Accessory spleen: presentation as a large abdominal mass in an asymptomatic young woman

Accessory spleen hypertrophy is usually related to hematologic, lymphomatous, and rheumatoid diseases. We describe here the case of an 18-year-old asymptomatic woman who presented with a very large accessory spleen occupying the lower abdomen. Its appearance on abdominal sonogram, computed tomogram, and hepatosplenic scintigraphy is correlated with the resected specimen.     

Pulmonary actinomycosis as a pseudotumor: a rare presentation

Some lung diseases are true diagnostic challenges due to their various clinical presentations. Actinomycosis is one such disease, potentially affecting various organs and systems. We report the case of a patient with pulmonary actinomycosis as a pseudotumor, which is usually only diagnosed by thoracotomy or thoracoscopy.     

Isolated abdominal vasculitis as an atypical presentation of Wegener's granulomatosis

Although current classifications characterize vasculitic syndromes based upon the size of the vessels involved, the histopathology, and the presence or absence of antineutrophil cytoplasmatic antibodies ANCA (1-3), those occasional patients with vasculitis whose features are not typical may evade diagnosis and effective treatment. We report one such patient who presented with bilateral refractory uveitis and abdominal angina who had a positive C-ANCA. Because of his atypical presentation, this patient's disease progressed over 8 yr despite an extensive gastrointestinal evaluation, before a diagnosis of vasculitis was established angiographically, and immunosuppressive therapy was begun.     

Neuronal intestinal dysplasia presenting as an abdominal mass

An unusual clinical presentation of a patient with neuronal intestinal dysplasia is presented. A 46-year-old male noted a palpable mass in the right lower quadrant of his abdomen for two months. A computed axial tomographic scan showed a thickened wall of the cecum with a tumor-like appearance. The excised specimen consisted of a mass caused by the thickened, edematous wall of the dilated cecum and appendix. The wall of the cecum and appendix measured up to 2.5 and 0.8 cm, respectively, in thickness. Microscopic studies showed extensive hyperplasia and hypertrophy of the ganglia and nerve plexuses and hypertrophy of the muscularis propria, consistent with neuronal intestinal dysplasia.     

Invasive thymoma: unique presentation as an anterior chest wall mass

A 57-year-old white woman presented with pericardial effusion and an anterior superior mediastinal mass protruding through the sternum. The diagnosis of thymoma was established by the light and electron microscopic features of a biopsy specimen and a pericardial aspirate. The tumour was a thymic carcinoma, a recently described variant characterized by cellular atypia, enhanced invasiveness, and a higher incidence of metastases. Presentation as an anterior chest wall mass has not been described. Response to radiotherapy was slow and incomplete, and tumour progression occurred during treatment with cisplatin. The chemotherapy of thymoma is reviewed: some apparent responses to agents that are primarily lympholytic may represent the elimination of non-neoplastic lymphocytes from the tumour mass, with spurious radiological improvement and theoretically a risk of tumour enhancement.     

Simultaneous presentation of actinomycosis and metastatic pharyngeal carcinoma

Although actinomycosis frequently presents as a pseudotumoral syndrome, the simultaneous diagnosis of actinomycosis and cancer is exceptional. Actinomycosis can occur as an opportunistic infection secondary to the antineoplastic treatment and even the cancer itself can act as facilitating factor. We report a patient who was diagnosed simultaneously of advanced oropharinx cancer (T4-N1-M0) and actinomycosis associated to the tumoral mass. This exceptional association and the importance of its early diagnosis justify the communication of the case.     

Primary abdominal actinomycosis in a diabetic woman—an intractable disease

Primary abdominal actinomycosis is very unusual. Only five previous cases have been reported in the English literature.We describe the case of a 57-year-old diabetic woman with primary abdominal actinomycosis, refractory to several antimicrobial regimens and surgical procedures.We conclude that primary abdominal actinomycosis in such a diabetic woman is an intractable disease.