Neoplastic Causes Research Articles

A Large Calf Mass in a Patient with Rheumatoid Arthritis: Giant Pannus Filling Baker’s Cyst

Abstract Rheumatoid arthritis (RA) presents a significant challenge among autoimmune diseases, affecting millions globally with diverse clinical manifestations, primarily targeting joints and inducing inflammation, pain, and deformities. In some cases, it leads to the formation of Bakers cysts, fluid-filled bursae in the popliteal region, resulting from chronic inflammation of the synovial membrane and subsequent pannus growth. Our case, a young female patient with RA, presenting with calf mass, highlights this complex interplay. She presented with large swelling and pain in her left calf region which on high-frequency ultrasound revealed a large, well-defined heteroechoic mass lesion distending bursa between the medial head of the gastrocnemius and semimembranosus muscle, measuring 25 cm craniocaudally, without any color Doppler abnormality. Ultrasound-guided biopsy was performed to rule out the possibility of sarcoma and it revealed inflammatory changes. Final diagnosis of excessive pannus formation within the Baker’s cyst forming large mass was made, with RA identified as the underlying cause. The differential diagnosis of masses in the popliteal fossa includes synovial/meniscal/ganglion cysts, lipomas, vascular pathologies, and neoplastic conditions. High-resolution ultrasound is an important diagnostic modality for evaluating popliteal fossa masses. Magnetic resonance imaging is typically performed to assess for neoplastic causes and internal derangement of the knee. Our case of a massive pannus filling a Baker’s cyst in the context of RA emphasizes the intricate nature of the disease and its diverse clinical expressions. It is important for the radiologist to be aware of this imaging appearance for timely diagnosis and management.

Lobar collapse: what radiologists need to know

Radiologists have to diagnose lobar collapse routinely, so they should be familiar with the direct and indirect signs of lobar atelectasis and with uncommon findings, for being able to make early diagnosis. Atelectasis can be caused by several mechanisms: by obstruction (due to neoplastic or non-neoplastic causes), by loss of negative pressure in the pleural space and/or by compression of lung parenchyma (e.g., pneumothorax, hydrothorax, and pleural effusion) or by an increase in alveolar surface tension (e.g., acute respiratory distress syndrome and neonatal respiratory distress syndrome). Collapses, moreover, can be observed in several ways. Lobar atelectasis occurs when entire pulmonary lobe is collapsed. Linear atelectasis (previously “plate like” or “band like”) is a local collapse with linear, plate-like or band-like shape which usually parallels the hemidiaphragms. Rounded atelectasis is a consequence of chronic or recurrent pleural effusion, which could be related to asbestos disease, chronic cardiac or renal failure, and thoracic malignancies. It occurs as a rounded mass abutting the pleura with adjacent pleural thickening. Collapsed lobes can assume quite limited forms and radiologists require familiarity with radiographic findings for helping clinical physician in the diagnostic process.

Case Report: Hyperandrogenism in Menopause.

Postmenopausal androgen excess often occurs due to the imbalance between the rapid decline in ovarian estrogen and a relatively gradual decline in androgen secretion. The rapid onset of hirsutism, alopecia, and acne, on the other hand, is a rare occurrence and requires further investigation in order to rule out an underlying neoplasm. A 54-year-old woman arrived at the endocrinology outpatient clinic for the appearance of hirsutism and defluvium capitis in the past 9 months. She had hypertrichosis of the face, trunk, and mammary areolae and reduced timbre of voice. Circulating androgens were higher than normal levels (testosterone: 7.7 ng/mL, DHEAS: 5437 mcg/L, 17-OH-progesterone: 3.1 nmol/L), gonadotropin and prolactin levels were normal, and Nugent test was negative. Abdominal CT scan was negative for adrenal lesions, while transvaginal ovarian ultrasonography revealed a left adnexal formation (19x18x24 mm) compatible with stromal neoplasm. A bilateral hysteroannessiectomy was performed. Histological examination was diagnostic for multiple ovarian Leydig cell tumors. The most frequent cause of postmenopausal hyperandrogenism is polycystic ovary syndrome. It is necessary to exclude the presence of neoplastic causes (ovarian or adrenal androgen- secreting tumors). In case of marked virilization and severe hyperandrogenism, it is useful to perform transvaginal ultrasonography to search for the presence of ovarian hypertrichosis or androgen-secreting ovarian tumors and a CT/RM scan to study the adrenal glands. The best treatment for hyperandrogenism of neoplastic origin is surgery. Patients who are not candidates for this approach are candidates for therapy with GnRH agonists.

Combined Cesarean Section and Splenectomy in a Patient with Massive Splenomegaly

Background To date, there is limited knowledge of patients with idiopathic splenomegaly in pregnancy, and the literature lacks cases of a combined cesarean section with splenectomy. The documented cases of splenomegaly in pregnancy often have infectious etiology such as that of malarial infection or an autoimmune component such as idiopathic thrombocytopenic purpura. This condition is life-threatening and complicates medical management, but its rarity has led to a paucity of management guidelines for patients with idiopathic splenomegaly in pregnancy. Objective The aim of this case is to provide novel insight into the management and outcomes of patients with idiopathic massive splenomegaly in pregnancy. Study Design This study is a case report with a review of the current literature on the reported cases of splenomegaly in pregnancy, splenectomy in pregnancy, and cesarean section with splenectomy. This case describes a history of pancytopenia and massive splenomegaly in a pregnant patient who underwent extensive workup with no clear etiology. This case additionally describes the course of care for this patient, including a combined cesarean section with splenectomy. We searched PubMed for all English language articles from 2000 to 2023, with search terms including “splenomegaly in pregnancy,” “splenectomy in pregnancy,” and “cesarean section and splenectomy.” Results In this patient’s case, despite an exhaustive infectious disease workup and evaluation for hematologic, inflammatory, and neoplastic causes, no clear etiology was identified. Delivery was deemed necessary at 34 weeks and 2 days gestation due to the patient’s severe, persistent pain, her worsening pancytopenia, and the risk of spontaneous splenic rupture during labor and delivery; our multidisciplinary team concluded that it was safer for both mother and baby to proceed with cesarean delivery and splenectomy in the early pre-term period. This patient’s pancytopenia improved within hours of spleen removal and has remained stable to date in outpatient follow-up. Baby Boy completed a NICU course of 22 days after requiring surfactant and respiratory support due to prematurity as well as monitoring due to maternal splenomegaly and thrombocytopenia. Conclusion This case offers valuable insights into managing patients with idiopathic splenomegaly during pregnancy and underscores the need for further investigation. Establishing clear delivery indications for these patients remains crucial, and prospective studies should evaluate the long-term impacts on both mother and child following combined splenectomy and cesarean delivery in the context of pancytopenia.

Pancreatobiliary Lymphadenopathy: Etiology, Location, and Factors Predicting Good Yield of Endoscopic Ultrasound-guided Biopsy.

Pancreatobiliary lymphadenopathy (PBL) may be due to a number of benign or malignant causes. Tissue sampling of these lymph nodes (LN) can be possible with the help of endoscopic ultrasound (EUS). Aim of this study was to identify the etiology of the PBL, morphology, and factors predicting good yield of biopsy with EUS. All patients found to have pancreatobiliary lymph node (PBLN) enlargement (>10 mm) on abdominal imaging and referred for EUS-guided biopsy were included in this prospective observational study. The facility of rapid on-site evaluation (ROSE) was not available. Adequacy of the tissue specimen was assessed by the endoscopist with macroscopic on-site evaluation (MOSE) and then sent to histopathologist for final diagnosis. Factors predicting good yield of biopsy were then analyzed. Of the total 87 patients with PBL, 54 (62.1%) were males. Mean age of the patients was 52.0 (±13.4) and range 18-80 years. The commonest locations of PBL were porta hepatis 37 (42.5%), peripancreatic 24 (27.6%), celiac 16 (18.4%), and others 10 (11.5%). Histological reports showed: neoplastic tissue in 34 (39.1%), non-neoplastic in 20 (23%), normal lymphoid tissue (27.6%) and suboptimal in 9 (10.3%). Among the 34 neoplastic causes, 26 had metastatic adenocarcinoma, 5 had lymphoma, and 3 had metastatic neuroendocrine tumors. Among the 20 non-neoplastic causes, 10 had tuberculosis, 4 had anthracosis, and 6 had other findings. Factors predicting good yield of biopsy were a PBLN size ≥12 mm and satisfactory MOSE on both univariate [PBLN (p = 0.005); MOSE (p < 0.0001)] and multivariate [PBLN (p = 0.011); MOSE (p < 0.0001)] analysis. The commonest etiology of PBLN enlargement was metastatic adenocarcinoma among the neoplastic causes and tuberculosis among the non-neoplastic causes. The most common PBLNs approached by EUS were in portahepatis and peripancreatic regions. A good biopsy yield can be predicted with PBLN size of ≥12 mm and a satisfactory MOSE. Tasneem AA, Yaseen T, Laeeq SM, et al. Pancreatobiliary Lymphadenopathy: Etiology, Location, and Factors Predicting Good Yield of Endoscopic Ultrasound-guided Biopsy. Euroasian J Hepato-Gastroenterol 2024;14(1):40-43.

#2608 Trends over time in the causes of death with a functioning graft among kidney transplant recipients

Abstract Background and Aims Cardiovascular diseases are traditionally considered as the leading cause of death in kidney transplant recipients. Significant improvements in immunosuppressive strategies but also in the prevention and management of cardiovascular diseases have been made over the last decades. Therefore, we aimed to explore the evolution over time of the causes of death with a functioning graft in kidney transplant recipients. Method We performed a retrospective study including all patients transplanted with a kidney between January 1995 and December 2009 at Cliniques Universitaires Saint-Luc in Brussels who died with a functioning graft. Patients younger than 18 years old and those who received bone marrow or other solid organ transplant were excluded. Clinical data were collected by electronic medical chart review. Differences in causes of death were assessed between two eras of transplantation (first era [1995-2001] vs second era [2002-2009]). Results A total of 256 patients (aged 56 ± 11.18 years, 164 (64.9%) man) were included. Among those patients, 65 (25.39%) died from infectious causes, 64 (25%) from neoplastic causes, 62 (24.22%) from cardiovascular causes and 24 (9.38%) from other causes. The cause of death was unknown for 42 (16.41%) patients. Patients who received a kidney graft during the first era mostly died from cardiovascular causes (33%), while those who received a graft during the second era mostly died from infectious causes (31%). Death from neoplastic causes remained similar across eras (32 (26%) versus 32 (24%), p-value &amp;gt; 0.1). Patients grafted in the more recent era have threefold higher odds of dying from infectious than cardiovascular causes compared to those grafted in the former graft era (OR 3.1, p=0.002). Infectious causes of death were the most prevalent early cause of death in both eras i.e. 3 patients (60%) in the first era and 6 patients (50%) in the second era. Conclusion We observed a significant shift from cardiovascular deaths to infectious deaths between the former and the more recent transplantation era. Neoplastic causes of death remained stable over time.

Acquired hemophilia A in a case of purple urine bag syndrome

The rare hemorrhagic disorder known as acquired hemophilia A (AHA) is brought on by the spontaneous development of autoantibodies against coagulation factor VIII (FVIII). It may be secondary to autoimmune diseases or cancers, or it may be idiopathic. Less than 10% of cases may have an infection as a secondary cause. We present the case of a 90-year-old anemic woman who was admitted to the hospital. She contracted a urinary tract infection (UTI) while in the hospital, and her urine took on a distinct purple hue. She had poor hemorrhagic manifestations and a prolonged partial thromboplastin time. After ruling out autoimmune and neoplastic causes, we diagnosed AHA as a result of a UTI caused by Enterococcus faecalis.

Evaluation of Neoplasia, Treatments, and Survival in Lizard Species.

Neoplasia has been reported in lizards, but more research is needed to accurately document the prevalence and prognosis of the various known neoplasms that affect lizards. This study reviewed medical records from an online database, the Exotic Species Cancer Research Alliance (ESCRA), and reviewed published literature to determine the prevalence of neoplasia, malignancy, metastasis, treatment strategies, and outcomes by species and sex. Records from 55 individual lizards, 20 different species, and 37 different tumors were identified. In the literature, 219 lizards, 59 species, and 86 unique tumors were identified from 72 published case reports. Potential signalment factors such as age, sex, and species were evaluated to see if they affected case outcome. Additional factors including neoplasia type, presence of metastasis, and types of pursued treatments were also evaluated. Statistical analysis was performed to determine whether a factor was significantly associated with animal death due to the identified neoplasia or with animal survival or death due to other causes (non-neoplastic outcomes). Komodo dragons and savannah monitors were more likely to die from neoplasia compared to other lizard species. Cases where the status of metastasis was unknown were significantly associated with death due to neoplasia. Having an unknown status of male versus female was significantly associated with non-neoplastic outcomes of death. Leukemia and islet cell carcinoma were significantly associated with death due to neoplastic causes. Chondrosarcoma, myxosarcoma, osteosarcoma, and squamous cell carcinoma were significantly associated with non-neoplastic outcomes of death. Surgery alone and radiation therapy alone each were significantly associated with non-neoplastic outcomes of death, while lizards not receiving treatment were significantly associated with death due to neoplasia. Benign neoplasia was significantly associated with non-neoplastic outcomes of death. These results will aid in the improved diagnosis and management of neoplasia in lizard species, as well as expanding our understanding of prognostic indicators of neoplasia in lizards.

Botulinum toxin: a new differential diagnosis for a lytic bone lesion

BackgroundBotulinum toxin, produced by the Gram-positive anaerobe Clostridium botulinum, is composed of seven antigenic subtypes (A, B, C, D, E, F, and G). Currently, only Botulinum toxin type A, commonly referred to as “Botox,” is approved for clinical use, given its relatively safe clinical profile. Botulinum toxin type A has a wide range of therapeutic indications, including treatment for dystonia, migraine headache, neurogenic bladder, and large muscle spastic disorders. However, the toxin is most widely known for its cosmetic effects in treating wrinkles and facial lines.Case presentationThis article describes a 62-year-old Caucasian female who presented for investigation and workup of an isolated lytic lesion of her frontal bone a few weeks after administration of botulinum toxin injection into the corresponding site in the frontalis muscle. This presented as a large, palpable, painless forehead lump causing significant psychological distress. After no neoplastic cause for the lesion was found and histopathology was performed, our researchers concluded that the most likely explanation was that the bony lytic lesion resulted from inadvertent injection of the “Botox” neurotoxin through the intended target muscle and into the cortex of the underlying bone.ConclusionsOur search of the literature failed to identify any previous cases of this occurring. However, as the popularity of this cosmetic procedure only increases, we believe that this represents an important possible differential for isolated lytic lesion after administration of “Botox” injection.

Stroke a rare manifestation of isolated sphenoid sinus aspergilloma: a case report.

Isolated sphenoid sinus disease is a rare paranasal sinus (PNS) problem, comprising only 2-3% of cases of sinonasal diseases. It is caused mainly by inflammation, and neoplastic causes are exceedingly rare. Due to the nonspecific nature of the symptoms and possible complications, the proper diagnosis and treatment has paramount importance. A 53-year-old woman with a history of diabetes experienced sudden paralysis of the right side of her body and face. A diagnostic workup revealed an acute infarction in her left medial pons and the left midbrain. However, an abnormal finding in her sphenoid sinus caught the neurologist's attention, which led to a consultation with the otorhinolaryngology service. During the sinonasal endoscopy, the surgeon detected the presence of secretions and fungal debris in the nasopharynx and sphenoid sinus. Following the surgery, antifungal treatment began. The pathology report revealed that the fungal ball was most likely caused by aspergillosis. According to the neurologist's opinion and the imaging results, the inflammation and infectious activity in the patient's sphenoid sinus may have damaged the basilar artery and caused the observed symptoms. This finding underlines the vital significance of the accurate diagnosis and treatment of sphenoid sinus disease, as it can prevent further complications.

Bone marrow histology of cytopenias : Contribution to hematological differential diagnosis

Besides microscopic evaluation of smears, flow cytometric analysis, chromosomal and molecular studies, histological analysis of bone marrow biopsies (BMbx) is animportant component of multiparameter diagnostics of cytopenias in hematology. More than in other fields of histopathology, correct interpretation of BMbx requires correlation with the results of these further studies and other clinical findings. Microcytic, normocytic and macrocytic anemia, isolated granulocytopenia and thromobocytopenia as well as pancytopenia represent frequent and recurrent diseases. With regard to aetiology, reactive and neoplastic causes must be differentiated. Reactive causes of cytopenia include substrate deficiencies, enhanced turn over and loss, and inflammatory processes. Neoplastic disorders with the exception of myeloproliferative neoplasms generally manifest as cytopenia and comprise myelodysplastic syndromes (MDS), acute myeloid leukemia (AML) and lymphoma.

Sonographic features of sternal pseudotumour in children

AbstractIntroductionSternal pseudotumour is an important but rare entity thought to be an inflammatory, non‐neoplastic lesion that can mimic tumours. The purpose of this paper was to illustrate the imaging features of this lesion to avoid unnecessary investigations.MethodsThe clinical notes and imaging features of four patients with a diagnosis of sternal pseudotumour were reviewed over a period from February 2016 to July 2019.ResultsAll patients were afebrile with no history of trauma. The median age at presentation was 12.5 months. The median length of symptoms prior to presentation was 3.5 days. One patient had a mildly elevated C‐reactive protein. Chest radiographs showed a pre‐sternal soft‐tissue mass, with or without osseous destruction of the subjacent sternum. Ultrasound showed a heterogeneous, hypoechoic pre‐sternal soft‐tissue mass with variable internal vascularity with extension between sternal ossification centres. CT and MRI showed an enhancing dumbbell‐shaped lesion with a pre‐sternal and retro‐sternal soft‐tissue component. The median time to complete resolution was 3 months. One patient had a biopsy that showed chronic inflammation and fibrosis.DiscussionThese lesions present in young children typically with a 1‐ to 2‐week history of a focal 2‐ to 4‐cm swelling over the sternum. The aetiology is unknown but may be on the basis of a yet‐to‐be identified pathogen. Inflammatory markers and cultures are normal or mildly elevated. Important differential considerations include sternal osteomyelitis or neoplastic causes such as Ewing sarcoma, rhabdomyosarcoma, Langerhans cell histiocytosis and infantile fibrosarcoma.ConclusionSternal pseudotumor is a rare but important entity to be aware of to avoid unnecessary invasive biopsy or further investigations. Our suggestion is that this is a ‘Don't touch’ lesion that requires close short‐interval follow‐up at a surgical outpatient clinic and with ultrasound until resolution.

18F-Fluorodeoxyglucose positron emission tomography [18F-FDG PET CT] in assessment of patients with vocal cord paralysis [VCP] secondary to extra laryngeal neoplastic causes: How is it reliable?

BackgroundThe main cause of voice hoarseness is vocal cord palsy (VCP) that may be induced by many diseases that could be due to local laryngeal or extra laryngeal causes, including neoplastic and non-neoplastic entities. Normal vocal cords 18F-fluorodeoxyglucose (FDG) activity should be symmetric and of low grade higher than the mediastinal background uptake. Vocal cords asymmetrical FDG uptake was a well-known finding in patients with VCP. When recurrent laryngeal nerve (RLN) palsy is suspected, FDG PET and computed tomography (CT) findings can give strong evidence of diagnosis, with ability to diagnose the underlying extra laryngeal neoplastic etiology. Our aim was to assess the sensitivity and accuracy of hybrid FDG PET CT scan in diagnosis of VCP secondary to an extra laryngeal neoplastic cause.MethodsA retrospective study for 50 patients, presented with hoarseness of voice, referred from Otorhinolaryngology department to outpatient clinical oncology units, with clinically suspected extra laryngeal neoplastic causes of VCP. Left lung cancer was detected in 52% of patients which was the most frequent cause, 10% had right lung cancer, 8% had thyroid cancer, 6% had mediastinal lymphoma, 6% had metastatic mediastinal lymph nodes from breast cancer, and 6% had esophageal carcinoma.ResultsPET CT scan versus CT scan showed true positive results in (44 vs. 29 patient), true negative results in 5 patients in both scans, and false negative in (1 vs. 16 patient), with no false positive in either. Thus, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for PET CT scan versus CT scan were 98% vs. 68%, 100% for both scans, 100% for both scans, 83.3% vs. 23.8%, and 86% vs. 56%, respectively.ConclusionsFDG PET CT scan plays an important role in diagnosis of oncology-related extra laryngeal causes of VCP, with higher sensitivity, negative predictive value, and accuracy than CT scan. FDG PET CT scan should be included in the workup of VCP if extra laryngeal oncological cause is suspected.

The patient with a painful knee.

Knee pain encompasses a wide array of differential diagnoses and can often pose a diagnostic challenge, as it can have traumatic or non-traumatic causes. A good clinical history, assessment and anatomical knowledge gives a strong foundation to narrow down the diagnosis, and understanding the correct imaging modality and findings further informs correct and timely management. This article reviews various disease processes including fractures, inflammatory, infective and neoplastic causes, and discusses the assessment and various imaging modalities to aid diagnosis in both primary and secondary care.

À propos d’une e-Hypercalcémie

IntroductionHypercalcemia is a common biological abnormality. The etiologies are mainly represented by hyperparathyroidism and neoplastic causes. The other causes, including poisoning, are rare, but should not be neglected. ObservationAn 82-year-old female patient presented to the emergency room for repeated falls at home, confusion, drowsiness and digestive symptoms. The initial assessment showed hypercalcemia above 3mmol/L. The etiological exploration revealed a very high concentration of 25OH-vitamin D. After repeated interrogations, it appeared that the cause of this intoxication was the intake of a food supplement purchased on the internet, following a prescription from her dentist. ConclusionIntoxication due to a food supplement containing vitamin D is possible and potentially serious. Raising the awareness of patients and healthcare professionals is necessary in order to prevent this type of poisoning and/or to diagnose it as soon as possible.

Successful Treatment with Dexamethasone of a Cat with Suspected Feline Atopic Skin Syndrome Not Responding to Prednisolone

A 6-year-old client-owned indoor, female neutered Persian-exotic shorthair cat was presented for further investigation of severe itchy lesions on the head and neck to our polyclinic. The patient had previously been applied selamectin and a cleansing, soothing, and protecting shampoo, but did not respond positively to the treatment. After the exclusion of ectoparasite infestation, retroviral infection, neoplastic and psychogenic causes, and food allergy, a suspect diagnosis of FASS in the cat was made. Although skin lesions clearly improved, the intensity of pruritus did not reduce during the 4-week prednisolone therapy. Based on these results, the case was considered to be resistant to prednisolone. Treatment with dexamethasone provided a fast and complete recovery of clinical signs and the cat has been clinically healthy maintained for over 2-years. This study suggests that oral dexamethasone can be a good alternative for treating cats with suspected FASS that has not responded positively to prednisolone therapy.

Update on Fever of Unknown Origin in Children: Focus on Etiologies and Clinical Approach.

Fever of unknown origin (FUO) can be caused by four etiological categories of diseases. The most common cause of FUO in children is represented by infections, followed by inflammatory conditions and neoplastic causes; a decreasing quote remains still without diagnosis. Despite the fact that several diagnostic and therapeutic approaches have been proposed since the first definition of FUO, none of them has been fully validated in pediatric populations. A focused review of the patient's history and a thorough physical examination may offer helpful hints in suggesting a likely diagnosis. The diagnostic algorithm should proceed sequentially, and invasive testing should be performed only in select cases, possibly targeted by a diagnostic suspect. Pioneering serum biomarkers have been developed and validated; however, they are still far from becoming part of routine clinical practice. Novel noninvasive imaging techniques have shown promising diagnostic accuracy; however, their positioning in the diagnostic algorithm of pediatric FUO is still not clear. This narrative review aims to provide a synopsis of the existent literature on FUO in children, with its major causes and possible diagnostic workup, to help the clinician tackle the complex spectrum of pediatric FUO in everyday clinical practice.

Non-inflamed appendix with LAMN causing closed-loop small bowel obstruction

Introduction: Low grade appendiceal mucinous neoplasms are generally encountered incidentally in appendicectomies for suspected appendicitis. This case is a documentation of a rare occurrence of LAMN presenting with small bowel obstruction. Case Report: An 83-year-old male presented to the Emergency Department with a three day history of nausea, vomiting, and obstipation and profoundly dehydrated. Computed tomography revealed a high grade small bowel obstruction with 2 transition points in the right iliac fossa, concerning for closed loop obstruction, necessitating an urgent laparotomy. Conclusion: While acute appendicitis is a common cause of emergency abdominal pathology, when coupled with small bowel obstruction, a neoplastic cause should be considered as part of the differential diagnosis.

Multidetector computed tomography evaluation of obstructive jaundice: a cross-sectional study from a tertiary hospital of Nepal

Background: The utilization of advanced multidetector computed tomography (MDCT) technology along with postprocessing reconstruction techniques has significantly enhanced the clarity of visualization of the hepato-biliary tree. Therefore, this study was conducted to evaluate the diagnostic statistics of MDCT and its associated features in the evaluation of obstructive jaundice, with respect to surgical or histopathological diagnoses. Methods and methodology: The authors conducted a cross-sectional study among 30 participants with obstructive jaundice using purposive sampling. The authors calculated the diagnostic statistics of non-neoplastic and neoplastic types, along with specific etiologies of obstructive jaundice identified through MDCT using a statistical package for social sciences (SPSS) v21 and MedCalc v12.3.0. The ethical clearance was obtained from the institutional review committee of BPKIHS, Nepal (Ref no: Acd/291/075/076-IRC). Results: The sensitivity and the negative predictive value of MDCT for non-neoplastic cause to detect obstructive jaundice were 100% (95% CI: 79.41–100.00) and 100% (95% CI: 75.29–100.00), while the specificity and the positive predictive value for neoplastic cause to detect obstructive jaundice were 100% (95% CI: 79.41–100.00) and 100% (95% CI: 75.29–100.00), respectively. Similarly, the accuracy for either non-neoplastic or neoplastic cause was 96.67% (95% CI: 82.78–99.92). The most common cause of obstructive jaundice was choledocholithiasis (33.34%) followed by cholangiocarcinoma (20%), ampullary carcinoma (13.33%), and choledochal cyst (13.33%). The diagnostic accuracy of the individual etiology of common causes of obstructive jaundice ranged from 82.78 to 100%. Biliary obstruction was most frequently observed in the periampullary region (83.33%), followed by the proximal common bile duct (6.67%), hilar region (6.67%), and intrahepatic region (3.33%). Conclusion: The MDCT could serve as the initial and time-efficient excellent imaging modality for diagnosing various causes of obstructive jaundice with greater accuracy. It can differentiate non-neoplastic from neoplastic causes of obstructive jaundice.

SAT383 Case Study: Impact of Weight Reduction and Oral Contraceptive Pills on Hyperandrogenism

Abstract Disclosure: A. Syeda: None. T.L. Anderson: None. D. Millar: None. P. Madhavan: None. Introduction: Polycystic ovarian syndrome (PCOS) is a commonly encountered cause of hyperandrogenism which could interfere with fertility. Typical therapeutic options for hyperandrogenism including hormonal contraceptives and anti-androgen medication are contraindicated when planning pregnancy. This case highlights the profound impact of weightloss and oral contraception use to treat severe hyperandrogenism in select cases. Case: A 31-year-old female presented for initial evaluation of hyperandrogenism noted during evaluation for infertility. Laboratory investigations revealed a free testosterone level of 172 ng/dL (n:9-55 ng/dl), SHBG of 17 nmol/L (25-122 nmol/L), DHEAS of 306 ug/dL (n:99-340 ug/dL), TSH of 1.79 uIU/mL (n:0.35-4.96 uIU/mL), ACTH of 12.1 (n:7.2-63.3 pg/mL), cortisol of 9.6 ug/dL (7-23 ug/dL), prolactin of 7.85 ng/mL (3.34-26.72 ng/mL). The patient reported hirsutism, increasing body hair, darkening of skin and significant weight gain over the past 4 years. Menstrual cycles have been reported as being irregular since menarche. Vital signs were stable with a blood pressure of 112/84 mm Hg. Physical examination was remarkable for generalized obesity, hirsutism, and acanthosis nigricans, no abnormal abdominal striae were appreciated. Considering significant elevation in testosterone levels despite low SHBG, an MRI of abdomen and pelvis was obtained which demonstrated ovarian cysts with no concern for ovarian malignancy. CT of the abdomen without contrast was negative for adrenal mass. The overall clinical picture was suggestive of a diagnosis of PCOS. As the patient was planning pregnancy, oral contraceptive agents and spironolactone were deferred initially. The patient was encouraged to lose weight with lifestyle modifications and was started on up titrating dose of Metformin as tolerated. The patient complied with the recommendations and over the course of two years her weight decreased from 171 lbs. to 158 lbs. In the interim, she was placed on oral contraceptive pills for 2 months to undergo hysteroscopy. Subsequently, the testosterone levels normalized to 17 ng/dL. Conclusion: Although previous research has demonstrated the significance of weight loss, for reducing symptoms in patients with PCOS, this role has not been well elucidated in cases of severe hyperandrogenism without a neoplastic cause. The mechanism of interaction between weight loss, oral contraceptive pills and decreased androgens is based on the reduction in insulin resistance which causes a decrease in theca cell androgen synthesis and an increased SHBG. Additionally, a decrease in adiposity reduces the conversion of Δ4-androstenedione to testosterone. Notably, in this case there is potentially a causal relationship between the patient's weight loss of 13 pounds (7.6% of her body weight), OCP use and her return to normal testosterone levels. Presentation Date: Saturday, June 17, 2023