Soft Tissue Nodules Research Articles

Gastrointestinal Stromal Tumor at Ampulla of Vater Presented With Upper Gastrointestinal Bleeding

Gastrointestinal stromal tumors (GISTs) is a mesenchymal tumor accounted for only one percent of primary GI cancer. An estimated 4,000 to 6,000 new cases of GISTs are diagnosed annually in the United States. Common locations of tumor are stomach and small intestine. GISTs at ampulla of Vater is extremely rare of only 12 cases per literature review. We presented the rare case of GISTs at ampulla of Vater presented with upper gastrointestinal bleeding. Sixty five years old female with history of diverticulitis status post laparoscopic sigmoidectomy, and gastroparesis presented with melena for 2 weeks. Upper endoscopy showed submucosal mass at the Ampulla of Vater (Figure 1). Biopsy showed normal duodenum. CT abdomen showed common bile duct dilation and 1 cm soft tissue nodule with peripheral enhancement within the third portion of duodenum. Endoscopic ultrasound confirmed submucosal mass (Figure 2), but the fine needle biopsy was complicated with bleeding, and the biopsy showed normal duodenum. ERCP with stent was placed in common bile duct to relieve the obstruction (Figure 3). MRI abdomen showed enhancing 1.7 x 1.5 cm mass within the periampullary region. She was referred to surgery. Open pancreatic sleeve duodenectomy was perfomed. Pathology revealed 2.3 cm GISTs with free margin and positive for CD 117, CD 34 and smooth muscle actin, negative for S100. No mitosis per fifty high power fields reported. No adjuvant chemotherapy is indicated. Melena is a common presentation of GISTs. However, diagnosis can be difficult because it is a submucosal mass which causes obtaining biopsy problematic. This patient was proved to have GISTs by expression of CD 117 which differentiate GISTs from leiomyoma and leiomyosarcoma. From previous reports, ulcerative lesion is concomitant findings in several cases but not presented in our case. Although GISTs at ampulla of Vater are rare, GISTs should be included in the differential diagnosis especially if the mass has an enhancement per CT scan which is characteristic of GISTs. Overall, prognosis is less favorable for small intestinal GISTs. Literatures reviews show that GISTs at Ampulla of Vater has fair prognosis. Almost all of them has no metastasis or lymph node involvement. Only one case had liver metastasis and died from hepatic failure.Figure: Upper endoscopy showed mass at ampulla of Vater.Figure: Endoscopic ultrasound confirmed submucosal mass.Figure: Side view from ERCP with stent.

Predictors of conversion to thoracotomy during video-assisted thoracoscopic surgery lobectomy in lung cancer: additional predictive value of FDG-PET/CT in a tuberculosis endemic region.

To evaluate the added clinical value of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scans to chest CT imaging in predicting the conversion to thoracotomy during video-assisted thoracoscopic surgery (VATS) lobectomy in patients with lung cancer. This is a retrospective study of 235 consecutive patients who underwent planned VATS lobectomy for primary lung cancer between 2011 and 2015. CT images were interpreted in terms of the presence and the attenuation of peribronchial lymph nodes (PLN) and peribronchial cuffs of soft (PCS) tissue, pleural calcification, and parenchymal calcified nodule. On FDG PET/CT images, anthracofibrotic lymph node was considered present when high FDG uptake (SUVmax >3.5) was observed on PET/CT images corresponded to PLN or PCS on chest CT. Among the 235 patients undergoing attempted VATS lobectomy, 55 (23.4%) underwent conversion to thoracotomy. Multivariate logistic regression analysis revealed that the attenuation of PLN or PCS on chest CT (OR, 2.57; 95% CI, 1.328-4.380, 0.005) was an only independent predictor of conversion. The ROC curve showed that combined FDG PET/CT and chest CT reading [areas under curve (AUC), 0.847 (95% CI, 0.795-0.891)] was significantly better than that of chest CT scans alone [AUC, 0.655 (95% CI, 0.50-0.751)] in predicting conversion (P=0.024). The addition of FDG PET/CT scanning to chest CT imaging provides better performance for predicting conversion to thoracotomy during VATS lobectomy in lung cancer patients. Therefore, in lung cancer patients undergoing surgical resection, FDG PET/CT can provide additional reliable information in selecting the appropriate surgical approach for a lobectomy.

Anaplastic carcinoma of thyroid gland with widespread soft tissue metastasis: an unusual presentation

Anaplastic thyroid cancer is the rarest tumour of the thyroid gland, representing only 2% of clinically recognised thyroid cancers. The most common metastatic sites are lungs, followed by the intrathoracic...

Application of magnetic resonance imaging in pigmented villonodular synovitis of knee joint

Objective To investigate MRI features and its clinical value in the pigmented nodular synovitis (PVNS) of the knee joint in order to improve the accuracy of diagnosis of the disease. Methods MRI signs of 9 cases with PVNS of knee joint confirmed by operation and pathology were analyzed retrospectively. Results In 9 patients, joint effusion and marginal bone erosion were found. Diffuse thickening of the synovial membrane, multiple soft tissue nodules showed hypointense on T1WI and mixed hypointense and hyperointense on T2WI, were revealed on MRI. Conclusion MRI features of PVNS of the knee joint are characteristic, which reflects the pathological basis and helps to improve the diagnostic accuracy of the disease. Key words: Synovitis; Knee joint; Magnetic resonance imaging

Adult Dominant Polycystic Kidney Disease (ADPKD)

Autosomal-dominant polycystic kidney disease (ADPKD) is the most common inherited renal cystic disease affecting up to 10% of patients requiring some form of renal replacement therapy such as hemodialysis or kidney transplant. An association between autosomal-dominant polycystic kidney disease (ADPKD) and renal cell carcinoma (RCC) has been suspected since the 1930s. Many cases of RCC in ADPKD patients have been observed and published in the meantime. The gene mutations responsible for ADPKD have been discovered in the 1990s, however a direct genetic link to RCC has not been discovered so far, and the debate about an association between these two diseases is still controversial and ongoing. Many clinical experts who have published about this issue suspect a genetic link and state that ADPKD patients are much more prone to develop RCC than patients with end-stage renal disease (ESRD) of other causes. Currently there are no clear clinical guidelines regarding early nephrectomy in ADPKD patients with growing soft tissue nodules within their native kidneys. This commentary/ review on this important clinical issue describes the experience with these patients in one institution and gives an overview of the literature.

P2.04-038 Primary Pulmonary Meningioma: Rare Tumor with Malignant Potential: Topic: Esophageal Cancer and Other Malignancies

Primary Pulmonary Meningioma (PPM) is a very rare tumor with approximately 40 cases described in previous medical literature. Although majority of the cases documented previously are benign, there were 3 cases that showed malignant characteristics. We report a case of PPM with atypical features. A 65-year-old lady, non-smoker, had an incidental finding of 1.9 × 1.6cm nodule in the right middle lobe on routine chest x-ray. The computed tomography (CT) of the thorax demonstrated a well-defined, homogeneous soft tissue nodule measuring 1.5 × 1.5 cm in the lateral segment of the right middle lobe. CT-guided biopsy did not show features of malignancy. Hence, the patient was managed conservatively with surveillance CT scans. Four years later, repeat CT thorax revealed enlargement of the tumor size to 3.1 × 2.2 cm, with increased lobulations. The patient underwent completely portal robotic middle lobectomy and mediastinal lymph node dissection. The patient made an uneventful recovery and was discharged on post-operative day 3. Histological examination revealed a 3.8 cm solid, circumscribed, whitish, homogeneous nodule that abuts the pleural surface. Microscopically, the tumor comprised of bland spindle cells arranged in fascicles and occasional whorls. The cells had round to ovoid nuclei and moderate amounts of eosinophilic fibrillary cytoplasm. Up to 7 mitotic figures per 10 high power fields were identified. Stromal hyalinization, ectatic blood vessels and focal necrosis were seen in some area. The tumor cells were diffusely positive for vimentin and S-100, focally positive for cytokeratin AE1/3, synaptophysin and EMA, and negative for chromogranin. Overall, histology of the specimen demonstrated characteristic patterns of meningiomas with atypical features. The lymph nodes sampled were negative for malignancy. There were no intra-cranial or spinal lesions. There was no tumor recurrence at the 1-yr follow-up. PPM is a rare tumor which requires timely surgical resection for diagnosis and treatment. Untreated benign behaving lesions have the potential to become aggressive and demonstrate atypical features.

Abdominal wall endometriosis: differentiation from other masses using CT features.

To assess the utility of morphologic and quantitative CT features in differentiating abdominal wall endometriosis (AWE) from other masses of the abdominal wall. Retrospective IRB-approved study of 105 consecutive women from two institutions who underwent CT and biopsy/resection of abdominal wall masses. CTs were independently reviewed by two radiologists blinded to final histopathologic diagnoses. Associations between CT features and pathology were tested using Fisher's Exact Test. Sensitivity, specificity, positive, and negative predictive values were calculated. P values were adjusted for multiple variable testing. 24.8% (26/105) of patients had histologically proven abdominal wall endometriosis. The other most common diagnoses included adenocarcinoma NOS (21%; 22/105), desmoid (14.3%; 15/105), and leiomyosarcoma (8.6%; 9/105). CT features significantly associated with endometriosis for both readers were location below the umbilicus (P=0.0188), homogeneous density (P=0.0188), and presence of linear infiltration irradiating peripherally from a central soft tissue nodule (i.e., "gorgon" sign) (P<0.0001). The highest combined sensitivity (0.69, 95% CI: 0.48-0.86) and specificity (0.97, 95% CI: 0.91-1.00) for both readers occurred for patients having all three of these features present. Border type (P=0.0199) was only significant for R2, peritoneal extension (P=0.0188) was only significantly for R1, and the remainder of features were insignificant (P=0.06-60). There was overlap in Hounsfieldunits on non-contrast CT (N=26) between AWE (median: 45HU, range: 39-54) and other abdominal wall masses (median: 38.5HU, range: 15-58). CT features are helpful in differentiating AWE from other abdominal wall soft tissue masses. Such differentiation may assist decisions regarding possible biopsy and treatment planning.

Rectovaginal Splenosis: An Unexpected Cause of Dyspareunia Approached by Laparoscopy

Study ObjectiveTo demonstrate the technique of laparoscopic approach in a rare case of rectovaginal splenosis with severe dyspareunia and dyschesia. DesignA step-by-step explanation of the patient's condition, diagnosis, surgical technique, and postoperative results (Canadian Task Force classification II-3). SettingSplenosis consists of ectopic functioning splenic tissue that can be located anywhere within the abdomen or pelvis. Fragments are often multiple and range in diameter from a few millimeters to a few centimeters. They are reddish-blue and are sessile or pedunculated. Their appearance can mimic that of neoplasms or endometriosis, which are the main differential diagnoses. Trauma and subsequent splenectomy is the cause in most cases. Splenosis is a benign condition usually found incidentally and is usually asymptomatic. The need for therapy is controversial, and treatment is suggested only in symptomatic cases, primarily those related to pelvic or abdominal lesions, as in our patient. The diagnosis of splenosis in a woman complaining of pelvic pain may present diagnostic difficulties. The splenic tissue has the macroscopic appearance of endometriosis, and its position in the pelvis also may suggest this diagnosis. Where excision of splenosis is considered necessary, the approach should be laparoscopic, unless this is considered too risky owing to the proximity of vital structures. InterventionA 40-year-old woman was referred to our department for severe dyspareunia and dyschezia. The gynecologic examination revealed a painfull nodularity on the posterior vaginal cul de sac. Further evaluation with 2- and 3-dimensional ultrasound and magnetic resonance imaging revealed several soft tissue nodules in the pouch of Douglas (POD), which were enhanced on contrast administration. She had undergone a splenectomy 15 years earlier after a car accident. A laparoscopic approach to a rectovaginal nodularity was performed. Under general anesthesia, the patient was placed in the dorsal decubitus position with her arms alongside her body and her legs in abduction. Pneumoperitoneum was achieved using a Veres needle placed at the umbilicus. Four trocars were placed: a 10-mm trocar at the umbilicus for the 0-degree laparoscope; a 5-mm trocar at the right anterosuperior iliac spine; a 5-mm trocar in the midline between the umbilicus and the pubic symphysis, approximately 8 to 10 cm inferior to the umbilical trocar; and a 5-mm trocar at the left anterosuperior iliac spine. The entire pelvis was inspected for endometriotic lesions. In the pelvis, hypervascular and bluish nodules were visible with extension from the POD into the deep rectovaginal space. The macroscopic appearance was atypical for endometriotic implants. The nodularities were carefully dissected and excised, and histological assessment revealed splenic tissue. At the time of this report, the patient had been asymptomatic for 6 months after surgery. ConclusionRectovaginal splenosis may mimic endometriosis. The laparoscopic approach to rectovaginal splenosis avoids an abdominal incision, with its associated pain and possible adhesion formation. It also provides a better view for dissection. In this patient, the splenosis was removed by laparoscopy, with no postoperative dyspareunia or dyschesia.

Hiperplasia folicular linfoide subcutánea secundaria a vacunas: descripción de los hallazgos ecográficos y correlación clínico-patológica

In recent years, the use of vaccines has been standardized within vaccination programs. Adverse effects at the puncture site are usually mild and transient. Nevertheless, in some cases, persistence subcutaneous nodules can develop; these are often underdiagnosed because they are so rare and because of the long time that can transpire between the vaccination and their appearance. Histologically, they consist of a lymphoid follicular hyperplasia that occurs as a reaction to the aluminum particles usually used as an adjuvant in some vaccines. We were unable to find any reference in the radiological literature to these soft-tissue nodules secondary to vaccination. We report the characteristic ultrasound findings that will enable radiologists to identify or strongly suspect these lesions and thereby avoid unnecessary imaging tests that might lead to confusion and inadequate management of these patients.

Diuertic induced hyperuricemia presenting as malignant gout in a 19-year old male with moderate rheumatic mitral stenosis

Gout, an inflammatory arthritis, is caused by an accumulation of monosodium urate crystals in the joints and soft tissues when serum uric acid concentrations rise above the physiological saturation limit (≥ 6.4 mg/dL). Here, we report the case of a 19 year-old male who presented with gradually progressive, nontender swelling of multiple joints of the upper and lower limbs of eight months’ duration. He had been receiving frusemide 40 mg, spirinolactone 50 mg, metoprolol 50 mg, and erythromycin 250 mg twice daily for the previous 12 months on account of rheumatic mitral stenosis (moderate). Though a histological diagnosis of gout is the gold standard, in our case we diagnosed frusemide-induced secondary gout with malignant course. This was based on a combination of an imaging tool (radiology showing well defined, ‘punched-out’ erosions with overhanging edges), and clinical presentation (soft tissue nodules, i.e. tophi , calcification of tophi, and asymmetric involvement). Frusemide was stopped, allopurinol and other urate lowering agent were started which led to regression of his swelling.

Peripheral giant cell granuloma: a case repo

Peripheral giant cell granuloma (PGCG) is a common benign gingival lesion in the oral cavity of unknown origin, believed to be stimulated by local irritation or chronic trauma. It is also known as giant cell epulis, giant cell reparative granuloma, or giant-cell hyperplasia, presenting as purplish-red soft tissue nodule clinically and histologically consisting of multinucleated giant cells in a background of mononuclear stromal cells and extravasated red blood cells. This case report describes a 40 year old male previously reported with peripheral giant cell granuloma 2 years back which on excision reoccurred after 3-4 months and persistently growing since then. The gingival lesion between his maxillary central incisors was excised and the Biopsy specimen sent in 10% formalin to histopathological lab and was diagnosed as PGCG. There was good healing of tissue of the surgical site during the 9 months follow-up.

A Rare Cause of Progressive Paresthesias, Cramps, Fasciculations and Weakness in a Collegiate Volleyball Player

HISTORY: A 21 year old female collegiate volleyball player presented with exertional paresthesias involving her cheeks, lips and chest. Her symptoms evolved to include twitching, stiffness and cramping of the thighs and calves, which forced discontinuation of participation in volleyball. She went on to develop upper extremity cramping and abnormal posturing of her hands, even at rest. She noticed symmetric hypertrophy of her calves and quadriceps muscles and increased sweating and salivation. Her cramping and leg stiffness worsened to the point that she needed aid of a walker for ambulation. PHYSICAL EXAMINATION: General medical exam was unremarkable. Her quadriceps and calves seemed abnormally muscular for body habitus. Movements of the upper and lower limbs were slow and stiff with visible cramping of calf and quadriceps muscles with activation. Neurological exam showed diminished reflexes. Strength testing was difficult due to non-painful muscle cramps with isolated testing of muscles. Sensation was normal. DIFFERENTIAL DIAGNOSIS: 1) Myotonia (DM1, DM2)/ Neuromyotonia 2) Diffuse Myopathy 3) Multiple Sclerosis 4) Peripheral Neuropathy TEST AND RESULTS: MRI brain and cervical spine: - No evidence of demyelination, inflammation, or infarction EMG: - Nearly persistent motor unit activity in upper and lower limb muscles with spontaneous, iterative, high frequency discharges consistent with neuromyotonia Laboratory Testing: - Blood tests for hereditary and acquired causes of myotonia/neuromyotonia were inconclusive PET Scan/MRI: - Showed focal, hypermetabolic activity in the thymus with two peripherally enhancing soft tissue nodules FINAL WORKING DIAGNOSIS: Hodgkin’s Lymphoma with presentation of paraneoplastic neuromyotonia (Isaac’s Syndrome) TREATMENT AND OUTCOMES: 1. Intravenous immunoglobulin was poorly tolerated with no clear benefit. 2. Gabapentin and mexiletine were started as membrane stabilizing agents with significant improvement in symptoms. 3. With imaging findings concerning for neoplasm, anterior mediastinal mass resection with total thymectomy was performed. 4. Surgical pathology showed interfollicular Hodgkin’s lymphoma with no abnormality in the thymus. 5. The patient recovered well from surgery, reports 80% improvement in symptoms and is exercising consistently

MP19-06 PREOPERATIVE RADIOLOGIC ASSESSMENT FOR PERINEPHRIC FAT INVASION (T3A): COMPARISON WITH PATHOLOGICAL STAGING

You have accessJournal of UrologyImaging/Radiology: Uroradiology III1 Apr 2016MP19-06 PREOPERATIVE RADIOLOGIC ASSESSMENT FOR PERINEPHRIC FAT INVASION (T3A): COMPARISON WITH PATHOLOGICAL STAGING Zhamshid Okhunov, Jae Young Park, Chenhui Zhao, Molly Baker, Mohammad Helmy, Chandana Lall, Mari Bozoghlanian, and Jaime Landman Zhamshid OkhunovZhamshid Okhunov More articles by this author , Jae Young ParkJae Young Park More articles by this author , Chenhui ZhaoChenhui Zhao More articles by this author , Molly BakerMolly Baker More articles by this author , Mohammad HelmyMohammad Helmy More articles by this author , Chandana LallChandana Lall More articles by this author , Mari BozoghlanianMari Bozoghlanian More articles by this author , and Jaime LandmanJaime Landman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2754AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We assessed the accuracy of computed tomography (CT) in diagnosing perinephric fat invasion (PNFI) in patients with renal cell carcinoma (RCC). METHODS We retrospectively reviewed preoperative CTs of patients who underwent extirpative surgery for pT1 - pT3a RCC. CT criteria used to assess PNFI were PN soft-tissue stranding (PNSTS), peritumoral vascularity (PTV), increased density of the PNF, tumor margins (TM), and presence of contrast-enhancing soft-tissue nodules in the PN space. PNSTS was defined as linear areas of soft tissue attenuation, corresponding to the bridging septa of the PN space. PTV was defined as asymmetrically enlarged, irregular vessels adjacent to the neoplasm, within the PN space. The CT density of the PNF was measured by placing a circular region of interest, as large as possible within the perirenal space, juxtaposed to the RCC. The CT density of the PNF of the normal contralateral kidney, measured at the area of the lower pole, was used as the standard of reference. A sharply demarcated tumor was characterized as confined within the kidney while ill-defined TM was suggestive of neoplastic invasion of the PNF. The final histopathology was used as the standard of reference. We analyzed the sensitivity and specificity stratified by tumor size (≤4cm, >4 - ≤7cm, >7 - ≤10cm, and >10cm). RESULTS A total of 161 patients were included. Table 1 demonstrates sensitivity and specificity of all assessed variables in predicting PNFI on CT. In logistic regression analysis, PNSTS, increased PTV, ill-defined TM and an enhancing nodule in the perinephric fat were significant predictors of PNFI. In multivariate analysis, PNSTS was the only significant factor for PNFI (table 2). CONCLUSIONS CT imaging does not reliably predict PNFI. However, for tumors >7cm, the absence of PNSTS excludes PNFI. Furthermore, absence of PTV reliably excludes PNFI among tumors from 4 to 10 cm. For tumors < 4cm, a well-defined tumor margin also excludes PNFI. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e205-e206 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Zhamshid Okhunov More articles by this author Jae Young Park More articles by this author Chenhui Zhao More articles by this author Molly Baker More articles by this author Mohammad Helmy More articles by this author Chandana Lall More articles by this author Mari Bozoghlanian More articles by this author Jaime Landman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Peritoneal sarcoidosis: an unusual presentation and a brief review of the literature

Peritoneal involvement continues to be a rare manifestation of sarcoidosis: its involvement is not always isolated and sarcoid granulomas are also found elsewhere. Peritoneal diseases tend to have an increased incidence in women. Peritoneal involvement presents as ascites, as peritoneal thickening and multiple soft tissue nodules, and can often simulate peritoneal carcinomatosis. We describe a case of a man presenting abdominal pain, nausea, vomiting and a clinical picture of intestinal obstruction, with peritoneal sarcoidosis and abdominal findings suggesting peritoneal carcinomatosis. The diagnosis of sarcoidosis was confirmed by biopsy of the peritoneum during surgical laparotomy. Peritoneal involvement is a rare manifestation of sarcoidosis (less than 30 cases described in English medical literature): to our knowledge this is the first reported case of the disease presenting with an acute abdominal obstruction treated with surgery.

The Natural History of Soft Tissue Hypertrophy, Bony Hypertrophy, and Nodule Formation in Patients With Untreated Head and Neck Capillary Malformations.

A percentage of patients with capillary malformation (CM) develop soft tissue hypertrophy, bony hypertrophy, and/or nodule formation. To determine the incidence, age of onset, anatomic distribution of soft tissue/bony hypertrophy, and nodule formation in patients with untreated CM. A retrospective medical records review of head and neck CM patients presenting to a tertiary referral center over a 7-year period (2004-2011) was performed. Of the 160 patients with CM, 96 demonstrated progression of disease to include either soft tissue/bony hypertrophy or nodule formation. Of these, 87 patients had not received previous treatment and met the inclusion criteria for analysis. On average, soft tissue hypertrophy began at 9 years of age. The V2/maxillary segment was most commonly involved with upper lip hypertrophy being the most prominent. Fourteen percent of the patients also presented with bony hypertrophy, which began at an average age of 15 years. Nodules were present in 38/87 (44%) of patients with an average age of onset of 22 years. This study demonstrates the nature progression of CM and quantifies the clinical characteristics of hypertrophy and nodule formation with untreated head and neck CM. Early and continuous treatment is recommended in hopes of preventing CM progression.

Dermatofibrosarcoma Protuberans: Computed Tomography and Magnetic Resonance Imaging Findings.

The aim of this study was to analyze the computed tomography (CT) and magnetic resonance imaging (MRI) findings of dermatofibrosarcoma protuberans (DFSP), with a view to improving the diagnosis of this kind of tumor.A total of 27 cases of histopathologically confirmed DFSP were analyzed retrospectively. Of these, 18 patients underwent a CT scan and 9 patients underwent an MRI. All patients underwent unenhanced and contrast-enhanced examinations; 1 patient underwent multiphrase CT enhancement examination. Imaging characteristics, including location, shape, size, number, edge, and attenuation or intensity of each lesion, both unenhanced and contrast enhanced, were analyzed.Of the 27 cases, 24 were solitary, 2 had 2 nodules, and 1 had multiple confluent tumors. The lesion with multiple confluent tumors was ill defined and irregular; the other lesions were oval or round, well-defined nodules or masses. The unenhanced CT images showed 19 homogenous isodense lesions. There was no calcification in any of the patients. The contrast-enhanced CT images showed intermediate and marked nonhomogeneous enhancement in 13 lesions, intermediate homogeneous enhancement in 4 lesions, and a mild heterogeneous enhancement in 2 lesions. MR T1-weighted images revealed 1 ill-defined and 9 well-defined homogeneous isointense lesions. T2-weighted images showed homogeneous hyperintensity to the muscles in 6 lesions, 3 mild hyperintense lesions with hypointense lesions, and 1 mixed, mild hyperintense and isointense lesion. Contrast-enhanced T1-weighted images demonstrated intermediate and marked nonhomogeneous enhancement in 9 lesions and intermediate homogeneous enhancement in 1 lesion.DFSP is characterized by a subcutaneous well-defined soft tissue nodule or mass on plain CT/MR scans, and shows intermediate-to-marked enhancement on contrast-enhanced CT/MR scans. The imaging findings for DFSP are nonspecific, but may help to define the diagnosis in an appropriate clinical setting.

Incidental Mammary Fibromyoblastoma on 82Rb Myocardial Perfusion Imaging

82Rb is frequently used in PET myocardial perfusion imaging to detect ischemia. We present the case of a 64-year-old man referred for PET myocardial perfusion imaging to rule out ischemia. On PET images, an abnormal focus of uptake was present in the subcutaneous soft tissue overlying the right chest, which corresponded to a soft-tissue nodule on CT. This lesion was biopsied and proved to be a mammary fibromyoblastoma, an extremely rare and benign lesion. This case is presented to emphasize the importance of reviewing extracardiac structures on PET/CT myocardial perfusion studies.

Exophytic renal angiomyolipoma and perirenal liposarcoma: revisiting the role of CT for differential diagnosis.

Exophytic renal angiomyolipoma and liposarcoma are two representative tumors in the retroperitoneum with fatty components that have potential to be misdiagnosed with each other. To compare the computed tomography (CT) findings of exophytic renal angiomyolipoma and perirenal liposarcoma. Fourteen and 16 cases with histologically-proven exophytic renal angiomyolipoma and perirenal liposarcoma, respectively, with preoperative CT from January 2000 to December 2013 were reviewed by two radiologists blinded to the clinical and pathological findings for an array of CT findings. These findings were compared between exophytic renal angiomyolipoma and perirenal liposarcoma using the Student t-test and Fisher's exact test. Patients with exophytic renal angiomyolipoma were younger (P = 0.001) without differences in sex (P = 1.000). Exophytic renal angiomyolipomas were smaller (P = 0.004) and more commonly showed the following findings: renal parenchymal defect (P < 0.001), multiple linear vessels (P = 0.026), aneurysmal dilatation of intratumoral vessels (P = 0.024), renal parenchymal vascular pedicle (P < 0.001), hemorrhage (P = 0.037), encapsulated margin (P = 0.001), and other intrarenal fatty lesions (P = 0.037). No significant difference was seen in laterality, renal hilar vascular pedicle, non-fatty soft tissue nodule, calcification, or kidney displacement (P = 0.236-1.000). Several CT findings were significantly different between exophytic renal angiomyolipoma and perirenal liposarcoma and may be helpful for differentiating between the two entities when confronting a fatty mass in the perirenal space.

Metastatic ameloblastoma to a cervical lymph node: a case report and review of literature

Case presentation A 54-year-old man, who 3 years prior had undergone successful surgical treatment of a left mandibular ameloblastoma, presented with a left submandibular swelling. Radiology confirmed a heterogenous solid nodule close to the previous mandibular resection site and the soft tissue nodule was resected. Histology revealed a lymph node containing a deposit of tumour with features typical of ameloblastoma. These included anastomosing strands of cells, peripheral palisading with reverse nuclear polarity and a dense fibrotic stroma. A further radical left neck dissection had 21 lymph nodes, none of which contained metastatic tumour. Discussion Ameloblastoma is a rare benign odontogenic tumour with locally aggressive behaviour and a high recurrence rate. Despite its benign histological appearance, ameloblastoma has the ability to metastasise, which occurs in less than 1% of cases. Most metastatic deposits are seen in the lung with few reported cases of lymph node metastases. Due to the rarity of cases, treatment of ameloblastoma with metastases to lymph nodes is controversial. Some recommend radical neck dissection, while others have proposed simple excision with close follow up in cases with a single node metastasis.

Mesenteric panniculitis: prevalence, clinicoradiological presentation and 5-year follow-up.

To determine prevalence, clinicoradiological characteristics and outcome of patients with mesenteric panniculitis (MP) in a large hospital-based population. Consecutive abdominal CT examinations of 3820 patients were evaluated for MP. Clinical characteristics, therapy and outcome of patients with MP were evaluated during a 5-year follow-up period. A matched pair analysis was performed to further investigate the relation between MP and malignancy. 94 (2.5%) patients with MP were identified (mean age, 66.6 ± 11.2 years, 70.2% male). MP coexisted with malignancy (especially prostatic carcinoma) in 48.9% of patients, and this was slightly but significantly higher than in age- and sex-matched control patients (n = 188, 46.3%). In 48 patients, MP was presumed to be idiopathic. The most frequent presenting symptom was pain (54.3%). Laboratory findings revealed increased acute-phase reactants in half of the patients with MP. CT findings included increased density of mesenterial fat (mean, -56.8 ± 10.8 HU), fat ring sign, tumoural pseudocapsule and small soft-tissue nodules. Patients with MP (14.6%) developed significantly more malignancies during a 5-year follow-up than did the control group (6.9%). One patient was treated with prednisone without satisfactory response. The prevalence of MP in this study was 2.5%. In most patients, radiologic features included increased mesenteric fat density, fat ring sign and small soft-tissue nodules. MP was associated with a significant higher prevalence of coexisting malignancies and a higher prevalence of future cancer development. A more accurate prevalence of MP on CT is demonstrated. An underlying malignancy may play a role.