Peritoneal Surface Malignancies Originating From Urachal Carcinoma: Case Reports and Review of the Literature.

Urachal carcinoma (UC) is a rare and aggressive tumor arising from the urachal remnants, with the potential for peritoneal dissemination. Patients diagnosed with UC often have a poor prognosis. To date, there is no standardized treatment. Our objective is to present two cases of patients with peritoneal carcinomatosis (PC) secondary to an UC, who were treated with cytoreductive surgery (CRS) and hyperthermic peroperative intraperitoneal chemotherapy (HIPEC). A review of the literature on CRS and HIPEC in UC suggests CRS and HIPEC to be a safe and viable treatment option. Two patients with PC of UC underwent CRS and HIPEC in our institution. All available data were gathered and reported on. A literary search was carried out to find all available cases of patients with PC secondary to UC treated with CRS and HIPEC. Both patients underwent CRS and HIPEC and are currently free of recurrence. Literature research revealed nine other publications adding up to a total of 68 additional cases. CRS and HIPEC can provide satisfactory long-term oncological outcome with acceptable morbidity and mortality rates in patients with PC of urachal origin. It should be considered as a safe and feasible treatment option with curative potential.

Diagnostic accuracy of a fast MRI T2-sequence for the diagnosis of internal herniation after Roux-and-Y gastric bypass during pregnancy: A retrospective single center study.

PURPOSE: The objective of this retrospective study was to evaluate the diagnostic accuracy of a fast sequence Magnetic Resonance Imaging (MRI) sequence, T2- half-Fourier acquisition single-shot turbo spin echo (HASTE) for the diagnosis of internal herniation (IH) in pregnant patients with a history of Roux-en-Y gastric bypass (RYGB). METHODS: Abdominal MRI studies, performed for the clinical suspicion of IH of pregnant patients with a history of RYGB, were analyzed by two abdominal radiologists. Thirty-one cases were included and for each case both readers independently evaluated the T2 HASTE sequence in different planes (axial, coronal and sagittal) to determine the presence or absence of IH. Diagnostic performance of T2 HASTE MRI was evaluated by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy compared to the clinical diagnosis of IH as the gold standard. IH was diagnosed as the presence of herniated bowel through the mesenteric defect at the time of surgical exploration. IH was deemed absent if the surgical exploration showed no herniated bowel or if patients had no subsequent clinical symptoms of IH after 90 days of clinical follow-up. RESULTS: The results in this study, with 16 patients with IH and 15 patients without IH, portray a high accuracy for the detection of IH, ranging from 87.9% to 90.3%. This fast T2 sequence shows a high NPV (86.7% - 100.0% 87.7), sensitivity (88.9% - 100.0%) and specificity (80.0% - 86.7%). This study also portrayed a substantial interobserver agreement (0.741) for the evaluation of IH. CONCLUSION: T2 HASTE MRI shows an excellent sensitivity and NPV for the detection of IH in pregnant patients. The fast acquisition time makes this sequence useful in the emergency setting, and it can be used for the diagnosis or exclusion of IH in pregnant patients.

Chest CT Diagnosis of COVID-19: Accuracy using CO-RADS and CT-Involvement Scoring.

OBJECTIVES: Both Reporting and Data System (CO-RADS) and CT-involvement scores (CTIS) have been proposed for evaluation of COVID-19 on chest CT. The purpose of this single-center, retrospective study was to evaluate both scoring systems to diagnose COVID-19 infection in a high-prevalence area. MATERIALS AND METHODS: Chest CT datasets (n = 200) and available reverse transcription polymerase chain reaction (RT-PCR) on nasopharyngeal swab were included. CT scans were assigned to four 'imaging groups' after scoring for both CO-RADS and CTIS. Diagnostic accuracy of chest CT was calculated respectively using RT-PCR and clinical diagnosis as gold standards: False-negatives and false-positives of chest CT regarding RT-PCR were studied in more depth using the medical files. RESULTS: The 'imaging group' including CO-RADS 4/5 scores reached the highest diagnostic values for COVID-19 considering either the initial RT-PCR or the final clinical diagnosis as the standard of reference: accuracies of 172/200 (86%) to 181/200 (90.5%), sensitivities of 60/80 (88.2%) to 70/79 (88.6%), specificities of 112/132 (84.9%) to 111/121 (91.7%), negative predictive values (NPV) of 112/120 (93.3%) to 111/120 (92.5%), respectively. False-negative CTs regarding RT-PCR were mainly explained by imaging very early in the disease course (5 out of 8 cases) or COVID-19 infection with no/minor respiratory symptoms (3 out of 8 cases). CONCLUSION: Assessing chest CT using CO-RADS is a valuable diagnostic approach for COVID-19 infection in a high-prevalence area, with a higher accuracy than CTIS.

Management and outcome of heterotopic interstitial pregnancy: Case report and review of literature.

OBJECTIVE: To report a case of heterotopic interstitial pregnancy after in vitro fertilization-embryo transfer (IVF-ET), presenting with a second trimester uterine rupture. To review the clinical presentations, risk factors, treatment options, and outcome of heterotopic interstitial pregnancies. METHODS: We describe the clinical presentation, management, and outcome of a patient with a heterotopic interstitial pregnancy, diagnosed following second trimester rupture of the interstitial pregnancy. We reviewed all published cases of heterotopic interstitial pregnancies. RESULTS: A 35-year-old pregnant woman with a past history of right adnexectomy and 16 weeks pregnant with dichorionic diamniotic twins following IVF-ET, was admitted to our department with unexplained recurrent abdominal pain and anemia. Further investigation showed a hemoperitoneum and because of hypovolemic shock an emergency laparotomy was performed, with diagnosis of a ruptured heterotopic interstitial pregnancy. The uterine defect was sutured using simple interrupted sutures. The intrauterine pregnancy progressed uneventful afterwards.We found 86 cases in the published literature, reporting on heterotopic interstitial pregnancies. 80.2% (69/86) occurred after IVF-ET. History of uni- or bilateral salpingectomy is a major risk factor, present in 39.5% (34/86). 37.2% (32/86) presented with cornual rupture. Surgery was performed in 53.5% (46/86) of cases. Medical management was possible in case of unruptured, early diagnosed heterotopic interstitial pregnancy (32.6% (28/86)). Watchful waiting was only possible when the interstitial pregnancy miscarried (5.8% (5/86)). The live birth rate of the intrauterine pregnancy, when viable at presentation, was 70.0% (56/80). The live birth rate of the interstitial pregnancy was only 4.7% (4/86). CONCLUSIONS: The majority of cases are diagnosed by detailed ultrasound in the setting of early follow-up after IVF-ET and are asymptomatic at diagnosis. Yet, a substantial number of patients present with cornual rupture. Risk factors are IVF-ET and a history of salpingectomy. Depending on clinical presentation, treatment options include watchful waiting, medical treatment, or surgery. Unfortunately, the interstitial pregnancy is generally lost, and only has a chance of survival in case of presentation at a viable gestational age. The outcome of the coexisting intrauterine pregnancy is generally good.

Rhabdomyolysis after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a case report.

Gastric cancer with peritoneal carcinomatosis is a disease with a poor prognosis. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal perioperative chemotherapy (HIPEC) can improve prognosis, although in most cases this should still be considered as a palliative treatment. Therefore, morbidity has to be avoided at all cost as quality of life is of utmost importance. We describe the case of a 64-year-old female with an adenocarcinoma of the stomach that was initially treated with a Billroth II gastrectomy, adjuvant chemotherapy and radiotherapy. During follow-up, the diagnosis of peritoneal carcinomatosis was made, and the patient was referred for CRS and HIPEC. Postoperatively, she developed rhabdomyolysis in both gastrocnemius muscles. Renal function remained within normal limits, but ultrasonography of the lower legs suggested the presence of bilateral abscesses. Drainage with pigtail catheters was necessary for more than 1 month, significantly impairing quality of life. The objective of this case report is to heighten awareness for this complication. Rhabdomyolysis is a rare complication of CRS and HIPEC, with a significant impact on quality of life. Prevention is necessary and can be achieved by adequate surgical positioning, using the altered lithotomy position, sufficient padding and by preventing hypovolemia.

A bronchogenic cyst, presenting as a retroperitoneal cystic mass.

Bronchogenic cysts are mostly benign, congenital abnormalities originating from the remnants of the primitive foregut. A retroperitoneal location is rare. Due to the mostly asymptomatic behavior and the historical confusion regarding histology, an exact prevalence is not known. We present here a case report of a retroperitoneal bronchogenic cyst. A literature review was performed for cases of retroperitoneal bronchogenic cysts written in English. Anatomopathological criteria for inclusion were pseudo stratified, ciliated, columnar epithelium together with the presence of at least one of the following: cartilage, smooth muscle or seromucous glands. In addition, the embryology, pathogenesis, radiological, clinical and suggested treatment modalities are reviewed. We report the surgical excision of a retroperitoneal bronchogenic cyst that presented as a non-functioning left adrenal mass. Our review of literature revealed only 62 potential cases of retroperitoneal bronchogenic cysts. After applying the strict anatomopathological criteria, only 30 cases of true retroperitoneal bronchogenic cysts could be identified. Retroperitoneal location of a bronchogenic cyst is rare. Despite the rarity of this pathologic entity, bronchogenic cysts should be considered in the differential diagnosis of retroperitoneal cystic lesions. Only histology can confirm definitive diagnosis. Surgery remains the recommended treatment of choice.

Magnetic resonance imaging in the detection and characterization of renal diseases.

Over the last decade, state-of-the-art magnetic resonance MRI has become a valuable partner in the clinical imaging arena to tackle a wide variety of kidney diseases in a non-invasive manner, mainly due to its high tissue contrast and multiplanar imaging capabilities. Paramagnetic contrast agents have further improved the performance of MRI of the kidney since their administration seems to be applicable in virtually all patients, irrespective of their age, renal function and their ability to cooperate. Moreover, MRI is particularly helpful for further differentiation of lesions that are equivocal on CT and/or ultrasound. Further technical developments of applied MR-techniques and further improvements in spatial resolution will expand the imaging possibilities and create new tracts and challenges in the MRI evaluation of kidney disease. An overview of the current status of MRI in the diagnosis of renal abnormalities, which includes description of technique and normal anatomy and congenital variants, is given. The benefits of MRI in diagnosing diseases of renal parenchyma mass lesions such as cysts, renal cystic diseases, and benign and malignant tumors is reviewed. Furthermore, the MRI diagnosis of vascular diseases, diffuse renal parenchymal diseases, renal infectious diseases and the pathology of the renal collecting system will be discussed.

Intrauterine pregnancy following transperitoneal oocyte and/or sperm migration in a woman with an ectopic (undescended) ovary.

This is the first report of an intrauterine pregnancy following timed coitus, resulting from transperitoneal sperm and/or oocyte migration as the oocyte originated from an ectopic (undescended) ovary. The patient was treated in the infertility clinic after a history of primary infertility for 2 years. Diagnosis of a moderate teratozoospermia and the presence of a unicornuate uterus with one right-sided normal ovary was made. During the first intrauterine insemination (IUI) treatment cycle with clomiphene citrate stimulation, a discrepancy between oestradiol concentrations and follicular growth was observed. Magnetic resonance imaging (MRI) was carried out because the presence of an ectopic ovary was suspected. The diagnosis of a left-sided undescended ovary was made, containing several follicles, the largest measuring 16 mm in diameter. Because of a spontaneous LH surge 2 days later without substantial follicular growth in the normal right-sided ovary, IUI was cancelled and timed intercourse was planned. Surprisingly, and although the largest follicle in the normally located ovary reached a maximum diameter of only 12 mm on repetitive ultrasound monitoring, this patient became pregnant and gave birth to a healthy baby boy.