Giant biliary cystadenoma: a case report

Biliary cystadenoma is a very rare benign cystic tumour of the liver. Fewer than 150 cases have been described in the literature so far. The authors present a case of a 29-year-old female with a giant intrahepatic biliary cystadenoma who presented with abdominal pain and obstructive jaundice. The patient was treated with left hepatectomy and now 12 months after the surgery she is in good condition with no signs of recurrence of the disease. Clinical presentation of biliary cystadenoma is not specific. Diagnosis is based on imaging methods, mainly ultrasound and CT scan. However, it is often misdiagnosed. For treatment, radical resection is advocated because a biliary cystadenoma is considered to be a premalignant lesion. The prognosis of biliary cystadenoma after complete resection is excellent. Nevertheless, there is a risk of recurrence or malignant transformation after incomplete resection.     

前列腺囊腺瘤1例报告及文献复习

目的:探讨前列腺囊腺瘤的临床病理特征。方法:应用常规病理、免疫组化方法观察1例前列腺囊腺瘤手术切除标本,结合相关临床资料及其病理特点进行分析,并复习文献。结果:患者男性,55岁,于1年前因排尿费力在外院行TUVP术。肿瘤大体为灰白色肿块,切面可见大小不等的囊腔,内充透明及浅白色液体。组织学特点:肿瘤呈筛状、微囊状或腺样排列,内衬覆立方上皮到柱状上皮细胞,细胞核位于基底部,无细胞异型性,无核分裂象。免疫表型:腺上皮表达PSA、PAP、CK7,而基底细胞34βE12阳性,CK20、P504S、CEA和绒毛蛋白均阴性,Ki67(+)<2%。结论:前列腺囊腺瘤是一种少见的前列腺来源的良性肿瘤,前列腺囊腺瘤在形态学上具有独特的组织结构,多表达PSA和PAP。     

肝内胆管囊腺瘤一例

腺瘤的管腔中有分泌物潴留呈囊状扩张者称为囊腺瘤.由于被覆内壁的腺上皮细胞的增殖,形成多数大小不一的房室,内容物可有浆液、黏液、假黏液、胶质等多种物质.囊腺瘤以卵巢最为多见,此外也见于乳腺、肾脏、胰腺,发生于肝脏的囊腺瘤较少见.现就我院肝胆外科收治的1例肝内胆管囊腺瘤(intrahepatic biliary cysta...     

Hepatobiliary cystadenoma: a case report and a review of the literature

BACKGROUND: Hepatic cystic lesions are rare; however, their management and treatment is dependent on early recognition and diagnosis. METHODS: In this report, the authors discuss a 72-year-old woman who presented to their clinic for treatment of a hepatocystadenoma. RESULTS: The history, physical examination, and diagnostic modalities lead to surgical intervention despite an unclear diagnosis. CONCLUSIONS: This case illustrates an unusual hepatic lesion in which the diagnosis was not known until the time of laparotomy. However, diagnostic modalities were important in establishing the need for surgical intervention. The authors offer a pertinent review of the literature and discuss current treatment modalities.     

Giant retroperitoneal myxoma: A case report and literature review

Introduction and importanceMyxoma is a benign tumor and is mesenchymal in origin. Myxomas of the retroperitoneum are extremely rare entities.Case presentationWe here report a case of a 67-year-old male who presented with progressive abdominal distention for 3 years. Laboratory investigations revealed a reduction in erythrocytes, lymphocytes, hemoglobin, and an elevation in carbohydrate antigen 19-9. Imaging findings showed a multilocular cystic mass in the right abdomen with thin septa and internal calcifications. Laparotomy revealed that the mass had arisen from the retroperitoneum and the histological study suggested the diagnosis of myxoma.DiscussionMyxoma features as a “cystic mass” in imaging studies. Therefore, the possibility of a cystic lymphangioma, cystic mesothelioma and myxoma should be considered when a multicystic lesion in the retroperitoneal space is observed. Due to the rarity of retroperitoneal myxomas and lack of specific manifestations and diagnostic methods, preoperative diagnosis is often delayed or incorrect. And until now, only a few cases of retroperitoneal myxoma have been reported.ConclusionThe report will increase the understanding of the diagnosis and treatment of retroperitoneal myxomas. A brief review of the related literature was also carried out.     

Giant gallbladder: A case report and review of literature

INTRODUCTION

Reports of a giant gallbladder are rare.

PRESENTATION OF CASE

A 77-year-old woman was admitted with complaints of dull pain in the right half of the abdomen and a palpable mass at the same place. A computerized tomography scan revealed an extremely enlarged gallbladder. Open cholecystectomy was performed. The volume of the removed organ was as much as 3.35 L.Follow-up after 18 months showed that the patient was well. Examination revealed no significant acquired or congenital anomalies that might explain the excessive enlargement of the gallbladder.

DISCUSSION

We define a ‘giant’ gallbladder as an extreme enlargement of the organ with a volume exceeding 1.5 L, so that its weight is comparable to or even exceeds the mean (estimated) weight of the adult liver (1.5 kg). The first clinical presentation of such an enlargement is likely to differ from any other gallbladder disease, but rather to resemble a tumour or cyst of the abdominal cavity.

CONCLUSION

A giant gallbladder is a special clinical and pathological entity in surgical practice, of unknown origin. It may develop in patients of any age, and mimics a large abdominal tumour or peritoneal cyst. Both the diagnostic process and surgical treatment demand non-routine approaches. Early and late follow-up results seem to be favourable.     

胆管囊腺瘤6例诊疗分析并文献复习

【摘要】〓目的〓分析6例胆管囊腺瘤的临床特点,提高对胆管囊腺瘤的认识。方法〓回顾性分析中山大学孙逸仙纪念医院自2009年9月到2014年9月收治的6例胆管囊腺瘤患者的临床表现、影像特点及手术治疗结局情况。结果〓6例患者均为女性,年龄28~46岁。就诊主诉为:上腹痛占50%(3/6),无症状体检发现33.3%(2/6),黄疸、发热占13.7%(1/6)。发病至就诊时间3天~16年。除黄疸、发热患者肝功能异常外,其余患者术前肝功能无异常。肿瘤指标均无异常。术前B超、CT均未能作出准确定性诊断,仅2例术前经MR检查准确诊断。全部患者均行外科手术完整切除病灶,术后无明显手术并发症。术后随访3月~46月无复发。结论〓胆管囊腺瘤发病稀少,病因未明,好发于中年女性,临床症状轻,实验室及影像学检查诊断本病有一定困难,目前仍然依赖于病理。本病手术效果良好,完整切除病灶对本病预后极为重要。     

Giant, benign, mucinous cystadenoma of the ovary: case study and literature review.

Benign, mucinous cystadenomas account for 15 per cent of all ovarian neoplasms. Of these, the giant variant occurs rarely. A morbidly obese, 52-year-old, white woman was seen for acute abdominal pain and diagnosed using computerized tomography as having a giant, benign, mucinous cystadenoma. At laparotomy, 21-kg cystic mass attached to the right ovary was removed. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. In such patients, special consideration must be given to hemodynamic and ventilatory monitoring and intraoperative fluid management. Recognition and subsequent surgical management of this and other large abdominal masses can be optimized by thoughtful, preoperative evaluation and careful planning of the operative approach.     

Appendiceal mucocele due to mucinous cystadenoma: case report and review of the literature

Mucinous cystadenomas of the appendix are rare tumours. In this article we describe the case of a young woman who presented with abdominal pain and a clinical pattern likely to a chronic appendicitis. At laparotomy we found a dilatation of the appendix which contained an abundant quantity of mucus. Histological examination showed a mucinous cystadenoma of the appendix. This neoplasm requires a surgical treatment, usually only appendectomy and right hemicolectomy in case of involvement of the caecum. During operation, the surgeon must take care in handling the appendix because of the risk of rupture with consequent dissemination of epithelial cells in the peritoneal cavity (pseudomyxoma peritonei).     

Giant biliary mucinous cystadenoma mimicking mesenchymal hamartoma of the liver in a child: A case report

IntroductionBiliary cystadenomas (BCAs) are rare benign tumors with malignant potential. They are most commonly found in middle-aged women and are quite infrequently reported in children. Even with advanced imaging, diagnosing and distinguishing BCA from other cystic liver lesions remain challenging.Case presentationA 5-year-old boy was brought in by his parents to our hospital with abdominal swelling that had been persistent for a year, along with loss of appetite and weight loss. On examination, the abdomen was distended and dull on percussion. We considered mesenchymal hamartoma of the liver (MHL) as the top differential after an abdominal CT scan with contrast showed a multi-loculated cystic tumour. For both definitive diagnosis and therapy, the patient underwent exploratory laparotomy with excision of the cystic mass. Surprisingly, histopathology examination of the resected specimen revealed biliary mucinous cystadenoma (BCA).ConclusionSince conservative methods are associated with high recurrence rates, biliary mucinous cystic neoplasms require a high index of suspicion and should be handled with total surgical resection. In the post-operative phase, periodic surveillance imaging is recommended due to the risk of recurrence and malignant transformation.     

Giant splenic artery aneurysms: case report and review of the literature

Although splenic artery aneurysms (SAAs) are the most common visceral aneurysms, giant SAAs >10 cm in diameter have rarely been reported. We present the case of a 67-year-old asymptomatic man who was diagnosed with a 15-cm SAA in the absence of a clear etiologic factor. The patient underwent open surgical repair. A medial visceral rotation was performed to gain good vascular control and subsequently the aneurysm was ligated from within. A systematic review was carried out, allowing us to analyze 12 cases of giant SAAs >10 cm published to date. The difference in terms of demographics, clinical presentation, and arterial location between the giant SAA group and usual SAAs may indicate a different underlying physiopathology that remains unclear at this time.     

Giant eccrine acrospiroma: A case report and review of the literature

BACKGROUND:

Acrospiromas are histologically distinct cutaneous tumours of sweat duct origin and usually measure 1 to 2 cm in size.

OBJECTIVE:

We describe a patient with a large benign eccrine acrospiroma.

METHODS:

Case report and literature review.

RESULTS:

A 50-year-old woman underwent excision of a 5.5×5.0 cm cystic mass located on the left gluteal region, and the resulting defect was closed by a local flap. A diagnosis of benign eccrine acrospiroma was made after histopathological examination. On histological examination, the lesion was characterized by multilobular dermal masses composed of a biphasic cell population. There was no recurrence five months after the operation.

CONCLUSION:

Although eccrine acrospiromas are usually benign, they can, on rare occasions, undergo malignant transformation. In addition, the clinical appearance of this lesion is not specific and differential diagnosis from other lesions, both benign and malignant, can only be done after the complete removal of the lesion.     

Giant intramuscular thigh lipoma: A case report and review of literature

IntroductionLipomas are the most common soft tissue tumor. Giant lipomas are defined by measuring at least 10 cm in diameter in one dimension or by a minimum of 1000 g. They often are asymptomatic; however, they can cause compression syndromes due to nerve damage and difficulties in walking.Presentation of caseWe described the case of a 25-year-old female with no significant medical history who began her condition two years before her consultation. The patient referred to the appearance of a non-painful mass on her right thigh with progressive growth that hinders daily activities. A simple CT scan reported a 10.3 × 8.1 × 19.6 cm adipose mass with infiltration towards the semitendinosus muscle and the biceps femoris muscle. A free margin resection of the tumor was performed, and the involved muscles were preserved. The patient had a satisfactory postoperative outcome.DiscussionLipomas are common benign soft tissue tumors that arise from fatty tissue and may challenge surgical management due to their extension and dimensions; they often require delicate surgical intervention due to their potential risk of malignant transformation. We believe surgical pathologists and radiologists must draw attention to muscle involvement and the infiltrative pattern.ConclusionGiant lipomas should always raise awareness of malignant transformation. Radiological guidance should provide enough evidence to decide whether to do a biopsy or not; hence, saving the patient an extra invasive procedure. We recommend taking at least 1 cm of border margin while removing these tumors to avoid local recurrence.     

Giant pericallosal artery aneurysm: case report and review of the literature

Pericallosal artery aneurysms comprise 5% of all intracranial saccular aneurysms and are usually small. Giant cerebral aneurysms mostly occur in major arteries. To date, 12 cases of giant pericallosal artery aneurysm have been reported in the literature. An unusual giant thrombosed pericallosal artery aneurysm is reported here. A 65-year-old female presented with headache and personality changes. Computed tomography, magnetic resonance imaging, and cerebral angiography revealed a right-sided giant thrombosed pericallosal artery aneurysm. The patient was operated via an anterior interhemispheric approach and the neck of the aneurysm was successfully clipped. The postoperative period was uneventful. This rare lesion is one of few cases presented in the literature in which neuroradiologic and neuropathologic evaluation was completely performed and the neck of the aneurysm was clipped. Received: 14 November 2000 / Accepted: 4 January 2000     

Giant adrenal myelolipoma: a case report and review of the literature

Adrenal myelolipoma is a rare nonfunctioning tumor consisting histologically of an admixture of adipose tissue and extramedullary hemopoietic elements within the adrenal glands. Most of these lesions are 5 small and asymptomatic, but there are also giant ones, associated with endocrine disorders. These tumors are mostly detected incidentally by imaging. The increasing number of incidentally discovered adrenal myelolipomas arise the question of appropriate treatment modalities. The authors report a case of giant myelolipoma associated with lithiasic cholecystitis and discuss different imaging and terapeutic aspects.     

巨大良性前列腺增生1例报告并文献复习

目的:探讨巨大良性前列腺增生的临床特点、诊断和手术方法。方法:回顾分析1例巨大良性前列腺增生患者的临床资料,并复习国内外文献进行分析及讨论。结果:患者77岁,临床表现主要为夜尿增多、肉眼血尿。最大尿流率10ml/s,PSA37μg/L,CT显示前列腺大小为11cm×10cm×8cm。行耻骨后前列腺切除术,术后前列腺重量450g,病理结果示"良性前列腺增生"。术后21d康复出院,无明显并发症。国内文献报道,重量在200g以上有83例;国外文献报道,重量在500g以上有14例。国内报道的83例均通过手术治疗,大多数学者采用耻骨上经膀胱前列腺切除术,部分学者采用耻骨后前列腺切除术或经尿道前列腺切除术,术后效果良好。国外报道14例中11例采用耻骨上前列腺切除术,2例采用耻骨后前列腺切除术,1例采用两种方法。结论:巨大良性前列腺增生临床少见,定义尚未统一。根据临床表现和经直肠B超、前列腺CT等辅助检查可作出诊断。治疗应行前列腺切除术,手术方式有经尿道前列腺切除术、耻骨上经膀胱前列腺切除术或耻骨后前列腺切除术,以及腹腔镜前列腺切除术,具体术式应根据患者的实际情况及术者的手术经验而定。