OBJECTIVE: To evaluate the feasibility and accuracy of cone-beam CT (CBCT) images for radiotherapy dose calculation in pelvic tumors. METHODS: An improved volumetric density coverage method was used to establish CT value-relative electron density (RED) curves for CBCT images. The planning CT plans were transferred to the CBCT images, and the constructed density curves were applied to calculate doses for CBCT plans while maintaining the optimization parameters unchanged. Dose calculation deviations between the two plans were analyzed. RESULTS: The mean differences in dosimetric parameters for the target volume and organs at risk (OAR) between the two plans were less than 1% and 1.5%, respectively. The target conformity index (CI), homogeneity index (HI), and gamma passing rates were highly consistent, with no statistically significant differences. CONCLUSION CBCT images corrected by this method can be used for dose calculation in pelvic tumor radiotherapy planning.
Cone-Beam Computed Tomography/methods* ; Humans ; Radiotherapy Planning, Computer-Assisted/methods* ; Radiotherapy Dosage ; Pelvic Neoplasms/diagnostic imaging*

BACKGROUND: Accurate evaluation of lymph node metastasis in bladder cancer (BCa) is important for disease staging, treatment selection, and prognosis prediction. In this study, we aimed to evaluate the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) for metastatic lymph nodes in BCa and establish criteria of imaging diagnosis. METHODS: We retrospectively assessed the imaging characteristics of 191 BCa patients who underwent radical cystectomy. The data regarding size, shape, density, and diffusion of the lymph nodes on CT and/or MRI were obtained and analyzed using Kruskal-Wallis test and χ test. The optimal cutoff value for the size of metastatic node was determined using the receiver operating characteristic (ROC) curve analysis. RESULTS: A total of 184 out of 3317 resected lymph nodes were diagnosed as metastatic lymph nodes. Among 82 imaging-detectable lymph nodes, 51 were confirmed to be positive for metastasis. The detection rate of metastatic nodes increased along with more advanced tumor stage (P < 0.001). Once the ratio of short- to long-axis diameter ≤ 0.4 or fatty hilum was observed in lymph nodes on imaging, it indicated non-metastases. Besides, lymph nodes with spiculate or obscure margin or necrosis indicated metastases. Furthermore, the short diameter of 6.8 mm was the optimal threshold to diagnose metastatic lymph node, with the area under ROC curve of 0.815. CONCLUSIONS The probability of metastatic nodes significantly increased with more advanced T stages. Once lymph nodes are detected on imaging, the characteristic signs should be paid attention to. The short diameter > 6.8 mm may indicate metastatic lymph nodes in BCa.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; diagnostic imaging ; pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Staging ; Pelvic Neoplasms ; diagnostic imaging ; pathology ; secondary ; surgery ; Pelvis ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed ; Urinary Bladder Neoplasms ; diagnostic imaging ; pathology ; surgery

Objective: To investigate the clinicopathological characteristics, diagnosis, and treatment of primary seminal vesicle adenocarcinoma (SVAC). METHODS: We analyzed the clinical data and clinicopathological characteristics of 4 cases of primary SVAC treated in the Department of Urology of the Second Hospital of Tianjin Medical University and reviewed relevant literature. RESULTS: All the 4 patients were treated by open radical resection of the seminal vesicle and prostate and pathologically diagnosed with SVAC. Preoperative prostatic biopsy had shown 1 of the cases to be negative, while preoperative CT and transrectal ultrasound had revealed a huge pelvic cystic neoplasm in another patient. Immunohistochemistry manifested that the 4 cases were all negative for prostate-specific antigen (PSA), prostatic acid phosphatase (PAP), and cytokeratin 20 (CK20), but positive for cancer antigen 125 (CA125) and CK7. All the patients recovered smoothly after surgery and experienced no recurrence or metastasis during 154, 41, 20, and 12 months of follow-up. CONCLUSIONS Primary seminal vesicle carcinoma is extremely rare and presents in an advanced stage. Immunohistochemistry plays a valuable role in its differential diagnosis. Various combinations of radical surgery, radiotherapy, androgen-deprivation therapy, and chemotherapy are recommended for the treatment of the disease.
Adenocarcinoma ; chemistry ; pathology ; surgery ; Biopsy ; CA-125 Antigen ; analysis ; Diagnosis, Differential ; Genital Neoplasms, Male ; chemistry ; pathology ; surgery ; Humans ; Immunohistochemistry ; Male ; Neoplasm Recurrence, Local ; Pelvic Neoplasms ; diagnostic imaging ; Prostate-Specific Antigen ; analysis ; Prostatectomy ; Seminal Vesicles ; pathology ; surgery

The occurrence of hepatocellular carcinoma (HCC) is closely associated with viral hepatitis or alcoholic hepatitis. Although active surveillance is ongoing in Korea, advanced or metastatic HCC is found at initial presentation in many patients. Metastatic HCC presents with a hypervascular intrahepatic tumor and extrahepatic lesions such as lung or lymph node metastases. Cases of HCC presenting as carcinoma of unknown primary have been rarely reported. The authors experienced a case of metastatic HCC in a patient who presented with a metastatic bone lesion but no primary intrahepatic tumor. This case suggests that HCC should be considered as a differential diagnosis when evaluating the primary origin of metastatic carcinoma.
Antineoplastic Agents/therapeutic use ; Bone Neoplasms/*diagnosis/diagnostic imaging/secondary ; Carcinoma, Hepatocellular/*diagnosis/drug therapy ; Cervical Cord/pathology ; Chemoembolization, Therapeutic ; Gamma Rays ; Humans ; Liver Neoplasms/*diagnosis/drug therapy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasms, Unknown Primary/pathology ; Niacinamide/analogs & derivatives/therapeutic use ; Pelvic Bones/pathology ; Phenylurea Compounds/therapeutic use ; Tomography, X-Ray Computed

OBJECTIVETo investigate the CT and MRI features of peripheral primitive neuroectodermal tumors (pPNETs) and evaluate its diagnostic value.

METHODSThe clinicopathological data of 9 surgically treated patients with peripheral primitive neuroectodermal tumors confirmed by pathology were collected, spiral CT (4/9) and MRI (6/9) plain scanning and dynamic enhancement scanning were performed preoperatively. Both CT and MRI scannings were performed in 1 case. Those CT and MR images were retrospectively reviewed and analyzed together with clinicopathological findings.

RESULTSThe 9 lesions were located in skeletal muscles (n = 6), pelvic cavity (n = 2) and thoracic cavity (n = 1). The tumor size was 7.4-18.3 cm in diameter with a mean diameter of 11.6 cm. The shape of those lesions was round or ellipse (4 lesions) and irregular (5 lesions). The tumor usually presented as ill-defined masses, with homogeneous (n = 2) or inhomogeneous density (n = 7). Seven cases, including the 3 lesions located in the chest and pelvis, showed obvious necrosis and multilocular cyst formation. The tumors showed iso-density as that of the adjacent muscles on CT plain scans and moderate heterogeneous enhancement after intravenous injection of contrast agents. The features of the tumors on the MRI including slightly low signal intensity on SE T1-weighted imaging, iso-signal intensity or slightly high signal intensity on FSE T2-weighted imaging and heterogeneous dynamic delayed contrast-enhancement with obvious necrosis in most of them. Six cases had a lesion in the skeletal muscles, presented as a giant ill-defined masse surrounding bone and extended along neural route with bone destruction to varying degrees.

CONCLUSIONPrimitive neuroectodermal tumor is a kind of malignant tumor with proliferation of small, undifferentiated neuroectodermal cells, usually occurring in children or adolescent and frequently located in the extremities, chest cavity, pelvic cavity and chest wall. It typically presents as a large, ill-defined masse extending along neural route with heterogeneous and obvious enhancement after intravenous injection of contrast agents. The tumors located in the chest and pelvic cavities and some in the extremities show obvious necrosis and multilocular cyst formation, while some of the tumors in the extremities appear as homogeneous solid masses.

Adolescent ; Adult ; Child ; Diagnostic Errors ; Female ; Histiocytoma, Malignant Fibrous ; diagnosis ; Humans ; Male ; Muscle Neoplasms ; diagnosis ; diagnostic imaging ; pathology ; Muscle, Skeletal ; Neuroectodermal Tumors, Primitive, Peripheral ; diagnosis ; diagnostic imaging ; pathology ; Pelvic Neoplasms ; diagnosis ; diagnostic imaging ; pathology ; Radiography ; Retrospective Studies ; Thoracic Neoplasms ; diagnosis ; diagnostic imaging ; pathology ; Young Adult

OBJECTIVETo explore the feasibility of CT guided percutaneous incisional needle biopsy (PINB) for deep pelvic masses at different locations via various puncture approaches.

METHODSPINBs under CT guidance were performed in 70 patients with 72 pelvic lesions through different puncture approaches. Their pathological findings and safety were evaluated after follow-up of a period of 1-34 months.

RESULTSPINBs were performed through transpiriform-muscle in 27 cases, 16 through transgluteal approach, 5 through posterior oblique approach in prone position, 8 by anterior or lateral transabdominal route, 8 through iliopsoas muscle and 8 by direct transosseous approach, respectively. Sixty-four malignant lesions were confirmed by pathology, including 30 adenocarcinomas, 19 squamous cell carcinomas, 5 unclassified malignant tumors, 3 small cell carcinomas, 2 malignant giant cell tumors of bone, 2 hepatocellular carcinomas and 3 false negative lesions which were confirmed at the second PINBs as malignant tumors, respectively. Benign neoplasms were confirmed in 8 cases, including fibrosis tissue in 6 lesions, bone tuberculosis in 1 and ovarian cyst in 1. The sensitivity, specificity, and accuracy rate were 95.3% (61/64), 100% (8/8), and 95.8% (69/72), respectively. Twenty-two cases via transpiriform-muscle approach suffered from transient deep pelvic pain which radiated to the lower limbs of the same side. No hematoma, nerve damage, infection, and tumor transplantation in pelvic cavity developed after the PINB procedure.

CONCLUSIONCT guided percutaneous incisional needle biopsy through different puncture approaches is safe and feasible for the patients with deep masses at different locations in the pelvic cavity.

Adenocarcinoma ; diagnostic imaging ; pathology ; secondary ; Adult ; Aged ; Aged, 80 and over ; Biopsy, Needle ; methods ; Carcinoma, Squamous Cell ; diagnostic imaging ; pathology ; secondary ; Colorectal Neoplasms ; diagnostic imaging ; pathology ; Diagnosis, Computer-Assisted ; methods ; Feasibility Studies ; Female ; Fibrosis ; diagnostic imaging ; pathology ; Follow-Up Studies ; Humans ; Lung Neoplasms ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Pelvic Neoplasms ; diagnostic imaging ; pathology ; secondary ; Pelvis ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed ; Uterine Neoplasms ; diagnostic imaging ; pathology

We report here two cases of foreign body granulomas that arose from the pelvic wall and liver, respectively, and simulated recurrent colorectal carcinomas in patients with a history of surgery. On contrast-enhanced CT and MR images, a pelvic wall mass appeared as a well-enhancing mass that had invaded the distal ureter, resulting in the development of hydronephrosis. In addition, a liver mass had a hypointense rim that corresponded to the fibrous wall on a T2-weighted MR image, and showed persistent peripheral enhancement that corresponded to the granulation tissues and fibrous wall on dynamic MR images. These lesions also displayed very intense homogeneous FDG uptake on PET/CT.
Adult ; Aged ; Colorectal Neoplasms/pathology/*surgery ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Fluorodeoxyglucose F18/diagnostic use ; Granuloma, Foreign-Body/complications/*diagnosis ; Humans ; Hydronephrosis/etiology ; Image Enhancement/methods ; Liver/pathology/radionuclide imaging ; Liver Neoplasms/*diagnosis/secondary ; Magnetic Resonance Imaging ; Male ; Pelvic Neoplasms/*diagnosis/secondary ; Pelvis/pathology/radiography ; Positron-Emission Tomography ; Radiopharmaceuticals/diagnostic use ; Tomography, X-Ray Computed

OBJECTIVETo study the clinicopathologic and radiologic features of dedifferentiated chondrosarcoma, focusing on its diagnosis and differential diagnosis.

METHODClinical, radiological and pathologic findings of 14 cases of dedifferentiated chondrosarcoma (including biopsy and surgical specimens) were analyzed by hematoxylin and eosin stained sections and immunohistochemistry.

RESULTSThe mean age of patients was 52 years. The male-to-female ratio was 9:5. The most common sites of involvement were pelvis, femur and humerus, similar to the conventional chondrosarcoma. Radiologically, they were malignant tumors with dimorphic pattern. Grossly, central chondrosarcomas were more common than those of the peripheral. An essential histological feature of dedifferentiated chondrosarcoma was an abrupt interface between the low-grade cartilaginous tumor and high-grade anaplastic sarcoma. The most common dedifferentiated components were osteosarcoma, malignant fibrous histocytoma and fibrosarcoma. False negative diagnosis and erroneous diagnosis were frequent when only one-time biopsy was available.

CONCLUSIONSDedifferentiated chondrosarcoma is a rare subtype of chondrosarcoma with poor prognosis, which has different features of clinical manifestation, imaging features and pathological characteristics, compared to conventional chondrosarcoma and chondroblastic osteosarcoma.

Adult ; Aged ; Bone Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; surgery ; Cell Differentiation ; Chondrosarcoma ; diagnostic imaging ; drug therapy ; pathology ; surgery ; Chondrosarcoma, Mesenchymal ; pathology ; Diagnosis, Differential ; Female ; Femoral Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; surgery ; Follow-Up Studies ; Humans ; Humerus ; pathology ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Osteosarcoma ; pathology ; Pelvic Bones ; pathology ; Radiography ; Vimentin ; metabolism ; Young Adult

The purpose of this study was to investigate the correlation between multi-detector row CT (MDCT) features, pathological findings and the anatomic basis of extra-organic primary tumors in pelvis so as to improve the document diagnosis of these entities. We retrospectively analyzed the MDCT manifestations of 20 cases with surgically and/or pathologically evidenced diagnoses of extra-organic primary tumors in pelvis. The results showed that, in 14 cases, the tumors were located in the pelvis, and 6 of them involved both pelvis and hypogastric zone. There were 8 tumors located in the peritoneal cavity of the pelvis, and 3 of them also involved the extraperitoneal space of the pelvis. In the peritoneal cavity, 2 tumors of male patients were located in the rectovesical pouch while 3 tumors of female patients were located in the rectouterine pouch. The majority of entities in these 2 pouches were germ cell tumors (3/5 cases, 60.0%). In the extraperitoneal space, 5 of 12 tumors were located in the pararectal space and 5 of them were located in the retrorectal space. The majority entities of these 10 cases were germ cell tumors (7/10 cases, 70.0%). Lymphoma mainly involved paravesical and pararectal space in disorder. Calcification occurred in 6 cases, including 4 cases of teratoma, 1 case of neurilemmoma, and 1 case of malignant teratoma. The fatty element occurred in 7 masses, including 4 cases of teratoma, 1 case of malignant teratoma, 1 case of mixed germ cell tumor, and 1 case of liposarcoma. MDCT with multi-planar reconstruction (MPR) could more clearly reveal the anatomic location of the extra-organic primary tumor in pelvis, could unveil the tumor's relationship with its surrounding organs, and could help to differentiate benign tumors from malignant tumors.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Humans ; Imaging, Three-Dimensional ; Infant ; Male ; Middle Aged ; Pelvic Neoplasms ; diagnostic imaging ; pathology ; Retrospective Studies ; Teratoma ; diagnostic imaging ; pathology ; Tomography, Spiral Computed ; Young Adult

OBJECTIVETo study the clinicopathologic features and immunophenotype of desmoplastic small round cell tumor (DSRCT), and to assess the feasibility of reverse transcriptase-polymerase chain reaction (RT-PCR) as a diagnostic adjunct for DSRCT in routine practice.

METHODSThe clinical (number = 15), cytologic (number = 1) and histopathologic (number = 14) features of 15 cases of DSRCT were investigated. The immunophenotype was studied by LSAB method using a panel of antibodies. RT-PCR was performed in one case using formalin-fixed, paraffin-embedded tissue for EWS-WT1 fusion gene mRNA.

RESULTSAmong the 15 patients studied, 13 were males and 2 were females. Their age ranged from 12 to 38 years (mean age = 23.8 years). Most presented with vague abdominal discomfort, distension or pain, accompanied by nausea, constipation and weight loss. Physical examination showed a palpable abdominal mass with ill-defined borders and tenderness. Ultrasound and computerized tomographic examination revealed single or multiple nodular tumor mass(es) in the peritoneal cavity, measuring 3 cm to 25 cm in greatest diameter (mean tumor diameter = 8.6 cm). Cytologic examination in 1 case showed clusters of small round cells in a hemorrhagic background. The tumor nuclei were hyperchromatic and contained inconspicuous nucleoli. Mitotic figures were readily identified. The cytoplasm however was scant. Histologically, the tumor was composed of small, round, ovoid to spindled cells arranged in nests of various shapes and sizes, embedded in a desmoplastic and focally hyalinized stroma. Immuno- histochemically, all cases showed diffuse and strong staining for AE1/AE3, vimentin, desmin and neuron-specific enolase. Some of them also expressed CAM5.2, epithelial membrane antigen, CD57, chromogranin A, synaptophysin and WT1. They were all negative for myogenin, CK5/6, CD117, calretinin and CD99. RT-PCR successfully amplified the EWS-WT1 chimeric mRNA in 1 case using paraffin-embedded tissue. Subsequent DNA sequencing showed that the gene fusion involved exon 7 of EWS and exon 8 of WT1 genes. The fusion gene contained KTS sequence.

CONCLUSIONSDSRCT is a highly malignant small round cell tumor occurring predominantly in the abdominal or pelvic cavity of young to middle-aged males. It is characterized by multiphenotypic differentiation. The peculiar perinuclear dot-like staining pattern for vimentin and desmin is characteristic for DSRCT. EWS-WT1 fusion transcript can be detected in formalin-fixed, paraffin-embedded tissue by RT-PCR, which may thus serve as a useful diagnostic adjunct for DSRCT.

Abdominal Neoplasms ; diagnostic imaging ; metabolism ; pathology ; Adolescent ; Adult ; Base Sequence ; Carcinoma, Small Cell ; diagnostic imaging ; metabolism ; pathology ; Child ; DNA, Neoplasm ; genetics ; Female ; Humans ; Immunophenotyping ; Male ; Molecular Sequence Data ; Oncogene Proteins, Fusion ; genetics ; metabolism ; Pelvic Neoplasms ; diagnostic imaging ; metabolism ; pathology ; RNA, Messenger ; genetics ; metabolism ; Retrospective Studies ; Tomography, X-Ray Computed