1/16. Secondary cardiac tumor in children.We describe our clinical experience of eight cases of secondary cardiac tumor. The pathology of the tumors were lymphoma (three), Wilms' tumor (two), malignant teratoma (one), neuroblastoma (one), and pleuropulmonary blastoma (one). Metastatic sites were the right atrium in Wilms' tumor and neuroblastoma, the left atrium in pleuropulmonary blastoma and malignant teratoma, and multiple sites in lymphoma. Primary masses in the mediastinum extended directly to the heart (three lymphoma, malignant teratoma, pleuropulmonary blastoma). Wilms' tumor and neuroblastoma showed cardiac metastases through the inferior vena cava. Many cases revealed vague abnormal cardiovascular findings (symptoms in six; physical signs in five). In five cases surgery was performed to relieve the possible obstruction to flow and to identify the pathology (lymphoma in three, Wilms' tumor in one, and malignant teratoma in one). Chemotherapy prior to operation resulted in the disappearance of the intracardiac masses in each case of Wilms' tumor and pleuropulmonary blastoma. All three patients with lymphoma died immediately after operation. Four died of multiple metastases or pneumocystis pneumonia several months after operation. This study indicates that suspicion of a secondary cardiac tumor is crucial to early diagnosis. Because of the poor postoperative outcome, surgery for secondary cardiac tumors should be done cautiously only in cases with definite hemodynamic decompensation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/16. Disseminated carcinomatosis after laparoscopic surgery for presumably benign ruptured ovarian teratoma.The authors reported the intraperitoneal carcinomatosis after laparoscopic surgery for presumably benign ruptured ovarian teratoma in a 28-year-old woman. A 28-year-old female patient exhibited intraperitoneal carcinomatosis after a laparoscopic surgery for ruptured mature teratoma of the ovary with occult malignant transformation. The complication was found two months after initial laparoscopic surgery. Laparoscopic surgery was smooth including oophorectomy, and removing all spilled specimens within the abdominal cavity. At the end of the laparoscopic surgery, cleaning the abdominal cavity and irritating the port site were also performed. Cytology of the abdominal cavity and all removed specimens did not show evidence of malignancy. She followed up regularly and uneventfully except for persistently abdominal fullness and erythematous change of umbilical portal site. Evidence demonstrated intestinal obstruction associated with ascites after a detailed evaluation. Although the patient received supportive treatment the symptom exacerbated. Therefore, the patient was treated with exploratory laparotomy. pathology proved with intraperitoneal carcinomatosis caused by squamous cell carcinoma. All tumor evaluations including tumor markers, a thorough physical examination, imaging studies and evaluations of the nuclear medicine were negative except of intraperitoneal carcinoma, origin to be determined. The patient is dead 14 months' post-treatment by exploratory laparotomy. Although it was not clear that the laparoscopic approach or the disease itself worsened indeed the prognosis because the disease was already disseminated before the laparoscopy, we still emphasized the possible limitation of laparoscopic surgery if diagnosis at original surgery is impaired, of if excision is incomplete and the delay between the laparoscopic procedure and the carcinomatosis.- - - - - - - - - - ranking = 19.227977525267keywords = physical examination, physical (Clic here for more details about this article) |
3/16. Intrapulmonary mature teratoma.Intrapulmonary teratoma is reported in a 22-year-old male. A chest X-ray in a physical examination showed a round shadow in the left hilum of a 22-year-old man who, on admission, reported slight malaise and a decrease in body weight. Computed tomographic scan and magnetic resonance imaging of the chest showed a heterogeneously dense cystic lesion. The preoperative diagnosis was anterior mediastinal teratoma, and the tumor was located in the anterior segment of the left upper lobe after thoracotomy. Segmentectomy of the left upper division showed a 4.0 x 3.5 cm tumor diagnosed as an intrapulmonary mature teratoma--the 27th such case reported in the English-language literature. This is, to the best of our knowledge, the first intrapulmonary teratoma involving magnetic resonance imaging.- - - - - - - - - - ranking = 19.227977525267keywords = physical examination, physical (Clic here for more details about this article) |
4/16. Curschmann's spirals in cyst fluid associated with a teratoma of the ovary. A case report.BACKGROUND: Curschmann's spirals, first described more than 100 years ago, are common in cytologic specimens from the respiratory tract and have also been observed in cervical smears, urine, and peritoneal and pleural effusions. No simple theory can explain the exact mode of spiral formation, which is presumed to be a complex physical and biochemical phenomenon. CASE: A 29-year-old woman, gravida 2, para 2, underwent right ovarian cyst excision after an abdominal ultrasound examination revealed a cystic mass of the right ovary. Histologically, the cyst was an immature cystic teratoma containing respiratory epithelium with mucous glands in the submucosa. Cytologic examination of the cyst fluid showed the presence of Curschmann's spirals. CONCLUSION: To the best of our knowledge, the formation of Curschmann's spirals associated with an immature cystic teratoma has not been previously reported. In this situation, the presence of spirals could be explained by formation from mucus normally found in that environment.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/16. Metachronous neurohypophysical immature teratoma occurring 10 years after total resection of pineal mature teratoma.An 18-year-old boy presented with an immature neurohypophysial teratoma occurring 10 years after total resection of a mature pineal teratoma through an occipital transtentorial approach in 1989. Thorough histological examination had revealed a mature teratoma. He developed panhypopituitarism and diabetes insipidus in 1999. magnetic resonance imaging revealed a suprasellar tumor occupying the third ventricle. This tumor was totally resected through a frontobasal approach. Histological examination revealed an immature teratoma. This tumor occurred in a different site from the initial tumor and was considered to be de novo and thus a so-called metachronous germ cell tumor. patients with completely resected mature teratoma require extended follow-up, including periodic magnetic resonance imaging, because of the risk of such a metachronous germ cell tumor.- - - - - - - - - - ranking = 4keywords = physical (Clic here for more details about this article) |
6/16. Congenital cervical teratomas.Congenital cervical teratomas are rare, representing 3% of teratomas in childhood. Although mostly benign, they are associated with a high mortality rate due to respiratory distress and require immediate surgical excision. The diagnosis is usually suggested on the physical examination. The imaging investigation is essential for the proper diagnosis and preoperative planning. We present the imaging characteristics of cervical teratomas identified in five neonates over a 10-year-period. The masses were surgically resected. Histopathology revealed the presence of congenital teratomas (three immature, two mature). Two neonates died soon after surgery, while the remaining were discharged from the hospital without symptoms.- - - - - - - - - - ranking = 19.227977525267keywords = physical examination, physical (Clic here for more details about this article) |
7/16. Ovarian teratoma with diffused peritoneal reactions mimicking advanced ovarian malignancy.BACKGROUND: Benign cystic teratomas are one of the most common benign ovarian neoplasms. Although its rupture is rare, once occurred it can cause complications such as granulomatous peritonitis, mimicking metastatic ovarian malignancy. CASE: A 39-year-old woman, Para 0-0-0-0, presented to the hospital with rapid abdominal distention for 3 months. Her physical examination and ultrasonographic findings led to a diagnosis of advanced stage ovarian carcinoma. An exploratory laparotomy was performed and the operative impression was that of stage III ovarian carcinoma. Total hysterectomy with bilateral salpingo-oophorectomy and surgical staging were done. The postoperative pathology revealed a benign cystic teratoma of right ovary with chronic granulomatous peritonitis. She was well at discharge and at her 1-year follow-up. CONCLUSION: Although ruptured a benign cystic teratoma is rare, it can cause granulomatous peritonitis, the clinical findings of which mimic advanced stage ovarian carcinoma. This warrants physicians to be aware of and intraoperative frozen section should be used, its correct management will provide a good outcome with less complication.- - - - - - - - - - ranking = 19.227977525267keywords = physical examination, physical (Clic here for more details about this article) |
8/16. Atypical compound nevus arising in mature cystic ovarian teratoma.BACKGROUND: Mature cystic ovarian teratoma (MCOT) is the most common primary ovarian tumor. Rarely, MCOT may undergo malignant transformation. Melanoma arising primarily in MCOT is a rare event. Melanocytic nevi have also rarely been reported in MCOT. CASE REPORT: A 28 year-old female presented with a palpable, 4.6 cm, right pelvic mass on physical examination. Histologically, the cystic neoplasm demonstrated epidermis with numerous pilosebaceous units and respiratory-type epithelium (endoderm) surrounded by adipose tissue and cartilage (mesoderm). A 2.0 x 1.0 cm pigmented area corresponded to a nevus with architectural and cytologic features of the so-called "dysplastic nevus," including variable-sized nests of nevomelanocytes irregularly distributed on distorted rete ridges, bridging of nests between rete ridges, fibroplasia around rete ridges, and junctional shouldering beyond the dermal nevus. The nevomelanocytes demonstrated moderate cytologic atypia. Diagnostic criteria of melanoma were not identified. CONCLUSIONS: Herein, we report, to the best of our knowledge, the first case of an atypical ("dysplastic") nevus, arising in a MCOT. No features of melanoma were present and the patient is disease-free at one-year follow-up. Rarely, melanocytic nevi and melanomas arise from the ectodermal component of MCOTs. Moreover, melanomas may arise de novo or in association with a nevus. Distinction between a melanocytic nevus, as in our case, and a primary melanoma is critical for determining the patient's prognosis and need for additional therapy. As primary ovarian melanomas, like their skin counterpart, may arise from a precursor lesion, removal of a melanocytic nevus, such as this atypical nevus, could theoretically prevent melanoma transformation.- - - - - - - - - - ranking = 19.227977525267keywords = physical examination, physical (Clic here for more details about this article) |
9/16. Misdiagnoses in obstetric and gynecologic ultrasound examinations: causes and possible solutions.Two small series of cases documenting ultrasound misdiagnoses are presented. The first concerns obstetric ultrasound misdiagnoses originating in the private offices of physicians. The second concerns gynecologic ultrasound misdiagnoses originating in a level II medical center. A dichotomy exists in the use of diagnostic ultrasound examination in the practice of obstetrics and gynecology. The dichotomy is a serious defect in our specialty that needs urgent addressing. The institutional problem can be partially resolved by furnishing the sonographer with the referred patient's history and physical findings. The problem of the ultrasound machine in the office of a private physician is much more complex. It may require government intervention and strict licensing measures for resolution.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/16. Malignant teratoma presenting with an adrenal mass.A case of extragonadal teratoma presenting with a large adrenal mass and lung metastases is reported. There was no history or physical sign of testicular abnormality, and serum levels of the tumour markers alphafoetoprotein and human chorionic gonadotrophin were normal. The histological diagnosis was established by adrenalectomy. It is important to consider this tumour in young men with malignancy from an unknown primary, since effective chemotherapy is available.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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