Pituitary Adenomas

Pituitary adenomas arise from epithelial pituitary cells and account for 10-15% of all intracranial tumors. Tumors exceeding 10 mm are defined as macroadenomas, and those smaller than 10 mm are termed microadenomas. Most pituitary adenomas are microadenomas.
Pituitary imaging is important in confirming the diagnosis of pituitary macroadenoma and also for determining the differential diagnoses of other sellar lesions.
CT scanning is better at depicting bony structures and calcifications within soft tissues than either plain x-ray films or MRI. Differential diagnoses of tumors with calcification, such as germinomas, craniopharyngiomas, and meningiomas, are better determined with CT scanning. CT scans are valuable when MRI is contraindicated, such as in patients with pacemakers or metallic implants in the brain or eyes.
MRI the modality of choice for pituitary imaging because it provides better visualization of soft tissues and vascular structures. No exposure to ionizing radiation occurs. At least a 1.5-T magnet should be used for MRI of the pituitary.
The goal of treatment is complete cure. When this is not attainable, reducing tumor mass, restoring hormone function, and restoring normal vision are attempted using medications, surgery, and radiation. Pituitary macroadenomas often require surgical intervention for cure. The exceptions to this rule are the macroprolactinomas, which usually have an excellent response to medical therapy. Medical treatment can play a role in reducing tumor size, controlling hormonal excess, or correcting hormonal deficiency. Transsphenoidal surgery is the approach of choice. Only about 1% of patients require a transcranial approach. Compared to remission rates of 90% in microadenomas, macroadenomas with significant extrasellar extension have remission rates of 15-37% when treated with surgery alone. Radiation therapy and medical treatment often complement surgery.

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Bronchial Adenoma

Alternative Names - Bronchial gland tumors; Mucous gland adenoma; Bronchial carcinoid tumors; Mucoepidermoid carcinoma; Cylindroma
Definition - A bronchial adenoma is a type of tumor in the windpipe (trachea) or large airways of the lung (bronchi) that usually blocks the airway. Although the term bronchial adenoma was once used to refer to noncancerous (benign) airway tumors, these tumors (with the exception of mucous gland adenomas), are now known to spread to other areas of the body.
Symptoms - Bloody sputum, Cough, Wheezing, Recurrent pneumonia, Slowly resolving pneumonia, Collapse of a lung lobe or segment, Cough lasting more than 6 weeks and
rarely Skin blushing/flushing
Exams and Tests - Bronchoscopy, Chest x-ray and CT scan
Treatment - Removing the tumor with surgery or endoscopy is the standard treatment.
Outlook (Prognosis) - Surgery usually results in a complete cure. The ability of these tumors to spread can vary, but most have a good prognosis when removed with surgery.

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Multicystic Dysplastic Kidney

Multicystic dysplastic kidney (MCDK) is a congenital maldevelopment in which the renal cortex is replaced by numerous cysts of multiple sizes. A dysplastic parenchyma anchors the cysts, the arrangement of which resembles a bunch of grapes. The calyceal drainage system is absent. Typically, MCDK is a unilateral disorder, the bilateral condition is incompatible with life. Furthermore, MCDK with contralateral renal agenesis does not support life. MCDK can be an incidental finding. They show the typical multicystic appearance of MCDK with little or no parenchyma.Cyst wall calcification may be seen.If a contrast-enhanced CT is performed, there is no excretion seen.The management of MCDK is a controversial topic. Routine nephrectomy is not indicated at this time.Surgery is indicated in patients with symptomatic MCDK, suspicious enlargement, hypertension, mass effect, pain, or infection

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Tarlov's Cysts

Tarlov's cysts are located in the perineural space, between the endo-and perineurium at the junction of the posterior nerve root and its ganglion. These lesions either surrounded the entire nerve root or invaded it and became surrounded by compressed nerve fibers. Regardless of the nomenclature or classification system, the defining feature of Tarlov's perineural cyst is the presence of spinal nerve root fibers within the cyst wall or within the cyst cavity itself.The authors of one study found that patients with Tarlov cysts greater than 1.5 cm and with associated radicular pain or bowel/bladder dysfunction benefited most from surgery.

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Medullary Sponge Disease

MSK is characterized by ectasia and cystic formation in the medullary collecting duct. This characterization contrasts with autosomal recessive polycystic kidney disease and with autosomal dominant polycystic kidney disease, in which cysts predominantly develop along the cortical collecting tubule or the entire nephron, respectively.Medullary sponge kidney may be part of other syndromes and conditions such as Beckwith-Wiedemann syndrome (BWS), hemihypertrophy, Caroli disease, Ehlers-Danlos syndrome, Marfan syndrome, and pyloric stenosis.Intravenous pyelography demonstrates radial, linear striations in the papillae or cystic collections of contrast material in ectatic collecting ducts. The result is a characteristic blushlike pattern to the papillae, the so-called "bouquet of flowers" or "paintbrush" appearance. Renal ultrasonography and CT scanning show the collections of calculi and distinguish MSK from papillary necrosis or autosomal dominant polycystic kidney disease.

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Scleroderma - Thoracic manifestations

This 47 year male patient had cardiomegaly, pericardial effusion, dilated oesophagus and secondary idiopathic pulmonary fibrosis. Scleroderma is a chronic disease characterized by excessive deposits of collagen in the skin or other organs. The localized type of the disease, while disabling, tends not to be fatal. The systemic type or systemic sclerosis, the generalized type of the disease, can be fatal as a result of heart, kidney, lung or intestinal damage.Some impairment in lung function is almost universally seen in patients with diffuse scleroderma on pulmonary function testing.Scleroderma can decrease motility anywhere in the gastrointestinal tract.[5] The most common source of decreased motility involvement is the esophagus and the lower esophageal sphincter, leading to dysphagia and chest pain.

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Giant Sigmoid Diverticulum

Giant sigmoid diverticulum is unusual, with only 103 cases previously reported in the world literature.These lesions probably arise as pseudodiverticula of the sigmoid colon with herniation of the mucosa through the muscle wall. The flap-valve mechanism with fibromuscular hyperplasia at the diverticular orifice seen by the pathologist confirms how this giant colonic diverticulum probably developed.All patients with giant sigmoid diverticula are generally elderly, with an age range of 40 to 90 years. The 19% complication rate associated with giant sigmoid diverticulum is relatively high.They are best treated by resection of the diverticulum, in continuity with the involved sigmoid, and primary anastomosis.

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