Meningomyelocele is one of the commonest neural tube closure defects. A 2-month-old girl presented with meningomyelocele in the lumbosacral region that had been present since birth. She had experienced paraparesis for 1 month. Terminally, she had excessive crying, and died within 1 week of presentation. An autopsy revealed focally infected meningomyelocele with features of Arnold-Chiari II malformation. Associated malformations included polymicrogyria, neuronal heterotopias and neuronal cytomegaly in the brainstem. Cortical malformations may be detected radiologically, thus prompting surgical intervention and reduced mortality. By contrast, the presence of cytomegaly may hinder postsurgical improvement, affecting intellectual outcome in survivors in particular. New genetic revelations also offer a scope for genetic counselling in these conditions.

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor. Website: www.ijcasereportsandimages.com Multifocal testicular capillary hemangiomaShikha Singhal, Waseem Akhtar, Mabel Das Thyveetil ABSTRACT Introduction: Capillary hemangioma of testis is extremely rare. Less than 20 cases have been reported and all of these were single lesion. To our knowledge this is the first case report of a multifocal testicular capillary hemangioma. Case Report: An elderly patient presented with pain in the right testis. Ultrasound showed a mass in the upper pole with increased vascularity at the periphery of lesion. The left testicle and testicular tumor markers were normal. Radical orchidectomy was performed that showed a well-defined cystic area within the testis. Histology showed an organizing hematoma in the cystic area with benign capillary proliferations in the periphery. There were multiple welldemarcated foci of benign capillary proliferations in the adjacent testicular parenchyma. These proliferative lesions were positive for CD34 and factor VIII. This case was diagnosed as multifocal capillary hemangioma. A review of color Doppler imaging of the right testis showed an area of hypervascularity inferior to the mass lesion that corresponded with multifocal capillary hemangiomas on histology. Conclusion: Vascular neoplasms of testis are rare and mainly reported in young adults. Preoperative imaging and frozen sections are vital for appropriate management of these patients. Conservative management or incomplete excision may cause recurrence or hemorrhage but malignant transformation of these lesions has not been reported. This case of multifocal capillary hemangioma in the testis emphasizes the need for an astute radiological examination with frozen section for the appropriate management of patients with a clinically suspicious testicular mass.

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