Laryngeal schwannoma with extralaryngeal extension mimicking a thyroid tumour

Objective: A schwannoma is a common benign tumour that can arise anywhere in the body. When it occurs in an unusual location such as the larynx, its differentiation from other tumours can be challenging. Herein, we report a case of a laryngeal schwannoma with extralaryngeal extension that mimicked a thyroid tumour, focusing on its characteristic features on MRI. Methods: A 19-year-old male presented with a mass in the left side of the neck and hoarseness for 2 years. Endoscopy showed a submucosal mass in the laryngeal region. MRI found a well-defined solid mass in the thyroid gland, extending to the larynx through the lower edge of the thyroid cartilage. T2 weighted MRI showed slightly low signal intensity at the central part of the tumour and high signal intensity at the peripheral part of the tumour. Pre-operative imaging suggested that the tumour originated in the thyroid gland. Left thyroidectomy with tumour excision was performed; the tumour was diagnosed as a laryngeal schwannoma with extralaryngeal extension, compressing the thyroid gland. In retrospect, features such as the dumbbell-shape and known as ‘target sign’ on T2 weighted MRI were typical features of schwannoma. Additionally, the tumour’s extension pattern was similar to previous reports of laryngeal schwannomas with extralaryngeal extension. Conclusion: A large laryngeal schwannoma may extend outside the larynx with significant compression of the thyroid gland. Understanding the pattern of extension and familiarity with the features on MRI can improve the preoperative diagnosis accuracy.

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A case of peripancreatic plexiform schwannoma

Surgical Case Reports ◽

10.1186/s40792-021-01284-7 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Kenji Fukushima ◽

Makoto Shinzeki ◽

Kentaro Tai ◽

Masaki Omori ◽

Natsuko Yamauchi ◽

...

Keyword(s):

Magnetic Resonance ◽

Signal Intensity ◽

Pancreatic Tissue ◽

The Body ◽

Nerve Plexus ◽

Diagnostic Process ◽

High Signal ◽

Spleen Preserving ◽

Plexiform Schwannoma ◽

Diffusion Weighted Images

Abstract Background Plexiform schwannoma is one of the least common variants of schwannoma, accounting for only 5% of all schwannoma cases. It generally occurs in the skin and subcutaneous tissues and is uncommon in deep soft tissue or viscera. We present an extremely rare case of plexiform schwannoma arising from the peripancreatic plexus. Case presentation A 29-year-old man presented with hyperglycemia detected during a medical checkup. He was diagnosed with type 1 diabetes based on the clinical findings and laboratory tests. During the diagnostic process for diabetes, a 2.5 cm mass was incidentally detected in the pancreas by abdominal ultrasound. Contrast-enhanced computed tomography revealed a mass that was gradually enhanced at the body and tail of the pancreas. Magnetic resonance imaging revealed low signal intensity of the mass on T1-weighted images and high signal intensity on T2-weighted and diffusion-weighted images. Magnetic resonance cholangiopancreatography showed no abnormal findings in the main pancreatic duct. Endoscopic ultrasonography (EUS) showed a lobulated, low-echoic mass with a clear boundary. EUS-guided fine needle biopsy was performed, and spindle-shaped cells that were diffusely immunopositive for S-100 and negative for c-kit and desmin were detected, resulting in a diagnosis of a neurogenic tumor arising from the pancreas or the peripancreatic nerve plexus. The patient underwent laparoscopic spleen-preserving distal pancreatectomy. Although the tumor was connected to the splenic plexus, the splenic artery could be divided along its adventitial plane. Macroscopic findings of the excised tumor consisted of multiple yellowish-white nodules, and its histopathological features were consistent with plexiform schwannoma. There was no pancreatic tissue on the dorsal surface of the tumor, which suggested that the tumor arose from the peripancreatic nerve plexus. Conclusions The findings documented herein can aid in the differential diagnosis of peripancreatic schwannoma and in planning appropriate treatment.

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THYROID DYSFUNCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE: THE STATE OF THE PROBLEM AND THE WAYS OF SOLVING

Nephrology (Saint-Petersburg) ◽

10.24884/1561-6274-2018-22-4-40-49 ◽

2018 ◽

Vol 22 (4) ◽

pp. 40-49 ◽

Cited By ~ 1

Author(s):

A. R. Volkova ◽

O. D. Dygun ◽

B. G. Lukichev ◽

S. V. Dora ◽

O. V. Galkina

Keyword(s):

Chronic Kidney Disease ◽

Thyroid Gland ◽

Kidney Disease ◽

Thyroid Hormones ◽

Thyroid Function ◽

Thyroid Dysfunction ◽

The Body ◽

Type I ◽

Low T3 ◽

Iodine Excretion

Disturbance of the thyroid function is often detected in patients with different profiles. A special feature of patients with chronic kidney disease is the higher incidence of various thyroid function disturbances, especially hypothyroidism. It is known that in patients with chronic kidney disease (CKD) iodine excretion from the body is violated, since normally 90% of iodine is excreted in urine. Accumulation of high concentrations of inorganic iodine leads to the formation of the Wolf-Chaikoff effect: suppression of iodine organization in the thyroid gland and disruption of the thyroid hormones synthesis. Peripheral metabolism of thyroid hormones is also disturbed, namely, deiodinase type I activity is suppressed and peripheral conversion of T4 into T3 is inhibited (so-called low T3 syndrome). Therefore, patients with CKD are often diagnosed with hypothyroidism, and the origin of hypothyroidism is not always associated with the outcome of autoimmune thyroiditis. The article presents an overview of a large number of population studies of thyroid gland dysfunction in patients with CKD, as well as experimental data specifying the pathogenetic mechanisms of thyroid dysfunction in patients with CKD. Therapeutic tactics are still not regulated. However, in a number of studies, replacement therapy with thyroid hormones in patients with CKD had some advantages.

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The joint involvement in adult onset Still's disease is characterised by a peculiar magnetic resonance imaging and a specific transcriptomic profile

Scientific Reports ◽

10.1038/s41598-021-91613-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Piero Ruscitti ◽

Antonio Barile ◽

Onorina Berardicurti ◽

Sonia Iafrate ◽

Paola Di Benedetto ◽

...

Keyword(s):

Signal Intensity ◽

Clinical Characteristics ◽

High Signal Intensity ◽

Adult Onset Still’S Disease ◽

Joint Involvement ◽

High Signal ◽

Bone Erosions ◽

Transcriptomic Profile ◽

Synovial Tissues ◽

Bone Oedema

AbstractAdult onset Still's disease (AOSD) is a rare systemic autoinflammatory disease, characterised by fever, arthritis, and skin rash, and joint involvement is one of its clinical manifestations. The aims of this work were to assess joint involvement, to describe main patterns of involvement, and associated clinical characteristics. In this work, we aimed at assessing the joint involvement in AOSD by using MRI, to describe main patterns and associated clinical characteristics. In addition, we aimed at assessing the global transcriptomic profile of synovial tissues in AOSD to elucidate possible pathogenic pathways involved. We also evaluated the global transcriptomic profile of synovial tissues to elucidate possible pathogenic pathways involved in the disease. Thus, AOSD patients, who underwent to MRI exam on joints, were assessed to describe patterns of joint involvement and associated clinical characteristics. Some synovial tissues were collected for RNA-sequencing purposes. The most common MRI finding was the presence of synovitis on 60.5%, mainly in peripheral affected joints, with low to intermediate signal intensity on T1-weighted images and intermediate to high signal intensity on T2-fat-saturated weighted and STIR images. Bone oedema and MRI-bone erosions were reported on 34.9% and 25.6% MRI exams, respectively. Patients with MRI-bone erosions showed a higher prevalence of splenomegaly, a more frequent chronic disease course, lower levels of erythrocyte sedimentation rate, and ferritin. In AOSD synovial tissues, a hyper-expression of interleukin (IL)-1, IL-6, and TNF pathways was shown together with ferritin genes. In conclusion, in AOSD patients, the most common MRI-finding was the presence of synovitis, characterised by intermediate to high signal intensity on T2-fat-saturated weighted and STIR images. MRI-bone erosions and bone oedema were also observed. In AOSD synovial tissues, IL-1, IL-6, and TNF pathways together with ferritin genes resulted to be hyper-expressed.

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Preoperative Magnetic Resonance Cholangiopancreatography for Detecting Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis

Diagnostics ◽

10.3390/diagnostics11030383 ◽

2021 ◽

Vol 11 (3) ◽

pp. 383

Author(s):

Kojiro Omiya ◽

Kazuhiro Hiramatsu ◽

Yoshihisa Shibata ◽

Masahide Fukaya ◽

Masahiro Fujii ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Magnetic Resonance ◽

Acute Cholecystitis ◽

Signal Intensity ◽

Magnetic Resonance Cholangiopancreatography ◽

Gallbladder Wall ◽

High Signal ◽

Mri Findings ◽

Open Conversion ◽

Preoperative Magnetic Resonance

Previous studies have shown that signal intensity variations in the gallbladder wall on magnetic resonance imaging (MRI) are associated with necrosis and fibrosis in the gallbladder of acute cholecystitis (AC). However, the association between MRI findings and operative outcomes remains unclear. We retrospectively identified 321 patients who underwent preoperative magnetic resonance cholangiopancreatography (MRCP) and early laparoscopic cholecystectomy (LC) for AC. Based on the gallbladder wall signal intensity on MRI, these patients were divided into high signal intensity (HSI), intermediate signal intensity (ISI), and low signal intensity (LSI) groups. Comparisons of bailout procedure rates (open conversion and laparoscopic subtotal cholecystectomy) and operating times were performed. The recorded bailout procedure rates were 6.8% (7/103 cases), 26.7% (31/116 cases), and 40.2% (41/102 cases), and the median operating times were 95, 110, and 138 minutes in the HSI, ISI, and LSI groups, respectively (both p < 0.001). During the multivariate analysis, the LSI of the gallbladder wall was an independent predictor of both the bailout procedure (odds ratio [OR] 5.30; 95% CI 2.11–13.30; p < 0.001) and prolonged surgery (≥144 min) (OR 6.10, 95% CI 2.74–13.60, p < 0.001). Preoperative MRCP/MRI assessment could be a novel method for predicting surgical difficulty during LC for AC.

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