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Omami G, Yeoh M. Malignant Lesions of the Oral Region. Dent Clin North Am 2024; 68:319-335. [PMID: 38417993 DOI: 10.1016/j.cden.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
This article focuses on the radiographic presentations of various malignant conditions that affect the oral region and delineates the role of CT, MR imaging, and PET in oral cancer imaging.
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Affiliation(s)
- Galal Omami
- Division of Oral Diagnosis, Oral Medicine, and Oral Radiology, Department of Oral Health Practice, University of Kentucky College of Dentistry, 770 Rose Street, MN320, Lexington, KY 40536, USA.
| | - Melvyn Yeoh
- Division of Oral and Maxillofacial Surgery, University of Kentucky College of Dentistry, 770 Rose Street, D-528, Lexington, KY 40536, USA
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2
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Sarcoma Botryoides: Optimal Therapeutic Management and Prognosis of an Unfavorable Malignant Neoplasm of Female Children. Diagnostics (Basel) 2023; 13:diagnostics13050924. [PMID: 36900067 PMCID: PMC10000398 DOI: 10.3390/diagnostics13050924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/05/2023] [Accepted: 02/14/2023] [Indexed: 03/05/2023] Open
Abstract
Embryonal rhabdomyosarcoma (ERMS) is a rare malignancy and occurs primarily in the first two decades of life. Botryoid rhabdomyosarcoma is an aggressive subtype of ERMS that often manifests in the genital tract of female infants and children. Due to its rarity, the optimal treatment approach has been a matter of debate. We conducted a search in the PubMed database and supplemented it with a manual search to retrieve additional papers eligible for inclusion. We retrieved 13 case reports and case series, from which we summarized that the current trend is to approach each patient with a personalized treatment plan. This consists of a combination of local debulking surgery and adjuvant or neoadjuvant chemotherapy (NACT). Effort is made in every approach to avoid radiation for the sake of preserving fertility. Radical surgeries and radiation still have a role to play in extensive disease and in cases of relapse. Despite the rarity and aggressiveness of this tumor, disease-free survival and overall prognosis is excellent, especially when it is diagnosed early, compared with other subtypes of rhabdomyosarcoma (RMS). We conclude that the practice of a multidisciplinary approach is appropriate, with favorable outcomes; however, larger-scale studies need to be organized to have a definite consensus on optimal management.
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Huang W, Zhang Y, Gao G, Li L, Yang Q, Qiu Y, Kang L. Multimodality imaging evaluation of nasal sinus alveolar rhabdomyosarcoma: Two case reports. Front Med (Lausanne) 2022; 9:1047464. [PMID: 36438027 PMCID: PMC9684465 DOI: 10.3389/fmed.2022.1047464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/05/2022] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Rhabdomyosarcoma (RMS) is a common pleomorphic malignant soft tissue sarcoma in children and adolescents that originates from rhabdomyoblasts or mesenchymal precursor cells. Alveolar rhabdomyosarcoma (ARMS) mostly occurs in adolescents aged 10-15 years and is characterized by more aggressive behaviors and worse prognosis than other sarcomas, prone to lymphatic and hematogenous metastasis in the early stage as well as metastasizing to breast, testis, pancreas, and other parts. ARMS often occurs in the limbs and genitourinary system, however, head and neck ARMS are relatively rare when involving the nasal cavity or sinuses. The role of MRI and 18F-FDG positron emission tomography combined with computed tomography (PET/CT) remains to be established in ARMS. CASE REPORT Case 1: An 18-year-old male was found with a left submandibular mass of approximately 1 cm in diameter 2 months ago, which gradually increased in size. CT showed multiple soft tissue masses in maxillofacial and neck regions and the lesions invaded the frontal lobe and the inner wall of the left orbital lobe. MRI showed the masses with hypointensity on T1WI, hyperintensity on T2WI, and diffusion-weighted imaging (DWI) with significant enhancement. 18F-FDG PET/CT showed multiple hypermetabolic lesions located in the maxillofacial, neck region, 3rd lumbar vertebra, and the right sacrum. A nasal endoscopic tumor biopsy and molecular testing finally helped to diagnose the ARMS. Case 2: A 14-year-old male presented with left maxillary pain with nasal congestion and left ocular swelling 15 days ago. CT demonstrated a soft tissue mass in the nasal cavity and sinuses with local protrusion into the left orbit. MRI showed the masses with a slightly low signal on T1WI, a high signal on T2WI, and DWI with significant heterogenous enhancement. 18F-FDG PET/CT showed hypermetabolic lesions in the left maxillofacial and neck regions. ARMS was finally diagnosed by a nasal endoscopic tumor biopsy and molecular testing. The patient had a recurrence of the lesion after chemotherapy and surgical resection and is currently undergoing radiation therapy. CONCLUSION Nasal sinus ARMS is highly malignant with a poor prognosis. Accurate diagnosis relies not only on histopathology and immunohistochemistry examination but also on genetic detection of characteristic chromosomal translocations and fusion genes. Imaging methods, such as MRI and PET/CT can accurately assess the extent of the lesions and metastases, assist in the diagnosis of the disease and the selection of treatment regimens, provide precise localization for surgery, and help with treatment monitoring and follow-up.
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Affiliation(s)
- Wenpeng Huang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Yongbai Zhang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Ge Gao
- Department of Medical Imaging, Peking University First Hospital, Beijing, China
| | - Liming Li
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qi Yang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Yongkang Qiu
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Lei Kang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
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Fisher discriminant model based on LASSO logistic regression for computed tomography imaging diagnosis of pelvic rhabdomyosarcoma in children. Sci Rep 2022; 12:15631. [PMID: 36115914 PMCID: PMC9482627 DOI: 10.1038/s41598-022-20051-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 09/08/2022] [Indexed: 12/03/2022] Open
Abstract
Computed tomography (CT) has been widely used for the diagnosis of pelvic rhabdomyosarcoma (RMS) in children. However, it is difficult to differentiate pelvic RMS from other pelvic malignancies. This study aimed to analyze and select CT features by using least absolute shrinkage and selection operator (LASSO) logistic regression and established a Fisher discriminant analysis (FDA) model for the quantitative diagnosis of pediatric pelvic RMS. A total of 121 pediatric patients who were diagnosed with pelvic neoplasms were included in this study. The patients were assigned to an RMS group (n = 36) and a non-RMS group (n = 85) according to the pathological results. LASSO logistic regression was used to select characteristic features, and an FDA model was constructed for quantitative diagnosis. Leave-one-out cross-validation and receiver operating characteristic (ROC) curve analysis were used to evaluate the diagnostic ability of the FDA model. Six characteristic variables were selected by LASSO logistic regression, all of which were CT morphological features. Using these CT features, the following diagnostic models were established: (RMS group)\documentclass[12pt]{minimal}
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\begin{document}$${G}_{1}=-14.283+6.613{x}_{1}+5.333{x}_{2}+5.753{x}_{3}+12.361{x}_{4}+8.095{x}_{5}-0.715{x}_{6}$$\end{document}G1=-14.283+6.613x1+5.333x2+5.753x3+12.361x4+8.095x5-0.715x6; (Non-RMS group)\documentclass[12pt]{minimal}
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\begin{document}$${G}_{2}=-2.008+3.539{x}_{1}+1.080{x}_{2}+1.154{x}_{3}+2.307{x}_{4}+1.656{x}_{5}+1.380{x}_{6}$$\end{document}G2=-2.008+3.539x1+1.080x2+1.154x3+2.307x4+1.656x5+1.380x6, where \documentclass[12pt]{minimal}
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\begin{document}$${x}_{1}$$\end{document}x1, \documentclass[12pt]{minimal}
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\begin{document}$${x}_{6}$$\end{document}x6 are lower than normal muscle density (1 = yes; 0 = no), multinodular fusion (1 = yes; 0 = no), enhancement at surrounding blood vessels (1 = yes; 0 = no), heterogeneous progressive centripetal enhancement (1 = yes; 0 = no), ring enhancement (1 = yes; 0 = no), and hemorrhage (1 = yes; 0 = no), respectively. The calculated area under the ROC curve (AUC) of the model was 0.992 (0.982–1.000), with a sensitivity of 94.4%, a specificity of 96.5%, and an accuracy of 95.9%. The calculated sensitivity, specificity and accuracy values were consistent with those from cross-validation. An FDA model based on the CT morphological features of pelvic RMS was established and could provide an easy and efficient method for the diagnosis and differential diagnosis of pelvic RMS in children.
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Qasseh REL, Bouyalik F, Majidi S, Moutahir M, Benhassou M, Ennachit M, El Keroumi M. Botryoid rhabdomyosarcoma of the uterine cervix: Report case. Int J Surg Case Rep 2022; 97:107389. [PMID: 35870214 PMCID: PMC9403093 DOI: 10.1016/j.ijscr.2022.107389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/15/2022] [Accepted: 07/03/2022] [Indexed: 02/07/2023] Open
Abstract
Rhabdomyosarcoma of the cervix is among the rare histological types of cervical cancers, which are usually seen in young girls or women in the general active period. The usual circumstances of diagnosis are dominated by recurrent metrorrhagia. At the initial stage, the lesions may be asymptomatic or take on the appearance of a benign polyp. In the case reported here, the clinical symptomatology was recurrent metrorrhagia with a cervical implanted polyp occurring 28 months after resection of a benign polyp. RMS is one of the malignant tumors of mesenchymal origin. Typically, it is a malignant tumor proliferation of cells with morphological and/or phenotypic striated muscle differentiation. The characteristic cells of this tumor are rhabdomyoblasts rhabdomyosarcomas are classified into three histological subtypes: embryonal, alveolar, and anaplastic. Within embryonal RMS, it is possible to distinguish between botryoid, leiomyomatous and anaplastic forms. Botryoid and leiomyomatous forms are classically described as having a more favorable prognosis. Treatment is based on a multidisciplinary approach that includes indications for conservative surgery, chemotherapy, radiotherapy and brachytherapy.
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Affiliation(s)
- R E L Qasseh
- Department of Gynecological-Mammary Surgery, Mohammed VI Center for Cancer Treatment Faculty of Medicine and Pharmacy, Hassan II University, Ibn Rochd University Hospital, Casablanca, Morocco.
| | - F Bouyalik
- Department of Gynecological-Mammary Surgery, Mohammed VI Center for Cancer Treatment Faculty of Medicine and Pharmacy, Hassan II University, Ibn Rochd University Hospital, Casablanca, Morocco
| | - S Majidi
- Department of Gynecological-Mammary Surgery, Mohammed VI Center for Cancer Treatment Faculty of Medicine and Pharmacy, Hassan II University, Ibn Rochd University Hospital, Casablanca, Morocco
| | - M Moutahir
- Department of Gynecological-Mammary Surgery, Mohammed VI Center for Cancer Treatment Faculty of Medicine and Pharmacy, Hassan II University, Ibn Rochd University Hospital, Casablanca, Morocco
| | - M Benhassou
- Department of Gynecological-Mammary Surgery, Mohammed VI Center for Cancer Treatment Faculty of Medicine and Pharmacy, Hassan II University, Ibn Rochd University Hospital, Casablanca, Morocco
| | - M Ennachit
- Department of Gynecological-Mammary Surgery, Mohammed VI Center for Cancer Treatment Faculty of Medicine and Pharmacy, Hassan II University, Ibn Rochd University Hospital, Casablanca, Morocco
| | - M El Keroumi
- Department of Gynecological-Mammary Surgery, Mohammed VI Center for Cancer Treatment Faculty of Medicine and Pharmacy, Hassan II University, Ibn Rochd University Hospital, Casablanca, Morocco
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Sarioglu FC, Sarioglu O, Guleryuz H, Ozer E, Ince D, Olgun HN. MRI-based texture analysis for differentiating pediatric craniofacial rhabdomyosarcoma from infantile hemangioma. Eur Radiol 2020; 30:5227-5236. [PMID: 32382846 DOI: 10.1007/s00330-020-06908-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/04/2020] [Accepted: 04/21/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate the diagnostic performance of MRI texture analysis (TA) for differentiation of pediatric craniofacial rhabdomyosarcoma (RMS) from infantile hemangioma (IH). METHODS This study included 15 patients with RMS and 42 patients with IH who underwent MRI before an invasive procedure. All patients had a solitary lesion. T2-weighted and fat-suppressed contrast-enhanced T1-weighted axial images were used for TA. Two readers delineated the tumor borders for TA independently and evaluated the qualitative MRI characteristics in consensus. The differences of the texture features' values between the groups were assessed and ROC curves were calculated. Logistic regression analysis was used to analyze the value of TA with and without the combination of the qualitative MRI characteristics. A p value < 0.05 was considered statistically significant. RESULTS Thirty-eight texture features were calculated for each tumor. Eighteen features on T2-weighted images and 25 features on contrast-enhanced T1-weighted images were significantly different between the RMSs and IHs. On contrast-enhanced T1-weighted images, the short-zone emphasis (SZE), which was a gray-level zone length matrix (GLZLM) parameter, had the largest area under the curve: 0.899 (sensitivity 93%, specificity 87%). The independent predictor for the RMS among the qualitative MRI characteristics was heterogeneous contrast enhancement (p < 0.001). Using only a GLZLM_SZE value of lower than 0.72 was found to be the best diagnostic parameter in predicting RMS (p < 0.001; 95% CI, 8.770-992.4). CONCLUSION MRI-based TA may contribute to differentiate RMS from IH without invasive procedures. KEY POINTS • Texture analysis may help to distinguish between rhabdomyosarcoma and infantile hemangioma without invasive procedures. • The gray-level zone length matrix parameters, especially the short-zone emphasis, may be a potential predictor for rhabdomyosarcoma. • Using contrast-enhanced T1-weighted images may be superior to T2-weighted images to differentiate rhabdomyosarcoma from infantile hemangioma in texture analysis.
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Affiliation(s)
- Fatma Ceren Sarioglu
- Department of Radiology, Division of Pediatric Radiology, Dokuz Eylul University School of Medicine, Balcova, 35340, Izmir, Turkey.
| | - Orkun Sarioglu
- Department of Radiology, Tepecik Training and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Handan Guleryuz
- Department of Radiology, Division of Pediatric Radiology, Dokuz Eylul University School of Medicine, Balcova, 35340, Izmir, Turkey
| | - Erdener Ozer
- Department of Pathology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Dilek Ince
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Hatice Nur Olgun
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Dokuz Eylul University School of Medicine, Izmir, Turkey
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Ovarian conservation in management of pediatric gynecology malignancies. Curr Opin Obstet Gynecol 2018; 30:316-325. [DOI: 10.1097/gco.0000000000000484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
PURPOSE OF REVIEW Three primary categories of gynecologic cancer are found in pediatric and adolescent patients: stromal carcinomas including juvenile granulosa cell tumors and Sertoli-Leydig cell tumors, rhabdomyosarcomas arising from the vagina and cervix (sarcoma botryoides), and ovarian germ cell tumors which comprise a wide range of histologies. These entities are rare and treatment approaches have focused on decreasing late effects of chemotherapy treatment. Here, we review presentation, histologic classifications, diagnosis, and treatment recommendations for pediatric gynecologic cancers. RECENT FINDINGS Event-free and overall survival for these cancers is high, and the goals of treatment are minimization of morbidity and preservation of fertility with unilateral salpingo-oophorectomies and limited staging. Surveillance of tumor markers after surgery is helpful in monitoring for disease progression and adjuvant chemotherapy is often reserved for patients at recurrence. Recent literature supports avoiding chemotherapy even in high-grade germ cell tumors in the pediatric population.
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Chauhan RS, Singh DK, Guha B, Kumar I, Verma A. Multimodality imaging of vaginal rhabdomyosarcoma. Indian J Radiol Imaging 2017; 27:148-151. [PMID: 28744074 PMCID: PMC5510311 DOI: 10.4103/ijri.ijri_444_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Rhabdomyosarcoma (RMS) is a malignant mesenchymal tumor arising from the embryonal muscle cells (rhabdomyoblasts), and is the most common soft tissue sarcoma in children and young adults accounting for 4-6% of all malignancies in this age group. Though rare overall, embryonal rhabdomyosarcoma is the most common malignancy arising in the pediatric female genitourinary tract with sarcoma botryoides being the most common variant of the tumor. In young and adolescent individuals, the cervix and uterus are affected; whereas in infants, vaginal lesions are more common. Imaging plays a crucial role not only in the initial diagnosis but also in long-term follow-up of genital RMS. We describe a rare case of embryonal rhabdomyosarcoma of the vagina occurring in a 23-year-old female who presented with abnormal vaginal bleeding ever since she was a child.
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Affiliation(s)
- Richa S Chauhan
- Department of Radiodiagnosis and Imaging, Institute of Medical sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Dheeraj K Singh
- Department of Radiodiagnosis and Imaging, Institute of Medical sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Bishwarup Guha
- Department of Urology, Institute of Medical sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ishan Kumar
- Department of Radiodiagnosis and Imaging, Institute of Medical sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ashish Verma
- Department of Radiodiagnosis and Imaging, Institute of Medical sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Up-To-Date Practical Imaging Evaluation of Neonatal Soft-Tissue Tumors: What Radiologists Need to Know. AJR Am J Roentgenol 2017; 209:195-204. [PMID: 28463563 DOI: 10.2214/ajr.16.17576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The purposes of this article are to provide an up-to-date overview of neonatal soft-tissue tumors, including information regarding their unique nature, and to present practical imaging techniques and characteristic imaging findings. CONCLUSION Neonatal soft-tissue tumors are a unique set of neoplasms that often have characteristic clinical and imaging findings. Imaging evaluation, mainly with ultrasound and MRI, plays an important role in the initial diagnosis, staging, preoperative assessment, and follow-up evaluation. Clear understanding of practical imaging techniques combined with up-to-date knowledge of characteristic imaging findings can help the radiologist provide a timely and accurate diagnosis of these neoplasms and can lead to optimal neonatal patient care.
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Abstract
Medical imaging is an important tool in the evaluation and classification of pediatric head and neck masses. Such lesions may include congenital, inflammatory, infectious, vascular, or neoplastic processes. Ultrasound is often the first line modality in the workup of a neck mass in a child, followed by MRI or CT depending on the scenario. This information must be interpreted in the context of the patient's clinical history, physical examination, and demographics. The medical imaging workup of a neck mass in a child must be focused to yield the maximum information possible while minimizing the risks of radiation and sedation.
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Acar T, Harman M, Guneyli S, Gemici K, Efe D, Guler I, Yildiz M. Cross-sectional Imaging Features of Primary Retroperitoneal Tumors and Their Subsequent Treatment. J Clin Imaging Sci 2015; 5:24. [PMID: 25973288 PMCID: PMC4421890 DOI: 10.4103/2156-7514.156135] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 04/08/2015] [Indexed: 02/07/2023] Open
Abstract
Basically malignant tumors in the retroperitoneal region arise from a heterogeneous group of tissues: mesodermal, neurogenic, germ cell, and lymphoid. Although rare, benign tumors and cystic masses can be also encountered in retroperitoneal space. Developments in computed tomography (CT) and magnetic resonance imaging (MRI) have contributed to both diagnosis and staging of the retroperitoneal tumors. High spatial resolution and superiority in calcification make CT indispensable; on the other hand, MRI has a better soft-tissue contrast resolution which is essential for the assessment of vascular invasion and tissue characterization. The aim of this article is to review the CT and MRI features of retroperitoneal tumors and their subsequent management.
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Affiliation(s)
- Turker Acar
- Department of Radiology, Mevlana University School of Medicine, Konya, Turkey
| | - Mustafa Harman
- Department of Radiology, Ege University School of Medicine, Izmir, Turkey
| | - Serkan Guneyli
- Department of Radiology, Bulent Ecevit University School of Medicine, Zonguldak, Turkey
| | - Kazim Gemici
- Department of General Surgery, Mevlana University School of Medicine, Konya, Turkey
| | - Duran Efe
- Department of Radiology, Mevlana University School of Medicine, Konya, Turkey
| | - Ibrahim Guler
- Department of Radiology, Konya Education and Research Hospital, Konya, Turkey
| | - Melda Yildiz
- Department of Radiology, Mevlana University School of Medicine, Konya, Turkey
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Zhu J, Zhang J, Tang G, Hu S, Zhou G, Liu Y, Dai L, Wang Z. Computed tomography and magnetic resonance imaging observations of rhabdomyosarcoma in the head and neck. Oncol Lett 2014; 8:155-160. [PMID: 24959237 PMCID: PMC4063592 DOI: 10.3892/ol.2014.2094] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 04/03/2014] [Indexed: 12/29/2022] Open
Abstract
Head and neck (HN) rhabdomyosarcoma (RMS) is an aggressive malignancy, which is rarely encountered and is commonly misdiagnosed as another type of tumor. The aim of the present study was to investigate the computed tomography (CT) and magnetic resonance imaging (MRI) features of HNRMS and analyze the correlations between the imaging observations and the pathological subtypes. A total of 10 HNRMS patients (three males and seven females; median age, 16 years) were reviewed retrospectively by only CT (n=1), only MRI (n=2), as well as CT and MRI (n=7). In addition, the clinical data, imaging observations and pathological results were recorded and analyzed. The origins of the 10 HNRMSs (eight embryonal and two alveolar subtypes) included the ethmoid sinus (n=4), maxillary sinus (n=1), orbit (n=3), nasopharynx (n=1) and frontotemporal subcutaneous area (n=1). On the CT and MRI images, the soft-tissue masses exhibited ill-defined borders (n=9), bony destruction (n=10), multi-cavity growth (n=7) and cervical lymph node metastasis (n=2), whereas calcification and hemorrhaging were not identified. On CT, eight of the HNRMSs appeared slightly hypodense (2/8) or isodense (6/8) with homogeneous enhancement (4/4). On T1-weighted images (WI), nine tumors exhibited isointensity (9/9) and on T2WI, six tumors demonstrated homogeneous hyperintensity with homogeneous enhancement on contrast-enhanced (CE)-T1WI. In addition, three embryonal RMSs, which originated from the ethmoid sinus, exhibited heterogeneous hyperintensity on T2WI and nodule-shaped enhancement patterns on CE-T1WI. The results of the present study indicated that MRI may accurately demonstrate the location and extent of HNRMS and that the imaging features of HNRMS may be similar to those of other tumors. However, a tumor exhibiting heterogeneous hyperintensity on T2WI and a nodule-shaped enhancement pattern on CE-T1WI in the ethmoid sinus may present specific MRI features, which clearly indicates the botryoid subtype of embryonal RMS.
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Affiliation(s)
- Jingqi Zhu
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, P.R. China ; Department of Radiology, East Hospital, Tongji University School of Medicine, Shanghai 200120, P.R. China
| | - Jianhua Zhang
- Department of Radiology, East Hospital, Tongji University School of Medicine, Shanghai 200120, P.R. China
| | - Guangyu Tang
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, P.R. China
| | - Shiyou Hu
- Department of Oncology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Guoxing Zhou
- Department of Radiology, East Hospital, Tongji University School of Medicine, Shanghai 200120, P.R. China
| | - Yongkang Liu
- Department of Radiology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Lingling Dai
- Department of Radiology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Zhongqiu Wang
- Department of Radiology, East Hospital, Tongji University School of Medicine, Shanghai 200120, P.R. China ; Department of Radiology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
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Sarkar D, Ray S, Saha M, Chakrabarti P, Chakrabarti P. Alveolar rhabdomyosarcoma with multiple distal metastases. A case report and review of literature. BMJ Case Rep 2012; 2012:bcr-2012-006523. [PMID: 22948994 DOI: 10.1136/bcr-2012-006523] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An 18-year-old boy, presented with a history of right hip pain with movement restriction and proptosis of right eye. There was severe anaemia, febrile neutropaenia and bleeding manifestations. CT scan of right orbit documented a retro orbital mass. MRI revealed a mass on right side of the pelvis with metastatic deposits in spine. Biopsy from that mass revealed alveolar rhabdomyosarcoma. Bone marrow biopsy showed sarcomatous involvement with decrease in all three cell lineages. Chemotherapy was started according to standard protocol. We lost the patient after 3 weeks of initiation of chemotherapy. In our case, the unusual primary site and presentation with multiple distal metastases makes this case stand apart and therefore worth reporting.
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Affiliation(s)
- Debojyoti Sarkar
- Department of General Medicine, North Bengal Medical College, Darjeeling, West Bengal, India. [corrected]
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Rajiah P, Sinha R, Cuevas C, Dubinsky TJ, Bush WH, Kolokythas O. Imaging of uncommon retroperitoneal masses. Radiographics 2012; 31:949-76. [PMID: 21768233 DOI: 10.1148/rg.314095132] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Retroperitoneal masses not arising from major solid organs are uncommon. Although there is no simple method of classifying retroperitoneal masses, a reasonable approach is to consider the masses as predominantly solid or cystic and to subdivide these into neoplastic and nonneoplastic masses. Because the treatment options vary, it is useful to be able to differentiate these masses by using imaging criteria. Although the differential diagnosis of retroperitoneal masses can be narrowed down to a certain extent on the basis of imaging characteristics, patterns of involvement, and demographics, there is still a considerable overlap of imaging findings for these masses, and histologic examination is often required for definitive diagnosis. Computed tomography (CT) and magnetic resonance (MR) imaging play an important role in characterization and in the assessment of the extent of the disease and involvement of adjacent and distant structures. Familiarity with the CT and MR imaging features of various retroperitoneal masses will facilitate accurate diagnosis and staging for aggressive lesions.
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Affiliation(s)
- Prabhakar Rajiah
- Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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16
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Abstract
After a brief discussion of the rarity of soft tissue sarcomas in children and of the limited ability of magnetic resonance imaging to provide a tissue diagnosis, this article discusses the incidence, presentation, treatment, prognosis, and imaging characteristics of the more common and unusual pediatric soft tissue sarcomas. It begins with extensive discussion of rhabdomyosarcoma, synovial sarcoma, and congenital/infantile fibrosarcoma. It then presents a more abbreviated discussion of uncommon tumors such as alveolar soft part sarcoma, epithelioid sarcoma, extraosseous Ewing's sarcoma, granulocytic sarcoma, hemangiopericytoma, liposarcoma, malignant fibrous histiocytoma, malignant peripheral nerve sheath tumor, and undifferentiated sarcoma.
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Affiliation(s)
- Rebecca Stein-Wexler
- Department of Radiology, University of California at Davis, Sacramento, CA 95817, USA.
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Abstract
Malignant tumours with nasopharyngeal primary location are relatively rare in children. One of the most frequent paediatric neoplasms in this region is the undifferentiated nasopharyngeal carcinoma tumour (UCNT). These tumours are usually revealed by nasal obstruction, headache or cervical nodal involvement. The nasopharyngeal mass can be discovered during an ear-nose and throat examination and confirmed after medical imaging investigation. Diagnostic is obtained by nasopharyngeal mass or cervical nodal biopsy. This tumor has a high chemo and radio-sensibility in children. Irradiation of the cavum and the nodes areas remains as the reference treatment of this disease. Most paediatric protocols add chemotherapy to radiotherapy. The value of concomitant or adjuvant chemotherapy is still debated in paediatric population. It was shown that the T and N staging at diagnosis determined by the classification TNM is a major prognostic factor. Due to the importance of the loco-regional sequelae after irradiation and the satisfactory global prognosis, the actual trend is a decrease in the total dose of irradiation delivered, particularly for patient with a good response to first chemotherapy. This article sheds light on the particularities of UCNT in paediatric patients.
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18
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El Bari S, Chellaoui M, Dafiri R. Primary pleural rhabdomyosarcoma: A case report and literature review. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.ejrex.2010.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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19
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Pathology of the thoracic wall: congenital and acquired. Pediatr Radiol 2010; 40:859-68. [PMID: 20432004 DOI: 10.1007/s00247-010-1604-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Accepted: 01/24/2010] [Indexed: 10/19/2022]
Abstract
This review aims to cover the main congenital and acquired lesions that arise in the thoracic wall of infants and children. Imaging often plays an essential role in the evaluation of symptomatic and asymptomatic thoracic wall abnormalities. The use of appropriate imaging modalities for each condition will be addressed, as well as the range of benign and malignant conditions that can occur.
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20
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Imaging findings in craniofacial childhood rhabdomyosarcoma. Pediatr Radiol 2010; 40:1723-38; quiz 1855. [PMID: 20725831 PMCID: PMC2950273 DOI: 10.1007/s00247-010-1787-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 06/07/2010] [Accepted: 06/14/2010] [Indexed: 12/12/2022]
Abstract
Rhabdomyosarcoma (RMS) is the commonest paediatric soft-tissue sarcoma constituting 3-5% of all malignancies in childhood. RMS has a predilection for the head and neck area and tumours in this location account for 40% of all childhood RMS cases. In this review we address the clinical and imaging presentations of craniofacial RMS, discuss the most appropriate imaging techniques, present characteristic imaging features and offer an overview of differential diagnostic considerations. Post-treatment changes will be briefly addressed.
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22
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23
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Soft tissue sarcomas at a glance: clinical, histological, and MR imaging features of malignant extremity soft tissue tumors. Eur Radiol 2009; 19:1499-511. [DOI: 10.1007/s00330-008-1292-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Revised: 11/26/2008] [Accepted: 12/02/2008] [Indexed: 02/07/2023]
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24
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Van Rijn RR, Wilde JCH, Bras J, Oldenburger F, McHugh KMC, Merks JHM. Imaging findings in noncraniofacial childhood rhabdomyosarcoma. Pediatr Radiol 2008; 38:617-34. [PMID: 18324394 PMCID: PMC2367394 DOI: 10.1007/s00247-008-0751-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 11/26/2007] [Accepted: 01/01/2008] [Indexed: 12/17/2022]
Abstract
Rhabdomyosarcoma (RMS) is the most common soft-tissue sarcoma of childhood. This paper is focuses on imaging for diagnosis, staging, and follow-up of noncraniofacial RMS.
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Affiliation(s)
- Rick R Van Rijn
- Department of Radiology, Academic Medical Centre Amsterdam, Suite G1-224, Meibergdreef 9, 1105 AZ, Amsterdam Zuid-Oost, The Netherlands.
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25
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Peng F, Rabkin G, Muzik O. Use of 2-deoxy-2-[F-18]-fluoro-D-glucose positron emission tomography to monitor therapeutic response by rhabdomyosarcoma in children: report of a retrospective case study. Clin Nucl Med 2007; 31:394-7. [PMID: 16785806 DOI: 10.1097/01.rlu.0000222954.38724.be] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to study the use of 2-deoxy-2-[F-18]-fluoro-D-glucose positron emission tomography (F-18 FDG PET) for monitoring therapeutic response by rhabdomyosarcoma (RMSA) in children. PATIENTS AND METHODS A retrospective case study was performed by searching a computer database for the patients with RMSA in whom F-18 FDG PET studies were performed pre- and posttreatment. The data of the PET studies from these patients were analyzed in conjunction with clinical treatment and other imaging studies to determine whether interval changes of F-18 FDG uptake by the RMSA reflect response of RMSA to treatment. RESULTS Four patients with RMSA who received both pretreatment and posttreatment F-18 FDG PET studies were identified from the database and included in this study. A dramatic decrease of F-18 FDG uptake by the tumor was evident in the patients who had a favorable response to the therapy and prolonged remission of the disease. In contrast, persistent abnormal FDG uptake in one patient was associated with early relapse of the RMSA. CONCLUSIONS F-18 FDG PET may be useful for monitoring therapeutic response by RMSA in children, which needs to be verified with a prospective study in a larger patient population.
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Affiliation(s)
- Fangyu Peng
- The Carman & Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
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26
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Philippe-Chomette P, Orbach D, Brisse H, Aigrain Y, Berrebi D, El Ghoneimi A. [Rhabdomyosarcoma of the genitourinary sinus in children]. ANNALES D'UROLOGIE 2006; 40:280-96. [PMID: 17100165 DOI: 10.1016/j.anuro.2006.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Genitourinary rhabdomyosarcoma (RMS) accounts for approximately 25% of all rhabdomyosarcomas. Management of RMS at this site has changed during the last 5 consecutive Intergroup Rhabdomyosarcoma (IRS) trials, with increasing emphasis of bladder and vaginal conservation. As more effective treatment regimens has improved survival, surgical approaches have evolved to less aggressive management of the primary tumour to improve conservation. Various combinations of chemotherapy, irradiation and surgery have resulted in a decreased late sequelae in the group of patients with sarcoma arising in the genitourinary tract.
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Affiliation(s)
- P Philippe-Chomette
- Service de chirurgie viscérale et urologique, Hôpital Robert Debré, 48, boulevard Sérurier, 75019 Paris, France.
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Panagiotou JP, Polychronopoulou S, Sofou K, Vanvliet-Constantinidou C, Papandreou E, Haidas S. Second and third malignant solid tumor in a girl with ovarian Sertoli-Leydig tumor. Pediatr Blood Cancer 2006; 46:654-6. [PMID: 16411221 DOI: 10.1002/pbc.20486] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We report a Sertoli-Leydig cell (SLC) tumor of the right ovary in a 10-year-old girl, which was dealt with surgical removal. Three months after resection, she presented with a new episode of acute abdomen because of an abdominal mass, which histologically was compatible with an undifferentiated embryonal rhabdomyosarcoma. Chemotherapy, according to SIOP-??? 89 protocol, was administered additionally to radiotherapy (3,960 cGy). Three years after completing treatment, the patient developed a painful swelling at her left upper arm. The diagnosis was Ewing sarcoma of the humerus, which was confirmed by identification of the typical 11; 22 translocation on cytogenetic and molecular analysis of the tumor tissue. The patient died 14 months from Ewing diagnosis due to progressive disease.
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Affiliation(s)
- John P Panagiotou
- Department of Pediatric Hematology/Oncology, "Aghia Sophia" Children's Hospital, Athens, Greece.
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28
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Brisse H, Orbach D, Klijanienko J, Fréneaux P, Neuenschwander S. Imaging and diagnostic strategy of soft tissue tumors in children. Eur Radiol 2006; 16:1147-64. [PMID: 16411083 DOI: 10.1007/s00330-005-0066-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2005] [Revised: 10/04/2005] [Accepted: 10/21/2005] [Indexed: 02/07/2023]
Abstract
The diagnosis of a soft tissue mass in children is a common clinical situation. Most of the lesions are benign and can be treated conservatively or by non-mutilating surgery. Nevertheless, the possibility of a malignant soft tissue tumor must be systematically considered. The most frequent benign soft tissue lesions in children are vascular lesions, fibrous and fibrohistiocytic tumors and pseudotumors, whereas rhabdomyosarcomas account for 50% of all soft tissue sarcomas. A child presenting an atypical soft tissue mass should be managed by a multidisciplinary centre, and primary resection must be proscribed until a definite diagnosis has been established. The role of imaging is essential either to confirm the benign nature of the mass or to give arguments to perform a diagnostic biopsy. Clinical examination, conventional radiography and ultrasound with Doppler represent the first-line examinations and are sometimes sufficient to assess a diagnosis. In all other situations, MRI is mandatory to establish the probable nature of the lesion and to assess local extension.
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Affiliation(s)
- Hervé Brisse
- Imaging Department, Institut Curie, 26 rue d'Ulm, 75005, Paris, France.
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29
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Orbach D, Brisse H, Helfre S, Freneaux P, Husseini K, Aerts I, Desjardins L, Fattet S. Effectiveness of chemotherapy in rhabdomyosarcoma: example of orbital primary. Expert Opin Pharmacother 2005; 4:2165-74. [PMID: 14640915 DOI: 10.1517/14656566.4.12.2165] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The survival of patients with rhabdomyosarcoma has been progressively improved with successive protocols due to the development of multidisciplinary management and the data accumulated by international groups. Orbital rhabdomyosarcoma represents 10% of all cases and affects young children (median age: 6.8 years). It is a chemosensitive and radiosensitive tumour. Chemotherapy is designed to decrease the indications for local therapy (mainly radiotherapy) responsible for a high rate of sequelae (cosmetic, functional or secondary cancer). According to the International Society of Paediatric Oncology guidelines, local therapy is not indicated as first-line treatment in case of complete remission after chemotherapy. The 10-year survival of children with non-parameningeal orbital rhabdomyosarcoma is currently 87% and identical survivals are reported by the various collaborative groups despite the use of different treatments. Despite clinical trials demonstrating the efficacy of many types of chemotherapy (cisplatin, etoposide, doxorubicin, dacarbazine), the value of adding these drugs to combination chemotherapy comprising of an alkylating agent (cyclophosphamide or ifosfamide), vincristine and dactinomycin has not been formally demonstrated in terms of survival benefit for children with rhabdomyosarcoma. The authors review these various results and compare the current guidelines for the management of orbital rhabdomyosarcoma recommended by North American and European groups.
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Affiliation(s)
- Daniel Orbach
- Département de Pédiatrie, Institut Curie, 26 Rue d'Ulm, 75005 Paris, France.
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30
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Abstract
This article discusses the imaging evaluation of chest wall disorders in children.
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Affiliation(s)
- Nancy R Fefferman
- Division of Pediatric Radiology, Department of Radiology, New York University School of Medicine, 560 First Avenue, RIRM 234, New York, NY 10016, USA.
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31
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Abstract
Soft-tissue tumors in children (<18 years) are a heterogeneous group of lesions. Masses may be asymptomatic or associated with pain or discomfort. Although most lesions are benign, developing an appropriate differential diagnosis requires knowledge of the clinical and radiographic characteristics of tumors and tumorlike conditions in children. A thorough history and physical examination, followed by appropriate imaging studies, when indicated, can establish a correct diagnosis and help determine appropriate treatment recommendations.
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Affiliation(s)
- Kamran Aflatoon
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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