1/19. Giant congenital solitary cyst of the liver: report of a case.Giant solitary nonparasitic cysts of the liver are rarely encountered in children, and establishing a preoperative diagnosis is usually difficult, especially when the cyst occupies the entire abdomen. We report herein the case of an 8-year-old girl found to have a giant congenital solitary cyst of the liver masquerading as an ovarian cyst.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/19. Laparoscopic extirpation of a giant ovarian cyst.BACKGROUND: The differential diagnosis of unilocular intraabdominal cysts includes ovarian, gastrointestinal, urological, and lymphatic processes. They occur at all ages and can be benign or malignant. methods: We present a case of a 17-year-old female with asymptomatic abdominal distension. ultrasonography (US) revealed a 20 x 21-cm unilocular cystic mass with smooth surface lining. paracentesis was performed during diagnostic laparoscopy, recovering more than 7 L of clear fluid. The cyst and left adnex were completely removed laparoscopically and diagnosis of ovarian cystadenoma was made. The patient made a quick and uneventful recovery. CONCLUSIONS: In all cases of abdominal distension, US must be performed and a tumor marker profile consisting of AFP, LDH, testosterone, estradiol, and CA-125 must be established in order to differentiate between benign and malignant processes. When the latter is suspected, additional computerized tomographic scanning must be performed. In this case, a normal tumor marker profile and benign ultrasonographic appearance excluded the possibility of malignancy. Conventional treatment in these large cysts is laparotomy. We propose that complete laparoscopic drainage and extirpation should be the treatment of choice, regardless of cystic size.- - - - - - - - - - ranking = 4keywords = giant (Clic here for more details about this article) |
3/19. A true splenic cyst producing carbohydrate antigen 19-9 and cancer antigens 50 and 125, but not interleukin 10.A giant cystic lesion of the left upper abdomen associated with a smaller ovarian cyst in a young female patient is reported. Laboratory data revealed elevated serum levels of carbohydrate antigen 19-9 (CA 19-9), carcino-embryonic antigen (CEA), cancer antigens 50 and 125, and tissue polypeptide antigen. In contrast, the serum levels of interleukin 10, a cytokine involved in modulating immune responses and produced by many cancer histotypes, were normal. Since ovarian cancer or cystic adenocarcinoma of the tail of the pancreas were not ruled out, the patient underwent laparotomy. After splenectomy and ovariectomy, the tumour marker serum levels normalized. histology and immunohistochemical analysis revealed a true splenic cyst with the inner epithelium strongly positive for CA 19-9 and CEA and high levels of cancer antigens in the fluid. The ovarian lesion was a serous cystadenoma. The inner epithelium showed no immunoreactivity for tumour markers which were not measurable in the fluid. True cysts of the spleen are rare; in a few cases, high serum levels of CA 19-9 and CEA have been reported. In such instances, cyst resection or splenectomy is indicated to rule out malignant lesions and to remove the cancer antigen producing epithelium. The reported case shows that the epithelium lining true splenic cysts may produce, besides CA 19-9 and CEA, other tumour markers, in particular cancer antigens 50 and 125. In addition, normal serum values of interleukin 10 correctly predicted the benign nature of the lesion.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
4/19. Giant hydronephrosis mimicking progressive malignancy.BACKGROUND: Cases of giant hydronephroses are rare and usually contain no more than 1-2 litres of fluid in the collecting system. We report a remarkable case of giant hydronephrosis mimicking a progressive malignant abdominal tumour. CASE PRESENTATION: A 78-year-old cachectic woman presented with an enormous abdominal tumour, which, according to the patient, had slowly increased in diameter. Medical history was unremarkable except for a hysterectomy >30 years before. A CT scan revealed a giant cystic tumour filling almost the entire abdominal cavity. It was analysed by two independent radiologists who suspected a tumour originating from the right kidney and additionally a cystic ovarian neoplasm. Subsequently, a diagnostic and therapeutic laparotomy was performed: the tumour presented as a cystic, 35 x 30 x 25 cm expansive structure adhesive to adjacent organs without definite signs of invasive growth. The right renal hilar vessels could finally be identified at its basis. After extirpation another tumourous structure emerged in the pelvis originating from the genital organs and was also resected. The histopathological examination revealed a >15 kg hydronephrotic right kidney, lacking hardly any residual renal cortex parenchyma. The second specimen was identified as an ovary with regressive changes and a large partially calcified cyst. There was no evidence of malignant growth. CONCLUSION: Although both clinical symptoms and the enormous size of the tumour indicated malignant growth, it turned out to be a giant hydronephrosis. Presumably, a chronic obstruction of the distal ureter had caused this extraordinary hydronephrosis. As demonstrated in our case, an accurate diagnosis of giant hydronephrosis remains challenging due to the atrophy of the renal parenchyma associated with chronic obstruction. Therefore, any abdominal cystic mass even in the absence of other evident pathologies should include the differential diagnosis of a possible hydronephrosis. Diagnostic accuracy might be increased by a combination of endourological techniques such as retrograde pyelography and modern imaging modalities.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
5/19. Deficiency of 17,20-lyase causing giant ovarian cysts in a girl and a female phenotype in her 46,XY sister: case report.A 13-year-old girl was referred because of progressive abdominal pain caused by ovarian torsion and giant ovarian cysts. Secondary sexual characteristics were absent. Hormone analysis revealed markedly elevated serum levels of progesterone and 17-hydroxyprogesterone in combination with very low peripheral concentrations of C19 steroids (dehydroepiandrosterone and androstenedione) and estrogens. serum concentrations of FSH and LH exceeded the upper limit of normal levels in adult women. The patient's 16-year-old 46,XY sibling showed a female phenotype with similar hormonal disturbances. Both siblings were found to be compound heterozygotes for two mutations in the CYP17 gene: an R347C mutation in one allele and a 25-base pair deletion in exon 1 in the other. The resulting block in 17,20-lyase activity caused an inability to synthesize androgens and estrogens, and increased levels of gonadotrophins due to a lack of negative feedback. The increased levels of gonadotrophins most likely stimulated growth of the ovarian cysts. The administration of a GnRH antagonist reduced the size of the cysts within a few weeks. At present, the girl is being treated with a combination of a GnRH agonist and hormone replacement therapy.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
6/19. A case of a large endometrial cyst imitating an ovarian neoplasm.A case of giant endometrioma imitating an ovarian neoplasm is reported and difficulties in radiological differential diagnosis of such lesions are discussed.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
7/19. Giant bilateral ovarian cysts in an adolescent masked by obesity and mimicking ascites: a case report.ovarian cysts are a common pathology after the 4th decade of life. We can find either smaller functional, non-neoplastic ones (belonging to the follicular and luteinic varieties) or larger tumoral cysts, which, however, are usually benign. These may be of the serous or mucinous type and can sometimes reach really large sizes. Reports of giant ovarian manifestations were more frequent a few decades ago. Prior to the advent of modern radiological, ultrasonographic, tomographic and magnetic resonance imaging techniques, diagnosis was often difficult. Nevertheless, even today, in some cases (as a result of pronounced obesity, for example, associated perhaps with diagnostic negligence), cases of giant ovarian cysts may still be encountered. We report the case of a (previously obese) 19-year-old female, admitted to our hospital for presumed ascites, identified and ultrasonographically misdiagnosed by her gynaecologist. The patient was, in fact, suffering from giant serous cystoadenomas in both ovaries.- - - - - - - - - - ranking = 3keywords = giant (Clic here for more details about this article) |
8/19. Giant cyst of the rete ovarii in a child.The ovarian cysts are mostly nonneoplastic in children and could be categorized as follicular, simple, and corpus luteum cysts. Follicle cysts are the most common type in both neonates and older children. The rete ovarii rarely gives rise to cysts and to benign and malignant tumors. The rete cysts are most often found in postmenopausal women and have not been reported in children yet. We describe herein a case of giant rete cyst of ovary in an 11-year-old girl and discuss the clinical and histopathologic features of such cysts.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
9/19. Giant diverticulum of the bladder simulating ovarian cyst.A patient was admitted for investigation of a giant ovarian cyst, confirmed by physical examination. At laparotomy the genital organs appeared normal. Ultrasonic reexamination affirmed the preliminary findings of a pelvic cystic mass. A urinary bladder diverticulum was suspected and confirmed by cystography and found to be nonobstructive in nature. Although extremely rare, bladder diverticulum should be considered in the differential diagnosis of a cystic pelvic mass.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
10/19. Laparoscopic management of giant ovarian cyst.INTRODUCTION: Giant intraabdominal cysts are very rare, and conventional treatment is full midline laparotomy. We present a case of complete laparoscopic extirpation of a giant ovarian cyst. CASE REPORT: A 16-year-old female presented with progressive abdominal distension for 1-year along with early satiety, constipation, and significant weight loss. A CT scan showed a giant multiseptated cystic mass in the abdomen measuring 22.5 x 30 x 40.5 cm with significant mass effect causing intrahepatic ductal dilatation and right hydronephrosis. The mass was decompressed via a mini-laparotomy in a controlled fashion, removing 15 liters of fluid. A laparoscopic left oophorectomy was then performed. The postoperative course was uneventful, and the patient was discharged home on postoperative day 1 with minimal pain and tolerating a regular diet. pathology examination revealed a mature cystic teratoma. CONCLUSION: Giant ovarian cysts can be managed laparoscopically when a normal tumor marker profile and benign imaging appearance exclude the possibility of malignancy.- - - - - - - - - - ranking = 6keywords = giant (Clic here for more details about this article) |
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