Germ cell tumors of the sacrococcygeal region: radiologic-pathologic correlation.

Germ cell tumors of the sacrococcygeal region include mature and immature teratomas and endodermal sinus tumor. Most sacrococcygeal teratomas are discovered in the newborn period as an obvious mass, but they may be detected prenatally. Endodermal sinus tumors are usually discovered later in early childhood. Pathologically and radiologically, teratomas are either both cystic and solid, predominantly cystic, or rarely solid. Over 50% have calcification or ossification. Most malignant teratomas have substantial solid components and may contain calcification. Treatment is surgical excision including coccygectomy. Malignant tumors are treated with both surgery and chemotherapy. Prognosis is excellent for teratoma, although local recurrences may occur. Malignant teratomas have had a dismal prognosis in the past, which has been improved with multiagent chemotherapy.

From the archives of the AFIP. Infantile hemangioendothelioma of the liver revisited.

Infantile hemangioendothelioma is a benign tumor of the liver composed of anastomosing vascular channels lined by plump endothelial cells. At initial presentation, most patients are 6 months of age or younger and have hepatomegaly or an abdominal mass. Congestive heart failure, bleeding, anemia, jaundice, and cutaneous or visceral hemangiomas may also be present. Grossly, the lesions are usually well circumscribed and may be focal, multifocal, or diffuse. Large solitary lesions are often associated with central hemorrhage or necrosis. Radiography reveals a mass that is occasionally calcified. Angiography reveals hypervascular lesions, often with arteriovenous shunting. A solid lesion with variable echotexture is noted at ultrasound. Computed tomography typically shows a low-attenuation solid lesion with peripheral enhancement. Central enhancement is often lacking except in smaller lesions. At magnetic resonance imaging performed with T2-weighted pulse sequences, the lesions usually have high signal intensity. Spontaneous regression of the tumor occurs, although patients may die of associated conditions.

Adrenal hemorrhage after liver transplantation.

During orthotopic liver transplantation, ligation and division of the right adrenal vein during recipient hepatectomy may lead to hemorrhagic infarction and/or hematoma formation in the right adrenal gland. Findings in seven liver transplant recipients included initially echogenic or anechoic suprarenal masses on ultrasound scans and inhomogeneous but predominantly hypoattenuating masses on computed tomographic scans. In patients who survived for 4 months or longer, hematomas resolved as early as 20 days and persisted as long as 11 weeks. There was autopsy proof of adrenal hemorrhage in three cases. The adrenal hematomas in this series produced no massive hemorrhages, adrenal insufficiency, or other clinical manifestations. Adrenal hemorrhage after liver transplantation should be recognized and specifically documented, but a hematoma that remains stable in size can be left alone.

Hepatobiliary imaging and the use of intravenous morphine.

Thirty-one patients suspected of acute cholecystitis were studied prospectively using hepatobiliary imaging in conjunction with intravenous morphine. If persistent nonvisualization of the gallbladder occurred post-morphine, delayed 4 hour imaging was performed. Intravenous morphine correctly diagnosed acute cholecystitis in 94% of cases. Through the use of intravenous morphine, imaging time can be decreased from 4 to 1.5 hours.