Pancreatic neuroendocrine tumor detected by technetium-99m methoxy-2-isobutylisonitrile single photon emission computed tomography/computed tomography:A case report

BACKGROUND Pancreatic neuroendocrine tumors(NETs)account for about 1%–2%of pancreatic tumors and about 8%of all NETs.Computed tomography(CT),magnetic resonance imaging,and endoscopic ultrasound are common imaging modalities for the diagnosis of pancreatic NETs.Furthermore,somatostatin receptor imaging is of great value for diagnosing pancreatic NETs.Herein,we report the efficacy of technetium-99m methoxy-2-isobutylisonitrile(99mTc-MIBI)single photon emission CT(SPECT)/CT for detecting pancreatic NETs.CASE SUMMARY A 57-year-old woman presented to our hospital with a 1-d history of persistent upper abdominal distending pain.The distending pain in the upper abdomen was aggravated after eating,with nausea and retching.Routine blood test results showed a high neutrophil percentage,low leukomonocyte and monocyte percentages,and low leukomonocyte and eosinophil counts.Amylase,liver and kidney function,and tumor markers alpha-fetoprotein,carcinoembryonic antigen,and cancer antigen(CA)125,CA72-4,CA19-9,and CA153 were normal.Abdominal CT showed a mass,with multiple calcifications between the pancreas and the spleen.The boundary between the mass and the pancreas and spleen was poorly defined.Contrast-enhanced CT revealed that the upper abdominal mass was unevenly and gradually enhanced.99mTc-MIBI SPECT/CT revealed that a focal radioactive concentration,with mild radioactive concentration extending into the upper abdominal mass,was present at the pancreatic body and tail.The 99mTc-MIBI SPECT/CT manifestations were consistent with the final pathological diagnosis of pancreatic NET.CONCLUSION 99mTc-MIBI SPECT/CT appears to be a valuable tool for detecting pancreatic NETs.

A correlation of computed tomography perfusion and histopathology in tumor edges of hepatocellular carcinoma

BACKGROUND： The peripheral morphologic characteristics of hepatocellular carcinoma （HCC） reflect tumor growth patterns. Computed tomography （CT） perfusion is a new method to analyze hemodynamic changes in tissues. We assessed the relationship between CT perfusion and histopathologic findings in the periphery of HCC lesions. METHODS： Non-contrast CT, enhanced dual-phase CT, and CT perfusion were performed on 77 subjects （47 patients and 30 controls）. Based on the imaging findings of enhanced dual- phase CT, the tumor edges were classified into three types： type Ⅰ （sharp）; type Ⅱ （blurry）; and type Ⅲ （mixed）. The CT perfusion parameters included hepatic blood flow, hepatic arterial fraction, hepatic arterial perfusion, and hepatic portal perfusion. The tissue sections from resected specimens were subjected to routine hematoxylin and eosin staining and immunohistochemical staining for CD34. The correlations between microvessel density （MVD） and the CT perfusion parameters were analyzed using Pearson＇s product-moment correlation coefficient. Changes in the perfusion parameters in tumor edges of different tumor types were evaluated. RESULTS： Type Ⅰ （sharp）： the pathologic findings showed fibrous connective tissue capsules in the tumor edges, and an MVD 〈30/ram2. Type Ⅱ （blurry）： the histology showed that the edges were clear with no capsules and an MVD 〉30/ram2. Type Ⅲ （mixed）： the pathology was similar to that of types I and II, and an MVD 〉30/mm~. Hepatic blood flow, hepatic arterial fraction, hepatic arterial perfusion, and hepatic portal perfusion were significantly increased in the tumor edges of HCC patients compared to those of the controls （P〈0.05）. The correlation between CT perfusion parameters and MVD was higher in blurry tumor edges of type II than in those of types Ⅰ or Ⅲ. CONCLUSION： CT perfusion imaging of tumor edges may be helpful in revealing histopathological features, and indirectly reflect angiogenic changes of HCCs.

Malignant giant cell tumors of the tendon sheath of the right hip:A case report

BACKGROUND Malignant giant cell tumor of the tendon sheath(MGCTTS)is an extremely rare malignant tumor originating from synovial and tendon sheath tissue with highly aggressive biological behavior and a high rate of local recurrence and distant metastasis which should be considered a highly malignant sarcoma and managed aggressively.How to systemically treat MGCTTS remains a challenge.In this case,a patient with MGCTTS suffered a recurrence after 2 surgical resections received adjuvant chemotherapy and radiation therapy,but the treatment outcome remained poor.More clinical trials and better understanding of the biology and molecular aspects of this subtype of sarcoma are needed while novel medicines should be developed to efficiently target particular pathways.CASE SUMMARY A 52-year-old man presented with persistent dull pain in the right groin accompanied by limited right hip motion starting 6 mo ago.Two months before his attending to hospital,the patient’s pain worsened,presenting as severe pain when standing or walking,limping,and inability to straighten or move the right lower extremity.Surgical excision was performed and MGCTTS was confirmed by pathology examination.Two recurrences occurred after surgical resection,moreover,the treatment outcome remained poor after adjuvant chemotherapy and radiation therapy.The patient died only 10 mo after the initial diagnosis.CONCLUSION MGCTTS is characterized by a joint mass with pain and limited motion.It typically grows along the tendons and infiltrated into the surrounding muscle and bone tissue,with a stubborn tendency to relapse,as well as pulmonary metastasis.Radically surgical resection provides a choice of treatment whereas post-operation care should be taken to preserve the function of the joint.Chemotherapy and radiotherapy can be used as alternative treatments when radical resection cannot be performed.

Imaging of the Extra-axial Tumors and Tumor-like Lesions Involving both Middle and Posterior Cranial Fossae: Classification and Diagnosis

Objective: To study the imaging features of extra-axial tumors and tumor-likelesions involving both middle and posterior cranial fossae and to make a classification. Methods:Sixty cases of pathologically confirmed extra-axil tumors and tumor-like lesions involving bothmiddle and posterior cranial fossae were analyzed. They were divided into central and lateral types,the latter of which were subdivided into three types: middle cranial fossae type, posterior cranialfossae type and the over-riding type. The constitution and imaging features of each type wereanalyzed. Results: There were 12 cases of central type, including chordoma (n=5), pituitary adenoma(n=3), nasopharyngeal carcinoma (n=2), craniopharyn-gioma (n=1) and meningioma (n=l). 48 cases oflateral type including trigeminal nerve tumors (n=14), meningioma (n=12), epidermoid cyst (n=11),dural cavernous hemangioma (n=4), dermoid cyst (n=2), metastasis (n=2), hemangiopericytoma (n=1),paraganglioma of glonius jugular (n=1) and nasopharyngeal carcinoma (n=1). Each type of the lesionshad its own shape features, some of which were characteristic for some specific tumors. Most of thetumors and tumor-like lesions could be qualitatively diagnosed according to their imagingcharacteristics and the extent of the lesions could be defined definitely. Conclusion: It is helpfulto categorize extra-axial tumors and tumor-like lesions involving both middle and posterior cranialfossae according to their location for qualitative diagnosis and description of the extent of theselesions. It is of great clinical value in providing more precise and thorough imaging informationfor planning therapeutic methods and route of operation.

Primary Malignant Renal Tumors in Infancy and Childhood: CT Appearances

Objective： To investigate the imaging manifestation of primary malignant renal tumor with CT. Methods： Forty-three cases of surgically and pathologically confirmed primary malignant renal tumor were retrospectively reviewed. Un-contrast and contrast CT was performed in all 43 patients in which 15 patients received MRI examination. Results： The residual normal renal tissue of 29 cases out of 34 cases of Wilms＇ tumor was enhanced and manifested ＂crescent sign＂ or ＂ring sign＂. Four cases of malignant rabdoid tumor （RTK） manifested as large mass with notable necrosis and subcapsular fluid collection; Two cases of clear cell sarcoma （CCS） showed metastases to the skull which could indicate the diagnosis; Renal cell carcinoma （RCC） （n=3） showed calcification in 1 case. Conclusion： CT can precisely delineate the location, size, extent of involvement, imaging characteristics and metastases of renal tumor, which can provide information necessary to the clinical staging, therapy planning and prognosis of the tumors.

Postoperative multiple metastasis of clear cell sarcoma-like tumor of the gastrointestinal tract in adolescent:A case report

BACKGROUND Clear cell sarcoma-like tumor of the gastrointestinal tract(CCSLGT)is a rare malignant gastrointestinal mesenchymal soft tissue tumor.Its genetic feature is EWSR1 gene rearrangement.Histologically,it is often accompanied by a varying number of CD68-positive osteoclast-like giant cells.CCSLGT mostly occurs in the small intestinal wall of young people and children.In terms of clinical manifestations,there is no significant difference between it and other gastrointestinal tumors,and the diagnosis depends on immunohistochemistry and gene detection.CASE SUMMARY A 16-year-old man developed dizziness and fatigue 2 mo ago,and 10 d ago showed progressive exacerbation of paroxysmal epigastric pain and stopped flatulence and defecation.Computed tomography showed a soft tissue mass in the distal ileum.After complete resection of the lesion,it was diagnosed by combined immunohistochemical and genetic examination as CCSLGT.After surgery,the patient gradually developed lymph node,liver,lung,bone,left thigh,pleura and adrenal metastasis.The survival time was 4 years and 8 mo.CONCLUSION Whole abdominal computed tomography enhancement is recommended for patients with gastrointestinal symptoms.There is no effective treatment for CCSLGT with multiple metastases via the lymphatic system and bloodstream after surgical resection.

Comparing Gross Tumor Volume of Delineation between CT and MRI for Nasopharyngeal Carcinoma

Objective: To study the accuracy between CT and MRI in delineating gross tumor volume (GTV) of nasopharyngeal carcinoma (NPC) in making radiotherapy plan. Methods: The clinical data of 39 cases pathologically proven as nasopharyngeal carcinoma selected from April 2003 to September 2004 were retrospectively analyzed. All were subjected to CT and MR examination one week before treatment. CT scanning was performed with GE Light speed 16, and axial scan was parallel to the OM line routinely from soft palate to the suprasellar cistern. MR scanning was performed by GE Signa super-conducting magnetic resonance imaging system (1.5 Tesla). The standard quadrature head coil was used. Routine axial, sagittal and coronal image with SE sequence were obtained, and FLAIR was used in 10 of 21 cases. Scanned field ranged from the soft palate to the suprasellar cistern. Part of all cases underwent enhanced scanned with Ultravist in CT group or/and GD-DTPA in MR group. All data were analyzed by using the paired-samples t test. Results: The media primary tumor volume (cm3) in CT group and MR group was 32.49±19.91, 29.06±18.75, respectively, and the difference between the two groups were significant (t=5.268, P=0.000). There was significant difference between the two groups in early stage (T1+T2) and advanced stage (T3+T4) by Fuzhou Staging System (t=5.677, P=0.000; t=3.310, P=0.005, respectively). There was significant difference in stage T1, T2, T3 (P=0.005, P=0.001, P=0.004, respectively), and not in stage T4 (P=0.146) between the two groups. Conclusion: MR was more accurate than CT in delineating GTV of NPC, so, is more valuable in making radiotherapy plan.

Value of Multi-slice spiral CT in diagnosis of malignant gastrointestinal stromal tumors

Objective： The aim of this study was to investigate the value of multi-slice spiral CT （MSCT） in the diagnosis of malignant gastrointestinal stromal tumors （GISTs）. Methods： Twenty-seven cases of MSCT images of malignant GIST proved by surgery and pathology were retrospectively analyzed. Both plain and enhanced CT scan was performed and multiplanar reconstruction was made in all cases. Results： The lesions originated from the stomach （n = 11）, small intestine （n = 9）, colon （n = 4）, rectum （n = 1）, and mesentery （n = 2）. The transverse diameters of mass were 4.2-22 cm, the edges clearly （n = 12）, unclearly （n = 15）. The mass were mainly irregular in shape Iobulated （n = 19）. The lesions were mainly heterogeneity on plain scan, moderate to marked enhancement in arterial phase and durative enhanced in venous phase. Cystic necrosis were observed in all the lesions, 9 cases were cystic and solid mixed mass. Hepatic metastases （n = 4）, pulmonary metastasis （n = 1）, lymphatic metastasis （n = 2） were detected. The accuracy rate of MSCT diagnosis for location and pathologic features of GISTs were 85.2% （23/27） and 77.8% （21/27）. Conclusion： Two-phase MSCT examination and axial images combined with multiplanar reconstruction images have important value for diagnosis of malignant GIST.

Malignant giant cell tumor in the left upper arm soft tissue of an adolescent:A case report

BACKGROUND Giant cell tumor of soft tissue(GCT-ST)is an extremely rare low-grade soft tissue tumor that is originates in superficial tissue and rarely spreads deeper.GCT-ST has unpredictable behavior.It is mainly benign,but may sometimes become aggressive and potentially increase in size within a short period of time.CASE SUMMARY A 17-year-old man was suspected of having a fracture,based on radiography following left shoulder trauma.One month later,the swelling of the left shoulder continued to increase and the pain was obvious.Computed tomography(CT)revealed a soft tissue mass with strip-like calcifications in the left shoulder.The mass invaded the adjacent humerus and showed an insect-like area of destruction at the edge of the cortical bone of the upper humerus.The marrow cavity of the upper humerus was enlarged,and a soft tissue density was seen in the medullary cavity.Thoracic CT revealed multiple small nodules beneath the pleura of both lungs.A bone scan demonstrated increased activity in the left shoulder joint and proximal humerus.The mass showed mixed moderate hypointensity and hyperintensity on T1-weighted images,and mixed hyperintensity on T2-weighted fat-saturated images.The final diagnosis of GCT-ST was confirmed by pathology.CONCLUSION GCT-STs should be considered in the differential diagnosis of soft tissue tumors and monitored for large increases in size.

Intrathoracic solitary fibrous tumor: a report of 3 cases and review of the literature

Objective: The aim of this study was to investigate the imaging findings of intrathoracic solitary fibrous tumor (SFT), so as to improve its diagnosis and differential diagnosis. Methods: The clinical, imaging and pathological data of three intrathoracic SFTs confirmed by surgical pathology were analyzed retrospectively. There three cases all received spiral CT plain scan and enhanced scan, among which two multi-planar reformation (MPR) and one MR plain scan. And literatures were reviewed to investigate the imaging findings of intrathoracic SFT. Results: The three intrathoracic SFT located at intra-pulmonary, oblique fissure pleura and posterior chest wall visceral pleura, respectively. All were solitary masses. One case was a peripheral lung mass at dorsal segment of left lower lobe which CT plain scan showed as a soft tissue mass well circumscribed, enhanced scan showed that there were enhanced clustered, lineal small vascular signs in the mass during arterial phase, delayed scanning displayed that the mass showed heterogeneous enhancement and parts of solid content showed gradual enhancement, and there were shorter T1 signals on MRI T1WI, map-like high-low mixed signals on T2WI, mainly with short T2 signals. One case was an oblique fissure mass which plain scan showed as a homogeneous soft tissue mass with oval in shape and smooth edge, and enhanced scan showed moderate homogeneous enhancement. One case was a mass localized at posterior chest wall visceral pleura which CT plain scan showed as a heterogeneous mass, and enhanced scan showed that there was slight ring-like enhancement, large non-enhancing necrosis area in the mass and facing vessels in the vicinity region. All these three cases had no hilar and mediastinal lymphadenectasis. Operation and pathology results showed that the mass was well circumscribed, with capsule or false capsule. Under microscope, tumor cells were long fusiform, presenting bundle, turbulence or irregular arrangement. Hypocellular and hypercellular area appeared alternately, with interspersed coarse scar-like collagen fibers with hyalinization. There were hemangiopericytoma-like structures under parts of visual fields. There were bronchiole and alveolar epithelium in the legion at dorsal segment of left lower lobe in one case. The results of immunohistochemistry showed that the expressions of CD34 or CD99, Bcl-2 and vimentin were all strong positive. Conclusion: Intrathoracic SFT might be rare, which imaging findings could have relative characteristic features and diagnosis must depend on histopathology and immunohistochemistry examination.

MSCT and MRCP features of intraductal papillary mucinous tumor of the pancreas

Objective:To study the multi-slice CT(MSCT) and magnetic resonance cholangio-pancreatography(MRCP) features of intraductal papillary mucinous tumor(IPMT) of the pancreas.Methods:The clinical information,laboratory val-ues,imaging features and pathological findings of 8 cases were reviewed.Results:There were 6 males and 2 females with average 71.3 years old in this series.These lesions involved pancreatic branch ducts or main duct.Among them,2 cases were involved in the pancreatic uncinate process,1 case in the pancreatic head,1 in the pancreatic body,2 in the pancreatic tail and 2 cases involved multiple pancreatic duct.The common complaint was chronic upper abdominal pain.The imaging features included cystic lesion and it's association with the dilated pancreatic main duct,and bulging of the duodenal papilla.Mucin plug,septa or mural nodule were found in these cystic lesions.5 cases were confirmed with endoscopic retrograde cholangio-pancreatography(ERCP).3 cases had undergone surgery.Pathological findings of the 3 cases were adenoma,adenocarcinoma and borderline tumor,respectively.Conclusion:The MSCT and MRCP features of IPMT are somewhat characteristic,and the correct diagnosis can be made with the combination of clinical features.Diameter of branch duct ≥ 3 cm with multiple or large mural nodules,or severe dilated main duct indicates the probability of malignant IPMT.

异位ACTH综合征:岩下窦采血结合综合影像学的诊断价值

目的：分析异位促肾上腺皮质激素（ACTH）综合征（EAS）的影像学表现,比较胸腹部多层螺旋CT（MSCT）、正电子发射断层扫描术（PET）在病灶检出中的差异,评估双侧岩下窦静脉采血（BIPSS）结合综合影像学对异位ACTH综合征的诊断价值。方法：20例根据临床症状、生化指标高度疑诊为EAS的病例,同时进行胸腹部MSCT及18F-FDG PET/CT检查,对照病理结果分析其影像学表现特点,统计不同检查方法对病灶的检出率及诊断准确性。结果：20例经综合影像学方法结合临床症状、生化指标明确为异位ACTH综合征,其中14例经手术病理证实,1例为2个病灶,13例为单发病灶。15个病灶位于纵隔9个（60%）,肺部4个（26.67%）,胰腺2个（13.33%）;6个为圆形,2个为卵圆形,2个分叶状,5个形态不规则,直径0.6~7.0 cm,平均2.45 cm,均无钙化及出血;8个肿块境界清楚（8/15）,11个肿块密度均匀（11/15）,增强后9例呈轻度强化,4例呈中度强化,2例呈明显强化。病理结果显示14例为神经内分泌肿瘤,1例为胸腺瘤A型。MSCT对EAS肿块定位诊断的阳性率为80%（16/20）,18F-FDG PET/CT的阳性率为68.75%（11/16）。结论：在异位ACTH综合征诊断中多种影像学的序贯检查非常重要,垂体MRI及BIPSS结合生化指标是异位ACTH综合征的定性诊断方法,胸腹部MSCT是肿瘤定位的首选方法,PET/CT是重要的补充手段,多种影像学方法结合可提高对异位内分泌肿瘤的检出率,有助于手术治疗方案的制定。

垂体腺瘤CT诊断

目的是分析垂体腺瘤ＣＴ表现，探讨其与肿瘤分类的关系。材料与方法为本组２１例垂体腺瘤中肢湍肥大８例，闭经伴泌乳８例，多饮多尿１例，无特异性明显临床表现４例，经冠状位ＣＴ扫描增强并局部放大。结果得到本组ＣＴ所见实性肿瘤７例，囊实混杂１３例，囊性１例。手术病理结果为嫌色性细胞腺瘤１３例，嗜酸性细胞腺瘤７例，垂体腺瘤恶变１例。结论明确ＣＴ是诊断垂体腺瘤的重要方法之一，根据ＣＴ改变，再结合临床表现对肿瘤分类有一定价值。

Primary gastric melanoma: A case report with imaging findings and 5-year follow-up

BACKGROUND Most melanomas identified in the stomach are metastatic;primary gastric melanoma(PGM)is extremely rare,and the relevant studies are relatively scarce.PGM may be incorrectly diagnosed as other gastric malignant tumor types.CASE SUMMARY We describe a rare case of PGM confirmed through long-term clinical observation and pathological diagnosis.A 67-year-old woman presented to our hospital with recurrent chest tightness and chest pain.Digital gastrointestinal radiography revealed a circular shadow in the gastric cardia.Computed tomography(CT)revealed a heterogeneous tumor with uneven enhancement.Enlarged lymph nodes were noted in the lesser curvature of the stomach.On magnetic resonance imaging(MRI),T1-and T2-weighted imaging revealed hyperintensity in and hypointensity in the tumor,respectively,both of which increased substantially after uneven enhancement.Near total gastrectomy was performed,and the tumor was pathologically confirmed to be a gastric melanoma.Because no other possible primary site of malignant melanoma was suspected,a clinical diagnosis of PGM was made.The patient was followed for nearly 5 years,during which she received CT reexamination,but no recurrence or metastasis was observed.CONCLUSION Certain imaging characteristics could be revealed in PGM.Imaging examination can be of great value in preoperative diagnosis,differential diagnosis,and followup of patients with PGM.

鞍区碰撞瘤一例:鞍区垂体腺瘤与颅咽管瘤共存

本文为回顾性研究,符合我国医学伦理的规范要求,符合2013年版赫尔辛基宣言。患者女,50岁,2020年2月12日因头痛于昆明医科大学第一附属医院就诊。患者专科检查显示一般情况可,神志清;双眼视力正常,无视野缺损,调节反射及生理反射存在,病理反射未引出。双侧指鼻实验(-),甲功全套及垂体激素全套未见明显异常。血电解质检验显示低钾、低氯血症。

Evaluation of CT findings for the differentiation of benign from malignant primary retroperitoneal tumors

Background Benign and malignant primary retroperitoneal tumors （RT） have different pathological manifestations,and overlapping imaging characteristics.This study aimed to evaluate the value of computed tomography （CT） for differentiating benign from malignant RT.Methods One hundred and ninety-four patients with clinical and radiographic data were evaluated retrospectively following surgical resection of primary RT.There were 38.1％ （n=74） benign lesions and 61.9％ （n=120） malignant lesions.Categorical variables were tested with a chi-square test or Fisher＇s exact test for the diagnostic indexes and sensitivity and specificity of CT characteristics.Results In univariate analysis,the differences in ill-defined margins,irregular surfaces,long diameter ＞6.75 cm,short diameter ＞6.25 cm,and solid or mixed texture had statistical significance; the sensitivity and specificity were 44.2％ and 91.9％,70.0％ and 62.2％,68.8％ and 60.7％,59.7％ and 74.2％,87.5％ and 35.1％,respectively.In multivariate analysis,a combination of all the above indexes was the best model for differentiating malignant tumors,resulting in the most accurate diagnosis of malignancies with a sensitivity of 77.2％ and a specificity of 81.1％ （P＜0.0001） when the score was 4.The differences in other findings including CT attenuation,number,and calcification had no statistical significance.The unique characteristics included the spotted enhancement （mottled high density）in schwannoma （P＜0.0001）,adipose tissue in liposarcoma （P＜0.0001）and paravertebral location in neurogenic tumors （P＜0.0001）.Conclusions More accurate differential diagnosis of primary RT can be made through comprehensive analysis of the combined diagnostic indexes of CT.Some specific characteristics of CT can assist in preoperative planning.