To avoid an unnecessary extend of surgery in primary central nervous system lymphoma (PCNSL), the diagnosis should be suspected after MRI. Pre-treatment MRI examinations of 100 immunologically competent patients with biopsy-proven PCNSL were evaluated. All patients had T2- and T1-weighted images with contrast enhancement. Diffusion-weighted MRI (DW-MRI) was available in 15, proton-MR-spectroscopy (1H-MRS) in four patients. The number of lesions ranged from one (n=65 patients) to eight (n=1) with a mean of 1.7. The most frequent locations were the cerebral hemispheres (n=66), the basal ganglia (n=27) and the corpus callosum (n=24). In the 65 patients with a solitary lesion, hemispheric lesions were most frequent (n=23) followed by corpus callosum (n=18). Contrast enhancement was found in all but one patient. 1H-MRS revealed a uniformly pathologic pattern of metabolite concentrations in all patients. Characteristic imaging features of PCNSL are contrast-enhancing lesions with a diameter of at least 15 mm in contact with the subarachnoid space. DW-MRI and proton spectroscopy may aid in differential diagnosis.
These results indicate a correlation between radiation and cavernoma, particularly in children under 10 years of age at the time of radiation therapy. In adults, cavernomas after radiation rarely occur, and then only after higher radiation dosages (3000 cGy or more).
We describe four patients with intraosseous cavernous hemangiomas of the skull which were localized supraorbitally, parietally (two cases), and occipitally. The diameter ranged from 15 mm to 25 mm. They presented with slowly growing mass, tender to pressure, with spontaneous pain, and with freely mobile skin above the cavernoma sites. Magnetic resonance imaging (hyperintensity on T2 and isointensity with brain on T1) and CT (osteolytic lesion with erosion of the tabula externa) confirmed the plain skull films showing the honeycomb or sunburst appearance pattern. Resections and postoperative course were uneventful. In three of these cases there was coexistence with tumors (meningeoma, malignant lymphoma, and malignant melanoma); none of these constellations has been described before. Generally, cavernous hemangiomas of the skull are rare. There is one extensive review published by Barnes in 1984 regarding a period of 136 years with 123 intraosseous hemangiomas of the skull and 74 of the jaws. Unfortunately, the histological confirmation is not completely clear and some capillary hemangiomas are included. In a review of the literature since 1975, we found 103 histologically proven intraosseous cavernous hemangiomas of the skull (with our four cases included) and 22 of the jaws, which are shown in an overview with respect to their localization. The most frequent site was frontal, followed by temporal.
Herpes simplex virus encephalitis (HSVE) is the most frequent fatal viral infection of the brain. Because antiviral treatment may improve the prognosis significantly, early diagnosis is mandatory. Imaging diagnosis rests on conventional MRI for the visualization of lesions in the limbic system, the hallmark of HSVE. Diffusion-weighted MRI (DW-MRI) has not been used for the evaluation of HSVE. We report on the DW-MRI findings in three patients with HSVE, who had cortical diffusion abnormalities in affected brain parenchyma, partially as the initial or most sensitive sign of encephalitis. Sequential imaging showed that the diffusion abnormality started to return to normal after 2 weeks in the presence of persistent contrast uptake. Thus, DW-MRI may be a valuable tool for early detection and diagnosis of HSVE whereas contrast-enhanced images are indispensable after the first week.
Aims
In this study, we aimed to independently evaluate the utility and prognostic value of tumour budding (TB) according to the International Tumour Budding Consensus Conference (ITBCC) criteria in a large and a well‐characterised European gastric cancer (GC) cohort.
Methods and results
In 456 consecutive, surgically treated GCs, TB was assessed according to the ITBCC criteria and scored as Bd0 (no buds), Bd1 (one to four buds), Bd2 (five to nine buds) or Bd3 (≥10 buds). Cases with TB present were divided into low‐ (Bd1/Bd2) and high‐budding (Bd3) groups. The TB score was analysed in relation to the clinicopathological parameters, overall survival (OS) and tumour‐specific survival (TSS); 115 (25.2%) cases had no, 104 (22.8%) had low and 237 (52.0%) had high TB. The TB score correlated significantly with sex, Laurén phenotype, pT‐, pN‐ and M categories, histological grade, R status; and lymph node ratio, lymphatic invasion, perineural invasion and HER2‐, MET‐ and MSI status. In both total and intestinal‐type early invasive GC (n = 57 and n = 41, respectively), significant associations between the presence and extent of TB and presence of lymph node metastasis were detected. Significant differences in OS and TSS between the TB groups were found; however, TB did not retain significance in multivariate models.
Conclusions
Our data show that the ITBCC criteria can be applied to GC. The data correlated significantly with the diverse clinicopathological characteristics, including patient outcome, and can help to standardise diagnostics and research into special histological features of malignant tumours in general and GC in particular.
Background: By using diffusion tensor magnetic resonance imaging (DTI) and subsequent tractography, a perisylvian language network in the human left hemisphere recently has been identified connecting Brocas's and Wernicke's areas directly (arcuate fasciculus) and indirectly by a pathway through the inferior parietal cortex.
Imaging findings in TBE resemble those of other infections, such as meningoencephalitis. However, a predilection for the thalami, basal ganglia, cerebellum, and anterior horns of the spinal cord suggests the possibility of TBE.
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