Mesenteric Cyst in a 5-Year-Old Child with Partial abdominal Obstruction: Case Report from Bahrain

Mesenteric cysts are rare, variably-sized intra-abdominal lesions developing during childhood. Their symptoms vary from being asymptomatic and incidentally found to non-specific, presenting as lower abdominal pain, nausea and vomiting, constipation and diarrhea. Clinically, these abdominal masses may be palpable in more than 50% of patients. The diagnosis of these lesions can be made accurately radiologically through abdominal ultrasound and CT. The treatment of choice is complete surgical resection. Hereby we report the clinical course of a 5 year old child with a mesenteric cyst who complained of acute abdominal pain, constipation and vomiting and were surgically treated after being diagnosed with a mesenteric cyst based on radiological examination.

A transcription factor signature predicts the survival of patients with adrenocortical carcinoma

Background Adrenocortical carcinoma (ACC) is a rare endocrine cancer that manifests as abdominal masses and excessive steroid hormone levels and is associated with poor clinical outcomes. Transcription factors (TFs) deregulation is found to be involved in adrenocortical tumorigenesis and cancer progression. This study aimed to construct a TF-based prognostic signature for the prediction of survival of ACC patients. Methods The gene expression profile and clinical information for ACC patients were downloaded from The Cancer Genome Atlas (TCGA, training set) and Gene Expression Omnibus (GEO, validation set) datasets after obtained 1,639 human TFs from a previously published study. The univariate Cox regression analysis was applied to identify the survival-related TFs and the LASSO Cox regression was conducted to construct the TF signature based on these survival-associated TFs candidates. Then, multivariate analysis was used to reveal the independent prognostic factors. Furthermore, Gene Set Enrichment Analysis (GSEA) was performed to analyze the significance of the TFs constituting the prognostic signature. Results LASSO Cox regression and multivariate Cox regression identified a 13-TF prognostic signature comprised of CREB3L3, NR0B1, CENPA, FOXM1, E2F2, MYBL2, HOXC11, ZIC2, ZNF282, DNMT1, TCF3, ELK4, and KLF6. The risk score based on the TF signature could classify patients into low- and high-risk groups. Kaplan-Meier analyses showed that patients in the high-risk group had significantly shorter overall survival (OS) compared to the low-risk patients. Receiver operating characteristic (ROC) curves showed that the prognostic signature predicted the OS of ACC patients with good sensitivity and specificity both in the training set (AUC > 0.9) and the validation set (AUC > 0.7). Furthermore, the TF-risk score was an independent prognostic factor. Conclusions Taken together, we identified a 13-TF prognostic marker to predict OS in ACC patients.

Case Report: Two Cases of Abdominal Aggressive Fibromatosis That Mimicked Abdominal Wall Endometriosis and Review of Literature

Background: Abdominal aggressive fibromatosis (AF) can be confounded with abdominal wall endomentriosis (AWE) because they share considerable similarity. Because of the different patient prognoses and treatment strategies available, accurate pre-operative diagnosis is important.Case Presentation: We here report two cases of abdominal masses presenting as periodic changes in tumor sizes, which occurred in correlation with the menstrual cycle. The clinical findings were highly suggestive of AWE. However, the final pathological findings revealed AF. The estrogen receptor and progesterone receptor expressions were negative in the two cases. The differences between the two diseases have been discussed in detail.Conclusion: A diagnosis of AWE should be scrutinized closely if the patient does not complain of cyclic pain. Fine-needle aspiration cytology is a suitable tool for pre-operative evaluation.

Intrauterine ovarian dermoid cyst complicated by torsion: an uncommon presentation of abdominal mass in a neonate

Fetal ovarian cysts are the most common abdominal masses in the female fetuses and believed to be caused by in utero exposure of fetus to maternal and placental hormones. Majority of them are diagnosed in third trimester and should be distinguished from other causes of abdominal masses of genitourinary and gastrointestinal origin. Once diagnosed serial ultrasound monitoring is recommended to document changes in size or appearance. Complications like torsion or rupture merit careful assessment and surgical intervention to preserve ovarian function and fertility. We report a case of intrauterine ovarian dermoid cyst complicated by torsion, which was diagnosed prenatally on ultrasound as complex cystic lesion within the abdomen.

Steady-state ferumoxytol-enhanced MRI: early observations in benign abdominal organ masses and clinical implications

Introduction The off-label use of ferumoxytol as a vascular MR imaging agent is growing rapidly. However, the properties of ferumoxytol suggest that it may play an important role in the detection and characterization of abdominal mass lesions. Methods Thirty-six patients with benign abdominal mass lesions who underwent MR angiography with ferumoxytol also had T2-weighted HASTE imaging and fat-suppressed 3D T1-weighted imaging. The T1 and T2 enhancement characteristics of the lesions were analyzed and correlated with other imaging modalities and/or surgical findings and/or clinical follow-up. Results In all patients with benign masses in the liver (n = 22 patients), spleen (n = 6 patients), kidneys (n = 33 patients), adrenal (n = 2 patients) and pancreas (n = 4 patients), based on the enhancement characteristics with ferumoxytol, readers were confident of the benign nature of the lesions and their conclusions were consistent with correlative imaging, tissue sampling and follow-up. One patient with a suspicious enhancing 2F Bosniak renal cyst had renal cell carcinoma confirmed on biopsy. Conclusion Ferumoxytol-enhanced MRI can increase diagnostic confidence for benign abdominal masses and can increase the conspicuity of mass lesions, relative to unenhanced MRI. Graphic Abstract

Exacerbation of Congenital Hydronephrosis as the First Presentation of COVID-19 Infection in Children: A Case Series

Background:Congenital hydronephrosis is one of the most common abnormalities of the upper urinary tract, which can be exacerbated by a variety of intrinsic or extrinsic triggers. The urinary tract system is one of the major organs complicated by COVID-19 infection. Case presentations:Here we report five patients with an established diagnosis of congenital hydronephrosis, who presented with acute abdominal pain and fever and an abrupt increase in the anteroposterior pelvic diameter (APD). Patients had a previous stable course and were under regular follow-up with serial ultra-sonographic studies. They underwent surgery or supportive treatment due to the later exacerbation of hydronephrosis. Based on the clinical and imaging findings, no plausible etiologies for these exacerbation episodes, including infection, nephrolithiasis or abdominal masses, could be postulated. The common aspect in all these patients was the evidence of a COVID-19 infection. Conclusions:Infection with COVID-19 in children with antenatal hydronephrosis may exacerbate the degree of hydronephrosis and renal APD in ultrasonography, which itself may be mediated by the increase in inflammatory mediators.

Giant paraovarian cyst in an adolescent: a challenge of accurate diagnostic

BackgroundParaovarian cysts (POCs) are rarely seen among pediatric female patients. The diagnosis still represents a challenge. Giant POCs are exceedingly rare and only few cases have been reported in the literature.Case presentationA 17-year-old girl from the rural area presented with abdominal pain, pollakiuria and a giant abdomino-pelvic mass. Ultrasound and computed tomography revealed a 14cm x 24cm x 30cm anechoic unilocular cyst which raised the suspicion of a mesenteric or ovarian cyst. The correct diagnosis of left POC was established intraoperatory. Cystectomy was performed. Histopathological diagnosis was serous cystadenoma.DiscussionsPOCs become symptomatic when reach large sizes or complicate, the most feared complication being ovary torsion. Imagistic investigations can establish the diagnosis of cyst, but the cyst’s origin often remains an intraoperatory discovery. Surgical excision is necessary to decrease the risk of complications, and adnexal preservation is essential in pediatric patients. Even for pediatric female patients POC should be considered in the differential diagnosis of cystic abdominal masses.

CT of pelviabdominal masses in pediatrics: Diagnostic algorithm

Background Pelviabdominal masses are common in children. It can be a leadig cause of considerable morbidity and mortality. Objective To review the different pelviabdominal masses and their diagnostic criteria using the multidetector CT scans in order to build an approach for diagnosis. Methods A retrospective study, conducted at Ain Shams University hospitals on children complaining of pelviabdominal masses, the patients were investigated using CT scans in the period between June 2018 till end of May 2019. Results pelviabdominal CT scan of 70 patients were reviewed. Their age ranged from 7 days to 18 years old, the mean was 8 years of age (SD ± 5.5). 31 male : 39 female. Abdominal masses of pediatrics were congenital ( 9 case), neoplastic ( 20 cases), inflammatory ( 23 casaes) and post traumatic in origin (3 cases). The most common congenital masses were PUJO, neoplastic were neuroblastomas, inflammatory were abscess. Diagnostic approach should start with determination of the organ of origin followed by determination of its morphology and pattern of contrast enhancement. The kidney was found to be the most common organ of origin in 25.7% of cases followed by the adenxa. Conclusion the organ of origin and morphology of the lesion are key imaging features that will help the radiologist reach a definitive diagnosis or deliver a possible differential diagnosis.