Cystic Necrosis Research Articles

Cystic duct necrosis, as a laparoscopic finding

An 88-year-old female patient presents with 72 hours of dull right upper quadrant pain after a fatty meal and gastric like emesis. Previous medical record of hypertension, left haemicolectomy due...

A case report of Acalculous gall bladder perforation with huge abdominal cyst

Background: Gall bladder perforation presents in various forms with the most common being peritonitis. The most common causes include gall stones obstructing the cystic duct and necrosis of gall bladder due to ischemia. Case Presentation: A 19-year-old female presented to the emergency department of East Surgical Ward of Mayo Hospital Lahore, Pakistan, with a history of abdominal distension for 4 months for which she was counseled because of pregnancy. She gave birth to healthy baby 1 month prior, but abdominal distension did not resolve. On examination, she had a distended and tender abdomen with visible striae. She was tachycardiac with a pulse rate of 124 per minute and blood pressure of 110/80 mmHg. Fluid cytology showed negative for malignant cells and total leukocyte count of 17 × 109 /l. Abdominal ultrasound showed a huge thick-walled cystic area with internal echoes measuring 31 × 19 × 19 cm with total amount of fluid volume in the cyst was approximately 5 l arising from the right hypochondrium. On opening the abdomen, a huge cyst was encountered extending from the epigastrium to the pelvis with dense adhesions. The cyst was opened and fluid aspirated. Communication between cyst was found with gall bladder in the epigastrium. The cyst wall was excised partially, and cholecystectomy carried out. The patient was discharged on 5th post-operative day. Conclusion: The development of thick-walled huge cyst within abdominal cavity after gall bladder perforation is a rare entity, especially when the patient had gone through full-term pregnancy with the presence of the cyst.

Diffusion weighted imaging in differentiation of the clear cell RCC from the major non-clear cell RCC subtypes

Introduction. Renal cell carcinoma (RCC) is the most common malignant renal tumor in adults accounting for 80-90% of primary malignant adult renal neoplasms. RCC represents a very heterogenous groups of tumors with a number of distinct histological varieties, of which the major 3 subtypes are clear cell RCC (70-80%), papillary RCC (13-20%), and chromophobe RCC (5%). Imaging features are varied from solid and relatively homogenous appearance to markedly heterogenous appearance with cystic changes, hemorrhage and necrosis. The use of diffusion weighted imaging (DWI) for RCC subtyping and also for differentiation of high grade and low grade tumors has been showed to be useful in many studies in the literature. Aim. In this study, we aimed to determine the comparative contribution of DWI in differentiation of the clear cell RCC from the major non-clear cell RCC subtypes at standard high b-value (1000 s/mm2) versus low b-value (500 s/mm2). In addition, we also aimed to assess the diagnostic performance of DWI for differentiating high grade clear cell RCC from low grade clear cell RCC based on Fuhrman grades in our patients. Material and methods. 62 cases with a prediagnosis of RCC according to MRI findings including DWI sequence with histological verification and subtyping of renal cortical tumor following a total or partial nephrectomy were included in the study. Results. Among 62 cases, 46 were male and 16 were female, with mean age of 59.5 ± 15.7. Pathological diagnoses of 62 cases were as follows, clear cell RCC, (44) papillary cell RCC (14) and chromophobe cell RCC (4). They were divided into two groups as clear cell RCC group (44 cases) and non-clear cell RCC group (18 cases). There was no statistically significant difference between the mean ADC values of clear cell and non-clear cell groups at b-value of 1000 s/mm2 (p>0.05). However, the mean ADC level for clear cell RCC group at b-value of 500 s/mm2 were significantly higher than for non-clear cell RCC group (p<0.05). When a value of 0.99x10-3 mm2/s was set as cut-off for ADC at b-factor of 500 s/mm2, differentiation was achieved with a high sensitivity (91%) and specificity (56%). Regarding the diagnostic performance of DWI for differentiating high from low Fuhrman grades clear cell RCCs, there was no statistically significant difference between the ADC values of Grade I-II clear cell RCC cases and Grade III-IV clear cell RCC cases at b-factor of 1000 s/mm2 (p>0.05). However, ADC values for grade III-IV group was statistically significantly lower than ADC values for Grade I-II group at b-factor of 500 s/mm2 level. Conclusion. ADC measurements at moderate b-value of 500 s/mm2 were more sensitive in subtyping and grading of RCC cases. This technique can be used in clinical practice as a fast and additional sequence in abdominal MRI.

Stereological and Histopathological Effects of Trigonella foenum-graecum Seeds on Rabbits Ovary

This study aimed to investigate the impacts of the Trigonella foenum-graecum (T. foenum-graecum) seeds on the female gonad. A total of twenty local rabbits were used in this study; were divided into four groups (5 each): first group (G1) was considered as the control group. The second group (G2), third group (G3) and fourth group (G4) were fed daily1.5%, 3%, and 4.5% of T. foenum-graecum seeds respectively for 60 days (twice daily). At the end of the experiment, the animals were euthanized by diethyl ether (C2H52O). Then the abdomen was incised, and the samples of ovaries were collected and fixed by 10% neutral buffered formalin. The histological assessment was done with a paraffin embedding technique and the histological sections were stained with Hematoxylin and Eosin stain. The result showed that the numbers of primary and secondary follicles were significantly (P<0.05) decreased in G3and G4 compared with the control (G1) and G2. The numbers of Graafian follicles were significantly P<0.05 decreased G4 compared with other groups. The diameters of the primary, secondary, and Graafian follicles were significantly smaller than the other groups. The thickness of the granulosa cell layer in G3and G4 were significantly thinner than the other groups. The histological figures declared that the ovary of G2 was similar to that in G1. The histological sections of G3 and G4 were revealed marked cortical and medullary vascular congestion and focal hemorrhage; there were also marked follicular degeneration and cystic necrosis. The study concluded that the low concentration of T. foenum-graecum (fenugreek) seeds do not have any positive effect in terms of ovarian stimulation.

Reassessing Patterns of Response to Immunotherapy with PET: From Morphology to Metabolism.

Cancer demands precise evaluation and accurate and timely assessment of response to treatment. Imaging must be performed early during therapy to allow adjustments to the course of treatment. For decades, cross-sectional imaging provided these answers, showing responses to the treatment through changes in tumor size. However, with the emergence of immune checkpoint inhibitors, complex immune response patterns were revealed that have quickly highlighted the limitations of this approach. Patterns of response beyond tumor size have been recognized and include cystic degeneration, necrosis, hemorrhage, and cavitation. Furthermore, new unique patterns of response have surfaced, like pseudoprogression and hyperprogression, while other patterns were shown to be deceptive, such as unconfirmed progressive disease. This evolution led to new therapeutic evaluation criteria adapted specifically for immunotherapy. Moreover, inflammatory adverse effects of the immune checkpoint blockade were identified, many of which were life threatening and requiring prompt intervention. Given complex concepts like tumor microenvironment and novel therapeutic modalities in the era of personalized medicine, increasingly sophisticated imaging techniques are required to address the intricate patterns of behavior of different neoplasms. Fluorine 18-fluorodeoxyglucose PET/CT has rapidly emerged as one such technique that spans both molecular biology and immunology. This imaging technique is potentially capable of identifying and tracking prognostic biomarkers owing to its combined use of anatomic and metabolic imaging, which enables it to characterize biologic processes in vivo. This tailored approach may provide whole-body quantification of the metabolic burden of disease, providing enhanced prediction of treatment response and improved detection of adverse events. ©RSNA, 2020.

Computed tomography manifestations and pathological features of neuroendocrine carcinoma in uncommon sites.

BackgroundA neuroendocrine carcinoma is a malignant tumor that originates from the diffused neuroendocrine system (DNES). The present study aims to analyze the computed tomography (CT) manifestations and pathological features of neuroendocrine carcinomas in uncommon sites, in order to raise awareness of this disease.MethodsThe CT manifestations and pathological features of 29 cases of neuroendocrine carcinoma (confirmed by pathology) were retrospectively analyzed. The pathological results of these 29 cases were obtained through operations, and all cases underwent preoperative CT plain scanning and dynamic enhanced scanning.ResultsThe neuroendocrine carcinoma sites were: the breast (five cases), the cervix (nine cases), the uterine body (one case), the gallbladder (two cases), the mediastinum (five cases), the pyelobladder (one case), the kidneys (one case), the bladder (two cases), the liver (one case), the pancreas (one case), and the ovaries (one case). The CT manifestations were as follows. Most of the carcinomas were solid, and in a mode of infiltrative growth. Poorly differentiated neuroendocrine carcinomas had blurred boundaries. Cystic necrosis could be observed in most lesions, and the calcifications were visible in some lesions. Of the 29 cases studied, 23 had moderate (>20 HU and <40 HU) or higher enhancement in the CT scans. Peripheral invasion, bone destruction and distant metastasis were more likely to be seen in these lesions.ConclusionsThe imaging manifestations of neuroendocrine carcinoma varies in uncommon sites. It would therefore be helpful to understand the diversity and imaging signs of neuroendocrine carcinoma, in order to improve diagnosis.

Primitive ovarian carcinosarcoma: a clinical and radiological analysis of five cases

BackgroundOvarian carcinosarcomas (OCS) are very rare tumors composed of a mixture of carcinomatous and sarcomatous elements. There have been only scattered case studies that have described the imaging findings. In order to improve the awareness of this rare tumor, this study aimed to analyze the clinical and imaging features of five cases of OCS confirmed by surgical pathologic evaluation.MethodsThis retrospective study includes five OCS patients diagnosed and treated at our institute. The clinical course and imaging findings of all patients were retrospectively analyzed. The patients were 31 to 59 years of age. All five patients underwent CT scans, two underwent MRI scans.ResultsThe five patients have no specific symptoms. Four patients had elevated CA 125 levels and three patients had elevated CA 153 levels. All patients had unilateral tumors, four in the left ovary, one in the right ovary. The largest transverse diameter of the tumors ranged from 11 cm to 14 cm. Two tumors showed solid masses with unequally sized cystic areas or necrosis, one showed a multilocular cystic mass with a large solid protrusion, two tumors showed a larger cystic mass with multiple mural nodules. The solid components of the tumors demonstrated restricted diffusion (the average ADC value being 998 mm2/s and 1102 mm2/s, respectively), and showed moderate or obvious enhancement. All five patients were treated by surgical resection and adjuvant chemotherapy. One patient is currently undergoing post-operative chemotherapy 1 month after operation and clinical stable. Three patients survived and showed no obvious recurrence and / or metastasis in follow-up from 9 to 59 months. One patient died from recurrence and metastasis.ConclusionsOCS are rare and demonstrate variable CT and MRI morphological appearances. Due to the heterogeneous nature and very low morbidity of OCS, combination of careful analysis of imaging findings and clinical features might be useful for a more accurate diagnosis of OCS.

Different outcomes of spontaneous gall bladder perforation owing to timing of surgical intervention: report of 2 cases

Gall bladder perforation (GBP) is a rare life-threatening complication with a high mortality due to atypical clinical presentation and delay in diagnosis due to atypical clinical presentation. Case report 1, 70-year-old female presented with complaints of pain abdomen, vomiting and blackish pigmentation over abdomen since a week. She was in shock on presentation, with necrotic patch over abdomen and abscess collection at umbilicus. Ultrasound revealed GBP at fundus with thick collection in gastrohepatic recess with overlying abdominal wall cellulitis. CECT was not possible and the patient could not be taken for surgery due to unstable vitals and expired the next day. Case report 2, a 68-year-old male presented with complaints of pain abdomen over right side with vomiting. Abdomen was tender diffusely with guarding in right hypochondrium. Ultrasound showed distended gall bladder (GB) with multiple calculi. Magnetic resonance cholangiopancreatography (MRCP) showed a GBP at fundus with pericholecystic collection extending into hepatogastric recess. He underwent total cholecystectomy and post-operative period was uneventful. Acute cholecystitis has a perforation rate of 2-11% due to cystic duct obstruction, ischemia and necrosis. Our first patient had type-III GBP and was in shock and did not survive due to bad condition on arrival whereas the second patient had type-I GBP and underwent cholecystectomy without any complications. Type-I and type-II GBP as proposed by Niemeier have better outcomes compared to type-III. Rapid diagnosis and surgical intervention are very much necessary for reducing mortality as they rarely present with typical signs and symptoms of perforation.

Multimodal MR Features of 8 Cases of Epithelioid Glioblastoma.

Purpose The MRI features of epithelioid glioblastoma (eGBM) were analyzed. The apparent diffusion coefficient (ADC), MR perfusion-weighted imaging (PWI), and magnetic resonance spectroscopy (MRS) findings were quantitatively analyzed.Methods The MRI images of 8 cases of eGBM were analyzed retrospectively. The location and edge, signal, peritumoral edema, adjacent meningeal invasion, and enhancement of the lesions were observed. The ADC value, relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), and N-acetylaspartate/acetylcholine (NAA/Cho) value were analyzed.Results Among the 8 patients, the tumors were mainly located in the temporal lobe (n = 3), frontal lobe (n = 3), and parietal lobe (n = 2). The lesion boundary was clear in 6 cases and unclear in 2. The lesions were superficial in 5 cases and in the deep white matter in 3. Internal hemorrhage was observed in 4 cases. There was cystic necrosis in 7 cases, and only 1 case was solid without cystic necrosis. There was no edema around the lesion in 1 case, severe edema in 5, and moderate edema in 2. In 4 cases, the adjacent meninges were involved, and in 1 case, the ependyma was involved. Two patients developed leptomeningeal metastasis within 2 months after the operation. The average ADC value of the tumor parenchyma among all 8 patients was7.15 × 10−4 mm2/s,which was 17.6% lower than that of the contralateral side. The Cho/NAA metabolite ratio was 5.27 and 0.81 in the lesions of 2 patients. The rCBV was 3.51 ml/100 g and 3.32 ml/100 g of lesions in 2 patients; these values were 36% and 29% higher, respectively, than those of the contralateral side. The rCBF was 31.5 ml/100 g/min and 82.1 ml/100 g/min of lesions in two patients; these values were 49% and 203% higher, respectively, than those of the contralateral side.Conclusion eGBM characteristics include a superficial location, easy cyst degeneration, easy necrosis and hemorrhage, and clear boundaries. It easily invades adjacent meninges and shows cerebrospinal fluid dissemination and metastasis. Combining new MR techniques, such as ADC values, PWI, and MRS, could be helpful for improving diagnostic accuracy.

Magnetic Resonance Imaging Features of Ovarian Thecoma

Objective To investigate the magnetic resonance imaging(MRI)findings of ovarian thecomas and improve the accuracy of preoperative MRI diagnosis of the disease.Methods A retrospective analysis of 48 patients with ovarian thecoma confirmed by operation and pathology was performed.According to the maximum diameter,the lesions were divided into≥5 cm and <5 cm groups and analyzed in terms of location,size,shape,boundary,cystic necrosis,T1WI/T2WI signals,DWI characteristics,enhancement features,and pelvic effusion.The diagnostic score was evaluated by MRI(the highest score was 6 points).Results All the 48 lesions were single.In the≥5 cm group(n=39),the tumor boundary was clear in 37 cases and unclear in 2 cases;necrosis was found in 35 cases;T1WI showed equal signals in 23 cases and equal low signals in 16 cases;T2WI showed equal signals in 7 cases,equal low signals in 23 cases,and slightly higher signals in 9 cases;DWI showed high signals in 23 cases and mixed high signals in 16 cases;dynamic enhanced scans showed slight enhancement in all cases;33 patients had different degrees of pelvic fluid;score evaluation showed 6 points in 33 cases,5 points in 2 cases,4 points in 2 cases,and 3 points in 2 cases.In the <5 cm group(n=9),all lesions had clear boundaries;cystic necrosis was seen in 3 cases;T1WI showed equal signals in 3 cases and equal low signals in 6 cases;T2WI showed equal signals in 2 cases,equal low signals in 4 cases,and slightly higher signal in 3 cases;DWI showed high signals;the dynamic enhancement of the lesions showed slight enhancement in 8 cases and significant enhancement in one case;a small amount of pelvic fluid was seen in 4 cases;score evaluation revealed 6 points in 3 cases,5 points in 1 case,4 points in 4 cases,and 3 points in 1 case.The incidences of pelvic effusion(χ2=6.680,P=0.010)and cyst necrosis(χ2=14.109,P<0.001)in the≥5 cm group were significantly higher than those in the <5 cm group.The number of patients with cystic lesions with elevated estrogen levels was significantly higher than that of patients without cystic lesions(χ2=5.847,P=0.016;contingency coefficeient=0.330).Conclusions Large ovarian thecomas have high or mixed high signals on DWI;they are often accompanied by pelvic fluid and cystic necrosis,and the cystic necrosis is common and has small involvement.For small ovarian thecomas,DWI often reveals high signals,and cystic necrosis is rare.MRI score evaluation combined with patient's age and other factors is helpful to improve the accuracy of preoperative diagnosis.

The Clinicopathological and Imaging Characteristics of Primary Hepatic Carcinosarcoma and a Review of the Literature.

PurposeTo improve the understanding of hepatic carcinosarcoma (HCS) by analyzing radiological imaging data and clinicopathological features.Materials and MethodsA retrospective analysis was performed on four patients with HCS confirmed immunohistochemically. The analysis included three males and one female, aged 29 to 64 years. Four patients underwent computed tomography (CT) scans, and one underwent magnetic resonance imaging (MRI) scans simultaneously.ResultsThree patients had a history of hepatitis B, cirrhosis or fibrosis, and two patients had schistosomiasis. Two cases tested positive for elevated serum carbohydrate antigen (CA) 19–9. The maximum diameters of the lesions ranged from 7.8 to 9.0cm. Pathologically, the carcinomatous and sarcomatous elements in two patients could not be classified, one of the patients had cholangiocellular carcinoma (CCC) and undifferentiated sarcoma, the other had hepatocellular carcinoma (HCC) and undifferentiated pleomorphic sarcoma (UPS). All tumors showed heterogeneous density/intensity, accompanied by vast cystic changes and necrosis, with two cases having cystic septations. Capsule formation was not identified. The margins of the radiological images showed irregular ring enhancement. One case presented continuous progressive enhancement, one case with “fast in fast washout” and two cases with “fast in late washout”. Lymphonodus metastasis, satellite nodules, vascular embolism, and organ invasion (hepatic flexure of the colon) were identified.ConclusionHCS is a rare, high-grade malignancy with poor prognosis. The preoperative diagnosis is expected to improve by carefully analyzing the imaging features of the patients in combination with their clinical characteristics. Radical resection and postoperative chemoradiotherapy can improve the survival rate of patients.

Computed tomography imaging and clinical features of congenital hepatoblastoma

Congenital hepatoblastoma (CHB) is the most common hepatic malignant tumor of fetus or neonates, but few studies focusing on the radiological characteristics of CHB have been reported to date.To investigate the characteristic clinical and computed tomography (CT) findings of CHB to facilitate recognition and noninvasive diagnosis.Medical records of 7 patients with CHB were retrospectively reviewed. The demographic, clinical, and laboratory data were extracted from the electronic medical records. Two pediatric radiologists evaluated the abdominal CT examinations for the hepatic tumor location, size, enhancement characteristics, vascular invasion, and intra-/extra-hepatic metastasis.Among the included 7 patients (3 males and 4 females), only 1 had an elevated serum alpha-fetoprotein level. All patients had solitary intrahepatic mass with a mean size of 4.7 cm (range: 2.9–10.2 cm), of which liver SV-VII were most involved. 4/7 tumors were round while 3/7 irregular or lobulated. 6/7 tumors were well-defined. Microhemorrhage, cystic necrosis, and coarse calcification were present in 5/7, 4/7, and 1/7 tumors, respectively. All lesions showed inhomogeneously significant enhancement, with multiple nodular or striped appearance in the center and periphery of the tumors on the arterial phase, and then the enhancement area showed progressive expansion and fusion filling over time but the attenuation gradually declined on the portal and delayed phases, and finally the majority (6/7) of tumors presented multiple band- or island-like characteristics with prominently peripheral enhancement on the delayed phase while the remaining 1 relatively small tumor showed nearly complete but inhomogenous enhancement. In addition, only 1/7 tumor had hilar hepatic bile duct and portal vein invasion and secondary intra-hepatic bile duct dilation. No metastatic lesions were identified in all patients at diagnosis. The abdominal aorta distal to the coeliac trunk was significantly narrowed in 3/7 patients. Pathological examinations suggested that 6/7 tumors showed fetal histology with only 1 containing mesenchymal elements.The relationship between serum alpha-fetoprotein and CHB could be more complicated and yet to be determined. Dynamic contrast-enhanced CT can facilitate recognition and noninvasive diagnosis of CHB, presenting a pattern of progressive expansion and fusion filling but inhomogeneously significant enhancement.

Neuroimaging Appearance of Cerebral Malignant Epithelioid Glioneuronal Tumors in Children.

Malignant epithelioid glioneuronal tumor is a rare high-grade, aggressive brain tumor that shows both glial and neuronal differentiation on histopathology but is not included in the current World Health Organization classification. The neuroimaging appearance is variable but may be secondary to the size of the mass and/or location of the tumor. In our series, all epithelioid glioneuronal tumors were encountered in the supratentorial space and included pineal, temporal, and extratemporal lobar cerebral hemisphere locations. When large, the tumors demonstrate cystic degeneration and necrosis, hemorrhage, contrast enhancement, and regions of low apparent diffusion coefficient scalars consistent with patterns seen with other high-grade pediatric brain tumors. The tumors also have a propensity to spread into the meninges at presentation and for distant CSF spread on follow-up imaging.

FDG PET/CT and CT Findings of Renal Cell Carcinoma With Sarcomatoid Differentiation.

OBJECTIVE. The purpose of this article is to investigate the value of 18F-FDG PET/CT and enhanced CT in the diagnosis of renal cell carcinoma (RCC) with sarcomatoid differentiation and the differential diagnosis of clear cell renal cell carcinoma (ccRCC). MATERIALS AND METHODS. Among patients with renal tumors confirmed by pathologic examination from September 2010 to August 2019, 29 patients with RCC with sarcomatoid differentiation and 82 patients with ccRCC who underwent FDG PET/CT, renal contrast-enhanced CT examination, or both, before surgery were studied. Features of the two groups on CT and PET/CT were retrospectively reviewed. RESULTS. The tumor size of RCC with sarcomatoid differentiation was larger than that of ccRCC (p = 0.0086). Cystic necrosis, peritumoral neovascularity, and metastasis were more common in RCC with sarcomatoid differentiation (p = 0.0052, p = 0.0008, p < 0.0001, respectively). The ratio of necrotic area to tumor diameter of RCC with sarcomatoid differentiation was statistically significantly larger than that of ccRCC (p = 0.0032). Three cases of RCC with sarcomatoid differentiation showed a large central necrotic area and dense intratu-moral neovascularity in the surrounding parenchyma, defined as the ring-of-fire sign, which was not found in ccRCC. The maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), and peak standardized uptake value (SUVpeak) of RCC with sarcomatoid differentiation were statistically significantly higher than those for ccRCC (all p < 0.0001), and the SUVmax, SUVmean, and SUVpeak cutoff values of 5.4, 4.2, and 5.0, respectively, were helpful for discrimination. CONCLUSION. Imaging features including higher SUVmax, SUVmean, and SUVpeak; a larger ratio of necrotic area to tumor diameter; the presence of peritumoral neovascularity; and metastasis are more commonly associated with RCC with sarcomatoid differentiation than with ccRCC. The ring-of-fire sign and SUVmax, SUVmean, SUVpeak cutoff values of 5.4, 4.2, 5.0, respectively, may be helpful to indicate RCC with sarcomatoid differentiation.

Abdominal perivascular epithelioid cell tumor (PEComa) without visible fat: a clinicopathologic and radiological analysis of 16 cases.

To retrospectively review the clinicopathological features and computed tomography (CT) and magnetic resonance imaging (MRI) findings of abdominal perivascular epithelioid cell tumor without visible fat (PEComawvf). Sixteen patients with surgically and pathologically confirmed perivascular epithelioid cell tumor without visible fat were enrolled. Their clinicopathological data and imaging findings were retrospectively reviewed. The CT and MRI features, including location, size, shape, margin, density, calcification, cystic necrosis and enhancement pattern, were analyzed. There were 4 males and 12 females (median age, 46years; range, 21-65years) in this study. All 16 patients were diagnostic asymptomatic unenhanced CT or MRI and revealed a well-defined (n = 13), oval (n = 10), mass with heterogeneous (n = 6) or homogeneous density/signal intensity (n = 7), calcification and hemorrhage was no found in any cases. On enhanced CT/MRI, markedly enhancement patterns (n = 14) were observed. The "peripheral enhancement" sign was observed in 13 cases. One in 16 cases recurrence was discovered during the follow-up period. Dynamic CT, MRI and pathology of PEComawvf had some characteristics of non-aggressive pattern of performance, and MRI would provide beneficial detection of microscopic fat. Enhanced imaging showed PEComawvf is characterized by a "peripheral enhancement" with a marked enhancement pattern. Knowing these characteristics could contribute to improving the understanding abdominal PEComawvf and related palliative care.

Ancient Schwannoma: Cervical Sympathetic Chain with Review of Literature.

Schwannoma in cervical region arising from Sympathetic chain is a very rare entity. Ancient schwannoma is the term used to describe a schwannoma that has undergone changes viz loss of antoni Type A cells, perivascular hyalinization, calcification, cystic necrosis, hemorrhage and presence of degenerative nuclear changes. Ackerman and Taylor (Cancer 4:669-691, 1951) introduced the term "ancient schwannoma". Badawi (Eur J Surg Oncol 28(1):88-90, 2002) in 2002 reported the first case of ancient schwannoma of the sympathetic chain. Surgery is the choice of treatment. In most of the cases Horner's syndrome may or may not be the presenting symptom but may appear postoperatively. First bite syndrome is another complication of surgery. These must be kept in mind and proper counseling should be done preoperatively. Fine needle aspiration cytology (FNAC) may be misleading. To diagnose, radiological investigations like CT/MRI are helpful. They may mimic carotid body tumor, vagal schwannoma, necrotic lymph node and sarcoma.

Analysis of magnetic resonance imaging features of ovarian thecoma.

To investigate the magnetic resonance imaging (MRI) findings in ovarian thecoma and improve preoperative diagnostic accuracy.Retrospective analysis was performed on 45 patients with surgically and pathologically confirmed ovarian thecoma. Patients were grouped into those with maximum lesion diameter ≥5 cm and <5 cm. Diagnostic scores (up to 6 points) were evaluated on the basis of MRI performance.The ≥5 cm group contained 36 cases (cystic necrosis, 32 cases) with the following findings: T1WI: isointense signal, 22 cases; slightly hypointense signal, 14 cases; T2WI: isointense signal, 6 cases; slightly hypointense signal, 21 cases; slightly hyperintense signal, 9 cases; Diffusion-weighted imaging (DWI): hyperintense signal, 23 cases; mixed hyperintense signal, 13 cases; slight enhancement on dynamic enhanced scans; pelvic fluid accumulation, 31 cases. The diagnostic score evaluations yielded 6 points in 31 cases, 5 points in 1 case, 4 points in 2 cases, and 3 points in 2 cases. The <5 cm group contained 9 cases (cystic necrosis, 3 cases) with the following findings: T1WI: isointense signal, 3 cases; slightly hypointense signal, 6 cases; T2WI: isointense signal, 2 cases; slightly hypointense signal, 4 cases; slightly hyperintense signal, 3 cases; DWI, hyperintense signal; slight enhancement in 8 cases and significant enhancement in 1 case; pelvic fluid accumulation, 4 cases. The diagnostic score evaluations yielded 6 points in 3 cases, 5 points in 1 case, 4 points in 4 cases, and 3 points in 1 case. (iii) Incidence of pelvic fluid accumulation and cystic necrosis differed depending on the size of the lesion (P = .007, .000).Larger lesions show hyperintense or mixed hyperintense signals on DWI along with pelvic fluid and cystic necrosis; whereas, smaller lesions show a hyperintense signal on DWI, cystic necrosis is rare. MRI characteristics along with the patient age and laboratory findings can improve the accuracy of preoperative diagnosis of these lesions.

The value of clinical parameters combined with magnetic resonance imaging (MRI) features for preoperatively distinguishing different subtypes of uterine sarcomas: An observational study (STROBE compliant).

To investigate clinical parameters combined with magnetic resonance imaging (MRI) features including apparent diffusion coefficient (ADC) values in preoperative identification of different subtypes of uterine sarcomas including uterine leiomyosarcoma (LMS), endometrial stromal sarcoma (ESS), and carcinosarcoma (CS).Data from 71 patients with uterine sarcoma confirmed by surgery and pathology were collected. The clinical characteristics, conventional MRI features, mean ADC values, minimum ADC values, and lesion-muscle ADC ratio (rADC) values were compared with different subtypes of uterine sarcomas.Age, clinical manifestation, tumor location, shape, and T1-weighted image (T1WI) signals were significantly different between CS and LMS or ESS (all P < .01). The presence of band sign was significantly higher in ESS than in LMS or CS (both P < .001). The cystic change or necrosis and enhancement could help to differentiate LMS from ESS or CS (both P < .02). Significant differences were observed in T2-weighted image (T2WI) signals of the solid components of LMS compared with CS (P < .001). There was a significant difference between ESS and CS in the rADC values (P = .004).Clinical parameters combined with MRI features could help narrowing preoperative diagnostic possibilities in distinguishing subtypes of uterine sarcomas. These findings may be beneficial in helping guide operative decisions.

Aortic Dissection with Polycystic Kidney Disease and Cystic Necrosis within Arterial Media

Aortic Dissection with Polycystic Kidney Disease and Cystic Necrosis within Arterial Media

Inflammatory lesions and brain tumors: is it possible to differentiate them based on texture features in magnetic resonance imaging?

Background:Neuroimaging strategies are essential to locate, to elucidate the etiology, and to the follow up of brain disease patients. Magnetic resonance imaging (MRI) provides good cerebral soft-tissue contrast detection and diagnostic sensitivity. Inflammatory lesions and tumors are common brain diseases that may present a similar pattern of a cerebral ring enhancing lesion on MRI, and non-enhancing core (which may reflect cystic components or necrosis) leading to misdiagnosis. Texture analysis (TA) and machine learning approaches are computer-aided diagnostic tools that can be used to assist radiologists in such decisions.Methods:In this study, we combined texture features with machine learning (ML) methods aiming to differentiate brain tumors from inflammatory lesions in magnetic resonance imaging. Retrospective examination of 67 patients, with a pattern of a cerebral ring enhancing lesion, 30 with inflammatory, and 37 with tumoral lesions were selected. Three different MRI sequences and textural features were extracted using gray level co-occurrence matrix and gray level run length. All diagnoses were confirmed by histopathology, laboratorial analysis or MRI. Results:The features extracted were processed for the application of ML methods that performed the classification. T1-weighted images proved to be the best sequence for classification, in which the differentiation between inflammatory and tumoral lesions presented high accuracy (0.827), area under ROC curve (0.906), precision (0.837), and recall (0.912). Conclusion:The algorithm obtained textures capable of differentiating brain tumors from inflammatory lesions, on T1-weghted images without contrast medium using the Random Forest machine learning classifier.