Rare Metastatic Sites of a Lung Adenocarcinoma.

We report a rare case of a lung adenocarcinoma presenting with chylothorax and metastases to the common bile duct and the rectum. From the radiological and endoscopic appearance of the tumors, the main differential diagnoses were metastatic lung cancer to multiple rare extra-thoracic sites and multiple synchronous primary oncological malignancies. Pathological examination of the biopsies with positive immunohistochemical staining for thyroid transcription factor-1 (TTF-1) played an important role in confirming metastatic pulmonary adenocarcinoma.

Role of computed tomography-calculated intraparenchymal tumor volume in assessment of patients undergoing partial nephrectomy.

OBJECTIVES: To determine the complexity of renal masses by using an objective novel imaging parameter (intraparenchymal tumor volume) based on computed tomography scans, to correlate this parameter to perioperative outcomes and to the RENAL nephrometry score. METHODS: After institutional review board approval, 87 patients who underwent partial nephrectomy between 2012 and 2016 at Singapore General Hospital, Singapore, were retrospectively analyzed. Preoperative computed tomography intravenous pyelogram scans were reviewed by a single senior radiologist who calculated the intraparenchymal tumor volume. Once the intraparenchymal tumor volume scores were obtained, they were compared with perioperative renal and surgical outcomes, and nephrometry scores. Furthermore, intraparenchymal tumor volume was subdivided into two categories, low and high intraparenchymal tumor volume, both using the 89th percentile. RESULTS: The mean patient age was 60 years, and the mean tumor size was 2.9 cm. The mean nephrometry score was 7.8, and the mean intraparenchymal tumor volume score was 12.7 cm³. The cut-off for high intraparenchymal tumor volume was >27.26 cm³. As a continuous variable, intraparenchymal tumor volume showed a significant relationship with the percentage of creatinine change (P = 0.009) and nephrometry scores (P < 0.001). As a categorical variable, high intraparenchymal tumor volume showed significance when compared with absolute creatinine change (P = 0.018), percentage of creatinine change (P = 0.004) and nephrometry score (P < 0.001). CONCLUSIONS: Intraparenchymal tumor volume represents a novel objective tool based on computed tomography imaging to determine the complexity of a renal mass. This tool correlates with renal functional outcomes of partial nephrectomy, and it also shows good correlation with RENAL nephrometry score.

Clinics in diagnostic imaging (143). Perianal mucinous adenocarcinoma arising from chronic fistula-in-ano.

We report a case of mucinous adenocarcinoma arising in the perianal soft tissue in association with chronic fistula-in-ano in a 43-year-old man who had a relapse of perianal pain and bloody discharge after six years of defaulted follow-up. He underwent magnetic resonance (MR) and computed tomography imaging with correct identification of the disease entity on imaging. Mesh-like septations and an enhancing solid component with high diffusion-weighted imaging (DWI) and intermediate apparent diffusion coefficient signals were observed. He underwent abdominoperineal resection of the tumour but succumbed due to postoperative complications. Literature on the MR imaging features of this tumour remains scarce. We highlight the MR imaging features, including those seen on DWI, which were useful in making the correct diagnosis. Though uncommon, this would be an important condition to recognise since assessment of fistula-in-ano by MR imaging is considered to be the standard of care in current clinical practice. The clinical features of this entity are also briefly discussed.