LAMN as a differential diagnosis for abdominal pain: a case report from Syria

Low-grade appendiceal mucinous neoplasms (LAMNs) are papillary or flat mucinous tumors with low-grade cytologic atypia found in <0.3% of appendectomy specimens among older population. They are the most frequent source of pseudomyxoma peritonei. They can be easily misdiagnosed, due to unspecific symptoms, with acute appendicitis, retroperitoneal tumors or adnexal mass. Macroscopically, the appendix may appear normal or be variably dilated. Microscopic study determines whether the studied specimen is LAMN or mucinous adenocarcinomas. We report a 77-year-old patient presented with 15-day abdominal pain accompanied with chills and hyperthermia. Decision was made for right hemicolectomy as a result of the findings on ultrasound and computed tomography scan. Diagnosis was made after the pathologic study, which revealedLAMN.

A case report of heterotopic pregnancy

Heterotopic pregnancy is the presence of both intrauterine and extrauterine (ectopic) implantation as described by Reece in 1983 and is extremely rare. It accounts for 1 per 30000, in natural cycles and 9 per 10000, in assisted reproduction cycles. The aim of this report is to introduce this case as it poses a challenge to diagnosis due to its complex clinical and laboratory findings. A primigravida aged 30 at 6 weeks period of gestation, reported with minimal bleeding per vaginum. On performing a physical examination her vitals were stable and no significant findings were noted except for an enlarged uterus corresponding to 6 weeks with posterior forniceal fullness. Her beta-hCG was 23765 IU/ml and ultrasound showed a live intrauterine gestation with left adnexal mass- likely ectopic gestational sac. Laparoscopy showed a left tubal pregnancy and salpingectomy was done. The postoperative period was uneventful and she was discharged with a single live intrauterine gestation of 6-7 weeks. She carried on with her pregnancy and delivered a healthy baby at term. The diagnosis is possible only in cases when there is a high index of suspicion by the treating clinician. The adnexa must be inspected carefully in the confirmatory ultrasound. The early timely diagnosis gives a good maternal outcome and hence crucial in the management.

The Clinicopathological Features And Surgical Procedure of Adnexal Mass With Abdominal Pain In Pediatric And Adolescent Patients

Objective: To investigate the clinicopathological features and surgical procedures of adnexal masses with abdominal pain in pediatric and adolescent patients.Methods: A total of 212 pediatric and adolescent adnexal masses with abdominal pain who underwent surgery were retrospectively reviewed. The patients were divided into two groups, namely, the emergency surgery (EMS, n=96) group and the elective surgery (ELS, n=116) group, according to whether they had been surgically diagnosed with emergency conditions. EMS group refers to patients who had been surgically diagnosed with emergency conditions including adnexal masses torsion，corpus luteum rupture，and rupture of ectopic pregnancy. ELS group refers to patients with adnexal mass without emergency condition. The differences between the two groups were compared using the chi- squared test.Results: At the surgery evaluation, the median age was 14.5±3.6 years. A total of 175 patients (82.5%, 175/212) had menstruation, and 37 patients (17.5%, 37/212) had not yet begun menstruating. A total of 126 (59.4%, 126/212) patients presented with an abrupt onset of abdominal pain. Pelvic abdominal ultrasound was the first imaging modality used in all the patients (n = 212/212; 100%). Tumor markers were abnormally elevated in 26 patients.Compared with the ELS group, the proportion of patients with emergency onset of pain, pain duration less than 3 months, persistent and intense of pain were significantly higher than those in ELS group (P < 0.05). There were significantly more patients without menarche in the EMS group than in the ELS group (p<0.05). The average tumor size in the ELS group was larger than that in the EMS group (p<0.05). In the EMS group, 78 cases（ 81.3%,78/96）had adnexal mass torsion, 16 cases (16.7%，16/96) had mass rupture, and 2 cases (2.1%, 2/96）had ectopic pregnancy. Of the 78 patients with adnexal mass torsion, 49 cases (62.8%, 49/78）underwent ovary-preserving surgery, and 24 cases (30.8%，24/78）underwent adnexectomy. The most common pathologic types of adnexal torsion were mature teratoma cysts and simple cysts, accounting for 29% and 26%, respectively.Conclusions: Adnexal masses combined with abdominal pain in pediatric and adolescent patients, especially for patients presented as acute pain which characterized by emergency pain onset, persistent pain that cannot be relieved or recurrent pain，should be considered due to the possibility of adnexal mass combined with acute complications, and emergency surgery should be performed immediately. For patients with suspected malignant lesions, a comprehensive evaluation of the lesions should be conducted preoperatively to select the appropriate surgical method and strategy. After the discovery of an adnexal mass, evaluation should be performed quickly, and long-term management should be implemented.

Symptoms based endometriosis prediction using machine learning

Endometriosis a painful disorder that stripes the uterus both inside and outside. Endometriosis can be diagnosed by the medical practitioners with the help of traditional scanning procedures. Laparoscopic surgery is the authentic method for identifying the advanced stages of endometriosis. The statistical approach is a state-of-art method for identifying the various stages of endometriosis using laparoscopic images. The paper focuses on a well-known statistical method known as chi-square and correlation coefficients are implemented for identifying the symptoms that are correlated with various stages of endometriosis. Chi-square analysis performs the association between symptoms and stages of endometriosis. With these analysis, an algorithm was proposed known as endometriosis prediction factor algorithm (EPF). The EPF algorithm predicts the presence of endometriosis if the derived value is greater than 1. From the chi-square analysis, it is identified that mild endometriosis is influenced 34% by menstrual flow, minimal endometriosis is influenced 40% by dysmenorrhea, where moderate endometriosis is influenced 31% by tenderness and deep infiltrating endometriosis is influenced 22% by adnexal mass.

A case of primary adenocarcinoma of Meckel’s diverticulum presenting as ovarian mass and literature review

Meckel’s diverticulum (MD) is the most common congenital anomaly affecting the gastrointestinal tract. It is located on the anti-mesenteric border of the small intestine and occurs due to incomplete obliteration of the omphalomesenteric duct during embryogenesis. Tumors, particularly cancers, are rare complications of MD. Carcinoids are the most common malignancies in this site. Adenocarcinomas are extremely rare and carry a poor prognosis. Here, we present the case of adenocarcinoma of MD presenting as Krukenberg tumor in a 42-year-old lady and causing a diagnostic dilemma. Pelviabdominal examination revealed large bilateral adnexal masses along with ascites and computed tomography-guided fine-needle aspiration cytology from the right adnexal mass was suggestive of adenocarcinoma. At exploratory laparotomy, a MD was found with hard intramural growth palpable at the tip of MD adnexal deposits and omental caking. Immunohistochemistry revealed CK 7- and CK 20+ve and also CDX2 positive. The rarity of presentation of bilateral adnexal mass due to primary adenocarcinoma of MD urges us to report this case.

Extrauterine Epithelioid Trophoblastic Tumor (ETT) Arising from an Antecedent Undiagnosed Molar Pregnancy Presenting as an Adnexal mass: A Case Report

Introduction/Objective Epithelioid trophoblastic tumor (ETT) is an extremely rare neoplasm derived from chorionic type intermediate trophoblast. ETT usually follows an antecedent term pregnancy but can also follow spontaneous abortions or molar pregnancy. ETT most often arises from the endometrium, followed by the cervix. Extrauterine ETT are extremely rare, with few cases reported in literature. Methods/Case Report A 41-year-old woman with three term pregnancies presented with abdominal pain, ten years after her last pregnancy. Imaging findings of a 3.5 cm adnexal mass coupled with an elevated serum β-hCG (~ 900 mIU/ml), led to the suspicion of an ectopic pregnancy. Hysterectomy with salpingectomy revealed a 4.7 cm, tan- yellow, necrotic mass in the adnexal region abutting but distinct from the uterine serosa. Histologic evaluation showed a well- circumscribed tumor with pushing borders. The tumor cells were epithelioid with well-defined eosinophilic cytoplasm, monomorphic nuclei, frequent mitosis, and abundant geographic necrosis. The tumor cells were positive for β-hCG, GATA-3, PLAP and inhibin, with focal weak staining squamous markers p63 and p40. DNA fingerprinting analysis, performed to confirm the diagnosis of ETT, revealed a homozygous tumor with two copies of non-maternal genes indicating that the antecedent index gestation giving rise to the tumor was an undiagnosed hydatidiform mole. Following surgery, serum β-hCG levels were normal and the patient is currently on surveillance. Results (if a Case Study enter NA) NA Conclusion We present an extremely rare case of extrauterine ETT arising from a previously undetected molar pregnancy. The diagnosis should be suspected when a mass is observed at extrauterine sites with elevated β-hCG levels in patients with or without vaginal bleeding. Histologic differential of squamous cell carcinoma needs to be ruled out with immunostains. Due to its rarity and highly variable presentation, this entity remains a diagnostic challenge. DNA fingerprinting analysis demonstrating non-maternal genes can help confirm the diagnosis of ETT.

Quantitative global lipidomics analysis of patients with ovarian cancer versus benign adnexal mass

Altered lipid metabolism has emerged as an important feature of ovarian cancer (OC), yet the translational potential of lipid metabolites to aid in diagnosis and triage remains unproven. We conducted a multi-level interrogation of lipid metabolic phenotypes in patients with adnexal masses, integrating quantitative lipidomics profiling of plasma and ascites with publicly-available tumor transcriptome data. Using Sciex Lipidyzer, we assessed concentrations of > 500 plasma lipids in two patient cohorts—(i) a pilot set of 100 women with OC (50) or benign tumor (50), and (ii) an independent set of 118 women with malignant (60) or benign (58) adnexal mass. 249 lipid species and several lipid classes were significantly reduced in cases versus controls in both cohorts (FDR < 0.05). 23 metabolites—triacylglycerols, phosphatidylcholines, cholesterol esters—were validated at Bonferroni significance (P < 9.16 × 10–5). Certain lipids exhibited greater alterations in early- (diacylglycerols) or late-stage (lysophospholipids) cases, and multiple lipids in plasma and ascites were positively correlated. Lipoprotein receptor gene expression differed markedly in OC versus benign tumors. Importantly, several plasma lipid species, such as DAG(16:1/18:1), improved the accuracy of CA125 in differentiating early-stage OC cases from benign controls, and conferred a 15–20% increase in specificity at 90% sensitivity in multivariate models adjusted for age and BMI. This study provides novel insight into systemic and local lipid metabolic differences between OC and benign disease, further implicating altered lipid uptake in OC biology, and advancing plasma lipid metabolites as a complementary class of circulating biomarkers for OC diagnosis and triage.