Diagnostic difficulties in secondary tumors of the heart

The authors describe case reports of 2 patients who died from malignant pulmonary neoplasms. In one case, tumor metastasized to the left ventricle myocardium, in the other one, pulmonary tumor invaded the interatrial septum. Clinically, coronary heart disease symptoms with acute manifestations prevailed in both the cases. Based on an analysis of the authors' clinicomorphological findings and reported data a number of the clinical signs were distinguished, enabling one to suspect the presence of secondary heart tumors in cancer patients.     

Imaging of tumors in the ankle and foot

Common bone and soft tissue tumors in the foot and ankle are described in this article, and x-ray and magnetic resonance imaging characteristics are given. Ultrasound can be used for limited indications only, noting that ultrasound features are nonspecific. Of the bone and soft tissue tumors, approximately 7% occur in the foot and ankle. Soft tissue tumors are more common than bone tumors. Tumors of the foot and ankle are generally benign or nonneoplastic. Patients with suspected malignant lesions should be referred to a specialized bone tumor unit before biopsy.     

Imaging of tumors of the pituitary gland

Macrotumors of the sella region usually involve the suprasellar and less commonly the parasellar space. The suprasellar extension of pituitary adenoma, meningeoma, craniopharyngioma, and hypothalamic or chiasmatic glioma count for the most frequent neoplastic entities. In macroadenomas of the pituitary gland invasion of parasellar spaces may occur in 6-10%. Imaging techniques are directed to increase the likelihood of surgical cure and to detect aggressive tumour invasion into surrounding tissues. A dedicated classification basing on indirect MRI signs of tumour extension has been established. With high-resolution high-field (3T) MRI the sella region may be displayed to provide better information compared to lower field strengths.     

Virilizing tumors of the ovary: imaging features.

AIM: Virilizing tumors of the ovary are an uncommon cause of a common clinical problem. The reported imaging features of these tumors are based on case reports. The purpose of this study was to determine the spectrum of imaging characteristics of these tumors based on a larger referral population. PATIENTS AND METHODS: Case records from the Armed Forces Institute of Pathology were searched for clinical evidence of virilization as a presentation of an excised sex cord-stromal and steroid cell ovarian tumor. Records and imaging studies on 14 patients with virilizing tumors were found. All available imaging studies (ultrasound studies of the pelvis (11 patients), CT scans of the pelvis (five patients), MRI examinations of the pelvis (two patients), and plain films of the pelvis (four patients) were reviewed by three radiologists independently for ascites, calcification, percent solid portion, echogenicity and attenuation. RESULTS: On CT and/or ultrasound most (69%) of the tumors appeared to be solid or mostly solid. The amount of solid tissue varied with the tumor type, granulosa cell tumors were predominantly cystic. The masses were isoechoic (82%) or hypoechoic (18%). Ascites was an infrequent (23%) finding. Only a minority of these tumors (14%) were calcified on imaging studies. Six tumors were 5.0 cm or less in mean size, and two less than 3.0 cm in size. All cases were stage I tumors at presentation. CONCLUSION: The majority of virilizing tumors of the ovary are typically solid, noncalcified, confined to the ovary at presentation, and not associated with ascites. Variability in appearance depends in part on tumor type. Many are small and may be difficult to recognize as a mass morphologically.     

畸胎类肿瘤的影像学诊断研究

目的:总结分析畸胎类肿瘤影像学检查的诊断价值。材料与方法:对90例经手术病理证实的畸胎类肿瘤的X线、超声、CT及MRI检查的表现特点进行分析。结果:超声诊断59例,CT诊断29例,MRI诊断10例,常规X线诊断2例。其中良性囊性畸胎瘤39例,囊实性畸胎瘤51例。结论:常规X线诊断价值较小,对于胸部纵隔内畸胎瘤有一定诊断价值,超声、CT及MRI对畸胎瘤的诊断均具有重要价值,超声检查方便、价廉,可改变体位实时成像,特别对腹部盆腔畸胎瘤具有优势。CT对钙化与骨骼的显示优于超声、MRI,而MRI多轴位成像能更好显示肿瘤全貌、囊内容物的成分。     

Imaging of gastrointestinal neuroendocrine tumors

Gastrointestinal neuroendocrine tumors are rare neoplasms that cause classic clinical syndromes because of the excess secretion of specific gastrointestinal hormones. The two most important tumors clinically are insulinomas and gastrinomas. The clinical management of patients with these disorders usually involves the localization and surgical removal of the responsible tumor. Many radiological techniques can be used for tumor localization, including preoperative and intraoperative ultrasound, endoscopic ultrasound, CT, MRI, radionuclide scanning, angiography, and venous sampling. However, there are conflicting claims as to the relative accuracy of these procedures, and many of these investigations are difficult to justify because of their high cost, degree of invasiveness, or lack of precise anatomic information that is obtained. If surgical resection of a neuroendocrine tumor is planned, intraoperative sonography should always be used to detect occult nonpalpable tumors and to discern the relationship of the tumor to vital adjacent pancreatic ductal anatomy. The choice of preoperative imaging is more controversial, and depends on the clinical problem, local expertise, and availability of imaging techniques. Sonography and contrast-enhanced helical CT are the most commonly used preoperative imaging methods, because of their relatively low cost and widespread availability. Radionuclide scanning with a somatostatin analogue, which is a relatively new procedure, may be valuable in patients with symptoms of tumor recurrence.     

Imaging of sinonasal tumors.

Imaging of the paranasal sinuses and the nasal cavity provides important anatomic information in the evaluation of suspected neoplasia. The primary modalities employed are conventional films, computed tomography (CT) and magnetic resonance imaging (MRI). Although plain sinus films remain the screening procedure of choice, CT is the preferred modality for more detailed assessment of the paranasal sinuses and the nasal cavity. When soft tissue discrimination is required, MRI is indicated. Imaging studies are used to define the limits of disease, not to diagnose malignancy.     

卵巢交界性上皮性肿瘤的诊治进展

卵巢交界性肿瘤（borderline ovarian tumors,BOT）又称低度恶性潜能肿瘤（low malignant potential ovarian tumor,LMP）,其生物学行为介于良性和恶性肿瘤之间,组织学具有核异型性、核分裂象及无间质浸润的特点。1973年国际妇产科联盟（FIGO）将其列入卵巢肿瘤的分类,使其成为卵巢肿瘤的一种独立临床病理类型。BOT可发生于卵巢的表面一上皮间质细胞、性索间质细胞和生殖细胞等,但以上皮性BOT为主,尤其以浆液性和黏液性的BOT最常见,本文将对这两种常见的BOT在诊治方面的进展进行总结。     

卵巢交界性与恶性布莱纳瘤4例观察与分析

目的 观察和分析卵巢交界性和恶性布莱纳（Brenner）瘤的临床和 和病理形态学特点,阐明其诊断和鉴别诊断要点。方法 对该瘤交界性和恶性各2例进行临床病理学、组织化学、免疫组织化学和电镜观察。结果 交界性瘤中可见良性瘤形态,上皮巢大小不一,层次增多,但外周和主腔缘细胞可见排列,巢间可排列紧密,但不见融合。细胞多与良性瘤相同,出现部分缩状核,核仁少,常见核沟,核分裂象少,无间质浸润;恶性瘤中可见交界性瘤形态,但不一定有良性瘤区域。以大巢、融合巢为主,尚见方形、菱形畸形巢。大巢旁有子巢或“出芽”。巢内细胞无极性。 罕见核沟,并见短梭性多核巨细胞,分裂象及病理性分裂象多见。有间质浸润,血管内可见瘤栓,可伴有腺癌。可向周围浸润和转移。结论 上眼巢和纤维间质共存是两者共同点,上皮巢和巢中细胞形态的差别是鉴别要点。由于两者治疗、手术和预后不同,准确鉴别十分重要。     

Imaging of secretory tumors of the gastrointestinal tract

Gastrointestinal secretory tumors, or gastroenteropancreatic neuroendocrine tumors, encompass a wide array of endocrine cell tumors. The significance of these tumors lies in their ability to alter physiology through hormone production as we well as in their malignant potential. Functioning tumors may present earlier due to symptomatology; conversely, non-functioning tumors are often diagnosed late as they reach large sizes, causing symptoms secondary to local mass effect. Imaging aids in the diagnosis, staging, and prognosis and provides key information for presurgical planning. Although most of these tumors are sporadic, some are associated with important syndromes and associations, knowledge of which is critical for patient management. In this article, we provide an overview of secretory and neuroendocrine tumors of the GI tract and pancreas.

     

Epithelial tumors of the ovary in women less than 40 years old

From Jan 1, 1978 through Dec 31, 1983, 64 patients with epithelial ovarian tumors, frankly malignant or borderline, were managed at one institution. Nineteen patients (29.7%) were under age 40. The youngest patient was 19 years old. Nulliparity was present in 32% of this group of patients. Of these young patients, 58% had borderline epithelial tumors, compared to 13% of patients over 40 years of age. Twenty-one percent of the young patients were initially managed by unilateral adnexal surgery. The overall cumulative actuarial survival rate of all young patients was 93%. Young patients with epithelial ovarian tumors tend to have earlier grades of epithelial neoplasms, and survival is better than that reported for older patients with similar tumors.     

VEGF及PCNA在卵巢上皮性肿瘤中的表达

目的探讨VEGF、PCNA表达在卵巢浆液性上皮性肿瘤进展中的作用。方法采用SP免疫组化染色法检测19例卵巢浆液性囊腺癌、15例交界性浆液性囊腺瘤和13例浆液性囊腺瘤中VEGF、PCNA的表达情况。结果浆液性囊腺癌中VEGF及PCNA显著高于交界性浆液性囊腺瘤和浆液性囊腺瘤，交界性浆液性囊腺瘤中VEGF、PCNA显著高于浆液性囊腺瘤；VEGF、PCNA在Ⅲ级卵巢浆液性囊腺癌中的表达显著高于Ⅰ-Ⅱ级；不同临床分期VEGF、PCNA表达没有显著差异。相关分析显示VEGF的表达与PCNA呈显著正相关。结论VEGF及PCNA在卵巢浆液性囊腺癌和交界性浆液性囊腺瘤中呈高表达，表明其与卵巢浆液性上皮性肿瘤的进展有关；随着癌组织分级的增高，VEGF、PCNA呈高表达，但与临床分期无关，显示其可能是评估卵巢浆液性上皮性肿瘤良、恶性程度的辅助指标。     

乳腺叶状肿瘤的影像学表现分析

目的：探讨乳腺叶状肿瘤的钼靶、超声及MRI的表现,以提高诊断水平。方法：回顾性分析28例经病理证实的乳腺叶状肿瘤影像学表现,钼靶及超声检查28例,MRI检查2例。结果：28例叶状肿瘤中,良性8例,交界性9例,恶性11例。钼靶多表现为均匀高密度、边缘清晰光滑的分叶状肿块,5例肿瘤内见钙化灶。超声多以不均匀中低回声为主,血流较丰富。2例MRI检查呈分叶状,平扫T1WI呈较低信号,T2WI及DWI呈高信号,1例有低信号的分隔,动态增强检查早期呈明显快速强化,时间-信号曲线分别为流入型及平台型,ADC值减低,病理诊断均为恶性。结论：钼靶、超声及MRI有助于乳腺叶状肿瘤的诊断,三者联合应用能提高本病的诊断,确诊仍需病理学检查。     

Imaging of pituitary gland tumors.

MRI has clearly improved the visualization of the perisellar region. Its full role in the diagnosis of pituitary adenomas remains to be defined. It is likely that three-dimensional Fourier transform thin-section imaging of the gland will further refine the diagnosis of adenoma, allowing not only for the visualization of tiny adenomas, but possibly helping to distinguish them from other nonadenomatous intraglandular abnormalities.     

卵巢囊性肿瘤的影像学分析

目的：分析卵巢囊性肿瘤的影像学特点,为临床提供可靠的诊断及治疗依据。方法回顾性分析45例经手术及病理证实的卵巢囊性肿瘤的C T或M RI影像资料。纳入标准为病灶囊性成分所占比例大于70％,肿瘤最大径超过5 cm。所有病例均行平扫及增强C T或M RI检查。结果45例中包括卵巢囊腺瘤16例、囊腺癌6例、腺癌5例、腺纤维瘤1例、畸胎瘤2例、囊肿4例、子宫内膜异位囊肿2例、输卵管系膜囊肿2例及输卵管卵巢囊肿7例。结论影像学检查对卵巢囊性肿瘤的定位、定性诊断和鉴别诊断具有一定的临床意义,明确诊断仍需要结合术后病理结果。     

胸腹部孤立性纤维性肿瘤的影像学表现

目的 探讨孤立性纤维性肿瘤的CT及MRI表现.方法 回顾分析10例经手术病理证实的孤立性纤维性肿瘤患者临床及影像资料.所有患者均行CT平扫及双期增强扫描,其中7例行后处理成像.5例同时行MRI平扫及增强.结果 肿瘤位于胸膜5例,肺内2例,腹膜后2例,腹膜1例,肿瘤直径5.5～27 cm.肿瘤边界清晰8例,2例与周边组织分界欠清,肿瘤密度均匀者6例,坏死囊变者4例.肿瘤增强后实质成分呈均质轻到中度强化9例,实质期肿瘤持续强化,明显强化者1例,伴有钙化1例.结论 孤立性纤维性肿瘤的影像学表现有一定的特征性,CT及MRI检查对诊断与鉴别诊断具有重要价值.     

Duodenojejunal intussusception secondary to duodenal tumors

Duodenojejunal intussusception secondary to duodenal tumors is an uncommon entity. The classic coiled-spring appearance, fairly visible in the jejunum, is not apparent in the duodenum due to its fixed position. This explains why the intussusception is located superiorly in the genu inferius and inferiorly in the duodenojejunal junction. This aspect should not be confused with two separated masses.     

Imaging bile duct tumors: staging

Cholangiocarcinoma (CC) is the most frequent neoplasm of the biliary system. According to its anatomic origin in the biliary tree it is usually classified as intrahepatic, perihilar, or extrahepatic distal CC. Tumors originated in these areas differ in biological behavior and management. The stratification of the patients aligned to therapeutic options and prognosis is a key point in the management of CC. Thus, specific staging systems have been designed for each anatomical location. They are precise for surgical planning, to establish prognosis after surgery, or to compare the benefits of different therapeutic approaches, but they are less accurate to stratify patients into a therapeutic decision algorithm. Imaging tools, mainly multidetector computed tomography and magnetic resonance imaging (MRI), allow full assessment of the diagnosis and extension of the tumor. They are especially useful in establishing the correct diagnosis and determining resectability, which reaches a high negative predictive value, identifying those patients in whom surgery will not be effective. We will discuss the different staging systems for CC, the radiologic characteristics with classical and recently described signs that allow a confident diagnosis of the disease and the criteria for resectability of biliary tract malignancies.