Radiation-induced Desmoid Tumor Development in the Radiotherapy Field in a Child With Pineoblastoma: A Case Report.

Although treatment-related secondary malignancies are rare, they are important problems after the treatment of childhood malignant diseases. Irradiation-induced sarcomas are the development of sarcoma different from the primary tumor after a latent period of ≥3 years or more in the radiotherapy field. Desmoid tumor is extremely rare as irradiation-induced tumor. A 7.5-year-old girl was referred to our hospital after a subtotal mass excision for a solid lesion with a cystic component located in the pineal gland. Pathologic examination revealed pineoblastoma. After surgery, craniospinal radiotherapy, and chemotherapy consisting of vincristine, cisplatin, and etoposide were performed. Painless swelling in the left parieto-occipital region ~75 months after the end of the treatment developed in the patient. A mass was detected in the intracranial but extra-axial region by radiologic imaging methods. Due to the total removal of the mass and the absence of a tumor in the surgical margins, she was followed up without additional treatment. The pathologic diagnosis was a desmoid tumor. She was followed up disease free for ~7 years after the primary tumor and ~7 months after the secondary tumor. Treatment-related desmoid tumor development after treatment for a central nervous system tumor in a child is extremely rare.

Conventional and advanced MR imaging findings of primary Ewing sarcoma of the tentorium: a case report with literature review.

BACKGROUND: Primary intracranial Ewing sarcoma/primitive neuroectodermal tumor (ES/PNET) is an extremely uncommon tumor. Care should be taken as it can be mistaken for a meningioma radiologically. CASE DESCRIPTION: This paper reports a case of a 44-year-old male presenting with headache. A magnetic resonance imaging demonstrated a mass involving the tentorium, cerebrum and cerebellum with solid-cystic component. The solid component was hyperintense on T1-weighted images with significant enhancement. There was restriction in diffusion-weighted images and microhemorrhagic signal change in susceptibility weighted images. MR perfusion revealed increased relative cerebral blood volume and mean transit time values. Surgical pathology was reported as ES. CONCLUSIONS: Intracranial ES/pPNET is a rare tumor that generally arises from the meninges. It must be distinguished from meningioma since it can be mistaken radiologically, because the treatment and prognosis are quite different. Localization and conventional MR signal characteristics of both lesions are similar. Whereas, MR perfusion findings may be helpful in discrimination.

Fahr's disease associated with anaplastic ependymoma: a case report and review of the literature.

Fahr's disease, also known as familial idiopathic basal ganglia calcification or bilateral strio-pallido-dentate calcinosis, is a rare entity characterized by abnormal vascular calcium depositionin the thalamus, basal ganglia, cerebral cortex and the dentate nuclei of the cerebellum. Intracranial ependymomas comprise approximately 2% to 9% of all neuroepithelial tumors. It is reported that supratentorial ependymoma constitute 30% to 50% of all intracranial ependymal tumors. Among supratentorial ependymomas, approximately 50% of them are located extraventricular and demonstrate no relationship with the ventricularsystem.The association of brain tumor with Fahr's disease is a rare entity and has been reported several times before. Whereas, to best our knowledge, the association of Fahr's disease and supratentorial anaplastic ependymoma is described in the present study for the first time.

Using 2-dimensional color superb microvascular imaging vascularization index technique in the assessment of thyroid surgical bed.

AIM: The purpose of this study was to investigate the effectiveness of the vascularization index (VI) obtained using color superb microvascular imaging (cSMI) technique in the assessment of thyroid surgical bed for remnant thyroid tissue (RTT). MATERIAL AND METHODS: We evaluated the thyroid surgical bed of 65 patients who had underwent total thyroidectomy (TT) due to papillary carcinoma (PC) using thyroid scintigraphy and cSMI. Color SMI was also performed for the examination of the thyroid parenchyma of 39 healthy asymptomatic participants. VI measurements were performed by manually drawing the contours of the RTT in those with remnant thyroid, the thyroid surgical bed in the patients' group without remnant thyroid, and normal thyroid parenchyma in the control group, using the free region of interest (ROI) with 2-dimensional color SMI VI (2DcSMIVI) mode. The volume of ROI was measured and echogenicity was evaluated. The quantitative 2DcSMIVI values of the surgical bed with RTT (Group A), the surgical bed without RTT (Group B) and normal thyroid of healthy asymptomatic participants (Group C) were compared. RESULTS: The mean 2DcSMIVI values of Group A was significantly higher than Group B and C (p=0.001). The presence of RTT can be diagnosed with 89.1% sensitivity and 87.5% specificity when 1.75 2DcSMIVI is designated as the cut-off value. CONCLUSION: The 2DcSMIVI is an effective imaging technique that can be used for the diagnosis of RTT.

A Rare Case of Secondary Hydatid Cyst: Uterus and Colon Locations in the Same Patient

The aim of the present study was to present a case with secondary hydatid cysts in both uterus and colon. The patient was a 71-year-old female living in Hakkari, Turkey. She was admitted to the Van Yuzuncu Yil University Faculty of Medicine Medical Center with complaints of chronic abdominal and pelvic pain, and swelling in the abdomen. First, the sagittal T2 weighted magnetic rezonance imaging (MR) showed a type-3 cyst hydatid with daughter vesicles located at the posterior of uterus. Later, MR revealed a type-2 cystic lesion with detached membrane adhered to the anterior wall of colon and it was reported to be associated with abdomen. When the previous liver surgery history of the patient was kept in mind, the new finding was suggestive of a secondary cystic hydatid . In conclusion, it is possible to diagnose secondary cystic echinococcosis in patients with a history of primary cyst surgery in liver or any other organ by combining the symptoms and imaging findings.

Measurement of Spleen Stiffness by Shear-Wave Elastography for Prediction of Splenomegaly Etiology.

OBJECTIVE: The aim of this study was to evaluate the reproducibility of measurement of spleen stiffness at the time of the initial detection of splenomegaly, whether it is found incidentally or not, in determining the etiology of splenomegaly. METHODS: The pathologies that brought about the diffuse splenomegaly were evaluated in 3 main groups as follows: hepatoportal, myeloproliferative, and infectious causes. In addition, 17 healthy control patients were recruited. All patients were examined with acoustic radiation force impulse imaging with VTQ. RESULTS: The difference between the splenic parenchymal elasticity values in the hepatoportal group (3.27 ± 0.36 m/s), in the myeloproliferative disease group (2.98 ± 0.33 m/s), in the infectious disease group (2.44 ± 0.21 m/s), and in the control group (2.08 ± 0.19 m/s) was found to be statistically significant (P = 0.001). The intraclass correlation coefficient for shear wave velocity measurement between hepatoportal causes and myeloproliferative causes was 71.2% (95% confidence interval [CI], 54.9%-87.4%), between hepatoportal causes and infective causes was 99.7% (95% CI, 98.6%-100.0%), and between myeloproliferative causes and infective causes was 83.3% (95% CI, 68.8%-97.9%). In the same patient groups, spleen volumes were measured as 64.08 ± 9.66, 78.18 ± 18.52, and 51.57 ± 7.44 cm, respectively; in the control group, it was 26.75 ± 6.57 cm. The difference between spleen volumes was found to be statistically significant (P = 0.001). CONCLUSIONS: Distinguishing the causes of splenomegaly is important because the disorders require different management strategies. In diseases that cause splenomegaly, tissue content may change according to pathogenesis. Such changes in the spleen are mechanical properties that can be quantified by elastography.

Hounsfield unit density in the characterisation of bile duct lesions.

PURPOSE: To study the density of lesions in the lumens of extrahepatic bile ducts through computed tomography examinations, and to compare their characterisations with the results of pathology and/or endoscopic retrograde cholangiopancreatography (ERCP). METHODS: The density of lesions along extrahepatic bile ducts were measured and compared with pathology and/or ERCP. The lesions were evaluated in two main groups: benign or malignant. The bile duct wall enhancement, intrahepatic bile ducts, and gallbladder were also evaluated. RESULTS: The study was conducted with computed tomography scans of 197 cases (93 females, 104 males) who had optimal imaging. The results regarding density of extrahepatic intraductal lesions that were studied at BT were compared with pathology and magnetic resonance cholangiopancreatography results. Of 197 lesions, 125 (63.5%) were reported as benign and 72 (36.5%) were reported as malignant. The results for benign lesions showed an average density of 66.67 ± 17.30 Hounsfield units (HU), and for malignant lesions the average density was 82.38 ± 13.67 HU. CONCLUSION: Lesion density level (HU) gives valuable information for the differentiation between benign and malign lesions in intraluminal extrahepatic bile ducts.

Transcervical resection of two parathyroid adenomas located on the anterior mediastinum.

The mediastinum is a possible location of ectopic parathyroid adenoma. Most ectopic parathyroid glands in the mediastinum are found in the superior mediastinum within the thymus. In this article, two cases with ectopic mediastinal parathyroid adenomas that were excised via transcervical resection are presented. Preoperative examination of the two cases was performed. Laboratory tests supported hyperparathyroidism. For both patients, the results of radiologic and scintigraphic examinations of the cases were compatible with parathyroid adenoma masses in the anterior mediastinum. Transcervical resection was performed via suprasternal incision through the sternal notch and the posterior wall of the sternum space by blunt dissection with the finger. The soft lesions were removed en bloc in both cases. The parathyroid hormone levels of the two cases decreased dramatically after the operation. Transcervical resection may be an alternative method to major surgery in anterior mediastinal small masses.

Usability of Transthoracic Shear Wave Elastography in Differentiation of Subpleural Solid Masses.

In this study, the effectiveness of transthoracic ultrasound elastography in the benign and malign distinction of subpleural/pleural solid lesions was investigated.Between July 2015 and December 2016, 33 consecutive patients with subpleural solid lesions detected via computed tomography (CT) of the thorax were identified and prospectively included in this study. The average for each lesion's shear wave velocity (SWV) value was detected, and benign and malignant lesions' SWV values are statistically compared. The CT and pathology results were used as a reference to compare these values. A receiver operating characteristic analysis was used to determine the cutoff value for benign/malignant neoplasms.The 33 patients (10 female, 23 male) included in the study had a mean age of 56.2 ± 15.40 years (range, 17-84 years), and the mean SWV value of the lesions in 13 (39%) cases evaluated benign after a CT scan, histopathological examination, or both 2.18 ± 0.49 m/s. The mean SWV value of the lesions which were histopathologically diagnosed as malign in 23 (61%) cases was 3.50 ± 0.69 m/s. (P < 0.001). When the cutoff value was set as 2.47 m/s for the SVW value, sensitivity and specificity were determined to be 97.7%.The present study has shown that transthoracic ultrasound shear wave elastography can be an effective radiological examination method in the benign and malign differentiation of subpleural lesions and has the potential for use in the routine clinical application of transthoracic ultrasound elastography, a noninvasive method for evaluating the malignancy potentials of such lesions.

The efficiency of acoustic radiation force impulse (ARFI) elastography in the diagnosis and staging of carpal tunnel syndrome.

OBJECTIVES: The aim of the present study was to quantify the stiffness of the median nerve (MN) at the carpal tunnel inlet by acoustic radiation force impulse (ARFI) elastography and to evaluate whether ARFI can be used in diagnosis and staging of carpal tunnel syndrome (CTS). METHODS: Sonographic examinations of 96 wrists in 50 patients were included in the study. The cross-sectional area and stiffness of the MN were quantitatively measured by B-mode ultrasonography (USG) and ARFI. The findings of CTS were assigned to four groups: (I) normal (n = 21), (II) mild (n = 39), (III) moderate (n = 38), and (IV) severe (n = 19). The differences between CTS patients and controls and the differences in electrodiagnostic tests among subgroups were statistically compared. ROC analysis was performed to determine the cut-off values between subgroups. RESULTS: Bilateral CTS was present in 46 patients (92 wrists) and unilateral CTS in four patients. Of the 96 nerves in the 50 symptomatic "idiopathic CTS" patients (48 women, 2 men; mean age 45.9 years, range 23-73 years), 39 (40.4%) were mild, 38 (39.8%) were moderate, and 19 (19.8%) were severely affected. When compared to controls, MN stiffness was significantly higher in the CTS group (P < 0.001); furthermore, it was higher in the severe or extreme severity group than the mild or moderate severity group (P < 0.001). A 3.250 m/s cut-off value on ARFI revealed sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 81, 82, 95.1, 50, and 82%, respectively. CONCLUSION: The MN stiffness measured by ARFI elastography is significantly higher in patients with CTS then in controls. ARFI elastography appears to be a highly efficient imaging modality for the diagnosis and staging of these patients.

A case of sarcoidosis with pleural involvement.

Sarcoidosis is a chronic, multisystem inflammatory disorder of unknown etiology that is characterized by noncaseating granulomas. Although lung involvement is common in sarcoidosis, pleural involvement is rare. Pleural involvement may manifest as a pleural effusion, pneumothorax, pleural thickening and nodules, hydropneumothorax, hemothorax, or chylothorax. Here, we describe a case of sarcoidosis with pleural nodular thickening.

Contribution of diffusion weighted MRI to diagnosis and staging in gastric tumors and comparison with multi-detector computed tomography.

BACKGROUND: Diagnostic performance of Diffusion-Weighted magnetic resonance Imaging (DWI) and Multi-Detector Computed Tomography (MDCT) for TNM (Tumor, Lymph node, Metastasis) staging of gastric cancer was compared. PATIENTS AND METHODS: We used axial T2-weighted images and DWI (b-0,400 and b-800 s/mm2) protocol on 51 pre-operative patients who had been diagnosed with gastric cancer. We also conducted MDCT examinations on them. We looked for a signal increase in the series of DWI images. The depth of tumor invasion in the stomach wall (tumor (T) staging), the involvement of lymph nodes (nodal (N) staging), and the presence or absence of metastases (metastatic staging) in DWI and CT images according to the TNM staging system were evaluated. In each diagnosis of the tumors, sensitivity, specificity, positive and negative accuracy rates of DWI and MDCT examinations were found through a comparison with the results of the surgical pathology, which is the gold standard method. In addition to the compatibilities of each examination with surgical pathology, kappa statistics were used. RESULTS: Sensitivity and specificity of DWI and MDCT in lymph node staging were as follows: N1: DWI: 75.0%, 84.6%; MDCT: 66.7%, 82%;N2: DWI: 79.3%, 77.3%; MDCT: 69.0%, 68.2%; N3: DWI: 60.0%, 97.6%; MDCT: 50.0%, 90.2%. The diagnostic tool DWI seemed more compatible with the gold standard method (surgical pathology), especially in the staging of lymph node, when compared to MDCT. On the other hand, in T staging, the results of DWI and MDCT were better than the gold standard when the T stage increased. However, DWI did not demonstrate superiority to MDCT. The sensitivity and specificity of both imaging techniques for detecting distant metastasis were 100%. CONCLUSIONS: The diagnostic accuracy of DWI for TNM staging in gastric cancer before surgery is at a comparable level with MDCT and adding DWI to routine protocol of evaluating lymph nodes metastasis might increase diagnostic accuracy.

Evaluation of maternal liver elasticity by acoustic radiation force impulse elastosonography in hypertensive disorders of pregnancy: a preliminary descriptive study.

PURPOSE: To compare maternal liver elasticity scores by Acoustic Radiation Force Impulse (ARFI) elastosonography in healthy and preeclamptic pregnancies and its association with the severity of the disease. MATERIALS AND METHODS: Forty-two healthy, 33 mild, 33 severe preeclamptic and 28 pregnant women with Hemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome were included into the study. Maternal liver elasticity was measured by ARFI elastosonography at the first day of puerperium. The maternal and neonatal outcomes of the patients were retrieved from the medical records. RESULTS: The ARFI-Mean liver elastosonography scores of controls and mild preeclamptic women were lower than severe preeclamptic and HELLP syndrome women (p: 0.001). The mean ARFI elastosonography score >1.22 m/s indicated the effect of severe preeclampsia on maternal liver elasticity with 72.7% sensitivity and 74.7% specificity (Area under curve [AUC], 0.835, 95% confidence interval [CI], 0.757-0.913). The mean ARFI elastosonography score >1.31 m/s indicated the effect of HELLP syndrome on maternal liver elasticity with 78.6% sensitivity and 75.9% specificity (AUC, 0.794, 95% CI, 0.695-0.892). CONCLUSIONS: The maternal liver becomes stiffer in severe preeclampsia and HELLP syndrome measured by ARFI elastosonography. The increased maternal liver ARFI scores may alert the obstetrician about the possible maternal puerperal morbidity.

Magnetic Resonance Imaging Features of Idiopathic Granulomatous Mastitis: A Retrospective Analysis.

BACKGROUND: Granulomatous mastitis is a rare and benign inflammatory breast disease that may clinically and radiologically mimic breast cancer. OBJECTIVES: The aim of this study was to evaluate the features of idiopathic granulomatous mastitis (IGM) on breast magnetic resonance imaging (MRI) with mammographic and sonographic findings. PATIENTS AND METHODS: A retrospective analysis was conducted on 20 patients with IGM who had been diagnosed by needle core or excisional biopsy at a single institution between 2006 and 2012. All of the patients underwent MRI for suspicious breast findings prior to biopsy. MRI examinations were performed on a 1.5 T scanner. The MRI findings were evaluated in accordance with the breast imaging-reporting and data system (BI-RADS) MRI lexicon established by the American College of Radiology. RESULTS: MRI detected a total of 29 lesions in the 20 patients. Fourteen of these lesions were seen as mass enhancements, with the remaining 15 identified as non-mass enhancements (NMEs). The median size of all lesions was 3.6 cm (range, 0.7 - 6.7 cm). The most frequently observed features were masses with a round shape (9 out of 14, 64%), smooth contour (11 out of 14, 78%), and a rim enhancement pattern (10 out of 14, 71%). The most common features of the 15 NME lesions were segmental distribution (6 out of 15, 40%) and heterogeneous enhancement patterns (8 out of 15, 53%). The time-intensity curves of the dynamic studies showed benign type one signal intensity (persistent enhancement pattern) in the majority of lesions (10 out of 20, 50%). CONCLUSION: Our study suggests that breast MRI findings of IGM have a wide spectrum. Rim enhancement patterns are frequently seen on contrast enhanced images, but the imaging findings are nonspecific and cannot be used definitively to distinguish between benign and malignant lesions.

Primary hyperparathyroidism causing putty kidney with brown tumor located in the pubic ramus.

Primary hyperparathyroidism (pHPT) is a condition caused by excessive and uncontrolled secretion of parathyroid hormone. The classical presenting symptoms in primary hyperparathyroidism are renal stones, hypercalcemic crisis, soft tissue calcifications, and cystic bone disease. Although most cases of pHPT are detected early and before symptomatic lesions appear, some patients may present late in the course of their disease. In this report, we present a patient with extensive parenchymal calcifications forming a cast of the right kidney which is called as "putty kidney" with Brown tumor located in the pubic ramus.

Imaging Findings for Bilateral Giant Vestibulocochlear Schwannoma.

Neurofibromatosis type 2 mostly develops with multiple neoplasms of the central and peripheral nervous system and is associated with ocular abnormalities. The presented case is a 19-year-old female patient with bilateral vestibulocochlear schwannomas in both pontocerebellar corners, intradural intra-extramedullary masses, and multiple neurofibromas in the spinal canal. The clinical picture for NF-2, also called central neurofibromatosis, is completely different from von Recklinghausen disease. Untreated bilateral vestibulocochlear schwannoma may cause hydrocephalus in NF-2, and lead to death. Therefore, it is recommended to carefully monitor and treat bilateral vestibulocochlear schwannoma in accordance with its stage.

Ultrasound Elastography for Distinction Between Parathyroid Adenomas and Thyroid Nodules.

OBJECTIVES: The aim of this study was to detect the level of stiffness of parathyroid adenomas and to distinguish them from benign and malignant thyroid nodules using ultrasound elastography with acoustic radiation force impulse imaging. METHODS: Twenty-one patients with parathyroid adenomas and 71 patients with thyroid nodules were evaluated by acoustic radiation force impulse imaging in this study. Acoustic radiation force impulse elastograms were obtained after evaluation of the thyroid nodules, which were predicted to undergo fine-needle aspiration biopsy, and patients with a diagnosis of hyperparathyroidism, which was identified by sonography at the same time. RESULTS: An analysis of mean shear wave velocity (SWV) values for parathyroid adenomas and thyroid nodules showed that parathyroid adenomas had significantly higher stiffness levels compared to benign thyroid nodules (mean SWV ± SD, 3.09 ± 0.75 versus 2.20 ± 0.39 m/s; P < .001) and lower stiffness levels compared to malignant thyroid nodules (mean SWV, 3.09 ± 0.75 versus 3.59 ± 0.43 m/s; P < .001). CONCLUSIONS: Acoustic radiation force impulse imaging has high sensitivity and specificity for differentiating parathyroid adenomas from benign and malignant thyroid nodules. As an adjunctive tool, it can help distinguish parathyroid adenomas from thyroid nodules, including posteriorly located nodules.

The utility of ultrasound elastography in differentiation of endometriomas and hemorrhagic ovarian cysts.

PURPOSE: To investigate the feasibility of acoustic radiation force impulse imaging in differentiation of endometriomas and hemorrhagic ovarian cysts. MATERIALS AND METHODS: We evaluated 84 ovarian cysts with high internal echogenicity diagnosed in 70 consecutive women. We excluded simple cysts and hemorrhagic cysts containing septations or mural nodules with detectable flow on Doppler ultrasonography. We obtained the elastographic shear wave velocity (SWV) value of the cysts that could be endometriomas or hemorrhagic ovarian cysts. RESULTS: Among the 78 ovarian cysts in 70 women without any septation or mural nodule, there were 42 endometriomas and 36 hemorrhagic ovarian cysts. Analysis of median SWV values of the ovarian cysts showed that the endometriomas had considerably higher levels of stiffness compared to the hemorrhagic ovarian cysts [median SWV 4.20 ± 0.42 vs 2.54 ± 1.04 m/s, p < 0.001]. A SWV cutoff value greater than 3.81 m/s yielded sensitivity and specificity values of 82.1 and 79.2 % respectively, for differentiation of endometriomas from hemorrhagic ovarian cysts. CONCLUSION: Sonoelastography is a novel imaging technique that enables us to evaluate the stiffness of adnexal lesions. The accurate discrimination of endometriomas and hemorrhagic ovarian cysts is important for avoiding unnecessary surgical procedures. ARFI imaging has a high sensitivity and specificity for distinguishing endometrioma from hemorrhagic ovarian cysts.

Colon cancer presented with sigmoid volvulus: A case report.

INTRODUCTION: Sigmoid volvulus is the most prevalent type of colonic volvulus. Colon cancer is seen less where sigmoid volvulus is common, so it is rare to see that colon cancer is synchronous with sigmoid volvulus. PRESENTATION OF CASE: We would like to present a case of sigmoid volvulus caused by colon cancer in a male patient aged 80 who was referred to the hospital with toxaemic shock presentation. DISCUSSION: Sigmoid cancer can be presented as sigmoid volvulus to the emergency department. In intestinal obstruction early diagnosis is of crucial importance. Computarized tomography is a diagnosis tool that should be preferred both in the diagnosis of obstruction and in detecting its cause, localisation, degree and complications. CONCLUSION: When surgery is performed due to the urgent colonic obstruction in colonic volvulus diagnosed patients, a colon tumour should be considered in the same column loops or in the distal colon. We believe that CT is the method that should be preferred in large-bowel obstruction suspected patients.

Uterin Lipoleiomyoma: MR Findings.

BACKGROUND: Uterine lipoleiomyoma is a rare and specific type of leiomyoma. CASE REPORT: A 60-year-old postmenopausal woman presented with abdominal pain. Her pelvic ultrasound demonstrated a normal- sized uterus with a well- circumscribed, heterogeneous mass located in the anterior corpus. A pelvic MRI revealed a mass including hyperintense areas on T1-weighted images and hypointense on fat-suppressed T1-weighted images, compatible with lipoleiomyoma. CONCLUSIONS: Uterine lipoleiomyomas are often misdiagnosed pre-operatively and it is important to distinguish leiomyomas from other tumors for prevention from supererogatory surgery. Imaging plays an important role for the exact differentiation.