Diagnostic imaging of a rare case of incidental adrenal ganglioneuroma.

A 53-year-old man complaining of pain in the right hypochondrium underwent an abdominal ultrasound that showed a left adrenal lesion. Further instrumental investigations (CT and MRI, both with contrast medium) were performed which diagnosed an adrenal ganglioneuroma, confirmed by the histological examination. The patient also underwent an endocrinological examination. The treatment was surgical and consisted of an adrenalectomy through video-laparoscopic access. Adrenal ganglioneuromas are rare tumors but well described and known in the literature. For this reason, this case report has primarily an educational purpose: the totality of the data collected (clinical, laboratoristic, instrumental, and histopathological) constituted a multidisciplinary case, with the focus on imaging.

Granulomatous prostatitis: mimicking locally advanced prostate adenocarcinoma.

We report the case of a 63-year-old male who came to the urology clinic with an increasing value of the prostate specific antigen and an asymmetrical enlargement at the digital rectal examination. The man was subjected to an MRI of the prostate following which a convincing radiological diagnosis of prostate cancer was made. The patient was assigned a provisional stage of disease T3a N0. In order to confirm this diagnosis, a prostate biopsy was performed but the histological analysis reported non-specific granulomatous prostatitis (GP). It is an uncommon condition that both clinically and radiologically on TRUS and MRI usually mimics prostate cancer (PCa), representing a diagnostic challenge due to its non-specific symptoms and aspecific radiological findings. In this case report we discuss the magnetic resonance imaging features of this rare clinical condition in order to help radiologists in the timely diagnosis for a correct diagnostic framing.

Staging of Prostate Cancer: Role of Multiparametric Magnetic Resonance Imaging in Different Risk Classes.

Using multiparametric magnetic resonance imaging, it is now possible to diagnose prostate cancer and categorize its risk. As it can accurately determine the extracapsu- lar extension of the tumor, invasion of seminal vesicles, involvement of lymph nodes, and the potential presence of bone metastases, multiparametric magnetic resonance imaging plays a crucial role not only in the diagnosis but also in the local staging of prostate cancer. The patients with a history of negative biopsy/increasing prostate- specific antigen and the existence of further data supporting its use in biopsy-naive patients and active surveillance are the most blatant indications for multiparametric magnetic resonance imaging in guidelines. The traditional clinical examination, pros- tate-specific antigen tests, and systematic biopsy are all enhanced by multiparametric magnetic resonance imaging, which will miss certain cancers due to insufficient size or changes in tissue density. The use of multiparametric magnetic resonance imaging is expected to rise, and further advances in the method will be crucial for the secure adoption of targeted therapeutic ideas. Here, we give a succinct overview of multipa- rametric magnetic resonance imaging's application to the identification and risk clas- sification of prostate cancer.

The promising role of DECT in the diagnosis of Osteitis Condensans Ilii: a case report.

Osteitis condensans ilii (OCI) is a noninflammatory condition of no clear etiology, cause of axial low back pain. It is characterized by sclerotic bone lesions at the iliac region of the sacroiliac joints. The diagnosis is based on radiological findings and the exclusion of other conditions associated with back pain. We present a case of bilateral OCI in a young woman with bone sclerosis at sacroiliac joints diagnosed with the use of Dual Energy CT.

A rare case of siliconomas resulting from free silicone injections in breast tissue.

One of the most common complications of free silicone injection at multiple sites is its leakage and more rarely its migration through the lymphatic system with a resulting local inflammatory reaction of granulomatous type, known as "siliconoma". This report describes the case of a young woman who came to our attention for bilateral mastodynia and palpable tumefactions in breast and gluteal region, a few years after percutaneous injections of free liquid silicone for breast augmentation.

Extragonadal germ cell tumor: A rare case in dorsal region.

Extragonadal germ cell tumors (GCTs) are a rare group of neoplasms that account for 1%-5% of all GCTs. These tumors can present with an unpredictable behavior and clinical manifestations depending on different factors such as histological subtype, anatomical site, and clinical stage. We report the case of a 43-year-old male patient with a primitive extragonadal seminoma located in the paravertebral dorsal region, an extremely rare site. He presented to our emergency department with a 3-month history of back pain and a 1-week history of fever of unknown origin. Imaging techniques revealed a solid tissue arising from the vertebral bodies of D9-D11 and extending in the paravertebral space. After a bone marrow biopsy and exclusion of testicular seminoma, he was diagnosed with primitive extragonadal seminoma. The patient underwent five cycles of chemotherapy, and the follow-up CT examinations showed a reduction of the mass initially till a complete remission with no evidence of recurrence.

Lumbar malignant peripheral nerve sheath tumor: a rare case in a young patient.

Malignant peripheral nerve sheath tumor (MPNST) is a rare soft tissue sarcoma that originate from peripheral nerves or from cells associated with the nerve sheath. We report the case of a 30­year­old male patient with a history of neurofibromatosis type I (NF-1) and a MPNST located in the lumbar region. The mass was resecated but surgical margins weren't clear. Recurrence of disease was observed after few months. A close monitoring of subjects with NF-1 is crucial to diagnose MPNST at an earlier stage and allow a complete surgical resection.

A prostate utricle cyst as a cause of haematospermia in a young adult: a case report.

BACKGROUND AND AIM: Prostatic utricle cyst is an embryological remnant of the Muller duct system, resulting from an incomplete regression of these structures during embryological development. Most of the time such congenital alteration is asymptomatic, but may sometimes present with various signs and symptoms, from urinary tract infections to episodes of haematospermia in a small percentage of cases. METHODS: We reported the case of a 42-years-old man who suffered from recurrent episodes of haematospermia for about 20 years; the instrumental examinations, first of all TRUS and then MRI evaluation, demonstrated the presence of a cystic formation, located in the posterior median site of the prostate closely to the prostatic urethra. RESULTS: The cytological examination on the liquid taken by transperineal US-guided fine-needle aspiration, confirmed the presence of seminal fluid and normal prostatic tissue consistent with the diagnostic hypothesis of prostatic utricle cyst. CONCLUSIONS: It's important to recognize the imaging characteristics of the prostatic utricle cyst since it may be one of the possible benign causes of hematospermia in the young adult subject.

A rare sacral localization of giant cell tumor in a young adult female: a case report.

We reported the case of a 42-years-old woman who suffered from a giant cell tumor of sacrum. Although the giant cell tumor primarily affects the long bones, especially those of the knee joint, it can rarely affect the axial skeleton and the sacrum. The onset of symptoms is generally insidious and may include locoregional pain and swelling as well as movement deficits if nerve roots are involved at this level. In this case report we discuss on the radiographic imaging, computed tomography and magnetic resonance imaging features of this type of tumor in an unusual location of the disease.

Wunderlich syndrome: a rare case in a young woman.

We report the case of a 29-year-old woman with Wunderlich syndrome, a rare spontaneous renal hemorrhage into the subcapsular and perinephric space. She presented to our emergency department with a sudden and persistent right flank pain in the abscence of abdominal injury. The onset of the symptoms can be insidious and lead to hypovolemic shock. Computed Tomography helps both in the diagnosis, detecting the renal hemorrhage, and contributes to an optimal patient management. Selective arterial embolisation is an efficient technique to stop acute and potential life-threatening hemorrhage and preserve the renal parenchyma.

Metabolic Bone Diseases in the Pediatric Population.

Bone plays an important role in regulating mineral balance in response to physiologic needs. In addition, bone is subject to a continuous remodeling process to maintain healthy bone mass and growth. Metabolic bone diseases are a heterogeneous group of diseases caused by abnormalities of bone mass, mineral structure homeostasis, bone turnover, or bone growth. In pediatrics, several significant advances have been made in recent years in the diagnosis of metabolic bone diseases (e.g., osteogenesis imperfecta, hyperparathyroidism, rickets, renal osteodystrophy, pediatric osteoporosis, and osteopetrosis). Imaging is fundamental in the diagnosis of these pathologies.

Radiation protection in non-ionizing and ionizing body composition assessment procedures.

Body composition assessment (BCA) represents a valid instrument to evaluate nutritional status through the quantification of lean and fat tissue, in healthy subjects and sick patients. According to the clinical indication, body composition (BC) can be assessed by different modalities. To better analyze radiation risks for patients involved, BCA procedures can be divided into two main groups: the first based on the use of ionizing radiation (IR), involving dual energy X-ray absorptiometry (DXA) and computed tomography (CT), and others based on non-ionizing radiation (NIR) [magnetic resonance imaging (MRI)]. Ultrasound (US) techniques using mechanical waves represent a separate group. The purpose of our study was to analyze publications about IR and NIR effects in order to make physicians aware about the risks for patients undergoing medical procedures to assess BCA providing to guide them towards choosing the most suitable method. To this end we reported the biological effects of IR and NIR and their associated risks, with a special regard to the excess risk of death from radio-induced cancer. Furthermore, we reported and compared doses obtained from different IR techniques, giving practical indications on the optimization process. We also summarized current recommendations and limits for techniques employing NIR and US. The authors conclude that IR imaging procedures carry relatively small individual risks that are usually justified by the medical need of patients, especially when the optimization principle is applied. As regards NIR imaging procedures, a few studies have been conducted on interactions between electromagnetic fields involved in MR exam and biological tissue. To date, no clear link exists between MRI or associated magnetic and pulsed radio frequency (RF) fields and subsequent health risks, whereas acute effects such as tissue burns and phosphenes are well-known; as regards the DNA damage and the capability of NIR to break chemical bonds, they are not yet robustly demonstrated. MRI is thus considered to be very safe for BCA as well US procedures.