Ileal epithelioid leiomyosarcoma with omental and peritoneal seeding / 영남의대학술지

Leiomyosarcoma (LMS) of the small intestine is a rare tumor, accounting for about 1% of all malignant mesenchymal lesions in the gastrointestinal tract. Since small bowel tumors are initially asymptomatic and nonspecific, delayed diagnosis and treatment are common. We found that a 44-year-old male patient who came in for lower abdominal pain had partial obstruction in the small bowel. Multiple ascites and ileal tumors involving peritoneal seeding were observed from his abdominal computed tomography. He was diagnosed as epithelioid LMS involving peritoneal transition after surgical resection, and the outpatient department has planned for a conservative therapy with observation. To the best of our knowledge, ileal epithelioid LMS accompanying a huge omental mass, with a size of 18 cm in dimension, and peritoneal seeding has not yet been reported in Korea. We report this rare case with literature review.

Ileal epithelioid leiomyosarcoma with omental and peritoneal seeding / 영남의대학술지

Leiomyosarcoma (LMS) of the small intestine is a rare tumor, accounting for about 1% of all malignant mesenchymal lesions in the gastrointestinal tract. Since small bowel tumors are initially asymptomatic and nonspecific, delayed diagnosis and treatment are common. We found that a 44-year-old male patient who came in for lower abdominal pain had partial obstruction in the small bowel. Multiple ascites and ileal tumors involving peritoneal seeding were observed from his abdominal computed tomography. He was diagnosed as epithelioid LMS involving peritoneal transition after surgical resection, and the outpatient department has planned for a conservative therapy with observation. To the best of our knowledge, ileal epithelioid LMS accompanying a huge omental mass, with a size of 18 cm in dimension, and peritoneal seeding has not yet been reported in Korea. We report this rare case with literature review.

Quantitatve Measurement of Total Cerebral Blood Flow Using 2D Phase-Contrast MRI and Doppler Ultrasound

PURPOSE: To compare of quantitative measurement of the total cerebral blood flow using two-dimensional phase-contrast MR imaging and Doppler ultrasound. MATERIALS AND METHODS: In 16 volunteers (mean age, 26 years; mean body weight, 66 kg) without abnormal medical histories, two-dimensional phase-contrast MR imaging was performed at the level of the C2-3 intervertebral disc for flow measurement of the internal carotid arteries and the vertebral arteries. Volume flow measurements using Doppler ultrasound were also performed at the internal carotid arteries 2 cm above the carotid bifurcation, and at the vertebral arteries at the level of the upper pole of the thyroid gland. Flows in the four vessels measured by the two methods were compared using Wilcoxon's correlation analysis and the median score. Total cerebral blood flows were calculated by summing these four vessel flows, and mean values for the 16 volunteers were calculated. RESULTS: Cerebral blood flows measured by 2-D phase-contrast MR imaging and Doppler ultrasounds were 233 and 239 ml/min in the right internal carotid artery, 250 and 248 ml/min in the left internal carotid artery, 62 and 56 ml/min in the right vertebral artery, and 83 and 68 ml/min in the left vertebral artery. Correlation coefficients of the blood flows determined by the two methods were 0.48, 0.54, 0.49, and 0.62 in each vessel, while total cerebral blood flows were 628+/-68 (range, 517 to 779) ml/min and 612+/-79 (range, 482 to 804)ml/min, respectively. CONCLUSION: Total cerebral blood flow was easily measured using 2-D phase-contrast MR imaging and Doppler ultrasound, and the two noninvasive methods can therefore be used clinically for the measurement of total cerebral blood flow.

High-resolution CT Features of Bleeding Foci in Patients with Massive Hemoptysis

PURPOSE: To compare the high-resolution CT features of bleeding foci in patients with massive hemoptysis during embolization with those revealed by angiography. MATERIALS AND METHODS: Between June 1997 and June 1999, we evaluated 25 patients who from among a total of 49 with arterial embolization due to massive hemoptysis underwent HRCT prior to embolization. We retrospectively analyzed medical records, and angiographic and HRCT findings. The time interval between HRCT and arterial embolization varied from two hours to six days. Angiography indicated that the bronchial, intercostal and internal mammary artery, and branches of the subclavian, were the foci of bleeding, and indicated the location of these in each pulmonary lobe. The HRCT findings were evaluated in terms of cavity, air-meniscus sign, bronchial dilatation, consolidation, ground-glass opacity, and fibrotic scar. We analyzed the corresponding sites of HRCT and the angiographic findings of the foci of bleeding. RESULTS: In 24 of 25 patients, the foci of bleeding were angiographically confirmed, their presence being noted in 28 pulmonary lobes. HRCT findings corresponding to the bleeding foci revealed by angiography were the air-meniscus sign (8 of 10 lobes, 80.0%), cavity (7 of 9 lobes, 77.8%), bronchial dilatation (21 of 30 lobes, 70.0%), and fibrotic scar (1 of 23 lobes, 4.3%). The findings in areas of consolidation and/or ground-glass opacity only did not correspond, however. CONCLUSION: As compared with those revealed by angiography, the HRCT features of bleeding foci in patients with massive hemoptysis during embolization are in order of frequency, the air-meniscus sign, cavity, and bronchial dilatation.

Helical CT Findings of Gastric Wall Thickening by Peptic Ulcer: Compared with Gastric Adenocarcinoma with Ulcer

PURPOSE: To compare on the basis of helical CT findings gastric wall thickening of peptic gastric ulcer with that of gastric adenocarcinoma with ulcer. MATERIALS AND METHODS: Thirty-eight patients with athologically proven gastric lesion [17 cases of peptic ulcer and 21 cases of ulcerative or ulceroinfiltrative gastric cancer (Borrman type II, III)] underwent helical CT, and the findings were retrospectively reviewed in terms of maximum abnormal wall thickness, preservation of the inner enhancing layer, the presence of three discriminate layers of gastric wall, and enhancment pattern. The enhancment pattern of abnormally thick wall was compared with that of the portal phase of back muscle, and was defined as low, iso, or high. The Chi-square test and Student t test were used for statistical analysis. RESULTS: In cases of peptic ulcer and gastric cancer with ulceration, maximum abnormal wall thickness was 7-30 (mean, 16.1)mm, and 11-33 (mean, 21.8)mm, respectively. The inner enhancing layer was preserved in 15 of 17 patients (88.2%) and one of 21 (4.8%); three discriminate layers of gastric wall were observed in 8 of 17 patients (47.0%), and one of 21 (4.8%). The enhancement pattern was low in 12 of 17 patients (70.5%), and 3 of 21 (14.3%); iso in 4 of 17 (23.5%), and 4 of 21 (19.0%), and high in one of 17 (5.9%), and 14 of 21 (66.7 % ). All figures refer, respectively, to the two distinct onditioins. In terms of preservation of the inner enhancing layer, three discriminate layers of gastric wall, and a low enhancement pattern, there were statistically significant differences between peptic ulcer and gastric adenocarcinoma with ulcer. Where the enhancement was high, however, the statistically significant difference between the two conditions was even greater. There was no statistically significant difference in terms of gastric wall thickness or iso-attenuation of thickened gastric. CONCLUSION: Helical CT findings of gastric wall thickening, preservation of the inner enhancing layer, and three discriminate layers of gastric wall, as well as the nature of the observed enhancement pattern, may help differentiate between peptic ulcer and gastric adenocarcinoma with ulcer.