A Rare Case of Melanotic Schwannoma Occurred Intraosseous of Sacrum: A Literature Review

BACKGROUND

Melanotic schwannoma is a rare tumor when it occurs in the sacrum. Though it is mostly classified as benign, the prognosis is unpredictable due to the possibility of recurrence and metastasis. Here, we reported a case of intraosseous of sacrum with good results and reviewed the literature.

CASE PRESENTATION

A 33-year-old male patient complained of low back pain and was discovered to have an obstruction at S2. Following the necessary imaging diagnosis, we treated the patient with piecemeal excision in conjunction with extended curettage, and the frozen biopsy revealed that the tumor was melanotic schwannoma. The intraosseous portion of the lesion was curettaged using high-speed drill to enlarge the edge of curettage, and piecemeal excision for lesion within the sacral canal. After surgery, the patient received total 56Gy radiotherapy and frequent follow-up. After 15 months follow-up, there was no evidence of recurrence, and the nerve function was normal.

CONCLUSION

Melanotic schwannoma that occurs intraosseous of the sacrum is extremely rare and lacks typical clinical manifestations; however it can be identified through careful pathological and imaging diagnosis. Intralesional extended curettage combined with radiotherapy can achieve a good local control with a satisfactory clinical effect in this rare disease.

Lymphadenitis associated with cat-scratch disease simulating a neoplasm: Imaging findings with histopathological associations

The lymphadenitis associated with cat-scratch disease (CSD) is often confused with neoplasms by a number of radiologists and clinicians, and consequently, unnecessary invasive procedures or surgeries are performed. In the present study, the contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) findings of 10 patients (6 men and 4 women) with clinically and pathologically confirmed lymphadenitis associated with CSD were retrospectively analyzed (CT in 3 patients, MRI in 6 patients, and CT and MRI in 1 patient) at The Second Affiliated Hospital of Zhejiang University School of Medicine (Hangzhou, China) between January 2007 and November 2014. As a result, 17 enlarged lymph nodes were identified in 10 cases. The 5 nodes identified by CT scan exhibited relatively inhomogeneous isodensity to muscle, with patchy low density in the center. All 14 nodes identified by MRI scan exhibited homogeneous or heterogeneous isointensity to muscle or slightly increased intensity compared with that of muscle on T1-weighted images (T1WI), and homogeneous or heterogeneous hyperintensity on fat-suppressed T2WI. Following enhancement, all 17 enlarged lymph nodes associated with CSD demonstrated the following 3 different enhancement patterns: Moderate homogeneous enhancement (n=8), which was associated with histologically identified early disease stage; marked heterogeneous enhancement with no enhancement of the necrotic areas (n=4), and heterogeneous enhancement with progressively ‘spoke-wheel-like’ (defined as radiating enhancement from the center) enhancement of the patchy low-density area (n=1), which was associated with histologically identified intermediate disease stage; and astral low-density/hypointensity with marked enhancement (n=2) or a ‘rose flower’ sign (n=2), which was associated with histologically identified late disease stage. We hypothesized that the CT and MRI results of lymphadenitis in CSD may be associated with the pathological features. It may be suggested that the diagnosis of CSD may be formed when considering the characteristic CT and MRI features of astral low-density/hypointensity with marked enhancement or a ‘rose flower’ sign (defined as marginal petaloid enhancement) in the late disease stage, or the MRI results of homogeneous, moderate enhancement in the early disease stage, or the CT/MRI data of heterogeneous enhancement with non-enhancing area in the center in the intermediate disease stage, in solitary or multiple enlarged lymph nodes associated with general subcutaneous edema in the vicinity of the nodes on CT/MRI and with a history of cat exposure.

Contrast-enhanced multiple-phase imaging features of intrahepatic mass-forming cholangiocarcinoma and hepatocellular carcinoma with cirrhosis: A comparative study

The intrahepatic mass-forming cholangiocarcinoma (IMCC) is frequently misdiagnosed as hepatocellular carcinoma (HCC) in patients with cirrhosis, by numerous radiologists and clinical doctors, which results in the incorrect therapeutic treatment. A retrospective case-control study was conducted, and the contrast-enhanced multiple-phase (CEMP) computed tomography (CT) and magnetic resonance imaging (MRI) findings of 22 pathologically confirmed IMCC patients and 22 HCC controls with underlying liver cirrhosis were analyzed at the present hospital, from January 2010 to December 2015. In addition, serum tests were conducted and clinical symptoms of patients evaluated. A statistical analysis revealed that the enhancement pattern, signal on MRI delayed phase (P<0.001), maximum diameter, capsule retraction, portal vein invasion, bile duct dilation and abdominal lymphadenectasis characteristics were different between IMCC and HCC patients with cirrhosis. On CEMP CT and MRI analysis, the most frequently occurring enhancement patterns of IMCC were progressive patterns (P=0.001 or P<0.001). Conversely, the most frequently occurring enhancement patterns present in HCC were the washout patterns (P<0.001). Therefore, the diagnosis of IMCC in cirrhotic patients should be verified with CEMP CT and MRI analysis for the future, to determine presence or absence of progressive and/or peripheral rim-like enhancement, a hyperintensive delayed phase with capsule retraction, portal vein invasion, bile duct dilation, abdominal lymphadenectasis and increased levels of CA199.

Multiple-phase spiral CT findings of pancreatic vasoactive intestinal peptide-secreting tumor: A case report

The present study reports a case of pancreatic vasoactive intestinal peptide-secreting tumor (VIPoma), of 2.2 cm in diameter, arising from the region of the uncus of the pancreas with liver metastases in a 50-year-old patient, which demonstrated unusual multiple-phase spiral computed tomography (MPSCT) results. The pancreatic lesion was isodense compared with the pancreatic parenchyma. During the hepatic artery phase and portal venous phase, the mass was hypodense compared with the enhanced pancreas, with the mean CT attenuation (HU) values being 56 HU and 66 HU, respectively. During the hepatic parenchymal phase, the mass became hyperdense with the mean CT attenuation values being 74 HU. The process of contrast-enhanced MPSCT demonstrated progressive strengthening. Pancreaticoduodenectomy and wedge resection of a number of the liver metastases was performed. There are only a limited number of studies reporting CT findings of pancreatic VIPoma and no MPSCT findings have been described previously.

Hemolymphangioma: A rare differential diagnosis of cystic-solid or cystic tumors of the pancreas

We report a case of pancreatic hemolymphangioma. Hemolymphangioma is a malformation of both lymphatic vessels and blood vessels. The incidence of this disease in the pancreas is extremely rare. To the best of our knowledge, only seven cases have been reported worldwide (PubMed). A 39-year-old woman with a one-day history of abdominal pain was admitted to our hospital. There was no obvious precipitating factor. The preoperative examination, including ultrasonography and computed tomography, showed a cystic-solid tumor in the pancreas, and it was considered to be a mucinous cystadenoma or cystadenocarcinoma. Pancreatic body-tail resection combined with splenectomy was performed. After the operation, the tumor was pathologically demonstrated to be a pancreatic hemolymphangioma. Although pancreatic hemolymphangioma is rare, we believe that it should be considered in the differential diagnosis of cystic-solid tumors of the pancreas, particularly when there is no sufficient evidence for diagnosing cystadenoma, cystadenocarcinoma or some other relatively common disease of the pancreas.

Effects of imperfections on localized bulging in inflated membrane tubes

The problem of localized bulging in inflated membrane tubes shares the same features with a variety of other localization problems such as formation of kink bands in fibre-reinforced composites and layered structures. This type of localization is known to be very sensitive to imperfections, but the precise nature of such sensitivity has not so far been quantified. In this paper, we study effects of localized wall thinning/thickening on the onset of localized bulging in inflated membrane tubes as a prototypical example. It is shown that localized wall thinning may reduce the critical pressure or circumferential stretch by an amount of the order of the square root of maximum wall thickness reduction. As a typical example, a 10 per cent maximum wall thinning may reduce the critical circumferential stretch by 19 per cent. This square root law complements the well-known Koiter's two-thirds power law for subcritical periodic bifurcations. The relevance of our results to mathematical modelling of aneurysm formation in human arteries is also discussed.

Accurate two-dimensional cardiac strain calculation using adaptive windowed Fourier transform and Gabor wavelet transform

PURPOSE

Cardiac strain calculated from tagged magnetic resonance (MR) images provides clinicians information about abnormalities of heart-wall motion in patients. It is important to develop an accurate method to determine the cardiac strain efficiently. An adaptive windowed harmonic phase (AWHARP) method is proposed for cardiac strain calculation.

MATERIALS AND METHODS

AWHARP is based on adaptive windowed Fourier transform (AWFT) and 2D Gabor wavelet transform (2D-GWT). The AWFT provides a spatially varying representation of the signal spectra, which allows the harmonic phase (HARP) image to be extracted with high accuracy. Instantaneous spatial frequencies are calculated using 2D-GWT, and the widths of the adaptive windows are then determined according to the instantaneous spatial frequencies for multi-resolution analysis of phase extraction. The proposed method was studied using simulated images and patients' MR images. Both single tagged images (SPAMM) and subtracted tagged images (CSPAMM) were generated using our simulation method, and their results calculated using AWHARP and HARP methods were compared. Normal and pathological tagged MR images were also processed to evaluate the performance of our method.

RESULTS

Our experimental results show that the accuracies of phase and strain images calculated using the AWHARP method are higher than that calculated using the HARP method especially for large tag line deformation. The improvement in accuracies can be up to 3.2 strain (E1) and 17.3 calculation from MR images reveals that the cardiac strain in the end-systolic state is significantly reduced for patients with hypertrophic cardiomyopathy (HCM) compared to that of healthy subjects.

CONCLUSION

The proposed AWHARP is an accurate and efficient method for cardiac strain estimation from MR images. This new algorithm can help clinicians to detect left ventricle dysfunctions and myocardial diseases with accurate cardiac strain analysis.

Comparison of five DNA extraction methods for molecular analysis of Jerusalem artichoke (Helianthus tuberosus)

DNA extraction is an essential step for molecular analysis of an organism, but it is difficult to acquire a sufficient amount of pure DNA from plant tissue with high levels of phenolic compounds, carbohydrates, proteins, and secondary metabolites. Jerusalem artichoke (Helianthus tuberosus) has high levels of such substances. We compared five commonly used methods of extracting genomic DNA in tests made with leaves and seed of four Jerusalem artichoke genotypes: 1) modified method of Tai and Tanksley, 2) method of Doyle and Doyle, 3) method of Porebski, 4) modified method of Štorchová, and 5) Plant DNA Kit of Omega Bio-tek. The quality and quantity of extracted DNAs were assessed by photometric assay, electrophoresis on 1% agarose gel and a PCR-based technique. The modified method of Tai and Tanksley was found to be superior for both young leaves and seed. The quality of the extracted DNA was confirmed by sequence-related amplified polymorphism. This information will be useful for molecular analyses of Jerusalem artichoke and other related Helianthus species.

Genetic diversity of worldwide Jerusalem artichoke (Helianthus tuberosus) germplasm as revealed by RAPD markers

Jerusalem artichoke (Helianthus tuberosus) is a wild relative of the cultivated sunflower (H. annuus); it is an old tuber crop that has recently received renewed interest. We used RAPD markers to characterize 147 Jerusalem artichoke accessions from nine countries. Thirty RAPD primers were screened; 13 of them detected 357 reproducible RAPD bands, of which 337 were polymorphic. Various diversity analyses revealed several different patterns of RAPD variation. More than 93% of the RAPD variation was found within accessions of a country. Weak genetic differentiation was observed between wild and cultivated accessions. Six groups were detected in this germplasm set. Four ancestral groups were found for the Canadian germplasm. The most genetically distinct accessions were identified. These findings provide useful diversity information for understanding the Jerusalem artichoke gene pool, for conserving Jerusalem artichoke germplasm, and for choosing germplasm for genetic improvement.

Contrast-enhanced multiple-phase imaging features in hepatic epithelioid hemangioendothelioma

AIM: To investigate and review the contrast-enhanced multiple-phase computed tomography (CEMP CT) and magnetic resonance imaging (MRI) findings in patients with pathologically confirmed hepatic epithelioid hemangioendothelioma (HEHE).

METHODS: Findings from imaging examinations in 8 patients (5 women and 3 men) with pathologically confirmed HEHE were retrospectively reviewed (CT images obtained from 7 patients and MR images obtained from 6 patients). The age of presentation varied from 27 years to 60 years (average age 39.8 years).

RESULTS: There were two types of HEHE: multifocal type (n = 7) and diffuse type (n = 1). In the multifocal-type cases, there were 74 lesions on CT and 28 lesions on MRI with 7 lesions found with diffusion weighted imaging; 18 (24.3%) of 74 lesions on plain CT and 26 (92.9%) of 28 lesions on pre-contrast MRI showed the target sign. On CEMP CT, 28 (37.8%) of 74 lesions appeared with the target sign and a progressive-enhancement rim and 9 (12.2%) of 74 lesions displayed progressive enhancement, maintaining a state of persistent enhancement. On CEMP MRI, 27 (96.4%) of 28 lesions appeared with the target sign with a progressive-enhancement rim and 28 (100%) of 28 lesions displayed progressive-enhancement, maintaining a state of persistent enhancement. In the diffuse-type cases, an enlarged liver was observed with a large nodule appearing with persistent enhancement on CEMP CT and MRI.

CONCLUSION: The most important imaging features of HEHE are the target sign and/or progressive enhancement with persistent enhancement on CEMP CT and MRI. MRI is advantageous over CT in displaying these imaging features.

[Oncocytic carcinoid tumor of the lung: clinical and pathological characteristics]

OBJECTIVE

To describe the clinical and pathological characteristics and the differential diagnosis of oncocytic carcinoid tumor of the lung (OCTL).

METHODS

The histopathological and immunochemical changes of 3 cases of OCTL were studied, and the clinical data and related literature were reviewed.

RESULTS

The 3 patients were all males, aged 32 - 73 years. Cough, sputum and hemoptysis were the major clinical manifestations. The cytopathology examination showed that the tumor cells were arranged in masses with a large amount of intracellular eosinophilic granules. The immunochemistry showed the expression of neurocrine markers such as NSE, Syn and CgA.

CONCLUSION

OCTL is a rare malignant tumor. Histopathology, immunochemistry and electronic microscopic examination play important roles in the diagnosis and differential diagnosis of this tumor.

Ascorbic acid alleviates pancreatic damage induced by dibutyltin dichloride (DBTC) in rats

PURPOSE

Because previous studies have reported depleted antioxidant capacity in patients with chronic pancreatitis (CP), prevention of free radical production has gained importance in antifibrotic treatment strategies for CP. The aim of this study was to investigate the effects of ascorbic acid on oxidative capacity and pancreatic damage in experimental CP.

MATERIALS AND METHODS

CP was induced in male Sprague-Dawley rats by infusion of dibutyltin dichloride (DBTC) into the tail vein. Ascorbic acid was given intraperitoneally at a daily dose of 10 mg/kg body weight. The treatment groups were as follows: group 1, DBTC plus intraperitoneal physiologic saline; group 2, DBTC plus intraperitoneal ascorbic acid; group 3, solvent plus intraperitoneal physiologic saline; group 4, no operation plus intraperitoneal physiologic saline. Each group contained 15 animals. Treatment was started after CP was established. After 4 weeks of treatment, serum hyaluronic acid and laminin levels were determined by radioimmunoassay, pancreatic tissue oxidative stress was analyzed, and the degree of pancreatic damage was determined.

RESULTS

Ascorbic acid treatment markedly increased superoxide dismutase (SOD) activity and decreased malondialdehyde (MDA) concentrations in pancreatic tissue (p < 0.01 for both). Significant serum hyaluronic acid and laminin reductions were observed in group 2 as compared with group 1 (p < 0.05). However, the serum hyaluronic acid and laminin levels remained elevated when compared with those of groups 3 and 4 (p < 0.05). Histopathologic scores were also lower in animals with CP that underwent ascorbic acid-treatment (p < 0.05).

CONCLUSION

Ascorbic acid treatment alleviated the degree of oxidative stress and pancreatic damage in rat CP. Antioxidant treatment might be considered a potential option to improve the pathologic process in CP.

Point estimation and graphical inference of marginal dominance for two viability loci controlling inbreeding depression

A deterministic analysis is conducted to examine marginal dominance for two linked viability loci influencing inbreeding depression and its graphical inferences. Four estimators of marginal dominance are derived, assuming a biallelic marker locus completely linked to one of the viability loci, and the biases in expected estimates due to the other deleterious locus are discussed. Three conditions under which apparent partial dominance or underdominance could occur are found, i.e. when two multiplicative, partially recessive loci are linked in coupling phase and when two synergistic, highly overdominant loci are linked in coupling or repulsion phases. Expected frequencies of the three marker genotypes in selfed progeny are derived, considering two linkage phases, two types of marker locus position with respect to the viability loci, and the multiplicative and synergistic fitness models. Segregation ratios are generated for the marker locus linked to either two overdominant or partially recessive loci and plotted in gene action graphs to examine the robustness of the graphical inferences of gene action due to the presence of an additional linked viability locus. Under a multiplicative fitness model, the presence of an additional partially recessive or overdominant locus in the vicinity of the marker locus does not greatly affect the graphical inferences of the relative role of partially recessive or overdominant genes in expression of inbreeding depression. A marker linked to two synergistic, highly overdominant loci can behave as though linked to a partially recessive, partially dominant or underdominant locus, even with relatively weak synergism.

Marker-based inferences about epistasis for genes influencing inbreeding depression

We describe a multilocus, marker-based regression method for inferring interactions between genes controlling inbreeding depression in self-fertile organisms. It is based upon selfing a parent heterozygous for several unlinked codominant markers, then analyzing the fitness of progeny marker genotypes. If loci causing inbreeding depression are linked to marker loci, then viability selection is manifested by distorted segregation of markers, and fecundity selection by dependence of the fecundity character upon the marker genotype. To characterize this selection, fitness is regressed on the proportion of loci homozygous for markers linked to deleterious alleles, and epistasis is detected by nonlinearity of the regression. Alternatively, fitness can be regressed on the proportion of heterozygous loci. Other modes of selection can be incorporated with a bivariate regression involving both homozygote and heterozygote marker genotypes. The advantage of this marker-based approach is that "purging" is minimized and specific chromosomal segments are identified; its disadvantage lies in low statistical power when linkage is not strong and/or the linkage phase between marker and selected loci is uncertain. Using this method in the wildflower Mimulus guttatus, we found predominant multiplicative gene interaction determining fecundity and some negative synergistic (nonmultiplicative) interaction for viability.

On estimating the linkage of marker genes to viability genes controlling inbreeding depression

Statistical properties and extensions of Hedrick and Muona's method for mapping viability alleles causing inbreeding depression are discussed in this paper. Their method uses the segregation ratios among selfed progeny of a marker-locus heterozygote to estimate the viability reduction, "s", of an allele and its recombination fraction, "c", with the marker. Explicit estimators are derived for c and s, including expressions for their variances. The degree of estimation bias is examined for cases when (1) the viability allele is partially recessive and (2) the marker locus is linked to two viability loci. If linkage or viability reduction is moderate, very large sample sizes are required to obtain reliable estimates of c and s, in part because these estimates show a statistical correlation close to unity. Power is further reduced because alleles causing viability reduction often occur at low frequency at specific loci in a population. To increase power, we present a statistical model for the joint analysis of several selfed progeny arrays selected at random from a population. Assuming a fixed total number of progeny, we determine the optimal number of progeny arrays versus number of progeny per array under this model. We also examine the increase of information provided by a second, flanking marker. Two flanking markers provide vastly superior estimation properties, reducing sample sizes by approximately 95% from those required by a single marker.

Evidence for the partial dominance of viability genes contributing to inbreeding depression in Mimulus guttatus

The relative importance of different modes of gene expression of viability genes contributing to inbreeding depression was investigated in the wild plant, Mimulus guttatus. Viability genes were identified by self-fertilizing 31 outbred plants, each heterozygous for three to nine unlinked allozyme markers, and analyzing segregation ratios of selfed progeny at maturity for deviations from 1:2:1 ratios. In this study, 24 linkages of viability genes to marker loci were detected. To infer the nature of gene action for these viability genes, a "model-free" graphical method was developed that examines the "space" of segregation ratios allowed by each of seven selection models (i.e., overdominance, complete recessivity, partial recessivity, additivity, partial dominance, complete dominance and underdominance). Using this method, we found that, of 24 linkages detected, 18 were consistent with either partial dominance, complete dominance or underdominance. Six were consistent with either partial recessivity, complete recessivity or overdominance. This finding indicates that, in these chromosomal segments identified by allozyme markers, partial dominance plays the predominant role in inbreeding depression. This is inconsistent with either the dominance or overdominance hypotheses proposed to account for inbreeding depression.

Pollen pool heterogeneity in jack pine (Pinus banksiana Lamb.): a problem for estimating outcrossing rates?

Pollen pool heterogeneity, which violates an assumption of the mixed-mating model, is a major potential problem in measuring plant mating systems. In this study, isozyme markers were used to examine pollen pool heterogeneity in two natural populations of jack pine, Pinus banksiana Lamb., in northwestern Ontario, Canada. Population multilocus estimates of outcrossing rate ranged from 0.83 to 0.95 and differed significantly between populations. Single-tree multilocus outcrossing rates were found to be homogeneous among trees in both populations. Computer simulation studies indicated that a consanguineous pollen pool (pollen gametes related to the mother tree) was capable of biasing population outcrossing estimates downward. Random pollen pool heterogeneity (uncorrelated with maternal genotypes) did not appear to affect population outcrossing estimates in the simulations. Heterogeneity G-tests and Spearman rank tests showed that pollen pool heterogeneity existed in the two natural populations examined; however, it did not have a major effect on population outcrossing estimates, since the consanguineous pollen pool detected was probably a relatively minor component of the outcross pollen pool in both populations. In addition, heterogeneity G-tests were found to be not sensitive in detecting pollen pool heterogeneity caused by consanguineous pollen pool.