Al-Makassed Islamic Charitable Society Hospital

Liposarcoma is a malignant mesenchymal tumor most commonly arising in the extremities and retroperitoneum. Involvement of the mesentery is rare, and primary liposarcoma of the large bowel mesentery has been reported fewer than 15 times in the English literature. Among its histological subtypes, myxoid liposarcoma is exceptionally rare in this location, with only four previous cases described. Owing to its rarity, there are no standardized management protocols, although wide surgical excision with negative margins remains the mainstay of treatment. We report a 73 year-old Arab male with hypertension and ischemic heart disease who presented with painless abdominal swelling and anorexia. Imaging revealed a large left mesocolon mass, and a left hemicolectomy with colosigmoid anastomosis achieved R0 margins. Histopathology confirmed primary myxoid liposarcoma of the mesocolon. The patient had an uneventful recovery and remains disease-free 1 year after surgery. Primary myxoid liposarcoma of the mesocolon is extremely rare, with this case representing only the fifth reported instance. Review of the literature indicates that complete surgical resection is the cornerstone of management, while the role of adjuvant radiotherapy or chemotherapy remains controversial. Reporting additional cases is essential to improve understanding, refine prognostic assessment, and guide the development of evidence-based treatment strategies.

Small bowel leiomyosarcoma (LMS) is a rare and aggressive malignancy that often presents with nonspecific abdominal symptoms, leading to delayed diagnosis and poor prognosis. We report the case of a 73-year-old male with an eight-month history of abdominal pain, constipation and anemia. Computed tomography revealed partial small bowel obstruction caused by a mass, and exploratory laparotomy identified an ulcerated lesion involving the small bowel and mesentery. The mass was completely resected with primary anastomosis. Histopathological examination confirmed a high-grade LMS with a high mitotic index, positive for smooth muscle actin and desmin, and negative for CD34, S100, and CD117. Notably, weak DOG1 positivity was observed, a rare finding that may complicate distinction from gastrointestinal stromal tumours. This case highlights the diagnostic challenges of small bowel LMS, the central role of surgical resection in management, and the need for careful pathological evaluation to avoid misclassification and guide prognosis.

With rising global obesity rates and an increasing number of bariatric procedures, physician awareness and understanding of bariatric surgery are critical for optimizing patient care and ensuring timely referrals. In Palestine, however, this topic remains underexplored, underscoring the need for context-specific data. This study aims to assess knowledge and perception gaps regarding Metabolic and Bariatric Surgery (MBS) and its complications among Palestinian healthcare professionals-including specialists and residents-across both public and private sectors. To our knowledge, this is one of the first Palestinian studies to investigate physician perspectives on bariatric surgery across multiple medical specialties. A cross-sectional survey was conducted among physicians from seven major hospitals in Palestine, targeting specialists in surgery, internal medicine, orthopedics, gynecology, and other fields. A structured questionnaire, informed by the existing literature, was developed to evaluate knowledge and perceptions related to bariatric surgery indications, referral criteria, and complications. A total of 192 completed surveys were analyzed. While 82.3% of physicians reported being aware of the referral criteria for MBS, only 23.4% and 20.8% correctly identified the BMI thresholds for patients with and without comorbidities, respectively. Notably, 63.5% stated they would refer patients for MBS even without prior failure of conservative management. Common barriers to referral included lack of sufficient knowledge (42.3%), patient safety concerns (32.7%), and failure to meet surgical criteria (51.9%). Financial limitations (50.3%) and fear of complications (71.2%) were also significant concerns. Encouragingly, 77.1% of respondents expressed interest in receiving further education on bariatric surgery. As the prevalence of MBS continues to grow, it is imperative that physicians possess accurate knowledge of its indications, outcomes, and potential complications. Misconceptions or gaps in knowledge may lead to underutilization or inappropriate referrals. Educational interventions targeting multidisciplinary healthcare providers could enhance decision-making, improve referral patterns, and ultimately support better patient outcomes.

<i>Background:</i> Ganglioneuromas are rare, benign tumors derived from neural crest cells of the sympathetic nervous system. These tumors are typically found in the posterior mediastinum and retroperitoneum, and are characterized by well-differentiated ganglion and Schwann cells. Presacral ganglioneuromas are extremely uncommon, with few cases documented in the literature. Their rarity and nonspecific clinical presentation can pose diagnostic challenges. It is worth mentioning that there are few cases in the literature report ganglioneuroma in association with MEN type 2B. <i>Case Presentation:</i> We report the case of a 30-year-old female who presented with a three-month history of mild lower abdominal discomfort and non-radicular lower back pain. Her physical examination was unremarkable, and routine laboratory investigations, including tumor markers and catecholamine levels, were within normal limits. Initial ultrasonography was inconclusive. However, contrast-enhanced computed tomography (CT) revealed a well-circumscribed, 5 × 3 cm lesion in the presacral region, causing widening of the right middle sacral foramina. Magnetic resonance imaging (MRI) further characterized the mass as isointense on T1-weighted imaging and heterogeneously hyperintense on T2-weighted imaging, with peripheral enhancement after gadolinium administration. Given its location and imaging characteristics, the lesion was surgically excised via microscopic resection. The postoperative course was uneventful, and the patient was discharged in stable condition. Histopathologic analysis confirmed the diagnosis of ganglioneuroma, revealing mature ganglion cells embedded in a schwannian stroma with fibrous and edematous areas. <i>Conclusion:</i> This case underscores the importance of considering ganglioneuroma in the differential diagnosis of presacral masses. Timely imaging and surgical intervention are key to effective management and favorable outcomes. We present a rare case of a presacral ganglioneuroma in a 30-year-old female patient who experienced mild lower abdominal discomfort and non-radicular lower back pain over a three-month period, without significant neurological symptoms. Diagnostic imaging revealed a presacral lesion at the S2-3 level, leading to a surgical intervention that resulted in a subtotal excision of the mass. Histopathological analysis confirmed the diagnosis of ganglioneuroma. This case underscores the importance of considering presacral ganglioneuroma in the differential diagnosis of presacral lesions, given their subtle presentation and potential complications.

BackgroundCor triatriatum sinister is a rare congenital heart disease that can mimic left atrial obstructive lesions. Symptoms vary based on the severity of obstruction.Case SummaryWe report a case of a 14-year-old girl with severe exercise intolerance. Echocardiography and computed tomography scan revealed a fibromuscular membrane causing left atrial obstruction and an anomalous venous drainage with a persistent left superior vena cava to the coronary sinus. Surgical intervention is definitive, typically via sternotomy.DiscussionGiven the complexity and lack of expertise in minimal invasive thoracotomy for such lesions, we used 3-dimensional (3D) heart printing for virtual surgical planning. This approach facilitated a safe and precise repair. To our knowledge, this is the first reported case using 3D printing to enable a minimally invasive thoracotomy for cor triatriatum sinister correction.Take-Home MessagesMinimally invasive approaches should not be dismissed for complex congenital heart defects. Multimodal imaging can enhance surgical feasibility.

Introduction and importance:Adult-onset nesidioblastosis is an exceedingly rare yet significant cause of persistent hyperinsulinemic hypoglycemia. This condition is often associated to bariatric surgeries such as Roux-en-Y gastric bypass and sleeve gastrectomy. Characterized by abnormal β-cell hyperplasia and hypertrophy, its diagnosis presents a unique challenge due to overlapping features with insulinomas and post-bariatric hypoglycemia syndrome (PBHS).Case presentation:We report a 55-year-old woman with a history of gastric sleeve and Roux-en-Y gastric bypass surgeries who presented with a 1.5-year history of recurrent hypoglycemic episodes. Her symptoms, including blurred vision, tremors, and altered consciousness, persisted despite medical therapy with octreotide, acarbose, and nifedipine. Extensive imaging, including magnetic resonance imaging and endoscopic ultrasound, ruled out insulinomas, raising suspicion of non-insulinoma pancreatogenous hypoglycemia syndrome. The patient underwent laparoscopic subtotal distal pancreatectomy with spleen preservation. Histopathological examination confirmed nesidioblastosis, revealing irregular islet distribution and β-cell hypertrophy. Post-surgery, the patient achieved normoglycemia without recurrence of hypoglycemic episodes during follow-up.Discussion:This case highlights the complexity of diagnosing nesidioblastosis in adults, especially following bariatric surgeries. Nesidioblastosis involves β-cell hyperplasia and hypertrophy driven by hormonal factors like GLP-1, whereas PBHS results from altered incretin patterns causing excessive insulin release. Advanced imaging and multidisciplinary collaboration are important for accurate diagnosis. Surgical management remains a cornerstone for refractory cases, as demonstrated in this patient’s remarkable recovery.Conclusion:Nesidioblastosis is a rare condition but should be considered in the differential diagnosis of post-bariatric surgery hypoglycemia. This case highlights the importance of distinguishing nesidioblastosis from PBHS to ensure appropriate and effective management strategies.

Combined immunodeficiency due to CARMIL2 mutations is a rare autosomal recessive primary immunodeficiency characterized by impaired T-cell activation and function, leading to diverse clinical manifestations. Fewer than 50 cases have been reported worldwide. We describe the clinical and genetic features of five patients from Palestine with homozygous CARMIL2 mutations, including the first documented case of recurrent visceral leishmaniasis associated with this gene defect. This retrospective case series was conducted using whole-exome sequencing to confirm the diagnosis. All patients exhibited significant immunologic symptoms, including chronic dermatitis, cutaneous warts, recurrent respiratory infections, and mucocutaneous candidiasis. Two developed cytomegalovirus-related disease. Genetic analysis revealed two novel homozygous variants: NM_001317026.3:c.1865 C > T (p.Ala622Val) in four patients, and c.1973 C > T (p.Ala658Val) in one. Notably, one adult male developed recurrent visceral leishmaniasis, an unusual presentation not previously reported in the context of CARMIL2 deficiency. Consanguinity was identified in two families. All patients required immunomodulatory therapy, and four were evaluated for hematopoietic stem cell transplantation. This case series underscores the clinical heterogeneity of CARMIL2-associated immunodeficiency and highlights the importance of genetic testing in patients with recurrent or atypical infections, particularly in populations with a high prevalence of consanguinity. The novel link to visceral leishmaniasis expands the known phenotypic spectrum of this condition.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10875-025-01956-1.

Lung adenocarcinoma may resemble the clinical presentation of an infectious or inflammatory lung disease. The coexistence of lung cancer, and polyserous effusions is uncommon, which may cause a diagnostic challenge. However, any polyserous effusions at a young age must always be suspicious for malignancy. We report a case of 38-year-old male patient with polyserous effusions and pneumonia who was treated accordingly and showed clinical improvement with a significant reduction of pericardial and pleural effusions. Subsequent testing and a biopsy resulted in the histopathological diagnosis of an adenocarcinoma of the lung. Nonrecurrent polyserous effusions in lung adenocarcinoma are uncommon, and negative cytology results may not exclude malignancy due to the moderate sensitivity of pleural and pericardial fluid cytology. Clinicians should remain vigilant for false-negative results, especially in younger patients. Malignancy should not be ruled out because pleural and pericardial fluid cytology have a sensitivity of 60% and 92%, respectively. Our case highlights the diagnostic challenges posed by atypical presentations of lung adenocarcinoma and emphasizes the importance of considering malignancy in the differential diagnosis of polyserous effusions, even when initial cytology results are negative. Clarifying the rationale for this study enhances its relevance and impact.