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Journal of Visceral Surgery Jun 2020Discovery of an adrenal mass is nowadays a frequent situation. While adrenal tumors can cause a variety of symptoms, more often than not they are diagnosed incidentally... (Review)
Review
Discovery of an adrenal mass is nowadays a frequent situation. While adrenal tumors can cause a variety of symptoms, more often than not they are diagnosed incidentally on imaging exams such as CT-scan or MRI performed for another purpose. However, any retroperitoneal supra-renal mass can have an extra-adrenal origin. Indeed, operated non-adrenal masses initially but wrongly diagnosed as an adrenal disease represent about 3.5% of adrenalectomies. These differential diagnoses principally include retroperitoneal tumors that are malignant in two thirds of cases (lymphomas, sarcomas, neurogenic or germinal tumors), and more rarely vascular anomalies or congenital malformations, which are most frequently left-sided due to the wide variety of anatomical structures surrounding the left adrenal gland. Several lesions can originate from the adrenal gland or be located near the gland (paraganglioma, ganglioneuroma). Even though unilateral adrenalectomy is associated with low morbidity, ignorance of these differential diagnoses can cause ill-adapted management; overly conservative surgery in case of sarcoma is one example. Some of these lesions have characteristic clinical or imaging features (cystic lymphangioma, angiomyolipoma…). In other cases, assessment of hormonal secretion is required and additional exams (MRI, percutaneous biopsy, PET-scan with 18-Fluorodeoxyglucose) can correct an erroneous diagnosis. The above diagnostic approach allows appropriate management (with or without surgery). The purpose of this review was to highlight the main differential diagnoses of adrenal masses, to describe their characteristics, and to discuss their therapeutic management.
Topics: Abdominal Neoplasms; Adrenal Gland Neoplasms; Diagnosis, Differential; Diagnostic Errors; Humans; Retroperitoneal Neoplasms; Soft Tissue Neoplasms
PubMed: 32201083
DOI: 10.1016/j.jviscsurg.2020.02.004 -
International Journal of Clinical and... 2015Abdominal leiomyomas are extremely rare intraabdominal tumors, especially in male patient. Here, we report a case of a 22 years-old male with a huge abdominal leiomyoma.... (Review)
Review
Abdominal leiomyomas are extremely rare intraabdominal tumors, especially in male patient. Here, we report a case of a 22 years-old male with a huge abdominal leiomyoma. The patient presented with a chief complaint of abdominal distension for three months, no others significant symptom were found. CT-scan showed a cystic-solid huge mass in the middle and lower abdominal peritoneal cavity with uneven density. An exploratory laparotomy was performed and the tumor was completely resected. Microscopically, Tumor cells have a spindled shape, eosinophilic cytoplasm, and cigar-like nuclei, arranged in bundles or intersecting fascicles. Immunohistochemistry, the tumor cells were SMA, desmin diffuse positive and CD117, S-100 negative, interestingly, ER, PR were positive. The characteristics of a few of the male abdominal leiomyoma reported in the literature were generalized.
Topics: Abdominal Neoplasms; Biomarkers, Tumor; Humans; Immunohistochemistry; Leiomyoma; Male; Multidetector Computed Tomography; Treatment Outcome; Tumor Burden; Young Adult
PubMed: 26339429
DOI: No ID Found -
Archives of Pathology & Laboratory... May 2011This review examines the histopathologic, immunohistochemical, ultrastructural, and molecular biologic features of epithelioid angiomyolipoma (EAML), with an emphasis on... (Review)
Review
This review examines the histopathologic, immunohistochemical, ultrastructural, and molecular biologic features of epithelioid angiomyolipoma (EAML), with an emphasis on the differential diagnosis of intra-abdominal EAML. Epithelioid angiomyolipoma is an uncommon mesenchymal tumor with malignant potential, frequently associated with tuberous sclerosis complex. Histologically, EAML is characterized by sheets or nests of large polygonal epithelioid cells with abundant eosinophilic or occasionally clear cytoplasm, often with prominent nucleoli, and EAML may include multinucleated and markedly pleomorphic forms. As these tumors share a distinctive perivascular epithelioid cell phenotype, they belong to the PEComa tumor family. Nearly all EAMLs show immunoreactivity for both melanocytic and myoid markers. Ultrastructurally, EAMLs show evidence of melanogenesis by the presence of premelanosomes. Epithelioid angiomyolipoma can pose significant diagnostic challenges as it mimics morphologically a variety of neoplasms including renal cell carcinoma, renal oncocytoma, adrenal cortical neoplasm, epithelioid smooth muscle tumor, epithelioid peripheral nerve sheath tumor, epithelioid gastrointestinal stromal tumor, epithelioid melanoma, hepatoblastoma, and hepatocellular carcinoma. The variation in immunophenotype in these tumors requires a prudent use of immunohistochemistry, which may occasionally need complementation by electron microscopy to establish the correct diagnosis.
Topics: Abdominal Neoplasms; Angiomyolipoma; Biomarkers, Tumor; Epithelioid Cells; Humans; Immunohistochemistry; Soft Tissue Neoplasms
PubMed: 21526965
DOI: 10.5858/2009-0637-RSR.1 -
Medical Physics Jun 2023Respiratory motion presents a challenge in radiotherapy of thoracic and upper abdominal tumors. Techniques to account for respiratory motion include tracking. Using...
BACKGROUND
Respiratory motion presents a challenge in radiotherapy of thoracic and upper abdominal tumors. Techniques to account for respiratory motion include tracking. Using magnetic resonance imaging (MRI) guided radiotherapy systems, tumors can be tracked continuously. Using conventional linear accelerators, tracking of lung tumors is possible by determining tumor motion on kilo voltage (kV) imaging. But tracking of abdominal tumors with kV imaging is hampered by limited contrast. Therefore, surrogates for the tumor are used. One of the possible surrogates is the diaphragm. However, there is no universal method for establishing the error when using a surrogate and there are particular challenges in establishing such errors during free breathing (FB). Prolonged breath-holding might address these challenges.
PURPOSE
The aim of this study was to quantify the error when using the right hemidiaphragm top (RHT) as surrogate for abdominal organ motion during prolonged breath-holds (PBH) for possible application in radiation treatments.
METHODS
Fifteen healthy volunteers were trained to perform PBHs in two subsequent MRI sessions (PBH-MRI1 and PBH-MRI2). From each MRI acquisition, we selected seven images (dynamics) to determine organ displacement during PBH by using deformable image registration (DIR). On the first dynamic, the RHT, right and left hemidiaphragm, liver, spleen and right and left kidney were segmented. We used the deformation vector fields (DVF), generated by DIR, to determine the displacement of each organ between two dynamics in inferior-superior (IS), anterior-posterior (AP), left-right (LR) direction and we calculated the 3D vector magnitude (|d|). The displacements of the RHT, both hemidiaphragms and the abdominal organs were compared using a linear fit to determine the correlation (R of the fit) and the displacement ratio (DR, slope of the fit) between displacements of the RHT and each organ. We quantified the median difference between the DRs of PBH-MRI1 and PBH-MRI2 for each organ. Additionally, we estimated organ displacement in the second PBH by applying the DR from the first PBH to the displacement of the RHT measured during the second PBH. We compared the estimated organ displacement to the measured organ displacement during the second PBH. The difference between the two values was defined as the estimation error of using the RHT as a surrogate and assuming a constant DR over MRI sessions.
RESULTS
The linear relationships were confirmed by the high R values of the linear fit between the displacements of the RHT and the abdominal organs (R > 0.96) in the IS and AP direction and |d|, and high to moderate correlations in the LR direction (0.93 > R > 0.64). The median DR difference between PBH-MRI1 and PBH-MRI2 varied between 0.13 and 0.31 for all organs. The median estimation error of the RHT as a surrogate varied between 0.4 and 0.8 mm/min for all organs.
CONCLUSION
The RHT could serve as an accurate surrogate for abdominal organ motion during radiation treatments, for example, in tracking, provided the error of the RHT as motion surrogate is taken into account in the margins.
TRIAL REGISTRATION
The study was registered in the Netherlands Trial Register (NL7603).
Topics: Humans; Diaphragm; Organ Motion; Motion; Lung Neoplasms; Magnetic Resonance Imaging; Abdominal Neoplasms
PubMed: 37009641
DOI: 10.1002/mp.16403 -
The Korean Journal of Internal Medicine May 2019
Topics: Abdominal Neoplasms; Humans; Lymphangioma, Cystic; Lymphatic Vessels; Magnetic Resonance Imaging; Male; Middle Aged
PubMed: 30613066
DOI: 10.3904/kjim.2017.029 -
BMC Cancer Jun 2021Surgery is still the mainstay of radical treatment for resectable esophageal cancer (EC). It is apparent that the presence or spread of lymph node metastasis (LNM) is a...
BACKGROUND
Surgery is still the mainstay of radical treatment for resectable esophageal cancer (EC). It is apparent that the presence or spread of lymph node metastasis (LNM) is a powerful prognostic factor in patients with EC who are eligible for curative treatment. Although the importance and efficacy of lymph node dissection in radical esophagectomy have been reported, the clinical or prognostic relevance of specific metastatic patterns within the mediastinal cavity and abdomen remains unclear.
METHODS
We retrospectively analyzed the association of postoperative survival with clinical mediastinal LNM (cMLNM) and abdominal LNM (cALNM) in 157 patients who underwent radical EC surgery at our hospital between May 2012 and March 2018.
RESULTS
A significant difference in cause-specific survival (CSS) was observed between patients with and without cALNM (log-rank p = 0.000). A multivariate Cox regression analysis revealed that cALNM and thoracic surgery (mediastinal lymphadenectomy via conventional open right thoracotomy or video-assisted thoracoscopic surgery) independently predicted CSS (p = 0.0007 and 0.021, respectively). Moreover, a significant difference in systemic recurrence-free survival was observed between those with and without cALNM (log-rank p = 0.000). Multivariate Cox regression analysis revealed that cALNM and sex independently predicted systemic recurrence-free survival (p = 0.000 and 0.015, respectively).
CONCLUSION
cALNM was an independent poor prognostic factor for CSS after EC surgery. It may also be an independent prognostic factor for postoperative systemic recurrence, which can shorten the CSS. For patients with cALNM-positive EC who have a high potential risk of systemic metastases, more extensive treatment besides the conventional perioperative systemic chemotherapy may be necessary.
Topics: Abdominal Neoplasms; Aged; Esophageal Neoplasms; Female; Humans; Male; Mediastinal Neoplasms; Neoplasm Metastasis; Prognosis; Retrospective Studies; Survival Analysis; Treatment Outcome
PubMed: 34162359
DOI: 10.1186/s12885-021-08484-2 -
British Medical Journal (Clinical... Feb 1985Although the diagnostic scope of computed tomography has widened considerably in recent years, assessment of patients with suspected or known malignant disease remains... (Review)
Review
Although the diagnostic scope of computed tomography has widened considerably in recent years, assessment of patients with suspected or known malignant disease remains the major reason for body CT referrals in the United Kingdom. This paper sets out to define important advantages and limitations of CT in cancer diagnosis, addressing the topics of primary diagnosis, staging, and patient follow up. There is relatively little information on the influence of CT on patient management in oncology but reported studies indicate that CT directly alters clinical decisions in 14-30% of patients. This aspect requires further evaluation and is of particular relevance when considering the appropriate use of high cost technology.
Topics: Abdominal Neoplasms; Biopsy; Brain Neoplasms; Female; Humans; Male; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neoplasm Staging; Neoplasms; Patient Care Planning; Tomography, X-Ray Computed; United Kingdom
PubMed: 3918659
DOI: 10.1136/bmj.290.6467.527 -
Pediatric Blood & Cancer Jun 2023This paper provides imaging recommendations for pediatric abdominal tumors that arise outside of the solid viscera. These tumors are rare in children and have been...
This paper provides imaging recommendations for pediatric abdominal tumors that arise outside of the solid viscera. These tumors are rare in children and have been categorized in two groups: abdominal wall and peritoneal tumors (desmoid tumor and desmoplastic small round cell tumor) and tumors that arise from the gastrointestinal tract (gastrointestinal stromal tumor and gastrointestinal neuroendocrine tumor). Authors offer consensus recommendations for imaging assessment of these tumors at diagnosis, during follow-up, and when off-therapy.
Topics: Humans; Child; Surface Plasmon Resonance; Abdominal Neoplasms; Gastrointestinal Neoplasms; Diagnostic Imaging; Soft Tissue Neoplasms
PubMed: 37073573
DOI: 10.1002/pbc.30341 -
International Journal of Clinical and... 2015In this study, we present a rare and difficult case of epithelioid inflammatory myofibroblastic sarcoma (EIMS) in abdominal cavity. A 47-year-old female presented as... (Review)
Review
In this study, we present a rare and difficult case of epithelioid inflammatory myofibroblastic sarcoma (EIMS) in abdominal cavity. A 47-year-old female presented as left upper abdominal pain for 6 months and abdominal distention for 1 month. CT examination showed a solid mass in the left upper intra-abdomen. Grossly, the tumor was found in the mesenterium of colon with the size of 7.5 × 6.5 × 3.5 cm, and was solid and gray-yellowish in the cut surface. Focal myxomatous appearance was observed. Microscopically, stromal myxoid change together with prominant infiltrated lymphocytes, neutrophils and eosinophils were found in the tumor, and the tumor cells were round, epithelioid with vesicular nuclei, large prominant nucleoli and high mitotic rate. Immunohistochemically, strong diffused positive for vimentin, desmin, ALK (nuclear membrane staining pattern) and AAT, focally positive for CD99 and CD30, were showed, Ki67 index was about 20%; Especially, WT-1 and D240 were focally expressed in this tumor. FISH analysis showed rearrangement of ALK, and reverse-transcription polymerase chain reaction (RT-PCR) analysis was used to detect the fusion location of the RANBP2 and ALK gene. The diagnosis of EMIS was made based on its location, typical morphology, the immunohistochemical features especially the nuclear membranous immunostaining of ALK and rearrangement of RANBP2-ALK. The tumor showed higher aggressive behaviors and a poor prognosis. The differential diagnosis and other treatments of EMIS are also discussed in the present study. This finding may increase the case information of EMIS.
Topics: Abdominal Neoplasms; Abdominal Pain; Biomarkers, Tumor; Diagnosis, Differential; Female; Gene Fusion; Gene Rearrangement; Humans; Immunohistochemistry; In Situ Hybridization, Fluorescence; Middle Aged; Myofibroblasts; Oncogene Proteins, Fusion; Predictive Value of Tests; Sarcoma; Tomography, X-Ray Computed; Tumor Burden
PubMed: 26097614
DOI: No ID Found -
Jornal de Pediatria 2023This study aimed to estimate the performance of single-phase-enhanced computed tomography and ultrasonography examinations in the preoperative evaluation of solid...
OBJECTIVE
This study aimed to estimate the performance of single-phase-enhanced computed tomography and ultrasonography examinations in the preoperative evaluation of solid abdominal tumors and their relationship with relevant adjacent structures in children.
METHODS
This retrospective study included 50 pediatric patients with malignant solid abdominal tumors treated with surgical resection between 2009-2017. Preoperative computed tomography and ultrasonography were compared to operative findings (gold standard) in the diagnosis of invasion or encasement of adjacent structures. Accuracy, sensitivity, specificity, and positive and negative predictive values were evaluated.
RESULTS
Renal (20.4%) and neuroblastic (19.4%) tumors were the most common. Complete surgical resection with negative margins was achieved in 44 (88%) patients. The comparison between single-phase-enhanced computed tomography and ultrasonography findings showed the following results: sensitivity = 90.3% vs 86.6%, specificity = 86.8% vs 94.6%, negative predictive value = 95.3% vs 94.4%, positive predictive value = 75.3% vs 86.9%, and accuracy = 87.9% vs 92.2%. The correlation (kappa index) between computed tomography and ultrasonography examinations was 0.72 (p < 0.001). In 14% (7/50) of the patients, the invasion of adjacent structures was diagnosed by ultrasonography but not by computed tomography (1 patient had 2 invaded structures).
CONCLUSION
Ultrasonography can be considered a complementary method to single-phase-enhanced computed tomography in the preoperative evaluation of children with an abdominal tumor. The present study showed that ultrasonography and single-phase-enhanced computed tomography each possess a high accuracy in the preoperative planning of resection of solid abdominal tumors in children. Thus, it seems that the combination of both imaging methods would be enough for the evaluation of most abdominal tumors in the pediatric population.
Topics: Humans; Child; Retrospective Studies; Sensitivity and Specificity; Ultrasonography; Tomography, X-Ray Computed; Abdominal Neoplasms
PubMed: 35718001
DOI: 10.1016/j.jped.2022.05.003