Primary retroperitoneal neoplasms are a rare but diverse group of benign and malignant tumors that arise within the retroperitoneal space but outside the major organs in this space. Although computed tomography and magnetic resonance imaging can demonstrate important characteristics of these tumors, diagnosis is often challenging for radiologists. Diagnostic challenges include precise localization of the lesion, determination of the extent of invasion, and characterization of the specific pathologic type. The first step is to determine whether the tumor is located within the retroperitoneal space. Displacement of normal anatomic structures of the retroperitoneum is helpful in this regard. For tumors that are located within the retroperitoneum, the next step is to identify the organ of origin. Specific signs, including the "beak sign," the "embedded organ sign," and the "phantom (invisible) organ sign," are useful for this purpose. When there is no definite sign that suggests the organ of origin, the diagnosis of a primary retroperitoneal tumor becomes likely. Awareness of specific patterns of spread, specific tumor components, and tumor vascularity help in further narrowing the differential diagnosis. Attention to these diagnostic clues is essential in making an accurate radiologic diagnosis of primary retroperitoneal tumors and in obtaining clinically significant information.
Degenerative change at the end plate of the discovertebral joint was studied in the elderly adult by correlating the histologic and radiographic findings. Undecalcified ground sections were made from 21 autopsied lumbar spines that demonstrated no evidence of disease except age-related osteoporosis. Histologic examination showed that the cartilaginous end plates were degenerated to various extents and were replaced by subchondral bone proliferation (endochondral bone formation) in the direction of the joint space. In advanced cases, this histologic finding was reflected in radiographs as a subchondral sclerotic zone protruding toward the disk space. The degree of end-plate change was positively correlated with disk-space narrowing and the vacuum phenomenon (degeneration of the nucleus pulposus) but not with osteoporosis and vertebral compression. Anatomically and functionally, this may be the most common form of degeneration at the discovertebral joint end plate. Further study will be necessary to clarify the process.
Distinction of renal oncocytoma (RO) from chromophobe renal cell carcinoma (ChRCC) is important because their clinical behavior is different. As part of a search for the best available immunohistochemical markers to distinguish ChRCC from RO, we investigated the immunohistochemical profiles of these tumors. We selected 30 renal tumors consisting of ChRCC, typical variant (n = 14), ChRCC, eosinophilic variant (n = 6), and RO (n = 10). Their expression of cytokeratin (CK) 7, KAI1, epithelial-specific antigen (ESA), epithelial-related antigen (ERA), Claudin- 7, and Claudin-8 was studied using an autostainer. Immunoreactivity was assessed based on a combined score of the extent and intensity of staining. Compared to RO, a significantly higher percentage of the total ChRCCs stained positive for CK7 (85% vs. 10%, respectively), KAI1 (90% vs. 10%), ESA (95% vs. 10%), ERA (95% vs. 10%), and Claudin-7 (95% vs. 20%) (P < 0.001). Additionally, there was a significant difference between the percentage of ChRCC eosinophilic variant (ChRCC-E) and RO that stained positive for KAI1 (100% vs. 10%, respectively), ESA (83% vs. 10%), and ERA (83% vs. 10%) (P < 0.001). We recommend immunohistochemical analysis of KAI1, ESA, and ERA to distinguish ChRCC-E from RO.
A 57-year-old man with pituitary metastasis from renal cell carcinoma is reported. He underwent right nephrectomy and total pancreatectomy for renal cell carcinoma and its pancreatic metastasis, respectively. Imaging studies showed an intrasellar mass lesion. The examination revealed panhypopituitarism, diabetes insipidus and bitemporal hemianospia. Metastatic renal cell carcinoma was diagnosed by the biopsy of the pituitary tumor. Metastatic renal cell carcinoma to the pituitary gland, which is extremely rare, appears to have unique features of presenting with hypopituitarism and visual disturbance more frequently than other metastatic pituitary tumors.
Gynecologic emergencies include a variety of gynecologic diseases that manifest with acute lower abdominal pain, fever, and vaginal bleeding. Recent technical advances enable the application of magnetic resonance (MR) imaging to these conditions, which may add clinically useful information in a short enough time for emergent diagnosis. In this study, the acute gynecologic conditions in which MR imaging studies were performed are reviewed, and the characteristic MR findings in gynecologic emergencies, including ovarian hemorrhage, ectopic pregnancy, tumor rupture, torsion, hemorrhage, infarction, and pelvic inflammatory diseases, are demonstrated. Familiarity of these findings aids accurate diagnosis and proper treatment choices in gynecologic emergencies.
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