Metabolic imaging characteristics of a rare disseminated synovial sarcoma diagnosed by brain biopsy

Synovial sarcoma (SS) accounts for 5- 10% of all adult soft-tissue sarcomas and only 5% arises in the spine. It presents like any other spinal tumor, namely axial pain with symptoms due to neural compression. Imaging findings can also be similar to any other benign spinal tumor. We present a 43-year-old male who presented with symptoms of radiculopathy and neural compression and imaging revealed a dumbbell tumor at C6 to D1 with transforaminal and paraspinal extension on the right side. After surgical excision the histopathology revealed a rare synovial sarcoma of the spine. Synovial sarcoma of the spine though rare, are difficult to differentiate based on their presentation and imaging characteristics from benign spinal tumors. However, subtle findings on imaging and a pre-operative biopsy may aid in performing a more definitive surgery upfront rather than a re-do surgery after the histopathological diagnosis.

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CS-1 Cerebellar liponeurocytoma; Report of two cases with detailed metabolic, immunohistochemical, and genetic evaluations

Neuro-Oncology Advances ◽

10.1093/noajnl/vdab159.106 ◽

2021 ◽

Vol 3 (Supplement_6) ◽

pp. vi27-vi27

Author(s):

Miyuki Shimizu ◽

Shinichi Origuchi ◽

Seiichiro Hirono ◽

Tomoo Matsutani ◽

Masayuki Oota ◽

...

Keyword(s):

Lipid Accumulation ◽

Splice Site Mutation ◽

Residual Tumor ◽

World Health ◽

Metabolic Imaging ◽

Site Mutation ◽

Genetic Profiling ◽

Imaging Characteristics ◽

Positron Emission ◽

Cerebellar Liponeurocytoma

Abstract Cerebellar liponeurocytoma (cLNC), World Health Organization grade II neoplasm, is a rare brain tumor characterized by advanced neuronal/neurocytic differentiation and focal lipid accumulation in neuroepithelial tumor cells. However, the expression and genetic profiling of cLNC, as well as metabolic imaging characteristics, have been poorly studied. Two patients with lower vermian tumors were operated on with telovelar approach. Moderate methionine uptake in positron emission tomography was observed in both cases. Histologically, the tumor was composed of small, uniform cells with round nuclei in a sheet-like fashion. Vacuolate cells with displacement of nuclei suggested the lipid accumulation, which was further supported by immunohistochemical staining of S-100. Although the extent of lipidization was relatively low compared with the reported cLNC cases, the immunohistochemical findings confirmed the diagnosis of cLNC. Next-generation sequencing of tumoral DNA in one case detected a splice site mutation of the ATRX gene, which is the first observation in the literature. Neither chemotherapy nor radiotherapy were administered postoperatively in both cases. In one case with spinal dissemination, residual tumor demonstrated progression 7 months after the resection. Long term follow-up data of cLNC cases with detailed expression and genetic profiles are essential for precise diagnosis and better understanding of the oncogenic pathway as well as the natural history of cLNC.

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Multiple Large Tumefactive MS Plaques in a Young Man: A Diagnostic Enigma and Therapeutic Challenge

Case Reports in Radiology ◽

10.1155/2012/363705 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Hossein Kalanie ◽

Ali Amini Harandi ◽

Reza Bakhshandehpour ◽

Daryoosh Heidari

Keyword(s):

Multiple Sclerosis ◽

Steroid Therapy ◽

Intramuscular Injection ◽

Clinical Presentation ◽

Brain Biopsy ◽

Mass Effect ◽

Considerable Improvement ◽

Imaging Characteristics ◽

History Of ◽

Tumefactive Demyelinating Lesion

Tumefactive demyelinating lesion is defined as large solitary demyelinating lesion with imaging characteristics mimicking neoplasm. These atypical features include size more than 2 cm, mass effect, edema, and/or ring enhancement. Distinguishing tumefactive lesions from other etiologies of intracranial space occupying lesions is essential to avoid inadvertent surgical or toxic chemotherapeutic intervention. Symptoms are generally atypical for multiple sclerosis (MS) and usually related to the pressure of a focal mass lesion without a history of MS. The clinical presentation and MRI appearance of these lesions often lead to biopsy. Here, we present a young man with fulminating neurological symptoms and multiple large tumefactive lesions on either hemisphere. Since patient and parents were not agreed on brain biopsy, a course of steroid therapy was commenced which ended to considerable improvement and confirmed the diagnosis of tumefactive MS. Thirteen months later, he experienced another relapse when his treatment was continued by weekly intramuscular injection of interferon b1a (Avonex). Two further MRIs showed shrinkage of tumefactive plaques and resolution of edema in the periphery of lesions.

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NIMG-62. ATYPICAL IMAGING CHARACTERISTICS OF PRIMARY CNS LYMPHOMA AT INITIAL PRESENTATION LEADS TO FREQUENT MISDIAGNOSIS AND DELAYS IN DIAGNOSIS

Neuro-Oncology ◽

10.1093/neuonc/noz175.731 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi175-vi175

Author(s):

Marissa Barbaro ◽

Peter Pan ◽

Kiran Thakur ◽

Mary Welch

Keyword(s):

Medical Center ◽

Primary Cns Lymphoma ◽

Brain Biopsy ◽

Cns Lymphoma ◽

Imaging Features ◽

Columbia University ◽

Imaging Characteristics ◽

Increased Risk ◽

Mri Scans ◽

Delays In Diagnosis

Abstract BACKGROUND Primary CNS lymphoma (PCNSL) has protean appearances on magnetic resonance imaging (MRI) that may lead to delays in diagnosis. METHODS We retrospectively reviewed histologically-confirmed PCNSL at Columbia University Irving Medical Center (CUIMC, 2010–2019), and characterize imaging features on pre-treatment MRI scans. RESULTS 64 patients were analyzed. 61 of 64 (95%) presented with enhancement. 35 of 64 (55%) were multiply enhancing, and 26 of 64 (41%) were singly enhancing (of which 2 were dural-based). 3 of 64 (5%) were non-enhancing. 42 of 59 (71%) had diffusion restriction. 36 of 49 (73%) lacked susceptibility. 40 of 64 (63%) were periventricular. 28 of 64 (43%) had callosal involvement. In 14 of 54 (26%), lymphoma was either not included in the differential or specifically noted less likely in radiographic report – this radiographically misdiagnosed group was significantly more likely to be either non-enhancing or non-periventricular (p=0.026). Furthermore, radiographic misdiagnosis was associated with an increased risk of a more than 14-day delay from the initial MRI to the initial invasive study, either lumbar puncture or brain biopsy (p=0.04). Presentation with a single enhancing lesion, on the other hand, was associated with significantly faster time to diagnosis – median 4.6 days (IQR 3) vs 21.6 days (IQR 4.5) from initial MRI (p=0.04). CONCLUSION In PCNSL, imaging characteristics influence outcomes. While a classic single enhancing lesion is associated with rapid diagnosis, non-enhancing and non-periventricular disease are the most likely to be misdiagnosed and require a heightened index of suspicion to avoid delays to diagnosis.

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Tumefactive demyelinating lesions: conventional and advanced magnetic resonance imaging

Multiple Sclerosis Journal ◽

10.1191/1352458505ms1145oa ◽

2005 ◽

Vol 11 (2) ◽

pp. 135-139 ◽

Cited By ~ 35

Author(s):

Christian Enzinger ◽

Siegrid Strasser-Fuchs ◽

Stefan Ropele ◽

Peter Kapeller ◽

Reinhold Kleinert ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Magnetization Transfer ◽

Correct Diagnosis ◽

Brain Biopsy ◽

High Dose ◽

Resonance Imaging ◽

Neuronal Marker ◽

Imaging Characteristics ◽

Demyelinating Lesions

In rare instances, demyelinating disorders present with radiological features that mimic a brain tumour. This often leads to biopsy, which-apart from carrying significant morbidity-frequently turns out as nondiagnostic or dispensable. We therefore set out to assess the contribution of repeated conventional magnetic resonance imaging (MRI), 1H-MR spectroscopy and magnetization transfer imaging in establishing a correct diagnosis of tumefactive demyelinating lesions (TDLs). We studied two females and one male, who presented with TDLs that led to brain biopsy in two cases, for up to three years. TDLs were characterized by the following features: (a) delayed or absent response to high-dose steroids together with progressive lesion growth over several weeks; (b) late or sparse enhancement, ill-defined borders, signal inhomogeneity and considerable concomitant oedema; and (c) normalization of initial increases in lipid and lactate peaks within three to four weeks, followed by persistent, marked reductions of the neuronal marker NAA and MTR values around or below 30%. These imaging characteristics reflected the histological correlate of marked demyelination in the absence of significant inflammation. MRI techniques thus appear to have the potential to establish a correct diagnosis of this subtype of TDLs. Awareness of these possibilities might obviate the need for biopsy at least in some cases in future.

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Multiparametric whole-body anatomic, functional, and metabolic imaging characteristics of peripheral lesions in patients with schwannomatosis

Journal of Magnetic Resonance Imaging ◽

10.1002/jmri.25236 ◽

2016 ◽

Vol 44 (4) ◽

pp. 794-803 ◽

Cited By ~ 10

Author(s):

Shivani Ahlawat ◽

Asad Baig ◽

Jaishri O. Blakeley ◽

Michael A. Jacobs ◽

Laura M. Fayad

Keyword(s):

Whole Body ◽

Metabolic Imaging ◽

Imaging Characteristics

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The High Resolution Scanning Transmission Electron Microscope

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100051591 ◽

1974 ◽

Vol 32 ◽

pp. 316-317

Author(s):

A. V. Crewe

Keyword(s):

Electron Microscope ◽

High Resolution ◽

High Vacuum ◽

Scanning Transmission Electron Microscope ◽

Ultra High Vacuum ◽

Resolving Power ◽

Imaging Characteristics ◽

Transmission Electron ◽

Scanning Transmission ◽

The Moment

The high resolution STEM is now a fact of life. I think that we have, in the last few years, demonstrated that this instrument is capable of the same resolving power as a CEM but is sufficiently different in its imaging characteristics to offer some real advantages.It seems possible to prove in a quite general way that only a field emission source can give adequate intensity for the highest resolution^ and at the moment this means operating at ultra high vacuum levels. Our experience, however, is that neither the source nor the vacuum are difficult to manage and indeed are simpler than many other systems and substantially trouble-free.

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