Pancreatic Schwannoma with Cystic Degeneration:A Case Report and Literature Review

Schwannomas originate from Schwann cells, and they are the most common benign neoplasms of the peripheral nerves. They can occur in most parts of the body but have a predilection for the head, the neck, and the flexor aspects of the extremities. Pancreatic schwannomas are uncommon, and only a few cases have been reported in the English literature. Approximately two-thirds of pancreatic schwannomas undergo cystic degeneration, and they should be considered in the differential diagnosis of solid pancreatic tumors with cystic changes to facilitate accurate diagnosis and optimal treatment. We report a case of a pathologically proven schwannoma in the pancreatic tail with multiple cystic and hemorrhagic changes followed by a review of relevant literature.

Retroperitoneal Bronchogenic Cyst Located in the Presacral Space: A Case Report

Bronchogenic cysts are rare congenital anomalies that are most frequently found in the mediastinum along the tracheobronchial tree, especially in the posterior aspect of the superior mediastinum. Bronchogenic cysts have also been reported in intrapulmonary, intrapericardial, abdominal, and retroperitoneal locations. Herein, we report a case of a retroperitoneal bronchogenic cyst in the presacral space. The patient was diagnosed based on a post-operative histopathological examination.

Pancreatic Paraganglioma: a Case Report and Literature Review

Paraganglioma is a rare tumor of paraganglia, derived from neural crest cells in sympathetic or parasympathetic ganglions. It can be widely distributed from the skull base to the bottom of the pelvis. The pancreas, however, is a rare location of this neoplasm, and only a limited number of cases have been reported in the English literature, especially with gadoxetic-acid-enhanced magnetic resonance imaging (MRI) and diffusion-weighted images (DWI). We herein report a case of pathologically proven paraganglioma in the pancreas head with a literature review on endoscopic ultrasonography (EUS), computed tomography (CT), gadoxetic-acid-enhanced MRI, and DWI sequence.

Pancreatic Paraganglioma: a Case Report and Literature Review

Paraganglioma is a rare tumor of paraganglia, derived from neural crest cells in sympathetic or parasympathetic ganglions. It can be widely distributed from the skull base to the bottom of the pelvis. The pancreas, however, is a rare location of this neoplasm, and only a limited number of cases have been reported in the English literature, especially with gadoxetic-acid-enhanced magnetic resonance imaging (MRI) and diffusion-weighted images (DWI). We herein report a case of pathologically proven paraganglioma in the pancreas head with a literature review on endoscopic ultrasonography (EUS), computed tomography (CT), gadoxetic-acid-enhanced MRI, and DWI sequence.

Pseudoradial Tear of the Medial Meniscus: A Relatively Common Potential Pitfall

PURPOSE: To determine the incidence of truncated triangle appearance of anterior horn (AH) to body of medial meniscus (MM) and determine its clinical significance. MATERIALS AND METHODS: IRB approval was obtained, and informed consent waived for this study. The criteria of "pseudoradial tear" was truncated triangle appearance of the tip of AH to body of MM on one or more coronal images with adjacent fluid signal intensity at the blunted tip. Two musculoskeletal radiologists retrospectively evaluated 485 knee MR images independently for the presence and number of sections with "pseudoradial tear" of AH to body of MM using proton density-weighted coronal MR images. Inter-and intraobserver agreement was calculated using kappa coefficients. Medical records were reviewed for arthroscopic correlation. RESULTS: A pseudoradial tear in the AH to body of MM was present in 381 (78.6%) patients. Locations were 112 in AH (29.4%), 143 in AH to body (37.5%), and 126 in body (33.1%). Number of consecutive sections of pseudoradial tear were 1 in 100 (26.2%), 2 in 164 (43.0%), 3 in 94 (24.7%), 4 in 21 (5.5%), and 5 in 2 (0.5%). Interobserver agreement was 0.99 for presence and 0.43 for number of sections of pseudoradial tear. Arthroscopies were performed in 96 patients and none of the pseudoradial tears were proven as true radial tears on arthroscopy. CONCLUSION: Pseudoradial tears are frequently seen in AH to body of MM on coronal MR images and may be another pitfall that a radiologist needs to be aware of and be able to differentiate from true radial tear.

Hydrocele of the Canal of Nuck: Sonographic and CT Appearances

The Canal of Nuck is the portion of the processus vaginalis within the inguinal canal in women. A hydrocele of the Canal of Nuck is equivalent to an encysted hydrocele of the spermatic cord in men. Little about this rare condition in the adult female patient has been reported in the literature. In this paper, we report on a case of hydrocele of the Canal of Nuck in a 30-year-old female. The diagnosis was made based on sonography and CT, and then confirmed during surgery. Although rare, a hydrocele of the Canal of Nuck must be included in the differential diagnosis of a groin lump in female patients.

An Immunoglobulin G4-Related Sclerosing Disease of the Small Bowel: CT and Small Bowel Series Findings

Immunoglobulin G4 (IgG4)-related sclerosing disease is rare and is known to involve various organs. We present a case of histologically proven IgG4-related sclerosing disease of the small bowel with imaging findings on computed tomography (CT) and small bowel series. CT showed irregular wall thickening, loss of mural stratification and aneurysmal dilatation of the distal ileum. Small bowel series showed aneurysmal dilatations, interloop adhesion with traction and abrupt angulation.

Angiomyofibroblastoma Arising from the Posterior Perivesical Space: a Case Report with MR Findings

Angiomyofibroblastoma is a rare benign soft tissue neoplasm that predominantly occurs in the genital region of middle-aged women. We present a case of an angiomyofibroblastoma that involved the posterior perivesical space in a 48-year-old woman. We have documented the magnetic resonance imaging features of this case.

The Efficacy of Unenhanced MR Imaging for the Diagnosis of Acute Appendicitis: A Performance Comparison Versus Abdominal Ultrasonography

PURPOSE: To evaluate the efficacy of unenhanced MR imaging compared to the diagnostic accuracy, advantage, and limitations of abdominal ultrasonography in the diagnosis of acute appendicitis. MATERIALS AND METHODS: The study included 40 patients suspected of having acute appendicitis and who were subjected to an unenhanced MR image, as well as an abdominal ultrasonography. A T1 FLASH in an axial image, a chemical shift-selective fat suppressed T2 HASTE in an axial image, as well as a T2 HASTE in an axial and coronal image were obtained as unenhanced MR images. The diagnosis was established based on a surgical or clinical follow-up of the unenhanced MR results, which were then statistically compared to the ultrasonographic results. RESULTS: The surgical or clinical follow-up results revealed that 25 patients were positively diagnosed with appendicitis. Of these, 7 patients had symptoms of acute appendicitis with no pathologic diagnoses, whereas the 8 remaining patients were diagnosed with another condition. The sensitivity and accuracy of the unenhanced MR imaging was 92% and 90%, compared to ultrasonography which was 68% and 72.5% accurate, respectively. The differences in sensitivity and accuracy between the two methods were found to be statistically significant (p < .05, chi-square test). Based on these results, unenhanced MR imaging was superior to sonography for the diagnosis of appendicitis. CONCLUSION: Unenhanced MR imaging may be a useful modality for the diagnosis of acute appendicitis, especially for suboptimal or nondiagnostic sonographies, as well as patients that are particularly sensitive to radiation exposure.

Enteroscopy-guided Contrast Radiography of Small Bowel Lesions

PURPOSE: To introduce the method of enteroscopy-guided contrast radiography (ECR) and evaluate the diagnostic value of ECR for those patients with small bowel lesions. MATERIALS AND METHODS: From Aug 2004 to Dec 2005, 43 double-balloon enteroscopy (DBE) examinations were performed in 32 patients with suspected small bowel diseases. Among them, DBE revealed abnormal finding in 24 patients, and ECR was then performed in 13 of these 24 patients. RESULTS: ECR demonstrated abnormal findings in 11 among the 13 patients. In the cases of tumors and bezoar, the ECR images were very helpful for the surgical planning. However, for the evaluation of inflammatory lesions, DBE showed more accurate results and ECR could not demonstrate small or shallow ulcerative lesions. CONCLUSION: ECR can be helpful for surgical planning or determination of treatment effect in the cases of small bowel lesions that require surgical treatment or follow-up study.

A case of scalp abscess caused by Achromobacter xylosoxidans after vacuum delivery / 소아과

Achromobacter xylosoxidans is an aerobic gram-negative bacillus that may cause opportunistic infections in immunocompromized patients and newborns. Neonatal scalp abscess is generally a complication of fetal scalp monitoring and is typically polymicrobial. We present a case of a newborn, delivered by vacuum extraction, who developed a scalp abscess that yielded growth of Achromobacter xylosoxidans.

The relationship of adiponectin, leptin and ghrelin to insulin resistance and cardiovascular risk factors in human obesity / 대한내과학회지

BACKGROUND: Adiponectin, letin and ghrelin are considered to take part in the regulation of energy metabolism. We investigated the relationship between these adipokines and body mass index (BMI), regional adiposity, insulin resistance and cardiovascular risk factors in human. METHODS: Eighty six (Male : Female = 36 : 50, Age = 21-71 year old, BMI : 18 - 39.5 kg/m2) subjects without known medical problems participated in this study. Subjects were grouped based on BMI or visceral fat area (VFA) and gender. We measured lipid concentration, fasting glucose, fasting insulin, insulin resistance (HOMA-IR) and high sensitivity CRP (hsCRP). Body fat distribution was determined by computed tomography. Fasting serum adiponectin, leptin, and ghrelin were measured by ELISA. RESULTS: The group of BMI over 25 kg/m2 showed significant difference in waist circumference (WC), total fat area (TFA), subcutaneous fat area (SFA), VFA, Triglyceride (TG), hsCRP and leptin. Visceral fat dominant (VFD) group (VFA>or=100 cm2 or VFA/SFA>or=0.4) showed significant difference in age, BMI, WC, TFA, SFA, free fatty acid, HOMA-IR, hsCRP, adiponectin, leptin and ghrelin. Leptin was positively correlated with BMI, waist hip ratio (WHR), TFA, VFA, SFA, low-density lipoprotein cholesterol (LDL-C), HOMA-IR and fasting insulin. Adiponectin was negatively correlated with BMI, WHR, TFA, VFA, HOMA-IR and positively correlated with High-density lipoprotein cholesterol (HDL-C). Ghrelin level was negatively correlated with WHR, VFA, fasting glucose, HOMA-IR and positively correlated with HDL-C. And leptin was negatively correlated with ghrelin. As regional adiposity, SFA was positively correlated with leptin, and VFA was negatively correlated with adiponectin and ghrelin and positively correlated with leptin. CONCLUSIONS: This study demonstrated that VFA had more significant association with lipid metabolism and adipokine secretion than BMI and leptin levels were inversely correlated with ghrelin level.

Metastatic Bone Tumors with Sunburst Periosteal Reaction

PURPOSE: The purpose of this study was to describe the clinical and imaging features of metastatic bone tumors with sunburst periosteal reaction and to define the characteristic findings which would be helpful for differentiating metastatic bone tumors from primary malignant bone tumors. MATERIALS AND METHODS: The authors retrospectively reviewed the cases of nine patients with pathologically confirmed metastatic bone tumors with sunburst periosteal reaction, for which imaging studies (plain radiographs [n=9], radioisotope [RI] scans [n=4], magnetic resonance [MR] images [n=6], and computed tomographic [CT] scans [n=4]) were performed. The imaging studies of each lesion were analyzed by two musculoskeletal radiologists focusing on the metastatic site, patterns of bone response, signal intensity characteristics and pattern of contrast enhancement on MR. The clinical records of the patients were reviewed with regard to the age and sex of the subjects, the clinical presentation, and the origin of the primary tumors. RESULTS: The cases consisted of six men and three women, whose mean age was 62 years (age range, 50-88 years). The primary tumors were adenocarcinoma of the stomach [n=4], adenocarcinoma of the lung [n=2], adenocarcinoma of the prostate [n=1], hepatocellular carcinoma of the liver [n=1], and adenocarcinoma of unknown origin [n=1]. The sites of metastatic involvement exhibiting sunburst periosteal reaction were the scapula [n=2], proximal humerus [n=2], rib [n=1], iliac bone [n=1], tibia [n=1], spine [n=1], and proximal phalanx [n=1]. In all patients, the imaging findings showed osteolytic [n=3] or osteoblastic [n=6] lesions with sunburst periosteal reaction. In six cases, the lesions were iso-intense on the T1-weighted images and heterogeneously hyperintense on the T2-weighted images. The gadolinium-enhanced T1-weighted images showed a nearly homogenous enhancement of the lesions without any central necrotic portion. CONCLUSION: Although metastatic bone tumor exhibiting sunburst periosteal reaction is rare, it should be included along with primary malignant bone tumors in the differential diagnosis of bone lesions with sunburst periosteal reaction, especially in older patients with or without a known primary malignancy.

Sclerosing Peritonitis with Gross Calcification: Case Report

Sclerosing peritonitis is an uncommon complication of continuous ambulatory peritoneal dialysis (CAPD) and can lead to small bowel dysfunction involving abdominal pain, progressive loss of ultrafiltration, and small intestinal obstruction. Peritoneal thickening, in which calcification can develop, often starts as a small plaque which gradually becomes larger. We report a case of CAPD-related calcifying peritonitis.