Objectives: We sought to compare the epidemiological and clinical features of variant leiomyoma, smooth muscle tumors of uncertain malignant potential (STUMP), and sarcoma to classical leiomyoma and assess the radio-histological correlation.Methods: This retrospective, observational study was conducted in Royal Hospital, Muscat, Oman. We included all patients who underwent surgical treatment for uterine fibroids from 1 January 2011 to 31 December 2016. Data was retrospectively collected from electronic patient records, pictures archiving system, and histopathology reports, and analyzed using SPSS version 29 and MedCalc Statistical Software. Results: Out of the 14269 patients who attended the gynecology outpatient department, 19.5% were clinically diagnosed with uterine fibroids. Surgical procedures were performed in 545 (19.6%) women. Diagnosis from histopathology reports was classical leiomyoma in 508 (93.2%) cases, variant leiomyoma in 35 (6.4%), and sarcomas in two (0.4%); there were no cases of STUMP. Magnetic resonance imaging (MRI) correctly identified 125 (89.9%) cases of classical leiomyoma and 2/11 (18.2%) cases of variants. The sensitivity and specificity of MRI to predict non-classical varieties was 22.22% and 88.65%, respectively. MRI had a strong negative predictive value (94.7%) for leiomyoma variants. The area under the curve for classical and variant leiomyoma was 0.63 (0.55–0.71) and 0.55 (0.47–0.64). The accuracy of MRI in predicting classical leiomyoma was 86.00 (79.40–91.12) and 84.67 (77.87–90.03) the non-classical varieties. Conclusions: Epidemiological and clinical features were not helpful in distinguishing between classical leiomyoma and non-classical varieties. MRI had weak discriminatory power to distinguish between classical and non-classical varieties.

Keywords:Leiomyoma; Magnetic Resonance Imaging; Oman.

Objectives: Obesity poses a significant challenge worldwide, increasing the risk of various metabolic diseases, including type 2 diabetes mellitus (T2DM), hypertension (HTN), and dyslipidemia. Bariatric surgery, specifically a laparoscopic sleeve gastrectomy (LSG), is effective in inducing weight loss, thereby improving the rate of obesity-related metabolic diseases. This study aimed to assess the short-term effectiveness and metabolic effects of LSG procedures among patients in Oman. Methods: This retrospective cohort study was conducted at the Royal Hospital, Muscat, Oman, and included patients who underwent LSG between 1 January 2017 and 31 December 2018. Demographic, clinical, and anthropometric data were collected from the hospital’s computerized records preoperatively and one year postoperatively. Results: A total of 168 patients were included in the study, of whom most were female (66.1%). Before surgery, the mean age was 36.1 years, and the mean body mass index (BMI) was 50.8 kg/m2. In terms of comorbidities, 28.6% had T2DM, 28.6% had HTN, and 20.8% had dyslipidemia. Postoperatively, more than two-thirds of the cohort (n = 132; 78.6%) achieved a target percent excess weight loss (EWL) of > 50%, including 89.5% and 73.0% of male and female patients, respectively (p = 0.014). The percent EWL was positively correlated to preoperative BMI (p < 0.001); however, no significant associations were observed with various comorbidities, including HTN, T2DM, dyslipidemia, and obstructive sleep apnea (p > 0.050). Conclusions: The results of this study indicate that LSG is effective for the short-term achievement of percent EWL among Omani patients with morbid obesity. However, further studies are needed to assess the long-term effectiveness of LSG on percent EWL and its effect on obesity-related metabolic diseases.

Keywords:Obesity, Morbid; Body Mass Index; Diabetes Mellitus, Type 2; Retrospective Studies; Bariatric Surgery; Treatment Outcome; Hypertension; Dyslipidemias; Weight Loss; Oman.

Cases of small bowel obstruction in the virgin abdomen are rare and can pose diagnostic challenges, especially when associated with endocrinopathy. We present a young woman with uncontrolled Graves’ disease who was admitted with a small bowel obstruction in a virgin abdomen a few weeks after developing a thyroid storm.

Keywords:Hyperthyroidism; Thyroid disease; Pseudointestinal Obstruction Syndrome; Oman.

Pericardial-pleural fistula (PPF) may complicate between 0.8–6% of echocardiography-guided pericardiocentesis procedures, but reports are sporadic. A 22-year-old male presented to the general medical ward with underlying end-stage renal disease complicated by secondary hyperparathyroidism with worsening left pleuritic chest pain and shortness of breath for one week. Ultrasonographic investigations revealed global pericardial effusion, with no pleural effusion initially. After echocardiographic-guided pericardiocentesis via the apical approach, the patient developed respiratory distress. Follow-up ultrasound revealed a new pleural effusion with resolved pericardial effusion. The patient recovered with drainage of the pleural effusion. Bacterial and tuberculous cultures were negative, and fluid cytology was benign. Hyperparathyroidism may have contributed to the increased risk of PPF due to pericardial calcification. Clinicians should be aware of the potential risk of PPF after pericardiocentesis in patients with hyperparathyroidism.

Keywords:Pericardial Effusion; Fistula; Hyperparathyroidism.

The artery of Percheron is a rare anatomical variant artery that supplies the bilateral thalami and midbrain. An acute occlusion of the vessel will lead to the presentation of a bilateral thalamic stroke syndrome. The classical presentation includes somnolence and a reduced level of consciousness. Therefore, this clinical entity often goes unrecognized and diagnoses are usually delayed due to the ambiguity of presenting symptoms. We report a case of a man presenting with an acute onset of drowsiness, later diagnosed with a bilateral thalamic infarct only days later due to the vague clinical symptoms. We also highlighted several key learning points from this case and emphasized the importance of recognizing this syndrome.

Keywords:Artery of Percheron; Bilateral Thalamic Stroke; Confusion; Magnetic Resonance Imaging.

Primary squamous cell carcinoma (SCC) of the renal parenchyma without a history of urolithiasis is a rare entity. Renal SCC is usually associated with other conditions like renal stone disease, chronic inflammation, and infection. We report three cases of primary SCC with no history of renal stone disease or identifiable risk factors. We also present a current review of the literature and a detailed description of the morphological features.

Keywords:Kidney; Carcinoma, Squamous Cell; Oman.

Carcinoid tumors are slow-growing tumors that typically occur in the gastrointestinal (GI) tract, lungs, and other endocrine glands. They are commonly discovered incidentally and usually cause no symptoms. When symptomatic, they tend to present with vague abdominal pain and may lead to carcinoid syndrome after metastasis to the liver. Such tumors rarely present with GI bleeding and thus rarely lead to iron deficiency anemia. In this report, we present an uncommon case of a 71-year-old male who presented with fatigue, weakness, intermittent rectal bleeding, and black stools. He was vitally stable but cachectic. Laboratory studies revealed iron deficiency anemia of unknown origin. Initially, a colonoscopy was performed, which only revealed internal hemorrhoids, so an upper endoscopy was scheduled. Upper GI endoscopy revealed a bleeding duodenal nodule in the upper half of the duodenum that was biopsied. Immunohistochemistry revealed a duodenal carcinoid tumor. The lesion was resected endoscopically as the patient was unfit for surgery due to concurrent comorbidities. Abdominal imaging showed no signs of liver metastasis. The patient was followed periodically by the gastroenterology clinic to ensure no recurrence or metastasis, but he eventually succumbed to other comorbidities. This case highlights the challenges in diagnosing and managing this rare presentation in a significantly ill patient with multiple comorbidities. Upon reviewing the literature, we found that it was uncommon for carcinoid tumors of the GI tract to present with bleeding or anemia. Of those reported in the literature to have caused bleeding, the majority were in the stomach or ileum. To the best of our knowledge, this is the first reported case of a duodenal carcinoid tumor presenting with iron deficiency anemia.

Keywords:Carcinoid Tumors; Gastrointestinal Tract; Endoscopy.

Hemangiolymphangioma is a rare malformation of the vascular and lymphatic system affecting different parts of the human body. Hemangiolymphangioma of the small bowel mesentery is extremely rare. We report the case of a 23-year-old woman who presented with generalized colicky abdominal pain. Computed tomography findings were initially thought to represent possible secondary mesenteric and peritoneal metastatic deposits. However, no primary tumor was identified. A pelvic magnetic resonance imaging was then performed, which favored the diagnosis of extensive mesenteric lymphangiomatosis. The diagnosis was confirmed histopathologically as hemangiolymphangioma of the small bowel mesentery.

Keywords:Lymphangioma; Mesentery; Mesenteric Cyst; Small Intestine; Oman.