Pancreatic acinar cell carcinoma (ACC) is a rare malignant epithelial tumor whose imaging appearance can overlap with pancreatic ductal adenocarcinoma (PDAC) and other solid pancreatic neoplasms. We report a man in his 50’s with a pancreatic head mass causing biliary and pancreatic ductal obstruction. A noncontrast computed tomography (CT) performed approximately 10 months earlier, retrospectively reviewed, showed a small pancreatic head lesion without secondary signs of malignancy, which subsequently enlarged to approximately 8 cm. Contrast-enhanced CT demonstrated a large expansile heterogeneous mass with prominent enhancement and extensive central necrosis, initially raising concern for PDAC but prompting consideration of ACC, which was confirmed by endoscopic biopsy with immunohistochemistry. Surgical resection was initially considered, but the patient repeatedly declined surgery, and systemic chemotherapy was given after biliary decompression. Follow-up CT showed near-complete morphological resolution of the mass, whereas FDG-PET/CT showed persistent focal uptake (SUVmax 6.2) and MRI showed a residual diffusion-restricting lesion. The patient was subsequently persuaded to proceed to surgery and underwent a Whipple procedure; histopathology confirmed residual acinar cell carcinoma with clear margins and no nodal metastases, indicating that the CT response had underestimated persistent disease. This case highlights the value of reviewing prior imaging for interval growth, recognizing atypical imaging features of a pancreatic head mass, and integrating CT, PET/CT, magnetic resonance imaging and, when feasible, pathological confirmation when assessing treatment response.
Primary female urethral carcinoma is an exceptionally rare and frequently underrecognized malignancy, accounting for less than 1% of genitourinary cancers. Clinical presentation is often nonspecific, resulting in delayed diagnosis and advanced local disease at the time of imaging evaluation. Magnetic resonance imaging (MRI) represents the imaging modality of choice for local staging because of its superior soft-tissue characterization, multiplanar capability, and ability to assess periurethral extension.We report the case of a 68-year-old woman presenting with progressive dysuria, recurrent urinary tract infections, urinary obstruction, and intermittent hematuria. Multiparametric pelvic MRI demonstrated an irregular infiltrative soft-tissue mass centered on the proximal urethra, characterized by intermediate-to-high T2 signal intensity, marked diffusion restriction, and avid heterogeneous post-contrast enhancement. The lesion extended superiorly toward the bladder neck with infiltration of adjacent periurethral tissues and suspected involvement of the anterior vaginal wall. Histopathological analysis confirmed high-grade urothelial carcinoma of the urethra.This case illustrates the pivotal role of MRI in defining tumor origin, local extension, and adjacent organ invasion in female urethral carcinoma, while also emphasizing the importance of differentiating malignant periurethral lesions from benign mimickers. Awareness of characteristic MRI findings may improve diagnostic confidence and facilitate appropriate multidisciplinary management in this uncommon but aggressive neoplasm.
Hemobilia secondary to intrabiliary rupture of a hepatic hydatid cyst is rare, and concomitant arterial pseudoaneurysm formation further increases the risk of life-threatening hemorrhage. Case: An 80-year-old woman presented with 3 months of melena, progressing to large-volume melena and hematemesis. She was hypotensive and severely anemic (hemoglobin 6.0 g/dL). Upper endoscopy revealed a clot at the sphincter of Oddi, consistent with hemobilia. Multiphase CT showed a right-lobe hydatid cyst with active intracystic arterial extravasation and communication with the biliary ducts, with additional right-lobe hydatid cysts. Angiography identified a pseudoaneurysm arising from a segment V branch of the right hepatic artery. Given the patient’s advanced age, hemodynamic instability, and high surgical risk, emergent selective endovascular embolization—rather than surgery—was chosen as first-line treatment, and superselective coil embolization achieved hemostasis. Post-procedure, hemoglobin improved to 10.6 g/dL by day 4; follow-up CT at day 4 demonstrated resolution of the pseudoaneurysm without rebleeding. Albendazole therapy was initiated after embolization. Echinococcus serology was not available, and reported follow-up was limited to 4 days; these are acknowledged as limitations. Conclusion: In elderly or hemodynamically unstable patients with hemorrhagic hydatid cyst and hemobilia, selective endovascular embolization can provide rapid, organ-preserving control of bleeding and a bridge to definitive antiparasitic management, although longer-term data are needed.
Delayed postischemic leukoencephalopathy (DPIL) is an under-recognized cause of delayed white matter injury following cerebral ischemia. We report the case of a 71-year-old woman who presented with delayed neurological deterioration 3-4 weeks after successful mechanical thrombectomy for left middle cerebral artery occlusion. Serial brain MRI documented progressive T2/FLAIR hyperintensity with moderate diffusion restriction confined to the vascular territory's subcortical white matter, strictly sparing the cortex and subcortical U-fibers. Extensive diagnostic work-up excluded infectious, autoimmune, and toxic causes. To exclude a suspected primary central nervous system lymphoma, a stereotactic brain biopsy was performed, demonstrating myelin loss, relative axonal preservation, and reactive gliosis without malignancy. To our knowledge, this case provides rare histopathological correlation supporting DPIL after large-vessel occlusion. Recognizing this specific territorial radiologic-pathologic pattern is essential to avoid misdiagnosis and unnecessary invasive diagnostic interventions in patients with secondary neurological worsening.
Aneurysms of the intrasplenic arterial branches are exceptionally rare. Rupture without trauma, and without the pancreatic disease behind most splenic arterial pseudoaneurysms, is rarer still, and it can be fatal. Cross-sectional imaging usually brings it to light.A 51-year-old multiparous woman with no relevant medical history presented with sudden left upper quadrant pain radiating to the left shoulder, and a positive Kehr sign. Her blood pressure was maintained and her hemoglobin normal. A heart rate of 101 beats/min, however, left open the possibility of early compensation for bleeding. Multiphasic contrast-enhanced computed tomography (CT), the arterial phase acquired as a CT angiogram, showed a ruptured saccular aneurysm of 18 × 12 mm in the mid-splenic parenchyma. There was an arterial-phase contrast blush, marking active extravasation, with a heterogeneous subcapsular hematoma and a moderate hemoperitoneum. The pancreas was normal and there had been no trauma. With no endovascular treatment on site, she underwent splenectomy. Serial counts showed no fall in hemoglobin, and she was discharged on the fifth postoperative day. Histopathology found hemorrhagic change but no malignancy, vasculitis, or fibromuscular dysplasia, and no discrete aneurysmal wall. Once rupture has occurred, CT cannot reliably tell a true aneurysm from a pseudoaneurysm, so the lesion is best called one of presumed true type.Early CT found the lesion, showed how far the bleeding had gone, and allowed treatment to start without delay. The diagnosis is worth considering in acute left upper quadrant pain, even when the blood pressure is maintained and the hemoglobin normal.
