Radio-diagnosis of Herlyn Werner Wunderlich Syndrome a rare case of urogenital abnormality

Herlyn-Werner-Wunderlich syndrome (HWWS) is a very rare urogenital abnormality, which is characterized by Mullerian duct anomaly with associated mesonephric duct anomaly. This syndrome is also known as OHVIRA (Obstructed hemivagina with Ipsilateral Renal Anomaly). The incidence of Mullerian Duct Anomaly is 2-3%, and incidence of OHVIRA is 0.16 to 10% of that. The three important components of Herlyn-Werner-Wunderlich (HWW) syndrome are didelphys uterus, obstructed hemivagina and renal agenesis on the same side. Typically presents with pelvic pain in young females after menarche. Presentation in the reproductive age group is unusual. The most common renal anomaly associated with this condition is renal agenesis. Other renal anomalies include renal dysplasia, duplication of kidneys and ureters, crossed fused ectopia and ectopic ureter. Ultrasound and Magnetic resonance imaging are considered as the vital modalities for detection. MRI is the gold standard modality for assessing the anatomical characteristics of the uterus, cervix, and vagina. Early diagnosis helps to prevent complications such as endometriosis, pyocolpos, adhesions, infertility. The unique feature of our case is a presentation in the reproductive age group. Only very few case reports of OHVIRA with a presentation in the reproductive age group are available in the literature. Whenever there is a renal anomaly or renal agenesis, screening of pelvic organs is important in a female child for early detection of Mullerian duct anomalies and prevention of further complications.

Radiological interpretation of a small cell neuroendocrine cancer of the lung

Neuroendocrine tumors may develop throughout the human body with the majority being found in the gastrointestinal tract and bronchopulmonary system. Neuroendocrine tumors are classified according to the grade of biological aggressiveness (G1–G3) and the extent of differentiation (welldifferentiated/ poorly-differentiated). The well-differentiated neoplasms comprise typical (G1) and atypical (G2) carcinoids. Large cell neuroendocrine carcinomas, as well as small cell carcinomas (G3), are poorly-differentiated. The identification and differentiation of atypical from typical carcinoids or large cell neuroendocrine carcinomas and small cell carcinomas are essential for treatment options and prognosis. Pulmonary neuroendocrine tumors are characterized according to the proportion of necrosis, the mitotic activity, palisading, rosette-like structure, trabecular pattern, and organoid nesting. These neuroendocrine tumors of the lung arise from Kulchitzky cells of the bronchial mucosa and comprise typical carcinoid, atypical carcinoid, large cell neuroendocrine carcinoma (LCNEC), and small cell lung cancer (SCLC). Here is a case report of the 75-year-old male patient presented with complaints of a cough and sudden onset of breathlessness and weight. On Computed Tomography (CT) a large heterogeneous lesion noted in the left anterior mediastinum which was subjected to CT guided biopsy. On histopathology and immunohistochemistry, the tumor was confirmed as small cell neuroendocrine tumor.