Discovery of Gastric Metastases From Primary Renal Cell Carcinoma Through MRI: A Case Report.

Gastric metastases from primary renal cell carcinoma (RCC) are rare and poorly documented in the existing literature. This case report presents the clinical course of a 65-year-old male with multi-metastatic clear cell RCC (ccRCC) who was incidentally found to have stomach metastases during follow-up magnetic resonance imaging (MRI). Gastric metastases from ccRCC are typically associated with other metastatic sites. They often emerge at an advanced stage of the disease, indicating a poor prognosis. It is therefore important to consider gastric metastases as a potential site of involvement in RCC patients. MRI revealed three gastric mucosal lesions exhibiting hypervascularity, a characteristic feature of ccRCC. Histological analysis confirmed the presence of malignant cells compatible with RCC.

Rare Solid Pancreatic Lesions on Cross-Sectional Imaging.

Several solid lesions can be found within the pancreas mainly arising from the exocrine and endocrine pancreatic tissue. Among all pancreatic malignancies, the most common subtype is pancreatic ductal adenocarcinoma (PDAC), to a point that pancreatic cancer and PDAC are used interchangeably. But, in addition to PDAC, and to the other most common and well-known solid lesions, either related to benign conditions, such as pancreatitis, or not so benign, such as pancreatic neuroendocrine neoplasms (pNENs), there are solid pancreatic lesions considered rare due to their low incidence. These lesions may originate from a cell line with a differentiation other than exocrine/endocrine, such as from the nerve sheath as for pancreatic schwannoma or from mesenchymal cells as for solitary fibrous tumour. These rare solid pancreatic lesions may show a behaviour that ranges in a benign to highly aggressive malignant spectrum. This review includes cases of an intrapancreatic accessory spleen, pancreatic tuberculosis, solid serous cystadenoma, solid pseudopapillary tumour, pancreatic schwannoma, purely intraductal neuroendocrine tumour, pancreatic fibrous solitary tumour, acinar cell carcinoma, undifferentiated carcinoma with osteoclastic-like giant cells, adenosquamous carcinoma, colloid carcinoma of the pancreas, primary leiomyosarcoma of the pancreas, primary and secondary pancreatic lymphoma and metastases within the pancreas. Therefore, it is important to determine the correct diagnosis to ensure optimal patient management. Because of their rarity, their existence is less well known and, when depicted, in most cases incidentally, the correct diagnosis remains challenging. However, there are some typical imaging features present on cross-sectional imaging modalities that, taken into account with the clinical and biological context, contribute substantially to achieve the correct diagnosis.

Unravelling Peritoneal Carcinomatosis Using Cross-Sectional Imaging Modalities.

Peritoneal carcinomatosis (PC) refers to malignant epithelial cells that spread to the peritoneum, principally from abdominal malignancies. Until recently, PC prognosis has been considered ill-fated, with palliative therapies serving as the only treatment option. New locoregional treatments are changing the outcome of PC, and imaging modalities have a critical role in early diagnosis and disease staging, determining treatment decision making strategies. The aim of this review is to provide a practical approach for detecting and characterizing peritoneal deposits in cross-sectional imaging modalities, taking into account their appearances, including the secondary complications, the anatomical characteristics of the peritoneal cavity, together with the differential diagnosis with other benign and malignant peritoneal conditions. Among the cross-sectional imaging modalities, computed tomography (CT) is widely available and fast; however, magnetic resonance (MR) performs better in terms of sensitivity (92% vs. 68%), due to its higher contrast resolution. The appearance of peritoneal deposits on CT and MR mainly depends on the primary tumour histology; in case of unknown primary tumour (3-5% of cases), their behaviour at imaging may provide insights into the tumour origin. The timepoint of tumour evolution, previous or ongoing treatments, and the peritoneal spaces in which they occur also play an important role in determining the appearance of peritoneal deposits. Thus, knowledge of peritoneal anatomy and fluid circulation is essential in the detection and characterisation of peritoneal deposits. Several benign and malignant conditions show similar imaging features that overlap those of PC, making differential diagnosis challenging. Knowledge of peritoneal anatomy and primary tumour histology is crucial, but one must also consider clinical history, laboratory findings, and previous imaging examinations to achieve a correct diagnosis. In conclusion, to correctly diagnose PC in cross-sectional imaging modalities, knowledge of peritoneal anatomy and peritoneal fluid flow characteristics are mandatory. Peritoneal deposit features reflect the primary tumour characteristics, and this specificity may be helpful in its identification when it is unknown. Moreover, several benign and malignant peritoneal conditions may mimic PC, which need to be considered even in oncologic patients.

An Uncommon Expression of Immunoglobulin G4 (IgG4)-Related Disease: Sclerosing Mesenteritis Concomitant With IgG4-Related Autoimmune Pancreatitis.

A 63-year-old male presented to our oncological hospital with a one-year evolving abdominal pain, with an abdominal mass feeling. Contrast-enhanced computed tomography displayed two soft tissue masses, one at the mesentery root and the second around the pancreatic tail; at the same time the patient presented with hyperlipasemia. Endoscopic biopsy for the pancreatic mass and surgical biopsy of the mesenteric one were performed in order to narrow diagnosis. No neoplastic cells but only dense fibro-inflammatory changes with immunoglobulin G4 (IgG4)-positive plasma cell inclusions were observed for both biopsies. A diagnostic and therapeutic strategy based on high suspicion of IgG4-related disease was adopted, with good clinical and imaging response to corticotherapy.

Utilidad de la biopsia asistida con vacío guiada con ecografía en el manejo de las pacientes con papilomas de mama / Usefulness of US-guided vacuum-assisted removal in the management of patients with breast papillomas

Objetivos. Revisar la utilidad a largo plazo del manejo percutáneo de los papilomas de mama mediante la extirpación con BAV guiada por ecografía. Material y método. Se realizó un estudio retrospectivo de las 122 lesiones papilares (entre 3-30mm, media 10mm) extirpadas con BAV guiada por ecografía en nuestro hospital entre abril de 2010 y abril de 2016, en 102 pacientes con edades comprendidas entre 22 y 85 años (media 59). Presentaban secreción uniorificial 74 lesiones en 68 pacientes. El protocolo de seguimiento después de la BAV fue realizar ecografía en 1-2, 6-8 y 12-14 meses, y posteriormente, de forma anual. Si en los controles se detectaban hallazgos sospechosos de papiloma residual o recidivante se realizaba una BAV de rescate. Resultados. El resultado de la BAV en las 122 lesiones fue: 114 papilomas benignos (PB), 6 PB con atipia, 2 PB con carcinoma intraductal. Se realizó seguimiento ecográfico (6-72 meses, media 54) en las 120 lesiones benignas (100 pacientes). Se sospechó recaída local en 19 PB (19 pacientes, 13 residual y 6 recidivante) y en 4 PB (3 pacientes, recaída a distancia o papilomatosis múltiple). Se realizó una nueva BAV en 18 PB con sospecha de recaída local (18 lesiones) y en un PB con recaída a distancia (2 lesiones). En 15 lesiones el resultado fue de PB, en una, de PB con atipia y en 4, de fibrosis. No hubo falsos negativos (carcinomas) en el seguimiento. En una paciente, un PB con recidiva en el interior del pezón se extirpó con cirugía. Dos pacientes desarrollaron papilomatosis múltiple incontable y no se realizó BAV. La secreción desapareció en 73 papilomas (67 pacientes). Conclusión. El tratamiento percutáneo mediante la extirpación con BAV guiada por ecografía es efectivo en la mayoría de las pacientes con PB o BP con atipia, y seguro en el seguimiento a largo plazo (AU)

Objectives. To review long-term outcomes of the percutaneous management of breast papillomas by US-guided vacuum-assisted removal (US-VAR). Material and method. A retrospective study was conducted of 122 papillary lesions (mean size 10mm, range 3-30mm) removed with US-VAR in our hospital between April 2010 and April 2016 from 102 patients (mean age 59 years, range 22-85 years). Pathological discharge was present in 74 lesions (68 patients). US follow-up was performed at 1-2, 6-8, and 12-14 months after US-VAR, followed by annually. When a residual or recurrent suspicious papilloma was detected at US follow-up, re-excision by US-VAR was performed. Results. At histology, there were 114 benign papillomas (BP), 6 atypical papillomas, and 2 papillomas with intraductal carcinoma. US follow-up (range 6-72 months, mean 54) was performed in 120 benign lesions (100 patients). US showed local recurrence in 19 BP (13 residual, 6 recurrent) in 19 patients and distant recurrence in 4 BP (multiple papillomatosis) in 3 patients. Re-excision US-VAR was performed in 18 BP with suspected local recurrence (18 patients) and in one atypical papilloma with distant recurrence (2 lesions). Histology showed BP in 15 lesions, atypical papilloma in one lesion and fibrosis in 4. There were no false negatives (carcinomas) at follow-up. In one patient, one recurrent papilloma grew inside the nipple and was surgically excised. In 2 patients with multiple recurrent papillomas in different locations, US-VAR was not performed. Nipple discharge disappeared in 73 papillary lesions in 67 patients. Conclusion. US-VAR allows percutaneous long-term management in most patients with papillomas and is a satisfactory alternative to surgery (AU)

Trapped on the "whirl": diagnostic sign on emergency CT.

The "whirl sign" is an uncommon finding on emergency CT. However, it is easy to overlook if not kept in mind. Its recognition is of capital importance, being most of its causes potentially lethal. Surgical treatment is also mandatory when signs of complication are found. The whirl sign is usually found associated to midgut, cecal and sigmoid volvulus, small-bowel volvulus and closed-loop obstructions, and post-surgical mesenteric windows (including retroanastomotic hernias). CT is an optimal imaging technique to depict the so-called sign and associated CT features suggesting complication (circumferential wall thickening, pneumatosis intestinalis, pneumoperitoneum, mesenteric fat stranding, free intraperitoneal fluid, mesenteric haziness). Radiologists must be able to recognize the whirl sign and seek associated findings that strongly support the diagnosis of a spectrum of entities, some of them lethal if no treatment is established.