Synchronous association of hepatocellular carcinoma and cystic echinococcosis with unusual pathology: report on diagnostic and pathological variability

2021 ◽  
Vol 14 (12) ◽  
pp. e246534
Author(s):  
Sushrutha Chikkanayakanahalli Suresh ◽  
Nagesh N Swamy ◽  
Pritik A Shah ◽  
Raghavendra Babu
Keyword(s):  
Hepatocellular Carcinoma ◽  
Cystic Echinococcosis ◽  
Acute Abdominal Pain ◽  
Abdominal Cavity ◽  
Mass Lesion ◽  
Free Fluid ◽  
Pathology Report ◽  
Cystic Hydatid Disease ◽  
Pathological Evaluation ◽  
Cystic Hydatid

Cystic hydatid disease or cystic echinococcosis (CE) is a globally endemic zoonosis caused by the larval cyst stage of the tapeworm Echinococcus granulosus. Concomitant presence of CE and hepatocellular carcinoma (HCC) is a rare clinical scenario. A 70-year-old male patient presented with acute abdominal pain to the surgical outpatient department. On evaluation, a cystic lesion with solid components and free fluid in the abdomen was observed, which led to multiple differentials in the working diagnosis. A CT showed the mass to have a delayed enhancement. Surgical exploration revealed a partially ruptured hydatid cyst with daughter cysts in the abdominal cavity and a solid-component mass lesion. We proceeded with a right partial hepatectomy. Pathological evaluation revealed a pale mass lesion with a large collapsed cyst. HCC with unusual dense fibrillar fibrosis and cystic interface with normal parenchyma was observed. This case connects the multimodal assessment of radiology, surgery and pathology.

scholarly journals Cystic Echinococcosis

2015 ◽  
Vol 54 (3) ◽  
pp. 518-523 ◽  
Author(s):  
Nelson Iván Agudelo Higuita ◽  
Enrico Brunetti ◽  
Cindy McCloskey
Keyword(s):  
Cystic Echinococcosis ◽  
Neglected Tropical Diseases ◽  
Clinical Manifestations ◽  
World Health ◽  
Cystic Hydatid Disease ◽  
Content Type ◽  
Major Species ◽  
Medical Importance ◽  
Health Organization ◽  
Cystic Hydatid

Echinococcosis is one of the 17 neglected tropical diseases (NTDs) recognized by the World Health Organization. The two major species of medical importance areEchinococcus granulosusandEchinococcus multilocularis.E. granulosusaffects over 1 million people and is responsible for over $3 billion in expenses every year. In this minireview, we discuss aspects of the epidemiology, clinical manifestations, and diagnosis of cystic echinococcosis or cystic hydatid disease caused byE. granulosus.

scholarly journals Chocolate Endometrial Cyst: A Case Report

2021 ◽  
pp. 1-6
Author(s):  
Yugandhara Hingankar ◽  
Vaishali Taksande ◽  
Manjusha Mahakarkar
Keyword(s):  
Unusual Case ◽  
Abdominal Cavity ◽  
Fibrin Clot ◽  
Mass Lesion ◽  
Free Fluid ◽  
Nursing Management ◽  
Case Presentation ◽  
Chocolate Cyst ◽  
Ovarian Endometriomas ◽  
Endometrial Cyst

Introduction: Chocolate cysts are noncancerous, fluid-filled cysts that typically form deep within the ovaries. They get their name from their brown, tar-like appearance, looking something like melted chocolate. They're also called ovarian endometriomas [1]. Case Presentation: The authors report an unusual case of chocolate endometrial cyst.  During history collection it found that patient develop a severe pain at midnight, after all the investigation the ultrasonography they diagnosed probe tenderness in RIF. Significant free fluid in abdominal cavity. Well circumscribed mix echoic mass lesion seen in hypogastric region more in right paraumbilical region with eccentrically placed small tubular structure visualized. Mass lesion of size 110mm×110mm. USG guided tapping done, the ascitic fluid smears shows fresh RBC’s and other blood cells entrapped in fibrin clot. Background is haemorrhagic and malignant cells are absent. Abdominal surgery was done and chocolate cyst was removed and sent to histopathology for further investigations. Conclusion: In this study, author mainly focus on expert surgical management and excellent nursing care which leads to fast recovery of patient. After conversation with patient her response was positive and after nursing management and treatment she was discharged without any postoperative complications and satisfaction of recovery.

scholarly journals Bilateral Krukenberg Tumor with Undetermined Origin during Pregnancy

2019 ◽  
pp. 354-358
Author(s):  
Siufi Neto J ◽  
Moraes W ◽  
Andres MP
Keyword(s):  
Neonatal Intensive Care ◽  
Abdominal Cavity ◽  
Ca 125 ◽  
Greater Omentum ◽  
Free Fluid ◽  
Pathology Report ◽  
Cytokeratin 20 ◽  
Krukenberg Tumor ◽  
Multiple Tumor ◽  
Adjacent Structures

Krukenberg tumor is a rare neoplasia and its occurrence during pregnancy is even more uncommon. In 80% of the cases, Krukenberg tumors are bilateral and the prognosis is poor, especially during pregnancy, which can mimic symptoms and delay diagnosis. We present the case of a 25-year-old woman with a gestational age of 15 weeks diagnosed with bilateral ovarian tumors in a routine ultrasound. Investigation with colonoscopy, esophagogastroduodenoscopy and breast ultrasound was negative. The MRI showed two expansive formations in the pelvic-abdominal region. The right-sided mass measured 12.6 x 12.8 x 14.0 cm with a volume of 1174 cc and the left-sized mass measured 6.0 x 6.8 x 5.1 cm with a volume of 108 cc. Neither side showed signs of invasion of adjacent structures. It was also observed a marked thickening of the greater omentum, minimal thickening of the iliac peritoneal surface, and a large amount of free fluid in the abdominal cavity. Ca – 125 levels were higher than 251, with normal Ca 19-9 and CEA levels. A diagnostic laparoscopy was firstly performed and further bilateral adnexectomy with omentectomy. Pathology report revealed both ovaries infiltrated by epithelioid cells with irregular nuclei consistent with signet-cells. Immunohistochemistry was positive for cytokeratin 20 (CK20), CDX2 and focally positive for cytokeratin 7 (CK7). Based on these findings, the final pathology report was mucinous adenocarcinoma with “signet ring” cells (Krukenberg tumor) favoring gastrointestinal tract origin (CK20, CDX2 and CK7 positive). Due to the need for systemic treatment, pregnancy was interrupted at 31 weeks and a C-section was performed, still showing ascites and multiple tumor implants. A viable female infant was born, weighting 1,715 g with Apgar scores 9 and 10. The infant was admitted to the neonatal intensive care unit for further care and was discharged home after five weeks in good conditions. The patient died one month after giving birth due to severe impairment of her general condition due to disease progression.

scholarly journals Late presentation of extrauterine adenomyomas after laparoscopic morcellation at hysterectomy: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohammed Nagdi Zaki ◽  
Aafia Mohammed Farooq Gheewale ◽  
Nada Ibrahim ◽  
Ibrahim Abd Elrahman
Keyword(s):  
Case Report ◽  
Transvaginal Ultrasound ◽  
Iliac Fossa ◽  
Abdominal Cavity ◽  
Laparoscopic Hysterectomy ◽  
Pathology Report ◽  
Presacral Space ◽  
Gnrh Analogue ◽  
Power Morcellation ◽  
The Right

Abstract Background An adenomyoma is a well circumscribed form of adenomyosis and can be located within the myometrium, in the endometrium as a polyp, or extrauterine with the last being the rarest presentation amongst the three. With the ongoing advancement in gynecological surgery, the use of electromechanical morcellators have made the removal of large and dense specimens possible with minimally invasive techniques. However, it has also caused an increase in complications which were previously rare. Whilst the tissue is being grinded within the abdominal cavity, residual tissue can spread and remain inside, allowing for implantation to occur and thereby giving rise to recurrence of uterine tissue as a new late postoperative complication. Case presentation A 45-year-old woman presented with worsening constipation and right iliac fossa pain. Her past surgical history consists of laparoscopic supra-cervical hysterectomy that was indicated due to uterine fibroids. Computerized tomography and magnetic resonance imaging were done, which showed an irregular lobulated heterogeneous mass seen in the presacral space to the right, located on the right lateral aspect of the recto-sigmoid, measuring 4.5 × 4.3 × 4.3 cm in size. A transvaginal ultrasound revealed a cyst in the left ovary. The patient had a treatment course over several months that included Dienogest (progestin) and Goserelin (GnRH analogue) with add-back therapy. In line with the declining response to medications, the patient was advised for a laparoscopic ovarian cystectomy. During the surgery, an additional lesion was found as a suspected fibroid and the left ovarian cyst was identified as pockets of peritoneal fluid which was sent for cytology. The surgical pathology report confirmed adenomyosis in both specimens, namely the right mass and the initially suspected fibroid. Conclusion In this case report, we showcase a rare occurrence of an extrauterine adenomyoma presenting two years post laparoscopic morcellation at hysterectomy. This poses questions regarding the benefits versus risks of power morcellation in laparoscopic hysterectomy.

scholarly journals Multiple peritoneal dissemination of T2 colorectal cancer without lymph node metastases: a case report

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Yosuke Namba ◽  
Yuzo Hirata ◽  
Shoichiro Mukai ◽  
Toshihiro Nishida ◽  
Syo Ishikawa ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Peritoneal Dissemination ◽  
Abdominal Cavity ◽  
Muscularis Propria ◽  
Ileocecal Resection ◽  
Pathology Report ◽  
Ascending Colon ◽  
Node Metastases

Abstract Most cases of peritoneal dissemination of colorectal cancers are from T3 or T4 tumors. A 61-year-old woman was admitted for examination of a positive fecal occult blood test. Colonoscopy showed an ascending colon tumor that was diagnosed as an adenocarcinoma with massive submucosal invasion. Imaging modality revealed numerous nodules throughout the abdominal cavity. Peritoneal dissemination of the ascending colon or ovarian cancer and pseudomyxoma peritonei were considered in the preoperative differential diagnoses, and laparoscopic ileocecal resection was performed. Intraperitoneal observation revealed numerous white nodules in the peritoneum, omentum and Douglas fossa. Both the nodules and tumor were diagnosed as mucinous carcinoma based on a pathology report. The tumor invasion depth was limited to muscularis propria, and no regional lymph node metastasis was detected. Peritoneal dissemination of the ascending colon cancer was considered. We report a rare case of multiple peritoneal dissemination of T2 colorectal cancer without lymph node metastases.

scholarly journals Minilaparotomy a Good Option in Specific Cases: A Case Report of Bilateral Ovarian Germ Cell Tumor

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
D. Bolla ◽  
N. Deseö ◽  
A. Sturm ◽  
A. Schöning ◽  
C. Leimgruber
Keyword(s):  
Acute Abdominal Pain ◽  
Adnexal Mass ◽  
Past History ◽  
Ovarian Tissue ◽  
Abdominal Cavity ◽  
Operating Time ◽  
Expectant Management ◽  
Small Incision ◽  
Risk Of Rupture ◽  
The Right

Mature cystic teratomas (MCTs) of the ovary represent 44% of ovarian neoplasmas. The surgical approach is important in young women especially for the cosmetic results. Nowadays most of the ovarian surgeries can be performed laparoscopically. An alternative between laparoscopy and laparotomy is the minilaparotomy (ML) which can be an interesting option, thanks to the small incision. We report a 39-year-old woman who was referred to our hospital with acute abdominal pain. In her past history the patient had an uncomplicated delivery. During pregnancy a 6 cm bilateral MCT was diagnosed and expectant management was followed. A left-sided ovarial torsion was postulated, and laparoscopic detorsion was performed. To avoid a rupture of the left MCT, the operation was interrupted. To remove the cyst, a ML was done two weeks later. A left-sided salpingo-oophorectomy was performed due to a large cyst including the entire ovary. On the other side, the right dermoid cyst was entirely removed. The advantage of a ML is not only shorter operating time with less learning curve compared to laparoscopy but also the possibility to extract the adnexal mass from the abdominal cavity with lower risk of rupture and in addition the possibility to preserve more ovarian tissue.

FEATURES OF ULTRASONIC CHARACTERISTICS OF MESENTERIC LYMPH NODES IN COVID-19 IN CHILDREN WITH ACUTE ABDOMINAL SYNDROME: DESCRIPTION OF CLINICAL CASES

2021 ◽  
Vol 100 (6) ◽  
pp. 178-181
Author(s):  
S.S. Nikitin ◽  
◽  
Yu.G. Pyattoev ◽  
N.B. Guseva ◽  
M.V. Leukhin ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Infection Type ◽  
Abdominal Cavity ◽  
Free Fluid ◽  
Mesenteric Lymph Nodes ◽  
Clinical Observations ◽  
Mesenteric Lymph ◽  
Ultrasound Diagnostics ◽  
Mesenteric Adenitis ◽  
Increased Blood Flow

The authors describe clinical observations of children with acute mesenteric adenitis with PCRconfirmed COVID-19 infection. Attention during ultrasound diagnostics is drawn to the condition of the lymph nodes – mesenteric adenitis in COVID-19 infection was manifested by a significant increase in the size of the nodes – more than 15 mm, a large number of nodes in the cut with a tendency to form a conglomerate, a more rounded shape, significantly increased blood flow, a reaction of the peritoneum in the form its thickening and the presence of free fluid in the abdominal cavity. Unusual for a «ordinary» respiratory viral or intestinal infection type of lymph nodes was the only sign that distinguishes the manifestations of mesenteric infection in COVID-19 infection.

scholarly journals Role of emergency physician–performed ultrasound in the differential diagnosis of abdominal pain

2018 ◽  
Vol 27 (2) ◽  
pp. 79-86
Author(s):  
Nalan Kozaci ◽  
Mustafa Avci ◽  
Gul Tulubas ◽  
Ertan Ararat ◽  
Omer Faruk Karakoyun ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Emergency Physician ◽  
Gold Standard ◽  
Acute Abdominal Pain ◽  
Point Of Care ◽  
Final Diagnosis ◽  
Free Fluid ◽  
Emergency Physicians ◽  
Abdominal Ultrasonography

Objectives: This prospective study was performed to evaluate the diagnostic accuracy of bedside point-of-care abdominal ultrasonography performed by emergency physician in patients with non-traumatic acute abdominal pain. Methods: The patients, who were admitted to emergency department due to abdominal pain, were included in this study. The emergency physician obtained a routine history, physical examination, blood draws, and ordered diagnostic imaging. After the initial clinical examinations, all the patients underwent ultrasonography for abdominal pathologies by emergency physician and radiologist, respectively. Point-of-care abdominal ultrasonography compared with abdominal ultrasonography performed by radiologist as the gold standard. Results: The study included 122 patients. Gallbladder and appendix pathologies were the most commonly detected in the abdominal ultrasonography. Compared with abdominal ultrasonography, point-of-care abdominal ultrasonography was found to have 89% sensitivity and 94% specificity in gallbladder pathologies; 91% sensitivity and 91% specificity in acute appendicitis; 79% sensitivity and 97% specificity in abdominal free fluid; 83% sensitivity and 96% specificity in ovarian pathologies. Compared to final diagnosis, preliminary diagnoses of emergency physicians were correct in 92 (75.4%) patients. Conclusion: This study showed that emergency physicians were successful in identifying abdominal organ pathologies with point-of-care abdominal ultrasonography after training.

scholarly journals Ultrasound Diagnostics of the Nature and Duration of Abdominal Trauma

2021 ◽  
Vol 6 (2) ◽  
pp. 169-180
Author(s):  
O. P. Babkina ◽  
◽  
S. I. Danylchenko ◽  
Keyword(s):  
Alcohol Intoxication ◽  
Abdominal Cavity ◽  
Kidney Damage ◽  
Mechanical Trauma ◽  
Free Fluid ◽  
Liver Size ◽  
Ultrasound Diagnostics ◽  
Characteristic Features ◽  
Size Heterogeneity ◽  
Almost All

The purpose of the study was to study a complex of changes in ultrasound parameters of injured tissues of the liver, spleen, pancreas in mechanical trauma and their dependence on the nature and duration of injury. Materials and methods. Ultrasound examinations were performed in 60 injured patients (41 males and 19 females) aged 20 to 60 years old in the dynamics as for the 1st, 2nd, 3rd, 4th and 5th days after injury. Puncture, transverse and oblique scans from all possible accesses were used. The conditions of the liver, pancreas, spleen, kidneys were studied. Results and discussion. In the course of the studies, a high number of injuries to the abdominal and retroperitoneal organs was demonstrated; it was proved that isolated liver injuries were observed in 32%, in 68% the liver injury was combined with injuries of other abdominal organs. We observed isolated damage to the pancreas in 10%, in the remaining 90%, the injury to the pancreas was combined with damage to the liver, gallbladder and extrahepatic bile ducts, spleen, and intestines. Isolated injuries of the spleen were observed in 31% of patients; in other cases, the injury to the spleen was combined with injuries of other organs of the abdominal cavity. We observed isolated kidney damage in almost 15%. In 85% of cases, kidney damage was observed in combination with injuries of other parenchymal organs. It has been demonstrated that in the area of injured tissues of the liver, pancreas, spleen, and kidneys with blunt trauma to the abdomen in persons with no signs of alcohol intoxication, regular ultrasound changes are observed, which are in direct proportion to the time elapsed since the injury was caused. The main ultrasound signs of liver damage were ruptures of the parenchyma with the formation of intra-parenchymal or subcapsular hematomas. In general, for almost all the injured people the following sings were characteristic as an increase in liver size (often due to increased part of damage), heterogeneity of structure, blurred contours and their discontinuity, presence of hypo- and anechoic areas (hematomas) on the background of intact parenchyma. Characteristic ultrasound criteria of pancreatic damage in the first day are the lack of clear contours of the gland, their discontinuity, increase in the size of the gland, the presence of hypoechoic areas of different sizes. At ultrasound examination of the spleen, the main signs of its damage are the heterogeneity of the parenchyma and the presence of anechoic structure and free fluid in the abdominal cavity. In 69% of cases, the main sings were blurred and uneven contours of the spleen, as well as an increase in its size. Characteristic features of renal hematoma are an increase in their size, heterogeneity of structure with increasing echogenicity of the parenchyma, blurred contours and their discontinuity. Conclusion. It has been proven that it is advisable to use in a complex of changes in the parenchymal organs revealed by ultrasound examinations, both in cases of isolated organ trauma, and in cases of combined trauma of the abdominal cavity and retroperitoneal organs, to determine the time of causing damage, since it makes it possible to increase the objectivity of the results of establishing the duration of the injury

Intestinal lymphoma in a Boxer breed dog – case report

2019 ◽  
Vol XXIV (142) ◽  
pp. 72-82
Author(s):  
Sayonara da Luz Ferro ◽  
Fernanda Jönck ◽  
Marta Cristina T. Heckler ◽  
Ewerton Cardoso ◽  
Mateus Rychescki ◽  
...  
Keyword(s):  
Weight Loss ◽  
Abdominal Cavity ◽  
Clinical Signs ◽  
Exploratory Laparotomy ◽  
Needle Aspiration ◽  
Free Fluid ◽  
Intestinal Lymphoma ◽  
Mesenteric Lymph Nodes ◽  
Abdominal Ultrasonography ◽  
Tissue Biopsy

Intestinal lymphoma is the second most common form of lymphoma in dogs. It is characterized by the presence of neoplastic lymphocytes in the gastrointestinal tract or mesenteric lymph nodes. The chief clinical signs are vomiting, diarrhea, anorexia and weight loss. The diagnosis is made through fine needle aspiration and cytology, or by tissue biopsy and histopathology, and chemotherapy is the treatment of choice. We report a case of intestinal lymphoma in a five years old Boxer, presented with history of hematochezia and lethargy of 7 days duration, and 20 days of anorexia and persistent weight loss. Abdominal ultrasonography revealed free fluid in the abdominal cavity, and an intestinal mass. Exploratory laparotomy was performed and a tissue biopsy was performed. Histopathology confirmed the diagnosis of intestinal lymphoma, but the patient died during the surgical procedure.

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