RADIOLOGIC PATHOLOGY

MUSCULAR SYSTEM

Dermatofibrosarcoma Protuberans

CT non contrast. Lobulated mass, just in the edge of FOV. Lobulated,similar density

CT scans shows a well-defined lesion with a distinct lobular or nodular architecture and tissue attenuation approximately equal to or greater than that of skeletal muscle. Moderate enhancement is seen on CT scans obtained after injection of contrast material. Dermatofibrosarcoma protuberans is a distinct clinicopathologic entity characterized by fibroblasts with a prominent storiform pattern. It accounts for about 6% of all softtissue sarcomas. The lesion is typically superficial, and the diagnosis can be suspected on the basis of the tumor's clinical appearance. Consequently, the imaging appearance of this entity is essentially unreported. Large lesions, however, can infiltrate the deep soft tissue and be confused with higher-grade sarcomas.

Intra-muscular Hemangioma

Enhancing mass in the anconius muscle with multiple flow voids on T1 and T2 weighted images. Hemangiomas are a type of benign neoplasm closely resembling normal blood vessels at histology. Hemangiomas are generally homogeneous although they may contain various components of fat, vascular thromcosis, phlebolith formation, and fibrosis. They are generally isointense to muscle on T1 and hyperintense on T2. They can be bright on both with large amounts of adipose tissue. They often contain serpintine structures with flow voids or phelboliths.

Intra-muscular Lipoma

Fatty lesion with low signal intensity (isointense with muscle on T1WI, STIR, and T1 fat sat post gad.

Semitendinosus Tears

Diagnosis: Grade II strain involving the musculotendinous junction of the semitendinosus. However, spontaneous hemorrhage into an underlying muscle sarcoma could not be excluded. Semitendinosus tears are a relatively infrequently injured structure in hamstring injuries. In Koulouris et al (Skeletal Radiology 2003; 32: 582-9), their retrospective review of hamstring muscle complex injuries demonstrated biceps femoris injuries in 124 cases, semimembranosus in 21 cases, and semitendinosis in only 9 cases. - Grade I muscle strains: increased interstitial fluid signal between muscle fibers. - Grade II strains: in addition, there is increased signal between muscles. A focal muscular defect may or may not be seen. The tendon is thinned and irregular, with surrounding abnormal signal. - Grade III strains: there is a complete muscle disruption, with associated gap between retracted components.

Spinal muscular atrophy

There is atrophy of the entire rotator cuff and deltoid. High signal on T1 and T2 sequences is present within the muscles. Note that there is no mass or lesion involving the spinoglenoid notch or suprascapular notch. Differential for muscle atrophy of the rotator cuff / deltoid includes Parsonage-Turner, Quadralateral Space Syndrome, and mass effect in one of the areas listed above.

DIGESTIVE SYSTEM

Ulcerative Colitis

Multiple small colonic ulcers seen on films 07-07-93. Flat / upright films from 07-24-73 demonstrated dilated transverse colon with obstruction. Radiographically - rectum normal in 20% although almost always involved; isolated right colon disease left colon does not occur; TI involved (backwash ileitis (20-25%) minimal inflammatory changes

Earliest Abnormal - fine granularity of mucosa hazy, fuzzy bowel contour Loss of haustral markings nonspecific Multiple, symmetric ulcers - "collar button" nonspecific Pseudopolyps - islands of edematous mucosa and re-epithelialized granulation tissue in between ulcers Chronic changes - fibrosis and muscular spasm - "lead pipe"

Colon Cancer

Cancerous growths in the colon, rectum and appendix. It is the third most common form of cancer and the second leading cause of cancer-related death in the Western world. Colorectal cancer causes 655,000 deaths worldwide per year. Many colorectal cancers are thought to arise from adenomatous polyps in the colon. These mushroom-like growths are usually benign, but some may develop into cancer over time. The majority of the time, the diagnosis of localized colon cancer is through colonoscopy. Colorectal cancer can take many years to develop and early detection of colorectal cancer greatly improves the chances of a cure. Therefore, screening for the disease is recommended in individuals who are at increased risk.

Achalasia

In this disorder, the smooth muscle layer of the esophagus has impaired peristalsis (muscular ability to move food down the esophagus), and the lower esophageal sphincter (LES) fails to relax properly in response to swallowing.The most common form is primary achalasia, which has no known underlying cause. Due to the similarity of symptoms, achalasia can be misdiagnosed as other disorders, such as gastroesophageal reflux disease (GERD), hiatus hernia, and even psychosomatic disorders.

Ascariasis

Perhaps as many as one quarter of the world's people are infected, and ascariasis is particularly prevalent in tropical regions and in areas of poor hygiene. Other species of the genus Ascaris are parasitic and can cause disease in domestic animals. Infection occurs through ingestion of food contaminated with feces containing Ascaris eggs. The larvae hatch, burrow through the intestine, reach the lungs, and finally migrate up the respiratory tract. From there they are then reswallowed and mature in the intestine, growing up to 30 cm (12 in.) in length and anchoring themselves to the intestinal wall. Infections are usually asymptomatic, especially if the number of worms is small. They may however be accompanied by inflammation, fever, and diarrhea, and serious problems may develop if the worms migrate to other parts of the body.

Barretts Esophagus

Barrett's esophagus is marked by the presence of columnar epithelia in the lower esophagus, replacing the normal squamous cell epitheliuman example of metap asia. The columnar epithelium is better able to withstand the erosive action of the gastric secretions; however, this metaplasia confers an increased cancer risk of the adenocarcinoma type. The metaplastic columnar cells may be of two types: gastric (similar to those in the stomach, which is NOT technically Barrett's esophagus) or colonic (similar to cells in the intestines). A biopsy of the affected area will often contain a mixture of the two. Colonictype metaplasia is the type of metaplasia associated with risk of malignancy in genetically susceptible people. The metaplasia of Barrett's esophagus is visible grossly through a gastroscope, but biopsy specimens must be examined under a microscope to determine whether cells are gastric or colonic in nature. Colonic metaplasia is usually identified by finding goblet cells in the epithelium and is necessary for the true diagnosis of Barrett's.

Hiatal Hernia

A hiatal hernia is an anatomical abnormality in which part of the stomach protrudes through the diaphragm and up into the chest. Although hiatal hernias are present in approximately 15% of the population, they are associated with symptoms in only a minority of those afflicted. Normally, the esophagus or food tube passes down through the chest, crosses the diaphragm, and enters the abdomen through a hole in the diaphragm called the esophageal hiatus. Just below the diaphragm, the esophagus joins the stomach. In individuals with hiatal hernias, the opening of the esophageal hiatus (hiatal opening) is larger than normal, and a portion of the upper stomach slips up or passes (herniates) through the hiatus and into the chest. Although hiatal hernias are occasionally seen in infants where they probably have been present from birth, most hiatal hernias in adults are believed to have developed over many years.

Hypertrophic Pyloric Stenosis

On the upper GI study, there is a lactobezoar present in the stomach. Also present are the antral "teat" sign and "double track" sign. Muscular thickening of the pylorus is seen on?ultrasound at 4mm with lengthening of the pyloric channel to 1.8cm. Diffuse hypertrophy and hyperplasia of the smooth muscle of the antrum of the stomach and pylorus proper narrow the channel, which then can become easily obstructed. The antral region is elongated and thickened to as much as twice its normal size. In response to outflow obstruction and vigorous peristalsis, stomach musculature becomes uniformly hypertrophied and dilated. Gastritis may occur after prolonged stasis. Hematemesis is occasionally noted. The patient may become dehydrated as a result of vomiting and develop marked hypochloremic alkalosis.

Pseudolymphoma

An inflammatory response that results in a lymphomatousappearing but benign accumulation of inflammatory cells. It may exhibit histological and sometimes clinical features suggestive of malignant lymphoma. Unlike lymphomas, pseudolymphomas usually undergo spontaneous remission. Causes include idiopathic, drugs, contact allergens, photosensitivity, insect bites, scabies and infections. The term "pseudo" means "not real", and "lymphoma" means "a cancerous tumor of lymphocytes".

Stomach Cancer

Can develop in any part of the stomach and may spread throughout the stomach and to other organs; particularly the esophagus and the small intestine. Stomach cancer is often asymptomatic or causes only nonspecific symptoms in its early stages. By the time symptoms occur, the cancer has generally metastasized to other parts of the body, one of the main reasons for its poor prognosis.