Multiloculated Cystic Mass Research Articles

Ex utero intrapartum treatment (EXIT) procedure for the second twin with neck mass in a twin pregnancy with vertex/breech presentation

We report a case of a dichorionic diamniotic twin pregnancy where twin B was diagnosed with a large multi-loculated exophytic cystic neck mass arising from the right side with involvement of the right proximal upper limb and significant mass effect on the trachea diagnosed during antenatal MRI. After multidisciplinary discussion, an ex utero intrapartum treatment (EXIT) procedure was planned given concerns about airway obstruction in twin B. Successful EXIT was performed with the delivery of twin A first, followed by an intraoperative external cephalic version of twin B and subsequent delivery of the fetal head and intubation on maternal circulation.

Recurrent symptomatic abdominopelvic cystic lesions of unknown etiology treated with image-guided sclerotherapy: A case report

This case report highlights the diagnostic approach and treatment for 30 cm bilateral multiloculated pelvic peritoneal cystic masses. The patient had a history of spina bifida with ventriculoperitoneal shunt placement and neurogenic bladder with partial cystectomy and ileal conduit diversion. The cysts were suspected to be peritoneal inclusion cysts. Due to prior failed surgical intervention, the patient was treated with image-guided sclerotherapy.

Cystic endometrial stromal sarcoma mimicking a cystic ovarian tumor : an unusual presentation

Low grade endometrial stromal sarcoma (LGESS) typically presents as a solid intracavitary or intramural uterine mass. On imaging, LGESS is usually seen as an endometrial or myometrial solid mass. Cystic change is unusal and may lead to a differential diagnosis of an ovarian mass as was seen in the present case. Here we present a case of a 38 year old woman who presented with a cystic ovarian mass clinically and radiologically. Per-operatively, it was found to be a multiloculated cystic mass, filled with serosanguinous fluid, in the uterine fundus. Histopathological examination showed a tumor mass composed of mainly spindle cells arranged in fascicular pattern showing marked myxoid degeneration and cystic areas. On immunohistochemistry(IHC), tumor cells showed positivity for CD 10, ER, PR, SMA and desmin while HMB45 was negative. Based on histopathological and IHC, a diagnosis of LGESS was made. Most cases of cystic uterine masses have a benign course but, LGESS exhibits a relatively poorer outcome and a risk of metastasis. Hence, we present this case for its unusual presentation which mimics an ovarian mass but has worse prognosis.

Adnexal Torsion of a 28 cm Paratubal Cyst: A Case Report

Objective: To report a rare case of a 28 cm left adnexal torsion requiring surgical intervention including detorsion and salpingectomy Methods: Case report. Results: An 18-year-old nulliparous female with morbid obesity presented to the emergency department complaining of one week of sharp right lower quadrant pain with nausea and vomiting that had acutely worsened. Vital signs were notable for tachycardia, but otherwise within normal ranges. She had a significant leukocytosis. Her pregnancy test was negative. A CT abdomen/pelvis was obtained that demonstrated a large multiloculated complex cystic mass measuring 28.5 x 19.8 x 13.3 cm with possible origin from the ovaries that could represent a serous cystadenoma. Additionally, the scan was remarkable for a heterogeneous and enlarged left ovary measuring 7.6 x 5.9 x 7.2 cm, surrounded by free fluid and mesenteric edema. On examination, she did not demonstrate any surgical abdomen findings. Her pain improved with pain medication. She was admitted, tumor markers obtained, and an ultrasound ordered. The ultrasound demonstrated normal appearing right ovary with present doppler flow and a simple cyst measuring 6.6 x 5.1 x 6.1 cm. The left adnexa was noted to have a complex versus solid mass with unclear boundaries of the ovary. Also noted on the ultrasound were two large simple midline cysts measuring 10.5 x 9.1 x 11.8 cm inferiorly and 18.2 x 15.5 x 17.2 cm superiorly. No free fluid was seen within the right upper quadrant on ultrasound. The view of the left upper quadrant was suboptimal. Due to these findings, Gynecologic Oncology service was also consulted and after discussion, decision made to proceed urgently to diagnostic laparoscopy with robotic assisted cystectomy versus oophorectomy. Upon laparoscopic entry into the abdomen, a large necrotic-appearing left adnexal mass was visualized coming from the left fallopian tube. Both the left fallopian tube and left ovary were necrotic, with the left ovary being torsed numerous times. After resection of the large left fallopian tube and cyst, the left ovary was detorsed, and the decision was made to leave the ovary in situ. It still appeared necrotic, but its blood supply was intact. There was a large simple paratubal cyst on the right fallopian tube that was also drained and excised. Postoperatively, her right lower quadrant pain resolved, and she was discharged on post-operative day 1. She prescribed a two-week course of doxycycline and metronidazole as pelvic inflammatory disease could not be ruled out. At outpatient follow-up, she was asymptomatic and ready to begin working again. Her pathology report confirmed a large left paratubal cyst with associated findings of ischemia due to torsion and a large right paratubal cyst. Conclusions: Adnexal torsion is a rare gynecologic disorder caused by the partial or complete rotation of the ovary and/or the fallopian tube on its vascular support, which can negatively impact fertility. Prompt diagnosis is key, but definitive diagnosis is only by direct visualization. The differential diagnosis for acute onset of severe pelvic pain with nausea and vomiting is broad and includes ectopic pregnancy, pelvic inflammatory disease, endometriosis, ruptured ovarian cyst, urologic issues and gastrointestinal issues. Commonly, ultrasound is used to help evaluate a possible torsion with several classic findings that were not noted in this case, other than a mass. The two best known risk factors for adnexal torsion are a mobile ovarian mass and a history of prior torsion. Although large ovarian masses greater than 5 cm are more likely to cause torsion, some experts hypothesize that very large masses are less likely to torse given the constraints of the pelvis. However, such was not the case here. Additionally, it has been observed that adnexal torsion typically affects the right adnexa due to theoretical protection from the descending colon on the left. Given that the case presented did not have any of the typical imaging findings for adnexal torsion and that her pain was on the right but the torsion on the left, it is important to maintain a high level of suspicion when evaluating patients with acute onset pelvic pain of any location with nausea and vomiting.

Pseudomyxoma peritonei leading to “jelly belly” abdomen: a case report and review of the literature

BackgroundPseudomyxoma peritonei is an infrequent condition with a global annual incidence of only one to two cases per million people. Mucinous neoplasms, widespread intraperitoneal implants, and mucinous ascites characterize it. Currently, most clinicians misdiagnose this condition, which leads to delayed management.Case presentationA 44-year-old North Indian female presented with a 1.5-month history of an abdominal lump. Physical examination revealed a sizeable abdominopelvic mass at 36 weeks. Contrast-enhanced computed tomography showed a massive multiloculated right ovarian cystic mass measuring 28 × 23 × 13 cm with mild ascites and elevated carcinoembryonic antigen levels (113.75 ng/ml). A provisional diagnosis of ovarian mucinous neoplasm was made, for which the patient underwent laparotomy. Intraoperatively, there were gross mucinous ascites, along with a large, circumscribed, ruptured right ovarian tumor filled with gelatinous material. The appendicular lump was also filled with mucinous material along with the omentum, ascending colon, right lateral aspect of the rectum, splenic surface, and small bowel mesentery. Cytoreductive surgery was performed along with an oncosurgeon, including total abdominal hysterectomy with bilateral salpingoophorectomy, omentectomy, right hemicolectomy, lower anterior resection, ileo-transverse stapled anastomosis with proximal ileal loop diversion stoma, excision of multiple peritoneal gelatinous implants, and peritoneal lavage. Histopathology and immunohistochemistry confirmed the presence of intestinal-type mucinous carcinoma. Postoperatively, the patient was given six cycles of chemotherapy. She tolerated it without any specific morbidity and had an uneventful recovery. Postoperative follow-up at 15 months revealed normal tumor marker levels and abdominal computed tomography findings and no signs suggestive of local recurrence or distal metastases.ConclusionsPseudomyxoma peritonei is a rare disease that is frequently misdiagnosed in the preoperative phase. Therefore, radiologists and clinicians should maintain a high index of suspicion for accurate diagnosis and multidisciplinary management.

A rare case of fibrous dysplasia in the mandible: a case report

Background: Fibrous dysplasia (FD) is a benign fibro-osseous lesion of the bone which can be monostotic FD and the polyostotic form. Polyostotic FD with café-au-lait spots of the skin and hormonal imbalances is called McCune–Albright syndrome. Besides, Mazabraud syndrome is characterized by polyostotic FD and intramuscular myxomas. FD has its onset during childhood or early adolescence and usually occurs within the first or second decade of life.
 The mode of presentation of the FD of the jaw ranges from asymptomatic to dental anomalies, pain, and facial asymmetry. Given the clinical history and radiological assessment, cystic lesions have some important differential diagnoses which range from cystic ameloblastoma, fibrous dysplasia, aneurysmal bone cyst, and odontogenic keratocyst.
 Case report: This presents a 19-year-old female who presented to the maxillofacial surgeons’ clinic with a referral from a peripheral hospital. Her major complaint was right-sided facial swelling which was noticed 4 years before the presentation. A plain radiograph revealed an expansile lesion of the mid-right mandible appearing as a well-outlined, fairly oval multiloculated cystic radiolucent mass with multiple internal septations. A preliminary diagnosis of a complex cystic right jaw mass with benign features was made with possible differential diagnoses such as ameloblastoma, fibrous dysplasia, aneurysmal bone cyst, and odontogenic keratocyst were suggested as possible differential diagnoses. Finally, she had an excision biopsy with a histological diagnosis of fibrous dysplasia. The outcome of the surgery was satisfactory at one year review.
 

Ultrasonography Features of Adenocarcinoma Mimicking Cystadenoma of Rete Testis

Background: Adenocarcinoma of rete testis is an extremely rare intra-scrotal extra-testicular neoplasm, this tumor usually occurs in men over 60 years of age but there are a few cases of younger patients described as well, has a wide age range of 8-91 years. Case Presentation: In this case, we report A 23-year-old Asian male patient with right scrotal swelling for the last 3 months. Scrotal ultrasound revealed an anechoic multiloculated cystic lesion mass in the right scrotum with the size of 11.89 cm x 7.73 cm lesion that fills almost the entire testicle. There are no solid parts, visible thickening of the scrotum, and visible fluid echo intensity outside the mass. Color Doppler showed a normal flow of blood signals within the mass. Pathological examination is also needed as a gold standard diagnosis, the results concluded that it was adenocarcinoma-type testicular carcinoma. Conclusion: This case highlights the utility of radiological findings, supported by other examinations to determine the diagnosis of Adenocarcinoma of rete testis.

Synchronous or Metastatic Gastric and Ovarian Malignancies: A Diagnostic Challenge

Primary ovarian carcinoma is the prevailing form of cancer in the female reproductive system, leading to a substantial number of cancer-related fatalities globally. One of the major obstacles encountered in diagnosing this condition is distinguishing between primary gastrointestinal tumors and tumors that have metastasized from the ovaries, since they may exhibit similar histological characteristics. This case report underscores the difficulties involved in determining whether multiple tumors originate primarily or are a result of metastasis. We report a case of a 65-year-old female who presented with abdominal pain and was found to have a large multiloculated cystic mass in the right ovary and a poorly detected left ovary on ultrasound and CT scan. Her serum CA125 level was elevated. She underwent exploratory laparotomy and frozen section analysis of the right ovarian and gastric tumors. The histopathological diagnosis was mucinous cystadenocarcinoma of the ovary and well differentiated adenocarcinoma of the stomach. She also underwent hysterectomy with left salpingo-oophorectomy, which revealed mucinous cystadenocarcinoma of the left ovary. Immunohistochemical staining for specific markers, including CK7, CK20, CDX2, and PAX8, was conducted to identify the origin of the adenocarcinoma. The results revealed that both ovarian and gastric tumors showed a positive expression for CK7, while CK20 was negative in the gastric tumor but positive in the ovarian tumor. Furthermore, both CDX2 and PAX8 were negative in both the gastric and ovarian tumors. These findings provide valuable insights into the differential diagnosis and help to distinguish the possible sources of the adenocarcinoma. This case emphasizes the significance of histopathological examination and immunohistochemistry profiling in accurately diagnosing and determining the primary tumor site. Recognizing the primary tumor and its immunohistochemistry profile aids in guiding treatment strategies and predicting patient prognosis, leading to improved management and outcomes. Keywords Ovarian carcinoma, Gastric carcinoma, Immunohistochemistry

A rare case of cervical gastric-type adenocarcinoma mimicking bilateral ovarian malignancy in a genetically confirmed Peutz-Jeghers syndrome without known polyposis

Abstract Introduction/Objective Cervical gastric-type adenocarcinoma (GAS) is rare and accounts for 2-4% of cervical cancer. GAS is usually sporadic but can be associated with Peutz-Jeghers syndrome (PJS), a rare autosomal dominant disorder caused by germline STK11 mutations and characterized by hamartomatous polyposis in the gastrointestinal (GI) tract, mucocutaneous pigmentation, and cancer predisposition. Although cases of GAS may occur in patients with PJS associated with polyposis, our patient with GAS has an unusual and perhaps unique association with the PJS mutation that is unassociated with polyposis. Methods/Case Report A 33-year-old female presented with abdominal pain, abnormal uterine bleeding, vaginal discharge, weight loss, and fatigue for one year. Pigmentations were noted on lips, gum, tongue, and hands. She had a family history of maternal ovarian and pancreatic cancers. Computerized tomography revealed large bilateral multiloculated complex cystic adnexal masses, thickened endometrium extending into the endocervix, and ascites. Tumor markers showed increased CA19-9 and CA125, suggesting either a primary ovarian malignancy or possible metastatic GI tract cancer to both ovaries. Her PAP smear demonstrated atypical glandular cells that favored endocervical origin. HPV was not detected. A cervical biopsy showed bland gastric-type glands without obvious stromal invasion. Given the clinical concern for malignancy, a cervical cone biopsy was performed, demonstrating unequivocal invasion by gastric-appearing glands. The tumor cells were positive for CK7, CEA, and PAX8, and were negative for CK20, CDX2, and p16. The pathologic diagnosis confirmed a primary GAS with a spread to bilateral ovaries. Although the upper GI tract and left colon were free of polyps or masses by endoscopic exam, the genetic evaluation revealed a germline heterozygous STK11 mutation consistent with PJS. Results (if a Case Study enter NA) NA Conclusion To our knowledge, this is the first case of occult PJS (confirmed by genetic analysis) presenting with widely advanced metastatic GAS without known polyposis.

Cystic pheochromocytoma: a rare variant of adrenal gland tumor case report

Abstract Introduction/Objective Pheochromocytoma is the primary adrenal medullary tumor in adults. Patients usually present with sustained or sporadic hypertension. The tumors are almost always solid. Cystic pheochromocytoma (CP) is extremely rare with only a few cases reported in the literature. Patients with CP may be asymptomatic and normotensive and be diagnosed incidentally on imaging or intraoperatively. Methods/Case Report We report a case of an 82-year-old male with a large CP who presented with back pain. The patient was hypertensive preoperatively (140/85 mmHg). Imaging showed a 5.4 cm complex right adrenal mass that could not be further classified. Labs showed markedly increased 24hr urine normetanephrine (1342 ug/24hr). The patient was presumed to have a pheochromocytoma and was preoperatively treated with an alpha-blocker. At surgery an 8.0 cm multiloculated cystic adrenal mass was removed, and grossly the specimen consisted of a brown, multicystic mass filled with brown liquid. Histology revealed the septa to contain nests of polygonal cells with vacuolated to basophilic granular cytoplasm with moderate nuclear pleomorphism . Immunohistochemical staining was positive for synaptophysin, chromogranin and S-100, which confirmed the diagnosis of CP. Patient’s postoperative blood pressure was 130/60 mmHg. Results (if a Case Study enter NA) NA Conclusion Cystic pheochromocytoma has to be in the differential for a retroperitoneal cystic mass in order that clinicians, radiologists as well as pathologists undertake proper patient management and diagnosis.

Benign Multicystic Peritoneal Mesothelioma: Two Rare Cases and Review of the Literature

Background:: Benign multicystic peritoneal mesothelioma is a multiloculated cystic mass which originates from the peritoneum. This rare tumor is usually seen in women of childbearing age and has a high recurrence rate after surgery. Case Presentation:: We present two benign multicystic peritoneal mesothelioma cases with different imaging modalities, which were also pathologically proven. Conclusion:: The imaging features which may be diagnostic should be well known as there are very few reports regarding this entity

Sarcomatoid (Spindle Cell) Carcinoma Arising in Mature Cystic Teratoma as a Mural Nodule: A Case Report

Mature cystic teratomas are the most common ovarian germ cell tumours.Malignant transformation is rare in mature cystic teratoma. Spindle cell/sarcomatoid carcinoma is an uncommon type of squamous cell carcinoma. A 45-year- old female presented with abdominal distention and discomfort. Magnetic Resonance Imaging (MRI) showed multiloculated cystic mass measuring 21×20×14 cm with heterogeneously enhancing solid component measuring 5x3.5 cm in right adnexal region. Excision of the mass done. Macroscopic examination showed irregular cystic mass containing pultaceous material and hair, and a mural nodule measuring 5x5 cm. On histopathological examination, the cyst wall showed mature teratomatous elements. Sections from mural nodule showed sheets of atypical spindle cells with increased mitosis and foci of necrosis. On immunohistochemical examination, the spindle cells showed patchy weak to moderate positivity for cytokeratin, 34 beta E12, CK5/6 and P40. Diagnosis of spindle cell/sarcomatoid carcinoma arising in mature cystic teratoma was given. Malignant transformation in mature cystic teratoma is rare and should be suspected in large sized tumours in older patients. Sarcomatoid carcinoma is an extremely rare form of secondary malignant neoplasm arising from mature cystic teratoma.

An atypical imaging characteristic of calvarial metastasis of neuroblastoma as multiple multi-loculated cystic masses with internal blood-fluid levels: a case report

As the third most common malignancy of childhood, Neuroblastoma has a great propensity to metastasize to multiple organs. The most common site of metastasis is the bone and bone marrow. Concerning the central nervous system, neuroblastoma usually involves the calvarium and the external dural surface. The skull metastases may show different appearances, including: multiple lytic bone lesions, bone thickening, hair-on-end periosteal reaction, irregular suture widening and/or plaque like epidural deposits. Here we present a case of metastatic neuroblastoma, appearing as multiple multi-loculated cystic epidural masses with internal blood-fluid levels as a rare imaging manifestation of calvarial metastasis. An 8-year-old boy with known history of autism, presented to the emergency department with a 3-month history of intermittent fever, malaise and myalgia and headache along with significant weight loss. Laboratory examination revealed elevated ESR and CRP and anemia. On Abdomino-Pelvic imaging a well-defined, 45*30*24mm, solid-cystic mass was observed, replacing the normal left adrenal gland. On brain MRI, multiple multi-loculated cystic, lentiform masses were observed on the external surface of cerebral hemispheric dura. Multiple fluid-fluid levels were noted in the locules in some of which the dependent fluid was hyperintense on T1w and FLAIR and hypointense on T2w sequences, compatible with blood, representing blood-fluid level. The wall and septa of the masses, enhanced after contrast administration. Associated abnormal marrow signal and aggressive type periosteal reactions were identified in the overlying bone. All of the lesions had increased uptake in MIBG scan. Bone marrow biopsy revealed small round cells, diagnostic for neuroblastoma. The patient underwent chemotherapy treatment. All calvarial/epidural metastatic lesions resolved after chemotherapy and residual adrenal tumor was resected. Cystic epidural lesions, especially when associated with adjacent abnormal bone marrow signal, or periosteal reaction and containing blood-fluid level should raise the suspicion of a calvarial metastasis.

COVID-19 AS A PROBABLE CAUSE OF PANCREATIC INJURY

COVID-19 AS A PROBABLE CAUSE OF PANCREATIC INJURY

S1678 Gastric Ectopic Pancreas With Pseudocyst Formation Causing Gastric Outlet Obstruction

Introduction: Ectopic pancreas (EP) is a rare entity referring to the presence of pancreatic tissue at an anatomic location distinct from the pancreas which is commonly asymptomatic and found incidentally. EP can become symptomatic due to similar pathologic changes found in the anatomic pancreas including pancreatitis, bleeding, or pseudocyst formation. Gastric EP lesions present a diagnostic challenge as they lack distinguishing imaging and endoscopic features from other types of gastric submucosal tumors. This case report describes a rare case of EP presenting as a gastric antral mass with a unique combination of complications: chronic pancreatitis and pseudocyst formation causing gastric outlet obstruction. Case Description/Methods: A 59-year-old man presented to the hospital with nausea, vomiting, weight loss, and epigastric pain for 5 days. Exam was notable for epigastric tenderness, and labs were unremarkable. Computed tomography (CT) and index upper endoscopy showed a 4.4 x 3.5 cm multiloculated cystic mass in the gastric antrum (Figure). Endoscopic ultrasound (EUS) showed that the lesion originated from the submucosa, and fine needle aspiration (FNA) demonstrated histiocytes and epithelial cells with a high amylase level. On repeat endoscopy, interval growth of the cystic gastric mass was observed, and repeat CT abdomen/pelvis again showed the mass now with multiple cystic collections causing mass effect on a distended stomach suggesting gastric outlet obstruction. The lesion was surgically resected and determined to be EP with histologic changes of chronic pancreatitis and multiple pseudocysts. Patient did well after surgical resection and had no recurrence on repeat upper endoscopy. Discussion: EP can occur anywhere in the GI tract but most commonly are found in the duodenum or stomach. Symptoms are associated with the location, size, and pathology of the tissue. Lesions greater than 1.5 cm are more likely to be symptomatic with non-specific symptoms such as epigastric pain, abdominal fullness, nausea, diarrhea or melena. Diagnosis can be challenging, and in this case, multiple diagnostic modalities (imaging, endoscopy, EUS with FNA biopsy and surgical resection) were needed to reach a definitive diagnosis. EP is often found incidentally, and the combination of pseudocyst formation and gastric outlet obstruction in this case has been rarely reported in the literature. Prompt recognition of ectopic pancreas can facilitate the management of these complications.Figure 1.: A: Computed tomography of abdomen and pelvis from initial presentation, showing a multiloculated cystic mass (noted by *) and thickening of the gastric antral wall. B: Esophagogastroduodenoscopy (EGD) image showing a submucosal mass in the gastric antrum. C: Endoscopic ultrasound of gastric antrum with multicystic lesion appearing to originate from the submucosa.

Imaging characteristics of ovarian sclerosing stromal tumor

ObjectivesThis study was designed to evaluate the specific imaging features of ovarian sclerosing stromal tumor (SST), improve its accuracy as well as the specificity of imaging diagnosing, and prevent overestimation of malignancy to reduce unnecessary surgical procedures.MethodsEight patients with magnetic resonance imaging (MRI) and six with computed tomography (CT) images were analyzed in this retrospective observational study. All the cases were confirmed by postoperative pathological examination as those of ovarian SST. Imaging and pathological features were also evaluated.ResultsAll the 14 masses displayed cystic and solid components with outer surface of tumors contained a capsular and complete smooth rim. Eight tumors of MRI exhibited “lake-island” sign on T2 weighted imaging (T2WI). Two of the 6 CT cases displayed a flaky calcification. One case showed as a multiloculated cystic mass with irregularly thickened septae and the tumor wall. The solid components in other 13 masses were comb- or wheel-like enhanced. After injection of contrast agent, the solid components in 8 cases (57.1%) appeared as early enhancement, whereas the other 6 cases (42.9%) appeared as progressive enhanced, and the cystic components of all the cases had no enhancement in the whole course. Vascular flow signals or/and marked enhancement of the blood vessels were found in 12 lesions (85.7%). Pathological examination demonstrated pseudolobule patterns, round to spindle shaped cells, collagenous areas, edematous hypocellular areas and prominent vasculatures.ConclusionsThe results demonstrated that MRI with “lake-island” signs on T2WI and MRI/CT dynamic enhancement could potentially play a critical role in facilitating appropriate diagnosis preoperatively.

Death from Malignant Transformation of Untreated Mucinous Borderline Tumor: Case Report

Mucinous borderline tumors (MBT) of the ovary with mild to moderately atypical epithelial cells that produce mucin rarely recur and very rarely become malignant after surgery. Due to their low malignant potential and large tumor size, most cases are diagnosed in stage I and have a good prognosis. The authors reported a case of MBT, which had been left untreated after diagnosis, progressed to stage IV, and caused massive pleural effusion (>3,000 mL) resulting in death. Grossly, severe abdominal swelling, a huge multiloculated cystic mass in the left ovary, and a metastatic mucinous mass in the pleura and peritoneum were observed. Histological findings include gastrointestinal type epithelial cells with mucin secretion, degenerative and autolytic nuclei, and occasional infiltration of inflammatory cells. Because sufficient sections cannot be made according to the clinical pathology criteria in forensic autopsy, efficient decisions are required during autopsy for diagnosis.

Endocrine cell micronests in an ovarian mucinous borderline tumor: a potential diagnostic pitfall for microinvasion

The occurrence of endocrine cell micronests in ovarian tumors is rarely reported. To our knowledge, there are only three prior cases reported to date: one occurring in an ovarian mucinous cystadenoma, one in an ovarian mucinous cystadenofibroma, and another in an ovarian mucinous carcinoma with a predominant borderline component. This is a 27-year-old woman that presented with a one-month history of abdominal pain and fullness. Imaging studies revealed a large multiloculated cystic and solid mass measuring 23 cm occupying the majority of the pelvis and abdomen concerning for a primary ovarian malignancy. The patient underwent a right salpingo-oophorectomy with appendectomy. Histologic sections from the ovary showed a multiloculated, cystic and focally solid mass lined by gastrointestinal-type mucinous epithelium with variable degrees of proliferation accounting for greater than 10% of the tumor. In addition to the mucinous epithelial component, there were several foci of bland, monotonous epithelioid cells arranged in solid nests with focal tubular/acinar formation within the fibrous septa and mucinous epithelium. Immunohistochemical studies showed that these cells were positive for cytokeratin, EMA, and synaptophysin, while negative for inhibin. The Ki-67 proliferation index was low (<1%). The presence of endocrine cell nests associated with an ovarian mucinous neoplasm is a rare phenomenon. Whether this represents preservation of endocrine cells in the context of epithelial degeneration or an independent neoplastic component is unclear. Progression related to this endocrine cell proliferation is unlikely and the recognition of this phenomenon holds more diagnostic value than prognostic significance, as it could be confused with microinvasion or sex cord stromal elements.

Intraosseous hydatid cyst

Hydatidosis is a parasitic disease caused by Echinococcus granulosus or echinococcal tænia, preferentially localized in the lung (20 to 30%) and in the liver (60 to 70%). Intraosseous localization is extremely rare. Imaging features takes a very important place for the diagnosis and therapeutic management such as ultrasound, CT and MRI. MRI shows a large, well-limited and multiloculated cystic mass in cotyloid cavity, with daughter vesicles in hypo-intensity T1-weighted, hyperintensity T2-weighted with low diffusion coefficient and no contrast enhancement after injection of gadolinium. This mass causes a breach of cortex and extension to the adjacent soft tissue.

Intraosseous hydatid cyst

Hydatidosis is a parasitic disease caused by Echinococcus granulosus or echinococcal tænia, preferentially localized in the lung (20 to 30%) and in the liver (60 to 70%). Intraosseous localization is extremely rare. She did not complain on any difficulties swallowing or breathing. She has a background of mild Asthma for which she uses inhalers but otherwise is generally well in herself. She is a non-smoker and is fully vaccinated. Imaging features takes a very important place for the diagnosis and therapeutic management such as ultrasound, CT and MRI. MRI shows a large, well-limited and multiloculated cystic mass in cotyloid cavity, with daughter vesicles in hypo-intensity T1-weighted, hyperintensity T2-weighted with low diffusion coefficient and no contrast enhancement after injection of gadolinium. This mass causes a breach of cortex and extension to the adjacent soft tissue.