Mass In Segment Research Articles

Robot-assisted laparoscopic hepatectomy for liver metastasis from clitoral malignant melanoma: a case report

Abstract Introduction Malignant melanomas occur most commonly in the skin, mucous membranes, or choroid. Clitoral malignant melanomas are extremely rare. Stage IV malignant melanomas have a poor prognosis, and molecularly targeted agents or immune checkpoint inhibitors are recommended. However, surgical resection is reportedly a valid option for improving the prognosis of patients with oligometastases, defined as a small number of metastases that can be completely resected. In this report, we describe hepatic resection for a recurrent liver metastasis in a patient who had undergone removal of a clitoral malignant melanoma 9 years previously. Case presentation An 82 year-old woman presented with a black nodule on her clitoris. Total resection of the nodule resulted in a diagnosis of clitoral malignant melanoma (pT4bN0M0, pStage IIC; UICC 8th edition). A follow-up computed tomography scan 4 years later revealed a single 5 mm mass in the lower lobe of the right lung, prompting partial resection of the right lung. Pathological examination of the operative specimen revealed a pulmonary metastasis of malignant melanoma. The patient was treated with pembrolizumab monotherapy as adjuvant chemotherapy for 1 year. A follow-up computed tomography scan 9 years after surgical removal of the primary lesion revealed an 18 mm mass in segment II of the liver, prompting robot-assisted laparoscopic left lateral sectionectomy. The provisional diagnosis of metastatic malignant melanoma in the liver was confirmed by histopathological examination of the operative specimen. The patient was treated with pembrolizumab monotherapy as postoperative adjuvant chemotherapy for 1 year. No further recurrence was detected at the 1.5 year follow-up. Conclusion We performed hepatectomy for oligometastasis of clitoral malignant melanoma, an extremely rare entity. Surgery has the potential to prolong the prognosis of patients with oligometastasis.

Primary pulmonary alveolar soft part sarcoma with ASPSCR1-TFE3 gene fusion: Case report and literature review.

Primary pulmonary alveolar soft part sarcoma (ASPS) is an extremely rare disease characterized by a specific genetic abnormality - the ASPSCR1-TFE3 gene fusion. This study presented a 27-year-old male patient who experienced persistent chest tightness for over 6 months. The computed tomography (CT) scan and enhanced CT scan revealed a mass in the medial segment of the right middle lobe of his lung. The patients then underwent further diagnosis. Pathological examination showed the tumor to be consisting of polygonal cells with abundant eosinophilic or transparent cytoplasm arranged in nests. Next-generation sequencing reported ASPSCR1-TFE3 gene fusion, confirming the final diagnosis of primary pulmonary ASPS. Regular follow-ups of 12 months showed no signs of tumor recurrence. The patients underwent the medial segment resection of the right middle lobe for treatment. A CT examination 3 months after the operation showed that the patient had improved. The last review showed no recurrence or metastasis. This case report highlights the importance of detailed diagnosis, prompt treatment, and close monitoring of patients with ASPS.

A case report of high-grade intraepithelial neoplasia of the bronchial mucosa

BackgroundLung cancer is the most common cause of cancer death worldwide and poses an immediate health threat. Despite decades of basic and clinical research, the 5-year survival rate for lung cancer patients is less than 10%.The most important drawbacks in efficient treatment of lung cancer are delayed diagnosis and absence of effective screening. Detection and study of precancerous lesions of the bronchial mucosa might be one of the turning points in understanding of neoplastic transformation. Therefore, it would be the most effective prevention and early treatment modality. We report a case of high-grade intraepithelial neoplasia of the bronchial mucosa in which a neoplastic growth in the lumen of intrinsic segment in the upper lobe of the left lung was detected on electronic bronchoscopy, and biopsy confirmed squamous papillary hyperplasia with high-grade intraepithelial neoplasia.Case presentationA 74-year-old male was admitted to the hospital due to a mass lesion in his left lung. After admission, computed tomography scan of the chest showed an intraluminal mass in the intrinsic segment of the upper lobe of the left lung and an enlarged left hilum.ConclusionsHigh-grade intraepithelial neoplasia of the bronchial mucosa is rare in the respiratory system. We report a case that can provide useful information for early diagnosis and treatment of the disease.

Primary Pulmonary Meningioma With Associated Multiple Micronodules: A Case Report With Comprehensive Diagnostic Overview

ABSTRACTBackgroundPrimary pulmonary meningioma (PPM) is an exceedingly rare neoplasm originating in the meninges within the lung. Despite sharing similarities with its central nervous system (CNS) counterparts, PPM presents unique diagnostic challenges and therapeutic considerations owing to its infrequent occurrence.CaseThis case report describes a 73‐year‐old male who underwent chest computed tomography (CT), which revealed a mass in the posterior basal segment of the right lower lobe, suggestive of a low‐grade malignant tumor approximately 30–40 mm in size. Single‐port video‐assisted thoracoscopic surgery (VATS) was performed to resect the mass via localized lesion excision (lung wedge resection). Intraoperative frozen section pathology indicated a low‐grade malignant epithelial tumor, leading to a decision for maximal lung function preservation, considering the patient's advanced age. The surgical team opted for a localized excision to ensure negative margins. Histopathological analysis confirmed the diagnosis of epithelioid PPM, a rare subtype even among PPM cases (World Health Organization [WHO] Grade I). The patient was discharged 9 days after surgery without complications and resumed normal daily activities 1 month postoperatively. The rarity of PPM precludes a standardized treatment protocol, with surgical resection as the primary approach. However, the efficacy of adjunctive therapies remains uncertain due to limited evidence.ConclusionThis case report contributes to a better understanding of PPM and emphasizes the importance of a comprehensive diagnostic evaluation and individualized treatment planning for this rare entity.

Rainbow trout (Oncorhynchus mykiss, Walbaum 1792) adenocarcinoma investigation with various diagnostic imaging techniques.

Diagnostic imaging techniques provide a new aspect of the ante-mortem and post-mortem diagnostics in fish medicine. Ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) can provide more information about the internal organs and pathognomic lesions. The authors used diagnostic imaging techniques to evaluate and describe the neoplastic malformation in a 3-year-old female rainbow trout (Oncorhynchus mykiss). The fish was examined with Siemens Somatom Definition AS + CT scanner and Siemens Biograph mMR scanner. The animal was lethargic and showed anorectic signs and muscular dystrophy. During the post-mortem investigation, histopathology and immunohistochemistry were also performed allowing us to identify the neoplasms. The results showed a large soft tissue mass in the first mid-intestine segment, which proved to be an adenocarcinoma. This subsequently led to digestion problems and absorption disorders. Immunohistochemically, neoplastic cells of carcinoma revealed E-cadherin and pancytokeratin positivity. This is the first study to report the use of MRI and CT for studying gastrointestinal adenocarcinoma in rainbow trout.

Primary hepatic undiferentiated pleomorphic sarcoma with recurrence and widespread metastasis.

A 59-year-old man was referred to us for evaluation of asymptomatic mass in the liver that had been detected on ultrasonography performed during a physical screening. He had no history of hepatitis, and was otherwise well. Tumor markers were normal, including alpha fetoprotein, carcinoembryonic antigen, neuron-specific enolase and cancer antigen 199. Abdominal CT showed a 5.0 cm diameter low density mass in the S6 segment of his liver, with mild peripheral enhancement. Abdominal MR demonstrated the mass with hypointensity on T1WI, inhomogeneous hyperintensity on fat-suppressed T2WI, and mild peripheral enhancement. Partial hepatectomy was performed and pathological examination indicated undiferentiated pleomorphic sarcoma, with immunohistochemical results as follows: Vimentin (+), CK (-), CD68 (+), INI-1 (+), Hepa (-), Gly-3 (-), Arg-1 (-), HMB45 (-), CAM5,2 (-), CD31 (-), CD34 (-), CK7 (-), CK19 (-),Desmin (-), SMA (+), EMA (-), S-100 (-), Ki67 (50%+). The patient underwent postoperative chemotherapy with karelizumab and gemcitabine. However, repeat MR 3 months later showed multiple nodules with rim-like enhancement around the surgical margin. Subsequent repeat CT 6 months later reveled marked progression of the lesions.

Recurrence of pulmonary sarcomatoid carcinoma presenting as haemothorax: a case report

Pulmonary sarcomatoid carcinoma (PSC) is a rare and highly invasive malignant tumour. It has similar clinical manifestations and imaging features to ordinary lung cancer. This current case report describes a 65-year-old male patient who had a mass in the apicoposterior segment of the left upper lobe with haemoptysis. Imaging studies revealed a central parenchymal mass surrounded by areas of ground-glass opacity, strongly indicating the presence of a pulmonary malignancy. Intraoperatively, the tumour was discovered to have invaded the chest wall and exhibited a significant propensity for bleeding. Consequently, a left upper lobe resection accompanied by extensive pleural debridement were performed. Subsequent postoperative histopathological examination confirmed the diagnosis of PSC. Unfortunately, 1 month after the surgery, the patient presented with left-sided haemothorax. Despite employing various haemostatic interventions, the patient eventually succumbed to haemorrhagic shock. This study provides a treatment strategy reference for patients with PSC presenting as haemothorax.

A case of primary pulmonary follicular dendritic cell sarcoma

Here, we report a 66-year-old woman who presented with an irregular and lobulated pulmonary mass in the apical segment of the right superior lobe with an enlarged mediastinal lymph node. Abdominal computed tomography (CT), brain magnetic resonance imaging, and fluorine-18 fluorodeoxyglucose positron emission tomography/CT scans showed no extrapulmonary distant metastases. The patient underwent surgical sleeve resection of the right superior lobe with systematic hilar and mediastinal lymph node dissection. Post-operative histopathology, including hematoxylin and eosin staining, immunohistochemistry, and Epstein–Barr virus in situ hybridization, suggested primary pulmonary follicular dendritic cell sarcoma (FDCS). A follow-up plain chest CT indicated recurrence with multiple metastases of the liver, ribs, and mediastinal lymph nodes 1 year after surgery. The patient declined further therapy and was lost follow-up. In this case, FDCS located in the lung was unusual and rare. Corresponding imaging and histopathological features have enhanced our understanding of this disease. Meanwhile, it is necessary to include this tumor as a differential diagnosis of lung tumors and pay particular attention to the possibility of post-operative recurrence and metastasis. Moreover, considering the heterogeneity of FDCS, it is essential to identify the biological or imaging features that can reflect or predict the high risk of tumor recurrence and metastasis. A corresponding post-operative examination is also necessary to determine if any lesions remain.

A Calcified Liver Mass

A Caucasian woman in her mid-30s presented to the hospital emergency department with a 3-week history of pain in the right hypochondrium and ribs, just below her breast implant. The pain started 3 weeks prior, and she complained of slowly progressive tiredness. She had no history of fever, cough, weight changes, or any other complaints. Her vital signs were normal and an abdominal computed tomography scan was performed without contrast. This examination showed an isolated calcified mass in liver segment VIII, measuring 68 × 55 × 50 mm, with irregular margins and nonspecific characteristics (Figure 1). There were no other findings. The patient received breakthrough analgesics and was discharged with a referral to a medical oncologist.

First Report of Immunoglobulin G4-related Hepatic Inflammatory Pseudotumor in Transplanted Liver.

Immunoglobulin (Ig)G4–related hepatic inflammatory pseudotumor (IgG4-HIPT) is a rare subset of IgG4-related disease characterized by IgG4-positive plasma cell infiltration and fibrosis.1 Only 28 cases have been reported, all occurring in native livers.1-3 We report herein the first case of IgG4-HIPT developing in a transplanted liver. All ethical approval and consent procedures were approved by the Medical Ethical Committee of Icahn School of Medicine at Mount Sinai. According to the institutional guidelines, the patient’s signed privacy consent is not necessary for a single case report with deidentified patient-specific information. Our patient, who is a 62-y-old women who underwent liver transplantation for primary biliary cholangitis 14 y prior, presented with bacteremia. Laboratory tests showed normal white blood cell count, elevated gamma-glutamyl transferase 101 U/L (normal, 8–35), normal alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and bilirubin. Blood culture was positive for methicillin-resistant Staphylococcus aureus and Klebsiella oxytoca. Serological tests for hepatitis A, B, C, and E; cytomegalovirus; and Epstein-Barr virus were negative. Serum total IgG 1654 mg/dL (normal, 586–1602) and IgG4 171 mg/dL (normal, 2–96) were elevated. Computed tomography (Figure 1A) and magnetic resonance imaging (Figure 1C–E) of the abdomen revealed a 6-cm infiltrative mass in segment 8 of the liver. A biopsy of the lesion demonstrated parenchymal collapse replaced with fibrosis and sheets of plasma cells (Figure 1F). Immunohistochemical stains showed up to 150 IgG4-positive plasma cells per high power field and an IgG4:IgG ratio of 60% (Figure 1G and H). There was no evidence of malignancy, recurrent primary biliary cholangitis, acute cellular rejection, or chronic rejection, and a diagnosis of IgG4-HIPT was rendered. Given the patient’s bacteremia, she was started on intravenous daptomycin and ertapenem. Prednisone was deferred because she was asymptomatic from the lesion. The patient was restarted on mycophenolate mofetil 1 mo postdischarge. Repeat computed tomography of the abdomen 7 mo later demonstrated the decreased size of the lesion to 2.3 cm (Figure 1B).FIGURE 1.: Radiology features (A–E). A, Contrast-enhanced computed tomography images demonstrate an infiltrative enhancing mass in segment 8 measuring 6 cm (arrow). B, Follow-up postcontrast computed tomography after 7 mo demonstrates the decreased conspicuity and size of the lesion (measuring 2.3 cm, arrow). Contrast-enhanced MRI obtained during the (C) arterial, (D) portal venous, and (E) delayed venous phases demonstrates an ill-defined lobulated infiltrative progressively enhancing mass (arrow). Microscopic and immunohistochemical features (F–H). F, The inflammatory cells consist predominantly of lymphocytes and plasma cells (arrow) (hematoxylin and eosin stain ×200). The inflammatory cells demonstrated diffuse reactivity for (G) cluster of differentiation 138 and (H) immunoglobulin G4. MRI, magnetic resonance imaging.IgG4-related disease is generally described as an autoimmune disease because the oligoclonal expansions of both activated B cells and cytotoxic CD4+ T cells were considered central to the process.4 In our case, the IgG4-HIPT developed in a liver allograft in a patient on immunosuppression (tacrolimus target trough level 2–6 ng/dL, mycophenolate mofetil 500 mg twice daily). It may seem counterintuitive that an autoimmune process may develop in such a setting. On the other hand, infections such as Escherichia coli and Klebsiella may also incite an IgG4-predominant inflammatory response.3 In our case, the patient developed bacteremia with methicillin-resistant Staphylococcus aureus and Klebsiella at the time the liver mass was noted. Bacterial translocation from the gut to the portal circulation may have provoked an intrahepatic inflammatory response. This theory was further supported by partial or complete treatment response observed in the current and prior reported cases2 upon administration of antibiotics. Diagnosing IgG4-HIPT is challenging because of its rarity and overlapping clinical and radiological features with malignancy. Because IgG4-HIPT is clinically benign, the recognition of this entity is important to avoid unnecessary treatment.

Multidisciplinary management in the treatment of intrahepatic cholangiocarcinoma.

Multidisciplinary management in the treatment of intrahepatic cholangiocarcinoma.

Fulminant hepatic failure: An unusual suspect.

A 66-year-old man was admitted to the emergency department for bradypsychia and asthenia. He had a history of alcohol consumption and epilepsy with no medical follow-up. Laboratory test results were compatible with acute liver failure and hyperammonemic encephalopathy: international normalized ratio, 3.35; fibrinogen, 2.25 g/L; total/direct bilirubin, 9.27/4.96 mg/dL; aspartate aminotransferase, 2595 U/L; alanine aminotransferase, 1958 U/L; ammonia, 125 µmol/L. Axial (Figure 1A) and coronal (Figure 1B) contrast-enhanced computed tomography shows a 4-cm wide hepatic mass in the VII segment (arrowheads) invading the right sus-hepatic vein (voided arrowheads) and inferior vena cava (IVC; voided arrows). The invaded veins are disproportionately enlarged for a cruoric thrombus, which measures 14 cm in the cranio-caudal axis and extends to the right atrium (arrow). Transthoracic echocardiography (Figure 2) shows a bulky thrombus emerging at the atrio-caval junction. Several therapeutic options, such as in situ thrombolysis, fibrinolysis, and surgical resection, were discarded as first-line therapy because of the risks of thrombus fragmentation, secondary pulmonary embolism, and bleeding. Despite continuous infusion of therapeutic unfractionated heparin and supportive measures, the patient died a week later. Elevated alpha-fetoprotein levels (33,460 µg/L) confirmed probable hepatocellular carcinoma causing intraluminal extension of tumor thrombosis into the IVC, which confers a very poor prognosis in the absence of curative surgical resection. Differential diagnoses, in the absence of congenital abnormalities of IVC, include primary leiomyosarcoma of the vessel wall or adjacent organ carcinoma causing extension of tumoral thrombosis, such as renal cell or adrenocortical carcinoma and retroperitoneal metastasis.1, 2

UTERINE SCAR ENDOMETRIOMA: A CASE REPORT

Introduction And Importance: Uterine scar endometriosis is a rare form of endometriosis due to previous surgical scars from obstetrical and gynecological procedures. Its challenging diagnosis to make. A 34- Case presentation: year-old multiparous female presented with intermittent lower abdominal pain and inter-menstrual bleeding for the past 4 months .Ultrasound revealed a heterogenous, predominantly hyperechoic lesion measuring 40x51x54mm in the myometrium of anterior lower uterine segment extending to cervical stroma. MRI revealed a lobulated mass lesion in the anterior wall of lower uterine segment, extending along the scar niche. The lesion showed heterogenous hyperintense signal on T2WI with hyperintense signal on T1WI (sub-acute blood). No significant post contrast enhancement was seen. Impression of a scar site endometriosis was made. Subsequently the patient underwent diagnostic laparoscopy, which revealed a lobulated cystic mass in the lower uterine segment, with oozing of chocolate brown material on compression. As the mass was deep-seated in the lower uterine segment, a laparotomy was decided upon and total abdominal hysterectomy with varian conservation was performed. Histopathology confirmed the diagnosis of endometriosis. Conclusion: In any women of reproductive age with lower abdominal pain and solid appearing mass lesion at the uterine scar from previous obstetric or gynaecologic surgery, uterine scar endometriosis should be considered.

Lemierre's Syndrome in Pediatric Patients: Case Report

Introduction: Lemierre's syndrome is a severe and extremely rare septic thromboembolic event of an infection usually located in the neck and head. It is a rapidly progressive disease that can cause fatal consequences when there is no timely treatment. Clinical Case: A 6-year 5-month old female patient was evaluated due to a clinical picture of a continuous burning pain in the left anterior cervical region of moderate intensity of 3 weeks of evolution that worsens with a sudden mass growth at the mentioned level. Physical examination revealed an asymmetric neck with limited mobility due to the presence of an oval mass of approximately 6 cm in diameter located in the left anterior cervical quadrant. A CT scan showed an invasive process in the left infrahyoid region that is enhanced with the use of intravenous contrast medium, measuring 4.7 cm x 3.8 cm x 4.2 cm, with an approximate volume of 39 ml. In addition, a hypodense image is observed in the left internal jugular vein suggesting thrombosis. Drainage of a cervical abscess is performed, revealing a mass in the left external segment. The result of the study of the collected purulent fluid reports isolation of two types of germs: Bacteroides fragilis and Peptococus species. Considering also the radiological finding of the internal jugular vein thrombosis, anticoagulation with low molecular weight heparins was started. Patient with good evolution of clinical picture. Conclusions: Lemierre's Syndrome is a disease in which early diagnosis and treatment can reduce morbidity and mortality, especially in pediatric patients, where its incidence is extremely rare. However, specific clinical data can guide us to its diagnosis.

Central Hepatectomy for Hepatocellular Carcinoma in a Non-Cirrhotic Liver: Case Report and Literature Review

Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver. HCC usually develops in cirrhotic liver but cases arising in a healthy liver are rare and its etiology remains uncertain. The treatment of choice of hepatocellular carcinoma is surgical resection. Centrally located liver tumors were traditionally treated by extensive liver resection. With recent improvements in surgical techniques, centrally hepatectomy became an alternative approach for parenchymal preservation. We report here, the case of a 68-year-old male patient with an incidental finding of a 9 cm hepatic mass in segment IV of a non-cirrhotic liver found to be a hepatocellular carcinoma successfully treated by central hepatectomy. Although technically challenging, improvements in the understanding of liver structure, based on functional segmental anatomy, together with advances in imaging technology have contributed to the development of segment-oriented liver surgery making central hepatectomy an acceptable procedure for centrally located malignancies and allowing parenchyma preservation.

Micro-lymph node metastasis in intrahepatic cholangiocarcinoma showing pathological complete response to primary tumor and intrahepatic metastasis treated by gemcitabine plus cisplatin chemotherapy and radical surgery.

Surgical resection is the only curative treatment option for achieving long-term survival in biliary tract cancer patients. However, regional lymph node dissection in intrahepatic cholangiocarcinoma (ICC) is controversial. Herein, we document our experience with a 76-year-old man who had a 70mm mass in liver segments 6 and 7 and a 10mm mass in liver segment 3, which were diagnosed as poorly differentiated adenocarcinomas by needle biopsy. Lymphadenopathy was not evident on multidetector computed tomography scanning. Twenty courses of gemcitabine plus cisplatin chemotherapy were administered to the patient. The tumor masses shrunk and exhibited a partial response to chemotherapy as per the Response Evaluation Criteria in Solid Tumors version 1.1. Although tumor markers were all within normal limits, renal function parameters showed deterioration due to systemic chemotherapy. Therefore, continuing systemic chemotherapy was deemed unfeasible and we decided to perform a radical resection using extended posterior segmentectomy and partial liver resection with regional lymph node dissection. Postoperative histopathological examination revealed complete response of primary tumor and intrahepatic metastases; however, a micro-lymph node metastasis was found. The patient is still alive, without recurrence, more than 30months after treatment initiation and 15months after surgery. Even if remarkably effective pathological findings may be observed in the primary tumor, there are cases in which a micro-lymph node metastasis remains that are not identified on imaging examinations. Thus, regional lymphadenectomy may be useful in obtaining the exact state of disease progression and evaluation of chemotherapeutic effect in radical surgery.

S3669 Spotting the Deceiver: Metastatic Urothelial Carcinoma to the Liver Masquerading as a Well-Differentiated Neuroendocrine Tumor Histologically

Introduction: Metastatic urothelial carcinoma of the bladder is generally considered an aggressive disease. It has the potential to metastasize to lymph nodes, bones, lungs, liver, and peritoneum. The accurate diagnosis of metastatic urothelial carcinoma is challenging especially in the setting of histological mimickers. Without pathological expertise and additional immunohistochemistry, metastatic tumors could remain incorrectly diagnosed and delay therapeutic intervention. Case Description/Methods: Herein, we describe a 62-year-old man who presented with jaundice, elevated LFTs, diffuse abdominal pain, and early satiety. MRI of the abdomen revealed a hilar hyperintense mass involving the common bile duct, bilateral hepatic ducts causing narrowing, a 1.1 cm mass in segment 6, and hydroureteronephrosis with thickening of the renal pelvis. Discussion: Clinical differential diagnosis included cholangiocarcinoma and other tumors including a metastatic neuroendocrine tumor (NET). Microscopic evaluation of liver mass biopsy revealed insular growth pattern with monotonous epithelioid cells arranged in nests morphologically suggestive of well-differentiated neuroendocrine tumor (WDNET). However, neuroendocrine immunohistochemical stains, including synaptophysin, chromogranin, and CD56, were all negative, and the Ki-67 staining was 37%, higher than expected for a WDNET, (see Figure 1) prompting broadening of the differential. Following further workup, a diagnosis of metastatic urothelial carcinoma was confirmed by immunopositivity for immunohistochemical markers P40, and GATA3 (see Figure 1). Familiarity with tumors that are histologically identical is critical. Considering an appropriate differential diagnosis, and following a stepwise immunohistochemical approach will be crucial in spotting the mimickers and rendering appropriate management promptly.Figure 1.: Metastatic urothelial carcinoma, hematoxylin & eosin (A and B), and immunohistochemical markers (C-F).

A case of tracheal tumor with unusual bronchoscopic presentation: A case report

Primary tumor of the trachea and bronchial tree is rare. Primary tracheobronchial malignancies make up about 0.1% of all pulmonary tumors. The survival rate depends on several factors which include the malignant potential of the tumor, the patient’s comorbidities, and the location of the tumor. The index case is a 60-year-old woman who had 7 months history of globus with an associated history of central chest discomfort and cough of 3 months duration. There was a positive history of dysphagia to solid meals, odynophagia, dyspepsia, nausea, excessive belching, bloating, and regurgitation. These symptoms led to the diagnosis of gastroesophageal reflux disease. However, the persistent symptom of globus and worsening cough necessitated her referral to the chest clinic. Chest radiograph revealed opacity in the left upper lobe. Chest computerized tomographic scan showed a solitary, lobulated, and calcified soft-tissue mass in the apicoposterior segment of the left upper lobe with loss of volume. Bronchoscopy showed multiple planes of non-glistering submucosa lesions which were biopsied. The histology report revealed invasive adenocarcinoma of the airway. The surgical resection of tumors with stents was done and she was discharged home 2 weeks later. However, the patient refused adjunct chemotherapy. She is alive and well with complete resolution of symptoms. Early presentation, availability of investigative tools, and prompt treatment may improve survival in cases of trachea tumors as seen in the index case. A high index of suspicion is also needed to make a prompt diagnosis of trachea tumors, especially in patients presenting with globus.

PEComa-A Rare Uterine Neoplasm: A Case Report

Perivascular Epithelioid Cell Tumors (PEComas) are rare mesenchymal tumors originating from perivascular epithelioid cells. The second common affected organ is uterine. Most of PEComas are benign and patients have good prognosis. At the present time, surgery is the main treatment and adjuvant chemotherapy is used in malignant cases, although the best diagnostic and management method is yet to be discovered considering the rarity of this neoplasm. The patient was a 53 year old lady with a history of two vaginal deliveries and no previous surgery. She had severe pelvic pain and underwent MRI with the primary impression of sarcoma. In MRI, she had a 7 cm mass in lower segment of uterus. The patient underwent laparoscopic hysterectomy, bilateral oophorectomy, lymphadenectomy, and omental biopsy in Jam Hospital. Pathologic report of the patient revealed malignant PEComa without lymph node and omentum involvement. Diagnosis of PEComa before surgery is difficult and its differential diagnoses form uterine leiomyoma or leiomyosarcoma. Final diagnosis can be made after surgical biopsy and immunohistochemistry evaluation. Surgery is still the main treatment and adjuvant therapy is used in high risk patients.

Rare case of hepatocellular carcinoma metastasis to urinary bladder: A case report

BACKGROUNDHepatocellular carcinoma (HCC) is a primary liver cancer with high prevalence and mortality. There are many cases of advanced HCC at the time of diagnosis. Treatment methods and prognosis are different depends on whether metastasis is present. Thus, it is necessary to make an accurate evaluation at the time of diagnosis. Extrahepatic metastases of HCC usually occur through hematogenous spread or through adjacent organs such as the peritoneum. Metastasis to the urinary bladder alone is rare. Here, we report a rare case of biopsy-proven solitary metastasis of HCC to the bladder in a 60-year-old woman. CASE SUMMARYA 60-year-old female patient was found to be positive for hepatitis B surface antigen by chance after abdominal ultrasonography showed abnormal findings. Thus, liver dynamic computed tomography (CT) was performed. The patient visited the hospital for further examination. Ultrasound and CT showed 3.6 cm sized arterial enhancing mass in segment 5 and an infiltrative mass in segment 8. The patient was diagnosed with HCC through liver dynamic magnetic resonance imaging and liver biopsy. Afterwards, she underwent two transcatheter arterial chemoembolizations within five months for HCC. During follow-up, a newly appeared bladder tumor was found on liver dynamic CT. She underwent transurethral resection of the bladder tumor for diagnosis and treatment. The tissue was confirmed as metastatic HCC. CONCLUSIONAlthough rare, metastasis to urinary bladder from HCC can occur without evidence of other distant metastases. Thus, regular follow-up imaging examination and clinical attention are required.