In utero torsion of an accessory hepatic lobe mimicking a congenital tumor.

Accessory hepatic lobes are rare anatomic variants connected to the liver by a fibrous stalk or parenchymal attachments. They are usually detected incidentally, but torsion is a rare complication. Here, we report torsion of an accessory hepatic lobe occurring in utero with a focus on the MRI findings. The lesion mimicked a congenital tumor, and we provide potential clues that may have narrowed the differential diagnosis prior to surgical exploration.

Rapidly growing massive abdominal sarcomatoid carcinoma on F18-FDG PET-CT scan.

Sarcomatoid carcinoma is a rare type of tumour and most commonly arises in the lungs. However, rarely can it also be found in the abdomen. Sarcomatoid tumours are aggressive with large tumoural volume showing cancerous epithelial cells mixed with sarcomatous (nerve, muscle, fat etc.) features on histopathology. Most of the carcinosarcomas arise in the background of pleomorphic adenoma, originating from a myoepithelial precursor. These tumours are resistant to treatment and rapidly metastasize. We present a unique case of hepatocellular sarcomatoid sarcoma, evaluated through F18-FDG PET/CT.

Colonic basidiobolomycosis in a patient with systemic lupus erythematosus (SLE).

BACKGROUND: Basidiobolus ranarum belongs to the Entomophthorales order and the Zygomycetes class. This fungus is an environmental saprophyte that can be found in soil and rotting vegetables.Primarily restricted to tropical regions including Asia, Africa, and South America. It might cause chronic inflammatory diseases, mostly affect subcutaneous tissue. Systemic infections involving the gastrointestinal tract are extremely rare. CASE PRESENTATION: Herein, we present a 44-year-old Persian man with the past medical history of lupus erythematosus with colicky abdominal pain started from three months before admission with many vomiting episodes, and a mass on the right lower quadrant, who had been thought initially to have an abdominal malignancy. The patient had vital signs were within normal ranges. His physical examination revealed tenderness and rebound tenderness on the right lower quadrant of the abdomen. A fixed mass 10 × 10 centimeter in diameter was palpated in the same quadrant. Laboratory, radiologic, colonoscopic examination was requested. The patient underwent laparotomy which revealed a mass in the terminal ileum and ascending colon with retroperitoneal adhesion and invasion to the right ureter behind it. Pathologic examination showed basidiobolomycosis infection in the specimen. CONCLUSION: Fungal infection should be among the differential diagnoses for adults present with abdominal mass in endemic regions of the world.

Mesenteric Cyst with GI Symptoms: A Fluid Approach to Treatment-Case Report and Literature Review.

Mesenteric cysts are defined as a heterogeneous group of intra-abdominal cystic lesions of the mesentery or omentum that may be found in any portion of the gastrointestinal tract from the duodenum to the rectum. The clinical condition is entirely asymptomatic in many patients, particularly with small cysts. The diagnosis is typically incidental and secondary to imaging performed for other purposes. In symptomatic patients, the clinical picture is characterized by nonspecific gastrointestinal signs and symptoms. Treatment may be surgical or via interventional radiology. We report the case of a 55-year-old female patient complaining of left-sided abdominal discomfort and constipation lasting three months. An abdominal ultrasound showed the presence of a 10 × 14 × 16 cm anechoic cystic mass filling the whole anterior and left abdominal cavity, confirmed by CT and MRI. The cyst, removed laparoscopically, was histologically a simple mesothelial cyst. We reviewed the international literature over the last 10 years of all cases with mesenteric cysts > 10 cm in evaluating gastrointestinal symptoms at diagnosis, histology, performed treatment, and outcome.

High intensity focused ultrasound for large abdominal wall endometriosis: a case report.

BACKGROUND: Abdominal wall endometriosis（AWE）is an unusual extra-pelvic endometriosis. Currently, multiple treatment modalities are available, but no clear guidelines exist for the management of large AWE. MATERIALS AND METHODS: We present a 36-year-old female patient with a large AWE lesion who underwent cesarean section due to abnormal fetal position 8 years ago. The mass lesion of AWE located in rectus muscle fascia and rectus muscle with a size of 61 × 25 × 49mm. RESULTS: HIFU treatment was completed in one session. One day post-HIFU MRI showed the mass was completely ablated. After HIFU treatment, the cyclical abdominal pain disappeared. The mass lesion shrank during follow-up period and disappeared in 1 year after HIFU. No complication was observed after HIFU. CONCLUSION: Surgical resection of AWE remains the standard of care. In patients with large AWE lesion located in rectus muscle fascia and rectus muscle where the muscle and fascia must be excised, HIFU treatment should be considered to avoid mesh implantation.

Predictive value of prenatal ultrasound in foetal intraabdominal cystic lesions and evaluation of perinatal outcomes: a single-centre study results.

The prenatal diagnosis of intra-abdominal cystic lesions is relatively common and it can be due to a wide variety of clinical conditions. The aims of this study were to determine the accuracy of the prenatal ultrasound in identifying the aetiology of foetal intra-abdominal cysts and to describe the prenatal and postnatal outcomes. This study is a retrospective analysis of 137 foetuses diagnosed with intraabdominal cysts during the prenatal period, except those originating from the urinary system, conducted from April 2015 to August 2018. Among 137 intraabdominal cysts identified as antenatal, ovarian cysts had the highest rate of prenatal diagnosis. The most frequently misdiagnosed pathologies were gastrointestinal system obstructions with 6 cases. There were 129 (94.2%)cases of intraabdominal cysts born alive. Intrabdominal cystic lesions resolved spontaneously in 23(16.8%) cases in the intrauterine period and 28 cases within 12 (20.4%) months after birth during follow-up. Postpartum surgical treatment was performed in 44 (%32.1) cases. The overall neonatal mortality was 21/137 (15.3%),with no death in the intrauterine period; 8(5.8%) of these were death following termination of pregnancy, 6(4.4%) were postpartum, and 7(5.1%) were post-surgical death. Postnatal results of intraabdominal cysts are variable. Therefore, individual assessing and managing each case is of clear benefit due to cyst's variable course. IMPACT STATEMENTWhat is already known on this subject? The prenatal diagnosis of intra- abdominal cystic lesions is relatively common and prenatal ultrasound is the main screening tool. The diagnosis of a foetal intra-abdominal cyst might represent a diagnostic and management dilemma due to the wide variety of potential diagnosis.What the results of this study add? The accuracy of prenatal ultrasound in identifying the origin of a foetal intra-abdominal cyst seems to be high with detailed ultrasonographic examinations and the perinatal outcome of these foetuses is favourable in most of them.What the implications are of these findings for clinical practice and/or future research? Regardless of the cyst's origin, it should be kept in mind that prenatal and postnatal clinical courses can be variable in each case, and every pregnant woman with a foetus with an intraabdominal cyst must be managed individually in every aspect.

GIANT ADRENAL GANGLIONEUROMA AND MYELOLIPOMA: A RARE CASE OF COLLISION TUMOR.

Background: An adrenal collision tumor is a rare entity. We present a rare combination of giant adrenal ganglioneuroma (GN) and myelolipoma. GN is a rare benign tumor of the adrenal medulla that originates from primitive neural crest cells, while myelolipoma is a benign tumor of the adrenal cortex comprising of mature adipose tissue and blood components. Case Report: We present a case of a 52-year-old male who presented with generalized body swelling with episodes of vomiting and diarrhea. There was no history of abdominal pain or any significant history. Routine laboratory investigations and endocrine workup were within normal limits. MRI was performed for unexplained symptoms, and which revealed a solid homogeneous mass measuring 9x7x4.5cm arising from the adrenal gland. A diagnosis of myxoid adrenocortical neoplasm was suggested, and laparoscopic left adrenalectomy was performed based on imaging findings. The final diagnosis of coexisting giant adrenal GN with myelolipoma was made on histopathological examination, which was further confirmed by immunohistochemistry. Conclusion: Ganglioneuroma coexistence with myelolipoma is a rare finding in the adrenal gland. Therefore, histopathology is imperative in such cases for a definitive diagnosis.

A mass in the upper abdomen derived from Talaromyces marneffei infected lymphadenopathy: a case report.

BACKGROUND: An upper abdominal mass without tenderness often indicates a benign or malignant tumor once liver or spleen hyperplasia has been excluded. A lymphadenopathic mass from Talaromyces marneffei infection is rare. CASE PRESENTATION: We report the case of a 29-year-old human immunodeficiency virus (HIV) infected man who presented with an upper abdominal mass and without any symptoms related with infection. Histopathology and next-generation sequencing (NGS) following biopsy of the mass confirmed T. marneffei-infected lymphadenopathy, and the patient was successfully treated with amphotericin B and itraconazole. CONCLUSIONS: This case report suggests that potential fungal infection should be considered during the diagnostic workup of a mass in clinical practice.

A CSF pseudocyst.

A 51-year-old female with prior history of ventriculoperitoneal shunt presented with worsening abdominal distension. Her abdomen was diffusely tender and firm with a slight fluid wave. CT imaging with IV contrast was notable for a large cystic lesion in the abdominal cavity with the differential of CSF pseudocyst versus ovarian mass. She underwent paracentesis of the cyst with interventional radiology and required a revision of her ventriculoperitoneal shunt. CSF pseudocysts are a rare complication of ventriculoperitoneal shunts, however, are an important consideration in patients presenting with abdominal complaints and require specialized intervention and assessment.

[Delirium in a 95-year-old patient]. / Delir bei einem 95-jährigen Patienten.

This article presents the case of a 95-year-old patient with acute urinary retention, postrenal acute renal failure, and subsequent delirium. Especially in older men, urinary retention is often the cause of clinically ambiguous confusional state and should always be considered in the differential diagnosis. This case report demonstrates the value of a good medical history and physical examination as fundamental elements of daily practice.

Giant abdominal aortic aneurysm of uncommon etiology due to Behçet disease.

Behçet disease is a multisystem disorder presenting with recurrent oral and genital ulcerations as well as with ocular involvement. Vascular involvement can occur in up to 50% of affected patients. Arterial aneurysms are often multiple and are characterized by a saccular configuration with increased risk of unexpected rupture, thrombosis, and aneurysm recurrence. Here we report a case of giant infrarenal abdominal aortic aneurysm in a 34-year-old man with Behçet disease who underwent aneurysmorrhaphy and aortobifemoral bypass.

Isolated gastric varices secondary to abdominal tuberculosis mimicking lymphoma: a case report.

BACKGROUND: Abdominal tuberculosis (TB) rarely presents with abdominal masses and rarely causes isolated gastric varices. CASE PRESENTATION: We report a case of isolated gastric varices secondary to abdominal TB mimicking lymphoma. A 42-year-old woman without any history of liver disease presented with melena and mild abdominal pain. Upon admission to the hospital, laboratory investigations revealed a hemoglobin level of 76 g/L. Gastroduodenoscopic examination showed isolated gastric fundal varices with red color signs. Abdominal contrast-enhanced computed tomography (CECT) revealed non-enhanced masses of soft-tissue density in the lesser omental and the retropancreatic areas, multiple para-aortic lymph nodes, and multiple small hypodense splenic lesions. Positron emission tomography-CT showed hypermetabolic [F-18]2-fluoro-2-deoxyglucose activity involving multiple regional lymph nodes and the bone marrow, suggestive of lymphoma. Bone marrow biopsy revealed no abnormality. Histopathological examination of a CT-guided biopsy specimen showed granulomatous inflammation with necrosis and microorganisms that stained positive with acid-fast stains. Abdominal CECT showed a decrease in the size of the lesser omental and peripancreatic masses, as well as the para-aortic lymph nodes after 4-month anti-TB therapy. CONCLUSIONS: TB should be considered among the differential diagnoses in patients with abdominal masses, isolated gastric varices, and regional lymphadenopathy. Prompt and definitive diagnosis of abdominal TB requires a coordinated approach involving laboratory tests, radiological examination, and invasive procedures for optimal decision making and management.

Subcutaneous Sparganosis on Abdomen Mimicking Multiple Lipomas.

Human sparganosis is a food-borne zoonosis mainly caused by the plerocercoid belonging to the genus Spirometra. The most common clinical sign of sparganosis is a subcutaneous mass in the trunk including abdominal or chest wall. The mass may be mistaken for a malignant tumor, thereby causing difficulty in terms of diagnosis and treatment. A 66-year-old woman visited our clinic for the removal of a lipoma-like mass. It was movable, hard, and painless. We identified 2 white mass, measuring 0.2×4 cm and 0.2×1 cm. Pathologic findings indicated the white mass was a sparganum. She recalled having eaten a raw frog approximately 60 years before. A 35-year-old who lived North Korea was also presented to our clinic with an asymptomatic nodule on her abdomen. Intraoperatively, we found sparganum approximately 24 cm size. Subcutaneous masses are associated with clinical signs of inflammation or they may mimic a soft tissue neoplasm. While the incidence rate of sparganosis has decreased with economic development and advancements in sanitation, surgeons still encounter patients with sparganosis in the clinical setting. Therefore, a careful history is required in order to diagnose sparganosis.

Prenatal diagnosis and prognosis assessment of fetal intra-abdominal cystic lesions: a retrospective study in 264 cases.

To assess the accuracy of prenatal diagnosis and the prognosis of fetal-abdominal masses, we reviewed all of the cases which had been diagnosed as having abdominal masses from January 2014 to December 2016. In total, 264 cases were identified as having abdominal masses. Among them, 141 cases (53%) had received specific prenatal diagnoses by prenatal ultrasound (US). MRI had assisted in the diagnosis and prognostic evaluation in 69 cases, increasing the diagnostic rate to 65%. The prenatal diagnoses of 111 cases (65%) were concordant with the postnatal diagnoses. Surgical intervention after birth was needed in 96 cases (39%). Most outcomes were good (89%). We suggest that prenatal US can detect and identify most fetal abdominal masses and that MRI helps to further describe the masses. With early intervention after birth, the prognosis was good in most cases. Impact Statement What is already known on this subject? Fetal-abdominal masses are commonly detected in antenatal examinations. A prenatal ultrasound is the main screening tool for detecting fetal intra-abdominal cystic lesions. What the results of this study add? We suggest that MRI is more helpful in some systems to reveal locations and structures. Even prenatal diagnosis cannot reach before birth, prognosis is quite good and expectant therapy is sufficient. What the implications are of these findings for clinical practice and/or future research? Our data strengthens the current knowledge of fetal abdominal masses to help relieve anxious parents by telling them that this congenital malformation has good outcomes. But multidiscipline consultation is necessary.

Lipoma of round ligament on the intraperitoneal portion (abdominal site): a case report.

OBJECTIVE: Primary tumors of round ligament are rare, and when found are typically leiomyomas. Endometrioma, and mesothelial cysts are the benign lesions recognized as involving the round ligament. We report a case of lipoma of the round ligament in a 48-year-old premenopausal woman. Round ligament lipoma on the intraperitoneal portion (abdominal site) is very rare and it should be kept in the differential diagnosis of ovarian and abdominal masses.