Incidental Findings

Surgery for abdominal aortic aneurysm may be challenging when rare renal or venous anomalies are present. This article reports two similar cases of aortic abdominal aneurysm associated with horseshoe kidney and left-sided inferior vena cava treated with a transperitoneal approach. Preoperative knowledge of the anatomic situation enabled appropriate aneurysm repair. Operative strategy is discussed. This report describes an uncommon venous vascular malformation complex and stresses the importance of computed tomography imaging not only in assessing the characteristics of the aneurysmal disease but also in detecting variations in pertinent vascular or parenchymal anatomy. (

Purpose: To evaluate imaging features of esophageal gastrointestinal stromal tumors (GIST) with clinical and histopathologic correlation and imaging follow-up. Materials and methods: In this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study, 14 patients with pathologically proven esophageal GIST seen from January 2001 to October 2011, 7 patients (4 women; mean age 70 years, range 5687 years) who had imaging of primary tumor and follow-up imaging at our institution were included. Imaging studies were evaluated by 3 radiologists in consensus. Location, size and imaging features of primary tumor and metastases, if any, were recorded, and correlated with pathologic (histopathologic subtype, presence of necrosis, mitotic rate, immunohistochemical profile) and clinical (treatment-related changes, distant spread and outcome) parameters. Results: Of 7 tumors, 5 were located in the lower esophagus and 2 in mid-esophagus. Four were intraluminal, 2 were exophytic, and 1 was intramural. All 7 patients underwent computed tomography (CT); tumors appeared as well-circumscribed, hypoattenuating masses showing mild enhancement, with mean size of 5.7 Â 4.2 cm. Necrosis and calcification were seen in 1 tumor each. Five patients underwent fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT. GISTs were FDG avid with mean standardized uptake value (SUV) max of 9.5 (4.512.3). All tumors were positive for KIT (7/7) and CD34 (6/6). Distant metastases to liver and pleura were seen in 1 patient. On imatinib treatment, the tumors responded with decreased attenuation values and unchanged size on CT, and decreased SUV max of primary tumor and metastases on FDG-PET/CT. Conclusion: Esophageal GISTs are well-circumscribed, FDG-avid, hypoattenuating masses that can metastasize to liver and pleura, and respond to imatinib treatment with decreased attenuation value on CT and decreased SUV max on FDG-PET/CT.

This scientific article investigates the CT-scan examination method for paranasal sinuses, an effective diagnostic modality for evaluating anatomy and soft tissue, including nasal polyps. This study aims to provide a qualitative and descriptive account of the CT-scan technique used on patients with a clinical history of nasal polyps at Primasatya Husada Citra Hospital, Surabaya.
The methodology employed was a descriptive qualitative study conducted through direct observation and a documentation study. The findings show that patient preparation, including the removal of metallic objects and the use of head immobilisation, successfully minimised motion artefacts. Optimised scanning parameters (120 kV, 90 mAs, a Window Width (WW) of 1400 HU, and a Window Level (WL) of 40 HU) were used to produce high-quality images. The images were reconstructed with a slice thickness of 3 mm in three main planes (axial, coronal, and sagittal) for comprehensive analysis. The radiologist's reading confirmed an accurate diagnosis of Paranasal Pansinusitis and a Polyp in the Left Nasal Cavity.
In conclusion, the CT-scan technique implemented aligns with standard protocols, providing reliable images for accurate clinical diagnosis.

Keywords: CT-Scan Technique, Paranasal Sinuses, Nasal Polyp, Radiology.

This scientific article investigates the CT-scan examination method for paranasal sinuses, an effective diagnostic modality for evaluating anatomy and soft tissue, including nasal polyps. This study aims to provide a qualitative and descriptive account of the CT-scan technique used on patients with a clinical history of nasal polyps at Primasatya Husada Citra Hospital, Surabaya. The methodology employed was a descriptive qualitative study conducted through direct observation and a documentation study. The findings show that patient preparation, including the removal of metallic objects and the use of head immobilisation, successfully minimised motion artefacts. Optimised scanning parameters (120 kV, 90 mAs, a Window Width (WW) of 1400 HU, and a Window Level (WL) of 40 HU) were used to produce high-quality images. The images were reconstructed with a slice thickness of 3 mm in three main planes (axial, coronal, and sagittal) for comprehensive analysis. The radiologist's reading confirmed an accurate diagnosis of Paranasal Pansinusitis and a Polyp in the Left Nasal Cavity. In conclusion, the CT-scan technique implemented aligns with standard protocols, providing reliable images for accurate clinical diagnosis.

Gallbladder cancer has a dismal prognosis, radical surgical resection offers the only chance of cure, but it is possible in only small proportion due to advanced disease and the recurrence is high. The extent of resection depends on the extent of disease. The aim of any therapeutic operation must be the radical removal of the tumor with no residual disease (R0 resection). Crucial for the surgical strategy is the TNM staging and the planning is decided in accordance with the T stage. In T1a simple cholecystectomy is considered as an adequate treatment. In T1b there is a controversy; some advocate simple cholecystectomy and others more extensive radical cholecystectomy. In T2 either extended radical cholecystectomy or resection of liver segments IVb and V. In all cases a radical lymph node dissection along the hepatoduodenal ligament is needed additionally. In T3 either hepatic segmentectomy IVb and V at least or extended right hepatectomy, both combined always with radical lymph node dissection. In T4 usually palliative operation; an extensive en-block resection with removal of included organs is rarely attempted.

Gall bladder cancer carries a dismal prognosis especially in advanced cases. Common sites of metastases include liver, lung and unusual sites have also been reported like orbit, cutaneous, adrenal, kidney, breast and thyroid. 66 years female diagnosed case of metastatic carcinoma gall bladder presented with bilateral inguinal lymphadenopathy. Cytology aspirate from inguinal node reported metastatic adenocarcinoma. Inguinal node metastases from gall bladder cancer is very rare and few case reports have been published. We present a case of a woman with advanced cancer of the gall bladder, who presented with bilateral inguinal metastases.

This case study presents a 53-year-old male with a history of obstructive sleep apnea, hypertension, Gastroesophageal Reflux Disease (GERD), morbid obesity, and chronic lower extremity edema who was found to be unresponsive and was diagnosed with an incidental asymptomatic portal vein aneurysm. This patient’s aneurysm was completely asymptomatic with no related findings despite this vascular anomaly usually occurring with clinical implications.

Enterobiasis is an intestinal parasitic infection that presents with anal itching and can have serious complications. A 44-year-old soldier with no known medical history was found deceased in his vehicle, not far from his father's farm. Autopsy revealed generalized visceral congestion and heavy, congested lungs, suggestive of acute pulmonary edema. Sterile swabs were systematically applied to the natural orifices (mouth, nose, anus, ear canals) of all autopsied bodies. Suprisingly, anal swab revealed the presence of eggs of Enterobius vermicularis, and the anal region was free of eczematization after inspection. Even though no link was found between the parasite and this patient's death. The gastrointestinal tract can be severely affected, potentially leading to a fatal outcome. Clinicians need to be aware that enterobiasis is common in crowded environments, especially among soldiers. It can also be a taboo subject, which may lead to neglect and potentially fatal outcomes in some young adult patients.

Introduction: Tumours of uterus and cervix are extremely common lesions encountered in our routine histopathology practice. However, a few entities like endometrial stromal tumours pose diagnostic challenges. With this study, an attempt has been made to broadly categorize the tumours of uterus and cervix and at the same time look into occurrence of rare lesion like endometrial stromal sarcoma. Materials and Method: Total 2400 hysterectomy specimens received at histopathology section of department of pathology, C U Shah medical college, Surendranagar were studied in a 3 year period from August 2013 to July 2016. A brief clinical history of patient was taken into account. All histopathological details like size, shape, presence of masses, etc were noted and extensive sampling of specimen was done. Result: Total 2400 cases were studied, of which 648 (27%) specimens were neoplastic. Of them, 635 (98%) cases were benign & constituted exclusively of leiomyomas. Amongst 13 malignant lesion...

La tuberculose de la cavité buccale reste rare, son tableau clinique non spécifique. L'étude bactériologique et histopathologique tient un rôle important, permettant de préciser la nature tuberculeuse des lésions. L'évolution est favorable sous traitement médical, maintenant bien codifié. Un homme de 45 ans, traité pour tuberculose pulmonaire 6 ans auparavant, a présenté un processus ulcérobourgeonnant dans la région rétromolaire gauche. Un orthopantomogramme a objectivé une image lacunaire sur la crête alvéolaire de l'extrémité distale de la branche horizontale gauche de la mandibule ; une biopsie a été réalisée et l'examen histopathologique orienté vers une tuberculose. L'intérêt de cette présentation est d'attirer l'attention sur la tuberculose que l'on peut retrouver de façon exceptionnelle dans certaines localisations, comme la cavité buccale.

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and is caused by incomplete obliteration of the vitelline duct during intrauterine life. MD affects less than 2% of the population. In most cases, MD is asymptomatic and the estimated average complication risk of MD carriers, which is inversely proportional to age, ranges between 2% and 4%. The most common MD-related complications are gastrointestinal bleeding, intestinal obstruction and acute phlogosis. Excision is mandatory in the case of symptomatic diverticula regardless of age, while surgical treatment for asymptomatic diverticula remains controversial. According to the majority of studies, the incidental finding of MD in children is an indication for surgical resection, while the management of adults is not yet unanimous. In this case report, we describe the prophylactic resection of an incidentally detected MD, which led to the removal of an occult mucosal carcinoid tumor. In literature, the association of MD and carcinoid tumor is reported as a rare finding. Even though the strategy for adult patients of an incidental finding of MD during surgery performed for other reasons divides the experts, we recommend prophylactic excision in order to avoid any further risk.

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The neuroendocrine tumors (NETs) have an increased incidence related to the age. Secondary osteoporosis might be found in patients with bone metastases and in those with NETs associated Cushing's disease or primary hyperparathyroidism. Primary osteoporosis might be found in postmenopausal women, but in case with non-metastatic NET as G1 NET it is difficult to establish the NET contribution to the bone loss. We present the case of a 53-year-old female accidentally diagnosed with G1 lung NET after surgery of the tumor. The immunohistochemistry pointed positive reaction for CHROMO, SYN and negative for CK7 and TTF1, and a Ki67 of 1-2% (well-differentiated neuroendocrine tumor). The central Dual X-Ray Absorptiometry (DXA) showed osteoporosis based on a T-score of -3. The patient had normal neuroendocrine markers and she was asymptomatic. She remained so for one year and the only therapy provided was weekly alendronate with adequate vitamin D and calcium supplements. Based on the pat...

Background: Hypertension (HTN) is a chronic disease prevalent worldwide, with a significant increase in the number of people diagnosed with HTN. This study aimed to determine the prevalence and awareness of HTN among adults in Palestine according to the 2017 American College of Cardiology and American Heart Association guidelines, and to investigate the risk factors affecting HTN. Methods: A cross-sectional study was conducted between August 2024 and November 2024 among residents of West Bank Palestine. A total of 1420 adults aged 18 years and older were recruited using convenience sampling. Data were collected through blood pressure and anthropometric measurements of BMI and waist circumference. A questionnaire was used to gather sociodemographic information, HTN history, physical activity, antihypertensive drug use, and other family history information. Statistical analyses, including chi-square tests and binary logistic regression, were performed. Results: The prevalence of HTN in this study was 60%. Moreover, 46.4% of participants with HTN were unaware of their condition. Several factors were found to be independent predictors of HTN, including smoking [adjusted odds ratio (aOR): 8; 95% confidence interval (CI): 5.1-11.1], older age (aOR: 1.022; 95% CI: 1.01-1.04), and living in urban areas (aOR: 1.9; 95% CI: 1.4-2.5). Conversely, normal BMI (aOR: 0.6; 95% CI: 0.4-0.9) and moderate physical activity (aOR: 0.6; 95% CI: 0.6-0.8) were protective against the development of HTN. Conclusion: Three out of five adults in Palestine had HTN, and approximately half of them were unaware of their condition. The study findings indicate the urgent need for appropriate public health interventions to address awareness, early detection, and modifiable risk factors, which will greatly alleviate the regional HTN burden.

OBJECTIVE-Current generation MDCT technology facilitates identification of small, nonenhancing lesions in the pancreas. The objective of this study was to determine the prevalence of findings of unsuspected pancreatic cysts on 16-MDCT in a population of adult out-patients imaged for disease unrelated to the pancreas. MATERIALS AND METHODS-Contrast-enhanced MDCT scans of the abdomen were reviewed from 2,832 consecutive examinations to identify pancreatic cysts. Patients with a history of pancreatic lesions or predisposing factors for pancreatic disease or who were referred for pancreatic CT were excluded. RESULTS-A total of 73 patients had pancreatic cysts, representing a prevalence of 2.6 per 100 patients (95% CI, 2.0-3.2). Cysts ranged in size from 2 to 38 mm (mean, 8.9 mm) and were solitary in 85% of cases. Analysis of demographic information showed a strong correlation between pancreatic cysts and age, with no cysts identified among patients under 40 years and a prevalence of 8.7 per 100 (95% CI, 4.6-12.9) in individuals from 80 to 89 years. After controlling for age, cysts were more common in individuals of the Asian race than all other race categories, with an odds ratio of 3.57 (95% CI, 1.05-12.13). There was no difference by sex in the prevalence of cysts (p = 0.527); however, cysts were on average 3.6 mm larger (p = 0.014) in men than women. CONCLUSION-In this outpatient population, the prevalence of unsuspected pancreatic cysts identified on 16-MDCT was 2.6%. Cyst presence strongly correlated with increasing age and the Asian race.

Pancreatic neuroendocrine tumors expressing serotonin (carcinoid tumors) account for a small portion of pancreatic neuroendocrine tumors. The purpose of this study was to describe cases of small serotonin-producing pancreatic neuroendocrine tumors associated with pancreatic duct obstruction. CONCLUSION. Serotonin produced by pancreatic neuroendocrine tumors can induce fibrosis and pancreatic duct obstruction. Pancreatic neuroendocrine tumors should be considered when CT shows a small hypervascular mass associated with upstream pancreatic duct dilatation or atrophy. Evidence of small pancreatic neuroendocrine tumors should be sought in cases of idiopathic pancreatic duct stenosis.

Gallbladder carcinoma is found in 0.2% to 5% of patients undergoing cholecystectomy, and gallstones are found in 70% to 98% of patients with gallbladder carcinoma. Early diagnosis of carcinoma is difficult because of the absence of specific symptoms and the frequent association with chronic cholecystitis and gallstones. At present, laparoscopic cholecystectomy is the gold standard for the surgical treatment of symptomatic cholelithiasis and other benign gallbladder diseases. The aims of this study were to evaluate retrospectively the incidence of occasional and occult gallbladder carcinomas to ascertain the effect of laparoscopy on diagnosis and treatment of unexpected extrahepatic biliary tree carcinomas and to assess possible guidelines that can be taken into consideration when the problem is encountered. Clinical records of 3900 patients undergoing laparoscopic cholecystectomy were reviewed. Patients with occasional (intraoperative = Group A) or occult (postoperative = Group B) d...

A goblet cell carcinoid (GCC) is an appendiceal neoplasm with mixed neuroendocrine and glandular differentiation that is uncommon and most typically affects middle-aged adults. The terminology of this tumor has recently been changed to goblet cell adenocarcinoma (GCA) to indicate the malignant behavior of this tumor, which is more than that of a neuroendocrine tumor (NET). The WHO has removed the term "carcinoid" in naming tumors in its 2022 classification. In this report, we present a 42-year-old man who was admitted to the hospital with complaints of severe pain in the right lower abdomen, fever, and elevated white blood cells, which were the common symptoms of acute appendicitis. He had a scheduled appendectomy and thought that he would recover like any other normal case. However, what was unexpected was the pathology report, which showed goblet cell adenocarcinoma (GCA), a rare and aggressive tumor that was previously known as GCC. In contrast to the general NETs, GCC acts rather like an adenocarcinoma, inclining to invade the adjacent tissues and metastasize. Here, the tumor has extended beyond the appendix and invaded the surrounding fat (T3N0M0, Stage IIA). The fat invasion also necessitated continued treatment, whereas the lymph nodes and distant organs were not affected. The carcinoid/adenocarcinoma terminology transformation signifies the actual nature of the tumor, which is more of a rapidly progressing cancer that needs vigorous treatment rather than a NET with a slow growth rate. This case serves as a reminder to keep a wide differential diagnosis, even in classical presentations, such as appendicitis. Cross-disciplinary tumor board discussion was key in decision-making regarding the treatment plan. Four years after surgery, the patient is still disease-free. We provide a brief literature review on this uncommon tumor and clarify the recent change in classification terminology.

Background Disseminated disease (DD) is often found at (re-)exploration in gallbladder cancer (GBC) patients. We aimed to assess the yield of staging laparoscopy (SL) and identify predictors for DD. Methods This retrospective study included patients from all Dutch academic centres with primary GBC (pGBC) and incidentally diagnosed GBC (iGBC) planned for (re-)resection. The yield of SL was determined. In iGBC, predictive factors for DD were assessed. In total, 290 patients were included. Of 183 included pGBC patients, 143 underwent laparotomy without SL, and 42 (29%) showed DD perioperatively. SL, conducted in 40 patients, identified DD in eight. DD was found in nine of 32 patients who underwent laparotomy after SL. Of 107 included iGBC patients, 100 underwent laparotomy without SL, and 19 showed DD perioperatively. SL, conducted in seven patients, identified DD in one. Cholecystitis (OR = 4.25; 95% CI 1.51-11.91) and primary R1/R2 resection (OR = 3.94; 95% CI 1.39-11.19) were independent predictive factors for DD. In pGBC patients, SL may identify DD in up to 20% of patients and should be part of standard management. In iGBC patients, SL is indicated after primary resection for cholecystitis and after initial R1/R2 resection due to the association of these factors with DD.

Due to the increasing occurrence of renal cell carcinoma (RCC) in the general population and the high prevalence of chronic kidney disease among cancer patients, many people with a previous RCC are considered as potential candidates for renal transplantation. They should accordingly be evaluated to assess their life expectancy and the risk that the chronic immunosuppressive therapy needed after grafting might impair their long-term outcome. Current guidelines on listing patients for renal transplantation suggest that no delay is required for subjects with small or incidentally discovered RCC, while the recommendations for patients who have been treated for a symptomatic RCC or for those with large or invasive tumours are conflicting. The controversial results reported by even recent studies focussing on the cancer risk in kidney graft recipients with a prior history of malignancy do not help to clarify the doubts arising in everyday clinical practice. Several tools, including integrated scoring systems, are currently available to assess the prognosis of patients with a previous RCC and, although they have not been validated in subjects receiving long-term immunosuppressive drugs, they can be used to identify patients suitable to be listed for grafting. Among these, the Leibovich score is currently the most widely used as it has proved simple and reliable enough and helps categorize renal transplant candidates. According to this system, subjects with a score from 0 to 2 are at low risk and may be listed without delay, while those with a score of 6 or higher should be excluded from grafting. In addition, other factors have an established positive prognostic value, including cromophobe or clear cell papillary tumour, or G1 grade cancer, while medullary or Bellini's duct carcinoma or those with sarcomatoid dedifferentiation at histological examination should be excluded. Pending studies specifically focussing on cancer risk evaluation in people already treated for malignancy receiving long-term immunosuppressive therapy, all other patients had better be submitted to careful individual evaluation by an Oncologist and Urologist before being listed for renal transplantation.

The method by which breast cancer is detected becomes a factor for long-term survival and should be considered in treatment plans. This report describes patient characteristics and time trends for various methods of breast cancer detection in the United States. Methods: The 2003 National Health Interview Survey (NHIS), a nationally representative self-report health survey, included 361 women survivors diagnosed with breast cancer between 1980 and 2003. Responses to the question, How was your breast cancer found? were categorized as accident, self-examination, physician during routine breast examination, mammogram, and other. We examined responses by income, race, age, and year of diagnosis. Results: Most women survivors (57%) reported a detection method other than mammographic examination. Women often detected breast cancers themselves, either by self-examination (25%) or by accident (18%). Conclusions: Despite increased use of screening mammography, a large percentage of breast cancers are detected by the patients themselves. Patient-noted breast abnormalities should be carefully evaluated.

Majority of the incidentally discovered adrenal masses, called adrenal incidentaloma (AI), are nonfunctioning adrenal adenomas. The appropriate management of AI is still a matter debate, so it is necessary to investigate their associated morbidity. However, data regarding morphological and functional cardiac alterations are limited in this group. In this study, we aimed to assess cardiac structural and functional characteristics and atrial conduction properties in patients with nonfunctioning AI. Thirty patients with nonfunctioning AI and 46 properly matched control subjects were included in the study. After hormonal and biochemical analysis, all participants underwent transthoracic echocardiography to obtain systolic and diastolic parameters of both ventricles, in addition to atrial conduction times by tissue Doppler echocardiography. Data were analyzed with Statistical Package for the Social Sciences (SPSS, Chicago, IL, United States) statistics, version 17.0 for Windows. P < 0...

Familial hypertrophic cardiomyopathy is an autosomal dominant genetic disease considered the most common cause of sudden cardiac death in individuals under 35 years old, especially the athletes. This study aimed to investigate the association between the presence of late potentials and a family history of sudden death, syncope, and complex ventricular arrhythmias on patients with hypertrophic cardiomyopathy. A case series study was carried out from March 2001 to December 2002, including 22 patients with hypertrophic cardiomyopathy according to transthoracic echocardiogram criteria. Patients on a cardiac pacemaker, right bundle branch block, cardiac transplant, and under no possibilities to realize the exams were excluded. The results showed that asymmetric septal hypertrophy was the most common type (73%), 63% had a positive familial history of hypertrophic cardiomyopathy, 55% sudden cardiac death, and 23% syncope. Also, complex ventricular arrhythmias were detected in 14% and late potentials in 23% of patients. According to this study, the presence of late potentials was not associated with familial sudden death, syncope, and complex ventricular arrhythmias.

Background: Fibroepithelial polyps of the urothelial system are rare and are considered to be benign tumors. Ultrasonography (USG), contrast-enhanced CT, and contrast-enhanced MRI can be used for detecting fibroepithelial polyps in the urothelial system. These polyps can be treated by performing open exploration and endoscopic or laparoscopic resection. Previous studies have also reported the frequent use of laser treatment for treating fibroepithelial polyps located in the proximal ureter. Case Presentation: A 54-year-old female patient presented to our clinic with right flank pain. Evaluation of the patient by performing USG and CT detected grade-2 hydronephrosis of the right kidney; however, no stone was detected in the urinary system. MRI detected thickening of the wall of the right proximal ureter along with contrast enhancement. These findings suggested the presence of a ureteral polyp. Ureterorenoscopy detected a 7-cm-long ureteral polyp in the proximal ureter, which was resected by performing monopolar cautery. Conclusion: Although fibroepithelial polyps of the urinary tract are rare, they should be considered in the absence of urinary calculi and in the presence of a ureteral obstruction. Furthermore, careful endoscopic resection by performing electrocautery is a safe and useful method for treating ureteral lesions.

A goblet cell carcinoid (GCC) is an appendiceal neoplasm with mixed neuroendocrine and glandular differentiation that is uncommon and most typically affects middle-aged adults. The terminology of this tumor has recently been changed to goblet cell adenocarcinoma (GCA) to indicate the malignant behavior of this tumor, which is more than that of a neuroendocrine tumor (NET). The WHO has removed the term "carcinoid" in naming tumors in its 2022 classification. In this report, we present a 42-year-old man who was admitted to the hospital with complaints of severe pain in the right lower abdomen, fever, and elevated white blood cells, which were the common symptoms of acute appendicitis. He had a scheduled appendectomy and thought that he would recover like any other normal case. However, what was unexpected was the pathology report, which showed goblet cell adenocarcinoma (GCA), a rare and aggressive tumor that was previously known as GCC. In contrast to the general NETs, GCC acts rather like an adenocarcinoma, inclining to invade the adjacent tissues and metastasize. Here, the tumor has extended beyond the appendix and invaded the surrounding fat (T3N0M0, Stage IIA). The fat invasion also necessitated continued treatment, whereas the lymph nodes and distant organs were not affected. The carcinoid/adenocarcinoma terminology transformation signifies the actual nature of the tumor, which is more of a rapidly progressing cancer that needs vigorous treatment rather than a NET with a slow growth rate. This case serves as a reminder to keep a wide differential diagnosis, even in classical presentations, such as appendicitis. Cross-disciplinary tumor board discussion was key in decision-making regarding the treatment plan. Four years after surgery, the patient is still disease-free. We provide a brief literature review on this uncommon tumor and clarify the recent change in classification terminology.

Cardiac metastases of malignant tumors occur more frequently than primary tumors of the heart. Local invasion of the pericardium and heart is commonly seen in primary lung cancer, but myocardial metastasis without local invasion rarely occurs. 18-F fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is widely used in the diagnostic evaluation and staging of different malignant tumors, but the FDG uptake of myocardium is intense and heterogeneous. A-55-year old male smoker was diagnosed with small cell lung cancer (SCLC) by bronchoscopic biopsy, and FDG PET/CT showed high FDG uptake in myocardium. Transthoracic echocardiagraphy revealed mass like lesions in the apical regions of both ventricules. After systematic evaluation of imaging studies, the mass was diagnosed as intracardiac metastasis of SCLC and histopathologic examination. This case shows that intracardiac metastases of malignant tumors can be seen without local invasion, and FDG PET/CT can be a useful diagnostic tool in evaluation of intracardiac metastasis.

Fibrous Dysplasia is a benign fibro-osseous lesion occurring throughout the skeletal system with a predilection for craniofacial bones, long bones, and ribs. Fibrous dysplasia develops during bone formation and growth with a variable natural evolution. It is considered a genetic nonheritable disease resulting from missense mutations that occur postzygotically in the GNAS1 gene. This mutation leads to a focal congenital failure of proper bone formation and arrest at the woven bone stage. In turn, this leads to a decreased mechanical strength, causing bone pain, pathological fractures, and skeletal deformities. Besides clinical examination, fibrous dysplasia is diagnosed based on the results of radiographic imaging and the microscopic histopathological findings. On CT scan, fibrous dysplasia shows the characteristic "Ground-glass" appearance with well-defined borders. On MRI, fibrous dysplasia has a low signal intensity on T1-weighted MRI and variable signal intensity on T2-...

Background: Nonalcoholic fatty liver disease (NAFLD) increases the risk of liver cirrhosis and hepatocellular carcinoma and is also strongly correlated with extrahepatic diseases, including cardiovascular disease and type 2 diabetes. This risk of NAFLD among obese individuals who are otherwise metabolically healthy is not well characterized. Objectives: To determine the prevalence and characteristics of NAFLD in individuals with metabolically healthy obesity. Setting: A tertiary, academic, referral hospital. Methods: All patients who underwent bariatric surgery with intraoperative liver biopsy from 2008 to 2015 were identified. Patients with preoperative hypertension, dyslipidemia, or prediabetes/diabetes were excluded to identify a cohort of metabolically healthy obesity patients. Liver biopsy reports were reviewed to determine the prevalence of NAFLD. Results: A total of 270 patients (7.0% of the total bariatric surgery patients) met the strict inclusion criteria for metabolically healthy obesity. The average age was 38 ± 10 years and the average body mass index was 47 ± 7 kg/m2. Abnormal alanine aminotransferase (>45 U/L) and asparate aminotransferase levels (>40 U/L) were observed in 28 (10.4%) and 18 (6.7%) patients, respectively. A total of 96 (35.5%) patients had NAFLD with NALFD Activity Scores 0 to 2 (n = 61), 3 to 4 (n = 25), and 5 to 8 (n = 10). A total of 62 (23%) patients had lobular inflammation, 23 (8.5%) had hepatocyte ballooning, 22 (8.2%) had steatohepatitis, and 12 (4.4%) had liver fibrosis. Conclusion: Even with the use of strict criteria to eliminate all patients with any metabolic problems, a significant proportion of metabolically healthy patients had unsuspected NAFLD. The need and clinical utility of routine screening of obese patients for fatty liver disease and the role of bariatric surgery in the management of NAFLD warrants further investigation.

There is currently a highly unusual disparity in international access to lung cancer screening. Typically, underserved people in nations withrestricted resources experience lower access to medical care and poorer outcomes than those in more prosperous societies. Today, the converse is true in Western Europe, where public access to lung cancer screening is unavailable outside of a research study. A review of global lung cancer screening public policy shows that, while population screening is now widely practiced in Asia and the United States, only three nations in Central Europe today offer national lung cancer screening programs, i.e., Poland (2020), Croatia (2020) and Czechia (2022). In Western Europe, despitemajor public expenditure to complete multiple randomized control trials (which reported highly favorable results), there is still today no nation that offers full access to a national CT screening program for citizens at risk. Why have Western European public health officials been reluctant to act in a timely manner while their citizens suffer and die—unscreened—from lung cancer? This question has major medical, social, ethical and political implications. The pathway from initial concept through research, guideline development, public health policy and funding is highly complex and differs substantially in individual nations. Policy research to determine the reasons for protracted delay in the implementation ofpopulation CT lung cancer screening in Western Europe is urgently needed. Every day of future delay in implementation will inevitably result inmore unnecessary suffering and preventable death.

To retrospectively determine the association between breast lesion morphology and malignancy and to determine the optimal value of lesion enhancement (HU, Hounsfield units) to improve the diagnostic accuracy of breast cancer in patients with incidental breast lesions (IBLs). A total of 97 patients with 102 IBLs detected from July 2009 to December 2012 were enrolled in this study. Two radiologists analyzed CT images for the presence of malignancy based on the morphology of the lesions alone and in combination with an enhancement value (HU) analysis. There were 36 malignant and 66 benign IBLs. When the morphology and enhancement values were combined, the sensitivity, specificity, and accuracy were 92%, 97%, and 95%, respectively, for reader 1 and 89%, 94%, and 92%, respectively, for reader 2. The addition of HU values led to correct changes in the diagnosis; specifically, the accuracy of the diagnosis of reader 1 and reader 2 improved by 6.9% and 11.8%, respectively. The addition of the enhancement value (HU) to the CT morphology improved the diagnostic accuracy in the differentiation of malignant from benign IBLs by using the region of interest (ROI) to measure the HU within the most suspicious part of the lesion.

Head and neck squamous cell carcinoma (HNSCC) often presents with cervical lymph node metastases and at times the primary tumor cannot be identified despite extensive workup. Lymphoma is the second most common neoplasm in the head and neck region but is seldom synchronous with HNSCC and rarely involves regional mucosal sites. We report herein a rare occurrence of tonsillar involvement by small lymphocytic lymphoma (SLL) incidentally detected during the workup for a cervical lymph node SCC metastasis of a 52-year-old nonsmoker male. The microscopic human papillomaviruspositive SCC involving the tonsillar surface and crypts was obscured by SLL leading to the initial designation of 'unknown primary'. The occult HNSCC are likely explained by small tumor size, quality and quantity of sampling, thoroughness of endoscopic, radiological and pathological assessment or a combination of the above. The coexistence of another tumor such as lymphoma has not yet been reported as a confounding factor in the workup for cervical SCC metastasis. Since oropharyngeal SCC can be very small and Waldeyer's ring is a common site for lymphoma involvement, identification of such rare collision tumors requires pathologists' awareness, extensive sampling and occasionally ancillary studies for the accurate diagnosis and staging essential for the correct management.

Introduction: Several clinical and pathological scenarios like hemodynamic procedures, cardiac surgery in heart trauma and arrhythmias from coronary occlusive disease management have importance of variations in the origin of Right Coronary Artery (RCA). The RCA presents a wide spectrum of morphological expressions regarding its sites of origin, course, branches, length, size and termination. RCA usually arises from the Anterior Aortic Sinus (AAS) and traverses through the right atrio-ventricular (AV) groove. Subjects and Methods: In the present study, Computed Tomographic (CT) coronary angiograms of 50 routine subjects of different age groups who came to the Department of Radiodiagnosis, King George's Medical University UP, Lucknow in the year 2010-2011 with known or suspected coronary artery disease, were analyzed. Coronary angiography (CA) was performed on a 64 slice Multidetector Computed Tomographic (MDCT) scanner, using retrospective electrocardiographic (ECG) gating. The incidence of different sites of origin of RCA was assessed. Results: In the present study, RCA originated from Anterior Aortic Sinus (AAS) in 47 (94%) subjects. In 3 (6%) subjects, RCA showed anomalous origin from Left Posterior Aortic Sinus (LPAS). These three subjects were males [3(9.38%)]. In all the subjects, the course of RCA was normal except three males having origin of RCA from LPAS. In these three males, the proximal part of RCA coursed between Right Ventricular Outflow Tract (RVOT) and aorta. Conclusion: Most common site for origin of RCA was AAS. Anomalous origin of RCA was seen only from LPAS. Anomalous origin of RCA was seen only in male subjects. In all subjects having anomalous origin of RCA from LPAS, RCA coursed between pulmonary trunk and ascending aorta.

A duplicated inferior vena cava and renal aplasia is rare and absence of one kidney has been considered to occur exclusively on the right side. We report an unusual case of a duplicated inferior vena cava and left renal aplasia and discuss the interrelationship between these developmental anomalies.

Background and aim: There are no reports of quantitative evaluation of metabolic changes in the mammary gland after radiation therapy. The purpose of this study was to investigate metabolic changes in the ipsilateral mammary gland after radiation therapy and to evaluate the late radiation effects. Patients and methods: Metabolic changes of the ipsilateral and contralateral mammary glands were retrospectively evaluated by F-18 fluorodeoxyglucose (FDG) PET/CT after whole breast irradiation following lumpectomy in five breast cancer patients. The maximum standardized uptake values (SUVmax) of the ipsilateral mammary gland (S1) and the contralateral mammary gland (S0) were measured. The relative SUVmax (5 S1/S0) was measured immediately before, one year after, three years after, and five years after radiation therapy. Results: The SUVmax of the ipsilateral mammary gland decreased gradually, but there was no decrease in the SUVmax of the contralateral mammary gland. Relative SUVmax values before, 1, 3, and 5 years after radiation therapy were 1.33 ± 0.20, 1.13 ± 0.35, 0.99 ± 0.26 and 0.62 ± 0.10, respectively. Relative SUVmax value at 5 years was significantly lower than before radiation therapy (P < 0.01). Conclusions: 18F-FDG PET/CT may be useful in assessing mammary gland function and predict lactation disorders in advance.

Sjogren’s syndrome is a rare autoimmune disease affecting multiple systems with varying clinical features.We report a case of 37 year old woman who presented with recurrent episodes of quadriparesis which was attributable to hypokalemia and initially labelled as hypokalemic periodic paralysis. Later on she was found to have metabolic acidosis rather than alkalosis which pointed towards the diagnosis of renal tubular acidosis (RTA) in the absence of apparent gastrointestinal tract loss. Once the diagnosis of RTA was established, an attempt to search the aetiology revealed that she was having primary Sjogren’s syndrome (pSS) though she did not have any symptom at the time of diagnosis. She was found positive for anti-SSA. Lip biopsy revealed lymphocytic infiltration in periductal as well as parenchymal region. Schirmer test confirmed presence of severe dry eye. A concomitant existence of autoimmune hypothyroidism was a noteworthy association. She responded well with potassium suppleme...

who underwent resection. Of particular concern, 20% of presumed Bd-IPMN had a main-duct component. Conversely, 5% of resected cysts were not even neoplastic. Clearly, better diagnostic methods are needed to aid in formulating appropriate treatment strategies.

Background: Routine preoperative laryngeal examination remains controversial. We aimed to assess the utility of preoperative routine flexible laryngoscopy (FL) by looking at the incidence, clinical significance and predictors for preoperative vocal cord paresis (VCP) and incidental laryngopharyngeal condition (LPC) in our consecutive cohort. Methods: Three hundred and two patients underwent laryngeal examination by an independent otorhinolaryngologist and were specifically asked about voice/swallowing symptoms suggestive of VCP one day before surgery. Apart from vocal cord (VC) mobility, the naso-pharynx and larynx were examined using FL. Any VCP and/or LPC was recorded. VCP was defined as reduced or absent movement in ≥1 VC. A LPC was considered clinically significant if the ensuing thyroidectomy was changed or deferred. Results: Seven (2.3%) patients had preoperative VCP while an additional 7 patients had incidental LPC. Of the 7 VCPs, 5 were caused by previous thyroidectomy while 2 were by a benign goiter. The incidence of asymptomatic VCP in a previously non-operated cohort was 1/245 (0.41%). Voice/swallowing symptoms (p=0.033) and previous thyroidectomy (p<0.001) were the two significant predictors for VCP. The 7 incidental LPC were vallecular cyst (n=1), VC scar and polyp (n=2), nasopharyngeal cyst and polyp (n=3) and redundant arytenoid mucosa (n=1) but since they were benign, all 7 patients proceeded to thyroidectomy as planned. Conclusions: Given the low incidence (0.41%) of asymptomatic VCP in a previously non-operated cohort and none of the 7 LPCs were considered clinically significant, routine preoperative laryngoscopic examination should be reserved for those with previous thyroidectomy and/or voice/swallowing symptoms.

Microarray-based comparative genomic hybridization (aCGH) is commonly used in diagnosing patients with intellectual disability (ID) with or without congenital malformation. Since aCGH interrogates the whole genome, there is a risk of being confronted with incidental findings (IF). In order to anticipate the ethical issues of IF with the generalization of new genome-wide analysis technologies, we questioned French clinicians and cytogeneticists about the situations they have faced regarding IF from aCGH. Sixty-five IF were reported. Forty corresponded to autosomal dominant diseases with incomplete penetrance, 7 to autosomal dominant diseases with complete penetrance, 14 to X-linked diseases, and 4 were heterozygotes for autosomal recessive diseases with a high prevalence of heterozygotes in the population. Therapeutic/preventive measures or genetic counselling could be argued for all cases except 4. These 4 IF were intentionally not returned to the patients. Clinicians reported diffi...

Recent advances in multi-detector computed tomography, magnetic resonance imaging, and ultrasound have led to the detection of incidental ovarian, uterine, vascular and pelvic nodal abnormalities in both the oncology and nononcology patient population that in the past remained undiscovered. These incidental pelvic lesions have created a management dilemma for both clinicians and radiologists. Depending on the clinical setting, these lesions may require no further evaluation, additional immediate or serial follow-up imaging, or surgical intervention. In this review, guidelines concerning the diagnosis and management of some of the more common pelvic incidentalomas are presented.

Technical advances in cross-sectional imaging have led to the discovery of incidental cystic pancreatic lesions in the oncology and non-oncology population that in the past remained undetected. These lesions have created a diagnostic and management dilemma for both clinicians and radiologists: should these lesions be ignored, watched, aspirated, or removed? In this review, recommendations concerning the assessment of the more common pancreatic cystic incidental lesions are presented.