Reports — Clinical Practice and Surgical Cases

Background and Clinical Significance: Frontal sinus disease remains one of the most challenging conditions in rhinology due to its complex and variable anatomy and high tendency toward postoperative stenosis. Paranasal sinus mucoceles are uncommon, delayed complications following functional endoscopic sinus surgery (FESS), most often involving the frontal or anterior ethmoidal sinuses. They may arise from obstruction or scarring of natural drainage pathways, producing recurrent sinusitis or headache; Case Presentation: A 21-year-old male presented with persistent left-sided frontal headache and nasal obstruction after two previous FESS procedures. Radiologically, CT and MRI demonstrated chronic left-sided sinonasal inflammatory disease and two frontal-ethmoidal mucoceles. Revision endoscopic sinus surgery was performed with an image-guided (neuronavigation-assisted) technique, including Draf IIb frontal sinusotomy, mucocele marsupialization, and corrective septoplasty. The postoperative course was uneventful with rapid clinical improvement; Conclusions: Double postoperative mucoceles following ESS are rare. Neuronavigation-assisted revision surgery can be used for effective management in scarred, anatomically distorted sinus regions. However, this single case cannot establish superiority over conventional endoscopic guidance or demonstrate an effect on safety, efficacy, or recurrence.

Background and Clinical Significance: Thyroid metastasis from clear cell renal cell carcinoma (ccRCC) is uncommon and may occur after radical nephrectomy despite no evidence of residual or metastatic disease at that time. Diagnosis can be challenging because imaging and fine-needle aspiration (FNA) may mimic benign or primary thyroid lesions. Case Presentation: A 55-year-old man underwent left radical nephrectomy for WHO/ISUP grade 3 ccRCC with focal grade 4 differentiation. Two years later, surveillance ultrasonography detected a suspicious lesion involving the thyroid isthmus and left lobe. FNA was interpreted as Bethesda II (benign), but metastatic ccRCC was subsequently confirmed after total thyroidectomy. Histopathology showed focal vascular and capsular invasion. Tumor reached the margin of the main thyroid specimen, whereas separately submitted perithyroidal soft tissue had tumor-free margins, resulting in a final R0 resection. The tumor was positive for CK8/18, PAX8, EMA, vimentin, and CD10 and negative for TTF-1, thyroglobulin, calcitonin, and CD5. Postoperative 18F-FDG PET/CT showed no additional metastatic disease. Conclusions: Benign thyroid cytology should be interpreted cautiously in patients with previous ccRCC when clinical or imaging findings remain suspicious. Diagnosis requires integration of oncological history, imaging, histopathology, and immunohistochemistry. Surgical resection may provide local disease control in selected patients, with surveillance.

Background and Clinical Significance: Meckel’s diverticulum is a remnant of the omphalomesenteric duct, arising from an incomplete obliteration of the embryonic vitelline duct, which connects the fetal gut to the yolk sac, typically regressing between the fifth and seventh weeks of gestation. There are many mechanisms for bowel obstruction arising from a Meckel’s diverticulum. Therefore, early diagnosis and treatment are the keys to prevent intestinal gangrene and perforation; Case Presentation: We report the management of sigmoid volvulus associated with acute Meckel’s diverticulitis and a fibrous band in an 85-year-old patient with multiple comorbidities and very high perioperative risk. Sigmoid volvulus was the mechanical cause of intestinal obstruction, whereas an inflamed Meckel’s diverticulum associated with a fibrous band extending toward the anterior abdominal wall was identified during surgical exploration. No twisting or mechanical obstruction of the distal ileum was observed. Histopathological examination subsequently confirmed acute Meckel’s diverticulitis. The unusual coexistence of these findings, together with the diagnostic and therapeutic challenges posed by the patient’s severe comorbidities, prompted us to report this case; Conclusions: Although no direct mechanical relationship between Meckel’s diverticulum and sigmoid torsion was demonstrated, their coexistence raises a hypothesis of a potential pathophysiological interaction; however, any such relationship remains hypothesis-generating only. Identification of one apparent cause of intestinal obstruction should not preclude systematic evaluation for concomitant pathology, particularly when the clinical, radiological, operative, and inflammatory findings are not fully explained by a single diagnosis.