Unicentric or Multicentric Castleman disease? A case report of a pelvic intraperitoneal mass in a middle aged woman.

Castleman Disease is a lymphoid disorder characterized by the presence of an enlarged or abnormal lymph node/lymphatic tissue. The disease is classified into unicentric or multicentric variants. The unicentric form is a benign disorder that is usually asymptomatic and consists of a single lymphoid mass that is predominantly located in the mediastinum, but can also rarely develop in the neck or abdomen. The multicentric type involves more than one lymphatic station and is related to the presence of type B symptoms (fevers, night sweats and weight loss), HIV/HHV8 infection and increased serum IL-6 levels. We present the case of an unusual pelvic intraperitoneal manifestation of Castleman Disease in a 52-year-old caucasian woman who showed clinical, radiological, histological and laboratory findings common to both Unicentric and Multicentric Castleman Disease.

Advanced native-kidney carcinoma in a heart- and kidney-transplanted patient: a case report.

Malignancies are one of the leading causes of death in long-term surviving transplant recipients. Dose and prolonged durations of immunosuppressive regimens are considered the main cause, through a direct oncogenic effect and a renowned interaction on physiological anti-viral and anti-oncogenic immune response. Specific neoplasms are known to occur with different frequencies according to the transplanted organ. As a consequence, imaging screenings have been implemented in many graft surveillance programs, although a wide consensus on the timing and modality has not been concurred. There are little data available in the literature regarding incidence of de-novo malignancies in multi-organ recipients. We report the case of a 66-year-old man who developed a renal mass 10 years after a combined heart-kidney transplant.

CT and MR findings in extramedullary haematopoiesis with biliary system encasement: a case report.

Extramedullary haematopoiesis is the production of blood elements outside the bone marrow cavity. In our case computed tomography and magnetic resonance imaging revealed the presence of a rare localization of extramedullary haematopoiesis with encasement of the biliary system in a 59 years-old male Caucasian patient, with chronic myelofibrosis and hepatic failure's symptomatology. Computed tomography detected the presence of homogeneous hypodense tissue around intra-hepatic bile ducts with minimal contrast enhancement, strongly suggestive for extramedullary haematopoiesis. Magnetic resonance confirmed the presence of a solid tissue surrounding the biliary tree, showing late enhancement after gadolinium administration suggestive for non-active lesion of extramedullary haematopoiesis. Final diagnosis was established by percutaneous biopsy.

Bilateral metachronous ovarian metastases from clear cell renal carcinoma: a case report.

INTRODUCTION: Bilateral ovarian metastases from a clear cell renal carcinoma are uncommon findings and need to be differentiated from primary cancers. Diagnostic imaging and histopathological features are often inconclusive, unless they are combined. CASE PRESENTATION: A 56-year-old woman with a history of right radical nephrectomy for a renal clear cell carcinoma diagnosed 10 years earlier was referred for abdominal distension and pelvic pain. Color-Doppler US and Computer Tomography scan revealed the presence of bilateral ovarian masses with regular margins, a low resistance index and poor contrast enhancement. Immunohistochemistry showed positive epithelial membrane antigen, cytokeratin, vimentin and CD10, suggesting clear cells from the previously diagnosed kidney cancer. CONCLUSION: Although bilateral metachronous ovarian metastases from clear cell renal carcinoma are a very uncommon finding, they can be considered in the differential diagnosis and investigated with imaging and immunohistochemistry. The 6 cases reported in the literature indicate a good prognosis for this condition.

Unusual abdominal findings of all-trans-retinoic acid syndrome: role of diagnostic imaging.

The standard therapy for patients affected by acute promyelocytic leukemia is based on all-trans-retinoic acid (ATRA), whose rare complication is a syndrome known as retinoic acid syndrome. We describe for the first time the computed tomography findings of a case of ATRA syndrome with typical pulmonary findings, along with the involvement of the upper abdomen organs (liver and spleen) as a further complication of the pathology.

Diagnostic imaging of lung cancer after heart transplantation.

AIMS AND BACKGROUND: In heart transplant recipients pulmonary neoplasms are among the most frequent solid tumors; they have a rapid and aggressive course, and therefore require an early diagnosis. We describe the role that diagnostic imaging plays in different diagnostic moments of this disease. METHODS: We evaluated the incidence and diagnosis of lung cancer in patients who underwent heart transplants at our institution. Taking into account the few different diagnostic imaging techniques (chest X-ray, high-resolution computed tomography [CT], staging CT and CT-guided biopsy) used in standard surveillance protocols or indicated by clinical symptoms, we evaluated their diagnostic accuracy, their efficacy in tumor staging, and their impact on the therapeutic choices. RESULTS: Seventeen neoplasms in a total of 712 patients were diagnosed (2.4%). In 16 of these 17 cases chest X-ray (routinely performed as follow-up in 11 cases, indicated by symptoms in 5 cases) was diagnostic. In another 11 cases chest X-ray was false positive. The diagnostic accuracy, sensitivity, specificity, positive and negative predictive value of chest X-ray was 98%, 91%, 98%, 50%, and 99%, respectively. Total-body CT correctly staged the tumors and provided information as to whether surgery was indicated or not (stage II or advanced). CONCLUSIONS: Chest X-ray is still the surveillance radiological technique in heart transplant recipients. Considering its low specificity and sensitivity, we propose high-resolution CT imaging during follow-up to identify pulmonary lesions as soon as possible and enable a differential diagnosis with parenchymal inflammation. The use of CT-guided fine-needle biopsy and culture examinations permits to differentiate neoplastic from inflammatory parenchymal opacities. Use of CT in cancer staging is effective for subsequent treatment choices.

Extramedullary hematopoiesis in chronic myelofibrosis encasing the pelvicaliceal system and perirenal spaces: CT findings.

We examined a 46-year-old male patient with idiopathic myelofibrosis diagnosed 28 months earlier. After chemotherapy and irradiation, CT showed nonnodular, soft tissue masses in the renal hilum, pelvicaliceal system, perirenal and periureteral spaces. Ultrasound-guided biopsy showed extramedullary hematopoiesis (EMH). The mass, which caused delayed nephrographic enhancement, without hydroureteronephrosis, was the only site of EMH. We report the CT findings of this uncommon EMH localization.

Unusual CT findings in urachus carcinoma with an extensive and atypical pattern of metastasis. A case report.

Carcinoma of the urachus is very rare. Usually it has a typical appearance on computed tomography, with calcifications in a midline supravesical mass, but advanced stages of this neoplasm require malignancy evaluation that is not easy to establish. We report a case of a urachal tumor where CT scan did not properly assess the response to chemotherapy, while it did show an uncommon metastatic localization in the laterocervical soft tissues.

Subserous uterine adenomyosis mimicking an adnexal mass on sonography.

Uterine adenomyosis usually manifests as diffuse disease involving the myometrium and the endometrial-myometrial junction, but it may also manifest as a focal lesion. It is usually only a few millimeters in diameter but may sometimes be larger. We report the case of a 32-year-old woman with a large isolated mass in the uterine wall. Transvaginal sonography demonstrated the cystic nature of the mass and its characteristic hemorrhagic pattern, whereas CT confirmed its uterine origin. The patient underwent laparoscopic resection of the mass, and pathologic examinations led to the diagnosis of adenomyosis.

Differential diagnosis of Krukenberg tumors using multivariate analysis.

AIMS AND BACKGROUND: Krukenberg tumors are ovarian metastases from a gastroenteric malignancy in 90% of cases. At present, diagnostic imaging techniques (US, CT, MRI) do not provide any reliable diagnostic criteria to differentiate these metastases from ovarian primaries. We tried to use multivariate analysis to distinguish malignant ovarian primaries from Krukenberg tumors based on their differential natural history. PATIENTS AND METHODS: We retrospectively compared the CT findings of Krukenberg tumors (47 patients, 79 masses, only from gastroenteric malignancy) with CT findings of primary epithelial ovarian cancers (46 patients, 67 masses). We compared the same independent variables in the two groups: age, morphology, margins, carcinomatosis, bilateral versus unilateral involvement, ascites, lymph node involvement, metastases on the basis of multivariate analysis. RESULTS: According to the best fitted model, clear-cut margins (OR: 3.75; 95% CI: 1.14-9.72) and the presence of carcinomatosis (OR: 4.21; 95% CI: 1.51-11.72) were the strongest predictors of a diagnosis of Krukenberg tumor. In contrast, the presence of ascites was more likely to be a protective factor (OR: 0.22; 95% CI: 0.08-0.62). CONCLUSIONS: We can try to make a differential diagnosis between a metastatic lesion from the gastroenteric tract and a primary adnexal lesion based on the multivariate statistical analysis of intraperitoneal spread of the different types of cancer rather than on morphologic findings at CT.