Brian R. J. Williamson

Residual tumor masses following treatment for advanced histiocytic lymphoma. Diagnostic and therapeutic implications

Forty percent or more of patients with advanced diffuse histiocytic (large cell) lyniphoma will achieve prolonged disease‐free survival with the use of intensive combination chemotherapy. These results are obtained only if complete resolution of all viable tumor is documented prior to the cessation of chemotherapy. Residual tumor masses at the time of re‐staging usually are excised or biopsied to confirm the presence or absence of viable tumor. Three patients are reported who had with advanced histiocytic (large cell) lymphoma, and who demonstrated residual intra‐abdominal tumor masses on CT scan following four courses of COPP chemotherapy. After two additional courses of a non‐cross‐resistant regimen and/or supplemental radiotherapy failed to reduce the size of the masses, abdominal exploration with removal of the tumors including splenectomy in one patient was performed, and in each instance no viable tumor was found. The patients have remained disease‐free for periods ranging from 24 to 48 months. The various options available to evaluate such patients are presented, and a systematic approach which should avoid the unnecessary prolongation of potentially harmful chemotherapy or radiotherapy is proposed.

Tumor detection with 67Ga-citrate: a literature survey (1970--1978).

Gallium scan detection of various neoplasms is tabulated by anatomic and histologic categories. The experience with many neoplasms is sufficient to accurately predict the likelihood of detection with gallium. This tabulation helps to point out other areas where the cumulative experience is insufficient to accurately predict sensitivity rates.

Computed tomography as a diagnostic aid in diabetic and other problem feet

Determining whether osteomyelitis is present in patients with foot infections represents a significant diagnostic challenge. As bone uptake with nuclide scans can be affected by soft tissue infection, we performed computed tomography (CT) on seven patients to see if marrow or bone abnormalities could be seen and used to predict the presence or absence of osteomyelitis. The CT scans correctly predicted the presence or absence of osteomyelitis in all seven patients. Four patients had osteomyelitis and three patients did not. Nuclide bone scans had one false-positive and one false-negative result. In this small series, CT proved helpful in evaluating foot problems.

Osteosarcoma Extraosseous Metastases Demonstrated on Bone Scans and Radiographs

Four patients with non-pulmonary soft tissue metastases of osteosarcoma are presented. These lesions were readily demonstrated on 99mTc bone scans. Calcification was evident radiographically in all of the non-pulmonary lesions. In one instance, the recurrence would have been missed without the bone scan, and in another the bone scan first suggested the diagnosis. Bone scans have proven useful in the initial evaluation of osteosarcoma and in monitoring the results of therapy.

Poorly Differentiated Lymphocytic Lymphoma with Ectopic Parathormone Production: Visualization of Metastatic Calcification by Bone Scan

Metastatic soft tissue calcification is known to occur in hypercalcemia and is usually present in the kidneys, stomach and lungs.1-3 This case presents two unusual features: 1) ectopic parathormone production in association with poorly differentiated lymphocytic lymphoma; and 2) uptake of 99 mTc-pyrophosphate in the liver in the absence of demonstrable abnormality at autopsy. The more usual sites of metastatic calcification also showed uptake of the radionuclide. We will discuss metastatic soft tissue calcification, ectopic parathyroid hormone production, hypercalcemia in malignancy and bone scan agent localization in soft tissues.

Epicardial lipoma: a CT diagnosis

Primary cardiac tumors are rare and epicardial lipomas are rare within this group. We are reporting a case diagnosed by CT in an 89-yr-old female.

Pericardial cyst a rare mass abutting the aorta

Pericardial cysts are infrequently found. They are generally located in the cardiophrenic angle, dominantly on the right side. We present an example of a pericardial cyst in the anterior mediastinum abutting the ascending aorta.

Patent umbilical vein. Diagnosis by technetium-99m tagged red blood cell scintigraphy

Abdominal scanning with Tc-99m labeled red blood cells serendipitously demonstrated collateral flow in a patent umbilical vein in a patient with unsuspected advanced cirrhotic liver disease and portal hypertension. Knowledge of this was crucial in planning the optimal surgical approach in this patient, referred for resection of a bladder carcinoma. Furthermore, the nuclide study was helpful in clarifying several questions posed by a prior abdominal pelvic CT scan.

Computed tomography of traumatic lung cyst: Case report

Blunt trauma to the chest may result in the formation of a traumatic lung cyst. The lesion itself is innocuous and requires no special treatment. Though it is important that traumatic lung cyst not be mistaken for a more serious complication of trauma requiring aggressive management, this distinction may be difficult to make on plain chest radiographs. However, in the setting of blunt chest trauma, the computed tomography appearance of a thin-walled cystic cavity completely surrounded by lung parenchyma is diagnostic of traumatic lung cyst.

The renal parenchymal stone: A benign calcified renal mass

Five patients are described, each with a densely calcified solitary mass in a peripheral location in the kidney. There was exophytic projection of the calcification in 4 cases. Three lesions were so completely calcified as to be regarded as stones. The bulk of the lesion was calcified in the 2 other cases, in which the noncalcified portion was either avascular or hypovascular. In no case was there evidence of a soft-tissue mass extending beyond the confines of the calcification.Pathologic correlation in 1 case showed only calcification in association with some renal scarring, and in a second case demonstrated an old organized and calcified abscess. Long-term follow-up in the other 3 cases has demonstrated complete stability without evidence of tumor.All cases are believed to represent examples of calcified renal parenchymal scars, resulting from old granulomatous disease, renal abscess, or hematoma. We propose that these lesions be regarded as solitary renal parenchymal stones without malignant potential, rather than calcified masses. The significance of the findings for patient management are discussed.