Pseudotumoral Lesions Research Articles

Malakoplakie rénale, urétérale bilatérale et vésicale : à propos d’un cas et revue de la littérature

Malakoplakia is an unusual chronic inflammation characterized macroscopically by pseudotumoral lesions and histologically by the presence of "Michaelis-Gutman" bodies in macrophages. It affects principally the urinary tract and is probably secondary to an unusual macrophagic reaction to recurrent urinary tract infections. If the bladder is the most frequent site of occurrence, the ureters can very rarely be affected resulting in urinary tract obstruction. We presented here a unique presentation of renal, bilateral ureteral and bladder malakoplakia.

Extra-articular inflammatory pseudotumor after well-fixed metal-polyethylene total hip arthroplasty

Objective To retrospectively analyze the diagnosis and treatment of the extra-articular inflammatory pseudotumor after well-fixed metal-polyethylene total hip arthroplasty (THA).Methods From March 2006 to June 2011,7 patients (7 hips) who presented with a progressive pain and/or swelling,discomfort in groin or upper thigh after metal-polyethylene THA were admitted to our hospital.There were 2 males and 5 females,with an average age of 48.8 years (range,32-65 years).All 7 patients were identified with a periprosthetic osteolysis at the acetabular and/or femoral components and a mass in the iliac fossa or the thigh; however,the components were all well-fixed.The masses were confirmed by CT scanning and/or ultrasound examination.The revision procedures were done through ilioinguinal approach and posterior-lateral approach,and the pseudotumors were excised and osteolytic lesions were debrided and packed tightly with morselized cancellous allograft.The liner and femoral head were also exchanged at the same time.Clinical and radiographic outcomes of revision THA were evaluated.Results All 7 patients were followed up for 3-42 months (average,30 months).At final follow-up,all hips were functioning well and the average Harris hip score was 92.4.All acetabular components remained radiographically well-fixed.All cavitary defects had complete radiographic incorporation of the bone grafts.There were no new pseudotumor or osteolytic lesions identified,and no revision of the components.Conclusion The presence of abdominal or pelvic pseudotumor in patient with a THA may be associated with polyethylene wear.Once the extra-articular pseudotumor and the periprosthetic osteolysis are identified,the surgical treatment,including pseudotumor excise,osteolytic lesion debride and bone defect grafting and bearing surface exchange,can achieve retention of well-fixed components. Key words: Arthroplasty, replacement, hip; Polyethylene; Granuloma, plasma cell

Liver Abscess and Pseudotumoral Gastric Lesion Caused by Chicken Bone Perforation: Laparoscopic Management

The accidental ingestion of a foreign body into the gastrointestinal tract is not uncommon, but the vast majority of foreign bodies pass through the gastrointestinal tract uneventfully within a week. Less than 1% of patients with foreign body ingestion develop complications such as perforation of the gastrointestinal tract. The migration of an ingested foreign body may result in chronic inflammation, a silent clinical course, and radiological features suggestive of a neoplasm. The authors report a case of chicken bone perforation of the gastric wall that leads to hepatic abscess formation and thereafter to submucosal pseudotumor of the gastric wall treated with totally laparoscopic management. Usefulness of endoscopic ultrasonography for a correct diagnosis is also stressed.

Ileal Vanek's Tumor Mimicking Cecal Carcinoma

Inflammatory fibroid polyps or Vanek's tumors are rare benign pseudotumoral lesions with morphological characteristics similar to those of submucosal mesenchymal tumors. They have been described in the gastrointestinal tract, most frequently in the gastric antrum. We present a case of ileal Vanek's tumor associated with a raised carcinoembryonic antigen level and with radiological and endoscopic features mimicking cecal carcinoma.

Pseudotumor of the Omentum Associated with Migration of the Ingested Crab-Leg

Foreign body ingestion is not uncommon in clinical practice, and it may occasionally lead to penetration injuries. Emergency physicians and radiologists sometimes fail to obtain complete histories including ingestion and may overlook the possibility of foreign body-induced complications. Herein, we report a case of stomach antrum perforation due to foreign body migration. We were unaware of the patient's history of eating the Korean delicacy "Kanjang-gaejang," which is raw crab seasoned with soy sauce. Several imaging diagnostic modalities had suggested the possibility of a malignant mass in the gastrocolic ligament area. During the operation, a crab leg was discovered as the cause of an intra-abdominal abscess. The patient underwent an antrectomy, a vagotomay, and a transverse colon wedge resection. We present this unusual case of a pseudotumorous lesion caused by ingestion of Kanjang-gaejang.

Diffuse pseudotumoral cerebral Schistosomiasis mansoni: a new form of presentation

AbstractWe describe two cases of cerebral schistosomiasis mansoni with multiple pseudotumoral lesions diagnosed by stereotactic brain biopsy. Both patients presented with seizures and one with left visual impairment. Imaging techniques revealed multiple brain lesions involving cerebral parenchyma, pons, cerebellum and thalamus. Brain histopathologic specimens of the patients showed multiple schistosomal granulomas in distinct evolutive phases. All patients presented good clinical response to treatment and reversion of the brain lesions. This new form of neuroschistosomiasis must be considered by those who work in the endemic area for Schistosoma mansoni.

Diagnostic accuracy and clinical utility of K-ras mutation analysis on FNA aspirates of pancreatic masses under EUS guidance

Introduction/Objectives: Cytological analysis on specimen obtained by Endoscopic Ultrasound-Fine NeedleAspiration (EUS-FNA) is known as the most accurate technique for the diagnosis of pancreatic adenocarcinoma. Nonetheless, differenzial diagnosis between adenocarcinoma and other pseudotumoral lesions (such as chronic pancreatitis) can be challenging. Almost all pancreatic adenocarcinomas show mutational activation of K-ras oncogene. Analysis of mutations of K-ras on aspirates provided by EUS-FNA could be a helpful method to distinguish neoplasia from benign lesions.

IgG4 Cholangiopathy.

IgG4 cholangiopathy can involve any level of the biliary tree which exhibits sclerosing cholangitis or pseudotumorous hilar lesions. Most cases are associated with autoimmune pancreatitis, an important diagnostic clue. Without autoimmune pancreatitis, however, the diagnosis of IgG4-cholangiopathy is challenging. Indeed such cases have been treated surgically. IgG4-cholangiopathy should be diagnosed based on serological examinations including serum IgG4 concentrations, radiological features, and histological evidence of IgG4+ plasma cell infiltration. Steroid therapy is very effective even at disease relapse. A Th2-dominant immune response or the activation of regulatory T cells seems to be involved in the underlying immune reaction. It is still unknown why IgG4 levels are specifically elevated in patients with this disease. IgG4 might be secondarily overexpressed by Th2 or regulatory cytokines given the lack of evidence that IgG4 is an autoantibody.

Classical Ehlers-Danlos syndrome: clinical, Histological and ultrastructural aspects

A 12-year-old boy with difficulty in wound healing and scars of unusual appearance was examined. Thin, shiny and protruding skin, characterizing pseudotumoral lesions, was observed on his knees and elbows. Loose joints and increased skin elasticity were also observed. Light microscopy showed rare collagen bundles and loosely dispersed collagen fibers. Irregularly distributed elastic tissue was observed, and transmission electron microscopy revealed disorganized collagen fibers. In cross sections under high magnifications, fibers of varying diameters could be seen, as well as an irregular fiber outline. Scanning electron microscopy of the dermis showed disorganized collagen fibers, which were rarely arranged in bundles. Isolated and crossed-over fibers were also found.

A Morphological Approach to the Diagnosis of Protozoal Infections of the Central Nervous System

Protozoal infections, though endemic to certain regions, can be seen all around the world, because of the increase in travel and migration. In addition, immunosuppression associated with various conditions, particularly with HIV infection, favors the occurrence of more severe manifestations and failure to respond to treatments. The CNS may be the only affected system; when not, it is often the most severely affected. Despite information obtained from clinical, laboratory, and imaging procedures that help to narrow the differential diagnosis of intracranial infections, there are cases that need confirmation with biopsy or autopsy. Predominant presentations are meningoencephalitis (trypanosomiasis), encephalopathy (cerebral malaria), or as single or multiple pseudotumoral enhancing lesions (toxoplasmosis, reactivated Chagas' disease). The immune reconstitution disease, resulting from enhancement of pathogen-specific immune responses after HAART, has altered the typical presentation of toxoplasmosis and microsporidiosis. In this paper, a morphological approach for the diagnosis of protozoal infections affecting the CNS (amoebiasis, cerebral malaria, toxoplasmosis, trypanosomiasis, and microsporidiosis) is presented.

Scaffolds Combined with Stem Cells and Growth Factors in Healing of Pseudotumoral Lesions of Bone

Reconstructions of large lesions or defects often require a bone graft or a bone substitute to promote healing. In common practice the reconstruction of a bone defect is dependent on the site and size of the lesion: in long bones intercalary defects may be managed with Ilizarov technique of bone transport and distraction osteogenesis or the use of a free or pedicled vascularized bone graft, or with Masquelet technique. For cavitary defects the available surgical options include autograft, allograft or xenograft or the use of synthetic scaffolds to promote bone regeneration. In order to promote a faster bone healing tissue engineering proposed the application of enriched graft to fill bone defects. The employment of enriched bone graft has been our choice in the last years to fill contained defects following curettage of a pseudotumoral lesion of bone. We report our clinical experience in terms of safety and success of these procedures at a long-term follow up.

Bilateral elastofibroma dorsi: A case report

Elastofibroma dorsi is a rare pseudotumoral lesion located in the periscapular region. Ultrasound can be used to evaluate its dimensions, margins, and internal structure. In the presence of bilateralism, diagnosis can be made on the basis of clinical and sonographic findings. The authors present a case of bilateral elastofibroma dorsi in which the clinical and ultrasound diagnosis was confirmed by magnetic resonance imaging.

Tumeurs cardiaques : aspects en scanner et en IRM

The CT and MR imaging features of the main cardiac tumors will be reviewed. Cross-sectional imaging features may help differentiate between cardiac tumors and pseudotumoral lesions and identify malignant features. Based on clinical features, imaging findings are helpful to further characterize the nature of the lesion. CT and MR imaging can demonstrate the relationship of the tumor with adjacent anatomical structures and are invaluable in the presurgical work-up and postsurgical follow-up.

Atypical Neurologic Complications in Patients with Primary Sjögren's Syndrome: Report of 4 Cases

Neurologic involvement occurs in approximately 25% of patients with primary Sjögren's syndrome. Manifestations are diverse and can affect the entire neuroaxis. Central nervous system dysfunction involves the brain as well as the spinal cord and may recur over time. Due to a variety of presentations, Sjögren's syndrome with neurologic involvement may be difficult to diagnose. We report 4 cases of patients with primary Sjögren's syndrome who presented with atypical neurologic manifestations. The first case describes a patient with a pseudotumoral lesion. The second patient was a 54-year-old woman suffering from a multiple mononeuropathy. The third case describes a 66-year-old man whose primary Sjögren's syndrome presented as progressive multiple sclerosis, and the fourth case reports a 57-year-old woman patient suffering from myelitis along with progressive cognitive disorders. Neurologic impairment in Sjögren's syndrome is probably underestimated and the diagnosis is often delayed. Primary Sjögren's syndrome should be suspected in patients presenting with atypical clinical and radiologic neurologic manifestations.

Total Hip Replacement pseudotumoral osteolysis

We report three cases of pseudotumoral lesion secondary to total hip replacement using metal on polyethylene bearings, presenting two distinct macroscopic aspects: (a) classic inflammatory granuloma and, in one case, (b) onset of hematoma associated with gluteal vessel lesions, probably affected by the pseudotumoral process. Diagnosis was radiographic, with CT-scan serving to confirm and, more importantly, to reveal extension and analyze surrounding tissue. Arteriography is needed when the lesion is liquid, and biopsy may be envisaged depending upon the clinical situation. In all three cases, histology was typically that of granulomatous lesions related to wear debris. Once diagnosis could be established, treatment was similar in both presentations, with surgical revision, which should be as early as possible in case of cortical bone involvement, to prevent pathologic fracture.

Bipolar Hypertrophic Herpes: An Unusual Presentation of Acyclovir-Resistant Herpes Simplex Type 2 in a HIV-Infected Patient

Hypertrophic pseudo tumoral herpetic lesion is an uncommon presentation in immunocompromized hosts that can be refractory to established therapies. We describe bipolar anal and tonsilar herpetic tumoral lesions related to acyclovir-resistant HSV-2 in a human immunodeficiency virus-infected patient. Treatment with valacyclovir, cidofovir, and thalidomide failed and surgical excision was required.

Using Endoscopic Ultrasound to Diagnose a Rare Lesion in the Spleen

Purpose: Introduction: Sclerosing angiomatoid nodular transformation (SANT) is a recently recognized pseudotumorous vascular lesion of the spleen with less than thirty cases reported in the literature. It commonly affects middle-aged adults and shows a 2:1 female predominance. Splenectomy is routinely performed on discovery of a splenic mass, and has been diagnostic and curative in all previously reported cases. We describe a case of SANT of the spleen confirmed by endoscopic ultrasound-guided fine needle aspiration. Case Report: An 82 year old otherwise healthy African American female was referred to the gastroenterology clinic with complaints of gradual onset of low-grade, dull, nonradiating, intermittent periumbilical and right upper abdominal pain for six months. Physical examination revealed minimal tenderness to palpation in the left and right upper quadrants. All of the laboratory values were within the normal range. A CT scan of the abdomen with contrast showed a homogeneous, hypodense 2.6 × 3.3 × 1.9 cm mass in the spleen that was not detected on imaging performed one year prior. The mass was well delineated and displaced the adjacent splenic parenchyma without invading it. Subsequently, endoscopic ultrasound (EUS)-guided fine needle aspiration of the lesion was performed without complication. Microscopically, there were multiple angiomatoid nodules composed of vascular slit-like spaces lined by plump endothelial cells with areas of collagen fibrosis and inflammation. The nodules displayed the immunohistochemically distinct type of vessels present in normal spleen. The findings were consistent with sclerosing angiomatoid nodular transformation (SANT) of the spleen. Discussion: Our case illustrates the presentation of a rare vascular splenic lesion. Despite its tumor-like radiographic appearance, SANT of the spleen is felt to be nonneoplastic and follows a benign clinical course. Splenic fine needle aspiration using EUS guidance is a safe and useful means to confirm the diagnosis of SANT, thus avoiding any unnecessary splenectomy. In follow-up at six months, our patient remains clinically stable and the lesion is unchanged on imaging.

0432: Ultrasound of Salivary Glands - Anatomy and Benign Conditions

Due to their superficial position the parotid, the submandibular and the sublingual glands can be imaged with high-resolution transducers. In acute inflammatory diseases sonography can differentiate between obstructive or non-obstructive sialoadenitis. Abscess formations may be detected and the maturation of the colliquation may be controlled. Abscesses may be punctured under US guidance. In Sjögren's Syndrome the sonographic changes correlate with the histological destruction, in acute forms hypervascularisation is found in color Doppler. In fibrotic cases the stimulation-induced hyperemia is impaired. In siaIoadenosis inflammatory and tumorous lesions can be ruled out by sonography. Tumors of the salivary glands can be visualized with high sensitivity. Like other imaging methods the specificity in assessment of the histology of a tumor is low. Multilocular lesions as sarcoidosis, lymphoma, metastases or cystadenolymphoma are discussed. In deep located, malignant tumors or when the tumor cannot be delineated completely, MR or CT are obligatory to delineate the tumor. Sonography enables the diagnosis of cysts or ranulae. The accuracy of sonography in assessment of sialolithiasis is about 90 %. Non-opaque stones can be visualized too. However small stones of less than 2mm are difficult to detect since the posterior shadow may be missing. The concrements can be differentiated into intraductal or intraglandular stones. Indirect signs like ductal dilatations or inflammatory changes may be found. Pseudotumorous lesions as hypertrophy of the masseter muscle, tuberculosis, sarcoidosis or lymphoepithelial lesions in AIDS are discussed. In children the main differential diagnosis of salivary gland pathologies are addressed.

Diffusion-weighted MRI provides additional value to conventional dynamic contrast-enhanced MRI for detection of hepatocellular carcinoma

The purpose of this study was to evaluate the accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) in differentiating HCC from benign cirrhotic lesions compared with conventional dynamic contrast-enhanced MRI. Fifty-five patients with cirrhosis underwent conventional and DW-MRI at 1.5 Tesla. Signal intensity ratios (SI(ratio)) of solid liver lesions to adjacent hepatic parenchyma were measured for b0, b100, b600 and b1000, and the apparent diffusion coefficients (ADC) were calculated. In 27 patients, imaging results were compared to histopathology, and in 28 patients, to imaging follow-up. Based on predetermined thresholds, sensitivity and specificity of DW-MRI and conventional MRI were compared. SI(ratio) was significantly different between malignant and benign lesions at all b-values (P < 0.0001). No significant difference in ADC was seen (P = 0.47). For detection of malignant lesions, DW-MRI with b600-SI(ratio) yielded a sensitivity of 95.2% compared to 80.6% for conventional MRI (P = 0.023) and a specificity of 82.7% compared to 65.4% (P = 0.064). The improved accuracy was most beneficial for differentiating malignant lesions smaller than 2 cm. DW-MRI with b600-SI(ratio) improved the detection of small HCC and the differentiation of pseudotumoral lesions compared with conventional MRI.

Pautas diagnósticas y actitud terapéutica ante un bruceloma hepático

Liver involvement due to brucellosis can occur during the acute or the chronic phase of the disease. The marked tendency toward circumscription can give rise to hepatic pseudotumoral lesions with a calcified granulomatous appearance, called brucellomas. Surgery is the only correct treatment, including Brucella PCR in the central calcified lesion, because serological studies are often inconclusive.