Round Nodules Research Articles

Les hidradénomes papillifères de l’anus ressemblent à ceux de la vulve : étude de 14 cas

Hidradenoma papilliferum (HP) is an adenomatous proliferation of mammary-like glands. These glands are located preferentially on the vaginal labia, the perineum and the anal skin. About ninety percent of HP occur on the vulva, with anal localization being much less common. To analyze the clinical and histological characteristics of anal HP and compare them to those seen on the vulva based on the literature. A monocentric retrospective analysis (in the medical and surgical proctology department of the Saint-Joseph Hospital Group, Paris) of patients for whom a diagnosis of anal HP was made based on pathological analysis of a resected sample. A total of 14 female patients were included between 2012 and 2018. The mean age was 48.2 years (22-70). The tumor, single in all cases, was asymptomatic with very slow progression. It was located on the anal skin in all patients. It generally consisted of a round nodule measuring under 1cm that was barely prominent, translucent, depressible and mobile. In 15% of patients the tumor was ulcerated. Histologically, the tumor displayed the usual characteristics of HP. Only one relapse was seen, six years after resection. The clinical and histological aspects of anal HP are the same as those of the vulva, which are better documented, namely a small, rounded, pink, translucent or bluish, and mobile tumor, with a smooth surface, and more rarely ulceration or budding, and in most cases asymptomatic. All HP were diagnosed in women and were located at the anal margin. Histopathological examination of an excised sample confirms the diagnosis and rules out a malignant tumor. The frequency of anal HP may be underestimated.

Clinical and Imaging Manifestations of Primary Benign Tracheobronchial Tumors

Objective To improve our knowledge of primary benign tracheobronchial tumors and increase the early diagnosis rate. Method The clinical and imaging features of 22 patients with benign tracheobronchial tumors were retrospectively analyzed. The lesions were surgically or pathologically confirmed as schwannomas(n=2),lipomas(n=3),hamartomas(n=3),leiomyomas(n=9),inflammatory myofibroblastoma(n=1),and pleomorphic adenomas(n=2).The early symptoms were concealed and atypical,accompanied by misdiagnoses at different time points.The tumors were located at trachea in 5 patients and at bronchus in 17 patients.All lesions manifested as intraluminal growth with mild to moderate enhancement,without thickening of the tracheobronchial wall.They had smooth margins and wide basements.The lesions were cast-shaped and occluded the lumen in 3 cases;in the remaining 19 cases,the lesions appeared as round or oval nodules. Conclusions Primary benign tracheobronchial tumors are rare.Patients with repeated cough and expectoration that respond poorly to treatment should be screened for benign tracheobronchial tumors.On CT,the benign tracheobronchial tumors are small intraluminal nodules with the smooth surface and wide basement,without thickening of the wall.

The imaging features and prognosis of primary central airway salivary gland-type tumor

Objective To analyze the image features and prognosis of primary central airway salivary gland-type tumor (SGT). Methods The clinical and imaging data of 25 cases with SGT confirmed by histopathology were retrospectively analyzed in our hospital from October 2009 to November 2017. Follow up of patients for survival was performed. Among 25 cases of SGT, there were 14 cases of adenoid cystic carcinoma (ACC), ten cases of mucoepidermoid carcinoma (MEC) and one case of mucoepidermoid carcinoma (EMC). All cases had non-enhanced CT scans (among which 20 cases underwent CT scan with contrast). Post-processing were performed to evaluate the location, range, density, degree of enhancement of the lesions and involvement of hilar or mediastinal lymph nodes. Eight cases underwent PET/CT imaging and one underwent MR imaging, respectively. Independent sample t test was used to compare difference in ages between ACC group and MEC group. Nonparametric test was performed to compare difference in tumor′s diameter between ACC group and MEC group. Comparison of genders, history of smoking, tumor-node-metastasis (TNM) stage and CT features between ACC group and MEC group were tested using Fisher′s exact tests. Survival was calculated using the Kaplan-Meier method, and the survival curves were compared by the log-rank test. Results Compared to MEC, patients with ACC were older. There were significant difference between the two groups (t=3.154, P<0.05). ACC tended to involved trachea or main bronchi (13/14) while MEC were mostly located at lobar or segment bronchi (6/10). The shape of ACC tumors were mainly lobulated or presented as circumferential wall thickening (13/14), while MECs were smoothly oval (7/10). On contrast-enhanced CT scans, ACC mainly showed mild or moderate enhancement (9/10), While most of MEC had shown avid enhancement (8/10). CT findings suggestive of airway obstructive disease were seen more with MEC (9/10) than ACC (4/14). There were significant differences of the above CT features between ACC and MEC group (P<0.05). A case of EMC in an 43 years old female presented rounded nodule in tracheal; The SUVmax in 6 of 8 cases of PET/CT exceeded 2.2; Overall survival (OS) was 87.5% in all cases. No significant difference was found between ACC and MEC groups regarding OS (χ2=0, P=1.000). Ages, surgical and nonsurgical patients and TNM stage were found to be related to OS (χ2=13.799, 13.799, 13.171, respectively, P<0.05). Conclusions Primary central airway salivary gland-type tumors are commonly occurred in patients at a low age, with weak invasive feature and good prognosis. The predominant site and CT characteristics between ACC and MEC were significantly different. Key words: Salivary gland neoplasms; Tomography, X-ray computed; Magnetic resonance imaging; Prognosis

TESTICULAR BUT NOT TESTICULAR: A GERM CELL TUMOR PRESENTING AS ACUTE RESPIRATORY FAILURE

SESSION TITLE: Medical Student/Resident Pulmonary Manifestations of Systemic Disease 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Germ cell tumors (GCTs) of the testes account for 95% of the testicular tumors. The most aggressive and least common type of the GCTs is choriocarcinoma (CC). It is a highly malignant tumor and patients typically present with early metastases, with lungs being the most common site. Given the rarity of the disease and its unusual presentation, CC remains a challenging diagnosis often leading to high mortality in young males. We present a very rare entity of CC known as the 'burned out phenomenon' in which an extra gonadal GCT develops without traces of neoplasm in the testes. CASE PRESENTATION: A 41-year-old previously healthy male presented with one month history of shortness of breath and cough. He was tachypneic and tachycardic with reduced oxygen saturation of 86% on room air. Physical exam revealed crackles in bilateral lungs. Chest x- ray showed diffuse bilateral pulmonary opacities concerning for malignancy. CT chest revealed a large left upper lobe mass measuring 10x9x12 cm and innumerable round pulmonary nodules in both lungs. Patient became progressively tachypneic requiring BiPAP and he was admitted to the ICU. His hypoxia and tachypnea worsened to the extent of requiring invasive ventilation, but patient opted against it and support was continued on the BiPAP. Further workup for his lung metastases with CT of the abdomen-pelvis revealed extensive metastatic disease involving the liver and adrenal glands. CT guided biopsy of the lung revealed necrotic tissue. There was a suspicion for GCT and ultrasound of the testes was done but no discrete testicular lesion was found. Tumor markers revealed a B-HCG level that was significantly elevated at 156,000 IU with normal alpha feto-protein. Based on the biopsy findings, elevated B-HCG levels, normal alpha feto-protein, and the metastatic presentation, the patient was diagnosed with CC. Despite multiple lines of chemotherapy, patient died within a month due to rapid disease progression with further metastases to brain. DISCUSSION: CC does not require histological confirmation and in rare cases no testicular lesion can be found. The primary tumor is thought to regress spontaneously in the testes, so the initial presentation is a manifestation of the metastases. Clinical picture, specific serum markers, and imaging findings can be diagnostic. In the early stage of advanced CC patients usually have no obvious clinical signs. The pulmonary symptoms can range from a mild cough, shortness of breath or hemoptysis. The latter usually presents in severe cases with multiple metastases. This was a challenging diagnosis due to absence of a palpable testicular mass, no tissue proven diagnosis, and rapid progression of the disease. CONCLUSIONS: Our case underlines the importance of having a high suspicion for CC in young males presenting with pulmonary symptoms and chest-x ray findings concerning for malignancy. Early chemotherapy is recommended. Reference #1: Horwich A, Shipley J, Huddart R. Testicular germ-cell cancer. Lancet. 2006;367:754–65 Reference #2: Ohno, Y., Yamauchi, T., Ueda, T., Aizawa, T., Kawakami, S., Tachibana, Y., Tsuchiya, S. (1993). A case of testicular choriocarcinoma achieving pathological complete response by “COMPE” chemotherapy, consisting of cisplatin, vincristine, methotrexate, peplomycin, and etoposide. Acta Urologica Japonica, 39(2), 183–187 DISCLOSURES: No relevant relationships by Muhamad Alhaj Moustafa, source=Web Response No relevant relationships by Nebiyu Biru, source=Web Response No relevant relationships by Rama Hritani, source=Web Response No relevant relationships by James Shaw, source=Web Response No relevant relationships by Anusha Vakiti, source=Web Response

LUNG NODULES: VALLEY FEVER OR CANCER IN HIV

SESSION TITLE: Medical Student/Resident Pulmonary Manifestations of Systemic Disease 3 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: The Human Immunodeficiency Virus (HIV) epidemic has vastly changed the prevalence and epidemiological burden of fungal infections. With worldwide travel, diseases such as coccidioidomycosis, while rare in non endemic parts of the United States of America, <1%, have been increasing in incidence. Coccidioidomycosis may present with a constellation of clinical and radiological findings that often confound diagnosticians, further emphasizing the need for more sensitive risk calculators. CASE PRESENTATION: A 45 year old caucasian male with HIV, last CD4 845, on highly active antiretroviral therapy (HAART) presents with a six week history of cough. He reports a persistent dry cough associated with right-sided chest pain now resolved and constitutional symptoms. He also has shortness of breath, treated with Albuterol inhaler. He is a current smoker with 16 pack years. Prior to onset of his symptoms, he completed a cross-country road trip from California to the east coast. He denied any ill-contacts or limitations in activity. On exam, he is afebrile in no respiratory distress with an unremarkable exam. His white blood cell count was 9.7 (13% eosinophils) along with positive coccidioidomycosis antibody complement fixation 1:4 and elevated IgG and IgM. Notably tuberculosis quantiferon gold, histoplasmosis antibodies and urine antigen were within normal limits. Computerized Tomography chest with contrast revealed 1.9x1.4x1.1 cm spiculated solid upper lobe nodule along with scattered subcentimeter, noncalcified solid round nodules in all lobes bilaterally and mediastinal lymphadenopathy. He was commenced on oral fluconazole for pulmonary coccidioidomycosis and scheduled for follow-up. DISCUSSION: Numerous advances have been made in the management of HIV, however aspects of the pathophysiology still remain unknown. ATS (2010) recommended treatment of coccidioidomycosis in all immunocompromised patients e.g. HIV AIDS as well as treatment in immunocompetent patients with HIV (BII). Nathan et al, later highlighted not only the role of a decreased number of CD4 cells as a component of immunosuppression in HIV patients but also the progressive loss of T cell function due to neutrophil immunosuppression in chronic HIV infection. As HIV places patients at higher risk for disseminated disease, it further confounds differentiating lung nodules due to coccidioidomycosis from lung cancer. Ronaghi et al, found significant radiographic overlap between the aforementioned. A study by Peterson et al, evaluated three existing online risk calculators and found they performed well in patients with lung cancer but poorly in patients with coccidioidomycosis. No serological marker has been validated. CONCLUSIONS: The increasing prevalence of HIV along with worldwide travel will mandate the need for more reliable risk assessment tools to prevent unnecessary invasive procedures and treatment for decades to come. Reference #1: Nathan L. Bowers, E. Scott Helton, Richard P. H. Huijbregts, Paul A. Goepfert, Sonya L. Heath, Zdenek Hel. Immune Suppression by Neutrophils in HIV-1 Infection: Role of PD-L1/PD-1 Pathway. PLOS Pathogens. 2014 March; 10(3). E10003993 Reference #2: Reza Ronaghi, MD; Ali Rashidian, MD; Paul Mills, PhD; Kurt Hildebrandt, MD; Keith Carson, MD; Michael Peterson, MD. Radiographic Features Differentiating Lung Nodules Caused by Coccidioidomycosis From Lung Cancer. CHEST. 2015 October; 148(4_MeetingAbstracts): 509A. https://doi.org/10.1378/chest.2248593 Reference #3: Michael Peterson, Reza Ronagi, Paul Mills. Differentiating incidental lung nodules due to lung cancer from those due to coccidioidomycosis. European Respiratory Journal. 2015; 46. https://doi.org/10.1183/13993003.congress-2015.PA2996 DISCLOSURES: No relevant relationships by Sahai Donaldson, source=Web Response No relevant relationships by Karlene Williams, source=Web Response

Preserving Fertility by Treating the 3 Compartments: Laparoscopic Approach to Deep Infiltrating Endometriosis

Study ObjectiveTo describe a laparoscopic technique for the resection of deep endometriosis, treating the 3 compartments. DesignEducational video. SettingTertiary referral center in Strasbourg, France PatientA 37-year-old primiparous woman. InterventionAdenomyomectomy, partial cystectomy, and bowel resection. Fertility preservation was mandatory because of the patient's desire for future pregnancy. Measurements and Main ResultsA 37-year-old primiparous woman presented with main symptoms of dysmenorrhea and dyspareunia associated with pollakiuria and macroscopic menstrual hematuria (with emission of endometriotic tissue on analysis). She also complained of dyschezia. Magnetic resonance imaging revealed an endometriotic nodule in the vesicouterine space with an involvement of the anterior wall of the uterus and a suspicion of bladder adenomyosis. There were lateral spicules attracting the ovaries toward the midline and an infiltration of the round ligaments and nodules related to the rectovaginal space's endometriosis. A possible invasion was noted underneath the rectal mucosa. The patient expressed her desire preserve fertility. The local institutional review board has approved the video. Initially, an ultrasonography was performed showing the adenomyoma invading the bladder. The second step was a cystoscopic evaluation by means of a double J probe and a bladder catheter. After surgery the bladder catheter was left in place for 15 days and the double J stents for 6 weeks. The first step was the dissection of the vesicouterine space to dissect the anterior adenomyoma from the bladder. A partial cystectomy was then performed to remove the bladder nodule. The adenomyoma was resected at its uterine portion and the uterus sutured. Surgery was then performed in the posterior compartment. Ureterolysis was performed bilaterally, and the pararectal fossas were then opened. The rectovaginal space was dissected. A rectosigmoid resection was mandatory to remove the bowel nodule. Patient follow-up included regular consultations and a hysterosonography at 6 weeks after surgery. Hysterosonography demonstrated an adequate patency. No adhesions to the uterus were found. We recommended to wait for 6 months to allow pregnancy according to the department's protocols. A clinical improvement was observed. Today, at 8 months she has not attempted pregnancy. ConclusionsA complete surgery is feasible for severe and deep endometriosis with a multicompartmental disease, using a laparoscopic approach aiming to preserve fertility.

Scar endometriosis: A case report and literature review

Introduction:Surgical scar endometrioma is defined as the presence of an endometrial tissue near or inside an abdominal surgical incision. This is a rare clinical event that can occur in women after gynecological or obstetric surgery, with a global prevalence estimated at 0.01%–1%. The most prevalent clinical feature includes a painful mass with a cyclic pain that exacerbates with menstruation. The aim of this work is to facilitate the identification and support the diagnosis of abdominal wall endometrioma associated with the cesarean section scar, with basis on a case study of a tumor in the cesarean surgical scar of a patient who also complains of dyspareunia and menorrhagia.Case report:A 43-year-old female patient, G4PC4A0, with a single, rounded and painful subcutaneous nodule in the right inguinal region, on the cesarean section scar, which had progressively grown for two years. Patient also reported increased nodule size during menstrual period, associated with pain and menorrhagia. In February 2016, a surgical procedure was performed and by the post-surgical evaluation, the patient had already presented a menstrual cycle and reported decrease in symptoms. Biopsy report brought findings compatible with endometriosis.Conclusion:According to the literature, the clinical picture of the patient confirms the suspected endometrioma. The set of signals and symptoms associated with well-specified additional tests allowed an early and efficient diagnosis. The knowledge of the disease and the adoption of these criteria may mean a reduced burden on health services, but mainly, improve the quality of life of patients.

Milker's nodule: an occupational infection and threat to the immunocompromised.

Milker's nodule virus, also called paravaccinia virus, is a DNA virus of the parapoxvirus genus transmitted from infected cows to humans. It results from contact with cattle, cattle by-products or fomites. Classified as an occupational disorder, those at risk of exposure include farmers, butchers and agricultural tourists. The viral infection begins 5-15days after inoculation as an erythematous-purple, round nodule with a clear depressed centre and a surrounding erythematous ring. While familiar to those in farming communities, the presence of the nodule may be concerning to others, particularly the immunosuppressed. Milker's nodules are self-limited in immunocompetent individuals and heal without scarring within 8weeks. Another member of the Parapoxvirus genus, the orf virus, is also transmitted from animals to humans by direct contact. While complications are rare, haematopoietic stem cell transplant recipients are at risk of graft-versus-host disease, as the parapoxvirus may trigger these complications in immunocompromised individuals. In addition, paravaccinia may serve as the antigen source for the development of erythema multiforme. The unique structure and replication process of viruses in the Poxvirus family, while includes the Parapoxvirus genus, have been a focus for treatment of infections and cancer. Manipulation of these viruses has demonstrated promising therapeutic possibilities as vectors for vaccines and oncologic therapy.

Automatic Solitary Lung Nodule Detection in Computed Tomography Images Slices

Lung nodule is an early indicator of some lung diseases, including lung cancer. In Computed Tomography (CT) based image, nodule is known as a shape that appears brighter than lung surrounding. This research aim to develop an application that automatically detect lung nodule in CT images. There are some steps in algorithm such as image acquisition and conversion, image binarization, lung segmentation, blob detection, and classification. Data acquisition is a step to taking image slice by slice from the original *.dicom format and then each image slices is converted into *.tif image format. Binarization that tailoring Otsu algorithm, than separated the background and foreground part of each image slices. After removing the background part, the next step is to segment part of the lung only so the nodule can localized easier. Once again Otsu algorithm is use to detect nodule blob in localized lung area. The final step is tailoring Support Vector Machine (SVM) to classify the nodule. The application has succeed detecting near round nodule with a certain threshold of size. Those detecting result shows drawback in part of thresholding size and shape of nodule that need to enhance in the next part of the research. The algorithm also cannot detect nodule that attached to wall and Lung Chanel, since it depend the searching only on colour differences.

Comparison of the efficiency and complications of Lumenis and Wolf morcellators after holmium laser enucleation of the prostate.

Introduction:Holmium laser enucleation of the prostate (HoLEP) is a recognized option for the surgical management of benign prostatic hyperplasia. While the laser parameters and enucleation techniques have been widely studied, the morcellation techniques still remain under-evaluated. The current study evaluates the two commonly used morcellation devices for their in vivo efficiency and patient safety.Materials and Methods:A total of 222 patients who underwent HoLEP at two medical centres between January 2011 to December 2013 by a single surgeon were included. Of these 222 patients, the Richard Wolf Piranha Morcellation System, Germany (WM), was used on 140 patients, while on the remaining 82, the Lumenis® VersaCut™ Morcellator, Yokneam, Israel (LM), was used. These devices were compared for safety parameters such as the incidence of bladder mucosal injury, deep muscle injury, bladder perforation, and bleeding requiring electrocoagulation. The morcellation efficiency (ME) defined as the ratio of the weight of morcellated tissue in grams to the time required for morcellation in minutes was also compared.Results:The incidence of bladder mucosal injury, deep muscle injury, and bleeding requiring electrocoagulation was statistically significantly lower for the WM than the LM. None of the patients had a full-thickness bladder perforation with either of the morcellators. The ME was higher for the LM. In eight patients, hard, smooth rounded adenomatous nodules could not be morcellated by the WM and had to be crushed by a stone grasping forceps before morcellation.Conclusions:While the LM is a faster morcellator, WM has a better safety profile.

Cutaneous metastases mimicking keratoacanthoma

A 60-year-old man, with history of pulmonary tuberculosis treated and chronic obstructive pulmonary disease, presented with multiple, round skin-colored nodules with a central keratin plug were observed in the left parietal area and the left shoulder. In addition, there were palpable enlarged lymph nodes around the inguinal region. A biopsy of one of the lesions showed histological characteristics of a metastatic adenocarcinoma. Computer tomography of thorax showed lesions in the lung. Subsequently, a bronchoscopy revealed a mass in the left lung. Biopsies of the bronchic mass showed an adenocarcinoma resembling the previous skin tumor biopsy. The tumor cells of both lesions expressed cytokeratin 7, but neither expressed cytokeratin 20 nor thyroid transcription factor, so a highly differentiated adenocarcinoma was diagnosed. After diagnosis of a metastatic bronchial adenocarcinoma, the patient was transferred to the department of Oncology, where chemotherapy was started. The patient is under regular monitoring. Metastatic cancer to skin is not a frequent occurrence. It can present with several morphologies including, rarely, keratoacanthoma-like lesions. This included patients with primary tumors of the breast, bronchus, cartilage, esophagus and pleura.

Tubular Apocrine Adenoma on Vulva: An Unusual Location.

Tubular Apocrine Adenoma on Vulva: An Unusual Location.

Magnetic susceptibility artefact on MRI mimicking lymphadenopathy: description of a nasopharyngeal carcinoma patient

: This report describes a case involving a 34-year-old male patient with nasopharyngeal carcinoma (NPC) who exhibited the manifestation of lymph node enlargement on magnetic resonance (MR) images due to a magnetic susceptibility artefact (MSA). Initial axial T1-weighted and T2-weighted images acquired before treatment showed a round nodule with hyperintensity in the left retropharyngeal space that mimicked an enlarged cervical lymph node. However, coronal T2-weighted images and subsequent computed tomography (CT) images indicated that this lymph node-like lesion was an MSA caused by the air-bone tissue interface rather than an actual lymph node or another artefact. In addition, for the subsequent MR imaging (MRI), which was performed after chemoradiotherapy (CRT) treatment for NPC, axial MR images also showed an enlarged lymph node-like lesion. This MSA was not observed in a follow-up MRI examination when different MR sequences were used. This finding suggests that when performing lymph node staging for patients with head and neck carcinomas such as NPC, the possibility of an MSA should be considered to avoid misinterpretation and excessive treatment.

Management of Hydradenitis Suppurativa by Apamarga Kshara Sutra - A Case Study

Hydradenitis suppurativa (HS), also known as Acne Inversa, is a chronic disease characterized by recurrent, painful, deep-seated, rounded nodules and abscesses. Subsequent hypertrophic scarring and suppuration of apocrine gland bearing skin: axilla, groin, peri-anal and perineal regions are main features. Onset is usually after puberty. The disease tends to become chronic with subcutaneous extension leading to indurations, sinus and fistula having a profound impact on the quality of life. The exact aetiology remains unknown. The clinical features of HS can be compared with Naadivrana mentioned in classics. Treatment modalities of Naadivrana includes mainly Ksharataila Poorana and Ksharasutra application are adopted in the present case. A case report of patient suffering from HS since 4.5 years (c/o multiple pus discharging abscesses and hardened area in both axillary region) was treated by number of allopathic surgeons and physicians but there was minimal relief and recurrence (6-7 times) even after Incision and Drianage (IandD) and wide excision. The patient was under Ayurveda treatment for approximately 5 months and pus discharge, hardness reduced completely and is on followup since 8 months there is no recurrence, patient was treated internally with Gandakarasayana, Triphala Guggulu and Varunadi Kashaya. Apamarga Kshara Taila infiltration followed by Apamarga Kshara Sutra application to the intercommunicating sinuses, adviced to maintain local hygiene.

Magnetic susceptibility artefact on MRI mimicking lymphadenopathy: description of a nasopharyngeal carcinoma patient

This report describes a case involving a 34-year-old male patient with nasopharyngeal carcinoma (NPC) who exhibited the manifestation of lymph node enlargement on magnetic resonance (MR) images due to a magnetic susceptibility artefact (MSA). Initial axial T1-weighted and T2-weighted images acquired before treatment showed a round nodule with hyperintensity in the left retropharyngeal space that mimicked an enlarged cervical lymph node. However, coronal T2-weighted images and subsequent computed tomography (CT) images indicated that this lymph node-like lesion was an MSA caused by the air-bone tissue interface rather than an actual lymph node or another artefact. In addition, for the subsequent MR imaging (MRI), which was performed after chemoradiotherapy (CRT) treatment for NPC, axial MR images also showed an enlarged lymph node-like lesion. This MSA was not observed in a follow-up MRI examination when different MR sequences were used. This finding suggests that when performing lymph node staging for patients with head and neck carcinomas such as NPC, the possibility of an MSA should be considered to avoid misinterpretation and excessive treatment.

Grumous Within a Pancreatic Cyst: A Rare Case of Lymphoepithelial Cyst of the Pancreas Arising Within an Accessory Spleen

Cystic pancreatic lesions are regularly encountered on imaging studies of patients. Pseudocysts are the most common cystic lesion of the pancreas, but true pancreatic cysts are often neoplastic in origin which makes their classification important. A 58 y.o. caucasian male with a past medical history of diabetes, hypertension, and bilateral Warthin's tumor removal was referred for evaluation after presenting with an incidental mass found on CT. The patients only symptoms prior to examination was an unintended weight loss of 24 pounds. There were no significant findings on physical exam. The patient underwent MRI of the abdomen which demonstrated a cystic mass abutting the distal pancreatic body, proximal pancreatic talon, and inferior margin of the gastric body. The patient underwent EUS and was found to have an anechoic cystic mass with intracystic hypoechoic round nodules. Under doppler guidance, fine needle aspirate biopsies were taken which demonstrated cystic contents with highly degenerated squamous epithelium and cholesterol crystals with mucinous-like cells suggestive of lymphoepithelial cysts. The patient was referred for surgery and received a distal pancreatectomy. Surgical pathology confirmed the presence of lymphoepithelial cells within the cystic mass. The patient was subsequently discharged without complication. One of the benign forms of cystic lesions of the pancreas, lymphoepithelial cysts, are characterized as being filled with keratinized material, lined by mature keratinizing squamous epithelium which is surrounded by lymphoid tissue containing a few lymphoid follicles.They can arise from any portion in the pancreas, and sometimes within an accessory intrapancreatic spleen.These cystic lesions have distinctive clinical and pathological features making their identification with a high degree of specificity important.Upon review of the literature there are approximately one hundred reported cases of lymphoepithelial cysts arising within the pancreas. As imaging studies produce more pancreatic lesions it is important to develop a broad differential diagnosis and to develop characterizations of these lesions through identification of various factors in order to obtain an accurate diagnosis without the need for surgical intervention. Further study of the pathogenesis and progression of lymphoepithelial cysts is needed to create more accurate guidelines for their management.Figure: Magnetic resonance Imaging with contrast enhancement demonstrating a 6.2 x 4.5 x 3.0 cm mass abutting the superior margin of the distal pancreatic body/proximal pancreatic tail and the inferior margin of the gastric body. On T1-weighted imaging, the lesion is predominantly T1 hyperintense with rounded areas of hypointensity. On T2-weighted imaging the lesion is predominantly T2 intermediate intensity with a few rounded areas of hypointense signal.Figure: Endoscopic ultrasound of the pancreas demonstrating a 22 mm x 42 mm anechoic cyst with intracystic hypoechoic round nodules abutting the tail of the pancreas. Multiple intracystic nodules, the largest measuring 19 mm x 24 mm are also demonstrated. The cyst was abutting the pancreas and gastric body and causing some displacement of distal body and tail of the pancreas.Figure: Surgical pathology of the lymphoepithelial cyst - arrow demonstrating a small portion of splenic parenchyma.

Benign metastasizing leiomyoma presenting as multiple cystic pulmonary nodules: a case report

BackgroundBenign metastatic leiomyoma (BML) is an extremely rare disease. Although uterine leiomyomas are benign histologically, they can metastasize to distant sites. While the incidence is very low, the lung is the organ most frequently affected by BML. Pulmonary BML usually presents as numerous well-defined nodules of various sizes, while the cavitary or cystic features in the nodules are rarely observed on radiologic images.Case presentationA 52-year-old woman complained of cough and dyspnea for one month. She had been previously diagnosed with uterine leiomyoma and had undergone total hysterectomy about 14 years prior. High-resolution computed tomography (CT) images showed that there were multiple cystic nodules of various sizes in both lungs. Pathologic examination revealed that the pulmonary nodule had complex branching glandular structures lined by a single layer of simple cuboidal to columnar epithelium that was surrounded by abundant spindle cells. Additional immunohistochemistry data suggested that pulmonary nodule diagnosis was BML-associated uterine leiomyoma.ConclusionIn this report, we introduce an interesting case of pulmonary BML that presented as a combination of various kinds of nodules including simple round nodules, simple cysts, and cysts with a solid portion, which are very rare radiologic features of BML in lung. In addition, when the patient is a woman of reproductive age, physicians should meticulously review the gynecological history and suspect BML when there are various cystic pulmonary lesions.

Neurofibromatosis type I with an Rare Oral Manifestation

Neurofibromatosis type I is one of the most common genetic diseases and it may have oral manifestation. Objetive : To report a case about a 33 years old female patient diagnosed with neurofibromatosis type I in the skin. Case Report : In the extraoral clinical examination were observed subcutaneous nodules and cafe-au-lait spots, in different sizes around the body. In the intraoral examination was diagnosed the presence of rounded nodule in the hard palate. The excisional biopsy of the lesion was performed and the histopathological examination suggested a diagnosis of neurofibroma. Conclusion: The case report emphasizes the importance of a detailed anamnesis and a thorough physical examination, so that systemic diseases can be considered in oral diagnosis.

Neurofibromatosis type I with an Rare Oral Manifestation

Neurofibromatosis type I is one of the most common genetic diseases and it may have oral manifestation. Objetive : To report a case about a 33 years old female patient diagnosed with neurofibromatosis type I in the skin. Case Report : In the extraoral clinical examination were observed subcutaneous nodules and cafe-au-lait spots, in different sizes around the body. In the intraoral examination was diagnosed the presence of rounded nodule in the hard palate. The excisional biopsy of the lesion was performed and the histopathological examination suggested a diagnosis of neurofibroma. Conclusion: The case report emphasizes the importance of a detailed anamnesis and a thorough physical examination, so that systemic diseases can be considered in oral diagnosis.

Eyelid Molluscum Contagiosum Lesions in Two Patients with Unilateral Chronic Conjunctivitis.

Molluscum contagiosum (MC) is a viral infection of the skin and mucosal tissues characterized by skin-colored or transparent round nodules with a dimple or pit in the center. The infection is caused by a DNA poxvirus called the MC virus. Although MC generally occurs in children, it has also been reported in immunocompromised and atopic patients. The virus is transmitted by skin contact or sexual intercourse. The lesions disappear spontaneously within several months in most cases. However, excision, cryotherapy, cauterization, topical chemical and antiviral agents, and/or oral cimetidine are used in refractory cases or to accelerate the healing process. Herein, we discussed the clinical findings and our treatment of two patients with unilateral chronic conjunctivitis associated with eyelid MC lesions in light of the literature.