CT and MRI findings of a solitary extramedullary plasmacytoma of the oropharynx: case report

We report a case of solitary extramedullary plasmacytoma (SEP) of the oropharynx. A 53-year-old man presented who had had bloody phlegm and a sore throat for a few days. A mass was endoscopically detected in his right posterior oropharyngeal wall, and biopsy revealed a neoplasm consisting of a uniform population of plasma cells. Computed tomography (CT) showed a broad-based papillary soft tissue density mass projecting into the oropharynx from the right posterior wall of the pharynx, and post-contrast CT showed marked enhancement of the tumor. The tumor showed slightly higher signal intensity compared with surrounding muscle on MR Tl-weighted images (T1WI) and high signal intensity on MR T2-weighted images (T2WI). The mass showed homogeneous enhancement on post-contrast T1WI. Further clinical examination showed an absence of multiple myeloma (MM). The patient was diagnosed as having SEP. Following radiation therapy, a reduction in tumor size was observed. Although SEP is a rare tumor, it should be included in the differential diagnosis of tumors of the oropharynx because of its imaging similarities to other, more common malignant tumors, such as squamous cell carcinoma and lymphoma.     

鼻腔髓外浆细胞瘤1例

患者女,63岁。因“鼻塞3年”入院,体检:外鼻无畸形,右下鼻甲稍肥大,右下鼻甲中份可见息肉样新生物,表面光滑,呈暗红色,质韧,向后生长,阻塞下鼻道。实验室检查无异常。CT平扫:右鼻腔下鼻甲处见不规则软组织肿块,密度均匀,病变向鼻咽腔生长,与翼内肌界线不清。右上颌窦内侧壁粘膜     

CT findings in a nasopharyngeal extramedullary plasmacytoma

We report a case of an extramedullary plasmacytoma arising from the nasopharynx. The computed tomographic appearance of this rare tumor is discussed.     

MR characteristics of primary extramedullary plasmacytoma in the head and neck.

PURPOSETo define MR characteristics of primary extramedullary plasmacytoma in the head and neck using a variety of plain and contrast-enhanced MR protocols.METHODSSix patients with primary extramedullary plasmacytoma in the head and neck were examined clinically and with MR imaging at 1.5 T. The morphologic appearance and signal intensities of the lesions were analyzed and the results of the imaging findings were compared with histopathologic findings.RESULTSQualitative analysis showed that five lesions were oval and sharply demarcated without signs of infiltration; the other lesion filled the parapharyngeal space bilaterally. On t2-weighted sequences, the lesions had moderate signal intensity. On plain T1-weighted sequences, the tumors were isointense or slightly hyperintense with respect to surrounding muscles; after administration of contrast medium, four lesions notable enhancement, with distinct central inhomogeneity.CONCLUSIONAlthough morphologic features or evidence of contrast enhancement do not assure certain diagnosis of extramedullary plasmacytoma, these MR imaging characteristics should prompt the radiologist to include this rare lesion in the differential diagnosis.     

CT and MR imaging of a solitary fibrous tumor of the thigh

Solitary fibrous tumor is a rare mesenchymal tumor usually involving the pleura. Extrapleural lesions may also occur. We report the CT and MRI appearance of a solitary fibrous tumor of the thigh.The imaging features as well as the histological and immunohistochemical characteristics are presented, especially its reactivity to the CD34 antigen. The tumor is most often benign, particularly in extra-pleural location, with good prognosis after total resection. Imaging is mainly useful to locate the tumor and assess its extension prior to surgery.     

MR imaging of intrathoracic extramedullary hematopoiesis

Intrathoracic extramedullary hematopoiesis is a rare neoplasm that is most often asymptomatic and usually discovered during a screening examination for another problem. We present a case of intrathoracic extramedullary hematopoiesis in a patient with homozygous sickle cell disease with CT and magnetic resonance correlation.     

Cellular leiomyoma of the nasal cavity: findings of CT and MR imaging

Nasal leiomyoma, a benign tumor composed of smooth muscle cells, is rare in the head and neck region. Cellular leiomyomas of the uterus exhibit high intensity on T2-weighted images. Here we present a case of nasal leiomyoma in which the pathologic findings are similar to those of cellular leiomyoma. The present case exhibited slightly elevated intensity on T2-weighted images and marked enhancement on postcontrast images. CT findings showed a soft tissue lesion without bone erosion. These findings appear to be characteristic of intranasal leiomyoma.     

MR imaging of intradural extramedullary tumors.

Thirty-one consecutive intradural extramedullary spinal tumors examined with MR at 0.3 T were reviewed. In 13 of the patients myelography had been performed. There were 11 patients with meningeoma, 14 with neuroma, one ependymoma, 3 metastases, and 2 lipomas. All tumors were surgically removed and verified by histology. The intradural extramedullary location of the tumors was accurately assessed by MR imaging in all patients and by myelography in 10 of 13. The MR diagnoses were in accordance with the histologic findings in 74% of cases. Compression of the spinal cord or cauda equina with widening of the subarachnoid space above and below the mass or outward displacement of epidural fat was characteristic of the intradural extramedullary tumors. The signal intensity of meningeoma as well as of neuroma was slightly lower or equal to that of the cord on T1-weighted images, and equal to or higher than cord signal on T2-weighted images. Neuroma had a lower signal intensity on T1-weighted images and a higher signal intensity on T2-weighted images than meningeoma. Meningeoma appeared more homogeneous than neuroma and had a broad base towards the dura.     

Solitary extramedullary plasmacytoma of the premaxilla

Solitary extramedullary plasmacytoma is a rare tumour with radiotherapy playing an important role in its management. This report describes the case history of a man with a solitary extramedullary plasmacytoma at an extremely rare site, the premaxilla, that posed certain diagnostic and therapeutic dilemmas. The patient underwent surgery followed by postoperative radiotherapy. The use of two modalities of treatment for this localized tumour has been justified by briefly reviewing the literature and defining the various prognostic factors. These prognostic factors in turn should guide the treatment of these uncommon tumours.     

Congenital nasal masses: CT and MR imaging features in 16 cases

The imaging studies of 16 children with pathologically proved nasal encephaloceles (eight), nasal dermal sinuses/nasal dermoids (seven), and nasal cerebral heterotopias, more commonly known as nasal gliomas (one), were retrospectively reviewed and compared with normal control subjects to define the normal anatomy and analyze deformities caused by these lesions. Nasal encephaloceles were always identified as complex masses of mixed soft tissue and CSF intensity that were contiguous with intracranial structures. The nasal glioma appeared as a mixed-intensity mass that, on the basis of the CT scan, appeared to be continuous with intracranial structures. Nasal dermal sinuses could only be identified as they coursed through the skin and subcutaneous soft tissue. They could not be identified when intraosseous. Moreover, on CT and, particularly, on MR, a number of potential diagnostic pitfalls were encountered. The most important of these was the normal fat deposition that occurs within bone during normal maturation and during aeration of the frontal sinuses and nasal bones. These fatty changes can easily be mistaken for fatty tumors if they are not recognized as normal anatomic changes. Interestingly, the classic plain film findings for congenital nasal masses were present only in the encephaloceles and nasal glioma; dermoids and dermal sinuses showed none of the classic plain film findings. In the six patients who had both CT and MR, the masses were easily identified and characterized by each imaging method. Congenital nasal masses are well characterized by both CT and MR. It is important to understand the normal changes in the anatomy of the nasofrontal region in the pediatric age group to avoid false-positive diagnoses in this region.     

MR imaging of intradural extramedullary tumors of the cervical spine

Magnetic resonance imaging was performed in eight patients with extramedullary cervical tumors; two were studied with a 0.15 T resistive system and six with a 0.5 superconductive unit. All tumors were verified surgically: Five meningiomas and three schwannomas were found. Magnetic resonance demonstrated the location and size of the tumors as well as their relationship with and mass effect on the adjacent spinal cord. Meningiomas showed a tendency to have relaxation times close to those of the normal parenchyma; in multiple echo sequences their signal tends to decay in a way similar to that of the spinal cord. The different signal from the surrounding cerebrospinal fluid sometimes provides a visual cleavage to define the extramedullary location of the neoplasm. Schwannomas and neurofibromas have a less constant behavior; their T2 relaxation time may be slightly longer than that of the spinal cord and the tumor may display a more intense signal in the T2 weighted images. Usually, however, the signal intensity of the extramedullary tumors is lower than that of the intramedullary.     

髓外硬膜下肿瘤的MRI诊断及鉴别诊断

目的:分析评价髓外硬膜下肿瘤的MRI表现及影像学特征,提高诊断与鉴别诊断水平。方法:收集经MRI检查手术病理证实的髓外硬膜下肿瘤58例,对其MRI表现及影像学特征进行回顾性分析。结果:58例髓外硬膜下肿瘤中,神经鞘瘤24例,神经纤维瘤18例,脊膜瘤8例,脂肪瘤5例,畸胎瘤3例,各种不同肿瘤的MRI征象,都各有其特征性。结论:髓外硬膜下肿瘤MRI检查是首选方法、定位、定性诊断及鉴别诊断均有重要价值。     

Radiotherapy of extramedullary plasmacytoma of the head and neck

The purpose of this study is to report the results of megavoltage irradiation in 23 previously unreported cases of extramedullary plasmacytoma of the head and neck. It has been found that 3500 cGy (rad) in three weeks provides good local control of disease with minimal morbidity and a significant proportion do not go on to multiple myeloma. Prognostic factors of significance with respect to subsequent development of multiple myeloma include site and presence or absence of bone destruction. The presence or absence of an M protein peak appears to be of no significance.     

原发于横纹肌的髓外浆细胞瘤MR表现及病理分析

髓外浆细胞瘤（extramedullary plasmacytoma,EMP）是原发于骨髓以外的器官和组织的以浆细胞增殖为特点的恶性肿瘤,是恶性单克隆浆细胞病变中较为罕见的一种,约占全部恶性肿瘤发生率中的3％左右。而原发于横纹肌的髓外浆细胞瘤更为罕见,此前国内外文献罕见相关报道。本文旨在通过对近年来遇到的2例病变进行回顾性分析,探讨其临床、MR影像表现特征及相关病理免疫组化结果,以期提高对该种疾病的认识。     

孤立性纤维瘤的CT、MR诊断

目的探讨孤立性纤维瘤(SFT)的CT、MR表现,以提高对其影像诊断水平。方法回顾性分析经手术病理证实的SFT 19例的CT和MR表现。结果共19例,其中头部3例,眼眶1例,颞下窝1例,胸部7例,腹盆部7例,其中多发2例,6例恶性。肿瘤直径1.5～25cm,瘤体呈类圆形或轻度分叶,11例有包膜。病灶小者密度均匀,等或稍高于肌肉,较大者中间可变性坏死、囊变,1例钙化。T1WI多呈等或稍低信号,T2WI信号变化较大,多呈等低信号。增强表现多样,5例轻中度强化,11例显著强化,其中4例渐进延迟强化,呈"地图样"改变。结论 SFT是一种少见可发生在全身各部位的富血供肿瘤。影像学上病灶孤立,体积较大,境界清楚,T1WI等低类似肌肉信号,T2WI表现为等或略高信号为主,增强后显著强化或渐进延迟强化,应考虑到该肿瘤可能。     

Computed tomography in the diagnosis of extramedullary plasmacytoma

Extramedullary plasmacytomas involving the retroperitoneum are rare. Review of the literature reveals only one case in which computed tomography (CT) findings were illustrated, and this case involved the pancreas. Described here is unusual case in which pancreatic and renal plasmacytomas occurred in a patient who 18 months previously had presented with a solitary plasmacytoma of bone. The clinically unsuspected renal masses was diagnosed by CT, allowing easy biopsy and radiotherapy planning.     

Spinal intradural extramedullary capillary hemangioma: MR imaging findings

SUMMARY: Spinal intradural extramedullary capillary hemangiomas are extremely rare. We present the MR imaging and histologic findings in three patients with this abnormality. The three patients were men who had symptoms of either myelopathy (n = 2) or radiculopathy (n = 1). The tumors were well demarcated, 1.5-2.0 cm in diameter, and were located at the posterior or posterolateral portion of the thecal sac (one at the L1 level and the other two at the midthoracic level). On MR images, the tumor showed isointensity relative to the spinal cord on T1-weighted images, hyperintensity on T2-weighted images, and strong homogeneous enhancement on contrast-enhanced T1-weighted images in all three patients. In two patients, the dural tail sign was observed. Capillary hemangioma should be included in the differential diagnosis of a spinal intradural extramedullary tumor.