Thirteen-year long-term follow-up in a rare case of anaplastic astroblastoma: What makes the difference?

Background: Astroblastomas are uncommon neuroepithelial tumors of the central nervous system with a distinct, yet, controversial radiological, histological, and molecular profile. Debatable differences between low- and high-grade astroblastoma have been reported in the medical literature; indeed, despite the increasing relevance of molecular genetic profiling in the realm of astroblastoma, its application is still in its early stages. As a result, the diagnostic criteria for astroblastoma remain undecided with yet no real consensus on the most ideal management. Case Description: This report describes a case of astroblastoma diagnosed 13 years ago in a young woman who despite six episodes of recurrence, transformation, and progression was able to retain a perfomace status of 0 by World Health Organization standard, throughout. Conclusion: This report discusses the clinical, radiological, histological features, and management of this rare tumor with an extraordinarily long survival, with an aim to strengthen the literature on management options. To the best of our knowledge, this is the longest surviving case of anaplastic astroblastoma reported in the available medical literature.

Caecal metastasis from breast cancer presenting as intestinal obstruction.

BACKGROUND: Gastrointestinal metastsasis from the breast cancer are rare. We report a patient who presented with intestinal obstruction due to solitary caecal metastasis from infiltrating ductal carcinoma of breast. We also review the available literature briefly. CASE PRESENTATION: A 72 year old lady with past history of breast cancer presented with intestinal obstruction due to a caecal mass. She underwent an emergency right hemicolectomy. The histological examination of the right hemicolectomy specimen revealed an adenocarcinoma in caecum staining positive for Cytokeratin 7 and Carcinoembryonic antigen and negative for Cytokeratin 20, CDX2 and Estrogen receptor. Eight out of 11 mesenteric nodes showed tumour deposits. A histological diagnosis of metastatic breast carcinoma was given. CONCLUSION: To the best of our knowledge, this is the first case report of solitary metastasis to caecum from infiltrating ductal carcinoma of breast. Awareness of this possibility will aid in appropriate management of such patients.

Scimitar syndrome: imaging by magnetic resonance angiography and Doppler echocardiography.

We report magnetic resonance angiographic demonstration of both an anomalous pulmonary venous drainage and an anomalous systemic arterial supply in a patient with scimitar syndrome. Contrast-enhanced magnetic resonance angiography provides an excellent non-invasive diagnostic tool for demonstrating this complex congenital lesion in detail. A two-dimensional and colour Doppler echocardiography was also performed to show the anomalous venous drainage and to analyse the anomalous flow velocity pattern.

Perfusion magnetic resonance imaging in intracerebral parenchymal tuberculosis: preliminary findings.

OBJECTIVES: To study the vascular perfusion patterns of focal intracerebral tubercular lesions using echoplanar magnetic resonance (MR) imaging-derived relative cerebral blood volume (rCBV) maps. METHODS: Seventeen focal tubercular lesions were evaluated with conventional and perfusion-weighted MR imaging on a 1.5-T MR system. The rCBVs of the center, peripheral wall, and perilesional white matter were calculated from the perfusion MR-derived data. Perfusion MR imaging findings as depicted on the rCBV maps were qualitatively compared with those of conventional MR findings. RESULTS: Eleven of the 17 lesions demonstrated vascularity greater than that of the contralateral white matter on rCBV maps. The mean of the measured rCBV values of the peripheral wall and center of the lesions was 2.5 +/- 1.42 and 0.33 +/- 0.3 (mean +/- SD), respectively. Most of the hypervascular lesions (8) revealed a concentric peripheral wall having alternating hypointense and hyperintense signal intensity rims surrounding a variable intensity center on T2-weighted images. All the lesions having a nodular enhancing pattern (4) were hypervascular. CONCLUSIONS: Focal cerebral tubercular lesions can have variable vascularity as shown on perfusion MR-derived rCBV maps. It may be difficult to differentiate hypervascular lesions from cerebral tumors in some patients based on perfusion MR imaging alone.

Petrous apex arachnoid cyst extending into Meckel's cave.

A rare case of arachnoid cyst involving the petrous apex with an unusual clinical presentation has been described with special emphasis in the imaging features and importance of accurate presurgical diagnosis. Differentiation from the other benign lesions involving the petrous apex and the role of newer MR techniques in the diagnosis of these lesions has been highlighted.

Magnetic resonance cholangiopancreatography: evaluation in 150 patients.

BACKGROUND AND AIMS: Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive imaging technique for evaluating the biliary and pancreatic ducts. MRCP has reached a level of resolution and reliability where it may replace diagnostic endoscopic retrograde cholangio-pancreatography (ERCP). We analyzed the results of MRCP in adult patients with biliary or pancreatic disease, and compared the findings with those at surgery or on ERCP. METHODS: Data of 150 patients who underwent MRCP with both single slab and multislice rapid acquisition with relaxation enhancement sequences with half-fourier acquisition single-shot turbo spin echo techniques were analyzed. Patients were divided into four groups according to reason for referral for MRCP: obstructive jaundice (n = 65), chronic/acute pancreatitis (n = 25), screening prior to laparoscopic cholecystectomy (n = 20), and failed ERCP (n = 40). RESULTS: MRCP could accurately identify the level of biliary obstruction in 58 of 61 patients. Characterization of benign or malignant nature of a stricture was possible in 30 of 32 patients when findings of both MRCP and magnetic resonance imaging were analyzed together. MRCP revealed the morphology of the entire pancreatic duct in 13 of 15 patients having ductal changes on endoscopic retrograde pancreatography. CONCLUSION: MRCP has high sensitivity and specificity for detection of biliary dilatation, calculi, strictures and anatomical variants.

Massive hemangioma or lymphedema? A case with a diagnostic dilemma.

The authors present an unusual case of massive enlargement of the right lower extremity that was treated as lymphedema secondary to filarial infection. A multiple-method approach beginning with scintigraphy led to the diagnosis of massive hemangioma with probable associated lymphatic proliferation. Abnormal local proliferation of vascular and lymphatic tissue is a developmental anomaly that is difficult to diagnose or characterize, even with histopathologic data. Individual imaging methods may also yield nonspecific findings. Blood-pool scintigraphy, therefore, has a definitive role to play in assessing such complex lesions.