Abdomen Cavity Research Articles

Radiological Findings of Multiple Peritoneal Calcifying Fibrous Tumors: A Case Report

Peritoneal calcifying fibrous tumor is a rare tumor in the peritoneal cavity. In this case, plain radiography showed multiple conglomerated calcifications and several separate calcifications scattered in the lower abdomen and pelvic cavity. CT showed several well-circumscribed masses with a group of conglomerated nodular calcifications in their centers, and these were surrounded by three bands with different attenuation. Ultrasonography showed a well-circumscribed mass with strong posterior shadowing from its anterior surface and hyperechoic calcifications in its center. The histopathological diagnosis was calcifying fibrous tumor. The mass was well circumscribed and non-encapsulated and it was mainly composed of hyalinized fibrosclerotic tissue and dystrophic calcification with no inflammatory cells. We report here on a case of peritoneal calcifying fibrous tumor, along with a review of the relevant literature.

Spinal Anaesthesia For Surgery Upper Part of Abdomen Cavity - Case Report

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Mesenteric plexiform neurofibroma in an 11-year-old boy with von Recklinghausen disease

We experienced the case of an 11-year-old boy diagnosed as having type 1 neurofibromatosis with intraabdominal and pelvic masses. On physical examination, there were multiple café-au-lait spots larger than 15 mm in diameter scattered over the patient's entire body and axillary freckling, but no cutaneous neurofibromas were present. Lisch nodules were detected in the iris by a slit lamp. A large, firm mobile mass was palpated in the lower abdomen. Abdominal computed tomographic scan showed the hypodense masses in the lower abdomen and pelvic cavity. At laparotomy, a 16 × 9-cm, firm nodular mass along the mesentery of the terminal ileum and ascending colon was found. The mesenteric mass was encasing the superior mesenteric vessels and extending into the serosa of the intestine. The mass was incompletely excised together with affected intestine. However, resection of the rectum could not be performed because of the extensive involvement of the entire mesorectum. Histopathologic study revealed a plexiform neurofibroma involving the mesentery and intestine without evidence of malignant transformation. The postoperative course was uneventful. Ten months after the operation, a magnetic resonance imaging showed no interval change of the mesorectal mass.

Evaluation of a serological test (indirect ELISA) for the diagnosis of sarcoptic mange in red foxes (Vulpes vulpes)

Sarcoptic mange occurs in many parts of the world and is common in populations of domestic and wild canids, including red foxes (Vulpes vulpes). In recent years, an indirect antibody enzyme-linked immunosorbent assay (ELISA), with higher sensitivity and specificity than traditional diagnostic methods, has been successfully applied in the diagnosis of sarcoptic mange in dogs. The same ELISA has also demonstrated specific antibodies to Sarcoptes scabiei in experimentally infected red foxes. The aim of this study was to evaluate the indirect ELISA when used to detect antibodies to S. scabiei in field sera from Swedish red foxes. One cohort of both infected and non-infected red foxes (cohort 1; n = 88), and one cohort of apparently non-infected foxes (cohort 2; n = 67) were examined for skin lesions and presence of S. scabiei by thorough visual examination at autopsy and skin scrapings. Samples of blood-tinted body liquid from the abdomen or thorax cavity were collected and analysed by the indirect ELISA. The relative sensitivity and specificity of the ELISA at different cut-offs (OD values) were estimated by comparing the test results to the infection status as determined by examination and skin scrapings. The highest combination of relative sensitivity and specificity, calculated based on cohort 1, was 95.4 and 100.0%, respectively. These estimates were constant for cut-offs 0.150-0.225, which included the cut-off based on the mean plus three standard deviations of test results from cohort 2 (0.165). It is concluded that this test can be useful in diagnosis and epidemiological studies of S. scabiei infection in red foxes.

Ewing’s sarcoma/primitive neuroectodermal tumor (ES/PNET) of the small bowel: a rare cause of intestinal obstruction

Dear Editor: Ewing’s sarcoma/primitive neuroectodermal tumor (ES/PNET) is the second most common primary bone tumor in pediatric patients, accounting for approximately 1.1% of childhood cancers in Korea. Extraskeletal or extraosseous ES/PNET, reported to develop in tissues derived from the neural crest, usually develops in the soft tissue of the lower extremities, paravertebral region, and pelvis in children and adolescents. ES/PNETof the small bowel is extremely rare, with only two such cases reported in young patients to date to our knowledge. The present study details a case of extraskeletal ES/PNET of the small bowel in a 63-year-old male Korean. A 63 year-old man was admitted experiencing progressive right low quadrant (RLQ) abdominal pain with distension in October 2005. Since January 2005, the patient had undergone treatment for non-small cell lung cancer (NSCLC) at the Center for Lung Cancer, National Cancer Center, Korea. In staging workups at diagnosis, abdominal CT scans showed three abdominal masses comprising a 12.0×9.0-cm mass in the right adrenal gland, a 7.0×7.0-cm mass in the left adrenal gland and a 5.6×2.7-cm mass in the RLQ. Radiology-based diagnosis of the abdominal masses suggested that the primary lung cancer had metastasized to both adrenal glands and mesenteric lymph nodes. A colonoscopy was performed to rule out colon cancer, and the results showed no abnormal findings in the entire large bowel and terminal ileum. The patient commenced chemotherapy on January 26, 2005. Three regimens were used; six cycles of Gemcitabine, Vinorelbine, and Cisplatin from January to June, three cycles of Docetaxel from June to August, and one cycle of Gefitinib in October. Surveillance computed tomography (CT) scans of the abdomen and pelvic cavity performed on November 4th showed that both adrenal masses had become necrotic without a significant change in size, the RLQ mass had increased to 18.0×12.5×11.0 cm, and there were several new enlarged mesenteric lymph nodes near the RLQ mass. Abdominal distension with pain had developed so severely by the end of October 2005 that the patient was referred to the Center for Colorectal Cancer to undergo surgical symptomatic palliation. A right hemicolectomy with a segmental resection of the jejunum was performed. The resected tumor was multinodular, solid, and 18.0 cm in the largest diameter and showed focal necrosis and hemorrhage. The tumor impinged on the terminal ileum and jejunum, invading the enteric wall extending to the mucosa and obliterating the lumen of the terminal ileum. The ascending colon was severely D.-W. Kim . H. Chang . J. Jeong . S.-B. Lim (*) . H. Choi . S.-Y. Jeong . J.-G. Park Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, 809 madu-1-dong, ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Repubic of Korea e-mail: sblim68@ncc.re.kr Tel.: +82-31-9202486 Fax: +82-31-9201959

Clinical and pathological analysis of solitary fibrous tumors

目的 探讨孤立性纤维性肿瘤(solitary fibrous tumor,SFT)的临床病理特点及鉴别诊断.方法对3例SFT病例进行组织形态学及免疫组化分析并复习文献.结果肿瘤位于胸腔及腹腔,大小为11.0 cm×9.5 cm×8.0 cm～10.0 cm×10.5 cm×7.2 cm.镜下肿瘤组织由梭形纤维母细胞和不同程度的胶原纤维构成,呈束状或编织状排列,局部有血管外皮瘤样形态,部分区域黏液变性.免疫组化显示:CD34、波形蛋白、bcl-2、CD99阳性,上皮和间皮等标记阴性.结论 SFT是一种少见的梭形细胞肿瘤,组织形态与其他梭形细胞肿瘤相似,需结合免疫组化来进行诊断及鉴别诊断,CD34阳性具重要鉴别作用。

Videoscopic fluorescence diagnosis of peritoneal and thoracic metastases from human hepatoblastoma in nude rats

Various medical disciplines are employing photodynamic diagnosis (PDD) when searching for malignancies. It is still unknown whether pediatric solid tumors such as hepatoblastoma are susceptible to this technique as well. Human hepatoblastoma cells were injected into the abdomen or right thoracic cavity of nude rats. Tumor growth was allowed for 7 weeks. Then, photosensitization was induced by peritoneal lavage with 5-aminolevulinic acid (ALA). Applying the Storz PDD system and one 4-mm scope, all animals were investigated by videoscopic white light diagnosis (WD) and PDD. Suspicious lesions were marked and analyzed by spectrometry and histology. Positive fluorescence was documented for every tumor seen by WD in the abdomen or right thoracic cavity. Spectrometry of lesions showed a 6.34-fold increased fluorescence intensity. Histology revealed hepatoblastoma in all specimens. Human hepatoblastoma can be detected by PDD in a rat model. Considering the clinical success of this method in other specialties, our findings indicate that further investigations to evaluate the benefit of PDD for children with hepatoblastoma should be performed.

Granulocyte-colony stimulating factor- and interleukin 6-producing diffuse deciduoid peritoneal mesothelioma

An autopsy case of granulocyte colony-stimulating factor (G-CSF)- and interleukin-6 (IL-6)-producing diffuse deciduoid peritoneal mesothelioma is reported. The patient was a 70-year-old man with abdominal distension and weight loss in the year prior to his death. Laboratory data suggested severe inflammation with marked leukocytosis, thrombocytosis and elevated serum levels of C-reactive protein, G-CSF and IL-6. Imaging studies showed an expansive mass occupying the entire abdomen and pelvic cavity. Histological diagnosis of tissue taken by needle biopsy was difficult due to the unusual sarcomatoid-appearance of the tumor. In addition, there was severe infiltration of numerous neutrophilic leukocytes. An autopsy revealed that the diffuse peritoneal tumor had a fresh fishmeat-like appearance with focal mucinous degeneration and entirely encased the abdominal organs. Histological examination showed a sheet-like proliferation of tumor cells with large ovoid or polygonal cytoplasm, large atypical nuclei and obvious nucleoli. The tumor cells showed abundant glycogen and hyaluronic acid, and were immunoreactive to cytokeratin, calretinin, epithelial membrane antigen (EMA), CA-125, and focally to vimentin. The tumor cells were immunoreactive to G-CSF and IL-6. Electron microscopy revealed long, slender microvilli on the tumor cell surface. This tumor was diagnosed as a G-CSF- and IL-6-producing, diffuse deciduoid mesothelioma. We report this case with special reference to the differential diagnosis of deciduoid peritoneal mesothelioma with paraneoplastic syndrome.

Intra-abdominal gout mimicking pelvic abscess

Gout is the most common crystal-induced arthritis. Gouty tophi typically deposit in the extremities, especially toes and fingers. We present an unusual case of intrapelvic tophaceous gout in a patient suffering from chronic gouty arthritis. CT and MRI of the abdomen and pelvic cavity disclosed calcified gouty tophi around both hips, and a cystic lesion with peripheral enhancement in the pelvic cavity along the course of the iliopsoas muscle. The intra-abdominal tophus mimicked pelvic abscess.

Establishment of a Teaching Animal Model for Sonographic Diagnosis of Trauma

Ultrasound is widely accepted as a valuable diagnostic tool for detecting intra-abdominal and intrathoracic bleeding in trauma patients. Nevertheless, many doctors are reluctant to use it because they do not have sufficient training. This study aimed to define intra-abdominal and intrathoracic fluid volumes that can be detected by sonography and their relation to fluid width in pigs to establish a clinically relevant animal model for teaching and training. Different volumes of normal saline were infused into the abdomen (50-2,000 mL) and chest (25-250 mL) in five anesthetized pigs. The maximum width of fluid as detected by ultrasound was recorded. The right upper quadrant, left upper quadrant, pelvis, and right paracolic section of the abdomen and right pleural cavity were studied. An experienced radiologist performed the studies. The effects on respiratory and cardiovascular functions were evaluated. The sonographic findings in the pig were similar to those in humans. Up to 50 mL of intra-abdominal fluid and up to 25 mL of intrathoracic fluid could be detected by ultrasound. There was a significant correlation between the volume infused and the fluid width detected. The respiratory and cardiovascular monitoring of the animals showed that the infused intrathoracic volumes mimicked a survivable hemothorax. The pig may serve as an excellent clinically relevant model with which to teach surgeons detection of different volumes of intra-abdominal and intrathoracic fluids. The value of this model as an educational tool has yet to be tested.

Multiple uterine angioleiomyomas in a woman presenting with severe menorrhagia

Background Angioleiomyoma is a rare benign neoplasm that originates from smooth muscle cells and contains thick-walled vessels. There were only five cases of uterine angioleiomyoma reported in the available English literatures. We present here the unique computed tomography finding in a patient with multiple uterine angioleiomyomas causing severe menorrhagia. Case A 50-year-old, nulligravid woman consulted us with the complaint of menorrhagia for 3 years and progressively palpable lower abdominal mass for a half year. Laboratory findings were all within normal limits except lower hemoglobin concentration (6.2 g/dl). An abdomino-pelvic computed tomography (CT) showed that a huge 30-cm heterogeneously multilobulate mass with solid and laminated configuration, with cystic and multiseptal contents was found in left lower abdomen and pelvic cavity. At laparotomy, the area beneath the left broad ligament was filled with a well-encapsulated, elastic, ovoid, and lobulate mass that connected to the uterus and measured up to 20 cm in greatest diameter. The uterus was composed of a huge intramural tumor and measured 28 × 21 × 12 cm. The uterus and huge subserosal tumor were resected completely and a frozen section was obtained. The final histopathologic diagnosis was angioleiomyoma, a definitely benign soft tissue tumor. Eighteen months after surgery there was no recurrence. Conclusion Uterine angioleiomyoma should be considered when prominent tortuous vascular-like enhancing structures are noted on CT examination of a well-demarcated soft tissue mass arising from the uterus in pelvis. Either angiomyomectomy with tumor-free margins or hysterectomy proved to be an effective treatment in these cases, and resulted in a good recovery and a satisfactory outcome.

The role of laparoscopy in patients with suspected peritonitis: experience of a single institution.

In this report, we retrospectively evaluate the effect of a laparoscopic approach in the diagnosis and treatment of acute abdominal pain in patients with suspected peritonitis. We evaluated the clinical records of patients admitted to our institution between January 1995 and July 2001 with a diagnosis of acute abdomen and suspected peritonitis. Ninety four of 229 patients underwent diagnostic laparoscopy. In this series, 83 (88.3%) of the cases were successfully treated by emergent laparoscopy for an acute abdomen. Eleven (11.7%) required conversion to an open laparotomy procedure. Overall, the preoperative diagnosis was confirmed by laparoscopy in 67 (71.27%) of the cases. It was not confirmed in 27 (28.73%). Postoperative mortality was 4.25%. Morbidity was 8.5%. Data reported in the literature establish that laparoscopy offers adequate visualization of the entire abdomen and pelvic cavity in the diagnosis of an abdomen acute secondary to peritonitis. In this series, laparoscopy confirmed the diagnosis in 97.8% of the patients, and minimally invasive treatment was achieved in 88.3% of the cases. Female patients with gynecologic disease particularly benefitted from a laparoscopic approach, which permitted the correct evaluation of this condition and may have prevented unnecessary laparotomy. We believe that laparoscopy is an accurate modality for the diagnosis and treatment of patients with an acute abdomen and suspected peritonitis when the diagnosis cannot be clearly made by physical examination and noninvasive methods.

FOLLOWUP OF PRIMARY MALIGNANT MELANOMA OF THE PROSTATE

A 61-year-old man presented with a 2-year history of prostatism. Transurethral resection of the prostate was performed with a diagnosis of benign prostatic hyperplasia on June 9, 1994. Black discoloration of the prostate was evident on urethroscopy. Histological examination of the surgical specimen demonstrated a solid tumor cell nest in the prostate with intact urethral epithelium. Tumor cells were polygonal with prominent nucleoli (fig. 1). Melanoma cells were distributed in the stroma, which were independent of the acinar glands (fig. 2). Urethroscopy revealed some purple-black discoloration on the prostatic urethra and verumontanum at 2-month followup. Residual melanoma was highly suspected. Radical prostatectomy and urethretomy with or without chemotherapy was suggested. However, the patient refused further surgical or systemic treatment. Close followup was recommended annually, including physical examination of the whole body skin surface, oral cavity, and mucosa and optic fundus. Computerized tomography and magnetic resonance imaging of the brain, abdomen and pelvic cavity, and endoscopy of gastrointestinal tract were also performed. All of the diagnostic methods failed to reveal evidences of malignant melanoma. To date panendoscopy has shown a widely open prostatic fossa and marked trabeculation of the bladder without any purpleblack discoloration of mucosa from 1 year postoperatively. DISCUSSION

Modelling and Supervision of Intra-Peritoneal Chemohyperthermia (IPCH)

Intraperitoneal chemohyperthermia is more and more considered as an interesting therapeutic option in cases of some abdominal cancers, particularly of digestive origin. However, many technical aspects of this treatment remain far from being mastered, particularly the homogeneous dispatch of temperatures and drugs within the abdomen cavity. The project described in this paper consists, first of all: in an experimental study, which has been carried out on a physical, in vitro «prototype» of the abdomen, on which different hot fluid flows and injection conditions (configurations) are investigated. The results of this experimental study have enabled to obtain a model of the « system » behaviour. The modelling results have helped to optimize the injection circuit and its running parameters while applied to the in vivo treatment of patients. A real-time software has been written to perform in vivo data acquisition and to provide an “on-line” help to the surgeon as well as to the radiesthesist, who are monitoring the operation. It has been validated during several in vivo IPCHs. Data has thus been acquired and first comparison conclusions could be drawn concerning the models as well as the supervision assistance.

Corynebacterium pseudotuberculosis infection in horses: 538 cases (1982-1993)

Objective To describe clinical manifestations of Corynebacterium pseudotuberculosis infection in horses and to evaluate diagnostic methods for identification of this disease. Design Retrospective case series. Animals 538 horses with a diagnosis of C pseudotuberculosis infection. Results Median age of horses with external abscesses was similar to that in horses with internal abscesses. Breed and sex did not appear to be associated with infection. Cases were detected during all 12 months; however, the disease was most common in the fall and early winter, with the highest incidence in September, October, and November in every year. Most horses (492/538, 91.4%) had a single episode of infection, without recurrence in subsequent years. Of 538 horses, 308 had pectoral abscesses, although infection was documented in many other anatomic locations. Forty-two horses had internal abscesses involving the abdomen or thoracic cavity. Corynebacterium pseudotuberculosis infection was readily identified by bacterial culture of aspirate samples from abscesses. The synergistic hemolysis inhibition test was useful for diagnosis of internal abscesses; however, it was unreliable for the diagnosis of external abscesses. Horses with external abscesses responded well to conventional treatment, in contrast to those with internal abscesses. The overall case fatality was low (3.9%), and was considerably lower for horses with external abscesses (0.8%) than for horses with internal abscesses (40.5%). Clinical Implications Serology (synergistic hemolysis inhibition titers ≥ 512) is useful for diagnosis of internal abscesses, but not reliable for diagnosis in horses with exernal abscesses. Prognosis for horses with internal abscesses is considerably poorer than for those with external abscesses. (J Am Vet Med Assoc 1996;209:804–809)

Laparoscopic splenectomy in the management of hematological diseases

After being successfully applied to other intraabdominal organs, the laparoscopic approach has been applied to the spleen since 1991. The experience with 17 cases of laparoscopic splenectomy performed due to immune thrombocytopenia purpura (10 instances), hereditary spherocytosis (2 cases), and Hodgkin's disease where the staging was done according to Standford (5 cases), have been reported. With the patient in anti-Trendelenburg position, and the surgeon between the patient's legs, four or five trocars are introduced into the upper abdominal quadrants and the spleen hilum is isolated. Hilar vessels are dissected and ligated with a surgical stapler. A plastic bag is introduced into the abdomen cavity and the spleen is slipped inside; it is then extracted through an umbilical incision after morcellation. Advantages of the open operation include a decrease in postoperative pain, a decrease in pulmonary sequelae, a reduced incidence of subphnic abscesses, and cosmetic advantages. The decrease of postoperative sequelae reduces hospitalization and costs, which are higher for the operation itself (materials and staff's training).

Primary Malignant Melanoma of the Prostate

CASE REPORT A 61-year-old man presented with a 2-year history of prostatism. Preoperative evaluations, including digital examination, transrectal sonography of the prostate and serum prostate specific antigen, revealed no evidence of malignancy. Diagnosis was benign prostatic hyperplasia and transurethral resection of the prostate was performed. Black discoloration of the prostate was evident on urethroscopy. Histology of the surgical specimen demonstrated a solid tumor cell nest in the prostate with intact urethral epithelium (fig. 1). Tumor cells were polygonal with prominent nucleoli. Melanoma cells were distributed in the stroma, which were independent of the acinar glands (fig. 2). Physical examination of the whole body skin surface, oral cavity, anal mucosa and optic fundus was done. Computerized tomography of the brain, abdomen and pelvic cavity, and endoscopy of the upper and lower gastrointestinal tract failed to reveal any other focus of malignant melanoma. Two months postoperatively urethroscopy showed some purpleblack discoloration on the prostatic urethra and verumontanum. Residual melanoma was suspected. The patient refused radical cystoprostatectomy and urethrectomy with or without chemotherapy.

Ultrasound Windows to Abdominal and Pelvic Veins

While ultrasound examination of leg veins has been largely accepted, assessment of the pelvic and lower abdominal veins has been largely ignored. The problem here is that the pelvic region contains important veins, which require assessment for deep vein thrombosis and pelvic and vulval varices, but these are superimposed by abdominal viscera. The need to assess the veins of the lower abdomen and pelvic cavity prompted us to develop a reproduceable technique of ‘windowing’ into the abdomen and pelvis to view certain veins. To view a certain vein, a nominated angle of approach from a particular anatomical point with the patient in a specific position will under most circumstances provide a sonic ‘window’ to that vein. There are eight of these such windows that can, in competent hands, be used to assess a variety of pelvic and lower abdominal veins.

Multiplanar computed tomography of abdomen and pelvic cavity

Multiplanar computed tomography of abdomen and pelvic cavity

Distribution of xenon-133 in mice from the urinary bladder.

The distribution of 133Xe from the bladder was investigated in sliced mice at autoradiography and quantitatively by counting tissue samples from the abdomen and thoracic cavity. Xenon is a highly diffusible inert gas that passes the bladder urothelium. In living mice activity could be seen in the intra-abdominal fat, liver and kidneys; the activity in the kidneys depended on reflux through the ureters. The xenon gas was found in the highest concentration in the lungs where it is expired. The study confirms the assumption that instillation of xenon in the bladder can be used as an indicator for permeability and flow in the wall of the urinary bladder.