RESUMO
Lipoblastomas are rare, benign tumors of mesenchymal origin that contain adipose tissue. They usually develop in the soft tissues of an extremity in infants, children, and young adolescents. We report the case of a 22-month old girl referred to our staff for swelling in the supraclavicular fossa, which was observed when the child cried. The ulstrasonographic examination revealed a mass in the anterosuperior portion of the mediastinum that extended into the right supraclacular fossa. The lesion was weakly hyperechoic with clear-cut margins and did not appear to invade surrounding tissues. On CT, it appeared inhomogeneously hypodense with denitometric characteristics of adipose tissue. On MRI, it was hyperintense on both T1- and T2-weighted sequences and reduced signal intensity in FAT SAT sequences. In light of the imaging features and predominant adipose tissue component, the mass was diagnosed as a mediastinal lipoblastoma, and this diagnosis was confirmed by surgical histology.
SommarioIl lipoblastoma è una rara neoplasia mesenchimale, benigna, contenente tessuto adiposo, che colpisce l'infanzia e la prima adolescenza e che si localizza preferenzialmente nelle parti molli delle estremità. Nel nostro caso una bambina di 22 mesi è giunta alla nostra osservazione per una tumefazione della fossetta sovraclaveare che si rendeva manifesta durante il pianto. L'esame ecografico ha evidenziato una neoformazione del mediastino antero-superiore a parziale sviluppo nella fossetta sovraclaveare destra, che appariva tenuemente iperecogena a margini netti. Tale neoformazione non presentava caratteristiche infiltrative nei confronti delle strutture limitrofe. La massa appariva alla TC disomogeneamente ipodensa, a densitometria adiposa, mentre alla RM risultava iperintensa nelle immagini T1 e T2-pesate, con abbattimento del segnale nelle sequenze FAT SAT. Le caratteristiche d'imaging ed in particolare la prevalenza di tessuto adiposo ci hanno suggerito l'ipotesi diagnostica di un lipoblastoma mediastinico, che è stata confermata dall'esame istologico eseguito sul pezzo operatorio.
RESUMO
AIM: To assess the accuracy of magnetic resonance imaging (MRI) in evaluating residual disease after neoadjuvant chemotherapy in patients with large breast cancers. MATERIALS AND METHODS: Forty-five women with large breast cancers underwent MRI mammography before and after neoadjuvant chemotherapy (three or six cycles). Dynamic MRI was performed using a 1.5 T unit using three-dimensional FSPGR sequences. For each patient tumour size, tumour volume and dynamic curve were obtained before and after neoadjuvant treatment. Residual tumour sizes obtained using MRI were compared with pathological findings to assess the accuracy of MRI in detecting and in measuring residual tumour. RESULTS: The sensitivity, specificity and accuracy of MRI in detecting residual disease was 90.5, 100, and 91.3%, respectively. The mean of largest diameters measured at histology and at MRI were 26 and 28.2mm, respectively. The tumour size correlation coefficient between MRI and pathology measurements was very high: r(2)=0.9657 (p<0.0001). The interclass correlation coefficient between preoperative imaging measurements and pathological measurements of residual disease was 0.944 (95% CI: 0.906-0.982). CONCLUSION: The presence and size of residual disease in breast patients treated with neoadjuvant chemotherapy could be accurately evaluated using MRI.
Assuntos
Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Lobular/diagnóstico , Imageamento por Ressonância Magnética , Terapia Neoadjuvante , Neoplasia Residual/patologia , Intensificação de Imagem Radiográfica , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma Lobular/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasia Residual/tratamento farmacológico , Sensibilidade e EspecificidadeRESUMO
A total of 39 patients with a mean age of 64 years (41 to 88) who had had anterior shoulder dislocation were followed-up an average of 2 years after trauma in order to evaluate the conditions of the rotator cuff. All of the patients were evaluated clinically, radiographically, and sonographically. Clinical evaluation revealed significant differences between the dislocated shoulders and the contralateral ones: the mean Constant score was 67 in the group with dislocated shoulders and 87 in the contralateral group. Ultrasound revealed partial injury of the cuff in 31% of cases and complete injury in 28%. Mean score was 81.4 in the group with a normal ultrasound, 67.1 in that with partial injury of the cuff, and 46.5 in that with complete injury of one or more tendons. These data confirm the high frequency of partial or complete injuries of the rotator cuff in patients aged over 40 years that have undergone anterior shoulder dislocation. Ultrasound confirms it is an excellent diagnostic method in the pathology of the rotator cuff, demonstrating good correlation with the clinical evaluation.
Assuntos
Lesões do Manguito Rotador , Luxação do Ombro , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Manguito Rotador/diagnóstico por imagem , Fatores Sexuais , Luxação do Ombro/complicações , Luxação do Ombro/diagnóstico , Luxação do Ombro/diagnóstico por imagem , Fatores de Tempo , UltrassonografiaRESUMO
The authors report the results of US-guided percutaneous ethanol injection into parathyroid glands of 11 patients with primary (2) and secondary (9) hyperparathyroidism. Selection criteria for choosing ethanol treatment were the patient's refuse of surgery and high surgical risks for age or severe chronic intercurrent conditions. At 18 months' follow-up, PTH serum levels had normalized in 2 primary and 2 secondary hyperparathyroidism patients; in all the others but one, PTH levels markedly decreased--always > 50% relative to pretreatment values. Serum calcium and phosphorus levels also decreased, which was not always the case with alkaline phosphatase. After injection, the glands became progressively hyperechoic, gland volume decreased and calcifications appeared. Parenchymal flow disappeared on color-Doppler US images. This study confirms the capabilities of US-guided ethanol injection in hyperfunctioning parathyroids, even though complications may occur and the condition recur. This method is thus suggested as an effective alternative to surgery.
Assuntos
Etanol/administração & dosagem , Hiperparatireoidismo/tratamento farmacológico , Adenoma/diagnóstico por imagem , Adenoma/tratamento farmacológico , Fosfatase Alcalina/sangue , Cálcio/sangue , Seguimentos , Humanos , Hiperparatireoidismo/sangue , Hiperparatireoidismo/diagnóstico por imagem , Hiperparatireoidismo Secundário/sangue , Hiperparatireoidismo Secundário/diagnóstico por imagem , Hiperparatireoidismo Secundário/tratamento farmacológico , Glândulas Paratireoides/diagnóstico por imagem , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/tratamento farmacológico , Fósforo/sangue , Fatores de Tempo , UltrassonografiaRESUMO
The authors report their personal experience with US, CT, biopsy and, lately, MRI, to localize enlarged parathyroid glands in primary and secondary hyperparathyroidism. December 1986 through December 1993, sixty-four primary and 55 secondary hyperparathyroidism patients were examined--119 in all. At biopsy and surgery, US sensitivity appeared to be 72%, with 0.94 positive predictive value; CT sensitivity was 80% with 0.91 positive predictive value. The two methods combined had 87% sensitivity in all. In the authors' experience, US proved to be a sensitive, accurate and cost-effective technique, as well as the best method to guide biopsy thanks to its multiplanar capabilities. Even though it requires great operator's experience, US is the method of choice in the localization of abnormal parathyroid glands. Its combination with CT increased overall sensitivity mainly in ectopic localizations and postoperative recurrences. Finally, technologic progress and increased MR sensitivity are likely to make MRI the imaging technique of choice, replacing CT, in the diagnostic protocol of hyperparathyroidism.
Assuntos
Hiperparatireoidismo Secundário/diagnóstico por imagem , Hiperparatireoidismo/diagnóstico por imagem , Adolescente , Adulto , Idoso , Biópsia por Agulha , Criança , Feminino , Humanos , Hiperparatireoidismo/patologia , Hiperparatireoidismo Secundário/patologia , Falência Renal Crônica/diagnóstico por imagem , Falência Renal Crônica/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/patologia , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , UltrassonografiaAssuntos
Carcinoma Hepatocelular/terapia , Etanol/uso terapêutico , Abscesso Hepático/microbiologia , Neoplasias Hepáticas/terapia , Infecções Estafilocócicas/etiologia , Idoso , Drenagem/métodos , Etanol/administração & dosagem , Humanos , Fígado/diagnóstico por imagem , Abscesso Hepático/diagnóstico por imagem , Abscesso Hepático/terapia , Masculino , Infecções Estafilocócicas/diagnóstico por imagem , Infecções Estafilocócicas/terapia , UltrassonografiaRESUMO
Between June 1988 and May 1991 88 orthotopic liver transplants and 1 liver and pancreas transplant were performed at the Liver Transplantation Department of the Ospedale Maggiore of Milan. All the patients underwent mycological surveillance and received antifungal prophylaxis with oral amphotericin B (6000 mg/day) or oral or intravenous fluconazole (200 mg/day) from the time of their transplant. The incidence of Candida colonization was 67%. Fluconazole was superior to oral amphotericin B in the treatment of C. albicans colonization (9/9 vs 6/15), but less effective in the treatment of colonization by other Candida spp. (0/3 vs 3/3). Deep-seated candidiasis developed in 5 patients, caused by C. albicans in 4 cases and C. krusei in 1. C. albicans infection resolved rapidly with fluconazole in 2 subjects, with intravenous amphotericin B alone in 1, and with amphotericin B plus flucytosine in the other. On the contrary, C. krusei infection did not respond to treatment with amphotericin B combined with flucytosine. Aspergillosis was diagnosed in 11 patients, of whom 4 died from invasive aspergillosis, despite 15 and 26 days of amphotericin B treatment in 2. In another patient invasive aspergillosis, diagnosed a few hours before retransplantation, improved with liposomal amphotericin B, but this man died from cytomegalovirus infection one month later. Aspergillosis was eradicated by itraconazole in 4 other patients and by topical amphotericin B in 2 whose infection was localized to surgical wound.
Assuntos
Aspergilose/tratamento farmacológico , Aspergilose/etiologia , Candidíase/tratamento farmacológico , Candidíase/etiologia , Transplante de Fígado/efeitos adversos , Infecções Oportunistas/tratamento farmacológico , Transplante de Pâncreas/efeitos adversos , Adolescente , Adulto , Anfotericina B/uso terapêutico , Aspergilose/prevenção & controle , Candidíase/prevenção & controle , Criança , Pré-Escolar , Fluconazol/uso terapêutico , Humanos , Lactente , Masculino , Infecções Oportunistas/prevenção & controle , Pré-MedicaçãoRESUMO
The authors report their experience with 19 percutaneous drainages of abdominal abscesses in 19 patients. Six collections were in the subphrenic spaces, 6 in the liver, 1 in the infracolic space, 2 in the psoas muscle, 3 within the abdominal wall, and 1 in the pararenal space. Their etiology was abdominal surgery in 10 patients, biliary obstruction in 1, and trauma in 2; in the extant patients a hematogenous infection was supposed. The procedures were performed under combined US and fluoroscopic guidance, following Seldinger technique in all but two cases. Van Sonnenberg double-lumen sump catheter was successfully employed in all cases. After a review of the technique the authors discuss the advantages of US-fluoroscopic over CT guidance. The latter is preferred if the collection is not well demonstrated by US and in the cases where a posterior approach is needed. The economic advantages of US-fluoroscopic over CT guidance are also stressed.
Assuntos
Abdome/diagnóstico por imagem , Abscesso/terapia , Fluoroscopia , Radiografia Abdominal , Abscesso/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo/instrumentação , Cateterismo/métodos , Humanos , Abscesso Hepático/diagnóstico por imagem , Abscesso Hepático/terapia , Pessoa de Meia-Idade , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/terapia , Abscesso Subfrênico/diagnóstico por imagem , Abscesso Subfrênico/terapia , Sucção/instrumentação , Sucção/métodos , UltrassonografiaRESUMO
The paper reports a case of teratoma of the urachus in a 53-year-old patient. The difficulties of diagnosing this pathology are underlined, in particular in relation to the rarity of the site of which no other examples have been reported in the literature.