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a6/61/PMC7803470/415_2020_10380_Fig3_HTML.jpg
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Brain imaging and histopathology from probable COVID-19 encephalitis and myelitis. A1-A6. A 52-year-old woman was admitted with convulsive seizures and reduced consciousness 19 days after symptom onset with dry cough, fever, a sore throat, headache and myalgias. Three weeks prior to presentation her entire family had experienced flu-like symptoms and a family member was tested positive for SARS-CoV-2. Previous medical history included hypertension, heterozygous Factor V Leiden mutation and chronic tension type headache. Medication before admission included amlodipine and gabapentin. On the morning of admission, the patient had generalized convulsive seizures. On examination, right-sided eye deviation and aphasia were noted. Twenty-four hours after admission, owing to a sudden decrease in consciousness and progressive hypoxemic respiratory failure, the patient was intubated and transferred to the ICU. Chest X-ray revealed a complete white-out of the left lung. Microscopic examination of the bronchoalveolar lavage fluid revealed no microorganisms, and the fluid was negative with broad infectious workup, including negative culture and negative tests for SARS-CoV-2, influenza virus type A and B, adenovirus, metapneumovirus, parainfluenza virus, atypical pneumonia, mycobacteria, pneumocystis, fungi and CMV, except for a positive aspergillus galactomannan antigen. Cytologic examination of the lung biopsy revealed type II pneumocyte hyperplasia and capillary inflammation with macrophages and neutrophils. No hyaline membranes, granulomas, necrosis, fibrosis or vasculitis were observed. There was no microscopic evidence of malignancy or fungi, including immunohistochemical (IHC) staining for fungi. In the alveoli, there were small precipitations of fibrin. The findings were concluded to be unspecific, resembling findings observed in viral infection. Assays for antinuclear antibodies, anti-double-stranded DNA and rheumatoid factor were negative. Lupus anticoagulant and anticardiolipin antibodies were negative. Electroencephalography revealed generalized slowing, with no epileptiform activity. MRI of the brain with axial T2W () and FLAIR () sequences demonstrated bilateral hyperintense lesions in the right basal ganglia and left thalamus. Axial SWI images () demonstrated hemorrhage, seen as hypointense signal intensity in the right basal ganglia lesion and ventricle system. Microbleeds were seen in the left thalamic lesion () and ring enhancement on the post contrast T1W images (). A lumbar puncture was performed. Gram’s staining of the cerebrospinal fluid (CSF) showed no cells or organisms. The white-cell count was 0 per microliter (reference range, < 5), the red-cell count was 0 per microliter (reference range, < 300), the glucose level was 4.4 mmol per liter (2.2–3.9 mmol per liter), and the protein level was 0.3 g per liter (reference value, 0.15–0.50). Cytologic examination of the CSF revealed no malignant cells, and there was no evidence of B- of T-cell lymphoproliferative disorder on flow cytometry. Polymerase-chain-reaction assays of the CSF for herpes simplex virus and VZV were negative, as were mycobacterial smear and culture of the CSF. Culture of the CSF showed no growth. Testing of the CSF for autoantibodies, Lyme disease, syphilis, human herpes virus and SARS-CoV-2 were negative. Whole-body positron-emission tomography and computed tomography (PET-CT), performed after the administration of intravenous 18F-fluorodeoxyglucose (FDG) tracer, revealed no extracranial malignant disease. The differential diagnosis consisted of cerebral abscess or malignant tumor, and the patient was transferred to the neuro-ICU for further evaluation and treatment. To obtain a neuropathological diagnosis, stereotactic biopsy of the cerebral lesions was performed (). Biopsy specimens from both right and left cerebral hemispheres showed thrombotic occlusion of small vessels by fibrin thrombi. The brain parenchyma showed reactive changes with astrogliosis and microgliosis, axonal swellings, proliferating capillaries and iron deposits (Perl’s stain) as sign of microbleeds. There were sparse diffuse lymphocytic infiltrates consisting of CD3 positive T- lymphocytes. CD20 staining showed no B-lymphocytic infiltrates. There were no granulomas. There was no sign of demyelinating disease when comparing neurofilament immunostaining with myelin stains (LUXPAS and immunostaining for myelin basic protein). Immune staining’s for toxoplasma, herpes 1, cytomegalovirus and JC virus were all negative. There were no fungi or bacteria in special staining’s with PAS, Gomori and Gram. [Biopsy from the left cerebral hemisphere () with thrombi and reactive changes (PAS staining). Fibrin thrombus in a small vessel (Masson trichrome staining) (). Higher magnification showing proliferating capillaries, hemosiderin in macrophages and gliosis (hematoxylin and eosin stain), (). Asterix: thrombus.] The team of neuropathologists concluded that the findings in the brain biopsy tissue were consistent with small necrotic lesions/infarctions, likely caused by fibrin thrombi in the vessels. The clinical suspicion of COVID-19 was confirmed by a positive serum test for SARS-CoV-2 showing high titers of neutralizing IgG-antibodies obtained on the 27th day of illness. A diagnosis of COVID-19-associated acute necrotizing encephalitis was made, based on clinical signs, MRI, brain pathology findings and high titers of SARS-CoV-2 IgG and exclusion of other causes following extensive diagnostic work-up. B1-B2. A 28-year-old woman with a previous medical history of hypothyroidism developed a dry cough and myalgia in the beginning of March and was tested SARS-CoV-2 positive 3 days later. COVID-19 symptoms lasted 6 days. Eight days after onset of COVID-19 symptoms, the patient developed lumbar back pain and progressive numbness in both legs with a mid-thoracic sensory level. The patient further developed paresthesia in the right hand, difficulties climbing stairs, and urinary retention with a sense of constant urge. Neurological examination revealed a mild symmetric tetraparesis, hypoesthesia in both legs with a Th5 dermatome sensory level, impaired proprioception in the legs, absent abdominal reflexes and a slightly broad-based gait. Cognitive evaluation and the rest of the exam were unremarkable. Spinal MRI demonstrated on sagittal T1 STIR () and sagittal T2 () hyperintense lesions from C1 to C7 and from Th1 to the conus medullaris, consistent with transverse myelitis. Lumbar puncture showed a lymphocytic pleocytosis of 125 cells/microl, protein levels of 0.59 g/L, with a negative microbiological CSF work-up including herpes simplex virus, varicella zoster virus, cytomegalovirus, enterovirus, and SARS-CoV-2. Blood was negative for HIV and syphilis. Screening for aquaporin-4 and myelin oligodendrocyte glycoprotein antibodies was negative. The patient was treated with high-dose prednisone and plasma exchange and made an uneventful recovery. Eight months later, the patient had a mild degree of Lhermitte’s but no other complaints. C1-C4. A 61-year-old woman with a previous medical history of type 2 diabetes, hypothyroidism and kidney transplant in 2019 due to adult onset polycystic kidney disease and immunosuppression with ciclosporine, developed muscle ache, dry cough, fever and dizziness resulting in a positive SARS-CoV-2 pharyngeal swab test and admission for 6 days. Eleven days after COVID-19 symptom onset, the patient developed headache, progressive confusion, apathy and speech difficulties and was re-admitted. Neurological examination revealed the patient was apractic, apathetic and amnestic. She answered questions with latency and with a mild, non-fluent aphasic speech. Brain MRI demonstrated bilateral hyperintense lesions in the basal ganglia on axial T2 (), FLAIR () and DWI (), with corresponding hypointense lesions on ADC (). Lumbar puncture showed a lymphocytic pleocytosis of 252 cells (E6/L), protein levels of 1.77 g/L. CSF microscopy was unremarkable, and cultures for bacteria and fungi were negative. CSF screening for E.coli., Hemophilus influenzae, listeria, neisseria, streptococcus, enterovirus, Cryptococcus neoformans, syphilis (both intrathecal and peripheral testing), Lyme’s disease, JC virus, 18S-RNA, flow cytometry, and LGI1, NMDA, GABA-B, and CASPR2 antibody screening for autoimmune encephalitis were all negative. HIV and hepatitis B testing, transesophageal
echocardiography, whole-body FDG-PET for occult malignancy were also unremarkable. There were a positive PCR and intrathecal antibody titer for EBV, HSV-1, VZV and human herpes virus, but the attending infectious disease and microbiology colleagues considered this to be consistent with a reactive phenomenon owing to chronic immunosuppression. The patient was initially treated with ceftriaxone and acyclovir, but treatment was stopped after a few days when no clear evidence of bacterial or herpes virus encephalitis was found. The patient made a gradual and spontaneous recovery, but cognitive impairment of memory and executive function remained after discharge
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b6/6f/PMC9323252/diagnostics-12-01622-g001.jpg
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Fibrous dysplasia (FD) is a benign fibro-osseous lesion with varying proportions of fibrous and osseous components. Depending on whether FD affects one or multiple bones, it is divided into monostotic and polyostotic types [1]. The craniofacial bones and femur are commonly involved in monostotic FD [2]. Malignant transformation of FD rarely occurs, and osteosarcoma (OS) is the most common histological subtype [3,4]. To date, there have been few reports demonstrating the molecular profiles of OS in FD [5]. Herein, we describe the clinicopathological, immunohistochemical, and molecular features of OS arising from FD of the proximal femur in a middle-aged woman. A detailed case presentation is presented in Figure 1 and Figure 2. As the degree of nuclear atypia and tumor cellularity in the outer portion suggested high-grade OS, we considered dedifferentiated low-grade central osteosarcoma (LGCOS) and OS arising in FD as the main differential diagnoses. LGCOS can be differentiated from FD by the presence of the following histologic features: infiltrative growth, cellularity, cytologic atypia, and mitotic activity [6,7]. Infiltrative growth, such as permeation or extension to the cortical bone and adjacent soft tissue, is an important gross feature of LGCOS. Microscopically, increased cellularity and intersecting fascicular patterns of spindle cells are usually detected in LGCOS but not in FD. LGCOS shows focal nuclear atypia, including hyperchromatic, enlarged nuclei, and irregular nuclear membranes. In addition to the morphological features, investigation of the underlying molecular profiles is helpful for differential diagnosis. While FD frequently harbors GNAS mutations [8,9], LGCOS frequently shows MDM2 and/or CDK4 amplification [10]. We conducted next-generation sequencing (NGS) analysis to determine whether the high-grade OS was dedifferentiation from LGCOS or malignant transformation from FD. DNA sequence-change analysis revealed GNAS (p.R201H, c.602G > A) and TP53 mutations (p.W53Cfs*70, c.159delG). Copy number variation analysis revealed a gain of PDGFRA, KIT, and CTNND2 and a loss of CDKN2A. TP53 mutations and CDKN2A deletions have been reported in primary OS or secondary OS associated with FD [5,11]. Our NGS results strongly supported the diagnosis of malignant transformation of FD. Following surgical resection and pathological diagnosis, the patient underwent Adriamycin-based chemotherapy and was alive without evidence of disease recurrence for 6 months. This case highlights the macroscopic, microscopic, and molecular characteristics of the malignant transformation of FD into OS. The diagnostic approaches, characteristic images, and interpretations of ancillary tests demonstrated in this case would help pathologists and clinicians make accurate diagnoses of malignant transformation of FD and their differential diagnosis from dedifferentiated LGCOS, which is essential for establishing an optimal treatment plan. A 38-year-old woman with no significant medical history was referred with stabbing pain in right hip joint. The pain occurred during load-bearing activities such as walking for 4 months, and became worse even after taking medicine. (A) X-ray shows a well-defined intramedullary lesion, 5.6 × 3.3 × 2.5 cm in size. (B) CT scan highlighted cortical destruction. (C) T2-weighted axial MR image reveals focal cortical destruction with thinning and endosteal erosion (arrow) in the anterior aspect of the femur. (D) Fat-saturated T2-weighted coronal MR image reveals a well-defined intramedullary lesion with peritumoral bone edema (arrow) in the meta-diaphysis of the femur. (E) Gadolinium-enhanced T1-weighted coronal MR image reveals heterogenous enhancement. (F) CT-guided bone biopsy was performed because pain and radiographic finding of cortical thinning were atypical features for fibrous dysplasia and suggested the possibility of malignancy. The first biopsy specimen includes mainly blood clots with some bland-looking spindle cells and woven bone. (G) The second biopsy reveals atypical spindle cells with moderate-to-high cellularity and frequent mitotic figures.
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05/9e/PMC6831061/cm9-132-2495-g001.jpg
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Radiological and pathological features of the patient with Dandy-Walker malformation and Ganglioglioma. Radiological findings of CT scan (A) and MRI axial T1WI (B), T2WI (C) and sagittal T1WI (D) showed an atrophy of the cerebellar hemispheres, hypoplasia of the vermis, and an enlargement of the fourth ventricle, which communicated with the occipital cistern forming a posterior cerebellar cyst (yellow arrows). At the same time, the upper part of the lesions with calcification on CT scan (E, red arrows), reached the interphalangeal cistern, which of the boundary near the right parahippocampal gyrus was not clearly demarcated on MRI axial T1WI (F) and T2WI (G). Moreover, a round soft tissue density masse was seen above the sellar region, with uneven internal density on MRI sagittal T1WI (H, red arrow). Pathological findings revealed the proliferation glial cells and vascular (I; H&E, original magnification ×400), with immature ganglion cells (J; H&E, original magnification ×400, yellow arrow heads). Tumor cells of ganglioglioma were immunoreactive for GFAP (K; immunohistochemical, original magnification ×400). Tumor cells of ganglioglioma were prominent cytoplasmic and membranous staining for CD34 (L; immunohistochemical, original magnification ×400, yellow arrow heads). CT: Computed tomography; GFAP: Glial fibrillary acidic protein; H&E: Hematoxylin and eosin; MRI: Magnetic resonance imaging.
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77/a5/PMC10864153/jksr-85-240-g001.jpg
|
Multicentric epithelioid angiosarcoma of bone involving lower extremities in a 61-year-old male. A. Plain radiograph of both femurs and lower extremity CT of the left thigh. Anteroposterior view shows multiple ill-defined osteolytic lesions in both centric and eccentric ways. Pathologic fracture is combined at the right femur (arrow). Note the cortical destruction with minimal periosteal reaction (arrowheads). Craniocaudally sequential axial CT images (bone and soft tissue windows) show cortical bone destruction and extraosseous soft tissue extension (arrowheads). B. MRI of the left thigh. Coronal T2WFS (left) and T1WFS (right) with enhancement show an aggressive bony lesion with cortical destruction and extraosseous soft tissue mass (arrowheads). C. MRI with DWI of the left thigh. Axial T2W FS image shows a heterogeneously hyperintense mass compared to signal intensity of adjacent muscles (arrowhead). The axial T1W FS image shows an iso-to-hyperintense mass with heterogeneous enhancement (arrowhead). Axial T1W FS image with enhancement shows an enhancing solid portion at the extraosseous area (arrowhead). DWI of b = 50 s/mm2 shows this tumor area with hyperintensity. DWI of b = 800 s/mm2 shows that this area remained hyperintense (arrowhead). ADC map shows this tumor area with hypointensity (arrowhead) and a mean ADC of 772 µm2/sec. D.
99mTc bone scan. Whole-body bone scintigraphy shows increased tracer uptake in the L3 vertebra, pelvic bones, femurs, and left tibia. E.
18F-FDG PET with CT. Whole-body PET imaging shows multifocal bone uptake in the sacrum of lumbar segments 3, 4, and 5, pelvic bones, femurs, tibiae, and left fibula. The SUVmax is 18.82 in the left iliac bone. The lesion shows severe cortical bone destruction with prominent extraosseous soft tissue extension (arrowheads). F. Histopathology of a biopsy specimen. H&E × 200 image and × 400 image show high cellularity with epithelioid cells and spindle cells lining abnormally dilated vascular channels. Tumor cells show evidence of abnormal mitotic figures. Cytokeratin and vimentin staining are positive, CD31 and ERG staining are highly positive. The Ki-67 index was 53.72% (not shown). The final pathological diagnosis was an epithelioid angiosarcoma. CE = contrast enhancement, DWI = diffusion-weighted image, ERG = ETS-related gene, FS = fat-suppressed, H&E = hematoxylin and eosin, SUVmax = maximum standardized uptake value, T1W = T1-weighted, T2W = T2-weighted
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fc/11/PMC10999629/fonc-14-1373607-g003.jpg
|
The ultrasound (A1–A4), MRI (B1–B3), surgical (C1–C5), and pathological images (D1–D9) of case 3. US: The ultrasonic images in panels (A1–A3) depict the two-dimensional sagittal section of the right labia majora, the two-dimensional axial section, and the three-dimensional coronal section of both labia majora. These images clearly demonstrate a well-defined, thick-walled mass measuring 3.7 × 1.1 × 2.9 cm located between 0.3 cm and 1.4 cm beneath the skin of the upper two-thirds of the right labia majora (M represents an AAM lesion). The echogenicity of this mass varies from echo-poor to hypoechoic, with dense internal dot echoes and enhanced far-field echoes. Panel (A4) shows the sagittal section of the left and right labia majora 3 months after the operation, and no lesions were found. MRI: Panels (B1–B3) illustrate the pelvic coronal plane, the right sagittal plane of the pelvis, and the axial plane of the low pelvic floor, respectively. These images reveal a well-defined, round lesion with prolonged T1 and T2 signals in the right vulva (yellow arrow indicates the AAM lesion). Surgery: Panel (C1) illustrates a 4.0 × 3.0 cm mass located in the right labia majora (M represents the AAM lesion). Panel (C2) depicts an oval soft tissue mass, which is a lesion located on the skin of the right labia majora. Panel (C3) illustrates the cavity formed by the subcutaneous expansion and growth of the lesion. The lesion, completely resected and displayed in Panel (C4), is an oval soft tissue mass measuring 4.0 × 3.0 cm with a pink appearance. Panel (C5) displays the lesion as pink, soft mucous tissue upon sectioning. HE: At low magnification, panel (D1) shows a tumor located within the dermis. The tumor has indistinct boundaries and is composed of spindle cells, blood vessels of varying sizes, and a myxoid matrix (HE, ×40). At low magnification in panel (D2), an abundance of blood vessels can be observed within the backdrop of myxedema, ranging from noticeably slender-walled vessels to substantially thick-walled ones (HE, ×100). Upon high magnification, panel (D3) reveals neoplastic cells residing in the stroma of myxedema with reduced cellular density. These cells are characterized by abbreviated fusiform shape and occasional presence of atypical nuclei (HE, ×200). IHC: Tumor cells exhibited strong positive staining for desmin in panel (D4) (×100) and panel (D5) (×200), estrogen receptors in panel (D6) (×100) and panel (D7) (×200), and progesterone receptors in panel (D8) (×100) and panel (D9) (×200). US, ultrasonography; MRI, magnetic resonance imaging; M, mass; A, anus; HE, histopathological examination; IHC, immunohistochemistry; AAM, aggressive angiomyxoma.
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98/05/PMC7485085/10.1177_2192568219881166-fig1.jpg
|
Case: Male 15 years. Lumbar pain 3 months. No trauma. Partially solved with nonsteroidal anti-inflammatory drugs. Labs okay. Neurologically intact. (A) Radiographs without findings. (B, C) Magnetic resonance imaging (MRI): axial and sagittal planes T1/T2. Lesion T12-L1. (D, E) Computed tomography (CT) scan: coronal and sagittal planes. Blastic lesion T12-L1. One week later. Percutaneous T12/L1 CT-guided biopsy and methylprednisolone (150 mg) and calcitonin (200 IU) injection. Pathology: compatible with aneurysmal bone cyst (ABC). (F, G). Post 60 days injection MRI axial and sagittal plane T2. Lesion T12-L1. (H) Arteriography. Right femoral artery catheterism, segmentary afferents T11-T12, L1-L2, no positive results. (I) MRI axial plane T2/STIR. Severe spinal cord compression. No signs of tumor ossification. Severe axial and radicular pain. (J, K) Radiographs anterior-posterior and lateral. Decompression and posterior spinal fusion T9 L3; 36 months postoperative.
|
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a7/c5/PMC3168804/kjr-12-620-g001.jpg
|
Bone metastasis identified concurrently with primary spinal cord astrocytoma. A-C. Fat suppressed T2-weighted image shows heterogeneous hyperintense mass of spinal cord (arrows) at level of T12 and L1 vertebrae (A), T1-weighted image shows isointensity of this mass (B), and fat-suppressed contrast enhanced T1-weighted image shows multifocal nodular enhancement (C). Fat suppressed T2-weighted image shows heterogeneous hyperintense multiple metastatic bone marrow lesions (arrowheads) (A), T1-weighted image shows hypointensity of these lesions (B) and fat suppressed contrast enhanced T1-weighted image shows heterogeneous enhancement (C). D. Microscopic examination (Hematoxylin & Eosin staining, original magnification: × 400) reveals high cellularity and nuclear pleomorphism (arrows) in fibrillary background without microvessel proliferation or tumor necrosis, which all suggests anaplastic astrocytoma. E-H. T2-weighted image shows aggravated multiple bone marrow lesions (arrowheads) with variable signal intensity (E), T1-weighted image shows hypointensity of these lesions (F) and contrast enhanced T1-weighted image shows variable contrast enhancement (G). These lesions, which correspond to those of MR images, are depicted as osteoblastic lesions on sagittal reformatted CT images of spine (H). I, J. Scintigraphy (I) and whole body 18F-FDG PET-CT (J) images of patient. Whole body bone scan (I) shows multiple foci of heterogeneously increased bony uptake (arrows) at thoracolumbar spine, rib cage and pelvic bones, which are thought to be consistent with multiple bony lesions seen on CT and MRI. Whole body FDG PET image (J) shows increased focal FDG uptake (arrowhead) of vertebral body, which is clearly visualized as being located in T11 vertebral body on fusion image of PET-CT. Extraskeletal FDG uptake is not observed. K, L. CT-guided localization using guide pin for subsequent open bone biopsy (K) and photomicrograph of surgical specimen from excised bone (L). CT image obtained with localization clearly shows guide pin whose tip is located at center of iliac bone, which contains osteoblastic lesions (K). Histologic examination of specimen (Hematoxylin & Eosin staining, original magnification × 100) reveals bone marrow and metastatic tumor (T). Bone marrow (BM) is infiltrated by metastatic tumor cells (arrowheads) that show histologic findings identical to those of spinal cord tumor.
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0d/b8/PMC4946170/12883_2016_632_Fig1_HTML.jpg
|
MRI and histological findings in the hemorrhagic lesion. (A) [CT and MRI findings in the hemorrhagic cerebellar lesion]. Sagittal (a) and Axial (b) MDCT reconstruction images show a hyperdense cerebellar-vermian lesion, with fluid-blood levels (white arrows), confirmed by MRI scan. Axial T2-weighted MRI (c) showed a hemorrhagic cerebellar-vermian lesion, expanding into IV ventricle, with multiple fluid-blood levels (white arrow). Axial-Sagittal T1-weighted MRI, without (d, e) and with (f, g) gadolinium, revealed a solid component inhomogeneously contrast-enhanced (white arrows). Axial gradient-echo sequence (h) showed lack of hypointense hemosiderin rim (cavernous hemangioma classical finding, white arrow). Preoperative left vertebral angiograms (i, l) show hypoplastic vertebral artery terminating as posterior inferior cerebellar artery (vascular variation) and the tumor stain; an aneurysm-like formation (arrow) is seen in the arterial phase. The tumor is fed by the vermian branch of the left posterior inferior cerebellar artery. (B) [Histological findings in hemorrhagic medulloblastoma]. Proliferation of small undifferentiated cells showing a diffuse/multinodular pattern (middle-right), associated to anomalous, thick-walled vascular structures (arrows) (a, H&E, 2.5x). Cells were synaptophysin (b, 20x) and beta-catenin (both cytoplasm and nucleus) positive (c, 20x). Anomalous vascularization was characterized by clusters of anomalous, thick-walled arterial-type vessels (d and f, CD31 20x) along with numerous variably anastomosing small venous and capillary structures (e, CD31, 20x)
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a1/12/PMC5549470/BMRI2017-9467402.004.jpg
|
A 47-year-old man with a malignant peripheral nerve sheath tumor involving T1. (a) Axial T2-weighted MRI shows a huge, irregular, lobulated unilateral mass extending into the posterolateral component. (b) An axial myelo-CT scan shows the osteolytic mass. (c) Destruction of the vertebral body of T1 (20% collapse with kyphotic deformity) is also seen on sagittal T2-weighted MRI. (d) Histological examination shows the proliferation of oval to spindle cells arranged in a fascicular pattern with nuclear atypia and pleomorphism, confirming the diagnosis of malignant peripheral nerve sheath tumor (H&E, original magnification ×200). ((e) and (f)) Axial (e) and coronal CT (f) slices showing the dose distribution indicate the highly conformal nature of the C-ion RT. (g) Sagittal T2-weighted MRI at 5 months after C-ion RT (70.4 Gy (RBE)) demonstrates progression of the vertebral collapse and dislocation at the T1/2 level. (h) The patient underwent a posterior spinal fusion with instrumentation.
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d1/12/PMC3484302/kjr-13-803-g001.jpg
|
CT, MR, US, and histologic findings in 72-year-old woman with IgG4-related inflammatory pseudotumor in urethra. A. Coronal reformatted CT image reveals a rim-enhancing soft tissue around urethra (arrows). B. Axial T1-weighted MR image (TR/TE, 790/14) reveals isointense soft tissue (arrows) around urethra. C. Sagittal T2-weighted MR image (TR/TE, 4800/95) reveals iso- to slightly hyperintense mass (arrows) around urethra. D. Axial diffusion weighted MR image (TR/TE, 4800/79) demonstrates intense high signal intensity in urethral mass (arrowheads). E. Axial apparent diffusion coefficient (ADC) map demonstrates concordant low ADC values of urethral mass (arrowheads). F. On gdolinium-enhanced fat-saturation T1-weighted MR images (TR/TE, 2.9/1.2), mass (arrowheads) shows rim-enhncement in arterial phase. G. On 5-minute delayed fat-saturation T1-weighted MR image, mass (arrowheads) shows diffuse enhancement. Note that central portion of mass is enhanced in delayed phase, in comparison with arterial phase image. H. After steroid therapy for three months, sagittal T2-weighted MR image (TR/TE, 4550/107) reveals marked interval decrease in size of urethral mass (arrows). I. Transvaginal ultrasonography image in 72-year-old woman with IgG4-related inflammatory pseudotumor in urethra. transvaginal ultrasonography scan in color Doppler mode reveals heterogeneously low echoic mass (arrows) encasing urethra. Note that vascularity in urethral mass is poor. J. Microscopic exam shows linear spindle cell (arrowheads) proliferation and lymphocyte (arrow) infiltration (Hematoxylin & Eosin, × 200). K. Immunohistochemical staining reveals positivity (brown color) for marker of proliferated spindle cells and smooth muscle actin, suggesting that specimen is compatible with IPT. L. Immunohistochemical staining for IgG4 demonstrates positivity (brown color) in some inflammatory cells and spindle cells, suggesting that specimen is associated with IgG4-related sclerosing disease. IgG4 = immunoglobulin G4, IPT = inflammatory pseudotumor.
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81/4b/PMC9178658/fonc-12-865865-g003.jpg
|
Preoperative CT showed medium-high mixed density in the sella (A). Preoperative MRI showed long T1 (B) and long T2 (C) signals in the left parasella. Multiple patchy short T2 signals were seen in the lesion (C). After enhancement, the lesion showed heterogeneous enhancement (D). Intraoperative drilling of anterior wall of sphenoid sinus and sella floor by EEETA (E). Resection of tumor located in sella turcica (F). Resection of tumor in the left parasella (G). Descent of sellar diaphragm after removal of tumor (H). Postoperative axial, coronal, and sagittal MRI enhancement showed that the tumor was completely removed and there was no residual tumor in surgical area (I–K). Histopathological examination (hematoxylin and eosin [H&E] staining) at 200× magnification showed tumors in the myxoid matrix background consisting of hyaline chondrocytes with irregular lobules, spindle cells, and chondrocytes with homogeneous micronuclei (L). Immunohistochemical staining at 400× magnification showed vimentin (+, M), Ki-67 (6%, N), SOX-9 (+, O), and S-100 (+, P). EEETA, extended endoscopic endonasal transsphenoidal approach; SD, sellar diaphragm.
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e8/ce/PMC8811062/41598_2022_5831_Fig1_HTML.jpg
|
Indolent enhancing spinal lesion (IESL)—Case 1. An 11-year-old girl with anaplastic astrocytoma (2016 WHO grade III) over the right thalamus (a,b) was treated with partial tumor removal, radiotherapy, and chemotherapy. Four months after the surgery, sagittal contrast-enhanced T1WI revealed diffuse leptomeningeal seeding and multiple enhancing lesions over the whole spine (c,d). Target enhancement (d, arrow), ring enhancement (c, white arrow) and corner involvement (c, black arrow) were present. In the follow-up MRI 6 months after brain tumor surgery, sagittal contrast-enhanced T1WI of the cervical to middle thoracic spine revealed progression of the lesions (e). A target-enhancing pattern was specified at the T10 level (d,e, white arrow; magnified in f), which appeared hypointense on T2WI (g, white arrow). Coexisting lesions with ring enhancement on T1WI (e, black arrow) and hyperintensity with a “double line sign” on T2WI were also noted (g, black arrow). The T10 target-enhancing lesion on axial contrast-enhanced T1WI (h) revealed osteoblastic changes on CT scan (i). The first CT-guided biopsy disclosed no histologic evidence of malignancy (j). One week later, the second CT-guided biopsy revealed hypocellular marrow tissue and bone dust (H&E staining) (k).
|
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] |
05/4a/PMC11152896/gr1.jpg
|
Typical imaging and pathology findings in mixed ECD-LCH. A. Brain MRI gadolinium-enhanced T1 FAT SAT reveals orbital fat histiocytic infiltration (arrows), pachymeningeal involvement (arrowhead), and right premaxillary involvement (asterisk). B. Brain MRI T2 FLAIR sequence showing degenerative changes with symmetrically increased signal intensity within the cerebellar parenchyma. C. Axial abdominal contrast-enhanced CT scan showing periaortic and bilateral perinephric infiltrates (“hairy kidneys”, arrow). D. Axial thin-section CT scan of the lungs showing multiple cysts and nodules in the upper lobes. E. Axial arterial contrast-enhanced CT scan showing circumferential periaortic infiltration (arrow). F. 99 mTC bone scan demonstrating multiple areas of abnormally increased uptake including a symmetric uptake in the femurs, tibia, knees, and ankles. Other locations in the appendicular skeleton show mild uptake. Left: anterior view; right: posterior view. G, H. Humeral X-ray (G) and CT-scan (H) showing a lytic lesion with periosteal reaction (arrow); osteosclerosis and cortical thickening are present on the lower half of the humeral diaphysis (empty arrows). I. Brown and purplish papules with crusted lesions in the breast folds and upper abdomen. J. Xanthelasma-like lesions of the eyelids. K. H&E staining of mixed ECD-LCH bone involvement, showing large histiocytes with abundant clear cytoplasm and smaller histiocytes with eosinophilic cytoplasm (200×) L, N. Low (L, 40×), and high (N, 400×) magnification of the same biopsy showing infiltration by CD1a + LCH cells. M. The same sample stained with CD68+ showing a strong positivity of the foamy ECD cells (200×).
|
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35/2e/PMC9432210/jksr-81-990-g001.jpg
|
A 24-day-old male patient with fever. A. The chest radiograph shows a round opacified lesion in the right lower lung zone. B. The axial contrast-enhanced CT shows a 4.7-cm mass, with heterogenous enhancement and internal low-attenuation portions in the right lower lobe, and a 0.5-cm subpleural nodule in the right middle lobe (arrow). C. The mass shows high signal intensity with multiple small high-signal-intensity foci on axial T2-weighted MRI (1st image). On axial T1-weighted MRI, the mass shows iso-signal intensity (2nd image). On axial contrast-enhanced T1-weighted MRI (3rd image), there are areas of nonenhancement, which show diffusion restriction on the coronal diffusion-weighted image (4th image) (arrows). There is a subpleural nodule in the right middle lobe showing similar characteristics as the main mass and several enlarged lymph nodes in both the axilla (not shown). D. On ultrasound, the lung mass shows heterogeneously increased echogenicity. On Doppler ultrasound, there is internal vascularity. E. The surgical specimen (× 200) stained with the periodic–acid–Schiff diastase stain shows the hyphae of Aspergillus species (arrows).
|
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b3/6d/PMC9818511/diagnostics-13-00042-g004.jpg
|
Ultrasound-guided percutaneous coarse needle biopsy (US-CNB) was carried out to acquire pathological diagnosis (A). The biopsy site and positioning were chosen after careful ultrasound examination and a spring-loaded 18-gauge core biopsy needle was used (MAXCORE®, Bard Medical Technologies Inc., Murray Hill, NJ, USA). Three cores of specimens were obtained and then sent for pathologic evaluation. Hematoxylin and eosin staining showed that the tumor was comprised of pigmented fusiform cells on microscopy scan ((B), 200×, arrow). Immunohistochemical staining demonstrated that the tumor cells were strongly and extensively stained with MITF and S-100, but it was negative for BRAF V600E. Consequently, the liver lesion was confirmed as metastatic melanoma. Of note, there was no history of cutaneous melanoma, and no primary tumor was revealed by systemic skin examination. In addition, a standard comprehensive examination for mucosal, ocular, and other occult sources did not reveal a definitive primary tumor. Due to the fever and pulmonary tuberculosis, the patient may not tolerate the side effects of systemic therapy. Finally, he refused systemic therapy and died from tumor progression seven months after the initial diagnosis. The incidence of melanoma increased rapidly in the United States as well as in Asian countries during the past few decades [2]. Over 90% of melanoma patients suffer from liver metastasis during the course of their disease, which generally implies poor prognosis [3]. Obtaining accurate diagnosis and clinical stage of the melanoma is important for individualized therapy and surveillance. However, isolated hepatic metastatic melanoma is difficult to recognize by imaging methods especially for those without a determined origin. In this case, the hepatic lesion was mistaken as hepatapostema using CEUS, whereas it was misdiagnosed as HCC using CEMRI. Clinically, the CEUS features of hepatapostema varies between different stages, presenting as temporal sub-segmental hyperenhancement without necrosis during the early stage, which is indistinguishable from solid tumors [4]. It is worth noting that the characteristic signal of melanoma is hyperintense on T1-weighted imaging due to the paramagnetism of melanin. Although rare, the imaging features of metastatic melanoma are varied, and may present as cystic, solid-cystic or solid nodule [5,6]. Thus, once it is detected, it’s difficult to recognize immediately. The treatment of malignant melanoma depends on the age, clinical staging, general condition, and personal preferences of the patient [7]. When 18F-FDG-PET/CT suggested that the tumor was in stage IV, histological examination was essential to determine the individual treatment schedule. US-CNB has been the procedure of choice in tissue diagnosis for its availability, high accuracy, and safety [8]. As such, an increasing number of biopsies has been performed in our center during the past few years. Whenever inconclusive imaging findings persist, US-CNB is performed by an experienced operator. The obtained tissue specimen is used for precise definition of specific biomarkers. In brief, the isolated hepatic malignant melanoma with undetermined origin is a rare condition and difficult to distinguish from other tumors through noninvasive imaging methods. CEUS and CEMRI play a fundamental role in the diagnosis of hepatic melanoma, and PET-CT is useful in clinical staging. For controversial results, US-CNB is essential to establish the pathological diagnosis.
|
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87/ca/PMC6540739/fonc-09-00420-g0001.jpg
|
The patient's intrahepatic cholangiocarcinoma, which was classified as TNM: cT3, cN1, cM1, and stage IV tumor [according to AJCC/UICC staging criteria (6)]. (A,B) CT scan demonstrates multiple liver lesions, exemplary shown on two different axial layers. (A) Arrows indicate right-sided cholestasis, caused by a hypodense lesion in liver segments IV/VIII. (B) Asterisk marks a large, lobular-configured tumor mass in liver segment II, that dorsally crosses liver capsule. (C) A representative axial CT scan layer shows multiple bilateral lung noduli, interpreted as pulmonary metastases (indicated by red arrows). A framed image section is displayed as magnified inset in the top left corner of (C). A likely single spleen metastasis and enlargement of retroperitoneal lymph nodes are not shown. (D) The unaffected pancreas neighboring the infiltrated liver is depicted in four serial CT scan layers in coronal plane (consecutively numbered 1–4 from ventral to dorsal). The border between both organs (highlighted by dashed ovals) is not obviously violated by infiltrating tumor tissue, arguing against a primarily pancreatic origin of malignancy. (E,F) Histology from ultrasound-guided liver-biopsy. (E) H&E stain shows infiltrates of an adenocarcinoma with scattered duct formation and a desmoplastic stroma component. (F) High-power field from inset in (E) demonstrates frequent mitoses (indicated by arrow-heads). Immunohistochemistry (not shown) reveals positivity for CK7 and DPC4 and negativity for Hep Par 1, CK20, TTF1, CDX-2, and PSMA, consistent with a tumor of biliopancreatic origin.
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3b/6d/PMC7044679/gr1a.jpg
|
Dedifferentiated liposarcoma arising from diaphragm in a 74-year-old man. (A) (left upper) Axial CT of the abdomen and pelvis shows lobulated heterogeneous mass (approximately 12 × 9 × 5.5 cm) in right hemidiaphragm with some low density components and some muscle like density components. (right upper). Axial CT of the abdomen and pelvis with contrast shows enhancement of thick septations and nodular components. (left lower) Coronal and (right lower) Sagittal CT of the abdomen and pelvis with contrast shows displacement of liver, gall bladder, and peritoneum due to mass effects. (B) (left upper) Plain chest radiograph showing COPD lung with Lt lower lobe atelectasis filled with bronchiectasis (6 months ago) (right upper) Plain chest radiograph showing elevated Rt diaphragm (when patient presented for the first time) (left lower) Coronal CT of the chest (6months ago) (right lower) Coronal CT of the chest (when patient presented for the first time). (C) (left) Post 1 month follow up axial CT of the abdomen and pelvis with contrast shows interval increase in size of diaphragmatic mass with exacerbation of mass effects compressing gall bladder and inferior vena cava. (right) Post 1 month follow up sagittal CT of the abdomen and pelvis with contrast shows interval increase in size of diaphragmatic mass with exacerbation of mass effects compressing and displacing gall bladder. Gall bladder appears collapsed. (D) (left upper) Axial MRI T1 weighted image shows region of high T1 signal intensity in posterolateral region of the mass which may suggest hemorrhagic components (right upper) Axial MRI T2 weighted image shows multiple low T1 high T2 cyst like structures around peripheral region of the mass (left lower) Axial MRI diffusion restriction and (right lower) ADC image shows increased diffusion restriction in posterolateral region of the mass (E) Axial MRI enhanced image shows enhancement of septas and central soft tissue region. (F) Gross pathologic specimen shows 24 × 16 × 12 cm, lobulated mass composed of hemorrhagic necrosis with central grayish fibrous mass with multifocal cystic cavities. (G) Dedifferentiated liposarcoma of the diaphragm stained with hematoxylin and eosin (H&E) stain (left) Peripheral region shows well differentiated fatty cells with myxoid materials (original magnification × 200) (right) Central region showed atypical malignant cells (original magnification × 200). CT, computed tomography; MRI, magnetic resonance imaging; COPD, chronic obstructive pulmonary disease; ADC, Apparent diffusion coefficient.
|
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9d/af/PMC10780302/jcm-13-00264-g014.jpg
|
A 50-year-old patient with L5 vertebral body fracture secondary to diffuse tumor infiltration with the collapse of the upper plateau, posterior wall retropulsion, and anterior epidural soft tissue mass (arrows (A–F)), causing thecal sac indentation. MRI shows an L5 vertebral body malignant lesion with soft tissue expansion in the epidural anterior space in sagittal Dixon “only water” T2w (A) and contrast enhancement in sagittal gadolinium-enhanced T1FSWI (B) and axial T2w (C). The lack of FDH uptake in the L5 level can be observed in sagittal (D–F) and axial (H,I) FDG-PET/CT reconstructions, making it difficult to determine a pathologic fracture diagnosis. Histologic sample with hematoxylin–eosin staining diagnostic for plasmacytoma (G). The immunohistochemistry revealed monoclonal lambda light chains in plasma cells. The patient was treated with radiotherapy.
|
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c9/11/PMC5101200/fonc-06-00225-g002.jpg
|
Example images showing advanced metabolic imaging approaches to PCa detection. (A) MRSI/MRI and PET/CT. Transverse T2-weighted MR image (upper left) shows bilateral signal hypointensities and corresponding 3D MR spectroscopic spectra (lower left) show bilateral abnormalities [mean (Choline + Creatine)/Citrate ratio = 0.95 on right side and 1.10 on left] indicative of cancer, while corresponding PET/CT transverse images (upper right) do not show any relevant pathologic focal accumulation of 11C-choline [background maximum SUV (standardized uptake value) = 2.5]. Corresponding pathologic specimen (hematoxylin–eosin stain; original magnification, ×1) (lower right) shows bilateral posterior adenocarcinoma (T3aNXMX, Gleason score 4 + 3) with right extracapsular extension (**). Reproduction with permission from Ref. (14) (RSNA). (B) mpMRI in a 62-year-old man with PCa. Axial T2-weighted MR image (upper left) demonstrates a low-signal intensity focus (arrow) at right apex mid peripheral zone suspicious for PCa. Raw dynamic contrast-enhanced MR image (lower left) and ktrans (wash in) (upper middle) and kep (wash out) (lower middle) maps help localize tumor (arrow). Histopathologic slide at apex mid prostate level (upper right) confirms presence of tumor (Gleason score, 8) more anteriorly (red line), secondary to distortion and shrinkage of specimen. A, anterior; L, left; P, posterior; R, right. Reproduction with permission from Ref. (28) (RSNA). (C) 13C-hyperpolarized MRSI in a patient, who had a serum PSA of 4.5 ng/ml, was originally diagnosed with bilateral biopsy-proven Gleason grade 3 + 3 PCa, and received the highest dose of hyperpolarized [1-13C]pyruvate (0.43 ml/kg). On the left, an axial T2-weighted images and on the right the corresponding spectral array with the area of putative tumor highlighted by pink shading. A region of tumor was observed on the T2-weighted images (red arrows). From Ref. (29) (Nelson SJ, Kurhanewicz J, Vigneron DB, Larson PE, Harzstark AL, Ferrone M, et al. Metabolic imaging of patients with prostate cancer using hyperpolarized [1-13C]pyruvate. Sci Transl Med (2013) 5(198):198ra108. Reprinted with permission from AAAS.) (D) Coronal PET (left) and CT fused (right) anti-18F-FACBC images of 63-year-old male patient with pathologically proven bilateral prostate carcinoma (arrows on the left). Note little bladder activity (white arrows on the right). This research was originally published in JNM (30). Schuster et al.© by the Society of Nuclear Medicine and Molecular Imaging, Inc. (E) PET/MRI fusion imaging in high-grade PCa. Specific image information derived from 11C-choline PET (upper middle), ADC (apparent diffusion coefficient) DWI (upper right), hematoxylin–eosin (HE) histology (lower left), and parametric fusion PET/MRI using PCHOL/ADC* (lower right) is coregistered with transaxial T2-weighted MRI (upper right). Color bars indicate 11C-choline SUV (standardized uptake value) (upper middle), PCHOL/ADC* (lower right), and inverted ADC (upper right). Zoomed registered HE histology slice is shown for increased clarity (lower left). At histology, Gleason 4 + 3 lesion is located in left lobe of prostate (red arrows) in peripheral and central zone, which is identified on registered imaging, whereas additional low-volume Gleason 3 + 3 lesion in right lobe is not identified (blue arrows) . This research was originally published in JNM. Park et al. (31) © by the Society of Nuclear Medicine and Molecular Imaging, Inc.
|
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63/b8/PMC9514585/jksr-83-931-g001.jpg
|
Diffuse large B-cell lymphoma associated with a chronic inflammatory condition induced by metallic implants. A. Serial right standing knee anteroposterior radiographs before HTO, 12 months, and 15 months after HTO (after HWR). Twelve months after HTO, a newly developed focal, low-density lesion (arrows) is observed in the proximal portion of the right tibia. Fifteen months after HTO, a focal, permeative-type osteolytic lesion with periosteal reaction in the distal portion is more apparent (arrowhead). B. Right knee MRI scans at 14.5 months after HTO and just before HWR. An approximately 6.5 cm × 3.7 cm × 7.7 cm lesion in the right popliteal area shows homogenous high signal intensity on sagittal FS T2WI and intermediate to high signal intensity on sagittal PD and axial FS PD (*). Evaluation of the right tibial bone marrow is limited due to metal artifacts; however, the MRI scan shows abnormal bone marrow signal intensity. C. Right knee MRI scans at 15 months after HTO and 2 weeks after HWR. Diffuse marrow involvement and an approximately 7.8 cm × 3.7 cm × 9.2 cm extensive extraosseous soft-tissue mass-like lesion (*) with a relatively preserved trabecular pattern (arrow) and bony cortex (arrowheads) is identified in the right tibia. The lesion shows intermediate signal intensity on axial FS PD and sagittal PD and iso- to slightly low signal intensity on T1WI with heterogeneous patchy enhancement on axial contrast-enhanced T1WI. D. US findings after HWR at pretibial area. US shows a heterogeneous hypoechoic lesion (+) containing increased vascularity with an irregular but relatively preserved cortex of the right tibia (arrowheads) in the right pretibial area. E. Histological and immunohistochemical analyses. The low-power magnification microphotograph of a histologic section of the neoplasm (H&E stain, × 100) shows infiltration of lymphoid cells into smooth muscle fibers. The high-power magnification microphotograph (H&E stain, × 400) shows neoplastic lymphoid cells with large vesicular nuclei containing large nucleoli and scant cytoplasm. In addition, irregular cellular membranes with no specific architecture are observed. Immunohistochemistry staining shows diffuse positivity for CD20 and 70% positivity for BCL6 but negativity for CD10 and MUM1. Ki-67 staining demonstrates a high proliferation index of 70%. These features are indicative of germinal center B cell-like diffuse large B-cell lymphoma. FS = fat-suppressed, HTO = high tibial osteotomy, H&E = hematoxylin & eosin, HWR = hardware removal operation, PD = proton density, WI = weighted imaging
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fc/11/PMC10999629/fonc-14-1373607-g002.jpg
|
The ultrasound (A1–A4), MRI (B1–B4), surgical (C1–C5), and pathological images (D1–D8) of case 2. US: In panel (A1), a sagittal section of the left vulva obtained by transvaginal ultrasound reveals an irregular and uneven echo in the subcutaneous vulvar soft tissue, indicating the presence of an AAM lesion. The boundary is indistinct with no apparent capsule, extending upward below the HLAM plane and reaching 0.5 cm into the subcutaneous perineum (M represents AAM lesion). Panels (A2) and (A4) depict axial planes of the anus, while TUI axial planes of the anus are reconstructed by three-dimensional ultrasound. These images reveal that the lesion is located in the left ischiorectal fossa. The inner boundary was close to the left external anal sphincter, the left superficial perineal transverse muscle, and the left anal levator muscle. The outer boundary reached the pelvic wall (M represents the AAM lesion). Panel (A3) displays the TUI axial planes of HLAM reconstructed by three-dimensional ultrasound, demonstrating that the lesion does not extend to the anal levator plane. Panels (A1) and (A2) display the blood flow signals within the lesion. MRI: Panels (B1–B4) illustrate the pelvic coronal plane, the left sagittal plane of the pelvis, the axial plane of the high pelvic floor, and the axial plane of the low pelvic floor, respectively. These images reveal a prolonged T2 signal in the left perineum, ischiorectal fossa, and pelvic space, which define the boundaries of the lesions (M represents the AAM lesion), including their extent on both sides (left and right), upper and lower limits, and anterior and posterior extents. Surgery: Panel (C1) illustrates the lesion as a cystic solid mass measuring 6.0 × 5.0 cm, which is palpable in the subcutaneous fossa of the left ischium. Panel (C2) illustrates an irregular solid mass with multiple pseudopodia-like extensions infiltrating the adipose tissue in an extreme manner. The lesion, completely resected and displayed in panel (C3), is a soft tissue mass measuring 12.0 × 10.0 × 3.0 cm. It exhibits an extremely irregular solid mass with multiple pseudopodia-like projections and a pink appearance. Panel (C4) displays the lesion upon sectioning, which appears as a gray color with medium soft tissue consistency. Panel (C5) illustrates the appearance of the vulva after the procedure is completed. HE: Under low magnification, panel (D1) shows a homogeneous distribution of spindle cells, blood vessels, and adipose tissue with varying diameters in the stroma of myxoid transformation (HE, ×100). Under high magnification in panel (D2), the tumor cells were irregularly dispersed within the mucous stroma and infiltrated into the adipose tissue. These tumor cells exhibited a short fusiform and oval-shaped morphology without evident nuclear division, displaying mild characteristics (HE, ×200). IHC: Tumor cells exhibited strong positive staining for desmin in panel D3 (×100) and panel (D4) (×200), estrogen receptors in panel D5 (×100) and panel (D6) (×200), and progesterone receptors in panel (D7) (×100) and panel (D8) (×200). US, ultrasonography; MRI, magnetic resonance imaging; M, mass; A, anus; HLAM, hiatus of the levator ani muscle; HE, histopathological examination; IHC, immunohistochemistry; AAM, aggressive angiomyxoma; TUI, tomographic ultrasound imaging.
|
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47/95/PMC11235509/WJCC-12-4836-g001.jpg
|
Pathological and imaging features of our melanoma patient. A: A-I: On the left cheek, there was a hairy nevus with the size of 1.5 cm × 2.2 cm. The color was relatively dark, and the edge blurred. It was as hard as a nasal tip and there was no ulcer around. Meanwhile, there was a hairy pigment spot on the inside left lower arm with the size of 3.1 cm × 2.5 cm. Its color was relatively light and the edge blurred. The rigidity was the same as the former. A-II: Histopathological examination: (Left frontal lobe lesion) the tumor tissue appears nest-like, with tumor cells showing polygonal shape, abundant cytoplasm, significant melanin content, large and deeply stained nuclei with irregular features. Immunohistochemistry: VIM (+), HMB45 (+), s-100 (+), Melin-A (+), P53 (+), CK (-), 70% Ki-67 (+). Pathological diagnosis: (Malignant melanoma) of the left frontal lobe. B: B-I: The distribution of carcinoma cells showed as nests (200 ×). The tumor cells were polygonal. The cell plasma was rich with a large amount of melanin in it. The nucleus was large and irregular. B-II: The tumor cells in immunohistochemical staining showed: VIM (+), HMB45 (+), S-100 (+), Melin-A (+), P53 (+), CK (-), KI-67 70% (+). CEDF: MRI showed a patch of long T1 and T2 signals on the left frontal lobe with nodular short T1 and T2 signals inside, and it was not enhanced in the enhancement scanning. However, in the enhancement scanning, the meninges were widely thickening and enhanced, especially around the abnormal signal lesion on the left frontal lobe and the tentorium of the cerebellum. There was a poor contrast agent filling in the superior sagittal sinus; C-I, II, III, and IV: T1 scan of the focal area; D-I, II, III, and IV: T2 scan of the focal area; E-I, II, III, and IV: Enhancement scan of the focal area; F-I, II, III, and IV: Enhancement scan on the focal area in coronal position; G and H: The head computed tomography (CT) scan after showed that there was still a high-density shadow on the left frontal lobe and the range got larger, inside new high-density shadow with the range of 23 mm × 45 mm was detected and the CT attenuation value was 58HU, and there was an edema zone around. In the adjacent sulci, there was a line-like high-density shadow. The ventricular system was enlarged.
|
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5f/ce/PMC4601959/gr1.jpg
|
Imaging and pathology features of a dural-based lesion in the left sphenoid wing. (A–C) Axial, coronal and sagittal T1-weighted, contrast-enhanced MR images revealing a 6 × 5 × 4 cm dural-based, enhancing lesion centered on the pterion. (D) Axial T2-FLAIR sequence illustrating lesion isointensity and peripheral cystic changes. (E) Non-contrast CT (bone window) revealing a subtle, plaque-like region of hyperostosis along the inner table of the left squamosal temporal bone (white arrow). (F) Pathological findings of meningeal infiltration showing adenocarcinoma with acinar formations (arrows) and no definitive neuroglial tissue identified therein. Small nucleoli were present in many nuclei (arrowheads) (H&E; original magnification: 400×). Of note, immunohistochemistry revealed positive staining for pancytokeratin, PSAP and PSA. The latter (inset) showed weak cytoplasmic and strong apical (arrows) staining (immunohistochemistry; original magnification: 400×). These findings were supportive of a prostatic origin for this metastatic adenocarcinoma.
|
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a2/23/PMC8769463/nmccrj-8-601-g001.jpg
|
Preoperative and postoperative MRI and pathological findings. (A–C) Sagittal scan of the thoracic spine. An intradural tumor at Th5–8 level accompanied by syrinx cranial to the lesion was observed. The tumor showed hyperintensity in T2-weighted image (A), isointensity in T1-weighted image (B), and slight heterogeneous enhancement with contrast medium (C). (D and E) Axial scan of the thoracic spine. Spinal cord compressed in crescent shape, and at Th5 level the ventral part of the deformed spinal cord was involved into the tumor (D; arrow). (F–H) T2-weighted images of postoperative MRI (sagittal scan (F) and axial scans (G and H)). The tumor was completely resected, and compression of the spinal cord was improved with some residual deformity. (I and J) Microscopic view of the stained tissue specimens (hematoxylin & eosin). They showed perivascular pseudo-rosettes, which is a typical characteristic of ependymoma. (K and L) Immunohistochemical analysis of the specimens (GFAP (K) and MIB-1 (L)). GFAP-positive cells were observed especially in perivascular region (K). MIB-1 positive cells were exceptional (L).
|
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e4/74/PMC4057823/1746-1596-9-111-1.jpg
|
Pre-treatment radiological analyses of the left knee of the patient. Plain radiographs show a soap-bubbly osteolytic lesion with thinned cortical bone in the epiphysis of the proximal tibia (A, B) and small osteolytic lesions with a nonsclerotic margin in the metaphysis of the distal femur (arrow). MRI shows a proximal tibial tumor displaying iso-intensity to the surrounding muscle on T1-weighted imaging (coronal view) (C), heterogeneous high intensity on T2-weighted fat-suppression imaging (axial view) (D), and diffuse enhancement on gadolinium-enhanced T1-weighted fat-suppression imaging (coronal view) (E). Enhancement of surrounding soft tissue which indicates an occult pathological fracture is also observed. Sagittal MRI of the distal tibia shows small lesions (arrows) displaying nearly the same patterns as the tibial tumor; iso-intensity to the surrounding muscle on T1-weighted imaging (F), high intensity on T2-weighted imaging (G), and diffuse enhancement on gadolinium-enhanced T1-weighted fat-suppression imaging (H). 18F-FDG PET/CT revealed the proximal tibial tumor showing marked bone destruction (I) with increased SUV uptake (SUVmax: 9.6) (J) and the distal femoral lesions with slightly increased SUV uptake (SUVmax: 0.7) (arrow) (K).
|
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02/1f/PMC5403697/mco-06-03-0307-g00.jpg
|
Images and pathological tissues at first visit. (A) Frontal and lateral views of the sacral vertebrae on plain radiography. (B) Magnetic resonance imaging, sagittal plane, T1- and T2-weighted images. Neoplastic lesions are seen in S1-S2. (C) Computed tomography (CT) scan images. Osteolytic images are seen in S1-S2. (D) Histological examination of pathological specimen obtained by a CT-guided core needle biopsy. Numerous stromal cells and osteoclast-like giant cells are concurrently present. Giant cell tumor of bone was diagnosed (hematoxylin and eosin staining; magnification, ×50).
|
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bf/2b/PMC5661490/ol-14-05-5801-g03.jpg
|
Periosteal/juxtacortical chondrosarcoma in a male aged 10 years. Chondrosarcoma of the left tibia. (A) Anteroposterior radiograph, (B) axial CT and (C) coronal reconstructed CT showing localized osteolytic destruction of the lateral bone cortex of the tibia, surrounded by a soft-tissue mass containing scattered calcifications of cartilage matrix (arrows). (D) Coronal T1WI and (E) fat-suppressed T2WI showing a lesion with equal signal and inhomogeneous high signal, respectively. (F) Whole-body technetium-99 m methylenediphosphonate bone scan showing increased radionuclide uptake of the upper section of the left tibia. (G) Photomicrograph showing small round tumor cells, with diffuse and intensive distribution (original magnification, ×400; hematoxylin and eosin staining). (H) Vimentin-positive, (I) cluster of differentiation 99-positive and (J) S-100-positive tissues (original magnification, ×400; immunohistochemical staining). The diagnosis was of mesenchymal chondrosarcoma. CT, computed tomography; WI, weighted images.
|
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74/25/PMC2718126/kjr-2-231-g001.jpg
|
A 42-year-old male patient who presented with a two-month history of headache and a four-day history of diplopia. A. T2-weighted axial MR image at the level of the sphenoid sinus shows very low heterogeneous signal intensity involving the clivus and bilateral cavernous sinuses, with sphenoid sinusitis (arrows). Note the narrowing of the cavernous part of the right internal carotid artery (arrowhead). B. T2-weighted axial MR image at the level of the nasopharynx shows a high signal intensity lesion in the prevertebral muscles (arrowheads) and a heterogeneous mixed high and low signal intensity lesion in the clivus (arrows). C. T2-weighted mid-sagittal MR image reveals an expansile heterogeneous low signal intensity lesion involving the entire clivus (arrows). Note the presence of an apparently normal pituitary gland and intact sellar floor. D. T1-weighted mid-sagittal MR image at the same level as C shows mixed intermediate and low signal intensity replacing the entire clival bone marrow. The posterior line of the cortical dark signal has been destroyed (arrows). E. Contrast-enhanced T1-weighted sagittal MR image at the same level as C demonstrates strong enhancement of the lesion (arrows), with small nonenhancing areas. F. Contrast-enhanced T1-weighted coronal MR image at the level of the pituitary stalk shows bilateral involvement of the cavernous sinuses associated with narrowing of the cavernous portion of the right internal carotid artery due to infiltration of the lesion (arrows). G. Coronal bone algorithm CT scan obtained at the level of the pituitary gland shows permeative bone destruction of the clivus (arrows). H. Pathologic specimen obtained from the clivus shows thick fibrous bands with scattered chronic inflammatory cells (H&E staining, original magnification ×100).
|
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89/27/PMC10480207/41598_2023_41378_Fig4_HTML.jpg
|
Comparison of preoperative and postoperative imaging and histopathological examination. Preoperative CT shows a patchy low-density shadow and a calcified lesion in the middle cranial fossa (A). Enhanced T1-weighted axial, sagittal, and coronal images show heterogeneous enhancement (B,C,D). Postoperative MRI T2-weighted (E) and enhanced T1-weighted images (F–H) demonstrate that total tumor resection was achieved. Histopathological examination at 200 × and 400 × magnification shows that tumor cells increased slightly with no clear nuclear division (I,J). Immunohistochemical staining at 400 × magnification shows S-100 positivity (+, K).
|
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e8/6a/PMC8385806/12891_2021_4610_Fig1_HTML.jpg
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Giant cell tumor originating in the Th12 vertebral body. a Axial computed tomography (CT), b reformatted sagittal plane, c sagittal plane T1-weighted image, d sagittal plane T2-weighted image, and e post-enhanced sagittal T1-weighted image showing lytic bony destruction in the Th12 vertebral body. (a) The lesion invaded the left pedicle and the margin was ill-defined. b–e The vertebral body had collapsed and the soft tissue of the anterior vertebral body had invaded the anterosuperior L1 vertebral body. e The lesion showed significant enhancement on contrast-enhanced magnetic resonance imaging (MRI). f Photomicrograph of the tissue from patient 1. Hematoxylin and eosin (H&E)-stained tissue section (200× magnification) demonstrated a highly cellular, solid neoplasm consisting of mononuclear cells as well as osteoclast-like giant cells
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56/a4/PMC8967877/41598_2022_9097_Fig1_HTML.jpg
|
Clinical presentation and tumor histology. (A) CT scan of the head demonstrating large cerebellar tumor causing obstructive hydrocephalus. (B) T1-weighted MRI scan of the brain with contrast showing a heterogenous lesion (red arrow) alongside large cyst (yellow arrow) within the cerebellum. (C,D) T2-weighted (C) and T1-contrast enhanced MRI scan (D) of the brain post-surgery showing near total resection of the tumor. (E) Lower magnification hematoxylin and eosin (H&E) stain of tumor tissue showing expansion and infiltration of normal cerebellum (left) by tumor cells (right). (F) Higher magnification H&E stain of tumor demonstrating nuclear pleomorphism (aggressive tumor feature). (G) Higher magnification H&E stain (of dashed box in F) showing nuclear pleomorphism (black arrows). (H) The tumor also demonstrates pseudopalisading necrosis (black arrows), a histopathological feature of glioblastoma multiforme. (I,J) Immunohistochemistry showing glial origin for tumor based on glial fibrillary acid protein (GFAP) expression (I) and a highly proliferative lesion based on approximately > 30–40% Ki-67 antigen expression in tumor cells imaged at medium power (J).
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30/28/PMC8068401/diagnostics-11-00672-g001.jpg
|
Initial scan: 18F-FDG-PET/MRI (T2 weighted) fused images (top row) transaxial, coronal and sagittal view, positron emission tomography (PET) images (middle row) and MRI (T2 weighted) images (bottom row). Suspicious lesion in the bladder wall is marked with blue arrows. 12-year-old previously healthy boy presents with pain in the left flank and dysuria 2 weeks prior to admission. The patient had also noticed a small skin lesion near the external urethral orifice, but no sign of macroscopic hematuria, urine retention or fever. Furthermore, the patient reported episodes of vomiting, intermittent headache, low appetite and a weight loss of 5 kg. The patient had no known allergies besides light seasonal allergic symptoms. At referral to the pediatric surgical department, a minor palpation of the abdomen caused severe pain in the area of the left kidney and less of the right kidney. Blood pressure was 166/102 mmHg (normal range <122/76 mmHg), p-creatinine was initial 127 micromol/L increasing to 137 micromol/L (normal range: 39–68 micromol/L) p-potassium 4.6 mmol/L increased to 5.0 mmol/L (normal range: 3.3–4.3 mmol/L) and urine-test positive for leucocytes and protein. Ultrasound (US) showed bilateral hydronephrosis with dilated ureters down to the bladder, most prominent on the left side, and reduced cortical thickness of the left kidney. The wall of the bladder was thickened with a prominence in the bottom. Computed tomography (CT) of the abdomen and pelvis confirmed the US findings. Cystoscopy (CS) revealed what could represent a polypoid rhabdomyosarcoma-alike tumor in the trigonum area mostly towards the right side. Multiple biopsies were taken, a double JJ-stent placed on the left side, a nephrostomy on the right side and a catheter. Due to suspicion of malignant disease a whole-body 18F-FDG-PET/CT combined with a 18F-FDG-PET/MRI of the pelvis was performed. 18F-FDG-PET/CT/MRI showed high uptake (SUVmax 9.9) in the top of the bladder, in the trigonum area and more inhomogeneous uptake posterior and in the ureters (Figure 1). Additionally, focal 18F-FDG-uptake in the liver hilum was also found and could represent malignant lymph nodes (Figure 2). This supported the initial tentative diagnosis of malignant disease. Renography showed split function right 76 %/left 24 % with severe delay on the left side and normal clearance. However, the final results of the biopsies from the urinary bladder revealed histological inflammation and eosinophilic cystitis. To confirm the benign findings, despite the malignant suspicion on CS and several imaging modalities, CS was repeated and biopsies were obtained again. US of the abdomen, like 18F-FDG-PET/CT/MRI, found two small lymph nodes in the liver hilum, but neither of them suspicious of malignancy on US and they could not be biopsied. Meanwhile, tests for concurrent parasitic infection were negative. The second set of biopsies confirmed the diagnosis of eosinophilic cystitis and thus, the patient was treated with high-dose Prednisolone. The increased 18F-FDG-uptake of the lymph nodes in the liver hilum, seen on the primary 18F-FDG-PET/CT/MRI-scan, were then interpreted as inflammatory. After 3 months of therapy, follow-up CS and 18F-FDG-PET/CT significantly showed the benefit of the treatment and now complete remission to normalization (Figure 3 and Figure 4), although the renography showed split function right 71%/left 29% with normalization of the earlier delay on the left side. To our knowledge, there is only one previously published case report describing eosinophilic cystitis (EC) mimicking pediatric rhabdomyosarcoma (RMS) with high uptake on 18F-FDG-PET and MRI, and thickening of the bladder wall on US, CS and CT, and our studies are furthermore performed in hybrid scanners as 18F-FDG-PET/CT/MRI [1]. The presenting symptoms of EC are hematuria, urine retention, dysuria, suprapubic pain and some have constitutional symptoms, which may increase the suspicion of a malignant disease [2]. Boys are more frequently affected than girls and approximately 30% of patients have a history of other allergic manifestations [3,4], however, this proportion is similar to the general prevalence of allergic conditions in the pediatric population. In conclusion, EC should be kept in mind regarding a differential diagnosis to RMS. This especially when symptoms, findings and imaging modalities can refer to both EC and RMS, but only histopathology can determine the final diagnosis and, in this case, biopsy was repeated in order to rule out malignancy. The uptake of 18F-FDG is higher and more homogeneous than most RMS, which is why EC should be kept in mind when this is seen. Moreover, studies are suggesting that 18F-FDG-uptake rate could be a potential future biomarker for therapeutic response in eosinophilic inflammation of the airway walls for non-invasive monitoring of asthma, raising the awareness whether it could also apply for monitoring of the therapeutic response and assisting the diagnosis in EC as well. Thus, further research within this field is needed [5].
|
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94/4f/PMC3655303/kjr-14-470-g001.jpg
|
Cervical meningeal melanocytoma with benign leptomeningeal spread in 37-year-old man. Cervical spinal meningeal melanocytoma in 37-year-old man. A. Non-enhanced cervical spinal CT image shows well-defined intraspinal mass (arrow) being hyperdense in relation to muscular tissue. B. Contrast-enhanced CT image shows homogeneously contrast enhancing intraspinal mass (arrow). C. Sagittal T1-weighted MR image reveals mass having homogeneous high signal intensity, which is consistent with T1-shortening effect of melanin (arrow). D. On sagittal T2-weighted image, majority of mass reveals low signal intensity and intradural extramedullary location at C5-C6. Compressed spinal cord shows intramedullary high signal intensity. E. After administration of contrast media, enhanced T1-weighted image (T1WI) shows homogeneous and strong hyperintensity of tumor. Visual assessment of degree of tumoral contrast enhancement is limited due to strong T1 hyperintensity of mass on unenhanced T1WI. Photomicrographs of cervical spinal meningeal melanocytoma from 37-year-old man. F. Microscopic examination shows tumor cells containing large amounts of melanin pigment and consequentially obscuring details of cells (H&E stain, × 400). G. After melanin bleaching, spindle cells with minimal cytologic atypia are seen (H&E stain, × 400). H. Immunohistochemical exmination shows tumor cells stained strongly positive for S-100 protein (× 400). Postoperative lumbar spinal MR images. I. Initial thoracolumbar MRI (2 weeks after first operation). Sagittal fat suppressed gadolinium enhanced T1-weighted image (T1WI) shows diffuse leptomeningeal enhancements (curved arrow) and small enhancing nodules (arrow) in cauda equina suggesting leptomeningeal spread. J. Repeated lumbar MRI (5 weeks after first operation). Sagittal fat suppressed gadolinium enhanced T1WI shows markedly extensive intraspinal masses with diffuse contrast enhancements in lumbosacral region (arrows). Postoperative brain MR images. K. Initial brain MRI (2 weeks after first operation). Axial fat supressed gadolinium enhanced T1-weighted image (T1WI) reveals no abnormal intracranial contrast enhancement or Hydrocephalus. L. Repeated brain MRI (4 weeks after first operation). Axial fat suppressed gadolinium enhanced T1WI shows newly developed hydrocephalus with mild leptomeningeal enhancements along cranial surface including left sylvian fissure (arrow), representing leptomeningeal seeding. M. Follow-up brain MRI (7 weeks after first operation). Axial fat suppressed gadolinium enhanced T1WI shows persistent hydrocephalus with diffuse leptomeningeal enhancements along cranial surfaces, brainstem and intracranial cranial nerves (arrow). N. Photomicragraph of surgical specimen of leptomeningeal seeding mass shows that mass is composed of histologically benign cells (H&E stain, × 400).
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42/1e/PMC9163949/jcn-18-367-g001.jpg
|
Brain MRI and pathologic findings of the patient with primary CNS lymphoma. Asymmetrical subcortical white-matter hyperintensities extending from the pons up to the corona radiata with some invasion to the thalamus and basal ganglia on axial fluid-attenuated inversion recovery (FLAIR) sequences were noted (A). Bilateral hyperintensities along with the corticospinal tracts (i.e., wine-glass sign, arrows) were seen on coronal T2-weighted imaging from the corona radiata to the pons (B). The lesions exhibited no gadolinium enhancement in T1-weighted imaging (C). Biopsy samples (D) histologically demonstrate infiltration of atypical large lymphocytes within the perivascular space in hematoxylin/eosin (H&E) staining, and the immunohistochemical markers indicate diffuse large-B-cell lymphoma: CD20 positive, CD3 negative, and MUM1 positive, and Ki-67 positive. The Ki-67 positivity rate was 90%.
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f0/91/PMC9299438/fimmu-13-918613-g001.jpg
|
Radiological and histological features of the patient suffering from Erdheim–Chester disease (ECD) at diagnosis. (A) Axial brain MRI showing hyperintense signal in the pons on T2-FLAIR sequence. (B) Axial CT scan showing sheathing of aorta adventitia. (C) Axial CT scan showing bilateral perinephric fat infiltration defined as “hairy-kidney”. (D) Axial heart MRI showing a right atrium mass suggestive of a pseudo-tumor. (E) Sagittal 18F fluorodeoxyglucose positron emission tomography demonstrating radiotracer uptake in meta-diaphysis. (F) Histopathological analysis of a CT scan-guided peri-renal adipose tissue biopsy showing massive infiltration by numerous foamy histiocytes and small lymphocytes, with features of cyto-steatonecrosis (HES, magnification ×300). (G) Similar biopsy sample with immunostaining showing CD163-positive histiocytes (brown staining, magnification ×300). (H) Sample biopsy showing the absence of CD1a-positive cells (brown staining, magnification ×300).
|
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a2/88/PMC3876725/1477-7819-11-269-2.jpg
|
Pre- and postoperative images of Case 2. (A) (B) Preoperative axial computed tomography (CT) scans (one year before admission) showing a high-density lesion with partial destruction of occipital cranium. (C) (D) Preoperative axial magnetic resonance imaging (MRI) scans (admission) of the tumor displaying a nearly equal T1 signal (partially high signal) with peripheral enhancement and extradural extension. The swelling experienced a spurt in growth over one year. (E) (F) Preoperative sagittal MRI scans showing a contrast-enhancing lesion in the occipital region with dural and bony involvement. (G) Preoperative axial MRI scan of the tumor displaying mixed T2 signals. (H) The skin incision during the operation. (I) (J) Postoperative CT scans demonstrating that the tumor was nearly completely resected. (K) Postoperative pathological examination of the tumor. Hematoxylin and eosin (H&E) staining revealed that the tumor consisted of a diffuse or fascicular proliferation of spindle-shaped cells. Mitotic figures were common (×200). (L) Strong, positive immunoreactivity to the antibody vimentin (×200).
|
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57/99/PMC9510170/402_2022_4615_Fig3_HTML.jpg
|
Radiological and histological findings. a, b 31-year-old male patient with a diffuse pathological contrast enhancement of the L2 and paravertebral soft tissue component on axial T2w fat-saturated MRI image (a). Osteolytic destruction of the vertebral body on sagittal CT image (inset). Sagittal T2w fat-saturated image shows bone marrow edema of the vertebral body with epidural abscess and spinal cord compression (b). Timely evolution of the intraosseous abscess formations in the proximal tibia in the 69-year-old-male patient on coronal post contrast T1w sequences baseline MRI (c) and after 1 month (d). Radiological signs of pyogenic arthritis with the osteo destruction of the tibial plateau and newly developed involvement of the distal femur and para-articular soft tissues medially. Antero-posterior plain radiograph of the right elbow in a 20-year-old female patient shows osteo destruction of the humeral capitellum with soft tissue edema (e). 3-dimensional T1w WATS (Water Selective Excitation) coronal image (f) shows a widening of the radio-humeral joint with osteo destruction of the periarticular bones, synovial proliferation, and pathological contrast enhancement of the periarticular soft tissue with abscess formation along the flexor muscles of the forearm (g). Granulomatous inflammation composed of granulomas with central necrotic areas surrounded by the palisading histiocytes involving the bone (h) and the soft tissue (i). Ziehl–Neelsen staining shows scattered acid-fast organisms (i inset)
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10/42/PMC8559620/MCS006109Ked_F1.jpg
|
Clinical history and histopathological findings of the case. (A–G) Timeline showing the treatment course of the patient with corresponding radiographs indicating location and progression of tumors. Initial pretreatment T2 FLAIR axial and coronal MR images (A,B) demonstrate T2 hyperintense nodular tissue along the ependymal surfaces of the lateral ventricles, greater on the left than the right. T1 post-contrast image shows evidence of progression on carboplatin plus vincristine therapy (C). Following initial entrectinib therapy there is marked reduction in the volume of tumor on axial T2 FLAIR imaging (D). Post-gadolinium axial T1 images (E) reveal disease progression with new enhancing nodular tissue in the sylvian fissure. The image in panel F also shows new T2 FLAIR nodularity at the ventricular margin. Cervical spine sagittal T1 post-gadolinium imaging (G) revealed new leptomeningeal tumor along the dorsal surface of the cord. (H–K) Histology and immunophenotype of the diagnostic excisional biopsy at clinical presentation. Hematoxylin and eosin (H&E)-stained sections showed a predominantly epithelioid neoplasm with spindled and myxoid areas and delicate fibrillary processes (H; scale bar, 100 microns). Most of the tumor cells showed abundant eosinophilic cytoplasm, moderately pleomorphic nuclei, and conspicuous nucleoli (I; scale bar, 20 microns). Immunoreactivity for glial fibrillary acidic protein (GFAP; J) and Olig-2 (K; scale bar, 100 microns applies to J and K). (L) Domain organization for ETV6, NTRK3, and ETV6-NTRK3 fusion. Exons 1–4 of ETV6 and exons 14–20 of NTRK3 form the final fusion product. The helix-loop-helix (HLH) of ETV6 and the tyrosine kinase domain (TKD) of NTRK3 are maintained in the ETV6-NTRK3 fusion. (M–P) H&E stained sections of postmortem tumor samples. Nodules of cerebral hemispheric disease showed a densely cellular, markedly pleomorphic glioma with brisk mitotic activity and focal necrosis (Nec), and limited infiltration of adjacent brain cortex (C) and white matter (WM) (M–N; scale bars, 500 microns). On higher magnification, frequent mitotic figures (arrowheads) were noted, with tumor cells showing high nuclear to cytoplasmic ratios and vesicular chromatin (N; scale bar, 50 microns). A section of spinal leptomeningeal disease showed limited infiltration of the spinal cord (SC) parenchyma, and a coating of pleomorphic tumor encasing the spinal nerve roots (NR) (P; scale bar, 100 microns).
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c5/10/PMC9514420/jksr-82-936-g001.jpg
|
A 51-year-old male with Langerhans cell histiocytosis in the mid-portion of right clavicle.
A. Right clavicular antero-posterior plain radiography showing a small osteolytic lesion (arrow) with no sclerotic margin and definite cortical disruption in the inferior margin of the mid-portion of the bone. B. A coronal, reformatted CT image showing a focal osteolytic lesion (arrow) with cortical destruction and inferiorly protruding soft tissue mass along the inferior margin of the mid-portion of the right mid-shaft clavicle. C. Fat-saturated T2-weighted axial (upper left) and sagittal (upper right) MR images show ill-defined focal high signal intensity (arrow) with diffusely increased T2-weighted high signal intensity in the adjacent bone marrow. The adjacent soft tissue also shows diffuse, infiltrative, edematous, increased signal intensity. T1-weighted coronal image (lower left) shows a focal low signal intensity (arrow) in the right mid-shaft clavicle. A T1-weighted fat-suppressed contrast-enhanced image (lower right) shows diffuse, homogenous enhancement of the mass lesion (arrow) and adjacent soft tissue in the right mid-shaft clavicle. Adjacent bone marrow shows mild diffuse enhancement. D. Technetium 99m-methyl diphosphonate bone scan shows an intense focus of radioisotope accumulation within the mid-portion of the right clavicle. E. PET/CT shows a maximum standardized uptake value of 3.6 in the mid-portion of the right clavicle (arrow). F. The photomicrography (left, scan view) of H&E-stained tissue shows multiple bone and fibrovascular tissue fragments. Scanning photomicrography (middle, × 40, H&E stain) shows aggregations of oval-shaped cells with complex folded nuclei, finely dispersed nuclear chromatin, and abundant cytoplasm (arrowheads). Eosinophils are abundantly present, producing eosinophilic microabscesses. Immunohistochemical staining (right, × 40) is positive for S100 protein. H&E = hematoxylin and eosin
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7b/d1/PMC9935967/jksr-84-304-g001.jpg
|
Extrapleural malignant solitary fibrous tumor of the pleura in a 88-year-old male patient who presented with back pain and had a history of pneumonectomy due to pulmonary tuberculosis. A. Axial (left) and coronal (right) contrast-enhancing chest CT scans demonstrate infiltrative bilateral paravertebral enhancing masses at T6-7 levels (white arrows) with extension into the central spinal canal. However, there is no neural foraminal widening (black arrows). Bony erosion is seen at the costovertebral junction of the left 6th rib (arrowhead). Left pneumonectomy status is noted with a large expansile fluid collection in the left hemithorax and partially calcified uneven pleural thickening. B. Axial T1-weighted MR image (left) and T2-weighted MR image (right) display diffuse T1 low and T2 heterogeneous high signal intensity space occupying lesions in both paravertebral aspects at the T6 level (white arrows) with direct invasion into the epidural space of the spinal canal. There is no definite evidence of bony cortical destruction or widening of the neural foramen at the T6 level (black arrows). Combined bone marrow signal intensity changes of the T6 vertebral body and the left posterior arc of the 6th rib are noted (arrowheads). C. The paravertebral masses show intense FDG uptake on fluorine-18-FDG PET/CT. D. CT-guided coaxial needle biopsy was performed for the left paravertebral mass at the T6 level. E. Microscopic findings show hypercellular proliferation of spindle cells with “staghorn” vascular spaces (left, H&E stain, × 100). Significant pleomorphism and atypical mitosis can be noted (arrow) (right, H&E stain, × 200). F. Immunohistochemistry shows positive staining for CD99 (left, × 200) and negative for CD34 (right, × 200). FDG = fluorine deoxyglucose, H&E = hematoxylin & eosin
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c9/d5/PMC9600283/curroncol-29-00595-g003a.jpg
|
(A) CT scan shows a hyperdense pineal gland mass with no calcification (arrow). (B) SE T1W MRI shows an isointense lesion with peripheral areas of hyperintensity. (C) Post-contrast T1W MRI shows enhancement of the lesion (arrow). (D) T2WI in coronal plan shows a low signal intensity behavioral appearance of the lesion. (E) Diffusion weighted images show bright signal indication diffusion restriction (ADC not shown) (F) Post-contrast T1W MRI after the first resection shows gross total resection. (G) Follow-up MRI T2 WI shows a recurrent lesion in the posterior inferior aspect of the third ventricle (arrow) with mass effect. (H,I) Post contrast T1W MRI in axial and sagittal shows the recurrent lesion. Histologic features of the tumor assessed by routine hematoxylin and eosin staining demonstrate (J) a mainly solid growth pattern with round-oval nuclei and abundant clear cytoplasm and (K) short columnar perivascular cells with clear cytoplasm. (L) DNA methylation class PTPR Group A.
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49/d3/PMC4603812/12883_2015_452_Fig1_HTML.jpg
|
Radiological and pathological study of the patient. CT scan (a, b) before surgery displayed an irregular hypo-density mass extending from the suprasellar cistern to the anterior horn of left ventricle, with fluid-fluid level formation. MRI scan (c-e) revealed multiple hypointense lesions in the anterior horn of both ventricles and over the sulci. The major lesion in the left anterior horn displayed a low to high stratified signal on T1-weighted image (c), slightly high to high on T2 weighted image (d) and no enhancement after contrast administration (e). Intraoperatively, the tumor was found to be cystic in nature with a yellowish lipoid content (f). Hematoxylin and eosin staining (g, magnification × 40) of the capsule demonstrated stratified squamous epithelium supported by an outer layer of collagenous connective tissue. The immunohistochemistry (h, magnification × 400) of tumor capsule displayed strong positive staining of CA 199
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69/97/PMC9008729/fonc-12-862243-g003.jpg
|
Medical imaging, pathological and immunohistochemical pictures of metastatic thoracic adamantinoma in case 2. (A, B) MRI of the thoracic spine demonstrates vertebral body destructive changes from T1-T4 and pathologic fracture of T2 vertebral body. Thoracic lesions were T2-weighted hyperintense signal (A), and post-contrast enhancement (B). (C) Thoracic CT shows that the T2 lesion has a mixed lytic/sclerotic appearance with paravertebral soft tissue mass. (D) Postoperative X-ray of the spine shows the patient underwent posterior thoracic decompression (T1-T3), partial vertebrectomy (T2), posterior fixation and fusion (C5-C7, T4-T6) with bone cement and pedicle screw. (E) Two months after surgery, contrast-enhanced MRI scan reveals an increase in osseous destruction and paravertebral mass size. (F) Microscopically, the tumor tissue was composed of prominent epithelial cell islands and admixed with bland spindle cells. Some epithelial islands were tubular cells (△), surrounded by spindle-shaped fibrous stromal cells (☆) (Scale 100μ). (G) Microscopically, the epithelial cell islands of the tumor tissue diffusely infiltrated between the trabecular bone in the form of nests (☆), and the trabecular bone was destroyed (Scale 100μ). (H) Mitotic phases were uncommon (yellow arrows) (Scale 100μ). (I) The tumor cells were positive for AE1/AE3 (★). The stromal cells were negative for AE1/AE3 (☆) (Scale 100μ).
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e8/ce/PMC8811062/41598_2022_5831_Fig2_HTML.jpg
|
Indolent enhancing spinal lesion (IESL)—Case 2. An 11-year-old boy with medulloblastoma of the cerebellum (a,b) had undergone surgical resection and chemoradiotherapy. Sagittal contrast-enhanced T1WI revealed multiple enhancing foci in the cervical to thoracic spine 15 months after the diagnosis (c,d). Focal leptomeningeal seeding was noted at the C1 level (c, black arrow). In the follow-up MRI 33 months after brain tumor surgery, sagittal contrast-enhanced T1WI revealed significantly progressive changes in the lesion at vertebrae T11 with a target enhancement pattern (e, arrow). The lesion exhibited hypointensity on T1WI (f) and hypointensity on T2WI (g). Several enhancing lesions were also present at the temperoparietal skull bone of the brain MRI (h). On axial images, the T11 lesion had strong enhancement on contrast-enhanced MRI T1WI (i) and osteoblastic changes on the CT scan (j). CT-guided biopsy of the T11 lesion showed mild marrow fibrosis, adipose tissue filled in the marrow spaces, and scattered hematopoietic cells (H&E staining) (k,l).
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92/cf/PMC7815655/gr1.jpg
|
a) Ultrasound image showing the parathyroid adenoma as an oblong hypo-echoic and capsulated lesion with signal color-Doppler of monopolar vascular pattern referred to as the arc or rim sign, posterior-inferiorly to the left thyroid lobe; b) Axial T2 IDEAL Fat Suppressed MRI image depicting hyperintense parathyroid adenoma posterior-inferiorly to the left thyroid lobe, and separated from the thyroid gland (arrow); c) 99-mTc sestamibi scan demonstrating a residual uptake on left side 2 h after the radiotracer administration (arrow); d) X-ray image of the skull showing an osteolytic lesion with lobulated margin in the right parietal bone (arrow); e) Sagittal post-contrast T1-weighted MRI image showing enhancement of the parathyroid adenoma and of the jaw brown tumor (arrow); f) 99-mTc scan demonstrating uptake of the jaw bone and of the right parietal lobe of the skull (arrow).
|
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}
] |
ab/c9/PMC4726837/jbr-30-01-075-g001.jpg
|
Radiological and pathological examination of a 10-year-old girl with alveolar soft part sarcoma of the orbit. A and B: Axial T1WI and T2WI MR show a left orbit mass which contains flow void signal. C: CT shows a well-circumscribed, irregular mass in the lower outer quadrant and no obvious bone destruction is found. D and E: Axial and coronal contrast-enhanced fat-suppressed T1WI MR shows markedly heterogeneous enhancement. F: Microscopic examination shows that the tumor is composed of round cells with mild nuclear pleomorphism, and the tumor cells are arranged in sheets separated by septa of vascularized fibrous connective tissue (H&E, magnification, ×100). G and H: Immunohistochemitry shows positive staining of the tumor cells for MyoD (+) and destin (+) (magnification, × 100).
|
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"tokens": [
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}
] |
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