Benign retroperitoneal schwannoma presenting as a giant adrenal tumor

We report a 51-year-old man with a primary adrenal tumor presenting as a giant juxta-adrenal benign schwannoma. The patient was initially admitted for persistent fevers and underwent a sepsis workup. Abdominal ultrasound initially revealed an incidental right suprarenal mass, which measured 10 x 10 x 11 cm, estimated by computed tomography. Following a successful laparotomy, histologic examination confirmed that this giant tumor was a benign retroperitoneal schwannoma. Postoperatively, the patient remains disease-free, undergoing rehabilitation.     

Gastrointestinal autonomic nerve sarcoma presenting as a giant intra-abdominal cyst

Gastrointestinal autonomic nerve sarcomas are rare tumours. A 36-year-old man presented with abdominal pain, distension and constipation. Abdominal ultrasound and CT scanning demonstrated a giant cystic intra-abdominal mass. Laparotomy confirmed a large cystic mass arising from the ileum with multiple metastases. Immunohistochemical staining was positive for vimentin, neuronal-specific enolase and PGP9.5. This is the first reported case to present as a giant intra-abdominal cyst. Specialist histopathological and immunohistochemical analysis is essential to establish the diagnosis of this rare tumour.     

Pulmonary sequestration presenting as retroperitoneal cyst: case report

A 21-year-old woman presented with flank pain, and an abdominal and pelvic CT scan demonstrated a left 7.4-cm simple cyst superior to the left kidney. She underwent laparoscopic cyst decortication complicated by a diaphragmatic injury and pneumothorax. The final pathology report described a retroperitoneal pulmonary sequestration (RPS). Urologists need to consider RPS in the differential diagnosis of a retroperitoneal cyst because of the associated morbidity of hemorrhage during surgical excision. With the widespread use abdominal imaging techniques, more cases of RPS are likely to be identified and referred for laparoscopic management.     

Hydatid cyst presenting as a breast lump

Cystic hydatid disease is caused by the parasite Echinococcus granulosus. Indigenous infections are seen among the Indians and Inuit. Man is an occasional intermediate host in whom the disease is manifested by the presence of one or more hydatid cysts, usually located in the liver or lung and rarely at other sites such as the breast, as in this case report. The cyst is usually asymptomatic; in this it case was discovered on routine mammography. On aspiration biopsy, 1 ml of clear fluid was removed, but there was a residual lump which was successfully excised.     

Retroperitoneal bronchogenic cyst presenting as adrenal tumor in adult successfully treated with retroperitoneal laparoscopic surgery

A bronchogenic cyst in the retroperitoneum is rare in adults. A 41-year-old woman presented with an incidental left retroperitoneal mass that was suspicious for an adrenal tumor. Retroperitoneal laparoscopic excision and complete resection were performed. The pathologic examination confirmed a bronchogenic cyst in the retroperitoneum. We present the case with review of the relevant published data.     

Pigmented villonodular synovitis presenting as a baker cyst

Pigmented villonodular synovitis (PVNS), a rare hyperproliferation of the synovial lining, commonly mimics other conditions. As a result, the diagnosis may remain elusive, as the classic signs of tenderness and effusion are not specific. Occasionally, PVNS presents as a popliteal cyst, which may divert attention from intra-articular pathology. In this article, we describe a case of PVNS that presented with a popliteal cyst as the chief problem report. In other cases PVNS presented as a popliteal cyst, and evidence was reported of PVNS within the cyst stalk and presumable intra-articular involvement. Our case did not present this way. We recommend that the diagnosis of PVNS be considered in young adults who present with a popliteal cyst.     

Carcinoma of prostate presenting as retroperitoneal mass

The pattern of dissemination of prostatic carcinoma varies, but skeletal metastasis is the single most common symptomatic mode of presentation. The clinical course and treatment of the 2 cases presenting with symptomatic metastases to the retroperitoneum are described in detail and pertinent literature is reviewed.     

Abdominal aortic aneurysm presenting as retroperitoneal fibrosis

A case of abdominal aortic aneurysm which presented as retroperitoneal fibrosis followed by fatal disseminated intravascular coagulation is reported. A diagnostic aortogram should be considered in all cases of apparent idiopathic retroperitoneal fibrosis.     

Disseminated nocardiosis presenting as retroperitoneal abscess: a case report

A 64-year-old man presented to our emergency room with right back pain on July 10, 2009. At the emergency room, abdominal enhanced computed tomography revealed a cystic lesion in the retroperitoneum. Then he was referred to our department. We performed percutaneous drainage of the retroperitoneal lesion and aspirated white pus. The retroperitoneal cystic lesion proved to be an abscess. Microscopic examination of a Gram stained specimen of the abscess revealed gram-positive bacillary fragments ; therefore, we suspected the pathogen to be Nocardia. He had a history of chronic glomerulonephritis and had received treatment consisting of 20 mg prednisolone, and 75 mg cyclosporine per day. He was regularly visiting the department of cardiovascular for follow-up of chronic heart failure. On the day before his visit to our emergency room, his chest X-ray medicine had revealed a nodular shadow. Then he was referred to the department of respiratory medicine and was scheduled to receive a bronchoscopy later. We suspected the nodule of the lung also to be an abscess of Nocardia. Later, head computed tomography (CT) revealed a brain abscess the pathogen of which was Nocardia. Nocardia is a filamentous, gram-positive, branched bacterium and classified as an aerobic actinobacteria. Nocardia species are difficult to diagnose due to non-specific clinical and histological manifestation. We report this case of disseminated nocardiosis presenting as retroperitoneal abscess. The disseminated nocardiosis was diagnosed without delay by percutaneous drainage and appropriate treatment was provided.     

A case of angiomyolipoma presenting as a huge retroperitoneal mass

A 60-year-old man was admitted to Hitachi General Hospital, Hitachi, Japan, with general fatigue and epigastric fullness. A large mass was palpated on whole abdomen and abdominal computed tomography scan showed a large lobulated fatty mass surrounding the right kidney, which indicated the existence of angiomyolipoma arising from the right kidney. The tumor was success-fully resected through a thoracoabdominal incision. The total weight of the resected specimen was 3500 g, apparently the largest angiomyolipoma resected by operation in Japan.     

Malignant abdominal paraganglioma presenting as a giant intra-peritoneal mass

INTRODUCTIONParaganglioma is a malignant tumor that arises from the extra adrenal paraganglionic cells of the sympathetic or parasympathetic systems. Herein, we present a case of abdominal mass of unknown histology that underwent a very difficult surgical mass resection. Its final histologic diagnosis was non-functional paraganglioma that was presented as a huge intra-peritoneal mass.PRESENTATION OF CASEThe patient was a 55-year-old Iranian lady who referred to our center with a giant abdominal mass. Fine needle aspiration (FNA) biopsy showed undifferentiated carcinoma. After laparotomy for mass resection pathology evaluation revealed; malignant paraganglioma, non-metastatic type. Further post-operative patients evaluations showed that the tumor was sporadic in nature and the subsequent patient's natural history was uneventful.DISCUSSIONPathologic evaluations have key roles in the exact diagnosis of abdominal masses with unidentified sources. For the paragangliomas, all of them should be regarded malignant until proved otherwise. However, combined use of biochemical markers, immunohistochemical techniques (IHC), and genetic analysis have key roles in the diagnosis and treatment of paragangliomas. Additionally, surgical removal is the proved curative way of paraganglioma treatment.CONCLUSIONAsymptomatic intra-peritoneal paraganglioma is very rare, especially its malignant variety. This case emphasizes that full pathologic investigation would reveal the exact nature of idiopathic abdominal masses, especially in the state of absence of typical clinical and para-clinical symptoms.     

Giant functioning parathyroid cyst presenting as a retrosternal goitre

Parathyroid cysts are rare and even more rarely cause a neck mass resembling a goitre. Such large parathyroid cysts may involve the mediastinum, growing to a sufficient size to produce symptoms related to obstruction, and if functioning, primary hyperparathyroidism. Parathyroid cysts should be considered in the list of differential diagnoses of anterior neck masses to allow for appropriate preoperative investigation to avoid unnecessary confusion at the time of operation. We report a case where a functioning parathyroid cyst presented as a retrosternal goitre to emphasize the potential pitfalls associated with their diagnosis and management.     

Dentigerous cyst presenting as facial pain

A rare case is presented in which a maxillary dentigerous cyst had eroded the posterior wall of the right maxillary sinus into the pterygo-palatine fossa causing facial pain due to pressure on the nerves. It had also eroded the lateral wall of sinus and into the oral cavity and got infected resulting in foul smelling oral discharge. The case was dealt with complete removal of cyst using Caldwell Luc's approach.     

Hepatic hydatid cyst presenting as anaphylaxis

A young soldier was brought to the emergency of Combined Military Hospital (CMH), Multan in a collapsed state with two day's history of chest pain. He was resuscitated and placed on ventilator. While the rest of examinations were normal, ultrasound examination of the abdomen revealed a cystic mass in liver most likely to be hydatid. The patient was fully conscious the next day and was put on tab albendazole (200 mg BID). CT scan of the abdomen revealed a large cystic mass having inner undulating wall with watery content diagnosed as hydatid cyst in right lobe of liver. Since anaphylaxis was considered consequent to hydatid cyst perforation, surgery was carried out. Approximately 100 ml of haemorrhagic fluid was aspirated and 10% hypertonic saline instilled. After re-aspiration, cyst cavity was opened and endocyst completely removed. Portion of ectocyst projecting away from the liver edge was also excised. He made an uneventful postoperative recovery and was discharged with the advice to continue tab albendazole 200mg BID for four weeks and weekly follow-up in surgical OPD. He is doing well now.     

Epigastirc hernia presenting as a giant abdominal interparietal hernia

INTRODUCTION

Epigastric hernia is a rare form of ventral abdominal hernia. When neglected it can attain an impressive size causing it un-aesthetic effect in addition to diagnostic difficulties.

PRESENTATION OF CASE

Presented is a 60-year-old female farmer with a 10-year history of a voluminous mass in the anterior abdominal wall.

DISCUSSION

Surgery revealed an epigastric hernia presenting as an interparietal hernia. The hernia was an omentocele with a grossly distended hernia sac filled with about 2.5 l of serous fluid. No similar case has been found in the medical literature.

CONCLUSION

Epigastric hernia can attain voluminous dimensions and present as a non-inguinal interparietal hernia.