Hiroya Ojiri

Primary staging of laryngeal and hypopharyngeal cancer: CT, MR imaging and dual-energy CT

Laryngeal and hypopharyngeal cancer, in particular T4a disease associated with cartilage invasion and extralaryngeal spread, needs to be evaluated accurately because treatment can impact heavily on a patients quality of life. Reliable imaging tools are therefore indispensible. CT offers high spatial and temporal resolution and remains the preferred imaging modality. Although cartilage invasion can be diagnosed with acceptable accuracy by applying defined criteria for combinations of erosion, lysis and transmural extralaryngeal spread, iodine-enhanced tumors and non-ossified cartilage are sometimes difficult to distinguish. MR offers high contrast resolution for images without motion artifacts, although inflammatory changes in cartilage sometimes resemble cartilage invasion. With dual-energy CT, combined iodine overlay images and weighted average images can be used for evaluation of cartilage invasion, since iodine enhancement is evident in tumor tissue but not in cartilage. Extralaryngeal spread can be evaluated from CT, MR or dual-energy CT images and the routes of tumor spread into the extralaryngeal soft tissue must be considered; (1) via the thyrohyoid membrane along the superior laryngeal neurovascular bundle, (2) via the inferior pharyngeal constrictor muscle, and (3) via the cricothyroid membrane. Radiologists need to understand the advantages and limitations of each imaging modality for staging of laryngeal and hypopharyngeal cancer.

Preoperative magnetic resonance imaging for localization of the origin of maxillary sinus inverted papillomas

PURPOSE It is essential to precisely localize the origin of an inverted papilloma within the maxillary sinus by preoperative imaging so that the lesion can be excised as thoroughly as possible. In the present study, we evaluated the use of preoperative magnetic resonance imaging (MRI) for pinpoint localization of the origin of inverted papillomas. MATERIALS AND METHODS The subjects were patients with an inverted papilloma of the maxillary sinus. Given the known histopathological features and pattern of growth of this tumor, we obtained preoperative MRIs in an attempt to localize its origin. RESULTS When different interpretation methods were applied to the preoperative MRIs, there was up to an 85.7% correlation with the surgical results for localization of the tumor origin. CONCLUSIONS We were able to demonstrate a high rate of agreement between diagnostic imaging and the actual surgical findings in identification of the origin of inverted papillomas.

Odontogenic cutaneous fistula mimicking malignancy

It is important for the dentists to make accurate diagnosis and appropriate treatment of odontogenic cutaneous fistula. Although large facial skin lesions may bring up malignancy on top of the differential list, careful evaluation including physical observation, imaging, and pathology can rule out malignancies.

Surfer's ear

Exostosis in external auditory canal is common among surfers. Common symptoms are decreased hearing or loss of hearing, ear infection, and/or plugging sensation. Repeated exposure to cold water is a key clinical history to suspect this condition. Based on symptoms and existence of infection, surgical removal of the exostosis is recommended.

SAPHO syndrome with mandibular manifestation.

A 47-year-old man was referred to our hospital due to symptoms of trismus and exacerbation of palmoplantar pustulosis. He had been presenting, for 20 years, with refractory and recurrent mandibular osteomyelitis accompanied by palmoplantar pustulosis and anterior chest pain—symptomatic treatment and surgery had been given at each presentation. When the mandibular lesion got worse this time, he also had anterior chest pain. He had experienced similar episodes before this event. MRI (STIR: short tau inversion recovery) showed high signal intensity in the right ramus of the mandible, with perilesional soft tissue swelling …

A rare solitary fibrous tumor in the ischiorectal fossa: a case report

BackgroundA solitary fibrous tumor (SFT) is a rare mesenchymal tumor that occurs mostly in pleural sites, and an SFT occurring in the ischiorectal fossa is extremely rare. Because of the rarity, there are few reports detailing an SFT in the ischiorectal fossa.Case presentationA pararectal tumor was incidentally found in a 42-year-old man during a routine medical examination. The patient had no symptoms and no previous medical history. In the physical examination, a smooth-margined and hard elastic mass was felt, and in a digital rectal examination, the rectal mucosa appeared normal. A computed tomography (CT) scan showed a 5-cm, well-defined, solid mass in the left ischiorectal fossa. Contrast-enhanced CT in the early phase showed intense heterogeneous enhancement that persisted during the delayed phase. T2-weighted images of magnetic resonance imaging yielded heterogeneous intermediate and low signal intensity. Intense arterial enhancement suggested a hypervascular nature, and persistent delayed enhancement and low signal bands on T2-weighted images suggested a fibrous component of the mass. An SFT was suspected. Most SFTs are benign but have malignant potential. Our patient did not hope for surgery if the tumor was benign; therefore, an ultrasound-guided transperineal core needle biopsy was performed to decide on a treatment strategy. Microscopic examination showed tumor cells appearing as spindle and fibroblast-like cells within a collagenous stroma. Immunohistochemistry identified CD34 and vimentin, supporting the diagnosis of an SFT. The patient consented to excision of the mass. He was placed in a prone jackknife position, and the tumor was removed transperineally using a posterior approach (modified Kraske procedure). The levator ani muscle, external sphincter muscles, and rectum were not involved and separated from the tumor. The tumor was successfully resected en bloc with no complications. Five uneventful days post surgery, the patient was discharged. There was no local recurrence during the year following surgery.ConclusionImaging findings reflect the tissue characterization such as hypervascularity and fibrous nature of SFTs. We have presented a rare case of an SFT in the ischiorectal fossa with useful imaging findings for diagnosis, treatment strategy, and successful surgical removal using a posterior approach.

Hepatic sarcoidosis with atypical radiological manifestations: A case report

Sarcoidosis is a multisystemic inflammatory disease of unknown origin characterized by the formation of noncaseating granulomas and accumulation of inflammatory cells. Sarcoidosis most commonly affects the lungs and lymphoid system. However, the liver can also be involved in 50%-65% of cases. On magnetic resonance imaging, sarcoidosis lesions usually present as hypointense lesions on all sequences. However, we present a rare case of nodular liver sarcoidosis presenting with T2 hyperintense lesions. In addition, while most cases of hepatic nodular sarcoidosis present with multiple small hepatic nodules, liver masses of our case are larger than usual. Moreover, this case suggested that when intact vascular structures penetrating liver nodular lesions are observed as in the current case, liver sarcoidosis can be included in a list of differential diagnosis.

Variceal bleeding in the small intestine successfully treated with balloon-occluded retrograde transvenous obliteration using N-butyl-2-cyanoacrylate: A case report

Rupture of small intestinal varices associated with portal hypertension can be a serious condition that is difficult to diagnose early and to manage. Moreover, optimal guidelines for the treatment of small intestinal varices have not yet been established. We herein report a case of a 73-year-old man with small intestinal varices. The man presented with bleeding from a stoma in the small intestine, which subsequently led to hemorrhagic shock. We successfully treated the patient with balloon-occluded retrograde transvenous obliteration via the right inferior epigastric vein using N-butyl-2-cyanoacrylate.

Schwannoma assumedly originating from the submandibular ganglion or glandular branches radiologically mimicking a submandibular gland tumor

Schwannoma is a benign nerve sheath tumor composed of Schwann cells. Schwannomas originating from ganglia are rare, and schwannomas of the submandibular ganglion or glandular branches have not been reported to date. We present a case of a Japanese woman in her sixties with a submandibular schwannoma originating from the submandibular ganglion, mimicking a submandibular gland tumor on radiological findings. As the radiological findings were nonspecific, the key finding in the present case may be the characteristic location of the tumor suspended from the undersurface of the lingual nerve and situated above the deep portion of the submandibular gland.

Clinical impact of the Sherlock 3CG® Tip Confirmation System for peripherally inserted central catheters

Objective This study was performed to evaluate the technical success rate and catheter tip malposition rate of peripherally inserted central catheter (PICC) placement using the Sherlock 3CG® Tip Confirmation System (TCS). Methods In total, 114 patients who underwent PICC insertion via the Sherlock 3CG® TCS from October 2017 to February 2018 were retrospectively evaluated. The primary endpoints were the technical success rate, malposition rate, and mean procedure time. The secondary endpoints were the sex-related difference in the malposition rate, radiologist’s experience level, and side of insertion. Technical success was defined as procedure completion using only the Sherlock 3CG® TCS without a guidewire or fluoroscopy guidance. In accordance with the North American guidelines, an adequate position was defined as the lower third of the superior vena cava and the cavoatrial junction. Results The technical success rate was 97% (111/114). The malposition rate was 16% (18/111), and four catheters were repositioned. There were no significant differences in the malposition rate between the sexes, radiologist’s level of experience, or side of insertion. Conclusions PICC placement using the Sherlock 3CG® TCS yielded a high technical success rate and low catheter tip malposition rate regardless of the radiologist’s level of experience or side of insertion.