Herman I. Libshitz

Cerebral radiation necrosis following treatment of extracranial malignancies

Nine patients with cerebral radiation necrosis following radiation therapy for extracranial neoplasms were seen at MD Anderson Hospital between 1956 and 1982. The diagnosis was confirmed at autopsy in one case, by surgical intervention in six cases, and strongly suspected based upon CT scan findings and radiation records in two cases. The world literature is reviewed, and diagnostic criteria using the CT scan and radiation doses presented.

Mediastinal extragonadal germ cell tumors

Mediastinal germ cell tumors are a rare primary malignancy. An overview of the presenting clinical symptoms, radiographic appearance, patterns of extention and metastasis, and autopsy findings are presented. The difficulty in totally excluding an occult gonadal primary lesion in noted. The theories of the genesis of these tumors are briefly reviewed.

Radiographic evaluation of therapeutic response in bony metastases of breast cancer

Response to chemotherapy was evaluated in 50 previously untreated patients with bony metastases of breast cancer. Lytic metastases respond in a definite sequence: sclerotic rim, filling-in, uniformly blastic, uniform fading. Increase in size of lytic areas or destruction in previously responding areas signals worsening. Mixed metastases are considered as beginning with a sclerotic rim. Response is otherwise similar. Particular attention is paid to the lytic areas. Blastic metastases are considered as beginning at the uniformly blastic stage. Progression is marked by a volumetric increase in blastic change or destruction in blastic regions. Change occurs slowly. Review of multiple studies is often necessary to reach the correct conclusion and clinical history is necessary.

Slipped proximal humeral epiphysis: A complication of radiotherapy to the shoulder in children

Slipped proximal humeral epiphyses as a sequela of radiotherapy were identified in two children treated for Ewings sarcoma in whom the shoulder was included in the field of treatment. The radiation doses were slightly greater than those in children developing slipped capital femoral epiphyses following radiotherapy. The lesser stress about the shoulder compared to the hip is believed to be the reason this is an infrequent complication of radiotherapy.

Malignant pleural mesothelioma: The role of computed tomography

Computed tomography is believed to have a definite role in the evaluation of malignant pleural mesothelioma based on a review of computed tomography findings in 23 of our patients and previous reports. Twelve patients had a single computed tomography examination, and 11 had two or more studies. Computed tomography permits better appreciation of the extent of the tumor. This permits appropriate selection of therapy and may demonstrate that surgery or radiotherapy is not indicated. computed tomography often permits more accurate evaluation following chemotherapy and may be the only means by which to follow a patient after radical surgery. Computed tomography also has a role in differential diagnosis. It facilitates distinction of malignant pleural mesothelioma from rounded atelectasis, pleural changes of asbestosis, and pleural involvement with lymphoma and thymoma. It aids, but may not be diagnostic, in separating malignant pleural mesothelioma from metastases to the pleura.

Cardiophrenic angle nodes: An unusual CT finding of advanced metastatic disease

Computed tomography (CT) is increasingly being used in the chest and mediastinum. In the mediastinum it is used to distinguish benign from malignant lesions, such as metastatic nodes from benign mediastinal fat deposits (1, 2). These abnormalities are usually first seen on a routine chest film. However, nodal enlargement involving the cardiophrenic angle nodes may or may not be seen on routine chest roentgenograms, depending on the size and location of the lesion. The purpose of this report is to demonstrate the CT findings of advanced metastatic disease involving the cardiophrenic angle nodes. The possible clinical significance of these findings is discussed.

Renal pseudoenlargement in patients with neoplasms

Renal pseudoenlargement due to compression of the kidneys by adjacent enlarged viscera and/or soft tissue masses is an important entity to consider in patients with known primary neoplasm, especially leukemia and lymphoma, who demonstrate enlarged kidneys on urography. This benign condition and its radiographic differentiation from infiltrative renal disorders will be discussed.