DX: Tongue Epidermoid Carcinoma

This was obviously a very graphic invasive tumor. It extends to ipsilateral upper maxilla, erodes body of mandible and compress oropharynx giving the patient dyspnea and dysphagia. It has inner liquid densities so abcsess could not be discharched although image characteristics are variable. The relevant findings are described below:

Biopsy revealed:  Epidermoid Carcinoma of the base of the tongue.

The epidermoid or squamous cell carcinoma is the most common malignant neoplasm of the oral cavity; males are more commonly affected, its mayor incidence being after the fourth decade. It presents in various forms: an ulcerated lesion, sometimes covered with a bloody scab; or a vegetative or wart-like growth which may reach a great size and may ulcerate and bleed or suffer partial necrosis, thus modifying its aspect. Upon palpation, this lesion usually has everted borders and indurated, infiltrated base. 

They are of variable size, from a few millimetres to a few centimetres. Initially they cause no pain, so the patient rarely seeks professional help. The risk factors and potentially malignant lesions are determining factors in the development of oral cancer.

Thank you for your comments..they are all welcome..

CASE 17: Elderly lady with a mandible mass

Patient has history of an irregular-growing, painful mass that alters face symmetry and protrudes tongue. At present time she experiences fever, nausea, dysphagia, and progressive weight loss.

CASE 16: Fetal MRI for abnormal US finding / Differentials are given

This case was provided by Dr. Marco Cabrera at Tecniscan Diagnostic Center. Was reffered because of a mass  in prenatal ultrasound. Images are pretty obvious so let's ask us these questions:

Is it normal or abnormal?

What is the radiologist recomendation?

 

NOTE:
This obviously has no final diagnosis yet because patient is still pregnant, so I'll give only differentials.

There is a cystic abdominal mass above urinary bladder..

DD: Mesenteric Cyst, Ovarian Cyst, Urachal Cyst.

The question was if diagnosis could alter perinatal management and it does. Even if in-utero treatment options are rare in Guatemala we need to exclude normal variant from a truly mass.  This has benign characteristics...thank you for your FB comments on Radiology Resident Group and COBRA.

DX: Heterotopic pregnancy with tubal rupture by ectopic embryo

This is the continuation of the case, here are the pictures:

Gross path specimen (ectopic embryo):

Correlation:

A heterotopic pregnancy is a rare complication of pregnancy in which both extra-uterine (ectopic pregnancy) and intrauterine gestation occur simultaneously.

Synonyms: Combined ectopic pregnancy, simultaneous intra‑ and extrauterine pregnancy, coexistent intra- and extrauterine pregnancy, multiple‑sited pregnancy, coincident pregnancy, concomitant intrauterine and extrauterine pregnancy.

Prevalence: 0.6‑2.5:10,000 pregnancies. There is a significant increase in the incidence of heterotopic pregnancy in women undergoing ovulation induction. An even greater incidence of heterotopic pregnancy is reported in pregnancies following assisted reproduction techniques such as In Vitro Fertilization (IVF) and Gamete Intra‑Fallopian Transfer (GIFT).

The normal implantation of a fertilized ovum within the uterine cavity and an abnormal implantation of a fertilized ovum outside the uterine cavity.

In the general population the major risk factors for heterotopic pregnancy are the same as those for ectopic pregnancy. For women in an assisted reproductive program there are additional factors: a higher incidence of multiple ovulation, a higher incidence of tubal malformation and/or tubal damage, and technical factors in embryo transfer which may increase the risk for ectopic and heterotopic pregnancy.

Differential diagnosis: Normal intrauterine pregnancy, a normal intrauterine pregnancy and a ruptured ovarian cyst, a corpus luteum, or an appendicitis.

Prognosis: The prognosis for the extrauterine fetus is very poor, having an estimated 90‑95% mortality rates. The mortality rate for the intrauterine pregnancy is approximately 35%.

Management: Surgical removal of the ectopic gestation by salpingectomy or salpingostomy. Expectant management has been successfully applied in select cases. Successful salpingocentesis has also been reported.

Thank you for your comments..

CASE 15: 38 y/o lady with acute pain in right illiac fossa

As I said in older posts, with only the clinical history we can approach to a diagnosis, at least differentials. This one is easy I guess. Here are the ultrasound images:

Differentials?..later I´ll post the conclusion and surgery images