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Park J, Won H, Park GG, Jeong HJ, Moon C, Jeong J, Lee HB, Kim DH, Jeong SM. Laparoscopic treatment of paraprostatic cyst in two dogs - complete resection, and partial resection with omentalization: a case report. Front Vet Sci 2024; 11:1270819. [PMID: 38650855 PMCID: PMC11033468 DOI: 10.3389/fvets.2024.1270819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/27/2024] [Indexed: 04/25/2024] Open
Abstract
Two intact male dogs were evaluated for symptoms, including hematuria, prostatomegaly, anuria, lethargy, and abdominal mass. Presurgical evaluations, including complete physical examinations, blood examinations, abdominal radiography with contrast (only in Case 2), ultrasonography, and computed tomography and magnetic resonance imaging (only in Case 1), were performed. A paraprostatic cyst was diagnosed initially, and laparoscopic exploration and surgery were performed. Complete resection was performed in case 1, whereas partial resection with omentalization was performed in case 2. Histopathological examination of the tissue samples confirmed the presence of paraprostatic pseudocysts in both cases, with no evidence of an epithelial lining. These two cases represent the first documented instances of laparoscopic treatment for extraparenchymal prostatic cysts. The laparoscopic treatment proved feasible even in the case of a giant cyst causing anuria (Case 2). Paraprostatic cysts should be considered a potential differential diagnosis for abnormal urination accompanied by an abdominal mass, and long-term postoperative follow-up is necessary.
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Affiliation(s)
- Jiyoung Park
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Heungseok Won
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Gyeong Gook Park
- Armed Forces Medical Research Institute, Daejeon, Republic of Korea
| | - Hee Jun Jeong
- Ulsan S Animal Medical Center, Ulsan, Republic of Korea
| | - Changhwan Moon
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jaemin Jeong
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Hae-Beom Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Dae-Hyun Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Seong Mok Jeong
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea
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Sam F, Jacob J, Rabi S. Riedel's Lobe and Beaver Tail Variant: A Cadaveric Case Report. Cureus 2024; 16:e54301. [PMID: 38496200 PMCID: PMC10944315 DOI: 10.7759/cureus.54301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/19/2024] Open
Abstract
Variations of the liver in the form of accessory lobes account for about less than 1%. One of the commonest accessory lobes on the right is Riedel's lobe. An occasional anatomical variant of the left lobe is the beaver tail variant. Both variants are reported to be common in females. We hereby report two cases. A 45-year-old female cadaver was noticed to have Riedel's lobe and beaver tail variant. Riedel's lobe appeared to be a tongue-like projection from the right inferior margin of the liver, almost reaching the level of the iliac crest. It was partially separated from the rest of the liver by a deep fissure. The left lobe was elongated, crossed the midline, and reached the left wall of the abdominal cavity after encircling the spleen. Splenomegaly was noticed, and the left lobe of the liver had a splenic impression. Riedel's lobe was drained by the middle hepatic vein (MHV) and supplied by the right branch of the portal vein (RPV). A similar variation of the beaver tail variant was noticed in an 85-year-old female cadaver. The left lobe of the liver crossed the midline and was related superior to the spleen. The right lobe of the liver and the spleen were normal. The beaver tail variant was drained by the left hepatic vein (LHV) and supplied by the left branch of the portal vein (LPV). These variations are prone to injuries and can be confused with the abdominal mass and could interfere with laparoscopic procedures.
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Affiliation(s)
- Femina Sam
- Anatomy, Christian Medical College, Vellore, IND
| | - Jenny Jacob
- Anatomy, Christian Medical College, Vellore, IND
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Ayesha S, Zaidi SMF, Shahid R, Khan NA, Sohail Rangwala B. Exploring the link between long-term intrauterine contraceptive device usage and abdominal actinomycosis in a middle-aged female: A case report. SAGE Open Med Case Rep 2024; 12:2050313X231222222. [PMID: 38187812 PMCID: PMC10768593 DOI: 10.1177/2050313x231222222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
Actinomycosis is a rare, chronic, and suppurative disease caused by Actinomyces species, which are filamentous, obligate, Gram-positive bacteria. This report presents a case of anterior abdominal actinomycosis in a 40-year-old female with a history of intrauterine contraceptive device placement. The patient presented with severe abdominal pain, an abdominal mass, low-grade fever, and weight loss. Imaging studies revealed thickening of the left rectus abdominis muscle and pericolic fat stranding. An exploratory laparotomy confirmed dense adhesions from the transverse colon and omentum to the abdominal wall with a purulent discharge. Resection of the affected colon segment and primary anastomosis were performed. Histopathological examination revealed characteristic colonies of Actinomyces within abscesses, confirming the diagnosis of actinomycosis. The patient received appropriate antibiotic therapy and showed improvement. This case highlights the rare occurrence of abdominal wall actinomycosis associated with an intrauterine contraceptive device and emphasizes the importance of considering actinomycosis in the differential diagnosis of abdominal pathologies. Thus, medical history related to intrauterine contraceptive device use should be regarded as in differentials if a patient presents vague abdominal mass and pain, and small details in history should be emphasized and looked upon so that a timely decision can be made for the betterment of the patient.
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Affiliation(s)
- Shabih Ayesha
- Department of Neurosurgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, Pakistan
| | | | - Ruqaiya Shahid
- Department of Histopathology, Dow University Hospital, Karachi, Pakistan
| | - Naveed Ali Khan
- Department of Surgery, Dow University Hospital, Karachi, Pakistan
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Akhverdyan N, Mutter M. Malakoplakia of the small intestine presenting as an abdominal mass. J Surg Case Rep 2023; 2023:rjad712. [PMID: 38164217 PMCID: PMC10758245 DOI: 10.1093/jscr/rjad712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024] Open
Abstract
Malakoplakia is a rare chronic granulomatous disease that typically involves the urinary and gastrointestinal tracts of immunocompromised individuals. Characteristic histologic features include von Hansemann cells and Michaelis-Gutmann bodies. Clinical manifestations, based on the organ system effected, range from cutaneous lesions, irritative urinary symptoms, and hematochezia. We report a rare example of malakoplakia presenting as an abdominal mass with extensive intestinal and pelvic involvement complicated by a superficial polymicrobial abscess. This case report aims to describe the proposed pathogenesis, variable clinical presentation, and surgical management of malakoplakia.
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Affiliation(s)
- Nazar Akhverdyan
- School of Medicine, University of Colorado, Aurora, CO 80045, United States
| | - Marina Mutter
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO 80045, United States
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Al Laham O, Adi A, Alaitouni A, Sharaf Aldeen R, Alshiekh A, Hamed H. An enormous benign primary retroperitoneal mucinous cystadenoma: a case report and literature review of a seldom seen abdominal pathology. Ann Med Surg (Lond) 2023; 85:5736-5741. [PMID: 37915663 PMCID: PMC10617834 DOI: 10.1097/ms9.0000000000001335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/08/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction and importance Retroperitoneal neoplasia comprise less than 2% of all tumours. benign primary retroperitoneal mucinous cystadenoma (PRMC) is an extremely rare tumour. Their clinical course is overall silent unless the patient presents with a vague abdominal or pelvic pain, abdominal distention, or a palpable mass. Their aetiology remains theorized and since 1989, only 46 cases (excluding ours) worldwide were documented in the literature. The majority of cases were discovered in females but the overall tumour incidence rate is still undetermined due to its rarity. Well-timed recognition of this pathology permits the necessary curative surgical intervention to take place. Case presentation We hereby illustrate the rare case of a 23-year-old female who presented to the surgical clinic complaining solely of an unexplained gradual increase of the abdominal contour. Their presurgical radiological analysis yielded an intraabdominal large-sized well-demarcated retroperitoneal mass. Clinical discussion Thorough resection of the mass was accomplished via open surgery. The subsequent microscopic analysis of excised tumour yielded the diagnosis of primary retroperitoneal mucinous cystadenoma of benign nature. Conclusion Primary retroperitoneal mucinous cystadenoma is a seldom seen tumour. The scarcity of its occurrence is further highlighted by the published data. Based on their conclusive review of the available published English-based literature, ours is the 47th documented case of a benign PRMC and it is the first documented case from our country; Syria. The impact of these findings warrants raising awareness on the subject and considering PRMC as a differential diagnosis when presented with a similar case in the clinical practice.
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Affiliation(s)
- Omar Al Laham
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic
| | - Amir Adi
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Radiology, Al Assad University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
| | - Aliaa Alaitouni
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Pathology, Al Assad University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
| | - Rahaf Sharaf Aldeen
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Surgery, Al-Mouwasat University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Surgery, Al Assad University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
| | - Ali Alshiekh
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Surgery, Al-Mouwasat University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Surgery, Al Assad University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
| | - Hamoud Hamed
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Surgery, Al Assad University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
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Villa G, Wang SS. Patient-Friendly Summary of the ACR Appropriateness Criteria®: Pulsatile Abdominal Mass, Suspected Abdominal Aortic Aneurysm. J Am Coll Radiol 2023:S1546-1440(23)00713-5. [PMID: 37805011 DOI: 10.1016/j.jacr.2023.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/29/2023] [Indexed: 10/09/2023]
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7
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Ghazwani SM, Arishi HM, Dhayhi NS, Shami MO, Gosadi IM, Rajab M, Badedi M, Mobarki M, Alhazmi AH. Pediatric Gastrointestinal Basidiobolomycosis: A Retrospective Study from Jazan Province, Saudi Arabia. Infect Drug Resist 2023; 16:4667-4676. [PMID: 37484908 PMCID: PMC10362874 DOI: 10.2147/idr.s416213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum, and its incidence is poorly understood due to its rarity. Gastrointestinal Basidiobolomycosis (GIB) is an uncommon presentation with limited reports in Saudi Arabia. This retrospective study aims to describe risk factors, clinical findings, diagnosis, and management of GIB in the pediatric population. Methods We conducted a retrospective analysis of all pediatric patients diagnosed with GIB at a tertiary hospital between 2010 and 2022. Patients were identified based on their diagnosis of GIB. A self-administered questionnaire was distributed to assess risk factors associated with GIB. Results We analyzed 25 cases of pediatric GIB, with approximately half of the cases (56%) occurring during the COVID-19 pandemic. The mean age of affected patients was 6.6 years, with a male predominance (60%, n=15). About 100% of parents acknowledged gecko existence in their residence, and their children were exposed to insect bites. Poor appetite was reported in all patients, and high counts of eosinophils and erythrocyte sedimentation rate were observed. Thrombocytosis was present in approximately 90% of patients, and 87% had anemia. Abdominal computerized tomography scans and ultrasound-guided biopsies were the most used diagnostic tools, with cases being diagnosed based on histopathological findings and confirmed via fungal culture. Conclusion Our study provides valuable information on the potential risk factors, clinical features, diagnosis, and management of pediatric GIB in the Jazan region. The observed increase in cases during the COVID-19 pandemic highlights the need for continued surveillance and research to understand better the epidemiology and associated risk factors with this rare fungal infection. These findings emphasize the need for heightened awareness, early detection, and effective prevention strategies to mitigate the impact of pediatric GIB.
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Affiliation(s)
- Salman M Ghazwani
- Department of Surgery, Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
- Department of Pediatric Surgery, King Fahad Central Hospital, Jazan, 82666, Saudi Arabia
| | - Haidar M Arishi
- Pediatric Infectious Diseases Unit, King Fahad Central Hospital, Jazan, 82666, Saudi Arabia
| | - Nabil S Dhayhi
- Pediatric Infectious Diseases Unit, King Fahad Central Hospital, Jazan, 82666, Saudi Arabia
| | - Mohammed O Shami
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | - Ibrahim M Gosadi
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | - Moutaz Rajab
- Department of Pediatric Surgery, King Fahad Central Hospital, Jazan, 82666, Saudi Arabia
- Department of General Surgery, Pediatric Surgery Unit, Faculty of Medicine, Cairo University, Cairo, 4240310, Egypt
| | - Mohammed Badedi
- Administration of Research and Studies, Jazan Health Affairs, Jazan, 82611, Saudi Arabia
| | - Mousa Mobarki
- Department of Pathology, Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | - Abdulaziz H Alhazmi
- Department of Microbiology and Parasitology, Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
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8
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Peitsidis P, Iavazzo C, Tsikouras P, Gkegkes ID. Pelvic splenosis: A systematic review of the literature. Clin Ter 2023; 174:379-385. [PMID: 37378510 DOI: 10.7417/ct.2023.2453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Background Splenosis is the presence of ectopic autotransplantation of splenic tissue in various compartments of the human body, occurring after rupture of the splenic parenchyma. Methods A systematic PubMed and Scopus search was conducted. Results The mean age of the patients was 51.7 years. The majority of patients were of female gender. An emergency presentation was noted in 30 out of 85 patients, having abdominal pain as main symptom. The principal reason for splenectomy were traffic accidents. The time span between splenectomy and the initial symptoms ranged between 1 and 57 years. The most frequent symptom at presentation of pelvic splenosis was abdominal pain. Almost a quarter of the included patients were without any symptom. Presence of extrapelvic splenosis was de-scripted in almost half of the included patients. With regards to the type of treatment provided, exploratory laparotomy, laparoscopic surgical exploration / laparoscopy, robotic removal of splenium and watchful waiting, were performed in 35 (41.2%), 32 (37.6%), 3 (3.5%) and 15 (16.3%) patients, respectively. No fatality was reported. Conclusion Pelvic splenosis is a rare clinical condition. It may mimic several clinical conditions and mislead diagnosis. The clinical history of splenectomy for trauma or different other reasons may es-tablish diagnosis and exclude other morbidities. Excision and complete removal of pelvic splenosis nodules is not always necessary and it depends on the clinical symptomatology. Careful imaging and precise assessment with the assistance of nuclear medicine may lead to correct diagnosis and avoid unnecessary surgical interventions.
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Affiliation(s)
- P Peitsidis
- REA Hospital, Athens, Greece
- Department of Midwifery University of West Attica, Athens, Greece
| | - C Iavazzo
- Gynaecological Oncology De-partment, Metaxa Cancer Hospital, Piraeus, Greece
| | - P Tsikouras
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Greece
| | - I D Gkegkes
- Department of Colorectal Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Athens Colorectal Laboratory, Athens, Greece
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Baisakh P, Baisakh MR, Kumari BS, Mohanty BB, Panda DK, Pradhan S. Diagnostic Accuracy of Ultrasonography-Guided Fine Needle Aspiration Cytology in Abdominopelvic Masses: A Prospective Study. Cureus 2023; 15:e41228. [PMID: 37529517 PMCID: PMC10387379 DOI: 10.7759/cureus.41228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/03/2023] Open
Abstract
Introduction Accurate diagnosis of deep-seated abdominopelvic masses is crucial to distinguish malignant from non-malignant lesions for proper treatment and prognosis. Ultrasonography-guided fine needle aspiration cytology (USG-FNAC) is a cost-effective and straightforward procedure that offers rapid diagnosis, facilitating early initiation of treatment. This study aimed to determine the diagnostic accuracy of USG-FNAC in comparison to the biopsy diagnosis of various abdominopelvic masses in a resource-limited setting. Materials and methods This prospective study enrolled 208 patients with clinically and ultrasonographically confirmed abdominopelvic masses over two years. Of these, 64 cases were excluded from the study because of the non-availability of biopsy specimens. The remaining 144 cases comprised 88 males and 56 females, with a male-to-female ratio of 1.57:1. Patients' ages ranged from 1.5 to 65 years, with most male patients aged 51 to 60 years and female patients aged 41 to 50 years. USG-FNAC was performed on these patients using a 22G spinal needle and a 10cc disposable syringe, and no complications were reported during the procedure. The cytological findings were compared to histopathological results when available. Dry smears were stained with May-Grunwald-Giemsa stain, while fixed smears were stained with Papanicolaou stain for cytological investigation. Results A total of 144 cases had both cytological and histological specimens available for comparison. The overall diagnostic accuracy of USG-FNAC was 90.97%, with 91.8% sensitivity for malignant lesions, 83.33% for benign lesions, and 85.7% for inflammatory lesions. Conclusions USG-FNAC provides high diagnostic accuracy for abdominopelvic masses, making it a valuable diagnostic tool in resource-limited settings. The technique allows for rapid diagnosis, triaging specimens for ancillary immunohistochemical and molecular studies, and in many cases, obviates the need for more expensive and time-consuming procedures like laparotomy and open biopsy.
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Affiliation(s)
- Pratima Baisakh
- Anatomy, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, IND
| | | | - B Shanta Kumari
- Anatomy, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, IND
| | - Biswa B Mohanty
- Anatomy, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, IND
| | - Dhiren K Panda
- Anatomy, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, IND
| | - Swagatika Pradhan
- Anatomy, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, IND
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Limaiem F, Hajri M. A rare pancreatic neoplasm in a 40-year-old male patient. Clin Case Rep 2023; 11:e7387. [PMID: 37220514 PMCID: PMC10199812 DOI: 10.1002/ccr3.7387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/07/2023] [Accepted: 05/03/2023] [Indexed: 05/25/2023] Open
Abstract
Key Clinical Message The differential diagnoses of solid pseudopapillary neoplasm of the pancreas include cystic pancreatic neuroendocrine tumor, acinar cell carcinoma, and pancreatoblastoma. Abstract Solid pseudopapillary neoplasm (SPN) is a low-grade malignant pancreatic tumor which accounts for 0.9%-2.7% of all exocrine pancreatic neoplasms. It predominantly affects young females (90%) and less frequently occurs in male patients. Its prognosis after surgical resection remains excellent. Herein, we report a case of SPN in a male patient.
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Affiliation(s)
- Faten Limaiem
- Tunis Faculty of MedicineUniversity of Tunis El ManarTunisTunisia
- Department of PathologyUniversity Hospital Mongi SlimLa MarsaTunisia
| | - Mohamed Hajri
- Tunis Faculty of MedicineUniversity of Tunis El ManarTunisTunisia
- Department of SurgeryUniversity Hospital Mongi SlimLa MarsaTunisia
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David Aulestia J, Piedra J, Guachilema Ribadeneira A, Remache V, Vasconez C, Arias G. Solitary mesenteric fibromatosis in a male patient: clinical case report. J Surg Case Rep 2023; 2023:rjad240. [PMID: 37192873 PMCID: PMC10182391 DOI: 10.1093/jscr/rjad240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/04/2023] [Indexed: 05/18/2023] Open
Abstract
Mesenteric fibromatosis is a rare tumor that grows slowly and asymptomatically and is more frequent among men. The risk factors described in the literature may not be present in all cases. The clinical presentation is variable and depends on the localization of the tumor and the involvement of surrounding structures. Imaging studies such as abdominal computed tomography and magnetic resonance imaging are the preferred methods for the diagnosis of this tumor. However, a definitive diagnosis is made based on histopathology and immunohistochemistry results. Surgical resection remains the preferred option for the treatment of mesenteric fibromatosis. This report presents a clinical case of mesenteric fibromatosis in a male patient who presented with partial abdominal obstruction and the absence of risk factors for mesenteric fibromatosis.
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Affiliation(s)
| | - Jorge Piedra
- Cirugía General, Hospital de Especialidades Eugenio Espejo, Quito 170803, Ecuador
| | - Alex Guachilema Ribadeneira
- Correspondence address. Cirugía General, Hospital General Enrique Garces, Quito 170131, Ecuador. Tel: +593979171311; Fax: 234218; E-mail:
| | - Veronica Remache
- Anatomía Patológica, Hospital de Especialidades Eugenio Espejo, Quito 170803, Ecuador
| | - Carla Vasconez
- Médico, Hospital General Enrique Garces, Quito 170131, Ecuador
| | - Grace Arias
- Posgrado de Cirugía General y Laparoscópica, PUCE, Quito 170143, Ecuador
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12
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Janike K, Pan A, Kheirkhah P, Shuja A. Isolated Cecal Necrosis Mimicking a Colonic Mass. ACG Case Rep J 2023; 10:e01030. [PMID: 37234999 PMCID: PMC10208693 DOI: 10.14309/crj.0000000000001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 03/14/2023] [Indexed: 05/28/2023] Open
Abstract
Isolated cecal necrosis (ICN) is a rare form of ischemic colitis that can mimic conditions such as appendicitis, malignancy, or diverticulitis. Most cases of ICN have been identified in patients with significant comorbidities that increase risk of vascular disease. We present a case of ICN mimicking a mass lesion in an elderly patient with few comorbid conditions. Although computed tomography was concerning for colonic mass, diagnostic colonoscopy revealed ischemic colon. The patient underwent right hemicolectomy, and pathology confirmed ICN. It is important to recognize conditions ICN can mimic, understand ICN can present without acute abdomen, and consider ICN in the differential diagnosis even in relatively healthy patients without a history of vascular disease.
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Affiliation(s)
- Katherine Janike
- Department of Internal Medicine, University of Illinois at Chicago, Chicago, IL
| | - Alexander Pan
- Department of Gastroenterology, University of Illinois at Chicago, Chicago, IL
| | - Pouyan Kheirkhah
- Department of Pathology, University of Illinois at Chicago, Chicago, IL
| | - Asim Shuja
- Department of Gastroenterology, University of Illinois at Chicago, Chicago, IL
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Muacevic A, Adler JR, Alderazi AE, Almahari SAI, Alawadhi AM. Gastrointestinal Stromal Tumor Recurrence Presenting as a Small Bowel Obstruction: A Case Report. Cureus 2023; 15:e33806. [PMID: 36655152 PMCID: PMC9841066 DOI: 10.7759/cureus.33806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2023] [Indexed: 01/18/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the alimentary tract in adults. The most common site is the stomach, followed by the small intestine. The clinical presentation varies from an incidental finding in asymptomatic patients to a large palpable mass causing complications such as bowel obstruction or viscus perforation. The best imaging modality is a CT scan of the abdomen. Treatment is determined by the size and location of the GISTs. Surgical intervention is considered for resectable tumors, while tyrosine kinase inhibitor therapy is considered for irresectable, metastatic, or recurrent GISTs. In this case report, we present a 30-year-old female who is a known case of gastric GIST and liver metastases. She presented to the emergency department with intestinal obstruction secondary to a recurrent GIST abdominal mass and underwent emergency laparotomy for mass resection. Following surgery, the patient developed aspiration pneumonia, which was treated with proper antibiotics. She was discharged in stable clinical condition with a recommendation to start alternative tyrosine kinase therapy. GISTs are difficult to diagnose preoperatively, as most patients are asymptomatic, and they may present with complications, as in our case, a small bowel obstruction. A proper imaging modality will guide the physician toward the diagnosis, but the final diagnosis will be achieved by biopsy. The diagnosis may be challenging, as small bowel obstruction has many causes, although GISTs should be kept in mind as one of the deferential diagnoses.
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14
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Gkegkes ID, Fotiou A, Mavroeidis VK, Gerogiannis IN, Iavazzo C. Pancreatic endometriosis: a systematic review. Ann Gastroenterol 2023; 36:61-67. [PMID: 36593814 PMCID: PMC9756029 DOI: 10.20524/aog.2023.0760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 07/07/2022] [Indexed: 01/04/2023] Open
Abstract
Background Extrapelvic manifestations of endometriosis can be identified in nearly every part of the female body, and the true prevalence of extrapelvic locations is unknown. Pancreatic endometriosis may manifest in several ways, ranging from emergency presentations to asymptomatic cysts. Method A systematic PubMed and Scopus search was conducted. Results Eighteen patients from 17 case reports were included. The patients' mean age was 39.3 (range: 21-72) years. An emergency presentation was noted in 8 of the 18 (44.4%) patients. Menstrual irregularity was present in 3 (16.7%) patients, while in 3 (16.7%) cases there was simultaneous presence of endometriosis elsewhere. The most frequent symptoms at presentation of pancreatic endometrial cysts were epigastric pain, acute left upper quadrant pain, back pain, nausea/vomiting/diarrhea, which occurred in 12 (66.7%), 11 (61.1%), 4 (22.2%), and 6 (33.3%) patients, respectively. Only one case presented as an asymptomatic pancreatic cyst. The maximum diameter of the endometrial cysts ranged from 1-16 cm. In the majority of cases, surgical treatment was offered (16/18, 88.9%). Recurrence of pancreatic endometrial cyst occurred in one case only, following needle aspiration of the endometrial cyst. No fatality was reported. Conclusions Review of the available published literature suggests that pancreatic endometriosis is a rare condition that should be included in the differential diagnosis of pancreatic masses. Further clinical and experimental studies are necessary to investigate the pathogenesis of extrapelvic and pancreatic endometriosis.
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Affiliation(s)
- Ioannis D. Gkegkes
- Department of Colorectal Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK (Ioannis D. Gkegkes)
- Athens Colorectal Laboratory, Athens, Greece (Ioannis D. Gkegkes)
| | - Alexandros Fotiou
- Gynaecological Oncology Department, Metaxa Cancer Hospital, Piraeus, Greece (Alexandros Fotiou, Christos Iavazzo)
| | - Vasileios K. Mavroeidis
- Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, London, UK (Vasileios K. Mavroeidis)
| | - Ioannis N. Gerogiannis
- Department of General and Emergency Surgery, Kingston Hospital NHS Foundation Trust, Kingston, Greater London, UK (Ioannis N. Gerogiannis)
| | - Christos Iavazzo
- Gynaecological Oncology Department, Metaxa Cancer Hospital, Piraeus, Greece (Alexandros Fotiou, Christos Iavazzo)
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15
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Abstract
Mesenteric and omental cysts can be seen at any age, with one in three cases seen in patients under 15 years old. These cysts represent one in 20,000 pediatric admissions. Here we share the case of a five-year-old female patient at a health center in a developing country, with the purpose of contributing to documentation in the region.
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Affiliation(s)
- Pedro Sureda
- Pediatric Surgery, Torre Profesional Corazones Unidos, Santo Domingo, DOM
| | - Rafael Mena Canto
- Pediatrics and Neonatology, Centro de Obstetricia y Ginecologia, Santo Domingo, DOM
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16
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Scott TN, Swenson CL, Stein L, Agnew DW. What is your diagnosis? Abdominal mass from a dog. Vet Clin Pathol 2022; 51:591-594. [PMID: 35254672 DOI: 10.1111/vcp.13082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 09/24/2021] [Accepted: 10/05/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Tiffany N Scott
- Department of Pathobiology and Diagnostic Investigation, Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Cheryl L Swenson
- Department of Pathobiology and Diagnostic Investigation, Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Leah Stein
- Department of Pathobiology and Diagnostic Investigation, Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Dalen W Agnew
- Department of Pathobiology and Diagnostic Investigation, Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
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17
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Muacevic A, Adler JR. Solid Pseudopapillary Epithelial Neoplasm of the Pancreas in the Paediatric Population: A Report of Two Cases. Cureus 2022; 14:e29805. [PMID: 36337824 PMCID: PMC9620738 DOI: 10.7759/cureus.29805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
A rare pathology, the solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas accounts for approximately 1% of pancreatic neoplasms. Initially called ‘Frantz’s tumour’, it has now been renamed to SPEN by the World Health Organization (WHO). This tumour has a predilection for females and a good prognosis with surgical excision being the treatment of choice. Palpable abdominal masses in children are of significant clinical importance. Identifying cystic lesions in the pancreas from CT or MRI scans always warrant further investigations. Primary pancreatic neoplasms account for 0.1% of pancreatic tumours in the paediatric population; an extremely rare circumstance constituting a diagnostic and therapeutic challenge to surgeons. This article comprises two paediatric cases of SPEN in 14- and 11-year-old females, respectively, and a literature review on current management.
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18
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Dai Y, Luo HJ, Peng Y, Liu BG, Jin P. High intensity focused ultrasound for large abdominal wall endometriosis: a case report. Int J Hyperthermia 2022; 39:1276-1282. [PMID: 36137606 DOI: 10.1080/02656736.2022.2126902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Abdominal wall endometriosis(AWE)is an unusual extra-pelvic endometriosis. Currently, multiple treatment modalities are available, but no clear guidelines exist for the management of large AWE. MATERIALS AND METHODS We present a 36-year-old female patient with a large AWE lesion who underwent cesarean section due to abnormal fetal position 8 years ago. The mass lesion of AWE located in rectus muscle fascia and rectus muscle with a size of 61 × 25 × 49mm. RESULTS HIFU treatment was completed in one session. One day post-HIFU MRI showed the mass was completely ablated. After HIFU treatment, the cyclical abdominal pain disappeared. The mass lesion shrank during follow-up period and disappeared in 1 year after HIFU. No complication was observed after HIFU. CONCLUSION Surgical resection of AWE remains the standard of care. In patients with large AWE lesion located in rectus muscle fascia and rectus muscle where the muscle and fascia must be excised, HIFU treatment should be considered to avoid mesh implantation.
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Affiliation(s)
- Yu Dai
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Guangdong, China
| | - Huang-Jin Luo
- Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Guangdong, China
| | - Yan Peng
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Guangdong, China
| | - Bing-Guang Liu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Guangdong, China
| | - Ping Jin
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Guangdong, China.,Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Guangdong, China
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19
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Agarwal AN, Chandler B, Dallas SD, Wiederhold NP, Cañete-Gibas C, Mais DD. The Brief Case: Histoplasma duboisii-an Infection with a Rare Organism Presenting as an Abdominal Mass. J Clin Microbiol 2022; 60:e0120121. [PMID: 35856696 DOI: 10.1128/jcm.01201-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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20
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Agarwal AN, Chandler B, Dallas SD, Wiederhold NP, Cañete-Gibas C, Mais DD. Closing the Brief Case: Histoplasma duboisii-an Infection with a Rare Organism Presenting as an Abdominal Mass. J Clin Microbiol 2022; 60:e0120221. [PMID: 35856699 DOI: 10.1128/jcm.01202-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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21
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Saraf P, Bharti J, Elhence P, Pandey H. GIANT ADRENAL GANGLIONEUROMA AND MYELOLIPOMA: A RARE CASE OF COLLISION TUMOR. Acta Endocrinol (Buchar) 2022; 18:379-382. [PMID: 36699157 PMCID: PMC9867824 DOI: 10.4183/aeb.2022.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background An adrenal collision tumor is a rare entity. We present a rare combination of giant adrenal ganglioneuroma (GN) and myelolipoma. GN is a rare benign tumor of the adrenal medulla that originates from primitive neural crest cells, while myelolipoma is a benign tumor of the adrenal cortex comprising of mature adipose tissue and blood components. Case Report We present a case of a 52-year-old male who presented with generalized body swelling with episodes of vomiting and diarrhea. There was no history of abdominal pain or any significant history. Routine laboratory investigations and endocrine workup were within normal limits. MRI was performed for unexplained symptoms, and which revealed a solid homogeneous mass measuring 9x7x4.5cm arising from the adrenal gland. A diagnosis of myxoid adrenocortical neoplasm was suggested, and laparoscopic left adrenalectomy was performed based on imaging findings. The final diagnosis of coexisting giant adrenal GN with myelolipoma was made on histopathological examination, which was further confirmed by immunohistochemistry. Conclusion Ganglioneuroma coexistence with myelolipoma is a rare finding in the adrenal gland. Therefore, histopathology is imperative in such cases for a definitive diagnosis.
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Affiliation(s)
- P. Saraf
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, India
| | - J.N. Bharti
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, India
| | - P. Elhence
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, India
| | - H. Pandey
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, India
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22
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Parasar K, Mohan S, John AG, Nigam J, Anand U, Jha CK. Giant Adrenal Pseudocysts: An Enigma for Surgeons. Surg J (N Y) 2022; 8:e112-e116. [PMID: 35252569 PMCID: PMC8894084 DOI: 10.1055/s-0042-1744153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 01/31/2022] [Indexed: 11/05/2022] Open
Abstract
Adrenal pseudocysts are cystic lesions arising within the adrenal gland enclosed by a fibrous connective tissue wall that lacks lining cells. They can attain a huge size and pose a diagnostic challenge with a broad range of differentials including benign and malignant neoplasms. There are only a few small case series and case reports describing these lesions. We report a series of five patients who presented with “indeterminate” abdominal cystic lesions and were later on found to have adrenal pseudocyst. Four out of five patients presented with non-specific abdominal symptoms, and one patient presented with symptoms suggestive of a functional adrenal tumor. The size of these tumors ranged from 6 to 30 cm. They had variable radiological features and in two cases even a percutaneous biopsy could not establish the diagnosis. In four of these “indeterminate” abdominal masses, an adrenal origin was not suspected preoperatively. Surgical excision provided a resolution of symptoms, ruled out malignancy, and clinched the diagnosis.
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Affiliation(s)
- Kunal Parasar
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Shantam Mohan
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna, Bihar, India.,Department of Gastroenterology, Saroj Madan Gastro and Liver Clinic, Patna, Bihar, India
| | - Aaron George John
- Department of Gastroenterology, Saroj Madan Gastro and Liver Clinic, Patna, Bihar, India
| | - Jitendra Nigam
- Department of Pathology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Utpal Anand
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Chandan Kumar Jha
- Department of General Surgery, All India Institute of Medical Sciences, Patna, Bihar, India
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23
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Grcevich LO, O'Connell A, Jabaay MJ, Scott JT. Postmenopausal Uterine Leiomyomas and Chronic Lymphadenopathy: Exploring Epigenetic Changes and Pathophysiology. Cureus 2021; 13:e18274. [PMID: 34722052 PMCID: PMC8545538 DOI: 10.7759/cureus.18274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/25/2021] [Indexed: 12/05/2022] Open
Abstract
Uterine leiomyomas (LM) are tumors arising from the non-neoplastic proliferation of smooth muscle cells within the myometrium. Like benign tumors, LM are not generally spread through the lymphatic system, and therefore should not be associated with lymphadenopathy. Herein, we present a case of a 60-year-old female who presented to the clinic with postmenopausal bleeding in the setting of sonographically evident uterine LM and abdominal lymphadenopathy. A lymph node biopsy revealed plasma cells and an eosinophilic material presumptively diagnosed as amyloid. She then underwent an abdominal hysterectomy for definitive treatment of LM. Surgical pathology confirmed the clinical diagnosis of uterine and cervical leiomyoma. Current literature suggests that genetic and epigenetic abnormalities contribute to the pathogenesis of LM in addition to hormonal signals such as estrogen and progesterone. It is unusual for LM to occur in post-menopausal women due to reduced hormonal influence. Therefore, this case explored an alternative mechanism of tumor proliferation. This case hypothesizes that genetic mutations and epigenetic changes resulting from chronic inflammatory offenses contributed to LM growth and lymphadenopathy.
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Affiliation(s)
- Leah O Grcevich
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Alexis O'Connell
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Maxwell J Jabaay
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
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24
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Bin Saqyan TM, Basunbul LI, Badahdah AA, Saleh YA, Filimban SS, Alwabari AA, Almutairi AA, Alanazi SR, Alghamdi AS, Aldadi BO, Alghamdi BA, Alzahrani SA, Alzahrani AR, Alghamdi OH, Alshammari M. Abdominal Pseudocyst: A Rare Complication of Ventriculoperitoneal Shunts. Cureus 2021; 13:e18956. [PMID: 34815902 PMCID: PMC8606019 DOI: 10.7759/cureus.18956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/05/2022] Open
Abstract
We present the case of a 69-year-old man patient who was brought with a history of gait disturbances, memory impairment, and urinary incontinence with gradual worsening over the past six months. The patient underwent magnetic resonance imaging of the brain which demonstrated enlarged ventricles, widening of the Sylvian fissure, and narrow sulci at the vertex. Subsequently, the patient underwent a lumbar puncture which revealed a normal opening pressure with normal cerebrospinal fluid analysis. The diagnosis of normal pressure hydrocephalus was established. The patient underwent a ventriculoperitoneal shunt for the management of his symptoms. Three years after the placement of the shunt, the patient was brought to the emergency department with an expanding right-sided subcutaneous abdominal mass. A computed tomography scan of the abdomen showed the subcutaneous mass superficial to the right rectus muscle and was containing the coiled distal end of the shunt. Such findings were consistent with a subcutaneous cerebrospinal fluid pseudocyst. The mass was aspirated and the fluid analysis was in keeping with the cerebrospinal fluid characteristics. The fluid culture revealed no bacterial growth. The ventriculoperitoneal shunt was replaced with a minimally invasive technique.
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Affiliation(s)
- Turki M Bin Saqyan
- College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, SAU
| | | | | | - Yasir A Saleh
- College of Medicine, Umm Al Qura University, Mecca, SAU
| | | | | | | | | | | | | | | | | | | | | | - Malak Alshammari
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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25
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Piombino E, D'Agata C, Picardo MC, Caltavuturo C, Magro G, Colarossi C, Memeo L. Sclerosing Mesenteritis, a Rare Cause of Mesenteric Mass in a Young Adult: A Case Report. Front Surg 2021; 8:722312. [PMID: 34490340 PMCID: PMC8417936 DOI: 10.3389/fsurg.2021.722312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/27/2021] [Indexed: 11/20/2022] Open
Abstract
Sclerosing mesenteritis (SM) is a rare fibroinflammatory disorder that involves mesenteric adipose tissue, more frequently localized in the small intestine, with an insidious clinical presentation having symptoms related to mass effect, usually resulting in bowel obstruction, mesenteric ischemia, as well as rapid weight loss. We report a case of a 23-year-old male presenting with palpable abdominal mass, mesogastric pain, and a history of rapid weight loss, who underwent exploratory laparoscopy. A hemorrhagic and gelatinous nodular tumor mass of the mesentery was identified and the surgical procedure was converted to a laparotomic approach. Histologically, the mass was composed of a proliferation of bland-looking spindle cells with slightly eosinophilic cytoplasm and elongated normochromatic nuclei with mild nuclear atypia, haphazardly set in a collagenized stroma; fat necrosis and inflammatory cells (lymphocytes, plasma-cells, and histiocytes) were also evident. The diagnosis of sclerosing mesenteritis was made. Our case emphasizes that histology remains pre-eminent for a correct diagnosis of SM, as pre-operative radiological-based diagnosis is non-specific.
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Affiliation(s)
- Eliana Piombino
- Pathology Unit, Department of Experimental Oncology, Mediterranean Institute of Oncology, Catania, Italy
| | - Costanza D'Agata
- Surgical Oncology Unit, Department of Experimental Oncology, Mediterranean Institute of Oncology, Catania, Italy
| | - Maria Carolina Picardo
- Surgical Oncology Unit, Department of Experimental Oncology, Mediterranean Institute of Oncology, Catania, Italy
| | - Claudia Caltavuturo
- Radiology Unit, Department of Experimental Oncology, Mediterranean Institute of Oncology, Catania, Italy
| | - Gaetano Magro
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, University of Catania, Catania, Italy
| | - Cristina Colarossi
- Pathology Unit, Department of Experimental Oncology, Mediterranean Institute of Oncology, Catania, Italy
| | - Lorenzo Memeo
- Pathology Unit, Department of Experimental Oncology, Mediterranean Institute of Oncology, Catania, Italy
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26
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Abstract
Disseminated peritoneal leiomyomatosis (DPL), also known as leiomyomatosis peritonealis disseminata, is a rare disease characterized by multiple benign smooth muscle tumors proliferating along the peritoneal surfaces. The cause of the disease is unclear, and possible factors include iatrogenic and hormonal stimulation. The patient was a 41-year-old Chinese woman with a history of laparoscopic myomectomy and subsequent pregnancy. Multiple abdominal masses were identified and required surgical intervention. The patient had no tenderness or other discomfort. The clinical and imaging diagnosis was gastrointestinal stromal tumor, but DPL was confirmed by postoperative pathological examination. The patient had a good prognosis, and no recurrence was observed during follow-up. Iatrogenic and hormonal stimulation leading to DPL is very rare, and we believe that multiple factors led to DPL in this case. Clinicians should be aware of such potential patients.
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Affiliation(s)
- Xu Liu
- Institute of Pathology, China Three Gorges University, Yichang, China.,Department of Pathology, Yichang Central People's Hospital, Yichang, China
| | - Yuchang Hu
- Institute of Pathology, China Three Gorges University, Yichang, China.,Department of Pathology, Yichang Central People's Hospital, Yichang, China
| | - Lu Chen
- Institute of Pathology, China Three Gorges University, Yichang, China.,Department of Pathology, Yichang Central People's Hospital, Yichang, China
| | - Quan Zhou
- Department of Gynecology and Obstetrics, the People's Hospital of China Three Gorges University, Yichang, China
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27
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Creger PE, Harper C, Curry C, Kramer A. Resection of an Asymptomatic Lymphangioma in a 76-Year-Old Male. Cureus 2021; 13:e15577. [PMID: 34277199 PMCID: PMC8270067 DOI: 10.7759/cureus.15577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/10/2021] [Indexed: 11/05/2022] Open
Abstract
Lymphangiomas are benign congenital malformation comprised of the lymphatic system. They typically present in the head, neck, and axillary regions of children with <1% being described in the small bowel mesentery. We report a case of a 76-year-old man who presented with incidental large (9x6 cm) multiloculated cystic mass in the right upper quadrant (RUQ) on a CT scan performed for nephrolithiasis. He was asymptomatic at the presentation. We performed a diagnostic laparoscopy which was converted to an open procedure due to the mesenteric mass extending deeply toward the mesenteric root. The depth of invasion required small bowel resection with primary side-to-side anastomosis. Pathology confirmed a lymphangioma of the small bowel mesentery with histopathological analysis and cytology negative for malignant cells. Lymphangiomas are benign masses, however, their complete resection, including the resection of the involved organs is necessary. Incomplete resection or drainage is no longer used in management due to high rates of recurrence. Mesenteric lymphangiomas, while typically benign congenital malformations, can progress and impact surrounding structures via mass effect. Definitive treatment of lymphangiomas, even when asymptomatic, should be complete resection.
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Affiliation(s)
- Paul E Creger
- Department of General Surgery, Kansas City University, Kansas City, USA
| | - Charles Harper
- Department of General Surgery, St. Mary's Medical Center, Blue Springs, USA
| | - Chelsea Curry
- Surgical Pathology, Centerpoint Medical Center, Independence, USA
| | - Adam Kramer
- Department of General Surgery, St. Mary's Medical Center, Blue Springs, USA
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28
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Pierre K, Gomez NF, Bing S, Garcia CE, Dalton BG. Benign Multicystic Peritoneal Mesothelioma Presenting as a Colonic Mass. Cureus 2021; 13:e15540. [PMID: 34277166 PMCID: PMC8269996 DOI: 10.7759/cureus.15540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/09/2021] [Indexed: 11/05/2022] Open
Abstract
Benign multicystic peritoneal mesothelioma (BMPM) is a rare neoplasm of the abdominal mesothelium (i.e., peritoneum, mesentery, and omentum). We present the case of a 74-year-old male who presented with a right paracolic gutter fluid collection and cystic mass. The patient underwent diagnostic laparoscopy with resection of the mass. The final pathology revealed BMPM. The pathogenesis may have been related to longstanding diverticular disease, which could prove to be an underrecognized risk factor for the development of BMPM. Therefore, this case suggests a broadened differential diagnosis to include BMPM in specific cases of pre-operatively diagnosed colonic masses. The patient is disease-free 11 months post-operatively.
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Affiliation(s)
- Kevin Pierre
- General Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Noah F Gomez
- General Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Shaoxu Bing
- General Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Carolina E Garcia
- General Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Brian G Dalton
- General Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
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29
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Leong W, Xu M, Ni L, Su J, Yang D. A gastro-colic fistula secondary to high-grade B-cell gastric lymphoma in a patient with AIDS: a case report. J Int Med Res 2021; 49:3000605211006602. [PMID: 33884916 PMCID: PMC8074477 DOI: 10.1177/03000605211006602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
To the best of our knowledge, there are no previous reports of a gastro-colic fistula (GCF) secondary to primary high-grade B-cell gastric lymphoma associated with acquired immunodeficiency syndrome (AIDS). Here, we report a 37-year-old man who presented with paroxysmal abdominal pain for 4 months, diarrhea for 15 days and weight loss of 4 kg. He had a history of human immunodeficiency virus (HIV) infection and was diagnosed with AIDS in 2013. The patient was diagnosed with a GCF secondary to primary high-grade B-cell gastric lymphoma by gastroscopy and histopathological examination. Two weeks after diagnosis, he died in another hospital. This is an uncommon case in which the GCF occurred secondary to malignant gastric lymphoma in a patient with AIDS. Supported by the literature, patients with HIV infection who complain of abdominal pain or a mass, severe diarrhea, and weight loss should be assessed for a GCF secondary to lymphoma because of its worse prognosis.
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Affiliation(s)
- Waiian Leong
- Division of Gastroenterology & Hepatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Accident & Emergency, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Mingfeng Xu
- Division of Gastroenterology & Hepatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Li Ni
- Division of Gastroenterology & Hepatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Jiajun Su
- Department of Anatomical Pathology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Dongye Yang
- Division of Gastroenterology & Hepatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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30
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Underwood JS, Ours C, Burns RC, Ferguson MJ. Immature teratoma in an adolescent with Proteus syndrome: A novel association. Clin Case Rep 2021; 9:e04143. [PMID: 34026175 PMCID: PMC8136448 DOI: 10.1002/ccr3.4143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/07/2021] [Accepted: 03/19/2021] [Indexed: 11/12/2022] Open
Abstract
Proteus syndrome (PS) is a complex disorder characterized by variable clinical findings of overgrowth and tumor susceptibility. This report presents the first known association between PS and an ovarian germ cell tumor in an adolescent with immature teratoma. A review of the diagnosis of PS and associated tumors is included.
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Affiliation(s)
- John S. Underwood
- Departments of Internal Medicine and PediatricsIndiana University School of MedicineIndianapolisINUSA
| | - Christopher Ours
- National Human Genome Research InstituteNational Institutes of HealthBethesdaMDUSA
| | - R. Cartland Burns
- Department of SurgeryIndiana University School of MedicineIndianapolisINUSA
| | - Michael J. Ferguson
- Department of PediatricsIndiana University School of MedicineIndianapolisINUSA
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31
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Kwache I, Meher S, Balogun M, Ewer AK, Toldi G. Fetal ultrasound diagnosis allows effective early postnatal treatment of hematometrocolpos. Clin Case Rep 2021; 9:e04088. [PMID: 34084504 PMCID: PMC8142401 DOI: 10.1002/ccr3.4088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/09/2021] [Accepted: 03/13/2021] [Indexed: 11/29/2022] Open
Abstract
Fetal hematometrocolpos is a rare finding with an incidence of 1 in 16 000 female births. We present a case of fetal hematometrocolpos managed exclusively by prenatal and postnatal ultrasound scans allowing for effective immediate postnatal surgical treatment.
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Affiliation(s)
- Iliya Kwache
- Birmingham Women’s and Children’s HospitalBirminghamUK
| | - Shireen Meher
- Birmingham Women’s and Children’s HospitalBirminghamUK
- University of BirminghamBirminghamUK
| | - Moji Balogun
- Birmingham Women’s and Children’s HospitalBirminghamUK
| | - Andrew K. Ewer
- Birmingham Women’s and Children’s HospitalBirminghamUK
- University of BirminghamBirminghamUK
| | - Gergely Toldi
- Birmingham Women’s and Children’s HospitalBirminghamUK
- University of BirminghamBirminghamUK
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32
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Abstract
Solitary fibrous tumors are rare mesenchymal tumors that typically arise from the pleura and rarely originate from the mesentery. We herein report a case involving a 66-year-old patient who presented with a mass on the left abdomen. This mass had been incidentally noticed 10 years earlier. The patient sometimes experienced abdominal pain. Physical examination revealed an irregular mass, which was resected. A biopsy of the mass revealed that it was a solitary fibrous tumor originating from the mesentery of the small intestine. The patient was discharged 1 week after surgery and had an uneventful clinical course throughout the 4-month postoperative follow-up.
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Affiliation(s)
- Jing-Ni Liu
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Zhao Liu
- Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Peng-Yu Ji
- Department of Clinical Laboratory, the First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Hong Zhang
- Department of Pathology, the First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Shun-Lin Guo
- Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, Gansu, China
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33
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Monib S, Habashy HF. Football Size Jejunal Gastrointestinal Stromal Tumour. Cureus 2020; 12:e11913. [PMID: 33415061 PMCID: PMC7781859 DOI: 10.7759/cureus.11913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Gastrointestinal stromal tumours (GISTs) are considered the most common mesenchymal neoplasms of the alimentary tract, yet they account for only 0.2% of all gastrointestinal neoplasms. We are presenting a case of a 68-year-old gentleman who was diagnosed with a 250 mm jejunal GIST only when he presented with abdominal pain and fullness in the upper abdomen. We believe that detailed medical history, followed by prompt investigations, will help in early diagnosis of small GISTs with less malignant potential, which in turn will lead to better outcomes.
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Affiliation(s)
- Sherif Monib
- Breast Surgery, West Hertfordshire Hospitals NHS Trust, St. Albans and Watford General Hospitals, London, GBR
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34
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Abstract
Peritoneal loose body (PLB) is an extremely rare clinical entity, and its preoperative diagnosis is often difficult. We report a case of giant PLB (GPLB) confirmed by exploratory laparoscopy. A 46-year-old man was admitted to hospital with an abdominal mass and urinary frequency. He underwent clinical and laboratory tests and computed tomography (CT), which indicated a lesion at the bottom of the bladder. Exploratory laparoscopic surgery revealed a GPLB, which was subsequently removed. The patient was comfortable after surgery and was discharged 3 days later. His symptoms of frequent urination improved during the 1-month follow-up period. The egg-shaped mass excised from the peritoneal cavity measured 45 × 40 × 33 mm. This case indicates that exploratory laparoscopy can be considered as the first-choice diagnostic procedure for patients with GPLB.
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Affiliation(s)
- RuiBin Li
- First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, BaoTou, Inner Mongolia, China
| | - ZhiHeng Wan
- First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, BaoTou, Inner Mongolia, China
| | - HaoTian Li
- First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, BaoTou, Inner Mongolia, China
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35
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Jiang S, Ren Q, Wang X, Yang G, Wei S, Zhao Q, Xu H. A huge bladder diverticulum in an elderly: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20943475. [PMID: 33282311 PMCID: PMC7685678 DOI: 10.1177/2050313x20943475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 06/26/2020] [Indexed: 01/10/2023] Open
Abstract
An 81-year-old male patient presented to the department of gastroenterology with increasing lower abdominal pain for 2 years, aggravated with bloody stool for 1 month. Computed tomographic examination revealed a huge cyst (207 × 93 × 208 mm3) in the abdominal cavity, absence of bladder, thickening and strengthening of the rectal wall, and benign prostatic hyperplasia. Colonoscopy showed colon cancer and surgery was planned. Interestingly, after magnetic resonance imaging and cystography, we found colon cancer and a large bladder diverticulum rather than tumor metastasis or others. Severe bacteremia occurred in the elderly chronic obstructive pulmonary disease patient before operation. After careful consideration, we decided to take a large risk and combined urology and gastrointestinal surgery professionals to carry out bladder diverticulectomy, cystostomy, radical resection of rectal carcinoma, and so on. Fortunately, the patient recovered well after the operation. In addition to the common tumor metastasis and cystadenoma, the abdominal mass should also be alert to the rare bladder diverticulum, which eventually leads to diagnostic confusion. Multidisciplinary diagnosis and treatment has become an important treatment for complex diseases.
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Affiliation(s)
- ShuangHong Jiang
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Quan Ren
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - XianFei Wang
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - GuoDong Yang
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - ShouJiang Wei
- Department of Gastroenterological Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - QiongHui Zhao
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Hao Xu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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36
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Rodrigues CF, Ferreira G, Oliveira E, Oliveira MS, Pinto S, Fonseca J. Complexities of Diagnosing and Treating a Mesenteric Cyst in a Chronic Myeloid Leukaemia Patient. Eur J Case Rep Intern Med 2020; 7:001457. [PMID: 32309252 PMCID: PMC7162577 DOI: 10.12890/2020_001457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/10/2020] [Indexed: 11/05/2022] Open
Abstract
Mesenteric cysts are a rare nosologic entity, the diagnosis of which is complex due to their nonspecific presentation. They may emerge from any part of the mesentery and grow to any size, thus conditioning a wide range of clinical manifestations that renders them easily mistaken for different gastrointestinal pathologies. Diagnosis encompasses a mixture of clinical suspicion, imaging techniques and sometimes surgery, and curative treatment is based on complete surgical resection of the cyst. We hereby present a case of a mesenteric cyst that developed on the anterior abdominal wall of a 59-year-old man awaiting allogeneic bone marrow transplantation after being diagnosed with chronic myeloid leukaemia. He was admitted to the emergency room with complaints of an increased abdominal perimeter and increased weight, not associated with alterations to his dietary or physical exercise habits. Suspecting ascites in the context of leukaemic progression, the patient was admitted to the medical ward; however, subsequent study identified a mesenteric cyst as the most probable diagnosis and the patient was proposed to undergo surgery. He underwent laparotomic cyst excision without complications and the histological evaluation of the surgical specimen confirmed the diagnosis. LEARNING POINTS Although rare entities, mesenteric cysts should be suspected whenever nonspecific gastrointestinal symptoms are present and liquid collections are identified.Treatment consists of complete surgical excision, which, although not free of complications, is usually safe and the recurrence rate is very low.In light of the lymphatic theory with respect to the aetiology of mesenteric cysts, this nosologic entity should be highly suspected in oncologic patients where lymphangiogenesis is potentiated.
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Affiliation(s)
- Carlos Fd Rodrigues
- Serviço de Medicina Interna, Hospital de Aveiro, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Gisela Ferreira
- Serviço de Hematologia, Hospital de Aveiro, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Eduardo Oliveira
- Serviço de Cirurgia, Hospital de Aveiro, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Marta S Oliveira
- Serviço de Medicina Interna, Hospital de Aveiro, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Sara Pinto
- Serviço de Medicina Interna, Hospital de Aveiro, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - João Fonseca
- Serviço de Medicina Interna, Hospital de Aveiro, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
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37
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Koç ZP, Özcan PP, Turgutalp K, Esen K, Kara T. Amyloidosis Associated Kidney Failure with Gross Hypermetabolic Intra- abdominal Mass. Mol Imaging Radionucl Ther 2020; 29:37-40. [PMID: 32079387 PMCID: PMC7057730 DOI: 10.4274/mirt.galenos.2019.92485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A 23-year-old male patient who presented with impaired kidney function tests attended to hospital for hemodialysis and underwent 18F-FDG positron emission tomography/computed tomography (PET/CT) examination for the metabolic characterization of the intra-abdominal mass which was found in the ultrasonography. 18F-FDG PET/CT revealed a mass lesion adjacent to the liver which was hypermetabolic and the pathology of the lesion was determined as amyloidosis. To the best of our knowledge, the case with 18F-FDG PET/CT images of a huge amyloid mass is the first in the literature.
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Affiliation(s)
- Zehra Pınar Koç
- Mersin University Faculty of Medicine, Department of Nuclear Medicine, Mersin, Turkey
| | - Pınar Pelin Özcan
- Mersin University Faculty of Medicine, Department of Nuclear Medicine, Mersin, Turkey
| | - Kenan Turgutalp
- Mersin University Faculty of Medicine, Department of Nephrology, Mersin, Turkey
| | - Kaan Esen
- Mersin University Faculty of Medicine, Department of Radiology, Mersin, Turkey
| | - Tuğba Kara
- Mersin University Faculty of Medicine, Department of Pathology, Mersin, Turkey
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38
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Abstract
Human sparganosis is a food-borne zoonosis mainly caused by the plerocercoid belonging to the genus Spirometra. The most common clinical sign of sparganosis is a subcutaneous mass in the trunk including abdominal or chest wall. The mass may be mistaken for a malignant tumor, thereby causing difficulty in terms of diagnosis and treatment. A 66-year-old woman visited our clinic for the removal of a lipoma-like mass. It was movable, hard, and painless. We identified 2 white mass, measuring 0.2×4 cm and 0.2×1 cm. Pathologic findings indicated the white mass was a sparganum. She recalled having eaten a raw frog approximately 60 years before. A 35-year-old who lived North Korea was also presented to our clinic with an asymptomatic nodule on her abdomen. Intraoperatively, we found sparganum approximately 24 cm size. Subcutaneous masses are associated with clinical signs of inflammation or they may mimic a soft tissue neoplasm. While the incidence rate of sparganosis has decreased with economic development and advancements in sanitation, surgeons still encounter patients with sparganosis in the clinical setting. Therefore, a careful history is required in order to diagnose sparganosis.
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Affiliation(s)
- Seung Ki Ahn
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan 31151, Korea
| | - Hwan Jun Choi
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan 31151, Korea
| | - Jun Hyuk Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan 31151, Korea
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39
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Abstract
Endometriosis is a pathological condition whereby endometrial glands and stroma are located outside the physiologically expected location, the uterus. A lesion is usually located in the pelvis but can also occur in the diaphragm, bowel, pleural cavity, or surgical scar. It is a benign estrogen-dependent condition. Here, we present the case of a 40-year-old woman with ectopic endometriosis.
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Affiliation(s)
- Gabriel O Ologun
- General Surgery, Robert Packer Hospital/Guthrie Clinic, Sayre, USA
| | - Cara Hannigan
- General Surgery, Robert Packer Hospital/Guthrie Clinic, Sayre, USA
| | | | - Aaron Bambil
- Family Medicine, Caribbean Medical University, Cupecoy, CUW
| | - David Bertsch
- Surgical Oncology, Robert Packer Hospital/Guthrie Clinic, Sayre, USA
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40
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Abstract
RATIONALE Splenic cysts (SCs) are rare findings in children, particularly the youngest. Here, we discuss a case that is useful for the differential diagnosis and treatment of SCs. PATIENT CONCERNS A 9-year-old Albanian boy was admitted for severe abdominal pain localized mainly in the left hypochondrium for approximately 24 hours. His medical history was without significant clinical problems. DIAGNOSIS Splenomegaly was diagnosed during the first clinical examination, and laboratory tests showed an increase in CA 125 and CA19-9. Abdominal ultrasonography showed splenomegaly with a large hypoechoic oval formation with well-defined margins and the presence of internal fine suspension spots; abdominal magnetic resonance imaging revealed a well-defined SC. The cystic lesion caused major effects on the neighboring organs, shifting them from their normal sites. INTERVENTIONS Considering the mass's volume, an open splenectomy was performed. Upon histopathological examination, the lesion was characterized by a stratified squamous keratinized thick lining and brownish liquid contents consisting of lymphocytes, erythrocytes, and hemosiderin-rich macrophages. These features informed the diagnosis of a giant epidermoid SC. OUTCOMES No complications occurred in the post-operative period, and blood exams revealed the quick normalization of CA 19.9 and CA 125 levels. The boy was discharged on the eighth post-operative day. No complaints were documented during the regular follow-up. LESSONS This case shows that modern imaging techniques are useful for the differential diagnosis between epithelial mass and SCs of different origins. Open splenectomy has been the treatment of choice for years, but future studies should clarify whether more conservative methods are associated with positive long-term outcomes and if they can also be used for large SCs.
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Affiliation(s)
- Susanna Esposito
- Paediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia
| | - Alberto Leonardi
- Paediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia
| | - Laura Penta
- Paediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia
| | - Marco Prestipino
- Pediatric Surgery Unit, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Mirko Bertozzi
- Pediatric Surgery Unit, S. Maria della Misericordia Hospital, Perugia, Italy
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41
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Abstract
Myelolipoma are tumors of adrenal glands typically found in the adrenal gland, and are comprised of marrow elements and fat. We report a case of an extra adrenal myelolipoma in a 91-year-old patient, who presented to the emergency department with complaints of abdominal pain and shortness of breath. A CT scan of the abdomen and pelvis revealed a mixed attenuation soft tissue mass with admixed fat located within the mesentery inferior to the body of the stomach. A fine needle aspirate of the mass demonstrated a cellular aspirate with maturing trilineage hematopoiesis and mature adipocytes. This case is being presented due to the rarity of extra adrenal myelolipomas.
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Affiliation(s)
- Syed H Abbas
- Pathology, Monmouth Medical Center, Long Branch, USA
| | - Geetika Goyal
- Pathology, Saint Barnabas Medical Center, Robert Wood Johnson Barnabas Health, Livingston, USA
| | - Kate Yu
- Pathology, Saint Barnabas Medical Center, Robert Wood Johnson Barnabas Health, Livingston, USA
| | - Abraham Loo
- Pathology, Monmouth Medical Center, Long Branch, USA
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42
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Rajaretnam N, Malcolm P, Aroori S. Granulocytic sarcoma: An uncommon cause of systemic inflammatory response syndrome. Clin Case Rep 2019; 7:469-473. [PMID: 30899474 PMCID: PMC6406164 DOI: 10.1002/ccr3.1779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/26/2018] [Accepted: 08/03/2018] [Indexed: 12/11/2022] Open
Abstract
Granulocytic sarcoma rarely arises from adrenal glands. Its necrosis can lead to systemic inflammatory response syndrome (SIRS), causing clinical difficulty in diagnosis without imaging and both biochemical and histological analysis. Compressive effects of the tumor may mask its source, and therefore, prompt resuscitation, symptom control, and investigation are vital in preventing clinical deterioration.
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43
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Abstract
Introduction Primary intestinal lymphangiectasia (PIL) is a very rare disorder usually diagnosed before the third year of life or later in adulthood, presenting with pitting edema, hypoproteinemia and low immunoglobulin levels. The location and the extent of the affected bowel greatly influence the clinical manifestation. The localized or segmental form of PIL is extremely rare with only five pediatric cases reported worldwide. Case presentation A 10 year-old Caucasian boy presented with 3 months history of recurrent abdominal pain and a 1 month history of diarrhea. An ultrasound scan was performed on two separate occasions 10 days apart, revealing a growing cystic mass on the right side of the abdomen, in front of the psoas muscle. Subsequently an MRI scan confirmed that the mass originated from the mesenteries and infiltrates a short segment of the small bowel. Surgical resection of the affected segment was performed. Histopathological examination of the removed segment of ileum was consistent with intestinal lymphangiectasia. We could not identify any associated genetic syndromes or any other conditions that could have caused secondary intestinal lymphangiectasia. The patient’s recovery from surgery was uneventful and no recurrence was observed in the following 4 years. Conclusion Despite being a benign condition, mortality of PIL can be as high as 13% due to the difficulties associated with the management of the disease. PIL should be considered as a rare but potential cause for an abdominal mass, even in the older child, when cystic mesenterial involvement might be seen on ultrasound or MRI. In selected cases of PIL affecting only a short segment of the bowel or following unsuccessful conservative treatment, surgical resection of the affected bowel segment can be curative.
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Affiliation(s)
- Judit Mari
- University of Szeged, Department of Pediatrics, Szeged, Hungary,
| | - Tamas Kovacs
- University of Szeged, Department of Pediatrics, Szeged, Hungary,
| | - Gyula Pasztor
- University of Szeged, Department of Radiology, Szeged, Hungary
| | | | - Csaba Bereczki
- University of Szeged, Department of Pediatrics, Szeged, Hungary,
| | - Daniel Szucs
- University of Szeged, Department of Pediatrics, Szeged, Hungary,
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44
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Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.
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45
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Aydın A, Söylemez T, Karateke A, Polat M, Girgin BR. Leiomyomatosis peritonealis disseminata in a nonpregnant woman. Turk J Obstet Gynecol 2019; 15:279-280. [PMID: 30693147 PMCID: PMC6334240 DOI: 10.4274/tjod.06881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 09/17/2018] [Indexed: 12/03/2022] Open
Affiliation(s)
- Abdullah Aydın
- İstanbul Medeniyet University Faculty of Medicine, Department of Pathology, İstanbul, Turkey
| | - Tuçe Söylemez
- İstanbul Medeniyet University Faculty of Medicine, Department of Pathology, İstanbul, Turkey
| | - Ateş Karateke
- İstanbul Medeniyet University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Mesut Polat
- İstanbul Medeniyet University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Burçin Rabia Girgin
- İstanbul Medeniyet University Faculty of Medicine, Department of Pathology, İstanbul, Turkey
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46
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Santos MA. Chronic Abdominal Pain from Disseminated Splenosis. J Gen Intern Med 2018; 33:976-977. [PMID: 29611090 PMCID: PMC5975174 DOI: 10.1007/s11606-018-4414-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Michael A Santos
- WellSpan Good Samaritan Hospital, Lebanon, PA, USA. .,Penn State Milton S Hershey Medical Center, Hershey, PA, USA.
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47
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Abstract
The objective of our study is to describe the sonographic findings of an extremely rare pathology. We therefore present two case reports of prenatal diagnosis of fetus-in-fetu (FIF) with a review of the literature. FIF is a benign disorder, unlike the teratoma with which often enter into the differential diagnosis, localized in most cases in the retroperitoneal space. Prenatal diagnosis is based mainly on ultrasound and radiological characteristics. The treatment of choice is surgical excision. The importance of prenatal diagnosis of fetus-in-fetu and the effect on subsequent management are described.
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Affiliation(s)
- Gabriele Ruffo
- a Diagnostica Ecografica e Prenatale "Aniello Di Meglio" , Napoli , Italia
| | - Lavinia Di Meglio
- a Diagnostica Ecografica e Prenatale "Aniello Di Meglio" , Napoli , Italia
| | - Letizia Di Meglio
- a Diagnostica Ecografica e Prenatale "Aniello Di Meglio" , Napoli , Italia
| | - Carmine Sica
- a Diagnostica Ecografica e Prenatale "Aniello Di Meglio" , Napoli , Italia
| | - Alessandro Resta
- a Diagnostica Ecografica e Prenatale "Aniello Di Meglio" , Napoli , Italia
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48
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Abstract
Schwannomas are nerve sheath tumors that occur in Schwann cells. They are usually benign, but malignant transformation can occur. Symptomatology depends on the involvement of the surrounding tissues or the mass effect of the tumor. We describe a case of a 28-year-old man who initially presented with right iliac fossa pain associated with radiating pain over the anterior and lateral aspect of his right knee. Following subsequent investigations, we found a retroperitoneal schwannoma of the right lateral femoral cutaneous nerve. The key to our diagnosis was the referred pain to his right knee, which gave us a clue of possible neuropathic pain. Our patient highlights the need to consider a unified diagnosis when faced with an incongruent set of symptoms. Magnetic resonance imaging is the diagnostic modality of choice for the diagnosis of schwannomas. Treatment is directed towards symptomatic control. Surgery, radiation, and, in rare instances, chemotherapy are the major treatment modalities employed.
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Affiliation(s)
- Ibrahim M Hanif
- Department of General Medicine, Sengkang General Hospital, Sengkang Health, Singhealth, Singapore
| | - Nilesh H Pawar
- Department of General Medicine, Sengkang General Hospital, Sengkang Health, Singhealth, Singapore
| | - Wing Yan Mok
- Department of Radiology, Sengkang General Hospital, Sengkang Health, Singhealth, Singapore
| | - Melvin Chua
- Department of General Medicine, Sengkang General Hospital, Sengkang Health, Singhealth, Singapore
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49
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Abstract
A 60-year-old African-American male presented to the emergency department with abdominal pain and distention associated with decreased appetite and weight loss for several weeks. A computed tomography (CT) scan of the abdomen and pelvis showed an 8 cm mesenteric mass with surrounding stranding and poorly defined borders. The patient underwent exploratory laparotomy and complete resection of the mass since the frozen section could not give a definite diagnosis. Histopathology showed fibro-adipose tissue with lymphoid hyperplasia, vague nodular collections of foamy histiocytes with giant cell reaction, marked chronic inflammation, fat necrosis, and prominent sclerosis/fibrosis. Methenamine silver and acid-fast stains were negative for fungal and mycobacterial organisms respectively. Examination of tissue with immunohistostains showed increased immunoglobulin G4 (IgG4)-positive plasma cells. Other features observed were scattered areas of phlebitis, pockets of tissue eosinophilia, and focal storiform fibrosis leading to the diagnosis of IgG4-related sclerosing mesenteritis. The patient did not require steroids after the surgical resection and was disease free at six-month follow up.
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Affiliation(s)
| | - Syed H Alam
- Department of Rheumatology, Temple University Hospital
| | - Oleksandr Semeniuk
- Internal Medicine, University of Maryland Prince George's Hospital Center
| | - Sonum Singh
- Internal Medicine, University of Maryland Prince George's Hospital Center
| | - Gurdeep S Chhabra
- Internal Medicine, University of Maryland Prince George's Hospital Center
| | - Irene J Tan
- Section of Rheumatology, Temple University Hospital
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50
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Abstract
Gallstone spillage is a common intraoperative event during laparoscopic cholecystectomy (LC). Patients present months to years with nonspecific symptoms after the original procedure. The complications of retained peritoneal gallstones are infrequent. Having a high index of suspicion is the key to early diagnosis. Every effort should be made to remove spilled gallstones at the index operation to prevent future complications, however, conversion from laparoscopy to laparotomy for retrieval of spilt gallstone is not recommended. Here we present a case of retained gallstone presenting as a large intra-abdominal mass four years after laparoscopic cholecystectomy in a middle age bariatric patient.
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Affiliation(s)
| | - Rachel Lovely
- Medical Student, Geisinger Commonwealth School of Medicine/robert Packer Hospital
| | | | - Mustafa Aman
- Minimally Invasive/bariatric Surgery, Robert Packer Hospital/Guthrie Clinic
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