Jerry Chin Wei Chien

Malignant transformation of an ovarian mature cystic teratoma: Computed tomography findings

IntroductionThe malignant transformation of an ovarian mature cystic teratoma is rare. We presented such a case of a 46-year-old woman with characteristic computed tomography (CT) findings.Case report The patient had suffered from fullness and tenderness of the lower abdomen for one year. A high serum CA-125 level was noted. Computed tomography images showed a left adnexal mass with fat, calcification and soft tissue components, and areas of invasion through the teratoma wall.OutcomeThe histologic diagnosis was compatible with a squamous cell carcinoma arising from a mature cystic teratoma of the ovary.

Inflammatory pseudotumor of the spleen: CT and MRI findings.

We report the CT and MRI findings of an inflammatory pseudotumour of the spleen, which is an extremely rare benign inflammatory lesion. CT scans obtained 1 h after contrast administration and T2-weighted MRI images clearly demonstrated the central fibrosis and peripheral granuloma of this lesion.Inflammatory pseudotumors rarely occur in the spleen. We report such a case with characteristic computed tomography (CT) and magnetic resonance imaging (MRI) findings. A CT scan showed an isodense nodular mass with gradual mild enhancement on delayed-phase contrast-enhanced images. MRI showed a mass with isointense signal on T1-weighted images and hypointense signal on T2-weighted images. The tumor mass showed progressive inhomogeneous enhancement on gadolinium-enhanced images. The patient received splenectomy, and histologic diagnosis was compatible with inflammatory pseudotumor.

MRI of epidermoid cyst of the conus medullaris

Study design:A case report of an epidermoid cyst in the conus medullaris with characteristic magnetic resonance imaging (MRI) findings.Objective:To describe an epidermoid cyst in the conus medullaris with characteristic MRI findings and point out these findings that correlated well with histologic findings.Setting:Taiwan.Case report:A 49-year-old man who suffered from pain and weakness in his right leg for 16 years. MRI showed a heterogeneous signal mass in the conus medullaris. The hyperintense signal area within the lesion may be attributed to the keratin content, whereas the hypointense signal area was related to calcification and soft-tissue component. The histologic findings were compatible with an epidermoid cyst.Conclusion:Epidermoid cysts in the conus medullaris must be considered in the differential diagnosis of mass lesions with long duration of related symptoms. The characteristic MRI findings are useful to differentiate epidermoid cysts from other tumors.

Follicular dendritic cell sarcoma of the omentum: multidetector computed tomography findings.

We report computed tomography (CT) findings for a rare case of follicular dendritic cell sarcoma of the greater omentum from a 47-year-old female patient. The tumor presented ash a palpable mass lesion in the umbilical region for the last two months. Multidetector CT scan of the abdomen showed a 14-cm soft-tissue mass with calcification and necrosis within the greater omentum. As a result, a follicular dendritic cell sarcoma should be considered in the differential diagnosis of a solitary omentum mass, especially one with coarse and chunk-like calcifications.

Case 210: Primary Ovarian Lymphoma

History A 45-year-old woman presented with a 4-day history of abdominal discomfort, nausea, and vomiting and a 1-month history of poor appetite and weight loss. Her white blood cell count was normal. Physical examination revealed a palpable mass in the abdominopelvic region. Her cancer antigen (CA) 125 level was 1366 U/mL. No history of malignancy had been noted previously. The patient underwent abdominopelvic computed tomography (CT) (Fig 1). There was no other mass lesion at any other site in this patient.

Bilateral spontaneous peripelvic urinary extravasation

An 82-year-old man was admitted because of recurrent swelling, local erythema, itch, desquamation, and ulcer in both legs for 2 years. He reported having no systemic disease. Physical examination revealed multiple healed wounds with eschar on his lower legs. With a provisional diagnosis of frequent recurrent cellulitis and to rule out occult venous deficiency, he had venography with 55 ml contrast medium injection, followed by computed tomography (CT) with a catheter placed in the iliac vein and 115 ml contrast medium administration to demonstrate the relationships of veins and arteries. An incidental finding of bilateral peripelvic extravasation of urine from the kidneys was noted (Figure 1). The distended urinary bladder and enlarged prostate were demonstrated by CT. On the right side the contrast medium leaked from the renal calix and on the left side from the renal pelvis (Figure 2). The CT image showed no stones in bilateral ureters and no mass lesions in the abdomen. The enlarged prostate causing urinary outlet obstruction and rapid increasing fluid volume induced bilateral peripelvic extravasation of urine. The patient felt mild flank pain in the meantime. A Foley catheter was inserted immediately and more than 1000 ml urine was collected. No fever or leukocytosis in the urine was noted over the following days. The patient was treated with observation and supportive treatment. No specific symptoms and no more flank pain were noted, and he was discharged uneventfully. The patient was then transferred to the urology clinic and received transurethral resection of prostate 2 months later.