J L Buck

Primary non-Hodgkin's splenic lymphoma

OBJECTIVES To describe the imaging, clinical and pathological features of primary splenic lymphoma using a strict definition. METHODS Of 21 cases, plain films were available in nine, sonograms in 10 and CT in 16. We categorized the spleen as either normal, enlarged with no focal defects (type 1), studded with miliary masses (type 2), containing multifocal masses of varying size (1-10 cm) (type 3) or containing a solitary large mass >5 cm without (type 4A) or with (type 4B) central hypodensity/anechoic areas. RESULTS Clinical presentations were left upper quadrant pain, weight loss and/or fever. One case was found incidentally on CT. Fourteen were type 4A, three type 4B, four type 3 and none were type 1 or 2. Nine of 10 cases were hypoechoic. In 11/12 cases with enhanced scans, the lesions are hypodense relative to the splenic parenchyma, and in one case, the lesion was necrotic. Rim enhancement was seen in one case. CONCLUSION Primary splenic lymphoma usually presents as a mass or masses rather than with splenomegaly alone. Splenectomy may be required for diagnosis.

Intussuscepted colonic lipomas: loss of fat attenuation on CT with pathologic correlation in 10 cases

Abstract.Background: To determine if infarction and necrosis is the cause of the confusing soft tissue density on CT within intussuscepting lipomas of the colon. Methods: The clinical records, radiologic examinations, and pathologic specimens of all 13 cases of colonic lipomas collected from 1988 to 1994 studied by CT and surgically resected were retrospectively reviewed. Ten of these cases were associated with intussusception; the CT attenuation of the lead point was graded according to its relative fat/soft tissue density. Pathologic specimens were graded independently by a GI pathologist and graded according to the degree of infarction/fat necrosis. Results: The lipomas ranged from 4 to 7 cm in diameter (mean = 5 cm). Only one case with intussusception, and all three cases without, demonstrated pure fat attenuation on CT and demonstrated pure fat histologically. One case demonstrated soft tissue attenuation and corresponded with the most severely infarcted specimen histologically; two cases with similar but less severe infarction/fat necrosis corresponded with less than 25% fat attenuation. These latter three cases were originally misinterpreted as malignancies rather than lipomas. Six cases maintained greater than 50% fat density and intermediate amounts of infarction/fat necrosis. Conclusion: Lipomas may have an atypical appearance when intussuscepted due to varying degrees of infarction/fat necrosis.

Encapsulated Hepatocellular Carcinoma: Radiologic Findings and Pathologic Correlation

The encapsulated form of hepatocellular carcinoma (HCC) is a pathologic subtype that has been found to occur with variable frequency in typical HCC in Japanese radiological, surgical, and autopsy series. It is a well-differentiated tumor that tends to grow slowly and noninvasively, and has a better prognosis than other gross forms of HCC.Among the 73 cases of typical HCC in patients of non-Asian extraction in our files, 11 could be positively identified as encapsulated based on strict pathological criteria. The purpose of this study was to review the radiographic appearance of these encapsulated tumors.Radiographically, the tumors demonstrated a hyperdense rim in 5 of 9 cases with postinfusion computed tomography scans, an anechoic halo in 4 of 6 cases with ultrasonograms, and an avascular rim on the capillary phase in 5 of the 8 cases with angiograms.Encapsulated HCC can be found in non-Asian patients, and the radiographic and pathologic findings are similar to the descriptions in the Japanese series.

Peritoneal mesothelioma : radiologic appearances correlated with histology

Previous imaging reports of peritoneal mesothelioma have described a variety of radiologic appearances, but have not included its pathologic classification. We retrospectively reviewed 10 cases of peritoneal mesothelioma representing the following histologic categories: 7 epithelial, 2 sarcomatoid, and one biphasic. By imaging, epithelial mesotheliomas demonstrated diffuse thickening of the peritoneum and mesentery and/or multiple small nodules. The sarcomatoid-type appeared as a mass and the biphasic-type had radiologic and gross pathologic features of both sarcomatoid and epithelial types. We conclude that peritoneal mesothelioma presents with a wide spectrum of radiographic appearances and should therefore be included in the differential diagnoses of diffuse as well as localized peritoneal processes.

Cronkhite-Canada Syndrome: Radiologic Features

We report 6 cases of Cronkhite-Canada syndrome, analyze the patterns of involvement, and review the literature on this entity. There were 4 women and 2 men, with an average age of 58 years. The stomach was diseased diffusely in 5 and focally (distally) in 1. Small bowel polyps were detected in 4 patients. Patterns of involvement were classified as (a) innumerable small polyps carpeting large areas, (b) scattered varying-size polyps, and (c) sparse involvement with few small polyps. There was concordance of patterns between the stomach and colon in 5 of the 6 patients.

Tumors of the esophagus

A REASONABLE approach for the differential diagnosis of esophageal tumors is to classify these lesions as mucosal and mural masses, and this report will be organized along these lines (Table 1). Both benign and malignant lesions in each category will be discussed. Although this approach is time honored and practical, it is important to recognize that radiographic differentiation between mural and mucosal lesions is not always possible. In most cases, endoscopy and biopsy are required for the definitive diagnosis of esophageal tumors.