HOW TO MANAGE SUDDEN IVC DECOMPRESSION IN CASE OF A LARGE RETROPERITONEAL MYELOLIPOMA.

31 year female patient presented to surgical OPD to take consult about incidental finding of large mass originating th from liver in routine antennal checkup at 5 month of pregnancy. We have done ultrasound which is suggestive of suprarenal mass patient was kept under regular follow up and checked for any increase in size of mass but there is no changes in mass .patient deliver baby with normal vaginal delivery ,after postpartum 7 months patient came back with right sided abdominal lump. No complaint of abdominal pain ,vomiting ,headache ,palpitation ,diarrhea ,constipation ,fever ,generalized weakness and weight loss. Past history of cesarean section before 8 years .

Suprarenal unicentric Castelman’s disease: A rare case report

Castleman Disease (CD) is a rare non-clonal lymphoproliferative disorder. The clinical presentation of CD often overlaps with autoimmune, infectious, or other malignant diseases. The diagnosis is confirmed by a biopsy of the affected lymph-node tissue. A 39-year-old gentleman was evaluated for intractable abdominal pain fatigue of 2 months duration. CT scan showed a 4 X 4 X 5 cm right suprarenal mass. Laparotomy and near total excision was performed which showed reactive B cells expressing CD20 and PAX5, favoring CD. Patient received adjuvant 6 cycles of Rituximab and steroids. A follow up CT scan after 3 months showed a near complete resolution.

Large adrenal mass heralding the diagnosis of occult extra-adrenal malignancy in two patients

We report two cases highlighting the role of fluorine-18-fluorodeoxyglucose positron emission tomography/computerised tomography (18F FDG PET/CT) in the diagnostic and preoperative workup of indeterminate adrenal masses. Case 1: a 60-year-old man was diagnosed with a large left-sided adrenal mass with indeterminate radiological characteristics on CT. Biochemical investigations ruled out tumour hypersecretion. 18F FDG PET/CT was performed to exclude metastases and identified a pulmonary nodule in the left upper lobe. Histology of the resected adrenal tumour demonstrated a secondary metastasis from an adenocarcinoma of the lung. Case 2: an 88-year-old male was found to have a heterogeneous and vascular left-sided suprarenal mass and a smaller right-sided adrenal nodule. Both adrenal nodules had indeterminate radiological characteristics. Biochemical investigations were negative. PET/CT demonstrated high avidity in the bilateral adrenal nodules but no extra-adrenal FDG avid disease. Histology demonstrated a metastatic carcinoma of pulmonary origin.

Leiomyosarcoma of the inferior vena cava posing as an adrenal incidentaloma

Adrenal incidentalomas are incidentally detected adrenal lesions on imaging, which have a variety of differential diagnoses, the most common being a non-functioning adenoma. Surgical intervention for these lesions is needed when there is hypersecretion, for lesions larger than 4 cm and smaller lesions with suspicious characteristics. Here we present a young woman who was incidentally found to have a right suprarenal mass with loss of fat planes with the inferior vena cava (IVC). She underwent resection of the tumour along with the posterior wall of IVC, which was primarily repaired. Her postoperative biopsy was suggestive of leiomyosarcoma arising from the IVC. In the absence of distant metastasis, the sole prognostic factor for this tumour is achieving negative margins through radical resection of the tumour with IVC resection. Retroperitoneal leiomyosarcomas should be considered as a differential diagnosis for larger lesions, especially those more than 10 cm.

A Rare Case of Adrenal Pheochromocytoma With Unusual Clinical and Biochemical Presentation: A Case Report and Literature Review

A 45 years old male, nondiabetic, hypertensive, nonasthmatic, nonsmoker, farmer from Pabna presented with the complaints of pain over right hypochondrium for 4 months andalso gave history of significant weight loss of about 15 kg in the last 6 months. He also developed bilateral gynecomastia for 2 years.On examination, Blood pressure was 200/100 mm of Hg and bilateral gynecomastia were present.Both testes were mildly atrophied.Systemicexamination revealed mild tenderness in right hypochondrium on deep palpation of abdomen.USG of W/A revealed A heterogenous mixed echogenic mass (9.9*8.9) was seen in upper polar region of right kidney. Suggestive of Right suprarenal mass. CT scan W/A with contrast showed heterogenous contrast enhancing well defined rounded soft tissue density lesion measuring about 90*86 mm was noted in right adrenal region which revealed a right adrenal mass consistent with adrenal pheochromocytoma. However,clinical biochemistry tests revealed normal levels of plasma catecholamines (dopamine,norepinephrine, and epinephrine) and metanephrine, which are unusual findings in adrenal pheochromocytoma.Serum Aldosterone,Basal cortisol, Renin in plasma, ACTH and 24 hours Urinary Free cortisol were normal.Meanwhile, The patient had persistent hypokalemia and serum Testosterone, LH and FSH were below normal level. Open right adrenalectomy was done. Histopathology and immunohistochemistryconfirmed the diagnosis of adrenal pheochromocytoma. Following surgery, the patient did well and showed full recovery at follow-up after one month. To our knowledge, this is the first report in Dhaka Medical college hospital of the extremely rare entity of pheochromocytoma with an unusual clinical and biochemical scenario. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.168-171

Primitive neuroectodermal tumour (PNET) of the renal capsule mimicking solid adrenal tumour

Primitive neuroectodermal tumour (PNET) of renal capsule is a rare entity. We report a case of a 17-year-old girl, who presented with symptoms of epigastric and right hypochondrium pain since 1 year. She was afebrile and physical examination revealed a soft, non-tender, firm, bimanually palpable and ballotable mass along right flank. Ultrasound abdomen showed a large heteroechoic mass in right suprarenal region with indistinct planes with upper pole of right kidney. On CT, a large right suprarenal mass was noted with origin likely from right adrenal gland. Surgery was done and intraoperatively, the large mass in right suprarenal region showed involvement of the upper pole of the right kidney. The right adrenal gland was small in size, compressed and displaced by the lesion. Histopathology revealed the mass to be PNET of kidney. We report the relevant imaging findings of the case with review of literature of this entity.

Adrenal Incidentaloma In Patient with Bilateral Nephrolithiasis and Infectef Right Kidney Cyst

Adrenal incidentaloma (AI) is a rare case, with a prevalence of 3-7% in the general population. We report a case of a 66 year old female, presented with the history of bilateral flank pain. The patient was performed urologic evaluation due to suspicion of right perirenal abscess and left kidney tumor, and from abdominal CT scan it was found suprarenal mass. There were no signs and symptoms of hormonal hyperfunction. Radiological evaluation in the patient showed the present of malignant lesion. Therefore, adrenalectomy was planned. Before undergoing adrenalectomy, the patient had passed away 6 days after first surgery (right pyelolitotomy and unroofing cyst), with septic shock suspected as cause of death due to hospital-acquired pneumonia.