1
|
Safai Zadeh E, Görg M, Görg C, Prosch H, Trenker C, Westhoff CC, Dietrich CF, Raab N, Alhyari A, Huber K, Pochepnia S, Weber M, Findeisen H. The value of contrast-enhanced ultrasound in percutaneous biopsy of retroperitoneal masses. Ultraschall Med 2024. [PMID: 38588693 DOI: 10.1055/a-2282-2353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
PURPOSE To evaluate the diagnostic yield of contrast-enhanced ultrasound (CEUS)-guided biopsy of retroperitoneal masses (RMs). MATERIALS AND METHODS Between 2006 and 2023, 87 patients presented at our US center for biopsy of an RM. In all biopsies, CEUS was performed prior to the intervention. The technical success rate of biopsy, the presence of diagnostic tissue in solid tumor biopsy samples, the accuracy of the biopsy and the occurrence of post-interventional complications were evaluated. RESULTS A US-guided biopsy could be conducted in 84/87 cases (96.6%). In 3/87 cases (3.4%), US-guided biopsy was impossible because the planned needle path was obstructed by vital structures. Of 84 lesions, 80 (95.2%) were solid lesions, and 4 (4.8%) were lesions containing fluid. In all solid tumors, 80/80 (100%), diagnostic vital tissue was successfully obtained. CEUS-guided biopsy showed a sensitivity of 93.2%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 72.2%, and a diagnostic accuracy of 94.2% for the differentiation between malignant and benign RMs. In one of the 84 cases (1.2%), there was a complication of postinterventional abdominal pain. CONCLUSION Percutaneous CEUS-guided biopsy is a safe procedure with a high diagnostic yield and a low complication rate.
Collapse
Affiliation(s)
- Ehsan Safai Zadeh
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Wien, Austria
- Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Mathis Görg
- Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Christian Görg
- Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Wien, Austria
| | - Corinna Trenker
- Haematology, Oncology and Immunology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Christina Carolin Westhoff
- Institute of Pathology, University Hospital of Giessen and Marburg, Campus Marburg, Philipps-University of Marburg, Marburg, Germany
| | - Christoph F Dietrich
- Department General Internal Medicine, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Nils Raab
- General internal medicine and gastroenterology, Westmecklenburg Klinikum Helene von Bulow GmbH, Ludwigslust, Germany
| | - Amjad Alhyari
- Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Katharina Huber
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Svitlana Pochepnia
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Wien, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Wien, Austria
| | - Hajo Findeisen
- Department for Internal Medicine, Red Cross Hospital Bremen, Bremen, Germany
| |
Collapse
|
2
|
Kroenig J, Safai Zadeh E, Westhoff CC, Klemmer A, Alhyari A, Görg C. Diagnosis of Thoracic Splenosis by Contrast-Enhanced Ultrasound (CEUS). Ultraschall Med 2023; 44:645-646. [PMID: 36063839 DOI: 10.1055/a-1926-7142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Johannes Kroenig
- Department of Medicine, Pulmonary and Critical Care Medicine, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound, Philipps-Universitat Marburg, Marburg, Germany
| | | | - Andreas Klemmer
- Department of Medicine, Pulmonary and Critical Care Medicine, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Amjad Alhyari
- Interdisciplinary Center of Ultrasound, Philipps-Universitat Marburg, Marburg, Germany
| | - Christian Görg
- Hematology, Oncology and Immunology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| |
Collapse
|
3
|
Trenker C, Görg C, Burchert A, Michel C, Kipper K, Westhoff CC, Keber CU, Safai Zadeh E. Presentation of Chloromas in B-Mode Ultrasound and Contrast-Enhanced Ultrasound. Ultrasound Med Biol 2022; 48:1933-1940. [PMID: 35778304 DOI: 10.1016/j.ultrasmedbio.2022.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/28/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
Chloromas, also referred to as myeloid sarcomas, describe rare extramedullary tumor aggregates of malignant myeloid progenitor cells. The aim of this study was investigate the diagnostic features and characteristics of chloromas using contrast-enhanced ultrasound (CEUS). Between July 2007 and April 2021, 15 patients with 20 myeloid neoplasms and suspected chloroma manifestations were examined using B-mode US (B-US) and CEUS. Clinical data and B-US (echogenicity, border, size) and CEUS (hyper-, iso-, hypo- or complex enhancement) characteristics were retrospectively analyzed. Absolute and relative frequencies were determined. In B-US, the chloromas were most frequently hypo-echoic (n = 15, 75%). In addition, a hyperechoic (n = 2, 10%) or echocomplex (n = 3, 15%) presentation was observed. On CEUS, 7 chloromas (35%) had an arterial hyperenhancement, 8 (40%) an iso-enhancement and 3 (15%) a complex enhancement. Two chloromas (10%) did not exhibit any enhancement. We describe for the first time CEUS and B-US patterns of chloromas. They are typically hypo-echoic on B-US and have a strong iso- or hyperenhancement on CEUS, which may help in the differential diagnosis of some unclear masses (e.g., hematoma, abscess) in patients with myeloid neoplasias. Nevertheless, histology is necessary for a reliable diagnosis.
Collapse
Affiliation(s)
- Corinna Trenker
- Department of Internal Medicine, Hematology, Oncology and Immunology, University Hospital Marburg und Giessen, Marburg, Hessen, Germany.
| | - Christian Görg
- Gastroenterology and Interdisciplinary Center of Ultrasound, Department of Internal Medicine, University Hospital Marburg and Giessen, Marburg, Hessen, Germany
| | - Andreas Burchert
- Department of Internal Medicine, Hematology, Oncology and Immunology, University Hospital Marburg und Giessen, Marburg, Hessen, Germany
| | - Christian Michel
- Department of Internal Medicine, Hematology, Oncology and Immunology, University Hospital Marburg und Giessen, Marburg, Hessen, Germany
| | - Katharina Kipper
- Gastroenterology and Interdisciplinary Center of Ultrasound, Department of Internal Medicine, University Hospital Marburg and Giessen, Marburg, Hessen, Germany
| | | | - Corinna Ulrike Keber
- Department of Pathology, University Hospital Marburg und Giessen, Marburg, Hessen, Germany
| | - Ehsan Safai Zadeh
- Gastroenterology and Interdisciplinary Center of Ultrasound, Department of Internal Medicine, University Hospital Marburg and Giessen, Marburg, Hessen, Germany.
| |
Collapse
|
4
|
Safai Zadeh E, Westhoff CC, Keber CU, Trenker C, Dietrich CF, Alhyari A, Mohr CGL, Görg C. Perfusion Patterns of Peripheral Organizing Pneumonia (POP) Using Contrast-Enhanced Ultrasound (CEUS) and Their Correlation with Immunohistochemically Detected Vascularization Patterns. Diagnostics (Basel) 2021; 11:1601. [PMID: 34573943 PMCID: PMC8468045 DOI: 10.3390/diagnostics11091601] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/22/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: To describe the perfusion patterns of peripheral organizing pneumonia (POP) by contrast-enhanced ultrasound (CEUS) and their correlation with vascularization patterns (VPs) represented by immunohistochemical CD34 endothelial staining. Methods: From October 2006 until December 2020, 38 consecutive patients with histologically confirmed POPs were standardized-examined by CEUS. The time to enhancement (TE; classified as an early pulmonary-arterial [PA] pattern of enhancement vs. delayed bronchial-arterial [BA] pattern of enhancement), the extent of enhancement (EE; classified as marked or reduced), the homogeneity of enhancement (HE; classified as homogeneous or inhomogeneous), and the decrease of enhancement (DE; classified as rapid washout [<120s] or late washout [≥120s]) were evaluated retrospectively. Furthermore, tissue samples from the study patients were immunohistochemically stained with CD34 antibody. The presence of avascular areas (AAs) and the VPs were evaluated in all tissue samples. Results: The majority of POPs showed a BA pattern of enhancement (71.1%), an isoechoic marked enhancement (76.3%), and an inhomogeneous enhancement (81.6%). A rapid DE was observed in 50.0% of cases. On CD34 staining, all POPs had a chaotic VP, indicating BA neoangiogenesis. AAs (abscess, necrosis, hemorrhage) were identified in (41.9%) cases with an inhomogeneous enhancement on CEUS. Conclusion: On CEUS, POPs predominantly revealed a marked inhomogeneous BA pattern of enhancement with a rapid washout in 50% of cases. Furthermore, we demonstrated that the presence of a PA pattern of enhancement, found in 28.9% of POPs, did not exclude a BA neoangiogenesis as an important feature of chronic inflammatory and malignant processes.
Collapse
Affiliation(s)
- Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (E.S.Z.); (C.G.L.M.)
| | - Christina Carolin Westhoff
- Institute of Pathology, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (C.C.W.); (C.U.K.)
| | - Corinna Ulrike Keber
- Institute of Pathology, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (C.C.W.); (C.U.K.)
| | - Corinna Trenker
- Haematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany;
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, 3018 Bern, Switzerland;
| | - Amjad Alhyari
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35033 Marburg, Germany;
| | - Charlotte Gabriele Luise Mohr
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (E.S.Z.); (C.G.L.M.)
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (E.S.Z.); (C.G.L.M.)
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35033 Marburg, Germany;
| |
Collapse
|
5
|
Sevinc S, Westhoff CC, Schrader AJ, Olbert PJ, Hofmann R, Hegele A. [Pelvic lymphadenitis after total hip arthroplasty : Mimicking of lymph node metastases in a patient with prostate cancer]. Urologe A 2010; 49:952-6. [PMID: 20182691 DOI: 10.1007/s00120-009-2212-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This report describes the case of a 65-year-old patient who underwent radical prostatectomy in our department. Intraoperatively we detected suspicious lymph nodes on the left side. The histopathological examination revealed histiocytosis and foreign body giant cells but no sign of tumor. The enlarged lymph nodes were ascribed to an ipsilateral total hip arthroplasty performed 14 years previously because of progressive coxarthrosis. Lymphadenitis after total hip arthroplasty is frequently observed. Histopathologically and with the use of polarized light microscopy, histiocytosis and wear particles such as titanium, polyethylene, and polyethylene-methylacrylate may be detected. When operating on patients with arthroplasty of a lower limb, particularly those with a total endoprosthesis, the surgeon should bear in mind that changes in lymph node consistency and size do not necessarily indicate tumor involvement or metastases.
Collapse
Affiliation(s)
- S Sevinc
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Giessen und Marburg GmbH, Standort Marburg, Baldingerstrasse, 35043, Marburg, Deutschland.
| | | | | | | | | | | |
Collapse
|
6
|
Lakemeier S, Westhoff CC, Fuchs-Winkelmann S, Schofer MD. Osseous hemangioma of the seventh cervical vertebra with osteoid formation mimicking metastasis: a case report. J Med Case Rep 2009; 3:92. [PMID: 19946508 PMCID: PMC2783091 DOI: 10.1186/1752-1947-3-92] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 11/02/2009] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION We report the case of an osseous hemangioma located in the seventh cervical vertebra with reactive osteoid formation and non-typical findings in the radiological and the histopathological examination, mimicking metastasis of a malignant tumor. To our knowledge, this is the first description of such a case in the literature. CASE PRESENTATION A 44-year-old otherwise healthy Caucasian German woman presented with a discrete sensorimotor loss of both upper limbs. Radiologically, an osteolysis in the seventh cervical vertebra suggestive of metastasis of a malignant neoplasm was diagnosed. After performing corporectomy and cage implantation of C7 on the patient, the histopathological examination was complicated by marked osteoid formation obscuring the true diagnosis of an osseous hemangioma with reactive osteoid formation. CONCLUSION Though hemangioma of the bone is a rare tumorous lesion in the cervical spine, it has to be taken into consideration as a reason for neck pain and sensomotoric loss of the upper limbs. Atypical radiological and histopathological presentations may hinder determination of the correct diagnosis. The treatment of such lesions must follow clinical guidelines but may be difficult to define in some cases when the correct diagnosis is not known at the time when therapy starts.
Collapse
Affiliation(s)
- Stefan Lakemeier
- Department of Orthopaedics, University Hospital Giessen and Marburg, Location Marburg, Baldingerstrasse, 35033 Marburg, Germany
| | | | | | | |
Collapse
|
7
|
Abstract
Pure clear cell lesions of the thyroid gland are rare and prone to pose severe diagnostic challenges. We report the case of a 61-year-old man with a clear cell adenoma of the thyroid. The patient presented with a hypoechoic thyroid nodule. Fine needle aspiration cytology rendered the primary diagnosis of a follicular neoplasia, and right thyroid lobectomy was performed. By intra-operative frozen section, the diagnosis given was clear cell lesion of unknown malignant potential. Based on the light microscopic findings and the immunohistochemical profile, the lesion was diagnosed as clear cell follicular adenoma of the thyroid. A follicular thyroid lesion presenting with clear cell changes in fine needle aspiration cytology or intra-operative frozen section consultation constitutes a diagnostic challenge to every surgical pathologist. As immunohistochemistry of cytologic specimens is hampered by several methodological problems, any thyroid lesion with clear cell features warrants further histologic assessment to render the correct diagnosis.
Collapse
Affiliation(s)
- C C Westhoff
- Institute of Pathology, University Hospital Giessen and Marburg GmbH, Medical Faculty of Philipps University Marburg, Marburg, Germany. westhoff @med.uni-marburg.de
| | | | | |
Collapse
|
8
|
Barth PJ, Westhoff CC. Fibroblasts in chronic submandibular sialadenitis. Oral Dis 2008; 14:671; author reply 672. [PMID: 19076551 DOI: 10.1111/j.1601-0825.2008.01453.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|