Pelvis magnetic resonance imaging to diagnose familial partial lipodystrophy

CONTEXT

The diagnosis of familial partial lipodystrophy (FPLD) is currently made based on clinical judgement.

OBJECTIVE

There is a need for objective diagnostic tools that can diagnose FPLD accurately.

METHODS

We have developed a new method that used measurements from pelvic magnetic resonance imaging (MRI) at the pubis level. We evaluated measurements from a lipodystrophy cohort (n = 59; median age [25-75 percentiles]: 32 [24-44]; 48 females and 11 males) and age- and gender-matched controls (n = 29). Another dataset included MRIs from 289 consecutive patients.

RESULTS

Receiver operating characteristic curve (ROC) analysis revealed a potential cut-point of ≤ 13 mm gluteal fat thickness for the diagnosis of FPLD. A combination of gluteal fat thickness ≤ 13 mm and pubic/gluteal fat ratio ≥ 2.5 (based on a ROC) provided 96.67% (95% Confidence Interval [CI]: 82.78-99.92%) sensitivity and 91.38% (95% CI: 81.02-97.14%) specificity in the overall cohort and 100.00% (95% CI: 87.23-100.00%) sensitivity and 90.00% (95% CI: 76.34-97.21%) specificity in females for the diagnosis of FPLD. When this approach was tested in a larger dataset of random patients, FPLD was differentiated from subjects without lipodystrophy with 96.67% (95% CI: 82.78-99.92%) sensitivity and 100.00% (95% CI: 98.73-100.00%) specificity. When only women were analyzed, the sensitivity and the specificity was 100.00% (95%CI: 87.23-100.00% and 97.95-100.00%, respectively). The performance of gluteal fat thickness and pubic/gluteal fat thickness ratio was comparable to readouts performed by radiologists with expertise in lipodystrophy.

CONCLUSION

The combined use of gluteal fat thickness and pubic/gluteal fat ratio from pelvic MRI is a promising method to diagnose FPLD that can reliably identify FPLD in women. Our findings need to be tested in larger populations and prospectively.

Malignant mesothelioma of tunica vaginalis: an extremely rare case presenting without risk factors

Testicular tumours have many different manifestations, including hydrocele formation. Herein, we present an extremely rare case of testicular mesothelioma presenting with left hydrocele, but without risk factors. Left radical inguinal orchidectomy was performed, and pathological examination revealed a malignant mesothelioma of the tunica vaginalis of the testis. No infiltration of the spermatic cord was evident, and upon advanced radiological evaluation, no sign of metastasis was detected. Follow-up was still ongoing in our urology outpatient clinic at the time of this report. Although hydrocele is a simple and common condition that is easy to diagnose, a detailed investigation should be performed. Thus, when encountering a patient with hydrocele, the clinician should evaluate the possibility of the presence of an underlying testicular/paratesticular tumour, including a rare one such as mesothelioma of the tunica vaginalis.

A rare pattern of lung metastasis of rectum adenocarcinoma

Lung is primary capillary filter of venous drainage for many organs. As a result of this, it is the most common metastasis site of extrapulmonary organ tumours. Cystic and cavitary forms of lung metastases are unusual. In evaluation of patients with these lesions benign and malignant lesions should be distinguished from each other. In this case report, we aimed to present computed tomography findings of an unusual cystic form of lung metastasis that is originated from rectum adenocarcinoma.

Pelvic inflammatory myofibroblastic tumour mimicking scrotal mass: an extremely rare case

Inflammatory myofibroblastic tumour (IMT) is a rare benign mesenchymal tumour. However, IMT may arise from a wide variety of tissues and is very rare in the elderly. IMT may mimic the mass in which it originates. Although IMT has been defined as uncertain behaviour, it is treated surgically. We present a-65-year old man whose mass was diagnosed as IMT extending from scrotum to pelvis. The mass was independent of any surrounding anatomic structures. According to our best knowledge this is the first case in the literature that pelvic IMT was diagnosed in an elderly man and successfully treated surgically with a long term follow-up period. Aetiology of IMT is still unknown, and more studies are needed for exact continuum of IMT.

Bilateral Epididymal Cyst in 14 year-old Boy: a case report

Bilateral epididymal cysts are rare in childhood. Clinically they may present as acute scrotum and should be differentiated from other pathologies. Here in, we report bilateral epididymal cysts in a 14-year-old boy. He was admitted to emergency department with symptoms of acute left scrotum. There was no history of trauma or infection. Blood analyses, including testis tumor markers were unremarkable. Bilateral epididymal cysts were diagnosed on ultrasonography evaluation. Medical treatment did not stop his scrotal pain. During scrotal exploration, there was no evidence of testicular torsion or any other pathology. An excision of cyst was performed. Histopathologically, the cyst wall was lined by columnar epithelia. As a result of these findings, a pathological diagnosis of epididymal cyst was made. The synchronized evaluation of clinical and ultrasonography findings with an appropriate histopathological evaluation can usually diagnose this rare pathology.

Kidney metastasis of invasive ductal breast carcinoma mimicking renal cell carcinoma

A 56-year-old female patient was admitted to the urology outpatient clinic with severe macroscopic hematuria. She was diagnosed with right kidney cancer after clinical and radiological evaluations. Pathology reported a metastasis of invasive ductal breast carcinoma in the right kidney after laparoscopic radical right nephrectomy was performed. After physical and radiological evaluations, she was referred to the Department of General Surgery, and was treated with radical mastectomy and axillary lymph node dissection for breast cancer. She was later referred to the Department of Medical Oncology at our institute for chemotherapy. We aimed for clinicians to be more aware of metastasis to the kidney, and perform regular and thorough breast examination for women every year.

Minimally invasive treatment of iatrogenic complete left ureter obstruction after hysterectomy

The iatrogenic ureter injuries are rare complications and may have serious consequences. The treatment options depend on situations. Pelvic surgeons, keep in mind that this kinds of complications, is very important for diagnosis and treatment, during the surgery. This report presents a case of a patient with iatrogenic left ureteral injury during hysterectomy. The patient visited emergency department of our hospital with the chief complaints of left lomber pain on the 17th day of hysterectomy. After evaluation in emergency clinic, the patient had an endoscopic treatment for iatrogenic ureter injury. The patient is still in follow-up period. We also review the literature and discuss diagnose, treatment, prognosis of iatrogenic ureter injuries. The treatmentoptions are still developing by technology.

Giant breast involvement in acute lymphoblastic leukemia: MRI findings

Breast metastases in cases of leukemia are rare. We aimed to report the conventional-advanced magnetic resonance imaging (MRI) findings of unilateral breast involvement of acute lymphoblastic leukemia (ALL) and review the literature. A 32-year-old woman was first diagnosed with ALL in treated in 2004. She did not continue the follow-up after 2008. She was presented with a giant, progressive right breast palpable mass in 2010. Mass, contralateral breast tissue were evaluated with MRI, diffusion weighted imaging and MR spectroscopy. With MRI findings, lesion was evaluated as malignant, tru-cut biopsy revealed recurrence of ALL. Lymphoma, malignant melanoma, rhabdomyosarcoma are most common tumors metastase to breast. Breast metastases of leukemia are rare and occur primarily in patients with acute myeloid leukemia. Secondary ALL breast involvement is uncommon. In a patient with malignancy, any enlarging breast mass, even with benign radiologic appearance, should be investigated carefully and metastasis should not be forgotten.