Anita P. Price

Radiology–Pathology Conference: Juvenile granulosa cell tumor☆

Juvenile granulosa cell tumor (GCT) of the ovary is a rare neoplasm occurring in premenarchal girls and young women. Juvenile GCT that occurs in premenarchal girls usually produces sexual precocity as a consequence of estrogen secretion. Juvenile GCTs are more likely to grow to a relatively large size with a much smaller likelihood of peritoneal spread, unlike their counterpart, epithelial ovarian neoplasms. We report the radiology and pathology of a patient with juvenile GCT and review the literature of this rare tumor.

Congenital portacaval shunt: CT demonstration

The CT findings of a congenital portacaval shunt are presented, and the literature on this unusual anomaly is reviewed.

Lymphomatoid granulomatosis in a pediatric patient

We report the radiology and pathology of a pediatric patient with lymphomatoid granulomatosis (LG) and review the literature, with an emphasis on the radiological findings and on the small subset of pediatric patients with this rare condition.

The Effects of Multiple Doses of Recombinant Human CuZn Superoxide Dismutase (rhSOD) in Premature Infants with Respiratory Distress Syndrome (RDS)

The Effects of Multiple Doses of Recombinant Human CuZn Superoxide Dismutase (rhSOD) in Premature Infants with Respiratory Distress Syndrome (RDS)

Pancreatic Involvement in Neuroblastoma With Radiologic-Pathologic Correlation: A Single-Institution Experience

OBJECTIVE Pancreatic involvement in neuroblastoma is extremely rare, with few cases reported in the literature. We present imaging findings of pancreatic involvement in neuroblastoma with clinical and pathologic correlation in the largest documented series to date. SUBJECTS AND METHODS We prospectively reported pancreatic involvement evident on multimodality imaging in neuroblastoma patients presenting to our institution from 1997 to 2011. Lesions were classified according to location within the pancreas, and imaging features were correlated with cytogenetic and surgicopathologic findings. RESULTS Neuroblastoma involving the pancreas was evident on imaging of seven of 1031 patients (mean age, 6.6 years). One patient had pancreatic involvement at presentation, and six developed pancreatic disease at relapse or disease progression. Pancreatic lesions were most frequently initially identified on concurrent CT and (123)I-metaiodobenzylguanidine scintigraphy, and additional lesions initially were found on MRI and ultrasound. Five of seven patients had focal lesions, one had diffuse pancreatic involvement, and one had pancreatic extension from contiguous disease. The distribution of lesions favored the pancreatic body and tail. All patients had International Neuroblastoma Staging System stage 3 or 4 disease, Childrens Oncology Group intermediate- or high-risk disease, and unfavorable histology at initial diagnosis. For the five patients with surgical correlation, pancreatic surgical specimens revealed neuroblastoma in three cases and ganglioneuroblastoma in two cases. CONCLUSION Although rare, pancreatic involvement in neuroblastoma occurs. Its variable imaging appearance should be considered when evaluating the retroperitoneum in patients with known or suspected neuroblastoma, particularly because increased patient survival holds the potential for uncommon patterns of recurrence.

Clinical evaluation of new workflow-efficient image processing for digital radiography

An observer study was conducted on a randomly selected sampling of 152 digital projection radiographs of varying body parts obtained from four medical institutions for the purpose of assessing a new workflow-efficient imageprocessing framework. Five rendering treatments were compared to measure the performance of a new processing algorithm against the control condition. A key feature of the new image processing is the capability of processing without specifying the exam. Randomized image pairs were presented at a softcopy workstation equipped with two diagnosticquality flat-panel monitors. Five board-certified radiologists and one radiology resident independently reviewed each image pair blinded to the specific processing used and provided a diagnostic-quality rating using a subjective rank-order scale for each image. In addition, a relative preference rating was used to indicate rendering preference. Aggregate results indicate that the new fully automated processing is preferred (sign test for median = 0 (α = 0.05): p < 0.0001 preference in favor of the control).

NEONATAL OVARIAN CYSTS: ULTRASONOGRAPHIC DETECTION AND THERAPEUTIC MANAGEMENT. 1505

Fetal abdominal masses are being diagnosed with increasing frequency due to greater utilization of pre-natal ultrasonography (US). Over a 15-month period, six inborn infants were recently diagnosed with large cystic abdominal masses(5 to 10 cm), an incidence of 1/1000, occurring in otherwise uncomplicated pregnancies. Five infants were diagnosed antenatally and were followed with serial US. All 6 infants had large palpable abdominal masses on newborn physical exam (1 bilateral). Pre-and post-natal US suggested that all cysts were ovarian in origin, with torsion present in 50% of cases. US findings of torsion included debris or septations seen within the cyst. All 6 infants had the cysts removed surgically and did well clinically. The diagnosis of ovarian torsion in the 3 patients (2 unilateral, 1 bilateral) by US was confirmed at surgery. All cysts were benign follicular cysts on pathological examination. The smaller cysts were removed with preservation of viable ovarian tissue, while the larger cysts and those causing torsion required oophorectomy. Most ovarian cysts are asymptomatic, but cysts >5cm can rupture, torse, hemorrhage, or obstruct the intestinal and urinary tracts through direct compression. Small cysts usually resolve spontaneously while complicated cysts or simple cysts >5 cm tipically require surgery. We conclude that antenatally-diagnosed cysts should be followed closely by serial US examination. The choice of treatment and perhaps the timing of delivery should be dependent on the appearance of the cyst and its evolution throughout pregnancy and the newborn period. Since recent studies have reported an incidence of large ovarian cysts (>5cm) in 1/2600 births, the cases reported here may be an isolated finding or may represent an increasing incidence of this problem. (Funded by a grant from Winthrop-University Hospital.)