Multiloculated Cystic Mass Research Articles

Metastasis of Small Cell Carcinoma of Lung Into an Ovarian Mucinous Neoplasm: Immunohistochemistry as a Useful Ancillary Technique for Diagnosis and Classification of Rare Tumors

The authors report the first case of ovarian mucinous adenocarcinoma with metastasis from a synchronous small cell neuroendocrine carcinoma of the lung. A 62-year-old white woman presented with weight loss and increased abdominal girth. She was found to have a large, complex cystic mass in the pelvis, and during the staging evaluation, a large, right pulmonary hilar mass was detected. Bronchial brushing as well as transbronchial fine-needle aspiration was diagnostic of small cell carcinoma. The patient received 3 cycles of chemotherapy with carboplatin and subsequently underwent a supracervical hysterectomy and bilateral salpingo-oophorectomy. A large, multiloculated cystic mass was found arising from the right ovary. Microscopic examination disclosed a mucinous neoplasm with both mucinous cystadenoma and mucinous papillary adenocarcinoma components. A microscopic focus of cells with "atypical" cytomorphologic features was detected within the mucinous neoplasm. Immunohistochemistry showed that group of cells to be positive for thyroid transcription factor 1 and chromogranin, confirming them to be metastasis from the pulmonary small cell neuroendocrine carcinoma. This case, in addition to being the first reported case of such metastasis, also highlights the diagnostic utility of immunohistochemistry as a reliable and very useful ancillary technique for the diagnosis of neoplasms with unusual clinical and/or histomorphologic presentations. The clinical and prognostic implications are also discussed.

Extragastrointestinal Stromal Tumor Of The Greater Omentum Presenting A Large Multilocular Cystic Mass: A Case Report And Review Of Literature

Primary neoplasms of the greater omentum are rare and and may pose difficulty for the preoperative histologic diagnosis. We report a case of extragastrointestinal stromal tumor of the greater omentum in a patient with chronic pancreatitis, which has been tentatively diagnosed of a benign omental cyst preoperatively. Computed Tomography showed a multiloculated large cystic mass of the greater omentum with multiple thick septa and a solid component and pancreatic calcification. Fine needle aspiration cytology showed a few histiocyte in a bloody background and it was negative for malignant cells. The patient underwent resection of the huge cyst including a major part of the greater omentum. Histologically, the tumor was consisted of sheets and strands of relatively uniform medium sized round epithelioid cells. Immunohistochemical staining of the tumor cells was positive for CD117 (c-kit, a transmembrane tyrosine kinase receptor), CD34 and vimentin, but it was negative for S-100 and Calretinin. These findings were compatible with extragastrointestinal stromal tumor (EGIST). We emphasized the possibility of extragastrointestinal stromal tumor of the greater omentum, although the preoperative radiologic findings suggested as a benign omental cyst.

Imaging diagnosis of 12 patients with hepatic tuberculosis.

To assess CT, MR manifestations and their diagnostic value in hepatic tuberculosis. CT findings in 12 cases and MR findings in 4 cases of hepatic tuberculosis proved by surgery or biopsy were retrospectively analyzed. (1) CT findings: One case of serohepatic type of hepatic tuberculosis had multiple-nodular lesions in the subcapsule of liver. Parenchymal type was found in 10 cases, including multiple, miliary, micronodular and low-density lesions with miliary calcifications in 2 cases; singular, low-density mass with multiple flecked calcifications in 3 cases; multiple cystic lesions in 1 case; multiple micronodular and low-density lesions fusing into multiloculated cystic mass or "cluster" sign in 3 cases; and singular, macronodular and low-density lesion with multiple miliary calcifications in 1 case. One case of tuberculous cholangitis showed marked dilated intrahepatic ducts with multiple flecked calcifications in the porta hepatis. (2) MR findings in 4 cases were hypointense on both T1-weighted imagings and T2-weighted imagings in one case, hypointense on T1-weighted imagings and hyperintense on T2-weighted imagings in 3 cases. Enhanced MR in 3 cases was slightly shown peripheral enhancement or with multilocular enhancement. Various types of hepatic tuberculosis have different imaging findings, and typical CT and MR findings can suggest the diagnosis.

Extragastrointestinal Stromal Tumor Presenting a Large Multilocular Cystic Mass Arising from the Greater Omentum: A Case Report

Extragastrointestinal stromal tumor (EGIST) has been reported to occur only rarely, and the cases of this disease appearing as cystic masses are also known to be very infrequent. Along with a review of the related articles, we report here on a case of EGIST arising from the omentum that was seen as a multiloculated large cystic mass with multiple thick septa and a solid component.

Management of Multiple Intra-Hepatic Biliary Cysts in a Desert Rosy Boa, Lichanura trivirgata gracia

ABSTRACT An adult female desert rosy boa, Lichanura trivirgata gracia, presented with clinical signs of intermittent, fluctuant swellings in the middle third of the body. The swellings, present over a three-year period, did not adversely affect the animal's health. Radiographs showed radiopaque masses of soft tissue density that were extraintestinal based upon endoscopy and barium enterogram. Ultrasonography confirmed that the masses were fluid-filled. Aspirated fluid was sterile and contained epithelial and a few inflammatory cells. Exploratory laparotomy revealed three multiloculated cystic masses associated with the liver. The masses were diagnosed histologically as biliary cysts. Due to the lack of adverse clinical signs, benign nature of the cysts, and potential for surgical complications due to extensive involvement of the liver, periodic drainage was elected for management. This is the first report of biliary cysts in snakes, and biliary cysts should be considered as a differential diagnosis in sna...

Cystic lymphangioma of the axilla and chest wall

Fetal cystic lymphangiomas are benign tumors arising from the lymph vessels. They have been demonstrated in a number of different anatomic locations, including the nuchal region, axilla, mediastinum, chest wall, retroperitoneal area, abdominal viscera, groin and pelvis. The defect is most often found in the nuchal region. In these cases, the etiology is related to inadequate drainage of the lymphatic vessel into the venous system. Nuchal lymphangiomas are often associated with chromosome abnormalities. Cystic lymphangiomas at other locations are thought to have a distinct etiology, most likely as a result of insufficient anastomoses with larger lymphatic channels. The association with chromosome anomalies in these cases is less distinct. We describe 2D and 3D ultrasound findings associated with the prenatal finding of cystic lymphangioma in two patients. The first patient is a 29-year-old G4P2 female referred for an ultrasound due to marginal sinus bleeding. A follow-up scan at 23 weeks identified a multiloculated cystic mass measuring 7.2 × 6.8cm in its largest dimensions. The patient was followed at 3-week intervals with 2D and 3D imaging performed at each visit. At the time of delivery, the mass measured 8.2×7.9cm. Surgical excision was performed on day 2. The second patient is a 23-year-old G1P0 female referred at 35 wks for an ultrasound secondary to the finding of a multiloculated mass on the right chest wall, 4 cm below the axilla. The mass measured 2×3cm. The right arm appeared to move freely. Both 2D and 3D imaging were performed. At birth, the mass measured 1×1 cm. Surgical excision has not been performed. Medical management is currently observational. Both patients were offered an amniocentesis. Neither patient opted for this procedure. Additional birth defects or genetic anomalies were not detected in either patient. The 3D ultrasound allowed for a unique imaging opportunity of a rare congenital malformation.

Sonographic Findings in Mesenteric Lymphangioma

A multiloculated cystic mass with multiple thin septations was visualized during ultrasound examination. This mass was found to be a mesenteric lymphangioma: a rare, benign tumor. Sonographically, it is difficult to confirm the mesentery as the origin of a neoplasm, but it should be included in the differential diagnosis. The normal sonographic presentation of mesentery is discussed. The appearance of a mesenteric lymphangioma, its etiology, symptoms, and a histologic explanation are given.

Intrathoracic extra‐mediastinal cystic hygroma in infancy

An infant with intrathoracic extra-mediastinal cystic hygroma is described. Fluid collection within the fetal chest was noted on routine antenatal ultrasound scan and this was subsequently drained. Postnatally, echocardiogram and thoracic CT scan demonstrated a cystic space between the pericardium and right mediastinal pleura. Thoracotomy performed at six weeks of age showed a multiloculated cystic mass adherent to the right pericardium and to the medial aspect of the diaphragm. Histology revealed the tumour to be a cystic hygroma (lymphangioma). Intrathoracic cystic hygroma occurring outside the mediastinum is extremely rare and has never been diagnosed previously in infancy.

Transvaginal sonographic appearance of endometriomata: spectrum of findings.

The spectrum of transvaginal sonographic findings was evaluated in 37 surgically proved endometriomas. Sonographic features assessed included lesion size, acoustic enhancement, wall thickness, wall contour, presence of a fluid-fluid level, and presence of internal echoes. A very characteristic finding seen in 31 (82%) cases is the presence of a homogeneous hypoechoic "carpet" of low-level echoes. This may be present diffusely or in one or several loculations of a multiloculated cystic mass. We consider this finding characteristic of an endometrioma, although not pathognomonic, as on occasion we have encountered other pathologic conditions that have the same appearance.

Magnetic resonance imaging of cystic,partially differentiated nephroblastoma

The magnetic resonance imaging (MRI) appearance of a cystic, partially differentiated nephroblastoma is described, together with pathologic correlation. The difficulty in reaching a correct preoperative diagnosis even with multimodal imaging techniques is emphasized. MRI is an adjunct to ultrasonography and may be superior to computerized tomography (CT) scan in the evaluation of a child with multiloculated cystic renal mass.

Intracranial teratomas of the basal ganglia

Intracranial teratomas other than those occurring in the pineal gland and at the suprasellar region are rare and few cases have been documented. Their putative origin from ectopic germ cells that have been segregated inside the brain during embryonic migration is controversial. We present the clinicopathologic features of three cases of primary intracranial teratomas affecting the left basal ganglia of three male patients aged 8,10 and 23. The radiological appearances were similar with large, multi-loculated cystic masses with calcifications situated at the left basal ganglia. Two tumours biopsied showed teratoma with germinoma and one case completely resected revealed mixed germ cell tumour containing teratoma with malignant transformation, choriocarcinoma and germinoma. Two patients had markedly raised pre-operative HCG levels. Treatment was complete excision in one case and biopsy followed by radiotherapy in two other cases. Two remained well 2 years and 18 months post-operation and one had a relatively short follow up. These cases suggest that i) intracranial teratomas of the basal ganglia possess distinct clinicopathologic features and ii) they have an indolent clinical behaviour in spite of the presence of choriocarcinoma, malignant transformation and the finding of raised preoperative HCG level.

Computed tomography of cervical cystic hygroma in the neck

The computed tomography findings in 4 infants and children with surgically proved cystic hygroma of the neck were reviewed and correlated with pathologic specimens. Cervical cystic hygroma characteristically appears on CT scan as a multiloculated cystic mass with smooth septa of variable thickness, which enhances uniformly following bolus injection of contrast media administration. This CT pattern can usually be used to differentiate cystic hygromas from other cervical masses such as soft tissue sarcomas. CT is also helpful in determining the extent of the lesion prior to the surgery and in assessing the recurrences.

Cystic renal cell carcinoma

Cystic renal cell carcinoma includes any malignant neoplasm of renal tubular epithelium which presents as a fluid filled mass. Approximately 15 per cent of cases of renal cell carcinoma will be cystic on radiologic and pathologic examination. The clinical features of cystic renal cell carcinoma are similar to those which are solid. The radiographic and pathologic findings of cystic renal cell carcinoma are often more confusing and less specific than the findings of renal cell carcinoma which are predominantly solid. There are four basic pathologic mechanisms resulting in cystic renal cell carcinoma: (1) intrinsic multiloculated growth; (2) intrinsic unilocular growth (cystadenocarcinoma); (3) cystic necrosis; and (4) origin from the epithelial lining of a preexisting simple cyst. There are three basic radiologic patterns of cystic renal cell carcinoma: unilocular cystic mass, multiloculated cystic mass, and discrete mural nodule in a cystic mass. Cystic renal cell carcinoma is often extremely difficult to differentiate from non-neoplastic, benign neo-plastic, and other malignant neoplastic masses utilizing radiologic studies alone. This review presents the clinical, pathologic, and radiographic features of cystic renal cell carcinoma and discusses its radiologic differential diagnosis.

Cystic nephroma: Morphologic spectrum and implications

Among 216 primary renal tumors collected from a pediatric population in metropolitan Chicago, 6 instances corresponded to multiloculated cystic masses conforming to the diagnostic criteria of so-called cystic nephroma. Histopathologically, the component tissues were entirely mature in 2 cases, but in the remaining 4 the septa between cysts contained variable amounts of primitive or embryonic tissues; in one of these, a grossly visible mass formed a nodule of typical Wilms tumor. Our experience agrees with previous reports that favor closer structural similarity of these lesions to nephroblastoma than to any known form of cystic malformation. This concept has important consequences on the therapeutic approach to preoperatively diagnosed multilocular cystic masses of the kidney, and supports the idea that nephrectomy is the treatment of choice. Metastases or local recurrence have not been reported in cases of cystic nephroma.