Solid and papillary neoplasm of the pancreas: radiological-pathological study of five cases and review of the literature.

OBJECTIVE: To present five cases of the rare solid and papillary neoplasm of the pancreas with pathological correlation and review of the literature. PATIENTS AND METHODS: Five patients (all female, two Caucasian, one Philipino and two Hispanic) with solid and papillary neoplasm of the pancreas were reviewed. Four patients were under 28 years of age but one patient was 44 years old at presentation. Review consisted of imaging (CT in all and ultrasound in three patients), gross pathological and histological appearance (5/5 specimens), immunohistochemistry (4/5 specimens) and clinical follow-up. RESULTS: All five tumours were successfully resected without recurrence. All tumours were well-encapsulated but showed a wide spectrum of solid peripheral tumour with central cystic degeneration on imaging. Cystic spaces corresponded to haemorrhagic necrosis on histology. One tumour showed rim calcification. Immunohistological staining showed variable expression of both exocrine and endocrine markers. CONCLUSION: Although non-specific, solid and papillary neoplasm of the pancreas is characteristically a benign, well-encapsulated solid tumor with varying degree of central necrosis in young female patients. No racial predilection was demonstrated in this small series.

Uncomplicated cat-scratch disease: findings at CT, MR imaging, and radiography.

PURPOSE: To describe the epidemiologic, clinical, and imaging features of cat-scratch disease (CSD) to facilitate prompt recognition and noninvasive diagnosis of this condition. MATERIALS AND METHODS: Eight otherwise healthy patients with pet cats presented with the subacute onset of epitrochlear, axillary, or groin masses. All underwent cross-sectional imaging with computed tomography (CT) (n = 1) or magnetic resonance (MR) imaging (n = 7). Five patients underwent radiography of the elbow. RESULTS: In all patients, MR imaging and CT showed a poorly defined soft-tissue mass with extensive surrounding edema in an efferent lymphatic distribution. Radiography revealed only soft-tissue edema in two patients and an ill-defined soft-tissue mass with soft-tissue edema in three patients. Six patients underwent biopsy; the findings of all pathologic specimens supported the diagnosis of CSD. No patients underwent serologic evaluation. All patients were asymptomatic within 4 weeks of beginning antibiotic therapy. CONCLUSION: CSD should be considered in all patients with upper extremity or head and neck adenopathy and a history of cat exposure. Although generally not required for diagnosis, cross-sectional imaging will reveal a mass with surrounding edema in an area of lymphatic drainage.

Fractures of the sesamoid bones of the thumb.

Stability of the thumb metacarpophalangeal joint is provided by the collateral ligament proper, the accessory collateral ligament, the proximal and distal palmar ligaments, and the palmar plate. The adductor pollicis and flexor pollicis brevis muscles also provide soft tissue support and insert on the proximal phalanx of the thumb by way of the sesamoid bones. Fractures of the metacarpophalangeal joint sesamoid bones are uncommon but are often associated with sporting injuries during which the joint is acutely hyperextended. Routine anteroposterior and lateral radiographs may be unremarkable, and oblique views are often necessary to document the fracture. We report eight cases of fracture of the thumb metacarpophalangeal joint sesamoid. Seven were isolated sesamoid fractures, and one was associated with a metacarpophalangeal joint dislocation. None of the fractures were evident on anteroposterior radiographs, but all were seen in the oblique projection. Six fractures were treated with splint or cast immobilization for 2 to 3 weeks, and two were taped. Clinical followup of the seven patients with isolated sesamoid fracture at 6 to 8 weeks revealed pain-free normal function. One patient could not be reached for followup.

Case report 847. Juxtacortical aggressive fibromatosis (desmoplastic fibroma) of the forearm.

A case has been presented of a 14-year-old male patient who developed a fusiform mass on the volar aspect of his left forearm following two fractures. Microscopic features and plain radiography, CT, and MRI appearance of juxtacortical aggressive fibromatosis are discussed.