Resection of Intracranial Giant Cavernous Malformation: Case Report and Literature Review

Cerebral cavernous malformations are a rare and congenital vascular malformation that can present as a challenge in neurosurgical management. The term “giant cerebral cavernous malformations” still does not have a clear definition in the literature, with a wide variety of results. It is known, however, that there is an association between the size of the cavernoma and postoperative sequelae, especially in those with a size greater than 3 cm in its largest diameter. We present a case report of resection of a giant brain cavernoma measuring approximately 8 cm in its largest diameter, emphasizing on clinical presentation, diagnoses and postoperative evolution. Additionally, we performed a comprehensive review of the existing literature on the subject, addressing the epidemiology, pathophysiology, diagnostic methods, treatment options, and prognosis associated with this condition.

Pathological diagnosis and immunohistochemical analysis of giant retrosternal goiter in the elderly: A case report

BACKGROUND Elderly giant retrosternal thyroid goiter is a rare yet significant medical condition,often presenting clinical symptoms that can be confused with other diseases,posing diagnostic and therapeutic challenges.This study aims to delve into the characteristics and potential mechanisms of this ailment through pathological diagnosis and immunohistochemical analysis,providing clinicians with more precise diagnostic and treatment strategies.A 77-year-old male,was admitted to hospital with the chief complaint of finding a goiter in the semilunar month during physical examination,accompanied by dyspnea.Locally protruding into the superior mediastinum,the adjacent structure was compressed,the trachea was compressed to the right,and the local lumen was slightly narrowed.The patient was diagnosed with giant retrosternal goiter.Considering dyspnea caused by trachea compression,our department planned to perform giant retrosternal thyroidectomy.Immunohistochemical results:Tg(+),TTF-1(+),Calcitonin(CT)(I),Ki-67(+,about 20%),CD34(-).Retrosternal goiter means that more than 50%of the volume of the thyroid gland is below the upper margin of the sternum.As retrosternal goiter disease is a relatively rare disease,once the disease is diagnosed,it should be timely surgical treatment,and the treatment is more difficult,the need for professional medical team for comprehensive treatment.CONCLUSION The imaging manifestations of giant retrosternal goiter are atypical,histomorphology and immunohistochemistry can assist in its diagnosis.This article reviews the relevant literature of giant retrosternal goiter immunohisto-chemistry and shows that giant retrosternal goiter is positive for Tg,TTF-1,and Ki-67.

Giant Cerebriform Nevus Cell Nevus of the Scalp: A Case Report

Giant cerebriform nevus cell nevus of the scalp is an extremely rare form of congenital melanocytic nevus. Giant cerebriform nevus of the scalp has a major psychosocial impact because of its unsightly appearance with fetid maceration. We report the case of a 35-year-old woman who had a painless, malodorous swelling of the cerebriform scalp measuring 20 × 17 cm in diameter with a wide base of insertion at the occipital level adhering to the deep planes. The excision associated with a skin plasty was carried out. Histology concluded that there was a giant cerebriform naevo-cellular nevus of the scalp.

The Extinction of the Giant Ape–A Long-standing Mystery Solved

Giants once roamed the karst plains of southern China,three-metre tall apes weighing in at 250 kilograms.These very distant human ancestors–Gigantopithcus blacki–went extinct before humans arrived in the region,with few clues to why,and so far leaving around 2,000 fossilised teeth and four jawbones as the only signs of their existence.

Precocious Puberty in a 5-Year-Old Girl with a Giant Hypothalamic Hamartoma Discovered Perinatally: Case Report

Background: Hypothalamic hamartoma is a rare non-neoplastic lesion, typically identified in early childhood during investigations for precocious puberty and/or gelastic seizures. However, cases of diagnosis even earlier or during fetal development have been documented. Case Presentation: A newborn girl was diagnosed with hydrocephalus during pregnancy. An MRI revealed a large oval hypothalamic process, which suggested a hypothalamic hamartoma. At the age of 2, she experienced alternating crying and laughing seizures, followed by a decrease in visual acuity. Due to involvement of the optic pathways, surgery was not performed and she underwent antiepileptic medicines and gamma knife radiotherapy. At the age of 5 years and 3 months, she presented with breast development and laboratory tests confirmed central precocious puberty. Quarterly injections of GnRH agonists have since been administered with favorable results. Conclusion: Early-diagnosed hypothalamic hamartomas require close monitoring, by an experienced multidisciplinary, to promptly detect and treat potential complications, especially precocious puberty, and prevent any undesirable impact on final height.

Stable seasonal migration patterns in giant pandas

A critical function of animal movement is to maximize access to essential resources in temporally fluctuating and spatially heterogeneous environments.Seasonally mediated resource fluctuations may influence animal movements,enabling them to track changing resource distributions,resulting in annual migration patterns.The conservation-dependent giant panda(Ailuropoda melanoleuca) displays seasonal movement patterns;however,the key factor driving these seasonal migration patterns remains poorly understood.Here,we used GPS tracking collars to monitor the movements of six giant pandas over a 12-year period across different elevations,and performed statistical analysis of seasonal migration directions,routes,habitat revisitation,home range overlap,first arrival events,and stability.Our results revealed a compelling pattern of seasonal migrations that facilitated the ability of the pandas to forage at the appropriate time and place to maximize nutritional intake.Our results indicated that pandas utilize spatial memory to locate reliable food resources,as evidenced by their annual return to the same or similar winter and summer home ranges and the consistently maintained percentage of home range overlap.These novel insights into giant panda foraging and movement ecology not only enhance our understanding of its ability to adapt to nutritionally poor dietary resources but also provide important information for the development of resource utilization-based protection and management strategies.

Identifying priority protection areas of key food resources of the giant panda

Animals that live in seasonal environments adjust their reproduction cycle to optimize seasonal forage quality.Giant pandas(Ailuropoda melanoleuca)are seasonal altitudinal migrants that feed on bamboo shoots and leaves with different nutritional quality.However,the importance of bamboo shoots to giant pandas,especially small and isolated populations,is not fully appreciated.Here,we explored whether mating time of giant pandas is shaped by bamboo shoot phenology.We also assessed the intensity of ongoing bamboo shoot harvesting by local communities in 42 giant panda reserves based on questionnaire surveys.Varying intensity and protection levels of bamboo shoot harvesting were found.From these data,we developed a priority ranking scheme of protection areas for this key food resource.Our study showed that pandas time their mating behavior to coincide with bamboo shoot phenology due to the high nutritional demands associated with mating and pregnancy.We also found that bamboo shoots were not well protected in many places.Liangshan,Daxiangling,and Xiaoxiangling,containing the most isolated panda populations,were identified as the areas with the most urgent need of protection.Furthermore,equal attention should be paid to the Qiong L-B population,as this region holds considerable potential to serve as a corridor between the Minshan and Qionglai populations.To address the challenges posed by bamboo shoot harvesting,we recommend establishing more practical bamboo shoot management policies,increasing public awareness of bamboo shoot protection,and providing alternative sources of income for local communities.

Sedimentary characteristics and genetic mechanism of the giant ancient pockmarks in the Qiongdongnan Basin,northern South China Sea

In the late Miocene,giant ancient pockmarks,which are fairly rare globally,developed in the Qiongdongnan Basin.In this paper,to determine the sedimentary characteristics and genetic mechanism of these giant ancient pockmarks in the Yinggehai Formation of the Qiongdongnan Basin,based on high-resolution 3D seismic data and multiattribute fusion technologies,we analyzed the planar distribution and seismic facies of the ancient pockmarks and compared the characteristics of the ancient pockmarks with those of channels,craters,and hydrate pits.Moreover,we also discussed the implications of the fluid escape system and paleo-bottom current activity in the ancient pockmark development area and analyzed the influence of the ancient pockmarks on the paleoclimate in this region.Finally,an evolutionary model was proposed for the giant ancient pockmarks.This model shows that the giant ancient pockmarks in the southern Qiongdongnan Basin were affected by both deep fluid escape and lateral transformation of paleobottom currents.In addition,the giant ancient pockmarks contributed to the atmospheric CO_(2)concentration in the late Miocene and played a great role in the contemporary evaluation of deepwater petroleum exploration.

Giant juvenile fibroadenoma in a 14-year old Chinese female:A case report

BACKGROUND A giant juvenile fibroadenoma(GJF)is a rare,benign breast tumor that affects females<18 years of age.GJFs are generally suspected based on a palpable mass.GJFs influence breast shape and mammary gland development via the pressure effect from their enormous size.CASE SUMMARY Herein we report a case involving a 14-year-old Chinese female with a GJF in the left breast.GJF is a rare,benign breast tumor that usually occurs between 9 and 18 years of age and accounts for 0.5%-4.0%of all fibroadenomas.In severe cases,breast deformation may occur.This disease is rarely reported in Chinese people and has a high clinical misdiagnosis rate due to the absence of specific imaging features.On July 25,2022,a patient with a GJF was admitted to the First Affiliated Hospital of Dali University.The preoperative clinical examination and conventional ultrasound diagnosis needed further clarification.The mass was shown to be an atypical lobulated mass during the operation and confirmed to be a GJF based on pathologic examination.CONCLUSION GJF is also a rare,benign breast tumor in Chinese women.Evaluation of such masses consists of a physical examination,radiography,ultrasonography,computer tomography,and magnetic resonance imaging.GJFs are confirmed by histopathologic examination.Mastectomy is not selected when the patient benefits from a complete resection of the mass with breast reconstruction and an uneventful recovery.

Giant cyst in heterotopic pregnancy:A case report

BACKGROUND The coexistence of a heterotopic pregnancy with a giant ovarian cyst is an incredibly rare abnormal pregnancy in cases of natural conception.The incidence of this condition has increased significantly as a result of the continuous development of assisted reproductive technologies.When this type of pregnancy occurs,both the continuation of intrauterine pregnancy and the life of the pregnant woman are severely threatened.Early diagnosis and treatment using safe and effective methods are paramount in this situation.CASE SUMMARY A 30-year-old primigravida at a gestation age determined as 8 wk 4 d by scan was admitted to the hospital with heterotopic pregnancy and a right ovarian cyst.Laparoscopic resection of the ectopic pregnancy was performed,but the intrauterine pregnancy and ovarian cyst were preserved.CONCLUSION The approach to a patient with heterotopic pregnancy and a giant ovarian cyst is individualized base on the fertility requirements.We recommend the following:(1)If the patient satisfies parity and has no fertility requirement,a laparoscopic salpingectomy should be performed and the giant ovarian cyst and intrauterine pregnancy removed;(2)If the patient has fertility requirements wishes to have more children in the future,laparoscopic salpingectomy or salpingostomy should be performed and the intrauterine pregnancy preserved.Serial ovarian cyst aspiration can be performed under ultrasound and resection can be done after delivery;and(3)Heterotopic pregnancy should be diagnosed early by active surveillance during antenatal visits using ultra sound as this is important for the avoidance of catastrophic complications.

Giant myxofibrosarcoma of the esophagus treated by endoscopic submucosal dissection:A case report

BACKGROUND Myxofibrosarcoma(MFS)is a fibroblast-derived sarcoma that mainly occurs in subcutaneous tissue.MFS rarely occurs in the gastrointestinal tract,especially in the esophagus.CASE SUMMARY A 79-year-old male patient was admitted to our hospital for dysphagia for a week.Computed tomography and electronic gastroscopy showed that a giant mass was located 30 cm from the incisor and extended to the cardia.There was incomplete esophageal stenosis.Endoscopic pathology showed spindle cell lesions,which were considered inflammatory myofibroblast like hyperplasia.Considering the strong demands of the patient and his family,and the fact that most inflammatory myofibroblast tumors are benign,we decided to perform endoscopic submucosal dissection(ESD)even if the tumor size was giant(9.0 cm×3.0 cm).Postoperative pathological examination resulted in a final diagnosis of MFS.MFS rarely occurs in the gastrointestinal tract,especially in the esophagus.Surgical resection and local adjuvant radiotherapy are the first choices to improve the prognosis.This case report firstly described the ESD for esophageal giant MFS.It suggests that ESD may be an alternative treatment for primary esophageal MFS.CONCLUSION This case report for the first time describe the successful treatment of a giant esophageal MFS by ESD,suggesting that ESD may be an alternative treatment for primary esophageal MFS,especially in elderly high-risk patients with obvious dysphagia symptoms.

Invasive breast carcinoma with osteoclast-like stromal giant cells:A case report

BACKGROUND Invasive breast carcinoma with osteoclast-like stromal giant cells(OGCs) is an extremely rare morphology of breast carcinomas.To the best of our knowledge,the most recent case report describing this rare pathology was published six years ago.The mechanism controlling the development of this unique histological formation is still unknown.Further,the prognosis of patients with OGC involvement is also controversial.CASE SUMMARY We report the case of a 48-year-old woman,who presented to the outpatient department with a palpable,growing,painless mass in her left breast for about one year.Sonography and mammography revealed a 26.5 mm ×18.8 mm asymmetric,lobular mass with circumscribed margin and the Breast Imaging Reporting and Data System was category 4C.Sono-guided aspiration biopsy revealed invasive ductal carcinoma.The patient underwent breast conserving surgery and was diagnosed with invasive breast carcinoma with OGCs,grade Ⅱ,with intermediate grade of ductal carcinoma in situ(ER:80%,3+,PR:80%,3+,HER-2:negative,Ki 67:30%).Adjuvant chemotherapy and post-operation radiotherapy were initiated thereafter.CONCLUSION As a rare morphology of breast cancer,breast carcinoma with OGC occurs most often in relatively young women,has less lymph node involvement,and its occurrence is not racedependent.

Management of a rare giant cell tumor of the distal fibula: A case report

BACKGROUND Aggressive giant cell tumor of the distal fibula is so rare that no consensus on a surgical strategy has been reached.Thus,an appropriate treatment strategy is still important to discuss.CASE SUMMARY A 61-year-old man who had been experiencing progressive swelling of the left lateral malleolus accompanied by pain for half a year was presented at our hospital.He had never been treated prior to coming to our hospital.Preoperative imaging revealed a 10 cm×6 cm mass located in the body of the distal fibula.Pathological biopsies confirmed it was a giant cell tumor.Preoperative examination revealed he had dilated cardiomyopathy with class 3 cardiac function.The cardiologist and anesthesiologist determined that he could tolerate the operation,but the operation should be as short and minimally invasive as possible.With the patient’s consent,we performed a tibiotalar fusion and followed up with him for 2years,finding no recurrence and a satisfactory recovery.CONCLUSION Tibial talus fusion is an effective method for the treatment of distal fibula tumors.

Does size matter for resection of giant versus non-giant hepatocellular carcinoma?A meta-analysis

BACKGROUND Research on long-term survival after resection of giant(≥10 cm)and non-giant hepatocellular carcinoma(HCC)(<10 cm)has produced conflicting results.AIM This study aimed to investigate whether oncological outcomes and safety profiles of resection differ between giant and non-giant HCC.METHODS PubMed,MEDLINE,EMBASE,and Cochrane databases were searched.Studies designed to investigate the outcomes of giant vs non-giant HCC were included.The primary endpoints were overall survival(OS)and disease-free survival(DFS).The secondary endpoints were postoperative complications and mortality rates.All studies were assessed for bias using the Newcastle–Ottawa Scale.RESULTS 24 retrospective cohort studies involving 23747 patients(giant=3326;non-giant=20421)who underwent HCC resection were included.OS was reported in 24 studies,DFS in 17 studies,30-d mortality rate in 18 studies,postoperative complications in 15 studies,and post-hepatectomy liver failure(PHLF)in six studies.The HR was significantly lower for non-giant HCC in both OS(HR 0.53,95%CI:0.50-0.55,P<0.001)and DFS(HR 0.62,95%CI:0.58-0.84,P<0.001).No significant difference was found for 30-d mortality rate(OR 0.73,95%CI:0.50-1.08,P=0.116),postoperative complications(OR 0.81,95%CI:0.62-1.06,P=0.140),and PHLF(OR 0.81,95%CI:0.62-1.06,P=0.140).CONCLUSION Resection of giant HCC is associated with poorer long-term outcomes.The safety profile of resection was similar in both groups;however,this may have been confounded by reporting bias.HCC staging systems should account for the size differences.

Unusual presentation of penile giant condyloma acuminatum with spontaneous prepuce perforation: A case report

BACKGROUND Giant condyloma acuminatum(GCA)is an uncommon condition affecting the anogenital area.CASE SUMMARY Here,we report an 88-year-old male patient who presented with a 5-year history of a progressive appearance of multiple cauliflower-like warts over his penile shaft,pubis region,and groin as well as urine leakage along the distal penile shaft.Physical examination revealed an ulcerative skin perforation with pus discharge under the distal prepuce base,which was initially suspected to be a urethral fistula.However,during surgery,it was discovered that the perforation was caused by a giant condyloma lesion that had obliterated the prepuce opening,with infection and high pressure causing subsequent skin perforation.He underwent circumcision and wide excision with electrocauterization of the warts.He was discharged after the surgery,and the residual lesion was treated with imiquimod and low-dose oral tegafur-uracil.CONCLUSION Penile GCA can cause prepuce perforation and can be postoperatively treated with imiquimod and low-dose oral tegafur-uracil.

Giant complex hepatic cyst causing pseudocystitis:A case report

BACKGROUND Hepatic cysts are common benign liver tumors that are typically asymptomatic.However,larger cysts,particularly giant liver cysts,can potentially induce symptoms.If the diameter of the cyst exceeds 10 cm,it can exert pressure on adjacent organs,leading to manifestations of corresponding symptoms.Here,we report the case of a complex giant hepatic cyst that caused pseudocystitis.CASE SUMMARY A 16-year-old girl was admitted to our hospital with frequent and urgent urination.Ultrasonography revealed no obvious uterine adnexal abnormalities but showed a hypoechoic,cystic mass(173 mm×84 mm×138 mm)with clear boundaries,and an unclear blood flow signal in the abdominal cavity(extending from the lower edge of the left lobe of liver to the upper edge of the bladder).Abdominal contrast-enhanced computed tomography revealed a giant cystic mass in the abdominal and pelvic cavities,possibly originating from the liver,and a small amount of free fluid in the pelvic cavity,which subsequent magnetic resonance imaging confirmed.The imaging characteristics were consistent with a benign lesion.The patient underwent laparoscopic resection of the giant liver cyst with partial liver resection.Post-surgery her symptoms urinary symptoms were relieved completely and she was discharged on the sixth postoperative day.CONCLUSION Our patient presented with symptoms suggestive of pseudocystitis,stressing the need for considering possibilities of other etiologies and differential diagnoses.

Multinucleated giant cells of bladder mucosa are modified telocytes:Diagnostic and immunohistochemistry algorithm and relation to PDL1 expression score

BACKGROUND Multinucleated giant cells(MGCs)in bladder carcinomas are poorly studied.AIM To describe the function,morphogenesis,and origin of mononuclear and MGCs in urothelial carcinoma(UC)of the bladder in Bulgarian and French patients.METHODS Urothelial bladder carcinomas(n=104)from 2016-2020 were analyzed retrospectively using immunohistochemical(IHC)and histochemical stain examination.Giant cells in the bladder stroma were found in 35.6%of cases,more often in highgrades.RESULTS We confirm that MGCs in the mucosa in UC of the bladder were positive for both mesenchymal and myofibroblast markers(vimentin,smooth muscle actin,Desmin,and CD34)and the macrophage marker CD68.Furthermore,IHC studies revealed the following profile of these cells:Positive for p16;negative for epithelial(CK AE1/AE3 and GATA-3),vascular(CD31),neural(PS100 and CKIT),cambial,blastic(CD34-blasts and C-KIT),and immune markers(IG G,immunoglobulin G4,and PD-L1);no proliferative activity,possess no specific immune function,and cannot be used to calculate the Combined Positive Score scale.CONCLUSION In conclusion,the giant stromal cells in non-tumor and tumor bladder can be used as a characteristic and relatively constant,although nonspecific,histological marker for chronic bladder damage,reflecting the chronic irritation or inflammation.Likewise,according to the morphological and IHC of the mono-and multinucleated giant cells in the bladder,they are most likely represent telocytes capable of adapting their morphology to the pathology of the organ.

Dual transformation therapy for giant hepatocellular carcinoma: Two case reports and review of literature

BACKGROUND In the translational therapy of giant hepatocellular carcinoma(HCC),hepatic arterial infusion chemotherapy(HAIC)combined with anti-PD-1 immunotherapy and tyrosine kinase inhibitors(TKI)after laparoscopic portal vein ligation(PVL)is extremely rare.This is a dual conversion therapy that combines surgery and oncology.Here,we report two cases of successful surgical completion after dual conversion therapy.CASE SUMMARY We report that a 54-year-old man and a 69-year-old woman were diagnosed with primary HCC combined with hepatitis B cirrhosis(case 2 also combined with fatty liver)on physical examination.Due to the insufficient residual liver volume assessed before surgery,laparoscopic right PVL was performed,followed by HAIC combined with anti-PD-1 immunotherapy and TKI.Finally,surgical resection was successfully completed,and pathology confirmed that the tumor was mostly necrotic(90%)in one case,and no live tumor tissue was found in the other case.CONCLUSION In the process of surgical transformation,our treatment plan takes into account the control and transformation of oncology at the same time,which is expected to provide more opportunities for radical hepatectomy and improve the prognosis of patients with large liver cancer.

Protection and Utilization of Chinese Giant Salamander Germplasm Resources

Chinese giant salamander(Andrias davidianus)is salamander germplasm resource that only distributed in China.It is the material basis of the evolution principle research,genetic research and artificial breeding.Since the 1990s,overharvesting,water pollution and habitat changes have seriously destroyed the germplasm resources of A.davidianus,their population density has decreased since then.Strengthening the protection and rational utilization of A.davidianus germplasm resources are key factors in impacting the healthy,stable and sustainable development of A.davidianus industry.Under the above background,we discussed the current problems with the protection for A.davidianus germplasm resources,put forward suggestions for the conservation of A.davidianus germplasm resources.It is expected to provide a reference to effective protection for A.davidianus germplasm resources,and provide a scientific foundation for further studies,so as to promote the high-quality development of related industry.

An Inahbitual Etiology of Acute Intestinal Obstruction: The Giant Fecalome

The authors report an observation of a 20-year-old patient, who was referred by the medical emergency department for abdominal distention. The disease would have started with the appearance of abdominal pain, a stop of materials without stopping gases appeared gradually and evolving for 4 months. The patient was chronically constipated. She administered daily enemas with homemade products to have a bowel movement. She never had rectal bleeding, there was no alteration diarrhea—constipation. Mother of 3 children alive and apparently healthy. On clinical examination the abdomen was enlarged in size, painless but of firm consistency. The hernial orifices were free. Hard and abundant stools were noted on digital rectal examination. The abdominal CT scan revealed a large endorectal fecal impaction going up into the left colon, an absence of abdominal mass. We retained the diagnosis of giant fecal impaction. The patient was hospitalized and we instituted paraffin oil therapy combined with an evacuator enema with glycerin. The evolution was marked by a resumption of transit in the form of stool and gas (3 to 4 stools per day). At Day 8 of hospitalization the abdomen had decreased in volume the transit was regular and the patient was discharged on Day 10. Reviewed 3 months later, she maintained a regular transit made of one bowel movement a day. After a setback of 3 years the transit is still preserved. The authors discuss the etiologies of fecal impaction and their respective treatments.