Apocrine hydroadenoma mimicking a Morton's neuroma: a rare differential diagnosis. Journal of ultrasound A 62-year-old woman, with neuropathic pain and paresthesia in her right forefoot, showed a circumscribed soft tissue swelling on the sole between the second and third metatarsal. Ultrasound (US) imaging showed a well-defined lesion in the second intermetatarsal space, without vascularization sign at Power Doppler (PD). In the first hypothesis, these findings led to Morton's neuroma. Magnetic Resonance Imaging (MRI), demonstrated a dumbbell-shaped lesion between the II and the III metatarsal heads; it extended cranially to the subcutaneous fat of the dorsal slope. The MRI findings weren't compatible with a classic Morton's neuroma and were radiologically undetectable. The patient had a sub-total excisional biopsy. The anatomopathological features were specific to an apocrine hydroadenoma from an ectopic sweat gland. This rare pathology has not been previously described in the literature and it must be considered as a differential diagnosis due to the clinical presentation and the US appearance mimicking Morton's neuroma. 10.1007/s40477-024-00911-x

A Comprehensive Approach to the Diagnosis and Management of Klippel Feil Syndrome. Archives of Razi Institute Klippel-Feil Syndrome (KFS) is a rare genetic disorder characterized by the abnormal development of the cervical spine, leading to the fusion of two or more cervical vertebrae. The syndrome presents diverse symptoms, including limited neck movement, chronic pain, and neurological manifestations such as limb numbness or weakness. The severity of KFS can vary significantly, and treatment primarily focuses on symptom management and preventing complications such as scoliosis or spinal cord compression. Surgical interventions are often necessary for patients with complex forms of the syndrome. Interestingly, Chiari 1 malformation, a cranial anomaly affecting the brainstem, can coincide anatomically with KFS. In this case report, we present the case of a 9-year-old patient who sought medical attention due to persistent, unchanging neck pain. The patient's medical history was notable for developmental delays and cervical restraint observed during physical examination. Magnetic resonance imaging (MRI) findings revealed hydrocephalus and brainstem descent, indicating the presence of Chiari 1 malformation. Comprehensive MRI and CT scans were performed, and a management plan was formulated, primarily involving cranial surgery and physiotherapy. Implementation of the treatment approach resulted in significant improvement in the patient's symptoms. This case highlights the significance of considering Chiari 1 malformation as a potential comorbidity in patients diagnosed with KFS who present with persistent neck pain. Early detection and appropriate management of both conditions are crucial for achieving favorable outcomes and enhancing the quality of life for affected individuals. Understanding the complex interplay between KFS and Chiari 1 malformation is essential for providing comprehensive care and tailored treatment strategies. Further research is warranted to elucidate the underlying mechanisms linking these two conditions and to explore optimal management approaches for patients with dual pathology. By reporting this case, we contribute to the existing literature and increase awareness among healthcare professionals regarding the potential coexistence of KFS and Chiari 1 malformation. Continued efforts in identifying associated anomalies and optimizing therapeutic interventions will aid in improving patient outcomes and ensuring optimal care for individuals affected by these conditions. 10.32592/ARI.2023.78.6.1868