Steroid Cell Tumours: Rare Ovarian Tumours that Cause Hyperandrogenaemia in Postmenopausal Women

2020 ◽  
Author(s):  
xiaodan zhu ◽  
linyu zhou ◽  
jian jiang ◽  
Tian'an Jiang
Keyword(s):  
Postmenopausal Women ◽  
Clinical Manifestations ◽  
Case Series ◽  
Resistance Index ◽  
Cell Tumor ◽  
Imaging Features ◽  
Ovarian Steroid ◽  
Clinical Recurrence ◽  
Imaging Characteristics ◽  
Ovarian Tumours

Abstract Background Diagnosing hyperandrogenemia in postmenopausal women is very difficult, because it occasionally manifests as excessive hair growth or no clinical manifestations, so it is often misdiagnosed or missed diagnosis. Ovarian steroid cell tumours that cause hyperandrogenaemia in women account for approximately 0.1% of all ovarian tumours. Due to the low incidence, corresponding imaging reports are rare, so ovarian steroid cell tumours lacks typical imaging findings to differentiate it from other ovarian tumours. Therefore, we summarized its clinical and imaging characteristics through this case series ,and we also elaborated on the differential diagnosis of steroid cell tumors. We hope to help clinicians have a deeper understanding of ovarian steroid cell tumours.Case presentation we report three cases of postmenopausal women with hyperandrogenaemia.Only 1 patient showed virilization symptoms, the other two patients were completely asymptomatic. All patients underwent total hysterectomy + bilateral adnexectomy. Histological results showed one case of leyding cell tumor (case 1) and two cases of benign non-specific steroid cell tumor (case 2 and case 3). After the operation, the androgen levels of all patients returned to normal, and there was no clinical recurrence since follow-up.Conclusions Through this series of cases, we found that although virilization caused by increased serum testosterone levels is an important clinical feature of ovarian steroid cell tumors, complete asymptomatic is also one of its features. A solid, slightly hypoechoic, round or oval mass with uniform internal echo, richer blood flow in the solid part and low resistance index are typical imaging features of ovarian steroid cell tumors. Diagnosis of ovarian steroid cell tumours after menopause is challenging, but surgery can be used for both diagnosis and clear treatment.

scholarly journals Case series, contemporary review and imaging guided diagnostic and management approach of congenital pericardial defects

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001103 ◽  
Author(s):  
Mohamed Khayata ◽  
Saqer Alkharabsheh ◽  
Nishant P Shah ◽  
Beni Rai Verma ◽  
James L Gentry ◽  
...  
Keyword(s):  
Cardiac Ct ◽  
Cleveland Clinic ◽  
Clinical Manifestations ◽  
Case Series ◽  
Left Ventricular ◽  
Management Approach ◽  
Imaging Features ◽  
Pericardial Defect ◽  
Congenital Pericardial Defect

ObjectiveCongenital pericardial defect (CPD) is a rare entity with an estimated frequency of 0.01%–0.04%. The recognition of this anomaly is important since it can be associated with serious complications. The aim of this study and review was to describe clinical and imaging features that help in establishing the diagnosis of this condition.MethodsWe retrospectively reviewed all adult patients at the Cleveland Clinic Health System with the diagnosis of CPD between the years 2000 and 2015. Baseline clinical characteristics, clinical manifestations, ECG, transthoracic echocardiography (TTE), cardiac CT and cardiac magnetic resonance (CMR) images were reviewed.ResultsEight patients were included in the study. Sixty-three percent of patients were males with mean age at diagnosis of 48 years, 63% had a partial pericardial defect on the left side and right ventricular (RV) dilation on TTE. Three patients had CMR. Levocardia was present in all CMRs. One patient had greater than 60° clockwise rotation and none of the CMRs showed ballooning of the left ventricular apex. One patient required surgical pericardioplasty. The remaining seven patients had a median follow-up of 17.3 months (5–144.9 months) and all remained asymptomatic.ConclusionCPDs are more likely to be partial on the left side and patients often have RV dilation on the TTE and levocardia on CMR. Most patients remain stable and do not require surgical intervention. TTE and CMR play an important role in making the diagnosis of this anomaly.

scholarly journals Imaging analysis of 13 rare cases of renal collecting (Bellini) duct carcinoma patients in northern China: a case series and literature review.

2020 ◽  
Author(s):  
Zhehao Lyu ◽  
Lili Liu ◽  
Huimin Li ◽  
Haibo Wang ◽  
Qi Liu ◽  
...  
Keyword(s):  
Ct Scan ◽  
Clinical Manifestations ◽  
Case Series ◽  
Northern China ◽  
Renal Tumors ◽  
Duct Carcinoma ◽  
Imaging Characteristics ◽  
Pet Ct ◽  
Bellini Duct Carcinoma ◽  
Mass Type

Abstract Background: Collective duct carcinoma (CDC) is a highly malignant kidney tumor which is rare in clinical. We report our 12-year experience of Collecting (Bellini) duct carcinoma (CDC) and retrospectively analyzed patients and tumour characteristics, clinical manifestations, different imaging characteristics including CT, MRI and PET/CT. Methods: From January 2007 to December 2019, we retrospectively examined all renal tumors and identifed 13 cases of CDC from 3 medical centers in the northern China. All 13 patients underwent CT scan, 8 of whom underwent dynamic enhanced CT scan, 2 underwent PET/CT scan and 1 underwent MRCP examination. The lesions were divided into nephritis type and mass type according to the morphology of the tumors.Results: The study group included 10 men and 3 women, with an average age of 64.23±10.74 years old. Of these 13 patients, the main clinical manifestations include gross hematuria, flank pain or waist discomfort. The mean tumour size was 8.48 ± 2.48 cm. In this group of cases, 6 (46.2%) cases are cortical-medullary involved type, 7 (53.8%) cases are cortex-medullary-pelvis involved type. 11 (84.6%) cases were nephritis type and 2 (15.4%) cases were mass type. The lesions appeared solid or complex solid and cystic on CT and MRI. The parenchymal part of 13 CDC tumors showed isodensity or slightly higher density on unenhanced CT scan. Two patients with PET/CT showed increased radioactivity intake. Evidence of intra-abdominal metastatic disease was present on CT in 9 ( 69.2% ) cases.Conclusions: The Collecting (Bellini) duct carcinoma has its certain imaging characteristics which were different from the other renal cell carcinoma. A renal tumor should be considered as CDC when it locates in the junction zone of the renal cortex and medulla, with unclear border, slight enhancement and metastases in early stage. PET/CT can greatly enrich the key information of diagnosis, surgery and treatment options, which provide significant help to the clinic.

scholarly journals Neurosyphilis presenting with myelitis-Case series and literature review

2019 ◽  
Author(s):  
Yali Wu ◽  
Wenqing Wu
Keyword(s):  
Clinical Symptoms ◽  
Treponema Pallidum ◽  
Clinical Manifestations ◽  
Case Series ◽  
Transverse Myelitis ◽  
Penicillin G ◽  
Imaging Features ◽  
Delayed Treatment ◽  
Systemic Corticosteroids ◽  
Magnetic Resonance Imaging Mri

Abstract Background Neurosyphilis is a great imitator because of its various clinical symptoms. Syphilitic myelitis is extremely rare manifestation of neurosyphilis and often misdiagnosed. However, a small amount of literature in the past described its clinical manifestations and imaging features, and there was no relevant data on the prognosis, especially the long-term prognosis. In this paper, 4 syphilis myelitis patients admitted to our hospital between July 2012 and July 2017 were retrospectively reviewed. In the 4 patients, 2 were females, and 2 were males. We present our experiences with syphilitic myelitis, discuss the characteristics, treatment and prognosis. Case presentation The diagnosis criteria were applied: (1) diagnosis of myelitis established by two experienced neurologist based on symptoms and longitudinally extensive transverse myelitis (LETM) at the cervical and thoracic levels mimicked neuromyelitis optic (NMO) on magnetic resonance imaging (MRI) ; (2) Neurosyphilis (NS) was diagnosed by positive treponema pallidum particle assay (TPPA) and toluidine red untreated serum test (TRUST) in the serum and CSF; (3) negative human immunodeficiency virus (HIV). Likewise, all patients were negative for serum anti-aquaporin 4 (AQP-4), as well as negative bacterial, fungal, virus, or mycobacterium tuberculosis in the CSF. Treatment included intravenous penicillin G, with 24 million units of penicillin G per day administered intravenously for 14 days, and three patients were also treated with systemic corticosteroids. Neurological examination, serologic syphilis diagnostic tests (TPPA, TRUST) and cerebrospinal fluid tests (TPPA, TRUST) were examined approximately every 12~24 weeks after treatment. The follow-up time ranged from 12 to 70 months, with an average of 36.6 months. The prognosis was well in 3 cases who received early anti-syphilis treatment, but 1 case who received delayed treatment due to misdiagnose had no improvement. Conclusions Neurosyphilis should be considered when there are long hyperintensity lesions in the MRI spinal cord. Prompt diagnosis and combined antibiotics-corticosteroid therapy may improve neurological prognosis.

scholarly journals Radiologic evaluation of discharge quality in patients with COVID-19

2020 ◽  
Author(s):  
Jingwen Li ◽  
Xi Long ◽  
Fang Fang ◽  
Xuefei Lv ◽  
Dandan Zhang ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Clinical Manifestations ◽  
Case Series ◽  
High Sensitivity ◽  
Imaging Features ◽  
Radiologic Evaluation ◽  
Discharged Patients ◽  
Novel Coronavirus ◽  
Discharge Criteria ◽  
Progressive Stage

Abstract Background Worldwide spread of the novel coronavirus disease 2019 (COVID-19) has made hundreds of thousands people sick and fortunately many of them have been treated and discharged. However, it remains unclear how well the discharged patients were recovering. Chest CT scan, with demonstrated high sensitivity to COVID-19, was used here to examine clinical manifestations in patients at discharge.Methods This study registered retrospectively single-center case series of 180 discharged patients, all confirmed with COVID-19 at Wuhan Red Cross Hospital in Wuhan, China. Epidemiological, demographic, clinical, laboratory and treatment data were collected. CT imaging features of absorption vs progressive stage were compared and analyzed.Results Five pulmonary lobes were affected in 54 (30%) of the 180 patients at the absorption stage, comparing to 66% of them at the progressive stage (P=1.45×10-11). Forty five (25%) patients had pleural effusion on admission and 13 of them still carried hydrothorax when discharged as per standard discharge criteria(P=4.48×10-6). Besides, compared with those at progressive stage, 97 (54%) discharged patients had interlobular thickening (P=6.95×10-3) and 43% of them still presented adjacent pleura thickening (P=5.58×10-5). The median total CT score of discharged patients at absorption stage was lower than progressive stage (3 vs 12.5 ). The median total CT score recovery rate was 67% (range, 0-100%) and 139 (77%) patients showed less than 90% improvement at discharge.Conclusions A majority (77%) of the discharged patients had not recovered completely. The current discharge criteria may need to include 90% or higher CT score-based recovery rate.Authors Jingwen Li, Xi Long, Fang Fang, and Xuefei Lv contributed equally to this work.Authors Zhicheng Lin and Nian Xiong are joint last coauthors.

Do All Notochordal Lesions Require Proton Beam Radiotherapy? A Proposed Reclassification of Ecchordosis Physaliphora as Benign Notochord Cell Tumor

2021 ◽  
Author(s):  
Aïsha Sooltangos ◽  
Istvan Bodi ◽  
Prajwal Ghimire ◽  
Konstantinos Barkas ◽  
Sinan Al-Barazi ◽  
...  
Keyword(s):  
Proton Beam ◽  
Case Series ◽  
Cell Tumor ◽  
Imaging Features ◽  
Csf Rhinorrhea ◽  
Proton Beam Radiotherapy ◽  
Tertiary Referral Center ◽  
Notochord Cell ◽  
Ecchordosis Physaliphora ◽  
Imaging Surveillance

Abstract Objectives Ecchordosis physaliphora (EP) is a benign notochord lesion of the clivus arising from the same cell line as chordoma, its malignant counterpart. Although usually asymptomatic, it can cause spontaneous cerebrospinal fluid (CSF) rhinorrhea. Benign notochordal cell tumor (BNCT) is considered another indolent, benign variant of chordoma. Although aggressive forms of chordoma require maximal safe resection followed by proton beam radiotherapy, BNCT and EP can be managed with close imaging surveillance without resection or radiotherapy. However, while BNCT and EP can be distinguished from more aggressive forms of chordoma, differentiating the two is challenging as they are radiologically and histopathologically identical. This case series aims to characterize the clinicopathological features of EP and to propose classifying EP and BNCT together for the purposes of clinical management. Design Case series. Setting Tertiary referral center, United Kingdom. Participants Patients with suspected EP from 2015 to 2019. Main Outcome Measures Diagnosis of EP. Results Seven patients with radiological suspicion of EP were identified. Five presented with CSF rhinorrhea and two were asymptomatic. Magnetic resonance imaging features consistently showed T1-hypointense, T2-hyperintense nonenhancing lesions. Diagnosis was made on biopsy for patients requiring repair and radiologically where no surgery was indicated. The histological features of EP included physaliphorous cells of notochordal origin (positive epithelial membrane antigen, S100, CD10, and/or MNF116) without mitotic activity. Conclusion EP is indistinguishable from BNCT. Both demonstrate markers of notochord cell lines without malignant features. Their management is also identical. We therefore propose grouping EP with BNCT. Close imaging surveillance is required for both as progression to chordoma remains an unquantified risk.

scholarly journals A diagnostic approach for differentiating abdominal tuberculosis from ovarian malignancy: a case series and literature review

2019 ◽  
Vol 13 (S11) ◽  
Author(s):  
Moh Nailul Fahmi ◽  
Annisaa Pelita Harti
Keyword(s):  
Ovarian Cancer ◽  
Extrapulmonary Tuberculosis ◽  
Clinical Manifestations ◽  
Case Series ◽  
Abdominal Tuberculosis ◽  
Diagnostic Approach ◽  
Ca 125 ◽  
Imaging Features ◽  
Ovarian Malignancy ◽  
Cancer Antigen 125

Abstract Background Abdominal tuberculosis is an uncommon variant of extrapulmonary tuberculosis. It accounts for 3.5% of extrapulmonary tuberculosis. Diagnosis of abdominal tuberculosis is still a challenge due to its non-specific symptoms. Abdominal tuberculosis and ovarian cancer may show similar symptoms, laboratory and imaging features. The goal of our report is to emphasize for the need of a diagnostic approach based on clinical manifestations, laboratory, imaging findings, and additional tests for considering a diagnosis of abdominal tuberculosis rather than ovarian cancer. Case presentation We report 3 cases of abdominal tuberculosis in our Onco-gynaecology Division, Department of Obstetrics and Gynaecology, Sardjito Hospital, Yogyakarta, Indonesia in 2018 which were previously diagnosed as ovarian malignancy and managed surgically. All of our patients experienced abdominal pain and enlargement but only two of them had significant weight loss. The general symptoms were typically found in onco-gynaecology patients, especially in those with ovarian malignancy. Ultrasound examination showed multilocular masses, 2 of them with solid parts and ascites. Cancer antigen 125 (CA-125) levels were found increasing in those three patients. All of them were treated surgically and diagnosis of abdominal tuberculosis was established through the histopathological result of tissue biopsy. Based on our cases and literature, we consider the need of a diagnostic approach to differentiate abdominal tuberculosis from ovarian malignancy, an attempt to avoid unnecessary invasive procedures that put burden risk for the patients. Conclusion Minimally invasive tests to establish the diagnosis of abdominal tuberculosis should be optimized to reduce the burden risk of laparotomy. Careful diagnostic steps should be followed to avoid wrong diagnosis.

scholarly journals Evaluation of the Clinical, Laboratory, and Radiological Findings and Treatment of 19 Cases of Pancreatic Echinococcosis

2020 ◽  
Vol 7 (5) ◽  
Author(s):  
Li Gou ◽  
Feng Gao ◽  
Maijudan Tiheiran ◽  
Hui Guo
Keyword(s):  
Cyst Wall ◽  
Rural Areas ◽  
Clinical Laboratory ◽  
Clinical Manifestations ◽  
Enzyme Linked Immunosorbent Assay ◽  
Imaging Features ◽  
Test Results ◽  
Radiological Findings ◽  
Abdominal Ct ◽  
Imaging Characteristics

Abstract Background Hydatid disease is a severe health problem in endemic areas. In recent years, the incidence of this disease in China has been increasing. As the imaging characteristics of pancreatic echinococcosis (PE) are similar to those of cystic diseases, such as cysts, tuberculosis, and tumors, PE is often misdiagnosed and mistreated. Methods The clinical manifestations, laboratory tests, radiological findings, and treatment of 19 patients with PE between January 2006 and December 2018 in 2 hospitals were retrospectively analyzed. Results The mean age of the patients was 38 years, and the ratio of women to men was 2. All patients came from rural areas. Clinical manifestations included cholestatic jaundice, mass, nausea, pain, and swelling. Hemagglutination inhibition test results were positive for all patients. Enzyme-linked immunosorbent assay test results were positive in 17 cases (89.5%). Foci in the pancreas were head in 52.6%, body in 26.3%, body and tail in 15.8%, tail in 5.3%. The size of lesions’ diameter ranged from 1 to 12 cm (mean, 6.5 cm). The imaging features of PE included the presence of (a) daughter cysts on abdominal computed tomography (CT) and/or magnetic resonance imaging (MRI); (b) internal cyst wall dissection and ribbon sign on abdominal CT and/or MRI; (c) typical eggshell cyst wall calcification on abdominal CT. Conclusions For patients with cystic lesions on CT and/or MRI combined with epidemiological history and positive echinococcosis serology, doctors can correctly diagnose PE earlier. Surgical treatment combined with drugs can reduce the mortality of PE, leading to a better prognosis.

scholarly journals Clinical Characteristics of 20 Patients with Chronic Eosinophilic Pneumonia: A 6-year Retrospective Study

2020 ◽  
Author(s):  
Yang Xu ◽  
Zhanbo Wang ◽  
Zhaorui Zhang ◽  
Yu Dai ◽  
Qiang Zhu ◽  
...  
Keyword(s):  
Peripheral Blood ◽  
Clinical Manifestations ◽  
Lavage Fluid ◽  
Eosinophilic Pneumonia ◽  
Imaging Features ◽  
Course Of Disease ◽  
Chronic Eosinophilic Pneumonia ◽  
Imaging Characteristics ◽  
Blood Eosinophils

Abstract Background: Chronic eosinophilic pneumonia (CEP) is a rare disease and there are few systematic studies on the disease. We summarized the clinical and pathological data of CEP to improve the understanding of the disease, as well as to reduce misdiagnosis and mistreatment. Methods: The data of patients pathologically diagnosed as CEP in PLA General Hospital between May 2013 and May 2019 were collected, and the clinical manifestations, imaging characteristics, pathological features, treatment and prognosis were retrospectively analyzed. Results: There were 20 patients with CEP, including 6 males and 14 females. The average age at the time of diagnosis was 47.0 ± 10.2 (22-83) years, and the average course of disease was 15.5 ±11.5 (2-72) months. The main clinical manifestations were cough, dyspnea, expectoration, and shortness of breath, and often accompanied by fever, weight loss, and asthenia. 19 patients had elevated peripheral blood eosinophils, with the proportion of eosinophils ranging from 5.3-64.7%, and the absolute value of eosinophils ranging from 0.72-14.43×109/L. 18 patients had increased proportion of eosinophils in bronchoalveolar lavage fluid (BALF), ranging from 12-67%, with an average of 46%. The main imaging features were patchy shadows, consolidated shadows, and ground glass shadows. The histological examination of bronchial mucosal biopsy indicated eosinophilic infiltration in submucosal tissues and the pulmonary biopsy indicated a large number of eosinophils infiltration in alveolar cavity and septum as the main pathological changes of CEP. All of 20 patients were treated with glucocorticoid, and one of them relapsed during follow-up. Conclusions: The onset of CEP is insidious and the clinical manifestations are lack of specificity. Eosinophils increase in peripheral blood and BALF in most of CEP patients. The typical image is peripheral and subpleural distribution of lung infiltrates. The diagnosis of CEP depends on pathology, and glucocorticoid therapy is effective.

scholarly journals Intraorbital wooden foreign bodies: case series and literature review

2021 ◽  
Vol 14 (10) ◽  
pp. 1619-1627
Author(s):  
Ya-Yan You ◽  
◽  
Xin-Yan Wang ◽  
Jin Chen ◽  
Zheng-Rong Wang ◽  
...  
Keyword(s):  
Foreign Bodies ◽  
Case Reports ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Case Series ◽  
Aged People ◽  
Imaging Characteristics ◽  
Close Observation ◽  
Missed Diagnosis ◽  
Magnetic Resonance Imaging Mri

Intraorbital wooden foreign bodies (IOWFBs) constitute a relatively rare ocular trauma, which occupy a special type of intraorbital foreign bodies (IOFBs). Data regarding IOWFBs must be obtained from case reports or small case series due to their rarity. Here, we reported 5 cases of IOWFBs and reviewed the related literatures, which could provide comprehensive information regarding the clinical manifestations, diagnosis, and surgical treatment of IOWFBs. Combined with the published literature, a total of 51 independent cases were counted after we added 5 cases. Among them, the number of male and female patients was 35 and 16 respectively; the mean age was 27.3±18.2 (range 1-66)y. Obviously, the disorder seemed to occur mainly in young and middle-aged people. Because of the diversity in the clinical manifestations and imaging characteristics of IOWFBs, misdiagnosis and missed diagnosis often occur during the initial visit. Delayed diagnosis may lead to a high risk of orbital infection caused by IOWFBs. Surgery is the treatment of choice for most patients; however, the missed diagnosis and residue of foreign bodies after previous surgery cannot be ignored. Therefore, an accurate diagnosis is governed by the detailed trauma history, careful ocular examination, close observation of clinical manifestations, correct imaging diagnosis [e.g., magnetic resonance imaging (MRI) or computerized tomography (CT)], and timely and completely elimination of IOWFBs.

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