An unusual colonic mass in a phlebosclerosis patient

A 47-year-old man with idiopathic mesenteric phlebosclerosis presented to our hospital because of a 2-month history of diarrhea and edema of both lower limbs. Contrastenhanced abdominal computed tomography (CT) showed a 2-cm mass of mixed density in the ascending colon. On coloscopy, a solid, ulcerated, semi-pedunculated, lobulated protruding mass of 3.5×3.5×1.5 cm was observed and removed with hot snare polypectomy. Histologic examination demonstrated a hamartomatous polyp with normal epithelium and an inflammatory infiltrate with dilated, mucus-filled cystic glands in the lamina propria, indicating a juvenile polyp.     

An unusual atrial mass

Giant coronary artery aneurysm is a rare manifestation of coronary artery disease. This patient presented at echocardiography and was successfully managed by surgical resection.     

An unusual abdominal mass in a renal transplant recipient

Abstract: Renal transplant recipients are at increased risk of malignancy and infection. We present the case of a 72-year-old-man with recurrent bladder carcinoma, abdominal aortic aneurysm repair, and end-stage renal failure due to renovascular disease. He received a cadaveric renal allograft into his left iliac fossa, was given cyclosporin A, azathioprine, and prednisolone triple therapy immunosuppression, and had no rejection episodes. He presented four years post-transplantation with a two-year history of intermittent sweats and fevers. Previous episodes had been investigated with no firm diagnosis made. This time he had right iliac fossa pain of three weeks' duration. Examination revealed a tender mass. Investigations showed unchanged graft function, but elevated inflammatory indices. Ultrasonography and computed tomography detailed an infiltrating mass associated with the sigmoid colon, which colonoscopy failed to visualise. At laparotomy a 6-cm tumor was removed, with adherent sigmoid colon and bladder dome. Macroscopically the mass was an abscess, and microscopy found acute and chronic inflammatory giant cells and fibrillary masses suggestive of actinomycosis, with no malignancy. The patient recovered uneventfully on antibiotics. At six months' follow-up, examination, inflammatory markers, and radiographic imaging showed no evidence of recurrence. Twelve months later the patient died of rupture of his proximal abdominal aorta. There was no evidence of recurrence at postmortem examination. We conclude with a brief review of actinomycosis in transplant recipients.     

An unusual right atrial mass in a two-month old infant

We report a 2-month old female with a rare cardiac mass. She was evaluated echocardiographically after physical examination revealed a low grade cardiac murmur. The mass, located in right atrium, was shown to be the consequence of candida endocarditis by means of pathological study and blood culture.     

Partial nodular transformation in a cirrhotic liver

We present a case of partial nodular transformation (PNT) of the liver in a 57-year-old man with a history of heavy drinking. On computed tomography, a low-density mass, measuring 3 cm in diameter, and associated with portal flow defect was visualized. Based on this finding and on the findings of other imaging studies, hepatic resection was performed because of suspected hepatocellular carcinoma. Pathology examination of the excised specimen showed small portal tracts in the lesion. The findings for the rest of the liver were suggestive of mild liver cirrhosis. While PNT is similar to nodular regenerative hyperplasia (NRH), in NRH there is diffuse nodular transformation of the whole liver, whereas in PNT only the area adjacent to the porta hepatis is affected. The portal flow defect in PNT may be the result of attenuation of the portal tracts in the lesion. This case is of interest because there was only one PNT lesion, rather than multiple lesions, and because it occurred in a cirrhotic liver, thus giving rise to the suspicion of hepatocellular carcinoma. PNT is a benign disorder, thus it is essential to establish a definitive diagnosis by imaging and ultrasound-guided histological biopsy to prevent unnecessary hepatic resection.     

An unusual cause of left atrial mass

A 47-year-old woman was hospitalized for the evaluation of non-exertionalleft chest pain and left upper arm weakness for     

An unusual case of a pleural effusion with an abdominal mass

A 38-year-old man presented to us with a left sided pleural effusion. Pleural fluid was aspirated and analysis revealed it to be an exudate with predominant lymphocytes and an elevated ADA level. He was discharged on antituberculous treatment. Patient returned with re-accumulation of pleural fluid. Computed tomography done in our institute picked up not only parenchymal disease in the lung which was not evident on chest radiographs but also picked up an abdominal mass in the left renal fossa. Pathological examination of excised mass revealed its tuberculous nature. The repeated recollection of pleural fluid was attributed to a "paradoxical response"; the patient was reassured and his anti-tuberculous treatment continued. Recognition of the fact that evidence of tuberculosis at distant sites may occasionally be needed to substantiate the diagnosis of tuberculous pleural effusion in a difficult and bacteriologically "negative" case prompted us to report this case.     

An unusual case of fatty liver in a patient with desmoid tumor

A desmoid tumor, also known as aggressive fibromatosis, is a rare benign neoplasm that arises from fascial or musculoaponeurotic tissues. It can occur in any anatomical location, most commonly the abdominal wall, shoulder girdle and retroperitoneum. The typical clinical presentation is a painless mass with a slow and progressive invasion of contiguous structures. It is associated with a high local recurrence rate after resection. Many issues regarding the optimal treatment of desmoid tumors remain controversial. Aggressive surgical resection with a wide margin (2-3 cm) remains the gold standard treatment with regard to preserving quality of life. Radiotherapy alone has been shown to be effective for the control of unresectable or recurrent lesions. Desmoid tumors tend to be locally infiltrative, therefore, the fields must be generous to prevent marginal recurrence. The radiation dose appropriate for treating desmoid tumors remains controversial. We present a 25-year-old Caucasian man with local recurrence of a desmoid tumor after repeated surgical resection, treated with radiotherapy. The patient achieved complete tumor regression at 4 mo after radiotherapy, and he is clinically free of disease at 12 mo after the end of treatment, with an acceptable quality of life. The patient developed short bowel syndrome as a complication of second surgical resection. Consequently, radiotherapy might have worsened an already present malabsorption and so led to steatohepatitis.     

An unusual mediastinal mass due to metastasis.

During childhood the common anterior middle mediastinal masses are either lymph node enlargement or teratomas/dermoids. A case of ossific mediastinal metastasis and pleural metastases from osteosarcoma, presenting three years after the primary disease (late metastasis) is reported for its rarity.