Retroperitoneal schwannoma: A common tumour in an uncommon site

We describe a female adult patient who presented with acute retention of urine and vague abdominal discomfort. A provisional diagnosis of ovarian tumour was made after crosssectional imaging. At laparotomy a very large retroperitoneal mass was biopsied and found to be a schwannoma after pathological examination. The clinical, radiological, and pathological features of this disease are discussed in this report.published_or_final_versio

Bone metastases from gastrointestinal stromal tumour: Correlation with positron emission tomography-computed tomography

Bone metastasis from gastrointestinal stromal tumour is a rare outcome of this uncommon disease. This report is of a 73-year-old man with gastrointestinal stromal tumour who developed bone metastases after complete tumour resection. The condition is worthy of attention as there are new imaging modalities and biological target agents available. This report highlights the positron emission tomography - computed tomography findings of this rare outcome of gastrointestinal stromal tumour, and the current imaging trends for gastrointestinal stromal tumours are discussed. © 2009 Hong Kong College of Radiologists.link_to_subscribed_fulltex

Clinical and radiological features of generalised lymphangiomatosis

We report a paediatric patient who presented with fever, shortness of breath, and vague abdominal discomfort. Lesions removed surgically proved to be generalised lymphangiomatosis and were treated conservatively. The spectrum of abnormalities and radiological features are discussed.published_or_final_versio

Peri-tumoural magnetic resonance spectroscopy to differentiate solitary primary intra-axial high-grade glioma and brain metastasis: A pilot study

Objective: To determine whether the peri-tumoural choline/N-acetyl- aspartate ratio can be used to differentiate solitary primary intra-axial brain tumour and metatasis. Methods: In this retrospective study, 18 treatment-naïve adults presenting with a solitary intra-axial mass underwent conventional contrast-enhanced and proton spectroscopic magnetic resonance imaging. The images were interpreted retrospectively by an experienced neuroradiologist and a radiology fellow with 6 years' experience. The radiologists were blinded to the clinicopathological and demographic data. The choline/N-acetyl-aspartate ratio was measured over the area of peri-tumoural oedema, which was defined by T2 hyperintensity and non-enhancing areas immediately adjacent to the enhancing portion of the tumour. A peri-tumoural choline/N-acetyl-aspartate ratio of >1 was classified as positive, meaning primary brain tumour. Statistical analysis was performed using a 2 x 2 contingency table. The interclass correlation coefficient (alpha) was calculated as the index of concordance exceeding chance for inter-rater reliability. Results: Of 18 patients, four were excluded from the study owing to absence of peri-tumoural cerebral oedema. Of the remaining 14 patients, nine had a solitary intra-axial high-grade gliomas confirmed pathologically, of whom eight had a peri-tumoural choline/N-acetyl-aspartate ratio of >1. The remaining five patients were classified as having a solitary brain metastasis with no known primary. A choline/N-acetyl-aspartate ratio of >1 in peritumoural region can be used as a parameter predicting a primary brain tumour; respective values for sensitivity, specificity, positive and negative predictive values were 90%, 100%, 100% and 83%, respectively. Conclusion: The peri-tumoural choline/N-acetyl-aspartate ratio of >1 can be used as a parameter to differentiate the intra-axial primary brain tumour from metastasis. © 2010 Hong Kong College of Radiologists.link_to_subscribed_fulltex

Identifying pleomorphic hyalinizing angiectatic tumor: a case report

A pleomorphic hyalinizing angiectatic tumor (PHAT) mainly affects superficial soft tissue in the lower extremities. PHAT is classified as a borderline/intermediate-grade soft tissue tumor because of the substantial risk of local recurrence. The diagnosis is based on histological, clinical, immunochemical, and radiological findings. We offer a case report of a middle-aged woman who presented with a painful slow-growing subcutaneous soft tissue mass in her left lateral thigh. An MRI scan showed a tumor mass located within the tensor fascia lata and iliotibial tract. The overall features were suggestive of a PHAT. This lesion often is CD34-positive and almost always is S100-negative; these features are used to differentiate PHAT from other conditionslink_to_OA_fulltex

An audit of the upper gastrointestinal contrast examination protocol in patients with suspected small bowel obstruction

Objective: Small bowel follow-through examination with Gastrografin (diatrizoate meglumine and diatrizoate sodium solution) is important for delineating the cause of small bowel obstruction. However, whether the standard protocol should include the 24-hour delayed image is uncertain. This retrospective study was performed to review the usefulness of the 24-hour delayed image and the subsequent treatment of patients suspected to have small bowel obstruction. Methods: All urgent Gastrografin follow-through examinations conducted from 1 January 2007 to 31 December 2007 were evaluated. Clinical data, including demographic data, presenting symptoms, imaging findings, subsequent treatment, and clinical outcomes were reviewed from the Electronic Patient Record, Radiology Information System, and medical records. Results: Seventy five examinations were performed, and 4 patients were excluded because of intolerance and subsequent incomplete examination. The commonest indication was acute small bowel obstruction (n = 66; 93%). Of 21 patients (30%) with positive results, 6 had significant small bowel obstruction diagnosed by imaging within 8 hours with no 24-hour delayed image, and 5 of these patients underwent emergency operation; the sixth patient rapidly worsened preoperatively. Of 15 patients with positive results confirmed by 24-hour delayed images, 14 required emergency operation, with complete bowel obstruction confirmed intraoperatively. For the 50 patients with negative results, 9 (18%) required 24-hour delayed images to confirm the radiological diagnosis, 3 (33%) of whom underwent emergency operation due to their deteriorating clinical condition; complete bowel obstruction was confirmed intraoperatively for all 3 patients. Conclusions: This audit of the role of 24-hour delayed imaging had a high false-negative rate (30%). Therefore, the standard protocol may be amended to eliminate the 24-hour delayed image to avoid delay to effective management of small bowel obstruction. © 2009 Hong Kong College of Radiologists.link_to_subscribed_fulltex

A questionnaire study assessing local physicians, radiologists and interns’ knowledge and practice pertaining to radiation exposure related to radiological imaging

PURPOSE: To assess the knowledge and practice pertaining to radiation exposure related to radiological imaging among medical doctors, in relation to specialty and year of experience. METHODOLOGY: Questionnaires as recommended by the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) were distributed to doctors in tertiary hospitals by convenience sampling. Their knowledge of radiation doses of common radiological investigations was assessed by any significant difference from correct answers by sampled t-test. Comparison between specialties and between the more (>6 years experience) and less experienced doctors was made by pairwise comparisons of 'right answer minus mean difference (RMD)' using Wilcoxon Signed Ranks Test. Descriptive analysis of their knowledge of harmful effects of radiation and the practices pertaining were also performed. RESULTS: Total 93 questionnaires were sent out and 82 (88.2%, 40 interns, 24 clinicians, 18 radiologists) were returned. Radiologists had the least deviation from correct answers compared to interns (1.29 vs. 2.40, p=0.018) and physicians (1.29 vs. 2.57, p=0.046). More-experienced doctors also performed better than the less-experienced (1.69 vs. 2.57, p=0.027). 12/80 (15%) and 4/80 (5%) failed to recognize MR and US as radiation-free modalities. Only 10/80 (12.5%) knew the risk of carcinogenesis from abdominal CT and only 4/81 (5%) will discuss radiation-related hazard with patients routinely. CONCLUSION: Knowledge of medical doctors, including radiologists, towards radiation exposure of imaging is unsatisfactory and could imply a tendency of radiation misuse and under-utilization of alternative radiation-free methods. On-job training and discussion of the radiation risk with patients are advised.link_to_subscribed_fulltex

Use of hemostatic matrix to reduce lymphcoceles requiring intervention in renal transplantation: a two center trial

Meeting Theme: Advances in Oncology and EndurologyOral Presentation - Session 8: Update on Urology and Androlog

Floseal hemostatic matrix reduces symptomatic lymphoceles after renal transplantation

Session - Transplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery 1: no. MP29-12This journal suppl. entitled: 2016 Annual Meeting Program Abstracts, AUA Annual MeetingINTRODUCTION AND OBJECTIVES: Lymphoceles are common after kidney transplantation with an incidence ranging from 0.6 to 26%. We evaluate the efficacy of novel use of FloSeal® hemostatic matrix in preventing symptomatic lymphoceles requiring intervention in two renal transplant centers in the territory. METHODS: This was a two-center, matched comparison of cadaveric or living-related renal transplantation performed in patients > 18 years of age between January 2011 and August 2015. Off-label application of FloSeal started since May 2013 in one center and December 2013 in the other. FloSeal (5ml per case) was applied to the graft hilar area and the peri-iliac vessel lymphatic area after graft reperfusion, and then gently compressed for two minutes without any flushing. The incidence of symptomatic lymphoceles were compared in the two groups and evaluated with Kaplan Meier method. Different potential risk factors for lymphocele formation were also reviewed and evaluated with logistic regression analysis. RESULTS: A total of 218 patients (mean age of 44.0 years and mean follow-up of 30.3 months) underwent cadaveric (186) or living-related (32) renal transplant in the period (94 with FloSeal, 124 without FloSeal). There was 8 (8.5%) symptomatic lymphoceles in the FloSeal group compared with 29 (23.4%) in the non-FloSeal group (p=0.004). Duration of renal replacement therapy and duration of peritoneal dialysis were also significantly associated with symptomatic lymphoceles in univariate analysis for risk factor analysis, but upon multivariate analysis using logistic regression, FloSeal use was the only independent factor (OR = 0.31 [CI 0.13-0.73], p = 0.007) for symptomatic lymphoceles. Symptomatic lymphoceles in FloSeal group presented and were intervened significantly earlier than in non-FloSeal group. No adverse events associated with FloSeal use were reported. CONCLUSIONS: Our data suggest that the use of FloSeal can reduce symptomatic lymphoceles in renal transplantation. Further cost analysis is useful in evaluating its cost-effectiveness in lymphocele treatment