CECT Scan Research Articles

Coexistence of Cecal duplication cyst and Meckel’s diverticulum presenting as intestinal obstruction: A rare case report

Introduction and importance: Enteric duplication cyst (EDC) is a rare congenital anomaly with incidence of 1 in 4500 live birth. Meckel’s Diverticulum (MD) is the most common congenital anomaly of gastrointestinal (GI) tract. The coexistence of EDC and MD in same patient is extremely rare. Presentation of EDC depends on it’s location, may present with dysphagia, respiratory distress, abdominal pain, abdominal distension and intestinal obstruction. However, MD remains asymptomatic in most of the cases. Case presentation: We present a case of 11month boy, presenting with fever, vomiting, and abdominal distension for four days and decreased frequency of defecation with fowl smelling stool, not mixed with blood. All the systemic examination findings were regular except soft and generalized distension of abdomen. CECT scan of abdomen showed features suggestive of EDC versus mesenteric cyst. The patient underwent exploratory laparotomy with ileocecal resection, ileocolic anastomosis and appendectomy. Meckel’s diverticulum was discovered incidentally at distal ileum, and was left intact. The patient was discharged in stable state. Clinical discussion: EDCs can occur anywhere in the GI tract, most frequently in small intestine and least often in cecum. MD is true diverticulum of small intestine. This case report discusses a rare occurrence of a pediatric patient having both an EDC and MD, emphasizing diagnostic and management challenges in such unique cases. Conclusion: Clinicians should be aware about simultaneous occurrence of EDC and MD in pediatric population who may present as intestinal obstruction.

Clinical impact of MRI on indeterminate findings on contrast-enhanced CT suspicious of HCC

Objectives In patients evaluated for hepatocellular carcinoma (HCC), magnetic resonance imaging (MRI) is often used secondarily when multiphase contrast-enhanced computed tomography (ceCT) is inconclusive. We investigated the clinical impact of adding MRI. Materials and methods This single-institution retrospective study included 48 MRI scans (44 patients) conducted from May 2016 to July 2023 due to suspicion of HCC on a multiphase ceCT scan. Data included medical history, preceding and subsequent imaging, histology when available, and decisions made at multidisciplinary team meetings. Results In case of possible HCC recurrence, 63% of the MRI scans were diagnostic of HCC. For 80% of the negative MRI scans, the patients were diagnosed with HCC within a median of 165 days in the suspicious area of the liver. In case of possible de-novo HCC in patients with cirrhosis, 22% of the scans were diagnostic of HCC and 33% of the negative MRI scans were of patients diagnosed with HCC within a median of 109 days. None of the non-cirrhotic patients with possible de-novo HCC and negative MRI scans (64%) were later diagnosed with HCC, but 3/5 of the indeterminate scans were of patients diagnosed with HCC in a biopsy. Conclusions Secondary MRI to a multiphase ceCT scan suspicious of HCC is highly valuable in ruling out HCC in non-cirrhotic patients and in diagnosing HCC non-invasively in cirrhotic patients and patients with prior HCC. Patients with cirrhosis or prior HCC are still at high risk of having HCC if MRI results are inconclusive or negative.

Nasopharyngeal carcinoma in a young adolescent with unilatral palatal palsy and neck mass – A rare case report

Less than 1% of all head and neck neoplasms are juvenile nasopharyngeal angiofibromas, a cancer almost exclusively found in adolescent males. Here we present a case report of 14 year old male presented with neck swelling, nasal discharge mixed with blood, right sided proptosis and right sided palatal palsy where we performed CECT scan of the patient which showed homogenous opacity over nasopharynx extending to soft palate and posteriorly to C1 vertebra and DNE was performed. Later patient was planned for DNE along with biopsy which came out to be undifferentiated non-keratinized squamous cell carcinoma grade III. Further patient received external beam intensity modulated radiation therapy with complete response to treatment.

Novel Staging Protocol for Management of Post Covid Mucor Mycosis

Introduction: There is an upsurge of Mucor Mycosis infection following Covid -19 pandemic. Disordered immune system due to covid19 infection coupled with indiscriminate use of steroids is believed to be responsible for this upsurge.Objectives: This study is aimed at analysing the preliminary epidemiological data of Mucormycosis patientsadmitted in a single tertiary care centre, stage them at presentation and to devise a treatment protocol according to their stage . To study the various surgical interventions, postoperative follow-up and treatment outcomes in terms of recovery rate and recurrence.Patients and Methods: This is a prospective longitudinal study, one of the largest of its kind involving around1841 patients diagnosed as Mucormycosis and admitted in a tertiary care hospital in India. A detailed case history, Diagnostic nasal endoscopy, CECT scan and MRI Scan were done. A novel staging was devised and patients were managed medically and surgically as per the stage. Debrided tissue was sent for microbiological and histopathological confirmation. Patients were followed-up and their recovery rates were analysed.Results: Among 1841 patients of mucor mycosis studied, 1288 were Rhino orbital and 78 were Rhino cerebraltype. 1229 patients under went surgical debridement according to the stage of disease, and rest were managed conservatively. Recovery rates fell from 90% to 26% from stage I to stage IV due to in volvement of CNS and Orbits. The mortality was as low as 17%. Re -do surgeries were done in only 12% of cases.Conclusion: Staging of mucor at presentation helps in planning, assessing response of treatment and prognosis.

Disseminated appendicular lymphoma presenting as acute appendicitis: a case report

Introduction and importance: Acute appendicitis is a common surgical emergency marked by appendix inflammation, presenting as acute abdominal pain and typically treated with appendectomy. The authors report a rare case of disseminated appendicular lymphoma presenting as acute appendicitis. Acute appendicitis is a common surgical emergency. Case presentation: This case involved a 75-year-old male patient who underwent appendectomy, revealing an enlarged appendix with lymphomatous nodules. Clinical discussion: Lymphoma involvement in the appendix is extremely rare, and lymphomas presenting as acute appendicitis are even more exceptional. Imaging investigations, including ultrasound and CECT scan of the abdomen, are recommended to aid in diagnosis. On computed tomography, appendiceal lymphoma is characterized by markedly diffuse mural soft-tissue thickening with preserved vermiform morphology and occasional aneurysmal dilatation of the lumen. Conclusion: This case underscores the importance of considering unusual etiologies in atypical appendicitis presentations.

Preliminary Results of Phase 2 Open Label Study of Lorlatinib Monotherapy in Relapsed/Refractory ALK + Lymphomas Previously Treated with Other Tyrosine Kinase Inhibitors

Introduction: Both aggressive T and B cell lymphoma may harbour Anaplastic Lymphoma Kinase (ALK) translocations: ALK+ Anaplastic Large Cell lymphoma (ALCL) offer a good outcome with first line therapy with 5-year survival of 79%, but relapses occur in half of the patients (pts) and salvage therapy still represents a challenge for clinicians; ALK+ large B cell lymphoma (LBCL) are very rare cases but with dismal prognosis. In addition other hematologic neoplasms can be caused by ALK fusions. Crizotinib, an ALK/MET tyrosine kinase inhibitor (TKI), provides long-term response in up to 70% relapsed/refractory (R/R) ALK+ ALCL and can obtain a similar but less durable response rates in ALK+ LBCL. In both cases the loss of response to crizotinib is frequently a fatal event. Lorlatinib, a selective ALK and ROS1 TKI, demonstrated preclinical inhibition of all reported ALK kinase domain mutations responsible for resistance to Crizotinib. Methods: From 2019 to 2022 six relapsed/refractory ALK + neoplasm pts previously treated with at least one ALK-inhibitor were enrolled in a phase 2 open label monocentric study with lorlatinib monotherapy (EudraCT2016-003970-41): Three patients had diagnosis of ALK+ LBCL (# 1, 2, 3) and 2 (#5 and #6) had ALK+ ALCL. One patient (#4) with an ALK+ histiocytosis was also included. Median age was 22 years (range 19-57), Ratio M/F was 1, all pts were in stage IV. Median prior therapy lines was 3 (range 2-5); all pts previously received Crizotinib, two pts received also Alectinib and 1 Ceritinib as TKI treatment. Lorlatinib was administered daily at dose of 100 mg. Clinical, laboratory, radiological and molecular data were collected at screening and during scheduled follow-up. Response was evaluated with 18F-FDG PET/CT (and with contrast enhanced (ce) CT scan) according Lugano Classification, and with ALK RT-PCR on peripheral blood and bone marrow. Side effects were classified according to CTCAEv4.03. PFS and OS were determined from Lorlatinib start to relapse and/or death. The primary endpoint was the evaluation of ORR considering 18F-FDG PET/CT scan and ALK- RT-PCR. Secondary endpoints were: PFS, OS, toxicity, QoL. Results: ALK rearrangement fusion pattern was detected in 6/6 pts: 3 pts with LBCL harboured Clathrin-ALK (CTCL::ALK) rearrangement and 2 ALCL pts the ATIC::ALK fusion; the ALK+ histiocytosis patient harbored an EML4::ALK rearrangement. Median follow-up was 13.7 months (IQR 22-55). At month +1 (M1) 3/6 patients had complete response (CR) defined as complete metabolic and complete radiologic response (CMR/CR) according to PET/CT scans and ALK RT-PCR negativity. The remaining 3 pts had a partial response (PR), for an Overall Response Rate (ORR) of 100% (95%CI: 0.6-1.0). One pt is still on treatment and in CR at 45 months, receiving Lorlatinib 100 mg daily with neither toxicities nor need for Allogenic Stem Cell Transplantation (ASCT); 2 CR pts underwent ASCT after 1 month, resumed lorlatinib after ASCT and are still in CR. 2 pts with PR relapsed within month +3: one pt received salvage therapy without benefit, the other one underwent ASCT but progressed 3 months later. Both pts had ALK+ BCL with CTCL-ALK rearrangement. 1 pts in PR AT M1 (ALK+ istiocytosis) obtain CR at M3 after surgical resection of a residual lung mass and is still receiving Lorlatinib at month 36. Median PFS and OS were not reached: PFS at 6 and 12 months is 83% and 62% respectively; OS at 6 and 12 months is 83% and 55%. Safety: 2/6 pts had thrombocytopenia grade 1, whereas 3/6 pts showed grade I-II hypertriglyceridemia/hypercholesterolemia and muscle cramps. Conclusions: Lorlatinib represents a safe and effective salvage therapy for ALK+ Lymphoma patients failing first line TKI treatment. The obtainment of CR at M1 seems to represent a pivotal prognostic factor. Lorlatinib also offers a promising bridging regimen to salvage ASCT especially for ALK+ BCL patients, with high response rates and no additional toxicities, .

The Pattern of Metastatic Breast Cancer: A Prospective Head-to-Head Comparison of [18F]FDG-PET/CT and CE-CT.

The study aimed to compare the metastatic pattern of breast cancer and the intermodality proportion of agreement between [18F]FDG-PET/CT and CE-CT. Women with metastatic breast cancer (MBC) were enrolled prospectively and underwent a combined [18F]FDG-PET/CT and CE-CT scan to diagnose MBC. Experienced nuclear medicine and radiology physicians evaluated the scans blinded to the opposite scan results. Descriptive statistics were applied, and the intermodality proportion of agreement was used to compare [18F]FDG-PET/CT and CE-CT. In total, 76 women with verified MBC were enrolled in the study. The reported number of site-specific metastases for [18F]FDG-PET/CT vs. CE-CT was 53 (69.7%) vs. 44 (57.9%) for bone lesions, 31 (40.8%) vs. 43 (56.6%) for lung lesions, and 16 (21.1%) vs. 23 (30.3%) for liver lesions, respectively. The proportion of agreement between imaging modalities was 76.3% (95% CI 65.2-85.3) for bone lesions; 82.9% (95% CI 72.5-90.6) for liver lesions; 57.9% (95% CI 46.0-69.1) for lung lesions; and 59.2% (95% CI 47.3-70.4) for lymph nodes. In conclusion, bone and distant lymph node metastases were reported more often by [18F]FDG-PET/CT than CE-CT, while liver and lung metastases were reported more often by CE-CT than [18F]FDG-PET/CT. Agreement between scans was highest for bone and liver lesions and lowest for lymph node metastases.

Role of Contrast-Enhanced Ultrasound in Evaluation of Cystic Renal Mass.

Contrast-enhanced ultrasound (CEUS) allows excellent delineation of perfusion in septa and nodules without exposure to ionizing radiation or nephrotoxic contrast media. The aim of our study was to evaluate the role of CEUS for the assessment of cystic renal masses and compare its diagnostic performance with that of CECT. Exactly 40 patients diagnosed to have cystic renal masses on CECT scan were prospectively evaluated with CEUS and were assigned a Bosniak class. Based on results of final histopathology and clinical follow-up, internal validity of both CEUS and CECT was evaluated, including agreement between these two modalities. Out of the 40 patients (mean size 3.1 ± 2.5 cm), 23 patients had benign lesions and 17 patients had malignant lesions. For CEUS, the sensitivity and negative predictive value was 100%, the specificity and positive predictive value was 73.9%. For CECT, the sensitivity and negative predictive value were 88.2 and 83.3%, respectively, whereas the specificity and positive predictive value was 87 and 90.9%, respectively. Both imaging modalities had similar accuracy with fair to good agreement with the final diagnosis (Κ = 0.71 and 0.75 for CEUS and CECT, respectively). Concordance between CEUS and CECT was seen in 29 patients (72.5%) with fair agreement between the two modalities (K = 0.66). CEUS has comparable accuracy with CECT and could be used as screening modality to rule out the presence of complex cystic renal masses without exposure of nephrotoxic contrast media and ionizing radiation.

151 Isolated tuberculosis liver abscess in an immuno-competent patient – A case report

Abstract Introduction Tuberculosis presenting as an isolated liver abscess is extremely rare. Case Summary A 55 year old woman presented with complaints of pain right hypochondrium associated with low grade fever and weight loss for last 1 year. Abdominal examination revealed mild tenderness in right hypochondrium. Rest of system examination was unremarkable. Laboratory investigations and chest radiograph were normal. Ultrasound abdomen showed coarse heterogeneous liver parenchyma with increased echogenicity. Single irregular hypoechoic area in segment IV A of the liver was noted. CECT scan of abdomen showed a single well defined focal lesion of 4.2*5.5*4.9 cm in segment V/VI, which was hypovascular on both arterial and venous phases. Delayed imaging revealed thick rim of contrast enhancement suggestive of fibrous capsule. Ultrasound guided biopsy of the lesion was done which showed chronic caseating granulomatous inflammation suggestive of tuberculosis. Patient was started on anti- tuberculous therapy. However, she showed worsening of symptoms. A repeat triphasic CT scan showed a complex multiseptated thick-walled necrotic lesion measuring 8.5*6.9*6.4 cm in segment V/VI of the liver. Her total leucocyte count was 14,500/mm3, CRP levels 19.4 mg/l and ESR 99mm3. Ultrasound guided drainage was done and a drain was placed in right hypochondrium. Patient was discharged on oral antibiotics. The follow- up CT scan showed a significant decrease in the size of abscess (3.8*4.2*5.8 cm) with marked improvement in the symptoms. Conclusion An isolated tuberculous liver abscess poses challenge to the clinical acumen of the treating physician and an early diagnosis can help reducing the morbidity and mortality associated with it.

Sinonasal Non-Intestinal-Type Adenocarcinoma: A Case Report

We report here a 54 year male who presented with a complaint of left sided epistaxis for 5 days & a swelling on the hard palate palate for 8 years. CECT scan revealed a soft tissue lesion involving the hard palate and extending into the left maxillary sinus as well as both nasal cavities. Direct nasal endoscopic biopsy initially suggested an adenocarcinoma not otherwise specified. Immunohistochemistry delineated it as low-grade non-intestinal-type, which occur very uncommonly in the sinonasal region.

MP64-17 THE ROLE OF 18-FDG PET/CT SCAN IN EARLY RESPONSE TO SYSTEMIC THERAPY FOR METASTATIC RENAL CELL CARCINOMA: BEYOND SUV max

You have accessJournal of UrologyCME1 Apr 2023MP64-17 THE ROLE OF 18-FDG PET/CT SCAN IN EARLY RESPONSE TO SYSTEMIC THERAPY FOR METASTATIC RENAL CELL CARCINOMA: BEYOND SUVmax Sanjoy Kumar Sureka, Sumit Mandal, and Uday Pratap Singh Sanjoy Kumar SurekaSanjoy Kumar Sureka More articles by this author , Sumit MandalSumit Mandal More articles by this author , and Uday Pratap SinghUday Pratap Singh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003322.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In metastatic renal cell carcinoma (RCC), the CECT scan evaluates lesions in their anatomic context while FDG-PET/CT scan demonstrates metabolic component. Often the size of the lesion may take time to respond and metabolic activity changes first. We evaluated the role of FDG PET/CT scan in this setting with an objective to evaluate the role of FDG-PET/CT as a monitoring tool for early response to systemic therapy in metastatic RCC. METHODS: From January 2017 to Dec 2021, 48 patients with synchronous and metachronous metastatic RCC with ECOG <2 underwent a baseline 18-FDG/PET-CT scan followed by repeat scan for response assessment 3 months later. Pregnant and nursing mothers, hypothyroid, diabetics and those with brain metastasis or another malignancy were excluded. Response evaluation was done with both RECIST version 1.1 (for CECT) and PERCIST (for PET-CT) criteria. Also, total lesion glycolysis (TLG), and metabolic tumour volume (MTV) were assessed. Interrater agreement was done using Cohen’s kappa between the scores. RESULTS: Mean age of 48 patients was 55.3±5.6 years and 28(58.3%) were males. Clear cell histology was present in 44 patients. Sunitinib, Pazopanib, Everolimus and Axitinib were given to 12, 22, 6 and 8 patients respectively. Out of 22 patients with partial response (PR) in RECIST, 8 patients were upgraded to Stable disease (SD) in 2 and Progressive disease (PD) in 6 as per PERCIST, subsequently leading to a change in their management. All 14 patients with PR in PERCIST had better long-term survival as compared to the rest upgraded 8. There was a significant decline in median SUVmax, MTV and TLG after 3 months in these patients. CONCLUSIONS: 18-FDG PET/CT scan is useful for monitoring the early response to systemic therapy in metastatic RCC based on 18-FDG avidity including TLG & MTV and correctly identifying partial responders. Changes in the metabolic parameters detect response to therapy earlier and guide subsequent changes in therapy. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e887 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sanjoy Kumar Sureka More articles by this author Sumit Mandal More articles by this author Uday Pratap Singh More articles by this author Expand All Advertisement PDF downloadLoading ...

Anesthetic Management of a Child with Adrenocortical Virilizing Tumour Excision

Introduction: A multidisciplinary team that includes an endocrinologist, radiologist, anesthesiologist, and surgeon is a prerequisite for adrenal gland surgeries. The prime indications for adrenal gland surgery can include both hormonal and non-hormonal secreting tumors. Adrenal hormone-secreting tumors usually present to the anesthesiologist with a unique set of challenges that require a good preoperative evaluation and hemodynamic control, corrections of all electrolytes and metabolic imbalances, a carefully planned anesthetic strategy, detailed knowledge about the specific diseases, maintaining of postoperative adrenal function, and finally a good collaboration with other involved colleagues. This review will mainly focus on endocrine issues and anesthetic management during the resection of a hormone-secreting adrenal gland tumor. Case Presentation: This is a case report of a 1.5-year-old boy weighing 13.5 kg who was admitted to our hospital with complaints of an increase in height and weight more than appropriate for age, macroglossia, facial oedema, abnormally enlarged genitals and development of pubic hair for 6 months. On examination along with signs of precocious puberty, he had presented raised blood pressure for which he was started on medication. Results: On ultrasonography, a 6*4 cm mass was seen in the right supra renal fossa which was confirmed on the CECT scan. He underwent surgery for the excision of the tumor mass under general anesthesia with a regional blockade (epidural). The histopathological report of the tumor specimen revealed Adrenocortical Carcinoma. The child required post-operative steroid treatment and subsequently was started on chemotherapy as well. Conclusion: The perioperative medical management of active Adreno Cortical Carcinomas is complex enough, but anesthesia causes even more substantial changes in physiology. Treatment with steroids helps to maintain hemodynamics to a great extent.

Abdominal Crunch Syndrome Creates a ­Diagnostic Challenge in Treating a Pilot with Acute Upper ­Abdominal Pain

BACKGROUND: A diagnosis in acute abdomen may remain elusive especially when the cause is rare. We report this interesting case of a fighter pilot presenting with acute abdominal pain. The case posed significant challenges in reaching the correct diagnosis of abdominal crunch syndrome. The syndrome is rare with only seven reports in the literature so far. To the best of our knowledge, this is the first ever report of this condition in an aircrew.CASE REPORT: A 37-yr-old pilot presented with severe upper abdominal pain and sweating. During examination, he developed bradycardia and was admitted with a presumptive diagnosis of acute coronary syndrome. Investigations revealed no myocardial ischemia on ECG, transaminitis, raised CPK, CKMB, and LDH. A CECT scan of chest and abdomen was normal. A GI surgery consult was sought where we connected the transaminitis and raised CPK and considered the possibility of rhabdomyolysis. On specific inquiry, the aviator gave history of unaccustomed exercise with a vigorous session of abdominal crunches a day prior. Thus, a diagnosis of abdominal crunch syndrome was concluded.DISCUSSION: The aviator did not associate his vigorous exercise with the occurrence of pain and, therefore, did not mention it. It would have avoided unnecessary investigations and delay in treatment. From the aeromedical safety aspect, had the aviator flown on the day he developed pain, there was a possibility of developing severe pain exacerbated by the G force and G suit and sudden in-flight incapacitation. From the perspective of the aircrew, it is advisable that they avoid sudden, unaccustomed exercise.Kumar A, Kaistha S. Abdominal crunch syndrome creates a diagnostic challenge in treating a pilot with acute upper abdominal pain. Aerosp Med Hum Perform. 2023; 94(2):86-89.

Aggressiveness of esthesioneuroblastoma: a rare case report and review of literature

Introduction. Esthesioneuroblastoma, also known as olfactory neuroblastoma, is a rare malignant neuroecto dermal nasal tumor with distinctive clinical, histopathological, radiological, and molecular features. It arises from olfactory receptors in the nasal mucosa or the cribriform plate of the ethmoid bone. It is generally slow-growing; fast-growing tumors may lead to widespread metastasis. Here, we present an atypical case of aggressive esthesioneuroblastoma treated with a multimodality approach. Case description. A 28-year male, presented with a painful swelling over the right cheek lasting for 5 months. The patient underwent surgery, and histopathology of the surgical specimen revealed a small round blue cell tumor with widespread positivity for synaptophysin and CD 56. The histopathological appearance and immunohistochemical profile of the biopsy tissue confirmed esthesioneuroblastoma. Owing to subtotal resection, the patient received adjuvant radical radiotherapy to the local site and lymph nodes. Three months post-radiotherapy, a CECT scan showed a partial response, so the patient received intravenous chemotherapy. However, the patient had local disease progression; establishing the aggressivness of esthesioneuroblastoma in our patient. The patient is alive with residual stable disease after 2.5 years from the initial diagnosis and is follow up. Conclusion. Esthesioneuroblastomas are uncommon tumors and owing to their slow-growing nature, the patient may neglect them. There is a wide spectrum of clinical presentations and outcomes in such patients, and as the literature on esthesioneuroblastoma is scarce due to its rarity, this case report seeks to contribute to a better understanding of such uncommon malignancy in terms of its clinical presentation, behavior, and outcomes.

Solid pseudopapillary neoplasm, a rare pancreatic tumor-case report

The uncommon cystic exocrine pancreatic tumor known as solid pseudopapillary epithelial neoplasm (SPEN) most frequently affects young females. We provide a case study of a 17-year-old female who experienced intermittent vomiting and epigastric pain. Her laboratory results were within normal ranges, and a clinical abdominal exam revealed pain in the region of epigastrium. A 40×3×31 mm iso-hyperdense minimally enhancing solid mass with well-defined borders was detected on her CECT scan. Nothing calcified. neither localized lymphadenopathy nor fat stranding. It was just next to the splenic vein, which was completely opaque. Her histopathology revealed a solid pseudopapillary pancreatic tumor after she underwent a spleen preserving distal pancreatectomy. Beta-catenin and vimentin IHC assays were significantly positive, confirming the diagnosis and she was on a regular follow-up. As of now, the patient is asymptomatic and has not experienced a recurrence. In contrast to other forms of pancreas tumors, SPEN is treatable with early identification and full surgical resection.

THYMOMA AS A NECK SWELLING - A SURGICAL DILEMMA

Thymomas are rare neoplasm of Anterior Mediastinum originating within the epithelial cells of the thymus and it is exceedingly uncommon in children and young adults, rises in incidence in middle age, and peaks in the seventh decade of life. One third to one half of patients present with an asymptomatic anterior mediastinal mass on chest radiograph, one third present with local symptoms (cough, chest pain, superior vena cava syndrome, and/or dysphagia), and one third of cases are detected during the evaluation of myasthenia gravis. Myasthenia gravis is a disease of the neuromuscular junction which causes progressive weakness of muscles. Indication of thymectomy for all cases of myasthenia gravis has been a topic of debate but thymectomy is indicated in all cases with thymomas no matter the stage of myasthenia gravis. We present a rare case of Thymoma as 70/Female patient presented with a painful lateral neck swelling on left side with Myasthenia Gravis and Dysphagia. We couldnt find any similar cases in literature. USG Neck was done which showed a 5.3x5.3x4.3cm multilobulated mass in left supraclavicular region inferior to left lobe of thyroid with calcification suspicious of malignancy which possible origin from Thyroid and Parathyroid Gland. On CECT scan there was 4.1x3.4x3.8 cm isodense mass which seems to be arising from lower pole of left thyroid lobe and extending in surrounding structures. FNAC was s/o Thymoma type A. Patient underwent Sternotomy- entire tumor along with thymus was dissected, however posteriorly it was densely adhered to Left Vagus Nerve Giving Suspicion of Neurofibroma. Specimen Sent for Frozen Section which confirmed it to be Type A thymoma. Histopathology Report concluded the diagnosis- Type A Thymoma. Post Operative was Uneventful. Thus, we conclude a rare case of Neck Swelling with series of event to reach to a Final Diagnosis of Thymoma.

Case Report: Adrenocortical carcinoma in an adult male with hypokalemic hypertensive: Report of a rare case in Nepal

Adrenocortical carcinoma (ACC), with an incidence of 2-5 percent, is an uncommon source of unilateral adrenal mass and hyperaldosteronism. In Nepal, there is no literature on this uncommon adrenocortical cancer. A forty-year-old Nepalese army regular with resistant hypertension on various antihypertensive medicines presenting with a background of considerable weight loss decreased appetite, and repeated episodes of vomiting were described. His blood tests revealed hypokalemia and a high aldosterone/renin ratio. A tumor in the left adrenal gland was discovered during an abdominal CECT scan. He was operated on for left adrenal incidentaloma and the procedure was uneventful. We recommend clinicians suspect hyperaldosteronism in an adult with refractory hypertension and hypokalemia.

Appendiceal mucocele presenting as a leading point in ileocolic intussusceptions: "Case report".

Introduction and importanceAppendiceal mucocele is a rare clinical scenario, which is found in 0.2–0.7 % of appendectomies. Ileocecal/ileocolic intusception caused by appendiceal mucocele is an extremely rare condition with few case reports in literatures. The treatment is surgery with the extent determined by intra-operative findings. Ultrasound and CECT scan can suggest the diagnosis, but definitive diagnosis is by histopathology. The aim of this presentation is to discuss appendiceal mucocele in terms of clinical features, diagnostic imaging and treatment. This case report can create awareness to primary care physicians, radiologists, surgeons and pathologists aiding in accurate diagnosis and early surgical intervention to prevent rupture.Presentation of the caseA fifty years old woman presented with intermittent colicky peri umbilical abdominal pain of one-week duration. She had nausea, vomiting, mild abdominal distension, and failure to pass feces and flatus. Physical examination was normal. Imaging suggested ileocolic intussusceptions with cystic leading point on ultrasound, but on CECT scan, no leading point reported. Appendiceal mucocele diagnosed intra operatively and confirmed by pathology.ConclusionAppendiceal mucocele is rare and can be benign or malignant. Preoperative diagnosis is often difficult. Definitive diagnosis is by histopathology. Appendiceal mucocele can rarely present with ileocolic intussusceptions. Radiologists, pathologists, primary care physicians and surgeons must be aware of this condition. Accurate preoperative diagnosis and early surgical treatment of appendiceal mucocele is important to prevent complications like pseudo myxoma peritonei(PMP), which has poor prognosis.

Abstract No. 169 A novel ultrasound-based technology for monitoring of thermal tissue damage in liver ablation procedures

To evaluate the accuracy of an algorithm-based imaging software (SW) system for Ultrasound based monitoring for safe execution, and verification of the treatment outcomes. Previous pathological and imaging studies reported an increase of ablation volume within 24 hrs. due to delayed tissue injuries. The SW provides, on procedure day, an estimation of the ablation in a high level of agreement with the one appear on a CECT scan acquired 24 hrs. post ablation.

Myxofibrosarcoma of neck: A rare case

Myxofibrosarcoma (MFS) is commonly seen among elderly patients, usually sixth to eighth decade of life. Most of these tumours arise in the extremities (lower limbs &amp;#62; upper limbs) and are less commonly seen on the Trunk, Head and Neck, Retroperitoneum and Pelvic areas. The World Health Organization (WHO) defines MFS as the malignant fibroblastic neoplasm characterized by cellular pleomorphism, variably prominent myxoid stroma, and prominent elongated, thin-walled stromal blood vessels. Head Neck MFS is rare site of occurrence with 19 cases reported worldwide till date, described subsites being Maxillary sinus, Infra Temporal fossa, Pterygopalatine fossa, or Parotid gland. The Surgical wide local excision is the main modality of treatment for Non metastatic stage followed by Adjuvant Radiotheraphy.We are presenting a young adult male, presenting with Asymptomatic progressive neck mass, predominantly in posterior triangle distorting upper Aerodigestive tract anatomy. The Diagnosis of MFS done with MRI imaging of neck, Trucut biopsy and CECT scan thorax. With the anticipation of difficult intubation, Broncoscopic directed intubation is planned and done. The surgical wide resection amounted in excision of Sternomastoid, IJV, SAN and part of posterior triangle bed muscles for getting margin free status. The Histopathology showed spindle cells with Myxoid stroma, areas of necrosis with circumferential free margins, along with IHC showed positive for vimentin and CD34 with diagnosis as High Grade Myxofibrosarcoma. Post op patient was adviced Adjuvant Radiotheraphy.