Radiologic diagnosis of a type-III pleuropulmonary blastoma.

Pleuropulmonary blastoma (PPB) is a rare and aggressive dysontogenic neoplasm, occurring in children under the age of 6 years in most cases. CT and MRI findings are well-known, a mixed solid and cystic lesion with variable contrast enhancement and a necrotic centre. We report the radiologic features of type III PPB case.

Interrelationship between liver hemodynamics and tumor metabolism in liver metastases: diagnostic value of Doppler perfusion index revisited.

It should be expected that the hepatic blood flow increase in the cases with liver metastasis. We aimed to find out if there is a correlation between Doppler parameters and hepatic metabolic activity in oncology patients. 35 patients with hepatic metastases who were identified by 18F-fluorodeoxyglucose positron emission tomography scan and assessed with Doppler ultrasound were included in this prospective study. Patients with hepatic disease, cardiac dysfunction, dehydration, history of alcoholism, intake of antihypertensive or vasoactive medication were excluded. Volume flow of the proper hepatic artery and the portal vein were measured in the hepatoduodenal ligament by Doppler sonography. Doppler perfusion index (the ratio of the hepatic artery flow to the total liver blood flow) and flow volumes of 31 age matched subjects were compared. Both flow of the proper hepatic artery and portal vein were found to be significantly higher in patients with liver metastasis. The mean Doppler perfusion index value was 0.2 ± 0.13 in hepatic metastases whereas 0.13 ± 0.05 in control group. Doppler perfusion index was significantly higher in liver metastases (p=0.008). A positive correlation was found between the maximum standardized uptake value of the liver and flow volume of the proper hepatic artery (r=0.774, p=0). Blood flow of the proper hepatic artery and Doppler perfusion index correlates with hepatic standardized uptake value. Flow measurements of the liver may become an important parameter for selecting patients for further positron emission tomography scan and following-up the response after systemic and local therapeutic procedures.

Post evar endovascular revision of late onset stent graft collapse due to type 1 endoleak in a complicated case with left limb occlusion and solitary kidney.

Type 1 endoleak is one of the most frequent complication usually seen at the initial phase of EVAR procedure. Balloon dilatation is mostly used to oversize the proximal or the distal part of the orifice to stabilize the attachment of the graft stent to the aortic wall. Late onset of type 1 endoleak with graft stents may cause severe lumen compression of the stent and aneurysm enlargement which might cause a serious problem especially in a patient whose graft stents left iliac branch is thrombosed and the left leg is supplied by the bypass graft from right CFA. Although operation was advised by the endovascular specialists the procedure was done in our hospital as the patient preferred the endovascular method instead of open surgery.

Massive osteoradionecrosis of facial bones and soft tissues.

Osteoradionecrosis (ORN) is one of the most serious and uncommon complications in head and neck irradiation for cancer. It is defined as a combination of necrotic soft tissue and bone not being able to heal spontaneously, it demonstrates a general resistance to antibiotics and requires conservative surgical management. Even with modern radiation therapy, its incidence is highly unpredictable and varies between 4-30%. We report on a patient with a huge open cavitation in the cheek, communicating with the mouth and extending to contralateral periodontal gingival and temporal fossa. He had been treated with radiation therapy for nasopharyngeal cancer 5 years ago and presented with restriction of the opening of the mouth. Osteonecrosis complicated with osteomyelitis was evident in bilateral mandible and maxillary bones and the temporal bone. The ramus of the mandible and zygomatic arc were resected, subtotal maxillectomy was performed and the defect was repaired by a free double island flap from the scapular and parascapular osteocutaneous latissimus dorsi muscle flap supplied by subscapular artery. To our knowledge, this is the most extensive bone and soft tissue destruction due to radiation reported in the literature.

A case of calcified ureteritis cystica: an indiscernible condition from ureterolithiasis.

Ureteritis cystica is characterized by formation of multiple cysts in the wall of the renal pelvis or ureter. The clinical course is usually slow, but manifests if the cysts cause infection or obstruction. Stones are further complication to the disease. In this case study, we present a 39-year-old male originally referred with renal colic and misdiagnosed as ureterolithiasis due to the calcifiying cysts.

Radiographic size versus surgical size of renal masses: which is the true size of the tumor?

PURPOSE: The size of a renal neoplasm is important for staging, prognosis and selection of appropriate treatment. Our aim was to determine whether there is a discrepancy between the radiographic and pathological size of renal tumors. PATIENTS AND METHODS: The maximum size of 35 resected renal tumors was measured by computed tomography (CT) by 2 independent observers. The radiographic and pathological sizes were compared by size range and tumor radiological features. RESULTS: Although the radiographic and pathological size for all tumors was not statistically different (7.50 vs. 6.25 cm, p=0.452), the average radiographic size was larger than pathological tumor size in tumors smaller than 7 cm. Solid tumors showed more reduction in size (17.02%) compared with cystic and necrotic tumors (p=0.731). Only the radiographic size of ill-defined tumors was smaller than their pathological size (average 33.33%; p=0.865). The influence of tumor side (left or right kidney) and its location within the kidney did not influence the degree of decrease (p=0.147 and p=0.981, respectively). CONCLUSION: A reduction in the size of renal tumors is observed in tumors<7 cm, which is explained by vasoconstriction during the temporary renal artery occlusion, surface hypothermia and blood loss during the operation. If this reduction of size is secondary to surgery, the radiographic size of renal tumors should be considered in staging and selecting the appropriate treatment for tumors<7 cm for which the decision of surgical approach depends on the size of the tumor.

Synovial cysts of the lumbar facet joints: a retrospective magnetic resonance imaging study investigating their relation with degenerative spondylolisthesis.

Patients with synovial cysts of the facet joints were compared with patients with degenerative spondylolisthesis (DS), based on the magnetic resonance imaging (MRI) findings of their spondyloses. The lumbar MRI of 30 patients with DS (group 1) 24 patients with synovial cysts of the facet joints (group 2) were studied. All patients were evaluated in terms of facet joint arthritis, disc degeneration, facet joint effusion, and the thickness of the flaval ligament. 54.1% of the patients with synovial cysts had associated DS. The mean grade of disc degeneration (2.43+/-0.50 and 2.13+/-0.68 in groups 1 and 2, respectively) and the mean thickness of the flaval ligament (3.20+/-1.22 mm and 3.83+/-1.46 mm in groups 1 and 2, respectively) did not differ between the groups (p=0.093 and p=0.097). The mean grade of facet joint osteoarthritis (2.53+/-0.51 and 2.08+/-0.72 in groups 1 and 2, respectively) was significantly higher in group 1 (p=0.18). The co-existance of synovial effusion was significantly higher in cases with synovial cysts. (p=0.008). Synovial cysts are associated with DS and facet joint osteoarthritis. The presence of synovial effusion and the high degree of disc degeneration are prominent features in patients with synovial cysts. Although osteoarthritis and DS are highly concomitant with facet joint synovial cysts, both conditions do not invariably lead to a cyst formation.

Gorham-Stout disease of the humerus.

Gorham-Stout disease is characterized by local proliferation of small vascular or lymphatic channels resulting in progressive destruction and resorption of bone. The etiology and pathogenesis of the disease remains mostly unknown, despite some 175 reported cases. A case of Gorham-Stout disease of the humerus in a 14-year-old boy is described. The patient presented with progressive pain and deformity of the right arm. Although the disease was described in different bones of the body its location in the humerus is rare. We report the natural history and clinical follow-up in a young patient. A fibular graft was performed but 10 months later, resorption and pathological fractures occurred again. This study presents the radiographic and MRI features of Gorham disease.

Hibernoma: a benign lipomatous tumor mimicking liposarcoma.

Hibernoma is a rare, benign, slow-growing soft tissue tumor. It was named after its resemblance to the brown fat found in hibernating animals. Due to its rich vascularity and magnetic resonance appearance, this tumor may mimic a liposarcoma before tissue diagnosis. Complete resection with meticulous hemostasis is enough for treatment. Malignant potential has not been demonstrated. Herein we present a case of hibernoma arising from the left groin in a young man. The clinical presentation, radiographic and histopathologic features of this rare benign soft tissue tumor are presented. This tumor is clinically important because it is indistinguishable from malignant lesions.

Magnetic resonance imaging of muscular involvement in juvenile dermatomyositis: case report.

A case of 5 year old juvenile patient with dermatomyositis together with conventional and diffusion-weighted MRI images is reported. The reported case was atypical for the pattern of involvement of the accompanying oedema which was affecting distal parts of the extremities and anterior muscle groups. Electromyography was negative. The case confirmed by a pathologist demonstrates the use of diffusion weighted imaging in determining unequivocal oedema and its exact extent.

An unusual association of cutaneous myxoma with Favre-Racouchot syndrome.

We present a case of bilateral foot multiple cutaneous myxomas, associated with Favre-Racouchot syndrome (FRS) which is a dermatologic condition of multiple large comedones and nodules of the periorbital areas. As the mucocutaneous and cardiac manifestations were absent, Carney complex was excluded. To our knowledge, there has been no report of the association of cutaneous myxoma and FRS. Additionally, the magnetic resonance images of this benign tumor which is rare in the literature are presented.

Non specific magnetic resonance features of chondromyxoid fibroma of the iliac bone.

Chondromyxoid fibroma is a benign cartilaginous neoplasm. The tumor is rare, perhaps the rarest of all bone tumors. It is more common in long bones and rare in pelvic bones. We report a case of a 31-year-old woman with chondromyxoid fibroma arising from the iliac bone and presenting with leg pain due to compression on the femoral nerve. Magnetic resonance imaging (MRI) features were non specific for chondromyxoid fibroma. We emphasize the need to consider it in the differential diagnosis of chondrosarcoma.