MR Imaging of Pancreatic Lesions

Aim: The aim of this work was to evaluate the role of MRI in differentiating between benign and malignant pancreatic lesions and its correlation with histopathological results as the reference standard. Patients and Methods: This MRI study included 30 patients, 17 females and 13 males with a mean age 50 years. Sixteen patients had malignant masses (14 patients were adenocarcinoma, one patient was lymphoma and one patient was metastasis) and 14 patients had benign masses (7 patients were pancreatic pseudocysts, two patients were pancreatic abscesses, three patients were simple cysts and two patients were focal pancreatitis). The main clinical symptom was abdominal pain and most of masses were located in the head of the pancreas. Results: In our study, 25 cases of the 30 patients showed increased intensity at T2-weighted images. Most of malignant cases showed low or equal intensity on T1- and high intensity on T2-weighted images compared to normal pancreatic parenchyma. In our study, DW-MRI was performed on all subjects at b-values of 500 and 1000 s/mm2. Benign pancreatic masses as pancreatic pseudocyst, simple cyst and abscess show low signal intensities on DWI, however malignant pancreatic masses as adenocarcinoma, lymphoma and metastasis show high signal intensities on DWI with a cut-off value of 1.5 x10-3 s/mm2 for the differentiation of benign from malignant pancreatic masses by b-value 1000 s/mm2 with the sensitivity, specificity, PPV, NPV& p value were 100%, 83.33%, 100%, 88.88% and <0.001 respectively. Conclusion: MRI plays an important role in the diagnosis of different pancreatic lesions and can assess the neoplastic pancreatic lesions with accurate detection of extension, nodal involvement and hepatic metastatic lesions. It also has a major role in differentiation between benign and malignant pancreatic lesions by the aids of DWI.

EP.TH.697The great mimic of mesenteric cyst - an interesting case report of mucinous adenocarcinoma of the ovary

Aims A mesenteric cyst, rare intra-abdominal pathology, poses a clinical challenge due to lack of pathognomonic symptoms, variability in presentation and location. We present an interesting case with a significant diagnostic dilemma; a suspected benign ovarian cyst invading the mesentery on repeat imaging and laparoscopy is questioned for mesenteric in origin. Methods A 77-year-old female presented with a 6-year history of abdominal mass. She had multiple radiological scans which reported it as a simple cyst, but the origin could not be defined. She had repeated aspirations with benign cytology. They cyst developed septations, filled-up rapidly, became an abdominal cyst from the pelvis. A careful decision was taken for surgery. The procedure undertook with general surgeons and gynaecologists with a possibility of the mesenteric cyst. During laparotomy, the cyst was found extending from pelvis and base of mesentery up to the diaphragm densely adhered to sigmoid colon. The cyst was completely excised with hysterectomy and oophorectomy. Results The patient recovered well from surgery. Post-operatively, histopathology confirmed Figo IC2 Grade 2 mucinous adenocarcinoma of the ovary with an expansive growth pattern. She is awaiting further treatment with chemotherapy after discussion in the Gynaecology MDT. Conclusion This case emphasises the importance of having an insight into the question of established diagnosis in the face of a changing clinical picture. Also, it highlights the need for understanding the mesenteric cyst. Early exploration can prevent diagnostic delays and further treatment.

Laparoscopic evaluation of pelvic organ in case of subfertility

Background: Globally subfertility affects 10-15% of couple. All these people need proper evaluation and treatment. Now a days laparoscopy considered as a gold standard procedure for evaluation of pelvic organ. The aim of this study was to find out the different causes of female factor infertility with the help of laparoscopy.Methods: This retrospective study was conducted in infertility clinic of BIRDEM hospital, Dhaka, Bangladesh during the period of May, 2007 to October 2007. The study group comprised 100 cases of infertile patients.Results: In this study, among 100 patients 68% had primary and 32% had secondary infertility. In laparoscopy majority (55.0%) had normal ovary, 20.0% had cystic change with thick capsule in right ovary and 22% had in left ovary, 7.0% had endometriosis, 8.0% had adhesion, 10.0% had simple cyst in right ovary and 8% had in left ovary and rest could not be visualized. 79.4% right and 77.9% left fallopian tube patent in primary subfertility cases and 56.3% right and 59.4% left tube normal in secondary subfertility cases. Both fallopian tube patent in 62%, unilateral block 21% and bilateral block in 17% cases in this study peritoneum was normal in 78% cases, 8% cases there was endometriosis and 14% cases there was adhesion of fallopian tube with the ovary, adhesion of uterus with intestine and also with bladder.Conclusions: Laparoscopy is an important tool for diagnosing anatomical and pathological abnormalities of pelvic organ which has a major role in subfertility management.

Isolated renal hydatid disease: varied presentations, treatments, dilemmas, and the way ahead: case report series

Background Hydatid disease is an infectious disease that affects several organs. Isolated renal involvement is very rare. The treatment for renal hydatid cyst ranges from minimally invasive percutaneous aspiration techniques to laparoscopic and open techniques. We describe five cases of isolated renal hydatidosis with varied presentations who were treated successfully by various methods. Case presentation The presenting symptoms included flank pain (n = 5), mass abdomen (n = 2), and hydaturia (n = 1). In 4 patients, the diagnosis of a hydatid cyst was known preoperatively, but one patient with a preoperative diagnosis of a simple cyst was found to harbor hydatidosis intra-operatively. Eosinophilia as a marker for the active disease was present in 60% (3/5), while echinococcal serology was positive in only 25% (1/4). Two cases were approached laparoscopically, while three required an open approach. Two patients were treated with nephrectomy due to the high bulk of the disease, while the other three underwent renal preserving cyst excision. Conclusions The presence of eosinophilia in the preoperative workup may indicate an infective/active hydatid disease. Echinococcal serology is representative of past hydatid infection but cannot reveal about current disease status. Cysts with varied attenuations and residence in an endemic region may support a renal hydatid cyst diagnosis. A holistic approach including clinical history, laboratory parameters, and imaging is needed for diagnosis. Surgical treatment requires cyst excision, along with precautions to prevent spilling. Nephrectomy may be preferred in cases with minimal residual function.

Surgery in congenital lung malformations: the evolution from thoracotomy to VATS, 10-year experience in a single center

Background Congenital lung malformation is an umbrella term and consist of various kind of parenchymal and mediastinal pathologies. Surgical resection is often required for diagnosis and curative treatment. We aimed to review our experience in surgical treatment for congenital lung disease and present the role of minimally invasive surgery. Methods Surgical resections performed for benign lesions of the lung and mediastinum between January 2009 and May 2019 were retrospectively analyzed. Patients who were found to have congenital lung malformation as a result of pathological examination were included in our study. Distribution characteristics of the patients according to congenital lung malformation subtypes, differences in surgical approach and postoperative results were investigated. Results A total of 94 patients who underwent surgical resection and were diagnosed with the bronchogenic cyst, sequestration, bronchial atresia, congenital cystic adenomatoid malformation (CCAM), or enteric cyst as a result of pathological examination were included the study. There were no significant differences between pathological subtypes in the postoperative length of hospital stay and drainage duration however, perioperative complication rate was higher in the sequestration group. In addition, in the first three days postoperatively, the mean pain score was found to be lower in the VATS group compared to thoracotomy. Conclusions Congenital lung malformations consist of a heterogeneous group of diseases and the surgical treatment in these patients can range from a simple cyst excision to pneumonectomy. Video-assisted thoracoscopic surgery should be considered as the first choice in the surgical treatment of these patients in experienced centers.

Intratesticular Simple Cyst - Ultrasound and Elastography Appearance

Simple intratesticular cysts are unusual lesions. They are mostly non-palpable and diagnosed incidentally. A fifty year old patient was presented for scrotal sonography due to vague scrotal pain. On examination, a 6.8 x 5.4 mm intratesticular hypoechoic lesion was seen with imperceptible walls and posterior acoustic enhancement which is an indication of cystic lesion. This cyst contained echogenic mobile material indicating benign nature of the lesion (Figure 1). Strain elastography revealed typical blue green red (BGR) sign confirming cystic nature of lesion. (Figure 2) Benign intra testicular lesions are uncommon, but proper diagnosis is important so that unnecessary surgical intervention is prevented. Benign lesions involve tubular ectasia, abscess, intra testicular varicocele, intratesticular simple cysts, epidermoid cyst, tunica albuginea cyst and hemorrhage.1 Gray-scale ultrasonography (USG) along with Color-Doppler ultrasound wherever possible mostly gives accurate diagnosis leading to appropriate treatment.2 Features of simple cyst on USG include an imperceptible wall, an anechoic center and through transmission. Simple cysts are incidental finding most commonly in males of age 40 years and above. Variable in size having diameter of two mili meters to two centimeters. These are commonly single, in some cases multiple cysts have also been found. Simple cysts are commonly found near the mediastinum of testis but can also be found in other parts of testis. Also, these are linked with extra testicular spermatoceles. On local examination, even large simple testicular cysts are generally not palpable as they are not firm. Tunica albuginea cysts are very firm. So, we can easily differentiate between tunica albuginea cyst and simple testicular cyst.3 Sometimes testicular cysts contain echoic material which is mobile with change in position (Figure 2). The mobility of material suggests whether the cyst is benign or if fixed, it can be a cyst of neoplastic etiology. 4 The 3 - layer pattern (blue / green / red layers) visible in smaller cystic areas is known as the BGR sign and is visible in a few elastography systems. This pattern is taken into consideration as beneficial because it highlights the cystic nature of the lesion and has been proven to be true even in cases of cystic lesions with inner echogenic material.