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Rhinosporidiosis is an endemic condition in India that is difficult to treat when it is disseminated. This condition commonly affects the nasal cavity and nasopharynx mucosa, accounting for 75% of the clinical cases. Although rare, rhinosporidiosis can present with only cutaneous involvement without mucosal disease. Symptoms of this condition include complaints of nasal obstruction and episodic nasal bleeding. Diagnosis is achieved through histopathological examination of tissue and demonstration of the sporangium. Rhinosporidiosis tends to recur as it spreads through autoinoculation. Therefore, during endonasal endoscopic excision of the mass, it is essential not to injure the surrounding mucosa. A trial of medical therapy with dapsone is advised, but it is mostly ineffective in cases of disseminated disease. Here, we present a case report of a patient who underwent seven surgeries for the same condition over 12 years but was unable to get rid of the recurrent menace.

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Background and Objectives: Several authors have reported cervical and axillary lymphadenopathies as known side effects following anti-COVID-19 vaccine administration. Few data are available about atypical locations of post-anti-COVID-19 vaccine lymphadenopathy. In this investigation, we evaluated the incidence and prevalence of postvaccine lymphadenopathy ultrasound (US) features in atypical sites. Materials and Methods: In this retrospective study, we retrospectively selected 64 patients on whom US was performed between January and October 2021 due to COVID-19 vaccine-related lymphadenopathy. We investigated lymph node anatomical sites, presence, number, size, shape, cortical profile, hilum outline, superb microvascular imaging (SMI), and elastosonography. Results: A total of 170 nodes were assessed. Atypical location was demonstrated in 5/64 patients (7.8%). In all these cases, atypical nodal involvement was associated with lymphadenopathy in a typical site (axillary, supraclavicular) ipsilateral to the vaccine injection site. Two patients presented lymphadenopathy in the infraclavicular station (3.1%), one in the pectoralis major muscle (1.6%), one in the left arm (1.6%), and one in the nuchal site (1.6%). All lymphadenopathies were oval-shaped, with a median size of 0.9 ± 0.2 cm. US features included a symmetric cortex with hilum evidence (4/6, 60%), vascular signal at SMI in both the hilar region and periphery of lymph node (5/6, 83.3%), and a US elastography pattern resembling that of adjacent tissues (5/6, 83.3%). The median age of patients with lymphadenopathies in an atypical location was 23 years. The main type of vaccine associated with lymph node appearance in atypical sites was Moderna's mRNA-1273 (60% of patients, 4/6 lymph nodes accounting for 66.7% among atypical locations). Conclusion: Post-COVID-19 vaccine administration lymphadenopathies in an atypical location represent an intense immune response to antigenic stimuli and they may show alarming US traits superimposed on malignant pathologies, which may complicate the patient's clinical and diagnostic pathway. Despite no distinctive US features between reactive post-COVID-19 vaccination and malignant lymph nodes being available, careful examination of atypical lymph node locations associated with accurate knowledge of patients' clinical background and delay of US exam to four to six weeks after vaccine injection should be considered.

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RATIONALE AND OBJECTIVES: Although computed tomography (CT) guided radiofrequency ablation (RFA) is accepted as the gold standard treatment for osteoid osteoma (OO) in extremities, most researchers have omitted OO in critical sites. We aimed to evaluate the efficacy and safety of CT-guided RFA in the management of OO in atypical sites. MATERIALS AND METHODS: A prospective interventional study conducted on 34 patients (12 women and 22 men; mean age, 22.3 ± 3.5 years; range, 12-48 years) with OO in atypical sites. All patients were treated with CT-guided RFA. All procedures were performed under general anesthesia using a single straight, rigid RF electrode for 6 minutes at 90°C. All patients were followed up; technical and clinical successes of treatment were evaluated. The severity of pain was assessed on a visual analogue scale (VAS). RESULTS: CT-guided RFA was performed in all patients with 100% technical success and 100% primary clinical success. All patients had complete pain relief and returned to their quality of life without further analgesics within 1 month after the procedure. All procedures were successfully completed without any major complications. The mean preprocedure VAS score dropped to zero by the end of the first week with a highly statistically significant difference (p < 0.001). CONCLUSION: CT-guided RFA is a safe and effective procedure in the management of OO in atypical sites with 100% primary success rate, 0% long-term recurrence rate, and very low complication rate.

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Objetivo: La metástasis gástrica del carcinoma de células renales es excepcional. Nosotros realizamos a una revisión de la literatura y presentamos un caso clínico. Métodos/Resultados: Varón de 62 años de edad, que se presenta con un tumor renal y metástasis gástrica detectados en una tomografía computada. Se realiza una nefrectomía radical más gastrectomía parcial. El paciente desarrolla metástasis progresivas y fallece siete meses más tarde. La revisión de la literatura revela que las metástasis gástricas producto de un carcinoma de células renales son excepcionales. Los casos reportados son principalmente detectados durante el seguimiento posterior a una nefrectomía, y generalmente asociados a una diseminación tumoral a otros órganos. El sangrado gastrointestinal como forma de presentación inicial del cáncer es muy infrecuente. El tratamiento consiste usualmente en manejo endoscópico del sangrado dado lo avanzado de la enfermedad. Conclusiones: Las metástasis gástricas en los pacientes con carcinoma de células renales son un evento tardío en el curso de la enfermedad, y el pronóstico es generalmente pobre.

Objective: Gastric metastases from renal cell carcinoma are exceptional. We reviewed the literature on this subject and present a case report. Method and Results: A 62 year old male patient presented with a renal tumor and a gastric metastasis detected on computed tomography. A radical nephrectomy and partial gastrectomy was performed. The patient developed progressive metastatic disease and died seven months later. Review of the literature shows that gastric metastases from renal cell carcinoma are exceptional. Cases reported are mainly detected during follow up after nephrectomy, generally associated with tumor spread to other organs. A gastrointestinal bleeding as a presenting sign of the cancer is very uncommon. Treatment usually consists in local endoscopic therapy to control the bleeding, due to advanced disease. Conclusions: Gastric metastases in patients with renal carcinoma are a late event in the course of the disease, and the outcome is generally poor.

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