Mucin-Producing Carcinoma of the Gallbladder: Evaluation by Magnetic Resonance Cholangiopancreatography in Three Cases

We report three cases of mucin-producing carcinoma of the gallbladder, along with the magnetic resonance (MR) findings, especially the findings on a MR cholangiopancreatography. In our cases, linear or curvilinear streaks were detected running along the long axis of an enlarged gallbladder (mucus thread sign). When such findings were seen, a mucin-producing carcinoma of the gallbladder should be included as a differential diagnosis. Thus, gadolinium-enhanced MR imaging is mandatory for the precise diagnosis of the mucin-producing carcinoma of the gallbladder.     

Calcified renal metastases: their etiology, pathogenesis, computed tomographic aspects and differential diagnosis

PURPOSE: To describe CT findings of calcified renal metastases focusing on differential diagnosis problems. MATERIAL AND METHODS: We retrospectively reviewed abdominal CT scans of 8000 patients with tumor, performed from 1984 to 1998. Among the 58 renal metastases, 9 showed a calcific component. We evaluated the location, morphostructural pattern, histology of the primary lesion, the synchronous or metachronous character and the type of treatment. All the lesions were pathologically proved. RESULTS: The primary histotype of the 9 metastases was as follows: 4 mucin-producing adenocarcinomas of the large bowel, 1 gastric mucinous adenocarcinoma, 1 chondrosarcoma, 1 osteosarcoma, 1 melanoma, 1 papillary thyroid carcinoma. In all the cases the renal metastasis was unilateral and unifocal. Granular multiple calcifications were demonstrated within the metastases of mucin-producing adenocarcinoma of the large bowel (3), within the metastasis of chondrosarcoma (1) and of melanoma (1). Diffuse "star-like" calcifications were demonstrated in renal metastases of mucin-producing adenocarcinoma of the large bowel and of gastric mucinous adenocarcinoma (1). Peripheral "egg-shell" calcifications were demonstrated in renal metastasis from papillary thyroid carcinoma (1). Completely calcified monofocal calcification was demonstrated in renal metastasis from osteosarcoma (1). DISCUSSION AND CONCLUSIONS: Calcified renal metastases are rare lesions related to specific oncotypes. The differential diagnosis (carcinoma with calcifications, osteosarcoma, chondrosarcoma, nephrocalcinosis, granulomatosis, hydatidosis etc.) is particularly difficult because of the aspecificity of the morphostructural pattern. Diagnosis is based on a history of specific oncotypes (papillary and mucin-secreting carcinomas, osteosarcoma and chondrosarcoma), but in most cases it requires pathologic confirmation.     

原发性胆囊癌的临床及CT分析

目的；分析胆囊癌的CT表现及其对临床诊断的价值。方法：本组42例胆囊均有完整的临床、实验室及CT扫描资料并经病理证实。结果：胆囊癌的主要CT表现有：胆囊壁的不规则增厚、胆囊腔内乳头状癌结节、胆囊呈等密度实质性肿块、直接侵犯肝脏、肝门及胰头部位淋巴结转移，增强后，囊壁和囊内的癌结节均被增强。结论：胆囊癌的CT表现对其诊断和鉴别诊断具有重要的价值。     

原发性胆囊癌的MRI诊断

目的：分析原发性胆囊癌的MRI表现。方法：回顾性分析经手术病理证实的83例原发性胆囊癌的MRI资料。结果：83例胆囊癌MRI术前诊断的符合率为91．57％（76／83）。原发性胆囊癌在MRI上分4型：胆囊壁增厚型（33例）,乳头结节型（16例）,肿块型（24例）,混合型（壁增厚及结节）（10例）;合并慢性胆囊炎及胆囊结石的有65例,占（78．31％）。结论：MRI对胆囊癌临床诊断及治疗能提供有价值指导资料。     

胆囊癌的CT诊断

目的探讨胆囊癌的CT表现与诊断价值.材料和方法104例经手术和病理证实的胆囊癌病人(术前诊断89例,术后复查15例),回顾复习其手术前后的影像学表现和分析漏、误诊因素.另有78例病人作了术后临床随访.结果CT对胆囊癌诊断正确率为85.2%,漏诊率为14.8%,经腹超声则分别为59.3%和40.7%(两者P值均＜0.001).CT图像显示胆囊癌的特征性表现有胆囊壁局限性或弥漫性不规则增厚46例次;腔内乳头状或结节状影20例次;胆囊肿块18例次.15例胆囊癌术后1年内复查,14例出现多处转移.78例临床随访者中,存活5年以上者8例(10.26%).结论胆囊癌病人的预后不甚理想.CT对其诊断正确率较高,但早期发现仍存在一定困难.     

F18-FDG-PET/CT for evaluation of intraductal papillary mucinous neoplasms (IPMN): a review of the literature

Intraductal papillary mucinous neoplasms (IPMN) are intraductal mucin-producing neoplasms with tall columnar, mucin-containing epithelium, with or without papillary projections, involving the main pancreatic duct and/or major side branches. They account for approximately 25 % of all cystic neoplasms and can be subdivided into benign lesions, borderline lesions, and carcinoma. In this clinical scenario accurate preoperative diagnosis can eliminate unnecessary surgery, which is risky and potentially harmful, yet enable effective selection of patients who are candidates for surgery. In this review we try to provide a complete evaluation of the use of F18-FDG-PET/CT for diagnosis of this neoplasm on the basis of published papers. F18-FDG-PET/CT seems to be an useful technique for preoperative work-up of patients with suspected IPMN and is an improvement over conventional imaging in distinguishing benign from malignant lesions, especially for selecting patients for surgical treatment or for long-term follow-up.     

原发性胆囊癌的影像学诊断(附52例分析)

目的:探讨超声、CT和MRI在胆囊癌诊断中的临床应用价值。方法:回顾性分析52例经手术及病理证实的胆囊癌的超声、CT和MRI资料。结果:52例胆囊癌术前超声诊断符合率为73.1%(38/52),CT诊断符合率为75%(39/52),MRI符合率为83.3%(15/18)。其中合并慢性胆囊炎伴胆囊结石21例(40.4%)。影像表现为4种类型:胆囊壁增厚型(16例),乳头结节型(15例),混合型(壁厚和结节8例),实体型(13例)。结论:超声、CT和MRI对胆囊癌的诊断具有重要的临床价值,合理的应用能更好地指导临床治疗和术后疗效观察。     

Usefulness of noncontrast MRI in differentiation between gallbladder carcinoma and benign conditions manifesting as focal mild wall thickening

BackgroundMagnetic resonance imaging (MRI) is a reliable imaging tool for evaluating gallbladder carcinoma, but it is costly and time-consuming.PurposeTo compare noncontrast MRI with multidetector row CT (MDCT) and gadoxetic acid-enhanced whole MRI in distinguishing gallbladder carcinoma from benign disease.Materials and methods101 patients (36 with gallbladder carcinoma and 65 with benign disease) with mild focal gallbladder wall thickening were included. Two radiologists reviewed the MDCT and MRI to determine the differential features between malignancy and benignity. Then, the diagnostic performance of MDCT and MRI (T1-, T2- and diffusion-weighted images) with and without gadoxetic acid enhancement in the diagnosis of gallbladder carcinoma was evaluated.ResultsThe benign group more often showed T2 necklace sign or T2 hyperintensity within the thickened wall (P < 0.0001) and T1 hyperintensity within the wall or gallbladder lumen (P = 0.0002). Meanwhile, malignancy more frequently showed T2 moderate hyperintensity of the thickened wall, papillary appearance, and diffusion restriction (all P < 0.0001). There were significant differences in sensitivity (79.2% vs 98.6% for observer 1; 84.7% vs 100% for observer 2) and specificity (80.7% vs 96.9%; 79.2% vs 95.4%) between the MDCT and noncontrast MRI (P < 0.05). We found similar diagnostic values between the noncontrast MRI and whole MRI (P = 0.479–1.000) for both observers.ConclusionNoncontrast MRI could be a useful alternative to gadoxetic acid–enhanced MRI in the diagnosis of gallbladder carcinoma that presents as mild gallbladder wall thickening on MDCT.     

Fundic adenomyomatosis bulged with the subserosal excessive fat of the gallbladder mimicking polypoid carcinoma: a case report with unusual imaging and morphological features.

This report describes a 41-year-old female who presented with adenomyomatosis of the gallbladder mimicking polypoid carcinoma, on the diagnostic imaging findings and revealing unusual histologic features for such a localized adenomyomatosis. The mass was located on the gallbladder liver-side wall at the fundus and papillary hyperechoic growth showed no clear ultrasonographic features of adenomyomatosis. The patient underwent a laparoscopic cholecystectomy with a tentative diagnosis of superficial polypoid carcinoma. Histologically, the tumor bulged due to subserosal excessive fat tissue.     

原发性胆囊癌的MRI、MRCP诊断分析

目的 分析原发性胆囊癌的MRI、MRCP表现. 方法 回顾性分析经手术病理证实的87例原发性胆囊癌的MRI 及MRCP资料.结果 原发性胆囊癌在MRI上分4型:胆囊壁增厚型( 35例),乳头结节型(17例),肿块型(25例),混合型(10例)( 壁增厚及结节).病检显示肿瘤合并慢性胆囊炎及胆囊结石者69例(79.31%).与手术结果相比,MRI诊断的确诊率为46/50(92%),MRCP为13/19(68.4%),两者联合为80/82(97.6%).在显示胆囊癌直接浸润肝脏者25/32(78.12%),肝脏转移17/19(89.47%),淋巴转移28/34(82.35%),腹内远处转移13/13(100%)以及胆管受侵25/26(96.15%). 结论 MRI结合MRCP对胆囊癌的诊断具有重要意义.     

低张饮水后螺旋CT增强对乳头型壶腹癌的诊断价值

目的探讨低张后螺旋CT增强对乳头型壶腹癌的诊断价值。方法对20例经手术病理证实的乳头型壶腹癌其CT表现进行回顾性分析,采用低张(肌注654-220mg)后饮水(300～500ml)行螺旋薄层CT增强扫描,侧重观察动脉期表现。结果20例常规平扫仅2例在胰腺钩突水平十二指肠降段靠内侧区似有类圆形肿块所致的充盈缺损,18例均未见明确病灶,低张饮水后薄层增强所有病例均显示局限性明显或不均一强化之充盈缺损影,肿块直径0.8～2.6cm;2例伴有胰头钩突受侵,肿块直径2.4～2.6cm,2例十二指肠周围淋巴结转移。所有病例均显示肝内胆管扩张、胆囊增大和胆总管扩张。结论低张饮水后螺旋CT增强较常规增强扫描在确定肿瘤大小、形态等方面更具优越性。     

胆囊癌的超声诊断(附25例分析)

目的 :探讨不同类型的胆囊癌B超特征性表现。方法 :按胆囊癌常规扫查方法仔细观察其声像图 ,并作回顾性分析。结果 :2 5例胆囊癌中 ,包括胆囊局部性向腔内隆起型 (3例 ) ,胆囊壁弥漫性或局限性不规则增厚型 (8例 ) ,胆囊实块型改变 (12例 ) ,胆囊壁乳突状结节突入腔内 (2例 )。本文分析了各型的声像图特征。结论 :B超可以帮助检出胆囊癌 ,尤其在帮助检出没有临床症状的早期胆囊癌时 ,有重要的临床意义。     

胆囊癌CT误诊分析

目的　分析胆囊癌CT误诊原因 ,以提高诊断正确率。方法　搜集经手术病理证实的胆囊癌病例 43例 ,均行CT扫描 ,其中误诊 2 3例。与手术结果对照 ,分析误诊原因。结果　 2 3例误诊中 ,诊断为急慢性胆囊炎 5例 ,胆囊息肉 1例 ,肝门区胆管癌 2例 ,胆管癌 1例 ,胆总管下端、壶腹部占位 3例 ,胰头癌 5例 ,胆总管炎症 1例 ,梗阻性黄疸 2例 ,胆囊肿大 2例 ,结肠癌 1例。结论　明确胆囊癌的CT征象及其转移途径 ,可以避免误诊 ,提高诊断正确率。     

胆囊癌的CT诊断及鉴别诊断(附33例报道)

目的:探讨胆囊癌的CT表现及鉴别诊断.方法:33例经手术病理证实的胆囊癌,对其CT表现进行观察分析.结果:胆囊癌以老年女性多见,临床表现为黄疸及腹部肿块、纳差.CT表现:胆囊区肿块,密度不均,胆囊腔缩小或消失;胆囊壁增厚,呈局限性或弥漫性不规则增厚;胆囊腔内软组织块影;合并胆结石;肝内外胆管扩张;肝脏直接受侵范;肝脏转移,侵犯腹壁,合并腹水.增强扫描可见病灶中度及明显强化.病灶周围及邻近器官侵犯、淋巴结转移更有助于诊断.结论:仔细观察胆囊及其周围结构、邻近器官改变,旨在提高胆囊癌的诊断正确率.     

Ultrasonography in carcinoma of the gallbladder

Cholecystosonography in approximately 40,000 patients over five years in two university hospitals revealed 30 (75%) of the 40 macroscopic primary carcinomas. In 3 cases the carcinoma was obscured by gallstones with shadowing, in 3 cases the origin of a tumour mass was misinterpreted, and in 4 cases the neoplastic growth mimicked gallbladder inflammatory changes or sludge. Malignancy was incorrectly diagnosed or suggested in 25 patients. The most frequent cause of a false positive report was acute or chronic inflammation, found at surgery in 16 gallbladders. Four carcinomas of the pancreatic head were believed to be gallbladder tumours. Cirrhosis with marked gallbladder wall thickening, gastric carcinomas with metastases, a common duct carcinoma, and two cases of sludge (with normal control studies) caused a false suggestion of gallbladder carcinoma. The most frequent ultrasonographic finding in gallbladder carcinomas was a mass filling the gallbladder (15 diagnosed cases), followed by wall thickening (9 cases), and polypoid or fungating tumour (6 cases). Real-time ultrasonography is a useful method for the preoperative diagnosis of gallbladder carcinoma, but considerable diagnostic problems in the differentiation from inflammatory diseases may be encountered.     

胆囊癌的CT表现研究(附22例分析)

目的:研究胆囊癌的CT表现。方法:回顾性分析22例经手术病理证实的胆囊癌的CT表现,测量9例胆囊癌静脉期和延迟期CT值,并与同层面正常肝实质静脉期和延迟期CT值进行比较。结果:12例表现为胆囊区肿块,4例表现为腔内结节,6例表现为胆囊壁不规则增厚。肝脏侵犯8例,肝内转移3例,腹膜后淋巴结转移4例。胆道系统扩张8例。胆囊癌较正常肝实质延迟期CT值下降缓慢,表现为"强化持续"。结论:CT扫描可以明确胆囊癌的存在以及周围侵犯和转移情况。     

胆囊癌的CT诊断

目的：提高对胆囊癌的认识和诊断水平并总结有鉴别诊断意义的征象。方法：收集经手术及病理证实的胆囊癌14例,进行回顾性分析。结果：（1）胆囊壁局限性或弥漫性不规则增厚8例;（2）胆囊壁突向腔内肿块4例,囊腔尚存;（3）肿块型2例,胆囊区软组织肿块,囊腔缩小或闭塞;其中合并胆囊结石6例、胆囊癌肝转移6例、淋巴结转移5例。结论：CT是诊断胆囊癌影像检查的重要手段之一,结合临床表现有助于提高诊断准确性。     

螺旋CT胆囊成像对胆囊疾病的诊断价值

目的：评价螺旋ＣＴ胆囊成像对胆囊疾病的诊断价值。方法：４３例胆囊疾病者中胆囊结石２７例,胆囊癌９例,胆囊息肉７例;利用口服胆囊造影ＣＴ和静脉输入胆道对比剂Ｂｉｌｉｓｃｏｐｉｎ相结合行上腹部螺旋ＣＴ容积５扫描,在工作站利用软件将图像处理后得到胆囊及胆管系统立体图像。结果：２７例胆囊结石中１０例为阳性结石,１７例为阴性结石;胆四维图像上,胆囊结石显示为１个或多个类圆形队影或致密影,与胆囊壁分界清楚,并     

Markedly high signal intensity lesions in the uterine cervix on T2-weighted imaging: differentiation between mucin-producing carcinomas and nabothian cysts.

PURPOSE: Both mucin-producing carcinomas and nabothian cysts in the cervix show very high signal intensity on T2-weighted images (WI). The purpose of this study was to evaluate the potential of MR imaging in differentiating mucin-producing carcinomas from nabothian cysts. MATERIALS AND METHODS: Forty-six patients who underwent hysterectomy and had very high signal intensity lesions in the uterine cervix on T2-WI were included in this study. The pathological diagnoses were mucin-producing carcinoma in 13 patients, non-mucin-producing carcinoma accompanied with nabothian cyst in four patients, and nabothian cyst in 29 patients. T1-WI, T2-WI, and Gd-T1-WI were obtained in all patients. Malignancies were diagnosed on Gd-T1-WI as follows: (1) an enhanced lesion, (2) an irregular margin, (3) iso-intensity on T1-WI. In contrast, high signal intensity on T1-WI was considered benign. RESULTS: Thirteen of 17 malignant lesions and three of 29 benign lesions were enhanced. Irregular margins were observed in 12 of 17 malignant lesions and four of 29 benign lesions. Nineteen benign lesions and seven malignant lesions demonstrated high signal intensity on supplemental T1-WI. Combining the lesion criteria of enhancement, irregular lesion margin, and iso-intensity on T1-WI, the overall accuracy, sensitivity, and specificity rates of diagnosing malignancy were 89%, 88%, and 90%, respectively (p < 0.01). CONCLUSION: MR imaging accurately differentiated mucin-producing carcinomas from nabothian cysts that showed high signal intensity on T2-WI in the cervical stroma. For diagnosing mucin-producing carcinomas and nabothian cysts when signal intensity was remarkably high on T2-WI, Gd-T1-WI findings provided key information for differentiation, and T1-WI was useful for improving specificity.     

Computed tomography of calcified gastric carcinoma

The CT findings in a case of calcified gastric carcinoma of the mucin-producing type are described. These findings include localized thickening of the gastric wall and multiple tiny calcific nodules within it.