Imaging­based diagnosis of intrapancreatic accessory spleen: A case report.

During a routine ultrasound examination of the abdomen, a 60-year-old male patient was diagnosed with mass in the tail of the pancreas. However, computed tomography (CT) suggested that the lesion was an intrapancreatic accessory spleen (IPAS). IPAS is a congenital anomaly, which usually does not present with symptoms. IPAS occurs during embryologic splenic development when a portion of the splenic tissue fails to fuse with the main body of the spleen. IPAS does not require treatment, except when it is combined with idiopathic thrombocytopenic purpura. In the present case, the diagnosis of IPAS was confirmed using magnetic resonance imaging (MRI). On CT and MRI, the IPAS had a density and intensity comparable with that of the spleen in all plain and contrast-enhanced phases. Due to comorbidities, the patient refused further evaluation or surgery. The lesion was periodically monitored using CT every 1-2 years. Since the tumour was stable during the 7-year follow-up, it was concluded that it was an IPAS. In patients that cannot undergo surgery, a characteristic location (near the spleen) and imaging features (such as a 'zebra-patterned' enhancement in the arterial phase on CT and high signal intensity on diffusion-weighted imaging sequences on MRI, which is comparative to that of the normal spleen) may allow for a diagnose of IPAS with a high level of certainty. Being aware of this condition could aid a correct diagnosis of IPAS and prevent unnecessary surgery.

[ULTRASOUND GUIDED PERCUTANEOUS SCLEROTHERAPY OF SIMPLE RENAL CYSTS: PRIMARY SUCCESS AND PROCEDURE SAFETY]. / PERKUTANA SKLEROTERAPIJA JEDNOSTAVNIH CISTA BUBREGA VODENA ULTRAZVUKOM: PRIMARNI USPJEH I SIGURNOST PROCEDURE.

OBJECTIVE: To evaluate primary (technical) success and procedure safety in ultrasound (US)-guided percutaneous sclerotherapy of simple renal cysts, using 96% ethanol. PATIENTS: 17 patients with symptomatic simple renal cysts referred by nephrologists or urologists. METHODS: US-guided percutaneous puncture of the cyst with an 18G (gauge) needle and a "pigtail" 5F (French) catheter, drainage and inspection of the cyst content, and injection of ethanol. RESULTS: Puncture was rejected in two referred patients because of Bosniak II cyst and renal hilum proximity. 15 patients underwent puncture and drainage of the cyst content. In 4 patients ethanol was not injected because: thick or bloody cyst, proximity of renal hilum and severe pain during injection of ethanol. 11 patients underwent sclerotherapy of the cyst. The average size of sclerosed cyst was 8 cm (range 6-12 cm). There were no significant complications. CONCLUSION: US-guided percutaneous sclerotherapy of simple renal cysts is easy to perform and safe procedure, with the previous good selection of cysts that are suitable for the sclerotherapy.

[Isolated myeloid sarcoma involving the mediastinum]. / Izolirani mijeloidni sarkom medijastinuma.

Myeloid sarcoma is a rare extramedullary solid tumor consisting of immature myeloid cells and most commonly involving the bone, skin, lymph nodes, soft tissue, gastrointestinal tract and testis. Mediastinal myeloid sarcoma is very rare. There are two major types of myeloid sarcoma: granulocytic sarcoma and monoblastic sarcoma, according to immature cell type. Myeloid sarcoma is found in 2%-8% of patients with acute myeloid leukemia (AML). Myeloid sarcoma may develop before or concurrently with AML, or may be the initial manifestation of AML relapse in previously treated patients. Blast transformation of some form of myeloproliferative neoplasm or myelodysplastic syndrome may also manifest as myeloid sarcoma. A major differential diagnostic problem is isolated primary myeloid sarcoma without bone marrow and peripheral blood involvement, which may precede leukemic stage for months or years, and which is frequently misdiagnosed, mostly as malignant lymphoma. A case is presented of a 56-year-old female patient complaining of weakness, vertigo, dry cough and breathing difficulties. Clinical examination revealed enhanced vascular pattern on the right chest and right arm edema. Computed tomography (CT) of the thorax showed an expansive growth measuring 11 cm craniocaudally in the anterior mediastinum. Fine needle aspiration cytology of tumor mass yielded a scarcely cellular sample with individual atypical immature cells, fine chromatin structure and scarce cytoplasm with occasional granules and Auer rods. Considering the morphological, cytochemical and immunocytochemical characteristics of immature cells, the diagnosis of myeloid sarcoma was made and verified by histopathology of tumor biopsy sample. Immature cells were not found by analysis of bone marrow puncture sample, immunophenotyping of bone marrow cells and bone biopsy analysis. As immature cell proliferation was not detected in bone marrow and peripheral blood, while spread of the disease beyond the mediastinum was ruled out by imaging methods (CT, ultrasonography), it was decided to be a primary non-leukemic form of mediastinal myeloid sarcoma. Myeloid sarcoma should be taken in consideration on differential diagnosis of solid tumors because making an accurate diagnosis is necessary for timely initiation of appropriate therapy. Weakly expressed or lacking clear signs of myeloid differentiation may hamper morphological diagnosis. As isolated myeloid sarcoma is a very rare entity frequently resembling lymphoma in clinical presentation, it poses a major diagnostic challenge for both morphologists and clinicians.

[Hepatocellular carcinoma initially diagnosed by fine needle aspiration cytology of the pelvic bone metastasis]. / Hepatocelularni karcinom primarno dijagnosticiran citoloskom punkcijom metastatskog procesa u zdjelicnoj kosti.

Hepatocellular carcinoma mostly develops in patients with liver cirrhosis due to chronic hepatitis C virus (HCV) infection. A case is presented of a patient with hepatorenal syndrome as a sequel of liver cirrhosis due to HCV infection. Primary tumor of the liver was not diagnosed by routine procedures, but by fine needle aspiration cytology of the extensive osteolytic lesion of the pelvic bone, performed as part of the pre-transplantation workup. Transplantation procedure was abandoned because of inappropriate donor liver (hepatic artery thrombosis), and palliative pain-relieving irradiation was recommended. However, hepatic coma developed very rapidly and the patient died within a month of the diagnosis of metastatic hepatocellular carcinoma. Although hepatocellular carcinoma metastases are not rare, massive bone infiltration from a primary tumor undetectable by routine methods is not frequently encountered.

Sonographic diagnosis of parotid gland lesions: correlation with the results of sonographically guided fine-needle aspiration biopsy.

PURPOSE: The aim was to assess the value of ultrasound (US) in differentiating benign from malignant parotid gland lesions. METHODS: During a 3-year period, US-guided fine-needle aspiration biopsy was performed on 89 parotid lesions with a size > or = 5 mm in 68 patients. In 80 (90%) lesions, specimens were adequate for cytologic analysis. We recorded the seven following US parameters: size, number, echogenicity, echotexture, margins' clarity, distal acoustic enhancement, and regional lymph node enlargement. RESULTS: Fine-needle aspiration biopsy revealed 18 (22%) malignant tumors, 30 (38%) benign tumors, and 32 (40%) nonneoplastic lesions. The mean size of the malignant tumors was 25 +/- 17 mm versus 27 +/- 17 mm for benign tumors versus 21 +/- 12 mm for nonneoplastic lesions (p > 0.05). Among 33 solitary tumors, 9 were malignant tumors and 24 were benign tumors. The majority of the parotid lesions were hypoechoic. The US feature that was most often associated with a benign lesion was distal acoustic enhancement. The US features that suggested malignancy were a heterogeneous echotexture, indistinct margins, and regional lymph node enlargement. CONCLUSION: US can aid in the differentiation of parotid gland tumors, although benign and malignant parotid tumors often have a similar sonographic appearance.

Sonographic diagnosis of thyroid nodules: correlation with the results of sonographically guided fine-needle aspiration biopsy.

PURPOSE: To assess the reliability of sonography in differentiating benign from malignant thyroid nodules and selecting lesions for fine-needle aspiration (FNA). METHODS: During a 2-year period, the following 7 sonographic parameters were assessed in 129 patients with thyroid nodules: size, number, echogenicity, echotexure, margin regularity, presence of calcifications, and presence of a hypoechoic rim. Sonographically guided FNA was performed on thyroid nodules 5 mm in diameter. Out of 184 FNAs, we obtained 168 specimens adequate for cytologic analysis and 16 (9%) nondiagnostic specimens. RESULTS: FNA diagnoses included 150 (89%) benign and 18 (11%) malignant nodules. Among 53 solitary nodules, 11 were carcinomas and 42 were benign (p < 0.01). The mean size of the carcinomas was 28 +/- 12 mm versus 18 +/- 10 mm for benign nodules (p < 0.01). The following sonographic features were significantly associated with malignancy: hypoechogenicity, irregular margins, calcifications, and absence of a hypoechoic rim. Differences in echotexure between malignant and benign nodules were not statistically significant. CONCLUSION: Sonographically guided FNA should be performed on thyroid nodules 5 mm in diameter with sonographic characteristics that suggest malignancy.