Intraparotid Lymphadenopathy: Ultrasonographic and CT Findings

PURPOSE: The purpose of this study was to evaluate the ultrasonographic and CT findings of various diseases that affect the intraparotid lymph node. MATERIALS AND METHODS: The subjects were 32 patients having various diseases involving the intraparotid lymph node. The final confirmed diagnoses were nonspecified benign inflammatory lymphadenopathy (n=20), metastasis (n=5), tuberculous lymphadenitis (n=4), and lymphoma (n=3). For the nonspecified benign inflammatory lymphadenopathy, there were multiple lesions in five patients and bilateral lesions in two patients, and a total of 26 lesions were included in this study. The pathologic proof of the diagnosis was made for 4 of 26 lesions, and by ultrasound follow-up on 22 of 26 lesions. All the patients underwent ultrasound. Color Doppler imaging was also performed in 19 patients and contrast-enhanced CT was also performed in 8 patients. All cases with metastasis, tuberculous lymphadenitis and lymphoma were pathologically confirmed and these patients were all examined with contrast-enhanced CT. RESULTS: For the nonspecified benign inflammatory lymphadenopathy, all the lesions were seen at the superficial lobe. All twenty six lesions were observed as well-defined ovoid or round hypoechoic nodules with posterior sonic enhancement on ultrasonography. A central echogenic hilum was seen in 12 of 26 inflammatory lymphadenopathies (46%), and a central hilar vascularity was noted in 13 of 19 inflammatory lymphadenopathies (68%) on color Doppler imaging. Contrast-enhanced CT showed well-defined nodules with homogeneous enhancement in most lesions. In 3 lesions, a central low density hilum was seen within a lymph node. In 12 cases with metastasis, tuberculous lymphadenitis and lymphoma, there were multiple lesions in 6 cases. CT revealed intraparotid masses with or without central necrosis and the associated multiple lymph node enlargements in the ipsilateral neck region, and their appearances were similar to that of parotid mass. CONCLUSION: Nonspecified benign inflammatory lymphadenopathy involving intraparotid lymph nodes often demonstrated characteristic ultrasonographic findings, including a central echogenic hilum on gray scale US and central hypervascularity on color Doppler ultrasonography. In the metastasic lesions, the tuberculous lymphadenitis and the lymphomas, the multiplicity of lesions and the associated enlarged lymph nodes in the ipsilateral neck region could be helpful in the differential diagnosis.

Tracheal Involvement of Bronchus-Associated Lymphoid Tissue Lymphoma: A Case Report

Primary malignant tumors of the trachea are rare, the most prevalent histologies beeing squamous cell and adenoid cystic carcinoma. A review of the literature revealed only ten cases of primary tracheal or bronchial non-Hodgkin's lymphoma. We describe a case in which tracheal involvement of bronchus-associated lymphoid tissue lymphoma, a subtype of non-Hodgkin's lymphoma, occurred.

Cystic Lymphangioma Arising from the Mesoappendix: A Case Report

Intra-abdominal lymphangiomas are a rare entity. We report a case of cystic lymphangioma arising from the mesoappendix of a 21-year-old female patient. Barium enema examination revealed a pliable submucosal lesion at the cecal base, without contrast filling in the appendiceal lumen. US and CT demonstrated a multiseptated cystic mass in the pericecal and periappendiceal areas.

Preoperative Lymph Node Staging of Advanced Gastric Cancer with Helical CT: Assessment of New TNMClassification

PURPOSE: To evaluate preoperative N staging of advanced gastric cancer(AGC) using helical CT according to thenew TNM classification. MATERIALS AND METHODS: Helical CT findings of AGCs in N staging were prospectivelyevaluated and correlated with pathologic staging in 60 patients with AGCs who underwent surgery. In all patients,contrast-enhanced helical CT with 5 -7 mm silce thickness and 5 -7 mm reconstruction was performed after ingestionof 600 - 800ml of water. A total of 150ml of contrast medium was administered intravenously at a rate of 4mL/secand CT scans were obtained 60 seconds after the initiation of intravenous administration of contrast medium. CTnodal status was assessed according to the 1997 UICC/AJCC N staging system as: N0, no lymph node metasta-sis; N1,1 -6 metastatic regional lymph nodes; N2, 7 -15 metastatic regional lymph nodes; N3, more than 15 metastaticregional lymph nodes. Lymph nodes at least 5mm in short-axis diameter or more than three lymph nodes in a focalarea (clustered appearance) regardless of size were interpretated as positive for metastasis. RESULTS: Of thetotal 1,334 lymph nodes dissected, 352(26%) were positive for metastasis. The sensitivity of helical CT scans in Nstaging of AGCs was 61%, specificity was 36 %, and overall accuracy was 55% (33 of 60cases), Nine(15 %) cases wereoverstaged and 18(30 %) were understaged. CONCLUSION: Our results indicate that the results of helical CT inpreoperative N staging of AGCs according to the new TNM classification showed no improvement despite theapplication of favorable criteria for lymph node metastasis. Further evaluation using various analytic approachesis necessary.

Dynamic CT Findings of Bilateral Castleman Disease in the Neck: A Case Report

We present a case of hyaline vascular type Castleman disease involving the bilateral cervical lymph nodes. To our knowledge, no previous case of this localized form of the disease has been reported. Dynamic CT demonstrated a hypervascular pattern of enhancement, with central less enhanced areas that corresponded histologically to fibrosis. For the diagnosis of this uncommon lymph node disease, these findings might be helpful.

Reassessment of Size Criteria on Lymph Node Metastasis of Gastric Carcinoma

PURPOSE: To reassess the usefulness of criteria for lymph node size in predicting metastatic lymph node ofgastric adenocarcinoma and to determine appropriate size criteria. MATERIALS AND METHODS: We reviewed the pathology of 1669 lymph nodes from 105 gastric adenocarcinoma patients and measured their long and short axis diameters. To determine the degree of lymph node shrinkage during fixation for pathologic examination, we measured the size of 105 lymph nodes both in the fresh state and on pathology slides after fixation and obtained their correlation equation ; this was used to determine the fresh-state size of the 1669 nodes. We analysed the distribution of metastatic and nonmetastatic lymph nodes according to their long and short axis and plotted a sensitivity-specificity curve to determine the appropriate size criteria for metastatic lymph nodes. RESULTS: There were 535 metastatic lymph nodes and their mean diameter was 8.2+/-4.9mm on the long axis and 5.7+/-3.8mm on the short axis. The mean diameter of nonmetastatic lymph nodes was 4.9+/-2.8mm, 3.0+/-1.7mm on the long and short axis, respectively. There difference in size between metastatic and nonmetastatic lymph nodes was not statistically significant. The (P>0.05) distribution curve of metastatic and nonmetastatic lymph nodesoverlapped over wide range of lymph node size. We determined appropriate size criteria at the point where sensitivity and specificity curves crossed, but the form of the curves was such that this was difficult. CONCLUSION: Appropriate size criteria on lymph node metastasis were 6.2mm for #1-6 lymph node group and 8.1mm for #7-12 lymph node group on long axis diameter and 4.0mm, 5.3mm on short axis diameter. But, even with this size criteria the expected accuracy was low(67-70%). This results showed limitation of size criteria to diagnose metastatic lymph node.

Lymphangitic Carcinomatosis of the Lung: Serial Changes on High-Resolution CT

PURPOSE: To present initial and follow-up HRCT findings of lymphangitic carcinomatosis of the lung. MATERIALS AND METHODS: Both initial and follow-up HRCT scans were obtained in 18 patients with lymphangitic carcinomatosis of the lung. After dividing the patients into two groups (with anticancer chemotherapy (n=12) and without chemotherapy (n=6), changes of pulmonary parenchymal abnormalities (percentile increase or decrease in the extent of each pattern) were assessed and compared on initial and follow-up HRCTs. RESULTS: Findings on initial CT were interlobular septal thickening (n=18) (smooth in 15 and mixed smooth and nodular in three), thickening of bronchovascular bundles (n=17), areas of ground-glass opacity (n=15), polygonal lines (n=15), and nodules (n=10). With chemotherapy, the finding of polygonal lines decreased by 20/3%, while findings of ground-glass opacity, bronchovascular bundle thickening, septal thickening, and nodules remained stable. Without chemotherapy, all CT patterns of abnormalities except nodules increased by 45-88%. In three patients who did not undergo chemotherapy, smooth interlobular septal thickening changed to nodular thickening. CONCLUSION: Lymphangitic carcinomatosis of the lung manifests initially as smooth thickening of the interlobular septae, bronchovascular bundle thickening,areas of ground-glass opacity, and polygonal lines, as seen on HRCT. Without chemotherapy, the extent of CT findings increases and there is a tendency for smooth septal thickening to change to nodular thickening. Chemotherapy induces improvement or cessation of the progression of CT findings.