1
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Ii Y, Gao G, Liao X, Yang J, Ye R, Zheng X. Intermittent urethral infusion of dimethylsulfoxide for urethral amyloidosis: a case report and literature review. Aging Male 2022; 25:180-184. [PMID: 35815465 DOI: 10.1080/13685538.2022.2097220] [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] [Indexed: 11/01/2022] Open
Abstract
Urethral amyloidosis (UA) is a very rare condition. We here report the case of a 63-year-old male patient who was admitted to our outpatient department due to aggravating dysuria, frequent urination, pain during intercourse, and a gradually enlarging mass at the ostium of his urethra, which he first notice one year earlier. Pathological tissue biopsy of urethral ostium mass confirmed UA. Intermittent urethra infusion of dimethyl sulfoxide was performed and the treatment effect is satisfactory.
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Affiliation(s)
- Yunzhi Ii
- Beijing University of Chinese Medicine, Beijing, PR China
| | - Guojing Gao
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, PR China
| | - Xiaoxing Liao
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, PR China
| | - Jianghua Yang
- Beijing Aerospace General Hospital, Beijing, PR China
| | - Rongzhen Ye
- Beijing Aerospace General Hospital, Beijing, PR China
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2
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Umolu AG, Venn R, Maxwell D, Al Shiekh Ali Z, Howlett DC. Hyperechoic kidneys in a patient with bronchiectasis. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2021; 29:260-263. [PMID: 34777546 DOI: 10.1177/1742271x21989064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/30/2020] [Indexed: 11/16/2022]
Abstract
Introduction Hyperechoic renal cortex in a normal-sized kidney has a range of causes, some of which irreparably damage the kidney and should initiate further investigations. Case Report We present a 72-year-old woman with longstanding bronchiectasis, noticed to have worsening renal function. Renal tract ultrasonography showed hyperechoic normal-sized kidneys. Renal biopsy confirmed amyloidosis. Discussion Imaging findings in renal amyloidosis tend to be non-specific and are not always present. However, ultrasonography findings of hyperechoic cortex in normal-sized kidneys should not be ignored. Conclusion Renal impairment from blood chemistry in addition to hyperechoic kidneys may be the key to diagnosing secondary amyloidosis in a patient with bronchiectasis, a rare association but important to recognise.
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Affiliation(s)
- A G Umolu
- Department of Radiology, East Sussex Healthcare NHS Trust, East Sussex, UK
| | - R Venn
- Department of Respiratory Medicine, East Sussex Healthcare NHS Trust, East Sussex, UK
| | - D Maxwell
- Department of Respiratory Medicine, East Sussex Healthcare NHS Trust, East Sussex, UK
| | - Z Al Shiekh Ali
- Department of Histopathology, East Sussex Healthcare NHS Trust, East Sussex, UK
| | - D C Howlett
- Department of Radiology, East Sussex Healthcare NHS Trust, East Sussex, UK
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3
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Buryakina SA, Tarbaeva NV, Volevodz NN, Karmazanovsky GG, Kovalevich LD, Shestakova MV, Dedov II. Adrenal incidentaloma. Part 2. Modern concepts of computed tomography semiotics of adrenal gland incidentalomas: algorithm of differential diagnosis. TERAPEVT ARKH 2021; 93:1381-1388. [DOI: 10.26442/00403660.2021.11.201169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 11/22/2022]
Abstract
While accidentally detecting an adrenal gland lesion (incidentaloma) during a routine computed tomography (CT) scan, the radiologist should correctly interpret revealed changes. The most common lesion is adenoma with high lipid content, but a lipid poor adenoma, pheochromocytoma, adrenocortical cancer, metastasis and other less common adrenal diseases are also worth of attention and require detailed knowledge of their CT semiotics. The article presents criteria of differential diagnosis of the adrenal incidentalomas on the basis of which an algorithm of differential diagnosis was proposed for the most common adrenal lesions.
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4
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Al-Obaidy KI, Grignon DJ. Primary Amyloidosis of the Genitourinary Tract. Arch Pathol Lab Med 2021; 145:699-703. [PMID: 32383975 DOI: 10.5858/arpa.2020-0102-ra] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Amyloidosis is caused by the deposition of misfolded proteins as insoluble eosinophilic material in the extracellular tissues of the body, leading to impairment of organ function. It can be systemic or localized. Localized genitourinary tract amyloidosis is rare and can be incidentally seen; however, in some cases, it can be the only presenting disease. OBJECTIVE.— To review the clinical presentation and pathologic findings related to primary amyloidosis of the urogenital system and highlight some of the associated pathologic findings based on our personal experience. DATA SOURCES.— Published peer-reviewed literature and personal experience of the senior author. CONCLUSIONS.— Primary localized amyloidosis within the urogenital tract can present as a neoplastic process and may be clinically and radiologically considered as a mass. Awareness of primary amyloidosis by pathologists and clinicians is required for accurate diagnosis and proper patient management.
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Affiliation(s)
- Khaleel I Al-Obaidy
- From the Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis
| | - David J Grignon
- From the Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis
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5
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Sugi MD, Kawashima A, Salomao MA, Bhalla S, Venkatesh SK, Pickhardt PJ. Amyloidosis: Multisystem Spectrum of Disease with Pathologic Correlation. Radiographics 2021; 41:1454-1474. [PMID: 34357805 DOI: 10.1148/rg.2021210006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Amyloidosis is a group of conditions defined by extracellular deposition of insoluble proteins that can lead to multiorgan dysfunction and failure. The systemic form of the disease is often associated with a plasma cell dyscrasia but may also occur in the setting of chronic inflammation, long-term dialysis, malignancy, or multiple hereditary conditions. Localized forms of the disease most often involve the skin, tracheobronchial tree, and urinary tract and typically require tissue sampling for diagnosis, as they may mimic many conditions including malignancy at imaging alone. Advancements in MRI and nuclear medicine have provided greater specificity for the diagnosis of amyloidosis involving the central nervous system and heart, potentially obviating the need for biopsy of the affected organ in certain circumstances. Specifically, a combination of characteristic findings at noninvasive cardiac MRI and skeletal scintigraphy in patients without an underlying plasma cell dyscrasia is diagnostic for cardiac transthyretin amyloidosis. Histologically, the presence of amyloid is denoted by staining with Congo red and a characteristic apple green birefringence under polarized light microscopy. The imaging features of amyloid vary across each organ system but share some common patterns, such as soft-tissue infiltration and calcification, that may suggest the diagnosis in the appropriate clinical context. The availability of novel therapeutics that target amyloid protein fibrils such as transthyretin highlights the importance of early diagnosis. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Mark D Sugi
- From the Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, 3rd Floor, M391, Box 0628, San Francisco, CA 94143 (M.D.S.); Departments of Radiology (A.K.) and Laboratory Medicine and Pathology (M.A.S.), Mayo Clinic Arizona, Scottsdale, Ariz; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P.)
| | - Akira Kawashima
- From the Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, 3rd Floor, M391, Box 0628, San Francisco, CA 94143 (M.D.S.); Departments of Radiology (A.K.) and Laboratory Medicine and Pathology (M.A.S.), Mayo Clinic Arizona, Scottsdale, Ariz; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P.)
| | - Marcela A Salomao
- From the Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, 3rd Floor, M391, Box 0628, San Francisco, CA 94143 (M.D.S.); Departments of Radiology (A.K.) and Laboratory Medicine and Pathology (M.A.S.), Mayo Clinic Arizona, Scottsdale, Ariz; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P.)
| | - Sanjeev Bhalla
- From the Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, 3rd Floor, M391, Box 0628, San Francisco, CA 94143 (M.D.S.); Departments of Radiology (A.K.) and Laboratory Medicine and Pathology (M.A.S.), Mayo Clinic Arizona, Scottsdale, Ariz; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P.)
| | - Sudhakar K Venkatesh
- From the Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, 3rd Floor, M391, Box 0628, San Francisco, CA 94143 (M.D.S.); Departments of Radiology (A.K.) and Laboratory Medicine and Pathology (M.A.S.), Mayo Clinic Arizona, Scottsdale, Ariz; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P.)
| | - Perry J Pickhardt
- From the Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, 3rd Floor, M391, Box 0628, San Francisco, CA 94143 (M.D.S.); Departments of Radiology (A.K.) and Laboratory Medicine and Pathology (M.A.S.), Mayo Clinic Arizona, Scottsdale, Ariz; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P.)
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6
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Diagnostic approach to primary retroperitoneal pathologies: what the radiologist needs to know. Abdom Radiol (NY) 2021; 46:1062-1081. [PMID: 32944824 DOI: 10.1007/s00261-020-02752-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/30/2020] [Accepted: 09/03/2020] [Indexed: 02/06/2023]
Abstract
Retroperitoneal soft tissue lesions represent a wide range of disease processes with overlapping imaging findings. Familiarity with the CT and MR characteristics of these conditions is important to guide clinical evaluation. We review the tissue types, characteristic clinical, demographic, and imaging features of retroperitoneal tumors and tumor-like non-neoplastic conditions with CT and MR correlation, including anatomic and imaging clues, and provide a diagnostic approach to aide the radiologist in making a specific diagnosis.
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7
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Buryakina SA, Tarbaeva NV, Volevodz NN, Karmazanovsky GG, Kovalevich LD, Shestakova MV, Dedov II. [Adrenal incidentaloma. Part 1. Computed tomography of adrenal incidentaloma: the possibilities and difficulties of differential diagnosis]. TERAPEVT ARKH 2020; 92:185-194. [PMID: 33720593 DOI: 10.26442/00403660.2020.12.200451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/07/2021] [Indexed: 11/22/2022]
Abstract
The adrenal incidentaloma is a lesion of a different etiology and found incidentally in patients who underwent a diagnostic study not about the disease of this organ. Lesions can be both hormonally inactive and hormonally active, can arise from different zones of the adrenal gland or have non-specific organ affiliation, can be benign or malignant. Computed tomography characterization of these lesions, especially the differential diagnosis of benign and malignant, is extremely important for the correct diagnosis in order to provide adequate management of the patient. The article presents the key computed tomography criteria that allow radiologist to characterize the lesion most accurately and consider appropriate diagnosis.
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Affiliation(s)
- S A Buryakina
- Endocrinology Research Centre.,Vishnevsky National Medical Research Centre of Surgery
| | - N V Tarbaeva
- Endocrinology Research Centre.,Vishnevsky National Medical Research Centre of Surgery
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8
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Vaxman I, Visram A, Pasvolsky O, Kumar S, Dispenzieri A, Buadi F, Dingli D, Lacy M, Hayman S, Kyle R, Kapoor P, Leung N, Gonsalves W, Kourelis T, Warsame R, Gertz M. Retroperitoneal involvement with light chain amyloidosis- case series and literature review. Leuk Lymphoma 2020; 62:316-322. [DOI: 10.1080/10428194.2020.1832670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Iuliana Vaxman
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Alissa Visram
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Oren Pasvolsky
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Francis Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Martha Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Robert Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Morie Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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9
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Catania R, Dasyam N, Furlan A, Borhani AA. Cross-sectional imaging of seminal vesicles and vasa deferentia. Abdom Radiol (NY) 2020; 45:2049-2062. [PMID: 31897685 DOI: 10.1007/s00261-019-02368-7] [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: 10/25/2022]
Abstract
A wide spectrum of pathologies, ranging from inconsequential degenerative and senile changes to clinically significant neoplasms, can affect seminal vesicles (SVs). With rapid rise in use of magnetic resonance imaging for evaluation of prostate in recent years an increasing number of cases of incidental SV pathologies are encountered by radiologists. Despite the high contrast resolution and high spatial resolution offered by multiparametric pelvic MRI, accurate diagnosis of SV processes can at times be challenging. In this article, we review the anatomy and embryology of the SVs and vasa deferentia and then explore the spectrum of diseases affecting them.
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Affiliation(s)
- Roberta Catania
- Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Intensive Medicine, Institute of Radiology, IRCCS Policlinico San Matteo Foundation, University of Parvia, Parvia, Italy
| | - Navya Dasyam
- University of Pittsburgh School of Medicine, UPMC Presbyterian, Radiology Suite 200 East Wing 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Alessandro Furlan
- University of Pittsburgh School of Medicine, UPMC Presbyterian, Radiology Suite 200 East Wing 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Amir A Borhani
- University of Pittsburgh School of Medicine, UPMC Presbyterian, Radiology Suite 200 East Wing 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
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10
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Kato H, Kawaguchi M, Ando T, Kaneko Y, Hyodo F, Matsuo M. Hypointense head and neck lesions on T2-weighted images: correlation with histopathologic findings. Neuroradiology 2020; 62:1207-1217. [PMID: 32562036 DOI: 10.1007/s00234-020-02483-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/15/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE On T2-weighted images, most solid lesions exhibit nonspecific intermediate signal intensity, whereas most cystic lesions exhibit marked hyperintensity. In contrast, on T2-weighted images, a relatively small number of lesions exhibit hypointensity. This review aimed to differentiate, according to the histopathologic findings, head and neck lesions showing hypointensity on T2-weighted images. METHODS In this review article, hypointense head and neck lesions on T2-weighted images are classified into the following nine categories: calcified or osseous lesions, granulomatous lesions, fibrous lesions, mucous- or proteincontaining lesions, hemosiderin-containing lesions, melanin-containing lesions, thyroglobulin-containing lesions, rapid blood flow, and air-filled spaces. CONCLUSION Knowledge regarding hypointense head and neck lesions on T2-weighted images allows radiologists to make accurate differential diagnoses. Key points • Hypointense head and neck lesions on T2-weighted images include calcified or osseous lesions, granulomatous lesions, fibrous lesions, mucous- or protein-containing lesions, hemosiderin-containing lesions, melanin-containing lesions, thyroglobulin-containing lesions, rapid blood flow, and air-filled spaces. • Radiologists should recognize the hypointense head and neck lesions on T2-weighted images for the final correct diagnosis, resulting in appropriate patient management.
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Affiliation(s)
- Hiroki Kato
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Masaya Kawaguchi
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Tomohiro Ando
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Yo Kaneko
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Fuminori Hyodo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
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11
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Di Giuliano F, Picchi E, Muto M, Calcagni A, Ferrazzoli V, Da Ros V, Minosse S, Chiaravalloti A, Garaci F, Floris R, Muto M. Radiological imaging in multiple myeloma: review of the state-of-the-art. Neuroradiology 2020; 62:905-923. [DOI: 10.1007/s00234-020-02417-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 03/26/2020] [Indexed: 12/16/2022]
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12
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Calcified Adrenal Lesions: Pattern Recognition Approach on Computed Tomography With Pathologic Correlation. J Comput Assist Tomogr 2020; 44:178-187. [PMID: 32195796 DOI: 10.1097/rct.0000000000000980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Incidental adrenal lesions are found in 2% to 10% of the population. The presence and pattern of calcifications, in conjunction with other clinical and imaging features, such as soft tissue attenuation, enhancement, and laterality, can aid in narrowing a differential diagnosis, thereby preventing unnecessary biopsies and avoiding delays in management. Calcified adrenal lesions can be categorized under the clinical and laboratory headings of normal adrenal function, hyperfunctioning adrenal tissue, and adrenal insufficiency. In this review, we provide an algorithmic approach to assessing calcified adrenal nodules with correlative radiologic findings.
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13
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Honda Y, Nakamura Y, Teishima J, Goto K, Higaki T, Narita K, Akagi M, Terada H, Kaichi Y, Fujii S, Hayashi T, Matsubara A, Sentani K, Yasui W, Iida M, Awai K. Clinical staging of upper urinary tract urothelial carcinoma for T staging: Review and pictorial essay. Int J Urol 2019; 26:1024-1032. [PMID: 31379021 DOI: 10.1111/iju.14068] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/18/2019] [Indexed: 12/17/2022]
Abstract
Upper urinary tract urothelial carcinoma is staged using the TNM classification of malignant tumors. Preoperative TNM is important for treatment planning. Computed tomography urography is now widely used for clinical survey of upper urinary tract carcinoma because of its diagnostic accuracy. Computed tomography urography is recommended as the first-line imaging procedure in several guidelines. Several reports stated that computed tomography urography is also useful for staging. However, no educational and practical reviews detailing the T staging of upper urinary tract urothelial carcinomas using imaging are available. We discuss the scanning protocol, T staging using computed tomography urography, limitations, magnetic resonance imaging, computed tomography comparison and pitfalls in imaging of upper urinary tract urothelial carcinoma. A recent study reported the high diagnostic accuracy of computed tomography urography with respect to T3 or higher stage tumors. To date, images that show a Tis-T2 stage have not been reported, but various studies are ongoing. Although magnetic resonance imaging has lower spatial resolution than computed tomography urography, magnetic resonance imaging can be carried out without radiation exposure or contrast agents. Magnetic resonance imaging also offers the unique ability of diffusion-weighted imaging without contrast agent use. Some researchers reported that diffusion-weighted imaging is useful not only for detecting lesions, but for predicting the T stage and tumor grade. We recommend the appropriate use of computed tomography and magnetic resonance while considering the limitations of each modality and the pitfalls in upper urinary tract urothelial carcinoma imaging.
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Affiliation(s)
- Yukiko Honda
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuko Nakamura
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Jun Teishima
- Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keisuke Goto
- Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toru Higaki
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keigo Narita
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Motonori Akagi
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroaki Terada
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoko Kaichi
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinsuke Fujii
- Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tetsutaro Hayashi
- Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akio Matsubara
- Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuhiro Sentani
- Department of Molecular Pathology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Wataru Yasui
- Department of Molecular Pathology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Makoto Iida
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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14
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Özcan HN, Haliloğlu M, Sökmensüer C, Akata D, Özmen M, Karçaaltıncaba M. Imaging for abdominal involvement in amyloidosis. Diagn Interv Radiol 2018; 23:282-285. [PMID: 28498108 DOI: 10.5152/dir.2017.16484] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Involvement of the abdominal organs has variable presentations mostly without specific findings. The objective of this pictorial essay was to illustrate the computed tomography and magnetic resonance imaging (MRI) findings of abdominal involvement in systemic amyloidosis. Heterogeneous appearance of the liver, periportal involvement, diffuse low signal intensity of spleen on T2-weighted MRI, and thickened bowel wall may be helpful imaging findings when accompanied by presence or history of chronic inflammatory disease and clinical suspicion for amyloidosis.
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Affiliation(s)
- H Nursun Özcan
- Department of Radiology, Liver Imaging Team, Hacettepe University School of Medicine, Ankara, Turkey.
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15
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Shikhman R, Curry J, Gazaille R. Amyloidosis of the renal pelvis presenting as flank pain. Radiol Case Rep 2017; 13:86-88. [PMID: 29552246 PMCID: PMC5853134 DOI: 10.1016/j.radcr.2017.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/08/2017] [Accepted: 10/09/2017] [Indexed: 11/18/2022] Open
Abstract
Amyloidosis is a rare disease defined by accumulation of extracellular amyloid systemically or within a specific organ. Localized amyloidosis of the genitourinary system is extremely rare, with the predominate location being the bladder. The imaging findings are often nonspecific and mimic urothelial carcinoma. We present a 49-year-old woman with a chief complaint of flank pain. A filling defect was discovered on radiological imaging. The defect was subsequently biopsied and proven to be a primary amyloidosis of the renal pelvis. We then review the radiological findings of amyloidosis of the genitourinary system.
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Affiliation(s)
- Rachel Shikhman
- Kettering Health Network Diagnostic Radiology Residency Program, 3535 Southern Blvd, Kettering, OH 45429, USA
| | - Jarrod Curry
- Kettering Health Network Diagnostic Radiology Residency Program, 3535 Southern Blvd, Kettering, OH 45429, USA
| | - Roland Gazaille
- Kettering Health Network Diagnostic Radiology Residency Program, 3535 Southern Blvd, Kettering, OH 45429, USA
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16
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Imaging manifestations of Behcet's disease: Key considerations and major features. Eur J Radiol 2017; 98:214-225. [PMID: 29196115 DOI: 10.1016/j.ejrad.2017.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/26/2017] [Accepted: 11/17/2017] [Indexed: 01/16/2023]
Abstract
Behcet's disease is an autoimmune disease most commonly seen in the Middle East. Although primarily known with painful oral and genital ulcers, it can lead to vasculitis. Therefore, several associated complications such as thrombotic syndromes, aneurysmal arterial disease may arise. In many cases, it might be difficult to make the diagnosis purely based on clinical grounds; however, imaging plays an important role for both diagnosis and assessment of the disease's complications. We provide a comprehensive review of the most notable imaging findings of Behcet's disease.
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Upper tract urothelial cancer. Eur J Radiol 2017; 98:50-60. [PMID: 29279170 DOI: 10.1016/j.ejrad.2017.10.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/21/2017] [Accepted: 10/23/2017] [Indexed: 12/25/2022]
Abstract
While urothelial carcinoma is a very common tumor, involvement of the upper tract is relatively uncommon. Consequently, there are no consensus imaging recommendations for upper tract disease. CT urography is the dominant imaging modality for the upper tract, but despite its excellent performance characteristics and being widely accepted as standard of care there is great variability in how CTU exams are performed across practices. MR urography has limited current application, but has the potential to become more mainstream in the future with continued technical advances. Upper tract urothelial carcinoma can manifest as a variety of appearances: a papillary lesion, focal wall thickening, focal enhancement, or as an infiltrative lesion. Pelvicalyceal location is about twice as common as in the ureter. Tumors in the pelvicalyceal location often manifest as an irregular enhancing soft tissue attenuation filling defect, and may be sessile or polypoid in morphology. Within the ureter, 73% are located in the distal segment.
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18
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Hartman R, Kawashima A. Lower tract neoplasm: Update of imaging evaluation. Eur J Radiol 2017; 97:119-130. [PMID: 29102424 DOI: 10.1016/j.ejrad.2017.10.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 01/13/2023]
Abstract
Cancers of the lower urinary tract can arise from the bladder, urachus or urethra. Urothelial carcinoma of the bladder (UCB) is the most common of these. The presentation of bladder, urachal and urethral cancers can differ but many result in hematuria as an initial indication. The diagnosis and staging of these cancers often necessitate radiologic imaging often in the form of cross-section CT urography or MR urography. The following article reviews the specific nature of lower tract cancers and their imaging.
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Affiliation(s)
- Robert Hartman
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
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19
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Nair AV, Yadav MK, Unni MN, Simi CM, Biji KA, Manoj KS, Ali S, Nair AK. Hepatic Amyloidosis: Something That Can camouflage and Deceive our Perception! INDIAN JOURNAL OF MEDICAL AND PAEDIATRIC ONCOLOGY : OFFICIAL JOURNAL OF INDIAN SOCIETY OF MEDICAL & PAEDIATRIC ONCOLOGY 2017; 38:236-239. [PMID: 28900341 PMCID: PMC5582570 DOI: 10.4103/ijmpo.ijmpo_46_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Amyloidosis is a multi-systemic diffusely infiltrating disease due to extracellular deposition of protein-mucopolysaccharide complexes. The type of protein deposited determines the subgroup of amyloid. Hepatic amyloidosis is a rare infiltrating disease affecting the hepatic parenchyma. A wide range of clinical presentation and atypical imaging findings delay the diagnosis of amyloidosis, while tissue biopsy demonstrating amyloid deposits is vital for a definitive diagnosis.
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Affiliation(s)
- Anirudh V Nair
- Department of Radiodiagnosis and Interventional Radiology, Kerala Institute of Medical Science and Research Centre, Trivandrum, Kerala, India
| | - Manish Kumar Yadav
- Department of Radiodiagnosis and Interventional Radiology, Kerala Institute of Medical Science and Research Centre, Trivandrum, Kerala, India
| | - Madhavan N Unni
- Department of Radiodiagnosis and Interventional Radiology, Kerala Institute of Medical Science and Research Centre, Trivandrum, Kerala, India
| | - C M Simi
- Department of Pathology, Kerala Institute of Medical Science and Research Centre, Trivandrum, Kerala, India
| | - K A Biji
- Department of Pathology, Kerala Institute of Medical Science and Research Centre, Trivandrum, Kerala, India
| | - K S Manoj
- Department of Radiodiagnosis and Interventional Radiology, Kerala Institute of Medical Science and Research Centre, Trivandrum, Kerala, India
| | - Shabeer Ali
- Department of Hepatobiliary, Pancreatic and Liver Transplant Surgery, Kerala Institute of Medical Science and Research Centre, Trivandrum, Kerala, India
| | - Ajith K Nair
- Department of Gastroenterology, Kerala Institute of Medical Science and Research Centre, Trivandrum, Kerala, India
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Hrabak-Paar M, Kralik M. Case 244: Systemic Amyloidosis-A Complication of Waldenström Macroglobulinemia. Radiology 2017; 284:597-602. [PMID: 28723285 DOI: 10.1148/radiol.2017151156] [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
History A 68-year-old man was admitted to the hospital for work-up because of generalized fatigue, anorexia, chronic diarrhea, and weight loss. Laboratory work-up revealed an erythrocyte sedimentation rate of 58 mm/h (reference range, 3-23 mm/h), a hemoglobin level of 14.1 g/dL (reference range, 13.8-17.5 g/dL), a leukocyte count of 8.1 × 109/L (reference range, [3.4-9.7] × 109/L), a platelet count of 223 × 109/L (reference range, [158-424] × 109/L), an alkaline phosphatase level of 85 U/L (1.42 μkat/L) (normal level, <142 U/L [2.37 μkat/L]), a serum creatinine level of 93 μmol/L (reference range, 79-125 μmol/L), a serum total protein level of 82 g/L (reference range, 66-81 g/L), a serum albumin level of 39.3 g/L (reference range, 40.2-47.6 g/L), an albumin-to-globulin ratio (a test showing relative amounts of major plasma proteins) of 0.92 (reference range, 0.8-2.0), a urine protein level of 15 mg/dL (normal level, <20 mg/dL), a total serum calcium level of 2.46 mmol/L (reference range, 2.14-2.53 mmol/L), and a carcinoembryonic antigen value of 2.69 μg/L (normal value, <3.4 μg/L). Serology findings were negative for celiac disease. Thyroid function was normal, as were 5-hydroxyindoleacetic acid and chromogranin A levels. Initial radiologic examination included chest radiography and plain abdominal erect radiography. Gastrointestinal endoscopy was performed to rule out inflammatory bowel disease or gastrointestinal neoplasm as a cause of chronic diarrhea. Endoscopic mucosal resection of two polyps from the cardia and duodenal bulb was performed during esophagogastroduodenoscopy, but histologic findings at hematoxylin-eosin staining were normal. Colonoscopy revealed diverticulosis involving the entire colon. Serum immunoelectrophoresis showed a monoclonal band, which was confirmed to be immunoglobulin Mλ at immunofixation. After histologic analysis of the bone marrow biopsy specimen, diagnosis of Waldenström macroglobulinemia was established, and computed tomography (CT) of the thorax, abdomen, and pelvis was requested to depict lymphadenopathy and organomegaly. On the basis of CT findings, two more specimens considered highly sensitive for the CT diagnosis were obtained via minimally invasive biopsy, but the results were negative. Magnetic resonance (MR) imaging was performed a year later to control the progression of CT findings.
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Affiliation(s)
- Maja Hrabak-Paar
- From the Department of Diagnostic and Interventional Radiology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Kišpatićeva 12, HR-10000 Zagreb, Croatia (M.H.P., M.K.); and Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland (M.H.P.)
| | - Marko Kralik
- From the Department of Diagnostic and Interventional Radiology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Kišpatićeva 12, HR-10000 Zagreb, Croatia (M.H.P., M.K.); and Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland (M.H.P.)
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21
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Intense Uptake in Amyloidosis of the Seminal Vesicles on 68Ga-PSMA PET Mimicking Locally Advanced Prostate Cancer. Clin Nucl Med 2017; 42:147-148. [PMID: 27879490 DOI: 10.1097/rlu.0000000000001460] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a case of benign senile seminal vesicle amyloidosis demonstrating intense Ga-prostate-specific membrane antigen (PSMA) uptake on PET/CT. A 68-year-old man underwent staging PSMA PET/CT and MRI for biopsy-proven prostate adenocarcinoma. There was an intense focus of Ga-PSMA uptake in the primary malignancy, as well as symmetrical intense uptake in the seminal vesicles bilaterally that was reported as multifocal disease with local invasion. Final histology after radical prostatectomy showed amyloidosis of the seminal vesicles without any evidence of prostate cancer. Care should be taken in the interpretation of seminal vesicle PSMA uptake to avoid overstaging.
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22
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A Rare Case of Hematuria; Primary Amyloidosis of the Bladder Neck. Urol Case Rep 2016; 10:48-50. [PMID: 27957427 PMCID: PMC5148768 DOI: 10.1016/j.eucr.2016.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/02/2016] [Indexed: 11/21/2022] Open
Abstract
Primary and localized amyloidosis of the urinary tract is considered to be a rare clinical entity with approximately 160 cases documented in the literature. Here we present a case of a 77 year old gentleman with painless visible hematuria. Flexible cystoscopy revealed abnormal and polypoidal bladder mucosa. Transurethral resection of these lesions revealed histology with congo-red staining and positive green-apple birefringence, these findings are consistent with amyloidosis. There has so far been no sign of recurrence in this gentleman, with routine cystoscopic surveillance. Here we present a literature review on the presentation, diagnosis and management of this rare condition.
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Purysko AS, Westphalen AC, Remer EM, Coppa CP, Leão Filho HM, Herts BR. Imaging Manifestations of Hematologic Diseases with Renal and Perinephric Involvement. Radiographics 2016; 36:1038-54. [PMID: 27257766 DOI: 10.1148/rg.2016150213] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The kidneys and perinephric tissues can be affected by a variety of hematologic disorders, which usually occur in the setting of multisystem involvement. In many of these disorders, imaging is used to evaluate the extent of disease, guide biopsy, and/or monitor disease activity and patient response to therapy. Lymphoma, leukemia, and multiple myeloma commonly manifest as multiple parenchymal or perinephric lesions. Erdheim-Chester disease and Rosai-Dorfman disease, rare forms of multisystemic histiocytosis, are often identified as perinephric and periureteral masses. Renal abnormalities depicted at imaging in patients with sickle cell disease include renal enlargement, papillary necrosis, and renal medullary carcinoma. Sickle cell disease, along with other causes of intravascular hemolysis, can also lead to hemosiderosis of the renal cortex. Thrombosis of renal veins is sometimes seen in patients with coagulation disorders but more often occurs in association with certain malignancies and nephrotic syndrome. Immunoglobulin G4-related sclerosing disease is another multisystem process that often produces focal renal lesions, seen along with involvement of more characteristic organs such as the pancreas. Perinephric lesions with calcifications should raise the possibility of secondary amyloidosis, especially in patients with a history of lymphoma and multiple myeloma. Although the imaging patterns of renal and perinephric involvement are usually not specific for a single entity, and the same entity can manifest with different or overlapping patterns, familiarity with these patterns and key clinical and histopathologic features may help to narrow the differential diagnosis and determine the next step of care. (©)RSNA, 2016.
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Affiliation(s)
- Andrei S Purysko
- From the Abdominal Imaging Section, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Mail Code JB-3, Cleveland, OH 44195 (A.S.P., E.M.R., C.P.C., B.R.H.); Abdominal Imaging Section, Department of Radiology and Biomedical Imaging, University of California, San Francisco, Calif (A.C.W.); and Department of Radiology, Hospital do Coração and Teleimagem, São Paulo, Brazil (H.M.L.F.)
| | - Antonio C Westphalen
- From the Abdominal Imaging Section, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Mail Code JB-3, Cleveland, OH 44195 (A.S.P., E.M.R., C.P.C., B.R.H.); Abdominal Imaging Section, Department of Radiology and Biomedical Imaging, University of California, San Francisco, Calif (A.C.W.); and Department of Radiology, Hospital do Coração and Teleimagem, São Paulo, Brazil (H.M.L.F.)
| | - Erick M Remer
- From the Abdominal Imaging Section, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Mail Code JB-3, Cleveland, OH 44195 (A.S.P., E.M.R., C.P.C., B.R.H.); Abdominal Imaging Section, Department of Radiology and Biomedical Imaging, University of California, San Francisco, Calif (A.C.W.); and Department of Radiology, Hospital do Coração and Teleimagem, São Paulo, Brazil (H.M.L.F.)
| | - Christopher P Coppa
- From the Abdominal Imaging Section, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Mail Code JB-3, Cleveland, OH 44195 (A.S.P., E.M.R., C.P.C., B.R.H.); Abdominal Imaging Section, Department of Radiology and Biomedical Imaging, University of California, San Francisco, Calif (A.C.W.); and Department of Radiology, Hospital do Coração and Teleimagem, São Paulo, Brazil (H.M.L.F.)
| | - Hilton M Leão Filho
- From the Abdominal Imaging Section, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Mail Code JB-3, Cleveland, OH 44195 (A.S.P., E.M.R., C.P.C., B.R.H.); Abdominal Imaging Section, Department of Radiology and Biomedical Imaging, University of California, San Francisco, Calif (A.C.W.); and Department of Radiology, Hospital do Coração and Teleimagem, São Paulo, Brazil (H.M.L.F.)
| | - Brian R Herts
- From the Abdominal Imaging Section, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Mail Code JB-3, Cleveland, OH 44195 (A.S.P., E.M.R., C.P.C., B.R.H.); Abdominal Imaging Section, Department of Radiology and Biomedical Imaging, University of California, San Francisco, Calif (A.C.W.); and Department of Radiology, Hospital do Coração and Teleimagem, São Paulo, Brazil (H.M.L.F.)
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Sandrasegaran K, Menias CO, Verma S, Abdelbaki A, Shaaban A, Elsayes KM. Imaging features of haematological malignancies of kidneys. Clin Radiol 2015; 71:195-202. [PMID: 26688550 DOI: 10.1016/j.crad.2015.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/02/2015] [Accepted: 11/10/2015] [Indexed: 11/26/2022]
Abstract
Haematological malignancies are relatively uncommon neoplasms of kidneys. Nevertheless, the incidence of these neoplasms is increasing, partly due to more widespread use of computed tomography and magnetic resonance imaging. This article discusses the clinical and imaging features of renal lymphoma, leukaemia, extra-osseous multiple myeloma, and post-transplant lymphoproliferative disorder. Although there is overlap of imaging features with other more common malignancies, such as transitional and renal cell cancers, the combination of imaging findings and the appropriate clinical picture should allow the radiologist to raise a provisional diagnosis of a haematological neoplasm. This has management implications including the preference for image-guided core biopsies and a shift towards medical rather than surgical therapy.
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Affiliation(s)
- K Sandrasegaran
- Department of Diagnostic Radiology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - C O Menias
- Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, AZ, USA
| | - S Verma
- Department of Diagnostic Radiology, University of Cincinnati, Cincinnati, OH, USA
| | - A Abdelbaki
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A Shaaban
- Department of Diagnostic Radiology, University of Utah, Salt Lake City, UT, USA
| | - K M Elsayes
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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25
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Boudabbous S, Arditi D, Paulin E, Koessler T, Rougemont AL, Montet X. Ossifying metaplasia of urothelial metastases: original case with review of the literature. BMC Med Imaging 2015; 15:30. [PMID: 26264044 PMCID: PMC4534062 DOI: 10.1186/s12880-015-0072-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 07/13/2015] [Indexed: 11/10/2022] Open
Abstract
Background Ossifying metaplasia is an unusual feature of urothelial carcinoma, with only a few cases reported. The largest series included 17 cases and was published in 1991. The mechanism of ossification is unknown and hypotheses of osteogenic precursor cells, inducing bone formation, are proposed. Case presentation A 75 year-old patient was treated for a high grade transitional cell carcinoma of the bladder by surgery, chemotherapy and radiotherapy. Histology showed foci of bone metaplasia, both at the periphery of the tumor, and in a lymph node metastasis. 1 year later, a heterotopic bone formation was discovered in the right retroperitoneal space, near the lumbar spine, increasing rapidly in size during follow-up. Several imaging exams were performed (2 CT, 1 MRI, 1 Pet-CT), but in the absence of typical features of sarcoma, diagnosis remained unclear. Histology of a CT-guided percutaneous biopsy showed urothelial carcinoma and mature lamellar bone. Integration of these findings with the radiological description of extraosseous localization was consistent with a diagnosis of osseous metaplasia of an urothelial carcinoma metastasis. The absence of bone atypia in both the primary and metastases argues against sarcomatoid urothelial carcinoma with osteosarcomatous differentiation. Conclusion Osseous metaplasia of an urothelial carcinoma metastasis is unusual, and difficult to distinguish from radiotherapy induced sarcoma, or from sarcomatoid carcinoma. Rapid progression, sheathing of adjacent structures such as vessels (like inferior vena cava in our case) and nerves and bony feature of lymph node metastases necessitate histological confirmation and rapid treatment. Our case illustrates this disease and evaluates the imaging features. In addition we discuss the differential diagnosis of osseous retroperitoneal masses.
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Affiliation(s)
- Sana Boudabbous
- Geneva University Hospital, Radiology department, Rue Gabrielle-Perret-Gentil 4, Genève 4, 1211, Switzerland.
| | - Daniel Arditi
- Geneva University Hospital, Radiology department, Rue Gabrielle-Perret-Gentil 4, Genève 4, 1211, Switzerland.
| | - Emilie Paulin
- Geneva University Hospital, Radiology department, Rue Gabrielle-Perret-Gentil 4, Genève 4, 1211, Switzerland.
| | - Thibaud Koessler
- Geneva University Hospital, Radiology department, Rue Gabrielle-Perret-Gentil 4, Genève 4, 1211, Switzerland.
| | - Anne Laure Rougemont
- Geneva University Hospital, Radiology department, Rue Gabrielle-Perret-Gentil 4, Genève 4, 1211, Switzerland.
| | - Xavier Montet
- Geneva University Hospital, Radiology department, Rue Gabrielle-Perret-Gentil 4, Genève 4, 1211, Switzerland.
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26
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Minutoli F, Benedetto C, Visalli C, Granata A, Gaeta M. Computed tomography and magnetic resonance imaging findings of ureteral myxedema in Graves' disease. Clin Imaging 2015; 39:711-3. [PMID: 25766333 DOI: 10.1016/j.clinimag.2015.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 01/26/2015] [Accepted: 02/12/2015] [Indexed: 01/31/2023]
Abstract
Ureteral myxedema is exceptionally rare. We describe computed tomography and magnetic resonance imaging findings in a case of ureteral myxedema. The demonstration of water-like hyperintensity around the ureteral lumen on heavily T2-weighted sequences should be considered a strongly suggestive sign for ureteral myxedema.
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Affiliation(s)
- Fabio Minutoli
- Section of Radiological Sciences, Department Biomedical Sciences and of Morphologic and Functional Imaging, University of Messina, Messina, Italy.
| | - Caterina Benedetto
- Section of Radiological Sciences, Department Biomedical Sciences and of Morphologic and Functional Imaging, University of Messina, Messina, Italy.
| | - Carmela Visalli
- Section of Radiological Sciences, Department Biomedical Sciences and of Morphologic and Functional Imaging, University of Messina, Messina, Italy.
| | - Antonio Granata
- Division of Endocrinology, Policlinico G. Martino, University of Messina, Messina, Italy.
| | - Michele Gaeta
- Section of Radiological Sciences, Department Biomedical Sciences and of Morphologic and Functional Imaging, University of Messina, Messina, Italy.
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27
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Loizos S, Shiakalli Chrysa T, Christos GS. Amyloidosis: Review and Imaging Findings. Semin Ultrasound CT MR 2014; 35:225-39. [DOI: 10.1053/j.sult.2013.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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28
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Schou-Jensen KS, Dahl C, Pilt AP, Azawi NH. Amyloidosis in the bladder: three cases with different appearance. Scand J Urol 2014; 48:489-92. [PMID: 24857645 DOI: 10.3109/21681805.2014.920414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Amyloidosis refers to a number of diseases characterized by extracellular deposition of misfolded proteins, called amyloid fibrils, in the tissues and organs of the body. Amyloidosis in the bladder is a generally localized, rare condition, with approximately 200 cases reported in the literature. This report presents three cases of amyloidosis in the bladder, two of which had coexisting transitional cell carcinoma. Evaluation for systemic disease is recommended in patients with newly discovered amyloidosis, even if first recognized in an area with the localized form, as in the bladder.
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Ding X, Yan X, Ma X, Wang C, Du Y, Wang H, Wang Y, Wang Y. Localized amyloidosis of the ureter: A case report and literature review. Can Urol Assoc J 2013; 7:E764-7. [PMID: 24282473 PMCID: PMC3840520 DOI: 10.5489/cuaj.576] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Localized amyloidosis of the ureter is a rare disease and can easily be confused with a neoplasm. We report the case of a 55-year-old woman who presented with loin pain and painless gross hematuria. We also reviewed the English literature about localized ureteral amyloidosis. Middle-aged women were likely to suffer from this disorder. Loin pain and hematuria were the main clinical features. There were no specific performance on radiologic imaging and ureteral calcification was not widespread. Compared to upper ureter and middle ureter, the lower ureter was the easiest involved part. Nephroureterectomy was the predominant treatment. Biopsies via a ureteroscope prior to surgery or intraoperative frozen section examination, which yielded the diagnosis of amyloidosis, could help to avoid unnecessary surgery. The use of dimethyl sulfoxide or follow-up with serial imaging may become a promising treatment.
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Affiliation(s)
- Xiaobo Ding
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Xu Yan
- Department of Pathology, First Hospital of Jilin University, Changchun, China
| | - Xiaobo Ma
- Department of Pathology, First Hospital of Jilin University, Changchun, China
| | - Chunxi Wang
- Department of Urology, First Hospital of Jilin University, Changchun, China
| | - Yujun Du
- Department of Nephrology, First Hospital of Jilin University, Changchun, China
| | - Haifeng Wang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yan Wang
- Department of Urology, First Hospital of Jilin University, Changchun, China
| | - Yanbo Wang
- Department of Urology, First Hospital of Jilin University, Changchun, China
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Occurrence of extensive spherical amyloid deposits in a prolactin-secreting pituitary macroadenoma: a radiologic-pathologic correlation. Ann Diagn Pathol 2013; 17:361-6. [DOI: 10.1016/j.anndiagpath.2013.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 03/08/2013] [Accepted: 03/15/2013] [Indexed: 11/23/2022]
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31
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Del Gaizo A, Silva AC, Lam-Himlin DM, Allen BC, Leyendecker J, Kawashima A. Magnetic resonance imaging of solid urethral and peri-urethral lesions. Insights Imaging 2013; 4:461-9. [PMID: 23686749 PMCID: PMC3731464 DOI: 10.1007/s13244-013-0259-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 04/25/2013] [Accepted: 04/29/2013] [Indexed: 01/26/2023] Open
Abstract
Solid urethral and peri-urethral lesions are rare and encompass benign and malignant aetiologies. A diagnosis without imaging is often challenging secondary to non-specific clinical symptoms and overlapping findings at the time of physical examination. Magnetic resonance (MR) imaging may be helpful in confirming a diagnosis while providing anatomical detail and delineating disease extent. This article reviews the normal MR anatomy of the male and female urethra, the MR appearance of solid primary and secondary urethral lesions, and the MR appearance of solid urethral lesion mimics. Teaching points • MRI is an important imaging technique in the evaluation of the spectrum of solid urethral lesions. • With excellent soft tissue resolution, MR is accurate in staging primary urethral carcinoma. • Disruption of the zonal anatomy of the female urethral wall indicates peri-urethral extension. • Be aware of benign urethral lesions, particularly those that may mimic solid urethral masses.
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Affiliation(s)
- Andrew Del Gaizo
- Department of Radiology, Wake Forest University, Medical Center Blvd., Winston-Salem, NC, 27157, USA,
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