Palpable Abdominal Mass Research Articles

Unusual Presentation: Nephroblastoma/Wilms tumor in an Adult – A Case Report

Abstract Introduction/Objective Nephroblastoma/Wilms tumor is a common renal tumor primarily observed in children, and its occurrence in adults is exceedingly rare. This rarity contributes to the diagnostic challenges encountered in adults. Here, we present a case of a 32-year-old male diagnosed with biphasic nephroblastoma/Wilms tumor in the kidney, with liver and lung metastases. Methods/Case Report A 32-year-old male, without significant past medical history, presented with the chief complaint of abdominal pain for 2-3 weeks. Imaging studies revealed a substantial 17.5 cm kidney lesion accompanied by numerous lung and liver lesions. A liver biopsy indicated a small blue cell tumor, morphologically and immunophenotypically, (positive WT1) resembling nephroblastoma, with a strong suspicion of metastasis. Subsequent kidney biopsy confirmed a small blue cell malignant tumor demonstrating biphasic features, including blastema and epithelial components forming tubular structures similar to the liver biopsy, predominantly showing the blastemal component. The renal tumor biopsy supported the diagnosis of nephroblastoma. Despite chemotherapy, the patient passed away two months after the initial liver tumor biopsy. Results (if a Case Study enter NA) NA Conclusion Diagnosing nephroblastoma in adults poses significant challenges, particularly when initial presentations involve metastases. The occurrence of pediatric tumors in adulthood, though rare, should be considered in the diagnostic process after exhausting other possibilities. It is also important to note that the clinical presentation of pediatric tumors in adults may deviate from typical patterns. While Wilm’s tumor commonly presents as a painless, palpable abdominal mass in pediatric cases, adults may exhibit abdominal pain as the predominant symptom, as present in our case.

Navigating treatment for basidiobolomycosis: a qualitative review of 24 cases

Background and ObjectivesZygomycosis, a severe form of fungal infection, is classified into two categories: Mucorales and Entomophthorales. Within the Entomophthorales category, Basidiobolomycosis is a rarely recognized genus that can have significant health implications. Prompt diagnosis and appropriate treatment, which includes the use of antifungal medication and surgical procedures, are vital for enhancing the prognosis of patients. The objective of this study is to investigate the response to treatment in patients hospitalized due to basidiobolomycosis.MethodsWe carried out a retrospective study, in which we analyzed data from 49 patients who were diagnosed with Entomophthorale, Zygomycosis, and Basidiobolomycosis at Namazi Hospital, Shiraz, between the years 1997 and 2019. The data included parameters such as demographic information, clinical symptoms, imaging findings, treatment methods, and patient outcomes.ResultsOut of 49 patients, 24 children, predominantly male (83.3%), were definitively diagnosed with basidiobolomycosis. The ages of the patients ranged from 1 to 16 years, with an average of 5.75 years. The most frequently observed clinical manifestations included abdominal pain (70.8%), fever (54.2%), hematochezia (41.7%), vomiting (20.8%), and anorexia (16.7%). Half of the patients exhibited failure to thrive (FTT), while abdominal distension was present in 25% of the cases, and a palpable abdominal mass was found in 37% of the patients. The primary treatment strategy incorporated surgical interventions complemented by a comprehensive antifungal regimen. This regimen included medications such as amphotericin B, cotrimoxazole, itraconazole, potassium iodide, and voriconazole. These were mainly administered in a combination therapy pattern or as a monotherapy of amphotericin B. Twenty-two patients were discharged, while two patients died due to complications from the disease.ConclusionOur findings indicate that the prevailing treatment modalities generally involve surgical intervention supplemented by antifungal regimens, including Amphotericin B, Cotrimoxazole, Potassium Iodide, and Itraconazole.

Obstructed Hemivagina and Ipsilateral Renal Anomaly Syndrome (Herlyn-Werner-Wunderlich Syndrome): A Case Report

Herlyn-Werner-Wunderlich Syndrome (HWW), also known as Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) syndrome, is a rare Müllerian duct anomaly characterized by a triad of didelphic uterus, obstructed hemivagina, and ipsilateral renal agenesis. We report a case of a 15-year-old girl presenting with acute pelvic pain, cyclic dysmenorrhea, and a palpable abdominal mass. Imaging revealed a bicornuate uterus with a blind hemivagina, hematocolpos, and hematometra. Surgical management included resection of the vaginal septum and reconstruction, resulting in prompt recovery without complications.

Disseminated abdominal actinomycosis with urinary tract involvement in a dog

AbstractA 2.5‐year‐old, female, neutered, Shih Tzu presented with a 4‐month history of pollakiuria, abdominal pain and lethargy. Physical examination identified abdominal discomfort and multiple palpable abdominal masses. Abdominal computed tomography confirmed multifocal masses, one of which was adhered to the urinary bladder wall, while another was causing right‐sided ureteral obstruction and hydronephrosis. The dog underwent exploratory laparotomy to perform partial excision of some of the masses and also to acquire samples for histopathology and culture. Histopathology documented severe pyogranulomatous peritonitis and steatitis, while tissue culture yielded Actinomyces viscosus. The dog was treated with amoxicillin/clavulanic acid, based on culture and sensitivity testing, for 7 consecutive months, 1 month beyond resolution of ultrasonographic evidence of disease. There were no signs of relapse 6 months after discontinuation of treatment. This is a unique case report of canine disseminated abdominal actinomycosis demonstrating successful long‐term management following treatment with surgery and antimicrobial therapy.

Rare Small Bowel Carcinoid Tumor: A Case Report

Carcinoid tumors are rare malignancies that develop from epithelial cells in the diffuse endocrine system, with a notable proportion originating in the gastrointestinal tract. Delayed diagnosis due to their nonspecific symptoms often results in advanced disease upon presentation. Surgery is the main treatment, involving tumor removal while preserving bowel function. We present a case of a patient with pain and palpable abdominal mass, who was diagnosed with carcinoid tumor and referred for surgical treatment. This case highlights the diagnostic challenges and emphasizes the significance of early detection in patients with this disease.

Primary Hydatid Cyst of the Pancreas

Background: Pancreatic primary hydatic cysts are rare not to say exceptional, with their incidence in large series being only 0.2% to 0.3% Setting: General Surgery Service "Pablo Luis Mirizzi" of the National Hospital of Clinics, Allende Sanatorium and Caraffa Clinic of Córdoba. Design: Retrospective and cooperative. Methods: Between December 2000 and December 2019, 9 patients with primary pancreatic hydatic have been treated surgically, with 5 of the male sex and the remaining four of the female sex, with an average age of 39.4 years. In relation to the clinic, all patients had abdominal pain, accompanied by vomiting, bloating and fever. In three they had a palpable abdominal mass. All were asked for laboratory and hydatic tests, highlighting in 6 of the 9 patients tested positive. Results: All patients with abdominal ultrasound, abdominal CT and a patient were studied for CPRMN plus MRI of the abdomen. Abendazole was previously treated prior to surgical treatment in all cases. In relation to surgical treatment, the traditional unroofing and drainage of the cyst was carried out with the Mabit-Lagrot technique in 6 opportunities and in 3 with the Goinard Technique. Conclusion: The location of hydatic cysts in the pancreas is rare. Diagnosis is based primarily on imaging studies, in addition if they correlate with epidemiology and positive hydatic serology. Treatment of the pancreas hydatic cyst is surgical.

Non-Wilms renal tumors: Twenty years experience in a referral center

BackgroundNon-Wilms Renal Tumors (NWRT) constitute less than 10% of all renal tumors diagnosed in childhood. We studied our experience in the diagnosis and management of these tumors to compare our results with the current literature. Study designThis is a retrospective observational study which includes all patients aged 0-18 years with histopathological diagnosis of NWRT treated in our center during the period 2000-2022. ResultsWe identified 10 patients with diagnosis of: cystic nephroma(3), congenital mesoblastic nephroma(1), renal cell carcinoma(2), clear cell sarcoma of the kidney (2), renal Ewing's sarcoma(1) and malignant rhabdoid tumor of the kidney(1). Sixty percent (60%) were female. The median age at diagnosis was 3.25 years (IQR 1.5-10). Median age at diagnosis excluding CN was 6 years old (IQR 2.62-10.75). Molecular alterations were detected in 60% of the cases. Hematuria (40%) and palpable abdominal mass (40%) were the most frequent presenting symptoms. In total, 62.5% patients were misdiagnosed during the preoperative period as Wilms' tumor (WT), based on imaging data. A Radical nephroureterectomy was performed in all cases and staging lymphadenectomy in 70%. We recorded a major complication in one patient, who suffered a contralateral lower renal pole infarction due to section of a polar vessel during surgery. This patient had no preoperative vascular study. The recurrence-free survival rate was 90% with a median follow-up of 6.4 years (IQR 2-13.9). DiscussionRadiological imaging has fundamental importance in the diagnosis of renal tumors, especially to identify children who might benefit from initial surgical treatment or the indication of biopsy for preoperative histopathological confirmation before initiating cytotoxic treatment. However, there are no pathognomonic imaging findings that clearly differentiate between WT and other renal tumors, nor among the heterogeneous group of NWRT[3]. In our series, 62.5% of patients were misdiagnosed as WT based on imaging features.We found different molecular alterations in 60% of our patients (Table 1). None of them predispose to the development of bilateral tumors nor correlates with predisposing syndromes of metachronous tumors.Apart from its retrospective design, this study is limited by small number of cases and a long study period. ConclusionsCorrect differential diagnosis of NWRT is necessary for an adequate therapeutic approach. The molecular-genetic profile is an important step in the diagnosis of NWRT that allows for the use of targeted therapies in refractory patients. Detailed anatomical study by vascular mapping minimizes the risk of iatrogenic damage during tumor resection.

Liver cystic echinococcosis: A retrospective study on the demographics and clinical profile of patients managed at a single tertiary institution in central Eastern Cape Province, South Africa.

Cystic echinococcosis (CE) is a zoonotic disease with an Africa-wide prevalence of 1.7%. CE is caused by the tapeworm Echinococcus granulosus sensu lato, with the liver being the most commonly affected organ. In South Africa (SA), there is a paucity of data on liver CE demographics and management. To describe the demographics and clinical profile of patients with liver CE in a single tertiary hospital in Eastern Cape Province, SA. A 4-year (2019 - 2022) retrospective clinical record review study was conducted on patients presenting with liver CE to the Department of Surgery at Frere Hospital. The demographics, clinical characteristics and management of patients with liver CE are reported. A total of 56 patients diagnosed with and managed for liver CE were included in the study. The mean age of the patients was 37.5 years. Abdominal pain (n=39; 69.6%) was the most common presenting symptom, and a palpable abdominal mass (n=36; 64.3%) was the predominant presenting sign. Most patients had disease confined to the liver (n=35; 62.5%). The right lobe of the liver was most commonly affected (n=38; 67.9%), and most patients had a single liver cyst on imaging (n=32; 57.1%). The majority of the patients (n=36; 64.3%) were managed with surgical partial cystectomy, with a perioperative bile leak being the most common complication. In our setting, liver CE contributes to a significant local burden of the disease. The disease often has a nonspecific clinical presentation, necessitating imaging for the diagnosis. We observed good short-term outcomes in patients managed with combined partial cystectomy and medical therapy, although there is a risk of perioperative bile leak.

Childhood Wilm’s tumour in Aba, South East Nigeria

Background: Wilm’s tumour is still a problem to paediatric oncologist in developing countries due to poverty, late presentation, high cost of chemotherapeutic drugs, ignorance and religious beliefs. Objective: To review the clinical presentation, management and outcome of Wilm’s tumour in Aba, South East Nigeria. Methods: The Demography, clinical presentation, investigation results, operative findings and outcome of patients less than 15 years old managed for Wilm’s tumour at the paediatric surgery unit of the Abia State University Aba, South East Nigeria from 2010 to 2020 were retrospectively reviewed. Results: There were 30 children (M: F 2 :1) with histological confirmed nephroblastoma over the 10 year period. Their median age was 5. Age range 4-15years. Palpable abdominal mass was the main presentation in all the patients. Treatment consisted of nephro-ureterectomy followed by adjuvant chemotherapy with Vincristine, Cyclophosphamide and Actinomycin D. Adriamycin was added for metastatic disease and anaplasia. Fifteen of the patients had stage III disease, 10 had stage II disease and 5 had stage IV disease. Stage I disease was not encountered. Five patients had inoperable tumour requiring preoperative chemotherapy. Five patients died from the complication of chemotherapy treatment. Seven relapsed with poor outcome, with a mean follow up of 20 months, 20months survival rate is 40%. Conclusion: There is high rate of morbidity and mortality from nephroblastoma in our environment due to late presentation, poverty, ignorance and poor compliance to treatment. The outcome will be improved through health enlightenment and healthcare funding.

Sclerosing Mesenteritis: A Concise Clinical Review for Clinicians.

Sclerosing mesenteritis (SM), an idiopathic nonneoplastic condition affecting 0.18% to 3.14% of the population, is characterized by chronic fat necrosis, inflammation, and fibrosis most commonly of the mesentery of the small intestine. Sclerosing mesenteritis typically presents in the fifth or sixth decade of life, where patients with a history of abdominal surgery and/or autoimmune disease may be at higher risk. While many patients are asymptomatic, clinical features and complications are related to the mass effect resulting from the inflammation and fibrosis involved in the pathogenesis of SM. When present, common signs, symptoms, and complications include abdominal pain, weight loss, diarrhea, palpable abdominal mass on examination, bowel obstruction, chylous ascites, and mesenteric vessel thrombosis. Although SM was historically diagnosed predominantly by biopsy, current practice has shifted away from this to computed tomography imaging of the abdomen, given the invasive nature of biopsy. However, certain conditions, including mesenteric neoplasia (lymphoma, metastatic carcinoid tumor, desmoid tumor, mesenteric carcinomatosis), can mimic SM on imaging, and if clinical suspicion is equivocal, a biopsy may be warranted for definitive diagnosis. Asymptomatic patients do not require treatment. For patients with pronounced symptoms or complicated SM, the combination of tamoxifen 10 mg twice daily and prednisone 40 mg daily is the first-line pharmacotherapy; no randomized controlled trial of this regimen has been performed. Rarely, surgery may be necessary in cases of persistent bowel obstruction refractory to medical management. Sclerosing mesenteritis has an overall benign course in most cases, but disease progression and fatal outcomes have been reported.

Malignancy in Abdominal Wall Endometriosis: Is There a Way to Avoid It? A Systematic Review.

Background: Malignant-associated abdominal wall endometriosis (AWE) is a rare pathology, likely to occur in 1% of scar endometriosis. The objectives of this study were to update the evidence on tumor degeneration arising from AWE to notify about the clinical characteristics, the different treatments offered to patients and their outcomes. Methods: A comprehensive systematic review of the literature was conducted. PubMed, Embase and Cochrane Library databases were used. Prospero (ID number: CRD42024505274). Results: Out of the 152 studies identified, 63 were included, which involved 73 patients. The main signs and symptoms were a palpable abdominal mass (85.2%) and cyclic pelvic pain (60.6%). The size of the mass varied between 3 and 25 cm. Mean time interval from the first operation to onset of malignant transformation was 20 years. Most common cancerous histological types were clear cell and endometrioid subtypes. Most widely accepted treatment is the surgical resection of local lesions with wide margins combined with adjuvant chemotherapy. The prognosis for endometriosis-associated malignancy in abdominal wall scars is poor, with a five-year survival rate of around 40%. High rates of relapse have been reported. Conclusions: Endometrial implants in the abdominal wall should be considered as preventable complications of gynecological surgeries. Special attention should be paid to women with a history of cesarean section or uterine surgery.

Rare presentations of Wilms tumor in children: A case report

Wilms tumor (WT) is the most common malignant tumor (neoplasm) of the urinary tract in early childhood. The median age at WT diagnosis is 3-4 years, and 90% of cases are diagnosed before the age of 7 years. In this report, three adolescent patients with WT, aged 12, 17 and 16, are investigated. Left kidney involvement was observed in these three cases. The clinical presentation in case one was the complaint of abdominal pain with a palpable abdominal mass. The second case was presented with hematuria and an abdominal mass. The clinical symptoms in case three included left flank pain and weight loss. Although WT is usually observed in children under 7 years of age, its diagnosis should also be expected in older children with abdominal pain, palpable mass and gross hematuria.

Jejunojejunal intussusception induced by a gastrointestinal stromal tumor: a case report and literature review.

Intussusception is defined as the invagination of a proximal segment of the bowel into the adjoining or distal segment. In most adults with intussusception, there is a demonstrable lead point with a definite pathologic abnormality. The clinical features of intussusception include chronic intermittent abdominal pain, nausea and vomiting, constipation, and a palpable abdominal mass. The present case report describes a 62-year-old woman with a 2-week history of abdominal pain and 9-day history of vomiting. Clinical, imaging, and histologic evaluations revealed a jejunojejunal intussusception with a gastrointestinal stromal tumor as the lead point. A gastrointestinal stromal tumor should be considered as a possible lead point in adult patients with intussusception. The implication of reducing the intussusception prior to tumor resection requires further evaluation in view of the risk of venous embolism, including direct spread of malignant cells, in cases involving a large polypoid mass with a necrotic surface that extends to the serosa as shown by intraoperative examination. Accordingly, the rationale for adjuvant therapy with imatinib also requires further evaluation.

Role of Ultrasound Guided Pneumatic Reduction of Intussusception in Children Under 3 Years with Early Presentation

Background: Intussusception remains the most common cause of intestinal obstruction in children under 3 years of age. Objective: To evaluate the role of ultrasound guided pneumatic reduction of intussusception in children under 3 years with early presentation. Methods: This prospective interventional study was carried out at the Department of Pediatric Surgery in Dhaka Medical College Hospital, Dhaka from July, 2020 to June, 2022 for a period of 24 months. A total number of 22 patients with intussusception scheduled for Ultrasound Guided Pneumatic Reduction procedure to reduce intussusception were enrolled for this study after fulfilling the selection criteria. After Ultrasound Guided Pneumatic Reduction, patients were evaluated with duration of reduction, hospital stay and mass existence. Results: The mean age of the patients was 1.28 ± 0.83 years, ranging from 4 months to 3 years. Of them, 54.5% were below or equal to 1 year and the rest, 45.5% were above 1 year. All patients had abdominal pain and 86.4% palpable abdominal mass. Most of the mass situated at right hypochondrium (59.1%). The mean duration of reduction was 6.45 ± 1.29 minutes, ranging from 4 to 8 minutes. The mean duration of hospitalization was 15.90 ± 1.57 hours, ranging from 14 to 18 hours. In 9.1% of cases, the mass remained after the procedure. Conclusion: Intussusception can be effectively treated using pneumatic reduction, which is also quicker, less messy, and risk-free.

P-02 A case of solitary fibrous tumor originating from the adrenal gland presenting with hypoglycemia

Abstract Introduction Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm usually located in the pleura and associated with NAB2-STAT6 gene fusion. According to the World Health Organization (WHO) classification, although most SFTs are considered well benign, some SFTs have cytological atypia, hypercellularity, tumor necrosis, Ki-67 greater than 5%, high mitotic rate (>4 per high-power field (HPF)) and/or the presence of infiltrative surgical margins are considered malignant. SFT with severe hypoglycemia is called Doege-Potter syndrome which occurs with ectopic secretion of a prohormone of insulin-like growth factor 2 (IGF-2) from tumor tissue. We present a case who applied with severe hypoglycemia and was diagnosed with a solitary fibrous tumor thought to originate from the adrenal gland located in the right retroperitoneal region. Clinical Case A 61-year-old female patient was admitted to the hospital after hypoglycemia was detected in her application due to clouding of consciousness. While the patient's glucose level was 23 mg/dL, insulin:0.4 µIU/mL, C-peptide:<0.01 ng/mL, serum cortisole: 24,20 (µg/mL), growth hormone (GH): 13,20 ng/ mL and insulin-like growth factor I (IGF-1) 38 ng/mL were measured. Insulinoma was excluded and because of IGF-2 level could not be measured in our hospital, low serum insulin and IGF-1 levels suggested high serum IGF-2 levels. HbA1c, adrenal gland, and pituitary function tests were normal (Table 1). A mass lesion of approximately 145×133 mm in size, with heterogeneous contrast, containing cystic areas, was seen, which was thought to originate from the right adrenal gland in the upper abdomen tomography taken due to the presence of a palpable abdominal mass on physical examination (Figure 1). Urine catecholamines were found to be normal, and the plasma aldosterone concentration (PAC)/plasma renin activity (PRA) ratio was 2.56. The patient was operated under intravenous infusion of 10% dextrose due to persistent hypoglycemia. The immunohistochemical evaluation showed CD34, SOX-1 and STAT6 positivity and negativity for S-100, HMB45, straight muscle actin, desmin, caldesmon and melan A, thus confirming the diagnosis of a solitary fibrous tumor. After the operation, the patient's hypoglycemia disappeared. Since there are cases in the literature in which Doege-Potter syndrome was diagnosed without measuring IGF-2, we think that our patient had IGF-2-related hypoglycemia. Conclusion The development of hypoglycemia in Doege-Potter syndrome has been associated with the secretion of large amounts of IGF-2 by tumor tissue, resulting in decreased IGF-1 and Insulin-like growth factor-binding protein 3 (IGFBP-3) concentrations. In these patients, the tumor originates from mesenchymal tumors of low malignant potential. In our case, the Ki-67 proliferation index was around 2%, it was considered benign, and the patient's symptoms completely regressed after resection.Figure 1.CT images of the patientA mass in the right retroperitoneal area, associated with the adrenal gland and containing areas of necrosis, is seen on non-contrast (a) and contrast-enhanced (b) CT scans. Table 1.Laboratory workup

Spotlight on Carcinosarcoma of the Ovary: A Scoping Review.

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

Congenital Mesoblastic Nephroma at Birth: A Case Report and Detailed Analysis

Renal tumours in infants and children, ranging from benign to highly malignant, present a significant medical challenge and constitute approximately 3% of all kidney tumours in neonates. This study focuses on congenital mesoblastic nephroma (CMN), the most common renal tumour in neonates. We present a case of a full-term neonate born with a palpable abdominal mass, diagnosed as the cellular subtype of CMN. Typically benign, CMN often appears as a symptomless abdominal mass without cystic elements. The neonate underwent a radical left nephroureterectomy, and a histopathological examination confirmed the diagnosis. Despite its generally benign nature, CMN can lead to serious complications, necessitating early surgical intervention. Our case, 18 months post-operation, shows no evidence of recurrence, underscoring the importance of regular surveillance in managing this rare renal tumour in neonates. This review discusses the diagnostic modalities, subtypes, genetic implications, and varying clinical outcomes associated with CMN, contributing to the understanding and management of this rare pediatric condition.

Intestinal cystic lymphangioma.

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

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

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

Biliary cysts in adults: Cerrahpaşa experience.

Biliary cysts are biliary duct dilatations, with 20% of the cysts being diagnosed in adulthood. Abdominal pain, jaundice and palpable abdominal mass are defined as the classical triad. However, nausea, vomiting, fever, itching and weight loss are frequent complaints. There are several treatment options depending on the type of the cyst. This study aimed to share our experience with biliary cysts and contribute to the literature on this subject. Thirty patients, who received treatment for biliary cyst from January 1981 to December 2018 at our clinic, were studied retrospectively. The patients were analyzed based on age, sex, type of the cyst, diagnosis and treatment methods, post-op follow up and complications. Twenty-seven of the patients were females, and three were males. The patients were aged between 16 and 76 years, and the median age was 41.9 years. All patients presented with abdominal pain, which was accompanied by cholangitis in nine patients, nausea and vomiting in four patients, dyspepsia in three patients and palpable mass in one patient. According to the Todani classification, biliary cyst findings were consistent with Type I in 23 patients, Type V in three patients, Type IV in two patients, Type II in one patient and Type III in one patient. Diagnosis and treatment are complex in biliary cysts due to anatomical proximity and variations. Therefore, it would be beneficial to refer them to referral centers. Choice of treatment should be based on the type of the cyst.