Abdominal Mass Research Articles

OR29-4 Prevention of Type 2 Diabetes by Testosterone in the T4DM Trial: Analysis of Effect Mediation

Abstract Background In men aged 50+ years at high risk of, or with newly diagnosed type 2 diabetes (T2D) testosterone (T) treatment reduced the risk T2D at 2-years by 40% beyond lifestyle change alone (Wittert et al Lancet Diabetes and Endocrinol 2021). Aim Determine whether changes in total fat mass (kg), abdominal fat mass (%), lean mass (kg), and non-dominant handgrip (kg) mediate the effect of T treatment on glycaemia. Hypothesis The effect of testosterone on glycaemia is mediated by changes in fat and functional skeletal muscle mass Methods: A randomised placebo-controlled trial enrolled 1007 men, 50–74 years, waist circumference (WC) ≥ 95cm, serum total T ≤ 14nmol/L (chemiluminescent RIA) and either impaired glucose tolerance or newly diagnosed T2D on an oral glucose tolerance test (OGTT). Participants were enrolled in a lifestyle program (WW) and randomised 1: 1 to 3 monthly IM injections of 1gm testosterone undecanoate or placebo. The primary outcome of T2D at 2-yrs (OGTT>=11.1mmol/L) was assessed by binomial regression with a log-link function. Mediators of interest were fat mass % abdominal fat, lean mass (dual x-ray absorptiometry) and non-dominant hand-grip strength (handgrip dynamometry). Mediation was determined by including the baseline and change at two years for each of the 4 factors of interest in the model. Significance: P< 0.05. There was no imputation for missing data. Results There were complete data for 775 men (77.5%). For the outcome of T2D at 2-yrs, the unadjusted RR for treatment was 0.59 (95% CI: 0.43–0.80), which became 0.66 (95% CI: 0.51–0.87) after adjustment for baseline values of the proposed treatment mediators and OGTT. After inclusion of changes in body composition (total fat mass, abdominal fat percentage, lean mass) and grip strength, the effect of treatment was attenuated, RR 0.85 (95% CI: 0.61–1.19). The individual effects for changes in fat mass, abdominal fat, lean mass, and grip strength were 0.88 (0.64–1.19), 0.79 (0.59–1.07), 0.52 (0.38–0.71) and 0.64 (0.48–0.86) respectively. Conclusion After including change in fat mass the RR increased and the effect of T was no longer significant indicating the decrease in fat mass mediates the effect of T. This did not however, entirely explain the effect of T to decrease risk for T2D. Although lean mass and hand grip strength increased, neither mediated the effect of testosterone on T2D. Presentation: Tuesday, June 14, 2022 10:30 a.m. - 10:45 a.m.

PSAT005 The Third Twin: A Rare Presentation of Adrenocortical Carcinoma

Abstract Introduction Adrenocortical carcinoma (ACC) is rare, even more so during pregnancy. It is frequently aggressive and carries an extremely poor prognosis. Although it is limited to < 2% of adrenal incidentaloma (AI), it remains a significant concern. Here we present a case of ACC that was diagnosed postpartum 4 years after discovering an AI. Case presentation A 30-year-old female G3P4 presented to the emergency department 4-weeks postpartum with intermittent fever and decreased appetite following an uncomplicated vaginal delivery of healthy twin boys. On physical examination, she had a palpable left-sided abdominal mass. She had a known left 2.2×2.2×2 cm adrenal mass that was discovered on Magnetic resonance imaging 4 years prior. At that the time, she had a comprehensive biochemical evaluation with 1 mg overnight dexamethasone suppression test, PM salivary cortisol, 24-hour urine free cortisol, DHEAS, total testosterone, 24-hour urine dopamine, 24-hour urine epinephrine, 24-hour urine norepinephrine, plasma metanephrine, normetanephrine, renin, and aldosterone. This testing was all unrevealing and she was diagnosed with non-functional AI. She did not undergo follow-up repeat imaging. Computed tomography of the abdomen and pelvis obtained on presentation revealed 19.3×15.6×12.7 cm left retroperitoneal heterogeneous soft tissue mass with a Hounsfield Unit (HU) of > 10. Metastatic workup was negative and repeat biochemical testing remained inconsistent with a functional lesion. She underwent radical left nephrectomy and adrenalectomy. Surgical pathology confirmed the diagnosis of ACC confined within the capsule. The surgery was complicated by a pancreatic leak and short-term total parental nutrition. Fortunately, she was doing well at her 4-month postoperative follow-up. Discussion ACC has an extremely poor prognosis, especially in pregnancy and in the postpartum period. A previous study has shown a 50% and 0% survival rate at 1 and 8-year follow-up for pregnant patients, respectively [1]. AI is a common finding radiologically and on autopsy with a prevalence of 1-9%. It is mostly benign nonetheless; ACC can occur in 1.9% of cases. Although a published review article about AI in New England Journal of Medicine recommends no further testing for adrenal masses < 4 cm and HU <10, the Italian Association of Clinical Endocrinologists (AME) recommends repeat imaging 12 months after initial diagnosis to reconfirm diagnosis of a benign adrenal mass [2]. Unfortunately, this patient did not undergo repeat imaging and was subsequently diagnosed with an impressive ACC. Hence, this case highlights the importance of radiologic monitoring of AI.

Disseminated Cryptococcosis Masquerading as a Large Abdominal Mass Concerning for Pancreatic Malignancy in an HIV-Positive Patient.

Disseminated Cryptococcosis Masquerading as a Large Abdominal Mass Concerning for Pancreatic Malignancy in an HIV-Positive Patient.

The Case of the Silent Abdominal Mass and Elevated α-Fetoprotein Level in an Infant.

The Case of the Silent Abdominal Mass and Elevated α-Fetoprotein Level in an Infant.

ODP049 Oncocytic adrenocortical carcinoma misdiagnosed as renal oncocytoma and use of urinary steroid profiling in disease monitoring after mitotane therapy

Abstract Introduction Oncocytic adrenocortical carcinoma (OAC) is a rare, more indolent variant of adrenocortical carcinoma (ACC). With fewer than 70 cases reported in the English literature, the biological behavior and its response to treatment are poorly characterized. The distinction of OAC from other oncocytic neoplasms (e. g., kidneys) and variants of renal cell carcinoma (RCC) may pose diagnostic challenge pathologically. Urine steroid profiling (USP) of OAC has not been previously reported. Case description A 65-year-old Chinese man was incidentally found to have a large left upper abdominal mass in September 2014. A CT urogram showed a 15×13×13cm solid mass in the upper pole of left kidney. Left radical nephrectomy and splenectomy was performed. Pathological examination of the 'nephrectomy' showed oncocytoma. He was managed as having a renal oncocytoma with complete resection with yearly follow-up. In December 2018, a surveillance chest X-ray showed multiple lung nodules over right lung base. PET-CT in June 2019 showed bilateral hypermetabolic lung nodules suggestive of lung metastases. CT guided fine needle aspiration biopsy of lung nodule showed oncocytoma. Pathology review of both the lung and 'nephrectomy' biopsy revealed identical cores of oncocytic tumor cells while immunohistochemical studies displayed positivity for SF-1 and Melan-A suggestive of adrenocortical origin. In the presence of lung metastases, a revised diagnosis of OAC was made with the original tumor classified as oncocytic adrenocortical neoplasm of uncertain malignant potential by the Lin-Weiss-Bisceglia system. Hormonally the tumor was non-functional with suppressible cortisol post 1mg overnight dexamethasone suppression test and normal renin, aldosterone, estradiol and DHEA-S levels. Twenty-four-hour urine steroid profiling showed elevated tetrahydro-11-deoxycortisol 788ug/day [RR 10-90µg /day], pregnanediol 374µg /day [RR 41-348µg/day] and pregnenetriol 487µg /day [RR 25-256µg /day]. Mitotane was started and titrated up to 1500mg daily, aiming at a serum mitotane level of 14- 20µg /ml. Resolution of lung metastases was noted 6 months later and the abnormal urinary steroid metabolites were also normalized. The patient remained in disease remission 18 months after commencement of mitotane. Conclusion Oncocytic adrenocortical carinoma may be mistaken as other oncocytic neoplasms or variants of RCC pathologically and is classified by the Lin-Weiss-Bisceglia system. An accurate diagnosis has significant impact on disease prognostication and management. OAC may respond more favorably to mitotane monotherapy in comparison to typical ACC. Urine steroid profiling is potentially useful in the surveillance and disease monitoring of OAC. Reference: (1) Harada et al. A rare case of oncocytic adrenocortical carcinoma clinically presented as an incidentaloma. Endocr J. 2020 Aug 28;67(8): 883-888. Presentation: No date and time listed

ODP039 Giant Cystic Pheochromocytoma and GIST in a Patient With NF-1

Abstract Introduction Neurofibromatosis-1 (NF-1) is a genetic condition known to be associated with pheochromocytoma. We report a case of giant cystic pheochromocytoma in a patient with NF-1 and hypertensionincidentally found to have gastrointestinal stromal tumor (GIST) at operation. Clinical case: A 60-years old woman presented with a 5-week history of left sided abdominal lump. Her history is significant for NF-1, flank surgery age 5 and hypertension managed by amlodipine. Examination revealed a large nontender left upper quadrant abdominal mass crossing the midline. Computed tomography showed a20. 0×13.1×21.1 cm septate cystic and/or necrotic lesion arising from the left retroperitoneum versus adrenal gland, displacing the kidney anteromedially. Plasma free metanephrine was 3.38 nM (0-0.49) normetanephrine 3.47 nM (0-0.89),urine metanephrine 2605 mcg/day (36-229), urine normetanephrine 1215 mcg/day (95-650). There were no prior images or screens for pheochromocytoma. After preoperative blockade with phenoxybenzamine, open left adrenalectomy was performed. Intraoperative blood pressure fluctuated significantly. Exophytic firm nodules were incidentally noted and removed from the jejunum. Pathology revealed a22.5×21. 0×11.9 cm pheochromocytoma weighing 3058.9 g and five 0.2-0.7 cm gastrointestinal stromal tumors, spindle type. One-month postoperative metanephrine was 0.16 with normetanephrine 0.53 nM. The blood pressure remained normal without antihypertensives. Discussion Giant cystic pheochromocytomas are rare and may be silent. In populations with NF-1 the prevalence of pheochromocytoma is 0.1-7.7% and GIST 1.2% 1–3 . Their co-existence is seen less frequently. Recommendations for pheochromocytoma screening in NF-1 vary, from only hypertensive or symptomatic patients to routinely every 3 years 2–5 . There is no screening test for GIST 1 . Our patient presented at age 60 with the rare combination of clinically giant unilateral cystic pheochromocytoma, with incidental GIST in the setting of NF-1 and hypertension . Conclusion Routine screening for pheochromocytoma in patients with NF-1, especially those with hypertension may lead to earlier diagnosis and treatment.

Laparoscopic Myomectomy in the Retzius Space

<h3>Study Objective</h3> To illustrate a laparoscopic approach for the excision of the rare fibroid found within the Retzius space, to showcase relevant anatomy of the paravesical and Retzius space as well as to review the retroperitoneal vascular anatomy of the female pelvis. <h3>Design</h3> Elective Laparoscopic Myomectomy. <h3>Setting</h3> After verification of informed consent, the patient was taken to the operating room where a safety surgical briefing was performed. The patient was given a general anesthetic. They were then prepped and draped in the dorsal lithotomy position. 2g of Ancef was given. A foley catheter was inserted under sterile conditions and a Mengeshkar uterine manipulator was placed. <h3>Patients or Participants</h3> Previously healthy 36-year-old G1P1 who presented with a growing abdominal mass, she was otherwise asymptomatic. She was consented for laparoscopic myomectomy and underwent GnRH agonist treatment for 3 months prior to surgery. <h3>Interventions</h3> Laparoscopic Surgery. <h3>Measurements and Main Results</h3> Estimated blood loss was 400cc. The patient had no postoperative complications and was discharged home on post-operative day 1. The final specimen pathology was leiomyoma with a specimen weight of 556g. <h3>Conclusion</h3> Leiomyomas within the Retzius space are rare and can be safely excised using a laparoscopic approach. Bladder insufflation along with recognition of pelvic anatomical landmarks optimizes surgical navigation. Awareness of vascular structures present within Retzius space is instrumental for safe dissection.

Surgical outcome of bladder exstrophy management with bilateral pelvic osteotomy and external fixation

Bladder exstrophy is a rare congenital anomaly that requires a complex multidisciplinary approach and multi-stage surgeries. We report two cases of bladder exstrophy, our management, and outcomes. Case 1 is a 17 days old female with lower abdominal mass on birth. Pelvic radiography showed a 7 cm pubic diastasis. Bladder closure and bilateral pelvic osteotomy with advancement flap were performed. Case 2 is a 1 year old female with lower abdominal mass and urinating problem. Pelvic radiography showed pubic diastasis. Bladder closure and anterior innominate osteotomy were performed. Both patients had satisfactory follow-up. Management goal is closure of the bladder with preserved renal function and satisfactory cosmetic and function of the genitalia. We showed that pelvic osteotomy combined with external fixation provided better wound healing. Pelvic osteotomy combined with external fixation resulted in better wound healing. Further research is required to determine best approach to osteotomy. • Bladder exstrophy is a rare congenital anomaly that requires a complex multidisciplinary approach and multi-stage surgeries. • We report two cases of bladder exstrophy successfully managed with bilateral vertical osteotomy and external fixation. • Surgical fixation through pelvic osteotomy with external fixation provide a better wound healing than pelvic osteotomy alone.

Endoscopic enucleation of gastric choristoma in a child

Introduction. In pediatric practice, one may encounter various volumetric formations of the stomach, both benign and malignant. The verification and localization of the neoplasma is the most difficult issue in everyday work. Most often, benign tumors are represented by a rounded submucosal formation, covered with an intact mucous membrane. The most common formations that can be found in a child are leiomyomas. Objective is to present the first experience of endoscopic submucosal dissection and enucleation of the choristoma in a child. Clinical observation. The girl was admitted for inpatient treatment with complaints of prolonged (2 years) abdominal syndrome and mass formation of the antrum of the stomach. According to CT data, a voluminous soft tissue formation 8 × 7 × 12 mm in size was revealed in the antrum of the stomach, which does not accumulate a contrast agent. When performing esophagogastroduodenoscopy and endosonography, a submucosal formation of the prepyloric stomach was visualized, with dimensions of 7 × 10 mm. The macroscopic picture of the tumor corresponded to gastric leiomyoma. However, given the clinical picture, it was impossible to exclude the chorous stomach. Thus, the diagnosis was formulated: volumetric formation of the stomach. Leiomyoma? Choristoma? In the course of further treatment, surgical treatment was performed, in the amount of submucosal enucleation of the formation. According to the morphological study, the remote formation corresponded to the ectopic pancreatic tissue. Conclusion. Choristoma does not always have a “classic” appearance with retraction in the center, and the clinical picture is of great importance in the verification of neoplasma. Endoscopic submucosal removal of gastric choristoma is a minimally invasive and effective method of surgical treatment that can be used in children.

Optimizing Imaging of Pediatric Liver Lesions: Guidelines from the Pediatric LI-RADS Working Group.

A differential diagnosis based on a patient's age, clinical presentation, and serum α-fetoprotein level will help guide the initial imaging workup in children with a liver lesion. Children vary significantly in size, the ability to stay still, and the ability to breath hold for imaging examinations. Choosing and tailoring imaging techniques and protocols for each indication and age group is important for optimal care with minimal invasiveness. The need for sedation or anesthesia can be obviated by using techniques like feed and bundle, distraction, contrast-enhanced US, and motion-insensitive sequences for MRI. US is often the first imaging modality used in children with a suspected abdominal mass. Once a hepatic lesion is confirmed, multiphasic contrast-enhanced MRI is recommended for most lesions as the next imaging modality allowing full characterization of the lesion and assessment of the liver parenchyma. Contrast-enhanced CT can also be performed for assessment of pediatric focal liver lesions, especially in patients who have a contraindication to MRI. Contrast-enhanced US has shown promise to decrease the need for MRI or CT in some lesions such as hemangioma and focal nodular hyperplasia. Children with a history of malignancy can develop multiple types of hepatic lesions at various stages, including infections during an immunocompromised state, manifesting as focal liver lesions. Based on available limited data in the literature and the collective experiences of the Liver Imaging and Reporting Data System Pediatric Working Group, the authors provide guidelines for the imaging workup of pediatric focal liver lesions with an indication- and age-based approach and discuss the selection and performance of various imaging techniques and modalities. ©RSNA, 2022 See the invited commentary by Chojniak and Boaventura in this issue.

Metastatic Invasive Lobular Carcinoma of Bilateral Breasts Presenting with an Abdominal Mass

Background: Breast cancer remains the most frequent malignancy in women, with the two most common histological subtypes of breast cancer being the invasive ductal carcinomas (IDC) and invasive lobular carcinomas (ILC). The most common sites of breast cancer metastases are the liver, lung, pleura, brain and bone. Gastrointestinal, peritoneal, gynaecological and renal metastases are less common, often masquerading as primary malignancies and causing diagnostic confusion, mostly occurring in ILC as compared to IDC. Case Presentation: We report a case of a young woman presenting with an enlarging abdominal mass which was suspicious of a primary abdominal malignancy. Endoscopy and gastric biopsy revealed poorly differentiated carcinoma. On the top-most slices of her abdominal CT, bilateral enhancing breast lesions were detected, suspicious of metastases. Ultrasound and biopsy done for the breast lesions showed bilateral ILCs. Further staining of the gastric biopsy specimen confirmed the final diagnosis of gastric metastases from bilateral breast ILCs rather than a primary gastric tumour with breast metastases. Conclusion: This case highlights how breast cancer metastases to the GI tract may mimic primary GI cancers as well as the importance of breast examination, family history, radiological and pathological examination in detecting the breast origin of advanced carcinomas. Awareness of the different patterns of metastatic spread of ILC and IDC is also important due to the infiltrating nature and non-specific imaging findings of these tumours, requiring a high index of suspicion from the surgeons, oncologists, radiologists and pathologists.

Resistance training for postmenopausal women: systematic review and meta-analysis.

Numerous studies have been published assessing the effects of resistance muscle training to mitigate menopausal symptoms, given the endocrine muscle function and its metabolic regulation. Therefore, mapping and synthesizing high-quality studies are necessary to help clinical decisions. The aim of this study was to assess the effects (benefits and harms) of resistance muscle training for postmenopausal women. Electronic searches were conducted in MEDLINE (via PubMed), EMBASE, CENTRAL, PEDro, LILACS, and SPORTDiscus up to December 2021. Two independent reviewers selected the retrieved references and extracted relevant data from included studies. The methodological quality (risk of bias) using the Cochrane Risk of Bias table and the certainty of the evidence (GRADE approach) were assessed. Twelve randomized clinical trials (n = 452) with unclear to high risk of bias were identified. Compared with no exercise, resistance training (up to 16 weeks) seems to promote an improvement in functional capacity (mean difference [MD], 2.90 points; 95% CI, 0.60-5.20) and bone mineral density (MD, 0.10; 95% CI, 0.10-0.10) and a reduction in the hot flash frequency (13/29 vs 1/29; risk ratio, 13.0; 95% CI, 1.82-93.01) and fat mass (MD, -3.15; 95% CI, -6.68 to 0.38), and no differences were observed between groups regarding abdominal circumference and body mass index. When compared with aerobic exercises, resistance training may result in a reduction of hot flash frequency (7/18 vs 14/18; risk ratio, 0.50; 95% CI, 0.27-0.94) and fat mass (MD, -7.80; 95% CI, -14.02 to -1.58) and no difference in the quality of life and body mass index. Regarding safety, no serious adverse events were reported. Based on the GRADE approach, the certainty of this evidence was graded as very low to low, leading to imprecisely estimated effects. Resistance muscle training seems to improve postmenopausal symptoms and functional capacity. Given the low to very low certainty of the evidence, further randomized clinical trials with higher methodological quality and better reports are still needed. As an implication for clinical practice, health professionals should consider individualized aspects such as the previous history of exercise practice, physical capacity, and adaptation period.

A protein- and fiber-rich diet with astaxanthin alleviates high-fat diet-induced obesity in beagles.

Overweight or obesity is one of the most prevalent health burdens in companion pets and predisposes subjects to multiple comorbidities and reduced longevity. Dietary management and sufficient exercise are effective options for weight loss but challenged by modern lifestyle and calorie control-triggered malnutrition. Therefore, this study aimed to develop a formulated obesity control diet characterized by protein- and fiber-rich diet and supplemented with astaxanthin. We systemically evaluated global influences of the designed weight-loss diet on metabolic homeostasis in an obese beagle model. Beagles were induced for obesity by a 24-week HFD treatment and then included into weight-loss programs. Briefly, obese beagles were randomly assigned to two groups that were fed with a formulated weight-loss diet or control diet, respectively. Body weight and body condition scoring (BCS) were analyzed biweekly. Computed tomography (CT), nuclear magnetic resonance imaging (MRI) measurements, and blood and adipose tissue biopsies were collected at 0 and 8 weeks. Plasma lipids and adipocyte size were also measured after 8 weeks of weight-loss diet feeding. The global influence of the formulated diet on the whole spectrum of gene panels were examined by adipose RNA assays. Twenty-four weeks of continuous HFD feeding significantly induced obesity in beagles, as evidenced by increased body weight, BCS, abdominal fat mass, and serum lipid levels. The obese and metabolic condition of the modeled canine were effectively improved by an 8-week weight-loss diet administration. Importantly, we did not observe any side effects during the weight loss duration. Transcriptional analysis of adipose tissues further supported that a weight-loss diet significantly increased energy metabolism-related pathways and decreased lipid synthesis-related pathways. The prescribed weight-loss diet exhibited profound benefits in canine weight management with well safety and palatability. These findings support effective strategies of nutritional management and supplementation approaches for weight control in companion animals.

Mild methylenetetrahydrofolate reductase deficiency accelerates liver triacylglycerol and uric acid accumulation in fructose-fed mice

A genetic predisposition to hepatic steatosis may be associated with dietary patterns. We hypothesized that a common variant in human methylenetetrahydrofolate reductase (MTHFR 677C→T) was previously associated with an increased risk of nonalcoholic fatty liver disease (NAFLD). In this study, we investigated the relationship between the human MTHFR polymorphism and NAFLD using fructose-fed male C57BL/6 Mthfr+/+ and Mthfr+/− mice, a model for the human gene variant. Mice were fed an 8% fructose solution for 12 weeks. Mthfr+/− mice had significantly increased abdominal fat mass and hepatic triglyceride (TG) but displayed a similar liver mass when compared with Mthfr+/+ mice. Liver morphology showed that mild MTHFR deficiency induced liver lipid droplet deposition and inflammatory cell infiltration, suggesting accelerated lipid accumulation in the liver. Moreover, mild MTHFR deficiency increased hepatic xanthine oxidase activity and uric acid accumulation. Using untargeted lipidomics, we identified 116 differentially expressed lipids species in the liver of Mthfr+/− mice when compared with Mthfr+/+ animals. The most significant lipid increase was observed in 47 TGs, followed by 33 phosphatidylcholines in Mthfr+/− mice liver. When compared with Mthfr+/+ liver, 9 TGs were dramatically decreased in Mthfr+/− liver. These changes were associated with upregulated gene expressions related to triglyceride synthesis and storage. Thus, Mthfr+/− mice developed NAFLD disease. These findings suggested the Mthfr variant may be at an increased risk of liver steatosis on a fructose solution diet.

A Teenager With Acute Abdominal Mass: A Case of Gastro-Gastric Intussusception

A previously healthy 17-year-old boy presented to the emergency department with worsening left upper quadrant abdominal pain, a history of nonbloody, nonbilious emesis for 2 days, more recent bloody emesis for 1 day, and an abdominal “mass.” He had eaten dinner as usual 3 days earlier and gone to sleep. He woke up that morning with abdominal pain and felt a “mass” in the left side of his upper abdomen, which he stated would decrease in size by applying pressure. He started vomiting the same day, which initially contained food contents and exacerbated his pain.

Enormous Pyosaplinx after Spontaneous Delivery

Enormous pyosalpinx after a spontaneous childbirth is very rare event. Illness and progressive fever accompanied by abdominal or pelvic masses, vaginal purulent discharge, pain and pelvic discomfort, days to weeks after spontaneous delivery should add a suspicion for this condition. Ultrasound examination is the principle tool that can visualize enlarged tube. In this article, we report a 38 year old woman with a post-partum enormous pyosalpinx in which the microbial agent was not identified. Progressively severe symptoms, such as vaginal discharge, abdominal and pelvic pain, malaise and high fever started 5 days postpartum. An exploratory laparotomy showed left enormous pyosalpinx and massive adhesions with bowel and omentum. An excision of tubal ampoulae and omentum, as well as extensive lavage and drainage were made. Postoperative course was normal and the patient was dismissed in good condition.

Clinical outcomes of fetal ovarian masses diagnosed by prenatal ultrasonography and literature review.

With the advancement of prenatal examination technology, more and more fetus with ovarian masses are diagnosed. However, whether such children need intervention measures after delivery, there is no more unified diagnosis and treatment measures in the world. In this study, postnatal data and clinical outcome of fetal diagnosed with ovarian masses were analyzed. We also combined with relevant literature to explore the postpartum intervention measures and timing of such children. A total of 57 cases of abdominal masses from the reproductive system were included in the study. These children were diagnosed with ovarian masses after birth. We collected from 2012 to 2020, the prenatal examination revealed the presence of abdominal masses from the reproductive system, and diagnosis was confirmed by imaging examinations after childbirth. We counted the fetal period data of these children, compared the changes in the postnatal pathology and intervention measures. A total of 57 cases of ovarian masses were diagnosed prenatally, 1 case was lost to follow-up, and 56 cases were finally included in the study. After birth a total of 21 cases of ovarian masses were treated conservatively, of which 18 cases resolved spontaneously during the follow-up process, with an average follow-up period of 30.88 ± 18.16 weeks. There were statistically significant differences in the nature and the maximum diameter of the mass between the two groups receiving conservative treatment or surgical treatment after delivery (P < .05).Univariate and multivariate Logistic regression analysis showed that there were significant differences in the nature and diameter of the mass between two groups (P < .05). In addition, we divided the children undergoing postpartum surgery into a laparoscopic surgery group and a conventional open surgery group. Through data analysis, we found that there were statistically significant differences in the age of operation, operation time, and hospitalization days in the two groups of these children (P < .05). Children diagnosed with ovarian masses prenatally generally have a good prognosis. For these children, the treatment plan should be developed according to the child general condition. If child with ovarian mass is treated with surgery, the preservation of ovarian tissue should be emphasized regardless of the size, nature, and torsion of the mass.

Clinical and prognostic analysis of 42 children with malignant rhabdoid tumor of the kidney: a 7-year retrospective multi-center study

ObjectiveTo discuss the clinical and prognostic indicators of pediatric malignant rhabdoid tumor of the kidney (MRTK), and to increase the understanding of the occurrence and development of MRTK.MethodsFrom July 2014 to September 2021, all cases were confirmed by postoperative pathological examination. Among the 42 patients, there were 25 males and 17 females, with a median age of 10 (1–84) months. Abdominal mass or hematuria were the main clinical manifestations. Preoperative chemotherapy was performed in 9 cases (VC). The tumor stages were stage I-IV. Preoperative metastasis was found in 9 cases; the most common site was the lung. Postoperative patients received conventional chemotherapy, including VDACE regimen and UH-1 regimen. Among the 42 children in this group, survival at follow-up in this study was 26.2%(11/42).ResultsPreoperative anemia was found by univariate analysis, hypertension and hypercalcemia had shorter survival time. In addition, tumor-related factors had a significant impact on survival, with incomplete tumor resection, lymph node metastasis, stage III-IV had a lower survival rate. The impact of postoperative factors on survival included postoperative complications had a lower survival rate. The children were younger than 12 months, preoperative metastasis, no chemotherapy was performed after surgery was an independent risk factor for the prognosis of MRTK.ConclusionThe main clinical manifestations about MRTK were abdominal mass and hematuria. Preoperative chemotherapy did not significantly improve the prognosis. Postoperative chemotherapy can significantly improve the survival rate. Diagnosis depends on clinical manifestations, imaging, histopathology, immunohistochemistry and other comprehensive judgment. Age less than 12 months, preoperative metastasis, and no postoperative chemotherapy were independent risk factors for prognosis.

Calcific uremic arteriolopathy in a young man on intermittent hemodialysis

A 42‐year‐old man with ESKD who has been on intermittent hemodialysis for 7 years, presented with extremely painful inguinal ulcer and abdominal mass. The lesion was developed 2 weeks after repairing aneurysmal cubital AVF. At first, it was a small and painful red nodule but then its size increased and a large ulcer was developed. In addition, the physical examination revealed a palpable and painful large mass at left lower side of abdominal wall. He did not have important risk factors such as diabetes mellitus, treatment with warfarin, and use of calcium containing phosphate binders, vitamin D or calcium supplements. The patient suffered a long standing and severe secondary hyperparathyroidism. The parathyroid hormone level was too high (3100 pg/ml). In addition, serum calcium and phosphorus levels were 9.4 mg/dl and 9.8 mg/dl respectively. The SPECT-CT scan with 99 m Tc-MIBI of parathyroid glands confirmed persistence of an adenoma in right lower parathyroid gland (Figure 1, green arrow). The BMI was 32 kg/m2. He had no adherence to use of phosphate binder or calcimimetic drugs. The radiological studies showed extensive microvascular calcification in soft tissues (Figure 1, small arrow) and osteitis fibrosa cystica in long bones (Figure 1, star). The patient underwent surgical debridement of ulcer and palpable abdominal mass, wound care, intensive dialysis therapy with low calcium dialysis bath, cinacalcet, sevelamer carbonate, antibiotic and analgesic therapy. The histological sample (H&amp;E, 200X) shows Intramural calcification and obliteration of arteriole (large arrow) with extensive calcification in fat tissue (Figure 1, arrow head) which was consistent with Calcific Uremic Arteriolopathy (CUA). In addition to patient’s poor compliance to treatment of severe secondary hyperparathyroidism, the recent surgery of aneurismal AVF could also be an important trigger to development of calcific uremic arteriolopathy.

P-019 BIOELECTRIC IMPEDANCE ANALYSIS TO DETERMINE THE RISK FACTORS FOR INGUINAL HERNIA

Abstract Aim To search the risk factors for inguinal hernia development by performing bioelectrical impedance analysis. Material &amp; Methods Prospective, multicenter, cross-sectional study. Patients with inguinal hernias constitues the study group (IH), and patients who admitted with other surgical problems in the control group (SC). Age, gender, and BMI of the patients were recorded. Body composition measurements were done by bioelectrical impedance analysis. The relations between the obtained parameters and inguinal hernia were evaluated. Results 9 female and 125 male patients with a mean age of 53.4± 15.4 in IH, whereas 44 women and 24 men with a mean age of 44.5±15.9 in (SC). There were statistically significant differences between two groups regarding BMI, total body fat, lean abdominal muscle mass, abdominal fat amount, and visceral fat rates. Male gender, low total body fat rate, low total body fat amount, low lean body mass rate, and low visceral fat rate were determined as risk factors for inguinal hernia in univariate analysis. Only low total body fat rate was found to be an independent risk factor. Conclusions Low total body fat rate is an independent risk factor for inguinal hernia development.