Bronchogenic cysts are primitive, foregut-derived developmental anomalies with bronchial-type, pseudostratified cylindrical epithelium. They are usually discovered in the thorax. The occurrence of such cysts in the retroperitoneum is extremely rare. Imaging techniques are generally effective in the detection of retroperitoneal bronchogenic cyst. Here, we report two cases (a 27-year-old man and a 33-year-old man) who had no clinical symptoms and were found by chance to have masses in the adrenal gland area during routine physical examination. We found that they had some similar computed tomography imaging features, including complete adrenal structure, cystic fusiform mass in adrenal region, and inclusion of calcifications in the lesions. However, accurate preoperative diagnosis remains difficult and only histology can provide a definitive diagnosis. Surgery remains the treatment of choice.

Rationale:Sarcomatous intrahepatic cholangiocarcinoma is a rare histological variant of cholangiocarcinoma (ICC). Previous medical literature has not mentioned the prevalence of this kind of disease, but a poorer prognosis than that of ordinary ICC was indicated. The diagnosis of the sarcomatous ICC is established on histopathological and immunohistochemical examinations. In this article, we present a new case of a patient with sarcomatous ICC who had no radiographic sign of intrahepatic tumor preoperatively.Patient concerns:A 63-year-old man was noted with cholecystolithiasis and right upper abdominal pain. Liver function was within normal limits, although the gamma-glutamyl transpeptidase level was elevated. Serum carbohydrate antigen 19-9 level was elevated. Radiography showed atrophy of the left lobe of the liver, high-intensity signals on T1 weighted images, and low/high-intensity signals on T2 weighted images in hepatic ducts.Diagnoses:The preoperative diagnoses were hepatolithiasis, choledocholithiasis, and cholecystolithiasis.Interventions:Exploratory laparotomy, adhesion release, cholecystectomy, choledocholithotomy, and T tube drainage were performed. During the surgery, an ill-defined tumor was detected on the atrophic left lateral lobe of the liver. Hepatic left lateral lobectomy was performed to remove the mass.Outcomes:The final diagnosis of sarcomatous ICC was made by histopathology after surgery. No evidence of local recurrence or distant metastasis was noted on imaging during follow-up.Lessons:Although rare, sarcomatous ICC does exist in patients presented with cholecystolithiasis and liver atrophy. Surgeons should be aware of the existence of sarcomatous ICC due to the poor prognosis. We recommend that multidisciplinary approaches may be key to improve prognosis, including adjuvant chemotherapy or radiotherapy.

Background: Glioblastomas (GBMs) represent both the most common and the most highly malignant primary brain tumors. The subjective visual imaging features from MRI make it challenging to predict the overall survival (OS) of GBM. Radiomics can quantify image features objectively as an emerging technique. A pragmatic and objective method in the clinic to assess OS is strongly in need. Purpose: To construct a radiomics nomogram to stratify GBM patients into long-vs. short-term survival. Study Type: Retrospective. Population: One-hundred and fifty-eight GBM patients from Brain Tumor Segmentation Challenge 2018 (BRATS2018) were for model construction and 32 GBM patients from the local hospital for external validation. Field Strength/Sequence: 1.5 T and 3.0 T MRI Scanners, T 1 WI, T 2 WI, T 2 FLAIR, and contrast-enhanced T 1 WI sequences Assessment: All patients were divided into long-term or short-term based on a survival of greater or fewer than 12 months. All BRATS2018 subjects were divided into training and test sets, and images were assessed for ependymal and pia mater involvement (EPI) and multifocality by three experienced neuroradiologists. All tumor tissues from multiparametric MRI were fully automatically segmented into three subregions to calculate the radiomic features. Based on the training set, the most powerful radiomic features were selected to constitute radiomic signature. Statistical Tests: Receiver operating characteristic (ROC) curve, sensitivity, specificity, and the Hosmer-Lemeshow test. Results: The nomogram had a survival prediction accuracy of 0.878 and 0.875, a specificity of 0.875 and 0.583, and a sensitivity of 0.704 and 0.833, respectively, in the training and test set. The ROC curve showed the accuracy of the nomogram, radiomic signature, age, and EPI for external validation set were 0.858, 0.826, 0.664, and 0.66 in the validate set, respectively. Data Conclusion: Radiomics nomogram integrated with radiomic signature, EPI, and age was found to be robust for the stratification of GBM patients into long-vs. short-term survival. Level of Evidence: 3 Technical Efficacy Stage: 2