ABSTRACT
CASE: This case demonstrates a 2-year-old boy with a rare benign supraclavicular mass diagnosed as neuromuscular choristoma through open biopsy. Postoperatively, he underwent semiannual surveillance with ultrasound without development of neurological complaints, limb deformity, or recurrence at 2-year follow-up. CONCLUSION: Neuromuscular choristoma involving the brachial plexus is a rare tumor that should be in the differential diagnosis of pediatric peripheral nerve-based tumors. The intimate association with neural elements limits complete resection. Therefore, open biopsy with partial resection is recommended. While postoperative fibromatosis may occur, open biopsy remains the gold standard for definitive diagnosis. Ultrasound can be used to monitor recurrence.
Subject(s)
Brachial Plexus , Choristoma , Humans , Male , Child, Preschool , Choristoma/diagnostic imaging , Choristoma/surgery , Choristoma/pathology , Brachial Plexus/diagnostic imaging , Brachial Plexus/pathology , Ultrasonography , Peripheral Nervous System Neoplasms/diagnostic imaging , Peripheral Nervous System Neoplasms/surgery , Peripheral Nervous System Neoplasms/pathologyABSTRACT
BACKGROUND: Heterotopic gastric mucosa (HGM) can be located in various parts of the gastrointestinal tract. As a rare anomaly in the small intestine, it can become complicated by intussusception, obstruction, gastrointestinal bleeding, and even peritonitis, leading to death. CASE PRESENTATION: This case report focuses on a 12-year-old Middle Eastern boy who presented with hematochezia and abdominal pain for a couple of days. A tagged Red blood cell (RBC) scan and Technetium scan revealed gastrointestinal bleeding at the lower abdomen, highly suggestive of the diagnosis of Meckel's diverticulum. Subsequently, exploratory laparotomy revealed contiguous and scattered mucosal lesions with multiple polyps of various sizes in the terminal ileum. Meckel's diverticulum was absent, and the patient was treated with resection and primary anastomosis. The resected tissue revealed extensive ectopic gastric mucosa and polypoid tissues. The patient recovered uneventfully and was discharged four days after the surgery. The symptoms did not recur within six months after his surgery. CONCLUSION: Our case demonstrated that despite the rarity of multiple polypoid gastric heterotopias in the terminal ileum, it should be considered as one of the differential diagnoses of gastrointestinal tract bleeding.
Subject(s)
Choristoma , Gastric Mucosa , Gastrointestinal Hemorrhage , Meckel Diverticulum , Humans , Male , Gastrointestinal Hemorrhage/etiology , Gastric Mucosa/pathology , Choristoma/complications , Choristoma/surgery , Choristoma/pathology , Meckel Diverticulum/complications , Meckel Diverticulum/surgery , Child , Ileal Diseases/surgery , Ileal Diseases/etiology , Diagnosis, Differential , Ileum/pathology , Ileum/surgery , Ileum/diagnostic imaging , Abdominal Pain/etiology , Treatment OutcomeABSTRACT
Heterotopic pancreas is a rare congenital abnormality. The most common location is the stomach, duodenum and proximal jejunum. Rare locations are represented by the ampulla of Vater, esophagus, ileum, Meckel diverticulum, biliary tract, mesentery and spleen. We present the case of a 49 year old patient investigated for obstructive jaundice and diagnosed with an ampullar heterotopy of pancreas parenchyma, initially considered to be a malignant tumor. A Whipple pancreatoduodenectomy was performed with good postoperative evolution, the serum levels of bilirubin being normal after the first postoperative week.
Subject(s)
Ampulla of Vater , Choristoma , Jaundice, Obstructive , Pancreas , Pancreaticoduodenectomy , Humans , Ampulla of Vater/surgery , Jaundice, Obstructive/etiology , Jaundice, Obstructive/surgery , Jaundice, Obstructive/diagnosis , Choristoma/complications , Choristoma/surgery , Choristoma/diagnosis , Pancreaticoduodenectomy/methods , Middle Aged , Treatment Outcome , Diagnosis, Differential , Male , Common Bile Duct Diseases/surgery , Common Bile Duct Diseases/diagnosis , Common Bile Duct Diseases/complicationsABSTRACT
Primary hyperparathyroidism (PHPT) is the most prevalent cause of hypercalcaemia, affecting 0.3% of the population. The only curative procedure is parathyroidectomy. Ectopic adenomas are challenging to localize and frequently result in persistent PHPT. This is a case report of a 29-year-old male patient who was diagnosed with PHPT prior to neck surgery and reoperated with bilateral neck exploration. However, the PHPT was not cured, until diagnostic CT with contrast had helped localizing a 1 cm ectopic parathyroid adenoma in the right horn of the thymus gland. The adenoma was then removed successfully.
Subject(s)
Adenoma , Hyperparathyroidism, Primary , Parathyroid Neoplasms , Tomography, X-Ray Computed , Humans , Male , Adult , Parathyroid Neoplasms/diagnostic imaging , Parathyroid Neoplasms/surgery , Parathyroid Neoplasms/pathology , Adenoma/diagnostic imaging , Adenoma/surgery , Adenoma/pathology , Hyperparathyroidism, Primary/surgery , Hyperparathyroidism, Primary/diagnostic imaging , Hyperparathyroidism, Primary/etiology , Choristoma/diagnostic imaging , Choristoma/surgery , Choristoma/pathology , ParathyroidectomyABSTRACT
Ectopic pancreas, also known as heterotopic pancreas, is a rare condition in which the pancreatic tissue is found outside its usual location in the gastrointestinal (GI) tract. It is commonly asymptomatic and benign, and is often discovered incidentally during routine imaging, endoscopy, surgery, or autopsy. However, complications can arise, such as inflammation, bleeding, obstruction, or even malignant transformation, necessitating surgical intervention in some cases. Ectopic pancreas at the ampulla of Vater (EPAV) is an extremely rare condition and a diagnostic and therapeutic nightmare. Most cases have been diagnosed through invasive surgery due to concerns for malignancy, which carries significant morbidity and mortality. In our case, endoscopic snare papillectomy (ESP) was employed to establish a diagnosis. Thus far, only one other case has been reported in which ESP was used to diagnose and resect a pancreatic heterotopia at the ampulla.
Subject(s)
Ampulla of Vater , Choristoma , Pancreas , Humans , Ampulla of Vater/surgery , Choristoma/surgery , Choristoma/diagnosis , Choristoma/pathology , Female , Male , Middle Aged , Cholangiopancreatography, Endoscopic RetrogradeABSTRACT
Middle-ear salivary gland choristoma (SGCh) is a rare, benign tumor that causes conductive hearing loss owing to middle-ear morphological abnormalities. Early diagnosis is challenging, and surgical resection is indispensable for a definitive diagnosis. We report the case of a 3-year-old boy diagnosed with middle-ear SGCh during the follow-up period for left-sided hearing loss discovered at newborn hearing screening (NHS). Long-term follow-up after the NHS result, subsequent computed tomography/magnetic resonance imaging, and surgical resection led to its relatively early diagnosis and treatment.
Subject(s)
Choristoma , Salivary Glands , Humans , Male , Choristoma/pathology , Choristoma/complications , Choristoma/diagnostic imaging , Choristoma/surgery , Child, Preschool , Salivary Glands/pathology , Salivary Glands/diagnostic imaging , Ear, Middle/diagnostic imaging , Ear, Middle/pathology , Hearing Loss, Unilateral/etiology , Hearing Loss, Unilateral/congenital , Magnetic Resonance Imaging , Tomography, X-Ray ComputedABSTRACT
The gradually progressive solitary cystic-solid mass of chest CT scans is highly suggestive of lung cancer. We report a case of a 29-year-old woman with a persistent cystic-solid lesion in the right upper lobe. A chest CT scan showed a 35 mm × 44 mm × 51 mm focal cystic-solid mass in the anterior segment of the right upper lobe. The size of lesion had increased over 3 years, especially for the solid component. The right upper lobe pneumonectomy was performed. Postoperative pathological examination showed placental transmogrification of the lung, which is a rare cause of pulmonary cystic lesion.
Subject(s)
Pneumonectomy , Tomography, X-Ray Computed , Humans , Female , Adult , Tomography, X-Ray Computed/methods , Pneumonectomy/methods , Lung Neoplasms/pathology , Lung Neoplasms/surgery , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/diagnosis , Lung/diagnostic imaging , Lung/pathology , Lung/surgery , Diagnosis, Differential , Pregnancy , Lung Diseases/surgery , Lung Diseases/pathology , Lung Diseases/diagnostic imaging , Lung Diseases/diagnosis , Cysts/surgery , Cysts/pathology , Cysts/diagnostic imaging , Cysts/diagnosis , Choristoma/surgery , Choristoma/pathology , Choristoma/diagnosis , Choristoma/diagnostic imaging , Treatment Outcome , Placenta/pathology , Placenta/diagnostic imagingABSTRACT
Ectopic goitre, presenting as an isolated thoracic mass without connection to the main thyroid gland enlargement, is a rare occurrence. We describe a case where a patient reported persistent dry cough and back pain for 1 year, along with throat discomfort unresponsive to medication. A 2×1 cm swelling was noted over the right anterior aspect of the neck. Extensive evaluation, including chest X-rays and contrast-enhanced CT of the thorax, revealed a mediastinal mass suggestive of an ectopic thyroid.This case presents a distinctive scenario involving the simultaneous presence of ectopic mediastinal and cervical thyroid lesions. Both were effectively managed using a minimally invasive approach, combining video-assisted thoracic surgery for the excision of the mediastinal mass and a bilateral axillo-breast approach for the cervical lesion in a single procedure. This approach yielded minimal morbidity, aesthetically pleasing outcomes and rapid recovery. Remarkably, such a case has not been previously documented in the available literature.
Subject(s)
Thoracic Surgery, Video-Assisted , Thyroidectomy , Humans , Thyroidectomy/methods , Thoracic Surgery, Video-Assisted/methods , Female , Neck/surgery , Neck/diagnostic imaging , Middle Aged , Tomography, X-Ray Computed , Choristoma/surgery , Choristoma/diagnostic imaging , Thyroid Gland/surgery , Thyroid Gland/diagnostic imagingABSTRACT
Thymoma is a rare malignancy with usual location in the antero-superior mediastinum. Ectopic cervical thymoma (ECT) is an extremely rare tumor that originates from ectopic tissue, and is caused by the aberrant migration of the embryonic thymus. Our patient was a 56-year-old man who had a nodular lesion in the neck for several years. Computed tomography and Enhanced magnetic resonance imaging were performed. He underwent surgery, and a histological examination resulted in a diagnosis of type AB thymoma.
Subject(s)
Choristoma , Magnetic Resonance Imaging , Thymoma , Thymus Neoplasms , Tomography, X-Ray Computed , Humans , Male , Middle Aged , Thymoma/surgery , Thymoma/diagnosis , Thymoma/diagnostic imaging , Thymoma/pathology , Thymus Neoplasms/surgery , Thymus Neoplasms/diagnosis , Thymus Neoplasms/diagnostic imaging , Thymus Neoplasms/pathology , Choristoma/surgery , Choristoma/diagnosis , Choristoma/pathology , Choristoma/diagnostic imaging , Neck/diagnostic imaging , Head and Neck Neoplasms/surgery , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/diagnostic imagingABSTRACT
Transverse testicular ectopia (TTE) is an infrequent ectopic testis where both testes descend via the same inguinal canal, located in the same hemiscrotum, and augments the risk of developing testicular tumours. Type II TTE is accompanied by persistent Müllerian duct syndrome, where the Müllerian structures persist for various reasons. Here, we present a case of an adult in his early 30s, who presented with a right testicular swelling and was diagnosed as type II TTE and testicular mixed germ cell tumour after surgery. We could find only 13 similar cases of TTE and testicular tumours in the literature. Our case highlights the importance of clinical acumen with detailed history, meticulous clinical examination, radiological investigations and a detailed pathological examination while dealing with such sporadic presentations.
Subject(s)
Disorder of Sex Development, 46,XY , Neoplasms, Germ Cell and Embryonal , Testicular Neoplasms , Testis , Humans , Male , Testicular Neoplasms/surgery , Testicular Neoplasms/diagnosis , Testicular Neoplasms/complications , Testicular Neoplasms/diagnostic imaging , Neoplasms, Germ Cell and Embryonal/surgery , Neoplasms, Germ Cell and Embryonal/complications , Neoplasms, Germ Cell and Embryonal/diagnosis , Neoplasms, Germ Cell and Embryonal/diagnostic imaging , Adult , Testis/abnormalities , Testis/surgery , Testis/diagnostic imaging , Disorder of Sex Development, 46,XY/diagnosis , Disorder of Sex Development, 46,XY/surgery , Disorder of Sex Development, 46,XY/complications , Choristoma/surgery , Choristoma/diagnosis , Choristoma/complications , Choristoma/diagnostic imagingABSTRACT
OBJECTIVE: Heterotopic pancreas, an uncommon condition in children, can present with diagnostic and treatment challenges. This study aimed to evaluate the clinical features and treatment options for this disorder in pediatric patients. METHODS: We conducted a retrospective analysis, including patients diagnosed with heterotopic pancreas at four tertiary hospitals between January 2000 and June 2022. Patients were categorized into symptomatic and asymptomatic groups based on clinical presentation. Clinical parameters, including age at surgery, lesion size and site, surgical or endoscopic approach, pathological findings, and outcome, were statistically analyzed. RESULTS: The study included 88 patients with heterotopic pancreas. Among them, 22 were symptomatic, and 41 were aged one year or younger. The heterotopic pancreas was commonly located in Meckel's diverticulum (46.59%), jejunum (20.45%), umbilicus (10.23%),ileum (7.95%), and stomach (6.82%). Sixty-six patients had concomitant diseases. Thirty-three patients had heterotopic pancreas located in the Meckel's diverticulum, with 80.49% of cases accompanied by gastric mucosa heterotopia (GMH). Patients without accompanying GMH had a higher prevalence of heterotopic pancreas-related symptoms (75%). Treatment modalities included removal of the lesions by open surgery, laparoscopic or laparoscopic assisted surgery, or endoscopic surgery based on patient's age, the lesion site and size, and coexisting diseases. CONCLUSIONS: Only one-fourth of the patients with heterotopic pancreas presented with symptoms. Those located in the Meckel's diverticulum have commonly accompanying GMH. Open surgical, laparoscopic surgical or endoscopic resection of the heterotopic pancreas is recommended due to potential complications. Future prospective multicenter studies are warranted to establish rational treatment options.
Subject(s)
Choristoma , Pancreas , Humans , Retrospective Studies , Choristoma/surgery , Choristoma/diagnosis , Male , Female , Pancreas/surgery , Child , Child, Preschool , Infant , Adolescent , Meckel Diverticulum/surgery , Meckel Diverticulum/diagnosisABSTRACT
A man in his mid-40s presented to the colorectal surgery clinic with complaints of chronic perianal pain for over 20 years. He had episodes of urinary incontinence associated with pain. There were no other symptoms to suspect bowel pathology. On examination, he was found to have a tender mass in the retro-rectal plane without any evidence of rectal mucosal irregularity. He underwent an MRI of the pelvis, which showed a well-defined T2 hyperintense partly cystic lesion in the presacral region abutting the mesorectal fascia and a normal prostate gland. With a suspicion of a tailgut cyst or a duplication cyst, he underwent an excision of the presacral mass. Intraoperatively, there was a 2 × 2 cm well-defined firm, cystic lesion anterior to the fifth sacral vertebra and coccyx. The lesion was adherent to the mesorectum and was excised. On histopathology, there were features of muscular stroma and bilayered glandular epithelium with clear cytoplasm conclusive of a benign ectopic prostate.
Subject(s)
Choristoma , Magnetic Resonance Imaging , Prostate , Humans , Male , Prostate/pathology , Prostate/diagnostic imaging , Prostate/surgery , Choristoma/surgery , Choristoma/diagnosis , Choristoma/diagnostic imaging , Diagnosis, Differential , AdultSubject(s)
Mediastinal Cyst , Thyroglossal Cyst , Humans , Thyroglossal Cyst/diagnostic imaging , Thyroglossal Cyst/surgery , Thyroglossal Cyst/pathology , Mediastinal Cyst/diagnostic imaging , Mediastinal Cyst/surgery , Mediastinal Cyst/complications , Tomography, X-Ray Computed , Female , Male , Choristoma/diagnostic imaging , Choristoma/surgeryABSTRACT
Introduction: Hyperfunctional ectopic parathyroid glands in the mediastinum pose a challenge to diagnosis and require optimal surgical management. Video-assisted thoracoscopic surgery (VATS) has emerged as a promising minimally invasive approach, offering potential benefits in terms of both patient comfort and oncological principles. This study aimed to evaluate the effectiveness and safety of VATS for the treatment of hyperfunctional ectopic parathyroid glands in the mediastinum. Methods: Among the 538 patients with mediastinal tumors who underwent thoracoscopic surgery at Istanbul University (2008-2021), 11 exhibited hyperfunctional ectopic parathyroid glands. The localization of the glands was performed using various diagnostic techniques, including neck ultrasound, sestamibi scan, CT (computerized tomography), and SPECT (Single-photon emission computed tomography). VATS (Video-assisted thoracoscopic surgery) was used to remove ectopic parathyroid glands in all 11 patients, with no need for conversion to open surgery. Results: The pathological results showed that VATS successfully removed the ectopic glands in all 11 patients. Serum parathyroid hormone (PTH) levels were monitored intraoperatively, and frozen sections were used to confirm the presence of parathyroid adenomas in all cases. Postoperative analysis showed that PTH levels dropped by at least 50% within 10-15 minutes after adenoma removal. Conclusion: VATS is a safe and effective method for the treatment of hyperfunctional ectopic parathyroid glands in the mediastinum with a low risk of complications.
Subject(s)
Parathyroid Glands , Thoracic Surgery, Video-Assisted , Humans , Thoracic Surgery, Video-Assisted/methods , Female , Male , Middle Aged , Adult , Parathyroid Glands/diagnostic imaging , Parathyroid Glands/surgery , Parathyroid Neoplasms/surgery , Parathyroid Neoplasms/diagnostic imaging , Mediastinal Neoplasms/surgery , Mediastinal Neoplasms/diagnostic imaging , Choristoma/surgery , Aged , Feasibility Studies , Retrospective Studies , Treatment OutcomeABSTRACT
The occurrence of ectopic pancreas in the mediastinum is rare. Herein, we report a 22-year-old female who presented with right shoulder pain, dysphagia, fever and headaches. Chest computer tomography revealed a mass in the posterior mediastinum with accompanying signs of acute mediastinitis. Needle biopsy and fine-needle aspiration revealed ectopic gastral tissue and ectopic pancreas tissue, respectively. Surgical resection was attempted due to recurring acute pancreatitis episodes. However, due to chronic-inflammatory adhesions of the mass to the tracheal wall, en-bloc resection was not possible without major tracheal resection. Since then, recurring pancreatitis episodes have been treated conservatively with antibiotics. We report this case due to its differing clinical and radiological findings in comparison to previous case reports, none of which pertained a case of ectopic pancreas tissue in the posterior mediastinum with recurring acute pancreatitis and mediastinitis.
Subject(s)
Choristoma , Mediastinitis , Pancreatitis , Female , Humans , Young Adult , Acute Disease , Choristoma/surgery , Choristoma/diagnosis , Mediastinitis/diagnosis , Mediastinitis/surgery , Mediastinitis/complications , Mediastinum/diagnostic imaging , Mediastinum/pathology , Pancreas/pathology , Pancreatitis/complications , Pancreatitis/diagnosisABSTRACT
A primary orbital respiratory cyst is a congenital choristoma that presents in the orbit and with different signs and symptoms depending on the location, which might also change the surgical approach. The aim of this report is to describe 2 new cases of primary respiratory epithelial cysts and to review the literature on presentation, management, and risk factors with different surgical approaches and complications. Two cases presenting with gradually increased proptosis had a confirmed diagnosis of a respiratory epithelial cyst. CT and MRI imaging revealed a thin-walled intraconal cystic lesion. Complete surgical removal was not possible and an incisional biopsy of the wall was performed. Rarely, orbital respiratory epithelium cysts are primary lesions. The high risk of breaking the capsule during surgery and the presence of residual epithelial cells within the orbit may cause cyst's recurrence. Indeed, we recommend careful attention during dissection maneuvers and a long-term follow-up.
Subject(s)
Cysts , Magnetic Resonance Imaging , Orbital Diseases , Tomography, X-Ray Computed , Humans , Cysts/diagnosis , Cysts/surgery , Orbital Diseases/diagnosis , Orbital Diseases/surgery , Male , Female , Respiratory Mucosa/pathology , Choristoma/diagnosis , Choristoma/surgeryABSTRACT
Ectopic parathyroid adenomas are an uncommon etiology of primary hyperparathyroidism. We present a case of a patient admitted to the hospital with severe hypercalcemia and elevated parathyroid hormone levels, in whom imaging revealed two distinct parathyroid masses in the prevertebral space, representing a rare and atypical location for parathyroid tissue. This case highlights the importance of considering ectopic parathyroid adenomas as a potential cause of hyperparathyroidism and discusses the diagnostic challenges and management strategies associated with such cases.
Subject(s)
Adenoma , Parathyroid Neoplasms , Humans , Parathyroid Neoplasms/surgery , Parathyroid Neoplasms/complications , Parathyroid Neoplasms/diagnosis , Adenoma/surgery , Adenoma/complications , Adenoma/pathology , Choristoma/complications , Choristoma/surgery , Choristoma/diagnosis , Female , Hyperparathyroidism, Primary/etiology , Hyperparathyroidism, Primary/surgery , Hyperparathyroidism, Primary/diagnosis , Hyperparathyroidism, Primary/complications , Middle Aged , Male , Parathyroid Glands/diagnostic imaging , Parathyroid Glands/pathology , Parathyroidectomy , Hypercalcemia/etiologyABSTRACT
BACKGROUND: An ocular osseous choristoma is a growth of mature, compact bone in the ocular or periocular soft tissue, and it is the rarest form of ocular choristoma, accounting for only 1.7% of all epibulbar choristomas. CASE PRESENTATION: Herein we present the case of a 20-month-old girl who was referred to the oculoplasty clinic with a progressively growing mass in the left lateral canthus. It had been present since birth without ocular involvement. Upon examination the mass was firm with a smooth surface, measured 9 × 6 × 3 mm, and exhibited no episcleral attachment or ocular involvement. An excisional biopsy was performed, and the histopathological findings were consistent with osseous choristoma of the left lateral canthus. CONCLUSIONS: This report highlights the importance of considering osseous choristoma in the differential diagnosis of eyelid lesions, particularly those that have been present since birth. It also emphasizes the need for further studies investigating associations between osseous choristomas and ocular canthi.
Subject(s)
Choristoma , Eye Diseases , Lacrimal Apparatus , Female , Humans , Infant , Choristoma/diagnosis , Choristoma/surgery , Choristoma/pathology , Lacrimal Apparatus/pathology , Eye Diseases/surgery , Eyelids/pathology , Bone and Bones/pathologyABSTRACT
A 29-year-old primigravida at 31 weeks of gestation was referred for intrathoracic kidney (ITK). Ultrasound revealed left kidney intrathoracic placement with an anteriorly positioned ectopic adrenal gland. Magnetic resonance imaging confirmed diaphragmatic interruption and colon herniation. A female neonate, delivered at 37 weeks, underwent successful thoracoscopic repair for a left Bochdalek hernia. Despite compression of the left lung, notably optimistic lung-to-head ratio (LHR) values were observed, correlating with favorable outcomes. This case underscores the rare occurrence of ITK, its association with Bochdalek hernia, and the importance of comprehensive prenatal evaluations.
Subject(s)
Adrenal Glands , Hernias, Diaphragmatic, Congenital , Kidney , Ultrasonography, Prenatal , Humans , Female , Hernias, Diaphragmatic, Congenital/diagnostic imaging , Hernias, Diaphragmatic, Congenital/surgery , Adult , Pregnancy , Kidney/diagnostic imaging , Kidney/abnormalities , Adrenal Glands/diagnostic imaging , Infant, Newborn , Magnetic Resonance Imaging , Choristoma/diagnostic imaging , Choristoma/surgery , Choristoma/diagnosisABSTRACT
A 9-year-old premenarchal female presented to pediatric dermatology with a 6-month history of periodically tender, bilateral and symmetric axillary masses. Magnetic resonance imaging and subsequent surgical excision confirmed the diagnosis of bilateral accessory axillary breast tissue. Accessory axillary breast tissue is a rare condition seen most in pubertal, pregnant and breastfeeding women. However, it can arise in pre-adolescent patients and should be added to the differential diagnosis of an axillary mass.