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Congenital pulmonary airway malformation is a rare congenital malformation of the lower respiratory tract with a worldwide incidence of 1: 11,000 to 1: 33,000 live births. CPAM cases are increasingly being diagnosed antenatally with antenatal anomaly scans having been made compulsory with the availability of improved imaging technologies. Here, we present a case of CPAM in a 14-month-old child who was diagnosed with congenital anomaly during the antenatal scan and was managed with lobectomy to prevent further progression of the disease and preserve the function of normal residual lung parenchyma. Histopathological examination of the lobectomy specimen revealed CPAM type II. During clinical follow-up, the child is asymptomatic and is achieving his developmental goals as per his age.

Multilocular Cystic Renal Neoplasm of Low Malignant Potential (MCRNLMP) is a distinct type of clear cell renal tumor. The diagnostic histological criteria for this entity have evolved, and specific histological features have been modified over the years. The WHO 2022 of Male Urinary System and Male Genital Tumours respecified diagnostic histopathological features. Maximum tumors are asymptomatic and are incidentally detected on radiological examination. Computed tomography using contrast agents is still the gold standard for classifying cystic tumors of kidney. The Bosniak category of renal cystic lesions is crucial for the management of other imaging modalities such as magnetic resonance imaging (MRI) and contrast-enhanced ultrasound, which can be used with the same effectiveness. The prognosis is excellent in MCRNLMP, and there are no reports of cancer progression or metastasis. Minimally invasive nephron-sparing surgery with strict clinical including imaging follow-up with contrast-enhanced computerized tomography and magnetic resonance imaging is a choice of treatment.

Congenital pulmonary airway malformation (CPAM) is a rare congenital lung malformation accounting for 25% of congenital malformations and 95% of congenital lung lesions. Diagnosis prenatally is by ultrasonography while postnatal diagnosis follows presentation with respiratory distress symptoms and radiographic imaging. Although they are often misdiagnosed radiologically, most cases of CPAM are manageable with proper assessment, diagnosis and interventions.

Objectives: We performed preoperative evaluations of giant ovarian tumors in older adult patients using the comprehensive geriatric assessment (CGA) and estimation of physiologic ability and surgical stress (E-PASS) scoring systems. We report a case in which the Aron Alpha method was performed, and perioperative management was performed using enhanced recovery after surgery (ERAS). Materials and Methods: We performed preoperative evaluations using the E-PASS scoring system and CGA on older adult patients with giant ovarian tumors, followed by the minimally invasive Aron Alpha method and perioperative management using ERAS. Results: The mean patient age was 75.8 ± 8.8 years; comorbidities included hypertension in three patients, hyperlipidemia in two, angina pectoris in one, cholecystitis in one, and lower extremity varicose veins in one. The mean tumor size was 21.0 ± 5.4 cm. The E-PASS scoring system showed a preoperative risk score of 0.7 ± 0.4, a surgical stress score of 0, and a comprehensive risk score of 0.3 ± 0.3. CGA showed that two patients had problems with activities of daily living and cognitive function. The mean duration of surgery was 89.0 ± 16.6 min, and the mean blood loss was 56.0 ± 65.4 mL. No surgery-associated complications were observed. No patients had prolonged hospitalization or a decline in activities of daily living. Conclusion: We showed the usefulness of performing detailed preoperative evaluations using CGA and the E-PASS system, followed by the minimally invasive Aron Alpha surgical method and perioperative management using ERAS in improving surgical outcomes in older adult patients with giant ovarian tumors.

Abstract Low grade endometrial stromal sarcoma (LGESS) typically presents as a solid intracavitary or intramural uterine mass. On imaging, LGESS is usually seen as an endometrial or myometrial solid mass. Cystic change is unusal and may lead to a differential diagnosis of an ovarian mass as was seen in the present case. Here we present a case of a 38 year old woman who presented with a cystic ovarian mass clinically and radiologically. Per-operatively, it was found to be a multiloculated cystic mass, filled with serosanguinous fluid, in the uterine fundus. Histopathological examination showed a tumor mass composed of mainly spindle cells arranged in fascicular pattern showing marked myxoid degeneration and cystic areas. On immunohistochemistry(IHC), tumor cells showed positivity for CD 10, ER, PR, SMA and desmin while HMB45 was negative. Based on histopathological and IHC, a diagnosis of LGESS was made. Most cases of cystic uterine masses have a benign course but, LGESS exhibits a relatively poorer outcome and a risk of metastasis. Hence, we present this case for its unusual presentation which mimics an ovarian mass but has worse prognosis.

Abstract Background While spontaneous pneumothorax has been documented in COVID-19 patients, reports on recurrent spontaneous pneumothorax due to cystic lesions in convalescent COVID-19 patients are scarce. The progression of these lung cystic lesions remains inadequately explored. Case presentation and literature review An 81-year-old male, a non-smoker with a history of rheumatoid arthritis, presented with fever, cough, and expectoration for 14 days. Initially diagnosed with moderate COVID-19, he deteriorated to severe COVID-19 despite adherence to local treatment guidelines. Successive identification of three cystic lesions termed “bulla” or “pneumatocele”, and one cystic lesion with air-fluid level, referred to as “pneumo-hamatocele” (PHC), occurred in his lungs. Gradual improvement followed anti-inflammatory therapy and optimal supportive care. However, on day 42, sudden worsening dyspnea prompted a computed tomography (CT) scan, confirming a right spontaneous pneumothorax and subcutaneous emphysema, likely due to PHC rupture. Discharge followed chest tube implementation for pneumothorax resolution. On day 116, he returned to the hospital with mild exertional dyspnea. Chest CT revealed recurrent right pneumothorax from a remaining cyst in the right lung. Apart from our patient, literature retrieval identified 22 COVID-19 patients with spontaneous pneumothorax due to cystic lesions, with a male predominance (95.6%; 22/23). Diagnosis of pneumothorax and lung cystic lesions occurred around day 29.5 (range: 18–35) and day 26.4 (± 9.8) since symptom onset, respectively. Except for one patient whose pneumothorax occurred on day seven of illness, all patients eventually recovered. Conclusions Recurrent spontaneous pneumothorax secondary to lung cystic lesions may manifest in convalescent COVID-19 patients, particularly males with COVID-19 pneumonia. Chest CT around 2 to 3 weeks post-symptom onset may be prudent to detect cystic lesion development and anticipate spontaneous pneumothorax.

Solitary fibrous tumor (SFT) is a rare spindle cell tumor originating from mesenchymal tissue, and even rarer when it occurs intracranially. This case report described a 42-year-old man who presented with headache and limb weakness for more than 10 days. Magnetic resonance imaging (MRI) showed a well-defined multicompartmental cystic space-occupying lesion in the left occipital region, with surrounding edema and a compressed left lateral ventricle, the mass growing across the cerebellar vermis, which was initially diagnosed as hemangioblastoma. Neurosurgery was utilized to successfully remove the mass, and intracranial solitary fibrous tumor (ISFT) was identified by postoperative pathological analysis. Here, this article describes the imaging manifestations and pathologic features of a case of cystic intracranial solitary fibrous tumor, aiming to improve the understanding and diagnosis of this disease in order to provide an accurate therapy plan.

Tubular ectasia of the rete testis (TERT) presents as multiple cystic structures within the rete testis, often incidentally detected on ultrasound as echo-free intratesticular cystic lesions. Despite its benign nature, assessing testicular cystic lesions can sometimes be challenging. The primary importance of identifying this uncommon condition lies in its distinction from cystic testicular malignancies and thus avoiding further radical procedures. We report an instance of TERT within the right testis discovered incidentally in a patient with a medical background of epididymitis, presenting for management of left testis cryptorchidism, and bilateral inguinal hernia.

One percent of all lymphangiomas are retroperitoneal lymphangiomas, which are uncommon benign cystic lymphatic tumors. Lymphangioma mainly occurs in the age group of

Ovarian lesions represent a diagnostic challenge for the radiologist and should be approached according to the patient's age, menstrual cycle, and imaging characteristics. These lesions can be cystic, mixed, or solid-predominant structures. Generally, the occurrence of benign lesions surpasses that of malignant ones at a ratio of 3:1. However, within infantile and juvenile age groups, this becomes an infrequent occurrence, making up only about 5% of ovarian tumor cases. This case report sheds light on a unique scenario involving a pediatric patient who harbored 2 benign tumors simultaneously: a mature cystic teratoma and a serous cystadenoma.

Capillary hemangiomas, usually found in skin and mucosal tissues, are rarely encountered within the spinal cord, presenting a significant diagnostic challenge. We report a rare case of intradural extramedullary capillary hemangioma at the conus medullaris in a 66-year-old female patient. Our initial diagnosis leaned towards a cystic hemangioblastoma based on MRI findings due to the presence of cystic formation with an enhanced mural nodule. However, surgical exploration and subsequent pathological examination revealed the lesion as a capillary hemangioma. To the authors’ knowledge, this case may represent the first documented instance of a spinal capillary hemangioma that mimics a cystic hemangioblastoma.

Objective: To compare the efficacy and safety of ethanol ablation (EA) and m icrowave ablation (MWA) in the treatment of cystic or predominantly cyst ic thyroid nodules. Methods: Patients with cystic or predominantly cystic thyroid nodules i ntervened with EA or MWA were retrospectively enrolled and divided into EA group (n = 30) and MWA group (n = 31). The volume and volume reduction rate (VRR) of thyroid nodules before ablation, and at 3 and 12 months after ablation were compared between the two groups. The effective rate (ER) and incidence of adverse events in both grou ps were recorded. Results: The median VRR and ER at 3 months after ablation were significa ntly higher in EA group than in MWA group (81.30% vs 75.76%, P = 0.011; 76.67% (23/30) vs 51.61% (16/31), P = 0.040), while no significant difference was detected at 12 months (93.39% vs 88.78%, P = 0.141; 86.67% (26/30) vs 87.10% (27/31), P = 0.960). The median VRR of small nodules in EA group was significantly higher than that in MWA group (81.30% vs 71.18%, P = 0.006; 93.40% vs 83.14%, P = 0.032). There was no significant difference of median VRR in medium nodules at final follow-up between MWA and EA group (93.01% vs 89.68%, P = 0.482). Serious adverse events were not reported in both groups. Conclusion: EA and MWA are both effective and safe in the treatment of cyst ic or predominantly cystic thyroid nodules. EA is more cost-effective and effective than MWA for small nodules, but it requires more cycles of treatment and may pose a higher risk of postoperative pain compared with MWA.

Purpose The aim of this multicenter study was to investigate the malignancy risk of minimally cystic thyroid nodules (MCTNs) using cyto-histopathologic diagnoses as the reference standard. Methods From June 2015 to September 2015, 5,601 thyroid nodules (≥1 cm) from 4,989 consecutive patients who underwent thyroid ultrasonography (US) at 26 institutions were retrospectively analyzed. Each thyroid nodule was categorized according to its cystic proportion: purely solid, minimally cystic (≤10%), and partially cystic (>10%). The malignancy risk of MCTNs was compared with those of purely solid nodules and partially cystic thyroid nodules (PCTNs). The malignancy risk of MCTNs was assessed according to echogenicity and the presence of suspicious US features. Results The prevalence of MCTNs was 22.5%. The overall malignancy risk of MCTNs was 8.8%, which was significantly lower than that of purely solid nodules (29.5%) (P0.05). MCTNs were associated with a higher risk of malignancy in hypoechoic nodules than in isohyperechoic nodules and in nodules with suspicious US features than in those without suspicious US features (all P

Background and Purpose: Liver metastases are common in neuroendocrine neoplasm (NEN). Cystic NEN liver metastases (cNENLM) are rare, and the efficacy of transarterial embolization (TAE) has not been reported. This study summarized and analyzed the efficacy and safety of TAE for cNENLM. Methods: From January 2016 to April 2022, 10 patients with cNENLM were enrolled in this study among 440 patients under TAE treatment at The First Affiliated Hospital, Sun Yat-sen University and Fudan University Shanghai Cancer center. The efficacy was evaluated according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. Objective response rate (ORR), disease control rate (DCR) and progression-free survival (PFS) were analyzed as well. The common terminology criteria for adverse events (CTCAE) v5.0 was applied to evaluate the adverse effects. Results: With 80.0% ORR and 100.0% DCR according to RECIST 1.1, 3 cases achieved PFS. Among them, the longest one was 25.0 months. Disease progression was not observed in the remaining patients. The common complications were fever, hepatalgia and transient liver dysfunction, which could be alleviated by symptomatic treatment. No severe complication occurred. Conclusion: cNENLM are infrequent. TAE had significant curative effect on cNENLM, and complications were manageable.

Schwannomas are benign nerve sheath tumors arising from differentiated Schwann cells. Common location is head & neck region, they are generally solitary. Retroperitoneal schwannomas are relatively rare accounting for 0.3 - 3.2% of benign schwannomas. Multiple schwannomas in the retroperitoneal region are extremely rare with only 4 cases reported till date. Pre-operative diagnosis of retroperitoneal schwannomas is difficult because they remain asymptomatic and also because they have a tendency to undergo cystic degeneration causing confusion in imaging studies. We present a case of 45 year old lady operated with provisional diagnosis of disseminated retroperitoneal hydatid cysts, which after histopathological examination was confirmed to be a case of multiple retroperitoneal schwannomas.

Multiple renal cysts in adult patients could have asymptomatic, benign and a nonprogressive course. However, these cysts could be renal features of a very rare hereditary, progressive syndrome defined as cranioectodermal dysplasia (CED or Sensenbrenner syndrome). Affected patients show dysmorphic features such as craniosynostosis, nail dystrophy, cutaneous dyshydrosis, dry or scaly palmar skin, trichodysplasia, deafness, pectus excavatum, telecanthus, hypertelorism, low set ears, everted lower lip, anteverted nares, short neck and height, joint laxity, inguinal hernia, widely spaced teeth, microdontia, hypodontia in addition to nephronophthisis. We report a 22-year-old male hypertensive patient with multiple renal cysts and dental malformations listed as malocclusion, screwdriver shaped crowns, widely spaced front teeth, microdontia and hyperdontia. Molecular analysis reported missense p.(Ala875Thr) and p.(Lys969Asn) variants in the WDR35 gene. The 1-year follow-up of this case provided the knowledge that angiotensin II receptor blocker drug (olmesartan) reduced the microalbuminuria to normal levels and preserved the renal functions. We suggest interdisciplinary studies, especially intraoral and genetic evaluations for patients with cystic renal diseases. For the first time we report that hyperdontia could be found as a dental feature of CED.

Brenner’s tumour is a rare epithelial ovarian cancer, accounting for less than 5% of all cases. It is characterised by the presence of cells with transitional features between epithelial and mesenchymal cells. The diagnosis of Brenner’s tumour of the ovary has become more frequent in recent years. Accurate diagnosis is crucial since it exhibits distinct clinical behaviour and prognosis compared to other types of ovarian cancer. Studies have confirmed that this type of ovarian cancer shares unique characteristics similar to urothelial tissue and can be differentiated from non cancerous abnormal growths known as metaplastic and/or malignant Brenner’s tumours. Hereby, the authors present a case report of a 54-year-old woman, who presented with lumbar pain, abdominal discomfort, weight loss, abnormal uterine bleeding, and a persistent abdominal mass for a month. Abdominal and pelvic magnetic resonance imaging revealed an abnormal extensive, lobulated, and ill-defined lesion with solid and cystic components. The patient’s alpha-fetoprotein tumour marker was within the normal range (5.20 IU/mL), while beta-human chorionic gonadotropin (8.67 mIU/ mL) and carcinoembryonic antigen (5.3 ng/mL) levels were slightly elevated. Serum Cancer Antigen (CA)-19-9 levels were within the normal range (9.0 U/mL). Following the surgical procedure, microscopic examination of the tissue confirmed the primary type of cancer in the ovary as Brenner’s tumour. Due to its rarity, favourable response to chemotherapy, and lower incidence compared to other tumour types, patients with Brenner’s tumours typically have a better prognosis.

We report a case of multifocal cystic meningioangiomatosis (MA), an exceptionally uncommon diagnosis even in patients with type 2 neurofibromatosis (NF2). A 2-year-old male with personal as well as family history of genetically-confirmed NF2 presented with incidental findings of MA after imaging for closed-head injury. Computed tomography and magnetic resonance imaging revealed multifocal subcortical and basal ganglia cysts, enhancing tumor-like vascular encasement, and a cerebellar ependymoma with atypical features. Given the paucity of available literature describing this pathology, imaging findings are discussed to further characterize this elusive disease. Radiologists must keep in mind that children with NF2 may not only present with MA, but also a constellation of MA with classic NF tumors, including ependymoma as in this case.

We present the first case of clival cystic chordoma with extradural location, transdural transgression, and moderate bone involvement in a 10-year-old girl. Chordoma showed unconventional appearances on computed tomography (CT) and magnetic resonance imaging (MRI), due to cystic components, extradural space location with extensive intradural extension, moderate superficial bone involvement. Surgery confirmed the extradural location and histopathological examination revealed cystic chordoma. MRI and CT findings were not characteristic for a single lesion; differential diagnoses included cystic lesions such as epidermoid and dermoid cyst, ecchordosis physaliphora, and benign notochordal cell tumors.

Category of research Treatment. Number and type of study designs reviewed Two relevant publications were found, both were retrospective case series. Strength of evidence Weak. Outcomes reported The success rate of horses returning to previous level of competition following arthroscopic debridement varies widely in the literature available, from 25–86%. While a study reports 64% return to soundness following rest, it is not clear which horses received strict box rest or paddock rest, the duration of the rest period, and whether non-steroidal anti-inflammatory drugs were also prescribed. It is also worth noting that all horses which undergo surgery will also undergo a period of box rest – which makes the two treatment options difficult to compare. Conclusion Newer techniques with better success rates are now available and should be considered in lieu of box rest or arthroscopic debridement. Across all treatments available, age remains an important factor with regards to return to soundness, with older horses having a poorer prognosis. Thorough examinations should therefore be performed to rule out concurrent conditions before deciding upon treatment options. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Background: Pancreatic cystic lesions are heterogeneous lesions that could be benign, borderline, or malignant. Neoplastic cystic lesions/tumours are rare tumours of the exocrine pancreas; difficult to diagnose preoperatively, and they account for 2%–10% of pancreatic tumours. Pancreatic pseudocyst is the most typical benign cystic pancreatic lesion arising from pancreatic ductal inflammation or ductal disruption. Both benign and malignant cystic pancreatic lesions are amenable to surgical treatments, with a good prognosis. Aim: The aim is to present our 11yrs of experience in the management of pancreatic cystic lesions. Materials and Methods: We conducted a retrospective review of pancreatic cystic lesions managed at the General Surgery Unit of Usmanu Danfodiyo University, Sokoto, Nigeria, from 2010 to 2020. A retrospective review of the case notes of patients was done with an emphasis on biodata, presentation, investigations treatment offered, complications, and follow-up were analysed using the Statistical Package for the Social Science (SPSS) version 22, Inc. (Chicago II, USA). Results: We managed 28 patients over 11 years. Three patients had pancreatic cystic tumours, whereas 25 patients had pancreatic pseudocysts. The age ranges of the patient with pancreatic cystic tumours are 29–50 years with a male-to-female ratio of 2:1. All the patients had tumour excision with histology revealing two pseudopapillary tumours of the pancreas and one serous cystadenoma. The age range of patients with pseudocyst is 27–42 years with a male-to-female ratio of 1:3.1, and most of the patient had internal drainage. Conclusion: Pancreatic cystic tumours are uncommon pancreatic neoplasms that are amenable to surgical interventions with a good prognosis. Pancreatic pseudocyst was seen mainly in females within the young age group. Both benign and neoplastic pancreatic cystic lesions are amenable to surgical intervention with a good prognosis.

Neuroblastoma is a neoplasm of the peripheral sympathetic nervous system. Depending upon the primary location of the tumor, it can present as incidental finding, hypertension, abdominal pain, and distention with nonspecific clinical signs. Our patient was four-months-old when he developed excessive crying, increased frequency of micturition, and loose bowel movements. On CT scan, a cystic mass was found in the left suprarenal region and was surgically removed. Immunohistochemistry of the mass confirmed the diagnosis of cystic neuroblastoma. The outcome was good after surgical excision and chemotherapy. Early diagnosis and management of cystic neuroblastoma will result in a good outcome.

Neuroblastoma is a neoplasm of the peripheral sympathetic nervous system. Depending upon the primary location of the tumor, it can present as incidental finding, hypertension, abdominal pain, and distention with nonspecific clinical signs. Our patient was four-months-old when he developed excessive crying, increased frequency of micturition, and loose bowel movements. On CT scan, a cystic mass was found in the left suprarenal region and was surgically removed. Immunohistochemistry of the mass confirmed the diagnosis of cystic neuroblastoma. The outcome was good after surgical excision and chemotherapy. Early diagnosis and management of cystic neuroblastoma will result in a good outcome.

Cystic meningiomas are very rare tumors of the central nervous system. We report the case of a 62-year-old female how presented headaches resistant to usual analgesics with behavior disorders. Cerebral CT scan showed a right frontal extra-axial tumor with firm and cystic component, brain MRI evoked the diagnosis, surgery removed the entire tumor and histological examination confirmed it. A cystic meningioma should not be omitted from the differential diagnosis of brain tumors with a cystic component and which clinical, radiological, histological and therapeutic features are discussed.

Abstract Background Adenomyoepithelioma (AME) of the breast is a rare subtype of breast tumor. Most of AMEs reported are solid, however, cystic or prominent cystic changes are extremely rare. Case presentation A 51-year-old woman presented a lump in the upper outer quadrant of right breast, and it was accompanied by continuous breast pain and bilateral axillary itching for more than 2 months. There were no other symptoms found. Preoperative mammography and ultrasound examination were performed. Mammography showed a noncalcified lobulated mass, and it was considered to be a benign cyst with septum on ultrasound, but ductal carcinoma of breast, adenoid cystic carcinoma could not be excluded. At first, AME was not considered preoperatively, because the imaging features of this rare tumor may vary widely, which may result in an incorrect diagnosis. But eventually, AME was diagnosed by postoperative pathology and immunohistochemistry. Conclusion We herein present a rare case of breast AME with prominent cystic changes. AME has no-specific imaging features, but the benign or malignant nature of the lesion might be suspected on imaging.

Abstract Cystic pulmonary tuberculosis is a unique form of pulmonary tuberculosis (PTB) presenting with multiple reversible cysts of the lung. Unlike the other forms, this cystic lung disease can improve with prompt tuberculosis treatments. Here we report the case of a 15‐year‐old girl who presented with respiratory failure and severe lung damage at hospital admission. We diagnosed her with PTB based on her positive GeneXpert result test. The patient was treated with a standard tuberculosis regimen for 6 months and recovered completely.

Myrlene Sanon Aigbogun,1 Robert A Stellhorn,1 Christina S Pao,1 Stephen L Seliger2 1Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA; 2University of Maryland School of Medicine, Baltimore, MD, USACorrespondence: Stephen L SeligerUniversity of Maryland School of Medicine, 10 N. Greene Street, Baltimore, MD, 21201, USATel +410 605-7000 x5231Fax +410 328-5685Email sseliger@som.umaryland.eduBackground: Progression of autosomal dominant polycystic kidney disease (ADPKD) is highly variable, with some patients progressing rapidly to end-stage renal disease (ESRD). Abdominal imaging is an important modality for verifying diagnosis in patients at risk for rapidly progressing ADPKD, targeting them for early treatment that could slow onset of ESRD. Published literature is limited on the real-world abdominal imaging utilization patterns in ADPKD.Methods: A retrospective healthcare administrative claims analysis examining abdominal imaging scans occurring from January 1, 2014, through June 30, 2017, was conducted using the IBM MarketScan® commercial and Medicare supplemental databases. Patients in the United States who were at least 18 years old and had at least 1 inpatient claim or 2 outpatient claims (with different dates of service) with an ADPKD diagnosis code, as defined by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM codes 753.12 [polycystic kidney, unspecified type] and 753.13 [polycystic kidney, autosomal dominant] and/or Tenth Revision (ICD-10-CM codes Q61.2 [polycystic kidney, adult type] and Q61.3 [polycystic kidney, unspecified]) were included.Results: Of the 4637 patients with ADPKD (mean age, 51.2 years [SD = 15.52]), 59% had ≥ 1 abdominal imaging scan. Of these patients, 46% had ≥ 1 computed tomography (CT) scan, 25% had ≥ 1 ultrasound, 10% had ≥ 1 magnetic resonance imaging scan. Among the 1754 patients (38%) with chronic kidney disease (CKD) stage information, CT imaging was more frequent in later stages (31% stage 1 versus 68% stage 5). The proportion of patients undergoing at least 1 CT or MRI scan increased with disease severity (37% in stage 1, 42% in stage 2, 48% in stage 3, 56% in stage 4, and 71% in stage 5).Conclusion: Results of this analysis support the need for further investigation into abdominal imaging utilization in managing patients with ADPKD. Future research could clarify barriers and increase access to imaging, which has the potential to inform risk stratification, help patients delay dialysis or transplantation associated with ESRD, and help health systems avoid the costs associated with ESRD.Keywords: polycystic kidney, autosomal dominant, kidney diseases, cystic, MRI, CT scan, ultrasound

Lymphangiomas are a rare benign proliferation of the lymphatic system. Intra-abdominal lymphangioma is rare and accounts for

Abstract We report a case of a 28‐year‐old immunocompetent woman found to have a mediastinal lesion on chest x‐ray performed as part of a visa renewal process. Computed tomographic imaging revealed a cystic superior anterior mediastinal mass. Although initially asymptomatic, the woman subsequently developed progressive chest discomfort. She underwent surgical resection of the mass. Histological assessment demonstrated necrotizing granulomatous inflammation, while Gene Xpert™ testing was positive for Mycobacterium tuberculosis complex and she was subsequently commenced on anti‐tuberculous therapy.

Background: Renal oncocytomas are benign epithelial tumors usually detected incidentally. They are typically solid,well-circumscribed,homogenous,mahoganybrown with a central stellate scar.Sometimes,they can have cystic degenerationand rarely present as a multilocular cyst which can be mistaken for other cystic renal carcinomas. Methods: We describe a case of incidentally detected multilocular cystic renal oncocytoma having an unusual gross appearance of multiloculation with perinephric fat invasion. The tumor exhibited tubulocystic architecture posed a diagnostic dilemma. Detailed study of multiple sections coupled with immunohisto chemistry helped elucidate the diagnosis. Till date, only eight cases of multicystic renal oncocytoma have been reported in the English literature. Conclusions: We emphasize the importance of awareness of this unusual morphologic variation to ensure correct diagnosis.

Rationale & Objective: Little is known about symptoms and disease impacts in adolescents with autosomal dominant polycystic kidney disease (ADPKD). The objective of the study was to explore these issues from the adolescent patient’s perspective. Study Design: Observational, qualitative study. Setting & Participants: Eligible participants were 12-17 years old and had a diagnosis of ADPKD. Semi-structured interviews were conducted in 18 cities in 13 countries to elicit participant experiences of ADPKD-related symptoms and physical, social, and emotional impacts. Analytical Approach: Interviews were recorded, transcribed, and coded. Symptom and impact frequencies from the interviews were calculated, and representative quotes concerning elicited concepts were collated. Results: Thirty-three participants (mean age, 14.6 years; 42.4% female) completed interviews. Frequently reported symptoms included urinary urgency (n = 10; 30.3%) and back pain (n = 9; 27.3%). Consistent with previous findings in adults, participants experienced 3 primary types of pain: dull kidney pain, severe or sharp kidney pain, and a feeling of fullness and/or discomfort. Reported disease impacts included avoiding sports and physical activity (n = 10; 30.3%), missing school (n = 6; 18.2%) and social activities (n = 6; 18.2%), and feeling worried (n = 6; 18.2%), sad (n = 4; 12.1%), or frustrated (n = 3; 9.1%) about the disease and their future. Approximately one-fifth of participants (n = 7; 21.2%) reported that they were bothered or impacted by dietary limitations (primarily the need for reduced sodium intake and increased water intake). Limitations: The study had a small sample size. The researchers were unable to conduct focus groups with participants because of parental preferences. Conclusions: The findings from this exploratory study indicate that a substantial proportion of adolescents with ADPKD experience physical, social, and emotional impacts from their disease.

Objective: The objective of the study is to study the efficacy of ultrasonography (USG) and fine- needle aspiration cytology (FNAC) in the evaluation of neck masses and differentiating between cystic, inflammatory, benign, and malignant neck masses with a histopathological correlation. Study Design: Prospective study and observational study. Setting: J. L. N. Hospital and Research Centre, Bhilai (C. G). Study Period: June 1, 2016–May 30, 2017. Materials and Methods: Sonographically, neck masses were evaluated final diagnosis was made on the basis of FNAC and histopathology of excised specimens. Finally, the USG findings were correlated with FNAC report and histopathology reports (wherever possible) to evaluate their sensitivity, specificity, and accuracy by statistical methods. Results: Most of the cases clustered between 31 and 60 years of age group. Among all patients, males outnumbered the females with the M:F ratio 1.5:1. Hyperechoic and anechoic lesions suggested benign pathology, whereas chances of malignancy were highest with hypoechoic lesions. As diagnosed by USG, the majority was benign lesion (36.4%), followed by inflammatory neck masses (27.08%), then cystic neck masses (20.83%) and least was malignant masses (15.63%). FNAC impression diagnosed benign mass (32.29%), inflammatory mass (26.04%), cystic mass (19.79%), and malignant mass (15.63%). The diagnostic accuracy of USG, FNAC, and Histopathological Examination (HPE) was comparable as P ≤ 0.05 for inflammatory, cystic, benign, and malignant neck masses. Conclusion: High-resolution grayscale ultrasound can differentiate inflammatory, cystic, benign and malignant neck masses. FNAC can be considered highly efficacious in distinguishing benign and malignant neck masses. A team work between a cytopathologist, radiologist, and clinician maximizes the diagnostic utility of USG and FNAC.

Cystic renal masses are commonly encountered in daily clinical practice. Improvements in the resolution of imaging modalities have led to an improved ability to detect cystic renal masses. It is important for radiologists to recognize and appropriately characterize cystic renal masses. Since 1986, the Bosniak classification system has been widely accepted for the evaluation of cystic renal masses, portions of which have been revised in 2019. Although the Bosniak classification system cannot fully differentiate aggressive lesions from indolent lesions, the system may help improve the specificity of detection for higher-risk classes for malignancy, increase the proportion of masses that are surveilled or ignored rather than resected, and select optimal management strategies.

The aim of this study was to analyze the clinical presentation, diagnosis and treatment of primary renal hydatidosis. A thorough review of the literature was made using the PubMed database. Cystic echinococcosis is a disease that results from infection with the larval stage of Echinococcus granulosus, a tiny tapeworm found in dogs (definitive host), sheep, cattle, goats, foxes and pigs, amongst others (intermediate hosts). Humans are accidentally intermediate hosts, who become infected by direct contact with infected dogs, by ingesting contaminated raw or undercooked vegetables or by drinking contaminated water. Renal involvement by hydatid disease is uncommon (less than 3-4%), most cystic lesions occurring in the lungs or liver. Patients may be asymptomatic or they can present with flank pain, hematuria or hypertension. Hydaturia, considered a pathognomonic sign, is seen in less than 20% of cases. Imaging investigations are essential in making the correct diagnosis, the most commonly used means being ultrasonography and CT scans. Surgery is the mainstay of treatment, but other therapeutic options are also available.

ABSTRACT: Pancreatic cysts are rare in both humans and animals. They are defined as an enclosed structure externally surrounded by a capsule, internally coated with a cuboidal epithelium and filled with liquid or semi-solid content. This case described the clinical and pathological characteristics of a pancreatic cyst in a feline. A mixed breed cat with a history of recurrent vomiting was attended. Physical examination revealed pain on abdominal palpation. Abdominal ultrasonography showed a cystic, anechoic structure with well-defined edges located in the left cranial abdomen and in close contact with the duodenum and pancreas. Partial pancreatectomy was performed. Microscopically, the structure was surrounded by fibrous material, coated with cuboidal to columnar epithelium, and containing eosinophilic material. Although, pancreatic cyst is rare in animals, they should be included in the differential diagnosis of causes of vomiting in young cats.

Appendiceal tumors comprise a variety of histologic types, including appendiceal mucinous neoplasms, which can be grouped as premalignant lesions, tumors of uncertain malignant potential, and malignant lesions. The appendiceal mucinous neoplasms are characterized by mucinous epithelial proliferation with extracellular mucin and pushing tumor margins, commonly an incidental finding during operative exploration. We report the case of a low-grade appendiceal mucinous neoplasm presenting as a subepithelial lesion in Crohn´s Disease patient. The diagnosis was not straightforward, and only surgical resection allowed an accurate diagnosis. Although Inflammatory Bowel Disease is a risk factor for the development of colorectal neoplasms, the absolute risk for appendiceal tumors is uncertain. The frequency of progression to malignancy remains to be determined.

Background: Cystic hygroma (cystic lymphangioma) is a malformation of the lymphatic system. It is rare in adults and trauma may be the cause in some cases. Surgical and non-surgical treatment methods have been described in the management of cystic hygroma. Case Report: A 38-year-old woman, known case of systemic lupus erythematosus (SLE), presented a huge cystic formation in the posterior aspect of her thigh following trauma. We treated the patient using a combination of three treatment methods including surgical excision, intra-cavity bleomycin injection, and post-operative use of compression pants. Conclusion: Huge post-traumatic cystic hygroma in adults is rare. By the combination of the above three therapeutic regimens, there was no cystic lesion recurrence after eight months.

Cystic hygromas are relatively rare, congenital, benign lymphatic malformations, characterized by single or multi-loculated, fluid filled cavities. As these masses most often occur in the head and neck they can result in significant airway obstruction. We present the case of an infant born with a large, obstructive cervical cystic hygroma and the challenges of airway management in this clinical scenario.

We report a case of a metastatic squamous cell carcinoma arising from a retrorectal cystic hamartoma (RCH). The RCH was first diagnosed at Singapore General Hospital (SGH) on magnetic resonance imaging (MRI) scan, and subsequently underwent malignant transformation and metastasized years later. Malignant transformation of RCHs is an exceedingly rare event and usually manifests as an adenocarcinoma or a well differentiated neuroendocrine tumour. There have only been two previously reported cases of squamous cell carcinoma and neither of them lead to metastatic disease. This is the first reported case of a metastatic tumour arising from a RCH.

Résumé Contexte Les lymphangiomes du pénis sont des manifestations rares des lymphangiomes ou des malformations lymphatiques qui sont plus fréquemment observés dans les régions de la tête ou du cou au niveau du corps. Les lymphangiomes sont aussi classés en lymphangiome circumscriptum, lymphangiome caverneux, hygroma kystique, ou en lymphangiomes acquis (aussi connus sous l’appellation lymphangiectasie), selon leur profondeur et leur étiologie. Résultats Une revue de la littérature ne révèle que 30 cas de lymphangiomes du pénis rapportés entre 1947 et Mars 2018. Plusieurs causes ont été attribuées aux lymphangiomes acquis du pénis, parmi lesquelles les traumatismes, le phimosis et les infections. Bien que les lymphangiomes péniens puissent être initialement pris pour une infection, une recherche des antécédents et un examen clinique minutieux sont suffisants pour diagnostiquer cliniquement un lymphangiome du pénis. L’excision chirurgicale a toujours constitué le gold standard du traitement de cette maladie. Lorsqu’elle est asymptomatique, les patients peuvent choisir un traitement conservateur en évitant les seuls traumatismes mécaniques. D’autres médecins ont proposé de nouveaux traitements ayant pour objectif de débarrasser les patients de leurs lymphangiomes péniens, comme la procédure au laser par étapes. Conclusion A partir des données de la littérature, nous avons clarifié dans cet article les causes, symptômes, traitements et résultats associés aux lymphangiomes du pénis ; nous avons aussi présenté le cas d’un homme afro-américain âgé de 30 ans diagnostiqué comme porteur d’un lymphangiome pénien acquis. Mots-clés Caverneux, Circumscriptum, Kystique, Hygroma, Lymphangiome, Lymphangiectasie, Pénien, Pénis.

Abstract Background Cystic lung lesions involving both lungs include a variety of diseases, such as pulmonary Langerhans cell histiocytosis, lymphangioleiomyomatosis and pulmonary metastasis. Primary pulmonary meningioma accompanied with intrapulmonary metastasis was extremely rare and we were not aware of previous studies reporting with cystic radiological manifestation. Case presentation A 64-year-old female patient was admitted to our department for a mass located in right posterior mediastinum with multiple cystic pulmonary lesions. A thoracoscopic lung biopsy was performed and the diagnosis was confirmed as bilateral pulmonary metastasis from primary pulmonary meningioma. Conclusions Intrapulmonary metastasis from a primary pulmonary meningioma may manifest as multiple thin-walled cystic lesions on computed tomography. Differential diagnosis of cystic pulmonary disease should include this situation. Our case shows the new CT manifestation of metastatic primary pulmonary meningioma and the importance of immunomolecular analysis.

Abstract Background Carcinomas composed predominantly or purely of malignant Paneth cells were rarely reported in gastrointestinal system. They have not been reported at gastroesophageal junction nor has the association with Barrett esophagus been explored. None of the previous studies has mentioned any peculiar histologic features other than typical adenocarcinoma containing neoplastic Paneth cells. The Her2/neu status and the expression of beta-catenin in Paneth cell carcinoma at gastroesophageal junction have not been studied although the activated beta-catenin pathway was recently demonstrated in neoplastic Paneth cells in colon. Case presentation A 70-year-old Caucasian male who initially presented in the emergency room due to upper gastrointestinal bleeding was subsequently found to have a submucosal nodule at gastroesophageal junction. A diagnosis of adenocarcinoma was rendered on biopsy. Histologic examination of the subsequent endoscopic mucosal resection revealed an adenocarcinoma with various levels of differentiation which are zonally distributed. The deeper portion of the tumor showed well-differentiated bland-appearing glands with extensive cystic and secretory changes. The cytoplasm of tumor cells and secretion demonstrated marked reactivity with lysozyme antibody on immunohistochemical stain. The tumor had a peculiar Her2/neu staining pattern with cytoplasmic and nuclear stain in poorly-differentiated area and no stain in well-differentiated area. Only membranous stain was detected with beta-catenin antibody. Conclusion We reported the first case of Paneth cell carcinoma at gastroesophageal junction. The tumor had well-differentiated area which, when sampled in small biopsies, can mimic benign lesions including those related to proton pump inhibitor therapy. Lysozyme immunohistochemical stain may be helpful when difficulty in diagnosis arises. Her-2/neu was negative but showed a distinct staining pattern. In contrast to neoplastic Paneth cells in colon, beta-catenin pathway did not seem to be activated. More studies are needed for the etiology, pathogenesis, clinical course, prognosis and treatment of Paneth cell carcinoma.

We describe the use of a novel interventional approach to the histopathologic diagnosis of a ventricular septal tumor using intraoperative ultrasound-guided trans-epicardial biopsy without the need for cardiopulmonary bypass in a 2-year-old child. This novel approach has not been previously reported. Multidisciplinary collaboration between cardiothoracic surgery, cardiology, cardiac imaging, and interventional radiology provided the ability to perform cardiac biopsy. This technique may be used in specific cases of cardiac tumors where tissue diagnosis is important, but surgical resection is deemed excessively risky or impossible.

Pheochromocytomas may show atypical imaging findings leading to diagnostic pitfalls. We correlated the results of magnetic resonance imaging (MRI) with those of radionuclide studies in patients with pheochromocytomas. T2-weighted (-w), T1-w chemical-shift and T1-w dynamic contrast enhanced (DCE) MRI sequences were evaluated to assess tumor structure. 131Iodine metaiodobenzylguanidine (MIBG) scintigraphy, 18fluoro (F) deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) or FDG PET/MRI were evaluated for direct comparison. Of a total of 80 adrenal lesions in 73 patients, 20 in 18 patients were pheochromocytomas. More than half (55%) of the pheochromocytomas (n = 11) had the typical increased signal intensity on T2-w and T1-w DCE, while the remaining (n = 9) lesions showed atypical findings; of these nine latter atypical lesions, seven (35%) were cystic (two totally, three predominantly and two partially) and two (10%) were hemorrhagic on MRI. In these atypical lesions, MIBG scintigraphy (n = 5), FDG PET/CT (n = 6) or FDG PET/MRI (n = 2) showed inhomogeneous tracer uptake in the residual viable tissue providing tumor characterization; however, one predominantly cystic pheochromocytoma showed false negative MIBG scan. Our preliminary results show that cystic degeneration may be frequent in pheochromocytoma being so marked that only a thin rim of viable cells may residue to disclose the true nature of the tumor. MRI findings together with those of correlative planar/hybrid radionuclide images are helpful to characterize these atypical pheochromocytomas. In particular, tumor accumulation of MIBG and/or FDG is able to classify these lesions as not simple cysts; in detail, the presence of partial MIBG uptake allows the diagnosis of pheochromocytomas, while the presence of partial FDG uptake generically reflects the presence of viable solid tissue of such cystic tumors.

Objective: The aim of this study was to assess the ability of CT to predict the pathological nature of pancreatic cystic lesions if it is benign, malignant or premalignant. Methods: This is a retrospective study from the database of our hospital EMR (electronic medical records) for pancreatic lesions from patients who proven to be of pathological cystic nature. The diagnosis and characterization of pancreatic cysts were done by multislice 32 CT examination. We reviewed the data from the radiology, surgery and pathology departments from the period of November 2012 until January 2015. We compared between operative and pathological data and findings of MDCT using chi square test. Results: We reviewed the data from the radiology, surgery and pathology departments from the period of November 2012 until January 2015. The study was done on 66 patients. Our results showed that CT features for benign cystic lesions are lobulated shape and a thin wall (≤1 mm) while the round or oval shape or a complex cystic shape with tubular cyst and a thick wall (>1 mm) are more frequently seen in pancreatic premalignant and malignant macrocytic lesions. Conclusion: CT with thin section images allows adequate morphological characterization of macrocytic pancreatic masses that could predict its pathological nature if benign or malignant.

Desmoplastic infantile ganglioglioma (DIG) is a rare supratentorial brain tumor occurring mostly before the age of 2 years. It has a good prognosis and total excision of the tumor is curative, necessitating no further treatment. An accurate pathologic diagnosis is crucial. Until now, approximately 70 cases of this tumor type have been reported. Solid-cystic variety is mostly described with occasional purely solid type lesion also. We are presenting a 12-month-old male infant with developmental delay and a giant cyst on the right side of supratentorial compartment, which showed histological features of desmoplastic ganglioglioma. Hence, the current case is reporting the rare histologic finding of cystic change in desmoplastic ganglioglioma. Cystic form of desmoplastic ganglioglioma should be considered in differential diagnosis of supratentorial cystic lesion in an infant. Prognosis is excellent after complete excision.

Purpose To evaluate the results of two-injection ethanol sclerotherapy in simple renal cysts performed with 5-minute ethanol exposure time. Materials and Methods We retrospectively reviewed 30 renal cysts in 30 patients treated by ethanol sclerotherapy between November 2002 and October 2015. Under ultrasound guidance, the renal cyst was punctured and a 7 Fr pigtail catheter was inserted, and then complete aspiration of the cystic fluid was performed. Then, 99.9% ethanol in a quantity amounting to 1/3–1/2 of the aspirated volume was infused into the cyst and it was immediately removed. The same amount of ethanol was re-infused and removed after 5 minutes. Follow-up examination was performed using ultrasound or CT images at least 3 months after the procedure and pre- and post-treatment cyst volumes were estimated. The therapeutic response was classified as either complete success (volume reduction, ≥ 95%), partial success (volume reduction, 50–95%), or failure (volume reduction, < 50%) based on the volume reduction rate. Results The average volume reduction rate was 96.3%. The rates of complete success, partial success and failure were 80% (n = 24), 20% (n = 6), and 0% (n = 0), respectively. There was no complication except for minor flank pain. Conclusion Two-injection ethanol sclerotherapy with 5-minute exposure time represents a simple and effective treatment for simple renal cysts.

A simple renal cyst usually remains asymptomatic and requires no invasive treatment. Occasionally, however, some cysts may cause pain, hematuria, hypertension, or obstruction of the collecting system. We describe a case of a 50-year-old man who presented with hydronephrosis caused by an ipsilateral simple renal cyst without any stone or significant mass in the urinary system. The patient was eventually treated successfully with sclerotherapy.

Astroblastomas are uncommon tumors of uncertain histogenesis. Recently tanycyte is postulated to be the cell of origin. These occur predominantly in the cerebral hemisphere of young adults and children. Astroblastoma constitutes approximately 0.45 to 2.8% of all neuroglial tumors. We are reporting a case of 28-year-old woman who presented with headache and double vision. Magnetic resonance imaging (MRI) of the brain revealed well-demarcated, ring-enhancing solid cystic mass in right temporoparietal lobe with significant mass effect. The patient underwent gross total resection of the lesion through right temporoparietal craniotomy. The histopathologic diagnosis was suggestive of astroblastoma. She was advised for postoperative radiotherapy, but she lost to follow-up and again presented 1 year later with recurrent tumor in the same location along with another lesion in infratentorial location. She was reoperated and gross total excision of supra- and infratentorial tumor was done. She also received radiotherapy. We are reporting this uncommon case of astroblastoma and also reviewing the existing literature.