A Rare Occurrence of Endometriosis Externa Individually Within the Rectus Abdominis Muscle.

Endometriosis is defined as the presence of ectopic functional endometrial tissue outside the uterine cavity. It most commonly occurs in the pelvic organs, including the ovaries, ligaments of the uterus, and the pouch of Douglas. Extrapelvic implantation of endometrial tissue has also been reported in the literature. Extrapelvic endometriosis can be explained by lymphatic/vascular migration or mechanical transplantation of the tissue during surgery. Rectus abdominis muscle endometriosis is a rare phenomenon that usually presents with a palpable abdominal mass and cyclic pain. Ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI) can be effective to define the location and size of the mass. Our patient was a 32-year-old woman presenting with cyclic abdominal pain and the development of an abdominal mass she had noticed for a year. USG and MRI scans revealed an endometrial focus in the right rectus abdominis muscle. Surgical excision with negative margins was performed, since surgical treatment of the lesion is offered as the definitive treatment.

Apparent diffusion coefficient histogram analysis for predicting neoadjuvant chemoradiotherapy response in patients with rectal cancer.

PURPOSE This study aimed to retrospectively evaluate the apparent diffusion coefficient (ADC) histograms in predicting chemoradiotherapy (CRT) response in patients with locally advanced rectal cancer (LARC). METHODS A total of 51 patients who underwent surgery in our institution for rectal cancer following neoadjuvant CRT between November 2013 and July 2019 were enrolled. Conventional magnetic resonance (MR) and diffusion-weighted images obtained before and after CRT were evaluated retrospectively. All tumor-containing regions of interests were drawn in 3 selected axial images, and special software for histogram analysis was used to evaluate ADC distribution. ADC cutoff values from post-CRT ADC histogram were calculated from receiver operating characteristic (ROC) analysis for evaluating CRT response. RESULTS In histopathological analysis, 5 patients (9.8%) had minimal response (group 1), 31 patients (60.8%) had partial response (group 2), and 15 patients (29.4%) had complete or almost complete response (group 3). In the ADC histogram, minimum, maximum, 10th, 25th, 50th, 75th, and 90th percentile, mean ADC values, and skewness values of groups 2 and 3 showed significant changes before and after CRT, but no difference was found within group 1 values. The mean, 25th, 50th, 75th percent ADC values after CRT and skewness, and kurtosis values were significantly different between group 1 and group 3. Skewness value from the ADC histogram in postCRT magnetic resonance imaging had the best diagnostic performance with an area under the ROC curve of 0.851 (P =.003) for detecting group 3. The skewness cutoff calculated from the ROC analysis was 0.210 for evaluating CRT response. The sensitivity and specificity of the cut-off value were 100% and 61.4%, respectively. CONCLUSION The ADC histogram analysis seems to have potential application in predicting response to neoadjuvant CRT in patients with locally advanced rectal cancer.

Concurrent Septal and Right Ventricular Aneurysms Detected on Second Trimester Ultrasound Scan: A Case Report.

Congenital aneurysms and diverticula of the heart are rare anomalies and their prenatal diagnosis is challenging. Fetuses with suspected cardiac aneurysms on ultrasound (US) screening should undergo targeted fetal echocardiography, postnatal imaging, and follow-ups. Herein, we describe the second trimester US scan and postnatal cardiac magnetic resonance imaging (MRI) findings of a baby girl with concurrent septal and right ventricular cardiac aneurysms. Other cardiac and extra-cardiac structures were normal. Upon consultation about the prognostic uncertainty of the situation, the family chose to continue the pregnancy. The rest of the pregnancy and birth was without any complications. Follow-up postnatal echocardiograms showed no progression regarding the size of the aneurysms. The baby is still on follow-up without any medication and is thriving. To the best of our knowledge, this case report is the first to show the prenatal diagnosis of two concurrent rare cardiac aneurysms.