Toru Maeda

Evaluation of microscopic tumor extension in early-stage cervical cancer: quantifying subclinical uncertainties by pathological and magnetic resonance imaging findings

We performed a detailed analysis of hysterectomy specimens of uterine cervical cancer to determine the appropriate length of uterine body to include within the clinical target volume. Between 2008 and 2011, 54 patients with uterine cervical carcinoma underwent hysterectomy. Those with quality pre-operative magnetic resonance imaging (MRI) data were included for analysis. Tumor sizes measured by MRI and microscopy were compared with regard to brachytherapy-oriented parameters. Detailed descriptive analysis focusing on the extent of tumor involvement was also performed. A total of 31 specimens were analyzed. The median maximal tumor length measured by MRI was slightly shorter than microscopic length (19 vs. 24 mm, respectively), while the maximal radius was almost identical. No tumors with a maximal size <2 cm by MRI (n = 6) extended to the uterine body ≥ 1/3. The majority of maximal tumor length underestimation on MRI was within 1 cm. Precise tumor delineation can be made by MRI. For patients with tumors <2 cm on MRI, treating the entire uterine body length may not be necessary. A 1-cm margin around an MRI-based gross tumor seems to be adequate to cover the actual tumor involvement.

The scab-like sign: A CT finding indicative of haemoptysis in patients with chronic pulmonary aspergillosis?

ObjectivesThe aim of this study was to assess the CT findings that characterise haemoptysis in patients with chronic pulmonary aspergillosis (CPA).MethodsWe retrospectively identified 120 consecutive patients with CPA (84 men and 36 women, 17–89 years of age, mean age 68.4 years) who had undergone a total of 829 CT examinations between January 2007 and February 2017. In the 11 patients who underwent surgical resection, CT images were compared with the pathological results.ResultsThe scab-like sign was seen on 142 of the 829 CT scans, specifically, in 87 of the 90 CT scans for haemoptysis and in 55 of the 739 CT scans obtained during therapy evaluation. In 48 of those 55 patients, haemoptysis occurred within 55 days (mean 12.0 days) after the CT scan. In the 687 CT scans with no scab-like sign, there were only three instances of subsequent haemoptysis in the respective patients over the following 6 months. Patients with and without scab-like sign differed significantly in the frequency of haemoptysis occurring after a CT scan (p<0.0001). Pathologically, the scab-like sign corresponded to a fibrinopurulent mass or blood crust.ConclusionsThe scab-like sign should be considered as a CT finding indicative of haemoptysis.Key Points• Haemoptysis is commonly found in patients with CPA.• A CT finding indicative of haemoptysis in CPA patients is described.• Scab-like sign may identify CPA patients at higher risk of haemoptysis.

A Case of Diffuse Alveolar Septal Amyloidosis Associated With Multiple Myeloma.

Primary amyloidosis (amyloid light-chain amyloidosis [AL amyloidosis]) is a rare condition characterized by extracellular deposition of amyloid protein comprising immunoglobulin light chain in multiple organs. Clinically evident AL amyloidosis develops during the disease course in 10% to 15% of patients with multiple myeloma.1 Thoracic manifestations of amyloidosis have 3 patterns: tracheobronchial, nodular, and diffuse alveolar septal. The diffuse alveolar septal pattern is the least common type of pulmonary amyloidosis.2 This pattern is sometimes seen in patients with multiple myeloma and is associated with a poor prognosis. We report a case involving a patient with diffuse alveolar septal amyloidosis associated with multiple myeloma. High-resolution computed tomography (HRCT) showed ground-glass opacity (GGO), interlobular septal thickening, and intralobular reticular opacity in both lungs.