Two adult cases of extralobar pulmonary sequestration: A non-complicated case and a necrotic case with torsion.

BACKGROUND: This case report describes two cases of extralobar pulmonary sequestration in adults with and without torsion/necrosis. CASE REPORTS: Non-complicated extralobar pulmonary sequestration was found incidentally in a 50-year-old asymptomatic woman (Case 1), diagnosed with the presence of a branching structure in a mass lesion and blood supply from the right inferior phrenic artery. Another case of a 38-year-old woman presented with a sudden onset of back pain caused by extralobar pulmonary sequestration with torsion/necrosis (Case 2). A 4-cm fusiform mass in the paravertebral region showed enhancement in the peripheral rim only, and no feeding artery. These were the same as it had been reported typical findings in extralobar pulmonary sequestration with necrosis. On magnetic resonance imaging, the masses in both cases showed inhomogeneous low signal and branching high signal on T2-weighted images. That was characteristic for a stroma without dilated alveoli as a solid part and dilated alveoli as fluid regions. CONCLUSIONS: By comparing those two cases, we came to a conclusion that only T2-weighted imaging reflects the native structure, even after infarction. Although differentiation from a cystic tumor with hemorrhage or infection can be problematic, inhomogeneous low signal and branching high signal on T2-weighted images may help us distinguish extralobar pulmonary sequestration from other cystic lesions.

An autopsy case of granulocyte-colony-stimulating-factor-producing extrahepatic bile duct carcinoma.

A 79-year-old man was referred to this department due to the presence of extrahepatic bile duct carcinoma with a tumor at the left chest wall. The lesion was suspected to be a metastasis of bile duct carcinoma to the left wall, however, computed tomography (CT) revealed no regional lymph node or liver metastases. In addition, cytological and pathological examinations did not show malignancy. At the time of admission, the white blood cell count was 21460 cells/muL (neutrophils, 18240 cells/muL) and this elevated to 106040 before death. In addition, serum granulocyte colony-stimulating factor (G-CSF) was elevated. At 28 d after admission, the patient died. An autopsy showed a poorly differentiated adenocarcinoma with sarcomatous change, which had slightly invaded into the pancreas around the bile duct, and was found in the distal bile duct with multiple metastases to the chest wall, lung, kidney, adrenal body, liver, mesentery, vertebra and mediastinal and para-aortic lymph nodes, without locoregional lymph node and liver metastasis. The cancer cells showed positive immunohistochemical staining for anti-G-CSF antibody. This is believed to be the first report of an extrahepatic bile duct carcinoma that produces G-CSF. Since G-CSF-producing carcinoma and sarcomatous change of the biliary tract leads to poor prognosis, early diagnosis and treatment are needed. When infection is ruled out, the G-CSF in serum should be examined. In addition, examinations such as bone scintigraphy and chest CT should also be considered for distant metastasis.

Pathophysiologic evaluation of MELAS strokes by serially quantified MRS and CASL perfusion images.

PURPOSE: To clarify the roles of serial MR spectroscopy (MRS) and continuous arterial spin labeling (CASL) perfusion images for evaluating cerebral lesions in patients with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS). MATERIALS AND METHODS: Two cases of MELAS followed up serially using MRS and CASL images in addition to routine MR imaging were enrolled. RESULTS: Newly appeared lesions assessed by MRS revealed increased lactate doublets which correlated well with CSF lactate level, and these showed a decreasing trend after treatment, although conventional T2 weighted images revealed hyper-intensity in both phases. Spectra from normally appearing white matter depicted slight lactate peaks during clinical exacerbation periods with marked elevation of CSF lactate and showed a decreasing NAA concentration during the prolonged course. In CASL images, acute lesions of the disease were clearly visible as hyper-perfusion foci, and chronic lesions were demonstrated as hypo- or iso-perfusion regions. CONCLUSION: The detection of lactate peaks in the MR spectrum from normally appearing white matter may be considered as systemic lactic acidosis or an exacerbation of MELAS, and active lesions can be distinguished from chronic inactive lesions by the increase of lactate peaks in MRS or the state of hyper-perfusion in CASL images.

Tissue characterization of glioma by proton magnetic resonance spectroscopy and perfusion-weighted magnetic resonance imaging: glioma grading and histological correlation.

BACKGROUND AND PURPOSE: Our intent was to clarify the usefulness of proton magnetic resonance spectroscopy (MRS) and perfusion-weighted magnetic resonance imaging (PW-MRI) in the grading of glioma. METHODS: Twenty-three consecutive patients with gliomas were investigated by both proton MRS and PW-MRI. For quantitative analysis, the metabolite data of the gliomas were estimated using the LCModel software. Receiver operating characteristic (ROC) curve analyses were also performed to assess which metabolite parameter was optimal for discrimination of glioma grade. From the PW-MRI data, the value of blood volume was measured on the parametric map corresponding to the location of MRS analysis. We then compared tumor blood volume with the amount of choline (Cho). RESULTS: The mean Cho/creatine (Cre) ratio was useful to discriminate between Grades II and III, and the mean lactate (Lac)/Cre ratio was found to be significantly different between Grades III and IV. ROC curve analysis showed that measurements involving Cho were superior indices for grading glioma compared with blood volume information. Furthermore, the correlation between tumor blood volume and the amount of choline was statistically significant. CONCLUSION: MRS may provide valuable information for glioma grading.