Giant Mass Research Articles

Postmenopausal woman with 24 kgs ovarian mucinous cystadenoma: a rare case report

A case of a 53-year-old postmenopausal woman presenting a giant ovarian cystic mucinous tumor weighing 24 kg is reported here. When she was seen first at our outpatient clinic, she had gross abdominal distension since 2 years, and she complained of unbearable aggressive pain. Her computed tomography (CT) scan was done which came suggestive of ovarian serous cystadenoma of large massive size 35 x 40 x 32 cm with moderate ascites. On exploratory laparotomy, a giant, totally cystic, vascularized and smooth mass attached to the right ovary was encountered. On the postoperative tenth day, she was discharged without any problem. Histopathology report of the right ovarian cystic mass came suggestive of multiloculated cyst with capsule intact with Borderline Mucinous tumor of right ovary weighing 24 kg. This is both one of the largest known examples in the literature and the largest ovarian cyst ever seen at our institution.

CT FINDINGS OF THREE GIANT MEDIASTINAL TUMORS IN YOUNG AGE

Background : Mediastinal teratoma and other mediastinal tumors are very challenging to be distinguished from other mediastinal tumors. Mediastinal tumors can be optimally evaluated with computed tomography (CT). In this paper we present three young male patients with similar symptom of chronic chest pain and chronic cough. Materials and Methods: Conducting a literature review and medical records. Results : All patients in this case are young age male, below two decades. All chest CT shows giant mass, but they have different enhancing pattern, different amount of solid, cystic, calcification component. To make correct diagnosis of the mediastinal mass is important because of treatment planning difference, surgery or chemoteraphy. The first case shows benign teratoma with characteristic of heterogenous mass with large amount of fat, with presence of solid and calcification component. The second case shows malignant germ cell tumor with feature of heterogenous mass with predominantly solid component and small amount of fat. It also shows metastatic process in lung and bone. The third case shows Hodgkin lymphoma with slight enhanced mass that narrowed pulmonary artery and caused pericardial effusion. Conclusion: Various features of mediatinal tumors can be distinguished with CT modality.

Huge Aortic Aneurysm? Massive Fistula!

A 73 year old man presented to the emergency room with lumbar pain, dyspnoea, and oliguria. An abdominal tender pulsatile mass with a thrill and bilateral lower limb oedema were noted. Abdominal X ray revealed a giant calcified spherical mass (A; arrows). Computed tomography angiography showed a 14 cm infrarenal abdominal aortic aneurysm associated with inferior vena cava contrast filling during the arterial phase (B; arrow). Blood work revealed a serum creatinine of 5.2 mg/dL (basal 0.6 mg/dL) and N terminal pro B type natriuretic peptide of 25 000 pg/dL.

A Giant Cystic Liver Mass in an Elderly Man

Question: An 80-year-old man presented to our tertiary referral center because a giant hepatic cyst was incidentally detected on ultrasonography at a health checkup. He did not have any symptoms. He had a background of hypertension and coronary atherosclerotic heart disease, without personal or family history of cancer. Physical examination revealed a bulge in the middle upper abdomen but absence of other signs (Figure A).

Abstract 11805: Giant Cardiac Lymphangioleiomyomatosis: A Previously Unreported Primary Cardiac Tumor

Lymphoangioleiomyoma is a benign lymphatic tumor characterized by proliferation of perivascular epithelioid cells and is commonly known as part of the lymphangioleiomyomatosis (LAM). LAM is a rare, slowly progressive systemic disease and is considered as a low-grade, metastatic neoplasm, almost exclusively affects women of child-bearing age. LAM generally presents with features of cystic lung destruction. Independent onset of extrapulmonary LAM without typical cystic lung destruction is very rare. Herein, for the first time, we present a giant primary cardiac lymphangioleiomyoma of a 24-year old man with exertional dyspnea and intermittent chest pain. A giant mass (52 mm х 65 mm) and multiple irregular dark purple cauliflower-like nodules were found with irregular margins and firm texture involving the right atrium, right ventricle, inferior vena cava, superior vena cava and sinus node (Attached figure). Given the large size and wide involvement of the heart tumors, radical surgery was not performed except for a tissue biopsy. The final diagnosis of cardiac lymphangioleiomyoma was defined after pathological reexamination of the tumoral tissue sample. After comprehensive communication, the patient refused further surgical treatment and discharged with waiting for heart transplant. To our knowledge, the presented cardiac lymphangioleiomyoma is the first to be reported in the literature.

The efficacy of oxaliplatin, surufatinib, and camrelizumab on neuroendocrine carcinoma: a case report and literature review

Extra-pulmonary neuroendocrine carcinomas (EP-NECs) are rare, accounting for ~1/100,000 of NECs, aggressive neoplasms and poor prognosis. Sometimes, a non-neuroendocrine component is also accompanying these EP-NECs. Curative surgery is suggested for early stage patients while system chemotherapy and locoregional radiotherapy are considered for advanced inoperable disease. Nonetheless, there was lack of standard second-line treatment strategy. Herein, we report a case of NEC involving a large cell neuroendocrine carcinoma (LCNEC) and adenocarcinoma of the gallbladder treated with a surufatinib-containing regimen in the second-line treatment setting and establish the efficacy of this regimen in the treatment of EP-NECs. A 58-year-old male presented with symptoms such as distension in the upper right abdomen and a palpable mass. The abdominal magnetic resonance imaging (MRI) scan showed a giant soft tissue mass in the left lobe of the liver, and liver biopsy suggested LCNEC with a non-neuroendocrine (NNE) component. Based on the available literature, a first-line therapy of oxaliplatin + gemcitabine + camrelizumab + apatinib was started initially; however, there was rapid tumor progression. Thus, a second line of treatment was started, where apatinib was replaced with surufatinib, which was given along with oxaliplatin and camrelizumab and continued for seven complete cycles. The patient was re-examined with MRI, which showed a significant decrease in tumor size. And a partial response was achieved. Main adverse events included hand and foot numbness, hypertension, proteinuria, hematuria, and hyperthyroidism. The patient underwent surgery after the second line of treatment and the post-operative pathology report revealed the presence of LCNEC and adenocarcinoma of the gallbladder. Two months later, re-examination result showed no tumor recurrence. As yet, the criteria strategy for unresectable EP-NECs to improve survival outcomes is scarce. EP-NECs are badly in need of effective second-line therapy to carry out survival benefits after resistance to first-line regimen. The case report demonstrated that a surufatinib-containing regimen including oxaliplatin and camrelizumab could be an effective treatment strategy for the second-line treatment of EP-NECs. Furthermore, this strategy is well tolerated and treatment-related toxicity are manageable. More clinical trials are warranted to further confirm the efficacy.

Giant adrenal ganglioneuroma in children: a case report

BackgroundGanglioneuromas (GNs) arise from the Schwann cells, ganglion cells, and neuronal tissues, and are extremely rare, slow-growing, benign tumors. GN has usually grown very large when it is diagnosed since no specific clinical symptoms or laboratory findings indicating GN are available, especially when it occurs in the retroperitoneal space. Total resection of the tumor is the recommended treatment.Case summaryWe present the imaging and pathological findings of a giant adrenal GN in a child. A 7-year-old boy suffered from nausea and postprandial vomiting for 1 week with no precipitating factors. There was no family history of any disease, and the boy did not suffer from any disease in the past. Biochemical examination showed normal results. Physical examination showed an immobilized palpable mass in the left abdominal area. Abdominal computed tomography revealed a 13 cm × 10 cm solid mass in the retroperitoneal space. The mass showed slight and heterogeneous enhancement after injection of a contrasting agent. The mass was surgically resected locally to address the embedded abdominal vessels, and the histopathological and immunohistochemical diagnosis of the mass was GN. After the surgery, the symptoms of nausea and vomiting were relieved, and no complications occurred.ConclusionGN should be considered when a child presents with a giant retroperitoneal hypodense mass and the mass presents uneven and delayed enhancement. Histopathology is the golden standard for the diagnosis of GN. Currently, surgical excision is the optimal treatment.

Retroperitoneal Liposarcoma: The Giant Type

Retroperitoneal tumors (RPTs) are very rare tumors that arise in the large space of the retroperitoneum. About two-third of these tumors are malignant, of which soft tissue sarcoma (STS) is the most common and comprises almost one-third of malignant RPTs. Twenty to thirty percent of RPTs are benign. The retroperitoneal cavity has a very large potential space for tumor enlargement to a very high diameters without causing specific symptoms, especially during the initial phase of tumor enlargement. On diagnosis, the average tumor weight is 15 - 20 kg and tumor diameter is 20 - 25 cm. The most common retroperitoneal sarcoma type is liposarcoma, which account for 20% of all sarcoma types and 40% of all retroperitoneal sarcomas (RPSs). Other less common STS arise in the retroperitoneum include leiomyosarcoma and undifferentiated pleomorphic type. Giant liposarcoma is usually defined either as tumor diameter of 30 cm or more or tumor weight of 20 kg or higher. This specific type of sarcoma is very uncommon, with few case reports published in the English literature. Herein, we present a case of a healthy 33-year-old male patient, who was admitted due to abdominal distension and increased body weight since few months. An abdominopelvic computed tomography (CT) scan demonstrated a giant retroperitoneal mass of almost 40 cm in diameter in its largest dimension, located in the right retroperitoneal space. Ultrasound (US)-guided fine needle biopsy (FNB) was consistent with well differentiated liposarcoma. Surgical resection of the tumor along with the right colon, right ureter and kidney, third and fourth duodenal parts and part of the right iliopsoas muscle was contemplated. Histopathological report revealed well-differentiated liposarcoma of 50 cm in diameter, with foci of dedifferentiation, presented by pleomorphic sarcoma. Surgical margins were microscopically negative.

S1739 Giant Mucinous Cystic Neoplasm of the Pancreas in a 17-Year-Old: A Case Report

Introduction: Mucinous cystic neoplasms (MCNs) of the pancreas represent one of the most common primary pancreatic cystic neoplasms, accounting for approximately half of all cases. The probability of pancreatic cystic neoplasms being detected is raising year by year, although they are usually detected between ages 40-60, affecting women more than men. We present an unusual case of a gigantic MCN occurring in a 17-year-old patient. Case Description/Methods: A 17-year-old female with no past medical history presented to the ER with 3-month history of progressive abdominal distention, pain and an unintentional 9lb weight loss for a month. She was hemodynamically compensated, with physical exam significant for epigastric tenderness. Hemoglobin/hematocrit was noted at 6.2 g/dL and 24%, lipase 221 U/L. CT abdomen and pelvis without contrast revealed a large cystic mass in the pancreas, with marked splenomegaly (Figure). MRI of the abdomen w/wo contrast confirmed the presence of a large, complex, cystic structure with septations measuring 18x17cm. EUS with FNA of the mass resulted in aspiration of 100 cc of clear, mucoid fluid. Analysis of the aspirate revealed amylase of 8 U/L, glucose 27 mg/dL, and a CA19-9 level of 25,960 IU, raising concern for mucinous cystic neoplasm. She successfully underwent open resection of the mass which measured 20cm, with distal pancreatectomy and splenectomy. Pathology of the mass revealed a mucinous cystic neoplasm with low-grade dysplasia. The patient recovered and was discharged home. She reported significant improvement at a follow up in clinic 2 months later. Discussion: Giant MCN of the pancreas is described in the literature but has not been observed at such a young age. The incidence of detection of pancreatic cystic lesions increases year by year and is thought to be due to better imaging modalities detecting incidental lesions. To our knowledge, this is the youngest reported patient with symptomatic MCN.Figure 1.: a) coronal view on CT scan of the mass, b) axial view on CT scan of the mass, c) EUS demonstrating multiple septations of the giant mass.

Solving the Mystery of Giant Intrathoracic Mass

Intrathoracic schwannoma are highly vascular nerve sheath benign tumors arising from neural crest derived schwann cells of the intercostal nerves. Common clinical presentation is palpable mass but in our case patient presented with shortness of breath which is rare presentation in Schwannoma. Imaging studies of the patient showed the lesion in left lung, however surgical finding showed mass to arise from chest wall and it was confirmed to be schwannoma by histopathological examination.

Primary mediastinal large B-cell lymphoma, difficult differentiation from the epithelial neoplasm

rimary Mediastinal Large B-Cell Lymphoma (PMBL) is a rare neoplasm that arises in the mediastinum, and then forms a mass. A female in 50s noticed malaise of right upper limb and a firm lump in the right clavicular region. After consulting with a nearby doctor, she was introduced to our medical center. Magnetic resonance imaging showed a giant mass (12 x 7 x 6 cm) in the anterior and superior mediastinum with expansion to the right supraclavicular fossa. Microscopic examinations of a biopsy specimen led to a diagnosis of PMBL. Methotrexate with Adriamycin, Cyclophosphamide, Vincristine, Prednisolone and Bleomycin (MACOP-B) chemotherapy was given as well as rituxan. Although CT scanning show a marked reduction in size, the tumor remained and radiation therapy was added. Two years later, the patient was transferred to our medical center, though died due to cardiac arrest. From the initial symptoms to death was approximately three years. Touch smear cytology results showed tumor cells present in loose aggregates, though some clusters had a tight aggregation, suggesting epithelial cells. The tumor cells showed abundant and clear cytoplasm, with round nuclei containing nucleoli, and numerous lymphoglandular bodies were also seen. Cells of tight in tight aggregates expressed CD20, in immunocytochemical results, and an epithelial neoplasm was ruled out.

Giant Temporal Bone Angiosarcoma: Case Report and Literature Review

The authors describe a very rare case of an angiosarcoma originating from the petrous portion of the temporal bone that evolved as an indolent lesion until it became a giant retroauricular mass. A biopsy demonstrated that it was an angiosarcoma. A presurgical embolization from the left occipital and left parietal branches of the left middle meningeal artery was performed, followed by a total resection of the tumor. The patient developed a transient dysphasia during early follow-up, from which, subsequently, she fully recovered. There were no signs of recurrence in the current 3 years of follow-up. Free margins can be achieved even in some giant tumors and remain the most important prognostic factor for soft tissue malignant tumors with intracranial infiltration.

A Rare Case of an Abdominal Giant Mass Induced by Pancreatitis

Question: A 54-year-old man experienced intermittent abdominal pain for more than 4 months, with the physical examination finding of epigastric tenderness. He had a long history of alcohol consumption. Laboratory tests showed significantly elevated amylase (404 U/L) and lipase (1071 U/L), and the clinician highly suspected pancreatitis. To clarify the diagnosis and the severity of the patient’s condition, the patient underwent abdominal computed tomography (CT) and magnetic resonance imaging, which showed increased fat density around the pancreas, visible as multiple patchy exudative shadows (Figure A, red arrows) with blurred borders and dilated pancreatic ducts.

The ‘Giraffe’: discovery of a stripped red giant in an interacting binary with an ∼2 M⊙ lower giant

ABSTRACT We report the discovery of a stripped giant + lower giant Algol-type binary, 2M04123153+6738486 (2M0412), identified during a search for non-interacting compact object – star binaries. 2M0412 is an evolved (Teff, giant ≃ 4000 K), luminous (Lgiant ≃ 150 L⊙) red giant in a circular P = 81.2 d binary. 2M0412 is a known variable star previously classified as a semiregular variable. The cross-correlation functions of follow-up Keck/HIRES and LBT/Potsdam Echelle Polarimetric and Spectroscopic Instrument (PEPSI) spectra show an radial velocity variable second component with implied mass ratio q = Mgiant/Mcomp ≃ 0.20 ± 0.01. The All-Sky Automated Survey for SuperNovae (ASAS-SN), Asteroid Terrestrial-impact Last Alert System (ATLAS), Transiting Exoplanet Survey Telescope ( TESS), and Zwicky Transient Facility (ZTF) light curves show that the giant is a Roche lobe filling ellipsoidal variable with an inclination of 49.4 ± 0.3°, and a giant mass of Mgiant = 0.38 ± 0.01 M⊙ for a distance of ≃ 3.7 kpc. The mass of the giant indicates that its envelope has been partially stripped. The giant companion on the lower red giant branch has a mass of Mcomp = 1.91 ± 0.03 M⊙ with Teff, comp ≃ 5000 K, Lcomp ≃ 60 L⊙, and Rcomp ≃ 11 R⊙. The lower giant contributes ${\sim }35{{\ \rm per\ cent}}$ of the flux in the V band. We also identify an orbital phase dependent, broad $\rm H\,\alpha$ emission line which could indicate ongoing accretion from the stripped red giant on to the companion.

Resection of a rare giant chondromesenchymal hamartoma of the scalp with intracranial blood supply in an adult woman: illustrative case.

Nasal chondromesenchymal hamartomas (NCMHs) are benign, slow-growing lesions formed by mesenchymal and cartilaginous components. They occur predominantly in male infants at the nasopharynx and orbit. Rare cases have been reported in adults. Ectopic NCMHs occurring in other head regions without the typical nasopharyngeal or orbital involvement have not been previously described. The authors presented the case of a 40-year-old woman with a giant mass in the left frontoparietal region that started to enlarge progressively after the patient's first pregnancy at the age of 21 years. The tumor caused intense headaches, nausea, vomiting, asthenia, and syncope. On admission, the neurological examination revealed no abnormalities. Brain magnetic resonance imaging showed a solid homogeneous tumor without intraaxial involvement extending inferiorly to the left zygomatic arch, with a significant mass effect on the adjacent bones but no infiltration. Remarkably, digital subtraction angiography demonstrated that the tumor received blood supply from superficial as well as intracranial branches of the left vertebral artery. After tumor resection, histopathological analysis revealed characteristics indistinguishable from an NCMH. The authors described a rare NCMH of the scalp with intracranial blood supply in an adult patient. A case with similar characteristics had not been reported before.

Giant Cardiac Rhabdomyoma with Mixed Atrial Tachycardia and Nonsustained Ventricular Tachycardia in a Newborn with Tuberous Sclerosis

Cardiac rhabdomyomas are typically presented in the tuberous sclerosis. Although benign and often associated with spontaneous regression, in rare circumstances huge mass size and critical location can lead to heart failure, ventricular outflow tract obstruction and refractory tachyarrhythmias. An 1-day-old girl was diagnosed as cardiac tumor during perinatal period. At birth, transthoracic echocardiography revealed huge cardiac mass located in septal area of both ventricle measuring 34×30 mm. It protruded into the left ventricular (LV) outflow tract, potentially obstructing it. A surface ECG revealed atrial tachycardia with nonsustained ventricular tachycardia with heart rate of 217 beats per min. The tachyarrhythmias were controlled with intravenous amiodarone. Reduction of the giant cardiac mass was treated with mammalian target of rapamycin pathway inhibitor sirolimus. However, she unfortunately died at 10 days-old because of sudden cardiac arrest maybe due to LV outflow tract obstruction during therapy. Gene analysis revealed TSC2 mutation after death. (Ewha Med J 2022;45(3):e5)

Giant retroperitoneal liposarcoma: A case report.

Introduction and importanceRetroperitoneal liposarcomas are rare malignancy. They can grow usually asymptomatic until large enough to compress the surrounding organ. Giant retroperitoneal liposarcoma with diameter over 30 cm and weight over 20 kg is extremely rare. There has been limited report of giant retroperitoneal liposarcoma.Case presentationA 34-year old woman complained about intermittent abdominal discomfort and progressive abdominal distension for last 2 years. There was history of weight loss for last 3 months. CT scan with contrast showed giant right abdominal mass that expanded to the pelvis (30.4 × 28 × 34 × 29 cm), oppressed surrounding organs and displaced the intestine to the left side with no visualization of normal right kidney structure. Complete resection of this retroperitoneal tumor was performed without combined resection of the surrounding organ. The biopsy of tumor showed a well differentiated liposarcoma. We diagnosed this patient with giant retroperitoneal liposarcoma. The postoperative course was uneventful and the patient was discharged on the 3th postoperative day. Last follow up, 3 months after surgical resection, patient had no complaints and there was no recurrence of this retroperitoneal liposarcoma.Clinical discussionComplete resection is the predominant treatment of retroperitoneal liposarcoma to avoid recurrence. Successful complete resection of retroperitoneal liposarcoma may increase the 5-year survival rate from 16.7 to 58 %. However, complete resection is a challenge, particularly in the well-differentiated subtype, for the reason that the margins are not easily distinguishable.ConclusionGiant retroperitoneal liposarcoma is an extremely rare tumor with high rate of recurrence, depends on some factors such as the histological type and grade, the metastasis, and also completeness of tumor resection. In this case we performed complete resection without combined resection of the surrounding organ. Furthermore, we will continue to observe our patient closely for recurrence.

Mezenterik Kisti Taklit Eden Dev Over Kistine Mini-Phannensteil İnsizyon ile Yaklaşım

Cysts can occur in all body tissues, but cysts in organs other than the ovaries present symptoms more rapidly due to the resulting dysfunction. Ovarian cysts often do not cause complaints because they are not in contact with other organs and are typically detected during routine checks. Although cysts of various sizes are encountered, giant ovarian cysts are extremely rare. This report presents the case of a 36-year-old female patient admitted to our clinic with complaints of inguinal pain, abdominal swelling, and constipation. In the ultrasonographic examination, a giant cystic mass thought to originate from the left adnexal area, was observed. A decision to perform surgical operation for the left ovarian mass was made. The cystic mass, 15 × 20 cm in size and originating from the mesoileum, was excised with its wall after peroperative aspiration with a mini-phannensteil incision. Considering this case, we aimed to demonstrate that giant ovarian cysts can be confused with mesenteric cysts and that giant benign cysts can be excised with a mini-phannensteil incision.

A Case Report of Oblique Vaginal Septum Syndrome with Difficulty in Defecation as the Initial Symptom

Oblique vaginal septum syndrome (OVSS) is a rare congenital disorder characterized by uterus didelphys, hemivaginal septum, and unilateral renal agenesis. Its clinical characteristics vary among different patients. Herein we report a case of OVSS with difficulty in defecation as the initial symptom and diagnosed with ultrasound and laparoscopic exploration. This 13-year-old girl was admitted to our hospital with the complaint of difficulty in defecation for more than 1 month and difficulty in urination for 6 days. Her ultrasound test showed that the left kidney was not displayed, and the right kidney was compensatory enlargement. A giant cystic-solid mass (110 mm × 96 mm × 87 mm) was seen in the pelvic cavity. Under laparoscopy, a huge mass was seen in the abdominal cavity. The surface resembled the seromuscular layer of the uterus. A uterine organ was seen on both sides of the tumor, and both fallopian tubes and ovaries were connected. The size of the right uterus was about 3 cm × 2 cm. The right fallopian tube and ovary were normal in appearance. The left uterus was enlarged (about 6 cm x 5 cm). The left fallopian tube was enlarged and contained a large amount of brown blood stains, and blood stains were seen flowing out from the umbrella end. The hysteroscopic incision and repair surgery were then performed. Most patients with OVSS presented with dysmenorrhea, abdominal pain, pelvic mass, and foul mucopurulent discharge, while in this case, difficulty in defecation was the initial symptom. Thus, this case report provided evidence supporting the heterogeneity of this disorder.

Autopsy case of a patient with rapidly progressive combined small‐cell lung carcinoma with spindle‐shaped cell tumor

A 69‐year‐old Japanese man visited our hospital because of worsening shortness of breath. His chest computed tomography (CT) showed a giant left lung mass with a massive left pleural effusion. He could not be treated with chemotherapy and eventually died from a rapidly progressive tumor. He was diagnosed with combined small cell lung carcinoma (C‐SCLC) with spindle‐shaped cell tumor at autopsy. C‐SCLC is characterized by pathologically concurrent SCLC and adenocarcinoma or squamous cell carcinoma, or rarely, spindle‐shaped cell tumor. The clinical course of C‐SCLC with spindle‐shaped cell tumor has not previously been determined. Our patient's tumor increased by 2.59‐fold in 20 days. The combination of C‐SCLC with spindle‐shaped cell tumor suggested rapid progression and a poor prognosis.