Splenic cysts and tumors: diagnosis and management

Cysts and tumors of the spleen are rare and are often discovered fortuitously. They are most often asymptomatic but may present with abdominal pain in the left upper quadrant. Splenic cysts are far more common than solid lesions; true cysts must be differentiated from pseudocysts of the pancreas and from cystic degeneration following splenic contusion or infarction. Cysts may be congenital (epidermoid cysts), infectious (abscess or hydatid cyst), or neoplastic (lymphangioma or angioma with tumor necrosis). Diagnosis can usually be established with the clinical context and imagery (ultrasound, CT, MRI). Surgery should be avoided for angiomas and pseudocysts. Spleen-conserving surgery is indicated for large symptomatic epidermoid cysts. Splenectomy is often required for hydatid cysts and tumors. Of the solid tumors, hemangiomas and lymphangiomas often have a characteristic fleshy appearance. For other solid tumors, whether benign or malignant, imaging may give some clues to the diagnosis, but diagnostic certitude often requires pathologic examination of the piece. Needle biopsy is contraindicated because of the risk of bleeding. Resection should be as limited as possible in order to avoid the risks of total splenectomy (overwhelming sepsis, thrombosis).     

Magnetic-resonance tomography in diagnosis of hepatopancreatoduodenal tumors

Results of magnetic-resonance tomography (MRT) in 112 patients with diseases of hepatopancreatoduodenal zone were analyzed, 24 of them had tumors of bile ducts and pancreas. New noninvasive diagnostic method--magnetic-resonance cholangiopancreatography (MRCPG)--performed in addition to routine MRT was evaluated. The technique of MRCPG, analysis of results, manetic-resonance semiotics are presented. This method is compared with endoscopic retrograde cholangiopancreatography. It is concluded that combination of consentional MRT with MRCPG increases possibilities in diagnosis of hepatopancreatoduodenal cancers, complicated by obstructive jaundice, as a rule.     

Malignant kidney tumors in children]

The authors have examined 92 children with renal tumors. The treatment for Wilms tumor should be combined: preoperative irradiation, nephrectomy, postoperative irradiation. Late results were studied in 48 patients. 16 patients (33.3%) are living without the recurrence and metastases for over two years, including 4 over 5 years.     

Human cystic kidney diseases: epithelial hyperplasia in the pathogenesis of cysts and tumors

Several examples of human renal cystic disease are associated with tubular epithelial hyperplasia. Micropapillary hyperplasia occurs in autosomal dominant polycystic kidney disease, in localized cystic disease, and in acquired cystic disease; neoplastic or severely dysplastic epithelial hyperplasia occurs in von Hippel-Lindau disease; a histopathologically distinctive epithelial hyperplasia occurs in tuberous sclerosis. In all of these conditions the epithelial hyperplasia appears to be responsible for cyst formation by causing tubular or ductal luminal obstruction, and in all of these conditions, save localized cystic disease (a rare condition with very few reported cases), epithelial hyperplasia imposes an increased risk of malignancy. The risk seems to be highest in patients under treatment with long-term hemodialysis for end-stage kidney disease. Some of these diseases may share common features, but it appears likely that the histopathological differences reflect different features converging on a common result.     

Thermographic diagnosis of bone cysts and giant cell tumors in children

In the present paper the authors share their experience of thermovision diagnosis of gigantocellular tumors and bone cysts, acquired in numerous clinical cases (65 patients). In parallel with thermographic investigations, traditional methods of ++clinico-roentgenologic and morphologic diagnosis have been carried out with the purpose of verification. The authors make an objective evaluation of infrared thermography possibilities, singling out its known advantages alongside with its drawbacks, absence of high specificity, that conditions the expediency of thermography application in the complex of examination.     

Possibilities of computerized tomography in the diagnosis of gastric tumors

On basis of experience in computed tomography (CT) of the stomach in 76 individuals, in 44 of whom gastric tumors were diagnosed, the possibilities of this method in the recognition of this pathological condition are discussed. The authors discuss in detail their own method of CT of the stomach, which combines elements of the classical gastroroentgenology and the specific features of CT characteristic of it as an independent method. The method is based on fractional contrasting of the gastric lumen by introducing air through a nasogastric catheter. It practically excludes the possibility of diagnostic errors associated with visualization of "pseudothickenings" of the gastric wall, and thus removes the main limiting factor of using CT in the diagnosis of gastric tumors. Appraising quite highly the CT potential in neoplastic diseases of the stomach, the authors emphasize that the method must be used in complex with the existing traditional means of examination of the stomach.     

Sonography and computed tomography in the diagnosis of orbitocranial malformations and tumors

Standardized sonography and CT scanning have distinct advantages and disadvantages in the evaluation of patients with orbital diseases. Echography provides an efficient screening examination in patients presenting with signs and symptoms of orbital pathology. It allows the detection, localization, measurement and in almost 80% differentiation of orbital lesions. High resolution CT scanning gives an excellent topographic display of masses in the orbit. In visualization of intracranial causes of orbital processes and demonstration of changes in the posterior third of the orbit, in the orbital bones and the periorbital sinuses it is superior to ultrasonography.     

The use of computerized tomography in the diagnosis of cerebral hydatid cysts.

Eleven cases of cerebral hydatid cyst, diagnosed by computerized tomography (CT), are presented. The importance of CT in minimizing the possibility of accidentally tapping or tearing the cyst membrane is stressed. Repeat CT scanning after removal of the cyst revealed atrophy in the affected hemisphere.