Revisitation of imaging features of skull base chondrosarcoma in comparison to chordoma

PURPOSE

Pre-surgical diagnosis of skull base chondrosarcoma (SBC) is often challenging due to the resemblance to chordoma. The goal of this study was to develop an optimal method for predicting SBC diagnosis.

METHODS

This retrospective study included patients with histologically diagnosed SBC and skull base chordoma. Their clinical and radiologic features were compared, and the predictive factors of SBC were examined.

RESULTS

Forty-one patients with SBC and 41 with chordoma were included. Most SBCs exhibited hypointensity (25, 64.1%) or isointensity (12, 30.8%) on T1-weighted images, and hyperintensity (34, 87.1%) or mixed intensity (5, 12.8%) on T2-weighted images. MRI contrast enhancement was usually avid or fair (89.7%) with "arabesque"-like pattern (41.0%). The lateral/paramidline location was more common in SBC than in chordoma (85.4% vs. 9.8%; P < 0.01), while midline SBCs (14.6%) were also possible. Multivariate analysis demonstrated that higher apparent diffusion coefficient (ADC) value (unit odds ratio 1.01; 95% confidence interval 1.00-1.02; P < 0.01) was associated with an SBC diagnosis. An ADC value of ≥ 1750 × 10^-6 mm²/s demonstrated a strong association with an SBC diagnosis (odds ratio 5.89 × 10²; 95% confidence interval 51.0-6.80 × 10³; P < 0.01) and yielded a sensitivity of 93.9%, specificity of 97.4%, positive predictive value of 96.9%, and negative predictive value of 95.0%.

CONCLUSION

The ADC-based method is helpful in distinguishing SBC from chordoma and readily applicable in clinical practice. The prediction accuracy increases when other characteristics of SBC, such as non-midline location and arabesque-like enhancement, are considered together.

Radiologic features of mixed epithelial and stromal tumors of the kidney: Hyperattenuating on unenhanced computed tomography and T2-hypointensity on magnetic resonance imaging

In the 2016 World Health Organization renal tumor classification, the mixed epithelial and stromal tumor family was introduced as a new entity. This family encompasses a spectrum of tumors, ranging from predominantly cystic tumors (adult cystic nephromas) to tumors that are variably solid (mixed epithelial and stromal tumors). The majority of previous studies incorporating “mixed epithelial and stromal tumor” in the titles were actually reports of imaging findings of adult cystic nephroma. Thus, the solid component of mixed epithelial and stromal tumors has not been well evaluated. In this study, we present 2 cases of mixed epithelial and stromal tumors, as defined by the 2016 World Health Organization classification, showing a predominantly solid component. The characteristic findings of the solid component of these tumors were T2-hypointensity on magnetic resonance imaging and hyperattenuation on unenhanced computed tomography. Angiomyolipoma with epithelial cysts and epithelioid angiomyolipoma should be considered in the differential diagnosis of mixed epithelial and stromal tumors.

Dumbbell-Shaped Jugular Foramen Tumors Extending to the Neck: Surgical Considerations Based on Imaging Findings

OBJECTIVE

Dumbbell-shaped jugular foramen tumors (DSJFTs) extending to the neck present diagnostic and management difficulties because of their rarity, various pathologies, and multidisciplinary involvement. Accurate imaging findings are of great importance for surgical planning and clinical outcomes. However, few articles have discussed this issue to date.

METHODS

Thirty-one patients with DSJFTs extending to the neck were surgically treated in a single stage at our institute. Their clinical and radiologic features, operative procedures, and outcomes were retrospectively reviewed.

RESULTS

Preoperative correct diagnosis of DSJFTs extending to the neck was made in all cases of benign tumor and in only 3 cases of malignant tumors in this series. All tumors were removed via a craniocervical approach by a multidisciplinary skull base team because of both their intracranial and neck extensions. Total removal was achieved in 26 patients (83.9%). Preoperative symptoms were improved in 18 patients, whereas new or worsening lower cranial nerve deficits occurred in 4 patients postoperatively. Follow-up (1-132 months, mean 64.4 months) was available in 90.3% of the patients. No clinical or radiologic signs of tumor recurrence were observed.

CONCLUSIONS

Preoperative radiologic evaluation of DSJFTs extending to the neck is essential for differential diagnosis, patient selection, and surgical planning. Favorable surgical outcomes can be achieved via a craniocervical approach, and some detailed imaging findings are helpful to increase the safety of tumor resection and reduce the morbidity of lower cranial nerve deficits and cerebrospinal fluid leakage.

An interesting radiological picture of post traumatic TMJ ankylosis due to sagittal condylar fracture

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A case of posttraumatic unilateral TMJ ankylosis resulting from closed reduction of a bilateral condylar fracture with interesting radiological findings.

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In a condylar fracture whether to intervene or to go for conservative management still remains a dilemma.

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Studies and hypothesis suggests that it’s medially dislocated condylar fracture segment that is more likely to ankylose.

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In our case the post trauma CT shows the lateral segment abutting with the arch and that the area has become ankylotic in a span of 2 years.

Introduction

In a condylar fracture whether to intervene or to go for conservative management still remains a dilemma. Studies and hypothesis suggests that it's medially dislocated condylar fracture segment that is more likely to ankylose, moreover no consensus have been put forth as to whether to remove the medially displaced fracture segment.

Presentation of case

The current article describes a case of unilateral temporomandibular joint (TMJ) ankylosis, which resulted as a sequlae from conservative management of a bilateral condylar fracture of which, the ankylosed side had a sagittal fracture of condyle. In our case the post trauma CT shows the lateral segment abutting with the arch and that the area has become ankylotic in a span of 2 years. Here we report a case of posttraumatic unilateral TMJ ankylosis resulting from closed reduction of a bilateral condylar fracture with interesting radiological findings.

Discussion

We have tried to discuss a rather interesting radiological picture of posttraumatic TMJ ankylosis which resulted as a sequlae from conservative management of a bilateral condylar fracture.

Conclusion

The dilemma for a clinician as to whether to intervene in a condylar fracture or to go for conservative management still remains at large. As in this case the medial fracture segment was intact and the lateral segment was resulting in ankylosis.