A child with an intra-abdominal testicular teratoma: a case report and review of prepubertal cryptorchid germ cell tumors.

OBJECTIVES: We report the case of a tumor in an intra-abdominal cryptorchid testis of a 7-month-old male infant. Torsion of a testicular teratoma was confirmed by pathologic examination. A review was undertaken to identify and characterize other reports of prepubertal cryptorchid germ cell neoplasms. METHODS: Cases of testicular germ cell neoplasms in association with cryptorchidism in phenotypically normal males were identified through a MEDLINE search of the English literature and review of published bibliographies. RESULTS: A total of 14 cases were identified with testis location provided in 12 patients. Half of the neoplasms were located in abdominal testis, and all of these were associated with torsion, although 2 of 6 patients were asymptomatic. Two patients had tumors in the contralateral normally descended testis. Teratoma was the most frequently encountered tumor type. CONCLUSIONS: Characteristics of prepubertal cryptorchid testicular germ cell tumors reflect those seen in post-pubertal cryptorchid tumors in location but differ in histologic type. Possible pathogenesis is discussed. Follow-up was not provided in all cases although outcome appears to be good. We believe that these lesions are likely underreported.

Plain film and CT observations in prostaglandin-induced bone changes.

Prostaglandin E1 intravenous infusion is used in infants with ductal-dependent congenital heart disease to maintain ductal patency and prolong life until palliative or corrective surgery is feasible. Complications of prostaglandin administration include fever, diarrhoea, hypotension, apnoea, bradycardia, pseudowidening of the cranial sutures, underossification of the calvarial bones, periostitis, and skin edema [1-3]. This paper presents dramatic plain radiographic features of prostaglandin-induced bone disease, including periosteal proliferation and the unusual bone-within-bone appearance, and provides the previously unpublished CT correlation.

Atypical hepatic vein leiomyoma extending into the right atrium: an unusual cause of the Budd-Chiari syndrome.

A 14-year-old male presented with a one week history of weakness, lightheadedness and vomiting. Bilateral pleural effusions were evident on chest radiography; electrocardiogram revealed decreased voltages. Echocardiogram, abdominal ultrasound and magnetic resonance imaging revealed a mass in an hepatic vein and the inferior vena cava extending up to and filling the right atrium. Under deep hypothermia and extracorporeal circulation the mass was removed en bloc. It originated from the hepatic vein. Pathology revealed a smooth muscle tumour intermediate between benign and malignant (atypical leiomyoma). This is the first reported pediatric primary leiomyoma of the hepatic vein. It caused the Budd-Chiari syndrome, a rare pediatric entity.

Atypical leiomyoma arising in an hepatic vein with extension into the inferior vena cava and right atrium. Report of a case in a child.

We report an atypical leiomyoma arising in an hepatic vein and extending into the inferior vena cava and right atrium in a fourteen year old boy. US, CT and MRI facilitated diagnosis and removal of this tumor.

MRI of periprostatic venous plexus in staging of early prostatic carcinoma.

The periprostatic venous plexus can be observed as a bright rim in coronal magnetic resonance (MR) images obtained by spin-echo (SE) 2060/60 technique. A carcinoma of the prostate which penetrates through the capsule into the periprostatic tissues interrupts or obliterates this rim, whereas an intact rim indicates that the tumor is confined within the prostatic capsule. One hundred patients with proven prostatic carcinoma were prospectively imaged by MR to detect periprostatic involvement. The results were compared with those obtained by cystoscopy and digital rectal examination under general anesthesia. The imaging and clinical methods agreed with each other in 76% of the patients.

Magnetic resonance imaging, computed tomography, and radionuclide scintigraphy in detection of liver metastases.

A series of 100 patients with suspected hepatic metastases was studied with magnetic resonance (MR), unenhanced computed tomography (CT), and radionuclide (RN) scintigraphy. Each set of images was read by three clinicians using a five-point scale to allow receiver operating characteristic (ROC) analysis using truth data derived from clinical review. Performance was measured by the areas under the ROC curves (0.940 +/- .018 for MR, 0.951 O +/- .013 for CT and 0.943 +/- .013 for RN) which were statistically not significantly different. We conclude that at their present level of development these three diagnostic examinations have equivalent performance and that MR is not superior in the detection of hepatic metastases.

Magnetic resonance imaging of retroperitoneal lymphadenopathy.

A prospective study was performed to determine the value of magnetic resonance imaging (MRI) in the detection of retroperitoneal lymphadenopathy. Fifty patients with known malignancy, who demonstrated enlarged lymph nodes on computed tomography (CT), were entered into the study. The best visualization of retroperitoneal lymphadenopathy was found with a multislice spin-echo pulse sequence having a repetition time of 2000 msec, and echo delay of 30 msec. Nodes had a signal intensity lower than fat and greater than muscle with this pulse sequence. More than 90% of the lymphadenopathies as shown by CT could be demonstrated by MRI. Due to the flow-void phenomenon, blood vessels did not have any signal and were easily visualized without the use of intravenous contrast medium. Sagittal and coronal images added to an appreciation of the size of nodes and the extent of retroperitoneal lymphadenopathy. Ten normal volunteers were also imaged by MRI and their retroperitoneal nodes were well demonstrated.

Mediastinal lymph node metastases from bronchogenic carcinoma: detection with MR imaging and CT.

Magnetic resonance (MR) imaging and computed tomography (CT) were compared in a prospective study of 48 patients for the detection of metastatic mediastinal lymphadenopathy from bronchogenic carcinoma. The images were interpreted by three experienced radiologists using a five-point rating scale, enabling receiver operating characteristic (ROC) analysis. Imaging results were evaluated against "truth" data based on analysis of surgical specimens from mediastinoscopy and thoracotomy. All MR images were cardiac gated to reduce cardiac motion artifacts in the mediastinum. MR and CT both performed well, as indicated by similar areas under the ROC curves of 0.779 +/- 0.039 for MR imaging and 0.781 +/- 0.038 for CT scanning. No strong correlation between nodal size and metastatic involvement could be found for either MR or CT results. As long as nodal size remains the sole criterion in the detection of metastatic mediastinal lymphadenopathy, MR imaging is unlikely to enable better interpretations than CT scanning.

Magnetic resonance imaging of the mediastinum.

Seven normal volunteers and 69 patients with known disease in either the mediastinum or hila or both were imaged using a prototype magnetic resonance imager operating at 0.15T. Normal mediastinal and hilar structures were readily identified and mediastinal diseases were well demonstrated by magnetic resonance imaging (MRI). The value of MRI lies in the morphological demonstration of the presence and extent of disease.