1
|
Saberian C, Lurain K, Hill LK, Marshall V, Cornejo Castro EM, Labo N, Miley W, Moore K, Roshan R, Ruggerio M, Ryan K, Widell A, Ekwede I, Mangusan R, Rupert A, Barochia A, Whitby D, Yarchoan R, Ramaswami R. Kaposi sarcoma herpesvirus viral load in bronchoalveolar lavage as a diagnostic marker for pulmonary Kaposi sarcoma. AIDS 2024; 38:1172-1180. [PMID: 38564482 PMCID: PMC11141217 DOI: 10.1097/qad.0000000000003897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Kaposi sarcoma is a vascular tumor that affects the pulmonary system. However, the diagnosis of airway lesions suggestive of pulmonary Kaposi sarcoma (pKS) is reliant on bronchoscopic visualization. We evaluated the role of Kaposi sarcoma herpesvirus (KSHV) viral load in bronchoalveolar lavage (BAL) as a diagnostic biomarker in patients with bronchoscopic evidence of pKS and evaluated inflammatory cytokine profiles in BAL and blood samples. DESIGN In this retrospective study, we evaluated KSHV viral load and cytokine profiles within BAL and blood samples in patients who underwent bronchoscopy for suspected pKS between 2016 and 2021. METHODS KSHV viral load and cytokine profiles were obtained from both the circulation and BAL samples collected at the time of bronchoscopy to evaluate compartment-specific characteristics. BAL was centrifuged and stored as cell pellets and KSHV viral load was measured using primers for the KSHV K6 gene regions. RESULTS We evaluated 38 BAL samples from 32 patients (30 with HIV co-infection) of whom 23 had pKS. In patients with airway lesions suggestive of pKS, there was higher KSHV viral load (median 3188 vs. 0 copies/10 6 cell equivalent; P = 0.0047). A BAL KSHV viral load cutoff of 526 copies/10 6 cells had a sensitivity of 72% and specificity of 89% in determining lesions consistent with pKS. Those with pKS also had higher IL-1β and IL-8 levels in BAL. The 3-year survival rate for pKS patients was 55%. CONCLUSION KSHV viral load in BAL shows potential for aiding in pKS diagnosis. Patients with pKS also have evidence of cytokine dysregulation in BAL.
Collapse
Affiliation(s)
- Chantal Saberian
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Kathryn Lurain
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Lindsay K Hill
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Vickie Marshall
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Elena M. Cornejo Castro
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Nazzarena Labo
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Wendell Miley
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Kyle Moore
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Romin Roshan
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Margie Ruggerio
- Critical Care Medicine and Pulmonary Branch, National Heart Lung and Blood Institute, Bethesda, MD
| | - Kerry Ryan
- Critical Care Medicine and Pulmonary Branch, National Heart Lung and Blood Institute, Bethesda, MD
| | - Anaida Widell
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Irene Ekwede
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Ralph Mangusan
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Adam Rupert
- AIDS Monitoring Laboratory, Leidos Biomedical Research, Frederick, MD
| | - Amisha Barochia
- Critical Care Medicine and Pulmonary Branch, National Heart Lung and Blood Institute, Bethesda, MD
| | - Denise Whitby
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Robert Yarchoan
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Ramya Ramaswami
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| |
Collapse
|
2
|
Belard S, Taccari F, Kumwenda T, Huson MA, Wallrauch C, Heller T. Point-of-care ultrasound for tuberculosis and HIV-revisiting the focused assessment with sonography for HIV-associated tuberculosis (FASH) protocol and its differential diagnoses. Clin Microbiol Infect 2024; 30:320-327. [PMID: 37923216 DOI: 10.1016/j.cmi.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/10/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The 'Focused assessment with sonography for HIV-associated tuberculosis' (FASH) protocol has been applied and researched for over a decade in HIV-infected patients with suspected extra-pulmonary tuberculosis. Interpretation of target FASH features may be challenging as they can also indicate alternative opportunistic diseases. OBJECTIVES The primary aim of the review was summarizing the accumulated evidence on the diagnostic accuracy of the FASH protocol including description of diagnoses of target FASH features. SOURCES Literature was searched using PubMed, Google Scholar, and publications referencing the original FASH publications; data from identified studies were compiled with data from studies identified by a preceding Cochrane review. A meta-analysis was performed based on a generalized linearized mixed model. Data on differential diagnoses were compiled by literature review and retrospective evaluation of clinical data. CONTENT We identified ten studies; abdominal target FASH features were most studied. Sensitivity and specificity estimates were 39% (95% CI 25-54) and 89% (95% CI 83-96) for enlarged lymph nodes (ten studies), and 30% (95% CI 16-45%) and 93% (95% CI 89-98%) for hypoechoic spleen lesions (eight studies). In people living with HIV differential diagnoses of target FASH features are multiple and primarily include other opportunistic infections and malignancies such as non-tuberculous mycobacterial infection, bacillary angiomatosis, hepato-splenic brucellosis, meliodiosis, visceral leishmaniasis, invasive fungal infections, and lymphoma as well as Kaposi sarcoma. Ultrasound-guided diagnostic sampling may assist obtention of a definitive diagnosis. IMPLICATIONS On the basis of current evidence, although limited by methodology, and personal experience, we recommend basic ultrasound training, including the FASH protocol and ultrasound-guided diagnostic interventions, for all healthcare providers working with people living with HIV in resource-limited settings.
Collapse
Affiliation(s)
- Sabine Belard
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany; Partner Site Tübingen, German Center for Infection Research (DZIF), Tübingen, Germany.
| | - Francesco Taccari
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Michaëla Am Huson
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Tom Heller
- Lighthouse Clinic Trust, Lilongwe, Malawi; International Training and Education Center for Health, University of Washington, Seattle, WA, USA
| |
Collapse
|
3
|
Ota Y, Lee E, Sella E, Agarwal P. Vascular Malformations and Tumors: A Review of Classification and Imaging Features for Cardiothoracic Radiologists. Radiol Cardiothorac Imaging 2023; 5:e220328. [PMID: 37693195 PMCID: PMC10483253 DOI: 10.1148/ryct.220328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 05/02/2023] [Accepted: 05/17/2023] [Indexed: 09/12/2023]
Abstract
The International Society for the Study of Vascular Anomalies (ISSVA) classification is a comprehensive histology-based scheme that was updated in 2018. It is important for cardiothoracic imagers to understand this classification to ensure that accurate terminology is used and that archaic terms are avoided when vascular lesions are described. Knowledge of the various malformations (including common conditions, such as venous malformation, arteriovenous fistula, and arteriovenous malformation) and vascular tumors allows for timely diagnosis and appropriate management. This review describes various vascular anomalies, in accordance with ISSVA classification and terminology; highlights key imaging features associated with each; and discusses the role of different imaging modalities. Keywords: Pulmonary, Soft Tissues/Skin, Vascular, Arteriovenous Malformation © RSNA, 2023.
Collapse
Affiliation(s)
- Yoshiaki Ota
- From the Division of Cardiothoracic Radiology, Department of
Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI
48109
| | - Elizabeth Lee
- From the Division of Cardiothoracic Radiology, Department of
Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI
48109
| | - Edith Sella
- From the Division of Cardiothoracic Radiology, Department of
Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI
48109
| | - Prachi Agarwal
- From the Division of Cardiothoracic Radiology, Department of
Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI
48109
| |
Collapse
|
4
|
Pitot MA, Tahboub Amawi AD, Alexander LF, LeGout JD, Walkoff L, Navin PJ, Kawashima A, Wood AJ, Dispenzieri A, Venkatesh SK. Imaging of Castleman Disease. Radiographics 2023; 43:e220210. [PMID: 37471247 DOI: 10.1148/rg.220210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Castleman disease (CD) is a group of rare and complex lymphoproliferative disorders that can manifest in two general forms: unicentric CD (UCD) and multicentric CD (MCD). These two forms differ in clinical manifestation, imaging appearances, treatment options, and prognosis. UCD typically manifests as a solitary enlarging mass that is discovered incidentally or after development of compression-type symptoms. MCD usually manifests acutely with systemic symptoms including fever and weight loss. As a whole, CD involves lymph nodes throughout the chest, neck, abdomen, pelvis, and axilla and can have a wide variety of imaging appearances. Most commonly, lymph nodes or masses in UCD occur in the chest, classically with well-defined borders, hyperenhancement, and possible characteristic patterns of calcification and/or feeding vessels. Lymph nodes affected by MCD, while also hyperenhancing, tend to involve multiple nodal chains and manifest alongside anasarca or hepatosplenomegaly. The polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, and skin changes (POEMS) subtype of MCD may demonstrate lytic or sclerotic osseous lesions in addition to features typical of MCD. Since a diagnosis of CD based solely on imaging findings is often not possible, pathologic confirmation with core needle biopsy and/or surgical excision is necessary. Nevertheless, imaging plays a crucial role in supporting the diagnosis of CD, guiding appropriate regions for biopsy, and excluding other potential causes or mimics of disease. CT is frequently the initial imaging technique used in evaluating potential CD. MRI and PET play important roles in thoroughly evaluating the disease and determining its extent, especially the MCD form. Complete surgical excision is typically curative for UCD. MCD usually requires systemic therapy. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
Collapse
Affiliation(s)
- Marika A Pitot
- From the Department of Radiology (M.A.P., A.D.T.A., L.W., P.J.N., S.K.V.), Department of Laboratory Medicine and Pathology (A.J.W.), and Department of Hematology-Oncology (A.D.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Jacksonville, Fla (L.F.A., J.D.L.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.K.)
| | - Ali D Tahboub Amawi
- From the Department of Radiology (M.A.P., A.D.T.A., L.W., P.J.N., S.K.V.), Department of Laboratory Medicine and Pathology (A.J.W.), and Department of Hematology-Oncology (A.D.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Jacksonville, Fla (L.F.A., J.D.L.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.K.)
| | - Lauren F Alexander
- From the Department of Radiology (M.A.P., A.D.T.A., L.W., P.J.N., S.K.V.), Department of Laboratory Medicine and Pathology (A.J.W.), and Department of Hematology-Oncology (A.D.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Jacksonville, Fla (L.F.A., J.D.L.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.K.)
| | - Jordan D LeGout
- From the Department of Radiology (M.A.P., A.D.T.A., L.W., P.J.N., S.K.V.), Department of Laboratory Medicine and Pathology (A.J.W.), and Department of Hematology-Oncology (A.D.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Jacksonville, Fla (L.F.A., J.D.L.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.K.)
| | - Lara Walkoff
- From the Department of Radiology (M.A.P., A.D.T.A., L.W., P.J.N., S.K.V.), Department of Laboratory Medicine and Pathology (A.J.W.), and Department of Hematology-Oncology (A.D.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Jacksonville, Fla (L.F.A., J.D.L.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.K.)
| | - Patrick J Navin
- From the Department of Radiology (M.A.P., A.D.T.A., L.W., P.J.N., S.K.V.), Department of Laboratory Medicine and Pathology (A.J.W.), and Department of Hematology-Oncology (A.D.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Jacksonville, Fla (L.F.A., J.D.L.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.K.)
| | - Akira Kawashima
- From the Department of Radiology (M.A.P., A.D.T.A., L.W., P.J.N., S.K.V.), Department of Laboratory Medicine and Pathology (A.J.W.), and Department of Hematology-Oncology (A.D.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Jacksonville, Fla (L.F.A., J.D.L.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.K.)
| | - Adam J Wood
- From the Department of Radiology (M.A.P., A.D.T.A., L.W., P.J.N., S.K.V.), Department of Laboratory Medicine and Pathology (A.J.W.), and Department of Hematology-Oncology (A.D.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Jacksonville, Fla (L.F.A., J.D.L.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.K.)
| | - Angela Dispenzieri
- From the Department of Radiology (M.A.P., A.D.T.A., L.W., P.J.N., S.K.V.), Department of Laboratory Medicine and Pathology (A.J.W.), and Department of Hematology-Oncology (A.D.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Jacksonville, Fla (L.F.A., J.D.L.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.K.)
| | - Sudhakar K Venkatesh
- From the Department of Radiology (M.A.P., A.D.T.A., L.W., P.J.N., S.K.V.), Department of Laboratory Medicine and Pathology (A.J.W.), and Department of Hematology-Oncology (A.D.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Jacksonville, Fla (L.F.A., J.D.L.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.K.)
| |
Collapse
|
5
|
Endemic Kaposi's Sarcoma. Cancers (Basel) 2023; 15:cancers15030872. [PMID: 36765830 PMCID: PMC9913747 DOI: 10.3390/cancers15030872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023] Open
Abstract
Kaposi's sarcoma (KS) is a common neoplasm in Eastern and central Africa reflecting the spread of human gammaherpesvirus-8 (HHV-8), now considered a necessary causal agent for the development of KS. The endemic KS subtype can follow an aggressive clinical course with ulcerative skin lesions with soft tissue invasion or even bone or visceral involvement. In the latter cases, a thorough imaging work-up and better follow-up schedules are warranted. As KS is a chronic disease, the therapeutic goal is to obtain sustainable remission in cutaneous and visceral lesions and a good quality of life. Watchful monitoring may be sufficient in localized cutaneous forms. Potential therapeutic modalities for symptomatic advanced KS include systemic chemotherapies, immunomodulators, immune checkpoint inhibitors, and antiangiogenic drugs.
Collapse
|
6
|
Soliman M, Guys N, Liu P, Moshiri M, Menias CO, Mellnick VM, Savas H, Badawy M, Elsayes KM, Gaballah AH. Multimodality imaging findings of infection-induced tumors. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3930-3953. [PMID: 36069914 DOI: 10.1007/s00261-022-03651-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 01/18/2023]
Abstract
Several infections can predispose to certain malignancies in different body parts. These infections include viral, bacterial, and fungal pathogens. Imaging plays a vital role in the diagnosis, staging, and management of these neoplastic conditions. Furthermore, it can help in differentiating infection-related non-neoplastic processes that can mimic malignancies. Both radiologists and clinicians should be familiar with these conditions. This review discusses the epidemiology, pathogenesis, and imaging features of infection-related tumors.
Collapse
Affiliation(s)
- Moataz Soliman
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nicholas Guys
- Department of Diagnostic Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter Liu
- Department of Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Mariam Moshiri
- Department of Diagnostic Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Vincent M Mellnick
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Hatice Savas
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Ayman H Gaballah
- Department of Diagnostic Radiology, University of Missouri, Columbia, MO, USA.
| |
Collapse
|
7
|
Tat J, Plitman J, Gold WL. A Pseudotumor. Am J Med 2022; 135:1320-1325. [PMID: 35636482 DOI: 10.1016/j.amjmed.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Jennifer Tat
- Department of Pathobiology and Laboratory Medicine, University of Toronto, Ont, Canada
| | - Jane Plitman
- Department of Medicine, University of Toronto, Ont, Canada.
| | - Wayne L Gold
- Department of Medicine, University of Toronto, Ont, Canada; Division of Infectious Diseases, University Health Network, Toronto, Ont, Canada; Division of General Internal Medicine, University Health Network, Toronto, Ont, Canada
| |
Collapse
|
8
|
Imaging More than Skin-Deep: Radiologic and Dermatologic Presentations of Systemic Disorders. Diagnostics (Basel) 2022; 12:diagnostics12082011. [PMID: 36010360 PMCID: PMC9407377 DOI: 10.3390/diagnostics12082011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Cutaneous manifestations of systemic diseases are diverse and sometimes precede more serious diseases and symptomatology. Similarly, radiologic imaging plays a key role in early diagnosis and determination of the extent of systemic involvement. Simultaneous awareness of skin and imaging manifestations can help the radiologist to narrow down differential diagnosis even if imaging findings are nonspecific. Aims: To improve diagnostic accuracy and patient care, it is important that clinicians and radiologists be familiar with both cutaneous and radiologic features of various systemic disorders. This article reviews cutaneous manifestations and imaging findings of commonly encountered systemic diseases. Conclusions: Familiarity with the most disease-specific skin lesions help the radiologist pinpoint a specific diagnosis and consequently, in preventing unnecessary invasive workups and contributing to improved patient care.
Collapse
|
9
|
Cross-Sectional Imaging Findings of Atypical Liver Malignancies and Diagnostic Pitfalls. Radiol Clin North Am 2022; 60:775-794. [DOI: 10.1016/j.rcl.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
10
|
Torres US, Caiado AH, Tiferes DA, Bretas EA, Ueda SK, Chamié LP, Fong MS, Silva LL, Ottaiano AC, D'Ippolito G. The Cecum Revisited: A Multimodality Imaging Case-based Review of Common and Uncommon Cecal Diseases. Semin Ultrasound CT MR 2022; 43:455-465. [DOI: 10.1053/j.sult.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
11
|
Anorectal pathology in the HIV population: a guide for radiologists. Abdom Radiol (NY) 2022; 47:1762-1774. [PMID: 35284963 DOI: 10.1007/s00261-022-03470-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/01/2022]
Abstract
Patients with human immunodeficiency virus (HIV) can present with a wide range of different acute and chronic pathologies. Anorectal conditions are particularly common in this unique patient population, including pathologies, such as proctitis, anorectal abscess, anorectal fistula, and anal squamous cell carcinoma. The radiologist plays a critical role in the assessment of these common forms of anorectal disease, as these conditions can present with various findings on imaging assessment. Pelvic CT, MRI, and FDG-PET/CT are among the most common modalities used for assessment of anorectal disease in the HIV patient population. Knowledge of the fundamental clinical and imaging findings associated with these pathologies in HIV patients is critical for radiologists.
Collapse
|
12
|
Pesqué L, Delyon J, Lheure C, Baroudjian B, Battistella M, Merlet P, Lebbé C, Vercellino L. Yield of FDG PET/CT for Defining the Extent of Disease in Patients with Kaposi Sarcoma. Cancers (Basel) 2022; 14:cancers14092189. [PMID: 35565319 PMCID: PMC9102885 DOI: 10.3390/cancers14092189] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
Simple Summary The potential role of positron emission tomography/computed tomography with fluorodeoxyglucose (FDG PET/CT) for assessing the extent of Kaposi sarcoma is not well studied. We analyzed FDG PET/CTs performed on 75 patients referred to our department for Kaposi sarcoma staging or restaging. FDG PET/CTs detected most lymph nodes, bone, and muscle lesions, whereas digestive and mucous lesions could be missed. Most cutaneous lesions can be identified when whole-body FDG PET/CT (including lower limbs) is performed. Thus, a true whole-body FDG PET/CT can be recommended for staging purposes in patients with active Kaposi sarcoma and, if positive, be useful for therapeutic evaluation and follow-up. Abstract Background: Positron emission tomography/computed tomography with fluorodeoxyglucose (F-18) (FDG PET/CT) is increasingly used in Kaposi sarcoma (KS), but its value has not been assessed. Objectives: In this study, we aimed to evaluate the diagnostic accuracy of FDG PET/CT to define the extent of disease in KS. Methods: Consecutive patients with KS referred to our department for FDG PET/CT were included. The diagnostic accuracy of FDG PET/CT for cutaneous and extra-cutaneous KS staging was assessed on a per lesion basis compared to staging obtained from clinical examination, standard imaging, endoscopy, histological analyses, and follow-up. Results: From 2007 to 2017, 75 patients with FDG PET/CT were analyzed. The sensitivity and specificity of FDG PET/CT for the overall detection of KS lesions were 71 and 98%, respectively. Sensitivity and specificity were 100 and 85% for lymph nodes, 87 and 98% for bone, 87 and 100% for lungs, and 100 and 100% for muscle involvement, whereas sensitivity was only 17% to detect KS digestive involvement. The sensitivity of the diagnostic for KS cutaneous involvement increased from 73 to 88% when using a whole-body examination. Conclusion: FDG PET/CT showed good sensitivity and specificity for KS staging (digestive involvement excepted) and could be used for staging patients with active KS.
Collapse
Affiliation(s)
- Louise Pesqué
- Nuclear Medicine Department, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (L.P.); (P.M.)
| | - Julie Delyon
- Department of Dermatology, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (J.D.); (B.B.); (C.L.)
- INSERM HIPI Team 1, U976, Saint Louis University Hospital, 1 Avenue Claude Vellefaux, 75010 Paris, France;
- Université de Paris Cité, 75006 Paris, France;
| | - Coralie Lheure
- Université de Paris Cité, 75006 Paris, France;
- Department of Dermatology, Cochin University Hospital, 27, Rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Barouyr Baroudjian
- Department of Dermatology, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (J.D.); (B.B.); (C.L.)
| | - Maxime Battistella
- INSERM HIPI Team 1, U976, Saint Louis University Hospital, 1 Avenue Claude Vellefaux, 75010 Paris, France;
- Université de Paris Cité, 75006 Paris, France;
- Department of Pathology, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Pascal Merlet
- Nuclear Medicine Department, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (L.P.); (P.M.)
- Université de Paris Cité, 75006 Paris, France;
| | - Céleste Lebbé
- Department of Dermatology, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (J.D.); (B.B.); (C.L.)
- INSERM HIPI Team 1, U976, Saint Louis University Hospital, 1 Avenue Claude Vellefaux, 75010 Paris, France;
- Université de Paris Cité, 75006 Paris, France;
| | - Laetitia Vercellino
- Nuclear Medicine Department, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (L.P.); (P.M.)
- Université de Paris, INSERM, UMR_S942 MASCOT, 75006 Paris, France
- Correspondence: ; Tel.: +33-142499411
| |
Collapse
|
13
|
Itani M, Kaur N, Roychowdhury A, Mellnick VM, Lubner MG, Dasyam AK, Khanna L, Prasad SR, Katabathina VS. Gastrointestinal Manifestations of Immunodeficiency: Imaging Spectrum. Radiographics 2022; 42:759-777. [PMID: 35452341 DOI: 10.1148/rg.210169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is a wide spectrum of hereditary and acquired immunodeficiency disorders that are characterized by specific abnormalities involving a plethora of humoral, cellular, and phagocytic immunologic pathways. These include distinctive primary immunodeficiency syndromes due to characteristic genetic defects and secondary immunodeficiency syndromes, such as AIDS from HIV infection and therapy-related immunosuppression in patients with cancers or a solid organ or stem cell transplant. The gut mucosa and gut-associated lymphoid tissue (the largest lymphoid organ in the body), along with diverse commensal microbiota, play complex and critical roles in development and modulation of the immune system. Thus, myriad gastrointestinal (GI) symptoms are common in immunocompromised patients and may be due to inflammatory conditions (graft versus host disease, neutropenic enterocolitis, or HIV-related proctocolitis), opportunistic infections (viral, bacterial, fungal, or protozoal), or malignancies (Kaposi sarcoma, lymphoma, posttransplant lymphoproliferative disorder, or anal cancer). GI tract involvement in immunodeficient patients contributes to significant morbidity and mortality. Along with endoscopy and histopathologic evaluation, imaging plays an integral role in detection, localization, characterization, and distinction of GI tract manifestations of various immunodeficiency syndromes and their complications. Select disorders demonstrate characteristic findings at fluoroscopy, CT, US, and MRI that permit timely and accurate diagnosis. While neutropenic enterocolitis affects the terminal ileum and right colon and occurs in patients receiving chemotherapy for hematologic malignancies, Kaposi sarcoma commonly manifests as bull's-eye lesions in the stomach and duodenum. Imaging is invaluable in treatment follow-up and long-term surveillance as well. Online supplemental material is available for this article. ©RSNA, 2022.
Collapse
Affiliation(s)
- Malak Itani
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., V.M.M.); Department of Radiology, University of Louisville, Louisville, Ky (N.K.); Department of Radiology, VA Medical Center, Fayetteville, NC (A.R.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.); Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., V.S.K.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Neeraj Kaur
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., V.M.M.); Department of Radiology, University of Louisville, Louisville, Ky (N.K.); Department of Radiology, VA Medical Center, Fayetteville, NC (A.R.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.); Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., V.S.K.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Abhijit Roychowdhury
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., V.M.M.); Department of Radiology, University of Louisville, Louisville, Ky (N.K.); Department of Radiology, VA Medical Center, Fayetteville, NC (A.R.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.); Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., V.S.K.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., V.M.M.); Department of Radiology, University of Louisville, Louisville, Ky (N.K.); Department of Radiology, VA Medical Center, Fayetteville, NC (A.R.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.); Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., V.S.K.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Meghan G Lubner
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., V.M.M.); Department of Radiology, University of Louisville, Louisville, Ky (N.K.); Department of Radiology, VA Medical Center, Fayetteville, NC (A.R.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.); Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., V.S.K.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Anil K Dasyam
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., V.M.M.); Department of Radiology, University of Louisville, Louisville, Ky (N.K.); Department of Radiology, VA Medical Center, Fayetteville, NC (A.R.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.); Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., V.S.K.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Lokesh Khanna
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., V.M.M.); Department of Radiology, University of Louisville, Louisville, Ky (N.K.); Department of Radiology, VA Medical Center, Fayetteville, NC (A.R.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.); Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., V.S.K.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Srinivasa R Prasad
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., V.M.M.); Department of Radiology, University of Louisville, Louisville, Ky (N.K.); Department of Radiology, VA Medical Center, Fayetteville, NC (A.R.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.); Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., V.S.K.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Venkata S Katabathina
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., V.M.M.); Department of Radiology, University of Louisville, Louisville, Ky (N.K.); Department of Radiology, VA Medical Center, Fayetteville, NC (A.R.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.); Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., V.S.K.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| |
Collapse
|
14
|
Johnson LN, Moran SK, Bhargava P, Revels JW, Moshiri M, Rohrmann CA, Mansoori B. Fluoroscopic Evaluation of Duodenal Diseases. Radiographics 2022; 42:397-416. [PMID: 35179986 DOI: 10.1148/rg.210165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The duodenum can be affected by a variety of abnormalities because of its development during embryogenesis and its dual intra- and retroperitoneal location. If small bowel embryogenesis is disturbed, congenital errors occur. Although some congenital variants may be asymptomatic and inconsequential to the patient, other anomalies can result in life-threatening emergencies such as malrotation, leading to midgut volvulus. Many infectious processes affect the duodenum, including duodenal ulcers and opportunistic infection in patients with HIV/AIDS or Crohn disease. Small bowel malignancies are uncommon but important to recognize, because the duodenum can be involved in polyposis syndromes or the development of primary adenocarcinoma, neuroendocrine tumors, lymphoma, and metastasis. Although endoscopy is currently the most used diagnostic method to assess the lumen of the upper gastrointestinal tract, fluoroscopy is a valuable adjunct technique and the study of choice for many diseases, specifically those for which anatomic and functional information is required. Fluoroscopy is also commonly used postoperatively to assess for complications such as obstruction and extraluminal leaks. Compared with endoscopy, fluoroscopy is an inexpensive and noninvasive technique that provides salient anatomic information and allows delineation of the duodenal mucosa and assessment of real-time duodenal motility. The authors examine the broad spectrum of conditions that can involve the duodenum, including congenital, infectious, inflammatory, and neoplastic abnormalities, and review their typical appearances at fluoroscopy. Online supplemental material is available for this article. ©RSNA, 2022.
Collapse
Affiliation(s)
- Lisa N Johnson
- From the Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195-7115 (L.N.J., S.K.M., P.B., M.M., C.A.R., B.M.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.)
| | - Shamus K Moran
- From the Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195-7115 (L.N.J., S.K.M., P.B., M.M., C.A.R., B.M.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.)
| | - Puneet Bhargava
- From the Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195-7115 (L.N.J., S.K.M., P.B., M.M., C.A.R., B.M.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.)
| | - Jonathan W Revels
- From the Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195-7115 (L.N.J., S.K.M., P.B., M.M., C.A.R., B.M.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.)
| | - Mariam Moshiri
- From the Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195-7115 (L.N.J., S.K.M., P.B., M.M., C.A.R., B.M.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.)
| | - Charles A Rohrmann
- From the Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195-7115 (L.N.J., S.K.M., P.B., M.M., C.A.R., B.M.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.)
| | - Bahar Mansoori
- From the Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195-7115 (L.N.J., S.K.M., P.B., M.M., C.A.R., B.M.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.)
| |
Collapse
|
15
|
Mansour J, Raptis D, Bhalla S, Heeger AP, Abbott GF, Parkar N, Hammer MM, Kiernan J, Raptis C. Diagnostic and Imaging Approaches to Chest Wall Lesions. Radiographics 2022; 42:359-378. [PMID: 35089819 DOI: 10.1148/rg.210095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chest wall lesions are relatively uncommon and may be challenging once they are encountered on images. Radiologists may detect these lesions incidentally at examinations performed for other indications, or they may be asked specifically to evaluate a suspicious lesion. While many chest wall lesions have characteristic imaging findings that can result in an accurate diagnosis with use of imaging alone, other entities are difficult to distinguish at imaging because there is significant overlap among them. The interpreting radiologist should be familiar with the imaging features of both "do not touch" benign entities (which can be confidently diagnosed with imaging only, with no need for biopsy or resection unless the patient is symptomatic) and lesions that cannot be confidently characterized and thus require further workup. CT and MRI are the main imaging modalities used to assess the chest wall, with each having different benefits and drawbacks. Chest wall lesions can be classified according to their predominant composition: fat, calcification and ossification, soft tissue, or fluid. The identification or predominance of signal intensities or attenuation for these findings, along with the patient age, clinical history, and lesion location, can help establish the appropriate differential diagnosis. In addition, imaging findings in other organs, such as the lungs or upper abdomen, can at times provide clues to the underlying diagnosis. The authors review different chest wall lesions classified on the basis of their composition and highlight the imaging findings that can assist the radiologist in narrowing the differential diagnosis and guiding management. ©RSNA, 2022.
Collapse
Affiliation(s)
- Joseph Mansour
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., D.R., S.B., C.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P.H., G.F.A.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (N.P.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, St Louis University Hospital, St Louis, Mo (J.K.)
| | - Demetrios Raptis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., D.R., S.B., C.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P.H., G.F.A.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (N.P.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, St Louis University Hospital, St Louis, Mo (J.K.)
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., D.R., S.B., C.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P.H., G.F.A.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (N.P.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, St Louis University Hospital, St Louis, Mo (J.K.)
| | - Allen P Heeger
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., D.R., S.B., C.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P.H., G.F.A.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (N.P.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, St Louis University Hospital, St Louis, Mo (J.K.)
| | - Gerald F Abbott
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., D.R., S.B., C.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P.H., G.F.A.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (N.P.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, St Louis University Hospital, St Louis, Mo (J.K.)
| | - Nadeem Parkar
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., D.R., S.B., C.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P.H., G.F.A.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (N.P.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, St Louis University Hospital, St Louis, Mo (J.K.)
| | - Mark M Hammer
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., D.R., S.B., C.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P.H., G.F.A.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (N.P.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, St Louis University Hospital, St Louis, Mo (J.K.)
| | - Julia Kiernan
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., D.R., S.B., C.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P.H., G.F.A.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (N.P.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, St Louis University Hospital, St Louis, Mo (J.K.)
| | - Constantine Raptis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., D.R., S.B., C.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.P.H., G.F.A.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (N.P.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); and Department of Radiology, St Louis University Hospital, St Louis, Mo (J.K.)
| |
Collapse
|
16
|
Dupin N, Jary A, Boussouar S, Syrykh C, Gandjbakhche A, Bergeret S, Palich R. Current and Future Tools for Diagnosis of Kaposi's Sarcoma. Cancers (Basel) 2021; 13:cancers13235927. [PMID: 34885035 PMCID: PMC8657166 DOI: 10.3390/cancers13235927] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Kaposi’s sarcoma, a rare opportunistic tumor, is observed in four epidemiological conditions (AIDS-related, iatrogenic, endemic or classic KS). Although in most cases KS is an indolent disease, it can be locally aggressive and/or it can invade other organs than the skin, resulting in more severe presentations, especially in patients with severe immunosuppression. There is no consensus on the imaging workup that is necessary for either the initial staging of the disease or the follow-up. Future perspectives include the use of certain non-invasive imaging tools that may help to evaluate the clinical response to treatment, as well as certain new histological markers that may help in guiding the treatment planning for this atypical neoplasm. Abstract Kaposi’s sarcoma (KS) is a rare, atypical malignancy associated with immunosuppression and can be qualified as an opportunistic tumor, which responds to immune modulation or restoration. Four different epidemiological forms have been individualized (AIDS-related, iatrogenic, endemic or classic KS). Although clinical examination is sufficient to diagnose cutaneous lesions of KS, additional explorations are necessary in order to detect lesions involving other organs. New histological markers have been developed in recent years concerning the detection of HHV-8 latent or lytic proteins in the lesions, helping to confirm the diagnosis when it is clinically doubtful. More recently, the evaluation of the local immune response has also been shown to provide some guidance in choosing the appropriate therapeutic option when necessary. We also review the indication and the results of conventional radiological imaging and of non-invasive imaging tools such as 18F-fluoro-deoxy-glucose positron emission tomography, thermography and laser Doppler imaging for the diagnosis of KS and for the follow-up of therapeutic response in patients requiring systemic treatment.
Collapse
Affiliation(s)
- Nicolas Dupin
- Dermatology Department, Cochin Hospital, AP-HP, Institut Cochin, INSERM 1016, Université de Paris, 75014 Paris, France;
| | - Aude Jary
- Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Sorbonne University, 75013 Paris, France;
| | - Samia Boussouar
- Cardiothoracic Imaging Unit, Pitié-Salpêtrière Hospital, AP-HP, ICAN Institute of Cardiometabolism and Nutrition, INSERM, Sorbonne University, 75013 Paris, France;
| | - Charlotte Syrykh
- Department of Pathology, University Cancer Institute of Toulouse-Oncopole, 31000 Toulouse, France;
| | - Amir Gandjbakhche
- Section on Analytical and Functional Biophotonics, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Sébastien Bergeret
- Nuclear Medicine Department, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 75013 Paris, France;
| | - Romain Palich
- Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Sorbonne University, 75013 Paris, France
- Correspondence: ; Tel.: +33-1-42-16-01-71; Fax: +33-1-42-16-04-45
| |
Collapse
|
17
|
Martínez-Trufero J, Cruz Jurado J, Gómez-Mateo MC, Bernabeu D, Floría LJ, Lavernia J, Sebio A, García Del Muro X, Álvarez R, Correa R, Hernández-León CN, Marquina G, Hindi N, Redondo A, Martínez V, Asencio JM, Mata C, Valverde Morales CM, Martin-Broto J. Uncommon and peculiar soft tissue sarcomas: Multidisciplinary review and practical recommendations for diagnosis and treatment. Spanish group for Sarcoma research (GEIS - GROUP). Part I. Cancer Treat Rev 2021; 99:102259. [PMID: 34311246 DOI: 10.1016/j.ctrv.2021.102259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 12/22/2022]
Affiliation(s)
| | - Josefina Cruz Jurado
- Hospital Universitario Canarias, Medical Oncology Department, Santa Cruz de Tenerife, Spain
| | | | - Daniel Bernabeu
- Hospital Universitario La Paz, Radiology Department, Madrid, Spain
| | - Luis Javier Floría
- Hospital Universitario Miguel Servet, Orthopedic and Traumatology Department, Zaragoza, Spain
| | - Javier Lavernia
- Instituto Valenciano de Oncología, Medical Oncology Department, Valencia, Spain
| | - Ana Sebio
- Hospital Universitario Santa Creu i Sant Pau, Medical Oncology Department, Barcelona, Spain
| | | | - Rosa Álvarez
- Hospital Universitario Gregorio Marañón, Medical Oncology Department, Madrid, Spain
| | - Raquel Correa
- Hospital Virgen de la Victoria, Radiation Oncology Department, Malaga, Spain
| | | | - Gloria Marquina
- Hospital Universitario Clínico San Carlos, Medical Oncology Department, Madrid, Spain
| | - Nadia Hindi
- University Hospital "Fundacion Jimenez Diaz" Madrid, Medical Oncology Department, Madrid, Research Institute FJD-UAM, Madrid (Spain), TBsarc, CITIUS III, Seville, Spain
| | - Andrés Redondo
- Hospital Universitario La Paz, Medical Oncology Department, Madrid, Spain
| | - Virginia Martínez
- Hospital Universitario La Paz, Medical Oncology Department, Madrid, Spain
| | | | - Cristina Mata
- Hospital Universitario Gregorio Marañón, Pediatric and Adolescent Hemato-oncology Department, Madrid, Spain
| | | | - Javier Martin-Broto
- University Hospital "Fundacion Jimenez Diaz" Madrid, Medical Oncology Department, Madrid, Research Institute FJD-UAM, Madrid (Spain), TBsarc, CITIUS III, Seville, Spain
| |
Collapse
|
18
|
Copeland MMM, Trainor J, Cash WJ, Braniff C. Fatal donor-derived Kaposi sarcoma following liver transplantation. BMJ Case Rep 2021; 14:14/6/e236061. [PMID: 34158319 DOI: 10.1136/bcr-2020-236061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Human herpesvirus-8 (HHV8) is a recognised precursor for a number of neoplastic and non-neoplastic processes. Immunosuppressed recipients of both solid organ and haematopoietic stem cell transplants are at risk of life-threatening lytic reactivations of HHV8-infected B-lymphocytes, primary infections after receiving grafts from HHV8-seropositive donors and more rarely by the direct transplantation of malignant Kaposi sarcoma cells seeded within graft tissue. We describe the case of an HHV8-seronegative patient with confirmed, post-orthotopic liver transplant transmission of HHV8 from a seropositive donor with quantitative evidence of viraemia and subsequent development of disseminated visceral and cutaneous Kaposi sarcoma with a rapidly fatal outcome.
Collapse
Affiliation(s)
| | - James Trainor
- Institute of Pathology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - W Johnny Cash
- Regional Liver Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Conor Braniff
- Regional Liver Unit, Belfast Health and Social Care Trust, Belfast, UK
| |
Collapse
|
19
|
Dai L, Jung BG, Chen J, Samten B, Forrest JC, Post SR, Qin Z. The potential impacts of early secreted antigenic target of 6 kDa of Mycobacterium tuberculosis on KSHV-infected cells. J Med Virol 2021; 93:4028-4032. [PMID: 32648938 PMCID: PMC7796979 DOI: 10.1002/jmv.26291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 12/31/2022]
Abstract
Kaposi's sarcoma-associated herpesvirus (KSHV) causes several human cancers, including Kaposi's sarcoma (KS) and primary effusion lymphoma, which are mostly seen in immunocompromised patients, such as human immunodefeciency virus (HIV)+ individuals. Tuberculosis (TB), caused by the bacterial pathogen Mycobacterium tuberculosis (Mtb), remains one of the deadliest infectious diseases in the world. The risk of developing TB is dramatically higher in people living with HIV than among those without HIV infection. Case reports link cutaneous or pulmonary KS in HIV+ patients with mycobacterial co-infections, however, impacts of Mtb infection or its products on KSHV-infected cells are not known. We report here that ESAT-6, a secreted Mtb virulence factor, induces viral reactivation from KSHV-infected cells. KSHV-infected pulmonary endothelial cells were resistant to ESAT-6 induced inhibition of cell growth. Our data demonstrate that Mtb virulence factors influence the biology of KSHV-infected cells, highlighting the need to study the interactions between these two pathogens commonly found in people living with HIV.
Collapse
Affiliation(s)
- Lu Dai
- Department of Pathology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Bock-Gie Jung
- Department of Pulmonary Immunology, University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
| | - Jungang Chen
- Department of Pathology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Buka Samten
- Department of Pulmonary Immunology, University of Texas Health Science Center at Tyler, Tyler, TX 75708, USA
| | - J. Craig Forrest
- Department Microbiology & Immunology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Steven R. Post
- Department of Pathology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Zhiqiang Qin
- Department of Pathology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| |
Collapse
|
20
|
Abstract
OBJECTIVE. The purpose of this article is to review important imaging and clinical features to help elucidate causes of lymphadenopathy in patients with HIV infection. CONCLUSION. HIV lymphadenopathy has various causes generally categorized as inflammatory or reactive, such as immune reconstitution syndrome; infectious, such as tuberculous and nontuberculous mycobacterial infections and HIV infection itself; and neoplastic, such as lymphoma, Kaposi sarcoma, and Castleman disease. It is important to consider patients' demographic characteristics, clinical presentations, CD4 lymphocyte counts, and radiologic features to identify likely causes of lymphadenopathy.
Collapse
|
21
|
Cross-Sectional Imaging Evaluation of Vascular Lesions in the Gastrointestinal Tract and Mesentery. J Comput Assist Tomogr 2020; 44:870-881. [PMID: 33196596 DOI: 10.1097/rct.0000000000001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Gastrointestinal (GI) tract and mesenteric vascular lesions can have various clinical presentations, of which GI bleeding is the most common. This collection of pathology is highly variable in etiology ranging from occlusive disease to vascular malformations to trauma to neoplasms which makes for a challenging workup and diagnosis. The advent of multiple imaging modalities and endoscopic techniques makes the diagnosis of these lesions more achievable, and familiarity with their various imaging findings can have a significant impact on patient management. In this article, we review the gamut of GI tract and mesenteric vascular lesions and their associated imaging findings.
Collapse
|
22
|
Primary Intrathoracic Sarcomas: A Review of Cross-sectional Imaging and Pathology. J Comput Assist Tomogr 2020; 44:821-832. [PMID: 33196594 DOI: 10.1097/rct.0000000000001097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The most common sarcomas in the thorax are metastasis from an extrathoracic primary malignancy. Primary intrathoracic sarcomas are rare albeit aggressive malignancies that are diagnosed on histopathology. Although a few imaging characteristics have been described that are common to sarcomas, it is still a diagnosis of exclusion as other tumors are much more common. Like elsewhere, primary thoracic sarcomas are also classified according to their histologic features. They are a rare group of tumors that can arise from the mediastinal structures, lung, pleura, or chest wall. On imaging, differentiating these from more common malignancies like lung cancer is difficult and often requires multimodality workup and tissue sampling. A few sarcomas are very specific to their locations, such as angiosarcoma in the right atrium, leiomyosarcoma in the pulmonary artery, where imaging has high accuracy for the diagnosis. Despite being nonspecific in a majority of cases, imaging plays a pivotal role in determining the organ of origin, tumor extent, invasion of adjacent structures, and thus help to assess the surgical resectability. Although sarcomas arising from chest wall are the most common primary sarcomas in the chest, they are excluded from this review to focus only on primary intrathoracic sarcomas. The article provides a comprehensive imaging and pathology review of the rare primary intrathoracic sarcomas, including but not limited to angiosarcoma, Kaposi sarcoma, fibrosarcoma, malignant transformation of fibrous tumor of pleura, sarcomatoid mesothelioma, leiomyosarcoma, and malignant small round blue cell tumors.Key points:Primary intrathoracic sarcomas are rare but clinically important.Imaging helps to determine local extent, invasion, metastases and appropriate site/mode of biopsy.Role of pathology is paramount in diagnosis and guiding treatment based on immunogenetic/molecular typing.
Collapse
|
23
|
Silva SQE, Frank CHM, Almeida TVR. Extensive pulmonary involvement in Kaposi sarcoma in a patient with human immunodeficiency virus-acquired immunodeficiency syndrome. Rev Soc Bras Med Trop 2020; 54:e20200192. [PMID: 33206879 PMCID: PMC7670751 DOI: 10.1590/0037-8682-0192-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/25/2020] [Indexed: 11/22/2022] Open
|
24
|
Cholet C, Delalandre C, Monnier-Cholley L, Le Pimpec-Barthes F, El Mouhadi S, Arrivé L. Nontraumatic Chylothorax: Nonenhanced MR Lymphography. Radiographics 2020; 40:1554-1573. [PMID: 33001788 DOI: 10.1148/rg.2020200044] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Chylothorax is a rare cause of pleural effusion, secondary to accumulation of lymph in the pleural space. Diagnosis is based on the triglyceride and cholesterol content of pleural fluid obtained with thoracentesis. Because the lymphatic system plays an essential role in fat absorption and immune response, lymphatic leak associated with chylothorax may cause life-threatening malnutrition and immunodeficiency. Chylothorax is usually described as traumatic or nontraumatic. The main cause of chylothorax is traumatic, typically postsurgical, secondary to iatrogenic direct puncture of the thoracic duct during thoracic surgery. Causes of nontraumatic chylothorax include a wide range of differential diagnoses. Lymphoma and thoracic malignancies are the most common causes and are responsible for chylothorax by extrinsic compression or invasion of the thoracic duct. Other rare causes include primary and secondary diffuse lymphatic diseases, responsible for chylothorax by lymphatic vessel wall dysfunction. Imaging the lymphatic system remains a challenge in the days of modern imaging. Nonenhanced MR lymphography is a noninvasive technique based on heavily T2-weighted sequences, thus enabling visualization of the lymphatic circulation. This technique allows diagnosis and differential diagnosis, evaluation of disease severity, and guidance of therapeutic management in nontraumatic chylothorax. Furthermore, it may offer radiologic classification of primary lymphatic diseases on the basis of morphologic features of lymphatic vessels. The authors describe the anatomy and physiology of the thoracic lymphatic system, present the technique of nonenhanced MR lymphography, and discuss pathophysiologic mechanisms and imaging features in different causes of nontraumatic chylothorax. ©RSNA, 2020.
Collapse
Affiliation(s)
- Clément Cholet
- From the Department of Radiology, Saint-Antoine Hospital (AP-HP), 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France (C.C., C.D., L.M.C., S.E.M., L.A.); Médecine Sorbonne University, Paris, France (C.C., L.A.); and Department of Thoracic and Pulmonary Surgery, Georges Pompidou European Hospital (AP-HP), Paris, France (F.L.P.B.)
| | - Coline Delalandre
- From the Department of Radiology, Saint-Antoine Hospital (AP-HP), 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France (C.C., C.D., L.M.C., S.E.M., L.A.); Médecine Sorbonne University, Paris, France (C.C., L.A.); and Department of Thoracic and Pulmonary Surgery, Georges Pompidou European Hospital (AP-HP), Paris, France (F.L.P.B.)
| | - Laurence Monnier-Cholley
- From the Department of Radiology, Saint-Antoine Hospital (AP-HP), 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France (C.C., C.D., L.M.C., S.E.M., L.A.); Médecine Sorbonne University, Paris, France (C.C., L.A.); and Department of Thoracic and Pulmonary Surgery, Georges Pompidou European Hospital (AP-HP), Paris, France (F.L.P.B.)
| | - Françoise Le Pimpec-Barthes
- From the Department of Radiology, Saint-Antoine Hospital (AP-HP), 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France (C.C., C.D., L.M.C., S.E.M., L.A.); Médecine Sorbonne University, Paris, France (C.C., L.A.); and Department of Thoracic and Pulmonary Surgery, Georges Pompidou European Hospital (AP-HP), Paris, France (F.L.P.B.)
| | - Sanaâ El Mouhadi
- From the Department of Radiology, Saint-Antoine Hospital (AP-HP), 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France (C.C., C.D., L.M.C., S.E.M., L.A.); Médecine Sorbonne University, Paris, France (C.C., L.A.); and Department of Thoracic and Pulmonary Surgery, Georges Pompidou European Hospital (AP-HP), Paris, France (F.L.P.B.)
| | - Lionel Arrivé
- From the Department of Radiology, Saint-Antoine Hospital (AP-HP), 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France (C.C., C.D., L.M.C., S.E.M., L.A.); Médecine Sorbonne University, Paris, France (C.C., L.A.); and Department of Thoracic and Pulmonary Surgery, Georges Pompidou European Hospital (AP-HP), Paris, France (F.L.P.B.)
| |
Collapse
|
25
|
Ghosh S, Mehta AC, Abuquyyas S, Raju S, Farver C. Primary lung neoplasms presenting as multiple synchronous lung nodules. Eur Respir Rev 2020; 29:29/157/190142. [PMID: 32878970 DOI: 10.1183/16000617.0142-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/08/2020] [Indexed: 12/26/2022] Open
Abstract
Multiple synchronous lung nodules are frequently encountered on computed tomography (CT) scanning of the chest and are most commonly either non-neoplastic or metastases from a known primary malignancy. The finding may initiate a search for primary malignancy elsewhere in the body. An exception to this rule, however, is a class of rare primary lung neoplasms that originate from epithelial (pneumocytes and neuroendocrine), mesenchymal (vascular and meningothelial) and lymphoid tissues of the lung. While these rare neoplasms also present as multiple synchronous unilateral or bilateral lung nodules on chest CT, they are often overlooked in favour of more common causes of multiple lung nodules. The correct diagnosis may be suggested by a multidisciplinary team and established on biopsy, performed either as part of routine diagnostic work-up or staging for malignancy. In this review, we discuss clinical presentations, imaging features, pathology findings and subsequent management of these rare primary neoplasms of the lung.
Collapse
Affiliation(s)
- Subha Ghosh
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Atul C Mehta
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sami Abuquyyas
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shine Raju
- Pulmonary, Critical Care and Sleep Medicine, University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - Carol Farver
- Dept of Pathology, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
26
|
Ballard DH, Mazaheri P, Oppenheimer DC, Lubner MG, Menias CO, Pickhardt PJ, Middleton WD, Mellnick VM. Imaging of Abdominal Wall Masses, Masslike Lesions, and Diffuse Processes. Radiographics 2020; 40:684-706. [PMID: 32330085 DOI: 10.1148/rg.2020190170] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abdominal wall masses, masslike lesions, and diffuse processes are common and often incidental findings at cross-sectional imaging. Distinguishing among these types of masses on the basis of imaging features alone can be challenging. The authors present a diagnostic algorithm that may help in distinguishing different types of abdominal wall masses accurately. Hernias may mimic discrete masses at clinical examination, and imaging is often ordered for evaluation of a possible abdominal wall mass. Once a discrete mass is confirmed to be present, the next step is to determine if it is a fat-containing, cystic, or solid mass. The most common fat-containing masses are lipomas. Fluid or cystic masses include postoperative abscesses, seromas, and rectus sheath hematomas. Solid masses are the most common abdominal wall masses and include desmoid tumors, sarcomas, endometriomas, and metastases. Multiple masses and other diffuse abdominal wall processes are often manifestations of an underlying condition or insult. The most frequently found diffuse processes are multiple injection granulomas from administration of subcutaneous medication. This article offers an algorithmic approach to characterizing abdominal wall masses on the basis of their composition and reviews abdominal wall diffuse processes. Online supplemental material is available for this article. ©RSNA, 2020.
Collapse
Affiliation(s)
- David H Ballard
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Parisa Mazaheri
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Daniel C Oppenheimer
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Meghan G Lubner
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Christine O Menias
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Perry J Pickhardt
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - William D Middleton
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| |
Collapse
|
27
|
Brahmbhatt AN, Skalski KA, Bhatt AA. Vascular lesions of the head and neck: an update on classification and imaging review. Insights Imaging 2020; 11:19. [PMID: 32034537 PMCID: PMC7007481 DOI: 10.1186/s13244-019-0818-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/13/2019] [Indexed: 02/07/2023] Open
Abstract
Vascular lesions have a varied appearance and can commonly occur in the head and neck. A majority of these lesions are cutaneous and congenital; however, some may be acquired and malignant. The presentation and clinical history of patients presenting with head and neck lesions can be used to guide further imaging, which can provide important diagnostic and therapeutic considerations. This review discusses the revised International Society for the Study of Vascular Anomalies (ISSVA) classification system for vascular tumors and malformations, as well as explores the most common vascular anomalies including their clinical presentations and imaging findings.
Collapse
Affiliation(s)
- Akshaar N Brahmbhatt
- Department of Imaging Sciences, University of Rochester - Strong Memorial hospital, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Kamila A Skalski
- Department of Imaging Sciences, University of Rochester - Strong Memorial hospital, 601 Elmwood Avenue, Rochester, NY, 14642, USA
| | - Alok A Bhatt
- Department of Radiology, Division of Neuroradiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| |
Collapse
|
28
|
Linhares LS, Vaz A, Trippia CR, Reifegerste CP. Test yourself: cutaneous mass on the thigh. Skeletal Radiol 2020; 49:331-332. [PMID: 31781786 DOI: 10.1007/s00256-019-03350-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Lucas Savaris Linhares
- Radiology Department, Nossa Senhora das Gracas Hospital, Rua Alcides Munhoz 433, Curitiba, Parana, 80810-040, Brazil
| | - André Vaz
- Radiology Department, Nossa Senhora das Gracas Hospital, Rua Alcides Munhoz 433, Curitiba, Parana, 80810-040, Brazil.
| | - Cesar Rodrigo Trippia
- Radiology Department, Nossa Senhora das Gracas Hospital, Rua Alcides Munhoz 433, Curitiba, Parana, 80810-040, Brazil
| | | |
Collapse
|
29
|
Reyes AJ, Ramcharan K, Giddings S, Aboh S. Facial disfigurement from Kaposi's sarcoma in a woman living with HIV/AIDS in the HAART era. BMJ Case Rep 2019; 12:12/12/e232871. [PMID: 31831518 DOI: 10.1136/bcr-2019-232871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Antonio Jose Reyes
- Infectious Diseases Unit, San Fernando Teaching Hospital, San Fernando, Trinidad and Tobago
| | | | - Stanley Giddings
- Infectious Diseases Unit, San Fernando Teaching Hospital, San Fernando, Trinidad and Tobago.,Medicine, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Samuel Aboh
- Infectious Diseases Unit, San Fernando Teaching Hospital, San Fernando, Trinidad and Tobago
| |
Collapse
|
30
|
Sharma S, Kurra C, Hyska-Campbell M, Taylor K, Hernandez M, Palma C, Alkhasawneh A, Wasserman P. Kaposi Sarcoma mimicking pedal osteomyelitis in a patient with HIV. Radiol Case Rep 2019; 14:1495-1499. [PMID: 31660095 PMCID: PMC6807071 DOI: 10.1016/j.radcr.2019.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 11/30/2022] Open
Abstract
Kaposi Sarcoma (KS) is an angio-proliferative mesenchymal neoplasm that typically affects the skin. In the setting of AIDS, it is usually disseminated, commonly involving noncutaneous sites like oral cavity, lymph nodes, pulmonary, and gastrointestinal systems. Musculoskeletal system involvement by KS is rare, and when encountered, it typically involves the axial skeleton (vertebrae, ribs, sternum, and pelvis) and/or maxillofacial bones. This report describes an unusual case of a 44-year old patient with HIV, who presented with a foot ulcer that fit the typical clinical features of osteomyelitis until MRI of the foot demonstrated atypical findings that challenged the original clinical diagnosis. This case highlights the role that advanced diagnostic imaging plays in the diagnosis of musculoskeletal Kaposi Sarcoma and serves as a reminder to radiologists to include Kaposi Sarcoma in the differential of multifocal osteolytic lesions in patients with HIV.
Collapse
Affiliation(s)
- Swati Sharma
- Department of Radiology, University of Florida, Jacksonville FL, USA
| | - Chandana Kurra
- Department of Radiology, University of Florida, Jacksonville FL, USA
| | | | - Kristin Taylor
- Department of Radiology, University of Florida, Jacksonville FL, USA
| | | | - Christine Palma
- Department of Podiatry, University of Florida, Jacksonville FL, USA
| | - Ahmad Alkhasawneh
- Department of Pathology, University of Florida, Jacksonville FL, USA
| | - Paul Wasserman
- Department of Radiology, University of Florida, Jacksonville FL, USA
| |
Collapse
|
31
|
Abstract
OBJECTIVE. Imaging plays an important role in the diagnosis and staging of malignancies. Many common lymphoproliferative and other solid tumor malignancies can be viral-related. CONCLUSION. This review discusses the imaging findings that can be associated with common viral-induced malignancies. Knowledge of these imaging presentations can help narrow the differential diagnosis to reach a specific diagnosis through a precise workup and proper management.
Collapse
|
32
|
Papali A, Minkove SJ, Pickering EM, Shah N, Sachdeva A. Electrocautery Snare Resection and Argon Plasma Coagulation of Endobronchial Kaposi Sarcoma Presenting as an Obstructing Tumor. Cureus 2019; 11:e5786. [PMID: 31728233 PMCID: PMC6827850 DOI: 10.7759/cureus.5786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Kaposi sarcoma (KS) is the most common neoplasm associated with Acquired Immune Deficiency Syndrome (AIDS), but antiretroviral therapy has reduced its incidence dramatically. Endobronchial KS is usually associated with concurrent mucocutaneous lesions and is highly vascular; so biopsy generally is not recommended. The use of advanced bronchoscopic techniques for evaluation of endobronchial KS may mitigate the bleeding risks but has not been described previously. We describe an unusual case of KS, which presented as an isolated obstructing endobronchial tumor that was effectively resected using electrocautery snare and argon plasma coagulation (APC) during bronchoscopy.
Collapse
Affiliation(s)
- Alfred Papali
- Pulmonary & Critical Care Medicine, Atrium Health, Charlotte, USA
| | - Samuel J Minkove
- Internal Medicine, University of Maryland Medical Center, Baltimore, USA
| | - Edward M Pickering
- Pulmonary & Critical Care, University of Maryland School of Medicine, Baltimore, USA
| | - Nirav Shah
- Pulmonary & Critical Care, University of Maryland School of Medicine, Baltimore, USA
| | - Ashutosh Sachdeva
- Pulmonary & Critical Care, University of Maryland School of Medicine, Baltimore, USA
| |
Collapse
|
33
|
Vosoughi E, Sheth CA, Gill AS, Saadat MS. A rare case of pulmonary Kaposi sarcoma presented with respiratory failure. J Community Hosp Intern Med Perspect 2019; 9:351-354. [PMID: 31528288 PMCID: PMC6735298 DOI: 10.1080/20009666.2019.1640017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/28/2019] [Indexed: 12/20/2022] Open
Abstract
Kaposi sarcoma (KS) is the most commonly diagnosed malignancy in HIV-infected patients. With new treatments, incidence and severity of KS have significantly decreased. A 57-year-old African American male with medical history of AIDS presented with progressively worsening cough, shortness of breath, fever, night sweats, and 60 lb weight loss. On physical examination, he had diffused dark purple skin lesions and decreased air entry in the right lower lung fields. Chest x-ray and subsequent chest computed tomography (CT) showed moderate right lung pleural effusion with scattered bilateral diffuse infiltrates. The patient’s absolute CD4 count was 27 cells/microliter. Thoracentesis was negative for infection or malignancy. He was started on chemotherapy paclitaxel along with HAART for extensive pulmonary KS. Since starting the treatment, his condition has significantly improved with near complete resolution of the pleural effusion, oral, and skin lesions. In conclusion, the diagnosis of AIDS-related pulmonary KS is often clinical, typically based on the presence of mucocutaneous disease and compatible features on CT chest. The differential diagnosis of pulmonary KS is broad. A detailed evaluation should exclude an infectious etiology or other tumors. Chemotherapy along with HAART can be used for treatment of severe pulmonary KS.
Collapse
Affiliation(s)
- Elham Vosoughi
- Department of Internal medicine, San Joaquin General Hospital, French Camp, CA, USA
| | - Chirag A Sheth
- Department of Internal medicine, San Joaquin General Hospital, French Camp, CA, USA
| | - Amandeep S Gill
- Department of Internal medicine, San Joaquin General Hospital, French Camp, CA, USA
| | - Mohsen S Saadat
- Department of Internal medicine, San Joaquin General Hospital, French Camp, CA, USA
| |
Collapse
|
34
|
Cipriano P, Nabais I, Melo N, Alves AR. Chylous ascites in disseminated Kaposi sarcoma: an unusual manifestation as immune reconstitution inflammatory syndrome. BMJ Case Rep 2019; 12:e228406. [PMID: 30904896 PMCID: PMC6510130 DOI: 10.1136/bcr-2018-228406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2019] [Indexed: 01/04/2023] Open
Abstract
A 29-year-old man with diarrhoea, fever, abdominal pain and multiple purple papular lesions, neither pruriginous nor painful, was diagnosed with HIV-1 infection and disseminated Kaposi sarcoma (KS) with gastrointestinal involvement. He was started on highly active antiretroviral therapy immediately, as well as doxorubicin. Three weeks later, the patient developed bilateral moderate pleural effusion and large-volume ascites compatible with chylothorax and chylous ascites. An immune reconstitution inflammatory syndrome (IRIS) reaction was assumed. KS flare was associated with lymphatic obstruction and infiltration of thoracic duct by the tumour itself with leakage of chylous into pleural and peritoneal cavities. KS is the most common tumour in HIV patients and the existence of related effusions is not uncommon. KS-related chylothorax is an unusual manifestation of KS; there are only four cases described in the literature of chylous ascites related to KS-HIV. Overall survival is improving in KS but explosive and debilitating IRIS reactions can explain cases with poor prognosis.
Collapse
Affiliation(s)
- Patrícia Cipriano
- Department of Internal Medicine, Hospital de Cascais, Cascais, Portugal
| | - Inês Nabais
- Department of Internal Medicine, Hospital de Cascais, Cascais, Portugal
| | - Nuno Melo
- Department of Internal Medicine, Hospital de Cascais, Cascais, Portugal
| | - Ana Rafaela Alves
- Department of Internal Medicine, Hospital de Cascais, Cascais, Portugal
| |
Collapse
|
35
|
Smith JD, Stowell JT, Martínez-Jiménez S, Desouches SL, Rosado-de-Christenson ML, Jain KK, Magalski A. Evaluation after Orthotopic Heart Transplant: What the Radiologist Should Know. Radiographics 2019; 39:321-343. [PMID: 30735469 DOI: 10.1148/rg.2019180141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Orthotopic heart transplant (OHT) is the treatment of choice for end-stage heart disease. As OHT use continues and postoperative survival increases, multimodality imaging evaluation of the transplanted heart will continue to increase. Although some of the imaging is performed and interpreted by cardiologists, a substantial proportion of images are read by radiologists. Because there is little to no consensus on a systematic approach to patients after OHT, radiologists must become familiar with common normal and abnormal posttreatment imaging features. Intrinsic transplant-related complications may be categorized on the basis of time elapsed since transplant into early (0-30 days), intermediate (1-12 months), and late (>12 months) stages. Although there can be some overlap between stages, it remains helpful to consider the time elapsed since surgery, because some complications are more common at certain stages. Recognition of differing OHT surgical techniques and their respective postoperative imaging features helps to avoid image misinterpretation. Expected early postoperative findings include small pneumothoraces, pleural effusions, pneumomediastinum, pneumopericardium, postoperative atelectasis, and an enlarged cardiac silhouette. Early postoperative complications also can include sternal dehiscence and various postoperative infections. The radiologist's role in the evaluation of allograft failure and rejection, endomyocardial biopsy complications, cardiac allograft vasculopathy, and posttransplant malignancy is highlighted. Because clinical manifestations of disease may be delayed in transplant recipients, radiologists often recognize postoperative complications on the basis of imaging and may be the first to suggest a specific diagnosis and thus positively affect patient outcomes. Online supplemental material is available for this article. ©RSNA, 2019.
Collapse
Affiliation(s)
- Jordan D Smith
- From the Departments of Radiology (J.D.S., J.T.S., S.M.J., M.L.R.d.C.), Cardiology (K.K.J.), and Medicine (A.M.), University of Missouri-Kansas City School of Medicine, Kansas City, Mo; Department of Radiology, Saint-Luke's Hospital of Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (J.D.S., S.M.J., M.L.R.d.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.L.D.); and Department of Cardiovascular Diseases, St. Luke's Mid America Heart Institute, Kansas City, Mo (A.M.)
| | - Justin T Stowell
- From the Departments of Radiology (J.D.S., J.T.S., S.M.J., M.L.R.d.C.), Cardiology (K.K.J.), and Medicine (A.M.), University of Missouri-Kansas City School of Medicine, Kansas City, Mo; Department of Radiology, Saint-Luke's Hospital of Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (J.D.S., S.M.J., M.L.R.d.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.L.D.); and Department of Cardiovascular Diseases, St. Luke's Mid America Heart Institute, Kansas City, Mo (A.M.)
| | - Santiago Martínez-Jiménez
- From the Departments of Radiology (J.D.S., J.T.S., S.M.J., M.L.R.d.C.), Cardiology (K.K.J.), and Medicine (A.M.), University of Missouri-Kansas City School of Medicine, Kansas City, Mo; Department of Radiology, Saint-Luke's Hospital of Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (J.D.S., S.M.J., M.L.R.d.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.L.D.); and Department of Cardiovascular Diseases, St. Luke's Mid America Heart Institute, Kansas City, Mo (A.M.)
| | - Stephane L Desouches
- From the Departments of Radiology (J.D.S., J.T.S., S.M.J., M.L.R.d.C.), Cardiology (K.K.J.), and Medicine (A.M.), University of Missouri-Kansas City School of Medicine, Kansas City, Mo; Department of Radiology, Saint-Luke's Hospital of Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (J.D.S., S.M.J., M.L.R.d.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.L.D.); and Department of Cardiovascular Diseases, St. Luke's Mid America Heart Institute, Kansas City, Mo (A.M.)
| | - Melissa L Rosado-de-Christenson
- From the Departments of Radiology (J.D.S., J.T.S., S.M.J., M.L.R.d.C.), Cardiology (K.K.J.), and Medicine (A.M.), University of Missouri-Kansas City School of Medicine, Kansas City, Mo; Department of Radiology, Saint-Luke's Hospital of Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (J.D.S., S.M.J., M.L.R.d.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.L.D.); and Department of Cardiovascular Diseases, St. Luke's Mid America Heart Institute, Kansas City, Mo (A.M.)
| | - Kaushik K Jain
- From the Departments of Radiology (J.D.S., J.T.S., S.M.J., M.L.R.d.C.), Cardiology (K.K.J.), and Medicine (A.M.), University of Missouri-Kansas City School of Medicine, Kansas City, Mo; Department of Radiology, Saint-Luke's Hospital of Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (J.D.S., S.M.J., M.L.R.d.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.L.D.); and Department of Cardiovascular Diseases, St. Luke's Mid America Heart Institute, Kansas City, Mo (A.M.)
| | - Anthony Magalski
- From the Departments of Radiology (J.D.S., J.T.S., S.M.J., M.L.R.d.C.), Cardiology (K.K.J.), and Medicine (A.M.), University of Missouri-Kansas City School of Medicine, Kansas City, Mo; Department of Radiology, Saint-Luke's Hospital of Kansas City, 4401 Wornall Rd, Kansas City, MO 64111 (J.D.S., S.M.J., M.L.R.d.C.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (S.L.D.); and Department of Cardiovascular Diseases, St. Luke's Mid America Heart Institute, Kansas City, Mo (A.M.)
| |
Collapse
|
36
|
Head and Neck Sarcomas: A Review of Clinical and Imaging Findings Based on the 2013 World Health Organization Classification. AJR Am J Roentgenol 2018; 212:644-654. [PMID: 30589383 DOI: 10.2214/ajr.18.19894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Head and neck sarcomas are a complex, heterogeneous group of tumors that present a diagnostic challenge to radiologists because they have many overlapping imaging features. The purpose of this article is to review the imaging and clinical features and highlight distinguishing features of head and neck sarcomas. CONCLUSION An understanding of characteristic imaging and clinical features of head and neck sarcomas is important for the radiologist to narrow the differential diagnosis and help guide management.
Collapse
|
37
|
Lima M, Matos AP, Ramalho M. Cytomegalovirus pseudotumor of the colon in an HIV patient. Radiol Case Rep 2018; 14:273-277. [PMID: 30510610 PMCID: PMC6262821 DOI: 10.1016/j.radcr.2018.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 12/31/2022] Open
Abstract
Cytomegalovirus (CMV) is the most common cause of severe opportunistic viral disease among patients with acquired immunodeficiency syndrome, and colitis is the most frequent manifestation of CMV infection. Nevertheless, the development of a colonic pseudotumor is a rare benign entity that can be easily misdiagnosed as a colonic neoplasm if the radiologist is not aware of this condition. We present a case of a 42-year-old male with a CMV pseudotumor of the colon. Imaging findings on computed tomography and magnetic resonance imaging are illustrated. Discussion of the differential diagnoses, based on clinical and imaging findings, is performed in order to propose the right diagnosis, which was histologically confirmed.
Collapse
Affiliation(s)
- Mariana Lima
- Department of Radiology, Centro Hospitalar de Lisboa Central, Hospital de Santo António dos Capuchos, Alameda Santo António Capuchos, 1169-050 Lisboa, Portugal
| | - António P Matos
- Department of Radiology, Hospital Garcia de Orta, EPE, Av. Torrado da Silva, Almada 2805-267, Portugal
| | - Miguel Ramalho
- Department of Radiology, Hospital Garcia de Orta, EPE, Av. Torrado da Silva, Almada 2805-267, Portugal
| |
Collapse
|
38
|
Javadi S, Menias CO, Karbasian N, Shaaban A, Shah K, Osman A, Jensen CT, Lubner MG, Gaballah AH, Elsayes KM. HIV-related Malignancies and Mimics: Imaging Findings and Management. Radiographics 2018; 38:2051-2068. [PMID: 30339518 DOI: 10.1148/rg.2018180149] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The risk of developing malignancy is higher in patients with human immunodeficiency virus (HIV) infection than in non-HIV-infected patients. Several factors including immunosuppression, viral coinfection, and high-risk lifestyle choices lead to higher rates of cancer in the HIV-infected population. A subset of HIV-related malignancies are considered to be acquired immunodeficiency syndrome (AIDS)-defining malignancies, as their presence confirms the diagnosis of AIDS in an HIV-infected patient. The introduction of highly active antiretroviral therapy (HAART) has led to a significant drop in the rate of AIDS-defining malignancies, including Kaposi sarcoma, non-Hodgkin lymphoma, and invasive cervical carcinoma. However, non-AIDS-defining malignancies (eg, Hodgkin lymphoma, lung cancer, hepatocellular carcinoma, and head and neck cancers) now account for an increasing number of cancer cases diagnosed in HIV-infected patients. Although the number has decreased, AIDS-defining malignancies account for 15%-19% of all deaths in HIV-infected patients in the post-HAART era. Most HIV-related malignancies in HIV-infected patients manifest at an earlier age with a more aggressive course than that of non-HIV-related malignancies. Understanding common HIV-related malignancies and their specific imaging features is crucial for making an accurate and early diagnosis, which impacts management. Owing to the weakened immune system of HIV-infected patients, other entities such as various infections, particularly opportunistic infections, are prevalent in these patients. These processes can have confounding clinical and imaging manifestations that mimic malignancy. This article reviews the most common AIDS-defining and non-AIDS-defining malignancies, the role of imaging in their diagnosis, and the imaging mimics of malignancies in HIV-infected patients. ©RSNA, 2018.
Collapse
Affiliation(s)
- Sanaz Javadi
- From the Departments of Diagnostic Radiology (S.J., K.S., A.O., C.T.J., K.M.E.) and Interventional Radiology (N.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.)
| | - Christine O Menias
- From the Departments of Diagnostic Radiology (S.J., K.S., A.O., C.T.J., K.M.E.) and Interventional Radiology (N.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.)
| | - Niloofar Karbasian
- From the Departments of Diagnostic Radiology (S.J., K.S., A.O., C.T.J., K.M.E.) and Interventional Radiology (N.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.)
| | - Akram Shaaban
- From the Departments of Diagnostic Radiology (S.J., K.S., A.O., C.T.J., K.M.E.) and Interventional Radiology (N.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.)
| | - Komal Shah
- From the Departments of Diagnostic Radiology (S.J., K.S., A.O., C.T.J., K.M.E.) and Interventional Radiology (N.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.)
| | - Adam Osman
- From the Departments of Diagnostic Radiology (S.J., K.S., A.O., C.T.J., K.M.E.) and Interventional Radiology (N.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.)
| | - Corey T Jensen
- From the Departments of Diagnostic Radiology (S.J., K.S., A.O., C.T.J., K.M.E.) and Interventional Radiology (N.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.)
| | - Meghan G Lubner
- From the Departments of Diagnostic Radiology (S.J., K.S., A.O., C.T.J., K.M.E.) and Interventional Radiology (N.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.)
| | - Ayman H Gaballah
- From the Departments of Diagnostic Radiology (S.J., K.S., A.O., C.T.J., K.M.E.) and Interventional Radiology (N.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.)
| | - Khaled M Elsayes
- From the Departments of Diagnostic Radiology (S.J., K.S., A.O., C.T.J., K.M.E.) and Interventional Radiology (N.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.)
| |
Collapse
|
39
|
Guan CS, Wang XM, Lv ZB, Yan S, Sun L, Xie RM. MRI findings of AIDS-related giant facial Kaposi's sarcoma: A case report. Medicine (Baltimore) 2018; 97:e12530. [PMID: 30313039 PMCID: PMC6203520 DOI: 10.1097/md.0000000000012530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Kaposi's sarcoma (KS) is the most common malignant tumor in HIV-infected people and occurs mainly in the skin, mucous membranes, and lymph nodes. Approximately 33% of the initial skin manifestations of AIDS and approximately 35% to 79% of KS occur during disease progression. Otherwise, AIDS-related facial KS that was simultaneously examined by magnetic resonance imaging (MRI) is rare. PATIENT CONCERNS This case was a 30-year-old male homosexual, with left facial nodule for 14 months, and HIV infection was diagnosed 1 month previously. The patient was admitted to hospital because the nodule gradually expanded from 0.2 to 10.0 cm in diameter. Ultrasound examination showed edema of the subcutaneous tissue of the left facial mass, and the boundary was not clear between lesion and normal tissues. Magnetic resonance imaging (MRI) indicated that the left facial mass showed low signal intensity on T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI), and a small amount of high signal intensity was seen in it. Diffusion-weighted imaging (DWI) and susceptibility-weighted imaging (SWI) showed low signal intensity. After enhanced scan, the tumor showed uneven enhancement. DIAGNOSES The pathological biopsy indicated KS. INTERVENTIONS The patient began chemotherapy with the intravenous drip infusion of Doxorubicin Hydrochloride Liposome. OUTCOMES The facial KS decreased and the facial swelling was relieved. LESSONS MRI could not only provide the diagnostic basis of KS for the therapy, but also could accurately determine the scope of the disease.
Collapse
Affiliation(s)
| | | | | | | | - Lei Sun
- Department of Pathology, Beijing Ditan Hospital, Capital Medical University, Chaoyang District, Beijing, China
| | | |
Collapse
|
40
|
Castellana G, Liotino V, Vulpi MR, Ali I, Marra L, Resta O. Bilateral pulmonary nodules and acute respiratory failure in a 22-year-old man with dyspnoea and fever. Breathe (Sheff) 2017; 13:317-322. [PMID: 29209425 PMCID: PMC5709794 DOI: 10.1183/20734735.008317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Can you diagnose the cause of this man's bilateral pulmonary nodules and acute respiratory failure? http://ow.ly/NfED30dDBzm.
Collapse
Affiliation(s)
- Giorgio Castellana
- Institute of Respiratory Disease, Cardio-Thoracic Department, University of Medicine "Aldo Moro", Bari, Italy
| | - Vito Liotino
- Institute of Respiratory Disease, Cardio-Thoracic Department, University of Medicine "Aldo Moro", Bari, Italy
| | - Maria Rosaria Vulpi
- Institute of Respiratory Disease, Cardio-Thoracic Department, University of Medicine "Aldo Moro", Bari, Italy
| | - Ina Ali
- Institute of Respiratory Disease, Cardio-Thoracic Department, University of Medicine "Aldo Moro", Bari, Italy
| | - Lorenzo Marra
- Institute of Respiratory Disease, Cardio-Thoracic Department, University of Medicine "Aldo Moro", Bari, Italy
| | - Onofrio Resta
- Institute of Respiratory Disease, Cardio-Thoracic Department, University of Medicine "Aldo Moro", Bari, Italy
| |
Collapse
|
41
|
Renn A, Kazmi F, Khan N, Rawal B, O'Boyle E. The HIV manifestations within the gastrointestinal tract: A pictorial review. SA J Radiol 2017; 21:1233. [PMID: 31754480 PMCID: PMC6837834 DOI: 10.4102/sajr.v21i2.1233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 07/27/2017] [Indexed: 11/18/2022] Open
Abstract
The aim of the pictorial review are to review the HIV manifestations within the gastrointestinal tract. We have detailed five conditions, with reference to the patients’ CD4 count – gastrointestinal tuberculosis, Kaposi’s sarcoma, small bowel lymphoma, cytomegalovirus colitis and anal carcinoma.
Collapse
Affiliation(s)
- Alexandra Renn
- Chelsea and Westminster Hospital, London, United Kingdom
| | - Farhat Kazmi
- Chelsea and Westminster Hospital, London, United Kingdom
| | - Nasir Khan
- Chelsea and Westminster Hospital, London, United Kingdom
| | - Bhavin Rawal
- Chelsea and Westminster Hospital, London, United Kingdom
| | - Elaine O'Boyle
- Chelsea and Westminster Hospital, London, United Kingdom
| |
Collapse
|
42
|
Mudau A, Makhanya NZ, Suleman FE. Disseminated Kaposi sarcoma presenting in unusual locations: A case report. SA J Radiol 2017; 21:1260. [PMID: 31754485 PMCID: PMC6837792 DOI: 10.4102/sajr.v21i2.1260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/28/2017] [Indexed: 11/25/2022] Open
Abstract
Kaposi sarcoma (KS) is the most common malignancy associated with HIV infection. It usually affects the skin, the gastrointestinal tract and the lungs. It is generally described in the setting of CD4 counts < 150 cells/mm3 – 200 cells/mm3. We describe a case of recurrence of KS with a rare presentation of breast and musculoskeletal involvement in the setting of a CD4 count of 374 cell/mm3 and an undetectable viral load. The patient was on highly active antiretroviral therapy for 5 years at the time of the second presentation.
Collapse
Affiliation(s)
- Adziambei Mudau
- Department of Radiology, University of Pretoria, South Africa
| | | | | |
Collapse
|
43
|
Thampy R, Elsayes KM, Menias CO, Pickhardt PJ, Kang HC, Deshmukh SP, Ahmed K, Korivi BR. Imaging features of rare mesenychmal liver tumours: beyond haemangiomas. Br J Radiol 2017; 90:20170373. [PMID: 28766950 PMCID: PMC5963373 DOI: 10.1259/bjr.20170373] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/18/2017] [Accepted: 07/24/2017] [Indexed: 12/14/2022] Open
Abstract
Tumours arising from mesenchymal tissue components such as vascular, fibrous and adipose tissue can manifest in the liver. Although histopathology is often necessary for definitive diagnosis, many of these lesions exhibit characteristic imaging features. The radiologist plays an important role in suggesting the diagnosis, which can direct appropriate immunohistochemical staining at histology. The aim of this review is to present clinical and imaging findings of a spectrum of mesenchymal liver tumours such as haemangioma, epithelioid haemangioendothelioma, lipoma, PEComa, angiosarcoma, inflammatory myofibroblastic tumour, solitary fibrous tumour, leiomyoma, leiomyosarcoma, Kaposi sarcoma, mesenchymal hamartoma, undifferentiated embryonal sarcoma, rhabdomyosarcoma and hepatic metastases. Knowledge of the characteristic features of these tumours will aid in guiding the radiologic diagnosis and appropriate patient management.
Collapse
Affiliation(s)
- Rajesh Thampy
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Hyunseon C Kang
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sandeep P Deshmukh
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Kareem Ahmed
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Brinda Rao Korivi
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
44
|
Hepatic Kaposi Sarcoma Revisited: An Important but Less Commonly Seen Neoplasm in Patients With Acquired Immunodeficiency Syndrome. Ultrasound Q 2017; 33:109-111. [PMID: 27984514 DOI: 10.1097/ruq.0000000000000267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hepatic Kaposi sarcoma (KS) is the most commonly seen hepatic neoplasm in patients with acquired immunodeficiency syndrome (AIDS), found in 34% of patients in an autopsy series. However, the incidence of hepatic KS has significantly declined since the advent of highly active antiretroviral therapy and is not as commonly seen on imaging. We present a case of hepatic KS in a patient with AIDS, which was initially mistaken for hepatic abscesses on computed tomography. We discuss the computed tomography, grayscale ultrasound, and contrast-enhanced ultrasound appearance of hepatic KS and how to distinguish this hepatic neoplasm from other common hepatic lesions seen in patients with AIDS.
Collapse
|
45
|
Abstract
Immunosuppression induced by chronic medication, such as occurs post-transplantation, may increase a patient's risk of developing solid tumors. These are often rare tumors characterized by odd presentations. This review focuses on commonly encountered iatrogenic, non-hematopoietic solid tumors following immunotherapy and provides a practical approach to their diagnosis. All of the malignancies covered in this review are viral-induced. They include human papillomavirus (HPV)-associated carcinomas, Epstein-Barr virus (EBV)-associated tumors, Merkel cell polyomavirus (MCPyV)-related Merkel cell carcinoma, and Human Herpesvirus 8 (HHV8)-related Kaposi sarcoma. The complementary diagnostic role of ancillary studies, such as immunohistochemistry and in-situ hybridization that target these oncogenic viruses, is addressed.
Collapse
Affiliation(s)
- Kossivi Dantey
- Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212-4756, United States.
| | - Liron Pantanowitz
- Department of Pathology, Presbyterian Shadyside Hospitals, University of Pittsburgh Medical Center, 5230 Centre Avenue Pittsburgh, PA 15232, United States.
| |
Collapse
|
46
|
Imko-Walczuk B, Kielbowicz M, Malyszko J, Malyszko J, Barczyk M, Debska-Slizien A, Mysliwiec M, Rutkowski B. Kaposi Sarcoma in the Genital Area in a Kidney Transplant Patient: A Case Report and Literature Review. Transplant Proc 2017; 48:1843-8. [PMID: 27496505 DOI: 10.1016/j.transproceed.2016.01.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 01/21/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Kaposi sarcoma (KS) is a cancer with an incidence in patients after transplantation (Tx) that is 500 times greater than that in the healthy population. The risk of KS increases significantly during therapy, especially when immunosuppressive therapy with cyclosporine A (CsA) is used. Most cases of KS develop during the first 2 years after transplantation. After a KS diagnosis, it is recommended to reduce the doses of immunosuppressive medications. Conversion of immunosuppressive treatment into mammalian target of rapamycin (m-TOR) inhibitors is strongly suggested. PATIENTS AND METHODS We present the case of a 65-year-old man with end-stage renal disease (ESRD) of unknown etiology, who had kidney transplantation in 2008. Immunosuppressive protocol was based on CsA, mycophenolate mofetil (MMF) and prednisolone (PRE). In 2011, during the dermatological consultation, on the penis glans a purple stain of uneven surface was noted. Histology study revealed the presence of KS. The treatment was modified. The patient was converted from CsA to everolimus. Before converting, the creatinine concentration was 1.79 mg/dl and proteinuria less than 0.3 g/day. RESULTS The change in the scheme of immunosuppresion from CsA to everolimus was performed to treat the Kaposi sarcoma. Gradually, within a year, the KS was cured. However, the graft function deteriorated, and the graft was lost in one-years' time. CONCLUSION We present the first documented case of KS in the genital area of a kidney patient. The reduction in the strength of immunosuppression, and the introduction of an m-TOR inhibitor, may have contributed to the deterioration of kidney function, however it was substantial in the treatment of KS.
Collapse
Affiliation(s)
- B Imko-Walczuk
- Copernicus-Independent Public Healthcare Centre, Dermatology & Venereology Clinic, Gdansk, Poland; College of Health, Beauty and Education in Poznan, Poland.
| | - M Kielbowicz
- College of Health, Beauty and Education in Poznan, Poland
| | - J Malyszko
- 1st Department of Nephrology and Transplantology with Dialysis Unit, Medical University, Bialystok, Poland
| | - J Malyszko
- 2nd Department of Nephrology Medical University, Bialystok, Poland
| | - M Barczyk
- 1st Department of Nephrology and Transplantology with Dialysis Unit, Medical University, Bialystok, Poland
| | - A Debska-Slizien
- Chair & Clinic of Nephrology, Transplantology and Internal Medicine, Gdansk University of Medical Sciences, Gdansk, Poland
| | - M Mysliwiec
- 1st Department of Nephrology and Transplantology with Dialysis Unit, Medical University, Bialystok, Poland
| | - B Rutkowski
- Chair & Clinic of Nephrology, Transplantology and Internal Medicine, Gdansk University of Medical Sciences, Gdansk, Poland
| |
Collapse
|
47
|
Petribu NCDL, Cisneiros MS, Carvalho GBD, Baptista LDM. Pulmonary Kaposi's sarcoma in a female patient: Case report. Rev Assoc Med Bras (1992) 2017; 62:395-8. [PMID: 27656847 DOI: 10.1590/1806-9282.62.05.395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 07/06/2016] [Indexed: 11/22/2022] Open
Abstract
Kaposi's sarcoma (KS) is a multicentric lymphoproliferative malignancy. Most of the time this tumor is confined to the skin and subcutaneous tissue, but it can present with widespread visceral involvement, such as in the lung. Pulmonary KS is the most frequent form in young adult males, in a ratio of 15:1. The disease usually affects individuals with low CD4 lymphocyte counts (<150-200 cells/mm3). We report a case of a female patient aged 35 years, with the presence of skin lesions, self-limiting episodes of diarrhea and weight loss of 15 kg for nearly 9 months, progressing to persistent fever. AIDS was diagnosed and biopsy of the lesions revealed Kaposi's sarcoma. Computed tomography of the chest showed peribronchovascular thickening, areas of ground glass opacity, condensations with air bronchograms surrounded by ground glass opacity (halo sign) and bilateral pleural effusion. The diagnosis of pulmonary KS is still a challenge, especially due to the occurrence of other opportunistic diseases that may also occur concurrently. Therefore, suspecting this diagnosis based on clinical and laboratory manifestations, and even more with CT findings, is fundamental, especially in patients who already have the cutaneous form of the disease.
Collapse
Affiliation(s)
| | | | - Glauber Barbosa de Carvalho
- Graduate student - Resident Physician in Radiology and Diagnostic Imaging, Hospital Barão de Lucena, Recife, PE, Brazil
| | - Lucyana de Melo Baptista
- Graduate degree - MD, Medical Clinic and Cardiology Resident, Hospital Barão de Lucena, Recife, PE, Brazil
| |
Collapse
|
48
|
Hu Z, Chen J, Wang J, Xiong Q, Zhong Y, Yang Y, Xu C, Wei H. Radiological characteristics of pulmonary cryptococcosis in HIV-infected patients. PLoS One 2017; 12:e0173858. [PMID: 28301552 PMCID: PMC5354418 DOI: 10.1371/journal.pone.0173858] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/28/2017] [Indexed: 11/19/2022] Open
Abstract
Background Current understanding of human immunodeficiency virus (HIV)-associated pulmonary cryptococcosis (PC) is largely based on studies performed about 2 decades ago which reported that the most common findings on chest radiograph were diffuse interstitial infiltrates. Few studies are available regarding the computed tomography (CT) findings. The aim of this study was to characterize chest CT features of HIV-associated PC. Methods HIV patients with cryptococccal infection and pulmonary abnormalities on Chest CT between September 2010 and May 2016 in the Second Affiliated Hospital of the Southeast University were retrospectively analyzed. Confirmed cases of tumors, mycobacterial infections and other fungal infections were excluded from the analysis. Results 60 cases were identified. The median CD4 T-cell counts were 20 cells/μL (range, 0–205 cells/μL). Chest CT scans demonstrated nodular lesions in 93.3% of the studied patients. Those nodular lesions were usually cavitated and solitary nodule was the most common form. Pleural effusions and pneumonic infiltrates occurred in 11.6% and 31.7% of the cases respectively. Those lesions were usually had co-existing nodular lesions. Etiological analysis suggested that 76.8% of the nodular lesions could have a relationship with PC that 12.5% of the nodular lesions were “laboratory-confirmed” cases, 48.2% were “clinically confirmed” cases and 16.1% were “clinically probable” cases. 85.7% of the pleural effusions could be “clinically confirmed” cases of PC. At least, 38.5% of the diffuse pneumonic infiltrates may be clinically attributed to pneumocystis pneumonia. Conclusions This study suggested that pulmonary nodules but not diffuse pneumonia are the most common radiological characteristics of HIV-associated PC. HIV-infected patients with pulmonary nodules on Chest CT should particularly be screened for cryptococcal infection.
Collapse
Affiliation(s)
- Zhiliang Hu
- Department of Infectious Disease, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China
| | - Jun Chen
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Juan Wang
- Department of Pathology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qingfang Xiong
- Department of Infectious Disease, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China
| | - Yandan Zhong
- Department of Infectious Disease, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China
| | - Yongfeng Yang
- Department of Infectious Disease, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China
| | - Chuanjun Xu
- Department of radiology, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China
- * E-mail: (CX); (HW)
| | - Hongxia Wei
- Department of Infectious Disease, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China
- * E-mail: (CX); (HW)
| |
Collapse
|
49
|
Karandikar A, Gummalla KM, Loke SC, Goh J, Tan TY. Approach to intensely enhancing neck nodes. Diagn Interv Radiol 2017; 22:168-72. [PMID: 26782154 DOI: 10.5152/dir.2015.14561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Cervical node evaluation is one of the most common problems encountered by a radiologist. Here, we present a pictorial review of intensely enhancing neck nodes. While enhancement in a cervical node is a common radiologic finding on contrast-enhanced computed tomography scan, only few conditions cause intense enhancement in cervical nodes. We discuss the common causes of intensely enhancing neck nodes along with pertinent radiologic features and key differentiating points that aid radiologists in reaching a diagnosis. In addition, we discuss certain potential non-nodal mimics, which need to be excluded.
Collapse
|
50
|
Dirweesh A, Khan MY, Hamiz SF, Karabulut N. Pulmonary Kaposi Sarcoma with Osseous Metastases in an Human Immunodeficiency Virus (HIV) Patient: A Remarkable Response to Highly Active Antiretroviral Therapy. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:181-185. [PMID: 28216610 PMCID: PMC5328198 DOI: 10.12659/ajcr.902355] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Kaposi sarcoma (KS) is known to involve the mucocutaneous tissues and the aero-digestive tracts. In acquired immune deficiency syndrome (AIDS) patients, KS has an aggressive course and carries poor prognosis. We present a case of pulmonary KS with osseous metastases as the first presentation of human immunodeficiency virus (HIV) infection in a young male. The lesions impressively decreased in size and numbers following initiation of highly active antiretroviral therapy (HAART). CASE REPORT A 34-year-old heterosexual male presented with a one month history of cough and 15-20 pound weight loss within six months. Examination revealed oral thrush, decreased breath sounds and crackles on the right lower lung base. Imaging showed a large right perihilar mass with multiple lytic lesions involving thoracic and lumber vertebrae, ribs, sternum, and clavicles. Blood and sputum cultures, smears for acid fast bacilli, and a QUANTIferon gold test were all negative. He tested positive for HIV and his CD4 count was 7 cells/uL. Bronchoscopy with biopsy was unrevealing. Pathology of the right hilar mass was diagnostic of KS. Following initiation of antiretroviral therapy his condition dramatically improved; repeat chest CT scan showed marked regression of the bony and pulmonary lesions. CONCLUSIONS The dual action of HAART on the recovery of the immune system and against human herpes virus 8 (HHV-8) may essentially cause regression of KS lesions.
Collapse
Affiliation(s)
- Ahmed Dirweesh
- Department of Internal Medicine, Saint Francis Medical Center, Seton Hall University, Trenton, NJ, USA
| | - Muhammad Yasir Khan
- Department of Internal Medicine, Saint Francis Medical Center, Seton Hall University, Trenton, NJ, USA
| | - Shaikh Fawad Hamiz
- Department of Internal Medicine, Saint Francis Medical Center, Seton Hall University, Trenton, NJ, USA
| | - Nigahus Karabulut
- Department of Infectious Diseases, Saint Francis Medical Center, Trenton, NJ, USA
| |
Collapse
|