Hungarian Radiology

[CALENDAR OF RADIOLOGICAL EVENTS, 2005]

FEBRUARY 15, 2005

Hungarian Radiology - 2005;79(01)

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Hungarian Radiology

[2005, International Year of Physics]

LOMBAY Béla

Hungarian Radiology

[Gastrointestinal stromal tumors]

BAHÉRY Mária

[Gastrointestinal stromal tumors are the most common mesenchymal neoplasm of the gastrointestinal tract. Gastrointestinal stromal tumors are characterized by remarkable variability in their differentiation potential. They are defined by their expression of KIT (CD117), a tyrosine kinase growth factor receptor. The expression of KIT is important to distinguish gastrointestinal stromal tumors with immunohistochemically method from other mesenchymal neoplasms such as leiomyomas, leiomyosarcomas, leiomyoblastomas and schwannomas. Pathologically proved gastrointestinal stromal tumors are appropriate KIT-inhibitor therapy. Gastrointestinal stromal tumors arise with variable frequency throughout the gastrointestinal tract, they most frequently occur in the stomach (40-70%), followed by the small intestine (20-30%), colorectum (5- 15%) and esophagus (<5%). The most gastrointestinal stromal tumors arise within the muscularis propria, they most commonly have an exophytic growth pattern and manifest as dominant extraluminal masses. Radiologic features of gastrointestinal stromal tumors vary depending of tumor size and organ of origin. They are characteristically well circumscribed, sharply defined and have hemorrhage, necrosis or cyst formation. The radiologic features of gastrointestinal stromal tumors are often distinct from those of epithelial tumors. There are no specific radiologic features to separate gastrointestinal stromal tumors from other mesenchymal tumors, yet.]

Hungarian Radiology

[Esophageal diverticula in mixed connective tissue disease]

SZÁNTÓ Dezső, SZŰCS Gabriella, DITRÓI Edit

[INTRODUCTION - The functional and morphological changes of oesophagus occur in two third of mixed connective tissue disease patients according to the literature. CASE REPORT - We report three cases of 27, 39 and 48 year old women suffering of lateral pharyngoesophageal, epibronchial and epiphrenic diverticula associated with connective tissue disease. Diverticula had an average diameter of 3.8 cm (maximal diameters: 7.2-8 cm). The esophageal pouches produced dysphagia, dystonia, motility disorders, food stagnation and vomiting, retrosternal burning sensation and tachyarrythmia after 5-16 month's latency period. In one patient pneumoesophagus also evolved. The high serum enzyme levels and proximal electromyogram proved the presence of polymyositis. CONCLUSION - The localization, number and the size of esophageal diverticula are determined by the interstitial myopathy.]

Hungarian Radiology

[Basics and methods of radiostereometric analysis in orthopaedic practice]

ILLYÉS Árpád, KISS Rita M., KÖLLŐ Katalin, KISS Jenő

[Photogrametry is a discipline processing geometric information of images according to the general image concept. Radiostereometric analysis (Roentgen stereophotogrametric analysis) is the most dynamically developing area of the orthopaedic photogrametry. The aim of the authors was to summarize the different methods of radiostereometric analysis in use. Two basically different methods are used: marker-based and model-based radiostereometric analysis. The authors summarize and compare the steps, the advantages and the disadvantages of either method. Radiostereometric analysis is because of its high precision appropriate as a tool in scientific research and diagnostic in orthopaedics, such as detecting the 3D micromotion of different components of implants, the wear of polyethylene inserts or determining anterior-posterior and rotational movements of the knee. Analyzing the reproducibility and accuracy of the reconstruction methods one can establish that the accuracy of analytical methods in use is behind the accuracy of digital automated software. The precision of the model-based radiostereometry can never achieve the accuracy of the marker based radiostereometry because of the inaccuracy of the initial input model of implants, although the one of the method of reversed engineering - one of model-based radiostereometric analysis - can approach the accuracy of marker-based radiostereometry.]

Hungarian Radiology

[Solitary fibrous tumor of the chest]

AGÓCS Ágnes, KISHINDI KISS Katalin, PENCS Mónika, TÓTH Tivadar

[INTRODUCTION - Solitary fibrous tumor is a rare, in most of the cases benign tumor of mesenchymal origin arising from the pleura. CASE REPORT - Significantly raised right hemidiaphragm was noted on the chest X-ray of an elderly female patient with good general condition. A large solid mass lesion was seen above the normally positioned right hemidiaphragm on ultrasound and chest CT examinations. The mass was removed by surgical resection and a solitary fibrous tumor was confirmed by histological and immunhistochemical examinations. CONCLUSION - Solitary fibrosus tumor is a rare and histologically benign tumor. Occasionally it may enlarge rapidly and transform into malignant variant after several years. Therefore complete surgical resection and long term follow up is needed in all cases.]

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[Risk of nonsteroidal antiinflammatory drugs. Focus on aceclofenac]

FARSANG Csaba

[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used pharmaceuticals. Nevertheless, a number of studies emphasized that NSAIDs were damaging not only the gastrointestinal (GI), but also the cardiovascular (CV) system, could increase the blood pressure, the frequency of coronary events (angina, myocardial infarction) and stroke incidence, as well as they might deterio­rate renal functions. The National Institute for Health and Care Excellence (NICE) did not find evidence that administering NSAIDs could increase the risk of developing COVID-19 or worsened the condition of COVID-19 patients. However, unwanted effects of specific drugs differ substantially in their occurrence and seriousness as well. It seemed to be for a long time that the NSAIDs provoked higher GI-risk was closely related to the COX1/COX2 selectivity, like the cardiovascular (CV) risk to the COX2/COX1 selectivity, however, the recent data did not prove it clearly. Based on the available literature while pondering the gastrointestinal and cardiovascular adverse events, among all NSAIDs the aceclofenac profile seemed to be the most favourable.]

Clinical Neuroscience

Life threatening rare lymphomas presenting as longitudinally extensive transverse myelitis: a diagnostic challenge

TOLVAJ Balázs, HAHN Katalin, NAGY Zsuzsanna, VADVÁRI Árpád, CSOMOR Judit, GELPI Ellen, ILLÉS Zsolt, GARZULY Ferenc

Background and aims – Description of two cases of rare intravascular large B-cell lymphoma and secondary T-cell lymphoma diagnosed postmortem, that manifested clinically as longitudinally extensive transverse myelitis (LETM). We discuss causes of diagnostic difficulties, deceptive radiological and histological investigations, and outline diagnostic procedures based on our and previously reported cases. Case reports – Our first case, a 48-year-old female was admitted to the neurological department due to paraparesis. MRI suggested LETM, but the treatments were ineffective. She died after four weeks because of pneumonia and untreatable polyserositis. Pathological examination revealed intravascular large B-cell lymphoma (IVL). Our second case, a 61-year-old man presented with headache and paraparesis. MRI showed small bitemporal lesions and lesions suggesting LETM. Diagnostic investigations were unsuccessful, including tests for possible lymphoma (CSF flow cytometry and muscle biopsy for suspected IVL). Chest CT showed focal inflammation in a small area of the lung, and adrenal adenoma. Brain biopsy sample from the affected temporal area suggested T-cell mediated lymphocytic (paraneoplastic or viral) meningoencephalitis and excluded diffuse large B-cell lymphoma. The symptoms worsened, and the patient died in the sixth week of disease. The pathological examination of the presumed adenoma in the adrenal gland, the pancreatic tail and the lung lesions revealed peripheral T-cell lymphoma, as did the brain and spinal cord lesions. Even at histological examination, the T-cell lymphoma had the misleading appearance of inflammatory condition as did the MRI. Conclusion – Lymphoma can manifest as LETM. In cases of etiologically unclear atypical LETM in patients older than 40 years, a random skin biopsy (with subcutaneous adipose tissue) from the thigh and from the abdomen is strongly recommended as soon as possible. This may detect IVL and provide the possibility of prompt chemotherapy. In case of suspicion of lymphoma, parallel examination of the CSF by flow cytometry is also recommended. If skin biopsy is negative but lymphoma suspicion remains high, biopsy from other sites (bone marrow, lymph nodes or adrenal gland lesion) or from a simultaneously existing cerebral lesion is suggested, to exclude or prove diffuse large B-cell lymphoma, IVL, or a rare T-cell lymphoma.

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Association of anterior thoracic meningocele and azygos lobe of the lung

DENIZ Ersay Fatih, SENAYLI Atilla, BICAKCI Ünal

Here we report an anterior thoracic meningocele case. Twoyears- old female patient was presented with kyphosis. Azygos lobe of the lung was also demonstrated during radiological studies. Posterolateral thoracotomy incision and extralpeural approach was performed for excision of the anterior meningocele to untether the cord. Although both anomalies are related to faulty embryogenesis and it is well known that faulty embryogenesis may also reveal coexisting abnormalities, we could not speculate a common mechanism for anterior thoracic meningocele and azygos lobe of the lung association.

Hungarian Radiology

[The quality control of radiological equipments in Hungary]

PELLET Sándor, PORUBSZKY Tamás, BALLAY László, GICZI Ferenc, MOTOC Anna Mária, VÁRADI Csaba, TURÁK Olivér, GÁSPÁRDY Géza

Clinical Neuroscience

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