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Brain tumors represent the second most frequent etiology in patients with focal seizure onset before 18 years of age and submitted to epilepsy surgery. Hence, this category of brain tumors, herein defined as low-grade, developmental, epilepsy-associated brain tumors (LEAT) is different from those frequently encountered in adults as (A): 77% of LEAT occur in the temporal lobe; (B): the vast majority of LEAT are of low malignancy and classified as WHO I°; (C): LEAT are often composed of mixed glial and neuronal cell components and present with variable growth patterns including small cysts or nodules; (D): LEAT do not share common gene driving mutations, such as IDH1 or 1p/19q co-deletions. Characteristic entities comprise the ganglioglioma (GG), the dysembryoplastic neuroepithelial tumor (DNT), the angiocentric glioma (AG), the isomorphic diffuse glioma (IDG) and the papillary glio-neuronal tumor (PGNT), representing 73.2% of 1680 tumors collected in a large German series of 6747 patients submitted to epilepsy surgery. In the realm of exciting discoveries of genetic drivers of brain tumors new genes have been also reported for LEAT. BRAF V600E mutations were linked to GG with CD34 expression, FGFR1 mutations to DNT, MYB alterations to AG and also IDG and PRKCA fusions to PGNT, suggesting the possibility to also develop a genetically driven tumor classification scheme for LEAT. Rare availability of LEAT in a single center is a challenging obstacle, however, to systematically unravel the neurobiological nature and clinical behavior of LEAT. Other challenges in need of clarification include malignant tumor progression of LEAT entities, seizure relapse in patients following bulk tumor resection and the controversial issue of associated focal cortical dysplasia as additional pathomechanism. In order to advance our understanding and promote reliable diagnostic work-up of LEAT, we recommend, therefore, international collaboration to achieve our goals.

Introduction/BackgroundThe processus vaginalis is an invagination of the parietal peritoneum that descends anterior to the gubernaculum and is shorter in females than in males. The superior part of the processus vaginalis obliterates at or soon before birth, and this obliteration continues caudally until the entire structure vanishes during the first year of life. When there is a partial or total failure of obliteration of this processus vaginalis, the canal of Nuck forms as a potential space.MethodologyWe present the case of a 39-year-old woman was referred to our gynaecological department with the diagnosis of a Bartholin’s cyst. Three years ago she had undergone surgery for the same diagnosis, complicated with important hematoma. The patient presented with a painless vulval swelling, that gradually became conspicuous, bothering his sexual activity.ResultsOn physical examination, a soft fluctuant sausage-shaped mass was found, measuring approximately 5 cm, extending to the all labia majora. There were no signs of infection or inflammation and the overlying skin had no lesions. Ultrasound revealed a well-defined hypoechoic elongated mass with 4.5 cm of long axis, septated, extending into labia majora. Sonographic findings were consisting with the diagnosis of a cyst of the canal of Nuck and treatment choices were discussed with the patient. She opted for surgical excision to avoid the possibility of a recurrence associated with aspiration treatment.Abstract #1080 Figure 1ConclusionThe cysts of Canal of Nuck encompass various differential diagnoses, including lymph node, cyst, inguinal hernia, infection/abscess, inguinal gonad, endometriosis, benign tumors, and neoplasia. A thorough understanding of these masses’ anatomy, clinical presentation, and imaging characteristics can help avoid misdiagnosis and inappropriate treatment. Surgical intervention is considered the gold standard for managing symptomatic masses in the canal of Nuck. In some cases, conservative management with close observation may be appropriate, especially in asymptomatic or low-risk lesions.DisclosuresNo disclosures

INTRODUCTION:Pancreatic lymphoepithelial cyst (LEC) is a rare, benign collection of keratinizing squamous epithelial cells encapsulated by lymphoid tissue. Because of its limited data and nonspecific features that can mimic malignant lesions, LECs can lead to unnecessary operations. Here we describe a rare case of pancreatic LEC.CASE DESCRIPTION/METHODS:A 62-year-old male with a known pancreatic mass presented with abdominal pain. CT scan showed a 36 × 52 mm mass in the pancreatic head with no pancreatic ductal dilation or retroperitoneal lymphadenopathy (Figure 1), which increased in size compared to previous imaging. Endoscopic ultrasound (EUS) showed a well-defined, avascular 49 × 29 mm heterogenous hypoechoic mass by the pancreatic neck without pancreatic ductal dilation (Figure 2). Subsequent EUS-guided fine needle aspiration (FNA) revealed rare fragments of benign-appearing squamous epithelium in a background of keratin debris, cyst contents, and scattered lymphocytes, consistent with a lymphoepithelial cyst (Figure 3).DISCUSSION:Pancreatic LEC is an extremely rare lesion that comprises of only 0.5% of all pancreatic cysts. It occurs in males 50-60 years of age as an incidental finding, albeit patients may present with abdominal pain and nausea. A majority of the LECs are round, anechoic or hypoechoic, exophytic complex cystic lesions with enhancing septa or rim. However, these features can overlap with other pancreatic lesions such as intraductal papillary mucosal neoplasms that have malignant potential, leading to unnecessary surgical intervention. Thus EUS-FNA has become the mainstay for diagnosing pancreatic LECs, which show an outer layer of lymphoid tissue and an inner layer of mature squamous epithelium without atypia. Given the slow growing and benign nature, conservative management and observation is adequate for pancreatic LECs with excellent long-term outcome. With increasing number of imaging ordered by clinicians, it is anticipated that there will be a greater number of incidental pancreatic LECs detected, which in turn can increase the number of unnecessary procedures. EUS-FNA should be utilized more frequently to help distinguish benign pancreatic LECs from premalignant or malignant lesions to avoid surgery. It is important for clinicians to become more familiar with the cytopathological characteristics of pancreatic LECs, and this case highlights the importance of EUS-FNA in accurately diagnosing a rare pancreatic LEC.

Echinococcosis is the most common cestode infection globally caused by the Echinococcusspecies. The most common organ involvement is the lungs and liver, but other organs can be rarely involved. Here, we present a case with a giant cerebral hydatid cyst. A 4-year-old boy presented with abnormal gait and walking at Marmara University School of Medicine Pendik Training and Research Hospital, Istanbul, Türkiye in September 2022. Cranial magnetic resonance imaging showed a cyst of 13 cm in diameter. The cyst was enucleated successfully with no rupture. Oral albendazole therapy was started. There was no eosinophilia, and the echinococcal indirect hemagglutination test was negative. Ultrasonography detected an anechoic cystic lesion in the liver. He was evaluated for deep-organ involvement; however, no cysts were detected in other organs. The histopathological examination was compatible with a hydatid cyst. Although intracranial hydatid disease in children is rare, it should be considered among the differential diagnoses in patients with neurological symptoms, especially in endemic regions.

[This corrects the article DOI: 10.1371/journal.pone.0209007.].

ObjectivesThe first documented use of 5-ALA in the excision of an intraparenchymal endodermal cyst.DesignCase review.Subjects52 year old female presented with headaches, progressive right sided hemiparesis and anomic aphasia. She had a large cystic frontal lesion, adjacent of the frontal horn of the lateral ventricles cyst which did not show any nodular or solid component, and did not enhance with gadolinium.MethodsCase report and review of the literature.Results5-ALA assisted, image guided fenestration of the cystic lesion and insertion of a ventricular catheter connected to an Ommaya reservoir was performed. The cyst wall was observed under the microscope and it fluoresced with 5-ALA. Multiple biopsies were obtained from this tissue, which confirmed diagnosis of endodermal cyst. The patient had improvement in clinical symptoms and size of the cyst radiologically in both the immediate post-operative period and the 6 months follow up.ConclusionsPrevious reports described the use of 5-ALA to identify tumour cells within the solid component of cystic haemangioblastomas as well as in cystic ependymomas where the cystic component does not fluoresce. In our patient, the homogeneous fluorescence of the wall suggested that this was indeed a different entity from a haemangioblastoma or an ependymoma because of the different pattern of fluorescence observed. 5-ALA-assisted resection of cystic lesions should be considered when a tumoral origin is uncertain.