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Primary Hepatic Angiosarcoma Presenting with Sepsis Mimicking Pyogenic Liver Abscess: A Case Report

Primary hepatic angiosarcoma (PHA) is an extremely rare neoplasm of liver with aggressive behavior and poor prognosis. PHA has variable and nonspecific clinical presentations and imaging features, which makes a great challenge in prompt and accurate diagnosis. We presented an uncommon case of a 57-year-old female with type 2 diabetes mellitus who presented with sepsis and a huge hepatic lesion mimicking pyogenic liver abscess on computer tomograph. The final diagnosis is PHA based on dynamic magnetic resonance imaging and histological diagnosis.

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Postoperative MRI is Necessary for Accurate Evaluation of Disc Reposition in Patients with Temporomandibular Joint Anterolateral Disc Displacement without Reduction Treated with Minimally Invasive Arthroscopic Discopexy

Abnormal temporomandibular joint (TMJ) disc displacement is commonly seen in patients with temporomandibular disorder. Anterior disc displacement is the most common type, followed by rotational disc displacement, which means the disc is simultaneously displaced anterolaterally or anteromedially in a complex fashion. Because of the inherent soft tissue contrast, magnetic resonance imaging (MRI) allows an excellent depiction of the TMJ anatomy and disc abnormalities. We report 2 cases of TMJ anterolateral disc displacement treated with arthroscopic discopexy, with emphasis on the diagnostic value of postoperative MRI. Changes in clinical symptom/sign may be not reliable predictors for the effectiveness of arthroscopic discopexy among patients with multidirectional disc displacement. MRI is necessary for accurate evaluation of disc reposition after surgery in these patients.

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Diagnostic Accuracy of Digital Breast Tomosynthesis-guided Core Needle Biopsy for Suspicious Breast Microcalcifications: A Single Hospital's Analysis

PURPOSE. This study aimed to assess the accuracy of digital breast tomosynthesis (DBT)-guided core needle biopsy (CNB) in the diagnosis of suspicious breast microcalcifications. MATERIALS AND METHODS. From October 2015 to April 2016, 238 women (age, 38-70 years; mean age, 52 years) with 256 lesions with Breast Imaging Reporting and Data System category 4 or 5 microcalcifications who underwent DBT-guided CNB using a 14-gauge needle were enrolled. Successful lesion sampling was determined by the presence of microcalcifications on specimen radiography. The outcomes of CNB were determined with surgical histology or mammogram follow-up. The mean follow-up time was 1066 days (range, 369-1553 days). RESULTS. Among 256 lesions, specimen radiography showed inadequate microcalcifications in 11 cases (4.3%). The CNB results revealed that 54 (21.1%), 2 (0.8%), and 200 (78.1%) lesions were carcinoma, atypical ductal hyperplasia, and benign, respectively. Of the 54 lesions diagnosed as carcinoma, 46 were surgically confirmed as malignancies, including 35, 4, and 7 lesions that were ductal carcinoma in situ (DCIS), DCIS with microinvasion, and invasive ductal carcinoma, respectively. One lesion diagnosed as mucocele-like lesion turned to mucinous carcinoma in surgery. Excluding patients without surgery management or with less follow-up period (＜ 1 year), 187 lesions were included for accuracy analysis. The false-negative rate was 2.1% and the accuracy rate was 98.4%. CONCLUSION. DBT-guided CNB is an accurate approach for preoperative histological diagnosis of suspicious breast lesions with microcalcifications.

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Malignant PEComa with Inferior Vena Cava Involvement: A Case Report

Perivascular epithelioid cell neoplasms (PEComas) are mesenchymal tumors that express both melanocytic and muscle markers. The clinical and imaging findings differ according to tumor location and size with the mass effect being the main presentation. Pelvic malignant PEComas with inferior vena cava (IVC) invasion may mimic intravenous leiomyomatosis, and pathology is still warranted to make a definite diagnosis. To further understand this malignancy, we present a case of malignant PEComa with IVC involvement.

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A Case Report of Adnexal Torsion in Pregnancy: The Diagnostic Value of Magnetic Resonance Imaging in Detecting Hemorrhagic Infarct

Adnexal torsion in pregnant women is uncommon but should be suspected in symptomatic patients with an adnexal mass. Magnetic resonance imaging (MRI) can assist in the evaluation of obstetric and non-obstetric causes of abdominal pain in pregnancy when ultrasound findings are equivocal. We report the case of a 34-year-old woman who was diagnosed with adnexal torsion using MRI in the second trimester. Twisting of the ovarian pedicle is a pathognomonic imaging finding. MRI findings, including ovarian hemorrhage, high signal intensity on diffusion-weighted imaging, and low apparent diffusion coefficient value in the swollen ovarian stroma may help detect hemorrhagic infarct, which is crucial for preemptive surgical intervention.

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Unicentric Castleman Disease Mimicking a Pancreatic Tumor: A Case Report

Castleman disease is a group of uncommon lymphoproliferative disorders. It is characterized by lymph node enlargement and may mimic various benign and malignant tumors in the neck, chest, abdomen, and pelvis. The most frequent appearance of abdominal or pelvic Castleman disease is a single, well-defined hypervascular enhancing mass with prominent feeding vessels on the surface. While smaller tumors (＜ 5 cm) display homogeneous enhancement, larger tumors (＞ 5 cm) show heterogeneous enhancement due to central necrosis and degeneration. We report a case of Castleman disease mimicking a pancreatic tumor that received surgical resection to make the final diagnosis.

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Appendiceal Mixed Adenoneuroendocrine Carcinomas with Bilateral Ovarian Tumors: A Case Report

Mixed adenoneuroendocrine carcinoma (MANEC) is a rare pathological diagnosis which is composed of both epithelial and neuroendocrine components. This report presents a case of a signet-ring cell subtype of appendiceal MANEC with bilateral ovarian metastasis.

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Thoracic Changes on Non-Enhanced CT of Infants and Children with Langerhans Cell Histiocytosis

PURPOSE. Langerhans cell histiocytosis (LCH), previously having various names, is caused by Langerhans cell proliferation. There are limited reports on imaging when the disease involves the thorax in the pediatric group. We attempt to describe such findings and incidence in this study. MATERIALS AND METHODS. The study reports the findings and its incidence of non-enhanced thoracic computed tomography (CT) changes in infants and children diagnosed with LCH. We retrospectively reviewed non-enhanced CT images of LCH patients that were less than 18 years old encountered at our hospital between January 2012 and December 2016. The cohort included 26 patients (12 males and 14 females) with a mean age of 6 years and 7 months (range, 4 months to 17 years and 2 months). RESULTS. Pulmonary cysts were found in 6 patients (23%) that all were female (mean age, 1 year and 6 months; range, 4 months to 2 years and 5 months). All the cysts were sub-centimeter, usually less than 5 mm (mean ± standard deviation, 2.60 ± 1.16 mm), were mostly found in one or two pulmonary lobes (5 out of 6, 83%), most commonly in right lower lobe (66%). Thymic calcifications were found in 3 patients (11.5%; mean age, 11 months; range, 4-19 months), and 2 of these patients concurrently displayed pulmonary cysts. Only 1 patient had concomitant osteolytic changes involving multiple vertebral bodies in thoracolumbar spine. CONCLUSION. Findings of LCH in pediatric patients with thoracic involvement on a non-enhanced CT study include pulmonary cysts, thymic calcifications, and osteolytic changes that are different in distribution and incidence in comparison with those found in adults. Non-enhanced chest CT may be used for evaluating pediatric LCH patients.