Necrotic Neoplasm Research Articles

Clinicopathological Characteristics of Small Cell Carcinoma of the Ovary, Hypercalcemic Type – a case Series

Abstract Introduction/Objective Small cell carcinoma of the ovary hypercalcemic type (SCCOHT) is a rare (<0.01%) and aggressive ovarian tumor primarily affecting young women (median of approximately 24 years), characterized by rapid growth, early metastasis, and association with hypercalcemia in two-thirds of cases. The diagnosis of SCCOHT is challenging due to its rarity and lack of specific clinical symptoms or biomarkers. Our study aims to delineate the clinicopathologic characteristics of SCCOHT based on our case series and add to the existing knowledge. Methods/Case Report A retrospective review of University of Pennsylvania Health system pathology database was conducted from 2012 to 2024. Our study identified four patients diagnosed with SCCOHT. Clinical information and histopathologic characteristics were reviewed. Results (if a Case Study enter NA) Among the four patients identified, the median age was 24 years, with a median tumor size of 14.5 cm, and all patients presented with weight loss, abdomen bloating, and elevated CA125 levels. Notably, two patients exhibited hypercalcemia, while one initially presented with normal calcium levels but developed hypercalcemia during disease recurrence. One patient maintained normal calcium levels throughout. Surgical intervention involved bilateral salpingo-oophorectomy in all cases, with pathological staging revealing two patients at pT1a, one at pT1c, and one at pT3c. Histopathological analysis consistently revealed similar morphology, including solid and cystic necrotic neoplasms with diffuse growth or nests/cords of undifferentiated small cells, which displaying vesicular chromatin and prominent nucleoli. Immunohistochemical staining demonstrated loss of BRG1 (SMARCA4) expression in two patients and diffuse positivity for WT1 in all patietns, while negative for cytokeratin, germ cell markers, and melanocytic markers. Genetic test revealed SMARCA4 mutation (p.E 717*, c.3169-1G>A) in one patient. Conclusion Small cell carcinoma of the ovary, hypercalcemic type, presents a diagnostic and therapeutic challenge due to its rarity and aggressive nature. Adequate treatment options are currently limited, highlighting the critical need for further research and development of targeted therapies in SCCOHT. Testing for mutations in the SMARCA4 gene is essential for accurate diagnosis of SCCOHT and may uncover new avenues for treatment and management strategies.

A NOVEL THEORY OF NECROTIC NEOPLASM TREATMENT ON AYURVEDIC PRINCIPLES OF RASAYAN CHIKITSA.

Introduction: - Necrotic neoplasms, or necrotic cancer tumors, are observed in many cancer patients of different origins. The cause of this phenomenon is not fully understood by modern medicine, and there is no specific treatment available. In this context, we seek to explore the condition and potential treatment from an Ayurvedic perspective, particularly through Rasayana Chikitsa. Aim: -To postulate a theory for treating Necrotic Neoplasm according to the Ayurvedic principles of Rasayana Chikitsa. Methods: - As this is a critical study, material collection from various sources was done. Critical reading was done. Critical thinking with deductive reasoning was done. Upon discussion with peers, the conclusion was deducted.

RARE-40. CASE REPORT: LONG-TERM SURVIVOR OF A RARE, PEDIATRIC PRIMARY HISTIOCYTIC SARCOMA (HS) OF THE CENTRAL NERVOUS SYSTEM (CNS) FOLLOWING COMPLETE RESECTION, CHEMOTHERAPY AND ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANTATION (ALLO-HCT)

We report an unusual case of a patient with primary CNS-HS a very rare neoplasm of histiocytic lineage with usually poor prognosis. An 8 year old boy presented with a one month history of headaches, nausea and vomiting. Physical examination revealed nystagmus and dysmetria. Brain MRI revealed a localized 2.4 cm posterior fossa (cerebellar) mass with restricted diffusion. The patient underwent a gross total resection of the mass. Initial post-operative lumbar puncture was positive for rare malignant cells. Pathology showed a focally necrotic neoplasm, composed of nests and cords of large relatively uniform cells with abundant eosinophilic cytoplasm, moderately pleomorphic nuclei and numerous mitotic figures, consistent with CNS-HS with juvenile xanthogranuloma phenotype, as supported by positive IHC expression of CD163, CD68, CD14, fascin, and Factor XIIIa, while negative for CD1a, Lymphoid and Myeloid markers, and BRAFv600e mutation. He was treated with two cycles of clofarabine and cytarabine and triple intrathecal (IT) chemotherapy. He developed generalized seizures and MRI showed demyelination consistent with IT methotrexate toxicity; MTX was then discontinued. He was then given two additional cycles of cladribine and weekly intrathecal therapy prior to consolidation with an Allo-HCT using a 10/10 HLA allelic-matched unrelated donor. His conditioning regimen included total body irradiation and cyclophosphamide. He did well post-transplant with peripheral blood chimerism at 1 year showing > 95% donor cells. He remains disease-free with an excellent quality of life since August 2016. We report one of the few known survivors of this unusual and highly malignant entity.

S1801 Got It From My Mama: Case Report of Mesenteric Adenocarcinoma

INTRODUCTION: Mesenteric tumors are uncommon. They arise from peritoneum, lymphatic, fat, and connective tissue. Generally, consist of nonneoplastic or neoplastic tumors. We report a case of an unusual mesenteric adenocarcinoma. CASE DESCRIPTION/METHODS: A 83-year-old female presented for a routine surveillance colonoscopy. She had undergone right hemicolectomy (2015) for stage II colon cancer (T3N0M0). She had a strong family history of cancer: colon and pancreatic cancer ( mother), rectal cancer (brother) and lung cancer (sister). She had previously undergone TAH BSO (1999). She presented with vague epigastric discomfort and post prandial pain but had no nausea, vomiting or weight loss. CT scan revealed a focal mass with rim enhancement near the inferior aspect of the pancreatic body measuring 4 cm × 3.7 cm and wall thickening of the gastric antrum. On EGD 4 nonbleeding antral ulcers were seen. EUS demonstrated a 5.2 × 3.6 cm irregular mass near the pancreatic neck, heterogenous and cystic but separate from the pancreas. FNA positive for adenocarcinoma. On PET scan a centrally necrotic neoplasm of the right mid abdomen was identified. CEA and CA19-9 were not elevated, HGB and LFTs were normal. At the time of this abstract the patient was receiving neoadjuvant chemotherapy. DISCUSSION: Mesenteric tumors consist of peritoneal cysts, enteric cysts, mesenteric mesotheliomas, mesenteric lipodystrophy, lymphangiomas, desmoid tumors (associated with FAP & Gardner syndrome), mesenteric lymphoma, mesenteric Carcinoid tumors & metastatic tumors. Medical evaluation consists of clinical examination, imagery and histopathology. Therapeutic management vary from observation, medical therapy to surgery: (Dufray et al. 239).This case underscores the importance of a thorough post-operative surveillance in patients with colo-rectal cancer. Implementation of postoperative surveillance guideline recommendations will potentially aide with early detection of metachronous colorectal lesions and other primary neoplasm in other organ systems.

ZEBRAS HAVE HOOVES TOO: A CASE OF THE PROSPECTIVE DIAGNOSIS OF A SMARCA4-DEFICIENT THORACIC SARCOMA IN A COMMUNITY HOSPITAL SETTING VIA INTERDISCIPLINARY AND INTERINSTITUTIONAL COLLABORATION

SESSION TITLE: Disorders of the Mediastinum 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 pm - 02:15 pm INTRODUCTION: In 2015, Le Loarer and colleagues retrospectively investigated nineteen previously unclassified sarcomas and reported a new type of aggressive thoracic malignancy, a SMARCA4-deficient thoracic sarcoma (SMARCA4-DTS).[1] An additional 12 cases were described in 2017 by Yoshida et al, with similar clinical features, immunohistochemistry, and gene expression profiles.[2] SMARCA4-DTS are readily recognizable in clinical practice as poorly differentiated, bulky thoracic malignant tumors, in predominantly middle-aged male smokers, with undifferentiated rhomboid morphology and abundant mitotic figures. Median overall survival is 7– 24 months, with mortality often due to local progression and mediastinal compression.[1] CASE PRESENTATION: A 55-year-old male with a history of tobacco and IV drug abuse presented with a two months history of progressive dyspnea, 100 lb weight loss, and new onset atrial fibrillation. Mediastinal and hilar masses were identified on CT, with encasement of broncho-vascular structures and mass effect on the SVC and aortic arch. Preliminary pathology reported a poorly differentiated necrotic neoplasm suggestive of carcinoma with neuroendocrine features. [Table 1] Considering the high level of suspicion for a SMARCA4 deficient tumor, no established standard of care, and rapidly deteriorating hemodynamic and respiratory status, the patient was not a chemotherapy candidate. Unfortunately, on the day of final pathology confirmation[Table 2], the patient had progressive respiratory failure and despite aggressive resuscitative measures continued to decline. Comfort measures were initiated on hospital day 16. DISCUSSION: Differential diagnosis of SMARCA4-DTS is wide and distinction from carcinomas can be difficult, as it requires extensive genomic profiling and immunohistochemical workup. In our case, the keys to the prospective diagnosis included 1) prior awareness of SMARCA4 deficiency, 2) an early high level of suspicion, 3) in-person collaboration between oncology and pathology services, and 4) established collaboration between our community medical center and an institution capable of extensive genetic testing. Per further literature review, CD34 is a useful, commonly available marker, as it is expressed in most SMARCA4-DTS but is not usually in lung carcinomas.[1,2] SMARCA4, SMARCA2 and SOX2 testing is important for confirmation of diagnosis. Imaging findings may also be helpful, as SMARCA4-DTS frequently arises in mediastinum and pleura, rather than in the lung. CONCLUSIONS: SMARCA4-DTS can be identified based on their unique presentation, distinctive rhabdoid morphology and immunohistochemistry. Awareness and prospective diagnosis of this rapidly progressive and rare malignancy, may provide opportunities for improved clinical management, prognostication, and identification of therapeutic or palliative options.Acknowledgement: Charles J. Nicely, MD. Dr. David Klimstra, MD. Reference #1: Le Loarer F, Watson S, Pierron G, et al. SMARCA4 inactivation defines a group of undifferentiated thoracic malignancies transcriptionally related to BAF-deficient sarcomas. Nat Genet 2015;47:1200-5. Reference #2: Yoshida A, Kobayashi E,Kubo T, et al. Clinicopathological and molecular characterization of SMARCA4-deficient thoracic sarcomas with comparison to potentially related entities. Mod Pathol 2017;30: 797-809. DISCLOSURES: No relevant relationships by Aliaksandr Ramaniuk, source=Web Response

Brain and Spinal Abscesses

Brain and spinal abscesses are focal infections of the central nervous system that are often associated with significant morbidity and mortality if not recognized early and managed in a timely manner. In patients with brain abscess, the clinical manifestations run the gamut from indolent to fulminant; most are related to the size and location of the space-occupying lesion within the brain and the virulence of the infecting organism. Untreated spinal epidural abscess usually progresses through four stages: backache and focal vertebral pain, nerve root pain, spinal cord dysfunction, and complete paralysis. Magnetic resonance imaging is the diagnostic neuroimaging procedure of choice in patients with brain and spinal abscesses; on diffusion-weighted images, restricted diffusion may be seen and may help distinguish abscesses from necrotic neoplasms. Aspiration of the abscess is important to facilitate microbiologic diagnosis; after aspiration and submission of specimens for special stains, histopathologic examination, and culture, empirical antimicrobial therapy should be initiated based on stains of the aspirated specimen and the probable pathogenesis of infection. Once the infecting pathogen is isolated, antimicrobial therapy can be modified for optimal treatment. Surgical therapy is often required for the optimal approach to patients with brain and spinal abscesses. This review contains 6 figures, 5 tables, and 72 references. Key words: antimicrobial therapy for central nervous system infections, brain abscess, epidural abscess, focal intracranial infections, head trauma, infections in immunocompromised hosts, spine infections, subdural empyema, toxoplasmosis

Brain and Spinal Abscesses

Brain and spinal abscesses are focal infections of the central nervous system that are often associated with significant morbidity and mortality if not recognized early and managed in a timely manner. In patients with brain abscess, the clinical manifestations run the gamut from indolent to fulminant; most are related to the size and location of the space-occupying lesion within the brain and the virulence of the infecting organism. Untreated spinal epidural abscess usually progresses through four stages: backache and focal vertebral pain, nerve root pain, spinal cord dysfunction, and complete paralysis. Magnetic resonance imaging is the diagnostic neuroimaging procedure of choice in patients with brain and spinal abscesses; on diffusion-weighted images, restricted diffusion may be seen and may help distinguish abscesses from necrotic neoplasms. Aspiration of the abscess is important to facilitate microbiologic diagnosis; after aspiration and submission of specimens for special stains, histopathologic examination, and culture, empirical antimicrobial therapy should be initiated based on stains of the aspirated specimen and the probable pathogenesis of infection. Once the infecting pathogen is isolated, antimicrobial therapy can be modified for optimal treatment. Surgical therapy is often required for the optimal approach to patients with brain and spinal abscesses. This review contains 6 figures, 5 tables, and 72 references. Key words: antimicrobial therapy for central nervous system infections, brain abscess, epidural abscess, focal intracranial infections, head trauma, infections in immunocompromised hosts, spine infections, subdural empyema, toxoplasmosis

Brain and Spinal Abscesses

Brain and spinal abscesses are focal infections of the central nervous system that are often associated with significant morbidity and mortality if not recognized early and managed in a timely manner. In patients with brain abscess, the clinical manifestations run the gamut from indolent to fulminant; most are related to the size and location of the space-occupying lesion within the brain and the virulence of the infecting organism. Untreated spinal epidural abscess usually progresses through four stages: backache and focal vertebral pain, nerve root pain, spinal cord dysfunction, and complete paralysis. Magnetic resonance imaging is the diagnostic neuroimaging procedure of choice in patients with brain and spinal abscesses; on diffusion-weighted images, restricted diffusion may be seen and may help distinguish abscesses from necrotic neoplasms. Aspiration of the abscess is important to facilitate microbiologic diagnosis; after aspiration and submission of specimens for special stains, histopathologic examination, and culture, empirical antimicrobial therapy should be initiated based on stains of the aspirated specimen and the probable pathogenesis of infection. Once the infecting pathogen is isolated, antimicrobial therapy can be modified for optimal treatment. Surgical therapy is often required for the optimal approach to patients with brain and spinal abscesses. This review contains 6 figures, 5 tables, and 72 references. Key words: antimicrobial therapy for central nervous system infections, brain abscess, epidural abscess, focal intracranial infections, head trauma, infections in immunocompromised hosts, spine infections, subdural empyema, toxoplasmosis

The role of diffusion-weighted MRI in the evaluation and differentiation of space-occupying brain lesions

Objectives: The aim of this study was to assess the role of diffusion-weighted MRI in the evaluation and differentiation of space-occupying brain lesions in patients whose conventional MRI (cMRI) examination revealed abnormal imaging features suggestive of space-occupying brain lesions. Diffusion-weighted imaging provides information about the physiological properties of the tumor that have been linked to cellularity, structural integrity, and necrotic transformation of brain or tumor tissue. MR diffusion imaging has become a powerful, multifaceted tool both for very basic clinical needs and for advanced, specialized diagnosis and treatment planning. Background: This study included 75 patients who presented with acute focal neurological deficit or with manifestations of space-occupying brain lesions. All of these patients were subjected to cMRI examination of the brain and to diffusion-weighted MRI. Postprocessing of apparent diffusion coefficient (ADC) maps was generated for all patients. Standard mean ADC values were calculated automatically and expressed in 10−S mm2/s. The cutoff value of 1 × 10−3 mm2/s was used to differentiate restricted areas from nonrestricted areas. Patients and methods: Among the 75 studied patients, the final diagnosis was intracranial neoplastic lesions (group A) in 46 patients (61.3%), non-neoplastic tumor-like lesions (group B) in 17 patients (22.6%), intracranial suppuration (group C) in seven patients (9.3%), and intracerebral hemorrhage (group D) in five patients (6.6%). Analysis of calculated ADC values using the t-test, the U-test, analysis of variance, and the c2-test revealed statistical difference of ADC values between high-grade/low-grade gliomas, abscesses, and intracranial necrotic neoplasms including glioblastoma multiforme, lymphoma/high-grade astrocytoma, medulloblastoma/ependymoma and pilocytic astrocytoma, and epidermoid/arachnoid cysts. Results On the basis of simplicity of the method and the results obtained, diffuse-weighted imaging should be used routinely as a valuable noninvasive tool besides cMRI, whenever available, to reach a definitive final diagnosis.

Diffusion-Weighted Magnetic Resonance Imaging and ADC Maps in the Diagnosis of Intracranial Cystic or Necrotic Lesions

This study evaluated the usefulness of diffusion-weighted (DW) magnetic resonance imaging (MRI) and ADC maps in the differential diagnosis of brain abscesses from cystic or necrotic neoplasms. MR images of 49 patients with 54 lesions were examined retrospectively. All patients underwent conventional MRI and DWI, and ADC values were calculated by placing ROIs of 30 mm(2) manually over the cystic part of the lesions. On DWI, all cystic portions of abscesses were hyperintense. Mean ADC values were 0.48×10 mm(2)/s (range 0.41-0.54×10 mm/s) for pyogenic abscesses, 0.73×10 mm(2)/s (range 0.65-0.91×10 mm/s) for mycotic abscesses and 0.6 mm(2)/s for Nocardia abscess. Cystic areas appeared hypointense on DWI in 33/44 tumours (mean value ADC 1.96 mm(2)/s). Eleven tumours (11/44) appeared hyperintense on DWI: eight metastases from lung cancer (mean ADC value 0.86 mm(2)/s, range 0.75-1.2 mm(2)/s), two GBMs (mean 0.7 mm(2)/s, range 0.67-0.76 mm(2)/s) and one anaplastic astrocytoma (ADC value 1.24 mm(2)/s). ADC values may help in differentiating pyogenic abscess from brain tumors or metastatic lesions.

Patterns of Contrast Enhancement in the Brain and Meninges

Contrast material enhancement for cross-sectional imaging has been used since the mid 1970s for computed tomography and the mid 1980s for magnetic resonance imaging. Knowledge of the patterns and mechanisms of contrast enhancement facilitate radiologic differential diagnosis. Brain and spinal cord enhancement is related to both intravascular and extravascular contrast material. Extraaxial enhancing lesions include primary neoplasms (meningioma), granulomatous disease (sarcoid), and metastases (which often manifest as mass lesions). Linear pachymeningeal (dura-arachnoid) enhancement occurs after surgery and with spontaneous intracranial hypotension. Leptomeningeal (pia-arachnoid) enhancement is present in meningitis and meningoencephalitis. Superficial gyral enhancement is seen after reperfusion in cerebral ischemia, during the healing phase of cerebral infarction, and with encephalitis. Nodular subcortical lesions are typical for hematogenous dissemination and may be neoplastic (metastases) or infectious (septic emboli). Deeper lesions may form rings or affect the ventricular margins. Ring enhancement that is smooth and thin is typical of an organizing abscess, whereas thick irregular rings suggest a necrotic neoplasm. Some low-grade neoplasms are "fluid-secreting," and they may form heterogeneously enhancing lesions with an incomplete ring sign as well as the classic "cyst-with-nodule" morphology. Demyelinating lesions, including both classic multiple sclerosis and tumefactive demyelination, may also create an open ring or incomplete ring sign. Thick and irregular periventricular enhancement is typical for primary central nervous system lymphoma. Thin enhancement of the ventricular margin occurs with infectious ependymitis. Understanding the classic patterns of lesion enhancement--and the radiologic-pathologic mechanisms that produce them--can improve image assessment and differential diagnosis.

Discrimination of capsular stage brain abscesses from necrotic or cystic neoplasms using diffusion-weighted magnetic resonance imaging

The authors' aim was to assess the ability of apparent diffusion coefficient (ADC) ratios in distinguishing brain abscesses from cystic or necrotic neoplasms. Fifty-three patients with rim-enhancing masses in the brain observed on T1-weighted MR images were included: 26 had abscesses (14 bacterial, six nonbacterial, and six of unknown origin), 11 had glioblastoma multiforme, and 16 had rim-enhancing metastasis. The ADC values, derived from diffusion-weighted imaging, were measured in the most homogeneous portion of the cystic component of the mass. The ADC ratios were calculated by dividing the ADC values from the nonenhancing cystic portion of the mass by the ADC values from contralateral normal-appearing white matter. Lesions were further differentiated based on presence, absence, or incompleteness of a T2 hypointensity rim. The mean (+/- standard deviation) ADC ratios were significantly higher in neoplasms than in abscesses (2.45 +/- 0.91 compared with 1.12 +/- 0:53, p < 0.01). The accuracy of ADC ratios in discriminating abscesses from neoplasms, determined by the area under the receiver operating characteristic curve (Az), was high: 0.91 +/- 0.04 (mean +/- standard error of the mean [SEM]). The threshold of 1.7 was associated with highest efficiency (87%) in discriminating abscesses from neoplasms. If only bacterial abscesses were analyzed compared with neoplasms, the Az increased to 0.96 +/- 0.03 (SEM). Using ADC ratios and T1 rim characteristics, 50 of 53 lesions were correctly classified (efficiency 94.3%). The accuracy of ADC ratios in discriminating brain abscesses from cystic or necrotic neoplasms is very high and can be further improved using T2 rim characteristics.

CARCINOSARCOMA OF THE PROSTATE WITH UROTHELIAL AND SQUAMOUS COMPONENTS

A 51-year-old male smoker presented with gross hematuria and obstructive voiding symptoms. Digital rectal examination was notable for a palpable abnormality of the prostate. Prostate specific antigen (PSA) level was 0.4 g/ml. Basic laboratory values, urinalysis, cytology and cystoscopic examination were within normal limits. Ultrasound guided prostate needle biopsy demonstrated sarcomatoid carcinoma with squamous and urothelial features in the epithelial component. Contrast enhanced magnetic resonance imaging of the pelvis revealed an enlarged prostate with central necrosis consistent with a necrotic neoplasm (fig. 1). Other imaging modalities showed no evidence of metastatic disease. Radical retropubic prostatectomy was attempted but the prostatic mass was found invading the bladder. Therefore, radical cystoprostatectomy with bilateral pelvic lymphadenectomy and ileal conduit diversion were performed. The resected prostate specimen had a grayish-white necrotic tumor located centrally measuring 4.2 cm in greatest dimension. The tumor extended out of the prostate at the base, involving the soft tissue around the seminal vesicles. Histological examination of the prostate demonstrated carcinosarcoma, including areas of urothelial carcinoma and squamous differentiation (fig. 2). No glandular component (ie adenocarcinoma) was identified in the serially sectioned and totally submitted specimen. The bladder specimen was normal on gross and microscopic examination, supporting a prostatic origin of the tumor. Postoperative course was uneventful and the patient was referred for counseling regarding adjuvant treatments.

Necrotic seminoma of the testis: establishing the diagnosis with Masson trichrome stain and immunostains.

○ We describe an infarcted mass in the testis containing ghost cells suspicious for neoplasm. The entire lesion was necrotic. A Masson trichrome stain greatly improved nuclear and cytologic detail, confirming the suspicion of neoplasm. Placental alkaline phosphatase revealed specific membrane staining of the neoplastic cells and established a diagnosis of seminoma. Masson trichrome plus selected immunostains offer a promising approach to the diagnosis of certain necrotic neoplasms.

Cerebral abscesses: investigation using apparent diffusion coefficient maps.

The combination of high signal and reduced apparent diffusion coefficients (ADC) within abscesses on diffusion-weighted MRI (DWI) has been reported as characteristic of abscesses, and useful for distinguishing them from cystic or necrotic neoplasms. To assess whether these are consistent findings in abscesses, we used DWI-derived ADC to investigate changes in water diffusibility in cerebral abscesses. We reviewed the MRI studies and clinical records of five patients with brain abscesses, who underwent DWI. Regions of interest were drawn within the abscesses on ADC maps, to obtain the ADC. The center of all five abscesses gave signal higher than that of white matter on DWI. The three largest also appeared bright on ADC maps, i. e., showed ADC substantially lower than those of normal white matter, consistent with restricted diffusion. However, the two smaller abscesses were not visible on ADC maps because their ADC were essentially the same as that of white matter; they did not show restricted diffusion. The absence of restricted diffusion within small abscesses may be related to intrinsic differences in molecular microenvironment between small and large abscesses, or to greater influence of volume averaging with surrounding edema on the ADC in smaller abscesses.

CT Appearance in Tuberculous Pancreatic Abscess

We report a case of a tuberculous pancreatic abscess in a 47-year-old human immunodeficiency virus positive intravenous drug abuser. She had a prolonged febrile course and persistent abdominal pain. On CT and sonography the lesion lacked the usual ancillary features of an abscess such as diffuse pancreatic enlargement and a peripancreatic fluid collection, and more closely resembled a necrotic neoplasm.

?False positive? immunoscintigraphic diagnosis of liver abscesses in a patient with a necrotic liver tumour

The following report describes the scintigraphic findings in a patient who underwent immunoscintigraphy with anti granulocyte Mab because of septic fever. Focal tracer accumulation in the liver corresponding with hypoechoic and hypodense areas documented by sonography and computed tomography was believed to represent liver abscesses, yet surgery and autopsy revealed a large necrotic cholangiocellular liver carcinoma. The possible mechanisms, which had led to the false positive immunoscintigraphic image are discussed and we conclude that a necrotic neoplasm has to be a major differential diagnosis in any case of positive liver uptake in an anti granulocyte scan.

Hepatic infarcts: new observations by CT and sonography.

Until recently hepatic infarcts were rarely diagnosed before autopsy and were nearly always fatal. Four cases of hepatic infarcts, three of them nonfatal, were diagnosed and followed by CT (three cases), sonography (two cases), arteriography (two cases), and sulfur colloid liver-spleen scan (one case). In three patients with multiple subsegmental hepatic infarcts, most of the lesions were round or oval and centrally located. Only a minority of the lesions were wedge-shaped and peripheral. The early lesion appears hypoechoic on sonography, and CT shows a poorly demarcated low-density region. Later, lesions become confluent with more distinct margins. Bile lakes are a late sequela of large infarcts. Gas formation within sterile infarcts is newly described in two cases. Hepatic infarcts have a variable appearance on CT and sonography and are not reliably distinguished from other lesions such as abscess or necrotic neoplasm.

The use of the absolute eosinophil count in the diagnosis of neoplasms; preliminary report.

SINCE differentiation of a necrotic neoplasm from an infectious process is often difficult, any diagnostic technics that might help should be welcome. The observation by previous workers1 , 2 of an increase in the number of white blood cells accompanied by a relative eosinophilia in patients with various neoplasms suggested that necrotizing tumors stimulate all elements of the leukocyte series, and not solely the neutrophils. If an absolute eosinophilia occurs with necrotizing tumors but not with simple infectious processes, the eosinophil count should prove to be a valuable test in differential diagnosis. This study was undertaken to determine the worth of that . . .