Radiology Case Reports最新文献

Glomus tumors are rare, benign vascular hamartomas of the glomus apparatus with unknown etiology. They can arise from anywhere in the body. However, up to 90% of them are located in the subungual region of the fingers, as in the case of our patient. These tumors typically present with the classic triad of pain, cold sensitivity, and point tenderness. Characteristic US and MRI findings aid the clinical diagnosis; nevertheless, a histopathologic examination is confirmatory. There is a well-documented mean delay in diagnosis of around 7 years, due to the rarity, benignity, small size, and lack of proper knowledge about the condition. However, we reported a case with a delay in diagnosis that reached 40 years, which is much longer than what is documented in the literature. A high index of suspicion is required for early diagnosis and management of glomus tumors to relieve the patient's long-term suffering and prevent possible secondary nail deformities. The curative treatment of glomus tumor is complete surgical excision, which is crucial to prevent recurrence and relieve the patient's symptoms.

Endometrioid adenocarcinoma of the uterine cervix is rare and difficult to distinguish from endometrial adenocarcinoma, particularly in large bulky cases. Herein, we report a rare case of a large endometrioid adenocarcinoma in a 58-year-old Japanese woman in which the tumor origin was difficult to identify. The patient presented with abdominal pain and vaginal bleeding and was referred to a gynecologist for suspected uterine cancer based on an evaluation performed at another institution. Imaging studies revealed an 11-cm cervical tumor without parametrial invasion, lymph node, distant metastases, or hydronephrosis, whereas cervical biopsy revealed an endometrioid adenocarcinoma. The patient was subsequently referred to our department for the determination of the tissue origin. The results of immunohistochemical staining were equivocal for cervical and endometrial origin. However, rectal examination confirmed a barrel-shaped cervix extending from the lower uterine segment to the hymenal ring. Human papillomavirus and microsatellite instability tests were negative. Finally, the patient was diagnosed with stage III endometrioid adenocarcinoma of the uterine cervix and achieved complete remission after concurrent chemoradiotherapy, followed by platinum-based systemic chemotherapy.

Basilar artery (BA) fenestration and its occlusion are relatively rare conditions. Mechanical thrombectomy for fenestrated BA occlusion has a high risk of complications. One limb occlusion or partial occlusion of fenestration mimics arterial stenosis or dissection. We present the case of a 75-year-old woman who presented with slight dysarthria, which subsequently worsened. Magnetic resonance imaging, magnetic resonance angiography, and basi-parallel anatomical scanning (BPAS) revealed BA fenestration and occlusion of the larger limb of the fenestrated BA, for which we performed thrombectomy with aspiration and achieved Thrombolysis in Cerebral Infarction Grade 3 flow restoration without procedure-related complications. If BA occlusion occurs at a site where a thrombus does not normally occur, confirming the anatomy of the BA before thrombectomy is desirable. As we obtained information on BA fenestration and occluded limb diameter using preoperative BPAS, we were able to safely achieve effective recanalization by guiding a relatively large-diameter aspiration catheter to the thrombus coaxially with a micro-guidewire and microcatheter.

Adenosquamous carcinoma of the pancreas (ASCP) is a rare and aggressive variant of pancreatic cancer, characterized by both adenocarcinoma and squamous cell carcinoma components. It presents significant diagnostic and therapeutic challenges due to its atypical histology and poor prognosis. A 72-year-old male presented with abdominal pain, lighter-colored stools, and intermittent nausea. Initial imaging revealed a complex mass in the distal pancreatic body and tail. Elevated lipase levels and subsequent endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) suggested an atypical pancreatic lesion with keratinizing squamous cells.

Further investigation through fiberoptic bronchoscopy and EBUS-guided transbronchial needle aspiration (TBNA) confirmed carcinoma with squamous differentiation. Genetic testing identified KRAS G12D and PIK3CA mutations. The multidisciplinary tumor board recommended systemic chemotherapy with mFOLFIRINOX and G-CSF support. The patient underwent twelve cycles of mFOLFIRINOX with dose adjustments for thrombocytopenia and effective management of chemotherapy-related side effects. Restaging CT scans showed a decrease in tumor size and stable metastatic nodes. The patient showed a partial biochemical response with decreasing CA 19-9 levels and disease stabilization on imaging. This case demonstrates the critical role of a multidisciplinary approach in managing rare pancreatic malignancies. ASCP requires a comprehensive diagnostic and therapeutic strategy involving advanced imaging, histopathological confirmation, and personalized chemotherapy. Integrating advanced diagnostic techniques, molecular profiling, and a multidisciplinary approach is essential for improving patient outcomes and providing comprehensive care for this challenging malignancy. Addressing the psychological aspects and offering compassionate care are vital for supporting patients through their treatment journey.

Hydatid cyst is a parasitic infection caused by the Echinococcus granulosus and multilocularis species of tapeworm. An intermuscular hydatid cyst is an unusual location for hydatid cyst disease, even in endemic regions. Therefore, intermuscular hydatid cysts might be mistaken for other benign and malignant soft tissue tumors. Magnetic resonance imaging plays a crucial role in diagnosing intermuscular hydatid cysts by showing the typical imaging characteristics of the disease. Here, we report a case of an isolated intermuscular hydatid cyst disease in a 34-year-old man who presented with left posterior thigh swelling of 5 years duration. The diagnosis was established using magnetic resonance imaging, which showed large, well-encapsulated cystic lesions containing multiple daughter cysts of varying sizes, with some cysts containing detached floating membranes. Surgery was performed, together with preoperative and postoperative albendazole treatment.

Appendiceal carcinoma, a rare malignancy comprising less than 1% of gastrointestinal cancers, often presents diagnostic challenges due to its atypical symptoms. This report details a 68-year-old female with a history of severe anemia, gastrointestinal bleeding, and persistent abdominal symptoms, ultimately diagnosed with chronic small bowel obstruction caused by an appendiceal adenocarcinoma. Despite initial treatment for Helicobacter pylori-induced gastritis, her symptoms persisted, prompting further imaging that revealed a narrowed small bowel segment. Exploratory laparotomy uncovered a stricturing tumor 2 meters from the duodenojejunal junction, leading to en bloc resection of the tumor, appendix, and part of the lateral abdominal wall. Histopathology confirmed moderately differentiated adenocarcinoma. A multidisciplinary team recommended a complete right hemicolectomy, successfully performed despite extensive adhesions and a mesenteric abscess. Postoperatively, the patient recovered well, with ongoing management for anemia and close surveillance. This case highlights the importance of considering rare malignancies in differential diagnoses for chronic small bowel obstruction.

Odontogenic tumors are slow-growing and generally nonaggressive; however, aggressive characteristics appear to exist in particular tumors. The author reports two cases of benign odontogenic lesions at the anterior maxilla. A 44-year-old woman came to an oral-maxillofacial surgeon with a complaint of asymptomatic swelling of the left anterior region of the maxilla 15 years ago, which started gently but gradually increased over time. The patient experienced a physical injury 15 years ago, resulting in the loss of the upper left front teeth. In the other case, a 50-year-old woman complained for 5 years about a little swelling in her left anterior maxilla that became larger over time without causing any discomfort or pain. The Cone-beam computed tomography (CBCT) exam revealed a partially multilocular radiopaque mixed radiolucent lesion in the anterior maxilla, with margins that are both well-defined and ill-defined. Both display features of infiltrative, expansive, and moderately aggressive growths, leading to the erosion and perforation of the cortical plates in the buccal and palatal regions. Based on the biopsy results, both samples showed similar findings, specifically a benign odontogenic lesion, likely desmoplastic ameloblastoma, and squamous odontogenic tumor without any atypic cells or malignancy. This study aims to further our understanding of the clinical and radiological features of these patients and emphasize the importance of investigating specific lesions as potential diagnoses.

Solitary plasmacytoma of bone (SPB) is a rare plasma cell malignancy that most often presents with localized pain. This case describes a 70-year-old female with a pathologic humeral fracture due to a large, hypervascular SPB. The tumor was assumed to be a metastatic lesion, and preoperative embolization was performed to minimize intraoperative blood loss, followed by tumor debulking and total shoulder arthroplasty. The total estimated blood loss was limited to 100cc, and the patient was returned to baseline functional status with full shoulder range of motion at 6 months postop. Literature on embolization of appendicular plasmacytomas is sparse; however, this case supports its efficacy. We recommend considering preoperative embolization as an adjunctive therapy for all hypervascular bone tumors requiring surgical management, regardless of origin.

Posterior urethral valves (PUV) present significant challenges in neonatal urinary management, often indicating the use of a suprapubic catheter (SPC). However, complications associated with SPC, coupled with specific contraindications call for alternative approaches. Here, we present a case of successful transurethral catheterization in a 1-day-old premature male infant with PUV, utilizing bedside Ultrasound without anesthesia, effectively alleviating the need for a SPC. The procedure involved careful wire insertion and subsequent catheter placement, facilitating urine drainage, and enabling a micturating cystourethrogram (MCUG) using the same access point. By avoiding SPC-related risks and allowing for essential diagnostic procedures, this approach presents itself as a less invasive and possibly better initial option, particularly in cases where SPC may pose complications. Our findings suggest that ultrasound-guided transurethral catheterization offers a minimally invasive and effective alternative to SPC, proving its potential to enhance patient care and outcomes in challenging PUV cases.

Carotid body tumors (CBTs) are rare, hypervascular neuroendocrine neoplasms that can lead to significant complications during surgical resection due to the high risk of bleeding. We present the case of a 64-year-old male with a palpable neck mass on the left side, diagnosed as a CBT through imaging studies. Given the tumor's increasing size and rich vascularization, percutaneous preoperative embolization with Onyx under ultrasound and angiographic guide, was performed to minimize intraoperative complications. Forty-eight hours later, the tumor was surgically resected with minimal blood loss and no injury to cranial nerves or the carotid bifurcation.