Abdominal Mass Research Articles

Solitary fibrous tumor of kidney

Abstract Solitary fibrous tumor is a rare mesenchymal tumor usually described in the thoracic cavity. They may present in the genitourinary system with hematuria, enlarging abdominal mass and flank pain. Here, we report a case of 36-year-male patient with an incidental diagnosis of a left renal mass with histopathology and immunohistochemistry suggestive of a solitary fibrous tumor in a radical nephrectomy specimen.

Clinical Features of Extragenital Scar Endometriosis: A Cross-Sectional Study

Objective: Abdominal wall endometriosis (AWE) is a rare form of extragenital endometriosis that usually develops in association with a prior surgical scar. The purpose of the study was to review the clinical characteristics, diagnostic methods, treatment modalities, and outcomes of patients with AWE. Methods: A descriptive cross-sectional study was performed in a Gynecology Department of a Portuguese tertiary hospital, concerning patients with histologic-proven AWE, between January 2012 and December 2020 (n = 22). Statistical analysis was performed using IBM SPSS Statistics Version 27.00, with a significance level of p < 0.05. Results: The most common locations of extrapelvic endometrial ectopic implants were cesarean delivery scar (n = 13, 59.1%) and the umbilicus (n = 5, 22.7%). The median (range) age was 36 (30-42) years old, and all patients had a history of previous surgery but one. Nineteen patients had undergone a previous cesarean section, and the mean (range) time from surgery to the onset of symptoms was 100 (32-168) months. All patients were symptomatic and presented with a palpable mass at physical examination. The majority complained of a painful abdominal mass (n = 20, 90.9%) which was associated with cyclic pain in thirteen patients (65%). Ultrasound scan was performed in all patients and the nodules had a median size of 20.5 mm (5-93 mm). One patient received hormonal therapy and surgical resection was performed in the remaining patients. The nodule’s median (range) size was 31 (12-50) mm on gross examination. Conclusion: AWE should be considered in the presence of a previous pelvic surgery history associated with abdominal scar cyclic pain and swelling. A careful history and clinical examination are essential for diagnosis to avoid unnecessary delay before surgical intervention.

A rare case of mixed gonadal dysgenesis in adulthood: diagnostic delay and unique outcomes

Mixed gonadal dysgenesis (MGD) is a rare sex development disorder, diagnosed by mosaic karyotype of 45,X/46,XY (classical form) with the presence of Müllerian structures, unilateral testis and contralateral streak gonad. MGD expresses diverse phenotypes, from female phenotype with virilization or turner stigmata, to ambiguous genitalia or male phenotype. Early diagnosis is crucial for effective correction of height, sexual development and cancer prevention. The study reports on a case of a 25-year-old patient, reared as female, presenting a large abdominal mass later confirmed as a mixed germ cell tumor. Associated findings were primary amenorrhea, ambiguous genitalia, short statue, gender dysphoria and hyperlipidemia. The study is the first to report on hyperlipidemia in MGD.

Surgical management of giant recurrent retroperitoneal liposarcoma: a case report and review of the literature.

A 59-year-old female patient consulting for a large abdominal mass. The abdominal computed tomography showed three retroperitoneal masses, and the surgical exploration revealed a huge process in the retroperitoneal cavity, which takes the left renal compartment, and the left colon. The intervention consisted of a mono-bloc excision of the mass taking the spleen, the left renal compartment, and the left colon with colonic anastomosis. The histological examination concluded the existence of a well-differentiated myxoid liposarcoma of grade I, the postoperative follow-up was simple. One year later, she underwent an excision of a recurrence of the same retroperitoneal location, but of a pleomorphic cell histological type of grade II according to the FNCLCC classification. We review the literature, the pathological, therapeutic, and prognostic aspects of this tumor. Retroperitoneal liposarcoma is a rare tumor. Its gravity is due to an often-late diagnosis, a complete imaging workup including ultrasound, computed tomography and often MRI is necessary preoperatively to determine the relationship with the different organs. The definitive diagnosis is histological, surgery is the most effective treatment and can be extended to neighboring organs. the frequency of recurrence requires particular surveillance. We highlight the importance of radical surgical excision to avoid retroperitoneal liposarcoma tumor complications and to minimize the recurrence risk.

Abstract #1380270: Struma Ovarii: A Rare Cause of Hyperthyroidism That Can Be Missed

Struma ovarii is an extremely rare monodermal teratoma of the ovaries that produce thyroid hormone. We report a case of unexplained hyperthyroidism in a female patient that was found to have struma ovarii of the right ovary. A 59-year-old woman with a past medical history of hyperthyroidism was diagnosed 4 years ago. She started taking Methimazole approximately 2 years ago when she developed palpitations and was diagnosed with atrial fibrillation with rapid ventricular response. The patient was being evaluated for Graves' disease with a thyroid scintigraphy scan. The result showed decreased iodine uptake in the thyroid. She was also being evaluated for radioactive iodine ablation. The patient was admitted to the hospital due to atrial fibrillation with rapid ventricular response secondary to hyperthyroidism. Thyroid-stimulating hormone (TSH) was suppressed, free T4 and T3 were elevated. The thyroid ultrasound showed unremarkable findings and the nuclear medicine thyroid uptake scan showed decreased uptake in the thyroid. Thyroid peroxidase antibody (TPO-Ab), thyroid stimulating hormone receptor antibody (TSH-receptor Ab), thyroglobulin antibody, thyroid-stimulating immunoglobulin (TSI) were all negative. Due to unexplained hyperthyroidism, there was a concern about ectopic thyroid hormone production. The patient had pelvic ultrasound which showed a 4.5 x 4.1 x 3.4 cm right ovarian cyst. She underwent salpingo-oophorectomy of the right ovary. Pathology results confirmed struma ovarii. After the surgery, hyperthyroidism resolved, and she was taken off Methimazole. This patient presented with primary hyperthyroidism in the setting of normal thyroid ultrasound, thyroid uptake scan, and negative thyroid antibodies. The possibility of ectopic thyroid-producing tissue or tumor should be considered in the differential diagnosis. Struma ovarii is a specialized or monodermal teratoma predominantly composed of more than 50% of mature thyroid tissue or sufficient thyroid hormone production to cause hyperthyroidism. The most common presenting symptoms at the time of diagnosis was lower abdominal pain and palpable lower abdominal mass, but patients can be asymptomatic on presentation. Struma ovarii may mimic malignant ovarian tumors or sometimes can present with symptoms of hyperthyroidism. The treatment is surgical resection of the tumor. In rare cases, this tumor could be malignant and must be ruled out by histology.

Giant desmoid fibromatosis of the pancreas.

A 15-year-old girl had abdominal distension and appetite loss with episodic heartburn and vomiting for approximately 2 months, but gained 3 kg of weight. Physical examination revealed a huge and hard abdominal mass. Tumor markers including α-fetoprotein, β-human chorionic gonadotropin, carcinoembryonic antigen, CA125, and CA19-9 were all normal. Computed tomography disclosed a gigantic solid mass, occupying the whole abdominopelvic cavity (Fig. 1). Notably, the pancreas was only identifiable by its head and contiguous splenic vein.

Safe and Aesthetic; Laparoscopic Cholecystectomy on The Bikini Line

Objective: Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic cholelithiasis and is the most commonly performed surgical procedure worldwide. It is superior to open cholecystectomy in terms of aesthetics, but the visibility of the trocar ports is a cosmetic problem due to increasing aesthetic concerns. We report the results of patients who underwent conventional four port LK with all incisions below the bikini line.
 Material and Method: The study included patients who underwent LK through bikini incision in our clinic between 01.11.2020 and 31.11.2021. Age, gender, comorbidities, indications for cholecystectomy, previous abdominal surgeries, anesthesia scores, and body mass index (BMI) were recorded. The procedure was not performed in patients undergoing emergency surgery for acute cholecystitis and other causes.
 Results: The study included 9 patients, all of whom were female. The mean age was 30 ± 7.8 years and mean BMI was 23.1 ± 4.3. Mean operative time was 33.9 ± 8.5 minutes. Open operation was not performed in any patient. The hospitalization period was one day for all patients. There were no complications in any of the patients. Eight of the nine patients (89%) expressed cosmetic satisfaction in the first month after surgery.
 Conclusion: The prevalence of LC leads to an increase in the number of patients expecting less scarring. Here, we propose a modified four-port laparoscopic cholecystectomy that is easy to perform, safe, requires no additional cost, and has high patient satisfaction

Histomorphological Analysis of Ovarian Neoplasms According to the 2020 WHO Classification of Ovarian Tumors: A Distribution Pattern in a Tertiary Care Center.

In 2018, ovarian carcinoma ranked as the eighth most common cancer diagnosed and the leading cause of cancer death in women. High-grade serous carcinoma is the most common histological type seen among malignant cases. A diverse group of neoplasms is seen in the ovary with variable clinical, morphological, and histological features, so assessing the nature of ovarian neoplasms further assists in the treatment of the disease. This study was conducted to assess the different histopathological variants of ovarian neoplasms according to the latest 2020 World Health Organization (WHO) classification of ovarian tumors. Further analysis of the frequency, age, clinical features in patients, and distribution of various ovarian tumors is assessed. A retrospective study was conducted in the Department of Pathology at Patna Medical College and Hospital (PMCH), Patna. The data of the patients from the past three years, from February 2020 to February 2023, were retrieved and assessed. Gross and microscopic findings, including clinical details of patients with ovarian masses, were analyzed from the previous records. A total of 110 cases of ovarian neoplasms on histopathology were analyzed. The age range was 11-70 years. The types of specimens received were those of total abdominal hysterectomy, salphingoopherectomy, and unilateral or bilateral ovarian cystectomy. The most common presentation was an abdominal mass, followed by pain in the abdomen.The majority ofthe tumors were benign (69%), malignancy was observed in 24.5% of cases, and borderline tumors were seen in 5.4% of cases. Epithelial tumors were the commonest tumors, accounting for 70%, followed by germ cell tumors (21%). Serous cystadenoma was the commonest benign tumor, followed by mature teratoma and serous cystadenocarcinoma. High-grade serous cystadenocarcinoma was the commonest malignant ovarian tumor (9%), followed by low-grade serous cystadenocarcinoma (4.5%) and metastatic carcinoma of the ovary. Krukenberg tumor was seen in two cases, and a very rare case of sclerosing stromal tumor was seen in one of the cases. Ovarian neoplasms usually present with a variety of clinicomorphological and histological features. The most common neoplasm observed in the ovary is surface epithelial tumors, which are benign lesions that commonly affect reproductive age groups. Newer advancements like immunohistochemistry(IHC) and genetic studies have made the diagnosis easier and more precise. However, in institutes with limited resources, a histopathological study is still the gold standard in the diagnosis and prognostic evaluation of these tumors.

Dual-phase contrast-enhanced multislice computed tomography scans play a key role in the diagnosis of abdominal wall desmoid-type fibromatoses.

Abdominal wall desmoid-type fibromatoses (AWDF) are occasionally encountered in clinical work, but related CT reports are rare, and most cases were misdiagnosed as malignant tumors. We aimed to determine the diagnostic value of multislice computed tomography (MSCT) in relation to the clinical diagnosis of AWDF. The medical records of 14 patients whose pathology results provided initial confirmation of AWDF were reviewed, and data describing their clinical characteristics, tumors' MSCT characteristics, and the condition of the surrounding tissues were analyzed and summarized retrospectively. Intraobserver and interobserver reproducibilities were evaluated. AWDF tended to occur in women of childbearing age (24-32 years). They occurred more frequently during the first year following pregnancy. The mean disease duration was 5.64 ± 3.78 months. All isolated tumors were growing along the musculoaponeurotic layer, and their maximum diameters were between 32 and 76 mm. Tumors' capsules were incomplete, and although the tumors infiltrated the surrounding muscles, the surrounding fat tissue and vessels were not infiltrated. None of the patients' tumors showed cystic degeneration, calcification, necrosis, or peritumoral edema. The tumors had slightly lower densities on the pre-contrast enhancement scans and mild-to-moderate enhancement after contrast enhancement. All tumors contained ribbon-like structures, and approximately 65% of the tumors encircled vascular structures. Dual-phase contrast-enhanced MSCT scans were associated with a high level of diagnostic efficacy for AWDF. The abdominal wall masses grew along the musculoaponeurotic layer, which, together with the ribbon-like structures within the tumors, should prompt clinicians to consider the presence of AWDF.

Echinococcosis of the detrusor: report of the first pediatric case

BackgroundThe parasitic disease known as the cystic echinococcosis (CE) is brought on by cysts made up of the larval forms (metacestodes) of Echinococcus tapeworms. In North Africa, it is greater in rural regions. This is unusual for a primary supravesical position.Case presentationWe report a case of a 6-year-old boy who had a palpable abdominal mass with hypogastric abdominal pain.A pelvic ultrasound examination demonstrated a voluminous intra-abdominal supravesical cystic formation with clear limits and regular contours of heterogeneous anechogenic echostructure and the presence of multiple hyperechoic septa separating the cubicles (daughter vesicles) in a honeycomb pattern. Computed tomography confirmed a cystic echinococcosis stage III of the pelvis.After a laparotomy surgery with total cystectomy, the patient was discharged with prescribed albendazole 10 mg/kg/day. Cystic echinococcosis was established by histological analysis.The aim is to demonstrate that from a literature search, we think this is the first case of cystic echinococcosis of the detrusor in children.ConclusionPrimary pelvic cystic echinococcosis is uncommon and even less common among children. Cystic echinococcosis must be taken into account in the differential diagnosis when there is an abdominal mass, particularly in locations where it is prevalent.

"Koshi-heso" (waist-umbilicus) test: A novel screening method for visceral fatty obesity

To evaluate the screening performance and validity of the "Koshi-heso" (waist-umbilicus) test for visceral fatty obesity in elderly diabetic patients. Subjects were diabetic patients ≥65 years old visiting our outpatient clinic. As a "Koshi-heso" test, the distance between the umbilicus and the superior border of the iliac crest (waist) was measured with the patient's own finger. When the index finger reached the umbilicus and there was a gap between the finger and the abdominal wall, the patient was classified as "smaller"; when the index finger reached the umbilicus and there was no gap between the finger and the abdominal wall, the patient was classified as "just fit"; and when the index finger did not reach the umbilicus, the patient was classified as "bigger". Abdominal circumference was used to assess visceral fat obesity, with a cut-off value of ≥85 cm for men and ≥90 cm for women. Visceral fat mass and body fat percentage were evaluated by the multi-frequency bioelectrical impedance method. The sensitivity and specificity of the waist-umbilical test for visceral fat obesity were calculated. Pearson's correlation coefficients between the "Koshi-heso" test and visceral fat mass and body fat percentage were calculated to evaluate the validity of the test. Furthermore, the association between the "Koshi-heso" test and risk factors for vascular disease, microvascular complications and cardiovascular disease was assessed by a logistic analysis. A total of 221 patients were included in the analysis population of the study. The cut-off values of "just fit" in men (sensitivity 0.96, specificity 0.62) and "bigger" in women (sensitivity 0.76, specificity 0.78) were optimal. Furthermore, the "Koshi-heso" test was significantly correlated with abdominal visceral fat mass and body fat percentage as well as with vascular disease risk factors and microvascular complications. The "Koshi-heso" test was able to be used as a screening method for visceral fatty obesity in elderly diabetic patients.

A-39 year old, nulligravida woman with giant leiomyomas: a case report

Introduction: The most common neoplasm of the uterus, uterine leiomyomas, or fibroids, are benign growths that affect 20–30% of women between the ages of 30 and 50. The smooth muscle of the uterus gives rise to leiomyomas. In this case report, we sought to highlight the case of a 39-year-old nulligravida lady with a fast expanding abdominal mass and abdominal pain. Case Presentation: The gynecologist department at Dr. Kariadi General Hospital Semarang received a visit from a 39-year-old nulligravida lady complaining of a fast-expanding lump in her belly and extreme weight loss over the past year. During the abdominal exam, an immovable mass that could have been an 8-month pregnancy was felt in the midline of the abdominal area, extending from the lower abdomen to the epigastric area. Ascites were also discovered. The multislice computerized tomography (MSCT) results showed a solid lobulated inhomogeneous mass with internal calcification which extended from the abdominal cavity to the pelvic cavity and visualized the size of (anteroposterior 21.7 cm x laterolateral 24.1 cm x craniocaudal 36.8 cm), compressing the surrounding bowel structures, liver, spleen, and bladder. Several lymphadenopathies were also discovered. A frozen section, a bilateral salpingo-oophorectomy, and a total abdominal hysterectomy were performed. The results of the histology suggested a benign leiomyoma. Her vital signs were steady after surgery, and she fully recovered. The patient was called for a follow-up one week after being released for surgical suture removal and evaluation. The patient was discharged on the sixth postoperative day in good condition. Conclusion: In determining if uterine smooth muscle tumors are benign or malignant, clinical characteristics, physical examination, imaging, and pathological findings are still considered very useful. The histopathology examination is still the most reliable diagnostic tool. The decision to perform a hysterectomy on this patient was determined accordingly to the tumor's size, probability of malignancy, and increasing morbidity.

Clinical profile of duplex kidneys in children and its association with vesicoureteric reflux

BackgroundDuplex kidney is a relatively common renal anomaly with a wide array of associations. With routine antenatal screening it is increasingly diagnosed these days. With this study, we aim to assess the clinical profile, prevalence of vesicoureteric reflux and highlighting the need for aggressive workup and management in selected cases to prevent further renal damage.ResultsFifty-three children with duplex kidneys who attended the department of pediatric surgery at our institution from December 2016 to December 2021 were included in the study. The most common mode of presentation was urinary tract infection (58%). Fifty-three percent had an antenatally detected renal anomaly (out of these 46% were asymptomatic, 33% had UTI and 11% had other symptoms like straining, incontinence and abdominal mass). Sixty-one percent of patients were conservatively managed and 19 patients needed surgical intervention. Ureterocele was the most common condition necessitating surgery. Prevalence of vesicoureteric reflux was 60% and was comparable with other studies. Thirty-six percent of patients had renal scarring. Among the patients with scarring, 84% had VUR and 63% had febrile UTI.ConclusionDuplex kidney though a common congenital anomaly, requires a systematic evaluation to detect its various associations and a structured management protocol according to the associations. It has a high incidence of VUR which is a potentially hazardous condition which can affect the renal function if not evaluated and managed appropriately. Duplex can also be associated with obstructive conditions like PUJO, ureterocele, and ectopic megaureter which can cause rapid deterioration of renal function if not managed early enough. Though majority of the patients need only follow-up and antibiotic prophylaxis, there may be a certain sub group of patients who develop early scarring and need aggressive management. Our study aims to highlight the need to detect such patients early enough to reduce the morbidity.

P024 Vasculitis of the female genital tract: is it a single organ or systemic disease?

Abstract Background/Aims Vasculitis of the female genital tract is rare. At one institution, incidence among all gynaecological surgeries was 0.15%. It is usually an incidental finding on histopathological examination after surgery done for another reason. Most commonly, it presents with vaginal bleeding, but can also present with pelvic pain, uterine prolapse, asymptomatic abdominal mass or atypical cervical smear. Constitutional and musculoskeletal symptoms are reported in about a quarter of cases. It can be localised to the female genital tract, most commonly the uterus and cervix. Less commonly, it can be part of a systemic vasculitis, including giant cell arteritis, polyarteritis nodosa, granulomatosis with polyangiitis, microscopic polyangiitis, cryoglobulinaemic vasculitis, lupus and rheumatoid vasculitis. Although data is limited, one review found 31.3% of cases to have systemic involvement. Approximately 60% of patients with vasculitis of the female genital tract and systemic vasculitis had GCA. In this group, about one third do not present with classical cranial, systemic or polymyalgia rheumatica symptoms. In localised disease, anaemia or raised inflammatory markers are unlikely. Histopathology mostly shows non-granulomatous inflammation. With systemic involvement, anaemia, raised inflammatory markers and granulomatous inflammation are more likely to be present. Localised vasculitis of the female genital tract tends not to require treatment. However, it can predate symptoms and signs of systemic disease. Therefore, follow-up for at least 12 months is recommended. Methods Written consent was obtained from the patient. Data was obtained from the patient's case notes, electronic records and histopathology results. Results We describe a 63-year-old lady with no past medical history and on no medications who presented with post-menopausal bleeding and abdominal cramping. Hysteroscopy showed two endometrial polyps. Biopsy showed grade 1A endometrial carcinoma. Total hysterectomy and bilateral salpingo-oophorectomy was performed. Histopathological analysis confirmed endometrial cancer but also showed some foci of granulomatous inflammation with multi-nucleating giant cells surrounding both small and medium calibre vessels. The vessels showed fibrinoid necrosis and disruption of the internal elastic lamina, suspicious for vasculitis. On review by the rheumatology team this lady was found to be well with no history of Raynaud’s; rashes; arthritis; ocular; ear, nose and throat; gastroenterological; respiratory; neurological; or constitutional symptoms. Examination was normal. C-reactive protein and immunoglobulins were normal. Anti-nuclear antibody, anti-neutrophil cytoplasmic antibody, rheumatoid factor and anti-CCP antibody were negative. Urine protein was raised at 0.29 (0-0.1) but protein/creatinine ratio was normal at 11 mg/mmol. Chest x-ray was clear. Conclusion In conclusion, female genital tract vasculitis is rare and is usually an incidental finding on histopathology. In this case, it appeared to be an isolated vasculitis of the female genital tract. It is important to recognise that uncommonly this condition can be associated with systemic involvement and therefore follow up in rheumatology clinic is recommended. Disclosure T. Nadin: None. N. Goadby: None. R. Smith: None.

Vitreous Haemorrhage and Retinal Neovascularization Secondary to Peripheral Retinal Ischemia as the Presenting Sign of a Disseminated Melanoma

ABSTRACT Purpose We describe a case of vitreous haemorrhage and retinal neovascularization secondary to peripheral retinal ischemia associated with disseminated melanoma. Methods A retrospective case report. Results A 48-year-old man presented with vitreous haemorrhage in the right eye, peripheral retinal ischemia, and retinal neovascularization in both eyes. CT and MRI scans were suggestive of disseminated malignancy and an ultrasound-guided biopsy of the abdominal mass confirmed metastatic melanoma. Immune checkpoint inhibitor therapy with ipilimumab/nivolumab was initiated. Regarding his ocular status, the vitreous haemorrhage cleared spontaneously, visual acuity improved to 6/7.5 and the patient underwent bilateral peripheral scatter laser photocoagulation to stabilize the retinopathy. The patient passed away 1 year after the initial presentation. Conclusion Our patient presented with melanoma and peripheral retinal ischaemia, leading to retinal neovascularization and vitreous haemorrhage. Therefore, melanoma should be considered as a differential diagnosis when investigating the aetiology of peripheral retinal ischaemia.

MALIGNANT STRUMA OVARII (KASUS LANGKA)

Struma ovarii (SO) are rare and accur in 2-3% of mature ovarian teratomas, most SO cases are benign. Malignant struma ovarii (MSO) is even more rare and occurs in 0,5- 5% of all cases, with the most common histologies identified are papillary and follicular carcinoma, most commonly affect patients in their 4th to 6th decade of life. Due to the rarity of malignant transformation, data about its management are lacking. A 49-years-old woman P2A0 with abdominal pain and pelvic mass, admitted for a hysterectomy and bilateral salpingo-oophorectomy. The left ovary was measured 13x11x5 cm, cystic and partly solid, filled with gelatinous fluid, composed of thyroid follicles with the appearance of "ground glass", "nuclear inclusion" and "nuclear groove", forming a papillifer structure. The diagnostic of MSO is based on histological features include cellular atypia, increased hyperplasia, nuclear pleomorphism, mitotic activity, vascular and/or capsular invasion. To be classified as a MSO, teratoma containing 50% or more thyroid tissue. MSO necessitates surgical staging for ovarian cancer with pelvic washings, total abdominal hysterectomy, bilateral salpingo- oophorectomy, lymph node sampling, total thyroidectomy, and radioactive I-131 ablation. Based on the clinical examination and histopatological examination the patient was diagnosed with MSO (ICD O: 9090/3).

An unusual case of a tibial metastasis as the first clinical presentation of a serous papillary carcinoma of the ovarian epithelial type of the testis.

Among testicular neoplasms, ovarian-type epithelial tumors constitute an exceedingly rare group, with only a few cases reported in the literature. We describe the case of an 82-year-old man, presented with complaints of right leg pain and difficulty walking, who was found to have a large right tibial metastasis of unknown primary origin. Whole body CT scan did not reveal any cranial, thoracic or abdominal tumor masses, but it showed abnormal para-aortic lymph nodes and right spermatic cord swelling. An extemporary ultrasound examination found a right testicular mass. The patient underwent radical orchiectomy, and the diagnosis of a serous papillary carcinoma of the ovarian epithelial type of the testis was made. To the best of our knowledge, this is the first case in the literature of isolated bone metastasis from ovarian-type epithelial tumor of testis.

Abdominal mass in a patient with autoimmune hepatitis, ulcerative colitis and BRCA family history - not always what you expect.

Marchegiani, Francesco1; Laurent, Alexis2,3; de’Angelis, Nicola1,2,* Author Information

Clinicopathological, immunohistochemical, molecular-genetic and risk profiles of gastrointestinal stromal tumors in a cohort of Sudanese patients.

Determining the risk of malignant behaviour and mutational status of gastrointestinal stromal tumours (GISTs) guide the management decision and allow optimal individualized patient treatment. To determine clinicopathological, immunohistochemical (IHC), risk and KIT mutational findings of GISTs in Sudanese patients. Histological slides were reviewed, IHC for DOG-1 and CD117 performed and hotspot KIT mutations examined. The risk group was assigned using combined risk criteria. 21 of the 36 patients (58.3%) were males (mean age, 54.83 ±12.57; range, 26-71). Abdominal pain and mass were the most frequent symptoms. Mean tumor size (±SD) was 11.6(±5.82) cm. Either CD117, DOG1 or both were positive in all cases. Using risk criteria, 33.3% (n=12) were clinically malignant at presentation, 13.9% (n=5) high risk, 16.7% (n=6) intermediate, 27.8% (n=10) low risk and 2.8% (n=1) very low risk. Sixteen of 23 (70%) tested cases had KIT (14 exon 11 and two exon 9) mutations. Six tumors were wild type. Exon 11 deletions (p.I563-L576 del and p.V559-N566delinsD) significantly correlate with disease recurrence (p-value: 0.028). Sudanese patients with GIST tend to present late. Nearly half of them correspond to the malignant/high-risk category. The frequency of KIT mutations (79.31%) is in line with the literature.

Giant Hydronephrosis Mimicking an Intraabdominal Mass: Case Report

Giant hydronephrosis (GH) is a rare entity that may mimic progressive and benign abdominal cystic tumor, is defined as a collection of more than 1 litre of urine in the excretory cavities or as a dilation beyond the mid-abdominal line with a kidney length exceeding 5 vertebrae in children. It is rare, often due to a pyelo ureteral junction syndrome. The antenatal ultrasound must make the diagnosis before birth. We report the case of an 2-month-old infant, brought to the consultation for progressive abdominal distension since birth but aggravated since 1 month. The physical examination had revealed an abdominal mass occupying the whole abdomen, but more marked on the right, taut and matt to the percussion and whose limits and origin were difficult to determine. The abdominopelvic ultrasound had shown an echo-fluid structure mass extending from the right hypochondrium to the pelvis and well beyond the midline. The urotomodensitometry (uro-TDM) had shown at right giant hydronephrosis in the form of a voluminous liquid mass extending from the subhepatic region into the pelvis beyond the midline. This mass was surrounded by a thin parenchymal border with an elevation corresponding to the renal parenchyma.