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Objective:To explore the CT features of inflammatory pseudotumor like follicular dendritic cell sarcoma (FDCS) of the spleen.Methods:The clinical data of 12 patients with splenic inflammatory pseudotumor like FDCS admitted to 3 central hospitals including Yongjia People's Hospital in Zhejiang Province from January 2015 to December 2022 were retrospectively analyzed, including 4 males and 8 females, with a median age of 60 years old. The number, shape, size and CT features of the lesions were analyzed based on patient's CT image data.Results:CT scans of 12 patients showed 15 lesions, including 10 single lesions and 2 multiple lesions. The lesions were circular in 5 cases, elliptical in 4 cases, and irregular in 3 cases. The median maximum diameter of the mass is 6.5 cm. On plain scan, all 12 tumors showed low density or slightly low density. The CT value is (41.3±7.2) HU; 8 cases had uneven density and 4 cases had uniform density. There were 8 cases with clear tumor boundaries and 4 cases with unclear boundaries. There were 8 cases with tumor necrosis and cystic transformation, and 5 cases showed patchy bleeding lesions in the center of the tumor. Enhancement: the arterial phase shows small patches or flocculent enhancement at the edges or parenchymal parts of the tumor, with CT value of (56.0±3.8) HU. Among them, there were 7 cases of mild enhancement, 4 cases of moderate enhancement, and 1 case of significant enhancement. During the portal phase, there was mild to moderate persistent small patchy uneven enhancement, with CT value of (62.0±4.3) HU. Among them, there were 8 cases of mild enhancement and 4 cases of moderate enhancement. The delayed phase showed a slow withdrawal of enhancement, with CT value of (45.0±8.2) HU. All 12 cases underwent complete resection and were diagnosed with FDCS through pathological examination.Conclusion:FDCS plain scan shows circular or elliptical uneven low-density masses, with small patches or flocculent light to moderate uneven enhancement in the arterial phase, continuous enhancement in the portal phase, and slow withdrawal in the delayed phase as the main characteristics.
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Objective:To investigate the magnetic resonance imaging (MRI) features of desmoplastic small round cell tumor (DSRCT) of the abdomen and pelvis.Method:The retrospec-tive and descriptive study was conducted. The clinicopathological data of 8 patients with DSRCT of the abdomen and pelvis, including 3 cases admitted in Yueqing People's Hospital and 5 cases admitted in Wenzhou People's Hospital, from January 2008 to June 2022 were collected. There were 5 males and 3 females, aged (43±5)years. All patients underwent MRI plain and enhanced scanning. Observa-tion indicators: (1) imaging features of DSRCT of the abdomen and pelvis; (2) treatment and pathological examination characteristics of DSRCT of the abdomen and pelvis; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distri-bution were represented as M(range). Count data were described as absolute numbers. Results:(1) Imaging features of DSRCT of the abdomen and pelvis. ① Tumor location. Of the 8 patients, there were 6 cases with tumors located respectively at the lower edge of the liver in the right quarter costal region, the medial side of the ileocecal region in the right iliac region, the medial side of the caecum in the right iliac region, the gastro-pancreatic space in the left quarter costal region, the mesenteric space in the left iliac region and the right side of pelvic bladder, and 2 cases with tumors located at retroperitoneal space of left quarter rib region. ② Tumor size. There were 13 lesions in the 8 patients, and the maximum diameter of tumor was 9.1 (range, 3.5?20.0)cm. Of the 8 patients, there were 5 cases with single tumor and 3 cases with multiple tumors. ③ Tumor shape and boundary. Of the 8 patients, there were 4 cases with tumor in expansive growth and 4 cases with tumor in invasive growth. There were 5 cases with tumor of intratumoral necrosis and cystic degene-ration, 4 cases with tumor of intratumoral hemorrhage, 4 cases with tumor of intratumoral spot calcification, 3 cases with tumor of peritumoral tissue exudation. One patient may combined with multiple imaging manifestations. ④ Imaging characteristics of MRI plain scanning. Of the 8 patients, there were 4 cases with tumor of homogeneous hypointensity signal and 4 cases with tumor of hypointensity mixed with speckled hyperintensity (with hemorrhage) in T1 weighted imaging of MRI plain scanning. There were 3 cases with tumor of homogeneous hyperintensity and 5 cases with tumor of high signal at the edge, patchy and spot-shaped in the center in T2 weighted imaging of MRI plain scanning. There were 5 cases with tumor of high, equal and low confounding signals and 3 cases with tumor of high and low signals in T2 weighted imaging fat suppression sequence of MRI plain scanning. There were 3 cases with tumor of uniform high signals and 5 cases with tumor of high, equal and low mixed signals in diffusion weighted imaging of MRI plain scanning. ⑤ Imaging characteristics of MRI enhanced scanning. All 8 patients had tumor of heterogeneous enhancement in MRI enhanced scanning, including 2 cases with significant enhancement in arterial phase, continuous enhancement in portal phase, slightly reduced enhancement in delayed phase, 4 cases with moderate enhancement in arterial phase, continuous enhancement in portal phase, slowly exited enhancement in delayed phase, 2 cases with mild enhancement in arterial phase, continuous enhancement in portal phase, slowly exited enhancement in delayed phase. Of the 8 patients, there were 3 cases with tumor of annular enhancement with intratumoral strip or grid signals and 3 cases with tumor of peritumoral blood vessels increased and thickened signals. ⑥ Tumor invasion and metastasis. Of the 8 patients, there were 4 cases with tumor invaded bowel, 2 cases with tumor invaded surrounding tissues, 1 case with tumor invaded left kidney, spleen and pancreatic tail, 1 case with tumor invaded distal of left ureter. There were 5 cases with abdominal, retroperitoneal and inguinal lymph nodes enlargement, 4 cases with multiple nodular thickening of peritoneum and ascites, 2 cases with tumor liver and lung metastasis and 1 case with tumor rib, femur and sacrum metastasis. One patient may combined with multiple tumor metastasis. (2) Treatment and patholo-gical examination characteristics of DSRCT of the abdomen and pelvis. Of the 8 patients, 3 patients underwent complete resection as clear tumor boundary, 3 patients underwent tumor partial resection as tight adhesion between tumor and surrounding blood vessels, 2 cases underwent tumor tissue pathological examination as extensive metastasis of peritoneum, omentum, mesentery and surrounding intestine. All 8 patients were diagnosed as DSRCT by microscopic examination, electron microscopic examination, immunohistochemical staining and cytogenetic examination. (3) Follow-up. All 8 patients underwent postoperative follow-up and died during the follow-up.Conclusion:MRI features of abdominal and pelvic DSRCT include single or multiple lobulated masses with unclear boundaries, invading the omentum, mesentery, peritoneum and adjacent tissues in most cases, mixed signals and heterogeneous mild to moderate enhancement in enhanced scanning.
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The patient, a 61-year-old female, was admitted to the hospital for 15 days of frequent urination, urgency, painful urination and hematuria. B-ultrasound showed irregular hypoechoic masses on the anterior wall of the bladder. CT showed that the right anterior wall of the bladder protruded into the cavity of the soft tissue mass, which was lobulated, and the edge of the mass showed arc-shaped calcification; enhancement shows that the mass continues to enhance. Cystoscopy showed a lobulated soft tissue mass protruding into the cavity on the right anterior wall of the bladder, and cystoscopy showed tumor-like lesions. The preoperative clinical and imaging diagnosis was a malignant tumor of the bladder. Open partial resection of the right anterior wall of the bladder under general anesthesia, and pathological diagnosis of bladder leiomyosarcoma after surgery. Adjuvant chemotherapy (gemcitabine 1.6 g + epirubicin 80 mg + cisplatin 30 mg) was started 2 months after the operation. The chemotherapy was discontinued after a year, and the patient had no obvious adverse reactions. There were no signs of recurrence and metastasis after a 2-year follow-up.
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Objective:To investigate the computed tomography (CT) features of primary hepatic fibrosarcoma (PHF).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 8 patients with PHF who were admitted to 2 medical centers from January 2010 to December 2019, including 3 cases of Yueqing People's Hospital of Zhejiang and 5 cases of Wenzhou People's Hospital of Zhejiang were collected. There were 5 males and 3 females, aged 50 years(range, 39?60 years). All patients underwent abdominal CT plain and enhanced examination, and surgical procedures were selected based on patients' will and individual situations. Surgical tumor specimens were given pathological examination and immunohistochemical staining. Observation indicators: (1) imaging features of CT examination; (2) treatment and pathological examinations; (3) follow-up. Follow-up was performed by outpatient examination or hospitalization to detect survival of patients and tumor recurrence up to December 2020. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Imaging features of CT examination: 8 patients received preoperative CT examinations, 3 cases of which were diagnosed as malignancies, 3 cases were diagnosed as hepatic space-occupying lesions, 2 cases were diagnosed as intrahepatic cholangiocarcinoma. ① Tumor location and general status: 8 patients had single tumor, of which 6 cases had tumor located in the right lobe of the liver and 2 cases had tumor located in the left lobe of the liver. The tumor was in oval shape in 5 patients and in circular in 3 patients. The maximum diameter of tumor in 8 patients was 9.3 cm(range, 4.0?15.0 cm). There were 1 case with tumor maximum diameter ≤5.0 cm, 4 cases with tumor maximum diameter as 5.1?10.0 cm, 3 cases with tumor maximum diameter >10.0 cm. ② CT plain scan showed uniform low density in 2 cases and uneven low density in 6 cases and the CT value of 8 cases was 40 HU(range, 29?43 HU). The tumor showed expansive growth with clear boundary in 6 cases, and invasive growth with unclear boundary in 2 cases. Five cases had intratumoral necrosis and cystic transformation, 2 cases had intratumoral strip hemorrhage, and 1 case of intratumoral calcification. There was 1 case with hilar lymph node metastasis. ③ Enhanced CT scan showed 8 cases with uneven enhancement in arterial phase, 8 cases with uneven tumor density in portal vein phase, 8 cases with intratumoral enhancement slowly withdrew in delayed phase and the density lower than liver parenchyma. (2) Treatment and pathological examinations: ① 8 patients under-went surgical resection, without intrahepatic or hilar metastasis. ② The results of postoperative pathological examination showed 2 cases with grade Ⅰ tumor differentiation (low potential malignancy), 5 cases with grade Ⅱ and Ⅲ tumor differentiation (moderate potential malignancy), 1 case with grade Ⅳ tumor differentiation (high potential malignancy). ③ Immuno-histochemical staining showed that 8 cases were positive for vimentin, CD10, p53 and negative for smooth muscle actin, keratin19, epithelial membrane antigen, endotheliocyte 34. All 8 patients were diagnosed as PHF. (3) Follow-up: all 8 patients were followed up for 7 to 128 months, with a median follow-up time of 53 months. The overall survival time of 8 patients was 15 to 122 months, and the median overall survival time was 45 months. One patient died of tumor recurrence and distant metastasis at 17 months after surgery, and the survival time of 7 patients was >28 months.Conclusions:CT plain scan of PHF showed uneven low-density masses. After enhancement, the arterial phase shows the tumor ring or peripheral nodular uneven enhancement, the intratumoral strip-shaped enhanced blood vessels. The portal vein phase shows the tumor-like small patches or grid-like continuous enhancement. The delayed phase is characterized by the slow withdrawal of intratumoral enhancement.
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Objective@#To investigate the imaging features of adult bones Langerhans cell histiocytosis (LCH).@*Methods@#The DR, CT, and MRI findings of 25 adults patients with LCH from January 2008 to June 2019 in Yueqing Sixth People′s Hospital of Zhejiang Province (3 cases), Yueqing Third People′s Hospital of Zhejiang Province (7 cases) and Wenzhou People′s Hospital of Zhejiang Province (15 cases) were retrospectively analyzed.@*Results@#Among the 25 patients, the lesions located in the skull in 5 cases, in the spine in 5 cases, in the long bones in 10 cases, in the other flat bones in 3 cases, and in multiple bones in 2 cases. DR features (17 cases) showed: cystic destruction in 11 cases (6 cases with dilated changes), osteolytic damage in 6 cases; peripheral bone cortex thickening in 5 cases, bone lesions with less smooth inner edge in 4 cases, soft tissue mass around the lesion in 12 cases; 'hole set cave sign' in 2 cases, 'flat vertebra' in 2 cases, and 'button-like dead bone' in 1 case. CT features (15 cases) showed: cystic destruction in 9 cases (5 cases with dilated changes), osteolytic damage in 6 cases; 'hole set cave sign' in 2 cases, 'flat vertebra' in 2 cases, and 'button-like dead bone' in 1 case. MRI features (14 cases) showed: cystic destruction in 9 cases (5 cases with dilated changes), osteolytic damage in 5 cases; in the bone destruction area, 8 cases had low T1WI signal and high T2WI signal, 4 cases had equal T1WI signal and higher mixed T2WI signal, 2 cases had slightly higher T1WI signal and higher mixed T2WI signal; STIR lipoprotein sequence showed high signal in 11 cases, and isointense signal in 3 cases; DWI showed high signal.@*Conclusions@#The imaging performance of adults LCH has certain characteristics, and the diagnostic accuracy can be improved according to the imaging performance and the clinic.
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Objective:To summarize the imaging and pathological features of primary central nervous system lymphoma in special sites, and analyze some misdiagnosed cases to provide help for clinical diagnosis.Methods:Thirty-nine patients with primary central nervous system lymphoma diagnosed by pathology from 2000 to 2019 in Wenzhou People′s Hospital and the Second Affiliated Hospital of Wenzhou Medical University were retrospectively analyzed. The imaging and pathological features of primary central nervous system lymphoma in special sites were summarized, and the misdiagnosed cases in these special sites were analyzed.Results:Primary central nervous system lymphoma in special sites included one case of primary dural lymphoma, with thickening of dura mater and obvious enhancement; two cases with lesions in lateral ventricle, with homogeneous enhancement, involving ependyma and spreading to medulla oblongata; two cases with lesions in middle cerebellar peduncle, with patchy abnormal signals and no specific masses, mild to moderate enhancement after enhancement, and one misdiagnosed as demyelinating lesions; one case with lesions in the sellar region which obviously enhanced with a typical “dent sign”, misdiagnosed as invasive pituitary tumor. All the pathological findings indicated diffuse large B cell lymphoma.Conclusions:It is difficult to diagnose primary central nervous system lymphoma in special sites, which is easy to cause misdiagnosis. Understanding its imaging characteristics and pathology can help to diagnose the disease.
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Objective:To analyze the MRI features of hepatic epithelioid hemangioendothelioma (HEHE).Methods:The data of patients with HEHE managed in the Wenzhou People's Hospital of Zhejiang Province and the First Affiliated Hospital of Wenzhou Medical University from April 2000 to April 2019 were retrospectively analyzed. Among the 26 patients with HEHE, there were 12 males and 14 females, aged from 23 to 65 years (average 44.4 years). The quantity, size, shape and type of the lesions were observed and the MRI features were analyzed.Results:Of the 382 nodules detected by MRI in the 26 patients, the size varied from 0.5cm to 12.0 cm, with 16 nodules being more than 5.0 cm in diameter (average of 2.2 cm). Four patients with a single nodular type presented with low signal on T 1 weighted imaging (T 1WI), high signal on T 2 weighted imaging (T 2WI), high signal on diffused weighted imaging (DWI), and high central signal and low peripheral annular signal on apparent diffusion coefficient (ADC). After enhancement, the lesions presented with annular centripetal enhancement or continuous annular enhancement. Fourteen patients with multiple nodules had a total of 147 lesions, presenting with low signal on T 1WI, high signal on T 2WI, high signal on DWI, and high central signal and low peripheral annular signal on ADC. After enhancement, the lesions presented with annular centripetal enhancement and continuous annular enhancement. There were 24 lesions in 6 patients who had a " double-ring sign" , 21 lesions in 7 patients who had a capsule " shriveled sign" , 16 lesions in 7 patients who had a " lollipop sign" and 18 lesions in 5 patients who had an " intravascular sign" . There were 231 lesions in 8 patients of the fusion type. The lesions showed low signal on T 1WI, high signal on T 2WI , high signal on DWI, and high central signal and low peripheral signal on ADC. After enhancement, the lesions presented with flocculent or annular centripetal enhancement. In 8 patients, 87 lesions had a " target sign" , 55 lesions had a " lollipop sign" and 42 lesions had a capsule " shriveled sign" , and 36 lesions in 5 patients had an " intravascular sign" . Conclusion:MRI signs of HEHE have certain characteristics, such as lesions being distributed near the capsule, and fusing with each other; a " target sign" on T 2WI; a capsule " shriveled sign " ; and a " double-ring sign" , a " lollipop sign" , an " intravascular sign" in the portal phase. These features are helpful in diagnosing HEHE.
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Objective:To analyze the CT and MRI features of primary hepatic sarcomatoid carcinoma.Methods:A retrospective study was conducted on 16 patients with primary hepatic sarcomatoid carcinoma who presented to Wenzhou People's Hospital of Zhejiang Province and the Second Affiliated Hospital of Wenzhou Medical University from January 2009 to June 2019. There were 8 males and 8 females, with age ranging from 35 to 71 years (average 56.8 years). The site, size, shape, margin, density of signal, adjacent tissue changes and degree enhancement of tumor were analyzed.Results:Tumors in the liver in the 16 patients were all solitary, with 11 in the right and 5 in the left liver. The maximum diameter of tumor ranged from 3 to 16cm (average 8.5cm). On plain CT scanning ( n=16), the tumors were round or oval in 6, and lobulated or irregular in 10 patients. The margins of the tumors were clear in 10 and unclear in 6 patients. All tumors showed low density, with 15 tumors showing uneven density, with necrosis and liquefaction of different sizes in the center, while 1 tumor showing uniform density. On plain MRI scanning ( n=4), four tumors had clear margins, with necrosis and liquefaction seen in the center of the tumors. The solid part showed a slightly lower signal on T 1 weighted imaging and a slightly higher signal on T 2 weighted imaging. The liquefaction focus of central necrosis showed higher signal intensity on T 2 weighted imaging. Enhanced scanning ( n=12 on CT enhancement and n=4 on MRI enhancement), the margins of the tumors were enhanced in the arterial phase. The enhancement was continued into the portal venous and delayed phases in 7 patients. Strip septate and margin enhancement in the tumor were enhanced in the arterial phase. The enhancement was continued into the portal venous and delayed phases in 7 patients. Inhomogeneous strengthening in the tumor was enhanced in the arterial phase. The enhancement was continued into the portal venous and delayed phases in 1 patient. Inhomogeneous strengthening in the tumor was enhanced in the arterial phase. The enhancement was continued into the portal venous phase. In the delayed phase, enhancement in the tumor decreased, but there was continuous enhancement of the margin and interval of the tumor in 1 patient. Conclusions:Hepatic sarcomatoid carcinoma showed dual imaging characteristics of sarcoma and cancer. The imaging features of hepatic sarcomatoid carcinoma depended on the proportion of sarcomatoid components. Large intrahepatic tumors showed necrotic cystic degeneration, moderate or significant persistent enhancement in striped septum and margin of tumor.
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Objective To investigate the imaging features of adult bones Langerhans cell histiocytosis (LCH).Methods The DR,CT,and MRI findings of 25 adults patients with LCH from January 2008 to June 2019 in Yueqing Sixth People's Hospital of Zhejiang Province (3 cases),Yueqing Third People's Hospital of Zhejiang Province (7 cases) and Wenzhou People's Hospital of Zhejiang Province (15 cases) were retrospectively analyzed.Results Among the 25 patients,the lesions located in the skull in 5 cases,in the spine in 5 cases,in the long bones in 10 cases,in the other flat bones in 3 cases,and in multiple bones in 2 cases.DR features (17 cases) showed:cystic destruction in 11 cases (6 cases with dilated changes),osteolytic damage in 6 cases;peripheral bone cortex thickening in 5 cases,bone lesions with less smooth inner edge in 4 cases,soft tissue mass around the lesion in 12 cases;‘hole set cave sign’ in 2 cases,‘flat vertebra’ in 2 cases,and ‘button-like dead bone’ in 1 case.CT features (15 cases) showed:cystic destruction in 9 cases (5 cases with dilated changes),osteolytic damage in 6 cases;‘hole set cave sign’ in 2 cases,‘flat vertebra’ in 2 cases,and ‘button-like dead bone’ in 1 case.MRI features (14 cases) showed:cystic destruction in 9 cases (5 cases with dilated changes),osteolytic damage in 5 cases;in the bone destruction area,8 cases had low T1WI signal and high T2WI signal,4 cases had equal T1WI signal and higher mixed T2WI signal,2 cases had slightly higher T1WI signal and higher mixed T2WI signal;STIR lipoprotein sequence showed high signal in 11 cases,and isointense signal in 3 cases;DWI showed high signal.Conclusions The imaging performance of adults LCH has certain characteristics,and the diagnostic accuracy can be improved according to the imaging performance and the clinic.
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Objective@#To analyze the CT and MRI manifestations of undifferentiated hepatic embryonal sarcoma in adults with an aim to improve the preoperative diagnosis of this disease.@*Methods@#A retrospective analysis was carried out on the clinical data of 11 patients with undifferentiated hepatic embryonal sarcoma treated in Wenzhou People’s Hospital of Zhejiang and Wenzhou Central Hospital of Zhejiang between January 2008 and December 2018. There were 5 males and 6 females. The age ranged from 46 to 76 years (median 64 years). The site, size, morphology, margin, and pattern and degree of enhancement of the tumors were analyzed.@*Results@#Among the 11 patients, 10 patients had a single tumor, only 1 patient had multiple tumors. A total of seven patients' tumors were located in the right liver, 2 in the left liver, and 2 involved both the left and right livers. The maximum diameter of the tumors ranged from 5.5 cm to 21.2 cm, the maximum diameter (10.2±4.8 cm). The edge of tumors was clear in 9 patients and unclear in 2 patients. The tumors were elliptical in 4 patients or irregular in 7 patients. Plain CT scan showed 4 patients' tumors had mainly a cystic component, while 5 patients had both cystic and solid components. Plain MRI scan showed that five tumors were cystic and solid, with mixed internal signals. T1 weighted imaging (T1WI) showed slightly lower and lower signals; T2 weighted imaging (T2WI) showed slightly higher and higher signals. There was a low signal stripe separating inside; Diffusion-weighted imaging showed a high signal and apparent diffusion coefficient showed a low signal. The enhancement was characterized by "fast in and fast out" (marked enhancement in the arterial phase and fast clearance in the venous phase), and "delayed enhancement" (mild to moderate enhancement in the arterial phase and even more obvious enhancement in the venous or delayed phase).@*Conclusion@#Adult undifferentiated embryonic sarcoma has certain CT and MRI features. Its shape is elliptical or irregular, and mostly with a clear boundary. There were intratumoral cystic or cystic solid components, with mixed density/signal on CT and MRI, being characterized by "fast in and fast out" and "delayed enhancement" on intravenous contrast enhanced scans.
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Objective@#To investigate the CT features of primary mediastinal neuroendocrine carcinoma and improve the diagnostic accuracy.@*Methods@#CT findings of 12 patients with primary mediastinal neuroendocrine carcinoma diagnosed by clinic and pathology were retrospectively analyzed. The location, size, growth pattern, density, degree of enhancement, invasion of surrounding tissues and metastasis of the tumor were observed, a control analysis was performed.@*Results@#Among the 12 cases, 4 cases were located in the anterior superior mediastinum, 4 cases in the middle superior mediastinum and 4 cases in the middle mediastinum. There were 5 cases on the left side, 4 cases on the right side and 3 cases in the middle. The maximum diameter of the tumor ranged from 1.5 cm to 12.0 cm, with an average of (6.74±3.65) cm. The tumors were round or quasi-round in 6 cases, irregular in 6 cases, clear boundary in 9 cases and unclear in 3 cases. Uniform density was found in 6 cases. The density was heterogeneous in 6 cases, including necrosis and cystic degeneration in 4 cases, and fine-grained calcification in 1 case. The average CT value of plain scan was (38±4.8) HU. There was 1 case of perivascular growth, 2 cases of adjacent vascular compression, 3 cases of adjacent pleural invasion, and 6 cases of infiltrating the surrounding fat space. After contrast enhancement, all cases showed mild and moderate enhancement, including 4 cases with homogeneous enhancement and 8 cases with heterogeneous enhancement. After contrast enhancement, the mean CT value was (55±7.7) HU. There were 9 cases with mild enhancement and 3 cases with moderate enhancement. There were 3 cases with small linear abnormally enhanced vascular shadow in the tumor, and 4 cases with no enhancement both in the central necrosis and the cystic areas. There were 7 cases of typical carcinoid, 2 cases of atypical carcinoid, 2 cases of small cell carcinoma and 1 case of large cell neuroendocrine carcinoma.@*Conclusion@#Primary mediastinal neuroendocrine carcinoma is mainly located in the anterior-mediastinum. When the tumor is large, necrosis, cystic degeneration and invasive growth are easy to occur. The enhanced scan shows mild and moderate enhancement. Combined with clinical history, it can improve the accuracy of diagnosis.
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Objective@#To investigate the CT and MRI features of adult rhabdomyosarcoma (RMS) of extremities.@*Methods@#A retrospective analysis was carried out on CT and MRI findings of 10 patients with rhabdomyosarcoma of extremities confirmed by surgery and pathology in Wenzhou People′s Hospital and the Second Affiliated Hospital of Wenzhou Medical University. The site, size, shape, margin, density or signal, adjacent tissue changes and enhanced degree of the mass were observed.@*Results@#In the 10 cases, the mass was located in the thigh in 6 cases, in the calf in 3 cases, and in the upper arm in 1 case. The maximum diameter of the tumor was 2.9-22.5 (12.0 ± 7.2) cm. The masses were oval in 2 cases and irregular in 8 cases. The margins of the masses were clear in 2 cases and unclear in 8 cases. There was invasive destruction of adjacent bone in 3 cases, intratumoral necrotic cystic changes in 8 cases, intratumoral hemorrhage in 2 case, and lymph node metastasis in 3 cases. Four patients underwent plain CT scan: CT presented isodensity in 1 case and slightly lower density in 3 cases. The mass density was uniform in 1 case and uneven in 3 cases. CT value of the solid part of the mass was 27-47 (42 ± 6) HU in average. Three patients underwent enhanced CT scan: all the enhanced masses showed uneven enhancement, including 1 case of mild enhancement and 2 cases of moderate enhancement, with no enhancement of necrotic cystic lesion area and clear in lesion boundary. Nine patients underwent plain MRI scan: mass of 9 cases presented iso-signal or slightly lower signal on T1WI, including 4 cases with iso-signal and 5 cases with slightly lower signal. There were 7 cases of uneven signals and 2 cases of uniform signals. The mass presented high signal on T2WI, including 8 cases with uneven signals and 1 case with uniform signals, and the necrotic cystic lesion showed higher signal on T2WI. Seven patients underwent enhanced MRI scan: all the enhanced masses showed uneven enhancement, including significant enhancement in 5 cases, moderate enhancement in 2 cases, no enhancement in necrotic cystic lesion area, and "perivascular" phenomenon in 4 cases.@*Conclusions@#CT or MRI examination shows that the soft tissue tumor of the extremities presents low density on CT, equal or slightly low T1WI signal on MRI, and high signal on T2WI, with necrotic cystic lesion inside peripheral blood vessel density in the tumor, without calcification and significantly or moderately uneven enhancement should consider the possibility of RMS should be considered.
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investigate the CT and MRI features of adult rhabdomyosarcoma (RMS) of extremities. Methods A retrospective analysis was carried out on CT and MRI findings of 10 patients with rhabdomyosarcoma of extremities confirmed by surgery and pathology in Wenzhou People′s Hospital and the Second Affiliated Hospital of Wenzhou Medical University. The site, size, shape, margin, density or signal, adjacent tissue changes and enhanced degree of the mass were observed. Results In the 10 cases, the mass was located in the thigh in 6 cases, in the calf in 3 cases, and in the upper arm in 1 case. The maximum diameter of the tumor was 2.9-22.5 (12.0 ± 7.2) cm. The masses were oval in 2 cases and irregular in 8 cases. The margins of the masses were clear in 2 cases and unclear in 8 cases. There was invasive destruction of adjacent bone in 3 cases, intratumoral necrotic cystic changes in 8 cases, intratumoral hemorrhage in 2 case, and lymph node metastasis in 3 cases. Four patients underwent plain CT scan: CT presented isodensity in 1 case and slightly lower density in 3 cases. The mass density was uniform in 1 case and uneven in 3 cases. CT value of the solid part of the mass was 27-47 (42 ± 6) HU in average. Three patients underwent enhanced CT scan: all the enhanced masses showed uneven enhancement, including 1 case of mild enhancement and 2 cases of moderate enhancement, with no enhancement of necrotic cystic lesion area and clear in lesion boundary. Nine patients underwent plain MRI scan: mass of 9 cases presented iso-signal or slightly lower signal on T1WI, including 4 cases with iso-signal and 5 cases with slightly lower signal. There were 7 cases of uneven signals and 2 cases of uniform signals. The mass presented high signal on T2WI, including 8 cases with uneven signals and 1 case with uniform signals, and the necrotic cystic lesion showed higher signal on T2WI. Seven patients underwent enhanced MRI scan: all the enhanced masses showed uneven enhancement, including significant enhancement in 5 cases, moderate enhancement in 2 cases, no enhancement in necrotic cystic lesion area, and "perivascular" phenomenon in 4 cases. Conclusions CT or MRI examination shows that the soft tissue tumor of the extremities presents low density on CT, equal or slightly low T1WI signal on MRI, and high signal on T2WI, with necrotic cystic lesion inside peripheral blood vessel density in the tumor, without calcification and significantly or moderately uneven enhancement should consider the possibility of RMS should be considered.
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Objective To investigate the CT features of primary mediastinal neuroendocrine carcinoma and improve the diagnostic accuracy. Methods CT findings of 12 patients with primary mediastinal neuroen-docrine carcinoma diagnosed by clinic and pathology were retrospectively analyzed. The location, size, growth pat-tern, density, degree of enhancement, invasion of surrounding tissues and metastasis of the tumor were observed, a control analysis was performed. Results Among the 12 cases, 4 cases were located in the anterior superior medi-astinum, 4 cases in the middle superior mediastinum and 4 cases in the middle mediastinum. There were 5 cases on the left side, 4 cases on the right side and 3 cases in the middle. The maximum diameter of the tumor ranged from 1.5 cm to 12.0 cm, with an average of(6.74±3.65) cm. The tumors were round or quasi-round in 6 cases, ir-regular in 6 cases, clear boundary in 9 cases and unclear in 3 cases. Uniform density was found in 6 cases. The density was heterogeneous in 6 cases, including necrosis and cystic degeneration in 4 cases, and fine-grained cal-cification in 1 case. The average CT value of plain scan was (38±4.8) HU. There was 1 case of perivascular growth, 2 cases of adjacent vascular compression, 3 cases of adjacent pleural invasion, and 6 cases of infiltrating the sur-rounding fat space. After contrast enhancement, all cases showed mild and moderate enhancement, including 4 cases with homogeneous enhancement and 8 cases with heterogeneous enhancement. After contrast enhancement, the mean CT value was (55±7.7) HU. There were 9 cases with mild enhancement and 3 cases with moderate enhance-ment. There were 3 cases with small linear abnormally enhanced vascular shadow in the tumor, and 4 cases with no enhancement both in the central necrosis and the cystic areas. There were 7 cases of typical carcinoid, 2 cases of atypical carcinoid, 2 cases of small cell carcinoma and 1 case of large cell neuroendocrine carcinoma. Conclu-sion Primary mediastinal neuroendocrine carcinoma is mainly located in the anterior-mediastinum. When the tumor is large, necrosis, cystic degeneration and invasive growth are easy to occur. The enhanced scan shows mild and moderate enhancement. Combined with clinical history, it can improve the accuracy of diagnosis.
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Objective To investigate the CT characteristics of primary pulmonary sarcomatoid carcinoma (PSC). Methods CT characteristics of 14 cases with primary pulmonary saromatoid cacinoma confirmed by surgical pathology were analyzed retrospectively. Results Among the 14 cases, the clinical manifestations were chest pain and cough in 6 cases, cough with blood-stained sputum in 5 cases, chest tightness and asthma in 2 cases, and no symptoms in 1 case. All the 14 cases had solitary masses in the lung. Carcinoma of 7 cases located in the upper lobe of the right lung, and carcinoma of 1 case located in the inferior lobe of the right lung. Carcinoma of 3 cases was located in the upper lobe of the left lung, and 3 cases were found in the inferior lobe of the left lung. Eleven cases had peripheral tumors and 3 cases had central tumors. CT plain scan revealed an isodense mass. There were 12 cases with uneven mass density and necrosis, and 2 cases had uniform mass density. The smooth margin was identified in 7 masses, and ill-defined margin and lobulation was shown in 7 masses. Cavity was observed in 1 mass, and speckled calcification was seen in 1 mass. Pleural invasion and thickening was in 5 cases, pneumothorax occurred in 1 case, and there was 1 case of liver metastasis. Enhancement scan showed patchy or annular enhancement around the mass, and the central enhancement of the mass was not obvious or uneven patchy enhancement. Conclusions The CT characteristics of primary pulmonary sarcomatoid carcinoma are solitary masses in the lung, especially if the mass is located in the periphery of the upper lobe of the right lung with uneven density, and enhancement scan shows patchy or annular enhancement around the mass.
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Objective To investigate the MRI features of ovarian theca fibroma (OTF) and compare it with histopathology features in order to improve the accuracy of OTF diagnosis. Methods The clinical data of 33 patients with OTF which were confirmed by surgical pathology from January 2005 to December 2016 were analyzed retrospectively. The signal characteristics and intensities of MRI were compared with histopathology features. Results The lump largest diameter of 33 patients with OTF was 2.5 to 18.0 (6.65 ± 4.46) cm. The substantial lump was in 22 cases. T2WI and T2WI fat suppression imaging showed a low or equal mixed signal among which there was slightly high or high signal, and T1WI imaging showed relatively uniform low signal. The cystic and solid lump was in 11 cases, including 7 cases of solid lumps and 4 cases of cystic-solid lumps, T2WI and T2WI fat suppression imaging of solid area showed equal or low signal among which there were a small patchy high or slightly high signal, and T2WI and T2WI fat suppression of cystic areas showed high signal; T1WI of solid and cystic areas showed uniform low signal. Enhanced appearance: in the 33 cases of enhancement, the parenchyma part showed mild enhancement, of which 14 cases were equal enhancement, 19 cases were uneven enhancement. During the arterial phase, all of 33 cases showed mild enhancement; 15 cases were obviously enhanced and 18 cases were mildly enhanced in the portal vein phase; 21 cases remained enhanced and the enhanced intensity of 12 cases decreased in the delayed phase. Comparison of histopathology features with MRI features showed that there were a higher proportion of fibrous cells under the microscope in 22 cases of parenchymal tumor, in which the fat suppression image of T2WI and T2WI showed equal or low signal in parenchyma, and T1WI showed even low signal; and there were a higher proportion of tumor cells and less collagen fibers under the microscope in 11 cases of cystic-solid tumor, in which the T2WI showed a slightly equal and higher signal and T1WI showed low signal in parenchyma. Conclusions The MRI features have some characteristics, such as low and equal signal of T2WI in parenchyma, mild enhancement during arterial phase and continuous enhancement in portal vein and delayed phase, which is helpful for diagnosis of OTF.
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Objective To summarize the computed tomography (CT) characteristics of primary hepatic angiosarcoma (PHA).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 9 PHA patients who were admitted to the Wenzhou Chinese Medicine Hospital (3 patients),Second Affiliated Hospital of Wenzhou Medical College (3 patients) and Wenzhou People's Hospital (3 patients) between January 2006 and June 2017 were collected.All 9 patients were fasting 8 hours before CT examination,and received screen scans without abdominal pressure.Scanning area was from dome of diaphragm to lower pole of the kidneys.Two associate senior doctors made images analysis.After preoperative examinations,patients selected whether or not to undergo treatment,resection,liver transplantation or chemotherapy + targeted therapy of monoclonal antibodies.Observation indicators:(1) plain scan appearances of CT;(2) enhanced scan appearances of CT;(3) results of pathological examinations;(4) follow-up and survival situations.Follow-up using outpatient,inpatient and imaging examinations was performed to detect tumor recurrence and stable condition up to December 2017.Results (1) Plain scan appearances of CT:9 patients showed solitary tumor,and tumors were respectively located in the left lobe (3 cases) and right lobe (6 cases) of the liver,including 5 with round tumors,3 with oval tumors and 1 with patchy tumor.The maximum diameter of tumor was 5.8-16.0 cm,with an average of 10.8 cm,including maximum diameter ＞ 6.0 cm in 8 patients.Tumors of 9 patients showed low-density shadow,and CT value was 32-46 HU,with an average of 41 HU,including homogeneous density in 3 patients and heterogeneous density in 6 patients;clear tumor boundary in 6 patients and unclear tumor boundary in 3 patients;tumor necrosis and cystolization in 4 patients,slightly strip-shaped high-density shadow in the center of tumor in 4 patients,and small patch-shaped intratunoral calcification in 1 patient.(2) Enhanced scan appearances of CT:① Arterial phase:tumors of 9 patients showed mild and moderate heterogeneous enhancements,with CT value of 63-76 HU and an average of 68 HU,including small patch-shaped or nodular enhancement in 3 patients and punetate or flocculent enhancement in the center of tumor in 6 patients.Tumors of 4 patients showed moderate enhancements,and tumor density was higher than that of normal liver parenchyma.Tumors of 5 patients showed mild enhancements,and tumor density was equal to or slightly less than that of normal liver parenehyma.② Portal vein phase:tumors of 9 patients showed mild and moderate,continuous and progressive enhancements,with a heterogeneous density,CT value of 56-71 HU and an average of 63 HU,including extended enhancement region in 3 patients,with a fusion and filling trend;small patch-shaped or nodular and lattice network-shaped enhancements of center and periphery of tumor in 6 patients,showing center filling and enhancement features of hepatic angiosarcoma.Tumors of 2 patients showed moderate enhancements,and tumor density was higher than that of normal liver parenchyma;tumors of 7 patients showed mild enhancements and tumor density was equal to or slightly less than that of normal liver parenchyma.③ Delayed phase:tumor enhancements of 9 patients slowly seceded,with CT value of 50-60 HU and an average of 53 HU,including density decreasing of periphery of tumor in 3 patients;partial fusion and center filling of enhancements in 6 patients,without enhancement in necrotic area.Tumor density was slightly higher than that of normal liver parenchyma in 2 patients,equal to that of normal liver parenchyma in 1 patient,and slightly less than that of normal liver parenchyma in 6 patients.(3) Results of pathological examinations:① Pathological examinations:cut surface of tumors showed grayish yellow and drab gray,and parts of surface were fish flesh shape,with internal bleeding and necrosis.Tumors were found in diffuse hyperplasia under microscopy,tumor tissues were made up of irregular and mutual matching lacuna vasorum,with infiltrating growths along hepatic sinus gap;hepatic angiosarcoma cells were spindle,round or irregular;there were slightly eosinophilia cytoplasm and deep chromatin of the nucleus,long-shaped or irregular nucleus,and different sizes of nucleolus.② Immunohistochemical staining:CD31 and CD34 were strongly positive,vimentin and Nestine were positive,and CK19,actin and creatine kinase were negative.(4) Follow-up and survival situations:of 9 patients,3 without treatment respectively died at 3,6 and 7 months;2 had recurrence at 4 and 5 months after tumor resection,with angiosarcoma invading right renal capsule,diaphragm and right pleural hemorrhage induced to haemothorax,and survived respectively for 13 and 15 months;2 respectively died of systemic metastasis at 4 and 8 months after liver transplantation;2 underwent chemotherapy + targeted therapy of monoclonal antibodies,and survived for 12 months.Conclusions CT appearances of PHA have certain characteristics.The plain scans of CT show heterogeneous low-density shadow,and enhanced scans of CT show small patch,punctate or nodular-shaped,continuous and progressive enhancements,with a clear boundary between tumor and liver parenchyma.
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Objective To investigate the features of soft tissue myxofibrosarcoma (MFS)on MRI.Methods The MRI data of 15 cases with MFS confirmed by surgery and pathology were analyzed retrospectively.Results Of all the 1 5 cases,7 were located in the thigh,3 were located in the lower leg,2 were located in the forearm,1 was located in the shoulders,1 was located in the back and 1 was located in the buttocks.The average maximum diameter of all lesions was (9.43±3.1)cm.Fifteen cases showed isointensity with slightly hypointensed fiber septa on T1WI.The signal intensity of MFS on T2WI was mixed.Five cases of low-grade MFS with myxoid area showed slightly hyperintensity,with sporadic small nodular and striped fibrous septa which showed hypointensity on T2WI and inhomogeneous enhancement.In 5 cases of high-grade MFS,the solid part and the septa showed hypointensity on T2WI;the myxoid matrix area and the necrotic area showed hyperintensity on T2WI.The myxoid matrix part showed mild inhomogeneous enhancement with peritumoral enhancement of"tail sign".Among the 5 cases,the solid part of 4 cases showed middle to severe annular heterogeneous enhancement,while the solid part of the remaining 1 case showed nodular enhancement.Five cases of intermediate-grade MFS showed slightly hyperintensity or isointensity on T2WI,and nodules and fibrous septa showed hypointensity.The enhanced solid part and myxoid matrix area showed mild to moderate inhomogeneous enhancement,and there were 2 cases with"tail sign".Conclusion MRI features of soft tissue myxofibrosarcoma have some characteristics including isointensity on T1WI,mixed signal intensity on T2WI,heterogeneous enhancement and peritumoral enhancement of"tail sign".
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Objective To investigate MSCT features of the intraductal papillary mucinous tumor of the pancreas.Methods The CT findings of 40 cases of intraductal papillary mucinous tumors confirmed by pathology were retrospectively analyzed,and the location,size,shape,edge and enhancement of the tumor were observed.Results Malignant (n=8):all of them were mainly pancreatic duct type,including 6 cases in the head of pancreas and 2 cases in the tail.All of them were multi-room,with 7 cases of cystic wall nodules and 7 cases of uneven septum thickening.The diameter of tumor cystic lesion was(41.0±0.5)mm on average,and the widest diameter of the dilated pancreatic duct was (6.9±1.0) mm.The cystic wall,wall nodule and interval were mild and moderate enhancement in the arterial phase,and continuous strengthening in the portal and delayed phases.Borderline(n=15):8 cases of main pancreatic duct type,1 case of branch pancreatic duct type,and 6 cases of mixed type.There were 10 cases in the head of the pancreas and 5 in the tail of the pancreas.There were 10 cases of multi room in the lesion,and the CT findings were composed of multiple clusters of small cystic lesions,with 3 cases of tuberous nodules on the cyst wall and 4 cases of irregular thickening of the cysts.5 cases were single room type,with capsule wall smooth and whole.The diameter of tumor cystic lesion was (28.0±0.5) mm on average,and the maximum diameter of the dilated pancreatic duct was (5.2±0.3) mm.The cystic wall and interval were mild and moderate enhancement in the arterial phase,and mild and continuous strengthening in the portal and delayed phases.Benign (n=17):1 case of main pancreatic duct type,10 cases of pancreatic duct type and 6 cases of mixed type;There were 12 cases in the head of the pancreas and 5 in the tail.All of them were single cystic type,and the cyst wall was smooth.The diameter of the tumor cystic lesion was (26±0.3) mm on average and the maximum diameter of the dilated pancreatic duct was (3.5±0.4) mm.There was no enhancement of the cystic wall in the arterial phase,mild enhancement in the portal phase,and mild continuous delayed phase in 2 cases,no enhancement in 15 cases.Conclusion MSCT expression of the intraductal papillary mucinous tumor of the pancreas has its characteristic features,which is helpful for the diagnosis and treatment of the disease.
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Objective To investigate the CT characteristics of ectopic pheochromocytoma and improve the diagnostic accuracy. Methods The CT imaging of 27 cases with surgery and pathology proved ectopic pheochromocytoma were retrospectively analyzed, and the tumor site, size, shape, density, cystic change, calcification, boundary and strengthening characteristics of these tumors were observed. Results Tumor located in mesentery in 6 cases and in the left side of abdominal aorta in 6 cases. Tumor located in duodenal ampulla, inferior vena cava, hepatic hilum, left renal portal, right adrenal gland and bladder in 2 cases for each spot. Tumor located in right jugular foramen, left carotid body and right lower lung in 1 case for each spot. The maximum diameter of the tumor was 2.8-19.0 (6.3 ± 2.4) cm. CT plain scan showed low density in 9 cases, isodensity in 10 cases, and high density in 8 cases. CT value was 20-58 (35.0 ± 11.6) HU. Enhanced CT scan showed that the CT value was 40-96 (74.0 ± 16.4) HU, 37- 90 (63.0 ± 14.2) HU in venous phase and 35-67(55.0 ± 12.6) HU in delayed phase. In arterial phase, 15 cases showed marked enhancement in parenchyma, 5 cases showed moderate enhancement, and 7 cases showed mild enhancement. In venous phase, the degree of enhancement decreased significantly in 5 cases, slightly in 15 cases, and continued in 7 cases. In delayed phase, the degree of enhancement decreased in 20 cases and continued in 7 cases. Conclusions The CT findings of ectopic pheochromocytoma have certain characteristics, CT examination is helpful to locate and characterize ectopic pheochromocytoma and to clarify the relationship between tumor and surrounding tissue structure.