A 14-year-old Maltese dog presented with progressive exophthalmos and external deviation of the right eye. Ultrasonography revealed the presence of a retrobulbar mass and fine-needle aspiration cytology was performed, which detected a malignant mass. There was no evidence of metastasis on thoracic and abdominal radiography. Computed tomography showed no invasion into the bony orbit and no metastasis to the lung or lymph nodes. Exenteration was performed to remove the mass completely. Malignant peripheral nerve sheath tumor was confirmed by histopathological examination.
Adolescent ; Animals ; Biopsy, Fine-Needle ; Dogs ; Exophthalmos ; Humans ; Lung ; Lymph Nodes ; Neoplasm Metastasis ; Neurilemmoma* ; Orbit* ; Peripheral Nerves ; Radiography, Abdominal ; Recurrence* ; Ultrasonography

For inflammatory bowel disease (IBD), antitumor necrosis factor treatment offers a new direction for both patients and medical doctors. This treatment has dramatically improved the quality of life for patients with ulcerative colitis and Crohn disease (CD). However, with increasing usage and longer follow-up periods, a wider range of possible adverse effects may be encountered. We report an unusual case of pulmonary sarcoidosis developed during the treatment of a patient with CD by using infliximab. A 30-year-old male who had been treated for CD with infliximab for 18 months was admitted due to abnormal opacities on chest radiography. Chest computed tomography displayed clustered small nodules in both lobes and enlarged multiple lymph nodes. The patient was diagnosed with sarcoidosis from the results of a biopsy of the subcarinal lymph node. Lung lesions were improved five months after infliximab was stopped.
Adult ; Biopsy ; Colitis, Ulcerative ; Crohn Disease* ; Follow-Up Studies ; Humans ; Inflammatory Bowel Diseases ; Infliximab* ; Lung ; Lymph Nodes ; Male ; Necrosis ; Quality of Life ; Radiography ; Sarcoidosis ; Sarcoidosis, Pulmonary* ; Thorax ; Tumor Necrosis Factor-alpha

OBJECTIVE: To comprehensively analyze the spectrum of imaging features of the primary tumors and metastatic patterns of the Extraskeletal Ewing sarcoma family of tumors (EES) in adults. MATERIALS AND METHODS: We performed a computerized search of our hospital's data-warehouse from 1996 to 2013 using codes for Ewing sarcoma and primitive neuroectodermal tumors as well as the demographic code for > or = 18 years of age. We selected subjects who were histologically confirmed to have Ewing sarcoma of extraskeletal origin. Imaging features of the primary tumor and metastatic disease were evaluated for lesion location, size, enhancement pattern, necrosis, margin, and invasion of adjacent organs. RESULTS: Among the 70 patients (mean age, 35.8 +/- 15.6 years; range, 18-67 years) included in our study, primary tumors of EES occurred in the soft tissue and extremities (n = 20), abdomen and pelvis (n = 18), thorax (n = 14), paravertebral space (n = 8), head and neck (n = 6), and an unknown primary site (n = 4). Most primary tumors manifested as large and bulky soft-tissue masses (mean size, 9.0 cm; range, 1.3-23.0 cm), frequently invading adjacent organs (45.6%) and showed heterogeneous enhancement (73.7%), a well-defined (66.7%) margin, and partial necrosis/cystic degeneration (81.9%). Notably, 29 patients had metastatic disease detected at their initial diagnosis. The most frequent site of metastasis was lymph nodes (75.9%), followed by bone (31.0%), lung (20.7%), abdominal solid organs (13.8%), peritoneum (13.8%), pleura (6.9%), and brain (3.4%). CONCLUSION: Primary tumors of EES can occur anywhere and mostly manifest as large and bulky, soft-tissue masses. Lymph nodes are the most frequent metastasis sites.
Adolescent ; Adult ; Aged ; Asian Continental Ancestry Group ; Bone Neoplasms/*pathology/radiography ; Brain Neoplasms/pathology/radiography ; Female ; Humans ; Lymph Nodes/pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Metastasis ; Neuroectodermal Tumors, Primitive/pathology/radiography ; Positron-Emission Tomography ; Sarcoma, Ewing/*pathology/radiography ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVE: The maximum standardized uptake value (SUVmax) of pulmonary mucoepidermoid carcinoma (PMEC) in fluorine-18fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) was evaluated as a preoperative predictor of pathologic grade and survival rate. MATERIALS AND METHODS: Twenty-three patients who underwent preoperative PET/CT and complete resection for PMEC were enrolled. The optimal cut-off SUVmax for tumor grade was calculated as 6.5 by receiver operating characteristic curve. The patients were divided into a high SUV group (n = 7) and a low SUV group (n = 16). Clinicopathologic features were compared between the groups by chi2 test and overall survival was determined by Kaplan-Meier analysis. RESULTS: The mean SUVmax was 15.4 +/- 11.5 in the high SUV group and 3.9 +/- 1.3 in the low SUV group. All patients except one from the low SUV group had low grade tumors and all had no nodal metastasis. The sensitivity and specificity of SUVmax from PET/CT for predicting tumor grade was 85.7% and 93.8%, respectively. During the follow-up period (mean, 48.6 +/- 38.7 months), four patients from the high SUV group experienced cancer recurrence, and one died of cancer. In contrast, none of the low SUV group had recurrence or mortality. Five-year overall survival rate was significantly higher in the low SUV group (100% vs. 71.4%, p = 0.031). CONCLUSION: Pulmonary mucoepidermoid carcinoma patients with high SUVmax in PET/CT had higher tumor grade, more frequent lymph node metastasis and worse long-term outcome. Therefore, PMEC patients with high uptake on PET/CT imaging might require aggressive mediastinal lymph node dissection and adjuvant therapies.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Mucoepidermoid/*pathology/radiography ; Female ; Fluorodeoxyglucose F18/metabolism ; Humans ; Kaplan-Meier Estimate ; Lung Neoplasms/*pathology/radiography ; Lymph Nodes/pathology/radiography ; Lymphatic Metastasis ; Male ; Mediastinum/radiography ; Middle Aged ; Neoplasm Grading ; Neoplasm Recurrence, Local/pathology/radiography ; Positron-Emission Tomography/*methods ; Prognosis ; ROC Curve ; Retrospective Studies ; Sensitivity and Specificity ; Survival Rate ; Tomography, X-Ray Computed/*methods ; Young Adult

PURPOSE: Ultrasound (US) and US-guided fine needle aspiration biopsies (FNAB) are considered the modalities of choice for assessing lymph nodes suspected of containing metastases, but the sensitivity of FNAB varies and is specific to the operator. We analyzed the risk of FNAB providing false negative results of lateral neck node metastasis, and evaluated diagnostic accuracy of FNAB, in patients with papillary thyroid cancer. MATERIALS AND METHODS: FNAB was performed in 242 patients suspected of having lateral neck node metastasis on preoperative imaging. Thyroglobulin in the fine-needle aspirate washout (FNA wash-out Tg) and computed tomography enhancement (Hounsfield units) were measured. Patients with negative results on FNAB were examined by intraoperative frozen section. The false negative and true negative groups were compared. RESULTS: Of the 242 patients, 130 were confirmed as having lateral neck node metastases. In 74 patients, the metastasis was identified by FNAB. False positive results were observed in 2 patients (0.8%) and false negatives in 58 (44.6%). Risk analysis showed that patient age <45 years (p=0.006), tumor size >1 cm (p=0.008) and elevated FNA wash-out Tg (p=0.004) were significantly associated with false negative results on FNAB. The accuracy of FNAB increased significantly when combined with FNA wash-out Tg (p=0.003). CONCLUSION: To reduce the false negative rate of FNAB, patient age (<45 years), tumor size (>1 cm) and FNA wash-out Tg (>34.8 ng/mL) should be considered in preoperative planning. Accuracy may be improved by combining the results of FNAB and FNA wash-out Tg.
Adolescent ; Adult ; Aged ; Biopsy, Fine-Needle ; Carcinoma/*diagnosis/*pathology/radiography/surgery ; False Negative Reactions ; Female ; Humans ; Lymph Nodes/*pathology/radiography ; Lymphatic Metastasis/*pathology/radiography ; Male ; Middle Aged ; Multivariate Analysis ; Preoperative Care ; Risk Factors ; Sensitivity and Specificity ; Thyroglobulin/metabolism ; Thyroid Gland/*pathology ; Thyroid Neoplasms/*diagnosis/*pathology/radiography/surgery ; Tomography, X-Ray Computed ; Young Adult

Optical imaging techniques use visual and near infrared rays. Despite their considerably poor penetration depth, they are widely used due to their safe and intuitive properties and potential for intraoperative usage. Optical imaging techniques have been actively investigated for clinical imaging of lymph nodes and lymphatic system. This article summarizes a variety of optical tracers and techniques used for lymph node and lymphatic imaging, and reviews their clinical applications. Emerging new optical imaging techniques and their potential are also described.
Contrast Media/diagnostic use ; Fluorescent Dyes/diagnostic use ; Humans ; Lymph Nodes/pathology/*radiography ; Lymphatic System/*pathology ; Lymphography ; Magnetic Resonance Imaging ; *Optical Imaging ; Positron-Emission Tomography ; Quantum Dots/diagnostic use ; Spectroscopy, Near-Infrared

OBJECTIVES: To  present  an  uncommon  cause  for  a  submandibular  mass  and  review  of  the literature.
METHODS:
Design: Case Report
Setting: Tertiary Government Hospital
Patient: One
RESULTS: A  25-year-old  lady  presented  with  a  painless  chronic  submandibular  swelling. Ultrasound identified a solid mass following which an uncomplicated core biopsy was performed obtaining    an    accurate    pre-operative    histopathological    diagnosis.    Pre-operative    arterial embolization of this vascular mass led to a relatively bloodless wide local excision. Radiological imaging for distant metastases was negative.
CONCLUSION: Epitheloid  Hemangioendothelioma  is  an  uncommon  cause  for  a  submandibular mass.   A malignant   vascular   soft   tissue   tumor   with   morphologic   characteristics   similar   to carcinomas, melanomas and epitheloid sarcomas, it has a high rate of metastasis and morbidity when it affects the soft tissues and viscera. Immunohistochemistry provides clues to differentiation and recommended treatment consists of a surgical wide local excision with regional lymph node resection. As there are no established standard therapeutic protocols for this disease due to its rarity, an individual case-by-case approach and follow-up needs to be undertaken.

Human ; Female ; Adult ; Neoplasms ; Immunohistochemistry ; Viscera ; Melanoma ; Hemangioendothelioma ; Radiography ; Sarcoma ; Biopsy ; Lymph Nodes

OBJECTIVE: To assess the feasibility of computed tomography (CT) lymphography using ethiodized oil for sentinel node mapping in experimentally induced VX2 carcinoma in the rabbit thigh. MATERIALS AND METHODS: This experiment received approval from the institutional animal use and care administrative advisory committee. Twenty-three rabbits with VX2 carcinoma in the thigh underwent CT before and after (1 hour, 2 hour) peritumoral injection of 2 mL ethiodized oil. After the CT examination, sentinel nodes were identified by peritumoral injection of methylene blue and subsequently removed. The retrieved sentinel and non-sentinel lymph nodes were investigated with radiographic and pathologic examinations. Based on the comparison of CT findings with those of radiographic and pathologic examinations, the diagnostic performance of CT for sentinel node identification was assessed. RESULTS: All 23 rabbits showed 53 ethiodized oil retention nodes on post-injection CT and specimen radiography, and 52 methylene blue-stained nodes at the right femoroiliac area. Of the 52 blue-stained sentinel nodes, 50 nodes demonstrated ethiodized oil retention. Thus, the sentinel node detection rate of CT was 96% (50 of 52). On pathologic examination, 28 sentinel nodes in 17 rabbits (nodes/rabbit, mean +/- standard deviation, 1.7 +/- 0.6) harbored metastasis. Twenty seven of the 28 metastatic sentinel nodes were found to have ethiodized oil retention. CONCLUSION: Computed tomography lymphography using ethiodized oil may be feasible for sentinel node mapping in experimentally induced VX2 carcinoma in the rabbit thigh.
Animals ; Carcinoma/pathology/*radiography/secondary ; Contrast Media/*diagnostic use ; Ethiodized Oil/*diagnostic use ; Feasibility Studies ; Female ; Injections ; Lymph Node Excision/methods ; Lymph Nodes/pathology/*radiography ; Lymphatic Metastasis/radiography ; Lymphography/*methods ; Rabbits ; Thigh ; Tomography, X-Ray Computed/*methods

In addition to imaging the lymphatics and detecting various types of lymphatic leakage, lymphangiography is a therapeutic option for patients with chylothorax, chylous ascites, and lymphatic fistula. Percutaneous thoracic duct embolization, transabdominal catheterization of the cisterna chyli or thoracic duct, and subsequent embolization of the thoracic duct is an alternative to surgical ligation of the thoracic duct. In this pictorial review, we present the detailed technique, clinical applications, and complications of lymphangiography and thoracic duct embolization.
Catheterization ; Chylothorax/*radiography/therapy ; Chylous Ascites/*radiography/therapy ; Embolization, Therapeutic ; Humans ; Lymph Nodes/radiography/surgery ; Lymphography ; Thoracic Duct/radiography ; Tomography, X-Ray Computed

OBJECTIVE: To evaluate the usefulness of measuring the apparent diffusion coefficient (ADC) in diffusion-weighted magnetic resonance imaging to distinguish benign from small, non-necrotic metastatic cervical lymph nodes in patients with head and neck cancers. MATERIALS AND METHODS: Twenty-six consecutive patients with head and neck cancer underwent diffusion-weighted imaging (b value, 0 and 800 s/mm2) preoperatively between January 2009 and December 2010. Two readers independently measured the ADC values of each cervical lymph node with a minimum-axial diameter of > or = 5 mm but < 11 mm using manually drawn regions of interest. Necrotic lymph nodes were excluded. Mean ADC values were compared between benign and metastatic lymph nodes after correlating the pathology. RESULTS: A total of 116 lymph nodes (91 benign and 25 metastatic) from 25 patients were included. Metastatic lymph nodes (mean +/- standard deviation [SD], 7.4 +/- 1.6 mm) were larger than benign lymph nodes (mean +/- SD, 6.6 +/- 1.4 mm) (p = 0.018). Mean ADC values for reader 1 were 1.17 +/- 0.31 x 10-3 mm2/s for benign and 1.25 +/- 0.76 x 10-3 mm2/s for metastatic lymph nodes. Mean ADC values for reader 2 were 1.21 +/- 0.46 x 10-3 mm2/s for benign and 1.14 +/- 0.34 x 10-3 mm2/s for metastatic lymph nodes. Mean ADC values between benign and metastatic lymph nodes were not significantly different (p = 0.594 for reader 1, 0.463 for reader 2). CONCLUSION: Measuring mean ADC does not allow differentiating benign from metastatic cervical lymph nodes in patients with head and neck cancer and non-necrotic, small lymph nodes.
Adult ; Aged ; Aged, 80 and over ; Diffusion Magnetic Resonance Imaging ; Female ; Head and Neck Neoplasms/pathology/*radiography ; Humans ; Lymph Nodes/pathology/*radiography ; Lymphatic Metastasis ; Male ; Middle Aged ; Necrosis ; Patients ; Sensitivity and Specificity