Malignant Peripheral Nerve Sheath Tumor of the Thigh Invading the Superficial Femoral Artery, with Necrotic Lung Metastases as Presenting Symptoms

A NF1 (neurofibromatosis 1) patient developed multiple necrotic lung metastases from a sciatic malignant peripheral nerve sheath tumor (MPNST) invading the superficial femoral artery. The first diagnosis was metastases of a non-small-cell adenocarcinoma because the right calf MPNST was not clinically noticeable ant that the chest/abdomen PET/CT did not include the region of the legs. When the MPNST was diagnosed, new histological analysis on the metastases changed the diagnosis to that of epithelioid undifferentiated sarcoma. The article deals with the sometimes-delayed diagnosis in those NF1 patients with large palpable masses and chronic pain pre-existing the malignant transformation, and discusses the difficulty of the biopsy of necrotic metastases.

Unusual Cystic and Papillary Appearance of Brain Metastasis from Papillary Lung Adenocarcinoma on MRI. Radiologic-Pathologic Correlations in Two Similar Cases

We report two cases of brain metastasis from a lung adenocarcinoma. Magnetic Resonance Imaging (MRI) appearance was closely correlated with the macroscopic and microscopic findings that showed multiples nodules of a well-differentiated papillary adenocarcinoma with secreting tubules, surrounded by mucoid fluid.

Intralobar Pulmonary Sequestration with Rete Mirabile as Part of Its Systemic Artery

Intralobar sequestration (ILS) is a complex lung lesion where part of a lower lobe lacks communication with the tracheobronchial tree and receives an aberrant arterial blood supply from the systemic circulation. That systemic artery is usually large, originating from the thoracic aorta or the abdominal aorta and its upper branches. We describe a case of ILS where a large systemic artery coming up from below the diaphragm is formed by the convergence of many very small serpiginous arteries coming up from the area of the celiac trunk and common hepatic artery: a kind of “rete mirabile”. This peculiar morphology was not described before.

Adult Presentation of a Complete Second Branchial Cleft Fistula Diagnosed by US and CT, Autosomal Dominant Transmission in Three Members of the Family: Case Report

Branchial arch anomalies can arise from the four first branchial arches, but the most encountered cases are from the second one. Second branchial arch cysts and abscesses occur mainly in older children or young adults while fistulae are discovered in young children. We report a case of complete second branchial arch fistula of Bailey III type with adult complaints of painful swelling and local reddishness followed by spontaneous discharge and disappearance of complaints. Diagnosis was based on ultrasound and confirmed by CT scan, with the classic “beak sign” visible on both exams. Three cases were encountered in the family, with no otologic or kidney symptoms, which is quite different from the classical branchiootorenal syndrome which associates severe inner ear and kidney congenital anomalies.

Intradural Disc Herniation Can Be Intra-Arachnoid or Extra-Arachnoid: 2 Case Reports with MRI Diagnosis and Non-Surgical Management

Intradural disc herniation is rare and often diagnosed during surgery. We present two patients with the disease, one with an intra-arachnoid type, the other with an extra-arachnoid location. The teaching point of those cases is that this very frequent pathology can take a variety of forms, depending on the structures that are infiltrated. The key point in correctly diagnosing the intradural disc herniation is to look at the angle between the fragment and the dura. Is it pushing it (as in the usual disc herniation), embedded in it (those with the extra-arachnoid type) or does it go through to fall into the CSF (In the intra-arachnoid type)? It could be diagnosed on MRI preoperatively. Contrary to many published cases of intradural disc herniation, the two patients could be managed non-surgically.