Large renal leiomyoma: A multidisciplinary approach to diagnosis

We report the case of a 45-year-old woman who presented with a large palpable abdominal mass. Initial sonographic and computed tomographic studies prompted a differential diagnosis of retroperitoneal or renal sarcoma, leiomyoma, and lipid-poor angiomyolipoma. A final diagnosis of renal leiomyoma was reached based on a consensus among radiology, surgery and pathology. In addition to reviewing the features of this entity, this case demonstrates the process of developing a working diagnosis, narrowing the differential as additional testing is performed and establishing a final diagnosis with interdepartmental coordination. Despite the rarity of this condition, the ability to recognize and apply imaging features to differentiate between abdominal masses of unknown origin is important for clinicians and researchers.

Choledochal cyst type I-A: a case report

Choledocal cysts are cystic dilations that can occur in a single or multiple form in the biliary tree. Cysts can be congenital or acquired and are associated with numerous anatomical abnormalities. The presence of pain in the upper right quadrant of the abdomen, jaundice and palpable abdominal mass form the classic triad that is present in 15% to 45% of patients. We report the case of a 19-year-old woman patient, who she was admitted with abdominal pain in the right hypochondrium, nausea and vomiting, which evolved into jaundice. When seeking medical care, a large liver cyst and cholelithiasis. Imaging exams revealed liver cyst in segments IV-B,V and VI, lithiasis and biliary polyp.

Difficult to Diagnose the Cause of Intestinal Obstruction due to Abdominal Cocoon Syndrome

Abdominal cocoon syndrome (sclerosing encapsulating peritonitis) is a rare condition associated with clinical signs of intestinal dysfunction, episodes of small bowel obstruction and sometimes a palpable abdominal mass. We present the case of a 46-year-old male patient with clinical signs of intestinal obstruction caused by primary sclerosing encapsulating peritonitis.

Genital tuberculosis mimic as a genital malignancy in post menopausal women

Genital tuberculosis tends to be an indolent infection and the disease may not manifest for year after initial seeding. The most common presentation reported in general population are pelvic pain, postmenopausal bleeding, ascites, abdominal mass, ovarian mass. The diagnosis is made by histopathological examination. Surgery is indicated as presence of abdominal pelvic mass with severe pain. Preoperative diagnosis of genital tuberculosis is often difficult because of confusion with ovarian malignancy. A 60 years old women present with weight loss, palpable abdominal mass with ascites, prominent bilateral ovaries and increase level of CA125. Pelvic malignancy was initially suspected but a diagnosis of tuberculosis was made following postoperative peritoneal wash biopsy. Patient managed with surgical laparotomy under a provisional diagnosis of ovarian malignancy but the final diagnosis was genital tuberculosis followed by anti tubercular regimen. Genital tuberculosis with high level of CA125 mimicking ovarian carcinoma.

Unusual Presentation of Rapunzel Syndrome in an 8-Year-Old Girl

Introduction: Trichobezoar is a rare clinical entity in which a ball of hair accumulates within the alimentary tract. It can be found as an isolated mass in the stomach or may extend into the duodenum and jejunum, which is labeled as Rapunzel syndrome. In this article, we report a rare case of Rapunzel syndrome with a long tail that presented with non-specific features. Case Presentation: An 8-year-old female patient was referred to our clinic due to palpable abdominal mass. Physical examination revealed non-tender, well-defined abdominal mass and signs of anemia. Imaging showed a giant bezoar filling the stomach, duodenum, and part of jejunum without features of mechanical obstruction. Laparotomy revealed large trichobezoar with long tail. Retrospective evaluation showed significant hair loss and frequent habit of trichotillomania and trichophagia. Conclusion: Rapunzel Syndrome is not a fairy tale. It may present with vague non-obstructing features. Significant hair loss and underlying psychiatric disorders should raise suspicion to do further investigations. Long-term follow-up and psychiatric management are recommended to prevent recurrence.

A rare case of fallopian tube lymphangioma

Lymphangioma of the fallopian tube is a very rare lesion, usually present as benign lesions of the lymphatic system. They are generally diagnosed incidentally, may be asymptomatic or present as a palpable abdominal mass. Lymphangiomas are usually seen in the head and neck region, intra-abdominal localisation is rare. A very limited number of cases of fallopian tube lymphangiomas have been reported. We present an extremely rare case of unilateral fallopian tube lymphangioma (right side) in a 32 year old parous lady who was presented to us with right lower abdominal pain. Clinically no significant findings were noted. CECT abdomen reported as a probable endometriotic cyst. On laparoscopy she was found to have a cystic lesion arising from the right fallopian tube. Patient underwent right salphingo-oophorectomy and histopathology reported as lymphangioma of the fallopian tube.

Management of an Infected Vesicourachal Diverticulum in a 42-Year-Old Woman

Urachal remnant anomalies are uncommon in adults and can be confused with a variety of clinical conditions when symptomatic or infected. Vesicourachal diverticulum is the rarest type, accounting for approximately 3% to 5% of congenital urachal anomalies. We report the case of a 42-year-old female patient, who presented to the emergency department with lower abdominal pain and a palpable abdominal mass. An infected vesicourachal diverticulum was diagnosed after imaging studies and was initially treated with intravenous antibiotic therapy and drainage of the urachal diverticulum to the urinary bladder through a JJ stent. Finally, the patient underwent open surgical excision of the urachal remnant. The postoperative course was uneventful, and the histopathological examination confirmed the diagnosis of vesicourachal diverticulum. We recommend drainage of an infected vesicourachal diverticulum through the bladder by JJ stent placement inside its lumen during cystoscopy, as an alternative to percutaneous drainage reported in the literature.

Gastro-Splenic Fistula Related to Large B Cell Lymphoma

We report a case of spontaneous gastrosplenic fistula in a 57 year old female who presented to the emergency department with abdominal pain and weight loss. From the physical examination, she had a palpable abdominal mass. A CT scan was performed and showed a mass involving the proximal greater curve of the stomach, infiltrating the spleen and pancreas. There was a 12 mm defect in the cardia of the stomach with gas entering the large mass but there was no free gas in the abdomen. The defect was a gastrosplenic fistula. A gastroscopic biopsy confirmed the diagnosis of diffuse large B cell lymphoma. Surgical removal of the mass was not feasible; therefore she was treated with RCHOP chemotherapy, achieving complete remission.

Complete Surgical Enucleation of a Giant Chylous Mesenteric Cyst

Mesenteric cysts are rare benign abdominal tumors, and they can appear anywhere in the mesentery of the gastrointestinal tract, from the duodenum to the rectum. They are generally asymptomatic and may present as an incidental finding. The diagnosis is confirmed by the laparotomy findings and the results of the histopathological examination. Complete surgical (open or laparoscopic) enucleation of the cyst is the treatment of choice. We present a case of a female patient who presented with abdominal pain and a giant palpable abdominal mass. The patient underwent a surgical exploration which showed a giant mesenteric cyst. A complete surgical enucleation of the cyst was successfully performed without the need of bowel resection. The histopathological examination of the cyst was compatible with the diagnosis of chylous mesenteric cyst.