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Extraneural perineurioma: CT and MRI imaging characteristics.
神经外神经周围瘤: CT和MRI影像学特征。
- 影响因子:1.50
- DOI:10.1007/s00256-019-03264-3
- 作者列表:"Broski SM","Littrell LA","Howe BM","Folpe AL","Wenger DE
- 发表时间:2020-01-01
Abstract
OBJECTIVE:To examine the CT and MRI characteristics of extraneural perineuriomas. MATERIALS AND METHODS:With IRB approval, our institutional imaging database was retrospectively reviewed for cases of pathologically proven extraneural perineuriomas. CT and MRI features were recorded, correlative imaging analyzed, and the electronic medical record cross-referenced. RESULTS:We identified ten patients [(seven males, three females, mean age 49.4 ± 18.3 years (range, 16-70 years)]. All cases were pathologically confirmed. Nine cases were conventional soft tissue extraneural perineuriomas, including one with "reticular" features and one with histologic features of malignancy; the tenth case contained admixed Schwann cells (hybrid perineurioma/schwannoma). Six out of ten patients underwent CT and ten of ten MRI evaluation. Nine out of ten MRIs were performed with IV contrast. Five lesions were subcutaneous, four intermuscular, and one intramuscular. Mean lesion diameter was 4.3 ± 2.7 cm (range, 0.9-10.2 cm). Nine out of ten lesions were well circumscribed; one had irregular margins. On CT, five of six were hypodense and one isodense compared to skeletal muscle. Most lesions were T1 isointense (5/10) or hypointense (4/10) and T2 hyperintense (7/10) relative to skeletal muscle, and demonstrated solid enhancement (6/9). There was no evidence of muscular denervation on any MRI exam, and a nerve of origin was identified in two out of ten cases. CONCLUSIONS:Extraneural perineuriomas have a distinctly different imaging appearance from intraneural perineuriomas, manifesting as rounded or ovoid soft tissue masses, without evidence of muscular denervation, and usually without an apparent nerve of origin. Because these features mimic other benign and malignant soft tissue lesions, including sarcomas, biopsy or excision is needed for definitive diagnosis.
摘要
目的: 探讨神经外膜瘤的CT和MRI表现。 材料和方法: 经IRB批准,我们的机构影像学数据库回顾性审查了经病理证实的神经外膜瘤病例。记录CT和MRI特征,分析相关影像,并对电子病历进行交叉参考。 结果: 我们确定了 10 例患者 [(7 例男性,3 例女性,平均年龄 49.4 ± 18.3 岁 (范围,16-70 岁)]。所有病例均经病理证实。9 例为常规软组织外耳神经丛瘤,其中 1 例具有 "网状" 特征,1 例具有恶性肿瘤组织学特征; 第 10 例为混合雪旺细胞 (混合型神经丛瘤/神经鞘瘤)。10 例患者中 6 例接受了CT和 10 例MRI评估。十分之九的mri用IV造影剂进行。5 个病灶为皮下,4 个肌间,1 个肌内。平均病变直径 4.3 ± 2.7厘米 (范围 0.9-10.2厘米)。10 个病灶中有 9 个界限清楚; 1 个边缘不规则。在CT上,与骨骼肌相比,6 个中有 5 个是低密度的,1 个是等密度的。相对于骨骼肌,大多数病变为T1 等信号 (5/10) 或低信号 (4/10) 和T2 高信号 (7/10),并表现为实性增强 (6/9)。在任何MRI检查中没有肌肉失神经支配的证据,10 例中有 2 例发现了起源神经。 结论: 神经外膜瘤的影像学表现与神经内膜瘤明显不同,表现为圆形或卵圆形软组织肿块,无肌肉失神经支配的证据,通常无明显的起源神经。由于这些特征与其他良性和恶性软组织病变相似,包括肉瘤,因此需要活检或切除才能明确诊断。
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METHODS:CONTEXT.—:Standards for pathology reporting of cancer are foundational to national and international benchmarking, epidemiology, and clinical trials, with international standards for pathology reporting of cancer being undertaken through the International Collaboration on Cancer Reporting (ICCR). OBJECTIVE.—:To develop standardized templates for brain tumor diagnostic pathology reporting. DESIGN.—:As a response to the 2016 updated 4th edition of the WHO (World Health Organization) Classification of Tumours of the Central Nervous System (2016 CNS WHO), an expert ICCR committee developed data sets to facilitate reporting of brain tumors that are classified histologically and molecularly by the 2016 CNS WHO; as such, this represents the first combined histologic and molecular ICCR data set, and required a novel approach with 3 highly related data sets that should be used in an integrated manner. RESULTS.—:The current article and accompanying ICCR Web site describe reporting data sets for central nervous system tumors in the hope that they provide easy-to-use and highly reproducible means to issue diagnostic reports in consort with the 2016 CNS WHO. CONCLUSIONS.—:The consistent use of these templates will undoubtedly prove useful for patient care, clinical trials, epidemiologic studies, and monitoring of neuro-oncologic care around the world.
METHODS:OBJECTIVE:To examine the CT and MRI characteristics of extraneural perineuriomas. MATERIALS AND METHODS:With IRB approval, our institutional imaging database was retrospectively reviewed for cases of pathologically proven extraneural perineuriomas. CT and MRI features were recorded, correlative imaging analyzed, and the electronic medical record cross-referenced. RESULTS:We identified ten patients [(seven males, three females, mean age 49.4 ± 18.3 years (range, 16-70 years)]. All cases were pathologically confirmed. Nine cases were conventional soft tissue extraneural perineuriomas, including one with "reticular" features and one with histologic features of malignancy; the tenth case contained admixed Schwann cells (hybrid perineurioma/schwannoma). Six out of ten patients underwent CT and ten of ten MRI evaluation. Nine out of ten MRIs were performed with IV contrast. Five lesions were subcutaneous, four intermuscular, and one intramuscular. Mean lesion diameter was 4.3 ± 2.7 cm (range, 0.9-10.2 cm). Nine out of ten lesions were well circumscribed; one had irregular margins. On CT, five of six were hypodense and one isodense compared to skeletal muscle. Most lesions were T1 isointense (5/10) or hypointense (4/10) and T2 hyperintense (7/10) relative to skeletal muscle, and demonstrated solid enhancement (6/9). There was no evidence of muscular denervation on any MRI exam, and a nerve of origin was identified in two out of ten cases. CONCLUSIONS:Extraneural perineuriomas have a distinctly different imaging appearance from intraneural perineuriomas, manifesting as rounded or ovoid soft tissue masses, without evidence of muscular denervation, and usually without an apparent nerve of origin. Because these features mimic other benign and malignant soft tissue lesions, including sarcomas, biopsy or excision is needed for definitive diagnosis.
METHODS:BACKGROUND:Pineal region glioma is a rare systematically reported tumor in the literatures, and little is known about its behavior, development, and best treatment strategies because of its complex anatomical relationship and rarity. OBJECTIVE:We reviewed the outcomes of patients with pineal region gliomas in West China hospital in the past 5 years and searched the literature to add more information. As a result, key factors related to prognosis are identified. METHODS:Twenty-five patients with pineal region gliomas were selected and information was collected about detailed medical history, imaging data, treatment methods, pathologic results, and latest neurosurgical radiologic progress during follow-up. RESULTS:Pilocytic astrocytomas (20%) and glioblastomas (24%) were the most common pathologic subtypes. Twenty-three patients underwent open surgery, 3 Gamma Knife radiosurgery, and 4 whole-brain radiation therapy. Chemotherapy was applied to 3 patients. Low-grade gliomas tended to have a better prognosis than did high-grade. Karnofsky Performance Status at admission (≤60) was intimately associated with prognosis for low-grade gliomas. As for high-grade gliomas, patients whose age at admission was ≤30 years had a better prognosis than did older patients (>30 years). However, whatever the grade, there was no overall survival difference as to gender, gross total resection versus not gross total resection, preoperative maximal tumor diameter (≤4 vs. >4 cm), and time since first symptoms (≤30 vs. >30 days), and radiation therapy versus no radiation therapy. CONCLUSIONS:Open surgery is the first-line strategy for pineal region gliomas with tolerable mortality and disability rate. Radiosurgery and chemotherapy can be applied as adjuvant or alternative methods when surgery is contraindicated.
神经系统实质细胞来源的原发性颅内肿瘤,位于颅内,但非脑实质细胞由来的原发性颅内肿瘤,转移性肿瘤。