Ovoid Mass Research Articles

Extra-adrenal Mesenteric Pigmented Paraganglioma: A Rare Case Report

Paragangliomas are rare neoplasms that arise from neural crest cells of the autonomous system. It has been estimated that 5% to 10% of paragangliomas occur in extra-adrenal sites, which can extend from the upper cervical region to the pelvis, parallel to the autonomic nervous system. This distribution corresponds to the embryologic development of the paraganglia from neural crest cells. Rarely, extra-adrenal paragangliomas can also occur outside this distribution. Herein, we present a case of a 70-year-old female with history of abdominal pain, in whom an abdominal mass was identified during ultrasonography. CT scan shows solid cystic mass arising from the right side of the pelvic cavity. Exploration laparotomy reveal well-circumscribed, encapsulated, ovoid and blackish mesenteric mass. After thorough microscopic and immunohistochemistry examination, the features were that of Pigmented Paraganglioma. This case report expands the morphologic spectrum of extra-adrenal paragangliomas and emphasizes the need to consider these tumors in the differential diagnosis of pigmented neoplasms.

EBV+ Inflammatory Pseudotumor-like Follicular/Fibroblastic Dendritic Cell Sarcoma: An Uncommon and Challenging Tumor

Abstract Casestudy: Inflammatory pseudotumor-like follicular/fibroblastic dendritic cell sarcoma (IP-L FDC/FRC) is a rare dendritic cell neoplasm recognized as a specific entity in the WHO classification of tumors of the hematopoietic and lymphoid tissues. The tumor has specific clinical features, including a predominance in young to middle-aged women typically involving the liver or spleen, with neoplastic cells typically positive for Epstein-Barr virus. Morphologically, the tumor poses a diagnostic challenge to distinguish it from inflammatory pseudotumor and inflammatory myofibroblastic tumor, with which it shares considerable morphologic and immunohistochemical overlap. We present a case report of a 35-year-old female who presented with weight loss, malaise, and intraabdominal mass. MRI revealed a 14 cm large ovoid solid mass with central hemorrhage and necrosis. Biopsy and subsequent resection of the tumor confirmed IP-L FDC/FRC sarcoma. Histologically, the tumor was composed of spindle cells admixed with many lymphocytes and prominent plasma cells. Immunohistochemical stains showed neoplastic spindle cells focally positive for dendritic cell markers CD21, CD23, and CD35, diffuse positivity for SMA, and striking in situ hybridization for Epstein-Barr virus (EBER). Due to its rarity, biologic behavior and outcomes are not well established. The tumors are generally regarded as indolent with a risk of repeated intraabdominal recurrence, although recurrences may be related to the ease and completeness of surgical resection. It is essential to distinguish this tumor from other high- grade sarcomas with greater metastatic potential and overall worse prognosis.

Post appendectomy young male proffer intussusception unveiled diffuse large B-cell lymphoma non-Hodgkin lymphoma

Intussusception is the telescoping of the proximal segment of the intestine within the lumen of the adjacent segment. Adult intussusception is rare and its aetiology differs from paediatrics. Surgery is highly recommended and challenging considering the possibility of carcinoma. Post-operative intussusception is a rare and bizarre complication. We report an 18-year old male who had undergone uncomplicated appendectomy outside the institute with missed histopathological examination (HPE) report, presented with abdominal pain for 1 week, vomiting 4 days, obstipation 1 day. On examination ovoid mass of size (12×7 cm) in right hypochondrium. A plain abdomen radiograph shows dilated bowel loops. Contrast-enhanced computed tomography (CECT) abdomen and pelvis showed telescoping of small bowel into the caecum. Suggestive of post-appendectomy intussusception causing intestinal obstruction, emergency laparotomy revealed telescoping of ileum into caecum, acting as the leading point of intussusception, proceeded with right hemicolectomy and ileo-transverse anastomosis. With blindsiding HPE defining high grade diffuse large B cell lymphoma, immunohistochemistry stains nuclear positivity for cluster of differentiation-20 (CD-20) >80%, and Ki-67 >90%. Surgery plus chemotherapy is warranted being a high-grade tumour. Surgery must be restricted to the primary tumour, with mesenteric lymph node involvement based on oncological principles. Laparoscopic approach is preferred nowadays.

A Case of Accessory Parotid Cyst Treated with Ultrasound-Guided Percutaneous Ethanol Injection

A cyst in the accessory parotid gland (APG) is extremely rare, with only three cases having been reported recently in English literature. They were all treated with sclerotherapy, where a cyst may appear as a painless superficial mass in the mid-cheek area. In sclerotherapy, the most commonly used materials are ethanol and OK-432, which report good therapeutic results for the treatment of benign cervical cystic mass. An 85-year-old man came to our clinic with superficial, well-margined ovoid mass on the left cheek. The mass was diagnosed as a benign cyst in APG through imaging studies and core needle biopsy. We performed the ultrasoundguided percutaneous ethanol injection and the cyst disappeared, leaving only the fused cystic wall. We report this very rare and interesting case with a literature review.

SUN-935 Invasive Neuroendocrine Breast Carcinoma Presenting as Liver Metastases

Introduction:Primary neuroendocrine carcinoma of the breast is rare and must be differentiated from metastatic neuroendocrine carcinoma from the gastrointestinal tract.Clinical Case:A 66-year-old white female presented to the outpatient clinic complaining of abdominal fullness with unintentional weight loss of over 30 pounds over 3 months. She had no nausea, vomiting, diarrhea, or constipation. During initial evaluation, she had hepatomegaly with the liver edge palpable 4 cm below the costal margin. Laboratory studies are within normal limits except for elevated alkaline phosphatase at 369 U/L (n<130 U/L).A CT scan of the abdomen and pelvis with contrast showed extensive malignant lesions involving the liver consistent with prior hepatocellular carcinoma versus metastatic disease. Patient had a colonoscopy and esophagogastroduodenoscopy in an attempt to identify a primary gastrointestinal malignancy, but both studies were unremarkable. Ultrasound guided biopsy of the liver masses revealed malignant cells with morphologic features that were suggestive of metastatic neuroendocrine carcinoma.The patient was started on monthly intramuscular octreotide 30 mg. She had a Gallium-68 dotatate scan showing increased uptake in the area of several large heterogeneous necrotic tumors throughout the liver, and in the left sixth posterolateral rib. The maximum uptake was noted in a 3.7 cm x 3.5 cm ovoid mass in the right breast. The patient admitted to noticing a mass in her right breast which decreased in size after her initial dose of octreotide. She had not had a mammogram in several years and refused a breast exam during initial evaluation. The patient was sent for mammography and ultrasound as well as for biopsy of the breast lesion.Results of the breast biopsy showed intermediate grade neuroendocrine tumor of the breast. The patient underwent right total mastectomy with lymph node staging, and intraoperative pathology identified neuroendocrine carcinoma of intermediate grade in the right breast and right axillary lymph nodes, and macrometastatic carcinoma in a right axillary tail lymph node. Immunohistochemistry showed the malignant cells were chromogranin and synaptophysin positive. They were also estrogen receptor positive. The cells were negative for progesterone receptor and human epidermal growth factor receptor 2.The patient follows up regularly with oncology and continues to receive monthly doses of octreotide. She was also started on exemestane and had Yittrium-90 radioembolization of liver metastases.Conclusion:Patients with neuroendocrine carcinoma of the breast rarely present with clinical conditions related to hormonal hypersecretion as in neuroendocrine carcinoma of the GI tract but respond to treatment with somatostatin analogs.

SAT-LB54 Acute Sterile Meningitis as a Primary Manifestation of Pituitary Apoplexy

Background: Pituitary apoplexy (PA) is a rare endocrinopathy that requires prompt diagnosis and treatment. Presentation with acute neutrophilic meningitis is uncommon.Clinical Case: A 67-year-old man presented to our hospital with a 2-week history of worsening bilateral frontal headache, nausea, and dry heaving. On admission, the patient was somnolent with a score of 13 on the GCS assessment (E2, V5, M6). The neurological exam was overall normal with normal ocular motion and intact cranial nerves, except for a left eye peripheral vision defect. Plain head CT revealed a well-circumscribed ovoid pituitary mass with suprasellar enlargement, consistent with a pituitary macroadenoma. Sellar MRI showed a pituitary mass, roughly 20 x 19 x 24 mm, bulging into the suprasellar cistern with optic chiasm elevation. Analysis of pituitary function revealed low ACTH concentration of 2.8 pg/mL (n = 7.2 - 63.3 pg/mL), a low random cortisol level of 1.7 ug/dL (n = 2.9 - 19.4 ug/dL), a low TSH of < 0.1 uIU/mL (n = 0.35 - 4.9 uIU/mL), a low free T4 level of 0.72 ng/dL (n = 0.77 - 1.48 ng/dL), a low LH of 0.8 IU/L (n = 1.7 - 8.6 IU/L) with a very low total testosterone level of < 3 ng/dL (n = 300 - 720 ng/dL) and normal prolactin, IGF-1 and GH levels. On hospital day 2, the patient had worsening encephalopathy with left eye ptosis and decreased vision. Repeat CT and MRI showed no interval change in the pituitary adenoma or evidence of bleeding. An immediate lumbar puncture was performed and CSF analysis revealed an increased leukocyte count of (1106/mm3) with 89% neutrophilic granulocytes, and increased total protein level of 138 mg/dL (n = 15 - 40 mg/dL), red blood cell count of 2040 without xanthochromia and glucose of 130 mg/dL (n = 40 - 70 mg/dL). Based on the laboratory results and new symptoms, empirical antibiotic (vancomycin, ceftriaxone, and ampicillin) therapy was started for suspected bacterial meningitis before the confirmation of the CSF culture study. CSF culture did not grow any organisms. Given the sudden visual impairment and neurological deterioration, the patient underwent transsphenoidal resection of the tumor with free nasal mucosal graft reconstruction. Histological examination revealed a necrotic pituitary adenoma with apoplexy and no evidence of hemorrhage. Postoperatively, his neurological exam greatly improved. His left pupil was reactive to light and the third palsy was improving.Conclusion: This case reinforces the importance of including PA in the differential diagnosis of acute headache, particularly in patients presenting with visual disturbances. Patients with PA often present with sterile meningitis due to increased debris and blood in the subarachnoid space which closely mimics acute bacterial meningitis. While MRI remains a sensitive imaging modality for the detection of PA, the latter remains a clinical diagnosis. Timely diagnosis with high clinical suspicion and treatment is essential.

Craniosquise with Meningocelis in Newborn Calf

Background: Cranioschisis is a malformation that occurs during embryological development and results in incomplete closure of the skull, leaving an opening through which the intracranial tissue can project. Meningocele consists of herniation of the meninges containing cerebrospinal fluid through the cranial defect. In cattle, this association usually manifested by the appearance of a floating saccular protrusion of variable size and volume in the frontal or parietal region of the cranium. This manuscript aims to report a case of cranioschisis associated with meningocele and neurological deficit in a newborn calf in the northwestern region of the state of Paraná.Case: A 2-day-old crossbred female calf was diagnosed with cranioschisis associated with meningocele in the frontal region of the head. On initial clinical examination, an ovoid mass with floating appearance was observed, extending from the supraorbital curvature of the frontal bone to the end of the nasal bones following the midline. The patient had normal parameters for the species and age and a positive sucking reflex. Neurological examination showed permanent lateral decubitus position, spastic paresis of the thoracic limbs and opisthotonus. Complementary imaging studies, including x-rays and ultrasonography, showed a failure in the frontal bone, approximately 5 cm in diameter. Despite the unfavorable prognosis, surgical reduction was chosen. After drainage of the cerebrospinal fluid, excision of the meningeal sac was continuously performed, exposing the subarachnoid space, showing circular failure in the frontal bone with a diameter of 4.5 cm, making it possible to observe part of the right frontal lobe. We opted for occlusion of the bone defect by covering it with the dura mater. Absorbable 0 catgut suture was applied in a simple continuous pattern for coaptation of the meningeal edges. The technique used proved to be viable, but due to lack of therapeutic response and maintenance of the neurological picture, the animal was euthanized three days after surgery.Discussion: The clinical signs of meningocele are generally observed in newborn calves, and the pathology is not reported in aborted animals, which explains the fact that all cases reported in the literature are of calves born at term. Treatment success is variable. In general, it depends on the absence of neurological symptoms, which are invariably linked to morphological alterations in nervous tissue. Thus, animals with neurological symptoms have poor prognosis and may even die spontaneously. In some cases surgical reduction without the use of grafts, as in this report, was successfully performed. The authors reported covering a 7-cm circular gap in the frontal bone thought coaptation of the meningeal edges using a simple continuous pattern of nylon suture, followed by dehorning. In this case, the animal showed no neurological abnormalities and had a good prognosis. We conclude that the surgical treatment of cranioschisis associated with meningocele in bovine species presented in this report had an unfavorable prognosis. As observed in other cases, when the animals have neurological symptoms the prognosis is bleak, probably due to morphological and functional changes of congenital origin in the nervous tissue, as described in the literature. More case studies are needed to elucidate the etiology and pathogenesis of this disorder in bovines, since the cases described in the literature are not associated with the most commonly reported causes, such as the ingestion of certain plants.

An Intracerebral Type of Cranial Chondroma

The vast majority of intracranial chondromas are located in the base of the cranium. Their presentation as an intracerebral neoplasm is considered to be extremely rare. A previously healthy 45-year-old man experienced recurrent seizure attacks over a period of 6 months. Imaging studies of the brain revealed an ovoid and calcified mass which involve the cortex in the left frontal lobe. Intraoperatively, the mass had no adhesion to the dura and arachnoid membrane. The tumor was completely removed and the final diagnosis was intracerebral chondroma. The patient remained free of disease over the period of 18-years follow-up. This communication adds an unusual case to the literature on the chondroma that expressed in the form of an intra-axial space-occupying lesion in the frontal lobe.

Cavernous hemangioma: A rare tumor in the breast region

Introduction: Hemangiomas are benign vascular tumors rarely located in the breast (incidence of 0.4% to 0.8%). They mainly affect post-menopause women on hormone replacement therapy (HRT). These tumors are classified as capillary or cavernous according to the size of vessels involved and can show heterogeneity in imaging tests. Case report: The patient is a woman aged 56 years, G3P3, living in the city of Florianópolis. She has been on HRT, without a family history of gynecological cancer. She reported breast implant and bariatric surgery in 2007. The patient sought medical care due to a tumor in the left breast that she noticed six months before, with slight growth. Physical examination identified a superficial purplish nodule in the left axillary tail, measuring 1.5 cm. Magnetic resonance imaging (MRI) revealed an intramammary lymph node (BI-RADS 2); mammography (MMG) indicated a 2.4 cm nodule in the left axillary tail (BI-RADS 4), suggesting biopsy; ultrasound (US) identified an irregular peripheral nodule at 2 h on the left, with the same classification. Core biopsy revealed cavernous hemangioma. Mammaplasty was performed with excision of the lesion. Commentaries: In hemangiomas, imaging findings can vary. MMG usually shows an oval or lobular mass, isodense or high-density, and circumscribed margins. The heterogeneity in the US may be related to vascular channels histologically seen in cavernous hemangiomas. MRI characteristics vary according to the possibility of internal thrombosis, but they often include an ovoid mass and circumscribed margins. The MRI report showed no hemangioma; however, MMG and US indicated similar characteristics. Although rare and with a heterogeneous presentation, hemangioma should be remembered as a differential diagnosis since, in addition to its similarities to benign lesions, such as bruises and sebaceous cysts, it can also be mistaken for inflammatory carcinoma and ductal carcinoma in situ, mimics that have been described in the literature.

Parasitic Leiomyoma After Laparoscopic Total Hysterectomy and Bilateral Salpingo-Oophorectomy, a Mimicker of Pelvic Neoplasm

Abstract Parasitic leiomyomas are rare occurrences that may mimic malignancy and thus present a diagnostic dilemma. They are thought to arise from a pedunculated subserosal leiomyoma that undergoes torsion and detaches from the uterus, surviving by revascularization from adjacent structures, or from iatrogenic implantation during surgery, more common with the clinical popularity of laparoscopic surgery and power morcellation. We report a case of parasitic leiomyoma with degenerative changes in a 57-year-old female who was initially found to have a 6.5-cm left adnexal mass and multiple submucosal and intramural masses consistent with leiomyoma by abdominal pelvic computerized tomography test (CT) 7 years prior to presentation. She experienced severe abdominal discomfort that persisted after total abdominal hysterectomy and a 7.8-cm mass was found in the left pelvic cavity on reevaluation. Grossly, the pelvic mass was a 6.5-cm tan-gray ovoid firm mass with a 4.0-cm cystic cavity. The cut surfaces of the solid areas/cyst wall were gray-white and firm with focal yellow streaks. Microscopically, there was central cystic degeneration, with cyst wall showing extensive granulation tissue. The solid portion also showed extensive hyaline degeneration, fibrosis, and perinodular hydropic degeneration. Smooth muscle differentiation was evident at the periphery of the mass, confirmed by strong staining with desmin and smooth muscle actin. This represents a parasitic leiomyoma left behind following the first procedure and it developed degenerative changes. In addition to the high index of suspicion for malignancy in assessing adnexal masses, degenerating parasitic leiomyomas should be included in the differential diagnosis of such mass lesions.

Uterine stump adenocarcinoma in a bitch with an ovarian remnant: A case report

A 3-year-old female spayed dog was presented with a history of sanguineous vaginal discharge of 2 month duration. The dog was spayed 1.5 years before presentation. Clinical examination revealed a large, solid, ovoid mass in the caudal abdomen, recognized by diagnostic imaging as an enlargement at the top of the uterine stump. Additionally, high serum progesterone concentration was measured, confirming the presence of functional ovarian tissue in dioestrus. With a suspicion for a related uterine stump pyometra or less likely, for other enlargements, a cοeliotomy was performed. A mass at the apex of the uterine body and a right side ovarian remnant were found. Both structures and the remaining uterine stump were excised. The uterine remnant mass was histologically diagnosed as uterine adenocarcinoma, herein detected for the first time at the uterine stump in the bitch. Unsuccessful, incomplete ovariohysterectomy may permit even neoplastic transformation of uterine stump tissues.

Juxta-articular tumoral calcinosis associated with the temporomandibular joint: a case report and concise review

BackgroundTumoral calcinosis is an uncommon clinicopathological condition which is characterized by the formation of calcium salt deposition in intra-articular or peri-articular soft tissues. It usually presents as a focal growth of hard tissue, either solitary or multiple, beneath the skin and connective tissue. Diagnostic techniques mainly include clinical and radiographic evaluation. The most commonly involved locations include the hip, elbow, shoulder and knee. Involvement of the head and neck regions are far less common. There have been 5 case reports of temporomandibular joint involvement in the literature so far.Case presentationWe present a case report which describes the diagnosis and management of a 59 year old female patient with chronic right temporomandibular joint pain and localized bony hard swelling over the right pre-auricular region. Patient retained normal range of motion and mouth opening. Computed tomography taken showed a radio-opaque juxta-articular ovoid mass over the right pre-auricular region in close proximity but not fused to the mandibular condyle. Surgical excision was performed for this swelling via a pre-auricular approach under general anaesthesia. Histological examination performed confirmed the diagnosis of tumoral calcinosis. Pain at the right temporomandibular joint was resolved after the surgery. Serum calcium and phosphate levels were normal in this patient.ConclusionSurgical excision is the primary treatment modality for tumoral calcinosis. Tumoral calcinosis may be associated with elevated serum calcium and phosphate levels. In patients with elevated serum electrolytes, it is important to consider the overall systemic health in management of this condition. Management of serum electrolytes levels plays a role in reducing recurrence rates. This case report and review aims to discuss the diagnosis, treatment and overall systemic management of this rare condition.

Extraneural perineurioma: CT and MRI imaging characteristics.

To examine the CT and MRI characteristics of extraneural perineuriomas. With IRB approval, our institutional imaging database was retrospectively reviewed for cases of pathologically proven extraneural perineuriomas. CT and MRI features were recorded, correlative imaging analyzed, and the electronic medical record cross-referenced. We identified ten patients [(seven males, three females, mean age 49.4 ± 18.3years (range, 16-70years)]. All cases were pathologically confirmed. Nine cases were conventional soft tissue extraneural perineuriomas, including one with "reticular" features and one with histologic features of malignancy; the tenth case contained admixed Schwann cells (hybrid perineurioma/schwannoma). Six out of ten patients underwent CT and ten of ten MRI evaluation. Nine out of ten MRIs were performed with IV contrast. Five lesions were subcutaneous, four intermuscular, and one intramuscular. Mean lesion diameter was 4.3 ± 2.7cm (range, 0.9-10.2cm). Nine out of ten lesions were well circumscribed; one had irregular margins. On CT, five of six were hypodense and one isodense compared to skeletal muscle. Most lesions were T1 isointense (5/10) or hypointense (4/10) and T2 hyperintense (7/10) relative to skeletal muscle, and demonstrated solid enhancement (6/9). There was no evidence of muscular denervation on any MRI exam, and a nerve of origin was identified in two out of ten cases. Extraneural perineuriomas have a distinctly different imaging appearance from intraneural perineuriomas, manifesting as rounded or ovoid soft tissue masses, without evidence of muscular denervation, and usually without an apparent nerve of origin. Because these features mimic other benign and malignant soft tissue lesions, including sarcomas, biopsy or excision is needed for definitive diagnosis.

SAT-611 Abdominal Goiter

A 79 year old woman with hyperlipidemia, hypertension, congestive heart failure was referred for evaluation of ectopic thyroid tissue found on a liver biopsy. The patient originally presented with abdominal pain and was noted to have a liver mass measuring 5.7 x 3.2 x 5 cm on computed tomography (CT) that appeared contiguous with the medial segment of the left hepatic lobe. A subsequent ultrasound (US) showed the same 3.1 x 4.7 x 4.7 cm ovoid mass with a central focus of increased echogenicity and a well-circumscribed margin; a fine needle aspiration (FNA) of the hepatic lesion showed thyroid follicular cells and abundant colloid. Magnetic resonance imaging of the abdomen was done 6 months later, which showed a soft tissue abnormality in the porta hepatis extending centrally into the liver of decreased T2 signal intensity relative to the liver and containing iron deposition. The size of the lesion by MRI was unchanged in comparison with the CT. Eight years later, she presented to the Emergency Room with suprapubic abdominal pain. On CT, she had a large mass (8.3 x 5.5 x 7.1 cm) in the porta hepatis with mass effect upon the gallbladder and pancreas without biliary dilatation or evidence of frank invasion. An FNA was repeated, again showing benign appearing thyroid tissue (bland follicular cells without features of papillary thyroid cancer and abundant colloid). Immunohistochemical staining for TTF-1 was positive, supporting thyroid origin. Thyroid function tests were normal ( TSH-0.85 uIU/mL; free T4 direct- 1.1 ng/dL; and total T3 - 125 ng/dL) There are only three prior case reports detailing ectopic thyroid tissue in the porta hepatis (1). Benign ectopic thyroid tissue in the liver is generally explained as a metaplastic phenomenon, as the thyroid shares a common embryologic origin with the liver and proximal segment of the gastrointestinal tract (2). Workup typically includes CT or US imaging, followed by I-123 imaging to determine the presence of functional thyroid tissue, followed by a biopsy. The prevalence of all ectopic thyroid tissue is 1 per 100,000-300,000 persons, with less than 1% being malignant. The majority (85%) of malignant ectopic thyroid tissue is papillary thyroid cancer. Excision of ectopic thyroid mass in the liver has generally been favored, due to their minor malignant potential. The patient has been referred to Surgical Oncology/Endocrine Surgery for possible resection.

A novel combined transoral and transcervical surgical approach for recurrent metastatic medullary thyroid cancer to the parapharyngeal space

Medullary thyroid cancer (MTC) represents less than 1% of all thyroid cancers. Complete surgical resection remains the mainstay of treatment for locoregional disease. Unfortunately, patients with recurrence may present with metastasis to challenging anatomic locations. We describe the first case of a recurrent MTC metastatic to the parapharyngeal space (PPS) that was managed using a combined transoral robotic surgery (TORS) and transcervical (TC) approach. We review the presentation, natural history, diagnosis and management of recurrent MTC, and describe a novel combined TORS-TC surgical approach for the treatment of PPS metastasis. A 66-year-old male with history of MTC treated with total thyroidectomy in 2000 and a liver resection in 2011 for metastatic MTC was referred to our Head and Neck Surgery Clinic in October 2016 due to increased calcitonin and CEA levels. Exam was significant for mild right tonsillar/pharyngeal bulging and induration. Imaging with PET-CT and MRI showed an enlarging ovoid mass centered within the right PPS without the presence of another systemic metastasis. FNA was consistent with MTC. The patient was taken to the operating room for a combined TORS-TC approach. Final pathology was consistent with metastatic MTC. Until recently, PPS tumors have been managed using highly morbid and cosmetically disfiguring open surgical approach. TORS provides a safe and effective alternative.

Aspergiloma pulmonar en paciente con síndrome de sobreposición: Reporte de caso

Introducción: La infección por Aspergillus spp. representa un reto diagnóstico y terapéutico para el clínico, puesto que existe un número aproximado de 180 especies. El pulmón es el principal órgano afectado por el Aspergillus debido a la alta capacidad esporulativa de este hongo, y a que sus conidias son lo suficientemente pequeñas para poder alcanzar el alveolo. Caso: Mujer de 41 años de edad con antecedente de lupus eritematoso sistémico, ingresó con un cuadro de disfagia, en el cual se confirmó la presencia de síndrome de sobreposición mediante perfil inmunológico. Posteriormente, mediante estudio imagenológico, realizado por tener tos y disnea, se encontró la presencia de una masa ovoidea en hemitorax derecho y al realizar una fibrobroncoscopia se evidenció que dicha lesión era compatible con un aspergiloma, por lo que se dio manejo antifúngico con una evolución clínica adecuada. Conclusión: El aspergiloma se presenta como una masa voluminosa constituida por filamentos miceliales, la cual se puede confundir con múltiples patologías principalmente de tipo tumoral, por lo que es necesario realizar biopsia de la misma.

"Many shades of gray": a Case report on segment viii hepatic mass, metastatic or hcc?

Summary: We report a Case of a 55y/o male diagnosed with Sigmoid Colon Adenocarcinoma Stage II s/p Anterior Resection (2015) s/p Adjuvant Chemotherapy (up to January 2016). Patient was on surveillance work-up and noted a hepatic mass 2 years post-operatively. Nine months prior to admission, dynamic liver and lower abdomen CT scan was done and showed new ovoid solid hepatic mass exhibiting arterial enhancement and washout in the succeeding phases at segment VIII/dome of the right lobe; primary consideration is metastatic focus; primary hepatic neoplastic process is not ruled out. Eight months prior, F18-FDG PET/CT scan showed non-specific findings revealing a fairly defined, non-FDG-avid, enhancing mass (i.e. approximately 2.8cm x 3.1cm x 3.4cm, previously reported as 3.7 x 2.7cm) is again seen in Segment VIII of the normal-sized liver; an intense FDG uptake (SUV max upto 15.6) is seen in multiple normal-to-enlarged right axillary lymph nodes upto approximately 1.1cm in size probably metastatic.Patient underwent excision biopsy of right axillary lymph node and revealed chronic caseating granulomatous inflammation;given anti-TB treatment for 6mos.Subsequent imaging were done such as MRI,PET/CT Scan(F-18 FDG,C-11 Acetate) revealed mild accentuated C-acetate metabolism with ill-defined margins in segment VIII,not avid for FDG metabolism; Tc-99m sulphur colloid SPECT/CT with complete photopenia t/c FNH and a second one done with HCC as a consideration,and 4-phased dynamic Liver CT scan.Patient was then advised surgery and underwent Laparoscopic-assisted enterolysis,Segment VIII liver resection with ICG fluorescence.Final histopathology revealed 4.8cm hepatocellular carcinoma at segment VIII with parenchymal margins negative for tumor.Liver mass with a background of a primary malignancy may be a diagnostic dilemma.Optimal pre-operative imaging such as 4-phased dynamic liver CT scan or MRI, and an alternative imaging such as PET/CT scan or biopsy are options to aid the surgeon or hepatologist for planning of the succeeding treatment.

Sonographic and CT findings of intraperitoneal focal fat infarction and its mimics

Objectives The term of intraperitoneal focal fat infarction (IFFI) is a group of self-limiting and relatively rare acute abdominal condition essentially characterized by infarction and/or torsion of the omentum and epiploic appendages. The purpose of this exhibit is to demonstrate the sonographic and CT findings of IFFI and its mimics. Methods IFFI represents the grouping of various acute abdominal conditions with the common denominator of spontaneous fatty tissue necrosis. We retrospectively reviewed the sonographic results in patients with acute abdominal pain, and selected uncommon entities such as greater omental infarction, lesser omental infarction, epiploic appendagitis or encapsulated fat necrosis. We also selected its mimics such as diverticulitis, appendicitis, inflammatory bowel disease, colon cancer or other miscellaneous conditions. Results Regardless of differences of its anatomical location, the sonographic appearances of IFFI show similar as a hyperechoic, solid, non-compressible, ovoid, or cake-like mass with a location that corresponds to the region of maximum tenderness. The integrities of adjacent organs differentiate IFFI from the hyperechoic fat in cases of its mimics. We demonstrate sonographic findings of IFFI using diverse cases, highlighting the differential diagnosis at each location. Most of the cases were also correlated with CT imaging. Conclusion Familiarity and recognition of the sonographic appearances of IFFI can provide guidance for appropriate conservative managements that are essential for preventing an unnecessary surgery.

Symptomatic Müllerian cyst in the retroperitoneum of an adult male: Case report and review of the literature

Retroperitoneal cysts of Mullerian origin are quite uncommon, and most of the cases reported in the literature are in females. This report details the case of a 20-year-old male who presented with recurrent right flank pain and right flank swelling. Imaging investigations revealed a simple cyst posterior to the right kidney. He subsequently had retroperitoneal exploration and excision of an ovoid cystic mass which was histologically confirmed as a Mullerian cyst. Thus, Mullerian cyst should be kept in mind in the differential diagnosis of retroperitoneal cysts.

Granular cell tumor of the urinary bladder: A case report

Granular cell tumors (GCTs) are the tumors arising from Schwann cells. They should be considered as one of the differential diagnosis in the solid tumors of the bladder. Here, we report the case of a 60-year-old female presented with lower abdominal pain and burning micturition who on evaluation with contrast-enhanced computed tomography was found to have a bladder mass of 4 cm × 3 cm in the left lateral wall. Cystoscopy showed a smooth ovoid mass 4 cm × 3 cm situated above and lateral to the left ureteric orifice covered by normal bladder mucosa. The patient underwent transurethral resection of the bladder tumor, which was diagnosed as a GCT on histopathological examination and immunohistochemistry.