Diagnostic dilemma in a large choledochal cyst

2019 ◽  
Vol 22 (2) ◽  
pp. 38-40
Author(s):  
Tul Maya Gurung ◽  
Rabin Koirala ◽  
Amit Shrestha
Keyword(s):  
Differential Diagnosis ◽  
Choledochal Cyst ◽  
Congenital Anomalies ◽  
Biliary Drainage ◽  
Abdominal Mass ◽  
Choledochal Cysts ◽  
Diagnostic Dilemma ◽  
Variable Presentation

Choledochal cysts are rare congenital anomalies that have a variable presentation with occasional diagnostic and therapeutic dilemmas. Our case is a 14-year female presented with recurrent abdomen pain with confusing diagnostic findings, suggestive of a large choledochal cyst (22x29x17cm) initially managed by percutaneous tube biliary drainage and later underwent excision and HPE revealing non-malignant findings. The choledochal cyst should always be a differential diagnosis for any patient presenting with an abdominal mass and should be managed accordingly.

Subdural hemorrhage as a first symptom in an infant with a choledochal cyst

2012 ◽  
Vol 9 (4) ◽  
pp. 414-416 ◽  
Author(s):  
Te-Yuan Chen ◽  
Hao-Kuang Wang ◽  
Ming-Lun Yeh ◽  
Shu-Hao Wei ◽  
Kang Lu
Keyword(s):  
Choledochal Cyst ◽  
Abdominal Mass ◽  
Subdural Hemorrhage ◽  
Choledochal Cysts ◽  
Vitamin K Deficiency ◽  
Abdominal Ultrasonography ◽  
Vitamin K Deficiency Bleeding ◽  
Intermittent Abdominal Pain ◽  
K Deficiency ◽  
Brain Ct Scan

Choledochal cysts are not rare in East Asia. The classic symptoms of these cysts are intermittent abdominal pain, jaundice, and a right upper quadrant abdominal mass. The authors report the case of an infant with a choledochal cyst presenting with intracranial hemorrhage. This 2-month-old girl with a partial coma presented at the authors' hospital. A brain CT scan revealed right-sided subdural hemorrhage. The routine preoperative survey found coagulopathy. After correcting the bleeding disorder, an emergency craniectomy was performed. Further examination found a choledochal cyst during abdominal ultrasonography and CT. Choledochal cysts are a cause of neonatal cholestasis but rarely produce vitamin K deficiency bleeding.

scholarly journals Diffuse steatonecrosis - presenting as an obscure abdominal mass - a diagnostic dilemma

2017 ◽  
Vol 5 (2) ◽  
pp. 734
Author(s):  
Binay Kumar ◽  
Upasna Chachra ◽  
. Bhuvan
Keyword(s):  
Differential Diagnosis ◽  
Fatty Acid ◽  
Acute Abdomen ◽  
Clinical Setting ◽  
Pancreatic Necrosis ◽  
Abdominal Mass ◽  
Special Method ◽  
Fat Necrosis ◽  
Diagnostic Dilemma ◽  
Palpable Lump

Diffuse steatonecrosis secondary to acute / gangrenous pancreatitis presenting as vague abdominal mass is difficult to diagnose and requires special method / techniques for demonstration of fatty acid crystalloids. We report a case of acute abdomen with palpable lump. On emergency exploratory laprotomy a large thick jumbled up omental mass was revealed adhered to parietal wall along with complete pancreatic necrosis. Biopsy show diffuse fat necrosis of pericolic fat, omentum / mesentry with involvement of gut submucosa and birefringent saponified fatty acid crystalloids were demonstrated. Steatonecrosis may cause diagnostic dilemma and should be considered as differential diagnosis in appropriate clinical setting.

Non-Gynecologic Causes of Adnexal/Pelvic Masses

2018 ◽  
Vol 15 (1) ◽  
pp. 46-49
Author(s):  
Michelle L. Gainty ◽  
Christina Jones
Keyword(s):  
Differential Diagnosis ◽  
Female Patient ◽  
Diagnostic Dilemma ◽  
Adnexal Masses ◽  
Pelvic Masses

Pelvic masses can pose a diagnostic dilemma with a broad differential to include both gynecological and non-gynecologic etiologies. While the initial instinct may be to search for gynecologic causes for the female patient, non-gynecologic etiologies must be considered as well. The presentation can be similar amongst many different causes of pelvic masses and imaging is generally required for further assessment to determine if the mass is intra- or extraperitoneal. The etiology of adnexal masses covers several subspecialties: gynecology, urology, gastroenterology, neurology, and oncology. For this reason, it is important for all to be aware of the differential diagnosis for pelvic masses.

scholarly journals Large intraperitoneal lipoleiomyoma in a pre-menopausal woman: a case report

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Sara L. Schaefer ◽  
Amy L. Strong ◽  
Sheena Bahroloomi ◽  
Jichang Han ◽  
Michella K. Whisman ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Smooth Muscle ◽  
Case Report ◽  
Smooth Muscle Actin ◽  
Abdominal Mass ◽  
Histopathological Analysis ◽  
Menopausal Woman ◽  
En Bloc ◽  
Cross Sectional

Abstract Background Lipoleiomyoma is a rare, benign variant of the commonplace uterine leiomyoma. Unlike leiomyoma, these tumors are composed of smooth muscle cells admixed with mature adipose tissue. While rare, they are most frequently identified in the uterus, but even more infrequently have been described in extrauterine locations. Case presentation We describe a case report of a 45-year-old woman with a history of in vitro fertilization pregnancy presenting 6 years later with abdominal distention and weight loss found to have a 30-cm intra-abdominal lipoleiomyoma. While cross-sectional imaging can narrow the differential diagnosis, histopathological analysis with stains positive for smooth muscle actin, desmin, and estrogen receptor, but negative for HMB-45 confirms the diagnosis of lipoleiomyoma. The large encapsulated tumor was resected en bloc. The patients post-operative course was uneventful and her symptoms resolved. Conclusions Lipoleiomyoma should be considered on the differential diagnosis in a woman with a large intra-abdominal mass. While considered benign, resection should be considered if the mass is symptomatic, and the diagnosis is unclear or there is a concern for malignancy.

scholarly journals Intracholecystic papillary-tubular neoplasm in a patient with choledochal cyst and anomalous pancreaticobiliary junction: case report

2019 ◽  
Vol 5 (2) ◽  
pp. 20180079
Author(s):  
Marta Reis de Sousa ◽  
Inês Santiago ◽  
Maria J Barata ◽  
Mireia Castillo ◽  
Celso Matos
Keyword(s):  
Case Report ◽  
Bile Duct ◽  
Gastric Adenocarcinoma ◽  
Choledochal Cyst ◽  
Histopathological Analysis ◽  
Gallbladder Neoplasms ◽  
Choledochal Cysts ◽  
Bile Duct Dilatation ◽  
Duct Dilatation ◽  
Anomalous Pancreaticobiliary Junction

A 75-year-old female incidentally presented with an enhancing intraluminal gallbladder mass, main bile duct dilatation and anomalous pancreaticobiliary junction (APBJ) during the staging of gastric adenocarcinoma. Histopathological analysis confirmed the diagnosis of intracholecystic papillary-tubular neoplasm. Intracholecystic papillary-tubular neoplasms (ICPN) of the gallbladder are rare gallbladder neoplasms, defined as intramucosal, preinvasive, exophytic, mass forming lesions. An association between choledochal cysts and anomalous pancreaticobiliary junction with gallbladder neoplasms is well known, and this case potentially illustrates gallbladder carcinogenesis related to these biliary anomalies.

scholarly journals Pneumatosis Intestinalis: A Case Report and Approach to Management

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Sean Donovan ◽  
Joseph Cernigliaro ◽  
Nancy Dawson
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Bowel Wall ◽  
Surgical Intervention ◽  
Wide Spectrum ◽  
Pneumatosis Intestinalis ◽  
Rapid Evaluation ◽  
Thought Process ◽  
Diagnostic Dilemma ◽  
Clinical Scenarios

Pneumatosis intestinalis (PI), defined as gas within the bowel wall, is an uncommon radiographic sign which can represent a wide spectrum of diseases and a variety of underlying diagnoses. Because its etiology can vary greatly, management of PI ranges from surgical intervention to outpatient observation (see, Greenstein et al. (2007), Morris et al. (2008), and Peter et al. (2003)). Since PI is infrequently encountered, clinicians may be unfamiliar with its diagnosis and management; this unfamiliarity, combined with the potential necessity for urgent intervention, may place the clinician confronted with PI in a precarious medical scenario. We present a case of pneumatosis intestinalis in a patient who posed a particularly challenging diagnostic dilemma for the primary team. Furthermore, we explore the differential diagnosis prior to revealing the intervention offered to our patient; our concise yet inclusive differential and thought process for rapid evaluation may be of benefit to clinicians presented with similar clinical scenarios.

The Diagnostic Dilemma of Myxedema and Madness, Axis I and Axis II: A Longitudinal Case Report

1989 ◽  
Vol 18 (3) ◽  
pp. 263-270 ◽  
Author(s):  
Denis F. Darko ◽  
Alice Krull ◽  
Mark Dickinson ◽  
J. Christian Gillin ◽  
S. Craig Risch
Keyword(s):  
Differential Diagnosis ◽  
Medical Diagnosis ◽  
Psychiatric Care ◽  
Paranoid Schizophrenia ◽  
Diagnostic Dilemma ◽  
Chronic Thyroiditis ◽  
Axis Ii ◽  
Probable Presence ◽  
Axis I ◽  
Primary Axis

A patient with presumed chronic paranoid schizophrenia had chronic thyroiditis and Grade I hypothyroidism. Psychosis cleared following treatment with thyroid replacement. The probable presence of two axis II disorders may have contributed to the missed medical diagnosis and the patient's eventual suicide. The personality disorders were a major problem in the patient's medical and psychiatric care. The differential diagnosis among hypothyroidism and primary axis I psychotic and depressive psychopathology has always been problematic. When axis II pathology is also present, the diagnostic dilemma is increased.

scholarly journals Anomalous choledocho-pancretic ductal junction in a choledochal cyst: A case report

2004 ◽  
Vol 132 (5-6) ◽  
pp. 179-181
Author(s):  
Miodrag Jovanovic ◽  
Dragoljub Bilanovic ◽  
Radoje Colovic ◽  
Nikica Grubor ◽  
Milenko Ugljesic
Keyword(s):  
Bile Duct ◽  
Choledochal Cyst ◽  
Bile Ducts ◽  
Postoperative Recovery ◽  
Biliary Colic ◽  
Duodenal Wall ◽  
Choledochal Cysts ◽  
Bile Duct Wall ◽  
Intrahepatic Bile Ducts ◽  
Inflammatory Changes

Choledochal cysts are rare congenital anomalies, mostly detected in adults. Pathogenesis of these cysts seems to be in anomalous junction between pancreatic and common bile duct, above the papillary sphincterand outside of the duodenal wall. The absence of the sphincter above the junction is followed by reflux of the pancreatic juice into the bile duct leading to dilatation and fibrous changes of bile duct wall. A 38-year-old female is presented in whom a choledochal cyst was found 11 years earlier, during the operation performed for obstructive jaundice, when cystojejunostomy with Roux-en Y jejunal limb was carried out. In February 1990, she was admitted to our Institution for jaundice and biliary colic. The patient was reoperated. Operative cholangiography showed an anomalous pancreatobiliary junction, choledochal cyst, dilated cystic duct and moderate dilatation of intrahepatic bile ducts. Cholecystectomy, desanastomosis with partial excision of choledochal cyst, and retrocolic choledochojejunostomy with the same Roux-en-Y jejunal limb were performed. Total excision of choledochal cyst was too risky due to chronic inflammatory changes in the hepatoduodenal ligament. Postoperative recovery was uneventful and the patient remained symptom-free so far.

scholarly journals Large choledochal cyst initially interpreted as Mirizzi syndrome - case report and literature review

2020 ◽  
Vol 148 (3-4) ◽  
pp. 216-219
Author(s):  
Vladimir Milosavljevic ◽  
Boris Tadic ◽  
Nikola Grubor ◽  
Djordje Knezevic ◽  
Slavko Matic
Keyword(s):  
Surgical Treatment ◽  
Choledochal Cyst ◽  
Surgical Techniques ◽  
Mirizzi Syndrome ◽  
Operative Techniques ◽  
Choledochal Cysts ◽  
Cystic Dilatation ◽  
Additional Imaging ◽  
Histological Confirmation ◽  
Extent Of Surgical Resection

Introduction. Choledochal cysts are congenital anomalies manifested as focal or diffuse cystic dilatation of the bile ducts. They are mostly diagnosed in childhood. The magnetic resonance and surgical management are the gold standard diagnostic and treatment modality. Case outline. We present a male patient who was presumed to have Mirizzi syndrome. This presumption was discarded by additional imaging procedures and by later surgical treatment. It was confirmed that it was a large choledochal cyst filled with stones. Considering the diagnosis and good patient?s general condition, we opted for surgical treatment. Conclusion. There are several surgical techniques that can be used in the treatment of choledochal cysts, wherein each is intended as a complete resection of the cyst with histological confirmation. Operative techniques do not affect the outcome of the treatment, but the time and extent of surgical resection, as well as any metaplasia of the epithelium, do.

p16 Expression in Keratoacanthomas and Squamous Cell Carcinomas of the Skin: An Immunohistochemical Study

2006 ◽  
Vol 130 (1) ◽  
pp. 69-73
Author(s):  
Emad Kaabipour ◽  
Helen M. Haupt ◽  
Jere B. Stern ◽  
Peter A. Kanetsky ◽  
Victoria F. Podolski ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Differential Diagnosis ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Immunohistochemical Study ◽  
Squamous Cell Carcinomas ◽  
Diagnostic Dilemma ◽  
Significant Difference ◽  
P16 Expression

Abstract Context.—Distinguishing between keratoacanthoma (KA) and squamous cell carcinoma (SCC) is not an uncommon histologic diagnostic dilemma. Objective.—To determine if p16 expression is useful in the differential diagnosis of SCC and KA. Design.—We studied the expression of p16 by immunohistochemistry in 24 KAs, 24 infiltrating SCCs of the skin, 4 histologically indeterminate lesions, and 8 nonmalignant keratoses. Results.—A range of immunohistochemical p16 expression was seen in KAs and SCCs in terms of the thickness of lesional staining and the percentage of cells staining. No significant difference in measures of p16 expression was identified among the KAs, the SCCs, the indeterminate lesions, or the benign keratoses. Conclusions.—These findings suggest that p16 is not a useful marker to distinguish between KA and SCC, supporting the similarity between the 2 lesions; p16 alterations appear to play a role in the pathogenesis of both KA and SCC.

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