Lipomatous meningioma of the brain harboring metastatic renal-cell carcinoma: A case report

A 70-year-old woman presented with mild left hemiparesis and intermittent global headache. Magnetic resonance imaging showed a 6×6×6-cm tumor in the right frontal lobe, and abdominal computed tomography revealed a 8×8×7-cm mass lesion in the left kidney. Magnetic resonance imaging showed that the brain tumor consisted of a central hyperintense cystic component and an outer hypointense component. The patient underwent total surgical excision of the intracranial mass. Histological and immunohistochemical examination showed that the lesion was a lipomatous meningioma harboring metastatic renal-cell carcinoma. Both of these tumors are rare. The magnetic resonance imaging findings are indicative of but not specific to meningioma harboring metastatic tumor.     

Clinical significance of magnetic resonance cholangiopancreatography for the diagnosis of cystic tumor of the pancreas compared with endoscopic retrograde cholangiopancreatography and computed tomography.

BACKGROUND: Cystic tumor of the pancreas has been investigated by a variety of imaging techniques. Magnetic resonance cholangiopancreatography (MRCP) is being widely used as a non-invasive diagnostic modality for investigation of the biliary tree and pancreatic duct system. The purpose of this study was to compare MRCP images with those of endoscopic retrograde cholangiopancreatography (ERCP) and computed tomography (CT) in order to clarify the diagnostic efficacy of MRCP for cystic tumor of the pancreas. METHODS: We retrospectively studied 15 patients with cystic tumor of the pancreas that had been surgically resected and histopathologically confirmed. There were five cases of intraductal papillary adenocarcinoma, five of intraductal papillary adenoma, two of serous cyst adenoma, two of retention cyst associated with invasive ductal adenocarcinoma and one of solid cystic tumor. RESULTS: In all cases MRCP correctly identified the main pancreatic duct (MPD) and showed the entire cystic tumor and the communication between the tumor and the MPD. On the other hand, the detection rate by ERCP of the cystic tumor and the communication between the cystic tumor and the MPD was only 60%. Although the detection rates by CT for the septum and solid components inside the cystic tumor were 100 and 90.0%, respectively, those of MRCP for each were 58.3 and 20.0%. CONCLUSION: MRCP is capable of providing diagnostic information superior to ERCP for the diagnosis of cystic tumor of the pancreas. Although MRCP may provide complementary information about the whole lesion of interest, the characteristic internal features of cystic tumor of the pancrease should be carefully diagnosed in combination with CT.     

Cystic neoplasms of the pancreas: a heterogeneous disorder.

Cystic neoplasms of the pancreas are rare tumors with a relatively better prognosis as compared to other pancreatic cancers. They may be mistaken for pseudocysts. Seventeen patients who underwent surgical resection were analyzed. Seventy percent of the patients were females and 76.7% of the tumors were located in the tail of the pancreas. Preoperative diagnosis was made on the basis of ultrasonography and/or computed tomography findings in 60% of patients. Retrospective review of the imaging modalities revealed one or more findings suggestive of cystic neoplasms in 90% of the patients. These included multiloculated cysts, thickened cyst wall, intracystic mass or calcifications, and presence of liver metastasis. All the tumors were completely or partly excised. The final histopathological diagnosis was microcystic adenoma in 2, mucinous cyst adenoma in 1, papillary cystic neoplasm in 3, cystic neuroendocrine tumor in 5, and cystadenocarcinoma in 6. Of the 17 patients, 10 had malignant tumors. Seven patients with benign tumors and 3 patients with malignant tumors are disease free 12-30 months after resection. Cystic neoplasm must always be considered as a possibility when dealing with cystic lesions of the pancreas and a careful evaluation of ultrasonography and computed tomographic scan may give a clue to the diagnosis.     

Planning of segmentectomy using three-dimensional computed tomography angiography with a virtual safety margin: Technique and initial experience

Objectives

In preoperative segmentectomy simulation for primary lung cancer, it is important to identify the intersegmental pulmonary veins and the relationship between them and the surgical safety margin. We have adopted a method that incorporates a virtual safety margin into three-dimensional computed tomography angiography images in order to plan adequate segmentectomy for lung cancer patients. In this study, we describe the new preoperative planning technique and review cases in which we performed segmentectomy based on its results.

Methods

We reviewed clinical, radiological, and pathological records and selected patients who underwent segmentectomy for a primary lung cancer lesion with a diameter of 2 cm or less. These segmentectomies were planned using preoperative three-dimensional computed tomography angiography with a virtual safety margin.

Results

A total of 17 primary lung cancers in 16 patients (11 male and 5 female, aged 52–82 years) were removed by segmentectomy, planned using the new technique. In 6 of 17 tumors (35%) were non-solid type adenocarcinomas, 3 tumors (18%) were partly solid type adenocarcinomas, 6 tumors (35%) were solid type adenocarcinomas and 2 tumors (12%) were squamous cell carcinomas. Pathological examination revealed no positive surgical margins and no lymph node metastases in any patients.

Conclusions

Three-dimensional computed tomography angiography with a virtual safety margin was able to non-invasively visualize the three-dimensional distances and the relationships between the primary tumor and intersegmental pulmonary veins. It was able to aid in the preoperative planning of a suitable segmentectomy procedure for patients with a primary lung cancer lesion of 2 cm or less in diameter.     

多层螺旋CT在多房囊性肾癌诊断中的应用

 目的　探讨多层螺旋CT（MSCT）在多房囊性肾癌（MCRCC）诊断中的应用价值,提高MCRCC的术前诊断正确率。方法　回顾性分析22例经手术病理证实的MCRCC,均行MSCT平扫和双期增强扫描,分析其CT征象。结果　22例病灶均边界清楚,14例囊壁局部增厚,8例囊壁均匀增厚;6例病灶分隔菲薄（≤2 mm）,11例不均匀增厚（2 mm＜厚度≤5 mm）,5例分隔结节;双期增强扫描囊壁及分隔均强化,但囊液、出血及钙化不强化;2例囊壁钙化,3例囊液内钙化。结论　MCRCC的CT表现具有特征性,平扫及双期增强扫描对MCRCC术前诊断有重要价值。     

囊性肾细胞癌的CT影像诊断和病理表现

目的：分析囊性肾细胞癌的CT特征及病理表现。方法：回顾分析9例经手术病理证实且临床和影像资料完整的囊性肾细胞癌。结果：9例患者中,女性2例,男性7例,病灶均为单发,多为外生性生长。CT平扫囊性2例,囊实性7例,5例囊内容物内见碎屑或絮状物,2例囊壁见小结节状钙化。增强后囊壁、分隔及附壁结节呈不同程度强化,囊内容物未见明确强化。9例病变大体病理显示肿瘤均有厚薄不等的假纤维包膜围绕,切面见单一或大小不等的囊腔,内含浆液性或血性液体。镜下见囊腔上皮被覆肿瘤细胞。结论：囊性肾细胞癌CT表现为单发,囊壁、分隔及附壁结节呈不同程度强化,具有一定的特征性。     

食管间质瘤影像学分析及病理对照

目的总结食管间质瘤的临床及影像学特点,探讨食管造影及CT（计算机体层成像）对其诊断价值。方法回顾性分析经手术病理证实的12例食管间质瘤的临床资料、食管造影及CT所见并将其与手术、病理所见进行对照,探究食管间质瘤食管造影及CT的影像学特点及其病理学基础。结果 12例患者共检出病灶13个,11例为单发病灶,1例为2个病灶。13个病灶中,4例为极低度侵袭危险性肿瘤,4个为低度侵袭危险性肿瘤,1个为中度侵袭危险性肿瘤,4个为高度侵袭危险性肿瘤。食管极低度侵袭危险性及低度侵袭危险性间质瘤造影表现为食管弧形外压性改变或较光滑充盈缺损,CT平扫表现为类圆形均匀软组织密度影,增强后均匀轻度强化。而中度及高度侵袭危险性间质瘤食管造影可见食管管壁僵硬,黏膜有破坏,CT扫描内部可见囊变坏死,增强扫描呈不规则强化。结论不同侵袭危险性的食管间质瘤影像学表现有一定差异,食管造影及CT对食管间质瘤的诊断及侵袭危险性分级有一定价值,但最终确诊要依靠病理学诊断。     

Low grade gliomas: comparison of intraoperative ultrasound characteristics with preoperative imaging studies

Thirty-three patients with low grade gliomas were evaluated with preoperative computed tomography (CT), magnetic resonance (MR) and intraoperative ultrasound (IOUS). Six patients had undergone previous surgical exploration. Tumor borders were marked with cortical letters and corresponding depths calculated. Resection of tumor corresponded to these ultrasound dimensions. The histology of biopsy specimens from tumor and ultrasound determined margins was studied on formalin fixed permanent sections using hematoxylin and eosin (H&E) and immunocytochemistry (GFAP).Tumors were all seen on preoperative MR studies and most commonly showed a decreased T₁ and increased T₂ signal. Seven tumors showed variable enhancement with gadolinium. On CT two tumors were not seen, twenty-three tumors were hypodense and eight hyperdense. Three tumors showed variable CT contrast enhancement. All tumors were hyperechoic on ultrasound. Twenty-five (75%) tumors were well defined with distinct margins compared to adjacent brain. Eight tumors had poorly defined borders on ultrasound; five (62%) of these lesions had previously undergone surgeery. Eight tumors invaded functional brain identified by stimulation mapping techniques (e.g., speech cortex), thus limiting the resection. Five resections were limited because of involvement of important anatomical structures (e.g., corpus callosum). Of the remaining 20 tumors, seventeen (85%) had ultrasound defined margins that were histologically free of solid tumor (normal brain or sparse atypical cells only).Low grade gliomas are readily identified and their margins well defined by intraoperative ultrasound regardless of preoperative imaging patterns. The results suggest that IOUS may enhance intraoperative delineation and extent of resection for low grade gliomas.     

Radiologic Diagnosis of Neuroendocrine Tumors

The radiologic work-up of a patient with a pancreatic endocrine tumor should follow a strict course. Ultrasonography as the first procedure should be followed by angiography, if possible. Negative ultrasonography should be followed by computed tomography (CT), which, whether positive or negative, is supplemented by angiography. Negative CT and angiography is followed by transhepatic venous sampling. In patients with suspected liver metastases from intestinal and pancreatic endocrine tumors, angiography may reveal more metastases than CT and ultrasonography.     

Microcystic meningioma presenting as a cystic lesion with an enhancing mural nodule in elderly women: report of three cases

Cystic meningioma with an enhancing mural nodule is uncommon and can present as a radiologic and clinical dilemma with wide differential. We report a series of rare and unique presentation of microcystic meningioma in three elderly women aged 76 (case 1), 72 (case 2), and 76 (case 3) years, respectively. The first patient presented with a 3-year history of vertigo and past history of carotid artery stenosis, hypertension, and hypothyroidism. The second patient presented with headache and an acute episode of weakness in her legs. The third patient presented with headache, vomiting, and confusion. Magnetic resonance imaging for these three cases showed a cystic lesion with an enhancing mural nodule in the right frontal lobe. The preoperative differential diagnoses included hemangioblastoma and well-circumscribed gliomas for the first two cases. Glioblastoma and metastatic tumor were the working diagnoses for the third case because of vasogenic brain edema and marked mass effect. The final pathological diagnosis was microcystic meningioma for all three cases. Case reports are mainly of fibrous or meningothelial meningiomas with cystic formation. Male predominance and young age are most commonly reported. Our series is unique because of the rare and unusual clinical-radiologic presentation of microcystic meningioma in elderly women.     

Right atrial angiosarcoma and electrocardiogramgated cardiac computed tomography： a case report

Primary cardiac tumors are quite rare and most of these tumors are benign. In this report, a patient presented with chest distress and shortness of breath after activity. Echocardiography of other hospital showed a hyperechoic right atrial mass. Electrocerdiogram-gated cardiac computed tomography (ECG-Gated CT) of our hospital provided accurate information about the site and extent of the tumor, and the involvement of neighboring structures, even about the malignant nature of the lesion. The pathological study indicated angiosarcorna. The role of ECG-Gated CT in the assessment of cardiac masses and tumors was discussed. Cardiac tumors are extremely rare and can be divided into benign and malignant lesions. Myxomas are the most common type of cardiac benign tumor, while angiosarcomas are the most common type of cardiac malignant tumor.Imaging studies play an important role in the diagnosis of cardiac angiosarcomas. Echocardiogram, computed tomography (CT) and magnetic resonance imaging (MRI) are the most common imaging studies for tumors evaluation. However, the precise tumor location is often difficult to evaluate precisely on the basis of two-dimensional source images. We conducted ECG-gated cardiac CT examination with 3D reconstruction for preoperative assessment in a patient with a angiosarcorna arising in the right atrium.     

Diagnosis and treatment of giant cell tumor in the thoracic spine

A 23-year-old woman with incomplete paralysis was operated upon for a giant cell tumor in the thoracic spine. X-ray films revealed a destruction lesion in the vertebral body of the 12th thoracic vertebra. On the plain thoracic computed tomography scan, the finding was a soap-bubble appearance with a linear high density area in the mass lesion which destroyed the vertebral body. Preoperative angiography showed no apparent feeding artery to the tumor tissue; preoperative myelography showed incomplete block at the level of the 12th thoracic vertebra. A radical operation was carried out in one stage via a combined antero-posterior approach. In order to give radiotherapy immediately after operation, a vascular pedicled rib graft was made. This paper discusses the role of thoracic computed tomography scan in the diagnosis of giant cell tumor and the surgical techniques used in treatment.     

多层螺旋CT灌注成像对部分颅脑肿瘤和瘤样病变的评估

目的探讨多层螺旋CT灌注成像在脑肿瘤和瘤样病变诊断与鉴别诊断中的临床价值。方法56例患者中,脑内肿瘤38例,其中胶质瘤29例(低级组12例,高级组17例),室管膜瘤2例,血管母细胞瘤2例,髓母细胞瘤1例,转移瘤2例,畸胎瘤和淋巴瘤各1例;脑外肿瘤8例,其中脑膜瘤5例,神经鞘瘤2例,生殖细胞瘤1例;非肿瘤性病变10例,其中海绵状血管瘤6例,非特异性炎性肉芽肿2例,结核瘤1例,脉络丛增生1例。采用GElightspeed 16 slice多层螺旋CT机,行头部横断面平扫确定病灶中心层面,采用电影模式5-10 mm/2～4层,120 kV,180 mA,使用高压注射器经肘静脉注射非离子型造影剂,50～70 ml(300 mgI/ml),速率3～5 ml/s,延迟7 s,数据采集50 s。研究数据采用Perfusion(GE)软件包(去卷积算法)处理。结果胶质瘤高级组肿瘤的T-D曲线多呈尖蜂状,低级组则较平滑;脑膜瘤灌注曲线为速升缓降型,有较长的高位平台期。各级胶质瘤平均脑血液量(CBF)、脑血容量(CBV)和表面通透性(PS)值随肿瘤分级的升高而呈增加趋势,其中PS值相对值最显著,在伪彩图上可以确定肿瘤的边界,特别是合并出血时,具有独特价值。脑膜瘤的CBF低于胶质瘤高级组,其他灌注值与胶质瘤高级组比较,差异均无统计学意义。颅内海绵状血管瘤的灌注具有多样性,MTT的大幅延长、灌注曲线的多样性及0灌注区的出现,是其区别于其他肿瘤的特征。生殖细胞瘤和松果体区畸胎瘤CBF和CBV相对较低,而PS显著增高,灌注曲线呈快速上升后继续缓慢上扬。神经鞘瘤的灌注特征符合病理学表现,炎性病变的灌注表现不具特征性。结论多层螺旋CT灌注成像可在一定程度上反映肿瘤和瘤样病变的组织学特征及血液动力学改变,为诊断与鉴别诊断脑肿瘤和瘤样病变提供有价值的信息。     

Diagnostic imaging approaches and relationship to hepatobiliary cancer staging and therapy

Diagnostic imaging plays an essential role in management of hepatobiliary tumors. High resolution images provided by computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US) allow detection of tumor within the liver. CT arterial portography remains the standard for detection of small lesions in the range of 1.5 cm, but noninvasive techniques such as contrast-enhanced helical CT and MR hold promise for comparable lesion detection. MRI provides lesion characterization for differentiation of benign and malignant tumors. Lesion characterization has been further improved by faster CT and MR techniques that allow imaging in both arterial and portal venous phases for characterization of lesions based on the rate and pattern of enhancement. Functional imaging such as 2-fluoro-2-deoxy-D-glucose-positron-emission tomography (FDG-PET) is increasingly utilized for detection of intrahepatic tumor and extrahepatic disease. Accuracy of FDG-PET for extrahepatic disease is better than conventional imaging and has been shown to change management in a significant number of patients. Imaging is also invaluable for surgical planning. Segmental anatomy is well shown by CT, MRI, and US. CT or MR angiography with newer 3D techniques delineate vascular variants and areas of encasement or occlusion by tumor. Biliary involvement at the hilus may be shown by US and MR cholangiography. Imaging detection of vascular involvement, bile duct extension, and lobar atrophy may alter the surgical approach.     

侧脑室内脑膜瘤的临床特点和手术策略

目的探讨侧脑室内脑膜瘤的临床特点、手术技巧及显微手术治疗。方法回顾分析21例侧脑室内脑膜瘤患者,所有病例均行CT和MRI检查,9例行脑血管造影检查,均采用显微手术切除肿瘤。结果所有患者均获肿瘤全切,无手术死亡。结论CT和MRI检查是诊断侧脑室脑膜瘤最可靠的方法,脑血管造影可明确肿瘤的血供,选择合适的手术入路,应用显微手术切除侧脑室脑膜瘤是一种安全有效的方法。     

Pancreatic carcinoma coexistent with pancreatic pseudocyst which penetrated into the stomach

We report a case of pancreatic adenocarcinoma coexisting with a pancreatic pseudocyst, which showed gradual disappearance during preoperative examinations. The patient, an 83-year-old woman, had upper abdominal and back pain, and abdominal computed tomography (CT), on December 6, 1997, revealed an 11.0 ≧ 5.8 cm cystic mass in the pancreas. On December 11, abdominal magnetic resonance imaging showed that the cyst had reduced in size to 3.8 ≧ 2.4 cm, and was enveloped in a large solid tumor. Repeat abdominal CT, on January 5, 1998, showed disappearance of the cystic lesion, while an obvious pancreatic tumor had invaded the posterior wall of the stomach and the left adrenal gland. Distal pancreatectomy combined with total gastrectomy and left adrenal glandectomy were performed on January 7, 1998. Histological examination revealed a moderately differentiated ductal adenocarcinoma with an abscess in the tumor, which had developed a fistula to the ulceration of the stomach. The large cyst presented on admission seemed to have penetrated into the stomach, and had disappeared within 1 month. Received: June 28, 1999 / Accepted: February 28, 2000     

囊性脑膜瘤的MRI特征分析(附17例)

目的:分析囊性脑膜瘤的磁共振成像特点,加深对该病的认识,以提高诊断准确率.方法:回顾分析经手术病理证实的17例囊性脑膜瘤,其中男8例,女9例,年龄36~70岁,平均49.7岁,行颅脑MRI平扫和增强,其中3例加做MRS,结合手术病理,采用Nauta分型分析囊性脑膜瘤的MRI表现及特点.结果:囊性脑膜瘤主要位于大脑凸面,以广基与硬脑膜相连,MRI多表现为实性肿物伴有大小不等的囊变区,实性部分以等或长T1长T2信号为主,囊性部分均表现为长T1长T2信号;增强扫描实性部分呈中度或明显强化,囊壁可有或无强化.本组17例中,Nauta I型7例,NautaⅡ型8例,NautaⅣ型2例.结论:囊性脑膜瘤较为少见且不易于与其他颅内囊室性病变进行鉴别,磁共振常规扫描结合增强扫描及MRS有助于对该疾病正确诊断,同时对临床治疗和手术方案设计有一定的指导意义.     

Effectiveness of multislice computed tomography for evaluating vascular invasion in retroperitoneal tumors

The potential of combined application of multislice computed tomography and angiography for evaluation of vascular invasion in retroperitoneal tumors has been assessed. The predictive value of the method was tested by comparing preoperative CT and angiographic data with intraoperative findings on vascular invasion--abdominal part of the aorta and its large branches, inferior vena cava and common iliac veins--in 44 patients; primary tumor--26, recurrent--18, pelvic localization--7, intraperitoneal--37. Thirty-one combined operations were performed. Multislice scans were obtained by using 4 rows of solid-state detectors. For intravenous injections, non-ionic contrasting substance Omniak (loxegol, Amersham, Ireland), 350 mg I/ml was used.     

肝脏转移性神经内分泌癌的CT表现

目的 总结肝脏转移性神经内分泌癌的CT表现,探讨肝脏转移性神经内分泌癌的影像学特征,提高肝脏转移瘤的诊断能力.方法 回顾性分析肝脏转移性神经内分泌癌CT的影像学表现,归纳其影像学特征.结果 肝脏转移性神经内分泌癌CT表现为等密度或稍低密度占位,肿瘤坏死囊变区域较小.尤其是瘤灶直径＜2cm时,肿瘤多呈均质改变;瘤灶直径＞3 cm时,少部分瘤灶可出现坏死囊变.对比强化扫描,不含坏死成分的瘤灶动脉期呈均匀强化,门脉期密度呈等密度为主或呈相对低密度,延时期呈相对低密度.结论 肝脏转移性神经内分泌癌的多层螺旋CT影像学表现具有一定的特征性,可为临床的鉴别诊断提供帮助.     

A cystic meningioma misdiagnosed as malignant glioma by radiologic and intraoperative histological examinations

Cystic meningiomas are radiologically difficult to differentiate from malignant brain tumors, particularly when the tumors are intraparenchymally located. In such cases, a surgical strategy relies on intraoperative histological diagnosis. A 60-year-old man had a tumor with multiple cysts in the left parietal lobe that was diagnosed radiologically as malignant glioma. In operative findings, there was no dural attachment of the tumor, and the border between the tumor and normal brain tissue was unclear. Intraoperative histological examination supported the diagnosis of malignant glioma based on a high cellularity and an existence of a multinuclear giant cell in the tumor tissue. We finished the surgery with partial tumor resection; however, postoperative histological diagnosis of the tumor was a typical meningothelial meningioma showing characteristic whorl formations, and in conclusion, a definite diagnosis of the tumor was an intraparenchymal cystic meningioma. In further histological investigations, the tumor tissue around cysts exhibited significantly different features from meningothelial meningioma, demonstrating small lymphocytes and histiocytes with a large nucleus, which resembled intraoperative histological findings. We deliberated that the removal of the tumor tissue from the degenerated portion for intraoperative histological examination might lead to the misdiagnosis of malignant glioma. Operative strategy is strongly influenced by intraoperative histological diagnosis. Therefore, surgeons are obliged to facilitate more precise intraoperative histological examinations by obtaining sufficient tissue from different parts of the tumor.