Abdominal Mass Research Articles

Prenatal Diagnosis of Fetal Ovarian Cyst. Report of a Case

Background: Prenatal diagnosis of abdominal cysts is relatively common; The ovarian cyst is the most predominant chemical lesion of abdominal masses in female fetuses; however, given the wide variety of intra-abdominal masses, determining the origin of the chemical lesion is the most frequent diagnostic challenge, especially to establish fetal prognosis. Clinical Case: 30-year-old patient, who went to the emergency department for uterine contractions, no prenatal control, during the ultrasound evaluation, polyhydramnios and an intra-abdominal cystic lesion measuring 4.9 x 3.9 cm, without septa and with a thin wall were documented, the area was intentionally reviewed. renal, hepatic, and intestinal; Without involvement of these structures, female genitalia were confirmed, concluding in a probable ovariandependent cyst, admission for resolution of the pregnancy via the abdomen due to pelvic presentation and labor, at birth the diagnosis was confirmed. Conclusions: Timely detection of an intra-abdominal chemical injury and ecological follow-up improve perinatal prognosis.

Rapunzel Syndrome in A 13-Year-Old Girl with Abdominal Pain Presenting to The Pediatric Emergency Department: A Case Report

Trichobezoar is a rare form of bezoar characterized by the accumulation of swallowed hair in the stomach. An unusual form of bezoar, in which the bezoar spreads from the stomach to the small intestine or beyond, is called Rapunzel syndrome. This syndrome is mainly seen in females and is often associated with psychiatric disorders. Trichobezoar usually presents with abdominal pain, early satiety, and nausea. However, it may also present as an asymptomatic abdominal mass or obstruction and pe rforation of the gastrointestinal tract. This diagnosis should be considered in young women with abdominal pain, an epigastric mass, and malnutrition, especially in patients with a history of trichophagy or psychiatric disorder. The case of a 13-year-old girl with Rapunzel syndrome is described. She presented to the emergency ward with a history of abdominal pain, non-bilious vomiting after meal and fluid intake, halitosis, decreased appetite, and weight loss. The patient was treated successfully by laparotomy.

CryptoImperforate Hymen with a Huge Abdominal Mass and Massive Hematocolpometra in a 15-Year-Old Girlmenorrhea with a Huge Abdominal Mass and Massive Hematocolpometra in a 15-Year-Old Girl

Background: Imperforate hymen is one of the commonest embryological defects of the lower genital tract which occurs due to failure of canalization of the sinovaginal bulb. Its incidence is 1 in 2000 girls. Case Presentation: This case is of a 15-year-old nullipara who presented on account of a 2-month history of recurrent abdominal pain, hesitancy, and primary amenorrhea. Her physical examination reveals a huge abdominopelvic mass about the size of a 26 weeks intra-uterine gestation, and a vagina examination revealed an imperforate hymen. A pelvic ultrasound confirmed a massive hematometra and hemaltocolpos leading to a diagnosis of imperforate hymen. She had a hymenotomy with a cruciate incision to drain the menstrum. Conclusion: Pediatricians and gynaecologists need a high index of suspicion to diagnose this defect for earlier treatment and reduced morbidity due to late diagnosis.

Anaesthetic Management of Retroperitoneal Fetus-in-Fetu - A Rare Case Report and Literature Review

Fetus-in-fetu (FIF) is a rare congenital anomaly caused by the abnormal development of monochorionic diamniotic twins. It usually presents as an abdominal mass in infancy or early childhood. It has to be differentiated from teratoma which has the potential to be malignant. Here, we report a case of a 13-month-old girl child with fetus-in-fetu in the retroperitoneum. In spite of its rare incidence, preoperative diagnosis is possible through various imaging techniques. The child underwent exploratory laparotomy and complete excision of FIF under general anaesthesia. Even though complete resection is curative, long-term follow-up with alpha fetoprotein and beta-human chorionic gonadotropin is essential for monitoring malignant transformation.
 Fetus-in-fetu (FIF), otherwise called as cryptodidymus, is an extremely rare congenital disease caused by the abnormal development of monochorionic diamniotic twins. Its incidence is about 1 in 5,00,000 births and so far, only 200 cases are reported worldwide.[1] FIF occurs when a complete foetus is parasitized by one or multiple incomplete foetuses. It can be divided into two types namely internal and external. If a foetus is inside the body of a host, it is known as internal fetus-in-fetu, it is referred to as an external fetus-in-fetu if it is attached to any surface of the host.
 There is no gender predisposition noted in the incidence of FIF but few articles found a male predominance in the ratio of 2:1.[2] Even though FIF occurs mostly in infants and children < 3 years of age, there are cases reported in adults and pregnant women as well. The oldest patient with FIF recorded in the literature was 47 years old during the time of diagnosis.[3] The most common presentation of FIF is gradually enlarging abdominal mass almost 80% in the retroperitoneum.
 Differentiation from other abdominal tumours including teratomas, is necessary because the latter has potential for malignancy. FIF is usually malformed because of the pressure exerted by the host organs. It can affect their host, hence, early diagnosis and management is crucial. Various imaging modalities like radiography, Color-Doppler ultrasound, Computed Tomography (CT), Magnetic Resonance Imaging (MRI) have increased the pre-operative diagnosis rate.[4] Treatment of FIF is essentially surgical and prognosis after en bloc resection is favourable. In this article, we present the anaesthetic management of a rare case of retroperitoneal fetus-in-fetu in a girl child.
 The perioperative management of fetus-in-fetu cases is not yet reported anywhere in the literature. The preoperative evaluation and optimisation is very crucial since it reflects on the anaesthetic management and post-operative recovery. Explorative laparotomy in the paediatric age group is quite challenging because of the associated major fluid shifts, blood loss as the mass is located adjacent to the large vessels. Smooth induction and extubation are essential to minimise hemodynamic fluctuations. Meticulous fluid management and adequate analgesia are critical for enhanced recovery. This case report will aid anaesthesiologists in the deeper understanding regarding management of fetus-in-fetu cases.

Limitations in the management of colorectal cancer in sub-Saharan Africa

Colorectal cancer (CRC) was regarded as a rare disease in native West Africans. It is now accepted as an established disease with a rising incidence. The CRC is now known to be a complex tumour with different aetiopathological pathways. With all cancers early detection is important if one aims to cure the patient. A summary of the clinical features include: Unexplained ill-health and anaemia in patients with cancer of the caecum and ascending colon; palpable abdominal mass for colon cancer; rectal bleeding and tenesmus for carcinoma of the rectum; palpable mass on digital rectal examination in at least 75% of cases. The current complete management of this disease involves extirpative surgery and adjuvant treatment with a combination of cytotoxic chemotherapy and tailored therapy. This presentation will look at ways in which seamless management of CRC in this environment is hampered. The ‘PATIENT’ factor: Ignorance (which leads to unfavourable health-seeking behaviour) Poverty (goes for all developing countries) Gullibility (under which falls religion and alternative treatment) Cultural taboos (which lead to refusal of colostomy-based treatments) Aversion of the sequelae of rectal cancer treatment especially in males where up to 30% of patients are under the age of 40 years. Late presentation (effect of 1–5) The ‘COUNTRY’ factor: Politics: inadequate budget for health Workers not enough; current brain drain of doctors, major cancer centres are stretched. Infra-structure: There is a glaring lack of any population screening programme, a lack of public enlightenment messages for awareness and only two government centres have functioning radiotherapy machines. Staplers and cytotoxic drugs have to be imported, thus are expensive and out of reach of the common man. The ‘GENETICS’ factor: The biology of CRC in the native African is different from that of Caucasians and more aggressive. Carcinomatosis peritonei is frequent. There’s also the emergence of unusual metastases to the lungs and spine, bypassing the liver. A summary of the findings by Nigerian researchers on the molecular biology of native Nigerian CRC showed MSI (Not otherwise stated) occurred in 23–53% of Nigerian CRC, MSI-H seen in 28.1–43%. KRAS in 21% while BRAF was seen in 4.5%. The significance of these results may mean that we might not be administering the right combination chemotherapy in over 50% of our patients. Some studies have shown that patients with MSI-H CRC appear to have ineffectual or even detrimental responses to 5FU-based adjuvant chemotherapy. We all know that 5FU is the cornerstone of most of the combination chemotherapy we administer to patients (FOLFOX, FOLFIRI, CapeOX, XelOX). In addition, the 2012 study on BRAF and KRAS in Nigerians by Abdulkareem et al. also suggests that Nigerian patients may benefit more from anti-EGFR therapy (Cetuximab, Panitumumab) than Caucasians. However, cost implications will make prescribing these drugs a mere academic exercise in most Nigerian patients.

Frantz tumor: Case reports

Introduction: Frantz tumor or Solid Pseudopapillary Neoplasm are rare neoplasms that represent between 0.2-2.7% of exocrine pancreatic neoplasms. It was first described by Virginia K. Frantz in 1959, but it was included in the World Health Organization (WHO) classification of pancreatic tumors in 1996 as a “pseudopapillary tumor” of the pancreas. Of unknown etiology, its incidence is observed in young women; Clinically it manifests with slow growth of a solid abdominal mass accompanied or not by abdominal pain. There has been a gradual increase in the incidence of this tumor in the last two decades, probably due to the greater frequency of the use of cross-sectional images in the evaluation of abdominal symptoms. Its degree of malignancy is low and complete resection allows the patient a favorable evolution and prognosis.Materials and Methods: A retrospective observational bibliography review of patients with PNS operated on from October 2016 to December 2022 was carried out.Results: The patients operated on for Frantz tumor analyzed in the study did not have recurrences and/or metastases.Conclusion: pseudopapillary neoplasia of the pancreas (Frantz's tumor) should be considered in the differential diagnosis of pancreatic tumors, especially in young women, since surgical treatment has a good prognosis even if the tumors are large

Yield of abdominal radiographs in children with suspected intussusception; rate of pneumoperitoneum and other abdominal pathology

ObjectivesUltrasound is the criterion standard imaging modality for the diagnosis of intussusception. However, to our knowledge the utility of abdominal radiographs to concurrently screen for pneumoperitoneum or other abdominal pathology that could have a similar presentation has not been studied. Our institutional protocol requires the performance of AP supine and left lateral decubitus views of the abdomen prior to ultrasound evaluation for intussusception, providing an opportunity to examine the yield of abdominal radiographs in this setting.Our primary objective was to determine the rate of pneumoperitoneum on screening abdominal radiographs in children undergoing evaluation for intussusception. Our secondary objective was to determine the rate that other clinically significant pathology is found on these screening abdominal radiographs. MethodsWe performed a retrospective chart review of all patients under 6 years of age who had any imaging ordered in our large urban pediatric emergency department to evaluate for suspected intussusception during the calendar years 2018–2020. Results1115 patient encounters met our inclusion criteria. Among 1090 who had screening abdominal radiographs, 82 (8%) had findings concerning for intussusception. Of those not concerning for intussusception, 635 (58%) were read as normal, 263 (24%) showed moderate to large stool burden, 107 (10%) showed generalized bowel distention, and 22 (2%) showed abnormal gastric distention. Individually the remainder of all other findings compromised <1% of encounters and included radiopaque foreign body (8), intraabdominal calcification (4), pneumonia/effusion (3), pneumatosis intestinalis, abdominal mass (2), diaphragmatic hernia (1), rib fracture (1), appendicolith (1), feeding tube malposition (1), and bowel wall thickening (1). In one encounter the patient had a bowel perforation with pneumoperitoneum present secondary to ingestion of multiple magnets. ConclusionsOur study indicates that radiograph-detected pneumoperitoneum is rare in children with suspected intussusception. Constipation is the most common abnormal finding on screening radiographs. Other findings occur in approximately 15% of total cases, some of which require further workup.

Value of computed tomography and abdominal ultrasound for chronic inflammatory complications of diverticular disease

Aim: to evaluate the diagnostic value of computed tomography (CT) and abdominal ultrasound (US) for chronic inflammatory complications in patients with diverticular disease (DD).Patients and Methods: the prospective cohort study included 50 patients with complicated DD. All patients underwent preoperative abdominal CT with intravenous contrast and abdominal US, with further elective bowel resection. The results of CT and ultrasound were compared with morphology of the removed specimens.Results: the sensitivity and specificity for chronic diverticulitis was 66.7% and 95.7% for CT and 100.0% and 95.7% for US. For chronic pericolic abdominal mass it was 94.8% and 90.9% for CT, 94.8% and 100.0% for US; for abdominal abscesses/cavities it was 87.5% and 96.2% for CT and 91.6% and 100.0% for US; for diverticular fistulas it was 87.5% and 100.0% for CT and 87.5% and 100.0% for US. No significant differences were obtained between two diagnostic modalities. A high level of consistency (κ-coefficient 0.71) of CT and US for the diagnosis of inflammatory complications of DD was found. Conclusion: CT and US have a similar high diagnostic value for chronic inflammatory complications of DD. Each of them can be used as a single diagnostic modality or both depending on the clinical case.

Abscess formation of abdominal wall mimicking lymphoma due to Morganella morganii infection in a prepubescent children

Introduction: Morganella morganii infection mainly occurred in elderly people and immunocompromised patients.However, the abdominal wall abscess due to Morganella morganii infection in prepubertal children hasn't been documented.Our presented case is a 4-year-old male patient with a 1 month history of left lower quadrant abdominal mass. Preoperative ultrasonography showed a hypoechoic, heterogeneous mass and the mass wasn't just confined to the abdominal wall, mimicking lymphoma. On CDFI, an image of highly vascularized mass was demonstrated. The patient underwent lump resection of abdominal wall.Postoperative process was uneventful except intermittent haematuria, and bladder sludge and urethral calculus on ultrasonography.By symptomatic treatment, haematuria disappeared and urethral calculus and bladder sludge decreased. Then the patient discharged home. Postoperative histopathology and immunohistochemistry were suggestive of abscess formation and Morganella morganii was isolated finally from the aspirated pus. Conclusion: Therefore, although the abdominal wall abscess due to Morganella morganii infection is rare, it should not be absent in the differential diagnosis of abdominal wall masses in children. Imaging features of abdominal wall masses should closely integrate the pertinent clinical history.

The Incidence of Acute Peritonitis Secondary to Different Sites of Viscus Perforation.

Objective The incidence of peritonitis secondary to viscus perforation will be examined to determine the most common sites of perforation and associated comorbidities. Methods This is a retrospective observational study based on data collected from the King Fahad Hospital of the University (KFUH). This research targeted patients who had viscus organ perforation and the relation of peritonitis secondary to it. The sample was taken from patients under the care of the General Surgery Department from the first of Feb 2016 to the 12th of Sep 2022. The final sample consisted of 450 patients. The method of diagnosis of peritonitis was mainly clinical, and the surgical approach was either through an exploratory laparotomy or a diagnostic laparoscopy. Incidental findings of viscus organ perforation were noted in addition to certain postoperative complications (e.g., adhesions) and hospital stay. Results Analysis of the results showed a significant relation (p<0.001) between viscus organ perforation and peritonitis. The most common comorbidities associated with secondary peritonitis were hypertension (12, 24.5%), diabetes mellitus (10, 20.4%), any abdominal mass (3, 6.1%), and inflammatory bowel disease (1, 2%). However, a chi-square analysis has shown no significant association between peritonitis and the targeted associated comorbidities. Conclusion Perforation of the small intestine carries the biggest association with peritonitis incidence, in addition to comorbidities such as hypertension and diabetes mellitus. Further study to establish the value of these factors might contribute to decreasing the morbidity and mortality of secondary peritonitis.

Late presentation of supernumerary kidney in a 35-year-old man: a case report

The supernumerary kidney is the rarest of all renal anomalies, and few cases have been diagnosed and reported over the years. Supernumerary kidneys are most commonly located on the left side of the abdomen with associated pathologic conditions which include malformations of the upper urinary tract and genital tract. More importantly, it usually presents with either unusual abdominal mass or features of urinary tract infections which might pose diagnostic challenges due to infrequent occurrence. In this case report, we present a 35-year-old man with a right-sided unilateral supernumerary kidney complicated by pyelonephritis. He was treated with antibiotics, and the treatment outcome was satisfactory.

Abdominal fat depots and their association with insulin resistance in patients with type 2 diabetes

Background Asian-Indians show thin fat phenotype, characterized by predominantly central deposition of excess fat. The roles of abdominal subcutaneous fat (SAT), intra-peritoneal adipose tissue, and fat depots surrounding the vital organs (IPAT-SV) and liver fat in insulin resistance (IR), type-2 diabetes (T2D) and metabolic syndrome (MetS) in this population are sparsely investigated. Aims and objectives Assessment of liver fat, SAT and IPAT-SV by MRI in subjects with T2D and MetS; and to investigate its correlation with IR, specifically according to different quartiles of HOMA-IR. Methods Eighty T2D and the equal number of age sex-matched normal glucose tolerant controls participated in this study. Abdominal SAT, IPAT-SV and liver fat were measured using MRI. IR was estimated by the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Results T2D and MetS subjects have higher quantity liver fat and IPAT-SV fat than controls (P = 9 x 10−4 and 4 x 10−4 for T2D and 10−4 and 9 x 10−3 for MetS subjects respectively). MetS subjects also have higher SAT fat mass (P = 0.012), but not the BMI adjusted SAT fat mass (P = 0.48). Higher quartiles of HOMA-IR were associated with higher BMI, W:H ratio, waist circumference, and higher liver fat mass (ANOVA Test P = 0.020, 0.030, 2 x 10−6 and 3 x 10−3 respectively with F-values 3.35, 3.04, 8.82, 4.47 respectively). In T2D and MetS subjects, HOMA-IR showed a moderately strong correlation with liver fat (r = 0.467, P &lt; 3 x 10−5 and r = 0.493, P &lt; 10−7), but not with SAT fat and IPAT-SV. However, in MetS subjects IPAT-SV fat mass showed borderline correlation with IR (r = 0.241, P &lt; 0.05), but not with the BMI adjusted IPAT-SV fat mass (r = 0.13, P = 0.26). In non-T2D and non-MetS subjects, no such correlation was seen. On analyzing the correlation between the three abdominal adipose compartment fat masses and IR according to its severity, the correlation with liver fat mass becomes stronger with increasing quartiles of HOMA-IR, and the strongest correlation is seen in the highest quartile (r = 0.59, P &lt; 10−3). On the other hand, SAT fat mass tended to show an inverse relation with IR with borderline negative correlation in the highest quartile (r = -0.284, P &lt; 0.05). IPAT-SV fat mass did not show any statistically significant correlation with HOMA-IR, but in the highest quartile it showed borderline, but statistically insignificant positive correlation (P = 0.07). Conclusion In individuals suffering from T2D and MetS, IR shows a trend towards positive and borderline negative correlation with liver fat and SAT fat masses respectively. The positive trend with liver fat tends to become stronger with increasing quartile of IR. Therefore, these findings support the theory that possibly exhaustion of protective compartment’s capacity to store excess fat results in its pathological deposition in liver as ectopic fat.

Abdominal wall mass resections: single-center closure practices and outcomes following oncologic resections of abdominal wall fascia.

Radical resections for abdominal wall tumors are rare, thus yielding limited data on reconstruction of defects. We describe surgical management and long-term outcomes following radical tumor resection. This was a single-center retrospective review of patients between January 2010 and December 2022. Variables included operative characteristics, wound complications, hernia development, tumor recurrence, and reoperation. A multivariable analysis compared wound morbidity for suture and mesh repairs while adjusting for defect width, fascial closure, and CDC wound class. 120 patients were identified. Mean follow-up was 3.9 ± 3.4years. Seventy-five (62.5%) of the masses were primary; most commonly desmoid (n = 25) and endometrioma (n = 27). Forty-five masses were metastases. Mean tumor width was 6.2 ± 3.4cm; mean defect width was 8.1 ± 4.1cm. Sixty-one patients (50.8%) had mesh placed, with variation in technique. Postoperative CT scans were available for 88 (73.3%) patients. Forty SSOs (33.3%), 11 SSIs (9.2%), and 18 (15%) SSOPIs occurred within 30 days. On multivariable analysis, increased defect width was associated with SSOPI (OR 1.17, p = 0.041) and CDC wound class II-III was associated with SSI (OR 8.38 and 49.1, p < 0.05) and SSOPI (OR 5.77 and 17.4, p < 0.05); mesh was not associated with these outcomes. Seven patients (5.8%) underwent 30-day reoperations and 35 (20.8%) required additional operations after 30 days. Thirteen percent developed abdominal wall (n = 8) or intra-abdominal tumor recurrence (n = 8) requiring reoperation. Twenty-seven (22.5%) patients developed hernias with a mean fascial defect width of 9.8 ± 7.2cm. Abdominal wall mass resections are morbid, often contaminated cases with high postoperative complication rates. Risks and benefits of mesh implantation should be tailored on an individual basis.

Associations of oxidative balance score with total abdominal fat mass and visceral adipose tissue mass percentages among young and middle-aged adults: findings from NHANES 2011-2018.

This study aimed to explore the association of the oxidative balance score (OBS) with total abdominal fat mass (TAFM) and visceral adipose tissue mass (VATM) percentages among young and middle-aged U.S. adults. Young and middle-aged adults in the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018 were included. Analysis of variance and Rao-Scott adjusted chi-square tests were used to compare the characteristics across quartiles of OBS. Univariate and multivariate weighted logistic regression models were employed to explore the relationship between OBS and the risks of high TAFM or high VATM percentage in the general population and subgroups, while the interaction effects were tested with a likelihood test. Weighted restricted cubic spline analyses were utilized to assess the non-linear association of OBS with TAFM and VATM percentages. The final sample included 8,734 young and middle-aged non-institutionalized U.S. adults representing 134.7 million adults. Compared with adults in the first quartile of OBS, those with higher OBS were less likely to have a high TAFM percentage; the ORs and 95% CI for adults in the second, third, and highest quartiles of OBS were 0.70 (0.53-0.94), 0.49 (0.36-0.60), and 0.25 (0.18-0.36), respectively. Similar trends were observed in the association between OBS and VATM percentages. Moreover, similar effects were confirmed in the sensitivity analyses and subgroup analyses according to demographic characteristics. Regarding the OBS subclass, higher dietary OBS and lifestyle OBS were also correlated with decreased ORs of high TAFM and VATM percentages. This study strongly suggests that higher OBS, as well as higher dietary OBS and lifestyle OBS, are significantly correlated with lower risks of abdominal obesity and visceral fat accumulation. The findings highlight the importance of an antioxidant-rich diet and maintaining a healthy lifestyle in reducing the risks.

Incidental Detection of a Rare Pediatric High-Grade Fibrosarcoma in a Post-traumatic Setting: The Conundrum of Intra-Abdominal Hematoma versus Neoplasia

Infantile fibrosarcoma (IF) is a rare malignant fibroblastic tumor that affects infants and young children, occurring most commonly in the extremities. Here, we present a 14-year-old patient with an abdominal mass incidentally detected after a blunt injury to the abdomen. The initial trauma protocol CT revealed a high attenuation mesenteric lesion in the left central abdomen suggestive of mesenteric hematoma. However, the possibility of a solid neoplastic mass lesion could not be excluded. Further evaluation with dynamic contrast-enhanced serial MRI showed a progressive enhancing mass and excluded a hyperacute hematoma with active bleeding. The mass was resected, and histopathological examination and molecular analysis of tumor cells were consistent with a high-grade fibrosarcoma with KMT2D : BCOR fusion.

PSEUDO-KYSTE DU PANCREAS CHEZ LA PERSONNE AGEE : A PROPOS D’UNE OBSERVATION A L’HOPITAL NATIONAL DONKA, CHU DE CONAKRY ET REVUE DE LA LITTERATURE

Introduction: Pancreatic pseudocysts (PKP) are fluid collections without their own epithelium, developed at the expense of or in contact with the pancreas, containing pure pancreatic juice or mixed with necrotic debris, following pancreatitis or trauma, or of undetermined cause. Treatment of PKP usually requires drainage. We discuss the diagnostic and therapeutic aspects of a case of pseudocyst of the pancreas drained by conventional surgery in an elderly patient with a good post-operative course. Observation: We admitted an 80-years-old patient with epigastric abdominal mass, pain, physical asthenia and anorexia evolving for 1 year. She had no previous medical history. Examination revealed a painful epigastric abdominal mass, more or less mobile in relation to the deep plane, with a smooth surface and irregular, matt edges. Pelvic touch was unremarkable. CT scan showed a large intra-abdominal cystic mass (pancreatic cyst? mesenteric cyst?). Biology revealed anemia and hyperleukocytosis. After laparotomy, we found a voluminous, firm cystic mass, about 10x5x8 cm in size, at the expense of the body of the pancreas. We proceeded to internal drainage of the cyst by retrogastric cystogastrostomy according to JEDLICKA. The patient was followed up for one year without any particularities. Conclusion: In our case, a symptomatic pancreatic pseudocyst was drained by surgical retrogastric cystogastrostomy with a favorable outcome. The management of pancreatic pseudocysts requires a multidisciplinary approach and an adequate technical platform. Key words: Pseudocyst, pancreas, diagnosis, treatment, elderly patient

Clinicopathological assessment of renal tumors in pediatric age group in a sample of Iraqi patients

Background: According to the Iraqi Cancer Registry, renal carcinoma is the 13th most common carcinoma, with 798 registered cases in 2020 and 418 deaths. Methods: This is a cross sectional retrospective study that includes the analysis of 116 randomly selected sample of pediatric patients (74 nephrectomies and 42 biopsies) sent to the Teaching Laboratories of AL-Emamain AL-Kadhmain city (AS), Baghdad medical city, and private laboratories from January 2019 to January 2023. Results: Histopathological diagnosis revealed a ratio from malignant to benign of 7.4:1. Wilm’s tumor was the most common malignant tumor (65.5%), while multicystic renal dysplasia was the most common benign tumor (7.8%). Abdominal pain was the most common clinical feature (67.2%), followed by abdominal mass (20.7%). Regarding malignant cases, Pathological stage I was the most common (39.0%). As for the histopathological subtype, triphasic type was the most common (57.1%), followed by the biphasic type (10.5%). Conclusions, Malignant tumors make up the vast majority of renal tumors. Wilm tumor is the predominant malignant tumor. Fortunately, most cases of Wilm tumors exhibited an early stage and favorable histology. Neuroblastoma was the second most common malignant tumor. The abdominal lump is the most common presentation of pediatric renal tumor.

Cystic partially differentiated nephroblastoma in an 18-month-old girl: a case report

Introduction and importance: Cystic partially differentiated nephroblastoma (CPDN) is a rare cystic tumor that affects the kidney. It has a low potential for malignancy. It usually presents as an abdominal mass. It may be difficult to confirm the diagnosis of CPDN without a histopathological study. Case presentation: The authors report a case of an 18-month-old girl with abdominal distention, which was noticed by her parents. An abdominal computed tomography scan showed a large multilocular cystic mass arising from the lower pole of the left kidney. A left total nephrectomy was performed. Immature blastemal elements without evidence of malignant cells were observed on histological analysis. Conclusion: The authors report a case of an 18-month-old girl with CPDN managed by total nephrectomy. CPDN should be considered in the differential diagnosis of patients with cystic renal lesions. The authors would also like to affirm that partial or total nephrectomy should be done in all cases of CPDN and other cystic renal tumors.

An important diagnosis of ascites and abdominal mass coexistence in a child: Peritoneal tuberculosis

Tuberculosis is still a life-threatening disease worldwide, particularly in developing countries. Miliary tuberculosis is an important diagnosis in children which needs urgent treatment. A 15-year-old male patient was investigated for an abdominal mass with the symptoms of chronic abdominal pain, weight loss, and ascites. On ultrasonography, a 4.5x4x4 cm sized mass that could not be differentiated whether cystic or solid was defined at left paraumbilical region. During laparotomy, widespread punctate granulomas were seen on the intestinal surfaces, peritoneum, and thickened omentum. Tissue biopsies were taken with preliminary diagnosis of possible tuberculosis. The pathological examination was compatible with granulomatous inflammation involving caseous necrosis. In conclusion, miliary tuberculosis with abdominal involvement is a rare type of the disease and can also be seen in pediatric patients without lung tuberculosis. Percutaneous sampling of ascites fluid may not be enough for the diagnosis. Tissue sampling is the most appropriate method for diagnosis and timely treatment for abdominal tuberculosis in children.

A rare case of Demons-Meigs’ syndrome with a 7.5 kg giant ovarian fibroma associated with severe dyspnea: case report

Introduction and importance: Demons-Meigs syndrome is a rare condition characterized by the presence of a benign fibroma of the ovary, ascites, and pleural effusion. It is very uncommon, and the diagnosis is made with difficulty based on symptoms that usually mimic disseminated malignancy or tuberculosis, but imaging may confirm the diagnosis. The definitive treatment is laparotomy, after which the symptoms resolve. Case presentation: We present a 36-year-old female with Demons-Meigs’ syndrome with severe dyspnea who underwent an abdominal surgical exploration, which revealed ascites of 1500 ml and an ovarian fibroma weighing 7.5 kg and measuring 12 cm in length. There were no postoperative complications. CA-125 was undetectable at 3 months post-procedure. Clinical discussion: The most common symptoms are dyspnea, fever, fatigue, and weight loss. In low- and middle-income countries, patients usually present with late-stage disease. The treatment of choice for Demons-Meigs’ syndrome is exploratory laparotomy. Conclusion: This tumor is often misdiagnosed as a uterine myoma on sonography. The symptoms resolved, and the patient became asymptomatic after laparotomy and thoracocentesis. For this reason, when patients present with effusion and an abdominal mass, a thorough assessment should be done to confirm if it is Demons-Meigs’ syndrome, which can be completely cured by the removal of the tumor.