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PMC4204450_01_fonc-04-00268-g002.jpg
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(A) Cumulative dose volume histograms (DVHs) of PTV and critical structures showing from left to right, PTV (red), brainstem (green), optic chiasm (yellow), and left optic nerve (blue). (B) SBRT DVHs for the corresponding structures shown in (A). According to the TG 101 SBRT tolerance for the brainstem is a maximum point dose of 25 Gy in five fractions and <5 cc of the brainstem receiving 6.6 Gy/fraction. The tolerance for the optic pathways is a maximum point dose of 25 Gy in five fractions.
At a median follow-up of 29 months (range 12-120 months) for all patients and 43 months for surviving patients (range 12-120 months), actuarial LRC, distant control (DC), PFS, and OS were 88, 81, 68, and 79%, respectively (Table 2, Figure 2).
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Survival outcomes at a median follow-up of 29 months for all patients and 37 months for surviving patients. (A) Locoregional control. (B) Distant control. (C) Progression-free survival. (D) Overall survival.
A summary of survival outcomes is shown in Table 2 and Figure 3.
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MRI on days 14, 50 and 71. A) MRI on day 14 shows a DWI hyperintense spot in the posterior horn of the left lateral ventricle (arrow). B) The lesion is iso-intense on ADC. C) On FLAIR, a hyperintense lesion is apparent in the white matter adjacent to the posterior horn of the left lateral ventricle (arrow). D, G) DWI on days 50 and 71 reveals gradual deterioration of ventriculitis (arrows). E, H) ADC mapping, the area of the DWI-hyperintense lesion appears partially hypointense (arrows). F, I) Spread of the FLAIR-hyperintense lesion in the white matter adjacent to the ventricles (arrows).
On magnetic resonance imaging (MRI) performed on day 14, diffusion-weighted imaging (DWI) revealed a high-intensity spot in the posterior horn of the left lateral ventricle of the brain (Fig. 2A), implying ventriculitis. However, this region appeared iso-intense on apparent diffusion coefficient (ADC) mapping (Fig. 2B). On fluid-attenuated inversion recovery (FLAIR) imaging, a high-intensity lesion was detected in the white matter adjacent to the posterior horn of the left lateral ventricle (Fig. 2C). DWI on days 50 and 71 revealed exacerbation of the ventriculitis (Fig. 2D and G) and partial ADC hypointensity (Fig. 2E and H). Spread of a hyperintense region was evident in the white matter adjacent to both lateral ventricles on FLAIR imaging (Fig. 2F and I). MRI on day 71 showed the ventriculitis and hyperintense lesion in the white matter adjacent to both lateral ventricles on FLAIR imaging had become more severe (Fig. 2D-F).
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Autopsy findings. A) Yellowish pus is seen flowing from a ventricle (arrow). B) Gram staining of pus from the ventricle reveals a delicate, branching, filamentous organism. C) Pus is scattered throughout the basal cistern and pontomedullary cistern (arrows). D) In formalin-fixed brain sections, both lateral ventricles are full of pus (arrows). E) Magnification of the outlined square in D shows some small abscesses in the cerebral white matter (arrows).
On opening the cranium, yellowish pus flowed from the left ventricle (Fig. 3A). This pus was not malodorous, and Gram staining revealed a delicate, branching, filamentous organism (Fig. 3B). Pus was observed throughout the basal cistern and pontomedullary cistern (Fig. 3C). In formalin-fixed sections of brain, both lateral ventricles were filled with pus (Fig. 3D) and some small abscesses that had remained undetectable on MRI were seen in the cerebral white matter (Fig. 3E).
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(A) A sagittal T2-weighted scan demonstrates a large clot (arrow) at the level of the internal os. Note that no overlying myometrium or fibrous stroma is seen. Dense adhesions involving the anterior uterine wall (arrowhead) attach to the abdominal wall on other images (not shown). (B) Fat-suppressed T1-weighted scan demonstrates high signal at cesarean delivery scar site consistent with hematoma (short arrow). Long arrows indicate blood in the endocervical canal and vagina.
As part of the patient's work-up, a magnetic resonance imaging (MRI) scan and an ultrasonogram were obtained and showed dehiscence at the lower uterine segment, with a collection of blood in the area of the dehiscence and hematocolpos (Figure 1).
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Color fundus images of the left eye over the course of disease. (A) An image of the fundus at the initial visit. The details of the fundus are not visible due to the dense vitreous opacity. (B) An image of the fundus one month after intravitreal methotrexate treatment administered six times, showing complete resolution of the optic and retinal edema.
The fundoscopic image of the left eye obtained on admission is shown in Fig. 1A. The treatment resulted in a dramatic improvement, and the patient achieved complete response (CR; Fig. 1B). As shown in Fig. 4, the repeat regions of LMP1 detected in the vitreous and brain lesion were identical.
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Magnetic resonance imaging (MRI) of the CNS lesion. MRI revealed hyperintense lesions with T2-weighted fluid-attenuated inversion recovery (FLAIR) in the right occipital lobe.
T2-weighted fluid-attenuated inversion recovery (FLAIR) imaging MRI in the right occipital and parietal lobes and the precentral gyrus, and a left visual field defect was detected on an ophthalmological evaluation (Fig. 2). The tumor was suspected to be high-grade glioma and was removed by craniotomy; however, the pathological diagnosis was ENKL.
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Pathological findings of the CNS lesions. (A) Hematoxylin and Eosin staining. Perivascular infiltration of atypical lymphoid cells observed in the CNS lesion. (B-E) The infiltrating cells were positive for CD3 (B), CD56 (C), Epstein-Barr virus (EBV) (D), and TIA1 (E). EBV was detected by in situ hybridization (ISH) of EBV-encoded mRNA (EBER). The original magnification was 1,000x. (F) The positive control for EBER-ISH using the specimen from EBV-positive gastric cancer.
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Normal portable AP CXR on the 1st day of admission.
PCR test was repeated after 2 weeks and still positive (Figs. 4 and 5 ).
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Intraoperative cholangiogram showing the flow of contrast into the duodenum.
The intraoperative cholangiogram revealed a retained stone in the distal CBD but flow of contrast in the duodenum (Figure 1).
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The T-tube cholangiogram demonstrates the presence of at least 1 gallstone in the common bile duct.
The T-tube cholangiogram showed at least 1 stone impacted in the distal CBD (Figure 2).
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The T-tube cholangiogram after the lithotriptic session shows free flow into the duodenum and no residual calculi.
A few more fragments were removed, and a cholangiogram revealed contrast flowing into the duodenum (Figure 3).
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Red arrow pointing to the IVC filter strut at the pulmonary vasculature. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Chest CT scan with IV contrast showed a high-density linear structure extending into the superior segmental and superior lingular segmental pulmonary artery branches and the left lower lobe (Fig. 1).
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3D reformat image of Computed Tomography angiogram of the neck vessels showing gradual tapering of the proximal right internal carotid artery (arrow) and complete occlusion of the internal carotid artery distally indicative of dissection.
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Sagittal T1 weighted image of the head showing T1 high signal (arrow) suggestive of the periluminal hematoma from the occluded right internal carotid artery.
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Slit-lamp photograph of the patient's left eye. Mild iritis and a large number of pigment cell keratoprecipitates can be seen.
Iritis was observed in the anterior chamber of the left eye, as well as a great number of pigment cell keratoprecipitates on the posterior surface of the cornea (fig. 1).
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Fundus photograph of the patient's left eye. A shiny, filamentous material in the vitreous cavity penetrating the sclera and choroid completely, extending from the 4- to 8-o'clock position, can be seen.
Around the entire peripheral area of the retina we observed a high, ring-shaped protrusion, but we also saw a shiny, filamentous material in the vitreous cavity that penetrated the sclera and choroid, completely extending from the 4- to 8-o'clock position of the protrusion (fig. 2).
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B-mode ultrasound scan of the patient's left eye. A high-luminance image on the edge of the buckle protrusion with an acoustic shadow can be seen.
During a B-mode ultrasound scan, we observed a high-luminance image on the edge of the buckle protrusion with an acoustic shadow (fig. 3).
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a Initial findings: 12 x 10 x 7 mm nodule on the right upper eyelid. b The tumor showed shrinkage after skin biopsy. c Histological finding (Hematoxylin and eosin staining (H & E) stain x4): epithelial hyperplasia with formation of pseudokeratinocyst within the epidermis and cells of high N/C ratio. d Initial findings: 8-mm-sized dark purple nodule with central keratinization on the right lower eyelid. e Histological finding (H & E stain x4): pseudokeratinocyst formation in the epidermis and an inflammatory cell infiltrate consisting mainly of mononuclear cells in the upper dermis. f The clinical images of typical keratoacanthoma case. g The clinical images of typical seborrheic keratosis case.
An 8-mm-sized dark purple nodule with central keratinization was detected (Fig. 1d). The histology of the biopsy showed pseudokeratinocyst formation in the epidermis and inflammatory cells consisting mainly of mononuclear cells in the upper dermis, which was suspicious of seborrheic keratosis (Fig. 1e).
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a Initial findings: 12 x 10 x 7 mm nodule on the right upper eyelid. b The tumor showed shrinkage after skin biopsy. c Histological finding (Hematoxylin and eosin staining (H & E) stain x4): epithelial hyperplasia with formation of pseudokeratinocyst within the epidermis and cells of high N/C ratio. d Initial findings: 8-mm-sized dark purple nodule with central keratinization on the right lower eyelid. e Histological finding (H & E stain x4): pseudokeratinocyst formation in the epidermis and an inflammatory cell infiltrate consisting mainly of mononuclear cells in the upper dermis. f The clinical images of typical keratoacanthoma case. g The clinical images of typical seborrheic keratosis case.
An 8-mm-sized dark purple nodule with central keratinization was detected (Fig. 1d). The histology of the biopsy showed pseudokeratinocyst formation in the epidermis and inflammatory cells consisting mainly of mononuclear cells in the upper dermis, which was suspicious of seborrheic keratosis (Fig. 1e).
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(a) Sagittal T1-W MRI without contrast injection, before the first surgery. An extradural hyposignal lesion is observed at S1-S3 level, which was neglected in the first intervention. (b) Sagittal T1 MRI with contrast from the lumbosacral region after the first operation. Homogenous enhancement of the lesion is observed. (c and d) Axial T1 MRI views of the lesion with and without contrast, after the first operation
Scalloping of the posterior aspect of the S2 vertebra was also detectable [Figure 1a-d].
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Photograph of sectioned gross specimen shows a dark red to brown soft tissue tumor which composed of two ovoid mass.
It was composed of two ovoid but contiguous masses, the larger 3.0 x 2.5 x 1.5 cm, and the smaller 1.2 x1.0 x0.8 cm (Fig. 2).
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Photomicrograph demonstrates a columnar cells surrounding vascular cores. (H & E, x 200)
The histology of the specimens again confirmed a myxopapillary ependymoma (Fig. 3).
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MR image taken 2 years after operation shows no local recurrence.
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(A and B) Hepatic venous phase contrast CT coronal and axial images show subjective widening of the interlobal fissure of the liver
The indication of LB was a suspicion of parenchymal liver disease, as suggested by the widening of inter-lobar fissure of liver on contrast-enhanced computed tomography (CT) examination [Figure 1A and B], which also showed normal portal veins [Figure 2A and B].
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(A and B) Note that the pre-biopsy CT scan imagesinportal venous phase (maximum intensity projection, coronal and axial images) show normal portal vein contrast opacification
The indication of LB was a suspicion of parenchymal liver disease, as suggested by the widening of inter-lobar fissure of liver on contrast-enhanced computed tomography (CT) examination [Figure 1A and B], which also showed normal portal veins [Figure 2A and B].
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(A and B) Portal venogram after thrombolysis showing restoration of blood flow in the right portal system
Repeat angiogram next day showed restoration of the blood flow in the right portal vein [Figure 4A and B].
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Objective response after CD137 agonist treatment. A baseline CT scan (A and B) detected left external iliac (A; white star) and popliteal metastatic lymph nodes (B; white arrow), which completely disappeared (C, black star; D, black arrow) after 6 months from the last dose of therapy.
Despite early treatment discontinuation, the patient achieved complete response (CR) in May 2009, 6 months after the last dose of urelumab, as shown by a CT scan (Figure 1).
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Complete metabolic response after fourth-line therapy with pembrolizumab. A baseline FDG-PET scan showed a left thigh subcutaneous lesion (A and B; black arrows), completely disappeared at week 24 (C and D; grey arrows).
Based on the confirmed PD, in October 2014 the patient received fourth-line therapy with the anti-PD-1 pembrolizumab (2 mgs) i.v. every 3 weeks within an EAP, achieving a new CR at week 24 of therapy (Figure 3).
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(A) CT revealed large dense shadows and cavity formation in the inferior lobe of the left lung. (B) The results of CT re-examination suggested that, the area of infection in the inferior lobe of the left lung was significantly reduced and the cavity was smaller. (C) The condition of the lung was further improved than before.
The images of computed tomography (CT) scan of the chest revealed large dense shadows and cavity formation in the inferior lobe of the left lung (Figure 1A). The results of CT re-examination suggested that the area of infection in the inferior lobe of the left lung was significantly reduced, and the cavity was smaller (Figure 1B). The condition of the lung was further improved than before (Figure 1C).
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(A) The opening of the left lower lobe is narrow. (B and C) There is a big and white neoplasm in the lower left lung, with a lot of white necrotic material in the subsegment.
The electronic bronchoscopy showed a big and white neoplasm in the lower left lung, with a narrow opening and a lot of white necrotic material in the subsegment (Figure 2).
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Biopsy revealed chronic inflammation of bronchial mucosa with lymphoid follicular hyperplasia, but no definite tumor cells (400X).
Biopsy revealed chronic inflammation of endobronchial membrane with lymphoid follicular hyperplasia, but without any definite tumor cells (Figure 3).
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Photos taken three weeks after mastectomy and immediate reconstruction showing development of necrotic skin in the areola and along the incision.
On post-operative day 23, dehiscence was noted at the apex of her vertical incision abutting the areola with an area of skin necrosis from mastectomy skin flap ischemia (Figure 1 and 2).
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Postoperative photo of the right neo breast 15 months after tissue expander exchange to silicone gel implant.
Post-operatively two years later, the patient has had no recurrent infections (Figure 3).
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The chest wall tumor measuring 10 cm in diameter
Physical examination revealed a mass of 10 cm localised in lateral chest wall (Figure 1). ignificant laboratory findings were as follows: haemoglobin: 9,3g/dL, erythrocyte sedimentation rate: 60 mm/h, LDH rate: 620 UI/ml.
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Computed tomography scan of the chest:Soft tissue mass lesion in posterior chest wall with thorax extension accompanied by pleural thickening
Computed tomographic scan confirmed the localisation in chest wall with invasion of the ribs (Figure 2).
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Intra-operative findings revealed a fistula in the third part of the duodenum (white arrows) and a defect in the aneurysm sac (black arrows).
In the third part of the duodenum there was a small fistula resembling the mouth of a fish measuring 1x1 cm (Fig. 3).
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MRI multiplanar reconstruction post-contrast. a Thrombosed sigmoid sinus. b Thrombosed ophthalmic vein. c Thrombosed sphenoparietal sinus. d CT with osseous erosion of the right sphenoid sinus.
Furthermore, thrombosis of the cavernous sinus, ophthalmic vein, superior petrosal sinus, sigmoid sinus, internal jugular vein, and sphenoparietal sinus on the right side (Fig. 2) was seen in post-contrast acquired images. The additional computed tomography scan showed a permeative osseous erosion of the posterior and lateral walls of the right sphenoid sinus, while the carotid artery remained covered by bone (Fig. 2d).
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CT scan image.
The pathological thickness was measured as 15 mm with diffuse hyperemia of the mucosa and marked hypodensity of the submucosa (Fig. 1).
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Image of the resected colon.
A surgical evaluation indicated the need for surgery; so, the patient underwent a right hemicolectomy with resection of the caecum and right and transverse colon till the splenic flexure with lateral ileostomy (Fig. 2).
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Image of the pathological anatomy.
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Subepithelial opacity (arrows) in the mid-peripheral to peripheral cornea and numerous opacities located near Descemet's membrane (arrow heads) from a 41-year-old male; similar findings were observed in both eyes. a Photograph with narrow slit illumination. b Photograph with wide slit illumination.
Slit-lamp biomicroscopy revealed a subepithelial opacity in the mid-peripheral to peripheral cornea OU and numerous opacities located at the level of Descemet's membrane OU; however, it was difficult to distinguish precisely the location of the opacity (i.e. deep stroma or Descemet's membrane) (fig. 1).
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(A) The defect after debridement. (B) Flap design. The blue dot marks the perforator identified with the handled doppler probe.
A portable Doppler probe was used to identify an intercostal artery perforator in the 6th intercostal space; a tear-shape flap was centred on this vessel, with the upper margin of the flap coinciding with the lower margin of the defect (Figure 1).
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Flap raising. After perforator identification, incision of the lower margin and flap raising (A). (B) De-epithelialization and transposition of the proximal portion of the flap. (C) The wound 1 week post-op.
Tisseel (Baxter Healthcare Corp., Deerfield, IL) was applied to promote flap adhesion to the surrounding tissue and further reduce dead space (Figure 2(A-C)). The wound was closed by bringing the upper margin of the flap to the upper margin of the defect (Figure 3).
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At one month post-op the flap was completely consolidated with the thoracic tissues, scars were well healed and no distortion of the thoracic surface was noted.
Tisseel (Baxter Healthcare Corp., Deerfield, IL) was applied to promote flap adhesion to the surrounding tissue and further reduce dead space (Figure 2(A-C)). The wound was closed by bringing the upper margin of the flap to the upper margin of the defect (Figure 3).
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The preoperative anterior-posterior radiograph demonstrated crossover sign at the left acetabulum indicating acetabular retroversion
The crossover sign and posterior wall sign were identified by radiography and computed tomography indicating the presence of acetabular retroversion (Fig. 1).
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A labrum tear was observed at the anterosuperior edge of the acetabulum. The articular cartilage appeared to be intact
The arthroscopic examination revealed a full thickness labral tear at the anterior-superior region (Fig. 2).
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The labrum was fixed back to the acetabulum using two suture anchors. After the labrum repair, osteochondroplasty of the femoral head was performed to prevent anterior impingement
A labral tear was identified at the anterosuperior edge of the acetabulum, and the tear was fixed back to the rim using two suture anchors (Fig. 3).
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The post-operative anterior-posterior radiograph showed improved acetabular coverage with disappearance of the crossover sign
The post-operative radiograph showed improved acetabular coverage of the femoral head with a resultant Sharp angle of 36 and CE angle of 50 , while the crossover sign as well as the posterior wall sign was no longer evident (Fig. 4).
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Imaging findings of a 25-year-old woman taking oral contraceptives for dysmenorrhea who was injured in a motorcycle accident. A, On day 1 of injury, the contrast-enhanced computed tomography findings showed hepatic contusion of the sixth segment (arrow). B, C, At 1 week after injury, contrast-enhanced computed tomography showed thrombus formation in the inferior vena cava (arrows). The thrombus had a maximum diameter of 0.6 cm.
The contrast-enhanced CT findings at 1 week after the injury revealed thrombus formation with a maximum diameter of 0.6 cm and a length of 0.2 cm (Fig. 1).
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Imaging findings of a 58-year-old man injured in a motorcycle collision. A, On day 1 of injury, the contrast-enhanced computed tomography findings showed hepatic contusion of the sixth segment (arrow). B, C, At 1 week after injury, the contrast-enhanced computed tomography findings showed the appearance of a hepatic false aneurysm at the site of liver injury and a thrombus (maximum diameter, 1.5 cm; length 6.5 cm) in the inferior vena cava (arrows).
The findings showed a false aneurysm of the hepatic artery at the liver injury site and a thrombus (maximum diameter, 1.5 cm; length, 6.5 cm) in the IVC (Fig. 2).
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Clinical manifestations of immunoglobulin A vasculitis. (A) Palpable purpuric rash on the lower extremities 2 weeks after the patient received the first dose of the severe acute respiratory syndrome coronavirus 2 mRNA vaccine (BNT162b2, Pfizer, Inc) and (B) after 2 weeks of oral corticosteroids. Microscopic examination of urinary sediment stained with Sternheimer-Malbin stain revealed glomerular hematuria, characterized by acanthocytes (arrows) inspected under (C) phase-contrast microscopy and (D) dark-field microscopy illumination. Original magnification x400.
Six weeks prior to presentation, the patient had developed a skin rash on his lower legs that erupted 2 weeks after he received the first dose of a SARS-CoV-2 mRNA vaccine (BNT162b2 (mRNA), Pfizer, Inc) (Figure 1). Microscopic examination of the urinary sediment revealed acanthocytes (Figure 1).
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Kidney biopsy specimen showing pathologic features of immunoglobulin A (IgA) nephropathy. (A) Focal mild mesangial hypercellularity was present (periodic acid Schiff stain, original magnification x400). (B) IgA-dominant granular diffuse global mesangial staining for IgA was present, 3+ on a 0 to 3+ scale (anti-IgA immunofluorescence, original magnification x400).
Mild mesangial hypercellularity was present in only 1 of the 16 glomeruli in the light microscopy sample, with no endocapillary hypercellularity, no segmental sclerosis, minimal (approximately 5%) interstitial fibrosis and tubular atrophy, and no crescents or necrosis (Figure 2).
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Waardenburg Syndrome (a) External photograph showing telecanthus. Yellow arrow indicates the left heterochromia iridum. (b): Montage Fundus photograph of the left eye. White arrowheads indicate the junction of the hypopigmented choroid and the normal choroid. (c) Montage autofluorescence. Yellow arrowheads indicate the area of hyperautofluorescence
A 27-year-old Asian-Indian lady, systemically normal, with diffuse iris hypopigmentation, telecanthus, mild synophrys with a congenital white forelock treated with hair color and 20/20 vision in both eyes presented for treatment of the heterogeneous iris color [Fig. 1a]. Fundus examination revealed a sectoral superonasal hypopigmented choroid in the left eye [Fig. 1b]. Fundus autofluorescence revealed hyperautofluorescence through the hypopigmented choroidal region in the left eye [Fig. 1c], indicating unmasking of scleral autofluorescence. Iris and choroidal hypopigmentation are central to all the subtypes [Fig. 1].
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Computed tomography scan image: the subdural collection is increased in dimension with a higher density in the posterior part by persistent midline brain shift
CT scan which showed an increase in density of the subdural collection with an increase in brain shift [Figure 2]. Considering that the conservative treatment was not sufficient, we considered and proposed a subdural hematoma evacuation, which the patient accepted.
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Postsurgical computed tomography scan control shows the evacuation of the collection with air in the anterior part and a reduction of midline brain shift
The postoperative CT scan showed the evacuation of the blood collection with reduction of the midline brain shift [Figure 3].
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Haematoxilin/eosin-stained pancreatic cytology revealed the presence (A) of poorly cohesive, pleomorphic, monucleated or multinucleated large cells (20x). Positivity (B) for cytokeratins AE-AE2 confirms the diagnosis of anaplastic cell carcinoma (20x). Peritoneal washing cytology (PWC) with Papanicolaou stain (C) detects cells with malignant features such as nuclear displacement, irregular nuclear membranes, small and eccentric nucleoli (40x).
A peritoneal washing cytology (PWC) revealed the presence of neoplastic cells (Figure 1).
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On admission CXR:round regular density in the right lower lobe of the lung.
The serological tests were within normal limits. chest x-ray showed a rounded regular density in the right lower lobe (Fig. 1).
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The hydatid cyst in the right lower lobe of the lung during the operation.
The right lung lesion was approached firstly through a right thoracotomy in the 5th inter-costal space, and the 10 x 6 cm cystic mass in the right lower lobe (Fig. 4) was excised by means of aspiration, injection of 20% hypertonic saline and re-aspiration and then the germinal membrane then was enbloc excised.
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The enucleation of left trapezius hydatid cyst.
A 5 x 4 cystic mass was found within the thickness of the left trapezius muscle, and was enucleated taking care not to induce any leak (Fig. 5) and the remainder cavity was closed with 2.0 vicryl stuture.
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MRI examination shows involvement of the lesion in the precentral gyrus and postcentral gyrus. The lesion shows strong diffusion restriction on diffusion-weighted imaging (a); and hypointensity on T1-weighted (b) and hyperintensity on T2-weighted imaging (c). The structural preservation of the gyri and sulci is a characteristic of this case and may reflect the pathology.
T1-weighted images, and hyperintensity on T2-weighted images [Figures 1a-c]. The epilepsy was controlled with medication, but the patient became increasingly drowsy in the days that followed.
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CT images obtained before surgery show massive hemorrhage surrounding the lesion (a) with significant mass effect (b).
Repeat CT examinations revealed a hematoma and associated edematous change around the lesion and progressive expansion of the hematoma despite efforts to control blood pressure and treatment by hemostatic agents [Figures 2a and b].
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Histopathologically, numerous red blood cells with fibrin and debris are present, with massive infiltration of atypical round blue cells (a: x40). The infiltrating cells are composed of clumped nuclear chromatin and eccentric eosinophilic cytoplasm (b: x200), suggesting a plasma cell origin. Immunohistochemistry study shows CD138 positivity (b; inset). In situ hybridization demonstrates uniform lambda light chain positivity and negative kappa signal, reinforcing the diagnosis of plasma cell neoplasm (c and d: x100).
Histopathological sections revealed numerous red blood cells with fibrin and debris and massive infiltration of atypical round blue cells [Figure 3a]. Atypical cells demonstrated clumped nuclear chromatin pattern and eccentric eosinophilic cytoplasm [Figure 3b] suggesting plasma cell origin. Immunohistochemistry study showed CD138 positivity [Figure 3b; inset] and in situ hybridization demonstrated uniform lambda light chain positivity and negative kappa signal, reinforcing the diagnosis of plasma cell neoplasm [Figures 3c and d].
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Postoperative CT shows evacuation of the hematoma and relaxation of the brain (a). Gadolinium-enhanced MRI demonstrates resection of the lesion, with a small amount of contrast enhancing tumor at the periphery of the cavity (b and c). Imaging obtained after intensity-modulated radiation therapy reveals a complete disappearance on gadolinium-enhanced MRI (d and e).
Although the patient was obtunded and showed severe left hemiparesis soon after the surgery, correlating with the focus of the lesion in the right central sulcus, postoperative CT revealed apparent brain decompression [Figure 4a]. Postoperative MRI demonstrated extensive near-total resection of the lesion with small residual tumor at the periphery of the cavity [Figures 4b and c]. The lesion showed an excellent response to IMRT, showing a complete disappearance on MRI [Figures 4d and e].
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(A-C) Nodules and ulcers without pus and marked boundary in the right preotic skin in a 14-year-old Chinese girl associated with Acinetobacter baumannii-related vasculitis (A: At presentation; B: A week later; C: Eleven days later).
Nodules and ulcers with marked boundary were seen on her right preotic skin (Fig. 1A). Biopsy was sampled on the ulcer for bacteriological and fungal culture and for histopathological examination (Fig. 1B). Ulcers and swelling began to shrink soon after treatment administration and healed within 3 weeks (Fig. 1B and C).
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Chest CT showing: diffusely distributed nodules in both lungs, bilateral bronchiolitis, and tuberculosis could not be excluded. The aortic arch was thickened, and the local calcified plaque moved inward, which indicated further aortic CTA examination.
The aortic arch was thickened and the local calcified plaque moved inward, which indicated further aortic computed tomography angiography (CTA) examination (Figure 1).
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Chest CT showing: bronchiole lesions and multiple miliary foci in both lungs with pleural effusion and slightly thickened pleura. This combined with the medical history is consistent with the diagnosis of hematogenous disseminated pulmonary tuberculosis.
Re-examination of lung CT revealed bronchiole lesions and multiple miliary foci in both lungs, which were larger than one week prior, with pleural effusion, and slightly thickened pleura, suggestive of miliary tuberculosis (Figure 3).
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Chest CT showing: partially absorption of the miliary foci, suggesting that anti-tuberculosis treatment is effective.
After two weeks of treatment, the patient's body temperature returned to normal, and a re-examination of the lung CT indicated that the lesion was partially absorbed (Figure 4).
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CT-scan of the chest showing a well-circumscribed mass in the right lung basis (arrow).
A rounded peripheral well-defined nodule, 1.23 cm in diameter, was detected in the right lung basis (Fig. 1).
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Inflammatory infiltrate with lymphocytes, macrophages, giant cells and numerous round cryptoccoci (arrows).
The procedure was performed without complications and resection specimen was collected and sent for pathologic analysis (Fig. 3) and a diagnosis of pulmonary cryptococcosis was made.
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B mode ultrasound image (A) shows the hypoechoic tract (arrow) which is extending from RPV to the IVC. Color Doppler ultrasound images (B, C) reveal blood flowing from RPV to IVC via this porto-caval shunt (arrows). B mode ultrasound image obtained on the 33rd day after birth (D) shows that the shunt closed and became a fibrotic ligamentous structure (arrow). Illustration (E) shows the normal pathway of umbilical vein catheterization (red arrows) and the abnormally located shunt (white open arrow). IVC - vena cava inferior; RHV - right hepatic vein; MHV - middle hepatic vein; LHV - left hepatic vein; PV - portal vein; RPV - right portal vein; LPV - left portal vein; UV - umbilical vein; DV - ductus venosus; * portal sinus.
Abdominal ultrasound findings were as follows: dilatations of the right-left portal vein, a thin hypoechoic tract between the right portal vein and inferior vena cava (IVC) (Figure 1A). Color Doppler US confirmed blood flow in these vessels (Figure 1B, 1C). Blood flow through the shunt gradually decreased on follow-up Doppler ultrasound examinations which closed on the 33rd day since birth and became a thin, hyperechoic ligamentous structure equivalent to the 'ligamentum venosum' (Figure 1D).
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Lymphangiomatosis in 38-year-old woman.. A. Coronal T2-weighted image shows large lobulated cystic mass with many septations in pelvic cavity. Preserved uterus (U) without tumor involvement is seen.. B. Perfusion lung scan with Tc-99m macroaggregated albumin shows perfusion defect in entire right lung, which was suspected to indicate complete occlusion of right pulmonary artery.. C, D. Transthoracic echocardiographs show heterogeneous echogenic mass with cystic component and incomplete coaptation of tricuspid valve, which resulted in tricuspid regurgitation (arrows in C). Mass extended to inferior vena cava (IVC) (arrows in D) (RA = right atrium, RV = right ventricle).. E, F. CT coronal (E) and axial (F) scans show non-enhanced mass with inferior vena cava and right atrial involvement, and hypoattenuating nodular lesion in right distal pulmonary artery (arrow in E).. G. Gross specimen excised from inferior vena cava, right heart and right pulmonary artery was seen as an elongated, reddish, 29 cm long mass with web-like tumor extension in right pulmonary artery (asterisk).. H. Hematoxylin & Eosin stained section of lesion shows dilated lymphatic channels with variable wall thicknesses. Based on immunohistochemical staining, tumor cells were positive for lymphatic vessel marker D2-40 (x40, insert).
At that time, pelvic MRI had demonstrated the presence of a large cystic mass with many septations and no involvement of the adjacent organs in the pelvis (Fig. 1A). Tc-99m macro-aggregated albumin identified the absence of perfusion throughout the right lung, indicating occlusion of the right main pulmonary artery (Fig. 1B). Transthoracic echocardiography (TTE) performed for the evaluation of persistent dyspnea demonstrated the presence of a mobile echogenic tumor adhering to chordae and papillary muscles of the tricuspid valve at the right atrium and right ventricle chordae. The tumor extended from the IVC into the right heart and caused tricuspid regurgitation (Fig. 1C, D). Chest CT confirmed the presence of an elongated non-enhanced mass in the right chambers of the heart and in the IVC, with extension to the right distal pulmonary artery (Fig. 1E, F). Despite the presence of a neoplastic thrombus in the IVC, excision was straightforward except for resections of an adhesive chordal portion and a web-like tumor, which occluded the right distal pulmonary artery (Fig. 1G). Grossly, the contiguous 29 cm long mass was a well-circumscribed, gray-white tumor with a soft, rubbery consistency (Fig. 1G). Based on the histology, the tumor consisted of dilated lymphatic channels with variable wall thicknesses (Fig. 1H). Atypical features, such as, endothelial tufting, atypia and mitotic activity of lymphatic endothelium were absent, and based on immunohistochemical staining, tumor cells were positive for lymphatic vessel marker D2-40 (Fig. 1H, insert) and CD31.
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Anteroposterior pelvic radiograph (24 year old male) after primary THA for secondary osteoarthritis due to Perthes disease (Right Hip: cementless CFP stem and TOP acetabular cup; Left Hip: Hybrid THA with cemented ENDO Mark III stem + cementless TOP acetabular cup, Waldemar Link GmbH, Hamburg, Germany).
A 24-year old patient with secondary osteoarthritis of the hips due to Legg-Calve-Perthes disease underwent primary hybrid THA of the left hip seven years before trauma, followed by primary cementless THA of the right hip one year later at our institution (Fig. 1) Six years after the right THA, he was involved in a motorcycle accident, in which he suffered direct trauma to this hip, as well as a complex ankle fracture which was treated in a smaller regional hospital on admission.
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Conventional pelvic radiographs directly after trauma, revealing ceramic head fracture.
Although initial anteroposterior radiographs of the pelvis and right hip axial views were performed, no signs of fractures, aseptic loosening or implant damage were diagnosed by the attending trauma surgeons (Fig. 2).
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Anteroposterior pelvic radiograph eight months after the initial radiographs, showing a fractured ceramic head.
Further conventional radiographs, in two planes, more than a year after the initial radiographs, revealed a completely destroyed multifragmented ceramic head (Fig. 3).
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Intra-operative image showing countless debris and the damaged taper junction of the femoral neck (in situ).
Intraoperatively, extensive damage of the ceramic head and correlating taper junction of the femoral neck was found (Figs. 4, 6, 7).
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Intra-operative image showing debris with ceramic fragments.
Concomitantly, there was severe debris-related metallosis throughout the entire joint (Fig. 5).
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Intra-operative image showing the fragmentation of the ceramic head.
Intraoperatively, extensive damage of the ceramic head and correlating taper junction of the femoral neck was found (Figs. 4, 6, 7).
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Image showing the explanted components: a fragmented ceramic head, a damaged stem and acetabular cup and liner.
Intraoperatively, extensive damage of the ceramic head and correlating taper junction of the femoral neck was found (Figs. 4, 6, 7).
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Postoperative anteroposterior pelvic radiograph.
The postoperative course was uneventful, with radiographs revealing a correct position and articulation of the cementless implant (Fig. 8).
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PMC4159397_01_opth-8-1675Fig1.jpg
PMC4159397_opth-8-1675Fig1_undivided_1_1.webp
Ultra-wide field color fundus photograph of the right and left eye depicting diffuse midperipheral chorioretinal atrophy with sparing of the central macula.. Note: The left eye also has central submacular fibrosis.
In the left macula, there was a subfoveal elevated gray-white membrane with an adjacent punctate area of subretinal hemorrhage (Figure 1).
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PMC4159397_01_opth-8-1675Fig3.jpg
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Fluorescein angiogram (FA) transiting the left eye reveals diffuse atrophy of the choriocapillaris sparing the central macula.. Notes: A central hyperfluorescent lesion in the early images stains (00:29) in the late angiographic images centrally (04:28) (arrowhead). Mild leakage is apparent nasally (arrow).
Spectral domain optical coherence tomography (SD-OCT) (Figure 2) and fluorescein angiography (FA) (Figure 3) revealed a subretinal membrane with late staining and mild leakage.
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CC BY-NC
PMC3173925_01_JPN-6-78-g001.jpg
PMC3173925_JPN-6-78-g001_undivided_1_1.webp
Patient diagnosed as esthesioneuroblastoma presenting with proptosis and diminished vision in right eye
Throat Out-Patient Department (ENT OPD) with complaints of right eye proptosis and loss of vision for last 20 days [Figure 1]. There was no history of nasal obstruction or epistaxis.
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PMC3173925_01_JPN-6-78-g002.jpg
PMC3173925_JPN-6-78-g002_undivided_1_1.webp
Coronal cuts of CECT showing homogeneously enhancing soft tissue involving right side of sinuses and orbit
Coronal [Figure 2] and axial [Figure 3] cuts of contrast enhanced computerized tomography (CECT) scan of nose, paranasal sinus and orbit showed heterogeneously enhancing soft tissue density involving right nasal cavity, anterior and posterior ethmoids with erosion of cribriform plate and with right intraorbital extension.
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PMC3173925_01_JPN-6-78-g003.jpg
PMC3173925_JPN-6-78-g003_undivided_1_1.webp
Axial cut of CECT of the paranasal sinuses (PNS) showing hyperintense mass involving right side of nose and orbit
Coronal [Figure 2] and axial [Figure 3] cuts of contrast enhanced computerized tomography (CECT) scan of nose, paranasal sinus and orbit showed heterogeneously enhancing soft tissue density involving right nasal cavity, anterior and posterior ethmoids with erosion of cribriform plate and with right intraorbital extension.
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PMC3173925
file_0017311
PMC3173925_01
CC BY-NC-SA
PMC4311031_01_trd-78-23-g001.jpg
PMC4311031_trd-78-23-g001_A_2_2.webp
Chest computed tomography (CT) scan in December of 2012 (B) showed a 2.5-cm diameter hilar mass that was little changed, as compared to the cardiac angio CT scan in March of 2010 (A).
A cardiac angio computed tomography (CT) scan performed at that time detected a 2.5-cm diameter, minimally enhanced mass in the right hilar area (Figure 1A). A chest CT scan showed a 2.5-cm diameter mass in the right hilum that changed little in terms of size since 2010 (Figure 1B).
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Grossly, several enlarged lymph nodes (arrows) were found in the hilar and interlobar area.
Grossly, several enlarged lymph nodes were found in the hilar and interlobar areas (Figure 2).
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PMC4311031_01_trd-78-23-g003.jpg
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Microscopic finding showed metastatic squamous cell carcinoma to the lymph nodes (H&E stain, x40; insert image: H&E stain, x200).
Microscopically, metastatic squamous cell carcinoma was found at several lymph nodes (8/45) and there was no tumor in the lung parenchyma and bronchial tree (Figure 3).
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PMC6883338_01_gr1.jpg
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Scrotal ultrasound showing a scrotal collection 1 month after the primary procedure.
Scrotal ultrasonography revealed 5.6 x 3.3 x 3.9 cm scrotal hematoma surrounding the prosthesis pump (Fig. 1).
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Pelvic MRI showing a scrotal collection around the pump.
A pelvic MRI showed a 6.4 x 3.6 x 3.9 cm scrotal collection with findings suggestive of an underlying infectious process (Fig. 2, Fig. 3).
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PMC6883338_01_gr4.jpg
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Purulent discharge noted upon opening the pump space.
Upon opening the capsule surrounding the pump, blood poured out and a sample was taken for culture (Fig. 4).
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PMC6883338_01_gr5.jpg
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Antimicrobial and antiseptic solutions used in irrigation and the penis is fully erected after a successful prosthesis recycling.
Complete hematoma evacuation and excision of the cavity was done, and the device was recycled successfully multiple times with no evidence of malfunction (Fig. 5).
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PMC10308279_01_fped-11-1205255-g001.jpg
PMC10308279_fped-11-1205255-g001_A_1_4.webp
(A,B) Photographs of vasculitic-like cutaneous lesions affecting lower legs bilaterally; (C) pedigree with proband/affected individual indicated by arrow/black circle; (D) sanger electropherograms of FBN1 gene in family members with blue vertical line indicating deletion of c.1211delC resulting in frameshift mutation in proband (II-1) and reference sequence along top. T, thymine; C, cytosine; A, adenine.
An initial 4 x 2 cm lesion on the right lower leg had gradually increased in size, followed by scattered 1 cm lesions developing across the left leg and buttocks (Figures 1A,B). This targeted gene panel revealed a frameshift variant in the fibrillin 1 gene: FBN1, NM_000138, c.1211delC, p.P404Hfs*44 het. Sanger sequencing results of parental samples were consistent with the variant having arisen de novo in the proband (Figure 1D).
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file_0007339
PMC10308279_01
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PMC8326104_01_SNI-12-312-g001.jpg
PMC8326104_SNI-12-312-g001_a_1_3.webp
(a and b) Midsagittal view of a T2-weighted (a) and a contrast-enhanced T1-weighted (b) magnetic resonance imaging (MRI) of the lumbar spine demonstrating an intradural extramedullary spinal lesion (white arrowhead) from L1 to L2 with avid contrast enhancement. (c) Axial view of a contrast-enhanced T1-weighted MRI of the lumbar spine demonstrating high-grade compression of conus medullaris and cauda equina from an intradural extramedullary lesion (white arrowhead).
A gadolinium-enhanced MR imaging (MRI) documented an intradural extramedullary solid lesion with marked gadolinium enhancement extending from L1 to L2, resulting in anterior compression/displacement of the cauda equina/ conus medullaris [Figure 1].
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PMC8326104_01_SNI-12-312-g002.jpg
PMC8326104_SNI-12-312-g002_a_1_2.webp
Postoperative magnetic resonance imaging, sagittal (a) and axial (b) views, confirmed complete tumor removal.
In addition, the postoperative MRI scans confirmed complete tumor removal [Figure 2].
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PMC8326104_01_SNI-12-312-g003.jpg
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Histologic findings of the lesion. (a and b) Show spindle cells, collagen fibers, microcystic changes, and hemosiderin deposits on Hematoxylin Eosin staining (black circle and arrowhead). (c) Shows a Ki67 <1%. (d) shows uniform S-100 protein immunoreactivity.
Pathology revealed a fusocellular tumor that was compatible with the diagnosis of a schwannoma of the cauda equina [Figure 3].
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PMC8326104_01
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file_0121876
PMC8326104_01
CC BY-NC-SA
PMC4367056_01_JNSBM-6-261-g002.jpg
PMC4367056_JNSBM-6-261-g002_undivided_1_1.webp
Patient with cutaneous neurofibroma
A 28-year-old male patient reported [Figure 1] with the chief complaint of a painless swelling in the right upper back tooth region since 3 years.
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PMC4367056_01_JNSBM-6-261-g003.jpg
PMC4367056_JNSBM-6-261-g003_undivided_1_1.webp
Cutaneous neurofibroma over the trunk
On general examination, multiple swellings all over the trunk region and arms were observed [Figure 2].
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PMC4367056_01_JNSBM-6-261-g004.jpg
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Patient's father with cutaneous neurofibroma
Family history revealed the patient's father [Figure 3] also had multiple swellings all over the body and face.
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PMC4367056_01_JNSBM-6-261-g005.jpg
PMC4367056_JNSBM-6-261-g005_undivided_1_1.webp
Gingival neurofibroma
Solitary well-defined oval shaped swelling [firm in consistency and nontender on palpation Figure 4] approximately 4 cm x 3 cm was present in the right maxillary posterior region extending from distal aspect of maxillary first premolar to mesial aspect of third molar.
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PMC4367056_01
CC BY-NC-SA