Imaging characteristics of subcutaneous amyloid deposits in diabetic patients: the "insulin ball".

OBJECTIVE: The purpose of this study was to describe the imaging characteristics of subcutaneous amyloid deposits occurring at sites of insulin injection, commonly known as "insulin balls," in diabetic patients on ultrasound, CT, and MRI with pathologic correlation. MATERIALS AND METHODS: We retrospectively reviewed the radiographic findings of 14 lesions in 9 patients diagnosed with subcutaneous amyloid deposits at our institution between 2005-2015. Three board-certified radiologists analyzed the following: (1) the shape, size, margin, morphologic characteristics, and blood flow on US using the color Doppler signal, (2) shape, size, margin, attenuation, and presence or absence of contrast enhancement on CT, and (3) shape, size, margin, signal intensity, and presence or absence of contrast enhancement on MRI. RESULTS: All lesions showed ill-defined hypovascular subcutaneous nodules with irregular margins. The median diameter of lesions was 50.4 mm on US, 46.8 mm on CT, and 51.4 mm on MRI. The internal echogenicity of subcutaneous amyloid deposits was hypoechoic and heterogeneous on US. All lesions showed isodensity compared to muscle with irregular margins and minimal contrast enhancement on CT. Both T1- and T2-weighted MR images showed low signal intensity compared with subcutaneous fat. Normal diffusion and minimal contrast enhancement were seen. CONCLUSIONS: Subcutaneous amyloid deposits which cause insulin resistance are typically ill-defined and heterogeneous hypovascular subcutaneous nodules with irregular margins on imaging that correspond to insulin injection sites. It is also characteristic that T2WI shows low intensity compared with fat on MRI, reflective of the amyloid content.

[Bilateral pulmonary metastases from hepatocellular carcinoma successfully treated by surgical resection and stereotactic radiotherapy; report of a case].

We report a case of 68-year-old-man with pulmonary metastases from hepatocellular carcinoma (HCC). Following right hepatic lobectomy in January 2005, 4 pulmonary metastases in the right lung were detected by chest computed tomography (CT) in September 2007. As chemotherapy was not effective, surgical resection (right upper lobectomy, partial resection of middle and lower lobe ) was performed. Secondary metastases in the left lung was detected in March 2008, and stereotactic radiotherapy was performed considering the site of tumor location and poor pulmonary function. Two years after radiotherapy, the patient is alive without recurrence.

[Granular cell tumor in the mediastinum; report of a case].

Granular cell tumor is found in various organs but is rare in the mediastinum. We report a case of 21-year-old woman with a granular cell tumor in the left upper mediastinum. Chest computed tomography (CT) showed a 30 x 20 mm well circumscribed tumor in the left upper mediastinum. Tumor resection was performed. It was found that the tumor involved the sympathetic nerve. Histopathologically, the tumor consisted of cells with eosinophilic granules and diagnosed as a granular cell tumor.

Palliative re-irradiation for in-field recurrence after definitive radiotherapy in patients with primary lung cancer.

AIM: To evaluate the efficacy and toxicity of palliative re-irradiation for in-field recurrence of primary lung cancer after radiotherapy. PATIENTS AND METHODS: Forty-four patients with locally recurrent lung cancer after radiotherapy were retreated with external beam radiation therapy. To evaluate palliative effectiveness, 31 symptoms in 25 patients were analyzed, while all patients were analyzed to evaluate pulmonary toxicity. RESULTS: The median time between prior and secondary irradiation was 12.6 months. Prior radiation doses ranged from 50 to 70 Gy and retreatment ranged from 30 to 60 Gy. The median survival after re-irradiation was 6.5 months. After treatment 74% (23 out of 31) of the symptoms had improvement or complete resolution. After re-irradiation, acute Grade 2 and 3 pulmonary toxicity were recognized in 3 patients each. No significant factors were observed regarding pulmonary toxicity. CONCLUSION: Re-irradiation with moderate doses for recurrent lung cancer after definitive radiotherapy is promising in palliating the symptoms and shows acceptable toxicity.