Case of the Week From 1/29/23

History: Abnormal laboratories.
Describe the lesion: Enhancing mass within the lower pole of the renal collecting system. (32 Hounsfield units of enhancement). Significant dilated left renal collecting system with cortical thinning and multifocal calcifications.
Based on the description and findings what is the most likely diagnosis/differential diagnosis? Consider transitional cell carcinoma given location and fungating appearance within the collecting system. Renal cell carcinoma is also within the differential diagnosis. Findings not typical for oncocytoma (tends not to grow into the collecting system. No sharp stellate scar). Other infectious inflammatory etiologies are less likely.
What are the pertinent positives and negatives to tell the referrer? No definite invasion of the renal vein. No adjacent adenopathy. Located within the renal collecting system. No definite infiltration of the adjacent retroperitoneum.

 

 

Case of the Week From

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1/22/23

History: Abdominal swelling
Describe the relevant findings and diagnosis: Large circumscribed cystic mass with fat density and calcifications extending from the pelvis into the abdomen. No free fluid, abnormal fat or calcium density external to the mass. (Need to check the lung windows to confirm fat density vs air!) Unruptured large teratoma.
What are the important additional pieces of information to let the ordering doctor know about this case? No findings to suggest rupture of the mass. Size is important. Fat in the mass usually indicated benignity,
What are the risks of leaving it in place? rupture with peritonitis, mass effect upon adjacent organs (hydronephrosis, obstruction, etc), rarely (malignant degeneration)

 

 

Case of the Week From 1/15/23

History: Thyroid cancer and prior thyroidectomy. Recent treatment 7 days ago.
Describe the relevant findings: Iodine scan showing an iodine avid mass corresponding to the upper pole of the right kidney.
What is the differential diagnosis? Calyceal diverticulum or  less likely primary renal cell carcinoma/other mass with increased flow.
What would be a reasonable next test and why? Contrast enhanced CT scan or MRI with delayed images. A calyces diverticulum will show filling of the mass with contrast.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Case of the Week From 1/8/23

History: Lesion seen in the pancreas on outside endoscopic ultrasound.
Describe the relevant findings: Enhancing lobulated mass contiguous with the SMV with similar appearance to the adjacent SMV.
What is the most likely diagnosis? Varix of the SMV.
How is it treated? If asymptomatic, does not need treatment (can be followed). In the setting of a normal liver (like in this case) and abdominal pain, patients can get an aneurysmectomy  or aneurysmorrhaphy.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Case of the Week From 1/1/23

History: Lower abdominal pain.
Describe each of the findings. Cystic structure with fluid fluid level at the cervix. Left vulvar hyperdense lesion, possibly a complex cyst.
What are the most likely common names for each of the findings? Nabothian cyst, Bartholin’s cyst
Give a differential diagnosis: Differential for the site at the cervix includes less likely cervical stenosis with fluid retention from benign or malignant etiologies. Differential for the left vulvar hyperdense lesion can also include less likely  hematoma or mass.