Abdominal Mass Research Articles

Unique presentation of Congenital ureteropelvic junction obstruction in adult

Summary: A 34-year-old female, without comorbidities, presented to the emergency department with sudden right flank pain. Initial workup showed elevated WBC (14.5) and normal creatinine (0.81), but later developed fever spikes and rising CRP (59.50). Gentamicin treatment was initiated. Transferred for a Diuretic Renogram, confirming suboptimal function of the right kidney with obstruction at the renal pelvis/PUJ. Split functions indicated 32% for the right kidney and 68% for the left. Radiological workup included ultrasound, CT KUB with contrast, and CT Urography, revealing right renal acute hydronephrosis without evidence of stones. Management involved symptomatic treatment, but with persistent symptoms, Gentamicin prophylaxis was initiated. The patient was transferred for Renogram, detecting suboptimal right kidney function. A planned stent insertion followed by Robotic-assisted and laparoscopic pyeloplasty was scheduled. Discussion: Uretero Pelvic Junction Obstruction (UPJO) is a partial blockage where the ureter enters the kidney. Congenital UPJO can result from intrinsic narrowing, high ureter insertion, ureteral polyps, or accessory renal artery crossing vessels causing extrinsic compression. Most cases are detected on prenatal ultrasound, while postnatal presentations include UTI, abdominal mass, hematuria, and intermittent flank pain. Diagnosis involves CT urography and diuretic renogram, confirming suboptimal function (

Case Report on Mucocele of Appendix with Tubo-ovarian Complex and Review of Literature

Mucocele of the appendix is a rare condition caused by mucus accumulation due to a blocked appendix resulting from inflammation, infection, or faecal matter blockage. It presents as lower abdominal pain, vomiting, nausea, abdominal mass, and distension. It is more common in individuals over 50 years old and is more prevalent in the elderly. Mucocele can be differentiated into mucinous cystadenocarcinoma, mucosal hyperplasia, and mucinous cystadenoma. It is often diagnosed incidentally during radiological, laparoscopic, or surgical interventions. Ultrasound and computed tomography imaging techniques are useful in screening and diagnosing appendiceal mucocele, as they can detect a cystic mass or soft tissue mass and differentiate between a mucocele and other neoplasms. Most cases are reported in older individuals, with few in young adults. In the present case report, the authors present a case of a 34-year-old female with a history of occasional abdominal pain. On investigation, it was found to be an inflamed appendix with a mass in the right iliac fossa for which the patient underwent appendectomy. Due to the involvement of the right adnexa with tubo-ovarian complex and omentum, the present case presents a unique manifestation of an appendix mucocele.

Grossing to reporting of Wilms tumor with emphasis on proper sampling in treatment-naive and postchemotherapy specimens and their clinicopathological correlation with outcome.

Emphasis on grossing to reporting for the assessment of histopathological parameters predicting outcomes in Wilms tumor. To analyze various clinicopathological parameters that effect outcomes in treatment naïve and post chemotherapy Wilms tumor specimens. This was a retrospective observational study. All patients diagnosed with Wilms tumor between 2012 and 2018 at our institute will be included with their clinical findings, laboratory reports, and radiological findings. The patients will be categorized into two groups based on treatment protocol (Society of Pediatric Oncology (SIOP) or the National Wilms Tumor Study Group/Children's Oncology Group (COG) guidelines) used. Details of Grossing and reporting protocols used for the in pre treatment and post treatment specimens will be analyzed. Follow-up till December 2020 will be analyzed. Chi-square and Fisher's exact tests were used for statistical analysis. A total of 36 patients with the diagnosis of Wilms tumor were included in the present study. The mean age of presentation was 3.9 ± 0.7 years, and males were more common than females. Most of them presented as abdominal mass and few with isolated hematuria. Twenty-six (72%) patients were treated under SIOP protocol with preoperative neoadjuvant chemotherapy. Ten patients underwent upfront surgery as per COG protocol. In SIOP group patients, the mean tumor size was 9.3cm. Forty percent (n = 10) we mixed histological type followed by blastemal type constituting (32%, n = 8). Regressive and epithelial histological types constituted 16% (n = 4) and 12% (n = 3), respectively. In the SIOP group 72% (n = 19) had no anaplasia and 28% (n = 7) had anaplasia. Fifty seven percent (n = 15) cases were Stage I, followed by 26.9% n = 7) and 11.5% (n = 3) being Stage II and Stage III, respectively. Ten patients underwent upfront surgery as per COG protocol. The mean tumor size among this group was 8 cm ranging from 7 cm to 11 cm. Eight (80%) cases had favorable histology and two cases showed focal anaplasia. Heterologous differentiation is seen in 3 (70%). Out of the 10 cases, one case was Stage I, six were Stage 2, one was Stage III, and two were clinical Stage IV. None of the cases showed either vessel or lymph node metastasis. All the patients received adjuvant chemotherapy postsurgery and were followed up till December 2020 for (at least 3 years). Of 25 patients in the SIOP group, 18 (72%) had complete remission with no radiological evidence of residual disease. Of the 10 patients in the COG group, 6 (70%) had complete remission. Histopathological evaluation of Wilms tumor is a critical aspect in the management of Wilms tumor, as tumor characteristics are different in the tumors treated under SIOP and COG protocols, which will ultimately affect the prognostic risk stratification. This necessitates the knowledge of the important grossing and reporting of these tumors under the two protocols.

Case of Ray Fungus Presenting with Abdominal Distension

Actinomycosis is a rare infection caused by filamentous, non acid fast staining and gram positive bacteria. The diagnosis is rarely made preoperatively, and only histopathological examination can confirm it, as the condition presents with varied clinical manifestations, often resembling a malignant lesion on radiographic images. Hereby, the authors present a case of a 67-year-old female, who was admitted for evaluation of an abdominal mass. Radiologically, the mass resembled a desmoplastic fibroma, and clinically, it was suspected to be the same. The mass was excised and sent for histopathological examination. Grossly, two specimens were received. The first consisted of adherent bowel loops, including the ileum, appendix, caecum and descending colon, with the mass arising from mesentery involving the bowel, measuring 11.5x9.5x6 cm. The second specimen was a partial cystectomy specimen, with the abdominal wall mass infiltrating the bladder anteroposteriorly, measuring 11x10x8 cm. Microscopic examination revealed extensive areas of inflammation with actinomycotic organisms exhibiting the Splendore-Hoeppli phenomenon, along with numerous multinucleated giant cells and acute on chronic inflammatory infiltrate. Surrounding areas showed dense collagen bundles. The prognosis after complete surgical resection is good, along with the administration of broad spectrum intravenous antibiotics.

Investigating the accuracy of Johnson’s rule in estimating fetal weight

BACKGROUND: Birth weight has a significant impact on perinatal mortality. Therefore, the estimation of fetal weight greatly influences the policies necessary for care during and after delivery. We aimed to investigate Johnson’s rule in estimating fetal weight. MATERIALS AND METHOD: This study was a single-group longitudinal study that was conducted in 6 months from October 2021 to April 2022 on 150 pregnant women in Isfahan-Iran. The sampling method was accessible. Inclusion criteria include being term, singleton, without abnormality, intact membranes, cephalic presentation, and exclusion criteria include diagnosed polyhydramnios or oligohydramnios and mother’s abdominal or pelvic known masses. After completing the informed consent, fetal weight was estimated by Johnson’s rule and was compared with the birth weight. Descriptive and analytical statistics (mean-standard deviation (SD), number-percentage, t-paired, and Spearman’s correlation coefficient) were used to achieve the objectives of the study. The receiver operating characteristic (ROC) curve was also used to determine the sensitivity, specificity, and positive and negative predictive value of Johnson’s law. RESULT: The mean (SD) birth weight was 3032.88 ± 481.11 g and the mean (SD) estimated fetal weight (EFW) by the clinical method was 3152.15 ± 391.95 g. There was a significant difference between the averages (P < 0.001). The percentage error of EFW showed a significant negative correlation (r = -0.286; P < 0.05) with gestational age (GA) and a significant positive correlation (r = 0.263; P < 0.05) with the fetal head station. The sensitivity and specificity of EFW with Johnson’s rule, in normal fetal birth weight, were higher than in low birth weight fetal. The accuracy of EFW with ± 10% of the actual weight was higher in average for gestational age (AGA) (84.3%) and high-for-gestational-age (LGA) (70%) than in low-for-gestational-age (SGA) (4%). The EFW mean percentage error in SGA was higher than in the other two weight groups. This method, especially for AGA and LGA fetuses, can be a suitable alternative to other weight estimation methods. CONCLUSION: Clinical estimation of weight via Johnson’s rule due to availability and no cost can be a suitable method for managing childbirth based on fetal weight.

A Large Tuberculous Abscess Mimicking an Abdomino-pelvic Cystic Mass: A Case Report

Introduction: Tuberculosis can involve any part of the gastrointestinal tract or the peritoneum and is the sixth most frequent site of extrapulmonary involvement. The pseudotumoral form is relatively rare and several predisposing factors are mentioned, a significant differential diagnostic problem with malignant tumor pathology is exposed , often considered first when encountering an abdominal or pelvic mass in the context of overall deterioration. Presentation of case: We report a rare case of a huge retroperitoneal TB abscess mimicking an abdomino-pelvic cystic mass. Discussion: Abdominal tuberculosis represents 1 to 2% of all locations and 31 to 58% of abdominal locations. The pseudotumoral form is relatively rare and are uncommon in immunocompetent patients. Tuberculosis abscess can present with variable radiologic features. It is difficult to differentiate it from malignant pathologies. Invasive explorations, such as laparoscopy or laparotomy, play a crucial role in confirming the diagnosis. Peritoneal cavity exploration may reveal whitish granulations, peritoneal nodules, peritoneal hyperemia, filamentous peritoneal adhesions, and intestinal adhesions. Histological examination of biopsies are the key to the diagnosis. The treatment of peritoneal tuberculosis relies on a combined therapy of antitubercular drugs . Conclusion: As TB remains endemic in our country and with the continued increase in multidrug-resistant TB infections, it is important to know various presentations and diagnosis forms features of extrapulmonary TB including TB abscess as the treatment remains basically the same combining anti-tuberculosis drugs and the recourse to surgery.

Desmoplastic Small Round Cell Tumors: Clinical Presentation, Molecular Characterization, and Therapeutic Approach of Seven Patients

Desmoplastic small round blue cell tumor (DSRCT) is a highly aggressive fatal sarcoma without evidence‐based therapeutic guidelines. We present here seven patients with DSRCT including immunohistochemistry combined with fluorescence in situ hybridization (FISH), next generation sequencing (NGS, n = 6) as well as OncoScan array (n = 3) analyses and show consecutive therapeutic approaches. All seven DSRCT patients presented with an extended abdominal mass; median age at diagnosis was 24.8 years. NGS analyses revealed five class 4 or 5 sequence variants. Remarkably, OncoScan and targeted analyses by FISH identified genomic gains of CCND1 in two cases. Cyclin D1 expression was present in all seven tumors as shown by immunohistochemical staining. Multimodal therapeutic concepts included systemic therapies, resection, and radiation. Six patients were treated as first‐line therapy with conventional chemotherapy. All except one patient had a dismal therapy response. Subsequent therapy lines consisted of chemotherapeutic combinations followed by targeted therapies. Due to Cyclin D1 expression, the CDK4/6 inhibitor palbociclib was applied to four patients. The median therapy duration until disease progression in these patients was 4.5 months (range, 1.5–5 months). So, CCND1 genomic gain and Cyclin D1 expression are common features pointing to cell‐cycle deregulation as a possible therapeutic target.

Meckel’s diverticulum with varied clinicopathological presentations: A case series at a rural tertiary care center

Meckel’s diverticulum (MD), first documented by Wilhelm Fabricius Hildanus in 1598 as a small bowel diverticulum and later detailed by Johann Friedrich Meckel in 1809, is a remnant of the vitellointestinal duct connecting the fetal gut with the yolk sac. It is a true diverticulum, comprising of all the layers of the bowel wall. The commonly cited “rule of 2s” regarding the diverticulum is: Occurs in 2% of the population, has a 2:1 male-to-female ratio, usually discovered by 2 years of age, located 2 feet from the ileocecal valve, and commonly 2 cm in diameter and 2 inches long. Most Meckel diverticula are benign and are incidentally discovered during autopsy, laparotomy, or barium studies. Vitellointestinal duct lining cell being pluripotent, heterotopic tissues such as gastric, pancreatic followed by others might be found. Common clinical presentation in symptomatic cases is gastrointestinal hemorrhages followed by intestinal obstruction, diverticulitis, cystic abdominal mass, patent umbilical fistula, and neoplasm. Clinical signs and symptoms are non-specific simulating other abdominal emergencies and routine radiology is unable to detect the anomaly in rural peripheral centers. Hence, prompt surgical intervention may be needed in emergency cases. Diverticulectomy or ileal segment resection with end-to-end anastomosis is done. Due to the difficulty of diagnosing a pathologic MD pre-operatively, many surgeons recommend prophylactic diverticulectomy in those found incidentally.

Disseminated Gastrointestinal Basidiobolomycosis: A Case Report with Review of Diagnostic Clues

Introduction. Basidiobolomycosis is a rare fungal infection caused by an environmental saprophyte, Basidiobolus ranarum. It usually presents as a chronic subcutaneous infection; however, few cases of gastrointestinal involvement have been reported. The exact transmission route of gastrointestinal cases is not clear, and diagnosis always requires a high index of suspicion because it tends to mimic other inflammatory and neoplastic conditions. Case Report. A 31‐year‐old immunocompetent woman presented with abdominal pain and an advanced colon mass. She was completely well until about 1.5 years ago, when she underwent bariatric surgery. One year after surgery, chronic abdominal pain developed. A colonoscopy showed an ulcerative lesion in the descending colon, and the biopsy was in favor of ulcerative colitis. Despite immunosuppressive treatment, there was no improvement, and with worsening symptoms, more investigations revealed advanced colon mass with entrapment of the stomach and pancreas. Colonic mucosa biopsy and trucut biopsy of the mass showed just necrosis and acute inflammation; thus, she underwent exploratory laparotomy with colectomy, partial gastrectomy, distal pancreatectomy, and left nephrectomy. On pathologic examination, there was granulomatous inflammation plus the Splendore–Hoeppli phenomenon around fungal hyphae, which was diagnostic for gastrointestinal basidiobolomycosis. Previous pathology slides were reviewed and revealed a tiny focus of basidiobolomycosis. After 6 months of treatment with itraconazole, she is relatively well without any clinical or radiologic abnormalities. Conclusion. Our case highlights the significance of suspicion for basidiobolomycosis in ulcerative and necrotic lesions with increased eosinophils, especially in the presence of abdominal mass and systemic eosinophilia.

Giant serous cystadenoma in an adolescent: A case report

Ovarian tumours occur at an incidence rate of 2.6 cases per 100,000 children, and their frequency escalates proportionally with age. These tumours typically have an organic origin and are seldom functional. The frequent presence of pain primarily characterizes the clinical manifestation of ovarian cysts. The complexity inherent in analyzing this pain can complicate diagnosis, necessitating a thorough evaluation that could potentially require resorting to a pelvic ultrasound to confirm the diagnosis and determine the optimal management. Additional imaging techniques and tumour marker assays aid in specifying the nature of this mass, where surgery remains the sole therapeutic option. The histopathological analysis further confirms the precise nature of the mass or cyst to establish a prognosis and guide the management strategies and progression follow-up. Our case is for a girl aged 15 years old without notable medical history, presenting at admission with a 6-month history of a gradually enlarging abdominal mass associated with abdominal pain and tumour markers (BHCG was negative). In addition, LDH, CA125, Inhibin, CEA and CA19.9 were negative. Radiologically, the ultrasound revealed a huge cystic abdominopelvic mass occupying the entirety of the abdomen and pelvis with posterior compression of the intestines without visualization of the left ovary; the right ovary appeared normal. MRI confirmed the presence of a voluminous intraperitoneal abdominopelvic cystic formation measuring 31 × 20 × 8 cm. The patient underwent laparoscopic surgery, revealing a large cystic mass with septations filling the abdomen and pelvis and displacing the gastrointestinal tract. After draining 6 L of clear fluid, the entire cyst was removed while preserving some left ovarian tissue, with the right ovary appearing normal. The follow-up is still ongoing, with the last consultation being 8 months post-operative.

Feline ventral abdominal wall angiosarcoma: haemangiosarcoma or lymphangiosarcoma? Clinical and pathological characteristics in nine cases.

Angiosarcomas are rare malignant mesenchymal neoplasms of endothelial cell origin with a predilection to the ventral abdominal wall in cats. Larger case series describing this entity are lacking. Two referral centre laboratory databases were searched for angiosarcoma of the ventral abdominal wall. Nine cases with a histological diagnosis were included. Immunohistochemistry (factor VIII and PROX-1 antibodies) was used to phenotype them as haemangiosarcoma or lymphangiosarcoma. All cats presented with a ventral abdominal mass, five of which were producing a serosanguinous discharge. Eight underwent tumour staging and pulmonary metastases were suspected in one cat (but not histologically confirmed). With histopathology alone, a diagnosis of angiosarcoma and lymphangiosarcoma was made in four and five cases, respectively. After immunohistochemistry, five cases had a haemangiosarcoma phenotype and four had a lymphangiosarcoma phenotype, including two cases of lymphangiosarcoma that were reclassified as hemangiosarcoma. Eight cats received treatment (either surgery with or without adjuvant therapies or medical management alone). Six cats were euthanased due to local disease progression. The median survival time for haemangiosarcoma was 166 days (range 137-381), and for lymphangiosarcoma it was 197 days (range 67-208). Two cats with haemangiosarcoma remained alive for a follow-up period of 329 and 580 days, respectively. Feline ventral abdominal angiosarcomas are rare locally aggressive neoplasms. While histology often provides a diagnosis of angiosarcoma, immunohistochemistry is ultimately required to differentiate between haemangiosarcoma and lymphangiosarcoma phenotypes. Further studies are required to evaluate whether the different phenotypes have an impact on treatment response and outcome.

Spotlight on Carcinosarcoma of the Ovary: A Scoping Review.

Ovarian carcinosarcoma, also referred as malignant mixed Mullerian tumour, is an uncommon, highly aggressive and malignant neoplasm which makes up 1 to 4% of all ovarian tumours. It is biphasic involving both malignant sarcomatous (mesenchymal) and carcinomatous (epithelial) cells. There are various subtypes such as serous and endometrioid. However, the mesenchymal part is sarcomatous. About 90% of cases of ovarian carcinosarcoma spread outside the ovary. The two most accepted theories of origin for carcinosarcoma of the ovary are the collision and conversion theories. A third theory is the combination theory. Prognosis remains poor even when still localised in the ovary. In the last few years, there has been no change in the survival rate. The median survival rate is lower than 2 years. Clinical features mainly include lower abdominal pain and a palpable abdominal mass. Ovarian carcinosarcoma remains poorly understood and understudied. Being a rare tumour, elaborate therapeutic consensus is not available for ovarian carcinosarcoma. The main treatment involves cytoreductive surgery and then chemotherapy. The type of chemotherapy, role of radiotherapy and novel therapies need to be further studied. The main objective of this article is to review the current literature on carcinosarcoma of the ovary.

Intestinal cystic lymphangioma.

A 7-year-old girl, coming from a rural area in Cameroon, presented to the emergency department with a 3-months history of abdominal pain. Her family also reported vomiting and minimal food intake for two weeks. Physical examination showed a palpable and mobile abdominal mass. An ultrasound showed a large intrabdominal multicystic lesion of about 10cm, close to the intestine and with no solid lesions in other organs. A laparotomy was scheduled and a mobile mass dependent on the jejunum was found. The mass caused an intestinal obstruction and was composed of several large cysts with whitish fluid. Excision of the mass and resection of a short segment of small bowel were performed. Intestinal cystic lymphangioma is a rare congenital malformation that normally presents with abdominal pain and distension. Abdominal ultrasonography is the procedure of choice for the diagnosis. Intestinal resection and anastomosis (while the cyst is normally intimate attached to the bowel) is an effective treatment.

Nodal T-cell lymphoma with eosinophilic infiltration and sclerosing fibroplasia in a cat with eosinophilia.

An 8-year-old castrated male mixed-breed cat presented with an abdominal mass of unknown origin, accompanied by eosinophilia. Autopsy revealed mild-to-severe enlargement of lymph nodes throughout the body and multiple nodules in the lungs. Histopathologically, the lymph nodes showed severe fibroplasia and infiltration by a large number of eosinophils and fewer tumor cells, exhibiting large-sized lymphoid cell morphology. Metastatic lesions of tumor cells with eosinophilic infiltration and fibrosis were observed in the lungs, liver, kidneys, stomach, and intestines. Immunohistochemistry revealed that the tumor cells were positive for CD3 and negative for B cell and mast cell markers. Thus, T-cell lymphoma with eosinophilic infiltration and sclerosing fibroplasia was diagnosed.

Anaesthetic Challenges in Paediatric Hepatoblastoma Resection: A Case Report

The most common primary liver tumour in children is hepatoblastoma, which is often diagnosed in the first three years of life. While the majority of hepatoblastomas are sporadic, some associations are reported with genetic disorders like BeckwithWiedemann syndrome and familial adenomatous polyposis. The annual incidence of hepatoblastoma in children has gradually increased during the past three decades. Babies born prematurely, weighing <1 kg, have been found to be significantly more likely to acquire hepatoblastoma. The most common symptoms with which children present are abdominal discomfort, easy fatigability, loss of appetite, and anaemia. The choice of treatment is surgical resection of the mass or surgical resection coupled with chemotherapy. Present case is of a seven-month-old, 7 kg infant who presented with a gradually increasing abdominal mass diagnosed as hepatoblastoma. Left hepatectomy was done under general anaesthesia and epidural analgesia. Liver resection is one of the major surgical procedures that carries a risk of blood loss and pulmonary embolism, but improved expertise in paediatric anaesthesia and surgical skills have reduced operative risk. The challenges in this case were securing vascular access, maintaining blood volume with considerable fluid and blood loss, and assuring haemodynamic stability. Maintenance of normothermia, glucose levels, and effective pain management were all crucial, necessitating careful planning and a multidisciplinary approach to maximise results and guarantee patient safety

Mixed Canine Mammary Gland Tumour in a 10 Year Old Lhasa Apso Bitch Histopathological Evaluation and Surgical Management

Mixed mammary gland tumors are the most frequent canine mammary gland neoplasms with a high incidence rate among females, however, there is paucity of studies that describe their clinic-pathological presentations and management approaches. This case evaluated the clinic-pathological data and management of mixed mammary gland tumors. A 10-year-old Lhasa Apso bitch weighing 11.4kg was referred to the University of Jos Veterinary Teaching Hospital with a ventral abdominal mass. Clinical examination revealed an enlarged left inguinal mammary gland with two palpable masses. The inguinal region was aseptically prepared for surgery and anesthesia achieved by the administration of 1% atropine sulphate (Atropine® - Shanxi Shuguang Pharmaceutical Co., Ltd., Qixian, China) and Chlorpromazine as preanesthetics and 50mg/mL Ketamine hydrochloride (Jawa ketamine® - Swiss Parenterals Ltd, Gujarat, India) + 2% Xylazine (Alfasan, Woerden-Holland) as induction and maintenance anesthetics. The glandular, connective/fibrous and fatty tissues of the mammary gland were carefully dissected to achieve the complete excision of the encapsulated mammary tumour masses before the reconstruction of the resulting defect. Postoperatively, penicillin and streptomycin, piroxicam, vitamin B complex, dexamethasone, vincristine sulphate and ivermectin were administered. The excised masses histologically presented numerous tubules with some containing mucin. Also there were the presence of acini with neoplastic epithelial cells and myoepithelial cells, cartilage and bony trabeculae. Surgical debulking with adjunctive immuno-chemotherapy was curative for the mixed mammary gland tumours in this bitch.

Costal Chondroid Tumors Mimicking Intraabdominal Masses: The Pivotal Role of Computed Tomography in Diagnosis.

Teaching Point: Costal chondroid tumors can mimic abdominal masses and, when located in the right hypochondrium, may suggest hepatic origin. Computed tomography is essential to determine their origin and nature and to guide appropriate treatment.

Large Chondrosarcoma of the Lower Rib Presenting as a Cystic Abdominal Mass.

Teaching point: Chondrosarcoma of the lower rib may present with only minimal calcified chondroid matrix and may be misinterpreted as a liver lesion.

Metastatic Desmoplastic Small Round Cell Tumor - A Case Report and Review of the Literature

Desmoplastic small round cell tumour is a rare malignancy most often seen in the abdomen or pelvis of young men. Unfortunately, this disease is usually metastatic at diagnosis and has dismal outcomes. Since 1991, when it was first described as a distinct clinical entity by Gerald WL and Rosai J some 200 cases were reported. All cases are characterized by the chromosomal translocation t (11;22) (p13; q12), which results in a formation of EWSR1-WT1 fusion gene. The diagnosis of IDSRCT is often made with core-needle tissue biopsy specimens of laparoscopy or laparotomy. Immunohistochemical analyses have shown the co-expression of epithelial, neuronal, myogenic, and mesenchymal differentiation markers. Multimodal therapy is usually indicated with chemotherapy, surgery & radiotherapy. We report a rare and unusual case of an extensive abdominopelvic desmoplastic small round cell tumour with liver & lung metastases, in an adolescent male patient from Bangladesh who presented with abdominal mass, pain & hepatomegaly. With various difficulties in diagnosis, we ultimately reached at diagnosis by open biopsy and immunohistochemistry as desmoplastic small round cell tutor. Now patient is on multidrug chemotherapy (modified p6) protocol.

PRIMARY OVARIAN LEIOMYOMA ASSOCIATED WITH MULTIPLE UTERINE LEIOMYOMAS: A CASE REPORT

Leiomyoma is a benign mesenchymal tumour, occurring frequently in uterus. But ovarian leiomyoma is rare, accounting less than 1% of all ovarian tumours. Ovarian leiomyoma is associated with uterine leiomyoma in about 78% of the cases. Being asymptomatic they are often incidentally detected in most of the patients. This is a case of ovarian leiomyoma associated with uterine leiomyomas in a 53 year old woman who had abdominal mass on examination during her regular check-up. Ultrasonography revealed multiple uterine fibroids and a unilocular cyst in right ovary. Total abdominal hysterectomy with bilateral salpingoophorectomy was performed. Gross examination showed left ovary totally replaced by grey-white firm mass. Microscopic features were typical of leiomyoma and was confirmed immunohistochemically. Major differential diagnostic considerations for this tumor in ovary were fibroma, thecoma and leiomyosarcoma. Though rare, ovarian leiomyoma should be considered in differential diagnosis of ovarian solid mass. The immunohistochemical staining with desmin, inhibin, and α-smooth muscle actin are useful to rule out the differential diagnosis.