Reports, Volume 8, Issue 4 (December 2025) – 15 articles

Background and Clinical Significance: Fetus papyraceus is a term describing fetal findings associated with miscarriage, wherein the fetus is not expelled, remains in the uterine cavity, and is compressed by neighboring structures, with an inability for fetal resorption due to advanced pregnancy. Case Presentation: Herein, we present the case of a 33-year-old primigravida with two previous presentations to our institution due to emotional stress without evidence of physical abuse, the last one being at the 14th week of pregnancy. The latest presentation was with complaints of intermittent lower abdominal pain and an outpatient gynecology consultation describing fetal demise, with fetal parameters corresponding to demise in the 15th to 16th week of gestation. Pregnancy termination was performed with the specimen sent for pathology, revealing fragmented placental parts, which, on section, were firm, with greyish areas and notable calcification, fragments of an umbilical cord appeared normal, and a significantly compressed fetus, which was flattened in the anteroposterior aspect with significant compressive deformation of the limbs—fetus papyraceus characteristics. Histology of the placental fragments revealed fibrin thrombi in large blood vessels, intense fibrosis of the villi with focal fibrin extravasation, and focal necrosis and inflammation, as well as extensive calcium deposits. Conclusions: Fetus papyraceus is a rare complication of intrauterine demise and fetal compression, which can vary in its degree of presenting severity and requires the co-occurrence of specific conditions. The condition is rarely associated with singleton pregnancies. Full article

Background and Clinical Significance: Spina bifida in the cervical region is closely associated with Chiari malformation, which is an amalgamation of terminology for separate conditions with similar pathophysiological mechanisms and progression from one another. Chiari malformations are associated with varying degrees of dilation of the foramen magnum or lack of fusion of the occipital bone with syringomyelia, herniation of the cerebellum, occipitocele and occipitomyelocele; Case Presentation: A previously healthy 23-year-old primigravida presented to our institution due to fetal demise in the third lunar month, established on routine outpatient maternal consultation. Point-of-care ultrasound revealed an amniotic sac measuring 3 cm in diameter and containing a single fetus, without cardiac function. Due to these, the patient was scheduled for pregnancy termination, during which the cervix was noted to be spontaneously dilated and abrasion accomplished complete evacuation of the amniotic sac, without its rupture. Upon sectioning of the amniotic sac, a fetus, measuring 2.5 cm in length, was noted, with a significant cuffing of the occipital and cervical paraspinal region. Histology revealed fetal structures with an adequate maturation index for its gestational age, but it presented with a pronounced meningoencephalomyelocele in the cervical and thoracic regions, characterized by the complete absence of vertebral arches and spinous processes from the atlanto-occipital to the sacral region; Conclusions: In the present case, not only is a significant and complex form of Chiari type III reported, but the condition is also associated with spina bifida aperta in all spinal regions, leading to meningoencephalomyelocele, incompatible with life. Full article

Background and Clinical Significance: Inherited metabolic disorders can result in fatal metabolic decompensation if not promptly recognized and treated. These conditions are common in Plain communities due to founder effects and the high prevalence of consanguinity. Case Presentation: We present the case of an adult Amish male with maple syrup urine disorder who sustained traumatic injuries and delayed metabolic intervention that contributed to a fatal outcome. Conclusions: This case highlights the critical need for increased awareness among emergency and adult care providers, especially in Plain communities, and emphasizes the importance of early multidisciplinary coordination and preparedness with metabolic resources to ensure timely, life-saving management in adult metabolic emergencies. Full article

Background and Clinical Significance: Roux-en-Y gastric bypass (RYGB) significantly alters glucose metabolism, yet managing glucose variability in patients undergoing bariatric surgery remains challenging. Continuous Glucose Monitoring (CGM) offers real-time insights into glucose fluctuations and may support long-term metabolic management in this population. This case highlights the utility of CGM in identifying postprandial glycemic variability and guiding dietary adjustments. Case Presentation: A 45-year-old female, 14 years post-RYGB, presented with symptoms including postprandial fatigue, nocturnal cravings, and unexplained weight gain, despite adherence to nutritional guidelines. Her BMI had decreased from 52 kg/m² (pre-surgery) to 29 kg/m². She was provided with a CGM device (FreeStyle Libre 3) by the clinical team and instructed to monitor glucose without modifying her routine initially. Data revealed significant glycemic variability, with peaks up to 220 mg/dL and hypoglycemic dips to 45 mg/dL. Based on this, she adjusted her diet by reducing non-complex carbohydrates and increasing vegetables, proteins, and complex carbohydrates. Within two weeks, her symptoms improved, including better sleep and energy levels, accompanied by a 3 kg weight loss following dietary adjustments informed by CGM feedback. Conclusions: This case suggests how CGM can empower patients having undergone bariatric surgery to manage glucose fluctuations through informed self-management. The patient’s ability to identify and address glucose variability without formal intervention highlights CGM’s potential as a supportive tool in long-term care. While further studies are needed, this case suggests CGM may benefit similar patients experiencing postprandial symptoms or weight regain after bariatric surgery. Full article

Background and Clinical Significance: The objective of this case study is to report on the clinical outcomes of a hard-to-heal posterior upper-thigh pressure ulcer when managed with a sterile human amniotic membrane tissue allograft. Case Presentation: Retrospective case data of a patient who received five applications of barrera^TM between February 2024 and April 2024 as part of their care regimen for a chronic pressure ulcer was obtained from a single wound care group. Data evaluated consisted of past patient medical history, concomitant medications, previous wound care treatments, wound type, wound size, adjunctive wound therapies and wound outcomes post allograft. The chronic pressure ulcer, measuring at 10.5 cm² prior to allograft application, achieved complete closure at the last observation post the final, fifth application. Wound size attenuation was seen as early as 1 week post initial allograft application. No adverse events or complications related to barrera^TM were observed. Conclusions: Results suggest that the application of dual-layer allografts in the context of chronic ulcers may represent a safe and effective wound management utility. Full article

Background and Clinical Significance: Thoracic dorsal arachnoid web (DAW) is a rare intradural extramedullary condition characterized by a thin band of arachnoid tissue compressing the dorsal spinal cord. A hallmark imaging feature is the “scalpel sign”, which refers to anterior displacement of the thoracic spinal cord with dorsal cerebrospinal fluid (CSF) accumulation, producing a sagittal profile resembling a surgical scalpel. Although highly specific for DAW, this sign may also appear in other intradural conditions such as idiopathic ventral spinal cord herniation and arachnoid cysts. The clinical presentation is typically progressive and nonspecific, including lower limb weakness, sensory changes, gait disturbances, and, less frequently, sphincter dysfunction. Diagnosis is often delayed due to the subtle nature of the lesion and limited resolution of conventional Magnetic Resonance Imaging (MRI). High-resolution Three-Dimensional Constructive Interference in Steady State (3D-CISS) sequences improve diagnostic accuracy by highlighting indirect signs such as spinal cord deformation and dorsal CSF flow obstruction. Case Presentation: We report the case of a 57-year-old woman presenting with chronic cervico-dorsalgia, bilateral lower limb weakness, paresthesia, and progressive gait instability. Neurological examination revealed spastic paraparesis and hyperreflexia. Conventional MRI was inconclusive. However, sagittal T2-weighted and 3D-CISS sequences demonstrated the scalpel sign at the T4–T5 level, with anterior cord displacement and dorsal subarachnoid space enlargement. Surgical exploration confirmed the presence of a dorsal arachnoid web, which was resected. Postoperative follow-up showed clear improvement in motor function and gait. Conclusions: DAW should be considered in cases of unexplained thoracic myelopathy or cervico-dorsalgia with neurological signs. Early recognition of the scalpel sign using advanced MRI sequences is critical for timely diagnosis and surgical planning, which may lead to significant clinical improvement. Full article

Background and Clinical Significance: In hepatocellular carcinoma (HCC), numerous signaling pathways become aberrantly regulated, resulting in sustained cellular proliferation and enhanced metastatic potential. Tumors that lack PYGO2 may not show the same types of tissue remodeling or regenerative features driven by the Wnt/β-catenin pathway, which could make the tumor behave differently from others that are Wnt-positive. PIK3CA-positive tumors are often associated with worse prognosis due to the aggressive nature of the PI3K/AKT pathway activation. This is linked to higher chances of metastasis, recurrence, and resistance to therapies that do not target this pathway. Case presentation: In this paper we present a rare case of hepatocellular carcinoma with PIK3CA-positive and PYGO2-negative signaling pathways, several key aspects of the tumor’s behavior, prognosis, and treatment options. Although alpha-fetoprotein (AFP) levels were significantly elevated, the CT and MRI examination showed characteristics of malignancy, HCC with secondary hepatic lesions and associated perfusion disturbances. The case particularities and immunohistochemistry features are highlighted in the context of literature review, the PIK3CA mutation suggesting the activation of the PI3K/AKT/mTOR pathway, a critical signaling pathway involved in cell survival, proliferation, and metabolism. Conclusions: Due to the aggressive nature of PIK3CA mutations, close monitoring and consideration of immunotherapy and targeted treatments are of crucial importance. Full article

Background and Clinical Significance: Palatal swellings may originate from various pathological disorders. These swellings may include congenital or acquired factors. The posterior hard palate, which contains many minor salivary glands, is a common site for such swellings. Case Presentation: We present a rare case of intraoral palatal myoepithelioma in a 45-year-old Egyptian male with a significant history of smoking. Detailed clinical, radiographic, and operative findings are discussed alongside histopathological evaluation, surgical management, and postoperative outcomes. This case highlights the importance of considering myoepithelioma lesions in the differential diagnosis of posterior palatal swelling. Conclusions: Palatal myoepithelioma is a rare but important benign salivary gland tumor that may resemble multiple other intraoral lesions. A complete clinical, radiographic, and histological investigation is required for a definitive diagnosis. Complete surgical excision achieved a favorable outcome. Increased awareness and reporting of this unusual pathology are critical for deepening knowledge and guiding clinical decisions. Full article

Background and Clinical Significance: Adenoid cystic carcinoma (ACC) is a rare neoplasm of salivary glands, accounting for approximately 2–4% of all ACCs of head and neck malignancies. Adenoid cystic carcinoma (ACC) of the larynx is exceedingly rare, accounting for only 0.07–0.25% of all laryngeal tumors. Within the larynx, ACC may arise in various locations; however, the subglottic region is most commonly affected, representing approximately 64% of cases. ACC typically manifests as a slow-growing tumor with a pronounced tendency for perineural invasion and local recurrence. Current treatment strategies primarily involve surgical resection followed by adjuvant radiotherapy. Chemotherapy demonstrates limited efficacy and is generally reserved for advanced, recurrent, or metastatic disease. Given the rarity of this malignancy and the limited number of cases reported in the literature, we aim to contribute to the existing body of knowledge by presenting a clinical case of laryngeal ACC. Case Presentation: A 77-year-old male with a significant smoking history (more than 20 cigarettes per day for over 40 years) presented to our department in October 2023 with persistent dysphonia lasting several months. Endoscopic evaluation of the upper aerodigestive tract revealed an extensive neoplastic lesion involving the larynx. Contrast-enhanced computed tomography (CT) confirmed the presence and extent of the lesion. The patient subsequently underwent surgical resection and was referred for adjuvant postoperative radiotherapy. Unfortunately, the patient died of a myocardial infarction a few days before radiotherapy could be initiated. Conclusions: Due to the rarity of laryngeal adenoid cystic carcinoma, further studies are necessary to define optimal management strategies. Sharing clinical experiences and outcomes is essential, as there is currently no universally accepted treatment consensus for this uncommon malignancy. At the same time, our aim is to highlight the importance of histological subtype and perineural invasion which have to be considered as important prognostic factors when dealing with ACC. Full article

Background and Clinical Significance: Granulomatous reactions are rare but clinically significant complications of aesthetic procedures involving dermal fillers, particularly in individuals with underlying immune dysregulation. These reactions present diagnostic and therapeutic challenges, especially when associated with undiagnosed or latent autoimmune diseases. This case illustrates the interaction between filler composition, immune status, and the risk of delayed inflammatory responses, underscoring the need for thorough patient evaluation and individualized management strategies. Case Presentation: A 49-year-old woman developed delayed-onset subcutaneous nodules following midface augmentation with two filler types: a monophasic, cross-linked hyaluronic acid gel (concentration 20 mg/mL, 1.0 mL per side) injected into the deep malar fat pads, and a calcium hydroxyapatite suspension (30% CaHA microspheres in a carboxymethylcellulose carrier, 0.5 mL per side) placed in the subdermal plane along the zygomatic arch. The procedure was performed in a single session using a 22 G blunt cannula, with no immediate adverse events. High-resolution ultrasound demonstrated hypoechoic inflammatory nodules without systemic symptoms. A retrospective review of her medical history revealed a latent, previously undisclosed diagnosis of granulomatosis with polyangiitis (GPA). The immune-adjuvant properties of calcium hydroxyapatite likely triggered a localized pro-inflammatory response in this predisposed patient. A conservative, staged, non-invasive therapeutic protocol—saline infiltration, intradermal polynucleotide injections, and manual lymphatic drainage—achieved complete clinical and radiological resolution without systemic immunosuppression or surgical intervention. Conclusions: This case highlights the critical importance of pre-procedural immunological assessment in aesthetic medicine. Subclinical autoimmune conditions may predispose patients to delayed granulomatous reactions after filler injections. An individualized, conservative management strategy can effectively resolve such complications while minimizing the risks associated with aggressive treatment. Greater awareness of immune-mediated responses to dermal fillers is essential to ensure patient safety and optimize clinical outcomes. Full article

Background: Post-traumatic epilepsy (PTE) is a recognized complication of traumatic brain injury (TBI), yet its risk following mild and moderate TBI remains underappreciated. Although mild TBI represents the majority of cases in clinical practice, a subset of patients develop unprovoked seizures months or even years post-injury. This review aims to synthesize current evidence on the incidence and predictors of PTE in mild and moderate TBI and to propose a clinically actionable decision-support tool for early risk stratification. Methods: We performed a narrative review of peer-reviewed studies published between 1985 and 2024 that reported on the incidence, risk factors and predictive models of PTE in patients with mild (Glasgow Coma Scale [GCS] 13–15) and moderate (GCS 9–12 or imaging-positive) TBI. Data from 24 studies were extracted, focusing on neuroimaging findings, early post-traumatic seizures, EEG abnormalities and clinical risk factors. These variables were integrated into a rule-based algorithm, which was implemented using Streamlit to enable real-time clinical decision-making. The decision-support tool incorporated five domains: injury severity, early post-traumatic seizures, neuroimaging findings (including contusion location and hematoma type), clinical and demographic variables (age, sex, psychiatric comorbidities, prior TBI, neurosurgical intervention) and EEG abnormalities. Results: PTE incidence following mild TBI ranged from <1% to 10%, with increased risk observed in patients presenting with intracranial hemorrhage or early seizures. From moderate TBI, incidence rates were consistently higher (6–12%). Key predictors included early seizures, frontal or temporal contusions, subdural hematoma, multiple contusions and midline shift. Additional risk-enhancing factors included prolonged loss of consciousness, male sex, psychiatric comorbidities and abnormal EEG patterns. Based on these features, we developed a decision-support tool that stratifies patients into low-, moderate- and high-risk categories for developing PTE. Conclusions: Even in non-severe cases, patients with mild and moderate TBI who exhibit high-risk features remain vulnerable to long-term epileptogenesis. Our proposed tool provides a pragmatic, evidence-based framework for early identification and follow-up planning. Prospective validation studies are needed to confirm its predictive accuracy and optimize its clinical utility. Full article

Background and Clinical Significance: The pathology of the round ligament (RL) is rare and often remains in the shadow of common surgical emergencies. The preoperative diagnosis is challenging, leaving the surgeon perplexed as to whether and when to operate. The presented case deserves attention due to the difficult decision to operate based solely on the clinical picture, despite negative imaging diagnostic results. Case presentation: A 76-year-old woman was admitted to the Emergency Department with 6 h complaints of epigastric pain, nausea, and vomiting. She was afebrile with stable vital signs. The abdomen was slightly tender in the epigastrium, without rebound tenderness or guarding. The following blood variables were beyond the normal range: WBC—13.5 × 109/L; total bilirubin 26 mmol/L; amylase—594 U/L; CRP 11.4 mg/L; ASAT—158 U/L; and ALAT—95 U/L. The ultrasound (US) and multislice computed tomography (MSCT) of the abdomen were normal. A working diagnosis of acute pancreatitis was established, and intravenous infusions were initiated. The next day, the patient became hemodynamically unstable with blood pressure 80/60 mm Hg, heart rate 130/min, chills and fever of 39.5 °C, and oliguria. There was remarkable guarding and rebound tenderness in the epigastrium. The blood analysis revealed the following: WBC—9.9 × 109/L; total bilirubin—76 µmol/L; direct bilirubin—52 µmol/L; amylase—214 U/L; CRP 245 mg/L; ASAT—161 U/L; ALAT—132 U/L; GGT—272 U/L; urea—15.7 mmol/L; and creatinine—2.77 mg/dL. She was taken to the operating room for exploration, which revealed local peritonitis and phlegmon of the RL. Resection of the RL was performed. The microbiological analysis showed Klebsiella varicola. The patient had an uneventful recovery and was discharged on the 5th postoperative day. In the next months, the patients had several readmissions due to mild cholestasis and pancreatitis. The magnetic resonance demonstrated a duodenal diverticulum adjacent to the papilla, located near the junction of the common bile and pancreatic duct. This clinical manifestation and the location of the diverticulum were suggestive of Lemmel’s syndrome, but a papillary dysfunction attributed to the diverticulum or food stasis cannot be excluded. Conclusion: To our knowledge, we report the first association between RL gangrene and Lemmel’s syndrome. We speculate that duodenal diverticulitis with lymphatic spread of the infection or transient bacteriemia in the bile with bacterial translocation due to papillary dysfunction, as well as cholestasis resulting from the diverticulum, could be plausible and unreported causes of the RL infection. The preoperative diagnosis of RL gangrene is challenging because it resembles the most common emergency conditions in the upper abdomen. The present case warrants attention due to the difficult decision to operate based solely on the clinical picture, despite negative imaging results. A high index of suspicion should be maintained in a case of unexplained septic shock and epigastric tenderness, even in negative imaging findings. MSCT, however, is a valuable tool to avert unnecessary operations in conditions that must be managed conservatively, such as acute pancreatitis. Full article

Background and Clinical Significance: Vascular complications occurring in the context of trans-trochanteric fractures are rare (mean incidence 0.2–0.5%) but can be fatal if not recognized and treated promptly. Most of the previously reported vascular injuries are iatrogenic, and various mechanisms of injury and producing agents have been reported. Case Presentation: We present a rare but severe vascular complication following proximal femur fracture fixation in the case of a 77-year-old patient, specifically, a deep femoral artery injury after DHS osteosynthesis. CT angiography identified the lesion in the territory of the profunda femoris artery, precisely at the level of the most distal screw, suggesting over-drilling as the underlying cause. The case is presented in the context of a literature review, updating the most important features of the vascular complications, incidence, diagnosis and treatment. Conclusions: This case highlights the critical role of early diagnosis and prompt interdisciplinary collaboration between orthopedic and vascular surgeons in managing iatrogenic vascular complications, achieving a favorable outcome. Full article

Background and Clinical Significance: Papillon–Lefèvre syndrome (PLS) is an autosomal recessive genetic skin disorder. Genetic studies have demonstrated that mutations in the Cathepsin-C (CTSC) gene, mapped to chromosome 11q14.1–q14.3, are responsible for the pathogenesis of PLS. The hallmark characteristics of this syndrome are palmoplantar keratoderma and severe periodontal disease that leads to premature tooth loss. Palmoplantar keratoderma commonly manifests during early childhood (ages one to four), followed by the onset of severe periodontitis around the age of three to four years. Although periodontitis and premature tooth loss are considered hallmark features, a limited number of cases lacking oral involvement have been reported, underscoring the phenotypic variability in PLS. Case Presentation: This report describes a 6-year-old female patient whose chief presenting complaint was palmoplantar keratoderma, recurrent skin infections, necrotizing granulomatous inflammation of the kidney, and delayed growth; she was genetically confirmed to have a CTSC mutation associated with PLS, yet without any dental manifestations. The lack of oral manifestations and the presence of necrotizing granulomatous inflammation of the kidney in this genetically validated case highlight an atypical presentation. Conclusions: This report discusses an unusual case of PLS of a patient displaying classic skin features without any dental issues. Full article

Background and Clinical Significance: Mucinous tubular and spindle cell carcinoma (MTSCC) is an uncommon subtype of renal cell carcinoma, representing 1–4% of epithelial renal tumors. It usually shows a low-grade morphology and indolent behavior, although sarcomatoid variants with an aggressive course have been described. Because of its overlap with papillary renal cell carcinoma (papRCC), sarcomatoid RCC, mesenchymal tumors, and oncocytic neoplasms, diagnosis requires the integration of imaging, histopathology, and immunohistochemistry. Case Presentation: We report a 71-year-old female who presented with a three-month history of right-sided lumbar pain and intermittent hematuria. Her laboratory tests were unremarkable. Contrast-enhanced CT revealed a well-circumscribed nodular lesion in the mid-portion of the right kidney, measuring 50 × 47 × 52 mm. The patient underwent right nephrectomy. Macroscopic findings revealed an encapsulated, yellowish-gray nodule (5.2 × 5 × 4 cm) without renal pelvis invasion. Microscopically, the tumor consisted of cuboidal- to spindle-shaped cells arranged in cords and tubular structures within a mucinous stroma, with focal necrosis and foamy macrophages. Immunohistochemistry showed positivity for CK19, CK7, EMA, PAX8, and AMACR, with a Ki-67 index <10%, while CD117, RCC, CD10, and chromogranin were negative. Together, the low Ki-67 proliferation index, absence of invasion, and low-grade histological architecture confirmed MTSCC of low malignant potential. At a five-year follow-up, the patient remained disease-free. Conclusions: MTSCC is a rare renal neoplasm that can be diagnosed by integrating clinico-radiological, histopathological, and immunophenotypic features. Molecular profiling may further distinguish MTSCC from papRCC and identify aggressive variants. Surgical excision remains the cornerstone of management, supported by vigilant long-term follow-up. Full article