Brenner tumors

Brenner tumors are rare ovarian neoplasms composed of ovarian transition cells surrounded by dense fibrous tissue. Most of them are small tumors (<2 cm), detected incidentally in asymptomatic women. Its predominantly fibrous content results in relatively low signal on T2 weighted images, establishing differential diagnosis with ovarian fibroma and thecoma. Their imaging features are very similar, the differentiation is based on secondary characteristics, such as signs or symptoms of estrogen excess and the presence of a second ovarian neoplasm, which has been reported in up to 30% of patients with Brenner tumor. Although originally thought to be universally benign, there have been scattered reports in the past decades of borderline and malignant forms of Brenner tumors.

Chronic Expansive Retroperitoneal Hematoma

Chronic expansive retroperitoneal hematoma is a hematoma that grows progressively sometime after the original trauma. It can appear in different locations. The mechanism of onset is unclear, but experimental evidence favours an inflammatory cause. For diagnostic imaging, magnetic resonance imaging is more useful than computed tomography (CT). However, it is difficult to differentiate it from other soft tissue tumors, sarcomas, actinomycosis or inflammatory pseudotumors, due to the uneven central uptake. Histopathological analysis of the lesion usually shows a dense fibrous tissue capsule containing numerous old clots without finding clear atypia or signs suggestive of malignancy. The treatment of choice is complete resection of the lesion (including the capsule), as incomplete treatments (such as drainage or curettage of the hematoma contents) may cause recurrence.

Craved by heart, carved next to it: Ballistic report of a souvenir bullet casing

A bullet which has been lodged in the body encapsulated by dense fibrous tissue for a long time without causing ill effects is a souvenir bullet. The bullet cartridge is divided into 3 parts: bullet, cartridge case holding bullet with gun powder and detonator at the base. Medicolegal consultation was done with Forensic Medicine Department where cartridge case acted as projectile and accidentally got embedded into the chest of the victim. In an attempt of making an ornament from the casing of bullet which was separated from bullet mechanically and gunpowder was partially removed from the bullet case. When he heated the bullet case to melt and mould, the remaining gun powder ignited with release of large amount of gas which resulted in forceful propulsion and acted as the projectile. An oval penetrating keyhole appearance injury measuring 2 cm x 1.5 cm was present on left side of the chest of the victim. The projectile was found just above the 6th rib and was confined within inter-costal muscle. Although late complications may arise from the metallic toxicity from the bullet case showing manifestations like abdominal pain, anorexia, chronic renal failure, abdominal pain, osteomyelitis, and fistula formation in bones, the projectile was left within the body as a souvenir to be intervened in case complications arise during follow-ups, as manipulating it could cause unanticipated therapeutic complications.

Experimental Modelling of the Processes for Connective Tissue Reparative Regeneration under Unfavorable Conditions

The purpose of the work was to elaborate experimental model for transverse tenotomy with intersection of facial membranes and mesenteric vessels as well as to study the process of connective tissue reparative regeneration under created conditions. Experiment was performed on 25 chinchilla rabbits of both sexes, aged 1 month with weight 1376 ± 124.8 g. Processes of Achilles tendon reparative regeneration was studied on days 15, 21, 30, 60 and 90 after operation. Histomorphologic study showed that within 30 days after tenotomy the substitution of defect zone with friable, reach in cells and gradually maturating fibrous tissue took place. By the end of day 60 a considerable part of the defect was substituted by dense fibrous connective tissue assumed a scar pattern. On day 90 after tenotomy a reverse development of the defect zone with focal substitution of dense fibrous tissue by friable unformed connective tissue containing histiocytes, lymphoid cells and inclusions of fatty tissue foci was observed. At that term histologic structure of the specimen showed its relatively low mechanical strength. The achieved data enabled to demonstrate that performance of tenotomy with traumatization of peritendinous tissues adversely affected the dynamics and pattern of reparative processes in the tendinosus defect zone.

Experimental Modelling of the Processes for Connective Tissue Reparative Regeneration under Unfavorable Conditions

The purpose of the work was to elaborate experimental model for transverse tenotomy with intersection of facial membranes and mesenteric vessels as well as to study the process of connective tissue reparative regeneration under created conditions. Experiment was performed on 25 chinchilla rabbits of both sexes, aged 1 month with weight 1376 ± 124.8 g. Processes of Achilles tendon reparative regeneration was studied on days 15, 21, 30, 60 and 90 after operation. Histomorphologic study showed that within 30 days after tenotomy the substitution of defect zone with friable, reach in cells and gradually maturating fibrous tissue took place. By the end of day 60 a considerable part of the defect was substituted by dense fibrous connective tissue assumed a scar pattern. On day 90 after tenotomy a reverse development of the defect zone with focal substitution of dense fibrous tissue by friable unformed connective tissue containing histiocytes, lymphoid cells and inclusions of fatty tissue foci was observed. At that term histologic structure of the specimen showed its relatively low mechanical strength. The achieved data enabled to demonstrate that performance of tenotomy with traumatization of peritendinous tissues adversely affected the dynamics and pattern of reparative processes in the tendinosus defect zone.

Vas Deferens Obstruction Due to Fibrosis after Plug Hernioplasty

The positioning of mesh and plug is routinely performed in hernioplasty, but knowledge about the long-term side effects of plug-induced fibrosis on the vas is incomplete. This is the first case of a documented fibrotic vas deferens obstruction resulting from compression of the plug that was in direct contact with the vas. During subsequent repair for a recurrent hernia, the cord and the plug appeared enveloped in dense fibrous tissue. Microscopy confirmed gross surgical findings. To reduce this morbidity, we suggest a cremaster sparing surgery, avoiding the positioning of bioprosthesis in direct contact with the vas deferens. We also found that positioning of a flat mesh over the transversalis fascia will avoid the unnecessary contact between mesh and bare vas below the transversalis fascia.

Diffuse Fibrous Pseudotumor of the Testicular Tunics Associated With an Inflamed Hydrocele

Fibrous pseudotumors of the testicular tunics and paratesticular soft tissue are uncommon lesions. They typically arise as painless scrotal masses that may be associated with a hydrocele or history of trauma or infection. Although these lesions are clinically worrisome for a malignant neoplasm, they are thought to be reactive in nature, since they are composed of dense fibrous tissue with interspersed bland fibroblasts and myofibroblasts and mixed inflammatory cells. Once excised, these lesions behave in a benign fashion. Typically, these masses are multinodular, but in rare cases they are diffuse, bandlike myofibroblastic proliferations that encase the testis and are termed fibromatous periorchitis. Herein, we describe a 57-year-old man with a diffuse fibrous pseudotumor/fibromatous periorchitis that encased the left testis and adnexa and arose in close apposition to an inflamed hydrocele.