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Yoshie Y, Kozaka K, Takeda Y, Ueda Y, Matsui O, Matsubara T, Igarashi S, Yoneda N, Kitao A, Gabata T, Kobayashi S. A case report: mucinous carcinoma of extrahepatic bile ducts with periportal calcification suggestive of lymphatic calcification. Abdom Radiol (NY) 2025; 50:1595-1599. [PMID: 39379517 DOI: 10.1007/s00261-024-04621-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Revised: 09/23/2024] [Accepted: 10/02/2024] [Indexed: 10/10/2024]
Abstract
Mucinous carcinoma is a rare subtype of extrahepatic bile duct (EHBD) cancer in which abundant mucin surrounds cancer cell nests. Calcification is often observed in mucus-producing tumors, and we herein report a case of mucinous carcinoma of EHBD with diffuse periportal calcifications. A 92-year-old woman was seen for jaundice. Non-contrast CT showed diffuse semi-linear branching calcifications extending from the hepatoduodenal ligament along the long axis of the intra- and extrahepatic portal veins. A bile duct mass and multiple lymph nodes were hyperintense on T2-weighted MRI images, and periportal abnormal intensity was visible along the intrahepatic portal tract. On contrast-enhanced CT, the mass and enlarged lymph nodes showed a weak enhancing effect. In addition, a lesion with a similar enhancing effect was observed in parallel with periportal calcification, raising suspicion of tumor extension. An endoscopic bile duct biopsy was performed, which resulted in the tumor being diagnosed as a mucinous carcinoma. Considering the imaging findings, it was determined to be a mucinous carcinoma of EHBD origin, with lymphatic vessel infiltration and multiple lymph node metastases. The lymphatic tracts presented lymphangitic carcinomatosis extending from the hepatoduodenal ligament to intrahepatic portal tracts, and the diffuse periportal calcification was presumed to be calcification associated with the mucin component of tumor infiltration.
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Affiliation(s)
- Yuichi Yoshie
- Saiseikai Kanazawa Hospital, Kanazawa, Japan
- Kanazawa University, Kanazawa, Japan
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Sood R, Badjatia T, Bhargava P. Mucinous rectal adenocarcinoma recurrence: A case report and literature review. Radiol Case Rep 2025; 20:2189-2193. [PMID: 39981160 PMCID: PMC11840533 DOI: 10.1016/j.radcr.2025.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Revised: 01/04/2025] [Accepted: 01/09/2025] [Indexed: 02/22/2025] Open
Abstract
Mucinous rectal adenocarcinoma (MRA) is a relatively uncommon type of rectal cancer, accounting for only about 5%-10% of all adenocarcinomas of the rectum. Characterized by the presence of extracellular mucin constituting at least 50% of the tumor volume, MRA is associated with a poorer prognosis and more advanced tumor stage at presentation compared to nonmucinous rectal adenocarcinomas. We report a case of a 42-year-old male patient with no family history of colorectal cancer, who presented with chronic diarrhea and was diagnosed with T3N0 MRA. We highlight the multimodality imaging features of recurrent and metastatic disease specific to this subtype of rectal carcinoma.
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Affiliation(s)
- Riya Sood
- Department of Radiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Trisha Badjatia
- Department of Radiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Peeyush Bhargava
- Department of Radiology, University of Texas Medical Branch, Galveston, TX, USA
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Wu S, Wang C, Xia J, Sun D, Wu PY, Wu Y, Yao Z, Ren Y, Zhang Q. Changes in the relaxivity of water-organic solvent miscible systems: Hidden forces beyond metal ions. Med Phys 2025; 52:1108-1118. [PMID: 39470256 DOI: 10.1002/mp.17471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 09/03/2024] [Accepted: 10/05/2024] [Indexed: 10/30/2024] Open
Abstract
BACKGROUND The relaxivity of magnetic resonance imaging (MRI) contrast agents is primarily attributed to metal ions such as gadolinium (Gd) and iron. However, the impact of organic solutes on relaxivity, particularly through alterations in water molecule dynamics, has not been thoroughly investigated. This research was aimed to explore how organic solutes affect the relaxivities of water and Gd-based contrast agents (GBCAs), potentially revealing new aspects for the development of contrast agents. PURPOSE To investigate the effects of different proportions of water-soluble organic solvents mixed with pure water and GBCA on T1 and T2 relaxivities. METHODS Ethanol, dimethyl sulfoxide (DMSO), 1,4-dioxane, glycerin, ethylene glycol, diethylene glycol, polyethylene glycol (PEG) 200, and PEG 400 were mixed with ultrapure water in various ratios (100:0, 90:10, 80:20, 70:30, 60:40, 50:50, 40:60, 30:70, 20:80, 10:90, 0:100). GBCA was added to these mixtures at a concentration of 0.05 mmol/L. The mixtures underwent T1 and T2 mapping scans using a 3.0 Tesla MRI machine, and the relaxivities R1 (1/T1) and R2 (1/T2) were calculated and compared. RESULTS The relaxivity R1 of ethanol, 1,4-dioxane, and DMSO mixtures with water or GBCA, as well as R2 of DMSO mixtures with GBCA, initially increased and then decreased. Conversely, R1 and R2 increased significantly with higher proportions of diethylene glycol, PEG 200, and glycerin in the mixtures with GBCA. The increase in relaxivity R1 was correlated with greater viscosity. When the proportion of DMSO and diethylene glycol exceeded 20%, minimal variability in R2 was observed as the water content decreased. CONCLUSIONS Adding organic solvents to water and paramagnetic relaxation reagents could alter T1 and T2 relaxivities, suggesting potential new directions for modifying current contrast agents. Additionally, increasing the viscosity of the contrast agent was found to enhance the relaxivity.
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Affiliation(s)
- Shiman Wu
- Department of Radiology, Huashan hospital, Fudan University, Shanghai, P.R. China
| | - Chaochao Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Tongji University Cancer Center, Shanghai, P.R. China
| | - Junjie Xia
- Department of Radiology, Huashan hospital, Fudan University, Shanghai, P.R. China
| | - Dijia Sun
- Department of Radiology, Huashan hospital, Fudan University, Shanghai, P.R. China
| | | | - Yue Wu
- Department of Radiology, Huashan hospital, Fudan University, Shanghai, P.R. China
| | - Zhenwei Yao
- Department of Radiology, Huashan hospital, Fudan University, Shanghai, P.R. China
| | - Yan Ren
- Department of Radiology, Huashan hospital, Fudan University, Shanghai, P.R. China
| | - Qi Zhang
- Department of Radiology, Huashan hospital, Fudan University, Shanghai, P.R. China
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Jiang M, Sun Y, Yang C, Wang Z, Xie M, Wang Y, Zhao D, Ding Y, Zhang Y, Liu J, Chen H, Jiang X. Radiomics based on brain-to-tumor interface enables prediction of metastatic tumor type of brain metastasis: a proof-of-concept study. LA RADIOLOGIA MEDICA 2025; 130:190-201. [PMID: 39572474 DOI: 10.1007/s11547-024-01934-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 11/12/2024] [Indexed: 03/01/2025]
Abstract
BACKGROUND Early and accurate identification of the metastatic tumor types of brain metastasis (BM) is essential for appropriate treatment and management. METHODS A total of 450 patients were enrolled from two centers as a primary cohort who carry 764 BMs originated from non-small cell lung cancer (NSCLC, patient = 173, lesion = 187), small cell lung cancer (SCLC, patient = 84, lesion = 196), breast cancer (BC, patient = 119, lesion = 200), and gastrointestinal cancer (GIC, patient = 74, lesion = 181). A third center enrolled 28 patients who carry 67 BMs (NSCLC = 24, SCLC = 22, BC = 10, and GIC = 11) to form an external test cohort. All patients received contrast-enhanced T1-weighted (T1CE) and T2-weighted (T2W) MRI scans at 3.0 T before treatment. Radiomics features were calculated from BM and brain-to-tumor interface (BTI) region in the MRI image and screened using least absolute shrinkage and selection operator (LASSO) to construct the radiomics signature (RS). Volume of peritumor edema (VPE) was calculated and combined with RS to create a joint model. Performance of the models was assessed by receiver operating characteristic (ROC). RESULTS The BTI-based RS showed better performance compared to BM-based RS. The combined models integrating BTI features and VPE can improve identification performance in AUCs in the training (LC/NLC vs. SCLC/NSCLC vs. BC/GIC, 0.803 vs. 0.949 vs. 0.918), internal validation (LC/NLC vs. SCLC/NSCLC vs. BC/GIC, 0.717 vs. 0.854 vs. 0.840), and external test (LC/NLC vs. SCLC/NSCLC vs. BC/GIC, 0.744 vs. 0.839 vs. 0.800) cohorts. CONCLUSION This study indicated that BTI-based radiomics features and VPE are associated with the metastatic tumor types of BM.
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Affiliation(s)
- Mingchen Jiang
- School of Intelligent Medicine, China Medical University, No. 77 Puhe Road, Shenyang, Liaoning, 110122, People's Republic of China
| | - Yiyao Sun
- School of Intelligent Medicine, China Medical University, No. 77 Puhe Road, Shenyang, Liaoning, 110122, People's Republic of China
| | - Chunna Yang
- School of Intelligent Medicine, China Medical University, No. 77 Puhe Road, Shenyang, Liaoning, 110122, People's Republic of China
| | - Zekun Wang
- Department of Medical Imaging, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, 110042, People's Republic of China
| | - Ming Xie
- Department of Radiology, The People's Hospital of Liaoning Province, Shenyang, Liaoning, 110016, People's Republic of China
| | - Yan Wang
- School of Intelligent Medicine, China Medical University, No. 77 Puhe Road, Shenyang, Liaoning, 110122, People's Republic of China
| | - Dan Zhao
- Department of Medical Imaging, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, 110042, People's Republic of China
| | - Yuqi Ding
- School of Intelligent Medicine, China Medical University, No. 77 Puhe Road, Shenyang, Liaoning, 110122, People's Republic of China
| | - Yan Zhang
- Liaoning Provincial Center for Disease Control and Prevention, Shenyang, Liaoning, 110005, People's Republic of China
| | - Jie Liu
- Second Department of Prosthodontics, Affiliated Stomatological Hospital of China Medical University, Liaoning Institute of Dental Research, Shenyang, Liaoning, 110002, People's Republic of China.
| | - Huanhuan Chen
- Department of Oncology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, Liaoning, 110004, People's Republic of China.
| | - Xiran Jiang
- School of Intelligent Medicine, China Medical University, No. 77 Puhe Road, Shenyang, Liaoning, 110122, People's Republic of China.
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Yang WL, Su XR, Li S, Zhao KY, Yue Q. Utilizing machine-learning techniques on MRI radiomics to identify primary tumors in brain metastases. Front Neurol 2025; 15:1474461. [PMID: 39835148 PMCID: PMC11743164 DOI: 10.3389/fneur.2024.1474461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 11/22/2024] [Indexed: 01/22/2025] Open
Abstract
Objective To develop a machine learning-based clinical and/or radiomics model for predicting the primary site of brain metastases using multiparametric magnetic resonance imaging (MRI). Materials and methods A total of 202 patients (87 males, 115 females) with 439 brain metastases were retrospectively included, divided into training sets (brain metastases of lung cancer [BMLC] n = 194, brain metastases of breast cancer [BMBC] n = 108, brain metastases of gastrointestinal tumor [BMGiT] n = 48) and test sets (BMLC n = 50, BMBC n = 27, BMGiT n = 12). A total of 3,404 quantitative image features were obtained through semi-automatic segmentation from MRI images (T1WI, T2WI, FLAIR, and T1-CE). Intra-class correlation coefficient (ICC) was used to examine segmentation stability between two radiologists. Radiomics features were selected using analysis of variance (ANOVA), recursive feature elimination (RFE), and Kruskal-Wallis test. Three machine learning classifiers were used to build the radiomics model, which was validated using five-fold cross-validation on the training set. A comprehensive model combining radiomics and clinical features was established, and the diagnostic performance was compared by area under the curve (AUC) and evaluated in an independent test set. Results The radiomics model differentiated BMGiT from BMLC (13 features, AUC = 0.915 ± 0.071) or BMBC (20 features, AUC = 0.954 ± 0.064) with high accuracy, while the classification between BMLC and BMBC was unsatisfactory (11 features, AUC = 0.729 ± 0.114). However, the combined model incorporating radiomics and clinical features improved the predictive performance, with AUC values of 0.965 for BMLC vs. BMBC, 0.991 for BMLC vs. BMGiT, and 0.935 for BMBC vs. BMGiT. Conclusion The machine learning-based radiomics model demonstrates significant potential in distinguishing the primary sites of brain metastases, and may assist screening of primary tumor when brain metastasis is suspected whereas history of primary tumor is absent.
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Affiliation(s)
- W. L. Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - X. R. Su
- Department of Radiology, West China Hospital of Medicine, Huaxi MR Research Center (HMRRC), Chengdu, Sichuan, China
| | - S. Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - K. Y. Zhao
- West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Q. Yue
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Gayibov E, Karim AH. A Rapid Review of Adenocarcinoma and Pulmonary Tumor Thrombotic Microangiopathy: A Deadly Duo. Cureus 2025; 17:e76842. [PMID: 39897287 PMCID: PMC11787629 DOI: 10.7759/cureus.76842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2025] [Indexed: 02/04/2025] Open
Abstract
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare paraneoplastic syndrome associated with various adenocarcinomas, most commonly gastric adenocarcinoma. This condition can progressively worsen pulmonary arterial hypertension, leading to acute or subacute pulmonary heart failure and respiratory insufficiency. This paper examines the pathogenesis, clinical presentation, diagnosis, treatment, and prognosis of PTTM. Given PTTM's poor prognosis, we emphasize treatment strategies. PTTM in adenocarcinoma patients can mimic other pulmonary diseases, causing diagnostic delays. Current PTTM treatment strategies primarily focus on managing the underlying malignancy and addressing thrombotic complications. Anti-angiogenic therapy with bevacizumab and the platelet-derived growth factor receptor antagonist imatinib have shown promise in multiple cases. Further research is needed to develop more effective and targeted therapies for this challenging condition. The precise mechanisms underlying this association remain to be fully elucidated.
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Affiliation(s)
- Emin Gayibov
- Third Faculty of Medicine, Charles University, Prague, CZE
| | - Amin H Karim
- Department of Cardiovascular Disease, Baylor College of Medicine, Houston, USA
- Department of Cardiovascular Disease, Weill Medical College of Cornell University, New York City, USA
- Department of Cardiovascular Disease, Methodist Academy of Medicine, Houston, USA
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Potente ALL, de Borborema CLP, Vieira ICP, Talans A, Pacheco EO, Torres LR, Ueda SKN, Mazzucato FL, Purysko AS, Martins DL, Torres US, D'Ippolito G. Tips and tricks for a proper radiological assessment of abdominal and pelvic lymph nodes. Abdom Radiol (NY) 2024; 49:4057-4073. [PMID: 38844622 DOI: 10.1007/s00261-024-04390-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 10/30/2024]
Abstract
The assessment of lymph node dimensions is a commonly used criterion in analyzing lymphatic involvement related to inflammatory or neoplastic diseases. However, it is important to understand that the interpretation of lymph nodes goes beyond simply considering their size. A pathologic lymph node can present with enlarged dimensions, a heterogeneous appearance, increased cortex thickness, irregular contours, or a lobulated shape. In this context, it is essential to consider not only the dimensions but also the morphology, attenuation, and enhancement of lymph nodes on imaging exams. This article aims to demonstrate how characteristics of lymph nodes, beyond their size, can provide crucial insights that assist in diagnostic reasoning, focusing on computed tomography. By emphasizing different enhancement patterns, attenuation, and the potential contents related to these patterns, the study seeks to show how these features can indicate possible differential diagnoses and guide more accurate clinical assessments.
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Affiliation(s)
| | | | | | - Aley Talans
- Grupo Fleury, São Paulo, Brazil
- Faculdade de Medicina da, Universidade de São Paulo, São Paulo, Brazil
| | | | - Lucas Rios Torres
- Grupo Fleury, São Paulo, Brazil
- Universidade Federal de São Paulo, São Paulo, Brazil
| | - Serli Kiyomi Nakao Ueda
- Grupo Fleury, São Paulo, Brazil
- Faculdade de Medicina da, Universidade de São Paulo, São Paulo, Brazil
| | - Fernanda Lopez Mazzucato
- Grupo Fleury, São Paulo, Brazil
- Faculdade de Medicina da, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | - Giuseppe D'Ippolito
- Grupo Fleury, São Paulo, Brazil
- Universidade Federal de São Paulo, São Paulo, Brazil
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Gkegkes ID, Milionis V, Goutas N, Mantzoros I, Bourtzinakou AA, Stamatiadis AP. Perianal Mucinous Adenocarcinoma: A Case Report and a Systematic Review of the Literature. J Gastrointest Cancer 2024; 56:6. [PMID: 39422801 DOI: 10.1007/s12029-024-01116-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2024] [Indexed: 10/19/2024]
Abstract
BACKGROUND Mucinous adenocarcinoma of anus is an uncommon neoplasm of the gastrointestinal tract. In most of the cases, early diagnosis of this disease is difficult since its symptoms frequently mimic benign inflammatory conditions. METHODS A systematic PubMed and Scopus search was conducted, a propos of a case report. RESULTS One hundred fifty patients from 93 case reports were included. The mean age of the patients was 60.5 years (range: 18-81). The majority of them were males (124 out of 150, 82.7%), while the main known risk factor was the history of chronic fistula (109 out of 150, 72.7%). Recurrent perianal sepsis and perianal pain were the principal symptoms at the time of presentation. No symptoms have been reported only in three patients (3 out of 150, 2%). Regarding the prior surgical history of the patients, multiple abscess drainage and perianal fistula's related interventions were present in 62 (41.3%) and 19 (12.7%) patients, respectively. Neoadjuvant chemoradiotherapy was administered in 53 out of 150 patients (35.3%), while the majority of them have been treated with combined treatment of chemotherapy and radiotherapy. APR and its variations were the most applied surgical treatment (68%). Adjuvant chemoradiotherapy was administered almost up to one-third of the included patients (34%). Recurrence of the disease was reported in 41 out of 150 patients (27.3%). Death was reported in 44 out of 150 patients (29.3%). CONCLUSION Review of the available published literature suggests that perianal mucinous adenocarcinoma is an extremely rare neoplasia. Τhere is no consensus as far as the diagnosis and the treatment strategies, due to the rarity of this neoplasm. High degree of clinical suspicion as well as histopathological confirmation is the principal requisites for the diagnosis of mucinous adenocarcinoma, especially in the ground of chronic ulcero-proliferative perianal lesions.
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Affiliation(s)
- Ioannis D Gkegkes
- Athens Colorectal Laboratory, Athens, Greece.
- Department of Colorectal Surgery, Royal Devon and Exeter NHS Foundation Trust, Residential Village, 17C James House, Bovemoors Lane, Exeter, EX2 5DS, UK.
| | | | - Nikolaos Goutas
- Laboratory of Forensic Medicine and Toxicology, The National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Mantzoros
- School of Medicine, Faculty of Health Science, 4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonia A Bourtzinakou
- School of Medicine, Faculty of Health Science, 4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos P Stamatiadis
- Department of Colorectal Surgery, Royal Devon and Exeter NHS Foundation Trust, Residential Village, 17C James House, Bovemoors Lane, Exeter, EX2 5DS, UK
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Gaeta M, Galletta K, Cavallaro M, Mormina E, Cannizzaro MT, Lanzafame LRM, D'Angelo T, Blandino A, Vinci SL, Granata F. T1 relaxation: Chemo-physical fundamentals of magnetic resonance imaging and clinical applications. Insights Imaging 2024; 15:200. [PMID: 39120775 PMCID: PMC11315875 DOI: 10.1186/s13244-024-01744-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/07/2024] [Indexed: 08/10/2024] Open
Abstract
A knowledge of the complex phenomena that regulate T1 signal on Magnetic Resonance Imaging is essential in clinical practice for a more effective characterization of pathological processes. The authors review the physical basis of T1 Relaxation Time and the fundamental aspects of physics and chemistry that can influence this parameter. The main substances (water, fat, macromolecules, methemoglobin, melanin, Gadolinium, calcium) that influence T1 and the different MRI acquisition techniques that can be applied to enhance their presence in diagnostic images are then evaluated. An extensive case illustration of the different phenomena and techniques in the areas of CNS, abdomino-pelvic, and osteoarticular pathology is also proposed. CRITICAL RELEVANCE STATEMENT: T1 relaxation time is strongly influenced by numerous factors related to tissue characteristics and the presence in the context of the lesions of some specific substances. An examination of these phenomena with extensive MRI exemplification is reported. KEY POINTS: The purpose of the paper is to illustrate the chemical-physical basis of T1 Relaxation Time. MRI methods in accordance with the various clinical indications are listed. Several examples of clinical application in abdominopelvic and CNS pathology are reported.
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Affiliation(s)
- Michele Gaeta
- Radiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Karol Galletta
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Marco Cavallaro
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Enricomaria Mormina
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | | | | | - Tommaso D'Angelo
- Radiology Unit - Biomorf Department, University of Messina, Messina, Italy.
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD, Rotterdam, The Netherlands.
| | - Alfredo Blandino
- Radiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Sergio Lucio Vinci
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Francesca Granata
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
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Benesch MGK, Nelson ED, O’Brien SBL. Location Has Prognostic Impact on the Outcome of Colorectal Mucinous Adenocarcinomas. Cancers (Basel) 2023; 16:147. [PMID: 38201574 PMCID: PMC10778219 DOI: 10.3390/cancers16010147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Mucinous (colloid) adenocarcinomas (MAs) are a rare histological subtype of tumors defined by extracellular mucin comprising more than 50% of the tumor. These tumors are on a continuum of mucin-producing malignancies with signet ring cell adenocarcinomas (SRCCs), which instead produce intracellular mucin. Mucin-containing cancers occur primarily in the stomach and colon, where for SRCCs, outcomes are relatively worse in the proximal stomach and the rectum. It is not known if MAs have similar outcomes. In this study, we use the Surveillance, Epidemiology, and End Results (SEER) database to examine the effects of tumor localization, age, sex, and stage on colorectal and gastric cancer outcomes for MAs. For right colon cancers, MAs are more common, particularly in females, and have slightly better or equivalent outcomes across all stages and ages compared to conventional adenocarcinomas, but outcomes are progressively worse compared to conventional adenocarcinomas for left colon and rectal cancers. Unlike SRCCs, MAs have similar outcomes to conventional adenocarcinomas in all stomach locations. Overall, these results suggest that MAs have an intrinsically different tumor biology in the left colon and rectum that promotes pathogenesis. Decoding this phenomenon could lead to more effectively tailored patient treatment regimens.
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Affiliation(s)
- Matthew G. K. Benesch
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (E.D.N.); (S.B.L.O.)
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Yang WW, Fang YT, Niu YR, Sun YK. Comparison of clinicopathological characteristics and survival outcomes between gallbladder mucinous adenocarcinoma and gallbladder adenocarcinoma: A propensity score-matched study. World J Gastrointest Oncol 2023; 15:1436-1450. [PMID: 37663946 PMCID: PMC10473937 DOI: 10.4251/wjgo.v15.i8.1436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/03/2023] [Accepted: 06/19/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Gallbladder mucinous adenocarcinoma (GBMAC) is a rare subtype of gallbladder adenocarcinoma (GBAC), with limited knowledge of its survival outcomes from small case series and single-center retrospective analysis. AIM To compare the clinicopathological characteristics of GBMAC with typical GBAC and its prognostic factors to gain insights into this field. METHODS This study was conducted using data from the Surveillance, Epidemiology, and End Results database, including cases of GBMAC and typical GBAC diagnosed from 2010 to 2017. The Pearson chi-square test or Fisher exact test was used to examine the differences in clinicopathological features between these two cohorts. In addition, propensity score matching (PSM) analysis was performed to balance the selection biases. Univariate and multivariate Cox hazards regression analyses were performed to determine independent prognostic factors for cancer-specific survival (CSS) and overall survival (OS). The Kaplan-Meier curves and log-rank tests were used to assess the OS and CSS of GBMAC and typical GBAC patients. RESULTS The clinicopathological and demographic characteristics of GBMAC were different from typical GBAC. They included a larger proportion of patients with unmarried status, advanced American Joint Committee on Cancer (AJCC) stage, higher T stage, higher N1 stage rate and lower N0 and N2 stage rates (P < 0.05). Multivariate analyses demonstrated that surgery [OS: Hazard ratio (HR) = 2.27, P = 0.0037; CSS: HR = 2.05, P = 0.0151], chemotherapy (OS: HR = 6.41, P < 0.001; CSS: HR = 5.24, P < 0.001) and advanced AJCC stage (OS: Stage IV: HR = 28.99, P = 0.0046; CSS: Stage III: HR = 12.31, P = 0.015; stage IV: HR = 32.69, P = 0.0015) were independent prognostic indicators for OS and CSS of GBMAC patients. Furthermore, after PSM analysis, there was no significant difference between GBMAC and matched typical GBAC patients regarding OS (P = 0.82) and CSS (P = 0.69). CONCLUSION The biological behaviors of GBMAC are aggressive and significantly different from that of typical GBAC. However, they show similar survival prognoses. Surgery, chemotherapy, and lower AJCC stage were associated with better survival outcomes. Further research is needed in the future to verify these results.
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Affiliation(s)
- Wen-Wei Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yu-Ting Fang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ya-Ru Niu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yong-Kun Sun
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Hebei Cancer Hospital, Langfang 065001, Hebei Province, China
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12
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Nakamura M, Inagaki F, Takemura N, Yoshizaki Y, Ito K, Mihara F, Kokudo N. Multivisceral resection for primary pancreatic signet ring cell carcinoma. Clin J Gastroenterol 2023; 16:482-487. [PMID: 36939986 DOI: 10.1007/s12328-023-01783-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/06/2023] [Indexed: 03/21/2023]
Abstract
Primary pancreatic signet ring cell carcinoma (PPSRCC) is a rare and aggressive tumor with poor prognosis. Here, we report a case of PPSRCC treated with curative surgery. A 49-year-old man presented with right mid-abdominal pain. Imaging tests showed a 3.6 cm tumor extending around the head of the pancreas, the second portion of the duodenum, and the retroperitoneum. Involvement of the right proximal ureter resulted in moderate right hydronephrosis. A subsequent tumor biopsy revealed suspected pancreatic adenocarcinoma. No apparent lymph node or remote metastases were observed. The tumor was considered resectable, and radical pancreaticoduodenectomy was planned. Pancreaticoduodenectomy, right nephroureterectomy, and right hemicolectomy were conducted to resect the tumor en bloc. Final pathology revealed a poorly differentiated ductal adenocarcinoma of the pancreas with signet ring cells infiltrating the right ureter and transverse mesocolon (pT3N0M0, stage IIA, according to UICC for International Cancer Control TNM classification). The postoperative course was uneventful, and oral fluoropyrimidine (S-1) was administered as adjuvant chemotherapy for 1 year. At the 16-month follow-up, the patient was alive without any evidence of recurrence. Pancreaticoduodenectomy with right hemicolectomy and right nephroureterectomy was performed for curative resection of PPSRCC infiltrating the transverse mesocolon and right ureter.
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Affiliation(s)
- Mai Nakamura
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine (NCGM), 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Fuyuki Inagaki
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine (NCGM), 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Nobuyuki Takemura
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine (NCGM), 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Yuhi Yoshizaki
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine (NCGM), 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Kyoji Ito
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine (NCGM), 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Fuminori Mihara
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine (NCGM), 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine (NCGM), 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
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13
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Mylonakis A, Karydakis L, Davakis S, Panagakis A, Kaniadaki M, Pergaris A, Alexandrou A, Papalampros A, Sakarellos P. A Huge Asymptomatic Urachal Mucinous Cystic Carcinoma: A Case Report With Differential Diagnosis and Surgical Considerations. Cureus 2023; 15:e37036. [PMID: 37143634 PMCID: PMC10153764 DOI: 10.7759/cureus.37036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2023] [Indexed: 05/06/2023] Open
Abstract
Cystic mucinous neoplasms of urachal origin cover a wide spectrum of benign and malignant lesions arising from the remnants of the urachus. They display various degrees of tumor cell atypia and local invasion, with no reported cases of metastasis or recurrence after complete surgical resection. We present a 47-year-old man who referred to our Surgical Department due to an abdominal cystic mass incidentally found upon abdominal ultrasound. He underwent en block resection of the cystic mass along with partial bladder dome cystectomy. The histopathology of the resected specimen revealed a cystic mucinous epithelial tumor of low malignant potential with areas of intraepithelial carcinoma. The patient showed no evidence of disease recurrence or distant metastasis 6 months after resection and is scheduled for follow-up with serial MRI or CT scans and blood tumor markers over the next 5 years.
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Affiliation(s)
- Adam Mylonakis
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Lysandros Karydakis
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Spyridon Davakis
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Andreas Panagakis
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Maria Kaniadaki
- First Deparment of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Alexandros Pergaris
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Andreas Alexandrou
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Alexandros Papalampros
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Panagiotis Sakarellos
- First Department of Surgey, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, GRC
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14
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Alradhi M, Wen S, Safi M, Al‐danakh A, Wang H, Shopit A, Sun M, Fan B, Li X. Molecular genetic and clinical characteristic analysis of primary signet ring cell carcinoma of urinary bladder identified by a novel OR2L5 mutation. Cancer Med 2023; 12:3931-3951. [PMID: 36779496 PMCID: PMC9972163 DOI: 10.1002/cam4.5121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/16/2022] [Accepted: 07/26/2022] [Indexed: 11/11/2022] Open
Abstract
To get a better understanding of the genetic basis of primary signet ring cell carcinoma (SRCC) of the bladder, which is highly rare and not yet explored. First, by using immunohistochemistry to find histological pathological characteristics. Second, a massively parallel whole-exome sequencing (WES) was performed on a 58-year-old male patient who had painless macroscopic hematuria and was pathologically diagnosed with primary SRCC of the bladder, followed by comparing with genes of ordinary urothelial cancer (UC) from TCGA. Furthermore, a population-based analysis using the SEER database was performed to investigate the prognosis (SRCC vs. UC). We identified 63 copy number variations (CNVs) with gain counts and 181 CNVs with loss counts. Totally 4515 mutations were discovered in C > T with a success rate of greater than 89%. The most frequently mutated pathway was RTK-RAS which has 85 genes involved in carcinogenic signaling. Final screening on predisposing genes is performed after filtering based on ACMG. Moreover, several driver genes, including NBN, KCTD18, SPATA13, ANKRD36, OR2L5, MALRD1, and LSMEM1, were detected. Sanger sequencing of germline DNA revealed the presence of a mutant base A/G of OR2L5 in the sequence, which was discovered for the first time in primary SRCC of the bladder. Furthermore, the immunohistochemical profile showed that primary SRCC of the bladder were positive for CK7, CK20, GATA-3, and expression of CK(AE1/AE2), EMA, and Ki67. In the SEER-based study, the patients with primary SRCC of the bladder got a worse prognosis compared to those with UC with median months overall survival (OS) 14 vs. 41, respectively, P = 0001, even after adjusting the variables in the Cox regression model, the SRCC of the bladder showed worse survival HR = 1.119, 95% CI = (1.081-1.328), P = 0.0001. These results imply that suppression of potential driver mutations may be a viable adjuvant treatment approach for primary SRCC in the bladder in place of standard chemotherapy, a possibility that warrants further clinical investigation.
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Affiliation(s)
- Mohammed Alradhi
- Department of Urology, Second Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Shuang Wen
- Department of Pathology, Dalian Friendship HospitalDalianChina
| | - Mohammed Safi
- Department of Respiratory DiseasesShandong Second Provincial General Hospital Shandong UniversityShandongChina
| | - Abdullah Al‐danakh
- Department of Urology, First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Honglong Wang
- Department of Pathology, Dalian Friendship HospitalDalianChina
| | - Abdullah Shopit
- Department of Pharmacology, Dalian Medical UniversityDalianChina
| | - Min Sun
- Department of General Surgery, Taihe Hospital, Hubei University of MedicineHubeiChina
| | - Bo Fan
- Department of Urology, Second Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Xiancheng Li
- Department of Urology, Second Affiliated Hospital of Dalian Medical UniversityDalianChina
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15
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Bera S, Sahoo J, Sharma M, Sarangi PK, Majumdar PK. Layered Enhancement with Punctate Foci of Calcifications. ONCOLOGY JOURNAL OF INDIA 2023; 7:17-20. [DOI: 10.4103/oji.oji_2_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/29/2024]
Abstract
Calcifications are rare in gastric adenocarcinoma and all reported cases correspond to a mucinous adenocarcinoma. Mucinous gastric adenocarcinoma (MGC) is a rare histological variety representing approximately 2.6%–6.6% of gastric cancers, sometimes associated with punctate and miliary calcification. We describe one such case having punctate calcifications with characteristic contrast-enhanced computed tomography showing hypoenhancing middle and outer layer of stomach suggestive of extracellular mucin pool, primarily in submucosa and deeper layer and thin enhancing inner layer suggestive of normal mucosa, referred to as layered enhancement pattern. We also describe the radiopathological correlation of MGC with brief review of literature.
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16
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Sassi F, Sahraoui G, Charfi L, Ines Z, Mrad K, Doghri R. A rare case report of a myxoid liposarcoma arising from the broad ligament. Rare Tumors 2022; 14:20363613221148839. [PMID: 36582402 PMCID: PMC9793064 DOI: 10.1177/20363613221148839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022] Open
Abstract
Myxoid liposarcoma (MLPS) is the second most prevalent subtype of liposarcoma. It is usually found in the deep tissues of the lower limbs and rarely in gynecologic tract. Herein we present the second case in the English literature of a primary MLPS arising from the broad ligament which was thought to be a borderline ovarian tumor. The aim is to discuss its clinical and pathological characteristics. A 42-year-old woman presented with pelvic pain for the last 6 months. Magnetic resonance imaging was not specific. She underwent a surgical resection of the tumor mass, and pathological examination confirmed the diagnosis of MLPS deriving from the broad ligament. She received radiotherapy and the patient is doing well at 3 months follow-up. The clinical aspects, pathological diagnosis, prognosis, and therapy approach of broad ligament MLPS are all poorly understood. Complete surgical resection with or without radiotherapy is the mainstay of treatment in located MLPS.
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Affiliation(s)
- Farah Sassi
- Pathology Department, Salah Azaiez Institute, Tunis, Tunisia,Farah Sassi, Pathology Department, Salah
Azaiez Institute, Tunis 1006, Tunisia.
| | - Ghada Sahraoui
- Pathology Department, Salah Azaiez Institute, Tunis, Tunisia,Research Laboratory LR21SP01, Salah Azaiez Institute Tunis, Tunisia
| | - Lamia Charfi
- Pathology Department, Salah Azaiez Institute, Tunis, Tunisia,Research Laboratory LR21SP01, Salah Azaiez Institute Tunis, Tunisia
| | - Zemni Ines
- Surgical Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Karima Mrad
- Pathology Department, Salah Azaiez Institute, Tunis, Tunisia,Research Laboratory LR21SP01, Salah Azaiez Institute Tunis, Tunisia
| | - Raoudha Doghri
- Pathology Department, Salah Azaiez Institute, Tunis, Tunisia,Research Laboratory LR21SP01, Salah Azaiez Institute Tunis, Tunisia
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17
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Nie D, Lan Q, Huang Y, Fang C, Cao Y, Chen Y. Epidemiology and prognostic analysis of patients with pancreatic signet ring cell carcinoma: a population-based study. BMC Gastroenterol 2022; 22:458. [PMCID: PMC9667582 DOI: 10.1186/s12876-022-02543-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background Pancreatic signet ring cell carcinoma (PSRCC) is a rare tumour subtype with poorly understood epidemiological characteristics and prognosis. We attempted to comprehensively characterise the epidemiology and survival outcomes of PSRCC. Methods Patients diagnosed with PSRCC between 2000 and 2018 were identified using Surveillance, Epidemiology and End Results Stat 8.3.9.2 software. Age-adjusted incidence and survival were calculated. Survival curves were plotted using the Kaplan–Meier method, and the differences between survival curves were compared using the log-rank test. Cox proportional hazards models were used to evaluate factors that independently predict overall survival. The primary analysis was a complete case analysis; multiple imputations were employed in a sensitivity analysis. Results We identified 585 eligible patients with PSRCC. The overall annual incidence from 2000 to 2018 was 0.349 (95% CI, 0.321–0.379) per million population. The incidence increased significantly in patients over 55 years of age and peaked at about 80 years of age (2.12 per million). Males and Black patients had the highest incidence. The observed survival rates at 1, 2 and 5 years were 20.1, 8.3 and 3.4%, respectively. Survival analysis revealed that primary surgery and chemotherapy are effective treatments for patients with PSRCC (P < 0.05). According to multivariate Cox regression analysis, early stage and receiving surgery and chemotherapy were favourable factors (P < 0.05). Similar conclusions were drawn from the interpolated data. Conclusions PSRCC is a highly malignant tumour that predominates in elderly, male and Black patients. The prognosis is poor with a 5-year survival rate of 3.4%; however, multivariate analysis and adjusted models accounting for missing data revealed that early diagnosis, surgery and chemotherapy are effective in improving the prognosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02543-z.
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Affiliation(s)
- Duorui Nie
- grid.488482.a0000 0004 1765 5169Graduate School, Hunan University of Chinese Medicine, Changsha, 410208 Hunan Province China
| | - Qingxia Lan
- grid.412595.eDepartment of Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405 Guangdong Province China ,grid.411866.c0000 0000 8848 7685First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405 Guangdong Province China
| | - Yue Huang
- grid.412595.eDepartment of Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405 Guangdong Province China ,grid.411866.c0000 0000 8848 7685First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405 Guangdong Province China
| | - Chongkai Fang
- grid.412595.eDepartment of Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405 Guangdong Province China ,grid.411866.c0000 0000 8848 7685First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405 Guangdong Province China
| | - Yang Cao
- grid.412595.eDepartment of Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405 Guangdong Province China
| | - Yao Chen
- grid.412595.eDepartment of Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405 Guangdong Province China
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18
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Wang M, Perucho JAU, Cao P, Vardhanabhuti V, Cui D, Wang Y, Khong PL, Hui ES, Lee EYP. Repeatability of MR fingerprinting in normal cervix and utility in cervical carcinoma. Quant Imaging Med Surg 2021; 11:3990-4003. [PMID: 34476184 DOI: 10.21037/qims-20-1382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/08/2021] [Indexed: 11/06/2022]
Abstract
Background Magnetic resonance fingerprinting (MRF) is a fast-imaging acquisition technique that generates quantitative and co-registered parametric maps. The aim of this feasibility study was to evaluate the agreement between MRF and phantom reference values, scan-rescan repeatability of MRF in normal cervix, and its ability to distinguish cervical carcinoma (CC) from normal cervical tissues. Methods An International Society of Magnetic Resonance in Medicine/National Institute of Standards and Technology (ISMRM/NIST) phantom was scanned using MRF 15 times over 65 days. Agreement between MRF and phantom reference T1 and T2 values was assessed by linear regression. Healthy volunteers and patients with suspected CC were prospectively recruited. MRF was repeated twice for healthy volunteers (MRF1 and MRF2). Volumes of interest of normal cervical tissues and CC were delineated on T1 and T2 maps. MRF scan-rescan repeatability was evaluated by Bland-Altman plots, within-subject coefficients of variation (wCV), and intraclass correlation coefficients (ICC). T1 and T2 values were compared between CC and normal cervical tissues using Mann-Whitney U test. Receiver operating characteristic (ROC) analysis was performed to evaluate diagnostic efficiency. Results Strong correlations were observed between MRF and phantom (R2=0.999 for T1, 0.981 for T2). Twelve healthy volunteers (28.7±5.1 years) and 28 patients with CC (54.6±15.2 years) were recruited for the in-vivo experiments. Repeatability of MRF parameters were wCV <3% for T1, <5% for T2 and ICC ≥0.92 for T1, ≥0.94 for T2. T1 value of CC (1,529±112 ms) was higher than normal mucosa [MRF1: 1,430±129 ms, MRF2: 1,440±130 ms; P=0.031, area under the curve (AUC) ≥0.717] and normal stroma (MRF1: 1,258±101 ms, MRF2: 1,276±105 ms; P<0.001, AUC ≥0.946). T2 value of CC (69±9 ms) was lower than normal mucosa (MRF1: 88±16 ms, MRF2: 87±13 ms; P<0.001, AUC ≥0.854), but was not different from normal stroma (P=0.919). Conclusions Excellent agreement was observed between MRF and phantom reference values. MRF exhibited excellent scan-rescan repeatability in normal cervix with potential value in differentiating CC from normal cervical tissues.
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Affiliation(s)
- Mandi Wang
- Department of Diagnostic Radiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jose A U Perucho
- Department of Diagnostic Radiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Peng Cao
- Department of Diagnostic Radiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Varut Vardhanabhuti
- Department of Diagnostic Radiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Di Cui
- Department of Diagnostic Radiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yiang Wang
- Department of Diagnostic Radiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Pek-Lan Khong
- Department of Diagnostic Radiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Edward S Hui
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Elaine Y P Lee
- Department of Diagnostic Radiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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19
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Schaible P, Schaible KL. Utility of ultrasound for assessing and confirming decompression of spinal cord. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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20
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Enhancement of Radiosurgical Treatment Outcome Prediction Using MRI Radiomics in Patients with Non-Small Cell Lung Cancer Brain Metastases. Cancers (Basel) 2021; 13:cancers13164030. [PMID: 34439186 PMCID: PMC8392266 DOI: 10.3390/cancers13164030] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/01/2021] [Accepted: 08/09/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Non-small cell lung cancer (NSCLC) is the most common cause of brain metastasis (BM). Approximately 50% of patients with metastatic NSCLC harbor BMs. Within the past decade, Gamma Knife radiosurgery (GKRS) has become one of the first-line treatments for BMs. Ability to predict treatment response after GKRS can therefore guide treatment strategy. This study aimed to determine whether pre-radiosurgical neuroimaging radiomics can predict survival and local tumor control after GKRS. Based on the collected magnetic resonance images and clinical characteristics of the 237 NSCLC BM patients with BMs (for survival prediction) and 256 NSCLC patients with 976 BMs (for prediction of local tumor control), we concluded that the identified radiomic features could provide valuable additional information to enhance the prediction of BM responses after GKRS. The proposed approach provided physicians with an intuitive way to predict the patient outcome based on pre-radiosurgical magnetic resonance images. Abstract The diagnosis of brain metastasis (BM) is commonly observed in non-small cell lung cancer (NSCLC) with poor outcomes. Accordingly, developing an approach to early predict BM response to Gamma Knife radiosurgery (GKRS) may benefit the patient treatment and monitoring. A total of 237 NSCLC patients with BMs (for survival prediction) and 256 patients with 976 BMs (for prediction of local tumor control) treated with GKRS were retrospectively analyzed. All the survival data were recorded without censoring, and the status of local tumor control was determined by comparing the last MRI follow-up in patients’ lives with the pre-GKRS MRI. Overall 1763 radiomic features were extracted from pre-radiosurgical magnetic resonance images. Three prediction models were constructed, using (1) clinical data, (2) radiomic features, and (3) clinical and radiomic features. Support vector machines with a 30% hold-out validation approach were constructed. For treatment outcome predictions, the models derived from both the clinical and radiomics data achieved the best results. For local tumor control, the combined model achieved an area under the curve (AUC) of 0.95, an accuracy of 90%, a sensitivity of 91%, and a specificity of 89%. For patient survival, the combined model achieved an AUC of 0.81, an accuracy of 77%, a sensitivity of 78%, and a specificity of 80%. The pre-radiosurgical radiomics data enhanced the performance of local tumor control and survival prediction models in NSCLC patients with BMs treated with GRKS. An outcome prediction model based on radiomics combined with clinical features may guide therapy in these patients.
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21
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Rupasinghe M, Houshyar R, Chahine C, Bui TL, Glavis-Bloom J, Cheng C, Tseng J. A 61-year-old woman with jejunal lymphatic malformation visualized on computed tomography: a case report. J Med Case Rep 2021; 15:302. [PMID: 34039402 PMCID: PMC8157699 DOI: 10.1186/s13256-021-02872-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/19/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Jejunal lymphatic malformations are congenital lesions that are seldom diagnosed in adults and rarely seen on imaging. CASE PRESENTATION A 61-year-old Caucasian woman was initially diagnosed and treated for mucinous ovarian carcinoma. After an exploratory laparotomy with left salpingo-oophorectomy, a computed tomography scan of the abdomen and pelvis demonstrated suspicious fluid-containing lesions involving a segment of jejunum and adjacent mesentery. Resection of the lesion during subsequent debulking surgery revealed that the lesion seen on imaging was a jejunal lymphatic malformation and not a cancerous implant. CONCLUSIONS Abdominal lymphatic malformations are difficult to diagnose solely on imaging but should remain on the differential in adult cancer patients with persistent cystic abdominal lesions despite chemotherapy and must be differentiated from metastatic implants.
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Affiliation(s)
- Mark Rupasinghe
- Department of Radiological Sciences, University of California Irvine, 101 The City Drive South, Route 140, Orange, CA 92868 USA
| | - Roozbeh Houshyar
- Department of Radiological Sciences, University of California Irvine, 101 The City Drive South, Route 140, Orange, CA 92868 USA
| | - Chantal Chahine
- Department of Radiological Sciences, University of California Irvine, 101 The City Drive South, Route 140, Orange, CA 92868 USA
| | - Thanh-Lan Bui
- Department of Radiological Sciences, University of California Irvine, 101 The City Drive South, Route 140, Orange, CA 92868 USA
| | - Justin Glavis-Bloom
- Department of Radiological Sciences, University of California Irvine, 101 The City Drive South, Route 140, Orange, CA 92868 USA
| | - Caleb Cheng
- Department of Pathology & Laboratory Medicine, University of California Irvine School of Medicine, Irvine, CA 92697 USA
| | - Jill Tseng
- Department of Obstetrics and Gynecology, University of California Irvine, 333 City Boulevard West, Suite 1400, Orange, CA 92868 USA
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22
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Soon JQJ, Aftab S, Ling LLA, Uppaluri SAS, Kok SXS. Appendicitis mimicking the CT appearance of an appendiceal mucinous neoplasm. J Radiol Case Rep 2020; 14:26-38. [PMID: 33708342 DOI: 10.3941/jrcr.v14i11.4081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Occasionally, radiologically diagnosed acute appendicitis is found to harbour underlying appendiceal neoplasm on post-surgical histopathology. Conversely, a situation in which radiologically, the appendix demonstrates features consistent with an underlying tumour but post-operative pathology finds no evidence of neoplastic change is rare. We describe a case of a 50-year-old man who presented with a markedly dilated "mass-like" appendix with minimal inflammatory changes on a computed tomography scan. Radiological findings were suspicious for an appendiceal neoplasm/mucocele (i.e. low-grade mucinous neoplasm). However, the post-surgical histopathological diagnosis did not concur with the radiological diagnosis and instead demonstrated findings compatible with acute appendicitis without neoplastic change. In this case report we provide a histopathological correlation and an explanation as to how this may have happened with the hope of helping radiologists avoid this pitfall in the future.
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Affiliation(s)
- Jia Qi Jeremy Soon
- Department of Diagnostic Radiology, Sengkang General Hospital Singapore, Singapore
| | - Syed Aftab
- Department of Diagnostic Radiology, Sengkang General Hospital Singapore, Singapore
| | | | | | - Shi Xian Shawn Kok
- Department of Diagnostic Radiology, Sengkang General Hospital Singapore, Singapore
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23
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Epidemiology of Mucinous Adenocarcinomas. Cancers (Basel) 2020; 12:cancers12113193. [PMID: 33143115 PMCID: PMC7692300 DOI: 10.3390/cancers12113193] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/19/2020] [Accepted: 10/27/2020] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Mucinous adenocarcinomas are a very uncommon type of cancer that is poorly studied. These cancers overexpress a jelly-like substance called mucin outside their cells. These cancers share characteristics to another group of cancers called signet ring cell adenocarcinomas, which express mucin inside their cells, and these cancers almost invariability have a worse outcome compared to conventional adenocarcinomas. In our study, we show that patient outcomes with mucinous adenocarcinomas depend largely on the site of the cancer, with both similarities and differences to cancers arising from signet ring cells. This work, along with our recent study on signet ring cell cancers, provides a solid epidemiological reference for future work to motivate investigations as to how recognizing this tumor histology should lead to more tailored cancer treatments in order to improve patient outcomes. Abstract Mucinous (colloid) adenocarcinomas (MAs) are a rare histological subtype of adenocarcinomas where extracellular mucin comprises more than 50% of the tumor. Most literature on MAs relate to cancers from colorectal and breast sites; however, the literature lacks a standardized overview of the MA disease entity. Particularly in colorectal cancer, some MAs may have signet ring cells floating within the mucin, which may represent a highly metastatic phenotype. MAs and signet ring cell adenocarcinomas represent a spectrum of mucin-producing neoplastic conditions where in the latter most mucin is intracellular rather than extracellular. We recently published a standardized overview of signet ring cells, and in this companion work, using a retrospective cohort approach, we summarize the clinicodemographic and mortality outcomes of MAs in sixteen primary sites, comprising 95.6% of all MAs in the Surveillance, Epidemiology, and End Results Program (SEER), a population-level cancer database covering nearly one-third of the United States population. Compared to matching nonvariant adenocarcinomas, MAs have a slightly earlier age of onset with increased rates of regional and distant disease at presentation. Survival outcomes are highly dependent on tumor location, illustrating our poor understanding of MA tumor biology. The clinical significance of MA histology depends largely on tumor site.
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Revoredo F, de Vinatea J, Reaño G, Villanueva L, Kometter F, Arenas J, Polanco PM. Mucinous cystic neoplasms of the pancreas associated with pregnancy: Two case reports. Medicine (Baltimore) 2020; 99:e21471. [PMID: 32756169 PMCID: PMC7402798 DOI: 10.1097/md.0000000000021471] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
RATIONALE Although rare, pancreatic neoplasms can occur during pregnancy, both in benign and malignant forms. Mucinous cystic neoplasms (MCNs) of the pancreas, a type of these neoplasms, are precursor lesions to invasive pancreatic cancer. The presence of the ovarian-type stroma is a defining feature. PATIENT CONCERNS The first case was a 38-year-old woman in her 18th week of pregnancy with abdominal pain that worsens a few weeks later. The second case was a 30-year-old woman in her 17th week of pregnancy with abdominal pain in the left hypochondrium. DIAGNOSIS The patients were under clinical examination and laboratory test including carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA). Both patients had magnetic resonance imaging (MRI). The diagnosis of a MCNs of the pancreas was done preoperatively in the 2 cases. INTERVENTIONS Both patients underwent distal pancreatectomy during pregnancy. One of them was an emergency laparotomy because of a ruptured MCN. OUTCOMES Both patients were completely recovered from distal pancreatectomy and continued to full term, delivering a healthy baby by Caesarean section. After 6 years of follow-up, the first patient underwent a total gastrectomy, because of a gastric cancer with carcinomatosis. Currently the 2 patients are still alive after 8 years and 5 years of follow-up, respectively. LESSONS Surgical resection of MCNs during pregnancy should be considered during the second trimester given common distal pancreas location, rapid growth, risk of spontaneous rupture, and malignant potential.
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Affiliation(s)
| | | | | | | | | | - José Arenas
- Department of Pathology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú
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Schawkat K, Manning MA, Glickman JN, Mortele KJ. Pancreatic Ductal Adenocarcinoma and Its Variants: Pearls and Perils. Radiographics 2020; 40:1219-1239. [PMID: 32678699 DOI: 10.1148/rg.2020190184] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC), an epithelial neoplasm derived from the pancreatic ductal tree, is the most common histologic type of pancreatic cancer and accounts for 85%-95% of all solid pancreatic tumors. As a highly lethal malignancy, it is the seventh leading cause of cancer death worldwide and is responsible for more than 300 000 deaths per year. PDAC is highly resistant to current therapies, affording patients a 5-year overall survival rate of only 7.2%. It is characterized histologically by its highly desmoplastic stroma embedding tubular and ductlike structures. On images, it typically manifests as a poorly defined hypoenhancing mass, causing ductal obstruction and vascular involvement. Little is known about the other histologic subtypes of PDAC, mainly because of their rarity and lack of specific patterns of disease manifestation. According to the World Health Organization, these variants include adenosquamous carcinoma, colloid carcinoma, hepatoid carcinoma, medullary carcinoma, signet ring cell carcinoma, undifferentiated carcinoma with osteoclast-like giant cells, and undifferentiated carcinoma. Depending on the subtype, they can confer a better or even worse prognosis than that of conventional PDAC. Thus, awareness of the existence and differentiation of these variants on the basis of imaging and histopathologic characteristics is crucial to guide clinical decision making for optimal treatment and patient management.
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Affiliation(s)
- Khoschy Schawkat
- From the Division of Abdominal Imaging, Department of Radiology (K.S., K.J.M.), and Department of Pathology (J.N.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02115; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland (K.S.); and American Institute for Radiologic Pathology, Silver Spring, Md, and MedStar Georgetown University Hospital, Washington, DC (M.A.M.)
| | - Maria A Manning
- From the Division of Abdominal Imaging, Department of Radiology (K.S., K.J.M.), and Department of Pathology (J.N.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02115; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland (K.S.); and American Institute for Radiologic Pathology, Silver Spring, Md, and MedStar Georgetown University Hospital, Washington, DC (M.A.M.)
| | - Jonathan N Glickman
- From the Division of Abdominal Imaging, Department of Radiology (K.S., K.J.M.), and Department of Pathology (J.N.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02115; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland (K.S.); and American Institute for Radiologic Pathology, Silver Spring, Md, and MedStar Georgetown University Hospital, Washington, DC (M.A.M.)
| | - Koenraad J Mortele
- From the Division of Abdominal Imaging, Department of Radiology (K.S., K.J.M.), and Department of Pathology (J.N.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02115; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland (K.S.); and American Institute for Radiologic Pathology, Silver Spring, Md, and MedStar Georgetown University Hospital, Washington, DC (M.A.M.)
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Rico Gala S, Calvo Gijón D, Sánchez Bernal ML, Fernández-Argüelles A, Bello Garrido A. Primary myxoid liposarcoma of the pelvis: An unusual location. Radiol Case Rep 2020; 15:431-434. [PMID: 32089761 PMCID: PMC7025956 DOI: 10.1016/j.radcr.2020.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 01/14/2020] [Indexed: 02/07/2023] Open
Abstract
Myxoid liposarcoma is the second most common type of liposarcoma, normally located in deep tissues of the lower extremities and rarely in the mesenchyma of abdomen and pelvis We present a patient who, incidentally, showed a large pelvis mass. CT and MR revealed a loculated lesión with hypodense areas and very high signal in T2 respectively as well as heterogeneous contrast enhancement. The imaging findings of pelvic myxoid liposarcoma are nonspecific, but nevertheless a painless mesenchymal mass should be considered when we see lesions of myxoid aspect in the pelvic area without a clear relationship with defined anatomic structures.
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Affiliation(s)
- Susana Rico Gala
- Department of Radiology, Hospital de Valme. Ctra de Cádiz s/n, C/ Angel Ganivet N° 12 Sevilla 41013 Spain
| | - Daniel Calvo Gijón
- Department of Radiology, Hospital de Valme. Ctra de Cádiz s/n, C/ Angel Ganivet N° 12 Sevilla 41013 Spain
| | | | - Amaya Fernández-Argüelles
- Department of Radiology, Hospital de Valme. Ctra de Cádiz s/n, C/ Angel Ganivet N° 12 Sevilla 41013 Spain
| | - Angela Bello Garrido
- Department of Radiology, Hospital de Valme. Ctra de Cádiz s/n, C/ Angel Ganivet N° 12 Sevilla 41013 Spain
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Alexander D, Rashid L, Hollis M, Kavuturu S. Primary signet ring cell carcinoma of the pancreatic head: A case report. Clin Case Rep 2019; 7:2235-2238. [PMID: 31788286 PMCID: PMC6878076 DOI: 10.1002/ccr3.2475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 08/02/2019] [Accepted: 08/22/2019] [Indexed: 12/16/2022] Open
Abstract
Pancreatic SRCC is a rare, aggressive tumor. Given limited evidence and the risk of side effects, physicians may elect to withhold chemotherapy in select patients, with the exception of neoadjuvant chemotherapy use to facilitate resectability.
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Affiliation(s)
| | - Lewis Rashid
- Department of General SurgeryMichigan State UniversityLansingMIUSA
| | - Michael Hollis
- Department of General SurgeryMichigan State UniversityLansingMIUSA
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Raposo Rodríguez L, Fernández García N, Tovar Salazar D, Gómez Illán R, Díaz Sánchez T. Imaging findings for mucinous tumors tumortumorof the abdomen and pelvis. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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The Impact of Epidemiological Factors and Treatment Interventions on Survival in Patients With Signet Ring Cell Carcinoma of the Pancreas. Am J Clin Oncol 2019; 41:1176-1184. [PMID: 29672365 DOI: 10.1097/coc.0000000000000447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Primary pancreatic signet ring cell carcinoma (SRCC) is a rare histologic variant of pancreatic carcinoma. A population-based analysis of pancreatic SRCC was performed to determine the predictive effects of epidemiological factors and treatment interventions on overall survival (OS) and disease-specific survival (DSS). MATERIALS AND METHODS The Surveillance, Epidemiology, and End Results registry was searched for pancreatic SRCC cases diagnosed between January 1, 1973 and December 31, 2013. Statistical analysis was performed using the Fisher exact test, χ(2) analysis, Kaplan-Meier method, log-rank test, and Cox proportional hazards regression. RESULTS The mean age among 497 patients was 66.6 years (SD, 11.9). Most patients were white (82.7%) and male (54.5%). The 1-, 2-, and 5-year OS rates were 17%, 9%, and 4%, respectively, while the corresponding 1-, 2-, and 5-year rates for DSS were 18%, 10%, and 5%, respectively. On univariable analysis; age, site, grade, stage, and treatment were predictive of OS and DSS (P<0.05). On multivariable analysis; radiation improved OS and DSS (adjusted hazard ratio [aHR], 0.592 and 0.589, respectively), pancreatectomy improved OS and DSS (aHR, 0.360 and 0.355, respectively), and combination therapy improved OS and DSS (aHR, 0.295 and 0.286, respectively). Age, site, and stage were also independent predictors of OS and DSS. Subgroup analysis demonstrated treatment to be an independent predictor of OS and DSS in localized/regional disease, in distant disease, and in patients diagnosed between 2000 and 2013. CONCLUSIONS Age, site, stage, and treatment independently predict OS and DSS in pancreatic SRCC.
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Mucin-Containing Rectal Carcinomas: Overview of Unique Clinical and Imaging Features. AJR Am J Roentgenol 2019; 213:26-34. [DOI: 10.2214/ajr.18.20864] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Imaging findings for mucinous tumors of the abdomen and pelvis. RADIOLOGIA 2019; 61:370-387. [PMID: 31078302 DOI: 10.1016/j.rx.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 02/25/2019] [Accepted: 03/15/2019] [Indexed: 11/23/2022]
Abstract
This article aims to describe the imaging findings for mucinous tumors of the abdomen and pelvis, which have a similar appearance on imaging tests regardless of the organ in which they develop. Due to the high water content of mucus, the appearance of these tumors is generally similar to that of water on ultrasonography, computed tomography, and magnetic resonance imaging. Another common feature of mucin-producing tumors is that calcifications are often present. The rupture of these lesions and accumulation of mucinous material in the peritoneal cavity gives rise to pseudomyxoma peritonei. It is important to identify mucinous tumors because they have a different prognosis and clinical course than non-mucinous tumors and require different management. Depending on their anatomic location and their imaging characteristics, the treatment approach varies from follow-up to radical surgery together with chemotherapy or radiotherapy or both.
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Kaneko M, Namisaki T, Takaya H, Mori H, Kitade M, Okura Y, Seki K, Sato S, Nakanishi K, Kitagawa K, Ozutsumi T, Shimozato N, Kaji K, Otani T, Nakai T, Obayashi C, Mitoro A, Yamao J, Yoshiji H. Calcified mucinous adenocarcinoma of the stomach metastatic to the iris: a case report. J Med Case Rep 2019; 13:64. [PMID: 30841908 PMCID: PMC6404271 DOI: 10.1186/s13256-019-1977-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/10/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Gastric cancer has a wide spectrum of clinical features, imaging manifestations, and pathology. Punctate calcifications in gastric cancer are infrequent but are usually found in mucinous adenocarcinoma. However, there have only been a few autopsy case reports describing the correlation between the radiology and pathology findings of calcified mucinous adenocarcinoma of the stomach. We present an autopsy case of mucinous gastric adenocarcinoma with iris metastases as the initial symptom. CASE PRESENTATION A 74-year-old Japanese woman presented with blurred vision. Her treating ophthalmologist diagnosed acute iritis with secondary glaucoma. The histopathological and immunohistochemical features of a trabeculectomy specimen favored metastatic carcinoma, most likely of gastrointestinal tract origin. Esophagogastroduodenoscopy revealed multiple irregularly shaped ulcerative lesions, multiple erosions, and thickened folds in the corpus of her stomach. Histologic examination of a gastric tissue specimen obtained by endoscopic biopsy revealed poorly differentiated carcinoma with signet ring cell features. Computed tomography revealed a tumor with multiple punctate calcifications in the thickened gastric wall with diffuse low attenuation and multiple lymph node metastases, including the para-aortic lymph nodes, and peritoneal dissemination. She was diagnosed with stage IV gastric cancer (T4N3M1) and underwent seven cycles of 5-weekly TS-1, a novel oral fluoropyrimidine derivative, plus cisplatin therapy. Serial follow-up computed tomography revealed successive increases in the gastric wall calcifications. Her disease stabilized, but she died of aspiration pneumonia 8 months after the first visit. Autopsy tissue specimens had miliary, punctate calcifications present in abundant extracellular mucin pools in the submucosa, corresponding to the thickened low-attenuating middle layer on computed tomography. The final diagnosis was mucinous gastric adenocarcinoma because mucinous adenocarcinoma is diagnosed when more than half of the tumor area contains extracellular mucin pools. CONCLUSIONS We report the pathology and computed tomography imaging characteristics of a case of calcified mucinous adenocarcinoma of the stomach metastatic to the iris, including findings at autopsy. Metastatic carcinomas in the iris originating in the stomach are exceedingly rare. Multiple punctate calcifications were present in pools of extracellular mucin, a diagnostic clue for mucinous adenocarcinoma. Possible mechanisms underlying scattered punctuate calcifications in gastric mucinous adenocarcinoma warrant further investigation.
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Affiliation(s)
- Miki Kaneko
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
| | - Tadashi Namisaki
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
| | - Hiroaki Takaya
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
| | - Hitoshi Mori
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
| | - Mitsuteru Kitade
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
| | - Yasushi Okura
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
| | - Kenichiro Seki
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
| | - Shinya Sato
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
| | - Keisuke Nakanishi
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
| | - Koh Kitagawa
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
| | - Takahiro Ozutsumi
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
| | - Naotaka Shimozato
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
| | - Kosuke Kaji
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
| | - Tomoyuki Otani
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Tokiko Nakai
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Chiho Obayashi
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Akira Mitoro
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
| | - Junichi Yamao
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
| | - Hitoshi Yoshiji
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522 Japan
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Mascianà G, Capolupo GT, Carannante F, Caricato M. An omental mass. Any idea? Int J Surg Case Rep 2019; 56:40-44. [PMID: 30831506 PMCID: PMC6403098 DOI: 10.1016/j.ijscr.2019.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/06/2019] [Accepted: 02/08/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Pseudomyxoma extraperitonei (PE) is a rare finding. The most common cause is the rupture of a mucocele of the appendix into the retroperitoneum. PRESENTATION OF CASE Here we report a case of a 52 years old female patient with a mass in the right abdomen and vague lower abdominal pain underwent resection of a extraperitoneal encapsulated mass. The histopathological examination revealed a mucinous pseudomyxoma with a low grade of differentiation. DISCUSSION We report a case of pseudomyxoma extraperitonei with a review of literature. CONCLUSION The treatment of pseudomyxoma differs substantially depending on whether it is intraperitoneal or extraperitoneal. The risk of recurrence is such that follow-up, based on a physical examination, CT scan and serum markers, is essential.
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Affiliation(s)
- G Mascianà
- Department of Geriatric Surgery, University Campus Bio-Medico, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - G T Capolupo
- Department of Geriatric Surgery, University Campus Bio-Medico, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - F Carannante
- Department of Geriatric Surgery, University Campus Bio-Medico, Via Alvaro del Portillo 21, 00128 Rome, Italy.
| | - M Caricato
- Department of Geriatric Surgery, University Campus Bio-Medico, Via Alvaro del Portillo 21, 00128 Rome, Italy
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Kniep HC, Madesta F, Schneider T, Hanning U, Schönfeld MH, Schön G, Fiehler J, Gauer T, Werner R, Gellissen S. Radiomics of Brain MRI: Utility in Prediction of Metastatic Tumor Type. Radiology 2018; 290:479-487. [PMID: 30526358 DOI: 10.1148/radiol.2018180946] [Citation(s) in RCA: 162] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose To investigate the feasibility of tumor type prediction with MRI radiomic image features of different brain metastases in a multiclass machine learning approach for patients with unknown primary lesion at the time of diagnosis. Materials and methods This single-center retrospective analysis included radiomic features of 658 brain metastases from T1-weighted contrast material-enhanced, T1-weighted nonenhanced, and fluid-attenuated inversion recovery (FLAIR) images in 189 patients (101 women, 88 men; mean age, 61 years; age range, 32-85 years). Images were acquired over a 9-year period (from September 2007 through December 2016) with different MRI units, reflecting heterogeneous image data. Included metastases originated from breast cancer (n = 143), small cell lung cancer (n = 151), non-small cell lung cancer (n = 225), gastrointestinal cancer (n = 50), and melanoma (n = 89). A total of 1423 quantitative image features and basic clinical data were evaluated by using random forest machine learning algorithms. Validation was performed with model-external fivefold cross validation. Comparative analysis of 10 randomly drawn cross-validation sets verified the stability of the results. The classifier performance was compared with predictions from a respective conventional reading by two radiologists. Results Areas under the receiver operating characteristic curve of the five-class problem ranged between 0.64 (for non-small cell lung cancer) and 0.82 (for melanoma); all P values were less than .01. Prediction performance of the classifier was superior to the radiologists' readings. Highest differences were observed for melanoma, with a 17-percentage-point gain in sensitivity compared with the sensitivity of both readers; P values were less than .02. Conclusion Quantitative features of routine brain MR images used in a machine learning classifier provided high discriminatory accuracy in predicting the tumor type of brain metastases. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Helge C Kniep
- From the Department of Diagnostic and Interventional Neuroradiology (H.C.K., T.S., U.H., M.H.S., J.F., S.G.), Department of Radiotherapy and Radiation Oncology (F.M., T.G.), Institute of Medical Biometry and Epidemiology (G.S.), and Institute of Computational Neuroscience (F.M., R.W.); University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Frederic Madesta
- From the Department of Diagnostic and Interventional Neuroradiology (H.C.K., T.S., U.H., M.H.S., J.F., S.G.), Department of Radiotherapy and Radiation Oncology (F.M., T.G.), Institute of Medical Biometry and Epidemiology (G.S.), and Institute of Computational Neuroscience (F.M., R.W.); University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Tanja Schneider
- From the Department of Diagnostic and Interventional Neuroradiology (H.C.K., T.S., U.H., M.H.S., J.F., S.G.), Department of Radiotherapy and Radiation Oncology (F.M., T.G.), Institute of Medical Biometry and Epidemiology (G.S.), and Institute of Computational Neuroscience (F.M., R.W.); University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Uta Hanning
- From the Department of Diagnostic and Interventional Neuroradiology (H.C.K., T.S., U.H., M.H.S., J.F., S.G.), Department of Radiotherapy and Radiation Oncology (F.M., T.G.), Institute of Medical Biometry and Epidemiology (G.S.), and Institute of Computational Neuroscience (F.M., R.W.); University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Michael H Schönfeld
- From the Department of Diagnostic and Interventional Neuroradiology (H.C.K., T.S., U.H., M.H.S., J.F., S.G.), Department of Radiotherapy and Radiation Oncology (F.M., T.G.), Institute of Medical Biometry and Epidemiology (G.S.), and Institute of Computational Neuroscience (F.M., R.W.); University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Gerhard Schön
- From the Department of Diagnostic and Interventional Neuroradiology (H.C.K., T.S., U.H., M.H.S., J.F., S.G.), Department of Radiotherapy and Radiation Oncology (F.M., T.G.), Institute of Medical Biometry and Epidemiology (G.S.), and Institute of Computational Neuroscience (F.M., R.W.); University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Jens Fiehler
- From the Department of Diagnostic and Interventional Neuroradiology (H.C.K., T.S., U.H., M.H.S., J.F., S.G.), Department of Radiotherapy and Radiation Oncology (F.M., T.G.), Institute of Medical Biometry and Epidemiology (G.S.), and Institute of Computational Neuroscience (F.M., R.W.); University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Tobias Gauer
- From the Department of Diagnostic and Interventional Neuroradiology (H.C.K., T.S., U.H., M.H.S., J.F., S.G.), Department of Radiotherapy and Radiation Oncology (F.M., T.G.), Institute of Medical Biometry and Epidemiology (G.S.), and Institute of Computational Neuroscience (F.M., R.W.); University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - René Werner
- From the Department of Diagnostic and Interventional Neuroradiology (H.C.K., T.S., U.H., M.H.S., J.F., S.G.), Department of Radiotherapy and Radiation Oncology (F.M., T.G.), Institute of Medical Biometry and Epidemiology (G.S.), and Institute of Computational Neuroscience (F.M., R.W.); University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Susanne Gellissen
- From the Department of Diagnostic and Interventional Neuroradiology (H.C.K., T.S., U.H., M.H.S., J.F., S.G.), Department of Radiotherapy and Radiation Oncology (F.M., T.G.), Institute of Medical Biometry and Epidemiology (G.S.), and Institute of Computational Neuroscience (F.M., R.W.); University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Extracellular fluid viscosity enhances liver cancer cell mechanosensing and migration. Biomaterials 2018; 177:113-124. [DOI: 10.1016/j.biomaterials.2018.05.058] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/10/2018] [Accepted: 05/31/2018] [Indexed: 12/31/2022]
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Yepuri N, Naous R, Richards C, Dhir M, Jain A. Poorly differentiated signet ring cell carcinoma of pancreas masquerading as chronic pancreatitis. J Surg Case Rep 2018; 2018:rjy218. [PMID: 30181863 PMCID: PMC6115602 DOI: 10.1093/jscr/rjy218] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/16/2018] [Indexed: 01/05/2023] Open
Abstract
Pancreatic cancer is typically arises in the context of inflammation, and a surrounding area of pancreatitis is often present within the tumor microenvironment. Signet ring cell carcinoma (SRCC) is a rare variant of pancreatic adenocarcinoma. Pathologically, it presents either as single cells or loose clusters masquerading in the background of pancreatitis. Sampling of these inflammatory cells during biopsy can result in the incorrect diagnosis of pancreatitis. We report a case of SRCC of the pancreas which the diagnosis of cancer was delayed because multiple biopsies revealed only inflammatory changes with no obvious evidence of malignancy. This case highlights the fact that negative results with endoscopic ultrasound fine needle aspiration in SRCC can be misleading. A cancer diagnosis should still be considered despite findings of inflammatory pancreatitis if the clinical presentation is concerning for cancer (mass on CT scan).
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Affiliation(s)
- Natesh Yepuri
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Rana Naous
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Camille Richards
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Mashaal Dhir
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Ajay Jain
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY 13210, USA
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Toyonaga T, Mibu R, Matsuda H, Tominaga Y, Hirata K, Takeyoshi M, Tsuneyoshi M, Matsushima M. Endoanal Ultrasonography of Mucinous Adenocarcinoma Arising from Chronic Fistula-in-ano: Three Case Reports. JOURNAL OF THE ANUS RECTUM AND COLON 2018; 1:100-105. [PMID: 31583308 PMCID: PMC6768671 DOI: 10.23922/jarc.2017-011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 04/04/2017] [Indexed: 01/06/2023]
Abstract
Mucinous adenocarcinoma arising in chronic fistula-in-ano is rare, and diagnosing it at an early stage is difficult. The role of endoanal ultrasonography in diagnosing the condition has not been discussed in the study. Herein, we report three cases of mucinous adenocarcinoma arising from anal fistulas in which endosonography played an important role in diagnosing malignant change. Three male patients with a 5- to 20-year history of anal fistula were referred to our hospital due to perianal induration, progressive anal pain, or mucopurulent secretion. In all three patients, endosonography revealed a multiloculated complex echoic mass with isoechoic solid components communicating with a trans-sphincteric fistula and sonography-guided biopsy under anesthesia revealed mucinous adenocarcinoma. All patients underwent abdominoperineal resection with lymph node dissection. One patient with a local recurrence died 3 years after surgery and two have remained disease-free for >6 years. These observations suggest that endosonography may be a reliable technique for the diagnosis of mucinous adenocarcinoma arising from chronic fistula-in-ano. Sonography-guided biopsy is useful for the definitive diagnosis of malignancy. Therefore, periodic endosonography assessment should be recommended for patients with persistent anal fistula, especially those with progressive clinical symptoms. Once malignancy is suspected, aggressive sonography-guided biopsy under anesthesia should be performed, which may enable an early diagnosis, curative treatment, and favorable long-term results.
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Affiliation(s)
| | - Ryuichi Mibu
- Department of Surgery, Fukuoka Sanno Hospital, Fukuoka, Japan
| | | | - Yohei Tominaga
- Department of Surgery, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Keiji Hirata
- Department of Surgery, Fukuoka Sanno Hospital, Fukuoka, Japan
| | | | | | - Makoto Matsushima
- Department of Surgery, Matsushima Hospital Coloproctology Center, Yokohama, Japan
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Fernandes ACDO, Rocha GRMD, Oliveira ADD, Guimarães MD, Carvalho SCD, Chojniak R. Pseudomyxoma peritonei in a pediatric patient: A case report and literature review. ACTA ACUST UNITED AC 2018; 64:195-199. [PMID: 29641675 DOI: 10.1590/1806-9282.64.02.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/26/2017] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Pseudomyxoma peritonei (PMP) is a rare clinical condition, with an incidence of 1-2 cases per million, characterized by the dissemination of mucinous implants on the peritoneal surface and progressive gelatinous ascites. Although it usually presents an indolent behavior, its non-specific clinical presentation contributes to many cases remaining undiagnosed until a laparotomy is performed. With late diagnosis, performed after a long period of clinical deterioration and disease progression, it is common to find complications such as the formation of intestinal fistulas and obstruction. METHOD Review of the medical record and search for references in the Medline, Lilacs, SciELO and MD Consult databases. RESULTS There are rare case reports found in the literature demonstrating atypical PMP presentations. Our report is that of a 17-year-old adolescent with a sporadic tumor diagnosed in a primary site in the transverse colon, contrary to data commonly found in the literature that mention a more frequent occurrence in women in the fifth decade of life and with a primary site in the ovary and appendix. The development of mucinous adenocarcinoma is rare in the pediatric population, and topography in the transverse colon and non-familial sporadic pattern are unusual. CONCLUSION The case reported not only raises awareness about the atypical presentations of the disease, but also emphasizes the use of imaging examinations for diagnosis, which has an important impact on prognosis and survival if performed timely.
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Affiliation(s)
| | | | - Alex Dias de Oliveira
- Department of Radiology and Imaging Diagnosis, Hospital A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Marcos Duarte Guimarães
- Department of Radiology and Imaging Diagnosis, Hospital A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | | | - Rubens Chojniak
- Department of Radiology and Imaging Diagnosis, Hospital A.C. Camargo Cancer Center, São Paulo, SP, Brazil
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39
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Handler M, Anand N, Wei L, Snieckus P. Adenocarcinoma of the Appendix Presenting as a Palpable Right Thigh Mass. J Radiol Case Rep 2017; 11:20-29. [PMID: 28567182 DOI: 10.3941/jrcr.v11i4.3087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Intra-abdominal and intra-pelvic pathologies initially presenting in extra-abdominal/pelvic locations is unusual. This spread predominantly occurs with infectious processes to sites including the buttock, thigh, and calf. The routes of extension into adjacent anatomically weak compartments include the pelvic outlet, greater sciatic foramen, obturator foramen, inguinal or femoral canal, weak bones, or along nerves and blood vessels. Malignant neoplasms of the appendix, while extremely rare and accounting for only 0.4% of all gastrointestinal cancers, is one of the intra-abdominal pathologies that can spread via these routes. Adenocarcinoma of the appendix accounts for 10-20% of primary appendiceal tumors. They usually present as acute appendicitis or as a right lower quadrant abdominal mass when associated with a mucocele. We report the unique case of mucinous appendiceal adenocarcinoma in a 57-year-old male who initially presented with a right thigh mass secondary to extension of the neoplasm from the right lower quadrant through the femoral canal. A similar presentation of a mucinous appendiceal cystadenoma has been previously reported, however, to our knowledge, this is the first case of a malignant appendiceal tumor extending into the thigh. We review the literature and discuss imaging findings and treatment of this tumor.
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Affiliation(s)
- Marci Handler
- Department of Radiology, Morristown Medical Center, Morristown, NJ, USA
| | - Neil Anand
- Department of Radiology, Morristown Medical Center, Morristown, NJ, USA
| | - Lawrence Wei
- Sidney Kimmel Medical College, Jefferson University, Philadelphia, PA, USA
| | - Peter Snieckus
- Department of Radiology, Overlook Medical Center, Summit, NJ, USA
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40
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Yu MH, Kim YJ, Park HS, Jung SI, Jeon HJ. Imaging Patterns of Intratumoral Calcification in the Abdominopelvic Cavity. Korean J Radiol 2017; 18:323-335. [PMID: 28246512 PMCID: PMC5313520 DOI: 10.3348/kjr.2017.18.2.323] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/20/2016] [Indexed: 12/12/2022] Open
Abstract
Intratumoral calcification is one of the most noticeable of radiologic findings. It facilitates detection and provides information important for correctly diagnosing tumors. In the abdominopelvic cavity, a wide variety of tumors have calcifications with various imaging features, though the majority of such calcifications are dystrophic in nature. In this article, we classify the imaging patterns of intratumoral calcification according to number, location, and morphology. Then, we describe commonly-encountered abdominopelvic tumors containing typical calcification patterns, focusing on their differentiable characteristics using the imaging patterns of intratumoral calcification.
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Affiliation(s)
- Mi Hye Yu
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
| | - Young Jun Kim
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
| | - Hee Sun Park
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
| | - Sung Il Jung
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
| | - Hae Jeong Jeon
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
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Hong GS, Byun JH, Kim JH, Kim HJ, Lee SS, Hong SM, Lee MG. Thread sign in biliary intraductal papillary mucinous neoplasm: a novel specific finding for MRI. Eur Radiol 2015; 26:3112-20. [DOI: 10.1007/s00330-015-4158-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 10/01/2015] [Accepted: 12/07/2015] [Indexed: 01/10/2023]
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Laurent PE, Thomassin-Piana J, Jalaguier-Coudray A. Mucin-producing tumors of the ovary: MR imaging appearance. Diagn Interv Imaging 2015; 96:1125-32. [DOI: 10.1016/j.diii.2014.11.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/25/2014] [Accepted: 11/26/2014] [Indexed: 11/29/2022]
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43
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Ying SH, Teng XD, Wang ZM, Wang QD, Zhao YL, Chen F, Xiao WB. Gd-EOB-DTPA-enhanced magnetic resonance imaging for bile duct intraductal papillary mucinous neoplasms. World J Gastroenterol 2015; 21:7824-7833. [PMID: 26167082 PMCID: PMC4491969 DOI: 10.3748/wjg.v21.i25.7824] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 02/20/2015] [Accepted: 04/17/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) of intraductal papillary mucinous neoplasms of the bile duct (IPMN-B).
METHODS: The imaging findings of five cases of IPMN-B which were pathologically confirmed at our hospital between March 2012 and May 2013 were retrospectively analyzed. Three of these cases were diagnosed by duodenal endoscopy and biopsy pathology, and two cases were diagnosed by surgical pathology. All five patients underwent enhanced and non-enhanced computed tomography (CT), magnetic resonance cholangiopancreatography, and Gd-EOB-DTPA-enhanced MRI; one case underwent both Gd-EOB-DTPA-enhanced MRI and positron emission tomography-CT. The clinical data and imaging results for these cases were compared and are presented.
RESULTS: Conventional imaging showed diffuse dilatation of bile ducts and multiple intraductal polypoid and papillary neoplasms or serrated changes along the bile ducts. In two cases, Gd-EOB-DTPA-enhanced MRI revealed dilated biliary ducts and intraductal tumors, as well as filling defects caused by mucin in the dilated bile ducts in the hepatobiliary phase. Gd-EOB-DTPA-enhanced MRI in one case clearly showed a low-signal tumor in the hepatobiliary phase, similar to what was seen by positron emission tomography-CT. In two patients, routine inspection was unable to discern whether the lesions were inflammation or tumors. However, Gd-EOB-DTPA-enhanced MRI revealed a pattern of gradual enhancement during the hepatobiliary phase, and the signal intensity of the lesions was lower than the surrounding liver parenchyma, suggesting tissue inflammation in both cases, which were confirmed by surgical pathology.
CONCLUSION: Gd-EOB-DTPA-enhanced MRI reveals the intraductal mucin component of IPMN-B in some cases and the extent of tumor infiltration beyond the bile ducts in invasive cases.
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MESH Headings
- Aged
- Bile Duct Neoplasms/diagnostic imaging
- Bile Duct Neoplasms/pathology
- Bile Duct Neoplasms/surgery
- Cholangiopancreatography, Magnetic Resonance
- Contrast Media
- Diffusion Magnetic Resonance Imaging
- Female
- Gadolinium DTPA
- Humans
- Male
- Middle Aged
- Multidetector Computed Tomography
- Multimodal Imaging
- Neoplasm Invasiveness
- Neoplasms, Cystic, Mucinous, and Serous/diagnostic imaging
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Neoplasms, Cystic, Mucinous, and Serous/surgery
- Positron-Emission Tomography
- Predictive Value of Tests
- Prognosis
- Retrospective Studies
- Ultrasonography, Doppler, Color
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44
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Chauhan A, Patodi N, Ahmed M. A rare cause of ascites: pseudomyxoma peritonei and a review of the literature. Clin Case Rep 2014; 3:156-9. [PMID: 25838904 PMCID: PMC4377246 DOI: 10.1002/ccr3.188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/12/2014] [Accepted: 10/25/2014] [Indexed: 01/15/2023] Open
Abstract
Pseudomyxoma peritonei is rare. The rarity is highlighted by the lack of published evidence regarding management. The latest treatments have altered the prognosis of a once incurable disease. This report serves to both raise awareness and critically appraise the literature regarding the latest management.
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Affiliation(s)
- Abhishek Chauhan
- Department of Gastroenterology, Good Hope Hospital Sutton, Coldfield, United Kingdom ; University of Birmingham Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Nishant Patodi
- Department of Gastroenterology, Good Hope Hospital Sutton, Coldfield, United Kingdom
| | - Monz Ahmed
- Department of Gastroenterology, Good Hope Hospital Sutton, Coldfield, United Kingdom
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45
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Virmani V, Ramanathan S, Virmani VS, Ryan J, Fasih N. What is hiding in the hindgut sac? Looking beyond rectal carcinoma. Insights Imaging 2014; 5:457-71. [PMID: 25038846 PMCID: PMC4141340 DOI: 10.1007/s13244-014-0347-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 06/14/2014] [Accepted: 07/03/2014] [Indexed: 11/08/2022] Open
Abstract
Objectives Although rectal cancer is by far and large the most common pathology involving the rectum that needs imaging, there are many other important but less common pathological conditions affecting anorectal region. The objective of this pictorial review is to discuss the cross-sectional imaging features of less common anorectal and perirectal diseases. Results Although a specific histological diagnosis cannot usually be made due to considerable overlap in the imaging appearances of anorectal diseases, this review illustrates the cross-sectional imaging findings with emphasis on magnetic resonance imaging (MRI) that can help in narrowing down the differentials to a reasonable extent. Teaching points • Variety of pathology exists in the anorectum apart from common rectal carcinoma • Anorectal diseases present as non-specific wall thickening indistinguishable from rectal carcinoma • Computed tomography (CT) and MRI can help in narrowing down the differentials, although often biopsy is warranted.
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Affiliation(s)
- Vivek Virmani
- Department of Diagnostic Imaging, The Ottawa Hospital, General campus, University of Ottawa, 501 Smyth road, Ottawa, ON, K1S8L6, Canada
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Toomey D, McNamara D. Mucinous ovarian tumour presenting as a ruptured incisional hernia. Ann R Coll Surg Engl 2012; 94:e223-4. [PMID: 23031756 PMCID: PMC3954266 DOI: 10.1308/003588412x13373405385818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We describe an ovarian borderline tumour that presented as an acute deterioration in an incisional hernia secondary to intraperitoneal mucin accumulation. The differential diagnosis associated with hernial sac contents and options for opportunistic diagnosis are discussed. This case raises awareness of potential serious diagnoses that may be overlooked during emergent hernia repair.
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Affiliation(s)
- D Toomey
- St Luke's Ward, Beaumont Hospital, Dublin, Ireland.
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