[Are there metastatic angiomyolipomas?]. / Gibt es metastasierende Angiomyolipome?

An angiomyolipoma is now mostly diagnosed by sonography due to sonographically typical criteria, such as abundant echoes and clear delineation, or via CT, since it is a process rich in fat and hence hypodense. Laying bare by surgery will only be required in case of an atypical localisation or expansive tumour growth. Two case reports are presented with ipsilateral lymph node infiltration in multifocal angiomyolipoma and expansion of the tumour into the vena cava via the renal vein.

[Angiolipoma of the kidney as a secondary tumor in a patient with a soft tissue sarcoma of the upper arm]. / Angiomyolipom der Niere als Zweittumor bei einem Patienten mit Weichteilsarkom des Oberarms.

The case of a 51-year-old male presenting with a tumour of the left kidney is reviewed. In respect of an operated tissue sarcoma of the right humerus 6 months ago, radiological findings suggested a benign lesion, but could not exclude a metastasis of the sarcoma. Histological diagnosis revealed an angiomyolipoma of the kidney.

Malignant epithelioid hemangioendothelioma arising in an intramuscular lipoma.

BACKGROUND: A malignant epithelioid hemangioendothelioma (EH) developed within a peripheral intramuscular lipoma. It was seen as a painful calf mass. At the time of biopsy and en bloc resection, lung metastases were observed. METHODS: Radiologic, histologic, immunohistochemical, and ultrastructural features of the neoplasm are described, and the literature pertaining to EH is reviewed. RESULTS: The features of this tumor permitted its classification as a malignant EH. CONCLUSIONS: This case illustrates the potential for aggressive behavior in an EH, often considered to be a low-grade malignant neoplasm. Because such tumors can metastasize, they should be removed with wide margins whenever possible. This malignant neoplasm was located within a benign intramuscular lipoma, demonstrating the diagnostic problem that may exist in such a complex lesion.

Duodenal neoplasms: predictive value of CT for determining malignancy and tumor resectability.

CT examinations of 25 patients with proved primary or metastatic duodenal neoplasms were retrospectively reviewed to determine if morphologic features seen on CT scans could be used to predict the benign or malignant nature of these neoplasms and to assess the effectiveness of using CT findings to predict tumor resectability. We studied 19 malignant and six benign tumors. Histologic proof was obtained by means of surgery in 20 patients and by endoscopic biopsy in five. CT features of tumor morphology were assessed in the 22 cases in which a duodenal tumor was seen on CT. These features included central necrosis, ulceration or excavation, and the location of the tumor with respect to the bowel wall. The specific morphologic features used to predict that a tumor was malignant included the presence of an exophytic or intramural mass, central necrosis, and ulceration. The only criterion used to predict that a tumor was benign was that the mass be entirely intraluminal. Whenever vascular encasement, invasion of contiguous organs other than the head of the pancreas, distant lymphadenopathy, or metastases were present, the tumor was predicted to be unresectable for cure. With the exception of three benign smooth muscle tumors, all tumors with one or more CT morphologic features indicative of a malignant neoplasm were malignant (n = 16). Three of four intraluminal masses were benign. In three cases of polypoid tumors smaller than 2 cm, a duodenal tumor was not seen on CT. Whenever extraduodenal disease was found (15 cases), the neoplasms were malignant. In the 22 cases in which a tumor was detected on CT, the sensitivity of using the presence of one or more morphologic features associated with a malignant neoplasm as a predictor was 94%; the specificity was 50%, and the accuracy was 82%. If the presence of any morphologic feature indicative of a malignant neoplasm was combined with the presence of any finding of extraduodenal disease, CT was 100% sensitive and 86% accurate for predicting that the tumor was malignant. CT appears to be reliable for predicting duodenal tumor resectability. On the basis of CT findings, 10 tumors were correctly predicted as being unresectable for cure, and 12 were predicted as being resectable; no surgery was performed in the remaining three cases. In conclusion, evaluation of the morphologic features of duodenal neoplasms is a sensitive, but nonspecific, method for predicting that a tumor is malignant.(ABSTRACT TRUNCATED AT 400 WORDS)

Melanoma metastatic to "lipomata".

Three patients presented with solitary melanoma metastases that mimicked a simple "lipomata." On further investigation each patient had a discrete fatty tissue tumor mass surrounding a melanoma metastasis. The presence of an enlarging mass in patients with a history of melanoma should be viewed with suspicion and a biopsy should be performed.

Involvement of the spleen by renal angiomyolipoma: metastasis or multicentricity?

Angiomyolipoma has been regarded as a benign renal neoplasm composed of adult fat cells, atypical blood vessels and smooth muscle. We report a case in which a renal angiomyolipoma showed clear evidence of involvement of the spleen and regional lymph nodes. The consensus in the literature suggests that this phenomenon is a manifestation of the multicentric nature of angiomyolipoma, rather than metastasis.

[Computed tomography and ultrasound: comparison with intraoperative findings of large metastases in the neck (author's transl)]. / Computertomogramm und Ultraschall: Vergleich zu operativen Befunden ausgedehnter Metastasen des Halses.

The evaluation of soft tissue lesions in cases with extensive metastases, in the neck is of great importance. The therapeutic concept will depend upon the size distribution and infiltration of the metastases into the structures of the lateral neck. The limiting factors include the great vessels of the neck, the deep neck muscles, the base of the skull, the mediastinum and the proximal parts of trachea and oesophagus. The timing of therapy (operation, radiation and cytostatic therapy) can be planned according to these factors. Computed tomography and ultrasound provide the information about the soft tissues of the neck. Spread, size and site of infiltration can be fairly estimated as shown in 25 patients which have been operated on.

Spinal intradural lipoma with intracranial extension.

2 cases of intradural spinal lipomas with extension into the posterior fossa in infancy are presented. Clinical features included associated subcutaneous posterior spinal lipomas and hypotonia. The cases were diagnosed by metrizamide myelography and spinocranial computerized tomography scanning. Operative therapy consisted of combined suboccipital craniectomy, spinal laminotomy, flap elevation and subtotal tumor decompression. The entity is reviewed.