Avascular Mass Research Articles

The Impact of the Sonographic Findings Within the Epididymis on the Differential Diagnosis of Acute Scrotum

Objective: The aim of this study was to assess the sonographic changes within the testis, epididymis, and the corresponding appendages, in contributing to the pediatric differential diagnosis, of an acute scrotum. Materials and Methods: A retrospective extraction of pediatric patients’ (age <13 years) data was completed for those initially seen with an acute scrotum. The data procured from the medical records included demographic characteristics, clinical and sonographic findings, and the final diagnosis. Results: The final diagnoses among a cohort of 86 pediatric males (average age 6 ± 3.9 years) with acute scrotum were as follows: epididymal and testicular appendix torsion (44.7% and 17.6%, respectively), testicular torsion (15.3%), trauma and hematoma (5.9%), incarcerated hernia (4.7%), idiopathic scrotal edema (4.7%), epididymitis (4.7%), and Henoch-Schonlein purpura (3.5%). The heterogeneous testicular appearance in patients with testicular torsion was significantly compared with the appendix torsion. The increased testicle size noted on the sonogram favored the diagnosis of testicular torsion. In cases of testicular torsion, the vascular flow was reduced or absent, although it was normal or increased in appendix torsion. Increased epididymal vascular flow was more common in cases of appendix torsion. Conclusion: Based on the diagnostic findings in this cohort, the following were the most common and accurate sonographic findings in distinguishing the causes of a pediatric acute scrotum: an epididymis enlargement coexisting with a small adjacent avascular mass, due to the torsion of intra-scrotal appendages and a mass shape of the epididymis.

Preoperative Direct Puncture Embolization Using aNonadhesive Ethylene Vinyl Alcohol (EVOH) Liquid Embolic Agent for Head and Neck Paragangliomas.

This retrospective study aimed to assess the safety and technical efficacy of preoperative direct puncture embolization using anonadhesive ethylene vinyl alcohol (EVOH) copolymer-based liquid embolic agent (LEA) combined with balloon occlusion at the origin of the external carotid artery for head and neck paragangliomas (HNP). We conducted areview of all consecutive cases of HNPs treated with direct puncture embolization using EVOH-based LEAs between 2017 and 2022 in 2 tertiary high-volume hospitals. Atotal of 25cases of HNPs in 24patients underwent direct puncture embolization (12males, 12females, mean age 50.9 ± 15.6 years). The average lesion volume was 299.95 mm3. The mean procedure time was 139.11 min, and the mean volume of EVOHs used per case was 19.38 mL. Successful complete devascularization was achieved in all cases, with ahomogeneous and deep penetration of the embolic agent into the tumor vessel bed regardless of the LEA type. Preoperative embolization of HNPs using adirect puncture technique and EVOHs is asafe, efficient, and feasible treatment option with alow risk of complications. This procedure facilitates surgery by transforming tumors into avascular masses that are well-delineated against the surrounding normal tissue.

V04-08 VIDEO ABSTRACT: NOVEL TREATMENT APPROACH OF A NEONATAL URETHRAL POLYP

You have accessJournal of UrologyCME1 Apr 2023V04-08 VIDEO ABSTRACT: NOVEL TREATMENT APPROACH OF A NEONATAL URETHRAL POLYP Kieran Moore, Rodrigo Romao, Daniel Keefe, and Dawn Maclellan Kieran MooreKieran Moore More articles by this author , Rodrigo RomaoRodrigo Romao More articles by this author , Daniel KeefeDaniel Keefe More articles by this author , and Dawn MaclellanDawn Maclellan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003252.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral polyps are a rare entity, and typically present in male patients being investigated for dysuria, hematuria, or urinary retention. The etiology of these benign tumours remains unclear; however, they are likely to arise from the verumontanum (mesonephric duct), or a remnant from the sinus tubercule (paramesonephric duct). We describe a novel surgical approach to a urethral polyp causing urinary retention in a newborn. METHODS: A term baby (3815 g) admitted to the neonatal intensive care unit with congenital diaphragmatic hernia and respiratory distress was found to be in urinary retention post operatively. Comorbidities included pulmonary hypertension, bilateral hydroceles, and ear dysmorphism with normal microarray and spinal ultrasound (US). A formal US demonstrated an avascular mass in the urethra, suspicious for a polyp with a distended bladder and no hydronephrosis. Voiding cystourethrogram (VCUG) revealed a well-defined pedunculated polyp protruding into the urethra with voiding, and no evidence of reflux. Surgical options that have been described include resection with cold knife, fulguration and more recently, laser ablation. Additionally, larger polyps not amendable to endoscopic removal may require a trans-vesical approach. RESULTS: In the operating room, the ureteric orifices were orthotopic. The polyp was identified using a 6-French cystoscope just proximal of the verumontanum, with a well-defined stalk. Debris within the bladder suggested incomplete emptying. Given its large size and thin stalk, the polyp was resected in its entirety using a zero-tip loop-snare. Hemostasis was achieved with a monopolar fulgurating electrode. Pathology confirmed a benign urethral polyp. The baby was voiding well without urinary tract infections at follow up 6 weeks later, with no residual polyp or hydronephrosis on US. With this complete resection, prognosis remains excellent with recurrence unlikely. CONCLUSIONS: When suspected, the diagnosis of urethral polyps is achieved with VCUG and US, with ultimate endoscopic resection. We describe the successful endoscopic resection of a urethral polyp in a neonatal child with a loop snare, the first approach to our knowledge. This approach uses instruments readily available to the pediatric urologist and avoids the use of a resectoscope, and thus, the need for urethral dilatation in the newborn. Source of Funding: No funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e340 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kieran Moore More articles by this author Rodrigo Romao More articles by this author Daniel Keefe More articles by this author Dawn Maclellan More articles by this author Expand All Advertisement PDF downloadLoading ...

Doppler ultrasound in the assessment of blood supply to choroidal melanoma: parallels with contrast angiography and histography

Evaluation of blood supply to choroidal melanoma based on comparison of Doppler characteristics of blood flow with angiographic variant of angioarchitectonics and densitometric parameters of the tumor. The study was performed in 135 patients (135 eyes) with choroidal melanoma. The initial prominence of the tumors varied from 0.6 to 15.2 mm (mean 5.07±3.58 mm), the diameter of the tumor base varied from 4.1 to 22 mm (mean 10.97±3.62 mm). Taking into account the biometric characteristics of choroidal melanoma, all patients were divided into 3 groups: «small» (n=49), «medium» (n=34) and «large» (n=52). In addition to standard diagnostic examination, the following instrumental methods for assessing the blood supply of choroidal melanoma were carried out: angiography with indocyanine green, optical coherence tomography angiography, ultrasound in color Doppler mapping mode, ultrasound histography. Comparative analysis of Doppler ultrasound and contrast angiography data in assessing the blood supply of choroidal melanoma established that the first angiographic type, presented by straight and parallel vessels (65%, p=0.037), is characteristic for hypovascular and avascular masses, the second type - for hypervascular choroidal melanomas, in which the new vessels can take the form of arches, loops and nets (68%, p=0.027). The study of densitometric characteristics in choroidal melanoma of various sizes indicates a natural decrease in the acoustic density of the tumor tissue with increase in the prominence of the mass, while there are significant differences in the acoustic density values in hypo/avascular (36.53±5.37 dB) and hypervascular variants (29.28±4.53 dB) of blood supply to tumor tissue. The obtained data on acoustic density of choroidal melanoma can be used in clinical practice for indirect assessment of the nature of blood supply to choroidal melanoma.

Chronic Ectopic Pregnancy Masquerading as Ovarian Cystadenoma: A Case Report

The term ‘chronic ectopic pregnancy’ refers to a type of tubal pregnancy in which a pelvic mass frequently develops as a result of repeated small ectopic ruptures or abortions, rather than a single episode of bleeding. Chronic ectopic pregnancy can often present with vague symptoms, making it susceptible to misdiagnosis and delaying treatment. In this case, a 27-year-old woman with para 2 and 2 live births presented with complaints of on-and-off abdominal pain in the right inguinal region for the past two months. During the clinical examination, a substantial, firm mass measuring 6×6 cm was palpated in the right adnexal region, not associated with any adnexal tenderness. Transabdominal sonography suggested an empty uterus with a solid cystic mass, round/ oval in shape, located in the right adnexal region measuring approximately 6.9×6.4 cm. The ultrasound findings in these patients can either show an amorphous, avascular mass or a highly vascular complex. The diagnosis can be mistaken for endometriosis, acute pelvic inflammatory illness, vascular tumours, pelvic abscess, or, in this instance, a cystadenoma. In most cases, radiologic findings are essential in the differential diagnosis, but it is mostly confirmed through surgery, as in this case. A laparotomy was performed, which revealed a chronic ectopic pregnancy, and a salpingo-oophrectomy was performed.

General Seizures Due to Brain Abscess Causa Suspected Intracranial Tuberculosis at Prof Aloei Saboe Hospital Gorontalo

Introduction: Seizures are a severe clinical condition with complications of brain abscess. This report will describe the rare occurrence of generalized seizures due to Mycobacterium tuberculosis (MTB) brain abscess.Case: Male, 57 years old, admitted to the emergency department with two episodes of generalized seizures one hour before admission. The patient had a history of pulmonary tuberculosis during four months of treatment and was treated with an anti-tuberculosis fixed drug combination (FDC) 3. The patient was in a state of delirium and had lower extremity weakness. The chest radiograph shows a multifocal patchy opacity in the right upper lobe with thickening in the right pericardium. Pre-Contrast MSCT-Scan of the brain showed multiple hypodense lesions in the left frontal lobe, right frontoparietal, left basal ganglia, and pons. Post-contrast shows multiple low-attenuation, oval-shaped lesions with peripheral enhancement (double rim sign) with vasogenic edema. Finally, the patient was diagnosed with a tuberculous brain abscess.Discussion: CNS tuberculosis is a rare cause of seizures and is often followed by a history of pulmonary tuberculosis. Tuberculosis appears on the Contrast MSCT Scan Brain as an avascular mass lesion of low density and sometimes more significant than expected around cerebral edema. End-stage tuberculosis is well encapsulated and has peripheral ring enhancement with vasogenic edema.Conclusion: Pre-Post Contrast Brain MSCT is the diagnostic imaging of choice for suspected tuberculous brain abscess.

Specific and Aspecific Molecular Checkpoints as Potential Targets for Dismantling Tumor Hierarchy and Preventing Relapse and Metastasis Through Shielded Cytolytic Treatments.

I have recently theorized that several similarities exist between the tumor process and embryo development. Starting from an initial cancer stem cell (CSC0), similar to an embryonic stem cell (ESC), after implantation in a niche, primary self-renewing CSCs (CSC1s) would arise, which then generate secondary proliferating CSCs (CSC2s). From these epithelial CSCs, tertiary mesenchymal CSCs (CSC3s) would arise, which, under favorable stereotrophic conditions, by asymmetric proliferation, would generate cancer progenitor cells (CPCs) and then cancer differentiated cells (CDCs), thus giving a defined cell heterogeneity and hierarchy. CSC1s–CSC2s–CSC3s–CPCs–CDCs would constitute a defined “tumor growth module,” able to generate new tumor modules, forming a spherical avascular mass, similar to a tumor sphere. Further growth in situ of this initial tumor would require implantation in the host and vascularization through the overexpression of some aspecific checkpoint molecules, such as CD44, ID, LIF, HSP70, and HLA-G. To expand and spread in the host tissues, this vascularized tumor would then carry on a real growth strategy based on other specific checkpoint factors, such as those contained in the extracellular vesicles (EVs), namely, microRNAs, messenger RNAs, long non-coding RNAs, and integrins. These EV components would be crucial in tumor progression because they can mediate intercellular communications in the surrounding microenvironment and systemically, dictating to recipient cells a new tumor-enslaved phenotype, thus determining pre-metastatic conditions. Moreover, by their induction properties, the EV contents could also frustrate in time the effects of cytolytic tumor therapies, where EVs released by killed CSCs might enter other cancer and non-cancer cells, thus giving chemoresistance, non-CSC/CSC transition (recurrence), and metastasis. Thus, antitumor cytotoxic treatments, “shielded” from the EV-specific checkpoints by suitable adjuvant agents, simultaneously targeting the aforesaid aspecific checkpoints should be necessary for dismantling the hierarchic tumor structure, avoiding recurrence and preventing metastasis.

Unusual\xa0glomus tumor\xa0of the bladder: a rare case report and literature review

BackgroundGlomus tumor (GT), which are neoplasms of the glomus body, usually occur in the extremities, particularly under the nail bed. GT occurring in the bladder is very rare and has been reported as sporadic. In the present study, a rare case of bladder GT is reported and its clinical and histopathological characteristics are summarized by literature review.Case presentationA 57-year-old woman presented with intermittent gross hematuria for 2 years. Urinalysis displayed hematuria. The bladder ultrasound showed an avascular and homogeneous isoechoic polypoid mass with a maximum diameter of 6 mm at the right lateral wall of bladder. The bladder endoscopic examination showed a polypoid lesion, with a smooth surface, located in the right lateral wall. Then, a transurethral resection was performed, its histopathological features indicated a benign GT.ConclusionsGT arising in the bladder is extremely rare, and only four cases have been identified in studies reported in English. It is difficult to diagnose bladder GTs according to their clinical features. The gold standard method used for their diagnosis is histopathology. However, it should also be considered in the differential diagnosis for bladder mass.

Subgaleal Lipoma: Imaging Findings

Subgaleal lipoma is a benign tumor of adipose tissue. It should be suspected when a semi-spherical avascular mass with well-defined margins, iso- or hyperechoic in most cases, with thin internal echogenic lines parallel to the long axis of the tumor, is observed between the galea aponeurosis and periosteum of the cranial bone. We report a series of cases of three patients who underwent surgical lesion excision and whose histopathological examination findings confirmed the diagnosis of lipoma.Main Teaching Point:The presence of long continuous echogenic lines within a lens-shaped soft tissue mass located beneath the galea aponeurosis may suggest the diagnosis of subgaleal lipoma.

Clinical Case of Fetal Lymphangioma

Lymphangioma is a benign lymphatic system tumor, often congenital, mainly affecting lymph nodes in various anatomic localizations. Postnatally mostly common lymphangioma manifestation occurs during the first year of life. Today it can be readily diagnosed prenatally. Diagnosis is based on non-invasive visualization, such as sonography and computed tomography. The objective: is to present clinical case of manifest fetal lymphangioma diagnosed during pregnancy. Fetal ultrasound (US) was performed at 28, 32, 34 weeks of gestation. As a result fetus was diagnosed with hypoechogenic mass in right axillary region, growing in dynamics gradually from 34×28 mm, 38×34 mm to 49×37 mm. Mass had clear even contours, hyperechogenic capsule with fine dispersed suspension content. Color doppler imaging showed avascular mass character. After delivery at 37–38 weeks of gestation (planned Cesarean section) at newborn examination we visualized asymmetric soft elastic consistency protrusion along right midclavicular and anterior axillary region. Described clinical case of fetal lymphangioma is a good illustration of dynamic prenatal and postnatal dynamic observation and its US interpretation.

Laser ablation and management of a retropharyngeal abscess caused by Corynebacterium pseudotuberculosis in a ram

A one-year-old crossbred ram presented for acute respiratory distress. Initial diagnostics revealed compression of the pharynx by a spherical, avascular mass. The ram was initially managed with a tracheostomy, antimicrobials...

Unusual Presentation of Groin Sarcoma Involving the Common Femoral Artery: A Case Report

Sarcomas are characterized by innumerable clinical presentations. Sarcoma tumors involving peripheral vessels are quite rare and not always easy to identify despite the availability of diagnostic tools such as sonography, computed tomography (CT), and magnetic resonance imaging (MRI). This case report discusses the imaging findings of angiography, sonography, and CT, which were the modalities used in this case. Initially, the patient underwent limited duplex ultrasound and CT imaging to evaluate a painful right groin area after right common femoral artery (CFA) angioplasty and laser atherectomy, with left groin access. Sonographic findings demonstrated a large, heterogenous, hypoechoic, and avascular mass surrounding the right CFA. CT imaging of the pelvis described a partially thrombosed pseudoaneurysm surrounding the CFA. Surgical evacuation of what was believed to be a hematoma was performed; a pathology report revealed sarcoma of the groin.

Clinicopathologic Characteristics of Stomach Cancer among Patients Admitted to the Surgical Departments of Teaching Hospitals in Sana'a, Yemen

Synovial Sarcoma is a rare malignancy. It presents in adolescents and young adults. It occurs in soft tissue of extremities usually near to the large joints, heart, lung, mediastinum, head and neck. A 23-year-old female presented with a big hard fixed swelling in right supraclavicular region for 15 years. X-Ray chest posterior-anterior view presented Homogenous opacity in upper lobe of right lung. USG of neck showed large heterogeneous lobulated almost avascular solid mass in right side of root of neck and anterior upper mediastinum may be associated with Schwannoma/ paraganglioma/soft tissue sarcoma. Spindle cell lesion was reported by FNAC. MRI showed large slightly lobulated mass along right side of root of neck and right side of superior mediastinum. A large soft tissue density mass along right side of neck and superior mediastinum was found in CT scan. Surgical excision was done successfully. Histopathological examination revealed spindle cell tumor favoring synovial sarcoma in the neck tissue and metastatic spindle cell tumor in the lung lesion.

The Motor Branch of the Median Nerve, a Rare Localization of Schwannoma

Schwannoma is the most common benign tumor of peripheral nerve. Only 7% of schwannomas arise from the median nerve, and its localization in the motor branch is extremely rare. A 57-year old right-handed female presented with a carpal tunnel syndrome symptoms associated to a little painful thenar swelling in the left hand with no motor or sensory deficit. An electromyogram confirmed the clinical diagnosis of carpal tunnel syndrome. Ultrasonography (US), performed to study the thenar swelling, revealed an infracentimetric avascular well-limited intramuscular mass. Surgical resection of the mass was performed satisfactorily with preservation of nerve fascicles. Histopathology concluded to a benign schwannoma of the motor branch of the median nerve. In the literature reviewed by us, this is the third case of motor branch of the median nerve schwannoma.

Relationship between diffusion parameters derived from intravoxel incoherent motion MRI and perfusion measured by dynamic contrast-enhanced MRI of soft tissue tumors.

Our aim was to evaluate the link between diffusion parameters measured by intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) and the perfusion metrics obtained with dynamic contrast-enhanced (DCE) MRI in soft tissue tumors (STTs). Twenty-eight patients affected by histopathologically confirmed STT were included in a prospective study. All patients underwent both DCE MRI and IVIM DWI. The perfusion fraction f, diffusion coefficient D and perfusion-related diffusion coefficient D* were estimated using a bi-exponential function to fit the DWI data. DCE MRI was acquired with a temporal resolution of 3-5 s. Maps of the initial area under the gadolinium concentration curve (IAUGC), time to peak (TTP) and maximum slope of increase (MSI) were derived using commercial software. The relationships between the DCE MRI and IVIM DWI measurements were assessed by Spearman's test. To exclude false positive results under multiple testing, the false discovery rate (FDR) procedure was applied. The Mann-Whitney test was used to evaluate the differences between all variables in patients with non-myxoid and myxoid STT. No significant relationship was found between IVIM parameters and any DCE MRI parameters. Higher f and D*f values were found in non-myxoid tumors compared with myxoid tumors (p = 0.004 and p = 0.003, respectively). MSI was significantly higher in non-myxoid tumors than in myxoid tumors (p = 0.029). From the visual assessments of single clinical cases, both f and D*f maps were in satisfactory agreement with DCE maps in the extreme cases of an avascular mass and a highly vascularized mass, whereas, for tumors with slight vascularity or with a highly heterogeneous perfusion pattern, this association was not straightforward. Although IVIM DWI was demonstrated to be feasible in STT, our data did not support evident relationships between perfusion-related IVIM parameters and perfusion measured by DCE MRI.

Lhermitte-Duclos Disease: Diagnosis on MRI, MR Spectroscopy, CT and Positron Emission Tomography.

A 30-year-old male patient presented with progressive occipital headache since one year with no associated nausea, vomiting or gait disturbance. Neurological examination revealed negative Rhomberg’s sign. Computed tomography revealed non-enhancing hypodense mass in right cerebellar hemisphere compressing fourth ventricle with obstructive hydrocephalus, however it was inconclusive. Afterwards, MRI was performed which revealed right cerebellar mass with striated hypo and iso intense signal on T1W images, hyper and iso intense signal on T2W images. Mass was compressing fourth ventricle postero-inferiorly with obstructive hydrocephalus. Associated inferior tonsillar herniation into upper cervical canal was also noted [Table/Fig-1,​,22]. [Table/Fig-1]: T2W axial (A) & FLAIR (B) coronal images reveals right cerebellar mass (arrows) with alternate bands of hyperintense and isointense signal giving “tiger stripes” appearance with mass effect over cisterna magna & 4th ventricle ... [Table/Fig-2]: T1W sagittal image reveals alternating bands of relative isointense and hypointense signal within the lesion (arrow) with mild inferior tonsillar herniation Proton MRS showed reduced NAA, Choline peaks. Cho/Cr and NAA/Cr ratios were within normal limits [Table/Fig-3]. On Flurodeoxyglucose (FDG) Positron emission tomography (PET) and PET-CT examinations the mass lesion showed evidence of hypermetabolism [Table/Fig-4,​,55]. [Table/Fig-3]: MRS image reveals reduced peaks of NAA and choline, decreased Cho/Cr ratio (0.65). NAA/Cr (1.02) & NAA/Cho (0.94) ratios were also reduced compared to normal [Table/Fig-4]: PET reveals increased FDG uptake in the lesion suggesting hypermetabolism (arrow) [Table/Fig-5]: PET, CT reveals increased FDG uptake by the right cerebellar mass (arrow) Considering diagnosis of Lhermitte-Duclos disease, Ultrasound and CT-scan of chest and abdomen were done, but they did not reveal any abnormality hence ruling out features suggesting Cowden Syndrome. Patient was operated and avascular mass was resected with free margins and sent for histopathological examination. HPE revealed WHO grade-I dysplastic cerebellar gangliocytoma according to criteria for the diagnosis of Lhermitte-Duclos disease. Postoperative course was uneventful and patient was discharged within 1 week after surgery without any neurological deficit. First described in 1920 [1] by Lhermitte and Duclos, Lhermitte Duclos disease (LDD) (dysplastic gangliocytoma) is a rare disorder of uncertain pathogenesis characterized by disarrangement of normal cerebellar laminar cytoarchitexture. This entity has been described by variety of terms like granular cell hypertrophy, ganglioneuroma and gangliocytoma dysplasticum [2]. LDD is found to be associated with Cowden syndrome in 40% cases. Cowden syndrome is also known as multiple hamartoma syndromes, a rare autosomal dominant condition characterized by multiple hamartomas and neoplasms of ectodermal, mesodermal and endodermal origin [3]. LDD can also be accompanied by megalencephaly, hydromelia, heterotopia, microgyria, polydactyly, leontiasis ossea and multiple haemangiomas [2]. Our patient did not show any features of this syndrome. Although LDD usually occurs in third or fourth decades, reported age ranges from newborn to 74 years [3]. Clinically, LDD typically presents with findings of increased intracranial pressure in young adults. Many patients suffer from headache due to increased intracranial pressure caused by mass effect and obstructive hydrocephalus. Nausea, vomiting, visual disturbance and cerebello-vestibular symptoms can also be seen [3]. Classical MRI findings of LDD is described as especially unilateral, non enhancing hemispheric mass with layered appearance consisting of alternating bands of relative iso-, and hypointensity to normal brain on T1W, and relative hyper and iso intensity on T2W images [3]. Wolansky et al., mentioned that “tiger stripes” appearance is so distinctive that that it is unlikely to be confused with another entity. Non-enhancement is not a rule, since LDD lesions with contrast enhancement have been reported rarely [4]. Our case showed right cerebellar lesion with hemispheric expansion and typical striated pattern resembling tiger stripes on both T1- and T2W images with no contrast enhancement or perilesional oedema. MRS shows some characteristic findings such as decreased NAA with increased lactate peak. Lack of increased Cho/Cr ratio is striking which are in contrast to cerebral tumors where choline levels are raised. Our case showed decrease level of NAA and choline. Cho/Cr ratio was also decreased (0.65). NAA/Cr (1.02) & NAA/Cho (0.94) ratios were also reduced compared to normal. The disease is difficult to diagnose on CT, which shows poorly defined hypodense lesion with no contrast enhancement but may show calcification and thinning of occipital bone. FDG-PET revealed increased 18-FDG uptake within whole right cerebellar lesion suggesting either increased overall cell metabolism or an isolated up regulation in enzyme activity of hexokinase remains unclear. Histological examination reveals typical findings of thickening and hypermyelination of the molecular layer and large pleomorphic cells replacing purkinje and granular cell layers. Demyelination of central white matter of the folia is also observed. Conventional MRI shows characteristic and pathognomic features of LDD, however MRS can provide useful additional information regarding benign nature of this lesion. Hypermetabolism on FDG-PET further supports diagnostic accuracy. Thus imaging can achieve accurate preoperative diagnosis of LDD along with delineation of the margins, thereby enabling complete excision.

Unilateral huge hydronephrosis necessitating fetal interventions.

Fetal intervention for obstructive uropathy was first performed at the University of California, San Francisco in 1981 [1]. Since then diagnostic criteria for fetal intervention have been laid down to assist in proper patient selection [1-3]. Unilateral fetal hydronephrosis doesn’t require prenatal intervention; but prenatal intervention might be required in selected cases, especially when hydronephrosis compresses adjacent organs [4]. A 26-year-old pregnant woman was referred to our prenatal center for a fetal abdominal cystic mass with severe oligohydramnios detected at 27th week of gestation. Prenatal scan showed a single male fetus with a cystic avascular mass (74×84 mm) located in the left hemi abdomen pushing left hemi diaphragm (Fig. 1).

Natural history of an early diagnosed retinocytoma: case report and literature review

AbstractPurpose To study the ophtahlmoscopic evolution of a retinocytoma diagnosed in a 8 months old boy.Methods The patient was referred at the Referral Center for Retinoblastoma of the University of Siena, with the suspect of unilateral retinoblastoma. The boy was diagnosed as having retinocytoma based on ophthalmoscopic appearance. Monthly ophthalmoscopic and ecographic evaluation were recommended. Detailed fundus drawings and fundus photographs and descriptions of the retinocytoma were collected. The little boy underwent also MRI, genetic testing and fluorangiography.Results Throughout the months, we observed a tumor regression from avascular mass with fish‐flesh appearance and microscopic calcifications to a retinal transparent mass with calcifications, retinal cysts and surrounded by chorioretinal atrophy.Conclusion Retinocytoma is a rare benign retinal tumor with characteristic clinical features. Usually diagnosed in parents of retinoblastoma children, “silent” retinocytoma diagnosis is more rare in babies. In our case, we observed a natural “regression” of a retinocytoma in a 8 months old boy kept under close RETCAM follow‐up for the risk of malignant transformation.

Complete preoperative embolization of hemangioblastoma vessels with Onyx 18

The authors present a preliminary experience with ethyl-enevinylalcohol copolymer (Onyx) for hemangioblastoma vessel embolization before surgical resection. The patient presented with neck pain, dizziness, blurred vision, vomiting, and loss of balance. Diagnostic imaging revealed a posterior fossa cystic mass with a nodular component. Angiography demonstrated a significant vascular blush with arteriovenous shunting that was characteristic of a hemangioblastoma. Tumor vessels originating off the left posterior inferior cerebellar artery were embolized before surgery using Onyx 18 (ev3, Covidien Vascular Therapies, Mansfield, MA, USA). This resulted in complete obliteration of all tumor vessels, transforming a highly vascular tumor into an avascular mass. A safe and uneventful surgical resection was performed the next day. Onyx is a valuable embolic agent for preoperative hemangioblastoma vessel embolization. Because of its low viscosity, Onyx penetrates deeply into the tumor vasculature and allows complete obliteration of tumor vessels. Risks of the intervention have to be carefully weighed against the benefits. If preoperative embolization is indicated, the use of Onyx should be strongly considered.

Fecaloma in an iatrogenic diverticulum: an unusual complication of the procedure for prolapsed hemorrhoids (PPH)

The procedure for prolapsed hemorrhoids (PPH) is associated with low levels of postoperative pain but may be followed by unusual and severe postoperative complications. We report a case of a 62-year-old woman affected by tenesmus, obstructed defecation and vaginal bulging 2 years after a PPH procedure performed in another institution. Clinical examination and colonoscopy revealed a mass within the anterior rectal wall bulging into the vaginal and rectum lumen 3 cm above the dental line, mimicking a stromal tumor. Magnetic resonance imaging (MRI) confirmed the presence of an avascular mass, 4 cm in diameter, confined to the anterior rectal wall (Figs. 1, 2). Intraoperative findings revealed a calcified fecaloma enclosed in a mucousal rectal diverticulum communicating with the rectal lumen with a little opening at the level of the staple line (Figs. 3, 4).