Abdominal Mass Research Articles

A rare case of non-treated fetal–type hepatoblastoma for five years stayed without metastases in a young boy

Hepatoblastoma is the most common malignant neoplasm of the liver in infancy. In this paper, we present a rare case of non-treated hepatoblastoma in an 18-month-old baby male who presented with an asymptomatic abdominal mass associated with elevated Alpha-fetoprotein. Contrast-enhanced CT revealed a solid mass located in the left lobe of the liver, measuring about 6 × 6 cm, and not enhancing the contrast. US-guided Tru-cut biopsy was performed which showed pure epithelial fetal-type hepatoblastoma. The parents refused neoadjuvant chemotherapy and the connection was disconnected with them because of the ongoing crisis in Syria. After five years, the patient returned with the same clinical picture. CT scan was repeated which revealed the same tumor without metastases. The decision was made to do a left hepatectomy after another confirmation with a surgical biopsy. Histopathological examination showed a multifocal pure epithelial-fetal well-differentiated type of hepatoblastoma with a favorable grade. Moreover, surgical margins and liver capsule appeared free, and the tumor was considered in Stage 1 accordingly. To this date, the boy was followed up with serial US and Alpha-fetoprotein (AFP)levels without signs of recurrence. Hepatoblastoma with pure fetal-type histology can be treated with complete surgical excision without neoadjuvant or adjuvant chemotherapy if the tumor was resected completely because this type of neoplasm is slow growing and has a good prognosis.

Symptomatic isolated right common iliac artery aneurysm in the setting of renal ectopia.

An 80-year-old man presented with right lower abdominal pain for 1 day. Physical examination revealed tenderness and a pulsatile abdominal mass in the right lower quadrant. Computed tomography angiography showed an isolated right common iliac artery aneurysm with a maximum diameter of 69.2 mm and a right pelvic kidney (A/Cover). Two right renal arteries arising from the aorta supplied the pelvic kidney (B). A retrograde pyelogram is displayed in (C). The anatomy was not suitable for endovascular devices.

An unusual case of a Wilms Tumor presenting as a mediastinal mass

Wilms Tumor (WT) is the most common renal malignancy in children. It normally presents in children as an asymptomatic abdominal mass noticed by the parents or physician of children below 48 months. We present an unusual case of a 16-year-old female with WT whose presenting signs and symptoms were dyspnea, left shoulder tip pain, and unintended weight loss. She was found to have a mediastinal mass on chest x-ray that was initially considered to be either lymphoma or sarcoma. However, a biopsy of the left chest mass revealed metastatic WT. This rare presentation emphasizes the importance of full metastatic imaging workup and tissue biopsy in order to confirm diagnosis of these diseases which have different treatment modalities.

Extraosseous Ewing's sarcoma/peripheral primitive neuroectodermal tumour of the kidney: a case report and literature review

BackgroundExtraosseous Ewing's sarcoma/peripheral primitive neuroectodermal tumours(EWS/pPNETs) of the kidney are rare. Signs and symptoms are atypical in EWS patients. Presenting symptoms include haematuria, abdominal pain, or a palpable mass. A comprehensive review of the literature shows that it is difficult to make an accurate diagnosis based on physical examination alone. The imaging findings of EWS/pPNETs are nonspecific. We used contrast-enhanced ultrasound (CEUS) to diagnose an EWS/pPNET in our patient, which had never been reported previously to our knowledge.Case presentationThis article reports the case of a 20-year-old female with an abdominal mass and gross haematuria for 1 month. The ultrasound revealed a hypoechoic mass with a clear margin at the lower pole in the left kidney. CEUS demonstrated signs of annular enhancement and heterogeneous enhancement of the tumour, and simultaneous wash-in was predominant. Computed tomography images showed an elliptical low-density tumour. The patient underwent a left kidney resection, and the pathological diagnosis was an EWS/pPNET. Twenty-one days after the kidney operation, the patient underwent 8 cycles of a CAV (vinorelbine, ifosfamide, epirubicin) + IE (isocyclophosphamide, etoposide) chemotherapy regimen. Subsequently, radiotherapy (dose: 45 Gy, radiation field:the tumour bed following surgical resection) was administered for nearly 30 days. The patient had no signs of local recurrence or metastasis within a follow-up of 4 years.ConclusionsAs a radiation-free, inexpensive, convenient, and repeatable examination method, ultrasound was the primary choice for kidney examination. Early CEUS was helpful to make an accurate diagnosis. Surgery and adjuvant radiation or chemotherapy administered in a timely manner can prevent further deterioration.

Adult intussusception: a challenge to laparoscopic surgery?

Intussusception can occur at any age and is common in children but less common in adults. This study aimed to evaluate our experience of 51 adult intussusception and study the etiology, clinical manifestations, diagnosis, and treatment. This analysis assessed the clinical manifestations, etiology, diagnosis, and treatment of adult intussusception in 51 adult patients at the Department of Gastrointestinal Surgery of China-Japan Union Hospital of Jilin University from January 2010 to December 2020. The mean age of the cohort was 54.43 ± 18.21 years, and 42 patients were diagnosed by abdominal ultrasonography and abdominal computed tomography (CT). Among them, 76.5% (39/51) had abdominal pain, 11.8% (6/51) had blood in stool, and 5.9% (3/51) had a palpable abdominal mass. Of these, 62.7% had tumors: malignant accounted for 39.2% (20/51) and benign accounted for 23.5% (12/51). CT is the preferred imaging method with a sensitivity of 92.2%, while colonoscopy provides a complementary diagnosis in patients involving the colon. All patients underwent surgical treatment, including 21.6% (11/51) laparoscopic surgery, 74.5% (38/51) open surgery, and 5.9% (3/51) intussusception reduction during the operation. The average operation time of the open group was 133.27 ± 43.75 min and the average hospital stay was 16.24 ± 12.55 days, while the average operation time of the laparoscopic group was 140.50 ± 46.15 mins, and the average hospital stay was 16.60 ± 16.98 days (P > 0.05). Adult intussusception is a rare disease in clinic. Laparoscopic surgery can be useful and safe for adult intussusception.

Paediatric renal tumours in Port Harcourt: A five-year retrospective study

Wilms’ tumour is the most common among renal tumours in the paediatric population. In Africa, data on pediatric renal tumours are rare. This study aims to highlight the challenges and peculiarities in the management of paediatric renal tumours in a resource-poor setting. Materials and Methods This is a five-year retrospective study conducted at the University of Port Harcourt Teaching Hospital. Ethical approval for the study was sought and gotten from the hospital’s ethical committee. The information gotten includes history, duration of symptoms, examination findings, age of the patient, stage of disease, intraoperative findings, number of chemotherapies, and post-operative complications. The data collected was analyzed and presented in tables and charts. Results: Twenty-eight patients met the inclusion criteria; 17 males and 11 females. The mean age was 3 years 6 months and the median age was 3 years 3 months. The age range was 9 months to 16 years. Most patients presented between 3 and 9 months after the onset of symptoms. The most common symptom was a painless abdominal mass which was present in all patients. Most patients presented late as fifty percent of patients presented with Stage 4 disease. Most patients had nephrectomy followed by adjuvant chemotherapy. Only three patients are alive five years after treatment. Conclusion: Mean age of presentation of patients with pediatric renal tumours was 3.5years. Late presentation with advanced stage is common. Painless abdominal mass was the most common presentation. The most common histological diagnosis was Wilm’s tumour. We carried out a nephrectomy before adjuvant chemotherapy or radiotherapy.

Neonate with Retroperitoneal Mature Cystic Teratoma – A Case Report

Retroperitoneal teratoma is a rare occurrence in neonates. They are usually asymptomatic and the only finding may be abdominal distension. We report an unusual case of a large retroperitoneal teratoma in a neonate who presented with abdominal distension. Imaging done showed a cystic lesion with calcifications, internal septations and fat dense areas. It was successfully managed by surgical excision, findings of which were consistent with that of a mature cystic teratoma. Despite being rare, we must consider retroperitoneal teratomas as a differential diagnosis of an abdominal mass in a newborn. Early detection and complete surgical excision may be life-saving.

The effect of habitat amount on flight‐related traits in the butterflyHamadryas februais sex‐dependent

AbstractMobility in flying animals can be assessed by variations in morpho–ecological traits such as body, thorax and wing sizes, wing shape and the proportion between body mass and wing area. Habitat loss and fragmentation can promote phenotypic plasticity and microevolutionary divergencies in natural populations. In this context, sexual differences in physiology and behaviour can impose different selection pressure on morphological aspects related to flight.We evaluated the relative impact of forest patch area and habitat amount in shaping flight‐related morpho–ecological traits of the tropical butterflyHamadryas februa. We find a marked sexual dimorphism in the species, with females being larger, having larger thorax, higher wing loadings and larger wing total area than males. These trait values indicate females as the more dispersive sex. We show that habitat amount modulates body mass allocations in both sexes, leading to an increase in thorax mass with decreasing habitat amount. The effect of habitat amount was more pronounced in females, which increased total mass and wing loading while decreasing thorax allocation with decreasing habitat amount. This outcome suggests that females increase abdominal mass in response to a reduction in habitat amount. The focal forest patch increasing area was linked to increases in hindwing lengths in both females and males.We advocate that both landscape metrics (i.e., habitat amount and patch area) should be considered in studies evaluating landscapes' impacts on insect mobility. We discuss results in terms of the species' sexual differences in flight behaviour and the relative importance of both landscape metrics.

Ovotesticular Disorder of Sex Development with Normal Karyotype: A Rare Case Report

Ovotesticular disorder of sex development (DSD) refers to the co-presence of testicular and ovarian tissue in one individual. Here we report a case of Ovotesticular Disorder of Sex Development in a 42 years old male, presented with abdominal mass and undescended testes who had a normal karyotype. Gonadal dysgenesis should always be kept a possibility in patient with undescended testis. Diagnosis relies on clinical findings, hormonal analysis, gonadal histology, chromosome analysis, and genetic testing.

Fetal Ovarian Torsion Presenting with Fetal Abdominal Solid Mass and Ascites.

Fetal ovarian torsion is quite a rare event during the antenatal period and usually seen because of an ovarian cyst complication. In this case report, we present a case of fetal ovarian torsion without any ovarian cyst or underlying detectable causes. A 27-year-old primigravid woman with no significant past medical history had a routine prenatal ultrasound at 30 weeks' gestation. The ultrasound showed abdominal ascites and a 47×42-cm intraabdominal solid diffuse mass at the left side under the stomach. Doppler examination showed no blood flow on the mass. Paracentesis was performed, cytological examination reported no abnormality. Based on these findings, the diagnosis was thought to be fetal ovarian torsion. There is lack of consistent recommendations to guide the prenatal and the postnatal management of cases with in-utero diagnosis of ovarian torsion. A "wait-and-see" policy is usually preferred, as in our case.

Fistulous communication with bowel loop: a rare presentation of intra-abdominal seminoma

BackgroundThe complications associated with abdominal testis include torsion, rupture, and malignant transformation.Case presentationA 40-year-old man presented with complaints of left-sided abdominal mass and abdominal pain. On contrast-enhanced computed tomography (CECT), there was a well-defined heterogeneously enhancing mass lesion in the lower abdomen with calcification showing fistulous communication to the adjacent ileal loops. The lesion was seen supplied by the left gonadal artery raising suspicion for testicular origin. On performing a scrotal ultrasound, the left testis was found absent. A radiological diagnosis of abdominal testicular neoplasm was made.ConclusionsHistopathological examination proved the lesion to be a germ cell tumor, consistent with seminoma.

Abdominal Wall Synovial Sarcoma, a Rare Presentation

Synovial sarcoma is a malignant mesenchymal neoplasm which com- monly arises in the extremities of adults, in close associationwith joint capsules. Only a few cases of synovial sarcoma occurring in the abdominal wall have been reported. We report an extremely rare case of monophasic synovial sarcoma of abdominal wall in a 58-year-old woman who had presented with painless left ante- rior abdominal wall mass. The patient underwent excisional surgery. Histological and immunohistochemistry examinations revealed monophasic synovial sarcoma. Base on the diagnosis, the patientreceived chemoradiation.Primary synovial sarcoma is rarely found in the anterior abdominal wall. But, it should be included in the differential diagnosis.

A Novel Fusion Partner in a Case of Myeloid/Lymphoid Neoplasm with FGFR1 Rearrangement

Abstract Introduction/Objective Myeloid/lymphoid neoplasms with rearrangement of FGFR1 are uncommon and heterogeneous group of hematological malignancies that may present as myeloproliferative neoplasm, acute myeloid leukemia, T or B lymphoblastic lymphoma/leukemia, or mixed phenotypic acute leukemia. Patients can present with lymphadenopathy, mediastinal mass, or systemic symptoms. Eosinophilia is common in peripheral blood or bone marrow. Several chromosomal rearrangements and fusion genes have been described with FGFR1 rearrangement and all of them encode an aberrant tyrosine kinase. Tyrosine kinase inhibitors may offer a prospective therapeutic approach although specific targeted therapies have yet to be established. Methods/Case Report We present a case of a 14-year-old male who presented with rapid neck pain and swelling. Imaging revealed a 15 x 8 x 6 cm neck mass extending into the anterior mediastinum. Laboratory evaluation revealed anemia, thrombocytopenia, and leukocytosis (41.7 K/mm3), with absolute eosinophilia and blasts of 50%. Flow cytometry of peripheral blood demonstrated a population of T-lymphoblasts comprising about 60% of the cellularity with dim CD45, cytoplasmic CD3, CD7, TdT, CD38, CD4, CD5, CD10, and CD15, supporting T-lymphoblastic leukemia/lymphoma. The patient received induction chemotherapy, and subsequent bone marrow biopsy showed morphologic remission. Six weeks from diagnosis, the patient developed a gluteal mass with an atypical T-cell infiltrate that was negative for TdT; and at 15 weeks from diagnosis, developed an enlarging abdominal mass, also with an atypical T-cell infiltrate also negative for TdT and CD1a. At that time molecular diagnostic studies of the abdominal wall mass discovered a previously unpublished ATG16L1-FGFR1 fusion, supporting myeloid/lymphoid neoplasm with FGFR1 rearrangement, T-lymphoblastic leukemia/lymphoma. Results (if a Case Study enter NA) NA. Conclusion Although a variety of translocations have been identified with FGFR1 rearrangement, the novel fusion partner ATG16L1 has not been previously reported. The case also illustrates an unusual extramedullary recurrence of the T-cell lymphoblastic leukemia/lymphoma with significant antigenic shift including loss of TdT and CD1a.

A Rare Case of Ectopic Liver Presenting as an Intraperitoneal Mass: A Case Report and a Concise Case Review

Abstract Introduction/Objective Ectopic liver is a rare developmental abnormality, in which liver tissue is localized outside the normal liver and has no connection to the native liver. The presence of ectopic liver tissue has been reported most commonly in the gall bladder. Intrathoracic cavity, kidney, abdominal wall, and esophagus are the other sites where it has been identified. But its presence in the intraperitoneal has rarely been reported previously. We report such a case in a young female. Methods/Case Report A 27-year-old female presented with shortness of breath and was diagnosed to have pulmonary embolism. On imaging, she incidentally was found to have a well circumscribed 4.4 x 4.8 cm enhancing mass in the left sub- diaphragmatic region wedged between splenic hilum and greater curvature of the stomach. Based on imaging diagnosis of accessory spleen was considered. She underwent a nuclear medicine scan that was not consistent with the accessory spleen. Esophagogastroduodenoscopy identified a mass that showed abutment of the mucosa of stomach. Cytology showed rare polygonal benign cells which were non-diagnostic. A robotic laparoscopic-assisted abdominal mass excision was performed, identifying a mass abutting, but not adherent, to the spleen, pancreas and stomach. Histopathological examination revealed benign liver tissue with several portal triads. Immunohistochemical staining showed positivity for Hepar 1 and arginase; reticulin stain; together supporting it to be a benign hepatic lesion. This was finally diagnosed as benign ectopic liver Results (if a Case Study enter NA) NA. Conclusion Ectopic liver is a rare condition, with an incidence between 0.24%-0.47%. It can be associated with other congenital anomalies but most crucial implication, is the development of malignancy. It is sometimes, difficult to identify ectopic liver on imaging modalities. It is important to be aware of such rare findings for optimal patient care.

Cross-Renal Ectopia about a Case

Crossed renal ectopia is a rare congenital anomaly, it was described by WILMER in 1938 [1], implies that one of the two kidneys sits on the contralateral side, the ureter of the ectopic kidney crosses the midline to meet in the bladder on the opposite side, the existence of a parenchymal fusion is frequent (85 to 90%). This anomaly is most often asymptomatic and discovered incidentally. We report the observation of a 21-year-old woman with a G1P1V1A0 obstetrical history (ATCD), presenting cross renal ectopia discovered fortuitously following pain in the right flank associated with palpation of an abdominal mass and to review the literature.

Abstract 11155: Recovery of Tricuspid Valve Function After Resection of a Primary Ovarian Carcinoid Tumor

Case Presentation: A 51-year-old woman presented with a >1-year history of bilateral leg edema, diarrhea, and facial flushing. Examination revealed a large abdominal mass, which CT scan confirmed to be a 15x11x13 cm ovarian mass with solid and cystic components. She underwent hysterectomy and bilateral salpingo-oophorectomy. Histopathology revealed a 17 cm ovarian dermoid cyst containing an insular carcinoid tumor. Her post-operative urinary 5-hydroxyindoleacetate (HIAA) level was 23 umol/d (normal 10-40 umol/d) and chromogranin-A level was 95 ug/L (normal <94 ug/L), but positron emission tomography (PET) scan showed lymph node metastasis, prompting initiation of lanreotide, a somatostatin analogue. A perioperative echocardiogram revealed thickened, fixed, and retracted tricuspid and pulmonic valves with severe tricuspid and pulmonary regurgitation consistent with carcinoid heart disease. The right ventricle was dilated but showed preserved systolic function. Valve intervention was considered but deferred as right heart catheterization 15 weeks after surgery showed normal right-sided pressures. A follow-up echo 8 months post resection showed unchanged pulmonary regurgitation but significant improvement in tricuspid valve mobility with a corresponding reduction in tricuspid regurgitation to a mild-to-moderate level. Discussion: Thickened and fixed tricuspid valve leaflets with significant regurgitation represents a hallmark of carcinoid heart disease that can lead to progressive right heart failure, often necessitating surgical intervention. This is a rare case of carcinoid heart disease where there was marked improvement in tricuspid valve function after surgical resection of a primary carcinoid tumor and initiation of somatostatin analog therapy. It highlights the potential for timely treatment to reverse the deleterious effects of carcinoid tumors on cardiac valves, which may ultimately spare the need for cardiac surgery.

Gastric GIST with 13 kg in Asymptomatic Patient: A Rare Case of Giant GIST and Literature Review

Gastrointestinal stromal tumors (GIST) account for 85% of all mesenchymal neoplasms of the digestive tract. Of these, two thirds are found in the stomach. GISTs usually present as small lesions, often incidentally discovered. On the other hand, the presence of an abdominal mass, a very infrequent finding, can produce symptoms: Abdominal pain, digestive bleeding, nausea, vomiting, in addition to weight loss and intestinal constipation.

Clinical Profile and Outcome of Patients Operated on for Renal Cell Carcinoma: Experience from a Tertiary Care Center in a Developing Country.

With nearly 500,000 new cases and over 150,000 deaths worldwide in 2020, renal cancers remain a significant component of the global burden of cancer. The aim of this study is to describe the clinical presentation, peri-operative condition and short-term outcome of patients operated with the primary diagnosis of renal cell carcinoma (RCC) at a large tertiary care referral center. A retrospective institution-based study was done. The study population consisted of all patients who were operated for a primary diagnosis of renal cell carcinoma from January 1st, 2015, to December 31st, 2020, at the Urology Unit of St Paul's Hospital Millennium Medical College. The final cohort consisted of 107 patients (mean (standard deviation) age 49 (±14) years, 48% male, 46% residence in Addis Ababa). The most common presenting complaint was flank pain (65%), followed by hematuria (34%) and abdominal mass (6%). One patient had the classic triad of RCC. The median (IQR) duration of illness was 9(7-11) months. Fourteen (13%) patients were asymptomatic and diagnosed incidentally. Over half (57%) of the cohort were clinical TNM stage II, with the remaining 17%, 18% and 8% being stage I, III and IV, respectively. Nearly all patients (94%) underwent open radical nephrectomy with a transabdominal approach. Most patients (61%) had no Clavien-Dindo grade complications, and a minority (11%) experienced post-operative complications (7% postoperative bleeding, 6% hospital acquired pneumonia, 3% surgical site infection). The median (IQR) length of stay was 6 (5-7.6) days. Nearly all patients (94%) were discharged and improved. In this retrospective study, we have shown that patients operated for RCC are a low-risk cohort with few comorbidities, have a relatively short symptomatic course and good discharge outcome. Further prospective studies are needed to show the long-term outcome and factors associated with such outcomes in this patient population.

ODP374 Abdominal Distention as a Unique Sign of Congenital Hypothyroidism

Abstract Background Most neonates with congenital hypothyroidism have a normal appearance at birth. Infrequent clinical presentations have been reported, including abdominal distention as the only sign, which remit with the initiation of levothyroxine therapy. Clinical Case Female newborn, full-term, appropriate weight for gestational age, six days old, who presented abdominal distension, without vomiting and with normal meconium elimination. No visceromegaly or abdominal masses were palpated. With the diagnosis of sepsis, treatment was started with ampicillin and amikacin, decompressive nasogastric tube and intravenous fluids. Abdominal X-ray showed intestinal distension. The requested cultures were negative. On the seventh day of life a TSH level of 89 mlU/L was reported; the free T4 value was analyzed and was found to be low. With the diagnosis of congenital hypothyroidism, levothyroxine therapy was indicated, and the abdominal distension remitted one week after initiation of therapy. Conclusion Most cases of congenital hypothyroidism are asymptomatic; abdominal distension, as the only sign of congenital hypothyroidism, is caused by the lower intestinal motility frequently observed in congenital hypothyroidism. Presentation: No date and time listed

Successful Surgical Treatment of Stage IVB Immature Teratoma Involving the Liver and Thoracic Cavity, With Combination Chemotherapy: A Case Report

Introduction Immature teratomas are very rare tumors, representing only 1% of ovarian cancers. Distant metastases to the liver effect late disease manifestation, rendering chemotherapy the only viable option. Case presentation Here, we report the successful surgical management of stage IVB immature teratoma after cisplatin-based chemotherapy. A 20-year-old woman presented with a huge abdominal palpable mass and dyspnea. Postoperative pathology confirmed immature teratoma with metastases to the liver, diaphragm, and thoracic cavity (stage IVB). The patient underwent right hemihepatectomy, diaphragm resection, thoracic mass resection, and diaphragm repair using aortic artificial graft. She did not receive postoperative adjuvant chemotherapy. After the complete surgical resection of the tumor, the patient had no recurrence during the 44-month follow-up period. Conclusion No established treatment modalities have been developed for further treatment, once the first-line combination chemotherapy achieves unfavorable results in stage IVB immature teratoma. Surgical resection may offer hope for excellent disease control in this dismal stage. To obtain best possible outcomes, coordinated care between oncologists and general surgeons is required.