Quiz. Correct answer to the quiz. Check your diagnosis. Mesenchymal chondrosarcoma of the orbit: two cases and a brief review of the literature.

Mesenchymal chondrosarcoma (MChS) is a rare, high-grade malignant tumor which occurs both in the bone and soft tissue. The extraskeletal location comprises one third of all MChS and in review of the up-to-date literature, about 30 cases of the orbital involvement were found. The authors present clinical, radiological and pathological findings of two cases of MChS of the orbit occurring in young adult females: primary extraskeletal MChS of the orbit and skeletal MChS of the ethmomaxillary complex with secondary orbit involvement. The histopathological examination revealed a characteristic biphasic pattern composed of small round to spindle-shaped cells, mimicking Ewing sarcoma family of tumors, with areas of a haemangiopericytoma-like pattern and admixed cartilage foci. One of the patients had local recurrence 3 years after initial surgical removal. Subsequently, she underwent enucleation followed by chemotherapy. The other patient had a biopsy and debulking resection of the tumor and started chemotherapy. Ten months follow-up of this patient show no evidence of metastasis.

The effect of early detection of occult brain metastases in HER2-positive breast cancer patients on survival and cause of death.

PURPOSE: The aim of the study is to evaluate disease-free survival, survival from the detection of brain metastases, overall survival, and cause of death in patients with occult brain metastases (Group I) vs. patients with symptomatic brain metastases (Group II). METHODS AND MATERIALS: In 80 HER2-positive breast cancer patients, treated with trastuzumab and cytostatic agents for metastatic disease, magnetic resonance imaging screening of the brain was performed, and in 29 patients (36%) occult brain metastasis was detected (Group I). Whole-brain radiotherapy was delivered to Group I. This first group was compared with 52 patients who had symptomatic brain metastases (Group II) and was treated the same way, at the same clinic, during the same time period. RESULTS: Median disease-free survival was 17 months in Group I and 19.9 months in Group II (p = 0.58). The median time interval between the dissemination of the disease and the detection of occult or symptomatic brain metastases was 9 and 15 months, respectively (p = 0.11). When the brain metastases were detected, the median survival was 9 and 8.78 months, respectively (p = 0.80). The median overall survival was 53 and 51 months, respectively (p = 0.94). In the group with occult brain metastases (Group I) 16% of patients died because of progression within the brain. In the group with symptomatic brain metastases (Group II) the rate of cerebral death was 48% (p = 0.009). CONCLUSIONS: Whole-brain radiotherapy of occult brain metastases in HER2-positive breast cancer patients with visceral dissemination produces a three-fold decrease in cerebral deaths but does not prolong survival.

[Disseminated peritoneal leiomyomatosis--case report and literature review]. / Rozsiana miesniakowatosc sródotrzewnowa--leiomyomatosis peritonealis disseminata (LPD) opis przypadku i przeglad pismiennictwa.

Leiomyomatosis peritonealis disseminata(LPD) is a rare smooth muscle pathology, characterized by the presence of multiple tumors in peritoneal cavity mimicking a malignant process with metastases. The diagnosis may be difficult in some cases as the results of ultrasonography and CT imaging may suggest malignancy. The final diagnosis was made on biopsy and pathologic examination performed during surgery. Exposure to estrogens probably plays the main etiologic role. In this report we describe the diagnostic difficulties and the clinical course of LPD in 45 year old women. The surgical treatment consisted on hysterectomy and removal of multiple nodules located in intestinal serosa. The additional hormonal treatment with GnRh agonist was applied. This report documents the possibility of effective surgical and hormonal treatment.

[Brain metabolic disorders after chemotherapy in the study by magnetic resonance spectroscopy]. / Zaburzenia metabolizmu mózgowia po chemioterapii w badaniu spektroskopii protonowej rezonansu magnetycznego.

UNLABELLED: The purpose of our study was to evaluate CNS pathology due to chemotherapy neurotoxicity, using MRI and localized proton MRS in patients with lung cancer treated with cisplatine, Vinca alkaloids and etoposide. A reduction in N-acetylaspartate was expected as a result of chemotherapy neurotoxicity. METHODS: 31 patients aged 42 to 73 years underwent the following procedures before and after chemotherapy: clinical examination; MRI of the brain (Elscint Prestige 2T), MRS (PRESS sequence, TR 1500 ms, TE 80 ms) with volumes of interest (VOI) of 8 ml localized in the semi-oval center and a cerebellar hemisphere. The analysis of each patient's NAA/Cr and Cho/Cr ratios was carried out separately for the semi-oval center and cerebellum measurements. RESULTS: None of the patients demonstrated any clinical manifestations of the CNS neuropathy. MRI of the brain did not reveal any abnormalities caused by chemotherapy. Pre-treatment NAA/Cr and Cho/Cr ratios in the semi-oval center did not differ significantly from these measured after chemotherapy. However, the analysis of the cerebellar spectra showed a significant decrease in the NAA/Cr ratio (p < 0.05) and a time-related decrease in the Cho/Cr ratio (p < 0.05) after chemotherapy. An analysis of Pearson's correlations showed a very strong linear relationship between NAA/Cr and Cho/Cr ratios (p < 0.001), both in the semi-oval center and cerebellum. CONCLUSION: The decreased NAA/Cr ratio can indicate some neuronal loss caused by chemotherapy. The decrease in the Cho/Cr ratio could be associated with some myelin damage. The MRS results suggest the presence of a sub-clinical selective cerebellar neuropathy caused by chemotherapy. The MRS revealed that reaction to chemotherapy was different at the semi-oval center than that in the cerebellum. The results allow theorizing about an alternative or two-stage brain response to the neurotoxic factor found both in the cerebrum (the semi-oval center) and cerebellum. These initial results indicate that proton MR spectroscopy is a potentially useful modality for detecting an early stage of the CNS pathology caused by neurotoxicity of chemotherapy.

Dynamic magnetic resonance imaging in soft tissue tumors -- assessment of the diagnostic value of tumor enhancement rate indices.

BACKGROUND: Dynamic MRI is routinely used in the diagnosis of soft tissue tumors to supplement static imaging. The aim of our study was to assess the diagnostic value of dynamic MRI using the coefficient of total tumor enhancement expressed as per cent (tec%) and the tumor enhancement rate coefficient expressed as per cent per minute (erc%/min), and to make a comparative analysis of the sensitivity and specificity of both parameters. MATERIAL/METHODS: The material consisted of 45 patients (30 sarcomas, 15 non-malignant lesions). The age of the patients was 16-64 years. The MRI was done using an Elscint 2T unit, applying gradient echo techniques. The coefficient of total contrast enhancement (tec%) and the tissue enhancement rate (erc%/min) were calculated. The limit values were determined for dividing the tumors into sarcomas and non-malignant lesions. The sensitivity and specificity of MRI were calculated and compared using both indices. RESULTS: Dynamic MRI with calculation of erc%/min and tec% makes it possible to differentiate between sarcomas and non-malignant lesions. CONCLUSIONS: The erc%/min was a more sensitive than tec% differentiating parameter in the diagnosis of soft tissue tumors.

Dynamic MR imaging of soft tissue tumors with assessment of the rate and character of lesion enhancement.

BACKGROUND: The aim of this study was to analyze the diagnostic usefulness of dynamic MRI with determination of the coefficient of enhancement rate and the character of tumor enhancement, and to assess both parameters in the differentiation of malignant lesions. MATERIAL/METHODS: The material consisted of 45 patients (30 sarcomas, 15 non-malignant lesions), age 16-64 years. MRI was done using an Elscint 2T unit, gradient echo techniques, apex angle 80 degrees. The repetition time (TR) was 80-200 ms, the echo time (TE) was 2-6 ms, 1 excitation; the acquisition time (TA) was 70-80 ms. The coefficient of tissue enhancement rate was calculated in the region of interest, and expressed as percent per second (erc%/s). The limit value of erc%/s was determined. The sensitivity and specificity of MRI were calculated in the differentiation of malignant tumors. The method of contrast filling of the tumors was assessed in successive phases after administration of gadolinium Gd-DTPA. RESULTS: Dynamic MRI with determination of the index of tumor enhancement rate is highly sensitive (93%) and specific (73%) in the differentiation of malignant and benign lesions. The usefulness of the assessment of tumor enhancement character was not confirmed, since the sensitivity and specificity were 73% and 33%. Dynamic MRI with determination of erc%/s and tumor enhancement character is highly sensitive (93%) and specific (87%). CONCLUSIONS: Dynamic MRI with determination of erc%/s and tumor enhancement character is the best method for differential diagnosis.

An assessment of the effectiveness of magnetic resonance imaging in delayed sequences after administration of Gd-DTPA contrast in the detection of metastatic lesions in the brain.

BACKGROUND: Advances in oncology in recent years have made it possible to undertake radical interventions even in advanced cases. Local treatment, surgical or radiosurgical, is applied ever more frequently in cases of metastases to the brain. This requires accurate determination of the number and location of metastases by means of imaging techniques. The goal of our research was to establish whether the use of sequences delayed by 20-30 minutes after gadolinium injection improves the number of metastatic lesions detected in the brain by MRI. MATERIAL/METHODS: Twenty-eight patients were studied, ranging in age from 24 to 72 years, diagnosed with malignant tumors and suspected metastases to the brain. MRI examinations were performed with a 2T unit in SE T1 immediately after i.v. administration of a 0.1 mmol/kg dose of gadolinium, and again 20-30 minutes after contrast injection; both sequences were done in axial projection in layers identical as in the SE T1 sequence made before gadolinium injection. The focal lesions were counted and classified by size. The number of detected lesions was calculated in each group, comparing early and late phases after contrast injection. RESULTS: The number of all nodules found in the delayed sequences was significantly higher in comparison to the early phase after gadolinium injection. CONCLUSIONS: Delayed sequence should be used to supplement basic sequences in the diagnosis of malignant metastases to the brain in selected oncological cases.