Differentiation of ovarian cancers from borderline ovarian tumors on the basis of evaluation of tumor vascularity in multi-row detector computed tomography--comparison with histopathology.

OBJECTIVE: The aim of this study was to evaluate the feasibility of multi-detector row computed tomography (MDCT) in the differentiation between borderline ovarian tumors and ovarian cancer on the basis of tumor morphology and specific features of tumor vascularity in correlation with the results at pathology. METHODS: A triphasic MDCT protocol was used for the analysis of tumor vascularity. The following features were taken into account: (1) The number of vessels in papillary projections, solid-tissue component, and septa (2 vs >2), (2) serpentine and chaotic configuration of vessels, (3) presence of microaneurysms, and (4) presence of arteriovenous microfistulas. Masses with at least 3 of 4 features were considered ovarian cancer (group A) and masses with 2 features or less as borderline tumor (group B). Radiological findings were compared with results of postoperative pathology. RESULTS: Pathologic vessels were found in all 56 patients. Thirty-two patients were included in group A and 24 in group B. The results of pathology were as follows: in group A: 31 malignant tumors, including 31 ovarian carcinomas and 1 benign cystadenoma; in group B: 22 borderline ovarian tumors, 1 benign cystadenoma, and 1 ovarian cancer. CONCLUSIONS: Morphological evaluation of tumor vascularity in MDCT seems to be an efficient method of differentiating between borderline ovarian tumors and ovarian carcinomas. Because of a small number of cases in the current study, a further research seems justified to confirm our results. The presented MDCT-angiographic criteria showed high sensitivity (97%) and specificity (96%) in differentiation of borderline ovarian tumors and ovarian cancers as compared with pathology. The presented CT-angiographic criteria of malignancy showed an excellent interobserver agreement.

Biliary cystadenoma and cystadenocarcinoma: two rare cystic liver lesions.

A case of hepatobiliary cystadenoma with mesenchymal stroma and a case of biliary cystadenocarcinoma are presented. Hepatobiliary cystadenoma and cystadenocarcinoma are rare liver lesions that are difficult to diagnose preoperatively. Regardless of the diagnostic modalities used these two pathologies cannot be differentiated with accuracy. The preoperative diagnosis of biliary cystadenoma and cystadenocarcinoma was suggested due to the radiological detection of vascularity in the septa and the invasion of the thoracoabdominal wall. The surgeon was informed in both of the cases. Pathologic examination confirmed the diagnosis in both of our patients. The radiological features of these pathologies are discussed in detail together with a brief review of the literature.

[Differential diagnosis of frequent pancreatic tumours with echo-enhanced power-Doppler sonography - presentation of case reports]. / Fallbeispiele zur Erläuterung der Differenzialdiagnostik von häufigen Pankreastumoren mit der echosignalverstärkten Power-Doppler-Sonographie.

UNLABELLED: The echo-enhanced Power-Doppler sonography is useful for the differential diagnosis of pancreatic tumours. Tumour criteria for the differentiation of pancreatic tumours with this procedure are explained using selected cases in the present publication. Ductal carcinomas are often hypovascularised compared with the surrounding tissue. On the other hand, neuroendocrine tumours are hypervascularised lesions. Tumours associated with pancreatitis have a different vascularisation pattern depending on inflammation and necrosis. Cystadenomas frequently show many vessels along the fibrotic strands. CONCLUSIONS: Pancreatic tumours have different vascularisation patterns in the echo-enhanced Power-Doppler sonography. These characteristics can be used for the differential diagnosis.

[Evaluation of doppler ultrasonography criteria for the differential diagnosis of pancreatic tumors]. / Evaluierung dopplersono-graphischer Kriterien zur Differentialdiagnostik von Pankreastumoren.

AIM: In order to improve the differential diagnosis of pancreatic lesions, dopplersonographic criteria for the tumours were evaluated. METHODS: 35 patients diagnosed by conventional ultrasound as having a tumour of pancreas were further investigated by B-mode sonography, fundamental and echo-enhanced power-Doppler sonography focusing on specific properties of the tumours. The results were correlated to the histological findings. RESULTS: Ductal carcinomas and cystadenocarcinomas are often hypovascularized in comparison to the surrounding tissue. In contrast to this, neuroendocrine tumours and cystadenomas are mostly hypervascularized. Tumours associated with pancreatitis show different vascularization patterns depending on inflammation and the extent of necrosis. CONCLUSIONS: Pancreatic tumours display different vascularization patterns in the echo-enhanced power-Doppler sonography. These characteristics can be useful for the differential diagnosis of pancreatic tumours.

Increased microvessel density in mucinous compared with malignant serous and benign tumours of the ovary.

Microvessel density of benign, borderline and malignant ovarian tumours was studied immunohistochemically using antibodies to the endothelial cell markers CD31, CD34 and factor VIII-related antigen. Microvessel density was compared in tumours of different histological subtype, stage and patient outcome. CD31-immunostained sections were examined and regions of high and average microvessel density were selected. Identical regions were located on CD34- and factor VIII-related antigen-immunostained serial sections and microvessel counts obtained and converted to vessels mm(-2). CD31 and CD34 immunostaining revealed increased microvessel density in both the high and average vessel density regions of mucinous (222.4 +/- 24.8; 79.9 +/- 8.5) compared with serous (105.4 +/- 20.7; 33.3 +/- 6.8) and benign (84.4 +/- 19.4; 20.4 +/- 4.4) tumours (P < 0.001). CD31 and CD34 immunostaining also revealed increased microvessel density in early-stage mucinous tumours (234.6 +/- 28.2; 87.8 +/- 9.2) compared with that observed in both early- (72.8 +/- 15; 12.9 +/- 2.4) and late- (115.6 +/- 26.5; 29.8 +/- 8.5) stage serous tumours (P < 0.001). No differences in microvessel density in samples from patients with differing outcomes were observed (P > 0.05). Reduced factor VIII-related antigen compared with CD31 and CD34 immunostaining was observed in both borderline and malignant mucinous and serous tumours (P < 0.02) but not in benign tumours (P > 0.05). Our results contradict the putative association between increased microvessel density and poor prognosis and suggest that the level and control of angiogenesis may differ between ovarian tumour types.

Microcystic adenoma of the pancreas: spectrum of computed tomographic findings.

Fourteen cases of microcystic adenoma (serous cystadenoma) of the pancreas were reviewed and radiological findings were correlated with pathological specimens. Microcystic adenomas appeared grossly either as solid tumors with innumerable tiny cysts or as honeycombed cystic tumors depending on the size and number of cysts and amount of connective tissue. Dynamic enhanced CT of the tumor reflected the amount of connective tissue and appeared as (a) densely enhanced spongy masses (n = 6: classic appearance); (b) cystic masses with (n = 6) or without (n = 1) enhanced septa; or (c) dense diffusely enhanced mass (n = 1). Ultrasound similarly showed a variety of features such as echogenic masses with or without small cystic portions, multilocular cysts, or mixed hyperechoic and hypoechoic masses. The ultrasonic features mainly reflected the dominant sizes of cysts. Angiography almost always showed inhomogeneously hypervascular masses with tumor vessels. The imaging diagnosis is easy and conclusive in classic subtypes, but a correct diagnosis can be made even in other subtypes. However, mucinous cystic neoplasm can be confused with microcystic adenoma with large cysts and a small amount of connective tissue, and islet cell tumors can be mistaken for microcystic tumors with minute cysts.

Cystic neoplasms of the pancreas. Radiological-pathological correlation.

Microcystic adenomas and mucinous cystic neoplasms of the pancreas have often been described interchangeably (cystadenoma, cystadenocarcinoma), causing confusion with respect to their radiographic characteristics. The former are composed of innumerable tiny cysts and are benign, whereas the latter contain large, unilocular or multilocular cysts, sometimes with shaggy excrescences, and are either frankly or potentially malignant. Microcystic adenomas are angiographically hypervascular and may have central calcification. Sonographically, they have a mixed hypoechoic and echogenic pattern, while CT numbers reflect a mixture of connective tissue and proteinaceous fluid and contrast enhancement is seen. Mucinous cystic neoplasms are hypovascular and may have peripheral calcification; ultrasound and CT reflect their predominantly cystic character and demonstrate excrescences when present.

[Cystadenoma of the pancreas. Study of the angiogenesis and the associated diseases (author's transl)]. / Cystadénomes du pancréas. Considérations sur leur vascularisation et les maladies qui leur sont associées.

We describe a case of pancreatic cystadenoma (PC) concerning a 66 year-old woman. This PC was a highly vascular cystic tumor, with typical signs: pulsatile tumor, systolic epigastric souffle and demonstrative phonangiography; the selective angiography revealed a hypervascular mass. Microscopically, tiny cysts lined by small, cuboid and columnar cells containing no glycogen, and numerous capillaries. With this case and 210 cases from the literature, two problems have been studied in this paper: the problem of the vascularity of the PC and the problem of the associated diseases. The vascularity allows to distinguish two types of PC: PC with hypervascular pattern and hypo- or avascular PC. The study of the associated diseases shows the high incidence of the tumors (23%), benign and malignant (13%) and of the cysts in other organs (5%). Comparison with polycystic disease of the kidney and the Von Hippel-Lindau disease and hypothesis concerning angio-genesis and cystogenesis in the PC are discussed.

Cystic neoplasms of the pancreas: new angiographic and ultrasonographic findings.

Cystic neoplasms of the pancreas (cystadenoma, cystadenocarcinoma) are rare tumors. Early diagnosis and differentiation from other pancreatic lesions are essential for appropriate management. Pancreatic angiography and gray scale ultrasonography facilitate rapid, accurate diagnosis and proper surgical therapy. In a 7 year period, eight patients were studied (one cystadenoma, seven cystadenocarcinoma); five had selective visceral angiography and six underwent abdominal ultrasonography. The ultrasonographic characteristics of these neoplasms and some new angiographic findings are presented. The sonographic findings for cystadenocarcinoma were similar to those of cystadenoma.

Angiographic findings in some rare pancreatic tumors.

Angiographic findings in one giant cell carcinoma, one cystadenocarcinoma, one poorly vascularized mucinous cystadenocarcinoma, as well as in two avascular (gastrin- and glucagon-producing) islet-cell tumors of the pancreas are described. Two hypervascularized islet-cell tumors are presented for comparison and a case of tumorous chronic pancreatitis in a child is reported because ot its rarity. The aggressiveness of the giant cell carcinoma of the pancreas was demonstrated by its expansive growth. In the case of cystadenocarcinoma angiography revealed the tumor with hepatic metastases not diagnosed at explorative laparotomy. The relative hypovascularity in the case of mucinous cystadenocarcinoma was unusual. Both avascular islet-cell tumors simulated a pancreatic pseudocyst and the final diagnosis was made only by immunoassay. Chronic pancreatitis in a child presented with marked hypervascularization.

Roentgenology-pathology correlative study of neovascularity.

In an attempt to evaluate the histologic picture of what is shown on angiograms as neovascularity, several benign and malignant tumors were examined. New vessels (neovascularity) are large capillaries or sinusoids, and neither contain smooth muscle in their walls. The walls may contain some fibrous connective tissue. Puddling, laking, and staining represent the collection of contrast medium in small capillaries or sinusoids. Some tumors, such as hemangioma of the liver, cystadenoma of the pancreas, and angiomyolipoma of the kidney contained abnormal vascularity, but this was not composed of vessels which had arisen or developed anew, as there was smooth muscle in their walls, and this indicates that those vessels had been there from birth. In xanthogranulomatous pyelonephritis and chronic renal disease, the appearance of increased vascularity is the result of rearrangement of the normal vascular structures.