Primary papillary serous carcinoma of the peritoneum: CT-pathologic correlation

We present the CT findings of three cases of primary papillary serous carcinoma of the peritoneum. All patients presented with massive ascites. CT of the abdomen and pelvis showed omental caking in all patients. The parietal peritoneum of the pelvis showed diffuse enhancement with nodular thickening in all patients. No calcification was noted in the omental and parietal peritoneal masses, although psammoma bodies were present microscopically in one case. The ovaries were normal in size but showed a fine enhancing surface nodularity similar to the pelvic peritoneum. The CT findings of primary papillary serous carcinoma of the peritoneum are nonspecific, but this diagnosis should be considered when peritoneal carcinomatosis is seen on CT with normal-sized ovaries in the absence of other primary malignant neoplasms.     

Primary papillary serous carcinoma of the peritoneum: four cases and review of computed tomography findings

Primary papillary serous carcinoma of the peritoneum is an uncommon primary malignancy of the peritoneum and is histologically indistinguishable from papillary serous carcinoma of the ovary. The diagnosis of primary peritoneal papillary serous carcinoma should be considered in the presence of peritoneal and omental masses in the absence of an ovarian mass. Although it has been extensively documented in the pathological and gynaecological oncology literature, the CT appearance of primary papillary serous carcinoma of the peritoneum has been reported in only 51 cases in five reports. We present four patients with CT findings of pathologically proven primary papillary serous carcinoma of the peritoneum. There were a total of 23 patients with a histopathologically proven diagnosis of primary papillary serous carcinoma of the peritoneum between 1980 and 2002 with CT imaging. However, only four of the 23 patients' CT films were retrieved for retrospective evaluation. The rest of the films were not available as either patients had misplaced the films or patients were deceased.     

CT features of serous surface papillary carcinoma of the ovary

OBJECTIVE: The purpose of this study was to determine the CT appearance of serous surface papillary carcinoma of the ovary. MATERIALS AND METHODS: CT scans of 17 patients with histologically proven serous surface papillary carcinoma of the ovary were retrospectively reviewed. We evaluated the ovary size, omental or mesenteric involvement (none, mild, or severe), ascites (none, small, moderate, or large), and peritoneal thickening (none, smooth, or nodular).We also noted the presence of a cul-de-sac mass, lymphadenopathy, and calcification within the peritoneal mass. The preoperative serum level of cancer antigen (CA)-125 was assessed in all patients. RESULTS: The diameter of ovaries was 3 cm or smaller in 14 patients (82%). All patients had omental or mesenteric involvement by the tumor (mild, n = 2; severe, n = 15) and ascites (small, n = 1; moderate, n = 3; large, n = 13). Peritoneal thickening (smooth, n = 5; nodular, n = 10) was noted in 15 patients (88%) and a cul-de-sac mass in 10 (59%). Lymphadenopathy was noted in five patients (29%) and calcification within the peritoneal mass in one (6%). Serum CA-125 level was elevated in all patients (168-63,300 U/mL). CONCLUSION: Serous surface papillary carcinoma of the ovary should be suggested as a diagnosis in patients who have peritoneal carcinomatosis, relatively normal-sized ovaries, and a highly elevated serum CA-125 level.     

附件脓肿的CT诊断

目的 探讨附件脓肿的CT特征及其诊断价值.方法 回顾性分析26例经手术证实的附件脓肿,分析其CT影像表现.结果 26例附件脓肿中,单侧6例,双侧20例,共46个病灶,其中输卵管脓肿33个病灶,输卵管卵巢脓肿13个病灶.输卵管脓肿的CT征象为输卵管壁增厚,呈管状、囊状或多房囊状扩张,输卵管积脓.输卵管卵巢脓肿多表现为多房囊实性肿块,卵巢脓肿位于中心,外围由输卵管脓肿包绕,脓肿壁呈环形10例,团片状3例,增强扫描脓肿壁呈分层强化.盆腔结缔组织炎21例,表现为盆腔脂肪模糊、密度增高,宫骶韧带增厚,盆腔腹膜炎.输卵管卵巢脓肿与周围结构粘连,其中5例引起肠梗阻,3例引起输尿管积水.子宫内膜炎19例,腹水18例.结论 附件脓肿的CT表现具特征性,掌握其影像特征及其与周围结构的关系,对疾病的及时诊断与治疗非常重要.     

几种常见腹膜弥漫性病变的MSCT诊断及鉴别诊断

目的分析几种常见腹膜弥漫性病变MSCT表现,探讨MSCT诊断及鉴别诊断价值。资料与方法回顾性分析经临床和/或病理证实的41例腹膜弥漫性病变(11例结核性腹膜炎、18例腹膜转移癌、12例原发性腹膜浆液性乳头状腺癌)的MSCT表现。观察指标:(1)壁腹膜、大网膜、肠系膜的受累情况(增厚部位及形式、密度及强化程度等);(2)腹腔积液密度、量及分布范围;(3)淋巴结改变。计算上述指标在各组病变中的出现率,经统计学处理以分析其间差异的显著性。结果3组病变的壁腹膜改变(χ2=12.919,P=0.002)及大网膜改变(χ2=18.025,P=0.001)差异有统计学意义;其中结核性腹膜炎与腹膜转移癌的壁腹膜改变(χ2=11.948,P<0.00125)和大网膜改变(χ2=15.277,P<0.00125)差异有统计学意义。结论壁腹膜光滑均匀增厚高度提示结核性腹膜炎;大网膜饼状增厚则对腹膜肿瘤性病变有较高诊断价值。通过分析腹膜弥漫性病变的MSCT特征,有助于提高病变的诊断准确率。     

Adnexal masses in women with breast cancer: US findings with clinical and histopathologic correlation

PURPOSE: To correlate ultrasonographic (US), clinical, and histopathologic findings in patients with breast cancer who underwent surgery for adnexal masses evident at US. MATERIALS AND METHODS: A database search yielded 54 patients with breast cancer and with adnexal masses at US and histopathologic examinations. Clinical, US, and histopathologic findings were correlated. RESULTS: Forty (74%) patients had benign adnexal masses, and 14 (26%) had malignant masses; three patients had both benign and malignant ovarian masses. Seven patients had primary ovarian cancer, and seven had breast metastases to the ovary. All breast metastases to the ovary were bilateral solid masses at histopathologic examination and occurred in women with stage IV breast carcinoma at the time of US. Eleven ovaries with breast metastases were solid at US. The remaining three ovaries with breast metastases had cystic components at US because of hemorrhage or coexistent benign ovarian cysts. Four of seven patients with primary ovarian carcinoma had bilateral ovarian tumors, and seven of 11 ovarian carcinomas were predominantly cystic at US. No patient with primary ovarian carcinoma had stage IV breast cancer. CONCLUSION: In this small series, half the ovarian malignancies in patients with breast cancer were primary ovarian carcinomas and half were breast metastases to the ovary. Breast metastases to the ovary most frequently are bilateral solid masses at US and are associated with stage IV disease at the time of US.     

Sonographic findings of an ovarian serous surface papillary borderline tumor

Sonographic findings of a serous surface papillary borderline tumor of the ovary have rarely been reported in the English literature. Here, we describe a case of serous surface papillary borderline tumor, which was depicted on gray-scale and Doppler ultrasonography as smoothly lobulated and polypoid heterogeneous echoic bilateral adnexal masses encased or surrounded by what was presumed to be normal-appearing ovarian follicles with increased vascular flow.     

Comparison between multislice CT and MR imaging in the diagnostic evaluation of patients with pancreatic masses

Purpose

This study compared the results of multislice computed tomography (MSCT) and high-field magnetic resonance imaging (MRI) in the diagnostic evaluation of pancreatic masses.

Materials and methods

Forty patients with clinical and ultrasonographic evidence of pancreatic masses underwent MSCT and MRI. The majority of patients (31/40, 78%) had proven malignant pancreatic tumours (24 ductal adenocarcinoma, six mucinous cystadenocarcinoma, one intraductal papillary mucinous carcinoma), whereas the remaining patients (9/40, 22%) were found to have benign lesions (eight chronic pancreatitis, one serous cystadenoma). Results of the imaging studies were compared with biopsy (n=33) and/or histology (n=7) findings to calculate sensitivity, specificity, accuracy and positive (PPV) and negative (NPV) predictive value for correct identification of tumours and evaluation of resectability of malignancies.

Results

Both for tumour identification and resectability, MSCT and MRI had comparable diagnostic accuracy, with no statistically significant differences between them. Tumour identification CT/MRI: accuracy 98/98%, sensitivity 100/100%, specificity 88/88%, PPV 97/97%, NPV 100/100%; tumour resectability CT/MRI: accuracy 94/90%, sensitivity 92/88%, specificity 100/100%, PPV 100/100%, NPV 78/70%.

Conclusions

MRI represents a valid diagnostic alternative to CT in the evaluation of patients with pancreatic masses, both for correct identification and characterisation of primary lesions and to establish resectability in the case of malignancies. New high-field MRI equipment allows optimal imaging quality with good contrast resolution in evaluating the upper abdomen.     

CT findings of abdominal tuberculosis in 12 patients.

Our purpose was to evaluate the Computed Tomography (CT) findings of the abdominal tuberculosis (TBC) retrospectively which was diagnosed histopatologically. This study included 12 patients. All patients were evaluated by abdominal CT study. Most findings of CT studies were mesenteric calcified or noncalcified lymphadenopathies, ascites, thickened intestinal wall located on the right lower quadrant of abdomen, thickening of peritoneum, mottled soft-tissue densities in omentum and mesenterium. In addition, one of the patients had bilateral calcified adrenal glands and one of them had calcified mass in adrenal gland. If peritoneal thickening, ascites, abdominal lymphadenophaties and thickened intestinal walls are obtained, TBC should be considered in differential diagnosis in developing countries.     

Malignant struma ovarii: Case report of an unusual ovarian tumor with CT imaging

Struma ovarii is categorised as a monodermal type of mature teratoma and consists primarily of thyroid tissue. It is an uncommon ovarian tumor, with non–specific clinical, and imaging findings. The majority of struma ovarii are benign and are typically associated with mature cystic teratomas. A small proportion of struma ovarii may undergo malignant transformation, with papillary carcinoma the most common type of malignancy. The criteria used to identify a malignant change in struma ovarii are identical to those used to evaluate the thyroid gland. Nevertheless, due to the rarity of struma ovarii, imaging diagnostic criteria, and subsequent management are not clearly defined. This case report describes a 41-year-old female patient who presented with rapid abdominal enlargement over a period of 1 month, accompanied by elevation of the tumor marker CA-125. Based on these clinically findings, ovarian cancer was suspected. The patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy. Histopathology results revealed a malignant struma ovarii.     

Role of chest CT in the follow-up of ovarian adenocarcinoma

OBJECTIVE: We describe the prevalence of metastatic chest disease in ovarian adenocarcinoma as seen on CT. We sought to determine whether routine chest CT added any pertinent information to the follow-up examination of patients with ovarian adenocarcinoma. MATERIALS AND METHODS: Retrospective review of our tumor registry yielded 96 patients with ovarian adenocarcinoma who had only a single primary malignancy and at least one CT scan of the chest, abdomen, and pelvis. CT scans were reviewed to assess the presence of metastatic chest disease in relation to disease activity in the abdomen and pelvis. Chest CT findings were correlated with the physical examination findings and CA-125 levels and were reviewed in consultation with a gynecologic oncologist to select only those patients with chest abnormalities attributable to metastatic disease. RESULTS: A total of 266 CT scans were obtained. Forty (41.7%) of the 96 patients had abnormalities attributable to metastatic chest disease on one or more scans. In the absence of disease progression in the abdomen and pelvis, chest disease progression was seen in only six (2.7%) of the 226 follow-up CT scans. Five of the six patients had rising CA-125 levels. CONCLUSION: Correlation of the findings of abdominal and pelvic CT with the physical findings and the CA-125 levels serves as effective follow-up in patients with ovarian adenocarcinoma. The contribution of additional chest CT in these patients is small.     

多层螺旋CT对继发性附件扭转的综合评估

目的探讨继发性附件扭转的CT特征及其诊断效能,构建继发性附件扭转的评分系统。资料与方法收集经手术证实的伴有附件肿物的继发性附件扭转患者37例,以及伴有腹痛、附件肿物的对照组患者34例,分析继发性附件扭转的CT特征,采用受试者工作特征(ROC)曲线评价其诊断效能,构建继发性附件扭转的综合评分系统(AT-CI)。结果与对照组比较,继发性附件扭转以下CT特征发生率较高,包括肿物壁偏心性增厚(X^2=4.41,P<0.05)、附件出血(X^2=12.68,P<0.001)、肿物-子宫之间团块状结构(X^2=13.62,P<0.001)、旋涡征(X^2=10.71,P<0.05)、附件周围脂肪模糊/腹水(X^2=5.82,P<0.05)。其中肿物-子宫之间团块状结构敏感度及诊断价值最高,为81.1%(ROC曲线下面积0.71),旋涡征特异度最高,为91.2%。ATCI诊断效能优于任意单一CT特征(ROC曲线下面积0.83),评分0~2分继发性附件扭转可能性小,3~4分怀疑继发性附件扭转,评分>4分,则高度怀疑继发性附件扭转且特异度为100%。结论继发性附件扭转具有典型的CT特征,包括肿物壁偏心性增厚、附件出血、肿物-子宫之间团块状结构、旋涡征、肿物周围脂肪模糊/腹水。AT-CI是综合了继发性附件扭转全部CT特征的实用评分系统,提高了继发性附件扭转的诊断准确性。     

Serous surface papillary carcinoma of the peritoneum: clinical, radiologic, and pathologic findings in 11 patients

OBJECTIVE: The purpose of our study was to describe the clinical, radiologic, and pathologic findings of serous surface papillary carcinoma of the peritoneum in 11 patients. CONCLUSION: Serous surface papillary carcinoma of the peritoneum should be included in the differential diagnosis when ascites, omental caking, and peritoneal nodules or enhancement are observed in a postmenopausal woman with or without ovarian enlargement.     

Invasive carcinomas derived from intraductal papillary mucinous neoplasms of the pancreas: a long-term follow-up assessment with CT imaging

OBJECTIVE: To describe computed tomography (CT) findings of invasive carcinoma derived from intraductal papillary mucinous neoplasms (IPMNs) of the pancreas during long-term follow-up. METHODS: Follow-up CT findings of 5 patients with IPMNs progressing to invasive carcinomas were respectively reviewed for 12 to 63 months. All patients underwent thin-section 3-phase helical and/or multislice CT. RESULTS: Invasive carcinomas were detected as hypo- (n = 3) or hyperattenuating (n = 2) solid masses in the pancreatic parenchyma on contrast-enhanced CT. Hypoattenuating masses were mostly visualized on arterial dominant phase images. In 4 branch-duct type IPMNs, the solid masses appeared with (n = 3) or without (n = 1) dilatation of the main pancreatic duct after 3 to 5 years. In the remaining combined-type IPMN, a solid mass was detected on initial CT and progressively increased during the follow-up. CONCLUSIONS: Arterial dominant phase CT is useful for detecting invasive carcinoma derived from IPMNs and is an effective follow-up method.     

CT of fundoplication

To determine the CT findings postfundoplication, we retrospectively compared CT in 22 postfundoplication patients with CT in 22 patients with unrepaired hiatal hernias and gastroesophageal (GE) junction abnormalities and 24 patients with gastric or esophageal carcinoma involving the GE junction. Seventeen of the 22 postfundoplication patients had undergone a Nissen procedure. Of the 22 patients, 11 had esophageal dilatation, 14 had GE junction masses, 4 had esophageal wall thickening, 7 had surgical clips, and none had hepatic metastases or upper abdominal lymphadenopathy. Statistically, on CT, postfundoplication patients are more likely to have a GE junction mass (p = 0.023) and least likely to have wall thickening (p = 0.021). Nonetheless, because the findings occur frequently in each group, they are not diagnostic in the individual patient. However, 11 of 12 post-Nissen masses had the unique finding of an oval or linear central fat density within the mass. This finding was absent in the other postfundoplication masses and in those patients with repaired hiatal hernia or tumor. We conclude that pseudomasses occur on CT postfundoplication and can be indistinguishable from hiatal hernias and GE junction neoplasms unless a central fat density is present.     

Krukenberg瘤病理及CT表现特点

目的:探讨胃肠道来源Krukenberg瘤的CT表现。方法:回顾性分析11例Krukenberg瘤患者的CT表现、临床病史和手术病理结果。结果:11例Krukenberg瘤来源于胃癌6例,直肠癌1例,结肠癌2例,另2例原发灶不明。CT 扫描共发现19个卵巢肿块灶,双侧肿块8例,单侧3例;囊实混合性病灶15个,实性4个,实性成分可强化;肿块与周围组织边界清楚16个,不清楚3个。结论:双侧卵巢出现边界较清的囊实性或实性为主肿块,应考虑Krukenberg瘤可能。CT 是发现消化道原发灶及远处转移的可靠方法之一。     

动态增强CT和MRI诊断乳头状肾细胞癌

目的:探讨乳头状肾细胞癌的影像学表现、生物学行为、血液动力学特征、病理等及其相关关系,以提高诊断准确性。方法:经手术病理证实的乳头状肾细胞癌患者13例,术前行CT平扫及皮髄交界期和实质期增强扫描,注射流率3～4ml/s,2例同时行MRI检查。回顾性分析其CT和MRI表现并与手术病理结果进行对照。结果:13例中肿瘤位于右侧5例,左侧8例;呈圆形或椭圆形7例,分叶结节状或不规则形6例,其中呈边缘结节状突起5例、不规则形1例;直径1.5～9.0cm,平均4.7cm;肿瘤密度均匀4例,不均匀9例,所有肿瘤境界清楚。肿瘤平扫CT值18.3～35.9HU,平均26.3HU;动态增强皮髓交界期CT值27.9～57.1HU,平均36.2HU;实质期CT值34.8～71.0HU,平均48.6HU。实质期肿瘤境界最清楚,坏死囊变区不强化。2例行MRI检查,T1WI示肿瘤呈低～中等信号,T2WI呈等～低信号,MR动态增强特点与CT相似。结论:乳头状肾细胞癌的影像学表现有一定特征性,动态CT扫描和MRI对诊断和鉴别诊断有重要价值。     

Radiologic findings of gastrointestinal tract involvement in hepatocellular carcinoma.

PURPOSE: The purpose of this work was to evaluate the radiologic findings of gastrointestinal (GI) tract involvement in hepatocellular carcinoma (HCC) and to discuss mechanisms of spread. METHOD: Eighteen patients with histologically proven GI tract metastasis in HCC for 4.5 years underwent CT and five also underwent upper GI (UGI) series. The cases were classified according to the mode of spread, based on the radiologic findings. RESULTS: The involved portion of the GI tract was the stomach (n = 11), duodenum (n = 4), and colon (n = 4). The mode of spread was direct invasion from a contiguous primary tumor (n = 12), hematogenous metastasis (n = 3), peritoneal seeding (n = 1), and undetermined (n = 2). In cases of direct invasion from contiguous primary tumors, CT revealed GI tract invasion directly from bulky hepatic masses (n = 9) or daughter masses at the portion of the bowel wall contiguous to the hepatic masses (n = 3). In cases of hematogenous spread, CT revealed an intramural mass in the stomach and duodenum (n = 2) or a diffuse thickening of the wall of the stomach (n = 1). In the case of peritoneal seeding, CT revealed multiple small nodules in the right paracolic gutter, omentum, and mesentery with invasion to the colon. CONCLUSION: GI tract involvement in HCC shows various radiologic findings according to the mode of spread, but the most common finding is direct invasion of the stomach, duodenum, or colon from contiguous primary tumor.     

Role of CT in the management of recurrent ovarian cancer

OBJECTIVE: The purpose of this study was to evaluate the potential role of preoperative CT in patients with recurrent ovarian cancer who undergo secondary cytoreductive surgery. MATERIALS AND METHODS: Preoperative CT examinations of 36 consecutive patients (age range, 30-75 years; mean age, 55 years) were reviewed retrospectively. Patients had recurrent ovarian cancer and secondary cytoreduction within a mean CT-surgery interval of 22 days (range, 2-69 days). The CT findings recorded were upper abdominal metastases (e.g., peritoneal carcinomatosis; perihepatic, perisplenic, gastrohepatic or gastrosplenic ligaments; gallbladder fossa; falciform ligament; lesser sac), lymphadenopathy (above or below the renal hilum), liver metastasis, large- and small-bowel obstruction, hydronephrosis, ascites, and the presence of a pelvic mass. CT findings and cancer antigen-125 (CA-125) levels were correlated with surgical resectability. RESULTS: At surgery, tumors in 27 patients were optimally debulked (residual disease of 相似文献   

CT features of systemic lupus erythematosus in patients with acute abdominal pain: emphasis on ischemic bowel disease

PURPOSE: To evaluate the computed tomographic (CT) features of systemic lupus erythematosus (SLE) in patients with acute abdominal pain. Special emphasis was placed on the analysis of ischemic bowel disease. MATERIALS AND METHODS: The authors retrospectively reviewed the images from 39 abdominal CT examinations performed in 33 patients with SLE and acute abdominal pain. Images were evaluated for bowel wall changes, mesenteric changes, fluid collection, retroperitoneal lymphadenopathy, peritoneal enhancement, and hepatomegaly as well as for changes in other abdominal organs. Ischemic bowel disease was diagnosed if at least three of the following signs were seen: bowel wall thickening, target sign, dilatation of intestinal segments, engorgement of mesenteric vessels, and increased attenuation of mesenteric fat. RESULTS: Thirty-one (79%) of the 39 examinations had CT findings diagnostic of ischemic bowel disease, including symmetric bowel wall thickening (n = 29), target sign (n = 26), and mesenteric vascular engorgement and haziness (n = 31). In 24 cases, bowel wall thickening was multifocal, with variable length, and did not appear to be confined to a single vascular territory. CONCLUSION: The most common CT finding in patients with SLE and acute abdominal pain is ischemic bowel disease. CT is useful for detecting the primary cause of gastrointestinal symptoms, planning treatment, and monitoring for infarction or perforation.