A Rare Case of Thoracic Intradural Epidermoid Cyst after Spinal Cord Stimulator Insertion: A Case Report

Spinal epidermoid cysts are extremely rare benign tumors and can be congenital or acquired.Acquired spinal epidermoid cysts are found in the lumbosacral region. To our knowledge, no case of epidermoid cyst related to spinal cord stimulator insertion has yet been reported. We report the MRI findings of a rare case of thoracic intradural epidermoid cyst acquired after spinal cord stimulator insertion in a 50-year-old female.

Extraskeletal Ewing's Sarcoma of the Thoracic Nerve Root: A Case Report

Extraskeletal Ewing's sarcoma (EES) is a rare malignant soft tissue tumor which is morphologically indistinguishable from skeletal ES. EES usually occurs in young adults and children and there has been only one case reported in a patient aged over 70 years old. We report a case of an EES arising from the first thoracic spinal nerve root in a 73-year-old female, which was misdiagnosed as benign nerve sheath tumor in preoperative imaging evaluation.

Mixed Adenoneuroendocrine Carcinoma of the Small Bowel in a Patient with Crohn's Disease: A Case Report

Mixed adenoneuroendocrine carcinoma (MANEC) is a rare tumor of the gastrointestinal tract that has both exocrine and neuroendocrine components. There are only 5 case reports about this combined tumor in the small bowel, arose in a background of long-standing Crohn's disease. Here, we report a case of small bowel MANEC in a 54-year-old male with Crohn's disease, who presented a heterogeneous enhancing, asymmetric small bowel wall thickening with small bowel obstruction and had a difficulty in differential diagnosis before surgery.

Primary Breast Carcinoma with Neuroendocrine Features: Imaging Features on Mammography and Ultrasonography

Primary breast carcinoma with neuroendocrine features is an extremely rare and underrecognized subtype of the breast carcinoma. And up to present, its biologic behavior, the most effective treatment, and prognosis are not well recognized. To diagnose this rare entity, special tumor stains of neuroendocrine markers are required, which are not routinely used. The imaging features of primary breast carcinoma with neuroendocrine features (BCNF) have not been accurately described due to the extreme rarity of this tumor type. We report the imaging features in a case of BCNF, with imaging findings different from the typical imaging findings of invasive breast carcinoma.

A Case of Granular Cell Tumor of the Breast in a Male Patient

A 52-year-old male complained of a painless, firm, and slow-growing mass in his right breast outer portion. The chest CT revealed a 3.3 cm-sized oval shaped, microlobulated, mild enhancing mass. Ultrasound showed a microlobulated marginated heterogeneous hypoechoic mass with internal vascularity and calcifications in the mass. On the ultrasound-guided core needle biopsy, the mass was confirmed as a benign granular cell tumor (GCT). The patient transferred to another hospital and underwent surgical removal of the lesion. GCT of the breast is uncommon and mostly benign neoplasm to originate from Schwann cell. Clinical and radiologic features of GCTs, including CT and ultrasound images, mimic malignancy and make diagnosis of GCT more difficult. The CT images of GCTs are much rarely reported. Physicians and radiologists must be aware of radiologic characteristics of this rare benign tumor for male breast, to avoid misdiagnosis this tumor for breast malignancy and overtreat.

Retroperitoneal Extraskeletal Osteosarcoma without Calcification Mimicking Pancreas Tumor: CT Imaging of a Case Report

Retroperitoneal extraskeletal osteosarcoma is a rare tumor. Typical imaging findings include a soft tissue mass accompanied with internal calcifications. The authors encountered a case involving a 44-year-old woman with a large retroperitoneal extraskeletal osteosarcoma, without calcification, that mimicked a pancreatic tumor. The present report highlights computed tomography features of retroperitoneal extraskeletal osteosarcoma, followed by a brief literature review. It is challenging for radiologists to diagnose retroperitoneal masses. However, in patients who present with large retroperitoneal masses, combined with clinical information including the elevation of serum alkaline phosphatase levels, retroperitoneal extraskeletal osteosarcoma should be considered in the differential diagnosis, even if the mass does not exhibit a gross calcification on the imaging.

Breast Cavernous Hemangioma with Increased Size on Ultrasonography: A Case Report

Cavernous hemangioma of the breast is a rare benign vascular tumor. It is usually diagnosed as non-palpable mass during imaging examination, incidentally. Common sonographic finding of the breast hemangioma is a superficially located, oval shape, circumscribed margin mass. But the appearance of breast hemangioma is variable and it can be difficult to diagnose in preoperatively. Here, we report a 68-year-old female case with palpable breast mass and increased size on follow up ultrasonography.

Isolated Myxoma in the External Auditory Canal: A Case Report

Myxoma is a benign mesenchymal neoplasm found in the heart, bone, and other soft tissues. However, myxoma of the external auditory canal is extremely rare. Since myxoma of the external auditory canal can be manifested as a part of the Carney complex, an autosomal dominant multiple familial neoplastic disorder, correct diagnosis and thorough investigation is important. We report a case of a 59-year-old man who presented to hospital with a complaint of growing mass within the right external auditory canal during one month. The surgical excision was done, and the histopathological examination revealed myxoma. In this article, we report the magnetic resonance imaging and computed tomography findings of the myxoma of the external auditory canal and correlate with the histopathological finding.

Relationship of Shape of Macrocalcification and Thyroid Cancer: Correlation with US and Pathologic Findings

PURPOSE: The purpose of this study was to categorize macrocalcifications into several subtypes by the US findings and to determine which type of macrocalcification in a thyroid nodule is associated with thyroid malignancy. MATERIALS AND METHODS: We retrospectively analyzed the macrocalcification patterns of thyroid nodules in 396 patients that underwent ultrasonography (US)-guided thyroid FNA or surgery in our institution between August 2009 and August 2011. Two radiologists evaluated US findings and categorized macrocalcifications into 5 subtyes : (A) solitary macrocalcification no association with thyroid nodule; (B) nodular macrocalcification(s) within indeterminate thyroid nodule; (C) dense macrocalcification without ability to interpret internal content by its posterior acoustic shadowing; (D) irregular-shaped macrocalcification(s); (E) macrocalcification with other suspicious malignant US finding(s). A chi-squared test and a Fisher exact test were used for comparison of categoric variables. The diagnostic sensitivity, specificity, positive and negative predictive values (PPV and NPV) were obtained. RESULTS: Among total of 417 nodules, 114 (27.3%) were suspicious malignancy or malignancy on histopathological result. Macrocalcification with other malignant US feature had the highest incidence of malignancy (77.5%), followed by irregular-shaped macrocalcification(s) (43.9%), and dense macrocalcification without ability to interpret internal content by its posterior acoustic shadowing (38.5%), solitary macrocalcification no association with thyroid nodule (8.3%) respectively, and nodular macrocalcification(s) with indeterminate thyroid nodule had the lowest incidence (7.5%). A nodule with macrocalcification with other malignant US finding(s) has the highest odds ratio (42.52), followed by a nodule with irregular-shaped macrocalcification(s) (9.65) and dense macrocalcification (7.72). Leaving macrocalcification with compositive malignant findings aside, irregular-shaped macrocalcification is more likely to be associated with increased risk for malignancy compared with other patterns of macrocalcification. CONCLUSIONS: Irregular-shaped macrocalcification is a fine indicator for differentiation between benign and malignant thyroid nodules on ultrasonography.

The Clinical Factors for Predicting Severe Diverticulitis in Korea: A Comparison with Western Countries

BACKGROUND/AIMS: It is unclear whether the risk factors associated with complicated diverticulitis in Asian and Western countries are the same. We evaluated the risk factors associated with severe diverticulitis (SD) in Korea and compared the clinical characteristics of diverticulitis according to location. METHODS: A retrospective review of 190 patients hospitalized with acute diverticulitis from January 2005 to June 2010 was conducted. SD was defined as one of the following: perforation, abscess, obstruction, sepsis, or peritonitis that required an urgent operation. RESULTS: Twenty-four patients (12.6%) were diagnosed with SD. SD was significantly associated with older age, a fever over 38degrees C, changes in bowel habits and a high visceral adipose tissue (VAT)/total adipose tissue (TAT) ratio. Multivariate analysis showed that the risk factors for developing SD were an age of 40 years or more (odds ratio [OR], 3.2; p=0.032), male gender (OR, 4.0; p=0.021) and left-sided diverticulitis (OR, 6.2; p=0.017). Right-sided diverticulitis (n=175, 92.1%) was significantly associated with younger ages, fewer changes in bowel habits, fewer comorbidities and non-SD. CONCLUSIONS: This study suggests that the risk factors for developing SD in Korea, where right-sided diverticulitis is predominant, are the male gender, an age of more than 40 years old, and left-sided diverticulitis. Given that there are different risk factors for developing SD in Western countries, different strategies for the treatment of diverticulitis in the Korean population seem to be needed.

Suppression of Autophagy and Activation of Glycogen Synthase Kinase 3beta Facilitate the Aggregate Formation of Tau

Neurofibrillary tangle (NFT) is a characteristic hallmark of Alzheimer's disease. GSK3beta has been reported to play a major role in the NFT formation of tau. Dysfunction of autophagy might facilitate the aggregate formation of tau. The present study examined the role of GSK3beta-mediated phosphorylation of tau species on their autophagic degradation. We transfected wild type tau (T4), caspase-3-cleaved tau at Asp421 (T4C3), or pseudophosphorylated tau at Ser396/Ser404 (T4-2EC) in the presence of active or enzyme-inactive GSK3beta. Trehalose and 3-methyladenine (3-MA) were used to enhance or inhibit autophagic activity, respectively. All tau species showed increased accumulation with 3-MA treatment whereas reduced with trehalose, indicating that tau undergoes autophagic degradation. However, T4C3 and T4-2EC showed abundant formation of oligomers than T4. Active GSK3beta in the presence of 3-MA resulted in significantly increased formation of insoluble tau aggregates. These results indicate that GSK3beta-mediated phosphorylation and compromised autophagic activity significantly contribute to tau aggregation.

Recurred Myofibroblastoma of Breast After Excision: A Case Report

Myofibroblastoma of the breast is a rare benign mesenchymal tumor that is known to occur in middle-aged and elderly men, yet there are some recent reports showing no certain difference for the gender distribution of this malady. Localized mass excision can usually provide a complete cure. To the best of our knowledge, there have been no reports of metastasis or recurrence of this tumor. Here we describe the sonographic findings of a case of recurrent myofibroblastoma after surgical excision for suspected fibroadenomas in both breasts of a 25-year-old woman.

The Ultrasonographic Findings of a Gallbladder Schwannoma: A Case Report

A schwannoma of the gallbladder is an extremely rare tumor. We report a case of a 45-year-old woman with a polypoid mass in her gallbladder. The mass was discovered incidentally as a heterogeneous enhancing mass in the infundibulum of the gallbladder on an abdominal CT scan performed during an evaluation of a reported nonspecific left lower abdominal pain. An ultrasonography revealed that the overlying mucosa of gallbladder was intact. Moreover, a laparoscopic cholecystectomy was performed and the mass was confirmed as a gallbladder schwannoma.

Sonographic Findings of Variable Chest Wall Disorders

Variable chest wall disorders include hemorrhage, inflammation and a tumor on the chest wall. Especially in females, abnormal anterior chest wall findings can appear as breast lesions due to the anatomic relationship between the chest wall and the breast. Sonography is the first diagnostic tool to utilize for chest wall disorders and has an important role for the differential diagnosis. In this study, we introduce sonographic findings of the various chest wall disorders that are discovered incidentally during an examination for a palpable mass or pain in the breast. We also describe sonographic findings that additionally performed of sonography-guided core needle biopsy.

Differentiation between Small Bowel Intussusception in Children and Adults and the Radiological Findings which Require an Operation

PURPOSE: To assess the differences in small bowel intussusceptions between children and adults, and to interpret the radiological findings requiring a surgical procedure. MATERIALS AND METHODS: A total of 62 study subjects (35 children, 27 adults) with small bowel intussusception diagnosed by US or CT and seen between January 2005 and December 2007 were included in this study. Two radiologists retrospectively reviewed both the medical records and radiological findings of each study subject. We contrasted the range of features found to be typical of small bowel intussusception for both children and adults based on cause, abdominal symptoms, diagnostic tools, and treatments. Also, we evaluated the radiological findings requiring a surgical procedure. RESULTS: The causes of small bowel intussusception were not identified in children; however, 4 adults were found to have tumors (a lipoma, a hemangioma, 2 metastases) (p=0.031). All of the children (100%) and 8 adults (29.6%) had abdominal symptoms (p < 0.001). The primary diagnostic tool in children was the US (31 cases, 88.6%), as opposed to the CT in adults (27 cases, 100%) (p < 0.001). A spontaneous reduction was confirmed in all children (100%) and supposed in 23 adults (85.2%) (p=0.031). The noteworthy radiological findings of 4 study subjects having undergone a surgical procedure are masses at the lead point and small bowel obstruction (p < 0.0001). CONCLUSION: Cases of small bowel intussusception in children are different from cases observed in adults, based on cause, symptoms, and diagnostic tools. However, most cases are spontaneously reduced. Important radiological findings requiring a surgical procedure were found to be caused by masses at the lead point and at the small bowel obstruction.

Radiologic Findings of Granulomatous Mastitis

PURPOSE: To describe the radiologic findings of granulomatous mastitis of the breast. MATERIALS AND METHODS: This study included 19 patients (age range: 22 to 56 years; mean 37 years) with 22 lesions that were pathologically confirmed as having granulomatous mastitis. All the patients underwent a breast ultrasonography and 13 patients underwent a mammography. RESULTS: The results of the mammography revealed focal asymmetry (n=9), multiple ill-defined isodense nodules (n=2), ill-defined nodular density on a craniocaudal view (n=1), and unremarkable finding (n=1). The sonographic findings included continuous or discontinuous multiple tubular and nodular low echoic lesions (n=7), ill-defined heterogeneously low echoic lesion (n=5), irregular-shaped, ill-defined low echoic mass (n=4), fluid collection with internal floating materials suggesting the presence of an abscess (n=4), ill-defined heterogeneously low echoic lesion and abscess (n=1), and multiple ill-defined nodules (n=1). CONCLUSION: In the case of granulomatous mastitis, the mammography results indicate a lack of specificity between normal findings and focal asymmetry. The sonographic findings indicate that ill-defined heterogeneously low echoic lesions or irregularly shaped, ill-defined low echoic masses are difficult to differentiate from breast cancer. The sonographic findings of abscesses indicate a difficulty in differentiating them from cases of pyogenic mastitis. However, multiple tubular and nodular low echoic lesions, especially with a continuous appearance, should point to granulomatous mastitis, and is helpful in its differential diagnosis and treatment.

Diagnostic Accuracy of Computed Tomography for the Lymph Node Staging of Endoscopically Resectable Early Gastric Cancer / 대한소화기내시경학회지

BACKGROUND/AIMS: Accurate staging of the lymph nodes (LNs) before endoscopic mucosal resection (EMR) is important. We evaluated the accuracy of CT for LN staging in patients the endoscopically resectable early gastric cancer (EGC). METHODS: The medical records of 155 EGCs patients who had undergone an operation were analyzed. The pre-operatively performed multidetector CT scans and the post-operative histopathologic findings were reviewed for comparing the LN staging with that using the Japanese classification system. Endoscopically resectable EGC was defined as EGC without LN metastasis and also the EGC that satisfied the EMR criteria according to the Japanese guideline. RESULTS: The diagnostic efficacy of CT for LN staging of all the enrolled EGC patients was as follow: accuracy 65.2%, overstaging rate 29.7%, understaging rate 5.2%. The overall accuracy and the overstaging rate of CT for LN staging of endoscopically resectable EGC were as follows: EGC without LN metastasis [69.8% (97/139), 30.2% (42/139)], EGC satisfying extended criteria [72.5% (58/80), 27.5% (22/80)] and EGC satisfying limited criteria [79.2% (19/24), 20.8% (5/24)]. The accuracy of the EMR criteria for predicting node negative EGC were as follows: the extended criteria 98.8% (79/80), the limited criteria 100% (24/24). CONCLUSIONS: Our study showed that prediction of LN metastasis before EMR according to CT staging had limited value due to the tendency of overestimation. Therefore, we should preferentially consider the treatment strategy according to the EMR criteria.

CT Findings of Swyer-James-MacLeod Syndrome in Adults: Are There Any Different Findings with Aging?

PURPOSE: We wanted to evaluate whether there is any different finding on CT with aging for the patients suffering with adult Swyer-James-MacLeod Syndrome (SJMS). MATERIALS AND METHODS: We included 11 patients (7 males and 4 females) who underwent chest CT scan among 18 patients who were suspected of suffering with SJMS on chest radiographs. The range of age was from 28 to 85 years (mean: 58.5). We evaluated the diameter of both the main pulmonary artery (MPA) with its ratio, and the diameter of the pulmonary trunk (PT) to evaluate the possibility of pulmonary arterial hypertension, and the presence or absence of bronchiectasis. We also evaluated the relationships between these findings and aging. RESULTS: SJMS affected the left lung in 10 of 11 patients. The mean diameter of the main pulmonary artery of the normal lung was 2.5 cm and it was 1.6 cm in the involved site. The mean ratio of the normal MPA diameter to the involved one was 1.6 and this did not correlate with age (p>0.1). The mean diameter of the pulmonary trunk was 2.8 cm and this increased with age (p0.5). CONCLUSION: SJMS absolutely affected the left lung much more than the right lung. All the patients demonstrated about 1.6 times the compensatory hypertrophy of MPA of the normal lung compared with that of the affected lung on chest CT, which was irrespective of age. The presence or absence of bronchiectasis has no correlation with age.

Solitary Schwannoma in the Breast: A Case Report

Schwannoma (neurilemoma) is a benign nerve tumor derived from the nerve sheath. The most common locations are the flexor surfaces of the extremities, and the head and the neck. Schwannoma of the breast is unusual. To our knowledge, few studies have reported the radiologic appearance of schwannoma in the breast and there has been only one report from Korea (1-3). This tumor can be clinically and radiologically considered to be fibroadenoma, which is a common benign tumor of the breast. We describe the mammographic and sonographic findings of a case of schwannoma in the breast.

Clinical Significance of Incidentally Detected Bowel Wall Thickening on Abdominal Computerized Tomography Scan / 대한소화기학회지

BACKGROUND/AIMS: Due to widespread use of computerized tomography (CT) scan to examine patients with variable disease or complaints, detection of incidental or unsuspected gastrointestinal abnormalities are not uncommon. Clinical significance of incidentally detected bowel wall thickening (BWT) on abdominal CT scan is uncertain at present. Despite the necessity for the clinical guidelines describing the evaluation of incidental bowel wall thickening on CT scan, there have been few studies concerning these radiological abnormalities. Our objective was to determine whether endoscopic evaluation is necessary for the evaluation of these abnormal findings. METHODS: This study evaluated one hundred and forty patients with incidentally detected BWT on abdominal CT scan in Inje University Sanggye Paik Hospital from 2001 to 2003. 102 patients of those were proceeded by endoscopic evaluation. Forty-eight patients had received upper endoscopy, 26 patients had colonoscopy, while 28 patients had sigmoidoscopy. RESULTS: Endoscopic work up revealed significant abnormalities in 83% of patients with incidental findings of the distal esophagus, 73% of patients with thickening of the stomach, 35% of patients with thickening of the right colon, and 71% of patients with thickening of the sigmoid colon and rectum. CONCLUSIONS: Although significant pathologic findings are less common in thickening of the right colon than other bowel wall thickening, all of these incidental findings on CT scan warrant further endoscopic evaluation.