A case of pedunculated hepatoma suspected of adrenal tumor

We herein report a case of pedunculated hepatoma which was preoperatively diagnosed as nonfunctioning adrenal tumor. A 51-year-old man was admitted for further examination of right hypochondrial pain. CT scan showed a right suprarenal mass. Tumor vessels were visualized on selective right renal arteriography and right inferior phrenic arteriography. Adrenal function was normal. Preoperative diagnosis was nonfunctioning right adrenal tumor. On operation, we found a right suprarenal tumor which was in continuity with the inferior part of the liver. Pathological diagnosis of the biopsy specimen was hepatocellular carcinoma (Edmondson's grade 3). Difficulty of preoperative diagnosis of pedunculated hepatoma is discussed.     

A case of exohepatic pedunculated hepatocellular carcinoma suspected of adrenal tumor

A case of exohepatic pedunculated hepatocellular carcinoma that was clinically diagnosed as nonfunctioning adrenal tumor is reported. A 66-year-old man was admitted to our hospital for further examination of unstable angina pectoris. Abdominal echogram and CT scan revealed a large tumor in the right retroperitoneal space. Selective right renal arteriography demonstrated that the tumor was fed by the capsular branch of right renal artery and the right adrenal artery. Adrenal function was normal. Preoperative diagnosis of right nonfunctioning adrenal tumor was made. On operation we found that the tumor was pedunculated from the liver and adhered massively to both right kidney and vena cava. The tumor and right kidney were removed. A histopathological examination demonstrated well differentiated hepatocellular carcinoma (Edmondson's grade II type).     

Pedunculated hepatocellular carcinoma suspected of right adrenal tumor: a case report]

We report a rare case of extrahepatic growing hepatocellular carcinoma which was clinically diagnosed as right adrenal tumor. A 61-year-old woman was admitted for further examination of right flank pain and hypertension. Abdominal computed tomographic scan and echogram revealed a suprarenal mass. Hypercatecholaminemia was suspected from urinary analysis. Preoperative diagnosis was right adrenal tumor; suspected pheochromocytoma. On operation, we found the tumor was pedunculated from right lobe of liver and compressing normal right adrenal gland. Its clinical diagnosis was hepatocellular carcinoma. Ten months after operation she is still alive. We discuss the difficulty of differential diagnosis between extrahepatic growing hepatocellular carcinoma and adrenal tumor.     

Metastatic adrenal carcinoma suspected as a primary tumor: a case report

A 62-year-old man was admitted with chief complaints of fever and general fatigue. Enhanced computed tomography revealed a tumor (5 cm in diameter) in the right suprarenal space, and the right renoportal lymph nodes were swollen. An abdominal TI-weighted MR image showed a low-intensity tumor measuring 4.5 x 5.5 x 6.0 cm. Chest computed tomography revealed two tumors. One was 1.5 cm, on the hilum of left lung, the other was 1 cm in the S6 lung field near the pleura. These findings strongly indicated primary adrenal carcinoma and lung metastasis. Right adrenalectomy was performed. Histological examination of this tumor revealed diffuse tumor cells with irregular nuclei, and it was diagnosed as poorly differentiated adenocarcinoma. There was no possibility of primary adrenal carcinoma. The primary site of the tumor was suspected to be the left lung.     

Vasitis nodosa suspected of the spermatic cord tumor: a case report]

We report a rare case of vasitis nodosa. A 54-year-old man was found to have a right spermatic cord mass during the herniorrhaphy operation. There was no history of surgical or traumatic causes. An indurated mass in the right spermatic cord was suspected to be spermatic cord tumor, and a right high orchiectomy was performed. Histological examination revealed disruption of the ductal lumen, granulomas with the sperm-like necrotic tissue and proliferation of the lymphocytes and plasma cells in the smooth muscle bundles. Pathological diagnosis was vasitis nodosa.     

A case of plasmacytoma involving adrenal gland]

We report a case of extramedullary plasmacytoma involving the right adrenal gland. A 52-year-old male was introduced under diagnosis of right adrenal tumor which was found incidentally by computerized tomography in a health check up. Laboratory data showed the presence of M protein and elevation of monoclonal lambda type IgG. It was a hormonally non-active tumor involving the adrenal area. Extramedullary plasmacytoma was confirmed by histological analysis of the resected specimen after laparoscopic right adrenalectomy. Extramedullary plasmacytoma is an uncommon neoplasm and occurs most frequently in the upper respiratory tract and is fairly rare in the adrenal area.     

Desmoid tumor of the abdominal wall preoperatively suspected as urachal tumor: a case report]

A case of desmoid tumor of the abdominal wall which was preoperatively suspected as urachal tumor is presented. The patient was a 56-year-old man, who was referred to our clinic for further examination of the mass detected incidentally in the ventral region of the urinary bladder by computed tomography. Ultrasonography showed that the mass had a heterogenous and hypoechogenic content. An urachal tumor was suspected and surgery was performed to remove the tumor. During the operation we found that the tumor was completely separated from the urinary bladder and that it had originated from the left rectus abdominal muscle. The pathological diagnosis was desmoid tumor of the abdominal wall. Since urachal tumor has no characteristic findings on the imaging examinations, it is difficult to differentiate desmoid tumor of the lower abdominal wall from urachal tumor, preoperatively.     

A case of urachal xanthogranuloma suspected to be a urachal tumor

A 47-year-old female consulted our hospital with the chief complaints of lower abdominal pain and fever. There was a palpable mass in the lower abdomen. The patient had undergone oophorectomy by lower abdominal median incision. Ultrasonography, computed tomography, and magnetic resonance imaging (MRI) demonstrated a cystic mass above the bladder dome extending to the umbilicus, which was strongly suspected to be a urachal tumor. Enhanced T1 weighted MRI showed a mass enhanced by contrast media. Partial cystectomy with urachal resection was performed by lower abdominal median incision. The histological diagnosis was xanthogranuloma. This is the thirteenth case report of xanthogranuloma of the urachus in the Japanese literature.     

A case of cystitis glandularis suspected of malignant tumor of urinary bladder

A case of cystitis glandularis is reported. A 70-year-old male was admitted to our hospital with the complaint of urinary frequency and gross hematuria. A bladder tumor was suspected by ultrasonography. Cystoscopy revealed multiple cystic lesions arising from the bladder neck and trigone. Transurethral biopsy of the bladder wall lesion revealed cystitis glandularis. Transurethral resection was performed. His postoperative course was uneventful.     

A case of adult Wilms' tumor]

Wilms' tumor is very rarely found in adults and there are no established treatment guidelines for such tumors in adults. A 56-year-old woman was referred to our hospital for further examination of macroscopic hematuria. Computed tomography scan revealed a large right renal mass with enlarged lymph nodes. Angiography showed a hypovascular tumor. She underwent right nephrectomy and resection of lymph node metastasis with a diagnosis of malignant renal tumor. Histopathological examination revealed nephroblastoma with lymph node metastasis. The disease was classified as stage III according to the National Wilms' Tumor Study classification. The patient received adjuvant chemotherapy consisting of ifosfamide, cisplatin, and etoposide. This protocol was selected because of the published poor results with the standard Wilms' tumor chemotherapeutic agents when used in adults. She remained without tumor recurrence as of six months after surgery. Development of better therapeutic approaches to adult Wilms' tumor is awaited.     

Bilateral adrenal tumor: A case report and current challenges

IntroductionA bilateral adrenal tumor is a rare case. It differs significantly from unilateral adrenal mass since it is related strongly to genetic and family history. Adrenocortical Carcinoma might cause related hormonal syndromes such as Cushing syndrome, Conn syndrome, and virilization.AimThis study aims to report an uncommon presentation of a 15-year-old female with bilateral Adrenal Tumor since an early age with virilization as the main symptoms.Case presentationThe patient is a 15-year-old girl with female genitalia presentation. She complained of a bulging mass on her right flank with pain four years ago. The mass size grew progressively and initially painless. However, the patient started to feel pain a year ago. Since she was six years old, the mass started to appear on the left flank, and then it also started to appear on the right side. The mass appearance is simultaneous with virilization symptom development, such as the emergence of facial hair, mustache, and sideburns. In 2020, MRI showed a lesion on the right suprarenal with contrast enhancement with 14.5 × 11.5 cm in size, and a 5.6 × 4 cm recurrent left suprarenal lesion. The patient underwent right adrenalectomy resection surgery on January 21st, 2021. The immunohistochemistry examination suggested Adrenocortical Carcinoma.ConclusionAdrenocortical Carcinoma is a hormone-secreting tumor that might affect the patient's condition systematically. Neglected cases of adrenal cortical carcinoma might affect secondary sexual organ development in the long term. Thus, an early diagnosis and treatment are paramount for this case.     

Adult Wilms' tumor mimicking adrenal tumor: case report

A 33-year-old woman was referred to our hospital for further examination of a right adrenal mass 4.5 cm in diameter. Hormonal findings were normal. Computed tomography, magnetic resonance image and angiograpy demonstrated non-functioning adrenal tumor. Right nephrectomy was performed, because the tumor adhered firmly to the upper pole of the right kidney. The pathological diagnosis was nephroblastoma (nephroblastic type, complex subtype). Postoperative chemotherapy was started for stage III Wilms' tumor. However, peripheral neuropathy such as numbness of the fingers developed. Therefore, chemotherapy was discontinued in the fifth week. The patient is currently alive without recurrence 17 months postoperatively. In adult patients, postoperative chemotherapy for nephroblastoma is often interrupted due to side effects. Further studies on the protocol for adults is necessary.     

A case of sclerosing hemangioma forming a pedunculated mass

We report our experience with an unusual case of sclerosing hemangioma (SH) that formed a pedunculated mass protruding into the thoracic cavity. A pulmonary tumor was found in a 60-year-old female during the medical examination. Computed tomography showed a 19 × 17-mm nodule with a clear border and smooth margin contiguous with the diaphragm in the right S8 segment. Uneven enhancement following contrast medium administration was observed. We performed a 3-port thoracoscopic wedge resection of the right lower lobe. We observed a yellow pedunculated tumor protruding from the diaphragmatic surface of the right lower lobe. The surface of the tumor was smooth and encapsulated. Microscopically, we diagnosed it as a SH. SHs usually exist adjacent to the visceral pleura, but rarely form pedunculated tumors protruding into the cavity as seen in this case. By thoracoscopic surgery, we successfully diagnosed and treated the patient in a minimally invasive manner. Since there have been reported cases of recurrence, we anticipate that periodic follow-up observations will be required.