Soft Tissue Mass Lesion Research Articles

Imaging features of periostitis as a manifestation of IgA vasculitis

Introduction:Periostitis in systemic vasculitis is very rare with only a few previously reported cases. The reported cases were seen in polyarteritis nodosa or Takayasu arteritis. We report the first case of periostitis associated with IgA vasculitis with demonstration of computed tomography (CT), magnetic resonance imaging (MRI) features, and serial changes of radiographs.Patient concerns:A 74-year-old man visited an orthopedic outpatient clinic for pain in both lower legs and left ankle pain. He underwent a total ankle arthroplasty of the left ankle 3 years ago. His medical history disclosed IgA vasculitis/nephropathy caused by cephalosporin antibiotic class 5 months earlier. Plain radiography, MRI of the right lower leg, CT scan of the left ankle showed single lamellar to spiculated periosteal reactions at both tibia, fibula and left calcaneus. There was no evidence of bone or soft tissue mass lesions or cortical destruction.Diagnosis:We concluded that this was a case of periosteal reactions associated with IgA vasculitis for the following reasons: (1) periosteal biopsy was negative for tumor. (2) there was no pulmonary lesion on chest radiography and CT, no history of trauma, inflammatory arthritis, metabolic disease, or genetic disease that could cause periostitis at multiple bones, (3) the initial MRI showed predominant signal changes around the tibial and fibular shafts, possibly explaining subsequent periosteal reactions, and (4) symptoms subsided with conservative treatment and follow-up radiographs showed remodeling of periosteal reactions.Interventions:The patient took conservative management.Outcomes:His calf pain improved, and a radiograph 7 months later showed remodeling to the solid or single lamellar periosteal reaction along the both tibia and left fibula.Conclusion:Awareness of this uncommon manifestation would help differential diagnosis of periostitis and could help decrease the patient's anxiety. It should also be noted that periosteal reactions by benign entities could cause aggressive-looking periosteal reactions in post-operative regions.

Duodeno-Duodenal Intussusception Presenting as Acute Pancreatitis due to Duodenal Adenocarcinomas: a Rare Case Report

Duodeno-duodenal intussusception (DDI) is very rarely encountered. A 40-yr old gentleman presented acute abdominal pain and recurrent episodes of bilious vomiting since 5 days. Serum amylase and serum lipase were raised. Upper gastrointestinal endoscopy revealed obstruction in the second part of duodenum with bile stasis and scope not negotiable. Abdominal contrast enhanced computed tomography (CECT) shows 4 × 3 × 3 cm heterogeneously enhancing complex soft tissue mass lesion in proximal duodenum. Exploratory laparotomy was planned. There was duodeno-duodenal intussusception with sessile polyp in posterior wall of second part of duodenum. Pancreatoduodenectomy with feeding jejunostomy was done. Histopathology report suggested moderately differentiated adenocarcinomas.

Soft Tissue Tumor Leg - A Rare Presentation of Cutaneous Rhinosporidiosis

Rhinosporidiosis presents commonly as polypoidal growth in nose, but presentation in other sites including skin, genitourinary tract is documented. Cutaneous presentation is rare, which may present as pedunculated swelling or cutaneous ulceration, but presenting as soft tissue tumor is extremely rare. The multifaceted presentation of the disease causes diagnostic dilemma to an unsuspecting physician. Clinical and radiological findings may mislead, but usually typical history helps, and typical histology clinches the diagnosis. We are presenting a case of disseminated cutaneous rhinosporidiosis presented as soft tissue mass lesion in the leg causing diagnostic difficulty due to the rare presentation.

Extramedullary plasmacytoma of Paranasal sinus: A rare case report

We report an extremely aggressive case of extramedullary plasmacytoma of the right maxillary sinus without any known metastasis. A 45 year old male presented to ENT Department with chief complaints of recurrent Right sided nasal mass and nasal obstruction with recurrent episodes of cold for 3 years. Patient also had decreased sense of smell. Before presenting to us, he underwent two previous surgeries for the same complaint elsewhere in the year 2015 and 2017. Patient was a known case of Hypertension for 3 years and took treatment, was immunocompetent. Subsequent investigations including CT scan of Paranasal sinuses and peri-operative findings revealed a sinonasal mass involving right maxillary antrum with erosion of all the walls of maxillary antrum. Soft tissue mass lesion also extending into retro-zygomatic space, nasal cavity and buccal space. The nasal cavity mass lesion extending posteriorly to occupy whole of nasopharynx and overhanging into oropharynx. The patient was treated surgically by Cald well Luc’s approach and mass removed. HPE reports suggestive of tumour comprising of plasma cells with varying degree of maturation and atypia, nucleus- characteristic “clock face chromatin”pattern seen. Abundant basophilic cytoplasm. On IHC- CD 138 weak positive. Suggestive of Extramedullary plasmacytoma. Patient underwent 20 cycles of radiotherapy. Patient is on follow up since then and is asymptomatic. Keywords: Extramedullary plasmacytoma, PNS and HPE.

Rare case of bronchoscopic debulking of endobronchial leiomyoma

An endobronchial leiomyoma is a rare benign tumour of lung. It occurs from the smooth muscle of tracheobronchial tree or within lung parenchyma. It presents less than 2% of all benign lung tumours. We present a case report of a 39-year-old male, ex-smoker, with no family history of malignancies, presenting with cough and dyspnoea for 7 months with no symptomatic relief. CAT scan thorax showed well-defined oblong soft tissue mass lesion 24.2 mm × 15.4 mm in right major bronchus compromising central lumen. Flexible bronchoscopy revealed an endobronchial mass at right major bronchus. Patient underwent rigid bronchoscopy with endobronchial mass excision with an electrocautery snare and cryoprobe in the same seating. Complete debulking of tumour was achieved and histopathology report was suggestive of leiomyoma. Prompt investigations and intervention can give favourable outcomes in cases of endobronchial tumours.

A Case of Small Cell Carcinoma of Lung Presenting as Opaque Hemithorax

The most common cause of an Opaque Hemithorax is Pleural Effusion. It is a rare occurrence to find patients with extensive mass leading to an opaque hemithorax. Thorough search of literature did not yield any case with such a large lung mass leading to opaque hemithorax, without the presence of pleural effusion. Lung cancer is the most common cancer diagnosed worldwide and has predominantly been attributed to tobacco smoke exposure. Of the several types, small cell lung cancer differs from others by its early spread and extensive dissemination leading to metastatic classification at the time of diagnosis. Here, is a case of a 50-year-old female patient who presented to the outpatient department with dry cough, weight loss and appetite loss since five months. Her chest radiograph revealed a right-sided homogeneous opacity involving the entire right hemithorax and left-sided pleural-based homogenous mass. Contrast Enhanced Computed Tomography (CECT) thorax revealed an enlarged hemithorax with evidence of large, ill-defined heterogeneously enhancing multilobulated soft-tissue density mass lesion occupying the entire right hemithorax. Biopsy was suggestive of Small Cell Carcinoma of Lung (SCLC), chemotherapy was given and patient is under regular follow-up.

A LATE DIAGNOSIS OF A PRIMARY INTEROSSEOUS SQUAMOUS CELL CARCINOMA: A CASE REPORT

<h3>Background</h3> Primary intraosseous squamous cell carcinoma is a rare malignant central jaw tumor derived from odontogenic epithelial remnants. It predominantly affects the mandible, although both jawbones may be involved. <h3>Objective(s)</h3> The purpose of this article was to represent the clinical, radiologic, and microscopic characteristics of a late diagnosed primary interosseous squamous cell carcinoma (PIOSCC). This case adds to the very few cases of PIOSCC in the literature. <h3>Study Design</h3> This case report describes a 60-year-old man who was initially misdiagnosed with a periapical infection related to the right lower wisdom tooth, that is, an infected odontogenic cyst of the mandible. After 4 months, the patient presented to a private dental clinic with a large swelling at the right side of the mandible. <h3>Results</h3> Extraoral examination revealed a swelling with paresthesia in the right mandibular angle. A panoramic radiograph was requested and revealed a complete erosion of the right ramus with an extension of the lesion to the body of the mandible. Advanced imaging revealed a large, ill-defined, right facial soft tissue mass lesion measuring 8.8 × 4.5 × 5 cm. The microscopic examination revealed fibrofatty tissue infiltrated by a tumor mass formed of solid groups of large pleomorphic atypical squamous cells with high nuclear-to-cytoplasmic ratio and focal intracytoplasmic keratin formation. The diagnosis was PIOSCC. <h3>Discussion/Conclusions</h3> Radiologic and clinical characteristics of PIOSCCs are similar to those of benign odontogenic cysts and tumors. In certain cases, early-stage PIOSCC may mimic routine dental disorders, such as periapical and periodontal disease, which may lead to misdiagnosis or delayed diagnosis. Clinicians must be aware that PIOSCC may initially present as a routine dental disorder, and that unsuccessful treatment may be a sign of underlying malignancy.

Metachronous extraskeletal (soft tissue) epithelioid osteogenic sarcoma: a case report

BackgroundMetachronous osteosarcoma is a rare form of osteosarcoma. The occurrence of metachronous tumor in soft tissue is exceedingly rare. The pathogenesis of metachronous osteosarcoma, as to whether it represents multiple true primaries or metastatic disease, is still obscure.Case presentationA 49-year-old Indian man presented with progressively increasing swelling in his left hand of 2 months’ duration. An X-ray showed a soft tissue lesion. Contrast-enhanced computed tomography showed a soft tissue mass lesion, with peripheral enhancement and central necrotic areas in radial palmar soft tissue overlying second metacarpophalangeal region with no obvious bony osteolysis. Possibilities of acute abscess, resolving hematoma, or aggressive soft tissue mass lesion were suggested. An incision biopsy showed morphological features of epithelioid osteosarcoma, which was confirmed on immunohistochemistry. A detailed history revealed that our patient was diagnosed as having osteosarcoma of his right leg 3 years previously. Based on history, radiology, morphology, and immunohistochemistry, a final diagnosis of extraskeletal (soft tissue) epithelioid osteogenic sarcoma of the left hand occurring as a metachronous tumor 3 years after diagnosis of primary osteosarcoma in the right leg was given.ConclusionThis is probably the first reported case of extraskeletal (soft tissue) epithelioid osteosarcoma occurring as a metachronous tumor 3 years after diagnosis of primary osteosarcoma in the right leg. The prognosis of metachronous skeletal osteosarcoma is poor as compared to that of relapse limited to lungs. In late metachronous osteosarcoma, combined-modality therapy comprising surgery and aggressive chemotherapy may affect long-term survival. Lifelong follow-up of surviving patients with osteosarcoma is necessary and if metachronous osteosarcoma is discovered, it should be treated with curative intent.

An Approach to Soft Tissue Mass In The Gall Bladder

Background: Soft tissue mass in gall bladder (GB) is a radiologic finding commonly encountered in surgical practice. It needs proper evaluation as there is a fair chance that it can be a malignant lesion. Gall bladder cancer (GBC) is considered an incurable disease with an extremely poor prognosis. However, there is good chance of survival if it can be diagnosed in earlier stages (stage Ib, II, selective III).&#x0D; Methods: All consecutive cases of soft tissue mass lesions of GB found in ultrasonogram of abdomen and admitted in Hepato-Biliary-Pancreatic Surgery (HBPS) unit of BIRDEM hospital, from January 2009- September 2016, were included in this study. Detailed history and thorough clinical examination was done in all cases. Pre-operative evaluations were done by ultrasound, Tumor marker (CA19.9) &amp; CT scan,. CT scan was a crucial investigation for all the patients, as depending on the findings, decision was made whether a patient is eligible for a possible curative surgery or not. On-table frozen section biopsy or imprint cytology was done for tissue diagnosis. Radical resection was done for the histology/ cytology proved malignancy of gallbladder (stage Ib, II, selective III). Post-cholecystectomy patients also underwent full thickness excision of the umbilical port. In benign cases only cholecystectomy was done. Advanced GBC cases underwent FNAC for tissue diagnosis followed by palliative chemotherapy. Some needed endoscopic or surgical palliation in the form of percutaneous external biliary drainage, endobiliary prosthesis, triple bypass, hepaticojejunostomy, left duct anastomosis, gastrojejunostomy, ileotransverse anastomosis, external biliary drainage etc before chemotherapy. All the GBC patients were regularly followed according to a schedule.&#x0D; Results: We are reporting 334 cases of soft tissue mass lesions of GB. Female 191 (57.2%) and male 143 (42.81%), M : F = 1 : 1.3 ,,between the ages of 32 and 88 years. Of these, 81 patients (24.2%) turned out to be benign; another 81 patients (24.2%) were in early stage (Ib, II selective III). The rest of 172 patients (51.5%) showed signs of advanced malignancy in USG &amp; CT scan. Post-operative complications occurred in 27 cases (8.1%). During follow-up, 34 patients (42%) have crossed their 5 years of disease free survival after curative surgery. Rest of the patients (44 cases), after curative surgery, are still under follow-up. The 172 patients in Stage III &amp; IV disease who underwent some sort of palliative procedure, had a mean survival of 7.2 months.&#x0D; Conclusion: Soft tissue mass in gall bladder picked up by imaging has a very high chance to be malignant. Among these malignant patients, a good number has a chance of curative resection if evaluated and managed properly.&#x0D; Bangladesh Crit Care J March 2019; 7(1): 29-34

Dural Plasmacytoma Involving Calvarium with Soft Tissue Extension Mimicking Meningioma: A Diagnostic Dilemma

AbstractHere, the authors describe a case of 25-year-old man diagnosed with dural plasmacytoma involving calvarium with soft tissue extension. Magnetic resonance imaging (MRI) revealed extra-axial heterogeneously enhancing soft tissue mass lesion in the left parieto-occipital region with a dural tail mimicking meningioma, destroying the left parietal bone, and bulging into the scalp. Mass was excised and histopathologic examination revealed plasmacytoma with amyloid deposition. There is no recurrence after postoperative radiotherapy and 2 years of follow-up, although the future course is still not certain. The clinician should consider alternative diagnosis other than meningioma prior to proceeding to surgery if the dural-based lesion is involving calvarium and soft tissue extension.

Triple-phase 99mTc-3P-RGD2 imaging of peripheral primitive neuroectodermal tumor in the hip muscle group with bone metastasis.

Peripheral primitive neuroectodermal tumors (pPNETs) are a group of aggressive neoplasms that are most commonly encountered in pediatric patients and may be located in the abdomen, pelvis, thoracopulmonary region and, rarely, in the head and neck region. pPNETs in adults are extremely rare. The present study reports a case of pPNET located in the hip muscles with bone metastasis. The patient was a 44-year-old woman who complained of progressive pain and swelling with a mass near the left hip. Computed tomography (CT) and enhanced CT revealed a soft tissue mass lesion in the hip muscle group measuring 4.3×4.3×4.4 cm. The lesion was ill-defined, heterogeneous, exhibiting mild post-contrast enhancement. There was a large number of bent neovessels and several branches from the left internal iliac artery and deep femoral artery on enhanced CT scan. Triple-phase dynamic imaging with integrin αvβ3-targeted 99mTc-3P-RGD2 as the radiotracer revealed increased blood perfusion and radiotracer aggregation in the large, ill-defined, heterogeneous, hypodense mass and adjacent bone. The patient was suspected of having pPNET with bone metastasis, which was confirmed by histological examination of a sample obtained by needle aspiration. Due to the high blood perfusion of primary pPNETs and high RGD uptake by the primary and metastatic lesions, chemoembolization and anti-angiogenic therapy were considered to be the optimal therapeutic choice. This also suggested that 177Lu-labeled RGD has great potential for the targeted treatment of pPNETs with multiple metastases.

Is It Appropriate to Treat Sarcoma Metastases With Intramedullary Nailing?

Patients with primary bone and soft tissue sarcoma are at risk for skeletal metastases. Although uncommon, these metastases can result in impending or pathologic fractures. Intramedullary nailing traditionally has been an accepted form of palliative treatment for patients with metastatic carcinoma, but we could find no studies that report specifically on intramedullary nailing of metastatic sarcoma lesions. We asked: (1) What is the survival of patients with an impending or pathologic fracture from a sarcoma metastasis? (2) What proportion of patients treated with intramedullary nailing subsequently underwent a revision procedure or nail removal during their lifetimes? Between 1996 and 2014, we performed 40 intramedullary nailing procedures in 34 patients with multifocal metastases from sarcomas who showed signs or symptoms of impending fracture or who presented with a pathologic fracture. All of these patients are accounted for, either through the time of death or to the present, and all are included at a mean of 13months (range, 0.3-86months) in this retrospective study. During the study period, we generally applied the same surgical indications for patients with nailing of metastatic sarcoma lesions as we did for patients with metastatic carcinoma; in general, we used intramedullary nailing (with or without cement) rather than resection for diaphyseal lesions with less cortical destruction and no substantial soft tissue mass or metadiaphyseal lesions that could be adequately supplemented with cementation. The goal was to use this approach when it would allow immediate weightbearing, or in patients whose medical conditions were such that a more-extensive procedure seemed unsafe. During the same period, an additional 58 patients underwent resection procedures for metastatic sarcomas to long bones because they either did not meet the above indications, had a solitary resectable metastasis, or because of surgeon preference; these patients were excluded from this study. The median age of the patients was 52years (range, 27-81years). Eleven patients with 11 impending or pathologic fractures were documented to have received either preoperative or postoperative radiation therapy and 29 patients received some form of chemotherapy. Thirty (88%) patients died during the period of observation, at a median of 5months (range, 0.3-80months) after surgery. Twenty-nine patients (85%) underwent no additional surgery and retained their original intramedullary nail. One patient (3%) underwent nail removal for infection, and four patients (12%) underwent further surgical revision secondary to local progression. Patients with an impending or pathologic fracture from multifocal metastatic sarcoma to a long bone have a dismal prognosis, but they may gain short-term benefit from surgical fixation with the goal of reducing pain and maintaining mobility. Although we have no group for comparison, such as treating with radiotherapy alone or resection and an endoprosthesis, our findings suggest that use of intramedullary nails is helpful for providing fixation that in most instances lasts for the lifetime of patients with multifocal bone metastases from sarcomas. Level IV, therapeutic study.

Image-guided percutaneous core needle biopsy of soft-tissue masses in the pediatric population.

A paucity of literature describes the use of imaged-guided percutaneous core needle biopsy for the diagnosis and characterization of pediatric soft-tissue masses and lesions. To retrospectively determine whether image-guided percutaneous core needle biopsy is adequate for diagnosing and characterizing benign and malignant pediatric soft-tissue masses and lesions. We identified children (≤18years old) who underwent US- or CT-guided percutaneous core needle biopsy of a soft-tissue mass or other lesion between January 2012 and March 2014. Using medical records, we documented the following data: age and gender, site of the mass or lesion, size and number of biopsy specimens, whether the biopsy procedure was diagnostic, whether sufficient tissue was obtained for necessary ancillary testing (e.g., cytogenetic evaluation), and whether there was a procedural complication within 1week. One hundred eight soft-tissue masses or lesions were biopsied under imaging guidance in 84 children; 39 (46%) were girls. Mean age ± standard deviation (SD) was 12.1 ± 5.1years (range 6months to 18years). Of these procedures, 105/108 (97%) were diagnostic; 82/108 (76%) were US-guided; 87/108 (81%) were performed using a 17-gauge introducer needle/18-gauge biopsy instrument. The mean number ± SD of core needle biopsy specimens obtained was 8.9 ± 5.0. For newly diagnosed malignancies, adequate tissue was obtained for ancillary testing in 28/30 (93%) masses. One minor complication was documented. Image-guided percutaneous core needle biopsy of pediatric soft-tissue masses is safe, has a high diagnostic rate, and provides sufficient tissue for ancillary testing.

A Case of Abdominal Aortic Retroperitoneal and Mesenteric Amyloid Light Chain Amyloidoma.

We report the case of a Japanese woman with amyloid light chain (AL) amyloidoma in the abdominal aortic retroperitoneum and mesentery. Irregular soft tissue mass lesions with calcification in the abdominal aortic retroperitoneum and mesentery were initially detected by computed tomography at another hospital. The lesions gradually compressed the duodenum, causing symptoms of bowel obstruction. The patient was clinically diagnosed with retroperitoneal fibrosis, and prednisolone was administered at a dose of 40 mg/day. However, the lesions did not change in size and her symptoms continued. She was transferred to our hospital and underwent mesenteric biopsy for histopathology using abdominal laparotomy. The histopathological and immunohistological findings of the mesenteric specimen demonstrated lambda light chain deposition. Accordingly, the patient was finally diagnosed with AL amyloidoma with no evidence of systemic amyloidosis. After laparotomy, her general condition worsened because of complications of pneumonia and deep vein thrombosis. She died suddenly from acute myocardial infarction. We have concluded that abdominal aortic retroperitoneal and mesenteric AL amyloidoma may have very poor prognoses in accordance with previous reports. In addition, the size and location of AL amyloidoma directly influence the prognosis. We suggest that early histopathology is important for improving prognosis.

Is cholesteatoma a precursor of verrucous carcinoma: A diagnostic dilemma

Verrucous carcinoma is an unusually well-differentiated variant of squamous cell carcinoma, characterized by local invasion and cytologically benign appearance. We report a case of 52-year-old male who presented with postauricular growth and cholesteatoma in the right ear. High-resolution computed tomography temporal bone showed an enhancing soft tissue mass lesion extending into the mastoid, external auditory canal, and middle ear. Growth was histopathologically confirmed to be verrucous carcinoma extending from the cholesteatoma in mastoid cavity. Review of literature confirms the rarity of cases of cholesteatoma which could progress and present as verrucous carcinoma in the postauricular region.

An unusual case of pleomorphic rhabdomyosarcoma of shoulder in an adult patient

Rhabdomyosarcoma (RMS) is a highly malignant soft tissue sarcoma (STS). It is the most common childhood STS and is exceedingly rare in adults. The pleomorphic subtype affecting patient older than 45 years is the least common subtype. It is histologically similar to a malignant fibrous histiocytoma. Many pleomorphic RMSs (PRMSs) have been reclassified as fibrous histiocytomas, thereby making the diagnosis of PRMS more unusual. Here, we report a case of PRMS in a 45-year-old male who reported with the painless soft tissue swelling over the posterior aspect of left shoulder for 1 year. Magnetic resonance (MR) imaging and MR angiography showed a large well defined heterogeneously enhancing soft tissue mass lesion arising from posterior fibers of left Deltoid muscle. The patient received nine cycles of neoadjuvant chemotherapy with ifosfamide, epirubicin every 3 weeks. The patient underwent wide local excision of the tumor and received four cycles of adjuvant chemotherapy ifosfamide, epirubicin, and etoposide every 3 weeks. Locoregional adjuvant radiotherapy 66 Gy in 33 fractions was given by 3-dimensional conformal radiotherapy. Now the patient has a complete response on follow-up imaging 2 years after completion of radiotherapy. PRMS in adults has a significantly worse prognosis than that for other pleomorphic sarcomas with 12.5–50% of 1-year to 20-month disease-free survival and 27% rate of 5-year disease free survival. Thus, the correct and early diagnosis of PRMS is important.

Local hyperthermia case study

Prostate cancer is the second most common reason of death in men. Multidisciplinary therapy is the best treatment option, although, there is no common consent on optimal therapy for advanced prostate cancer. The present study reports a case of 75 year-old male who had a huge heterogeneous soft tissue mass lesion with non-homogeneous enhancement consisted low attenuated foci occupying pelvis cavity and lower abdomen with loss of mesenteric fat and invasion to posterior bladder wall due to T4N1Mx prostate cancer. The patient was treated with adjuvant radiotherapy (RT) plus local hyperthermia (HT). This report shows the potential capability of HT application during RT. Radiotherapy with hyperthermia combination revealed a dramatic response in this case and after treatment it left the patient asymptomatic.

Local hyperthermia case study

Prostate cancer is the second most common reason of death in men. Multidisciplinary therapy is the best treatment option, although, there is no common consent on optimal therapy for advanced prostate cancer. The present study reports a case of 75 year-old male who had a huge heterogeneous soft tissue mass lesion with non-homogeneous enhancement consisted low attenuated foci occupying pelvis cavity and lower abdomen with loss of mesenteric fat and invasion to posterior bladder wall due to T4N1Mx prostate cancer. The patient was treated with adjuvant radiotherapy (RT) plus local hyperthermia (HT). This report shows the potential capability of HT application during RT. Radiotherapy with hyperthermia combination revealed a dramatic response in this case and after treatment it left the patient asymptomatic.

Kesesuaian MRI 1,0 Tesla untuk Membedakan Spondilitis dan Metastasis Vertebra dengan Konfirmasi Hasil Histopatologi

Background: Magnetic Resonance Imaging (MRI) is the most accurate modality imaging to evaluate vertebral abnormality. Infection and metastatic in musculoskeletal is most commonly found in the vertebra. It is often difcult to di?erentiate between spondylitis and metastatic, both clinically and radiographically, mainly on atypical case.Objective: To analyze the precision of MRI 1,0 Tesla in di?erentiation of radiological imaging between spondylitis and vertebral metastatic with histopathological confrmation.Materials and methods: This is an analytic observational study, with cross-sectional research design. Statistical analysis was performed with Mc Neemar test. Samples were selected by consecutive sampling with 35 patients (15 men, 20 women), 22samples of spondylitis and 13 of samples metastatic which were confrmed by histopathological examination.Result: From 22 samples of spondylitis confrmed by histopathology, only 86% (19 samples) were diagnosed as having spondylitis on MRI, whereas 13 metastatic samples 100% was correctly diagnosed on MRI.Conclusion: Statistically there was no signifcant di?erences between radiology diagnostic using 1,0 Tesla MRI with histopathological diagnosis, p=0,250 (p&gt; 0,05), with tendency MRI 1,0 Tesla is more precise in diagnosing metastatic. MR imagesshow typical fndings in spondylitis such as anterior component corpus vertebral and discus intervertebralis involvement, disk signal abnormalities, paravertebral abscesses and involvement of multiple vertebral bodies sequentially. MR images show typical fndings in metastasis such as anterior and posterior corpus vertebral involvement, paravertebral soft tissue mass and skip lesion.

Gastric Glomus Tumour: A Rare Cause of Gastrointestinal Bleeding.

A 62-year-old man was referred to the Gastroenterology Department with complaints of haematemesis and maleana since past four days. His general physical examination showed no organomegaly. Cancer antigen (CA) 19.9 levels were normal. An esophago-gastro duodenoscopy revealed a 4x3 cm polypoid endophytic soft tissue mass lesion at the body and greater curvature on the posterior surface of stomach with an overlying normal mucosa. Computed tomography (CT) abdomen showed well-circumscribed submucosal masses in stomach with homogeneous density and no attached peritoneal soft tissue infiltration; findings were suspicious of gastrointestinal stromal tumour (GIST). Laproscopically wedge resection was performed with no complications. A wedge gastrectomy specimen was received measuring 2.5x2.0x1.5 cm with a stapled margin. On cut section a mass was noted in the wall measuring 2.0x1.0x1.0 cm which was homogenous on cut section. Mucosa was unremarkable. Histopathology showed multiple well circumscribed solid nests of tumour cells with dilated blood vessels in the submucosa separated by bundles of smooth muscle and fibrous tissue with hyalinization. Cells were small monomorphic, round cells with sharply demarcated margins, vescicular chromatin and scanty cytoplasm [Table/Fig-1a-c]. Mitosis was inconspicuous. There was no vascular invasion. Immunohistochemistry (IHC) revealed diffuse positivity for smooth muscle actin (SMA) (Dako, IA4) [Table/Fig-1d] and vimentin (Dako, V9) immunostains. Ki 67 (Dako; MIB-1) index was <1%. Cytokeratin (CK) (Biogenix; AE1 and AE3), CD 34 (Dako, QBE nd 10), CD117 (Biogenix, YR117) [Table/Fig-1e], S-100 (Dako, 5Y38), Synaptophysin (Dako;SY38), Chromogranin (Dako;IS 502), Desmin (Dako;D33) and DOG-1 (Thermo-Scientific;SP 31) were negative. Focal ulceration with necrosis was noted. Resection margin of stomach as well as circumferential margin was free. Diagnosis of Glomus tumour of stomach was given. One month follow-up period was uneventful. [Table/Fig-1a-e]: Well circumscribed lesion in submucosa (a, haematoxylin and eosin,100X) composed of monomorphic small round cells along with dilated vessels surrounded by glomus cells (b, haematoxylin and eosin,200X) with stippled chromatin and scanty cytoplasm (c, haematoxylin ... Glomus tumours are rare mesenchymal tumours arising from the neuromyoarterial canal (the canal of Sucquet-Hoyer) or glomus body. It commonly occurs in the peripheral soft tissue and extremities, but can grow anywhere in the body. As gastric glomus tumour lacks specific clinical and endoscopic characteristics, it is difficult to distinguish from more common gastrointestinal stromal tumour (GIST), paraganglioma or carcinoid tumours [1]. The epithelioid pattern of GIST is confused with glomus tumour. However, GIST usually lacks dilated capillaries and tumour cells are positive for CD117, DOG-1 and CD34. Paraganglioma cells are arranged in a characteristic Zellballen pattern with rich thin-walled blood vessels in stroma which can mimic glomus tumour. On IHC the tumour cells are positive for synaptophysin, chromogranin A and neuron specific enolase. These nests are surrounded by sustanticular cells which are positive for S-100 protein. Carcinoid tumour is a neuroendocrine carcinoma and comprised of oval or spindle tumour cells arranged in cords or nests with thin-walled blood vessels. Carcinoid tumour cells are positive for CK, S-100 protein, synaptophysin, chromogranin A, and neuron specific enolase, but negative for SMA. Glomus tumour of stomach is rare and the diagnosis is mostly dependent on the histopathologic (presence of uniform small round glomus cells) and IHC findings (Vimentin, SMA positivity and S-100 protein, CD34, CD117, DOG-1, desmin, CD56, synaptophysin, chromogranin A, neuron specific enolase and cytokeratin negativity) [2,3].