scholarly journals Adrenocortical adenoma with myelolipomatous metaplasia: a potential diagnostic pitfall: a case report and review of the literature

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Mohammad Hossein Anbardar ◽  
Neda Soleimani ◽  
Saman Nikeghbalian ◽  
Maryam Mohebbi
Keyword(s):  
Case Report ◽  
Pancreatic Cyst ◽  
Imaging Techniques ◽  
Case Reports ◽  
Adrenal Adenoma ◽  
Adrenal Incidentaloma ◽  
Adrenocortical Adenoma ◽  
Complete Evaluation ◽  
Adrenal Myelolipoma ◽  
Lipomatous Tumors

Abstract Background Adrenal incidentalomas are often found during investigation for another tumor or unrelated problems. Except for adrenal myelolipoma (second most common primary adrenal incidentaloma following adrenocortical adenomas), adrenal lipomatous tumors are uncommon generally and are often described as case reports in the literature. Since the amount of fat is variable, without the help of advanced imaging techniques, some adrenal lipomatous tumors may be misdiagnosed before pathologic examination. Herein, we report a case of adrenal adenoma with myelolipomatous metaplasia that was excised as a periceliac mass in the setting of recurrent pancreatic cyst. Case report A 45-year-old Iranian woman with hypertension and end-stage renal disease presented with recurrence of a pancreatic cyst (previous pathologic report was mucinous cyst adenoma). During exploratory laparotomy, the mentioned pancreatic cyst was tightly attached to the stomach and jejunum. There was also a periceliac round rubbery lesion (firstly diagnosed by endoscopic ultrasound) that was excised for ruling out malignancy. Histologic examination of the periceliac mass was found to be adrenocortical adenoma with foci of myelolipomatous metaplasia. The pancreatic cyst histology was just a pseudocyst. Conclusion Our case highlights the significance of complete evaluation of incidental findings before surgical intervention, even in the setting of another primary tumor. Myelolipoma and myelolipomatous change (metaplasia) are two different entities. Although very similar as to pathogenesis, there are still some differences.

scholarly journals Adrenocortical Adenoma With Myelolipomatous Metaplasia as a Diagnostic Pitfall: A Case Report and Review of the Literature

2021 ◽  
Author(s):  
Mohammad Hossein Anbardar ◽  
Neda Soleimani ◽  
Saman Nikeghbalian ◽  
Maryam Mohebbi
Keyword(s):  
Pancreatic Cyst ◽  
Imaging Techniques ◽  
Case Reports ◽  
Adrenal Adenoma ◽  
Adrenal Incidentaloma ◽  
Adrenocortical Adenoma ◽  
Complete Evaluation ◽  
Adrenal Myelolipoma ◽  
Diagnostic Pitfall ◽  
Lipomatous Tumors

Abstract BackgroundAdrenal incidentalomas are often found during investigation for another tumor or unrelated problems. Except for adrenal myelolipoma (second most common primary adrenal incidentaloma following adrenocortical adenomas), adrenal lipomatous tumors are uncommon generally and are often described as case reports in the literature. Since the amount of fat is variable, without the help of advanced imaging techniques, some adrenal lipomatous tumors may be misdiagnosed before pathologic examination. Herein, we report a case of adrenal adenoma with myelolipomatous metaplasia which was excised as a periceliac mass in the setting of recurrent pancreatic cyst.Case reportA 45-year-old woman with hypertension and end stage renal disease presented with recurrence of a pancreatic cyst (previous pathologic report was mucinous cyst adenoma). During exploratory laparatomy, the mentioned pancreatic cyst was tightly attached to the stomach and jejunum. There was also a periceliac round rubbery lesion(firstly diagnosed by endoscopic ultrasound) which was excised for ruling out malignancy. Histologic examination of the periceliac mass was found to be adrenocortical adenoma with foci of myelolipomatous metaplasia. The pancreatic cyst histology was just a pseudocyst.ConclusionOur case highlights the significance of complete evaluation of incidental findings before surgical intervention, even in the setting of another primary tumor. Myelolipoma and myelolipomatous change (metaplasia) are two different entities. Although very similar as to pathogenesis, there are still some differences.

scholarly journals Locked Wrist: A Case Report and Literature Review on Pisotriquetral Loose Bodies

2020 ◽  
Vol 9 (06) ◽  
pp. 518-522
Author(s):  
R. Gil Thompson ◽  
George C. Poulis ◽  
Gary M. Lourie
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Imaging Techniques ◽  
Case Reports ◽  
Loose Body ◽  
Radiographic Imaging ◽  
Loose Bodies ◽  
Advanced Imaging ◽  
Radiographic Findings ◽  
Magnetic Resonance Imaging Mri

Abstract Background Pisotriquetral (PT) loose bodies have been described in the literature only a few times as case reports. While PT pathology remains the differential for ulnar-sided wrist pain, it can often be difficult to diagnose, as symptoms can be variable and radiographic imaging may be negative for any findings. Case Description A 24-year-old major league baseball player presented with pain and locking of his wrist during follow through of his bat swing. Plain radiographic imaging, as well as computed tomography (CT) imaging, was negative for any pathology. Dynamic magnetic resonance imaging (MRI) demonstrated a loose body which entered the PT joint when the wrist was moved into a flexed position. This caused entrapment of the loose body and locking of the wrist. Literature Review A total of 17 reported patients in the literature have been diagnosed with a PT loose body. The clinical examination findings, radiographic findings, and surgical findings are reviewed. Case Relevance PT loose bodies can present a challenging clinical picture to diagnose. The purpose of this case report is to review the appropriate clinical workup, including common examination findings and advanced imaging techniques, to help the clinician with the diagnosis.

scholarly journals Case Report of a Giant Adrenal Myelolipoma in a Patient with Sickle Cell Anaemia

2021 ◽  
pp. 88-93
Author(s):  
Udochikwuka Patience Ikejiaku ◽  
Chidinma Adaobi Udah ◽  
Johnpatrick Uchenna Ugwoegbu ◽  
Emeka Nwolisa
Keyword(s):  
Case Report ◽  
Physical Examination ◽  
Sickle Cell ◽  
Sickle Cell Anaemia ◽  
Imaging Techniques ◽  
Vena Cava ◽  
Operative Management ◽  
Lumbar Region ◽  
Adrenal Myelolipoma ◽  
The Right

Adrenal myelolipomas (AMLs) are rare benign adrenal tumours containing adipose and hematopoietic tissue as a result of reticuloendothelial cell metaplasia. In this case report, we describe the diagnostic evaluation and the operative management of a giant adrenal myelolipoma in a 14-year-old male who has sickle cell anaemia. He presented with a one-week history of bilateral leg swelling. A physical examination revealed a mass in the right lumbar region. Ultrasound of the abdomen revealed a well-defined rounded echo-complex encapsulated supra-renal mass impinging on the upper pole of the right kidney, displacing it downwards. There was also marked compression of the inferior vena cava. A computed tomography scan showed a large mass occupying the right adrenal gland. The patient had an exploratory laparotomy with excision of the right adrenal tumour. Histopathological (Immunohistochemistry) evaluation of the mass confirmed the diagnosis of adrenal myelolipoma. The diagnosis of an adrenal myelolipoma requires a good history, physical examination, a high index of suspicion, imaging techniques, and a thorough histopathological evaluation. Surgery is the main treatment modality and good post-operative management minimizes complications and guarantees rapid recovery.

scholarly journals SAT-208 An Adrenal Incidentaloma with Extramedullary Hematopoiesis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Tyler Zachary ◽  
Lillian Lien
Keyword(s):  
Adrenal Mass ◽  
Hepatic Duct ◽  
Adrenal Adenoma ◽  
Adrenal Incidentaloma ◽  
Thalassemia Major ◽  
Extramedullary Hematopoiesis ◽  
Osseous Metaplasia ◽  
Common Hepatic Duct ◽  
Beta Thalassemia ◽  
Adrenal Myelolipoma

Abstract Introduction: Adrenal adenomas are incidentally noted during nonadrenal disease imaging at a rate up to 4%. Frequency of incidentalomas increases with age, most being adrenocortical adenomas. This case highlights an uncommon etiology of such an adrenal mass finding. Case Description: A 37-year-old with a history of hypertension, hypothyroidism, and tobacco use was admitted after post-operative complication. Prior to surgery, she had been experiencing right upper quadrant pain along with 70 lb weight loss and diarrhea. She otherwise had frequent palpitations. Patient had undergone cholecystectomy and common hepatic duct injury was noted. Imaging revealed a 5.3 x 3.5 cm right adrenal mass previously unknown prior to surgery. Hormonal workup was negative for overproduction of aldosterone, cortisol, DHEA-S or metanephrines. Discussion: Patient underwent successful resection of adrenal mass, revealing adrenal adenoma with osseous metaplasia and hematopoiesis. Extramedullary hematopoiesis is a usually discovered incidentally as in this case. Typical sites are the spleen and liver. Cases of adrenal gland manifestations have been reported in the presence of hemoglobinopathies (thalassemia, hereditary spherocytosis) or myelofibrosis. At four-month follow-up, laboratory testing on this patient didn’t suggest any erythrocytic or leukocytic disorder. Conclusion: This case highlights an uncommon finding of hematopoiesis in an adrenal incidentaloma without any underlying hematologic defect or disease. References: Motta, I., Boiocchi, L., Delbini, P., Migone De Amicis, M., Cassinerio, E., Dondossola, D., Rossi, G. and Cappellini, M. D. (2016), A giant adrenal myelolipoma in a beta-thalassemia major patient: Does ineffective erythropoiesis play a role?. Am. J. Hematol., 91: 1281-1282. doi:10.1002/ajh.24446. Stewart P, Newell-Price J. (2016). The Adrenal Cortex. In Melmed S, Polonsky K, Larsen P, Kronenberg H, Williams Textbook of Endocrinology. (13th ed., pp 489-555). Philadelphia, PA: Elsevier

Symptomatic scalp fistula present in a 14-month-old toddler

2020 ◽  
Vol 13 (3) ◽  
pp. e232103
Author(s):  
Jacob Gramacy ◽  
Sarah Sanford ◽  
Narlin B Beaty ◽  
Lutheria Hollis
Keyword(s):  
Case Report ◽  
Surgical Intervention ◽  
Imaging Techniques ◽  
Case Reports ◽  
Arteriovenous Fistulas ◽  
Patient Diagnosis

This case report covers the resection of a pulsatile scalp fistula, in a 14-month-old toddler. We discuss the patient diagnosis, imaging techniques used, as well as the patient’s surgical intervention. We highlight the aetiology of arteriovenous fistulas, while comparing and contrasting previous case reports and their interventions, to our own specific case.

scholarly journals Bilateral low origin of testicular artery: a case report

2017 ◽  
Vol 16 (3) ◽  
pp. 258-261
Author(s):  
Satheesha Nayak Badagabettu ◽  
Swamy Ravindra Shantakumar ◽  
Surekha Devadas Shetty ◽  
Gayathri Prabhu
Keyword(s):  
Case Report ◽  
Testicular Torsion ◽  
Undescended Testis ◽  
Imaging Techniques ◽  
Case Reports ◽  
Diagnosis And Treatment ◽  
Radiographic Imaging ◽  
Testicular Artery ◽  
First Case

Abstract The testicular artery is frequently subjected to radiographic imaging techniques such as angiography for diagnosis and treatment of conditions like epididymitis, testicular torsion, tumor, hematoma, and hydrocele and in cases of undescended testis. Radiologists and surgeons should therefore be aware of testicular artery variants. Although there are numerous studies and case reports that mention testicular artery variants, this is probably the first case, reporting a bilateral low origin of the testicular artery and discussing its probable embryological etiology.

084 Treating yourself: a glucocorticoid secreting tumour suppressing myasthenia gravis

2018 ◽  
Vol 89 (6) ◽  
pp. A34.1-A34
Author(s):  
Andrew Swayne ◽  
Michael Lane ◽  
Helen Brown ◽  
Kerri Prain ◽  
Richard Wong ◽  
...  
Keyword(s):  
Case Report ◽  
Myasthenia Gravis ◽  
Adrenal Adenoma ◽  
Adrenal Incidentaloma ◽  
Lower Limbs ◽  
Tumour Resection ◽  
Pemphigus Foliaceus ◽  
List Type ◽  
Balance Of Nature ◽  
Morning Cortisol

IntroductionWe aimed to report a single patient seen at a tertiary neurology centre with a rarely described phenomenon of interaction between myasthenia gravis and a glucocorticoid secreting tumour.CaseA 70 year old, otherwise healthy male underwent a CT imaging of his chest after being trampled by a cow. Apart from several rib fractures, this revealed a slightly lobulated but well-defined right adrenal mass. Further studies revealed elevated morning cortisol levels of 847 nmol/L (reference range 140–640 nmol/L). The mass was excised and was found to be a 60 mm by 30 mm by 25 mm lesion, which was well circumscribed. It comprised of clear cells with foamy cytoplasm and a lesser component of eosinophilic cells, consistent with a functional adrenal adenoma producing glucocorticoid. Within days of the resection the patient described becoming weaker with fatigable proximal weakness of both upper and lower limbs. Acetylcholine receptor antibodies were positive and a diagnosis of myasthenia gravis was made. Upon commencement of pyridostigmine at 60 mg TDS and prednisolone 10 mg OD the symptoms improved and the patient was able to resume his previous active lifestyle.ConclusionThe phenomenon of myasthenia gravis being suppressed by a functional adrenal adenoma has only previously been reported twice.1 2 This case report adds to the literature and can be distinguished from the other two cases by the rapidity of onset of symptoms of myasthenia over days after tumour resection. It tells a cautionary tale of medical therapy disrupting the brittle balance of nature.References. Petramala L, Marinelli C, Giallonardo AT, Concistre A, Lucia P, Venuta F, … Letizia C. A case report of subclinical hypercortisolism due to adrenal incidentaloma complicated by myasthenia gravis after adrenalectomy. Tumori2016;102(Suppl.2).. Topham L, Chapman A, Gibbs C, Saha M. A patient with pemphigus foliaceus and myasthenia gravis treated by a cortisol-secreting adrenal adenoma. Br J Dermatol2015;172(1):280–282.

Fournier's gangrene as Amyand's hernia complication

2019 ◽  
Vol 98 (7) ◽  
pp. 291-296
Keyword(s):  
Case Report ◽  
Case Reports ◽  
Rare Condition ◽  
Sporadic Case ◽  
Fournier’S Gangrene ◽  
Amyand’S Hernia ◽  
Fournier's Gangrene ◽  
Randomized Controlled Studies ◽  
Based Medicine ◽  
Hernia Complication

Introduction: Fournier’s gangrene is a rare but fast deteriorating and serious condition with high mortality. In most cases, it is characterized as necrotizing fasciitis of the perineum and external genitals. Amyand’s hernia is a rare condition where the appendix is contained in the sac of an inguinal hernia. Inflammatory alterations in the appendix account only for 0.1 % of the cases when Amyand’s hernia is verified. Fournier’s gangrene as a complication of a late diagnosis of appendicitis located in the inguinal canal is described in the literature as rare case reports. Case report: The case report of a 70-year-old patient with Fournier’s gangrene resulting from gangrenous appendicitis of Amyand’s hernia. Conclusion: Fournier’s gangrene as a complication of Amyand’s hernia is a rare condition. Only sporadic case reports thereof can be found in the literature. Because of the rarity of this pathology and the lack of randomized controlled studies, it is difficult to determine the optimal treatment according to the principles of evidence-based medicine. An appropriate approach for this condition appears to be the combination of guidelines developed in Amyand’s therapy according to Losanoff and Basson, along with the recommended “gold standard” therapy for Fournier’s gangrene. This means early and highly radical surgical debridement, adequate antibiotic therapy and intensive care.

Hemangiomatosis of the greater omentum – a case report

2019 ◽  
Vol 98 (4) ◽  
pp. 178-180
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Histological Examination ◽  
Case Reports ◽  
Greater Omentum ◽  
Surgical Removal ◽  
Consumption Coagulopathy ◽  
Cavernous Hemangiomas ◽  
Mesodermal Origin ◽  
Benign Tumours

Cavernous hemangiomas are benign tumours of mesodermal origin. Even though various localizations of hemangioma have been described in the literature, its occurrence in the greater omentum is very rare. Only symptomatic hemangiomas are indicated for surgical treatment. There are case reports presenting resection or surgical removal of the greater omentum with hemangioma because of mechanical syndrome, consumption coagulopathy, bleeding, infection or suspicion of a malignancy. This article presents a case report of a patient operated on for a suspicion of carcinomatosis of the greater omentum. Histological examination found hemangiomatosis in the resected greater omentum.

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