Patrón de crecimiento y características imagenológicas de tumores malignos sinonasales / Growth pattern and imaging characteristics of malign synonasal neoplasms

Objetive: To describe the local and regional anatomical spread and growing pattern of the sinonasal malignant tumors based on pretreatment CT and MRI findings. Material, patients and methods: The current study was performed as a retrospective clinical series that includes 21 patients studied and treated in MD Anderson Cancer Center, Houston, Texas. Anatomical analisis was performed based in CT and MRI findings. Results: Here is described in detail the growing pattern of sinonasal malignancies and the corresponding secondarily affected structures. Conclusion: The sinonasal malignancies mainly affects elderly people, corresponding to carcinomas, arising frequently from the maxilary sinus that compromises the suprastructure and secondarily involves the pterigopalatine fossa, orbits and nasal cavity. Imaging based anatomical mapping of the tumoral spread leads the desition of resectability and focuses the attention in possible areas of recurrence

Hallazgos en resonancia magnética de sarcoma sinovial primario y recurrente / Findings in magnetic resonance of primary and recurrence synovial sarcoma

Object: To evaluate MRI findings of primary synovial sarcoma and to differentiate recurrent tumor from post-treatment changes. Material and methods: We retrospectively analyzed pre and post-treatment MRI findings of proven primary and recurrent synovial sarcomas in 22 patients. MRI findings were correlated with histological diagnoses and clinical follow-ups for 1-5 years. Results: Ninety-one percent of the studied synovial sarcomas were in the extremities (68 percent) in the lower extremities), and sizes ranged 3-12 cm. Aproximately 73 percent of the primary tumors were located less than 5 cm. from a synovial joint. Most common MRI findings were nodular masses with heterogeneous intermediate signal intensity (SI) on T1 weighted images (WI), high SI on T2-WI and heterogenous contrast enhancement. A cystic component was recognized in 17 cases (77 percent). Ninety percent of the sarcomas were oval and well-defined. MRI findings consistent with intratumoral hemorrhage was noted in 73 percent. Lung and nodal metastases were found in 27 percent and 5 percent respectively. Lung metastases were found more commonly in biphasic than monophasic histologic types (50 percent vs 41 percent). Involvement of adjacent bones was seen in 23 percent (3 biphasic abc 2 monophasic sarcomas). Calcification was only noted in three monophasic sarcomas on plain films and CT. Two recurrent sarcomas showed focal nodular masses with high SI on T2-WI and homogenous contrast enhancement. Post-treatment changes revealed diffusely increased SI on T2-WI and slight diffuse contrast enhancement with feathery appearence. Conclusion: Detection of primary and recurrent synovial sarcoma can be made by recognizing both morphology and MR signal characteristics including contrast enhancement pattern. Contrary to other reports, sarcomas with biphasic histologic type showed more metastases and bone involvement. Association between calcifications and monophasic type was not previously reported