RESUMO
OBJECTIVE: To test the hypothesis that both indolent and aggressive chronic lymphocytic leukemia (CLL) can be differentiated from diffuse large B cell lymphoma (DLBCL) of Richter syndrome (RS) by CT texture analysis (CTTA) of involved lymph nodes. MATERIAL AND METHODS: We retrospectively included 52 patients with indolent CLL (26/52), aggressive CLL (8/52), and DLBCL of RS (18/52), who underwent standardized contrast-enhanced CT. In main lymphoma tissue, VOIs were generated from which CTTA features including first-, second-, and higher-order textural features were extracted. CTTA features were compared between the entire CLL group, the indolent CLL subtype, the aggressive CLL subtype, and DLBCL using a Kruskal-Wallis test. All p values were adjusted after the Bonferroni correction. ROC analyses for significant CTTA features were performed to determine cut-off values for differentiation between the groups. RESULTS: Compared with DLBCL of RS, CTTA of the entire CLL group showed significant differences of entropy heterogeneity (p < 0.001), mean intensity (p < 0.001), mean average (p = 0.02), and number non-uniformity gray-level dependence matrix (NGLDM) (p = 0.03). Indolent CLL significantly differed for entropy (p < 0.001), uniformity of heterogeneity (p = 0.02), mean intensity (p < 0.001), and mean average (p = 0.01). Aggressive CLL showed significant differences in mean intensity (p = 0.04). For differentiation between CLL and DLBCL of RS, cut-off values for mean intensity and entropy of heterogeneity were defined (e.g., 6.63 for entropy heterogeneity [aggressive CLL vs. DLBCL]; sensitivity 0.78; specificity 0.63). CONCLUSIONS: CTTA features of ultrastructure and vascularization significantly differ in CLL compared with that in DLBCL of Richter syndrome, allowing complementary to visual features for noninvasive differentiation by contrast-enhanced CT. KEY POINTS: ⢠Richter transformation of CLL into DLBCL results in structural changes in lymph node architecture and vascularization that can be detected by CTTA. ⢠First-order CT textural features including intensity and heterogeneity significantly differ between both indolent CLL and aggressive CLL and DLBCL of Richter syndrome. ⢠CT texture analysis allows for noninvasive detection of Richter syndrome which is of prognostic value.
Assuntos
Sarcoma de Células Dendríticas Foliculares/patologia , Leucemia Linfocítica Crônica de Células B/patologia , Linfoma Difuso de Grandes Células B/patologia , Idoso , Diferenciação Celular , Sarcoma de Células Dendríticas Foliculares/complicações , Sarcoma de Células Dendríticas Foliculares/diagnóstico por imagem , Feminino , Humanos , Leucemia Linfocítica Crônica de Células B/complicações , Leucemia Linfocítica Crônica de Células B/diagnóstico por imagem , Linfonodos/patologia , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Síndrome , Tomografia Computadorizada por Raios X/métodosRESUMO
PURPOSE: To assess the effect of intraparenchymal blood patching (IBP) as well as tumor- and operator-related risk factors on the rate of pneumothoraxes after percutaneous CT-guided core needle biopsy of the lung. MATERIALS AND METHODS: We performed a retrospective analysis of 868 CT-guided lung biopsies that were conducted at our institution between 2003 and 2018, of which 419 (48%) received an IBP. Outcome variable included the rates of pneumothorax and chest tube placement, as well as lesion size (<3 cm versus ≥3 cm long axis diameter), lesion depth (≤2 cm, >2-4 cm, >4-5 cm and >5 cm distance to the pleura), location within the lungs (upper lobe, lower lobe, middle lobe), needle caliber (13 G, 15 G, 17 G, 19 G), number of samples taken (1-3 versus ≥4 samples), and experience of the performing physician. RESULTS: The rate of pneumothorax was significantly (p < 0.05) lower in the group with IBP (10.7%) compared to the group without IBP (15.4%). The number of post-interventional chest tube placements was also lower in the IBP group (3.1% vs. 5.8%) but not statistically significant. The lesion size correlated negatively with the rate of pneumothoraxes, whereas in both groups (±IBP) lesions ≥ 3 cm showed a significantly lower rate of pneumothorax (p < 0.05). With increasing lesion depth, the pneumothorax rate increased with (p < 0.01) and without (p < 0.001) IBP. The rate of pneumothorax was significantly lower (p < 0.05) for 17 G needles with IBP, but not for other calibers. For biopsies in the lower lobe, the pneumothorax rate reduced significantly (p < 0.001) with IBP. In case of ≥4 tissue samples, the pneumothorax rate was significantly lower with IBP (p < 0.01). For experienced operators, the overall pneumothorax rate was significantly lower compared to less experienced operators (p < 0001). CONCLUSIONS: IBP significantly reduces the rate of pneumothorax following CT-guided lung biopsies in particular for lesions located deeper in the lungs, when ≥4 samples are taken, when samples are taken by less-experienced operators, and when sampling from the lower lobes.
Assuntos
Terapia Biológica/métodos , Pulmão/patologia , Pneumotórax/epidemiologia , Pneumotórax/prevenção & controle , Radiografia Intervencionista/métodos , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia com Agulha de Grande Calibre/efeitos adversos , Tubos Torácicos/estatística & dados numéricos , Competência Clínica/estatística & dados numéricos , Feminino , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/métodos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
PURPOSE: To compare the diagnostic performance of frequency-selective non-linear blending and conventional linear blending contrast-enhanced CT for the diagnosis of acute (AC) and gangrenous (GC) cholecystitis. MATERIALS AND METHODS: Following local ethics committee approval for retrospective data analysis, a database search derived 39 patients (26 men, mean age 67.8⯱â¯14.6 years) with clinical signs of acute cholecystitis, contrast enhanced CT (CECT) evaluation, cholecystectomy, and pathological examination of the resected specimen. The interval between CECT and surgery was 4.7⯱â¯4.1 days. Pathological gross examination was used to categorize the cases into AC and GC. Subsequently, two radiologists categorized the CECT studies in a blinded and independent fashion into AC and GC, during two different reading sessions using linear blending and frequency-selective non-linear blending CECT. RESULTS: Histologic analysis diagnosed 31/39 (79.4%) cases of GC and 8/39 (20.6%) cases of AC. Image interpretation of linear blending CECT resulted in classification of 7/39 (17.9%) patients as GC and 32/39 (82.1%) as AC, whereas image interpretation of frequency-selective non-linear blending CECT resulted in classification of 29/39 (74.3%) patients as GC and 10/39 (25.7%) as AC. Sensitivity/specificity/PPV/NPV for detection of GC were 22.6%/100%/100%/25% with linear blending CECT and 80.6%/50%/86.2%/40% with frequency-selective non-linear blending CECT, respectively. Based on the histopathologic diagnosis frequency-selective non-linear blending had a significant improvement (pâ¯>â¯0.0001) in the diagnostic accuracy of gangrenous cholecystitis compared with linear blending. CONCLUSION: Frequency-selective non-linear blending post-processing increases the diagnostic accuracy of gangrenous cholecystitis owing to improved visualization of absence of focal enhancement and mural ulcerations.
Assuntos
Doenças Maxilomandibulares/diagnóstico , Neoplasias Maxilomandibulares/diagnóstico , Diagnóstico Diferencial , Diagnóstico por Imagem , Humanos , Doenças Maxilomandibulares/classificação , Doenças Maxilomandibulares/terapia , Neoplasias Maxilomandibulares/classificação , Neoplasias Maxilomandibulares/secundário , Neoplasias Maxilomandibulares/terapia , Cistos Odontogênicos/classificação , Cistos Odontogênicos/diagnóstico , Cistos Odontogênicos/terapia , Tumores Odontogênicos/classificação , Tumores Odontogênicos/diagnóstico , Tumores Odontogênicos/terapia , Osteomielite/classificação , Osteomielite/diagnóstico , Osteomielite/terapia , PrognósticoRESUMO
A 35-year-old woman who had previously undergone a lung transplantation presented with severe abdominal pain and vomiting. The gastroscopy showed diffuse ulcerative gastric lesions. Tests for varicella zoster virus and Epstein-Barr virus via polymerase chain reactions (PCR) on endoscopically obtained gastric biopsies were found to be positive and confirmed varicella gastritis. Intravenous antiviral therapy with acyclovir was administered resulting in a normalization of all clinical symptoms, especially of abdominal pain and inflammation parameters.
Assuntos
Varicela/diagnóstico , Gastrite/diagnóstico , Granulomatose com Poliangiite/cirurgia , Transplante de Pulmão , Aciclovir/uso terapêutico , Adulto , Antivirais/uso terapêutico , Varicela/complicações , Varicela/tratamento farmacológico , Feminino , Gastrite/tratamento farmacológico , Gastrite/virologia , Herpesvirus Humano 3 , Humanos , Hospedeiro ImunocomprometidoRESUMO
PURPOSE: To evaluate whether VEGFR-2-expression in hepatocellular carcinoma (HCC), dysplastic (DLN) and regenerative liver nodules (RLN) correlates with pre-histology, in vivo Dynamic Contrast Enhanced-Computed Tomography (DCE-CT) data as VEGFR-2-expression affects prognosis and therapeutic options. MATERIALS AND METHODS: 34 patients (63.6±8.9years, 7 females) underwent liver biopsy or surgery due to suspected HCC or dysplastic nodules after DCE-CT between 2009 and 2015 with no previous chemo- or interventional therapy. Immunohistochemistry staining for VEGFR-2 was performed using Immunoreactive-Remmele-Stegner-Score (IRS) for quantification. A 128-row CT-scanner was used for DCE-CT with assessment of perfusion parameters blood flow (BF), blood volume (BV), arterial liver perfusion (ALP), portal venous perfusion (PVP), and hepatic perfusion index (HPI). RESULTS: Histology confirmed HCC (n=10), DLN (n=7) and RLN (n=34). Mean IRS for VEGFR-2 in HCCs was 9.1±3.0, 7.3±1.6 for DLN and 5.2±2.8 for RLN (p=0.0004 for HCC vs. RLN). Perfusion values varied significantly between all three groups for BF and HPI (p<0.001 and p<0.0001) and for BV in HCC vs. RLN (p<0.0001) and DLN vs. RLN (p=0.0019). Strong correlations between VEGFR-2-IRS and perfusion parameters were observed for BF in HCC (r=0.88, p<0.01) and HPI in HCC and DLN (r=0.85, p<0.04; r=0.9, p<0.01). CONCLUSION: Immunostaining revealed different VEGFR-2-expression levels in HCC, dysplastic and regenerative liver nodules. Perfusion markers blood flow, blood volume and hepatic perfusion index correlated well with VEGFR-2-immunostaining. This non-invasive discrimination between regenerative and dysplastic/HCC nodules might open new perspectives for diagnosis, therapy planning, and anti-VEGFR therapy monitoring.
Assuntos
Carcinoma Hepatocelular/metabolismo , Neoplasias Hepáticas/metabolismo , Regeneração Hepática , Fígado/diagnóstico por imagem , Fígado/metabolismo , Tomografia Computadorizada Espiral/métodos , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/metabolismo , Idoso , Biópsia , Volume Sanguíneo , Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Feminino , Humanos , Imuno-Histoquímica , Fígado/patologia , Fígado/cirurgia , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão , Prognóstico , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
AFP-producing adenocarcinoma of the esophagus and esophagogastric junction are rare tumor diseases. These tumors show an aggressive behavior characterized by early occurrence of liver metastases and mimic hepatocellular carcinoma (HCC). A general recommendation for palliative therapy is not established for these special tumors.Here we report about a 61-year-old man with multiple liver metastases and high serum alpha-fetoprotein (AFP) level. First, HCC was suspected, but further evaluation showed an AFP-producing adenocarcinoma of the esophagogastric junction with unusual findings on further immunohistochemical analysis. Palliative chemotherapy with FLOT (5-fluorouracil, leucovorin, oxaliplatin, and docetaxel) regime showed a 9 month duration of partial response.
Assuntos
Adenocarcinoma/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/patologia , Cuidados Paliativos/métodos , Adenocarcinoma/metabolismo , Adenocarcinoma/patologia , Docetaxel , Neoplasias Esofágicas/metabolismo , Fluoruracila/administração & dosagem , Humanos , Leucovorina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Compostos Organoplatínicos/administração & dosagem , Oxaliplatina , Taxoides/administração & dosagem , Resultado do Tratamento , alfa-Fetoproteínas/metabolismoAssuntos
Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Imageamento por Ressonância Magnética/métodos , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Aumento da Imagem/métodos , Masculino , Pessoa de Meia-IdadeAssuntos
Cistos/diagnóstico por imagem , Hamartoma/diagnóstico por imagem , Aumento da Imagem/métodos , Doenças Peritoneais/diagnóstico por imagem , Espaço Retroperitoneal/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodosAssuntos
Obstrução das Vias Respiratórias/diagnóstico por imagem , Síndrome do Lobo Médio/diagnóstico por imagem , Adulto , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/fisiopatologia , Obstrução das Vias Respiratórias/terapia , Brônquios/fisiopatologia , Broncografia , Criança , Diagnóstico Diferencial , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Pessoa de Meia-Idade , Síndrome do Lobo Médio/etiologia , Síndrome do Lobo Médio/fisiopatologia , Síndrome do Lobo Médio/terapia , Tomografia Computadorizada MultidetectoresAssuntos
Ameloblastoma/diagnóstico , Neoplasias Maxilomandibulares/diagnóstico , Ameloblastoma/patologia , Ameloblastoma/cirurgia , Transformação Celular Neoplásica/patologia , Diagnóstico Diferencial , Progressão da Doença , Humanos , Interpretação de Imagem Assistida por Computador , Imageamento Tridimensional , Neoplasias Maxilomandibulares/patologia , Neoplasias Maxilomandibulares/cirurgia , Imageamento por Ressonância Magnética , Mandíbula/patologia , Mandíbula/cirurgia , Reconstrução Mandibular , Maxila/patologia , Maxila/cirurgia , Invasividade Neoplásica , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/patologia , Radiografia Panorâmica , Tomografia Computadorizada por Raios XRESUMO
Non-Langerhans cell histiocytoses (N-LCH) of adulthood are rare disorders with heterogeneous pathogenesis, morphology and clinical presentation. In this review two disorders are presented, which predominantly develop in extracutaneous sites in adults. Erdheim-Chester disease is a rare nonhereditary clonal disorder of lipid storing histiocytes most commonly presenting as osseous involvement of the long bones. Other organ manifestations include the central nervous system (CNS), the cardiovascular system, the retroperitoneum and kidneys and less commonly the skin and the lungs. Immunohistochemical staining reveals positivity for the macrophage markers CD163, CD68 and lysozyme but CD1a and langerin are negative, in contrast to Langerhans cell histiocytosis. Rosai-Dorfman disease is considered to be a reactive histiocytic proliferation occurring mainly in lymph nodes. Prominent sinuses filled with commonly multinucleated, S100-positive histiocytes with emperipolesis are a characteristic feature and develops particularly as extensive lymphadenopathy with massive sinus histiocytosis but can also occur extranodally. Painless bilateral cervical lymph node enlargement is the most common clinical presentation. This review summarizes the clinical, radiological and histopathological findings and discusses the recent molecular advances in these rare disorders.
Assuntos
Doença de Erdheim-Chester/diagnóstico por imagem , Doença de Erdheim-Chester/patologia , Histiocitose de Células não Langerhans/diagnóstico por imagem , Histiocitose de Células não Langerhans/patologia , Histiocitose Sinusal/diagnóstico por imagem , Histiocitose Sinusal/patologia , Adulto , Biomarcadores Tumorais/análise , Diagnóstico Diferencial , Emperipolese/fisiologia , Histiócitos/patologia , Humanos , Gotículas Lipídicas/patologia , Linfonodos/patologia , Macrófagos/patologia , RadiografiaAssuntos
Diagnóstico por Imagem/métodos , Linfoma Cutâneo de Células T/tratamento farmacológico , Linfoma Cutâneo de Células T/patologia , Paniculite/diagnóstico , Paniculite/patologia , Antineoplásicos/uso terapêutico , Diagnóstico Diferencial , Humanos , Imunossupressores/uso terapêutico , Invasividade NeoplásicaAssuntos
Doenças Ósseas/diagnóstico , Histiocitose de Células de Langerhans/diagnóstico , Imageamento por Ressonância Magnética/métodos , Imagem Multimodal/métodos , Doenças da Hipófise/diagnóstico , Dermatopatias/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Diagnóstico Diferencial , HumanosAssuntos
Diagnóstico por Imagem/métodos , Neoplasias Hepáticas/diagnóstico , Neoplasias de Células Epitelioides Perivasculares/diagnóstico , Diagnóstico Diferencial , Humanos , Aumento da Imagem , Interpretação de Imagem Assistida por Computador , Achados Incidentais , Fígado/patologia , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/terapia , Imagem Multimodal/métodos , Neoplasias de Células Epitelioides Perivasculares/irrigação sanguínea , Neoplasias de Células Epitelioides Perivasculares/patologia , Neoplasias de Células Epitelioides Perivasculares/terapia , Prognóstico , Sensibilidade e EspecificidadeRESUMO
In a retrospective study, 43 patients with dysplastic neoplasms of the bone marrow (myelodysplastic syndromes and myelodysplastic/myeloproliferative-overlap neoplasms) associated with marked (grades 2-3) fibrosis were examined. Histopathologic and morphologic findings as well as cytogenetic and molecular results were correlated with clinical endpoints. Multilineage dysplasia (34 of 43 patients, 79 %) and hypercellular bone marrow (64 %) were found in most patients. In ten of 35 patients, poor risk karyotypes according to the International Prognostic Scoring System (IPSS) were recorded. The JAK2 V617F mutation was detected in four of 30 patients (13 %), and the KIT D816V mutation was found in two of 30 patients (6 %). Patients were mainly treated with palliative drugs and best supportive care. After an observation time of 1-41 (median 21) months, ten of 43 patients (23 %) had developed a secondary acute leukemia. The median survival of all 43 patients was 21.4 months (range 1.8-88.2 months). Of all prognostic parameters examined, the blast cell count at diagnosis was found to be a most reliable and most predictive marker concerning survival and leukemia progression. This confirms previous studies in dysplastic bone marrow neoplasms without fibrosis.
Assuntos
Medula Óssea/patologia , Células-Tronco Hematopoéticas/patologia , Síndromes Mielodisplásicas/patologia , Transtornos Mieloproliferativos/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Contagem de Células , Linhagem da Célula , Progressão da Doença , Feminino , Seguimentos , Humanos , Janus Quinase 2/genética , Estimativa de Kaplan-Meier , Cariotipagem , Leucemia Mieloide Aguda/epidemiologia , Leucemia Mieloide Aguda/patologia , Masculino , Pessoa de Meia-Idade , Mutação de Sentido Incorreto , Síndromes Mielodisplásicas/genética , Síndromes Mielodisplásicas/mortalidade , Transtornos Mieloproliferativos/genética , Transtornos Mieloproliferativos/mortalidade , Cuidados Paliativos , Mutação Puntual , Mielofibrose Primária/genética , Mielofibrose Primária/mortalidade , Mielofibrose Primária/patologia , Prognóstico , Proteínas Proto-Oncogênicas c-kit/genética , Estudos RetrospectivosRESUMO
Since early February 2010 we have been implementing the latest version of the 2009 AJCC Melanoma Staging and Classification in our institution. Since, according to the guidelines for stage pT1 melanomas, the number of mitoses/mm(2) is of particular significance, we have been able to observe a notable shift from pT1a to pT1b. Highlighting the mitotic count as one of the key features of the diagnosis of malignant melanoma, we observed that the major part of stage-switched melanomas belonged to a minimally invasive subset of melanomas previously categorized as pT1a UICC (7(th) edition). A level of reasonable doubt remains regarding the distinct histogenetic classification of mitosis as early stage melanoma with regard to their epithelial or melanocytic origin.