Pelvic lipoma causing venous obstruction syndrome.
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Continuous spinal analgesia (CSA) offers considerable advantages: (1) it requires 10% of the local anesthetic; (2) it may be instituted after patient positioning, thus minimizing the potential for cardiovascular instability; and (3) with low doses of dilute short-acting local anesthetic, the recovery period is shortened (1). Continuous spinal analgesia has been used for various procedures such as surgery and cancer pain control. However, CSA has not gained wide popularity because of its possible complications, such as headache, nerve injury, infection and accidental removal or migration of the catheter. Although real possibilities, these complications have been rarely documented. We describe an episode of aseptic meningitis during combined CSA and EA.
The metastatic sites of infiltrating duct (IDC) and infiltrating lobular carcinoma (ILC) have been compared using both clinical and autopsy data. The following statistically significant differences were found: Lung parenchymal metastases were more common in IDC. Bone trephine biopsies were more likely to be positive in ILC. Carcinomatous meningitis was associated almost exclusively with ILC. Peritoneal/retroperitoneal metastases of distinctive pattern occurred in ILC. There was often associated linitis plastica-like involvement of the stomach wall and diffuse infiltration of the uterus. Hydronephrosis was a common secondary phenomenon.
Prostate cancer is the second cause of cancer mortality in men in Western countries. To study new therapeutic approaches such as gene therapy, animal models of human prostate cancer with metastatic behavior are mandatory. We used the Nod Scid mouse strain to develop an orthotopic animal model. Two androgen-independent cell lines (PC-3 and DU 145) were used. Local tumor growth and metastases were analyzed. The tumor take rates were close to those reported in the literature. However, a high frequency of various metastatic sites has been observed (liver, lung, spleen, adrenal, kidney, lymph node, and diaphragm). It can be concluded that the Nod Scid mouse is a relevant preclinical animal model to study human prostate cancer. Metastatic sites seem more numerous in comparison to other orthotopic mice models described.
The parotid gland and its lymph nodes are frequent sites of metastases from head and neck cancers. However, metastasis from a distant primary below the clavicle is unusual. These originate from a variety of sites, most commonly the lung, kidney and breast. A case of a 59-year-old woman with parotid lymph node metastasis from an adenocarcinoma of the urachus, diagnosed on the basis of two discrete periparotid masses on CT and the patient's history, is presented.
A previously healthy 12-year-old boy presented with a mass in the right retroperitoneum adjacent to an ipsilateral hypoplastic kidney. Complete resection of the tumor and kidney were done. The tumor was found to be papillary adenocarcinoma lying 3 cm apart from a contracted kidney, which was free of tumor. No adjuvant therapy was given. After 50 months of follow-up the child is healthy without evidence of tumor recurrence.
Gastrointestinal stromal tumors (GIST) represent an extremely rare group of tumors, which are mostly of smooth muscle origin like leiomyomas, leiomyosarcomas and leiomyoblastomas. With the introduction of immunohistochemical analysis an epithelioid and an autonomic nerve variant can be distinguished. The purpose of this review is to demonstrate the image morphological appearance of these rare tumors together with the pathology based upon a retrospective analysis of five of our own cases since 1997. There are no pathognomonic imaging findings for characterizing a gastrointestinal stromal tumor; however, it should be included in the differential diagnosis if one or multiple large, round or oval, well-delineated gastrointestinal tumors occur in combination with central necrosis. Carney's syndrome is characterized by the syndromal association of a gastrointestinal stromal tumor (originally: gastric leiomyosarcoma) with an extra-adrenal paraganglioma and a pulmonary chondroma. In this rare syndrome, the radiological approach is important to diagnose or rule out the--simultaneous or consecutive--appearance of at least two of the three tumor entities (GIST, extra-adrenal paraganglioma, pulmonary chondroma).
PURPOSE: The aim of this study was to demonstrate the typical appearance of ganglioneuromas in computer-assisted tomography (CT), and magnetic resonance imaging (MRI). MATERIAL AND METHODS: Retrospective analysis of diagnostic imaging (9 CT, 6 MRI) in 9 children aged 3 to 15 years with the histological diagnosis of ganglioneuroma. RESULTS: The tomographies showed large (max. 13.4 cm in diameter) round or oval tumors with sharp delineation. The sites of the tumors were the retroperitoneum (5), the mediastinum (3), and the adrenal gland (1). Intraspinal tumor involvement occurred in 4 cases. On comparing CT with MRI, MRI was more accurate in defining the intraspinal involvement. The ganglioneuromas were of hypodense appearance in the native CT scan and showed moderate enhancement upon administration of contrast media. In five patients tumor calcifications with a disseminated sprinkled pattern were seen in CT. In MRI T1-weighted scans the tumors were homogeneous and hypointense, after gadolinium application a marked enhancement was evident. In T2-weighted scans the tumors were hyperintense. CONCLUSION: At the time of diagnosis ganglioneuromas are generally large tumors which can be well detected by CT and MRI. Information towards the diagnosis is given by the appearance of the ganglioneuromas in CT and MRI. However, MRI is the modality of choice due to its superiority in documenting intraspinal tumor expansion.
Retroperitoneal mucinous cystadenomas are extremely rare tumors found exclusively in women. An additional case of retroperitoneal mucinous cystadenoma histologically confirmed in a 41-year- old woman is reported herein. Computed tomographic (CT) scanning showed a cystic mass, 21 x 16 cm in size, in the right retroperitoneal space. Removal of the cystic tumor was performed without any other additional procedures, and further histological diagnosis was confirmed as primary mucinous cystadenoma of borderline type. Histologic findings suggested that the tumor developed from mucinous metaplasia of the coelomic mesothelium. Clinicopathological features, diagnostic findings, therapeutic options and the outcome are analyzed in this paper having reviewed the cases reported in world literature.
The ganglioneuroma is a benign neuroblastal tumor. All neuroblastomas and ganglioneuromas derive from immature cells of the sympathetic nerve system. The ganglioneuroma is a very rare disease and effects newborns and infants more often than adolescents and adults. The benign tumors are relatively difficult to diagnose since they usually are asymptomatic. A 5-year old girl with persistent bladder wall thickening and prominent course of the prevesical ureter presents for diagnosis and therapy. Sonography demonstrated a space-occupying lesion of the left kidney. Subsequent MRI raises the suspicion of a retroperitoneal neuroblastoma. The tumor could be removed in two surgical sessions. The ganglioneuroma is a benign tumor with symptoms depending on location and with a relatively good prognosis. Its low incidence and resultant limited experience often leads to delayed diagnosis, potentially determining therapy and diagnosis.
PURPOSE: To evaluate in which parts of the gastrointestinal tract and in what clinical situations the diagnostic quality of MR examination may be improved by a positive enteral contrast agent. METHODS: MR examinations of 37 patients performed before and after application of a Gadolinium-DTPA preparation suitable for oral and rectal application were evaluated. Exams were evaluated by two independent observers. Neoplastic disease of the gastrointestinal tract constituted the majority of indications followed by inflammatory changes and extraenteral space-occupying lesions. RESULTS: The majority of examinations (62%) were improved by the application of enteral contrast agent. No effect was observed in 35%; in two patients image quality was poorer after contrast application. The benefit of enteral contrast agents was highest in MR examinations of the sigma and rectum. The enteral contrast agent was most valuable in the detection of lymphoma if an evaluation according to indication was performed. CONCLUSION: In selected cases, the diagnostic quality of abdominal MRI can be improved by the application of an enteral contrast agent. Apart from the effect of greater signal intensity, the contrast agent does complement MR imaging by a functional aspect.
Because of the anatomic localisation of the retroperitoneal space, the detection and elucidation of pathology in the retroperitoneum calls for clinical acumen and the utilisation of imaging techniques. During the past two decades, efforts spearheaded by the work of M. A. Meyers led to an enhanced understanding of retroperitoneal anatomy and pathology. Conventional radiographic techniques are often incapable of detecting and/or characterising retroperitoneal abnormalities. Sonography may be limited by patient-dependent-factors. CT is unaffected by bowel gas and provides discrete cross-sectional images of the organs, fascial planes and retroperitoneal compartments, making it an ideal tool for assessment of retroperitoneal disease. In clinically stable patients MRT may be a useful modality for providing helpful and additional information in characterising retroperitoneal abnormalities. In this review article the diagnostic possibilities of benign not organ-related diseases of the retroperitoneum are described. This is intended to give the reader an insight into the etiology and distribution patterns of retroperitoneal fluid and gas collections as well as into diagnosis and differential diagnosis of benign retroperitoneal diseases. The diagnostic impact of the different imaging modalities is discussed.
Most of the recurrences in patients with dysgerminoma occur, in more than 80%, in the first 2 years. Late recurrences are very rare. In this paper we report on a paraaortic recurrence, 12 years after primary therapy. Tumour biology and its influence on indication for surgery are discussed. Therapy of recurrence should be individualized including surgery, chemotherapy and radiotherapy. High remission rates in patients with recurrent dysgerminoma can be expected. In fact, our patient has been tumour-free for more than 5 years.
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Seventy-eight solid, non-organic retroperitoneal tumours were biopsied with a 14-gauge Tru-Cut needle in 73 consecutive patients with the exception of one. Adequate material was not obtained in only one patient with the primary known (1.3%). In the adequate material (98.7%), the dignity of all lesions was accurately determined and 93.1% of lesions were accurately classified. Typing accuracy reached 100% in histologically known primaries (n = 31) and 87.8% in histologically unknown primaries (n = 41). A hypertensive crisis and a small haematoma following biopsy of an inadvertent extra-adrenal phaeochromocytoma was the single complication found in this series. An arterial bleeding following biopsy was prophylactically embolised through the biopsy needle. CT-guided large-bore biopsy of solid non-organic retroperitoneal tumours is a safe, non-invasive procedure with a high diagnostic yield that obviates the need for open diagnostic procedures in a large number of cases.
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Percutaneous CT-guided biopsies were carried out in 350 patients; on 291 occasions, 14- or 18-gauge and, on 59 occasions, an 0.95 mm cutting biopsy cannula was employed. Using the 14- and 18-gauge needles, a histological diagnosis was possible in 191 cases, a sensitivity of 82.7%. The 0.95 mm cannulas proved successful in 39 of the 59 punctures, producing a markedly lower sensitivity of 66.2%. The most common cause of an incorrect biopsy with large needles was bad position of the needle, whereas the small needles provided inadequate material. Complications which, however, did not require treatment, occurred in 5 patients (1.4%).