Giant suspensory lipoma with calcification

A seventy-four-year-old woman presented with a giant lipoma suspended from her left upper arm. The surgically removed tumor weighed 2,600 g and included calcified areas in its periphery. Our histologic observations suggested that the calcification was generated in association with degenerated fat.     

Coexistence of spindle cell lipoma and ordinary lipoma

We report a patient with a spindle cell lipoma on the nape and three ordinary lipomas on the abdomen and extremities. The coexistence of spindle cell lipoma and ordinary lipoma in a single patient is rare. Abundant CD34-positive spindle cells and mast cells were found in the spindle cell lipoma, but in the ordinary lipomas, only a small number of CD34-positive spindle cells were found in the interstitial connective tissue and no mast cells were seen. Because mast cells are known to stimulate mesenchymal cell proliferation and collagen production, mast cell infiltration may be a trigger for the proliferation of CD34-positive spindle cells, leading to the conversion of ordinary lipoma into spindle cell lipoma.     

ENDOSCOPICALLY RESECTED LIPOMA OF THE ESOPHAGUS: REPORT OF A CASE

Lipoma of the esophagus is rare. There are few reports of the endoscopic resection of esophageal lipoma. We present a 73‐year‐old woman with lipoma of the esophagus which was successfully extirpated using the technique of endoscopic mucosal resection. To determine the depth of tumor invasion, endoscopic ultrasonography was used. A total of 31 cases of esophageal lipoma have been reported in Japan. Of these, seven were successfully resected using endoscopic techniques. Lipomas of the esophagus can grow to become large pedunculated tumors which can obstruct the airway. The majority of these tumors occur in the cervical portion of the esophagus. Most patients have no symptoms. These tumors can be resected using minimally invasive surgery when they are small.     

原发性颅骨内脑膜瘤的诊断与治疗（附4例报告并文献复习）

目的探讨原发性颅骨内脑膜瘤的病理发生机制，诊断与治疗。方法4例原发性颅骨内脑膜瘤术前均进行了CT和／或MRI检查，随后均经显微外科治疗。术后均经过病理检查确诊，同时结合文献并对其发生机制、诊断和治疗进行讨论。结果4例颅骨内脑膜瘤均全切除，同时切除了其周围部分颅骨。病理检查显示，4例颅骨内脑膜瘤中，砂粒型2例，脑膜上皮型和恶性脑膜瘤各1例。结论颅骨内脑膜瘤的发生机制尚不完全清楚，但起源于胚胎脑发育期间残留的蛛网膜细胞可能性大，结合临床表现及CT、MRI检查一般可以诊断，但确诊需进行病理检查，手术治疗效果好。     

颅内脂肪瘤的CT和MRI诊断

目的：研究颅内脂肪瘤的分布特征、CT和MRI表现及诊断价值。方法：16例颅内脂肪瘤，男9例，女7例，平均年龄37．6岁。结果：CT表现为脂肪样低密度区（CT值：－44～－71HU），MRI表现为短T1中等T2和高质子密度信号，在各序列上与脂肪组织信号同步。11例单发，5例多发。主要分布在中线及旁中线区，其中9例（56．25％）为胼胝体区。11例（68．75％）合并有颅内、外的单或多发异常，其中9例（56．25％）为胝低体发育异常。结论：颅内脂肪瘤好发于颅中线区及其邻近部位，CT及MRI有特征性表现，常合并颅内、外多发异常，结合CT及MRI检查可诊断。     

The tethered spinal cord syndrome: a correlation of radiological features and peroperative findings in 30 patients

Summary The aim of this investigation is to evaluate the accuracy of the diagnostic parameters of the radiological features, especially in conventional lumbar myelography, since these will be used in the future as a gold standard for new developing diagnostic methods like ultrasonography (US) and magnetic resonance imaging (MRI). A short review of the clinical symptoms and diagnostic radiology of the tethered spinal cord (TSC) is given. The radiological features of the TSC syndrome are compared with the peroperative findings in 30 patients investigated and operated in our hospital. All patients showed lumbar or sacral osseous malformations on the plain X-ray films. This means a high diagnostic sensitivity although the specificity for TSC is low. Conventional myelography had a sensitivity of 0.82 and positive predictive value of 0.94, while the specificity and negative predictive value are respectively 0.96 and 0.85. The positive predictive value of the total diagnostic procedure of plain X-ray films and lumbar myelography for TSC may be estimated at 1.     

Micro Perfusion and Quantitative Analysis of the Femoral Head Intraosseous Artery

The present study investigates the feasibility of micro perfusion of femoral head specimens from femoral neck fracture patients by the inferior retinacular arteries and performing intraosseous artery quantitative analysis of the femoral head. Twelve femoral neck fracture patients who had undergone conventional hip replacement surgery were included in this study. Femoral head specimen arteries were first dissected and exposed and then perfused by the inferior retinacular arteries and all the femoral heads underwent micro‐CT scanning. After micro‐CT scanning, a digital 3‐D model was reconstructed to quantify the femoral head intraosseous arteries for comparison with a normal femoral head. The artery length density, artery volume density, and artery length/volume ratio were calculated separately and compared with normal femoral head parameters. Micro‐CT scanning displayed the epiphyseal arterial network structure and their fine vascular branches in all 12 femoral neck fractures. Blood was supplied from the inferior retinacular artery to the epiphyseal arterial network then to all the fine blood vessels within the femoral head. No statistical differences were observed in femoral heads’ intraosseous artery length densities or volume densities between the normal and femoral neck fracture specimens, while the artery length/volume ratio showed a statistical difference, and the ratio increased from 19 to 46. Micro perfusion of the femoral head by the inferior retinacular arteries is possible and can present the epiphyseal network and their fine arterial branches in pathologic conditions to provide a morphological basis for the study of femoral head disease.     

Multiple cardiac lipomas and pericardial lipomatosis: Multidedector-row computer tomography findings

Being rare tumors of the heart, cardiac lipomas are usually discovered incidentally during non-cardiac-related examinations of the chest. Although they are reported to be typically solitary, multiplicity has been described in tuberosclerosis patients. Here we reported the multidedector-row computer tomography (MDCT) findings of a nontuberosclerosis case with multiple cardiac lipomas along with pericardial lipomatosis, who presented with symptoms of left heart failure after a histerectomy surgery but otherwise healthy before that operation.     

Asymptomatic cardiac lipoma originating from the interventricular septum diagnosed by multi-slice computed tomography

A 45 year-old asymptomatic man was admitted to preoperative cardiovascular evaluation for noncardiac surgery. Physical examination and ECG were normal. Transthoracic echocardiography showed a 17 × 35 mm suspicious hyperechoic mass in the interventricular septum. Multi-slice computed tomograpy (MSCT) was used. Volume rendered image and an axial maximal intensity projection image demonstrated a mass with a density consistent with fat tissue ( − 78 HU). The MSCT findings were diagnostic of a benign lipoma. Thus, this mass was noninvasively diagnosed as cardiac lipoma. Neither life-threatening arrhythmia on Holter monitoring nor myocardial ischemia on exercise scintigraphy was observed. Transthoracic echocardiography is usually the initial diagnostic test in patients with a suspected cardiac mass. However, its sensitivity for differentiating tissue characteristics is limited. MSCT allow for detailed delineation of intra and pericardiac masses. In conclusion, we demonstrated the value of cardiac MSCT to diagnose an interventricular lipoma.