Low-grade liposarcoma with osteosarcomatous dedifferentiation: radiological and histological features

We describe the radiological and pathological findings of a rare case of a low-grade liposarcoma associated with a high-grade osteosarcomatous component in a 78-year-old woman. Pre-operative imaging demonstrated a well-encapsulated homogeneous fatty tumour in the right buttock deep to the gluteal musculature. Centrally within the fatty tumour a region of increased soft tissue attenuation on CT and heterogeneous high signal on fat-saturated T2-weighted MRI was seen with amorphous calcification/ossification. Histological assessment revealed a low-grade liposarcoma containing an area of dedifferentiation that resembled an osteosarcoma. We describe the radiological-pathological findings in this rarely reported clinical entity and discuss the differential diagnosis of calcification within lipomatous tumours.     

超声诊断性索-间质肿瘤的临床分析

目的：探讨性索-间质肿瘤声像图表现及诊断价值。方法：回顾总结了经手术病理证实70例性索-间质肿瘤的超声诊断资料。结果：70例术前超声检查,24例提示卵泡膜细胞瘤,3例提示颗粒细胞瘤的诊断,超声诊断符合率38.6%。超声提示卵巢实性肿瘤18例,占25.7%;囊腺癌8例,占11.4%,囊腺瘤3例,占4.3%;卵巢畸胎瘤3例,占4.3%;误诊子宫浆膜下肌瘤11例,占15.7%。结论：尽管性索-间质肿瘤不具有特异性声像图表现,但是掌握其声像图特征结合临床女性化表现有助于超声提示正确诊断。     

Retroperitoneal Pleomorphic Liposarcoma Mimicking Adrenal Cancer in F-18 FDG PET/CT

Liposarcoma is the second most common type of soft tissue sarcoma, but pleomorphic liposarcoma is the least common subtype. We present the case of a 42-year-old man who had experienced intermittent left flank pain for a month. A large soft-tissue mass was detected by ultrasonography in a local clinic, and he was referred for further evaluation. Positron emission tomography/computed tomography (PET/CT) with F-18 fluoro-2-deoxy-D-glucose (F-18 FDG) showed intense uptake in the retroperitoneal mass, which mimicked an adrenal cancer. The patient underwent left radical nephroadrenalectomy, and the tumor was revealed to be a pleomorphic liposarcoma upon pathological examination. When there is a large retroperitoneal mass with intense F-18 FDG activity, the possibility of a pleomorphic liposarcoma should be considered.     

Prediction of lack of response to neoadjuvant chemotherapy in rare breast tumour histology with Tc-99m sestamibi scintimammography

The authors report a case of a 47-year-old female with a malignant lump in the right breast and ipsilateral axillary nodal involvement. She was pathologically misinterpreted as a case of ductal cell carcinoma with papillary component on fine needle aspiration cytology (FNAC) pre-operatively. On lines of the FNAC report, the patient underwent scintimammography (SMM) for prediction of treatment response based on washout pattern. The SMM revealed rapid washout of radiotracer predictive of poor responder. Despite unfavourable result seen with SMM, the patient received 4 cycles of neo-adjuvant chemotherapy (NACT). However, there was no clinical response after chemotherapy. The post-surgical histopathology revealed the actual histology to be pleomorphic liposarcoma. This case highlights that SMM has the ability to predict non-responsiveness of unusual tumour histology to standard NACT.     

Benign thymic cyst following mantle radiotherapy for Hodgkin's disease

The case history of a patient who was treated for Stage IA Hodgkin's disease involving the left supraclavicular region is presented. Shortly after mantle field radiation therapy she developed a mass in the anterior mediastinum. Histological examination of the lesion revealed it to be a benign cyst of the thymus. We consider it important that the possibility of the existence of such a benign growth be considered when a mediastinal mass appears in a patient treated for Hodgkin's disease, before more intensive tumour therapy is given.     

Liposarcoma of the chest wall mimicking a breast mass in a man: a case report

We report a rare case of dedifferentiated liposarcoma in a man. A 60-year-old male patient presented with a left mass involving the whole breast area, with no lymph node enlargement, growing during a one-year-period. Imaging studies revealed a fat-containing mixed-density mass apparently associated with the pectoralis major muscle. A core biopsy was performed that yielded a diagnosis of a well-differentiated liposarcoma. Further tests to check for metastases were ordered and no distant disease was found. Left mastectomy with en bloc resection of the pectoralis major muscle was performed. The pathologic diagnosis revealed a high-grade dedifferentiated liposarcoma with extensive necrosis. This tumor type is primarily described in the retroperitoneum and extremities. We report an unusual presentation of a liposarcoma mimicking a breast mass.     

Imaging features of primary pulmonary liposarcoma

Primary liposarcoma of the lung is extremely rare. We report a 28-year-old pregnant woman who complained of dyspnoea during the third trimester. Chest radiography, thoracic ultrasound, CT and MRI showed a huge heterogeneous tumour involving all the left lung and the mediastinum. The tumour was composed of soft tissue, and fatty and cystic components with calcifications. Diagnosis was made on core biopsy under CT guidance. Surgical excision was performed but unfortunately the patient died during the operation.     

Experience with ultrasonographically guided vacuum-assisted resection of benign breast tumors

AIM: To evaluate the feasibility and safety of vacuum-assisted resection of benign breast tumours using an 8 G handheld device. MATERIALS AND METHODS: Over a 2-year period, 22 patients with 26 breast tumours diagnosed as benign using aspiration biopsy cytology were enrolled. The mean patient age was 38 years, and the mean maximal diameter of the tumour was 13 mm. A handheld Aloka SSD 6500 ultrasonography device with a linear-type 7.5 MHz transducer was inserted into the posterior aspect of the tumour with the patient under local anaesthesia, and the tumour was resected under ultrasonographic guidance. RESULTS: This method was employed successfully in all patients, and the mean operation time was 33 min. Post-procedure complications included subcutaneous bleeding in 12 cases and haematoma in one. The pathological diagnoses were fibroadenoma in 16 cases, mastopathy in six, and tubular adenoma and pseudoangiomatous stromal hyperplasia in two cases each, respectively. Follow-up ultrasonography revealed residual tumours in four cases (15.4%). CONCLUSIONS: Although this method is feasible and safe without severe complications, it is necessary to select appropriate patients, and to obtain informed consent regarding the possibility of recurrence or residual tumour.     

Variability of the ultrasonic picture in carcinoma of the breast

The authors performed a retrospective analysis of ultrasonographic findings in 63 female patients with mammary cancer verified by histology. The ultrasonographic examination contributed significantly to the diagnostic results in 16.4% of patients. The ultrasonographic picture of mammary cancer was characteristically variable with the occurrence of various deviations, with prevailing main symptoms of cancer (irregularity of the shape in 81% and the contour in 100%, prevailing low and medium echoes in 97%, irregular distribution of internal echoes in 76.2%, retro-tumorous middle acoustic shade in 63.4%). The authors draw attention to the diagnostic role of individually marked deviations of echographic structure; the importance of careful examination of the formation in different planes in view of the tumour is pointed out, since the symptom of malignant process may be present in only one of them.     

Subluxation of the ulnar nerve in the elbow region--ultrasonographic evaluation

Chronic ulnar nerve subluxation out of its sulcus in the elbow region may be a rare reason for undefined chronic disorders in the medial elbow aspect. We present two cases, a 38-year-old male patient complaining of a recurrent painful disorder including paresthesia of the 4th and 5th fingers and a 12-year-old boy presenting with a palpable band in the medial elbow region without pain. Ultrasonography was performed using a high frequency linear probe in the longitudinal and horizontal planes including dynamic examination. In both patients, the ulnar nerve was completely identified, both in the transverse and longitudinal planes. The sonomorphology and echogeneity of the nerve were the same as in the contralateral limb. Ulnar nerve subluxation was diagnosed in elbow joint flexion, in both cases. It is possible through dynamic ultrasonographic examination to diagnose and document ulnar nerve subluxation for further (surgical) treatment.     

Influence of negative ultrasound findings on the management of in- and outpatients with suspected deep-vein thrombosis.

Real-time ultrasonography (US) was used as a single non-invasive method in the management of 174 patients (56 inpatients and 118 outpatients) with suspected deep-vein thrombosis (DVT). Therapeutic decisions were based on the results of ultrasonography alone. If the US examination was abnormal anticoagulant treatment was started. If the initial US examination was normal, no treatment was given and the patient underwent repeated testing and physical examination after 1 day, 7 days and 3 months. In the outpatient group, 1.3% of the ultrasonographic negative patients developed thromboembolic complications (95% confidence limits, 0.03-7.21%). None of the initial ultrasonographic negative patients developed proximal DVT after 1 day and 7 days. In the inpatient group, 10% of the ultrasonographic negative patients developed thromboembolic complications (95% confidence limits, 1.2-31.7%). In 18% of the ultrasonographic negative patients an alternative, unexpected diagnosis was obtained by ultrasound. The most frequent alternative diagnosis was a popliteal cyst. The results indicate that US alone appears to be a safe diagnostic method in the management of outpatients with suspected DVT. In the inpatient group further research is required for definite recommendations regarding a safe ultrasound follow-up schedule.     

High-grade intra-articular liposarcoma of the knee

A high-grade pleomorphic intra-articular liposarcoma of the knee is described in a 48-year-old man, which was diagnosed histologically after arthroscopy of the knee for suspected pigmented villonodular synovitis (PVNS). The patient proceeded to undergo an extra-articular resection with a custom-made prosthesis. This report highlights the need to remember this rare tumour in the differential diagnosis of atypical soft tissue lesions within the knee joint prior to instrumentation.     

Nine pheochromocytomas in the same patient. Final mapping with ultrasound and angiography

A 37-year-old man presented with hypertension and elevated urine catecholamine. Ultrasound scanning revealed a solid tumour of the right adrenal gland and two solid tumours in the retroperitoneum. The findings were confirmed with computed tomography and abdominal angiography. At surgery only the tumour of the right adrenal gland was removed. The histopathologic diagnosis was pheochromocytoma. Postoperatively the symptoms and biochemistry were unchanged and the patient was referred for further treatment. At ultrasonography and abdominal aortography 6 remaining tumours were demonstrated. Surgery was performed and 8 pheochromocytomas were extirpated (3 were closely spaced small tumours in a conglomerate corresponding to one of the visualized tumour sites). On histopathologic examination no signs of invasive growth were found. The patient recovered completely. The blood pressure was still normal 2 1/2 years later. Angiography and non-invasive examination of the entire abdomen and pelvis should be routine when pheochromocytomas are searched for.     

Ultrasonographic examinations of muscle hematomas in hemophiliacs

Twenty-one ultrasonographic examinations were performed in 14 hemophiliacs with suspected intramuscular bleeding. In all patients who had an ultrasonographic examination within the first days after the onset of the symptoms, a hematoma was identified, and its resolution during transfusion therapy was possible to follow. In patients who had their first examination 3 to 5 weeks after the onset of symptoms and who had received transfusion therapy during this period, no hematoma was detectable. It is concluded that ultrasonography provides all necessary information needed for diagnosis and follow-up of treatment. Being a safe method, and giving no radiation, it should be the method of choice in the evaluation and follow-up of muscle hematomas in this patient group.     

Incidental findings of gastrointestinal tumours at abdominal ultrasound examinations

A retrospective review was performed of 11 patients referred to ultrasound examination because of abdominal pain and/or a palpable abdominal tumour, which eventually was proven to be gastrointestinal malignancy. Primary gastric carcinoma was present in 4 cases, carcinoma of the small bowel in one case, and of the large bowel in 6 cases. All the patients were examined with conventional ultrasound technique using a 3.5 MHz and a 5.0 MHz transducer. In all the cases bowel wall thickness exceeded 10 mm. A correct organ localization and primary diagnosis of tumour was made in 6 cases, of which only 2 had a palpable abdominal mass. In the remaining cases a bowel tumour was revealed in 3 but the site was incorrectly defined. Reviewing the documentations made at ultrasonography in these cases the tumour origin corresponded well with radiologic and surgical findings. In 2 patients an abscess was diagnosed which later proved to be due to a large bowel carcinoma. Ultrasound examination of patients with uncharacteristic abdominal complaints can spare the patient unnecessary examinations when the findings are pointing at a tumour in the gastrointestinal tract, save time and therefore is of economical importance.     

Two cases of schwannoma with marked cystic changes

We report two cases of schwannoma displaying marked cystic changes; one in the temporalis muscle and one in the submandibular space. The first patient, a 44-year-old male, presented after complaining of a swelling rapidly increasing in size in the left temporal region. Computed tomography (CT) indicated a low-density area surrounded by soft tissue. Magnetic resonance imaging (MRI) revealed signal hypointensity on T1 weighted imaging and strong signal hyperintensity on T2 weighted imaging. The extirpated tumour specimen measured 58 mm x 58 mm x 30 mm. Histopathological examination identified schwannoma, comprising spindle cell proliferation in a palisading pattern with obvious cystic changes. The second case involved a 46-year-old female who presented with swelling of the right submandibular region. Panoramic radiography and lateral oblique mandible projection, which were used together with conventional sialography of the submandibular gland, revealed the so-called "ball in hand" appearance of the submandibular gland, and contrast-enhanced CT identified a lesion of 30 mm diameter with a well-defined annular margin and homogeneous low-density near the tumour centre. Benign pleomorphic adenoma was suspected, but histopathological examination identified schwannoma, predominantly comprising Antoni B type tissue.     

Liposarcoma of the cord presenting at vasectomy counselling

A case of liposarcoma of the cord is reported in a patient presenting for vasectomy. This paper discusses such tumours and illustrates the importance of a careful clinical examination during counselling.     

Liposarcoma or lipoma: Does genetics change classic imaging criteria?

Differentiating benign from malignant fatty tumours has always been very difficult for both radiologists and pathologists. Cytogenetic and molecular genetic analyses provide complementary tools for differentiating soft tissue tumours.Our objective was to compare imaging criteria of malignancy with a new diagnostic gold standard, namely, pathological analysis combined with cytogenetic and molecular genetic analyses. Nineteen patients with a fatty tumour were included. All had computed tomography and/or magnetic resonance imaging examination before any biopsy or surgery. All had histopathological and cytogenetic and/or molecular genetic analyses. The imaging diagnosis of benign or malignant lesions was accurate in 15 cases, with 4 false positives for malignancy. Erroneous criteria were a large size (4 cases), and a mass that was not purely fatty.In conclusion, the main pitfall for a false positive radiological diagnosis of liposarcoma is certainly a large-sized tumour. Cytogenetic and molecular genetic analyses contribute to the diagnosis and can be performed at the same time with a core biopsy.     

Pseudotumor of the left epigastrium

The authors describe the case of a patient with an accessory spleen located between the spleen and upper pole of the left kidney. A repeated sonographic examination suggested a suspicion for a kidney tumour, shape anomaly of the spleen, accessory spleen or kidney, but did not exclude even benign tumour in retroperitoneum. Computer tomography proved a formation between the upper pole of the kidney and the spleen, whose density characteristic after a rapid intravenous injection of 60% Verografin at the amount of 1 ml per kg body weight was the same as that of the spleen. Only angiographic examination revealed that the case is an accessory spleen and not a tumour.     

Primary extragonadal retroperitoneal teratoma in an adult

Primary retroperitoneal teratoma is a rare entity in adults. It has a distinctive imaging appearance. We describe a case of a 22-year-old patient who was referred to our hospital with the complaint of abdominal distension. Radiological work-up disclosed a retroperitoneal teratoma. Laparotomy with tumour resection was performed. Pathological examination revealed a benign cystic teratoma. The patient is doing well at follow-up.