Urachal mucinous cystic tumor of low malignant potential in a polymorbid female: a case report and review of the literature

Neoplasms of the urachus are exceedingly rare, representing 0.17% of all bladder cancers. The mucinous cystic tumor of low malignant potential (MCTLMP) subtype is particularly rare with just 25 previous cases reported in the literature. Although rare, MCTLMPs are important to identify due to potential devastating complications and good cure rates with surgical removal. We present a 43 year old female with a nuanced constellation of comorbidities and confirmed MCTLMP following a workup for abdominal pain and irritative lower urinary tract symptoms. Notably, this tumor did not change in size over a 3-year course of serial imaging prior to surgical excision. This urachal MCTLMP represents roughly the 26th and one of the smallest of its subtype reported in the literature. This case illustrates the diagnosis and management of this rare urachal MCTLMP. Individual patient medical history, clinical considerations, and neoplasm characteristics are examined. Although rare, the potential for increased malignancy and potential complications necessitates surgical management and further investigation by the academic community.

Pancreatic neuroendocrine tumor trapped in a cyst

Pancreatic neuroendocrine tumor (Pan NET) accounts for only 1–2% of pancreatic neoplasms and <1% of tumors present as cystic lesions. A diagnosis of cystic tumor in the pancreas can be very challenging and confusing. Endoscopic ultrasound (USG) and fine needle aspiration (FNA) of these cystic lesions can help the clinician to narrow down the differential diagnosis. A multidisciplinary approach is warranted for a definitive diagnosis and optimal treatment. Here, we present to you a very rare case of Pan NET presenting as a cystic mass. A 65-year-old man was admitted with a history of abdominal pain. Laboratory tests showed increased levels of serum amylase, and other biochemical tests were normal. The patient underwent transabdominal USG and computed tomography (CT). CT showed well-defined cystic lesion in the proximal body of the pancreas. Endoscopic guided FNA (EUS-FNA) using 22 gauges was done. Cytological examination demonstrated clusters and sheets of plasmacytoid cells. EUS core needle biopsy was done which showed loose clusters of cells with fine uniformly distributed chromatin that stained positively for insulinoma associated protein-1 which was suggestive of a Pan NET. The differential diagnosis of cystic lesions in the pancreas is very difficult with conventional radiology such as CT and magnetic resonance imaging. Cytology is helpful for a pre-operative diagnosis of cystic Pan NET. A diagnosis of Pan NET in a pancreatic biopsy or FNA with limited and suboptimal material is often challenging. This unusual case highlights the importance of pre-operative workup of EUS followed by FNAC in cystic pancreatic lesions.

Case Report: Robotically Assisted Excision of Cystic Tumor Located in a Difficult to Access Area in the Liver

Introduction: Cystic liver lesions may be benign cysts, parasitic infestations, or malignant tumors requiring surgical resection. Hilar location and relation to major vasculature present challenges in conventional surgical access and resection.Materials and Methods: We describe totally robotic excision of a cystadenoma in a 55-year-old woman without complication. Time points in the accompanying video (https://youtu.be/Tn_QPgpSHA4) are embedded within the text.Results: Advantages of the robotic technique lie in overcoming the natural restriction of conventional laparoscopic instruments, easier repair, and control of intraoperative vascular injuries using EndoWrist® instruments, ergonomic dissection close to major vasculature and reduced intraoperative blood loss as dissection is easier.Discussion: Indications for robotic surgery included the large size of the cystic lesion, its intrahepatic location, and compression of the inferior vena cava (IVC) and right and middle hepatic veins. Had robotic removal of the lesion not been feasible, the entire lobe of the liver would have required resection.

A RARE CASE OF MUCINOUS CYSTADENOCARCINOMA OF LIVER PRESENTING AS HYDATID CYST

Hepatobiliary cystadenocarcinoma is a very rare cystic tumor that arises in the liver or, less frequently, in the extrahepatic biliary system mostly seen in elderly patients. It has been shown to arise in congenital liver cysts, bile ducts, biliary cystadenoma, in the context of bro- polycystic disease and in the hepatoduodenal ligament. In the present case report, we describe a case of rare entity of hepatobiliary cystadenocarcinoma presented in a 36 year old male patient presented to opd with complaints of pain abdomen in right side of upper abdomen since 2 months. Main concern of this case report is preoperative imaging is imprecise and frequently misdiagnosed as benign cystic lesions and delays in treatment.

Reporte de Caso Clínico: Linfangioma quístico de epiplón

BACKGROUND: Mesenteric lymphangioma is a rare, benign congenital cystic tumor of the lym-phatic vessels, which occurs in less than 5% pf the cases at the abdomen. They appear most often during childhood. This tumor should be considered as a differential diagnosis of acute abdomen and other abdominal masses. CASE REPORT: A 6-year-old boy presented with abdominal pain and peritonism. He presented a low-grade fever, a positive rebound sign, as well as leukocytosis and neutrophilia. Ultrasono-graphy showed abundant free fluid in abdomen and pelvis. EVOLUTION: Exploratory laparotomy was performed, finding a cystic mass dependent on the greater omentum, this mass was resected. Histopathology was negative for malignancy and compatible with cystic lymphangioma, immunohistochemistry was positive for D2-40 marker. The patient evolved favorably without surgical complications and without evidence of recurrence up to one year of follow-up. CONCLUSION: Mesenteric cystic lymphangioma can present with symptoms of acute abdomen, it can also have a chronic evolution. Complete resection is the treatment of choice, currently minimally invasive procedures are performed with favorable results. Ultrasound is useful for long-term follow-up.