RESUMEN
A 45-year-old man presented with right flank pain and haematuria for one month. Computed tomography showed a large, well-circumscribed exophytic complex cystic mass with enhanced, irregular thickened walls arising from the upper pole of the right kidney, which was associated with bilateral renal stones. Partial right nephrectomy with removal of the right renal stones was performed. Histopathology revealed papillary cell carcinoma confined to the kidney. The patient made good postoperative recovery. The Bosniak classification system of renal cystic lesions and cystic renal cell carcinoma are discussed. Various cases of renal cystic lesions and cystic renal cell carcinoma are shown.
Asunto(s)
Carcinoma de Células Renales/diagnóstico , Presión Sanguínea , Carcinoma de Células Renales/diagnóstico por imagen , Carcinoma de Células Renales/patología , Medios de Contraste/farmacología , Quistes/patología , Humanos , Riñón/diagnóstico por imagen , Riñón/patología , Enfermedades Renales Quísticas/patología , Neoplasias Renales/diagnóstico , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Nefrectomía/métodos , Tomografía Computarizada por Rayos X/métodosRESUMEN
We report a case of a 45-year-old woman who had a palpable mass in the left lower quadrant of the abdomen. Computed tomography (CT) showed a circumscribed mass in the left round ligament of the uterus. The mass had heterogeneous density and enhancement accompanied by mottled calcification, which was initially identified as a leiomyoma. A histopathological examination revealed a malignant perivascular epithelioid cell tumour (PEComa), which is a rare soft tissue tumour. This case demonstrates that the appearance of malignant PEComa on the CT can mimic leiomyoma, which is the most common tumour of the round ligament. To the best of our knowledge, this is the first report of a CT appearance of this round ligament tumour. The radiological features and differential diagnosis are discussed.
Asunto(s)
Células Epitelioides/citología , Leiomioma/diagnóstico por imagen , Leiomioma/diagnóstico , Neoplasias de Células Epitelioides Perivasculares/diagnóstico , Ligamento Redondo del Útero/patología , Neoplasias de los Tejidos Blandos/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Diagnóstico Diferencial , Femenino , Humanos , Laparoscopía/métodos , Persona de Mediana Edad , Neoplasias de Células Epitelioides Perivasculares/diagnóstico por imagen , Ligamento Redondo del Útero/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Resultado del TratamientoRESUMEN
INTRODUCTION: The diagnosis of tuberculous peritonitis is still challenging and very important. Early and accurate diagnosis leads to an effective therapy and good survival rates. With the widespread use of computed tomography (CT) in the abdomen, it is important to be familiar with the spectrum of CT appearances seen in tuberculous peritonitis. Our retrospective study aims to describe the common CT features of this disease. METHODS: Abdominal CT images in 17 patients with tuberculous peritonitis in our institution from January 2002 to December 2005 were retrospectively reviewed. CT findings were evaluated for the presence of ascites, the abnormal patterns of mesentery, omentum and peritoneum. RESULTS: Ascites and mesentery involvement were present in all patients. The most common pattern of mesenteric changes was thickened soft tissue strands with crowded vascular bundles (65 percent). The involvement of the omentum was present in 15 patients (88 percent), and the most common type was smudged pattern (82 percent). Peritoneal involvement was present in 15 patients (88 percent). Smooth uniform thickening pattern was the most common type (76 percent). CONCLUSION: Common features in the patients with tuberculous peritonitis include the combination of free ascites, thickened strands with crowded vascular bundles within the mesentery, smudged pattern of the omental involvement and smooth uniform thickening of the peritoneum.
Asunto(s)
Peritonitis Tuberculosa/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: Biliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCAC) are rare biliary ductal neoplasms of the liver. This study aims to describe the computed tomography (CT) findings of these neoplasms and to distinguish between both entities. METHODS: We retrospectively reviewed the CT findings of five patients with proven BCA and seven patients with proven BCAC at our institution from July 2000 to August 2006. The CT parameters were analysed, including number, size, location, and characteristics of the cystic lesion: presence and number of internal septation, calcifications and enhanced mural nodule. RESULTS: All 12 patients had a solitary, large well-defined intrahepatic cystic lesion. Lesions in all five patients with proven BCA (100 percent) and six patients with proven BCAC (86 percent) had a multilocular appearance. The remaining patient with proven BCAC had a unilocular lesion. Smooth, thin septa and walls were found in five patients with BCA (100 percent). The enhanced mural nodule at the septum or wall was identified in seven patients with BCAC (100 percent) but was not found in the BCA patients (p-value is less than 0.001). The other parameters including size, location and number of septa had no statistically significant differences between BCA and BCAC. CONCLUSION: BCA and BCAC should be considered in the differential diagnosis, when a solitary large well-defined multilocular intrahepatic cystic lesion is detected in a middle-aged woman. The presence of an enhanced mural nodule is the most important finding to suggest BCAC.
Asunto(s)
Neoplasias del Sistema Biliar/diagnóstico por imagen , Cistadenocarcinoma/diagnóstico por imagen , Cistoadenoma/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Many benign breast lesions pose diagnostic challenges. These lesions include abscess, haematoma, radial scar, post surgical scar, diabetic mastopathy, focal fibrosis, sclerosing adenosis, granular cell tumour, extra-abdominal desmoid tumour, medial insertion of pectoralis muscle and sternalis muscle, and axillary lymphadenopathy (due to HIV infection, collagen vascular lesions, tuberculous and bacterial lymphadenitis). Radiologists should be familiar with the characteristic imaging features of these benign lesions, and should include these benign lesions in the differential diagnosis whenever malignant-appearing findings are encountered. Correlation of the patient's clinical features with the mammographical findings and additional use of ultrasonography, fine-needle aspiration biopsy or core biopsy are helpful in establishing the final diagnosis and obviating unnecessary surgical intervention. In some of these lesions, surgery may be avoided while in others, the appropriate surgical procedure may be planned. This pictorial essay aims to illustrate the mammographical features of these lesions in a group of proven cases.
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Enfermedades de la Mama , Mamografía , Ultrasonografía Mamaria , Adulto , Biopsia con Aguja , Enfermedades de la Mama/diagnóstico por imagen , Enfermedades de la Mama/patología , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Carcinoma/diagnóstico por imagen , Carcinoma/patología , Diagnóstico Diferencial , Femenino , Histocitoquímica , Humanos , Persona de Mediana EdadRESUMEN
INTRODUCTION: Mammography has proven to be an effective modality for the detection of early breast carcinoma. However, 4-34 percent of breast cancers may be missed at mammography. Delayed diagnosis of breast carcinoma results in an unfavourable prognosis. The objective of this study was to determine the causes and characteristics of breast carcinomas missed by mammography at our institution, with the aim of reducing the rate of missed carcinoma. METHODS: We reviewed the reports of 13,191 mammograms performed over a five-year period. Breast Imaging Reporting and Data Systems (BI-RADS) were used for the mammographical assessment, and reports were cross-referenced with the histological diagnosis of breast carcinoma. Causes of missed carcinomas were classified. RESULTS: Of 344 patients who had breast carcinoma and had mammograms done prior to surgery, 18 (5.2 percent) failed to be diagnosed by mammography. Of these, five were caused by dense breast parenchyma obscuring the lesions, 11 were due to perception and interpretation errors, and one each from unusual lesion characteristics and poor positioning. CONCLUSION: Several factors, including dense breast parenchyma obscuring a lesion, perception error, interpretation error, unusual lesion characteristics, and poor technique or positioning, are possible causes of missed breast cancers.
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Neoplasias de la Mama/diagnóstico por imagen , Errores Diagnósticos , Mamografía/normas , Auditoría Médica , Servicio de Radiología en Hospital/normas , Anciano , Neoplasias de la Mama/patología , Femenino , Hospitales Universitarios , Humanos , Mamografía/métodos , Persona de Mediana Edad , Servicio de Patología en Hospital , Estudios Retrospectivos , Singapur , Factores de TiempoRESUMEN
INTRODUCTION: This article assesses the diagnostic sensitivity of mammography in the preoperative detection of breast cancer in young women. MATERIALS AND METHODS: We retrospectively reviewed 1010 women with breast carcinoma between January 1996 and September 2002. The patients were identified from pathological reports. Of these, 237 women were below 40 years of age, accounting for 23.5% of all breast cancers. Only 76 of 237 patients had mammograms performed prior to surgery. Seventy-five of the 76 patients also had ultrasonography performed. Histological types were reviewed and the proportions of each type were compared with those found in a consecutive series of 773 breast carcinomas in women above 40 years of age seen during the same period in our hospital. The breast patterns, as seen on mammograms, were classified as follows: fatty, scattered fibroglandular, heterogeneously dense and homogeneously dense. Specific features of a mass, microcalcifications, architectural distortion and asymmetrical density were evaluated. RESULTS: Of the 76 patients who had mammograms performed prior to surgery, 81 cancers were found. The patients' age ranged from 25 to 40 years, with a mean of 36.4 years. The breast parenchymal patterns were homogeneously dense in 6.6%, heterogeneously dense in 67.1% and had scattered fibroglandular density in 26.3%. Abnormal mammographical findings were present in 93.8%. The most common mammographical findings were mass in 60% and microcalcifications, with or without associated breast abnormality, in 28.7%. The most frequent tumour (82.7%) was invasive ductal carcinoma, which is not significantly different to those found in older women (P = 0.895). Ultrasonography showed solid masses in 73 patients and was negative in the other 2 patients. CONCLUSION: Mammography is a useful imaging technique in providing preoperative detection and diagnosis of breast carcinoma in women below 40 years of age with clinical suspicion of malignancy. Mass and microcalcifications are the most common abnormal mammographical findings and invasive ductal carcinoma is the most common tumour found in our study.
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Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Mamografía/métodos , Tamizaje Masivo/métodos , Invasividad Neoplásica/patología , Adulto , Factores de Edad , Neoplasias de la Mama/mortalidad , Estudios de Cohortes , Femenino , Humanos , Incidencia , Cuidados Preoperatorios , Estudios Retrospectivos , Medición de Riesgo , Sensibilidad y Especificidad , Análisis de Supervivencia , Estados Unidos/epidemiologíaRESUMEN
The clinical and mammographic findings of 10 patients with pathologically proven tuberculous axillary lymphadenitis were reviewed. The cases were identified from 10 173 mammograms performed over 6 years at Maharaj Nakorn Chiang Mai University Hospital. The 10 patients were aged 31-65 years. All cases were initially diagnosed to have breast carcinoma with axillary nodal metastases. Eight patients presented with axillary swelling, while two presented with breast enlargement. None of these cases had a palpable breast mass. Associated supraclavicular, cervical or groin nodes were found in seven cases, and two patients had evidence of pulmonary tuberculosis. All lesions were unilateral, affecting the right side in eight cases and left side in two cases. On mammogram, the axillary nodes were enlarged and homogeneously dense. The nodes were sized 2.5-5 cm. Nodal margins were variable. Some nodes were matted. Macrocalcifications were noted in three cases. Ipsilateral breast oedema without mass or microcalcifications was present in two cases. Patients with tuberculous axillary lymphadenitis have large homogeneously dense nodes with either well- or ill-defined margins. It is impossible to differentiate tuberculous from malignant nodes. The presence of macrocalcifications might suggest tuberculous axillary lynphadenitis. Biopsy of enlarged axillary nodes is necessary to determine its aetiology.
Asunto(s)
Mamografía , Tuberculosis Ganglionar/diagnóstico por imagen , Adulto , Anciano , Axila , Femenino , Humanos , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
OBJECTIVE: To assess the value of mammography in the detection of cancer in the contralateral breast in women with ipsilateral breast carcinoma. MATERIALS AND METHODS: From February 1994 through May 2001, a total of 500 patients with unilateral mastectomy from breast carcinoma had mammograms performed for the first time following mastectomy. We retrospectively reviewed the clinical findings and mammograms of these patients. Four hundred and sixty-four patients were asymptomatic and 36 patients presented with palpable breast or axillary masses. Specific mammographic features of a mass, microcalcifications, architectural distortion and asymmetric density were evaluated. Diagnosis was confirmed by fine needle aspiration biopsy or surgical excision in all patients. RESULTS: Four hundred and sixty-four patients had screening mammograms and 36 patients had diagnostic mammograms. All 36 symptomatic patients had abnormal mammograms. Of these, 12 (33.33%) patients were found to have second primary breast carcinoma, 12 (33.33%) had metastases to the contralateral breast or axillary lymph nodes, six (16.66%) had fibroadenomas, two (5.55%) had abscesses, three (8.33%) had fibrocystic change, and one (2.77%) had axillary node reactive hyperplasia. Of the 464 asymptomatic patients, five (1.07%) had second primary breast carcinoma, five (1.07%) had fibrocystic change, and two (0.43%) had fibroadenomas. The mean age at the time of diagnosis of the first primary carcinoma in the symptomatic patients was 41.9 years (range 35-60 years), and was 43.4 years (range 36-56 years) in the screening group. The mean time interval between the two carcinomas was four years (range one to 13 years) in symptomatic group and 3.4 years (range one to four years) in screening group. The tumour stage in the screened group was in situ (n = 2), stage I (n = 3) and in the symptomatic group was stage I (n = 2), stage II (n = 5), stage III (n = 5). CONCLUSION: Patients who have ipsilateral breast carcinoma have a strong risk to develop a second primary carcinoma in the contralateral breast. Close follow-up of the second breast with careful clinical examination and mammography are necessary for the early detection of cancer.
Asunto(s)
Adenocarcinoma/diagnóstico , Neoplasias de la Mama/diagnóstico , Mamografía/métodos , Neoplasias Primarias Secundarias/diagnóstico , Adenocarcinoma/patología , Adenocarcinoma/secundario , Adenocarcinoma/cirugía , Adulto , Neoplasias de la Mama/patología , Neoplasias de la Mama/secundario , Neoplasias de la Mama/cirugía , Femenino , Humanos , Tamizaje Masivo , Mastectomía , Persona de Mediana Edad , Metástasis de la Neoplasia , Estadificación de Neoplasias , Neoplasias Primarias Secundarias/patología , Examen Físico , Estudios RetrospectivosRESUMEN
A 53-year-old woman who presented with drug-induced jaundice and urinary tract infection was incidentally found to have a large abdominal mass. Radiographs and ultrasonography showed a large fatty mass located between the right lobe of the liver and the right kidney. Diagnosis of right adrenal myelolipoma was made on computed tomography. The patient was treated conservatively. The causes of large fatty masses of the abdomen in adults are discussed, with emphasis on the imaging appearances of myelolipoma, renal angiomyolipoma, cystic teratoma and liposarcoma.