Luminal Mass Research Articles

A Case Report of a Rare Aetiology of a Sigmoid Volvulus Involving a Congenital Omental Defect

Sigmoid volvulus is a rare form of large bowel obstruction and makes up < 5% of all colonic obstruction. The commonest aetiologies include a lead point involving an intra or extra luminal mass such as a malignancy or a benign stricture or colonic dysmotility especially in the geriatric population. Rare aetiologies include a mesenteric defect, or as in this case report, a congenital omental defect acting as the lead point. This makes for an increasingly unusual case report, and we believe that this is the first such report in English language literature. The management remains the same, irrespective of the aetiology. Endoscopic bowel decompression in the acute phase is followed by definite surgical management with or without a primary surgical anastomosis.

Effects of non-Newtonian viscosity on arterial and venous flow and transport

It is well known that blood exhibits non-Newtonian viscosity, but it is generally modeled as a Newtonian fluid. However, in situations of low shear rate, the validity of the Newtonian assumption is questionable. In this study, we investigated differences between Newtonian and non-Newtonian hemodynamic metrics such as velocity, vorticity, and wall shear stress. In addition, we investigated cardiovascular transport using two different approaches, Eulerian mass transport and Lagrangian particle tracking. Non-Newtonian solutions revealed important differences in both hemodynamic and transport metrics relative to the Newtonian model. Most notably for the hemodynamic metrics, in-plane velocity and vorticity were consistently larger in the Newtonian approximation for both arterial and venous flows. Conversely, wall shear stresses were larger for the non-Newtonian case for both the arterial and venous models. Our results also indicate that for the Lagrangian metrics, the history of accumulated shear was consistently larger for both arterial and venous flows in the Newtonian approximation. Lastly, our results also suggest that the Newtonian model produces larger near wall and luminal mass transport values compared to the non-Newtonian model, likely due to the increased vorticity and recirculation. These findings demonstrate the importance of accounting for non-Newtonian behavior in cardiovascular flows exhibiting significant regions of low shear rate and recirculation.

Large Colonic Lipoma, Presentation and Treatment: Case Reports and Literature Review

Colonic lipomas are uncommon tumors that may remain asymptomatic and seen incidentally on endoscopy, surgery, or autopsy. They can cause constipation, bleeding that may lead to anemia, and acute abdominal pain due to intussusception if larger than five centimeters, particularly when pedunculated. Colonoscopy can reveal a protruding luminal mass, whereas a Computed Tomography (CT) can precisely localize, indicate the nature, and characterize the composition. Removal by endoscopy in smaller and surgical resection remains the treatment of choice for larger lesions by open laparotomy or laparoscopy. We describe a case series of three patients who underwent laparoscopic resection of the colon for symptomatic large lipomas in our hospital.

Development of alimentary tract organs for ICRP pediatric mesh-type reference computational phantoms

In line with the activities of Task Group 103 under the International Commission on Radiological Protection (ICRP), the present study was conducted to develop a new set of alimentary tract organs consisting of the oral cavity, oesophagus, stomach, small intestine, and colon for the newborn, 1 year-old, 5 year-old, 10 year-old, and 15 year-old males and females for use in the pediatric mesh-type reference computational phantoms (MRCPs). The developed alimentary tract organs of the pediatric MRCPs, while nearly preserving the original topology and shape of those of the pediatric voxel-type reference computational phantoms (VRCPs) of ICRP Publication 143, present considerable anatomical improvement and include all micrometre-scale target and source regions as prescribed in ICRP Publication 100. To investigate the dosimetric impact of the developed alimentary tract organs, organ doses and specific absorbed fractions were computed for certain external exposures to photons and electrons and internal exposures to electrons, respectively, which were then compared with the values computed using the current ICRP models (i.e. pediatric VRCPs and ICRP-100 stylised models). The results showed that for external exposures to penetrating radiations (i.e. photons >0.04 MeV), there was generally good agreement between the compared values, within a 10% difference, except for the oral mucosa. For external exposures to weakly penetrating radiations (i.e. low-energy photons and electrons), there were significant differences, up to a factor of ∼8300, owing to the geometric difference caused by the anatomical enhancement in the MRCPs. For internal exposures of electrons, there were significant differences, the maximum of which reached a factor of ∼73 000. This was attributed not only to the geometric difference but also to the target mass difference caused by the different luminal content mass and organ shape.

Huge Colonic Granuloma of Schistosomiasis Mimicked Cancer in a 10-Years-Old Child: A Case Report

IntroductionSchistosomiasis is a trematodes infection more prevalent in tropical and subtropical areas such as Yemen. Giant colonic polyp manifestations of intestinal bilharziasis are uncommon, difficult to differentiate from other colonic polyps, and can mimic cancer.Case ReportA 10-year-old child presented with chronic abdominal pain that started ten months ago. The patient had a family history of lymphoma in his brother. The computed tomography scan showed a sigmoid luminal mass measuring 10×3 cm with significant lumen narrowing and diffuse circumferential wall thickening of the sigmoid colon, hepatomegaly, and multiple perilesional, para-hepatic, and pulmonary lymph nodes enlargements. The mass was morphologically mimicked cancer and proved to be of bilharzial etiology (Schistosoma mansoni) after surgical excision.ConclusionEven though the bilharzial colonic polyps are rare, it is challenging to differentiate them from other malignant colonic polyps. Clinicians should have a high suspicion regarding its manifestations to avoid unnecessary surgical interventions, especially in an endemic area, even in patients with a strong family history of cancer.

S2167 Rare Cause of Dysphagia Due to Thoracic Vertebral Osteophytes

Introduction: Symptomatic degenerative changes of the spine affect atleast 75% of the population above 60 years of age. Anterior bridging osteophytes can develop in association with diffuse idiopathic skeletal hyperostosis. They are usually asymptomatic. However, in some cases, osteophytes can impinge on the anteriorly located esophagus thereby causing dysphagia. Case Description/Methods: A 68-year-old man with osteoarthritis and hypertension presented with intermittent episodes of dysphagia to solids for 3 months. Symptoms had not progressed over this time and he was able to tolerate liquids without any difficulty. He denied vomiting, loss of appetite, weight loss or night sweats. He denied history of tobacco use or any significant alcohol intake. Hemoglobin was 12.6 g/dL. He was initially evaluated by speech language pathology with a modified barium swallow (MBS) that did not identify oropharyngeal dysphagia. An upper endoscopy revealed extrinsic compression in the mid esophagus, but no evidence of luminal mass, ulceration or candidiasis. A barium esophagram showed indentation on the posterior wall of the esophagus. Computerized tomography (CT) chest imaging demonstrated large anterior osteophytes at thoracic vertebral level T2/T3 (Figure 1). Given the clinical presentation and workup, the patient’s dysphagia was attributed to the large anterior thoracic osteophytes. He was referred to an orthopedic surgeon and preferred conservative non-operative management with dietary modification. Discussion: We present here a case of dysphagia due to large thoracic vertebral osteophytes. Symptomatic osteophytes usually originate in the cervical spine. Thoracic osteophytes may not initially present with esophageal symptoms because the thoracic esophagus is a relatively mobile structure that can be displaced anteriorly or laterally without being compressed. Large osteophytes can cause dysphagia by obstruction and altered esophageal peristalsis. An osteophyte should be considered as the cause of obstruction and dysphagia when an esophagogram shows marked hypertrophic changes in the thoracic spine at that level. CT or magnetic resonance imaging (MRI) may be helpful for demonstrating a bony mass impinging on the esophagus and to exclude a vascular anomaly, neoplasm, or other possible lesions. Patients should be counseled on the importance of dietary modification, speech and swallow therapy, along with weight loss and physical therapy. Surgical removal of the osteophytes is considered for intractable symptoms.Figure 1.: Computerized tomography (CT) chest imaging in sagittal view demonstrated large anterior osteophytes at thoracic vertebral level T2/T3.

Transmurally migrated gossypiboma rarely posing as surgical site infection: a case report and review of literature

The term gossypiboma is used to describe a retained surgical sponge or gauge after surgery. The clinical features range from being asymptomatic to frank bowel obstruction, perforation and peritonitis. Radiological modalities also do not provide a definite diagnosis. We report a case of a 30-year-old lady who presented to the emergency room with recurrent surgical site infection. She had a history of caesarean section 5 months ago. Following the caesarean section, she developed superficial wound dehiscence which was re-sutured. At the present facility, the lady underwent Computed tomography (CT) scan and was suspected to have a foreign body around the gut. She was planned for an exploratory laparotomy. Upon laparotomy, a large thick-walled ileal loop with some unusual intra luminal mass was found. Dense adhesions were present between the ileal loop and sigmoid colon. Adhesiolysis led to an iatrogenic sigmoid colon perforation, around 2 cm length. On incision over the ileal loop, surgical sponge was retrieved. Ileal loop was resected along with perforated site with end-to-end ileo-ileal anastomosis was done. Primary repair of sigmoid colon perforation was done. Patient was stable in postoperative period. Although rare, gossypiboma should be kept in mind as a differential diagnosis in postoperative cases presenting with recurrent surgical site infection.

Jejunal gastrointestinal stromal tumors masquerading as an appendicular mass: an unusual presentation

Gastrointestinal stromal tumors (GISTs) are a rare variety of tumors of mesenchymal origin found in the gastrointestinal (GI) tract forming about 1% of all GI tumors. These originate from the interstitial cells of Cajal. Small bowel GISTs have been shown to present as obscure GI bleeding, obstruction and perforation in literature. We report a 57 years old female patient presenting with pain abdomen, fever and vomiting and palpable right iliac fossa (RIF) mass diagnosed as an appendicular mass and managed conservatively. She was planned interval appendicectomy and was discovered to have a jejunal GIST at laparotomy treated with resection and anastomosis. There are case reports of small bowel GISTs presenting as sources of obscure or overt GI bleeding and luminal or extra luminal mass causing small bowel obstruction. Surgery is mainstay of treatment with imatinib for adjuvant or neoadjuvant therapy. This case highlights an unusual presentation of a jejunal GIST with a sealed off perforation mimicking an appendicular mass in the RIF treated by surgical resection followed by adjuvant Imatinib therapy. GIST being an uncommon tumor with varied presentations can lead to misdiagnosis and delays in treatment. This differential should be kept in mind while evaluating small bowel pathologies to aid a timely diagnosis.

Case of proximal small bowel obstruction: is it the motility or the chewing?

An otherwise healthy 80‐year‐old gentleman presents with 1‐day history of generalized abdominal pain and vomiting associated with abdominal distention and bowels not opening for 3 days. He has not had any previous abdominal surgery apart from an elective laparoscopic total extraperitoneal repair of bilateral inguinal hernia. On examination, he was haemodynamically stable with a distended abdomen but without any peritonism. Computed tomography of the abdomen/pelvis demonstrated evidence of small bowel obstruction (SBO) at the mid‐jejunum with a transition point in the left upper abdomen (Fig. 1). He was initially managed conservatively with nasogastric tube decompression, intravenous fluids and a trial of gastrografin. Unfortunately, he failed to improve and underwent exploratory laparoscopy. Intraoperatively, the small bowel was followed from the terminal ileum proximally, finding a hard luminal mass in the mid‐jejunum. The duodeno‐jejunal junction was identified and the small bowel was again followed distally and the luminal mass was again identified. With this single transition point identified, the segment of jejunum was eviscerated and examined. A limited small bowel resection was performed to deliver this mobile hard pigmented intraluminal mass measuring 3 × 4 cm (Fig. 2). Histopathology confirmed normal small bowel with ghosted plant cell walls throughout the firm mass consistent with food bezoar (Fig. 3). The patient made an uneventful recovery and was discharged on day 6

Primary and metastatic melanoma of the GI tract: clinical presentation, endoscopic findings, and patient outcomes.

Melanoma incidence has increased worldwide with a concurrent rise in both primary and metastatic melanomas of the gastrointestinal tract. This retrospective single-center case series includes patients with histopathology-confirmed primary or metastatic melanoma of the GI tract between 1998 and 2018. Thirty-four patients were identified for inclusion, of whom 7 were primary and 27 were metastatic cases of gastrointestinal melanoma. For both primary and metastatic cases, the majority of patients presented with frank or occult GI bleeding (57.1% and 70.4%). Primary and metastatic lesions were predominantly diagnosed endoscopically (100% and 63.0%), with 71.4% of primary lesions found at the anorectal junction and 51.9% of metastatic lesions in the small bowel. Endoscopically diagnosed lesions were either polypoid (50%) or a luminal mass (37.5%) in the majority of cases. Common features included: amelanotic (83%), ulcerated (50%), and friable (33.3%). All primary patients were treated with surgical excision or resection. Of the metastatic patients, 56% were resected. The median interval between initial primary and gastrointestinal metastases was 65months (ranging from 1month to 24years). At the time of data analysis, 85.7% of primary and 29.6% of metastatic patients remained alive. The majority of patients in this series were diagnosed endoscopically while investigating a source of gastrointestinal blood loss. Heightened clinical suspicion and recognition of the endoscopic features of gastrointestinal melanoma during evaluation of GI symptoms in a patient with a personal history of primary melanoma are advised.

Bowel Wall Thickening on Emergency Room CT Scans - Is It Always IBD?

Introduction: Patients presenting to Emergency Room with abdominal pain frequently undergo urgent CT scans, often revealing bowel wall thickening (BWT). In the absence of guidelines, endoscopic evaluation is performed in most of them. The study aims to evaluate the significance of such BWT and assess predictors of significant pathology on endoscopic evaluation Methods: Medical Records of patients referred to Gastroenterology Service with BWT on Emergency Department CT scans between July 2015-July 2017 at Hamad General Hospital, Qatar were retrospectively analyzed. Correlation of endoscopic findings to clinical presentation, laboratory parameters and histopathology was studied. Exclusion Criteria: 1. Endoscopy done after 4 weeks of CT scan reporting of BWT. 2. Patients with known GI Pathology (IBD, malignancy). 3. Evidence of luminal obstruction, stricture or mass on CT scan. Results: 109 of 160 referred patients satisfied criteria for study inclusion. Endoscopic appearance was normal in 37/109(33.9%). Significant findings confirmed as chronic pathology were found in 41/109(37.6%) patients. Of these 21(19.1%) had IBD {13 Crohn's Disease (11.9%), 8 Ulcerative Colitis (7.3%)}, 9(8.3%) had Tuberculosis, 11(10.1%) had malignancy. Mucosal abnormalities but normal or acute inflammation on histopathology were observed in 31/109(28.4%) patients.(Table 1) Age or gender had no correlation with significant findings. Symptom duration was the strongest predictor of significant endoscopic findings (> 2 weeks 25/35, 71.4%; < 2weeks 16/74, 21.6%; P< 0.001). Blood diarrhea, fever and weight loss were also positively associated with having significant findings. Laboratory parameters: WBC, Hemoglobin, ESR, Albumin and CRP were not correlated with IBD. Calprotectin was done in 36/109 patients. Mean Calprotectin was significantly higher with IBD and TB (199.5±299.8 vs 809.8±540.8; P< 0.001). Four radiologically reported parameters - fat stranding, lymphadenopathy, vascular engorgement and pelvic free fluid were analyzed from CT reports. Of these only fat stranding was associated with IBD or TB (20/46, 44% vs 10/52, 19%; P=0.009). Conclusion: One Third of the patients in the study had significant pathology (IBD/TB/Malignancy). Two thirds of patients had a negative endoscopy or acute inflammatory findings on endoscopy. Prospective data may guide patient selection for endoscopic evaluation in patients with Bowel Wall Thickening on CT scans.595_A Figure 1. Diagnosis and Distribution595_B Figure 2. Diagnosis595_C Figure 3. Calprotectin has high sensitivity and specificity to detect abnormality

Mutations in LNPK, Encoding the Endoplasmic Reticulum Junction Stabilizer Lunapark, Cause a Recessive Neurodevelopmental Syndrome

The dynamic shape of the endoplasmic reticulum (ER) is a reflection of its wide variety of critical cell biological functions. Consequently, perturbation of ER-shaping proteins can cause a range of human phenotypes. Here, we describe three affected children (from two consanguineous families) who carry homozygous loss-of-function mutations in LNPK (previously known as KIAA1715); this gene encodes lunapark, which is proposed to serve as a curvature-stabilizing protein within tubular three-way junctions of the ER. All individuals presented with severe psychomotor delay, intellectual disability, hypotonia, epilepsy, and corpus callosum hypoplasia, and two of three showed mild cerebellar hypoplasia and atrophy. Consistent with a proposed role in neurodevelopmental disease, LNPK was expressed during brain development in humans and mice and was present in neurite-like processes in differentiating human neural progenitor cells. Affected cells showed the absence of full-length lunapark, aberrant ER structures, and increased luminal mass density. Together, our results implicate the ER junction stabilizer lunapark in establishing the corpus callosum.

Differentiation of cancerous and inflammatory colorectal perforations using multi-detector computed tomography.

To determine reliable CT features to distinguish cancerous from inflammatory colorectal perforations. A total of 43 patients with surgically and pathologically confirmed colorectal perforation caused by either colorectal cancer (n =27) or an inflammatory conditions (n = 16) were identified. Two radiologists independently assessed the contrast-enhanced CT features for locations of perforation, mural configurations, soft-tissue alterations, lymphadenopathy, and metastases. Intergroup comparisons for univariate analysis were performed using Fisher's exact test or chi-square test for categorical data and Mann-Whitney test for numeric data. Stepwise logistic regression analysis was conducted with features that were found significant under the univariate analysis. Interobserver agreement was assessed using intraclass correlation coefficient (ICC) and kappa test. Maximal mural thickness >1.39 cm (sensitivity, 100%; specificity, 68.75%), luminal mass or shoulder formation (sensitivity, 88.89%; specificity, 68.75%), absence of diverticula (sensitivity, 96.30%; specificity, 50.00%), irregular mural thickening (sensitivity, 92.59%; specificity, 81.25%), lymphadenopathy (sensitivity, 40.74%; specificity, 93.75%), and metastases (sensitivity, 25.93%; specificity, 100%) were significantly frequent in cancerous perforations. The maximal mural thickness (P = 0.0493, odds ratio = 439.83) and irregular mural thickening (P = 0.0343, odds ratio = 4.69) were identified as the highly distinguished identifiers. The CT manifestations of cancerous and inflammatory colorectal perforations overlap. Definitive diagnosis is not always possible with imaging alone. The maximal mural thickness >1.39 cm and irregular configuration of the thickened bowel wall were the two highly statistically significant CT features that may help order the difference between the two entities.

Ileocolic intussusception caused by a lipoma in an adult

Intussusception is rarely observed in adults. Adult cases account for only 5% of all cases of intussusceptions and almost 1%-5% of bowel obstruction cases. The etiology, presentation and management of intussusception in adults are different from those in children. The clinical presentation in adults often includes nonspecific signs and symptoms, thereby complicating differential diagnosis from other causes of abdominal pain. We report a 29-year-old Asian woman who visited our emergency department with complaints of fever associated with epigastric pain since one day. Abdominal computed tomography demonstrated ileocolic intussusception, and laparoscopic small bowel luminal mass resection was performed. Histopathology report confirmed a 3.5 cm × 2.7 cm submucosal lipoma in the terminal ileum. Sufficient vigilance and appropriate investigations are important for prompt diagnosis and surgical referral of patients to enable favorable outcomes. A computed tomography scan can be a helpful modality in establishing a diagnosis.

Case Report: Primary Germ Cell Tumour Presenting as a Luminal Duodenal Mass

Introduction: Extragonadal germ cell tumors (GCTs) are rare and account for only 1-5% of all GCTs. They most commonly occur in the mediastinum or sacrococcygeal region; however, they can occur at various other locations, including the neck and retroperitoneum. We report a case of a primary GCT discovered endoscopically …

Inflammatory Fibroid Polyp of the Ileum Presenting with Acute Intestinal Obstruction In An Adult Patient: A Case Report.

A 49-year-old male patient presented in the emergency department with acute pain abdomen. Upon auscultation of the abdomen, bowel sounds were found to be consistent with mechanical bowel obstruction. Digital rectal examination did not show the presence of feces, mucus or blood. Laboratory investigations showed total leukocyte count 9,400/mm3 with 75% polymorphs, Hb 12.2 g/dl, creatinine 0.9 mg/dl, urea 41.3 mg/dl, sodium 135 mmol/l and potassium 4.5 mmol/l. An upright plain abdominal film revealed small bowel obstruction, with marked small bowel air-fluid levels. Abdominal ultrasound revealed a well-defined hypoechoic lesion measuring 2.8x2.3 cm noted within the bowel loop with evidence of intrusion of proximal bowel loops within the bowel in right hypochondriac –lumbar region. CT scan showed luminal soft tissue density mass in right upper quadrant small bowel loop, possibility of gastrointestinal stromal tumour (GIST) was suggested [Table/Fig-1]. During exploratory laparotomy an ileal intussusception due to a mass lesion 50 cm proximal to the ileocecal junction was found [Table/Fig-2]. Partial ileal resection and anastomosis were performed. On gross examination, cut opened part of ileum measured 13.5 cm in length. Inner surface showed normal mucosal folds along with a solitary sessile polypoidal lesion at the site of intussusception measuring 3.8x 2.5x1.5 cm [Table/Fig-3]. On light microscopic examination, the polypoidal lesion at the site of intussusception showed a mesenchymal sub mucosal lesion extending upto serosa comprising of plump spindle cells in a background of loose fibro-myxoid stroma, proliferative blood vessels some of which appeared to be hyalinized along with mixed inflammatory infiltrate predominantly eosinophils [Table/Fig-4,​,55 and ​and6].6]. Immunohistochemistry for CD-117 was negative [Table/Fig-7]. [Table/Fig-1]: CT scan showing soft tissue mass in the small bowel. [Table/Fig-2]: Photograph showing lead point of intussusceptions [Table/Fig-3]: Photograph showing intraluminal polypoidal lesion. [Table/Fig-4]: Photomicrograph showing the submucosal origin of the polyp (H&E, 4x). [Table/Fig-5]: Photomicrograph showing proliferating blood vessels and inflammation (H&E, 100x). [Table/Fig-6]: Photomicrograph showing hyalinized blood vessels and eosinophils (H&E, 400x). [Table/Fig-7]: Photomicrograph showing tumour cells negative for CD-117 (IHC, 100x). IFPs (Vanek’s tumour) are rare, idiopathic tumorous lesions of the gastrointestinal tract, which were first described by Vanek in 1949 as an eosinophilic submucosal granuloma [1]. They are most commonly localized to the gastric antrum (66%-75%), but can develop anywhere in the gastrointestinal tract. The small bowel (18%-20%) is the second most common site of origin, where IFPs usually present as intussusception or obstruction [2]. The tumour usually projects into the bowel lumen as a pedunculated or sessile mass measuring 0.2-20 cm in diameter [3]. Histologically, the tumour arises from the submucosa and is composed of mononuclear, spindle-shaped cells along with vascular proliferation and inflammatory infiltrates predominantly comprising of eosinophils [2]. Increased/abnormal mitosis and cellular atypia are not seen [3]. Many factors have been suggested as a trigger such as intestinal trauma or eosinophilic gastroenteritis [4]. IFPs are typically identified during endoscopic procedures and laparotomy and are often asymptomatic [5]. Abdominal pain is the main symptom in patients with lesions in the stomach. The polyp when located in the small intestine usually causes intussusception and obstruction as initial symptoms [6]. IFP affects both sexes and all age groups, with a peak of incidence in the fifth and sixth decades [7]. IFPs or Vanek’s tumour should be considered in the differential diagnosis of both tumour and non-tumour processes of the gastrointestinal tract which includes spindle cell lesions, such as inflammatory fibrosarcoma, spindle-cell carcinoids, and gastrointestinal stromal tumours (GISTs). However, it is difficult to differentiate, especially between IFPs and GISTs. GISTs are common in the stomach and frequently present as polypoid masses. In the intestine, these tumours can present with intussusception similar to IFP. Immuno-histochemistry is used to distinguish between IFPs and GISTs. Both tumours are positive for CD34 and vimentin, but GISTs are positive for CD117, while IFPs are not [6]. Inflammatory fibroid polyps are rare benign tumours and does not metastasize. The recommended treatment for intussusceptions caused by IFP is exploratory laparoscopy or laparotomy [3]. Histopathological examination along with immunohistochemistry is helpful in differentiating Vanek’s tumour from GIST [8]. Intestinal obstruction due to intussusception is a very rare cause in adults and IFP is one of the least common causes of this rare condition. Although IFPs are benign lesions, surgical resection along with histopathological examination and IHC is important for diagnosis.

Aortic chondroid neoplasia in two Labrador Retriever dogs

In the same week, two Labrador Retriever dogs presented to The Ohio State University Veterinary Medical Center for cardiac evaluation. The presenting signs in both dogs included: weight loss, weakness, lethargy, and decreased femoral pulses. The first dog presented in cardiogenic shock and biventricular congestive heart failure, which initially responded to treatment; however, the dog was euthanized due to deteriorating clinical condition. In contrast, the second dog had a milder clinical course without signs of congestive heart failure, and remained stable over the 2-month period of clinical evaluation prior to euthanasia.Echocardiographic evaluation revealed a dilated cardiomyopathy phenotype in the first dog, while a space-occupying intraluminal mass originating at the aortic valve with preserved left ventricular systolic function was observed in the second dog. At autopsy, each dog had a large obstructive luminal mass affecting the ascending aorta and arch. Histopathology revealed that the mass in the first dog was consistent with a benign chondroma, while in the second dog the morphologic characteristics, mitotic activity, and infiltrative growth justified a diagnosis of chondrosarcoma. This report presents the contrasting clinical disease progression and findings in two dogs with aortic neoplasia, with a proposed pathogenesis of cardiac failure secondary to aortic neoplasia.

Primary Leiomyosarcoma of inferior vena cava: a Case of Rare Malignancy

Vascular leiomyosarcoma is a rare tumor, only about 200 cases have been reported worldwide. It commonly arises from inferior vena cava (IVC). There is a strong predilection for females and middle segment of IVC is most commonly affected. The diagnosis is often challenging as patients present with non-specific complaints such as dyspnoea, abdominal discomfort, or back pain. Computed tomography (CT) and Magnetic resonance imaging (MRI) individually or in combination with cavography, ultrasonography (US) and echocardiography, allow an early preoperative diagnosis. Here in, we present a rare case report of leiomyosarcoma of IVC in a 70 year old male patient who presented with vague abdominal discomfort. Ultrasound of abdomen detected a mass in retro peritoneum with mixed echogenicity. CT scan revealed a 10.5 x 6 x 6 cm lobulated, heterogeneously enhancing luminal mass with necrotic changes in supra-renal segment of IVC. Diagnosis of primary Vena caval tumor was made. En bloc resection of the tumor with 1 cm cuff of IVC with closure of the lower end of IVC was performed with excision of a cuff of the liver which was adherent to the IVC. Specimen grossly revealed a soft tissue mass adherent to vessel measuring 10 x 6.5 x 6 cm. External surface was smooth and bosselated. Cut section was nodular, grey white and firm in consistency. Microscopically diagnosis of Leiomyosarcoma was made. IHC study revealed positivity for Smooth muscle actin and desmin and Ki 67 positivity in 12-15 % of tumor cells and was consistent with diagnosis of Leiomyosarcoma. Key words: Desmin, Inferior vena cava, Leiomyosarcoma, Smooth muscle actin, Vascular tumor.

MRI characteristics of intraductal papilloma

Intraductal papilloma (IDP) is the most common pathological finding in women with pathological nipple discharge. Magnetic resonance imaging (MRI) has shown potential for characterizing breast tumors; however, MRI findings of IDPs are inconclusive, and certain diagnostic standards are lacking. To characterize the MRI features of IDP from a relatively large cohort. We retrospectively reviewed from 358 women with IDPs that were confirmed by histopathology. The clinical and imaging findings in 70 patients who underwent preoperative MRI were analyzed. MRI analyses included morphology and dynamic contrast-enhanced MRI. In 70 patients, 77 IDPs were detected on MRI, which revealed the following three patterns: small luminal mass papillomas; tumor-like papillomas; and MRI-occult papillomas. Fourteen IDPs involved small, oval, smooth, and contrast-enhanced masses at the posterior end of the enlarged duct corresponding to small luminal mass papillomas. Seven IDPs had large diameters along the direction of the breast duct, indicating the typical MRI findings for IDP. Of 47 tumor-like papillomas, 16 cases showed large diameters along the direction of the breast duct and close to the nipple (within 4 cm), seven cases resembled invasive breast cancer on MRI, and the remaining 24 were (24/47) undistinguishable from other benign breast diseases. Sixteen IDPs were MRI-occult papillomas that could not be distinguished from the surrounding benign disease by either contrast-enhanced MRI or fat-suppressed T2-weighted MRI. Small luminal mass papillomas or tumor-like papillomas with the largest diameters along the direction of the breast duct and close to the nipple (within 4 cm) might be the typical MRI findings for IDPs.

Tumor Mimicking Bladder Endometriosis

Endometriosis is described as the presence of endometrial tissue outside the uterine corpus. Though urinary tract endometriosis is uncommon, the bladder is the most common localization amongst them. Here we present three cases admitted to our hospital with similar complaints such as dysuria and abdominal pain. All of the patients had previous cesarean section history. And radiological examination of the bladder revealed solid masses located on the bladder wall. One of the case additionally had a protruding, polipoid luminal mass. Two of the cases were treated with transurethral resection and one with partial cystectomy. We noted similar histological findings such as endometrial stroma and glands within the smooth muscle fibers. The stromal components were positive with CD10, epithelial components were positive with both estrogen and progesterone receptor immunohistochemically. As a result bladder endometriosis should be kept in mind in the differential diagnosis of mass forming urinary tract lesions.