Showing 3 Abstracts.
A 17-month-old female presented with a one-month history of abnormal soft tissue protruding from the vaginal introitus. The patient’s past medical history was significant for hemi-hypertrophy of the left lower extremity. Physical examination demonstrated normal external genitalia, with pink solid tissue protruding from the vagina posterior aspect, and mild associated white fluid discharge. Laboratory analysis revelaed a normal CBC, serum HCG and AFP. An ultrasound examination of the pelvis demonstrated a heterogeneous echogenicity soft tissue mass with scant internal vascularity centered in the vagina and cervix, measuring approximately 4.0 x 2.3 x 2.5 cm. The patient’s clinical and imaging findings were most concerning for malignancy, namely vaginal rhabdomyosarcoma, so consultation was requested from Pediatric Surgery and Oncology. As a result of these consultations, the patient was scheduled for vaginoscopy with biopsy under general anesthesia, as well as surgical port placement due to the high suspicion for malignancy. Also to be performed under the same anesthetic was a CT examination of the chest and MR examination of the pelvis. Vaginoscopy revealed a “pebbly appearance” of the vaginal walls, which also reportedly “felt thickened” on digital exam. Multiple surgical biopsy specimens were obtained from the visibly abnormal areas. MR examination immediately post biopsy showed circumferential mural thickening of the cervix and vagina, with a more prominent area of soft tissue thickening at the level of the vaginal introitus. The areas of mural thickening appeared T1 and T2 signal isointense with mild post-contrast enhancement and no evidence of abnormal restricted diffusion. No focal mass was identified. CT examination of the chest was normal. Histopathologic analysis revealed a benign lesion composed of a relatively small number of spindle cells embedded in a loose fibrous stroma. No significant numbers of mitoses or atypia were observed, including in the lining squamous epithelium. These features were most consistent with a fibroepithelial stromal polyp. In light of the pathology findings, the port implant was removed, and the patient has since undergone surveillance vaginoscopy examinations. This case illustrates MRI findings of a rare benign condition which may mimic vaginal rhabdomyosarcoma on the basis of clinical and ultrasound findings. MRI demonstrating an absence of aggressive features may help to suggest this rare differential consideration. Read More
Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016
Authors: Green Jared, Jaju Alok, Richard Jamie
Branchial apparatus anomalies (BAA) due to aberrations in the development and involution of the branchial apparatus can present as a cyst, fistula, or sinus tract. Definitive treatment for a BAA is complete surgical excision. The embryology of BAA has been well described, but few reports in the published literature discuss optimally imaging these patients. The purpose of this study is to describe the CT and MR imaging findings of BAA, and to correlate the imaging findings with surgery and pathology results. The goal is to develop a standardized imaging approach and search pattern specific to each subtype of BAA that would answer the most pertinent clinical questions for surgical planning. Read More
Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016
Authors: Neveu Melissa, Jaju Alok, Ryan Maura, Maddalozzo John
Keywords: Branchial Apparatus Anomalies
This review describes the CT and MRI features of developmental variants and pathological lesions that involve the skull base, excluding those centered in the nasal cavity, nasopharynx, sinuses and orbits. Normal anatomy of developing bony skull base will be illustrated. The lesions are categorized by pathology rather than locations, and the following entities will be covered. Congenital and developmental lesions - arrested pneumatization, aberrant arachnoid granulations, dermoid/epidermoid cysts, ecchordosis physaliphora, encephaloceles, persistent craniopharyngeal canal Inflammatory/Infectious lesions - skull base osteomyelitis, petrous apicitis, cholesterol granuloma Benign lesions - Fibrous dysplasia, aneurysmal bone cyst, osteoma, osteochondroma, meningioma Malignant lesions - Langerhans cell histiocytosis, lymphoma, neuroblastoma metastasis, Ewing’s sarcoma, osteosarcoma, chordoma, chondrosarcoma Read More
Meeting name: SPR 2019 Annual Meeting & Postgraduate Course , 2019
Authors: Masum Rukya, Dixon Chanae, Ryan Maura, Jaju Alok
Keywords: Skull base, Pediatrics, skull base lesion