Radiology Notes

My notes during radiology residency, fellowship, and beyond…

Archive for the ‘tumor’ Category

Spinal Mass Differential

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A. Intradural, Intramedullary: astrocytoma, ependymoma, hemangioma, cavernoma, dermoid/epidermoid
B. Intradural, Extramedullary:  nerve sheath tumors, meningioma
C. Extradural: bone neoplasm, mets, abscess, TB, hematoma, disk, synovial cyst, lipomatosis, neuroblastoma/ganglioneuroma

Written by lmwong

December 17, 2010 at 1:14 pm

Posted in differential, neuro, tumor

Tumor Cancer Staging

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Nasophyngeal Squamous Cell Carcinoma Head and Neck

  • Tis = carcinoma in situ
  • T1 = confined to 1 site
  • T2 = 2 sites
  • T3 = extends to nasal cavity or oropharynx
  • T4 = invades skull, cranial nerve
  • N0 = no nodes
  • N1 = homolateral node ❤ cm
  • N2 = homolateral node > 3 cm
  • N3 = node > 6 cm
  • M0 = no mets
  • M1 = distant mets

Thyroid Cancer

  • T1a = nodule < 4cm
  • T1b = nodule > 4cm
  • T2 = nodule with partial fixation
  • T3 = nodule with complete fixation
  • N1 = regional nodes
  • N2 = fixed regional nodes
  • M1 = mets

Lung Cancer (TNM)

  • T0 = no tumor
  • T1 ❤ cm
  • T2 >3 cm, >2 cm from carina
  • T3 extends to chest wall, sulus, diaphragm, pleura, pericardium, <2 cm from carina
  • T4 distant mets
  • N0 = no nodes
  • N1 = ipsilateral hilar
  • N2 = ipsilateral mediastinal and subcarinal
  • N3 = contralateral, supraclavicular
  • M0 = no mets
  • M1 distant mets

Stomach Cancer

  • T1 = mucosa
  • T2 = muscle, serosa
  • T3 = penetration
  • T4 = adjacent organs

Renal Cell Carcinoma

  • Stage I = confined to kidney, <7 cm
  • Stage II = confined to kidney, >7 cm
  • Stage III = fatty infiltration, venous invasion, LN mets
  • Stage IV = through Gerota’s fascia, distant mets

Wilm’s Tumor

  • I = kidney
  • II = extend to perinephric space
  • III = LN
  • IV = mets to lung or liver
  • V = bilateral renal involvement

Colon Cancer (Dukes)

  • A = bowel wall only
  • B = serosa
  • C = LN
  • D = mets

Colon Cancer (TNM)

  • T1 = mucosa or submucosa
  • T2 = invasion or muscularis propria
  • T3 = invasion into subseroa
  • T3 = adjacent structures, fistulas
  • N1 = 1-3 LN
  • N2 = >4 LN
  • N3 =  LN along named vascular trunk
  • M = Mets

Bladder Cancer

  • T1 = mucosal and submucosal tumors
  • T2 = superficial muscle layers
  • T3a = deep muscular wall
  • T3b = perivesicular fat
  • T4 = other organs

Prostate Cancer (Jewett)

  • A = nonpalpable, found at biopsy
  • B = palpable, confined to prostate
  • C = through prostate capsule
  • D = mets

Endometrial Carcinoma

  • 1 and 2 = confined to uterus
  • 3 and 4 = extrauterine

Cervical Cancer

  • IA = confined to cervix
  • IB = extend to uterus
  • IIA = extend to upper vagina
  • IIB = parametrial involvement
  • IIIA = extend to lower vagina
  • IIIB = pelvic wall
  • IVA = adjacent organs
  • IVB = distant organs

Ovarian Cancer

  • 1 = ovary
  • 2 = both ovaries +/- ascites
  • 3 = intraperitoneal mets
  • 4 = mets outside peritoneal cavity

Breast Cancer

  • 0 = DCIS
  • 1 = <2 cm
  • 2 = 2-5 cm, axillary nodes
  • 3 = >5 cm, pectoralis involvement or matted LN
  • 4 = distant mets

Written by lmwong

March 30, 2010 at 9:56 am

Pediatric Renal Tumors

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  • Wilm’s tumor
  • nephroblastomatosis
  • Clear cell sarcoma
  • Rhabdoid tumor
  • Hamartoma
  • Angiomyolipoma
  • Ossifying Renal Tumor of Infancy
  • Metanrphric Adenoma
  • Adjacent Neuroblastoma from adrenal gland

Written by lmwong

March 20, 2010 at 10:57 am

Pituitary Adenoma

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  • >10 mm = macroadenoma
  • <10 mm = microadenoma
  • 75% hormonally active = prolactinoma (MC), growth hormone (acromegaly)
  • from anterior lobe of gland
  • pseudocapsule demarcates from normal gland
  • bromocriptine – high incidence of adenoma hermorrhage

Written by lmwong

January 25, 2010 at 11:31 am

Posted in neuro, tumor

Ventricular Tumors

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Ventricular Tumors

  • choroid plexus papilloma (24%)
  • choroid plexus carcinoma
  • ependymoma (18%)
  • subependymoma (11%)
  • central neurocytoma (10%)
  • subependymal giant cell astrocytoma
  • all other astrocytomas
  • meningioma
  • colloid cyst
  • met

Lateral Ventricle Mass by Age and Location

  • 0-10y
    • body: primative neuroectodermal tumor, teratoma, choroid plexus papilloma
    • trigone: choroid plexus papilloma
  • 10-40y
    • foramen: subependymal giant cell astrocytoma, pilocytic astrocytoma
    • body: ependymoma, pilocytic astrocytoma, central neurocytoma
  • >40y
    • body: subependymoma
    • trigone: meningioma, met

3rd Ventricle Masses

  • craniopharyngioma
  • colloid cyst
  • meningioma
  • choroid plexus papilloma
  • hamartoma
  • glioma
  • vascular lesion
  • granulomatous disease

4th Ventricle Masses

  • Choroid plexus papilloma/ca
  • Ependymoma
  • Medulloblastoma
  • Meningioma
  • mets

read more

Written by lmwong

January 22, 2010 at 3:08 pm

Posted in differential, neuro, tumor

Malignant Bone Tumors by Age

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Age Type
1 Neuroblastoma
1-10 Ewing of tubular bones
10-30 Osteosarcoma, Ewing of flat bone
30-40 reticulum cell sarcoma (Primary histiocytic lymphoma), fibrosarcoma, parosteal osteosarcoma, malignant giant cell tumor, lymphoma
>40 metastatic carcinoma, multiple myeloma, chondrosarcoma

Written by lmwong

January 16, 2010 at 9:59 am

Posted in bone, differential, msk, tumor

Thymic tumors

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  • anterior mediastinal mass
  • thymoma (MC); invasive, can spread locally
  • thymic hyperplasia
  • thymolipoma
  • thymic cyst
  • thymic carcinoma; metastatic disease
  • thymic carcinoid

Written by lmwong

January 12, 2010 at 8:22 am

Posted in chest, mediastinal, tumor

Extrapulmonary Chest Mass

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  • obtuse angles with adjacent chest wall
  • extrapleural = rib destruction
  • mets and myeloma
  • enhancement = thyroid or renal met

Written by lmwong

January 5, 2010 at 1:31 am

Posted in chest, tumor

Hemangioblastoma

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  • benign
  • most common primary cerebellar neoplasm in adults
  • multiple vs solitary
  • multiple, supratentorial ~ von Hippel-Lindau disease
  • spinal cord, medulla, cerebral hemispheres
  • always superficial location; pia matter blood supply
  • CT = well-defined cystic lesion, intensely enhances; 40% solid nonspecific findings; rarely calcify
  • MRI = low T1, high T2, enhances, flow voids
  • DDx: posterior fossa tumors
  • Link

Written by lmwong

September 24, 2008 at 4:18 am

Posted in cystic, neuro, tumor

Brain Stem Glioma

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  • majority are astrocytoma, mostly WHO Grade I and II
  • exophytic growth into adjacent cisternal spaces
  • enlarged pons, extending beyond anterior margin of basilar artery
  • abnormal fourth ventricle contour
  • bright on T2
  • enhancement is variable: avid to none
  • 80% occur in childhood
  • 15% of posterior fossa tumors in kids
  • DDx: posterior fossa tumors
  • link

Written by lmwong

September 24, 2008 at 3:54 am

Posted in neuro, pediatrics, tumor

Ependymoma

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  • posterior fossa tumor in children
  • from ependymal cell lining ventricular system
  • intraventricular or spinal cord mass
  • 70% in 4th ventricle
  • WHO grade II

CT

  • isodense
  • mixture of calcification, cystic changes, hemorrhage; heterogenous appearance

MRI

  • iso to gray matter on T1
  • hyper to gray matter on T2
  • heterogenous enhancement

DDX: posterior fossa tumors

link

Written by lmwong

September 24, 2008 at 3:42 am

Posted in neuro, pediatrics, tumor

Hepatocellular Carcinoma (HCC)

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  • most common malignant primary tumor of liver
  • associated with Hep B, Hep C, and cirrhosis
  • ETOH, Wilson’s disease, Type 1 glycogen storage disease, aflotoxin ingestion (Africa)
  • solitary, multifocal, diffuse, or infiltrating
  • typically large dominant lesion with scattered smaller satellite lesions
  • strong association with venous invasion; portal vein >> hepatic veins
  • hypervascular; hyperattenuated on delayed imaging compared to liver

http://brighamrad.harvard.edu/Cases/bwh/hcache/335/full.html

Written by lmwong

September 19, 2008 at 11:27 pm

Posted in cancer, gi, liver, tumor

Neuroblastoma

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  • most common extracranial solid tumor in kids
  • from neural crest tissue, sympathetic nervous system
  • 50% fatal; 2/3 have mets at diagnosis
  • ages 2-4 yo, 90% diagnosed at 5 yo; younger diagnosed, better outcome
  • 65% abdominal, 2/3 of which are adrenal; remainder in neck
  • fever, malaise, bone pain, racoon eyes (periordbital ecchymosis and proptosis), blueberry muffin baby (skin mets)
  • associated syndromes: myoclonic encephalopathy of infancy (MEI), watery diarrhea, heterochromia and Horner’s syndrome
  • mets to lymph nodes, liver, bone, cns, skin (blueberry muffin)
  • prognosis: age, state, histology, site of primary
  • NM MIBG: increased uptake in tissue, photpenia in bone mets, hot on bone scan
  • X-ray: calcifications, moth-eaten bony mets
  • CT: calcification, necrosis, LAD, mets, IVC thrombus, encases mesenteric vessels

Staging

1: tumor localized, resected
2A: tumor localized, non-resectable
2B: tumor unilateral, ipsilateral nodes
3: tumor crosses midline, +/- nodes
4: tumor crosses midline, + nodes, distant mets
4S: mets to skin, liver, bone marrow

Written by lmwong

September 9, 2008 at 1:24 pm

Posted in abdomen, gi, pediatrics, tumor

Gallbladder Carcinoma

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  • 5th most common GI malignancy
  • stones are a risk factor
    • 75% have stones
    • chronic inflammation leads to epithelial dysplasia –> adenocarcinoma
  • 20% 5ys
  • 80% have direct tumor invasion at presentation
  • ST mass in GB lumen, partially or completely obliterates GB lumen
  • Greater than 1 cm (distinguish from polyp)
  • irregular, asymmetric and eccentric wall thickening
  • polypoid intraluminal mass
  • porcelain gallbladder
  • early spread to liver and lymph nodes
  • invades liver, bile ducts, portal veins
  • invades hepatoduodenal ligament –> CBD obstruction

Written by lmwong

June 6, 2008 at 5:21 pm

Adrenal Carcinoma

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  • large 4-20 cm
  • areas of central necrosis and hemorrhage
  • irregular enhancement
  • delay CECT shows poor washout
  • liver and lymph nodes metastasis
  • invasion in renal vein or IVC
  • MR: low T1, high T2

Written by lmwong

May 24, 2008 at 2:23 pm

Posted in abdomen, adrenal, gi, tumor

Medulloblastoma

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  • most common (along with pilocytic astrocytoma) posterior fossa tumor in children
  • less than 10 years old
  • male 60%
  • brief clinical onset: headache, vomiting, truncal ataxia
  • compress 4th ventricle, cause hydrocephalus
  • WHO grade 4, high grade malignant neoplasm
  • Subarachnoid CSF spread common at diagnosis

CT findings

  • solid, hyperdense mass (vs pilocytic astrocytoma hypo)
  • cystic and necrotic change in 60%
  • calcfications in 20%

MR findings

  • T1 hypo
  • T2 variable
  • heterogenously enhances
  • blurring of cerebellar folia

read more

Written by lmwong

May 6, 2008 at 7:57 pm

Posted in neuro, pediatrics, tumor

Oligodendroglioma

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  • intra axial tumor differential
  • frontal lobes affected
  • calcification in 100%
  • contrast enhancement is variable
  • calvarial erosion

Written by lmwong

May 6, 2008 at 7:41 pm

Posted in neuro, tumor

Gliomatosis cerebri

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  • rare
  • at least 3 lobes must be affected
  • diffuse involvement of cerebral white matter without mass effect
  • loss of gray and white matter distinction
  • intra axial tumor differential

Written by lmwong

May 6, 2008 at 7:40 pm

Posted in neuro, tumor

Metastasis to the CNS

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Intra-axial

  • lung carcinoma
  • breast carcinoma
  • melanoma
  • colon carcinoma

Extra-axial

  • breast carcinoma
  • prostate carcinoma
  • lung carcinoma
  • neuroblastoma

Hemorrhagic

  • melanoma
  • renal carcinoma (posterior fossa)
  • thyroid carcinoma
  • choriocarcinoma

Written by lmwong

April 23, 2008 at 4:17 am

Glioblastoma Mulitforme

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  • most malignant and most common astrocytoma
  • WHO Grade IV Astrocytoma
  • intra-axial
  • 45-55 yo, men
  • deep white matter of frontal lobe > temproal lobe > basal ganglia
  • central necrosis, hemorrhage, neovascularity
  • “butterfly glioma” = bihemispheric spread through corpus callosum involving both frontal lobes
  • multicentric gliomas (rare) = NF1
  • subependymal spread > leptomeninges, subarachnoid space, subependymal region along ventricular margins

CT findings

  • heterogenous and lobulated
  • calcification
  • ring enhancement

MR findings

  • T1 and T2 prolongation
  • necrosis and debris gives “dirty” CSF look
  • vascular = flow voids
  • ring enhancement
  • followup MRI performed within 24-48 hours to look for enhancing residual tumor; after 48 hours, cannot discern between tumor and scar

Rx:

  • surgical resection, chemotherapy, radiation
  • frequently recur in 1 year
  • 2% 3 year survival

Written by lmwong

April 23, 2008 at 3:55 am

Posted in neuro, tumor