ABSTRACTNodular fasciitis (NF) is a rare, self‐limiting benign soft tissue disorder characterized predominantly by fibroblastic proliferation. NF in breast is rare. We report a 61‐year‐old female patient who was pathologically diagnosed with NF. She had a rapidly increasing mass in the central region of the right breast. After imaging examinations, complete mass resection was performed on the patient. By pathological examination and immunohistochemical tests, NF was the final diagnosis.

ABSTRACTAcquired hemophilia A is a rare, potentially life‐threatening bleeding disorder caused by autoantibody inhibitors to coagulation factor VIII. We report the case of an 87‐year‐old female who presented with symptomatic bleeding and was subsequently diagnosed with acquired hemophilia A. Her clinical course, treatment, and recovery are described. Notably, her recent medication history included ixekizumab, an immunotherapy agent used for an underlying autoimmune condition, and a course of antibiotics, complicating the identification of a definitive etiology. This case raises the possibility of ixekizumab as a potential novel pharmacologic trigger for AHA. We highlight challenges in establishing causality and review current literature on hematologic manifestations of drug‐induced autoimmunity, with a focus on biologic immunotherapies.

ABSTRACTRhinophyma recurrence after surgical excision poses a significant therapeutic challenge, often stemming from the incomplete removal of deep hyperplastic pilosebaceous units. We present the case of a 66‐year‐old male with a third occurrence of rhinophyma after two prior failed cold‐steel excisions. The definitive intervention consisted of a modified deep tangential excision, removing all rhinophymatous tissue to a deep dermal plane that approached, but did not violate, the nasal perichondrium, thereby eradicating the pathologic glandular nidus while preserving the deepest adnexal remnants essential for re‐epithelialization. The wound was primarily managed by secondary intention healing, guided by selective, tension‐free suture re‐approximation of key wound edges to optimize contour. Cold‐steel excision was specifically chosen to ensure a specimen free of thermal artifact for definitive histopathology, a critical step in a recurrent case, which ultimately confirmed marked sebaceous gland hypertrophy and excluded malignancy. The postoperative course was uneventful, and at an 18‐month follow‐up, the patient demonstrated a stable, successfully restored nasal contour with no signs of recurrence. This case demonstrates that for severe, recurrent rhinophyma, a surgical strategy that balances thorough debulking of pathologic tissue with meticulous preservation of deep adnexal structures is critical for achieving a durable, long‐term outcome.

Mangled limb injuries, typically caused by high-energy trauma, present significant challenges in surgical decision-making, particularly when considering limb salvage versus primary amputation. While common mechanisms include vehicular or industrial accidents, unconventional etiologies are rarely documented. We report a unique case of a 43-year-old female who sustained a mangled left lower limb injury following a gearbox explosion in a Porsche Cayenne. The injury resulted in a near-complete amputation at the distal third of the leg, with extensive contamination by oily and metallic debris. Radiologic assessment confirmed complex fractures and vascular injury, with transection of the posterior tibial and peroneal arteries. Despite a high Mangled Extremity Severity Score (MESS) of 7 and initial surgical consensus favoring below-knee amputation, the patient and her family strongly advocated for limb preservation. The initial management involved damage control surgery with extensive debridement and external fixation. A multidisciplinary team provided staged reconstruction despite significant soft tissue loss and neurological deficits. The patient demonstrated favorable vascular recovery and maintained foot viability, ultimately preserving the limb. This case highlights an unusual mechanism of mangled limb trauma and underscores the critical role of shared decision-making in trauma care. It reinforces that, in carefully selected patients, limb salvage may be feasible even in scenarios traditionally warranting amputation.

While infection is a recognized complication of congenital urachal cysts, progression to an inflammatory phlegmon causing bowel ischemia is an exceptionally rare and life-threatening event in the pediatric population. We report the case of a 14-year-old male with a 7-year history of an infraumbilical mass who presented with an acute abdomen. Contrast-enhanced computed tomography revealed a 7.1 cm urachal phlegmon with a central necrotic core and dense adherence to the adjacent ileum. Exploratory laparotomy confirmed irreversible segmental small bowel ischemia, necessitating en-bloc excision of the urachal remnant and the affected 12 cm ileal segment with a primary anastomosis. Histopathology confirmed a benign infected cyst with associated transmural bowel necrosis. This case highlights that long-standing urachal anomalies can evolve into aggressive inflammatory masses capable of precipitating visceral compromise. It underscores the importance of a high index of suspicion for rare complications and supports the consideration of definitive surgical excision for symptomatic remnants to mitigate the risk of severe morbidity.

ABSTRACTAberrant course of the internal carotid artery (ICA) within the pharyngeal wall is an uncommon vascular anomaly that can present with symptoms mimicking structural or neoplastic lesions. Recognition of this variation is critical to avoid catastrophic complications during diagnostic or therapeutic interventions. Case Presentation: An 89‐year‐old woman presented with a one‐year history of gradually progressive, painless, and persistent dysphagia. Clinical examination was unremarkable. Flexible laryngoscopy revealed a bulge in the left lateral pharyngeal wall just above the level of the vocal cords with pooling of secretions in the vallecula and the left pyriform sinus. Contrast‐enhanced computed tomography (CECT) of the neck demonstrated an aberrant ICA causing the submucosal protrusion. Given the high risk of hemorrhage, surgical intervention was deferred. The patient was managed conservatively with counseling and ergotherapy focused on swallowing rehabilitation. This case underscores the importance of considering rare vascular anomalies, including aberrant ICA, in the differential diagnosis of dysphagia. Preoperative imaging evaluation is crucial before attempting any invasive procedure in the pharyngeal region to prevent potentially fatal vascular injury.

In recent years, significant progress has been made in the management of pediatric arrhythmias through the use of cardiac implantable electronic devices (CIEDs) such as pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs). Remote monitoring (RM) ideally enables rapid arrhythmia detection and shortens the time to clinical intervention. We herein present three pediatric cases from our institution to illustrate the clinical utility of RM in patients with complex cardiac conditions. In each case, RM facilitated timely recognition of arrhythmias, guided appropriate interventions, and contributed to improved patient outcomes. These experiences highlight the importance of daily RM as an integral component of care not only for children with CIEDs, offering both safety benefits and reduced hospitalization burden.

Severe hypertriglyceridemia (HTG) can interfere with laboratory assays. HTG-induced pancreatitis usually presents with hypocalcemia, but the effect of severe HTG, with no associated pancreatitis, on calcium levels is not well described. We present a 25-year-old male with severe HTG and diabetes who presented with generalized weakness, nausea, and vomiting. His labs revealed a severely elevated triglyceride level, as well as a critically low total calcium of 2.8 mg/dL, but only mildly reduced ionized calcium (1.10 mmol/L), with no evidence of laboratory or imaging findings of pancreatitis. Hypocalcemia signs were positive on physical examination. Treatment for HTG led to rapid normalization of total calcium levels, while intravenous calcium gluconate normalized ionized calcium and resulted in symptom resolution. This case shows that severe HTG can cause significant total pseudohypocalcemia alongside mild true ionized hypocalcemia, highlighting the importance of monitoring ionized calcium in this setting.

X-linked anhidrotic/hypohidrotic ectodermal dysplasia (XLHED), also known as Christ-Siemens-Touraine syndrome, is a rare genetic disorder characterized by the abnormal development of ectodermal structures, primarily affecting sweat glands, hair, and teeth. It results from mutations in the Ectodysplasin A (EDA) gene. Clinically, the classic triad of hypohidrosis, hypotrichosis, and hypodontia or anodontia forms the diagnostic hallmark. Herein, we report a case of a 19-year-old male who presented generalized dryness of skin, heat intolerance, and inability to sweat since early childhood. On examination, the patient appeared lean, with a striking facies characterized by frontal bossing, a depressed nasal bridge (saddle nose), prominent lips, and periorbital and peri-oral wrinkling, giving an aged appearance. Oral examination revealed oligodontia, with two conical-shaped maxillary anterior teeth. As genetic testing is not available in Nepal, the diagnosis for this patient relied upon family history, typical clinical features, and supportive ancillary investigations such as orthopantomogram to identify hypodontia, anodontia, and/or iodine starch test to demonstrate the reduced or absent sweat gland function. The management of this patient largely relied on providing symptomatic aid and improving his quality of life via functional restoration. A multidisciplinary team work formed the fundamental basis of management for this patient.

Oral epithelioid angiosarcoma arising in the oral cavity is exceptionally rare. This case reports the first instance of synchronous primary epithelioid angiosarcoma in the oral cavity and oropharynx. Accurate diagnosis requires an understanding of the importance of immunohistochemistry to differentiate this vascular tumour from similar pathologic entities.