Urinary bladder malignant paraganglioma with vertebral metastasis: a case report with literature review / 癌症

Paraganglioma is a rare neuroendocrine neoplasm observed in patients of all ages, with an estimated incidence of 3/1,000,000 population. It has long been recognized that some cases are familial. The majority of these tumors are benign, and the only absolute criterion for malignancy is the presence of metastases at sites where chromaffin tissue is not usually found. Some tumors show gross local invasion and recurrence, which may indeed kill the patient, but this does not necessarily associate with metastatic potential. Here, we report a case of vertebral metastatic paraganglioma that occurred 19 months after the patient had undergone partial cystectomy for urinary bladder paraganglioma. We believe this to be a rarely reported bone metastasis of paraganglioma arising originally within the urinary bladder. In this report, we also provide a summary of the general characteristics of this disease, together with progress in diagnosis, treatment, and prognosis.

Histopathological observation of bone remodeling in rabbit sinusitis model / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To observe the histopathological finding of bone remodeling in rabbit sinusitis model at different time and the tendency, and to discuss the effect of bone in the pathogenesis of sinusitis.</p><p><b>METHODS</b>First, the rabbit sinusitis model was made, then the experimental animals were divided into 3 groups according to the time of infection. There were 8 rabbits in each experimental group, and 4 rabbits in the control group. The sinus specimen were collected, embedded and stained. The bone in the inoculating side and noninoculating side was scored, and the bone in inoculating side was evaluated quantitatively and semiquantitatively. The parameters included the thickness of mucosa, mucoperiosteum, the density of osteoblast, the amount of osteoclast.</p><p><b>RESULTS</b>The average bone score in the inoculating side was 2.250, 2.875, 2.875; in the noninoculating side was 1.625, 2.250, 2.500. Between group A and the control group, the difference of all three parameters had statistical significance. Between group B and group A, the difference of the thickness of mucosa and the density of osteoblast had statistical significance. Between group C and group B, none of the three parameters had statistical significance.</p><p><b>CONCLUSIONS</b>Bacterial sinusitis can lead to bone remodeling, obvious bone destroy can occur at the early phase, then the bone proliferation follows. These results demonstrate that bone remodeling is one of the basic histopathological characters of CRS and might be the reason to lead CRS to a constant and chronic process of inflammation.</p>

Study of the clinical heterogeneity of movement disorder in Parkinson disease / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the clinical heterogeneity of movement disorder in Parkinson's disease (PD).</p><p><b>METHODS</b>Ninety-eight PD patients (68 males and 30 females) were divided into tremor-dominant PD (n=23), mixed subtype PD (n=29) and postural instability and gait disorder (PIGD)-dominant PD (n=46) groups, and the clinical heterogeneity of the movement function of the patients was compared.</p><p><b>RESULTS</b>The initial symptom of tremor-predominant PD was tremor, but patients with PIGD-dominant PD had rigidity and gait disorder as the initial symptoms, commonly compromising the left limb. The amended Hoehn-Yahr stage of tremor-dominant PD was significantly lower than that of the PIGD-dominant PD, while the score of Mini-Mental State Examination (MMSE) was significantly higher in the former. No statistical differences were found in the gender, course of disease and family history between the patients with different subtypes of PD.</p><p><b>CONCLUSION</b>There are significant differences in the initial and typical symptoms between tremor-dominant PD and PIGD-dominant PD.</p>

High resolution CT study on post-traumatic visual loss / 眼科

Objective To analyze the high resolution CT(HRCT)appearance and its clinical significance in patients with post-traumatic visual loss.Design Retrospective study.Participants 150 patients with post-traumatic visual loss.Methods The optic canal HRCT of 150 patients admitted from March to June of 2007 by Department of Emergency for post-traumatic visual loss were ana- lyzed retrospectively.Main Outcome Measures Pedilection sites and their incidence rates of optic canal and orbital apex region. Results Optic canal fractures were found in 78 patients,manifesting as rupture and displacement of optic canal wall,accompanied with or without adjacent structure fractures.(1)Among 88 sides of fractures,22 sides presented with single fracture,and 66 sides with multi- ple fractures,revolving several optic canal walls.(2)156 sites of fractures were displayed in 78 patients,and the most frequent types were displacement fractures(47.4%).(3)Accompanied adjacent structure fractures were found in 73 cases of the 78 patients,while 40 cases were found in 72 patients without optic canal fracture.Totally,283 sites of adjacent structure fractures were discovered with the most frequent sites of orbital apex region,accounting for 44.5%.Conclusion HRCT could well display optic canal fractures and accom- panied fractures of adjacent structures,providing important informations for diagnosis and intervention of traumatic visual loss.(Oph- thalmol CHN,2007,16:326-329)

MRI findings of uveal metastases / 中华放射学杂志

Objective To evaluate MR imaging findings of uveal metastases.Methods MR imaging findings of 20 cases with uveal metastases comfirmed by pathology or follow-up were retrospectively analyzed.MR imaging was performed in 20 patients,of which postcontrast T1-weighted imaging was performed in 19 patients including dynamic contrast enhancement scanning in four cases.Results Metastatic tumor was found in the iris and ciliary body in two cases,and in choroid in 18 cases.The tumor demonstrated slightly hypointense signal on Tl-weighted imaging and isointense signal on T2-weighted imaging in two cases,isointense signal on T1-weighted imaging and isointense signal on T2-weighted imaging in nine cases,isointense signal on T_1-weighted imaging and slightly hyperintense signal on T_2-weighted imaging in three cases,isointense signal on T_1-weighted imaging and slightly hypointense signal on T_2- weighted imaging in three cases,slighdy hyperintense signal on T_1-weighted imaging and slightly hypointense signal on T_2-weighted imaging in two cases,and slightly hyperintense signal on T_1-weighted imaging and slightly hyperintense signal on T_2-weighted imaging in one case.The tumor appeared as mild thickness of the wall of the globe in eight cases,a crescent mass in three cases,a fusiform mass in seven cases,and a nodule in two cases.Nineteen patients showed moderate or marked enhancement on postcontrast T_1-weighted imaging.The time-intensity curve of dynamic contrast enhancement in four patients suggested a rapid enhancement and slow washout pattern.Retinal detachment was observed in 11 patients and abnormal signal intensity within the vitreous body was seen in two cases.Conclusion MRI can display the location,shape, signal characteristics,and enhancement pattern of uveal metastases,contributing to diagnosis and differential diagnosis.

High-resolution CT appearance of pneumatization of the inferior turbinate / 中华放射学杂志

Objective To study the HRCT features of pneumatized inferior turbinate and to evaluate their diagnostic value.Methods Twelve cases of pneumatized inferior turbinates demonstrated by HRCT were retrospectively analyzed.Results Coronal HRCT could demonstrate pneumatization of the inferior turbinate clearly and directly.Unilateral pneumatization was found in 11 cases and bilateral in one case. According to the location of pneumatization,pneumatized inferior turbinates were classified into three types : bulbous,lamellar,and extensive types.Five of 12 cases were bulbous,5 were lamellar and 2 were extensive type.On coronal HRCT scans,bulbous type showed nodular shape in one case,oval and ellipse shape in 2 cases each,respectively.Lamellar pneumatization appeared as curved stripe-like shape in 4 cases communicating with the maxillary sinus and ellipse shape in one case.Extensive type was found in 2 cases, curled lamella-like shape was found in 1 case communicating with the maxillary sinus and ellipse shape in another case.In 5 cases with maxillary sinus communication,axial HRCT revealed a defect on the medial wall of the maxillary sinus.In such a condition,the maxillary process of palatine bone and maxillary bone attached to the lower turbinate separately.Conclusion HRCT was an optimal imaging modality for the diagnosis of pneumatization of the inferior turbinate and may help the clinicians to differentiate from other causes of the inferior turbinate hypertrophy.

Diffusion-weighted MR imaging in benign and malignant orbital masses / 中华放射学杂志

Objective To analyse the characteristics of orbital benign and malignant masses on diffusion weighted imaging in combination with conventional MR imaging and evaluate the diagnostic value of apparent diffusion coefficient in distinguishing benign and malignant orbital lesions.Methods Seventy- seven cases with orbital masses,including fifty-five benign lesions and twenty-two malignant tumors,who underwent conventional MRI and diffusion imaging scanning were studied with use of a 1.5 T magnetic resonance system.Quantitative ADC measurements of masses(ADC_M)and of the white matter of eontralateral temporal lobe(ADC_W)were made with two different b-values of 0 and 1000 s/mm~2.The ADC ratio(ADCR)of the lesion to the control was calculated.The receiver operating characteristic curves(ROC) were constructed using various cut points of ADC_M and ADCR for different parameters to differentiate between benign and malignant masses.The area under the ROC curve for each parameter was also calculated. Results All cases were proved by histopathology.The mean ADC_M and ADCR of benign orbital masses were(1.56?0.75)?10~(-3)mm~2/s and 1.85?0.91,respectively.The mean ADC_M and ADCR of malignant orbital masses were(1.09?0.42)?10~(-3)mm~2/s and 1.28?0.53,respectively.There were significant difference both between ADC_M and ADCR of benign and malignant masses(t=2.803,2.735,P

CT and MRI diagnosis of cavernous hemangioma in paranasal sinus / 中华放射学杂志

Objective To investigate the CT and MRI findings of cavernous hemangioma in paranasal sinus so as to promote the diagnostic accuracy.Methods All 30 cases of cavernous hemangioma in paranasal sinus were verified with pathological examinations.The CT and MRI findings were analyzed retrospectively.Results The lesions occurred in the maxillary sinus in 25 cases,in the anterior ethmoid sinus in 3 cases and in the sphenoid sinus in 2 cases.The lesions extended and compressed adjacent structures.MRI showed the extent and the associated changes of the lesions more clearly compared to CT. On CT,all the involved paranasal sinuses invariably expanded.The bony walls of paranasal sinuses were compressed and remodeled with focal defect in 28 cases,mostly in the medial wall of the maxillary sinus (21 cases).Bony scelerosis of the residual walls of paranasal sinus were found in 8 cases.The lesions demonstrated well-defined margin and heterogeneous density with phlebolith in 10 cases.Postcontrast CT showed marked inhomogeneous enhancement in 16 cases.On MR T_1WI,canernous hemangioma showed hypointense signal compared to brain in 4 cases and isointense signal in 14 cases.On T_2WI,the lesions revealed heterogeneous hyperintense singal in 16 cases and isointense signal in 2 cases with multiple hypointense foci.Postcontrast MR imaging demonstrated marked inhomogeneous enhancement in these cases,honeycomb-like appearance in 8 cases and variegated appearance in 10 cases.The feature of progressive enhancement was found on dynamic contrast enhancement of MRI in 8 cases.Conclusions The characteristic bony change together with phlebolith can suggest the diagnosis of cavernous hemangioma in paranasal sinus on CT.The heterogeneous hyperintense singal on MR T_2WI,progressive enhancement and honeycomb-like or variegated appearance on postcontrast MRI were also the characteristic findings of cavernous hemangioma in paranasal sinus.Combination of CT and MRI findings can provide more accurate information for the diagnosis and therapy of cavernous hemangioma in paranasal sinus.

CT and MRI diagnosis of osteosarcoma in paranasal sinus / 中华放射学杂志

Objective To study the CT and MRI findings of osteosarcoma in paranasal sinus and evaluate their clinical value.Methods All 9 cases of osteosarcoma were verified by histopathology.Imaging data were analyzed retrospectively.Results The lesion occurred in maxillary sinus in 5 cases,in ethmoid sinus in 3 cases and in sphenoid sinus in one case.Primary osteosarcoma was found in 7 cases.Secondary osteosarcoma occurred from fibrous dysplasia and ossifying fibroma each in one case.On CT,the involved areas revealed bony destruction associated with ill-defined and irregular soft tissue mass.The lesion showed heterogeneous density with minimal or massive tumor bone formation,cloud-like in 3 cases,ivory-like in 2 cases,spicule-like in 2 cases,cloud- and spicule -like in one case and spicule- and ivory-like in one case.Postcontrast CT showed mild to moderate inhomogeneous enhancement in 3 cases.On MR T_1 WI,the lesions showed hypointensity compared to brain in 5 cases and iso-intensity in 2 cases.On T_2WI,the lesions showed heterogeneous hyperintensity in 4 cases and isointensity in 3 cases with marked hypointense foci which corresponded to tumor bone on CT.Postcontrast MR imaging demonstrated moderate to marked inhomogeneous enhancement in these cases.MRI showed accurately the extent and associated changes of the lesions.The lesions invaded the orbit,pterygopalatine and infratemporal fossae,skull base and extensive craniofacial structures in 5,4,3 cases and 1 case,respectively.Conclusion CT is the optimal modality in showing tumor bone of osteosareoma in paranasal sinus.MRI can demonstrate optimally the invading extent of the lesions.Combined imaging modalities can provide more comprehensive information for diagnosis and therapy of osteosarcoma in paranasal sinus.

Radiological findings of hemangioendotheliomas in the orbit / 中华放射学杂志

Objective Radiological findings of very rare hemangioendotheliomas in the orbit have not been reported.Radiological findings on different imaging studies of four cases with hemangioendotheliomas in the orbit were described and the literature was reviewed so as to understand features of hemangioendotheliomas in the orbit.Methods CT and MR imaging findings of four cases with hemangioendotheliomas in the orbit confirmed by histopathology were analyzed retrospectively.Results A mass was found in the superotemporal quadrant in the anterior extraconal space of the orbit in three cases and in the inferonasal quadrant in one case. CT studies revealed a homogeneously ovoid tumor with benign remodeling of the adjacent bone in three cases and a homogeneously irregular mass without any bony change in one case.MR imaging showed a mass in the orbit that was mildly hypointense on T_1-weighted sequences and hyperintense on T_2-weighted images with areas of flow voids representing vessels within the peripheral portion of the tumor in four cases.All four patients demonstrated significant enhancement immediately after intravenous administration of contrast material and a type D time-signal intensity curve (TIC)pattern on MR dynamic contrast enhancement scanning.Conclusions Hemangioendotheliomas in the orbit appeared as a hypervascular tumor predominantly in the extraconal space with areas of flow voids within the tumor and early significant enhancement of the tumor after intravenous administration of contrast material.MR imaging is the best method in demonstration of features of hemangioendotheliomas in the orbit and in diagnosis of these tumors.