Clear Cell Carcinoma Arising in an Abdominal Wall Cesarean Section Scar: A Case Report With Description of Pathological and Molecular Features

Clear cell carcinoma is a clinically and biologically distinct type of carcinoma predominantly encountered in the ovary and endometrium. In the ovary, it is frequently associated with endometriosis, which is a well-known risk factor. Endometriosis has often been described in the abdominal wall of women who had a cesarean section; however, malignant transformation is a very rare event, occurring in <1% of cases. The authors report a case involving a 52-year-old woman with an abdominal wall nodule at a cesarean section scar. Radiology revealed a mass, measuring 8 cm in size, in the abdominal wall suggestive of a soft tissue tumor. After resection, histology revealed the presence of clear, eosinophilic, and hobnail cells, which, together with immunohistochemical and molecular findings, enabled the diagnosis of clear cell carcinoma of the abdominal wall. The present report describes the clinical, radiological, pathological, and molecular features of an unusual abdominal lesion that represents a rare but challenging diagnosis.

Bartonella quintana Infection Manifesting as Leucocytoclastic Vasculitis Rash

We present the first case described in the literature of leucocytoclastic vasculitis due to Bartonella quintana infection. A 73-year-old woman presented to the hospital with persistent fevers, retro-orbital headache, generalized weakness, and left lower thigh pain for one week. She was found to have truncal and proximal lower extremity papules and small plaques. Serology revealed Bartonella quintana IgM titer of 1:256 with undetectable Bartonella quintana IgG and undetectable Bartonella henselae IgG and IgM. Skin biopsy of an abdominal lesion revealed fibrinoid necrosis of vessel walls in the superficial and mid-dermis consistent with leucocytoclastic vasculitis. Doxycycline 100 mg orally twice daily was initiated, after which she had defervescence within 36 hours and rapid improvement of other presenting symptoms.

Unusual finding after treatment for testicular cancer

In the context of a post-treatment testicular germ cell tumour, an abdominal lesion found on surveillance CT studies led to a differential diagnosis, including recurrent germ cell tumour. We report the case of a 48-year-old man who was noted to have a new interval soft tissue lesion on a surveillance CT scan, 5 years after initial orchidectomy and chemotherapy. Excision of this lesion and histopathological review revealed an intra-abdominal desmoid.

A Case of Late Delayed Metastasis of Malignant Melanoma After 27 Years After First Excision

We report a case of an ultra-late delayed metastasis of malignant melanoma 27 years after the excision of the first tumor. The patient is a 67 years old Italian woman. She underwent a primary excision of a skin lesion of 1cm in diameter on the lower third of the left leg in 1984 when she was 39. According to the histological examination the lesion was a lentigo malign melanoma with an epithelial histological pattern with intra- and subepidermal diffusion. The lesion was 2.2 mm in thickness (Breslow) and was a Clark level IV melanoma; mitotic rate was 6 mitosis/mm2. No melanocytic lesions were found on excision edges and no lymph nodes were removed and examined. In March 2011, when the woman was 67 years old, an inguinal lymph node and an intraabdominal lesion were considered suspect for neoplastic process during a clinical exam of the GP. A histological examination and an eco-imaging procedure described the lesions as metastasis of malignant melanoma probably related to the first skin tumor. Within a few days she was treated with the excision of the abdominal lesion, the total greater omentectomy and the lymphadenectomy of the left inguinal region. Histological examination confirmed the suspect of metastasis of the first melanoma with a predominant epithelioid growing pattern. This case underlines the need of a long-term follow-up period for patients with melanoma.

Role of Ultrasound Guided Fine Needle Aspiration Cytology in Intra-abdominal lesion

Introduction: All of the imaging techniques have advantages and disadvantage in various parts of the body. In intraabdominal lesion ultrasonography guided FNAC has advantage over computerised tomography guided FNAC because CT is very costly and not freely available. CT gives high dose of radiation and therefore should not be used in pregnant women and in small children whereas ultrasonography has no radiation effects and hence can be safely used in these cases. Mobile version of CT is not available and therefore it cannot be used in faraway places whereas ultrasonography machine is mobile. Thus, with localization by ultrasonography diagnosis of the malignancy and staging can be accomplished through FNAC. Method: Total of 100 cases who came for FNAC of intraabdominal masseswere included in the study, irrespective of their age, sex or possible nature of mass. Ultrasound guided Fine needle aspiration was done in all.The aim of the present study was to assess the feasibility of ultrasound guided Fine needle aspiration cytology of routine procedure for detection of abdominal lesion. Result: Total of 100 cases were studied. In the 80(80%) cases, aspirates were positive for malignancy and in 17(17%) cases were negative for malignancy. There were 3% false negative cases encountered. There were no false positive cases. Ultrasound was used for mass localization. In 80 positive cases of malignancy, 36 cases from liver, 10 from lymph node, 7 from gall bladder, 6 from stomach, 6 from ovary, 3 from urinary bladder, 1 from pancreas, I from uterus, 3 from miscellaneous sites. Conclusion: Percutaneous fine needle aspiration cytology is reliable method of diagnosing the various pathological lesions of abdomen. Its diagnostic accuracy is further increased when performed under Radiological guidance. Of all modalities of guidance at present is the most suitable.

Ileal impaction resolution in a horse with colic via a standing right flank laparotomy ˗ case report

ABSTRACT This report describes a horse presenting ileal impaction that went through a right flank laparotomy procedure while standing. The decision to use this technique was made under the influence of several factors: the patient exhibited a calm temperament and demonstrated responsiveness to the analgesic treatment for pain control; the abdominal lesion was amenable to correction by a standing right flank approach. Also, the owner reported financial problems. Ileal obstruction was relieved successfully, and the horse recovery was satisfactory. This case highlights that, in specific cases of colic syndrome, the use of surgical procedures in the standing position might be a viable option and promote fast recovery.

SUN-939 Case Report: Malignant Pheochromocytoma

Introduction: The concept of malignancy for pheochromocytoma is complex and the best definition is the presence of metastases, according to WHO. Anatomopathological scoring systems are not effective in predicting metastases. Malignancy should be considered when tumors larger than 8cm (> 80g), paragangliomas (especially retroperitoneal), dopamine / methoxythyramine increase, Ki67> 6% and SDHB mutation. At 5 years, survival ranges from 50-69%. Metastases may appear 20-40 years after initial treatment of pheochromocytoma. We describe a case that metastasis was identified 33 years after pheochromocytoma excision Case report: A 57-year-old female patient with a postoperative history of 33 years of right adrenal pheochromocytoma was discharged from the endocrinologist after 10 years of follow-up. At diagnosis 33 years ago, she had symptoms of hypertension with paroxysms and weight loss that disappeared after tumor removal. 2 years investigating weight loss with general practitioner without another celebratory. On physical examination, orthostatic hypotension was highlighted. Plasma methanephrine 0.8 nmol / L (VR <0.5) and plasma normetanephrine 1.8 nmol / L (VR <0.9), chromogranin A 5.7 nmol / L (VR <3 nmol / L) and clonidine test with 36.6% suppression of metanephrines, suggesting tumor recurrence. MRI localized recurrence of the adrenals and MIBG scintigraphy with I131 that showed, respectively, in the topography next to the paracaval and retroportal right diaphragmatic crura, isointense T1 and slightly hyperintense T2 at 1.8 cm and radiopharmaceutical hypercaptation in right adrenal topography. Genetic panel by NGS did not identify germline mutation in 22 pheochromocytoma-related genes. FDG PETCT was consistent with MRI and MIBG images. Gallium PETCT68 DOTATOC detected the lesions already described, in addition to a lytic lesion in the left femoral intertrochanteric medulla. Anatomopathological approached abdominal lesion confirming pheochromocytoma metastasis in lymph node conglomerate. Currently has a negative methanephrine plasma, however chromogranin A 142 ng / mL (VR <93), and was chosen by the observant approach. Conclusion: The case of the patient illustrates that pheochromocytoma should be followed indefinitely, as metastases may appear many years later and may present different aggressiveness potentials.

Metastatic malignancy mimics: a rare case of traumatic splenosis mimicking intra-abdominal malignancy

We present a case of a patient, undergoing imaging for an unrelated presentation, whose adolescent abdominal trauma had caused an unrecognised disseminated intra-abdominal splenosis, resulting in an imaging presentation on CT that suggested intra-abdominal malignancy. The lack of correlative symptoms of disseminated malignancy, in addition to imaging findings suggesting previous upper abdominal trauma, led to a suggestion that the intra-abdominal lesion might represent spleen tissue. A denatured red cell scan with radio-labelled technetium-99m, allowed this tissue to be confirmed as splenic in nature, and an invasive, and potentially risky biopsy was averted.

Endoscopic ultrasound guided fine needle aspiration in the diagnosis of intra-abdominal lesions

Background: Endoscopic ultrasound guided fine-needle aspiration cytology (EUS-FNA) in the diagnosis of intra-abdominal lesion is a safe and accurate procedure which is practiced in various parts of the world.12 However, this technique is very new in Bangladesh. To evaluate the diagnostic utility of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in the diagnosis of abdominal lesions. Methods: EUS-FNA was carried out on a total of ­48 cases during the study period. The lesions were categorized according to the site of FNA. Clinical impression was compared with the final cytological diagnosis and the percentage of non diagnostic smears was calculated. Results: Out of 48 cases, 10 cases (20.8%) were reported as inconclusive while a definite diagnosis was given in 38 cases (79.21%). The mean patient age was 47.68 years. There were 28 (58.33%) males and 20 (41.67%) females. The most common site biopsied was pancreas followed by abdominal lymph node. The average number of passes made was two. Conclusion: Endoscopic Ultrasound Guided Fine-Needle Aspiration in the diagnosis of intra-abdominal lesion is a useful procedure in the evaluation of deep seated lesions of gastrointestinal tract (GIT) and abdominal cavity. Bangladesh Med Res Counc Bull 2019; 45: 41-46