Currently, there are two classic approaches to correcting and setting fractured facial bones globally, which are "Correction sequence from bottom to top-from inside to outside" and "Correction sequence from top to bottom-from outside to inside." No method achieves optimal results in all cases. Depending on each case, the surgeon applies the appropriate sequence of bone correction. Therefore, the application becomes mechanical when relying on one of the two treatment strategies. When patients are treated according to the third principle of correction based on the "firm segment," it becomes more flexible and effective. The "firm segment" here refers to the most stable area on the face, allowing the correction of fractures near cthe "firm segment" first, followed by those farther away. Patients with pan-facial fractures, classified according to Follmar's classification, undergo Computed Tomography (CT) scans and Three Dimensional (3D) reconstruction to identify the "firm segment" on the 3D images. From there, the correct occlusion is determined, and the fractures are set according to the principle of setting fractures near the firm segment first, followed by those farther away from the firm segment. 48 patients with pan-facial fractures classified according to Follmar's classification have been identified with the firm segment on 3D images. There are 4 types of firm segments divided on the images, providing the basis for correcting the right occlusion and setting fractures, restoring the facial contour. Correcting based on "Firm segment" is one of the strategies to effectively treat Pan facial fractures, this is an organized and flexible approach, setting fractures near the "firm segment" first and followed by those farther away. This strategy helps shorten the surgical time, ensure stability of the fractures, restore the anatomical shape of facial skeleton and function of the organs.
Corporate social responsibility (CSR) and irresponsibility (CSIR) impact firm risk in complex, dynamic ways, rather than as mere opposites. In a meta-analysis of 197 empirical studies, we find asymmetric patterns in which CSIR's risk-generation effects outweigh CSR's risk-mitigation effects. These impacts vary across dimensions of social outcomes, risk types, and contextual moderators. Moreover, CSR's risk-mitigation effects are influenced by indirect paths related to CSIR, whereas CSIR's risk-generation effects are not associated with indirect paths. Our findings highlight the nuanced interplay among CSR, CSIR, and risk, offering new insights for future research on theoretical mechanisms, contexts, measurements, and methods.
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Investors can play a significant role in reviving the economy and addressing the national agenda of poverty elimination through job creation. Though foreign and local investment are the backbone of any economy, especially in developing economies like Pakistan, investors face the challenge of assessing investment risk to protect the capital employed and achieve an appropriate return on investment. The aim of this research is to assess investment risk faced by firms in Pakistan using the most suitable approach, and then to develop an economic model for a comprehensive assessment of the factors influencing investors' risk, focusing on firm-specific characteristics, economic conditions, and political stability. The introduction of the Investment Risk Index based on Altman Z-scores provides a structured diagnostic approach to assessing investment risk in Pakistan. Earlier studies have mainly used financial ratios to explain risk. The estimation results using an analytical approach (the Investment Risk Framework) confirm that firm-specific characteristics and economic, political, and financial stability indicators significantly impact investment risk. The findings, based on 443 firms over the period 2014-2023, reveal that the proportion of firms in the distress zone increased from 4.8% to 8.5% (a doubling) during the study period. Retained earnings relative to total assets emerged as a strongly correlated factor with investment risk, while the market value of equity relative to total liabilities played a significant role in keeping firms (around 88% of the sample) in the safe zone. For the determinants, the GMM results indicate that past values of investment risk strongly predict future risk. A 1% increase in past risk is associated with a 0.395% higher future risk. Additionally, political stability, GDP growth, inflation, current account balance, broad money, dividend premium paid, and growth opportunities are found to have a significant impact on the investment risk. Furthermore, internal factors such as fixed asset accumulation, firm size, and tax expenses also influence risk, with larger firms facing higher risk. This study underscores the importance of understanding investment risk factors for informed decision-making. The findings offer valuable insights for investors and policymakers, with potential applicability to other developing economies.
Profitability is a fundamental aspect of corporate survival in the pharmaceutical industry, shaped by both firm-level and macroeconomic factors. In Iran, the sector encounters challenges such as reliance on imports, inflation, and sanctions, alongside a lack of empirical evidence regarding the determinants of profitability. This study aims to fill this gap by investigating these factors in listed firms. Panel data from 28 companies listed on the Tehran Stock Exchange (2009-2023) were analyzed using fixed-effects Feasible Generalized Least Squares (FGLS) regression. The dependent variables were return on assets (ROA) and return on equity (ROE). The independent variables included firm-specific factors (e.g., leverage, sales growth) and macroeconomic factors (e.g., GDP, inflation). Diagnostic tests, including unit root, cointegration, and heteroskedasticity tests, were conducted. Results indicated that GDP, money supply, and sales growth were positively associated with profitability. Conversely, interest rates, exchange rates, inflation, government expenditure, leverage, P/E ratio, and liquidity ratios exhibited negative associations. The effects of firm size and tax revenue were mixed. The models accounted for 69-89% of the variation (R-squared), with significant F-statistics (P<0.001). The hypotheses were confirmed, partially supported, or contradicted, as summarized. The profitability of Iranian pharmaceuticals is susceptible to macroeconomic volatility and firm-specific strategies. It is imperative that policies are implemented to stabilize exchange rates and promote domestic production to enhance sustainability.
Food allergies (FAs) are rising worldwide, but research has mainly focused on younger groups. Older adults may have distinct risk factors (eg, immunosenescence, chronic inflammation, micronutrient deficiencies, multimorbidity, and polypharmacy) that could influence allergic responses. This review aimed to assess FAs prevalence in older adults. Following PRISMA guidelines, a systematic search across PubMed/Medline, Scopus, Embase, and Web of Science identified studies published up to December 2024. The review planning phase began in July 2023 and included protocol drafting and methodological discussions. No study screening, data extraction, or data analysis was conducted prior to PROSPERO submission and registration (CRD42023445399). Studies reporting FAs prevalence in older adults by all available methods were included. Self-reported and sensitization-based estimates reflect potential FAs, whereas challenge-confirmed FAs represent clinically confirmed allergy. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Data were pooled using random-effects meta-analyses. Sixteen studies, involving 33,165 older adults from 11 countries, were included qualitatively, and fourteen were included quantitatively. Most studies were graded as having a moderate risk of bias. The pooled prevalence of self-reported FAs was 12% (95% CI 9-15). Self-reported physician-diagnosed FAs showed a prevalence of 7% (95% CI 5-8). Specific IgE (sIgE) sensitization indicated a prevalence of 14% (95% CI 10-18). Only 1 study reported challenge-confirmed FAs with a prevalence of 0.5%. Exploratory comparisons suggest similar combined prevalence estimates across low- and middle-income countries (LMIC) (10%) and high-income countries (9%), though the small number of LMIC studies and differences in assessment methods preclude firm conclusions. sIgE sensitization to common allergens was 3% for cow's milk and peanut, 2% for egg and 1% for soy. Older adults show meaningful rates of self-reported food-related symptoms and sensitization. However, the prevalence of clinically confirmed FAs remains poorly defined. The limited evidence and heterogeneity across studies highlight the need for standardized diagnostic criteria and greater inclusion of older adults in future FAs research. www.crd.york.ac.uk/prospero identifier is CRD42023445399.
Stress affects cardiometabolic health, but evidence linking objective, occupation-specific stressors to individual-level biomarkers (blood pressure, lipids) remains limited. Prior studies on market fluctuations mostly focus on macro outcomes (eg, population hospitalisations) or narrow samples, leaving gaps in understanding stress-driven metabolic changes in working populations. We used employee health examination data from all publicly listed financial firms in a provincial capital city in eastern China, covering the period from 1 October 2017 to 30 September 2023. It examined the associations between fluctuations in the stock returns of these firms and the blood pressure and lipid levels of their employees, employing restricted cubic splines and fixed-effects regression models. A 10% decline in a firm's daily stock return was associated with significant increases in several biomarkers: a rise of 3.054 mm Hg (95% CI 0.384 to 5.723; ~2.5%) in systolic blood pressure; 0.350 mmol/L (95% CI 0.238 to 0.463; ~7.5%) in total cholesterol; 0.221 mmol/L (95% CI 0.101 to 0.341; ~16.4%) in triglycerides; and 0.215 mmol/L (95% CI 0.088 to 0.343; ~8.0%) in low-density lipoprotein cholesterol. Declines in returns had no significant effect on diastolic blood pressure or high-density lipoprotein cholesterol. Conversely, increases in stock returns showed no association with any measured biomarker. Crucially, these adverse health effects were observed exclusively among employees of financial firms; no such associations were found in the matched non-financial employee population. Stock return declines associate with metabolic disruptions in exposed employees. This study provides a generalisable framework for linking objective stressors to cardiometabolic health, informing cross-occupational health interventions.
Injectable dermal fillers are widely used in esthetic practice for lip augmentation and perioral soft-tissue enhancement. Although delayed complications such as foreign-body reactions and filler migration are described in the dermatologic literature, their manifestation as oral lesions during routine dental examination is less commonly recognized. A 67-year-old woman had multiple firm, white, elevated nodules on the right lower labial mucosa approximately 1 month after receiving injectable dermal filler in the lip. The lesions were nonmobile, with intact overlying mucosa and no ulceration, and the patient was concerned about possible malignancy. Because a neoplastic process could not be excluded clinically, excisional biopsy was performed for diagnostic and therapeutic purposes. Intraoperatively, firm, white deposits consistent with migrated filler material were identified. Superficial material was removed and submitted for histopathologic examination, whereas deeper deposits were intentionally left in place to avoid injury to adjacent neurovascular structures. Histopathologic evaluation showed chronic granulomatous foreign-body reaction to exogenous material without dysplasia or malignancy. At 6 weeks, the patient reported persistent sensitivity without objective paresthesia and was treated with a short course of methylprednisolone. At 6 months, no clinically detectable filler material remained, and symptoms had resolved. Complications associated with injectable dermal fillers may manifest as labial lesions that mimic primary oral pathology. Dentists should obtain a complete history of prior esthetic procedures when evaluating unexplained perioral or labial lesions. Appropriate surgical management and histopathologic confirmation are important when the diagnosis is uncertain.
This study examines the heterogeneity of CEOs' risk attitudes and how fixed versus variable compensation components shape their strategic risk-taking, as part of corporate governance policy. Building on psychological Regulatory Focus Theory (RFT) and established management frameworks, we developed a conceptual model with six hypotheses. We applied a validated Polish Linguistic Inquiry and Word Count (LIWC) dictionary to measure CEOs' promotion and prevention focus through content analysis of their shareholder letters. Our dataset covers 82 companies listed on the Warsaw Stock Exchange (WSE) from 2011 to 2020, analyzed using longitudinal panel data. The results confirmed that a CEO's regulatory focus is a significant motivational factor in strategic risk-taking. Promotion-focused CEOs tend to pursue bolder, riskier decisions, increasing the firm's strategic risk, whereas prevention-focused CEOs are more cautious and inclined to mitigate risk, aligning with prior findings in the literature. Moreover, these relationships are moderated by compensation structure. Higher fixed salaries are associated with reduced strategic risk, reinforcing risk aversion, while larger annual bonuses are associated with greater risk-taking. In particular, fixed compensation strengthened the natural risk-avoidant tendencies of prevention-focused CEOs, suggesting that higher guaranteed income reinforces a cautious strategy. Unexpectedly, large annual bonuses did not temper the risk appetite of promotion-focused CEOs; instead, bonuses amplified their risk-taking, indicating that intrinsic motivation can outweigh extrinsic incentives for risk moderation. These findings underscore the need for tailoring executive compensation policies to individual CEOs' risk preferences. Fixed salaries may temper excessive risk-taking in promotion-focused CEOs, while performance-based bonuses may motivate otherwise cautious, prevention-focused CEOs to undertake strategic risks. Such insights are valuable for refining corporate governance strategies in European public firms, especially in Poland, to better align CEO behavior with shareholder interests.
Hyalinizing Trabecular Tumor (HTT) is an extremely rare thyroid neoplasm. Preoperative imaging diagnosis and Fine-Needle Aspiration Cytology (FNAC) are considerably challenging. We present a case of invasive HTT, describing its clinical course and imaging manifestations. A 49-year-old woman presented with a 12cm left thyroid mass that had been incidentally detected as a 9×8mm nodule ten years previously. Following asymptomatic gradual enlargement, she developed severe dyspnea in March 2024, prompting admission. Physical examination confirmed a large, firm left thyroid mass. Ultrasound (US) was limited by the lesion's size. Dual-Phase Contrast-Enhanced CT (DP-CECT) revealed a 12cm oval mass replacing the left lobe. US-FNAC yielded suspicious for malignancy (TBSRTC Category III). She underwent left thyroid lobectomy and isthmusectomy. Pathology and immunohistochemistry confirmed HTT with focal capsular invasion. The patient recovered uneventfully during follow-up. Elucidating the characteristic features of HTT will facilitate early diagnosis and clinical intervention, providing valuable insights for future clinical research.
The Trump Administration has pursued most-favored nation (MFN) drug pricing agreements with major pharmaceutical manufacturers, raising concerns about potential effects on pharmaceutical revenues, profitability, and innovation incentives. We examined whether equity markets interpreted these developments as positive or negative for the pharmaceutical sector. We conducted an event study of 16 publicly traded pharmaceutical firms announcing MFN agreements. Abnormal returns and cumulative abnormal returns were estimated using standard market-model regressions based on each firm's historical relationship to the S&P 500. We analyzed market reactions surrounding "Liberation Day," the date MFN letters were announced, and subsequent agreement announcements. The strongest market response was observed following the first MFN agreement announced by Pfizer, with largely positive market reactions across most of the pharmaceutical firms analyzed. In contrast, "Liberation Day" generated limited market reaction, while the MFN letters produced more modest negative effects. Investors did not interpret the announced MFN agreements as materially value destructive, likely because the deals primarily targeted Medicaid and the limited TrumpRx platform, while also resolving some regulatory and tariff uncertainty. Future expansion of MFN may lead to different market reactions.
Background and Objectives: The HER2-low designation has emerged as a clinically actionable category in breast cancer following the approval of trastuzumab deruxtecan for HER2-low metastatic disease. However, the clinical relevance of HER2-low expression in the neoadjuvant chemotherapy (NAC) setting remains uncertain. This study aimed to evaluate pathological complete response (pCR) as the primary endpoint and overall survival (OS) and disease-free survival (DFS) as exploratory secondary endpoints across HER2-low, HER2-zero, and HER2-positive subgroups in a NAC-treated cohort. Materials and Methods: This single-center retrospective cohort study included 118 patients with histopathologically confirmed invasive breast cancer who received NAC at our institution between January 2010 and March 2021. Patients were classified as HER2-zero (IHC 0, n = 66), HER2-low (IHC 1+ or IHC 2+/FISH-non-amplified, n = 17), or HER2-positive (IHC 3+ or IHC 2+/FISH-amplified, n = 35). pCR was defined as ypT0/Tis ypN0. Univariate analyses used χ2 or Fisher's exact tests; multivariable logistic and Cox regression were performed for adjusted analyses, and Kaplan-Meier survival curves were compared by log-rank, Breslow, and Tarone-Ware tests. Results: The overall pCR rate was 24.6%, differing significantly across HER2 subgroups (HER2-positive 45.7%, HER2-low 29.4%, HER2-zero 12.1%; p = 0.001). After multivariable adjustment for age, ER, PR, and tumor grade, HER2-positive status retained an independent association with pCR (OR 4.37, 95% CI 1.46-13.10, p = 0.008), whereas HER2-low status did not (OR 2.65, 95% CI 0.60-11.75, p = 0.201). At a median follow-up of 48.8 months, neither OS (log-rank p = 0.567) nor DFS (log-rank p = 0.901) differed significantly across HER2 subgroups, and HER2 subgroup status was not independently associated with survival in exploratory Cox models. Conclusions: In this NAC-treated cohort, the unadjusted pCR advantage of HER2-low over HER2-zero tumors was not retained after adjustment for hormone receptor expression and tumor grade, and no HER2 subgroup-specific survival difference was demonstrated. Within the standard NAC framework, HER2-low disease did not show a pCR or survival pattern clearly distinct from HER2-zero disease after adjustment; the small HER2-low subgroup and wide confidence intervals preclude firm conclusions, and an exploratory hormone receptor-stratified analysis indicated that the apparent pooled HER2-low advantage was confined to the hormone receptor-negative subgroup. Future prospective studies powered for hormone receptor-stratified analyses are warranted.
Oral focal mucinosis (OFM) is a benign lesion of the oral cavity. It is usually a slow-growing, painless nodular swelling commonly located on the gingiva. It has non-specific clinical features and is often confused with reactive lesions of the gingiva. It is rarely reported among adolescents. An 11-year-old girl reported with a firm, painless nodular swelling on the lingual gingiva of the lower jaw for six months. Growth was excised surgically, and histopathological examination was performed using H&E stain. Microscopic analysis revealed the presence of a myxoid stroma with spindle-shaped stellate fibroblasts and plenty of mucin, which confirmed the diagnosis of OFM. Healing was uneventful, and 12 months of follow-up did not report any recurrence. This case highlights the need to include OFM as a differential diagnosis of gingival swellings presented in adolescents. Clinicians should take OFM into account when making a differential diagnosis of gingival swellings to facilitate accurate diagnosis and appropriate management.
Pig welfare around slaughter remains a sensitive issue, as animals are exposed to multiple hazards within a short period. The objective of this review was to provide a comprehensive assessment of the key factors affecting pig welfare in commercial slaughterhouses, to evaluate their impact on meat quality, and to examine contemporary alternatives to high-concentration CO2 stunning with respect to their implications for both animal welfare and meat quality. During lairage, exposure to a novel environment and unfamiliar animals can hinder recovery from transport stress. Limited space allowance negatively impacts welfare by impairing rest, exacerbating heat stress, and increasing agonistic behaviours. Cooling strategies, such as intermittent water spraying, can improve thermal comfort and reduce stress within groups. Although feed withdrawal is necessary for food safety, it should be limited to less than 16 h to avoid prolonged hunger and additional stress. Handling practices during movement to the stunning point are another significant source of stress when poorly executed. Effective stunning is essential to ensure that pigs are rendered unconscious without pain before exsanguination. While electroencephalography remains the most accurate method to assess consciousness, practical evaluation in commercial settings relies on animal- and resource-based indicators, whose reliability depends on standardised protocols and proper training. The two most widely used stunning methods are electrical stunning and exposure to high concentrations of CO2. Electrical stunning induces immediate unconsciousness but raises welfare concerns due to handling and restraint, particularly in high-throughput systems. In addition, the use of electric goads to move pigs from groups into raceways, although reducible, cannot yet be eliminated, highlighting the need for improved facility design. CO2 stunning, although widely adopted, is aversive, as it induces hyperventilation and irritation of mucous membranes. Alternatives such as improved electrical systems and inert gas stunning using argon, nitrogen, or helium at residual oxygen levels below 2% show potential welfare benefits by reducing pain, fear, and respiratory distress. However, these systems typically result in slower induction of unconsciousness and faster recovery, posing practical challenges. Preslaughter stress significantly affects carcass and meat quality, leading to defects such as bruising, blood spots, and alterations in colour, firmness, and water-holding capacity. In severe cases, this results in conditions such as pale, soft, and exudative or dark, firm, and dry pork, reducing product quality and economic value. Implementing low-stress handling and optimised stunning practices can improve both animal welfare and meat quality outcomes.
ObjectiveTo preliminarily investigate sensory integration strategies of proprioception, vision and vestibular sensation in static balance control in patients with knee osteoarthritis.DesignRepeated-measures design.SettingA university-based rehabilitation assessment laboratory.Participants69 patients with knee osteoarthritis (19 men, 50 women).InterventionsNot applicable.Main outcome measuresStatic balance metrics (centre of pressure displacement in the mediolateral and anteroposterior directions, sway velocity) were recorded using a Pro-Kin platform under four conditions: firm support with eyes open (T1), firm support with eyes closed (T2), foam support with eyes open (T3) and foam support with eyes closed (T4). Sensory contributions were estimated using sway velocity-based ratios.ResultsCentre of pressure displacement in the mediolateral and anteroposterior directions differed between T1-T4, T1-T3 and T2-T3 (P < 0.05), and centre of pressure displacement in the anteroposterior direction also differed between T2-T4. Sway velocity increased when proprioception or vision was disrupted. With full sensory input, vestibular sensation, proprioception and vision contributions were 62.07%, 21.87% and 15.49%. Removing vision raised proprioception to 32.58% and vestibular sensation to 67.42%. Removing proprioception elevated vision to 28.75% and vestibular sensation to 71.25%.ConclusionsIn individuals with knee osteoarthritis, balance control depends mainly on vestibular sensation, then proprioception and least on vision. Without vision, proprioception contributes more in the sagittal plane. The central nervous system can reorganise and optimise postural control. Therefore, rehabilitation should include vestibular training, sagittal-plane proprioceptive training without vision and multisensory coordination.
This paper investigates how quantum entanglement and heterogeneous expectations jointly affect the stability, complexity, and controllability of a Cournot triopoly with isoelastic demand. Based on the Li-Du-Massar quantization scheme, we construct a discrete-time quantum Cournot triopoly in which three firms adopt different updating mechanisms: boundedly rational adjustment, naïve and adaptive expectations. The quantum boundary equilibrium and the unique interior quantum Nash equilibrium are derived explicitly. By linearizing the resulting three-dimensional nonlinear map and applying the Jury criterion, we obtain analytical local stability conditions for the interior equilibrium. The results show that increasing the entanglement level reduces the admissible range of the adjustment speed, thereby shrinking the stability domain and making the market dynamics more prone to bifurcation and chaos. Numerical simulations further reveal a typical transition from stable convergence to flip bifurcation, period-doubling cascades, chaotic attractors, and sensitive dependence on initial conditions. Finally, a control parameter is introduced to rescale the effective adjustment speed of the boundedly rational firm. This mechanism preserves the equilibrium set while restoring convergence to a stable fixed point once the control intensity exceeds a critical threshold. The findings highlight the joint role of entanglement, expectation heterogeneity, and nonlinear demand in shaping complex quantum oligopoly dynamics.
Background/Objectives: Passive postural change from the supine position to sitting requires rapid circulatory and autonomic adjustment. This small-scale exploratory study examined whether prior verbal notice is associated with changes in cerebral and peripheral haemoglobin dynamics and heart rate variability during passive postural change in healthy middle-aged and older men. Methods: Ten healthy men completed both experimental conditions in randomized order: passive postural change with prior verbal notice and passive postural change without prior verbal notice. Each condition consisted of 10 min of supine rest, 10 min of sitting with feet on the floor, and 10 min in the supine position after return. Near-infrared spectroscopy was used to assess haemoglobin changes in the left frontal region and right gastrocnemius muscle, and heart rate variability was used to estimate autonomic modulation. Results: In both conditions, frontal total haemoglobin and oxygenated haemoglobin decreased shortly after sitting and subsequently tended to recover by approximately 5 min after postural change. The low-frequency/high-frequency (LF/HF) ratio increased earlier in the prior-notice condition, and no adverse events occurred. Because the sample was small, these findings should be interpreted as preliminary within-sample patterns rather than as confirmatory evidence. Conclusions: Prior verbal notice may be associated with earlier autonomic adjustment during passive postural change. The findings do not establish clinical benefit or causality. Larger crossover studies that include women, frail older adults, and clinical populations are needed before firm clinical recommendations can be made.
Apocrine sweat gland adenocarcinoma is an uncommon feline adnexal neoplasm, and lower-lip involvement is rarely documented. A 14-year-old spayed female Siamese cat was evaluated for a firm 1.3 cm right lower-lip mass at a documented hemorrhagic lesion site. Approximately 1 year earlier, the lesion was fluctuant and superficially erosive to ulcerative; fine-needle aspiration yielded bloody fluid with cytologically nondiagnostic material. The lesion reportedly subsided after empirical treatment, but reassessment, tissue diagnosis, and objective confirmation of resolution were not performed. Cytology of the later same-site mass supported malignant epithelial neoplasia. Contrast-enhanced computed tomography (CT) identified a 12.5 × 13.2 × 16.6 mm rim-enhancing mass without mandibular invasion or distant metastasis; the ipsilateral mandibular lymph node was mildly thickened. Histopathology supported a diagnosis of lower-lip apocrine sweat gland adenocarcinoma with lymphovascular tumor emboli, lymphatic invasion, and nodal metastasis. The diagnosis was supported by superficial dermal/subcutaneous location, adjacent adnexal structures, skeletal-muscle separation from nearby minor salivary glands, epithelial immunoreactivity, periodic acid-chiff (PAS) and Alcian blue findings without distinct intratumoral mucin/mucopolysaccharide-rich material. The cat died without necropsy on postoperative day 87. This case supports tissue-based diagnosis and regional lymph node assessment for suspicious feline lower-lip glandular epithelial lesions.
Here, we report a case of a 48-year-old man with a longstanding firm, asymptomatic nodule on the left upper arm who presented to clinic with a 1 year history of the lesion slowly enlarging to a size of 15 mm by 13 mm and becoming faintly pigmented. Initial concerns about the possibility of a nodular malignant melanoma meant that the lesion was excised with a 2 mm margin; however, histology demonstrated a hyperplastic epidermis with an underlying intradermal lesion with fibrocyte-like cells with a storiform and haphazard arrangement. Occasional histiocytes were present, many of which were xanthomatous. Numerous, almost confluent cleft-like spaces representing cholesterol deposition were noted as well as peripheral entrapment of collagen bundles. These findings confirmed the presence of a cholesterotic fibrous histiocytoma, a very rare variant of a common dermatological presentation.
Hamartoma is a rare benign malformation characterized by a disorganized but non-neoplastic proliferation of tissues normally found within the affected organ. Neonatal hamartoma is an uncommon condition of the central nervous system. We report the case of an 18-day-old female neonate brought by her family to the University Teaching Hospital of Kinshasa in the Democratic Republic of the Congo with a congenital occipital mass. On admission, the patient was alert, with stable vital signs and a preserved general condition. Physical examination revealed a 10 × 6 cm occipital mass, firm centrally and fluctuant at the periphery, with an irregular surface. The lesion was mobile relative to both superficial and deep planes and exhibited pulsatility. Cranial computed tomography revealed a heterogeneous extra-axial mass, initially suspected to be a teratoma. Complete surgical excision of the lesion was performed. Histopathological analysis confirmed the diagnosis of an exocranial and endocranial hamartoma. The postoperative course was complicated by a surgical site infection, which was successfully managed with broad-spectrum antibiotic therapy. Follow-up at three months was favorable. This case highlights an unusual occipital localization of hamartoma and underscores the importance of imaging and histopathological examination in the diagnosis and management of this congenital malformation.