It is uncommon for schwannomas to present as neck swellings. This case presented as painless, cystic and slow growing neck swelling which was excised. Histopathology proved it to be cystic schwannoma. Cystic change occurs in only 4% of all schwannomas. The cystic change renders the schwannoma to mimic second branchial cyst on clinical and radiological examination. Although modality of treatment remains the same which is extracapsular excision, the follow up differs in terms of recurrence.

Introduction: We present an unusual case of papillary renal cell carcinoma, which is a rare subtype of kidney malignancy. Objective: The present case report emphasizes a voluminous left renal tumoral mass causing bowel obstruction and necessity of emergency surgical intervention. Presentation of case: A 74 year old patient with a history of multiple severe cardiovascular conditions, presented in the emergency room accusing abdominal distension and pain, nausea, vomiting and lack of intestinal transit for about 72 hours. Based on the symptomatology, physical examination and imagistic explorations a clinical diagnosis of bowel obstruction was arisen, caused by a voluminous tumor with compression of the large vessels and invasion of the left colon. Given the severity of the cardiovascular comorbidities and the complexity of the case, the possibility of patient’s transfer to a university hospital was arisen, which was not practicable due to the COVID 19 pandemic. During surgical intervention en-bloc resection of the left kidney and tumoral mass was practiced. Histopathologic examination identified the tumoral mass as type I papillary carcinoma of the left kidney. The postoperative evolution was unfavorable, due to the severe cardiovascular comorbidities, on maximal vasoactive support the patient remained hemodynamically unstable, showed progressive myocardial infarction with the persistence of arrhythmias and severely reduced ejection fraction which led to his unfortunate death. Conclusion: Careful patient selection is needed to ensure a favorable risk-benefit ratio. Also a thorough multidisciplinary evaluation of patient and the possible therapeutic options is necessary, in order to create an optimal and individualized treatment plan.

Objective: A practical approach to determining risk in sedentary and active patients for coronary artery disease. Identify how personal/family history, atherogenic risk factors, and coronary calcium are essential to determining and predicting risk potential. Materials/Methods: Review of the medical, behavioral psychology, and standard of care literature to identify how human psychology, statistical risk of coronary disease, and coronary calcium shape risk prediction. Results: A comprehensive personal/family history, risk factor assessment and comprehensive physical examination are the foundation of risk assessment. Understanding the cognitive process of risk potential is critical to management strategies. Stress testing and coronary calcium scoring are useful adjuncts when initial screening is suggestive of intermediate atherogenic risk. Conclusion: Comprehensive personal/family history, risk factor assessment, comprehensive physical examination, cognitive processing of risk potential, stress testing and calcium scoring all have a role in risk assessment of sedentary and active patients.

Background: Antiphospholipid syndrome (APS) is an acquired, immune-mediated thrombophilia occurring alone (primary APS, PAPS) or in association with other autoimmune diseases, mainly systemic lupus erythematous (SLE), (secondary APS), characterized by recurrent venous or arterial thrombosis and /or pregnancy morbidity in association with antiphospholipid antibodies (aPL) and/or lupus anticoagulant (LA). Case report: A 36-year-old woman was admitted to the hospital because of acute renal failure and thrombocytopenia. This woman presented with an acute illness characterized by a prodrome of respiratory symptoms and fever that were unresponsive to antibiotic therapy, followed by the progressive involvement of multiple organs. There was enzymatic and functional evidence of myocardial necrosis leading to intermittent, severe heart failure, as well as acute renal failure requiring dialysis, laboratory evidence of pancreatic injury, pulmonary infiltrates with respiratory failure, and central nervous system involvement, with confusion. After a renal biopsy was detected a perinephric hematoma and thrombocytopenia. The laboratory criteria for the diagnosis of the antiphospholipid-antibody syndrome are an elevated value for IgG anticardiolipin antibody, a positive test for lupus anticoagulant, and an elevated value for IgM anticardiolipin antibody. Conclusions: This patient has the antiphospholipid antibody syndrome, with an acute thrombotic angiopathy that caused ischemic damage in the myocardium, pancreas, kidneys and lungs. The renal interstitial inflammation is more severe than that expected from the ischemic injury alone and many reflect either a hypersensitivity drug reaction or in view of the dry Sjogren’s syndrome.