A Case of Incidental Schwannoma Mimicking Necrotic Metastatic Lymph Node from Bladder Cancer.

Background and Objectives: Retroperitoneal schwannoma is a very rare case of schwannoma which commonly occurs in the other part of the body. However, it is difficult to distinguish schwannoma from other tumors before pathological examination because they do not show specific characteristics on imaging study such as ultrasound, computed tomography (CT), and magnetic resonance image (MRI). Case summary: A 60-year-old male showed a retroperitoneal cystic tumor which is found incidentally during evaluation of coexisted bladder tumor. Neurogenic tumor was suspicious for the retroperitoneal tumor through pre-operative imaging study. Finally, a schwannoma was diagnosed by immunohistochemical examination after complete surgical excision laparoscopically. Conclusion: As imaging technology is developed, there may be more chances to differentiate schwannoma from other neoplasm. However, still surgical resection and histopathological examination is feasible for diagnosis of schwannoma.

A Focal Defect at the Lateral Patellar Retinaculum on Clinical Knee MRI and Cadaveric Study: A Normal Variant or Pathologic Lesion?

OBJECTIVE: The purpose of this study is to retrospectively investigate the frequency of a focal defect at the lateral patellar retinaculum on knee MRI and to determine the variables that are significantly associated with the defect. MATERIALS AND METHODS: Two radiologists independently reviewed 99 knee MR images for the presence of a focal defect at the lateral patellar retinaculum and categorized patients with concordant results into two groups: a group with the defect (≥ 3 mm; group 1) and a group without the defect (< 3 mm; group 2). Clinical and radiologic variables, including the Kellgren-Lawrence radiographic grade, subcutaneous fat thickness, infrapatellar fat pad area, and the amount of joint effusion, were evaluated. The size and location of the defect were measured in group 1. To correlate MRI and histologic findings, MRI was performed for 11 cadavers, and three histologic specimens were obtained. RESULTS: Of the 99 knee MR images, concordant results between two reviewers were obtained for a total of 96 knees (97%): 25 knees (26%) in group 1 and 71 knees (74%) in group 2. A statistically significant difference between groups (p = 0.033) was noted for the infrapatellar fat pad area only. In all three cadaveric specimens, the lateral patellar retinaculum was more loose and sparse than the medial patellar retinaculum, and this site corresponded to the location of the defect on MRI. CONCLUSION: A focal defect of the lateral patellar retinaculum was not found to be a rare finding on knee MRI (frequency, 26%), and it may be a normal variant rather than a pathologic change. In addition, we suspect that a focal defect can be a route of infrapatellar fat herniation and a route of superficial extension of the infrapatellar fat pad lesion without a lateral patellar retinaculum tear or invasion.

Sonographic appearance of proliferative fasciitis---A case report.

Proliferative fasciitis is a benign entity involving the subcutaneous tissues and fascias, characterized by the proliferation of fibroblast-like spindle cells and ganglion-like cells. However, proliferative fasciitis may be easily confused with sarcoma clinically and pathologically, because it appears as a rapidly growing painful mass and has histologic features such as high cellularity, bizarre morphologic patterns, mitotic figures, and diffuse infiltrative proliferation. Imaging findings of proliferative fasciitis have been very rarely reported. We report the sonographic findings in a case of proliferative fasciitis in a 43-year-old woman with histopathological correlation. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:445-449, 2017.

The Prognostic Nutritional Index Predicts Survival and Identifies Aggressiveness of Gastric Cancer.

Nutritional status has been associated with long-term outcomes in cancer patients. The prognostic nutritional index (PNI) is calculated by serum albumin concentration and absolute lymphocyte count, and it may be a surrogate biomarker for nutritional status and possibly predicts overall survival (OS) of gastric cancer. We evaluated the value of the PNI as a predictor for disease-free survival (DFS) in addition to OS in a cohort of 314 gastric cancer patients who underwent curative surgical resection. There were 77 patients in PNI-low group (PNI ≤ 47.3) and 237 patients in PNI-high group (PNI > 47.3). With a median follow-up of 36.5 mo, 5-yr DFS rates in PNI-low group and PNI-high group were 63.5% and 83.6% and 5-yr OS rates in PNI-low group and PNI-high group were 63.5% and 88.4%, respectively (DFS, P < 0.0001; OS, P < 0.0001). In the multivariate analysis, the only predictors for DFS were PNI, tumor-node-metastasis (TNM) stage, and perineural invasion, whereas the only predictors for OS were PNI, age, TNM stage, and perineural invasion. In addition, the PNI was independent of various inflammatory markers. In conclusion, the PNI is an independent prognostic factor for both DFS and OS, and provides additional prognostic information beyond pathologic parameters.

Increased signal intensity at the proximal patellar tendon: correlation between MR imaging and histology in eight cadavers and clinical MR imaging studies.

OBJECTIVES: We set out to investigate the cause of persistently increased signal intensity (SI) in the posterior portion of the proximal patellar tendon (pPT) on T1-weighted images (T1WI). METHODS: MR imaging was performed in eight cadavers, followed by gross histological examination. In addition, 84 patients without trauma history or anterior knee pain were included to compare the SI of the PTs. The patients were divided according to their age, sex, and Kellgren-Lawrence (KL) grades. The length and thickness of the increased SI portion in the pPT and whole PT (wPT) on T1WI were recorded. RESULTS: Histological specimens demonstrated that the adipose tissue, vessels, and perivascular connective tissue invaginated into the posterior portion of the pPT. This histological anatomy corresponded to the pPT signal change on MR imaging. There was linear and interdigitating increased SI of the pPT in all of the 84 patients (100%). There were no differences in the lengths and thicknesses of the increased SI portion of pPTs and wPTs according to age, sex, and KL grade (all p > 0.05). CONCLUSIONS: The increased SI of the pPT on T1WI and fluid-sensitive MR images results from invaginating fat, vessels, and perivascular connective tissue. It is not pathological, but a normal and common finding. KEY POINTS: • Increased linear/interdigitated SIs of the pPT is a normal and common finding. • Invaginated adipose tissue, vessels, and connective tissue could contribute to increased SI. • The fibrocartilage has a minimal role in increased SI of the pPT. • Age, sex, and KL grade do not significantly influence the increased SI. • Knowledge of this increased SI should help clinicians to avoid unnecessary treatment.

A Different Type of Talocalcaneal Coalition With Os Sustentaculum: The Continued Necessity of Revision of Classification.

OBJECTIVE: The objective of our study was to retrospectively determine the prevalence and image findings of extraarticular talocalcaneal coalition with os sustentaculum, a type of talocalcaneal coalition that does not appear in current classification systems, in patients with an imaging diagnosis of foot coalition. MATERIALS AND METHODS: This study was performed using a database query of radiology reports of ankle and foot CT or MRI examinations performed from August 2001 to November 2013. Eighty-one patients were identified through a keyword search of the database for "talocalcaneal coalition," "tarsal coalition," "coalition," or "os sustentaculum." Imaging features of CT or MRI findings were evaluated. Chart review was used to identify demographic information. RESULTS: Extraarticular talocalcaneal coalition with os sustentaculum was diagnosed in 13 patients (nine men, four women), which represents a prevalence of 16.0% (13/81) in all foot coalitions and 24.1% (13/54) in all talocalcaneal coalitions. Four of 13 patients underwent surgical resection, and histology was obtained in three patients. Nine patients who had no history of trauma were symptomatic and all patients with bone marrow edema at the coalition sites on MRI (n = 5) were also symptomatic. Coexisting extraarticular talocalcaneal coalition with os sustentaculum and intraarticular talocalcaneal coalition were observed in 11 of 13 patients. CONCLUSION: The os sustentaculum is a component of extraarticular talocalcaneal coalitions and as such is usually related to the presence of symptoms. If a patient with an os sustentaculum has symptoms in the medial talocalcaneal joint area, an extraarticular talocalcaneal coalition related to the os sustentaculum should be considered.

Sonographic Features of Superficial-Type Nodular Fasciitis in the Musculoskeletal System.

OBJECTIVES: We evaluated the sonographic features of superficial-type nodular fasciitis in 9 pathologically proven cases. METHODS: Review of the radiology and pathology databases yielded 14 cases of histologically proven superficial-type nodular fasciitis, which was defined as nodular fasciitis located in the subcutaneous fat layer or outer muscle fascia between the subcutaneous fat layer and muscle. Sonograms were available in 9 patients. Two musculoskeletal radiologists retrospectively reviewed all cases in consensus. Imaging features evaluated included the fasciitis location in the body, size, relationship with the fascia, echogenicity, vascularity, and location of the center. RESULTS: There were 4 male and 5 female patients. The mean age was 35 years (range, 8-49 years). The masses ranged in size from 0.8 to 2 cm, with 90% measuring less than 1.8 cm. Five masses developed in the forearm (4 cases) or elbow (1 case). Six masses were located in the subcutaneous fat layer, and 3 masses were in the fascia. Seven masses were in direct contact with the outer muscle fascia, whereas 2 masses were indistinctly in contact with the fascia. These masses showed a hypoechoic background with echogenic foci or peripheral hyperechoic nodules. In all 3 of the masses within the fascia, the findings were similar to those of neurogenic tumors. The vascularity of the masses was variable, but most (7 of 9 cases) showed no substantial vascularity. All masses had centers of less than half the thickness of the subcutaneous fat layer. CONCLUSIONS: Superficial-type nodular fasciitis is often located in the deep subcutaneous fat near the muscle fascia, has a hypoechoic appearance with echogenic foci or peripheral hyperechoic nodules, and quite often does not show internal vascular flow. If a superficial soft tissue mass has the above findings, superficial-type nodular fasciitis should be included in the differential diagnosis.

Concurrent FDG-Avid and Non-FDG-Avid Pleomorphic Adenomas in the Submandibular Gland and Parapharyngeal Space.

ABSTRACT: Pleomorphic adenoma is the most common benign tumor of salivary glands. Here we present an interesting case of concurrent pleomorphic adenomas in the parapharyngeal space and submandibular gland. The tumors showed stark differences in the imaging findings on FDG PET/CT and MRI. Pathology confirmed the diagnosis of pleomorphic adenomas with the different composition of the cellular component and chondromyxoid stroma. This case suggests that the difference in cellularity of pleomorphic adenomas can affect FDG uptake and diffusion-weighted MRI-derived apparent diffusion coefficient values.

Expression of the mammalian target of rapamycin pathway markers in lung adenocarcinoma and squamous cell carcinoma.

OBJECTIVE: We investigated whether the expression of mammalian target of rapamycin (mTOR) pathway components is associated with clinicopathologic characteristics and patient outcome in lung adenocarcinoma (AC) and squamous cell carcinoma (SCC). METHODS: We used immunohistochemistry to evaluate the expression of phosphorylated Akt (pAkt), mTOR, p70 ribosomal protein S6 kinase (p70S6K) and phosphatase and tensin homolog deleted on chromosome 10 (PTEN) in 91 cases of AC and 154 cases of SCC. RESULTS: pAkt expression was positively correlated with the expression of mTOR (p < 0.001) and p70S6K (p < 0.001), and mTOR expression was positively correlated with p70S6K expression (p < 0.001). PTEN expression was inversely correlated with the expression of pAkt (p = 0.001), mTOR (p < 0.001) and p70S6K (p = 0.012). In addition, loss of PTEN expression, observed in 37.4% (34/91) of AC patients, was significantly associated with a higher histologic grade (p = 0.013), pathologic T stage (p = 0.016) and N stage (p < 0.001) and advanced TNM stage (p = 0.001), as well as a shorter overall survival of AC patients (p = 0.015). CONCLUSION: The high prevalence of PTEN loss and its association with aggressive tumor behavior and poor patient outcome in AC suggest that loss of PTEN expression is involved in AC progression and serves as a prognostic marker for patients with AC.

Correlation between FDG uptake by PET/CT and the expressions of glucose transporter type 1 and hexokinase II in cervical cancer.

BACKGROUND: The aim of this study was to explore the association between 2-deoxy-2-F18-fluoro-D-glucose uptake and the expressions of glucose transporter type 1 (GLUT-1) and hexokinase II (HK-II) in the lymph nodes of patients with cervical cancer. METHODS: This prospective study included 20 women with International Federation of Gynecology and Obstetrics stage IB to stage IIA cervical cancer who underwent positron emission tomography (PET)-computed tomography (CT) (PET/CT) before surgical treatment. In 333 dissected lymph nodes (LNs) obtained, we examined the size, tumor involvement, and expressions of GLUT-1 and HK-II. These characteristics were compared with PET/CT and pathological findings. RESULTS: Pathological analysis found that 21% (70) of the 333 surgically dissected LNs were metastatic. Positron emission tomography/CT detected metastasis with 22.8% sensitivity and 98.5% specificity. The levels of GLUT-1 and HK-II expression in false-positive LNs were higher than those in pathologically confirmed negative nodes (P = 0.015 and P = 0.001, respectively). In metastatic LNs, PET/CT-positive nodes were significantly different from PET/CT-negative nodes in mean size (P = 0.043), tumor involvement (P = 0.008), and proportion of GLUT-1-positive tumor cells (P = 0.042). CONCLUSIONS: Our results indicate that overexpression of GLUT-1 and HK-II may be related to 2-deoxy-2-F18-fluoro-D-glucose uptake in false-positive tissues on PET/CT. In metastatic lymph nodes, the ability of PET/CT to detect cancer may depend on tumor involvement, lymph node size, and GLUT-1 expression.

Uterus-like mass involving the appendix: US and CT findings.

Uterus-like mass is a rare extrauterine mass composed of a central cavity lined by endometrium and surrounding smooth muscle. Uterus-like mass has frequently been reported in the ovary, but has rarely been found in extraovarian regions. We report a case of uterus-like mass involving the appendix in a woman who presented with right lower abdominal pain indistinguishable from acute appendicitis. Sonography revealed a heterogeneous mass of mixed echogenicity with inner cystic change, abutting the appendix. CT depicted an enhanced mass with inner cystic change abutting the appendix. Histopathologic examination confirmed the diagnosis.

Expression of HuR, COX-2, and survivin in lung cancers; cytoplasmic HuR stabilizes cyclooxygenase-2 in squamous cell carcinomas.

Hu antigen R (HuR) is a member of the human family of embryonic-lethal, abnormal vision-like proteins, which serves as an mRNA-binding protein. In the cytoplasm, HuR can stabilize the mRNA of cyclooxygenase-2 (COX-2), an enzyme that catalyses the synthesis of prostaglandins and is associated with promotion of carcinogenesis and tumor cell resistance to apoptosis. Intracellular (cytoplasmic and nuclear) localization of survivin has a prognostic significance as an apoptosis inhibitor and a regulator of cell division in tumors. Patients with 151 squamous cell carcinomas and 93 adenocarcinomas underwent lobectomy or pneumonectomy with hilar and mediastinal lymph node sampling. Paraffin-embedded tumor sections were retrieved for evaluation of nuclear and cytoplasmic staining of survivin and HuR, and cytoplasmic staining of COX-2. In squamous cell carcinomas, COX-2 expression was correlated with a difference of survivin (cytoplasmic-nuclear; P=0.004), cytoplasmic HuR (P=0.018), total HuR (cytoplasmic+nuclear; P=0.009), and difference of HuR (P=0.020). COX-2 was inversely correlated with nuclear survivin (P=0.006). In a univariate analysis by log-rank test, survival was associated with cytoplasmic survivin (adenocarcinoma, P<0.001; squamous cell carcinoma, P=0.005), difference of survivin (adenocarcinoma, P<0.001; squamous cell carcinoma, P=0.014), and COX-2 (squamous cell carcinoma, P=0.001). Survival was inversely associated with nuclear survivin (adenocarcinoma, P=0.006, squamous cell carcinoma, P=0.014). In a multivariate survival analysis, cytoplasmic survivin (adenocarcinoma, P=0.002; squamous cell carcinoma, P=0.015) and COX-2 (squamous cell carcinoma, P=0.020) were determined as independent prognostic factors. Cytoplasmic HuR expression is associated with COX-2 expression in squamous cell carcinomas. The expression of COX-2 in squamous cell carcinomas, and cytoplasmic survivin in adenocarcinomas and squamous cell carcinomas could be useful independent prognostic markers.

Sonographic appearances of small organizing hematomas and thrombi mimicking superficial soft tissue tumors.

We retrospectively reviewed 2 cases of organizing hematomas and 2 cases of intravascular organizing thrombi and investigated correlations between sonographic and pathologic findings. In all 4 cases, a well-defined hypoechoic heterogeneous mass with surrounding increased echogenicity was evident in the subcutaneous fat layer. Organizing hematomas and thrombi have sonographic features similar to those of benign-looking soft tissue tumors. These lesions should therefore be considered in the differential diagnosis of superficial soft tissue masses.

Stromal CD10 expression and relationship to the E-cadherin/beta-catenin complex in breast carcinoma.

AIMS: Previous investigations have indicated that stromal CD10 expression, and altered levels of both E-cadherin and beta-catenin, are associated with the biological aggressiveness of human carcinoma. The aim was to evaluate stromal CD10 expression and the association of stromal CD10 with E-cadherin and beta-catenin in breast carcinoma. METHODS AND RESULTS: The expression of CD10, E-cadherin and beta-catenin was immunohistochemically analysed in tissue microarrays containing 104 cases of invasive ductal carcinoma (IDC) and 10 cases of ductal carcinoma in situ (DCIS). Stromal CD10 was detected in 49.5% (50/101) of the IDC. No immunoreactivity was identified in the stromal cells of normal breast, DCIS or intraductal components of IDC. Accumulation of the cytoplasmic beta-catenin was found in 87.0% (87/100) of the IDC. Stromal CD10 expression in IDC was significantly correlated with tumour size (P = 0.027), stage (P < 0.001) and histological grade (P = 0.006), the presence of nodal (P = 0.048) and distant (P = 0.015) metastases, oestrogen receptor-negative status (P = 0.016), cytoplasmic beta-catenin accumulation (P = 0.031) and lower overall survival rate (P = 0.041). CONCLUSIONS: Stromal CD10 expression in IDC may constitute an important prognostic marker. Stromal CD10 expression with associated aggressive features might be related to aberrant beta-catenin expression.

The spectrum of vascularized superficial soft-tissue tumors on sonography with a histopathologic correlation: Part 1, benign tumors.

OBJECTIVE: The objective of this article is to illustrate the sonographic findings of benign, vascularized superficial soft-tissue tumors. CONCLUSION: Sonography can play an important role in the diagnosis of benign, vascularized superficial soft-tissue tumors. Awareness of these findings is important in establishing the correct diagnosis and determining the optimal treatment.

The spectrum of vascularized superficial soft-tissue tumors on sonography with a histopathologic correlation: Part 2, malignant tumors and their look-alikes.

OBJECTIVE: The objective of this article is to illustrate the sonographic findings of malignant, vascularized superficial soft-tissue masses and their look-alikes. CONCLUSION: Radiologists need to be aware of the sonographic findings of malignant, vascularized superficial soft-tissue tumor findings and their look-alikes for the differential diagnosis and determining an optimal treatment plan.

Giant superficial angiomyxoma of the vulva: a case report and review of the literature.

Superficial angiomyxomas (SAMs) are rare, benign cutaneous tumors frequently involving the subcutis. Only 15 cases of SAM involving the vulva have been reported, ranging from 0.9 to 4 cm in diameter. A 26-year-old woman presented with a 7-year history of a large, pedunculated cutaneous mass on the left labium major, measuring 12.5 x 11 x 10.5 cm and mimicking a soft tissue sarcoma. The mass was relatively well-circumscribed, but unencapsulated and multilobulated. Microscopically, the mass showed a conglomerate of moderately-to-sparsely cellular angiomyxoid lobules. Each lobule consisted of scattered spindle-shaped or stellate tumor cells set in an abundant myxoid stroma. Thin-walled, small-to-medium-sized blood vessels were distributed diffusely throughout the stroma. Scattered stromal neutrophils were also observed. No large vessels or plexiform capillaries were apparent. There was no perivascular accentuation of stromal cells or smooth muscle bundles. The tumor cells constantly expressed vimentin, CD34, CD44 and S-100, but none expressed estrogen receptors (ERs) and progesterone receptors (PRs), desmin or cytokeratin. Together, these findings were diagnostic of a SAM. Giant SAMs of the vulva can mimic aggressive angiomyxomas (AAMs) and angiomyofibroblastomas (AMB), as well as soft tissue sarcomas. Giant SAMs should be included in the differential diagnosis of vulvar soft tissue tumors.

Hippo pathway and tumoral FOXP3 expression correlate with tumor growth in squamous cell carcinoma of the lung.

BACKGROUND: Expression of FOXP3 in tumors is associated with proliferation, migration, and invasion, has been implicated in cancer prognosis, and may be related to metastatic potential. The Hippo signaling pathway is known to regulate tissue homeostasis and organ size through cell proliferation and apoptosis. We investigated tumoral FOXP3, Lats2, and YAP expression related to the Hippo pathway in squamous cell carcinoma (SCC) of the lung. METHODS: Between 1983 and 2006, 149 cases of SCC were diagnosed and surgically resected at Kyung Hee University Hospital. Immunohistochemical staining for FOXP3, YAP, and Lats2 was done. RESULTS: Tumor size was inversely correlated with tumoral FOXP3 expression (p = 0.015), Treg count (p < 0.0001), and positive Lats2 expression (p = 0.028). YAP expression was inversely correlated with lymph node metastasis (p = 0.039). Positive tumoral FOXP3 expression was significantly associated with infiltrated Treg count (p = 0.001) and positive Lats2 expression (p = 0.007). CONCLUSION: Tumoral FOXP3 has the potential to suppress tumor function in SCC of the lung. The decrease or loss of FOXP3 expression in cancer cells is thought to contribute to SCC tumorigenesis and progression in the lung. The tumor suppressor function of FOXP3 in SCC of the lung was related to Lats2 and YAP expression in the Hippo pathway.

Pulmonary adenocarcinoma with heterotopic ossification.

Pulmonary adenocarcinoma is a common malignancy that often involves calcification; however, bone formation in primary lung adenocarcinoma is extremely rare. In ten cases of primary pulmonary adenocarcinoma with heterotopic ossification, we detected immunoreactivity against TGF-beta1, osteopontin, osteocalcin and Runx2 in the fibroblastic stroma and tumor cells within the area of ossification. Our results suggest that in primary pulmonary adenocarcinoma, heterotopic ossification occurs via intramembranous bone formation. To our knowledge, only 11 other cases of pulmonary adenocarcinoma with heterotopic ossification have been reported. Here, we present ten cases of pulmonary adenocarcinoma showing heterotopic ossification with a description of previously published results and the histogenesis of heterotopic bone formation.

Undifferentiated pleomorphic sarcoma of the liver presenting as a unilocular cyst.

BACKGROUND: A malignant fibrous histiocytoma, recently referred to as an undifferentiated pleomorphic sarcoma (UPS), is very rare in the liver, and only 34 cases of primary hepatic malignant fibrous histiocytoma have been reported in the English literature. METHODS: We report a rare case of a hepatic UPS presenting as a unilocular cystic lesion with respect to histopathologic features, the newly revised diagnostic criteria, and the differential diagnosis. RESULTS: A 60-year-old man presented for evaluation of epigastric pain of 7 months duration. Abdominal computed tomography revealed a hypodense, unilocular cystic mass in the right lobe of the liver, measuring 14.0X11.1 cm. A right lobectomy was performed. Grossly, the cut surface showed a single, well-circumscribed unilocular cystic tumor mass containing dark red-brown necrotic debris and blood clots, which occupied most of the mass. Microscopically, the tumor consisted of haphazardly arranged mononuclear pleomorphic tumor cells, admixed with abundant osteoclast-like multinucleated giant cells. Immunohistochemically, the tumor cells expressed vimentin only. The histopathologic and immunohistochemical findings were compatible with a UPS. The patient is alive and well 41 months after surgery without recurrence. CONCLUSIONS: Clinically, most of the hepatic UPSs are solid masses. Only two cases have presented as multilocular cystic masses. A primary hepatic UPS presenting as a unilocular cyst has never been reported. A UPS should be included in the differential diagnosis of unilocular cystic lesions in the liver.