SUMMARYAppendicular intussusception is an uncommon entity, with a reported incidence of 0.01%. The diagnosis is difficult and often only performed at the time of surgery. Intussusception has multiple causes including tumours, foreign bodies and polyps. The definitive treatment is surgical, and the extent of resection is determined by the underlying pathology and degree of invagination. Endometriosis is a rare cause of appendicular intussusception, with 194 cases described in the English literature. We report a case of a 42-year-old woman who presented with chronic abdominal pain in the lower right quadrant. A mass at the caecum was identified during investigations for renal stones by CT. Colonoscopy showed a polypoid lesion, with presumed origin in the appendix. Ileocaecal resection was performed because an appendicular tumour was suspected. Pathological examination identified endometriosis of the appendix and associated peritoneum with invagination of the caecum. The patient was discharged 7 days after surgery and is currently asymptomatic. BACKGROUND

Submucosal lesions are mass-like protuberances into the gastrointestinal lumen covered by normal mucosa. Making a definitive diagnosis is difficult because of the number of benign and malignant lesions and extrinsic compression. Here we report the case of a 42-year-old woman referred for colon polypectomy. Colonoscopy revealed a polypoid formation with externalization from the appendicular orifice covered by normal mucosa and another formation at the sigmoid colon. The histopathology of both lesions was normal. Endoscopic ultrasound showed a hypoechoic lesion that was slightly heterogeneous in the fourth layer, and CT colonography confirmed the findings. Surgical therapy with ileocolic resection and resection of the sigmoid lesion was performed. Surgical specimens revealed an appendicular intussusception by endometriosis and endometrial foci in the sigmoid. Intestinal endometriosis may have several presentations, but it should always be considered in the differential diagnosis of a submucosal lesion in the colon.

Background: Acute onset abdominal pain through the pedunculated leiomyoma torsion is a rather uncommon presentation and a rare source of acute abdominal pain in the emergency department during pregnancy. Due to its rarity, this condition is not always considered, leading sometimes to inappropriate or unnecessary therapeutic approaches. Given that there are no specific clinical findings, radiological examination represents a fundamental tool for achieving the correct diagnosis. Pelvic ultrasound is usually the first imaging approach, but MRI is recommended for further evaluation, showing high diagnostic accuracy. Case presentation: A 35-year-old primigravid woman presented at the gynecological emergency department at 21 weeks of gestation, with a complaint of sudden onset of strong intensity right abdominal pain. Vital signs and blood test results were normal. A pelvic ultrasound was requested and showed a heterogeneous pelvic mass in the right lower quadrant, between the uterine body and the right ovary (which was not enlarged and presented normal venous and arterial blood flow) raising the suspicion of a right ovary tumor or an exophytic uterine tumor. An MRI was performed and revealed a well-defined and heterogeneous mass, with predominantly high signal intensity on T2-weighted images (WI) with and without fat saturation and with hyperintense areas on axial T1WI; the presence of bridging vessels in the interface between the tumor and the uterus was also demonstrated-the "bridging vessel sign." The tumor presented restricted diffusion with high signal intensity on axial diffusionweighted imaging (b1000) and low signal intensity on the axial ADC map. The set of MR imaging features was consistent with the torsion of a pedunculated subserosal uterine leiomyoma with hemorrhagic necrosis. A successful conservative approach was the first-option treatment, with no further surgical intervention. Conclusion: The torsion of a pedunculated subserous leiomyoma should be considered in a pregnant woman with acute onset abdominal pain. The correct diagnosis, based on clinical and radiological findings, is essential for good outcomes concerning maternal and fetal well-being, allowing the safest and most appropriate treatment. A conservative approach seems to be a safe and appropriate first-option treatment to this condition.

Male breast cancer is a rare disease, representing approximately 1% of all breast cancers, but its incidence appears to be increasing over the years. As normal male breast does not develop acini and lobules, lobular carcinoma is very rare, accounting for 1% - 2% of all cases of male breast cancer. Pleomorphic lobular carcinoma is an aggressive variant of invasive lobular carcinoma with only six cases of male breast reported in the literature until now, and none with associated Paget’s disease. We report a case of an invasive pleomorphic lobular carcinoma with axillary lymph node involvement and associated Paget’s disease in a high-risk man. Low awareness among men and a lack of a screening program often lead to a late diagnosis of male breast cancer, and consequently, at a later stages of disease, with lower survival rates compared to women. Early diagnosis is essential in order to improve patient outcomes and achieve better survival rates in men.

This is a case report of intramedullary spinal cord metastasis (ISCM) of a colorectal cancer (CRC). A 67-year-old male with no relevant medical history presented with paresthesias in the lower limbs and paraparesis for 7 days. Thoracic spinal cord magnetic resonance imaging (MRI) demonstrated an oval intramedullary lesion suggestive of metastatic lesion. Primary tumor was a rectosigmoid transition zone invasive adenocarcinoma. He had a rapidly progressive neurological condition and became paraplegic with urinary and fecal incontinence. A conservative approach was performed, with spinal cord radiotherapy and derivate colostomy. The patient died 3 months later. This case report describes ISCM from CRC. Although it represents a rare clinical entity, we must be alert in order to achieve the earliest possible diagnosis trying to preserve the patient's quality of life.