Prenatal sonographic features of congenital lobar emphysema

The prenatal sonographic features of congenital lobar emphysema (CLE) have not been well characterised. Five cases have been reported in the literature and on all these occasions either an echogenic (3) or a cystic (2) lung lesion was detected prenatally and the diagnosis was confirmed after the operation. This is the sixth case of CLE in the literature with prenatal sonographic features documented. The prenatal scans of a 23-year-old lady performed at 22 weeks of gestation revealed cystic lesions and increased echogenicity of the right fetal lung. There were no other anomalies and the karyotype was normal. The lesion decreased in size at 28 weeks and the baby was born by a normal vaginal delivery at 41 weeks. CT scan performed on day 6 confirmed cystic changes on the right lung with compression of the right lower lobe. A repeat CT scan performed at 4 months revealed extensive cystic changes in a hyper-inflated right lung and mediastinal shift to the left. At operation, abnormally inflated right upper and middle lobes were found suggesting a CLE. There were no subsequent complications after removal and histology confirmed CLE. The reported cases are reviewed and the prenatal sonographic features of CLE are discussed.     

Prenatal diagnosis of congenital cystic adenomatoid lung malformation: case report and review of the literature

Congenital cystic adenomatoid malformation of the fetal lung is an extremely rare developmental abnormality characterized by excessive overgrowth of the terminal respiratory bronchioles at the expense of the saccular spaces. We present a case of a 33-year-old, gravida 2, para 1, woman with congenital cystic adenomatoid lung malformation-type II diagnosed by ultrasound at the 20th week of gestation. On the right side of the chest an area with a maximum diameter of 18.5 mm and with small cystic lesions was recognized. The maximum diameter of the cysts was 0.5 cm. There were no other fetal abnormalities. The pregnancy was terminated and the postmortem examination confirmed the ultrasonographic findings. The cysts had the appearance of bronchiolus-like structures and were lined with cuboidal and columar epithelium. Distended alveoli were present, while the airways were normal in structure. No other congenital anomalies were found. In conclusion, in this study we describe the ultrasonographic and pathologic findings of an unusual case of congenital cystic adenomatoid malformation of the fetal lung.     

Cystic colon duplication as differential diagnosis to ovarian cyst

OBJECTIVE: We report the case of a female fetus with a single spherical anechoic cyst on the right side of the lower abdomen first diagnosed at 22 weeks of pregnancy. METHODS: Serial ultrasound monitoring and needle aspiration of the cyst were performed. RESULTS: The cyst grew during pregnancy up to 8 cm diameter. Needle aspiration was performed at 33 and 36 weeks. At 38 weeks labor was induced and a girl was delivered spontaneously. Postnatally the child showed abdominal distention, vomiting, and an obstruction of venous return of the right leg. To improve venous circulation, another needle aspiration of the cyst was performed. Laparoscopy revealed cystic colon duplication. CONCLUSIONS: Prenatal differentiation of a single round anechoic cyst in the pelvis of a female fetus can be difficult. As a rare abnormality cystic colon duplication has to be considered.     

Prenatal and perinatal aspects of a giant fetal cervicothoracal lymphangioma.

A massive cervicothoracal lymphangioma was diagnosed in a fetus at 25 weeks of gestation. On ultrasound study, the mass showed septated, cystic components and extended from the right submandibular region to the right anterolateral thoracic wall including the right axilla and right scapula. Close sonographic follow-up revealed an increase in the size of the lymphangioma without fetal hydrops. An interdisciplinary approach including a pediatric surgeon, neonatologist, perinatologist and anesthesiologist was chosen. Elective cesarean section under general anesthesia was planned at 37 + 0 weeks of gestation. Surgical correction of the lymphangioma was successfully performed on the 4th day of life. Possible differential diagnoses and the obstetrical management are presented.     

Primary pelvic hydatid cyst

We report a case of hydatid cyst of the pelvis in a 36-year-old woman presented with right adnexal cystic mass with similar cystic lesions in the liver. Laparatomy revealed a right paraovarian cystic mass densely adhered to the uterus, to the pelvic side wall, and to the right fallopian tube. Histopathological examination of the cyst wall showed the cuticular layer of the cyst. Cystic liver lesion was later proved to be hepatic hemangioma by magnetic resonance imaging. Received: November 1999 / Accepted: 14 January 2000     

Supernumerary ovary on sigmoid colon resembling an endometriotic lesion

A 30-year-old woman with a history of endometriosis and chronic pelvic pain had right-sided pain and sonographic evaluation demonstrated a right ovarian cyst 5 cm in diameter. Laparotomy revealed a right ovarian cystic mass and the cystic mass was found on the sigmoid colon. After excision, histopathologic study revealed endometrioma for the ovarian cyst and a supernumerary ovary for the cystic mass on the sigmoid colon.     

Transabdominal application of transvaginal transducer enhancing depiction of mature cystic teratoma at 34 weeks' gestation

We present an unusual case in which a 36-year-old patient was referred for consultation due to increasing upper left abdominal pain at 35 weeks' gestation. Transabdominal ultrasonography disclosed an appropriate-for-gestational-age singleton, vertex-presenting fetus with normal anatomy. An unclear, complex, semisolid, semicystic mass was noted in the upper right abdomen. Due to the close proximity of the adnexal mass to the patient's abdominal wall, a high-frequency transvaginal transducer was applied transabdominally. Unlike the unclear images generated at conventional transabdominal ultrasonography, this application depicted a discrete mass with multiple characteristics consisting of calcifications, hair and fatty tissue, considered diagnostic of a mature cystic ovarian teratoma. The patient delivered spontaneously at 39 weeks' gestation. At 6 weeks' postpartum an elective laparotomy left ovarian cystectomy was performed and a mature cystic teratoma confirmed by pathology examination.     

Primary retroperitoneal mucinous cystadenoma of borderline malignancy: a case report and review of the literature.

A case of primary retroperitoneal mucinous cystic tumor of borderline malignancy is reported. A 36-year-old, nulliparous woman complained of abdominal fullness. Physical examination revealed a cystic mass 12-cm x 8-cm in size. At laparotomy, a cystic tumor was observed in the right retroperitoneal space. Both ovaries appeared normal and the uterus was almost normal except for small myomatous nodules. Removal of the retroperitoneal tumor, an appendectomy, and a myomectomy were performed. The histologic diagnosis was a primary retroperitoneal mucinous cystic tumor of borderline malignancy, similar to findings for ovarian tumor. There was no evidence of disease 6 months after the surgery.     

An unusual case of trapped ovary in a peritoneal pouch causing extrinsic ureteric compression associated with endometriosis

A 35-year-old woman presented with long-standing right loin to groin pain and a right ovarian cyst. The ovarian cyst was considered physiological at the initial gynaecological evaluation. A subsequent transvaginal scan demonstrated a cystic immobile ovary adherent to the pelvic side wall. Laparoscopy revealed endometriosis and a peritoneal defect holding the cystic ovary against the ureter and causing compression with secondary loin pain. The trapped ovary was removed and the patient was cured of the long-standing ureteric colic. This is the first reported case of extrinsic ureteric compression caused by trapped ovary in a peritoneal pouch associated with endometriosis. The diagnosis was suspected preoperatively from the transvaginal scan findings demonstrating a cystic immobile ovary adherent to the pelvic side wall. This case demonstrates that in women with unresolved ureteric compression where adnexal cyst is found, the investigator should look for features that suggest entrapment to the pelvic side wall.     

Primary carcinoid tumor of the ovary: a case report

Primary ovarian carcinoid tumors are rare. A 47-year-old woman presented to our emergency room with lower abdominal pain. Physical examination, pelvic ultrasonographic evaluation and abdominal computed tomography revealed a 10-cm mass in the right ovary containing cystic and solid components, as well as calcifications typical of a dermoid cyst. At laparotomy, a smooth-surfaced, firm and mobile right adnexal mass with solid and cystic portions was detected. Initially, right salpingo-oophorectomy was performed. Frozen-section examination identified the mass as a sex cord stromal tumor containing a mature cystic teratoma. Based on this finding, total abdominal hysterectomy, left salpingo-oophorectomy, omentectomy, appendectomy were performed, and the pelvic-paraaortic lymph nodes were also removed. All histological findings in the right ovary were similar to the features of cystic teratoma and trabecular carcinoid tumor. Examination of the resected lymphatic, omental, and appendiceal tissue indicated no tumoral invasion. The diagnosis was ovarian carcinoid Stage IA. Serum testing post-surgery revealed that the levels of cancer antigen (CA) 19-9 and CA125 were 18.5 u/ml and 10.5 u/ml, respectively. The patient was discharged on postoperative day 5. The report describes the clinicopathologic and immunohistochemical features of a primary ovarian carcinoid that contained a mature cystic teratoma.     

Rare case of an ovarian monodermal teratoma with functional stroma and extensive ovarian decidualization in a 74-year-old woman

We present the clinicopathological findings of a rare case of a monodermal teratoma of the right ovary with functional ovarian stroma and extensive decidualization in a 74-year-old woman. The patient presented with vaginal bleeding. Ultrasound scan revealed a pelvic mass measuring 9.5 cm in the lower right abdomen. A right oophorectomy was performed. The tumor was cystic and multilocular filled with colloid material. Histological examination revealed follicles of thyroid type, and stromal clusters of fusiform or polygonal cells were found in the stroma. An extensive decidual reaction was observed. Morphological and immunohistochemical examination of the tumor revealed cystic struma ovarii with functional ovarian stroma and ectopic decidua. Total abdominal hysterectomy with oophorectomy was performed. A benign endometrial polyp, proliferative endometrium, two fibroids, and an ovarian cyst were observed.     

A Case of Paratubal Serous Borderline Tumor Driven by a Somatic BRAF Mutation in an Adolescent Patient

BackgroundWe describe a rare paratubal serous borderline tumor occurring in an adolescent and provide insight into its molecular underpinnings.CaseA 14-year-old girl presented with irregular menstrual cycles and a large right pelvic mass. Computed tomography imaging revealed a cystic neoplasm arising from the right ovary with peripheral calcification. During laparotomy, a cystic tumor located at the right parametrium independent of the fallopian tube was identified. The ovary was intact and the tumor was successfully removed. Intraoperative diagnosis using the frozen section technique and subsequent pathology revealed a paratubal serous borderline tumor. Molecular analyses revealed a chromosomally stable tumor genome and a pathogenic somatic mutation (c.1799 T > A, p.Val600Glu) in the B-Raf proto-oncogene, serine/threonine kinase (BRAF) gene.Summary and ConclusionThis case shows that the BRAF p.Val600Glu mutation likely acts as an oncogenic driver in this rare neoplasm.     

Major hepatectomy and right hemicolectomy at the time of primary cytoreductive surgery for advanced ovarian cancer: report of a case

Major liver involvement at the time of diagnosis is a rare event in patients with ovarian cancer, and the issue of major hepatectomy at the time of primary cytoreductive surgery is controversial. A 61-year-old woman was admitted to our hospital with nonspecific abdominal pain of 2-month duration and weight loss of 5 kg during the last semester. A computed tomography scan demonstrated bilateral ovarian masses, extending to the right iliac fossa, pressing the cecum-ascending colon. In the liver parenchyma, three cystic lesions were found of about 6-cm maximum diameter each, along with pelvic lymphadenopathy. There was no ascites. The diagnosis of advanced ovarian cancer was clinically suspected; the patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy, right hemicolectomy, omentectomy, left lobectomy, deroofing, and draining of the cystic formation of the right liver lobe along with systematic pelvic and para-aortic lymphadenectomy. Systemic chemotherapy (six cycles of paclitaxel/carboplatin) was subsequently administered, and after 15 months of follow-up period, the patient is still in first remission and alive. Ovarian cancer with concomitant extensive right colon infiltration and hematogenous liver metastases can be successfully managed with aggressive surgical resection and postoperative chemotherapy in carefully selected patients.     

Uterus-like ovarian mass presenting near menarche.

An eleven year-old girl presented with right lower quadrant abdominal pain near menarche that coincided with the onset of her most recent menstrual period. A smooth-lined cystic structure with a thick wall was discovered in the right adnexa at surgery that was adherent to a multicystic ovary and a dilated fallopian tube. Histologic examination determined the lesion to be a uterus-like ovarian mass. The patient had a history of a resected right pelvic kidney at four months of age. This case is believed to represent a congenital malformation of the urogenital system rather than smooth muscle metaplasia of ovarian stromal cells.     

Adenocarcinoma Arising from the Gastrointestinal Epithelium in Benign Cystic Teratoma of the Ovary

Malignant transformation of benign cystic teratoma of the ovary is rare, with an incidence of 1.8%. The commonest malignant neoplasm to develop is squamous carcinoma (80%). Adenocarcinoma occurs with less frequency, and only one of which has ever been cited to be of gastrointestinal origin. A 38-year-old female underwent TAH-BSO due to a large right ovarian tumor. Microscopically and immunohistochemically, the tumor was defined as mucinous adenocarcinoma originating from gastrointestinal epithelium in benign cystic teratoma.     

Successful intrauterine therapy for congenital cystic adenomatoid malformation of the lung. A case report

Congenital cystic adenomatoid malformation (CCAM) of the lung is a rare abnormality which is amenable to be diagnosed by prenatal ultrasonography. In general, CCAM associated with non-immune hydrops has a poor prognosis unless a fetal intervention is performed. In some series almost 100% of either prenatal or early neonatal deaths are observed without intervention. Recently the cystic adenomatoid malformation volume ratio (CVR) has been proposed as an index to predict the development of hydrops in this condition. If the CVR is >1.6, the risk of hydrops is approximately 75%. We report a case of CCAM (macrocystic type) of the left lung referred to our center at 21 weeks of gestation. Fetal therapy was considered owing to enlargement of the CCAM volume, severe mediastinal shift, right lung compression, polyhydramnios and ascites from 21 to 26 weeks. Thoracoamniotic shunting was performed successfully at 26 weeks with resolution of the cystic mass. At 37 weeks a male infant was born vaginally weighing 3,210 g with Apgar scores of 5 and 10. Resection of the mass was performed uneventfully on day 3. The infant is currently 22 months of age, asymptomatic and in good condition.     

Extragonadal mature cystic teratoma at anterior uterine wall coexisting with a pararectal corpus luteum cyst and agenesis of left fallopian tube and left ovary

ObjectiveMature cystic teratomas are mostly confined to the ovaries, but several authors have reported findings of extragonadal occurrences along the migration pathway of primordial germ cells. Extragonadal mature cystic teratomas are extremely rare; their occurrences and pathogenesis are unknown.Case reportWe report the case of a 26-year-old woman who was admitted for scheduled laparoscopic right ovarian tumor excision. An anterior uterine wall mature cystic teratoma and a pararectal corpus luteum cyst were found intraoperatively with coexistence of left adnexal agenesis.ConclusionThe existence of an extragonadal mature cystic teratoma over the anterior uterine serosal layer may be caused by autoamputation and reimplantation as a result of ovarian torsion or displacement of primordial germ cells along their migration path. The existence of an ovarian mass over the sigmoid colon combined with left adnexal agenesis may be the result of ovarian torsion with remnant tissue attached to the sigmoid colon.     

Computed tomography diagnosis of primary thyroid teratoma.

Teratomas occur mainly in the gonads, and rarely in the thyroid. They are common in reproductive age women. Teratomas in the thyroid occur mainly in neonates and are often benign. Here we report a case of primary benign teratoma of the thyroid gland in a 15-year-old female, which was accurately diagnosed by computed tomography before surgery. The tumor was a well-defined cystic mass in the right thyroid region, with a fat-containing nodule in the cystic tumor causing displacement of the trachea. The patient was treated with right subtotal thyroidectomy and no recurrence was noted during 2 years' follow-up. Demonstration of the fat component within a well-defined cystic mass in the thyroid region allows accurate diagnosis of teratoma, localization of the tumor extent before operation, and adequate treatment.     

Early prenatal diagnosis of congenital cystic adenomatoid malformation of the lung (Stocker's type I); a case report

A congenital cystic adenomatoid malformation was diagnosed by ultrasound examination at 20 week's gestation. The entire right lung was cystic and elements of poor prognosis such as hydrops fetalis and polyhydramnios were present. After verification of the karyotype, abortion was performed and autopsy confirmed prenatal findings and Stocker's type I. Cystic congenital adenomatoid malformation of the lung is a rare form of congenital pulmonary disease. Our case shows that this malformation can be accurately diagnosed during the midtrimester of pregnancy by ultrasound examination. Ultrasound examination permits an evaluation of the three types described by Stocker and may reveal certain lesions associated with poor prognosis, such as anasarca or polyhydramnios. Also, it offers the possibility to save some fetuses by surgical decompression in the immediate postnatal period, or to terminate earlier pregnancies by abortion.