Search Results (11)

Background/Objectives: Salivary stones, also known as sialoliths, are calcified structures that develop within the salivary glands and/or their ducts. They occur in approximately 1 per 10,000 to 30,000 individuals per year, primarily affecting adults between 30 and 50 years of age. Although several hypotheses have been proposed, the exact mechanisms of formation and their predisposing factors are yet to be confirmed. The submandibular gland is the most commonly affected site, accounting for nearly 80% of cases, while giant and asymptomatic sialoliths are rare clinical findings in dental practice. This study is divided into two components: first, a case report of a giant, asymptomatic sialolith located in Wharton’s duct; second, a systematic review of the literature to explore the clinical procedures, diagnoses, outcomes, and other relevant aspects of this pathology. Methods: The case involved a 42-year-old woman who sought dental care due to the presence of a painless sublingual swelling. Intraoral examination and imaging revealed a calcified mass consistent with sialolithiasis in Wharton’s duct. The stone was successfully removed via sialolithotomy. For the systematic review, an extensive search was conducted in PubMed, Embase, and Cochrane Library up to June 2025, using specific keywords. Initially, 262 studies were identified. After applying inclusion and exclusion criteria, six case reports were included in the final analysis. Results: All selected studies described giant salivary stones located in Wharton’s duct and/or the parenchyma of the submandibular gland, notably without associated pain. Computed tomography and ultrasonography were the most commonly used imaging modalities for diagnosis. In all cases, the primary treatment was sialolithotomy. Conclusions: This study explored a rare case report of an asymptomatic giant sialolith in Wharton’s duct, and it includes a systematic review focused exclusively on asymptomatic giant sialoliths. It specifically addresses key characteristics, preferred imaging modalities, treatment strategies, and clinical considerations for managing this uncommon condition. Registration number: Prospero registration nº CRD420251076737. Full article

Background: Sciatic nerve schwannomas are rare benign tumors that can develop along the nerve’s course, from the pelvis to the thigh. Giant schwannomas, defined as those exceeding 5 cm, are particularly rare and may alter the tumor’s anatomical relationship with the nerve, impacting surgical strategy. Methods: A PRISMA 2020-compliant systematic review was conducted using the terms (“sciatic” AND “schwannoma”) for publications from 2000 to October 2024. Of 166 identified articles, we excluded those lacking giant schwannoma cases or involving syndromic associations. We also report a novel case from our center. Results: Our patient, a 35-year-old woman, presented with tingling and discomfort while sitting, localized to the left thigh, without radicular pain or motor deficits. MRI revealed a 14 × 7 cm mass. This is, to our knowledge, the first reported case of a giant solitary sciatic schwannoma of these dimensions located exclusively in the thigh, resected via intracapsular dissection with nerve monitoring, that was fully documented and reported. The review yielded 22 relevant articles, most involving pelvic or pelvic–thigh junction locations, with low recurrence rates. Conclusions: Giant sciatic schwannomas may be asymptomatic and slow-growing. This case is notable for tumor’s location, large size, and successful nerve-sparing surgical outcome. Full article

Uterine adenosarcoma with sarcomatous overgrowth (ASSO) is an exceptionally rare and aggressive subtype of uterine sarcomas, characterized by high mitotic activity, deep myometrial invasion, and an elevated risk of recurrence and metastasis. We report the case of a 79-year-old institutionalized woman with a history of hypertension, type 2 diabetes, chronic hepatitis B, and mild Alzheimer’s disease. During routine hepatic ultrasound surveillance, an incidental 26 mm endometrial lesion was detected. Initial diagnostic hysteroscopy revealed a benign endometrial polyp. However, due to the patient’s institutionalization and absence of gynecologic symptoms, no specialized follow-up was conducted. Four years later, she presented with profuse postmenopausal bleeding. Imaging revealed a markedly enlarged uterus with a 12–13 cm heterogeneous endometrial mass containing cystic and hemorrhagic areas, demonstrating diffusion restriction and significant contrast enhancement on MRI, with no radiologically suspicious lymphadenopathy. Hysteroscopy demonstrated a giant polyp with a broad implantation base; histology suggested sarcomatous transformation. Definitive diagnosis after total hysterectomy with bilateral salpingo-oophorectomy confirmed high-grade ASSO with homologous sarcomatoid overgrowth, consistent with endometrial stromal sarcoma. This case illustrates the progressive malignant transformation of an initially benign-appearing lesion in a patient with significant comorbidities and limited follow-up. It underscores the importance of clinical vigilance, regular monitoring, and interdisciplinary coordination in the evaluation of uterine enlargement in asymptomatic postmenopausal women. Full article

Introduction: Lipomas are among the most encountered neoplasms in clinical practice, occurring mainly in adults between the fourth and sixth decades of life. Deep-seated lipomas in children are found in the thorax, chest wall, mediastinum, pleura, pelvis, retroperitoneum, and paratesticular area. Herein, we present a case of a three-year-old child with a giant mesenteric lipoma, along with a review of the literature on mesenteric lipomas in childhood. Case presentation: A three-year-old male toddler was referred to our hospital for severe, intermittent abdominal pain. Imaging studies at admission revealed a fat lesion occupying most of the peritoneal cavity and dislocating adjacent structures. An urgent laparotomy was performed. A giant lipoma arising from the mesentery and leading to the torsion of the mesenteric radix was confirmed and completely excised alongside an adherent small tract of jejunum. The child recovered uneventfully and is still being followed-up with no signs of recurrence. Discussion: Lipomas of the mesentery in children are very rare, and they are reported to be more common among children younger than three years of age. Mesenteric lipomas appeared to be more frequent in males than females. Even though they might be asymptomatic, voluminous lipomas can also create a lead point for intermittent torsion of the mass causing ischemia and infarction. Abdominal pain was the most frequent symptom, and the ileum was the tract of bowel more frequently involved by the tumor. Laparotomy was reported to be the preferable approach to safely remove this abdominal mass, especially in case of huge dimensions. Full article

There is a considerable increase in the use of substances and medical procedures aimed at changing the esthetics of the face, particularly the appearance of the lips. Permanent fillers such as polydimethylsiloxane, also called liquid silicone, are widely used, but their application for facial esthetics is currently obsolete. Silicone belongs to this polymer family; its viscosity is determined by its degree of polymerization. Liquid injectable silicone is odorless, colorless, non-volatile, and oily to the touch. The substance is not altered by storage at room temperature and is not carcinogenic or teratogenic. However, the long-term complications remain a reality, as they can occur decades after the application. Thus, the goal of this case report was to present a complication after 16 years of treatment using liquid silicone. This case report involved a 52-year-old male with a complication of bilateral permanent filler in the upper lip performed 16 years ago, its surgical removal, and histological analysis. The patient had the first appointment at the University Dental Clinic—Universidade Católica Portuguesa (Viseu, Portugal) in April 2022, dissatisfied with his upper lip’s esthetic appearance and shape. He was not a smoker or diabetic but had hypertension and hypercholesterolemia and was medicated with Losartan, Hydrochlorothiazide, and Pitavastatin. No relevant findings were observed in the extraoral examination; he had bruxism and a good periodontal condition. The patient had an asymptomatic bilateral mass, hard to palpation, located on the upper lip due to permanent lip filling performed to increase its volume in 2006 associated with non-related generalized granules of Fordyce. The treatment options presented just observation or complete material removal in two surgical steps, which was the patient’s choice. Then, the first surgical procedure was performed under local anesthesia on the right side of the lip, one carpule of Lidocaine 2% with adrenaline 1:100,000, with a chalazion clamp, a diode laser for hemorrhagic control, and a simple suture. In this procedure, three fragments were biopsied: a cuboid measuring 1 × 1 × 0.8 cm and an irregular one consisting of two fragments that at one end of the piece were in continuity with each other, one measuring 1.6 × 0.5 × 0.4 cm and the other 2.5 × 0.6 × 0.5 cm. A similar macroscopic appearance in all the material, white in color, irregular surface, elastic, white section surface, or slightly fasciculate. The patient was medicated with Tylenol 500 mg thrice a day for two days. With 20-day intervals, the sutures from the first surgery were removed, as well as the foreign body from the upper lip on the left side, following the same surgical technique and medication. Histologically, it was possible to identify a chronic inflammatory, lymphoplasmacytic, and granulomatous reaction, with foreign body giant cells’ reaction, in relation to non-polarizable exogenous material due to the reaction to silicone. The most common complications are granulomas’ appearance and material displacement. The case report shows these granulomas are characterized as chronic low-caliber inflammation around the silicone. They have an unknown etiology but are probably multifactorial, from continuous trauma, friction or irritation, iatrogenic factors, infection, immunological mechanisms, and genetic and molecular variations, and can be highly related to the impurity of the injected material. This case brings the opportunity for health professionals to increase awareness of the long-term adverse effects of the silicone material used to fill the lip in order to make its application more predictable and conscious. Full article

Introduction: calvarial capillary hemangiomas are vascular tumors rarely seen in newborns. Differential diagnosis may be not straightforward on imaging studies and the management depends on patient and lesion characteristics. Case report: we present the case of a large congenital intracranial extra-axial lesion detected by routine prenatal US screening, a giant calvarial congenital hemangioma, treated with a multimodal strategy. Neonatal MR showed a hemorrhagic solid lesion, causing compression of brain tissue. Conservative treatment was attempted, but a one-month follow-up MR showed growth of the lesion with increased mass effect. Pre-operative endovascular embolization and surgical resection were performed. The pathology was consistent with intraosseous capillary hemangioma. The post-operative course was uneventful. At the 8-month follow-up, the patient had no clinical deficits and MR showed complete resection of the lesion. At the 13-month follow-up, the patient was asymptomatic, showing normal neurological examination and psychophysical development. Conclusions: although wait-and-see policy is feasible for small and asymptomatic lesions, radical resection is indicated when the mass is large, thus causing severe mass effect on the brain. Hypervascularization of the tumor may be responsible for hemorrhagic complications and severe anemia. On these grounds, endovascular treatment is feasible and effective to reduce hemorrhagic complications. Full article

Diagnostic and surgical difficulties were presented in case of a giant mass, found incidentally, in a 65-year-old healthy and asymptomatic man. The patient underwent different diagnostic procedures. Surgery was the treatment of choice. A combination of both open technique and videothoracoscopy to reduce the risk of seeding, pending a certain diagnosis, was resolutive. The postoperative period and recovery time were uneventful. The patient was discharged on the 5th postoperative day. The histological diagnosis was benign schwannoma. There are different aspects to think about, based also on the experience of each center. According to our experience, this is a rare situation; the combined surgical techniques to control the vascular risk and tissue infiltration of the mass seemed to us the approach of choice. Full article

The first case of hyaline vascular type of unicentric Castleman disease (HV-UCD) was reported more than six decades ago. Since patients with HV-UCD are often asymptomatic and this condition is generally discovered incidentally on imaging tests, most of the previous reports were of mediastinal origin detected by chest radiography. In recent years, improved access to imaging modalities has provided new insights in the diagnosis of this condition. In this study, we reviewed the detailed clinical and pathological findings of 38 HV-UCD cases (20 males and 18 females, mean age: 42.8 years). The most common site involved was the abdominal cavity (34.2%), followed by mediastinum (23.7%) and retroperitoneum (15.8%). In the abdominal cavity, mesenteric origin was the most common. The mean size of masses was 4.8 cm. Pathologically, thick hyalinized collagen fibers surrounding large blood vessels and calcification were observed (81.6% and 23.7%, respectively). Multinucleated giant cells resembling Warthin–Finkeldey cell were also observed in occasional cases (23.7%). This is a unique paper that summarizes detailed clinical and pathological findings of a large series of a rare disease. The clinical information presented in this paper is more plausible than previous views and is useful for accurate diagnosis and understanding of the disease. Full article

Background: Placental chorioangioma is the most common benign non-trophoblastic neoplasm of the placenta. Its clinical relevance lies in the size of the tumor since larger masses cause pregnancy complications, including an unfavorable neonatal outcome. Case presentation: We report the case of a 34-year-old second gravida and nullipara at the 35th week of gestation, admitted to the gynecological department for antibiotic-resistant fever. The cardiotocography performed during hospitalization showed an abnormal fetal pattern. A 2250 g newborn was delivered by cesarean section. No complications were observed during childbirth and postpartum was insignificant. On gross inspection a white fleshy intraparenchymal mass blooming on the maternal surface was noted; routinely stained sections revealed features consistent with chorioangioma with vascular channels lined by inconspicuous endothelial cells immunoreactive for CD31 and CD133. Focal expression of CD133 was also observed in placental villi. Discussion: CD133 expression indicated the presence of stem cells in chorioangioma, suggesting their possible role in the development of mesenchymal lesions including chorioangioma. Full article

We study the effects of a reduced mass-loss rate on the evolution of low metallicity Jsolated stars, following our earlier classification for angular momentum (J) isolated stars. By using the stellar evolution code MESA we study the evolution with different mass-loss rate efficiencies for stars with low metallicities of $Z=0.001$ and $Z=0.004$ , and compare with the evolution with solar metallicity, $Z=0.02$ . We further study the possibility for late asymptomatic giant branch (AGB)—planet interaction and its possible effects on the properties of the planetary nebula (PN). We find for all metallicities that only with a reduced mass-loss rate an interaction with a low mass companion might take place during the AGB phase of the star. The interaction will most likely shape an elliptical PN. The maximum post-AGB luminosities obtained, both for solar metallicity and low metallicities, reach high values corresponding to the enigmatic finding of the PN luminosity function. Full article

The foot and ankle are rare sites of involvement for giant cell tumor of tendon sheath. We present three rare cases of giant cell tumor of tendon sheath arising from the tendon sheaths of the flexor hallucis longus, peroneus brevis, and extensor hallucis brevis tendons, along with a literature review of such cases in the foot and ankle region. All of the patients were treated with surgical excision of the mass and were asymptomatic after minimum follow-up of 18 months. Giant cell tumor of tendon sheath involving the foot and ankle region is a rare clinical entity, and good results can be expected after surgical excision. Full article