To determine the diagnostic values of magnetic resonance imaging and computed tomography and characteristics of the lesions in traumatic lesions of the corpus callosum.In 49 cases with traumatic lesions of the corpus callosum whose Glasgow Coma Scale (GCS) scores were 12 or under, presence and characteristics of the lesions of corpus callosum were evaluated retrospectively. All of the cases had both of MRI and CT scans at early posttraumatic periods.In 20 patients (40.8%) there were 31 lesions. There were lesions in only 7 of 20 patients that had lesions in MRI. Despite most of lesions (87%) were nonhemorrhagic in MRI, 3 of 7 lesions (42.8%) were nonhemorrhagic in CT. Lesions were limited to the splenium in 7 of 20 patients (35%). In other cases there were lesions at anterior regions of corpus callosum with or without splenial lesions. There were more lesions of brain stem and subcortical white matter in patients with corpus callosum trauma than ones without, but differences were not statistically significant.Traumatic lesions of the corpus callosum are frequently seen in moderate and severe head injury. Most of the lesions are nonhemorrhagic and localized in splenium. The diagnostic value of MRI is rather high than of CT in traumatic lesions of corpus callosum.
Testis tumors are extremely rare tumors, especially if they are bilateral, interstitial tumors. We present a case with bilateral Leydig cell tumors, which were detected incidentally. First, radical left orchiectomy was performed and pathologic diagnosis was Leydig cell tumor. One week later, partial right orchiectomy was done. The diagnosis was the same. After the 12-month follow-up, no recurrence or metastasis was detected. We suggest organ-sparing surgery as an alternative in the treatment of bilateral Leydig cell tumors especially for young males, since this surgical approach prevents hormonal replacement therapy and maintains fertility and potency.
(2004). Spontaneous Rupture of Mediastinal Cystic Teratoma with High Levels of Amylase, Lipase, CA 19‐9, CA 125 and CEA in Cystic Fluid: a Case Report. Acta Radiologica: Vol. 45, No. 1, pp. 111-112.
Teratomas are rare tumors in the mediastinum. Benign cystic teratomas of anterior mediastinum are rarely complicated by rupture into an adjacent body cavity. Such rupture, however, is usually associated with life-threatening complications. We present a case with spontaneous rupture of mediastinal cystic teratoma. The patient was evaluated with chest radiograph, computed tomography (CT) and magnetic resonance imaging (MRI). A complex mass including predominantly cystic components was detected in the left anterior mediastinum. After surgery, pathologic diagnosis was reported as mature cystic teratoma. High levels of amylase and lipase were detected in both the cystic fluid and serum. This finding supported the hypothesis of autolysis for the explanation of rupture. In addition, carbohydrate antigen (CA) 19-9, CA 125 and carcinoembryonic antigen (CEA) levels were high in the cystic fluid.
1693 Objectives: Lymphatic mapping with sentinel node biopsy is currently being used at most institutions for staging patients with cutaneous melanoma and breast cancer without the morbidity associated with elective lymph node dissection. Identification and subsequent surgical removal of occult metastases before the development of clinical disease may improve survival in these patients. Success in finding the sentinel node relies on the successful injection technique of the radiotracer. We evaluated whether a physician’s case experience with the sentinel node lymphoscintigraphy injection technique might affect the successful identification of the sentinel node(s) and the time it takes for the visualization. Methods: To achieve the required level of training for successful performance of sentinel lymph node scintigraphy, physicians who were not familiar with the test underwent systematic training for the injection technique used in sentinel node scintigraphy. They must demonstrate technical competence in its performance. The training protocol included reading an instruction manual and performance of two patient studies. A consecutive cohort of 68 patients during a 10-month period who had undergone sentinel lymph node localization and biopsy for cutaneous melanoma (n: 55) and breast cancer (n: 13) was retrospectively analyzed. Two areas were studied: success in finding the sentinel node(s) and the duration of the imaging in minutes needed for a successful localization. These parameters were compared for Group-1, the studies performed by an experienced nuclear medicine resident, and Group-2, rotating radiology residents. The statistical significance levels were determined. Results: Six radiology residents injected 35, and the 2 NM resident injected 20 patients with melanoma. The radiology residents injected 4/13 patients with breast cancer. The sentinel node(s) were successfully identified in 93% of the patients (63/68) studied. Of the 5 patients with non-visualized SLNs, 3 had melanoma and 2 had breast cancer. The radiology residents injected 3 of these 5 and the NMresidenst injected 2 of them. The mean ± SD SLNs visualization time in minutes was 23 ± 33 for the radiology residents, and 26 ± 31 minutes for the NM residents. The non-visualization rates and SLNs visualization time were not different between two groups, with p values of 0.66 and 0.61 respectively. Conclusions: Sentinel node lymphoscintigraphy has a high localization rate, which can be achieved with basic training of the physicians performing the tests. The number of patients previously studied does not affect the physician’s ability to visualize the sentinel node or the time that it takes for the SLN localization.
Primary central nervous system lymphoma (PCNSL) is a rare form of non-Hodgkins lymphoma of the central nervous system and eye. It is over 1000 times greater in HIV positive than in non-HIV populations. The decline in its incidence since the introduction of the highly active anti-retroviral therapy (HAART) suggests an association of this tumor with severe and prolonged immunosuppression. Clinical presentation results from neurological deficits related to the site of the tumor. Systemic B symptoms are also common. The detection of EBV DNA from the CSF, by nested PCR, is a highly sensitive and specific for HIV-related PCNSL. We present the case of a 31-yearold African American man with medical history significant for AIDS who presented with one-month history of lack of energy and somnolence. CSF appearance was normal. MRI suggested primary CNS lymphomas or toxoplasmosis. CSF EBV DNA by PCR was found to be positive. The clinical presentation of PCNSL is similar to that of toxoplasmosis encephalitis in patients diagnosed with HIV. The initial differentiation between the two pathologies on presentation is important since treatment differs and early treatment has been shown to reduce mortality.
The knee is the most frequently injured joint that physical examination and plain radiographies are limited to diagnose precisely the knee injuries. Magnetic resonance imaging (MRI) has been contributed great benefits to the accurate diagnosis by determining the injuries of menisci and ligaments in addition to bone structures. We evaluated MRI findings in traumatic knees and compare them to literature.The patients with the knee injury who were admitted to orthopedic surgery service were reviewed. Of them, 49 patients (50 knees) correlated operatively, arthroscopically and clinically were included in our study population. If the diagnosis was not sufficient by using plain films and clinical evaluation, the patients underwent MRI examination.Bone contusions were the most common finding in the injuries (n:33). The other findings were respectively, the anterior cruciate ligament injuries in 17 patients, meniscal tears in 12 patients, osteochondral fractures in 9 patients, collateral ligament injuries in 7 patients and bone fractures in 5 patients.MR imaging-plays a major role in decisions on evaluation and management of traumatic knees, improves clinician diagnostic certainty and reduces the need for arthroscopy.
