The role of ultrasound examination in the management of a patient with hemoperitoneum and an ovarian mass: a clinical-diagnostic challenge

Background: Cancer antigen 19-9 (CA 19-9) is a tumor-associated mucin glycoprotein antigen that may be elevated in healthy individuals as well as in patients with benign and malignant tumors. It is useful in the management of pancreatic and other gastrointestinal tumors. CA 19-9 is also elevated in benign and malignant ovarian tumors. Aim: To study the pattern of serum CA19-9 in complex ovarian tumors. Methods: The study design was descriptive, based on data collected from medical records. Patients with a complex ovarian mass, who were investigated with CA 19-9 and had undergone surgery, wereincluded in the study. The study duration was 2 years from January 2014 to December 2015. A total of 273 patients (119 - benign and 154 malignant) with complex ovarian mass and elevated CA 19-9 underwent surgery during the study period. Results: CA 19-9 was elevated in 55 patients (20%). Of these, 23 patients had benign tumors while 32 had malignant tumors.Among patients with benign tumors, 21 had dermoid, 23 had mucinous tumors and 75 had other types of tumors. CA 19-9 was elevated in 10 (47.6%) of the dermoids, 7 (30.4%) of the mucinous tumors and 6 (8%) of the other benign tumors. Among patients with malignant tumors, 138 were epithelial and 16 were non epithelial tumors. Of the epithelial tumors, 31 were mucinous and 107 were non mucinous types. Overall, 29 (21%) had elevated CA 19-9. Of the epithelial tumors, 22.6% of the mucinous type and 20.6% of the non mucinous type had elevated CA 19-9. Among the non-epithelial tumors, 3 (18.8%) had elevated CA19-9. Conclusion: CA 19-9 is elevated in several conditions but most likely to be raised in dermoid cysts and mucinous tumours. CA19-9 levels need to be interpreted along with clinical and radiological findings.

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Role of community diagnostic ultrasound examination in the diagnosis of full-thickness rotator cuff tears

ANZ Journal of Surgery ◽

10.1046/j.1445-2197.2003.02790.x ◽

2003 ◽

Vol 73 (10) ◽

pp. 797-799 ◽

Cited By ~ 13

Author(s):

Jerome A. Goldberg ◽

Warwick J. M. Bruce ◽

William Walsh ◽

David H. Sonnabend

Keyword(s):

Rotator Cuff ◽

Ultrasound Examination ◽

Diagnostic Ultrasound ◽

Rotator Cuff Tears ◽

Full Thickness

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Squamous cell carcinoma of the breast as a clinical diagnostic challenge

Molecular and Clinical Oncology ◽

10.3892/mco.2018.1581 ◽

2018 ◽

Cited By ~ 1

Author(s):

Katarzyna Jakubowska ◽

Luiza Kańczuga‑Koda ◽

Wojciech Kisielewski ◽

Mariusz Koda ◽

Waldemar Famulski

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Diagnostic Challenge ◽

Carcinoma Of The Breast ◽

Clinical Diagnostic

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Rhabdomyosarcoma in Ovary- Pathologist’s Diagnostic Dilemma

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqab191.173 ◽

2021 ◽

Vol 156 (Supplement_1) ◽

pp. S82-S82

Author(s):

A C Srivastava ◽

F Hussain ◽

T Patel

Keyword(s):

Soft Tissue ◽

Ovarian Tumor ◽

Ca 125 ◽

Axillary Lymph ◽

Ovarian Mass ◽

Diagnostic Challenge ◽

Diagnostic Dilemma ◽

Epithelial Tumor ◽

True Nature ◽

Right Hand

Abstract Introduction/Objective Rhabdomyosarcoma is the most common pediatric soft tissue sarcoma. However, rhabdomyosarcoma in the ovary is exceptionally unusual and presents a diagnostic challenge. We report one such case and its clinical and pathological perspective. Methods/Case Report 16-year-old female presented with an enlarging pelvic mass, abdominal distension, and pain. Imaging revealed a heterogeneous left ovarian mass, right axillary lymphadenopathy, and right-hand soft tissue mass. CA-125 was 1833.0 U/ml. Patient underwent left salphingo-oophorectomy, omentectomy, peritoneal and mesenteric biopsy for ovarian staging, incidental appendectomy, and right axillary lymph node excision with suspicion of ovarian epithelial tumor. Pathological evaluation revealed a 16-cm intact ovary with multiple solid and cystic nodules with areas of hemorrhage and necrosis. Microscopic examination of ovarian tumor showed a high-grade malignant tumor consisting of sheets of small round blue cells with severe cytologic atypia, increased mitoses, and features suggestive of rhabdoid morphology. The other specimens were positive for metastases. The tumor cells were immunopositive for Myogenin and MyoD1 while immunonegative for Cytokeratin AE1/AE3, SF-1, PLAP, SALL4, MelanA, and S-100. INI-1 and BRG-1 demonstrated intact nuclear expression. FISH testing identified rearrangement of the FOX01 gene at 13q14. Based on these findings, diagnosis of alveolar rhabdomyosarcoma was rendered. Currently, the patient is receiving rhabdomyosarcoma chemotherapy treatment and has responded well. Results (if a Case Study enter NA) NA Conclusion In cases with complex and urgent clinical presentation, where the existence of a primary tumor is unknown and where symptoms attributable to primary ovarian tumor dominate the clinical picture, rhabdomyosarcoma is rarely proposed in the differential diagnoses of small round blue cell tumors of the ovary. At present, the right-hand mass is under evaluation; thus, the true nature of the ovarian mass, primary or metastatic is unknown. Our case illustrates the importance of exact diagnoses, as treatment of rhabdomyosarcoma, is different from other ovarian tumors.

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‘Lipo-tourism’ gone wrong: blood transfusion-transmitted cytomegalovirus disease

BMJ Case Reports ◽

10.1136/bcr-2020-236892 ◽

2021 ◽

Vol 14 (3) ◽

pp. e236892

Author(s):

Mark Brahier ◽

Rhanika Neuda ◽

William Davis ◽

Rita Poon

Keyword(s):

Blood Transfusion ◽

Medical Tourism ◽

Wound Dehiscence ◽

Immunocompetent Patient ◽

Cytomegalovirus Disease ◽

Diagnostic Challenge ◽

Risks And Benefits ◽

Life Threatening ◽

Cmv Disease

Medical tourism is the pursuit of more affordable surgeries; however, this comes at the risk of suboptimal standards and potential for life-threatening complications. In this case, we describe the diagnostic challenge of cytomegalovirus (CMV) pneumonia in a 40-year-old woman who experienced wound dehiscence and subsequent blood transfusion-transmitted CMV as complications of liposuction in the Dominican Republic. We explore the role of histopathology in the diagnosis of disseminated CMV, discuss the underlying aetiology of CMV pneumonia in this patient and weigh the risks and benefits of initiating antiviral therapy in an immunocompetent patient with CMV disease.

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Invasive cardiac aspergillosis as contiguous infiltration from mediastinum: Imaging evaluation using cardiac MRI

Asian Cardiovascular and Thoracic Annals ◽

10.1177/02184923211064650 ◽

2021 ◽

pp. 021849232110646

Author(s):

Arun Sharma ◽

Shayeri Roy Choudhury ◽

Ajay Bahl ◽

Uma Nahar ◽

Manphool Singhal

Keyword(s):

Cardiac Mri ◽

Potential Role ◽

Imaging Features ◽

Diagnostic Challenge ◽

Fatal Disease ◽

Imaging Evaluation ◽

Fungal Isolation ◽

Appropriate Therapy ◽

High Index Of Suspicion

Invasive cardiac aspergillosis is a rare, potentially fatal disease which poses a significant diagnostic challenge. Combination of clinical details, imaging features, fungal markers, serology and fungal isolation with demonstration of invasion is usually necessary to establish the diagnosis. High index of suspicion is the key for early diagnosis with potential role of cardiac MRI in its early detection, delineation of extent of involvement and guidance to the appropriate site for tissue sampling, thereby allowing for improved prognosis with early institution of appropriate therapy.

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Role of high-resolution ultrasound in the assessment of abdominal wall masses and mass-like lesions

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-019-0027-6 ◽

2019 ◽

Vol 50 (1) ◽

Cited By ~ 1

Author(s):

Ahmed Abdelrahman Mohamed Baz ◽

Hatem Mohamed Said El-Azizi ◽

Mohamed Sayed Qayati Mohamed ◽

Ahmed Yehia Ibrahim Abdeldayem

Keyword(s):

High Resolution ◽

Abdominal Wall ◽

Predictive Value ◽

Ultrasound Examination ◽

Ct Findings ◽

Operative Findings ◽

A Prospective Study ◽

Histopathological Results ◽

Contrast Media Administration

Abstract Background To evaluate the diagnostic accuracy of high-resolution ultrasound in the assessment of abdominal wall masses and mass-like lesions and to provide an overview of the sonographic appearances of different abdominal wall pathologies, 54 patients were included in a prospective study. The patients’ age was ranging from 1 to 75 years. Twenty-eight were females (51.9%) and 26 were males (48.1%); all were evaluated by a high-resolution ultrasound examination, and the results were correlated to the patients’ operative findings and histopathological results as well as the pelviabdominal CT findings. Results In comparison to the operative, histopathological, and CT findings, the high-resolution ultrasound had an overall 100% accuracy for abdominal wall lesions, and for hernia cases, it had 100% sensitivity, 100% specificity, 100% accuracy, 100% positive predictive value, and 100% negative predictive value. Conclusion The current study had encouraging results regarding the role of high-resolution ultrasound in the assessment of abdominal wall masses and mass-like lesions; nevertheless, it is considered as an effective and simple diagnostic tool that may limit the patients’ exposure to invasive biopsies and to the hazardous exposure to ionizing radiation and contrast media administration like that in CT examination.

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