Cystic Feature Research Articles

Solid pseudopapillary epithelial neoplasm of the pancreas: a case report

Solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas is a rare neoplasm of the pancreas accounting for only 0.17–2.7% of all pancreatic neoplasms, often detected initially on imaging. Despite advances in imaging, pseudocysts and other cystic neoplasms feature in the differential diagnosis. We report a case of solid pseudopapillary epithelial neoplasm in a young female who presented with a progressively increasing abdominal lump in whom the diagnosis was considered based on imaging studies. She underwent exploratory laparotomy, pancreaticoduodenectomy, pancreaticojejunostomy, hepaticojejunostomy, gastrojejunostomy, and made an uneventful recovery in the postoperative period. Histopathological examination and immunohistochemistry confirmed the diagnosis. This case highlights the need for a high index of suspicion and timely surgical intervention for optimal outcomes.

Atypical and uncommon CT and MR imaging presentations of pancreatic ductal adenocarcinoma.

Pancreatic ductal adenocarcinomas (PDACs) occasionally have atypical and uncommon imaging presentations that can present a diagnostic dilemma and result in false interpretation. This article aimed to illustrate these CT and MR imaging findings, including isoattenuating PDAC, coexisting acute pancreatitis, PDAC with a cystic feature, groove PDAC, diffuse PDAC, hypointensity on diffusion-weighted imaging (DWI), multifocal PDAC, intratumoral calcification, and extrapancreatic invasion with a barely discernable mass. A subset of PDACs with atypical features are occasionally encountered during routine clinical practice. Knowledge of and attention to these atypical and uncommon variable imaging features may allow radiologists to avoid misinterpretation and a delayed diagnosis.

Contrast-Enhanced Ultrasound (CEUS) for Follow-Up of Bosniak 2F Complex Renal Cystic Lesions-A 12-Year Retrospective Study in a Specialized European Center.

Bosniak 2F renal cystic lesions feature morphologic characteristics between Bosniak I and III categories, the majority of which remain benign. However, a minor part of Bosniak 2F lesions may progress to malignancy. The purpose of this study was to assess Bosniak 2F cystic lesions during follow-up examinations by CEUS. One-hundred-and-twelve out of 364 patients with Bosniak 2F lesions underwent follow-up CEUS examinations between February 2008 and February 2020. Twelve out of 364 patients underwent renal surgery without follow-up CEUS. The progression rate of Bosniak 2F renal lesions detected by CEUS accounted for 7.1% (8/112 patients) after a mean of 12.9 months. The first follow-up CEUS revealed 75% of progressions (6/8), the remaining 25% (2/8) of progressions were detected during second follow-up CEUS. Underlying clear-cell renal cell carcinoma was histopathologically validated in 5/8 progressive complex cystic renal lesions. Stable sonomorphologic features were observed in 92.1% (104/112 patients). CEUS depicts a promising diagnostic imaging modality in the diagnostic work-up and follow-up of complex renal cystic lesions at higher spatial and temporal resolutions than CT or MRI. Its excellent safety profile, its easy and repeatable accessibility, and low financial costs render CEUS an attractive and powerful alternative imaging tool for monitoring complex renal cystic lesions.

Pancreas ductal adenocarcinoma with cystic features on cross-sectional imaging: radiologic-pathologic correlation.

Most pancreatic ductal adenocarcinomas (PDAs) show solid growth pattern, but ductal adenocarcinomas may demonstrate intratumoral cystic appearance or accompany peritumoral non-neoplastic cystic lesions, thus mimicking cystic pancreatic tumors on imaging studies. The histopathologic findings for PDA with cystic feature are divided into neoplastic and non-neoplastic cysts. Neoplastic cystic changes include large-duct type cysts (microcystic appearance), neoplastic mucin cysts (macrocystic appearance), colloid carcinomas (mucinous noncystic adenocarcinomas), and degenerative cystic change usually caused by hemorrhagic necrosis of tumor. Non-neoplastic cystic changes include retention cysts caused by ductal obstruction and pseudocysts caused by tumor-associated pancreatitis. Depending on the presence, size, number, and configuration of cystic changes, PDA should be differentiated from various types of cystic neoplasms. This pictorial essay provides histopathologic classification of PDAs with cystic features along with the corresponding cross-sectional imaging findings, and their differential diagnosis.

MR Imaging Characteristics Associate with Tumor-Associated Macrophages in Glioblastoma and Provide an Improved Signature for Survival Prognostication.

In glioblastoma, tumor-associated macrophages have tumor-promoting properties. This study determined whether routine MR imaging features could predict molecular subtypes of glioblastoma that differ in the content of tumor-associated macrophages. Seven internally derived MR imaging features were assessed in 180 patients, and 25 features from the Visually AcceSAble Rembrandt Images feature set were assessed in 164 patients. Glioblastomas were divided into subtypes based on the telomere maintenance mechanism: alternative lengthening of telomeres positive (ALT+) and negative (ALT-) and the content of tumor-associated macrophages (with [M+] or without [M-] a high content of macrophages). The 3 most frequent subtypes (ALT+/M-, ALT-/M+, and ALT-/M-) were correlated with MR imaging features and clinical parameters. The fourth group (ALT+/M+) did not have enough cases for correlation with MR imaging features. Tumors with a regular margin and those lacking a fungating margin, an expansive T1/FLAIR ratio, and reduced ependymal extension were more frequent in the subgroup of ALT+/M- (P < .05). Radiologic necrosis, lack of cystic component (by both criteria), and extensive peritumoral edema were more frequent in ALT-/M+ tumors (P < .05). Multivariate testing with a Cox regression analysis found the cystic imaging feature was additive to tumor subtype, and O6-methylguanine methyltransferase (MGMT) status to predict improved patient survival (P < .05). Glioblastomas with tumor-associated macrophages are associated with routine MR imaging features consistent with these tumors being more aggressive. Inclusion of cystic change with molecular subtypes and MGMT status provided a better estimate of survival.

P12.01: Fetal cystic mass which was found out as fetus in fetu

The patient was 36 years old, gravida 3, para 0. The cyst in fetal abdominal cavity was found at 29 weeks gestation. In ultrasound imaging, size of the cyst was 12.07cm X 10.24cm and it was located toward left kidney. The cyst was very irregular, mixed cystic and solid feature was seen. Some portion of the cyst looked like multi-chamber. (see image a) Also, the border of the bladder was unclear and the kidney size was small, furthermore, blood flow toward the kidney was not observed. The predictive diagnosis was teratoma, lymphangioma. For the further evaluation, fetal MRI was done and it also showed mixed nature with dominantly cystic feature. Left kidney was compressed and surrounded by the mass. The mass was extended to retroperitoneum and pelvis. To determine treatment plan, we discussed with pediatric surgery department and pediatric urology department. We decided to delivery at 37 gestational weeks as long as the mass does not grow rapidly. And because the other organs in the peritoneal location were being pushed by the mass, therefore, open surgery was planned after birth. Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Solid pseudopapillary tumor of the pancreas. An unusual presentation

The pseudopapillary solid tumors of the pancreas are a rare entity of which cell origin is unknown. Its solid papillary cystic feature is due to the formation of a solid tumor with areas of necrobiotic degeneration due to lack of vascularization. Its symptoms are nonspecific, with compression and dilation of the main biliary tract with the onset of obstructive jaundice uncommon. Differential diagnoses include solid and cystic tumors. The treatment of choice is resective surgery with oncologic criteria.

Solid Pseudopapillary Neoplasm of the Pancreas: A Case Report with Review of the Diagnostic Dilemmas and Tumor Behavior

Solid pseudopapillary neoplasm of the pancreas is a rare tumor of the pancreas often detected initially on imaging. Of uncertain histogenesis, it has a low-grade malignant potential with excellent post-surgical curative rates and rare metastasis. Despite advances in imaging, pseudocysts and other cystic neoplasms feature in the differential diagnosis. Pathological and/or cytological evaluation remains the gold standard in reaching a definitive diagnosis. On morphology alone, other primary pancreatic tumors and metastatic tumors pose a diagnostic challenge. Recent advances in immunohistochemical characterization have made the histopathologic diagnosis more specific and, in turn, shed light on the likely histogenesis of this rare tumor. We report a case of solid pseudopapillary neoplasm of the pancreas that was suspected on radiology and diagnosed intraoperatively on imprint cytology guiding definitive surgery. The diagnostic dilemmas are reviewed.

Desmoplastic Medulloblastoma Arising From an Ovarian Teratoma

The primary neuroectodermal tumor of the ovary is extremely rare, and it manifests in 3 forms: differentiated, primitive, and anaplastic. The medulloblastoma belongs to the subgroup of primitive neuroectodermal tumor of the ovary. Only 3 cases of ovarian medulloblastoma have been reported in the literature, and all of them are presented without information about the specific pathological subtype. We present the fourth case of a 26-year-old woman who presented with abdominal fullness for months. Ultrasound exam showed a right adnexal mass with cystic feature and foci solid components. A partial oophorectomy was performed, and the mass was a desmoplastic medulloblastoma arising from an ovarian teratoma.

Cystic Variant of Endometrial Stromal Sarcoma

Endometrial stromal sarcoma is an uncommon tumor representing 0.2% of all uterine neoplasm and 15% to 26% of uterine sarcomas. Endometrial stromal sarcoma has a gross appearance as single nodule, multiple masses, or a poorly demarcated lesion with occasional cystic degeneration; rarely, it shows a cystic multilocular feature. We report 2 cases of endometrial stromal sarcoma with a prominent cystic appearance, forming multilocular cystic mass, detected by ultrasonography. The differential diagnosis among multicystic endometrial stromal sarcoma and cystic uterine tumors might be very difficult.

High Prevalence of Papillary Thyroid Microcarcinoma in Danish Patients: A Prospective Study of 854 Consecutive Patients with a Cold Thyroid Nodule Undergoing Fine-Needle Aspiration

We aimed to investigate the diagnostic accuracy of ultrasound (US)-guided fine-needle aspirates (FNAs) obtained from 854 consecutive Danish patients with a scintigraphically cold thyroid nodule in a borderline iodine-deficient area. Clinical, sonographic, and pathological findings in patients with a cold thyroid nodule undergoing US-guided FNA were prospectively registered. 408 patients underwent thyroid surgery, resulting in 50 cancers and in addition 37 patients had an incidental finding of papillary thyroid microcarcinomas. Based on the diagnostic FNA, we found sensitivity and specificity for malignancy of 73.9 and 99.2%, respectively. The positive and negative predictive values of a diagnostic FNA for malignancy were 89.5 and 97.7%. We identified 6 false-negative and 2 false-positive diagnoses. Solid versus cystic feature of the nodule, as well as >2 high-risk US features, were predictive for malignancy. Cancer incidence was 13% among females and 9% among males. The accuracy of a diagnostic set-up based on clinical examination, scintigraphy, US, and US-guided FNA was determined with a 48% rate of histopathological validation in the cohort. The overall thyroid cancer incidence has increased worldwide, but our results suggest that the most frequent occurring cancer is an incidental papillary thyroid microcarcinoma of which the clinical significance has yet to be established.

Destructive Radiologic Development of Intravascular Papillary Endothelial Hyperplasia on Skull Bone

Intravascular papillary endothelial hyperplasia (IPEH) is a rare vascular benign lesion that rarely involves the central nervous system with or without skull invasion. We report a rare case of IPEH on the skull bone, which displayed destructive radiologic development associated with hemorrhage. A 14-year-old male presented with an incidentally detected a small enhancing, left frontal osteolytic lesion. Previously, he underwent operation and received adjuvant chemoradiation therapy for cerebellar medulloblastoma. Follow-up magnetic resonance imaging revealed a left frontal bone lesion, which expanded to an approximately 2 cm-sized well-circumscribed osteolytic lesion associated with hemorrhage for 20 months. Frontal craniectomy and cranioplasty were performed. Destructive change was detected on the inner table and diploic space of the skull. The mass had a cystic feature with hemorrhagic content without dural attachment. Pathologic examination showed the capsule consisted of parallel collagen lamellae representing a vascular wall, vascular lumen, which was pathognomonic for IPEH. Immunohistochemical staining revealed that the capsule was positive for CD34 and factor VIII, which favor the final diagnosis of IPEH. This was the first case of intracalvarial IPEH.

Predictive factors for detecting malignancy in central and lateral cervical lymph nodes in papillary carcinoma of the thyroid

To determine the factors for predicting malignant diagnosis and limitations in ultrasonography guided fine-needle aspiration cytology of central and lateral cervical lymph nodes in patients with primary differentiated thyroid papillary carcinoma. Biopsies of cervical lymph nodes were performed in 120 patients, 31 of whom had subsequent surgical diagnoses. Factors examined were patient's age and gender of the patients, location (central and lateral compartments), hypoechogenicity with loss of hilum, microcalcification, cystic feature, minimum and maximum diameters and index value (minimum/maximum diameter). The mean minimum diameter and index value of the lymph nodes were 9.9 ± 4.9 mm and 0.60 ± 0.19, respectively. Microcalcifications and cystic parts were specific findings with rates of 93.9% and 95.1%, respectively. Microcalcification, cystic feature, minimum diameter and index value were poor predictors of malignancy. The predictors were central location (P = 0.031) and hypoechogenicity with loss of hilum in lateral neck (P = 0.019). Central nodes led to a major problem for biopsy success due to postoperative changes and anatomic position. Nondiagnostic (30%) nodes were therefore mostly central. The involvement of the central neck should be a major indication of lymph node biopsy and pathological diagnosis regardless of the imaging findings. In the lateral compartment, hypoechogenicity with loss of hilum, microcalcifications, cystic parts and an index value ≥ 0.51 are indications of a lymph node biopsy to rule out malignancy.

Fine-needle aspiration biopsy of cervical lymph nodes: factors in predicting malignant diagnosis

The objective of the study was to determine the predicting factors in malignant diagnosis in ultrasonography guided fine-needle aspiration biopsy of cervical lymph nodes. Design is retrospective follow-up study. Ultrasonography guided fine-needle aspiration biopsies of cervical lymph nodes were performed in 290 patients. The mean age was 45.5 ± 14.4 years (range; 15-85). 207 (71.4%) and 83 (28.6%) were women and men, respectively. Cytopathologist was not present in any biopsy procedure. Factors in predicting malignancy were age, gender, presence of primary malignancy, localization (Level 1-6), hypoechogenicity with loss of echogenic hilum, microcalcification, cystic feature, minimum and maximum sizes, and index value (minimum size/maximum size). Factors were analyzed by univariate and multivariable tests. The mean minimum size and index value of the lymph nodes were 10.4 ± 5.5 mm and 0.58 ± 0.18, respectively. Age, gender, microcalcification, cystic feature, minimum size, and index value were poor predictors in malignancy. Predictors were presence of primary malignancy (p-< 0.001), the level of localization (p=0.001), and hypoechogenicity (p-< 0.001)- in malignancy. Microcalcification and cystic parts were specific US findings of metastasis of thyroid carcinoma; nevertheless cystic parts were seen more specific finding in the other malignancies. Malignant lymph nodes were often found in the presence of primary malignancy, mid neck and lower neck localizations as Level 3-6, and markedly hypoechoic lymph nodes. In 131 patients with a primary thyroid carcinoma, the predictors for malignancy were localization where the most often regions were Level 3, 4, and 6 and hypoechogenicity. Malignancy rate was relatively low in patients with thyroid malignancy than those with non thyroid malignancies in Level 5. Level 6 was the most difficult area for biopsy due to postoperative changes. Microcalcification was specific only in thyroid carcinoma, whereas cystic parts were more specific in the other malignancies

Invasive ductal carcinoma of the pancreas tail with noninvasive growth through the nondilated main pancreatic duct and macroscopically cystic invasive carcinomatous glands

Noninvasive growth forming macroscopically dilated cystic pancreatic ducts is a fundamental feature of intraductal papillary mucinous neoplasm (IPMN), from which invasive carcinomas can arise. However, some invasive ductal carcinomas of the pancreas also show a macroscopically cystic feature. We experienced 2 cases of invasive ductal carcinoma of the pancreas tail with noninvasive growth through the main pancreatic duct without dilation at the body side, and with collection of macroscopically cystic carcinomatous glands infiltrating at the spleen side, which resembled some IPMNs and/or IPMN-derived invasive carcinomas. These cases were different from IPMN in that they lacked macroscopic dilatation of the pancreatic ducts, and the macroscopically dilated cystic carcinomatous glands were invasive but not intraductal. The intraductal component of the carcinomas showed papillary growth of neoplastic epithelia with atypia consistent with PanIN-3. Both intraductal and invasive components predominantly showed gastric mucin phenotype (MUC5AC+, MUC6 focally +, MUC2- or MUC2+ in scattered small number of cells). Recognition of these pancreatic carcinoma cases is important in the following 2 points: (1) The presence of such cases should always be kept in mind as differential diagnosis of IPMN or IPMN-derived invasive carcinoma in imaging and pathologic diagnoses. (2) The histogenesis of these cases might be placed in the intermediate between 2 major histogenetic pathways of pancreatic carcinoma, that is, one from microscopic precursors called PanIN and the other from macroscopic precursors of IPMN. These cases can be regarded as invasive carcinomas derived from semimacroscopic extension of the intraductal lesion of the main pancreatic duct.

ATYPICAL INITIAL MANIFESTATION OF ACUTE PYELONEPHRITIS IN CONTINUOUS IMAGE STUDY: RENAL CYSTIC FEATURE

Renal infection, including acute and chronic pyelonephritis, focal bacterial nephritis, renal and perinephric abscess, pyonephrosis and others, represents a spectrum of interrelated conditions. In recent years, computed tomography, ultrasound, nuclear scintigraphy, excretory urography (IVP) and magnetic resonance imaging have offered varying degrees of utility in evaluating renal infection. Although imaging in acute pyelonephritis has been extensively studied, this condition is a rare initial presentation as a renal cystic feature. This investigation presents a case of acute pyelonephritis, with an atypical initial imaging manifestation in renal cystic feature, which became a heterogeneous mass during follow up, and disappeared after treatment. Two conclusions can be drawn: first, a renal cystic lesion may be an initial presentation of acute pyelonephritis; secondly, the abnormalities of the ultrasonography imaging study of renal pyelonephritis persisted and progressed despite the improvement in clinical symptoms and laboratory findings, and displayed complete resolution of imaging abnormalities several months later.