Incidental Findings In Patients Research Articles

Incidental Extrauterine Stromal Sarcoma in a Patient With Ovarian Carcinoma

Most low-grade endometrial stromal sarcomas are intrauterine in origin, and a primary extrauterine location in the mesentery or omentum is extraordinarily rare. Hence, we report a well-documented, low-grade endometrial stromal sarcoma of extrauterine origin as an incidental finding in a patient who had extensive ovarian intra-abdominal carcinomatosis. This case adds to the literature experience in this entity and illustrates that such lesions may occur as incidental and unexpected findings in patients with other gynecologic neoplasms.

Paraovarian and paratubal cysts: Preoperative diagnosis using transabdominal and transvaginal sonography

Objective Paraovarian and paratubal cysts constitute about 10% of adnexal masses. Our purpose was to determine whether pathologically proven examples of these lesions were correctly identified during preoperative transabdominal and transvaginal sonographic evaluations. Methods Between 1990 and 1994, 15 women with 10 paraovarian cysts and 5 paratubal cysts underwent preoperative sonography. The sonograms were performed using transabdominal and transvaginal probes. Mean interval before surgery was 22 days (range: 1–96 days). The sonographic interpretation at the time of the examination was correlated with the pathological findings. Results In only 1 of 15 patients was a paraovarian or paratubal cyst suggested before surgery. Paraovarian cysts were misdiagnosed as ovarian cysts. Because of the microscopic size of paratubal cysts in our series, none was diagnosed before surgery and these were usually an incidental finding in patients with ovarian masses. Conclusions In our experience, paraovarian and paratubal cysts are difficult to diagnose before surgery with the use of transabdominal and transvaginal sonography. We speculate that when there is close proximity of a paraovarian cyst to the ovary, an ovarian cystic mass cannot reliably be differentiated from a paraovarian cyst. © 1996 John Wiley & Sons, Inc.

Paraovarian and paratubal cysts: preoperative diagnosis using transabdominal and transvaginal sonography.

Paraovarian and paratubal cysts constitute about 10% of adnexal masses. Our purpose was to determine whether pathologically proven examples of these lesions were correctly identified during preoperative transabdominal and transvaginal sonographic evaluations. Between 1990 and 1994, 15 women with 10 paraovarian cysts and 5 paratubal cysts undewent preoperative sonography. The sonograms were performed using transabdominal and transvaginal probes. Mean interval before surgery was 22 days (range: 1-96 days). The sonographic interpretation at the time of the examination was correlated with the pathological findings. In only 1 of 15 patients was a paraovarian or paratubal cyst suggested before surgery. Paraovarian cysts were misdiagnosed as ovarian cysts. Because of the microscopic size of paratubal cysts in our series, none was diagnosed before surgery and these were usually an incidental finding in patients with ovarian masses. In our experience, paraovarian and paratubal cysts are difficult to diagnose before surgery with the use of transabdominal and transvaginal sonography. We speculate that when there is close proximity of a paraovarian cyst to the ovary, an ovarian cystic mass cannot reliably be differentiated from a paraovarian cyst.

Intracranial cysts in autosomal dominant polycystic kidney disease.

Autosomal dominant polycystic kidney disease (ADPKD) is a systemic disorder well known for its association with intracranial aneurysms. A series of patients with ADPKD who were screened for the presence of an intracranial aneurysm were reviewed and found to include an unexpectedly high number with intracranial arachnoid cysts. Among 247 patients with ADPKD who underwent magnetic resonance imaging (180 cases) or high-resolution contrast-enhanced computerized tomography (67 cases), there were 151 women and 96 men with a mean age of 44 years. Intracranial arachnoid cysts were found in 20 patients (8.1%) with ADPKD compared to two (0.8%) in a control group without ADPKD matched for age, sex, and method of imaging (p < 0.0001). Multiple intracranial arachnoid cysts were found in two patients. Polycystic liver disease was present in 17 (85.0%) of the 20 patients with intracranial arachnoid cysts compared to 119 (52.4%) of the 227 patients without (p < 0.004). Pineal cysts were found in two patients (0.8%) and choroid plexus cysts were found in three patients (1.2%) but this was not different from the control population. None of the intracranial cysts was symptomatic and none was treated surgically. Intracranial arachnoid cysts are a relatively frequent incidental finding in patients with ADPKD, providing further support for the systemic nature of this disease. In the authors' experience with approximately 1500 patients with ADPKD, no complication has been encountered from an intracranial arachnoid cyst, suggesting that asymptomatic intracranial arachnoid cysts in patients with ADPKD require no treatment.

Saccular aneurysms of the distal anterior cerebral artery and its branches.

We report a series of 84 consecutive patients (41 women) with 92 distal anterior cerebral artery aneurysms (DACAA). All aneurysms were saccular. Four different locations of DACAAs were found: proximal, 5 aneurysms; frontobasal, 8; genu corporis callosi, 72; and distal, 7. Sixty-five patients presented with subarachnoid hemorrhage (SAH), the rest were incidental findings in patients with multiple aneurysms. Forty-five patients had single DACAAs. Multiple aneurysms (a total of 117) were found in 39 patients (46.4%), and DACAAs were responsible for SAH in 20 patients. Of the 65 patients with SAH, 54 underwent mainly early direct surgery, and 46 (85%) of these had good outcomes 1 year after surgery. Three patients remained severely disabled, and five patients (9%) died. All of the poor surgical results were obtained in patients with severe preoperative deficits. Exact measurements of DACAA sizes and necks were smaller than those of cerebral aneurysms in other locations. Aside from localization, microsurgery of these aneurysms presented no special difficulties, as compared with surgery of aneurysms in other locations.

The Case for Conservative Management of Venous Angiomas

Venous angiomas (developmental venous anomalies) are vascular malformations increasingly recognized in general neurosurgical or neurological practice. They are associated with intracranial hemorrhage, seizures, or progressive neurological deficits or found as incidental findings in patients who present with headaches or have neuroimaging studies for investigation of unrelated neurological disorders. Since venous angiomas drain normal cerebral tissue within a functionally normal arterial territory, resection can lead to venous infarction. This report studies 27 patients with venous angiomas, all of whom had conservative treatment. The venous angioma was considered to be responsible for the onset of neurological symptoms in 14 patients (7 with hemorrhage, 3 with hemorrhage and seizures, 2 with seizures, one with an extrapyramidal movement disorder, and one with motor deficit). Thirteen patients had incidental lesions (8 with headache, and 5 with unrelated neurological symptoms). Ten venous angiomas were in the posterior fossa; seven in the cerebellum. Location did not correlate with symptomatic presentation. No patient with hemorrhage required surgical evacuation of the hematoma. No patient died or had significant morbidity during the follow-up interval (mean of 3.7 years). Venous angiomas are low flow, low resistance vascular malformations, many of which are not associated with neurological sequelae. Our series supports the concept that surgical removal or radiosurgical obliteration should not be performed unless a patient has a second life threatening hemorrhage.

MRI of the paranasal sinuses: incidental abnormalities and their relationship to symptoms

Magnetic resonance imaging is able to demonstrate a wide range of sinus abnormalities. Incidental findings in patients referred for neuroradiology because of suspected intracranial pathology are surprisingly common and were present in 37.5 per cent of 483 images examined. The maxillary and ethmoid sinuses were most commonly affected with 27 and 26 per cent of images abnormal whereas the frontal and sphenoid sinuses were less commonly affected with 5 per cent of each abnormal. If minor changes were excluded then 17 per cent of patients had either fluid, a polyp or marked mucosal thickening in at least one sinus. Nasal symptoms, other than the presence of a cold, showed no statistically significant relationship to abnormal findings. Many people with inflammatory changes in their sinuses demonstrated on MRI do not have symptoms classically attributed to sinusitis.

New spiral bacterium in gastric mucosa.

A new spiral bacterium, distinct from Campylobacter pylori, was found in the gastric mucosa of six patients with gastrointestinal symptoms. All patients had chronic active type B gastritis and four had oesophagitis. Culture and microscopy for C pylori infection was negative. These unculturable spiral organisms were probably an incidental finding in patients presenting for upper gastrointestinal endoscopy, but it is not possible to say from this small series whether these organisms cause chronic active gastritis. The organism is helical, 3.5-7.5 microns long and 0.9 micron in diameter with truncated ends flattened at the tips, and up to 12 sheathed flagella 28 nm in diameter at each pole. It is proposed that this spiral bacterium should be called "Gastrospirillum hominis Gen.nov., Sp.nov."

Focal areas of decreased echogenicity in the liver at the porta hepatis.

Twelve patients are described in whom solitary focal hypoechoic areas in the liver were observed adjacent to the gallbladder and portal vein. These areas were all homogeneously hypoechoic relative to adjacent liver, had variable shapes but well-defined borders, and were less than 4 cm in diameter. These apparent pseudolesions were incidental findings in patients who had no evidence of significant liver disease, metastatic malignancy, or subsequent evidence of developing liver masses. In one patient, a second sonogram done 21 months after one such area was identified showed no change. In another patient, a computed tomogram done to clarify the finding was normal. Solitary hypoechoic areas in the liver at the porta hepatis fitting the above criteria should be interpreted cautiously. When there is no clinical suspicion of focal liver disease, these areas may be dismissed as insignificant or may be followed. If focal liver disease is suspected, the liver should be assessed by an additional method of examination.

Benign Hepatocellular Tumors

A survey of benign hepatocellular tumors in a metropolitan area included six cases of hepatocellular adenoma, eight of focal nodular hyperplasia, and two of nodular transformation. Two thirds of the adenomas occurred in women using oral contraceptives; two had life-threatening complications. The focal nodular hyperplasias were generally asymptomatic tumors occurring in patients over a wide age range and apparently not related to oral contraceptive use. The two cases of nodular transformation were incidental findings in patients having abdominal surgery. One of them had used oral contraceptives.

Chronic erosive (verrucous) gastritis. A study of 108 patients.

Chronic erosive gastritis (C.E.G.) is a gastric mucosal lesionwith characteristic radiological and endoscopic appearances. Pyloric gland hyperplasia is seen on histological examination of biopsy specimens. C.E.G. is uncommonly reported in the English literature. In reviewing 3,800 upper gastro-intestinal endoscopies from 1971--1976, 108 patients were diagnosed as having typical features of chronic erosive gastritis, an incidence of 2.8%. There was a significant association with duodenal ulceration and an overall male predominance. The lesion can also co-exist with gastric ulceration and has been observed as an incidental finding in patients examined urgently for upper gastro-intestinal bleeding. In this context C.E.G. should be distinguished from acute mucosal erosions. Symptoms may relate to the accompanying peptic ulceration, although dyspepsia epigastric pain, fullness and nausea may possibly occur with C.E.G. alone.

Occurrence of Trichomonads in the Respiratory Tract. Report of Three Cases

Judging from the few reports available in the literature, the finding of trichomonads in the respiratory tract of man is an extremely rare occurrence. However, three cases observed as incidental findings in patients with chest disease were encountered in one hospital in a 6-month period. The organisms were first observed alive in bronchial washings and later in Papanicolaou smears of sputum. No details regarding identification of the parasite or of its relationship to the associated disease conditions were elucidated, but the cases are reported to stimulate interest, with the belief that further search will prove pulmonary trichomonads to be much commoner than present knowledge indicates them to be. The literature concerning trichomonads affecting man is voluminous, but is concerned almost entirely with forms found in the intestinal, urinary, and vaginal tracts. Invasion of the respiratory tract by flagellate protozoans is a phenomenon seldom recorded and an infection that is little known by either parasitologists or clinicians in the United States. In the winter of 1959-1960 at Fitzsimons General Hospital, the occurrence of trichomonads in the respiratory tree of three patients was noted.

UPPER RESPIRATORY INFECTIONS-Reply

To the Editor:— I thank Dr. Rose for his frank appraisal of my paper. I believe Dr. Rose will agree that the treatment of acute upper respiratory illnesses is extremely divergent and haphazard today. I confess my own consternation at the problem. I cannot explain whyPseudomonas aeruginosa, Escherichia coli, andKlebsiella pneumoniaewere cultured from these patients. It certainly is not the usual situation. All patients in this study were acutely ill and did respond to therapy as indicated in the paper. No ancillary therapy, other than rest and adequate fluids, was employed. Our methods of culture leave me to believe that these organisms may have been incidental findings in patients suffering from viral infections. I submit to Dr. Rose's objections on all but one count. He points out that 14 patients in the study responded without benefit of sulfadimethoxine as revealed by resistance on sensitivity studies. Allow me