Adenocarcinoma ; diagnosis ; metabolism ; pathology ; secondary ; Brain ; metabolism ; pathology ; Brain Neoplasms ; diagnosis ; metabolism ; pathology ; secondary ; Carcinoembryonic Antigen ; metabolism ; Diagnosis, Differential ; Female ; Humans ; Keratin-7 ; metabolism ; Lung Neoplasms ; pathology ; Magnetic Resonance Imaging ; Middle Aged ; Nuclear Proteins ; metabolism ; Thyroid Nuclear Factor 1 ; Transcription Factors ; metabolism

Adenoma ; pathology ; Brain Neoplasms ; secondary ; Chromogranin A ; metabolism ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Pituitary Neoplasms ; diagnosis ; metabolism ; pathology ; surgery ; Reoperation ; Synaptophysin ; metabolism ; Temporal Lobe ; pathology

OBJECTIVE: To evaluate the clinical feasibility and obtain useful parameters of 31P magnetic resonance spectroscopy (MRS) study for making the differential diagnosis of brain tumors. MATERIALS AND METHODS: Twenty-eight patients with brain tumorous lesions (22 cases of brain tumor and 6 cases of abscess) and 11 normal volunteers were included. The patients were classified into the astrocytoma group, lymphoma group, metastasis group and the abscess group. We obtained the intracellular pH and the metabolite ratios of phosphomonoesters/phosophodiesters (PME/PDE), PME/inorganic phosphate (Pi), PDE/Pi, PME/adenosine triphosphate (ATP), PDE/ATP, PME/phosphocreatine (PCr), PDE/PCr, PCr/ATP, PCr/Pi, and ATP/Pi, and evaluated the statistical significances. RESULTS: The brain tumors had a tendency of alkalization (pH = 7.28 +/- 0.27, p = 0.090), especially the pH of the lymphoma was significantly increased (pH = 7.45 +/- 0.32, p = 0.013). The brain tumor group showed increased PME/PDE ratio compared with that in the normal control group (p = 0.012). The ratios of PME/PDE, PDE/Pi, PME/PCr and PDE/PCr showed statistically significant differences between each brain lesion groups (p < 0.05). The astrocytoma showed an increased PME/PDE and PME/PCr ratio. The ratios of PDE/Pi, PME/PCr, and PDE/PCr in lymphoma group were lower than those in the control group and astrocytoma group. The metastasis group showed an increased PME/PDE ratio, compared with that in the normal control group. CONCLUSION: We have obtained the clinically applicable 31P MRS, and the pH, PME/PDE, PDE/Pi, PME/PCr, and PDE/PCr ratios are helpful for differentiating among the different types of brain tumors.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Astrocytoma/diagnosis/*metabolism ; Brain Abscess/diagnosis/*metabolism ; *Brain Chemistry ; Brain Neoplasms/diagnosis/*metabolism/secondary ; Case-Control Studies ; Diagnosis, Differential ; Feasibility Studies ; Female ; Humans ; Hydrogen-Ion Concentration ; Lymphoma/diagnosis/*metabolism ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy/*methods ; Male ; Middle Aged ; Phosphorus/diagnostic use ; Prospective Studies ; Young Adult

We report an extremely rare case of metastatic common bile duct cancer from pulmonary adenocarcinoma presenting as obstructive jaundice. The patient was a 76-year-old male, who presented with generalized weakness and right upper quadrant pain. Plain chest X-ray noted multiple small nodules in both lung fields. Abdominal computed tomography scan showed a stricture of the mid common bile duct along with ductal wall enhancement. Endoscopic retrograde cholangiography revealed a concentric, abrupt narrowing of the mid-common bile duct suggestive of primary bile duct cancer. However, pathology comfirmed metastatic common bile duct cancer arising from pulmonary adenocarcinoma with immunohistochemical study with thyroid transcriptional factor-1 (TTF-1).
Adenocarcinoma/*diagnosis/pathology/radiography ; Aged ; Brain Neoplasms/radiography/secondary ; Bronchoscopy ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct Neoplasms/*diagnosis/secondary ; DNA-Binding Proteins/metabolism ; Humans ; Immunohistochemistry ; Jaundice, Obstructive/*etiology ; Lung Neoplasms/*diagnosis/pathology/radiography ; Male ; Positron-Emission Tomography ; Tomography, X-Ray Computed

12E7 Antigen ; Adolescent ; Adult ; Antigens, CD ; metabolism ; Biomarkers, Tumor ; metabolism ; Brain Neoplasms ; secondary ; Cell Adhesion Molecules ; metabolism ; Child ; Child, Preschool ; Diagnosis, Differential ; Extremities ; Female ; Follow-Up Studies ; Humans ; Immunohistochemistry ; In Situ Hybridization, Fluorescence ; Infant ; Ki-67 Antigen ; metabolism ; Male ; Neuroectodermal Tumors, Primitive ; metabolism ; pathology ; Oncogene Proteins, Fusion ; metabolism ; Repressor Proteins ; metabolism ; Sarcoma, Ewing ; metabolism ; pathology ; Sarcoma, Synovial ; diagnosis ; metabolism ; pathology ; surgery ; Soft Tissue Neoplasms ; diagnosis ; metabolism ; pathology ; surgery ; Vimentin ; metabolism ; Young Adult

In a patient receiving 5-fluorouracil and levamisole, neurologic deficits suggest the cerebral demyelinating syndrome as a differential diagnosis. The authors report a patient diagnosed as multifocal inflammatory leukoencephalopathy for which thallium-201 ((201)Tl) single photon emission computed tomography (SPECT) and proton magnetic resonance spectroscopy (MRS) were employed as noninvasive diagnostic tools. (201)Tl SPECT study was negative and proton MRS showed an increase of choline and lactate and well preserved N-acetylaspartate. These findings support histopathologic findings of multifocal inflammatory leukoencephalopathy revealing demyelination with relative axonal sparing in the patient.
Adjuvants, Immunologic/adverse effects/therapeutic use ; Antimetabolites, Antineoplastic/adverse effects/therapeutic use ; Aspartic Acid/*analogs & derivatives/metabolism ; Axons/pathology ; Biopsy ; Brain/pathology ; Brain Neoplasms/secondary ; Choline/metabolism ; Colorectal Neoplasms/drug therapy/pathology ; Diagnosis, Differential ; Fluorouracil/adverse effects/therapeutic use ; Human ; Lactic Acid/metabolism ; Leukoencephalopathy, Progressive Multifocal/*diagnosis/etiology ; Levamisole/adverse effects/therapeutic use ; Magnetic Resonance Spectroscopy/*methods ; Male ; Middle Aged ; Neoplasm Metastasis ; Thallium Radioisotopes/*diagnostic use ; Tomography, Emission-Computed, Single-Photon/*methods

Spindle cell carcinoma (SpCC) is a rare tumor consisting of spindle cells which express cytokeratin. Despite recent advances in immunohistochemical and genetic studies, precise histogenesis of SpCC is still controversial and this tumor had been referred to with a wide range of names (in the past): carcinosarcoma, pseudosarcoma, sarcomatoid carcinoma, pseudosarcomatous carcinoma, and collision tumor. Recently, the authors experienced an extremely rare case of SpCC arising from the stomach. A 64-year-old male presented with unintended weight loss and hematochezia. Endoscopic examination revealed a fistulous tract between the stomach and the transverse colon which was made by direct invasion of SpCC of the stomach to the colon. Histologically, the tumor was positive for both vimentin and cytokeratin but negative for CD117, CD34, actin, and desmin. Herein, we report a case of SpCC arising from the stomach that formed a fistulous tract with the colon which was diagnosed during evaluation of hematochezia and weight loss.
Antineoplastic Agents/therapeutic use ; Brain Neoplasms/secondary ; Carcinoma/*diagnosis/drug therapy/pathology ; Colon, Transverse ; Endoscopy, Digestive System ; Fistula/pathology ; Gastrointestinal Hemorrhage/etiology ; Humans ; Keratins/metabolism ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Stomach Neoplasms/*diagnosis/drug therapy/pathology ; Tomography, X-Ray Computed ; Weight Loss