Pineal region lesion masquerading choroid plexus papilloma: case report

BACKGROUND: Choroid plexus papillomas (CPPs) are rare intracranial neoplasms, especially in the third ventricle. We report a patient with a posterior third ventricular CPP extending into the pineal that radiographically and clinically presented as a pineal region lesion. CASE DESCRIPTION: In a 51-year-old female with headache and upward gaze impairment radiological examination showed a mass in the pineal region obstructing the aqueduct of Sylvius and causing hydrocephalus. After ventriculoperitoneal shunting the tumor was approached through the infratentorial-supracerebellar approach and pathological examination revealed a typical CPP. CONCLUSIONS: This case represents an unusual presentation of an intracranial CPP. This entity should be considered an extremely rare cause of a lesion in the pineal region.     

Chronic pyelonephritis masquerading as a renal neoplasm

A case of chronic pyelonephritis masquerading as a renal neoplasm in a young adolescent male is presented. The diagnostic dilemma posed by the disease, and its management, are discussed.     

Subclinical papilloma viral infection of male genitalia

One hundred male patients with a history of genital condylomata were evaluated by the use of 3% acetic acid staining of their external genitalia. In 36 per cent positive aceto-white areas were discovered on the shaft of the penis (flat condylomata), and a 35 per cent meatal-urethral involvement, suggesting that flat and exophytic condylomata of the shaft and urethra are the most logical reservoir for transmitting the HPV infection to the female genitourinary tract.     

Sarcoidosis masquerading as a parathyroid adenoma.

Two patients presented with a presumptive diagnosis of hyperparathyroidism. Surgically excised "parathyroid glands" were found to be, in fact, large lymph nodes with sarcoid granulomata. In one patient, the preoperative localization of the "parathyroid adenoma" was based on scintigraphy (thallium-technetium subtraction imaging) and sonography procedures. The differential diagnosis of hypercalcemia, and positive scintigraphy-sonography studies, must include sarcoidosis in an isolated cervical lymph nodes.     

Myeloid metaplasia masquerading as a urethral caruncle

A 64-year-old woman presented with a painless bleeding mass of the urethral meatus that was diagnosed as a caruncle and removed surgically. Histological examination revealed a cellular and vascular polypoid lesion that contained megakaryocytes, as well as groups of hematopoietic stem cells, and maturing cells of the erythroid and granulocytic series. The diagnosis of myeloid metaplasia was confirmed by marker studies with immunoperoxidase techniques. The patient had a long history of bleeding and clotting problems owing to a myeloproliferative disorder with thrombocytosis and gradual development of myelofibrosis. No other foci of extramedullary hematopoiesis were apparent. The patient was free of urinary symptoms 22 months postoperatively.     

Metastatic bronchogenic carcinoma masquerading as a felon

This report describes a rare occurrence of a subcutaneous metastatic bronchogenic carcinoma to the distal fingertip. The original clinical presentation suggested an infectious process. Subsequent roentgenograms, sterile cultures, and positive biopsy material revealed that the lesion started as a subcutaneous metastasis that secondarily involved adjacent bone. Amputation of the digit was performed.     

Accessory spleen masquerading as a pancreatic neoplasm

A patient with a pancreatic mass noted on a computed tomography scan was suspected of having a nonfunctioning pancreatic neuroendocrine neoplasm. The eventual diagnosis of intrapancreatic accessory spleen was made by noninvasive means, thus avoiding unnecessary surgery.     

Castleman's tumor masquerading as a pancreatic neoplasm

Castleman's disease, or giant lymph node hyperplasia, occurs most commonly in the mediastinum, with infrequent presentation in the abdominal cavity. We describe a rare occurrence of Castleman's tumor initially seen as a pancreatic mass. The clinical presentation, course, and treatment of this condition are discussed. Clinicians should be aware that giant lymph node hyperplasia may involve the peripancreatic tissues and simulate a pancreatic neoplasm.     

Foreign body masquerading as a ruptured globe

Low density orbital foreign bodies may not be detected on plain x-ray. In this case, a large anterior orbital foreign body was seen by examiners, but was misinterpreted as a ruptured globe. This misdiagnosis was supported by conventional x-rays which failed to show the object. It was later easily visualized on CT scan.     

Thymic teratoma masquerading as a thyroid lump

Teratomas are germ cell tumours commonly found in the sacrococcygeal region, ovary, testicle or, infrequently, the mediastinum. In very rare circumstances, these tumours are found in the neck. This case represents a thymic teratoma presenting as what appeared to be an intrathyroid lesion. This has not been described previously and demonstrates an unusual presentation of a neck lump necessitating two operations and a multidisciplinary approach for management. We would also like to highlight that while patients undergo imaging to guide surgery, the surgeon must always be prepared for the unexpected and recognise situations where the operation should be converted to an exploratory procedure instead of full resection. Often, combined surgical care is the best option for difficult congenital cases.     

Lymphoma masquerading as infection

During surgical training, medical students and residents constantly are reminded to culture every suspected tumor and send tissue for pathologic evaluation for every suspected abscess. A diagnosis of cancer can be missed easily if this procedure is not followed, delaying the diagnosis and possibly adversely affecting the patient's prognosis. The confusion also may be compounded by a sterile abscess, positive culture results or a negative biopsy specimen. Therefore it is imperative to do a biopsy and a culture on any suspect lesion. An additional workup and possible biopsy may be warranted for a nonhealing wound that has been treated appropriately. The cases of three patients with lymphoma that were treated as infectious processes are presented. In all three instances, the appropriate treatment was delayed because of a delay in diagnosis.     

Chondrosarcoma masquerading as cardiomyopathy

A 17-year-old male patient presented to his primary care provider with heart failure symptoms and was transferred to our hospital with the diagnosis of idiopathic cardiomyopathy. His workup identified a large mediastinal mass with right ventricular outflow obstruction, which was resected. The pathology of the mass was a low-grade chondrosarcoma. The patient currently remains disease free at 4 years.     

A ventriculoperitoneal shunt masquerading as a paratesticular tumor

A 3-year-old boy with hydrocephalus was observed to have a painless 2.0-cm right scrotal mass. Abdominal radiograph showed ventriculoperitoneal shunt tubing in the right scrotal sac. Removal of a detached shunt catheter and inguinal hernia repair resolved the problem.     

Carcinoma masquerading as a pancreatic pseudocyst on ultrasound

Ultrasound has proven invaluable in detecting and evaluating pancreatic pseudocysts, and it is now a standard test to rule out complications of pancreatitis. In reviewing the authors' experience with 122 patients treated surgically for a pancreatic pseudocyst, five patients were identified in whom an ultrasound demonstrated a pseudocyst that was associated with an unexpected cancer at the time of operation. A sixth patient, with a pseudocyst documented by ultrasound, died prior to surgery and was found at autopsy to have metastatic common bile duct carcinoma. There was little difference in presenting symptoms, age, frequency of alcoholism, or physical findings compared with patients with pseudocysts secondary to pancreatitis. In two patients, pseudocysts were found in the tail of the pancreas at operation, in addition to carcinoma. In the other three patients, no pseudocyst was found; however, a subcapsular splenic hematoma was present in one. Five patients had metastatic disease, three from pancreatic adenocarcinoma, one from islet cell carcinoma, and one from a common bile duct carcinoma. One patient with a pancreatic adenocarcinoma confined to the head underwent a Whipple procedure and has no evidence of disease 6 months later. Malignancy may cause or coexist with pancreatic pseudocysts. Ultrasound is often not helpful in distinguishing pseudocysts associated with malignancy from those associated with pancreatitis. Biopsy should be performed to rule out malignancy when operating for pancreatic pseudocysts.