Sino nasal melanoma of nasal cavity: a case report

<p class="abstract">Sino-nasal melanoma is a rare, recurrent aggressive tumour among head and neck cancers. Nasal obstruction and recurrent, painless epistaxis are commonly reported symptoms seen in old aged individuals. The symptoms are non-specific and tend to delay the diagnosis resulting in poor prognosis. We report 80 year old male patient who presented with recurrent, painless epistaxis from the left nasal cavity with nasal obstruction. Anterior rhinoscopic examination revealed bluish black proliferative bleeding mass completely filling left nasal cavity. Contrast enhanced computed tomography showed a polypoidal soft tissue attenuation with heterogeneous enhancement completely filling left nasal cavity. Patient underwent endoscopic excision. Histopathology of specimen showed small round blue cell tumour, suggestive of sino nasal melanoma. S100 and HMB 45 were found to be positive on immunohistochemistry. Patient was then subjected to chemoradiation. No evidence of recurrence till date.</p>

Malignant Pleural and Peritoneal Mesothelioma Consequential to Brief Indirect Asbestos Exposure

This report highlights that pleural and peritoneal mesothelioma can occur without direct asbestos exposure as was seen in our young patient. The patient had indirect exposure for as short as 3 months as a child, 15 years earlier, when she was residing with her miner father in the district of Jharia, Jharkhand, which is an asbestos-rich mining area in eastern India. The patient presented with chest pain and breathlessness. Chest X-ray showed opaque right hemithorax. Typical contrast- computed tomography (CECT) enhanced radiological features included nodular, soft-tissue attenuation and homogenously enhancing rind-like mass causing scalloping of the underlying lung and liver. Similar lesions were also found involving the pelvis. Diagnosis of malignant mesothelioma was confirmed on lung biopsy. Under-reporting of exposure is usual because it is unrecognized by both patients and investigators.

Hemangioma presenting as a painful neck mass: A case report

Hemangiomas of muscles are rare congenital benign vascular tumors usually seen on the trunk and extremities, but can also appear on the head and neck regions. In a young adult with soft tissue attenuation mass in the skeletal muscle, hemangioma should be considered in the differential diagnosis. Ultrasound and computed tomography are the useful imaging modalities for the diagnosing of hemangioma and complete surgical excision is the treatment of choice. We report a case of 24 year old woman with an intramuscular hemangioma involving the posterior neck muscles who presented to our department with painful neck mass. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-1, 56-59 DOI: http://dx.doi.org/10.3126/jcmsn.v9i1.9674

An Unusual Fat-Containing Presacral Tumor in an Elderly Patient

The authors present a case of a presacral myelolipoma diagnosed in an 84-year-old male patient with longstanding pelvic pain and past medical history of bladder cancer. Pelvic computed tomography (CT) revealed a well-encapsulated and lobulated presacral mass, with mixed fat and soft-tissue attenuation. Magnetic resonance (MR) imaging provided further confirmation of macroscopic intralesional fat and excluded either adjacent bone invasion or bladder cancer recurrence. A presacral myelolipoma was suspected based on imaging findings, with liposarcoma and teratoma having also been considered for the differential diagnosis. The histological confirmation of the tumor was only attained postoperatively. This case report alerts to the possible presacral location of myelolipomas, which should be considered for every fat-containing lesion detected in this region. The main clinical, imaging, and differential diagnoses of this entity are reviewed in this paper.

Imaging Manifestations of Mediastinal Fat Necrosis

Mediastinal fat necrosis (MFN) or epipericardial fat necrosis, as it is commonly referred to in the literature, is a rare self-limiting cause of chest pain of unclear etiology. MFN affects previously healthy individuals who present with acute pleuritic chest pain. Characteristic computed tomography (CT) findings include a fat attenuation lesion with intrinsic and surrounding increased attenuation stranding. There is often associated thickening of the adjacent pericardium and/or pleural effusions. We present two cases of MFN manifesting as ovoid fat attenuation lesions demarcated by a soft tissue attenuation rim with intrinsic and surrounding soft tissue attenuation stranding and review the clinical and pathologic features of these lesions. Knowledge of the clinical presentation of patients with MFN and familiarity with the characteristic imaging findings of these lesions should allow radiologists to prospectively establish the correct diagnosis and suggest conservative management and follow-up.

Soft tissue attenuation in middle ear on HRCT: Pictorial review

The authors would like to acknowledge with gratitude Dr Anagha Joshi, LTM medical college, for the images 1 to 4 and 7.

Soft Tissue Attenuation Patterns Associated with Supine Acquisition SPECT Myocardial Perfusion Imaging: A Descriptive Study

Purpose: Soft-tissue attenuation patterns in SPECT-myocardial perfusion imaging (MPI) of supine acquisition systems are well recognized. Their prevalence and interaction with body-habitus and gender are ill-defined, which we sought to describe in this study. Methods: In a cross-sectional study, we described the prevalence of soft-tissue attenuation patterns in normal SPECT-MPI studies acquired with a supine patient-position SPECT system. Results: In 263 normal, clinically-indicated, supine-acquisition SPECT-MPIs the attenuation patterns observed were: anterior (35.4%), inferior (41.8%) and lateral (13.3%). Anterior attenuation was more prevalent among women (50.7% vs. 15.7%, P<0.001) and was associated with chest circumference among men. Conversely, inferior attenuation was more prevalent among men (78.3% vs. 13.5%, P<0.001) and was not affected by body-habitus. Lateral attenuation was more common among women (19.6% vs. 5.2%, p=0.001) and was associated with obesity (p=0.015). Conclusions: Soft-tissue attenuation artifacts are common in supine-acquisition SPECT-MPI. The recognition of their prevalence and association with body-habitus and gender is critical for the accurate interpretation of SPECT-MPI.

Soft Tissue Attenuation Patterns Associated with Upright Acquisition SPECT Myocardial Perfusion Imaging: A Descriptive Study

Background: Little is known about soft tissue attenuation artifacts when an upright patient-position SPECTmyocardial perfusion imaging (MPI) system is used. In this investigation we sought to describe the patterns and frequency of attenuation artifacts associated with this type of instruments and we explored the impact of gender and body habitus on these artifacts. Methods: In a cross-sectional study, we described the prevalence of various soft-tissue attenuation patterns in 212 normal SPECT-MPI studies acquired with an upright patient-position imaging system. Results: In these 212 normal, clinically-indicated, upright-acquisition SPECT-MPIs the attenuation patterns observed were: anterior (6.1%), inferior (63.7%) and lateral (24.1%). Though uncommon, anterior attenuation trended to being more prevalent among women [9.5% vs. 3.4%, P=0.07] and was independently associated with chest circumference. Lateral attenuation was more common among women [34.7% vs. 15.4%, p=0.001] and was strongly associated with obesity (p<0.001). Inferior attenuation was more prevalent among men than women (75.2% vs. 49.5% respectively, P<0.001). Conclusions: Soft-tissue attenuation artifacts are common in upright-acquisition SPECT-MPI. Recognizing the frequency of these attenuation patterns and their interaction with gender and body habitus is critical for the accurate interpretation of SPECT-MPI.