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International Journal of Surgery Case... Jun 2024Disseminated Peritoneal Leiomyomatosis (DPL) is a rare benign proliferation of solid peritoneal lesions along the abdominopelvic cavity comprised of smooth muscle and...
INTRODUCTION AND IMPORTANCE
Disseminated Peritoneal Leiomyomatosis (DPL) is a rare benign proliferation of solid peritoneal lesions along the abdominopelvic cavity comprised of smooth muscle and connective tissue. Though hormonal and iatrogenic causes have been theorized, the exact etiology remains unknown. Most patients with DPL are frequently premenopausal with a history of myomectomy or prior hysterectomy. These patients can present asymptomatically or with abnormal uterine bleeding and abdominal discomfort. DPL is a rare entity with less than 150 cases reported in the literature, showcasing the need of awareness of this poorly understood neoplasm. Imaging, if performed, is helpful as positron emission tomography (PET) can differentiate DPL from malignant peritoneal disease. Treatment involves medical and surgical options based on patient's clinical presentation, with medical treatment with gonadotropin-releasing hormone agonist being first line.
CASE PRESENTATION
We report a case of a previously healthy female presenting for desired laparoscopic tubal ligation with incidental countless peritoneal nodules suspicious for carcinomatosis found during the operative event but proven leiomyomas after histologic examination.
CLINICAL DISCUSSION
Differentiating DPL from mimickers such as leiomyosarcoma, endometriosis, and carcinomatosis remains a challenge as macroscopic appearances are similar ultimately requiring histology evaluation.
CONCLUSION
Awareness of the entity is crucial to avoid misdiagnosis and unnecessary anxiety associated with a presumptive diagnosis of malignancy for a largely benign entity.
PubMed: 38878730
DOI: 10.1016/j.ijscr.2024.109908 -
Medicine Jun 2024Most adrenal tumors are benign and primary adrenal malignancies are relatively rare. Primary adrenal lymphoma (PAL) is a very rare and highly aggressive malignant tumor...
INTRODUCTION
Most adrenal tumors are benign and primary adrenal malignancies are relatively rare. Primary adrenal lymphoma (PAL) is a very rare and highly aggressive malignant tumor with unknown etiology, atypical clinical symptoms, nonspecific imaging manifestations, difficult disease diagnosis and poor prognosis.
CASE REPORT
This case report details a 42-year-old woman who was admitted to the hospital with a 1-year-old bilateral adrenal mass and 1-month-old left upper abdominal pain. Enhanced CT of the abdomen showed a right adrenal nodule and a large occupying lesion in the left adrenal region, with a high probability of pheochromocytoma. Intraoperatively, a huge tumor measuring about 12*12*10 cm was found in the left adrenal region, infiltrating the left kidney, spleen and pancreatic tail. Postoperative pathology: lymphocytes were found in the renal capsule and subcapsule, lymphocytes were found in the pancreas; lymphocytes were found in the spleen. Consider a tumor of the lymphohematopoietic system, possibly lymphoma.
CONCLUSION
This case demonstrates that primary adrenal diffuse large B-cell lymphoma (PADLBCL) is highly aggressive, has a poor prognosis, is prone to recurrence, has poor therapeutic outcomes, and is difficult to diagnose. Clinicians should consider the possibility of PADLBCL when encountering huge adrenal-occupying lesions and consider chemotherapy before surgery. Reducing the tumor size before surgery is a more favorable therapeutic approach, thus prolonging the patient life and improving the quality of survival.
Topics: Humans; Female; Lymphoma, Large B-Cell, Diffuse; Adrenal Gland Neoplasms; Adult; Tomography, X-Ray Computed; Adrenal Glands
PubMed: 38875421
DOI: 10.1097/MD.0000000000038298 -
Diagnostic and Interventional Radiology... Jun 2024Non-neoplastic tumor-like conditions of the liver can appear similar to hepatic neoplasms. In many cases, a biopsy is required to confirm the pathology. However, several...
Non-neoplastic tumor-like conditions of the liver can appear similar to hepatic neoplasms. In many cases, a biopsy is required to confirm the pathology. However, several tumor-like conditions can be correctly diagnosed or suggested prospectively, thus saving patients from unnecessary anxiety and expense. In this image-focused review, we present the ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography scan features of eight such entities. Clues that indicate the correct pathology are discussed, and the usual clinical setting is described. Many of these lesions are treated differently from true neoplasms, and the current treatment plan is discussed in many of the cases presented. After reviewing this article, the reader will have a better understanding of these lesions and the situations in which they should be included in the differential diagnosis.
PubMed: 38874132
DOI: 10.4274/dir.2024.242826 -
Mathematical Biosciences and... Apr 2024Precise segmentation of liver tumors from computed tomography (CT) scans is a prerequisite step in various clinical applications. Multi-phase CT imaging enhances tumor...
Precise segmentation of liver tumors from computed tomography (CT) scans is a prerequisite step in various clinical applications. Multi-phase CT imaging enhances tumor characterization, thereby assisting radiologists in accurate identification. However, existing automatic liver tumor segmentation models did not fully exploit multi-phase information and lacked the capability to capture global information. In this study, we developed a pioneering multi-phase feature interaction Transformer network (MI-TransSeg) for accurate liver tumor segmentation and a subsequent microvascular invasion (MVI) assessment in contrast-enhanced CT images. In the proposed network, an efficient multi-phase features interaction module was introduced to enable bi-directional feature interaction among multiple phases, thus maximally exploiting the available multi-phase information. To enhance the model's capability to extract global information, a hierarchical transformer-based encoder and decoder architecture was designed. Importantly, we devised a multi-resolution scales feature aggregation strategy (MSFA) to optimize the parameters and performance of the proposed model. Subsequent to segmentation, the liver tumor masks generated by MI-TransSeg were applied to extract radiomic features for the clinical applications of the MVI assessment. With Institutional Review Board (IRB) approval, a clinical multi-phase contrast-enhanced CT abdominal dataset was collected that included 164 patients with liver tumors. The experimental results demonstrated that the proposed MI-TransSeg was superior to various state-of-the-art methods. Additionally, we found that the tumor mask predicted by our method showed promising potential in the assessment of microvascular invasion. In conclusion, MI-TransSeg presents an innovative paradigm for the segmentation of complex liver tumors, thus underscoring the significance of multi-phase CT data exploitation. The proposed MI-TransSeg network has the potential to assist radiologists in diagnosing liver tumors and assessing microvascular invasion.
Topics: Humans; Liver Neoplasms; Contrast Media; Tomography, X-Ray Computed; Microvessels; Algorithms; Neoplasm Invasiveness; Image Processing, Computer-Assisted; Liver; Radiographic Image Interpretation, Computer-Assisted; Male; Female
PubMed: 38872556
DOI: 10.3934/mbe.2024253 -
International Journal of Surgery Case... Jun 2024Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare neoplasms, accounting for only 1 %-2 % of all pancreatic tumors, and predominantly affect female patients.
INTRODUCTION
Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare neoplasms, accounting for only 1 %-2 % of all pancreatic tumors, and predominantly affect female patients.
CASE PRESENTATION
The present case report details a patient presenting to the emergency department with abdominal pain for 3 days who ultimately received a diagnosis of SPNs in the pancreatic body and tail. A contrast-enhanced computed tomography (CT) scan revealed a sizable mass arising from the pancreas, featuring an enhancing cystic component with involvement of the liver and spleen. The patient underwent subsequent exploratory laparotomy, a distal pancreatectomy, splenectomy, and partial hepatectomy. SPN diagnosis was confirmed by histopathology and immunohistochemistry with negative resection margins.
CLINICAL DISCUSSION
Approximately 70 % of SPN cases are asymptomatic and are incidentally discovered. Despite advances in diagnostic modalities, preoperative diagnosis of SPNs remains a clinical challenge. Surgical management with negative resection margins remains the primary treatment approach. The recurrence rate after surgical resection has been reported to be 3 %-9 %. The prognosis for SPNs limited to the pancreas is generally favorable, with a cure rate exceeding 95 % after complete surgical resection.
CONCLUSION
An SPN of the pancreas is a rare tumor observed in young female patients. Although it is classified as a malignant tumor, SPN has low malignant potential. Aggressive surgical resection, however, has proven effective in curing SPN for the majority of patients.
PubMed: 38870658
DOI: 10.1016/j.ijscr.2024.109867 -
Tuberkuloz Ve Toraks Jun 2024Tuberculosis (TB) is an airborne infectious disease caused by Mycobacterium tuberculosis (MTB). Although it typically affects the lungs (pulmonary TB), one-fifth of TB...
Tuberculosis (TB) is an airborne infectious disease caused by Mycobacterium tuberculosis (MTB). Although it typically affects the lungs (pulmonary TB), one-fifth of TB cases present as extrapulmonary TB. The diagnosis of extrapulmonary TB is often overlooked due to its atypical clinical and radiological manifestations. Differentiating TB from neoplastic conditions poses significant challenges. A 33-year-old female patient was admitted to the emergency clinic with shortness of breath, cough, and abdominal pain. Postero-anterior chest X-ray revealed massive pleural effusion leading to mediastinal shift. With a preliminary diagnosis of malignant pleural effusion, a pleural catheter was inserted, and the patient was referred for a positron emission tomography (PET/CT) to assess the primary site and the optimal location for a biopsy. The PET/CT revealed asymmetric soft tissue thickening on the left side of the nasopharynx, and increased fluorodeoxyglucose (FDG) uptake in the left cervical lymph nodes raised suspicion regarding primary nasopharyngeal cancer. Additionally, there was an increased FDG uptake observed in the mass lesion located in the right upper lobe, mediastinal lymph nodes, pleural surfaces in the left hemithorax, perihepatic areas, and peritoneum, indicating diffuse metastatic disease. Tuberculosis diagnosis was confirmed through biopsies demonstrating granulomatous inflammation in the lung and nasopharynx, along with culturing MTB from pleural effusion. Positron emission tomography played a crucial role in identifying sites of TB involvement. Despite its rarity, healthcare professionals should consider nasopharyngeal TB as a potential diagnosis when evaluating nasopharyngeal masses.
Topics: Humans; Female; Adult; Diagnosis, Differential; Positron Emission Tomography Computed Tomography; Tuberculosis; Fluorodeoxyglucose F18; Neoplasm Metastasis
PubMed: 38869209
DOI: 10.5578/tt.202402915 -
The Journal of International Medical... Jun 2024We herein report a rare case of simultaneous intrauterine molar pregnancy and tubal pregnancy. A woman of childbearing age who had never been pregnant underwent an...
We herein report a rare case of simultaneous intrauterine molar pregnancy and tubal pregnancy. A woman of childbearing age who had never been pregnant underwent an ultrasound examination 70 days after the onset of menopause. She had a history of ovulation induction. The ultrasound findings suggested a partial hydatidiform mole. She was then pathologically confirmed to have a complete hydatidiform mole after uterine suction dilation and curettage. On postoperative day 4, an ultrasound examination before discharge showed an inhomogeneous mass in the left adnexal region with mild lower abdominal pain. On postoperative day 17, the blood human chorionic gonadotropin level did not drop as expected, and a follow-up examination still indicated a mass in the left adnexal region. We were unable to rule out an ectopic hydatidiform mole. Hysteroscopy with laparoscopic exploration of the left adnexal mass and salpingotomy suggested a diagnosis of intrauterine hydatidiform mole combined with left tubal pregnancy.
Topics: Humans; Female; Pregnancy; Hydatidiform Mole; Pregnancy, Tubal; Adult; Uterine Neoplasms; Pregnancy, Heterotopic; Ultrasonography
PubMed: 38869107
DOI: 10.1177/03000605241258572 -
CNS Oncology Jun 2024Primary effusion lymphoma (PEL) is an uncommon B-cell lymphoma associated with human herpesvirus 8 and comprises 3-4% of all HIV-related lymphomas. It traditionally...
Primary effusion lymphoma (PEL) is an uncommon B-cell lymphoma associated with human herpesvirus 8 and comprises 3-4% of all HIV-related lymphomas. It traditionally presents as a pleural, pericardial, and/or peritoneal effusion, though it can occasionally manifest as an extracavitary or solid mass in the absence of an effusion. The extracavitary or solid variant of primary effusion lymphoma has been reported in the skin, gastrointestinal tract, lung, and lymph nodes. However, very few cases have been reported in the central nervous system. We describe a case of extracavitary or solid variant of primary effusion lymphoma presenting as a brain mass in an HIV-positive man, highlighting the clinicopathologic and immunophenotypic findings of a rare entity.
Topics: Humans; Lymphoma, Primary Effusion; Male; Brain Neoplasms; Middle Aged
PubMed: 38864818
DOI: 10.1080/20450907.2024.2357535 -
Iranian Journal of Pathology 2024The occurrence of rectosigmoid junction inflammatory myofibroblastic tumor (IMT) is uncommon in children. This is a rare form of mesenchymal tumor, belonging to the...
The occurrence of rectosigmoid junction inflammatory myofibroblastic tumor (IMT) is uncommon in children. This is a rare form of mesenchymal tumor, belonging to the category of soft tissue tumors, and can be found at any anatomical site from the central nervous system to the gastrointestinal tract. Our patient was a 10-year-old male subject complaining of lack of defecation and constipation. The patient had decreased the frequency of defecation and constipation about two weeks before his referral and had not improved despite the use of laxatives. The abdomen was completely distended and there was no tenderness or guarding in the examination. Several airfluid levels are shown on the abdominal X-ray. In the ultrasound, free fluid was reported in the interlobular and pelvic spaces. The patient was transferred into the operating room. A tumor of the rectosigmoid junction was detected. Histopathologic studies showed evidence of IMT. IMT is a rare neoplasm of unknown origin, which may occur in various sites of the body. Complete surgical removal is usually curative, but early detection of recurrence is required. Treatment options include chemotherapy, radiation therapy, and immunotherapy. Further investigations are needed to improve the understanding and management of this rare tumor.
PubMed: 38864087
DOI: 10.30699/ijp.2024.2003653.3122 -
Journal of Surgical Case Reports Jun 2024Isolated splenic lymphangiomas are rare benign lesions mostly seen in children are exceptionally rare in adults, often discovered incidentally due to their typically...
Isolated splenic lymphangiomas are rare benign lesions mostly seen in children are exceptionally rare in adults, often discovered incidentally due to their typically asymptomatic nature. This case report elaborates on the surgical excision of a rare splenic cystic lymphangioma in a 33-year-old woman, underscoring the diagnostic and therapeutic challenges these tumors pose. The patient's symptoms, abdominal pain and a palpable mass led to imaging through ultrasound and CT, which revealed a cystic splenic lesion. Total splenectomy was performed, revealing a large cystic mass, with pathological examination confirming a cystic lymphangioma. This case emphasizes the necessity of considering splenic lymphangiomas in adult patients presenting with splenic lesions. It also highlights the critical role of surgical interventions for definitive diagnosis and to prevent complications such as rupture and hemorrhage, thereby emphasizing on the complexity of managing rare splenic tumors.
PubMed: 38863957
DOI: 10.1093/jscr/rjae411