A case of Schistosoma japonicum retroperitoneal pseudotumor diagnosed by cone-beam CT-guided coaxial biopsy system.

We report a rare case of retroperitoneal pseudotumor caused by Schistosoma japonicum that was diagnosed by computed tomography (CT) guided percutaneous biopsy in a 15-year-old Filipino male. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a mass lesion, including a mesenteric artery, in the right retroperitoneal space. His mother had a history of S. japonicum infection but his initial stool examination was negative. As schistosomiasis was suspected, cone-beam CT-guided biopsy was performed to enable transcatheter therapeutic arterial embolization to be performed immediately in the event of hemorrhage. Histopathological examination revealed schistosomal eggs. Cone-beam CT-guided technique with a coaxial biopsy system is a safe and accurate diagnostic procedure for S. japonicum retroperitoneal pseudotumor.

Clinical and magnetic resonance imaging feature differences between solitary and multiple type Langerhans cell histiocytosis involving the craniofacial bone.

PURPOSE: To investigate the clinical and contrast-enhanced magnetic resonance imaging (MRI) features of craniofacial bone Langerhans cell histiocytosis (LCH) and discuss the differences between a solitary lesion group (SLG) and multiple lesions group (MLG). METHOD: This study included 22 consecutive patients with pathologically proven LCH who underwent contrast-enhanced MRI. The clinical data and MRI features were retrospectively assessed. RESULTS: The mean patient age was 5 years, and 15 patients were male. The frontal bone was the most frequently affected bone. Ten and 12 patients were classified into the SLG and the MLG, respectively. The following MRI features were observed in >50% cases: T1WI hyperintensity in 15 (68%) cases, T2WI hyperintensity in 16 (73%) cases, bulging sign in 18 (82%) cases, concentric or eccentric soft tissue mass formation in 13 (59%) cases, soft tissue edema in 16 (73%) cases, any grade of bone marrow edema in 16 (73%) cases, surrounding bone enhancement in 17 (77%) cases, and surrounding soft tissue enhancement in 16 (73%) cases. Patient age was significantly higher in the SLG than that in the MLG (P = 0.0014). Perilesional bone marrow edema and enhancement were significantly more prominent in the SLG than in the MLG (P = 0.032, P = 0.040). CONCLUSIONS: Contrast-enhanced MRI showed additional significant findings of mainly the surrounding details. Older age, extensive bone marrow edema, and enhancement may indicate solitary-type LCH rather than multiple-type LCH. These differences may help distinguish between solitary- and multiple-type LCH, which have different treatment strategies.

Quantitative evaluation of COVID-19 pneumonia severity by CT pneumonia analysis algorithm using deep learning technology and blood test results.

PURPOSE: To evaluate whether early chest computed tomography (CT) lesions quantified by an artificial intelligence (AI)-based commercial software and blood test values at the initial presentation can differentiate the severity of COVID-19 pneumonia. MATERIALS AND METHODS: This retrospective study included 100 SARS-CoV-2-positive patients with mild (n = 23), moderate (n = 37) or severe (n = 40) pneumonia classified according to the Japanese guidelines. Univariate Kruskal-Wallis and multivariate ordinal logistic analyses were used to examine whether CT parameters (opacity score, volume of opacity, % opacity, volume of high opacity, % high opacity and mean HU total on CT) as well as blood test parameters [procalcitonin, estimated glomerular filtration rate (eGFR), C-reactive protein, % lymphocyte, ferritin, aspartate aminotransferase, lactate dehydrogenase, alanine aminotransferase, creatine kinase, hemoglobin A1c, prothrombin time, activated partial prothrombin time (APTT), white blood cell count and creatinine] differed by disease severity. RESULTS: All CT parameters and all blood test parameters except procalcitonin and APPT were significantly different among mild, moderate and severe groups. By multivariate analysis, mean HU total and eGFR were two independent factors associated with severity (p < 0.0001). Cutoff values for mean HU total and eGFR were, respectively, - 801 HU and 77 ml/min/1.73 m2 between mild and moderate pneumonia and - 704 HU and 53 ml/min/1.73 m2 between moderate and severe pneumonia. CONCLUSION: The mean HU total of the whole lung, determined by the AI algorithm, and eGFR reflect the severity of COVID-19 pneumonia.

DWI scoring system for prognosis of acute encephalopathy with biphasic seizures and late reduced diffusion.

PURPOSE: The aim of this study was to predict neurological outcomes for acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) using diffusion-weighted imaging (DWI), and assess relationships between anatomical sites of lesions and their outcomes. MATERIALS AND METHODS: We assessed DWI abnormalities and neurological outcomes in 30 patients with AESD, and classified patients into severe and non-severe groups according to their neurological outcomes. We also established a DWI scoring system as follows: zero for normal, and one for lesion at each location. Differences between the severe and non-severe groups were examined, and receiver operating characteristic (ROC) curve analysis was performed. RESULTS: Nine (30%) patients were classified into the severe group. On DWI, patients in the severe group were more likely to have temporal lobe (P = 0.014), perirolandic (P = 0.008), and corpus callosum (P = 0.0008) lesions than those in the non-severe group. The total DWI scores were significantly higher in the severe group than those in the non-severe group (P = 0.0002). ROC curve showed an area under the curve of 0.929, with a cutoff value of five, sensitivity of 88.9%, and specificity of 81.0%. CONCLUSION: Patients with severe AESD had more extensive DWI abnormalities than those with non-severe AESD. Our DWI scoring system may be useful for the prediction of outcomes of AESD. Widespread lesions seemed to have stronger influence on outcomes than each lesion location.

Peripheral T-cell lymphoma, not otherwise specified accompanied by central nervous system involvement with features of lymphomatosis cerebri.

Lymphomatosis cerebri (LC) is a rare variant of primary central nervous system lymphoma, and it is characterized by diffuse cerebral infiltration of malignant lymphoma cells without evidence of a mass lesion. Herein, we report a patient with systemic peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) who had central nervous system involvement mimicking LC. A 72-year-old immunocompetent male presented with rapidly progressive dementia. Fluor-deoxy-glucose (FDG) -positron emission tomography revealed increased FDG uptake in the bone and skin. Histopathological examination of the skin lesion revealed PTCL-NOS infiltration. A FLAIR MRI scan of the brain revealed diffuse hyperintense lesions in the cerebral white matter of both hemispheres. These lesions were not enhanced with gadolinium, and there was no perceptible mass effect. We performed a brain biopsy, and the histology results were consistent with PTCL-NOS. The patient was treated with corticosteroid and chemotherapy; however the disease progressed, and he died 4 months after the diagnosis. This was a rare case of systemic lymphoma accompanied with central nervous system involvement mimicking LC.

[Familial Hemophagocytic Lymphohistiocytosis, That was Considered as Progressive Encephalitis before Sibling was Diagnosed].

Familial hemophagocytic lymphohistiocytosis (FHL) is an autosomal recessive disorder that is clinically characterized by fever, hepatosplenomegaly, cytopenia and sometimes vague or dramatic central nervous system (CNS) dysfunction. FHL affecting the CNS imitates several neurologic disorders and may be misdiagnosed, in particular when family history is unknown. We report an autopsy case of FHL that was firstly considered as progressive encephalitis. FHL was suspected after sibling had been affected by hemophagocytosis and the same CNS symptoms. Histopathologically, lymphocytes and macrophages infiltrated into the meninges, perivascular space, and parenchyma of the brain. Those lymphocytes were positive for CD3, CD8, GranzymeB, and negative for CD4, perforin. FHL must be included in the differential diagnostic considerations in children with progressive encephalitis.

Low-k periodic mesoporous organosilica with air walls: POSS-PMO.

Periodic mesoporous organosilica (PMO) with polyhedral oligomeric silsesquioxane (POSS) air pockets integrated into the pore walls has been prepared by a template-directed, evaporation-induced self-assembly spin-coating procedure to create a hybrid POSS-PMO thin film. A 10-fold increase in the porosity of the POSS-PMO film compared to a reference POSS film is achieved by incorporating ∼1.5 nm pores. The increased porosity results in a decrease in the dielectric constant, k, which goes from 2.03 in a reference POSS film to 1.73 in the POSS-PMO film.

Prognostic value of pretreatment levels of tumor markers for hepatocellular carcinoma on survival after curative treatment of patients with HCC.

BACKGROUND/AIMS: We evaluated the prognostic value of the pretreatment elevation of tumor markers for hepatocellular carcinoma (HCC) in patients who underwent curative treatment. METHODS: We studied 801 patients who had been diagnosed as initial HCC and fulfilled the following criteria: maximum tumor size, < or = 3 cm; number of tumors, < or = 3; remnant liver function, Child-Pugh class A or B; treated by hepatectomy or locoregional thermal ablation (LTA); and alpha-fetoprotein (AFP), Lens culinaris agglutinin A-reactive fraction of AFP (AFP-L3), and des-gamma carboxy prothrombin (DCP) were measured at diagnosis. We analyzed the effects of elevated tumor markers on patient survival in these 2 distinct groups with different types of treatment, i.e. hepatectomy and LTA. RESULTS: By multivariate analysis in 345 patients who underwent hepatectomy, no tumor marker significantly affected decreased survival rate. In the 456 patients who underwent LTA, the elevation of AFP-L3 (p=0.0171) and DCP (p=0.0004) significantly affected decreased survival rate; DCP elevation had the strongest effect on patient survival. CONCLUSIONS: The prognostic value of pretreatment tumor marker elevation was different in patients who underwent the curative treatment according to the type of treatment. Pretreatment elevation of AFP-L3 and DCP had prognostic values only in patients treated with LTA.

Spontaneous regression of hepatocellular carcinoma: report of a case.

A spontaneous regression of hepatocellular carcinoma is an extremely rare phenomenon. A 69-year-old Japanese man with hepatitis C virus-related chronic hepatitis presented with a liver tumor. We diagnosed the tumor to be hepatocellular carcinoma in the course of spontaneous regression, by imaging studies and changes in the tumor markers. Because the possible presence of viable cancer cells could not be ruled out, we recommended surgery. He refused all treatments at first, but finally agreed to undergo surgery about 10 months after presentation. A hepatectomy was performed. Histologically, no viable tumor cells were found. In our case, the vascularity of the tumor according to the imaging findings was followed up during the clinical course. The patient is now doing well and without any evidence of recurrence at 37 months after surgery.

An insulinoma for which secretin test and selective arterial calcium injection test were useful.

A 76-year-old woman suffered from somnolence while fasting for almost 2 years. Fasting plasma glucose (FPG) (40 mg/dl) and the immunoreactive insulin (IRI) level (8.8 microU/ml) were not compatible with Fajan's ratio or Turner's ratio observed in typical insulinoma. The secretin test showed no response to insulin secretion, suggesting the presence of insulinoma. Abdominal dynamic computed tomography (CT) revealed a 12-mm hypervascular lesion in the head of the pancreas. A selective arterial calcium infusion test (SACI) was performed, during which IRI in the hepatic venous blood was measured following selective intraarterial calcium infusion. An increase in IRI levels in the gastroduodenal and superior mesenteric arteries suggested the presence of a functional insulinoma in the head of the pancreas. Enucleation of the tumor improved FPG and IRI levels to 138 mg/dl and 3.8 microU/ml, respectively. After surgery, a secretin test showed a 5-fold increase in IRI levels, suggesting normal beta cell function. This case illustrates the value of the secretin test for the diagnosis of insulinoma and for the postoperative assessment of beta cell function. It further illustrates the value of the SACI for localizing an insulinoma.