Primary malignant fibrous histiocytoma of the liver MRI findings

Primary malignant fibrous histiocytoma (MFH) is an unusual tumor which involves the deep fascia or skeletal muscles of the extremities or retroperitoneum. It rarely arises in the liver and, to our knowledge, the MRI appearance of primary MFH of the liver has never been reported. We present a patient with primary MFH of the liver and discuss the findings on MRI, CT, and angiography.

Gastric carcinoma after gastrojejunostomy for benign disease: radiographic findings

Although it is not well recognized in the radiologic literature, gastric carcinoma has been reported to occur as a late complication of gastrojejunostomy for benign disease, even in the absence of partial gastrectomy. We present the radiographic findings in two patients with this complication and review clinical and experimental data supporting the role of gastrojejunostomy in the subsequent development of gastric carcinoma.

Radiographic appearance of bullet tracks in the lung

Penetrating missile or bullet wounds to the lung result in a number of abnormalities visible on chest radiographs. One finding that is unique to pulmonary parenchyma is the bullet track, which occurs along the course of a bullet as it traverses the lung. A bullet track may occur in the lung because of this organ's low specific gravity and high elasticity. In other tissues, such as liver and brain, that have higher specific gravities and lower elastic content, bullet tracks are rarely, if ever, noted because widespread destruction usually occurs. Bullet tracks may have a delayed appearance on chest radiographs, and thus may cause confusion in interpretation if a history of injury is not elicited. With the increase in violet confrontations in the United States, it is more and more likely that radiologists will be asked to interpret chest radiographs of patients who have had penetrating bullet injuries to the thorax. In this pictorial essay, we illustrate the appearance of bullet tracks in lung on chest radiographs.

Treatment of stages B3 and C seminoma with chemotherapy followed by irradiation therapy. Southwest Oncology Group Study

Beginning in 1981, 28 patients with advanced seminoma were treated with combination chemotherapy followed by irradiation to evaluate the possibility of improved survival using both modalities. The treatment protocol consisted of two courses of vincristine, actinomycin-D, and cyclophosphamide followed by reassessment. Those initially presenting with Stage B3 disease who achieved a complete response to two cycles of chemotherapy then underwent irradiation. All others were given a third course of chemotherapy before undergoing irradiation. The pre-radiation portion of this protocol produced a complete response rate of only 25 percent, substantially less than other, more recent, protocols. Radiation therapy produced a complete response in 69 percent of those who did not achieve a complete response from chemotherapy, increasing the complete response rate from 25 percent to 64 percent. Given this response rate to radiation therapy and the difficulty of dissection and associated morbidity with the surgical excision of postchemotherapy residual masses, the best option at this time may be observation with salvage chemotherapy and/or radiation reserved for those with disease progression.

Low-pressure balloon angioplasty of an occluded portacaval shunt

Safe angioplasty of a portacaval shunt requires particular knowledge of the tissue characteristics of an anastomosis and the behavior of a balloon during inflation. The nature and true diameter of a portacaval shunt anastomosis are more difficult to evaluate than those of a peripheral arterial lesion, and complications are potentially more hazardous than those related to peripheral arterial angioplasty. We suggest that in some instances low pressure and incomplete balloon inflation are all that is necessary to yield safe and satisfactory results.

Phase II evaluation of didemnin B in advanced adenocarcinoma of the kidney. A Southwest Oncology Group study

The Southwest Oncology Group studied the response rate and toxicity of didemnin B (3.47 mg/m2 i.v. q 28 days) in patients with advanced renal cell carcinoma. There were no responses in 22 response evaluable patients. Toxicity was significant with 10 patients having grade 3 or 4 toxicity. Toxicity seen included nausea and vomiting, exacerbation of coronary artery disease, hyperglycemia, anorexia, diarrhea and hepatitis. Didemnin B was toxic but inactive in patients with renal cell treated at this dose.

Squamous cell carcinoma of the maxillary sinus and palate in epidermolysis bullosa: CT demonstration

Extracutaneous squamous cell carcinoma is an unusual complication of epidermolysis bullosa (EB). We present a patient with long-standing EB who developed squamous cell carcinoma involving the palate and the maxillary sinus, and we describe the findings on CT.

Diffuse neonatal hemangiomatosis: imaging findings in two patients

Diffuse neonatal hemangiomatosis is a rare condition in which cutaneous and visceral hemangiomas may coexist. Intra-abdominal involvement occurs commonly and, if untreated, may result in high-output cardiac failure and other life-threatening conditions. We report two neonates with this disease and discuss the radiographic findings and the role of vascular embolization in the treatment of hepatic hemangiomatosis.

Invasive squamous cell carcinoma of the anus arising in condyloma acuminatum: CT demonstration

We present two cases of invasive squamous cell carcinoma of the anus complicating long-standing anal condyloma acuminatum. The computed tomographic (CT) findings are reviewed, and the increasing importance of malignant transformation of anal condylomas is discussed.

Extrusion of PEG tube from the stomach with fistula formation: an unusual complication of percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy (PEG) has become an accepted technique for providing long-term enteral feeding. We report two cases of extrusion of the PEG tube into a short fistulous tract that communicates with the stomach. Although this unusual complication led to difficulty with tube feedings, both patients were asymptomatic, and, in one case, it was possible to reposition another catheter in the stomach via the fistula.

Postoperative atrophy of abdominal wall musculature: CT demonstration

Eleven cases in which CT demonstrated severe unilateral atrophy of abdominal wall musculature were reviewed. All patients had undergone surgery on the ipsilateral side 6 months to 28 years prior to CT. The patterns of muscular atrophy correlated well with the type of incision made and the nature of surgery performed. Denervation injury resulting from surgical incision is the most likely explanation for this finding on CT. Normal innervation of abdominal wall muscle groups is discussed, and the relationship of unilateral muscular atrophy to previous surgical incision is emphasized.

Phase II evaluation of amonafide in renal cell carcinoma. A Southwest Oncology Group study

Twenty four patients with advanced renal cell carcinoma were treated in a phase II trial with amonafide 300-450 mg/m2/day on days 1-5 every 21 days. There were no responders, 6 patients had stable disease, 14 experienced progressive disease and 4 were assumed to be non-responders as no evaluation was performed. There were no fatal toxicities although 8 patients had grade 3 or 4 granulocytopenia, 1 patient had grade 4 thrombocytopenia. Other toxicities included grade 3 diarrhea in 1 patient, grade 3 myopathy in 1 patient, severe nausea and vomiting in 1 patient and a facial rash, possibly a hypersensitivity reaction, in 1 patient. The median survival is 7.5 months. At this dosage and schedule, there is no evidence that amonafide has meaningful anti-tumor activity in patients with advanced renal cell carcinoma.

"Reverse-figure 3" sign in duodenal adenocarcinoma arising in a villous adenoma: radiographic demonstration

The radiographic "reverse-figure 3" sign is a well-known indicator of pancreatic head enlargement. We present a case in which this characteristic sign was produced by an invasive adenocarcinoma of the duodenum that arose in a periampullary villous adenoma.

A phase II trial of recombinant tumor necrosis factor in patients with adenocarcinoma of the pancreas: a Southwest Oncology Group study

Twenty-two evaluable patients with advanced adenocarcinoma of the pancreas, but without prior chemotherapy or immunotherapy, received recombinant tumor necrosis factor (rTNF). rTNF was given as an intravenous infusion over 30 min daily x 5, every 14 days, at a starting dose of 150 micrograms/m2/day. Toxicities included fevers/rigors, nausea/vomiting/anorexia, flu-like symptoms, hypotension, hyperglycemia, anemia, coagulopathy, hepatotoxicity, and hypertriglyceridemia. Laboratory evidence of disseminated intravascular coagulopathy occurred in 11 patients, with only 3 of these patients having clinical manifestations. Two patients suffered from pulmonary emboli. The high incidence of coagulopathy was felt to be, at least in part, disease related. No objective responses were observed with a 95% confidence interval of 0-15%.

Aberrant insertion of the common bile duct into an accessory pancreatic duct: cholangiographic demonstration

Variations in the pancreatic ductal anatomy result from abnormalities in embryological development of the pancreas from ventral and dorsal buds. We describe a case in which cholangiography demonstrated insertion of the common bile duct into an aberrant pancreatic duct. To our knowledge, this finding has not been previously reported in the literature.

Uterine perforation by an intracavitary tandem: CT demonstration

Perforation of the uterus by a tandem device is an important complication of intracavitary radiotherapy for cervical carcinoma. Although the sonographic appearance of this complication is well recognized, its demonstration by computed tomography (CT) has been reported in only a single case. We report a second case and discuss the CT findings.