Ovoid Mass Research Articles

7407 Normosmic Idiopathic Hypogonadotropic Hypogonadism in Women: A Case Report and Comprehensive Review

Abstract Disclosure: E.G. Bustamante: None. M. Sulehri: None. I. Patoli: None. A. Karunakaran: None. Normosmic Idiopathic Hypogonadotropic Hypogonadism (nIHH) in Women: A Case Report and Literature ReviewIntroduction: IHH is a rare genetic disorder affecting gonadotropic-releasing hormone (GnRH) production and/or action, resulting in diminished sex steroid levels. Characterized by the absence of spontaneous pubertal development. In women, it manifests with normal adrenarche but absent thelarche and menarche. Our case highlight a late diagnosis of IHH in a 34-year-old woman with primary amenorrhea. Case report: A 34 year old lady with a history of primary amenorrhea sought evaluation. At age 16, she underwent assessment for short stature and primary amenorrhea, denying anosmia, headache, visual disturbances. Evaluation revealed bone age concordant with chronological age and normal MRI Brain. Pelvic ultrasound (US) showed small premenarchal uterus and ovaries. She initiated oral contraceptive pills (OCP) and experienced regular menses. Seeking fertility assistance at age 24, a normal Hysterosalpingogram was followed by successful delivery of twins after ovarian stimulation. Post-delivery menses did not resume and OCP was not restarted. Family history revealed a sister with irregular periods requiring OCP.Subsequently workup at age 30 showed Estradiol 22 pg/ml, FSH/LH 4.1/2.3 mUI/mL; normal PRL, TFT, DHEAS, 17OHP. Repeat Pelvic US showed normal uterus, endometrial stripe normal at 0.24 cm and non-visualized ovaries. PCOS testing negative for hyperandrogenism. Progesterone challenge resulted in no withdrawal bleeding. Brain MRI demonstrated a 2.2 x 1.3 mm hypoenhancing ovoid mass in the pars Intermedia of the pituitary gland suggestive of pituitary microadenoma. Pituitary axis hormonal testing was normal. Karyotype revealed 46 XX (normal female). Genetic evaluation identified a pathogenic variant (p.R35C) in GNRH1 gene. Her final diagnosis: nIHH. Discussion HH is diagnosed in 5% of all women with primary amenorrhea and is divided into 2 major categories: Kallmann syndrome and nIHH. The majority of known causes of HH can be attributed to mutations in KAL1, FGFR1, or GNRHR. The p.R35C variant has been associated with autosomal dominant nIHH. Diagnosis involves clinical suspicious, low LH/FSH and sex steroid levels, normal hypothalamic–pituitary imaging, and exclusion of differentials.Treatment goal for female focus on regular breast and uterine development, as well as the capability to conceive. Use of hormonal replacement therapy and/or gonadotropins or pulsatile GnRH for ovarian stimulation are essential. ConclusionWhile IHH predominantly affects men, limited literature explores its manifestation in women and its impact on fertility. The identification of a GNRH1-related nIHH variant highlights the role of genetic testing in specific HH diagnoses. Failure to diagnose in adolescence may compromise women overall well-being Presentation: 6/1/2024

Clinical analysis of 21 cases of children with ectopic bronchogenic cyst

Objective: To analyze the clinical characteristics, treatment, and prognosis of ectopic bronchogenic cysts in children. Methods: A retrospective analysis was conducted on the data including the clinical characteristics, auxiliary examination and treatment of 21 children with ectopic bronchogenic cysts diagnosed pathologically at Children's Hospital Affiliated to Zhengzhou University from July 2015 to December 2023. There were 16 males and 5 females, with a male-female ratio of 3.2∶1, and the age ranged from 4 days to 8 years old (median age 2 years and 8 months). Results: Among the 21 cases of ectopic bronchogenic cysts, 11 cases were found in the pharynx, with symptoms including dyspnea (4 cases), snoring during sleep (3 cases), and choking on milk(4 cases).Ten cases were found in the head, neck or anterior chest, 5 of these cases had infection history, and 5 showed progressive mass growth.Imaging and endoscopy showed 9 patients underwent preoperative color ultrasonography revealed cystic masses with well-defined boundaries. CT examination was performed on 13 patients, which showed round or nearly round masses with homogeneous density, smooth margins, and regular cyst walls. CT attenuation values ranged from 2 to 52 Hounsfield Units (HU). Four cystic lesions were assessed via MRI, 3 cases demonstrated long T1 and long T2 signals, while 1 case had a slight short T1 and long T2 signal, with high signal intensity on fat-suppressed images. Eleven cases of pharyngopharyngeal cysts were examined by electronic nasopharyngoscopy. The cysts appeared as spherical or ovoid masses with smooth surfaces, close to or slightly light in color with the surrounding tissue, with one cyst presenting with a bluish blue in the oropharynx. All 11 pharyngeal cysts were excised using low-temperature plasma under general anesthesia and intubation assisted by a nasal endoscope. The cysts were pulled and excised as completely as possible.Ten cases of neck and anterior chest cysts were completely excised. Postoperative histopathology confirmed bronchogenic cyst. Twenty-one children were followed up postoperatively for 4 months to 7 years without recurrence, except for 1 patient who was lost to follow-up. Conclusions: Ectopic bronchogenic cysts are uncommon and lack of typical imaging and clinical features.Combination of ultrasonography, CT and MRI is recommended for cases occuered in neck and anterior chest, while electronic nasopharyngoscopy complements pharyngeal evaluations. Surgical intervention is the preferred treatment choice for this disease.

Schwannoma of the hepatoduodenal legament: A case report and review of literature

Schwannomas are extremely rare and almost constantly benign tumors arising from Schwann cells. Gastrointestinal tract schwannomas are usually asymptomatic, and their radiologically/endoscopic features are not pathognomonic. Schwannomas in the hepatoduodenal ligament are even more unusual. In this article, we present a rare case of a Schwannoma of the hepatoduodenal ligament and a brief overview of the literature. A 65-year-old Caucasian female presented for outpatient general surgery evaluation in our institute after sonography and contrast-enhanced abdominal computed tomography (CT) scan incidentally revealed an ovoid mass extended along the lesser curvature of the stomach. The patient underwent a laparoscopic excision of the mass. The final histopathologic examination was suggestive for Schwannoma. At 12-month follow-up, the patient is well with no signs of recurrence or metastasis. Even if their incidence is extremely low, Schwannomas should be included in the broad range of abdominal mass differential diagnosis.

Radiographic and ultrasonographic appearance of pyometra with unilateral uterine torsion in a domestic shorthair cat.

An 8-year-old female domestic shorthair, presenting for a 3-day history of lethargy and hyporexia, was obtunded, dehydrated, tachypneic, and had abdominal distension on physical exam with no vaginal discharge or pyrexia. Abdominal radiographs revealed a large, ovoid soft tissue mass and a tortuous, tubular soft tissue structure in the abdomen. Abdominal ultrasound revealed a severely fluid-distended uterus with a left uterine torsion, which was demonstrated by a "whirl sign." Emergency ovariohysterectomy surgically confirmed a 360° torsion of the left uterine horn with a fluid-distended right uterine horn. Histopathology confirmed a diagnosis of pyometra, and the cat recovered uneventfully.

Peripapillary Hyperreflective Ovoid Mass-Like Structures in a Patient with Nonarteritic Anterior Ischemic Optic Neuropathy

A 78-year-old woman presented with an upper visual field defect in the left eye. Her best-corrected visual acuity (BCVA) was 1.2 in both eyes. Fundoscopy revealed inferior optic disc swelling. Peripapillary optical coherence tomography (OCT) demonstrated the presence of peripapillary hyperreflective ovoid mass–like structures (PHOMS) that was located in the inferior portion of the left eye. The patient was diagnosed with nonarteritic anterior ischemic optic neuropathy (NAION) of the left eye. One month after the initial visit, her BCVA decreased to 0.15 in the left eye. Fundoscopy revealed superior optic disc swelling. OCT demonstrated the presence of PHOMS that was located in the superior portion of the left eye. She was diagnosed with recurrent NAION. Three months later, her BCVA was maintained at 0.2, however, the optic disc looked diffusely pale. This case highlights the importance for clinicians to be aware of PHOMS with NAION.

A Myxofibroma of the Soft Tissue of Face: A Rare Case Report

Myxoma is a locally invasive neoplasm usually involving the jaw bones, typically occurs between the second and fourth decades. This tumor may comprise 3%-6% of odontogenic tumors. Myxomas of the soft tissue of the face are very rare. We present an unusual case of myxofibroma occurring in a 13-year-old man involving the soft tissue of the face. It congenitally occurred and was a 1 cm sized, ovoid in shape, swelling located on the glabella without any symptoms. An excisional biopsy was performed. A well encapsulated ovoid mass was attached to the corrugator supercilli muscle below the frontalis muscle. It was measured 1.1 x 1 x 0.8 cm and completely excised. Histological examination revealed myxofibroma showing stellate and spinde-shaped cells throughout myxoid ground substance. The unusual features of this case are the site of the tumor, which was localized to the non-tooth bearing area of the mandible and its congenital occurrence history.

Inguinal hernia containing pyometra, jejunum and ileum in a dog

AbstractAn 8‐year‐old, intact, female, mixed breed dog was presented due to vomiting, constipation and inguinal swelling. Haematology and biochemistry revealed leukocytosis. A lateral abdominal radiograph revealed a soft tissue opacity, round to ovoid mass, in the caudal inguinal region. Gas‐filled intestinal loops were present at the cranial aspect of the mass. Further imaging was declined. Thus, an exploratory laparotomy was performed. An inguinal hernial sac containing fluid, a closed pyometra and intestinal loops was revealed. The contents of the inguinal hernia were returned to the abdominal cavity, an ovariohysterectomy was performed via a median laparotomy and the inguinal ring was closed, leaving the caudal aspect open. The dog's recovery was uneventful. To the authors’ knowledge, this is the first reported case of pyometra inguinal herniation in a dog with concurrent herniation of the jejunum and ileum.

Epipericardial Fat Necrosis and Covid-19.

Epipericardial fat necrosis (EFN) is a rare and self-limiting cause of acute chest pain. We describe a case of EFN in a patient with a recent coronavirus disease (COVID-19). A 55-year-old male presented with a sudden onset of left-sided pleuritic chest pain for the past two days. The patient was diaphoretic, tachypneic, and tachycardic. Acute coronary syndrome was ruled out. A computed tomography (CT) pulmonary angiogram revealed an ovoid encapsulated fatty mass surrounded by dense appearing tissue. Patient symptoms improved remarkably with a short course of non-steroidal anti-inflammatory drugs (NSAIDs). EFN typically presents with a sudden onset of excruciating chest pain. Misdiagnosis, under-diagnosis, and mismanagement are unavoidable. EFN is incidentally diagnosed on CT scan. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects visceral adipose tissue and appears to increase the risk of EFN by promoting inflammatory cytokine production and death of adipocytes. EFN is a rare cause of acute chest pain. SARS-CoV-2 is likely to induce EFN. This rare clinical entity should be considered in the differential of acute chest pain especially in patients with active or recent COVID-19. Epipericardial fat necrosis (EFN) is a rare cause of acute pleuritic chest pain that is often misdiagnosed and mismanaged.SARS-CoV-2 can possibly increase the risk of EFN and this entity should be considered in the differential of chest pain, especially in patients with active or recent coronavirus disease (COVID-19).Clinician awareness of EFN and its potential association with COVID-19, can reduce unnecessary testing and emotional distress.

Pleomorphic Adenoma With Cystic Change, Extensive Squamous Metaplasia and Positive Block-Like p16 Staining Pattern: A Sheep In Wolf’s Clothing

Abstract Introduction/Objective Pleomorphic adenoma, the most common benign salivary gland neoplasm may show squamous metaplasia in up to 25% of cases, and less frequent cystic change. We report an unusual case of pleomorphic adenoma with cystic change, extensive squamous metaplasia and block-like p16 staining that was misdiagnosed as metastatic p16-positive squamous cell carcinoma in a limited core biopsy. Methods/Case Report A 78-year-old female with no history of malignancy presented with a right neck painless mass. PET-CT demonstrated a hypermetabolic ovoid mass adjacent to the right submandibular gland measuring 1.7 cm concerning for metastatic disease within a lymph node. Fine needle aspiration of lesion was hypocellular and showed cystic contents and rare atypical squamoid cells. Core biopsy of the lesion demonstrated sheets of squamoid cells with mild to moderate cytologic atypia in a hyalinized fibrotic stroma. Immunostain for p16 showed cytoplasmic and nuclear block-staining pattern. The biopsy was diagnosed as metastatic p16-positive squamous cell carcinoma. Subsequent human papilloma virus (HPV) in situ hybridization for low- and high-risk types was negative. The patient underwent right level 1B neck dissection revealing a pleomorphic adenoma arising at the periphery of the submandibular gland with cystic change and extensive central squamous metaplasia. Repeated p16 staining showed diffuse positivity in the area with squamous metaplasia and heterogenous staining in the non-metaplastic areas. Cobas HPV-PCR test covering 14 high-risk HPV subtypes was also negative. Results (if a Case Study enter NA) NA Conclusion We describe the unusual coexistence of extensive squamous metaplasia, cystic change and aberrant p16 staining pattern in an exophytic pleomorphic adenoma to raise awareness of how these changes individually, and more so in combination can mimic squamous cell carcinoma. The mechanism of p16 overexpression in metaplastic PAs appears to be independent of HPV infection.

Computed tomographic, magnetic resonance imaging, and ultrasonographic characteristics of retrobulbar meningiomas in 15 dogs.

Meningioma is the most common tumor of the cranium in dogs and an important differential diagnosis for a potentially treatable disease that can be found in the periorbital tissues. The objective of this retrospective, case series study was to describe the CT, MRI, and US characteristics of confirmed retrobulbar meningiomas in a group of dogs. Medical records from multiple institutions were searched for canine patients with CT, MRI, and/or US imaging of a cytologically or histologically confirmed retrobulbar meningioma. Fifteen dogs met the inclusion criteria. Retrobulbar meningiomas typically appeared as a relatively well-defined conical to ovoid mass within the retrobulbar space, most often along the optic nerve and expanding the extraocular muscle cone. On CT, masses were predominantly soft tissue attenuating and variably heterogeneously contrast enhancing. While MRI features were variable, moderate to marked contrast enhancement was seen in all cases. Many of the tumors had evidence of partial mineralization, best appreciated on CT in nine patients, but also suspected based on susceptibility artifacts in three MRI cases, one of which was confirmed on CT. Regional osteolysis was a rare finding, noted in three cases, but was often accompanied by cranial cavity extension (2/3). Cranial cavity extension was also seen in the absence of regional osteolysis, identified in a total of six patients. On US, masses were echogenic and compressed the globe. The findings were consistent with previous gross and histologic descriptions and supported prioritizing retrobulbar meningioma as a differential diagnosis for dogs with the described imaging characteristics.

Juvenile psammomatoid ossifying fibroma: A case report and a review of the literature

Abstract Juvenile psammomatoid ossifying fibroma (OF) is a rare histological variant of OF with aggressive behavior. It is a benign fibro-osseous lesion with a high rate of recurrence. It occurs mainly in male children with paranasal sinuses and orbits the most common sites. The diagnosis depends on clinical, radiologic, and pathologic correlation. This study aims to present a case report of juvenile psammomatoid OF (JPOF) in a 9-year-old boy and to also review the relevant literature. A case of a 9-year-old boy who presented with a 1-year history of the left maxillary swelling was presented. There was no associated history of pain, ulceration, bleeding, or teeth mobility. There was no history of previous trauma to the site or teeth extraction. The patient had no difficulty in chewing, speaking, nasal blockage, or discharge. Examination revealed an ovoid left maxillary buccal mass measuring about 4 cm × 3 cm, which was hard, nontender with no teeth mobility. The diagnosis of JPOF made was confirmed through a combination of clinical, radiological, and histopathological findings. The patient had enucleation of the lesion under general anesthesia. Follow-up was satisfactory with no recurrence. JPOF is a rare histological variant of OF that is known to exhibit a high rate of recurrence. Although clinical and radiological features contribute to its diagnosis, histopathological examination has been the main diagnostic modality. Early detection and treatment are essential.

Non-Small Cell Lung Cancer Presenting as Anterior Nasal Mass and Epistaxis.

Lung malignancy presentation with an uncommon metastatic site is a diagnostic challenge and often associated with poor prognosis. Nasal cavity is a rare metastatic site for any type of lung cancer. We report an unusual case of poorly differentiated adenosquamous carcinoma of the lung with widespread metastasis presenting as a right vestibular nasal mass with epistaxis. A 76-year-old male patient with chronic obstructive pulmonary disease and 80 pack-year smoking history presented with spontaneous epistaxis. He reported a new rapidly growing right-sided nasal vestibular mass first noticed 2 weeks prior. Physical examination showed fleshy mass with crusting in right nasal vestibule along with a left nasal domus mass. Imaging revealed an ovoid mass in the right anterior nostril and a large mass in the right upper lobe of the lung (RULL) along with thoracic vertebral sclerotic metastasis and large left frontal lobe hemorrhagic lesion with severe vasogenic edema. Positron emission tomography scan showed large right upper lobe mass and suspected to be the primary malignancy along with widespread metastasis. Biopsy of the nasal lesion revealed poorly differentiated non-small cell carcinoma with squamous and glandular features. The diagnosis of very poorly differentiated adenosquamous carcinoma of the lung with widespread metastasis was made. In conclusion, unusual metastatic sites with unknown primary lesions require a thorough diagnostic workup involving biopsy and extensive imaging. Lung cancer with unusual metastatic sites is inherently aggressive and associated with poor prognosis. Multidisciplinary treatment modalities should be employed keeping in view the functional status and comorbidities of the patient.

Fine-needle aspiration biopsy diagnosis of histiocyte-rich rhabdomyoblastic tumor (inflammatory leiomyosarcoma): A case report.

Histiocyte-rich rhabdomyoblastic tumor (HRRMT) is an exceedingly rare soft tissue tumor of primitive myogenic differentiation. We report herein a case involving the soft tissue in the left lateral peri-scapular region in a 68-year-old female with a 2-month history of a non-painful soft tissue mass. Ultrasound revealed a solid, ovoid subcutaneous mass lesion that lacked significant internal vascularity. Percutaneous fine-needle aspiration (FNA) biopsy with concomitant core needle biopsy was performed, and a diagnosis of HRRMT was rendered. Cytologic smears were hypercellular, composed of a mixture of foamy histiocytes and a variably cohesive population of epithelioid and plasmacytoid to vaguely spindled cells in cohesive clusters and singly dispersed. Histologic material showed sheets of epithelioid and plasmacytoid to spindled cells with admixed foamy histiocytes with distended, vacuolated cytoplasm. To our knowledge, this is the first reported example of HRRMT evaluated by FNA biopsy.

226: THE PHEO-HEPATO PHENOMENON: TRANSAMINITIS IN THE SETTING OF ACTIVE PHEOCHROMOCYTOMA

Introduction: Pheochromocytomas are neuroendocrine tumors that cause release of excess catecholamines. This release causes commonly known signs and symptoms of hypertension, tachycardia, headache, flushing, and palpitations. Less commonly seen is abdominal pain with transaminitis. Description: A 47-year-old woman with no medical history presented with one day of severe abdominal pain, nausea, vomiting, palpitations, and symptoms of feeling flushed. Initial evaluation found the patient to be hypertensive, tachycardic, and tachypneic. On CT imaging, the patient was found to have a 6.5cm ovoid adrenal mass and lab work showed elevated 24-hour urine and plasma metanephrines, consistent with pheochromocytoma. The patient’s course was complicated by the development of transaminitis (had been normal on initial lab work), with elevation to AST 4882 U/L, ALT 4183 U/L, with normal alkaline phosphatase and bilirubin. Both ultrasound and CT imaging showed intrinsic fatty liver disease with patent vasculature, though no underlying pathology in the setting of no personal history of alcohol abuse, IV drug use, and non-reactive hepatitis panel. Hepatology consulted, and etiology thought to be in the setting of poor perfusion due to catecholamine storm. With medical treatment of the pheochromocytoma, AST and ALT significantly down-trended (75% within one week), and had normalized by the patient’s adrenalectomy and have remained normal in the post-operative period. Discussion: Pheochromocytoma is a rare neuroendocrine tumor, which has varying symptomatology on presentation, though commonly includes severe hypertension with headache, sweating, and palpitations related to catecholamine surge. A less common, though still reported presenting symptom, is abdominal pain. There have been cases in the literature wherein patients with pheochromocytoma present with abdominal pain and transaminitis, though not to the degree that has been seen in our patient. The pathogenesis of this in the setting of pheochromocytoma is not completely understood, though is thought to be related to increased vascular resistance due to catecholamine release, leading to decreased blood flow and oxygenation. With medical and ultimate surgical management of pheochromocytoma, liver function tests can be expected to return to baseline values.

241 LEFT ATRIAL SEPTAL POUCH THROMBOSIS AFTER COVID19 INFECTION: IS IMMUNOTHROMBOSIS THE CULPRIT MECHANISM?

Abstract Aims The atrial septal pouch (ASP) is an incomplete fusion between septum primum (SP) and septum secundum (SS), resulting in a kangaroo pouch, that has a high prevalence in general populations (47%) and it is a potential site of blood stasis and thrombosis. After the novel coronavirus disease (COVID19) -related thrombotic complications, immunothrombosis has been widely investigated and proposed as key pathogenic mechanism linking coagulation and inflammation, leading sometimes to intracardiac thrombosis. In this paper we describe a case of thrombus in the ASP interestingly developed after COVID19 and made a literature review. Methods and Results A 85 years old woman with a history of hypertension and chronic atrial fibrillation (AF) in therapy with dabigatran, was admitted to our hospital for dyspnea, atypical chest pain and fever. Laboratory exams showed only mild leukocytosis and elevated levels of d-dimer; EKG confirmed AF with a normal ventricular rate and CT scan excluded pulmonary embolism. Transthoracic and transesophageal echocardiogram (TEE) (Figure 1) showed a mobile ovoid mass (13×26 mm) attached to a left-sided ASP mimicking a myxoma, no mass was seen in the left atrial appendage (LAA). Four months earlier she had been hospitalized for idiopathic thrombocytopenia and concurrent COVID19 infection with mild symptoms, therefore dabigatran was discontinued for a month. The patient underwent surgery and histopathology confirmed it was a thrombus. In the PubMed search we conducted for reports demonstrating ASP masses, or alleged thromboembolism (TE) from this site, we found 25 reports, whose characteristics are briefly summarized in Table 1. Interestingly mild thrombocytopenia was described just in one case. Conclusions In addition to the LAA, the atrial septal pouch is a newly described, common anatomic entity of the interatrial septum, that potentially serves as a site of stasis and thrombus formation. Despite its high prevalence, the finding of a thrombus in this site is very rare. According to Virchow triad, we assume that in this case an endothelial injury and hypercoagulability could have played a pivotal role, since the concomitant thrombocytopenia and high levels of d-dimer. This could be the first case of a thrombus in the ASP associated with COVID19-immunothrombosis.

PSUN380 A Case of Sclerosing Epithelioid Fibrosarcoma With Metastases to the Thyroid

Abstract Background Sclerosing Epithelioid Fibrosarcoma (SEF) is a rare form of soft tissue sarcoma, often presenting in the soft tissues of the extremities. This tumor is characterized by slow growth, often with local recurrences and/or distant metastases. First described in 1995, subsequent case reports and case series have demonstrated that metastases are primarily to the lung, pleura and bone, but can occur anywhere. Treatment is primarily by wide excision and adjuvant chemotherapy or radiotherapy. However, treatment of this rare form of sarcoma is often unsatisfactory. Clinical case A 36-year-old female, had for 30 years presented with a slowly enlarging mass on the left axilla. She had no constitutional symptoms and had previously been in good health. She was first diagnosed with SEF when she presented with abdominal pain where workup showed elevated Lipase 8,098 U/L (73-393 U/L) and Amylase 976 U/L (25-115 U/L). CT scans showed an ill-defined hypodense focus in the body of the pancreas, with incidental findings of a mixed intensity ovoid lesion in the left erector spinae, and heterogeneously enhancing ovoid masses in the left axilla, left lateral chest wall, left lower lung lobe, and the liver. Biopsy of the left axillary mass showed a round cell sarcoma consistent with Sclerosing Epithelioid Fibrosarcoma. PET scan confirmed widespread metastases to the lungs, pancreas, abdominal wall, left thigh and scalp. She underwent wide excision of the masses in the left axilla, thigh, and scalp. Adjuvant chemotherapy with Doxorubicin and Ifosfamide was then initiated. 6 months after starting treatment, she reported a rapidly enlarging anterior neck mass. She denied tremors, palpitations, any change in weight, heat/cold intolerance, changes in bowel movement, fatigue or muscle weakness. On physical examination there was a 2×2 cm, firm, non-tender, palpable nodule on the right thyroid lobe. Thyroid function tests were as follows: TSH 0.52 uIU/mL (0.55-4.78 uIU/mL), FT4 1.27 ng/dL (0.89-1.76 ng/dL), FT3 2.84 pg/mL (2.30–4.20 pg/mL). On thyroid ultrasound there was a 2.6×1.8×2.4 cm, mixed hypoechoic, solid, lobulated nodule in the upper to middle third of the right thyroid lobe, and a 0.3×0.2×0.3 cm hypoechoic solid nodule in the lower third of the left thyroid lobe. FNAB showed hypercellular smears with atypical round to spindle-shaped cells arranged in singly and loose to crowded clusters. She underwent total thyroidectomy, and histopathologic examination was consistent with a multifocal metastatic Sclerosing Epithelioid Fibrosarcoma. She was subsequently started on Levothyroxine replacement. Conclusion This case, to our knowledge, is the first reported case of Sclerosing Epithelioid Fibrosarcoma (SEF) metastatic to the thyroid. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

S2510 Limitations of Endoscopic Tools for Foreign Body Retrieval: A Case of Massive Ferromagnet Ingestion

Introduction: Esophagogastroduodenoscopy (EGD) remains the standard of care for foreign body (FB) retrieval. The decision to pursue endoscopic intervention is based on multiple considerations including the probability of passage of the FB, the risk of potential injury caused by ingestion of the foreign body, and the risk of potential injury caused by performing the intervention. We present a case of FB ingestion resulting in practically impossible endoscopic retrieval. We also highlight endoscopic cues that should prompt a gastroenterologist to consider surgical evaluation in high-risk cases. Case Description/Methods: A 49-year-old man with schizoaffective disorder and a history of multiple ingestions of foreign bodies presented to the hospital for vomiting and diarrhea for 4 days. An abdominal x-ray revealed a large radiopaque structure that conformed to the shape of the stomach in the gastric region [Figure 1a]. EGD revealed multiple large consolidated ovoid masses of gray metal in the gastric body and antrum [Figure 2a]. Endoscopic retrieval was attempted using a large cold snare, which could not be wrapped around or secured around the FB without slipping upon closure. A Roth net was tried with the same unsuccessful result. Bites of the FB using rat-tooth forceps slightly deteriorated the mass and the foreign body material impeded the full-closing of the jaws of the forceps so that the forceps could not be retrieved through the working channel. The malleable material then had to be irrigated and scraped off to allow for reuse. Due to the large size of the FB and small space in the stomach for gastroscope maneuverability and the presence of multiple scattered large and deeply cratered ulcers along the gastric wall, the procedure was aborted to avoid perforation [Figure 2b]. The patient was referred for surgical intervention and soon thereafter underwent FB removal via partial gastrectomy with gastric reconstruction [Figure 1b]. The recovered FB weighed 2,885 grams and measured 32 x 31 x 1.5 cm Discussion: Care should be practiced when planning and executing the retrieval of foreign bodies. The type, size, and location of the FB, the patient’s anatomy, the presence of deep ulceration and the risk of organ perforation are important considerations for the endoscopist. Surgical intervention should be considered when the risk of perforation with endoscopic intervention is high and/or endoscopic attempts at retrieval have been unsuccessful after practically exhausting the endoscopic tools available.Figure 1.: 1a: CT scan without contrast on admission Figure 1b: CT scan without contrast post-surgery. Figure 2a: Foreign body in gastric body Figure 2b: Foreign body with ulcers in gastric body.

Meningioma – A spectrum of varied case presentations: A case series

Meningiomas are most common primary intracranial neoplasm. They arise from the arachnoid cap cells. They were previously divided into WHO grade I, grade II and grade III depending on their histological features and clinical features. However, in the new WHO 2021 updates it has been assigned a single group. Meningiomas may arise in the brain and spinal cord. An integrated approach based on clinical examination, history, radiology and histopathology aids in diagnosis. Herein we present a case series of a spectrum of clinico-pathological presentations of meningiomas. A 35-year-old female presented with headache. After clinical examination and on CT scan an intracranial lesion was noted. Craniotomy was performed and tissues examination was consistent with meningothelial meningioma. A 55-year-old female presented with pain in the limbs associated with weakness to the orthopaedics clinic. On neurological examination there was loss of power in the limbs. MRI spine revealed a round extramedullary intradural mass at T7 level. Laminectomy was done and histopathological examination showed features of Psammomatous meningioma, based on histomorphology and immunohistochemistry.A 32-year-old female presented to the Surgery clinics with dizziness and headache which was progressive and not responding to medications. MRI revealed an ovoid enhancing mass involving left parieto-occipital region, with a provisional diagnosis of meningioma. A report of Transitional meningioma was given based on histomorphology and immunohistochemistry. A 40-year-old female presented to the ophthalmic clinic with complaints of diplopia and disturbances in gait. Fundus examination revealed disc oedema and retinal vessel narrowing. MRI revealed large ovoid extra axial mass, with a provisional diagnosis of meningioma. A report of Secretory meningioma was signed out on histomorphology and immunohistochemistry.

Pedunculated Fibrolipoma of the Hypopharynx: A Case Report

Fibrolipomas are a rare microscopic variant of lipomas, characterized by mature adipose tissue interspersed with dense fibrous connective tissue. These lesions are rarely observed in the head and neck region and represent <0.6% of all benign tumors of the larynx and hypopharynx. Their clinical presentation depends on the location and size of lesions. Patients present with variable symptoms; however, fibrolipomas of the larynx and hypopharynx are clinically important because these tumors can cause unpredictable airway obstruction, particularly during general anesthesia induction. We present a case of a hypopharyngeal fibrolipoma in a 61-year-old patient with frequent dyspnea, dysphagia, and muffled voice. Laryngoscopy revealed a well-demarcated pedunculated ovoid mass involving the larynx. We performed laryngomicrosurgery using a carbon dioxide laser for surgical excision and subsequent evaluation confirmed the diagnosis of fibrolipoma. We report a case of hypopharyngeal fibrolipoma, together with a literature review.

426 Conservative Management of Bilateral Undescended Testes in an Adult

Abstract Bilateral undescended testes are an uncommon finding in children and even a rarer phenomenon in adults. Undescent of the testes (UDT) has important consequences on fertility, testicular injury, hormonal concerns, testicular torsion, and testicular cancer risk, as well as psychological health. We present the case of a then 21-year-old native caucasian who was referred to the urology clinic with an ‘empty scrotum’ in 2009. On examination, he had secondary sexual characteristics with expected pubertal transformation. Testes were palpated as small smooth ovoid masses in each groin with the inability to be reduced into the scrotum. The basic hormonal screen was within the normal range. Ultrasound of the scrotum and groins identified testes in the left and right inguinal canal, respectively. Semen analysis showed azoospermia. Treatment wise no pharmacological therapies were warranted in view of normal hormonal function. The patient opted for conservative options for fertility in view of likely low success rates in atrophic testes including sperm extraction techniques After detailed discussions around the dilemmas of Bilateral UDT, a decision for a tailored surveillance regimen including ultrasound and self-examination was taken. Psychological counselling was declined by the patient as felt unwarranted. He continues to remain well in himself to date with his wife and adopted children. Greater awareness of testicular self-examination amongst young men should be advocated. With established neonatal screening availability, UDT in adults is seldom heard of but it is a primary risk factor for testicular cancer. Proper counselling advice and prosthesis should be offered proactively.