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Dhillon P, Naidu M, Olson MC, VanBuren WM, Sheedy SP, Wells ML, Fidler JL, Heiken JP, Venkatesh SK, Kelm ZS. Diffusely Infiltrative Small Bowel Disease. Radiographics 2024; 44:e230148. [PMID: 39207924 DOI: 10.1148/rg.230148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Multiple infiltrative disorders can affect the small bowel, often resulting in diffuse small bowel wall thickening. These infiltrative disorders can manifest owing to various factors such as an influx of immunologic or neoplastic cells or the accumulation of substances within one or more layers of the intestinal wall. Although there can be considerable overlap in the appearances of infiltrative diseases on cross-sectional images, a comprehensive understanding of more specific ancillary imaging features and clinicopathologic correlation can substantially narrow the differential diagnosis. The radiologist can be instrumental in synthesizing the clinical and imaging information and guiding subsequent workup. The authors present a comprehensive review of the infiltrative disorders that commonly involve the small bowel. These disorders are organized on the basis of their pathophysiologic features, with multiple illustrative case examples to enhance understanding of these entities. CT and MRI are currently the most commonly used imaging modalities for evaluating small bowel disorders, and this review is focused on these two modalities. Detailed information regarding the pathologic features, clinical presentation, and imaging findings of these infiltrative disorders is provided to aid radiologists in recognizing and differentiating these conditions. ©RSNA, 2024.
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Affiliation(s)
- Preet Dhillon
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Madeline Naidu
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Michael C Olson
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Wendaline M VanBuren
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Shannon P Sheedy
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Michael L Wells
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Jeff L Fidler
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Jay P Heiken
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Sudhakar K Venkatesh
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Zachary S Kelm
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
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Sato M, Kurokawa R, Okimoto N, Tokushige J, Ikemura M, Abe O. CT and Fluorine-18-Fluorodeoxyglucose (18F-FDG) PET/CT Imaging Findings of Aggressive Systemic Mastocytosis: A Case Report. Cureus 2024; 16:e64879. [PMID: 39156319 PMCID: PMC11330563 DOI: 10.7759/cureus.64879] [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] [Accepted: 07/18/2024] [Indexed: 08/20/2024] Open
Abstract
Aggressive systemic mastocytosis (ASM) is an advanced subtype of systemic mastocytosis characterized by organ involvement. In this article, we report a case with ASM in a 54-year-old woman with characteristic findings on computed tomography (CT) and fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET)/CT. Contrast-enhanced CT on admission revealed hepatosplenomegaly, generalized osteosclerosis, colonic edema, edematous thickening of the wall in the ascending colon and edema in the surrounding regions of these organs and mesentery, ileus, subcutaneous edema, periportal collar sign, and multiple mesenteric lymphadenopathies. There was no 18F-FDG uptake in the lesions other than mild 18F-FDG uptake in the vertebrae, making the possibility of differential diagnoses such as metastasis, lymphoma, and extramedullary leukemia lower. Based on bone marrow biopsy results and clinical findings, the diagnosis of ASM was established. ASM can be a potentially fatal disease with a poor prognosis, and understanding its distinctive clinical course and imaging findings is crucial for early therapeutic intervention.
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Affiliation(s)
- Mai Sato
- Radiology, The University of Tokyo, Tokyo, JPN
| | | | | | - Junji Tokushige
- Hematology and Oncology, The University of Tokyo, Tokyo, JPN
| | | | - Osamu Abe
- Radiology, The University of Tokyo, Tokyo, JPN
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Velloso EDRP, Padulla GA, de Cerqueira AMM, de Sousa AM, Sandes AF, Traina F, Seguro FS, Nogueira FL, Pereira GDF, Boechat JL, Pagnano KBB, Marchi LL, Ensina LF, Giavina-Bianchi M, Aun MV, Agondi RC, Santos FPDS, Giavina-Bianchi P. Diagnosis and treatment of systemic mastocytosis in Brazil: Recommendations of a multidisciplinary expert panel. Hematol Transfus Cell Ther 2022; 44:582-594. [PMID: 35688791 PMCID: PMC9605912 DOI: 10.1016/j.htct.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/04/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Systemic Mastocytosis comprises a group of neoplastic diseases characterized by clonal expansion and infiltration of mast cells into several organs. The diagnosis and treatment of this disease may be challenging for non-specialists. OBJECTIVE Make suggestions or recommendations in Systemic Mastocytosis based in a panel of Brazilian specialists. METHOD AND RESULTS An online expert panel with 18 multidisciplinary specialists was convened to propose recommendations on the diagnosis and treatment of Systemic Mastocytosis in Brazil. Recommendations were based on discussions of topics and multiple-choice questions and were graded using the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence Chart. CONCLUSION Twenty-two recommendations or suggestions were proposed based on a literature review and graded according to the findings.
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Affiliation(s)
- Elvira D Rodrigues Pereira Velloso
- Clinical Immunology and Allergy Division. Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Geórgia A Padulla
- Clinical Immunology and Allergy Division. Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Adriana Martins de Sousa
- Instituto de Pediatria e Puericultura Martagão Gesteira da Universidade Federal do Rio de Janeiro (IPPMG UFRJ), Rio de Janeiro, RJ, Brazil
| | - Alex Freire Sandes
- Grupo Fleury, São Paulo, SP, Brazil; Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Fabiola Traina
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP USP), São Paulo, SP, Brazil
| | - Fernanda Salles Seguro
- Clinical Immunology and Allergy Division. Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Frederico Lisboa Nogueira
- Hospital Luxemburgo, Instituto Mário Penna, Belo Horizonte, MG, Brazil; Grupo Oncoclínicas, Belo Horizonte, MG, Brazil
| | | | - José Laerte Boechat
- Faculdade de Medicina da Universidade Federal Fluminense (FM UFF), Niteroi, RJ, Brazil
| | | | - Luan Lima Marchi
- Clinical Immunology and Allergy Division. Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Mara Giavina-Bianchi
- Clinical Immunology and Allergy Division. Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcelo Vivolo Aun
- Clinical Immunology and Allergy Division. Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil
| | - Rosana Câmara Agondi
- Clinical Immunology and Allergy Division. Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Fabio Pires de Souza Santos
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; A Beneficência Portuguesa de São Paulo, BP, São Paulo, SP, Brazil
| | - Pedro Giavina-Bianchi
- Clinical Immunology and Allergy Division. Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Elsaiey A, Mahmoud HS, Jensen CT, Klimkowski S, Taher A, Chaudhry H, Morani AC, Wong VK, Salem UI, Palmquist SM, Elsayes KM. Mastocytosis-A Review of Disease Spectrum with Imaging Correlation. Cancers (Basel) 2021; 13:cancers13205102. [PMID: 34680251 PMCID: PMC8533777 DOI: 10.3390/cancers13205102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/08/2021] [Accepted: 10/10/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary In this review will discuss the clinical presentation, pathophysiology, and role of imaging in detection and extent estimation of the systemic involvement of the disease, in addition to demonstration of appearance on varying imaging modalities. Familiarity with the potential imaging findings associated with mastocytosis can aid in early disease diagnosis and classification and accordingly can lead directing further work up and better management. Abstract Mastocytosis is a rare disorder due to the abnormal proliferation of clonal mast cells. Mast cells exist in most tissues, mature in situ from hematopoietic stem cells and develop unique characteristics of local effector cells. Mastocytosis develops by activation mutation of the KIT surface receptor which is involved in the proliferation of a number of cell lines such as mast cells, germ cells, melanocytes, and hematopoietic cells. It manifests as two main categories: cutaneous mastocytosis and systemic mastocytosis. Imaging can play an important role in detection and characterization of the disease manifestation, not only by radiography and bone scans, but also magnetic resonance imaging and computed tomography, which can be more sensitive in the assessment of distinctive disease patterns. Radiologists should be aware of various appearances of this disease to better facilitate diagnosis and patient management. Accordingly, this review will discuss the clinical presentation, pathophysiology, and role of imaging in detection and extent estimation of the systemic involvement of the disease, in addition to demonstration of appearance on varying imaging modalities. Familiarity with the potential imaging findings associated with mastocytosis can aid in early disease diagnosis and classification and accordingly can lead directing further work up and better management.
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Affiliation(s)
| | - Hagar S. Mahmoud
- Department of Diagnostic Radiology, Yale New Haven Health at 1939 Bridgeport Hospital, Bridgeport, CT 06610, USA;
| | - Corey T. Jensen
- MD Anderson Cancer Center, Department of Diagnostic Imaging, University of Texas, Houston, TX 77030, USA; (C.T.J.); (S.K.); (A.C.M.); (V.K.W.); (U.I.S.); (S.M.P.)
| | - Sergio Klimkowski
- MD Anderson Cancer Center, Department of Diagnostic Imaging, University of Texas, Houston, TX 77030, USA; (C.T.J.); (S.K.); (A.C.M.); (V.K.W.); (U.I.S.); (S.M.P.)
| | - Ahmed Taher
- Transitional Year Residency Program, Trinity Health Midatlantic, Nazareth Hospital, Philadelphia, PA 19152, USA;
| | - Humaira Chaudhry
- Department of Radiology, The State University of New Jersey, Piscataway, NJ 08854, USA;
| | - Ajaykumar C. Morani
- MD Anderson Cancer Center, Department of Diagnostic Imaging, University of Texas, Houston, TX 77030, USA; (C.T.J.); (S.K.); (A.C.M.); (V.K.W.); (U.I.S.); (S.M.P.)
| | - Vincenzo K. Wong
- MD Anderson Cancer Center, Department of Diagnostic Imaging, University of Texas, Houston, TX 77030, USA; (C.T.J.); (S.K.); (A.C.M.); (V.K.W.); (U.I.S.); (S.M.P.)
| | - Usama I. Salem
- MD Anderson Cancer Center, Department of Diagnostic Imaging, University of Texas, Houston, TX 77030, USA; (C.T.J.); (S.K.); (A.C.M.); (V.K.W.); (U.I.S.); (S.M.P.)
| | - Sarah M. Palmquist
- MD Anderson Cancer Center, Department of Diagnostic Imaging, University of Texas, Houston, TX 77030, USA; (C.T.J.); (S.K.); (A.C.M.); (V.K.W.); (U.I.S.); (S.M.P.)
| | - Khaled M. Elsayes
- MD Anderson Cancer Center, Department of Diagnostic Imaging, University of Texas, Houston, TX 77030, USA; (C.T.J.); (S.K.); (A.C.M.); (V.K.W.); (U.I.S.); (S.M.P.)
- Correspondence:
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Systemic Mastocytosis: Radiological Point of View. Mediterr J Hematol Infect Dis 2021; 13:e2021056. [PMID: 34527208 PMCID: PMC8425380 DOI: 10.4084/mjhid.2021.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/10/2021] [Indexed: 12/27/2022] Open
Abstract
Radiological diagnosis of systemic mastocytosis (SM) can be hard to establish. This difficulty is mainly due to the variable radiological features involving many organ systems (e.g., respiratory, cardiovascular, lympho-reticular, digestive systems, and most commonly skin), and above all, to the broad spectrum of skeletal findings. Skeletal involvement is the most common and prominent imaging feature in patients with SM and represents a prognostic factor as it may entail an aggressive course of the disease. Diagnosis, largely established by histological evaluation of a bone marrow trephine biopsy, supplemented by imaging modalities such as radiography, CT, and magnetic resonance imaging, requires a team approach between the hematologist, radiologist, and pathologist. The general radiologist needs to be familiar with the imaging findings because they may be the first to suggest the correct diagnosis. The primary purpose of this review article was to equip clinicians with pertinent radiological semiotics by presenting relevant radiological features that assist early diagnosis and selection of an effective treatment.
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Ozturk K, Cayci Z, Gotlib J, Akin C, George TI, Ustun C. Non-hematologic diagnosis of systemic mastocytosis: Collaboration of radiology and pathology. Blood Rev 2020; 45:100693. [PMID: 32334853 DOI: 10.1016/j.blre.2020.100693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/28/2020] [Accepted: 04/02/2020] [Indexed: 11/19/2022]
Abstract
Systemic mastocytosis (SM) is a hematologic disease with a wide range of clinical courses ranging from an indolent condition with normal life expectancy to exceedingly aggressive disorder with a poor prognosis. The symptoms and signs of SM result from the release of mast cell mediators with heterogeneous functions, and/or organ damage from neoplastic mast cell infiltration, or both. Diagnostic criteria for SM are well-defined by the World Health Organization (WHO). However, the diagnosis of SM can be difficult when especially it is not in the differential diagnosis. Routinely used radiologic techniques (e.g., X-ray, ultrasound, CT scans can show findings such as lytic-, sclerotic- or mixed-bone lesions, splenomegaly, hepatomegaly, retroperitoneal or periportal mesenteric lymphadenopathy, and omental thickening). It is essential to emphasize that the constellation of these radiologic findings should strongly concern of SM, especially in patients who also have a skin rash, allergic reactions, gastrointestinal tract symptoms (lasting, intermittent nausea, diarrhea), paroxysmal tachycardias, unexplained weight loss, persistent bone pain, cytopenias, liver dysfunction, eosinophilia. These findings, even coincidentally noted, will likely lead to a tissue biopsy, which reveals diagnosis (as we discussed and illustrated some tissue biopsies here). Moreover, the role of MRI and new techniques such as [18-fluorodeoxyglucose positron emission computed tomography, fibroscan] in the diagnosis of SM have been discussed. Furthermore, we reviewed the use of radiologic methods to evaluate treatment response and prognostication of SM..
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Affiliation(s)
- Kerem Ozturk
- Department of Radiology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Zuzan Cayci
- Department of Radiology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Jason Gotlib
- Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, CA, USA
| | - Cem Akin
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Tracy I George
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Celalettin Ustun
- Division of Hematology, Oncology and Cellular Therapy, Department of Medicine, Rush University, Chicago, IL, USA.
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Epelboym Y, Keraliya AR, Tirumani SH, Hornick JL, Ramaiya NH, Shinagare AB. Differences in the imaging features and distribution of non-indolent and indolent mastocytosis: a single institution experience of 29 patients. Clin Imaging 2017; 44:111-116. [DOI: 10.1016/j.clinimag.2017.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/21/2017] [Accepted: 05/01/2017] [Indexed: 11/27/2022]
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8
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de Mol CL, Hermans MAW, Gerth van Wijk R, van Hagen PM, van Daele PLA. Routine abdominal ultrasonography has limited value in the care for patients with indolent systemic mastocytosis. Hematology 2017; 22:544-547. [DOI: 10.1080/10245332.2017.1324377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- C. L. de Mol
- Department of Internal Medicine, Section of Clinical Immunology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - M. A. W. Hermans
- Department of Internal Medicine, Section of Clinical Immunology, Erasmus University Medical Centre, Rotterdam, Netherlands
- Department of Internal Medicine, Section of Allergology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - R. Gerth van Wijk
- Department of Internal Medicine, Section of Allergology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - P. M. van Hagen
- Department of Internal Medicine, Section of Clinical Immunology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - P. L. A. van Daele
- Department of Internal Medicine, Section of Clinical Immunology, Erasmus University Medical Centre, Rotterdam, Netherlands
- Department of Internal Medicine, Section of Allergology, Erasmus University Medical Centre, Rotterdam, Netherlands
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Nay J, Menias CO, Mellnick VM, Balfe DM. Gastrointestinal manifestations of systemic disease: a multimodality review. ACTA ACUST UNITED AC 2016; 40:1926-43. [PMID: 25548008 DOI: 10.1007/s00261-014-0334-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Systemic diseases have many different presentations, including imaging findings in the bowel. Recognizing the imaging findings in these diseases is important in making the correct diagnosis. Although certain imaging features overlap, knowledge of specific findings along with the clinical presentation aid in narrowing the differential or in making an imaging diagnosis. The pictorial review will focus on the gastrointestinal manifestations of systemic diseases, including amyloidosis, angiotensin converter enzyme inhibitor-induced angioedema, celiac sprue, distal intestinal obstruction syndrome, graft-versus-host disease, hemolytic uremic syndrome, hemophilia, Henoch-Schönlein purpura, intestinal lymphangiectasia, mastocytosis, scleroderma, systemic lupus erythematosus, Wegener's granulomatosis, and Whipple's disease. The aforementioned diseases can be subdivided based upon the underlying process leading to the disease. The diseases discussed are categorized into autoimmune, infiltrative, treatment related, congenital/hereditary, and infectious etiologies.
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Affiliation(s)
- John Nay
- Washington University School of Medicine Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd, Saint Louis, MO, 63110, USA,
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Abstract
Biliary strictures and masses are commonly a result of cholangiocarcinoma. However, there are several congenital, infectious, inflammatory, autoimmune, iatrogenic, and neoplastic etiologies that should also be considered in the differential diagnosis. Knowledge of the key imaging and clinical findings will aid in facilitating the diagnosis and treatment.
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Chehab M, Copelan A, Al-faham Z, Bahoura L, Wong CYO. Systemic mastocytosis: a rare cause of single vertebral body uptake on bone scan. J Radiol Case Rep 2015; 9:31-41. [PMID: 25926926 DOI: 10.3941/jrcr.v9i2.2264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Systemic Mastocytosis is a rare condition characterized by the abnormal proliferation of Mast Cells. Presentation as a solitary vertebral body lesion is extremely uncommon and may be confused with more ominous conditions such as metastasis. Familiarity with the condition can heighten clinical suspicion, direct tissue diagnosis, guide management and indicate appropriate follow up. We present a case of a 64-year-old woman undergoing staging for recently diagnosed breast cancer who was found to have Systemic Mastocytosis of a single vertebral body.
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Affiliation(s)
- Monzer Chehab
- Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Michigan, USA
| | - Alexander Copelan
- Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Michigan, USA
| | - Zaid Al-faham
- Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Michigan, USA
| | - Lawrence Bahoura
- Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Michigan, USA
| | - Ching Yee Oliver Wong
- Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Michigan, USA
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Katz DS, Scheirey CD, Bordia R, Hines JJ, Javors BR, Scholz FJ. Computed Tomography of Miscellaneous Regional and Diffuse Small Bowel Disorders. Radiol Clin North Am 2013. [DOI: 10.1016/j.rcl.2012.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Fritz J, Fishman EK, Carrino JA, Horger MS. Advanced imaging of skeletal manifestations of systemic mastocytosis. Skeletal Radiol 2012; 41:887-97. [PMID: 22366736 DOI: 10.1007/s00256-012-1374-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 01/26/2012] [Accepted: 01/27/2012] [Indexed: 02/02/2023]
Abstract
Systemic mastocytosis comprises a group of clonal disorders of the mast cell that most commonly involves the skeletal system. Imaging can be helpful in the detection and characterization of the osseous manifestations of this disease. While radiography and bone scans are frequently used for this assessment, low-dose multidetector computed tomography and magnetic resonance imaging can be more sensitive for the detection of marrow involvement and for the demonstration of the various disease patterns. In this article, we review the pathophysiological and clinical features of systemic mastocytosis, discuss the role of imaging for staging and management, and illustrate the various cross-sectional imaging appearances. Awareness and knowledge of the imaging features of this disorder will increase the accuracy of image interpretation and can contribute important information for management decisions.
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Affiliation(s)
- J Fritz
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD 21287, USA.
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Alfter K, von Kügelgen I, Haenisch B, Frieling T, Hülsdonk A, Haars U, Rolfs A, Noe G, Kolck UW, Homann J, Molderings GJ. New aspects of liver abnormalities as part of the systemic mast cell activation syndrome. Liver Int 2009; 29:181-6. [PMID: 18662284 DOI: 10.1111/j.1478-3231.2008.01839.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIMS This study was aimed at investigating the form and prevalence of liver involvement in patients with systemic mast cell activation syndrome, a possibly common subvariant of systemic mastocytosis. An attempt was made to shed light on potential mechanisms responsible for mast cell mediator-related liver abnormalities. METHODS The methods used were clinical investigation, biochemical determination of cholesterol, transaminases and bilirubin in blood, determination of chitotriosidase by enzyme-linked immunosorbent assay technique, and quantitative reverse transcribed-polymerase chain reaction to determine chitotriosidase expression. RESULTS An elevation of plasma cholesterol was detected in 75% of the patients; elevations of transaminases and bilirubin were determined in 40 and 36% of the patients respectively; hepatomegaly or morphological hepatic alterations were observed in 34%. Chitotriosidase level in blood as a surrogate parameter for Kupffer cell activation in the liver was unchanged. However, chitotriosidase expression in isolated mast cells was downregulated at the mRNA level. CONCLUSIONS Hypercholesterolaemia and liver abnormalities are frequently found in patients with the mast cell activation syndrome. Hence, the mast cell activation syndrome should be considered at an early stage as a possible cause of hypercholesterolaemia and of hepatic abnormalities of unknown reason. Mast cell activation may be indicated by a reduced expression of the enzyme chitotriosidase in blood-derived mast cells as well as by an increased plasma cholesterol level.
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Affiliation(s)
- Kirsten Alfter
- Evangelische Kliniken, Waldkrankenhaus, Department for Internal Medicine, Bonn, Germany
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Dong P, Wang B, Sun QY, Cui H. Tuberculosis versus non-Hodgkin’s lymphomas involving small bowel mesentery: Evaluation with contrast-enhanced computed tomography. World J Gastroenterol 2008; 14:3914-8. [PMID: 18609719 PMCID: PMC2721452 DOI: 10.3748/wjg.14.3914] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the specific computed tomography (CT) imaging criteria for differentiating tuberculosis involving the small bowel mesenteric lymph nodes from lymphomas.
METHODS: We retrospectively reviewed the anatomic distribution, CT enhancement patterns of lymphoma in 18 patients with mesenteric tuberculosis and 22 with untreated non-Hodgkin’s lymphomas (NHL) involving small bowel mesentery (SBM). Of the 18 patients with tuberculosis, 9 had purely mesenteric tuberculous lymphadenopathy (TL), and 9 had mesenteric TL accompanied with tuberculous mesenteritis (TLM).
RESULTS: CT showed that tuberculosis and NHL mainly affected lymph nodes in the body and root of SBM. Homogeneously enhanced lymph nodes in the body and root of SBM were found more often in the NHL (P < 0.05). Homogeneously mixed peripheral enhanced lymph nodes in the body of SBM were found more often in mesenteric TL and TLM (P < 0.05). Peripheral enhanced lymph nodes in the root of SBM were found more often in mesenteric TL and TLM (P < 0.01). “Sandwich sign” in the root of SBM was observed more often in NHL (P < 0.05).
CONCLUSION: Anatomic lymph node distribution, sandwich sign and specific enhancement patterns of lymphadenopathy in SBM on CT images can be used in differentiating between tuberculosis and untreated NHL involving SBM.
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16
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Affiliation(s)
- Panuch Yenarkarn
- Department of Radiology, University of California San Francisco Medical School, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143-0628, USA
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17
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Kasprowicz S, Chan IJ, Wall DJ, Tharp MD. Nodular mastocytosis. J Am Acad Dermatol 2006; 55:347-9. [PMID: 16844528 DOI: 10.1016/j.jaad.2005.11.1032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Revised: 10/12/2005] [Accepted: 11/02/2005] [Indexed: 10/22/2022]
Abstract
Mastocytosis refers to a group of disorders characterized by the pathologic proliferation of mast cells. We present a 70-year-old white man with a rare presentation of nodular mastocytosis, characterized by disseminated nodular lesions, myelodysplastic syndrome, and a c-kit V560G receptor mutation. The patient presented to the clinic after initial presentation 6 months earlier, with ear pruritus, associated hearing loss, and widespread rash.
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Affiliation(s)
- Sarah Kasprowicz
- Department of Dermatology, Rush University Medical Center, Chicago, IL 60612, USA.
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18
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Papakonstantinou O, Maris TG, Kostaridou S, Ladis V, Vasiliadou A, Gourtsoyiannis NC. Abdominal lymphadenopathy in beta-thalassemia: MRI features and correlation with liver iron overload and posttransfusion chronic hepatitis C. AJR Am J Roentgenol 2005; 185:219-24. [PMID: 15972427 DOI: 10.2214/ajr.185.1.01850219] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to describe the MRI features of abdominal lymphadenopathy in patients with beta-thalassemia major and investigate the relation of abdominal lymphadenopathy with the severity of iron overload and posttransfusion chronic hepatitis C. MATERIALS AND METHODS Abdominal MRI studies of 60 consecutive patients with beta-thalassemia major, performed for quantification of liver iron overload at a single institution, were retrospectively studied for the presence of lymph nodes and their distribution, size, and number. The signal intensity ratios of liver, spleen, and the largest lymph node to the right paraspinous muscle (L/M, S/M, and LN/M, respectively) were calculated on T1-weighted gradient-echo images. MRI findings for the lymph nodes were compared with the histologically assigned activity level of chronic hepatitis C that was available in 17 patients who had undergone liver biopsy within 1 month of the MRI examination. RESULTS Hypointense abdominal lymph nodes larger than 7 mm were seen in 19 (32%) of 60 thalassemic patients in perihepatic and paraortic distributions. Lymphadenopathy was related to both the severity of hepatic siderosis, as expressed by the L/M values, and the presence of chronic hepatitis C, given that 18 (95%) of the 19 thalassemic patients with lymphadenopathy had chronic hepatitis C. Moreover, thalassemic patients with a moderate or severe level of hepatic inflammation presented with abdominal lymphadenopathy more frequently than those with mild hepatic inflammation. CONCLUSION The development of hypointense abdominal lymphadenopathy in patients with beta-thalassemia major who have received multiple transfusions depends both on the severity of liver iron overload and on the presence and the activity level of coexistent chronic hepatitis C.
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Affiliation(s)
- Olympia Papakonstantinou
- Department of Radiology, MRI Unit, University Hospital of Heraklion, University of Crete Medical School, Crete, Greece.
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19
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Sato AF, Solano M. Ultrasonographic findings in abdominal mast cell disease: a retrospective study of 19 patients. Vet Radiol Ultrasound 2004; 45:51-7. [PMID: 15005361 DOI: 10.1111/j.1740-8261.2004.04008.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
A retrospective survey from January 1989 to January 1999 of Tufts University Foster Hospital for Small Animals radiology records of 12 dogs and seven cats with cytologically or histopathologically confirmed abdominal mast cell disease was performed. Ultrasound changes in hepatic mast cell infiltration in dogs included a subjective increase in size, a diffuse increase in echogenicity, and one or more hypoechoic nodules. Ultrasound findings in the affected canine spleen included one or more hypoechoic nodules and a subjective increase in size. Two ultrasonographically unremarkable canine livers and one unremarkable spleen were found to be infiltrated by mast cells. The mast cell-infiltrated feline spleen was subjectively increased in size, mottled, irregular, or contained nodules. The affected lymph nodes in both dogs and cats were hypoechoic or inhomogeneous, subjectively increased in size, and rounded. Gastrointestinal involvement in cats was characterized by a thickened ileocecocolic junction or colon with loss of wall layering. Mast cells were not found in the gastrointestinal tract in any dog. One dog with mast cell infiltrate of the kidneys had multiple hypoechoic nodules in the cortex that distorted the outer contour of the kidney. Although these findings are not specific to the disease in either species, abdominal ultrasound is considered a useful tool for determining the extent of disease in small-animal patients with mast cell tumor if used in conjunction with histopathology or cytology.
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Affiliation(s)
- Amy F Sato
- Section of Radiology, Department of Clinical Sciences. Tufts University School of Veterinary Medicine, 200 Westborough Road, North Grafton, MA 01536, USA
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20
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Hackmon-Ram R, Holcberg G, Bashiri A, Sapir O, Tov GY, Yermiahu T, Mazor M. Thalassemia intermedia and cavernous transformation of portal vein thrombosis in pregnancy. Eur J Obstet Gynecol Reprod Biol 2003; 107:101-4. [PMID: 12593907 DOI: 10.1016/s0301-2115(02)00260-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report a rare case of a cavernous transformation of portal vein (CTPV) thrombosis accompanied by Thalassemia and thrombophilia during pregnancy that was successfully treated by low molecular weight heparin. The clinical presentation, diagnosis and the treatment are discussed.
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Affiliation(s)
- Rinat Hackmon-Ram
- Division of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev PO Box 151 Beer Sheva 84101, Israel
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21
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Sheth S, Horton KM, Garland MR, Fishman EK. Mesenteric neoplasms: CT appearances of primary and secondary tumors and differential diagnosis. Radiographics 2003; 23:457-73; quiz 535-6. [PMID: 12640160 DOI: 10.1148/rg.232025081] [Citation(s) in RCA: 157] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Computed tomography (CT) remains the optimal imaging modality for diagnosing tumors in the mesentery. Although primary neoplasms arising from the mesenchymal tissues of the mesentery are rare, the small bowel mesentery is a major avenue for the dissemination of tumor within the peritoneal cavity. Tumors spread to the mesentery by four major routes: (a) direct extension, commonly seen with carcinoid tumor of the small intestine as well as intraabdominal cancers such as pancreatic and colon cancer; (b) lymphatic dissemination of lymphoma and some epithelial malignancies; (c) hematogenic spread resulting in embolic metastases to the small intestinal wall, usually seen in melanoma and breast cancer; and (d) seeding through the peritoneum from ovarian and gastrointestinal malignancies as well as some lymphomas. Although percutaneous imaging-guided or surgical biopsy is often necessary to guide management, analysis of CT features along with the clinical history may be useful in differentiating mesenteric tumors from infectious, inflammatory, or vascular processes affecting the mesentery. The article presents the characteristic appearances of primary and secondary mesenteric neoplasms at CT and offers a rational approach to the differential diagnosis of mesenteric masses depicted at CT.
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Affiliation(s)
- Sheila Sheth
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 600 N Wolfe St, HAL B176D, Baltimore, MD 21287, USA.
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22
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Zettinig G, Becherer A, Szabo M, Uffmann M, Dudczak R, Valent P, Kletter K. FDG positron emission tomography in patients with systemic mastocytosis. AJR Am J Roentgenol 2002; 179:1235-7. [PMID: 12388504 DOI: 10.2214/ajr.179.5.1791235] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Systemic mastocytosis is a hematologic neoplasm characterized by abnormal accumulation and growth of mast cells in one or more organ systems. We analyzed five patients with systemic mastocytosis referred for FDG positron emission tomography who had biopsy-proven mast cell infiltrates in various organs. CONCLUSION Our findings indicate that FDG positron emission tomography is not useful for staging and follow-up of aggressive systemic mastocytosis.
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Affiliation(s)
- Georg Zettinig
- Department of Nuclear Medicine, University of Vienna, Währinger Gürtel 18-20, A-1090 Wien, Austria
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23
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24
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Coakley FV, Lin RY, Schwartz LH, Panicek DM. Mesenteric adenopathy in patients with prostate cancer: frequency and etiology. AJR Am J Roentgenol 2002; 178:125-7. [PMID: 11756105 DOI: 10.2214/ajr.178.1.1780125] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study was undertaken to determine the frequency and etiology of mesenteric adenopathy revealed at initial-staging CT in patients with prostate cancer. CONCLUSION Mesenteric adenopathy is a rare finding at initial-staging CT in patients with prostate cancer and is more often due to coexistent lymphoma than to metastatic disease, particularly in the absence of associated pelvic adenopathy and a markedly elevated serum prostate-specific antigen level. Appropriate radiologic interpretation of the finding prevents overstaging of prostate cancer.
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Affiliation(s)
- Fergus V Coakley
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, USA
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25
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Abstract
Mastocytosis represents a heterogeneous group of clinical disorders resulting from the infiltration of mast cells in the skin and other organs. Although mastocytosis was first described over 130 years ago, the pathophysiologic mechanisms responsible for this disease have been identified only recently. This article discusses the salient clinical features of the disease, the mechanisms responsible for its development, and provides treatment approaches that have proven useful for managing patients with this disorder.
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Affiliation(s)
- M D Tharp
- Department of Dermatology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA
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26
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Valent P, Horny HP, Escribano L, Longley BJ, Li CY, Schwartz LB, Marone G, Nuñez R, Akin C, Sotlar K, Sperr WR, Wolff K, Brunning RD, Parwaresch RM, Austen KF, Lennert K, Metcalfe DD, Vardiman JW, Bennett JM. Diagnostic criteria and classification of mastocytosis: a consensus proposal. Leuk Res 2001; 25:603-25. [PMID: 11377686 DOI: 10.1016/s0145-2126(01)00038-8] [Citation(s) in RCA: 765] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The term 'mastocytosis' denotes a heterogeneous group of disorders characterized by abnormal growth and accumulation of mast cells (MC) in one or more organ systems. Over the last 20 years, there has been an evolution in accepted classification systems for this disease. In light of such developments and novel useful markers, it seems appropriate now to re-evaluate and update the classification of mastocytosis. Here, we propose criteria to delineate categories of mastocytosis together with an updated consensus classification system. In this proposal, the diagnosis cutaneous mastocytosis (CM) is based on typical clinical and histological skin lesions and absence of definitive signs (criteria) of systemic involvement. Most patients with CM are children and present with maculopapular cutaneous mastocytosis (=urticaria pigmentosa, UP). Other less frequent forms of CM are diffuse cutaneous mastocytosis (DCM) and mastocytoma of skin. Systemic mastocytosis (SM) is commonly seen in adults and defined by multifocal histological lesions in the bone marrow (affected almost invariably) or other extracutaneous organs (major criteria) together with cytological and biochemical signs (minor criteria) of systemic disease (SM-criteria). SM is further divided into the following categories: indolent systemic mastocytosis (ISM), SM with an associated clonal hematologic non-mast cell lineage disease (AHNMD), aggressive systemic mastocytosis (ASM), and mast cell leukemia (MCL). Patients with ISM usually have maculopapular skin lesions and a good prognosis. In the group with associated hematologic disease, the AHNMD should be classified according to FAB/WHO criteria. ASM is characterized by impaired organ-function due to infiltration of the bone marrow, liver, spleen, GI-tract, or skeletal system, by pathologic MC. MCL is a 'high-grade' leukemic disease defined by increased numbers of MC in bone marrow smears (>or=20%) and peripheral blood, absence of skin lesions, multiorgan failure, and a short survival. In typical cases, circulating MC amount to >or=10% of leukocytes (classical form of MCL). Mast cell sarcoma is a unifocal tumor that consists of atypical MC and shows a destructive growth without (primary) systemic involvement. This high-grade malignant MC disease has to be distinguished from a localized benign mastocytoma in either extracutaneous organs (=extracutaneous mastocytoma) or skin. Depending on the clinical course of mastocytosis and development of an AHNMD, patients can shift from one category of MC disease into another. In all categories, mediator-related symptoms may occur and may represent a serious clinical problem. All categories of mastocytosis should be distinctively separated from reactive MC hyperplasia, MC activation syndromes, and a more or less pronounced increase in MC in myelogenous malignancies other than mastocytosis. Criteria proposed in this article should be helpful in this regard.
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Affiliation(s)
- P Valent
- Department of Internal Medicine I, Division of Hematology, University of Vienna, Währinger Gürtel 18-20 Vienna, Austria.
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