Sinonasal hemangiopericytoma

Findings

Figure 1 and Figure 2: There is an enhancing mass in the nasal cavity (Figure 1) with involvement of left sphenoid sinus and bony destruction (Figure 2).
Figure 3 and Figure 4: Sagittal and axial postcontrast T1WI images show avid enhancement of the sinonasal tumor highly suggestive of a vascular tumor. No definite evidence of invasion to the base of skull is seen.
Figure 5: Left ECA injection shows a vascular blush corresponding to the mass seen on MRI.


Diagnosis: Sinonasal hemangiopericytoma


Hemangiopericytomas are rare soft-tissue tumors originating from extravascular cells (pericytes). They can arise from any part of the body but occur most frequently in the skeletal muscles. Approximately 15 to 30% of all hemangiopericytomas occur in the head and neck; of these, approximately 5% occur in the sinonasal area.

They demonstrate greater than 50% local recurrence and 10% metastatic disease although sinonasal lesions are less aggressive. Sinonasal hemangiopericytoma usually affects both middle-age males and females equally. It occurs in the nasal cavity more often than paranasal sinuses. When it does involve the sinuses, it occurs in the ethmoid and sphenoid sinuses four times more often than it does in the maxillary sinuses.

These lesions typically have a benign course and enlarge slowly over a period of months or years. Symptoms include nasal and sinus obstruction, intermittent epistaxis, and possibly ophthalmologic findings if there is involvement of orbits.

Clinical history and imaging findings are usually not sufficient for diagnosis and tissue diagnosis is needed. However, CT can demonstrate sinonasal mass which is usually enhancing. CT is particularly helpful in evaluation of adjacent bony destruction. On MRI, these tumors appear as solid masses with isointense signals on T1WI with diffuse enhancement after contrast injection. They are isointense to hypointense on T2WI. MRI is of great value in differentiating tumor from inflammatory fluid and demonstrating tumor extension to the base of the skull. Conventional angiography is the best method to demonstrate the vascular supply to the tumor in order to plan for preoperative embolization.

Treatment options are wide local resection or endoscopic resection. Preoperative embolization is usually necessary to avoid excessive bleeding especially prior to endoscopic resection. Radiation therapy has been used both for palliation and adjuvant therapy but there is not sufficient data to compare the results with surgical resection alone.

Contrast agent for blood flow approved by FDA

"The U.S. Food and Drug Administration today approved Vasovist Injection (gadofosveset trisodium), the first contrast imaging agent for use in patients undergoing magnetic resonance angiography, or MRA, a minimally invasive test for examining blood vessels."

Reference-

FDA Approves First Imaging Agent To Enhance Scans Of Blood Flow - Helps Detect Possible Blood Vessel Problems. Medical News Today

Cancer risk from cardiac CT

"Scientists have found evidence that the risk of cancer from exposure to radiation during computed tomography for cardiovascular disease has been overstated. Radiology and cardiovascular researchers from the Medical University of South Carolina in Charleston, S.C., also said that the new estimates are several times lower than previously published conclusions. In earlier studies, many scientists claimed that the risk of cancer from radiation exposure during CT for cardiovascular disease was approximately 1 in 114, but the new study suggests that the risk is 1 in 1000."

The findings of the study were presented at the annual meeting of the Radiological Society of North America in Chicago.

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Mike Rowe

You all probably recognize rugged and handsome Mike Rowe from the show "Dirty Jobs" on the Discovery Channel.

Well, what you may not have known is that Mr. Rowe was previously professional singer with Baltimore Opera Company and a host on the QVC network! There are many YouTube clips of him taking calls on QVC while selling porcelain dolls and lava lamps....

Mr. Rowe apparently did a lot of voice over work, including a alleged narration for the "Wunder Boner" infomercial. I thought it was a fake product too, but it's real AND it's still sold today in outdoors shops! I can't help but giggle when the chubby man says "My wife would like that!"

A First Day of the Year

I don't usually have any visitor at home on New Year's Day, except for some nephews (exactly 12 of them), a few Uncles and Aunts (exactly 8 of them), my godchildren (exactly about...hmmm...9 of them, I think), and some friends and well-wishers (numbering about 10-20).

In the early morning of January 1, after all the smoke of firecrackers and whistle bombs had settled onto the ground as dust and smog, I woke up feeling lucky that I still have all my ten fingers intact, despite the fact that I didn't light a single whistle bomb, last night. Okay, I did light some Luces, but very small enough not to hurt even a small bird, let alone a fully-matured finger. Some people were not so lucky though, as they will welcome the New Year with fewer digits in their hands.

I was also glad and thankful to the Lord that I survived the hail of bullets sprayed into the air last midnight by some unlawful elements of society trying to celebrate the coming New Year by their unique and deadly way. But some people were not so fortunate. There were six reported victimized by stray bullets right on New Year's Eve.

Anyway, come New Year and there's my visitors coming and going out of the secluded privacy of my home. Thankfully I made some nice food preparations for all of them. Or to make it more truthfully, I pre-ordered them from restaurants or have them cooked by my mother: Spaghetti, Macaroni Salad, Biko, and Leche Plan. After all the visitors were gone, my kitchen looks like a devastated casualty of Hurricane Katrina. Mess all around. Thankfully all of them are paper plates and disposable spoons and forks, and they happily made their way to the trash bin afterwards.

There are more food and sweets in the refrigerator, threatening to kill me with High Blood, Stroke, Heart Attack and Diabetes. I already have a friend who got stroke last Christmas, but thankfully he survived, although his left side of the body was paralyzed. I wish he'll get well very soon.

Anyway, to escape raiding the refrigerator once more, I decided to walk around and exercise my legs to help reduce the amount of calories I punished my body for the past holiday celebrations. But where to go? Malls are open but the stores inside them are closed. So I just decided to walk where it's best to walk: Manila Bay.

It was already late in the afternoon when I arrived at the Baywalk. As usual, a lot of people are spending quality time with their loved ones in the beautiful seaside--just hanging around, small talk, eating left-overs of the last night's feast, and viewing the lovely Manila bay sunset. Me, well, I just enjoyed the cool breeze of air, and the sights I see around: the lovers, the vendors, whole families having picnics, and even some homeless people trying to sleep the New year out of their minds.

I took some photos too, not for anything, but just to capture away the mood of what it's like to be at the Manila Bay on the very first day of the New Year.

Hello 2009!

Malate Church, a few blocks away from the Manila Bay

Hugging the light

Caught in the act using Maximo Soliven's typewriter

I wonder if they don't fall over the breakwater. Some sharp rocks are below that wall.

Yahoo!

Happy New Year Everyone! Here's to a wonderful 2009! I have been shocked again by interests of internet users throughout the world. Yahoo has released the list of top searches for 2008, and they are awesome. The list includes:

10. American Idol

9. Angelina Jolie

8. Lindsay Lohan

7. Naruto (Some Sort of Anime Cartoon)

6. Jessica Alba

5. RuneScape (Some Sort of Online Game)

4. Miley Cyrus

3. Barack Obama

2. World Wreslting Entertainment

1. Britney Spears

Really? I'm not really shocked that more people searched for Britney Spears more than the recent President Elect of the United States of America, with her craziness and her new album and all. But more people searched for World Wrestling Entertainment than for Barack Obama? I could understand if they election was only focused on by the media for a couple months during 2008, but that wasn't the case! There has been election coverage since late 2007!

By the way I hope you appreciate the tedious task that I pushed myself to complete. I had to spend many, many minutes searching through multiple photos of Jessica Alba, Angelina Jolie, Lindsay Lohan, Miley Cyrus and Britney Spears, just to find good pictures for all of you.

One more fun thing. Go to www.Yahoo.com, and click on the exclamation point in the logo to hear the name of my mother-in-law's favorite mexican restaurant.

Jugular foramen schwannoma

Findings

Post gadolinium axial T1 weighted images demonstrate homogenous enhancement of a dumbbell-shaped mass in the left cerebellopontine angle cistern extending through and widening the jugular foramen. There is anterior displacement of the left internal carotid artery. The inferior portion of the mass lies directly external to the left hypoglossal canal. There is mass effect intracranially on the medulla and extracranially on the left jugular vein.
Coronal T2 weighted images demonstrate a hyperintense dumbbell shaped lesion at the inferior aspect of the left CPA extending through and widening the left jugular foramen. Intracranially, there is mass effect on left caudal brainstem. Extracranially, the inferior portion of the mass lies exterior to the opening of the left hypoglossal canal and also exerts mass effect on the contents of the carotid sheath.
Post contrast coronal T1 weighted images show decreased size of the left tongue, with associated increased signal, compatible with atrophy and fatty replacement.

Differential diagnosis for a jugular foramen mass:
- Schwannoma
- Paraganglioma
- Meningiomas
- Lymphoma
- Metastatic disease.


Diagnosis: Jugular foramen schwannoma


Jugular foramen schwannomas arise from schwann cells that form the myelin coating of peripheral axons. They most often occur in the third to fifth decades of life and are more commonly seen in females. These tumors may involve cranial nerves IX-XI. Most commonly, cranial nerve IX is involved. These tumors can remodel the temporal bone and extend into the posterior cranial fossa, possibly producing mass effect on the brainstem and cerebellum. Some tumors may extend below the skull base. The presenting symptoms depend on tumor growth pattern. Symptoms may include hearing loss due to the close proximity of the jugular foramen to the internal auditory canal. As a result, jugular foramen schwannomas can be confused with the more common vestibular schwannoma. Similarly, there may be symptoms referable to CN XII, as in this case.

As seen with other schwannomas, jugular foramen schwannomas are isodense or hypodense to cortex on CT. They demonstrate low signal intensity on T1 weighted images and high signal intensity on T2 weighted images. There is strong enhancement that is typically homogenous, but may demonstrate increasing heterogeneous enhancement with larger lesions. These lesions enhance less intensely than paragangliomas, although without the rapid washout which may be seen in paragangliomas.

Paragangliomas are a form of neuroendocrine tumor that arise from glomus cells. Glomus cells are chemoreceptive organelles found along blood vessels and are involved in blood pressure regulation and flow. Although generally rare, a common location for paraganglioma in the head is the jugular foramen (glomus jugulare). This entity will cause an erosive appearance to the expanded jugular foramen, as opposed to the smooth remodeling seen with the less locally aggressive schwannoma (best appreciated on CT). Paragangliomas also typically demonstrate intense enhancement and flow voids. If MR and CT are equivocal, nuclear scintigraphy (octreotide) may be used to confirm a paraganglioma. Primary jugular foramen meningiomas may have a characteristic dural tail and lack flow voids. Treatment is surgical resection with a varying approach based on the location and extension of the tumor.