November Case of the Month
Authors: Omar D. Katib, MD, PGY-IV, Radiology Resident, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI; Christopher Hartley, MD, PGY-IV, Pathology Resident, Department of Pathology, Medical College of Wisconsin, Milwaukee, WI; Parag P. Tolat, MD, Assistant Professor of Radiology, Abdominal/Body Imaging, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
1. Why did you select this case for submission?
I was lucky enough to assist in the biopsy for this case and I had never seen anything like it. I was surprised by the pathology results and became more interested the more I read about this entity, especially after learning how rarely it presents at that location. In the Case in Point archives, there hadn't been a case exactly like this so I thought I would share it.
2. What should readers learn from this case?
A lesson would be that common entities can present in very uncommon ways or locations. Knowing all possible differential diagnoses helps when seeing something for the first time. And even if the diagnosis remains unclear on imaging, it is still valuable to describe the findings and make a recommendation (biopsy, in this case) that will lead to the diagnosis.
3. What did you learn from working on the case?
I learned about many different types of abdominal masses as well as where they usually (and unusually) are located. I also learned how imaging can help depict the composition of a mass, and that the imaging appearance really can correlate with pathology at the microscopic level.
4. How did guidance from senior staff at your institution impact your learning and case development?
Senior staff helped me think about possible etiologies based on the initial CT appearance. They also helped me adjust my case questions to be more effective and educational.
5. Why did you choose Case in Point for submission of your case?
I think Case in Point is used by so many because it has a very engaging, convenient, and efficient way of conveying valuable and practical information. I think it is the best format for presenting and learning from cases.
6. Are you a regular reader of Case in Point? What are your favorite types of cases?
Yes, I am. I enjoy cases which require analyzing images in order to think of and then narrow down a differential diagnosis. I also appreciate any practical teaching points in the discussions that I can incorporate into my practice.
7. What else should we know about the case that you’d like to share?
The patient underwent surgery to remove the mass due to discomfort, with pathology confirming a benign myelolipoma. She presumably feels much less "full".