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PubMed1995

[Three-dimensional helical CT angiography of the abdomen].

To evaluate the quality of three-dimensional (3D) images of the abdominal vasculature acquired using enhanced helical CT, 3D reconstructions were performed for 43 examinations (38 patients). Twenty-one of 43 examinations were also reconstructed by Maximum Intensity Projection (MIP). The CT scanner employed was the Toshiba Xforce. Helical CT data were acquired using up to 20 continuous 1.5-sec rotations with an X-ray beam width of 5 mm and a couchtop movement speed of 5 to 10 mm/1.5 sec. Axial images were reconstructed at a section interval of 2 mm. Optimal protocol on enhanced helical CT was as follows: Iopamidol 300 mg I/ml was administered intravenously using a biphasic technique (3-4 ml/sec for the initial 100 ml, followed by 0.7-1.5 ml for the remaining 50 ml), and delay times of the early and late phases were 25-35 and 90 sec, respectively. Aortic branches were clearly demonstrated on early phase, while portal branches were well defined on late phase. In the visualization of abdominal vessels, 3D images were nearly equal to MIP images. However, for anteroposterior images, MIP images were superior to 3D images in quality, because 3D images had some longitudinal direction artifacts. Three-dimensional images were considered to be useful for correctly evaluating overlapping abdominal vasculatures. From the above results, 3D and MIP images of the abdominal vasculature obtained using enhanced helical CT were considered to compensate for each other.

Abdomen↗
PubMed2000

Desmoplastic small round cell tumour in children and adolescents.

BACKGROUND: Desmoplastic small round cell tumour (DSRCT) is a rare highly aggressive neoplasm, and clinical studies are scarce. PROCEDURE: We report six cases of children and adolescents (median age 14 years, range 6.9-17.5) with DSRCT (5 abdominal, 1 paratesticular) registered by the Italian Cooperative Group (ICG) for soft tissue sarcoma over a 9-year period. Patients received a multidisciplinary treatment, including aggressive initial or delayed surgery and radiotherapy. Chemotherapy regimen was based on the use of ifosfamide, vincristine, dactinomycin, and a few doses of antharacyclines (doxorubicin or epirubicin). RESULTS: Complete surgical resection was possible only for the paratesticular tumour. Among the patients with abdominal lesions, macroscopically radical excision was possible in only one case. All patients received multidrug chemotherapy, and tumour reduction was obtained in the 4 evaluable patients. No relapses were evident in the irradiated fields in the 4 patients who received radiotherapy. Two patients remained progression-free 22 and 63 months after diagnosis, one is in third complete remission, whereas three died 10-25 months after diagnosis. CONCLUSIONS: DSRCT is a chemosensitive tumour, but survival rates remain disappointing despite aggressive multimodality therapy. Our results support surgical tumour removal and radiotherapy to achieve local control. Our experience and a review of the literature suggest that patients with localised abdominal tumours or a paratesticular primary may have a better prognosis.

Abdominal Neoplasms↗
PubMed2005

CT in children with abdominal cancer: should we routinely include the pelvis?

BACKGROUND: It has been suggested that the pelvis should not be habitually included on abdominal CT examinations, but the potential benefit of such a practice in childhood abdominal malignancies is unknown. OBJECTIVE: To estimate the yield and potential diagnostic benefit of abnormal findings on CT of the pelvis in children with malignant primary tumours in the upper abdomen. MATERIALS AND METHODS: From a paediatric tertiary referral hospital we retrospectively included patients having abdominal CT for primary upper abdominal tumours (1997-2004), the scan range routinely including the pelvis. We reviewed and tabulated any pelvic abnormality, and calculated group proportions with 95% confidence intervals. RESULTS: We identified 230 children (2 days to 17 years old, median 2.9 years). Six (2.6%; 95% CI 0.5-4.7%) had abnormalities in the pelvis that would not have affected clinical management. Four (1.7%; 95% CI 0.1-3.4%) had findings that might have influenced staging, but only one was not detected by other modalities within 1 week of the CT. CONCLUSIONS: Our data suggest that diagnostically significant findings in the pelvis are rare; consequently, the habitual inclusion of the pelvis on abdominal CT for primary malignant tumours in the abdomen is not justified.

Abdominal Neoplasms↗
PubMed2005

The management of indeterminate incidental findings detected at abdominal CT.

Abdominal computed tomography (CT) scans often have findings that are incidental to the reason the study was ordered. Several recent studies and reviews have addressed how these findings should be managed. This article summarizes current management strategies for several types of lesions that are commonly encountered. Some of these findings can be characterized without additional imaging (including simple renal cyst, angiomyolipoma, hepatic steatosis). Other findings are indeterminate. While some of these indeterminate incidental findings can be ignored based on statistical arguments (for example, a sharply circumscribed homogeneous low-attenuation renal lesion under 1 cm in patients without a predisposition to develop renal cell carcinoma), many may need additional imaging studies to either characterize them or demonstrate stability over time. Adhering to these strategies will hopefully reduce overutilization of imaging services while directing attention to those findings which need diagnostic or therapeutic interventions.

Abdominal Neoplasms↗
PubMed1981

Reformatted coronal display of upper abdominal computed tomography: comparison with ultrasonography.

The coronal plane is the most common format used for descriptions of the radiographic and surgical anatomy of the upper abdomen. Coronal reformatted computed tomographic (CT) studies of the upper abdomen were compared to coronal ultrasonic images of equivalent cephalocaudad dimension obtained with a water path echoscope. In most cases, the reformatted CT images were equivalent or superior in the display of selected mass lesions and their anatomic relationships. Direct coronal CT studies should be useful in the evaluation of upper abdominal pathology.

Abdomen↗
PubMed1993

[Clinical relevance of abdominal imaging examinations in malignant lymphoma].

We prospectively evaluated the clinical importance of abdominal imaging examinations (US, CT, upper gastrointestinal barium X-ray) in 233 consecutive patients who gave informed consent for the examinations. The examinations revealed intra-abdominal lesions in 99 of 233 patients. Intra-abdominal lymph nodes were most frequently affected, followed by stomach, spleen, liver, small intestine and large intestine. In Hodgkin's lymphoma, no gastrointestinal involvement was noted but one in the small intestine. Prognosis was poorer with advancing stage according to Ann Arbor classification. However, the presence or absence of intra-abdominal lesions did not influence the prognosis when patients were matched for the stage. Abdominal imaging examinations altered the bed-side staging to more advanced stages in 22 of 163 patients with stage I through stage III lymphoma, influencing prognosis as well as the decision of therapeutic modalities. These three diagnostic modalities were complementary to one another. In conclusion, every one of these abdominal imaging examinations is important for planning the management of patients with malignant lymphoma.

Abdomen↗
PubMedDate not supplied

Neuroblastoma with concomitant giardiasis: report of a case with diagnosis by fine needle aspiration cytology.

BACKGROUND: Diagnosis of two pathologies, including a neoplasm and infectious condition, by fine needle aspiration (FNA) cytology in the same patient is rare. CASE: A 2-year-old, male child presented with fever, abdominal pain and abdominal mass. Imaging findings were strongly in favor of a neuroblastoma. FNA smears from the mass revealed fecal material containing numerous trophozoites of Giardia lamblia. FNA was repeated in view of the imaging findings. Repeat smears showed a small round cell tumor with rosettes and background filamentous/fibrillar material consistent with a neuroblastoma. Chemotherapy reduced the mass considerably. Histopathology of the resected residual mass revealed a ganglioneuroma in addition to remnants of neuroblastoma. The patient was free of disease two years after the initiation of chemotherapy. CONCLUSION: When FNA cytology shows an infectious pathology in the clinical and imaging setting of a tumor, FNA should be repeated so that an important component of the diagnosis is not missed.

Abdominal Neoplasms↗
PubMed2006

Analysis of TGF-beta protein expression in aggressive fibromatosis (desmoid tumor).

Aggressive fibromatosis, usually termed desmoid tumor, develops from muscle connective tissue, fasciae and aponeuroses. Aggressive fibromatosis located in various parts of the body demonstrates differentiated biological behavior. Abnormalities in TGF-beta expression are very common in many disease processes, including neoplasms. Immunohistochemical analysis employing a monoclonal antibody against TGF-beta was performed on archival material, consisting of 38 cases of aggressive fibromatosis, among which 23 represented abdominal, 11 extra-abdominal and 4 intra-abdominal localizations. The sections for immunohistochemical study were stained using the streptavidin-biotin (ABC) method. The average percentage of cells positively stained for TGF-beta protein was 40.2% in the group of extra-abdominal, 58.5% in the group of abdominal and 72.8% in the group of intra-abdominal localizations. There were significant differences observed between the analyzed groups of desmoid tumor (p<0.05). A positive cytoplasmic reaction for TGF-beta was noted in 65.8% (25/38) of the aggressive fibromatoses. Overexpression of TGF-beta protein was noted in 39.5% (15/38) of the aggressive fibromatoses. High expression noticed in desmoid fibroblasts might indicate that this protein plays a crucial role in the development of aggressive fibromatosis.

Abdominal Neoplasms↗
PubMed2001

[Multi-slice spiral CT of the abdomen in oncological patients: influence of table support and detector configuration on image quality and radiation exposure].

PURPOSE: To evaluate the image quality and radiation exposure of different spiral CT scanning parameters for routine staging examination of the abdomen in oncologic patients using a multi-slice CT scanner. METHODS/MATERIALS: Examination of 40 patients in 4 groups on a multi-slice CT scanner (Somatom VolumeZoom, Siemens AG, Forchheim). Functional detector width (4 x 2.5, 4 x 5 mm) and pitch (table feed in relation to collimated slice width) were varied (3 and 5). Tube voltage (120 kV), effective tube current (160 mAs), slice-thickness (6 mm), increment (4 mm), kernel (B 30), and contrast injection parameters were kept constant. Axial images were assessed by three radiologists regarding delineation of anatomic structures, artifacts, and overall image quality. RESULTS: Significantly reduced image quality especially due to artifacts was observed using a 5 mm detector configuration with a pitch of 5 (scan time 9 sec). Image quality was rated best for a 2.5 mm detector configuration with a pitch of 3 and a scan time of 28 sec. The effective dose was independent of the pitch. However, the mean effective dose was 9% higher using the smaller detector configuration (9.9 mSv vs 10.9 mSv). CONCLUSIONS: For routine staging CT of the abdomen use of a 4 x 2.5 mm detector configuration with a pitch between 3 and 5 is recommended. A 4 x 5 mm detector configuration using overlapping data acquisition can also be recommended, but additional thin slice reformations are not possible.

Abdominal Neoplasms↗
PubMed1986

Phase I and pharmacologic studies of intraperitoneal leucovorin and 5-fluorouracil in patients with advanced cancer.

Many patients with gastrointestinal (GI) tumors develop extensive peritoneal and serosal metastasis and/or malignant ascites which respond poorly to available treatments. Twelve patients with tumors confined primarily to the intraabdominal cavity were treated with intraperitoneal (IP) 5-fluorouracil (5-FU) in escalating concentrations (2 to 4 mmol/L) in combination with leucovorin (dl-5-formyltetrahydrofolic acid or folinic acid; dl-CF) in a 2-L volume, either by eight consecutive four-hour dwells or once daily for five days. CF dose was 20.8 or 104 mumol/L. Nine of the patients had pancreatic carcinoma, one had stomach carcinoma, and two had hepatobiliary neoplasms. Median age was 62.5 years and median Eastern Cooperative Oncology Group (ECOG) performance status was 3. Toxicity included mucositis, diarrhea, nausea and vomiting, leucopenia, skin rash, and abdominal pain, and was similar to that previously reported for IP 5-FU used as a single agent. Four episodes of peritonitis occurred, but all patients responded to antibiotics. At the 20.8 mumol/L dose, dl-CF concentration in the peritoneal fluid declined from 10.4 +/- 3.0 3.0 mumol/L at one hour to 4.9 +/- 2.2 mumol/L at four hours, corresponding to a mean absorption half-life of 127 +/- 49 minutes and a mean peritoneal clearance of 13.0 +/- 4.5 mL/min. Decline was biphasic in all but five of the 19 exchanges evaluated. The levels of l-CF (biologically active isomer of dl-CF) were 2.8 +/- 2.5 mumol/L after 60 minutes and 1.2 +/- 0.7 mumol/L after four hours. The peritoneal area under the concentration v time curve (AUC) for 5-FU increased proportionally with dose. For example, the AUC at 2.0 and 3.5 mmol/L was 129 +/- 25 and 201 +/- 23 mmol/L X minute, respectively. However, the maximal peritoneal to plasma AUC ratio was 461 at the 2 mmol/L dose, but decreased with increasing doses as systemic clearance decreased. This regimen was well tolerated in patients with advanced cancer, but must be evaluated further to determine its clinical efficacy.

Abdominal Neoplasms↗
PubMed1993

Nonvascular emergencies presenting as ruptured abdominal aortic aneurysms.

BACKGROUND: Patients may present with signs and symptoms of ruptured abdominal aortic aneurysm (RAA) but actually have other diseases mimicking RAA. The outcome of these patients has not been reported. METHODS: During the past 10 years, 16 patients presumed to have RAAs were found at operation to have other diseases accounting for the symptoms. Fifteen patients (94%) had abdominal pain, 9 (56%) had a pulsatile abdominal mass, and 7 (44%) were hypotensive on presentation. RESULTS: Ten of the 16 patients had intact aortic aneurysms at surgery; there were no reliable physical signs or diagnostic tests that could discern between RAAs and intact aneurysms with other intraabdominal diseases. Eight patients (50%) died in the perioperative period, including four with widespread metastases, three with overwhelming sepsis, and one with an acute myocardial infarction. None of the 10 patients with aneurysms suffered RAA after emergency laparotomy. Exploratory laparotomy was necessary to treat underlying disease in nine patients and was probably harmful only to the patient with a myocardial infarction. Two survivors with aneurysms underwent successful staged repairs. CONCLUSIONS: Mistaken diagnoses in patients who are suspected of having RAAs on the basis of physical findings are relatively uncommon. Exploratory laparotomies are required to correct the primary disease in most of these misdiagnosed patients. Few die as a direct result of laparotomy; true iatrogenic catastrophes associated with mistaken diagnoses are distinctly uncommon.

Abdominal Neoplasms↗
PubMed2007

[Advanced ovarian cancer with Sister Mary Joseph's nodule--a case report].

A metastatic umbilical tumor,which we call Sister Mary Joseph's nodule (SMJN), is a sign of poor prognosis despite the primary site of malignant tumor. We describe here a patient with an advanced ovarian cancer and SMJN. A 51-year-old woman was referred to our department for evaluation of an umbilical tumor. As a result of systemic examination, the patient was diagnosed as stage IV ovarian cancer and rapidly underwent an optimal operation. Postoperatively, the chemotherapy for advanced ovarian tumors was begun (paclitaxel 180 mg/m(2) and carboplatin AUC 5, 10 courses every 3 weeks). The patient is well without signs of tumor recurrence or metastasis 10 months after the operation. Forty percent of all navel neoplasms are malignant tumors. It is important to perform a pathological examination of a navel neoplasm or a systemic examination as fast as possible.

Abdominal Neoplasms↗