Pleomorphic liposarcoma originating from intracranial dura mater

Liposarcomas are the most common soft tissue sarcoma found in adults; however, disease involving or spreading to the head and neck is extremely rare. To our knowledge, we present the first case of primary pleomorphic liposarcoma originating intracranially. A 56-year-old man presented with new weakness and imaging findings confirming a right frontal mass. After resection, histological analysis confirmed the diagnosis of pleomorphic liposarcoma. The patient underwent radiation treatment and surveillance imaging, which revealed no other areas of disease. Results reported previously in the literature indicate that pleomorphic liposarcoma is very aggressive in nature. The authors review the few cases of primary or metastatic pleomorphic liposarcoma that have been reported involving the head.     

Positron emission tomography in non-Hodgkin's lymphoma (NHL): relationship between tracer uptake and pathological findings,including preliminary experience in the staging of low-grade NHL

Advances in imaging techniques have allowed more precise staging and better evaluation of the effect of new treatment modalities. The limitations of conventional morphologic imaging techniques are well known. Positron emission tomography (PET) using fluorine-18-labeled fluorodeoxyglucose is now routinely used for initial staging and re-evaluation during or after treatment of Hodgkin's disease and aggressive non-Hodgkin's lymphoma (NHL), but not in low-grade NHL. In the first part of this review, the relationship between glucose metabolism as measured by PET, pathological findings including histological grade and proliferative activity, and prognosis are analyzed. In the second part, the potential role of PET in the staging and follow-up of low-grade NHL is discussed. Published data indicate that PET may contribute to the management of low-grade follicular NHL.     

MRI findings of carcinosarcoma in the parotid gland

True malignant mixed tumours of the salivary gland (carcinosarcoma) are rare tumours composed of both carcinomatous and sarcomatous components. They predominantly occur in the parotid gland. This report presents the clinical, histological and imaging findings of a carcinosarcoma arising in the deep lobe of the parotid. We present magnetic resonance imaging (MRI) findings of this tumour. MRI demonstrated heterogenous intermediate T2-W signal with a thick irregular enhancing rim was suggestive of a malignant lesion.     

Multifocal presentation of medulloblastoma in adulthood

Medulloblastoma in adulthood is uncommon but not rare; annual incidence is 2–20/1,000,000. Some peculiarities characterize medulloblastoma in adult patients compared with the child type: lateral cerebellar location, heterogeneous signal intensity on magnetic resonance imaging, desmoplastic histological variant, and more favourable prognosis. Preoperative diagnosis is crucial for correct management of these patients. However, because of the low incidence of medulloblastoma in the adult population, preoperative diagnosis remains challenging and prognostic factors and best treatment options are still controversial. In this setting, some unusual findings, for example multifocal presentation and extra-axial location, can confound diagnosis and make treatment difficult. We present a short case-illustrated review on these remarkable issues.     

Primary lymphoepthelial carcinoma of the parotid gland,pictorial review of a rare entity

Lymphoepithelial carcinoma (LEC) is a rare malignancy of the salivary gland arising from the parotid in 80% of cases. LEC is indistinguishable histologically from more common non‐keratinising undifferentiated nasopharyngeal carcinoma (NPC). Up to 40% of patients with primary LEC present with a cervical metastasis and histological assessment of the primary lesion or nodal metastasis may be reported as NPC. The absence of a nasopharyngeal lesion on imaging and endoscopic assessment together with a parotid mass strengthens the case for a LEC. A retrospective review of three cases of primary parotid LEC presenting to a tertiary head and neck clinic was performed. Clinical information, imaging and histopathology findings are presented in the form of a pictorial review. Two female and one male patient with an average age of 42 years presented with a neck lump. Initial pathology results were poorly differentiated carcinoma (2/3) and possible NPC (1/3). MR neck revealed unilateral parotid masses with ipsilateral cervical lymphadenopathy and assessment of the nasopharynx was negative (3/3). Resection occurred in all patients and consensus was metastatic LEC with parotid primary in all cases (3/3). 2 patients are disease free, and 1 patient is deceased (as a result of disease) at the time of this report. Lymphoepithelial carcinoma is identical histologically to NPC, this pictorial review highlights the need for clinical and radiological correlation to establish the diagnosis.     

Parafalcine lesions in the cancer patient: diagnostic dilemma—meningioma or metastatic lesion?

The authors present two cases that illustrate the difficulty in radiographically distinguishing between meningioma and metastatic lesions in patients with known cancer, especially with a parafalcine tumor location. The first patient with known metastatic prostate cancer had imaging studies suggestive of a parafalcine meningioma, but after surgical resection the lesion was found to be histologically consistent with metastatic disease. Conversely, the second patient was thought to have a metastatic breast cancer lesion in the parafalcine region. This presumptive diagnosis based on imaging findings led the patient to undergo radiosurgery treatment; however, the lesion grew over a several-month course and was eventually resected. The pathological analysis revealed that the tumor was, in fact, a meningioma. Using these cases, as well as an extensive review of the literature, the authors highlight the difficulty in making accurate radiographic diagnosis of dural-based lesions, especially in the parafalcine location, where meningiomas are commonly found but can have multiple entities mimicking their presentation. Caution must be used in managing patients with presumed parafalcine meningiomas or metastatic disease that have no histological diagnosis.     

Endoscopic Diagnosis for H. pylori Infection: White Light Imaging (WLI) vs. Image-Enhanced Endoscopy (IEE)

Helicobacter pylori infection is a class I carcinogen that can lead to gastric cancer. Early diagnosis and eradication of H. pylori infection are important to eliminate the risk of gastric cancer. Several invasive diagnostic techniques require biopsy samples, resulting in avoidable injury and medical expense. Furthermore, due to the localized distribution of H. pylori, random biopsies are not always reliable in diagnosing H. pylori infection. This article aimed to review endoscopic findings and new endoscopic options for the diagnosis of H. pylori infection. Using conventional white light imaging (WLI) and image-enhanced endoscopy (IEE), the endoscopic features associated with histological changes have increasingly become apparent. Real-time endoscopy is essential to make a diagnosis of H. pylori infection and allow targeted biopsy. Image-enhanced endoscopy (IEE), such as narrow-band imaging (NBI), linked color imaging (LCI), and blue laser imaging (BLI), enhances visualization of the surface vascular pattern and provides accurate diagnostic performance in H. pylori infection, as well as gastric neoplastic lesions, compared to conventional white light endoscopy. In conclusion, the new endoscopic technologies could be used in current practice with conventional white light endoscopy for accurate and real-time diagnosis of H. pylori infection and pre-cancerous lesions.     

原发性肝脏类癌的诊断一例报道

Primary hepatic carcinoid tumor (PHCT) is a extremely rare neoplasm, usually lacking specific symptoms. We present a histologically proved case and review the cases in the literature. The patient was an 65-year-old man with right upper abdominal pain and weight loss who underwent exploratory laparotomy for huge mass of the liver. Ultrasonography showed a well-demarked, cystic mass with irregular thick wall, whereas CT revealed a low-density tumor in nephrographic phase and peripheral enhanced areas in artery phase. He was diagnosed as PHCT by histological findings including positive staining of tumor cells for chromogranin A and synaptophysin, and no evidence of other primary source of tumor. Thus, a patient with this type of mass showed by imaging examination should be suspected of PHCT, for it is of great importance to clinical treatment.     

Case report: chondromyxoid fibroma arising at the clavicular diaphysis

This report presents an extremely rare case of chondromyxoid fibroma arising at the clavicle. To the best of our knowledge, this may be the first case report demonstrating in detail the clinicopathological findings of chondromyxoid fibroma at the clavicle. The patient was a 34-year-old housewife. Radiography and CT demonstrated an osteolytic lesion with cortical thinning and expansion with partial destruction at the diaphysis of the left clavicle. MRI showed a homogeneous iso-signal intensity mass in T1-weighted imaging and a heterogeneous high-signal intensity in T2-weighted imaging. Histological findings of the widely resected tumor were consistent with chondromyxoid fibroma. The pre-operative diagnosis of chondromyxoid fibroma at an unusual location, as in this case, is difficult from the imaging examinations, or sometimes even from the histological examination of biopsy materials.     

Ductal adenoma of breast: imaging characteristics and radiologic–pathologic correlation of unique findings which reflect “pseudoinvasion”

Purpose

To investigate the imaging characteristics of rare ductal adenoma of the breast, we evaluated the detailed imaging findings and correlated them with the pathologic features of the ductal adenomas. In particular, we describe in detail the imaging findings derived from “pseudoinvasion,” one of the histological features unique to this tumor.

Materials and methods

We reviewed the imaging findings including magnetic resonance imaging (MRI) in three patients with ductal adenomas of the breast and correlated the findings with the detailed histological features.

Results

All patients exhibited well-demarcated nodules with smooth margins on mammography. On ultrasonography, two patients exhibited mural nodules within cysts. The bases of mural nodules protruded into the mammary glands. On contrast-enhanced MRI, these margins were smooth. Histologically, the bases showed foci of tumor cells scattered into collagenous materials (pseudoinvasion), the tumor foci were located along the collagen fibers; therefore, the margins were smooth.

Conclusions

Distinguishing ductal adenoma from invasive carcinoma is an urgent issue. A clear margin of ‘pseudoinvasion’ on MRI is both a unique finding and a useful diagnostic clue.

     

Magnetic resonance imaging findings of central nervous system in lysosomal storage diseases: A pictorial review

Lysosomal storage diseases (LSD) are a complex group of genetic disorders that are a result of inborn errors of metabolism. These errors result in a variety of metabolic dysfunction and build‐up certain molecules within the tissues of the central nervous system (CNS). Although, they have discrete enzymatic deficiencies, symptomology and CNS imaging findings can overlap with each other, which can become challenging to radiologists. The purpose of this paper is to review the most common CNS imaging findings in LSD in order to familiarize the radiologist with their imaging findings and help narrow down the differential diagnosis.     

Imaging Cancer in Neuroradiology

Neuroimaging plays a pivotal role in the diagnosis, management, and prognostication of brain tumors. Recently, the World Health Organization published the fifth edition of the WHO Classification of Tumors of the Central Nervous System (CNS5), which places greater emphasis on tumor genetics and molecular markers to complement the existing histological and immunohistochemical approaches. Recent advances in computational power allowed modern neuro-oncological imaging to move from a strictly morphology-based discipline to advanced neuroimaging techniques with quantifiable tissue characteristics such as tumor cellularity, microstructural organization, hemodynamic, functional, and metabolic features, providing more precise tumor diagnosis and management. The aim of this review is to highlight the key imaging features of the recently published CNS5, outlining the current imaging standards and summarizing the latest advances in neuro-oncological imaging techniques and their role in complementing traditional brain tumor imaging and management.     

Extraskeletal myxoid chondrosarcoma arising from the clavicle

This report presents an extremely rare case of extraskeletal myxoid chondrosarcoma (EMC) arising from the clavicular periosteum. To the best of our knowledge, this may be the first detailed report of its clinicopathological findings. The patient was a 48-year-old man. Plain radiography and CT did not demonstrate any osteolytic lesion or periosteal reaction in the right clavicle. However, MRI showed an isosignal-intensity mass on T1-weighted images and a homogeneous high signal intensity lesion on T2-weighted images. The histological findings of the widely resected tumor were consistent with the diagnosis of extraskeletal myxoid chondrosarcoma. Preoperative diagnosis of extraskeletal myxoid chondrosarcoma at an unusual location, as in this case, is difficult not only with imaging examinations alone, but sometimes even after histological examination of biopsy specimens.     

Functional Imaging to Predict Tumor Response in Locally Advanced Cervical Cancer

Worldwide, cervical cancer is the third commonest cancer. Prognostic factors for cervical cancer include tumor size, histological subtype, histological grade, International Federation of Gynecology and Obstetrics (FIGO) stage, nodal status and performance status. However these known parameters are not sufficient to accurately predict treatment response or prognosis. There is a clinical need for noninvasive prognostic biomarkers to provide more detailed tumor characterization at the baseline and/or early during therapy, which may permit personalized treatment and potentially improve outcomes. Functional imaging techniques have been developing rapidly over the past decade. Imaging parameters derived from PET/CT and functional MRI techniques are emerging as promising response biomarkers. This review details the current evidence and future potential of functional imaging to predict tumor response in locally advanced cervical carcinoma.     

The expanding role of imaging in the management of renal cell carcinoma

The management of renal cell carcinoma (RCC) is evolving owing to the increasing detection of small renal masses, greater understanding of the metabolic pathways involved, new targeted medical treatments for metastatic RCC, and evolving surgical and minimally invasive image-guided treatment techniques. Consequently, the role of imaging and radiology has expanded, with new challenges encompassing all aspects of management, including diagnosis, predicting cell type, staging, preoperative vascular mapping, image-guided treatment and biopsy, detection of recurrence and the use of imaging as a biomarker to assess response to treatment. This article is a comprehensive review of RCC, outlining the etiology of the disease, RCC histological subtypes and their imaging characteristics, imaging modality techniques for evaluation of RCC, treatment strategies and the management of small renal masses.     

The role of contrast-enhanced MR mammography for determining candidates for breast conservation surgery

PURPOSE: The aim of this study was to assess the impact of preoperative magnetic resonance mammography (MRM) on the surgical determination of breast conservation treatment for breast cancer patients. METHODS: From September 1997 to March 2000, 57 consecutive breast conservation treatment candidates were prospectively evaluated with conventional imaging studies (mammography and ultrasonography) and preoperative MRM. RESULTS: In 47 of 54 (87% ) breast cancer patients breast conservation surgery (BCS) was indicated on the basis of mammography (MMG) and ultrasonography (US). However in 40 of the 54 (74% ) patients BCS was indicated on the basis of MRM. Thirty-eight of the 40 patients ultimately underwent BCS and only 1 showed a positive margin. There were 7 patients whose MRM findings suggested that more aggressive treatment than BCS was needed but for whom US/MMG suggested that BCS was appropriate. Five of the 7 patients underwent mastectomy rather than BCS based on the MRM findings, which were justified by post-surgical histological findings. Of the 2 remaining patients who underwent BCS, one had a positive histological margin and one had recurrence, both of which resulted in salvage mastectomy. CONCLUSION: Our study suggests that high resolution preoperative MRM provides more accurate information compared with US and MMG for selecting candidates for BCS. Using MRM as a routine staging tool may reduce unnecessary repeated excisions. A larger study will be required to confirm these findings and to define the patients most likely to benefit from breast MR imaging.     

Current and future trends in imaging informatics for oncology

Clinical imaging plays an essential role in cancer care and research for diagnosis, prognosis, and treatment response assessment. Major advances in imaging informatics to support medical imaging have been made during the last several decades. More recent informatics advances focus on the special needs of oncologic imaging, yet gaps still remain. We review the current state, limitations, and future trends in imaging informatics for oncology care including clinical and clinical research systems. We review information systems to support cancer clinical workflows including oncologist ordering of radiology studies, radiologist review and reporting of image findings, and oncologist review and integration of imaging information for clinical decision making. We discuss informatics approaches to oncologic imaging including, but not limited to, controlled terminologies, image annotation, and image-processing algorithms. With the ongoing development of novel imaging modalities and imaging biomarkers, we expect these systems will continue to evolve and mature.     

Multiple brain metastases: a rare manifestation of adenoid cystic carcinoma of the parotid gland

A rare case of multiple hematogenous brain metastases from adenoid cystic carcinoma of the parotid gland is reported. The patient had a parotid tumor that was treated ten years prior to the appearance of the brain metastases. Magnetic resonance imaging (MRI) and histological findings, as well as the radiation therapy response, of this tumor are presented.     

FDG PET: advantages for staging the mediastinum?

Correctly staging lung cancer is extremely important because treatment options and prognosis differ significantly by stage. In this review, the performance characteristics of positron emission tomography using F-18-fluoro-deoxyglucose (FDG PET) for staging the mediastinum are given in comparison with other non-invasive imaging modalities on the basis of current literature data. There are three meta-analyses demonstrating that FDG PET is more accurate than CT for detecting mediastinal metastases. First publications suggest that dual-modality PET-CT may provide a further gain in accuracy. Additionally, whole-body FDG PET provides information on M-staging and prognosis. Data comparing FDG PET with other functional imaging modalities or endoscopic ultrasound are limited. The necessity of a histological confirmation of PET results is still under discussion.     

Therapeutic strategies for breast cancer based on histological type

Breast cancer has various histological types that reflect not only morphological features but also biological characteristics. Therefore, it is not an exaggeration to say that breast cancers of different histological types are different diseases. It is generally accepted that the histological types of breast cancer are clinically significant because they serve as prognosticators and as the common language for improving the accuracy of clinical diagnosis. It is necessary to diagnose breast cancer at the level of not only histological findings by needle biopsy, but also the histologic type based on diagnostic imaging and cytological diagnosis. From the viewpoint of treatment, preoperative drug therapy is being performed more frequently to shrink tumors before breast-conserving therapy or to determine treatment sensitivity. The prognosis is favorable for patients who respond completely or patients in whom interstitial infiltration is completely eliminated histopathologically, and, as a result, it is important to assess therapeutic efficacy clinically and pathologically. Past experience has shed some light on differentiating cancers responsive to drug therapy from those unresponsive to drug therapy, as well as differentiating cancers in which therapeutic efficacy can be easily ascertained from those in which therapeutic efficacy cannot be easily ascertained. Preoperative drug therapy can be planned by making a histological diagnosis based on needle biopsy findings. Preoperative drug therapy is not indicated for noninvasive carcinoma and papillotubular carcinoma (invasive carcinoma with predominant intraductal components). While complete loss of interstitial infiltration can be expected with solid-tubular carcinoma, it cannot be expected with other histological types, such as invasive lobular carcinoma, adenoid cystic carcinoma, or metaplastic carcinoma (squamous-cell carcinoma and spindle-cell carcinoma). On therapeutic response assessment, the clinical and pathological findings generally match for solid-tubular carcinoma but not for scirrhous carcinoma and invasive lobular carcinoma. With mucinous carcinoma, mucus accumulation can remain, even though most cancer cells disappear; as a result, assessment based on tumor diameter changes is difficult. Histological diagnosis is also significant from the viewpoint of drug sensitivity, and it is important to maintain the accuracy of histological diagnosis.