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Tsukamoto S, Kawabata K, Ito S, Ando S, Kuriyama K, Morooka S, Muramaki M, Kanagaki M, Hosono M. Adrenal ganglioneuroma with nodal metastases on 123I-MIBG SPECT/CT and 18F-FDG PET/CT. Radiol Case Rep 2024; 19:5128-5132. [PMID: 39263517 PMCID: PMC11388043 DOI: 10.1016/j.radcr.2024.07.128] [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: 04/28/2024] [Revised: 07/20/2024] [Accepted: 07/22/2024] [Indexed: 09/13/2024] Open
Abstract
Ganglioneuroma is a well-differentiated tumor originating from neural crest cells of the sympathetic nervous system. Although benign, a few cases have been reported that ganglioneuroma can metastasize to other sites. We report a case of adrenal ganglioneuroma with para-aortic nodal metastases with low FDG and MIBG uptake. In order to avoid unnecessary wide excision or aggressive medication, it is important to consider the possibility of ganglioneuroma preoperatively even if with metastases.
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Affiliation(s)
- Suzune Tsukamoto
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Kazuna Kawabata
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Shunsuke Ito
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Saya Ando
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Kaori Kuriyama
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Shin Morooka
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Mototsugu Muramaki
- Department of Urology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Mitsunori Kanagaki
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Makoto Hosono
- Department of Radiology, Kindai University Faculty of Medicine, Osaka, Japan
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Bteich F, Larmure O, Stella I, Klein O, Joud A. Spinal ganglioneuroma: a rare and challenging tumor in the pediatric population. Childs Nerv Syst 2024:10.1007/s00381-024-06603-5. [PMID: 39243334 DOI: 10.1007/s00381-024-06603-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 08/28/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND "Spinal ganglioneuroma" is a rare entity of neuroblastic tumors, frequent among children, that has been sparsely reported in articles involving both the pediatric and adult populations. These tumors mostly arise from the sympathetic ganglia located in the paravertebral region, near the intervertebral foramina of the spine. This makes their extension into the spinal canal possible but quite rare, in a dumbbell fashion, producing radicular or medullary symptoms. We provide an extensive review of the pediatric cases found in the literature; while reporting a challenging case we have recently got to treat at the CHRU de Brabois in Nancy, France. METHODS We searched PubMed's database for articles and abstracts related to "spinal ganglioneuromas," from inception until June 1, 2024. We combined every case among patients under 18 years of age and divided them between the different spinal areas. We excluded those that originated from outside of the spine. We particularly focused our attention on the thoraco-lumbar region, which involved our case report, since the surgical management is completely different from other regions of the spine. RESULTS As per June 1, 2024, 21 patients aged between 3 and 17 years were identified with "spinal ganglioneuromas," with a predominance of females (81%). The thoracic region of the spine seems to be the area of predilection for these tumors (42.85%), although some have been found in the cervical (9.5%), cervico-thoracic (4.76%), thoraco-lumbar (19.04%), lumbar (19.04%), and sacral (4.76%) regions. DISCUSSION Our specific case included long-date abdominal pain and recent progressive paraparesis as the main symptoms, with radiological manifestations of renal atrophy and hydronephrosis, due to the compression and complete displacement of the kidney, as well as scoliosis. To our knowledge, this combination of symptoms has never been seen with spinal ganglioneuromas before in the pediatric population, given the gigantic size of the tumor, and its significant extension to both the spinal canal and the retroperitoneal space, which is quite uncommon. CONCLUSION Spinal ganglioneuromas are very rare, benign lesions, that should be included in the differential diagnosis of dumbbell tumors that can cause in the pediatric population, alongside neurological symptoms in the limbs and back pain, thoracic, abdominal, and even urinary symptoms.
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Affiliation(s)
- Fred Bteich
- Pediatric Neurosurgery Department, CHU de Brabois, Nancy, France.
| | - Olivier Larmure
- Pediatric Visceral Surgery Department, CHU de Brabois, Nancy, France
| | - Irene Stella
- Pediatric Neurosurgery Department, CHU de Brabois, Nancy, France
| | - Olivier Klein
- Pediatric Neurosurgery Department, CHU de Brabois, Nancy, France
| | - Anthony Joud
- Pediatric Neurosurgery Department, CHU de Brabois, Nancy, France
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Narra RK, Are K, Nuzhat P. Invasive trigeminal ganglioneuroma: A case report and review of the literature. Acta Radiol Open 2024; 13:20584601241283780. [PMID: 39257594 PMCID: PMC11384535 DOI: 10.1177/20584601241283780] [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: 03/18/2024] [Accepted: 08/30/2024] [Indexed: 09/12/2024] Open
Abstract
Ganglioneuromas are rare tumors arising from retroperitoneal and posterior mediastinal sympathetic nerves. Intracranial trigeminal nerve ganglioneuromas are even more rare, with only seven cases reported to date. We present a case of a 65-year-old male with a right-sided throbbing headache type and blindness in his right eye. Magnetic resonance imaging revealed an ill-defined mass lesion in the middle-cranial fossa, with a few areas having a reduced apparent diffusion coefficient and multiple microhemorrhages. Piecemeal debulking of the tumor was achieved by performing a right-middle craniotomy via the pterionic and sub-temporal approach. The detected histological features matched those of a ganglioneuroma (maturing type) of the trigeminal nerve.
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Affiliation(s)
| | - Kavya Are
- Department of Radio diagnosis, Katuri Medical College, Guntur, India
| | - Parveen Nuzhat
- Department of Radio diagnosis, Katuri Medical College, Guntur, India
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Ncheye MS, Mrimba PM, Dekker M, Massawe H, Mwanga D, Rabiel H. Spinal ganglioneuroma with extension to the brachial plexus. The challenges for total surgical excision, a case report. Int J Surg Case Rep 2024; 119:109756. [PMID: 38754158 PMCID: PMC11109351 DOI: 10.1016/j.ijscr.2024.109756] [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: 03/18/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Ganglioneuromas are benign neurogenic tumors that arise from the sympathetic ganglia. They are less aggressive compared to the more immature neuroblastomas and ganglioneuroblastomas but can grow to exert mass effect on surrounding tissues. PRESENTATION OF CASE A 7 years old girl who presented with progressive quadriplegia for 4 months. On examination, she had a right supra-clavicular mass with reduced power in the right hand than the left. Power in the lower limbs was also reduced with hyper-reflexia, clonus and Babinski positive. Laboratory investigations were unremarkable and Chest X-Ray showed a widened mediastinum. Magnetic Resonance Imaging (MRI) scan revealed an extra-medullary spinal tumor at C6/C7 extending laterally on the right through the C6/7 neuro-foramen to the para-spinal tissue and brachial plexus. A C6/7 laminectomy with Spinal cord decompression by partial resection of the tumor was done. Histology of the resected tissue showed ganglioneuroma. DISCUSSION The presentation of Ganglioneuromas is usually asymptomatic until they are huge enough to exert mass effect on surrounding tissue. Most are located in the posterior mediastinum, retro-peritoneum and neck. Due to this, it may be very challenging to achieve total resection especially when they surround major vessels or nerves. A multi-disciplinary approach is needed for the best surgical outcomes but this is not always realized in our setting. CONCLUSION In resource limited settings, more collaboration and training is needed to realize appropriate management of complex surgical conditions. Although complications are not uncommon, total surgical excision is necessary to prevent recurrence and progression of Ganglioneuromas.
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Affiliation(s)
- Mathias S Ncheye
- Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania; Department of Orthopedics and Trauma, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania.
| | - Peter Magembe Mrimba
- Department of Orthopedics and Trauma, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - Marieke Dekker
- Department of Pediatrics and Child Health, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - Honest Massawe
- Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania; Department of Orthopedics and Trauma, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - Daniel Mwanga
- Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania; Department of Orthopedics and Trauma, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - Happiness Rabiel
- Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania; Department of Neurosurgery, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
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Lasca A, Laia I, Pires Santos R, Dias Carneiro A, Moreira D. Paravertebral Ganglioneuroma in Pediatric Age: A Case Report. Cureus 2024; 16:e63363. [PMID: 39070384 PMCID: PMC11283751 DOI: 10.7759/cureus.63363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
Ganglioneuromas (GNs) are rare benign tumors common in the pediatric population. Although mostly asymptomatic, some can cause symptoms, particularly neurological ones. Here, we report a case of a two-year-old male child, who presented changes in gait, an alarming sign, during a child health surveillance appointment. On physical examination, the child presented a "duck" gait pattern, axial and appendicular hypotonia, proximal weakness of the pelvic girdle, and a positive Gowers sign. The child was referred to a pediatric neurology appointment where he underwent neuraxial magnetic resonance imaging, identifying a large and expansive formation in the dorsolumbar transition suggestive of neuroblastoma, considering the age group. However, a computed tomography-guided biopsy revealed it to be a paravertebral GN. Tumor resection was performed, leaving some paravertebral tumor residue. After one year of motor rehabilitation, the child had a normal neurological examination. The child is currently five years old and is undergoing annual clinical and imaging surveillance. This case allows us to reflect on the importance of encouraging children and young people to attend recommended surveillance appointments and reminds us that the rarest situations can occur.
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Affiliation(s)
- Andreia Lasca
- Family Medicine, Unidade de Saúde Familiar Viriato, Serviço Nacional de Saúde, Viseu, PRT
| | - Inês Laia
- Family Medicine, Unidade de Saúde Familiar Viriato, Serviço Nacional de Saúde, Viseu, PRT
| | - Raquel Pires Santos
- Family Medicine, Unidade de Saúde Familiar Viriato, Serviço Nacional de Saúde, Viseu, PRT
| | - António Dias Carneiro
- Family Medicine, Unidade de Saúde Familiar Viriato, Serviço Nacional de Saúde, Viseu, PRT
| | - Daniela Moreira
- General and Family Medicine, Unidade de Saúde Familiar Viriato, Serviço Nacional de Saúde, Viseu, PRT
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Wang T, Han D, Xiao H, Yang H, Chen JY, Tang Y. A Preliminary Study on the Application of Contrast-Enhanced Ultrasonography in Children With Peripheral Neuroblastic Tumors. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:954-960. [PMID: 38575414 DOI: 10.1016/j.ultrasmedbio.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 04/06/2024]
Abstract
The purpose of this study was to retrospectively analyze the characteristics of contrast-enhanced ultrasound (CEUS) images and quantitative parameters of time-intensity curves (TICs) in children's peripheral neuroblastic tumors (pNTs). By comparing the imaging features and quantitative parameters of the TICs of neuroblastoma (NB) and ganglioneuroblastoma (GNB) patients, we attempted to identify the distinguishing points between NB and GNB. A total of 35 patients confirmed to have pNTs by pathologic examination were included in this study. Each child underwent CEUS with complete imaging data (including still images and at least 3 min of video files). Twenty-four patients were confirmed to have NB, and 11 were considered to have GNB according to differentiation. The CEUS image features and quantitative parameters of the TICs of all lesions were analyzed to determine whether there were CEUS-related differences between the two types of pNT. There was a significant difference in the enhancement patterns of the CEUS features (χ2 = 5.303, p < 0.05), with more "peripheral-central" enhancement in the NB group and more "central-peripheral" enhancement in the GNB group. In the TIC, the rise time and time to peak were significantly different (p < 0.05). The receiver operating characteristic curve showed that the probability of ganglion cell NB increased significantly after RT > 15.29, with a sensitivity of 0.636 and a specificity of 0.958. When the peak time was greater than 16.155, the probability of NB increased significantly, with a sensitivity of 0.636 and a specificity of 0.958. The CEUS features of NB and GNB patients are very similar, and it is difficult to distinguish them. Rise time and time to peak may be useful in identifying GNB and NB, but the sample size of this study was small, and the investigation was only preliminary; a larger sample size is needed to support these conclusions.
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Affiliation(s)
- Ting Wang
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, China
| | - Dan Han
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, China
| | - Huan Xiao
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, China
| | - Hao Yang
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, China
| | - Jing-Yu Chen
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, China
| | - Yi Tang
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, China.
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Kim J, Choi YH, Yoon H, Lim HJ, Han JW, Lee MJ. Prediction of High-Risk Neuroblastoma Among Neuroblastic Tumors Using Radiomics Features Derived from Magnetic Resonance Imaging: A Pilot Study. Yonsei Med J 2024; 65:293-301. [PMID: 38653568 PMCID: PMC11045346 DOI: 10.3349/ymj.2023.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/19/2023] [Accepted: 01/08/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE This study aimed to predict high-risk neuroblastoma among neuroblastic tumors using radiomics features extracted from MRI. MATERIALS AND METHODS Pediatric patients (age≤18 years) diagnosed with neuroblastic tumors who had pre-treatment MR images available were enrolled from institution A from January 2010 to November 2019 (training set) and institution B from January 2016 to January 2022 (test set). Segmentation was performed with regions of interest manually drawn along tumor margins on the slice with the widest tumor area by two radiologists. First-order and texture features were extracted and intraclass correlation coefficients (ICCs) were calculated. Multivariate logistic regression (MLR) and random forest (RF) models from 10-fold cross-validation were built using these features. The trained MLR and RF models were tested in an external test set. RESULTS Thirty-two patients (M:F=23:9, 26.0±26.7 months) were in the training set and 14 patients (M:F=10:4, 33.4±20.4 months) were in the test set with radiomics features (n=930) being extracted. For 10 of the most relevant features selected, intra- and inter-observer variability was moderate to excellent (ICCs 0.633-0.911, 0.695-0.985, respectively). The area under the receiver operating characteristic curve (AUC) was 0.94 (sensitivity 67%, specificity 91%, and accuracy 84%) for the MLR model and the average AUC was 0.83 (sensitivity 44%, specificity 87%, and accuracy 75%) for the RF model from 10-fold cross-validation. In the test set, AUCs of the MLR and RF models were 0.94 and 0.91, respectively. CONCLUSION An MRI-based radiomics model can help predict high-risk neuroblastoma among neuroblastic tumors.
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Affiliation(s)
- Jisoo Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Haesung Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ji Lim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Woo Han
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Mi-Jung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Niranjan G, Prasad P, Gupta N, Agrawal V, Mishra A, Jain N, Kapoor V. Characteristics of Bilateral Adrenal Lesions: Experience from an Indian Tertiary Care Centre. Indian J Endocrinol Metab 2024; 28:273-278. [PMID: 39086566 PMCID: PMC11288507 DOI: 10.4103/ijem.ijem_232_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 01/15/2024] [Accepted: 01/20/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction The aetiologies in unilateral and bilateral adrenal lesions can be different with different clinical implications and management guidelines, the latter having aetiologies like hyperplasia, infections, infiltrative lesions and neoplasia. Bilateral tumours are more likely to have hereditary/syndromic associations. There is limited data on the clinical and pathological profile of bilateral adrenal lesions. Methods This was a retrospective study where patients with bilateral adrenal lesions were selected from a total of 266 patients with adrenal lesions who presented to our institute between January 2016 and August 2022. The demographic, laboratory and imaging data were retrieved from the Hospital Information System and patient case files. Results The study included 51 patients; the mean age at presentation was 51.15 years (range 14 to 82 years). Forty-eight patients (94.1%) were symptomatic at presentation with an average duration of symptoms being 10.68 months (range 10 days to 1 year). The most common presentation was adrenal insufficiency in 18 cases (38%), followed by fever in 17 cases (36%). The commonest aetiology, as revealed on histopathology, was histoplasmosis (n = 22, 43%), followed by pheochromocytoma (n = 11, 21.5%), metastases (n = 6, 11.7%), adrenal hyperplasia (n = 5, 9.8%), adrenocortical adenoma (n = 1, 1.9%), lymphoma (n = 3, 5.8%), neuroblastoma (n = 1, 1.9%), myelolipoma (n = 1, 1.9%) and tuberculosis (n = 1, 1.9%). Histoplasmosis and metastatic lesions were commonly seen in older people, and pheochromocytoma was associated with young age. 6/11 patients with a diagnosis of bilateral pheochromocytoma were associated with family history, genetic mutation and extra-adrenal involvement. Conclusion The approach to bilateral adrenal lesions differs from that of unilateral lesions due to differences in aetiologies and the more significant role of genetics in some bilateral tumours. The age at presentation, presenting symptoms, lesion size and biochemical features help delineate varied underlying aetiologies.
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Affiliation(s)
- Gauri Niranjan
- Department of Pathology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Pallavi Prasad
- Department of Pathology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Neelima Gupta
- Department of Pathology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Vinita Agrawal
- Department of Pathology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Anjali Mishra
- Department of Endocrine Surgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Neeraj Jain
- Department of Radiodiagnosis, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Vishwas Kapoor
- Department of Biostatistics and Health Informatics, SGPGIMS, Lucknow, Uttar Pradesh, India
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Veiga-Canuto D, Cerdá Alberich L, Fernández-Patón M, Jiménez Pastor A, Lozano-Montoya J, Miguel Blanco A, Martínez de Las Heras B, Sangüesa Nebot C, Martí-Bonmatí L. Imaging biomarkers and radiomics in pediatric oncology: a view from the PRIMAGE (PRedictive In silico Multiscale Analytics to support cancer personalized diaGnosis and prognosis, Empowered by imaging biomarkers) project. Pediatr Radiol 2024; 54:562-570. [PMID: 37747582 DOI: 10.1007/s00247-023-05770-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 09/26/2023]
Abstract
This review paper presents the practical development of imaging biomarkers in the scope of the PRIMAGE (PRedictive In silico Multiscale Analytics to support cancer personalized diaGnosis and prognosis, Empowered by imaging biomarkers) project, as a noninvasive and reliable way to improve the diagnosis and prognosis in pediatric oncology. The PRIMAGE project is a European multi-center research initiative that focuses on developing medical imaging-derived artificial intelligence (AI) solutions designed to enhance overall management and decision-making for two types of pediatric cancer: neuroblastoma and diffuse intrinsic pontine glioma. To allow this, the PRIMAGE project has created an open-cloud platform that combines imaging, clinical, and molecular data together with AI models developed from this data, creating a comprehensive decision support environment for clinicians managing patients with these two cancers. In order to achieve this, a standardized data processing and analysis workflow was implemented to generate robust and reliable predictions for different clinical endpoints. Magnetic resonance (MR) image harmonization and registration was performed as part of the workflow. Subsequently, an automated tool for the detection and segmentation of tumors was trained and internally validated. The Dice similarity coefficient obtained for the independent validation dataset was 0.997, indicating compatibility with the manual segmentation variability. Following this, radiomics and deep features were extracted and correlated with clinical endpoints. Finally, reproducible and relevant imaging quantitative features were integrated with clinical and molecular data to enrich both the predictive models and a set of visual analytics tools, making the PRIMAGE platform a complete clinical decision aid system. In order to ensure the advancement of research in this field and to foster engagement with the wider research community, the PRIMAGE data repository and platform are currently being integrated into the European Federation for Cancer Images (EUCAIM), which is the largest European cancer imaging research infrastructure created to date.
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Affiliation(s)
- Diana Veiga-Canuto
- Grupo de Investigación Biomédica en Imagen, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106 Torre A planta 7, 46026, Valencia, Spain.
- Área Clínica de Imagen Médica, Área Clínica de Imagen Médica, Hospital Universitari i Politècnic La Fe, Avinguda Fernando Abril Martorell, 106 Torre E planta 0, 46026, València, Spain.
| | - Leonor Cerdá Alberich
- Grupo de Investigación Biomédica en Imagen, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106 Torre A planta 7, 46026, Valencia, Spain
| | - Matías Fernández-Patón
- Grupo de Investigación Biomédica en Imagen, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106 Torre A planta 7, 46026, Valencia, Spain
| | | | | | - Ana Miguel Blanco
- Grupo de Investigación Biomédica en Imagen, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106 Torre A planta 7, 46026, Valencia, Spain
| | - Blanca Martínez de Las Heras
- Pediatric Oncology Department, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell, 106 Torre G planta 2, 46026, Valencia, Spain
| | - Cinta Sangüesa Nebot
- Área Clínica de Imagen Médica, Área Clínica de Imagen Médica, Hospital Universitari i Politècnic La Fe, Avinguda Fernando Abril Martorell, 106 Torre E planta 0, 46026, València, Spain
| | - Luis Martí-Bonmatí
- Grupo de Investigación Biomédica en Imagen, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106 Torre A planta 7, 46026, Valencia, Spain
- Área Clínica de Imagen Médica, Área Clínica de Imagen Médica, Hospital Universitari i Politècnic La Fe, Avinguda Fernando Abril Martorell, 106 Torre E planta 0, 46026, València, Spain
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Cao L, Liu Q, Ma Y, Wang S. Identification of immune-related signature with prognosis in children with stage 4 and 4S neuroblastoma. Clin Transl Oncol 2024; 26:905-916. [PMID: 37709978 DOI: 10.1007/s12094-023-03320-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE Spontaneous regression of tumors is an attractive phenomenon that most commonly occurs in stage 4S neuroblastoma (NB). However, the mechanism underlying this phenomenon remains unclear. METHODS Datasets correlated with NB were downloaded from online public databases, the differentially expressed genes (DEGs) between stage 4 and 4S associated with immunity were identified, and functional enrichment analysis was utilized to explore the potential functions and signaling pathways of these DEGs. In addition, based on these DEGs, a prognostic signature was constructed and validated, and differences in immune cell infiltration were analyzed. RESULTS A total of 13 DEGs were finally identified, and functional enrichment analysis revealed that these DEGs were primarily enriched in the positive regulation of neuron differentiation and TGF-β signaling pathway. The signature successfully stratifies patients into two risk score groups and performs well in judging prognosis and predicting overall survival time. In addition, the prognostic value of the risk score calculated by the signature was independent of clinical factors. The results of immune cell infiltration showed that patients with a high infiltration of resting CD4 + memory T cells had a better prognosis, while plasma cells had a worse prognosis. CONCLUSION The results of the functional enrichment analysis of these identified DEGs suggested that these DEGs may be related to spontaneous regression of NB. In addition, the prognostic signature has the potential to create new risk stratification in patients with NB.
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Affiliation(s)
- Lijian Cao
- Department of Pediatric Surgical Oncology, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University and the National Clinical Research Center for Child Health and Disorders, Chongqing, 400014, People's Republic of China
| | - Qingqing Liu
- Department of Pediatric Surgical Oncology, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University and the National Clinical Research Center for Child Health and Disorders, Chongqing, 400014, People's Republic of China
| | - Yue Ma
- Department of Pediatric Surgical Oncology, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University and the National Clinical Research Center for Child Health and Disorders, Chongqing, 400014, People's Republic of China
| | - Shan Wang
- Department of Pediatric Surgical Oncology, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University and the National Clinical Research Center for Child Health and Disorders, Chongqing, 400014, People's Republic of China.
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11
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Jiang X, Wu J, Su F, Huang H, Ding Y, Zhu X. Gastric Ganglioneuroblastoma in an Elderly man: A Case Report and Literature Review. Int J Surg Pathol 2024; 32:401-407. [PMID: 37331966 DOI: 10.1177/10668969231177703] [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: 06/20/2023]
Abstract
Background. Ganglioneuroblastoma is a borderline tumor of sympathetic origin that is considered a childhood disease, with the majority of patients occurring in children less than five years old and few patients occurring in adults. There are no treatment guidelines for adult ganglioneuroblastoma. Here, we report a rare patient of adult gastric ganglioneuroblastoma that was completely resected by a laparoscopic approach. Case presentation. A 73-year-old man presented with dull pain in the upper abdomen along with abdominal distension for one month. Gastroscopy examination revealed chronic gastritis and submucosal tumors of the gastric antrum. Endoscopic ultrasonography showed a hypoechoic mass in the gastric antrum arising from the muscularis propria. An abdominal computed tomography scan revealed an irregular soft tissue mass in the gastric antrum with heterogeneous enhancement in the arterial phase. The mass was completely resected by laparoscopic surgery. Postoperative histopathology revealed that the mass contained differentiated neuroblasts, mature ganglion cells and ganglioneuroma components. The pathological diagnosis was ganglioneuroblastoma intermixed, and the patient was determined to be in stage I. The patient received no adjuvant chemotherapy or radiotherapy. At his two-year follow-up, the patient was doing well and showed no signs of recurrence. Conclusion. Despite the rarity of gastric ganglioneuroblastoma as a primary site of origin, it should be considered in the differential diagnosis of gastric masses in adults. Radical surgery is sufficient for the treatment of ganglioneuroblastoma intermixed, and long-term follow-up should be performed.
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Affiliation(s)
- Xuetong Jiang
- Department of Gastrointestinal Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University (Suqian Hospital of Nanjing Drum Tower Hospital Group), Suqian, China
| | - Jianqiang Wu
- Department of Gastrointestinal Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University (Suqian Hospital of Nanjing Drum Tower Hospital Group), Suqian, China
| | - Feng Su
- Department of Digestion, The Affiliated Suqian Hospital of Xuzhou Medical University (Suqian Hospital of Nanjing Drum Tower Hospital Group), Suqian, China
| | - Hailong Huang
- Department of Gastrointestinal Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University (Suqian Hospital of Nanjing Drum Tower Hospital Group), Suqian, China
| | - Yang Ding
- Department of Pathology, The Affiliated Suqian Hospital of Xuzhou Medical University (Suqian Hospital of Nanjing Drum Tower Hospital Group), Suqian, China
| | - Xinqiang Zhu
- Department of Gastrointestinal Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University (Suqian Hospital of Nanjing Drum Tower Hospital Group), Suqian, China
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12
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Sheng J, Li T, Xu H, Xu R, Cai X, Zhang H, Ji Q, Duan X, Xia W, Yang X. Evaluation of clinical and imaging features for differentiating rhabdomyosarcoma from neuroblastoma in pediatric soft tissue. Front Oncol 2024; 14:1289532. [PMID: 38406807 PMCID: PMC10884217 DOI: 10.3389/fonc.2024.1289532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/16/2024] [Indexed: 02/27/2024] Open
Abstract
Background In this study, we developed a nomogram predictive model based on clinical, CT, and MRI parameters to differentiate soft tissue rhabdomyosarcoma (RMS) from neuroblastoma (NB) in children preoperatively. Materials and methods A total of 103 children with RMS (n=37) and NB (n=66) were enrolled in the study from December 2012 to July 2023. The clinical and imaging data (assessed by two experienced radiologists) were analyzed using univariate analysis, and significant factors were further analyzed by multivariable logistic regression using the forward LR method to develop the clinical model, radiological model, and integrated nomogram model, respectively. The diagnostic performances, goodness of fit, and clinical utility of the integrated nomogram model were assessed using the area under the curve (AUC) of the receiver operator characteristics curve (ROC) with a 95% confidence interval (95% CI), calibration curve, and decision curve analysis (DCA) curves, respectively. Diagnostic efficacy between the model and radiologists' interpretations was examined. Results The median age at diagnosis in the RMS group was significantly older than the NB group (36.0 months vs. 14.5 months; P=0.003); the fever rates in RMS patients were significantly lower than in patients with NB (0.0% vs.16.7%; P=0.022), and the incidence of palpable mass was higher in patients with RMS compared with the NB patients (89.2% vs. 34.8%; P<0.001). Compare NB on image features: RMS occurred more frequently in the head and neck and displayed homogeneous density on non-enhanced CT than NB (48.6% vs. 9.1%; 35.3% vs. 13.8%, respectively; all P<0.05), and the occurrence of characteristics such as calcification, encasing vessels, and intraspinal tumor extension was significantly less frequent in RMS children compared to children with NB (18.9% vs. 84.8%; 13.5% vs. 34.8%; 2.7% vs. 50.0%, respectively; all P <0.05). Two, three, and four features were identified as independent parameters by multivariate logistic regression analysis to develop the clinical, radiological, and integrated nomogram models, respectively. The AUC value (0.962), calibration curve, and DCA showed that the integrated nomogram model may provide better diagnostic performance, good agreement, and greater clinical net benefits than the clinical model, radiological model, and radiologists' subjective diagnosis. Conclusion The clinical and imaging features-based nomogram has potential for helping radiologists distinguish between pediatric soft tissue RMS and NB patients preoperatively, and reduce unnecessary interventions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Xiujun Yang
- Department of Radiology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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13
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Sweet C, Shmuel N, Shoaf JN, Stoecklein M, Muthukrishnan A, Stern E, Nguyen NC. A Pictorial Review of I-123 MIBG Imaging of Neuroblastoma Utilizing a State-of-the-Art CZT SPECT/CT System. Nucl Med Mol Imaging 2024; 58:1-8. [PMID: 38250182 PMCID: PMC10796310 DOI: 10.1007/s13139-023-00825-2] [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: 02/15/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 01/23/2024] Open
Abstract
The field of nuclear medicine is entering a new era of gamma-camera technology. Solid-state SPECT/CT systems will gradually replace the thallium-activated sodium-iodide NaI(Tl) systems. This digital technology allows drastic improvements in image quality, radiotracer dose reduction, and procedure efficiency. This pictorial review presents our initial experience on an NM/CT 870 CZT system (GE Healthcare), equipped with dual-head cadmium zinc telluride (CZT) detectors, for I-123 metaiodobenzylguanidine (MIBG) imaging in pediatric neuroblastoma. On planar imaging, CZT shows greater image quality than at conventional gamma-camera using the Infinia Hawkeye (GE Healthcare). Physiologic structures such as salivary glands and myocardium show sharper borders with a more notable signal-to-noise ratio at CZT than conventional gamma camera. On SPECT imaging, the CZT scanner, combined with resolution recovery, demonstrates either comparable or greater image quality at 80% of the conventional gamma camera’s acquisition time. Due to the 2.46-mm detector pixel with fully registered collimator holes matching each pixel and direct conversion of photons into electrical signals, the CZT gamma camera system provides significant advantages in photon localization and energy resolution.
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Affiliation(s)
- Cassidy Sweet
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA USA
| | | | - Jennifer N. Shoaf
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA USA
| | - Marcy Stoecklein
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA USA
| | | | | | - Nghi C. Nguyen
- Department of Radiology, University of Texas, Southwestern Medical Center, Dallas, TX USA
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14
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A E, Prakash A, Ashta A, Garg A, Verma A, Padaliya P. Pediatric presacral tumors with intraspinal extension: a rare entity with diagnostic challenges. Acta Radiol 2023; 64:3056-3073. [PMID: 37753549 DOI: 10.1177/02841851231202688] [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: 09/28/2023]
Abstract
The presacral space is a potential space located between the rectum and the lumbosacral spine. It contains various primitive germ cell types that serve as the origin for a range of tumors. Imaging is crucial in characterizing, assessing the extent of and evaluating the treatment response to these tumors. We report a series of six cases of pediatric presacral tumors with intraspinal extension, including an immature sacrococcygeal teratoma (Altman type II), a malignant sacrococcygeal teratoma (Altman type IV), a neuroblastoma, a rhabdomyosarcoma, a clear cell sarcoma and an Ewing's sarcoma of the ilium. These tumors can be broadly categorized as tumors of germ cell, neuroblastic, mesenchymal and osteogenic origin. Despite overlapping imaging features, a review of the existing literature and careful retrospective observation revealed several distinctive features that aid in the optimal characterization of tumors. These include the tumor's epicenter, the pattern and degree of bone involvement, the status of sacral foramina and neural elements, and internal tumor characteristics such as the presence of fat, calcification, hemorrhage and necrosis.
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Affiliation(s)
- Ebinesh A
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
| | - Anjali Prakash
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
| | - Aanchal Ashta
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
| | - Anju Garg
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
| | - Abhishek Verma
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
| | - Prerna Padaliya
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
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15
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Saadi A, Chebbi S, Mokadem S, Kacem LBH, Chakroun M, Slama MRB. Retroperitoneal ganglioneuroma: A five-case series from a single Tunisian center. Int J Surg Case Rep 2023; 111:108840. [PMID: 37734125 PMCID: PMC10518479 DOI: 10.1016/j.ijscr.2023.108840] [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: 08/13/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Retroperitoneal ganglioneuroma is an infrequent, benign tumor originating from the sympathetic nervous system. The diagnosis predominantly relies on histological assessment, often as an incidental discovery. Surgical removal stands as the primary treatment modality, and the overall prognosis tends to be favorable. CASE PRESENTATION Objective: In order to comprehensively examine the diagnostic, therapeutic, and progressive aspects of retroperitoneal ganglioneuroma, this study aims to analyze five cases of retroperitoneal ganglioneuroma that were surgically managed between 1993 and 2013. PATIENTS AND METHODS We present a series of five cases involving retroperitoneal ganglioneuromas that underwent surgical intervention in the urology department of Charles Nicolle Teaching Hospital of Tunis between the years 1993 and 2013. The study cohort comprised three females and two males, with an average age of 36.4 years (ranging from 10 to 88 years). Among these cases, four instances showcased incidental tumor detection, while one case manifested with cruralgia due to nerve compression. Complete tumor excision was achieved in all cases, with a single instance necessitating concurrent nephrectomy. Accurate diagnosis was ascertained through meticulous histological examination. CLINICAL DISCUSSION Results: The case series encompassed three women and two men, with an average age of 36.4 years (ranging from 10 to 88 years). The majority of cases (four out of five) unveiled tumors incidentally, whereas one case presented with cruralgia. Surgical removal resulted in complete resection of all tumors, although nephrectomy was necessary in one instance. Postoperative complications were minimal, and effective anticoagulant treatment addressed one thrombotic event. While recurrence was noted in a solitary case, subsequent imaging confirmed its stability. The average follow-up duration extended to 23.2 months (ranging from 6 to 72 months). CONCLUSION Retroperitoneal ganglioneuroma, being a rare and benign neoplasm, mandates meticulous pathological assessment and precise imaging for precise localization. Unquestionably, complete surgical resection remains paramount to forestall recurrence and mitigate the likelihood of malignant transformation. Overall, the prognosis associated with retroperitoneal ganglioneuroma tends to be favorable.
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Affiliation(s)
- Ahmed Saadi
- University of Tunis El Manar, Faculty Of Medicine, Charles Nicolle Hospital of Tunis, Urology Department, Tunisia
| | - Sami Chebbi
- University of Tunis El Manar, Faculty Of Medicine, Charles Nicolle Hospital of Tunis, Urology Department, Tunisia.
| | - Seif Mokadem
- University of Tunis El Manar, Faculty Of Medicine, Charles Nicolle Hospital of Tunis, Urology Department, Tunisia
| | - Linda Bel Hadj Kacem
- University of Tunis El Manar, Faculty Of Medicine, Charles Nicolle Hospital of Tunis, Pathology Department, Tunisia
| | - Marouene Chakroun
- University of Tunis El Manar, Faculty Of Medicine, Charles Nicolle Hospital of Tunis, Urology Department, Tunisia
| | - Mohamed Riadh Ben Slama
- University of Tunis El Manar, Faculty Of Medicine, Charles Nicolle Hospital of Tunis, Urology Department, Tunisia
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16
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Ryu J, Igawa T, Mohole J, Coward M. Congenital Neck Masses. Neoreviews 2023; 24:e642-e649. [PMID: 37777610 DOI: 10.1542/neo.24-10-e642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
There are many possible causes of congenital neck masses, with the most common ones being thyroglossal duct cysts, branchial cleft anomalies, and vascular malformations. Most congenital neck masses are asymptomatic in the neonatal period, but depending on the location and the size, they can cause airway obstruction and serious complications at birth. Proper diagnosis is important for optimal treatment planning, and if the airway is compromised, multidisciplinary teamwork is critical for proper airway management. This review summarizes the clinical features, etiology, diagnosis, management, and prognosis of different types of congenital neck masses.
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Affiliation(s)
- Jane Ryu
- Department of Pediatrics/Neonatology, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, CA
| | - Teryn Igawa
- Department of Pediatrics/Neonatology, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, CA
| | - Jyodi Mohole
- Department of Pediatrics/Neonatology, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, CA
| | - Melissa Coward
- Department of Pediatrics/Neonatology, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, CA
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17
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Zhang K, Zhang Y, Zhang Y, Chao M. A retrospective analysis of the clinical characteristics of 207 hospitalized children with adrenal masses. Front Pediatr 2023; 11:1215095. [PMID: 37520057 PMCID: PMC10374947 DOI: 10.3389/fped.2023.1215095] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/21/2023] [Indexed: 08/01/2023] Open
Abstract
Objective The detection rates of adrenal masses (AMs) have recently increased. The present study aimed to examine the clinical characteristics of these adrenal masses for guiding the clinical diagnosis and treatment among hospitalized children. Methods The clinical data of AM cases admitted to our hospital from January 2014 to March 2023 were collected and analyzed retrospectively. The data included composition, sex, age, initial presentation, size and site of mass, functional tumor, intervention or surgery, pathological or clinical diagnosis, and imaging data. Results A total of 207 hospitalized children were included. Among them, adrenal hematoma was the most common finding (53.6%), followed by adrenal neuroblastoma (36.2%). Most masses were larger-sized (51.2%) and non-functional (94.7%). We found that adrenal hematoma commonly occurred in a neonate or child with abdominal trauma. Most adrenal hematoma cases were found in male patients (63.1%), on the right side (71.2%), and with sizes <4 cm (73.9%). Adrenal neuroblastoma was commonly detected in male patients (56.0%), on the right side (66.7%), and with sizes ≥4 cm (85.3%). Moreover, the metastases were frequently explored at the time of diagnosis. In addition, there was no significant difference between ultrasound and computed tomography (CT) scans under suspicion of hematoma (P > 0.05). However, CT showed a priority over ultrasound in the diagnosis of neuroblastoma (P < 0.05). Conclusion Most masses were non-functional and benign. Of these, adrenal hematoma was the most common type of pediatric AM, followed by adrenal neuroblastoma. They were both commonly found in male patients and on the right side. Neuroblastoma revealed a larger tumor size. Compared to cases of adrenal hematoma, cases of adrenal neuroblastoma required CT scans for further assessment.
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Affiliation(s)
| | | | | | - Min Chao
- Correspondence: Yin Zhang Min Chao
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18
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Pacella G, Brunese MC, Donnarumma F, Barrassi M, Bellifemine F, Sciaudone G, Vallone G, Guerra G, Sallustio G. Imaging of Ganglioneuroma: A Literature Review and a Rare Case of Cystic Presentation in an Adolescent Girl. Diagnostics (Basel) 2023; 13:2190. [PMID: 37443583 DOI: 10.3390/diagnostics13132190] [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: 05/16/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
Retroperitoneal ganglioneuroma is a rare neuroectodermal tumor with a benign nature. We performed a literature review among 338 studies. We included 9 studies, whose patients underwent CT and/or MRI to characterize a retroperitoneal mass, which was confirmed to be a ganglioneuroma by histologic exam. The most common features of ganglioneuroma are considered to be a solid nature, oval/lobulated shape, and regular margins. The ganglioneuroma shows a progressive late enhancement on CT. On MRI it appears as a hypointense mass in T1W images and with a heterogeneous high-intensity in T2W. The MRI-"whorled sign" is described in the reviewed studies in about 80% of patients. The MRI characterization of a primitive retroperitoneal cystic mass should not exclude a cystic evolution from solid masses, and in the case of paravertebral location, the differential diagnosis algorithm should include the hypothesis of ganglioneuroma. In our case, the MRI features could have oriented towards a neurogenic nature, however, the predominantly cystic-fluid aspect and the considerable longitudinal non-invasive extension between retroperitoneal structures, misled us to a lymphatic malformation. In the literature, it is reported that the cystic presentation can be due to a degeneration of a well-known solid form while maintaining a benign character: the distinguishing malignity character is the revelation of immature cells on histological examination.
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Affiliation(s)
- Giulia Pacella
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100 Campobasso, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100 Campobasso, Italy
| | | | - Michele Barrassi
- Department of Radiology, Cardarelli Hospital, 86100 Campobasso, Italy
| | - Fabio Bellifemine
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100 Campobasso, Italy
| | - Guido Sciaudone
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100 Campobasso, Italy
| | - Gianfranco Vallone
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100 Campobasso, Italy
| | - Germano Guerra
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100 Campobasso, Italy
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Chaurasiya K, Kireeva E, Shamanskaya T, Kachanov D, Likar Y. Primary Neuroblastoma of the Thymus. Clin Nucl Med 2023; 48:e316-e317. [PMID: 37083676 DOI: 10.1097/rlu.0000000000004654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
ABSTRACT Primary neuroblastoma is the most common extracranial solid tumor in children and may occur anywhere along the sympathetic chain, but most commonly occur in abdominal/retroperitoneal region including the adrenal glands, followed by the thorax. In children, the most primary neuroblastomas in the thorax are in the posterior mediastinum. We present herein an extremely rare case of primary neuroblastoma of thymus in pediatric patient.
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Affiliation(s)
- Kailash Chaurasiya
- From the Department of Nuclear Medicine and PET/CT, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
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20
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Çinar HG, Gulmez AO, Üner Ç, Aydin S. Mediastinal lesions in children. World J Clin Cases 2023; 11:2637-2656. [PMID: 37214576 PMCID: PMC10198114 DOI: 10.12998/wjcc.v11.i12.2637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/17/2023] [Accepted: 03/24/2023] [Indexed: 04/25/2023] Open
Abstract
The mediastinum is where thoracic lesions most frequently occur in young patients. The histological spectrum of diseases caused by the presence of several organs in the mediastinum is broad. Congenital lesions, infections, benign and malignant lesions, and vascular diseases are examples of lesions. Care should be taken to make the proper diagnosis at the time of diagnosis in order to initiate therapy promptly. Our task is currently made simpler by radiological imaging techniques.
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Affiliation(s)
- Hasibe Gökçe Çinar
- Department of Pediatric Radiology, Ankara Etlik City Hospital, Ankara 06000, Turkey
| | - Ali Osman Gulmez
- Department of Radiology, Erzincan Binali Yıldırım University Faculty of Medicine, Erzincan 24100, Turkey
| | - Çiğdem Üner
- Department of Pediatric Radiology, Ankara Etlik City Hospital, Ankara 06000, Turkey
| | - Sonay Aydin
- Department of Radiology, Erzincan Binali Yıldırım University Faculty of Medicine, Erzincan 24100, Turkey
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Zhang Y, Yang Y, Ning G, Wu X, Yang G, Li Y. Contrast computed tomography-based radiomics is correlation with COG risk stratification of neuroblastoma. Abdom Radiol (NY) 2023; 48:2111-2121. [PMID: 36951989 DOI: 10.1007/s00261-023-03875-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE Although a risk stratification strategy for neuroblastoma (NB) has been proposed, precise and convenient clinical risk estimation remains challenging. This study aimed to investigate the correlation of contrast computed tomography (CT)-based radiomics with NB risk stratification. METHODS Patients with NB (n = 289) from two centers (244 and 45 patients in the training/testing and external validation cohorts, respectively) were divided into nonhigh- and high-risk groups. A total of 1648 radiomics features were extracted from the arterial phase, and the radiomics signature was constructed using rad scores, whereas the clinical model was established based on clinical factors. Further, a combined nomogram was developed based on the clinical factors and radiomics signatures. Finally, receiver operating characteristic curve and decision curve analyses (DCA) were used to assess the performance of the established models. RESULTS Seventeen radiomics features were used to construct the radiomics signature. A significant difference was observed in the rad score between the two groups in the training (0.540 vs. 0.704, P < 0.001) and testing (0.563 vs. 0.969, P < 0.001) cohorts. The nomogram showed a higher area under the curve (AUC) in the training (AUC = 0.87), testing (AUC = 0.83), and external validation (AUC = 0.84) cohorts than other models. The Hosmer-Lemeshow test and calibration curves indicated that the nomogram fit perfectly. DCA demonstrated that the clinical-radiomics nomogram was more beneficial. CONCLUSIONS Contrast CT-based radiomics shows correlation with COG risk stratification of NB. Radiomics features combined with clinical factors showed the best performance, which may improve the management of patients with NB.
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Affiliation(s)
- Yimao Zhang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, China
| | - Yuhan Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, China
| | - Gang Ning
- Department of Radiology, West China Second Hospital, Sichuan University, No. 20, Section 3, Renmin South Road, Chengdu, Sichuan, China
| | - Xin Wu
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, China
| | - Gang Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, China
| | - Yuan Li
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, China.
- Laboratory of Digestive Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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22
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Taka M, Kobayashi S, Mizutomi K, Inoue D, Takamatsu S, Gabata T, Matsumoto I, Ikeda H, Kobayashi T, Minato H, Abo H. Diagnostic approach for mediastinal masses with radiopathological correlation. Eur J Radiol 2023; 162:110767. [PMID: 36921376 DOI: 10.1016/j.ejrad.2023.110767] [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: 12/21/2022] [Revised: 02/13/2023] [Accepted: 03/06/2023] [Indexed: 03/13/2023]
Abstract
PURPOSE Mediastinal masses have various histopathological and radiological findings. Although lymphoma is the most common type of tumor, thymic epithelial and neurogenic tumors are common in adults and children, respectively, but several other types are difficult to distinguish. No previous review has simply and clearly shown how to differentiate mediastinal masses. METHOD We conducted a review of the latest mediastinal classifications and mass differentiation methods, with a focus on neoplastic lesions. Both older and recent studies were searched, and imaging and histopathological findings of mediastinal masses were reviewed. Original simple-to-use differentiation flowcharts are presented. RESULTS Assessing localizations and internal characteristics is very important for mediastinal mass differentiation. The mass location and affected organ/tissue should be accurately assessed first, followed by more qualitative diagnosis, and optimization of the treatment strategy. In 2014, the International Thymic Malignancy Interest Group presented a new mediastinal clinical classification. In this classification, mediastinal masses are categorized into three groups according to location: prevascular (anterior)-, visceral (middle)-, and paravertebral (posterior)-compartment masses. Then, the internal characteristics and functional images are evaluated. CONCLUSIONS Differentiation of mediastinal masses is very difficult. However, if typical imaging findings and clinical characteristics are combined, reasonable differentiation is possible. In each patient, proper differential diagnosis may contribute to better treatment selection.
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Affiliation(s)
- Masashi Taka
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Satoshi Kobayashi
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Kaori Mizutomi
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Dai Inoue
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Shigeyuki Takamatsu
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Isao Matsumoto
- Department of Thoracic Surgery, Kanazawa University, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Hiroko Ikeda
- Department of Pathology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8530, Japan.
| | - Takeshi Kobayashi
- Department of Radiology, Ishikawa Prefectural Central Hospital, 2-1, Kuratsukihigashi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Hiroshi Minato
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, 2-1, Kuratsukihigashi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Hitoshi Abo
- Department of Radiology, Toyama Prefectural Central Hospital, 2-2-78, Nishinagae, Toyama City, Toyama 930-8550, Japan.
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Whole-tumor radiomics analysis of T2-weighted imaging in differentiating neuroblastoma from ganglioneuroblastoma/ganglioneuroma in children: an exploratory study. Abdom Radiol (NY) 2023; 48:1372-1382. [PMID: 36892608 DOI: 10.1007/s00261-023-03862-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE To examine the potential of whole-tumor radiomics analysis of T2-weighted imaging (T2WI) in differentiating neuroblastoma (NB) from ganglioneuroblastoma/ganglioneuroma (GNB/GN) in children. MATERIALS AND METHODS This study included 102 children with peripheral neuroblastic tumors, comprising 47 NB patients and 55 GNB/GN patients, which were randomly divided into a training group (n = 72) and a test group (n = 30). Radiomics features were extracted from T2WI images, and feature dimensionality reduction was applied. Linear discriminant analysis was used to construct radiomics models, and one-standard error role combined with leave-one-out cross-validation was used to choose the optimal radiomics model with the least predictive error. Subsequently, the patient age at initial diagnosis and the selected radiomics features were incorporated to construct a combined model. The receiver operator characteristic (ROC) curve, decision curve analysis (DCA) and clinical impact curve (CIC) were applied to evaluate the diagnostic performance and clinical utility of the models. RESULTS Fifteen radiomics features were eventually chosen to construct the optimal radiomics model. The area under the curve (AUC) of the radiomics model in the training group and test group was 0.940 [95% confidence interval (CI) 0.886, 0.995] and 0.799 (95%CI 0.632, 0.966), respectively. The combined model, which incorporated patient age and radiomics features, achieved an AUC of 0.963 (95%CI 0.925, 1.000) in the training group and 0.871 (95%CI 0.744, 0.997) in the test group. DCA and CIC demonstrated that the radiomics model and combined model could provide benefits at various thresholds, with the combined model being superior to the radiomics model. CONCLUSION Radiomics features derived from T2WI, in combination with the age of the patient at initial diagnosis, may offer a quantitative method for distinguishing NB from GNB/GN, thus aiding in the pathological differentiation of peripheral neuroblastic tumors in children.
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Ramallo P, Blanque S, Méndez Uriburu L, Ahualli J, Méndez A, Méndez M. Case 311: Generalized Lymphatic Anomaly. Radiology 2023; 306:e213229. [PMID: 36803000 DOI: 10.1148/radiol.213229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
HISTORY A 14-year-old boy presented with asthenia, low back pain, and abdominal distention. The onset of symptoms was slow and progressive over a few months. The patient had no contributing past medical history. At physical examination, all vital signs were normal. Only pallor and positive fluid wave test results were noted; there was no lower limb edema, mucocutaneous lesions, or palpable lymph node enlargement. Laboratory work-up revealed a decreased hemoglobin concentration of 9.3 g/dL (normal range, 12-16 g/dL) and a decreased hematocrit level of 29.8% (normal range, 37%-45%), but all other laboratory values were normal. Contrast-enhanced CT of the chest, abdomen, and pelvis was performed.
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Affiliation(s)
- Pablo Ramallo
- From the Department of Body Imaging, Centro Radiológico Dr. Luis Méndez Collado, Muñecas 444, San Miguel de Tucumán, Tucumán, Argentina T4000
| | - Sara Blanque
- From the Department of Body Imaging, Centro Radiológico Dr. Luis Méndez Collado, Muñecas 444, San Miguel de Tucumán, Tucumán, Argentina T4000
| | - Luis Méndez Uriburu
- From the Department of Body Imaging, Centro Radiológico Dr. Luis Méndez Collado, Muñecas 444, San Miguel de Tucumán, Tucumán, Argentina T4000
| | - Jorge Ahualli
- From the Department of Body Imaging, Centro Radiológico Dr. Luis Méndez Collado, Muñecas 444, San Miguel de Tucumán, Tucumán, Argentina T4000
| | - Alfonso Méndez
- From the Department of Body Imaging, Centro Radiológico Dr. Luis Méndez Collado, Muñecas 444, San Miguel de Tucumán, Tucumán, Argentina T4000
| | - Marco Méndez
- From the Department of Body Imaging, Centro Radiológico Dr. Luis Méndez Collado, Muñecas 444, San Miguel de Tucumán, Tucumán, Argentina T4000
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25
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Kandasamy D, Gulati A, Simon B, John R, Goyal A. Imaging Recommendations for Diagnosis, Staging, and Management of Adrenal Tumors. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1759714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
AbstractAdrenal glands are affected by a wide variety of tumors apart from infective and inflammatory lesions and their noninvasive characterization on imaging is important for the management of these patients. Incidentalomas form the major bulk of adrenal tumors and differentiation of benign adenomas from other malignant lesions, especially in patients with a known malignancy, guide further management. Imaging is an integral part of management along with clinical and biochemical features. The cornerstone of clinical and biochemical evaluation of adrenal tumors is to determine whether the lesion is functional or nonfunctional. Computed tomography (CT) is considered as the workhorse for imaging evaluation of adrenal lesions. CT densitometry and CT contrast washout characteristics are quite reliable in differentiating adenomas from malignant lesions. CT is also the modality of choice for the evaluation of resectability and staging of primary adrenal tumors. Magnetic resonance imaging (MRI) has superior contrast resolution compared to other morphological imaging modalities and is generally used as a problem-solving tool. MRI chemical shift imaging can also be used to reliably detect adrenal adenomas. Ultrasonography (USG) is used as a screening tool that is usually followed by either CT or MRI to better characterize the tumor and it is not routinely used for assessing the resectability, staging, and characterization of adrenal tumors. Another important role of USG is in image-guided sampling of tumors. Fluorodeoxyglucose positron emission tomography-computed tomography and other nuclear medicine modalities are a valuable addition to morphological imaging modalities. Image-guided interventions also play an important role in obtaining tissue samples where diagnostic imaging is not able to characterize adrenal tumors. In the functioning of adrenal tumors, adrenal venous sampling is widely used to accurately lateralize the secreting tumor.
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Affiliation(s)
- Devasenathipathy Kandasamy
- Department of Radiodiagnosis & Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Gulati
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
| | - Betty Simon
- Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
| | - Reetu John
- Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
| | - Alpesh Goyal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Primary thymic neuroblastomas in adults: A clinicopathological and immunohistochemical study of three cases. Ann Diagn Pathol 2023; 62:152071. [PMID: 36495734 DOI: 10.1016/j.anndiagpath.2022.152071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
Three cases of primary neuroblastomas presenting as anterior mediastinal tumors are presented. The patients are two women and one man between the ages of 57 and 63 year. Clinically, the patients presented with symptoms of chest pain, cough, and shortness of breath. Diagnostic imaging revealed the presence of an anterior mediastina mass. Initial biopsy was non-diagnostic in two patients, while in one patient no biopsy was obtained. Surgical resection via thoracotomy was performed in all three patients. Grossly, the tumors vary in size from 3 to 4.5 cm in greatest dimension, and they were described as well circumscribed but not encapsulated, light brown in color. Areas of hemorrhage and/or necrosis were not described. Histologically, at low power the tumors were surrounded by a rim of adipose tissue containing remnants of thymic tissue with Hassall's corpuscles. At higher magnification, the tumors show the characteristic small round cell proliferation with varying amounts of neurophil. Mitotic activity was present but not in large number. Areas of necrosis and/or hemorrhage were not identified. Immunohistochemically, the tumors show positive staining for NSE, while synaptophysin highlighted neurophil. Other markers epithelial and neuroendocrine were negative. Clinical follow-up information shows that two patients have remained alive 8 and 12 months after initial surgical resection. One patient was lost to follow-up.
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Tanaka J, Sasaguri M, Yada N, Tanaka M, Habu M, Yoshiga D, Matsuo K, Tominaga K, Yoshioka I. A case of cervical ganglioneuroma incidentally detected during surgery for oral cancer. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2023. [DOI: 10.1016/j.ajoms.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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28
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Paterra R, Bettinaglio P, Borghi A, Mangano E, Tritto V, Cesaretti C, Schettino C, Bordoni R, Santoro C, Avignone S, Moscatelli M, Melone MAB, Saletti V, Piluso G, Natacci F, Riva P, Eoli M. A Translational Approach to Spinal Neurofibromatosis: Clinical and Molecular Insights from a Wide Italian Cohort. Cancers (Basel) 2022; 15:cancers15010059. [PMID: 36612057 PMCID: PMC9817775 DOI: 10.3390/cancers15010059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Spinal neurofibromatosis (SNF), a phenotypic subclass of neurofibromatosis 1 (NF1), is characterized by bilateral neurofibromas involving all spinal roots. In order to deepen the understanding of SNF’s clinical and genetic features, we identified 81 patients with SNF, 55 from unrelated families, and 26 belonging to 19 families with at least 1 member affected by SNF, and 106 NF1 patients aged >30 years without spinal tumors. A comprehensive NF1 mutation screening was performed using NGS panels, including NF1 and several RAS pathway genes. The main features of the SNF subjects were a higher number of internal neurofibromas (p < 0.001), nerve root swelling (p < 0.001), and subcutaneous neurofibromas (p = 0.03), while hyperpigmentation signs were significantly less frequent compared with the classical NF1-affected cohorts (p = 0.012). Fifteen patients underwent neurosurgical intervention. The histological findings revealed neurofibromas in 13 patients and ganglioneuromas in 2 patients. Phenotypic variability within SNF families was observed. The proportion of missense mutations was higher in the SNF cases than in the classical NF1 group (21.40% vs. 7.5%, p = 0.007), conferring an odds ratio (OR) of 3.34 (CI = 1.33−10.78). Two unrelated familial SNF cases harbored in trans double NF1 mutations that seemed to have a subclinical worsening effect on the clinical phenotype. Our study, with the largest series of SNF patients reported to date, better defines the clinical and genetic features of SNF, which could improve the management and genetic counseling of NF1.
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Affiliation(s)
- Rosina Paterra
- Molecular Neuroncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20122 Milano, Italy
| | - Paola Bettinaglio
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Segrate, 20122 Milan, Italy
| | - Arianna Borghi
- Molecular Neuroncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20122 Milano, Italy
| | - Eleonora Mangano
- Institute of Biomedical Technologies (ITB) National Research Center (CNR), ITB-CNR, Segrate, 20122 Milan, Italy
| | - Viviana Tritto
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Segrate, 20122 Milan, Italy
| | - Claudia Cesaretti
- Medical Genetics Unit, Woman-Child-Newborn Department, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Carla Schettino
- Department of Advanced Medical and Surgical Sciences, 2nd Division of Neurology, Center for Rare Diseases and InterUniversity Center for Research in Neurosciences, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy
| | - Roberta Bordoni
- Institute of Biomedical Technologies (ITB) National Research Center (CNR), ITB-CNR, Segrate, 20122 Milan, Italy
| | - Claudia Santoro
- Neurofibromatosis Referral Center, Department of Woman, Child and of General and Specialized Surgery, and Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy
| | - Sabrina Avignone
- Neuroradiology Department, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Marco Moscatelli
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Mariarosa Anna Beatrice Melone
- Department of Advanced Medical and Surgical Sciences, 2nd Division of Neurology, Center for Rare Diseases and InterUniversity Center for Research in Neurosciences, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, Temple University, Philadelphia, PA 19122, USA
| | - Veronica Saletti
- Developmental Neurology Unit, Mariani Foundation Center for Complex Disabilities, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Giulio Piluso
- Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 81100 Naples, Italy
| | - Federica Natacci
- Medical Genetics Unit, Woman-Child-Newborn Department, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Paola Riva
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Segrate, 20122 Milan, Italy
- Correspondence: (P.R.); (M.E.); Tel.: +39-02-503130462 (P.R.); +39-02-23942285 (M.E.)
| | - Marica Eoli
- Molecular Neuroncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20122 Milano, Italy
- Correspondence: (P.R.); (M.E.); Tel.: +39-02-503130462 (P.R.); +39-02-23942285 (M.E.)
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Khoei S, Boustani MR, Pak N. An atypical imaging characteristic of calvarial metastasis of neuroblastoma as multiple multi-loculated cystic masses with internal blood-fluid levels: a case report. BMC Neurol 2022; 22:471. [PMID: 36494678 PMCID: PMC9733139 DOI: 10.1186/s12883-022-03001-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND As the third most common malignancy of childhood, Neuroblastoma has a great propensity to metastasize to multiple organs. The most common site of metastasis is the bone and bone marrow. Concerning the central nervous system, neuroblastoma usually involves the calvarium and the external dural surface. The skull metastases may show different appearances, including: multiple lytic bone lesions, bone thickening, hair-on-end periosteal reaction, irregular suture widening and/or plaque like epidural deposits. Here we present a case of metastatic neuroblastoma, appearing as multiple multi-loculated cystic epidural masses with internal blood-fluid levels as a rare imaging manifestation of calvarial metastasis. CASE PRESENTATION An 8-year-old boy with known history of autism, presented to the emergency department with a 3-month history of intermittent fever, malaise and myalgia and headache along with significant weight loss. Laboratory examination revealed elevated ESR and CRP and anemia. On Abdomino-Pelvic imaging a well-defined, 45*30*24 mm, solid-cystic mass was observed, replacing the normal left adrenal gland. On brain MRI, multiple multi-loculated cystic, lentiform masses were observed on the external surface of cerebral hemispheric dura. Multiple fluid-fluid levels were noted in the locules in some of which the dependent fluid was hyperintense on T1w and FLAIR and hypointense on T2w sequences, compatible with blood, representing blood-fluid level. The wall and septa of the masses, enhanced after contrast administration. Associated abnormal marrow signal and aggressive type periosteal reactions were identified in the overlying bone. All of the lesions had increased uptake in MIBG scan. Bone marrow biopsy revealed small round cells, diagnostic for neuroblastoma. The patient underwent chemotherapy treatment. All calvarial/epidural metastatic lesions resolved after chemotherapy and residual adrenal tumor was resected. CONCLUSION Cystic epidural lesions, especially when associated with adjacent abnormal bone marrow signal, or periosteal reaction and containing blood-fluid level should raise the suspicion of a calvarial metastasis.
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Affiliation(s)
- Samin Khoei
- grid.414574.70000 0004 0369 3463Radiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Boustani
- grid.411259.a0000 0000 9286 0323Department of Neurosurgery, AJA University of Medical Sciences, Tehran, Iran ,grid.411705.60000 0001 0166 0922Department of Neurosurgery, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Pak
- grid.411705.60000 0001 0166 0922Department of Radiology, Children’s Medical Center of Excellence and Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Paloka R, Gopireddy DR, Virarkar M, Galgano SJ, Morani A, Adimula P, Singareddy A, Montanarella M. Multimodality imaging of adrenal gland pathologies: A comprehensive pictorial review. J Clin Imaging Sci 2022; 12:62. [PMID: 36601600 PMCID: PMC9805616 DOI: 10.25259/jcis_92_2022] [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: 08/08/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
The assessment of acute abdominal and pelvic emergencies typically involves a multimodal approach consisting of plain radiographs, ultrasound, computed tomography (CT), and rarely magnetic resonance imaging (MRI). Although MRI is not traditionally employed in acute care settings, there are several instances in which MRI provides superior functional and prognostic information. In this manuscript, we highlight multimodal findings of adrenal gland emergencies: Hemorrhage, infarction, and infection. The purpose of our study is to highlight significant findings in various modalities, including CT, MRI, ultrasound, and PET/CT. Due to the scarcity of published data and limited clinical use, primary ultrasound findings are limited in our multimodal review. In conclusion, we find that synergistic use of CT, MRI, and functional imaging provides an effective tool for evaluation and management of adrenal pathology.
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Affiliation(s)
- Rinald Paloka
- Department of Radiology, University of Florida Jacksonville, Jacksonville, Florida, United States,Corresponding author: Rinald Paloka, Department of Radiology, University of Florida Jacksonville, Jacksonville, Florida, United States.
| | - Dheeraj Reddy Gopireddy
- Department of Radiology, University of Florida Jacksonville, Jacksonville, Florida, United States
| | - Mayur Virarkar
- Department of Radiology, University of Florida Jacksonville, Jacksonville, Florida, United States
| | - Samuel Joseph Galgano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, United States
| | - Ajaykumar Morani
- Department of Radiology, University of Texas MD Anderson, Houston, Texas, United States
| | - Padma Adimula
- Department of Radiology, University of Florida Jacksonville, Jacksonville, Florida, United States
| | - Anastasia Singareddy
- Department of Radiology, University of Florida Jacksonville, Jacksonville, Florida, United States
| | - Matthew Montanarella
- Department of Radiology, University of Florida Jacksonville, Jacksonville, Florida, United States
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Liu Q, Wang S, Chu P, Sun J, Jin Y, Guo Y, Ma X, He L, Su Y, Zhang J, Peng Y, Li Y, Zhang X, Sun N, Liu Z, Ni X. Clinical and surgical outcome differences on the basis of pathology category in cervical neuroblastic tumors. J Pediatr Surg 2022; 57:926-933. [PMID: 35961818 DOI: 10.1016/j.jpedsurg.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/20/2022] [Accepted: 07/01/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cervical neuroblastic tumors (NTs) are rare but less aggressive cancer with an above-average survival rate. Little has been published regarding the management and surgical outcomes of patients with cervical NTs based on pathology category. This study compared and identified the preoperative characteristics of cervical NTs in different pathology categories and evaluated the outcomes of patients undergoing surgical resection. MATERIALS AND METHODS Upon the institutional review board's approval, a retrospective chart review was performed at Beijing Children's Hospital from April 2013 to August 2020. Demographics of patients, imaging data, lab test results, operation details and outcomes were recorded and analyzed. RESULTS Of 32 cervical NTs, 24(80%) were classified as neuroblastoma (NB) /ganglioneuroblastoma-nodular (GNBn) and 8(20%) as ganglioneuroblastoma-intermixed (GNBi)/ ganglioneuroma (GN). Patients with GNBi/GN were older than those with NB/GNBn (44.5 months (IQR 16-81) vs 9 months (IQR 1-47); P = 0.001). GNBi/GN patients presented more frequently with stage 1 disease compared with NB/GNBn patients (100% vs. 29.2%, P = 0.001), less frequently with tumor-related symptoms (0% vs. 70.8%, P = 0.001), artery encased tumor (0% vs. 41.7%, P = 0.035), and surgical complications (25% vs. 70.8%, P = 0.038). GNBi/GN patients were also less likely to show elevated neuron specific enolase (NSE) (12.5% vs. 79.2%, P = 0.002). CONCLUSIONS Cervical NB/GNBn and GNBi/GN patients had distinct characteristic clinical presentations and surgical outcomes. For children with features suggestive of benign disease (older age, asymptomatic, normal serum tumor markers) and no artery image-defined risk factors (IDRFs), upfront resection can be considered.
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Affiliation(s)
- Qiaoyin Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shengcai Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ping Chu
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing Pediatric Research Institute, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jihang Sun
- Imaging center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yaqiong Jin
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing Pediatric Research Institute, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yongli Guo
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing Pediatric Research Institute, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaoli Ma
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lejian He
- Department of Pathology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yan Su
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jie Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yun Peng
- Imaging center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yanzhen Li
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xuexi Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Nian Sun
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhiyong Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xin Ni
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
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Association of Image-Defined Risk Factors with Clinical, Biological Features and Outcome in Neuroblastoma. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111707. [PMID: 36360435 PMCID: PMC9688519 DOI: 10.3390/children9111707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 11/10/2022]
Abstract
Background: Neuroblastoma (NB) is the most common pediatric extracranial solid tumor and the most common cancer encountered in children younger than 12 months of age. Localized tumors have a good prognosis, but some cases undergo treatment failure and recurrence. The aim of the study was to analyze the link between the neuroblastoma risk factors and the prognosis for patients diagnosed with NB. Method: All patients admitted to the department of Pediatric Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, between 1 January 2010 and 1 July 2022 were included in this analysis when diagnosed with neuroblastoma. Results: Thirty-one patients with NB were admitted to the surgical department, 20 boys and 11 girls. We observed an association between large tumors and positive imaging-defined risk factor (IDRF) status; The Fisher test showed an association between the tumor’s diameter when bigger than 8 cm and a positive IDRF status, with p < 0.001. We supposed that positive IDRF status at diagnosis may be linked to other prognostic factors. We discovered that an NSE value over 300 was associated with IDRF status (p < 0.001, phi = 0.692) and death. Conclusions: This study confirms the impact of IDRF status at diagnosis as it can be clearly correlated with other risk factors, such as a high level of NSE, MYCN amplification status, large tumor size, incomplete tumor resection, and an unfavorable outcome.
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Dahal A, Malla JJ, Neupane D, Lageju N, Jaiswal LS, Chaudhary S, Kandel A, Chhetri S, Pahari S. Large posterior mediastinal ganglioneuroma with intradural cervical spine extension: A rare case report and review of literature. Ann Med Surg (Lond) 2022; 84:104833. [PMID: 36582868 PMCID: PMC9793127 DOI: 10.1016/j.amsu.2022.104833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/22/2022] [Accepted: 10/30/2022] [Indexed: 11/08/2022] Open
Abstract
Introduction Ganglioneuroma (GN) is a rare benign tumor of ganglion cell origin and can occur anywhere along the sympathetic chain. These tumors can grow to a significant size without any symptoms unless they exert a mass effect on the region they grow and start showing symptoms. Spinal extensions are rare and they may produce neurological symptoms warranting further investigation. Case presentation We described a case of posterior mediastinal ganglioneuroma in a 4-year-old boy with cervical extension who presented with quadriparesis. The radiological scan revealed large ganglioneuroma having an intradural extramedullary extension with a large posterior mediastinal component compressing and displacing the surrounding structures. He underwent consecutive surgeries for complete excision of the tumor following which he regained his power in his upper and lower limbs over the period of 2 months. Conclusion Para spinal mass with consistent radiological features suggests ganglioneuroma but confirmation should be done with biopsy. Complete excision of the tumor is the treatment of choice with close follow-up for clinical improvement and recurrence.
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Affiliation(s)
- Alok Dahal
- Department of Surgery (Division of Neurosurgery), B.P. Koirala Institute of Health Sciences, Dharan, Nepal,Corresponding author.
| | - Justin Jung Malla
- Department of Surgery (Division of Neurosurgery), B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Durga Neupane
- Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Nimesh Lageju
- Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Lokesh Shekher Jaiswal
- Department of Surgery (Division of CTVS), B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sushant Chaudhary
- Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Ashim Kandel
- Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sunit Chhetri
- Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Soumya Pahari
- Department of Surgery, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
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Wang S, Ma JX, Zheng L, Sun ST, Xiang LB, Chen Y. Multiple bilateral and symmetric C1-2 ganglioneuromas: A case report. World J Clin Cases 2022; 10:11549-11554. [PMID: 36387807 PMCID: PMC9649540 DOI: 10.12998/wjcc.v10.i31.11549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/08/2022] [Accepted: 10/09/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ganglioneuromas are rare tumors of the sympathetic nervous system that originate from neural crest sympathogonia. Since the cervical spine has rarely been reported as a site for ganglioneuroma, we present a case report on this uncommon manifestation.
CASE SUMMARY A 34-year-old male presented with a 4-month history of progressive paralysis of both upper limbs along with an unsteady gait. The touch sensitivity of both hands was reduced, and there was conspicuously high muscle tonus in his upper and lower limbs, along with hyperactive physiological reflection and deep reflexes. Magnetic resonance imaging showed several nodules around the C2-7 intervertebral foramena, among which the masses lying between C1 and C2 were obviously bilaterally compressing the spinal cord. Successful posterior decompression was performed without fixation and the tumors in the upper cervical spine were removed intact, with rapid relief of symptoms. The pathological diagnosis was ganglioneuroma.
CONCLUSION Multiple and bilateral ganglioneuroams are a rare occurrence in the cervical spine. In this case report, timely resection of the neoplasms around C1 and C2 resulted in spinal cord decompression, with rapid relief of symptoms and a good prognosis. Including the current case, we are aware of only seven such cases in the literature, of which four arose from Japan, one from China, and one from Spain. We suppose that ethnicity and geographic associations with this rare disease presentation may be an aspect for future consideration and investigation.
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Affiliation(s)
- Shuang Wang
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang 110006, Liaoning Province, China
| | - Jun-Xiong Ma
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang 110006, Liaoning Province, China
| | - Liang Zheng
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang 110006, Liaoning Province, China
| | - Shao-Tong Sun
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang 110006, Liaoning Province, China
| | - Liang-Bi Xiang
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang 110006, Liaoning Province, China
| | - Yu Chen
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang 110006, Liaoning Province, China
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Zuraski CR, Wales C, Nguyen CV, Chan EF, Kovarik C, Seykora JT, Elenitsas R, Moshiri AS. Cutaneous Ganglioneuromas With Overlying Epidermal Hyperplasia: A Case Series Presentation and Proposal of Potential Etiopathogenesis. Am J Dermatopathol 2022; 44:812-816. [PMID: 35925148 DOI: 10.1097/dad.0000000000002249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Cutaneous ganglioneuromas (GNs) are exceptionally uncommon tumors, and many reported cases describe association with overlying epidermal hyperplasia that may be interpreted as seborrheic keratosis (SK) or SK-like proliferation. We report 5 cases of cutaneous GN in adult patients; all of which were discovered incidentally in the immediate vicinity of epidermal hyperplasia. A review of the literature demonstrates the current-although likely imperfect-understanding of the etiopathogenesis of both SK and GN in the skin. We explore the putative pathophysiologies of other common, well-characterized skin lesions and, taking them into account, provide rationale for the coexistence of cutaneous GN with overlying SK and SK-like epidermal changes. However, we ultimately acknowledge a dilemma of causality and, given the rarity of their co-occurrence, objectively question whether occasional cameo appearances by GN lying subjacent to SK and SK-like hyperplasia may be due merely to chance.
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Affiliation(s)
- Connor R Zuraski
- Department of Pathology, University of California, San Diego, CA
| | - Cameron Wales
- Department of Pathology, University of California, Los Angeles, CA
| | - Cuong V Nguyen
- Department of Dermatology, Northwestern University, Chicago, IL
| | - Edward F Chan
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA; and
| | - Carrie Kovarik
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA; and
| | - John T Seykora
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA; and
| | - Rosalie Elenitsas
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA; and
| | - Ata S Moshiri
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
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Castle JT, Levy BE, Chauhan A. Pediatric Neuroendocrine Neoplasms: Rare Malignancies with Incredible Variability. Cancers (Basel) 2022; 14:cancers14205049. [PMID: 36291833 PMCID: PMC9599522 DOI: 10.3390/cancers14205049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/07/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022] Open
Abstract
Neuroendocrine neoplasms (NENs) encompass a variety of neuroendocrine tumors (NETs) and neuroendocrine carcinomas (NECs) which can arise anywhere in the body. While relatively rare in the pediatric population, the incidence of NENs has increased in the past few decades. These neoplasms can be devastating if not diagnosed and treated early, however, symptoms are variable and can be indolent for many years. There is a reported median of 10 years from the appearance of the first symptoms to time of diagnosis. Considering some of these neoplasms have a mortality rate as high as 90%, it is crucial healthcare providers are aware of NENs and remain vigilant. With better provider education and easily accessible resources for information about these neoplasms, awareness can be improved leading to earlier disease recognition and diagnosis. This manuscript aims to provide an overview of both the most common NENs as well as the rarer NENs with high lethality in the pediatric population. This review provides up to date evidence and recommendations, encompassing recent changes in classification and advances in treatment modalities, including recently completed and ongoing clinical trials.
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Affiliation(s)
- Jennifer T. Castle
- Department of Surgery, Markey Cancer Center, University of Kentucky, 800 Rose Street, Lexington, KY 40536, USA
| | - Brittany E. Levy
- Department of Surgery, University of Kentucky, 800 Rose Street, Lexington, KY 40536, USA
| | - Aman Chauhan
- Department of Internal Medicine-Medical Oncology, Markey Cancer Center, University of Kentucky, 800 Rose Street, Lexington, KY 40536, USA
- Correspondence: or
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Hemrom A, Arora G, Damle NA, Bal C. Comparative Role of 18F-DOPA PET/CT and 131I-MIBG Scintigraphy in Neuroblastoma and Application of Curie and SIOPEN Scoring Systems in 18F-DOPA PET/CT. Nucl Med Mol Imaging 2022; 56:236-244. [PMID: 36310834 PMCID: PMC9508302 DOI: 10.1007/s13139-022-00762-6] [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: 02/27/2022] [Revised: 06/15/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Neuroblastoma (NB) is childhood's most common extracranial solid malignancy. We have compared two imaging modalities, 131I-MIBG and 18F-DOPA PET/CT, to evaluate NB. Also, feasibility of the application of standardised scoring systems, SIOPEN and Curie scoring systems, in 18F-DOPA PET/CT was explored. Methods Patients with histopathology-proven NB underwent 131I-MIBG (planar and SPECT/CT) and 18F-DOPA PET/CT scans, as per standard imaging protocols. Duration between scans ranged from 1 to 30 days (median = 8 days). Number of lesions in Curie and SIOPEN scoring systems applied on both modalities was compared. Results Forty-six patients were included (M:F = 29:17) with a median age of 36 months. Both 131I-MIBG and 18F-DOPA scans were positive in 39 patients and negative in four patients. 18F-DOPA PET/CT was positive in additional three patients, in which 131I-MIBG was negative (p = 0.25). Overall, 18F-DOPA identified significantly greater number of lesions than 131I-MIBG, especially metastatic skeletal lesions (p < 0.05). Significant difference was observed between Curie scores in the two modalities, unlike SIOPEN scores. However, when the cut-off age of 18 months was taken, no significant difference was seen in either of the scoring systems in both the scans (p > 0.05). CS and SIOPEN scores were significantly higher in bone marrow-positive patients. Conclusion 18F-DOPA PET/CT detected more lesions than 131I-MIBG but had little impact on staging of the disease. For evaluation of NB, both scans can be used interchangeably as per the availability. Furthermore, both SIOPEN and Curie scoring systems, standardised for MIBG, can also be used to semi-quantify disease extent in 18F-DOPA PET/CT. Supplementary Information The online version contains supplementary material available at 10.1007/s13139-022-00762-6.
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Affiliation(s)
- Angel Hemrom
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Geetanjali Arora
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Nishikant Avinash Damle
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029 India
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Guo N, Zhu A, Zhao M, Li H, Zhang W. Solitary Periaortic Tuberculous Granuloma Mimicking Neoplastic Disease on 18 F-FDG PET/CT. Clin Nucl Med 2022; 47:e640-e642. [PMID: 35426844 DOI: 10.1097/rlu.0000000000004245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Solitary tuberculoma of periaortic space is extremely rare. We report a case of periaortic tuberculous granuloma revealed by 18 F-FDG PET/CT in a 51-year-old woman without pulmonary or any other organ involvement. Awareness of this rare but possible atypical presentation of tuberculosis is helpful for the differential diagnosis of periaortic mass.
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Affiliation(s)
- Na Guo
- From the Department of Nuclear Medicine, Peking University Third Hospital, Beijing, China
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Diagnostic value of the relative enhancement ratio of the portal venous phase to unenhanced CT in the identification of lipid-poor adrenal tumors. Abdom Radiol (NY) 2022; 47:3308-3317. [PMID: 35778569 DOI: 10.1007/s00261-022-03593-3] [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: 03/27/2022] [Revised: 06/12/2022] [Accepted: 06/14/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE Adrenal incidentalomas are common lesions found on abdominal imaging, most of which are lipid-rich adrenal adenomas. Imaging diagnoses differentiating lipid-poor adrenal adenomas (LPA) from non-adenomas (NA) are presently challenging to perform. The aim of the study was to investigate the diagnostic performance of the relative enhancement ratio parameter in identifying LPA from NA. METHODS We retrospectively evaluated consecutively presenting patients with lipid-poor adrenal lesions (January 2015 to August 2021). Lesions were divided into LPA and NA (including hyperenhancing and hypoenhancing NA). Kruskal-Wallis and Bonferroni tests were used to determine the differences in feature parameters between these three groups. Receiver operating characteristic curve analysis was performed to determine the sensitivity for diagnosing LPA and NA at 95% specificity; the parameters were compared using the McNemar test. RESULTS A total of 253 patients (mean age, 55 ± 12 years; 135 men), 121 with LPA and 132 with NA, were analyzed herein. The sensitivity (achieved at 95% specificity) of the relative enhancement ratio was higher than that of unenhanced attenuation in differentiating LPA from NA (60% vs. 52%, p = 0.064). The relative enhancement ratio yielded a higher sensitivity than unenhanced attenuation (79% vs. 59%, p < 0.001) in differentiating LPA from hypoenhancing NA, and a lower sensitivity (26% vs. 69%, p < 0.001) in differentiating LPA from hyperenhancing NA. CONCLUSION The relative enhancement ratio showed better diagnostic performance than unenhanced attenuation in differentiating LPA from hypoenhancing NA, while simultaneously showing poor diagnostic performance in identifying LPA from all NA.
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Li S, Mao S, Ma Y, Zhu Z, Liu Z, Qian B, Sun X, Qiu Y. Scoliosis: an unusual clinical presentation of paraspinal ganglioneuroma. Spine Deform 2022; 10:1185-1195. [PMID: 35486319 DOI: 10.1007/s43390-022-00511-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/09/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To comprehensively present the clinical characteristics and treatment strategies in patients with scoliosis secondary to ganglioneuroma (S-GN). METHODS Six patients with S-GN treated surgically at a median age of 12 years were retrospectively reviewed and the median follow-up period was 6 years (4-14 years). The radiological features of GN and the associated scoliosis were evaluated. The surgical strategies and the corresponding outcomes were investigated. RESULTS All patients had a delayed diagnosis age of GN than scoliosis (12 vs. 9 years). GN was located at the posterior mediastinum in four patients (66.7%) and at retroperitoneum in two, respectively. Tumor occupancies were frequently detected on the X-ray films for four patients (66.7%), being uniformly on the convexity of the main curve. All patients complained of rapid progressive deformities during the growth period. Five patients (83.3%) received total tumor resections, one accepted partial resection. Deformity correction was implemented for all patients with an average rate of 66.4% on the main curve. No recurrence of the GN was detected for all totally tumor-resected patients at the latest follow-up. CONCLUSION S-GN is often misdiagnosed clinically. Paravertebral mass neighboring the apex of scoliosis can be meticulously detected from the X-ray films. Total tumor resection should be aggressively performed if possible. The deformity correction could be satisfactorily obtained and the risk of recurrence of the GN was relatively low.
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Affiliation(s)
- Song Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiangsu Province, China
| | - Saihu Mao
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiangsu Province, China.
| | - Yanyu Ma
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiangsu Province, China
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiangsu Province, China
| | - Zhen Liu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiangsu Province, China
| | - Bangping Qian
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiangsu Province, China
| | - Xu Sun
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiangsu Province, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiangsu Province, China
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Impellizzeri P, Peri FM, Arena S, Trimarchi R, Romeo C, Dionigi G. Retroperitoneal approach in a child with ganglioneuroma: points of technique and literature review. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00205-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background data
Ganglioneuroma is rare in children and often incidentally discovered. The transperitoneal laparoscopic approach is the surgical choice for most of the surgeons because of the familiar anatomy and the wider working spaces. However, a posterior retroperitoneal approach started to be used in pediatric population demonstrating to be safe and effective.
Case presentation
We present a case of a child with radiological finding of a right adrenal mass. Due to the increased risk of having a malignant transformation, a surgical resection was decided using a retroperitoneal approach. The adrenal mass was recognized and completely enucleated. The histopathological examination revealed a GN. Clinical course was uneventful with hospital discharge after 3 days. The outcome was evaluated by ultrasound examination performed 3–6 to 12–24 months and then annually. After 24 months, the patient is completely asymptomatic, and no adrenal masses in both sides have been detected.
Conclusions
The posterior retroperitoneoscopy permits a more direct exposure of the adrenal gland, without violating the peritoneum, and a close vision to the main vessels. We believe that this technique is a valid option for pediatric patients with small adrenal lesions.
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Farma JM, Porpiglia AS, Vo ET. Benign Neurogenic Tumors. Surg Clin North Am 2022; 102:679-693. [PMID: 35952696 DOI: 10.1016/j.suc.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Neurogenic tumors arise from cells of the nervous system. These tumors can be found anywhere along the distribution of the sympathetic and parasympathetic nervous system and are categorized based on cell of origin: ganglion cell, paraganglion cell, and nerve sheath cells. Ganglion cell-derived tumors include neuroblastomas, ganglioneuroblastomas, and ganglioneuromas. Paraganglion cell-derived tumors include paragangliomas and pheochromocytomas. Nerve sheath cell-derived tumors include schwannomas (neurilemmomas), neurofibromas, and neurofibromatosis. Most of these are benign; however, they can cause local compressive symptoms. Surgery is the mainstay of treatment, if clinically indicated. Nonetheless, a thorough preoperative workup is essential, especially for catecholamine-secreting tumors.
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Affiliation(s)
- Jeffrey M Farma
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA.
| | - Andrea S Porpiglia
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
| | - Elaine T Vo
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
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Dey S, Ghosh A, Sil K, Saha Basu K, Chatterjee U. Congenital Sacrococcygeal Neuroblastoma: A Report of Two Cases with Summary of Prior Published Cases. Fetal Pediatr Pathol 2022; 41:643-650. [PMID: 33307929 DOI: 10.1080/15513815.2020.1857486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BackgroundNeuroblastoma can arise from extra-adrenal sites in the paraspinal sympathetic chain, including the presacral region, where they must be differentiated from an immature or malignant neural lesion arising from a teratoma.Case ReportWe describe two congenital presacral neuroblastomas. The main clinical differential diagnoses were sacrococcygeal teratoma and meningomyelocele. Pathologically, they lacked teratomatous tissues, lacked germ cell serum markers, were localized without metastases, and were MYCN non-amplified. Both patients have done well without chemotherapy at 18 and 15 months of follow-up.ConclusionCongenital presacral neuroblastoma should be differentiated from teratomatous lesions, and in general have a good prognosis.
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Affiliation(s)
- Soumya Dey
- Pathology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Arindam Ghosh
- Nilratan Sircar Medical College and Hospital, Pediatric Surgery, Kolkata, India
| | - Kaushik Sil
- Neonatology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Kalyani Saha Basu
- Nilratan Sircar Medical College and Hospital, Pediatric Surgery, Kolkata, India
| | - Uttara Chatterjee
- Pathology, Institute of Postgraduate Medical Education and Research, Kolkata, India
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Filizoglu N, Ozguven S. Caso único de ganglioneuroblastoma mediastínico posterior de inicio en el adulto en una PET/TC con [68Ga]Ga-DOTA-TATE. Rev Esp Med Nucl Imagen Mol 2022. [DOI: 10.1016/j.remn.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Veiga-Canuto D, Cerdà-Alberich L, Sangüesa Nebot C, Martínez de las Heras B, Pötschger U, Gabelloni M, Carot Sierra JM, Taschner-Mandl S, Düster V, Cañete A, Ladenstein R, Neri E, Martí-Bonmatí L. Comparative Multicentric Evaluation of Inter-Observer Variability in Manual and Automatic Segmentation of Neuroblastic Tumors in Magnetic Resonance Images. Cancers (Basel) 2022; 14:cancers14153648. [PMID: 35954314 PMCID: PMC9367307 DOI: 10.3390/cancers14153648] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary Tumor segmentation is a key step in oncologic imaging processing and is a time-consuming process usually performed manually by radiologists. To facilitate it, there is growing interest in applying deep-learning segmentation algorithms. Thus, we explore the variability between two observers performing manual segmentation and use the state-of-the-art deep learning architecture nnU-Net to develop a model to detect and segment neuroblastic tumors on MR images. We were able to show that the variability between nnU-Net and manual segmentation is similar to the inter-observer variability in manual segmentation. Furthermore, we compared the time needed to manually segment the tumors from scratch with the time required for the automatic model to segment the same cases, with posterior human validation with manual adjustment when needed. Abstract Tumor segmentation is one of the key steps in imaging processing. The goals of this study were to assess the inter-observer variability in manual segmentation of neuroblastic tumors and to analyze whether the state-of-the-art deep learning architecture nnU-Net can provide a robust solution to detect and segment tumors on MR images. A retrospective multicenter study of 132 patients with neuroblastic tumors was performed. Dice Similarity Coefficient (DSC) and Area Under the Receiver Operating Characteristic Curve (AUC ROC) were used to compare segmentation sets. Two more metrics were elaborated to understand the direction of the errors: the modified version of False Positive (FPRm) and False Negative (FNR) rates. Two radiologists manually segmented 46 tumors and a comparative study was performed. nnU-Net was trained-tuned with 106 cases divided into five balanced folds to perform cross-validation. The five resulting models were used as an ensemble solution to measure training (n = 106) and validation (n = 26) performance, independently. The time needed by the model to automatically segment 20 cases was compared to the time required for manual segmentation. The median DSC for manual segmentation sets was 0.969 (±0.032 IQR). The median DSC for the automatic tool was 0.965 (±0.018 IQR). The automatic segmentation model achieved a better performance regarding the FPRm. MR images segmentation variability is similar between radiologists and nnU-Net. Time leverage when using the automatic model with posterior visual validation and manual adjustment corresponds to 92.8%.
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Affiliation(s)
- Diana Veiga-Canuto
- Grupo de Investigación Biomédica en Imagen, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106 Torre A 7planta, 46026 Valencia, Spain; (L.C.-A.); (L.M.-B.)
- Área Clínica de Imagen Médica, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell, 106 Torre A 7planta, 46026 Valencia, Spain;
- Correspondence:
| | - Leonor Cerdà-Alberich
- Grupo de Investigación Biomédica en Imagen, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106 Torre A 7planta, 46026 Valencia, Spain; (L.C.-A.); (L.M.-B.)
| | - Cinta Sangüesa Nebot
- Área Clínica de Imagen Médica, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell, 106 Torre A 7planta, 46026 Valencia, Spain;
| | - Blanca Martínez de las Heras
- Unidad de Oncohematología Pediátrica, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell, 106 Torre A 7planta, 46026 Valencia, Spain; (B.M.d.l.H.); (A.C.)
| | - Ulrike Pötschger
- St. Anna Children’s Cancer Research Institute, Zimmermannplatz 10, 1090 Vienna, Austria; (U.P.); (S.T.-M.); (V.D.); (R.L.)
| | - Michela Gabelloni
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma, 67, 56126 Pisa, Italy; (M.G.); (E.N.)
| | - José Miguel Carot Sierra
- Departamento de Estadística e Investigación Operativa Aplicadas y Calidad, Universitat Politècnica de València, Camí de Vera s/n, 46022 Valencia, Spain;
| | - Sabine Taschner-Mandl
- St. Anna Children’s Cancer Research Institute, Zimmermannplatz 10, 1090 Vienna, Austria; (U.P.); (S.T.-M.); (V.D.); (R.L.)
| | - Vanessa Düster
- St. Anna Children’s Cancer Research Institute, Zimmermannplatz 10, 1090 Vienna, Austria; (U.P.); (S.T.-M.); (V.D.); (R.L.)
| | - Adela Cañete
- Unidad de Oncohematología Pediátrica, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell, 106 Torre A 7planta, 46026 Valencia, Spain; (B.M.d.l.H.); (A.C.)
| | - Ruth Ladenstein
- St. Anna Children’s Cancer Research Institute, Zimmermannplatz 10, 1090 Vienna, Austria; (U.P.); (S.T.-M.); (V.D.); (R.L.)
| | - Emanuele Neri
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma, 67, 56126 Pisa, Italy; (M.G.); (E.N.)
| | - Luis Martí-Bonmatí
- Grupo de Investigación Biomédica en Imagen, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106 Torre A 7planta, 46026 Valencia, Spain; (L.C.-A.); (L.M.-B.)
- Área Clínica de Imagen Médica, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell, 106 Torre A 7planta, 46026 Valencia, Spain;
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Jiang M, Hu X, Qian K, Yang P, Tang Y, Wang P, Cai J. Atypical CT findings of renal neuroblastoma: a case report. Transl Pediatr 2022; 11:1267-1273. [PMID: 35958006 PMCID: PMC9360815 DOI: 10.21037/tp-22-205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The neuroblastoma (NB) is a highly malignant tumor of the ectoderm of sympathetic nerve cells and one of the most common malignant tumors in children, which can occur in any part of the sympathetic nerve plexus distribution, however it is less common in the kidney. CASE DESCRIPTION Here we present a case of a 4-year-old boy who came to our hospital for medical help because of "abdominal distension for 1 day". Abdominal computed tomography (CT) revealed a huge retroperitoneal soft tissue mass with unclear boundaries with kidneys and adrenal glands, and low-density cystic necrosis areas were seen in the tumor. Contrast-enhanced scan showed that the mass showed mild heterogeneous enhancement. Based on these findings in the patient, he was initially considered to have Wilms tumor, but was finally pathologically confirmed as renal NB. The purpose of this article is to provide the clinicopathological features and CT manifestations of renal NB, and to discuss its differential diagnosis with other renal tumors, in order to better provide clinicians with a better understanding of the rare solid tumor. The renal NB is usually a large lobulated soft tissue mass with unclear boundary and incomplete capsule, which is prone to hemorrhage, necrosis, cystic degeneration and calcification. On CT, the mass is usually isodensity or slightly hypodense, and the cystic degeneration and necrosis area is hypodense, and on contrast-enhanced scan, it can be mildly to significantly enhanced, but the cystic degeneration and necrosis area have no enhancement. CONCLUSIONS The CT findings of our case were atypical and overlapped with those of Wilms, so our case suggests that renal NB should be considered as one of the differential diagnoses of Wilms, the most common malignancy of the kidney in children.
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Affiliation(s)
- Maoyan Jiang
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xianwen Hu
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Kai Qian
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Peiqing Yang
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yang Tang
- Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Pan Wang
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jiong Cai
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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Chandrahas S, Meller J. Free floating abdominal ganglioneuroblastoma in a 3 year old male. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Zeng Z, Liu J, Xu S, Qin G. Ganglioneuroblastoma in the Retropharyngeal Space: A Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2022:1455613221101941. [PMID: 35533289 DOI: 10.1177/01455613221101941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Ganglioneuroblastoma is a rare peripheral neuroblastic tumor located anywhere in the sympathetic nervous system but rarely in the retropharyngeal space. Diagnosis can often be difficult based on imaging alone. We describe one case of a child presenting with snoring. The lesion was located in the rare retropharyngeal space, and its histology finally revealed ganglioneuroblastoma. Therefore, clinicians should be aware of pediatric patients with respiratory symptoms indicating cervical ganglioneuroblastoma. To make a definite diagnosis as soon as possible, a core needle biopsy or even immunohistochemistry may need to be performed before surgery.
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Affiliation(s)
- Zesheng Zeng
- Department of Otolaryngology-Head and Neck Surgery, Ringgold: 556508The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jinping Liu
- Department of Otolaryngology-Head and Neck Surgery, Ringgold: 556508The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Shengen Xu
- Department of Otolaryngology-Head and Neck Surgery, Ringgold: 556508The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Gang Qin
- Department of Otolaryngology-Head and Neck Surgery, Ringgold: 556508The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Karbasian N, Segaran N, Solomon N, Pellerito JS, Katz DS, Moshiri M, Revzin MV. Pathologic Conditions at Imaging of the Spermatic Cord. Radiographics 2022; 42:741-758. [PMID: 35394888 DOI: 10.1148/rg.210161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A wide range of benign and malignant processes can affect the spermatic cord (SC). Familiarity with and recognition of the characteristic imaging features of these entities are imperative for accurate diagnosis and optimal clinical care. While some SC diseases are self-limiting, others can result in infertility and potentially life-threatening infection or bleeding if they are left untreated. Therefore, correct diagnosis is important for life-saving treatment and preservation of fertility. Disorders including anomalies of the vas deferens and the processus vaginalis, arterial and venous diseases (torsion of the SC and varicoceles), infection, trauma, and neoplasms are the most pertinent entities with which radiologists should be familiar when assessing the SC. Knowing what to expect in a patient who has undergone SC interventions is imperative. US has a fundamental role in the initial examination of patients who present with symptoms that indicate abnormalities of the SC, such as suspected posttraumatic testicular retraction or SC torsion. Other imaging techniques including abdominal and pelvic MRI and CT have their own importance. For correct interpretation of the findings and to establish an accurate diagnosis, it is crucial to have a thorough knowledge of the anatomy, the utility and limitations of various imaging modalities, optimal imaging and scanning techniques, and the imaging features of various benign and malignant pathologic conditions that can involve the SC. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Niloofar Karbasian
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - Nicole Segaran
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - Nadia Solomon
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - John S Pellerito
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - Douglas S Katz
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - Mariam Moshiri
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - Margarita V Revzin
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
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Saadat S, Fritz C, Tran D, Parry N, Yuhan BT, Bolduan A, Thorpe E. A Systematic Review of Cervical Ganglioneuromas. OTO Open 2022. [DOI: 10.1177/2473974x221106784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To perform a systematic review of the literature evaluating clinical characteristics and management of cervical ganglioneuromas (CGNs). Data Sources PubMed, Embase, and Cochrane Library databases were searched. Data such as patient demographics, imaging, and treatments were obtained. Review Methods Pertinent studies were downloaded, and the full text was reviewed by 4 authors (N.P., S.S., C.F., D.T.). Results were reported via the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Results Fifty-two studies with 58 patients were identified in the literature. Of the 58 patients, 22 were adults and 36 were pediatric. The most common reported location of CGN was within the parapharyngeal space (76%), followed by the retropharyngeal (19%) and paravertebral/prevertebral (7%) spaces. The most common presenting symptoms included a nontender mass (29.3%), dysphagia (17.2%), and hoarseness (10.3%). Interestingly, the average tumor volume for patients with postoperative Horner’s syndrome was 183 mm3 (n = 21, 47.7%) vs 946 mm3 in patients without Horner’s syndrome (n = 23, 52.3%). This represents a statistically significant finding ( P = .018). There exists no significant difference in tumor volumes between adult and pediatric patients with Horner’s syndrome ( P = .645). Conclusion CGN is a rare tumor of the sympathetic nervous system. Management should involve complete surgical excision with biopsy. We found that patients with small-volume CGNs are significantly more likely to experience postoperative Horner’s syndrome. This finding is independent of age and should therefore be taken into consideration in any patient with suspected CGN.
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Affiliation(s)
- Saad Saadat
- Oakland University William Beaumont School of Medicine, Rochester Hills, Michigan, USA
| | - Christian Fritz
- Oakland University William Beaumont School of Medicine, Rochester Hills, Michigan, USA
| | - Deanna Tran
- Oakland University William Beaumont School of Medicine, Rochester Hills, Michigan, USA
| | - Nathan Parry
- Oakland University William Beaumont School of Medicine, Rochester Hills, Michigan, USA
| | - Brian T. Yuhan
- Oakland University William Beaumont School of Medicine, Rochester Hills, Michigan, USA
- Department of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Alyssa Bolduan
- Department of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Eric Thorpe
- Department of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
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