Osteoid osteoma: radiologic and pathologic correlation

Sixty-seven cases of osteoid osteoma were studied at the Hospital for Joint Diseases between 1980 and 1989. The lesions were categorized according to location: medullary, cortical, or subperiosteal and were further grouped as intracapsular and extracapsular. The histologic features of trabecular thickness, reactive bone formation, proportion of fibrovascular stroma, and ratio of osteoid and mineralized matrix were examined. The radiographic features were compared. The literature is reviewed. We include our experience with tetracycline labelling.     

Caroli's disease: radiologic spectrum with pathologic correlation

OBJECTIVE: The purpose of our study was to describe the spectrum of radiologic and pathologic features of Caroli's disease. CONCLUSION: Caroli's disease and its complications have overlapping radiologic appearances that reflect the underlying pathology of fibrosis, ductal dilatation, cholangitis, stone formation, and malignancy.     

Ovarian masses revisited: radiologic and pathologic correlation.

Diagnosis of ovarian masses can be difficult because many pathologic conditions can affect the ovary and have similar clinical and radiologic manifestations. Knowledge of pathologic, age-specific characteristics can help refine the differential diagnosis. Ovarian masses are nonneoplastic (ovarian functional cysts, polycystic ovary disease, and ovarian torsion) or neoplastic (surface epithelial, sex cord-stromal, germ cell, and metastatic tumors). Functional cysts, if complicated by hemorrhage, can have a confusing ultrasonographic (US) appearance. Polycystic disease and torsion are easily diagnosed with US. Benign and malignant forms of serous and mucinous surface epithelial tumors can usually be differentiated with US. Imaging features of surface epithelial tumors of low malignant potential are nonspecific, resembling those of benign serous and mucinous tumors. Mature (benign) teratomas are usually cystic, with components of fat, soft tissue, and calcium, and are sonographically distinct from immature (malignant) teratomas, which are mostly solid. Sex cord-stromal tumors occur more often in menopausal or postmenopausal women and are typically solid. Metastatic disease is less common than other ovarian tumors; however, its radiologic appearance may resemble those of other masses.     

Intraosseous meningioma of the skull: radiologic pathologic correlation

Intraosseous meningiomas are rare ectopic meningiomas. The authors report the case of a hyperostotic intraosseous meningioma of the parietal bone without dural extension. The preoperative imaging findings, as well as imaging features of the surgical specimen and pathologic findings are discussed.     

Bilateral fallopian tubal polyps: radiologic and pathologic correlation

A case of bilateral fallopian tube filling defects found on hysterosalpingography performed on a patient for infertility work-up is presented. Repeat hysterosalpingography performed 4 years later showed no change. Microsurgical resection revealed the defects to be fallopian tubal polyps of endometrial origin.     

Primary spinal chondrosarcoma: radiologic findings with pathologic correlation

Purpose: To describe the radiologic appearance of the four types of primary spinal chondrosarcoma (CHS) (conventional intramedullary, juxtacortical, clear cell, and mesenchymal) and to correlate with histopathologic findings.

Material and Methods: A retrospective review was carried out of 5 patients with histopathologically confirmed primary spinal CHS; 3 F and 2 M ranging in age between 27 and 66 years (mean 40.2; median 39). Charts, conventional radiographs, computed tomography scans, and magnetic resonance images were reviewed. All the patients underwent surgical excision, followed by postoperative chemotherapy (1 patient) and radiotherapy (3 patients). Follow-up was available for all patients but one. The mean follow-up was 42 months (14-120 months). Histopathological specimens for all patients were available for review.

Results: Vertebral column distribution was 3 thoracic (60%), 1 cervical (20%), and 1 lumbar (20%). Neurological deficits were present in 3 (60%) cases. The radiological appearance of the four types of primary spinal CHS varies with specific lesion type. Imaging findings suggest diagnosis of the conventional intramedullary and juxtacortical types. While the clear cell and mesenchymal types show some distinctive features, these do not allow confident radiologic diagnosis.

Conclusion: The radiologist must be aware of imaging features of these tumors in order to improve diagnostic accuracy, treatment planning, and prognosis.     

Pediatric liver neoplasms: a radiologic–pathologic correlation

Only 1–2 % of all pediatric tumors occur in the liver. Two thirds of these tumors are malignant and almost all of the tumors cause clinical symptoms due to their mass effects. Besides the poor prognosis in most of the malignant tumors, for further treatment the origin and nature of the neoplasm has to be known. Due to the mostly unimpeded growth into the peritoneal cavity, the origin of the tumors is primarily often unclear and can non-invasively only be determined by advanced imaging techniques. The display of the macro- and microhistological key features of primary pediatric liver neoplasms, including hepatoblastoma (HB), infantile hemangioendothelioma (IHE), mesenchymal hamartoma (MH), undifferentiated (embryonal) sarcoma (UES), and hepatocellular carcinoma (HCC), together with their imaging representation by ultrasound, computed tomography, and magnetic resonance imaging, may deepen the understanding of the underlying pathology and its imaging appearance. Furthermore, in many cases sufficient information may be provided not only to differentiate benign from malignant tumors, but also to guide for adequate treatment. Received: 28 September 1998; Revision received: 22 December 1998; Accepted: 23 December 1998     

Periosteal chondroid tumors: radiologic evaluation with pathologic correlation

OBJECTIVE: The purpose of this study was to determine whether the imaging features of periosteal chondroid tumors correlate with histopathology. MATERIALS AND METHODS: Twenty-two patients (nine women and 13 men; mean age, 33 years) with pathologically proven periosteal chondroid lesions were retrospectively reviewed. The imaging modalities included conventional radiography (n = 17), CT (n = 10), and MR imaging (n = 14). The images were reviewed by two osteoradiologists, with agreement by consensus. Evaluation criteria included lesion location, mineralization, and size; periosteal reaction; and cortical response. Intramedullary extension, adjacent intramedullary edema, soft-tissue edema, and intrinsic characteristics were also evaluated on MR imaging. After the evaluation, a radiologic diagnosis of chondroma or chondrosarcoma was obtained. An experienced osteopathologist who was unaware of the patient's medical history and radiologic findings reviewed all histopathology. Agreement between the radiologic and the histopathologic diagnosis was tested using the kappa analysis. Imaging features were correlated with the pathologic findings, and a statistical analysis was performed. RESULTS: Using strict pathologic criteria, we diagnosed 11 chondromas and 11 chondrosarcomas (nine, grade I; two, grade II). Moderate agreement was reached between the radiologic and the pathologic diagnosis (kappa = 0.55). The size of periosteal chondrosarcomas (range, 3-14 cm; median, 4 cm) was considerably larger than the size of the chondromas (range, 1-6.5 cm; median, 2.5 cm; p < 0.05). Other imaging features did not significantly correlate with benign versus malignant disease at pathology (all p > 0.05). CONCLUSION: A variable overlap existed in the imaging appearances of benign and malignant periosteal chondroid lesions, with size being the most reliable indicator in distinguishing the two lesions. This and the fact that histologic differentiation of the entities can be difficult, suggests that surgical wide excision may be the most appropriate procedure in treating patients with lesions greater than 3 cm.     

多层螺旋CT结肠充气成像诊断结肠癌的影像与病理对照研究

目的:评价多层螺旋CT结肠充气成像对结肠癌分期的准确性。方法:对52例临床怀疑结肠癌的患者行结肠充气成像多层螺旋CT增强扫描并进行图像重建,观察肿瘤情况,作出诊断及分期并与病理对照。结果:低张结肠充气扩张显示良好,肿瘤显示清晰。多层螺旋CT检出全部47例结肠癌,敏感性100‰.依据Dukes分期标准,MSCT分期与手术病理对照,其符合率为:A期57.1‰,B期94.1‰,C期76.4‰,D期100‰,47例结肠癌中39例CT进行了正确分期,总体符合率为82.9‰。结论:多层螺旋CT结肠充气成像能够清晰显示结肠癌的形态、大小、周围组织侵犯及远处转移情况。CT分期与手术病理分期有高度的一致性。     

Gastrointestinal stromal tumors: radiologic features with pathologic correlation.

Gastrointestinal stromal tumors (GISTs) are unique neoplasms that occur throughout the gastrointestinal tract, mesentery, omentum, and retroperitoneum. They are the most common mesenchymal neoplasm of the gastrointestinal tract and are defined by their expression of KIT (CD117), a tyrosine kinase growth factor receptor. The expression of KIT is important to distinguish GISTs from other mesenchymal neoplasms such as leiomyomas, leiomyosarcomas, schwannomas, and neurofibromas and to determine the appropriateness of KIT-inhibitor therapy. The series described herein was accumulated over 2 years and includes 64 pathologically proved GISTs (28 gastric, 27 small intestinal, six anorectal, one colonic, one esophageal, and one from the small bowel mesentery). Radiologic features of GISTs vary depending on tumor size and organ of origin. Since most GISTs arise within the muscularis propria of the stomach or intestinal wall, they most commonly have an exophytic growth pattern and manifest as dominant masses outside the organ of origin. Dominant intramural and intraluminal masses are less common radiologic manifestations. GISTs occurring in the gastrointestinal tract and mesentery characteristically have hemorrhage, necrosis, or cyst formation that appears as focal areas of low attenuation on computed tomographic images. Although the radiologic features of GISTs are often distinct from those of epithelial tumors, criteria to separate GISTs radiologically from other nonepithelial tumors have not yet been fully developed.     

Small renal cell carcinoma: pathologic and radiologic correlation.

The authors correlated the radiologic and pathologic findings of 36 patients with small renal cell carcinoma (less than or equal to 3 cm in diameter). Tumors were discovered incidentally or by means of mass surveys with ultrasound (US). Computed tomography (CT) and angiography were performed before surgery. Of the 36 tumors, 24 were of solid (alveolar) architecture, five were of papillary architecture, three were of tubular architecture, and four were of multilocular cystic architecture. Cell arrangement was closely correlated with radiologic appearance, especially in regard to tumor vascularity and echogenicity. Histologically homogeneous tumors of solid architecture were hypoechoic at US and hypervascular at angiography and contrast medium-enhanced CT. Tumors of papillary, tubular, and multilocular cystic architecture were hyperechoic at US and hypovascular at angiography. There was no correlation of cell differentiation and cell architecture with echogenicity or tumor vascularity. Tumors with hemorrhage showed marked hyperattenuation at CT. A tumor capsule was observed in 25 patients (69%); this was demonstrated as a rim at US or angiography.     

Primary neuroendocrine carcinoma of the breast: radiologic and pathologic correlation

Primary neuroendocrine carcinoma of the breast (PNCB) is a rare type of breast cancer. There have been few reports on PNCB and radiologic–pathologic correlation in PNCB has not been described thoroughly. We present a rare case of pathologically confirmed poorly differentiated PNCB removed via lumpectomy. Image findings on mammography, ultrasonography, computed tomography, magnetic resonance image, and positron emission tomography-computed tomography are also presented.     

Diffuse panbronchiolitis: correlation of high-resolution CT and pathologic findings.

Diffuse panbronchiolitis (DPB) is characterized by chronic airflow limitation and airway inflammation with bronchiolar lesions. Chest radiographs of patients with DPB usually show small nodular shadows throughout both lungs. The authors investigated the nature and pathogenesis of the radiologic features of DPB by correlating high-resolution computed tomographic (HRCT) findings with histopathologic features. The HRCT images of nine patients with DPB were compared with the observations made with inflated lung specimens. The HRCT findings of DPB included centrilobularly distributed, small rounded areas of attenuation; branched linear areas of attenuation, contiguous with the small rounded areas; dilated airways with thick walls, also common outside secondary pulmonary lobules; and decreased lung attenuation in peripheral areas due to air trapping caused by bronchiolar narrowing in the subpleural zones. The authors believe that HRCT best demonstrates this characteristic location of small rounded areas of attenuation associated with dilated airways.     

Annulus fibrosus calcification in the cervical spine: radiologic — pathologic correlation

Intervertebral disc calcification can be secondary to a variety of pathologic processes including some of the arthritidies, metabolic diseases, and trauma. The annulus fibrosus is the most commonly calcified component and may mimic vertebral body fracture, limbus vertebra, or a persistent ring apophysis. We describe two young patients who developed calcification in the anterior annulus fibrosus and present radiologic-pathologic correlation in this condition in another case. This calcification may actually be secondary to subclinical or chronic stress on the involved intervertebral disc.     

Hydropic leiomyoma: A radiologic pathologic correlation of a rare uterine tumor

Hydropic leiomyoma is a rare leiomyoma subtype composed of a conspicuous zonal watery edematous stroma that causes compartmentalization of the smooth muscle cells. It exhibits atypical imaging features which can mimic malignancy, so differential diagnosis with malignant uterine tumors such as leiomyosarcoma is crucial for treatment decisions and patient follow-up.We describe the case of a 54-year-old postmenopausal woman presenting with a fast-growing abdominopelvic tumor associated with abdominal bloating, urinary frequency, and metrorrhagia. Radiologic evaluation depicted a voluminous, well-circumscribed, slightly lobulated, heterogeneous mass with mixed solid and cystic components arising from the uterus. Given the postmenopausal patient status, size of the tumor, and uncertainty about a possible malignant origin, an uneventful total abdominal hysterectomy with bilateral adnexectomy was performed as definitive treatment. However, as it is common practice in our institution, a second opinion report of the previous MRI was done before surgery, with the proposed diagnosis being hydropic leiomyoma.Pathologic examination of the surgical specimen revealed a large subserosal tumor with nodules separated by empty spaces and cysts due to watery exudate. Histologically, it was a mesenchymal neoplasm with trabecular and nested architecture, with tumor cells separated by watery fluid without mitosis or necrosis, securing the diagnosis of a hydropic leiomyoma.     

Retroperitoneal and pelvic hemangiopericytomas: clinical, radiologic, and pathologic correlation

Seventeen cases of hemangiopericytoma of the retroperitoneum were retrospectively analyzed for demographic, morphologic, and radiologic features. These tumors were found in all age groups (2 months to 72 years) and occurred in similar numbers of male and female patients. The tumors tended to be large (11 were greater than 8 cm), were well encapsulated, and occurred less frequently in the pelvic retroperitoneal space (six cases) than in abdominal retroperitoneum (11 cases). All tumors were bulky enough to displace part of the gastrointestinal tract, with only two being inoperable. The most distinctive radiologic feature was hypervascularity (found on 11 of 11 angiograms). Other nondiscriminating radiologic features included well-defined margins and necrosis, with nondistinctive amorphous calcification identified in one case. Angiographic or computed tomographic demonstration of hypervascularity in a retroperitoneal tumor is more suggestive of hemangiopericytoma than of a liposarcoma or malignant fibrous histiocytoma, two of the more common tumors of this region.