Huge Abdominal Mass Research Articles

Congenital Mesoblastic Nephroma Mimic Wilms Tumor on 18 F-FDG PET/CT and PET/MR.

Congenital mesoblastic nephroma is an extremely rare, low-grade malignant renal tumor in children. A 10-month-old boy and a 4-month-old girl were admitted to our hospital with a huge abdominal mass. For staging of the mass, 18 F-FDG PET/CT and PET/MR were performed showing a huge heterogeneous abdominal mass accompanied by extensive heterogeneous aggregation. Both of them were highly suspected to be Wilms tumor, the most common renal malignant tumor in children. However, histopathological examination after surgery confirmed congenital mesodermal nephroma.

CryptoImperforate Hymen with a Huge Abdominal Mass and Massive Hematocolpometra in a 15-Year-Old Girlmenorrhea with a Huge Abdominal Mass and Massive Hematocolpometra in a 15-Year-Old Girl

Background: Imperforate hymen is one of the commonest embryological defects of the lower genital tract which occurs due to failure of canalization of the sinovaginal bulb. Its incidence is 1 in 2000 girls. Case Presentation: This case is of a 15-year-old nullipara who presented on account of a 2-month history of recurrent abdominal pain, hesitancy, and primary amenorrhea. Her physical examination reveals a huge abdominopelvic mass about the size of a 26 weeks intra-uterine gestation, and a vagina examination revealed an imperforate hymen. A pelvic ultrasound confirmed a massive hematometra and hemaltocolpos leading to a diagnosis of imperforate hymen. She had a hymenotomy with a cruciate incision to drain the menstrum. Conclusion: Pediatricians and gynaecologists need a high index of suspicion to diagnose this defect for earlier treatment and reduced morbidity due to late diagnosis.

Giant Hydronephrosis Presented as a Huge Abdominal Mass in a 22-Year-Old Male: A Case Report

Giant Hydronephrosis Presented as a Huge Abdominal Mass in a 22-Year-Old Male: A Case Report

Uterine angioleiomyoma with disseminated intravascular coagulation: a case report

BackgroundUterine angioleiomyoma is benign tumor that composed of smooth muscle cells and thick-walled vessels. It is a very rare condition reported to present as lower abdominal mass, accompanied by dysmenorrhea and hypermenorrhea. However, its clinical presentation is not known.Case presentationWe report the case of a 44-year-old Japanese woman who developed severe anemia with disseminated intravascular coagulation without obvious external bleeding. The patient had a huge abdominal mass of over 20 cm in size, which was thought to be a uterine tumor. She received daily blood transfusions and her condition improved rapidly after she underwent hysterectomy. Pathological examination of the tumor revealed spindle-shaped cells with little atypia and mitosis, and numerous large vessels with smooth muscle and thrombus in the vessels.ConclusionsUterine angioleiomyoma was identified as the cause of the coagulation abnormality. CCND2 and AR gene amplification was detected in the tumor. Uterine tumors that present with coagulopathy despite a clinical course suggestive of benign disease should undergo differential diagnosis for uterine angioleiomyoma.

Giant gastric stromal tumor with predominant cystic formation misdiagnosed as gastric cyst under endoscopic ultrasonography and fine-needle aspiration.

A 78-year-old man was admitted owing to 10 days of abdominal pain. He had a history of coronary heart disease, diabetes mellitus, and hypertension. Laboratory results, including tumor markers, blood amylase, and lipase, were unremarkable. During physical examination, a mass was palpated in the left upper abdomen (from the left costal arch to the umbilicus), which had an indistinct boundary and was poorly mobile. Esophagogastroduodenoscopy revealed a bulge in the gastric fundus with an unremarkable mucosa ([Fig. 1]). Computerized tomography revealed a huge abdominal cystic mass (23.3 × 14 × 22 cm), which had an indistinct boundary with the stomach ([Fig. 2]), and distinct boundaries with adjacent organs such as the liver, pancreas, etc. Endoscopic ultrasonography revealed a hypoechoic cystic lesion with scarred hyperechoic strip, and fine-needle aspiration was performed ([Video 1]). A rapid on-site evaluation was unremarkable. The cystic fluid analysis revealed a negative stringing test, normal amylase and lipase, slightly elevated CA125 and ferroprotein, with normal CEA, CA199, and AFP. Cell block and immunocytochemistry were also undiagnosed. Surgical resection was performed ([Fig. 3]), and 3000-mL cystic fluids were aspirated intraoperatively. Postoperative histology showed a spindle cell tumor ([Fig. 4]) with necrosis and cystic degeneration, and immunohistochemical results showed positive staining of CD117, DOG1 ([Fig. 5]), and CD34, with negative staining of SMA, S100, and Ki-67 index of 25 %, and mitoschisis of 8/50 HPF. Therefore, the final diagnosis was a high-risk gastrointestinal stromal tumor (GIST). He refused imatinib treatment and died within 2 years.

Successful Surgical Treatment of Stage IVB Immature Teratoma Involving the Liver and Thoracic Cavity, With Combination Chemotherapy: A Case Report

Introduction Immature teratomas are very rare tumors, representing only 1% of ovarian cancers. Distant metastases to the liver effect late disease manifestation, rendering chemotherapy the only viable option. Case presentation Here, we report the successful surgical management of stage IVB immature teratoma after cisplatin-based chemotherapy. A 20-year-old woman presented with a huge abdominal palpable mass and dyspnea. Postoperative pathology confirmed immature teratoma with metastases to the liver, diaphragm, and thoracic cavity (stage IVB). The patient underwent right hemihepatectomy, diaphragm resection, thoracic mass resection, and diaphragm repair using aortic artificial graft. She did not receive postoperative adjuvant chemotherapy. After the complete surgical resection of the tumor, the patient had no recurrence during the 44-month follow-up period. Conclusion No established treatment modalities have been developed for further treatment, once the first-line combination chemotherapy achieves unfavorable results in stage IVB immature teratoma. Surgical resection may offer hope for excellent disease control in this dismal stage. To obtain best possible outcomes, coordinated care between oncologists and general surgeons is required.

Giant hydronephrosis presented as a huge abdominal mass in a 16-year-old female: a case report

Giant hydronephrosis owing to ureteropelvic junction obstruction is a rare condition characterized by the accumulation of more than 1000 ml of urine in the pyelocaliceal system. It could mimic the other benign cystic kidney disease or other causes of abdominal mass in radiologic images. We reported a 16-year-old female who presented with three months of abdominal pain and gradual abdominal mass ingrowth. Abdominal computed tomography scan showed a giant left cystic mass favored hydronephrosis secondary to ureteropelvic junction obstruction. The patient underwent a left nephrectomy, and more than 12 litters of turbid urine were suctioned from the affected kidney. In conclusion, giant hydronephrosis is an infrequent entity and should be considered in the differential diagnosis of large cystic abdominal masses. The treatment is determined by the underlying cause and the visual appeal of the affected kidney.

Adrenal and Mesenteric Teratomas in Infants

ABSTRACTTeratomas are common tumors in children. The most common sites are gonads, however, several extragonadal sites are well known such as sacrococcygeal region, mediastinum, head and neck, stomach, and vagina. Occasionally, teratomas occur in unusual sites which pose diagnostic difficulties. Here, we describe two cases of infantile teratomas with unusual presentation. The first case was a 6-month-old girl who presented with a mass in the right side of the abdomen. Computed tomography (CT) scan showed a solid-cystic mass in the right suprarenal region. The second was a 4-month-old boy who came with a huge abdominal mass. Contrast-enhanced CT showed a tumor arising from the jejunal mesentery. On microscopic examination, they were diagnosed as mature and immature teratoma, respectively. Although neuroblastoma is the most common infantile adrenal neoplasm, the possibility of teratoma should be considered for cystic adrenal lesions. Mesenteric teratoma can be difficult to distinguish radiologically from the more common lymphangioma; however, accurate diagnosis is important in view of long-term follow-up for teratomas because of the possibility of malignant transformation.

Pseudocyst of Abdomen Presenting as a Huge Abdominal Mass after Ventriculoperitoneal Shunt: A Case Report

A ventriculoperitoneal shunt is a major surgical modality to relieve intracranial pressure in patients with hydrocephalus. Shunt obstruction and infection are the most common complications following shunt surgery whereas VP shunt-associated pseudocyst formation is a rare complication. These are the cystic space without the epithelial lining, filled with fluid around the distal tip of the catheter.
 In this case report, we present you a 47-year-old male who underwent VP shunt placed a year back presented with huge abdominal swelling, headache, and weight loss. CT scan of the abdomen showed abdominal pseudocyst with the peritoneal end of the shunt within the cyst.
 Though the exact mechanism is not known, abdominal adhesion, multiple revisions, obstruction, or dislodgement are thought to predispose to the formation of a pseudocyst.

Preoperative Transcatheter Arterial Embolization and En-Bloc Resection for Giant Non-Functioning Left Adrenocortical Carcinoma: A Case Report

Objective: To demonstrate efficacy and relative safety of compartment surgery in a case of large sized adrenocortical carcinoma (ACC), whenever associated with preoperative transcatheter arterial embolization (TAE) and adjuvant treatment with mitotane. Introduction: ACC is a rare illness; non-functioning lesions account for 40-55% of patients, may reach a large size, and show a clear attitude to infiltrate neighbouring organs. Case Report: Middle aged male visited for a huge left abdominal mass; contrast CT scan showed origin from the left adrenal lodge and possible extension of the tumor to surrounding structures. Preoperative adrenal work-up confirmed non-functioning nature of the adrenal mass. In order to allow a safe compartment excision and to decrease blood loss, preoperative angiography and TAE was performed. Patient underwent en-bloc resection of the mass, together with nephrectomy and distal splenopancreasectomy. No postoperative transfusions were required. Patient received adjuvant therapy with mitotane for 36 months since surgery, without any sign of tumor recurrence. Conclusion: An aggressive surgical approach seems justified also in locally advanced and infiltrating ACC; compartment resection is mandatory in order to obtain adequate resection margins. Preoperative TAE decreases intraoperative blood loss and need for transfusions. Adjuvant treatment with mitotane may contribute to reach remarkable disease-free survival.

Dysgerminoma: diagnostic impasse

Dysgerminoma is a rare malignant ovarian tumour in women of reproductive age group, featuring lower abdominal pain and abdominal mass with elevated tumour markers. The tumour grows rapidly and diagnosed at an earlier stage. We present a short-statured 20 years girl with intermittent abdominal pain and distention for 4 months, on examination huge abdominal mass of size 20x15 cm, firm in consistency was palpable, lower limit not ascertained. Routine blood investigations normal, thyroid function test showed hypothyroidism. A plain abdominal radiograph shows a large homogenous mass fitting mid part of abdomen with displaced bowel loop. Contrast-enhanced computed tomography abdomen and pelvis show up 20x18.5x9.5 cm well defined heterogeneous mass, with areas of necrosis suggesting mesenchymal tumour or germ cell tumour. CA 125, alpha-fetoprotein, lactate dehydrogenase, beta human chorionic gonadotropin were raised. Magnetic resonance imaging abdomen and pelvis show 10x16x17cm hetero intense lesion, bilateral ovary normal. After tumour board discussion image-guided biopsy was done, suggestive of epithelioid gastrointestinal stromal tumour. Laparotomy displayed a large mass 22x16x10 cm arising from left ovary, no enlarged lymph node, completed with left salpingo-oophorectomy. Histopathology examination and immunohistochemistry definitive of dysgerminoma. In this clinical scenario, we narrate the importance of clinical examination and increased dependence on imaging modalities in diagnosing the patient. The treatment is based on the international federation of gynaecology and obstetrics staging with surgical treatment, adjuvant chemotherapy and radiotherapy.

Giant Retroperitoneal Dedifferentiated Liposarcoma: A Case Report

Summary Retroperitoneal soft tissue sarcomas comprise a relatively rare entity with incidence rates of less than 1% of all malignancies. The surgical treatment of these tumors is challenging. We present a case of a 70-year-old patient who underwent radical surgery at the Department of Surgical Oncology at the University Hospital in Pleven for giant dedifferentiated liposarcoma. The patient presented with cachexia, anemia, dull abdominal pain, and a huge abdominal mass. After ultrasound and CT, the tumor was assessed as resectable. The removed tumor mass weighed 5.7 kg. Nowadays, complete resection of such tumors remains the most important predictive factor for local recurrence and overall survival.

Huge abdominal mass with hematocolpometra due to imperforate hymen: an unusual clinical presentation

The imperforated hymen is one of the commonest genital tract malformations usually present with cyclic abdominal pain and an obstructive pelvic mass at post-pubertal age. The unusual pre­sentations are delayed menarche with obstructive symptoms rarely acute retention of urine, te­nesmus, and constipation. We report an unusual case of 12- year old girl with a huge mass in the lower abdomen examination revealed imperforate hymen at early pubertal age.
 Further investigation of Magnetic Resonance Imaging (MRI) confirmed hematocolpometra. Then, she underwent simple hymenotomy and drainage of collected menstrual blood from the genital tract. She recovered well during the postoperative periods. We conformed normal menstrual flow at her first follow-up. In conclusion, Imperforate hymen at peripubertal age with an unusual huge abdominopelvic mass concerns further imaging to assure the best outcome.

Juvenile granulosa tumor of the ovary: Report of two cases

Sex cord ovarian tumours are rare tumours that develop in non-germinal ovarian cells. The pathogenesis of these tumours remains undetermined and several cellular and molecular alterations may be involved in the development of juvenile granulosa cell tumours. The individualization of juvenile granulosa cell tumors has been a major advance in the treatment of these tumors in children over the past two decades. However, their natural history is reported in the literature and through a short and reliable series, prognostic factors have to be established. We report two cases of an 8 and 11 year old girl who presented with an abdomino-pelvic mass gradually increasing in size, on surgical exploration found a huge abdominal mass of the ovary. An anatomopathological study with immunostaining of the surgical specimen confirmed the diagnosis of a Juvenile granulosa cell ovarian tumor.

Seminal Vesicle Cystadenoma Presenting as a Giant Cystic Abdominal Mass: Case Report and Literature Review

Benign primary tumors including cystadenomas are the rarest tumors of the seminal vesicles. All around only 22 cases of cystadenoma of the SV have been reported since 1944. The diagnosis is typically made on final pathology since clinical findings and imaging techniques are non-specific. The only curative treatment is surgical resection, either by open or laparoscopic surgery. In our work, we report the case of a giant seminal vesicle cystadenoma in an 80 yearsold patient in whom the huge abdominal cystic mass was suspicious to be related to a malignant process since it presented intimate contact with pelvic structures. Pathological examination after excision of the mass has confirmed the nature of the huge mass as a benign cystadenoma of the seminal vesicle

Large Endometriotic cyst-masquerading as ovarian malignancy

Endometriosis usually affects premenopausal females. Its pathogenesis is not completely understood. The presence of functioning endometrial glands and stroma outside the uterine cavity is known as endometriosis. Endometriosis can be found in both ovaries, the pouch of Douglas, pelvic peritoneum, and uterosacral ligaments. Cystic forms of endometriosis can occasionally present as a huge abdominal mass, mimicking ovarian malignancy. Hereby, we present one such case of a large endometriotic cyst in a pre-menopausal female. She underwent surgery, and the histopathology, along with immunohistochemical examination, proved it to be a case of endometriotic cyst. Although this diagnosis is relatively rare, this should be considered as a differential diagnosis in the case of cystic lesions in premenopausal females.

A rare case of adult granulosa cell tumor of ovary as a cause of huge abdominal mass and postmenopausal bleeding

Adult granulosa cell tumor (GCT) is a rare ovarian malignancy with incidence of 1%–2% of all tumors. They are usually detected in an early stage as they often have features of hyperestrogenism unlike epithelial ovarian tumors. Treatment consists of surgery to remove the tumor and depending on the extent of the tumor, additional treatments may also be used. Surgical management of granulosa tumors is based on the stage of the tumor as well as age of the patient. In postmenopausal women and those who have completed childbearing, surgery consists of a total abdominal hysterectomy and bilateral salpingo-oophorectomy, along with standard surgical staging. The prognosis of granulosa cell tumors is comparatively better than other epithelial tumors. For the optimal management of these unusual neoplasms, prospective multicentric trials are required to assess the function of adjuvant therapies. Knowing more about GCT's molecular pathogenesis can determine appropriate targeted disease management therapies.

Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of a case of a huge abdominal mass.

Testicular mixed germ cell tumor is characterized by high degree of malignancy and prone to metastasis, the common of which is retroperitoneal lymph node metastasis. At present, EUS has a very important diagnostic value for mediastinal, enterocoelia and retroperitoneal lymph node metastasis of malignant tumors. It also has a positive value for the space occupying of parenchyma or cavity organ and can be used for the puncture operation of multiple lesions under real-time ultrasound monitoring with high safety and small complications.

Colonic duplication presenting as a huge abdominal mass in an adult female

IntroductionDuplications of the alimentary tract are a rare congenital malformation. Most of the cases are symptomatic and diagnosed before 2 years of age. Here, we report a young female presented with a huge abdominal mass, and colonic duplication was confirmed during laparotomy.Case presentationA 29-year-old female had chronic constipation treated with laxative agents. She presented to the emergency room with abdominal cramping for 3 days, accompanied with intermittent fever and vomiting. A huge movable abdominal mass was noted during physical examination. Computerized tomography showed a long segmental dilated bowel lumen with stool impaction and bowel wall thickening of the dilated lumen in the left abdomen, highly suggestive of a long tubular colon duplication. The patient underwent subtotal colectomy. Specimen subsequently confirmed the diagnosis for colonic duplication from cecum to sigmoid colon, and the duplicated colon was found on the antimesenteric side of the native colon. She had a stable postoperative course and was discharged 9 days later.DiscussionDuplications of the alimentary tract are a rare congenital anomaly. Colonic duplication is an even more unusual malformation of this type. It can be classified into cystic or tubular type according to the gross morphology and may or may not be associated with other congenital anomalies. Most common presentation includes abdominal distention, refractory constipation, and bowel obstruction like many other colorectal conditions. Thus, its indistinct symptoms make it difficult to be diagnosed preoperatively. The recommended treatment is surgical resection of the duplicated lumen along with the attached native colon.

REACTIVE NODULAR FIBROUS PSEUDOTUMOR: A RARE MESENCHYMAL TUMOR

Reactive nodular fibrous pseudotumor (RNFP) is a recently described non-neoplastic mesenchymal lesion arising from thegastrointestinal tract, mesentery, or retroperitoneum. It is a rare entity with only a few cases reported in literature so far and is lessaggressive when compared to other mesenchymal lesions such as gastrointestinal stromal tumor (GIST) or fibromatosis. Here, wepresent the case of a 20-year-old female who presented with a huge abdominal mass. Contrast-enhanced computed tomographywas suggestive of pseudopapillary tumor of the pancreas. The patient underwent exploratory laparotomy and excision of the massin toto along with sleeve gastrectomy and splenectomy. Post-operative histopathology confirmed the entity to be RNFP. This caseillustrates the need for keeping RNFP in mind as a differential diagnosis in a case of large abdominal mass as it has a fairly goodprognosis with no reported recurrence after surgical excision.