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The deep-sea isopod Bathynomus propinquus Richardson, 1910, was described based on a single male juvenile from the Verde Island Passage, central-western Philippines, but owing to its immaturity, had long been considered unidentifiable and treated as a nomen dubium. Settling the identity of B. propinquus, however, is important because the name remains available and nomenclaturally precedes all other species of supergiant Bathynomus in the Indo-West Pacific, with its type locality within the reported range of B. jamesi Kou, Chen & Li in Kou et al. 2017, raising the obvious possibility that the two nominal species could be conspecific. Detailed studies of B. jamesi sensu lato in the South China Sea revealed that it comprises two species distinguished by morphology and strong mitochondrial sequence divergence: a northern form (B. jamesi sensu stricto) ranging from Vietnam to off Hainan and the Dongsha Islands, and a southeastern form (here identified as B. propinquus) from the Verde Island Passage, southern Luzon, Philippines. Bathynomus propinquus is here considered a valid species based on re-evaluation of the holotype, additional material, new characters, size-related variation, and molecular data. Bathynomus propinquus belongs to the group of Indo-West Pacific supergiants sharing upturned pleotelson spines, most of which were formerly confused with B. kensleyi Lowry & Dempsey, 2006 from the Coral Sea, herein referred to as the B. kensleyi group. Given the new data on supergiants in the South China Sea, a key to the species of the B. kensleyi group is provided. A new record of B. wilsoni Ahyong, 2025 from the northern Sulu Sea is also reported.

Solid pseudopapillary neoplasm is a rare epithelial tumor of the pancreas with low malignant potential and a marked predilection for adolescent girls and young women. Although the overall prognosis is favorable after complete resection, preoperative characterization and surgical planning become more challenging in giant tumors with intratumoral degeneration, hemorrhage, and adjacent vascular compression. We report a 15-year-old girl who presented with acute abdominal pain persisting for 24 hours after strenuous physical activity. Imaging revealed a giant mixed solid-cystic mass in the pancreatic body and tail, and computed tomography angiography and venography demonstrated narrowing of the splenic vein with collateral venous circulation. After multidisciplinary assessment of oncologic safety and perioperative bleeding risk, the patient underwent laparoscopic distal pancreatectomy with splenectomy. Histopathology confirmed solid pseudopapillary neoplasm with negative margins and no nodal metastasis; ectopic splenic tissue was identified in the peripancreatic fat. Immunohistochemistry showed nuclear/cytoplasmic positivity for beta-catenin, loss of E-cadherin, positivity for CD10 and CD56, and partial positivity for lymphoid enhancer-binding factor 1, supporting the diagnosis. The postoperative course was uneventful, and no evidence of recurrence was detected on short-term follow-up. This case suggests that giant solid pseudopapillary neoplasm may have been related to acute abdominal pain in the setting of intratumoral degeneration, hemorrhagic change, and local tension effect. Surgical strategy should balance oncologic safety, bleeding risk, and organ preservation. In patients requiring splenectomy, long-term infection prevention should include immunization planning, fever emergency counseling, and individualized antibiotic prophylaxis according to local guidance and risk stratification.

Femoral artery pseudoaneurysm is a well-recognized complication of arterial catheterization. While ultrasound-guided thrombin injection and endovascular interventions are increasingly employed, open surgical repair remains mandatory for large, symptomatic, or complicated lesions. However, obtaining surgical vascular control can be extremely challenging in giant pseudoaneurysms that extend beyond the inguinal ligament and distort the femoral bifurcation anatomy. A 60-year-old woman on maintenance hemodialysis presented with severe pain and tense swelling in her right groin two months after undergoing cardiac catheterization via a right femoral approach. Computed tomography revealed a giant pseudoaneurysm with a maximum diameter of 8 cm, extending proximally above the inguinal ligament and distally into the upper thigh. The pseudoaneurysm neck originated near the bifurcation of the superficial femoral artery (SFA) and profunda femoris artery (PFA). Due to signs of impending rupture, including excruciating pain and overlying skin discoloration, emergency surgery was indicated. Because conventional surgical exposure for proximal and distal clamping was deemed hazardous due to the massive size and anatomical complexity of the lesion, a hybrid approach was adopted. Through a contralateral femoral approach, dual-balloon occlusion of both the SFA and PFA was performed to control systemic inflow and retrograde collateral backflow. Immediate surgical incision of the pseudoaneurysm sac under a completely bloodless operative field allowed for precise identification and direct suture closure of the neck. The patient's postoperative course was uneventful, and she was discharged on postoperative day 3. At the two-month outpatient follow-up, she remained asymptomatic with no clinical evidence of recurrent pseudoaneurysm or wound-related complications. Dual-balloon occlusion combined with open surgical repair represents a highly effective and safe hybrid strategy for treating giant femoral pseudoaneurysms when conventional vascular control is technically demanding or unsafe. This technique provides excellent visualization, facilitates precise neck closure, and minimizes surgical invasiveness in anatomically complex lesions.

Giant cell arteritis (GCA) is the most common type of systemic vasculitis and predominantly affects women over the age of 50 years. Clinical presentation includes cranial and ocular involvement, joint and systemic features. Diagnosis is confirmed by positive temporal artery biopsy or ultrasound or large vessel vasculitis on positron emission tomography. Treatment includes high-dose glucocorticoids (GC) and immunosuppressants. Health-related quality of life (HRQoL) can be impacted by pain, fatigue, and sight loss; glucocorticoid therapy adds further physical, psychological, and social burdens. Patient-reported outcome measures (PROMs) aim to capture the impact of disease from the patient's perspective. A range of PROMs have been used to highlight the impact of GCA. The generic 36-Item Short Form Health Survey (SF-36) has demonstrated the effectiveness of novel treatments including Tocilizumab in clinical trials, the symptom-specific Hospital Anxiety and Depression scale has demonstrated 50% of people with GCA suffer with anxiety and a third depression, and condition-specific (GCA PRO) and treatment-specific (Steroid PRO) PROMs have been developed and validated in people with GCA for clinical practice and trials. Shared decision-making (SDM) is essential in GCA management, ensuring patients understand treatment options and decisions reflect their preferences and "what matters to them." PROMs support SDM and enhance the patient-clinician dialogue. Early evidence from use of the GCAPRO demonstrated that PROMs have helped patients explain their symptoms, providing clinicians with clearer insights into the patient's health. There is a growing role for electronic PROMs (E-PROMs) to support patient and clinician communication and facilitate effective clinical triage. Considerations about E-PROMs include potential for digital exclusion in older patients, data governance with online apps, and clinical safety (i.e., for people reporting active disease). To fully implement E-PROMS in clinical practice and gain the maximum benefit, full integration into intuitive clinical and patient systems will be required. Measuring the impact of giant cell arteritis and steroids from the patients’ perspective Giant cell arteritis (GCA) is the most common type of vasculitis. It is most common in women and those over 50 years old. GCA causes the blood vessels of the head and neck to become inflamed and narrowed. People can have headaches and pain and it can affect chewing and cause loss of vision. Some people can also get internal inflammation of the blood vessels around the aorta. A type of steroid called glucocorticoids are used to treat GCA. GCA and treatment with steroids can cause side effects and reduce quality of life. Fifty percent of people can feel anxious and a third have depressive symptoms. Patient reported outcome measures (PROMs) are questionnaires that ask people about their quality of life. They have been used in GCA in clinical trials to show the benefit of new treatments that do not have the side effects of steroids. They can also be used in clinic to improve understanding between patients and doctors and nurses. They do this by raising awareness of what is important to patients–e.g fatigue or pain or how the condition is affecting peoples’ life. A plan can then be made together to help with this. Electronic PROM questionnaires are now being used to help patients and their clinical team. These can help communication and efficiency. It is however important to think about people who may not be confident with digital questionnaires, e.g because of visual problems or older age.

Intestinal obstruction due to a giant fecaloma is a rare clinical condition, characterized by a markedly hardened fecal mass that is more severe than a simple fecal impaction. We report a case of a 24-year-old female with a history of repaired anorectal malformation (ARM) during infancy who presented with the complaint of abdominal rigidity, progressive abdominal distention, and chronic constipation. The contrast-enhanced computed tomography of the abdomen showed a grossly dilated rectosigmoid region. During laparotomy, a giant fecaloma (4 kg) was found obstructing the descending colon. The distal sigmoid stump was closed, and a diversion transverse colostomy was created to allow the passage of stool. The postoperative period was uneventful, and she was discharged with a well-functioning stoma. This case highlights that exploratory laparotomy with enterotomy and fecaloma extraction with the creation of a diversion transverse colostomy can be an effective and safe treatment approach, leading to excellent postoperative recovery and symptom relief.

Laparoscopic surgery is widely preferred for benign ovarian tumors because it is associated with less postoperative pain, fewer complications, and shorter recovery time compared with laparotomy. However, laparoscopic surgery for giant cystic ovarian tumors occupying the entire abdominal cavity poses substantial challenges, including difficult trocar insertion and the risk of intraperitoneal spillage, particularly when the cyst contains highly viscous mucinous material that is difficult to aspirate with standard suction devices. We report a case of a 72-year-old woman with a 37.7 × 32.0 × 15.5 cm multilocular ovarian tumor extending from the pouch of Douglas to the upper abdomen. Ultrasonography suggested highly viscous contents, and magnetic resonance imaging showed no findings of malignancy. Given that the tumor markedly bulged into the pouch of Douglas, a transvaginal approach was selected to achieve safe decompression prior to trocar placement. Through a posterior colpotomy, the cyst wall was exposed extraperitoneally, enabling controlled extracorporeal incision and drainage of 9,782 mL of highly viscous fluid facilitated by manual abdominal compression. Tumor decompression enabled safe trocar insertion, pneumoperitoneum establishment, and laparoscopic adhesiolysis of dense adhesions to the abdominal wall and omentum. The adnexa were subsequently ligated and removed transvaginally without macroscopically evident intraperitoneal spillage of the tumor contents. Histopathology examination confirmed mucinous cystadenoma arising in a mature cystic teratoma. The patient experienced an uneventful recovery and was discharged on postoperative day 3. This case highlights that transvaginal drainage via posterior colpotomy is an effective strategy for giant ovarian cystic tumors with highly viscous contents, particularly when the tumor protrudes into the pouch of Douglas. Tailoring the surgical approach to the tumor's anatomical characteristics can facilitate safe, minimally invasive management even in cases traditionally managed by laparotomy.

Pregnancy in women with Marfan syndrome markedly increases the risk of life-threatening aortic complications due to superimposed haemodynamic and hormonal stress on an intrinsically fragile aortic wall. Management becomes particularly challenging when a giant aortic root or ascending aortic aneurysm with severe aortic regurgitation is diagnosed during early pregnancy before fetal viability. A 19-year-old primigravid woman at 15 weeks and 2 days of gestation with known Marfan syndrome presented with persistent palpitations. Evaluation revealed a giant fusiform aneurysm involving the aortic root and ascending aorta measuring 69 mm on transthoracic echocardiography and ∼9-10 cm intraoperatively, severe aortic regurgitation due to annular dilation, and left ventricular systolic dysfunction with an ejection fraction of 40%-42%. Following multidisciplinary consultation and counselling regarding maternal and fetal risks, urgent surgical intervention was undertaken without termination of pregnancy. The patient underwent an emergency Bentall procedure. The perioperative course was complicated by major bleeding requiring delayed sternal closure and transfusion support. Post-operative echocardiography demonstrated a functioning mechanical prosthesis with acceptable haemodynamics and persistent severe left ventricular systolic dysfunction with an ejection fraction of 25%-30%. Obstetric ultrasonography confirmed a viable fetus. The patient was discharged in stable condition on post-operative day 11. This case demonstrates that emergency aortic root replacement during early second-trimester pregnancy may be lifesaving in selected patients with Marfan syndrome and severe aortic pathology when guided by multidisciplinary coordination and meticulous perioperative management.

This study aims to evaluate the demographic characteristics, anatomical distribution, diagnostic and treatment patterns, postoperative complications, recurrence rates, and recurrence-associated factors in patients diagnosed with tenosynovial giant cell tumors (TGCTs). A total of 246 patients diagnosed with TGCT and treated between January 2010 and March 2021, were retrospectively analyzed. Pre- and postoperative data of the patients were recorded. Histopathological diagnosis was reviewed, and tumors were classified as localized TGCT and diffuse-type TGCT. Recurrence was defined as the reappearance of a lesion at the same location following an initially complete surgical excision. Survival time was defined as the time elapsed since surgery. Recurrence-free survival was calculated from the date of the surgical procedure to the date of recurrence or the last follow-up. Of a total of 246 patients included in the study, 87 were male and 159 were female with a mean age of 44.3 ± 16.3 (range, 18 to 75) years. The lesions were most commonly located in the hand (62.6%), predominantly at the phalangeal level (89.6%). Foot involvement was mainly at the ankle region (40.8%), while the knee was the third most frequently affected site (15%), with 64.8% of knee lesions being intra-articular. Multiple lesions were observed in 3.3% of patients. Small joints were involved in 63% of cases. Excisional biopsy was the most common diagnostic approach (63.8%), followed by Tru-Cut biopsy (23.2%) and incisional biopsy (8.5%), while macroscopically complete marginal resection was performed in 4.5% of cases. Postoperative complications occurred in 15.4% of patients, including infection, sensory deficits, hematoma, motion restriction, and vascular complications. The median follow-up was 43 months, and recurrence occurred in 15.4% of patients, of whom 76.3% required reoperation. Our study results suggest that TGCT is associated with a notable recurrence rate and postoperative morbidity. Accurate diagnosis, complete surgical excision, and long-term follow-up are essential for optimal management. Recurrence may be associated with factors such as pain at presentation, presence of multiple lesions, delayed treatment, and postoperative infection. Adequate surgical excision with sufficient margins is of utmost importance in reducing the risk of recurrence.

Coronary artery aneurysm (CAA) is a rare pathological phenomenon of coronary arteries. The etiology, pathogenesis, and epidemiology of CAA remain unclear. Coronary artery fistula (CAF) is an abnormal connection between a coronary artery and either a cardiac chamber or the great vessels. In this paper, we report the surgical treatment of a 53-year-old woman with a giant left coronary aneurysm and a coronary pulmonary artery fistula.

Condyloma acuminata is an uncommon epithelial proliferative and infiltrative growth associated with human papillomavirus (HPV) subtypes 6 and 11. Giant condyloma acuminata is a more aggressive variant characterised by extensive growth, anatomical disfigurement, psychosocial morbidity and a high recurrence rate. Extragenital involvement in an immunocompetent individual is uncommonly reported in the literature. We report a case of an immunocompetent young woman who developed a rapidly progressive verrucous growth involving the vulva, lower vagina, perianal region and also extragenital sites (inframammary fold and axilla). Pelvic MRI demonstrated a large exophytic lesion without underlying stromal involvement. Complete surgical excision with histopathological confirmation demonstrated condyloma acuminata with low-risk HPV type 11. Early recurrence occurred within 3 months, which was managed by topical medication. This case highlights the importance of clinical examination, the role of MRI followed by surgical excision with long-term follow-up even in immunocompetent patients.

We report a case of giant hepatocellular adenoma (HCA) in a 24-year-old man. The patient had no definite known risk factors, and both the clinical manifestations and imaging findings were nonspecific, making preoperative diagnosis difficult. Also, the inconsistency between intraoperative frozen-section findings and postoperative routine histopathology further complicated the diagnostic process. In fact, hepatocellular carcinoma (HCC) was initially suspected preoperatively, while postoperative pathology temporarily suggested focal nodular hyperplasia (FNH). The diagnosis was ultimately confirmed as HCA after expert pathological consultation at a tertiary center. The patient underwent right hepatectomy and cholecystectomy, with no significant adverse complications observed during the 1-year follow-up. This case highlights that HCA should be included in the differential diagnosis of hepatic space-occupying lesions in young male patients without clearly identifiable risk exposures. Moreover, when the nature of the lesion cannot be definitively established by preoperative or intraoperative pathology, surgical resection remains an important approach with both diagnostic and therapeutic value.

Tenosynovial giant cell tumor (TGCT) is a rare mesenchymal neoplasm arising from the synovium, tendon sheath, or bursa. Although the localized and diffuse forms of TGCT are typically considered benign, malignant TGCT characterized by marked histologic atypia and increased mitotic activity may exhibit aggressive clinical behavior. Pulmonary metastasis from malignant TGCT is rare and, in previously reported cases, pulmonary involvement has predominantly been described as parenchymal nodules or pleural lesions. In this article, we describe a rare case of endobronchial pulmonary metastasis occurring approximately 72 months after the initial diagnosis of malignant TGCT originating from the tendon sheath of the knee.

Acute appendicitis may mask rare surgical emergencies. Torsion of an intra-abdominal undescended testis with malignancy is exceptionally uncommon. A 27-year-old man presented with 3 days of right lower quadrant pain, vomiting, and anorexia. Examination showed peritonitis and an absent right testis. Laparotomy for presumed appendicitis revealed a normal appendix and an 11 × 13 × 12 cm intra-abdominal mass with a 540° torsed spermatic cord. Right radical orchiectomy was performed. Histopathology confirmed classical seminoma. Final stage was pT2N0M0S0 Stage IB. Giant torsed seminoma can mimic appendicitis; genital examination is essential.

Giant cell arteritis (GCA) is a large vessel vasculitis classically presenting with headache, jaw claudication, visual disturbance, and raised inflammatory markers. However, atypical presentations occur, and a delay in recognition can lead to irreversible visual loss. We report a 75-year-old male with sequential ocular involvement in whom erythrocyte sedimentation rate and C-reactive protein remained within normal limits. Carotid/vertebrobasilar imaging showed atherosclerotic change without critical stenosis, and 18F-fluorodeoxyglucose PET demonstrated vertebral arterial uptake consistent with cranial GCA. High-dose corticosteroids were commenced with rheumatology input. Normal inflammatory indices do not exclude GCA. Clinicians should maintain a high index of suspicion when visual symptoms evolve and initiate treatment without delay where clinical probability is high.

Adrenal endothelial cysts are rare lesions that may present as large retroperitoneal masses and mimic other cystic adrenal or retroperitoneal tumors. We report a 54-year-old man with progressive left lumbar pain caused by a giant left retroperitoneal cystic mass measuring 19.2 × 18.1 × 12.0 cm, displacing adjacent organs. Open surgical excision was performed after controlled intraoperative decompression. Histopathology showed a fibrous cyst wall lined by bland flattened CD34-positive endothelium with residual adrenal tissue, confirming an adrenal endothelial cyst. Surgery provided definitive diagnosis and treatment with an uneventful postoperative course.

Giant retinal tears (GRTs) pose a threat to vision, and contralateral retinal detachment can have a significant burden on the patient and remains a major concern. We investigated the natural history of the fellow eye, the effectiveness of prophylactic laser treatment, and risk factors for contralateral detachment. Retrospective cohort study at Sheba Medical Center, a tertiary referral hospital. Seventy-seven patients with non-traumatic, non-syndromic GRTs who underwent surgical repair were followed for contralateral retinal events. Prophylactic laser was offered for contralateral eyes based on physician recommendation and patient consent. Demographic, ocular, and surgical outcomes were analyzed using paired t-tests, Pearson's Chi-square tests, and logistic regression. Retinal tears occurred in 44.2% (34/77) of contralateral eyes, with 33.8% (26/77) progressing to detachment or GRTs. Prophylactic 360° laser was performed in 15.6% (12/77), but no significant difference in detachment rates between treated eyes and untreated eyes (33.3% vs. 33.8%, P = 0.972). No significant associations were found with age, axial length, or refraction. Despite excluding syndromic patients, we observed a high incidence of contralateral detachment in GRT patients. A two-line anterior 360° Prophylactic laser, as currently applied at our institute, showed no protective effect, suggesting that if applied, a more aggressive approach is needed. While treating 3-4 patients might prevent one detachment, meaningful prevention likely requires more extensive and denser treatment. Prospective evaluation of protocols defined by anatomical landmarks is warranted to establish the optimal technique and risk-benefit balance. Close monitoring remains essential allowing safer, more effective interventions.

Acquired tonsillar descent with syringomyelia secondary to intracranial space-occupying lesions is rare, and supratentorial causes are particularly uncommon. These cases are of particular pathophysiological interest because they suggest that tonsillar descent and syrinx formation may arise as downstream consequences of altered intracranial compliance, compartmental pressure transmission, and impaired craniocervical cerebrospinal fluid buffering, rather than from a primary hindbrain malformation. We report a previously healthy 39-year-old woman who presented with progressive headache, papilledema, and left homonymous hemianopia. Imaging demonstrated a giant posterior tentorial dural-based mass confined to the supratentorial compartment, with marked mass effect, inferior tentorial deformation, 7-mm caudal tonsillar descent below McRae's line, and a small C1 syrinx. The patient underwent preoperative embolization and near-total microsurgical resection, followed 6 weeks later by single-fraction LINAC-based stereotactic radiosurgery to a small residual remnant. Follow-up MRI showed reduction of the remnant, resolution of the midline shift, restoration of normal tonsillar morphology and position, and complete resolution of the syrinx, accompanied by substantial visual recovery. The observed reversal after treatment of the causative lesion supports a model in which the supratentorial mass secondarily disturbed craniocervical hydrodynamics and produced a reversible acquired Chiari-like state with upper cervical syringomyelia. This case highlights the need for careful cranial imaging before posterior fossa decompression is considered in adults with newly identified tonsillar descent and syringomyelia.

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