The Diagnostic Dilemma of Primary Epiploic Appendagitis and How to Establish a Diagnosis.

Primary epiploic appendagitis (PEA) is a relatively uncommon, non-surgical situation that clinically mimics other conditions requiring surgery. In PEA, torsion and inflammation of an epiploic appendix results in localized abdominal pain. This condition may be clinically misdiagnosed, resulting in unnecessary surgical intervention. We report the unusual case of a healthy 44-year-old man, who presented to the 417 NIMTS Military Veterans' Fund Hospital of Athens with non-migratory left lower quadrant abdominal pain, which had started 24 hours before admission. The patient described a constant, sharp, non-radiating pain. He had no symptoms of nausea, vomiting, constipation, diarrhea, or fever. Abdominal examination showed focal abdominal tenderness with slight rebound tenderness. The diagnosis of PEA of the sigmoid colon was made based on the findings of an abdominal contrast computed tomography (CT). The key findings of CT were an oval lesion with a maximum diameter of 2.4 cm, with fat attenuation, and a circumferential hyperdense ring located adjacent to the sigmoid colon. This case is presented to highlight the clinical characteristics of PEA, which may help clinicians to overcome this diagnostic dilemma and reach the correct diagnosis.

Asymptomatic extraperitoneal inguinoscrotal hernia involving ureter: A case presentation and review of the literature.

An inguinoscrotal hernia is a common disorder that usually contains intraperitoneal organs (small intestine, colon, appendix, ovaries). Extraperitoneal ureteral herniation into an inguinoscrotal hernia is a rare condition and often associated with congenital abnormalities or postoperative anatomic changes. A high index of suspicion is needed in order to avoid intraoperative ureteric injuries. We herein report the case of a ureteric herniation into an inguinoscrotal hernia incidentally found during a scheduled hernia repair.

True ectopic ovary in the right iliac fossa mimicking acute appendicitis and associated with ipsilateral renal agenesis.

Ectopic ovarian tissue is a rare gynecologic condition. The presence of ectopic ovary may be accompanied by maldevelopments of the genital and urinary tract. We report an extremely rare case of a 39-year-old woman presenting with abdominal pain localized in the right lower quadrant. During the preoperative investigation and the exploratory laparotomy, an ectopic ovary in contact with the appendix accompanied by a single left kidney was found. The present report also includes a review of the related published work. To the best of our knowledge, this is one of the very few cases reported describing the co-occurrence of true ovarian ectopia and ipsilateral renal agenesis.

The immunohistochemical expression of growth hormone-releasing hormone receptor splice variant 1 is a favorable prognostic marker in colorectal cancer.

Hypothalamic growth hormone (GH)-releasing hormone (GHRH) regulates the release of GH from the pituitary gland. The receptors for GHRH (GHRH-R) are expressed predominantly in the pituitary. Recent evidence demonstrates that splice variants of the GHRH receptor are also expressed in several nonpituitary tissues, both normal and tumoral, as well as in cancer cell lines. The aim of this study was to investigate the expression of the splice variant 1 (SV-1) of GHRH-R in colorectal cancer (CRC). Seventy patients who underwent partial colectomy for CRC were enrolled in the study. Immunohistochemical expression of SV-1 was studied in paraffin-embedded sections of patient tumor tissue. A cytoplasmic supranuclear expression of SV-1 was observed in CRC as well as in the normal colon mucosa. Tumor grade and pathological stage were negatively correlated with expression of SV-1 (P = 0.012 and P = 0.013, respectively). CRCs metastatic to the liver showed a lower expression of SV-1 than did primary tumors, but this difference was not statistically significant. Kaplan-Meier and Cox univariate survival analyses indicated an improved survival time in patients with high SV-1 compared with those with low GHRH-R expression, but this difference was not statistically significant. The immunohistochemical expression of SV-1 seems to be a favorable prognostic factor in CRC.

Bilateral polyorchidism associated with intraabdominal cryptorchidism: a case report.

OBJECTIVE: The aim of this study was to present a rare congenital anomaly of polyorchidism and to review the current management. CLINICAL PRESENTATION AND INTERVENTION: We report the case of a 19-year-old man who was referred for the treatment of an indirect left inguinal hernia. The ultrasound demonstrated a testis on the right side with an additional mass. The preoperative laboratory studies were normal. At surgery, a solid mass consistent with an ectopic testis was removed. The histological evaluation showed the presence of a fourth testis without malignancy, confirming the diagnosis of bilateral, double testes associated with intraabdominal cryptorchidism, which was removed for histology. The postoperative endocrinological evaluation revealed hypergonadotrophic hypogonadism. The patient was followed up conservatively. CONCLUSION: Polyorchidism should be included in the differential diagnosis of a solid extratesticular mass, and its management should be conservative.

Synchronous early gastric cancer and gastrointestinal stromal tumor in the stomach of a patient with idiopathic thrombocytopenic purpura.

The synchronous occurrence of gastrointestinal stromal tumour (GIST) in the stomach and early gastric cancer is uncommon, with only a few previous reports. In particular, the collision of GIST and early gastric cancer in a patient with idiopathic thrombocytopenic purpura (ITP) has never been reported. We present the case of a 78-year-old male patient with ITP who was diagnosed with a synchronous development of GIST and early gastric cancer of the stomach. He underwent an elective subtotal gastrectomy with splenectomy. We discuss whether the development of GIST in the stomach in concert with early gastric cancer is an incidental coexistence or involve the same carcinogenic agents. Furthermore, it is not known whether or not such a situation is connected with ITP. To our knowledge this is the second report of a small GIST concomitant with an early gastric cancer and the first one in a patient with ITP.