[Liposarcoma of the hypopharynx]. / Liposarcoma de hipofaringe.

Liposarcomas (LS) of the hypopharynx are uncommon tumors. All the literature considers laryngeal and hypopharyngeal liposarcomas together, and they represent 10-15% of all LS of the head and neck. Obstruction of the upper respiratory tract and dysphagia are usually the initial symptoms. The histological subtype is the most important prognostic factor. Surgery is the treatment of choice. Recurrences are frequent. We present a case about a liposarcoma in a 81 years-old man. Diagnosis, evolution and treatment are evaluated.

[Magnetic resonance angiography (MRA) of the abdominal aorta and its branches]. / Angiographie par résonance magnétique (ARM) de l'aorte abdominale et de ses branches.

Technical aspects of 3D contrast-enhanced magnetic resonance angiography are exposed, detailing more particularly the pulse sequence used and the mode of injection of contrast agent. Then, various vascular territories are analyzed, and illustrated using various examples of main pathologies observed in routine clinical practice: abdominal aorta, renal arteries, pelvic and mesenteric vessels, and peripheral arteries.

Percutaneous mitoxantrone injection for primary and secondary liver tumors: preliminary results.

PURPOSE: To determine the effects of percutaneous intratumoral chemotherapy with mitoxantrone (PIM) in the palliative treatment of malignant liver lesions. METHODS: We treated 15 progressive lesions in nine patients in whom either previous therapy failed or serious complications developed as a result. Seven lesions were metastatic and eight were due to foci of hepatocellular carcinoma. Under computed tomography (CT) guidance, we percutaneously injected 10-20 mg of mitoxantrone mixed with 0.5 ml of contrast medium into the tumor, performing one to three treatments at intervals of 1 month. RESULTS: There were no complications. The morphologic responses of the tumors after treatment were: minor response in one case, no change in 11 cases, progressive disease in three cases. Mitoxantrone induced tumor necrosis with no viable cancer tissue in eight of 11 biopsies. Recurrence was observed in nine of the treated lesions 2-9 months after treatment. New lesions were observed in five of nine patients 1-9 months after treatment. CONCLUSION: In patients with malignant liver lesions with no other therapeutic possibilities, minimally invasive intratumoral mitoxantrone injection was carried out safely with good tumor delivery of chemotherapy, and tumor necrosis was demonstrated at biopsy. We feel this approach warrants further investigation.

Helical CT and 3D reconstruction of ureteropelvic junction obstruction: accuracy in detection of crossing vessels.

PURPOSE: The purpose of our study was to evaluate the accuracy of 3D helical CT and its value in surgical planning for the treatment of ureteropelvic junction obstruction (UPJO). METHOD: CT scans and 3D reconstruction of renal vessels and the renal pelvis were performed in 20 cases of UPJO treated by open surgery. We analyzed scans in search of a vessel at the junction and its position relative to the UPJ. Helical CT scans and 3D reconstructions were correlated with macroscopic surgical findings. RESULTS: CT scans demonstrated the presence of a UPJO in all cases. Crossing vessels were present at the junction in 13 of 20 cases. The vessel crossed the junction posteriorly in six cases and anteriorly in seven cases. Macroscopic surgical findings were in agreement with helical CT reconstructions in 100% of the cases. CONCLUSION: Axial scans together with 3D reconstruction are an accurate way of detecting crossing vessels when UPJO occurs, and the choice of the most adequate surgical technique is facilitated.

[Cowper's gland: anatomic, physiological and pathological aspects]. / Glandes de Cowper: aspects anatomique, physiologique et pathologique.

Cowper's glands are small appendages of the male genital tract, that are sometimes observed on intravenous urography voiding films. They are involved in the immune defence of the genitourinary tract, play a role in fertility, and secrete many glycoproteins, including PSA. They can be visualized in the form of a duct image parallel to the urethra, sometimes associated with opacification of the gland on IVU. This image can be differentiated from a fistula, extravasation of contrast agent, urethral duplication, or an artefactual image, by the course parallel to the urethra, the upper limit not exceeding the urogenital diaphragm, and the position of the orifice. These glands can be affected by neoplastic, infectious, stone and especially cystic disease: syringocele. The physician should think of these glands in patients with unusual genitourinary symptoms in order not to miss disease of these organs, and to prescribe appropriate treatment.

Spiral CT angiography: study of stenoses and calcification at the origin of the vertebral artery.

The origin of the vertebral artery may be difficult to show on sonography or conventional angiography. Our aim was to evaluate the accuracy of CT angiography (CTA) in detecting arteriosclerotic changes in the first segment (V1) of the vertebral artery. We performed CTA and intra-arterial digital subtraction angiography (DSA) on 24 patients with vertebrobasilar insufficiency. The ostium and the V1 segment were examined. Stenosis was assessed on a three-grade scale, and calcification and the degree of kinking were recorded. DSA and CTA results were compared. The ostium of the artery was seen in all cases on CTA and in 33 of 47 cases with DSA. All ostial stenoses diagnosed on DSA were seen with CTA. CTA revealed 4 stenoses in cases in which angiography proved inadequate, 11 zones of calcification and 5 cases of luminal reduction due to calcified plaques undetected on DSA. In the V1 segment DSA and CTA showed 3 stenoses, 9 cases of kinking, 1 of coiling and 4 stenoses due to kinking. CTA also demonstrated 4 additional stenoses, 2 cases of kinking and 3 stenoses due to kinking.

Preoperative staging of osteosarcoma: efficacy of MR imaging in detecting joint involvement.

OBJECTIVE: Selecting the appropriate surgical procedure for treatment of patients with osteosarcoma requires accurate preoperative evaluation of tumor extent. Establishing the presence or absence of joint involvement is particularly important. Accordingly, we studied the efficacy of MR imaging for detecting joint involvement in 46 patients with osteosarcoma around joint spaces. SUBJECTS AND METHODS: Preoperative MR examinations were performed in 46 consecutive patients with osteosarcoma whose tumors were located around the knee (n = 33), the hip (n = 8), or the shoulder (n = 5). T2-weighted and unenhanced and contrast-enhanced T1-weighted spin-echo MR images were obtained for all patients. We assessed the presence or absence of tumor invasion of the intracapsular-intrasynovial joint space, either by disruption of the joint capsule or by intraarticular destruction of the cortical bone and articular cartilage or the intracapsular-extrasynovial cruciate ligaments of the knee. All patients subsequently had surgery. The MR findings were correlated with findings from macroscopic and microscopic pathologic examinations. RESULTS: All 10 patients who subsequently proved to have tumor involvement of the joint were correctly identified (sensitivity, 100%). The tumor involved the knee joint in seven patients, the hip joint in two, and the shoulder joint in one. However, the MR diagnosis was false-positive in another 11 patients who did not have joint involvement at surgery (specificity, 69%). In the knee, MR imaging was more accurate in identifying tumor extension to the cruciate ligaments than to the intrasynovial joint space. Post-contrast T1-weighted images were most useful in detecting joint involvement. CONCLUSION: MR imaging is highly sensitive for detecting joint invasion of osteosarcoma. However, false-positive diagnoses may lead to overstaging of tumor and result in unnecessarily radical surgical procedures.

[Ultrasound-guided needle biopsies of thoracic space-occupying lesions]. / Ultraschallgezielte Nadelbiopsien thorakaler Raumforderungen.

This study is concerned with the results and experience gained from performing ultrasound-guided needle biopsies of thoracic masses in 56 patients. The accuracy of the biopsy results were related to the certainty of the method, the visibility of the biopsy needle on real time images, the effect of biopsy needle thickness and tumour size. Correct diagnosis was achieved in 84.6%. Inability to see the biopsy needle resulted in only 5.4% of cases and only when using a low frequency transducer (3 MHz). The thickness of the biopsy needle affected the accuracy of the biopsy, since all false negative or inconclusive biopsies resulted from the use of fine calibre needles. There was no significant correlation between tumour size and the accuracy of the biopsy results.

[The radiologic clinical picture of primary bone lymphoma]. / Radiologisches Erscheinungsbild des primären Knochenlymphoms.

Primary lymphoma of bone is a rare form of non-Hodgkin lymphoma which involves a single bone and has a relatively good prognosis following radiation therapy. We observed 17 histologically verified cases and found 97 cases in the literature. This rare tumour may occur at any time in adults and usually affects the metaphyses of long bones. It produces osteolytic changes and usually only mild periosteal reactions. Radiologically as well as histologically, differentiation from other highly malignant bone tumours is extremely difficult and sometimes impossible. A correct diagnosis can only be made from an accurate knowledge of the radiological appearances, localisation of the tumour and age of the patient.

["Pseudo-dissection" in an abdominal aortic aneurysm]. / "Pseudodissektion" beim abdominellen aortenaneurysma.

Sonography of 52 patients with aneurysms of the abdominal aorta revealed in 7 cases hypoechoic crescent-like zone between parietal thrombus and the aortic wall which simulated aortic dissection. Duplex-sonography was performed in all cases and no flow could be detected in this area. In two patients intraoperatively several milliliters of a serous fluid could be aspirated from this zone which confirmed the suggestion of seroma within the parietal thrombus. This observation may be found rather frequently and should not be a reason for immediate surgery.

Tumor vascularization: assessment with duplex sonography.

In this prospective study, the authors examined 123 patients with benign or malignant neoplasms (breast cancer, n = 44; liver neoplasms, n = 43; and tumors affecting other organs, n = 36) to establish general criteria for evaluation of neoplastic lesions by means of duplex sonography. The frequency shifts determined by means of different Doppler frequencies (2.31 or 3.75 MHz) were converted into flow velocities. Only the highest systolic peak flow velocity obtained from a lesion was used for statistical evaluation. Receiver operating characteristic curves showed that a flow velocity of 0.4 m/sec is the optimal threshold value with which to differentiate benign from malignant tumors. The data obtained in all lesions indicated that only positive findings are potentially reliable. It is concluded that negative results of sonography should not be used to diagnose the presence of a benign lesion. The resistive index of the tumors was of negligible importance.

[The value of mammography in patients up to the age of 35]. / Stellenwert der Mammographie bei Patientinnen bis zum 35. Lebensjahr.

The use of mammography in young women is under debate. In this prospective study of 220 women aged up to 35 years, the indications for mammography were compared with the final diagnosis. In this way, an attempt was made to define the signs and symptoms that justify mammography in this age group. The results show that mammography is indicated only in the presence of palpable lumps. All other signs or symptoms should not be investigated by means of ionising radiation in this particular age bracket.

[Intrathoracic splenosis]. / Intrathorakale Splenose.

Intrathoracic splenosis is an unusual event after diaphragmatic and splenic rupture, which causes intrathoracic mass lesions. It results from spontaneous autotransplantation of splenic tissue to serous surfaces. On chest X-rays, three different radiological appearances were distinguished: pulmonary mass lesions, pleural lesions and mediastinal tumors. Since the radiological appearance is nonspecific, a diagnosis may only be suspected together with the characteristic anamnesis. In those case scintigraphy should be performed because this method may verify the diagnosis. Here we report the radiological and clinical appearances of this entity by one of our own and 13 well-documented cases in the literature.

[Diagnosis of liver trauma: ultrasound versus computed tomography]. / Diagnostik des Lebertraumas: Ultraschall versus Computertomographie.

This study used 14 of our own patients and a review of the literature in order to determine the value of CT and sonography for investigating injuries to the liver. It appears that CT, with a sensitivity of 0.93, has a somewhat higher accuracy than sonography, which has a sensitivity of 0.83. We were also able to observe typical changes in the appearances, depending on the interval since the injury. Fresh injuries appeared as isodense or mildly hypodense areas, together with variable hyperdense portions on CT. Subsequently these areas become increasingly hypodense and may evolve into cystic lesions. Sonographically, recent injuries of the liver show echo-rich, non-homogeneous lesions which may contain smaller echo-free portions. Older lesions become increasingly devoid of echoes and become increasingly demarcated from normal liver parenchyma.