Characterization of Clinical and CT Manifestations of Pulmonary Cryptococcosis with Consolidation.

Considering the insufficient understanding of pulmonary cryptococcosis (PC) with consolidation, 22 patients were evaluated based on the chest computed tomography (CT) images and clinical manifestation. The clinical symptoms were mild, mainly manifesting as cough and sputum. Pulmonary lesions mostly involved a single lobe in a single lung with multiple lesions. Specifically, single lung involvement was observed in 17 cases, single lobe in 16 cases and multiple lesions in 14 case. Fifteen cases were mainly distributed in the periphery and 17 cases in the long axis in parallel to the pleura. Nineteen cases had air bronchograms. Eight cases displayed cavitation inside the lesions and 18 cases had surrounding halo signs. Seventeen cases had pleural thickening, of which 10 cases had "pasting wall" signs. The clinical symptoms of PC with consolidation were relatively mild. Comprehensive clinical and imaging performance could improve the diagnosis of the disease.

The Usefulness of Imaging Quantification in Discriminating Non-Calcified Pulmonary Hamartoma From Adenocarcinoma.

BACKGROUND: Patients with non-calcified hamartoma were more susceptible to surgery or needle biopsy for the tough discrimination from lung adenocarcinoma. Radiomics have the ability to quantify the lesion features and potentially improve disease diagnosis. Thus, this study aimed to discriminate non-calcified hamartoma from adenocarcinoma by employing imaging quantification and machine learning. METHODS: Forty-two patients with non-calcified hamartoma and 49 patients with adenocarcinoma were retrospentation; Manual lesion segmentation, feature quantification (e.g., texture features), and artificial neural network were performed consecutively. Independent t-test was used to conduct the inter-group comparisons of those imaging features. Receiver operating characteristic curve was performed to investigate the discriminating efficacy. RESULTS: Significantly higher contrast, cluster prominence, cluster shade, dissimilarity, energy, and entropy in non-calcified hamartoma were observed compared with lung adenocarcinoma. Texture-grey-level co-occurrence matrix showed a well discrimination between non-calcified hamartoma and adenocarcinoma as the detection sensitivity, specificity, accuracy, and the area under the curve were 87.22% ± 9.07%, 82.64% ± 8.07%, 85.11% ± 5.40%, and 0.942, respectively. CONCLUSION: Quantifying imaging features is a potentially useful tool for clinical diagnosis. This study demonstrated that non-calcified hamartoma has a heterogeneous distribution of attenuations probably resulting from its complex organizations. Based on this property, imaging quantification could improve discrimination of non-calcified hamartoma from adenocarcinoma.

Intracranial Rosai-Dorfman disease with the petroclival and parasellar involvement mimicking multiple meningiomas: A case report and review of literature.

RATIONALE: Rosai-Dorfman disease (RDD) is a rare non-Langerhans cell histiocytosis. Petroclival RDD is extremely rare. To the best of our knowledge, only 7 cases of petroclival RDD have been reported so far. Herein, we present the 8th case of intracranial RDD with the petroclival and parasellar involvement mimicking multiple meningiomas. PATIENT CONCERNS: A 57-year-old woman presented with a 1-year history of vision diminution and 1-month hearing loss in her right ear. DIAGNOSES: Contrast-enhanced Magnetic resonance imaging (MRI) of the brain demonstrated multiple well-defined, homogenous mass which closely related to the dura mater in the bilateral parasellar and petroclival regions range from the basement of anterior to posterior cranial fossa. The lesions were T1 isointense, T2 hypointense, and homogeneously enhanced. Initial diagnosis of multiple meningiomas was made according to MRI findings. Final diagnosis of RDD was confirmed by histopathological and immunohistochemical examinations after subtotal surgical resection. INTERVENTIONS: The patient received subtotal resection because multiple lesions were extensive. OUTCOMES: The vision diminution recovered well after the surgery but the hearing loss in her right ear was still persisted. LESSONS: Although rare, a standard RDD typically are dural-based, extra-axial, well-circumscribed masses mimicking meningioma, and presenting with characterized hypo to isointense on T1-weighted images, hypo to isointense on T2-weighted images, and obvious enhancement. Resection of the intracranial lesion is the most effective treatment. In case of subtotal resection, the application of adjunctive radiotherapy and/or steroid agents should be advised. Final diagnosis of RDD should be confirmed by histopathological and immunohistochemical examinations.

Giant cell tumor of the tendon sheath: Magnetic resonance imaging findings in 38 patients.

The present study aimed to investigate the value of magnetic resonance imaging (MRI) in the diagnosis of giant cell tumor of the tendon sheath (GCTTS), including localized (L-) and diffuse (D-) types. A total of 38 patients with GCTTS, including 31 with L-GCTTS and 7 with D-GCTTS, diagnosed by surgery and pathology, were retrospectively analyzed. All patients underwent MRI examination. Of the 31 patients with L-GCTTS, the tumors were located in the hand and wrist (18 patients), the ankle and foot (10 cases), the knee joint (2 cases) and the temporomandibular joint (1 case). All 31 lesions were either located in relation to a tendon or were partially/completely enveloping it and all were well marginated. With respect to the 7 D-GCTTS patients, the tumors were located in the ankle and foot (6 cases) or the hand and wrist (1 cases). All 7 lesions presented as an aggressive soft tissue mass infiltrating the tendon sheath and adipose tissue around the joint. The characteristic internal signal of GCTTS, including L-GCTTS and D-GCTTS, was demonstrated by MRI examination. MRI is currently the optimal modality for preoperative assessment of tumor size, extent and invasion of adjacent joint and tenosynovial space.

[Diagnostic value of dual energy CT for lymph node metastasis in patients with non-small cell lung cancer].

OBJECTIVE: To assess the diagnostic value of dual energy CT for lymph node metastasis in patients with non-small cell lung cancer (NSCLC). METHODS: Forty NSCLC patients, including 15 cases of squamous cell carcinoma and 25 cases of adenocarcinoma, underwent dual energy CT examination in pre-contrast and venous phase contrast scans, then the CT attenuation value of the lung cancer lesions and 85 mediastinal enlarged lymph nodes (the short diameter ≥ 5 mm, 53 metastatic and 32 non-metastatic) were measured at different energy levels (40-190 keV, spacing 10 keV) in venous phase contrast. CT spectral curves of the lung cancer lesions, hilus pulmonis and mediastinal enlarged lymph nodes were produced automatically, through comparing their CT spectral curves slope to judge whether or not the lymph nodes were metastatic. Receiver operating characteristic (ROC) curve was used to evaluate the efficiency of CT spectral curve in diagnosis of lymph node metastasis. RESULTS: The CT spectral curves slopes of the lung cancer, metastatic lymph nodes and non-metastatic lymph nodes were 1.10±0.11, 1.08±0.07 and 1.54±0.17, respectively. There was no significant difference in curve slope between metastatic lymph nodes and lung cancer (t=-1.32,P>0.05); while there was significant difference between non-metastatic lymph nodes and lung cancer (t=-2.58,P<0.05). The CT spectral curve slope ratios of metastatic and non-metastatic lymph nodes to lung cancer were 0.98±0.05 and 1.40±0.12, respectively (t=-2.86,P<0.05). ROC curve showed that taking CT spectral curve slope ratio of 1.15 as cut-off value for the diagnosis of metastatic lymph nodes, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 81.1%, 87.5%, 91.5%, 73.7% and 83.5%, respectively. CONCLUSIONS: Dual energy CT is of value in improving the diagnostic accuracy of lymph node metastasis in NSCLC patients before treatment.

Inflammatory pseudotumor of the pineal region: First reported case.

Inflammatory pseudotumors originating in the central nervous system (CNS) are quite rare. To the best of our knowledge, the present study reports the first case of a inflammatory pseudotumor that developed in the pineal region, and describes the neuroimaging, morphological and immunohistochemical findings. A 53-year-old male presented with hearing loss that had been apparent for 1 year and blurred vision that had persisted for 10 months. Magnetic resonance imaging (MRI) demonstrated a homogeneously-enhanced mass in the pineal region and obstructive hydrocephalus. A pathological examination revealed that the lesion was comprised predominantly of spindled cells in a collagenous background, with dense infiltrates of small lymphocytes, plasma cells and uninucleated histiocytes. Immunopositivity for cluster of differentiation (CD)138 was noted. Immunohistochemical staining showed that the cells were immunonegative for glial fibrillary acidic protein, S-100, placental alkaline phosphatase, neurofilament and Pit-Oct-Unc class 5 homeobox 1. The Ki-67 labeling index was <5%. The lymphocytic infiltrates consisted of CD3- and CD43-positive T-cells, and CD20- and CD79A-positive B-cells. Plasma cells displayed polytypic reactivity for immunoglobulin κ and λ light chains. Based on the MRI and the morphological and immunohistochemical analysis, a diagnosis of an inflammatory pseudotumor was formed. The patient underwent a surgical resection of the tumor and currently has a good prognosis.

CT findings of pleomorphic hyalinizing angiectatic tumor (PHAT) of soft parts of the neck.

Pleomorphic hyalinizing angiectatic tumor (PHAT) is a rare and recently recognized mesenchymal tumor with intermediate malignant potential, most of which arises in the soft tissue of the extremities with obvious specificity on histopathology. Here, we report a case of CT findings of PHAT arising from the posterior neck as a 3.4 × 4 × 5-cm mass in a 35-year-old woman. Precontrast CT showed an ill-defined, inhomogenous and oval-shaped mass. On contrast-enhanced CT, the mass appeared well defined except for a very small part, most of which showed marked and heterogenous enhancement, with a maximum CT value of 161 HU, which was almost identical to that of the vessels.