A case of head and neck cutaneous squamous cell carcinoma highlighting aggressive perineural features

Cutaneous squamous cell carcinoma (cSCC) is the second most common nonmelanoma skin cancer in the United States following basal cell carcinoma. The majority are successfully cured by surgical excision or Mohs microsurgery. A subset of cSCCs are more aggressive and likely to recur locally, spread to regional lymph nodes or even distantly, and can even result in death. High-risk features of cSCC including perineural invasion of nerve >0.1 mm in diameter and invasion beyond the subcutaneous fat are not routinely reported by Mohs microsurgery. Facial cSCC commonly involves branches of the facial nerve (VII) or trigeminal nerve (V). Clinical symptoms associated with cranial nerve VII and V involvement include pain, paresthesia of the face and tongue, facial paralysis. Assessment of nerve involvement by magnetic resonance imaging (MRI) is the most optimal imaging modality. Here, we present a case where Mohs microsurgery was performed on a facial cSCC 1.5 years prior to the development of facial paresis. We aim to highlight the interesting perineural path resulting in facial paralysis and associated symptomatology, the importance of MRI, and to remind clinicians of important high-risk features of cSCC.     

侵袭性纤维瘤病的MRI特征

目的探讨侵袭性纤维瘤病的MR特征。方法对11例经手术病理证实的侵袭性纤维瘤病MRI征象进行回顾性分析。结果 11例侵性纤维瘤病表现为腹内或腹壁软组织肿块,肿块呈圆形、类圆形或不规则形、爪形。MRI检查,T2WI病灶均呈稍高信号;T1WI呈等信号6例,呈稍低信号3例,呈稍高信号2例;脂肪抑制T2像,病灶呈明显高信号,并能清晰显示肿瘤的边界及范围。其中4例病灶在各序列均见有条带状致密胶原纤维形成的低信号影。动态增强扫描动脉期及静脉期病灶轻中度不均匀强化,延迟期病灶明显强化并趋于均匀。其中4例病灶周边及内部残留有斑片状、条状无强化稍低密度区。结论侵袭性纤维瘤病的MRI表现具有一定特征性,MRI检查对该病有较高的诊断价值。     

Imaging features of aggressive angiomyxoma

AIM: To describe the imaging features of aggressive angiomyxoma in a rare benign mesenchymal tumour most frequently arising from the perineum in young female patients. MATERIALS AND METHODS: We reviewed the computed tomography (CT) and magnetic resonance (MR) imaging features of patients with aggressive angiomyxoma who were referred to our hospital. The imaging features were correlated with clinical information and pathology in all patients. RESULTS: Four CT and five MR studies were available for five patients (all women, mean age 39, range 24-55). Three patients had recurrent tumour at follow-up. CT and MR imaging demonstrated a well-defined mass-displacing adjacent structures. The tumour was of low attenuation relative to muscle on CT. On MR, the tumour was isointense relative to muscle on T1-weighted image, hyperintense on T2-weighted image and enhanced avidly after gadolinium contrast with a characteristic "swirled" internal pattern. MR imaging demonstrates the extent of the tumour and its relation to the pelvic floor. Recurrent tumour has a similar appearance to the primary lesion. CONCLUSION: The MR appearances of aggressive angiomyxomas are characteristic, and the diagnosis should be considered in any young woman presenting with a well-defined mass arising from the perineum.     

肾集合管癌1例

患者男,50岁。反复发热4个月,超声查体发现右肾占位2天入院。入院查体未发现阳性体征。血及尿常规、肝肾功能、电解质正常,心电图、胸部X线片正常。入院MRI检查示：右肾下极可见一不规则短T2异常信号灶,边界欠清（图1）,FS-T1WI呈等、略低信号（图2）。注入Gd-DTPA动态扫描示病灶呈渐进性强化,皮髓质期肿瘤呈轻度不均匀强     

胸部腹外型侵袭性纤维瘤病的CT表现

目的：分析发生于胸部的腹外型侵袭性纤维瘤病的CT表现,提高对本病的诊断水平。方法：回顾性分析19例经手术病理证实的胸部侵袭性纤维瘤病患者的CT 表现。19例均行 CT 平扫,9例行增强扫描,1例行 CTA 检查。结果：19例共检出23个病灶,其中3例为多发病灶（发生于软组织1例、骨骼2例）。病变位于软组织15例共16个病灶（两侧和前胸壁8个、背部5个、肩部1个、腋窝1个）,位于骨骼4例共7个病灶（肋骨5个、胸肋关节1个、胸骨上段1个）。16个软组织肿块中呈类圆形或梭形13个,分叶形或不规则形3个;边界不清13个,边界清晰3个（其中2个有假包膜）;CT平扫表现为等或低密度肿块14个,囊实性肿块2个,3个病灶内可见钙化（分别呈点状、弧形和爆米花样）;增强扫描9例共10个病灶中,表现为轻度均匀强化2个,明显不均匀强化2个,边缘轻度强化1个,边缘明显强化2个,轻中度不均匀强化2个,多发小圆形轻中度环形强化1个;5个病灶可见肿瘤与骨质粘连伴骨质破坏。4例共7个骨骼病灶,CT 平扫6个表现为骨内软组织肿块、膨胀性骨质破坏（1个出现周缘硬化边）,1个表现为软组织肿块伴有局限性骨皮质压迫吸收;肿块呈较低密度3个,等或稍低密度3个,稍高密度1个;1例行增强扫描,肿瘤呈轻度～中度不均匀强化。结论：胸部侵袭性纤维瘤病的CT表现有一定特征性,CT对本病具有较高的诊断价值。     

Giant cell reparative granuloma of the phalanx of the hand with aggressive radiographic features

This report describes a giant cell (reparative) granuloma in the proximal phalanx of the third finger of the right hand in a 52-year-old man. Radiographically it showed aggressive features with bony permeation, breaking of the cortex, and soft tissue extension. These features suggested a malignant lesion. Histology was characteristic of giant cell reparative granuloma. This lesion, along with aneurysmal bone cyst and giant cell tumor in the small bones of hand and foot, occasionally may show aggressive features mimicking a malignant lesion.     

A case with primary hyperaldosteronism associated with chronic kidney disease

Primary hyperaldosteronism (PA) is one of the most common causes of secondary hypertension. PA may be associated with a decline in renal function. About 20% of cases with resistant HTN eventually cause PA, so all these patients should be evaluated for PA. Herein, we present a case with drug-resistant hypertension and chronic kidney disease (CKD), the cause of which was PA. Despite his low-salt diet modifications and treatment with several classes of antihypertensive medication, he had poorly controlled blood pressure (BP). Measurements of aldosterone and renin raised the concern of PA. Imaging confirmed bilateral adrenal hyperplasia. Due to the persistently high BP, despite the modification of the antihypertensive treatment, the patient underwent unilateral adrenalectomy, as the only feasible possibility of lowering aldosterone levels. After surgery, the patient had an improvement in both BP values and renal function. PA is difficult to diagnose in patients with CKD and Arterial Hypertension because hypertension is often associated with CKD, but PA accounts for a significant percentage of drug-resistant hypertension, so these patients should be screened for secondary arterial hypertension.     

侵袭性血管黏液瘤CT、MRI征象分析

目的 分析侵袭性血管黏液瘤(AA)的CT及MRI表现特点.方法 收集本院病理证实为AA患者8例(男1例,女7例),分别应用多排螺旋CT(平扫2例,平扫+增强4例)或磁共振(平扫+增强6例)检查及后处理.观察病灶大小、位置、质地、形态、强化方式等表现并记录分析.结果 病灶直径＞10 cm者4例;CT平扫为不均匀等/低密度影,边界清或大部分清楚6例;含囊变成分2例,有附壁结节2例;增强表现片状不均匀逐渐强化并范围扩大4例,多平面重建(MPR)显示分层漩涡征2例,病灶内成熟小血管影3例.MRI T2 WI呈高/略高信号5例,其中分层漩涡征3例,含囊变成分2例;增强呈分层漩涡征逐渐强化并范围扩大3例,3例时间-信号曲线(TIC)均为缓升型.结论 AA女性多见,CT/MRI表现病灶多较大,质地不均,逐渐强化并范围扩大,分层漩涡征具有特征性,CT可显示灶内小血管影,MRI表现缓升型曲线.     

先天无子宫阴道并盆腔异位融合肾超声表现1例

患者女,18岁。因无月经来潮而就诊。8岁时第二性征显现,15岁乳房开始发育,但一直未来月经。以往体健,无周期性下腹疼痛、膀胱刺激征及漏尿等临床表现。妇科检查:女性阴毛分布,大小阴唇发育好,尿道口正常,无阴道开口。肛诊:盆腔内未扪及子宫,但隐约可及两则卵巢。于盆腔内扪及一     

A case of breast carcinoma with sarcomatous metaplasia

We report the distinct mammographic appearance of a breast carcinoma in a woman of 58 years, which proved on histology to be adenocarcinoma with metaplasia to osteosarcoma. The unusual appearance may alert radiologists, surgeons and pathologists to the possibility of an uncommon tumour.     

飞行员肾结石一例

一、临床资料 患者,男性,29岁,歼-7飞行员,飞行时间:700 h.2006年12月高性能战斗机改装体检时腹部B超检查双肾无异常,CT示右肾上极有1个约2 mm×3 mm大小结石,腹部X线平片及静脉肾盂造影检查均未见肾结石,倾斜试验阳性,无任何不适,查体无异常,结论:改装体检飞行不合格,原机种暂时飞行不合格;建议地面观察3个月后返院复查.     

Rhabdoid tumor of the kidney: A case report

Rhabdoid tumor of the kidney may simulate other pediatric renal tumors radiographically but it has a characteristic clinical course with a high incidence of intracranial tumors. This clinical course and its implications for prognosis and radiographic work-up are discussed.     

肾尤文肉瘤一例

患者男,26岁.右侧腰背部间隙性胀痛2周,于2009年11月10日入我院就诊.B超示右肾实质性占位性病变. CT检查:平扫右肾于肾门上方体积增大,见混杂密度影,高密度血块CT值68 HU,等密度肿瘤实质CT值35 HU,肾包膜下见半月形低密度影,未凝固的血液CT值14 HU.     

Splenic lymphangioma: A rare adult case with imaging features

This paper describes imaging findings of splenic lymphangioma in a 59-year-old female patient, together with a critical review of the literature. Lymphangioma exclusively in the spleen in adults is a rare event and, in most cases, it is asymptomatic.     

右肾多发囊肿性肾发育不良1例

患者女,17个月.于2001年7月17日因右上腹部肿块渐大半年入住本院.入院检查:发育稍差,腹部明显隆起,以右上腹为甚,未见胃肠型及蠕动波,腹肌软,无压痛及反跳痛,肝脾扪及不满意.