Desmoplastic fibroma of bone: a report of 18 cases

Desmoplastic fibroma is a rare benign primary bone tumor, histologically identical to the extra-abdominal desmoid tumor of soft tissues. The incidence in major series of bone tumors is 0.1%–0.3%. In the present study 18 cases from the files of the Netherlands Committee on Bone Tumors are reported, with an emphasis on the radiographic features. Eight female and ten male subjects were affected, with a fairly even age distribution from the second to the seventh decade of life. The most frequent sites of involvement were the femur and the pelvis. Radiographically the lesions nearly always demonstrated benign features with respect to pattern of destruction, margins, and reactive bone formation; however, soft tissue extension was sometimes present. Although desmoplastic fibroma usually presents with pain or swelling, in 5 of the 18 cases the existence of the lesion was an accidental finding, and in 2 cases the patient had long-standing, vague complaints of pain. Though overall benign radiographic features may support the final diagnosis, the main and often troublesome histological differential diagnosis is of a low-grade fibrosoma. En bloc resection is the treatment of choice in view of the high incidence of recurrence after curettage.     

The role of mammography in the diagnosis of cystosarcoma phylloides (author's transl)

Cystosarcoma phylloides is not a single disease entity, but, a spectrum, which includes a benign, a non-metastatic malignant and a metastatic malignant form. Neither macroscopic nor microscopic examinations enable one to prediction as to whether the tumor is of a potentially metastatic kind or not. Neither pain nor infiltration or ulceration of the skin are reliable signs of malignancy; palpable axillary lymphnodes are misleading too. The treatment is composed of either a wide local excision of the tumor or a simple mastectomy. In cases where the lymphnodes have increased in size, simple mastectomy plus axillary lymphnodes dissection will be done. Since most tumor recurrence occurs following a local excision of the tumor only simple mastectomy is the surgical method of choid. The author presented two cases, examined by mammography; one case of malignant cystosarcoma phylloides malignum and one case of carcinoma. Both were similar in their clinical and radiographic presentation. Both cases demonstrate the difficulty of radiographie and pathologic diagnosis. A warning is given to radiologists not to compete with the pathologists for the histologic diagnosis but to limit themselves to suggest the presence of a possibly malignant tumor and the need for surgery.     

Radiologic manifestations of peritoneal mesothelioma

We report four cases of histologically proved peritoneal mesothelioma and describe the radiographic (mainly CT and angiographic) findings. There were three malignant diffuse tumors and one benign localized tumor. In one case, the lesion extended to the omentum and entrapped the fat tissue, and differentiation from peritonitis carcinomatosa was difficult. In the other three cases, reflecting necrotic change within the tumor, CT showed hypodensity throughout most of the mass. In two cases with hemorrhage, CT showed hyperdensity in the center of the mass. Angiography showed slight or medium neovascularity in the periphery of the tumor, but most of the tumor was avascular. Angiography was helpful for topographic diagnosis, but it was difficult to make a specific diagnosis or differentiate between malignant and benign types. We emphasize that it is important to consider peritoneal mesothelioma in the differential diagnosis when a mass of unknown origin is found in the abdomen, particularly when it is accompanied by necrosis and hemorrhage.     

Sedimented calcium in benign breast cysts: the full spectrum of mammographic presentations

We retrospectively reviewed the mammograms of 318 patients that showed sedimented calcifications within benign breast cysts to describe the natural history and full spectrum of the mammographic appearances. Sedimented calcifications are seen in approximately 4% of symptomatic women undergoing mammography. Their recognition is important to avoid unnecessary workup, follow-up, or biopsy. Key to recognition is the difference in their radiographic features on lateral and craniocaudal views. The classic appearance is that of milk of calcium, seen as linear, curvilinear, or teacup-shaped particles on horizontal-beam lateral views and as ill-defined smudges on vertical-beam craniocaudal views. The most common presentation is multiple, bilateral, scattered and occasionally clustered calcifications within microcysts. Other presentations include milk of calcium within microcysts in a unilateral, clustered distribution; milk of calcium within macrocysts; sandlike calcifications (discrete particles rather than smudges on craniocaudal view) within cysts of various sizes; and rarely, milk of calcium within the lipid cysts of either fat necrosis or galactoceles. None of our cases has proved to be malignant. However, adjacent malignancies are a potential pitfall. We encountered eight patients with carcinoma presenting as clustered microcalcifications in a breast also containing typical sedimented calcifications. In each of these cases, the malignant calcifications could be distinguished by their mammographic appearance. The recognition of sedimented calcifications present in about 4% of symptomatic women undergoing mammography is important because these characteristic calcifications are an indication of benignity. Malignant-appearing microcalcifications found in the vicinity of sedimented calcifications can be distinguished and require biopsy.     

Primary tumors of the spine

Primary osseous tumors of the spine are rare lesions and much less frequently encountered than metastases, multiple myeloma, and lymphoma. The interpreting radiologist must be aware of the typical radiographic appearance of the most common nonmyeloproliferative tumors of the spine because these tumors must be considered when a solitary spinal lesion is encountered. The purpose of this article is to describe the radiologic appearance and radiologic staging of the most common benign (hemangioma, enostosis, osteoid osteoma, osteoblastoma, giant cell tumor, aneurysmal bone cyst, and osteochondroma) and malignant (chordoma, chondrosarcoma, Ewing tumor, and osteosarcoma) osseous spine tumors.     

Angiographic appearance of leiomyomas of the small intestine: Report of two cases

Benign and malignant smooth muscle tumors of the small intestine have each been considered as displaying distinct angiographic characteristics. However, as two cases illustrate, the angiographic features of benign and malignant smooth muscle tumors overlap, and radiographic differentiation of these tumors is not feasible. In most cases angiography can distinguish smooth muscle tumors from other vascular lesions.     

乳腺肿块的热断层成像分析

目的:探讨乳腺肿块在热断层成像系统(TTM)中热源的特点。方法:将乳腺肿块106例病人进行TTM检查,与病理结果对照,从乳腺异常热源的形态、结构、深度及热辐射值来分析良、恶性病变在TTM上的表现。结果:病理结果恶性病变49例,良性病变57例,TTM在乳腺良、恶性肿瘤诊断与病理诊断的符合率为89.5%和91.9%,良、恶性肿瘤热辐射值分别为1.822和2.599(P<0.001),深度在良、恶性肿瘤中也有明显差异。结论:恶性病变的形态多不规则,结构密实,热辐射值较高,良性病变则相反;TTM在乳腺良、恶性肿瘤的鉴别诊断中有重要的价值。     

Asymptomatic syringomatous adenoma of the nipple: A rare nipple neoplasm

Syringomatous adenoma of the nipple is a very rare benign tumor, with radiographic and clinical characteristics that are difficult to differentiate from malignant tumors. Less than 60 cases have been identified thus far and most studies have not included radiographic findings. As such, the neoplasm requires more characterization within the literature. The usual clinical presentation of syringomatous adenoma of the nipple is symptomatic with a solitary, unilateral nipple mass within the subareolar region which may be tender and/or painful and may cause nipple inversion or discharge. We present a case of a 43-year-old woman that is unique, as the patient was asymptomatic and only presented following standard screening mammography. Moreover, we offer further characterization of the neoplasm through documented imaging and histologic findings.     

Angiography of retroperitoneal tumors. A review.

Abdominal aortography and selective angiography of the branches, large and small, of the abdominal aorta were used systematically to establish the diagnosis in 45 consecutive cases of primary retroperitoneal tumor. No angiographic features peculiar to tumor types were elicited, probably because of the great variety of histologic material encountered. Angiography, nonetheless, proved most helpful for the surgical approach, whether radical removal or an exploratory operation with biopsy was contemplated. In 80 per cent of cases the tumor margins were demarcated, the details of the blood supply defined, and the nature, benign or malignant, correctly diagnosed.     

MRI of soft tissue tumors

Magnetic resonance imaging (MRI) is the only noninvasive method of defining a soft tissue tumor. The extent of the tumor and the question of involvement or noninvolvement of various adjacent tissues and structures can be determined. This information, determination of lymphatic and distant metastatic spread, is invaluable for staging and management of the disease. Whether or not the tumor type can be reliably determined, or even whether the malignant or benign nature of the tumor can be ascertained on MRI examination, is open to question. Review of the literature indicates proponents on both sides of the issue. This review illustrates the imaging features that are relevant to suggesting a histologic diagnosis, and the pitfalls that are encountered in trying to determine the malignancy or benignity of a lesion. The clinical significance of these determinations is also discussed.     

Unusual Malignant Solid Neoplasms of the Kidney: Cross-Sectional Imaging Findings

Malignant kidney neoplasms are the most frequently encountered solid kidney masses. Although renal cell carcinoma is the major renal malignancy, other solid malignant renal masses should be considered in the differential diagnosis of solid renal masses that do not contain a macroscopic fatty component. In this pictorial essay, we present the imaging findings of a primitive neuroectodermal tumor, primary liposarcoma of the kidney, primary neuroendocrine tumor, leiomyosarcoma, synovial sarcoma, malignant fibrous histiocytoma, sclerosing fibrosarcoma and renal metastasis of osteosarcoma.     

Usefulness of barium studies for differentiating benign and malignant strictures of the esophagus

OBJECTIVE: The purpose of our investigation was to determine the usefulness of barium studies for differentiating benign and malignant strictures of the esophagus. MATERIALS AND METHODS: A search of radiology and endoscopy files revealed 100 patients with esophageal strictures on barium studies who underwent endoscopy (with endoscopic brushings or biopsy specimens in 57). The images from these barium studies were reviewed by two gastrointestinal radiologists who were unaware of the clinical, endoscopic, and pathologic findings; these observers classified the strictures as having a benign, malignant, or equivocal appearance. The radiographic data were correlated with the endoscopic and pathologic findings to determine the usefulness of barium studies for differentiating benign strictures from malignant tumor. RESULTS: Of the 100 esophageal strictures detected on barium studies, 75 (75%) had a benign radiographic appearance, 11 (11%) had a malignant appearance, and 14 (14%) had an equivocal appearance. None of the 75 patients with radiographically benign strictures had malignant tumor on endoscopy, which revealed benign strictures in 48 patients and no definite strictures in the remaining 27. Conversely, all 11 patients (100%) with radiographically malignant strictures had malignant tumor on endoscopy. Finally, 13 (93%) of 14 patients with radiographically equivocal strictures had benign strictures without tumor on endoscopy and one (7%) had esophageal carcinoma. CONCLUSION: Radiographically benign esophageal strictures are not found to be caused by malignant tumor on endoscopy, so these patients can be treated medically before endoscopy or endoscopic dilatation procedures are performed. However, radiographically malignant or equivocal strictures require early endoscopy and biopsy for a definitive diagnosis.     

MSCT 增强扫描对脾脏肿瘤诊断的应用

目的：探讨 MSCT 增强扫描对脾脏肿瘤的诊断及鉴别诊断。方法回顾性分析23例经影像检查、病例随访以及手术病理证实的脾脏肿瘤的 MSCT 增强表现,探讨脾脏肿瘤增强扫描的 MSCT 特征。结果良性肿瘤12例(囊肿5例,血管瘤6例,淋巴管瘤1例),恶性肿瘤1 1例(原发淋巴瘤2例,继发淋巴瘤3例,转移瘤6例)。结论MSCT 增强扫描对脾脏肿瘤的定性诊断具有较高价值。     

MR imaging of edema accompanying benign and malignant bone tumors

To evaluate the incidence, quantity, and presentation of intra- and extraosseous edema accompanying benign and malignant primary bone lesions, the magnetic resonance (MR) studies of 63 consecutive patients with histologically proven primary bone tumors were reviewed. MR scans were assessed for the presence and quantity of marrow and soft tissue edema and correlated with peroperative findings, resected specimens and follow-up data. The signal intensity and enhancement of tumor and edema prior to and after intravenous administration (if any) of gadolinium-labled diethylene triamine pentaacetate (Gd-DTPA) was analyzed. Marrow edema was encountered adjacent to 8 of 39 malignant tumors and 14 of 24 benign lesions. Soft tissue edema was found accompanying 28 of 39 malignancies and 10 of 24 benign disorders. On unenhanced T1-weighted MR images tumor and edema were difficult to differentiate. Tumor inhomogeneity made this differentiation easier on T2-weighted sequences. In 36 patients the contrast medium Gd-DTPA was used. Edema was present in 27 of these patients and the respective enhancement of tumor and edema could be compared. Edema always enhanced homogeneously, and in most cases it enhanced to a similar degree as or more than tumor. Marrow and, more specifically, soft tissue edema is a frequent finding adjacent to primary bone tumors. The mere presence and quantity of marrow and soft tissue edema are unreliable indicators of the biologic potential of a lesion. Unenhanced MR scans cannot always differentiate between tumor and edema, but the administration of Gd-DTPA is of assistance in differentiating tumor from edema. Awareness of marrow and/or soft tissue edema adjacent to bone lesions is of importance because edema can be a pitfall in the diagnostic work-up and staging prior to biopsy or surgery.     

外周性神经源性肿瘤的MRI表现与病理基础研究

目的　分析外周性神经源性肿瘤的MRI表现。方法　对 2 5例神经源性肿瘤 (良性 19例 ,恶性 6例 )进行组织学观察 ,分析其与MR表现之间的关系及良恶性肿瘤的MRI鉴别诊断。结果　神经鞘瘤 14例 ,神经纤维瘤 5例 ,恶性周围性神经鞘瘤 (MP NST) 5例 ,原始神经外胚层瘤 1例。起源于神经干的肿瘤常呈纺锤形 ;肿瘤信号多欠均匀 ,T2 WI呈“靶征”者 3例 ,2例神经鞘瘤靶心有较多纤维组织 ,靶周明显水肿、粘液变性 ,1例MPNST靶心有较多纤维组织和部分钙化。 2例MPNST破坏骨质。结论　肿瘤的部位、形态和信号对诊断有较大帮助 ,恶性肿瘤可伴灶周水肿并可破坏邻近骨质。     

Primary rib tumours in children (report of 27 cases with short literature review)

27 cases of primary malignant and benign rib tumours are reported. The most common malignant rib tumour in childhood is Ewing sarcoma (20 cases). Some other rare bone tumours and tumorous conditions (reticulosarcoma, aneurysmal bone cyst, monostotic rib eosinophilic granuloma, osteoid osteoma and lymphangioma) are also described. In the authors' opinion Ewing sarcoma presents with characteristic clinico-radiographic findings in most of the cases. Other monostotic, primary rib tumours and tumorous conditions in childhood--with the exception of exchondroma and enchondroma--rarely show diagnostic radiographic features.     

Accuracy of fine needle aspiration cytology in the diagnosis of bone lesions with radiological assistance: Experience from the National Cancer Institute,Cairo University,Egypt

Aim

To evaluate the accuracy of fine needle aspiration cytology in the diagnosis of bone lesions with radiological assistance.

Patients and methods

85 cases of FNAC of bone lesions were included. Sixty two procedures were performed by the radiologist and 23 procedures by the histopathologists. The aspirates were immediately fixed in 95% ethanol alcohol for Papanicolaou staining. If there was sufficient material, cell block was prepared. Diagnosis was established in 81 cases (95.3%), classified into 3 categories: (1) positive for malignant cells (57.6%); (2) suspicious for malignant cells (10.6%); and (3) benign, borderline or inflammatory lesions (27.1%). Cytology findings were compared with subsequent available histology.

Results

The overall accuracy was 91%. The 49 cases diagnosed as malignant by cytology were all correct. FNAC could differentiate various giant cell rich lesions and round cell malignancies as Ewing’s sarcoma, myeloma and NHL. Uncommon bone lesions as chordoma and MFH were also correctly diagnosed. Cytological diagnosis of benign and borderline lesions was made in 23 patients. The authors encountered difficulties diagnosing a case of MFH that was reported as osteosarcoma and a case of metastasis that was reported as chondrosarcoma.

Conclusion

FNAC of bone lesions is a simple, safe and accurate diagnostic technique for diagnosis of bone lesions especially when other diagnostic modalities are unavailable.     

胃肠道间质瘤18例的~(18)F-FDG PET/CT显像及病理对照研究

目的探讨胃肠道间质瘤的18F-FDG PET/CT显像特点及其相应病理学表现,以提高对胃肠道间质瘤的诊断水平。方法对18例病理证实为胃肠道间质瘤患者的PET/CT显像进行回顾性分析,记录、总结病灶特点,并与既往PET/CT报告及病理报告进行比较、分析。结果本组18例间质瘤,原发瘤灶均为单发,其中良性3例、潜在恶性5例、恶性10例,3例良性病变PET显像均为阴性表现,潜在恶性及恶性间质瘤15例均表现为均匀或不均匀核素异常浓聚灶,CT表现3例良性间质瘤均表现为边界清楚、光滑肿块影,潜在恶性及恶性间质瘤CT表现不一,多数病灶内可见坏死、囊变区,部分病灶内可见出血,少部分病灶内密度均匀,呈软组织密度;大部分病例可准确定位、定性诊断,少数病例定位诊断及病理学分型不明确。结论PET/CT在对间质瘤的定位及定性诊断方面具有重要价值,可鉴别间质瘤良、恶性,且一次扫描可判断肿瘤有无转移,但对于间质瘤恶性程度分级上还有一定困难,最后确诊有赖于病理组织学和免疫组化检查。     

Magnetic resonance appearance of fibromatosis

We reviewed retrospectively the magnetic resonance (MR) images of 14 soft-tissue lesions of fibromatosis (desmoid tumors) encountered in 11 patients. The lesions were typically inhomogeneous in texture and round to oval in configuration. Margins were well-defined in 78% of the lesions at presentation and were infiltrating in all recurrences. On T₁-weighted spin echo MR images, the predominant signal intensity was either isointense or minimally hyperintense when compared with skeletal muscle. On T₂-weighted MR images the predominant signal intensity was typically intermediate between skeletal muscle and subcutaneous fat or isointense to fat. Linear and curvilinear areas of decreased signal intensity were distributed throughout the lesions on both pulse sequences in 86% of cases. This pattern strongly suggested fibromatosis. Speculation concerning possible etiologies of this appearance are discussed, and the relevant literature on previously reported cases is reviewed.The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army, the Department of Defense, or the Uniformed Services University of the Health Sciences     

Xeroradiography of bone tumors

Xeroradiography of benign and malignant bone tumors was performed in 48 patients, 45 of whom also underwent conventional film radiography. The diagnosis was confirmed by surgery and histologic examination in 42 cases (87%).Xeroradiography was found to be more effective than film radiography in 25 cases and less effective in representing bone tumors in 8 cases (18%). The two techniques were substantially equivalent for diagnostic purposes in 15 cases (33%).The main features of the xeroradiographic picture of bones are reviewed with emphasis on the differences between positive and negative modes. Positive xeroradiographs may be useful for the study of trabecular structure while negative xeroradiographs offer a good view of soft tissues.Xeroradiography is not suggested as a first choice examination, but as an useful second-line technique in selected cases with minute lesions or extraosseous malignant spread.