Unilateral Mass Research Articles

Asymptomatic Necrotizing Granulomatous Disease of the Neck With Unknown Etiology

Patients presenting with unilateral neck masses is not an uncommon occurrence in an otolaryngology clinic. Especially those with risk factors such as older age and a history of smoking or drinking along with certain characteristics of the mass including rapidgrowth, immobility, and the presence of other masses elsewhere in the head and neck that can lead to more concerning etiologies such as cancer. However, in those who are younger with non-tender unilateral mobile masses, the differential is wide. We present the case of a 30-year-old male who presented with a non-tender left-sided neck mass with no associated or systemic symptoms. Workup including labs for HIV, syphilis, and fungal stains was negative. Pathology demonstrated lymphadenitis with necrotizing granulomas with no recurrence of symptoms after excisional biopsy. The patient continued to have no associated symptoms or recurrent mass thus no further workup was deemed necessary. Although unilateral neck mass and lymphadenitis with necrotizing lymphadenitis have a broad differential diagnosis, this patient's etiology continues to be unknown.

Case report of a 60-year-old male with giant adrenal myelolipoma

Adrenal myelolipoma is a benign neoplasm of the adrenal gland that is the second most common primary adrenal incidentaloma, following adrenocortical adenomas. It is composed of elements of adipose tissue and with varying amounts of hematopoietic components. In the past, these tumors were discovered at autopsy, with an incidence ranging from 0.08% to 0.4%. Today, with the widespread use of radiological studies such as ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI), the incidental detection of myelolipoma has become more common, constituting up to 10-15% of incidental adrenal masses. The patient was hospitalized for a 3-month history of discomfort in the right flank, swelling over the right hypochondriac area, constipation, retrosternal burning sensation, and early satiety. His vitals were stable but per abdominal examination revealed a mass in the right hypochondrium. B-mode ultrasound screening revealed an adrenal tumor. A hematological examination revealed thrombocytopenia. The presence of unilateral adrenal mass with the absence of new-onset hypertension with CECT suggestive of mixed tissue density mass with multiple ill-defined heterogeneously hypodense fat attenuation led to the primary diagnosis of an adrenal mass After correction of thrombocytopenia, the mass was excised and subjected to histological evaluation. The histological study results corroborated with the original diagnosis of unilateral adrenal myelolipomas. The patient was followed up for 2 months postoperatively and was found to be relieved from the presenting symptoms with no postoperative complications. Adrenal myelolipoma is an uncommon, benign, and hormonally inactive adrenal gland tumor. It may present with symptoms due to compression of adjacent structures which warrants a surgical excision.

The effects of India's bilateral investment treaties termination on foreign direct investment inflows

AbstractIndia initiated the unilateral mass termination of bilateral investment treaties (BIT termination) in 2016. We consider it a natural experiment to clarify the issue of whether BITs attract foreign direct investment (FDI) to a developing country. We evaluate the effect of BIT termination on the FDI inflows using the double and triple difference approaches (DD and DDD) and the synthetic control (SCM) methods. Our study finds that BIT termination led to a significant decrease in FDI inflows from the country with which India terminated the agreement. Thus, the study confirms that BIT is an essential mechanism for attracting FDI.

Bilateral antrochoanal polyp: a case report of an extremely rare entity managed conservatively with a review from the past 26 years

We report a rare case of a middle-aged man presenting with nasal obstruction, rhinorrhea, and sleeping disturbances, eventually diagnosed with bilateral ACPs. After confirming the diagnosis with imaging and biopsy studies, the patient was treated conservatively, with marked improvements in his symptoms during 2-3 months of regular follow-ups. A review of the relevant literature regarding the presentation, diagnosis, and outcome of this rare entity is presented, highlighting its controversial etiopathogenesis. Presenting symptoms of ACP in most cases is unilateral progressive nasal obstruction. The occurrence of ACP bilaterally is rarely encountered in clinical practice. Diagnosis is mainly clinical and is achievable via nasal endoscopic examination and supported by computed tomography imaging. Treatment remains to be surgical, with 2 years of regular follow-ups being advised to detect any recurrence. This case report adds to the scarce data pool on bilateral ACPs and highlights the necessity of prudent and timely diagnosis of this uncommon entity to avoid unnecessary investigations and lengthy medical or surgical treatment. Additionally, a trial of medical therapy may provide symptomatic relief for patients who do not qualify for surgery.

Spontaneous bilateral tubal ectopic pregnancy preoperatively diagnosed by the ultrasound: a case report

BackgroundBilateral ectopic pregnancy is extremely rare, with a tremendous maternal mortality and morbidity risk, requiring rapid diagnosis and management. This condition is usually diagnosed during surgery, as radiologists may not pay enough attention to the contralateral side of interest. Therefore, reminding of this rare but emergent situation can be beneficial for both radiologists and gynecologists. Here we report a case of bilateral ectopic pregnancy, which was first diagnosed with ultrasound and was confirmed during laparoscopy.Case presentationA 34 years old woman complaining of light vaginal bleeding at 6 weeks of gestation by her last menstrual period presented to our institute. The serum β-HCG levels were analyzed and followed during patient’s admission. Unfortunately, serum levels weren’t decreasing and blood test titration before surgery were as: 851,894,975 IU/l (checked daily and not every 48 h because of patient’s status and being bilateral). There was no evidence of intrauterine pregnancy at the transvaginal ultrasound, but heterogeneous adnexal masses were seen at both adnexa, suspected of bilateral ectopic pregnancy. She underwent laparoscopic exploration, which confirmed the diagnosis. Bilateral salpingostomy was done to preserve fertility, and the patient’s recovery was uneventful.ConclusionsEven with a unilateral report of ectopic pregnancy preoperatively in ultrasonography, surgeons should always be aware of the probability of bilateral ectopic pregnancies anytime facing susceptible cases, especially in patients with known risk factors. Also, it is an important reminder for radiologists to check both adnexa when facing a unilateral adnexal mass resembling ectopic pregnancy.

Vulvar leiomyoma in an adolescent girl: a case report and review of the literature

BackgroundVulvar leiomyoma is a rare soft tissue tumor, with only around 300 cases described in the literature. Owing to its low incidence of just 0.03% of all gynecological tumors, it often poses a great diagnostic challenge, especially in teenagers. We report this rare occurrence of vulvar leiomyoma in a teenage girl who was primarily left untreated due to cultural taboos and fear of loss of virginity. The main aim in presenting such rare case studies is to raise awareness and expand the diagnostic horizon of the surgeon for appropriate management.Case presentationWe describe a case of a 15-year-old North Indian, sexually inactive unmarried girl, who presented with a history of painless swelling in the left labia majora for the last 1 year, which gradually increased in size. There was no associated pain or any other difficulty. Local examination revealed a 14 × 10 cm solid, unilateral nonpedunculated mass on the left labia majora with superficial vascularity. Differential diagnoses of sarcoma, lipoma, Bartholin cyst, and fibroid were kept in mind. Ultrasonography revealed a solid mass with superficial vascularity with normal internal genitalia. The mass was enucleated with an intact capsule under anesthesia. Histopathology confirmed it to be benign vulvar leiomyoma. The patient was discharged after 3 days in a satisfactory condition.ConclusionLeiomyoma of the vulva is an exceptionally rare tumor and is seldom seen in teenagers. It is often misinterpreted as a Bartholin cyst and should be kept as one of the differential diagnosis in teenage girls presenting with unilateral vulvar swelling. Vulvar leiomyoma can be completely cured by surgical removal if diagnosed timely without compromising virginity, so should never be missed in adolescents.

The Therapeutic Intensity Score as Predictor of Clinical Outcomes after Total and Partial Adrenalectomy for Unilateral Primary Aldosteronism: Results of a Multicentric Series.

To evaluate the ability of therapeutic intensity score (TIS) in predicting the clinical outcomes of partial (PA) and total adrenalectomy (TA) for UPA. Between 2011 and 2022, a four-center adrenalectomy dataset was queried for "unilateral adrenal mass" and "UPA" (n = 90). Preoperative TIS of each antihypertensive medication were individually calculated and merged to create a single, cumulative variable. Probability of complete clinical, partial, and absent pooled success rates according to TIS were assessed for the overall cohort by Kaplan-Meier. Cox analyses were used to identify predictors of complete clinical and partial/absent success, respectively. For all analyses, a two-sided p < 0.05 was considered significant. At a median follow-up of 42 months (IQR 27-54) complete partial, and absent clinical success were observed in 60%, 17.7%, and 22.3%, respectively. On Kaplan-Meier analysis, TIS < 1 predicted higher complete success rates (p < 0.001), while TIS ≥ 1 was predictor of either partial and absent clinical success (p = 0.008). On multivariable analysis, TIS < 1 (HR 0.25; 95% CI 0.11-0.57; p = 0.001) and adenoma size (HR 1.11; 95% CI 1-1.23; p = 0.0049) were independent predictors of complete clinical success, while TIS ≥ 1 (HR 2.84; 95% CI 1.32-6.1; p = 0.007) was the only independent predictor of absent clinical success. TIS score and adenoma size may help to identify patients who are likely to be at risk of persistent hypertension after surgery.

Sinonasal Lymphoma: A Rare Pathology Presenting with Common Post-Influenza Symptoms

Sinonasal malignancies are uncommon and only account for 3% of head and neck cancers. Despite diffuse large B-cell lymphomas (DLBCL) being the most common type of non-Hodgkins lymphoma occurring at various extranodal sites, its occurrence as a sinonasal tumor is exceedingly rare. Early detection and treatment of sinonasal lymphoma, have favourable outcomes with improvements in the 2-year and 5-year survival rates. We are reporting a case of primary sinonasal DLBCL in a 63-year-old lady who initially presented with nasal obstruction and epistaxis, both common symptoms in patients who have had a recent Influenza A infection. However, due to the unilaterality and progressive nature of her nasal obstruction, she warranted a specialist otorhinolaryngology assessment. Naso endoscopy revealed a unilateral nasal mass extending from the right middle meatus to the nasal floor and was friable with contact bleeding. These clinical findings are similarly seen in most of the various types of sinonasal malignancies, and diagnosis can be challenging. Pathologists rely upon immunohistochemical staining profiles to differentiate this highly heterogeneous group of malignancies. Histopathological examination confirmed the diagnosis of sinonasal lymphoma. The treatment of this rare pathological entity is discussed. International Journal of Human and Health Sciences Supplementary Issue: 2023 Page: S28

Clinical and histopathological correlation of unilateral nasal mass – A retrospective observational study

INTRODUCTION: Nasal obstruction and nasal discharge are the most common symptoms in otorhinolaryngology practice; they may be unilateral or bilateral. Unilateral persistent nasal obstruction may indicate the presence of sinonasal lesion that could be inflammatory or neoplastic. Biopsy and histopathological examination of the nasal mass will give the definitive diagnosis, which was correlated with the clinical diagnosis.MATERIALS AND METHODS: This study was conducted retrospectively in a tertiary health care center after collecting the data of patients who underwent biopsy or surgical excision of unilateral nasal mass during 6 years period from January 2015 to December 2020. A total of 208 patients who met the inclusion criteria were included in the present study. These cases were subjected to a detailed history, clinical examination, nasal endoscopy, computed tomography scan, biopsy or excision biopsy, and histopathological examination. The data collected from these cases were compiled, analyzed, and conclusions were drawn.RESULTS: Of these 208 patients, majority (127; 61.1%) had non-neoplastic lesions while 81 (38.9%) had neoplastic lesions based on clinical diagnosis. Among patients with neoplastic lesions, 50 (61.7%) were benign and 31 (38.3%) were malignant.CONCLUSION: Antrochoanal polyp is the most common type of unilateral nasal mass, followed by inflammatory polyp among nonneoplastic lesions and hemangioma and inverted papilloma among neoplastic lesions in this study. Majority of the patients were in the age group of 11‒20 years. Nasal obstruction and rhinorrhea were the most common symptoms in majority of patients.

PS-R07-8: A CASE OF PRIMARY ALDOSTERONISM CAUSED BY BILATERAL ALDOSTERONE-PRODUCING MICROTUMORS WITH A UNILATERAL ADRENAL MASS

Introduction: Primary aldosteronism (PA) is defined as a disease in which overproduction of aldosterone causes various complications such as hypertension, cardiovascular disorder and kidney disease. We herein report a case of PA caused by bilateral aldosterone-producing microtumors with a unilateral adrenal mass. Case presentation: A 54-year-old man was referred to our hospital with a clinical suspicion of PA. He had a history of hypertension and chronic kidney disease for 10 years and had experienced paresthesia that was caused by putaminal hemorrhage in the past. In the initial examination, he exhibited hypertension (150/90 mmHg), high aldosterone (pg/mL)-to-renin (ng/mL/h) ratio (1,744), and overt hypokalemia (K, 2.9 mEq/L). The serum creatinine level was 1.89 mg/dL. The captopril challenge test showed no changes in his blood pressure or plasma aldosterone concentration. These results led to a clinical diagnosis of PA. Computed tomography (CT) revealed the presence of left adrenal mass, so that we suspected that the mass should be responsible for overproduction of aldosterone. We performed adrenal venous sampling. Unexpectedly, the adrenal venous sampling highly suggested the presence of aldosterone-producing microtumors in bilateral adrenal glands (lateralized ratio, 1.3; left contralateral ratio, 0.2). After evaluation, we decided that there was no indication for the removal of left adrenal mass. Then, a low dose of a mineralocorticoid receptor (MR) antagonist was started. Although the dose of an MR antagonist could not be increased sufficiently due to poor renal function, he exhibited an improved control of blood pressure and was followed up thereafter. Discussion and Conclusion: Although PA is one of the most common causes of secondary hypertension, making an accurate diagnosis and appropriate treatment is sometimes problematic due to the difficulty in assessing the site of aldosterone overproduction. The Japanese Endocrine Society clinical guideline states that PA with unilateral adrenal tumor in young patients may not require adrenal venous sampling. From the current case, however, we should always consider the possibility of bilateral microtumors or hyperplasia even in the presence of a unilateral adrenal mass.

Laparoscopic retroperitoneal lymph-node dissection in metastatic nonseminomatous germ-cell tumors.

To support laparoscopic post-chemotherapy retroperitoneal lymph-node dissection (L-PC-RPLND) as a potential new standard, we report on a large dataset of patients systematically undergoing L-PC-RPLND. Patients with unilateral residual mass (≥1cm), normalized markers, limited encasement (<30%) of gross retroperitoneal vessels underwent unilateral L-PC-RPLND with no adjuvant chemotherapy. Surgical performances, histology, hospital stay, complications within 30 days and follow-up visits were recorded. Multivariable linear and logistic regression models were used. Between February 2011 and January 2021, 151 consecutive patients underwent L-PC-RPLND. Median size of the residual mass was 25mm (interquartile range [IQR] 20-35mm). Overall median operative time was 208min (IQR 177-241) and was 51min longer (p-value <0.001) for right L-PC-RPLNDs. Eleven procedures were converted to open surgery. Median number of removed and positive nodes was 11 (IQR 8-16) and 1 (IQR 1-2), respectively. Mean hospital stay was 2 days (IQR 2-3). Nine complications (6%) occurred: two were Clavien-Dindo grade III. Definitive pathology revealed post-pubertal teratoma in 65.6%, fibro-necrotic tissue in 23.8%, teratoma with malignant somatic component in 6.6% and viable tumour in 4.0% patients. In multivariable linear regression models, fibro-necrotic tissue (32min, CI 8.5-55.5; p<0.01) and residual volume (1.05min, CI 0.24-1.85; p<0.01) achieved independent predictor status for longer operative time. All patients, but one, are alive and disease-free after a median follow-up of 22 months (IQR 10, 48). L-PC-RPLND, when adequately planned, is safe and effective for most patients with low to medium volume residual masses.

PS-C22-6: PERFORMANCE OF PREDICTION ALGORITHM FOR THE SUBTYPE DIAGNOSIS OF PRIMARY ALDOSTERONISM WHICH WAS ADVOCATED IN THE JAPAN PRIMARY ALDOSTERONISM STUDY

Objective: In the part of the Japan Primary Aldosteronism Study (JPAS), the prediction algorithm for the subtype diagnosis of primary aldosteronism (PA) was advocated and published in 2018 (Umakoshi.H et.al, J Clin Endocrinol Metab, 2018, 103(3):900–908). In the algorithm, patients with PA with bilateral normal results on CT and normokalemia likely have a low prior probability of a lateral form of PA in AVS (6.2%) and could be treated medically, whereas those with unilateral visible mass on CT and presence of hypokalemia have a high probability of a lateralized form of PA in AVS (70.6%). To validate the efficacy of the algorithm, we applied the algorithm for recent PA cases in our institute, Keio University hospital. Patients: A total of 77 patients with PA who underwent adrenal venous sampling (AVS) between November 2018 and October 2019 were enrolled in this study. They were classified into four groups according to CT findings and potassium status. Subtype diagnosis of PA was determined by AVS. Results: In our case, the prevalence for unilateral hyperaldosteronism on AVS was as follows: CT-negative with normokalemia, 7.9%; CT-positive with normokalemia, 15.4%; CT-negative with hypokalemia 22.2%, and CT-positive, 71.4%. The results were quite similar to the results in the previous report. In the algorithm, it was stated that AVS could be spared in patients with unilateral lesion on CT and hypokalemia if they were younger than 35 years, however, in our cases, there was one patient whose age was 30 with unilateral lesion on CT and hypokalemia and the AVS result of whom indicated bilateral PA. In the algorithm, it was also stated that AVS could be spared in patients with bilateral lesions on CT and normokalemia if plasma aldosterone concentration was less than 8 ng/dl and it was consistent in our cases. Conclusion: Overall, the prediction algorithm for the subtype diagnosis of PA developed in JPAS could be applied well in our recent PA cases.

Isolated unilateral lateral mass fracture of the C1 vertebrae, a systematic review and two case presentation

Isolated unilateral lateral mass fracture of the C1 vertebrae, a systematic review and two case presentation

Kimura Disease: A Diagnostic Perplexity

Introduction: Kimura disease (KD) is a rare condition of unknown etiology and pathogenesis. This is more common in young males of Asian descent. The most common clinical presentation is presence of unilateral subcutaneous mass in the head and neck region, especially in post-auricular area. We present a case of KD in 26- year- old Asian man who presented with subcutaneous mass behind both auricles. Case report: A 26- year- old man presented to ORL-HNS outpatient department of tertiary care centre with chief complaint of mass behind both ear for 5 months. Incisional biopsy was performed under local anesthesia. Histopathological examination report confirmed the case as KD. Patient was managed with intralesional triamcinolone injection. Conclusion: Kimura disease, though rare, should be considered in differential diagnosis of head and neck subcutaneous masses. A high-index of suspicion and tissue biopsy confirmation is essential to diagnose this condition.

Kimura's disease: A clinicopathological study of 23 cases.

Kimura's disease (KD) is an uncommon lymphoproliferative fibroinflammatory disorder. Patients present with head and neck subcutaneous nodules with or without lymphadenopathy. Peripheral blood eosinophilia and elevated serum immunoglobulin E (IgE) levels are typical. This study was designed to delineate the clinicopathological features, pattern of care, and disease course of 23 Taiwanese patients with KD. We retrospectively analyzed the clinical data of 23 consecutive cases (16 male and 7 female; age at diagnosis: 12-77 years) of KD diagnosed at our institution from 2015 to 2020. The median time from presentation to diagnosis was 1 month. Twenty-one patients presented with unilateral or bilateral head and neck masses. The remaining two presented with right flank and right arm lesions, respectively. Peripheral blood eosinophilia was observed in nine, and elevated IgE levels were observed in four. All were diagnosed using either excisional or core-needle biopsy. Seven patients underwent fine needle aspiration without a diagnostic yield. Salivary gland and lymph node involvement was observed in three and seven patients, respectively. Most lesions showed tissue eosinophilia (100%) and florid follicular hyperplasia (78.26%). Three cases had histological KD-IgG4-RD overlap and three had comorbid IgG4-RD were recognized. Thirteen patients underwent surgical resection, one received adjuvant therapy, and two received prednisolone monotherapy. KD should be considered in patients with subcutaneous masses, eosinophilia, and elevated IgE levels. Biopsy remains the gold standard of diagnosis. Increased recruitment of IgG4+ plasma cells is a common feature. Consideration of IgG4-RD in all KD patients may be prudent.

The Etiological Profile of Adrenal Incidentalomas.

Introduction An adrenal incidentaloma (AI) is an unsuspected tumor in one or both adrenal glands, whichis discovered incidentally on an imaging exam not prompted by adrenal exploration. The etiologies can be multiple; they condition therapeutic management. The objective of our study is to describe the etiological and therapeutic profiles of AI in our department. Materials and methods A retrospective study was carried out in theEndocrinology, Diabetology, and Nutrition Department of the Hassan II University Hospital of Fezon patients managed for AI from September 2009 until March 2022. We included all the patients who were followed and/or hospitalized for adrenal incidentalomas. Results There were 86, predominantly female, patients (67.85%). The mean age was 58.91+/-14.40 years. The clinical findings were a unilateral adrenal mass in 73.25% of patients, localized on the left in 39.53%, on the right in 33.72%, and a bilateral one in 26.75%. Its size varied from 12 to 196 mm, with an average of 35.5 mm. The most common etiologies found in our series were a non-functional adrenal adenoma in 54.56%, a subclinical cortisolic adenoma in 19.76%, an adrenocortical carcinomain 5.81%, and a pheochromocytoma in 5.81%. Adrenalectomy was indicated in 19.76% of our patients, 17.44% were monitored closely, 20.94% were monitored for comorbidities, and 41.86% had been advised to abstain from treatment. Conclusion An adrenal incidentaloma has become more and more frequent. It constitutes an entity with various etiologies, which can be serious. The main etiology in our serieswas non-functioning adrenal adenoma, for which therapeutic abstention was indicated in 48% of cases.

Allergic fungal rhinosinusitis presented as a unilateral nasal mass: A first case report from Thailand and literature review

Allergic fungal rhinosinusitis (AFRS) is a relatively new inflammatory sinonasal disease. Prevalence of the disease is reported to be highly different across Asia. A 23-year-old Thai male came to our hospital with left-sided nasal obstruction. Endoscopic examination found a mass originated from the left sphenoethmoidal recess. Incisional biopsy result of the mass indicated an inflammatory process and high level of serum specific IgE to several aeroallergens was found. Based on the biopsy results and other investigations, the diagnosis of AFRS was made and the patient was treated successfully with endoscopic sinus surgery and postoperative systemic/topical steroids. While AFRS is quite common in some regions, the disease is rarely encountered in Thailand and can be presented as a unilateral lesion, mimicking a tumor mass, which could lead to an incorrect diagnosis and inappropriate treatment. Even though AFRS is rarely reported in our country, it still can be found and might be recognized falsely as a neoplastic process. High level of awareness of the disease features could help to minimize inappropriate disease management.

A case of unilateral post-COVID-19 adrenal haemorrhage and follow-up during pregnancies.

The spectrum of endocrine-related complications of COVID-19 infection is expanding; one of the most concerning of which is adrenal haemorrhage due to the risk of catastrophic adrenal crisis. In this study, we present a case that highlights the challenging management of a large, indeterminate unilateral adrenal mass during pregnancy and draws attention to a rare yet probably underestimated complication of COVID-19. During hospitalization for severe COVID-19 pneumonia, a 26-year-old woman was incidentally found to have a 12.5 cm heterogeneous left adrenal mass. Soon after the discovery, she became pregnant and upon referral, she was in the seventh week of gestation, without clinical or biochemical features of hormonal excess. The uncertainty of the diagnosis and the risks of malignancy and surgical intervention were discussed with the patient, and a period of radiological surveillance was agreed upon. An MRI scan performed 3 months later showed a size reduction of the adrenal lesion to 7.9 cm, which was against malignancy. A Doppler ultrasound showed a non-vascular, well-defined round lesion consistent with an adrenal haematoma, likely a complication of the recent COVID-19 infection. The multidisciplinary team recommended further radiological follow-up. The patient then spontaneously had miscarriage at 12 weeks gestation. Subsequent radiological surveillance showed a further size reduction of the adrenal lesion to 5.5 cm. The patient conceived again during follow-up, and the repeated Doppler ultrasound showed stable appearances of the adrenal mass, and thus, it was agreed to continue radiological monitoring after delivery. The pregnancy was uneventful, and the patient delivered a healthy baby. An MRI scan performed after delivery showed a stable but persistent lesion consistent with a likely underlying adrenal lesion. Unilateral adrenal haemorrhage can occur as a complication of COVID-19 and should be considered in the differential diagnosis of heterogeneous adrenal masses if there is a history of recent infection. Management of large indeterminate adrenal masses during pregnancy poses several challenges and should be led by an experienced multidisciplinary team. Underlying adrenal tumours may trigger non-traumatic haemorrhages, especially if exacerbated by stressful illness.

Pediatric Small Renal Masses: Can Tumor Size Predict Histology and the Potential for Nephron-sparing Surgery?

The majority of children with unilateral renal masses suspicious for malignancy undergo radical nephrectomy, while nephron-sparing surgery is reserved for select cases. We investigated the impact of tumor size on the probability of histology. We hypothesized that pediatric small renal masses are more likely benign or non-Wilms tumor, thus potentially appropriate for nephron-sparing surgery. The SEER (Surveillance, Epidemiology, and End Results) database was analyzed for patients aged 0-18 years diagnosed with a unilateral renal mass from 2000-2016. Statistical analysis was performed to help determine a tumor size cut point to predict Wilms tumor and assess the predictive value of tumor size on Wilms tumor histology. Additionally, a retrospective review was performed of patients 0-18 years old who underwent surgery for a unilateral renal mass at a single institution from 2005-2019. Statistical analysis was performed to assess the predictive value of tumor size on final histology. From the SEER analysis, 2,016 patients were included. A total of 1,672 tumors (82.9%) were Wilms tumor. Analysis revealed 4 cm to be a suitable cut point to distinguish non-Wilms tumor. Tumors ≥4 cm were more likely Wilms tumor (OR 2.67, P ≤ .001), but this was driven by the statistical significance in children 5-9 years old. From the institutional analysis, 134 patients were included. Ninety-seven tumors (72.3%) were Wilms tumor. Tumors ≥4 cm had higher odds of being Wilms tumor (OR 30.85, P = .001), malignant (OR 6.75, P = .005), and having radical nephrectomy-appropriate histology (OR 46.79, P < .001). The probability that a pediatric unilateral renal mass is Wilms tumor increases with tumor size. Four centimeters is a logical cut point to start the conversation around defining pediatric small renal masses and may help predict nephron-sparing surgery-appropriate histology.

Sinonasal angiomatous polyp: a case report

&lt;p&gt;Sinonasal angiomatous polyp (SAP) is a rare variant of sino-nasal polyp. Sinonasal inflammatory polyps are classified histo-pathologically into 5 types: edematous, glandular, fibrous, cystic and angiomatous. They present with various different patterns and clinical features like epistaxis, nasal discharge, nasal blockage and characterised histo-pathologically by presence of prominent dilated capillary-type blood vessels. It constitutes about 4-5% of all nasal polyps. They usually present as a unilateral, painless, soft, gelatinous, translucent and polypoidal mass in nasal cavity. These polyps can grow rapidly and aggressively causing erosion of bone and severe bleeding like a cancerous lesion, making difficult to differentiate it from malignant lesion. Various differential diagnosis of SAP include inflammatory polyp, haemangioma, mucocele, fungus ball, inverted papilloma, juvenile naso-pharyngeal angiofibroma, and malignant tumors like squamous cell carcinoma, adenoid cystic carcinoma, and melanoma MRI is considered better than CT scan for diagnosis. Treatment of choice is endoscopic surgical excision with restoration of sinus drainage.&lt;/p&gt;&lt;p&gt;.&lt;/p&gt;