Transperineal-incision urethrectomy combined with laparoscopic prostatectomy for a male patient with squamous cell carcinoma involving distal plus proximal urethra and untypical symptoms—a case report

Primary urethral carcinoma (PUC) is a rare malignancy, covering less than 1% of all genitourinary cancers. Different tumor location, classified as tumor in distal or proximal urethra, represents different characteristics and often leads to different treatment modality. However, data on the surgical approach for PUC involving both distal and proximal urethra remains rare. In this case, we presented a 75-year-old man with untypical symptoms of perineal mass and unspecific frequent and painful urination. Results of multiparametric magnetic resonance imaging (mp-MRI), positron emission tomography/computed tomography (PET/CT) scan, and percutaneous biopsy revealed a cT2N1M0 PUC involving both distal and proximal urethra. Given the request of patients for a normal penile appearance after surgery, a transperineal-incision urethrectomy combined with laparoscopic prostatectomy and iliac lymphadenectomy was performed with optimal outcomes. The results of histopathological analysis revealed a moderately-high differentiated PUC with no positive lymph node. Post-operative recovery was uneventful. On first visit 1-month after surgery, physical examination revealed a satisfactory wound healing and appearance of penis and no recurrent lesions were found on mp-MRI. This is a rare case with untypical symptoms indicating that patients with PUC involving both distal and proximal urethra may present with no symptoms of urethral stricture but only non-specific lower urinary symptoms. The surgical approach we proposed in this case proves to be a safe and feasible one to completely resect the tumor and preserve a normal appearance of penis, thus worth to be applied in the specific patient population.     

Primary oligodendroglioma of the lateral ventricle with computed tomographic and positron emission tomographic evaluations

Two cases of primary intraventricular oligodendrogliomas are presented. Total excisions of well-demarcated large tumors in the lateral ventricle were successfully performed in young women by means of a frontal transventricular approach. An evaluation by computed tomography and positron emission tomography was attempted to obtain definite diagnosis of not only the location of the tumor but also the histologic grade of malignancy.     

Epithelioid hemangioma of the distal humerus with pathologic fracture

Epithelioid hemangioma is a rare tumor that can have bone involvement. Its clinically and radiographically aggressive appearance mimics a malignant neoplasm. Although epitheliod hemangioma has been described as having an aggressive appearance on magnetic resonance imaging (MRI) and plain radiographs, this is the first reported case of pathologic fracture associated with this lesion to our knowledge. This article describes a case of epithelioid hemangioma involving the distal humerus, which initially presented with progressive pain and fracture of the lateral condyle. The aggressive appearance on plain radiographs and MRI suggested a malignant bone tumor. This preliminary diagnosis was confirmed due to the presence of local lymph node spread on positron emission tomography/computed tomography. After a core needle biopsy revealed nondiagnostic tissue, rather than performing a wide resection based on a presumptive malignant diagnosis, we followed the standard diagnostic algorithm and performed an open biopsy with temporary internal stabilization. The tissue sample was adequate and revealed a diagnosis of epithelioid hemangioma. Based on this finding, we were able to proceed with surgical management, including curettage of the lesion, placement of a bone graft, and internal fixation, rather than a wide resection with elbow joint replacement. This article emphasizes the need for careful adherence to the diagnostic algorithm for musculoskeletal tumors. In doing so, a definitive diagnosis was reached, and our patient was able to resume his occupation as a laborer without the restrictions that would have accompanied elbow arthroplasty.     

Lymphoplasmacyte-rich meningioma with atypical invasive nature

A 12-year-old boy presented with a lymphoplasmacyte-rich (LPR) meningioma in the posterior fossa. The tumor was subtotally removed. Histological examination showed the tumor had invaded the normal brain tissue despite its benign grade in the World Health Organization classification. The Ki-67 staining index using MIB-1 monoclonal antibody was relatively high. (18)F-2-fluoro-2-deoxy-D-glucose positron emission tomography revealed high uptake in the tumor. These findings indicate the atypical nature of LPR meningioma.     

Primary epithelioid hemangioendothelioma of the retroperitoneum: report of a case

We herein report the case of a 48-year-old Japanese female with retroperitoneal epithelioid hemangioendothelioma (EHE), a rare malignant vascular tumor of intermediate grade. She was referred to our hospital because a retroperitoneal tumor was found during a medical checkup, in which strong accumulation of (18)F-fluorodeoxyglucose (FDG) was observed by (18)F-FDG-positron emission tomography (PET). A histological examination of the resected tumor revealed that it consisted of large epithelioid cells with vesicular nuclei, and clear cells with vacuolated cytoplasm and intracytoplasmic lumina. These cells expressed CD31 and vimentin, and the final pathological diagnosis was EHE. Postoperative surveillance with FDG-PET revealed distant metastasis in Virchow's lymph node 7?months after the operation. After dissection of the metastatic lymph node, the patient has been free from recurrence for 13?months. Close follow-up with FDG-PET seemed to be useful for surveillance of the recurrence of this tumor with unpredictable behavior, making an early treatment for the recurrent lesions possible.     

Retroperitoneal malignant solitary fibrous tumor of the small pelvis causing recurrent hypoglycemia by secretion of insulin-like growth factor 2

A 28-yr-old man presented with recurrent reduced consciousness, generalized seizures of unknown etiology, recurrent hypoglycemia, psychomotor retardation, and grade 2 ectasia of the left kidney. Abdominal computed tomography (CT) and positron emission tomography (PET) scans demonstrated a well-circumscribed suprapubic pelvic mass, measuring 18 x 15 x 11 cm, with involvement of para-aortic lymph nodes and dilatation of the left ureter suggestive of an extragonadal testicular tumor. We excised the tumor by laparotomy, and it was confirmed to be a solitary fibrous tumor (SFT). After surgery and R0 tumor resection, the patient had no further evidence of hypoglycemia or of recurrence.     

High resolution computed tomography as a predictor of lung histology in systemic sclerosis.

BACKGROUND: The relative proportions of fibrosis and inflammation seen by open lung biopsy examination is a predictor of disease outcome in fibrosing alveolitis. This study was designed to assess the ability of high resolution computed tomography to predict the histological appearance of open lung biopsy specimens from patients with systemic sclerosis. METHODS: Twenty abnormal biopsy specimens from 12 patients were assessed; abnormalities were categorised as fibrotic (fibrosis exceeding inflammation) or inflammatory (inflammation equal to or exceeding fibrosis). Computed tomography appearances were scored for the lobe from which the biopsy specimen was taken; scans were graded from parenchymal opacification alone through to a reticular pattern alone. RESULTS: Two lobar appearances were identified on computed tomograms: amorphous parenchymal opacification equal in extent to reticulation (grade 3) and a predominantly reticular pattern (grade 4). There was a significant association between a fibrotic histological appearance and a grade 4 computed tomogram, and between an inflammatory histological appearance and a grade 3 computed tomogram. Computed tomography grade 4 was associated with a fibrotic histological appearance in 12 out of 13 lobes, and grade 3 with an inflammatory histological appearance in four out of seven lobes. CONCLUSION: Computed tomography discriminated between biopsy specimens that were predominantly fibrotic and a smaller group with a larger amount of inflammation.     

Adrenal myelolipoma simulating virilizing adrenal tumor

We describe a case of adrenal myelolipoma that simulated clinically and biochemically a virilizing adrenal tumor. The tumor was removed surgically. The preoperative diagnosis of adrenal myelolipoma can be made by the characteristic appearance on ultrasonography, computerized tomography and in equivocal cases by guided needle biopsy.     

Positron emission tomography defines metastatic disease but not locoregional disease in patients with malignant pleural mesothelioma

BACKGROUND: Computed tomography and magnetic resonance imaging often fail to predict resectability in patients with malignant pleural mesothelioma. Small studies suggest that fluorodeoxyglucose-positron emission tomography may improve staging. We analyzed our experience to determine more definitively the potential utility of fluorodeoxyglucose-positron emission tomography. METHODS: Patients with malignant pleural mesothelioma who underwent fluorodeoxyglucose-positron emission tomography scanning were identified from an institutional database. All patients fasted and received a minimum of 10 mCi of F-18-fluorodeoxyglucose. Whole-body emission studies were acquired, followed by whole-body transmission studies, allowing iterative reconstruction. Blinded review of positron emission tomography scans was performed for clinical staging, which was then correlated with surgical and pathologic findings. Sensitivity and specificity were determined for tumor and nodal status. RESULTS: From 1998 to 2002, 63 patients underwent positron emission tomography scans, 60 preoperatively and 3 to assess disease recurrence after surgery. Increased fluorodeoxyglucose uptake was seen in all but 1 tumor, which was very early stage (IA). Positron emission tomography findings yielded sensitivities of only 19% and 11% for tumor and nodal status, respectively. However, a high standard uptake value in the primary tumor correlated with the presence of N2 disease. Positron emission tomography correctly identified supraclavicular N3 or M1 disease in 6 patients. CONCLUSIONS: Positron emission tomography does not identify the local extent of tumor or mediastinal nodal metastases reliably but detects extrathoracic metastases, thereby obviating inappropriate thoracotomy. Further studies of the association between tumor standard uptake value and the presence of N2 disease are warranted.     

Minute pulmonary meningothelial-like nodules coexisting with pulmonary cryptococcosis mimicking lung cancer

A 68-year-old woman was found to have an abnormal shadow on chest X-ray. Computed tomography showed some small ground-glass opacities in the bilateral lung field and also a 22-mm tumor in the left lower lobe, which showed high accumulation on ¹⁸F fluorodeoxyglucose positron emission tomography. Each of them was difficult to distinguish from lung cancer clinically. Preoperative localization of a small ground-glass opacity nodule with computed tomography-guided lipiodol marking and resection of each using a fluoroscopic unit was performed. Pathological findings from the small nodule showed minute pulmonary meningothelial-like nodule, and those from the tumor and fungal culture showed pulmonary cryptococcosis. To the best of our knowledge, this is the first reported case of coexisting minute pulmonary meningothelial-like nodules and pulmonary cryptococcosis mimicking lung cancer. Thoracoscopy assisted by computed tomography-guided lipiodol marking enabled us to diagnose them.     

Successful resection of mediastinal seminoma evaluated the response to induction chemotherapy with fluorodeoxyglucose-positron emission tomography

Mediastinal seminoma is a rare malignant tumor, and the current strategy for primary mediastinal seminomas is making a prompt diagnosis and achieving an appropriate chemotherapy. However, consensus regarding the optimal post-chemotherapy management has not been reached. We experienced a case of 26-year-old man who was diagnosed mediastinal seminoma and evaluated the response to induction chemotherapy with fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT). Complete surgical excision of the tumor was performed. Pathologic findings of the surgical specimen showed no viable cells in the tumor.     

Masked prosthetic graft to sigmoid colon fistula diagnosed by 18-fluorodeoxyglucose positron emission tomography.

The diagnosis of low grade prosthetic graft infection or aorto-enteric fistula is difficult using conventional radiographic imaging modalities. We report a case of aorto-enteric fistula to the sigmoid colon diagnosed by the new technique of 18-fluorodeoxyglucose positron emission tomography.     

Positron emission tomography in a patient with renal malacoplakia

Positron emission tomography is increasingly used for the diagnosis of occult infection or malignancy. The altered metabolic rate of cells in areas of malignancy or infection provides a sensitive method to identify pathology that is otherwise not identified by standard imaging methods. This case report describes a patient who presented with a pyrexia of unknown origin and renal impairment. She had a positron emission tomography scan that showed intense accumulation of fluoro-deoxy-glucose in both kidneys. Subsequent renal biopsy results showed a diagnosis of malacoplakia, the treatment of which resulted in a resolution of the fever and a stabilization of renal function. This is the first report of the positron emission tomographic appearance of renal malacoplakia.     

18氟脱氧葡萄糖显像正电子发射体层摄影术在肝移植受者筛选中的应用

目的　探讨18氟脱氧葡萄糖(18F FDG)符合线路显像在肝移植受者筛选中的临床应用价值。方法　应用正电子发射体层摄影术,对16例原发性肝癌患者及21 例肝硬化失代偿期患者进行18F FDG符合线路显像,并与CT图象进行图象融合,根据18 F FDG显像及融合图象18 F FDG的浓集情况判断有无肝外恶性肿瘤灶存在。此前的常规检查中,37 例均未发现肝外恶性肿瘤(包括肝外原发肿瘤及肝癌肝外转移灶)。结果　21例肝硬化失代偿期患者中有5 例发现肝外原发肿瘤灶及转移灶,16例原发性肝癌患者中有7例发现肝癌肝外转移病灶。结论　利用18 F FDG的正电子发射体层摄影术能发现其它检查所不能发现的肝外肿瘤,能为肝移植受者的筛选提供较多有价值的信息。     

Tenosynovial giant cell tumor of the thigh: positron emission tomography findings

Tenosynovial giant cell tumors (TGCTs) are pigmented villonodular proliferative lesions originating from the synovium, bursa, or joint. TGCTs tend to be locally aggressive, and there is a chance for multiple occurrences, which often lead to impairment of joint function. In this article, we report the case of a diffuse-type extra-articular TGCT found in the thigh of a 36-year-old woman. Surveillance F-18 fluorodeoxyglucose positron emission tomography detected increased activity within the left thigh. This activity was confirmed with magnetic resonance imaging and with surgical excision and histopathologic determination of the tumor. This patient's case suggests that TGCTs may be discovered and followed after resection with positron emission tomography.     

Chest wall lipoma mimicking a well differentiated liposarcoma; report of two cases

We experienced 2 cases of chest wall lipoma mimicking a well differentiated liposarcoma. The 1st case was a 60-year-old female. She admitted to our hospital with abnormal shadow detected by chest X-ray. Positron emission tomography combined with computed tomography (PET-CT) revealed fatty tumor penetrating left chest wall without significant accumulation of fluoro-2-deoxy-D-glucose (FDG). Resection of the tumor with partial resection of the 6th and 7th ribs with were performed, because the tumor was suspected to invade surrounding tissues by surgical findings. The other case was a 41-year-old male. He admitted to our hospital with abnormal shadow detected by chest X-ray. PET-CT revealed fatty tumor penetrating left chest wall and its standard uptake value (SUV) was 1.2. The tumor was resected with surrounding periosteum and intercostal muscle without thoracotomy. Both cases were diagnosed as lipoma by pathology.     

Spontaneous renal rupture resulting from ureteral tumor left untreated for 6 years: a case report]

A 57-year-old man, 6 years after discovery of a left ureteral tumor was admitted to our hospital complaining of severe left abdominal pain. With the diagnosis of acute abdomen, the patient was examined by computed tomography, which showed severe left hydronephrosis with renal rupture. Retrograde and antegrade pyelography showed the hydroureteronephrosis due to the tumor in the lower ureter, so left nephroureterectomy was performed. The ureteral tumor was diagnosed as transitional cell carcinoma, grade 3 and pT2. The present case is the 9th case of spontaneous renal rupture caused by renal pelvic and ureteral tumors in Japan.     

Late recurrence after resection of mass-forming intrahepatic cholangiocarcinoma: report of a case

The outcome after surgical resection for intrahepatic cholangiocarcinoma has not been satisfactorily evaluated due to its malignant behavior. Surgical resection, however, has the potential to improve the prognosis and may allow surgeons to experience rare cases with long survival. This report presents the case of a patient who developed recurrence 9?years after resection of intrahepatic cholangiocarcinoma. A 76-year-old female was diagnosed to have intrahepatic cholangiocarcinoma and underwent an extended right posterior subsegmentectomy. The gross appearance showed a mass-forming type tumor. The histopathological examination revealed well to moderately differentiated adenocarcinoma associated with portal vein invasion. Subcutaneous metastasis in the head as the first sign of relapse was diagnosed 9?years after hepatectomy. The histopathological findings of the subcutaneous tumor were similar to those of the intrahepatic cholangiocarcinoma, thus suggesting metastasis from intrahepatic cholangiocarcinoma. Positron emission tomography with 2-[fluorine-18]-fluoro-2-deoxy-d-glucose was useful for detecting multiple metastases. Long-term follow-up for more than 5?years is recommended because the present case shows that late recurrence of intrahepatic cholangiocarcinoma occurs even 5?years after resection.     

Szintigraphie/Positronenemissionstomographie

Skeletal scintigraphy and fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) are established nuclear medicine modalities in the diagnosis of soft tissue tumors. Skeletal scintigraphy scans are performed for detection of osseous infiltration by the primary tumor, of bone metastases and planning of magnetic resonance imaging (MRI). The PET/CT technique has a great potential for assessing tumor grade, for accurate N and M staging, treatment monitoring and in biopsy planning. Recurrent tumors can be detected with high sensitivity, particularly if conventional imaging is impaired by metallic implants. According to current guidelines, if a malignant soft tissue tumor is suspected or proven, PET/CT and PET/MRT should be considered even in children and adolescents.     

11C-acetate positron emission tomography for occult prostate cancer

We report, to our knowledge previously not described, a case of occult prostate cancer, in which 11C-acetate positron emission tomography disclosed tumor manifestation after failure of conventional diagnostic procedures.