Tender Mass Research Articles

A case of giant cell tumor of the breast, clinically suspected as malignant breast tumor

BackgroundGiant cell tumor (GCT) of the breast is scarce. We report a case of GCT of the breast which was suspected as a malignant breast tumor.Case presentationA 74-year-old woman noticed a tender lump in her right breast. We suspected a malignant tumor spreading widely with axillary lymph node metastasis on clinical examination and imaging. Histological evaluation of the biopsy tissue revealed a tumor composed the proliferation of oval to spindle-shaped cells and multinucleated giant cells without malignant epithelial cells. The tumor cells stained positively for CD68 and negatively for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2. The pathological findings suggested GCT, and fine needle aspiration biopsy for the axillary lymph node was negative. However, there was a gap between the clinical presentation, such as a tender mass suggesting rapid growth and multiple lymphadenopathies, and the pathological presentation of biopsy, which made us hesitate to conclude GCT as the final preoperative diagnosis. We could not rule out the possibility of malignant tumors with OGCs before surgery. We performed mastectomy and sentinel lymph node biopsy according to a surgical procedure for node-negative breast cancer with a wide ductal spread. The resected tissue histologically showed the same findings to the biopsy tissue. The definitive diagnosis of GCT of the breast was given, because the tumor lacked epithelial components, marked cellular atypia, and pleomorphism.ConclusionsGCT of the breast occasionally pretends as breast malignant tumors. Complete tumor resection should be performed for local control and the definitive diagnosis.

SUN-616 A Rapidly Enlarging Neck Mass in a 59-Year-Old Woman

Background: Anaplastic thyroid cancers (ATC) are extremely aggressive and rapidly fatal. We report a case of ATC presenting as a rapidly enlarging, painful neck mass. Case Presentation: A 59 year old female presented with 2 month history of a right-sided, painful neck mass and inability to project her voice. Review of systems was positive for dyspnea when supine, intermittent headaches, and difficulty swallowing. Exam revealed a palpable 3.0 cm hard, tender thyroid mass. Cranial nerves were grossly intact. Initial laboratory results showed TSH 1.1 mcIU/mL, calcitonin <2.0 pg/mL. Fine needle aspiration of thyroid mass revealed large cells with abundant eosinophilic cytoplasm, nuclear pleomorphism, and abundant necrosis. Thyroid u/s revealed a 3.5 cm irregular right thyroid mass with cystic areas, abutting the trachea and multiple nodules with irregular margins in the left thyroid lobe. Neck CT described a 3.8 cm mass with variegated enhancement abutting the trachea without luminal invasion. Brain MRI noted a 2.1 cm dural mass over the left occipital lobe with histology confirming metastatic ATC. Discussion Patient’s thyroid biopsy revealed de-differentiated (anaplastic) thyroid cancer given the abundant necrosis and negative TTF-1 mRNA. Distant metastatic disease was found on PET scan to include brain and lungs. This is a rare (1-2 cases per million), aggressive and often lethal malignancy (1). The mean age at diagnosis is 65 years with 60-70% of tumors occurring in women. Mean survival time is usually less than 6 months with 90% presenting with metastatic disease (2). An enlarging hard and often tender neck mass and cervical lymphadenopathy are typical at presentation. On cytopathology, morphologic patterns include spindle cell, pleomorphic giant cell +/- squamoid with extensive necrosis is typical as seen in our patient. There is no effective therapy for metastatic anaplastic thyroid cancer with few randomized control trials evaluating different strategies. Our patient underwent total thyroidectomy with tracheostomy tube placement to protect her airway. Resection of the dural-based mass revealed metastatic ATC. In addition to surgery, chemotherapy and radiation have been used as well as mutation directed (BRAF and p53 are common in anaplastic) therapy but studies have been small and only showing a 29% response rate (3). Radiation and chemotherapy were planned but ultimately, the patient chose to forgo further therapy and return to her native country of Kenya.

AN UNUSUAL CASE OF PORTAL, SPLENIC AND MESENTERIC VENOUS THROMBOSIS PRESENTING WITH ACUTE ABDOMEN

Porto-spleno-mesenteric vein thrombosis is a rare, life-threatening condition of extrahepatic portal venous system thrombosis. We report a rare case of a 49-year-old lady with late presentation of acute portal vein thrombosis in a non-cirrhotic liver with an incidental finding of left adnexal teratoma. She presented with a one-week history of severe abdominal pain associated with vomiting and diarrhea. She gave no history of prior risk for venous thromboembolism or liver diseases. Physical examination revealed a tender mass extending from suprapubic to left iliac fossa. Abdominal computed tomography scans showed a well-defined fatcontaining left adnexal mass, likely a benign teratoma, with no involvement of surrounding structures or calcification. There was evidence of porto-splenic-mesenteric vein thrombosis with liver infarction, bowel and splenic ischemia. Management of the extensive thrombosis causing multi-organ failure includes resuscitation, supportive care and treatment of thrombosis. Treatment options include early anticoagulation and if feasible, thrombolysis. Keywords: Acute Abdomen, Mesenteric Vein Thrombosis, Non-Cirrhotic Vein Thrombosis, Portal Vein Thrombosis,Splenic Vein Thrombosis

Mammary Myofibroblastoma in a Male Patient

A mammary myofibroblastoma is a rare benign lesion found within the breast tissue of both males and females. Although it is a benign mass, it may mimic breast carcinoma on mammography and sonographic imaging. This is a case report of a 68-year-old male with a history of prostate cancer presenting with a tender and palpable mass of the left breast in the 11 o’clock position. Ultrasound-guided core biopsy was performed and pathology confirmed the diagnosis of myofibroblastoma of the breast. Mammary myofibroblastoma should be considered in a patient presenting with a breast mass, particularly older men and postmenopausal women. A core biopsy should be obtained to rule out a more serious diagnosis.

Dacryocele in an adult presenting as facial cellulitis

A 47-year-old male presented with left sided facial cellulitis of one-week duration associated with a painful mass over the left medial canthal area. On examination, there was a firm, tender mass below the medial canthal tendon. Computed tomography scan revealed a bulky, cystic lesion at the left inferomedial orbit and medial maxilla with bony remodeling suggestive of a chronic dacryocele. The patient underwent marsupialization of the dacryocele at the inferior meatus with silicone tube intubation. His symptoms of epiphora resolved after surgery.&#x0D; We describe a rare clinical presentation of dacryocele in an adult and its simple, yet effective treatment option.

Recurrent abdominal pain with thrombocytosis

Splenic congenital anomalies are many. Wandering spleen (WS) is a rare anomaly account for about 0.2%. It is usually associated with absent or maldevelopment of one or all splenic ligaments that hold the spleen in its place. A 15-year-old girl had complaints of repeated attacks of mid-abdominal pain for the last month. Abdominal examination revealed a central fixed and slightly tender abdominal mass in the umbilical region. Complete blood count revealed platelets (790 × 103/mL), white blood cells (9700 × 103/mL), and hemoglobin (8 g/dL), and other investigations were normal, but unfortunately ultrasound and computed tomography report revealed WS. Abdominal exploration revealed the spleen not in the anatomical place, and there is a mass in the umbilical region surrounded by dense adhesions. The adhesions were released and this mass discovered to be WS, splenectomy was done. Vaccination against pneumococci and Haemophilus influenza were given, and the patient discharged uneventfully on the fourth postoperative day. Asymptomatic WS could be found incidentally during surgery or during abdominal imaging for any reason. Furthermore, WS can present with an acute abdomen or recurrent abdominal pain. The only treatment is surgery even in asymptomatic cases because of the high possibility of complications. Splenopexy can be done if the spleen showed no torsion or splenomegaly or hypersplenism otherwise splenectomy is the second option.

Kyste hydatique de la loge des adducteurs de la cuisse

A rural origin, 60-year old female patient, with no particular previous history, was hospitalized in our department for assessment of a swelling on the inner face of the left thigh that had appeared progressively and insidiously over the past 4 months. This lesion, initially asymptomatic, caused, after 2 months, unsystematized inguinal pain, then left lower limb pain. The pain, at first mechanical and calmed down by rest and analgesics, had gradually become inflammatory, causing insomnia, leading the patient to seek care. Clinical examination showed afebrile patient in good general condition. Palpation showed poorly differentiated lightly tender and simmering mass, adhering to the deeper structure (Figure 1A). Sedimentation rate was 45 mm/1st hour and white blood cells 6500/mm3 with eosinophilia 2.1%. Standard radiographs of the left hip were normal. Ultrasound of the left thigh revealed a huge, homogeneous encysted collection without calcification or vegetation, well defined by a thin membrane (capsule) which was enhanced by Doppler. MRI was performed to better study mass relations with the surrounding vascular and nerve structures. It showed type 1 hydatid cyst in the thigh lodging the abductor muscle of the left thigh measuring 108*82mm, in close contacts with the superficial femoral artery (Figure 1B, C, D). Excisional biopsy of the cyst was performed. Anatomopathological examination objectified hydatid cyst of the thigh. Surgery was associated to medical treatment with Albendazol for 28 days with good clinical and radiological outcome.

Isolated Testicular Tuberculosis in a 9-Year-Old Boy: An Incidental Finding

Isolated testicular Tuberculosis (TB) is a rare clinical condition. A 9-year old boy presented to the paediatric surgical clinic with a 3-month history of a painless mass in the right testis and 1-month history of low- grade continuous fever. The boy had normal anthropometry, no abnormal respiratory signs, there was a right hemiscrotal swelling with a solid hard, non- tender mass felt on the upper pole of the right testis. The chest radiograph was normal, histopatholgic results of the mass showed tuberculotic granuloma with caseous necrosis, FBC revealed WBC of 9.7×10³/MM³, HCT-33% Platelets-357×10³/MM³, Neutrophil-24, Lymphocyte-34, Eosinophils-1O, Monocyte-30, Basophils-2, ESR-26mm/hr, Mantoux-0mm², Cytology smear revealed a mixed inflammation consisting mainly neutrophils and plasma cells with an eosinophilic background. Hydrocele fluid aspirate for M/C/S showed no significant bacterial growth. To date, no clinical method has been defined for the definitive diagnosis of such cases and the definitive diagnosis is only achieved by surgical exploration and histopathological examination. Testicular tuberculosis (TB), a rare form of (EP-TB), may present with diagnostic challenge.

Spontaneous rectus sheath hematoma mimicking acute abdomen

Rectus sheath hematoma has been described in the past due to various etiologies with varying degrees of severity. It is a rare cause of acute abdomen. Clinical presentation may vary from person to person and based on site of collection and source of bleeding. Various management options including surgical and non-surgical measures have been described and generally present with tenderness with a mass of varying size based on the duration and amount of bleeding. Here, we present the case of a 72-year-old female with acute abdomen on presentation, unstable vitals, and severe pallor. A tender mass over the left lower part of the abdomen was found, and on further evaluation with imaging, the patient was found to have a rectus sheath hematoma. The hematoma was successfully treated with the evacuation of the hematoma and ligation of the bleeding vessel.

Endoscopic Ultrasound Isolates Type B Aortic Dissection

An aortic dissection (AD) occurs when the inner layer of the aorta tears. ADs have a predilection toward men and those aged 60 to 70 [1]. Type A aortic dissections are more dangerous due to the tear situated in the ascending aorta whereas Type B is more rare with the tear limited to the descending aorta. Symptoms of aortic dissections such as chest pain are similar to other cardiovascular conditions, making aortic dissection detection tricky [1,2]. We report a 74 year old female with constant chest pain radiating from the right breast to the right upper quadrant after eating Chinese food for dinner. The pain was accompanied with non-radiating back pain and nausea. Physical examination was significant for a tender mass palpated in the right upper and lower quadrants. Right upper quadrant ultrasound showed choledocholithiasis with common bile duct dilation at 1.1cm, unchanged from 1 year prior, and sludge in the gallbladder but no cholecystitis. Her vitals were stable with mild hypertension (149/67 mmHg). Endoscopic ultrasound examination showed a gallbladder filled with stones and sludge as well as a thickened wall consistent with possible cholecystitis. Mild intrahepatic biliary dilation was present. The celiac axis, superior mesenteric vessels, splenic vessels and portal vein were normal. Type B Dissection of the thoracic aorta and aortic arch was identified in the endoscopic ultrasound. Traditionally, CTs with contrast dye, echocardiograms and MRIs are commonly used to diagnose AD [1]. Meanwhile, endoscopic ultrasound (EUS) provides clear images to facilitate the diagnosis of gastrointestinal conditions. Our case highlights that EUS can also be used to examine cardiovascular disorders. EUS offers complete visualization of the aortic valve, the mitral valve, ascending and descending aorta, pericardium, left atrial appendage, and interatrial septum [3]. The proximity of the aorta to the esophagus allows for a very detailed view of the aorta [2,3]. It is essential that every complete endoscopic ultrasound exam include an evaluation of the thoracic organs in order to capture critical incidental findings that would be otherwise missed.2139_A Figure 1. Type B aortic dissection as seen on endoscopic ultrasound.2139_B Figure 2. Type B aortic dissection as seen on endoscopic ultrasound.

GIANT CLEAR CELL RENAL CARCINOMA: A CASE REPORT

Objective: This article is aimed to report an unusual presentation of renal cancer T4N0M0 in which the tumor weighed about 5 kilograms in a patient admitted to Urology Department of Hasan Sadikin Hospital in Bandung, Indonesia, in August 2016. Case presentation: We report a case 62 year old male with history of growing mass in his left abdominal. There are also painless hematuria and weight loss of approximately 10 kg over the past 2 years. Discussion: Physical examination found a significant palpable, immobile and mild tender mass in the left upper quadrant of the abdomen. Abdominal Pelvic Computed Tomography (CT) scan revealed inhomogenous hypodens mass in the left kidney. Resection of the tumor revealed a 5 kg (22 x 25 x 18 cm, with total volume of 9.900 cm3) encapsulated neoplasm. Histophatological examination revealed a clear cell type renal cell carcinoma (RCC) with positive margin and Fuhrmann grade 2. In Asia, a giant chromophobe RCC exceeding 10 kg in weight was reported in 2009. As for previously reported giant clear cell RCC, we found out the data to be very limited. Conclusion: Giant RCC is rare, especially clear cell type in histophatological result. The size of the tumor reported in this article is considered as the largest-sized giant clear cell RCC ever reported in Asia. The size of the tumor in this case presented several challenges in the operative settings. However, the outcome and six months post-operative follow-up of the patient was satisfying in which there was no presence of single symptom within the six-month follow-up period.

Young Woman With Abdominal Pain

A previously healthy 22-year-old woman presented to the emergency department with worsening abdominal pain and emesis for 3 days. Her vital signs were normal. Physical examination revealed a tender mass suspicious for hepatomegaly, extending from the right upper quadrant to the midabdomen. There was no guarding or rebound tenderness on examination. Laboratory study results were unremarkable and serum pregnancy test was negative. Contrast-enhanced computed tomography (CT) was performed (Figure 1, Figure 2, Figure 3).Figure 2CT (axial view) demonstrating soft tissue, bone, and fat-density elements within the superior multiloculated mass (between arrowheads).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3CT (axial view) demonstrating soft tissue, bone, and fat-density elements within the inferior multiloculated mass, between the rectum (black arrow) and vagina (white arrow).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Bilateral benign cystic teratomas with right ovarian torsion. The coronal and axial CT views show 2 heterogeneous masses, one in the midabdomen and the other in the pelvis, with internal components of fat, soft tissue, and bone consistent with benign cystic teratomas. The patient was taken to the operating room, where intraoperative examination demonstrated bilateral abdominopelvic masses arising from the left and right ovary, with right ovarian torsion. The masses contained fat, hair, and bone on gross examination and were removed with preservation of ovarian tissue (Figure 4). Benign cystic teratomas are tumors of well-differentiated derivations from at least 2 of the 3 germ cell layers.1Comerci Jr., J.T. Licciardi F. Bergh P.A. et al.Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature.Obstet Gynecol. 1994; 84: 22-28PubMed Google Scholar, 2Outwater E.K. Siegelman E.S. Hunt J.L. Ovarian teratomas: tumor types and imaging characteristics.Radiographics. 2001; 21: 475-490Crossref PubMed Scopus (409) Google Scholar Teratomas are the most common germ cell neoplasm and generally affect a younger age group (mean age 30 years).2Outwater E.K. Siegelman E.S. Hunt J.L. Ovarian teratomas: tumor types and imaging characteristics.Radiographics. 2001; 21: 475-490Crossref PubMed Scopus (409) Google Scholar They are bilateral in approximately 10% of cases.3Park S.B. Kim J.K. Kim K.R. et al.Imaging findings of complications and unusual manifestations of ovarian teratomas.Radiographics. 2008; 28: 969-983Crossref PubMed Scopus (107) Google Scholar Most teratomas are asymptomatic, with abdominal pain or other nonspecific symptoms occurring in the minority of patients.1Comerci Jr., J.T. Licciardi F. Bergh P.A. et al.Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature.Obstet Gynecol. 1994; 84: 22-28PubMed Google Scholar Teratomas can be associated with complications, including rupture, malignant degeneration, or, most commonly, ovarian torsion (3.2% to 16%). Larger teratomas, greater than 6 cm, are more likely to undergo torsion.1Comerci Jr., J.T. Licciardi F. Bergh P.A. et al.Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature.Obstet Gynecol. 1994; 84: 22-28PubMed Google Scholar

Giant intrascrotal embryonal rhabdomyosarcoma in an adult: a case report and review of the\xa0literature

BackgroundIntrascrotal embryonal rhabdomyosarcoma in adults is a rare tumor with high aggression and a poor prognosis. We report our patient’s case and review the relevant literature to improve the understanding of this rare disease.Case presentationA 21-year-old Han Chinese man presented to our hospital with a right intrascrotal mass of 1 year’s duration. His physical examination revealed an enlarged right scrotum containing a huge tender mass measuring about 10 × 7 cm. Ordinary and contrast-enhanced ultrasonography showed a solid mass in the right scrotum, which was suspected to be a malignant tumor. An abdominopelvic computed tomographic scan revealed metastases in the retroperitoneal lymph nodes. The patient was diagnosed with malignant testicular tumor and underwent a right radical orchiectomy by an inguinal approach. Postoperative pathological examination suggested an intrascrotal embryonal rhabdomyosarcoma.ConclusionsIntrascrotal embryonal rhabdomyosarcoma is a rare but highly aggressive tumor. Clinical and imaging manifestations of this tumor are nonspecific, so the definitive diagnosis depends on postoperative pathology and immunohistochemistry. Early suspicion, radical orchiectomy, accurate pathologic diagnosis, and adjuvant chemotherapy and/or radiotherapy are the keys to optimal prognosis.

Case 253: Thrombosed Umbilical Venous Varix in an Infant

History A 3-month-old previously healthy girl presented to an outside institution with a 4-day history of low-grade fever, irritability, and a tender "knot" in the upper abdomen. Ultrasonography (US) was performed at an outside hospital. US images were not available for review; however, they showed a mass in the left hepatic lobe, per the outside report, and the patient was referred to our institution for further evaluation. Her parents reported a normal full-term pregnancy, with regular prenatal care and normal prenatal US findings. The baby was born after an uncomplicated gestation. She was delivered at term via an uncomplicated cesarean section due to a maternal history of cesarean section. The perinatal course was uncomplicated, and there was no history of umbilical catheterization, per the parents. On arrival at our institution, the patient had a temperature of 38.2°C. All other vital signs were normal. Palpation revealed a tender and firm mass in the periumbilical region; otherwise, physical examination findings were normal. Results of laboratory work-up were normal, except for elevated white blood cell count (26 600/mm3 [26.6 × 109/L]; normal, 6000-17 500/mm3 [6-17.5 × 109/L]). The patient underwent US followed by intravenous contrast material-enhanced (10 mL ioversol, Optiray 320; Medtronic, Santa Rosa, Calif) computed tomography (CT) on the same day.

Presentation with Personality changes and Tinnitus to a Vascular Intervention: Rare case of Carotid Body Paraganglioma

Background: Carotid body paragangliomas are rare neuroendocrine neoplasms of chromaffin negative glomus cells. This case report explains an atypical case with unusual presentation and treatment.&#x0D; Case Report: A healthy smoker technician by profession was brought to the emergency room (ER) with coprolalia. The general physical exam did not reveal any information. His history revealed unilateral tinnitus and odynophagia leading to a consultation by the neurologist with head imaging. Acoustic neuroma was ruled out and the caregiver was asked to elaborate the events mentioned in the history and a psychiatric examination was done. The personality changes were evaluated by the psychiatrist that showed overlapping of delirium and depression. The patient was further examined by a vascular surgeon. After careful revisiting of the history, examination and indication of tender mass in the neck by the patient's vascular surgeon, the diagnosis of carotid body paraganglioma was made which was followed by surgical resection for treatment.&#x0D; Conclusion: Carotid Body Paragangliomas are very vascular structures and their manipulation in a surgery setting requires expertise. This case presented with personality changes and tinnitus, a very less likely event to occur in a carotid body tumor. The present care report, thus adds on to the literature of carotid body tumors and its presenting symptoms.

Aneurysmal Bone Cyst of the Clavicle

Aneurysmal bone cyst (ABC) is a benign but locally aggressive and destructive neoplasm of bone, slightly more frequent in females and commonly located in the metaphysis of long bones such as the distal femur, proximal tibia, and proximal humerus. The clavicle is an extremely rare location. A 46-year-old male patient presented for evaluation of a tender and palpable mass in the superior aspect of the right shoulder after failing conservative treatment and having initial normal shoulder radiographs. An magnetic resonance imaging and subsequent computerized tomographic-guided biopsy confirmed the diagnosis of ABC. The patient underwent lateral clavicular resection with coracoclavicular ligament reconstruction with TightRope. At the 2-year follow-up, the patient is free of disease with excellent oncologic and functional results—Quick-DASH: 30; Toronto Extremity Salvage Score: 100; MSTS: 30 (100). We present the rare case of a 46-year-old male patient with a clavicular ABC treated with lateral clavicle resection and reconstruction of the coracoclavicular ligaments. In addition to a review of the literature and discussion of treatment modalities, we report a new technique with reconstruction of the coracoclavicular ligaments, optimizing oncologic and functional result.

Idiopathic Granulomatous Mastitis: Manifestations at Multimodality Imaging and Pitfalls.

Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory breast entity characterized by lobulocentric granulomas. IGM has a persistent or recurrent disease course and affects parous premenopausal women with a history of lactation. It has also been associated with hyperprolactinemia. The most common clinical sign is a palpable tender mass. However, the nonspecific manifestations and varied demographic features of this condition, as well as the other similar-appearing and superimposed breast entities, pose substantial diagnostic challenges. Entities with similar manifestations include inflammatory breast cancer (IBC), infective mastitis, foreign body injection granulomas, mammary duct ectasia, diabetic fibrous mastopathy, and systemic granulomatous processes. The strategy for imaging IGM depends on patient age, clinical manifestations, and risk factors. Targeted ultrasonography, mammography, and less commonly, magnetic resonance imaging have proven to be useful for imaging evaluation. Core-needle biopsy, with or without fine-needle aspiration for cytopathologic examination, and culture analysis are usually required to exclude IBC and other benign inflammatory breast processes. Patients with IGM have an excellent prognosis when they are appropriately treated with oral steroids or second-line immunosuppressive and prolactin-lowering medications. However, surgical excision may be an option for patients in whom medication therapy is unsuccessful. Imaging surveillance can be offered to patients with incidentally encountered IGM or mild symptoms. Clinical suspicion for this rare disease and the breast imager's prompt diagnosis can lead to an improved patient outcome. The purpose of this article is to review the imaging manifestations of IGM in a multimodality case-based format and to describe relevant clinical and imaging-based differential diagnoses. The associated pitfalls, epidemiologic and histopathologic factors, clinical manifestations, natural course, and management of IGM also are discussed. ©RSNA, 2018.

Microsurgical Resection of a Common Peroneal Nerve Schwannoma: A 3-Dimensional Operative Video.

Peripheral nerve sheath tumors are benign entities that manifest with pain or neurological deficits from mass effect. Treatment is mostly surgical, however, the aggressiveness of treatment needs to be carefully considered with respect to preserving function. We present a case of a 62-year-old male with a 2-year history of left lower extremity pain radiating toward the dorsolateral foot. There was a tender and palpable mass in the lateral popliteal fossa with imaging consistent with Schwannoma of the common peroneal nerve. The patient was counseled for surgery and informed consent was obtained. Microsurgical resection was undertaken and gross total resection was achieved without compromise of function. We demonstrate the placement of neurophysiological monitoring electrodes in all 3 compartment of the calf as well as the use of stimulation to identify a nonfunctioning area for entering the nerve sheath. Anatomy of the popliteal fossa and microsurgical technique for resection of nerve sheath tumors are discussed. When dealing with these pathologies, it is important to use intraoperative neurophysiology as well as careful technique in order to achieve maximal resection without compromising neurological function.

Torsion of Enlarged Wandering Spleen in Child with Gaucher's Disease

Background: Wandering spleen is a rare condition characterized by malposition of spleen due to laxity or absence of supporting ligaments .Gaucher disease is high risk factor for torsion and trauma of migrant spleen. Case presentation: Six- year's old male patient presented to our institution for emergency treatment with acute abdomen, hemodynamic instability with palpable tender mass in the abdomen, the diagnosis was settled as twisted WS and splenectomy was done. Conclusion: clinical diagnosis of wandering spleen torsion is rare particularly in the pediatric age-group makes it an enigma for the surgical world.

Quiste esplénico gigante en una adolescente: Caso clínico

A 13-y old female with clinical history of abdominal pain since the last two months. On physical examination a firm, tender mass was palpable in left hypochondrium. Diagnosis of a large cystic splenic mass was made based on ultrasound and abdominal computed tomography scan. Splenectomy was performed, and histopathological-immunohistochemistry studies revealed findings suggestive of primary epithelial cyst. The post-operative clinical course was satisfactory and uneventful. Treatment of giant nonparasitic splenic cysts is surgical. Preserve splenic parenchyma must be the aim in an individualized decision-making. The different types of surgical modalities will be according to the diagnosis and clinical situation (cyst size, age, comorbidities).