Cystic Lesions of the Gastrointestinal Tract: Multimodality Imaging with Pathologic Correlations

Lee, Jongmee,Park, Cheol Min,Kim, Kyeong Ah,Lee, Chang Hee,Choi, Jae Woong,Shin, Bong Kyung,Lee, Soon Jin,Choi, Dongil,Jang, Kee-Taek The Korean Society of Radiology 2010 KOREAN JOURNAL OF RADIOLOGY Vol.11 No.4

<P>The cystic lesions of the gastrointestinal (GI) tract demonstrate the various pathologic findings. Some lesions may present a diagnostic challenge because of non-specific imaging features; however, other lesions are easily diagnosed using characteristic radiologic features and anatomic locations. Cystic masses from the GI tract can be divided into several categories: congenital lesions, neoplastic lesions (cystic neoplasms, cystic degeneration of solid neoplasms), and other miscellaneous lesions. In this pictorial review, we describe the pathologic findings of various cystic lesions of the GI tract as well as the radiologic features of GI cystic lesions from several imaging modalities including a barium study, transabdominal ultrasound (US), computed tomography (CT), and magnetic resonance (MR) imaging.</P>

우연히 발견된 췌장 낭성 병변에 대한 임상적 접근

이상협 ( Sang Hyub Lee ) 대한소화기학회 2010 대한소화기학회지 Vol.55 No.3

Cystic lesions of the pancreas are being incidentally recognized with increasing frequency and become a common finding in clinical practice. Despite of recent remarkable advances of radiological and endoscopic assessment and a better understanding of natural history of certain subgroups of cystic lesions, differentiating among lesions and making an optimal management plan is still challenging. A multimodal approach should be performed to evaluate incidentally detected cystic lesions. Emerging evidence supports selective nonoperative management for the majority of patients with cystic lesions, but, for those in whom a suspicion of malignancy remains, surgery is indicated. Concerning long-term follow-up, there is limited data to support the ideal modality, intensity, and duration. Therefore, evidence-based guidelines for the diagnosis, management, and follow-up of cystic lesions of the pancreas should be established. (Korean J Gastroenterol 2010;55:154-161)

췌장 낭성 병변의 평가에 있어 다중검출 전산화단층촬영과 자기공명영상의 유용성 비교

문성민,정용연,신상수,박진균 대한영상의학회 2015 대한영상의학회지 Vol.72 No.6

Purpose: To compare the diagnostic performance of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in characterization of pancreatic cystic lesions. Materials and Methods: We conducted a retrospective study on 34 patients with histopathologically proven cystic pancreatic lesions who underwent both preoperative MDCT and MRI. CT and MRI were independently evaluated for differentiating mucinous vs. non-mucinous lesions, differentiating aggressive vs. non-aggressive lesion, analyzing morphological features, and evaluating specific leading diagnoses. Sensitivity, specificity, and accuracy were determined. Competency assessment of lesional morphology analysis was performed using the kappa values of the 2 tests. Results: The sensitivity, specificity, and accuracy of MRI for differentiating mucinous vs. non-mucinous lesions were higher than CT (p = 0.03). For differentiating aggressiveness, the sensitivity of MRI was better than CT, but the specificity of CT was better than MRI. In evaluation of morphologic features, MRI showed better performance in characterization of septa and wall. Otherwise, the 2 modalities showed similarly good performance. MRI was better than CT in determining a specific diagnosis (58.8% vs. 47.2%, respectively). Conclusion: CT and MRI are reasonable diagnostic methods for characterization of pancreatic cystic lesions. However, MRI enables more confident assessment than CT in differentiating mucinous vs. non-mucinous lesions and characterization of the septa and wall. 목적: 췌장 낭성 병변 평가에서 다중검출 전산화단층촬영(multidetector CT; 이하 MDCT)과 자기공명영상(이하 MRI)의 유용성을 비교하고자 하였다. 대상과 방법: 2010년부터 2012년 3월까지 췌장 낭성 병변이 병리조직학적으로 확진된 환자 중 수술 전 MDCT와 MRI 검사를 모두 시행한 34명을 대상으로 후향적 연구를 하였다. 영상 소견 분석은 병변을 점액성과 비점액성 및 침습적과 비침습적 병변으로 분류하였다. 또한 병변 형태 분석과 질환명 진단 및 특정 질환의 진단율을 구하였다. 각각의 항목은 CT와 MRI에서 개별적으로 평가하였다. CT 또는 MRI의 민감도, 특이도 및 정확도를 구하였다. 두 검사의 병변의 형태 분석 역량 평가는 kappa치를 이용하였다. 결과: 점액성과 비점액성 병변 감별에서 MRI의 민감도(0.889), 특이도(0.857) 및 정확도(0.882)가 CT에 비해 높았다(p = 0.03). 비침습적과 침습적 병변 감별에서 민감도는 MRI (0.842 vs. 0.684)가 높았으나, 특이도는 CT (0.667 vs. 0.800)가 높았다. 병변의 형태 분석 항목 중 병변의 중격과 벽에 대한 평가에서 CT에 비해 MRI의 분석 능력이 우수하였다. 그 외의 항목에 대하여 두 방법 간 유의한 차이는 없었다. 특정 질환 진단율은 CT의 경우 47.1%, MRI의 경우 58.8%였다. 결론: CT와 MRI 검사는 췌장의 낭성 병변에 대한 타당한 진단방법이나 점액성 병변의 감별이나 중격과 벽의 평가에 있어서는 MRI가 보다 우수한 방법이었다.

췌장의 낭종성 질환-수술 혹은 경과관찰

방성조 ( Sung Jo Bang ),김명환 ( Myung Hwan Kim ) 대한내과학회 2010 대한내과학회지 Vol.78 No.3

The decision of surgical treatment for pancreatic cystic lesions may mainly depend on the malignant potential of each lesion. Surgical excision is the most optimal treatment for the mucinous cystic neoplasm due to its high malignant potential. On the other hand, intraductal papillary mucinous neoplasm (IPMN) is divided into main duct type and branch-duct type. Main duct IPMN has high risk of malignant transformation. Therefore, surgical resection has been recommended for all main duct IPMN. Branch duct IPMN has relatively low malignant potential, and usually shows slow progression. A branch duct IPMN that is asymptomatic, less than 3 cm in size and without mural nodules may be followed-up without resection. Serous cystic neoplasm is usually benign in nature. Surgical treatment for serous cystic neoplasm should be considered when definitive diagnosis being uncertain, larger than 4 cm in size, or presence of symptoms. Solid pseudopapillary neoplasm also has low malignant potential which needs surgical excision. Surgical treatment for pancreatic pseudocyst is considered in limited cases with complication, such as infection or bleeding, and which is not controlled with non-surgical treatment. Management strategy for pancreatic cystic lesions should be individualized, and the decision to resect or follow-up a lesion should be based on factors such as the presence or absence of symptoms, patient age, cyst size, grading of malignant potential, location of the lesion, and the surgical risk of the patient. (Korean J Med 78:295-300, 2010)

악성 선종과 유사한 자궁경부의 거대 다방성 낭성 종괴

김태희 ( Tae Hee Kim ),이해혁 ( Hae Hyeog Lee ),정수호 ( Soo Ho Chung ) 대한폐경학회 2011 대한폐경학회지 Vol.17 No.2

자궁경부의 다방성 낭성질환은 양성질환부터 악성질환까지 다양하게 발생한다. 자궁경부에 드물게 생기는 악성 선종은 조직학적, 영상의학적으로 양성질환들과 구별하기가 힘들어 매우 주의해야 한다. 경부에 발생하는 양성 낭성 병변들은 나보시안 낭종, 자궁경부염, 터널 클러스터 등을 포함하며 육안으로 감별진단이 어렵다. 특히 악성 선종과의 감별진단은 매우 중요하고 어렵기 때문에 이번 두 증례의 거대 나보시안 낭종을 보고하며 그 접근법과 치료법에 대해 알아보고자 한다. Multilocular cystic lesions in the uterine cervix can vary widely from benign to malignant. Pseudoneoplastic glandular lesions are benign lesions that are often histologically and radiographically confused with adenoma malignum, which is a rare variant of mucinous adenocarcinoma of the uterine cervix. The benign lesions include uterine cervicitis, tunnel cluster, deep endocervical glands, deep nabothian cysts, endocervical hyperplasia, infectious and reactive atypias. It is crucial but difficult to differentiate between an adenoma malignum and the benign cystic lesions. We report two cases of large nabothian cysts mimicking adenoma malignum. Radiologic findings, signs, and symptoms of these cases are described. (J Korean Soc Menopause 2011;17:114-117)

다발성 낭종성 병변을 보인 급성 파종성 뇌척수염 - 증례보고 -

김대원,김태영,김종문,윤기중,Kim, Dae Won,Kim, Tae Young,Kim, Jong Moon,Yun, Ki Jung 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.5

Acute disseminated encephalomyelitis(ADEM) is an uncommon immune-mediated inflammatory demyelinating disorder that typically affects the white matter of the central nervous system. Radiologic findings of acute disseminated encephalomyelitis are not pathognomomic. The differential diagnosis is always difficult. Occasionally, the clinical features, radiological and histopathological findings of patients with acute disseminated encephalomyelitis mimic the brain tumor or other space occupying lesions. The authors report a 6-year-old girl who presented with right hemiparesis two days after nausea and vomiting. Brain MRI of the patient revealed non-enhanced multiple cystic lesions in subcortical white matter of both cerebral hemisphere with prominent edema. One of the cystic lesions was resected to differentiate with metastatic tumor or inflammatory disease such as abscess and confirmed as the acute disseminated encephalomyelitis via various immunohistochemical stains. Pertinent literature is reviewed with discussion on this uncommon ADEM associated with multiple cystic lesions.

Mucocele mistaken for epidermal cyst

( Do Hyeon Kim ),( Bora Lim ),( Chil Hwan Oh ),( Kun Park ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Cystic lesions of oral, facial and neck soft tissues have been defined, described and studied in numerous studies. Cysts of the soft tissues are in general recognized by their clinical appearance, site and symptoms. A 67-year-old man presented with asymptomatic cystic mass on right cheek. The lesion developed 3 years ago and size slightly increased. However there are no symptoms in the oral cavity. The patient had no medication history. We performed excision with suspicion of epidermal cyst. On the histopathological examination, the lesion was diagnosed as mucocele. Mucocele is most common minor salivary gland lesion. Minor salivary glands are found in most parts of the oral cavity except the gingiva. Clinically they are characterized by single or multiple, soft, fluctuant nodule. The development of mucoceles depend on the disruption of the flow of saliva from the secretory apparatus of the salivary glands. Therefore, most mucocele occur in the oral cavity and have intraoral symptoms. However, our case showed only cutaneous symptom. For treatment mucocele, surgical excision of the mucocele along with the adjacent associated minor salivary glands is recommended.Herein, We report a rare case of mucocle on face that was mistaken for epidermal cyst.

증상있는 척추 경막외 기낭성병변: 증례 보고

조병준,이상호,박지영,박현선,윤득희,정승은 대한영상의학회 2006 대한영상의학회지 Vol.54 No.4

Symptomatic spinal epidural gas-containing cystic lesion is a rare clinical disease entity. We recently experienced two cases of symptomatic epidural gas-containing cysts that were the main cause of the patients' radiculopathy and the cysts were removed surgically. These lesions were actually gas containing ruptured disc herniations from the vacuum discs at the same level. We report herein on the radiological findings along with conducting a review of the related literature. 척추경막외 위치한 기낭성 병변에 의한 신경근병증을 보이는 경우는 매우 드물어 아직 정확한 발생기전이 알려져 있지않다. 저자들은 최근 경막외 기낭성 병변에 의한 신경근병증으로 수술하여 진공디스크에서 유래된 파열성디스크로 확인된 두 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

하악 후방에 발생한 낭성 백악질 골화성 섬유종: 증례보고 및 문헌 고찰

전민아,하규봉,유미현,황대석 대한구강악안면병리학회 2021 대한구강악안면병리학회지 Vol.45 No.3

Cemento-ossifying fibroma is a benign fibrous lesion with an unknown cause, mostly asymptomatic, painless swelling of the affected jaw. This is a case report on a cystic lesion found on radiographic examination in a patient with an extraction of mandibular left tooth. A 29-year-old female was referred to Pusan National University Dental Hospital due to a radiopaque lesion in the left mandible. On the medical history examination, the left lower mandibular tooth had been extracted 4 years ago, and there were no specific findings in the general medical history. According to histopathologic findings, along with proliferation of spindle cells, cementum-like substances were observed along with irregularly shaped osseous calcified substances containing osteocytes in the cellular fibrous connective tissue. In this study, we report a case that showed cystic changes due to tooth extraction, which made it complicated to determine the differential diagnosis from the existing fibrous-osseous lesion.

간이식 환자에서의 췌관내유두상점액종양

김관일(Kwan -Il Kim),서경석(Kyung-Suk Suh),김주현(Joohyun Kim),신우영(Woo Young Shin),이남준(Nam-Joon Yi),장진영(Jin-Young Jang),김선회(Sun-Whe Kim),김세형(Se Hyung Kim),이건욱(Kuhn Uk Lee) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.2

Purpose: The incidence and risk of malignancy are elevated in solid organ transplant recipients compared to persons in the general population. Epidemiological data reveal that the length of exposure to immunosuppressive therapy and the intensity of therapy are clearly related to the post-transplant risk of malignancy. The purpose of this study was to investigate the course of incidental intraductal papillary mucinous neoplasms (IPMN) of the pancreas after liver transplantation. Methods: We retrospectively reviewed the medical records of 17 patients with IPMNs of the pancreas who underwent liver transplantation between January 2000 and December 2006. The mean follow-up duration was 29.6 ± 22.8 months. Results: The mean patient age was 55.2 ± 7.2 years, and the male to female ratio was 14:3. All patients had branch duct type IPMNs. The lesions were located principally in the head (64.7%) and body (52.9%) of the pancreas. The mean tumor size was 13.0 ± 6.2 mm. There were no newly developed symptoms associated with these lesions, and none of the lesions enlarged during the follow-up period. No patients underwent surgical resection of their lesions. Conclusion: The course of each of the incidental small IPMNs of the pancreas was uneventful for more than 2 years after liver transplantation. Therefore, patients with incidental small IPMNs of the pancreas are not immediate candidates for surgical pancreas resection. However, a longterm follow-up study with a larger sample size will be required to establish treatment guidelines in immunosuppressed patients.