Wegener granulomatosis of the eustachian tube and skull base mimicking a malignant tumor.

Wegener granulomatosis is a well-studied yet sometimes difficult-to-diagnose systemic vasculitis. Early treatment with immunosuppressants is the therapy of choice and usually controls the disease. Two cases of Wegener granulomatosis are presented, both with symptoms and imaging findings suggestive of a malignant tumor of the nasopharynx or skull base. The focus of upper respiratory involvement in each case was the eustachian tube.

Leiomyosarcoma of the larynx presenting as a laryngopyocele.

An 87-year-old man had an 8-month history of hoarseness, respiratory distress, and dysphagia. Physical examination, including direct laryngoscopy, revealed a mass on the right anterolateral side of the neck and a submucosal mass of the supraglottic larynx. A contrast-enhanced CT scan showed a more superior cystic mass, a laryngopyocele resulting from a more inferior, solid-appearing and obstructing mass at the level of the true vocal cord. The obstructing mass was also entirely submucosal at direct laryngoscopy; however, a biopsy specimen revealed a malignant tumor. Subsequent total laryngectomy and pathologic review showed it to be a leiomyosarcoma.

Rhabdomyoma of the pharyngeal musculature extending into the prestyloid parapharyngeal space.

A 66-year-old woman reported fullness in the right ear for 6 months before admission. A submucosal mass shown by MR imaging and CT to arise in the prestyloid parapharyngeal space was the cause of her symptoms. Histologically, the mass proved to be a rhabdomyoma, a rare benign neoplasm, that arose from the muscular wall of the pharynx.

Pancreatic neoplasms: MR imaging and pathologic correlation.

Magnetic resonance (MR) imaging can aid in the detection and characterization of many pancreatic neoplasms. The MR imaging appearances of common pancreatic neoplasms such as ductal adenocarcinoma are well-known. However, MR imaging features of more unusual pancreatic neoplasms are not well understood. Such tumors include mucin-hyper-secreting carcinoma, serous microcystic neoplasm, mucinous macrocystic neoplasm, solid and papillary epithelial neoplasm, multiple cysts associated with von Hippel-Lindau disease, acinar cell carcinoma, pancreaticoblastoma, and endocrine neoplasms (eg, nonfunctioning islet cell tumors, insulinoma, and gastrinoma). In general, pancreatic neoplasms demonstrate high signal intensity on T2-weighted images; the signal intensity on T1-weighted images is more variable but is often intermediate or low. Gadolinium enhancement is often helpful in further characterizing pancreatic neoplasms. The gross and histologic features of pancreatic neoplasms are also not well-known. Correlation with the underlying pathologic features enhances understanding of the MR imaging characteristics of both common and unusual pancreatic neoplasms.