Hemangiomas are the most common benign tumors of the liver. Hepatic hemangiomas originate from the proliferation of vascular endothelial cells, and enlarge by ectasia rather than hyperplasia. They are very variable in size and are classified accordingly and their management in the larger variety is debatable. Hypergiant hepatic hemangiomas are defined as those which are more than 10 cm in size. These are fairly uncommon in clinical practice. The treatment spectrum varies from masterly inactivity to resection depending upon a number of factors. We report a series of 10 cases of hyper giant hepatic hemangiomas studied and reviewed over a period of 5 years. These were evaluated with respect to their age, gender, clinical presentation, investigation findings, treatment offered, and final outcome. Five were treated with resection, four with enucleation, and one was kept under observation. All operated patients had an uneventful post-operative recovery and the one managed conservatively was asymptomatic on follow-up.

Background: Spinal intramedullary cysts present a radiological dilemma. We present a rare case of a conus intramedullary arachnoid cyst and report on its differentiating features and management. Case Description: We report a case of a 30-month-old child who presented with decreased gluteal sensation and urinary dribbling for 6 months. Apart from some slowness in walking, the power was normal in all four limbs. Imaging showed a non-enhancing, T2-weighted hyperintense 12 × 8 mm conus intramedullary cyst without any edema. A T12-L1 laminotomy followed by marsupialization of the cyst was done. Histopathology was suggestive of an arachnoid cyst. The postoperative course was uneventful with improvement in muscle strength and achievement of regular milestones. We also present the pertinent review of the literature to date. Conclusion: Intramedullary arachnoid cysts are a rare entity and should form the differential diagnosis for cysts presenting in the conus medullaris. Simple decompressive options may suffice for symptomatic cases and radical excision may be avoided. A high index of suspicion is essential considering the subtle nature of presenting symptoms.

A 52-year-old male presented with upper abdominal pain and intermittent vomiting of a year's duration. Physical examination and clinical chemistry were normal. Upper gastrointestinal endoscopy revealed a submucosal lesion in the pyloroantral region with normal overlying mucosa. Contrast-enhanced computed tomography (CECT) scan of the abdomen (Fig. 1) showed an intramural lesion with low attenuation in the pyloroantral region with obstruction. Endoscopic ultrasound-guided fine-needle aspiration cytology revealed a well-defined hyperechoic submucosal lesion composed of adipose tissue. A limited resection with gastroduodenostomy was done. The operative specimen showed a submucosal lipoma (Fig. 2). Gastric lipomas accounts for 3 % of all benign tumors of the stomach. They are usually asymptomatic but may present with gastric outlet obstruction, hematemesis, or iron deficiency anemia [1,2]. CECT is diagnostic because of the low attenuation factor but does not differentiate liposarcoma. References 1. Bijlani RS, Kulkarni VM, Shahani RB, Shah HK, Dalvi A, Samsi AB. Gastric lipoma presenting as obstruction and hematemesis. J Postgrad Med. 1993;39:42-3. 2. Ramaraj R, Roberts SA, Clarke G, Williams G, Thomas GA. A rare case of iron deficiency. Eur J Gastroenterol Hepatol. 2012;24:82-3.Fig. 1 CECT of the abdomen showing a 3 cm × 2.5 cm × 1.5 cm (arrow) low-attenuation (−89 Hounsfield units) lesion in the pyloroantral region with mild proximal gastric dilatation Fig. 2 Surgical specimen showing the submucosal lesion (thick arrow) and the proximal resection margin (thin arrow)