Intralesional hemorrhage in Krukenberg tumor: a case report and review of the literature.

Acute abdomen due to female genital apparatus disease is very rare. Most are due to intralesional effusion of benign tumors. The authors present a 40-year-old woman with acute abdomen pain due to haemorrhagic ovarian metastasis of colorectal cancer, focusing on the role of imaging to get the management of the patient.

Peliosis hepatis associated with hereditary haemorrhagic telangiectasia.

Hereditary haemorrhagic telangiectasia (HHT) is an autosomal, predominantly inherited disease characterized by diffuse telangiectases involving the skin, mucous membranes, lung, brain, gastrointestinal tract and liver. Peliosis hepatis is a rare, benign disorder causing sinusoidal dilatation and the presence of multiple blood-filled lacunar spaces within the liver. We report a case of an HHT patient with incidental magnetic resonance findings of focal hepatic peliosis.

Isolated nodular metastases in perirenal space: our experience of nine cases and review of the literature.

AIM: The aim of this paper was to report authors' experience and review of the literature on rare isolated perirenal space metastases from different primary tumors. METHODS: From January 2004 to August 2008 we evaluated retrospectively 9 patients with isolated nodular neoplastic lesions of the perirenal space with computed tomography (CT) imaging and we reported the follow-up after relapse of disease. RESULTS: All the masses resulted being of secondary tumor involvement (melanoma (2/9 cases 22.22%), esophagus-gastric tract adenocarcinoma (3/9 cases 33.33%), gynecological tumor (2/9 cases 22.22%) and gastrointestinal tumor (2/9 cases, 22.22%), diagnosed by biopsy CT-guided (2 cases), or histological post-surgical examination (1 case), or clinical and instrumental follow-up (4 cases) or postmortem examination (2 cases). The lesions were bilateral in 3 cases and monolateral in 6 cases, isolated in four cases and multiple in five cases; they have demonstrated partially necrotic parenchymal density as soft tissues masses, with frequently hypervascularization, with portal venous enhancement. The dimensions of lesions resulted to be between minimal value of about 7-8 mm and maximum value of about 50 mm (mean 29 mm). The patients had generally poor prognosis (death for disease ­ DOD ­ in 5 cases; life with disease - LWD ­ in four cases). CONCLUSION: Isolated perirenal metastases are unusual site of relapse of disease. Our study confirms the utility of CT evaluation of metastatic localization of perirenal space; this technique can also be used for focused biopsies and follow-up. This site of isolated metastases had a poor prognosis.

Diagnostic imaging of inverted Y duplication of the ureter with anomalous point angle. A case report.

A rare anomaly of ureteral duplication is the inverted Y configuration, occurring when 2 distal ureteral limbs fuse proximally to become a single tube draining the kidney. In international literature there is a female predominance. Previous reports documented distal limbs that were atresic or associated with ureterocele or ectopically located. We report a case of inverted Y ureter with an obtuse point angle open caudally; the 2 ureteral limbs reach the bladder trigone and are canalized, even if the supernumerary one is partially stenotic in the distal tract.

Splenic metastases in gynaecologic cancer: clinical considerations, US, and CT diagnostic results.

PURPOSE: Splenic metastases from lesions in the genital system are an uncommon finding, both at staging and at follow-up. Most metastases are not an isolated finding but are quite frequently associated with metastases to lymph node or parenchymal sites. The aim of this paper is to describe the patterns of splenic metastasis at US and CT, the diagnostic imaging techniques most often employed in primary evaluation and follow-up of gynaecologic cancer. We consider both the issues of differential diagnosis and clinical decision making. MATERIALS AND METHODS: From January, 1996, to May, 2001, we retrospectively reviewed the CT and US findings of 16 (2.2%) patients with splenic metastases out of 724 patients examined for malignant gynaecologic lesions. US was performed on 479 patients with standard equipment, applying colour and power-Doppler. CT was performed with helical scan, at baseline and after the i.v. administration of a nonionic iodinated contrast agent (120-140 mL at 300-350 mgI/mL concentration, 2 mL/s flow, 70 s administration delay). We used pitch 1.2 with 5-7 mm collimation. We considered metastases lesions that appeared as roundish or irregular, avascular parenchymal nodules at US, and lesions which were hypodense both at baseline and after i.v. administration of iodinated contrast agent at CT. At baseline examination of serous ovarian cancer, metastatic calcifications due to the presence of psammomatous bodies were considered. The presence or absence of splenic metastasis was assessed for all patients by pathology of the surgical specimen, or based on the clinical evolution of the disease. RESULTS: Epithelial ovarian cancer was the most frequent tumour causing splenic metastases (14 cases), while the other two cases were due to advanced endometrial adenocarcinoma and squamous cell vaginal carcinoma. Splenic metastases were detected most frequently during the follow-up and were associated with other sites of recurrence. In two cases US gave false-positive results (multiple micronodular lesions, missed at CT). Negative follow-up at 12 months confirmed absence of recurrence. CT provided only one false-negative result (clinical and US-CT evidence of recurrent disease two months later). We recorded the diagnostic accuracy (99.9% vs 99.9%), sensitivity (100% vs 93.6%), specificity (99.9% vs 100%), positive (87.5% vs 100%) and negative (100% vs 99.9%) predictive value, for US and CT, respectively. CONCLUSIONS: Splenic metastases from female genital system cancers are an uncommon finding. These lesions must be considered with other recurrences, especially in follow-up patients. US and CT provided high accuracy and both can be used for lesion assessment. The micronodular splenic pattern may cause false-positive findings at US.

Epithelial ovarian cancer in female pseudohermaphroditism. A diagnosis by computed tomography and review of the literature.

We describe the case of a patient proven to be a female pseudohermaphrodite with a complete virilization syndrome who developed an epithelial tumor of the ovary of borderline malignancy. The tumor appeared as an abdominal mass with cystic features on ultrasonography. The diagnosis of the intersexual condition and adnexal cancer was made by computed tomography (CT).

Lymphangioma of the spleen in an elderly patient.

Splenic cystic lymphangioma is a very rare condition, and is classified among cystic proliferations of the spleen. It is considered to be the result of a developmental malformation of the lymphatic system and can involve the spleen alone or be a part of multiorgan disease. It is usually seen in children, often found incidentally. We describe a case of cystic lymphangioma of the spleen in an elderly woman putting emphasis on the rarity of the case in old age, and on the problems of differential diagnosis with the other cystic proliferations of the spleen, in particular hydatid disease, in the absence of histologic information.

Extraperitoneal pelvic leiomyosarcoma. MR findings in a case.

The magnetic resonance imaging (MRI) of a patient with nongynecologic pelvic leiomyosarcoma is presented. A retroperitoneal mass appeared under the broad ligaments, in the right paravesical and parametrial, lateral pararectal site. The mass leaned on the uterus and vagina. On MRI, the mass had solid structure, isointense on T1-weighted images, inhomogeneously iperintense on T2-weighted images with central areas of increased intensity. Late after contrast agent administration, the mass appeared inhomogeneously ipointense with areas of fair late contrast enhancement. The morphology of the tumor, the retroperitoneal site, and MRI sequences make the differential diagnosis. These evidences were useful in treatment planning.

Correlation between pretreatment prognostic factors and lymph node metastases in endometrial adenocarcinoma. Clinical application.

PURPOSE: To evaluate the prognosis of stage I endometrial adenocarcinoma, which differs by various prognostic factors. Some of them (tumor grading, histotype, myometrial infiltration, the latter evaluated with Magnetic Resonance Imaging) can be assessed before surgery. These prognostic factors correlate with patient survival and the presence of lymph node metastases. MATERIAL AND METHODS: We used tumor grading, histotype, myometrial infiltration for the preoperative and prospective classification into a low- and a high-risk group of 80 patients with endometrial adenocarcinomas stage I. Low-risk patient [group A: G1-G2, pure adenocarcinoma involving the inner portion of the myometrium (M0-M1)] underwent surgery without lymph node resection, while high-risk patients [group B: G3, pure adenocarcinoma with deep infiltration of the myometrium (M2) and/or clear cell, serous papillary, adenosquamous carcinomas] had pelvic and lumboaortic lymphadenectomy. The minimum 36 months' follow-up (median: 61 months) was requested for all patients. RESULTS: Histotype evaluated by dilatation and curettage and hysteroscopic and/or office biopsy, had 100% agreement with tumor histotype. Tumor grading was in agreement in 72/80 patients (81%). The grade of myometrial infiltration was confirmed in 72/80 cases (81%). Eight misdiagnoses were divided in over--(4 cases) and under--(4 cases) estimated infiltration. All 16 mistakes resulted in 10 inclusion in the wrong risk group (8 in the low-risk and two in the high-risk group). Surgical-pathological staging did not change the prognosis but only staging in 6 preoperatively high-risk group. CONCLUSIONS: This initial study confirms the importance of prognostic factors in the treatment of endometrial adenocarcinoma, as well as that of the different surgical choices which can be made after correct pretreatment prognosis.

Spontaneous hemorrhage of a liver metastasis from squamous cell cervical carcinoma: case report and review of the literature.

Liver metastases are an uncommon cause of spontaneous bleeding compared with primary benign/malignant liver lesions. Since metastatic lesions tend to maintain the vascular characteristics of the primary tumor, some metastases have a greater proclivity for hemorrhage into the host organ than others. We describe the clinical and computed tomography (CT) features of a patient previously treated for nonkeratinizing small cell squamous carcinoma of the cervix uteri. As the metastatic rupture was diagnosed while still intraparenchymal and subcapsular, with minimal peritoneal reaction, the patient's outcome was favorable.

Blind megaureter with ipsilateral renal agenesis and mullerian anomaly: MR findings in a case.

The magnetic resonance imaging (MRI) of a patient with congenital blind megaureter and mullerian anomaly are presented. A retroperitoneal pelvic mass appeared as elongated tubular cystic structure spreading from parametrium to the adnexa and reaching the recto-sigma. On MRI, the mass was hyperintense on T1 and T2-weighted images and disappeared in STIR sequences. The mass with pseudo-intestinal structure, the retroperitoneal site, and the MRI sequences make the differential diagnosis.

Multiple nodular metastases in mesenteric panniculitis by uterine papillary serous adenocarcinoma (UPSC): CT appearance of a case.

Intra-abdominal panniculitis is a thickening of the mesentery of the small/large intestine due to infiltration of lipid-laden macrophages associated with a variable amount of fibrosis. This condition is rarely associated with malignant neoplasms. We report the computed tomography (CT) findings of a patient treated for uterine papillary serous adenocarcinoma (UPSC). She had mesenteric panniculitis where metastatic tumor nodules implanted. This was the only intraperitoneal recurrence. To our knowledge, no such finding has been reported in the gynecologic and radiologic literature to date. On CT images, the differential diagnosis is with cystic dilatations of mesenteric lymph vessels.

Magnetic resonance appearance of endometrial sarcoma: report of a case with unusual findings.

We report the MR findings of an endometrial stromal sarcoma. The uterus was enlarged and completely replaced by neoplastic tissue, with full-thickness myometrial infiltration. It had isointense signal on T1- and irregularly hyperintense signal on T2-weighted images and the dynamic study with intravenous gadoteridol showed centripetal enhancement. This sarcomatous-like pattern correlates well with the pathologic and CT findings reported in the literature.

[Complex maxillofacial trauma: diagnostic contribution of multiplanar and tridimensional spiral CT imaging]. / Traumi complessi del massiccio facciale: apporto diagnostico dell'imaging TC multiplanare e tridimensionale ottenuto con tecnica spirale.

INTRODUCTION: Adequate radiologic assessment of the maxillofacial trauma patient is the basis for planning reparative surgery. We investigated the yield of the integration of axial CT with multiplanar (MP) and three-dimensional (3D) reconstructions with the Spiral technique. MATERIAL AND METHODS: Thirty-five patients (21 men and 14 women, mean age: 31.2 years) with complex maxillofacial traumas were submitted to Spiral CT. Images were acquired with 2-3-mm collimation, 1:1 to 2:1 pitch, 210 mAs, 120 kV, 15-24 s Spiral scan, RI = 1. 3D reconstructions were always obtained and used to guide MPRs targeted on the single injury. The examinations were retrospectively given a score, namely 1 if 3D and MPR yielded no more important diagnostic information than axial CT, 2 if 3D and MPR permitted better detailing of some axial CT findings and thus improved image reading, and 3 if 3D and MPR showed new injuries missed on axial images. Then, a radiologist and a maxillofacial surgeon reviewed the 3D images together only to assess in which cases they were useful to optimize surgical planning. RESULTS: Nine cases (25.7%) scored 1, seventeen (48.6%) scored 2 and nine (25.7%) scored 3. MP and 3D reconstructions were useful or determinant (2 + 3) in over 74% of cases. 3D images made surgical planning easier in 15 of 32 surgical patients (46.8%), allowing the surgeon a better panoramic view of the complex fracture. CONCLUSIONS: The greatest advantage of multiplanar imaging is the improved depiction of skeletal injuries along a horizontal plane, paralleling that of axial scans. The depiction of fractures of cribrum and of orbital roof and floor was particularly useful from a clinical viewpoint. MPRs clearly depicted herniation and incarceration of the lower rectus muscle in blow-out fractures. MP and 3D reconstructions better defined the presence and grade of displaced bone fragments in nearly vertical structures, such as the upward branches and coronoid apophysis of the mandible. 3D images alone never showed any more fractures than those seen on axial and MP images. 3D images are especially useful to the surgeon because they permit the panoramic depiction of the fracture complex, which facilitates treatment planning. The radiologist can use 3D reconstructions to guide the acquisition of targeted MP reconstructions, for better diagnostic yield. The Spiral technique, with its pitch increases up to 2, permits to limit the radiation dose while preserving the quality of postprocessing reconstructions. Finally, decreasing the execution time is important in multiple trauma patients who are often clinically unstable or have damaged vital organs.