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Soni N, Ora M, Singh R, Mehta P, Agarwal A, Bathla G. Unpacking the CNS Manifestations of Epstein-Barr Virus: An Imaging Perspective. AJNR Am J Neuroradiol 2023; 44:1002-1008. [PMID: 37500288 PMCID: PMC10494941 DOI: 10.3174/ajnr.a7945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/26/2023] [Indexed: 07/29/2023]
Abstract
Epstein-Barr virus is a ubiquitous herpesvirus that may cause both infective (encephalitis, meningitis, and so forth) and postinfection inflammatory (such as Guillain-Barré syndrome, acute disseminated encephalomyelitis) manifestations in the CNS. Diagnosis of Epstein-Barr virus-related CNS pathologies is often complicated due to a nonspecific clinical presentation and overlap with other infectious and noninfectious causes, both clinically and on imaging. The Epstein-Barr virus is also implicated in several lymphoproliferative disorders in both immunocompromised and immunocompetent hosts. MR imaging is preferred for evaluating the extent of involvement and monitoring therapy response, given its high sensitivity and specificity, though imaging findings may be nonspecific. Herein, we review the imaging spectrum of Epstein-Barr virus-associated CNS disorders.
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Affiliation(s)
- N Soni
- From the Department of Radiology (N.S.), University of Rochester Medical Center, Rochester, New York
| | - M Ora
- Department of Nuclear Medicine (M.O.), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - R Singh
- Department of Hematology (R.S.), University of Vermont Medical Center, Burlington, Vermont
| | - P Mehta
- Department of Radiology (P.M.), Mayo Clinic, Rochester, Minnesota
| | - A Agarwal
- Department of Radiolgy (A.A.), Mayo Clinic, Jacksonville, Florida
| | - G Bathla
- Department of Radiology (G.B.), Mayo Clinic, Rochester, Minnesota
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Pons-Escoda A, Naval-Baudin P, Velasco R, Vidal N, Majós C. Imaging of Lymphomas Involving the CNS: An Update-Review of the Full Spectrum of Disease with an Emphasis on the World Health Organization Classifications of CNS Tumors 2021 and Hematolymphoid Tumors 2022. AJNR Am J Neuroradiol 2023; 44:358-366. [PMID: 36822829 PMCID: PMC10084903 DOI: 10.3174/ajnr.a7795] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/19/2023] [Indexed: 02/25/2023]
Abstract
Lymphomas of the CNS are the second most frequent primary brain malignancy in adults after gliomas. Presurgical suspicion of lymphoma greatly impacts patient management. The radiologic features of this tumor have been widely covered in the literature for decades, but under current classifications, mainly corresponding to the most common presentations of the most frequent type: primary diffuse large B-cell lymphoma of the CNS. Nevertheless, rarer presentations of this specific lymphoma and of other World Health Organization lymphoma subtypes with different imaging features are rarely treated. Moreover, important advances in imaging techniques, changing epidemiologic factors with relevant impact on these tumors (eg, immunodeficiency/dysregulation), and recent updates of the World Health Organization Classification of CNS Tumors 2021 and Hematolymphoid Tumors 2022 may have rendered some accepted concepts outdated. In this article, the authors aim to fulfill a critical need by providing a complete update-review, emphasizing the latest clinical-radiologic features of the full spectrum of lymphomas involving the CNS.
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Affiliation(s)
- A Pons-Escoda
- From the Radiology (A.P.-E., P.N.-B., C.M.)
- Neurooncology Unit (A.P.-E., R.V., N.V., C.M.), Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
| | | | - R Velasco
- Neurooncology Unit (A.P.-E., R.V., N.V., C.M.), Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
- Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology (R.V.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - N Vidal
- Pathology Departments (N.V.), Hospital Universitari de Bellvitge, Barcelona, Spain
- Neurooncology Unit (A.P.-E., R.V., N.V., C.M.), Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
| | - C Majós
- From the Radiology (A.P.-E., P.N.-B., C.M.)
- Neurooncology Unit (A.P.-E., R.V., N.V., C.M.), Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
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Pons-Escoda A, García-Ruíz A, Naval-Baudin P, Grussu F, Viveros M, Vidal N, Bruna J, Plans G, Cos M, Perez-Lopez R, Majós C. Diffuse Large B-Cell Epstein-Barr Virus-Positive Primary CNS Lymphoma in Non-AIDS Patients: High Diagnostic Accuracy of DSC Perfusion Metrics. AJNR Am J Neuroradiol 2022; 43:1567-1574. [PMID: 36202547 PMCID: PMC9731258 DOI: 10.3174/ajnr.a7668] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/02/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Immunodeficiency-associated CNS lymphoma may occur in different clinical scenarios beyond AIDS. This subtype of CNS lymphoma is diffuse large B-cell and Epstein-Barr virus-positive. Its accurate presurgical diagnosis is often unfeasible because it appears as ring-enhancing lesions mimicking glioblastoma or metastasis. In this article, we describe clinicoradiologic features and test the performance of DSC-PWI metrics for presurgical identification. MATERIALS AND METHODS Patients without AIDS with histologically confirmed diffuse large B-cell Epstein-Barr virus-positive primary CNS lymphoma (December 2010 to January 2022) and diagnostic MR imaging without onco-specific treatment were retrospectively studied. Clinical, demographic, and conventional imaging data were reviewed. Previously published DSC-PWI time-intensity curve analysis methodology, to presurgically identify primary CNS lymphoma, was used in this particular lymphoma subtype and compared with a prior cohort of 33 patients with Epstein-Barr virus-negative CNS lymphoma, 35 with glioblastoma, and 36 with metastasis data. Normalized curves were analyzed and compared on a point-by-point basis, and previously published classifiers were tested. The standard percentage of signal recovery and CBV values were also evaluated. RESULTS Seven patients with Epstein-Barr virus-positive primary CNS lymphoma were included in the study. DSC-PWI normalized time-intensity curve analysis performed the best for presurgical identification of Epstein-Barr virus-positive CNS lymphoma (area under the receiver operating characteristic curve of 0.984 for glioblastoma and 0.898 for metastasis), followed by the percentage of signal recovery (0.833 and 0.873) and CBV (0.855 and 0.687). CONCLUSIONS When a necrotic tumor is found in a potentially immunocompromised host, neuroradiologists should consider Epstein-Barr virus-positive CNS lymphoma. DSC-PWI could be very useful for presurgical characterization, with especially strong performance of normalized time-intensity curves.
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Affiliation(s)
- A Pons-Escoda
- From the Departments of Radiology (A.P.-E., P.N.-B., M.V., M.C., C.M.)
- Neurooncology Unit (A.P.-E., N.V., J.B., G.P., C.M.), Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - A García-Ruíz
- Radiomics Group (A.G.-R., F.G., R.P.-L.), Vall d'Hebron Institut d'Oncologia, Barcelona, Spain
| | - P Naval-Baudin
- From the Departments of Radiology (A.P.-E., P.N.-B., M.V., M.C., C.M.)
| | - F Grussu
- Radiomics Group (A.G.-R., F.G., R.P.-L.), Vall d'Hebron Institut d'Oncologia, Barcelona, Spain
| | - M Viveros
- From the Departments of Radiology (A.P.-E., P.N.-B., M.V., M.C., C.M.)
| | - N Vidal
- Pathology (N.V.)
- Neurooncology Unit (A.P.-E., N.V., J.B., G.P., C.M.), Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - J Bruna
- Neurooncology Unit (A.P.-E., N.V., J.B., G.P., C.M.), Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - G Plans
- Neurosurgery (G.P.), Hospital Universitari de Bellvitge, Barcelona, Spain
- Neurooncology Unit (A.P.-E., N.V., J.B., G.P., C.M.), Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - M Cos
- From the Departments of Radiology (A.P.-E., P.N.-B., M.V., M.C., C.M.)
| | - R Perez-Lopez
- Radiomics Group (A.G.-R., F.G., R.P.-L.), Vall d'Hebron Institut d'Oncologia, Barcelona, Spain
- Department of Radiology (R.P.-L.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - C Majós
- From the Departments of Radiology (A.P.-E., P.N.-B., M.V., M.C., C.M.)
- Neurooncology Unit (A.P.-E., N.V., J.B., G.P., C.M.), Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
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Averyanov AV, Danilevskaya OV. Diffuse Lung Disease in Convalescents of COVID-19. HERALD OF THE RUSSIAN ACADEMY OF SCIENCES 2022; 92:412-417. [PMID: 36091843 PMCID: PMC9447983 DOI: 10.1134/s1019331622040037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/11/2022] [Accepted: 03/09/2022] [Indexed: 06/15/2023]
Abstract
The most common causes of diffuse interstitial lung damage following COVID-19, often either imitate it but have a different nature or remain due to prolonged persistence of SARS-CoV-2 in the lower respiratory tract. A diagnostic algorithm is proposed to make mostly a correct diagnosis, the key element of which is study of the bronchoalveolar lavage fluid.
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Affiliation(s)
- A. V. Averyanov
- Pulmonology Research Institute, Federal Medical‒Biological Agency, Moscow, Russia
| | - O. V. Danilevskaya
- Pulmonology Research Institute, Federal Medical‒Biological Agency, Moscow, Russia
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Masuoka S, Hiyama T, Kuno H, Morishita Y, Sakashita S, Kobayashi T. A case of Epstein–Barr virus-positive mucocutaneous ulcer of the hypopharynx: a mimicker of hypopharyngeal squamous cell carcinoma. Int Cancer Conf J 2021; 11:71-74. [DOI: 10.1007/s13691-021-00523-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
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Dutta R, Miao SY, Phan P, Fernandez-Pol S, Shiraz P, Ho D, Mannis GN, Zhang TY. Epstein-Barr virus-positive lymphoproliferative disorder manifesting as pulmonary disease in a patient with acute myeloid leukemia: a case report. J Med Case Rep 2021; 15:170. [PMID: 33773605 PMCID: PMC8005240 DOI: 10.1186/s13256-021-02744-2] [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: 08/06/2020] [Accepted: 02/15/2021] [Indexed: 11/21/2022] Open
Abstract
Background Patients with lymphoproliferative disorders following hematopoietic stem cell transplant (HSCT) most commonly present with fever and lymphadenopathy within the first 5 months of transplant. Pulmonary post-transplant lymphoproliferative disorder (PTLD) is a particularly aggressive and rapidly progressive disease, with high morbidity and mortality. There are a very limited number of reported pulmonary PTLD cases following HSCT in patients with acute myeloid leukemia (AML). Early diagnosis and detection of pulmonary PTLD is critical given its high lethality. However, variable clinical presentations and nonspecific radiographic findings make pulmonary PTLD difficult to distinguish from other more common causes of pulmonary disease in AML patients. Case presentation Here, we describe a 68-year-old Caucasian man who presented for salvage induction therapy following relapse of his AML after a haploidentical allogeneic HSCT 10 months earlier. He developed recurrent fevers, dry cough, and hypoxemia, with chest computed tomography (CT) showing bibasilar consolidations and increased nodularity without increased lymphadenopathy. His symptoms initially improved with antibiotic and antifungal therapy, but his follow-up chest CT showed progression of disease despite symptomatic improvement. Epstein–Barr virus (EBV) was detected in his blood by polymerase chain reaction (PCR), and a lung biopsy revealed monomorphic PTLD with B cells positive for EBV. Unfortunately, the patient’s condition rapidly deteriorated, and he passed away prior to treatment initiation. Conclusions To our knowledge, this is the first reported case of an AML patient developing pulmonary PTLD relatively late in his post-transplant course in the setting of relapsed disease and salvage therapy. Pulmonary PTLD, a rare but highly lethal disorder, can imitate the symptoms and radiographic findings of pneumonia, a common diagnosis in immunocompromised AML patients. This case illustrates the importance of considering pulmonary PTLD in the differential diagnosis for pulmonary disease in AML patients with a history of HSCT, especially in the setting of progressive radiographic findings despite broad antibacterial and antifungal therapy. Further, our case demonstrates the importance of biopsy and uninterrupted EBV DNA monitoring in the definitive diagnosis of PTLD, given nonspecific symptomatology and radiographic findings.
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Affiliation(s)
- Ritika Dutta
- Department of Medicine, Division of Hematology, Cancer Institute, and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA, USA.,Stanford University School of Medicine, Stanford, CA, USA
| | - Susanna Y Miao
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Paul Phan
- Department of Medicine, Division of Hematology, Cancer Institute, and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA, USA
| | | | - Parveen Shiraz
- Department of Medicine, Division of Blood and Marrow Transplantation, Stanford University, Stanford, CA, USA
| | - Dora Ho
- Department of Medicine, Division of Infectious Diseases & Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Gabriel N Mannis
- Department of Medicine, Division of Hematology, Cancer Institute, and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA, USA
| | - Tian Y Zhang
- Department of Medicine, Division of Hematology, Cancer Institute, and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA, USA. .,Stanford University School of Medicine, Stanford, CA, USA.
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Yoon S, Ryu KH, Baek HJ, An HJ, Joo YH. Epstein-Barr virus-positive diffuse large B-cell lymphoma with human immunodeficiency virus mimicking complicated frontal sinusitis: A case report. World J Clin Cases 2021; 9:1654-1660. [PMID: 33728309 PMCID: PMC7942051 DOI: 10.12998/wjcc.v9.i7.1654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 12/14/2020] [Accepted: 01/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary non-Hodgkin’s lymphoma of the frontal sinus is extremely rare. In addition, Epstein-Barr virus (EBV) has been reported to play a role in the development of human immunodeficiency virus (HIV)-related malignant lymphomas. To the best of our knowledge, there is no report for the HIV-associated, EBV-positive primary diffuse large B-cell lymphoma (DLBCL) in the frontal sinus.
CASE SUMMARY We present a unique case of HIV-associated, EBV-positive DLBCL in the frontal sinus in a 46-year-old man. Computed tomography of paranasal sinuses revealed dense opacification of the right frontal sinus with combined soft tissue swelling. Based on the clinical and radiological findings, the initial diagnosis was complicated frontal sinusitis, presenting Pott’s puffy tumor. Unexpectedly, HIV testing was positive on preoperative laboratory test, and the frontal sinus lesion was confirmed as EBV-positive DLBCL on biopsy.
CONCLUSION Through this article, we suggest that EBV-positive DLBCL should be considered as possible diagnosis for patients with nonspecific space-occupying lesion of the paranasal sinuses. We also highlight an importance of clinical suspicion in diagnosing HIV infection because HIV serology is not routinely tested in patients with paranasal sinus problem.
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Affiliation(s)
- Seokho Yoon
- Department of Nuclear Medicine and Molecular Imaging, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, South Korea
| | - Kyeong Hwa Ryu
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, South Korea
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, South Korea
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 52727, South Korea
| | - Hyo Jung An
- Department of Pathology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, South Korea
| | - Yeon-Hee Joo
- Department of Otorhinolaryngology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, South Korea
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Groner LK, Green DB, Weisman SV, Legasto AC, Toy D, Gruden JF, Escalon JG. Thoracic Manifestations of Rheumatoid Arthritis. Radiographics 2021; 41:32-55. [PMID: 33411607 DOI: 10.1148/rg.2021200091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Rheumatoid arthritis (RA) is one of the most common chronic systemic inflammatory diseases and the most common chronic inflammatory arthritis. Classically a progressive symmetric polyarthritis, RA is characterized by inflammation, erosions, bone loss, and joint destruction. Up to half of patients with RA exhibit extra-articular manifestations (EAMs), which may precede articular disease and are more common in patients with seropositive RA (patients with detectable serum levels of rheumatoid factor and/or anticitrullinated peptide antibodies). Cardiovascular and pulmonary EAMs are the largest contributors to morbidity and mortality in RA and may be especially devastating. Imaging has a significant role in diagnosing these EAMs and assessing response to treatment. Although treatment with disease-modifying antirheumatic drugs has redefined the natural history of RA and helped many patients achieve low disease activity, patients are at risk for treatment-related complications, as well as infections. The clinical features of drug-induced lung disease and infection can overlap considerably with those of EAMs, presenting a diagnostic challenge. Radiologists, by recognizing the imaging characteristics and evolution of these various processes, are essential in diagnosing and distinguishing among EAMs, treatment-related complications, and unrelated processes and formulating an appropriate differential diagnosis. Moreover, recognizing these disease processes at imaging and contextualizing imaging findings with clinical information and laboratory and pathologic findings can facilitate definitive diagnosis and proper treatment. The authors review the articular and extra-articular thoracic imaging manifestations of RA, including cardiovascular, respiratory, and pleural diseases, as well as treatment-related complications and common infections. ©RSNA, 2021.
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Affiliation(s)
- Lauren K Groner
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Daniel B Green
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Stacey V Weisman
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Alan C Legasto
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Dennis Toy
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - James F Gruden
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Joanna G Escalon
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
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Abstract
The liver normally produces a large amount of lymph. It is estimated that between 25% and 50% of the lymph received by the thoracic duct comes from the liver. In normal conditions, hepatic lymphatics are not depicted on cross-sectional imaging. They are divided in lymphatics of deep system (lymphatics following the hepatic veins and the portal tract) and those of superficial system (convex surface and inferior surface). A variety of diseases may affect hepatic lymphatics and in general they manifest as lymphedema, lymphatic mass, or cystic lesions. Abnormal distended lymphatics are especially seen in periportal spaces as linear hypoattenuations on CT or strong linear hyperintensities on heavily T2-weighted MR imaging. Lymphatic tumor spread as in lymphoma and lymphangitic carcinomatosis manifests as periportal masses and regional lymph node enlargement. Lymphatic disruption after trauma or surgery is depicted as perihepatic fluid collections of lymph (lymphocele). Lymphatic malformation such as lymphangioma is seen on imaging as cystic spaces of variable size.
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Lee M, Kim SK, Chung YE, Choi JY, Park MS, Lim JS, Kim MJ, Kim H. Necrotic lymphoma in a patient with post-transplantation lymphoproliferative disorder: ultrasonography and CT findings with pathologic correlation. Ultrasonography 2014; 34:148-52. [PMID: 25541069 PMCID: PMC4372711 DOI: 10.14366/usg.14050] [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: 11/01/2014] [Revised: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 11/05/2022] Open
Abstract
Seventeen months after kidney transplantation for the treatment of nephrotic syndrome, a retroperitoneal mass was incidentally detected in a 30-year-old man during routine follow-up. Ultrasonography revealed a mass measuring 5.5 cm×4.3 cm located between the liver and the atrophic right kidney, which showed markedly heterogeneous internal echogenicity. Contrast-enhanced computed tomography displayed a mild degree of enhancement only at the periphery of the mass, while the center lacked perceivable intensification. The patient underwent surgical resection. The final pathological diagnosis was non-Hodgkin lymphoma (diffuse large B-cell lymphoma), and extensive necrosis was observed on microscopic examination. We found that the prominent heterogeneous echogenicity of the mass (an unusual finding of lymphoma) demonstrated on ultrasonography is a result of extensive necrosis, which may sometimes occur in patients with post-transplantation lymphoproliferative disorder.
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Affiliation(s)
- Minsu Lee
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea ; Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Kyum Kim
- Department of Pathology, Severance Hospital, Yonsei University College of medicine, Seoul, Korea
| | - Yong Eun Chung
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea ; Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Young Choi
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea ; Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mi-Suk Park
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea ; Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Seok Lim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea ; Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea ; Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Honsoul Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea ; Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Sidani C, Freiser ME, Saigal G, Sklar E. Unusual case of cerebral aspergillosis with clinical and imaging findings mimicking lymphoma. Neuroradiol J 2013; 26:290-6. [PMID: 23859284 DOI: 10.1177/197140091302600306] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 06/10/2013] [Indexed: 11/17/2022] Open
Abstract
A 14-year-old female post-transplant patient with a history of post-transplant lymphoproliferative disease/lymphoma presented with fever and lethargy. Computed tomography of the brain demonstrated a hypodense lesion with surrounding edema in the right periventricular region not seen on a routine study performed two weeks earlier. On magnetic resonance imaging (MRI) this lesion was mainly iso-intense to gray matter on T2-weighted (T2W) images and demonstrated peripheral contrast enhancement. Diffusion restriction was seen within most of the lesion including, but not limited to, its periphery. Lesion location and MRI characteristics, particularly on T2W and diffusion sequences, were suggestive of lymphoma. The patient's history of post-transplant lymphoproliferative disorder also supported this diagnosis. However, in view of the patient's immunocompromised state, rapid onset of symptoms, and recent normal CT scan of the brain, infection was also entertained. Biopsy revealed short branching hyphae consistent with aspergillosis. This case is interesting as the MRI restriction pattern and the patient's history were more suggestive of lymphoma, but in reality the lesion represented an evolving aspergillosis abscess. Biopsy was necessary to further proceed with appropriate medical management, which is significantly different for the two entities.
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Affiliation(s)
- C Sidani
- Department of Radiology, University of Miami, Miller School of Medicine; Miami, FL, USA.
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