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Biomedical subjects

D S Hartman

Publications and source records attributed to D S Hartman.

At least 73 records · Page 4Linked to original sources
PubMed1986

The varied radiographic manifestations of retroperitoneal malignant fibrous histiocytoma revealed through 27 cases.

Malignant fibrous histiocytoma, a pleomorphic sarcoma, represents the most common soft tissue sarcoma of late adult life. Approximately 15 per cent of the cases of malignant fibrous histiocytoma arise within the abdominal cavity or retroperitoneum. Although tumors in this series arose in many different sites, their proximity to the kidney necessitated a nephrectomy in 44 per cent of the cases (12 of 27). In 3 cases calcification was noted, which varied from a few small speckled areas to extensive large, coarse densities. The masses tended to compress or displace adjacent structures and vessels radiographically. Renal, duodenal and cecal invasion occasionally occurred. Ultrasonically, most tumors were hypoechoic (9 cases), with a few having a mixed pattern (2). On computerized tomography the masses were well circumscribed, with computerized tomography numbers in the range of solid tissue except for a few small areas of decreased density. The vascularity was variable, with 8 tumors being hypovascular and 8 showing a moderate to hypervascular pattern. Interestingly, the tumor derived a part of its blood supply from the renal vasculature in 12 cases (44 per cent). Even though malignant fibrous histiocytoma often was diagnosed incorrectly as an intrarenal or adrenal neoplasm, a cleavage plane usually could be identified between the tumor and the renal parenchyma in 1 of the studies, especially on the angiogram. This finding suggested its extrarenal origin. Knowing the tendency of malignant fibrous histiocytoma to arise from or be physically near the kidney and/or adrenal gland in elderly men may be of some diagnostic value.

Adult↗
PubMed1986

Lipomatous tumors of the liver: evaluation with CT and US.

Seven cases of lipomatous masses within the liver parenchyma were demonstrated with computed tomography (CT). Five of these cases were obtained from a retrospective review of 50 cases of renal angiomyolipoma in which the liver was adequately demonstrated. The other two cases were from the files of the Armed Forces Institute of Pathology and had no associated renal lesions. Three of the five cases were associated with tuberous sclerosis. In all seven cases, the fatty tumors appeared on CT scans as a well-defined, 0.8-13-cm mass, with attenuation coefficients of less than -30 HU. On ultrasound studies, the lesions were well circumscribed, highly echogenic, and similar to hemangiomas. While distinctly rare lesions, these lipomatous masses are not as unusual as the literature would indicate. One may anticipate such masses in patients with renal angiomyolipomas and in a relatively high percentage of those with tuberous sclerosis.

Adult↗
PubMed1986

Mesenchymal hamartoma of the liver: radiologic-pathologic correlation.

Mesenchymal hamartoma of the liver (MHL) is an uncommon cystic mass of infancy that is a developmental anomaly rather than a neoplasm. Fourteen cases of MHL were retrospectively reviewed. Grossly, MHL is a solitary mass with cystic spaces of variable size. Patients are seen initially with painless progressive abdominal enlargement. On plain films, MHL appears as a large, noncalcified mass in the right upper quadrant. Scintigraphy is helpful in confirming its hepatic origin. Ultrasonography and computed tomography demonstrate a large multiloculated mass with considerable variation in the size of septa and cystic spaces. Angiographically, MHL is avascular or hypovascular. Recognition of these radiographic findings allows a correct diagnosis to be made in many cases. With resection, the prognosis is excellent.

Angiography↗
PubMed1986

Undifferentiated (embryonal) sarcoma of the liver: radiologic-pathologic correlation.

Undifferentiated (embryonal) sarcoma (UES) is an uncommon malignant mesenchymal hepatic tumor that occurs in older children and young adults. Fourteen cases are correlated with radiologic and pathologic findings. Radiologic findings reflect the spectrum of solid to cystic appearances observed in the gross specimens. Sonography typically demonstrates a large mass that may be predominantly solid with many small anechoic spaces or may be cystic. Computed tomography reveals a hypodense mass with hyperdense septa of variable thickness and a dense peripheral rim corresponding to the fibrous pseudocapsule of the tumor. Angiographically, UES is usually hypovascular with tumoral vessels, although hypervascular and avascular patterns occur. Prognosis of UES is poor, with a median survival of less than 1 year. Radiologists should be familiar with this malignant tumor since it may present as a large cystic hepatic mass, suggestive of a benign lesion.

Adolescent↗
PubMed1984

The sonographic distinction between neonatal multicystic kidney and hydronephrosis.

Distinction between multicystic kidney and hydronephrosis, the two most common causes of neonatal abdominal masses, is important because of differences in management; however, these two entities may have a similar ultrasonographic appearance. Sonograms of 22 cases of multicystic kidney and hydronephrosis were retrospectively reviewed without knowledge of the pathologic findings to determine if the sonographic patterns were sufficiently distinct to be usable in clinical diagnosis. Nine of the 22 cases were correctly diagnosed with ultrasound as multicystic kidney, 6 cases were correctly diagnosed as hydronephrosis, and 7 cases of pathologically proved multicystic kidney were incorrectly diagnosed as hydronephrosis. Four of these incorrect diagnoses occurred in cases of the hydronephrotic type of multicystic kidney. An additional 9 cases were reviewed with knowledge of the pathologic results. It is concluded that sonography is accurate at differentiating classic multicystic kidney disease from moderate hydronephrosis; however, there is often considerable difficulty in distinguishing severe hydronephrosis from the hydronephrotic form of multicystic kidney disease.

Diagnosis, Differential↗
PubMed1984

Renal oncocytoma: new observations.

Renal oncocytomas are uncommon, benign tumors that can be treated by local excision or heminephrectomy; their preoperative differentiation from renal cell carcinoma, treated by radical nephrectomy, would be invaluable. A particularly important finding, a central scar--not stressed in previous reports, is frequently demonstrated by CT examination. We evaluated radiographic studies of 18 pathologically confirmed cases of oncocytoma and compared findings with results of CT, sonography, and angiography studies of 18 renal cell carcinoma cases. Oncocytomas can be suggested if a stellate scar is identified within an otherwise homogenous tumor on ultrasound (US) and CT; if the mass appears homogeneous but no scar is present, angiography should be performed. An oncocytoma can be suggested in these cases if a spoke-wheel configuration and homogeneous blush are present. These criteria, which are reliable only if the mass is 3 cm or larger, would have resulted in the correct diagnosis of oncocytoma in 16/18 cases.

Adenocarcinoma↗
PubMed1984

CT of xanthogranulomatous pyelonephritis: radiologic-pathologic correlation.

A clinical-radiologic-pathologic correlation study was performed in 18 (17 female) patients with xanthogranulomatous pyelonephritis (XGP) with CT scans available for analysis. Presenting signs and symptoms included pain (66%), urinary frequency (66%), dysuria (66%), nocturia (66%), palpable mass (56%), leukocytosis (50%), and fever (50%). The duration of symptoms was usually relatively short (less than 6 months), considering the extent of the pathologic process. In 14 patients, the disease was diffuse; the kidney was enlarged with preservation of the reniform outline in 13. The renal pelvis, lined with sheets of lipid-laden macrophages and surrounded by a marked fibrotic reaction, was contracted in 11 and contained pelvic calculi in 12. The parenchyma was replaced by multiple, rounded, low-density areas on CT that corresponded to dilated calices and/or inflammatory tissue. These areas had enhancing rims (10 cases) that corresponded to preserved, compressed normal parenchyma and/or inflammatory tissue. There was CT identification of unsuspected extension through the renal capsule with involvement of the perirenal space in 11 patients, the pararenal spaces in 13, and the psoas muscle in six. The pararenal space and the psoas muscle were often extensively involved with minimal perirenal disease in six patients, a reflection of chronic indolent infection. There were four cases of focal XGP that appeared on CT as low-density mass lesions with wall enhancement surrounding dilated, stone-filled calices or as focal masses occupying one pole of a duplication. Extensive pararenal disease was present in two of the four cases of focal XGP. The preoperative diagnosis of XGP was suspected in only 44% of cases. It is concluded that CT should play a role in diagnosis and preoperative planning to demonstrate the extent of extrarenal disease that is poorly depicted by other means.

Adolescent↗
PubMed1984

Xanthogranulomatous pyelonephritis: sonographic--pathologic correlation of 16 cases.

Xanthogranulomatous pyelonephritis (XGP) is an uncommon renal inflammatory disease characterized by the destruction and replacement of normal parenchyma by sheets of lipid-laden histiocytes. The process may be diffuse or segmental. Sonograms of 16 cases of XGP (13 diffuse, three segmental) were retrospectively reviewed and correlated with their pathologic findings. The typical case of diffuse XGP demonstrates the following: renal enlargement, replacement of normal architecture by multiple fluid-filled masses, pelvic contraction or only moderate separation of the central echo complex, and a pelvic calculus. Although most cases have a large staghorn calculus, its sonographic demonstration may be difficult, perhaps as a consequence of peripelvic fibrosis. Atypical cases of diffuse XGP mimic pyelonephrosis with massive hydronephrosis and fluid--debris levels. In these atypical cases, a staghorn calculus is often conspicuously absent. Segmental XGP is recognized as an area of parenchymal destruction surrounding one calyx or one pole of duplication. Segmental XGP should be distinguished from focal xanthogranulomatous inflammation of the kidney, which is a distinct pathologic entity (cortical location, no pelvic communication, absent pyelitis). When typical gross pathologic features are present, sonography should make possible accurate identification of diffuse and segmental XGP.

Adult↗
PubMed1984

Renal ultrasonography 1984: a practical overview.

Renal sonography is quite sensitive, although experience has demonstrated its lack of specificity. The abnormal renal sonogram should therefore suggest several differential possibilities. This article addresses the strengths and limitations of renal ultrasound. Although renal ultrasound was once thought to be tissue-specific in many instances, this has not proved to be true. It is thus incumbent on the sonographer to interpret the findings in light of the overall clinical setting and to recommend other imaging modalities as appropriate for confirmation of the final diagnosis.

Adult↗
PubMed1983

Transitional cell carcinoma of the kidney with invasion into the renal vein.

Eight cases of transitional cell carcinoma with extension into the renal vein are presented. In 2 cases the tumor had also invaded the inferior vena cava. Venous invasion represents an uncommon, late finding of transitional cell carcinoma and is associated with a poor prognosis. The excretory urogram usually demonstrates nonfunction or a pelvic mass with extensive renal invasion. As these findings are nonspecific, definitive preoperative diagnosis is dependent on direct visualization of the renal vein utilizing sonography, computed tomography, or venography. Since vascular invasion is a late finding, venous evaluation is required only in advanced cases of transitional cell carcinoma.

Adult↗
PubMed1983

The CT appearance of Wilms tumor.

The computed tomographic (CT) findings in 30 Wilms tumors in 25 patients were reviewed and correlated with the pathological findings. Most tumors were quite large at the time of detection (average diameter 11 cm) and were cortical in origin. Peripheral lesions tended to grow exophytically. On the noncontrast studies an inhomogeneous mass with low-density areas (tumor necrosis) was seen. Small, focal calcifications (13.3%) and fat (6.9%) were much more readily identified with CT than with intravenous pyelography. After contrast medium injection, slight enhancement of the tumors was noted, and foci of necrosis became more prominent. A sharp demarcation between the tumor and normal parenchyma (seen in 19 cases) correlated with the pseudocapsule that is often present. Particularly striking was the presence of a persistent, ellipsoid area of increased attenuation corresponding to the compressed uninvolved renal parenchyma seen in 14 cases. Two cases were seen with complete tumor infiltration of the kidney pathologically and on CT. The primary clinical usefulness of CT in Wilms tumor is to detect multiple masses, to determine the extent of tumor, and to evaluate the opposite kidney.

Adult↗
PubMed1983

Multilocular cystic nephroma: a radiographic-pathologic correlation of 58 patients.

Clinical radiographic, and pathologic findings of multilocular cystic nephroma (MLCN) in 58 patients are presented. The lesion that affects predominantly boys in childhood and women in adulthood is usually solitary but rarely can be multiple, and it commonly occurs as an asymptomatic mass, occasionally with hematuria. Tumors may grow slowly over years or rapidly within months. A mass that is usually identified on plain radiographs occasionally has curvilinear calcification. Excretory urography and retrograde pyelography are helpful when pelvic herniation of the tumor is recognized, or when septae are noted with total body opacification. Angiography showed an avascular mass (six lesions), a hypovascular mass (14 lesions), or a hypervascular mass three lesions). Ultrasonography is helpful when multiple circumscribed sonolucent areas are identified. Similarly, a multilocular mass with septae is usually identified by computed tomography (six of seven cases). Our findings and a review of the literature indicate that this lesion is a neoplasm that can be strongly suspected preoperatively if pelvic herniation or a multilocular pattern is noted on imaging studies.

Adolescent↗
PubMed1983

The radiology of juxtaglomerular tumors.

Nine cases of proven juxtaglomerular tumor of the kidney are reviewed. Each patient presented with hypertension; elevated peripheral renin levels were found in four patients. As in past studies, this tumor occurred more frequently in women (7/9 cases). Although the patients tended to be younger (mean age, 31 years) than those with essential hypertension, all but two patients were more than 20 years of age. In all cases, the tumor was solitary, well-defined, and curable by surgery. The tumor was identified by excretory urography in 5/8 patients who underwent this procedure. A solid renal mass was detected in each of the seven patients examined by ultrasound. Since the tumor tends to be isodense with normal renal parenchyma, it is sometimes not seen on computed tomography without intravenous contrast material. Arteriography revealed a hypovascular mass in each of the nine patients. The combination of a hypovascular solid renal mass in a patient with elevated renin but no renal artery lesions should suggest the diagnosis of a juxtaglomerular cell tumor.

Adolescent↗
PubMed1982

Primary malignant renal tumors in the second decade of life: Wilms tumor versus renal cell carcinoma.

Primary renal malignancies occur least frequently in the second decade of life. Of the 4,798 cases of renal cell carcinoma and Wilms tumor referred to the Armed Forces Institute of Pathology 53 renal cell carcinomas and 56 Wilms tumors occurred in the 10 to 20-year age group. Pathologically, both tumors in this age range are similar to those occurring at a more typical age, and histologic differentiation between renal cell carcinoma and Wilms tumor is seldom a problem. While radiographic evaluation is useful to characterize the neoplasm, evaluate the contralateral kidney and detect the presence of tumor extension, current imaging techniques cannot confidently distinguish these 2 tumors.

Adenocarcinoma↗
PubMed1982

Renal lymphoma: radiologic-pathologic correlation of 21 cases.

The radiologic findings in 21 cases of renal lymphoma were correlated with the gross and microscopic pathologic findings. The gross morphology and consequent radiographic images depend upon the mechanism of renal involvement (hematogenous or direct extension); the pattern of intrarenal growth (interstitial or expansile); the size, number, and distribution of lesions; and the presence of extension beyond the kidney. Initially, the lymphoma grows between nephrons that may continue to function and, because this interstitial proliferation preserves gross morphology, radiographic detection may be difficult. With continued growth, the scaffolding along which the tumor infiltrates is destroyed, growth becomes expansile, and the lymphomatous mass resembles other renal neoplasms that enlarge by appositional growth. Continued growth and coalescence of small foci result in progressive parenchymal replacement and, rarely, in destruction of the entire kidney. Perinephric extension with subsequent vascular and ureteral encasement is common.

Adolescent↗