Obstructive jaundice occurs when an obstruction in the bile duct system prevents bile from flowing from the liver into the intestine, accumulating bilirubin in the blood. This condition can result from various causes, including gallstones, tumors, or inflammation of the bile ducts. The management of obstructive jaundice depends on the underlying cause (malignant obstructions such as cholangiocarcinoma or pancreatic cancer), indicating the need for surgical intervention. The Whipple procedure (pancreaticoduodenectomy) is the standard curative approach for resectable distal common bile duct (CBD) adenocarcinoma. Doctors usually recommend adjuvant chemotherapy to reduce the risk of recurrence. We report the case of a 70-year-old male with a history of untreated hypertension, type 2 diabetes, and long-term smoking, who presented with classic signs of obstructive jaundice, including yellowing of the eyes, itching, right upper quadrant pain, and intermittent fevers. Laboratory findings revealed elevated inflammatory markers, bilirubin, liver enzymes, and leukocyte count, indicative of an inflammatory and obstructive biliary condition. Imaging studies confirmed a distal CBD stricture, including abdominal ultrasound, computed tomography scans, and endoscopic retrograde cholangiopancreatography (ERCP). Brush cytology obtained during ERCP revealed a well-differentiated adenocarcinoma of the distal CBD. The patient\'s treatment plan included preoperative optimization, surgical resection via the Whipple procedure, and postoperative adjuvant therapy. This case emphasizes the importance of a thorough diagnostic workup and a multidisciplinary treatment strategy in managing complex cases of obstructive jaundice in the elderly, highlighting the need for personalized care to achieve optimal outcomes.

The parathyroid gland is responsible for the synthesis and secretion of parathyroid hormone, which is synthesized and released at an inverse relationship to the level of ionized calcium in the blood. Primary hyperparathyroidism affects women more than men. There are various causes for hyperparathyroidism-induced hypercalcemia and the most common cause is parathyroid adenoma. A less common cause of vitamin D-mediated parathyroid hormone-independent hypercalcemia is the loss of function mutation of the CYP24A1 gene. The CYP24A1 gene encodes the vitamin D 24-hydroxylase enzyme, responsible for hydroxylating the active form of vitamin D into an inactive form, and mutations in the CY24A1 gene can lead to elevated active vitamin D metabolite levels. It can result in hypercalcemia and hypercalciuria-related complications. We present a case of a 72-year-old male patient referred to the endocrine clinic, who had repeated treatments for hypercalcemia and recurrent renal calculi. He underwent ultrasound, computerized tomography, and sestamibi scans, all reported as normal. Following this, the patient underwent a positron emission tomography (PET) scan, which was also normal. He then finally underwent genetic testing and tested positive for the CYP24A1 gene. He was started on fluconazole 50mg once a day and cinacalcet 30mg twice with normalization of calcium level. Three of his family members also tested positive for the condition.

Sinus histiocytosis with massive lymphadenopathy (SHML), an alternative term for Rosai-Dorfman disease (RDD), is a rare benign idiopathic immune-related lymphoproliferative condition. The central nervous system (CNS) has been documented to be involved in RDD, although lymph nodes are the organs that are most frequently and primarily associated with the disease manifestation. Nonetheless, CNS involvement in RDD is rare and poorly understood. As a result, there is a lack of a solid basis for therapeutic approaches for CNS involvement in RDD. Here, we present a case of RDD with cerebral involvement, a rare presentation of RDD with atypical symptoms. A brief assessment of the radiographic appearance, histological findings, and the peculiar manifestations of the disease is provided.

Squamous cell carcinoma (SCC) of salivary glands, also referred to as epidermoid carcinoma, is a very rare neoplastic tumor. It occurs as metastasis of a cutaneous or mucosal squamous carcinoma of the head and neck or as a primary SCC. In the latter case, the most known risk factor is previous irradiation to the gland. Common clinical symptoms are represented by cervical swelling and hyposialia. The treatment is essentially surgical, most often supplemented by a radical neck dissection and postoperative radiation therapy. A 75-year-old male patient with a history of chronic smoking was consulted for a tumefaction in the right submandibular region evolving for three months. No cervical lymphadenopathy in the submandibular and superior jugulo-carotid areas was palpable. CT scan showed an enhancing heterogeneous process of the right cervical region, invading the mylohyoid and stylohyoid muscles. A biopsy-excision of the lesion has shown a keratinizing tumor with cytonuclear atypia, consistent with SCC. Radical resection of the mass was associated with the removal of the infiltrated skin. The cutaneous defect was repaired with a rhomboid flap. The patient was started on sessions of adjuvant radiotherapy and chemotherapy. Eight months postoperatively, the patient came for follow-up, with no signs of local disease. The EGFR protein is found in ~70% of salivary neoplasms and is considered as a factor of poor prognosis and rapid proliferation. PET CT is currently the best examination to detect the existence of a concomitant malignant lesion. Diagnosis of primary SCC (PSCC) of the submandibular gland is made on histopathology. Differential diagnoses include mucoepidermoid carcinoma, lymphoepithelial carcinoma and submandibular metaplasia. There is an increased prevalence of nodal involvement in the PSCC, which justifies neck dissection (regions I, II and III of the neck). The RAS mutation leading to resistance to anti-EGFR therapies may be assessed. This would allow for a treatment depending on molecular features for metastatic PSCCs. PSCC of major salivary glands is a very rare lesion with local and general aggressiveness. The diagnosis is based on a combination of clinical examination, MRI, fine needle aspiration and histological examination. Immunotherapy constitutes a ground of research to treat metastatic and advanced pathological cases.

Sinonasal malignant melanoma is a rare but aggressive tumor of the head and neck area. It has a poor prognosis. Common symptoms are nasal obstruction, epistaxis, or purulent rhinorrhea. Diagnosis relies on histopathology with immunohistochemistry (IHC) studies. Surgery is the essential treatment, most often supplemented by radiotherapy or immunotherapy. A 63-year-old female patient, with a history of right dacryocystorhinostomy and Parkinson\'s disease, consulted for symptoms of right nasal obstruction with increasing intensity accompanied by two episodes of mild unilateral epistaxis. Rigid optic examination showed a white-pinkish right obstructive supra-centimetric endonasal tumor. CT revealed an extensive tissue process of the right nasal cavity invading the maxillary sinus, the inferior and middle conchas. A biopsy of the lesion was conducted under local anesthesia. The immunohistochemical study has shown undifferentiated tumor with positive antibody anti PS100 and anti-melan A evoking malignant sinonasal melanoma. The patient underwent two surgeries for maxillectomies as she presented a first local recurrence. She was started on adjuvant radiotherapy. At one year of follow-up, she does not present any local or general signs of disease. Sinonasal melanoma is a particular entity of head and neck mucosal melanomas. The highest incidence is described to be in the seventh and eighth decades of life with no sex difference. IHC profiling of different melanoma subtypes showed the importance of alterations in the KIT gene, this genetic data may constitute a therapeutic target. After surgery, the important local recurrence rates and regional failure justify adjuvant radiotherapy also for resections in free margins. Most authors consider that prophylactic neck dissection is not necessary. Preoperative imaging features (CT scan) are characteristic and helpful for diagnosis. IHC is essential, has a high sensitivity for differentiating achromic melanomas from other neoplasms. Sinonasal achromic melanoma is a very uncommon tumor, invasive, and frequently associated with distant metastasis. Paraclinic examinations are essential for staging and guiding therapeutic management. Immunotherapy is a promising ground of research as it comes to metastatic and advanced disease.

We report the case of a 71-year-old man affected by testicular large B-cell lymphoma (DLBCL), treated with right orchiectomy and first-line chemotherapy (R-CHOP, 8 cycles). A complete remission was obtained after therapy. Twenty-two months after the primary diagnosis the patient suddenly presented dyspnoea and superior vena cava syndrome; thus, he underwent a CT scan that revealed a large mass in the right atrium, expanding to the superior vena cava. A differential diagnosis between a neoplastic mass and a clot was proposed. The subsequent MR did not clarify the nature of the mass; therefore, the patient underwent an 18F-FDG PET/CT scan (PET/CT), after a specific preparation to reduce fluoro-deoxyglucose (FDG) myocardial uptake. PET/CT revealed an intense FDG uptake involving the whole mass (SUVmax 9.4), suggestive for neoplasm and confirmed by the subsequent endocardiac biopsy. The patient was treated with 8 cycles of R-COMP, obtaining a complete remission, as indicated by the PET/CT performed after the seventh cycle of therapy. The case that we are reporting highlights that DLBCL can have an uncommon relapse presentation in the atrium. PET/CT, compared to conventional imaging, can be a valuable tool to detect early and better characterize cardiac lesions in order to improve the poor prognosis of these conditions.

Plexiform Angiomyxoid Myofibroblastic Tumor (PAMT) is a recently identified mesenchymal tumor of the stomach, which was first described in the year 2007 and was added in the 2010 WHO classification of tumors of the digestive system World J Gastroenterol 16(6): 2835-2840, 2010. It closely resembles with other gastric tumors but distinctly varies in clinical management as well as the histopathology. We had a 51 year, female patient, laborer by profession with low socio economic status, who had abdominal pain with vomiting since 6 months. She had similar complaints 3 years ago for which she was evaluated and presumed to have Carcinoma Stomach and underwent laparotomy which ended up only with Gastro- Jejunal anastomosis. She was admitted at our institution. Endoscopy revealed antral bulge with central area ulceration and biopsy was taken which was not confirmatory for malignancy. CT images showed heterogeneous mass with necrotic changes arising from the duodenum favored the diagnosis of perigastric neoplasm. PET CT was done, 8.4 × 5 × 6.1 cm exophytic mass in the pyloric region of stomach with solid and cystic components causing significant gastric outlet obstruction. She underwent exploratory laparotomy and complete excision of mass with achievement of R0 clearance. Histopathology was reported as Plexiform angiomyxoid myofibroblastic tumor (PAMT).