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Plexiform Fibromyxoma of Stomach: A Rare Case Report of the Sonographic and Pathological Evaluation
Abstracts PPT12-022
PPT12-024
Plexiform Fibromyxoma of Stomach: A Rare Case Report of the Sonographic and Pathological Evaluation Chih-Jung Chen,1 Hsu-Heng Yen,2 Pei-Ru Wu3 1 Department of Surgical Pathology, Changhua Christian Hospital, Taiwan, 2Department of Gastroenterology, Changhua Christian Hospital, 3Department of Pathology, Cheng Ching Hospital
Role of Emergency Ultrasound in Diagnosis of Hollow Organ Perforation Sheng Teck Tan, Kam Hong Chang Department of Emergency, Mackay Memorial Hospital, Malaysia
Objectives: Plexifrom fibromyxoma is a rare entity and recently adopted by the 2010 WHO tumor classification of digestive system so that most clinician is not familiar with this tumor. Herein, we introduced a typical case in this section. Methods: A 59-year-old female patient suffered from long term acid regurgitation. Endoscopic ultrasound examination was done and showed a 2 cm well-defined submucosal tumor lesion at the gastric antrum. A gastrointestinal stromal tumor (GIST) was highly suspected clinically. Then tumor excision was performed. Pathological exam including histology and immunohistochemical studies was also done. Results: Microscopically, there was a submucosal tumor composed of plexiform and multinodular architectures with myxoid and fibrocollagenous stroma. Bland spindle tumor cells with myofibroblastic immunoprofiles were noted. The tumor cells showed SMA(+), CD117(-), CD34(-), S-100 protein(-), ALK(-), DOG1(-), HMB45(-), EMA(-), beta-catenin(no nuclear staining), CD56(-) and desmin(+, focal) by immunohistochemical studies. The post-operative course was uneventful after 20 months follow-up. Conclusions: Plexiform fibromyxoma is a rare distinct benign tumor mainly in the stomach and is easily mistaken as other mesenchymal tumors of gastrointestinal tract, especially GIST, in clinical practice. Distinct histopathology and immunoprofiles are helpful in making a correct diagnosis. In addition, by molecular examination, KIT and PDGFRA mutational analyses also show wild-type sequences which are quite unique and different from the GIST. PPT12-023 Recurrent Lower Abdominal Pain among the Infertility Maria Goretti Ametembun Department of Internal Medicine, Cicendo Eye Hospital, Bandung, Indonesia Objectives: To describe the cause of recurrent colic abdominal pain among fertility with ultrasound examination. Methods: This cross sectional study was conducted at St Elisabeth Hospital in Lela, Flores island, Nusa Tenggara Timur Province from February through September 2012. All infertile spouses with recurrent lower abdominal pain who were examined with trans-abdominal ultrasound using Aloka SSD 1100 with 3,5 MHz convex probe ultrasound by ultrasound certified internal medicine physician. Examination for fluor albus and sperm analyse were also performed. Results: There were 18 infertile spouses, age of 18-42 years, mean 26,2. 11 (61%) with primary infertility and 7 ( 39%) with secondary infertility. All patient had tuberculosis dry type peritonitis clinically, and ultrasound showed thickening and irregular margin of small bowel wall, hypo-peristaltic movement were found in all affected dullness lower abdomen area. All women had irregular thickening of urinary bladder mucosa wall; recurrent abnormal fluor albus history and microscopic smear of vaginal secret showed gonococcal infection. Sperm analyse showed decrease of number and motility. Conclusions: Tuberculosis dry type peritonitis, chronic cystitis and pelvic inflammatory disease were related to the recurrent lower abdominal pain among the infertility patients.
S169
Objectives: Perforation of the gastrointestinal tract may be suspected based upon the patient’s clinical presentation, or the diagnosis becomes obvious through a report of extraluminal ‘‘free’’ air on diagnostic imaging performed to evaluate abdominal pain or another symptom. Methods: Case report and literature review. Results: A 52 years-old male patient without any underlying disease presented with sudden onset epigastric dullness pain. Ultrasound showed hyperechoic density over right subphrenic space above liver dome with suspected hollow organ perforation. Abdominal computed tomography showed hollow organ perforation and operation was arranged. Conclusions: This case revealed that abdominal ultrasound can be used to aid in the diagnosis of hollow organ perforation. Ultrasound has also been studied and shows some excellent potential for identifying pneumoperitoneum. PPT12-025 Role of Emergency Ultrasound in the Diagnosis of Liver Abscess Shih-Chun Chien, Henry Kam Hong Cheng, Wei-De Tsai, Wen-Han Chang Department of Emergency, Mackay Memorial Hospital, Taiwan Objectives: Liver abscess is an uncommon disease that is easy to ignore at emergency room. The diagnosis is usually made by Computer Tomography (CT) scan, but CT scan was not always easy to arrange due to patient’s renal dysfunction or availability of medical facilities. We present a case of liver abscess with unspecific symptoms which diagnosed by emergency ultrasound. Methods: Case report and literature review. Results: A 81 year old woman with history of type II diabetes mellitus presented with fever, chest pain and poor appetite for few days. Emergency ultrasound showed some air density inside left lobe of liver with some air above liver margin. Clinically highly suspected liver abscess and proved by noncontrast CT scan. Finally the patient is consult for radiologist for percutaneous drainage and discharge uneventfully. Conclusions: This case illustrates that emergency ultrasound can be used to search for unspecific fever source, like liver abscess. Emergency ultrasound is portable, repeatable , non-radioactive and everyday use in emergency Department. PPT12-026 Small Bowel Ultrasound among Undernourished Children Maria Goretti Ametembun Department of Internal Medicine, Cicendo Eye Hospital, Bandung, Indonesia Objectives: Children who are already undernourished can suffer from protein-energy malnutrition when rapid growth, infection, or disease. Abdominal discomfort, anorexia, weight loss, low-grade fever, night sweats, pale; chronic recurrent cough and diarrhea were been complained. The aim of this study was to describe small bowel ultrasound finding among the undernourished children. Methods: This study was conducted at Saumlaki Community Health Centre at Tanimbar, a remote boundary island in the West of South-East
PPT12-024
Plexiform Fibromyxoma of Stomach: A Rare Case Report of the Sonographic and Pathological Evaluation Chih-Jung Chen,1 Hsu-Heng Yen,2 Pei-Ru Wu3 1 Department of Surgical Pathology, Changhua Christian Hospital, Taiwan, 2Department of Gastroenterology, Changhua Christian Hospital, 3Department of Pathology, Cheng Ching Hospital
Role of Emergency Ultrasound in Diagnosis of Hollow Organ Perforation Sheng Teck Tan, Kam Hong Chang Department of Emergency, Mackay Memorial Hospital, Malaysia
Objectives: Plexifrom fibromyxoma is a rare entity and recently adopted by the 2010 WHO tumor classification of digestive system so that most clinician is not familiar with this tumor. Herein, we introduced a typical case in this section. Methods: A 59-year-old female patient suffered from long term acid regurgitation. Endoscopic ultrasound examination was done and showed a 2 cm well-defined submucosal tumor lesion at the gastric antrum. A gastrointestinal stromal tumor (GIST) was highly suspected clinically. Then tumor excision was performed. Pathological exam including histology and immunohistochemical studies was also done. Results: Microscopically, there was a submucosal tumor composed of plexiform and multinodular architectures with myxoid and fibrocollagenous stroma. Bland spindle tumor cells with myofibroblastic immunoprofiles were noted. The tumor cells showed SMA(+), CD117(-), CD34(-), S-100 protein(-), ALK(-), DOG1(-), HMB45(-), EMA(-), beta-catenin(no nuclear staining), CD56(-) and desmin(+, focal) by immunohistochemical studies. The post-operative course was uneventful after 20 months follow-up. Conclusions: Plexiform fibromyxoma is a rare distinct benign tumor mainly in the stomach and is easily mistaken as other mesenchymal tumors of gastrointestinal tract, especially GIST, in clinical practice. Distinct histopathology and immunoprofiles are helpful in making a correct diagnosis. In addition, by molecular examination, KIT and PDGFRA mutational analyses also show wild-type sequences which are quite unique and different from the GIST. PPT12-023 Recurrent Lower Abdominal Pain among the Infertility Maria Goretti Ametembun Department of Internal Medicine, Cicendo Eye Hospital, Bandung, Indonesia Objectives: To describe the cause of recurrent colic abdominal pain among fertility with ultrasound examination. Methods: This cross sectional study was conducted at St Elisabeth Hospital in Lela, Flores island, Nusa Tenggara Timur Province from February through September 2012. All infertile spouses with recurrent lower abdominal pain who were examined with trans-abdominal ultrasound using Aloka SSD 1100 with 3,5 MHz convex probe ultrasound by ultrasound certified internal medicine physician. Examination for fluor albus and sperm analyse were also performed. Results: There were 18 infertile spouses, age of 18-42 years, mean 26,2. 11 (61%) with primary infertility and 7 ( 39%) with secondary infertility. All patient had tuberculosis dry type peritonitis clinically, and ultrasound showed thickening and irregular margin of small bowel wall, hypo-peristaltic movement were found in all affected dullness lower abdomen area. All women had irregular thickening of urinary bladder mucosa wall; recurrent abnormal fluor albus history and microscopic smear of vaginal secret showed gonococcal infection. Sperm analyse showed decrease of number and motility. Conclusions: Tuberculosis dry type peritonitis, chronic cystitis and pelvic inflammatory disease were related to the recurrent lower abdominal pain among the infertility patients.
S169
Objectives: Perforation of the gastrointestinal tract may be suspected based upon the patient’s clinical presentation, or the diagnosis becomes obvious through a report of extraluminal ‘‘free’’ air on diagnostic imaging performed to evaluate abdominal pain or another symptom. Methods: Case report and literature review. Results: A 52 years-old male patient without any underlying disease presented with sudden onset epigastric dullness pain. Ultrasound showed hyperechoic density over right subphrenic space above liver dome with suspected hollow organ perforation. Abdominal computed tomography showed hollow organ perforation and operation was arranged. Conclusions: This case revealed that abdominal ultrasound can be used to aid in the diagnosis of hollow organ perforation. Ultrasound has also been studied and shows some excellent potential for identifying pneumoperitoneum. PPT12-025 Role of Emergency Ultrasound in the Diagnosis of Liver Abscess Shih-Chun Chien, Henry Kam Hong Cheng, Wei-De Tsai, Wen-Han Chang Department of Emergency, Mackay Memorial Hospital, Taiwan Objectives: Liver abscess is an uncommon disease that is easy to ignore at emergency room. The diagnosis is usually made by Computer Tomography (CT) scan, but CT scan was not always easy to arrange due to patient’s renal dysfunction or availability of medical facilities. We present a case of liver abscess with unspecific symptoms which diagnosed by emergency ultrasound. Methods: Case report and literature review. Results: A 81 year old woman with history of type II diabetes mellitus presented with fever, chest pain and poor appetite for few days. Emergency ultrasound showed some air density inside left lobe of liver with some air above liver margin. Clinically highly suspected liver abscess and proved by noncontrast CT scan. Finally the patient is consult for radiologist for percutaneous drainage and discharge uneventfully. Conclusions: This case illustrates that emergency ultrasound can be used to search for unspecific fever source, like liver abscess. Emergency ultrasound is portable, repeatable , non-radioactive and everyday use in emergency Department. PPT12-026 Small Bowel Ultrasound among Undernourished Children Maria Goretti Ametembun Department of Internal Medicine, Cicendo Eye Hospital, Bandung, Indonesia Objectives: Children who are already undernourished can suffer from protein-energy malnutrition when rapid growth, infection, or disease. Abdominal discomfort, anorexia, weight loss, low-grade fever, night sweats, pale; chronic recurrent cough and diarrhea were been complained. The aim of this study was to describe small bowel ultrasound finding among the undernourished children. Methods: This study was conducted at Saumlaki Community Health Centre at Tanimbar, a remote boundary island in the West of South-East