Entire Abdomen Research Articles

A Case of Foetus-in-Fetu

Background: A foetus-in-fetu (FIF) is a very rare congenital abnormality (incidence of 1 in 5.00,000 live births) in which a mass of tissue, a malformed foetus grows within the body of the foetus. It is an unusual cause of the abdominal mass in neonates. We here report a case of FIF in a newborn male for its rarity and interest in its evolution. Case report: A one-day-old male term neonate was referred for evaluation of abdominal mass. Antenatal ultrasonogram at 32 weeks of gestational age revealed a complex multi-septated cystic lesion with internal echogenic components. Clinical examination revealed a distended abdomen with an ill-defined mass filling the entire abdominal cavity. Plain X-ray abdomen revealed a mass on the right side of the abdomen with few long bone-like densities and few vertebrae. An ultrasonogram showed ill-defined hetero echoic lesions, measuring 10.9 × 11.1 Centimeters, with solid and cystic components and few calcifications in the mass. The CT scan of the abdomen showed an ill-defined mass lesion on the right side of the abdomen, measuring 11.3 × 6.6 × 9.9 Centimeters, with internal soft tissue, distorted long bones, and few vertebrae in the subhepatic region of the right hypochondrium. The 3-dimensional reconstruction of the CT scan confirmed the diagnosis of FIF. On laparotomy, the mass had a covering membrane attached to the adjacent abdominal wall and was connected by a cord-like structure with vessels. Excision of the mass was done in toto and the post-operative period was uneventful. Conclusion: FIF is considered a benign condition that causes mass effects on the adjoining organs and should be considered a differential diagnosis in neonates with abdominal distension.

Synchronously Mature Intersex Japanese Flounder (Paralichthys olivaceus): A Rare Case.

Japanese flounder is usually gonochoristic, with gonads that are either testes or ovaries. Here, we report an unusual case of hermaphroditism in Japanese flounder captured from the Bohai Sea. In the intersex flounder, the membrane of the upper ovary was closely connected to the abdominal muscles and internal organs, and the eggs filled the entire abdomen. The lower ovary was small and closely connected to the testes. The testes contained few fully mature sperm. Both eggs and sperm were capable of fertilization. The levels of several reproduction-related hormones (17β-estradiol, 11-ketotestosterone, 17α, 20β-dihydroxyprogesterone, luteinizing hormone, follicle-stimulating hormone, and testosterone) in the intersex flounder were intermediate, between those in females and males. The results showed that the heterozygosity of the intersex flounder was 0.632, and there were 28 single-nucleotide polymorphisms in the cyp21a gene. Compared with that of wild flounder, the activity of 21-hydroxylase was reduced by approximately 20.0%, and expressions of cyp19a, amh, and dmrt1 differed. We present the first report of its kind, detailing the anatomy, hormonal endocrinology, molecular biology, and physiology of the intersex Japanese flounder.

Giant serous cystadenomas encountered in clinical practice: A case series

Benign serous cystadenomas represent 16% of all ovarian epithelial neoplasms, and account for up to two-thirds of epithelial tumors of the ovary. They are commonly encountered after the 3rd decade of life and in the later decades, due to the slow growth nature over lifetime. These tumors may begin as small unilocular subcentimeter lesions, but may expand to fill the entire abdominal cavity. This may present with mass effect to surrounding tissues and organs, and lead to sequela of compartment syndrome of the peritoneal cavity. We present a case series of surgical evaluation and management of extremely enlarged serous cystadenomas of the ovary (>30 cm) encountered in an atypical age presentation, with the first case involving a 19 year old who had a known 6 cm cyst four years prior, who presented to emergency room (ER) with gastrointestinal (GI) symptoms secondary to the tumors mass effect, imaging demonstrating a massive tumor, subsequently requiring surgical dissection. The second case demonstrates a 25 year old with known cyst (>20 cm) two years prior who presented with even larger effect (close to 40 cm size) and worsening symptoms due to the tumors mass effect requiring removal. In both cases, patients presented to emergency room with acute symptoms, exploratory laparotomy was required for complete evacuation of lesion and for resolution of symptoms.

Rupture of liver myelolipoma in a patient who underwent mitral valve replacement 16 years ago: A case report.

Myelolipoma is a rarely encountered benign tumour of the liver. Patients may be asymptomatic or may present with clinical signs such as silent hepatomegaly, pain in the right upper quadrant of the abdomen, and anorexia. The patient, who had a history of mitral valve replacement, had been on warfarin for 16 years. The pain, which began in the right upper quadrant of the abdomen two days ago, has since spread to the entire abdomen. The patient, who was in hypovolemic shock, underwent an exploratory laparotomy with a preliminary diagnosis of bleeding. During the procedure, a ruptured mass in the liver was incidentally discovered. Histopathological and immunohistochemical examinations revealed that the mass consisted of fat and bone marrow cells, leading to a definitive diagnosis of myelolipoma. To the best of our knowledge, this is the first reported case of spontaneous rupture of a liver myelolipoma in the literature.

Double Primary Cancer: Breast Cancer and Gastric Cancer

Introduction: Breast carcinoma is the most prevalent malignancy and the second leading cause of cancer death in women, while multiple primaries are conditions where there is more than one synchronous or metachronous cancer in one individual. Double primary between breast carcinoma and colon cancer is a primary tumor with a high incidence, while breast carcinoma metastasis to the colon is a rare entity except for lobular histotype breast carcinoma. In this case report, a woman with double primary breast cancer is reported. Case Report: A 50-year-old woman came with complaints pain of the entire abdomen since 2 days before go to hospital, worsening when starting to eat, accompanied by nausea. The patient had a history of modified radical mastectomy (MRM) for indications of right breast carcinoma cT3N0M0. In addition, a history of ovarian carcinoma that had undergone chemotherapy was also found. On esophagogastroduodenoscopy examination, a gastric mass was found with ulceration and necrosis and a biopsy showed high-grade neuroendocrine carcinoma and adenocarcinoma. Conclusion: Breast malignancy can be invasive or non-invasive and can undergo metastasis. In addition to metastasis, cancer can also appear in two different places but histologically or morphologically different. This condition is called multiple primaries due to host, lifestyle, and environmental factors.

Mucinous Carcinoma of Ovary in a 15-Year-Old Girl, A Rare Case Report and Literature Review.

Ovarian epithelial tumors are common in adults, and the median patient age at presentation is 55 years. In children, epithelial tumors are rare and mostly benign. Mucinous cystadenocarcinoma is reported in only 11 cases less than 15 years old. This report describes the case of a 15-year-old postmenarchal Omani girl with ovarian mucinous carcinoma. She was admitted with severe epigastric pain and abdomen distension. CT scan showed a huge cystic lesion arising from the left adnexa filling the entire abdominal and pelvic cavity. The patient underwent laparotomy with left ovarian cystectomy and omental biopsy which revealed a 35 x 30 cm left ovarian cyst filled with turbid straw color fluid. Histopathology was reported as mucinous carcinoma. The patient later underwent cytoreductive surgery with left salpingo-oophorectomy, omentectomy, appendicectomy, and lymph node dissection that were negative for malignancy or metastatic disease. During follow-up, she developed a lymphocele in the pelvic cavity that was drained. There were no other significant issues during follow-up, as well as no evidence of recurrence or metastasis. Epithelial tumors of the ovary are rare in young girls, with malignant tumors being exceedingly rare. Fertility-sparing surgery is adopted over radical surgery in these patients, even though the recurrence rates with this treatment protocol are high. All cases should be under follow-up to look for recurrence and timely management.

An unusual case of longest intussusceptum without any pathological lead point in an adult: A rare case report from a peripheral tertiary care institute of Eastern India

Bowel obstruction is known to be caused by intussusception, which is far more common in pediatric patients. The majority of people with adult intussusception require a predisposing cause, which might be a benign lesion, a malignant lesion, or an irregularity of the intestinal wall such as inflammatory bowel disease. Adult intussusception is a very rare condition. We present the case of a patient presenting with upper abdominal pain, nausea, vomiting, and weakness. The patient had ongoing mild intermittent abdominal pain for months which was investigated with an upper gastrointestinal endoscopy that showed gastritis. There were features of peritonism on clinical examination and this was associated with raised inflammatory markers. A contrast-enhanced multidetector computed tomography (MDCT) scan showed a long-segment telescoping of the ileum into the cecum with ascending colon with proximal bowel distension suggesting bowel obstruction: Ileocolic intussusception. The patient underwent emergency surgical resection with a double-barrel stoma. Histopathology assessment did not identify a causative factor for the intussusception. An uncommon instance of adult idiopathic enteroenteric intussusception is presented here. The diagnosis can be established with the use of the clinical history of chronic intermittent abdominal pain, entire abdomen ultrasonography, and abdomen MDCT. In patients who are unstable and exhibit indications of peritonitis, surgery remains the only choice, even though a more cautious strategy is outlined in the literature. Adult intussusception is a rare and challenging diagnosis to make. Individuals suffering from intussusception may experience prolonged bouts of sporadic abdominal pain that intensify suddenly as a result of acute obstruction. The most helpful investigative technique for confirming the intussusception diagnosis is CT.

Prediction of the minimum amount of anti-adhesive agent required for entire intra-abdominal cavity using fluorescent dye.

Studies on the appropriate amount of anti-adhesive agents for preventing postoperative adhesion are lacking. This animal study aimed to investigate the distribution of an anti-adhesive agent in the abdominal cavity and estimate the necessary amount to cover the entire cavity. Fluorescent dye Flamma-552 was conjugated to Guardix-sol to create Guardix-Flamma, which was laparoscopically applied to the abdominal cavity of two 10-kg pigs in different amounts: 15 mL for G1 and 35 mL for G2. After 24 hours, the distribution of Guardix-Flamma was examined under the near-infrared mode of the laparoscope, and the thickness was measured in tissues from the omentum, small, and large intestine by immunohistochemistry. The average area of the abdominal cavity in 10 kg pigs was 2,755 cm2. Guardix-Flamma fluorescence was detected in the greater omentum, ascites in the pelvis, and right quadrant area in G1, whereas in G2, it was detected everywhere. On average, the total thickness of G1 and G2 were 12.68 ± 9.80 μm and 18.16 ± 15.57 μm, respectively. Guardix-Flamma thickness applied to the omentum, small, and large intestines of G2 were 1.31-, 1.45-, and 1.49-times thicker than those of G1, respectively, and were all statistically significant (P < 0.05). The entire abdominal cavity of the 10 kg pig was not evenly covered with 15 mL of Guardix. Although 35 mL of Guardix is sufficient to cover the same area with an average thickness of 18 µm, further studies should evaluate the minimum thickness required for an effective anti-adhesive function.

Bioecology of Electric Fish (Actinopterygii: Gymnotiformes)

The poraquê has an elongated and cylindrical body, with just one anal fin, which extends across almost the entire abdomen it resembles the shape of an eel. Its head is flat and its mouth is equipped with a row of sharp, conical teeth. The color of this animal is always very dark, but the ventral part of the body is yellowish and they have poor vision. This group of fish is known for their ability to generate and detect electrical fields in the environment in which they occur, and these characteristics are used in communication, prey detection, defense, reproduction and even to help these animals move in the absence of light. This manuscript aims to describe the biology, ecology, morphology, geographic distribution, life cycle, habitat, and therapeutic use of electric fish (Chordata: Actinopterygii: Gymnotiformes). Concerned with establishing a public profile of quality research in the area, we sought to answer these questions based on a literature review in the main journals (national and international) classified by the Coordination for the Improvement of Higher Education Personnel (CAPES). Complement this analysis with other documents such as books, theses, dissertations, scientific journals, documents, and digital platforms.

Clinical case of treatment of giant uterine fibroid

Uterine leiomyomas are the most common type of benign tumor that occurs in the female pelvis. Uterine leiomyoma is a tumor of smooth muscles. Its prevalence is higher in the reproductive age group and decreases after menopause. Giant uterine fibroids are a rare tumor of the uterus. Giant uterine fibroids, especially subcutaneous types, are complicated by malnutrition due to deterioration of their blood supply. The complaints of the patients are non-specific: an increase in the size of the abdomen, aching pains, sometimes difficulty urinating and defecating. A physical examination reveals a giant abdominal and pelvic formation. Ultrasound with Dopplerometry and contrast-enhanced MRI diagnoses a giant tumor next to the uterus with a heterogeneous structure and the presence of cystic cavities, which is difficult to distinguish from a true large ovarian tumor. The article illustrates the complexity of differential diagnosis of giant tumor of the uterus and ovaries. There are no significant differences between these tumors during ultrasound and MRI examinations. The final diagnosis can be made intraoperativery. The article presents a clinical observation of the giant uterine fibroids of a 48-year-old female patient. Ultrasound and contrast-enhanced MRI revealed a giant tumor of the right ovary, which occupied the entire abdominal cavity, of a heterogeneous structure. Intraoperatively, two tumors, intimately adjacent to each other, 31 cm and 28 cm in diameter, emanating from the isthmus of the uterus, were found. The final diagnosis of uterine fibroids was established histologically. Difficulties in differential diagnosis between uterine fibroids and ovarian tumors before surgery are associated with the large size of the tumor and the heterogeneity of the structure due to its malnutrition.

To study thyroid profile in CKD patients in Eastern Uttar Pradesh

Chronic kidney disease (CKD) remains a universal pandemic that has evolved into a serious public health problem that imposes a significant socioeconomic burden. Thyroid profile is disrupted in CKD patients due to aberrant thyroid hormone metabolism. The purpose of our study was to assess thyroid function in people who had chronic renal disease (CKD).According to the inclusion-exclusion criteria, this cross-sectional observational research enrolled 150 chronic renal disease patients.All patients who met the above criteria underwent a detailed history as well as a general and systemic examination. Thyroid function tests, USG entire abdomen, chest X-ray, ECG, and 2D Echocardiogram, were performed. There were 84 men and 66 women among the 150 CKD patients. Thyroid hormone abnormalities were found in 93.3 % of the individuals. 14.7 % of the participants had hypothyroidism, 14.7 % had low T3 and T4 readings, 10% had low T4 values alone, 38 % had low T3 only, and 17% had subclinical hypothyroidism. Low T3 levels (58 %) were the most prevalent thyroid anomaly, with or without low T4 or elevated TSH levels. Low T3 levels were more common in patients with advanced CKD.Thyroid hormone abnormalities are linked to different stages of chronic renal disease.

Cistoadenoma mucinoso gigante de ovario

Although ovarian mucinous cystadenoma has a benign growth, it can grow to be very large. We present the case of a 70-year-old patient who came to the clinic for recurrent and diffuse abdominal pain. On physical examination, a large mass was palpated that occupied the entire abdominal cavity, up to the xiphoid appendix, rounded, retentive, with defined edges, non- painful, non-movable. Presence of edema in lower limbs. During the surgical act, a myomatous uterus and a giant left ovarian cyst measuring approximately 40 x3 0 cm and weighing 13.6 kg were identified. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. The biopsy confirmed the diagnosis of benign ovarian mucinous cystadenoma and uterine leiomyomatosis. The postoperative period progressed favorably. The incidence of giant ovarian cystadenoma is relatively unknown due to the lack of a standardized concept and currently available advanced imaging modalities. Keywords: Ovary, Ovarian cysts, Mucinous cystadenoma, Ovarian neoplasms.

Giant retroperitoneal myolipoma mimicking liposarcoma: report of a resected case and review of the literature.

Myolipomas are rare tumors that are often difficult to differentiate from liposarcoma. Herein, we report a case of resected giant myolipoma preoperatively diagnosed as liposarcoma. A 63-year-old woman was suspected of having a large retroperitoneal liposarcoma on October 202X. The patient was referred to our department for tumor resection and a histological diagnosis. After consultation with the urology, obstetric and gynecology, and vascular surgery departments, tumor resection was planned, including the potential resection of other organs. Intraoperative findings revealed a large, elastic, soft tumor with a smooth surface and a capsule occupying the entire abdominal cavity. The tumor was adherent to the stomach, left colon, and uterine adnexa, and no invasion was observed. The tumor was completely resected, and organ resection was not necessary. The tumor was 40cm in diameter and 4.0kg in weight. Pathological examination and immunostaining confirmed a diagnosis of myolipoma. The patient's postoperative course was uneventful, and she was discharged on postoperative day 10 with no complications. Twelve months after surgery, the patient was doing well. To the best of our knowledge, we report a complete resection of the largest retroperitoneal myolipoma reported to date. Physicians should consider surgery, even for suspected large sarcomas that may be difficult to resect completely.

Abdominal Ultrasonography and Splenoportal Doppler Study for Predicting Oesophageal Varices in Patients Admitted with Chronic Liver Disease at a Tertiary Medical Hospital in Kolkata, India: A Cross-sectional Study

Introduction: Upper Gastrointestinal Endoscopy is considered the best screening tool for varices among patients with chronic liver disease. However, it is an expensive and invasive procedure that is not routinely available in rural India. Abdominal ultrasonography along with colour Doppler study is an inexpensive test commonly ordered for patients with chronic liver disease. Recent literature suggests that ultrasonographic parameters can be used to predict varices. Aim: To determine if ultrasonography of the entire abdomen and spleno-portal Doppler study findings can predict oesophageal varices in patients with chronic liver disease. Materials and Methods: The present hospital-based observational, cross-sectional study was conducted in the indoor ward of the Department of General Medicine at Medical College and Hospital, Kolkata, India, over a duration of one year from February 2021 to February 2022. Total 100 patients with chronic liver disease, admitted to the hospital ward, were included in the study. Child-Turcotte-Pugh (CTP) scores were obtained for all patients. Ultrasonographic and spleno-portal Doppler indices, such as liver size, spleen size, portal vein diameter, splenic vein diameter, peak systolic velocity of the portal vein, and portal vein/splenic vein diameter ratio, were measured alongside upper gastrointestinal endoscopy to detect varices. The data were analysed using Statistical Package for Social Sciences (SPSS) version 28.0. The Chi-square test was used to test for significant differences in proportions (categorical data), and the independent t-test and Analysis of Variance (ANOVA) with Tukey’s Post-hoc test were employed to test for significant differences in means (continuous data). Additionally, Receiver Operating Characteristic (ROC) curves were obtained for statistically significant parameters to predict the presence of varices. Results: The study enrolled 100 patients (63% males, 37% females) with a mean age of 49.19±14.965 years, ranging from 14 to 91 years. (median age of 52, range 14-91 years). Of these, 68 patients (68%) had oesophageal varices, while 32 (32%) did not. The study found that a mean spleen size of 13.55 cm, a mean portal vein diameter of 12.5 mm, and a mean splenic vein diameter of ≥9.05 mm were predictive of varices. Additionally, a mean portal vein/splenic vein diameter ratio of 1.6150 was also predictive of varices. However, there was no significant difference in mean liver size and peak systolic velocity between those with and without varices. Conclusion: The present study suggests that a spleen size, portal vein diameter, splenic vein diameter, and portal vein/splenic vein diameter ratio can be reliably used to predict oesophageal varices among patients with chronic liver disease.

Giant Congenital Melanocytic Nevi: A Case Report in Madinah, Saudi Arabia

Giant congenital melanocytic nevi (GCMN) is an uncommon disorder that impacts newborns, with a prevalence of less than 1 in 20,000 births. Even though it is uncommon, detecting the condition early is essential because of the higher chance of complications such as malignant melanoma, central nervous system involvement, and negative effects on the patient and their family's mental well-being due to its unattractive appearance. A giant congenital melanocytic nevus (GCMN) is described as a dark brown skin lesion acquired at birth that has the potential to grow to over 40 cm in size as a person reaches adulthood. The diagnosis of the GCMN is clinically confirmed, while management is mainly symptomatic. Nevertheless, treatment options could consist of surgical and non-surgical methods, psychological therapy, and/or regular clinical monitoring, taking into account alterations in color, size, texture, or the area of the lesion. We describe here a case of GCMN in a male neonate observed in our practice. The patient presented with a huge, pigmented patch over the body since birth, encompassing the entire abdomen, extending to the chest, thighs, and genitalia with multiple satellite, a few lesions on the face, and laterally towards the posterior aspect of the trunk, involving the entire back and buttocks. Radiological investigations were performed and were reported as normal with no significant findings. Additionally, the MRI also did not indicate any involvement of the central nervous system; hence, multidisciplinary comprehensive care was followed for this neonate with monthly regular follow-ups at dermatology and pediatric clinics. Our case significantly highlights the observatory interdisciplinary management of this condition; however, if needed in the future, surgical intervention maybe considered to decrease the risk of malignancy.

Giant renal tumor in adolescent: a diagnostic dilemma and a surgical challenge

Giant renal tumors filling the entire abdominal cavity are rare in adolescents and pose a surgical challenge. Unlike their pediatric counterparts, where upfront chemotherapy can be administered without histologic confirmation, management of a giant renal tumour in adolescents follows that of the adults and is primarily surgical. Herein, we report a case of 17 years old male who presented with a 15×15 cm, 3.75 kg metastatic right renal tumour filling the entire abdominal cavity and displacing the great vessels and was managed by surgical resection, as multiple attempts of obtaining a percutaneous histologic diagnosis were unsuccessful.

The Main Patterns of Transformation in Organs of Reproductive System During the Evolution of Vertebrates

The article presents an analysis of the main directions of transformations of the organs of the reproductive system during the evolution of vertebrates at various levels of the hierarchical organization of vertebrates - cellular, tissue, organ, organism, population. During the evolution of vertebrates, gonadal oligomerization occurred, a decrease in the number of hermaphrodite species, a decrease in the relative mass of gonads in the body, and a transition from isogamy to heterogamy (oogamy) was observed. In vertebrates, 4 types of structural and functional organization of male gonads have been formed: follicular type, follicular-cystic type, tubular-cystic type, tubular type. In representatives of different classes of vertebrates, the transformation of the ovaries proceeded in different directions. Large, grape-shaped ovaries have evolved in fish, amphibians, reptiles, birds, and cloacal mammals. These ovaries, just before the breeding season, can occupy almost the entire abdominal cavity. The ovaries of placental mammals are small in size, their shape is most often oval, the surface is smooth. One of the directions of the evolutionary transformation of the gonads was the compartmentalization of the structures of the male and female gonads, while there was a structural and topographic division into the actual gonads and the genital tract, which were formed on the basis of the structures of the primary kidney. Higher vertebrates have well-developed accessory sex glands. In the gonads, there was a clear topographical distinction between endocrine and germinal structures. Against the background of an increase in the number of species with internal fertilization, against the background of the formation of a complexly organized vagina and uterus in female mammals, the formation and complication of the copulatory organs of males occurred.

Decreasing Radiation Exposure to the Abdomen in Children with Chronic Constipation.

Bowel management for children with chronic constipation may include repeated single-view abdomen radiographs (AXR) to monitor treatment success. Only one image of the abdomen is needed to include most of the colon, but technologists often make a second (or even third) exposure to be sure they have imaged the entire abdomen. Our quality improvement project aimed to reduce radiation exposure by decreasing the frequency of >1 exposure performed for AXR orders in children with chronic constipation from 27% to <10% by December 2022 and sustain. We counted baseline (01/2020-11/2020) and intervention (12/2020-5/2023) examinations with >1 exposure. Initial interventions were a structured communication to technologists and an article in the monthly department newsletter and later, a technologist education module. Additional interventions included communication to radiologists, project updates and encouragement to all technologists, and individual technologist feedback. A statistical process control chart tracked data to study process changes over time. During the baseline and intervention periods, 525/1944 and 1329/8334 examinations, respectively, had >1 exposure performed for AXR orders. Interventions created 2 centerline shifts. Overall, examinations with >1 exposure decreased from 27% to 13.5%. Frequency of >1 exposure performed for AXR orders in children with chronic constipation decreased from 27% to 13.5% through education and communication. This was sustained. We plan to assign training modules for all new technologists, policy reminders (annual training in odd years) for all technologists, and continue individualized learning opportunities.

Functional Divergence of the Tribolium castaneum engrailed and invected Paralogs.

Engrailed (en) and invected (inv) encode paralogous transcription factors found as a closely linked tandem duplication within holometabolous insects. Drosophila en mutants segment normally, then fail to maintain their segments. Loss of Drosophila inv is viable, while loss of both genes results in asegmental larvae. Surprisingly, the knockdown of Oncopeltus inv can result in the loss or fusion of the entire abdomen and en knockdowns in Tribolium show variable degrees of segmental loss. The consequence of losing or knocking down both paralogs on embryogenesis has not been studied beyond Drosophila. To further investigate the relative functions of each paralog and the mechanism behind the segmental loss, Tribolium double and single knockdowns of en and inv were analyzed. The most common cuticular phenotype of the double knockdowns was small, limbless, and open dorsally, with all but a single, segmentally iterated row of bristles. Less severe knockdowns had fused segments and reduced appendages. The Tribolium paralogs appear to act synergistically: the knockdown of either Tribolium gene alone was typically less severe, with all limbs present, whereas the most extreme single knockdowns mimic the most severe double knockdown phenotype. Morphological abnormalities unique to either single gene knockdown were not found. inv expression was not affected in the Tribolium en knockdowns, but hh expression was unexpectedly increased midway through development. Thus, while the segmental expression of en/inv is broadly conserved within insects, the functions of en and inv are evolving independently in different lineages.

Incidental finding of appendiceal mucinous neoplasms

Low-grade appendiceal mucinous neoplasms (LAMN) are rare and are diagnosed in at least 0.13% of appendectomies in Germany, although significant underreporting is likely. Perforation of the tumors can result in abdominal mucinous collections, so-called pseudomyxoma peritonei (PMP). The challenge in the treatment of LAMN is the adequate approach to the incidental finding of these tumors. If a mucinous neoplasm is preoperatively suspected in cases of an acute condition, usually appendicitis, it must be weighed up whether aconservative approach is justifiable or whether immediate appendectomy is necessary. If this is the case, an intraoperative perforation of the appendix must be avoided and the complete abdominal cavity must be inspected for mucin deposits. If conservative treatment is possible, further treatment should take place at aspecialized center. If the neoplasm is first found incidentally during surgery, perforation of the appendix should also be avoided and the entire abdominal cavity should be inspected for aPMP. If a PMP is present cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) should be performed in a specialized center. If LAMN are found during the postoperative histological work-up, it should be evaluated whether aperforation was present and mucin collections are noted in the surgical report. In the case of LAMN without evidence of a PMP, appendectomy is the adequate treatment. In cases of intra-abdominal mucinous collections, samples should be taken and further treatment should be performed at a center with sufficient expertise. An ileocecal resection or oncological hemicolectomy is not indicated. After adequate treatment, all patients should receive a follow-up using cross-sectional imaging (preferably magnetic resonance imaging, MRI) and determination of the tumor markers CEA, CA 19-9 and CA 125.