Giant benign solitary fibrous tumour of the pleura (> 15 cm): role of radiological pathological correlations in management. Report of 3 cases and review of the literature.

OBJECTIVES: Solitary fibrous tumour pleura (SFTP) is a localized tumour arising from the submesothelial areolar mesenchyme. In the present study, we defined "giant" lesions with diameter greater than 15 cm. We have studied the role of radiological-histological correlations of three cases in the management of the disease with review of the literature. METHODS: We conducted a retrospective review of the clinical records of three patients who had undergone surgical resection for giant benignant SFTP between 2007 and 2011. RESULTS: Three symptomatic patients (all woman, mean age 80 years) with a giant benign SFTP (mean diameter 19.3 cm and mean weight 1290 gm) underwent surgery with full excision of the tumour. All tumours showed histological features of benignancy and intense immunopositivity for CD34. CONCLUSIONS: The integration of CT and pathological findings is essential in the optimal management of giant benign SFTP. Chest radiograph and CT cannot differentiate between benign and malignant giant SFTP. Surgical resection is necessary to determine the nature of tumour. The immunohistochemical staining pattern assists in differentiating SFTPs from other spindle cell neoplasms of the pleura including diffuse malignant mesothelioma. The choice of surgical approach is determined by the location of the tumour and by spatial relations in the imaging study rather than by the radiologist's impressions. Recurrence after complete resection is possible in giant benign SFTP, as a consequence of incomplete excision. Long-term follow-up is highly recommended because of the possibility of late recurrence. Due to rarity of these tumours, further studies and multicentre trials are needed to confirm these preliminary findings.

Value of imaging and aspiration cytology in the diagnosis of oncocytic carcinoma.

Oncocytic carcinoma of the parotid gland is a rare neoplasm. To date 70 cases have been described in 55 reports. To the best of our knowledge the simultaneous occurrence of oncocytic carcinoma and second malignancy in another site (outside the parotid gland) has not been reported. An oncocytic carcinoma of the parotid gland is described in 56-year-old male with simultaneous breast cancer, emphasising the value of aspiration cytology and imaging procedures in the diagnosis of parotideal neoplasms.

Pulmonary congenital cystic disease in adults. Spiral computed tomography findings with pathologic correlation and management.

PURPOSE: The aim of this study was to assess the computed tomography (CT) features of intrapulmonary congenital cystic diseases in adults and to correlate the imaging features with the pathological findings, with emphasis on the oncogenic potential of the lesions. MATERIALS AND METHODS: We retrospectively reviewed the CT scans in three institutions from August 1996 to December 2008, of nine patients (six men, three women; mean age 48.6 years; range 26-75 years) who had histological diagnosis of pulmonary cystic disease after surgery. Six patients had a diagnosis of intrapulmonary bronchogenic cyst (IBC), and three had a type-I cystic adenomatoid malformation (CAM). In one case, intralobar sequestration (ILS) was associated with type-I CAM. RESULTS: Three patients were symptomatic and six were asymptomatic. On CT scans, IBCs showed homogeneous fluid attenuation (n=2), air-fluid level (n=2), air attenuation (n=1) or soft-tissue attenuation (n=1). The surrounding lung tissue showed areas of band-like linear attenuation in three IBCs, atelectasia in two and mucocele-like areas in one. On CT, type-I CAM appeared as a unilocular cystic lesion with air-fluid level (n=1) or air content (n=1). Both cases had thin walls surrounded by normal lung parenchyma. ILS appeared as a fluid-filled cyst with afferent and efferent vessels. Of the six IBCs, one occurred in the upper right lobe, two in the middle lobe and three in the lower right lobe. Of the three type-I CAMs, one was in the upper left lobe and one in the middle lobe. The type-I CAM associated with ILS was located in the left lower lobe. CONCLUSIONS: The similar CT patterns preclude differentiation between IBC and type-I CAM. Surgical resection of all intrapulmonary cystic lesions detected in adults is mandatory because type-I CAM is a precursor of mucinous bronchioloalveolar carcinoma.

Small (< or = 2 cm) atypical hepatic haemangiomas in the non-cirrhotic patient: pattern-based classification scheme for enhancement at triple-phase helical CT.

PURPOSE: The aim of this study was to determine by triplephase helical computed tomography (CT) the appearance of atypical small (< or = 2 cm) hepatic haemangiomas (HHs) in the non-cirrhotic patient. MATERIALS AND METHODS: We retrospectively reviewed the hepatic arterial-dominant phase (HAP), portal venous phase (PVP) and delayed-phase (DP) helical CT images of 47 patients with 52 atypical small (< or = 2 cm) HHs associated with 34 typical small HHs. Images were assessed to identify the patterns of enhancement of atypical HHs and correlate their appearance with that of typical small HHs in the delayed phase. Interobserver variability and kappa value were calculated. Statistical significance was calculated by the Fisher exact test. RESULTS: The 52 atypical small HHs were categorised as follows: type 1a (hyperattenuating in the HAP, n=17), type 1b [hyperattenuating with transient hepatic attenuation difference (THAD) around the lesion in the HAP, n=12], type 2a (homogeneously hypoattenuating in the HAP or PVP, n=9), type 2b (hypoattenuating with "bright-dot" sign in the HAP or PVP, n=13) and type 3 (hypoattenuating with central enhancing area, n=1). Interobserver agreement was perfect for HHs of types 1a, 1b, 2a and 3. On DP images, the appearance of atypical small HHs was identical to that of typical small HHs in all cases (p<0.0001), with lesions showing homogeneous isoattenuation to the aorta or liver parenchyma without peripheral capsule. CONCLUSIONS: Triple-phase helical CT scans can distinguish several types of atypical small HHs. The demonstration of patterns similar to those of typical forms on DP CT is fundamental for the diagnosis.

First report of an unusual, rare complication of pregnancy: rupture of multiple lienal vein aneurysms.

Lienal vein aneurysms are a very unusual pathology. Usually they are extremely rare incidental findings, associated with many diseases as hepatic cirrhosis, portal hypertension and other conditions as pregnancy. We report here the case of death of a mother and her fetus at the third trimester of her third pregnancy due to haemoperytoneum for rupture of aneurysm. The autoptic examination revealed the presence of three fusiform and saccular aneurysms of the lineal vein. The histopathological features of aneurysms' wall are described. The aetiopathogenetic hypothesis of the lesion is discussed. To our knowledge this is the first case report describing the sudden death of pregnant woman and fetus from a rupture of maternal lineal vein aneurysm, complication of multiple aneurysms.

Plexiform lipoleiomyoma of the uterus: first case report.

We describe the first report of plexiform lipoleiomyoma with amyloid stroma. A 57-year-old woman underwent an abdominal hysterectomy for methrorragia. The hysterectomy specimen exhibited a soft, rubbery, encapsulated 11 cm ovoid mass with aciniform, white cut surface on the right edge of the uterus. The histology was distinctive and typical of plexiform lipoleiomyoma: long cords, strands and small nests of cells embedded in a collagenous matrix. The neoplastic cells showed eosinophilic cytoplasm, crumpled, bland nuclei. Scattered islands of mature adipocytes were distributed throughout the leiomyomatous proliferation. Immunohistochemistry showed positivity for smooth muscle actin in the plexiform component, and for S100 in the adipocytes. Histogenesis and origin of the cellular neoplastic component are discussed.