A Rare Tumor of the Scalp: Papilliferous Cystadenoma

Introduction: Papilliferous cystadenoma is a rare adnexal tumor of early childhood. Case Report: We report a case of papilliferous cystadenoma of the scalp in a 22-year-old adult with no previous history of the disease. She had been presenting with a slowly progressing scalp mass for about 10 years. The mass was mildly pruritic and painless, but the patient reported several painful episodes treated with local herbal applications and unspecified antibiotics. On inspection, the lesion was raised, granular, sessile and vegetated, greyish in color, with an irregular surface, nippled and hemispherical in shape. On palpation, the lesion was painless, fleshy and surrounded by crusts that were easily removed by applying a saline-moistened compress. The patient underwent excision with at least 4-mm margins. Pathological examination of the operative specimen revealed a papilliferous syringocystadenoma. There was no tumor recurrence after three years. Conclusion: Papilliferous cystadenoma is a rare benign tumor of the scalp requiring clinical analysis and surgical excision to confirm its histological nature. Post-operative follow-up is necessary due to frequent recurrences.

Preoperative differential diagnosis between intrahepatic biliary cystadenoma and cystadenocarcinoma:A single-center experience

AIM:To investigate preoperative differential diagnoses made between intrahepatic biliary cystadenoma and intrahepatic biliary cystadenocarcinoma.METHODS:A retrospective analysis of patient data was performed,which included 21 cases of intrahepatic biliary cystadenoma and 25 cases of intrahepatic biliary cystadenocarcinoma diagnosed between April 2003and April 2013 at the General Hospital of PLA.Potential patients were excluded whose diagnoses were not confirmed pathologically.Basic information(including patient age and gender),clinical manifestation,duration of symptoms,serum assay results(including tumor markers and the results of liver function tests),radiological features and pathological results were collected.All patients were followed up.RESULTS:Preoperative levels of cancer antigen 125(12.51±9.31 vs 23.20±21.86,P<0.05)and carbohydrate antigen 19-9(22.56±26.30 vs 72.55±115.99,P<0.05)were higher in the cystadenocarcinoma subgroup than in the cystadenoma subgroup.There were no statistically significant differences in age or gender between the two groups,or in pre-or post-operative levels of alanine aminotransferase,aspartate aminotransferase,total bilirubin(TBIL),and direct bilirubin(DBIL)between the two groups.However,eight of the 21 patients with cystadenoma and six of the 25 patients with cystadenocarcinoma had elevated levels of TBIL and DBIL.There were three cases in the cystadenoma subgroup and six cases in the cystadenocarcinoma subgroup with postoperative complications.CONCLUSION:Preoperative differential diagnosis relies on the integration of information,including clinical symptoms,laboratory findings and imaging results.

Giant mucinous biliary cystadenoma:a case report

BACKGROUND: Biliary cystadenoma is a very rare cystic neoplasm of the liver. Its clinical features, diagnosis, pathologic characteristics, and optimal surgical management have not been defined clearly. In this article we describe the details of this rare disease. METHODS: A 40-year-old woman with a mass of the liver was verified by ultrasonography and LT. Ultrasonography showed a mixed echo of 18.4 cmx14.72 cmx 15.54 cm in the left lobe of the liver. CT showed a vesicula of 19.9 cmx 13.5 cm in the right epigastrium, with a low density, clear edge, uneven density, and calcified shadow. The patient received successfully a left hepatectomy. Laboratory examination showed an elevation of CA125 to 62.62 U/ml and CA199>1000 U/ml. RESULTS: After the left hepatectomy, the patient was fully recovered. Her biliary cystadenoma was characterized by specific histological findings. During operation, a large cystic lesion was seen in the left hepatic lobe; its surface was dark red with abundant blood supply. Gross examination showed that the tumor almost occupied. The whole left lobe with a small amount of normal liver tissue close to the deltoid ligament. Pathologically, additional lobulated spaces were seen in the tumor with a lot of mucusa. The interior wall was lined with bile duct tissue, indicating a benign mucinous biliary cystadenoma. CONCLUSIONS: Ultrasonography and CT are the major methods for the diagnosis of mucinous biliary cystadenoma liver. Operation is the best way of treatment.

Giant biliary cystadenoma complicated with polycystic liver:A case report

Biliary cystadenoma(BCA)is a rare hepatic neoplasm.Although considered a benign cystic tumor of the liver,BCA has a high risk of recurrence with incomplete excision and a potential risk for malignant degeneration.Correct diagnosis and complete tumor excision with negative margins are the mainstay of treatment.Unfortunately,due to the lack of presenting symptoms,and normal laboratory results in most patients,BCA is hard to distinguish from other cystic lesions of the liver such as biliary cystadenocarcinoma,hepatic cyst,hydatid cyst,Caroli disease,undifferentiated sarcoma,intraductal papillary mucinous tumor,and hepatocellular carcinoma.Ultrasound(US),computed tomography(CT)and magnetic resonance imaging(MRI)may be necessary.They demonstrate intrahepatic cystic lesions with features such as mural nodules,varying wall thickness,papillary projections,and internal septations.Nevertheless,surgery is still the only means of accurate diagnosis.Definitive diagnosis requires histological examination following formal resection.We describe a57-year-old woman initially diagnosed with polycystic liver who was subsequently diagnosed with giant intra-hepatic BCA in the left hepatic lobe.This indicates that both US physicians and hepatobiliary specialists should attach importance to hepatic cysts,and CT or MRI should be performed for further examination when a diagnosis of BCA is suspected.

Primary retroperitoneal mucinous cystadenoma:A case report

Primary retroperitoneal mucinous cystic tumors are extremely rare.These tumors can be classified as a primary retroperitoneal mucinous cystadenoma with or without borderline malignancy or primary retroperitoneal mucinous cystadenocarcinoma.The most common of these is primary retroperitoneal mucinous cystadenoma,which almost always occurs in female patients;only ten cases have been reported in males.The most common clinical findings for this tumor type include nonspecific abdominal pain and a palpable abdominal mass.A definitive diagnosis is usually obtained from histopathology after surgical excision.Here,we report the case of a 60-year-old female patient who complained of abdominal pain that had been present for 3 mo and presented with a palpable abdominal mass.Multidetector computed tomography scanning revealed a large,unilocular cystic mass in the left retroperitoneal space.Surgical intervention was performed and the tumor was completely removed.Histopathologic examination confirmed that the tumor was a primary retroperitoneal mucinous cystadenoma.Two years after surgery,the patient remains disease free.

Clinical diagnosis and management of pancreatic mucinous cystadenoma and cystadenocarcinoma:Single-center experience with 82 patients

BACKGROUND Mucinous cystic neoplasm(MCN)of the pancreas is characterized by mucinproducing columnar epithelium and dense ovarian-type stroma and at risk for malignant transformation.Early diagnosis and treatment of MCN are particularly important.AIM To investigate the clinical characteristics of and management strategies for pancreatic mucinous cystadenoma(MCA)and mucinous cystadenocarcinoma(MCC).METHODS The clinical and pathological data of 82 patients with pancreatic MCA and MCC who underwent surgical resection at our department between April 2015 and March 2019 were retrospectively analyzed.RESULTS Of the 82 patients included in this study,70 had MCA and 12 had MCC.Tumor size of MCC was larger than that of MCA(P=0.049).Age and serum levels of tumor markers carcinoembryonic antigen(CEA),carbohydrate antigen(CA)19-9,and CA12-5 were significantly higher in MCC than in MCA patients(P=0.005,0.026,and 0.037,respectively).MCA tumor size was positively correlated with serum CA19-9 levels(r=0.389,P=0.001).Compared with MCC,MCA had a higher minimally invasive surgery rate(P=0.014).In the MCA group,the rate of major complications was 5.7%and that of clinically relevant pancreatic fistula was 8.6%;the corresponding rates in the MCC group were 16.7%and 16.7%,respectively.CONCLUSION Tumor size,age,and serum CEA,CA19-9,and CA12-5 levels may contribute to management of patients with MCN.Surgical resection is the primary treatment modality for MCC and MCA.

Intrahepatic biliary cystadenoma:A case report

BACKGROUND Biliary cystadenoma(BCA)is a rare benign tumor,accounting for only 5%of reported cystic lesions of the liver.Given its potential for malignancy and high rate of recurrence,surgical resection is the preferred treatment.Therefore,early and accurate preoperative diagnosis is critical to the choice of treatment.We here report the first male case of BCA in our hospital,diagnosed by our team and confirmed by pathological biopsy.This article aims to improve the understanding of this disease and help make a correct diagnosis to better manage it.CASE SUMMARY A 58-year-old man with irregular abdominal discomfort came to our clinic and was found to have a distended abdomen during physical examination.Computed tomography and magnetic resonance imaging both showed a huge cystic mass in the liver.The patient underwent left hepatic lobectomy,cholecystectomy,and liver cyst fenestration,and most of the masses had decreased in size as of the 6-mo follow-up.The pathological diagnosis was consistent with BCA,and no recurrence was detected after the surgery.BCA occurred mainly in middle-aged women.To the best of our knowledge,this patient is the 11th male case of BCA reported in the literature.CONCLUSION The combination of magnetic resonance imaging and magnetic resonance cholangiopancreatography is of great significance for the early accurate diagnosis of the disease and the choice of surgical methods.

Asymptomatic hepatobiliary cystadenoma of the hepatic caudate lobe: a case report

Human hepatobiliary cystadenoma is a rare benign cystic tumor of the liver, and is extremely rare in the caudate lobe. We herein present a case of a 70-year-old male with a hepatobiliary cystadenoma originating from the caudate lobe.

Rare monolocular intrahepatic biliary cystadenoma: A case report

BACKGROUND Intrahepatic biliary cystadenoma(IBC)is a rare benign hepatic tumor that is often misdiagnosed as other hepatic cystic diseases.Therefore,imaging examinations are required for preoperative diagnosis.Contrast-enhanced ultrasound(CEUS)has gained increasing popularity as an emerging imaging modality and it is considered the primary method for screening IBC because of its specificity of performance.We describe an unusual case of monolocular IBC and emphasize the performance of CEUS.CASE SUMMARY A 45-year-old man complained of epigastric pain lasting 1 wk.He had no medical history of hepatitis,liver cirrhosis or parasitization.Physical examination revealed a mass of approximately 6 cm in size in the upper abdomen below the subxiphoid process.Tumor marker tests found elevated CA19-9 levels(119.3 U/mL),but other laboratory tests were unremarkable.Ultrasound and computerized tomography revealed a round thick-walled mass measuring 83 mm×68 mm located in the left lateral lobe of the liver that lacked internal septations and manifested as a monolocular cystic structure.CEUS demonstrated that in the arterial phase,the anechoic area manifested as a peripheral ring with homogeneous enhancement.The central part presented with no enhancement.During the portal phase,the enhanced portion began to subside but was still above the surrounding liver tissue.The patient underwent left partial liver lobectomy and recovered well without tumor recurrence or metastasis.Eventually,the results of pathological examination confirmed IBC.CONCLUSION A few IBC cases present with monolocular characteristics,and the lack of intracystic septa in imaging performance cannot exclude IBC.

Robotic surgery in giant multilocular cystadenoma of the prostate:A rare case report

BACKGROUND Giant multilocular cystadenoma(GMC)of the prostate gland is a very rare benign tumor.Although the benign nature has been known,complete surgical excision is the major treatment consensus because of its high recurrence rate.We report a rare case of GMC with accompanying lower urinary tract symptoms and repeated urine retention initially thought to be symptoms of benign prostatic hyperplasia,which was treated with robot-assisted laparoscopic radical prostatectomy.CASE SUMMARY A 65-year-old man presented with a 2-year history of lower urinary tract symptoms that had deteriorated gradually within the previous six months,even though he had received treatment with a selective alpha-blocking agent.He had undergone two transurethral resections of the prostate(TURP)at a local hospital during a 4-mo interval because initial ultrasound imaging and prostatic core needle biopsy showed benign prostate hyperplasia.Upon the third recurrence,the patient underwent TURP with a green-light laser at our institution.The diagnosis was a tumor composed of variously sized dilated glandular and cystic structures lined by blended prostatic type epithelia positive for prostate-specific antigen;the final diagnosis was giant multilocular cystadenoma.Magnetic resonance imaging showed a large multilocular retrovesical mass 8.0 cm×7.3 cm×6.4 cm,with heterogeneous enhancement.A coexisting malignant part could not be excluded.Considering the high recurrence rate,risk of coexisting malignancy,and possible sequelae of open surgery for radical excision,the patient decided to undergo robot-assisted radical prostatectomy,with good outcomes at the 2-year follow-up.CONCLUSION Robot-assisted surgery for the treatment of prostate GMC provides another choice for simultaneous attention to disease-control and postoperative quality of life.

Laparoscopic fenestration of pancreatic serous cystadenoma:Minimally invasive approach for symptomatic benign disease

Serous cystadenoma(SC) is a benign pancreatic cystic tumor. Surgical resection is recommended for symptomatic forms, but laparoscopic fenestration of large symptomatic macrocystic SC was not yet described in the literature. In this study, 3 female patients underwent laparoscopic fenestration for macrocystic SC(12-14 cm). Diagnosis was established via magnetic resonance imaging and endoscopic ultrasound, with intra-cystic dosage of tumors markers(ACE and CA19-9) in 2 patients. All patients were symptomatic and operated on 15-60 mo after diagnosis.Radiological evaluation showed constant cyst growth.Patients were informed about this new surgical modality that can avoid pancreatic resection. The mean operative time was 103 min(70-150 min) with one conversion.The post-operative course was marked by a grade A pancreatic fistula in one patient and was uneventful in the other two. The hospital stay was 3, 10, and 18 d, respectively. The diagnosis of macrocystic SC was histologically-confirmed in all cases. At the last followup(13-26 mo), all patients were symptom-free, and radiological evaluation showed complete disappearance of the cyst. Laparoscopic fenestration, as opposed to resection, should be considered for large symptomatic macrocystic SC, thereby avoiding pancreatic resection morbidity and mortality.

Papillary cystadenoma of the parotid gland: A case report

BACKGROUND Papillary cystadenoma is a rare benign epithelial tumor of the salivary gland,which is characterized by papillary structures and oncocytic cells with rich eosinophilic cytoplasm. We found only one case of papillary cystadenoma in nearly 700 cases of salivary gland tumors. Our case was initially mistaken for a tumor of the right temporomandibular joint(TMJ) capsule rather than of parotid gland origin. Preoperative magnetic resonance imaging(MRI) and computed tomography(CT) should be carefully studied, which allows for appropriate preoperative counseling and operative planning.CASE SUMMARY Here, we report an unusual case of a 54-year-old woman with a parotid gland papillary cystadenoma(PGPC) that was misdiagnosed as a tumor of the right TMJ capsule. She was initially admitted to our hospital due to a mass anterior to her right ear inadvertently found 5 d ago. Preoperative CT and MRI revealed a well circumscribed tumor that was attached to the right TMJ capsule. The patient underwent a resection through an incision for TMJ, but evaluation of an intraoperative frozen section revealed a benign tumor of the parotid gland. Then we removed part of the parotid gland above the temporal facial trunk. The facial nerve was preserved. Postoperative histopathological findings revealed that the tumor was PGPC. No additional treatment was performed. There was no recurrence during a 20-mo follow-up period.CONCLUSION The integrity of the interstitial space around the condyle in MRI or CT should be carefully evaluated for parotid gland or TMJ tumors.

Spontaneous rupture of a recurrent hepatic cystadenoma

Biliary cystadenoma is a rare cystic tumor of the middle aged woman that usually arises in the liver or occasionally in the extrahepatic bile ducts.It has a strong potential for recurrence and for malignant tr ansformation.The lack of specific clinical and biological features hinders diagnosis before surgery.The spontaneous rupture of a hepatobiliary cystadenoma is a very rare and potentially life-threatening complication,with only two reported cases in the English literature.We report a case with spontaneous rupture of a recurrent hepatobiliary cystadenoma in a 32 year-old woman.

Elevation of Serum CA-125 in Mucinous Cystadenoma of the Ovary with Torsion: A Rare Occurrence and Review of the Literature

Aim: Benign neoplasms of the ovary originating from epithelial tissue are common tumors in adult women. They are, however, rarely seen in children or adolescent girls with elevation of serum carbohydrate antigen- 125 (CA-125). The present report describes a rare case of premenarchal women with a giant mucinous cystadenoma (MCA) of the ovary with torsion complicated with elevation of serum CA-125. Case: A 15-year-old, premenarchal, previously healthy girl was referred to our hospital with a 2-week history of left lower abdominal pain. Physical examinations showed a firm and mobile mass with tenderness in the left lower quadrant. Tumor markers showed CA-125 at 124.1 U/ml. An enhanced computed tomography scan showed a multiloculated tumor that was partly solid, compressing the small intestine, uterus, and urinary bladder, but no signs of organ invasion, lymph node swelling, or ascitis. Via a lower transverse incision, the right Fallopian tube was observed to have twisted 1620。 counterclockwise, and a tense cyst measuring 22.0 × 12.0 × 10.5 cm and weighing 1.78 kg was found in the right ovary. Release from torsion and unilateral salpingo-oophorectomy with tumor removal was performed because blood flow to the right Fallopian tube did not improve after torsion release. The histopathological findings showed an MCA of the ovary without cell dysplasia. The patient did not receive adjuvant chemotherapy following surgery. There was no evidence of recurrence at 2 years. Disucussion: We need to consider MCA of the ovary when there is elevation of the serum CA-125 and an ovarian mass.

Resection of the main trunk of the superior mesenteric vein without reconstruction during surgery for giant pancreatic mucinous cystadenoma:A case report

Pancreatic tumors, with peri-pancreatic main vascular invasion, especially the superior mesenteric vein(SMV) or the portal vein, are very common. In some cases, vascular resection and reconstruction are required for complete resection of pancreatic tumors. However, the optimum surgical method for venous management is controversial. Resection of the SMV without reconstruction during surgery for pancreatic tumors is rarely reported. Here we present the case of a 58-year-old woman with a giant pancreatic mucinous cystadenoma adhering to the SMV, who underwent an en bloc tumor resection, including the main trunk of the SMV and the spleen. No venous reconstruction was performed during surgery. No ischemic changes occurred in the bowel. The presence of several welldeveloped collateral vessels was shown by 3-dimensional computed tomography examination. The patient had an uneventful postoperative period and was discharged. This case indicated that the main trunk of the SMV can be resected without venous reconstruction if adequate collateralization has formed.

Huge mucinous borderline ovarian cystadenoma in a premenarchal girl

Epithelial ovarian tumors are common in adult women, but rare in children. Especially mucinous ovarian cystadenoma is extremely rare, with only 16 cases in premenarchal girls reported to date. We present a case of 12-year-old premenarchal girl with symptoms of lower abdominal distension. CT showed a large multilocular tumor spreading throughout the entire abdominal cavity from the right upper quadrant to the pelvic cavity. The tumor was brought out little by little with aspiration of the fluid contents with a small incision. The tumor was found to originate from the left ovary, and oophorectomy was performed. The tumor measured 26 × 18 cm and weighed 5860 g. Histological diagnosis was mucinous ovarian cystadenoma with borderline malignancy. No evidence of recurrence had been seen as of 2 years postoperatively. In the review of premenarchal mucinous borderline ovarian cystadenoma, all cases were stage I and underwent salpingo-oophorectomy or oophorectomy. Those patients were alive without recurrence. Al-though mucinous borderline ovarian cystadenoma was characterized as malignancy, premenarchal cases showed favorable outcomes and salpingo-oohprectomy or oophorectomy appears appropriate.

Association of endometrioma with ovarian teratoma and mucinous cystadenoma in a patient diagnosed with endometriosis: A case report

BACKGROUND Co-occurrence of different tumor types in a same patient’s ovaries diagnosed with endometriosis is a rare phenomenon.CASE SUMMARY In this article we present an uncommon association of three distinct ovarian pathologies in a same woman presenting with adnexal mass.A 31-year-old nulliparous woman with a large persistent adnexal mass underwent laparoscopic surgery.Imaging demonstrated a multi-cystic mass with internal echoes.Tumor markers were within normal range.Based on histopathologic assessment,benign mucinous cystadenoma and mature cystic teratoma of the right ovary together with endometrioma of left ovary were revealed.CONCLUSION In cases of large adnexal mass,the of existence of more than one tumor type and the involvement of the contralateral ovary is possible.Also,the possibility of concurrent underlying malignancy or diminished ovarian reserve should be kept in mind.

Serous cystadenoma with co-existing stromal tumor with sex-cord stromal elements: An extremely rare tumor

Surface epithelial-stromal tumors are the most common neoplasm of ovary in the reproductive age and beyond. Less than 1% of epithelial ovarian tumors occur before the age of 21 years while 75% of sexcord stromal tumors (Sertoli and Leydig Cell) occur in the third and fourth decades of life. Serous tumors rarely occur in combination with germ cell tumors, sex-cord stromal tumors or granulosa cell tumors. Thus it is extremely rare for a combination of the above two tumors to occur before 21 years although a case report for a tumor with epithelial, stromal and sex-cord stromal elements for a 58-year-old patient has been documented. We believe ours is the first case in literature of a massive Serous Cystadenoma with co-existing stromal tumor with minor sex-cord stromal (Sertoli-Leydig Cell) elements.

Giant benign mucinous cystadenoma: A case report

Giant benign tumours of the ovary are rare in the modern world due to the improved technologies and general awareness. They are known to cause pressure symptoms to the surrounding structures. Though they appear frighteningly large, they are amenable to surgical debulking with good results in survival and post operative recovery. Here we would like to present a case where the patient could not access medical care, which led to the presentation of a very large mucinous cystadenoma which responded remarkably to surgical excision. The patient could go back to her normal life following the procedure. Conclusions Giant benign mucinous tumours are a rarely seen in the modern world. They have excellent surgical results and survival rates.

Papillary Cystadenoma of Larynx: A Case Report

An uncommon clinical entity of papillary cystadenoma of the larynx in a lady of 37-year-old is presented. The diagnosis after clinical examination was achieved by video-stroboscopy, CT scan of the neck, biopsy and histopathological examination. This case study emphasizes the importance of recognition of this lesion by the clinician as the differential diagnosis includes lesions with similar clinical appearance.