Radiation diagnostics of peripheral primitive neuroectodermal tumors (PNET) in children at the Scientific Center of Pediatrics and Pediatric Surgery (Almaty, Kazakhstan)

Relevance: Peripheral primitive neuroectodermal tumor (primitive neuroectodermal tumor – PNET) belongs to the group of malignant tumors that develop from migrating embryonic neural crest cells. PNET includes several nosological forms: Askin’s tumor, esthesioneuroblastoma, the very peripheral primitive neuroectodermal tumor, and Ewing’s sarcoma. PNET accounts for 3–9% of all soft tissue tumors and 19% of all soft tissue sarcomas in children. In Europe and the US, PNETs account for 3.4 cases per year per 1 million children below 15 years; in Kazakhstan – 0.6-1.2 cases per 1 million child population. Rapid tumor growth, malignancy, and early metastasis to other organs and systems predetermine the PNET’s specific role in oncology. The purpose of the study was to improve the quality and availability of early sarcoma diagnostics in children at medical institutions of the general medical network. Results: 35 cases of peripheral PNET in children were analyzed. The age of the patients was 1.5 to 17 years, the average age – 9.3 years. Boys were 1.3 times more than girls. One patient (3.6%) had extra-skeletal tumor localization. Children with stage IIB prevailed – 46.4% of cases (13 children). Radiographical differentiation between Ewing’s sarcoma and primary chronic or “healed” (antibiotic) acute hematogenous osteomyelitis in the initial phase of the process is almost impossible before the extraosseous soft tissue component is formed. The bone damage process is more often localized in the bone diaphysis and subsequently spreads to its metaphyses. Conclusion: PNET is more likely to come from the chest wall, so it is advisable to start the X-ray examination from the chest. In terms of radiation semiotics, PNET is similar to Ewing’s sarcoma and Askin’s tumor; therefore, an additional immunohistochemical study of the tumor tissue is required. An important indirect diagnostic criterion in Ewing’s sarcoma is the predominance of the soft tissue component over the bone manifestations. Extended CT and MRI studies with contrast enhancement (chest, abdominal cavity, pelvis, and the primary lesion area) and skeletal scintigraphy are required to clarify the extent of changes, stage the tumor accurately, and assess the tumor dynamics after treatment. The above conclusions generally confirm the available literature data.

Magnetic Resonance Imaging Profile of Chordomas - A Retrospective Evaluation from a Tertiary Institution of Eastern India

BACKGROUND Chordomas are tumours presumed to originate from the remnants of embryonic notochord. They present a diagnostic challenge as they can occur in any region within the craniospinal axis and are rare with an incidence of less than 0.1 / 100,000 per year. Imaging is required for their evaluation and magnetic resonance imaging (MRI) is the imaging modality of choice due to excellent soft tissue resolution, multiplanar imaging capabilities and precise anatomical delineation. METHODS MRI scans of 10 patients, who had proven chordomas histologically, were evaluated retrospectively in the Department of Radiodiagnosis, Bangur Institute of Neurosciences from July 2012 to June 2018. Patients without histological proof of chordomas and those lost to follow-up were not included in the study. Clinical information such as age, sex, presenting symptoms were noted. Imaging parameters assessed included tumour location, bone destruction, extraspinal soft tissue component, spinal canal and neural foramina encroachment, arterial encasement, signal intensity, morphology and enhancement pattern by MRI. All the cases were scanned in a 1.5 Tesla MRI machine. Intravenous contrast were used in all cases. RESULTS Of the 10 cases, 7 were male and 3 were female. There were 7 cases of sacrococcygeal chordomas and 3 cases of clival chordomas. The tumours appeared as multilobulated masses with bone destruction. All sacrococcygeal lesions involved more than one vertebral segment with extraspinal soft tissue component encroaching the pelvic cavity and showed cystic spaces containing hypointense septae. All 3 cases of clival chordomas showed compression of the pons and basilar artery. In one case there was compression of optic chiasma with displacement of internal carotid arteries laterally. On T1 weighted imaging, the chordomas were isointense in 4 and hypointense in 6 cases. These tumours were hyperintense in T2WI in 8 and intermediate to high in signal intensity in 2 cases. All demonstrated heterogenous enhancement on contrast with moderate enhancement in 8 patients and mild enhancement in 2 cases. CONCLUSIONS Chordomas are rare tumours that can occur anywhere in the craniospinal axis. MRI is the modality of choice for imaging of chordomas. Characteristic findings in MRI include low to intermediate signal intensity on T1w images and high signal intensity on T2w images. Sacral chordomas have T2 hyperintense cystic masses with hypointense septa. Enhancement is heterogenous ranging from mild to moderate. MRI is invaluable for a pre-operative diagnosis, delineation of tumour extent and as roadmap for surgery and radiotherapy. KEYWORDS Chordomas, Magnetic Resonance Imaging, Clivus, Sacrococcygeal

Juxtacortical Osteosarcoma-Imaging Spectrum

Juxtacortical Osteosarcoma (OS) presents with three sub-types. These include parosteal OS, periosteal OS, and Highgrade surface OS. Imaging diagnosis of sub-types of Juxtacortical osteosarcoma is difficult. However, an analysis of 14 cases of these sub-types presents a spectrum of findings in each entity. The analysis of the Site, Transitional zone, Age, Matrix mineralization, Periosteal reaction, and Soft tissue component (STAMPS) are essential in making the final diagnosis and differential diagnosis.

Percutaneous C-arm-guided Wide Bore Needle Biopsy for Intraosseous Spinal Lesions

ABSTRACT Study design Retrospective analysis of data of those patients who underwent a percutaneous transpedicular biopsy at our hospital was done. All patients had a bony lesion in a vertebra (thoracic, lumbar, sacrum) without a soft tissue component around the bone and neurodeficit. Objective To analyze the role of percutaneous wide bore needle biopsy in vertebral lesions without any soft tissue component. Summary of background data Adequate treatment of spinal lesions requires formulation of diagnosis-best achieved by a tissue biopsy when all attempts at diagnosis fail by noninvasive methods. Percutaneous CT guided fine needle biopsy is technically difficult in intraosseous lesions leading to frequent inconclusive results and hence the necessity of wide bore needle biopsy. Materials and methods Retrospective analysis of data of 26 patients with mean age of 58.8 years who underwent a percutaneous transpedicular biopsy at our hospital was done. All patients had a bony lesion in a vertebra (thoracic, lumbar, saccrum) without a soft tissue component around the bone and neurodeficit. The procedure was done under local anesthesia with sedation. Results Positive diagnosis was achieved in 23 out of 26, i.e. 88.4% of cases (adequacy). Out of 26, there were 13 cases of malignancy (50%), 8 cases of tuberculosis (30.7%), 2 cases of osteoporosis (7.6%) and biopsy was inconclusive in 3 (11.5%) cases. Of the 13 malignancies, 7 cases were of metastasis (53.8%), 5 cases of plasmocytoma (38.4%) and 1 case of lymphoma (7.6%). Conclusion Percutaneous biopsy under fluoroscopic guidance by transpedicular approach is quite safe and gives high adequacy (88.4%) without significant complications that are associated with open and paraspinal techniques. How to cite this article Basu S, Tikoo A, Malik FH, Ghosh JD, Jain M, Sarangi T. Percutaneous C-arm-guided Wide Bore Needle Biopsy for Intraosseous Spinal Lesions. J Postgrad Med Edu Res 2015;49(1):5-9.

Case 14.19

52-year-old woman with a sacral mass that was incidentally identified after minor trauma Axial T1-weighted FSE images (Figure 14.19.1) and fat-suppressed T2-weighted FSE images (Figure 14.19.2) reveal a lobulated mass with marked T2 hyperintensity originating in the sacrum and having a large anterior soft tissue component. The mass is predominantly hypointense to skeletal muscle on the T1-weighted images, with smaller regions of increased signal intensity. Sagittal fat-suppressed T2-weighted FSE images (...

Case 3.19

21-year-old woman who noticed a right upper quadrant bulge, which her physician thought was a hernia; eventually, CT was performed, revealing a complex hepatic mass Coronal 3D SSFP images (Figure 3.19.1) and axial postgadolinium 3D SPGR images (Figure 3.19.2) demonstrate a multicystic lesion with multiple mildly enhancing septations. The inferior axial image shows a more prominent enhancing soft tissue component along the lateral margin of the mass. A volume-rendered image reconstructed from 3D SSFP source data (...