A Ureteral Mass Presenting As Deep Vein Thrombosis: A Very Rare Presentation

Deep Vein Thrombosis (DVT) is a dreaded condition, caused by an interplay of a triad of factors consisting ofhypercoagulability, vascular endothelial dysfunction, and stasis. Stasiscan lead tothe development of DVT due to mass external compression over pelvic veins. Here, we present the case of a 45-year-old female who presented with sudden onset left lower limb swelling who was diagnosed to have left iliac venous thrombosis caused by external compression due to an advanced ureteric malignancyunderlining the need for a thorough evaluation in such patients to reveal a more sinister pathology.

Adrenocortical Carcinoma With Contralateral Renal Metastases And Tumor Thrombus: A Case Report

Adrenocortical carcinoma (ACC) is a rare aggressive malignancy. ACC with renal vein or inferior vena cava (IVC) thrombus is very rare. ACC with contralateral renal metastasis with renal vein thrombus has never been reported. Here we report first such case in the literature where a 40-year-old male presented with right flank pain and weight loss. Definitive reoperative diagnosis failed to be established. Intraoperatively, there was right adrenal mass with left renal vein thrombus invading its wall and extending upto IVC. Right adrenalectomy with left radical nephrectomy with thrombectomy was done. On cut specimen, there was a small mass lesion in the left kidney (upper pole). The diagnosis of ACC with left renal metastasis and renal vein tumor thrombus was confirmed by pathological and immune-histochemical examination. We faced various perioperative challenges in our case. Care must be taken in preoperative diagnostics, intraoperative planning, and postoperative management as ACC may present with contralateral renal metastasis and tumor thrombus.

Laparoscopic Management Of A Giant Prostatic Utricle: A Case Report And Review Of Literature

Prostatic utricle is a Mullerian duct remnant with an incidence of 1 %. Excision of utricle is challenging because of the close proximity of seminal vesicle, ejaculatory ducts, bladder, rectum, ureter, and nerve plexus. Here, we report the case of a 23-year-old male presented with complaints of painful terminal hematuria associated with clots along with retrograde ejaculation. The abdominal and local examination was within normal limits. MRI pelvis showed a large non-communicating cystic structure present in the pelvic cavity, compressing posterior wall of the urinary bladder, seminal vesicle, anterior wall of the rectum and also causing left hydroureteronephrosis. After evaluation, the patient was diagnosed with giant prostatic utricle cyst. Laparoscopic excision of prostatic utricle cyst was done successfully. Postoperative period was uneventful and the patient was discharged in satisfactory condition. Laparoscopic excision of prostatic utricle cyst is technically challenging but with acceptable complications and good surgical results

Acute T-cell lymphoblastic leukaemia presenting with cutaneous involvement in a child: a rare case report.

Primary cutaneous involvement in T-cell lymphoblastic leukemia is rare in childhood. We present a case of 6-year-old girl admitted to our hospital because of multiple skin lesions. She was looked pale and weak. Generalized lymphadenopathy was present. Complete blood count revealed 216,000/mm3 white blood cell count. Peripheral blood smear showed 80% lymphoblasts. Bone marrow aspiration revealed 96% blastic cells with immunophenotype and morphological characteristics of acute lymphoblastic leukemia (T-ALL) which was confirmed by flowcytometry. ALL BFM -95 remission induction treatment protocol was started. Skin lesion remained same after two month of the cytotoxic therapy. The symptoms became more aggressive and she died after 4 months of treatment.

Epigastric mass in a young girl: trichobezoar. Imaging diagnosis.

A 16-year old girl presented with a history of abdominal pain, lump in epigastrium since one year. The ultrasound examination showed an epigastric mass, which was delineated as a filling defect in the stomach on barium studies. Upper GI endoscopy showed a large intragastric mass composed of hair. The CT scan showed a gastric mass extending to the duodenum. She was managed by surgical removal. A large gastric trichobezoar extending upto the jejunum was found. This case highlights the characteristic radiological appearance on barium, ultrasound and computed tomography of a bezoar within the stomach and a trichobezoar with a long tail extending upto the jejunum without intestinal obstruction is unusual.

Correlation of gestational age by sonographic measurement of fetal parameters in women in eastern Nepal with existing standard normograms.

This is the prospective study carried out to correlate gestational age by sonographic measurements of fetal parameters by normograms of Frank P Hadlock with the gestational age by Last Menstrual Period (LMP) (considered our standard) in various trimesters of normal pregnant women of eastern Nepal. Seventy normal pregnant women with regular menstrual cycles of eastern Nepal were evaluated in this study. Gestational age was calculated by Rempen (in case of Mean Sac Diameter) and Hadlock (in case of Biparietal Diameter, Head circumference, Femoral Length and Abdominal circumference) normograms. Calculations of gestational age was also done by LMP at the same time. Correlation of gestational age by Rempen and Hadlock with average of different fetal parameters in different trimesters was done with gestational age by LMP applying paired t test. On applying paired t test between gestational age by Mean Sac Diameter and Crown-Rump Length in the first trimesters, mean difference was only -3.58 days (significance < 0.01). It showed statistically significant difference though difference is little. Paired t test application in second trimester showed significant difference (-5.06 days) with gestational age by LMP at < 001 significance level. In 3rd trimesters, paired t test showed significant difference with gestational age by LMP with mean of difference -7.86 days. Significant difference between average gestational age by Hadlock and gestational age by LMP in 2nd and 3rd trimesters of pregnancy indicates that we should stantardise our measurements of different fetal parameters for estimation of gestational age.