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Patient presented with a dural-based mass lesion and was diagnosed as having meningioma on imaging. Post-resection histological examination revealed a low grade follicular lymphoma. The patient received cranial radiotherapy and is recurrence-free at 6-month follow-up. Primary dural follicular lymphoma is an exceedingly rare entity with only as few as six reported cases. Herein, the clinico-radio-pathological appearances and treatment protocol of this entity are discussed.

SummaryWe present a case of a 5-year-old child with a painless swelling on the neck. Imaging revealed a multilocular cystic lesion lying in close proximity to carotid vessels. Based on imaging a possibility of ectopic thymic cyst was considered, which was confi rmed on histopathology. Ectopic cervical cyst is an infrequent cause of neck cyst in a child which is rarely diagnosed preoperatively.BMJ Case Reports 2011; doi:10.1136/bcr.05.2011.4250 2 of 4 mass on lateral aspect of neck, deep to sternocleidomastoid muscle. It can occur anywhere along the line of descent that is between pyriform recesses and the mediastinum.Majority of them are seen in infants or young children less than 10 years of age 3 . A slight higher incidence on the left side has been seen. 3 They vary in size from 1-17cm and most are multilocular with smooth inner lining. Some authors report an equal sex distribution while others detected a 2:1 male predominance. Majority of the lesions present as asymptomatic slowing growing lateral neck masses.The clinical features are non-specifi c and indistinguishable from other causes of cystic neck masses such as thyroglossal duct cyst, branchial cleft cyst, lymphangioma, dermoid/epidermoid cysts and cystic nerve tumours. Necrotic lymphadenopathy and abscess may be diffi cult to distinguish from a cyst particularly if it has been previously infected.Imaging contributes by defi ning the nature and extent of mass. Sonography shows an anechoic multilocular cyst with thin septations on lateral aspect of neck. A CT scan better defi nes the character and relations of the cyst. Cranially the ectopic thymic cyst passes posteromedial to the carotid vessels and ends near the pyriform sinus while caudally it often extends below the thyroid, sometimes as far as the mediatinum 2 . On MRI, it is seen as T2 hyperintense lesion situated between carotid artery and internal jugular vein, MRI better delineates the thin band like extension upto the mediastinum. Additionally imaging helps to ascertain the presence/absence of the normal mediastinal thymus.The differential diagnoses of cystic neck mass include second branchial cleft cyst, cystic hygroma,/lymphangioma, thyoglossal cyst, ectopic thymic cyst, vallecular cyst, dermoid, epidermoid, necrotic lymphadenopathy and cystic nerve tumours and cystic neuroblastoma.The necrotic adenopathy and cystic nerve tumour/ neuroblastoma have thick walls on sonography. A thinwalled cystic mass as in the presented case can be due to branchail cleft cyst, lymphangioma, thyroglossal cyst and ectopic thymic cyst. While thyroglossal cyst is more in midline the other three are lateral as in our case. Imaging appearances of these three can be indistinguishable except for some subtle pointers. While branchial cleft cyst passes between the carotid fork to terminate at the base of tonsils, thymic cyst passes behind the carotid artery to end at the pyriform sinus. In addition, thymic cyst extends more caudally, sometimes up to the mediastinum which is never seen with branchial cyst 2 . A preoper...

Gall bladder duplication is a rare congenital anomaly. True duplication is still rarer. Pre-operative detection helps in avoiding complications or missing the gall bladder during surgery. Ultrasonography (USG) and magnetic resonance cholangiography are investigation of choice. Laparoscopic cholecystectomy is the preferred modality for management of double gall bladder. We present a case diagnosed as cholelithiasis on USG. While doing laparoscopic surgery 2 gall bladders were found. She had a normal gall bladder that was lying in the supraduodenal area. It had cystic duct that joined the common bile duct. There was an accessory gall bladder attached to the anterior free margin of the liver. This gallbladder was occluded with a big solitary calculus occupying the whole of gall bladder cavity and had a small feeding vessel; whereas its duct had fibrosed.

BackgroundAdenine phosphoribosyl transferase (APRT) deficiency is a rare genetic form of kidney stones and/or kidney failure characterized by intratubular precipitation of 2,8 dihydroxyadenine crystals. Early diagnosis and prompt management can completely reverse the kidney injury.Case presentation44 year old Indian male, renal transplant recipient got admitted with acute graft dysfunction. Graft biopsy showed light brown refractile intratubular crystals with surrounding giant cell reaction, consistent with APRT deficiency. Patient improved after receiving allopurinol and hydration.ConclusionAPRT forms a reversible cause of crystalline nephropathy. High index of suspicion is required for the correct diagnosis as timely diagnosis has therapeutic implications.