Adrenocortical carcinoma (ACC) is a rare malignancy, especially in children. The overall incidence is approximately 2 cases per million per year.[1] In children, the incidence is 0.3 cases per million per year, except in southern Brazil where the incidence is 3.4–4.2 cases per million per year.[2] We describe a giant nonfunctioning metastasized ACC in a 6-year-old girl who presented with a history of increasing abdominal girth incidentally noticed by her mother since 1 week. Ultrasound abdomen showed a large right suprarenal tumor with calcifications and necrosis. Empty left renal fossa and compensatory enlarged right kidney were seen. Computed tomography (CT) scan revealed a large heterogenously enhancing right suprarenal mass with calcification and necrosis with pulmonary metastasis. Histopathology report from the right suprarenal mass revealed an ACC. With a stage IV disease, the patient died after 2 months from diagnosis.
Magnetic resonance imaging has been shown to be a useful tool in the evaluation of oral malignancies because of direct visualization of lesions due to high soft tissue contrast and multiplanar capability. However, small oral cavity tumours pose an imaging challenge due to apposed mucosal surfaces of oral cavity, metallic denture artefacts and submucosal fibrosis. The purpose of this pictorial essay is to show the benefits of pre and post contrast MRI sequences using various dynamic manoeuvres that serve as key sequences in the evaluation of various small oral (buccal mucosa and tongue as well as hard/soft palate) lesions for studying their extent as well as their true anatomic relationship.
Highlights
Glomangiopericytoma is rare sinonasal disease with very good prognosis after surgical excision.
Prognosis is very good after surgical excision.
As most nasal tumors our case was also an accidental diagnosis following endoscopic sinus surgery. and complete clearance was suspicious.
Patent was referred for adjuvant radiation.
Revision surgery was done and wide clearance was established.
Patient was saved from radiation.
A middle aged male presented with acute bilateral vision loss, 4 weeks after undergoing gastric bypass surgery for gastric carcinoma. He had normal sensorium, fundoscopy, normal pupillary reaction to light, but had mild opthalmoparesis and nystagmus with ataxia. Magnetic resonance imaging of the brain revealed post-chiasmatic optic tract edema along with other classical features of Wernicke's syndrome. Thiamine supplementation leads to complete resolution of clinical as well as imaging findings. In appropriate clinical settings, a high index of suspicion and early treatment are essential for managing Wernicke's syndrome even in patients with atypical clinical and imaging presentation.
Oral cavity cancers contribute to a majority of cancers in India. Clinical examination alone cannot determine the deeper extent of the disease; therefore, need for cross-sectional imaging including computed tomography and magnetic resonance imaging becomes indispensable for pre-treatment evaluation to decide optimal plan of management. Oral cavity squamous cell cancers (OSCC) can be treated with surgery alone, whereas deep muscle, neurovascular, osseous, or nodal involvement on imaging suggests advanced disease that requires a combination of surgery, radiation, and/or chemotherapy. Because of the complex anatomy of the oral cavity and its surrounding structures, imaging is crucial for locoregional staging and early detection of distant metastases. Imaging plays indispensable role not only in diagnosis but also in planning the management. An optimal guideline paper for developing countries like India is lacking that not only helps standardize the management but will also assist oncologists make reasonable decisions and reduce the unnecessary imaging. This imaging guideline paper will discuss the optimal imaging in diagnosis and management OSCC for Indian subcontinent.
Leiomyoma is a benign tumor of smooth muscle origin and commonly diagnosed in the uterus, gastrointestinal tract, skin, and mucous membranes. To the best of our knowledge, the only reported intraosseous leiomyomas in extremities occurred in the proximal aspect and distal aspect of the femur, in the tibia, and in the ulna. We are not aware of any previous reports of intraosseous leiomyomas in the foot. The radiograph of the intraosseous leiomyoma shows unilocular or multilocular lytic lesion with sclerotic rim. Due to lack of definitive radiological features on magnetic resonance imaging and computed tomography diagnosis of this rare tumor is established with histopathological study and immuno-histochemistry markers. Smooth muscle spindle cells and positive immunohistochemistry markers for muscle cells is hall mark for the diagnosis. The treatment of intraosseous leiomyoma is surgical intervention by excision with wide margin and curettage followed by filling the cavity. The diagnosis of this tumor is challenging due to its extraordinarily rare incidence. Intraosseous leiomyoma should be included in the differential diagnosis of intraosseous lesion with benign radiographic feature. We report of the first published case of primary intraosseous leiomyoma of calcaneum in a 22-year-old male patient.
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