Multiple Satellite Nodules Research Articles

A Case of Synchronous Primary of CA Breast and Non-Hodgkins Lymphoma

A 66 years old female with diabetes and hypertension was evaluated for a lump in the left breast of six months duration, the lump was gradually increasing in size. On clinical examination it was found that the lump measured 4x4cm and was present in the left upper outer quadrant and was non tender. As a part of metastatic work up a PET CT was done which showed metabolically active lobulated soft tissue density mass lesion with multiple satellite nodules in left breast upper and outer quadrant measuring 3.2x2.1x4.4cms with max SUV 4.4, the lesion maintained fat planes with skin anteriorly and muscles posteriorly. Multiple non FDG avid to mildly FDG avid sub cm to cm size soft tissue density lesion in left breast around the main lesion was noted. Non FDG avid multiple sub cm left axillary lymph nodes were also present. Imageologically Stage II disease. Biopsy from the breast lesion was invasive carcinoma of nos type. Patient underwent left sided MRM. The final pathological staging was pT2N1a.Section from one lymph node showed partially effaced lymph node architecture with sheets of medium to large sized atypical lymphoid cells with fine chromatin prominent nucleolus and scant cytoplasm. IHC done showed the tumor cells to be positive for CD20, CD45, CD15, CD30(40%), MUM1, cmyc (30%) and negative for CK, CD3, EBV, ALK, BCL-2CD10, SOX11, Ki67-60%. The final diagnosis was Diffuse Large B Cell Lymphoma, non-germinal center type.

Localized Mesothelioma of the Pleura: Report of 2 Cases, From Benign to Malignant

Abstract Localized mesotheliomas of the pleura are rare, and form a spectrum of low-grade noninvasive indolent lesions that are presumably benign, to more aggressive invasive cancers that, although fully malignant, have a relatively better prognosis than the diffuse type of mesothelioma. Localized mesotheliomas can be either epithelioid, sarcomatoid, or biphasic. The defining characteristics are circumscription and origin from the visceral pleura. The vast majority are single lesions, although multifocal ones, as the second case in this report, have rarely been described. We present a “benign” localized epithelioid mesothelioma and a malignant localized sarcomatoid mesothelioma with multiple satellite nodules.

Multiple Pulmonary Pleomorphic Adenomas of Unknown Primary

Abstract Introduction/Objective The most common site of pleomorphic adenomas (PAs) is salivary glands, which behave as benign tumors and rarely metastasize. Primary PAs in lungs are exceedingly rare. We report a case of multiple PAs in lungs with an inconclusive origin. Methods A 65-year-old woman had a two-year history of numerous scattered bilateral well-circumscribed pulmonary nodules measuring up to 2.1 cm. She had no prior history of smoking, asbestos exposure and salivary gland diseases, and denied any symptoms. The latest chest computed tomography (CT) scan showed the two largest lower lobe nodules had mildly increased in size compared to two years before. The patient then underwent wedge resections. Results Grossly, the wedge resection specimens showed multiple well-circumscribed, pale tan, firm nodules. Microscopically, the nodules comprised cytologically bland nests of polygonal to plasmacytoid cells with eosinophilic cytoplasm, variably set in a myxoid matrix. Immunohistochemical stains demonstrated that the cells were positive for AE-1/AE-3, S-100, bcl-2 and SOX-10, and negative for chromogranin, smooth muscle actin, p63, calponin, PAX-8, CD34, CD31, HMB-45, melan-A, HHF-35, GATA-3, GFAP and RCC marker; TTF-1 highlighted entrapped pulmonary epithelium but the tumor cells were negative. These findings might suggest metastatic low grade PA from salivary glands. However, the patient’s follow-up examination by an otolaryngologist was normal; the CT scan of her chest and abdomen did not show any remarkable findings other than her lung nodules. Conclusion To our knowledge, this is the first reported case of multiple pulmonary PAs without a preceding primary. It has raised questions about the pathogenesis of multiple PAs in lungs. Could PA present as multiple primary nodules in lungs? Could one primary pulmonary PA generate multiple satellite nodules in lungs? Do multiple primary pulmonary PAs have a different IHC profile than that of a single primary pulmonary PA? More research is needed.

Desmoplastic Small Round Cell Tumor: The Value of Cytology, Immunohistochemistry, and Molecular Features in the Diagnosis of This Challenging Diagnostic Entity

Abstract Desmoplastic small round cell tumor is a rare malignant neoplasm that usually occurs in adolescents and young adult males and typically presents as a large, often multinodular, intra-abdominal mass. The peritoneal cavity is the most common location of the tumor with multiple satellite nodules often noted at presentation. Extra-abdominal locations, such as the lung, kidney, middle ear, stomach, pancreas, pleura, bone, and the central nervous system, have been described. Distant metastases commonly involve the lymph nodes, liver, and lungs. Desmoplastic small round cell tumor is relatively rare, and only few cytologic descriptions are available. We present the case of a 16-year-old boy with unusually rapidly fatal desmoplastic small round cell tumor of the peritoneum with emphasis on the cytologic features. Recent advances in imaging techniques have resulted in increased number of cytologic preparations from unusual tumors or tumors in unusual locations. Morphologically, these tumors often display a divergent phenotype and immunophenotype. Immunohistochemistry plays a pivotal role in the characterization of these tumors and discrimination from other mimickers, particularly other “blue cell tumors.” Once suspected, identification of the characteristic translocation in these tumors confirms the diagnosis. Therefore, awareness of the cytologic features and the divergence of the immunophenotype of this tumor are crucial in order to arrive to the correct diagnosis and to ensure proper management plans of these often difficult-to-treat tumors.

Pulmonary sclerosing pneumocytoma with multiple satellite nodules mimicking tuberculosis

Pulmonary sclerosing pneumocytoma with multiple satellite nodules mimicking tuberculosis

Localized overexpression of alpha-internexin within nodules in multinodular and vacuolating neuronal tumors

Multinodular and vacuolating neuronal tumors (MVNT) have been recently referred to as a distinctive neuronal tumor entity based on histopathological findings. They are characterized by multiple tumor nodules, vacuolar alteration and widespread immunolabeling for human neuronal protein HuC/HuD. Only 13 cases have been reported in the literature to date and little is known about the histopathology of these tumors. Herein, we report a case of MVNT with additional confirmation of immunohistochemical features. A 22-year-old woman presented with a continuous headache. MRI showed a subcortical white matter lesion with multiple satellite nodules in the frontal lobe appearing as T2/fluid-attenuated inversion recovery (FLAIR) hyperintensities. Histological examination of the resected lesion revealed well-defined multiple nodules composed of predominant vacuolating tumor cells. The tumor cells exhibited consistent immunolabeling for doublecortin, as well as HuC/HuD, both representative neuronal biomarkers associated with earlier stages of neuronal development. Immunopositivity for oligodendrocyte transcription factor 2 (Olig2) and S100 was also detected in tumor cells. Additionally, significant overexpression of alpha-internexin was observed in the background neuropil limited to tumor nodules. Neuronal nuclear antigen (NeuN), synaptophysin and neurofilament, markers for mature neurons, were either negative or weakly positive. The expression profile of neuronal biomarkers can be distinguished from that of classic neuronal tumors and is the immunohistochemical hallmark of MVNT. In summary, we identified the characteristic tumoral expression of HuC/HuD and doublecortin and the presence of abundant neuropil localized in MVNT tumor nodules, which exhibited widespread alpha-internexin expression. These results supported the presumption that MVNT is a distinct histopathological entity.

In Response to the Article "Computed Tomography Features of Pulmonary Nocardiosis in Immunocompromised and Immunocompetent Patients"; Pol J Radiol, 2015; 80: 13-17.

Dear Editor, The article by Mehrian P. et al. [1] on CT features of pulmonary nocardiosis in immunocompromised and immunocompetent patients was quite informative and made an interesting reading. Nocardiosis is an uncommon infection that occurs primarily in the immunocompromised patients, especially in patients with defective cell-mediated immunity [2]. Less commonly it may also be encountered in immunocompetent hosts. However, its incidence is rising probably due to the advent of improved and advanced laboratory detection methods and also due to the growing number of immunosuppressed patients. The incidence of nocardiosis ranges from 0.7% to 3.5% in solid organ transplant recipients [3]; whereas its incidence in patients infected with human immunodeficiency virus (HIV) is decreasing probably due to effective medical therapy. CT features of nocardiosis are highly variable, with the most common findings on chest CT being consolidation, nodules which are often cavitating, pleural involvement in the form of thickening and effusions, and extension to the chest wall resulting in formation of an abscess or phlegmon [1,2,4]. Other less common features which have also been described include bronchiectasis, ground glass haze with superimposed septal thickening [2]. Herein are present two cases of pulmonary nocardiosis, one in an immunocompromised and one in an immunocompetent patient, highlighting the variable and non-specific nature of CT findings in this condition. A 24-year-old male who was a kidney transplant recipient, presented with complaints of cough with expectoration and fever. Based on the clinical suspicion of an opportunistic infection, a CT scan of the thorax (Figure 1A–1C) was carried out, which revealed cavitatory nodules with multiple small satellite nodules in the upper lobes of both lungs. Pulmonary nocardiosis was diagnosed with a CT-guided biopsy. Figure 1 A 24-year-old male, kidney transplant recipient, with pulmonary nocardiosis. Axial (A), coronal (B) and sagittal (C) CT images showing cavitatory nodules with multiple satellite nodules in the upper lobes of both lungs. (Sagittal image is of the right ... Figure 2 shows a CT picture of a 50-year-old man with COPD (chronic obstructive pulmonary disease) with no history of corticosteroid intake. He presented with increased cough for the past several months with fever for the last few weeks. There was no history of weight loss. Intradermal tuberculin test was negative and the sputum was sterile. Chest radiograph showed multiple nodular opacities in the bilateral upper zones along with the presence of a cavity in the upper zone of the right lung. These findings were confirmed on CT which also revealed a patch of ground glass haziness in the middle lobe of the right lung and bilateral irregular pleural thickening. Pulmonary nocardiosis was diagnosed with a CT-guided biopsy. Figure 2 A 50-year-old man with COPD presenting with gradually increasing chronic cough and fever. Axial CT chest image depicting multiple nodular opacities in bilateral upper lobes along with the presence of a cavity in the right upper lobe. To conclude, although the CT features of pulmonary nocardiosis are nonspecific and can mimic other infections and tumors, familiarity with nocardiosis and its CT findings may help the radiologist/physician in suggesting the diagnosis when it is not suspected clinically.

Primary hepatic neuroendocrine carcinoma: MR imaging findings including preliminary observation on diffusion-weighted imaging

To investigate MR imaging findings of primary hepatic neuroendocrine carcinoma (PHNEC) including preliminary observations on diffusion-weighted imaging (DWI). MR images of eight patients with pathologically confirmed PHNEC were retrospectively analyzed. The morphological characteristics and dynamic enhancement patterns were evaluated. One case showed a well-defined solitary nodule with homogenous hypointensity on T1-weighted imaging (T1WI) and hyperintensity on T2-weighted imaging (T2WI) and DWI. The remaining seven cases appeared as well-defined dominant masses with multiple satellite nodules. The dominant masses demonstrated heterogeneous hypointensity on T1WI and hyperintensity on T2WI, which all appeared as a marked enhancement at arterial phase and rapid washout at portal venous phase. Six cases demonstrated rim-like enhancement at equilibrium phase. The satellite lesions showed heterogeneous hypointensity on T1WI and marked hyperintensity on T2WI with variable enhancements, such as homogeneous, rim-like enhancement. All the dominant masses and satellite nodules appeared as markedly hyperintensity and reduced apparent coefficient (ADCs) values on DWI. The mean ADC value of the tumors was significantly lower than that of surrounding liver parenchyma (1.02 ± 0.57 vs. 2.24 × 10(-3) mm(2)/s, p = 0.000). PHNECs typically appear as a large dominant hypervascular mass accompanied by satellite nodules, with rapid washout and capsular enhancement on dynamic MR imaging and restricted diffusion on DWI.

A Rapidly Recurring Cutaneous Xanthogranuloma-Like Histiocytic Tumor

Xanthogranuloma (XG) is a benign cutaneous histiocytic tumor occurring mainly in young children. Onset in adulthood is rarely observed. We encountered an unusual case of an XG-like cutaneous tumor on the scalp of a 50-year-old man. The tumor recurred with multiple satellite nodules soon after surgical excision. This unusual clinical behavior has not previously been described for XG and caused a diagnostic challenge; it was unclear whether the tumor was an atypical XG or a malignant dermal tumor mimicking an XG. Our analyses favored an XG-like dermal histiocytic tumor. A longer follow-up and reports of similar cases will reveal its true nature.

Metastasizing “Benign” Cutaneous Fibrous Histiocytoma

Cutaneous fibrous histiocytoma (FH) is considered a benign tumor; however, certain types of FH have been shown to have a tendency for local recurrence, and there are rare reported cases of metastasis. In this study, 16 cases of morphologically benign FH with locoregional or distant metastasis were identified in consult files. Pathologic features of primary, recurrent, and metastatic tumors, as well as clinical outcome, were evaluated. Nine were male and 7 were female patients; mean age was 42 years (range, 3 to 68 y). Primary tumors arose on the leg in 5 patients, buttock in 1, trunk in 3, shoulder in 3, neck in 2, and finger in 1. The primary site in 1 case was unknown. Fifteen primary tumors available for review involved the dermis; 6 extended into the superficial subcutis. Tumor size ranged from 1 to 5 cm (median 3.2 cm). Histologically, primary tumors showed characteristic features of FH, being composed in most cases of a polymorphous population of bland spindle and histiocytoid cells in a mixed storiform and fascicular growth pattern with admixed foam cells, multinucleate cells, and inflammatory cells in varying proportions. Histologic variants included 11 cellular (2 with mixed atypical and cellular features), 2 aneurysmal, 1 atypical, and 1 epithelioid type. All tumors showed entrapment of hyalinized collagen bundles. Mitotic activity ranged from <1 to 13/10 HPF. Focal necrosis was seen in 1 primary tumor. Ten patients had local tumor recurrence; 4 patients had multiple local recurrences. Time to first recurrence ranged from 6 weeks to 13 years. The local recurrences of 1 tumor showed increased cytologic atypia, but recurrences were otherwise morphologically similar to primary tumors. Metastases occurred 0 to 180 months after diagnosis (median 17 mo) and involved the lungs (12 patients), lymph nodes (8), soft tissues (6), and liver (1). Five patients developed multiple satellite nodules in the region of the primary tumor. Metastases were morphologically similar to the primary tumors. So far, 6 patients died of disease, with a median time to death of 64 months (range, 10 to 168 mo). Four patients are alive with metastatic disease. Two patients are disease free at last follow-up, and 1 patient died of unrelated disease. Metastasis of morphologically benign cutaneous FH is an extremely rare but clinically aggressive event. Primary tumors tend to be large and cellular, but aggressive behavior cannot be predicted on morphologic grounds alone; however, early or frequent local recurrence may warrant closer clinical follow-up.

Monophasic Synovial Sarcoma of the Liver

We report a hepatic monophasic synovial sarcoma in a 60-year-old woman who presented with right upper quadrant pain subsequent to an intrahepatic bleed from a highly vascular tumor mass. Imaging studies showed a dominant tumor mass in the right hepatic lobe with multiple satellite nodules. A detailed physical examination and radiologic workup failed to reveal a primary tumor elsewhere. A right partial hepatectomy was performed with a preoperative differential diagnosis of angiosarcoma versus hepatocellular carcinoma. The morphologic, immunophenotypic, and cytogenetic findings (t(X;18)(p11.2;icq11.2)) were consistent with a monophasic synovial sarcoma. Postoperative clinical evaluation of the extremities and a positron emission tomographic scan performed 4 weeks after surgery showed no evidence of recurrent or metastatic disease. The patient was started on an aggressive 4-drug chemotherapy regimen, but died 3 months thereafter from widespread metastatic disease. No autopsy was performed. The presence of multiple lesions in the liver certainly suggests the possibility of metastatic disease. It would, however, be very unusual for a synovial sarcoma to present as an occult primary, and the negative radiologic workup 1 month after the partial hepatectomy also argues against this possibility. The clinical presentation, radiographic findings, and subsequent course in this patient was therefore most consistent with a primary monophasic synovial sarcoma of the liver.

Monophasic synovial sarcoma of the liver.

Abstract We report a hepatic monophasic synovial sarcoma in a 60-year-old woman who presented with right upper quadrant pain subsequent to an intrahepatic bleed from a highly vascular tumor mass. Imaging studies showed a dominant tumor mass in the right hepatic lobe with multiple satellite nodules. A detailed physical examination and radiologic workup failed to reveal a primary tumor elsewhere. A right partial hepatectomy was performed with a preoperative differential diagnosis of angiosarcoma versus hepatocellular carcinoma. The morphologic, immunophenotypic, and cytogenetic findings (t(X;18)(p11.2;icq11.2)) were consistent with a monophasic synovial sarcoma. Postoperative clinical evaluation of the extremities and a positron emission tomographic scan performed 4 weeks after surgery showed no evidence of recurrent or metastatic disease. The patient was started on an aggressive 4-drug chemotherapy regimen, but died 3 months thereafter from widespread metastatic disease. No autopsy was performed. The prese...

Radiological Findings of Giant Pulmonary Chondromatous Hamartoma: Case Report

Among lung tumors, multiple hamartomas are uncommon and multiple chondromatous hamartomas are extremely rare. In this report, we describe a patient with an interval growth of a giant chondromatous hamartoma with accompanying multiple satellite nodules in the adjacent lung and the parietal pleura. We also present the follow up chest radiograph, computed tomograph, magnetic resonance images and photographs of the operating field of the tumor with pathologic correlation.

Multiple enhancing lesions detected on dynamic helical computed tomography-mammography.

To review pathologic diagnoses of multiple enhancing lesions in a unilateral breast detected on dynamic helical computed tomography (CT)-mammography and to correlate imaging findings with pathologic results. From May 1998 to July 2001, preoperative contrast-enhanced helical CT scanning of the breast was performed in 200 female patients clinically diagnosed with breast cancer. The patients were scanned in the prone position in a specially designed CT-compatible device, with rapid intravenous bolus injection of 100 mL contrast material. Three-dimensional maximum intensity projection images were reconstructed. The cases with multiple enhancing lesions in a unilateral breast were retrospectively reviewed. The maximum diameter of the largest stain in each breast was measured, the patterns of multiple enhancing lesions were classified, and imaging findings were correlated with surgical and pathologic outcomes. Twenty-five of 200 (12.5%) patients (age range: 39-86 years, mean age: 56 years) showed multiple stains on CT-mammography. Two patients showed multiple stains in bilateral breasts. The maximum diameter of the largest stain in each breast ranged from 5 to 55 mm (average: 22 mm). Among cases with multiple stains, 21 (78%) were shown to be invasive ductal carcinoma with multiple satellite cancer nodules. Four cases were ductal carcinoma in situ with multiple satellite nodules. One case revealed multiple fibroadenomas, and another showed intraductal papilloma. Multiple enhancing lesions on CT-mammography in patients with breast cancer were relatively common, and most of them represented multiple cancer lesions. Dynamic CT-mammography is potentially useful in evaluating the spread of breast cancer.

Seudotumor inflamatorio multifocal del pulmón con buena respuesta a corticoides

A 75-year-old woman was admitted to our hospital with persistent fever, productive cough and systemic symptoms of two months' duration. A chest film showed bilateral infiltration in the form of subpleural plaques with multiple satellite nodules in both lung fields. The biopsy specimens taken by thoracoscopy were compatible with inflammatory pulmonary pseudotumor. Lung resection was ruled out because the lesions were bilateral and corticosteroid treatment was instated. The clinical and radiologic response was excellent and the patient was asymptomatic after 30 months of low-dose corticoid therapy.

Solitary mass in the lungs of coal miners.

Coal miners with at least 15 years of dust exposure may have a solitary density caused by progressive massive fibrosis (PMF), even when there is little or no nodularity elsewhere in the lungs. The mass may closely resemble a carcinoma, but the correct diagnosis can be made if the typical roentgen features of PMF are present. The characteristic findings are as follows:1. The lateral border of the mass is flat, often elongated, and parallels the rib cage.2. The mass is thin in the lateral or oblique projection and is more radiolucent in the frontal projection than a spherical lesion.3. Characteristic calcifications are present.4. There are multiple satellite nodules near the mass.Previous roentgenograms are most helpful and may be virtually diagnostic, if there is evidence that the mass developed by the coalescence of nodules, if the mass decreased in size, if its margin became more sharply defined or if the mass migrated medially.Careful evaluation of the lung mass according to the above criteria will help...

Simultaneous Haemorrhage and Perforation of Meckel's Diverticulum

Iris metastases secondary to primary malignancy are rare and usually have poor overall survival. We report a case of a man aged 60 years who presented with chief complaints of progressive pain and redness of right eye of 5 days duration. Slit-lamp examination revealed a greyish white irregular nodular mass, arising from anterior iris surface reaching up to mid-periphery. With a clinical suspicion of iris metastasis, systemic investigations were requested. CT scan of chest reported a well-defined lobulated lesion in the lower lobe of lung with presence of multiple satellite nodules in both lungs suggestive of primary malignant neoplasm of lung. Tissue diagnosis was obtained through an iris lesion biopsy, which was opted for relative ease of approach. Histopathology and immunohistochemistry confirmed the diagnosis of iris metastasis secondary to non-keratinising squamous cell carcinoma of lung. Local intravitreal injection of antivascular endothelial growth factor was administered for tumour regression along with systemic chemotherapy.