Abdominal Subcutaneous Mass Research Articles

Hemangiosarcoma Associated with Polypropylene Suture in a Cat

Background: Sutures plays an important role in wound repair by providing hemostasis and support for healing suture. Synthetic non-absorbable like polypropylene suture materials induce minimal tissue reaction. Polypropylene has not been associated to neoplasms in domestic animals. The aim this study is to describe the first case of polypropylene suture induced hemangiosarcoma in an abdominal wall of a feline.Case: A 13-year-old female domestic shorthair cat was presented with a ventral abdominal subcutaneous mass. Clinical examination revealed a firm, rough, and irregular, approximately 6 x 4 cm subcutaneous mass involving the caudal ventral abdomen. A complete blood (cell) count (CBC) was within normal limits. Leukemia and FIV tests were negative; andthe results of a chemistry panel revealed elevated creatinine (valor: 2.0 reference range: 0.5-1.9). Abdominal ultrasound revealed a large mass of mixed echogenicity in the mid-ventral abdomen cranial to the bladder, measuring approximately 6 x 4 cm in the middle line with suture deeply embedded within mass suggesting foreign body reaction or neoplasm. There was evidence of sutures (hyperechoic lines) along the caudal abdominal wall extending into the mass. Records indicated that ovariohysterectomy procedure was performed 12 years previously at the same clinic and the closure of the abdominal wall was made with polypropylene sutures. No other abdominal surgery was performed in this cat. A fine-needle aspirate of the mass and contrast-enhanced computed tomography was not performed due to owner’s finance restrains. The catwas referred to surgery and the mass was excised. No evidence of metastasis was noted during surgery. Histologically, the neoplastic cells were oval to round with granular cytoplasm and vesicular nucleus and exhibited moderate cellular and nuclear pleomorphism. A diagnosis of abdominal wall hemangiosarcoma was made with suture deeply embedded within mass. Surgical margins were clear. Chemotherapy was indicated, but the owner declined due to financial reasons. This is the first polypropylene suture mass associated hemangiosarcoma in cats.Discussion: Hemangiosarcoma is a malignant neoplasm of vascular endothelial cells origin and it may be associated with chronic inflammation and neoplastic transformation. It was reported in previous studies, and it could be a hypothesis for the presented clinical case. There are two cases described in the literature of abdominal wall tumor associated with foreignbody and exuberant inflammatory response in cats using different types of suture; one case is a steel staple developing hemangiosarcoma and the other is polyester sutures developed fibrosarcoma. The present study shows a primary hemangiosarcoma diagnosed several years after closure of abdominal wall using polypropylene sutures in a female cat. Polypropylene is a monofilament suture that create less tissue-drag and induces less inflammation than multifilament sutures and is the preferred suture to close abdominal wall. Cats demonstrate a peculiar predisposition to neoplasms at the site of injury. Although the pathogenesis is still unclear, the introduction a “foreign body” may cause inflammatory process that act as a stimulus to neoplasia formation. We believe that polypropylene was the foreign material that may have played arole in tumor development in this case and it has not been reported before. Polypropylene sutures were found on gross examination of excised material. Any uncoated braided non-absorbable material located deeply in tissues may evoke a chronic inflammatory response (granuloma). A granuloma may evolve to malignancy in some cats. Despite polypropylenematerials induce minimal tissue reaction, it may be associated to neoplasm.Keywords: polypropylene suture, hemangiosarcoma, cat, tumor induced by foreign body.

Utility of cell block preparation for preoperative diagnosis of scar endometriosis

Endometriosis is a condition where endometrial glands and stroma are ectopically located in sites other than the uterine cavity. Cesarean scar endometriosis is rare with an incidence varying from 0.03% to 0.5%. Fine-needle aspiration cytology (FNAC) can be a valuable diagnostic aid in the evaluation of these subcutaneous abdominal masses which are often misdiagnosed. We report a case of cesarean scar endometriosis presenting as a tender abdominal nodule which was diagnosed by FNAC and confirmed by cell block preparation with progesterone receptor and CD10 positivity on immunohistochemistry. The use of cell blocks has been widely advocated in the diagnostic workup of patients with masses amenable to fine-needle aspiration (FNA) since they provide diagnostic architectural information which complement FNA smears.

Commentary on: Abdominal Subcutaneous Mass After Laser-Assisted Lipolysis and Immediate Multiple Treatments with a Dual-Wavelength Laser, Vacuum, and Massage Device.

No one can question the benefit that properly administered light- and energy-based therapies provide aesthetic patients. A “pioneer” forwarding aesthetic technology is often subject to resistance and close scrutiny by their colleagues, and rightfully so. However, if not for such visionaries, we may be without the benefit of advances such as non-invasive body contouring, laser hair removal, photo-rejuvenation, and photodynamic therapy, to name a few. Ablative skin resurfacing, the rave of the 1990s has evolved. Microabalation delivery is now available that when performed correctly, may shorten the initial recovery. Acceptance of technological advances progresses from their initial presentation based on patient results, feedback, manufactures' product evolution, and most important, peer reviewed articles. The surgeon has an “artistic license” when treatment is not conforming to published stands. In this situation, the physician has an obligation to keep patient safety at the forefront, regardless of a potential benefit. Clinical studies often utilize an independent review board to insure patient safe protocols. Whenever I consider a procedure that is not corroborated by peer reviewed articles as I explore new technology, the wisdom of my mentors, Drs. Robert Chase and Donald Laub echo in my mind. Be true to the basic principles of surgery and wound healing. Historically, this translates into ensuring adequate blood flow to a flap, minimizing skin tension and trauma to the surgical area, optimizing hemostasis, providing adequate immobilization when appropriate, personally examining the patient after surgery, and thoroughly investigating any unexpected outcomes. In the light- and energy-based therapy venue, there are no such basic principles to fall back on when combining technologies. It seems as though every day there are new energy sources, delivery systems, and protocols, which seem promising. The aesthetic provider has an expanded arsenal of evolving options that, while efficacious in a confirmed format via peer reviewed …

A Novel Dirofilaria Species Causing Human and Canine Infections in Hong Kong

Dirofilariasis is globally the commonest manifestation of zoonotic filariasis. We report the detection of a novel canine species causing human and canine dirofilariasis in Hong Kong. Three human cases occurring over 10 months were identified, one presenting with cervical lymphadenopathy, one with an abdominal subcutaneous mass, and one with a subconjunctival nodule. Transected worms recovered from the resected abdominal subcutaneous mass were morphologically compatible with Dirofilaria. The cox1 gene sequences of the three human isolates were identical; however, they were only 96.2% and 89.3% identical to the cox1 gene of Dirofilaria repens and Dirofilaria immitis, respectively. Sequencing of the 18S-ITS1-5.8S gene cluster was successful in the intact worm, and the nucleotide sequences were 94.0% and 94.9% identical to those of D. repens and D. immitis, respectively. Screening of the blood samples from 200 dogs and 100 cats showed the presence of the novel Dirofilaria species in 3% (6/200) of the dogs' but none of the cats' blood samples. Nucleotide sequences of the cox1 gene and 18S-ITS1-5.8S gene clusters of the dogs' samples were identical to those in the human samples. The sera of canines infected by this novel Dirofilaria species were negative when tested with the SNAP 4Dx D. immitis detection kit, except in the case of dogs with a mixed infection with D. immitis as detected by PCR. The results from this study suggest that this novel Dirofilaria species is a cause of filarial infection in humans and dogs in Hong Kong. We propose to name this Dirofilaria species "Candidatus Dirofilaria hongkongensis."

Subcutaneous mass as the primary manifestation of gestational choriocarcinoma: A case report

1. IntroductionChoriocarcinoma is a highly malignant trophoblastic tumor com-posed of two types of cells, syncytiotrophoblasts and cytotrophoblasts(Seckl et al., 2010). Its incidence is reported variously from 1 in 13,000 to 50,000 pregnancies (Alveyn and Loehry, 1988). Metastasis ismost often associated with choriocarcinomas in contrast to other vari-ants of the GTT (Berkowitz and Goldstein, 1996). Choriocarcinomacommonly metastasizes to the lungs and vagina, and less commonly,to the liver, brain, kidneys and gastrointestinal tract (Bagshawe,1992). Vaginal bleeding, abdominal swelling, amenorrhea, chest andneurologicalsymptomsarethemostcommonpresentationsdependingontheextentofthedisease,butbyfarthecommonestsymptomisvag-inal bleeding, a consequence of the tumor invading the uterus (Chamaet al., 2002).To the best of our knowledge, there was no choriocarcinoma withclinical presentation of subcutaneous metastasis reported in the liter-ature. An abdominal subcutaneous mass as the primary manifestationof choriocarcinoma is extremely rare and difficult for diagnosis. Herewe reported a case of gestational choriocarcinoma with the primarymanifestationof subcutaneousmetastasis10 yearsafterher lastpreg-nancy. No uterine or ovarian tumors were noted except subcutaneoustumor over anterior abdominal wall with bilateral multiple pulmo-nary nodules by image studies. Wide excision of the abdominal tumorrevealed that the tumor cells were positive for cytokeratin and humanchorionic gonadotropin by immunohistochemical stainings. DNA poly-morphism analysis revealed that the tumor cells possessed both geno-mic DNA alleles from the patient and her husband. Gestationalchoriocarcinoma was finally diagnosed. The serum level of β-hCG inthepatientwas 382 mIu/ml after surgery. So the EMA-COchemothera-peutic regimens (etoposide, methotrexate, and actinomycin, followedbycyclophosphamideandvincristine)weregiven.Thepatientachievedclinicalremissionfor7 monthsafterchemotherapy.Subcutaneousmasscan be the first manifestation of choriocarcinoma. Choriocarcinomashould be the differential diagnosis for special manifestation ofwomen in reproductive ages.2. Case reportA49-year-oldwomanpalpatedarapidgrowingmassoverlowerab-domen for three months. Her menstrual cycles became irregular since2 months ago. The patient had conceived 7 times with 4 miscarriagesand her three children were all delivered through cesarean section.Her last cesarean section was 20 years ago and her last pregnancy wasartificial abortion 10years ago.Pelvicexaminationrevealedasmoothcervix,andnormalsizeofuter-usandbilateraladnexae.Amultilo culatedmasswhichwasaroundbase-ball size within the abdominal wall was noted. The subcutaneous masslocated nearby the wound of the cesarean section with intact abdominalskin. Transabdominal ultrasonography revealed a multilocular tumormeasuring 8×6×5 cm located behind the cesarean scar and within thelower anterior subcutaneous layer. No abnormal finding was identifiedin the endometrial cavity, uterus and bilateral ovaries. Magnetic reso-nance imaging (MRI) study showed a large in filtrative and heteroge-neous mass, measured around 14 cm in largest dimension, and locatedwithin the anterior pelvis wall ( Fig. 1). Computed tomography (CT)study showed bilateral multiple pulmonary nodules. Subcutaneous ma-lignancy with pulmonary metastases was suspected. Biopsies of the ab-dominal wall tumor were undergone and the pathologic reportrevealed a poorly-differentiated squamous cell carcinoma. Immunohis-tochemically, the tumor cells were po sitive for cytokeratin (AE1/AE3)andp63butnegativeforvimentin,CD31,CD34,S-100 protein,calretinin

Subcutaneous Neoplasms of the Ventral Abdomen with Features of Adrenocortical Tumors in Two Ferrets

A ventral abdominal subcutaneous mass was removed from each of 2 young adult spayed female ferrets. In both cases, the neoplasms were composed of islands of polygonal cells separated by interlacing streams of spindloid cells reminiscent of ferret adrenocortical tumors with smooth muscle proliferation. Immunohistochemically, the polygonal cells demonstrated strong cytoplasmic reactivity for inhibin and weak cytoplasmic reactivity for pancytokeratin and S-100 protein. Spindloid cells demonstrated strong cytoplasmic reactivity for alpha smooth muscle actin, muscle-specific actin, desmin, and glial fibrillary acidic [corrected] protein. Ultrastructurally, the polygonal cells contained numerous intracytoplasmic clear vacuoles, mitochondria, scant rough endoplasmic reticulum, and few intermediate filaments. In one tumor, vesicular tubular mitochondria were found in polygonal cells. The spindloid cells contained numerous aggregates of parallel intermediate filaments. The histologic, immunohistochemical, and ultrastructural findings are suggestive of adrenocortical tumors with smooth muscle proliferation, but cannot be differentiated from an ovarian gonadal stromal tumor. Neither ferret had a clinically detected primary adrenal gland tumor or clinical signs of adrenal-associated endocrinopathy.

Case Report: Umbilical Hernias in Turkeys from Two Flocks

On May 30, 1972, six 11-week-old Nicholas turkeys from a flock of 5500 birds on range were presented to the Southern Indiana-Purdue Animal Disease Diagnostic Laboratory. One hundred and forty birds had died in a two-week period at a rate averaging 15 to 20 a day. The history indicated a 15% morbidity, with signs described as lameness, coughing, and some birds staggering. No mention was made of subcutaneous abdominal masses or hernias. However, two of the six birds presented had umbilical hernias. Pictures were taken of one bird before the skin was dissected off the abdominal area (Fig. 1) and also after (Fig. 2). Five of the six birds had airsacculitis, swollen livers, and pericarditis. Escherichia coli was isolated from the livers and was considered a probable pathogen. Serologic tests for Mycoplasma gallisepticum were negative. The hernias did not become a flock problem.