1261/4526. Retroperitoneal lymphocele associated with lumbar spine fracture: report of an unusual case. DESIGN:To describe a case of retroperitoneal lymphocele as an extremely rare complication after lumbar spine fracture.OBJECTIVE:To discuss the possible mechanism of development of retroperitoneal lymphocele following blunt trauma to the ureter and lumbar spine.SETTING:Fukui University Hospital, Fukui, japan.RESULTS:A 71-year-old man presented with severe intractable low back pain caused by a huge retroperitoneal lymphocele, which was considered to be related to an occult L4 vertebral fracture and a blunt ureteral injury. The retroperitoneal lymphocele also caused significant instability at L3-4 level, thus requiring surgical resection followed by interbody fusion.CONCLUSION:physicians should be aware that such unusual retroperitoneal lymphocele might develop even after a blunt ureteral injury or a minor lumbar spine fracture. ( info) |
1262/4526. Anterior pseudomeningocele evaluated as a pelvic mass. OBJECTIVE: The differential diagnosis of pelvic masses is broad, and nongynecologic causes should be considered. RESULTS: A patient with a presumed adnexal mass was diagnosed eventually with an anterior pseudomeningocele. ( info) |
1263/4526. Successful resection of an infected duodenal duplication cyst after percutaneous cyst drainage: report of a case. We report a case of a duodenal duplication cyst complicated by infection. An 8-year-old boy was brought to our hospital with severe abdominal pain and a fever of 39.8 degrees C. He had a 5-year history of occasional abdominal pain with vomiting. On examination, a cystic mass was felt under the liver. We performed percutaneous drainage of the cyst under a suspected diagnosis of a choledochal cyst complicated by acute biliary infection. A contrast study through the drainage tube and surgical exploration revealed a duodenal duplication cyst communicating with the second part of the duodenum. The patient had an uneventful recovery and remains well 5 years after surgery. To the best of our knowledge, this is the first documented case of an infected duodenal duplication cyst successfully treated by resection after percutaneous drainage. ( info) |
1264/4526. Mullerian duct remnant involving Wolffian system: a case report and literature review. A 14-month-old boy with repeated left acute epididymitis was admitted to our department. ultrasonography detected a midline round cystic mass in a retrovesical region. This was easily opacified by cystourethrography and seen to have a free communication with the posterior urethra. Since urethroscopy revealed a passable orifice in the center of the verumontanum, while a cystic-wall biopsy specimen showed squamous epithelium, we considered this cystic lesion to be an enlarged prostatic utricle. Vasography showed that the bilateral vasa was implanted directly into this cystic lesion, and was the possible cause of his left epididymitis. Ligature of the left vas deferens was performed to prevent left epididymitis. An enlarged prostatic utricle involving the vasa is a rare presentation. ( info) |
1265/4526. Cervical cyst of the ligamentum flavum and C7-T1 subluxation: case report. A patient with progressive gait disturbance resulting from a cyst of the cervical ligamentum flavum associated with C7-T1 listhesis is reported. Surgical removal of the cyst improved the patient's myelopathy. Intraspinal degenerative cysts are preferentially located in the lumbar region:unusual is the cervical localization. Differential diagnosis includes ligamentum flavum cyst, synovial and ganglion cysts. association between degenerative intraspinal cysts and listhesis is discussed. To our knowledge, this is the first case of cyst of the ligamentum flavum associated with cervical subluxation. ( info) |
1266/4526. Different transformation of mature teratoma in a patient with mixed germ cell tumor of the testis. A 44-year-old male was referred with a left supraclavicular lymphadenopathy. A biopsy of the lymph node showed metastatic embryonal carcinoma. Tumor markers were present at high levels: alpha-fetoprotein 253.9 ng/mL, beta-human chorionic gonadotrophin 62 ng/mL. Computed tomography (CT) showed retroperitoneal adenopathy. High orchiectomy was done. The patient was treated with three cycles of etoposide plus cisplatin, achieved normalization of the serum tumor markers and underwent retroperitoneal lymph node dissection. Pathological findings of multiple lymph nodes showed teratomatous glands without viable cells. At follow-ups performed every 3 months, tumor markers remained within normal limits and no evidence of recurrence was observed. Eight years after first admission a CT scan revealed a cystic tumor 1 cm in diameter in the para-aortic region. The cystic tumor continued to slowly grow, expanding by 1 cm in diameter per year without elevation of tumor markers. The para-aortic tumor had grown to 4 cm in diameter and a left supraclavicular lymphadennopathy recurred. A resection of the supraclavicular cystic tumor showed mucinous cystadenocarcinoma, but a cystic tumor in the para-aortic region revealed mature teratoma. Here we report a case of mature teratoma with metastases at supraclavicular and para-aortic lymph nodes which had different transformations in spite of both regions consisting of cystic tumors. ( info) |
1267/4526. Iliopsoas bursal distension caused by acetabular loosening after total hip arthroplasty. A rare complication of total hip arthroplasty. In a 58-year-old woman, a cystic mass at the ileocecal region communicated with the loosened hip prosthesis 20 years after total hip arthroplasty (THA). The preoperative arthrogram of the hip and the intraoperative cystogram suggested a one-way communication from the hip to the cystic mass. The mass was diagnosed as an iliopsoas bursitis distended by the influx of the synovial fluid from the loosened THA. ( info) |
1268/4526. Complex multilocular cystic lesion of rete testis, accompanied by smooth muscle hyperplasia, mimicking intratesticular Leydig cell neoplasm. Non-neoplastic smooth muscle cell proliferation occurs under a variety of circumstances in many body organs. These abnormalities have been described as hypertrophy, hyperplasia or hamartomatous proliferations. In the male genital system, the excessive growth of smooth muscle in spermatic cord or paratesticular tissue is rare. In previously described cases, these lesions presented as masses but lacked the microscopic features of a neoplasm. We describe a complex multilocular cystic lesion composed of cystic transformation of the rete testis associated with smooth muscle proliferation mimicking intratesticular Leydig cell neoplasm. The lesion consists of three separate components: (1) cystic dilatation of the rete testis; (2) diffuse, interstitial smooth muscle proliferation with intraseptal expansion; and (3) extensive stroma with myxoid areas and scattered interstitial leydig cells. These morphological findings, supported by a wide immunohistochemical panel, are consistent with cystic dilatation of the rete testis associated with smooth muscle hyperplasia, most probably of myoid origin. To the best of our knowledge, no similar complex lesion of the rete testis has yet been reported. ( info) |
1269/4526. Coexistence of a hemorrhagic cyst and carcinoma in the prostate gland. This report details a case of prostatic carcinoma coexisting with a hemorrhagic cyst in a 66-year-old man; this combination was a challange for diagnosis and mamagement. The patient presented with lower urinary tract symptoms and a serum prostate-specific antigen (PSA) level of 33.3 ng/ml. magnetic resonance imaging of the prostate showed a cystic mass with soft-tissue density and hemorrhage. Histological examination of the suprapubic prostatectomy specimens showed nodular hyperplasia with focal adenosis, high-grade prostatic intraepithelial neoplasia, a Gleason score of 6 for prostatic carcinoma, and a hemorrhagic cyst which appeared to be nonmalignant. We suggest that elevated serum PSA should raise the suspicion of coexisting malignancy in a hemorrhagic cyst. ( info) |
1270/4526. Visualization of conjunctival cyst using Healon V and trypan blue. PURPOSE: To report a new modified method using the mixture of an ophthalmic viscosurgical devices (Healon V) and trypan blue solution to facilitate complete removal of a conjunctival cyst. METHOD: A 54-year-old woman was referred to us for removal of a conjunctival cyst in her right eye. To achieve a complete removal of the conjunctival cyst, a mixture of Healon V and trypan blue solution was injected through a 27-gauge needle into the cyst. RESULTS: This new technique achieved excellent visualization with an easy and complete resection of the cyst. CONCLUSIONS: The mixture of Healon V and trypan blue is effective in delineating the capsule while preserving its integrity during removal. Such a technique may also have a role in facilitating visualization and excision of other cystic conjunctival lesions. ( info) |