ABSTRACT:Malignant fibrous histiocytoma-currently known as undifferentiated pleomorphic sarcoma-is the most common soft tissue sarcoma of mesenchymal origin. Undifferentiated pleomorphic sarcoma is commonly located in the extremities, trunk, head, and neck in decreasing order of frequency. We report a case of primary undifferentiated pleomorphic sarcoma of the biceps femoris muscle in a 50-year-old man complicated by hemorrhage. Diagnostic workup included imaging, histopathology, and positive results on immunohistochemistry, especially CD68. High-grade liposarcoma and rhabdomyosarcoma were regarded as differential diagnosis of undifferentiated pleomorphic sarcoma. Demonstration of spontaneous hemorrhage within the lesion on follow-up ultrasonography done at one month from the time of diagnosis deserves special mention in this report. Radical excision with tumor-free margins of the biceps femoris and tendon reconstruction were undertaken. MRI at six-month follow-up did not reveal tumor recurrence at the site of surgery and CT chest did not reveal metastases.

Vascular tumors constitute the most common primary tumors of the spleen. Splenic hamartoma and littoral cell angioma have been reported only in the spleen. Splenic hamartomas are rare benign vascular tumors which are incidentally detected during imaging and are seldom symptomatic. This case report describes a rare sonological appearance of splenic hamartoma in a 31-year-old female with occasional pain in the left hypochondrium.

Concomitant Hodgkin’s lymphoma with tuberculosis is an exceedingly rare clinical scenario and a condition that is difficult to manage due to similar clinical presentation. This case report describes the same in a 44-year-old male patient diagnosed with Koch’s and initiated on antituberculosis therapy, based on confirmation of findings from the spine biopsy and culture. The patient’s clinical condition worsened despite being on treatment for tuberculosis. Hence, further work up of the patient was done which included mediastinoscopy and endobronchial ultrasound. Biopsy samples from a conglomerate mass in the lower cervical region and mediastinum revealed Hodgkin’s lymphoma of the nodular sclerosis type. This time, the patient showed significant improvement following treatment with chemotherapy and radiotherapy along with antituberculosis therapy.

Cystic tumors of the pancreas are rare and may be confused with hydatid cysts, especially in endemic areas. The incidence of cystic neoplasms of the pancreas is relatively rare in the pediatric population and young adults. We present a 21-year-old female with a well-defined giant multiloculated cystic lesion in the body and tail of the pancreas, which was diagnosed as a hydatid cyst elsewhere. The patient underwent laparoscopic spleen-preserving distal pancreatectomy. There was no visible communication between the mucinous cystic neoplasm and the pancreatic duct. Histopathology confirmed the diagnosis of benign mucinous cystadenoma of the pancreas. Ambiguity in the management of the lesion arises when mucinous cystadenoma is commonly misdiagnosed as pancreatic pseudocyst because the surgical management is entirely different.

Radiation-induced sarcoma is an exceedingly rare entity associated with high morbidity and mortality even if radiation is received several years prior. Aggressive cancer surveillance following radiotherapy is essential for improving survival rates in patients with radiation-induced sarcoma. Surgical resection with negative margins is the most important factor affecting long-term survival. This case report describes secondary osteosarcoma of the distal third of the femur in a 32-year-old female following previous radiotherapy treatment for Ewing's sarcoma.

A true diverticulum is a congenital rare anomaly of the gallbladder and includes all 3 layers of the gallbladder wall. The ultrasound appearance of a true diverticulum of the gallbladder is typical and clinches the diagnosis. This case report describes a 44-year-old male with features of acute calculous cholangitis and a rare presentation of an incidentally detected true gallbladder diverticulum.

Hamartoma of the breast is a rare benign lesion that leads to unilateral breast enlargement with evidence of a localized palpable mass. Ultrasonography findings are typical and include a well-defined mass lesion of heterogeneous echotexture consisting of mixed echogenic and sonolucent areas. This case report describes a hamartoma of the breast in a 17-year-old female.

The authors declare no conflict of interest.

INTRODUCTION:Bronchogenic carcinoma accounts for more cancer-related deaths than any other malignancy and is the most frequently diagnosed cancer in the world. Bronchogenic carcinoma is by far the leading cause of cancer death among both men and women, making up almost 25% of all cancer deaths. The objective of this study was to identify the changing trends, if any, in radiological patterns of bronchogenic carcinoma to document the various computed tomography (CT) appearances of bronchogenic carcinoma with histopathologic correlation.METHODS:This was a single-center cross-sectional study on 162 patients with clinical or radiological suspicion of bronchogenic carcinoma with histopathological confirmation of diagnosis.RESULTS:There was a male preponderance with bronchogenic carcinoma and smoking being the most common risk factor. Squamous cell carcinoma followed by adenocarcinoma and small cell carcinoma is the most common histologic subtype. Squamous cell carcinoma was noted to be present predominantly in the peripheral location (55.5%), and adenocarcinoma was noted to be present predominantly in the central location (68.4%).CONCLUSION:CT is the imaging modality of choice for evaluating bronchogenic carcinoma and provides for precise characterization of the size, extent, and staging of the carcinoma. Among 162 bronchogenic carcinoma cases evaluated in the current study, a definite changing trend in the radiological pattern of squamous cell carcinoma and adenocarcinoma was observed. Squamous cell carcinoma was predominantly noted to be a peripheral tumor, and adenocarcinoma is predominantly noted to be a central tumor. Surveillance or restaging scans are recommended, considering the high mortality rate in patients with bronchogenic carcinoma.

BackgroundIntracerebral hemorrhage is a leading cause of death and disability worldwide. After intracerebral hemorrhage, cerebral blood flow (CBF) becomes extremely low approaching ischemic thresholds. Concurrently, CBF velocities become strongly correlated to CBF itself post-injury. Identification of such hemodynamic disturbances can be used to predict outcome immediately post-injury when indices are measured using transcranial doppler ultrasonography (TCD). TCD permits non-invasive assessment of different CBF velocities as well as pulsatility index (PI). Abnormal measurement of such indices is believed to correlate to poor outcome.AimTo investigate the effect of cerebral hemodynamics after cranioplasty in decompressive craniectomy patients using pre and postoperative TCD.Materials and MethodsThis study is a prospective study of 3 years duration undertaken on 64 patients. All the patients were evaluated by TCDbefore and after decompressive craniectomy.All patients were evaluated by transcranial Doppler (TCD) 1 week before and 7-15 days after cranioplasty. TCD results were obtained though trans-temporal approach.ResultsStatistically significant differences between the values before and after craniectomy were detected in Peak Systolic Volume (PSV) for the Anterior Cerebral Artery (ACA) (P = 0.001), in PSV for the Middle Cerebral Artery (MCA) (P < 0.004), in Mean Bloodflow Velocity (MV) for the MCA (P < 0.003), and in PSV for the Posterior Cerebral artery (PCA) (P = 0.001) on the ipsilateral side. There were statistically significant differences between the values before and after cranioplasty in PSV for the PCA (P = 0.004), on contralateral side.After decompressive craniectomy, the PI values for the MCA decreased, on average, to 31+/- 33% of the pre-surgical value in the treated side and to 28+/- 31% on the opposite side. On the other hand, the mean PI values for the extracranial ICA reduced to 34+/- 21% of the initial values in the treated side, and to 21+/- 31% on the opposite side.Cranioplasty improved CBF velocities in all major intracrainal arteries, not only on the side of the lesion adjacent to the cranioplasty, but also in distant regions, such as in the contralateral hemisphere.ConclusionDecompressive craniectomy significantly improves cerebral hemodynamics both on ipsilateral and contralateral cerebral hemispheres.Concomitantly, PI values on TCD decrease significantly postoperatively, mainly in the decompressed cerebral hemisphere, indicating reduction in cerebrovascular resistance. We conclude that cranioplasty improves neurological status and the mechanism of postoperative improvement of neurological status may be due to increased CBF velocity.

The first carpometacarpal (CMC) joint consists of seven ligaments. The magnetic resonance imaging (MRI) examination of the first CMC joint should be performed in a high field 1.5/3 T MRI with a dedicated hand coil for high-resolution images. Degeneration of anterior oblique ligament (AOL) is the most important cause for the development of osteoarthritis of first CMC joint. Since the AOL undergoes a predictable pattern of alteration at its metacarpal attachment as degeneration proceeds, MRI imaging can provide an accurate assessment of this ligament.

Pyelocalyceal diverticulum is an incidental finding detected on routine ultrasonography scans which may also show symptoms of recurrent urinary tract infections secondary to urinary stasis and calculi formation within the diverticulum. Orthotopic type of ureterocele occurs as an isolated abnormality and is mostly confined to adults as opposed to ectopic type of ureterocele which is congenital in origin and commonly seen in children and is almost always associated with a duplicated collecting system. We report a case of concomitant occurrence of pyelocalyceal diverticulum and ipsilateral large sized orthotopic ureterocele diagnosed on high-resolution ultrasonography and confirmed on contrast enhanced computed tomography in a 54-year-old adult female. The patient underwent resection of the ureterocele with insertion of left sided double-J ureteral stent which was left in place for 4 weeks following which the patient's symptoms improved and she was discharged after an uneventful post-operative recovery period.

Detection of giant umbilical cord prenatally should lead to vigilant monitoring particularly at term as fetal demise is a possibility, as noted in the present case because of altered hemodynamics and related vascular complications such as compromised fetal circulation. A case of prenatally diagnosed, giant umbilical cord with fetoplacental insufficiency and impending heart failure is reported. An 18‐year‐old primigravida, presented at 34 weeks of gestational age with complaints of acute onset abdominal pain. Fetal umbilical artery obstetric Doppler examination demonstrated reversal of diastolic flow. 2D echocardiography demonstrated dilated all 4 chambers of the heart with reduced contractility suggesting impending heart failure. Subsequently, fetal demise was noted after 2 days, and labour was induced followed by vaginal delivery of the dead fetus. A giant umbilical cord was seen at delivery with absent knots or strictures. This case report deserves a special mention as there were no earlier reported cases of giant umbilical cord in literature presenting with impending heart failure and fetal demise. We have presented the detailed clinical course of the fetus with giant umbilical cord along with a review of the related literature.

Background  Mediastinal mass lesions span a wide histopathological and radiological spectrum. Partition of the mediastinum into specific compartments aids in differential diagnosis of mass lesions, assistance in biopsies, and other surgical procedures. Multidetector row computed tomography (MDCT) is a promising three-dimensional imaging tool allowing substantial anatomical volumes to be routinely covered with isotropic submillimeter spatial resolution to precisely localize lesions and biopsy needles for both benign and malignant disease lesions of the mediastinum. Objective  The aim of this study was to categorize mass lesions according to the mediastinal compartments to study their MDCT characteristics and to provide a comparative role of fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in the diagnostic evaluation of mediastinal mass lesions. Materials and Methods  Patients with clinical or radiological suspicion of mediastinal lesions on the basis of an abnormal chest radiograph were referred to the department of radiodiagnosis at a tertiary care center between April 2015 and December 2019 for MDCT evaluation. A total of 80 cases were correlated with the histopathological diagnosis excluding aneurysms. Size, CT density (Hounsfield unit [HU] mean), and maximum standardized uptake value (SUV max ) of mediastinal and chest wall lesions were determined on FDG-PET/CT. Results  This study included a total of 102 cases, 72 males and 29 females. Mediastinal mass lesions were most common in the age group 46 to 60 years. Anterior mediastinum ( n  = 43, 42.2%) is the most commonly involved compartment followed by posterior mediastinum ( n  = 37, 35.9%) and middle mediastinum ( n  = 22, 21.8%). Transcompartmental involvement is more commonly seen involving the anterior and middle mediastinum. The SUV max , HU mean, and size were higher in malignant cases ( p  = 0.001, p  = 0.003, and p  = 0.004, respectively). The current study found a cutoff value of 4.61 for SUV max to discriminate benign lesions from malignant ones with a sensitivity and specificity of 73.7 and 75.9%, respectively (area under the curve: 0.841, 95% confidence interval: 0.793–0.965, p  = 0.0001). The values of SUV max and HU mean were higher in solid benign lesions than those of cystic benign lesions ( p  = 0.007 and p  = 0.003, respectively). Conclusion  In the current study, MDCT has high diagnostic accuracy of ∼94% overall as compared with histopathology, and 97 and 92% for benign and malignant lesions, respectively, in the evaluation of mediastinal mass lesions. FDG-PET/CT may be complementary to conventional imaging methods for the evaluation of mediastinal and chest wall mass lesions. However, confirmatory tissue sampling is required to confirm PET positive findings for the definite diagnosis.