Radiographic and ultrasound appearances of an intra-mural haematoma of the pylorus

The case of a haemophilic baby boy who developed a pyloric haematoma due to trauma caused by a feeding gastrostomy catheter balloon is presented. Intramural gastric haematomas are rare and the authors are not aware of any previous reports of intramural haematomas affecting the pylorus alone in this age group. The barium meal appearances of the pyloric haematoma were identical to those seen in hypertrophic pyloric stenosis but ultrasound demonstrated a circumferential pyloric haematoma.     

Granular cell tumour of the oesophagus: endoscopic ultrasound appearances

A case of granular cell tumour of the oesophagus in a middle-aged woman is reported. The pathological features and appearances on endoscopic ultrasound (EUS) are described, and the role of EUS in the characterization of intramural oesophageal tumours is discussed.     

The transrectal ultrasound and MRI appearances of granulomatous prostatitis and its differentiation from carcinoma

AIMS AND METHODS: Granulomatous prostatitis is a benign inflammatory condition of the prostate which can be mistaken for prostatic carcinoma both clinically and on ultrasound, but is distinguishable histologically. The transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI) appearances of 10 patients with histologically confirmed granulomatous prostatitis were evaluated to try and identify any correlation between the two techniques or any specific features on MRI to help distinguish it from carcinoma. Clinical findings and serum prostatic specific antigen (PSA) levels were also evaluated. RESULTS: In five patients, both TRUS and MRI were concordant, showing only changes of benign prostatic hypertrophy (three patients) or showing no abnormality (two patients). In a further three patients, both TRUS and MRI were abnormal, with appearances suggestive of carcinoma. One of these patients had tuberculous prostatitis and had a past history of tuberculosis. In the remaining two patients, there was a discrepancy between TRUS and MRI findings, carcinoma being suspected on TRUS in one with a normal MRI, and carcinoma suspected on MRI in the other with a normal TRUS. CONCLUSION: There is no pattern of clinical, biochemical, ultrasound or MRI findings that allows a specific diagnosis of granulomatous prostatitis to be made, or differentiation from prostatic carcinoma.     

Acute segmental testicular infarction: differentiation from tumour using high frequency colour Doppler ultrasound.

Segmental testicular infarction is rare, of variable aetiology but usually idiopathic. B-mode ultrasound may demonstrate a focal mass indistinguishable from a testicular tumour, with confirmation only achieved following surgery. We report a case of segmental testicular infarction presenting as a heterogeneous mass on B-mode ultrasound, confidently diagnosed as an area of infarction on high frequency colour Doppler ultrasound and proven on histology. The pre-operative differentiation of tumour from segmental infarction allows testis-sparing surgery.     

Wilms' tumour: pre- and post-chemotherapy CT appearances.

Pre-operative chemotherapy is used in our institution for patients with Wilms' Tumours (WT) when surgical 'operability' is in doubt. To date, the computed tomographic (CT) appearances of chemotherapy-induced changes in WT have not been described. We have analysed CT examinations of 18 children undergoing pre-operative chemotherapy to assess the effects of treatment on size, extent and qualitative changes of the tumour. Clinical response to chemotherapy was associated with a reduction in tumour size of at least 50%. Cystic changes were commonly seen within tumours following chemotherapy. CT did not reliably differentiate lymph nodes involved by tumour from those showing only reactive change. Pre-chemotherapy CT scans were incorrect in predicting liver invasion in 4/18 (22%) cases: of these, two were right-sided tumours, and two were bilateral.     

Scrotal calcification: ultrasound appearances, distribution and aetiology

This pictorial review illustrates the ultrasound appearances of scrotal calcification, distinguishing between intratesticular and extratesticular calcification. Intratesticular calcification may be due to phleboliths, spermatic granulomas or vascular calcification, or it may occur in association with tumours. Extratesticular calcification is more frequently encountered and is usually related to previous inflammatory disease of the epididymis. Testicular microlithiasis, a rare condition characterized by multiple scattered echogenic foci within the testis, is produced by the formation of microliths from degenerating cells in the seminiferous tubules. Testicular microlithiasis has been demonstrated as an incidental finding as well as in association with both benign and malignant tumours of the testis.     

MRI appearances mimicking the dural tail sign: a report of two cases

We report two cases in which the MRI appearances mimicked the dural tail sign; a glioma extending into the subarachnoid space, and a meningioma extending to the subdural space. They indicate that tumour invasion into the subarachnoid or subdural space, should be considered when prominent linear enhancement is observed along the dura mater adjacent to tumours. Received: 31 March 1999/Accepted: 21 July 1999     

Synovial sarcoma with radiological appearances of primitive neuroectodermal tumour/Ewing sarcoma: differentiation by molecular genetic studies

Synovial sarcoma (SS) arises in soft tissues but may invade adjacent bone. We describe a case of SS presenting as aggressive lysis of the proximal ulna, the imaging of which suggested a primary bone lesion. Needle biopsy showed a ‘small round blue cell tumour’, and a primitive neuroectodermal tumour (PNET)/Ewing sarcoma was suggested on the basis of the imaging appearances. The definitive diagnosis of synovial sarcoma was made following molecular genetic studies, which demonstrated a fusion product incorporating the genes SYT and SSX1. The importance of correct diagnosis to guide appropriate management, and, therefore, the necessity for molecular genetic studies, is discussed.     

Low-grade fibromyxoid sarcoma: ultrasound and magnetic resonance findings in two cases

Low-grade fibromyxoid sarcoma is a rare, slow-growing, yet metastasizing neoplasm characterized by histopathological fibrous/myxoid zonal alternations, which occasionally display an intralesional multinodular appearance. We report on the radiological features of two cases of low-grade fibromyxoid sarcoma. Case 1 was a large ovoid mass with a well-defined margin in the thigh, showing the characteristic multiple, intralesional variable-sized nodules on high-frequency ultrasound (US) and magnetic resonance imaging (MRI), some of the nodules showing a target-like appearance. Case 2 was a dumbbell-shaped chest wall mass showing invasive features without the intralesional multinodular appearance on MRI. The gross radiological appearances of our two cases were somewhat dissimilar, but they shared a pattern of low/high signal zonal distinction without hemorrhage or necrosis within the masses on MRI.     

Benign hidradenoma: magnetic resonance and ultrasound features of two cases

Tumors of sweat gland origin are rare in the hand but should be considered in the differential diagnosis when certain imaging features are present. We present a case of nodular hidradenoma of the hand, with previously unreported magnetic resonance imaging features, and a further case in the thigh, both with ultrasound and histopathological correlation. The imaging literature of this tumor is reviewed, and its significance is discussed with respect to the current understanding of its malignant potential.     

Forensic evaluation of fatal-suffocating retropharyngeal haematoma secondary to cervical fractures: Report of two cases

PurposeTraumatic retropharyngeal haematoma, a condition of low incidence, often occurs secondary to cervical injuries. Owing to the adjacent anatomical location and its insidious formation, retropharyngeal haematoma is prone to cause airway obstruction, which can occasionally be fatal. Though well known in clinical practice, retropharyngeal haematomas are rarely encountered in forensic practice and are not sufficiently explored from a forensic perspective.Case presentationHerein, we present two cases of fatal-suffocating retropharyngeal haematoma following cervical vertebral fractures. In both cases, the time from injury to death was evident, showing unusually long periods from injury to death, specifically 4 days and 2 days, respectively. The causes of death were illustrated, and the delayed onset of fatal airway obstruction was explained. The important points regarding autopsies suspected to be fatal traumatic retropharyngeal haematomas were discussed.ConclusionsKnowledge of the possibility of late onset and understanding of the features of imaging and autopsy findings of traumatic retropharyngeal haematoma is beneficial for forensic pathologists dealing with similar cases.     

Breast lymphoma: radiologic imaging and clinical appearances

Lymphoma of the breast is rare. To evaluate the radiologic imaging and clinical appearances of this condition, the authors studied, over a 26-year period, 20 patients (19 women) with primary lymphoma of the breast and 7 (all women) with secondary involvement. The right breast was affected in 14 cases. A wide spectrum of appearances was noted on mammography and ultrasonography, but the use of both techniques is indicated because lesions may be missed by either technique used alone.     

MRI diagnosis of ovarian fibrothecomas: tumour appearances and oestrogenic effect features

Objective:

To study MRI diagnosis of ovarian fibrothecomas.

Methods:

MRI appearances of 27 ovarian fibrothecomas 26 female patients confirmed by surgical pathology were retrospectively reviewed and correlated with clinical and histological findings.

Results:

Most patients were post-menopausal females 73.1% (19/26) of cases. 38.5% (10/26) of patients showed an elevated serum carbohydrate antigen 125 (CA-125) level (>35 U ml⁻¹). On MR T₂ weighted imaging, 3 distinct features were revealed. (1) Homogeneous hypointense masses in 25.9% (7/27) cases. (2) Heterogeneous tumours with mostly isointense and few patchy hyperintense areas in 51.9% (14/27) cases. (3) Heterogeneous tumours with predominantly hyperintense and few isointense parts in 22.2% (6/27) cases. On T₁ weighted imaging, all the fibrothecomas turned out to be homogeneous masses except six cystic degeneration cases. After contrast, 70.4% (19/27) tumours showed homogeneous mild enhancement in all phases. Beyond the tumours, endometrial abnormality and uterus enlargement were found in 38.5% (10/26) and 15.4% (4/26) patients, respectively. Ascites were seen in 53.8% (14/26) patients. There was a statistically significant difference among the 3 T₂ weighted image features (F = 7.024; p = 0.003) in terms of the size of fibrothecomas. The cystic tumours also had the tendency to show the ascite condition (p = 0.002) as well as elevated serum CA-125 levels (p = 0.014). Vimentin was positively stained in 10 (76.9%) of 13 cases who underwent the immunohistochemical analysis.

Conclusion:

MRI has the superiority to show the distinct appearances of tumours as well as their functional features according to oestrogenic effect.

Advances in knowledge:

This study describes the unique features of fibrothecomas on MRI on a relatively large series of patients with tumours and the indirect oestrogenic effect findings.Fibrothecomas are rare benign ovarian tumours extending from solid fibromas to lipid-rich thecomas, making up approximately 4% of all ovarian neoplasms, while constituting the most common sex cord-stromal tumours of the ovary.¹ These tumours also account for the most common hormonally active ovarian neoplasms, which often show oestrogenic effects, and could present as uterine morphological changes and thickened endometrium, particularly in females of post-menopausal age.^2,3 Clinically, ovarian fibrothecomas are generally latent masses and might be detected occasionally during routine gynaecologic examinations. At gross inspection, fibrothecomas typically present as solid tumours with or without cystic degeneration. In pathology, fibrothecomas contain theca cells with abundant lipids in the cytoplasm and varying degrees of fibrous content, the theca cells may be responsible for the oestrogenic effects of the tumours. The intraperitoneal ascites or pleural effusions are often associated with fibrothecomas and might make them difficult to differentiate from malignant epithelial ovarian tumours. Correct diagnosis of these benign tumours can greatly affect the patient''s management, especially avoiding unnecessary invasive surgical procedures. So far, most of the previous studies^4,5 have reported non-specific ultrasound and CT features of these tumours, while MR studies^6,7 had only small sample sizes. The purpose of our study was to describe the unique features of fibrothecomas on MRI in a relatively large series of patients with tumours as well as to report indirect oestrogenic effect findings, and to discuss the points of differential diagnosis.     

Wilms' tumour: ultrasound and changing concepts

This review traces the changes that have occurred in our understanding of the pathology, radiographic diagnosis and prognosis of Wilms' tumour. Ultrasound has replaced intravenous urography as the main method for primary diagnosis. Computed tomography and magnetic resonance have with few exceptions added little to the primary diagnosis. Follow-up should be by ultrasound and examination but computed tomography has advantages in detecting pulmonary metastases. The survival rate has dramatically improved in the last 15 years and this is shown by tabulating the treatment and survival rates during this period.     

Case report: the ultrasound and Doppler appearances of pelvic varices

Dilatation of the veins of the broad ligament and ovarian plexi cause a very specific clinical entity called the pelvic congestion or pelvic pain syndrome. The ultrasound and Doppler appearances of this condition are unique and should be easily recognized. We describe these appearances in one patient and review the literature.