Metastatic hypernephroma to the head and neck: unusual case reports and review of the literature.

Hypernephroma is one of the most common tumours to spread by extranodal metastases to the head and neck. We herein report on six patients with unusual metastatic hypernephroma to the head and neck area. In two of the six cases, the metastatic tumour in the head and neck was the presenting symptom, and the renal tumour was secondarily detected. Metastatic hypernephroma to the head and neck area has been demonstrated mostly in the paranasal sinuses, parotid gland, and the mandible. Among the six cases presented, four belong to the above-mentioned group, but the other two are rather rare cases, one metastatic to the nasopharynx and soft palate and the other to both lobes of the thyroid gland. Hypernephroma should be sought and excluded whenever a metastatic lesion is encountered in the head and neck area, even if the metastatic lesion is the first clinical presentation. The diagnosis of metastatic hypernephroma should be suspected in any patient with even a remote history of renal cell carcinoma.

The peritoneal membrane in peritoneal dialysis patients: estimation of its functional surface area by applying stereologic methods to computerized tomography scans.

The surface area of the peritoneal membrane in contact with dialysate is an important determinant of solute transport across the peritoneum. Yet there is no method for its estimation in peritoneal dialysis patients. In this study, stereologic methods were applied to computerized tomography (CT) imaging of the peritoneal membrane to estimate the peritoneal membrane surface area. The method was first validated by implementing stereologic methods on a phantom of known surface area. The phantom was a distorted bottle filled with contrast media. Series of thin helical CT sections were performed, and random sections were obtained after reconstruction. A transparent counting grid was placed over the random sections. The surface area was estimated using 9, 18, and 36 random sections. To calculate the coefficient of variation (CV) of the method, 20 different combinations of 9, 18, and 36 random sections were used. With 36 random sections, the error in estimation of the bottle's surface area was -9.4% to +8.8%. The CV was 5.0%. Decreasing the number of sections used to 18 and 9 yielded a CV of 7.8 and 12.3%, respectively. This method was then applied to the peritoneal membrane, which was visualized by instilling dialysate containing contrast media into the peritoneal cavity of peritoneal dialysis patients. The estimated peritoneal membrane surface area of six patients was 0.55 +/- 0.04 m2. This novel method permits the measurement of the peritoneal membrane surface area with a high degree of accuracy.

[Head and neck sarcoma].

We reviewed patients with primary soft tissue and bone sarcomas treated in our department. Malignant tumors arising in somatic, connective, soft tissues, especially those of the head and neck, are uncommon and few reports have been published. Between 1980 and 1995 15 patients with head and neck sarcoma were seen. The major sites involved included: paranasal sinuses and orbits (2 patients), neck (4) and 1 each in the forehead, temporal region, mandible, parapharyngeal space, tongue, hypopharynx, larynx, cervico-mediastinal region and nasal cavity. Follow-up ranged from 1-16 years. The youngest patient was a 12-year-old male. Rhabdomyosarcoma, one of the most common mesenchymal tumors found in the head and neck, especially in children, was excluded from our study because of its different clinical behavior and its chemosensitivity, unlike other sarcomas. Most of our patients were treated with wide-field resection; 12 received postoperative radiation, and 3 combined surgery and chemotherapy. Wide excision with negative margins is considered an important, positive, prognostic factor, as the extent and adequacy of excision largely determines survival and the incidence of local recurrence. All our patients underwent initial, wide, local excision of the lesion. Our observations strongly suggest that wide resection is the most effective means of therapy for sarcoma of the head and neck. Radical neck dissection was not only performed for manifest regional neck metastases, but was also used for completing the enlarged, wide-excisions of liposarcomas. The worst survival was in patients with osteosarcoma, angiosarcoma and fibrosarcoma, with an absolute 5-year survival of 60% (9/15).

An evaluation of lateral and medial transposition of the ovaries out of radiation fields.

BACKGROUND: Transposition of the ovaries is practiced in young women before possible radiation to the pelvic fields. In patients with carcinoma of the uterine cervix (Ca cervix), the ovaries are transposed laterally (LOT), whereas in patients with Hodgkin's disease (HD), they are usually transposed medially (MOT). Nevertheless, not all transposed ovaries are successfully protected. METHODS: Computed tomography was performed in 16 patients (7 Ca cervix and 9 HD) after ovarian transposition. The location of all identified ovaries was depicted on diagrams of the respective radiation fields for evaluation of the efficacy of LOT or MOT in relocating the ovaries out of these fields. RESULTS: All 13 ovaries transposed laterally were easily identified by CT, as compared with only 13 of 18 ovaries transposed medially (P = 0.2). Eleven of the 13 ovaries that underwent lateral transposition (6 of 7 patients) were located outside the radiation field. In contrast, only 3 of 13 identified ovaries in the medially transposed group were completely outside the radiation field (P = 0.005). Of the remainder, six were completely within the radiation field, and four were at least partially within the radiation field. CONCLUSIONS: Although LOT achieves its purpose in patients with Ca cervix, the use of MOT in patients with HD should be revised to achieve better protection of the ovaries from the effects of radiation. The authors suggest that LOT is preferred over MOT also in patients with HD if radiation of the pelvic lymph nodes is planned.

Suture granuloma simulating lung neoplasm occurring after segmentectomy.

A suture granuloma was resected which developed after segmentectomy of a squamous cell carcinoma of the lung and radiologically mimicked a neoplasm. This report emphasises that although the appearance of the lesion may be typical for malignancy, the possibility of a benign suture granuloma should be considered, especially if the lesion appears shortly after surgery.

Pitfalls in the follow-up of cervical and mediastinal goitres: role of CT imaging.

Four patients with cervical and mediastinal goitres were described. Routine investigation in these patients, including chest X-rays, oesophageal and tracheal X-rays and scintigraphy of the thyroid gland, failed to show significant changes over the years, or underestimated the true extent of the goitres. Three of the goitres caused severe mediastinal compression, evident only on computed tomography (CT) imaging, and requiring urgent surgery. The pros and cons of different diagnostic modalities for imaging cervical and mediastinal goitres are discussed, stressing the importance of CT imaging as exemplified in the cases presented.

Short pancreas in polysplenia syndrome.

Two cases with the polysplenia syndrome also had a short pancreas. To the best of our knowledge the radiologic characteristics of this anatomic anomaly have not yet been reported. Both cases were asymptomatic with regard to their anomaly-complex. The radiologic findings of the short "pancreas" are similar to the only pathologic description of this association. The awareness of this association led to the diagnosis of the second case after a few months only. A physician performing ERCP in the polysplenia syndrome should keep in mind the possible presence of the "short pancreas" when the whole length of the pancreatic duct is not visualized.

Air in vagina. Indicator of intrapelvic pathology on CT.

Computed tomography of the normal female pelvis may show the presence of a tiny air bubble within the vagina. Among 2,800 female abdomino-pelvic CTs, 27 were found to contain large amounts of intravaginal air. Twenty-three patients suffered from pelvic malignancy while in 4, non-tumorous pelvic pathology was present. Detection of air bubbles in the vagina is abnormal and indicates, in the majority of cases, an intrapelvic malignancy.