Reports doi: 10.3390/reports9040394

Authors: Marie Kratzer Olivia Massard Birgit Andrea Gartner

Background and Clinical Significance: Chest pain is a common reason for activating emergency medical services and can be associated with a wide range of conditions. Rapid identification of life-threatening causes, such as cardiac tamponade, is crucial for timely intervention and improved patient outcomes. In this case neither the clinical signs nor the electrocardiogram (ECG) suggested the diagnosis, which was established by point-of-care ultrasound. Case Presentation: We report the case of a 70-year-old man with cardiovascular risk factors, whose initial presentation suggested stable chest pain. The prehospital electrocardiogram showed a nonspecific pattern with 1 mm ST elevation in leads V1 to V3 with lateral ST depression, without PR-segment depression or low QRS voltage. He rapidly developed shock of undetermined cause, which was managed in the field with fluids and vasopressors. Focused cardiac ultrasound in the emergency department revealed cardiac tamponade, and emergent pericardiocentesis drained 400 mL of hemorrhagic fluid. After an extensive work-up, presumed viral pericarditis was retained, with no recurrence over almost two years. Conclusions: A nonspecific ECG does not exclude pericardial disease, and normal QRS voltage does not exclude cardiac tamponade in unexplained shock. Point-of-care ultrasound is a valuable tool for diagnosing cardiac tamponade; its prehospital application is a promising area for development, supported by provider training and resource availability.

Reports doi: 10.3390/reports9040393

Authors: Aysel Ashir Jhia Jiat Teh Aarti Chadha Shabana Syed

Background and Clinical Significance: Fannyhessea vaginae (formerly Atopobium vaginae) is an anaerobic, Gram-positive coccus associated with bacterial vaginosis and, rarely, invasive infection. Its role in adverse pregnancy outcomes, particularly following invasive prenatal procedures, remains poorly understood. Case Presentation: We report a 32-year-old woman, gravida 3, para 2, who underwent transabdominal chorionic villus sampling (CVS) at 12 + 6 weeks gestation for prenatal diagnosis of ABCA3 deficiency, following the death of a previous child from the same condition. She developed a persistent subchorionic haematoma with recurrent vaginal bleeding, followed by rising inflammatory markers, malodorous amniotic fluid and a late miscarriage with placental abruption at 20 + 6 weeks. Blood cultures taken at the onset of labour grew F. vaginae, identified after discharge, prompting readmission for intravenous antibiotics. She subsequently underwent evacuation of retained products of conception. Placental histopathology confirmed abruption with only early inflammatory changes, and vaginal and placental swabs did not isolate the organism. To our knowledge, this is the third reported case of F. vaginae bacteraemia associated with pregnancy loss following CVS, and the first following a transabdominal approach. We propose that the persistent subchorionic haematoma may have facilitated ascending infection from the lower genital tract, although a causal relationship could not be established. Conclusions: This case highlights F. vaginae as an under-recognised but potentially clinically significant pathogen capable of causing septic miscarriage and underlines the need for raised clinical suspicion and further research into its role in pregnancy.

Reports doi: 10.3390/reports9040392

Authors: Miloslav Mišánik Marek Smolár Diana Musová Michal Hošala Juraj Miklušica

Background and Clinical Significance: Traumatic diaphragmatic hernia may remain clinically silent after thoracoabdominal trauma and subsequently present with bowel obstruction. Right-sided defects pose particular diagnostic and operative challenges because of their relationship with the liver. We report delayed right-sided herniation with transverse colon incarceration and omental gangrene treated laparoscopically. Case presentation: A 74-year-old man presented with sudden abdominal pain and recurrent vomiting approximately one month after a fall down stairs for which he had not sought medical attention. Examination revealed abdominal distension, absent bowel sounds, and diminished breath sounds over the right lower hemithorax. Chest radiography demonstrated an intrathoracic colonic loop, and computed tomography confirmed incarceration of the transverse colon through a right diaphragmatic defect. Laparoscopy identified an approximately 4 cm defect containing the transverse colon and greater omentum. After reduction, the colon was edematous but viable and was preserved; the gangrenous portion of the omentum was resected. The defect was closed without tension using interrupted non-absorbable monofilament sutures, without mesh or conversion. Recovery was uneventful, with mobilization on the day of surgery, a normal diet from postoperative day one, and discharge on postoperative day five. At three months, clinical assessment and chest radiography showed no symptoms or radiographic signs of recurrence. Conclusions: A recent history of trauma should prompt consideration of diaphragmatic hernia in patients with intestinal obstruction and abnormal thoracic findings. This case illustrates the feasibility of laparoscopic reduction, preservation of viable colon, selective omental resection, and primary repair in an appropriately selected patient.

Reports doi: 10.3390/reports9040391

Authors: Kiera Kavcic Zak Ahmed Minu Ponnamma Mohan Vipanchika Satheeshkumar Joel Brian. Epstein Parikshit Padhi Roberto Pili Poolakkad S. Satheeshkumar

Background/Objectives: Oral mucositis (OM) is a recognized toxicity of antibody–drug conjugates (ADCs), but its long-term systemic implications are unknown. We assessed long-term systemic complications and mortality associated with OM in patients with breast cancer treated with monoclonal antibodies and antibody–drug conjugates (mADCs). Materials and Methods: This retrospective cohort study used TriNetX data from 88 healthcare organizations. Adults with breast cancer receiving mADCs with (n = 1784) or without (n = 61,616) OM (ICD-10-CM K12.31) were 1:1 propensity score-matched on race, external causes of morbidity, ECOG performance status, and body mass index (1784 per cohort). Outcomes included volume depletion, fluid/electrolyte disorders, respiratory and circulatory disease, malaise/fatigue, pain, dysphagia, and all-cause mortality, assessed from 1 day after the index event using risk differences, Kaplan–Meier analysis, and Cox hazard ratios (HRs). Results: Patients with OM had higher risks of fluid/electrolyte disorders (39.1% vs. 32.1%), respiratory disease (48.5% vs. 39.0%), circulatory disease (63.7% vs. 51.2%), pain (16.1% vs. 11.7%), dysphagia (10.4% vs. 8.2%), and mortality (26.1% vs. 19.3%), with HRs (no OM vs. OM) of 0.664–0.753 (log-rank p ≤ 0.002 for all). Volume depletion and malaise/fatigue showed no significant absolute risk differences but significant survival differences (HR 0.824 and 0.855). Recurrent event counts did not differ. Conclusions: In patients with breast cancer treated with mADCs, OM was associated with greater long-term systemic morbidity and mortality after propensity score matching. OM may serve as a marker of systemic vulnerability, supporting routine oral health assessment and oncology–dentistry collaboration during ADC therapy, with implications for toxicity management as ADC use expands.

Reports doi: 10.3390/reports9040390

Authors: Luca Costanzo Francesco Lorenzo Di Pino Marco Mangiafico

Background and Clinical Significance: Acquired arteriovenous fistula (AVF) following deep vein thrombosis (DVT) is an uncommon condition, typically reported in association with persistent venous obstruction. Case Presentation: We report the case of an 18-year-old male with pulmonary embolism (PE) and extensive left iliofemoral–popliteal DVT treated with anticoagulation and compression therapy. Follow-up duplex ultrasound demonstrated progressive venous recanalization, with complete restoration of popliteal vein patency and persistent external iliac vein occlusion. During routine surveillance, in the absence of post-thrombotic symptoms, a popliteal AVF was incidentally detected. This anatomical localization is exceptionally rare, and the delayed appearance of the lesion after documented venous patency makes an early recanalization-related mechanism less likely. Although the absence of overt post-thrombotic syndrome limits definitive conclusions, a delayed hemodynamic alteration secondary to persistent proximal venous outflow obstruction was hypothesized as a possible contributing factor. Given the asymptomatic presentation and recent detection, conservative management comprising anticoagulation, elastic compression, venoactive therapy, and close ultrasound follow-up was adopted. Conclusions: This case highlights that post-thrombotic AVFs may manifest as late incidental findings and supports a tailored management approach based on clinical and hemodynamic features.

Reports doi: 10.3390/reports9040389

Authors: Ayma Aqib Dilkash Kajal Angela Li Miguel Russo Nigel Pereira

Background and Clinical Significance: Endometriosis is a chronic, estrogen-dependent inflammatory condition that can cause pain, infertility, and, in its deep infiltrating form, bowel involvement. Dienogest is a progestin that is commonly used for the long-term medical treatment of endometriosis or prior to surgery. Dienogest has been previously used as the progestin in progestin-primed ovarian stimulation (PPOS). However, the use of dienogest as a short-term bridge to maintain disease suppression and prevent ovulation during controlled ovarian stimulation (COS) in patients awaiting surgery has not been well described. This case highlights a novel application of dienogest therapy as a bridging strategy in severe endometriosis, enabling continued disease suppression while facilitating COS and fertility preservation before definitive surgical management; Case Presentation: A 26-year-old nulligravid woman with stage IV endometriosis presented for fertility preservation following hospitalization for small bowel obstruction (SBO) associated with extensive deep infiltrating endometriosis (DIE). Radiologic imaging demonstrated bilateral endometriomas, involvement of the distal ileum, rectosigmoid colon, and adherence of multiple small bowel loops to the right ovary. Following conservative management of the SBO, oral dienogest 2 mg daily was initiated for disease and symptom suppression. Given the extent of the disease, risk of recurrent obstruction and anticipated definitive surgery, oocyte cryopreservation was planned before surgical management. Baseline ovarian reserve testing demonstrated an anti-Müllerian hormone (AMH) of 7.5 pmol/L (1.05 ng/mL) and antral follicular count (AFC) of 3. Approximately one week after dienogest initiation, COS was initiated with recombinant follicle stimulating hormone (rec FSH) 275 IU daily and increased to 300 IU after four days, while dienogest 2 mg daily was continued without additional medications to suppress ovulation. On stimulation day 13, her serum estradiol measured 3280 pmol/L (893.4 pg/mL) and three follicles measured >17 mm. A combined gonadotropin releasing hormone-agonist and human chorionic gonadotropin trigger was administered. Eleven oocytes were retrieved, all of which were mature and cryopreserved. Symptoms did not recur before surgery. Three weeks later, she underwent laparoscopic radical excision of endometriosis, ureterolysis, bilateral ovarian cystectomy, and bowel resection. She was discharged on postoperative day 5 and continued dienogest; Conclusions: In this patient’s case, continuing dienogest during COS provided a dual-purpose bridge, maintaining disease suppression and preventing ovulation during COS, which facilitated fertility preservation with a short interval to planned surgery. Given that this is a single-case study, further research is required to determine safety, efficacy and optimal duration of this approach.

Reports doi: 10.3390/reports9040388

Authors: Jonas Povilavičius Kamilė Bagdonaitė Rūta Bernatavičienė Geistė Tubutytė Arūnas Strumila

Background and Clinical Significance: Percutaneous endoscopic gastrostomy (PEG) is widely used to provide long-term enteral nutrition in neurologically impaired children. Although generally safe, inadvertent visceral organ damage during placement may result in rare, serious complications like gastrocolic perforation. Subsequent laparoscopic repair introduces further subtle risks, including the retention of broken surgical sharps due to the physical limitations of minimally invasive environments. Finding and extracting these small ferromagnetic components poses a severe technical dilemma, often prolonging anesthesia or forcing conversion to open laparotomy. Magnet-assisted techniques may potentially serve as a rapid, low-impact rescue alternative in selected circumstances. Case Presentation: A 14-year-old boy with severe neurodevelopmental deficits (Dandy–Walker malformation, cerebral palsy, refractory generalized epilepsy) presented with severe peritonitis two weeks following a PEG tube placement. Urgent diagnostic laparoscopy identified multi-site visceral injuries: a through-and-through perforation involving both the anterior and posterior walls of the transverse colon alongside an anterior gastric perforation, secondary to severe colon interposition. While laparoscopically repairing these visceral defects, a 26-mm curved suturing needle fractured inside a 10-mm working trocar, and the sharp tip disappeared into the peritoneal environment. Initial thorough inspection failed to localize the sharp. Postoperative abdominal radiography verified the fragment’s location within the left upper quadrant. During a secondary re-exploration, an improvised magnetic delivery system (comprising small sterile neodymium spheres sealed within a surgical glove finger) was passed through a trocar to rapidly target, capture and extract the fragment. The subsequent course was complicated by adhesive mechanical small-bowel obstruction, requiring further laparoscopic adhesiolysis before successful stabilization. Conclusions: Concurrent gastrocolic organ perforation and intra-operative instrument fracturing represent a concurrent complication in children with complex comorbidities. This case highlights the biomechanical vulnerabilities of minimal-access closures and demonstrates the clinical feasibility of an improvised, glove-contained magnetic capture array, suggesting it may represent a useful, low-impact rescue option to locate and remove retained sharps without open surgery.

Reports doi: 10.3390/reports9040387

Authors: Annamaria Nicolli Mauro Alaibac Cinzia Bertolin Fabiola Pasqualato Leonardo Salviati Paolo Simioni Andrea Trevisan Carlo Poci

Background and Clinical Significance: Variegate porphyria (VP) is a rare hepatic porphyria caused by a partial deficiency in protoporphyrinogen oxidase (PPOX), the penultimate enzyme in the heme biosynthesis pathway. This enzymatic defect leads to the accumulation of porphyrins and their precursors, resulting in a broad spectrum of clinical manifestations. The disease may present with cutaneous symptoms, typically chronic skin blistering, and/or acute episodes characterized by severe neurovisceral symptoms. Case presentation: We present the case of 24-year-old woman with VP who began working as an entertainer at a tourist resort in Turkey. Her role involves intense, prolonged shifts, often with significant sun exposure and considerable physical and psychological stress. After several months of work, the patient developed severe hand lesions, significantly influencing both her job performance and daily life, leading to pain, discomfort, and general malaise. The village doctor prescribed a topical treatment with corticosteroids and antibiotics, without an improvement in dermatological lesions. Conclusions: The case presented has two important implications: (1) it is the first case of a subject affected by a rare disease such as VP exacerbated by occupational exposure and (2) it suggests that hemin, routinely used to treat acute attacks, may also have a therapeutic benefit for the cutaneous manifestations of VP.

Reports doi: 10.3390/reports9040386

Authors: Léopoldine Lapierre Suzanne Tavitian Solange Grunenwald Lucie Rigolot Françoise Huguet

Background and Clinical Significance: Gynecomastia is not considered as an expected adverse event in patients treated by asciminib. We provide the first detailed description of this occurrence. Case presentation: Two elderly patients treated with asciminib for chronic myeloid leukemia—in the third-line setting for 6 months and in the second-line setting for 3 months, respectively, experienced gynecomastia. Both exhibited hormonal disturbances, with elevated follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels, along with low serum total testosterone and increased prolactin levels in one. Imaging was performed in one patient and ruled out breast and testicular cancer. In both cases, advanced age, renal insufficiency and long-lasting exposure to previous tyrosine kinase inhibitors were confounding factors, but chronological arguments were in favor of an adverse effect of asciminib. The temporary discontinuation of asciminib in one patient and local treatment with androstanolone in both alleviated symptoms. The optimal response of CML was acquired and maintained, which allowed a later dose reduction in one case. Conclusions: Pathophysiological mechanisms are discussed but remain uncertain and probably multifactorial. Possible management options are presented.

Reports doi: 10.3390/reports9040385

Authors: Konstantinos Poulopoulos Nikolaos Spantidakis Vasileios Zisis Mateus José Dutra Amalia Syrioti Filippos Fytros Asterios Katsagkolis Panagiota Dimitropoulou Christina Charisi Athanasios Poulopoulos

Background/Objectives: Bullous pemphigoid (BP) in children is a rare autoimmune subepidermal blistering condition that shows significant clinical variability depending on age. This narrative review summarizes the available literature on the epidemiology, etiology, clinical manifestations, diagnosis, management, outcomes, and future perspectives of pediatric BP. Methods: A search of the PubMed/MEDLINE and Scopus databases from their inception to July 2026 was conducted for English-language articles on BP in patients younger than 18 years old. After record screening and full-text assessment, 55 publications were selected and narratively synthesized. Results: Infants with BP frequently present with acral and palmoplantar blistering, whereas older children and adolescents show more heterogeneous clinical manifestations. BP180 is the principal autoantigen, although antigenic heterogeneity has been reported. Diagnosis requires integration of clinical, histopathological, and immunopathological findings. Linear IgG and/or C3 deposition along the basement membrane zone on direct immunofluorescence (DIF) is an important but non-specific finding. Salt-split skin testing and antigen-specific serology may assist in distinguishing BP from other autoimmune subepidermal blistering diseases. Corticosteroids are the most frequently reported initial treatment, while dapsone and other steroid-sparing agents have been used in selected patients. Intravenous immunoglobulin (IVIG), immunosuppressants, and targeted therapies have primarily been reported in refractory cases, with evidence derived predominantly from case reports and small series. Conclusions: The prognosis reported in the pediatric literature is generally favorable, although there are some reports of resistant or recurrent cases. However, relapse rates in the long-term are not known. There is a need for multicenter prospective trials and standardization of outcomes.

Reports doi: 10.3390/reports9040384

Authors: Emir Mert Koçoğlu Nehir Çopur Zümra Köse Özgür Eken Monira I. Aldhahi

Background/Objectives: Feedforward—viewing a self-representation performing at a level not yet achieved—is increasingly delivered through virtual reality, avatars and generative artificial intelligence. This critical review synthesizes the evidence base for feedforward, video self-modeling and avatar-based observational learning on motor skill performance, self-efficacy and state anxiety, and appraises the methodological quality of that evidence. Methods: Source identification followed snowballing guidelines across four streams: a start set, a targeted supplementary search (six databases, one academic search engine, two conference series; 1999–2026), and backward and forward citation chaining. Of 24 core sources, 18 were primary empirical studies; the 17 testing an intervention effect were coded independently by two raters across five methodological quality dimensions, without summing them. Results: In only four of the 18 primary studies does the observed movement belong to the participant; three use a hybrid stimulus combining another person’s movement with the participant’s identity, and one tests a generative AI implementation. Sixteen of the 17 appraised studies fell below the sample required to detect a medium effect (d = 0.50) at α = 0.05 with power = 0.80, and no between-subjects study reached it. Assessor blinding was reported in two studies, and a delayed retention or transfer test in seven. A between-condition difference in self-efficacy could not be demonstrated in six of the seven studies measuring it, none of which reported an equivalence test. Conclusions: The evidence does not support practice recommendations, least of all for the AI-supported variant, which rests on one conference paper. The weakness lies in statistical power, assessor blinding and retention testing rather than in an overall quality ranking.

Reports doi: 10.3390/reports9040383

Authors: Faraz Behzadi Jed Whetten Thomas C. Varkey Khalid Alsherbini Roy Zhang

Background and Clinical Significance: Listeria monocytogenes meningitis is an uncommon cause of bacterial meningitis, with a mortality rate close to 15%, particularly in immunocompromised patients. A concurrent presentation with neuropsychiatric systemic lupus erythematosus (SLE), including lupus cerebritis, poses a significant diagnostic and therapeutic challenge because treatment strategies are inherently conflicting, requiring both aggressive immunosuppression and prompt antimicrobial therapy. We report a rare case of Listeria meningitis with potential lupus cerebritis in a young woman with recently diagnosed discoid lupus receiving corticosteroid therapy. Case Presentation: A 35-year-old woman with SSA/B-positive discoid lupus on a prednisone taper presented with fever, headache, progressive confusion, and encephalopathy. A cerebrospinal fluid analysis demonstrated marked pleocytosis and elevated protein levels, while blood and CSF cultures grew Listeria monocytogenes. Despite the initiation of targeted ampicillin and gentamicin therapy, a concern for active lupus cerebritis based on serologic testing (high-titer ANA 1:640 speckled with positive anti-Smith, RNP, and chromatin antibodies) and neuroimaging prompted treatment with high-dose corticosteroids and plasmapheresis. Serial magnetic resonance imaging revealed multifocal diffusion-restricting lesions and a progressively enlarging ring-enhancing midbrain abscess, findings attributable to both infectious and autoimmune etiologies. Her hospital course was complicated by persistent encephalopathy, autonomic instability, prolonged mechanical ventilation, and the need for tracheostomy and gastrostomy placement. Following prolonged antimicrobial therapy, preventative immunosuppression, and rehabilitation, she demonstrated substantial neurologic recovery with a near-complete return of cognition at the 30-day follow-up. Conclusions: This case highlights the diagnostic complexity and management challenges of uncertainty regarding bacterial meningitis, non-infectious cerebritis, or their potential coexistence. Overlapping clinical and radiographic findings can delay diagnosis and complicate treatment decisions, particularly when immunosuppression required for autoimmune disease may worsen the active infection. Clinicians should maintain a high level of suspicion for multiple concurrent pathologies in immunocompromised patients presenting with encephalopathy, emphasizing the importance of the comprehensive evaluation and timely initiation of either antimicrobial or immunomodulatory therapies.

Reports doi: 10.3390/reports9040382

Authors: Nikolaos Spantidakis Stefanos Zisis Filippos Fytros Dimitrios Paraskevis Emmanouil Spantidakis Konstantinos Poulopoulos Christina Charisi Athanasios Poulopoulos Vasileios Zisis Maria Kalyva

Objectives: To critically evaluate the clinical evidence on patient-, tooth-, biology-, and treatment-related risk factors for endodontic flare-ups and postoperative pain after nonsurgical root canal therapy. Particular emphasis was placed on the issue of inconsistent results due to differences in definitions and methodological issues. Materials and Methods: PubMed and Scopus were searched on 28 June 2026 using specific search strategies within each database that encompassed endodontic therapy, post-treatment pain, risk factors, and pulpal and periapical lesions. The eligible publications consisted of English clinical studies that had been published from 28 June 2006 to 28 June 2026. Title and abstract screening, full-text eligibility assessment, and data extraction were performed by a single reviewer without independent second-reviewer verification. Seventeen eligible reports were included in the revised narrative synthesis, comprising 13 from the original database searches and four identified through supplementary reference screening. Related genetic publications were considered together because of confirmed or suspected overlap in their patient populations. Due to heterogeneity in study populations, outcome definitions, treatment protocols, follow-up periods, and statistical analyses, findings were evaluated through critical appraisal and narrative synthesis. Results: Preoperative pain showed the strongest association with postoperative pain, whereas evidence specifically addressing clinically defined endodontic flare-ups was more limited. Associations for periapical condition, pulpal diagnosis, and the number of appointments were variable among studies. There was insufficient evidence or inconsistency on the role of age, sex, tooth factors, irrigation, instrumentation, and obturation factors. Psychological factors and genetic polymorphisms emerged as potential factors associated with postoperative pain, although their clinical relevance remains uncertain. Differences in outcome definitions, patient populations, treatment protocols, and adjustment for confounding variables may have contributed to discrepancies between studies. Conclusions: Flare-ups and postoperative pain are two different conditions that have some similarities but must be assessed independently of each other. Preoperative pain can be considered one of the main factors related to postoperative pain. However, the relatively small and methodologically heterogeneous evidence base limits firm conclusions regarding individual risk factors, particularly for clinically defined flare-ups. Further outcome-specific investigations are needed. Clinical Relevance: Evaluation of preoperative symptoms and relevant clinical characteristics may support patient counseling and treatment planning. However, there is no valid predictive tool for individual endodontic flare-ups based on the current literature.

Reports doi: 10.3390/reports9040381

Authors: Aariez Khalid Szymon Matejuk Pamela Tuli

Background and Clinical Significance: Adult T-cell leukemia/lymphoma (ATLL) is an aggressive mature T-cell malignancy associated with human T-lymphotropic virus type 1 (HTLV-1) and generally has poor outcomes in its acute form. Case Presentation: A 39-year-old woman originally from Jamaica presented with leukocytosis greater than 100 × 109/L, hypercalcemia, lymphadenopathy, splenomegaly, lytic osseous lesions, and multilobulated “flower cells.” Peripheral-blood flow cytometry identified an abnormal T-cell population comprising approximately 85% of events and expressing CD2, cytoplasmic CD3, CD4, CD5, CD25, bright CD15, and HLA-DR, with loss of surface CD3, CD7, CD8, and other markers. Marrow flow cytometry detected approximately 2% atypical T cells. The clinicopathologic findings supported acute ATLL; however, only a reactive HTLV-I/II screening result was available. HTLV-1-specific confirmation, proviral quantification, and clonal proviral integration analysis were not documented. Cerebrospinal fluid later contained an aberrant T-cell population. The treatment record documented one cycle each of EPOCH, Hyper-CVAD, and CHOEP. Formal response assessments and the reasons for each treatment change were unavailable. Zidovudine plus interferon-alpha began in October 2022. CHOEP was administered on 26 October 2022, and mogamulizumab was initiated on 28 October 2022, precluding independent assessment of the CHOEP response. A January 2023 marrow summary stated that no abnormal cells were seen, although the assessment method and specimen adequacy were not specified. At 41 months after diagnosis, the oncology summary described the patient as being in remission without allogeneic stem-cell transplantation. Conclusions: This case describes clinical remission during extended follow-up after overlapping multimodal therapy. It does not establish refractoriness to each chemotherapy regimen, the contribution of any individual treatment, additive or synergistic benefit, optimal treatment sequencing, or the duration of remission.

Reports doi: 10.3390/reports9040380

Authors: Nahar Alanezi

Background and Clinical Significance: Popliteal artery aneurysmal involvement is an uncommon arterial manifestation of Behçet disease, and bilateral disease with thrombotic complications is particularly rare. Management is challenging because urgent limb revascularization must be balanced against an inflammatory vasculopathy associated with recurrent arterial events and loss of graft patency. Case presentation: A 50-year-old man presented with Rutherford IIa acute right lower-limb ischemia caused by thrombosis and distal embolization from a 4.4 cm true fusiform distal femoral-to-popliteal aneurysm. Computed tomography angiography also demonstrated a 2.4 cm contralateral true fusiform aneurysm with mural thrombus. Catheter-directed thrombolysis and adjunctive endovascular treatment restored distal perfusion, followed by Viabahn covered-stent exclusion of the right aneurysm. The asymptomatic left aneurysm was electively excluded 5 months later. Within the following year, acute left stent-graft occlusion required endovascular salvage, while right in-stent restenosis was treated with drug-coated balloon angioplasty. Recurrent vascular events prompted rheumatological evaluation, and vascular Behçet disease was diagnosed in 2022, followed by corticosteroid and methotrexate therapy. During approximately 5 years of follow-up, both popliteal stent grafts eventually occluded; however, collateral perfusion preserved limb viability, with only mild intermittent claudication and no rest pain or tissue loss at the latest follow-up. Conclusions: Bilateral popliteal aneurysmal disease with thrombosis may lead to recognition of vascular Behçet disease. Endovascular exclusion can provide immediate limb salvage and aneurysm control, but recurrent thrombosis, restenosis, and late loss of patency remain possible. Long-term management should integrate inflammatory disease control with vascular surveillance while distinguishing anatomical graft failure from clinical limb outcome.

Reports doi: 10.3390/reports9040379

Authors: Stoyan Kostov

Background/Objectives: The superior gluteal artery (SGA) is usually the largest branch of the internal iliac artery. It lies close to the ventral rami of the sacral plexus and to the internal iliac vein (IIV). The purpose of the present study was to describe the course of the SGA among the ventral rami and the position of the IIV relative to the SGA. Methods: Fifty-eight formalin-embalmed adult cadavers (12 whole bodies and 46 isolated hemipelves) were studied, giving 70 hemipelves (35 left, 35 right). The SGA course was assessable in 56 hemipelves and the IIV position in 22. The other specimens were excluded because of poor preservation, previous teaching dissection or an unclassifiable venous pattern. Side differences were tested with Fisher’s exact test and, in whole bodies, with the exact McNemar test. Results: The SGA passed between the lumbosacral trunk and the first sacral ventral ramus in 44/56 hemipelves (78.6%; 95% CI 66.2–87.3%). This is the classic suprapiriform route. In 12/56 hemipelves (21.4%), it passed between the L4 and L5 ventral rami (16.1%) or lateral to the lumbosacral trunk (5.4%). The IIV lay medial to the SGA in 16/22 hemipelves (72.7%; 95% CI 51.8–86.8%) and lateral in 6/22 (27.3%). No statistically significant side difference was detected (p = 0.746 and p = 1.000; paired analysis, p = 1.000). Conclusions: The SGA followed a non-classic course in 21.4% of assessable hemipelves. The venous findings are exploratory and are not population estimates. Awareness of these variations may help during internal iliac artery ligation and pelvic sidewall dissection.

Reports doi: 10.3390/reports9040378

Authors: Styliani Voutidou Christoforos Roumpakis Lydia Inglezou Paschalis Steiropoulos Fotios Drakopanagiotakis

Background and Clinical Significance: Sarcoidosis and lymphoma may precede, follow or accompany each other, and lymphoma can also induce a sarcoid-like granulomatous reaction. Case Presentation: We describe a 62-year-old woman with exertional dyspnea, abdominal pain and fluctuating cervical lymphadenopathy. Computed tomography showed mediastinal, hilar and abdominal lymphadenopathy with hepatosplenomegaly; a subcarinal lymph node obtained by mediastinoscopy showed non-necrotizing granulomas, and sarcoidosis was diagnosed and managed with observation. Four months later, worsening dyspnea and progressive lymphadenopathy led to FDG-PET/CT, which showed markedly hypermetabolic cervical nodes (SUVmax 20.5) but only moderate mediastinal uptake (SUVmax 4.8). Excisional cervical lymph node biopsy established diffuse large B-cell lymphoma (DLBCL), non-germinal-center B-cell phenotype, and Ann Arbor stage IIIS-A. After six cycles of R-CHOP, she achieved a complete metabolic response and remains in remission three years after treatment. Because both diagnoses were established within one year and lymphoma had initially been excluded on a single mediastinal node, a lymphoma already present at first presentation with an accompanying sarcoid-like reaction cannot be ruled out. Conclusions: In patients labeled as having sarcoidosis, peripheral or abdominal lymphadenopathy, splenomegaly and discordant FDG uptake should prompt excisional biopsy of the most accessible FDG-avid node, ideally before corticosteroids are started. Thirty-nine published cases of sarcoidosis associated with DLBCL are summarized.

Reports doi: 10.3390/reports9040377

Authors: Angeliki Syggelou Despoina Maritsi Serafeim Zisimos Alexandros Panos

Skin disorders are one of the commonest causes of children’s referral to the emergency department and include changes in skin structure and appearance due to allergic reaction, infection, trauma or systemic disease. Skin infection can also be attributed to viral, bacterial, fungal or parasitic pathogens and varying lesions might often lead to diagnostic overshadowing. Herein, we report an interesting case of a young infant with a bug bite that was later infected by Staphylococcus aureus and rapidly progressed to eczema herpeticum despite no prior history of known atopic dermatitis. Challenges in diagnosis and investigations will be analyzed.

Reports doi: 10.3390/reports9040376

Authors: Yassin Hamzaoui Thomas C. Varkey Jacob Lahti Jordan Farhat Emma Tobin Joshua A. Tobin

Background and Clinical Significance: B-vitamin deficiencies can lead to widespread diseases including cardiac, neurologic, hematologic, dermatologic, and oral pathologies. The often-multi-organ effects of B-vitamin deficiencies occur secondary to the roles that B-vitamins play in metabolism, myelin sheath formation, and deoxyribonucleic acid maintenance—key components of necessary processes for life; Case Presentation: The authors present an educational case of a 44-year-old female presenting with left-sided lower extremity cramps and bilateral lower extremity swelling, who on routine serological testing was found to have severe deficiencies of multiple B-vitamins—explaining her semiology; Conclusions: When B-vitamin concentrations fall below physiologically necessary levels, their dependent biochemical reactions cease, which can lead to devastating effects on the entire body, including but not limited to significant biochemical injury, disability, and/or death. Furthermore, one B-vitamin deficiency will often co-present with or co-precipitate other B-vitamin deficiencies for reasons that remain fairly unelucidated as of yet, despite numerous animal model studies. This case serves as a reminder that neurologic manifestations of systemic disease are common and that a wide differential, including metabolic causes of neurologic disease, should always be kept in the workup of patients with neurologic disease.

Reports doi: 10.3390/reports9040375

Authors: Marsela Goga Fjorba Mana Ermal Likaj

Blunt cardiac trauma is rare but potentially fatal, especially when associated with cardiac chamber rupture. We report a case of a 53-year-old female who sustained right atrial rupture and pericardial tear following a motor vehicle collision. The patient presented with clinical signs of tamponade and was transferred urgently for surgical intervention. Emergency sternotomy, initiation of cardiopulmonary bypass, and right atrial repair led to full recovery. This case highlights the critical importance of rapid diagnosis and prompt surgical management in cases of cardiac trauma.

Reports doi: 10.3390/reports9040374

Authors: Eiichi Kakehi Gaku Shimazaki You Nabika Kazuhiko Kotani

Background and Clinical Significance: Autoimmune gastritis (AIG) can cause iron-deficiency anemia (IDA) before vitamin B12 deficiency develops. Although AIG-associated IDA is more common in younger individuals, it can also occur in older adults. Type 1 gastric neuroendocrine tumors (gNETs) associated with hypergastrinemia may indicate previously unrecognized AIG; Case Presentation: A 72-year-old woman was referred for microcytic anemia. Laboratory tests revealed severe IDA, with hemoglobin of 4.7 g/dL, mean corpuscular volume of 56 fL, and ferritin of 3.2 ng/mL, despite normal vitamin B12 levels. Gastrointestinal endoscopy identified no bleeding source but revealed extensive gastric mucosal atrophy and a 5 mm gastric lesion. Histopathological examination confirmed a grade 1 gNET. Probable AIG was diagnosed based on a composite clinical assessment of corpus-predominant endoscopic atrophy, anti-parietal cell antibody positivity, and marked hypergastrinemia (1147.2 pmol/L) in the absence of acid-suppressive therapy, although biopsies did not clearly demonstrate the characteristic corpus-predominant histological pattern. The NET G1 was therefore considered consistent with a type 1 gNET. Although the initial biopsy suggested Helicobacter pylori infection, subsequent histology, gastric mucosal polymerase chain reaction, and serum antibody testing were negative. Anemia improved after red blood cell transfusion and intravenous iron therapy. The gNET was completely resected endoscopically. A second gNET detected during follow-up was also completely resected; Conclusions: AIG should be considered in older adults with unexplained IDA, even without vitamin B12 deficiency or macrocytic anemia. A gNET may provide an important clue to underlying AIG. In this case, the diagnosis of probable AIG represented a composite clinical judgment, given the absence of definitive histological findings. Even when H. pylori infection is suspected, gastric mucosal atrophy should not be attributed solely to H. pylori-associated gastritis, and coexisting AIG should be evaluated using integrated serological, endoscopic, and histopathological findings.

Reports doi: 10.3390/reports9040373

Authors: Ashley H. Yaskanich Brent Zutaut Geoffrey Bradford James Vernon Odom Monique Leys

Background and Clinical Significance: CNGA3 variants have been implicated in congenital retinal photoreceptor disorders, especially those affecting cone photoreceptor cells and therefore color discrimination. This report details the diagnosis and unusual phenotype of a pediatric patient diagnosed with two pathogenic CNGA3 variants reported in trans. Case Presentation: A patient presented to pediatric ophthalmology at two years of age and was diagnosed with high myopia, left strabismic amblyopia, and exotropia with a binocular visual acuity of 20/1400. Amblyopia was managed with atropine 1% drops in the right eye and strabismus corrected with bilateral lateral rectus muscle recession surgery. Genetic testing revealed a compound heterozygous CNGA3 variant. An unexpectedly mild phenotype was noted with normal amplitude, slightly delayed electroretinography (ERG) responses, relatively preserved color vision with Hardy-Rand-Rittler (HRR) testing, and fundus imaging consistent with high myopia. By the age of 10, best corrected monocular visual acuity was 20/40. Conclusions: Compound heterozygous CNGA3 variants demonstrate significant variable expressivity, highlighting the need for functional testing.

Reports doi: 10.3390/reports9040372

Authors: Manasi Telang Georgi P. Georgiev Lyubomir Gaydarski Violeta Groudeva Peyo Simeonov Monica Valcheva Boycho Landzhov Iva N. Dimitrova

Background and Clinical Significance: Pulmonary cement embolism (PCE) is a recognized complication of vertebral augmentation, with presentations ranging from incidental radiological findings to severe cardiopulmonary compromise. This case series illustrates the clinical importance of assessing embolus distribution together with symptoms and hemodynamic status; Case Presentation: Three women aged 65, 84, and 55 years were diagnosed with PCE following vertebroplasty for osteoporotic or metastatic vertebral compression fractures. In the first patient, predominantly peripheral cement emboli were detected incidentally five years after vertebroplasty, and no PCE-specific treatment was undertaken. The second patient developed chest pain, dyspnea, and cough 15 days after vertebroplasty. Despite extensive pulmonary cement deposition, she remained hemodynamically stable and received apixaban. The third patient presented with severe cardiopulmonary deterioration 20 days after a second vertebroplasty procedure. CT demonstrated subtotal right pulmonary artery obstruction and intracardiac cement. Despite intensive supportive treatment and unfractionated heparin, she died before mechanical removal could be performed. Paravertebral venous cement leakage was identified on CT in both symptomatic patients; Conclusions: These cases illustrate the variable clinical consequences of PCE and the importance of integrating clinical assessment with imaging findings. The intervals to presentation or detection do not establish the timing of embolization. Previous vertebral augmentation should remain relevant when investigating unexplained cardiopulmonary symptoms, even when the procedure was not recent.

Reports doi: 10.3390/reports9040371

Authors: Ursula Medeiros Araujo de Matos Matylda Mazur Poolakkad S. Satheeshkumar Cherian Verghese Kapil Meleveedu

Background and Clinical Significance: Azacitidine (AZA) is a hypomethylating agent used in the treatment of several hematologic malignancies. Although its hematologic and gastrointestinal toxicities are well described, cardiovascular adverse events remain rare and incompletely characterized. Increasing pharmacovigilance data suggest a potential association between AZA and cardiac complications, including pericarditis and pericardial effusion. We report a case of acute pericarditis progressing to cardiac tamponade during AZA-based therapy and review the available literature on azacitidine-associated pericardial disease. Case Presentation: A woman with acute myeloid leukemia treated with AZA and venetoclax developed acute pericarditis with probable myopericardial involvement during the first treatment cycle. Despite initial improvement with anti-inflammatory therapy, she re-presented with a large pericardial effusion causing cardiac tamponade, requiring emergent pericardiocentesis. In parallel, we conducted a review of the literature to identify reports of azacitidine-associated pericardial disease. Cardiac events most commonly occurred early in therapy and were frequently reported in the setting of combination therapy, most commonly AZA with venetoclax. Management generally involved discontinuation of AZA and corticosteroid therapy. Conclusions: Azacitidine-associated pericarditis with progression to pericardial effusion and cardiac tamponade is rare but potentially life-threatening. These events appear to occur predominantly early in treatment, emphasizing the importance of heightened clinical awareness, prompt cardiac evaluation, and multidisciplinary management. Causal attribution remains challenging in patients receiving combination regimens. To our knowledge, this represents the first focused review of azacitidine-associated pericardial disease, consolidating the available evidence and highlighting important gaps in recognition, reporting, and understanding of this uncommon toxicity.

Reports doi: 10.3390/reports9040370

Authors: Daniel A. Ponce-Guerrero Rosa A. Salcedo-Hernández Guillermo A. Pérez-Correa Leonardo S. Lino-Silva

Background: Within gynecological oncology, vulvar metastases represent an exceptionally rare clinical entity, accounting for 5% to 8% of all observed vulvar lesions. Secondary vulvar tumors usually reflect advanced metastatic disease and are associated with poor prognosis. This study describes the clinical and morphological characteristics of metastatic vulvar neoplasms and compares them narratively with previously reported cases and primary vulvar malignancies. Methods: We conducted a retrospective review of institutional medical records spanning from 2013 to 2021. The study specifically selected patients diagnosed with metastatic vulvar neoplasms whose predominant initial symptom and primary reason for medical consultation was the development of localized vulvar lesions. Results: During the specified study period, 6 distinct cases of metastatic disease were identified, comprising merely 2.33% of the total vulvar neoplasm cases evaluated at our institution. Anatomically, 83.3% of these metastatic lesions were localized on the vulvar lips. Clinical presentation was evenly distributed, with 50% of patients presenting with a solitary lesion and 50% exhibiting multiple lesions. Prognostic outcomes were overwhelmingly unfavorable; only 1 patient survived beyond one year of continuous medical treatment. Conclusions: Our analysis suggests that several critical clinical parameters can effectively guide the timely differential diagnosis of metastatic vulvar lesions. These key clinical markers include the patient’s age at presentation, the physical extent of the lesion, the number of tumors present, associated localized or systemic symptoms, and the critical presence of other concurrent metastatic sites confirmed via imaging.

Reports doi: 10.3390/reports9040369

Authors: Vilija Bubnaitienė Agnė Panavienė Jurgita Makštienė Agnė Čibirkaitė

Background and Clinical Significance: Acute generalized exanthematous pustulosis (AGEP) is a rare, usually drug-induced severe cutaneous reaction characterized by the sudden appearance of numerous sterile non-follicular pustules on erythematous skin. This case highlights the diagnostic challenges of AGEP in paediatric patients. Case presentation: We report a case of a 13-year-old boy who developed a rapidly progressive pustular eruption predominantly involving intertriginous areas. The patient had a history of epilepsy treated with long-term antiepileptic therapy, with levetiracetam introduced two weeks before the onset of the pustular eruption and prior exposure to cefadroxil. The diagnosis was confirmed using the European Study of Severe Cutaneous Adverse Reactions (EuroSCAR) scoring system. Histopathological examination revealed subcorneal neutrophilic pustules, dermal oedema and a mixed perivascular infiltrate including eosinophils, favouring AGEP. The skin lesions improved after withdrawal of suspected medications, topical treatment, systemic corticosteroids and methotrexate, which was prescribed while pustular psoriasis remained a concern. Patch testing performed five months later was positive to cefadroxil, supporting delayed sensitization without establishing it as the cause of this episode. Levetiracetam remained a competing suspect. Conclusions: This case highlights the need to distinguish evidence of sensitization from certainty about drug causality.

Reports doi: 10.3390/reports9040368

Authors: Claudiu Octavian Ungureanu Catalin Andrei Bulai Cosmin Cozma Cristian Mareș Dragos Adrian Georgescu Bogdan Florin Geavlete Niculae Iordache

Background and Clinical Significance: Seminal vesicle abscess (SVA) is a rare genitourinary condition with a nonspecific presentation that may delay diagnosis. Treatment includes antimicrobial therapy and, when necessary, drainage. Managing large collections that cannot be evacuated by image-guided aspiration remains challenging. This case illustrates an infected epidermoid cyst in a patient with a congenital solitary kidney, managed by laparoscopy after unsuccessful conservative and image-guided treatment; Case Presentation: A 76-year-old man presented with fever and perineal pain. Transrectal ultrasonography (TRUS) and computed tomography revealed an SVA measuring 115.8 × 83.1 × 72.4 mm. Initial conservative treatment produced only partial improvement, and symptoms recurred four weeks later. TRUS-guided drainage was attempted but failed because of the dense, highly viscous contents. Transperitoneal laparoscopic drainage and unroofing were subsequently performed. The abscess was separated from the surrounding structures, drained by aspiration, and partially excised. Two drains were placed. The operative time was 110 min, with no intraoperative complications. Recovery was uneventful, and the patient was discharged on postoperative day 4. Histopathological examination of the excised wall demonstrated an epidermoid cyst with secondary infection, suggesting that the abscess developed within an underlying epidermoid cyst. No recurrence was observed over two years of ultrasound follow-up and on a control CT at two years; Conclusions: Laparoscopic drainage and unroofing may be considered for selected large SVAs when conservative treatment and image-guided drainage are unsuccessful. Direct visualization facilitates access to the deep pelvic collection. This single case supports procedural feasibility but does not establish superiority over other drainage approaches.

Reports doi: 10.3390/reports9040367

Authors: Sofia-Chrysovalantou Zagalioti Aristeidis Ioannidis Alexandra-Eleftheria Menni Sofia Gkarmiri Barbara Fyntanidou Katerina Kotzampassi Vasileios Grosomanidis

Urinary bladder catheterization in swine can be technically challenging, particularly when experimental preparation also requires femoral vascular access. We illustrate a preperitoneal approach combining femoral vessel catheterization and cystostomy through a single inguinal incision. The technique was used in 20 three-month-old Landrace pigs (10 male and 10 female; 25–30 kg) during an approved acute, non-recovery experimental protocol. After femoral venous and arterial catheterization, the bladder was identified and exposed without formal mobilization. An 18 Fr Foley catheter was inserted through a small cystotomy and secured with a purse-string suture. Catheterization succeeded in all animals, with no observed intraoperative complications or urinary leakage; catheters remained patent. These observations demonstrate the technical feasibility of combined femoral vascular and urinary bladder access through a single inguinal incision in 20 pigs during an acute, non-recovery experiment; they do not establish comparative advantage or procedural safety.

Reports doi: 10.3390/reports9040366

Authors: Vasileios Zisis Athanasios Poulopoulos

Oral and maxillofacial diseases include a variety of developmental abnormalities, inflammatory and immune-mediated conditions, salivary gland disorders, periodontal diseases, benign and malignant tumors, and complications related to dental treatment [...]

Reports doi: 10.3390/reports9040365

Authors: Dorothea Pliaka Filippos Fytros Stefanos Zisis Vasileios Zisis Panagiota Dimitropoulou Konstantinos Poulopoulos Christina Charisi Amalia Syrioti Nikolaos Shinas Athanasios Poulopoulos

Background: Effective management of peri-implant disease relies primarily on mechanical removal of the bacterial biofilm. However, achieving adequate surface decontamination can be challenging due to complex implant-surface morphology and restricted access to deep peri-implant pockets. This has prompted the use of adjunctive antimicrobial agents to complement mechanical therapy and improve therapeutic outcomes. Objective: To investigate whether the adjunctive use of antimicrobial strategies improves clinical, microbiological, and radiographic outcomes in patients with peri-implant mucositis and peri-implantitis. Materials and Methods: A structured narrative review was conducted using PubMed/MEDLINE and Scopus in July 2026. No database filters concerning language, human participants or study design were applied. During the screening process, only randomized controlled clinical trials involving human participants and available as English-language full texts were selected. Eligible interventions included locally or systemically administered antibiotics, antiseptics, antimicrobial drug-delivery systems, antimicrobial photodynamic therapy (aPDT), ozone-based therapies, and microbiome-modulating adjuncts. Conventional laser therapy was not classified as an eligible antimicrobial intervention. The database searches retrieved 462 records, including 252 from PubMed and 210 from Scopus. Following duplicate removal and eligibility assessment, 100 publications representing 93 independent clinical trials were included. Results: adjunctive antimicrobial efficacy was highly variable and appeared to depend on disease severity, debridement strategy, antimicrobial agent, delivery modality, and follow-up period. Repeated or sustained local antimicrobial delivery was associated with modest, short-term benefits in several studies, whereas chlorhexidine (CHX) generally provided limited additional benefit over mechanical therapy. Evidence for systemic antibiotics remained inconsistent and insufficient to support routine use, while aPDT offered potential benefits that varied according to treatment protocol. Ozone therapy, herbal agents, and novel drug-delivery systems yielded encouraging preliminary results, although evidence remains scarce. Moreover, reductions in bleeding and probing depth (PD) did not reliably correspond to superior microbiological outcomes, radiographic bone gain, or complete disease resolution. Conclusions: Mechanical debridement (MD) and effective plaque control remain central to peri-implant disease management. Some adjunctive interventions produced modest short-term improvements in individual studies; however, the available evidence does not demonstrate durable disease control or support routine use. Therapeutic decisions should be tailored to disease severity, patient and implant characteristics, and the balance between potential benefits and antimicrobial-associated risks. Further well-designed and adequately powered randomized controlled trials with extended follow-up periods are needed to establish more definitive recommendations.

Reports doi: 10.3390/reports9040364

Authors: Nestor S. Arce Hisham A. Imad Prakaykaew Charunwatthana

Background: Chikungunya virus (CHIKV) has circulated in the Philippines for more than six decades. We systematically reviewed the epidemiology of CHIKV in the Philippines, integrating evidence on transmission, seroprevalence, diagnostics and molecular lineages. Methods: We searched PubMed and Embase to March 2026 for original studies reporting incidence, prevalence, seroprevalence, outbreak characteristics, or surveillance findings in human populations in the Philippines. The gray literature from the Department of Health (DOH) Epidemiology Bureau’s national chikungunya surveillance (2018–March 2026) was included separately. Findings were synthesized narratively because of substantial heterogeneity. Results: Sixteen studies and one national surveillance dataset were included. National surveillance recorded 12,662 cases from 2018 to early 2026, including 722 laboratory-confirmed cases and three fatalities. The Asian genotype predominated during the 2011–2013 epidemic, while Indian Ocean lineage (IOL) viruses were detected in southern Mindanao. Conclusions: Transmission of CHIKV in the Philippines is mostly sporadic with periods of low-level transmission. Because the clinical features overlap with dengue, acute febrile illness surveillance should test for both viruses.

Reports doi: 10.3390/reports9040363

Authors: Haidara Almansour Mohammadhossein Ghasempourabadi Darren Klass

Background and Clinical Significance: Uterine artery embolization (UAE) is a well-established treatment for symptomatic leiomyomas; however, treatment failure may occur owing to collateral arterial supply from extra-uterine sources. While ovarian artery collaterals are the most commonly reported cause, parasitic vascularization from the celiac axis and superior mesenteric artery (SMA) remains exceedingly rare and poorly documented; Case Presentation: A 41-year-old woman with symptomatic fibroids underwent technically successful bilateral UAE. Follow-up imaging revealed persistent vascularity of a dominant 19 cm pedunculated fibroid supplied by collateral branches from the celiac axis and SMA. As surgery was contraindicated owing to a recent pulmonary embolism that occurred after UAE, gonadotropin-releasing hormone (GnRH) agonist therapy was initiated, resulting in partial fibroid shrinkage and symptomatic improvement; Conclusions: Persistent fibroid vascularization after technically successful UAE may result from unrecognized extra-uterine arterial feeders. Cross-sectional angiographic imaging is essential for identifying atypical collateral pathways and guiding subsequent management in cases of treatment failure.

Reports doi: 10.3390/reports9040362

Authors: Víctor Manuel Loza-González Patricia Aurea Cervantes-Báez Andrea Paola Saucedo-Quintero José Luis Ramírez-GarcíaLuna Mario Aurelio Martínez-Jiménez

Background and Clinical Significance: Herpes zoster (HZ) results from reactivation of latent varicella-zoster virus and disproportionately affects older adults. Antiviral therapy and systemic analgesia are well established, but local wound care of the eroded skin remains largely empirical: no dressing has been validated in controlled trials for this indication, and denuded HZ lesions are frequently mismanaged with dry gauze that adheres to the wound bed and aggravates pain. Case Presentation: An 85-year-old man with no known chronic disease presented with a one-week history of thoracic HZ unresponsive to outpatient antiviral therapy, requiring admission for uncontrolled pain (9/10 on the Numeric Rating Scale, NRS), vomiting, asthenia, and hyporexia. Examination revealed confluent, superficial-partial-thickness erosions across the T6–T8 dermatomes (12.5 × 24 cm). After a negative wound culture, a single polylactic-acid-based membrane (Suprathel®250) was applied over the entire denuded area. Pain decreased from 9/10 to 2/10 on the NRS within seven days and complete re-epithelialization was observed by day 12, under concurrent antiviral and systemic analgesic therapy and the patient resumed independent daily activities by the third week without scarring. Conclusions: In this single uncontrolled case, pain reduction and wound closure followed one application of a polylactic acid membrane to an extensive HZ lesion. Because antiviral and analgesic therapy were given concurrently and HZ improves spontaneously over time, no causal or comparative inference is possible; the observation is hypothesis-generating and supports further controlled investigation. Suprathel® is CE-marked and FDA-cleared for burn and wound care, so its use for HZ erosions extends an established burn indication.

Reports doi: 10.3390/reports9040361

Authors: Marios Theologou Kassiani Boulogeorgou Nikolaos Syrmos Nicoleta Pastelli Panagiotis Kyriakongonas

Background and Clinical Significance: Posterior epidural migration of a sequestered disc fragment is a very rare entity that may present significant diagnostic challenges, due to radiological characteristics that may mimic other lesions; Case Presentation: A young adult male presented with acute deteriorating low back pain, paraparesis, and urinary incontinence. Magnetic Resonance Imaging (MRI) revealed a massive posterior intraspinal mass causing critical canal stenosis. Although the dorsal location and severe mass effect initially suggested a neoplasm, the complete absence of contrast enhancement strongly pointed toward an avascular lesion. Given the patient’s rapid neurological decline, an emergency full-endoscopic left-sided L4-L5 interlaminar approach was employed, and a massive free disc fragment was removed. The patient achieved complete motor and sphincter recovery within a month, with mild paresthesia resolving by six months; Conclusions: Posterior epidural migration of a sequestered disc fragment is a rare entity that should be included in the differential diagnosis of posterior intraspinal masses with atypical MRI characteristics. The full-endoscopic interlaminar approach is a viable minimally invasive surgical option.

Reports doi: 10.3390/reports9040360

Authors: Hamza A. Alsayouf Redab Al-Ghawanmeh Luay S. Alhawawsha Osama Alsarhan Hala Abdulsalam Hamada

Background/Objectives: Chronic constipation in patients with autism spectrum disorder (ASD) may be undetected during routine care and can exacerbate ASD symptoms such as irritability and hyperactivity. This retrospective study evaluated the prevalence of radiographic findings suggestive of chronic constipation in children newly diagnosed with ASD, and it compared these findings with those based on routine clinical history and examination alone. Methods: A retrospective chart review of pediatric patients diagnosed with ASD at neurology clinics in Jordan between 2022 and 2025 was conducted. Informed consent was required for an abdominal radiographic examination at screening to initiate the standard treatment protocol at participating clinics. A more stringent version of the Leech criteria, equivalent to a total Leech score of ≥10, was applied to the radiographic images to identify patients with findings suggestive of chronic constipation. Data were extracted via retrospective chart review using a standardized data collection form. Results: Among the 455 patients who met the study eligibility criteria, the mean ± SD age was 6.7 ± 3.3 years (median, 6 years; range, 2–18 years) and 80.2% were male. Most patients had radiographic findings suggestive of chronic constipation at baseline (81.5%, n = 371/455), whereas 5.3% (24/455) had findings suggestive of constipation based on their medical history and clinical examination alone. Conclusions: Radiographic findings suggestive of chronic constipation were common in children newly diagnosed with ASD and were identified substantially more frequently than constipation identified through routine history-taking and clinical examination in the same patients. Prospective studies are warranted to determine whether the use of alternative, standardized methods as adjunct diagnostic tools can improve clinical outcomes in this population.

Reports doi: 10.3390/reports9040359

Authors: Andrija Matetic Frane Runjić Ivona Mustapić Darija Baković Kramarić

Background and Clinical Significance: Tricuspid transcatheter edge-to-edge repair (T-TEER) is an established therapy for severe tricuspid regurgitation (TR) in selected patients. Single-leaflet device attachment (SLDA) is the commonest device-related complication, but complete intraprocedural detachment with embolization is rare, and percutaneous retrieval of an embolized tricuspid device has been reported only exceptionally. Case Presentation: An inoperable elderly patient with previous transcatheter aortic valve implantation (TAVI) and torrential functional TR underwent T-TEER. After implantation of the first clip at the anteroseptal commissure with apparently adequate leaflet capture, anterior SLDA was identified and progressed to complete detachment and right atrial embolization of the device. Despite this, the T-TEER was completed by successful implantation of the second clip, leaving only mild residual central TR. In the same session, the embolized device was retrieved percutaneously from the femoral venous system using a 15 mm gooseneck snare advanced through a 22 Fr sheath, with a safety wire and en-bloc removal, without forcing ensheathing and without venous injury. The patient was discharged on post-procedure day 2 with durable TR reduction and clinical improvement. Conclusions: Complete leaflet detachment is a possible complication of T-TEER. Confirming deep, symmetric insertion in multiple echocardiographic windows before every release is essential. When embolization occurs, knowledge of device dimensions and immediate availability of a complete snare kit is important. Although this approach may be considered in selected patients, particularly those at high surgical risk, the available evidence is limited to isolated case reports and does not allow general conclusions on its safety or efficacy.

Reports doi: 10.3390/reports9040358

Authors: Alessandro Avitabile Maria Ludovica Ruggeri Alberto Quarta Corina Valentina de Santis Ciacci Vincenza Maria Elena Bonfiglio

Background and Clinical Significance: Epiretinal membranes (ERMs) are uncommon in young patients, and spontaneous anatomical resolution is rare. We report spontaneous disappearance of a unilateral ERM after marked worsening in an 18-year-old woman with bilateral peripheral occlusive/telangiectatic retinal vasculopathy and vitritis of undetermined etiology. Case Presentation: She presented with right-eye (RE) metamorphopsia and uncorrected visual acuity of 20/25. Optical coherence tomography (OCT) showed a macular ERM; fluorescein angiography showed bilateral peripheral telangiectasia, leakage, vascular truncation, and capillary nonperfusion. Bilateral vitritis was present. Treatment comprised a single intravitreal ranibizumab injection in the RE and peripheral laser photocoagulation in both eyes for the vascular abnormalities; the ERM was managed conservatively. Before its disappearance, the ERM showed marked anatomical worsening accompanied by progressive visual decline. RE central macular thickness (CMT) peaked at 901 µm on Day 71; the lowest uncorrected visual acuity, 20/200, was recorded on Days 166 and 187. Posterior vitreous detachment was not clinically detectable throughout follow-up. On Day 243, the ERM was first documented as absent clinically and on OCT; visual acuity with correction was 20/30, CMT was 464 µm, and vitritis was no longer clinically detectable. At approximately 38 months, macular contour remained restored and recorded visual acuity was 20/20 in both eyes. When mapped to the MANE Select transcript, the retained VCAN variant notation corresponds to NM_004385.5:c.2234A>C (p.Lys745Thr); ClinVar reports conflicting classifications, and the finding was therefore considered non-diagnostic. Conclusions: This case documents spontaneous ERM disappearance without vitreoretinal surgery after marked anatomical and functional worsening. The separation mechanism and any causal contribution of ranibizumab or laser photocoagulation remain uncertain.

Reports doi: 10.3390/reports9040357

Authors: Antonio Alma Samantha Gherbassi Alessandro Clementi Silvana Ciardo Francesca Farnetani

Background and Clinical Significance: Inflammatory linear verrucous epidermal nevus (ILVEN) is a non-melanocytic skin lesion, typically present in early childhood, that is characterized by a linear verrucous appearance distributed along Blaschko’s lines. However, cases with onset in adolescence can present a diagnostic challenge, requiring accurate distinction from other linear dermatoses. Case Presentation: We present the case of a 16-year-old boy with a linear verrucous lesion on his thigh showing atypical clinical features. The lesion was evaluated using dermoscopy and reflectance confocal microscopy (RCM), which revealed specific diagnostic patterns consistent with the final diagnosis. Conclusions: The combined use of dermoscopy and RCM provided valuable non-invasive diagnostic information, avoiding the need for an invasive biopsy, particularly in pediatric and adolescent patients.

Reports doi: 10.3390/reports9040356

Authors: Houssam Eddine Belaid João Gabriel De Carvalho Mariangela Gagliano

Background and Clinical Significance: The nutritional management of onco-geriatric patients after a total gastrectomy remains a challenge, especially in the context of postoperative complications, such as stenosis of the esophagojejunal anastomosis, and in the presence of an aorto-esophageal fistula. Parenteral nutrition is a relevant therapeutic option to maintain nutritional support and enable rehabilitation when oral and enteral feeding are no longer feasible in this specific clinical context; Case Presentation: We report here the case of a 76-year-old patient who underwent a total gastrectomy for gastric adenocarcinoma with several dilated and stented esophagojejunal anastomoses. During the first postoperative year, the nutritional adaptation facilitated rehabilitation and helped him recover well. However, the occurrence of an aorto-esophageal fistula and its treatment with thoracic endovascular aortic repair (TEVAR) made oral and enteral feeding impossible. This was associated with persistent asthenia, physical deconditioning, sarcopenia, weight loss, exercise intolerance, and increased dependence for activities of daily living. Although parenteral nutrition allowed for nutritional stability and the beginning of rehabilitation, a suspected nosocomial infection involving the aortic endograft led to his death before his treatment was complete; Conclusions: This case highlights the relevance of parenteral nutrition as a therapeutic option to continue rehabilitation when enteral access is judged unacceptably risky. However, the risk of infectious complications in the context of malnutrition can compromise the prognosis, and any suspicion of infection involving prosthetic material should be documented microbiologically as completely as possible whenever compatible with the patient’s care objectives. Onco-geriatric assessment to manage older patients with esophagogastric cancer is recommended.

Reports doi: 10.3390/reports9040355

Authors: Masafumi Yamada Etaro Hashimoto Yoshifumi Yamada Akihiro Nishi Tetsuhiro Maeno Seiji Kawamura

Background and Clinical Significance: Kawasaki disease (KD) lacks specific diagnostic tests and requires early diagnosis and treatment to prevent coronary artery lesions. Concurrent infections may produce KD-like presentations; however, practical management of this time-sensitive uncertainty remains poorly described. Case Presentation: A previously healthy 4-year-old boy developed a rash after fever, rhinorrhea, cough, and a sore throat. On day 5, bilateral bulbar conjunctival injection, rash, palmar erythema, and fever met the four principal Japanese diagnostic criteria for KD. Purulent ocular discharge was accompanied by conjunctival injection, and the rash was scarlatiniform. Rapid antigen tests for group A Streptococcus (GAS) and adenovirus (AdV) were positive. Echocardiography revealed no coronary artery dilatation. The clinical presentation was considered most consistent with concurrent GAS and AdV infections, and amoxicillin was initiated. As incomplete KD remained possible, the patient was reassessed on day 7, 48 h later; all symptoms resolved. C-reactive protein was elevated (5.59 mg/dL), but none of the six supplemental laboratory criteria in the American Heart Association incomplete-KD algorithm were met. As the clinical support for KD decreased, observation was continued, with instructions to return if the principal features recurred. No KD-related symptoms occurred, and a telephone follow-up confirmed a favorable course. Conclusions: In children with multiple principal clinical features of KD and suspected co-infections, KD should not be excluded solely based on positive pathogen tests. Characterizing individual findings, including ocular discharge and rash morphology, and short-interval reassessment of the same findings within the therapeutic window for KD may help manage diagnostic uncertainty.

Reports doi: 10.3390/reports9040354

Authors: Florian Lipka Maya Brink Christian Behle Rainer Lutz Sarah-Maria Meier

Background and Clinical Significance: Removable partial dentures still present a relevant treatment option in an aging population. With the exception of clasps, the vast majority of attachment systems available for anchoring these restorations on natural abutments requires invasive tooth preparations causing secondary problems such as caries and abutment tooth fractures. In cases where an abutment tooth cannot be salvaged, placing an implant and connecting the existing prosthesis to this implant presents a viable solution. While a common path of insertion has been established during initial fabrication, it is almost impossible to match this with a newly placed retentive element. In the case presented, a novel ball anchor that allows for compensatory movements was used as a retentive implant abutment for salvaging a removable partial prosthesis. Case Presentation: An 83-year-old, medically compromised male patient, restored with a removable partial denture, stabilized by one abutment tooth and two clasps in the mandible, suffered from a non-restorable fracture of the abutment tooth. After tooth extraction, immediate implant placement (MT implant, AlfaGate, Bonn, Germany), closed healing of the implant for three month, then second-stage implant surgery and soft tissue healing for another four weeks, the implant was connected to a novel flexible attachment system, the REFLEX abutment (Hader Solutions, Dublin, Ireland). Shaped as a retentive ball, the REFLEX abutment allows lateral movements of the male attachment part while maintaining vertical dimensions like rigid locator-type attachments. Conclusions: The retrofitting of the novel flexible attachment under an originally telescopic-crown-retained partial denture allowed for a successful conversion of the prosthesis while preserving prosthetic fit and retention for the patient.

Reports doi: 10.3390/reports9040353

Authors: Haidara Almansour Mohammadhossein Ghasempourabadi Darren Klass

Background and Clinical Significance: Thoracic endovascular aortic repair (TEVAR) involving zone 2 of the aortic arch frequently necessitates left subclavian artery (LSA) revascularization to reduce the risk of neurologic and ischemic complications. If endovascular methods are employed, conventional upper extremity access via the brachial or axillary artery often requires surgical cutdown and carries meaningful access-site morbidity. Distal radial (snuffbox) access offers a less invasive percutaneous alternative, yet its use for thoracic branch endoprosthesis (TBE) deployment has only rarely been reported; Case Presentation: We present two patients who underwent successful zone 2 TEVAR with TBE implantation and LSA revascularization using a femoral-to-distal radial through-and-through wire technique. In both cases, the branch component was deployed via the distal radial artery with excellent angiographic results and preserved antegrade flow to the LSA. Neither patient experienced access-related complications; Conclusions: These cases demonstrate the technical feasibility and safety of distal radial access for TBE deployment in zone 2 TEVAR. This approach offers a less invasive alternative to conventional upper extremity access, potentially reducing vascular complications and facilitating earlier recovery.

Reports doi: 10.3390/reports9040352

Authors: Nikolay Balgaranov Teodora Marinova-Bulgaranova Stanimira Elkina

Background and Clinical Significance: Longstanding human immunodeficiency virus (HIV) may remain clinically unrecognized until adolescence. Growth failure, delayed puberty, and recurrent or atypical infections may represent manifestations of underlying immunodeficiency but can initially be attributed to other conditions. Case Presentation: A 16-year-old male, adopted at 4 years of age, was admitted with prolonged low-grade fever, chronic productive cough, and recurrent sinonasal symptoms. Marked growth retardation and absent pubertal development were also present. No perinatal or early-childhood medical records were available, and maternal HIV status could not be established. Laboratory investigations demonstrated severe CD4+ T-cell depletion, hypergammaglobulinemia, and elevated liver enzymes. Repeated SARS-CoV-2 antigen/PCR tests were positive, while anti-SARS-CoV-2 antibodies were undetectable. CT demonstrated chronic pansinusitis and hepatosplenomegaly. HIV infection was confirmed by positive ELISA and Western blot, with a plasma HIV RNA level of 127,721 copies/mL. The findings were consistent with advanced HIV infection with severe immunosuppression. Although the clinical history suggested longstanding infection, the timing and route of HIV acquisition could not be established. Similarly, the available SARS-CoV-2 results did not allow definitive differentiation between persistent infection and separate infection or reinfection episodes. Previous CMV IgG positivity had contributed to an earlier attribution of the hepatic abnormalities to CMV, although active CMV disease was not documented. Conclusions: Severe growth failure, absent pubertal development, recurrent or atypical infections, and profound CD4+ T-cell depletion should prompt consideration of underlying immunodeficiency, including HIV. In patients with incomplete medical records, previous diagnoses should be reassessed, especially when the clinical course remains unexplained.

Reports doi: 10.3390/reports9040351

Authors: Khansa Shara Hasan AlAjmi Nada Baatiah Sara Darag Renad Bakhamis Amr Abdelhakim

Background and Clinical Significance: Refractory below-knee amputation (BKA) stump wounds can delay prosthetic rehabilitation. This report describes wound healing during multimodal care that included autologous platelet-rich plasma (PRP) activated with autologous thrombin serum (ATS); Case Presentation: A 33-year-old man with Charcot–Marie–Tooth disease and a persistent right BKA stump wound after surgical revisions underwent three PRP–ATS applications on 16 and 23 February and 8 March 2026. Collagen dressings were applied on 2 and 15 March, and compression was continued thereafter. The estimated wound volume decreased from 14.18 cm3 at baseline to 0.48 cm3 at week 3 (approximately 97%); advanced epithelialization was observed at week 4. Complete closure was documented on 16 April 2026, approximately eight weeks after treatment began. No treatment-related adverse events were reported. After closure, the patient was referred for prosthetic rehabilitation assessment; fitting and functional use were not documented; Conclusions: Healing was temporally associated with PRP–ATS as part of a multimodal treatment course. This single case supports the feasibility of the approach but cannot establish the independent efficacy of PRP–ATS.

Reports doi: 10.3390/reports9040350

Authors: Farnaz Delavari Patrik Michel Vincent Dunet Guillaume Fahrni

Background and Clinical Significance: Bow Hunter’s syndrome is an uncommon cause of vertebrobasilar insufficiency caused by dynamic vertebral artery narrowing during head rotation or extension. It is classically described at the atlantoaxial level, whereas subaxial compression is less recognised. Thyroid cartilage-related vertebral artery compression is particularly rare and may mimic vertebral artery dissection on static imaging. This case highlights the need to distinguish anatomical conflict from clinically causal haemodynamic compression. Case Presentation: A 51-year-old man with vascular risk factors and a well-anticoagulated mechanical aortic valve presented with three transient ischaemic attacks within two hours, including left-hand paraesthesia, right hemianopia, transient aphasia, and right-hand paraesthesia. Symptoms occurred spontaneously, without clear relation to head or neck movement or trauma. Doppler ultrasound showed normal carotid and vertebral flow. CT angiography demonstrated focal stenosis of the right vertebral artery at the V1–V2 junction caused by an osteocartilaginous “pincer” between the right thyroid cartilage ala and the C5 transverse process. The axial appearance mimicked vertebral artery dissection, but multiplanar CTA and contrast-enhanced MRA supported external indentation without mural haematoma, intimal flap, pseudoaneurysm, or double lumen. Perfusion CT showed no focal hypoperfusion, and diffusion-weighted MRI showed no acute infarct. Because symptoms were not positional and competing embolic risk factors were present, conservative management was chosen. Conclusions: Thyroid cartilage-related subaxial vertebral artery compression is a rare diagnostic pitfall. Static imaging may suggest dissection or Bow Hunter’s syndrome, but causality should not be inferred without compatible symptoms, exclusion of alternative mechanisms, and, when needed, dynamic confirmation.

Reports doi: 10.3390/reports9040349

Authors: Isabela Ioana Loghin Ion Cecan Andrei Vâţă Anton Knieling Otilia-Elena Frăsinariu Victor Daniel Dorobăţ Vlad Hârtie Carmen Mihaela Dorobăţ

Background and Clinical Significance: Cryptococcal meningitis remains a life-threatening complication of advanced HIV infection. Its recognition can be challenging when neurological manifestations are nonspecific or cerebrospinal fluid inflammation is limited. This case series illustrates the diagnostic variability and therapeutic challenges encountered in five patients managed at a regional HIV/AIDS center in northeastern Romania. Case Presentation: Five men aged 26–69 years were hospitalized between November 2022 and March 2025 with HIV-associated cryptococcal disease involving the central nervous system. All had profound immunosuppression, with CD4+ T-cell counts of 6–31 cells/mm3. Clinical manifestations included headache, confusion, altered consciousness, and focal neurological deficits. Cerebrospinal fluid opening pressures were elevated, while inflammatory findings ranged from lymphocytic pleocytosis to an almost acellular profile. Microbiological investigations included direct microscopy, fungal culture, and molecular testing, according to availability. In one patient, culture confirmed Cryptococcus neoformans despite negative India ink microscopy and absent documented pleocytosis. Antifungal treatment included liposomal amphotericin B and fluconazole-based regimens, with treatment selection constrained by drug availability and organ dysfunction. Three cases had fatal outcomes during hospitalization. Conclusions: Cryptococcal meningitis should remain a diagnostic consideration in profoundly immunosuppressed patients with neurological symptoms, even when initial microscopy is negative or cerebrospinal fluid inflammation is minimal. These cases emphasize the importance of complementary microbiological investigations, assessment and management of intracranial pressure, reliable access to recommended antifungal regimens, and appropriate timing of antiretroviral therapy.

Reports doi: 10.3390/reports9040348

Authors: Mitsutoshi Ooishi Osamu Togao Hiroshi Ito Fumitaka Yoshioka Tatsuya Abe

Background/Objectives: World Health Organization (WHO) Grade 2–3 meningiomas have high recurrence rates despite postoperative radiotherapy. This study aimed to characterize patterns of failure and clinical outcomes after postoperative external beam radiotherapy. Methods: We retrospectively analyzed 10 patients with WHO Grade 2 (n = 6) or Grade 3 (n = 4) meningiomas treated at a single institution between January 2017 and May 2024. Nine patients underwent gross total resection. Radiotherapy was delivered using three-dimensional conformal radiotherapy (n = 6) or intensity-modulated radiotherapy (n = 4), with a median dose of 60 Gy in 30 fractions. Recurrence patterns were assessed relative to the high-dose region. Results: The 1- and 3-year overall survival rates were 90% (95% CI, 47–99%) and 79% (95% CI, 38–94%), respectively; corresponding local control rates were 70% (95% CI, 33–89%) and 39% (95% CI, 7–71%), respectively. Recurrence occurred in six patients, predominantly within the high-dose region. Acute toxicities were limited to Grade 1 radiation dermatitis. During follow-up, Grade 3 seizures occurred in three patients, and worsening of pre-existing Grade 2 paresis occurred in four patients. Two seizure events and two cases of worsening paresis were considered more likely related to recurrent or progressive disease, whereas attribution of the remaining neurological events to radiotherapy was uncertain. Conclusions: Despite postoperative radiotherapy, local control remained limited in this small, single-institution series, with a predominance of in-field recurrence. This pattern raises the possibility that tumor biological factors, in addition to technical and treatment-related factors, may contribute to treatment failure in WHO Grade 2–3 meningiomas. These findings are exploratory and warrant validation in larger studies incorporating molecular stratification and standardized treatment approaches.

Reports doi: 10.3390/reports9040347

Authors: Chiara Rustichelli Eleonora Ghessa Alessandro Serrone Guido Cavigioli Giovanni Cavallo Gian Luca Fadda

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.

Reports doi: 10.3390/reports9040346

Authors: Constantinos Papadopoulos Konstantina Dinaki Rafail Ioannidis Ioanna Gravalidou Anna Zisi

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.

Reports doi: 10.3390/reports9040344

Authors: Sergiu Balan Claudiu Octavian Ungureanu Razvan A. Stoica Floris Cristian Stanculea Niculae Iordache

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.

Reports doi: 10.3390/reports9040345

Authors: Andrei Machado Viegas da Trindade Leonardo Pinheiro Rezende Junichiro Sado Junior Marcos Henrique Alves Resende Claudia Santos Oliveira

Background and Clinical Significance: Longitudinal observations that combine major postoperative weight loss with limb-specific gait assessment after total knee arthroplasty (TKA) are uncommon. This case report describes three single-trial instrumented assessments in one patient and is intended as a descriptive observation; it does not establish causality, measurement stability, mechanical loading, or a clinically meaningful persistent deficit; Case Presentation: A man in his early sixties at the first assessment had undergone left TKA for end-stage osteoarthritis and subsequently underwent Roux-en-Y gastric bypass. Three assessments were available from approximately 31 to 67 months after TKA. Body mass was 120, 88, and 69 kg (body mass index 43.03, 31.55, and 24.74 kg/m2), while two-minute walk distance (2MWT) was 67.8, 105.1, and 118.1 m. The third walk test was launched in the software’s six-minute module and stopped at 1 min 58 s, so 118.1 m is the distance accumulated over 118 s and was neither adjusted nor extrapolated to 120 s. The operated limb showed longer stance duration than the non-operated limb by 3.04, 5.28, and 2.05 percentage points, and a proprietary propulsion index was lower on the operated side by 18.18%, 17.95%, and 14.06%; the direction of both differences was the same at every session but the magnitude was not, and the index has no published calculation or post-TKA interpretive threshold. Each session comprised one trial, and the third-session gait means were based on only five operated-limb and four non-operated-limb steps. Valid Timed Up and Go (TUG) totals were available for sessions 1 and 2 (13.41 and 14.95 s); the available source documentation did not contain a valid session-3 TUG result. Vendor-derived walk-test speed was excluded from primary interpretation because its calculation could not be reconciled with distance divided by test duration; Conclusions: Across these three observations, 2MWT distance increased while side-to-side differences in stance duration and the exploratory propulsion index were present at each session. These co-occurring changes cannot be attributed to weight loss specifically, because time since arthroplasty, rehabilitation exposure and repeated testing varied together with body mass. The findings are descriptive and hypothesis-generating; confirmation requires prospective studies with repeated trials per session, an adequate number of analysed steps, and validated kinetic or limb-specific outcomes.

Reports doi: 10.3390/reports9040343

Authors: Nikolaos Fylaktou Athanasios Vlachodimitropoulos Gerasimos Danielides Georgios Batsaouras Spyridon Lygeros

Background and Clinical Significance: Tympanostomy tubes (TTs) are normally extruded into the external auditory canal within 6–18 months, whereas medial migration into the middle ear is a rare complication. Medialized tubes have been associated with otalgia, otorrhea, conductive hearing loss, granuloma and perilymphatic fistula, yet may remain clinically silent; no consensus exists on whether asymptomatic medialized tubes should be removed. Case Presentation: A 24-year-old man attended a routine otorhinolaryngological examination without otological complaints. He had undergone bilateral TT insertion at four years of age for otitis media with effusion, with complete resolution and no further otological procedures. Otoscopy demonstrated an intact tympanic membrane through which a round, blue structure was visible within the posteroinferior quadrant of the tympanic cavity; otoendoscopy confirmed a foreign body in contact with the middle ear mucosa. Tympanometry showed a type A curve and pure-tone audiometry showed normal, symmetrical thresholds. High-resolution computed tomography showed an aerated middle ear cleft, well pneumatized mastoid cavities, an intact ossicular chain and no radiological features of chronic otitis media. Conservative management was adopted, with clinical and audiological review planned at 6–12-month intervals; at the most recent review, three months after diagnosis, the patient remained asymptomatic. Conclusions: A medially migrated TT may be retained within the middle ear for two decades without inflammation, structural damage or hearing loss. In selected patients with an intact tympanic membrane, normal audiometry and unremarkable imaging, structured observation is a defensible alternative to removal, provided the patient is counseled about the symptoms that should prompt review.

Reports doi: 10.3390/reports9040342

Authors: Alexey Vasilyevich Shabunin Pavel Alexeevich Drozdov Oksana Nikolaevna Levina Sergey Andreevich Astapovich Daria Andreevna Teplyuk Dzhennet Agamovna Beibalaeva

Background and Clinical Significance: Before effective viral inactivation of plasma-derived factor concentrates, many patients with hemophilia acquired hepatitis C virus infection and later developed cirrhosis or hepatocellular carcinoma. Liver transplantation treats end-stage liver disease and may also restore factor VIII production; however, long-term oncologic outcomes in this setting are rarely reported. Case Presentation: Two men with severe hemophilia A (baseline factor VIII activity < 1%) and hepatitis C-related cirrhosis underwent deceased-donor orthotopic liver transplantation. Both received an extended-half-life recombinant factor VIII (efmoroctocog alfa; 33,000 and 35,000 IU in total) tapered until postoperative days 13–14, and intraoperative hemostasis was guided by conventional coagulation tests and thromboelastography. Neither patient had major bleeding or thrombotic events, and replacement therapy was not required thereafter. In Patient 1, graft function remained satisfactory 45 months after transplantation, with factor VIII activity of 62.5%. Patient 2 was transplanted for hepatocellular carcinoma outside the Milan criteria (two lesions of 6.8 and 2.7 cm; alpha-fetoprotein 110–150 ng/mL) under center-specific expanded criteria, without bridging therapy. Factor VIII activity remained clinically sufficient, but pulmonary nodules suspected 20 months after transplantation progressed; atypical pulmonary resections 45 months after transplantation confirmed metastatic hepatocellular carcinoma, and lenvatinib was initiated. Conclusions: Liver transplantation can provide durable correction of severe hemophilia A without long-term replacement therapy. However, correction of the coagulation disorder does not eliminate risks related to the original liver disease; in patients transplanted for hepatocellular carcinoma, particularly beyond conventional criteria, long-term outcome remains dependent on tumor burden, tumor biology, candidate selection, and sustained oncologic surveillance.

Reports doi: 10.3390/reports9040341

Authors: Yoshihiro Ito Koji Hayashi Haruka Kurihara Yuka Nakaya Mamiko Sato

A 69-year-old man with a history of heavy alcohol consumption and poor nutrition presented with disorientation and gait instability. The cognitive assessment was severely affected, with the Hasegawa Dementia Scale-Revised score was 4. Neurological examination revealed anisocoria (right 4.0 mm, left 2.0 mm) with sluggish light reflexes, gaze-evoked horizontal nystagmus, and vertical gaze restrictions. He exhibited disorientation and limb ataxia; deep tendon reflexes were normal. Brain MRI showed bilateral thalamic hyperintensities on diffusion-weighted imaging and periaqueductal high signal on T2 FLAIR. Laboratory testing confirmed a severely reduced serum thiamine level of 10.5 ng/mL, establishing Wernicke encephalopathy (WE) based on Caine’s criteria. Immediately upon admission (Day 1), high-dose thiamine therapy was initiated at 700 mg/day (300 mg/day intravenous drip plus 400 mg/day oral) for 7 days, followed by 400 mg/day oral. Despite prompt, high-dose thiamine administration, the 2.0 mm anisocoria persisted consistently throughout the 19-day hospitalization, whereas cognitive function and ataxia partially improved. The 2.0 mm interocular difference confirmed pathologic anisocoria, indicating asymmetric autonomic disruption involving descending sympathetic pathways in the periaqueductal gray matter. While neuro-ophthalmic signs in WE are typically reversible, this case demonstrates that autonomic deficits may persist despite comprehensive thiamine therapy, highlighting WE as a critical metabolic mimic of life-threatening structural brainstem disorders.

Reports doi: 10.3390/reports9040340

Authors: Yoshiyuki Miyamoto Keigo Kubota Hiroshi Kawakami Atsushi Hosono Yasuhiko Tsuyama

Background and Clinical Significance: Hemorrhage from advanced oral cancer can threaten both circulation and airway patency. Case Presentation: A 60-year-old man with advanced left buccal mucosal squamous cell carcinoma (cT4bN2bM0, Stage IVB) was medically unsuitable for radical surgery. Definitive radiotherapy was initiated, but after 20 Gy in 10 fractions, massive tumor hemorrhage on 12 July 2022 posed an imminent risk of airway obstruction and required intubation. After local hemostatic measures and transfusion, transcatheter arterial embolization (TAE) of tumor-feeding external carotid branches was performed on 14 July using coils and n-butyl-2-cyanoacrylate. Angiography showed markedly reduced tumor staining; the patient was extubated the next day. No recurrent tumor bleeding or clinically apparent neurological deficit was documented through the last outpatient evaluation on 8 August 2022. Conclusions: TAE achieved short-term hemostasis and facilitated early extubation in this patient; durable efficacy and survival benefit cannot be established from this case.

Reports doi: 10.3390/reports9040339

Authors: Georgi Popivanov Boryana Ilcheva Marina Konaktchieva Roberto Cirocchi Mihail Tabakov Vladimir Pavlov Ventsislav Mutafchiyski

Background and Clinical Significance: Idiopathic megacolon (IM) in adults is a rare disease with an unknown aetiology. The condition remains poorly understood, with ongoing debate over the specificity of its histopathology. Case Presentation: Case 1: A 40-year-old man was admitted due to moderate lower abdominal pain and a distended, asymmetric abdomen. X-ray demonstrated the sigmoid colon with a diameter of 13 cm. Colonoscopy found a significantly enlarged and elongated sigmoid colon, which precluded the examination of the entire colon due to the insufficient length of the colonoscope. All blood assays were within the normal range. Intraoperatively, there was a significantly dilated sigmoid colon measuring 20 cm in width with a length of 60 cm. A sigmoid resection with mechanical T-T anastomosis between the descending colon and proximal rectum circular stapler was performed. The patient had an uneventful recovery. Seven years after the operation, he is symptom-free. The histopathological examination revealed a slight oedema of the lamina propria, submucosal fibrosis, hyperplastic submucosal ganglia and nerve fibres, hypertrophy of the muscle layers and hyperplastic myenteric nerve plexuses and ganglion cells. Case 2: A 28-year-old otherwise healthy man was admitted due to intermittent diffuse abdominal pain that manifested suddenly during a military mission. There was no remarkable medical history. The abdominal contrast CT revealed a segmental sigmoid megacolon with a diameter of 10 cm without any other noteworthy pathology. All organic causes for megacolon were excluded. No conservative treatment was applied. The intraoperative finding was a dilated sigmoid measuring 15 cm in diameter. A sigmoid resection was performed, followed by T-T anastomosis between the descending colon and proximal rectum. During the postoperative course, there was significant anastomotic bleeding, which was managed successfully by blood transfusion and haemostatic clips. The patient was discharged on the 8th postoperative day. Eighteen months after the operation, he is symptom-free. The histopathological examination was performed using Formalin-Fixed Paraffin-Embedded (FFPE) tissue, cut at 3 µm. Immunohistochemistry was performed on an autostainer Leica Bond with ready-to-use reagents—CD117 clone EP10 and S100 clone EP32. The dilated part revealed a fibrotic submucosa with hyperplastic vessels and nonspecific inflammatory changes, hypertrophy of the muscle layers, and hyperplastic submucosal and myenteric ganglia and plexuses, but did not fulfil the criteria for IND. The same picture was observed in both the distal narrowed part and the resection lines. There was no obvious abnormality of the Cajal cells in both parts of the specimen. Conclusions: We were unable to identify a specific cause of IM in the presented cases. The histopathological findings were not compatible with IND, Hirschsprung disease, or other neuromuscular pathology. The critical analysis of the literature does not support IND as a possible cause of IM. Due to the heterogeneity of colonic motility disorders and the lack of a consistent histological pattern in IM, we hypothesise that it has a multifactorial aetiology.

Reports doi: 10.3390/reports9040338

Authors: Al-Naser Al Bahlani Hiba Saadeddin Ayman Al Husini Mubarak Al Dosari Hussein Hado

Background and Clinical Significance: Multivessel coronary artery spasm (CAS) is an uncommon, high-risk form of vasospastic angina that can produce transient ST-segment elevation mimicking acute myocardial infarction. Evidence to guide management when calcium channel blockers and nitrates fail is scarce, and renal sympathetic denervation (RSD) has been reported in very few patients; Case Presentation: A 53-year-old man with hypertension, type 2 diabetes, and dyslipidemia presented with nocturnal chest pain and inferior ST-segment elevation. Coronary angiography showed severe spontaneous spasm of the right coronary and left anterior descending arteries that resolved completely with intracoronary nitrate; the coronary arteries were otherwise angiographically normal. High-sensitivity cardiac troponin I remained below 10 ng/L (reference 0–34 ng/L), and echocardiography was normal, fulfilling the criteria for definite vasospastic angina without myocardial infarction. The same two-vessel spasm was documented at a second angiogram three months later. Despite maximally tolerated dual calcium channel blockade, nitrates, and statin therapy, he required more than ten further admissions. A self-terminating accelerated idioventricular rhythm lasting about two minutes was recorded. No syncope or malignant arrhythmia occurred, and an electrophysiology review found no current indication for an implantable cardioverter–defibrillator. Radiofrequency RSD was performed off-label for refractory symptoms without complications, but at six months, his symptoms and admissions were unchanged; Conclusions: Our case highlights the diagnostic and therapeutic difficulties in refractory CAS. Accelerated idioventricular rhythm after relief of spasm is a reperfusion rhythm and does not by itself indicate device therapy. In this patient, RSD did not control refractory multivessel CAS, a negative observation that adds to the very limited evidence on autonomic modulation in this setting.

Reports doi: 10.3390/reports9040337

Authors: Mona Makhlouf Stanley Calderwood

Background and Clinical Significance: A 4-year-old nonverbal boy with level 3 autism spectrum disorder and Duchenne muscular dystrophy (DMD) who was receiving chronic prednisone therapy presented to the emergency room with acute appendicitis. The diagnosis was significantly delayed due to atypical pain presentation, a potentially blunted inflammatory response from chronic steroid use, and an uncertain contribution from DMD-related muscle weakness. Case Presentation: The patient presented with five days of fever, poor oral intake, decreased stool output and behavioral changes. Initial physical examination and evaluation over two emergency department visits failed to establish the diagnosis. By the third visit, the patient exhibited abdominal distension, hypoactive bowel sounds, and bandemia. Computed tomography demonstrated perforated appendicitis with a walled-off abscess. Nonoperative management was unsuccessful, resulting in the development of multiple intra-abdominal abscesses that required percutaneous drainage. Following a 10-day hospitalization, the patient improved and was discharged. He subsequently underwent a scheduled laparoscopic appendectomy two months later, with pathology demonstrating persistent inflammation. Conclusions: This case raises awareness of the atypical presentation of pain in children with autism and the potential for DMD and chronic steroid therapy to complicate clinical assessment. These factors should prompt clinicians to maintain a low threshold for advanced imaging when clinical concern is present. It also illustrates the importance of close monitoring during nonoperative management of perforated appendicitis in medically complex or immunosuppressed children.

Reports doi: 10.3390/reports9040336

Authors: Kosuke Mori Hidehiro Someko Miyuki Ando

Background and Clinical Significance: Anemia is commonly detected during health screening and may initially appear to be an isolated hematologic abnormality. Careful history-taking is important because associated symptoms may provide clues to serious underlying disease. We report a case of multiple myeloma in which unintentional weight loss was the key clinical clue during evaluation of screening-detected anemia. Case Presentation: A 45-year-old woman was referred for evaluation of anemia detected during routine health screening. Initial laboratory testing showed normocytic anemia without evidence of iron deficiency, vitamin B12 deficiency, or folate deficiency. Routine history-taking for anemia revealed unintentional weight loss of 3.5 kg (4.6% of her body weight) over three months, prompting evaluation for malignancy. Non-contrast computed tomography demonstrated an osteolytic lesion in the manubrium. Serum protein electrophoresis showed an M-peak, and immunofixation detected an IgA-kappa monoclonal protein and urinary kappa-type Bence Jones protein. Serum free light-chain testing revealed a markedly elevated kappa/lambda ratio. At the referral hematology department, bone marrow aspiration showed 77.8% plasma cells, and biopsy and clot sections showed extensive infiltration by CD138-positive plasma cells, consistent with plasma cell myeloma. She subsequently received chemotherapy at the referral hospital, achieved remission, and has returned to work. Conclusions: Unintentional weight loss can serve as an important red flag when evaluating non-iron-deficiency anemia detected through health screening. Actively eliciting weight change may facilitate prompt diagnosis of an otherwise unsuspected hematologic malignancy.

Reports doi: 10.3390/reports9040335

Authors: Francisco J. Mérida De Ia Torre Mónica Coll Vidal Ivette Rubio Martínez Lucía Quintana Tello Ramón Brugada Terradellas

Background and Clinical Significance: Cardiofaciocutaneous syndrome (CFC) is a rare autosomal dominant RASopathy characterized by craniofacial dysmorphism, congenital heart defects, cutaneous abnormalities, growth impairment, and neurodevelopmental delay. Pathogenic variants in KRAS account for a minority of cases and define cardiofaciocutaneous syndrome type 2 (CFC2). Establishing a molecular diagnosis is often challenging because of the substantial clinical overlap among RASopathies, including Noonan and Costello syndromes. Case Presentation: We describe a one-year-old boy presenting with macrocephaly, ventriculomegaly, hypotonia, developmental delay, hypertrophic cardiomyopathy, gastroesophageal reflux, and mild dermatological abnormalities. To clarify the diagnosis, a custom next-generation sequencing panel targeting RASopathy-associated genes was performed. Genetic analysis identified a heterozygous KRAS variant, NM_033360.4:c.101C>G, p.(Pro34Arg), which was confirmed by Sanger sequencing and shown to have arisen de novo through parental testing. Additional variants of uncertain significance were detected in ABCC9, CACNA1G, and DES; however, these were considered unlikely to account for the phenotype because of limited clinical concordance and current ACMG/AMP classification. The KRAS variant was classified as pathogenic based on its de novo occurrence, absence from population databases, localization within a critical functional domain, supportive computational evidence, and previously reported pathogenic substitutions affecting the same residue. Conclusions: This case provides additional evidence supporting the pathogenicity of KRAS p.(Pro34Arg), a variant reported only rarely in association with CFC. The observed phenotype further expands the clinical spectrum of KRAS-associated CFC and highlights the value of comprehensive molecular testing for the differential diagnosis of RASopathies and the refinement of genotype–phenotype correlations.

Reports doi: 10.3390/reports9040334

Authors: Abdulmalek M. H. Almasri Mohammad Y. Hajeer Ahmad S. Burhan Safwan Jaber

Background/Objectives: Efficient en-masse retraction of the maxillary anterior teeth requires adequate anchorage control while maintaining acceptable incisor torque. This prospective clinical case series aimed to provide an initial clinical evaluation of a novel laser-welded bi-dimensional archwire designed for miniscrew-supported en-masse retraction in adult patients with Class II Division 1 malocclusion. Methods: Six patients requiring extraction of the maxillary first premolars were treated using a custom-made stainless-steel archwire consisting of a 0.019 × 0.025-inch anterior segment and 0.016 × 0.022-inch posterior segments. Retraction was performed using nickel-titanium closed-coil springs delivering approximately 250 g of force per side. The primary outcome was the monthly rate of maxillary anterior retraction measured on three-dimensional digital models. The secondary outcome was the change in maxillary incisor torque assessed on lateral cephalometric radiographs using the bracket–archwire angle. Results: Repeated measurements showed no statistically significant systematic error, with method errors ranging from 0.14 to 0.31 mm for linear variables and from 0.72° to 1.08° for angular variables; intraclass correlation coefficients ranged from 0.91 to 0.97. The overall mean retraction rate was 0.97 ± 0.05 mm/month, and the mean retraction duration was 5.78 ± 0.79 months. The mean change in maxillary incisor torque was 7.08 ± 1.29°. Conclusions: Within the limitations of this six-participant clinical case series, the novel bi-dimensional archwire was associated with a relatively stable observed rate of anterior retraction, although a measurable change in the bracket–archwire angular relationship remained. These descriptive findings should be regarded as preliminary and hypothesis-generating and require confirmation in adequately powered controlled studies. Trial registration: ClinicalTrials.gov, NCT07664215; retrospectively registered on 24 June 2026.

Reports doi: 10.3390/reports9040333

Authors: Olivera Dzatic Smiljkovic Vesna Mandic Markovic Ksenija Lalic Lazar Nejkovic Aleksandar Ristic

Background/Objectives: Intravenous leiomyomatosis (IVL) is a rare, histologically benign proliferation of uterine smooth-muscle cells that extend intravascularly. The clinical significance of IVL lies in the potential for mechanical obstruction of the major veins and heart, as well as possible thromboembolic complications. Methods: A retrospective case series included four patients with confirmed IVL, treated at the Clinic for Gynaecology and Obstetrics “Narodni front” between 1 January 2020 and 31 December 2025. The following were recorded: medical history, imaging diagnostics (ultrasound, MRI), operative findings, histopathology, and follow-up data. The study was approved by the Ethics Committee, and written informed consent for participation in the study was obtained from all the patients. Results: The series included four patients aged 40 to 73 with histologically confirmed IVL who were treated surgically. In one patient, an intraoperative complication occurred in the form of sigmoid colon lesion and consequential resection, requiring surgical reconstruction, while the remaining procedures were completed without major complications. Histopathological findings in all cases indicated benign smooth-muscle differentiation with the presence of intravascular nodules of smooth-muscle cells (IVL). Residual disease and recurrence were documented in one patient. Conclusions: Our cases reflect a diverse spectrum of clinical presentations of IVL indicating the heterogeneity of the disease and the importance of a multimodal, multidisciplinary approach to the optimal management of this rare entity. The absence of further disease progression in our patients following bilateral oophorectomy, i.e., iatrogenic menopause, suggests the possible hormonal dependence of IVL.

Reports doi: 10.3390/reports9040332

Authors: Alina Badlaeva Natalia Mezhelumova Natalia Arzhanukhina Dmitry Bulanov

We present the case of a 40-year-old woman diagnosed with schwannoma at an infrequent localization. The patient complained of multiple painful lesions in the vulvar region and perianal fold, accompanied by intense, constant pain that slightly increased during menstruation. The initial diagnosis was extragenital endometriosis. Histopathological analysis demonstrated a characteristic proliferation of bland spindle cells arranged in short fascicles containing Verocay bodies, as well as a distinctive immunophenotype, supporting the diagnosis of schwannoma. This case underscores the diagnostic difficulty of distinguishing schwannoma from other mesenchymal tumors and non-tumor lesions at this site using imaging alone and emphasizes the need for histopathological confirmation to reach a definitive diagnosis.

Reports doi: 10.3390/reports9040331

Authors: Elena Cristina Gîrbovan Alexandra Ioana Asztalos Adrian Vlad Pop Anca Meda Văsieșiu Mircea Gîrbovan Anca Cighir

Background and clinical significance:Pasteurella spp. are Gram-negative coccobacilli, aerobic facultatively anaerobic, belonging to the Pasteurellaceae family. In humans, they are known to cause zoonotic diseases, which usually develop after dog or cat bites, licks or scratches. Case presentation: We present the case of a 61-year-old patient, with cardiovascular comorbidities, who presented to the Orthopedics Department, 38 days after knee replacement surgery, with recurrence of pain on walking, an antalgic gait with auxiliary support, and local signs of inflammation at the level of the left knee joint. The patient admitted to owning a dog who accidentally licked the post-surgical wound. The symptoms were suggestive of a post-surgical wound infection with extension to the periprosthetic area. A purulent discharge was collected from the wound during surgical debridement and sent to the microbiological laboratory for diagnosis, where Pasteurella canis was identified using MALDI-TOF MS. Antibiotic susceptibility testing (AST) was performed according to the EUCAST guidelines and empiric antibiotic treatment was started with Cefuroxime. During his future admissions to the Orthopedics and Infectious Diseases departments, two more samples were collected, in which Pasteurella canis was isolated, along with Klebsiella oxytoca (second sample), and Klebsiella oxytoca and Pseudomonas aeruginosa (third sample). Patient evolution was favorable due to the debridement of the wound and combined antibiotic treatment, with Ceftazidime and Gentamicin. Conclusions: Infections with Pasteurella canis are rare but slowly increasing due to more and more humans owning pets. The present case underlines the importance of interdisciplinary collaborations when rare pathogens are identified.

Reports doi: 10.3390/reports9040330

Authors: Fernando Martins Braga Elena Tello Santamaria Margarita Vallès Hatice Kumru

Background and Clinical Significance: Non-contiguous traumatic spinal cord injury (SCI) can be difficult to recognise and classify in severe polytrauma, especially when traumatic brain injury (TBI) and limb injuries limit neurological examination. Case Presentation: A 17-year-old male was involved in a motorcycle accident resulting in severe polytrauma with TBI. Brain magnetic resonance imaging (MRI) showed a grade III diffuse axonal injury. Trauma computed tomography (CT) identified C2 and T3–T5 vertebral fractures. Spinal MRI revealed a non-haemorrhagic C3–C6 contusive myelopathy, a T4 spinal cord contusion, and a thoracic posterior epidural haematoma. He underwent posterior T2–T7 fixation. Acute neurological examination was limited by impaired consciousness and associated injuries. At four months, the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) assessment showed a neurological level of C2, and a total motor score of 55. Electrodiagnostic testing showed active bilateral C5–T1 denervation. At seven months and one year, the total motor score increased to 63 and 82, respectively, accompanied by substantial functional improvement. Conclusions: In severe polytrauma with TBI, non-contiguous SCI should be considered when neurological examination is unreliable. In non-contiguous SCI, clinical assessment should integrate neurological examination, including quantitative motor and sensory scores, with imaging and neurophysiological studies, cognitive status, associated injuries, and functional outcomes.

Reports doi: 10.3390/reports9040329

Authors: Damián Ochoa Guette Jennifer Patricia Vargas Gomez Breallan De Jesús Romero Pájaro Rafael Tous Bertel Amilkar Almanza Hurtado

Background and Clinical Significance: Secondary hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome that can closely resemble sepsis in adults, potentially delaying recognition and treatment. Because infection may trigger or coexist with HLH, persistent or disproportionate inflammation despite appropriate antimicrobial therapy should prompt reassessment for concomitant HLH and investigation of the underlying trigger; Case Presentation: We describe three adults initially managed for presumed sepsis or severe infection at a referral hospital in Colombia. All developed persistent fever, cytopenias, organomegaly, and marked hyperferritinemia. HScore values were 222, 246, and 248, respectively; the score in Case 3 was calculated retrospectively from available pretreatment data. Bone marrow hemophagocytosis was demonstrated in Cases 1 and 2 but not in Case 3. The underlying triggers were acute myeloid leukemia, disseminated histoplasmosis in the setting of advanced HIV infection, and visceral leishmaniasis. The malignancy-associated case had an unfavorable outcome. Both infection-associated cases improved after pathogen-directed therapy combined with corticosteroids to control hyperinflammation, without escalation to an etoposide-based regimen; Conclusions: Sepsis and secondary HLH should not be regarded as mutually exclusive diagnoses. Persistent or disproportionate inflammation accompanied by progressive multilineage cytopenias, splenomegaly, markedly elevated or rising ferritin levels, hypertriglyceridemia, and/or decreasing fibrinogen should prompt early HScore calculation, assessment of HLH-2004 criteria, and concurrent investigation for an underlying trigger. Recognition of the clinical pattern and individualized treatment of both the trigger and hyperinflammatory state may facilitate timely management.

Reports doi: 10.3390/reports9040328

Authors: Ayman M. Abulhamael

Background and Clinical Significance: External cervical resorption (ECR) is an insidious form of root resorption that frequently progresses undetected until an advanced stage, particularly when the lesion extends apical to the alveolar crest or involves a substantial proportion of the root circumference, precluding adequate visualization and debridement via conventional intraoral approaches. Case Presentation: This report describes the management of a 30-year-old male who presented with an acute apical abscess associated with a mandibular second molar with inadequate previous root canal treatment, in conjunction with an extensive distal cervical resorption defect and a large periapical radiolucency. Due to lack of availability of a CBCT machine at the time, no preoperative CBCT was obtained; diagnosis and treatment planning were based on clinical examination and periapical radiography. Given the anatomical inaccessibility of the resorptive lesion and the concurrent persistent periapical pathology, treatment consisted of nonsurgical root canal retreatment followed by intentional replantation to permit extraoral access and repair. The tooth was replanted after an extraoral period of less than 15 min and stabilized with a flexible splint. The patient was reviewed at 2 weeks and was then lost to routine follow-up until a 4-year reassessment. At that time, the tooth was functional and asymptomatic, with complete radiographic resolution of the previous periapical radiolucency and no clinically or radiographically evident signs of progressive root resorption or ankylosis. Conclusions: This case documents a favorable four-year outcome following intentional replantation combined with endodontic retreatment and bioceramic repair in a multi-rooted tooth with extensive, conventionally inaccessible ECR.

Reports doi: 10.3390/reports9040327

Authors: Mihai Grigore Camelia Nicolae Horațiu Moldovan Ana-Maria Balahura Adriana-Mihaela Ilieșiu

Background and Clinical Significance: Infective endocarditis following transcatheter aortic valve implantation (TAVI) is a severe complication that may be associated with prosthetic valve dysfunction, local infectious extension, and systemic embolization. Visceral mycotic aneurysms are uncommon, particularly those involving the hepatic arterial circulation. Case Presentation: We report the case of an 80-year-old woman who developed Streptococcus gallolyticus TAVI-associated prosthetic valve endocarditis (TAVI-PVE) four months after valve implantation. Despite prolonged antimicrobial therapy and subsequent negative blood cultures, the clinical course was complicated by persistent prosthetic and periprosthetic echocardiographic abnormalities, cerebral and splenic embolic events, and new-onset abdominal pain. Contrast-enhanced computed tomography revealed two hepatic arterial aneurysmal lesions with surrounding inflammatory changes, consistent with mycotic aneurysms. After initially declining surgery, the patient underwent redo surgical aortic valve replacement; cultures of the surgically excised specimens were negative. Abdominal pain resolved and inflammatory markers normalized following surgery and continued antimicrobial therapy. Follow-up contrast-enhanced CT demonstrated marked interval enlargement of the hepatic arterial aneurysmal lesion to 28 mm × 28 mm × 26 mm despite clinical improvement and normalization of inflammatory markers. Conclusions: This case highlights that microbiological, clinical, and biological improvement does not necessarily indicate resolution of local cardiac or extracardiac structural complications and emphasizes the importance of repeated imaging, guideline-based antimicrobial therapy, timely source control, and multidisciplinary vascular management in complicated TAVI-PVE.

Reports doi: 10.3390/reports9040326

Authors: Priscilla Nardi Giulia Guadalupi Valerio Rinaldi Edoardo De Meis Valeria Iacoucci Greta D’Onofrio Eleonora Zedda Rocco Pasqua Fabio Miraldi Gaetano Tanzilli Nicola Viceconte Francesco Pelliccia Giampaolo Prezioso Vito D’Andrea Giulio Illuminati

Background and Clinical Significance: Complex abdominal aortic aneurysms (AAAc) involving visceral and renal vessels can be treated via open surgery or less invasive fenestrated endovascular aneurysm repair (FEVAR). Intravascular ultrasound (IVUS) minimizes contrast and radiation while improving placement accuracy, though its specific role in FEVAR remains understudied. This CARE-compliant article reports a FEVAR case guided by IVUS. Case Presentation: A 75-year-old male with multiple comorbidities presented with an enlarging AAAc extending to the renal artery ostia, lacking an adequate neck. Anatomical variants included a left renal artery with a caudal origin (pelvic left kidney), a left renal polar artery originating from the right common iliac artery, and a patent inferior mesenteric artery (<3 mm). Following multidisciplinary evaluation, the patient successfully underwent simultaneous FEVAR and coronary angiography. Guided by IVUS, the fenestrated endograft was deployed with preserved visceral patency. The patient recovered uneventfully and was discharged on postoperative day two. A 30-day CT angiogram detected a stable inferior mesenteric artery endoleak, managed conservatively through a 6-month follow-up. Conclusions: IVUS-guided FEVAR may offer a promising alternative to traditional angiography, reducing radiation and contrast exposure. Further large-scale studies are needed to confirm these findings and establish clinical and economic benefits.

Reports doi: 10.3390/reports9040325

Authors: Ayuhei Nako Koji Hayashi Mamiko Sato Hiroaki Maeda Yasutaka Kobayashi

Miller Fisher syndrome (MFS) is a variant of Guillain–Barré syndrome characterized by a triad of ophthalmoplegia, ataxia, and areflexia, typically associated with anti-GQ1b antibodies. While cranial nerve enhancement is sometimes seen on high-resolution MRI, involvement of the trigeminal (CN V) and vestibulocochlear (CN VIII) nerves is rare. We report a 62-year-old woman presenting with diplopia, preceded by ophthalmalgia, nasal congestion, and vertigo. Neurological assessment revealed right-sided ptosis, total ophthalmoplegia, sluggish pupillary reflexes, diplopia without nystagmus, bilateral limb ataxia, hyporeflexia, and impaired vibration and joint-position sensation. Serology was positive for anti-GQ1b antibodies. Contrast-enhanced MRI demonstrated signal changes suggestive of CN V and CN VIII involvement. Although cerebrospinal fluid showed no albuminocytologic dissociation, she was diagnosed with MFS. She received immunotherapy, including intravenous immunoglobulin therapy. While her vertigo, ophthalmalgia and ataxia significantly improved, ophthalmoplegia persisted. The patient was discharged on hospitalization day 44 with residual ocular motility deficits. In this patient, orbital pain with cranial autonomic features (ocular pain, nasal congestion) and vertigo of uncertain localization acted as misleading early signs. This case illustrates an unusual MFS presentation where prodromal CN V and VIII symptoms preceded classic features, highlighting the need for careful clinical evaluation when sensory and vestibular symptoms precede classic features.

Reports doi: 10.3390/reports9040324

Authors: Hassan Zmerly Federica Dellafiore Silvio Caravelli Massimiliano Mosca Luigi Di Lorenzo

Background and Clinical Significance: Anterior cruciate ligament (ACL) mucoid degeneration is a rare, non-traumatic condition characterized by the deposition of mucoid material within the ligament, resulting in hypertrophy and potential impingement against surrounding intra-articular structures; Case Presentation: A 43-year-old man presented with knee pain, swelling, and restricted range of motion. Magnetic resonance imaging demonstrated mucoid degeneration of the ACL associated with mild articular degenerative changes, without evidence of a meniscal tear. Following the failure of conservative management, the patient underwent knee arthroscopy. Intraoperative findings revealed an enlarged ACL with impingement against the intercondylar notch and the lateral femoral condyle. The patient was treated with arthroscopic ACL debridement, which resulted in adequate decompression. At the 54-month follow-up, the patient remained pain-free, had regained full range of motion, and showed no clinical instability. The Lysholm score improved from 41 preoperatively to 95 postoperatively; Conclusions: Mucoid degeneration of the ACL is a rare but important cause of knee pain and restricted range of motion. When conservative treatment fails, arthroscopic management can provide symptom resolution and restore range of motion. However, careful preservation of healthy ACL fibers during debridement is a key technical consideration for achieving symptom relief while maintaining ligament function and knee stability. This case suggests that selective arthroscopic debridement may provide sustained symptom relief while preserving ACL stability in patients with isolated symptomatic mucoid degeneration, with favorable outcomes maintained at long-term follow-up.

Reports doi: 10.3390/reports9040323

Authors: Maciej Laskowski Piotr Paździora Łukasz Antkowiak Jan Herzyk Anna Zioła-Paździora Maciej Wojtacha

Background and Clinical Significance: Meningeal melanocytoma is an exceptionally rare, typically benign melanocytic tumor of the central nervous system. Its clinical management becomes particularly challenging when located at the craniovertebral junction, where proximity to critical neurovascular structures limits the extent of safe surgical resection. Due to its rarity and complex anatomical location, each case contributes valuable insight into optimal diagnostic and therapeutic strategies. We report a case of circumscribed meningeal melanocytoma arising at the craniovertebral junction and provide a focused review of previously reported cases, with particular emphasis on clinical presentation, radiological characteristics, surgical challenges, treatment strategies, and outcomes; Case Presentation: A 65-year-old Caucasian woman presented with progressive binocular diplopia. Magnetic resonance imaging revealed two contrast-enhancing extra-axial lesions at the level of the foramen magnum, with one dominant mass. The patient underwent near-total microsurgical resection of the dominant lesion under intraoperative neurophysiological monitoring. Histopathological and immunohistochemical evaluation confirmed the diagnosis of meningeal melanocytoma. In the postoperative period, the patient developed transient lower cranial nerve dysfunction, which improved with conservative treatment. Follow-up imaging demonstrated a stable residual tumor. Given the subtotal nature of resection and the anatomically complex location, adjuvant proton beam radiotherapy was recommended; Conclusions: Meningeal melanocytoma of the craniovertebral junction poses distinctive diagnostic and surgical challenges because of its proximity to critical neurovascular structures. The available literature supports maximal safe resection as the primary treatment strategy, with adjuvant radiotherapy considered in selected patients with residual disease. Long-term radiological surveillance is warranted because late recurrence and malignant transformation have been reported.

Reports doi: 10.3390/reports9040322

Authors: Maria Rogalidou Konstantina Dimakou Kalliopi Stefanaki Evanthia Botsa Anna Messaritaki Christina Kanaka-Gantenbein

Background and Clinical Significance: Turner syndrome is associated with an increased prevalence of autoimmune disorders, particularly celiac disease, and is also associated with impaired bone health. The coexistence of Turner syndrome, celiac disease, and ulcerative colitis is rare and represents a challenging clinical scenario requiring multidisciplinary management; Case Presentation: We report the case of a 7-year-old girl referred for short stature who was diagnosed with celiac disease based on positive serology and duodenal histology (Marsh 3a/3c). Cytogenetic analysis revealed 46,X,i(X)(q10) Turner syndrome. Despite strict adherence to a gluten-free diet, persistent growth impairment led to initiation of recombinant human growth hormone therapy. At 14 years of age, she developed bloody diarrhea, weight loss, iron-deficiency anemia, and elevated inflammatory markers. Colonoscopy and histology confirmed extensive ulcerative colitis. During follow-up, dual-energy X-ray absorptiometry demonstrated reduced bone mineral density (lumbar spine Z-score −2.7; whole-body Z-score −2.5). At 16 years of age, treatment with azathioprine and 5-aminosalicylic acid was complicated by pancreatitis, with recurrence of pancreatic enzyme elevation following sequential drug reintroduction, leading to discontinuation of both agents. Infliximab therapy was subsequently initiated, resulting in sustained clinical, endoscopic, and near-complete histological remission. The patient was later transitioned to adult multidisciplinary care; Conclusions: The coexistence of Turner syndrome, celiac disease, ulcerative colitis, and low bone mineral density is an exceptionally rare combination of genetic susceptibility, autoimmunity, and chronic inflammation. This case highlights the importance of lifelong multidisciplinary surveillance in patients with Turner syndrome, including monitoring for additional autoimmune disorders, growth impairment, and skeletal complications.

Reports doi: 10.3390/reports9040321

Authors: Amalia Syrioti Faidra Chatzikallinikidou Christina Charisi Filippos Fytros Nikolaos Spantidakis Panagiota Dimitropoulou Konstantinos Poulopoulos Stefanos Zisis Athanasios Poulopoulos Vasileios Zisis

Background: Amelogenesis imperfecta affecting enamel formation is frequently associated with a variety of malocclusions and eruption disturbances. Orthodontic treatment is crucial in comprehensive patient management. Previous studies have shown that orthodontic treatment becomes more challenging in patients with AI as the defective enamel affects the bracket bonding, retention of appliances and treatment mechanics and often needs modified bonding protocols, pre-treatment restorative build-ups, skeletal anchorage and general multidisciplinary management. There is no evidence of the ideal orthodontic treatment yet; available evidence only consists of case reports and small observational studies that address specific aspects with no established consensus. Therefore, this narrative review aimed to critically examine the contemporaneous evidence on orthodontic assessment and treatment planning in AI patients, drawing on studies identified through a structured literature search. Materials and Methods: An electronic search of the literature was conducted in the PubMed, Scopus, and ScienceDirect databases. Out of 640 records that were initially identified, 11 studies met the inclusion criteria for qualitative synthesis. Results: Bonding issues resulting from enamel defects tend to be identified as a significant clinical challenge necessitating modified orthodontic techniques. The included studies demonstrated that by using individualized treatment planning, modified bonding procedures, fixed appliances, expansion procedures, skeletal anchorage and combined orthognathic surgery in some cases within the multidisciplinary treatment approach, there can be successful orthodontic management for these patients. Conclusions: Vital steps such as early diagnosis, careful treatment planning, and coordination with restorative and prosthodontic treatment were associated with better functional and esthetic outcomes. Consequently, even though there is limited evidence, the available literature supports a customized interdisciplinary approach as the most predictable and effective strategy for managing orthodontic problems in patients with AI, while emphasizing that case reports and small observational studies are the main sources of current findings.

Reports doi: 10.3390/reports9040320

Authors: Pavol Skáčik Vladimír Nosáľ Štefan Sivák Egon Kurča

Background and Clinical Significance: Vertigo is a common manifestation of posterior circulation ischaemia, and obesity, type 2 diabetes mellitus, hypertension, and dyslipidaemia are established cardiometabolic risk factors for the underlying atherosclerotic disease. Brief, isolated episodes may be diagnostically challenging because bedside findings can be normal after symptom resolution, despite clinically significant cerebrovascular disease. We present a case in which an adverse cardiometabolic risk profile—rather than the clinical presentation itself—prompted the vascular imaging that established the diagnosis, together with a targeted review of comparable reports; Case Presentation: We investigate the case of a 67-year-old man with type 2 diabetes mellitus, hypertension, dyslipidaemia, obesity, and known asymptomatic right internal carotid artery (ICA) stenosis presented after a single spontaneous episode of rotatory vertigo lasting five minutes, which resolved completely before assessment. Neurological and structured neuro-otological examinations were normal. Because of his cardiometabolic and vascular risk burden, further imaging was pursued: CT angiography demonstrated progression of the right ICA stenosis to 85%, chronic occlusion of the left vertebral artery, and mild stenosis of the right vertebral artery, and brain MRI subsequently confirmed a small acute ischaemic lesion in the left cerebellar hemisphere. Management combined carotid artery stenting with a personalised, multidisciplinary secondary prevention plan addressing his full cardiometabolic risk profile. At three months, he remained asymptomatic, with NIHSS and modified Rankin Scale scores of 0. A targeted, CABARET-guided literature review of six comparable case reports showed that our patient carried the most extensive cardiometabolic burden yet had the mildest and most transient presentation, in contrast to the recurrent or progressive symptoms typical of the comparator reports; Conclusions: A single brief episode of isolated vertigo may be the only manifestation of acute posterior circulation ischaemia, even when bedside findings are normal. In patients with an adverse cardiometabolic and vascular risk profile, a reassuring examination should not preclude further neurovascular investigation, and early, risk-guided recognition—supported by personalised, multidisciplinary care—may provide an important opportunity for stroke prevention.

Reports doi: 10.3390/reports9040319

Authors: Dragan Vasin Djuro Cutura Djordjije Saranovic

Acute subhepatic appendicitis is an exceptionally rare anatomical variant (accounting for 0.01–0.09% of all appendicitis cases) that arises from embryological intestinal malrotation or incomplete cecal descent. A 39-year-old male presented to the emergency department with a 48-h history of progressive right upper quadrant pain, anorexia, mild nausea, low-grade fever (37.8 °C), marked leukocytosis (19 × 109/L with a left shift), and elevated C-reactive protein (5.2 mg/L). Physical examination demonstrated localized tenderness and guarding in the right hypochondrium, with a negative clinical Murphy’s sign. Bedside abdominal ultrasonography was performed utilizing a dedicated dual-probe strategy: a low-frequency convex transducer (1–5 MHz) for anatomical orientation and a high-frequency linear transducer (6–12 MHz) for targeted near-field interrogation. Graded compression identified a non-compressible, aperistaltic, blind-ending tubular structure in the hepatorenal recess (Morison’s pouch) measuring 9 mm in outer diameter with a thickened wall (3.2 mm), an appendicolith at the base, mural hyperemia on color Doppler, and surrounding hyperechoic fat stranding with localized free fluid. Real-time sonography systematically excluded acute cholecystitis, hepatic lesions, and perforated peptic ulcer. Preoperative CT was omitted, and the patient proceeded directly to emergent diagnostic laparoscopy, which confirmed an inflamed, non-perforated appendix in the right subhepatic space adjacent to the liver margin. A laparoscopic appendectomy was successfully performed. Histopathology confirmed uncomplicated suppurative appendicitis, and the patient was discharged uneventfully on postoperative day three. Emergency high-resolution ultrasonography using a targeted dual-probe technique can conclusively diagnose subhepatic appendicitis, challenging the paradigm that CT is strictly mandatory. In patients presenting with atypical right upper quadrant pain, dedicated sonographic interrogation of the hepatorenal space facilitates prompt surgical management while eliminating ionizing radiation and diagnostic delays.

Reports doi: 10.3390/reports9030318

Authors: Ryusuke Horaguchi Shohei Kikuchi Kento Ono Tomoki Minemura Tsutomu Sato

Background and Clinical Significance: Older, frail patients with relapsed diffuse large B-cell lymphoma (DLBCL) face limited treatment options due to poor tolerance for standard cytotoxic chemotherapy. While novel chemotherapy-free regimens like polatuzumab vedotin plus rituximab (Pola-R) have emerged, optimizing their use requires careful evaluation of patient vulnerability via geriatric assessment (GA) and shared decision-making (SDM). Case Presentation: We present the case of a male in his late 70s with multiple-relapse DLBCL who was classified as frail by a comprehensive geriatric assessment, complicated by cognitive impairment and functional decline. Due to his frailty and previous intolerance to cytotoxic chemotherapy, a safety-prioritized, chemotherapy-free Pola-R regimen was selected through an SDM process in which his family supported his decision-making. The patient achieved a complete metabolic response without severe adverse events and has remained progression-free for 15 months. Conclusions: This case illustrates the feasibility and potential clinical activity of the chemotherapy-free Pola-R regimen for frail older patients with DLBCL, underscoring the critical role of integrating GA and SDM to individualize therapy and honor patient goals.

Reports doi: 10.3390/reports9030317

Authors: Sara Riolo Dario Brunello Agostino Fraia Salvatore Papi Roberto Knez Giovanni Costa Bernardino De Concilio Tommaso Silvestri Ivan Di Giulio Guglielmo Zeccolini Antonio Celia

Background and Clinical Significance: Malignant priapism is a rare manifestation of advanced malignancy caused by malignant infiltration of the corpora cavernosa. We report a case of persistent and refractory priapism associated with penile carcinoma and extensive metastatic disease, with a suspected pulmonary primary. Case Presentation: An 81-year-old man with a history of prostate cancer treated by radical prostatectomy and persistently undetectable PSA levels developed persistent low-flow priapism. Despite aspiration and irrigation, followed by distal and proximal shunting procedures, the condition recurred with progressive corporal induration and severe pain. Cavernous biopsy was initially interpreted as moderately differentiated squamous carcinoma, while total penectomy performed for refractory pain showed poorly differentiated carcinoma with morphological adenosquamous features. CT and PET/CT demonstrated a pulmonary mass and widespread metastatic disease, although bronchoscopy was non-diagnostic and no histological confirmation of the pulmonary lesion was obtained. A focused review of the literature identified 32 published cases of malignant priapism; bladder cancer was the most frequently reported primary malignancy (37.5%), followed by prostate cancer (18.8%) and renal cell carcinoma (9.4%), while penectomy was performed in 34.4% of cases. Conclusions: Persistent or recurrent priapism associated with corporal induration, progressive or atypical pain, failure of conventional treatment, or discordant imaging findings should raise suspicion of malignant infiltration and prompt consideration of repeat imaging and tissue sampling. In the present case, carcinoma involving the penile structures was histologically confirmed, whereas pulmonary origin remained a clinicoradiological suspicion; penectomy provided immediate pain relief in the setting of extensive refractory local disease.

Reports doi: 10.3390/reports9030316

Authors: Panagiota Dimitropoulou Filippos Fytros Christina Charisi Amalia Syrioti Nikolaos Spantidakis Konstantinos Poulopoulos Maria Fasoula Efstratios Karagiannidis Athanasios Poulopoulos Vasileios Zisis

Background: Oral potentially malignant disorders (OPMDs) comprise clinically and histologically heterogeneous lesions associated with an increased risk of oral squamous cell carcinoma (OSCC). Histopathological grading of oral epithelial dysplasia (OED) remains central to risk estimation but has limited predictive precision. Podoplanin and selected cancer stem cell (CSC) or stemness-associated markers may capture complementary biological processes involved in progression. Objective: To synthesize evidence on podoplanin and selected CSC or stemness-associated markers as indicators of malignant transformation and risk stratification across a prespecified OPMD spectrum, while distinguishing longitudinal prediction from cross-sectional, diagnostic, and mechanistic evidence. Methods: Three original PubMed searches covered database inception to 13 July 2026. A post hoc recall audit against three key evidence syntheses identified one eligible longitudinal report missed during the initial selection; this report was added by backward citation checking. A broader supplementary sensitivity query was run during revision and reported separately without being merged into the original selection counts. In total, 47 publications were included. Study design, effect measure, threshold provenance, internal validation, and possible cohort overlap were charted and synthesized narratively. Results: Among the biomarkers reviewed, podoplanin had the most developed longitudinal evidence, including a pooled hazard ratio (HR) of 3.72 (95% confidence interval [CI] 2.40–5.76) in one meta-analysis. A separate diagnostic-accuracy synthesis reported sensitivity of 78.9% and specificity of 55.0%, corresponding to a positive likelihood ratio (LR+) of 1.75 and a negative likelihood ratio (LR−) of 0.38. Predictive values varied materially with baseline transformation risk. CD133, BMI1, and ABCG2 showed large associations in individual cohorts, but independent replication and external validation were limited. Cross-sectional expression gradients were not treated as evidence of prospective prediction. Conclusions: Within the defined OPMD scope, podoplanin has the most developed longitudinal evidence, but its predictive values are prevalence-dependent and no marker is sufficiently validated for stand-alone clinical use. Prospective multicenter studies should compare prespecified biomarker models with established clinical, histopathological, and molecular predictors and should evaluate calibration, clinical utility, and external validity before management decisions are altered.

Reports doi: 10.3390/reports9030315

Authors: Andrija Matetic Frane Runjić Nikola Crnčević Goran Potočki Antonija Sviličić Ivona Mustapić Darija Baković Kramarić

Background and Clinical Significance: Intimal sarcoma is a rare, aggressive malignancy of the large arteries that grows within the vessel lumen and frequently mimics thromboembolic disease, leading to diagnostic delay. Flow restoration and tissue biopsy are both difficult if the tumour occupies a technically demanding arterial segment, which is further aggravated if conventional large-bore arterial access is precluded by peripheral arterial disease. Case Presentation: A 66-year-old woman with multiple cardiovascular risk factors presented with subacute left upper-limb ischaemia and painless digital cyanosis (embolic phenomena) that had progressed despite therapeutic anticoagulation. Computed tomography angiography demonstrated a sub-occlusive filling defect extending from the origin of the left subclavian artery towards the aortic arch, initially interpreted as thrombus. There were no clear signs of malignant disease, despite differential screenings. Multiple on- and off-site surgical consultations were done, but the patient was repeatedly rejected for operation due to disease characteristics and high surgical risk. Severe iliofemoral peripheral arterial disease precluded usual transfemoral arterial delivery of a large-bore system, so the subclavian mass was aspirated using a 22/26-French sheath and extracorporeal aspiration system (AngioVac System (AngioDynamics)) delivered through percutaneous transcaval (caval–aortic) access, under cerebral embolic protection. Repeated aspiration runs with mechanical snare augmentation achieved substantial debulking, angiographic normalisation of flow and abolition of the invasive pressure gradient, without injury to the target artery. The caval–aortic tract was eventually closed with an occluder device. Histopathology of the aspirate revealed a malignant spindle-cell mesenchymal neoplasm consistent with intimal sarcoma. Staging subsequently demonstrated metastatic disease, and the patient proceeded to covered-stent maintenance of subclavian patency and first-line systemic chemotherapy. The patient is undergoing chemotherapy at 7-month follow-up, but palliation is being considered due to disease progression. Conclusions: Transcaval delivery of a large-bore aspiration system (AngioVac) is a feasible strategy to achieve both flow restoration and diagnostic tissue sampling when conventional arterial access is unavailable. Intimal sarcoma should be considered when arterial “thrombus” fails to respond to anticoagulation, particularly alongside constitutional symptoms.

Reports doi: 10.3390/reports9030314

Authors: Woochan Choi Yang-Ha Hwang

Background and Clinical Significance: Anticoagulation timing after atrial fibrillation (AF)-related ischemic stroke is uncertain when hemorrhagic transformation (HT) is progressive. Although early direct oral anticoagulant (DOAC) initiation is supported in selected patients, evidence is limited for parenchymal hemorrhage or progressive HT. Case Presentation: A 72-year-old man receiving aspirin therapy, in whom AF was newly diagnosed on admission, presented with multi-territorial ischemic stroke and HT. He was febrile, with a C-reactive protein level of 15.54 mg/dL, and underwent serial abdominal computed tomography (CT) to investigate the source of fever. Given concern regarding intracranial bleeding associated with HT, apixaban 2.5 mg twice daily was initiated on day 4 but discontinued on day 6 because of progressive HT. No antithrombotic therapy was subsequently administered. CT on day 2 showed no left atrial appendage (LAA) filling defect. On day 10, after reduction in inflammatory activity, repeat CT demonstrated a new 15-mm LAA filling defect radiologically suggestive of thrombus. The defect was no longer visible on day 16. Transesophageal echocardiography on day 19 showed no intracardiac thrombus. Apixaban was resumed on day 35 after radiographic HT resolution. He received antithrombotic therapy for only 2 of the first 35 days after stroke onset. Conclusions: A transient LAA filling defect was observed during a prolonged antithrombotic-free interval and was not visualized on follow-up CT. Although contemporaneous dedicated cardiac imaging was unavailable and slow flow or contrast-mixing artifact could not be excluded, this serial observation raises the possibility of a transient thrombotic phenomenon during anticoagulation interruption.

Reports doi: 10.3390/reports9030313

Authors: Maria Rogalidou Amalia Patereli Kalliopi Stefanaki Konstantina Dimakou Eleanna Stasinou Vasiliki-Maria Karagianni Daphne Margoni Alexandra Papadopoulou

Background and Clinical Significance: Collagenous gastritis (CG) is a rare disorder characterized by subepithelial collagen deposition, typically presenting in children with iron deficiency anemia (IDA) and abdominal pain. Its pathogenesis remains unclear, and no standardized treatment exists. Case Presentation: A female patient developed IDA at 4.5 years of age, requiring repeated intravenous iron infusions, and recurrent epigastric pain. CG was diagnosed at 13.5 years, with marked gastric eosinophilia (peak 685 eosinophils/mm2) and subepithelial collagen thickening (103.6 μm). Extensive evaluation excluded alternative causes. Proton pump inhibitor (PPI) therapy failed to meaningfully improve symptoms, endoscopic findings, or histology. A 10-week course of oral systemic corticosteroids resolved abdominal pain and normalized hemoglobin and ferritin levels, but endoscopic abnormalities persisted, histologic improvement was limited, and pain recurred after withdrawal. Dupilumab was initiated as a steroid-sparing, histology-targeted therapy. Over 15 months, the patient remained asymptomatic, hemoglobin and ferritin levels remained normal without intravenous iron or routine oral iron supplementation, and endoscopic abnormalities improved although residual histologic abnormalities persisted. Dupilumab achieved a decrease in gastric eosinophil counts and subepithelial collagen thickness by 41% and 33%, respectively; steroids achieved decreases of 17% and 13%, respectively, and PPIs achieved decreases of 23% and 0.6%, respectively. Conclusions: Dupilumab was associated with sustained clinical and hematologic remission together with gradual endoscopic and histologic improvement in pediatric CG with prominent eosinophilic inflammation. To our knowledge, this is the first reported pediatric case of CG treated with dupilumab. These findings suggest that dupilumab may represent a promising steroid-sparing therapeutic option and support further evaluation in larger case series and controlled studies.

Reports doi: 10.3390/reports9030312

Authors: Edy Quizhpe Alex Paúl Guachilema Rivadeneira Jaime Eduardo Ortíz Flores Melany Micaela Montalvo Cevallos

Background and Clinical Significance: Lymphatic malformations (cystic lymphangiomas) are rare benign tumors in adults, with retroperitoneal and ischioanal involvement being exceptionally uncommon. These lesions often present significant surgical challenges because of their infiltrative growth pattern and high risk of recurrence following incomplete excision. We present a rare case of a giant recurrent retroperitoneal lymphangioma with extension into the pelvic and perineal regions after two previous unsuccessful surgical interventions; Case Presentation: A 46-year-old Hispanic female presented with progressive pelvic and perineal swelling associated with discomfort and functional limitation. The patient had a history of two prior surgeries for lymphangioma recurrence. Imaging studies revealed a large multicystic retroperitoneal mass extending through the pelvis into the ischioanal fossa and perineal region. Given the lesion’s size and complex anatomical involvement, a multidisciplinary surgical approach was planned. The patient underwent a combined abdominal–perineal en bloc resection, achieving complete removal of a 20 × 8 × 9.5 cm mass while preserving anal sphincter integrity and function. Histopathological examination confirmed the diagnosis of cystic lymphangioma. The postoperative course was uneventful, and no recurrence was observed for 6 months follow-up; Conclusions: Giant recurrent pelvic lymphangiomas require complete en bloc excision and a multidisciplinary approach to ensure disease clearance and prevent recurrence.

Reports doi: 10.3390/reports9030311

Authors: Khalid Ahmed Ahmad Kloub Ayman El-Menyar Mohammad Asim Hassan Al-Thani Ruben Peralta Sandro Rizoli

Background: Trauma surgeons face a challenge in the management of high-grade pancreatic injuries (HGPIs), as optimal strategies remain controversial. HGPIs are uncommon and difficult to manage due to dynamic trauma physiology and complications from the injury and management. We aimed to evaluate HGPI presentations, management, and outcomes. Methods: This retrospective study included 13 patients with HGPIs (American Association for the Surgery of Trauma [AAST] grade III–V) who underwent interventions between 2017 and 2024. Results: There were 13 cases with HGPIs (five Grade III, four Grade IV, and four Grade V). Liver injury was the most common associated organ injury (61.5%), followed by splenic injury (46.2%). Distal pancreatectomy was the most frequently performed operation, with either concomitant splenectomy (53.8%) or spleen preservation (23.1%). Severe postoperative infection was observed in this cohort, with sepsis occurring in 69.2% of patients and peripancreatic collections noted in 76.9% and intra-abdominal infection in 61.5%. Other postoperative complications included ileus (61.5%), pancreatic fistula (30.8%), and diabetes (15.4%). Conclusions: This case series demonstrates that high-grade pancreatic injuries are associated with substantial morbidity, along with prolonged hospitalization. A higher Abbreviated Injury Scale (AIS) among HGPIs is associated with greater overall injury severity and higher rates of major complications. Clinicians should consider prioritizing early drainage procedures, particularly in Grade IV and V injuries. Multicenter and larger-sample-size studies are required.

Reports doi: 10.3390/reports9030310

Authors: Maria Rogalidou Konstantina Dimakou Kalliopi Stefanaki Amalia Patereli Alexandra Papadopoulou

Background and Clinical Significance: Congenital tufting enteropathy (CTE), or autosomal recessive congenital diarrhea type 5 (DIAR5), is a rare intestinal epithelial disorder characterized by severe neonatal-onset watery diarrhea, failure to thrive, and intestinal failure. Most cases are caused by biallelic EPCAM variants. Case Presentation: A 53-day-old female infant presented with severe watery diarrhea and failure to thrive from the first days of life. She was born at term with a birth weight of 3.4 kg and had 10–20 watery stools daily. At admission, she was dehydrated, dystrophic, and below the third weight percentile. Diarrhea persisted despite an amino acid-based formula and cessation of enteral feeding. Duodenal biopsy showed disturbed villous–crypt architecture, variable lamina propria inflammation, absence of intraepithelial lymphocytosis, epithelial tufts, and regenerative epithelial changes, supporting CTE. Whole-exome sequencing identified compound heterozygous EPCAM variants: a maternally inherited likely pathogenic frameshift variant, c.687_688del, p.(Lys230Asnfs*23), and a paternally inherited missense variant, c.757G>A, p.(Asp253Asn), classified as a variant of uncertain significance. TPN was initiated for intestinal failure. Follow-up was complicated by catheter-related sepsis, cholelithiasis, and recurrent pancreatitis requiring laparoscopic cholecystectomy. She subsequently tolerated limited enteral feeding but did not achieve enteral autonomy and remained dependent on TPN, while maintaining normal growth with nutritional support. Conclusions: CTE should be considered in infants with severe neonatal-onset diarrhea. Histopathology combined with genetic testing is essential for diagnosis. Long-term TPN and multidisciplinary management are required.

Reports doi: 10.3390/reports9030309

Authors: Nulvin Djebbara-Bozo Nikolaj Warming Abdullah N. Maarouf Bence Gabor Szilvasy

Background and Clinical Significance: Melanoma is predominantly a cutaneous malignancy, whereas metastatic involvement of the endometrium is exceptionally rare. Melanoma of unknown primary (MUP) accounts for a small portion of such cases. Patients typically present with abnormal uterine bleeding, and diagnosis can be challenging because metastatic melanoma can mimic other uterine malignancies. We report a rare case of MUP presenting with synchronous endometrial and subcutaneous metastases, a combination not previously reported in the literature. Case Presentation: A multiparous woman in her seventies presented with persistent postmenopausal bleeding. Transvaginal ultrasonography demonstrated endometrial thickening, and endometrial biopsy revealed metastatic melanoma confirmed by immunohistochemical positivity for S100, SOX10, HMB-45, and Melan-A. Positron emission tomography–computed tomography identified fluorodeoxyglucose uptake in the uterine corpus and a metabolically active subcutaneous lesion in the right anterolateral abdominal wall. Surgical excision of the abdominal lesion confirmed metastatic melanoma. Despite extensive investigations, including dermatological examination, ophthalmological assessment, and imaging studies, no primary tumor was identified. The patient underwent hysterectomy followed by adjuvant nivolumab. At 24-month follow-up, no evidence of disease recurrence was detected. Conclusions: Endometrial metastasis of melanoma may occur in the absence of an identifiable primary lesion and should be considered in patients presenting with abnormal uterine bleeding, particularly those with a history of melanoma or unexplained metastatic disease. Because these lesions frequently present as polypoid, nodular, or infiltrative endometrial masses, prompt hysteroscopy and endometrial sampling are essential for diagnosis. This case highlights the importance of comprehensive histopathological evaluation and multidisciplinary management in rare presentations of metastatic melanoma.

Reports doi: 10.3390/reports9030308

Authors: Fiza Waseem Aun Bin Tariq Nahian Kazi Muaad Reyad Abdulla Ahmed H. Abdelhafiz

Background and Clinical Significance: Epstein–Barr virus (EBV) is a common infection that rarely causes acute pancreatitis. EBV-associated acute pancreatitis is an uncommon but potentially serious complication that may result from direct viral invasion of pancreatic tissue or immune-mediated inflammation. Because its presentation can overlap with other causes of acute pancreatitis, EBV may be overlooked when common aetiologies are not identified. Recognising EBV as a potential cause is important for accurate diagnosis and appropriate management, particularly in patients presenting with pancreatitis alongside features of acute EBV infection; Case Presentation: We report a case of 58-year-old female with EBV-induced acute pancreatitis. She had a flu like illness two weeks prior to hospital admission, tested positive for EBV IgM antibodies and received supportive treatment by her general practitioner. However, her condition deteriorated, leading to hospital admission. She developed epigastric pain and investigations showed elevated serum lipase, impaired liver function tests and acute kidney injury. CT abdomen showed hepatosplenomegaly, lymphadenopathy and peripancreatic oedema consistent with acute pancreatitis. She was initially treated with antibiotics, however; her condition worsened and she developed severe hypotension requiring intensive care admission. Aggressive fluid resuscitation, inotropic support and continuous veno-venous haemofiltration (CVVH) were required. She gradually improved and subsequently was stepped down to the medical ward for supportive care and rehabilitation. She made full recovery and was discharged home after a 6-week length of stay; Conclusions: EBV-associated acute pancreatitis is an uncommon but potentially severe complication of EBV infection. EBV should be considered in patients with acute pancreatitis when common aetiologies have been excluded, particularly when pancreatitis occurs alongside features of acute viral infection. Early recognition and appropriate supportive management may be important in preventing or limiting severe complications.

Reports doi: 10.3390/reports9030307

Authors: Yeseo Kwon Pooja Raibagkar Bharat B. Yarlagadda Jayashri Srinivasan David J. Ramsey

Background and Clinical Significance: Cancer-associated retinopathy (CAR) is a rare paraneoplastic autoimmune retinopathy caused by antibodies targeting tumor antigens with cross-reactivity to retinal proteins. Paraneoplastic cerebellar degeneration (PCD) results from autoimmune injury to cerebellar tissue triggered by onconeural antigens. We report a rare case of CAR occurring concurrently with seronegative PCD in a patient with poorly differentiated tonsillar squamous cell carcinoma, and we describe the long-term sequelae of CAR-related macular atrophy; Case Presentation: A 66-year-old male presented with progressive painless bilateral peripheral and night vision loss, truncal ataxia, dysmetria, and dysarthria. Optical coherence tomography demonstrated diffuse outer retinal loss, and multifocal electroretinography showed markedly reduced responses bilaterally. Evaluation revealed poorly differentiated squamous cell carcinoma of the right tonsil. CAR antibody testing was positive for recoverin, enolase, and carbonic anhydrase II antibodies. Brain MRI demonstrated cerebellar atrophy. After exclusion of other autoimmune etiologies, he was diagnosed with seronegative PCD. Treatment included robotic tonsillectomy with neck dissection, intravenous immunoglobulin, high-dose corticosteroids, and maintenance rituximab. At 6 months, visual acuity, color vision, and electro-retinography improved. Seven years later, he remains independent in activities of daily living despite the progression of retinal atrophy and cerebellar dysfunction; Conclusions: This case highlights the rare coexistence of CAR and seronegative PCD associated with tonsillar squamous cell carcinoma. Multimodal oncologic and immunosuppressive therapy produced meaningful neurologic and visual improvement, despite progressive long-term retinal degeneration.

Reports doi: 10.3390/reports9030306

Authors: Ryo Maekawa Shun-Ichiro Sakamoto Atsushi Hiromoto Kenji Suzuki Yosuke Ishii

Background and Clinical Significance: Hemoptysis caused by acute type B aortic dissection rupturing into the lung is rare but life-threatening; Case Presentation: An 81-year-old man receiving maintenance hemodialysis developed hemoptysis due to an aortobronchial fistula involving the left upper lobe. The ulcer-like projection was located on the greater curvature of the distal aortic arch and enlarged during the clinical course. Immediate thoracic endovascular aortic repair (TEVAR) and open repair were initially considered unsuitable because of hostile access through a previous abdominal aortic graft, a shaggy aorta, and severe cardiac comorbidities. Left upper lobe bronchial ligation was performed as a temporizing airway-isolation procedure and initially controlled airway bleeding. However, recurrent hemoptysis occurred after further enlargement of the aortic lesion and development of a new fistula involving the left lower lobe. Emergency TEVAR was then performed through the previous abdominal aortic prosthetic graft, and no further hemoptysis occurred; Conclusions: Bronchial ligation may temporarily control life-threatening airway bleeding when immediate aortic repair is not feasible, but strict surveillance and readiness for subsequent aortic intervention remain essential.

Reports doi: 10.3390/reports9030305

Authors: Hadas Rabani Ilana Rosenblat Khaled Osman Adel Shalata Leonard Saiegh

Background and Clinical Significance: Congenital hyperinsulinism (CHI) is a disorder involving excessive insulin secretion due to mutations in the insulin regulation pathways. Patients are typically diagnosed during infancy following recurrent hypoglycemic events, which may lead to irreversible neurologic damage if left untreated. Adult presentation and diagnosis are rare. Case Presentation: Here, we report the unusual case of a 41-year-old patient who presented with recurrent episodes of hyperinsulinemic hypoglycemia. An extensive diagnostic evaluation yielded no evidence of an acquired cause. Genetic testing revealed a heterozygous novel c.4078G>C substitution in the ABCC8 gene, which plays a role in the insulin secretion pathway. This variant may have been the cause for CHI going unrecognized during the patient’s childhood and could have also contributed to his uncontrolled convulsive disorder. Treatment with diazoxide and octreotide led to significant clinical improvement, with no severe hypoglycemic events during the final week of hospitalization. Conclusions: This case emphasizes the importance of considering congenital hyperinsulinism in the differential diagnosis of adult patients evaluated for hyperinsulinemic hypoglycemia, especially when standard workup fails to identify an underlying cause.

Reports doi: 10.3390/reports9030304

Authors: Keisuke Seki Kenji Ito Juntaro Sanada Taiki Akiyama Yoshiyuki Hagiwara

Background and Clinical Significance: In two-stage implant treatment the cover screw must be removed at second-stage surgery. Removal is occasionally prevented by cold welding or seizure. When the drive slot is damaged by escalating torque, no standard salvage protocol has been established, and the implant body itself may ultimately require removal. Case Presentation: During second-stage surgery for three implants placed in the mandibular right posterior region (#44, #45, #46) of a 68-year-old man, the cover screw at the #46 site was seized and could not be loosened with a manual screwdriver. An attempt at removal with a contra-angle implant driver, set first to 20 Ncm and then to 35 Ncm, stripped the drive slot. The procedure was suspended, and a revision was performed two weeks later. A tungsten carbide bur was used under water irrigation to prepare a straight slot across the damaged screw head, and a crown remover with a narrowed flat-blade tip was engaged in this slot. The screw was retrieved intact and the internal connection of the implant remained serviceable. A healing abutment was connected and the implant was restored with a definitive prosthesis, which was in function at the most recent review. At seven weeks after delivery, the distance from the implant platform to the crestal bone was greater at #46 than at the two adjacent implants. Conclusions: This report describes a salvage technique that preserved the implant body without the use of a system-specific retrieval kit. The peri-implant bone level observed at the treated site indicates that the procedure may have been accompanied by a loss of crestal bone, and whether the technique is reproducible will require further cases.

Reports doi: 10.3390/reports9030303

Authors: Pier-Valerio Mari Lorenzo Carriera Filippo Lococo Stefano Margaritora Simone Ielo Veronica Ojetti Giulio Onelli Fabrizio Liberati Vittorio Pietrangeli

Background and Clinical Significance: Interstitial lung disease (ILD) is an uncommon but potentially serious complication of imatinib. Its histopathological characterization has so far relied on surgical biopsy or transbronchial forceps sampling, and no case characterized by transbronchial lung cryobiopsy (TBLC) has been reported. The single previous description of a non-specific interstitial pneumonia (NSIP) pattern with imatinib came from a surgical specimen and was cellular in type, with complete radiological resolution after withdrawal. Case Presentation: A 69-year-old never-smoker began imatinib 400 mg daily for Philadelphia chromosome-positive chronic myeloid leukemia; chest computed tomography performed immediately beforehand was normal. Approximately three months later, she developed dyspnea, dry cough and a cutaneous rash, progressing to acute respiratory failure with forced vital capacity 49% and diffusing capacity 30% of predicted. Avian exposure had ceased one month before symptom onset, and she had never received amiodarone. Although serum precipitins were unavailable, hypersensitivity pneumonitis was considered less likely given the temporal relationship but could not be definitively excluded. TBLC yielded specimens showing fibrotic thickening of the alveolar septa by hyaline collagen deposition with a focal lymphomonocytic infiltrate, corresponding to a fibrotic NSIP pattern. After drug withdrawal and administration of corticosteroids, forced vital capacity rose to 82% of predicted. Multidisciplinary discussion concluded that this was drug-induced ILD, graded probable on the Naranjo scale. Imatinib was subsequently replaced by bosutinib for insufficient molecular response, without pulmonary recurrence. Conclusions: Imatinib-associated ILD may present with an organizing-pneumonia-like radiological pattern followed by a fibrosing pattern, with cryobiopsy performed later demonstrating fibrotic NSIP. Because no tissue was obtained during the acute phase, this sequence remains a hypothesis rather than a demonstrated evolution. Cryobiopsy can be performed safely when surgical biopsy is not appropriate.

Reports doi: 10.3390/reports9030302

Authors: Mohammed M. Abusayf Nada F. Alsaif Razan A. Alotaibi

Introduction and Clinical Significance: Descemet membrane detachment (DMD) is an uncommon but potentially vision-threatening complication of anterior segment surgery. Although immune-mediated graft rejection is a recognized cause of postoperative graft edema following arcuate keratotomy (AK) in eyes with previous penetrating keratoplasty (PKP), structural complications such as DMD may present with similar clinical findings and require fundamentally different management. We report a case of DMD initially misdiagnosed as acute graft rejection following manual AK in a post-PKP eye. Case Presentation: A 47-year-old female with a 20-year history of PKP in the right eye (RE) presented with decreased vision three weeks after undergoing manual AK using a diamond blade to correct high astigmatism. The procedure was complicated by an intraoperative wound leak requiring suturing. Postoperatively, she developed corneal edema and was initially misdiagnosed with acute graft rejection. Despite treatment with topical and systemic corticosteroids, her condition did not improve. Upon referral to our clinic, slit-lamp examination and anterior segment optical coherence tomography (AS-OCT) revealed a near-total, nonplanar DMD. The patient underwent a single air descemetopexy session involving three sequential intracameral air injections, resulting in Descemet membrane apposition and improvement in graft clarity. At 3-month follow-up, visual acuity had improved from hand motion to 20/200, with IOP within normal limits. Longer-term follow-up was unavailable. Conclusions: DMD should be considered as a cause of graft edema after AK in post keratoplasty eyes especially in the presence of complications.

Reports doi: 10.3390/reports9030301

Authors: Paulina González-Aguilar Mario Aurelio Martínez-Jiménez Arturo Ortiz-Álvarez Jose L. Ramirez-Garcialuna

Background and Clinical Significance: Dystrophic calcinosis cutis involves calcium deposition in damaged or chronically inflamed tissues despite normal calcium and phosphate metabolism. Although typically associated with systemic sclerosis and dermatomyositis, it is rare in rheumatoid arthritis. Ulceration over calcified deposits may impair healing and function. This case highlights a staged reconstructive strategy to remove calcified tissue and achieve definitive wound closure. Case Presentation: A 73-year-old woman with a 22-year history of rheumatoid arthritis presented with painful, partially confluent pretibial ulcerations, purulent drainage, impaired mobility, and extrusion of chalk-like material. Radiographic and histopathological findings supported dystrophic calcinosis cutis. Deep-tissue culture grew Escherichia coli, treated with intravenous ertapenem. Tangential excision of necrotic tissue and accessible calcific deposits resulted in an irregular full-thickness defect extending to the pretibial fascia. A synthetic polylactic acid matrix was applied with single-use negative pressure wound therapy for 14 days, followed by split-thickness skin grafting on day 21. Graft take exceeded 90%, and residual areas epithelialized without regrafting. At 12 months, the wound remained completely epithelialized without recurrent ulceration, with pain resolution and return to baseline activities. Conclusions: In this patient with ulcerated dystrophic calcinosis cutis associated with rheumatoid arthritis, staged reconstruction using surgical excision, a polylactic acid matrix, single-use negative pressure wound therapy, and split-thickness skin grafting facilitated recipient-bed preparation and definitive cutaneous closure of the post-excisional defect. This case supports the feasibility of this sequence for wound reconstruction in selected complex ulcerated lesions. Further studies are needed to define its comparative role.

Reports doi: 10.3390/reports9030300

Authors: Manabu Mogitate

Background: Granular changes observed under band-limited epipharyngeal endoscopy are considered a characteristic finding of chronic epipharyngitis; however, their biological significance remains unclear. This study investigated whether granular changes are associated with allergen sensitization and peripheral allergic biomarkers in patients with chronic epipharyngitis. Methods: A retrospective analysis was conducted in 59 patients with chronic epipharyngitis. Granular changes were graded endoscopically as 0 (absent), 1 (mild-to-moderate), or 2 (severe). Nasal eosinophil counts, peripheral blood eosinophil counts, total immunoglobulin E (IgE), mite-specific IgE, house dust-specific IgE, and peripheral blood CD4/CD8 ratios were evaluated. Comparisons among groups were performed using the Kruskal–Wallis and Mann–Whitney U tests, and correlations were assessed using Spearman’s rank correlation analysis. Results: Patients with granular changes demonstrated significantly higher mite-specific IgE and house dust-specific IgE levels than those without granular changes. In comparisons between patients without granular changes (grade 0) and those with granular changes (grades 1 and 2), significant differences were observed for mite-specific IgE (p = 0.016) and house dust-specific IgE (p = 0.016). In contrast, nasal eosinophil counts, peripheral blood eosinophil counts, total IgE levels, and CD4/CD8 ratios showed no significant associations with granular changes. Furthermore, Spearman correlation analysis revealed no significant correlations between granular change scores and any evaluated biomarker. Conclusions: Granular changes on epipharyngeal endoscopy were associated with sensitization to mite and house dust allergens but were not associated with peripheral eosinophil counts, total IgE levels, or CD4/CD8 ratios. These findings suggest that the presence of granular changes may be associated with allergen sensitization; however, no association with increasing granular severity was observed. Further studies incorporating local immune profiling and cytokine analyses are warranted to clarify the biological significance of granular changes.

Reports doi: 10.3390/reports9030299

Authors: Daniel Gondorf George Triantafyllou Nikolaos-Achilleas Arkoudis Georgios Velonakis Kostis Gyftopoulos Maria Piagkou

We describe a rare case of LRV pseudo-fenestration in a 68-year-old female identified on contrast-enhanced multidetector computed tomography. Unlike true fenestration, in which a single vessel splits and reunites, this pseudo-fenestration resulted from the convergence of two distinct hilar venous trunks. Multiplanar and three-dimensional reconstructions demonstrated that the left suprarenal vein drained into the superior limb, whereas the left gonadal vein drained into the inferior limb, reflecting a consistent and anatomically meaningful tributary pattern. This configuration is most plausibly explained by incomplete or asymmetric embryological fusion of the cardinal venous system. Accurate preoperative recognition of this variant is clinically important to reduce the risk of iatrogenic injury during laparoscopic donor nephrectomy, adrenal venous sampling, and other retroperitoneal or endovascular procedures.

Reports doi: 10.3390/reports9030298

Authors: Georgi P. Luchev Lyubomir Gaydarski Svetoslav A. Slavchev Ahmed Al-Sadek Vera Megdanova Iva N. Dimitrova Georgi P. Georgiev

Background and Clinical Significance: Local recurrence of extremity leiomyosarcoma after multiple operations and radiotherapy presents a major therapeutic challenge. Adequate oncologic clearance must be balanced against preservation of skeletal stability and reliable wound coverage within a scarred and poorly vascularized tissue bed; Case presentation: A 78-year-old woman presented with a painful recurrent leiomyosarcoma of the anterior proximal third of the right leg after three previous operations and adjuvant radiotherapy. Preoperative magnetic resonance imaging demonstrated a recurrent soft-tissue lesion extending to the anterior surface of the proximal tibia. Staging computed tomography of the chest, abdomen, and pelvis showed no distant metastatic disease before definitive surgery. A one-stage limb-sparing procedure was performed, including resection of the recurrent tumor bed and an approximately 7-cm anterior cortical lamella of the proximal tibia containing an area considered suspicious for neoplastic involvement. A locking tibial plate was applied prophylactically to reduce the risk of pathological fracture. The approximately 12 × 10-cm soft-tissue defect was covered with a muscle flap from the medial head of the gastrocnemius and a free skin graft harvested from the paraumbilical region. Gross pathological examination identified an 8-cm subcutaneous tumor formation. Histopathological examination demonstrated well-differentiated leiomyosarcoma; the spindle cells expressed vimentin, actin, and desmin. All examined resection lines were free of tumor infiltration. No pathogenic microorganism was isolated, and no early postoperative complication was documented. The patient mobilized with walking aids and protected weight bearing for 30 days. At approximately 16 months, the flap and skin graft provided stable coverage, no postoperative tibial fracture or clinically apparent implant-related complication had occurred, and the patient was independently ambulatory. Postoperative MRI demonstrated expected postoperative changes and a small indeterminate subcutaneous focus without diffusion restriction, requiring continued surveillance; Conclusions: This case illustrates the feasibility of combining oncologic resection, prophylactic tibial stabilization, and vascularized soft-tissue reconstruction in a previously irradiated extremity. The documented early functional and reconstructive outcome supports this individualized limb-sparing approach, although longer oncologic surveillance is required.

Reports doi: 10.3390/reports9030297

Authors: Filippos Fytros Panagiota Dimitropoulou Christina Charisi Dorothea Pliaka Nikolaos Spantidakis Konstantinos Poulopoulos Maria Fasoula Efstratios Karagiannidis Athanasios Poulopoulos Vasileios Zisis

Background: Pemphigus is a rare group of autoimmune blistering diseases characterized by autoantibody-mediated loss of keratinocyte adhesion, resulting in intraepithelial blister formation involving the skin and mucous membranes. Pemphigus Vulgaris (PV) is the most common type of pemphigus, which usually presents in adulthood and has a prevalence rate of about 2.83 cases per million person years worldwide. The prevalence rate in children and adolescents is relatively uncommon; however, it accounts for about 1.4 to 3.7 percent of all cases of pemphigus vulgaris reported worldwide. The involvement of oral cavity is clinically significant since it can present prior to the disease or as its predominant feature. Hence, this narrative review seeks to review literature on pemphigus with involvement of oral cavity in children and adolescents. Objective: The objective of this study was to review the current literature regarding epidemiology, pathogenesis, clinical presentation, diagnosis, histopathological characteristics, treatment, and outcomes of pemphigus with oral involvement in children and adolescents. Materials and Methods: A literature search was conducted using the PubMed/MEDLINE, Scopus, and Cochrane Library databases to identify relevant studies published between 2015 and 2026. The search strategy included terms related to pemphigus, pediatric patients, and oral manifestations. Articles involving patients younger than 18 years of age with oral involvement were screened according to predefined inclusion criteria. Following database screening, duplicate removal, and full-text assessment, 25 studies comprising a total of 51 patients with documented oral or orofacial involvement were included in the final review. Results: Pemphigus vulgaris was the predominant subtype, with oral lesions representing the initial or sole manifestation in the majority of patients. The gingiva, mucosa, tongue, lip, and palate were the most common affected areas in the mouth. The lesions in these areas usually appeared as painful erosion, ulcers, and desquamative gingivitis. Histopathology with the presence of acantholysis in the suprabasal area and direct immunofluorescence was the most definitive test for diagnosis. Systemic corticosteroids were the mainstay of treatment in conjunction with steroid sparing agents in some cases, with good results in difficult cases using rituximab. Overall, most patients achieved partial or complete clinical remission following appropriate treatment, although relapses were occasionally reported. Conclusions: Pemphigus in children and adolescents is rarely encountered; however, it should be included as a differential diagnosis of erosive/ulcerative lesions. Early identification, diagnosis, and treatment through a collaborative approach from dental practitioners are critical. Further research is required at multiple centers to gain a better understanding of the disease and to develop evidence-based guidelines for diagnosis and treatment of pediatric patients.

Reports doi: 10.3390/reports9030296

Authors: Lisa Lotta Cirkel Isabel Klein Karel Kostev

Background: Oral cavity cancer is a clinically relevant subgroup of head and neck malignancies and is associated with substantial treatment burden and healthcare utilization. Hospital length of stay (LOS) is an important indicator of inpatient resource use and complexity of care, yet large multicenter data from Germany are limited. Methods: This retrospective multicenter analysis used anonymized inpatient administrative data from 49 German hospitals; eligible oral cavity cancer hospitalizations were contributed by 34 of these hospitals. Adult inpatient hospitalizations (≥18 years) with malignant neoplasms of the oral cavity, defined using ICD-10-GM codes C00–C06, recorded between January 1 2019 and 31 December 2024 were included. The primary outcome was hospital LOS in days. Multimorbidity was quantified using the van Walraven-weighted Elixhauser Comorbidity Score. Prolonged hospitalization was defined as LOS ≥ 7 days and LOS ≥ 14 days. Associations between demographic, clinical, and treatment-related variables and LOS were examined using multivariable Poisson regression models. Because overdispersion was present, a negative binomial mixed model was additionally fitted as a sensitivity analysis. To account for inter-hospital variability, hospital was included as a random intercept in all multivariable models. Associations with prolonged LOS were analyzed using multivariable logistic regression models. All analyses were performed at the hospitalization level. Results: A total of 3957 inpatient hospitalizations for oral cavity cancer were included. Mean age was 65.6 years, and 66.2% of hospitalizations involved male patients. The median LOS was 6 days (interquartile range [IQR] 3–13; mean 10.2 days, standard deviation 11.8). Overall, 49.4% of hospitalizations had an LOS ≥ 7 days and 23.5% had an LOS ≥ 14 days. Older age, particularly >80 years, and higher comorbidity burden were associated with longer LOS (adjusted Poisson rate ratio [RR] for age > 80 years 1.17, 95% CI 1.13–1.21; high comorbidity burden RR 1.58, 95% CI 1.54–1.63). Several treatment-related variables, including surgical procedures in the oral and facial region, lymphatic system operations, blood transfusions, and complex intensive care treatment, were associated with prolonged hospitalization (e.g., blood transfusion RR 1.80, 95% CI 1.76–1.85; complex intensive care RR 1.70, 95% CI 1.65–1.75). Chemotherapy-related hospitalizations were associated with shorter LOS. Conclusions: LOS varied substantially across inpatient hospitalizations for oral cavity cancer in Germany. Older age, higher comorbidity burden, and markers of more complex inpatient treatment were associated with extended hospital stay. These findings may help identify hospitalizations at increased risk of prolonged LOS and inform inpatient planning and resource allocation.

Reports doi: 10.3390/reports9030295

Authors: Francesco Russano Vittoria Patti Cinzia Bettin Massimiliano Caravello Davide Brugnolo Paolo Del Fiore

Background and Clinical Significance: Patent Blue V (PBV) is widely used for sentinel lymph node mapping but may rarely cause severe hypersensitivity reactions. These reactions can present atypically, with predominant cardiovascular collapse and minimal cutaneous manifestations, potentially delaying recognition and treatment. Case Presentation: We report the case of a 52-year-old woman who developed sudden and prolonged refractory hypotension shortly after PBV injection during melanoma surgery. The reaction initially occurred in the absence of bronchospasm or early significant cutaneous manifestations. Profound cardiovascular collapse preceded the delayed appearance of erythema and piloerection, making early recognition of perioperative anaphylaxis particularly challenging. Hemodynamic instability required aggressive fluid resuscitation and prolonged vasopressor support. Subsequent diagnostic work-up, including serum tryptase measurement and allergological evaluation, confirmed PBV-induced anaphylaxis. PBV-induced anaphylaxis may present with isolated cardiovascular collapse without typical clinical features. Conclusions: Early recognition and prompt hemodynamic support are essential to optimize outcomes in the perioperative setting.