Ercüment Ünlü

Inflammatory pseudotumor of the spleen with EBV positivity: report of a case

Inflammatory pseudotumor (IPT) of the spleen is a rare benign tumor with unknown etiology. It causes problems in the diagnosis because of mimicking some hematopoetic malignancies. Here we report the case of a 36‐yr‐old woman complaining of nausea and insomnia. Laboratory investigations were limited to increase of leukocyte and thrombocyte count. Ultrasonography and magnetic resonance (MR) imaging showed circumscribed solid lobulated mass, measuring about 6.5 cm in diameter, located in the dorsal region of the spleen. Splenectomy was performed with the differential diagnosis including hamartoma and lymphoma of the spleen. Histological examination of the sharply demarcated splenic mass consisted of myofibroblasts and admixture of inflammatory cells. Immunohistochemistry and in situ hybridization were performed. IPT of the spleen was diagnosed. Epstein–Barr virus (EBV) was detected in the tumor by in situ hybridization. This rare entity is presented because of its clinical, radiological and pathological difficulties in the differential diagnosis.

Evaluation of Tumor Angiogenesis with Contrast-Enhanced Dynamic Magnetic Resonance Mammography

Abstract:  The goal of this research was to correlate dynamic magnetic resonance (MR) mammographic contrast enhancement and microvessel densities in breast masses. Forty‐six female patients with breast masses detected by mammography and/or ultrasonography were included in the study. MR contrast enhancements of the lesions were investigated dynamically using axial three‐dimensional fast low‐angle shot sequences. After excisional biopsy or mastectomy, immunohistochemical staining with factor VIII‐RA was performed, followed by microvessel density measurements. Contrast enhancement patterns in dynamic MR mammography were compared with microvessel density measurements using Students t‐test, Pearsons moment correlation coefficients, and one‐way analysis of variance (ANOVA). Malignant lesions exhibited three different enhancement patterns: 1) a peak enhancement within 120 seconds (early phase), followed by a decrease in the delayed phase (25 cases); 2) an increase in the early phase, followed by a plateau in the delayed phase (9 cases); and 3) an increase throughout the examination without any peak (5 cases). In benign lesions, signal intensity did not exhibited a peak in five cases, whereas in two cases enhancement was increased in the early phase and made a plateau in the delayed phase. A significant correlation was found between microvessel density and the percentage of maximal signal increase following paramagnetic contrast administration (r = 0.322, p < 0.05). Dynamic enhancement patterns and rates of maximal signal increase predict microvessel density in breast malignancies and may possibly be used as prognostic indicators.

Prevalence and MDCT characteristics of asymptomatic Bochdalek hernia in adult population.

PURPOSE To determine the frequency of asymptomatic incidental Bochdalek hernias in adults, using multidetector computed tomography (MDCT), and to ascertain any possible relationship between Bochdalek hernia and age, gender, or body mass index (BMI). MATERIALS AND METHODS Seven hundred and forty-eight abdominal, and 602 chest MDCT scans, which had been performed for a variety of reasons on 1350 adults, were investigated retrospectively. Location and size of Bochdalek hernias seen on these scans were correlated with age, gender, and BMI. On the basis of BMI, patients with Bochdalek hernia were classified as group A (BMI < 25) and group B (BMI > or =25). RESULTS A total of 171 Bochdalek hernias were identified in 142 of 1350 patients, ranging in age from 25 to 90 years (median age, 57.2), representing a prevalence of 10.5%. Sixty leftsided unilateral Bochdalek hernias (42.2%), 53 (37.4%) rightsided unilateral Bochdalek hernias, and 29 (20.4%) bilateral Bochdalek hernias were detected. Forty-five (31.6%) were categorized as small, 82 (57.8%) were medium-sized, and 15 (10.5%) were large. BMI was < 25 in 62 patients (43.7%), and > or =25 in 80 patients (56.3%). Fourteen patients (9.9%) were young adults, while 86 (60.6%) were middle aged, and 42 (29.6%) were elderly. No statistically significant relationship was found between dimensions or hernia locations and age, gender, or BMI of patients with Bochdalek hernia. CONCLUSION In view of the high prevalence of Bochdalek hernia in our study (10.5%), the multiplanar and reconstruction features of MDCT seem to facilitate the diagnosis of asymptomatic incidental Bochdalek hernia. No relationship was found between asymptomatic incidental Bochdalek hernia and age, gender, or BMI in adults.

Pulmonary alveolar proteinosis in a patient with acute lymphoid leukemia regression after G-CSF therapy.

Pulmonary alveolar proteinosis (PAP) is the intra-alveolar accumulation of periodic-acid schiff (PAS) positive material. PAP is one of the underrecognized causes of pulmonary infiltrates in patients with hematologic malignancies. Here, we present a patient with acute lymphoid leukemia (ALL) in first remission that developed fever and diffuse pulmonary infiltrates during the neutropenic stage of consolidation chemotherapy. The histopathologic examination of bronchoalveolar lavage (BAL) fluid and transbronchial biopsy specimen demonstrated the presence of PAS-positive eosinophilic material. Empirical antibiotherapy and granulocyte-colony stimulating factor (G-CSF) were given. After the correction of neutropenia with G-CSF, the patients fever disappeared, acute phase reactants decreased, pulmonary infiltrates resolved. We present this case because it was the first patient in whom the correction of neutropenia with G-CSF was followed by resolution of PAP.

Oncocytic Carcinoma of the Parotid Gland

Background: Oncocytic carcinoma is a rare tumor of major salivary glands. Despite being described 5 decades ago, not much is known about these rare tumors. Histochemical or electron microscopic confirmation of the oncocytic nature of the tumor cell is needed for differential diagnosis. The main treatment modality is surgery with or without adjuvant radiotherapy. Malignant oncocytomas have the potential risk of developing distant metastases and demand long term follow-up after therapy. Case Report: A 58-year old man presented with a recurrent mass in the left parotid gland with a prior diagnosis of monomorphic adenoma in the same localization which had been treated by tumor excision in July 2002. Left superficial parotidectomy followed by radiotherapy into tumor bed and upper neck were carried out in September 2004. To date, he has had no evidence of recurrence for 14 months. Conclusion: For an accurate approach in the management of patients, oncocytic adenocarcinoma should be considered in the differential diagnosis of lesions of the parotid gland, most of which are benign.

Stroke due to Bee Sting

Although bee stings can cause local reactions, neurovascular complications are rare. A 60-year-old man developed a focal neurologic deficit 2 hours after multiple bee stings, which was confirmed to be acute cerebral infarctions on magnetic resonance imaging scan.

Computed tomographic and magnetic resonance imaging findings of asymptomatic intra-abdominal gastrointestinal system lipomas.

Lipomas are common benign mesenchymal neoplasms documented in literature. This study aimed to describe the computed tomographic (CT) and magnetic resonance imaging (MRI) findings of gastrointestinal system lipomas, all of which are incidentally found in routine abdominal imaging studies. Lipomas were depicted as homogeneous, nonenhancing, well-marginated lesions consistent with adipose tissue on CT and MRI. The density measurements on CT images consistent with fat are virtually diagnostic. Lipomas can incidentally be found and should be considered in the differential diagnosis of soft tissue gastrointestinal system-related masses. Computed tomographic or MRI examinations can correctly diagnose a lipoma nonoperatively, thereby allowing better treatment planning.

Granulomatous hypophysitis: presentation and MRI appearance

Granulomatous hypophysitis (GrHy) is a relatively rare inflammatory disease compared with lymphocytic hypophysitis. Only a few cases with magnetic resonance imaging (MRI) findings have been reported to date. We describe the MRI findings for two patients with GrHy with unusual histories and clinical outcomes.

Postural tremor as a manifestation of spontaneous intracranial hypotension.

Spontaneous intracranial hypotension (SIH) is a syndrome caused by low cerebrospinal fluid (CSF) pressure due to leakage of CSF. Clinically, orthostatic headache, neck pain, nausea, emesis, interscapular pain, diplopia, dizziness, changes in hearing, visual blurring and radicular upper extremity symptoms are most frequently observed. We describe a 57-year-old man with SIH who presented with postural tremor. CSF leakage was revealed by cranial MRI. Lumbar puncture identified low CSF pressure and intrathecal gadolinium enhanced MR cisternography showed diffuse CSF leakage in the thoracolumbar region. The patient underwent epidural blood patching, which resulted in complete resolution of postural tremor within 2 months.

Bilateral extra-adrenal perirenal myelolipomas: CT features.

Myelolipomas are rare benign tumours composed of adipose tissue and haematopoietic cells that are typically found in adrenal glands but have also appeared in extra-adrenal sites. Distinguishing between extra-adrenal myelolipomas and malignant tumours, such as liposarcomas, is crucial to avoid an invasive procedure. To this end, we present a comprehensive report of the CT imaging characteristics of a pathologically proven bilateral extra-adrenal perirenal myelolipoma.