[Show abstract][Hide abstract] ABSTRACT: Objective
Objective: To demonstrate a diagnostic challenge of sclerosing mesenteritis initially considered as liposarcoma.
Clinical Presentation and Intervention
Clinical Presentation and Intervention: A 45-years old man was admitted with a painful abdominal mass. Abdominal computed tomography demonstrated a well-demarcated tumor in left hemiabdomen, with a large fat component and areas of soft tissue attenuation suggestive for liposarcoma. Intraoperative finding showed a tumor arising from the greater omentum. The tumor was removed and histopathology confirmed pseudotumorous type of sclerosing mesenteritis with dominant mesenteric lipodystrophy.
Conclusion:The pseudotumorous type of sclerosing mesenteritis should be considered in differential diagnosis of the mesenteric tumors .
Full-text · Article · Oct 2015 · Medical Principles and Practice
[Show abstract][Hide abstract] ABSTRACT: Purpose:
Standardized perfusion value (SPV) is a universal indicator of tissue perfusion, normalized to the whole-body perfusion, which was proposed to simplify, unify and allow the interchangeability among the perfusion measurements and comparison between the tumor perfusion and metabolism. The aims of our study were to assess the standardized perfusion value (SPV) of the esophageal carcinoma, and its correlation with quantitative CT perfusion measurements: blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability surface area product (PS) of the same tumor volume samples, which were obtained by deconvolution-based CT perfusion analysis.
Forty CT perfusion studies of the esophageal cancer were analyzed, using the commercial deconvolution-based CT perfusion software (Perfusion 3.0, GE Healthcare). The SPV of the esophageal tumor and neighboring skeletal muscle were correlated with the corresponding mean tumor and muscle quantitative CT perfusion parameter values, using Spearman's rank correlation coefficient (rS).
Median SPV of the esophageal carcinoma (7.1; range: 2.8-13.4) significantly differed from the SPV of the skeletal muscle (median: 1.0; range: 0.4-2.4), (Z=-5.511, p<0.001). The cut-off value of the SPV of 2.5 enabled discrimination of esophageal cancer from the skeletal muscle with sensitivity and specificity of 100%. SPV of the esophageal carcinoma significantly correlated with corresponding tumor BF (rS=0.484, p=0.002), BV (rS=0.637, p<0.001) and PS (rS=0.432, p=0.005), and SPV of the skeletal muscle significantly correlated with corresponding muscle BF (rS=0.573, p<0.001), BV (rS=0.849, p<0.001) and PS (rS=0.761, p<0.001).
We presented a database of the SPV for the esophageal cancer and proved that SPV of the esophageal neoplasm significantly differs from the SPV of the skeletal muscle, which represented a sample of healthy tissue. The SPV was validated against quantitative CT perfusion measurements and statistically significant correlation was proved.
No preview · Article · Dec 2014 · European Journal of Radiology
[Show abstract][Hide abstract] ABSTRACT: To estimate if CT perfusion parameter values of the esophageal cancer, which were obtained with the deconvolution-based software and maximum slope algorithm are in agreement, or at least interchangeable.
278 esophageal tumor ROIs, derived from 35 CT perfusion studies that were performed with a 64-MDCT, were analyzed. "Slice-by-slice" and average "whole-covered-tumor-volume" analysis was performed. Tumor blood flow and blood volume were manually calculated from the arterial tumor-time-density graphs, according to the maximum slope methodology (BFms and BVms), and compared with the corresponding perfusion values, which were automatically computed by commercial deconvolution-based software (BFdeconvolution and BVdeconvolution), for the same tumor ROIs. Statistical analysis was performed using Wilcoxon matched-pairs test, paired-samples t-test, Spearman and Pearson correlation coefficients, and Bland-Altman agreement plots.
BFdeconvolution (median: 74.75ml/min/100g, range, 18.00-230.5) significantly exceeded the BFms (25.39ml/min/100g, range, 7.13-96.41) (Z=-14.390, p<0.001), while BVdeconvolution (median: 5.70ml/100g, range: 2.10-15.90) descended the BVms (9.37ml/100g, range: 3.44-19.40) (Z=-13.868, p<0.001). Both pairs of perfusion measurements significantly correlated with each other: BFdeconvolution, versus BFms (rS=0.585, p<0.001), and BVdeconvolution, versus BVms (rS=0.602, p<0.001). Geometric mean BFdeconvolution/BFms ratio was 2.8 (range, 1.1-6.8), while geometric mean BVdeconvolution/BVms ratio was 0.6 (range, 0.3-1.1), within 95% limits of agreement.
Significantly different CT perfusion values of the esophageal cancer blood flow and blood volume were obtained by deconvolution-based and maximum slope-based algorithms, although they correlated significantly with each other. Two perfusion-measuring algorithms are not interchangeable because too wide ranges of the conversion factors were found.
Full-text · Article · Jun 2013 · European journal of radiology
[Show abstract][Hide abstract] ABSTRACT: Somatostatinomas are rare functioning neoplasms usually arising in the pancreas and duodenum. They are seldom associated with typical clinical symptoms. Their diagnosis is confirmed only by histological and immunohistochemical studies and the presence of specific hormones. Two distinct clinicopathological forms of somatostatinoma exist: duodenal and pancreatic somatostatinomas. Clinically, compared to pancreatic somatostatinomas, duodenal somatostatinomas are more often associated with nonspecific symptoms and neurofibromatosis, but less often with somatostatinoma syndrome or metastasis. We report a case of somatostatin-producing duodenal carcinoma in a 45-year-old female with neither neurofibromatosis nor somatostatinoma syndrome. Abdominal computed tomography showed a 18 mm mass in the duodenum which had given rise to multiple lymph node metastases. Although the endoscopic biopsies were free of malignancy, the patient subsequently underwent Whipple's operation for the duodenal mass. Immunohistochemical analysis confirmed the diagnosis of somatostatin-producing carcinoma.
Full-text · Article · Jan 2013 · Acta chirurgica iugoslavica
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to assess the utility of (18)F-FDG PET/CT for detection of inflammation in granulomatous sites and management of patients with chronic sarcoidosis. The 3 specific aims were to assess differences between (18)F-FDG PET/CT and multidetector CT (MDCT) findings, to compare (18)F-FDG PET/CT results with serum levels of angiotensin-converting enzyme (ACE), and to determine whether (18)F-FDG PET/CT findings are associated with the decision to change therapy.
We studied 90 sarcoidosis patients (mean age ± SD, 47 ± 12 y; 32 men and 58 women) with persistent symptoms who were referred for (18)F-FDG PET/CT evaluation to assess the extent of inflammation. They also underwent MDCT and measurement of serum ACE level. After the follow-up (12 ± 5 mo after (18)F-FDG PET/CT), the clinical status and changes in therapy were analyzed.
(18)F-FDG PET/CT detected inflammation in 74 patients (82%) (maximum standardized uptake value, 8.1 ± 3.9). MDCT was positive for sarcoidosis in 6 additional patients (80, 89%). The difference between the 2 methods was not significant (P = 0.238, McNemar test), and their agreement was fair (κ = 0.198). Although ACE levels were significantly higher in patients with positive than negative (18)F-FDG PET/CT results (P = 0.002, Mann-Whitney test), 38 patients (51%) with positive (18)F-FDG PET/CT results had normal ACE levels. The therapy was initiated or changed in 73 out of 90 patients (81%). Both univariate and multivariate logistic regression analyses indicated that positive (18)F-FDG PET/CT results were significantly (P < 0.001) associated with changes in therapy, with no contribution from age, sex, ACE level, CT results, or previous therapy.
Our results indicate that (18)F-FDG PET/CT is a useful adjunct to other diagnostic methods for detecting active inflammatory sites in chronic sarcoidosis patients with persistent symptoms, especially those with normal ACE levels. (18)F-FDG PET/CT proved advantageous for determining the spread of active disease throughout the body and influenced the decision to adjust the therapy.
Full-text · Article · Aug 2012 · Journal of Nuclear Medicine
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to estimate the volume of normal pancreas in adults using the CT volumetry (summation of the areas technique), analyze the correlation between the volume and the diameters of pancreas, which are measurable by the cross-sectional imaging, and assess the relationship with the gender, age, and body constitution.
220 CT examinations were analyzed retrospectively (102 females, 118 males; age 16-82, average 56). Following diameters were measured: cranial-caudal-CC(pancreas), CC(body&tail), CC(body), CC(head); anterior-posterior-AP(tail), AP(body), AP(head); lengths-LL(head), L(body&tail); and maximal transversal diameter of the L1 vertebral body (LL(L1)) and thickness of the abdominal subcutaneous fat (AP(ASF)), as markers of body constitution.
The average volume of the pancreas was 79.2 ± 24.1 cm(3) (ranging from 37.4 to 168.2 cm(3)). Pancreatic volume strongly correlated with all measured diameters of the pancreas (P < 0.0001). Pancreatic volume significantly correlated with gender (M:F = 86.1:72.8 cm(3), P = 0.002) and the LL(L1) (r = 0.185, P = 0.008), and did not correlate with the age (r = -0.110, P = 0.151) and the AP(ASF) (r = -0.115, P = 0.104). Correlation of vertebral body-pancreas volume ratio of each subject and the age was strongly negative (r = -0.202, P = 0.006).
Marked individual variations in normal pancreas volume were observed. Pancreatic volume could be computed using the diameters measurable by the cross-sectional imaging employing the formula: V = (AP(tail) + AP(body))/2 × L(body&tail) × CC(body) + (AP(head)/2)(2) × 3.14 × CC(head).
[Show abstract][Hide abstract] ABSTRACT: Gastrointestinal metastases from invasive lobular breast cancer are uncommon with the stomach and small intestines being the most common metastatic sites. Peritoneal and rectal metastases are very rare and only rarely occur as the first manifestation of disease. We herein report the case of a 47-year-old woman who presented with abdominal carcinomatosis as a first sign of invasive lobular breast carcinoma (ILC). Identifying the most important immunohistochemical markers for ILC: gross cystic disease fluid protein 15, estrogen and progesterone receptors enabled a correct diagnosis. After a six year disease-free period, relapse occurred with severe obstruction due to rectal metastasis from lobular breast carcinoma. Since there was no widespread metastatic disease, surgery with concomitant hormonal therapy was performed.
[Show abstract][Hide abstract] ABSTRACT: Combined endovascular interventions on carotid and coronary arteries are rare. Stenting of the unprotected coronary left main stem is a high risk procedure. We presented hemodynamically unstable patient with combined carotid artery and left main stem coronary artery stenting.
A 78-year-old female patient was admitted to our institution for right carotid endaterectomy. The patient had 80% stenosis of the right carotid artery and occlusion of the left carotid artery. Coronary angiography revealed 70% ostial left main stenosis, occlusion of the right coronary artery and the left circumflex artery, and 80% stenosis of the left anterior descending artery. Simultaneous carotid artery endaterectomy and coronary artery by-pass grafting were considered. Due to high perioperative risk, surgery was rejected, and the patient was treated endovascularly with stenting of arteries occluded. The procedure was completed without complications and the patient was hemodynamically stabilised.
This report illustrates simultaneous coronary and carotid stenting as a successfull lifesaving procedure.
Full-text · Article · Aug 2011 · Vojnosanitetski pregled. Military-medical and pharmaceutical review
[Show abstract][Hide abstract] ABSTRACT: The goal of the study was to evaluate the outcome and complications after percutaneous nephrostomy (PCN) insertion in advanced and terminal-stage gynecological malignancies with ureteral obstruction (UO).
We analyzed data of 117 patients with UO due to gynecological malignancies, who had undergone PCN between 1996 and 2006. Cervical cancer was evidenced in 108 patients, uterine carcinoma in six and ovarian cancer in three patients. Eighty-nine had UO at the initial manifestation of the disease, 22 had persistent or recurrent cancer, and six were disease-free after initial therapy. Oliguria was observed in 22.2% and creatine elevation in 79.5%. Mean follow-up was 11.43 months (range 0-112).
The median age was 51 years (range 28-85). Bilateral nephrostomy was performed in 36.7% and unilateral in 63.3%. Renal function normalization occurred in 24.8%. Overall two-year survival (OS) was 16.8%. Higher OS occurred in patients without initial azotemia versus those with azotemia (26.8% vs 13.9%). Median survival time for all the patients was seven months, eight in primary cases versus six in recurrent ones, and eight months in patients after initial therapy. Complications appeared in 53.85%. Most frequent were the loss of the nephrostomy catheter in 37.61% and urinary tract infections in 19.6%.
Improvement of renal function after PCN can be of clinical benefit in patients who might be cured or for prolonged palliative care. Azotemia seems to be poor prognostic sign.
No preview · Article · Jan 2010 · European journal of gynaecological oncology
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION: Chest sonography was used until recently mainly for diagnosis of pleural diseases. High resolution ultrasound machines enable ultrasound application not only in pleural diseases detection, but in diagnosing peripheral lung and mediastinal lesions. Ultrasonography can define the origin and structure of the lesion of thoracic wall, pleural and peripheral lung lesions and mediastinal lesions. PLEURAL LESIONS: Ultrasonography is very useful in diagnosing pleural effusion and distinguishing pleural fluid and pleural thickening. This method can also differentiate transudate from exudates and tumor mass from pleural thickening. LUNG LESIONS: Ultrasonography can reveal the cause of white hemithorax differentiating pleural effusion from large tumor mass or atelectasis. Peripheral pulmonary lesions, extending into visceral pleura can be visualized by ultrasonography and differentiation solid tumor from inflammation is possible. MEDIASTINAL LESIONS: Computerized tomography and magnetic resonance are methods of choice in diagnosing mediastinal diseases. Ultrasonography is useful in distinguishing normal thymus from tumor mass and for ultrasonography-guided biopsy. CONCLUSION: Ultrasonography is a very useful second line method in diagnosis of chest disease. The advantages of this method include bed, side availability, absence of radiation, and guided aspiration of fluid-filled areas and solid tumors.
[Show abstract][Hide abstract] ABSTRACT: Pulmonary sequestration is a non-functioning pulmonary parenchyma that is separated from tracheobronchial tree and receives its blood supply via systemic arteries. The diagnosis of sequestration pulmonis is based on clinical symptoms and characteristic radiologic findings.
In this report, radiological findings of pulmonary sequester in three patients with non-resolving pneumonia were retrospectively reviewed. All patients underwent chest x-ray, computerized tomography of thorax and angiography. X-ray revealed in all cases tumorlike, unsharply bordered shadows in the posterior basal parts of the lung, two on the right and one on the left side. Computerized tomography (CT) finding showed solid-cystic tumor masses and angiography revealed anomalous blood supply from systemic arteries arising from aorta and running to the shadow in the lung. This finding is typical of bronchopulmonary sequestration. All patients were operated on and histological analysis of operative material confirmed diagnosis of intralobar pulmonary sequestration.
Sequestration pulmonis can cause a diagnostic problem due to unspecific symptoms and atypical radiographic and CT findings. Therefore, it is important to demonstrate the arterial supply and venous drainage of the sequestered segment preoperatively. Today, with the help of non-invasive imaging techniques such as CT and magnetic resonance imaging (MRI), preoperative diagnosis of pulmonary sequester can be made easily, so, invasive techniques such as angiography are not required frequently.
Full-text · Article · May 2009 · Medicinski pregled
[Show abstract][Hide abstract] ABSTRACT: To review clinical and radiological characteristics of a patients with bronchial carcinoid.
In this retrospective study, we reviewed the clinical, pathological and imaging findings in 42 patients diagnosed with bronchial carcinoid during the seven years period.
There were 23 women and 19 men, with a mean age of 47 years (range from 15 to 75). Thirty patients had typical and 12 atypical bronchial carcinoid. Dominant symtoms were cough (46.7%) and 38%. Tumor was localized in 28 patients in the left, and 14 in the right lung. On radiographs carcinoid manifested as tumor shadow in 40.5%, nodule and atelectasis in 21.4% cases each respectively, pleural effusion and pneumonia in 7.1% each respectively and hyperinflation in 2.4% of the cases. Computerized tomography revealed endoluminal tumor in 30.9% patients.
Major imaging findings are central, tumor mass or nodule and obstruction signs like atelectasis. Diagnosis is confirmed by pathological examination of samples taken by bronchoscopy or surgery.
Full-text · Article · Jan 2009 · Acta chirurgica iugoslavica
[Show abstract][Hide abstract] ABSTRACT: At the current level of stent application in urology each irreversible urostasis contraindicated for surgical therapy implies consideration of indications for metal stent insertion. Stent incrustation which leads directly into a new uroobstruction is a characteristic complication of this method. Available experience in different uroobstructive conditions has shown that very different clinical aspects of stent usage may directly determine the possibility of their incrustation. Stent incrustation may occur in the early postprocedural course or several months later. After that, prevention of stent incrustation starts with postprocedural evaluation, selection of the stent type, and it is subsequently continued by insertion technique and lasts practically permanently after the insertion (infection control, promotion of diuresis and maintenance of normal urodynamics). Authors present own experianse in clinical aplication of metal stents in uroradiology strictures for period of last 15 years.
No preview · Article · Jan 2009 · Acta chirurgica iugoslavica
[Show abstract][Hide abstract] ABSTRACT: We presented the X-ray and CT findings characteristic for gastric cancers of different localizations (localized in different parts of the stomach). Particularly, esophagogastric junction (EGJ) carcinomas and antral carcinomas are singled out, as two localizations of gastric cancer that we usually meet in everyday clinical and radiological practice, and which have completely different radiological presentation. Advanced carcinomas of esophago-gastric junction, whose incidence is on the rise, usually affect the distal segment of the esophagus, cardia, and proximal part of the stomach, in different proportions. Siewert's, and the Japanese classification of these tumors are listed. Due to the involvement of the distal esophagus, scanning region, besides the abdomen, should be expanded to the chest. Advanced cancer of the antral part of the stomach is presented by the X-ray as a fungating, infiltrative, or combined form, often capturing the entire wall circumference. Possible infiltration of the left liver, the body and neck of the pancreas, colon and anterior abdominal wall should be estimated by CT.
Preview · Article · Jan 2009 · Acta chirurgica iugoslavica
[Show abstract][Hide abstract] ABSTRACT: Transcatheter antitumor therapy very quickly accepted during the last decade and their importance in the treatment of oncology patients will be increasing. By improvement of new targeted agents, which can be given intraarterial or systemic, efficiency of transcatheteric therapeutic approaches can be drastically increased. Numerous clinical trials (study phase I / II / III) relating to the synergy of two antitumor therapeutic approaches are already in progress. Preliminary results of these trials are already very encouraging. Further improvement in the development of specific therapeutics antitumor drugs and systemic applications will be a big step in the quest for medication against malignant tumors.
Full-text · Article · Jan 2009 · Acta chirurgica iugoslavica