Can MRI Accurately Diagnose and Stage Endometrial Adenocarcinoma?

Background and Objectives: Endometrial carcinoma is one of the most common gynecological cancers, and benign lesions such as endometrial hyperplasia, polyps, adenomyosis and leiomyomas should be included in the differential diagnosis. Magnetic resonance imaging has an important role in evaluating endometrial cancer and assessing the depth of myometrial invasion, and it closely correlates with the prognosis of the patient. The purpose of this study is to evaluate the MRI semiology of the endometrial carcinomas that mimic benign lesions, the main factors that may affect the correct diagnosis and the feasibility of magnetic resonance imaging to evaluate the depth of the myometrial invasion of endometrial cancer. Materials and Methods: This is a retrospective analysis of 45 patients that underwent MRI examinations and the lesions were pathologically diagnosed as endometrial carcinoma after surgical resection. This study evaluated the staging accuracy of T2-weighted imaging, diffusion-weighted imaging (DWI), ADC mapping and T1-weighted imaging with fat saturation before and after gadolinium injection. Results: In 36 of the 45 cases, the MRI of the lesion showed the characteristics of endometrial cancer and the diagnosis was certain. Nine lesions (20%) were described as unequivocal and had unspecific MR appearance. In eight of the nine cases (89%), the histopathologic report revealed the presence of leiomyomas and two of these cases (22%) were also associated with adenomyosis. The cause of underestimation in these patients was coexisting lesions exhibiting heterogenous intensity and contrast enhancement, which made it difficult to detect the margins of the lesions. The depth of the myometrial invasion was underestimated in nine cases and overestimated in three cases. The staging accuracy with MRI was 74%. There was a significant correlation between MR imaging and histopathologic finding in the assessment of myometrial invasion (p < 0.001). Cervical extension was noted in eight cases (18%), but was missed on MR imaging in two patients and overstaged in none. Six of them were associated with myometrial invasion in more than 50% of the thickness. There was a significant correlation between MR imaging and histopathologic finding in the assessment of cervical extension (p < 0.001). Conclusions: Our data confirm the high accuracy of MRI in the diagnosis and local staging of endometrial carcinoma. The information provided by MRI has an important role in planning the treatment and the prognosis of the patients.

Prostatic Artery Origin Variability: Five Steps to Improve Identification during Percutaneous Embolization.

Background and Objectives: The purpose of the current paper is to present our study on the variability in the prostatic artery origin, discuss the less frequent origins, and present the challenges of the prostatic artery embolization (PAE) procedure, thus aiding young interventional radiologists. Materials and Methods: We studied the origins of the prostatic artery on digital subtraction angiography (DSA) examinations from PAE procedures on 35 male pelvises (70 hemi-pelvises). Results: Our study has demonstrated that the most frequent origin of the prostatic artery (PA) is the internal pudendal artery (IPA), 37.1%, followed by the anterior gluteal trunk, 27.1%, and the superior vesical artery (SVA), 21.4%. Less frequent origins are the obturator artery (OBT), 11.4%, and the inferior gluteal artery (IGA), 2.8%. Conclusions: Compared to other studies, we notice some differences in the statistical results, but the most frequent origins remain the same. What is more important for young interventional radiologists is to be aware of all the possible origins of the PA in order to be able to offer a proper treatment to their patients. The important aspect that will ensure the success of the procedure without post-procedural complications is represented by the successful embolization of the targeted prostatic parenchyma.

Ovarian metastases reported after adjuvant laparoscopic oophorectomies in breast cancer.

INTRODUCTION: Ovarian metastases (OM) of breast cancer (BC) can occur with different rates, ranging from 3-30%, being reported after prophylactic, therapeutic ovariectomies or discovered at necropsy. The aim of the study was to review the histopathological aspects of 59 laparoscopic oophorectomies performed in our Department as part of the oncological treatment of premenopausal women with BC. A number of eight (13.55%) patients were histologically confirmed with OM. The initial tumor, node, metastasis (TNM) stage of BC tumors was advanced with no pelvic symptoms or imaging abnormalities associated. Five (62.5%) patients had unilateral ovarian involvement and three (37.5%) bilateral, two of them being associated with primary bilateral BC. The immunohistochemical markers used to confirm the breast origin of metastasis were estrogen receptor (ER), progesterone receptor (PR), gross cystic disease fluid protein 15 (GCDFP15), Wilms' tumor 1 (WT1), cancer antigen-125 (CA-125), cytokeratin 7 (CK7), cytokeratin 20 (CK20). One case showed positive cytoplasmic reaction for thyroid transcription factor-1 (TTF-1). GCDFP15 was positive in all OM and almost all (seven of eight) were noted as non-immunoreactive for WT1. Although six cases of metastatic BC were positive for CK7 and negative for CK20, only four of them retain the same immunoprofile of their primary tumor for the metastatic ovarian lesions. Only one case out of eight showed weak and focal positivity for CA-125. Three cases were positive for mucin 1 (MUC1) and epithelial membrane antigen (EMA). CONCLUSIONS: The differential diagnosis between OM and primary ovarian cancer can be challenging for the pathologist as well and immunostaining is of help. GCFDP15 is the most specific for breast carcinoma. In contrast with the recent papers published in the literature, we detected TTF-1 cytoplasmic expression in invasive breast carcinoma by SPT24 clone.

A Case of Squamous Cell Carcinoma of the Oropharynx Invading Skull Base.

Squamous cell carcinoma is the most common type of neoplasia which affects the mucosa of the upper aero-digestive tract. We present the case of a male patient that at the clinical exam showed a tumor mass at the rhinopharynx. The CT examination showed a tumor mass developed from the upper portion of the oropharynx, from the soft palate. The tumor was invasive into the nasopharynx, and into the structures of skull base the skull base, and with bilateral lymphnodes metastasis. At histopathological examination, the fragments of tumor biopsy revealed the aspect of a moderately differentiated keratinised squamous cell carcinoma, with lymph node metastasis, and with invasion in the adjacent fibro-muscular tissue.

MRI differential diagnosis: bone metastases versus bone lesions due to malignant hemopathies.

Bone determinations are usually the first sign of disseminated cancers, whether is a hematological malignancy or other type of neoplasia. The aim of this paper is the possibility of differentiating the bone lesions from hematological malignancies by other malignancies that give bone metastases for the purpose to guide the clinician concerning causality of bone lesions. The research involved a retrospective study, which included 309 cases that were investigated by magnetic resonance imaging (MRI) at a segment of the spine, between 2010 and 2014, from which 137 were diagnosed with a form of hematological neoplasia, and the remaining had another form of cancer. Imaging aspect differs in these two study groups. Bone determinations due to malignant hemopathies (MH) were in general hypointense on T1-weighted sequences, iso- or hyperintense on T2-weighted sequences. On the other hand, bone metastases were hypo- or isointense on T1-weighted sequences, and had no specific signal intensity on T2-weighted sequences. In post-contrast images, all lesions showed contrast enhancement, with some differences. In terms of imagistic aspect, there are certain characteristics that can make a clear differentiation between bone determinations due to MH from the bone metastases, and some are found in the majority of the cases studied.

Semiological characters and morphopathological-radiological correlations in duodenal malignancy.

Localized duodenal neoplasms are relatively rare entities, most often representing invasions of the duodenum by malignant masses developed in the duodeno-pancreatic region. The paper makes a more exact analysis of radiological semiology of duodenal localized tumors and seeks to determine through this analysis the role of radiological examinations in the support for the anatomopathologist. The study group included 17 cases of duodenal localized tumors, nine cases of which have been shown to be vaterian ampulloma and eight malignant tumors of the duodenum. All cases were CT (computed tomography) examined and two-thirds were performed conventional radiological examinations, prior to CT examination. Pre-operatively, all cases were evaluated endoscopically, and in three of them bile prostheses were made. CT examination protocol included a native acquisition and post-administration of intravenous contrast agent in both the arterial phase and in parenchymal and venous phase. The acquisition was made with 3 mm thin sections, subsequently coronal and sagittal plane reconstructions being made. The paper tries to establish possible correlations between the morphopathological aspect and the radio-imaging semiological characteristics of lesions.

Low-grade appendiceal mucinous neoplasm mimicking an adnexal mass.

We present a rare case of malignant epithelial neoplasm of the appendix, an uncommon disorder encountered in clinical practice, which poses a variety of diagnostic and therapeutic challenges. We report a particular case in which the appendix was abnormally located in the pelvis, mimicking an adnexal mass. Therefore, it was difficult to make the preoperative diagnosis on clinical examination, imaging studies and laboratory tests and we discovered the lesion during the diagnostic laparoscopy. No lymphadenopathy or mucinous ascites were found. The case was completely handled via the laparoscopic approach keeping the appendix intact during the operation. The frozen section, the detailed histopathology overview as well as multiple immunostaining with a complex panel of markers report diagnosed a low-grade appendiceal mucinous neoplasm (LAMN) with no invasion of the wall. No adjuvant therapy was considered needed. At a one-year follow-up oncological assessment, the patient was free of disease. In women with cystic mass in the right iliac fossa an appendiceal mucocele should be considered in the differential diagnosis. Laparoscopic appendectomy can represent an adequate operation for the appendiceal mucinous neoplasm if the histological report is clear and surgical precautionary measures are taken.

CT characters versus morphopathological characters in pharyngeal squamous cell carcinoma.

Pharyngeal squamous cell carcinoma is a rare neoplasm, whose incidence increases with age. Computed tomography (CT) imaging is an easy way to explore the pharyngeal region, having the advantage of being able to highlight and characterize the existence of a tumor in this region, and to determine its local extension and lymphatic metastasis. In this group were included a total of 27 patients, who, following the histopathological findings were diagnosed with pharyngeal squamous cell carcinoma and who have previously received a CT scan. CT examination protocol included a native scan and post-intravenous administration of contrast medium, in both the arterial phase and in parenchymal and venous phase. The scan was made with 2 mm thin sections, subsequently were performed coronal and sagittal reconstructions. The examination plan included the thoracic region down to the aperture. The paper tries to establish correlations between the morphological appearance and semiological computed tomography characters of the lesions.

Bone marrow edema - premonitory sign in malignant hemopathies or nonspecific change?

Bone marrow edema (BME) is defined as an excess of fluids that builds up in the bone marrow (BM), commonly found because of osteoporosis, trauma, infections, ischemia or neoplasia. Histologically, BME is characterized by accumulation of extracellular eosinophilic fluid. Magnetic Resonance Imaging (MRI) is the only method that highlights the presence of BME caused by various diseases, including the one associated with hematological malignancies. The classic MRI protocol for the study of BM and BME includes T1- and T2-weighted sequences, the STIR sequence, and in some cases, the administration of intravenous contrast agents in T1-weighted sequences. Fifty-four patients were investigated; there were identified 30 patients with MRI features of BME. Out of the 30 patients with BME, 24 were known to have a malignant hematological disease (multiple myeloma, leukemia, lymphoma); for the remaining subjects, imagistic findings and other laboratory investigations led to multiple myeloma diagnosis. Of the 30 patients, six showed characteristic lesions of the underlying disease as well as BME; four patients had only BME. BM is a structure that is commonly investigated using MRI scans, regardless of the examined bone segment. T1-weighted images and T2-weighted with fat suppression are essential for BME evaluation. Moreover, MRI allows monitoring disease progression and treatment response in patients with malignant hemopathies.