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A 50 year old man presented with progressive unilateral cranial nerve palsies (Garcin's syndrome) for one year. Skull radiography and computed tomography (CT) showed intracranial extension of a soft tissue tumour from the right base of the skull. Necropsy revealed a papillary cell carcinoma of the right kidney and metastases in the base of the skull.
Thymoma is the most common primary neoplasm of the thymus. The majority of thymomas are encapsulated masses and exhibit a benign behavior. Less frequently, thymomas may be locally invasive, or rarely they may metastasize to distant sites. The usual clinical presentation is that of an anterior mediastinal mass found incidentally in an asymptomatic patient. The variable gross features of thymoma and the potential for local invasion result in a variety of radiologic appearances. The most common radiologic manifestation is a rounded, soft-tissue mass of the anterior superior mediastinum. Computed tomography and magnetic resonance imaging typically show a prevascular mediastinal mass of variable size and may be helpful in the evaluation of adjacent structures in cases of invasive thymoma. The treatment of choice is complete surgical excision. Radiation therapy and chemotherapy may be used adjunctively to surgery in the treatment of invasive tumors. The prognosis of encapsulated thymoma is generally favorable. Invasive tumors are associated with a worse prognosis but may respond to radical resection.
The accumulation of technetium-99m diethylenetriamine pentaacetic acid (Tc-99m DTPA) in benign soft-tissue neurofibromatosis tumors is reported. In a series of 16 patients with clinical stigmata of neurofibromatosis, 28 sites of abnormal soft-tissue localization of the isotope observed scintigraphically were documented to be sites of soft-tissue tumor by clinical and/or radiographic (predominantly computed tomographic) correlations. The smallest lesion detected was a 1.5-cm subcutaneous neurofibroma. Normal physiologic nonrenal distribution of the Tc-99m DTPA was established by scintigraphic imaging of a control population.
Dual-energy X-ray absorptiometry (DEXA) is reported to be inferior to computed tomography (CT) to measure changes in appendicular soft tissue composition. We compared CT- and DEXA-measured thigh muscle and fat mass to evaluate the random and systematic discrepancies between these two methods. Thigh skeletal muscle area (single-slice CT) was suboptimally (r(2) = 0.74, P < 0.0001) related to DEXA-measured thigh fat-free mass (FFM). In contrast, thigh muscle and adipose tissue volumes (multislice CT) were highly related to DEXA-measured thigh FFM and fat (both r(2) = 0.96, P < 0.0001). DEXA-measured leg fat was significantly less than multislice-CT-measured leg adipose tissue volume, whereas multislice-CT-measured leg muscle mass was less (P < 0.0001) than DEXA-measured leg FFM. The systematic discrepancies between the two approaches were consistent with the 10-15% nonfat components of adipose tissue. In conclusion, CT and DEXA measures of appendicular soft tissue are highly related. Systematic differences between DEXA and CT likely relate to the underlying principles of the techniques.
BACKGROUND: Primary adenocarcinomas of the appendix are uncommon. Mucoceles that result from mucinous adenocarcinomas of the appendix may be incidentally detected on imaging. CASE PRESENTATION: A case of a mucocele of the appendix, due to cystadenocarcinoma, is presented as an incidental imaging finding in a female, 86-year-old patient. The patient was admitted due to rectal hemorrhage and underwent colonoscopy, x-ray, US and CT. Adenocarcinoma of the ascending colon, adenomatous polyp of the sigmoid colon and a cystic lesion in the right iliac fossa were diagnosed. The cystic lesion was characterized as mucocele. The patient underwent right hemicolectomy, excision of the mucocele and sigmoidectomy. She recovered well and in two-year follow-up is free from cancer. CONCLUSIONS: Preoperative diagnosis of an underlying malignancy in a mucocele is important for patient management, but it is difficult on imaging studies. Small lymph nodes or soft tissue stranding in the surrounding fat on computed tomography examination may suggest the possibility of malignancy.
Oral lipomas buried deep in soft tissues can be difficult to diagnose clinically. Computed tomography or magnetic resonance imaging can aid the diagnosis of this rare oral lipoma.
We report a case of a 27-year-old Japanese female with Sjogren's syndrome (SS), who suffered from several episodes of subcutaneous and mesenteric panniculitis with a recurrence within one year. After a history of fever and skin rash, the patient underwent surgery at a local hospital with a diagnosis of acute appendicitis complicated with an ileocecal abscess. She was also diagnosed as having SS. After the operation, the fever and skin rash persisted. She was treated with prednisolone (PSL), and her symptoms resolved. A recurrent bout of abdominal pain with fever, annular erythema on the trunk and a nodular erythematous rash on the lower extremities occurred six months after the operation. A skin biopsy from the lower extremities showed findings that were compatible with panniculitis. Abdominal computer tomography (CT) showed a diffuse swelling with soft tissue density in the intestinal mesenterium and para aortic area. A retrospective examination of the operative specimen obtained from the local hospital revealed centrilobular infiltration of neutrophils in the mesenteric adipose tissue with fat necrosis, which is compatible with mesenteric panniculitis. Twenty mg/day of PSL was successful in treating the systemic panniculitis, and the abnormal diffuse soft tissue density on the abdominal CT disappeared after three weeks of PSL administration. Systemic panniculitis is a rare complication in SS, and the pathogenesis is unclear.
Synovial sarcoma with extensive osteoid production is rare. We report a case of synovial sarcoma of monophasic type with massive ossification. The diagnosis was confirmed by reverse-transcripitase polymerase chain reaction (RT-PCR). The patient was an-81-year-old woman with recurrent synovial sarcoma in her right knee. The tumor was primarily excised in 1989. It recurred and was removed again in 1996. However, in 1999 a painful mass appeared in the same site. Preoperative plain radiography and computed tomography revealed a 5 x 5 cm soft tissue mass with extensive ossification in the medial side of the right knee joint. The tumor was widely excised in 2000. Soft X-ray examination revealed a trabecular pattern of ossification in the excised tumor. Microscopically the tumor was composed of hypercellular spindle cells with fascicular arrangement with prominent ossification but no epithelial component. The tumor cells were positive for vimentin and focally positive for cytokeratin. The tumor expressed a sequence of SYT-SSX1 fusion gene transcript demonstrated by RT-PCR. Twelve years long survival of the present case without metastasis in spite of repeated recurrence suggests a better prognosis of synovial sarcomas with ossification.
A 64-year-old man presented to our department with urinary retention. Rectal examination revealed a small and soft prostate. PSA was within the normal limits. Computed tomography showed a low-density area around the prostatic urethra and urethrography revealed an irregular prostatic urethra compressed by the prostate. We performed transurethral resection of prostate (TUR-P). On resectoscopy, jelly-like round substances were seen in the bladder. Prostatic urethra and bladder neck were covered with a jelly-like substance. Pathological diagnosis was mucinous adenocarcinoma of the prostate with bladder neck involvement. One month later after TUR-P, we performed radical cystoprostatectomy. Histological findings showed the cancer, of which 70-80% was composed of extracellular mucin lakes containing floating clumps of tumor cells. Mucin lake was stained with alcian blue and PAS. Immunohistochemical study revealed the tumor cells positive for carcinoembryonic antigen (CEA) and negative for prostatic specific antigen (PSA).
OBJECTIVE: Occlusal contact plays an important roll in masticatory procedure. It infers to biting force and masticatory performance. In order to analysis the oral function in UCLP, the author tested the occlusal contact areas of upper premolars and molars in UCLP. METHODS: 22 UCLP patients (male 13, female 9, permanent teeth) were selected, which had no temporomandibular joint dysfunction. All of them had received plastic surgery treatment and never received orthodontic therapy. Their occlusal contact areas of upper premolars and molars in intercaspid position were recorded by performed soft wax, and the results were managed by computer with the software of micro image analysis system. All the data were input to computer and be analyzed by statistics. RESULTS: 1. In normal people, the occlusal contact areas of upper premolars and molars had no differences in bilateral and in sexual. 2. there was no sexual difference in UCLP as that in normal group, and the occlusal contact areas in cleft side or non-cleft side had no difference yet. 3. The occlusal contact areas in UCLP were lower than that in normal people. 4. The decrease of occlusal contact areas was the most important factor to low masticatory performance in UCLP patients. CONCLUSION: After plastic surgery in UCLP, orthodontic therapy will improve masticatory contact and contribute to craniofacial esthetic and masticatory function.
We treated a case of prostate cancer with cyst formation in an 80-year-old Japanese man presenting with constipation. Fist-sized elastic soft mass was palpable by digital rectal examination. Computed tomography and magnetic resonance imaging demonstrated a retrovesical cystic mass arisen from the prostate. Serum prostate-specific antigen (PSA) was elevated to 15.7 ng/ml. Transrectal prostate needle biopsy revealed moderately differentiated adenocarcinoma and puncture of the cyst yielded aseptic bloody fluid. With a clinical diagnosis of prostate cancer (T2b N0 M1b) with cystic formation, hormonal therapy with a luteinizing hormone releasing hormone analogue and bicalutamide significantly lowered the serum PSA level. One year later, the cyst was reduced in volume and constipation had resolved. A total of 57 cases of prostate cancer with cyst formation are reviewed.
A 63-year-old man had a history of diabetes mellitus for more than 10 years and took oral hypoglycemic agents regularly. He visited Taipei Veterans General Hospital with the complaint of progressive weakness in all 4 limbs and neck pain for 6 months. Computed tomography of the cervical spine revealed increased soft tissue density in the epidural space from C2 to C5 with cord compression. Surgical decompression was done and Aspergillus flavus was isolated from the inflammatory tissue. He was initially treated with oral itraconazole 200 mg 3 times per day for 4 days and then twice daily. Later, the treatment regimen was shifted to intravenous amphotericin B 25 mg/d. He died of intraventricular hemorrhage and complicated fungal meningoencephalitis 2 weeks postlaminectomy. This case reminds us that a prolonged history of back pain accompanied with peripheral neuropathy in diabetic patients should raise the suspicion of Aspergillus epidural abscess. Prompt aggressive diagnostic testing and management is needed to improve the likelihood of a good outcome of these patients.
Solitary fibrous tumor (SFT) is a mesenchymal neoplasm that most frequently arises in the pleura and uncommonly involves the orbit. We report the clinical and pathological features of an orbital SFT in a 50-year-old woman. The patient presented with an 8-year history of painless, slow-growing, visible mass in the right caruncle. Computed tomography showed a well-circumscribed, homogenous, soft tissue mass in the inferomedial aspect of the orbit. The tumor was totally excised via anterior orbitotomy. Histopathologic and immunohistochemical evaluation identified the mass as an SFT. The patient was free of tumor recurrence at 1-year follow-up. Orbital SFT can present as a visible mass in the caruncle and may recur if not excised completely. Long-term follow-up of patients is necessary because SFT may recur many years after operation.
AIM: To identify the clinical predictors and assist surgeons in their clinical management of obstructive sleep apnoea (OSA) - a prospective study with a new approach to analyse the static and dynamic upper airway morphology between patients with OSA and normal subjects. To introduce a new method of assessment for surgical outcome. MATERIALS AND METHODS: Quantitative computer-assisted videoendoscopy (validated with upper airway magnetic resonance imaging) was performed in 49 (43 males, 6 females) patients with OSA and compared with 39 (22 males, 17 females) controls (apnoea-hypopnoea index <5). Absolute cross-sectional areas, transverse and longitudinal diameters at the retro-palatal and retro-lingual levels were measured during end of quiet respiration and during Mueller's manoeuvre in the erect and supine positions, allowing us to study static and dynamic morphology (collapsibility) of the upper airway. We analysed 3744 parameters. RESULTS: In males, retro-palatal and retro-lingual areas during Mueller's manoeuvre in the supine position of 0.7981 cm2 [receiver operating characteristics (ROC) = 0.9284, positive predictive value (PPV) = 86.05%, negative predictive value (NPV) = 84.62%] and 2.0648 cm2 (ROC = 0.8183, PPV = 76%, NPV = 83.33%), respectively, were found to be good predictors/ cut-off values for OSA. Retro-palatal area measured in the supine position during Mueller's manoeuvre (AS1M) and collapsibility of retro-palatal area in the supine position calculated (CAS1) were found to have significant correlations with severity of OSA. In females, areas measured during Mueller's manoeuvre in the supine position of 0.522 cm2 at retropalatal level (ROC = 1, 100% PPV and NPV) and transverse diameter at retro-lingual level during erect Mueller's manoeuvre of 1.1843 cm (ROC = 0.9056, PPV = 100%, NPV = 83.33%) were found to be predictive. All measurements at the retro-palatal level and in the supine position had higher predictability. Area measurements obtained during Muller's manoeuvre were more predictive (ROC >0.9910) than resting measurements (ROC >0.8371). Several gender and anatomical-site specific formulas with excellent predictability (ROC close or equal to 1) were also devised. Examples of surgical outcome assessment were introduced. CONCLUSION: Upper airway Mueller's studies are predictive and useful (independent samples t-test/Mann Whitney U test, ROC) in identifying patients with OSA. With these gender and anatomical-site specific OSA predictors/formulas and this innovative clinical method, we hope to assist other surgeons with quantitative clinical diagnosis, assessment, surgical planning and outcome assessment tools for OSA patients.
Among the minor soft structures of the lumbosacral spinal canal that computed tomography can visualize, the meningovertebral ligaments have been neglected. There are no specific reports on this subject, and the only knowledge we have comes from very ancient and nearly forgotten anatomical works. From our studies on cadaveric specimens, it has been confirmed that the ligaments consist segmentally of ventral and lateral fibrous bands, connecting the outer surface of the dura to the endostium of the spinal canal. The most characteristic component is the ventral one, running from the anterior wall of the dural sac to the posterior longitudinal ligament and vertebral endostium. Due to their anchoring function, the ligaments are significantly developed at the level of the dural conus (sacrodural ligaments of Trolard and Hofmann). On in vivo computed tomography studies, the ligament image appears most commonly on transverse scanograms of the lumbosacral segments as a median sagittal septum, easily identifiable when the extradural fat that it crosses is abundant. The meningovertebral ligaments may be implicated in pathological conditions of the spinal canal. They can calcify singly, though very rarely, and this process must be differentiated from degenerative marginal spurs, calcific disc herniation, circumscribed calcification of the posterior longitudinal ligament, or partial diplomyelia.
The pathogenesis, clinical features, and histology of extraskeletal chondromas, along with a review of the literature, demonstrate that extraskeletal chondromas are rare, benign cartilaginous tumors found most frequently in the hands and feet. A case of extraskeletal chondroma is described in a patient who had a volar carpal mass of long duration, with an acute inflammatory episode that subsided with antiinflammatory medication. Roentgenograms and computed tomographic scanning revealed the presence of soft-tissue calcifications. An excisional biopsy was performed, revealing a benign lobular cartilage tumor with marked cellularity and prominent calcification that are characteristic of these lesions.
Abnormalities of the wrist present a difficult diagnostic challenge requiring thorough evaluation of both osseous and soft-tissue structures. Advanced techniques such as scintigraphy, computed tomography, three-phase arthrography, and, most recently, magnetic resonance imaging have added greatly to our understanding of wrist pathology. This article discusses the application of these techniques in imaging the wrist.
The various clinical pictures of lower limb's mononeuropathies are described. An essential step in the diagnosis of pressure and entrapment neuropathies is to obtain an accurate description of the patient's symptoms and to ascertain whether the sensory and motor symptoms and signs correspond to the distribution of a single peripheral nerve. EMG is a useful adjunct to the physical examination and nerve conduction studies. Computer tomogram scanning may reveal bone, joint or soft tissues abnormalities responsible for the neuropathy. The attitude and the prognosis depend on the physical and functional state of damaged nerve trunks, mainly based on the classification of neuropraxia, axonotmesis and neurotmesis.