Pure Uterine Lipoma and Focal Nodular Hyperplasia of the Liver: Concurrence of a Rare Tumor and Another Incidental Finding

Background. Fatty uterine tumors, especially pure uterine lipoma, are very rare, but clinically and radiologically, they can mimic other primary benign and malignant uterine neoplasms. Case Report. A multipara 61-year-old postmenopausal woman presented with abnormal vaginal bleeding for 3 months. Assessment by ultrasound and magnetic resonance imaging (MRI) revealed a hyperechoic mass in the uterine corpus. Furthermore, during radiologic investigation, there was an incidental isoechoic mass in the left lobe of the liver. Pure uterine lipoma and hepatic focal nodular hyperplasia were diagnosed. Conclusion. Pure lipoma of the uterus, even though rare, has to be kept in the differential diagnosis of uterine neoplasms, especially in postmenopausal women. Till now, just a few concurrent tumors have been reported with pure uterine lipoma, and among them, FNH is the first extragenital tumor.

Giant osteomas: Clinical results and surgical approach from ophthalmic point of view

Purpose: To present clinical ocular manifestations, radiological features and surgical results of giant paranasal osteomas involving the orbit. Design: Retrospective, interventional, case series Methods: The study included patients treated for giant paranasal osteoma involving the orbit. Total or subtotal excision of the tumor was performed via external approach. Clinical characteristics including presenting symptoms, radiologic investigation, histopathology and details of the surgery were recorded. Results: Of the six patients included; four were male and two were female. Mean age was 46.8 years (range 12–70 years). Five patients had unilateral, one patient had bileteral disease. The presenting complaints included complete ( n = 2/6) or partial ( n = 4/6) limitation of eye movements depending on the location and size of the tumor, diplopia ( n = 5/6), vision loss ( n = 2/6) exophthalmos ( n = 6/6) and reduced pupillary light reflex ( n = 2/6). The presumed origin of the tumor was frontoethmoidal region ( n = 2/6), frontal sinus ( n = 3/6) and ethmoid sinus ( n = 1/6). Total resection was achieved in three of the patients whereas partial resection was achieved in remaining three patients due to risk of incremental neurological damage. Mild ptosis was observed in all patients during the postoperative period (temporary, n = 4; permanent, n = 2). Conclusion: Despite the benign nature of osteomas, severe functional impairment including vision loss due to compression of the optic nerve and diplopia might occur in case of orbital involvement. Osteomas with an orbital extension > %50 of the bony orbit volume are more prone to cause irreversible visual loss. Surgical resection is still the mainstay of therapy.

Radiologic practice in the face of COVID-19. The impact on private Radiologic facilities in south-south Nigeria.

Background: CoronaVirus Disease (Covid-19) is a highly contagious disease that has spread to many countries all over the globe and the index case in Nigeria was confirmed on 27th February 2020. The study is aimed at evaluating the impact of the COVID-19 pandemic on private radiologic facilities in south-south Nigeria. Methodology: This was a retrospective survey of 5 private radiologic facilities in Port Harcourt, south-south Nigeria from November 2019 to April 2020 using the facilities monthly statistics. The statistics were evaluated to assess the attendance of patients to radiologic investigation before and during the pandemic. The inclusion criteria are the availability of personal protective equipment (PPE) and radiologic practise guideline in accordance with the COVID-19 pandemic. Records concerning patient’s attendance to Plain radiography, Ultrasonography, Computed tomography, hysterosalpingography, mammography and Magnetic resonance imaging were reviewed. The data collated were analyzed and presented in tables, charts and graphs.Results: The highest number of patients was observed in November 2019 with 2.6% decrease in January, 82.9% and 90.1% decrease in March 2020 and April 2020 respectively. All the centres had a significant reduction in the use of radiologic facilities within this period of the pandemic. The negative economic impact was estimated to be huge drawing an inference from the very poor patient’s turnout. Conclusion: In conclusion, the COVID-19 pandemic was a global catastrophe in radiologic investigation and its impact in private radiologic facilities in Port Harcourt was enormous.

Cystic Lesions of Anterior Mediastinum: Case Report

Cystic lesions of the mediastinum are uncommon, comprising 12% to 18% of all primary mediastinal tumors and unless they attain a large size and cause compressive symptoms, these tumors are generally asymptomatic and are discovered incidentally upon radiologic investigation of some other condition.We present in this paper a case of cystic lesions of the mediastinum in a 70-year-old male patient who underwent a surgery for mediastinal mass removal. Histopathology report had shown it was the case of mature cystic teratoma of anterior mediastinum.Based on a review of the literature, as well as our experience, we conclude that best treatment for cystic lesions of anterior mediastinum is complete surgical resection if possible.

Adrenal incidentaloma: management of patients with functionally autonomous cortisol synthesis

Over recent decades due to improved visualization (ultrasound, computer tomography and magnetic resonance imaging) prevalence of adrenal incidentaloma has increased. The term «adrenal incidentaloma» is generic and includes a group of tumors of various morphology and over 1 cm in diameter accidentally discovered during radiologic investigation. The found tumor can be hormonally inactive or actively releasing different hormones, malignant or benign, and originating from different adrenal zones or having non-specific organ origin. Based on the frequency of revealing and clinical significance the most noteworthy is functionally autonomous cortisol synthesis. It means changes of hypothalamic pituitary adrenal axis without classic clinically prominent signs of cortisol excess such as proximal myopathy, stretch marks, body fat redistribution and other metabolic changes related to cortisol. Currently a large number of recommendations on the management and tactics of treatment of adrenal incidentaloma can be found in the literature. Based on the analysis of these guidelines the conclusions were made about the diagnostic errors and incorrect approaches to the choice of treatment of such patients. Recently a lot of studies have been directed to the early detection of carbohydrate and lipid metabolism disorders, relation with obesity and type 2 diabetes mellitus, arterial hypertension and osteoporosis for preserved quality of life of such patients. Influence of hypercorticism is considered to worsen the course of these conditions but at the moment no effect of adrenalectomy on mortality and life duration was confirmed.

INTRAOSSEOUS GANGLION CYST OF SCAPHOID AND LUNATE: A CASE REPORT

INTRODUCTION:Intraosseous ganglion cyst of carpal bones is an uncommon cause of wrist pain. Although isolated cases of scaphoid and lunate have been reported in literature,intraosseous ganglion cyst in both scaphoid and lunate is rare. CASE REPORT:We report a case of 27 year old female who presented with a 6 month history of progressive left wrist pain. History of trauma was not reported. Conservative treatment with medications was unsuccessful. Examination revealed moderate swelling and tenderness over volar aspect of wrist with terminally painful wrist motions. Plain radiograph and MRI revealed well defined lesion in both scaphoid and lunate bone. Curettage and filling with radial bone graft provided a good functional recovery. CONCLUSION:we propose that early diagnosis of intraosseous ganglion is based on clinical presentation, proper radiologic investigation and index of suspicion can be helpful in the surgical management of intra osseous ganglion cyst in small bones of hand and intraosseous ganglion cyst may be considered as a differential diagnosis for wrist pain

Persistent free-floating pelvic trophoblastic cysts following an interstitial ectopic pregnancy

Persistent trophoblast after ectopic pregnancy has been demonstrated at the surgical site or as peritoneal implants. A 37-year-old woman (G5P2) experienced persistently low levels of beta-human chorionic gonadotropin (hCG) after surgical treatment for an interstitial pregnancy. Evaluation for persistent trophoblast, gestational trophoblastic neoplasm and heterophilic antibodies was negative. After 15 months without resolution, she elected for hysterectomy. We found four smooth, freely floating avascular cysts intraoperatively; pathological evaluation identified the cysts as trophoblastic tissue. Serum beta-hCG resolved postoperatively and remained negative at 1 year. Our case demonstrates the novel finding of trophoblastic tissue existing as free-floating cysts in the peritoneal cavity. With appropriate suspicion, these cysts can be identified on radiologic investigation and removed laparoscopically.