Tsuyoshi Itoh

Septum-like structures in lipoma and liposarcoma: MR imaging and pathologic correlation

ObjectiveTo investigate the septum-like structures in pre-dominantly lipomatous tumors, by correlating fat-suppressed MR images with histopathologic findings.Design and patientsThe MR findings of three cases of well-differentiated liposarcoma (atypical lipoma), one case of lipoma-like component of dedifferentiated liposarcoma, and nine cases of lipoma were analyzed. T1-, T2-, and fat-suppressed T1-weighted images after Gd-DTPA administration were obtained. Surgical specimens from five patients (four with liposarcoma and one with lipoma) were also scanned with a MR unit, and compared with the pathologic findings.Results and conclusionsEnhancement features of lipoma and liposarcoma were well visualized on fat-suppressed T1-weighted images after Gd-DTPA administration. The septum-like structures of liposarcoma are thick and enhanced considerably, while septa of lipoma are thin and enhanced only slightly. Pathologically, the septum-like structures of liposarcoma contained muscle fibers and the septa of lipoma represented fibrous capsule. Identification of well-enhanced septa in a predominantly lipomatous tumor helps to differentiate malignant tumors from lipomas. As the septum-like structures of lipo-sarcoma contain a skeletal muscle component the tumor might need more extensive surgical procedures including resection of adjacent muscles.

Pancreatic Cavernous Hemangioma: CT, MRI, US, and Angiography Characteristics

A large pancreatic cavernous hemangioma was found in a 30-year-old man with abdominal distention. Plain and contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US), and angiography were performed prior to operation. Contrast-enhanced CT and angiography showed a large poorly enhanced hypovascular tumor at the head of the pancreas. But MRI and US disclosed findings compatible with a cavernous hemangioma.

Diagnostic imaging of idiopathic adult respiratory distress syndrome (ARDS)/diffuse alveolar damage (DAD) histopathological correlation with radiological imaging

In ten patients with idiopathic adult respiratory distress syndrome (ARDS) who had histopathologically diffuse alveolar damage (DAD), and who did not have specific underlying diseases, we compared the histopathological findings with their radiographic images in order to study the detail analysis of radiographic images and the clinical courses. These patients were roughly classified as having the interstitial pneumonia dominant type (type IP) of idiopathic ARDS, in which alveolar septal thickening, alveolitis, or both were the predominant histological findings and images showed increasing attenuation of lung fields with small honeycomb lung, or the organizing pneumonia dominant type (type OP), in which organizing exudate predominantly filled the alveoli histologically and images showed consolidation shadows with some air. Hyaline membrane was seen very frequently in patients with a short clinical course, and in accordance with a longer clinical course, widespread fibrosis and honeycomb lung covered by organizing hyaline membrane was seen with both types. Patients with type OP in whom collapse of the normal pulmonary structure was less and for whom changes on radiographic images were larger seemed to respond relatively favorably to steroid treatment, as judged from pulmonary function and radiographic images.

Primary retroperitoneal plasmacytoma with tumor thrombus within the renal vein

A case of primary retroperitoneal plasmacytoma causing a tumor thrombus within the renal vein is described. The use of radiographic techniques, including ultrasonography, computerized tomography and angiography, facilitated an accurate diagnosis. Tumor thrombi within the renal vein are rare except in cases of primary renal or adrenal neoplasms. In a patient with radiological evidence of retroperitoneal tumor and tumor thrombus within the renal vein plasmacytoma should be considered in the differential diagnosis of retroperitoneal neoplasms.

Duct ectasia due to mucus-producing cancers with intraductal extension: histopathologic correlation with radiologic imagings

BackgroundAlthough duct ectasia due to mucus-producing pancreatic cancer has been well known, its occurrence in other organs has not been reported. We have studied the pathologic basis of the radiologic features in cases of mucus-producing cancer with intraductal extension.MethodsWe conducted a comparative study of detailed various radiographic images and pathological findings in 10 cases of mucus-producing cancers (four of mucusproducing pancreatic cancer, two of mucinous gastric cancer with diffuse lymphangitic liver metastasis, and four cases of bronchoalveolar cell carcinoma with cyst or cavity).ResultsWhen mucus-producing cancer occurs in a secretory duct or extends into lymphatic ducts, the normal duct is dilated due to the mucus and increased internal pressure, leading to the formation of a cyst and cavity. Because of having the liquid property of mucus floating cancer cells, the lesion can easily progress to continuous ducts as well as regionally.ConclusionsIn cases of mucus-producing cancer with extension into the ductal structure not only in the pancreas but also in the lung and liver, continuous duct ectasis and cysts filled with mucus or cavities of all sizes made by the nature of the mucus may be detected by CT and US.

Periduodenal panniculitis due to spontaneous rupture of a pancreatic pseudocyst into the duodenum

We report a patient with transient periduodenal panniculitis due to spontaneous rupture of a pancreatic pseudocyst into the duodenum. He developed sudden onset of severe epigastric and back pain with jaundice, mimicking the symptoms of acute pancreatitis. However, the serum and urinary amylase levels did not increase. CT scans showed disappearance of his pseudocyst and periduodenal panniculitis without any evidence of acute pancreatitis. The CT findings of periduodenal panniculitis and his symptoms both improved within 3 weeks. A duodenal fistula leading to the remnant pseudocyst and narrowing of the periduodenal portion of the common bile duct were demonstrated by endoscopic retrograde cholangiopancreatography.

Detection of intrarenal venous invasions of malignant renal neoplasms by retrograde renal venography

The purpose of this study was to detect intrarenal venous invasion of malignant renal neoplasms not detected by other methods, with retrograde renal venography using a renal artery obstructing balloon. By this method, we studied 21 patients with malignant renal neoplasms, and clearly demonstrated the intrarenal branches up to the interlobar veins in all of these cases without any complications. This method detected small intrarenal venous lesions in three cases of renal cell carcinoma.

The Endoscopy-Guided Plan of Radiotherapy for Detecting Esophageal Cancer Using Lugol Staining

Abstract: The Lugol staining method has recently come to play an important role in the detection of superficial esophageal cancers which are extremely difficult to detect using only a barium double‐contrasted esophagogram and/or a conventional esophagoscopy. We have therefore tested the endoscopy‐guided treatment by radiotherapy using Lugol stainings as a technique for detecting 8 lesions of esophageal cancers in 5 patients.