Comparisons of magnetic resonance imaging, histopathological and Ki-67 labeling index findings in a single myxofibrosarcoma: a case report.

BACKGROUND: Myxofibrosarcoma is a myxoid soft tissue sarcoma showing T2 high intensity on magnetic resonance imaging. However, myxofibrosarcoma is a heterogeneous sarcoma with both myxoid and cellular portions. Magnetic resonance imaging findings were obtained MRI findings for comparison with histological and Ki-67 immunohistochemical features, in different portions of one myxofibrosarcoma. CASE PRESENTATION: Magnetic resonance imaging observations were compared with gross pathological and microscopic findings of a myxofibrosarcoma from a 50-year-old Japanese female. The Ki-67 labeling indices of different portions of the tumor, that is, the myxoid, cellular, and histologically confirmed infiltrative margin portions (pathological tail sign), were compared. The T2 low intensity area was more cellular than the T2 high intensity area, while the cellular portion had a significantly higher Ki-67 index than the myxoid portion (p = 0.0313). The portions with the pathological tail sign had a significantly higher Ki-67 labeling index than those without this sign (p = 0.0313). CONCLUSIONS: More cellular portions of a myxofibrosarcoma correspond to more areas of the tumor showing aggressive features. Furthermore, our data also support the hypothesis of high aggressiveness being associated with the pathological tail sign in myxofibrosarcoma. To our knowledge, this is the first case report to describe comparisons among the imaging findings, histological features, and Ki-67 immunohistochemistry results for different portions of one myxofibrosarcoma.

The "K-Sign"-A Novel CT Finding Suggestive before the Appearance of Pancreatic Cancer.

Pancreatic invasive ductal adenocarcinoma (PDAC) has a poor prognosis, and the detection of PDAC during the early stage is thought to improve prognosis. In this study, we retrospectively investigated pancreatic morphological abnormalities that lead to the early diagnosis of PDAC with computed tomography (CT) imaging. In total, 41 out of 308 patients diagnosed with pancreatic cancer between 2011 and 2017 in our institution were enrolled. As a control group for the group with pancreatic cancer, 4277 patients without pancreato-biliary diseases were enrolled. We retrospectively reviewed and analyzed the clinical data including patient characteristics, the clinical course and preoperative CT imaging with pancreatic morphological features. Out of 41 patients, 24 patients (58.5%) showed local K-shaped constriction of the pancreatic parenchyma "K-sign" on preoperative CT images. Eight patients (19.5%) showed localized fatty change. Out of 4277 control patients, seven patients (0.16%) showed K-sign. "K-sign" may be used for the early diagnosis of PDAC by CT imaging.

Evaluation of Normal Epiglottis on Computed Tomography with Special Attention to Thickness.

To our knowledge, this is the first study to investigate the thickness of the normal epiglottis on computed tomography (CT) in a Japanese population. The focus was on determining the thickness of a normal epiglottis, which could then serve as a reference in detecting abnormalities. We believe that this would facilitate diagnosing and determining the extent of cancerous invasion of the supraglottis and secondary invasion of the epiglottis. This retrospective study was based on a review of radiographic data in patient charts. Cervical CT scans obtained from 79 Japanese patients (44 men [55.7%] and 35 women [44.3%]; age range, 28-85 years; mean, 58.9 years) showing a normal epiglottis under laryngoscopy were evaluated. The thickness of the epiglottis was measured on CT scans and the results analyzed with the Student's t-test, an analysis of variance, and the Tukey-Kramer test. The epiglottis in men was significantly thicker than that in women (p<0.05). A statistically significant difference was observed in thickness depending on longitudinal height (p=<0.001). The thickness at the median was larger than that bilaterally in all patients (p=<0.001). No statistically significant difference was observed in thickness depending on side or age. The thickness of the normal epiglottis was established at each level. We believe that these data could serve as a reference in diagnosing and detecting abnormalities of the epiglottis.

Undetectability of oral tongue cancer on magnetic resonance imaging; clinical significance as a predictor to avoid unnecessary elective neck dissection in node negative patients.

METHODS:: We retrospectively reviewed early stage oral tongue cancer patients treated with radical surgery with clinically N0, between May 2009 and February 2016. Collected data include age, sex, pathological DOI, DOI on MRI, locoregional control rate, disease-free survival rate, and overall survival rate. These data were statistically compared between the detectable lesion (DL) group and undetectable lesion (UL) group on MRI. Interobserver agreement in evaluation of detectability of the oral tongue cancer was assessed by k statistics. RESULTS:: Total of 53 patients were studied, and 28 were DLs and 25 ULs. Pathological DOI in UL was significantly smaller than that of DL (average 1.7 vs 4.6 mm, p < 0.001). Cut-off value between UL group and DL group was 3.5 mm (sensitivity 96 %, specificity 75 %). 96 % of ULs had pathological DOI smaller than 4 mm, the recommended cut-off value for neck dissection. There was no significant difference in locoregional control rate (p = 0.24), disease-free survival rate (p = 0.24) or overall survival rate (p = 0.92). Interobserver agreement in evaluation of detectability on MRI was very good ( k-value = 0.89, p < 0.001). CONCLUSIONS:: When oral tongue cancer is not detected on MRI, it indicates pathological DOI being smaller than 4 mm, which may imply that elective neck dissection is unnecessary.

Schwannoma assumedly originating from the submandibular ganglion or glandular branches radiologically mimicking a submandibular gland tumor.

Schwannoma is a benign nerve sheath tumor composed of Schwann cells. Schwannomas originating from ganglia are rare, and schwannomas of the submandibular ganglion or glandular branches have not been reported to date. We present a case of a Japanese woman in her sixties with a submandibular schwannoma originating from the submandibular ganglion, mimicking a submandibular gland tumor on radiological findings. As the radiological findings were nonspecific, the key finding in the present case may be the characteristic location of the tumor suspended from the undersurface of the lingual nerve and situated above the deep portion of the submandibular gland.

Essentials on Oncological Imaging: Postoperative Computed Tomography and Magnetic Resonance Imaging of Oral Tongue Cancer.

The contribution of diagnostic imaging in evaluating the pre- and postoperative status of tongue cancer is essential. Interpretation of postoperative images is made difficult by deformation; therefore, it is necessary to know how surgical technique, biological reaction, postoperative anatomy, and local recurrence are reflected on the images. This study explains the postoperative imaging features of tongue cancer to help in the early detection of local recurrence and avoid inappropriate treatment. We review schematic drawings of representative surgical procedures for tongue carcinoma, variable radiological features in postoperative conditions with or without complications, and typical features of local failures and their mimics. This article clarifies the important tasks of radiologists and clinicians in the postoperative evaluation of tongue carcinoma.

Wandering carotid arteries: Reciprocating change between normal and retropharyngeal positions on serial CT studies.

Positional change in the retropharyngeal carotid artery, a rare phenomenon over time, is even rarer in previous reports, and it is important to be aware of this before any neck surgical procedure. A woman in her 50s underwent an anterior maxillectomy for upper gingival cancer, without neck dissection. The patient had medical histories of diabetes mellitus and liver dysfunction, with unremarkable family histories. Serial neck contrast-enhanced computed tomography for detecting locoregional recurrence had been performed as a follow-up during 4 years. A radiological course of moving carotid arteries in serial computed tomography studies showed reciprocating positional changes (wandering) between normal and retropharyngeal regions. There was no locoregional recurrence of the gingival cancer. This is the first case to describe a so-rare presentation of wandering carotid arteries. It is important for clinicians to be aware of a wandering carotid artery to avoid potentially fatal complications.

Totally implantable venous access port via the femoral vein in a femoral port position with CT-venography.

BACKGROUND AND PURPOSE: We aimed to determine the success rate and any complications using a percutaneous approach to the femoral vein (FV) for placement of a totally implantable access port (TIVAP), with a preoperative assessment of the femoral and iliac veins using computed tomography-venography (CT-V). METHODS: A prospective study of 72 patients was conducted where placement of a TIVAP was attempted via the right FV, with the port placed in the anterior thigh, when subclavian vein or jugular vein access was contraindicated. Preoperative assessment of the femoral venous plexus was performed with CT-V in 72 patients. RESULTS: CT-V success was achieved in 72 of 72 patients (100%). The average distance between the inguinal ligament and the saphenofeomral (FV-GSV) junction was 42.8 ± 12.9 mm. The FV approach had a 97% successful cannulation rate. Two patients had a thrombosis in either the femoral vein or the great saphenous vein. One procedural complication (1.4%) and one initial complication (1.4%) occurred. Late complications occurred in four patients (5.7%). CONCLUSIONS: The percutaneous FV approach with CT-V guidance is an option for patients with multiple central venous cannulations, as well as those with bilateral breast cancer, or those undergoing hemodialysis. J. Surg. Oncol. 2016;114:1024-1028. © 2016 Wiley Periodicals, Inc.

An Unusual Clinical Presentation of Kimura Disease Manifesting with a Typical Cephalocervical Lesion and an Atypical Subcutaneous Hip Mass Lesion.

Kimura's disease (KD) is a rare lymphoproliferative inflammatory disorder, typically presenting as firm, painless or pruritic single or multiple subcutaneous lesions in the head and neck, especially in the parotid and submandibular regions. We herein report a case of a 39-year-old Japanese man presenting with a typical cephalocervical KD lesion around the salivary glands with a rare association with a distant subcutaneous mass at the hip. We also emphasize the radiologically and clinically important features in the differential diagnosis and management. To the best of our knowledge, this case is the first report of KD manifesting with a typical cephalocervical lesion and an atypical subcutaneous hip mass lesion.

Petersen hernia after open gastrectomy with Roux-en-Y reconstruction: a report of two cases and literature review.

Petersen hernia is a rare internal hernia that occurs after Roux-en-Y (R-Y) reconstruction. To our knowledge, there are a few reports on internal hernia, especially Petersen hernia after open gastrectomy for gastric cancer. Two rare cases of Petersen hernia are presented in this report. A man in his 70s was referred to our hospital due to a complaint of postprandial sudden abdominal pain. He had a history of open total gastrectomy with R-Y jejunal reconstruction through the antecolic route for gastric corpus cancer. On computed tomography (CT), bowel obstruction and strangulation of the small intestine were suspected. Emergency laparotomy was done, and an internal herniation of the small intestine through Petersen space was observed. A man in his 50s was referred to our hospital due to a complaint of severe sudden abdominal pain. He had a history of open gastrectomy and abdominal/lower intrathoracic esophageal resection with R-Y jejunal reconstruction of an antecolic jejunal limb for esophagogastric junction carcinoma. On CT, internal herniation of the small intestine was suspected. During emergency laparotomy, an internal herniation of the bowel through the Petersen space was observed. Though history of R-Y reconstruction surgery may be helpful, preoperative diagnosis of Petersen hernia is difficult to establish. Here we present two rare cases of this type of internal hernia.