MRI findings of epithelial–myoepithelial carcinoma of the parotid gland with radiologic–pathologic correlation

Purpose This study aimed to describe the MRI findings of epithelial-myoepithelial carcinoma (EMC) of the parotid gland. Materials and methods Seven patients (four males and three females) aged 40–86 years (mean age, 64 years) with histologically proven EMC of the parotid gland who underwent surgical resection after preoperative MRI were enrolled. MRI images were retrospectively reviewed and contrasted with pathological findings. Results Five patients (71%) had predominantly solid lesions, and two (29%) had predominantly cystic lesions. All seven lesions had well-demarcated margins and capsules without the invasion of adjacent structures. The capsules were incomplete in five lesions (71%) and complete in two (29%). Four lesions (57%) exhibited a multinodular structure with internal septa. Cystic components were observed in three lesions (43%). On T1-weighted images, the solid components were frequently homogeneous (5/7, 71%), and demonstrated isointensity in five lesions (71%) and hypointensity in two (29%) relative to the spinal cord. On T2-weighted images, the solid components were usually heterogeneous (6/7, 86%), and demonstrated hyperintensity in five lesions (71%) and isointensity in two (29%) relative to the spinal cord. The mean apparent diffusion coefficient value of the solid components was 0.967 × 10−3 mm2/s. Conclusion Parotid gland EMCs usually appeared as predominantly solid lesions with well-demarcated margins and capsules. A multinodular structure with internal septa was characteristics of EMCs.

Peritoneal disease: key imaging findings that help in the differential diagnosis

The peritoneum is a unique serosal membrane, which can be the site of primary tumors and, more commonly, secondary pathologic processes. Peritoneal carcinomatosis is the most common malignant process to affect the peritoneal cavity, and the radiologist plays an important role in making the diagnosis and assessing the extent of disease, especially in sites that may hinder surgery. In this review we address the role of the radiologist in the setting of peritoneal pathology, focusing on peritoneal carcinomatosis as this is the predominant malignant process, followed by revising typical imaging findings that can guide the differential diagnosis. We review the most frequent primary and secondary peritoneal tumor and tumor-like lesions, proposing a systemic approach based on clinical history and morphological appearance, namely distinguishing predominantly cystic from solid lesions, both solitary and multiple.

A Novel Endoscopic Ultrasonography Imaging Technique for Depicting Microcirculation in Pancreatobiliary Lesions without the Need for Contrast-Enhancement: A Prospective Exploratory Study

Detective flow imaging endoscopic ultrasonography (DFI-EUS) provides a new method to image and detect fine vessels and low-velocity blood flow without using ultrasound contrast agents. The aim of this study was to evaluate the utility of DFI-EUS for pancreatobiliary lesions and lymph nodes. Between January 2019 and January 2020, 53 patients who underwent DFI-EUS, e-FLOW EUS, and contrast-enhanced EUS were enrolled. The ability of DFI-EUS and e-FLOW EUS to detect vessels was compared with that of contrast-enhanced EUS. This article describes the DFI technique along with our first experience of its use for vascular assessment of pancreatobiliary lesions. Vessels were imaged in 34 pancreatic solid lesions, eight intraductal papillary mucinous neoplasms (IPMNs), seven gall bladder lesions, and four swollen lymph nodes. DFI-EUS (91%) was significantly superior to e-FLOW EUS (53%) with respect to detection of vessels (p < 0.001) and for discrimination of mural nodules from mucous clots in IPMN and gallbladder lesions from sludge (p = 0.046). Thus, DFI-EUS has the potential to become an essential tool for diagnosis and vascular assessment of various diseases.

Obstruction at the level of foramen of monro causing obstructive hydrocephalus

Background: The foramen of monro is also known by the name of interventricular foramen. The study was conducted to determine the etiology, clinical picture, radiological features, and different modalities of management and related complications.Methods: A prospective study of 30 cases with diagnosis of hydrocephalus due to obstruction at the interventricular foramen. Lesions at the foramen of monro were addressed either by open craniotomy approach or neuroendoscopy approach. For open craniotomy transcortical or interhemispheric approach was preferred and Karl Storz’s LOTTA system was used for all the neuroendoscopic procedures.Results: Craniopharyngioma and colloid cysts were the most common pathology in children and adults respectively. Endoscopic approach was particularly helpful in decreasing the convalescence period and postoperative complications. Wound site CSF leak is the most commonly faced complications. In our study, out of 30 patients, males accounted for 23 (77%) cases and females for 7 (23%) cases. Majority were in the age group of 20-40 years. The most common presenting complaints of patients having foramen of monro obstruction with hydrocephalus were headache and vomiting. Gadolinium enhanced contrast MRI of brain was the investigation of choice for diagnosing these lesions.Conclusions: Endoscopic approach can be offered as a first line of treatment as a part of standard treatment in all patients having foramen of monro obstruction. It obviates the need for multiple shunt procedures. Although small solid lesions less than 3 cm in size can be addressed by endoscopic approach, the learning curve required for endoscopic approach to deal with solid lesions is very steep.

Accuracy and other quality indicators of solid pancreatic mass endoscopic ultrasound-guided fine needle aspiration and biopsy in two academic endoscopy centers

Background and aims : Endoscopic ultrasound fine-needleaspiration/biopsy (EUS-FNA/FNB) is highly accurate, but dis-crepancies between cytological and surgical diagnoses are stillobserved. We aimed to determine its accuracy and monitor qualityindicators in our facilities. Patients and methods : We performed a retrospective review ofall cases of pancreatic solid lesions evaluated by EUS-FNA/FNB,between July 2015 and June 2018, in two centers. Cytologicaland surgical findings were categorized into five groups: benign,malignant, suspect of malignancy, undetermined and insufficientfor diagnosis. Final diagnosis was based on surgical diagnosis and,in patients who did not undergo surgery, on clinical outcome after6 months follow-up. Results : Altogether, 142 patients were included. FNA was thepreferred tissue acquisition method (88%), with a predilection forthe FNA 22G needle (57%). Cytology was insufficient for diagnosisin 2 cases, therefore a full diagnostic sample was available in 98.6%of the patients (>90%, ESGE target). Fifty-five (38.7%) patientsunderwent surgery. In term of cancer diagnosis, comparison withfinal surgical pathology (n=55) revealed 89% true positives, 5.5%true negatives, 3.6% false positives and 1.8% false negatives. Whencombining surgical diagnosis and clinical outcomes together, EUS-guided sampling sensitivity was 97.4% (92.5-99.5), specificity was92.3% (74.9-99.1), positive predictive value was 98.2% (93.6-99.5),negative predictive value was 88.9% (72.3-96.1) and accuracy was96.4% (91.9-98.8). Post-procedural acute pancreatitis was reportedin 2 patients (1.4%). Conclusions : These results reveal a performance for diagnostictissue sampling well above the ESGE proposed target standard.Also, the uncommon high specificity illustrates the determiningrole of the pathologist’s final interpretation and diagnosis.

Performance of a new flexible 19 G EUS needle in pancreatic solid lesions located in the head and uncinate process: A prospective multicenter study

Background and study aims The poor flexibility of large-bore EUS needles often leads to technical failure when sampling from the duodenum. The aim of this study was to evaluate the technical and diagnostic performances of a new Menghini tip 19G nitinol EUS needle for sampling pancreatic solid lesions in the head and uncinate process. Patients and methods This was a European prospective multicenter single-arm study. A maximum of four passes were allowed. In case of failure, different needles were permitted. Results We included 75 patients (51 % males) with lesions in the head (n = 68; 91 %) and uncinate process (n = 7; 9 %) (mean size: 33 ± 12 mm; number of passes: 1.8 ± 0.9). Technical success was seen in 71 of 75 (94.7 %). Diagnostic rates were 89.3 % (67/75) and 94.4 % (67/71) in the intention-to-treat (ITT) and per-protocol (PP) analysis, respectively. In the eight cases with failure, diagnosis was obtained with another needle (n = 4), from another lesion (n = 3) or with follow-up (n = 1). A histological sample was obtained in 64 patients (ITT 85.3 % and PP 90 %) and immunohistochemistry was successfully performed in 13 of 15 lesions in which it was required. No differences between rapid on-site evaluation (ROSE) and non-ROSE groups were observed regarding diagnostic success (87.5 % vs 91 %, P = 0.582) and diagnosis at the first pass (70 % vs 81 %, P = 0.289). Number of passes was lower in the ROSE group (1.4 + 0.9 vs 2.2 + 0.7, P < 0.001). One adverse event was recorded (1.3 %) consisting in a duodenal perforation after a single session EUS-ERCP. Conclusions The new nitinol Menghini tip 19G EUS needle showed high technical diagnostic success in safely sampling solid lesions in the head and uncinate process of the pancreas.