Emphysematous gastritis: Case report and literature review

Emphysematous gastritis is a rare form of gastritis that results from infection of the stomach wall by gas‐forming organisms. Diagnosis of this commonly fatal condition rests on radiological demonstration of gas within the stomach wall. This can be observed on plain radiographs or CT scans of the abdomen. Only by prompt diagnosis and treatment can mortality be avoided. A new case of empysematous gastritis, diagnosed on CT scan by the demonstration of both intramural and portal venous gas, is presented and the literature is reviewed.     

Case report and brief review: IL-2-induced myocarditis

High dose bolus interleukin 2 (IL-2) used in the treatment of metastatic melanoma and renal cell carcinoma is known to have the potential for serious cardiac toxicity. At our institution 2 of 57 (3.5%) patients developed IL-2 induced myocarditis. The constellation of electrocardiographic changes and elevated troponin I is the hallmark of myocarditis. In this setting of high dose IL-2 therapy it is important to keep myocarditis in the differential in addition to the more frequently sought diagnosis of acute myocardial infarction. Although the gold standard for diagnosis is endomyocardial biopsy, there is considerable false negative rate. It may be reasonable to make the diagnosis on clinical grounds, while providing supportive care. Future investigation is required to better understand the pathophysiology and what factors may influence expression of this toxicity.     

Orbital multiple myeloma: Case report and review of computed tomography features

Orbital involvement at diagnosis in multiple myeloma is rare. Only a few a cases are reported with computed tomographic features. We report a case of orbital myeloma, and relevant medical reviews on computed tomography features are discussed.     

Diffuse panbronchiolitis: Case report and review of the literature

Diffuse panbronchiolitis is an uncommon disease of unknown aetiology mainly occurring in Asian races. Treatment with erythromycin acting through unclarif ied mechanisms is promising and may improve the poor prognosis currently associated with the disease. A case is presented illustrating how the imaging features of the disease, particularly on high-resolution computed tomography, may be used to support a diagnosis suggested on clinical grounds.     

Disseminated histoplasmosis and aids: relapse and late mortality in endemic area in north‐eastern Brazil

The State of Ceará in north‐eastern Brazil has one of the highest rates in the world of relapse and death due to disseminated histoplasmosis (DH) in acquired immunodeficiency syndrome (AIDS) patients. The objective of this study is to characterise the relapse and mortality of DH in AIDS cases residents in Ceará. We performed a retrospective analysis of the medical records of AIDS patients who had a first episode of DH from 2002 to 2008. We analysed the outcomes until December 31, 2010. A total of 145 patients participated in the study. The mean clinical follow‐up duration was 3.38 years (SD = 2.2; 95% CI = 3.01–3.75). The majority of the subjects were male with a mean age of 35 years (SD = 2.2; 95% CI = 3.01–3.75) and were born in the capital of Ceará. DH was the first manifestation of AIDS in 59% of the patients. The relapse rate was 23.3%, with a disseminated presentation in 90% of these patients. The overall mortality during the study period was 30.2%. The majority of patients who relapsed or died had irregular treatment with antifungals or highly active antiretroviral therapy and did not have active clinical follow‐up. High rates of recurrence and mortality were found in AIDS‐associated DH in this area of the country.     

Giant cell tumour of the temporal bone: Case report and review of the literature

This paper presents an expansile lesion of the temporal bone, in a 14-year-old boy, that was initially diagnosed as intra-osseous meningioma from CT appearance. At histopathology a final diagnosis of giant cell tumour was made. A brief review of the literature is presented for this rare case.     

Hepatic plasmacytomas: Case report and review of imaging features

Extramedullary plasmacytomas are uncommon and have a better prognosis than disseminated myeloma. We describe the second case of hepatic plasmacytomas (multiple) following a solitary bone plasmacytoma. The imaging characteristics of the few reported cases of these rare hepatic tumours are compared. The value of ultrasound in the assessment of liver lesions is emphasized.     

Adrenal myelolipoma: Case report with a review of the literature

A 40 year old woman who was pre-operatively diagnosed as possibly having adrenal myelolipoma is reported. Adrenal myelolipomas are rare, non-functional benign tumours comprising varying amounts of fat and haematopoietic elements. Albeit possibly coincidental, there is a frequent association with obesity, hypertension, and/or diabetes mellitus. A growing number of patients are being diagnosed during ultrasonographic or computerized tomographic scanning for unrelated problems.     

Multiplanar reconstruction in adult intussusception: Case report and literature review

We describe the use of computed tomography (CT) with multiplanar reconstruction (MPR) in positive diagnosis of a case of enteric intussusception in an adult. To our knowledge, there have been no previous reports of the use of MPR in this setting. Intussusception in adults is an uncommon cause of bowel obstruction that usually presents with non‐specific symptoms. An underlying lesion is found in most cases. Multiplanar reconstruction should be used to confirm the diagnosis of intussusception when suspected on axial views, and should increase the yield of positive diagnoses when used in the assessment of a complex abdominal mass involving the bowel.     

Lymphomatoid granulomatosis: Case report and review of the literature

Lymphomatoid granulomatosis (LG) is an uncommon disease now regarded by most authors as an unusual form of lymphoma with the ability to affect any bodily system. The disease and its complications may result in a spectrum of radiological appearances. A case illustrating how cerebral lesions may mimic demyelinating plaque, neoplasm or infection and how pulmonary lesions may lead to pneumopericardium is presented. The difficulty in establishing a definitive diagnosis, due to the non-specificity of symptoms, pathological investigations and radiological appearances of the disease, is emphasized. Clinicians must therefore consider LG in their differential diagnoses, as delayed treatment may affect prognosis.     

ADM3, TFF3 and LGALS3 are discriminative molecular markers in fine-needle aspiration biopsies of benign and malignant thyroid tumours

Background:

Previously, we reported a six-marker gene set, which allowed a molecular discrimination of benign and malignant thyroid tumours. Now, we evaluated these markers in fine-needle aspiration biopsies (FNAB) in a prospective, independent series of thyroid tumours with proven histological outcome.

Methods:

Quantitative RT–PCR was performed (ADM3, HGD1, LGALS3, PLAB, TFF3, TG) in the needle wash-out of 156 FNAB of follicular adenoma (FA), adenomatous nodules, follicular and papillary thyroid cancers (TC) and normal thyroid tissues (NT).

Results:

Significant expression differences were found for TFF3, HGD1, ADM3 and LGALS3 in FNAB of TC compared with benign thyroid nodules and NT. Using two-marker gene sets, a specific FNAB distinction of benign and malignant tumours was achieved with negative predictive values (NPV) up to 0.78 and positive predictive values (PPV) up to 0.84. Two FNAB marker gene combinations (ADM3/TFF3; ADM3/ACTB) allowed the distinction of FA and malignant follicular neoplasia with NPV up to 0.94 and PPV up to 0.86.

Conclusion:

We demonstrate that molecular FNAB diagnosis of benign and malignant thyroid tumours including follicular neoplasia is possible with recently identified marker gene combinations. We propose multi-centre FNAB studies on these markers to bring this promising diagnostic tool closer to clinical practice.     

Clinical Utility of BRAF,NRAS, and TERT Promoter Mutation in Preoperative Thyroid Fine-Needle Aspiration Biopsy: A Diagnostic Study From Dharmais Cancer Hospital

Objective: Molecular testing of thyroid nodules becomes important for improving the accuracy of fine-needle aspiration biopsy (FNAB). This study aimed to investigate the diagnostic utility of BRAF, NRAS, and TERT promoter mutation in thyroid nodules at Dharmais Cancer Hospital.Methods: We performed a prospective diagnostic study involving 50 patients with thyroid nodules who needed surgery between September 2013 and August 2014. Mutational hotspots in BRAF exon 15, NRAS exon 3, and TERT promoter region were analyzed by Sanger sequencing from FNAB specimens. Cytology and molecular data were compared to histopathology results.Result: Of the 50 cases included in the analysis, 39 cases (78%) were thyroid malignancies. Mutations of BRAF, NRAS, and TERT promoter were detected in 31% (12/39), 18% (7/39), and 13% (5/39) cases, respectively. BRAF and NRAS mutations were found mutually exclusive, while all of TERT promoter mutation was found coexistent either with BRAF (40%) or NRAS (60%). The combination of FNAB cytology and molecular testing resulted in 69% sensitivity, 100% specificity, 100% positive predictive value, 48% negative predictive value, and 76% accuracy.Conclusion: Molecular testing of BRAF, NRAS, and TERT mutations improve the sensitivity of thyroid FNAB and is beneficial for more definitive treatment in selective cases. However, the NPV is relatively low to avoid the need for diagnostic surgery. Therefore, further studies to identify more sensitive methods and more comprehensive molecular markers in the diagnosis of thyroid nodules are needed.     

精氨酸酶-1在原发性肝癌及肝转移癌鉴别中的作用

目的： 探讨精氨酸酶-1(Arg-1)在原发性肝癌(PHC)和肝转移癌(HM)鉴别中的意义。方法：123例肝癌患者行超声引导下细针穿刺活检,标本制作成细胞块进行免疫组化染色,观察Arg-1表达情况。所有患者行手术切除后进行组织病理学诊断,结合细胞学、血清肿瘤标记物、临床及影像学随访结果进行最终判定。计算采用Arg-1鉴别PHC和HM的敏感度和特异性。结果：123例患者中PHC 78例,HM 45例。在PHC患者中,Arg-1呈高表达(83.3%)且以强染色为主(60.3%),高、中度分化肝细胞癌患者中阳性表达率(92.9%)高于低分化患者(76.9%),在胆管细胞型肝癌患者中不表达,在混合型肝癌患者中阳性表达率为75%;在HM患者中,Arg-1阳性表达率较低(8.9%),存在于结直肠癌、胰腺癌、乳腺癌肝转移患者中且均为弱染色,其他原发部位肝转移患者未见Arg-1阳性表达。Arg-1用于PHC和HM鉴别的敏感度为83.3%,特异性为91.1%。结论：细针穿刺活检标本行Arg-1免疫组化染色用于PHC和HM鉴别的敏感度和特异性均较高,值得进一步推广。     

Acquired spontaneous intercostal abdominal hernia: Case report and a comprehensive review of the world literature

Intercostal hernias develop most often as a result of a blunt or penetrating thoracoabdominal trauma. We know of no prior report of a spontaneously occuring intercostal hernia. This study presents a review of the published literature that deals with this uncommon phenomenon, along with a discussion of our patient’s clinical presentation and imaging findings.     

Investigations of fatal causes of chest pain: Case report and literature review

A case of fatal ascending aortic dissection (AAD) misdiagnosed as pulmonary embolism (PE) despite strong radiological evidence is described. The occurrence of this serious pathology is uncommon. Its prompt diagnosis and treatment are crucial. Anticoagulant therapy for pulmonary embolism should be withheld until acute aortic dissection is excluded definitively. A management approach to optimise the outcome of patients with chest pain in which ascending aortic dissection and/or pulmonary embolism are suspected is presented.     

Role of fine-needle aspiration cytology and core biopsy in the preoperative diagnosis of screen-detected breast carcinoma

Core biopsy (CB) has now largely replaced fine-needle aspiration cytology (FNAC) in the preoperative assessment of breast cancer in the UK. We studied the contribution of FNAC and CB in the preoperative diagnosis of screen-detected breast carcinoma. Data were prospectively collected on 150 840 women who underwent breast screening over a 4-year period from 1999 to 2003. Data on women who had both FNAC and CB taken from the same lesion preoperatively and in whom surgical excision of the lesion subsequently confirmed malignancy was analysed. In 763 cancers, FNAC was inadequate (C1) in 8% and benign (C2) in 10%. Most of these cases presented with microcalcification (25% were C1 or C2). Core biopsy was not representative (B1) or benign (B2) in 7%. The absolute and complete sensitivities were 65 and 82% for FNAC and 80 and 93% for CB in the diagnosis of cancer. Core biopsy was abnormal (B3 or above) in 86% of the cancers missed by FNAC and FNAC was abnormal (C3 or above) in 65% of those missed by CB. Core biopsy is better than FNAC at preoperative diagnosis of screen-detected breast cancer as it missed fewer cancers. However, combining FNAC resulted in a better preoperative diagnosis rate.     

原发性膀胱嗜铬细胞瘤一例并文献复习

目的:探讨膀胱嗜铬细胞瘤临床诊疗过程中的特征,以期提高对该病的认识。方法:回顾性分析我院一例膀胱嗜铬细胞瘤患者的临床资料,并检索中国知网、万方、Pubmed等数据库,对相关文献进行系统性分析,归纳其临床特点。结果:本例患者行膀胱部分性切除术,术后一般情况良好,无阵发性血压升高,无头痛尿痛,随访五个月未见进展。结论:膀胱嗜铬细胞瘤是一种罕见的泌尿系肿瘤,有些甚至无特异临床表现。膀胱嗜铬细胞瘤的诊断应该结合临床表现,儿茶酚胺及其代谢产物的检测,再同时结合影像学资料,确诊依靠病理。治疗应以手术切除为主,对于难以切除的膀胱嗜铬细胞瘤可行辅助化疗、放疗等治疗等。 【关键词】膀胱嗜铬细胞瘤;膀胱部分性切除术;阵发性高血压;无痛性肉眼血尿     

Adrenal leiomyoma: A case report and review of the literature

We describe a case of a 65-year-old Caucasian woman found to have an enlarging mass of the left adrenal gland. Laboratory examination revealed the mass to be nonfunctional. The patient underwent an uneventful left adrenalectomy. Pathological examination revealed the mass to be a leiomyoma. These tumors are benign and develop from smooth muscle cells. They can occur in any part of the body where smooth muscular layers exist, but occur frequently in the uterus and gastrointestinal tract. This case report presents a review of the recent literature on this rare entity. J. Surg. Oncol. 1998;69:111–112. © 1998 Wiley-Liss, Inc.