MRI diagnosis of tumor‑like IgG4 masses in bilateral distal ureters: A case report

IgG4 masses in the bilateral distal ureters are rare and frequently misdiagnosed. The present study reported the case of a 55-year-old male patient with IgG4-related disease (IgG4-RD) who had symmetrical soft tissue masses of the bilateral distal ureters found on magnetic resonance imaging (MRI) with a significant increase in the serum levels of IL-6, IgG4 and IgE. Regarding treatment, this patient received prednisone acetate tablets (40 mg/day) and mycophenolate mofetil dispersible tablets (1 g/day). During the follow-up, significant reductions in the levels of IgG4 and IgE were found after 30 days. MRI after 6 months indicated complete disappearance of the masses. The prognosis has been good so far. In clinical practice, it is necessary to consider the possibility of IgG4-RD in cases with soft tissue masses surrounding both ureters and elevated levels of serum IgG4.

Diagnosis and differentiation of mature cystic teratoma of pancreas from its mimics: A case report

INTRODUCTION

Mature cystic teratoma originating in the pancreas is very unusual, often observed as an incidental finding during routine examinations or recognized perioperatively as the patients present with very unspecific clinical symptoms. The confirmatory diagnosis of a pancreatic cystic teratoma is generally made by histopathology after surgical excision. So, the preoperative diagnosis is very challenging, especially differentiation from the other pancreatic pathologies.

PATIENT CONCERNS

A 23-year-old woman was admitted to our hospital with a complaint of mild grade periumbilical abdominal pain. A pancreatic mass was revealed on a preliminary abdominal ultrasound examination. Her medical history was unremarkable with no long-standing illness or malignancy.

DIAGNOSIS

Mature cystic teratoma in the head of the pancreas.

INTERVENTIONS

Roux-enY choledochojejunostomy with gastrojejunostomy was performed, excising the tumor from the pancreatic head.

OUTCOMES

The postoperative course was uneventful; the patient was asymptomatic and has no evidence of recurrence on a 2-year follow up.

CONCLUSIONS

Pancreatic cystic teratoma is a benign, well-differentiated, and extremely rare congenital tumor. MRI is the choice of imaging modality and phase-GRE or fat suppression is the best technique for pre-operative diagnosis.

Descriptive study of knee lesions using magnetic resonance imaging and correlation between medical imaging diagnosis and suspected clinical diagnosis

Objective:

This study aimed to assess the meniscus and cruciate ligament lesions of the knee using magnetic resonance imaging (MRI) and to investigate the correlation between clinical and MRI diagnoses.

Patients and Methods:

Herein, we reviewed the electronic medical records of 240 patients who underwent knee MRI. The images were evaluated and then the clinical and MRI diagnoses were compared.

Results:

Of the 240 patients, 66% were male and the mean age was 40.6 ± 15.5 years (range, 2-79 years). Knee pain alone was the most common presenting symptom (50.64%) followed by pain after trauma (47.92%). Majority of the knee lesions were medial meniscus (MM) lesions (63%) followed by osteoarthritis (48%) and ACL lesions (35%). The majority of the MM and ACL lesions were tears (54.6% and 69.41%, respectively) followed by degeneration (33.55% and 17.65%, respectively). However, the MM lesions were predominantly observed in the posterior horn (Odds ratio [OR], 152; 95% confidence interval (CI), 21.550–1072.113; P < 0.001). The ACL lesions were significantly more common in men than in women (OR, 0.355; 95% CI, 0.191-0.661; P = 0.001), and altered signal intensity on T2- and proton density–weighted images was the most common sign (P < 0.001). A strong compatibility was observed between the clinical and MRI diagnoses (Kappa = 0.141; P < 0.001).

Conclusion:

MM and ACL lesions are the most common injuries of the knee, which can be diagnosed by physical examination in most cases. Further confirmation by MRI should be reserved for doubtful cases only.