Nulvin Djebbara-Bozo

Background and Clinical Significance: Melanoma is predominantly a cutaneous malignancy, whereas metastatic involvement of the endometrium is exceptionally rare. Melanoma of unknown primary (MUP) accounts for a small portion of such cases. Patients typically present with abnormal uterine bleeding, and diagnosis can be challenging because metastatic melanoma can mimic other uterine malignancies. We report a rare case of MUP presenting with synchronous endometrial and subcutaneous metastases, a combination not previously reported in the literature. Case Presentation: A multiparous woman in her seventies presented with persistent postmenopausal bleeding. Transvaginal ultrasonography demonstrated endometrial thickening, and endometrial biopsy revealed metastatic melanoma confirmed by immunohistochemical positivity for S100, SOX10, HMB-45, and Melan-A. Positron emission tomography–computed tomography identified fluorodeoxyglucose uptake in the uterine corpus and a metabolically active subcutaneous lesion in the right anterolateral abdominal wall. Surgical excision of the abdominal lesion confirmed metastatic melanoma. Despite extensive investigations, including dermatological examination, ophthalmological assessment, and imaging studies, no primary tumor was identified. The patient underwent hysterectomy followed by adjuvant nivolumab. At 24-month follow-up, no evidence of disease recurrence was detected. Conclusions: Endometrial metastasis of melanoma may occur in the absence of an identifiable primary lesion and should be considered in patients presenting with abnormal uterine bleeding, particularly those with a history of melanoma or unexplained metastatic disease. Because these lesions frequently present as polypoid, nodular, or infiltrative endometrial masses, prompt hysteroscopy and endometrial sampling are essential for diagnosis. This case highlights the importance of comprehensive histopathological evaluation and multidisciplinary management in rare presentations of metastatic melanoma.

Human experience unfolds continuously, yet it is remembered and understood as a sequence of discrete events. How the brain segments this stream of experience, particularly under naturalistic conditions, remains poorly understood. Here we investigate the neural dynamics associated with event boundaries during active navigation through architectural transitions. Using mobile electroencephalography combined with virtual reality, we analyzed data from participants freely walking between rooms and repeatedly crossing doorways. Time-frequency analysis of source-localized neural activity revealed a robust increase in theta-band power (4-8 Hz) over temporo-occipital and parietal regions approximately 300-450 ms after passing through a doorway. This effect was consistent across participants and independent component clusters, indicating a reliable neural signature of architectural transitions. We interpret this theta response within frameworks of event segmentation and Bayesian inference, suggesting that doorways trigger a transient reconfiguration of distributed neural networks when ongoing predictions can no longer be maintained and a new event model must be inferred. By preserving the natural coupling between perception, movement, and environmental structure, our findings demonstrate that architecture provides meaningful boundaries that shape brain dynamics and the organization of experience. More broadly, this work highlights the power of naturalistic experimentation and positions architectural space as an active medium for investigating how the brain structures events.

Purpose: Parastomal hernia is a frequent complication after stoma construction, with increasing incidence over time. Surgical repair is reported with a high recurrence rate and the evidence on the topic is limited. We conducted a retrospective study to evaluate the incidence of recurrence after parastomal hernia repair and assessed the risk factors and predictors for recurrence at the Regional Hernia Center at Horsens Regional Hospital, Denmark. Methods: 119 patients underwent primary parastomal hernia repair from January 2017 until April 2021. Mean follow-up period was 72 months. Information including demographic data, non-modifiable risk factors and modifiable risk factors were assessed and analyzed using LASSO to select relevant predictors and GLM was employed hereafter. Results: Multivariate analysis showed that age, diabetes, IBD, constipation, and fecal incontinence were strong pre-operative predictors, with age, IBD, ileostomy, and colorectal cancer also reaching significance in univariate analyses. Post-operatively, EHS classification 1, and Clavien Dindo Grade 3b were identified as strong predictors in univariate analyses. Conclusion: Recurrence after parastomal hernia repair was 17.64% during a follow-up period of minimum 3.5 years.

Introduction: Traumatic injury of a vascular prosthesis-to-prosthesis anastomosis leading to an extravasation and pseudoaneurysm is rare. If not identified the complications associated with this condition can lead to high morbidity and mortality and require surgical treatment. Case: We describe a patient who presented with a tear in prosthesis-prosthesis anastomosis eight years after implantation resulting in a pseudoaneurysm. The patient had a severe fall prior to the non-symptomatic leakage. The complication was successfully treated by re-lining the graft with a new anastomosis at the Department of Vascular and Endovascular Surgery, Kolding Hospital in Denmark. Discussion: Cause of tear is speculated to be due to weakness at site of reconstruction, fabric degradation, and/or degradation of suture material. Conclusion: Late prosthesis-prosthesis anastomosis tear caused by a traumatic event is rare. In the event of a late tear, anamnesis and histological analysis of involved material is important. Highlights: