头颈部椎周间隙良性肿瘤的MR成像研究

目的：分析头颈部椎周间隙良性肿瘤MR成像特征及病变的诊断与鉴别诊断。方法：18例头颈椎周间隙良性肿瘤均经Philips0.5T超导型MR成像仪扫描,包括12例神经鞘瘤、2例神经纤维瘤和4例脊索瘤,其中13例行Gd-DTPA增强,结果：18例良性肿瘤于T2加权像上均呈高信号（大多数接近脑脊液）,增强后显著强化。6例神经鞘瘤、1例神经纤维瘤和4例脊索瘤信号不均匀,所有病例均位于椎周间隙椎前部分。其中7例位于舌骨上,结论：MR成像可清晰显示椎周间隙病变,划分椎周间隙在一定程度上能进行病变的定性诊断和鉴别诊断。     

Follicular lymphoid hyperplasia simulating intussusception in a 6-year-old boy: clinical, radiological and histopathological findings

We report the case of a 6-year-old boy who initially presented with recurrent abdominal pain. Diagnostic imaging, including ultrasound and CT, showed findings typical of an ileocecal intussusception with abdominal lymphadenopathy. Sonographically, the morphological appearance of the intussusception did not change during a 4-week follow-up period. Surgery was performed on the tentative diagnosis of a tumour versus lymphoma. Upon laparatomy, intussusception was ruled out and a large, broad-based tumour of the caecum was palpable. The histopathology after ileocecal resection revealed follicular lymphoid hyperplasia. Where there is radiological suspicion of an intussusception in children with no or insignificant symptoms, follicular lymphoid hyperplasia should be included in the differential diagnosis.     

Lumbar vertebral chordoma arising from an intraosseous benign notochordal cell tumour: radiological findings and histopathological description with a good clinical outcome

Benign notochordal cell tumours have recently been described as intraosseous benign lesions of notochordal cell origin. The lesions are found in vertebral bodies in 20% of autopsy studies and are a potential precursor of chordoma. We report a rare case of lumbar vertebral chordoma that was thought to arise from a benign intraosseous notochordal cell tumour and which showed significant osteosclerotic change. Radiologically, the lumbar vertebral mass lesion showed hyperintensity on T₂ weighted images, with scanty enhancement on post-contrast T₁ weighted MR images. High uptake corresponding to the mass was noted on fluorine-18-fluorodeoxyglucose positron emission tomography. Bone biopsy revealed proliferation of the physaliphorous cells between thickened bone trabeculae; no nuclear mitosis was observed. Although the mass was diagnosed clinically as spinal chordoma, histopathology contained both benign notochordal cell tumour and conventional chordoma. After heavy particle (¹¹C)-charged radiation therapy was applied to the lesion with a sufficient radiation field margin, the tumour volume significantly decreased and there was improvement in the patient''s symptoms. On follow-up radiological studies, the tumour had markedly regressed and there was no tumour regrowth or distant metastasis. In this case report, benign notochordal cell tumour and conventional chordoma are histopathologically identified in the L1 vertebral body, which contains osteosclerotic and osteolytic areas. It is suggested that the benign notochordal cell tumour coexists with a conventional chordoma and that this histopathological finding supports a hypothetical relationship between benign notochordal cell tumour and chordoma.A 59-year-old woman presented with urinary incontinence and progressive perineal numbness of six months’ duration. She also complained of having recently developed difficulty in walking. There was no history of major medical problems. No remarkable abnormality was observed in the laboratory tests. Physical examination showed paraparesis of the lower extremities and decreased sensation in the perineal region.A plain radiograph (not shown) displayed faint sclerotic change in the L1 vertebral body; CT depicted osteosclerotic change with some small foci of osteolysis in the L1 vertebral body and posterior marginal erosion of the T12 and the L1 vertebral bodies (Figure 1a). On MRI, the mass exhibited homogeneous low intensity with small foci of high intensity on T₁ weighted images (Figure 1b) and heterogeneous low to high intensity in the intraosseous component and hyperintensity in the extraosseous component on T₂ weighted images (Figure 1c), compared with the normal vertebral body. The mass extended into the spinal canal posteriorly and perivertebral space anterolaterally (Figure 1d). After intravenous administration of contrast material, the posterior aspects of the mass enhanced slightly (Figure 1e). Fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) (not shown) revealed moderate FDG uptake (standardised uptake value _ 3.4) in the L1 vertebra. No abnormal FDG uptake was recognised in other areas. The clinical and radiological manifestations were indicative of conditions ranging from a benign bone disorder to a malignant spinal neoplasm, including Paget’s disease, osteoblastic metastasis, Hodgkin’s lymphoma, osteosarcoma or a multiple myeloma in polyneuritis-ostitis-endocrinopaithy-myeloma-splenomegaly syndrome (POEMS) syndrome. Bone biopsy was performed by a right-sided transpedicle approach with a 13 G needle, and multiple histological samples were taken from the osteosclerotic part of the L1 vertebral body.Open in a separate windowFigure 1(a) A sagittal reformatted CT image (bone algorithm) demonstrates posterior marginal destruction at the T12 and L1 level (arrowheads). (b) Pre-contrast-enhanced T₁ weighted sagittal image (repetition time/echo time (TR/TE), 633/11.8 ms) shows a low-signal-intensity mass with small foci of high intensity (curved arrow). (c) T₂ weighted sagittal image (TR/TE, 4000/97.9 ms) demonstrates that the mass extends posteriorly, with narrowing of the spinal canal, and involves the posterior aspect of the T12 vertebral body (arrowhead). (d) T₂ weighted axial image (TR/TE, 4000/102.6 ms) depicts a significant extension of the mass into the perivertebral space (asterisks) and compression of the conus medullaris (arrow). (e) Post-contrast-enhanced T₁ weighted sagittal image (TR/TE, 633/11.8 ms) displays ill-defined slight enhancement on the posterior aspect of the mass (curved arrows).The photomicrograph of the specimen from the L1 vertebral body demonstrated different histology. One showed proliferation of adipocyte-like vacuolated cells between thickened trabecular frameworks without intercellular myxoid matrix, nuclear atypia or intracellular matrix (Figure 2). The other specimen demonstrated proliferation of physaliphorous cells with a prominent intracellular eosinophilic matrix, increased intercellular myxoid matrix and nuclear atypia (Figure 2, inset image). Immunohistochemical stains were positive for vimentin, S-100, cytokeratin and CD-68 (not shown). Although results from haematoxylin and eosin staining were suggestive of metastatic renal cell carcionoma, the results from immunohistochemical stains revealed an intraosseous lesion of notochordal cell origin. The Ki67 index was mostly negative in the sampled specimen. Considering the locally aggressive features of the tumour and results from abdominal CT, which were negative for renal cell carcinoma, a spinal chordoma was the most likely diagnosis. However, histopathologically, the intraosseous tumour was predominantly a benign notochordal cell tumour.Open in a separate windowFigure 2Bone biopsy specimen of the L1 spine reveals proliferation of physaliphorous cells (asterisks) without abundant intercellular myxoid matrix and no mitotic figures between the thickened trabecular frameworks (arrows). In contrast, the inset image demonstrates atypical physaliphorous cells with nuclear atypia and increased intracellular matrix. (Haematoxylin and eosin stain; low-power field with original magnification of ×40, and a smaller inset image of high-power field and original magnification of ×400.)The tumour extended significantly into the perivertebral area anteriorly and the intraspinal canal posteriorly, with compression of the conus medullaris and bilateral nerve roots at the L1 level (Figure 1d). The lesion was probably accessible by the retroperitoneal approach for tumour resection and concurrent spinal reconstruction, followed by adjuvant radiation therapy. In accordance with the patient''s wishes, however, heavy particle ¹¹C-charged radiation therapy with a wide radiation field margin was initially applied to the lesion. The total dose of particle-charged radiation therapy was 64 Gy, fractioned in 16 applications and delivered by quadro portal over 3 weeks. On the patient’s last visit to our department 24 months after radiation therapy, physical examination showed significant recovery of her motor weakness, and follow-up MRI displayed a significant reduction in tumour volume, especially in the spinal canal. No relapsing tumour in the L1 vertebral body was observed, although mild compression fractures developed in the T11 and L2 vertebrae (Figure 3).Open in a separate windowFigure 3Follow-up T₂ weighted sagittal image displays a significant decrease in the size of the mass in the spinal canal, although the mass probably remains in the T12 and L1 vertebral bodies. The T11 and L2 vertebral bodies show a compression fracture in contrast to the sclerotic anterior part of L1, where vertebral morphology is preserved.     

A case of pulmonary synovial sarcoma diagnosed with detection of chimera gene: imaging findings

Pulmonary synovial sarcoma is a rare disease, and reports detailing clinicians' radiological findings are few. We report a case of a primary pulmonary synovial sarcoma in a 68-year-old woman. Chest CT revealed a well-defined and homogeneous oval mass measuring 3x2.5 cm in the left lower lobe in contact with the visceral pleura. No pleural effusion was evident. No calcification or fat component was detected. The tumor showed homogeneous hypointensity on both T1- and T2-weighted MR imaging. In this case, a lung metastasis could be excluded with fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET), and the final diagnosis was histopathologically confirmed by the chimeric gene detection.     

脊柱滑膜肉瘤的影像表现

滑膜肉瘤（synovial sarcoma）是一种起源于原始间叶细胞的恶性肿瘤,较常见,然而发生于脊柱的滑膜肉瘤十分罕见。笔者收集本院经手术和病理证实的脊柱旁滑膜肉瘤2例,现报告讨论如下,旨在提高对脊柱滑膜肉瘤CT表现的认识。     

A case of synovial sarcoma in the submandibular region

Synovial sarcomas are a less common cervical tumor in young patients. We report a 23-year-old man with synovial sarcoma in the submandibular region. T2-weighted MR images demonstrated a mixed-intensity tumor attached to the submandibular gland. T1-weighted MR images revealed a focal area with mildly increased signal intensity, indicating intratumoral hemorrhage. MR images were also useful for visualization of tumor extension. Synovial sarcoma should be considered in the differential diagnosis of well-defined inhomogeneous tumors adjacent to the submandibular gland in young adults.     

脊柱滑膜肉瘤的影像特征分析

目的 探讨脊柱滑膜肉瘤的影像表现,提高对该病的认识.方法 回顾性分析经手术病理证实的4例(男2例,女2例)脊柱滑膜肉瘤的临床及影像资料,重点分析影像特点及手术病理特征.结果 4例患者均行CT及MRI平扫,3例患者行CT及MRI增强检查.CT平扫等密度2例,稍高密度2例;增强扫描不均匀强化3例.T1WI序列:2例低信号,2例等信号;T2WI序列:1例高信号,1例稍高信号,2例混杂高信号;T2WI压脂序列:2例高信号,1例混杂高信号,1例稍高信号;DWI序列:4例明显高信号.T1WI增强序列:1例明显强化,2例不均匀强化.结论 脊柱滑膜肉瘤CT及MRI影像表现具有一定的特征性,结合临床表现有助于提高对本病的认识及诊断.     

Malakoplakia presenting as Pleuropulmonary masses: A rare clinical,radiological and histopathological diagnosis

Pleuropulmonary malakoplakia is a rare granulomatous inflammatory condition characterized by the accumulation of histiocytes that contain basophilic inclusions called Michaelis-Gutmann bodies . It is usually reported in patients with acquired immunodeficiency syndrome. We present clinical, radiological, pathological features and management of a rare case of pulmonary malakoplakia in an immunocompetent male patient with a past history of empyema treated with surgical decortication. Clinically, the patient presented with shortness of breath, productive cough and lethargy. On imaging, Computed Tomography of Thorax showed multiple nodular lung masses and nodular pleural thickening with marked Fluorodeoxyglucose Positron Emission Tomography avidity raising suspicion of advanced pulmonary malignancy. Characteristic Michaelis-Gutmann bodies were identified on histopathology, confirming the diagnosis of malakoplakia. The patient was medically managed with a long course of antibiotics. On follow-up, there was a significant clinical and radiological improvement. Pulmonary malakoplakia is a rare entity, with very few cases reported worldwide, and even fewer in immunocompetent individuals.     

Primary synovial chondromatosis of the shoulder: clinical, arthroscopic and histopathological aspects

Primary synovial chondromatosis is an uncommon condition, and involvement of the glenohumeral joint is rare. Currently, the recommended treatment is arthroscope-assisted synovectomy and removal of the loose bodies. We report a case with the clinical findings, radiographic features, arthroscopic technique for treatment of this disease and the main histological appearance of the removed loose bodies. We believe this is an easy and safe method for management of this disorder and that the support of an experienced pathologist is necessary to avoid differential diagnostic problems with the uncommon malignant transformation.     

Spongiform leucoencephalopathy following intravenous heroin abuse: radiological and histopathological findings

A case of spongiform leucoencephalopathy in a known intravenous heroin abuser is presented. To our knowledge, this is the only case of heroin-related spongiform leucoencephalopathy reported in Australia. The relationship to intravenous rather than inhaled heroin is particularly unusual with only one other possible case documented in the literature. The imaging and histopathological findings are described.     

Erdheim-Chester disease: clinical and radiological findings

Purpose

The authors retrospectively reviewed six cases of histologically proven Erdheim-Chester disease (ECD) to evaluate organ involvement and clinical and radiological findings.

Materials and methods

Through a search of the pathology databases of four Italian hospitals, we identified six men (mean age, 56 years) with a histological diagnosis of ECD. Histology was performed on retroperitoneal or pulmonary biopsy, depending on disease involvement on imaging. Patients underwent plain radiography of the lower limbs and chest, total-body computed tomography (CT) and bone scintigraphy. Magnetic resonance (MR) imaging was performed in two patients to evaluate the lower limbs and in one patient to study the brain, the chest and the abdomen.

Results

Clinical manifestations included dyspnoea (n=2), hydronephrosis (n=2) and bone pain (n=1). Bilateral symmetrical osteosclerosis of the metaphyseal and diaphyseal portions of the lower-limb long bones was present in five patients. Imaging studies revealed extraskeletal manifestations in all patients, including involvement of the retroperitoneal space (n=4), the lung (n=4) and the heart (n=2).

Conclusions

ECD is a multiorgan disease that displays constant involvement of the bones and retroperitoneum; in particular, of the perirenal fat. Although the diagnosis of ECD is histological, imaging can raise suspicion and help to establish a presumptive diagnosis.     

Scrub typhus: radiological and clinical findings

OBJECTIVES: To describe the radiological and clinical findings of scrub typhus. We retrospectively analysed the radiographic, thin-section CT and clinical features of scrub typhus. METHODS: The study included 75 consecutive patients (median age = 47 years, range = 18-81 years) with scrub typhus. Plain chest radiographs were obtained in all 75 patients and 19 underwent thin-section CT within 6 days of initial radiography. The radiographic and thin-section CT findings were retrospectively analysed by three radiologists. RESULTS: Most common clinical symptoms were fever (73/75, 98%), myalgia (61/75, 81%) and headache (60/75%, 80%). Rash (59/75, 79%) and eschar (56/75, 75%) were the most common signs. Radiography showed abnormalities in 54/75 (72%) patients. The most frequent findings were parenchymal abnormalities (53/75, 71%) with lower lung predilection including bilateral reticulonodular opacities (30/75, 40%), ground-glass opacity (19/75, 25%), consolidation (19/75, 25%), septal lines (27/75, 36%) and hilar lymph node enlargement (19/75, 25%). Thin-section CT (n = 19) showed ground-glass opacity (17/19, 89%) predominantly in the lower zones. Bronchial wall thickening (11/19, 58%), centrilobular nodules (9/19, 47%) and interlobular septal thickening (9/19, 47%) were less frequent findings. CONCLUSIONS: Scrub typhus is an acute febrile illness characterized by eschar, which usually has a limited course without serious complication. Diffuse bilateral reticulonodular opacities with lower lung predominance was the most frequent radiographic finding. Chest radiography and thin-section CT show pulmonary interstitial disease which may have a component of pulmonary oedema secondary to cardiac dysfunction.     

Methamphetamine-induced toxic leukoencephalopathy: clinical,radiological and autopsy findings

Toxic leukoencephalopathy represents a process of structural alteration of the white matter. It is caused by substance abuse including drugs such as heroin, cocaine, toluene and ethanol. We reported the clinical, radiological and autopsy findings of a rare case of toxic leukoencephalopathy following chronic methamphetamine (MA) usage. A 34-year-old man with a 3-year history of MA abuse experienced progressive sluggish state, limb weakness, inability to stand and eating disorders, followed by rapid progression to coma and death. Imaging revealed hypodense CT and long T1 and T2 signals in MRI in the white matter of the bilateral periventricular and centrum semiovale regions. Histologically, white matter rarefaction, loss of myelin and axonal injury were observed. This pattern of clinical presentation, radiological manifestations and histological findings show a certain degree of particularity in toxic leukoencephalopathy. Clinically, the condition may be easily misdiagnosed as withdrawal symptoms. In suspected cases, MRI is recommended for diagnosis. The case reported here reminds clinicians and forensic pathologist of the possibility of toxic leukoencephalopathy related to MA abuse.     

A case of gastric plexiform fibromyxoma: radiological and pathological findings

Plexiform fibromyxoma is a relatively new pathological category that consists of a rare group of non-gastrointestinal stromal tumors with a peculiar plexiform growth pattern. We report a case of gastric plexiform fibromyxoma in a 60-year-old man. Gastroscopic examination revealed a gastric submucosal tumor in the antrum. Magnetic resonance imaging (MRI) showed a nodule with distinct signal hyperintensity on T2-weighted images, with strong enhancement peripherally in the early phase to the entire lesion in the delayed phase. Endoscopic ultrasound-guided fine-needle aspiration cytology was performed, and the cytological diagnosis was spindle cell tumor, so partial gastrectomy was performed under a preoperative diagnosis of GIST. The resected tumor demonstrated plexiform architecture, myxoid stroma, prominent vasculature, and spindle cells, reflecting the characteristic findings on MRI. This is the first report to describe radiological findings for gastric plexiform fibromyxoma.     

Epithelioid sarcoma: clinical,MR imaging and pathologic findings

OBJECTIVE: To report and describe the MR imaging features of eight new cases of this rare soft tissue sarcoma and correlate them with the clinical and histologic findings.DESIGN AND PATIENTS. Retrospective analysis was carried out for the MR imaging characteristics and histologic findings of eight patients with pathologically proven epithelioid sarcoma and the literature was reviewed. Findings were correlated in each case with the patient's clinical presentation and eventual outcome.RESULTS: The patients, whose primary tumors ranged from 2.5 cm to 19 cm in maximum dimension, were 1 to 90 years of age. Tumors involved the extremities ( n=5), the scalp ( n=2) and the paraspinal muscles ( n=1). Five tumors presented as well-defined, frequently painful, deeply situated masses and three as subcutaneous nodules or cutaneous ulcers with no palpable mass. Four patients had associated regional lymphadenopathy and one had distant metastases at diagnosis. MR imaging showed tumor infiltration of adjacent tissues in seven patients. Signal characteristics reflected varying degrees of cellularity, and the presence of necrosis, hemorrhage, fibrosis, hyalinization and inflammation. Bone marrow involvement was demonstrated in one patient. Clinical outcomes were generally poor.CONCLUSIONS: Epithelioid sarcoma is an aggressive soft tissue sarcoma with a varied clinical presentation, growth pattern, MR signal characteristics and histologic picture. The tumor favors the distal extremities and is commonly infiltrative and accompanied by enlarged regional lymph nodes. This neoplasm may present as an intramuscular mass but should also be suspected in patients with ulcerating cutaneous nodules with or without regional lymphadenopathy.     

The choledochocele: correlation of radiological, clinical and pathological findings.

Two cases of choledochocele are presented and 14 cases in the literature reviewed. Choledochocele is defined as a herniation of the common bile duct into the duodenum. This entity is distinguishable radiographically from duodenal diverticulum and duodenal duplication cyst by filling during cholangiography but not during upper gastrointestinal series. The duodenal diverticulum fills on upper gastrointestinal series but not on cholangiography. The duplication cyst will not fill with either method.