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A 36-year-old female patient was referred from a secondary rural hospital to the outpatient department, presented with a gradually increasing lump in the abdomen associated with dull aching pain and discomfort, along with weight loss since three months. Physical examination revealed a palpable diffuse mass of about 14×14 centimeters in the epigastric region extending to the right hypochondrium as well as a mild shift towards the left hypochondrium. Routine haematological and biochemical parameters, including complete blood count, liver function tests, and renal function tests, were normal. Chest radiography was normal.

The article focuses on the case of a 36-year-old female patient with a growing abdominal mass, diagnosed with concomitant hepatic hydatid cysts. Topics include the clinical presentation and diagnostic process, surgical intervention and post-operative care, and the histopathological findings of the excised cysts.

Solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas is a rare neoplasm of the pancreas accounting for only 0.17–2.7% of all pancreatic neoplasms, often detected initially on imaging. Despite advances in imaging, pseudocysts and other cystic neoplasms feature in the differential diagnosis. We report a case of solid pseudopapillary epithelial neoplasm in a young female who presented with a progressively increasing abdominal lump in whom the diagnosis was considered based on imaging studies. She underwent exploratory laparotomy, pancreaticoduodenectomy, pancreaticojejunostomy, hepaticojejunostomy, gastrojejunostomy, and made an uneventful recovery in the postoperative period. Histopathological examination and immunohistochemistry confirmed the diagnosis. This case highlights the need for a high index of suspicion and timely surgical intervention for optimal outcomes.

Uterine smooth muscle tumor of uncertain malignant potential (STUMP) is a rare tumor belonging to a group of smooth muscle tumor that possess both benign and malignant features, complicating the diagnosis. STUMP is a rare uterine tumor with a paucity of literature available regarding management and subsequent malignant potential. A 22-year-old unmarried lady presented as uterine fibroids with 24 weeks size uterus. There was one intramural and another subserosal mass both of which revealed smooth muscle tumor of uncertain malignant potential in histopathology. [ABSTRACT FROM AUTHOR]

Solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas is a rare neoplasm of the pancreas accounting for only 0.17-2.7% of all pancreatic neoplasms, often detected initially on imaging. Despite advances in imaging, pseudocysts and other cystic neoplasms feature in the differential diagnosis. We report a case of solid pseudopapillary epithelial neoplasm in a young female who presented with a progressively increasing abdominal lump in whom the diagnosis was considered based on imaging studies. She underwent exploratory laparotomy, pancreaticoduodenectomy, pancreaticojejunostomy, hepaticojejunostomy, gastrojejunostomy, and made an uneventful recovery in the postoperative period. Histopathological examination and immunohistochemistry confirmed the diagnosis. This case highlights the need for a high index of suspicion and timely surgical intervention for optimal outcomes. [ABSTRACT FROM AUTHOR]

Primary Haemangioendothelioma (HE) of spleen is a rare vascular tumour. These tumours have intermediate biologic behaviour between haemangioma and angiosarcoma. So far, few cases have been reported in literature and most of them are in adults or adolescents. Here the present authors report a 6-month-old infant who presented with mass per abdomen. Contrast Enhanced Computerised Tomography (CECT) abdomen revealed a splenic mass which was treated by partial splenectomy. Histopathology confirmed it to be haemangioendothelioma of spleen.

Adrenal haemorrhage, although a rare entity in the neonatal period, is a known complication of birth asphyxia. Adrenal haemorrhage progresses differently depending on the type and extent of the glands involved. Adrenal haemorrhage can cause persistent jaundice, fever, dehydration, scrotal swelling, abdominal wall discolouration, septicemia, and a shock-like state. Here, we report the case of a four-day-old male infant who presented with jaundice, poor feeding, and hypernatremic dehydration. The patient developed acute kidney injury and, eventually, renal failure due to adrenal haemorrhage. He had an abdominal lump with deranged renal parameters along with hyperbilirubinemia. Abdominal ultrasonography and contrast computed tomography scan showed left suprarenal enlargement with evidence of adrenal haemorrhage. The patient was managed well with ventilatory support and peritoneal dialysis and discharged successfully. A subsequent follow-up showed complete resolution of the adrenal haemorrhage. Single ultrasonography is a good modality for diagnosis but not sufficient, so serial ultrasonography at subsequent follow-up is a must., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Lakra et al.)

Gastric teratoma is a very rare tumour. We reviewed the literature and found that only around 100 cases have been reported. Almost all reported cases of gastric teratoma were of mature variety. Only a few cases were of immature variety. The rarity of the disease makes the diagnosis very difficult most of the cases occurred in infants. The disease is more common in males than in females. Majority of cases have been reported to arise from the greater curvature and posterior wall of the stomach. Histopathological examination confirms the diagnosis. Treatment of choice is surgical excision with close follow up. Following surgical excision prognosis is excellent. Hence, in an infant who presents with abdominal lump gastric teratoma should be kept as one of the differential diagnosis. Here, we are reporting a case of immature teratoma.

Large renal tumours are not uncommon in developing countries. Enhancing renal tumours are considered to be malignant unless proved otherwise and radical surgical resection remains the mainstay of treatment of such tumours. A giant renal tumour, especially on right side, poses a big challenge for the operating team and requires a thoracoabdominal approach for successful excision. We report successful removal of the largest documented Multilocular Cystic Nephroma (MLCN, 5.5 kg) from a 28-year-old female who presented with right abdomen lump since two years. The surgery was done through a 9th intercostal thoracoabdominal incision as the mass (31 x 19 x 19.6 cm) extended from right sub-diaphragmatic space up to the dome of the bladder. We discuss here the technique of removing such a huge renal mass and the challenges an operating surgeon may encounter.

Castleman’s disease is an uncommon lymphoproliferative disorder. It can present as unicentric disease or multicentric disease. Here we present a case in which a 60 year old female who presented with upper abdominal discomfort was evaluated with contrast enhanced CT scan and was initially thought to have a paraganglioma at hepatoduodenal ligament, but was later diagnosed as having Castleman’s disease.

Introduction An interparietal inguinal hernia is a rare form of hernia. In this type of hernia, the sac passes between the layers of the abdominal wall of the inguinal canal area. Although its treatment is very simple but pre-operative diagnosis is really a challenging issue. Presentation of case A 62 years old male patient presented with complaint of a large swelling over right lower abdomen with absence of right testes since birth. The lump was measured 26 × 22 cm in size. Ultrasonography (USG) and Contrast enhanced computed Tomography (CECT) failed to diagnose as interparietal inguinal hernia which was proved intra-operatively. Few cases have been reported in the medical literature like this. Discussion Exploration revealed the large abdominal lump presenting as an interparietal inguinal hernia. Hernia sac was lying in between external & internal oblique muscles. The right testis was intraabdominal & atrophied. The external inguinal ring was almost completely obstructed. Conclusion An interparietal hernia with undescended testis is a very rare presentation. Even with USG & CT scan diagnosis is very challenging and final diagnosis can be made only intraoperatively. [ABSTRACT FROM AUTHOR]

Background: The presence of jaundice or an abdominal lump in gall bladder cancer (GBC) is often translated to advanced and unresectable disease. We examined whether this was true. Methods: We retrospectively analysed 120 GBC patients, who had been operated on, for presenting symptoms, staging and resectability. The outcomes in patients with jaundice and/or an abdominal lump were compared with those who did not have these features. Early disease was represented by stages I and II, while stages III and IV represented advanced disease. Results: Sixty-eight patients (57%) presented with an abdominal lump and 62 (52%) had jaundice. An abdominal lump, jaundice or both were present in 89 patients (74%), of whom 78 (88%) had advanced disease, while 22 of the 31 patients (71%) with neither jaundice nor an abdominal lump had advanced disease. Forty-four patients (50%) with either or both of these features had R0 resections, while 20 patients (64%) with neither jaundice nor an abdominal lump had R0 resections. The presence of jaundice or an abdominal lump was significantly associated with advanced disease (p = 0.025), but not with unresectability (p = 1). Conclusions: Jaundice or an abdominal lump was present in 74% of the patients with GBC. While this represented advanced-stage cancer, it did not preclude resectability. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Primary Haemangioendothelioma (HE) of spleen is a rare vascular tumour. These tumours have intermediate biologic behaviour between haemangioma and angiosarcoma. So far, few cases have been reported in literature and most of them are in adults or adolescents. Here the present authors report a 6-month-old infant who presented with mass per abdomen. Contrast Enhanced Computerised Tomography (CECT) abdomen revealed a splenic mass which was treated by partial splenectomy. Histopathology confirmed it to be haemangioendothelioma of spleen. [ABSTRACT FROM AUTHOR]

Abdominoscrotal hydrocele is an hourglass hydrocele with both an inguinoscrotal and abdominal component. It is a rare surgical entity with few cases reported in the literature. We report a case of abdominoscrotal hydrocele that gives an insight into its pathogenesis. [ABSTRACT FROM AUTHOR]

A 57-year-old male presented with right upper abdominal lump since 3 months. He was diagnosed to have a hepatic artery aneurysm. He was investigated thoroughly but no cause was found. He was subjected to endovascular embolisation of the aneurysm using endovascular coils. Subsequently the aneurysm was completely occluded. Hepatic artery aneurysms are very rare among all visceral aneurysms. We report this rare case of hepatic artery aneurysm presenting as an abdominal lump. This case highlights the importance of early diagnosis and management of this rare entity as a rupture may be catastrophic. [ABSTRACT FROM AUTHOR]

Retroperitoneal abscess may simulate other abdominal masses. A 2-year-old girl presented with abdominal pain and lump in right iliac fossa for the last one week. Investigations revealed a mass extending from pelvis up to right sub-hepatic region. Diagnostic laparoscopy revealed an unremarkable peritoneal cavity, except that ascending colon up to hepatic flexure was elevated suggestive of retroperitoneal mass. A small flank incision was then made and abscess was drained. [ABSTRACT FROM AUTHOR]

Summary: Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant condition characterized by parathyroid, anterior pituitary and enteropancreatic endocrine cell tumors. Neuroendocrine tumors occur in approximately in 5-15% of MEN1 patients. Very few cases of ovarian NETs have been reported in association with clinical MEN1 and without genetic testing confirmation. Thirty-three-year-old woman with MEN1 was found to have right adnexal mass on computed tomography (CT). Attempt at laparoscopic removal was unsuccessful, and mass was removed via a minilaparotomy in piecemeal fashion. Pathology showed ovarian NET arising from a teratoma. Four years later, patient presented with recurrence involving the pelvis and anterior abdominal wall. She was treated with debulking surgery and somatostatin analogs (SSAs). Targeted DNA sequencing analysis on the primary adnexal mass as well as the recurrent abdominal wall tumor confirmed loss of heterozygosity (LOH) at the MEN1 gene locus. This case represents to our knowledge, the first genetically confirmed case of ovarian NET arising by a MEN1 mechanism in a patient with MEN1. Extreme caution should be exercised during surgery as failure to remove an ovarian NET en masse can result in peritoneal seeding and recurrence. For patients with advanced ovarian NETs, systemic therapy options include SSAs, peptide receptor radioligand therapy (PRRT) and novel agents targeting mammalian target of rapamycin (mTOR) and vascular endothelial growth factor (VEGF)., Learning Points: Ovarian NET can arise from a MEN1 mechanism, and any adnexal mass in a MEN1 patient can be considered as a possible malignant NET. Given the rarity of this disease, limited data are available on prognostication and treatment. Management strategies are extrapolated from evidence available in NETs from primaries of other origins. Care should be exercised to remove ovarian NETs en bloc as failure to do so may result in peritoneal seeding and recurrence. Treatment options for advanced disease include debulking surgery, SSAs, TKIs, mTOR inhibitors, PRRT and chemotherapy.

Key Clinical Message The incidence of primary hydatid cyst of peritoneum is 2%. It can present as a palpable abdominal lump. The differential diagnosis is cystic ovarian tumor clinically and radiologically. Peritoneal hydatid disease should be included in differential diagnosis of sonographically diagnosed pelvic cystic lesion. [ABSTRACT FROM AUTHOR]

In a 61-year-old Caucasian male with prostate cancer, leuprolide and bicalutamide failed to suppress the androgens. He presented to endocrinology with persistently normal testosterone and incidental massive (up to 18 cm) bilateral adrenal myelolipomas on CT scan. Blood test did not reveal metanephrine excess. The patient was noted to have short stature (151 cm) and primary infertility. Elementary school photographs demonstrated precocious puberty. Physical examination revealed palpable abdominal (adrenal) masses. Abiraterone and glucocorticoid treatment was commenced with excellent suppression of testosterone. Genetic testing revealed a mutation in CYP21A2 confirming 21-hydroxylase-deficient congenital adrenal hyperplasia (CAH). Association of large myelolipomas with CAH has been reported in the literature. Our case highlights the importance of considering CAH in patients with non-suppressed testosterone despite androgen deprivation therapy. Large myelolipomas should raise the suspicion of congenital adrenal hyperplasia., Learning Points: Adrenal myelolipomas are rare benign lesions that are more common in patients with longstanding untreated congenital adrenal hyperplasia thought to be due to ACTH stimulation.Consider undiagnosed congenital adrenal hyperplasia in patients with adrenal myelolipoma.Glucocorticoid replacement may be an efficacious treatment for patients with prostate cancer and CAH. Abiraterone therapy has a risk of adrenal crisis if glucocorticoids are not replaced.

Two cases of fetus-in-fetu, on which we performed surgery in 2003 and 2006, are being reported. Both the cases presented with a lump in the abdomen. Radiology confirmed the diagnosis. The lumps were found in the retroperitoneum and successfully excised. Because of the rarity of the condition, these two cases are being reported with relevant salient features and are discussed in the light of available literature.