Fat Planes Research Articles

P0548 Comparison of C-reactive protein level and intestinal ultrasonography in Crohn’s Disease activation

Abstract Background Noninvasive diagnostic methods and laboratory parameters play an important role in the activation of Crohn’s Disease (CD). C-reactive protein (CRP) is one of the best laboratory measurements used to evaluate the activity of CD. Ultrasonography is a non-invasive, easily accessible, inexpensive, ionizing radiation-free imaging method that can be performed at the bedside. In this study, we aimed to compare CRP level and intestinal ultrasonography (IUS) findings in CD. Methods 79 Crohn’s patients who applied due to activation or for routine control were included in the study. Patients with other causes of colitis, malignancy, chronic and rheumatological diseases that may cause elevated CRP were excluded from the study. CRP values of the patients were measured on the day of IUS. IUS examination was performed using the Toshiba aplio HDI-300 ultrasound system. The examination started from the right inguinal region using a convex probe (3.5-5.5 MHz). Wall thickness, wall echogenicity, mural stratification, involved segment, inflammation in mesenteric fat planes, lymphadenopathy, and intestinal complications such as stricture, abscess formation, and fistulas were examined using a linear probe (7-12 MHz). A wall thickness greater than 3 mm was considered pathologic. The short axis of mesenteric lymph nodes greater than 5 mm was considered pathologic. The Superior mesenteric artery (SMA) was examined by duplex color Doppler. In the spectral Doppler examination, the peak systolic velocity (PSV) and resistive index (RI) were assessed. The Limberg score was used to assess bowel wall vascularization. According to Limberg, intestinal wall vascularity is classified in 5 grades. Results In this study, increased intestinal wall thickness in IUS, inflammation findings in the mesenteric fatty planes and CRP values were highly significant (p<0.001). CRP values were significantly higher in the group with decreased peristalsis and loss of wall layer delineation (p ˂ 0.01) and in complicated Crohn’s patients (p ˂ 0.05). CRP value did not differ significantly (p = 0.076) in the groups with and without lymphadenopathy detected on IUS. The CRP value in the group with a Limberg score of 1 and above was significantly higher (p < 0.001) compared to the group with a Limberg score of 0. A significant (p <0.05) positive correlation was observed between SMA flow velocity and CRP on Doppler USG. No correlation (p ˃0.05) was observed between RI, PSV and CRP on Doppler USG. Conclusion In this study, CRP elevation was found to be associated with many parameters of IUS in evaluating CD activity. In clinical use, CRP and IUS are simple, noninvasive, bedside diagnostic tools. References 1)Haber HP, Busch A, Ziebach R, Stern M. Bowel wall thickness measured by ultrasound as a marker of Crohn’s disease activity in children. The Lancet. 2000;355(9211):1239-40. 2)Kucharzik T, Wittig BM, Helwig U, Börner N, Rössler A, Rath S, et al. Use of intestinal ultrasound to monitor Crohn’s disease activity. Clinical Gastroenterology and Hepatology. 2017;15(4):535-42. e2. 3)Filik L, Dagli U, Ulker A. C-reactive protein and monitoring the activity of Crohn’s disease. Advances in therapy. 2006;23(4):655-62.

Novel MRI signs for differentiating neurogenic and non-neurogenic peripheral nerve Tumors: Insights from Contrast-Enhanced magnetic resonance neurography.

To investigate the specific manifestations of neurogenic and non-neurogenic tumors involving peripheral nerves on contrast-enhanced magnetic resonance neurography (CE-MRN) and explore the potential of CE-MRN in aiding differential diagnosis. Twenty-nine patients with neurogenic tumors and 23 with non-neurogenic tumors involving peripheral nerves were enrolled in this study. Both routine MRI and CE-MRN scanning were performed on all subjects. The location, pattern of involvement, classical MRI signs, and novel CE-MRN signs of nerve involvement were evaluated and compared between the two groups. The novel CE-MRN signs included "Enhanced target sign", "Nerve effacing sign", "Nerve wrapping sign", "Nerve compressing sign", "Nerve tail sign", and morphological changes of nerves. Diagnostic confidence in identifying nerve involvement and lesion conspicuity were assessed and compared between routine MRI and CE-MRN. The majority of neurogenic tumors were schwannoma (79.3%) and involved a single nerve (75.9%), whereas the majority of non-neurogenic tumors were malignant tumors (78.3%) and involved multiple nerves (78.3%) (P < 0.001). In terms of classical MRI signs, neurogenic tumors exhibited a significantly higher incidence of the "Tail sign" (75.9% vs 13%), "Dumbbell sign" (31% vs 4.3%), "Target sign" (51.7% vs 8.7%), and "Split fat sign" (55.2% vs 4.3%), while showing a lower incidence of the "Effacement of fat plane" (3.4% vs 60.9%) compared to non-neurogenic tumors (all p<0.05). Regarding novel CE-MRN signs, neurogenic tumors demonstrated a significantly higher incidence of the "Enhanced target sign" (65.6% vs 13%) and the "Nerve tail sign" (100% vs 13%), while exhibiting a lower incidence of the "Nerve effacing sign" (0% vs 52.2%) and the "Nerve wrapping sign" (0% vs 17.4%) compared to non-neurogenic tumors (all p<0.05). CE-MRN yielded significantly higher diagnostic confidence scores (2.87±0.35 vs 1.75±0.84), but lower lesion conspicuity scores (2.35±0.71 vs 2.92±0.27) compared to routine MRI (all P < 0.001). CE-MRN is a valuable imaging modality for the identification of tumor-related peripheral nerve involvement, as it offers supplementary indicators and enhances diagnostic confidence.

Unveiling spindle cell lipoma: a radiological case report

BackgroundSpindle cell lipoma is a benign adipocytic tumour, commonly occuring in the subcutis of posterior neck, upper back and shoulder, particularly in middle aged males. It is often composed of relatively equal ratio of fat and spindle cells, yet either component may predominate. Because of its variable ratio, a spindle cell lipoma may mimic liposarcoma radiologically. This article aimed to describe the MRI characteristics that assist in diagnosing spindle cell lipoma.Case presentation:A 45-year-old female presented with a gradually progressive neck swelling along the posterior aspect over a period of 2 years. Physical examination revealed a firm, mobile, non-tender mass in the left suboccipital region. Radiographic imaging showed a well-defined heterogeneous, minimally enhancing soft tissue swelling with areas of macroscopic fat and multiple macrocalcifications in the left suboccipital region extending to the left parapharyngeal space, showing loss of fat plane with adjacent muscles. Differential diagnoses of soft tissue neoplasms such as atypical lipoma and low-grade liposarcoma were considered. Surgical excision confirmed a myxoid variant of spindle cell lipoma upon histopathological examination.ConclusionSpindle cell lipomas, commonly found in the posterior neck, have varied imaging features that are not distinctive. Despite their non-specific nature, radiologists should recognize these features, as the tumor can be treated effectively with simple excision. When encountering a well-defined, complex fatty mass in the subcutaneous tissue of the posterior neck, consider a diagnostic possibility of spindle cell lipoma.

Neurovascular crossing patterns between leash of Henry and deep branch of radial nerve: implications for neurointervention and diagnostic imaging

ObjectiveTo detail the neurovascular crossing patterns between the leash of Henry (LoH) and the deep branch of the radial nerve (DBRN) in supination and pronation of the forearm, using imaging methods with anatomic correlation.Materials and methodsThis cross-sectional study was performed ex vivo with HRUS and MRI with anatomic correlation on 6 samples and in vivo with HRUS with Doppler on 55 participants scanned bilaterally. The in vivo participants were enrolled over a 6-month period. The crossing patterns between the LoH and DBRN were assessed ex vivo and in vivo. Additional morphological features of the DBRN, LoH, and fat plane were assessed in vivo only. Biometric features of the participants were recorded. Statistical analyses were performed using Shapiro–Wilk, parametric and non-parametric tests.ResultsThe most common neurovascular crossing pattern was the ascending branch of the radial recurrent artery (RRAab) crossing below (ex vivo: 83.3%, in vivo: 85.3%) and the muscular branch crossing above (ex vivo: 100%, in vivo: 63.2% %) the DBRN. Both the deep and superficial surfaces of the DBRN exhibited an intimate relationship with the vessels of the LoH. A positive correlation between vessel diameter and anthropometric factors was observed. In addition, the muscular branch exhibited a significantly smaller diameter than the RRAab.ConclusionOur study detailed the relationship between the LoH and the DBRN and highlighted the high incidence of vessel crossing above the DBRN at the level of the muscular branch. Knowledge of neurovascular crossings is crucial for understanding neurovascular entrapment syndromes and planning interventional procedures to reduce vascular complications.

Beyond the Baker's Cyst: Pathology and Variant Anatomy in the Popliteal Fossa on Routine Knee MRI

Primary evaluation of the knee focuses on evaluation of cartilaginous degeneration, meniscal injury, ligamentous or tendinous abnormality, and bony lesions, rather than the posterior and extracapsular popliteal fossa. A succinct review of normal popliteal fossa anatomy and normal fat planes is key to recognizing clinically significant pathology and variant anatomy. Abnormal insertion of the medial head of the gastrocnemius, or an accessory head of the gastrocnemius, can increase the risk of popliteal artery entrapment, an underrecognized cause of posterior calf and knee pain. Abnormal branching and course of the popliteal artery can increase risk of surgical vulnerability during multiple knee procedures, including arthroscopy and high tibial osteotomy. Finally, not all masses in the popliteal fossa are Baker's cysts; synovial sarcomas, vascular malformations, and other tumors can present in this anatomic space and can mimic popliteal cysts.

Patellar Tendon-Lateral Femoral Condyle Friction Syndrome: About 5 Cases

Objective: The objective is to illustrate the MR imaging findings occurring in the posterior inferolateral patellar tendon and the lateral femoral condyle in patients experiencing chronic anterior and/or lateral knee pain. Material and methods: A retrospective review of the MR images in (patients who presented with chronic anterior or lateral knee pain. In all patients, postcontrast images were available. Results: Sagittal and axial imaging planes best demonstrated the patellar tendon and its relationship with the lateral femoral condyle. In all the patients, there was obliteration of the fat planes and abnormal signal intensity in the lateral soft tissues of the inferior patellofemoral joint. Enhancement after administration of gadolinium was noted in all cases in which contrast was administered. One patient showed cystic changes in the soft tissues adjacent to the lateral femoral condyle in addition to fat plane obliteration. Abnormal patellar alignment was noted in one patient. Patellar tendon pathology was seen in one patient. Conclusion: When assessing anterior knee symptoms, MR imaging facilitates the identification of changes associated with patellar tendon-lateral femoral condyle friction syndrome, which should be differentiated from other causes of anterior or lateral knee pain.

Elastofibroma dorsi’de BT bulguları: tek merkezli bir çalışmad

Aim: Elastofibroma dorsi (ED) is a benign pseudotumor detected by CT and/or MRI due to the penetration of fibrous and fatty tissues between the muscle structures and is more common in elderly people, especially in women, with subscapular topography. This study investigated the prevalence of elastofibroma dorsi in large series and CT findings.&#x0D; Material and Methods: A total of 469 patients (212 women, 257 men) who underwent thoracic CT for various reasons were included in this study. The presence, dimensions, contour and density of ED were investigated in these patients.&#x0D; Results: The mean age of 469 patients was 54.51±17.42 (18-88 years). Elastofibroma was detected in 15.4% (n=72) of these patients. It was determined that 69.9% (n=51) of the patients with ED were female, and the mean age of these patients was 63.21±15.72. ED was usually isodense in both sexes. Again, in both sexes, ED was more regularly contoured, and the fat planes between adjacent muscle structures were usually closed.&#x0D; Conclusion: Additional studies are not required when the lesion is typical and asymptomatic on CT scans. However, surgical treatment may be recommended if the lesion is symptomatic or if doubt remains regarding the benign nature of the lesion.

Where Should We Focus in Emergency Orbital Trauma?

Aim: To describe the most common findings in orbital trauma and to support radiologic decision making by comparing them in 7 pathology regions.&#x0D; Material and Methods: A total of 190 patients (119 males and 71 females) participated in the study. Orbital injury pathologies were documented and compared in seven regions. The most typical results of orbital tomography were determined. Binominal regression analysis was also performed for each trauma region.&#x0D; Results: 190 orbital CT scans showed 13.7% orbital bone fractures (n=26), 7.9% bulbus pathology (n=15), 2.6% vitreous pathology (n=5), 2.1% extraocular muscle pathology (n=4), and 6.3% (n=13) retrobulbar pathology. The most common globe pathologies were lens displacement and globe rupture. Retrobulbar fat plane changes (4.2% n=8) were the most common pathology in the region. Periorbital edema was the most common periorbital disease in 86.3% of cases (n=164). When evaluated using cross-tabulations between the seven pathologic regions, the relationship between bone pathology and retrobulbar area and between globe and vitreous was statistically significant (p

Matted Lymph Nodes on MRI in Nasopharyngeal Carcinoma: Prognostic Factor and Potential Indication for Induction Chemotherapy Benefits.

Lymph node characteristics markedly affect nasopharyngeal carcinoma (NPC) prognosis. Matted node (MN), an important characteristic for lymph node, lacks explored MRI-based prognostic implications. Investigate MRI-determined MNs' prognostic value in NPC, including 5-year overall survival (OS), distant metastasis-free survival (DMFS), local recurrence-free survival (LRFS), progression-free survival (PFS), and its role in induction chemotherapy (IC). Retrospective cohort survival study. Seven hundred ninety-two patients with non-metastatic NPC (female: 27.3%, >45-year old: 50.1%) confirmed by biopsy. 5-T/3.0-T, T1-, T2- and post-contrast T1-weighted fast spin echo sequences acquired. MNs were defined as ≥3 nodes abutting with intervening fat plane replaced by extracapsular nodal spread (ENS). Patients were observed every 3 months for 2 years and every 6 months for 5 years using MRI. Follow-up extended from treatment initiation to death or final follow-up. MNs were evaluated by three radiologists with inter-reader reliability calculated. A 1:1 matched-pair method compared survival differences between MN-positive patients with or without IC. Primary endpoints (OS, DMFS, LRFS, PFS) were calculated from therapy initiation to respective event. Kappa values assessed inter-reader reliability. Correlation between MN, ENS, and LNN was studied through Spearman's correlation coefficient. Clinical characteristics were calculated via Fisher's exact, Chi-squared, and Student's t-test. Kaplan-Meier curves and log-rank tests analyzed all time-to-event data. Confounding factors were included in Multivariable Cox proportional hazard models to identify independent prognostic factors. P-values <0.05 were considered statistically significant. MNs incidence was 24.6%. MNs independently associated with decreased 5-year OS, DMFS, and PFS; not LRFS (P = 0.252). MN-positive patients gained significant survival benefit from IC in 5-year OS (88.4% vs. 66.0%) and PFS (76.4% vs. 53.5%), but not DMFS (83.1% vs. 69.9%, P = 0.145) or LRFS (89.9% vs. 77.8%, P = 0.140). MNs may independently stratify NPC risk and offer survival benefit from IC. 3 TECHNICAL EFFICACY: Stage 2.

Computed tomography evaluation of alterations in the masticator space due to invasion by malignant head and neck neoplasms.

To evaluate alterations in the masticator space due to the dissemination of malignant neoplasms originating from the tonsillar fossa, retromolar trigone, maxillary sinus, or nasopharynx, using computed tomography (CT), as well as to correlate the presence of trismus with the CT findings and the dimensions of the tumor. We evaluated the medical records of 65 patients with malignant tumors in the regions described. The images were analyzed by two physician examiners, working independently, who were blinded to the clinical data. In the evaluation of the masticator space, the following parameters were considered: symmetry with the contralateral space; obliteration of the fat plane, retromolar trigone, or pharyngeal space; edema/atrophy of the medial or lateral pterygoid muscles; and destruction of the mandibular ramus. Obliteration of the fat plane was found in 69.2% of the patients. Asymmetry, edema/atrophy, and bone destruction were detected in 27.7%, 26.2%, and 20.0% of the patients, respectively. Trismus was identified in 15.4% of the patients. Of the patients with trismus, 90.0% had stage T4 tumors, compared with only 43.8% of those without trismus. Trismus was 11.6 times more common among the patients with stage T4 tumors than among those with lower-stage tumors. Neoplasms of the tonsillar fossa and retromolar trigone collectively accounted for 95.0% of the cases. The CT scans showed edema/atrophy of the pterygoid muscles in 60.0% of the patients with trismus and in 21.8% of those without. An association was observed between T4 tumor stage and edema/atrophy of the pterygoid muscles. In addition, the risk of trismus was 5.4 times higher among the patients with stage T4 tumors. In our patient sample, the most common finding was obliteration of the fat plane, followed by asymmetry and edema/atrophy. Most of the patients with T4 tumors had trismus, together with edema/atrophy of the pterygoid muscles.

Feasibility of total and partial uncinectomy during anterior cervical approach: MRI-based analysis of 176 patients regarding vertebral artery location.

To determine the technical feasibility of uncinate process (UP) resection (uncinectomy) during anterior cervical approach with risk-avoidance of vertebral artery (VA) injury. One hundred and seventy-six magnetic resonance imaging images with cervical spondylosis were evaluated. The diameter between UP and VA (UP-VA distance), the presence of a fat plane, and the VA's anterior-posterior position relative to UP (anterior[A], middle[M], posterior[P]) at C3-4 to C6-7 segments were investigated. Subsequently, easy-to-use classifications were developed according to the feasibility of total and partial uncinectomy. Total uncinectomy: easy (distance: > 2mm); moderate (distance: ≤ 2 and fat plane: +); advanced (no fat plane). Partial uncinectomy: easy (distance: > 2mm and P, A, or M position); moderate (distance: ≤ 2; fat plane: + and P position), and advanced (no fat plane and P position). UP-VA distance of C5-6 on the right side (left/right: 0.41/0.31mm) was the smallest. The ratio of no fat plane of C5-6 (46.6%/49.4%) was the highest. C5-6 had a high rate of P position (7.4%/8.5%) while C6-7 had a high rate of A position (19.3%/18.2%). More than 90% individuals were classified as easy for partial uncinectomy at any vertebral segment (C3-7), while more than 30% were classified as advanced at C4-7 with the highest rate at C5-6 for total uncinectomy. When performing uncinectomy during the anterior cervical approach, the C5-6 segment may be at the greatest risk of VA injury. Hence, preoperative MR images should be thoroughly evaluated to avoid VA injury.

Bladder Endometriosis in Perimenopausal Woman- A Rare Case Report

Endometriosis is a gynaecological disease. It is caused by the presence of the endometrial tissue exterior of the uterus. A 45-year-old woman presented with recurrent episodes of dysuria. Computed tomography (CT) scan showed ill-defined mildly enhancing soft tissue density within the vesicouterine region showing loss of fat planes with the posterior wall of the urinary bladder in the region of the trigone s/o bladder endometriosis. The patient was planned for cystoscopy and cystoscopy resection of bladder endometriosis. Endometrioma was resected using a resectoscope. Bilateral ureteric reflexes were elicited, and the rest of the bladder mucosa was normal. Effective treatment of bladder and urethral endometriosis is best done in collaboration with a team of doctors familiar with endometriosis, such as a gynaecological, radiologist, and urologist.

Does joint-sparing tumor resection jeopardize oncologic and functional outcomes in non-metastatic high-grade osteosarcoma around the knee?

BackgroundWe previously reported joint-sparing tumor resection for osteosarcoma with epiphyseal involvement in which transepiphyseal osteotomy went through the in situ ablated epiphysis. However, we do not know whether this is a safe approach when compared with joint-sacrificed tumor resection. Our objective was to compare oncologic and functional outcomes between patients who underwent joint preservation (JP) and joint replacement (JR) tumor resection. Furthermore, we identified the risk factors of local recurrence, metastasis and survival.MethodsEighty-nine patients with non-metastatic high-grade osteosarcoma around the knee were treated with limb-salvage surgery (JP in 47 and JR in 42). Age, gender, tumor location, pathologic fracture, plain radiographic pattern, limb diameter change, perivascular space alteration, surgical margin, local recurrence, metastasis, death, and the Musculoskeletal Tumor Society (MSTS)-93 scores were extracted from the records. Univariate analysis was performed to compare oncologic and functional outcomes. Binary logistic and cox regression models were used to identify predicted factors for local recurrence, metastasis, and survival.ResultsLocal recurrence, metastasis and overall survival were similar in the JP and JR group (p = 0.3; p = 0.211; p = 0.143). Major complications and limb survival were also similar in the JR and JP group (p = 0.14; p = 0.181). The MSTS score of 27.06 ± 1.77 in the JP group was higher than that of 25.88 ± 1.79 in the JR group (p = 0.005). The marginal margin of soft tissue compared with a wide margin was the only independent predictor of local recurrence (p = 0.006). Limb diameter increase and perivascular fat plane disappearance during neoadjuvant chemotherapy were independent predictors for metastasis (p = 0.002; p = 0.000) and worse survival (p = 0.000; p = 0.001).ConclusionsJoint-sparing tumor resection with the ablative bone margin offers advantage of native joint preservation with favorable functional outcomes while not jeopardizing oncologic outcomes compared with joint-sacrificed tumor resection. Surgeon should strive to obtain adequate soft tissue surgical margin decreasing risk of local recurrence. Novel drug regimens might be reasonable options for patients with obvious limb diameter increase and perivascular fat disappearance during chemotherapy.

A rare cause of dysphagia in children: Squamous cell carcinoma of the esophagus: A case report and review of literature

Globally, an estimated 572 000 cases occurred in 2018 of malignant tumors of the esophagus but in children and adolescents, this cancer is a rare disease. Through this case report, i tried to analyze the clinical, paraclinical, therapeutic and prognostic profile of squamous cell carcinoma of the esophagus in children. This 10 years old female school child is presented with a complaint of worsening of difficulty of swallowing of 01 week duration. She had Symptoms complex of TB for the last 3 months. FNAC from right axillary, bilateral inguinal LNs, discrete with pus oozing sinus tract about 2x2 cm Microscopy shows caseous necrotic material= suggestive of TB. SAM (NE) + Severe Pneumonia + R/O Diss TB (Lung, LN) + Tungiasis was considered and anti TB was started but the patient was deteriorating. After one month course in the hospital the patient condition was deteriorating, the dysphagia become worsened. CHEST CT SCAN of the child was taken and the Finding: there is multifocal coalescing tree in bud opacity in posterior segment of the right upper lobe and superior segment of the lower lobe on the same side. There is consolidation with bronchiectasis changes on the left lower lobe. Multiple enlarged Para tracheal, sub carinal and Para esophageal nodes noted. There is circumferential wall thickening of the mid and part of proximal esophagus with no fat plane from the enlarged adjacent nodes. Calcified right axillary nodes visualized. the Impression was Bilateral pulmonary opacities with mediastinal LAPs (likely 2ry to TB) + circumferential wall thickening of mid and part of proximal esophagus DDx: Esophageal malignant mass with mediastinal nodal deposits and aspiration pneumonia- so needs clinical correlation and endoscopic study. Esophageal biopsy was taken and section shows nests and single cells of malignant squamous cells having high N/C ratio hyper chromatic nucleo and dense eosinophilic cytoplasm along with keratin pearls along with monocular infiltration and atypical mitosis invading in to desmoplastic stroma. Conclusion: Squamous cell carcinoma The child was transferred to oncology ward for chemotherapy and radiotherapy after one week of ward stay the patient passed away. Malignant esophageal tumors in children and adolescents are extremely rare conditions. The ingestion of caustic products and smoking are currently the most well-known risk factors for this disease, factors not found in our patient. Dysphagia is the main clinical sign of squamous cell carcinoma of the esophagus. Thus, in the event of dysphagia in children or adolescents, a mediastinal process should be considered, and a paraclinical assessment should be carried out. Since squamous cell carcinoma of the esophagus is a rare malignant tumor in children, the interest of this case report is to underline the importance of evoking a malignant esophageal process in children who present a notion of dysphagia to solids then to liquids, associated with an alteration of the general condition and anemia.

Spontaneous Bilateral Rectus Abdominis Rhabdomyolysis in a 24-Year Old Male Following Intense Physical Activity in a Sub-Urban Nigerian Town: A Case Report

Introduction: Exercise induced Rhabdomyolysis is a syndrome characterised by disintegration of the skeletal muscles and release of toxic intracellular contents into the plasma. It can be precipitated by strenuous exercise and its diagnosis can easily be missed by physicians. Soft tissue ultrasonography is an invaluable tool for evaluating patients with rhabdomyolysis especially in sub Saharan Africa where sophisticated imaging modalities like magnetic resonance imaging (MRI) and computed tomographic scanners are not readily available. Ultrasonography in this case is the commonly available modality. It is cheap and easier to use. It can aid in the diagnosis of suspected cases, help to determine extent of the disease, identify associated complications and also for monitoring disease progression. Spontaneous rhabdomyolysis following exercise has not been previously reported in our environment. Objectives: To report a case of exercise induced rhabdomyolysis in a 24 year old male patient. To highlight the importance of ultrasound in evaluating patients with rhabdomyolysis, describe the notable ultrasound findings and review relevant existing literature on this condition. Case Report: A 24 year old male with spontaneous rhabdomyolysis of the infra-umbilical segment of both recti abdominis muscles, who presented to a private ultrasound facility in Agbor, Delta state, Nigeria. His symptoms were; lower abdominal pain made worse with movements, and passage of dark red urine which developed spontaneously following a week history of intense physical exercise at a gymnasium. An ultrasound scanner of the Toshiba Medical systems Corp Model 2016 (Xario 100) with a 7 to 12 MHz linear array transducer was used to scan both recti abdominis muscles in different planes. Abnormal findings were noted involving the infra umbilical segment of both abdominal recti muscle belly. Notable findings were thickening of the muscle fascia, blurring of the fat planes, fat stranding, disorganization of the normal architectural pattern of the fibres as well as presence of hypoechoic lesions within the affected muscle segment. The images were frozen and the sonograms were acquired and saved. Conclusion: Ultrasonography is an indispensable tool for evaluating patients with exercise induced spontaneous rhabdomyolysis. This case study is of immense significance in developing affordable methods of image based diagnosis and investigation of rhabdomyolysis that also aids in standard clinical, laboratory and histopathological studies of the condition.

Abstract P2-14-12: Endoscopic Nipple-Sparing Mastectomy: A single Institutional Experience of 50 Consecutive Cases

Abstract Purpose: The purpose of this study is to to introduce an early experience of endoscopic nipple-sparing mastectomy (NSM) combined with immediate breast reconstruction through simple single-port access that placed in axillary incision. Methods and Materials: Between November 2018 and June 2022, 48 female patients with breast cancer, total 50 cases of breast cancer (bilateral breast cancer in 2 patients) were treated with endoscopic NSM combined with immediate breast reconstruction through simple single-port access that placed in axillary incision. Forty-six patients, total forty-eight cases, underwent breast reconstruction with silicone implant, two patient underwent TRAM reconstruction. Surgical procedures of endoscopic NSM: Patients were placed in a supine position with both upper limbs on arm boards abducted 90 degree. An incision of 5 cm was made along the anterior axillary line from the inferior mammary fold. The sentinel lymph node was excised through the incision. .A workspace for the insertion of a Glove Port (Nelis, Republic of Korea) was created within a radius of 3 cm from the incision, and the subcutaneous tissue flaps were raised. The Glove Port was inserted first into the retromammary space, carbon dioxide (CO2) gas was insufflated, and the pressure was maintained at approximately 7 mmHg. The retromammary space dissection was performed with caution to avoid dissecting the interpectoral space, using an energy device and an endoscopic grasper guided by a flexible endoscope (ENDOEYE FLEX 10 mm, OLYMPUS, Japan). The breast was elevated to the edge of the latissimus dorsi muscle laterally, to the thoracoabdominal aponeurosis inferiorly, to the level of the clavicle superiorly, and to the edge of the sternum medially. After dissecting the retromammary fat plane, the Glove Port was relocated into the subcutaneous space. Skin flap was dissected using an energy device, and the duct beneath the nipple was cut off using endoscopic scissors. The subcutaneous flap was dissected completely along the boundaries of the breast, and the entire breast was removed Results: The patients were 30-55 years old (mean, 43 years). The tumor located at the left breast in 26 cases and at the right breast in 23 cases. The diameter of tumor ranged from 1.5 to 5.2 cm (mean, 3.4 cm). Median operation time was 153 minutes. After operation, nipple necrosis or skin flap necrosis was not observed. No subcutaneous emphysema occurred. There is one tumor involvement to nipple in postoperative pathological examination. So, excision of nipple-areolar-complex was performed 2 weeks after first operation. All patients were followed up 1-43 months (median, 19 months). According to the Harris assessment criteria for appearance of reconstructed breast, there were 43 cases of excellent and 7 cases of good. No tumor recurrence or metastasis occurred during follow-up. Conclusion: It is a safe and feasible method of endoscopic NSM combined with immediate breast reconstruction through simple single-port access that placed in axillary incision, and can obtain good cosmetic results. It is a new option to breast reconstruction. Citation Format: HYEYOON LEE, Kyusang Cho, YOUNGWOO CHANG, GILSOO SON. Endoscopic Nipple-Sparing Mastectomy: A single Institutional Experience of 50 Consecutive Cases [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-14-12.

A Case of Synchronous Primary of CA Breast and Non-Hodgkins Lymphoma

A 66 years old female with diabetes and hypertension was evaluated for a lump in the left breast of six months duration, the lump was gradually increasing in size. On clinical examination it was found that the lump measured 4x4cm and was present in the left upper outer quadrant and was non tender. As a part of metastatic work up a PET CT was done which showed metabolically active lobulated soft tissue density mass lesion with multiple satellite nodules in left breast upper and outer quadrant measuring 3.2x2.1x4.4cms with max SUV 4.4, the lesion maintained fat planes with skin anteriorly and muscles posteriorly. Multiple non FDG avid to mildly FDG avid sub cm to cm size soft tissue density lesion in left breast around the main lesion was noted. Non FDG avid multiple sub cm left axillary lymph nodes were also present. Imageologically Stage II disease. Biopsy from the breast lesion was invasive carcinoma of nos type. Patient underwent left sided MRM. The final pathological staging was pT2N1a.Section from one lymph node showed partially effaced lymph node architecture with sheets of medium to large sized atypical lymphoid cells with fine chromatin prominent nucleolus and scant cytoplasm. IHC done showed the tumor cells to be positive for CD20, CD45, CD15, CD30(40%), MUM1, cmyc (30%) and negative for CK, CD3, EBV, ALK, BCL-2CD10, SOX11, Ki67-60%. The final diagnosis was Diffuse Large B Cell Lymphoma, non-germinal center type.

Dermoid cyst of pancreas: A report of an unusual case

Introduction: Pancreatic dermoid cyst is a rare, benign germ cell tumour and part of differential diagnosis for cystic neoplasm of pancreas, where it shows a slight preference for the pancreatic head. Case Report: We report a case of dermoid cyst of pancreas in a 17-year-old female patient. Patient presented with epigastric pain, anorexia and lump in epigastric region. CECT showed a well marginated cystic lesion with tiny speck of calcification in wall and fatty component anteriorly in epigastric region in midline and towards right arising from anterior aspect of head of pancreas. The fat planes surrounding the lesion are normal. The CBD was seen lying on posterior aspect of the lesion. Conclusion: Pre-operative diagnosis is difficult and it is usually diagnosed intraoperatively or by histopathological examination of the specimen.

A Rare Report of Vaginal Rhabdomyosarcoma

Sarcomas are connective tissue cancers and Rhabdomyosarcomas are cancers originating from the skeletal muscle cells of the body. A 23 year old female unmarried, nulligravida presented in our emergency with the complaint of bleeding per vagina on and off since last 4 months. The lesion measured 9.2 (cc) x8.7 (cs)x7.8 (ap) cm. The lesion displaced the uterus superiorly distended the vaginal canal compressed the urinary bladder and urethra anteriorly but with no evidence of infiltration into the pelvic side wall and with maintained fat plane. Rest all pelvic organs as well as abdominal organs were within normal limit. The HPE report on microscopic examination of the tissue showed features suggestive of malignant spindle cell neoplasm. Immunohistochemistry was done and IHC report showed: Positive for Desmin, Myogenin predominantly cytoplasmic positive. Correlating the morphologic and IHC markers the report came to be Embryonal Rhabdomyosarcoma (Botryoid Rhabdomyosarcoma). As soon as the final diagnosis was made patient was referred to Department of Oncology and chemotherapy with Cyclophosphamide was started. She has been on regular follow up since then and is keeping well. The presence of a cervical polyp in an adolescent is a gynecologic oddity and must necessarily be examined histologically because it might be a rhabdomyosarcoma. This is extremely important because diagnosis at an early stage of the disease is a highly favorable prognostic factor.

A CASE REPORT ON: MANAGEMENT AND OUTCOME OF MALIGNANT NEOPLASM OF EYE AND ADNEXA

Introduction: Although ocular adnexal cancers are relatively uncommon, their distinct spreading behavior and the functional significance of the eye and periocular tissues necessitate special diagnostic and therapy considerations. Case presentation: In this case, a 50-year-old male admitted to a rural hospital in Wardha. He was admitted with complaints of small growth over the upper eyelid since 1 year hence he visited to a private hospital and took homeopathic treatment but did not get relief. Then it increased in size of swelling hence he visited to rural hospital in Wardha and was investigated. CECT Orbit (10.05.2022) – There is an e/o heterogeneously enhancing soft tissue density lesion with areas of necrosis within it seen in the left periorbital region. The lesion measures 3.6*4.4*3.8 cm. The lesion is causing erosive destruction of the lateral wall of the left orbit and the anterior part of the left zygomatic arch. Anteriorly the fat plane is lost with preseptal and premaxillary soft tissues, medially involving the extra and intraconal compartment, lateral rectus muscle the fat plane with eyeball is lost with its compression, laterally involving the full thickness of adjacent subcutaneous tissue. A similar small lesion is seen in the subcutaneous plane adjacent to the left zygomatic arch. There are enhancing LNs seen in bilateral submental, submandibular, left preauricular region largest of size 18*10 mm with necrosis within in left submandibular region. There is an e/o heterogeneously enhancing lesion seen in the left parotid region with a necrotic area within it. Previous treatment has taken Surgery (06.06.2022) – Left Orbital exenteration with left MRND and left free ALT flap. He had started radiotherapy and completed 30 fractions Patient was admitted under radiation oncology. Conclusion: Careful visual examination should be a part of cancer patients' long-term follow-up strategy. Timely treatment and management of disease complications can be prevented.