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Biomedical subjects

E Moskovic

Publications and source records attributed to E Moskovic.

33 records · Page 2Linked to original sources
PubMed1992

The association of germ cell tumours of the testis with sarcoid-like processes.

Sarcoid-type pulmonary lymphadenopathy associated with testicular cancer is a rare condition which has been previously reported in only 14 cases. Earlier case reports have failed to distinguish between generalized sarcoidosis as opposed to a local granulomatous reaction to tumour. We describe a further 8 cases of the association and provide strong supportive evidence for systemic sarcoidosis in 5 of our patients. In 3 of our patients with systemic sarcoidosis there was coexisting testicular cancer requiring additional treatment. We therefore advise caution in the interpretation of the clinical and histological findings in these patients, and recommend thorough investigation of all such cases.

Adult↗
PubMed1992

Massive abdominal lymphadenopathy in hairy cell leukaemia: a report of 12 cases.

Lymphadenopathy is an uncommon finding in hairy cell leukaemia (HCL). We report 12 HCL patients in whom relapse was associated with massive abdominal lymphadenopathy. All but one had long-standing HCL (range 3-25 years; median 10 years); in one it was discovered at presentation. Nine patients had been splenectomized and seven had previously been treated with 2'deoxycoformycin (DCF) and/or alpha-interferon (alpha IFN): three had achieved complete remission and four a partial response. The computerized tomography (CT) scan appearances were similar in all cases with a primary lymph node mass centred around the coeliac axis and involving upper para-aortic and retropancreatic regions. Histology and/or cytology confirmed nodal involvement by HCL in six patients. Large immature hairy cells were seen in both lymph nodes and bone marrow, suggesting a degree of transformation. Nine patients were treated with DCF: one had complete resolution, six responded with 50-90% reduction of the lymphadenopathy, one did not respond and one is still on treatment; alpha-IFN was used concomitantly or sequentially in two of the responders. One responding patient died of sepsis after four injections of DCF. Three patients received either alpha- or beta-IFN alone with no response. One elderly patient was not treated. Abdominal lymphadenopathy could be part of the natural history of HCL and/or may represent a transformation analogous to that seen in other low-grade lymphoproliferative disorders. Routine abdominal CT scanning should be part of the work up of all patients with HCL.

Adult↗
PubMed1992

Chest radiography in the management of breast cancer.

This study was undertaken to assess the utility of chest radiography (CXR) in the management of patients with breast cancer and to devise a suitable imaging policy for such patients. A retrospective analysis was performed of the case notes and the CXRs of a series of 141 patients presenting to this hospital in 1980 with a diagnosis of early breast cancer. Data retrieved covered the entire clinical course to date and included the number of CXRs performed for a clinical reason and the number performed as "routine". Correlation of the result of every CXR requested to subsequent therapeutic decision-making throughout the complete clinical course of each patient was undertaken and the proportion of CXRs initiating a management change, or performed for a clinical reason, out of the total requested was assessed. A total of 1161 CXRs were performed on the 141 patients studied. Of these, only 174 (15%) were undertaken for a direct clinical reason and 987 (85%) were undertaken as part of "routine" follow-up procedures and had no impact on patient management. Four "routine" CXRs (< 0.4%) demonstrated previously undiagnosed pulmonary metastases, in patients with no other history of metastatic disease. Thus, routine chest radiography is not a cost-effective method of monitoring asymptomatic patients with breast cancer for metastasis. It is recommended that outside staging procedures for clinical trials, the CXR is used only to address a clinical problem relating specifically to the thorax. It is anticipated that the cessation of all other chest radiography in patients being followed up for breast cancer at this institution will have significant budgetary implications.

Bone Neoplasms↗
PubMed1991

High-resolution computed tomography in extrinsic allergic alveolitis.

Seventeen patients with extrinsic allergic alveolitis were examined with high-resolution computed tomography (CT). Increased attenuation of the lung parenchyma was present in eleven cases; the corresponding abnormality on chest radiography of ground-glass opacification was found in only five cases. The apparent upper zone sparing on chest radiography was not confirmed on CT which demonstrated a global increase in lung density. Several other abnormalities identified on CT in the subacute phase of extrinsic allergic alveolitis are described and correlated with chest radiographs. Whilst there is no single pathognomonic CT feature of extrinsic allergic alveolitis, there is a characteristic constellation of abnormalities which provide support for an otherwise uncertain clinical diagnosis.

Adult↗
PubMed1991

Retroconversion of immature teratoma of the ovary: CT appearances.

We have studied seven patients presenting to the Royal Marsden Hospital between 1983 and 1989 with metastatic immature teratoma of the ovary. All patients underwent initial surgery followed by combination chemotherapy and a second laparotomy. Serial CT scans were performed at 2-3 monthly intervals from diagnosis until the second laparotomy, and the results of this were correlated with the CT appearances. In six of the seven patients CT scanning demonstrated 'retroconversion' of immature malignant tumour masses to benign mature disease during treatment. CT features of maturation included increased density of mass lesions, whose margins became better circumscribed in relation to adjacent tissues, and the onset of internal calcification, with fatty areas and cystic change. These changes on CT correlated exactly with normalization of an initially raised serum tumour marker, alpha feto-protein (AFP) in all six patients. The second laparotomy revealed only mature teratoma in all patients following chemotherapy. In three patients show continued growth of the mature deposits necessitated further surgery for local pressure symptoms, but overall, none has shown malignant relapse, and all are currently well between 1 and 6 years after diagnosis. This is the first report of the CT appearances of retroconversion of immature ovarian teratoma in a series of patients, which is an important radiological diagnosis to make in order to avoid confusion with advancing malignancy. A review of the literature is presented.

Adolescent↗
PubMed1991

Lymphography--current role in oncology.

A review of the use of lymphography at this hospital, a major oncology centre, is presented. The advent of computed tomography has brought a dramatic reduction in the number of lymphograms currently performed for diseases such as lymphoma, testicular tumours and gynaecological malignancies. This study analyses the reasons for this decline, and concludes that valuable information can still be obtained from lymphography in certain selected groups of patients.

Female↗
PubMed1991

Focal myositis, a benign inflammatory pseudotumour: CT appearances.

Focal myositis is a rare benign pseudotumour of skeletal muscle, of unknown cause. Clinically it presents as an enlarging mass within muscle, usually of an extremity, and is often mistaken for a soft tissue neoplasm. The diagnosis is made by biopsy which reveals characteristic histological changes of inflammation, focal degeneration and regeneration, and some evidence of denervation. The CT findings include irregularity and enlargement of the muscles involved, with diffuse, poorly defined fatty infiltration of the muscle planes, but no evidence of an associated mass. We present two cases of focal myositis of the calf, both of which mimicked a soft tissue neoplasm, and in which CT was helpful in determining the nature and extent of the abnormality, for needle biopsy, and follow-up.

Adult↗
PubMed1990

The accuracy of mammographic diagnosis in surgically occult breast lesions.

This paper reports a retrospective study of 69 breast biopsies carried out for surgically occult but radiologically apparent lesions. Specimen radiography was required to confirm excision. The group included 17 carcinomas. Review of the pre-operative mammogram reports provided by a 'pool' of general radiologists demonstrated a high sensitivity (88%), but poor specificity (32%), with an overall accuracy of 46%. 'Blind' review of the mammograms by one experienced mammographic radiologist showed high sensitivity (100%), good specificity (73%) and overall accuracy of almost 80%. This result shows the need for the most experienced radiologist available to be involved in deciding which of these difficult lesions require biopsy. This will reduce unnecessary breast surgery and highlights the role of clinical and radiological review instead of biopsy, the need for continuing self audit by radiologists and the need for regular communication between clinicians, radiologists and pathologists.

Adult↗
PubMed1990

High resolution computed tomography of Pneumocystis carinii pneumonia in AIDS.

High resolution computed tomography (CT) was performed on 11 homosexual men with the Acquired Immune Deficiency Syndrome (AIDS). All had bronchoscopically proven Pneumocystis carinii pneumonia (PCP). Six patients were re-scanned following treatment and symptomatic recovery. All the scans were abnormal, most showing fine diffuse bilateral alveolar consolidation with bronchial wall thickening, despite having a normal or near-normal chest radiograph in three cases. A variety of unexpected changes such as peripheral consolidation only, upper or lower zone predominance, unilaterality, bronchial dilatation, cystic air spaces and sub-pleural sparing were also seen. Following therapy, resolution of CT changes was shown to be incomplete despite clinical recovery, and whilst all the cases showed a reduction in alveolar consolidation, other findings such as new interstitial shadowing, peripheral predominance, and persistent cystic changes were observed, suggesting the healing process to be complex. Whilst the changes of PCP and its progression following treatment are well described on the plain chest radiograph, this is the first specific documentation of its appearances on narrow section CT, and its response to therapy. The usefulness of high resolution CT scanning to show early infection with PCP in the face of a normal chest radiograph is discussed, and the wide variety of CT changes occurring once the disease is established is emphasized.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Routine computerized tomography scanning, groin ultrasound with or without fine needle aspiration cytology in the surgical management of primary squamous cell carcinoma of the vulva.

We set out to study whether computerized tomography (CT) scanning of the vulva and the groin and groin ultrasound scanning (USS) alone or with fine needle aspiration cytology (FNAC) (USS/FNAC) influenced or could influence the surgical management of primary squamous cell carcinoma of the vulva (SCCaV). Forty-four patients underwent surgery for primary SCCaV following radiologic imaging by one or more modalities. Patient details included the clinical assessment of the carcinoma, radiologic findings, the operation performed, and whether the decision regarding the type and extent of surgery for the vulval carcinoma and, in particular, for the groin node dissection was or could be influenced by the radiologic findings. The age range was 38-87 years, with a median of 74 years. A total of 75 groin dissections were performed. Twenty-five of the 44 patients (56.8%) did not have groin node metastasis, 14 had unilateral metastasis (31.8%), and 5 (11.4%) had bilateral metastasis. All cases with histologically proven nodal status were analyzed to compare the preoperative imaging status with the histology. The calculated sensitivity, specificity, negative predictive value, and positive predictive value for CT were 58%, 75%, 75%, and 58%, for USS alone-87%, 69%, 94%, and 48%, and for USS-guided FNAC-80%, 100%, 93%, and 100%, respectively. There was no patient in whom surgical planning for the vulval carcinoma or the groin nodes was or could be altered by the CT findings. The data do not support the routine use of CT scanning in patients with primary SCCaV, either in assessment of the primary vulval carcinoma or in detecting groin nodal metastases. For the groin nodes, USS/FNAC is superior to CT in assessing disease status. In contrast to CT, USS/FNAC may have a useful clinical role in the management of the groin nodes in vulval carcinoma.

Adult↗