Problems in the radiologic diagnosis of renal parenchymal tumors

There has been a great increase in the detection and earlier diagnosis of a host of renal parenchymal tumors because of the continued improvement in imaging studies. Although this change will tend to improve the cure rate of renal cell carcinoma, it also has uncovered many cases that are problematic in both diagnosis and management. It is hoped that performance of high-quality examinations and the experience gained in dealing with these cases have improved our ability to diagnose and manage these problematic cases successfully.

Color flow mapping and Doppler velocimetry in the diagnosis and management of a placental chorioangioma associated with nonimmune fetal hydrops

BACKGROUND

Placental chorioangiomas are the most common tumors of the placenta, occurring in 1% of all pregnancies. With the increasing use of ultrasound, prenatal recognition of these tumors is becoming more common.

CASE

A 36-year-old woman presented at 28 weeks' gestation with an intrauterine mass suggested by color flow and Doppler studies to be a vascular tumor. Because of the association of these findings to nonimmune fetal hydrops, management included umbilical blood sampling and intravascular transfusion for fetal anemia. This intervention temporarily corrected the hydrops and significantly prolonged the pregnancy.

CONCLUSION

Color flow mapping and Doppler flow studies of intrauterine tumors associated with fetal nonimmune hydrops can be helpful in both diagnosis and management.

Fine-needle aspiration cytology of sclerosing hemangioma of the lung: case report with immunohistochemical study

Sclerosing hemangioma of the lung (SHL) is a rare benign neoplasm, usually found incidentally on a routine chest X-ray. We present a case of SHL initially diagnosed by fine-needle aspiration cytology. Cytomorphologic characteristics were confirmed by a cell block examination and immunohistochemical findings. The differential diagnoses of the fine-needle aspiration are discussed.

Hemangiomas of the maxillofacial area. Usefulness of 99Tcm-labelled red cell scintigraphy

Recent work reports the usefulness of radionuclides in the study of hepatic hemangiomas. In particular, 99Tcm-red blood cell (RBC) scintigraphy is useful to evaluate the vascularization and to plan the therapy. The aim of this paper is to confirm the usefulness of 99Tcm-RBC scans in the detection and follow-up of maxillofacial hemangiomas. Results using this technique in a selected group of patients with maxillofacial hemangiomas are reported.

Radiosurgery for venous angiomas

Radiosurgical treatment with the gamma knife for venous angiomas was used as an alternative to microsurgical removal in order to avoid abrupt cessation of venous drainage, which may be shared by the venous angioma and important parts of the brain. Thirteen cases of venous angioma were treated between 1977 and 1991. In two cases cavernous angiomas were also present and in one case a distant arteriovenous malformation (AVM) was also found. In two cases the angioma shared the venous drainage with an adjoining AVM; this is the first description of such pathology. For venous angiomas irradiation was prescribed to cover at least the convergence of the medullary veins. For AVM's close to a venous angioma the treatment was exclusively prescribed to the AVM nidus. After treatment, complete obliteration of the venous angioma was observed in one case, partial obliteration was observed in three cases, and five venous angiomas were unaffected by the treatment. Undue effects of radiation occurred in four cases: one focal edema and three radionecroses. Extirpation of the radionecrotic tissue 6 months after radiosurgery was necessary in one case. In the other three cases, the venous angioma was observed to be completely or partially obliterated, or unaffected by the treatment (one case each). In two cases of combined AVM and venous angioma, complete obliteration of the treatment AVM nidus was obtained. It is concluded that radiosurgery for venous angioma, although conceptually attractive, still does not fulfill the rigid criteria of minimal risk which must be set for the treatment of a lesion with a benign natural history.

Placental chorioangioma: prenatal diagnosis and clinical significance

We report the prenatal diagnosis of placental chorioangioma in a 32-week intrauterine pregnancy associated with polyhydramnios and enlarged fetal cardiac size that resulted in intrauterine fetal death. Ultrasound appearance, pathophysiology, and clinical significance of this entity are discussed.

A study of blood supply of liver tumors using duplex Doppler ultrasound and color Doppler flow imaging

With the use of duplex Doppler ultrasound and color Doppler flow imaging (CDFI), the characteristics of blood supply in neoplasma were studied in 51 cases of 60 liver tumors, and compared with the results of surgery, pathological examination and hepatic arterial angiography. The result showed that: 1. Doppler blood flow signals could be detected in all hepatic carcinomas, and in 10 cases of 18 hemangiomas, significant difference was observed (P < 0.001); 2. Doppler blood flow spectra showed pulsatile pattern in 41 of 42 hepatic carcinomas, and in 6 of 10 hemangiomas (P < 0.01); and 3. the peak flow velocity was obviously lower in hemangioma group than in hepatic carcinoma group (20.34 +/- 23.93 vs 64.74 +/- 30.18 cm, P < 0.001). The characteristics of CDFI show that hemangiomas and hepatocellular carcinomas are different. It can, therefore, be concluded that the blood supply of hepatic carcinomas mainly comes from hepatic arterial system, and is of value in duplex Doppler ultrasound and CDFI.

[The "blue rubber bleb nevus" (Bean's syndrome): uncommon cause of gastrointestinal bleeding]

A ten year old boy had six cutaneous angiomas and recurrent rectal bleeding responsible for iron deficiency anemia. Histological examination established the diagnosis of blue rubber bleb naevus syndrome. Endoscopy, arteriography, computed tomography, and angioscintigraphy disclosed additional angiomas in the stomach and rectum and along the blood vessels in the lower limbs. The value of angioscintigraphy for identifying angiomas escaping detection by other means was illustrated in this case. Embolization of the inferior mesenteric artery was successful in preventing further rectal bleeding. Treatment of this disorder remains controversial.

Vulvar angioleiomyoma

A rare case of vulvar angioleiomyoma was diagnosed, and examined by electron microscope. The tumor cells appeared to be derived from pericytes. Intracytoplasmic inclusions, which are sometimes observed in infantile digital fibroma, were noted in the myofibroblasts.

Flow characteristics of hepatic tumors at color Doppler sonography: correlation with arteriographic findings

OBJECTIVE

We studied benign and malignant hepatic tumors with color Doppler sonography and arteriography in order to correlate color Doppler flow characteristics with tumor hemodynamics (vascularity, arteriovenous shunting, and portal vein involvement) shown by arteriography. We also evaluated the usefulness of color Doppler flow characteristics in discriminating between tumor types.

SUBJECTS AND METHODS

We performed color Doppler sonography and hepatic arteriography in 58 patients with 72 hepatic lesions larger than 2.0 cm in diameter. Differences in pulsatile flow (peritumoral or intratumoral) and the highest systolic peak flow velocities reached were evaluated on color Doppler sonograms and compared with arteriographic findings.

RESULTS

Color flow sonograms were obtained in 43 of 45 hepatocellular carcinomas, 15 of 16 cholangiocellular carcinomas or hepatic metastases, and six of 11 hemangiomas. Mixed peritumoral and intratumoral pulsatile flow was shown by arteriography in highly vascular tumors. The mean peak systolic flow velocity seen in hepatocellular carcinomas (0.52 m/sec) significantly exceeded the velocity seen in hemangiomas (0.16 m/sec), but not the velocity seen in other malignant hepatic tumors (0.51 m/sec). Six hepatocellular carcinomas, one cholangiocellular carcinoma, and two hepatic metastases with peak systolic flow velocities greater than 0.80 m/sec were each proved arteriographically to have arteriovenous shunting or portal vein involvement.

CONCLUSION

Color Doppler sonography was useful for evaluating hepatic tumor hemodynamics as seen at arteriography, and peak systolic velocity may be useful in differentiating malignant hepatic tumors from hemangiomas.

[The infiltrating angiolipoma--a rare soft tissue tumor with a malignant appearance]

Angiolipomas are rare benign soft tissue tumours that are mostly encapsulated by fibrous tissue. A case of an infiltrating angiolipoma with mixed vascularisation, not surrounded by a capsule, is described. Differentiation between lipoid degenerated fibromas, lipoid histiocytoses and haemangiomas is radiologically possible with an extensive security and enables an adequate choice of the surgical procedure.

Improved evaluation of technetium-99m-red blood cell SPECT in hemangioma of the liver

This paper reports the results of a prospective study carried out to evaluate a new reading method of tomographic 99mTc red blood cell (RBC) imaging in liver hemangiomas. For this purpose, assessment of planar imaging and conventional, static 99mTc-RBC SPECT presentation (x-ray type film) (Method 1) was compared to a dynamic three-view display of SPECT slices (Method 2) in 21 patients with 56 hemangiomas and 18 patients with malignant liver lesions. Of the 56 hemangiomas, 47 were diagnosed by US, 6 by CT and 56 by MRI. Twenty-nine (52%) hemangiomas were detected by planar scintigraphy and 38 (68%) by SPECT Method 1, whereas 53 (95%) were visualized by SPECT Method 2. Comparing Methods 1 and 2 in hemangiomas < or = 1.0 cm, 1.1-2.0 cm and 2.1-3.0 cm in diameter, Method 2 improved sensitivity from 18% to 82%, 50% to 93% and 82% to 100%, respectively. The smallest hemangioma detected with Method 2 was 0.5 cm in diameter; with Method 1, 0.9 cm; and with planar imaging, 1.0 cm. As assessed by evaluation of the metastases and carcinomas, the specificity for hemangioma was 100%, independent of the method applied, resulting in a positive predictive value of 100%. This study suggests that evaluation of dynamically displayed 99mTc-RBC SPECT studies is superior to conventional reading of static display and comparable to MRI in liver hemangioma > or = 1 cm. Therefore, this approach is suggested as an alternative to MRI for confirming the diagnosis of liver hemangioma > or = 1 cm if planar imaging is negative. This option is available with most modern computer software systems and saves additional disbursement.

Acquired spinal stenosis secondary to an expanding thoracic vertebral hemangioma

Intraosseous hemangioma is a slow-growing primary benign neoplasm of capillary, cavernous, or venous origin. The most common type is the cavernous hemangioma, composed of large thin-walled vessels and sinuses lined by endothelial cells. Although found in any bone, hemangioma is most common in the vertebrae, where it represents 2-3% of all radiographically detectable spinal tumors. Most spinal hemangiomas are solitary, asymptomatic lesions of the vertebral body, with 10-15% showing concomitant involvement of the posterior elements. Rarely, the lesion is located to the posterior arch. An unusual case of an expanding vertebral hemangioma isolated to the posterior elements of T9 is presented.

Tumors and aneurysms of the upper extremity

A group of surgical abnormalities more diverse than vascular tumors would be difficult to find. These lesions are growths and are identified by cellular or gross appearance. They range in size from tiny glomus tumors to massive arteriovenous fistulas. This article discusses both congenital and acquired types of vascular tumors.

[Role of 99mTc-labeled RBC SPECT in the diagnosis of hepatic hemangioma--comparison with US, CT and angiography]

The roles of planar imaging and SPECT with 99mTc-labeled RBC, US, Dynamic CT and angiography in the diagnosis of hepatic hemangioma were evaluated. The study group consisted of 18 patients with a total of 40 hemangiomas and 13 patients with a total of 21 non-hemangiomas. Among these patients, 5 patients with a total of 8 hemangiomas and 10 patients with a total of 14 non-hemangiomas were diagnosed by operation and biopsy. In all 40 hemangiomas, sensitivity for planar imaging was 35%, SPECT 50%, US 53%, Dynamic CT 82% and angiography 81%, respectively. When the tumor size was greater than 2.2 cm by SPECT and 2.8 cm by planar imaging, their sensitivity for both methods was 100%. Specificity for planar imaging was 100%, SPECT 95%, US 81%, Dynamic CT 100% and angiography 83%, respectively. One patient with hepatocellular carcinoma diagnosed by angiography showed increased uptake on SPECT. Because of the highest accuracy for SPECT in hemangioma greater than 2.0 cm, SPECT should be considered to be the method of choice for noninvasive diagnosis of hemangioma.

Radiologic-pathologic correlation. Capillary hemangioma of the meninges

Hemangiomas are the most common tumor of the head and neck in children, including intracranial neoplasms. Capillary hemangioma in turn is the commonest type of hemangioma. Our case establishes that its anatomic distribution may include the intracranial compartment. We were unable to distinguish capillary hemangioma from meningioma based on imaging findings alone.