Intranodal Palisaded Myofibroblastoma: Radiological and Cytological Overview.

BACKGROUND: Intranodal palisaded myofibroblastoma is a benign and very rare mesenchymal neoplasm of the lymph nodes originating from differentiated smooth muscle cells and myofibroblasts. CASE REPORT: We report a case of intranodal palisaded myofibroblastoma in an 84-year-old woman with Parkinson's disease that presented as a left inguinal mass. The diagnosis was made using ultrasound-guided fine needle aspiration biopsy and consequent cytopathological examination that included immunohistochemical analysis. Herein, we discuss the presentation of a rare intranodal palisaded myofibroblastoma with emphasis on its ultrasonographic and cytopathologic features. CONCLUSIONS: Intranodal palisaded myofibroblastoma should be considered in the differential diagnosis of inguinal lymphadenopathy and the diagnosis is possible with cytopathologic exam and immunohistochemical analysis using ultrasound-guided FNA biopsy, guiding the clinician to nodal excision rather than aggressive measures.

Diagnostic value of diffusion weighted MRI and ADC in differential diagnosis of cavernous hemangioma of the liver.

AIMS: To investigate the use of diffusion weighted magnetic resonance imaging (DWI) and the apparent diffusion coefficient (ADC) values in the diagnosis of hemangioma. MATERIALS AND METHODS: The study population consisted of 72 patients with liver masses larger than 1 cm (72 focal lesions). DWI examination with a b value of 600 s/mm2 was carried out for all patients. After DWI examination, an ADC map was created and ADC values were measured for 72 liver masses and normal liver tissue (control group). The average ADC values of normal liver tissue and focal liver lesions, the "cut-off" ADC values, and the diagnostic sensitivity and specificity of the ADC map in diagnosing hemangioma, benign and malignant lesions were researched. RESULTS: Of the 72 liver masses, 51 were benign and 21 were malignant. Benign lesions comprised 38 hemangiomas and 13 simple cysts. Malignant lesions comprised 9 hepatocellular carcinomas, and 12 metastases. The highest ADC values were measured for cysts (3.782±0.53×10(-3) mm(2)/s) and hemangiomas (2.705±0.63×10(-3) mm(2)/s). The average ADC value of hemangiomas was significantly higher than malignant lesions and the normal control group (p<0.001). The average ADC value of cysts were significantly higher when compared to hemangiomas and normal control group (p<0.001). To distinguish hemangiomas from malignant liver lesions, the "cut-off" ADC value of 1.800×10(-3) mm(2)/s had a sensitivity of 97.4% and a specificity of 90.9%. To distinguish hemangioma from normal liver parenchyma the "cut-off" value of 1.858×10(-3) mm(2)/s had a sensitivity of 97.4% and a specificity of 95.7%. To distinguish benign liver lesions from malignant liver lesions the "cut-off" value of 1.800×10(-3) mm(2)/s had a sensitivity of 96.1% and a specificity of 90.0%. CONCLUSION: DWI and quantitative measurement of ADC values can be used in differential diagnosis of benign and malignant liver lesions and also in the diagnosis and differentiation of hemangiomas. When dynamic examination cannot distinguish cases with vascular metastasis and lesions from hemangioma, DWI and ADC values can be useful in the primary diagnosis and differential diagnosis. The technique does not require contrast material, so it can safely be used in patients with renal failure.

The Doppler ultrasonographic evaluation of hemodynamic changes in hepatic vascular structures in patients with hepatosteatosis.

BACKGROUND: The hemodynamic changes in hepatic vascular structures of hepatosteatosis patients were examined using Doppler ultrasonography. MATERIAL/METHODS: Ninety hepatosteatosis patients, classified as mild, moderate or severe, and 30 healthy volunteers were included in this 120-person study. The height, weight, liver size, blood lipids and blood liver function tests of the subjects were measured. Those values were compared in the patient and control groups. In the patient and control groups, color duplex Doppler ultrasonography was used to examine portal vein peak velocity, portal vein flow volume, hepatic artery resistive index (RI), hepatic artery pulsatility index (PI) and hepatic artery flow volume. RESULTS: Similarly to the degree of hepatosteatosis, increases in body mass index, liver size, liver enzyme levels and blood lipid levels were statistically significant (p<0.05). While the difference in portal vein peak velocity in the hepatosteatosis and control groups was not statistically significant, there was an increasing reduction in the degree of steatosis (p>0.05). As the degree of hepatosteatosis increased, there was a reduction in hepatic artery flow volume, portal vein flow volume and total flow volume that was not statistically significant. In the mild hepatosteatosis group, hepatic artery RI and PI values were statistically significantly lower than in the other groups (p<0.05). In the severe hepatosteatosis group, although the hepatic artery RI and PI values were not statistically significant, there was a minimal increase compared to the other groups. CONCLUSIONS: It is believed that those results were caused by a reduction in liver compliance and hepatic vascular compliance, in addition to resistance increase in vascular structures.

Intra-arterial treatment with 90yttrium microspheres in treatment-refractory and unresectable liver metastases of neuroendocrine tumors and the use of 111in-octreotide scintigraphy in the evaluation of treatment response.

PURPOSE: The aim of this study was to examine the efficacy of intra-arterial (90)Yttrium treatment in the management of unresectable hepatic neuroendocrine tumors (NET) metastases unresponsive to treatment and the role of (111)In-octreotide scintigraphy in the evaluation of treatment response. METHODS: Thirteen (13) patients with a mean age of 53.3 years not eligible for surgical treatment were included. Before the procedure, routine tests for renal/hepatic functions and bilirubin levels as well as (99m)Tc-macroaggregated albumin test to detect any leakage to the lungs were done. Treatment doses were calculated using body surface area method and all patients received (90)Y resin microspheres through hepatic artery catheter. Abdominopelvic computed tomography (CT) and (111)In-octreotide scintigraphy were done before and after treatment. Patients were divided into two groups based on their treatment response as assessed by either (111)In-octreotide scintigraphy or CT: group 1, responders; group 2, nonresponders. RESULTS: For all patients, 1-year survival rate and overall survival was 84.7% and 20 months, respectively. Based on (111)In-octreotide scintigraphy findings, 1-year survival rate was 90% and 66.7% for responders and nonresponders, respectively, whereas corresponding overall survival was 21.3 months and 15.3 months. Survival data based on CT findings were as follows: 1-year survival rate, responders, 80%; nonresponders, 100%; overall survival, responders, 20.4 months, nonresponders, 18.5 months. CONCLUSIONS: Intra-arterial treatment with (90)Y has survival benefits in treatment-refractory liver metastases from NETs and it could be used in these patients. Since it is a functional imaging method, (111)In-octreotide scintigraphy may be better discriminates patients responding to treatment from patients not responding.

Selective intra-arterial Y-90 microsphere therapy in hemangioendothelioma.

Epithelioid hemangioendothelioma is a malignant soft tissue tumor originating from the endothelial cell. Its clinical course varies from benign hemangioma to angiosarcoma. The therapy procedure remains unclear. Although resection of the tumor is the most frequently suggested treatment, due to its multinodular type, transplantation is frequently performed. Therapy regimens other than transplantation and resection are not effective and the median survival in hemangioendothelioma with unresectable lesions is approximately eight months. In this case, we report the therapeutic effect of selective intra-arterial radionuclide yttrium (Y)-90 microspheres and the value of F-18 fluorodeoxyglucose positron emission tomography/computed tomography to evaluate therapy response in hemangioendothelioma.