospital course, his speech and visual deficits improved. Blood pressure was carefully controlled, and repeat imaging demonstrated stable hemorrhage without progression. He was diagnosed with probable CAA and discharged home with supportive services. Conclusions: This case highlights the importance of considering cerebral amyloid angiopathy in elderly patients presenting with spontaneous lobar intracerebral hemorrhage and cognitive symptoms. Prompt recognition and appropriate neuroimaging are critical for diagnosis, risk stratification, and guiding management.

Reports doi: 10.3390/reports9020190

Authors: Līna Petrova Jūlija Ustiča Elīna Rasčevska Shaju Jacob Pulikkotil

Background and Clinical Significance: Pre-eruptive intracoronal resorption is a rare developmental anomaly resembling occlusal caries despite the absence of an external breach. Case Presentation: We report of two cases. The first case involves a 9-year-old girl with PEIR of tooth 24 that was not identified on a panoramic radiograph taken one year earlier. The lesion later became clinically evident, presenting with symptoms and discoloration, and progressed to irreversible pulpitis requiring pulpotomy. This case highlights the importance of careful interpretation of paediatric panoramic radiographs and timely intervention to preserve pulp vitality in developing permanent teeth. The second case concerns a 16-year-old girl in whom PEIR was incidentally detected on cone-beam computed tomography (CBCT) in tooth 38. As the tooth has not yet erupted, its future clinical presentation and progression remain uncertain. To the best of the authors’ knowledge, there are no published reports specifically describing PEIR in patients from the Baltic region. Conclusions: Early radiographic detection of pre-eruptive intracoronal resorption is essential to prevent pulpal involvement and improve treatment outcomes, particularly when combined with careful interpretation of routine paediatric radiographs to minimize the risk of delayed diagnosis. This case emphasizes the importance of recognizing asymptomatic disease progression and integrating multidisciplinary approach to provide individualized treatment planning.