Management of locally advanced mesonephric carcinoma of the cervix in the setting of Mullerian Duct anomaly spectrum and unilateral renal agenesis: A case report and review of the literature.

Cervical mesonephric adenocarcinoma is a rare histologic cervical carcinoma variant arising from remnants of the mesonephric duct. Few clinical cases have been reported in the literature, and given the low rate of occurrence, the optimal management strategy is unknown. Most reported cases involve patients with either early stage (FIGO I) or metastatic disease. Herein, we report the only known case of locally advanced, node-positive cervical mesonephric carcinoma in a 55-year old woman with Mullerian duct anomaly of the uterus, obstructed hemivagina, and ipsilateral renal agenesis. To our knowledge, this would be the first case report with the concurrence of both rare entities. We review the treatment paradigm in this patient, and the literature, including radiotherapy and brachytherapy techniques.

Multimodality Radiological Pictorial Review of Testicular Carcinoma: From Initial Staging to Restaging.

With an overall 5-year survival rate >95%, patients with testicular cancer have a great prognosis. Although initial diagnosis is based on clinical examination, imaging does play a significant role in the diagnosis and prognosis of testicular cancer, which are dependent on tumor burden and staging. Successful treatment requires appropriate disease assessment throughout a patient's treatment: evaluating treatment response, restaging, and monitoring for disease recurrence after treatment completion. Ultrasound is usually the initial screening modality for painless testicular masses, and computedtomography (CT) the most commonly used for staging and restaging. However, with regard to seminomas, positron-emission tomography (PET) combined with CT is slowly taking priority. With regard to nonseminomatous germ-cell tumors, PET-CT has not proven to be completely effective, due to a high number of false-negative results. The purpose of this paper is to provide radiologists with a pictorial review of testicular carcinoma from initial staging through posttreatment follow-up.

Primary Intra-abdominal Ewing's Sarcoma in Adults: A Multimodality Imaging Spectrum.

Ewing sarcoma (ES) and peripheral primitive neuroectodermal tumor are part of a spectrum of neoplastic diseases known as the ES family of tumors, which also includes extraosseous ES, peripheral primitive neuroectodermal tumor, malignant small-cell tumor of the thoracopulmonary region (Askin's tumor), and atypical ES. Although imaging features of these tumors have been previously described, extensive discussion about intra-abdominal manifestations is scarce in the literature. We present an imaging spectrum of these tumors in the abdomen and pelvis with particular attention to multimodality approach for staging and restaging.

Magnetic Resonance Imaging of Pelvic Masses: A Compartmental Approach.

Magnetic resonance imaging (MRI) is often "one stop shop" for evaluating female pelvic masses that helps in diagnosis, staging, and restaging of these tumors. A pelvic mass can arise from any tissue present within the pelvis. Although most masses in the female pelvis arise from the reproductive organs, masses may also arise from the gastrointestinal tract, urinary system, adjacent soft tissues, peritoneum, etc. It may not always be possible to determine the site of origin or distinguish these masses based on imaging characteristics. However, familiarity with the clinicopathologic and MRI features of most common pelvic masses helps in narrowing the differential diagnosis. Diagnosis of these masses needs a holistic approach as required for any tumor including clinical history, laboratory data, and imaging characteristics. We focus on MRI characteristics of commonly encountered pelvic masses. A compartmental imaging approach is discussed in this article that helps in identifying and characterizing these masses.

Magnetic Resonance Imaging of Gynecological Malignancies: Role in Personalized Management.

Gynecological malignancies are a leading cause of mortality and morbidity in women and pose a significant health problem around the world. Currently used staging systems for management of gynecological malignancies have unresolved issues, the most important being recommendations on the use of imaging. Although not mandatory as per the International Federation of Gynecology and Obstetrics recommendations, preoperative cross-sectional imaging is strongly recommended for adequate and optimal management of patients with gynecological malignancies. Standardized disease-specific magnetic resonance imaging protocols help assess disease spread accurately and avoid pitfalls. Multiparametric imaging holds promise as a roadmap to personalized management in gynecological malignancies. In this review, we will highlight the role of magnetic resonance imaging in cervical, endometrial, and ovarian carcinomas.

Abdominal manifestations of histiocytic disorders in adults: imaging perspective.

Histiocytic disorders (HDs) are a diverse group of diseases characterized by pathologic infiltration of normal tissues by cells of the mononuclear phagocyte system. The spectrum of these diseases ranges from treatable infectious diseases to rapidly progressive, life-threatening conditions. Although they are rare and difficult diagnoses, HDs can be diagnosed with the help of clinical and laboratory analyses, imaging features and tissue biopsy. The clinicopathology and imaging spectrum of select entities belonging to this disorder are presented in this review.

Impact of Image Orientation on Measurements of Thyroid Nodule Stiffness Using Shear Wave Elastography.

OBJECTIVES: To assess the effect of orientation on the stiffness measurement by shear wave elastography (SWE) within a thyroid nodule. METHODS: Forty-five patients with 50 thyroid nodules were enrolled in this study. After a short sonographic examination, SWE images were acquired in transverse and longitudinal orientations. Multiple elastograms of each nodule were obtained in both orientations. Mean and maximum stiffness values were recorded from each region of interest. The overall mean and maximum stiffness values of each nodule were calculated for both orientations separately. The concordance correlation coefficient was used to assess overall agreement between measurements. A receiver operating characteristic curve analysis was conducted to assess diagnostic performance for benign versus malignant nodules. RESULTS: The 45 patients included 6 men and 39 women (mean age, 53 years; range, 23-84 years). The mean stiffness values ± SD were 19.1 ± 18.4 and 20.9 ± 21.5 kPa for transverse and longitudinal measurements, respectively, with a small overall bias between the orientations (1.8 kPa; P = .09). Overall agreement was good (concordance correlation coefficient, 0.93) although moderated somewhat after the stiffness values were log transformed to reduce skewness (concordance correlation coefficient, 0.76). Of the 50 nodules, 6 were classified as malignant. The area under the curve based on the mean stiffness value from longitudinal images tended to be better than for transverse images, but the difference was not statistically significant (0.93 versus 0.83; P = .17). CONCLUSIONS: Our study has shown that good diagnostic performance can be achieved by using SWE in longitudinal and transverse orientations. Moderate to good agreement in mean and maximum stiffness values for both orientations was observed, with only a small bias. Diagnostic performance for benign and malignant nodules was similar. The similar performance of both orientations gives flexibility in imaging patients with anatomic or physical limitations.

Multimodality approach for imaging of non-traumatic acute abdominal emergencies.

"Acute abdomen" includes spectrum of medical and surgical conditions ranging from a less severe to life-threatening conditions in a patient presenting with severe abdominal pain that develops over a period of hours. Accurate and rapid diagnosis of these conditions helps in reducing related complications. Clinical assessment is often difficult due to availability of over-the-counter analgesics, leading to less specific physical findings. The key clinical decision is to determine whether surgical intervention is required. Laboratory and conventional radiographic findings are often non-specific. Thus, cross-sectional imaging plays a pivotal role for helping direct management of acute abdomen. Computed tomography is the primary imaging modality used for these cases due to fast image acquisition, although US is more specific for conditions such as acute cholecystitis. Magnetic resonance imaging or ultrasound is very helpful in patients who are particularly sensitive to radiation exposure, such as pregnant women and pediatric patients. In addition, MRI is an excellent problem-solving modality in certain conditions such as assessment for choledocholithiasis in patients with right upper quadrant pain. In this review, we discuss a multimodality approach for the usual causes of non-traumatic acute abdomen including acute appendicitis, diverticulitis, cholecystitis, and small bowel obstruction. A brief review of other relatively less frequent but important causes of acute abdomen, such as perforated viscus and bowel ischemia, is also included.

MRI of female urethra and periurethral pathologies.

INTRODUCTION AND HYPOTHESIS: Accurate diagnosis of a wide spectrum of urethral/periurethral pathologies in women remains challenging due to its anatomical location and nonspecific clinical presentations. Magnetic resonance imaging (MRI) has emerged as the modality of choice for diagnosing female urethral and periurethral pathologies due to its multiplanar scanning capability, superior soft tissue differentiation, noninvasive nature, and overall excellent contrast resolution. METHODS: In this narrative review, we describe the use of MRI to visualize the female urethra and periurethral pathologies. RESULTS: MRI can confidently characterize lesions into cystic or solid, provide a more succinct differential diagnosis, and in some cases provide a specific and accurate diagnosis, enabling surgeons to prepare a roadmap before operative procedure. Moreover, functional MRI can be useful to assess dynamic disorders such as urethral hypermobility. CONCLUSIONS: We provide a comprehensive review of normal MR anatomy of the female urethra, as well as the MR features of practically important urethral and periurethral lesions.

American College of Radiology Appropriateness Criteria for Infertility.

The new American College of Radiology Appropriateness Criteria for Infertility provide updated imaging guidelines for evaluating infertility in females. It provides a meticulous overview of common causes of infertility including ovulatory, uterine, tubal, peritoneal, and pituitary factors. The article provides great detail regarding the imaging modalities for evaluation of infertility in females. The article title mentioned is American College of Radiology Appropriateness Criteria for Infertility, whereas the article discusses female factors of infertility, and the male factors such as obstructive azoospermia, which could be evaluated by imaging, are not been addressed.

Radiopathological evaluation of primary malignant skull tumors: a review.

Skull tumors comprise a wide variety of entities, ranging from chronic inflammatory disease to primary and secondary neoplasms. There is no valid incidence or data about the incidence of skull tumors in general. Primary malignant skull tumors are rare, with most articles reporting single cases. We would discuss some of the frequent tumors in this group and review of the literature for the same.

A Complete Constellation of Nervous System Lesions of NF2: Imaging Evaluation.

The radiological findings fulfilling the criteria of neurofibromatosis type 2 (NF2) were reviewed. NF2 is a rare disease with few cutaneous but frequent, typical radiological findings in the central nervous system. The presenting symptom is most commonly hearing loss due to acoustic schwannomas, although symptoms emanating from other intracranial or tumors are not uncommon. The discovery of multiple spinal neurofibromas or multiple meningiomas without cutaneous lesions should initiate a search for acoustic schwannomas even when the patient has normal hearing as in our case patient who actually presented for weakness of all four limbs.