CT imaging of primary pleuropulmonary synovial sarcoma.

AIM: To evaluate the computed tomography (CT) imaging findings of primary pleuropulmonary synovial sarcoma. MATERIALS AND METHODS: Five cases of synovial sarcoma confirmed by histopathology and cytogenetic study were retrospectively analysed. All patients had undergone chest radiography and unenhanced and contrast-enhanced CT examinations, and three had also undergone multiphase CT enhancement examinations. Image characteristics, including shape, size, margin, and attenuation of each lesion before and after contrast enhancement, were analysed. RESULTS: The chest radiographs of the five patients showed well-defined or partly well-defined masses, which were homogeneous and without associated calcification or lymphadenopathy. Pneumothorax was present in one patient. The unenhanced CT images showed well-defined, heterogeneous masses with patchy low density in all five patients. The contrast-enhanced CT images showed heterogeneous enhancement in all cases, three of which demonstrated cystic and necrotic areas. The tumour showed no prolonged or delayed enhancement in three cases using multiphase CT. There were small pleural effusions in four cases. No calcification was observed in any of the cases. There was no evidence of hilar or mediastinal lymphadenopathy. CONCLUSIONS: In these five patients, primary pleuropulmonary synovial sarcoma presented as a well-defined mass with patchy low density and heterogeneous enhancement, with no evidence of regional lymphadenopathy. It should be included in the differential diagnosis of regional tumours.

Imaging findings of Castleman disease of the abdomen and pelvis.

BACKGROUND: The purpose of this study was to analyze the characteristic features of Castleman disease in the abdomen and pelvis as suggested by imaging findings in order to deepen the recognition and understanding of this rare disease. METHODS: A group of ten patients with pathologically proven Castleman disease in the abdomen (n = 9) and pelvis (n = 1) were included in this study. Patients were 18 approximately 56-year-old (mean = 40); seven of them were men and three were women. Imaging findings (CT&MRI, n = 4; only CT, n = 4; only MRI, n = 2) were retrospectively reviewed and correlated with clinical and pathologic findings. RESULTS: The lesions were divided into those with localized Castleman (n = 9) and disseminated Castleman (n = 1). The pathologic subtype of all nine cases of localized disease was hyaline vascular with six patients showing a solitary mass and three having a single dominant mass surrounded by small satellite nodules. On nonenhanced CT images, the lesions were manifested as homogeneous masses of soft tissue attenuation, which was isoattenuated relative to normal muscle. On MRI, the lesions were isointense or slightly hypointense compared with that of normal muscle on T1-weighted images and hyperintense on T2-weighted images. After intravenous injection of contrast media, most of the masses (7/9) showed marked enhancement and slow washout with the degree of enhancement approaching that of the large arteries. And in the interior of four cases of larger masses (>5 cm) was observed fissured and radial patterns in both low-density area on CT and low-signal area on MRI. These patterns were pathologically proved to be fibrous. The pathological subtype of a sole disseminated case was plasma-cell type, where imaging findings showed a lining of well defined, sharply enhanced soft-tissue nodules in retroperitoneal zone. CONCLUSION: Imaging findings of Castleman disease in the abdomen and pelvis are closely related to pathological type diagnosed. The characteristic features of localized and hyaline vascular type of Castleman disease include a solitary mass or a dominant mass surrounded with small satellite nodules, and high enhancement and slow washout with the degree of enhancement approaches that of large arteries. The presence of central areas of fibrosis of the larger tumors is one of the characteristic features of this disease.

Primary spinal melanoma of extramedullary origin: a report of three cases and systematic review of the literature.

STUDY DESIGN: A review of the literature and three case reports. OBJECTIVES: Primary spinal melanoma (PSM) of extramedullary origin is a rare malignant condition with limited current literature in regards to its clinical course, magnetic resonance imaging (MRI) findings, treatment strategies and prognosis. We reported here three cases of PSM of extramedullary origin. SETTING: China, Guangzhou. METHODS: We report three cases of PSM of extramedullary origin. The clinical and radiological findings of these cases were retrospectively analyzed. RESULTS: The three cases were all of males aged 39, 47 and 76 years, respectively. The duration of their symptoms was 3 weeks, 2 months and 11 months respectively. The extramedullary tumors were all well-defined solitary tumors and were located at C4-5, L2-3 and T9-10, respectively. In one case, involvement of the intervertebral foramen was found. Preoperative MRI showed hyperintense T1W signals and hypointense T2W signals in all three cases and all tumors were clinically misdiagnosed as schwannomas. The patients received total or subtotal resection surgery without radiotherapy or chemotherapy. Patients were alive at 18 months, 27 months and 36 months postoperative follow-up, respectively. CONCLUSION: PSM of extramedullary origin is a rare malignant tumor that shows characteristic findings on MRI. Surgical resection is the preferred treatment strategy.

CT and MRI findings of thoracic ganglioneuroma.

OBJECTIVE: Thoracic ganglioneuroma is sporadic and rarely reported. Pre-operative misdiagnosis often occurs in clinical practice. To improve diagnostic accuracy and facilitate differential diagnosis, we summarised the CT and MRI findings of thoracic ganglioneuroma. METHODS: 22 cases of thoracic ganglioneuroma confirmed by surgery and pathology were retrospectively analysed in terms of CT (16 cases) and MRI data (6 cases). RESULTS: Of 22 lesions, 19 occurred in the posterior mediastinum, 2 in the lateral pleura and 1 in the right chest. The CT value of the plain scans ranged from 20 to 40 HU (mean 29.1 HU) in 16 cases. Punctate calcification was noted in four cases. Patchy fat density shadow was found in one case. Arterial-phase CT found nearly no enhancement (6 cases) or slight enhancement (10 cases) with a CT value of 0-12 HU (mean 5.8 HU). In the delayed phase, enhancement was strengthened progressively, and CT value of 10-20 HU (mean 13.6 HU) was achieved after 120 s. T(1) weighted images showed homogeneous hypointense signals in five cases and hypointense signals mixed with patchy hyperintense signal shadow in one case. T(2) weighted images demonstrated heterogeneous hyperintense signals in all six cases, of which the whorled appearance was noted in one case. Gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA)-enhanced MRI found mildly heterogeneous enhancement in the arterial phase, and progressive mild enhancement in the delayed phase. CONCLUSION: Thoracic ganglioneuroma shows hypodensity in plain CT. On CT and MRI, non-enhancement or slight enhancement in artery phase and progressive mild enhancement in delay phase are characteristic manifestations of ganglioneuroma in the thorax.