Plasma cell leukemia presenting as a pancreatic mass

A 62-year-old woman presented with a 3-week history of obstructive jaundice. Computed tomography of the abdomen showed marked enlargement of the head of the pancreas and a prominent pancreatic body, suggestive of a neoplasm with associated pancreatitis. The peripheral blood showed an increased number of plasma cells accounting for 50% of the leukocytes. Biopsy specimens of the pancreas, liver, and a peritoneal lymph node showed a diffuse infiltrate of typical and atypical plasma cells (50% of which had cytoplasmic IgG-lambda). Serum and urine protein electrophoresis revealed a monoclonal IgG-lambda spike and Bence Jones-lambda protein, respectively. The bone marrow was diffusely infiltrated by plasma cells. To our knowledge, this is the first reported case of a plasma cell leukemia presenting as a pancreatic mass producing extrahepatic biliary obstruction.     

Renal artery aneurysm presenting as a chest mass

An enlarging mass in the right chest in a 25-year-old woman was found at operation to be a false aneurysm of the renal artery. Preoperative diagnosis was not made despite an extensive workup including arteriography. Successful resection was carried out via a posterolateral thoracotomy. Although vascular reconstruction was not feasible. The danger of rupture of such an aneurysm from an incisional biopsy is emphasized.     

Lipoblastoma presenting as a mesenteric mass in an infant

PURPOSE: This article describes an infant with a large abdominal mass and hypertension. PATIENT AND METHODS: A 5-month-old infant girl with diarrhea of 1 week's duration and a large right-sided abdominal mass was brought for treatment. Computed tomography of the abdomen revealed a large, generally homogeneous, hypodense mass, which compressed the right kidney, resulting in dilatation of the right renal collecting system. At surgery, the mass was adherent anteriorly to the transverse colon and attached by a stalk to the mesentery near the origin of the right colic artery. RESULTS: Examination of the mass showed an encapsulated lipoblastoma. Cytogenetic analysis revealed a 46,XX karyotype with a reciprocal translocation between chromosome 2 and chromosome 8 with breakpoints at q23 and q11.2, respectively. CONCLUSION: Lipoblastoma is a rapidly growing but benign tumor, which can cause severe medical problems by compressing major organs. Cytogenetic analysis can reveal translocations involving chromosome 8 band q11.2, which appears to be a specific chromosome marker for lipoblastoma.     

Primary amyloidosis presenting as extensor tenosynovitis

Primary amyloidosis is a systemic disease. Amyloid arthropathy is an invalidating and uncommon form of presentation, but tenosynovitis is even rarer as the first sign of the disease. We report herein a case of unilateral amyloid deposit in the synovium of the extensor tendons of the hand, which was the first manifestation of a primary amyloidosis.     

Lymphoma presenting as an intramuscular mass

BACKGROUND: Resection of an intramuscular mass without tissue diagnosis can lead to unnecessary surgery. METHOD: During a 4.5-year period 19 previously healthy patients referred with an undiagnosed soft tissue tumour were found to have intramuscular non-Hodgkin's lymphoma. In seven patients this was the only focus of disease (Stage IE). Patients were treated with chemotherapy or radiotherapy alone or in combination. RESULTS: After mean follow-up of 43 months all of the patients with stage IE lymphoma are alive and disease free. CONCLUSION: Primary intramuscular non-Hodgkin's lymphoma has a good prognosis. The importance of a tissue diagnosis by needle core biopsy is emphasized.     

Unretrieved gallstone presenting as an inguinal mass

It is well known that renal cell carcinoma metastasizes to unusual sites. We report a case in which two rare sites of metastasis, the maxilla and contralateral ureter, appeared in a single patient.     

Anterior sacral meningocele presenting as abdominal mass

Anterior sacral meningocele is a rare entity. It arises from a congenital defect of the sacrum and the coccyx through which herniation of the caudal portion of the meninges and their contents occurs, forming a cyst-like structure. The cystic mass, which lies between the rectum and sacrum, produces a variety of symptoms depending on its size and contents and constitutes a diagnostic problem. A case of anterior sacral meningocele is presented, including the physical signs, differential diagnosis, and the dangers of aspiration or surgical intervention.     

Systemic small noncleaved cell lymphoma presenting as a posterior choroidal mass

PURPOSE: To describe a patient with intraocular involvement by systemic, small noncleaved cell lymphoma. METHODS: Case report and review of the literature. RESULTS: A patient presented with a diffusely elevated choroidal mass. Systemic evaluation led to the diagnosis of unsuspected disseminated lymphoma. CONCLUSION: Small noncleaved cell lymphoma should be included in the differential diagnosis of a choroidal mass.     

Cat-scratch disease presenting as an epitrochlear arm mass

Delayed sciatic neuropathy due to pelvic reconstruction plate loosening following complex acetabular reconstruction in total hip arthroplasty seems not be have been previously reported. We identified a 79-year-old woman who developed progressive neurologic signs of entrapment 6 months following reconstruction of a pelvic discontinuity due to fracture nonunion caused by radiation necrosis. Magnetic resonance imaging of the lumbar spine was unrevealing and electromyography demonstrated a peripheral neurogenic process involving the sciatic nerve. Sciatic nerve exploration was done at 12 months after surgery finding a loose screw in the pelvic plate impinging the nerve. Substantial improvement in clinical symptoms resulted from removal and nerve release.     

Radionecrosis of the brain presenting as a mass lesion: a case report

A case of radionecrosis of the brain in a patient previously treated for squamous cell carcinoma of the scalp is presented. Cerebral angiography revealed a mass effect primarily in the right frontal area. Computed tomography showed extensive hemispheric oedema. A frontal lobectomy was performed, and the recovery was excellent. The lower limit for brain tolerance for irradiation is about 5000 rads given in five weeks. This dose should not be exceeded when extracranial lesions are treated. Although computed tomography cannot diagnose brain necrosis, specifically, it should, along with the clinical history, be very helpful.     

Superficial venous thrombosis presenting as a painful popliteal fossa mass in a child

We report an unusual case of superficial venous thrombosis in a cyanotic 12-year-old child who had undergone recent appendectomy. Although compression, color Doppler, and duplex ultrasound techniques remain the keys to the diagnosis of venous thrombosis, SieScape sonography was beneficial in demonstrating the extent of the thrombi and their location along a superficial thrombosed vein.     

Cirsoid arteriovenous malformation of kidney presenting as a mass suggestive of malignancy

This paper reports a rare case of cirsoid renal arteriovenous malformation (AVM) that showed radiological characteristics of a renal malignancy. Using only conventional procedures such as computerized tomography, the present case was misdiagnosed as a solid tumor mass and therefore radical nephrectomy was indicated. Angiographic analysis is expected to improve the accuracy of diagnosis of AVM, thus reducing the need to resort to invasive techniques.