Large Abdominal Mass Research Articles

The Vertical Rectus Abdominis Myocutaneous Flap for Complex Abdominal Wall Reconstruction on a Relapse Case of Monophasic Synovial Sarcoma

Introduction: Vertical Rectus Abdominis Myocutaneous (VRAM) flap is a chosen method for a large wound closure instead of Anterolateral Thigh (ALT) flap. Both versatile and highly vascularized flaps share almost similar advantages for large wound closure. In our case, the site and size of the wound are the points of consideration. Case Presentation: A 16-year-old girl with a chief complaint of a large progressive lower abdominal mass enlarged since January 2021 that has grown back from the same site. Abdominal CT-Scan shows a tumor in the right lower abdomen infiltrated to the pelvic cavity and spanning from the lower abdominal area all the way to the groin area. Histopathology interpretation suggests a Monophasic Synovial Sarcoma. The patient underwent a second tumor resection with VRAM flap as the wound closure. The benefits of this versatile flap are excellent dead space obliteration and low Surgical Site Occurrence (SSO’s). Conclusion: As postulated in many studies VRAM flap is an excellent flap for a CAWR procedure. The expected SSO’s is non-existence during the postoperative follow-up

Advanced tubal pregnancy at 34 weeks with eclampsia and HELLP syndrome: a case report and literature re

BackgroundTubal ectopic pregnancies in the late stages of pregnancy are uncommon, and reports on their complications are scarce. We present the case of a woman who had a tubal ectopic pregnancy at around 34 weeks and developed severe pre-eclampsia complications.CaseA 27-year-old woman presented to our hospital several times with vomiting and convulsions. A physical exam revealed hypertension, scattered ecchymosis, and a large abdominal mass. A computed tomography (CT) scan performed in an emergency revealed an empty uterus, a stillbirth baby in the abdominal cavity, and a crescent-shaped placenta. Blood tests revealed that the patient had a low platelet count and clotting dysfunction. Laparotomy confirmed advanced right fallopian tube pregnancy without rupture, and salpingectomy was performed. Pathological examination revealed a significantly thickened tubal wall, adhesion of the placenta, and poor placental perfusion.ConclusionThe unusually thickened muscular layer of the tube may be one of the reasons for tubal pregnancy progressing to an advanced stage. Placenta adhesion and the special site to which it is attached reduce the risk of rupture. The detection of a crescent-shaped placenta on imaging may aid in the accurate diagnosis, distinguishing between abdominal and tubal pregnancy. Women with advanced ectopic pregnancy are more likely to develop pre-eclampsia and have poorer maternal-fetal outcomes. These negative outcomes may be influenced by abnormal artery remodeling, villous dysplasia, and placental infarction.

Recurrence of mature cystic teratoma with gliomatosis

Gliomatosis is characterised by the implantation of mature glial tissue on the surface of the peritoneum, with glial nodules 1–10 mm in size. We report a rare case of gliomatosis peritonei associated with a recurrent mature teratoma. A 27-year-old female patient presented with a large abdominal mass after 6 months of caesarean section with a history of mature teratoma resection. Ultrasound and MRI both suggested mature ovarian teratoma. A laparotomy was performed to remove the tumour. During the operation, a large ovarian tumour was noted with a haemorrhagic mass in the peritoneum.

A case of rapid canine nephroblastoma presumed metastasis documented with advanced imaging

AbstractA 1.5‐year‐old, female, entire German shepherd dog was presented for evaluation of an abdominal mass. The dog had a 4‐month history of polydipsia, polyuria, diarrhoea, and weight loss despite polyphagia. Abdominal ultrasound confirmed a large abdominal mass suspected to be uterine in origin. An exploratory celiotomy revealed a 4.3 kg, 26 × 17 × 17 cm multinodular mass entirely encompassing the uterus, left ovary and left kidney. A combined ovariohysterectomy and left nephrectomy were undertaken. Histopathology confirmed stage ΙΙ renal nephroblastoma with favourable histology. Chemotherapy was declined and 86 days following surgery, significant abdominal metastases were identified on a computed tomography scan. The patient was euthanased 113 days after surgery due to progressive disease. This is the first report to display the rapid presumed metastasis of a canine nephroblastoma, without gross metastasis at initial surgical resection, through advanced imaging. This is also the first reported case of polyphagia despite weight loss as a presenting clinical sign.

Desmoid of the Abdominal Wall: Mimicking an Ovarian Mass

Abdominal wall desmoid tumors (DTs) are a rare group of fibrous tumors of soft tissues and are locally aggressive. These tumors have a strong tendency for local invasion and recurrence without any metastatic potential. In large DTs with predominantly intra-abdominal component, the origin of mass becomes difficult to predict unless a keen observation for origin is done on advanced imaging such as magnetic resonance imaging (MRI). Surgery is the optimal treatment. We report a case of DT in a 32-year-old woman with a history of cesarean section 3 years back who presented with a chief complaint of progressive mass in the lower abdomen, noticed from the last 3 to 4 months. It was diagnosed as an ovarian mass on ultrasonography, but MRI confirmed a large abdominal wall mass. Resection of the tumor was done, and histopathology revealed a spindle cell tumor favoring fibromatosis. Large-sized DTs with predominantly intra-abdominal component may be mistaken for mass with intra-abdominal origin like uterine leiomyoma and ovarian mass as seen in our case. Therefore, careful attention is to be given to the origin if the mass is large and abutting the abdominal wall. MRI plays a crucial role in determining a diagnosis or narrowing the differential diagnosis, thus facilitating effective management.

Missed Opportunities to Prevent N-methyl-D-Aspartate Receptor (NMDAR) Encephalitis in a DREAMer

Objective Describe a case of NMDAR encephalitis in a young Latino male patient, additionally the factors resulting in delayed preventative and diagnostic medical care, which contributed to the development of a preventable case of NMDAR encephalitis. Background Adolescent undocumented immigrants in the United States face a history of prejudice and bias that perpetuates disparities and stigmas related to their healthcare. The lack of culturally informed practices among healthcare workers can create multiple lost opportunities to deliver standard of care practices, including routine testicular exams. The treatment of NMDAR encephalitis with immunotherapy, and resection of culpable tumors when present, can be lifesaving. Recognition of the germ cell tumor association has also renewed awareness of the importance of screening for such tumors. Design/Methods N/A. Results Case: A 25-year-old male who immigrated from Mexico to the U.S. at age 13 presented to the hospital for concern of status epilepticus. His past medical history included atypical developmental delay beginning in late teenage years. A large abdominal mass was identified on imaging as a stage IIIC (pT1bN0M1bS2) NSGCT (70% teratoma/30% seminoma) tumor arising from an unresected, undescended left testicle. Autonomic instability in the setting of this malignancy prompted an evaluation for, and diagnosis of, NMDAR encephalitis. His course was complicated by altered mental status, seizures, sympathetic storming, and orofacial dystonia. After tumor resection, and initiation of immune therapy, the patient showed a remarkable recovery. Conclusions This patient's preventive healthcare was impacted at multiple timepoints by changing political policies and a lack of culturally informed practices that unpredictably disrupted reliable access to medical care. Recognition of care gaps allows us to expand our differential diagnoses, and enact a comprehensive approach to fill in gaps. Effective communication, incorporating focused discussions within culturally sensitive frameworks, requires ongoing education for clinicians regarding the populations they serve to prevent disease and minimize health care disparities.

Abstract 11155: Recovery of Tricuspid Valve Function After Resection of a Primary Ovarian Carcinoid Tumor

Case Presentation: A 51-year-old woman presented with a >1-year history of bilateral leg edema, diarrhea, and facial flushing. Examination revealed a large abdominal mass, which CT scan confirmed to be a 15x11x13 cm ovarian mass with solid and cystic components. She underwent hysterectomy and bilateral salpingo-oophorectomy. Histopathology revealed a 17 cm ovarian dermoid cyst containing an insular carcinoid tumor. Her post-operative urinary 5-hydroxyindoleacetate (HIAA) level was 23 umol/d (normal 10-40 umol/d) and chromogranin-A level was 95 ug/L (normal <94 ug/L), but positron emission tomography (PET) scan showed lymph node metastasis, prompting initiation of lanreotide, a somatostatin analogue. A perioperative echocardiogram revealed thickened, fixed, and retracted tricuspid and pulmonic valves with severe tricuspid and pulmonary regurgitation consistent with carcinoid heart disease. The right ventricle was dilated but showed preserved systolic function. Valve intervention was considered but deferred as right heart catheterization 15 weeks after surgery showed normal right-sided pressures. A follow-up echo 8 months post resection showed unchanged pulmonary regurgitation but significant improvement in tricuspid valve mobility with a corresponding reduction in tricuspid regurgitation to a mild-to-moderate level. Discussion: Thickened and fixed tricuspid valve leaflets with significant regurgitation represents a hallmark of carcinoid heart disease that can lead to progressive right heart failure, often necessitating surgical intervention. This is a rare case of carcinoid heart disease where there was marked improvement in tricuspid valve function after surgical resection of a primary carcinoid tumor and initiation of somatostatin analog therapy. It highlights the potential for timely treatment to reverse the deleterious effects of carcinoid tumors on cardiac valves, which may ultimately spare the need for cardiac surgery.

Disseminated Cryptococcosis Masquerading as a Large Abdominal Mass Concerning for Pancreatic Malignancy in an HIV-Positive Patient.

Disseminated Cryptococcosis Masquerading as a Large Abdominal Mass Concerning for Pancreatic Malignancy in an HIV-Positive Patient.

ODP049 Oncocytic adrenocortical carcinoma misdiagnosed as renal oncocytoma and use of urinary steroid profiling in disease monitoring after mitotane therapy

Abstract Introduction Oncocytic adrenocortical carcinoma (OAC) is a rare, more indolent variant of adrenocortical carcinoma (ACC). With fewer than 70 cases reported in the English literature, the biological behavior and its response to treatment are poorly characterized. The distinction of OAC from other oncocytic neoplasms (e. g., kidneys) and variants of renal cell carcinoma (RCC) may pose diagnostic challenge pathologically. Urine steroid profiling (USP) of OAC has not been previously reported. Case description A 65-year-old Chinese man was incidentally found to have a large left upper abdominal mass in September 2014. A CT urogram showed a 15×13×13cm solid mass in the upper pole of left kidney. Left radical nephrectomy and splenectomy was performed. Pathological examination of the 'nephrectomy' showed oncocytoma. He was managed as having a renal oncocytoma with complete resection with yearly follow-up. In December 2018, a surveillance chest X-ray showed multiple lung nodules over right lung base. PET-CT in June 2019 showed bilateral hypermetabolic lung nodules suggestive of lung metastases. CT guided fine needle aspiration biopsy of lung nodule showed oncocytoma. Pathology review of both the lung and 'nephrectomy' biopsy revealed identical cores of oncocytic tumor cells while immunohistochemical studies displayed positivity for SF-1 and Melan-A suggestive of adrenocortical origin. In the presence of lung metastases, a revised diagnosis of OAC was made with the original tumor classified as oncocytic adrenocortical neoplasm of uncertain malignant potential by the Lin-Weiss-Bisceglia system. Hormonally the tumor was non-functional with suppressible cortisol post 1mg overnight dexamethasone suppression test and normal renin, aldosterone, estradiol and DHEA-S levels. Twenty-four-hour urine steroid profiling showed elevated tetrahydro-11-deoxycortisol 788ug/day [RR 10-90µg /day], pregnanediol 374µg /day [RR 41-348µg/day] and pregnenetriol 487µg /day [RR 25-256µg /day]. Mitotane was started and titrated up to 1500mg daily, aiming at a serum mitotane level of 14- 20µg /ml. Resolution of lung metastases was noted 6 months later and the abnormal urinary steroid metabolites were also normalized. The patient remained in disease remission 18 months after commencement of mitotane. Conclusion Oncocytic adrenocortical carinoma may be mistaken as other oncocytic neoplasms or variants of RCC pathologically and is classified by the Lin-Weiss-Bisceglia system. An accurate diagnosis has significant impact on disease prognostication and management. OAC may respond more favorably to mitotane monotherapy in comparison to typical ACC. Urine steroid profiling is potentially useful in the surveillance and disease monitoring of OAC. Reference: (1) Harada et al. A rare case of oncocytic adrenocortical carcinoma clinically presented as an incidentaloma. Endocr J. 2020 Aug 28;67(8): 883-888. Presentation: No date and time listed

ODP039 Giant Cystic Pheochromocytoma and GIST in a Patient With NF-1

Abstract Introduction Neurofibromatosis-1 (NF-1) is a genetic condition known to be associated with pheochromocytoma. We report a case of giant cystic pheochromocytoma in a patient with NF-1 and hypertensionincidentally found to have gastrointestinal stromal tumor (GIST) at operation. Clinical case: A 60-years old woman presented with a 5-week history of left sided abdominal lump. Her history is significant for NF-1, flank surgery age 5 and hypertension managed by amlodipine. Examination revealed a large nontender left upper quadrant abdominal mass crossing the midline. Computed tomography showed a20. 0×13.1×21.1 cm septate cystic and/or necrotic lesion arising from the left retroperitoneum versus adrenal gland, displacing the kidney anteromedially. Plasma free metanephrine was 3.38 nM (0-0.49) normetanephrine 3.47 nM (0-0.89),urine metanephrine 2605 mcg/day (36-229), urine normetanephrine 1215 mcg/day (95-650). There were no prior images or screens for pheochromocytoma. After preoperative blockade with phenoxybenzamine, open left adrenalectomy was performed. Intraoperative blood pressure fluctuated significantly. Exophytic firm nodules were incidentally noted and removed from the jejunum. Pathology revealed a22.5×21. 0×11.9 cm pheochromocytoma weighing 3058.9 g and five 0.2-0.7 cm gastrointestinal stromal tumors, spindle type. One-month postoperative metanephrine was 0.16 with normetanephrine 0.53 nM. The blood pressure remained normal without antihypertensives. Discussion Giant cystic pheochromocytomas are rare and may be silent. In populations with NF-1 the prevalence of pheochromocytoma is 0.1-7.7% and GIST 1.2% 1–3 . Their co-existence is seen less frequently. Recommendations for pheochromocytoma screening in NF-1 vary, from only hypertensive or symptomatic patients to routinely every 3 years 2–5 . There is no screening test for GIST 1 . Our patient presented at age 60 with the rare combination of clinically giant unilateral cystic pheochromocytoma, with incidental GIST in the setting of NF-1 and hypertension . Conclusion Routine screening for pheochromocytoma in patients with NF-1, especially those with hypertension may lead to earlier diagnosis and treatment.

S2799 Disseminated Cryptococcosis Masquerading as Large Abdominal Mass Concerning for Pancreatic Malignancy in HIV-Positive Patient

Introduction: Gastrointestinal cryptococcus is a rare occurrence in HIV-positive patients. Symptoms may be nonspecific thus the differential for abdominal masses must remain broad. We report a patient with HIV who presented with abdominal pain and watery diarrhea, found to have a large abdominal mass on computed tomography initially thought to be lymphoma or a primary pancreatic tumor. He underwent endoscopic ultrasound-guided (EUS) biopsy of the mass which was consistent with a cryptococcoma. Case Description/Methods: A 55-year-old male presented with severe, diffuse abdominal pain for one week duration associated with profuse watery, non-bloody diarrhea and intermittent chills. Medical history included HIV for 30 years with poor compliance with antiretroviral regimen, recent pneumocystis pneumonia and previous cryptococcal meningitis. Physical exam revealed an ill appearing, cachectic male with abdominal tenderness. Labs revealed a white blood cell count of 18.5 K/uL (ref: 4.0-10.8 K/uL) with 84% neutrophils (ref: 40-75%), sodium of 132 mmol/L (ref: 135-146 mmol/L) and potassium 2.7 mmol/L (ref: 3.5-5.1 mmol/L). His viral load was 109,385 copies/mL (ref: neg copies/mL) and absolute CD4 count was 56 lymphocytes/uL (ref: 330-1520 lymphocytes/uL). Liver chemistries were unremarkable. Stool studies for regional pathogens, ova and parasites, and clostridium difficile were negative. A CT scan of the abdomen and pelvis revealed ill-defined cystic/necrotic upper abdominal lymphadenopathy with mass effect and possible invasion of the adjacent liver (Figure 1A). The pancreas and caudate lobe of the liver were inseparable from the mass which raised concern for primary pancreatic tumor or lymphoma. He underwent EUS-guided biopsy of the peripancreatic mass (Figure 1B) with pathology consistent with a cryptococcoma (Figure 1C, 1D). He was started on amphotericin B and transitioned to high dose fluconazole due to adverse effects. Repeat imaging revealed significant reduction of the mesenteric lymphadenopathy (Figure 1E). He was discharged in stable condition and remained on fluconazole indefinitely. Discussion: Cryptococcal infection remains the second most common cause of acquired immunodeficiency syndrome related mortality after tuberculosis. The most common sites of cryptococcal infection are the lungs, brain, eyes, or central nervous system; abdominal dissemination is rare. Biopsy via EUS can be useful in diagnosis of cryptococcoma. Early identification and treatment of cryptococcal infections can increase survival rates.Figure 1.: A) CT image showing ill-defined cystic/necrotic upper abdominal lymphadenopathy with mass effect and possible invasion of the adjacent liver B) Endoscopic ultrasound imaging showing peripancreatic mass C) Hematoxylin and Eosin cellblock at 40X magnification showing abundant neutrophils and necrotic debris D) Grocott’s Methenamine Silver stain showing fungal yeast with narrow base budding E) Significant reduction of the mesenteric lymphadenopathy after antifungal therapy initiation.

S3455 Unusual Presentation of a Young Male Diagnosed With a Perforated Gastrointestinal Stromal Tumor (GIST) in the Jejunum With a Previous History of Multiple Myeloma (MM)

Introduction: Studies suggest an increase in the frequency of additional malignancies in patients with GIST. This relationship remains unclear and needs further exploration. We present a case of GIST in a patient with Multiple Myeloma. Case Description/Methods: A previously healthy 38 years old male presented in 2016 complaining of weakness, fatigue, and back pain; he was diagnosed with Multiple Myeloma. Remission was achieved using chemotherapy and autologous bone marrow transplantation. He had a relapse of Multiple Myeloma on a bone marrow biopsy in 2020. Since then, he has been receiving chemotherapy. In March 2022, he presented to the ER complaining of abdominal distension, severe pain, and vomiting, based on a physical exam and CT. Scan, he was diagnosed with small bowel obstruction and peritonitis. Surgical exploration revealed a large abdominal perforated mass originated from the proximal jejunum, with adhesions to the root of the mesentery, urinary bladder, small bowel, transverse, descending, and sigmoid colons. Excision of the mass with resection of about 30 cm and re-anastomosis of the jejunum was performed. Postoperatively, the patient was admitted to the ICU for three days to control cardiac arrhythmia. He was discharged from the hospital ten days later. Pathology confirmed the diagnosis of GIST. Currently, the patient is receiving chemotherapy and doing well (Figure). Discussion: Despite being the most common mesenchymal neoplasms of the gastrointestinal tract, GIST are still rare tumors that account for less than 1% of all GI tumors; they occur mostly in the stomach or small intestines. The average age of diagnosis is 50-70 years and is considered non-hereditary or sporadic. There are reports of co-existing GIST with adenocarcinomas within the GI tract or distant organs. In a single case series of 43 patients with GIST, 6 (14%) had an additional primary tumor, five within the GI tract. In a larger population-based study with 6,112 GIST patients, 1,047 (17.1) had additional cancers. Despite that, so far, only one case of (MM) was reported in a patient with GIST in 2007 in Greece, which ended with the patient’s death six months after the diagnosis of (MM). This case highlights the relationship between GIST and other primary neoplasms at a young age. It is unclear whether the GIST was due to genetic association, environmental exposure, or chemotherapy. Clinicians should look for tumors within or outside the GI tract, which could significantly affect the prognosis.Figure 1.: Resected GIST from with 30 Cm of the jejunum.

S3440 Malignant Melanoma of Unknown Primary Presenting With Small Intestinal Masses

Introduction: GI melanomas are extremely rare and require thorough investigation. Most GI melanomas are metastatic from an oculocutaneous lesion, however, and if not found, are termed melanoma of unknown primary (MUP.) MUP represents only 2% of all melanomas yet it is a major cause of mortality. Common areas of metastasis involve the lymph nodes, small intestines, and subcutaneous sites. We present a case of MUP that developed large abdominal masses within 7 months. Case Description/Methods: A 68 year old male presented with 1 week of LLQ abdominal pain and constipation. He had undergone a normal colonoscopy 1 year prior. He had normal vitals and labs excluding hemoglobin of 9.5 g/dL, compared to a baseline of 15.2 g/dL. CT scan of the abdomen and pelvis showed: a multi-lobulated heterogeneously enhancing mass centered in the LLQ involving the small bowel measuring 6.8 x 5.6 x 6.5 cm, as well as a 3.5 x 9.0 x 4.1 cm metastatic hilar lymph node encompassing the duodenal bulb. Of note, these findings were not visualized on imaging 7 months prior. Tumor markers were normal. EGD showed an extrinsic mass compressing the duodenal bulb with a superficial ulcer. Colonoscopy was normal. Percutaneous biopsy of the porta hepatis lymph node was done showing evidence of malignant melanoma. The patient had an extensive skin evaluation yielding no skin/ocular findings consistent with melanoma, making a diagnosis of MUP. (Figure) Discussion: GI MUP has rarely been reported in the literature. Diagnosis is typically definitive in the absence of primary cutaneous, ocular, or mucosal melanoma. Melanoma first found in the GI tract requires a thorough investigation to determine the primary lesion. After a GI melanoma is diagnosed, a detailed physical exam of the lymph nodes. nasopharynx, eyes, anus, and skin must be performed. If no primary lesion is discovered, a PET scan should be done to determine if the GI melanoma is primary, metastatic, or of unknown origin.Figure 1.: (A) Axial view of contrast-enhanced CT showing a partially cystic heterogeneous mass in the hilar region encompassing the duodenal bulb measuring 3.5x 9.0x 4.1 cm (Red Arrow). (B) Coronal view showing RUQ mass causing duodenal bulb compression(Red Arrow), as well as partially visualizing LLQ mass (Yellow Arrow.) (C) Sagittal view of multi-lobulated heterogeneously enhancing mass centered in the LLQ involving the small bowel measuring 6.8 x 5.6 x 6.5 cm (Yellow Arrow.)

S352 Presidential Poster Award Light at the End of the Tunnel: Pipeline to the Jejunum

Introduction: Small intestinal strictures that are distal to the duodenum, particularly the jejunum, are uniquely complicated to manage. Adult endoscopes are often too short or too rigid to reach this region of the small bowel. Furthermore, duodenal stents are not flexible enough and are uncovered. In this case, we were able to place several esophageal stents in the proximal jejunum using a pediatric colonoscope that could not be placed previously. Case Description/Methods: A 56 year-old woman with hypertension, obstructive lung disease, and a prior ischemic stroke presented to the hospital for four days of postprandial emesis, abdominal distention, epigastric pain, and constipation. She previously underwent appendectomy and hysterectomy, and had no prior endoscopic studies. Computed tomography (CT) was performed demonstrating mural thickening of the distal duodenum and partial occlusion of the small bowel with regional lymphadenopathy, and a large left adrenal mass. Esophagogastroduodenoscopy (EGD) showed an intrinsic severe stenosis in the distal duodenum. After biopsies were taken, the tissue was found to be a primitive neuroectodermal tumor. Because of the presence of mesenteric adhesion and extensive stenosis, it was decided to correct the stricture endoscopically rather than with surgical intervention. Using a pediatric colonoscope and fluoroscopic guidance, three stents were placed sequentially and telescoping each other from the proximal jejunum to the distal duodenum: a fully covered 20 mm x 120 mm esophageal stent, a partially covered 18 mm x 97 mm esophageal stent, and a fully covered 20 mm x 60 mm esophageal stent (Figure). There were no immediate complications with the procedure and repeat imaging demonstrated luminal patency. Due to the expansion of the stents through a tight stricture, the abdominal pain and pressure was present despite no evidence of perforation on CT. Discussion: This demonstrates the feasibility of utilizing multiple esophageal stents to help relieve more distal gastrointestinal obstructions that were not feasible in the past. The covered esophageal stents are extremely useful when there is discontinuity in the lumen of the small bowel to keep the natural flow of food and help prevent surgical interventions. Watch the video at https://tinyurl.com/ACGAbstractS352Figure 1.: (A) Coronal CT image of a large abdominal mass involving loops of bowel and jejunum. (B) Abdominal x-ray showing interval placement of stents from the distal duodenum to the proximal jejunum.

Left pancreaticoduodenostomy after removal of the right lobe and the head of the pancreas in a cat

To report a surgical technique for pancreaticoduodenostomy and its outcomes in a cat. A 14-year-old domestic cat. Case report. A cat was referred to our hospital with a large abdominal mass. On ultrasonographic examination, this mass was identified as a large fluid-filled cavity in place of the right pancreatic duct and involved the pancreatic and accessory pancreatic ducts. A small echoic cavity was observed in the left pancreatic lobe. Serous fluid was collected from the large cavity. On cytology, the small cavity was consistent with an abscess. A partial left pancreatectomy was performed to remove the abscess. The large cavity was excised with the remnant of the right pancreatic lobe and body. After ligation of the pancreatic ducts, the left pancreatic duct was isolated and an end-to-side pancreaticoduodenostomy was performed. The cat recovered without complications. Histological examination was consistent with chronic pancreatitis and peripheral inflammation. No evidence of postoperative pancreatic insufficiency was detected on clinical examination or laboratory findings. A focal ampulla-like dilation of the pancreatic duct was noted on ultrasonography, with no other complications at the anastomosis. The cat presented 225 days postoperatively with respiratory distress. Multiple nodules were identified throughout the lung parenchyma on radiographs. Abnormalities on ultrasonographic examination included an enlarged liver infiltrated with nodules. Due to poor prognosis, the cat was euthanized. Final histopathological diagnosis was diffuse carcinoma. Pancreaticoduodenostomy restored pancreaticointestinal continuity after extensive pancreatectomy involving the pancreatic ducts and resulted in long-term survival in the cat reported here.

Clinicopathologic features of a patient with primary monophasic synovial sarcoma of the jejunum.

A case of primary synovial sarcoma of the jejunum was collected and analyzed retrospectively. A 19-year-old man who presented to hospital with abdominal pain. The CT scan showed a large mixed abdominal mass with bleeding. Laparotomy revealed that the tumor originated from the jejunum, accompanied by rupture and hemorrhage. Microscopically, the tumor was composed of spindle cells. The tumor cells demonstrated diffuse expression of vimentin, transducin-like enhancer (TLE)-1, B-cell lymphoma protein (Bcl)-2, CD99 and focal expression of epithelial membrane antigen (EMA). The presence of specific SS18 gene rearrangement was confirmed in tumor cells. The patient received 6 cycles of chemotherapy after jejunal tumor resection. And 12 months later, the patient presented pancreatic metastasis and had radiotherapy. The patient died 15 months after the diagnosis.

Syndrome de RESLES iatrogène aux antipsychotiques

Intraductal papillary mucinous neoplasms (IPMNs) constitute a group of rare conditions with a potential for malignant degeneration. The appearance of symptoms should suggest degeneration. This case demonstrates an unusual case of a patient presenting an intestinal type IPMN that was revealed by a large abdominal mass.47-year-old woman with a history of hydatid cyst of the liver. The patient was admitted to our hospital for management of large abdominal mass measuring 185 × 128*190 mm. Intra-operative findings showed a voluminous tumor, of approximately 20 cm in all its dimensions, with double solido-cystic component at the expense of the neck and the body of the pancreas. The patient underwent splenopancreatectomy. The histopathological examination confirmed the presence of intestinal type of IPMN of pancreas.Acute pancreatitis is revealed in the majority of cases of IPMNs, related to duct obstruction by secreting mucus plug. IPMNs are rarely the cause of a large abdominal mass. They are cystic lesions of slow evolution, macroscopically visible and rarely macrocystic, unlike serous cystadenoma. The tumor size is a powerful indicator of the malignancy of IPMNs. The current definitive and ideal treatment for main duct and mixed type IMPNs is a surgical resection.IPMNs are a cystic lesion, rarely revealed by a large mass.

PARA OVARIAN SOLITARY FIBROUS TUMOUR – A CASE REPORT

The solitary brous tumour is a rare broblastic tumour which accounts for less than 2 % of soft tissue tumours and is associated with NAB2- STAT6 fusion [1]. It was originally described in pleura but has been reported in various anatomical sites. We report a case of solitary brous tumour in Para ovarian location. A 69-year-old female presented with a large abdominal mass which was initially thought to be a parasitic leiomyoma on MRI. The tumour was surgically removed and the diagnosis of a solitary brous tumour was conrmed on immunohistochemical analysis. Para ovarian location of the solitary brous tumour is rare, hence presenting this case.

Short and long-term outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for colorectal and appendiceal cancer peritoneal metastasis: Propensity score-matched comparison between laparoscopy vs. open approaches

BackgroundIn light of today's role of minimally access surgery in colorectal oncologic treatment, we analyzed the impact of laparoscopic cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) in selected patients with peritoneal metastases (PM) originating from colorectal and appendiceal cancer (CRAC). MethodsPostoperative and oncologic outcomes were compared between patients with CRAC-PM treated by CRS/HIPEC undergoing laparoscopic (L-CRS/HIPEC) or open (O-CRS/HIPEC) procedures according to data collected from our tertiary referral hospital prospective database from April 2016 to April 2021. We excluded patients who did not undergo operation with curative intent. L-CRS was performed in patients who had no multifocal mesenteric lesions, no large abdominal mass, nor massive adhesions. Patients were matched by propensity scores 1:1 for peritoneal cancer index, completeness of cytoreduction score, concomitant resectable distal metastasis, primary tumor location, RAS mutation status and American Society of Anesthesiologists (ASA) classification. ResultsOf 106 eligible patients, 68 were matched (34 L-CRS/HIPEC; 34 O-CRS/HIPEC) by propensity scores. Compared with the open approach, L-CRS/HIPEC was associated with less overall surgical morbidities (14.7% vs. 38.2%; p = 0.028), shorter median hospital stay (10 [5-15] vs. 12 [8–33] days; p < 0.001) and reduced median waiting time before adjuvant chemotherapy (4.7 [3.0–13.2] vs. 5.7 [4.1–24.1] weeks; p = 0.047). No statistically significant difference was found in operative time or major morbidity rates between the two groups. After a median follow-up of 33.2 months, the rate of early peritoneal loco-regional recurrence, location of initial recurrence or 3-year survival outcomes were not statistically significantly related to the type of access (L-CRS/HIPEC vs. O-CRS/HIPEC). ConclusionsLaparoscopy for CRS/HIPEC is technically feasible and oncologically safe to treat selected patients with CRAC-PM. Further randomized control trials are required to confirm the benefits of minimal access surgery for the management of PM.

A large upper abdominal mass in an adolescent with high Ca 19.9: a case report

Mucinous cystic neoplasms of the liver are uncommon cystic lesions of the liver, most commonly seen in women in the fifth decade of life. We present a case of a 16-year-old girl with an incidentally discovered abdominal mass while undergoing a tonsillectomy. Investigation revealed a multiloculated, septated 17 × 17 × 11 cm cystic lesion arising from the left lobe of the liver, with displacement of the remaining upper abdominal viscera. Serum Ca19.9 was significantly elevated at 2256 U/ml (range 0–37), but other bloods including liver function tests, alphafoetoprotein and carcinoembryonic antigen were within normal limits. We proceeded to open formal left hemi-hepatectomy. Histology was consistent with a diagnosis of mucinous cystic neoplasm with low-grade intra-epithelial neoplasia.