Primary leiomyosarcoma of the oral tongue: magnetic resonance and ultrasonography findings with histopathologic correlation.

Leiomyosarcoma is a malignant smooth muscle tumor that frequently occurs in the gastrointestinal tract and female genital tract. It is aggressive and tends to recur and metastasize. Clinical behavior is unpredictable, mostly influenced by a proper surgical approach. Oral leiomyosarcoma, in particular of the tongue, is extremely rare and poorly documented in the radiology literature. Diagnostic assessment of oral leiomyosarcoma is often challenging, mostly founded on its peculiar immunohistological features. However, imaging evaluation is essential in staging and for preoperative planning. We illustrate the case of a 52-year-old woman with 2-months history of a painless growing mass on the left hemitongue, with magnetic resonance and ultrasonographic features correlated to histopathologic examination.

Blake's pouch cyst: an entity within the Dandy-Walker continuum.

Abnormal cerebrospinal fluid (CSF) collections within the posterior fossa are defined by the Dandy-Walker complex (DWC) and by arachnoid cysts (AC). The DWC includes the Dandy-Walker malformation (DWM), the Dandy-Walker variant (DWV) and the mega-cisterna magna (MCM). In addition, Tortori-Donati et al. added persistent Blake's pouch cyst (BPC) as an independent entity within the DWC. BPC represents a posterior ballooning of the superior medullary velum into the cisterna magna. All of these malformations are overlapping developmental anomalies characterized by varying degrees of malformation of the medullary vela, the cerebellar vermis and hemispheres, the fourth ventricle choroid plexus, the posterior fossa subarachnoid cisterns and the enveloping meningeal structures. We present two cases of persistent BPC detected in two adult women without history of gestational or subsequent growth problems. They underwent neuroradiological investigation because of headache and because of recurrent episodes of loss of consciousness, respectively. The MRI findings included tetraventricular hydrocephalus, wide communication of the fourth ventricle and the cystic posterior fossa (i.e. BPC), inferior posterior fossa mass effect with or without hypoplasia of both the cerebellar vermis and the medial aspects of the cerebellar hemispheres, and absence of communication between fourth ventricle and the basal subarachnoid space in the midline posteriorly. Persistent BPC is defined by a failure of embryonic assimilation of the area membranacea anterior within the tela choroidea associated with imperforation of the foramen of Magendie. Typically this condition becomes symptomatic early in life. In the current cases the normal function of the laterally positioned foramina of Luschka probably helped to maintain some CSF flow between intraventricular and subarachnoid spaces, with the establishment of a precarious equilibrium characterized by a compensatory enlargement of the cerebral ventricular system (i.e. hydrocephalus).

[Brain magnetic resonance with magnetization transfer in multiple sclerosis. Lesion hyperintensity before and after intravenous gadolinium administration]. / Risonanza Magnetica encefalica con trasferimento della magnetizzazione nella sclerosi multipla. Iperintensità lesionale prima e dopo somministrazione endovenosa di Gadolinio.

PURPOSE: To evaluate lesion contrast enhancement in brain magnetic resonance (MR) images with and without magnetization transfer pulse (MT) in patients affected with multiple sclerosis (MS). MATERIAL AND METHODS: Ten patients affected with relapsing-remitting MS underwent a 1.5-T (Magnetom Vision, Siemens) MR examination with T1-weighted spin-echo sequences without MT (TR/TE = 630/14 ms) and with MT (840/14 ms) using the following common parameters: 21 para-axial slices (thickness 5 mm, 10% gap); matrix 256 x 256; field of view 25 cm (rectangular 5/8); 2 excitations. The postcontrast sequences with and without MT were acquired in a randomized order, starting 5 minutes after the intravenous injection of 0.1 mmol/kg Gadoteridol (ProHance, Bracco). The images were blindly evaluated in four separate sessions: only the postcontrast images with MT (post-Gd with MT); only the postcontrast images without MT (post-Gd without MT); comparing the pre- and postcontrast images with MT (pre/post-Gd with MT); comparing the pre- and postcontrast images without MT (pre/post-Gd without MT). The number of hyperintense areas referred to contrast enhancement and the evaluation time were measured for each session. The Wilcoxon test was used for statistical analysis. RESULTS: The number of areas referred to lesion contrast enhancement per patient were as follows: post-Gd with MT, 6.9 +/- 6.8 (mean +/- standard deviation) (range 1-24); post-Gd without MT, 3.6 +/- 4.3 (0-14); pre/post-Gd with MT, 5.2 +/- 6.1 (1-21); pre/post-Gd without MT, 3.6 +/- 4.9 (0-16). A nonsignificant difference was found for the comparison between post-Gd without MT and pre/post-Gd without MT while significant differences were found between post-Gd with MT and pre/post-Gd with MT (p = .028), pre/post-Gd without MT and pre/post-Gd with MT (p = .012), as well as between post-Gd without and post-Gd with MT (p = .008). The mean evaluation time for the different sessions was always less than a minute, ranging from 33 seconds for pre/post-Gd without MT to 51 seconds for post-Gd with MT. CONCLUSIONS: The postcontrast sequence obtained with the MT pulse detects more active lesions than the postcontrast sequence without MT. However, the comparison with the plain images with the MT pulse is mandatory to exclude pseudoenhancement foci, i.e. hyperintense areas already present in the precontrast images with the MT pulse, without disruption of the blood-brain barrier. The post-Gd without MT sequence needs not be compared with the precontrast images without MT. Differences in evaluation time are practically negligible.

Subependymoma of the lateral ventricle presenting with sudden onset.

A 52-year-old man presented with sudden onset of severe headache, fever, mental confusion and mild signs of left hemisphere dysfunction. Computed tomographic and magnetic resonance imaging findings suggested a preoperative diagnosis of subependymoma of the left lateral ventricle, which was subsequently confirmed by surgery. The neoplasm could be totally removed and the postoperative clinical course was favourable. The reported case is unusual because symptomatic subependymomas of the lateral ventricle are definitely rare, and almost invariably present with a progressive clinical course over a period of weeks to years.

Anterior clinoid mucocele: a trans-nasal endoscopic approach.

The goals of the treatment of paranasal sinuses mucocele are the relief of the symptoms due to compression and the prevention of recurrence. Because of the benignity of the pathology, it is mandatory to choose the approach that minimizes the surgical trauma. When an anterior clinoid mucocele is found, the conventional approaches are the trans-nasoethmoidal, the subtemporal or the pterional ones: we think that as a really mini-invasive approach, the transnasal endoscopy may be proposed. Anterior clinoid localization may be reached by a trans-sphenoidal way and treated by endoscopic microsurgery with a very low morbility. This paper deals with a case of anterior clinoid mucocele treated by this way with good anatomic and functional results and stresses the importance of the pre-operative imaging (CT/MR) allowing one to make a sure diagnosis and to choose the cases suitable for this surgical approach.

Lateral ventricle subependymomas. Case report taking into particular consideration the aspects of magnetic resonance and review of the literature.

Subependymomas are rare neuroectodermic tumours. The authors report a case of a patient he had a subendymoma in the left lateral ventricle, with particular attention to the MR aspects on these lesions and review of the literature.

Orbital pseudotumor as a presenting sign of temporal arteritis.

Both unilateral proptosis (2 cases) and radiological evidence of orbital inflammatory pseudotumor in the absence of exophthalmos (1 case) have been separately described as presenting signs of temporal arteritis. We report a patient presenting with bilateral exophthalmos associated with CT and MRI signs of orbital inflammation, who had biopsy-proven temporal arteritis. Our case is unique in view of the association of the above clinical and radiological features, and the bilateral involvement of orbital tissues.

Gas bubbles within acute intracranial epidural haematomas.

In order to assess the actual incidence of gas bubbles trapped within acute intracranial epidural haematomas, as revealed by computed tomography (CT) of the skull, a series of 204 patients with surgically verified epidural haematomas was retrospectively reviewed. Gas bubbles were observed on CT scan in 22.5% of the cases, with the incidence rising to 37% when CT scanners of the last generation were employed. The available data failed to demonstrate the actual source of intracranial gas. No correlation was found between the presence of gas bubbles and outcome. No patient in the whole series showed any sign of intracranial infection.

Degenerative changes in hypophyseal adenomas: CT features.

16 patients with hypophyseal adenoma undergoing degenerative changes, namely necrotic-cystic changes, bleeding and calcification, were subjected to CT and the resulting density values studied. The cases were verified at operation and at histological examination. Evaluation of these features, despite the limitations of the method, proved to be very useful in differential diagnosis and in the planning of treatment.