Extensive Cystic Degeneration Research Articles

Pulmonary blastoma: A rare, unexpected diagnosis mimicking hydatid cyst on radiology

Pulmonary blastomas (PB) are rare, aggressive tumours which constitute <0.1% of resected lung cancers. The fifth edition of WHO classification of thoracic tumors categorises them under sarcomatoid carcinomas along with pleomorphic carcinoma and carcinosarcoma. PBs are large and aggressive tumors that portend a poor prognosis with limited response to standard chemotherapy and chiefly occur in the fourth to fifth decade of life. Here, we present a unique case of a PB with extensive cystic degeneration in a young female, mimicking a hydatid cyst.

A case of phrenic nerve schwannoma with extensive cystic degeneration

A case of phrenic nerve schwannoma with extensive cystic degeneration

Clinicopathological study of cystic and atypical uterine leiomyoma: a rare entity

ABSTRACT A 43-years-old Brazilian woman, Caucasian, premenopausal, was attended with a history of lower abdominal pain, distension, and bleeding. Pelvic and transvaginal ultrasound revealed an enlarged uterus with a large, well-defined, uniformly hyperechoic lesion. The patient underwent total hysterectomy and the specimen was sent for anatomopathological evaluation. The histopathological analyses revealed a leiomyoma with extensive cystic degeneration and atypical characteristics, the immunohistochemical study confirmed the benignity of the case. The finding of atypical leiomyoma with cystic degeneration is rare and should be carefully evaluated to exclude malignant diseases.

Primary Mesothelioma of the Liver: A Case Report

Abstract Primary hepatic mesotheliomas are very rare with only a few cases reported in the literature. Here we present a 55-year-old female with an 18 cm intrahepatic epithelioid mesothelioma with cystic changes who presented with non-specific abdominal pain and no prior history of exposure to asbestos. The tumor was resected with negative margins. The tumor was composed of islands of relatively monotonous epithelioid cells with extensive cystic degeneration. The nuclei were quite bland, round to oval with frequent grooves and inconspicuous nucleoli and minimal pleomorphism. Tumor necrosis was not seen. No keratinizaton or glandular differentiation was evident. The tumor background consisted of a rich inflammatory cell infiltrate composed of lymphocytes, plasma cells and histiocytes. The tumor was positive for mesothelial markers (calretinin, WT-1 and D2–40), keratins (CK5/6, CK7, CK19) and negative for a variety of other markers to exclude adenocarcinoma and other neoplasms. The patient is well and free of disease 8 years following the surgical resection.

Thoracic aortic dissection. Death may not always be due to rupture with haemorrhage. Unusual complications which can be missed at autopsy

ObjectivesAortic dissection (AD) can be a challenging diagnosis. At autopsy, the aorta may not be dilated and intimal tears may be missed or found without obvious rupture or haemorrhage. We report our experience of AD at a tertiary referral centre with review of 32 cases and discuss 2 unusual complications. Methods/Results32 cases of which 12 females and 20 male and 18 out of 32 cases were aged below 40. All of the cases were examined macroscopically and microscopically. 30 out of 32 cases (93%) died due to rupture associated with the AD. Two unusual complications were proximal extension of AD into left coronary artery (CA) with intramural haematoma blocking the vessel and AD involving the ostium of the right CA resulting in avulsion of the right CA from the aorta. Mode of death in both these cases were myocardial ischemia. Sections of the aorta in all cases confirmed extensive cystic medial degeneration with disorganisation, fragmentation and disappearance of the elastin fibres with increased collagen and smooth muscle nuclear degeneration. ConclusionPathologists should be thorough when examining the aorta, the aortic valve and root in AD. When a rupture site cannot be found it is important to look for unusual complications involving the CAs. Histology plays an important role to corroborate the cause of death.

Fibroid Mimicking Ovarian Malignancy: A Rare Case Report

Uterine fibroids usually have typical appearance on imaging. However, when fibroids present in unusual locations or undergo degenerations, confusion in imaging studies may arise. Here, we present a case of a 47-year-old woman with a preoperative diagnosis of ovarian malignancy. Surprisingly, a large pedunculated uterine leiomyoma which had undergone extensive cystic degeneration was found on laparotomy. Pedunculated leiomyomas with extensive cystic degeneration should be considered in the differential diagnosis of adnexal mass.

Ovarian Fibrothecoma with Acute Torsion and Extensive Cystic Degeneration after Long Quiescence in a Young Patient

Ovarian Fibrothecoma with Acute Torsion and Extensive Cystic Degeneration after Long Quiescence in a Young Patient

Giant Plexiform Lipoleiomyoma of the Broad Ligament with Extensive Cystic Degeneration in a Reproductive-Age Female

Abstract Background: Lipoleiomyomas and plexiform leiomyomas are uncommon variants of leiomyomas, although myomas are the commonest neoplasms in women, particularly in the reproductive-age group. Giant leiomyomas are known to occur in the uterus and occasionally in the subserosal or broad-ligament locations. Nearly half of leiomyomas have some of the secondary changes such as hyaline, myxoid, cystic, or red degeneration. Ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI) have all been used to delineate pelvic masses. Case: A 37-year-old female presented with an abdominal mass. She underwent USG, CT, and MRI, followed by surgical removal and histopathologic confirmation of the presence of a giant plexiform lipoleiomyoma of the broad ligament with extensive cystic degeneration. USG had shown a mixed solid-cystic mass with “honeycomb” areas. CT features were suggestive of a mixed-density tumor with small nodular areas separate from the uterus. MRI revealed the broad-ligamen...

A Case of Giant Uterine Lipoleiomyoma Simulating Malignancy.

Introduction. Uterine leiomyoma is the most common benign pathology in women and lipoleiomyoma is an extremely rare and specific type of leiomyoma. Here, we report an unusual case of giant pedunculated subserous lipoleiomyoma misdiagnosed preoperatively as leiomyosarcoma. Case. A 45-year-old woman admitted to our gynecology outpatient clinic for complaints of abdominal distention, tiredness, and pelvic pain for the last 6 months. Sonography and abdominal magnetic resonance imaging (MRI) showed a giant semisolid mass that filled whole abdominal cavity from pelvis to subdiaphragmatic area. A primary diagnosis of uterine sarcoma or ovarian malignancy was made. On operation, total abdominal hysterectomy with a pedunculated mass of size 30 × 23 × 12 cm and weighing 5.4 kg and bilateral salpingo-oophorectomy were performed. The histopathology revealed a lipoleiomyoma with extensive cystic and fatty degeneration without any malignancy. Discussion. The diagnosis of leiomyoma is done usually with pelvic ultrasound but sometimes it is difficult to reach a correct diagnosis especially in cases of giant and pedunculated lipoleiomyoma that included fatty tissue which may mimick malignancy. Conclusion. Subserous pedunculated giant lipoleiomyoma should be kept in mind in the differential diagnosis of leiomyosarcoma or ovarian malignancy.

Axillary Schwannoma with Extensive Cystic Degeneration

Schwannoma affect mainly head, neck, and flexor aspect of the limbs. Neurogenic tumors arising from the brachial plexus are rare and axillary schwannoma is extremely uncommon. Cystic degeneration is common in longstanding cases and which when aspirated may yield only macrophages or lymphocytes leading to false diagnosis of the case in spite of strong clinical suspicion. We report one such rare case of a solitary axillary schwannoma with extensive cystic degeneration, which was misdiagnosed on fine needle aspiration cytology and subsequently confirmed by the histopathological examination and immunohistochemistry.

Unusual Appearance of a Pendulated Gastric Tumor: Always Think of GIST

Objective. To investigate the clinicopathological characteristics of gastrointestinal stromal tumor (GIST) with significant cystic changes and to assess the molecular genetic characteristics. Methods. In a 68-year-old man, a large abdominal tumoral mass was discovered incidentally. Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the presence of a large cystic lesion with multiple contrast-enhancing septae and papillary projections. No clear connection with any of the surrounding organs was identified. Malignancy could not be excluded, and surgery was indicated. During surgery, the large mass was found to be attached by a narrow stalk to the large curvature of the stomach. Results. The histological features and immunohistiochemical profile of the tumor cells (positivity for CD117 and CD34) were consistent with a gastrointestinal stromal tumor with a high risk of progressive disease according to the Fletcher classification. Diagnosis was confirmed by mutational analysis; this demonstrated mutation in exon 14 of PDGFRA. During the followup of 97 months, the patient had a cancer-free survival. Conclusions. This case demonstrates that gastrointestinal stromal tumors (GISTs) with extensive cystic degeneration should be considered in the differential diagnosis of a cystic abdominal mass.

Cystic fibroadenoma of the breast: a case report

Fibroadenoma is the most common breast tumor in adolescent and young women. Fibroadenomas that consist of sclerosing adenosis, papillary apocrine metaplasia, epithelial calcifications, and/or cysts greater than 3 mm are considered as complex fibroadenoma. The relative risk of developing breast cancer in patients with complex fibroadenoma is increased, compared to women with noncomplex fibroadenoma. Extensive cystic degeneration in a fibroadenoma, so called "cystic fibroadenoma" is very rare. Herein, we present a case of such a lesion in a 43-year-old female who has been on follow-up for fibrocystic changes of the breast, and discuss both radiological and histopathologic differential diagnosis of this lesion with other cystic lesions of the breast, including cystic papilloma. The patient is free of disease after 17 months of clinical follow-up.

Orbital schwannoma with cystic degeneration

Schwannoma is a benign, slowly growing, painless, peripheral nerve sheath tumour that is uncommon in orbit. Longstanding tumours may develop degenerative changes. Extensive cystic change in orbital schwannoma is quite rare. We conducted this study to analyse the cases of orbital schwannoma, which were predominantly cystic and describe their clinical, imaging and histopathological features. A retrospective analysis of histopathology records of all the orbital tumours operated between 1993 and 2008 was undertaken at a tertiary care referral centre in northern India. The clinical, imaging and histopathological features of patients with cystic schwannoma were studied. A total of 600 specimens of orbital tumours were received during the study period. We found 39 cases of orbital schwannoma. Out of these, 16 (41%) had extensive cystic degeneration. The age of these patients ranged from 20 to 65 years. Eleven of the patients were female. Duration of symptoms varied from 3 months to 15 years. The most common clinical symptom was painless progressive proptosis with diminution of vision. The radiological picture was quite variable resulting in a primary diagnosis of combined venous-lymphatic vascular malformation in 2, lacrimal gland tumour in 2, dermoid cyst in 1, hydatid cyst in 2 and schwannoma in 5 cases. Orbital schwannoma is a great masquerader in the orbit. Extensive cystic changes in schwannoma are uncommonly reported. Cystic schwannoma constituted 41% of all orbital schwannomas in our series. To the best of our knowledge, this is the largest case series of orbital cystic schwannomas.

Combined Liver-Kidney Transplantation in Polycystic Disease: Case Reports

Polycystic disease causes a progressive decrease in renal function and liver degeneration. The progression of the disease evolves separately between organs and transplantation options vary: simultaneous or sequential liver-kidney transplantation or single-organ transplantation. From September 2006 to June 2007 3 combined liver kidney transplantations (CLKT) were performed for polycystic disease with end-stage renal disease: 2 with polycystic liver disease, and 1 with hepatic failure due to congenital hepatic fibrosis. The widest dimensions of the polycystic liver of 50 and 60 cm diameter were due to extensive cystic degeneration. We performed 1 simultaneous CLKT and 2 sequential transplantations: 1 liver after kidney, and 1 kidney after liver. At present all patients are alive with 100% graft function. Median creatinine level at discharge was 0.9 mg/dL (ranges, ±0.2). Good liver graft function was reported in all 3 cases. Transplant benefit in polycystic liver-kidney disease has been already demonstrated; conservative surgical options may result in a high incidence of complications in highly involved polycystic livers. Delaying transplantation results in a more difficult surgical technique, a higher rate of postoperative complications, and a disturbance of optimal graft retrieval because of the worse preoperative condition of the patients.

Neuroradiological findings of intracranial schwannomas not arising from the stems of cranial nerves

Four cases of intracranial schwannomas not arising from the stems of cranial nerves are reported. All cases were confirmed by surgery and pathological examination. The related histogenesis and the CT and MRI findings are discussed, and the literature is reviewed. The CT and MRI findings of these tumours were analysed retrospectively and their pathological characteristics were reviewed. The tumours presented as heterogeneous hypointense to isointense mixed dense lesions with multiple areas of cystic degeneration and necrosis. Extensive cystic degeneration was the prominent characteristic on CT. The tumours showed hypointense to isointense signal on T(1) weighted images and heterogeneous hyperintense signal on T(2) weighted images. On contrast enhanced CT and MRI, the solid component and the wall of the tumours showed moderate to strong enhancement. Haematoxylin and eosin staining of the lesion demonstrated two histological patterns, Antoni type A and Antoni type B. Immunostaining showed intense immunoreactivity for S-100 protein. The CT and MRI findings of these tumours were similar to those of schwannomas arising from cranial nerves, although the former show a higher rate of cystic degeneration. Therefore, even when a mass is not in the usual cranial nerve region, if its imaging characteristics are similar to those of common schwannomas, the possibility of a schwannoma not arising from cranial nerve should be considered.

A Case of Cystic Leiomyoma Mimicking an Ovarian Malignancy

Introduction: We report an unusual case of a large cystic, pedunculated uterine leiomyoma mimicking a primary malignant ovarian tumour on sonography and computed tomography (CT). Clinical Picture: A 56-year-old post-menopausal woman presented with a right pelviabdominal mass. Sonography and CT examination showed a large extrauterine mass arising from the right adnexa and extending into the abdomen. The mass was predominantly cystic with a solid component at the periphery. A preoperative diagnosis of a primary malignant ovarian tumour was made. Treatment: The patient underwent laparotomy. The large mass was found to arise from the uterine fundus; the ovary was not involved. The mass was resected, followed by total hysterectomy and bilateral salpingo-oophorectomy. Histology was that of a leiomyoma with extensive cystic degeneration. Outcome: The patient made an uneventful recovery. Conclusion: A pedunculated, subserosal uterine leiomyoma with extensive cystic degeneration can mimic an ovarian tumour on imaging and should be considered in the differential diagnosis of an adnexal mass.

A Case of Well-Differentiated Thymic Carcinoma with Extensive Cystic Degeneration

Thymoma is the most common tumor in the compartment of anterior mediastinum. The malignant thymoma is classified into invasive thymoma(category I) and thymic carcinoma(category II). Recently, well-differentiated thymic carcinoma is a proposed category 1.5 used to describe a subset of thymic epithelial tumors, allowing for the existence of intermediate form based on the clinical features and the histological characteristics. Thymic cyst is a congenital or a acquired disorder. Congenital thymic cyst may develop due to failure of the thymopharyngeal duct to obliterate and acquired thymic cyst develops from inflammation(multilocular thymic cyst), or neoplasm(cystic thymoma). Cystic degeneration in thymoma is a relatively frequent but focal event. In rare cases, the process proceeds to the extent that most or all of the lesion becomes cystic. Until now, well-differentiated thymic carcinoma with extensive cystic degeneration has not been reported in our country. We experienced a case of 14 year-old female patient showing extensive cystic degeneration in well-differentiated thymic carcinoma. And so we report it with review of the articles related.

A new leukoencephalopathy with vanishing white matter.

We identified nine children with a leukoencephalopathy of similar type according to clinical and MRI findings. The patients included three affected sibling pairs. The age range was 3 to 19 years. The onset of the disease was in childhood; the course was both chronic-progressive and episodic. There were episodes of deterioration following infections and minor head traumas, and these could results in unexplained coma. In eight patients with advanced disease, MRI revealed a diffuse cerebral hemispheric leukoencephalopathy, in which increasing areas of the abnormal white matter had a signal intensity close to that of CSF on all pulse sequences. In one patient in the early stages of disease, initial MRI showed diffusely abnormal cerebral white matter, which only reached the signal characteristics of CSF at a later stage. In the patients in whom the disease was advanced, magnetic resonance spectroscopy (MRS) of the white matter showed an almost complete disappearance of all normal signals and the presence of glucose and lactate, compatible with the presence of mainly CSF and little brain tissue. Spectra of the cortex were much better preserved. However, in addition to the normal resonances, there were signals representing lactate and glucose. MRS of the white matter in the patient whose disease was at an early stage was much less abnormal. Autopsy in one patient confirmed the presence of extensive cystic degeneration of the cerebral white matter with reactive change and a preserved cortex. Typical involvement of pontine tegmental white matter was suggested by MRI and confirmed by autopsy. The disease probably has an autosomal recessive mode of inheritance, but the basic metabolic defect is not known.

Cystic thymomas: A clinicopathologic study of ten cases

Cystic degeneration in thymoma is a relatively frequent but focal event. In rare cases, the process proceeds to the extent that most or all of the lesion becomes cystic. The authors studied ten cases of thymoma undergoing cystic degeneration of such degree that the lesions initially were mistaken grossly and microscopically for nonneoplastic thymic cysts. The patients' ages ranged from 23 to 81 years, and the sex distribution was equal. The lesions were characterized by the formation of multiple large cystic cavities filled with clear, hemorrhagic or grumose material. Histologically, residual solid islands showing the characteristic features of thymoma, i.e., biphasic cell population (epithelial cells/lymphocytes), perivascular spaces, and areas of medullary differentiation, were present within the cyst walls. In contrast with nonneoplastic thymic cysts, the walls of the cavities generally were devoid of an epithelial lining; most of the cysts appeared to predominantly result from extreme dilatation and confluence of perivascular spaces. In some instances, the cystic degeneration of the tumor was accompanied by cystic changes of an inflammatory nature in the surrounding, nonneoplastic thymic tissue leading to firm adhesions and apparent infiltration of adjacent mediastinal structures. None of the lesions in the studied patients recurred during follow-up periods of from 2 to 10 years (average follow-up, 5 years). Cystic thymomas should be distinguished from nonneoplastic congenital and acquired thymic cysts and other primary thymic neoplasms undergoing extensive cystic degeneration. It is important not to misinterpret the apparent infiltration of surrounding mediastinal structures that results from the inflammatory changes that often accompany these tumors as evidence of aggressive or malignant behavior.

Thymoma with extensive cystic degeneration-a case report

A 40-year-old female had been told she had an abnormal chest X-ray shadow 6 years earlier. An anterior mediastinal benign tumor was diagnosed and resected. The tumor contained a cyst with a thick fibrous wall. The cut surface revealed a dark brown, semi-solid mass and a soft gray tumor. The histological diagnosis was a thymoma with extensive cystic degeneration. We suspected that this tumor resulted from hemorrhagic necrosis of the thymoma.