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International Medical Case Reports... 2024Pancreatic pseudocysts are benign lesions that typically originate within the pancreatic parenchyma, or peripancreatic tissue. They commonly occur following recurrent...
Pancreatic pseudocysts are benign lesions that typically originate within the pancreatic parenchyma, or peripancreatic tissue. They commonly occur following recurrent episodes of pancreatitis or trauma. In this article, we present a case of a giant pancreatic pseudocyst with unusual trans-spatial extensions and spontaneous size decrement in a 40-year-old male patient with a history of alcohol abuse. He presented with chronic epigastric pain, and a physical examination showed only mild abdominal tenderness. Initial computed tomography showed a giant (18.4cm in its largest axis) pancreatic pseudocyst with left subdiaphragmatic and gastrohepatic extensions and concurrent splenic cysts. On follow-up ultrasound, the pseudocyst showed a significant spontaneous size decrement to less than half of its initial size. The giant size and trans-spatial characteristics of the pseudocyst, along with a relatively benign symptomatology and subsequent spontaneous shrinkage, constitute unique aspects of this case.
PubMed: 38596401
DOI: 10.2147/IMCRJ.S458492 -
World Journal of Orthopedics Mar 2024Tumoral calcinosis is a condition characterized by deposits of calcium phosphate crystals in extra-articular soft tissues, occurring in hemodialysis patients. Calcium...
BACKGROUND
Tumoral calcinosis is a condition characterized by deposits of calcium phosphate crystals in extra-articular soft tissues, occurring in hemodialysis patients. Calcium phosphate crystals are mainly composed of hydroxyapatite, which is highly infiltrative to tissues, thus making complete resection difficult. An adjuvant method to remove or resolve the residual crystals during the operation is necessary.
CASE SUMMARY
A bicarbonate Ringer's solution with bicarbonate ions (28 mEq/L) was used as the adjuvant. After resecting calcium phosphate deposits of tumoral calcinosis as much as possible, while filling with the solution, residual calcium phosphate deposits at the pseudocyst wall can be gently scraped by fingers or gauze in the operative field. A 49-year-old female undergoing hemodialysis for 15 years had swelling with calcium deposition for 2 years in the shoulders, bilateral hip joints, and the right foot. A shoulder lesion was resected, but the calcification remained and early re-deposition was observed. Considering the difficulty of a complete rection, we devised a bicarbonate dissolution method and excised the foot lesion. After resection of the calcified material, the residual calcified material was washed away with bicarbonate Ringer's solution.
CONCLUSION
The bicarbonate dissolution method is a new, simple, and effective treatment for tumoral calcinosis in hemodialysis patients.
PubMed: 38596192
DOI: 10.5312/wjo.v15.i3.302 -
Imaging Science in Dentistry Mar 2024This study aimed to evaluate age-stratified radiographic features in temporomandibular joint osteoarthritis using cone-beam computed tomography.
PURPOSE
This study aimed to evaluate age-stratified radiographic features in temporomandibular joint osteoarthritis using cone-beam computed tomography.
MATERIALS AND METHODS
In total, 210 joints from 183 patients (144 females, 39 males, ranging from 12 to 88 years old with a mean age of 44.75±19.97 years) diagnosed with temporomandibular joint osteoarthritis were stratified by age. Mandibular condyle position and bony changes (flattening, erosion, osteophytes, subchondral sclerosis, and subchondral pseudocysts in both the condyle and articular eminence, thickening of the glenoid fossa, joint space narrowing, and joint loose bodies) were evaluated through cone-beam computed tomography. After adjusting for sex, the association between age groups and radiographic findings was analyzed using both a multiple regression model and a multinomial logistic regression model (α=0.05).
RESULTS
The prevalence of joint space narrowing and protruded condyle position in the glenoid fossa significantly increased with age (<0.05). The risks of bony changes, including osteophytes and subchondral pseudocysts in the condyle; flattening, erosion, osteophyte, and subchondral sclerosis in the articular eminence; joint loose bodies; and thickening of the glenoid fossa, also significantly rose with increasing age (<0.05). The number of radiographic findings increased with age; in particular, the increase was more pronounced in the temporal bone than in the mandibular condyle (<0.05).
CONCLUSION
Increasing age was associated with a higher frequency and greater diversity of bony changes in the temporal bone, as well as a protruded condyle position in the glenoid fossa, resulting in noticeable joint space narrowing in temporomandibular joint osteoarthritis.
PubMed: 38571783
DOI: 10.5624/isd.20230229 -
Surgical Case Reports Apr 2024Pancreatic adenosquamous cell carcinoma (PASC) is a relatively rare histological type of pancreatic malignancy, and preoperative diagnosis is difficult because of its...
BACKGROUND
Pancreatic adenosquamous cell carcinoma (PASC) is a relatively rare histological type of pancreatic malignancy, and preoperative diagnosis is difficult because of its rarity. PASC accounts for 1-4% of all pancreatic cancers, and even after curative surgery, its prognosis is poorer than that of ordinary pancreatic adenocarcinoma. Pathologically, it shows glandular and squamous differentiation of cells. Complete resection is the only method to achieve a good long-term prognosis, and an increasing doubling time of PASC is considered to indicate early recurrence after surgery. Here, we report a rare case of PASC with an infected pancreatic cyst that was difficult to treat, along with a review of the literature.
CASE PRESENTATION
A woman in her 80s with a history of breast cancer presented with pericardial pain. Computed tomography revealed a 20-mm hypovascular tumor in the body of the pancreas and a 27-mm pseudocyst. Endoscopic retrograde cholangiopancreatography showed a severe main pancreatic duct stenosis in the body of the pancreas that made cannulation impossible, and contrast media extravasation was due to pancreatic duct disruption in the pancreatic tail. Endoscopic fine-needle aspiration revealed that the tumor was a PASC. Because the patient had an infected pancreatic cyst, central intravenous nutrition and antibiotics were administered, which stabilized her general condition. She was diagnosed with resectable PASC and underwent distal pancreatectomy with lymphadenectomy. The postoperative course was uneventful. Immunohistochemical analysis of the resected specimen confirmed T2N0M0 stage IB. Systemic adjuvant chemotherapy with S-1 is ongoing.
CONCLUSION
Appropriate preoperative management and preoperative accurate staging (T2N0M0 stage IB) of PASC with curative surgery can ensure predictable outcomes.
PubMed: 38557796
DOI: 10.1186/s40792-024-01868-z -
Journal of Medical Case Reports Mar 2024Pancreaticopleural fistula is a rare complication of pancreatitis and poses diagnostic and therapeutic challenges. This case report sheds light on the unique challenges... (Review)
Review
BACKGROUND
Pancreaticopleural fistula is a rare complication of pancreatitis and poses diagnostic and therapeutic challenges. This case report sheds light on the unique challenges posed by pancreaticopleural fistula as a rare complication of pancreatitis. The aim is to contribute valuable insights to the scientific literature by presenting a case involving a middle-aged man with acute necrotizing pancreatitis and associated pleural effusion.
CASE PRESENTATION
A 41-year-old Asian male with a history of pancreatitis and chronic alcohol use presented with severe dyspnea, chest pain, and left-sided pleural effusion. Elevated serum amylase lipase levels and imaging confirmed acute necrotizing pancreatitis with a computed tomography severity index of 8/10. Magnetic resonance cholangiopancreatography revealed pancreatic necrosis and pseudocyst formation and findings suggestive of pancreaticopleural fistula. The patient was then treated with octreotide therapy.
CONCLUSION
The management of pancreaticopleural fistula demands a comprehensive and individualized approach. Recognition guided by high clinical suspicion coupled with appropriate investigations and a careful balance between medical, endoscopic, and surgical interventions is crucial for achieving favorable outcomes. This case report adds to the scientific literature by providing insights into the complexities of pancreaticopleural fistula and emphasizing the importance of personalized strategies in its management.
Topics: Adult; Humans; Male; Cholangiopancreatography, Endoscopic Retrograde; Pancreatic Fistula; Pancreatitis, Acute Necrotizing; Pleural Diseases; Pleural Effusion; Respiratory Tract Fistula
PubMed: 38549170
DOI: 10.1186/s13256-024-04457-8 -
Surgical Case Reports Mar 2024Mesenteric cysts are one of the rarest abdominal tumor masses, representing a little-studied pathology. In turn, the variability and non-specificity of clinical...
BACKGROUND
Mesenteric cysts are one of the rarest abdominal tumor masses, representing a little-studied pathology. In turn, the variability and non-specificity of clinical manifestations make diagnosis difficult, as it can be reached by imaging findings due to another cause or by non-specific abdominal pain.
CASE PRESENTATION
This article describes the case report of an asymptomatic 28-year-old patient who presented a 6-cm abdominal cystic mass with mixed density, which was found incidentally by computed tomography. Exploratory laparoscopy was performed followed by conversion to conventional surgery to extract the tumor mass. The anatomical pathology diagnosis was pseudocyst of the mesentery root. Mesenteric cysts are one of the rarest abdominal tumor masses, representing a little-studied pathology. In turn, the variability and non-specificity of clinical manifestations make diagnosis difficult, as it can be reached by imaging findings due to another cause or by non-specific abdominal pain.
CONCLUSIONS
Mesenteric cysts are rare, and their nonspecific symptoms often lead to diagnosis based on imaging findings. Complete laparoscopic enucleation is the standard treatment.
PubMed: 38548968
DOI: 10.1186/s40792-024-01830-z -
Cureus Feb 2024Retroperitoneal chyloma is a rare entity that presents with non-specific symptoms. Although benign, it can cause complications due to the mass effect. In this case...
Retroperitoneal chyloma is a rare entity that presents with non-specific symptoms. Although benign, it can cause complications due to the mass effect. In this case report, we present the case of a 24-year-old woman who presented with a complaint of left-sided colicky abdominal pain and mild dysuria for one year. On physical examination, there was only mild abdominal tenderness. Computed tomography (CT) revealed a thick-walled cystic retroperitoneal mass with a small amount of fat in the superior part and a displaced left hydronephrotic kidney. Magnetic resonance imaging (MRI) confirmed the findings and also revealed a fat-fluid level in the cyst. A laparotomy was performed, and the cystic mass, containing milky fluid, was excised. Histopathology showed a pseudocyst with chronic inflammation and a xanthomatous reaction, with no evidence of infection or malignancy. The patient recovered without complications and has not had a recurrence so far. Retroperitoneal chyloma is difficult to diagnose preoperatively. A definitive diagnosis is usually made only after surgery and a histopathological examination. The treatment of choice is a complete excision. Other approaches, such as marsupialization or drainage, will likely result in a recurrence. However, surgery in the retroperitoneal space is associated with a risk of injury to major vessels or organs. In conclusion, retroperitoneal chyloma is a rare entity that is best treated by complete excision. For small lesions, a wait-and-watch approach may be advisable.
PubMed: 38544606
DOI: 10.7759/cureus.54924 -
International Journal of Molecular... Mar 2024Undetermined pancreatic cystic lesion (PCL) differentiation benefits from endoscopic ultrasound (EUS) based on morphology and cyst fluid analysis, but room for new...
Undetermined pancreatic cystic lesion (PCL) differentiation benefits from endoscopic ultrasound (EUS) based on morphology and cyst fluid analysis, but room for new biomarkers exists. Our aim was to assess the intracystic and serum diagnostic value of neutrophil gelatinase-associated lipocalin (Ngal) and interleukin 1 beta (IL-1β) for differentiation of PCLs. This prospective study included patients from one tertiary hospital, evaluated between April 2018 and May 2020. EUS fine-needle aspiration or pancreatic pseudocysts drainage was the source of PCL intracystic liquid. The final diagnosis was based on surgery or EUS results (morphology, cytology, glucose, and CEA-carcinoembryogenic antigen). The intracystic samples were tested for Ngal, IL-1β, glucose, and CEA, and serum for Ngal and IL-1β. We evaluated 63 cysts, 33 pseudocysts, and 30 non-inflammatory cysts. The diagnostic sensitivity and specificity for mucinous PCL was 70.8% and 92.3% for intracystic Ngal (cut-off: 500-800 ng/dL), without correlation with serum Ngal, no matter the inclusion of infected pseudocysts. After exclusion of infected pseudocysts, the sensitivity and specificity for glucose were 87% and 75%, respectively, and for CEA, they were 87.1%, and 96.8%, respectively. Intracystic Ngal shows promise in differentiating mucinous PCLs, but researchers need to conduct further studies to confirm its effectiveness. Intracystic IL-1β and serum Ngal made no diagnostic contribution.
Topics: Humans; Carcinoembryonic Antigen; Glucose; Lipocalin-2; Pancreatic Cyst; Pancreatic Neoplasms; Prospective Studies
PubMed: 38542201
DOI: 10.3390/ijms25063224