Pedunculated Mass Research Articles

Localized Pigmented Villonodular Synovitis of the Knee Joint: A Case Report and Literature Review

The incidence rate of PVNS, which is synovium tissue as nodules or pedunculated masses, is low however, the localized type is even less. We reported a case of the unusual properties of LPVNS located in the knee. A 32-year-old man presented to our clinic with pain and mechanic symptoms in his right knee. Magnetic resonance imaging (MRI) showed an intra-articular mass in the infrapatellar area of the knee adjacent to the Hoffa fat pad close to femoral trochlea groove. The mass was hypo intense in the T1 sequence and heterogeneously hypointense in the T2 sequence as well, which was considered as a local type of tenosynovial giant cell tumor (LPVNS). Excision was carefully performed without penetrating the tumor. The gross appearance of the tumor was yellow-reddish and brown in color. Histopathologic examination revealed pigmented villonodular synovitis of the local type. Localized Pigmented Villonodular Synovitis (LPVNS) is a very rare disease and it is silent and insidious, symptoms are non-specific, nevertheless, differentiation diagnosis should be keeping this entity in mind. Even though the LPVNS of the knee is an uncommon intra-articular presenttion, overlook this lesion based on imaging findings is an import approach for diagnosis of LPVNS, and arthroscopy assisted excision is an option for management of the LPVNS if doing it appropriately.

A rare case report on solitary pigmented neurofibroma over scalp region

Neurofibromas are benign proliferations that are made up of all nerve elements, and arise as fleshy and nontender, sessile or pedunculated masses on the skin. Pigmented (or melanocytic) neurofibroma constitutes only 1% of cases and is considered a rare variant of neurofibroma containing melanin-producing cells. Our patient has solitary pigmented neurofibroma over scalp region which is very rare and only few cases were reported. Here we present a case of 25 year old female patient who had brown colored swelling since birth over left temporo-parietal region which gradually increased in size with age. Patient had no any other swelling or pigmentation over any other regions of body. Patient underwent excision for the same with skin grafting. Her recovery was uneventful.

Right third eyelid ulcerated and pedunculated mass in a dog.

Right third eyelid ulcerated and pedunculated mass in a dog.

A rare case of trapezium osteochondroma: unveiling a unique tumour with clinical implications

Osteochondroma is a benign bone tumour commonly found on the metaphysis of long bones. The presentation of osteochondroma on the trapezoid bone, a carpal bone in the wrist, is exceptionally rare. To our knowledge, no such cases have been reported in India. This report details a rare case of osteochondroma located on the trapezoid bone and its successful surgical management. A 55-year-old female presented with pain and swelling in the wrist. Radiological imaging, including X-rays and MRI, revealed a well-defined, pedunculated mass arising from the trapezoid bone. The patient underwent surgical resection of the tumour. Histopathological examination confirmed the diagnosis of osteochondroma. Postoperatively, the patient experienced significant relief from symptoms and showed no evidence of tumour recurrence during follow-up. This case contributes to the limited body of literature on osteochondromas in rare locations, particularly on the trapezoid bone. It illustrates the successful outcome of surgical treatment for rare bone tumours and emphasizes the need for heightened awareness and comprehensive diagnostic approaches in similar cases.

Rare Case of Atrial Myxoma with Mitral Regurgitation - Case Report

Atrial myxomas are the most common primary cardiac tumors, typically arising from the left atrium. However, their presentation can vary widely, with mitral regurgitation being a rare but significant complication. This report discusses a rare case of atrial myxoma associated with severe mitral regurgitation in a 45-year-old patient presenting with dyspnea and palpitations. The interatrial septum was connected to a massive, pedunculated mass that prolapsing into the left ventricle during diastole caused considerable regurgitation and occlusion of the mitral valve, as seen by echocardiography. The patient's hemodynamic instability necessitated urgent surgical intervention. The tumor was successfully excised, and mitral valve repair was performed. Histopathological examination confirmed the diagnosis of atrial myxoma. Postoperative recovery was uneventful, with significant improvement in symptoms and echocardiographic findings. The significance of taking atrial myxoma into account while making a differential diagnosis for mitral regurgitation is demonstrated by this instance, particularly in those with unexplained cardiac symptoms. Early diagnosis and prompt surgical management are crucial to prevent potential complications such as embolization, heart failure, or sudden cardiac death. This case also underscores the role of echocardiography as a vital diagnostic tool in identifying and assessing cardiac masses and associated valvular dysfunction.

Phyllodes - like Tumor of the Anogenital Mammary - like Glands – A Rare Entity

Abstract Introduction/Objective Phyllodes tumor (PT), a biphasic fibroepithelial tumor typically found in the breast, is an exceedingly rare finding outside the mammary gland, with only about 160 cases reported to date. We describe a rare case of PT arising from anogenital mammary-like glands (AGMLG). Methods/Case Report A 68-year-old woman presented with a small perianal mass that was incidentally detected during hemorrhoidectomy procedure. It appeared as a pedunculated olive-sized mass on the perianal skin. A papillectomy was performed, and upon sectioning, a solid-cystic lesion measuring 2.0 x 1.4 x 0.9 cm was observed. Microscopic examination revealed a biphasic pattern comprising of glandular epithelium and a stromal component, with a predominance of the latter and together they formed leaf-like slits. These spaces were lined by a bilayered epithelium consisting of secretory (apocrine)-type cells and myoepithelial cells resembling mammary glandular epithelia. Focal clusters of benign glands, morphologically consistent with AGMLGs, were identified at the periphery of the tumor. Immunohistochemically, epithelial components reacted positively for GATA3, mammoglobin, CK7, estrogen receptor and progesterone receptor, while the myoepithelial cells were highlighted by calponin and p63. The AGMLGs in the periphery also stained for GATA3, estrogen receptor and progesterone receptor. The mitotic rate was low (1 to 2 per 50 high-power fields), without atypical mitoses. The lesion was diagnosed as a benign PT. Results (if a Case Study enter NA) NA Conclusion The current case highlights the importance of recognizing PT when it occurs at extra-mammary locations. The entity merits greater attention not only for its malignant potential but also due to the mystery surrounding its origin and the histogenetic link to breast tissue.

Second Recurrence of Aggressive Angiomyxoma of Labia Majora in a 34-Year-Old Woman: A Case Report and Review of Literature

AbstractAggressive angiomyxoma (AAM) is a rare, slow-growing, benign neoplasm with high recurrence and local invasion. It is usually asymptomatic and frequently presents as a mass affecting the perineal and pelvic regions of women in reproductive age group. We present a rare case of a 34-year-old woman with second recurrence of a giant AAM arising from labia majora. The patient presented with a slow-growing pedunculated mass (around 20 × 12 cm) over the right labia majora for the past 1 year. In the last 10 years, she was operated on two different occasions (2013 and 2015) for similar lesion and was a confirmed case of AAM. Ultrasound of the lesion and magnetic resonance imaging of the abdominopelvic region was suggestive of recurrent AAM. The patient underwent en bloc dissection of the tumor with negative margin. Histopathological examination confirmed the diagnosis of recurrent AAM. En bloc dissection with negative margin leads to complete removal of tumor mass. However, long-term follow-up with annual magnetic resonance imaging is advised.

When a Child has Neck Mass, Consider a Choristoma too! Here's a Rare Instance: A Cervical Chondrocutaneous Branchial Remnant.

Cervical chondrocutaneous branchial remnants (CCBR) are rare causes of neck masses in young children. It is commonly associated with genitourinary and cardiac anomalies. We report a case of CCBR in a two-year-old male child who presented with a unilateral painless pedunculated neck mass. Although ultrasonography is noncontributory, histopathology reveals a central core of hyalin cartilage with surrounding skin tissue. A diagnosis of CCBR was made on histopathology, and the patient was further clinically evaluated. The child did not reveal any other anomalies and is currently on follow-up.

WP1.17 - Double Trouble - A Case of Duplex Appendix

Abstract Introduction Duplex appendix, a rare anatomical anomaly is often encountered incidentally during appendicectomy procedures. It is characterised by the presence of two appendiceal lumens and can be classified using the Cave-Wallbridge classification system. Case An 18-year-old male presents to the Emergency Department with a two-day history of migratory right iliac fossa pain. He was consented and booked for a laparoscopic appendicectomy based on clinical suspicion of acute appendicitis. Intra-operatively, an unexpected finding surfaces—a second pendunculated mass adjacent to the inflamed appendix. Employing laparoscopic linear staples, both the appendix and the adjacent mass were divided. One day post-discharge, the patient presents with severe abdominal pain and computed tomography imaging suggests an intra-abdominal leak. The patient underwent an emergency laparotomy and ileo-caecal resection overnight. Histology revealed the second pedunculated mass was indeed a second appendix, a phenomenon with a reported incidence of 0.004 to 0.009%. Discussion Addressing the nuances of using imaging modalities in the diagnosis and operative planning of acute appendicitis, our discussion raises pertinent questions regarding the necessity of definitive pre-operative imaging in suspected cases. Considering potential pitfalls of incorrect clinical diagnoses; the presence of anatomical anomalies; and other factors influencing surgical decision-making; we scrutinise the proposition of pre-operative imaging protocols in suspected acute appendicitis. Conclusively our case encapsulates the diagnostic and therapeutic conundrums posed by duplex appendix instances, prompting a deeper exploration into the use of imaging techniques in a traditionally clinically diagnosed presentation and the implications thereof in surgical management.

A Rare Placental Site Nodule Involving the Ovary.

Placental site nodule (PSN) is a benign lesion representing a nodular aggregate of intermediate trophoblast, embedded in a hyalinized stroma, thought to arise from noninvoluted placental site remaining from a past gestation. Uterus is the most common site of PSN. Occurrence in extrauterine sites is rare, with most examples being reported in the fallopian tubes. Here we report an example of PSN in the ovary. A 35-year-old woman, gravida 4, para 1, with history of adnexal ectopic pregnancy treated with methotrexate, at 39 weeks and 1 day of a subsequent pregnancy, underwent a scheduled C-section. The surgery was successful, and a healthy female infant was delivered. Intraoperative adnexal inspection revealed a small pedunculated mass on the right ovary, which was excised and sent for pathological examination. Gross inspection showed a soft, tan-white tissue fragment measuring 2.0 × 1.0 × 0.2 cm. Microscopic examination showed epithelioid cells with hyperchromatic, mildly atypical nuclei and abundant eosinophilic cytoplasm, embedded in a hyalinized stroma, forming a nodule. A diagnosis of placental site nodule was made. Immunohistochemical stains for keratin AE1/AE3, vimentin, and inhibin were strongly positive in the epithelioid cells, and immunostain for p63 was focally positive, supporting the diagnosis. PSN of the ovary is extremely rare. To our knowledge, there has been only one reported patient in the literature so far. Extrauterine PSNs are thought to arise from ectopic pregnancies. Our patient's ovarian PSN is most likely a consequence of her previous adnexal ectopic pregnancy, which was treated medically.

Bizarre parosteal osteochondromatous proliferation in the distal ulna where the lesion is continuous with the medullary cavity: a case report

BackgroundBizarre parosteal osteochondromatous proliferation (BPOP) is a rare benign bone tumor, it is also called “Nora’s lesion”. The lesion is characterized by heterotopic ossification of the normal bone cortex or parosteal bone. The etiology of BPOP is unclear and may be related to trauma. In most BPOPs, the lesion is not connected to the medullary cavity. Here we report an atypical case, characterized by reversed features compared to the typical BPOP, which demonstrated continuity of the lesion with the cavity.Case presentationAn 11-year-old female child had a slow-growing mass on her right wrist for 8 months with forearm rotation dysfunction. Plain X-rays showed an irregular calcified mass on the right distal ulna, and computed tomography (CT) showed a pedunculated mass resembling a mushroom protruding into the soft tissue at the distal ulna. The medulla of this lesion is continuous with the medulla of the ulna. A surgical resection of the lesion, together with a portion of the ulnar bone cortex below the tumor was performed, and the final pathology confirmed BPOP. After the surgery, the child’s forearm rotation function improved significantly, and there was no sign of a recurrence at 1-year follow-up.ConclusionIt is scarce for BPOP lesions to communicate with the medullary cavity. However, under-recognition of these rare cases may result in misdiagnosis or inappropriate treatment thereby increasing the risk of recurrence. Therefore, special cases where BPOP lesions are continuous with the medulla are even more important to be studied to understand better and master these lesions. Although BPOP is a benign tumor with no evidence of malignant transformation, the recurrence rate of surgical resection is high. We considered the possibility of this particular disease prior to surgery and performed a surgical resection with adequate safety margins. Regular postoperative follow-up is of utmost importance, without a doubt.

Adenomyoma presenting as a primary subserosal pedunculated exophytic mass

Adenomyoma is a benign gynecologic condition affecting women in their late reproductive years. Common clinical presentations include pain, particularly dyspareunia and dysmenorrhea, abnormal uterine bleeding, and infertility. Majority, however, may be asymptomatic. Various presentations of adenomyoma have been written in the literature, but exophytic subserosal growths have rarely been reported. More commonly, it involves the endometrium with invagination into the myometrium. We present a rare case of a primary subserosal pedunculated adenomyoma with no evidence of adenomyosis in a nulligravid premenopausal woman who underwent a uterine-sparing surgery and an extensive colonic resection with colostomy.

Pedunculated Angiomyofibroblastoma of Labia Minora: A Case Report and Review of the Literature

Background: Angiomyofibroblastoma was first described by Fletcher et al. in the year 1992. It is a distinctive benign tumor that most often occurs in the superficial area of the vulva and is rarely reported in men in the inguinoscrotal region. Case Presentation: A 23-year-old female presented with a painless pedunculated labial mass which was initially pea-sized and reached 7 cm in maximum dimension over four months. The case was diagnosed on morphology, IHC and the patient was treated surgically. The interesting feature of the case was the rarity of its incidence at labia minora and pedunculated form and its resemblance to other benign and more aggressive tumours. To the best of our knowledge, the extensive English literature search revealed only seven cases of pedunculated angiomyofibroblastoma at labia majora in middleaged female and one case of labia minora in a young female. Conclusion: The lesion must be differentiated from another benign mesenchymal tumor of vulva which requires extensive surgical management.

Oral Squamous Acanthoma – A Histopathologic Entity Or Not

Oral squamous acanthoma (OSA) is an uncommon benign epithelial lesion of the oral cavity, presenting as a solitary, painless, sessile or pedunculated mass. It is considered a variant of oral squamous papilloma, characterized by acanthosis without papillomatosis. Although typically asymptomatic, OSA can cause discomfort or functional impairment depending on its size and location. Diagnosis is primarily based on clinical and histopathological examination, with characteristic features including hyperkeratosis, acanthosis, and elongated rete ridges. Treatment involves conservative surgical excision, with a low recurrence rate reported in the literature. Here, we present a rare case of OSA in a 55-year-old female patient, highlighting its clinical and histopathological characteristics, differential diagnosis, and management. This case underscores the importance of considering OSA in the differential diagnosis of oral lesions and the significance of histopathological analysis in confirming the diagnosis.

PAPILLARY FIBROELASTOMA: AN UNUSUAL CAUSE OF TRANSIENT ISCHEMIC ATTACK

Abstract Papillary fibroelastomas (PFEs) are small, avascular benign tumors. Despite that, PFEs could lead to important clinical consequences such as transient ischemic attack and myocardial infarction. A 65–year–old female patient was admitted to our ER presenting a transient ischemic attack characterized by retrograde amnesia lasting about an hour. She had a history of systemic scleroderma and left breast cancer treated with local radiotherapy. In our hospital she underwent a neurological examination and a head CT which were negative for ongoing acute pathologies. An electrocardiogram was performed which showed sinus rhythm at 65 bpm. A transthoracic echocardiogram was also performed revealing a floating mass arising from left ventricular outflow tract between aortic and mitral valves. The transesophageal echocardiogram confirmed a solitary lesion approximately 2 centimeters long localized between A2 and A3 mitral valve scallops. The patient was therefore referred for surgery. During surgery the mass was found to arise from anterior mitral annulus and was resected. The histopathological examination of the mass confirmed the morphologic diagnosis of papillary fibroelastoma. Histologically PFEs are made up of a single layer of endocardial cells covering a matrix of collagen. The main risk factors for the development of PFEs are iatrogenic causes, such as radiotherapy, and autoimmune diseases such as systemic scleroderma. In 54% of cases PFEs are asymptomatic at the time of diagnosis. Since over 95% of PFEs present on the left side of the heart, systemic embolism is the most frequent presentation typically as transient ischemic attacks. Initial evaluation is accomplished with echocardiography. PFEs appear as echo–dense and pedunculated masses. Cardiac computed tomography and magnetic resonance imaging are second line modalities in PFEs evaluation. Definitive diagnosis of PFE requires pathological confirmation. Surgical resection remains the treatment of choice for all symptomatic patients. For symptomatic patients who are not surgical candidate, long term antiplatelets or anticoagulation therapy should be initiated. Asymptomatic patients should have surgical resection if the size of the tumor is > 1 cm. PFEs are associated with significant morbidity and mortality. Echocardiography remains the most utilized diagnostic modality. Surgical treatment should always be considered. Antithrombotic therapy should be considered in non–surgical candidates.

Inflammatory myofibroblastic tumor of urinary bladder in young male: A case report and literature review

The objective of this study is to present a rare case of inflammatory myofibroblastic tumor (IMT) of the urinary bladder in young male, detailing its clinical presentation, diagnostic approach, treatment strategy, and outcome. Additionally, the objective includes conducting a literature review to provide insights into the characteristics, management, and prognosis of this uncommon tumor entity.A 20-year-old male presenting with dysuria and dribbling of urine underwent diagnostic workup including imaging studies, cystoscopy. On cystoscopy there was a presence of 5x4 cm sized pedunculated mass in the urinary bladder. Partial cystectomy is done and specimen is examined for histopathology. Histopathological examination and Immunohistochemistry study of the tumor specimen was performed to confirm the diagnosis of inflammatory myofibroblastic tumor. A thorough literature review was conducted to gather relevant studies on IMT of the urinary bladder, focusing on clinical presentations, diagnostic modalities, treatment approaches, and outcomes. Diagnostic evaluation revealed a mass lesion in the urinary bladder, and histopathological examination following partial cystectomy confirmed the diagnosis of inflammatory myofibroblastic tumor. The patient underwent surgical excision of the tumor followed by adjuvant therapy. Regular follow-up examinations showed no evidence of tumor recurrence. The literature review identified a limited number of reported cases of IMT of the urinary bladder in young male, emphasizing its rarity and diverse clinical presentations. Various diagnostic modalities and treatment options, including surgery, chemotherapy, and targeted therapy, were discussed in the reviewed literature. Inflammatory myofibroblastic tumor of the urinary bladder is a rare neoplasm at younger age that can present with nonspecific symptoms, making its diagnosis challenging. However, timely recognition and appropriate management, including surgical resection and adjuvant therapy, can lead to favorable outcomes with low recurrence rates. This case report highlights the importance of considering IMT in the differential diagnosis of bladder masses in young patient and underscores the need for further research to better understand the pathogenesis and optimal treatment strategies for this rare tumor entity.

Vaginal leiomyoma in a goat expressing the nuclear progesterone receptor (PGR): a case report

BackgroundThe risk of developing tumorous diseases in the genital tract also increases with age in animals. One of the classified tumor types is genital leiomyoma. Presently, our understanding of the pathogenesis of this tumor in goats is, however, limited. This accounts also for the information regarding the presence of steroid hormone receptors and, thus, possible responsiveness to circulating steroids.Case presentationThis study describes the case of a vaginal tumor in a seven-year-old Anglo-Nubian goat. The goat was presented due to blood mixed vaginal discharge. Per vaginal examination a singular pedunculated mass in the dorsum of the vagina measuring approximately 3 cm x 4 cm x 4 cm was revealed. After administering epidural anesthesia, the mass was removed electrothermally. There were no postoperative complications. The histopathological examination identified the mass as a leiomyoma. The immunohistochemical examination revealed the presence of the nuclear progesterone receptor (PGR) in the tumor tissue. One year after the surgery, during the follow-up examination, the goat was in good overall health, and the owners had not observed any recurrence of vaginal discharge.ConclusionsWhen observing vaginal discharge in goats, it is important to consider the possibility of genital tract tumors. These tumors may express sex steroid receptors. In the future, it is worth considering the investigation of potential approaches for preventing tumorigenesis or treating the tumor, such as castration or the administration of antiprogestogens.

Osteochondroma of Pelvis - A Case Report on Rare and Incidental Finding

Osteochondromas may present in form of multiple hereditary exostosis or solitary osteochondroma. They are derived from aberrant cartilage from the perichondral ring and are benign chondrogenic lesions. Typical presenting age between 10 years to 30 years. They develop as a painless mass and appear on the bone's surface. Osteochondromas frequently occur at the points where tendons insert; the knee (proximal tibia, distal femur), proximal femur, and proximal humerus are common sites. Typically, the patient complains of deformity and swelling or are asymptomatic. They may appear as a pedunculated mass or as a sessile mass. This typically appears as mushroom shaped. It predominantly impacts enchondral ossification bones, occasionally affecting intramembranous ossification bones. We hereby reported a peculiar instance of osteochondroma of pedunculated type developing at a rare site –surface of ilium bone. Keywords Osteochondroma, Pelvis, Incidental, Benign bone tumour

An ampullary adenoma presenting with jaundice caused by duodenal intussusception: a case report.

Ampullary adenomas are premalignant lesions. However, biliary obstruction causing jaundice is rare. Duodenal intussusception secondary to an ampullary adenoma rarely occurs because of the fixed position of the duodenum in the retroperitoneum. Herein, we have described a rare case of ampullary adenoma with jaundice caused by duodenal intussusception. A 40-year-old woman presenting with vomiting and yellowish discoloration of the skin was admitted to another hospital. The patient had experienced recurrent epigastric pain and vomiting for the past 18months. Blood test results showed elevated levels of bilirubin (3.9mg/dL), and abdominal computed tomography (CT) showed a 60-mm hypovascular mass in the third part of the duodenum and a left lateral shift of the dilated common bile duct. The patient was referred to our hospital for further evaluation. She recovered from hyperbilirubinemia spontaneously (levels of bilirubin, 1.0mg/dL), and the CT showed a tumor shift from the third part of the duodenum to the second part and improvement of the dilated common bile duct. Hypotonic duodenography revealed a tumor that moved easily from the second to the third portion of the patient's position. Upper gastrointestinal endoscopy revealed a large papillary tumor occupying the second part of the duodenum, which was diagnosed as an adenoma through biopsy. The possibility of malignancy could not be negated owing to the presence of jaundice and an elevated carbohydrate antigen 19-9 level (76.0U/mL). Pancreaticoduodenectomy was performed. The resected specimen showed a 60 × 40 × 40-mm pedunculated ampullary mass with submucosal elongation. The pathological examination indicated that the ampullary tumor was a high-grade intestinal adenoma. The postoperative course was uneventful, and the patient was discharged 26 days postoperatively. This report describes a rare case of a patient with an ampullary adenoma presenting with jaundice resulting from duodenal intussusception. Owing to the possibility of a postoperative cancer diagnosis which may have caused the biliary obstruction and the difficulty in making an accurate preoperative diagnosis, it is imperative to choose the appropriate surgical procedure such as a pancreaticoduodenectomy.

A rare case of perivulvar hemangiosarcoma in a bitch

An 11-year old, Rottweiler bitch was presented to the clinic with the complaint of a huge mass protruding from the left side of the vulvar labium. The bitch had been ovariohysterectomized due to the pyometra 2 years ago. The perivulvar mass was surgically removed by using an electrocautery device under general anesthesia. Macroscopically, the pedunculated mass was 20 cm x 25 cm in diameter, capsulated and slightly firm. Histopathological examination revealed that the mass was a hemangiosarcoma originating from the mucosa. Marked anisocytosis and anisokaryosis were noted in microscopic examination. Immunohistochemically, neoplastic cells showed positive staining for von-Willebrand factor-related antigen. On postoperative 3rd and 12th month follow-up protocols, the female dog was in good health condition and no metastases were detected in any organ. In this report, clinical follow-up, histological and immunohistological examination of a rare perivulvar hemangiosarcoma case in a female dog was presented.