Spindle?Cell Sarcoma of the Heart: A Case Report of a Rare Cause of Cardiac Mass

Spindle cell sarcoma of heart are the least reported primary cardiac tumours. We present a case of a 60-year-old man reported to us following successful resuscitation after cardiac arrest. This patient presented with symptoms of dyspnoea on exertion. The echocardiography showed features of cardiac tamponade. CT scan chest+ Abdomen + Pelvis confirmed echocardiography findings, and showed significant pericardial effusion with early cardiac tamponade. Patient continued to suffer dyspnoea even after pericardiocentesis and was unstable in the intensive care unit, hence he was shifted to operating room for re-exploration. The mass was excised in a piecemeal without instituting cardiopulmonary bypass. The total weight of the mass was approximately 500gms. The macroscopic examination of the specimen revealed a cystic mass with solid grey brown tissue. Following surgical debulking, chest X -ray in Intensive Care Unit showed improvement. The patient visited the outpatient clinic after 15 days of surgery. 2-D echocardiography revealed minimal pericardial effusion and patient was comfortable.

Retracted: When a giant ovarian cyst poses a diagnostic dilemma

The article " When a giant ovarian cyst poses a diagnostic dilemma" is retracted by the Editor-in-Chief, on the request of corresponding author and co-authors. The corresponding author informed that the patient described in this article, although willingly gave her consent for revealing her clinical data for publication, later withdrew her consent after knowing about the publication of clinical material during she came for a follow up visit.

Distinguishing between Thymic Epithelial Tumors and Benign Cysts via Computed Tomography

OBJECTIVE: To investigate whether computed tomography (CT) and fluorine-18-labeled fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) may be applied to distinguish thymic epithelial tumors (TETs) from benign cysts in the anterior mediastinum. MATERIALS AND METHODS: We included 262 consecutive patients with pathologically proven TETs and benign cysts 5 cm or smaller who underwent preoperative CT scans. In addition to conventional morphological and ancillary CT findings, the relationship between the lesion and the adjacent mediastinal pleura was evaluated qualitatively and quantitatively. Mean lesion attenuation was measured on CT images. The maximum standardized uptake value (SUVmax) was obtained with FDG-PET scans in 40 patients. CT predictors for TETs were identified with multivariate logistic regression analysis. For validation, we assessed the diagnostic accuracy and inter-observer agreement between four radiologists in a size-matched set of 24 cysts and 24 TETs using a receiver operating characteristic curve before and after being informed of the study findings. RESULTS: The multivariate analysis showed that post-contrast attenuation of 60 Hounsfield unit or higher (odds ratio [OR], 12.734; 95% confidence interval [CI], 2.506–64.705; p = 0.002) and the presence of protrusion from the mediastinal pleura (OR, 9.855; 95% CI, 1.749–55.535; p = 0.009) were the strongest CT predictors for TETs. SUVmax was significantly higher in TETs than in cysts (5.3 ± 2.4 vs. 1.1 ± 0.3; p < 0.001). After being informed of the study findings, the readers' area under the curve improved from 0.872–0.955 to 0.949–0.999 (p = 0.066–0.149). Inter-observer kappa values for protrusion were 0.630–0.941. CONCLUSION: Post-contrast CT attenuation, protrusion from the mediastinal pleura, and SUVmax were useful imaging features for distinguishing TETs from cysts in the anterior mediastinum.

Benign multicystic peritoneal mesothelioma treated with laparoendoscopic single site surgery: a case report and review of the literature

Benign multicystic peritoneal mesothelioma (BMPM) is rare and difficult to diagnose before surgery. We report a case of BMPM incidentally discovered during laparoendoscopic single site surgery (LESS) for treatment of a pelvic mass. A 47-year-old Korean menopaused woman presented to our outpatient clinic with a pelvic mass. She had a history of right ovary cystectomy with adhesiolysis at a local hospital in 2010. Imaging study of the pelvis revealed a multilocular cystic mass. LESS was performed and multiple grapelike clusters of cysts were seen in the uterus, cul-de-sac, both adnexa, pelvic wall, and omentum. The appendix was grossly free. Frozen biopsy confirmed BMPM. Excision of multiple cyst clusters of cysts, resection of the uterus with both adnexa, appendectomy, omentectomy, and adhesiolysis were performed with LESS. She is well for 2 years with no recurrence. BMPM should be included in the differential diagnosis when small multichamber cystic mass is found on ultrasonography.

A Case of Contrast Enhanced Cystic Mass of External Ear Canal Diagnosed as Engorged Hard Tick

A 58-year-old female complained earfullness and otalgia and came to the clinic. Dark gray colored cystic mass obstructing the left ear canal was observed during the endoscopic exam. Contrast enhanced CT image showed an oval shape soft tissue lesion in the mid part of the external auditory canal with a homogenous increased contrast uptake. The mass was removed under microscopic view at outpatient clinic. While dissecting the mass in the ear canal, a pod like structure was visualized. The external organism was densely adherent to the skin and turned out to be an engorged hard tick. Considering the final diagnosis, contrast uptake observed in the CT scan implicates the patient communication of blood between host and parasite. This unique image finding differs from a benign mass lesion in the ear canal was one of the differential diagnosis points for the lesion. This article is reporting the case of tick bite in the ear canal with a rare CT scan finding.

Disseminated multiple hydatidosis at unusual location: Two rare case reports.

Hydatid disease, a parasitic infection is caused by cestode tapeworm Echinococus granulosus which is endemic in cattle grazing areas including India. Dogs are the definitive host. In human, commonly involved organs are liver and lungs. Peritoneal hydatidosis secondary to liver hydatid diseases is not uncommon but peritonial hydatidosis herniating to inguinal canal mimicking irreducible inguinal hernia is rare. Patient on clinical examination appears normally with complain of progressive abdominal pain and distention and irreducible cystic swelling in the inguinal region. Patients also gave history of contact with animals. Laboratory findings were not constant. Imaging and investigation necessary for establishing diagnosis were done. There always choice between ultrasound and computed tomography. Treatment includes conservative and surgical intervention. In case of single, symptomatic and large cyst was surgically treated. Small asymptomatic cysts, some daughter cysts, and peritoneal secondary cysts and splenic cysts may also be effectively conservatively treated. We reported here two cases of multiple hydatidosis at unusual location. In all patients large and symptomatic cyst was excised and all patient recover clinically. This case series emphasized that current understanding of disseminated multiple hydatidosis etiology still very little known. Study for additional risk factor may be necessary.

Ultrasonography as a Breast Imaging Modality: A Review.

Introduction: Ultrasonography and Magnetic Resonance Imaging (MRI) serves as the most prominent adjunct imaging modality to mammography. Ultrasound (US) is cheap, non-invasive and widely available in healthcare centres in Ghana but often used for obstetrics and gynaecological investigations. These including many other factors have stimulated a challenge to further investigate and optimise the use of the ultrasound equipments’ availability in order to facilitate the early diagnosis and treatment of breast diseases. Aim: The aim of this article is to review the role played by ultrasonography in diagnosing breast masses. Methods: Google search engine was used to search for ultrasonography related articles. The selected articles were reviewed to prepare this manuscript. Results: It was established that though mammography is the orthodox and only modality suitable for screening and should not be replaced, ultrasound is a helpful and reliable diagnostic tool for first-line imaging (screening) especially in younger women to diagnose a palpable mass in the breast without having to necessarily perform a mammogram examination and it is also the only modality that can accurately detect a cystic mass without a biopsy. MRI has a higher sensitivity but low specificity and hence not suitable to be used as a screening tool. Conclusion: Ultrasound is non- invasive, common and cost effective, however it is advisably to do this procedure when clinically necessary or deemed fit.

A Case of Cholangiocarcinoma with Brain and Leptomeningeal Carcinomatosis / 대한내과학회지

Cholangiocarcinoma is a malignant disease originating from the epithelium of the biliary tract, and its prognosis is dismal due to distant metastasis in its early stages. The most common metastatic sites are the intra-abdominal organs, lymph nodes, and lungs. A patient was diagnosed with intrahepatic cholangiocarcinoma and underwent surgical resection. During the follow-up period, metastases were detected at the remnant liver and both lung fields. Eleven months after resection, the patient complained of severe headache. An approximately 5-cm cystic mass was found at the left occipital lobe of the cerebrum, and metastatic malignant cells were present on cerebrospinal fluid cytology. The patient underwent whole-brain radiotherapy. We herein report a rare case of cholangiocarcinoma with cystic brain metastasis together with a review of the relevant literature.

Evaluation of cystic renal mass with contrast enhanced ultrasonography / 中华泌尿外科杂志

Objective To investigate the value of contrast enhanced ultrasonography in evaluating cystic renal mass. Methods According to the imaging diagnosing standard, 29 cystic renal mass lesions were studied with contrast enhanced ultrasonography(CEUS), unenhanced ultrasonography (US), contrast enhanced CT(CECT) and then correlated their results with final histopathological results. The data were tested by receiver operating characteristic(ROC) curve. Results The area under ROC curve of CEUS and US was 0. 721, 0. 997, respectively. There was significant difference between the 2 groups (P=0. 003). The area under ROC curve of CEUS and CECT was 0. 997, 0. 997,respectively. There was no significant difference between the 2 groups (P= 1. 000). Conclusions CEUS is better than US and similar to CECT in evaluating cystic renal mass. CEUS with the Bosniak classification is useful for evaluating cystic renal mass.

Occult Papillary Thyroid Carcinoma Presenting as a Cystic Neck Mass / 대한내분비외과학회지

The majority of cystic masses in the lateral neck are benign entities, and these entities include branchial cyst. Occult papillary thyroid carcinoma can occasionally present with regional lymph node metastasis. However, cystic metastasis from occult papillary thyroid carcinoma is a very rare condition. We present here a case of a cystic neck mass as the sole initial clinical manifestation of metastatic occult papillary thyroid carcionoma.

A Case of Allergic Bronchopulmonary Aspergillosis During Childhood

Allergic bronchopulmonary aspergillosis(ABPA) is an inflammatory disease which causes a hypersensitivity to Aspergillus spores growing in the bronchi. The clinical syndrome is characterized by asthma, recurrent pulmonary infiltrations or mucoid impaction, eosinophilia, and central bronchiectasis. A 12-year-old boy was admitted to our hospital because of right lower chest pain and cystic mass-like shadows on a chest X-ray film. He had asthma as an infant, but had no asthmatic symptoms on admission. Chest CT scan showed low density cystic mass of the right lower lobe. The total eosinophil count and IgE level were abnormally high. Test for immediate skin reaction to Aspergillus fumigatus was positive but precipitating antibody to Aspergillus antigen was negative. After steroid treatment, he became asymptomatic. Radiologic abnormalities including mass-like shadows were resolved by two months after the start of treatment and a follow-up high resolution CT scan obtained after clinical improvement revealed central saccular bronchiectasis. We report one case of ABPA with review of literature.

A Case of Ectopic Paragonimiasis Mimicking Urachal Cystic Mass / 대한비뇨기과학회지

Paragonimiasis is an infection caused by the tematode Paragonimus westermani. Paragonimiasis is endemic in parts of South America, Africa, East and Southest Asia. Human infection occurs by ingestion of raw or incompletely cooked flesh crabs or crayfish infected with metacercaria. Although the lung is the primary site of infection, other organs, notably the brain, may be involved. It rarely affects in abdomen. However, involvement of several intra-abdominal organs has been described. In our knowledge, an ectopic paragonimiasis in prevesical space mimicking urachal cystic mass has not been reported. In this report, we present a case of ectopic paragonimiasis mimicking urachal cystic mass in 66-year-old male.

A Case of Clear Cell Hidradenoma / 대한피부과학회지

We report herein a case of clear cell hidradenoma in a 65-year-old man, who had a 8-month history of a asymptomatic, smooth-surfaced, round, blue tumor mass with cystic grape-like nature on the left upper chest, measuring 2.0 x 2.0 x 1.5cm in size. A histopathological examination revealed tubular and cystic structures within the intradermal tumor composed of predominant fusiform cells and clear cells, and some transitional cells. The patient remained free of recurrence for a period of one-year follow-up after the excision.

Gastric Duplication

Gatric duplication is a rare congenital anomaly. Thus for about 90 cases of gastric duplication have been recorded in the literature. It is less frequent than small intestinal or eosphageal duplication, and accounts for only 3.8% of all gastrointestinal tract duplication. Most gastric duplications are seen during the first year of life. Palpable abdominal mass and gastric outlet obstruction in infancy are most common presentation. We experienced a case of non-communicating gastric duplication. A 12-year-old girl visited St. Mary's Hospital because of indigestion, intermittent vomiting, and left upper quandrant pain for about 40 days. She have had intemittent abdominal pain with concomitant increased level of amylase since 5 years old. Physical examination showed a hen's egg sized palpable mass on left upper quadrant of the abdomen. Upper GI series and barium enema revealed only indentation of duodenal C-loop, and sonogram and abdominal CT demonstrated isolated cystic mass along the greater curvature of gastric antrum. She had taken an operation under the impression of pancreatic pseudocyst. Operation revealed a cystic mass, located along the greater curvature. There was no pathologic change in the pancreas. Microscopic findings of the cyst wall revealed normal gastric mucosal lining and common muscle layer, shared with gastric antral muscle layer.

A Case of Racemose Cysticercus Infection

Racemose cysticercosis, which is almost exclusively found in intracranial cavity in vary rare occasions, was recognized in a 54-year-old Korean woman. Brain CT revealed a large lobated cystic mass without marginal enhancement, in the right frontotemporal lobe, together with irregularly distributed calcified spots in the parietal area. A 5x6x7cm sized irregularly lobated mass in the subarachnoid space, containing 38ml of xanthochromic fluid was removed. Pathologically the cyst was a racemose cysticercus without scolex. The serum and CSF of the patient showed positive reaction with antigen of Cysticercose celluosae by micro-ELISA for their specific IgG antibody. After the surgery, the patient was treated with Praziquantel for remaining worms(as revealed by calcified spots on brain CT). Follow-up examinations showed improvement in both clinical symptoms and brain CT findings, but Cysticercus-specific IgG antibody level did not fall to normal for 1 year. The rarity of racemose cysticercus infection, together with evidences of concomitant occurrence with C. cellulosae warranted one's case report.

ANALYSES OF 88 CACES OF ABDOMINAL CYSTIC MASS / 西安交通大学学报(医学版)

3626 cases of abdominal cystic mass wereclassified by authors. Results showed that ovarycystic mass was the most common among them.there were 2653 cases in all, accounting for73. 167%. In this paper 88 cases that were compar-atively rare were classified in details, according tooriginal tissue inflammatory cystic mass and reten-tive hydrops were the mose common, there were40 cases in all (45. 45%), congenital cystic masswas the second, 26 cases (29. 55%), developing lo-cation abserved was the most common in meson-tery, 32 cases (36. 36%), the second in abdominalcavity, and then, retroperitoneum, appendix, ete.