Central Calcification Research Articles

Renal oncocytoma: sonographic analysis of 14 cases.

The sonographic features of 15 histologically confirmed renal oncocytomas in 14 patients are presented. Lesions were evaluated for homogeneity, echogenicity, margination, venous invasion, and nodal enlargement. Nine were less than 5.5 cm in diameter, homogeneous, and well circumscribed. Three lesions were greater than 8 cm in diameter, contained areas of central necrosis or calcification, and were nonspecific for renal oncocytoma. One of these lesions (12 cm) contained a central scar. Two masses were slightly inhomogeneous and, at best, moderately circumscribed. In no case were metastatic nodes or venous invasion present. Since about 6% of renal cell carcinomas may have this appearance, the homogeneous, well marginated renal mass that is isoechoic with cortex and less than 5.5 cm in diameter is as likely to represent renal cell carcinoma as it is an oncocytoma. Although only present in one of the cases, the central fibrotic scar in a larger mass has been described in oncocytoma and may be the most specific feature. Preoperative investigation with fine-needle aspiration biopsy for cytology may be indicated in an attempt to avoid radical nephrectomy in selected patients.

POST‐ISCHEMIC CALCIFICATION IN SKELETAL MUSCLE

The extent of post-ischemic calcification in skeletal muscle was studied in rats subjected to 5.5 h of ischemia followed by periods of reperfusion ranging from 30 min to 16 h. Sections from the tibialis posterior and soleus muscle were stained with alizarin red S (ARS) and were inspected with light microscopy. The number of ARS-positive cells increased during the first 5 h of reperfusion. The extent of calcification varied between fibers and the pattern of calcification appeared to be dependent on fiber type. In some fast glycogenolytic fibers (FG) central calcifications, probably representing mitochondria, were observed. In fast oxidative glycogenolytic (FOG) and slow oxidative (SO) fibers the most common pattern was an ARS-positive granulation, probably representing calcification of sarcoplasmic reticulum and/or mitochondria. The granulation was more extensive in FOG than in SO fibers. In some areas extracellular ARS-positive material was observed. In such areas, which probably represent areas of no-reflow, no calcification of muscle fibers was observed.

Cystic neoplasms of the pancreas. Radiological-pathological correlation.

Microcystic adenomas and mucinous cystic neoplasms of the pancreas have often been described interchangeably (cystadenoma, cystadenocarcinoma), causing confusion with respect to their radiographic characteristics. The former are composed of innumerable tiny cysts and are benign, whereas the latter contain large, unilocular or multilocular cysts, sometimes with shaggy excrescences, and are either frankly or potentially malignant. Microcystic adenomas are angiographically hypervascular and may have central calcification. Sonographically, they have a mixed hypoechoic and echogenic pattern, while CT numbers reflect a mixture of connective tissue and proteinaceous fluid and contrast enhancement is seen. Mucinous cystic neoplasms are hypovascular and may have peripheral calcification; ultrasound and CT reflect their predominantly cystic character and demonstrate excrescences when present.

High CT Attenuation Values of a Benign Pulmonary Nodule

Computed tomography (CT) is thought to be a reliable predictor of the benignancy of pulmonary nodules when high attenuation values can be demonstrated. However, the cause of increased attenuation has not been proven. A pulmonary nodule evaluated initially by CT and subsequently followed for 4 years has developed central calcification by conventional tomography. This observation supports the contention that elevated CT attenuation values are the result of microscopic calcification.

Curvilinear calcification in renal cancers: Two etiologies

Two cases of hypernephroma are presented, each containing central curvilinear calcification. The etiology of these calcifications is discussed, together with the significance of calcifications in renal masses.

CEREBRAL HCG SECRETING TUMER-RESPONSE TO CHEMOTHERAPY

A 9-year-old white male with bitemporal vision loss and sexual precocity, had optic atrophy and panhypopituitarism(Peak hGH response to arginine/insulin -3.5ng/ml, cortisol response to hypoglycemia -5μg/ml). The T4 was 1.6ng/100ml and morning urine specific gravity 1.001. His FSH was 5.5mIU/ml but hLF was >100m IU/ml. Tim testosterone was 1, 644ng/100ml. ENI scan was negative. The air study and carotid angiogram revealed a large avascular suprasellar mass. The greatly elevated hLH level and panhypopituitarism suggested hCG of tumor origin which was confirmed at a level of 884ng/ml. The parents refused surgery or radiotherapy on religious grounds. Three months later he was readmitted with signs and symptoms of increased intracranial pressure. Repeat ENI scan revealed a large suprasellar nass with central calcification and obstructive hydrocephalus. A (R) V-A shunt was performed and the patient was started on Methotrexate 3mg/kg every two weeks for six weeks. During this time, he deteriorated to a state of dementia, stupor, blindness, and spasticlty. In the seventh post-op week, triple therapy of Vincrlstine, Actinomycin D, and Cytoxan was initiated. By the 8th week of triple therapy he was a happy, alert, articulate, ambulatory boy. His optic atrophy, and panhypopituitarism persist. By the llth week, the hCG level was <4ng/ml and by the 14th week, his ENI scan revealed a narked reduction in tumor size.

Extensive central nervous system calcification in a stillborn male infant due to cytomegalovirus infection

The radiologic and pathologic findings of a stillborn male fetus with cytomegalic inclusion disease are described. Massive calcification of the cerebrum, cerebellum, eye (sclera and choroid), and spinal cord was present. There were unique deformities and apparent aplasia of some of the ribs. Classic intranuclear cytomegalic inclusion bodies were present primarily in the kidney. Routine radiography of stillborn infants is recommended for further study of intrauterine growth abnormalities.

PRIMARY MYOCARDIAL FIBROMAS: REPORT OF 2 CASES.

Primary cardiac tumors, though uncommon, are not as rare as one might think. The recent literature contains several excellent review articles that classify and tabulate the various types of primary benign and malignant cardiac tumors (1, 7, 8, 10, 13). This communication presents 2 cases of primary benign cardiac tumors, i.e., myocardial fibromas. In these the x-ray examination showed an unusual pattern of calcification within the tumor. This has not been described in other case reports of cardiac fibromas or other primary cardiac tumors (5, 12, 16, 17). In earlier literature the term fibroma referred to papillary tumors of the cardiac valves. As described by Yater and Hertzog (1, 2), these were essentially fibrous papillomatous growths with an endothelia covering arising from the surface of a valve. Prichard, in his excellent review article (7), pointed out the difficulty of classification in regard to fibromas versus hamartomas, but he also considered fibromas papillary fibrous tumors arising from heart valves. More recently, fibroma has been used to describe a fibrous neoplasm sometimes called fibrous hamartoma, a nonencapsulated but well demarcated intramyocardial lesion which appears very similar to a leiomyoma in gross (9). They are most common in the first few years of life and most often primary in the left ventricular wall or intraventricular septum (5, 12, 16, 17). Neither the reviews nor the case reports, however, described calcification within the tumor mass. Central and peripheral calcification is seen frequently in myxomas, the most common primary cardiac tumors, and almost always in intracavitary polypoid tumors in the atria (7). Case Reports Two cases of primary benign cardiac tumors are described. The pathologic diagnosis in each case was confirmed by the Armed Forces Institute of Pathology. Case I. This 17-month-old white male was the product of a normal pregnancy but was delivered by cesarean section because of abnormal third trimester vaginal bleeding in the mother. During the first month of life the infant was normal, but from one to four months of age he suffered severe respiratory infection with congestive heart failure and cyanosis. This responded to digitalization. The patient did well until the age of sixteen months when he was seen for pneumonia. Chest radiographs were abnormal, with a homogeneous density in the left lower lobe confluent with the heart shadow. Diagnosis by the referring physician was cyst of the lung, possibly dermoid cyst, and the infant was referred to Wilford Hall USAF Hospital. Admission examination revealed a normally developed child in no acute distress. The pulse was 120 and regular. Oily skin and a fine scaly erythematous rash were present. Respiration was labored with left lower lobe râles. Sinus rhythm was normal without murmurs. The liver was palpable 2 finger-breadths below the right costal margin.

Surgical Consideration for Bronchial Tuberculosis seen on the Resected Specimens

In considering the surgical resections treatment for the pul. tbc., the very existence of the bronchial tbc. is Iiable to cause various post-operative complications such as broncho-pleural fistulas and spreadings of Iesions to healthy pulmonary resions. We have seen on the microscopic examination of the 115 resected Lnng specimens, 16 cases.(13.9%), who had preoperative combined therapy extending from 0 to 20 months duration, with tuberculous lesions on their bronchial walls. Of these 16 cases, 8 from cases of lobectomy and 8 from cases of segmental resections sere derived respectively, 15 were navy personnel and 1 was a civilian. Original lesions of these 16 cases were 13 cavitations, 1 tuberculoma, 2 small foci and the microbiological study on these showed 13 cases to be positive both on staining and cultures, 1 case to be negative on the staining while positive on the culture and 2 cases to be positive on the stainings while negative on the cultures. As for the sites of the lesions of these 16 cases of bronchial tuberculosis, 6 lesions seen on the mucosal layer, 6 in the submucosal, 5 in the muscular, 5 don't the serosal, 4 on the glands, and 1 invaded cartilage were noticed respectively. And describing the findings of lesions, 3were tubercles with liquefactions, 1 was tubercle with central calcification, 2 with squamous metaplasia of the mucosal epithelium and the rest of lesions showed solid tubercles only. The 5 cases with 7 complications out of these 16 cases were observed that is, 2 cases with blood in sputa, 3 with bronchopleural fistulated and 2 with lesions spread to the healthy regions. Of these last 2 one died accompanying bronchopleural fistule and pyothorax and the other is still receiving medical treatment for three years after the operation, although, except these 2 cases the rest showed drastic cures with massive antibiotic treatment provided.

Differentiation of benign and malignant pulmonary nodules by growth rate.

Solitary pulmonary nodules have been analyzed by many investigators (11, 13, 15, 16, 17, 31, 33, 38, 43) for signs indicative of their etiology, the main effort having been directed toward separation of benign and malignant lesions. Of all the signs mentioned, including size, shape, density, sharpness of margin, umbilication, satellite nodules, cavitation, densities extending into the hilus and/or pleura, growth, and calcification, only the last has been considered to be a reliable aid in differentiation. The presence of any calcification in a pulmonary lesion makes malignancy extremely unlikely, although it is recognized that minute central calcification can on rare occasions be found in malignant lesions. Ring-shaped, laminated, and large central “popcorn” calcifications are reliable signs of benignity (16, 31). In general, the appearance of a nodule in a lung which was previously normal or enlargement of a pulmonary nodule, with the reservation that there are some exceptions, is thought by most to indicate a malignant lesion. Because of the difficulty in differentiating benign from malignant nodules, the general attitude in the last few years, particularly since about 1945, has been to recommend the immediate removal of all solitary pulmonary nodules except those in which the presence of calcification indicates their benign nature. Few objections have been raised against this procedure. One of those who protests is Garland (13) who advised: “Don't be like Lady Macbeth. Don't say ‘Out, damned spot!’ and I think you will diagnose most of these nodules correctly. ” The concept of exponential growth of cancer at a constant rate, advanced by Mottram in 1935 (29) and later by Collins et al. in 1956 (5), has received support in the work of several independent investigators (1, 2, 10, 21, 22, 25, 34, 41, 42). Collins collected a series of 177 cases of malignant pulmonary nodules with serial chest films showing the growth of neoplastic nodules. The nodules were measured and growth rate was expressed as “doubling time.” Values ranged from 7 to 465 days (5–9). Enlargement of non-neoplastic. nodules also may occur, but the mechanisms are not the same as for neoplasms and would not be expected to result necessarily in exponential growth at a constant rate. Although granulomas, pneumonitis, abscesses, infarcts, hematomas, fluid collections, etc., may enlarge, they do not do so by cell division. Nevertheless, observation of change (or lack of change) in size may demonstrate that the pattern of growth is not that of a malignant tumor. This may therefore be a useful diagnostic test. If differences could be found to exist between the rate of tumor growth and the rate of enlargement of benign lesions, then a useful diagnostic tool would become available to add to the few radiographic and clinical signs for differential diagnosis.

OSTEOGENIC FIBROMA OF BONE

Two cases of benign osteoblastic tumours of the spine, occurring in young patients, and presenting as expanding osteolytic lesions with some central calcification and ossification, are described. It is suggested that they represent a condition allied to, but usefully separated from, osteoid osteoma of bone. The name osteogenic fibroma of bone, proposed by Lichtenstein for this type of case, is accepted.

INFANTILE TOXOPLASMOSIS

A fatal case of infantile toxoplasmosis with autopsy findings is described, bringing to 21 the number of acceptable autopsied cases. The characteristic central nervous system necrosis and calcification were present in this case. In addition, focal chorioretinitis, involvement of the spinal cord and of the periorbital and paravertebral striated muscles and the heart were present. Of great interest is the finding of testicular involvement which has been described in only one other previous case.

A Special form of Chondroma of the Lung

Tumors composed of cartilage occur in the substance of the lung but are infrequent. They are much rarer than the chondromata of the bronchi and still less frequent than malignant tumors of the bronchi or the lungs. A number of cases have been reported, all in adults. The type of tumor about to be described is of a somewhat different nature. It is characterized by the presence of epithelial in addition to cartilaginous elements. It was not possible to find analogous tumors described in the literature—with perhaps the exception of a case reported by Hart as follows: Age of patient 67 years. Cause of death, diabetes. At the periphery of the lower right lobe there was found a lobulated tumor. Microscopic examination showed, besides cartilage, connective tissue in part myxomatous, and gland formation. There is central calcification. Long tubules with many lateral branches are frequent. They are lined with single or multiple layers of low cylindrical cells. These tubules apparently pass through the ground substance in all directions. In addition there are many strands of cells arranged in single and double rows. Diverticula, sac-like in part, filled with desquamated epithelium and occasionally forming cysts, are to be seen. Minute gland-like structures are present, often lying in fat tissue, with a narrow lumen lined with high cylindrical epithelium.