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Aim: To conduct a multi-lesional computed tomography (CT) analysis of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) patients to determine volumetric changes in lesions over 5 years., Materials and Methods: A retrospective case-note review was undertaken to identify 16 patients with histological and radiological features of DIPNECH between 2012-2021. Area and volume were calculated for 17 sets of lesions identified on high-resolution CT. Clinical data were extracted from electronic patient records, which included demographic data, outpatient clinic letters, histology reports, and imaging reports., Results: One hundred and twenty-eight lesions were identified in 16 patients (one male, 15 female) and followed-up annually over a median 1,985 days (range 1,450-2,290). At year 1 follow-up, lesion area ranged from 1-48 mm 2, and lesion volume ranged from 8-18,380 mm 3 ; lesion area ranged from 1-45mm 2 and lesion volume ranged from 11-17,800 mm 3 and year 5. Half (8/16) of the patients had concomitant typical carcinoid tumours and one patient had an atypical carcinoid tumour. No statistically significant correlation (p<0.05) was found between lesion cross-sectional area or volume and duration of follow-up (years and days). No metastatic spread was observed at the time of analysis., Conclusions: No significant increase was observed in the size of over 100 lesions in patients with DIPNECH over a 5-year period and no metastasis occurred during the study period affirming the relatively indolent course of the disease., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: To review histologically confirmed diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) cases and carry out a detailed pathological-radiological correlation to see if computed tomography (CT) can be used to confidently identify DIPNECH., Materials and Methods: Twenty-three histologically confirmed DIPNECH patients in the shared database of two NHS Trusts were reviewed. CT images were reviewed by two independent radiologists, each of them with >10 years of experience in thoracic imaging. All histological specimens were reviewed by a single pathologist with >25 years of experience. The diagnosis of DIPNECH was made according to the current World Health Organization (WHO) definition included in the WHO 2015 classification of pulmonary tumours. The results on histology were compared to the presence of nodules and air trapping on CT. Demographic information and, when available, molecular imaging studies and pulmonary function tests were also considered., Results: There are prototypal clinical and radiological findings reflecting the presence of underlying histological DIPNECH: middle-aged women with multiple small and scattered nodules due to the clustering and proliferation of neuroendocrine cells. At least one larger, dominant, lung nodule reflecting a carcinoid tumour is very common and mosaic attenuation/air trapping is seen approximately in 50% of cases in inspiratory scans. Airflow obstruction is rarely associated with histological bronchial or peribronchial fibrosis, which suggests other mechanisms must be involved in its development., Conclusion: CT can be used to predict pathological DIPNECH in the appropriate clinical setting. It is important to consider DIPNECH to avoid overdiagnosis of more sinister conditions such as lung cancer or metastases., (Copyright © 2023. Published by Elsevier Ltd.)

Aim: To observe the morphological changes of bronchovascular bundles within subsolid nodules on high-resolution (HR) computed tomography (CT) and analyse the correlation with the new adenocarcinoma classification., Materials and Methods: Two hundred and sixteen lesions (absent consolidation on mediastinal window) were reviewed retrospectively. CT features including dimensions, contour, morphological changes of the blood vessels, and bronchi/bronchioles, vacuole signs, and their correlation with histopathology were evaluated., Results: Excluding nine non-cancerous lesions, 34 pre-invasive lesions (PILs) including 15 atypical adenomatous hyperplasias (AAHs) and 19 adenocarcinomas in situ (AISs), 21 minimally invasive adenocarcinomas (MIAs), and 152 invasive adenocarcinomas (IACs) were analysed. Lepidic, acinar, and papillary patterns were identified in this cohort of adenocarcinomas. IACs were grouped into three types: type I (lepidic pattern ≥80%, n=47), type II (lepidic pattern ≥50%, <80%, n=67), and type III (lepidic pattern <50%, n=38). The contour of lesions, and morphological changes in vessels and bronchi/bronchioles significantly correlated with the classification of PIL, MIA, and IACs (p=0.000, p=0.000, and p=0.017, respectively). In IACs, the prevalence of vascular abnormalities on HRCT significantly correlated with (p=0.000) the proportion of non-lepidic pattern (23.40% in type I, 58.21% in type II, and 76.32% in type III); the prevalence of bronchial/bronchiolar abnormalities was higher (p=0.008) in type II/III (20.95%) compared with type I (6.38%)., Conclusions: The morphological changes of vessels and bronchi/bronchioles within the subsolid nodules on HRCT help to differentiate IAC from PIL and MIA, and are more common in non-lepidic predominant adenocarcinomas., (Copyright © 2017. Published by Elsevier Ltd.)

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is an under-recognized disease characterized by proliferation of neuroendocrine cells in the bronchial wall. It is considered a pre-invasive lesion for lung carcinoid tumours and is found in 5.4% of patients undergoing surgical resection for lung carcinoid tumours. Other manifestations of DIPNECH include bronchial obstruction and formation of tumorlets. DIPNECH preferentially affects middle-aged women. Patients are either asymptomatic or present with long-standing dyspnoea due to obstructive syndrome that can be mistaken for asthma. At CT, mosaic attenuation with multiple small nodules is very suggestive of DIPNECH. The aim of this review is to describe DIPNECH-related CT features and correlate them with histology, in order to help radiologists suggest this diagnosis and distinguish DIPNECH from other causes of mosaic perfusion., (Copyright © 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Aim: To review the imaging features on mammogram and ultrasound of pseudoangiomatous stromal hyperplasia (PASH) of the breast., Materials and Methods: A systematic search of the breast cancer screening centre and pathology department database at a teaching hospital was performed to identify cases reported as PASH between 2000 and 2007. The findings on mammogram and ultrasound were reviewed. Information on demographics and clinical outcome were obtained from the patient's medical records., Results: Seventy-three cases of PASH were identified, which occurred in women with a mean age of 51.1 +/- 10.5 years. The mean size of the lesion was 18 mm. Up to 70.8% of cases were radiologically detected and 29.2% presented as palpable masses. The most common appearance on mammography was of a solitary, non-calcified mass (30.4%) or localized increased stroma (30.4%). The distribution of mammographic findings differed in screen-detected patients compared with those presenting clinically (p = 0.015, Fisher's exact test). The most frequent sonographic appearance was of a well-defined hypoechoic mass (36.7%)., Conclusion: Although there are emerging patterns associated with PASH on imaging, the features are not sufficiently specific to allow for a prospective diagnosis. Histological confirmation, preferably with core biopsy, should always be considered., (Copyright 2009 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Aim: Nodular regenerative hyperplasia (NRH) and large regenerative nodules (LRN) are distinct types of hepatocellular nodules that have been confused in the radiology literature. However, distinction is critical because their clinical significance is quite different. Our purpose was to review the clinical and imaging findings in a series of patients with NRH and LRN in order to identify distinguishing clinical and imaging features., Materials and Methods: This was a retrospective case series. The clinical and imaging features were compared in 36 patients with pathological proof of NRH and 23 patients with pathological evidence of LRN., Results: NRH and LRN have different predisposing factors and imaging findings. NRH is often associated with organ transplantation, myeloproliferative disease, or autoimmune processes. Livers with NRH typically do not have enhancing nodules; none of the present patients with NRH had enhancing liver masses. In contrast, LRN are often associated with Budd-Chiari syndrome. Enhancing liver masses were noted in 19 (83%) of the 23 patients with LRN. The p values for the comparisons were less than 0.001 for both enhancing liver masses and hepatic vein thrombosis., Conclusion: NRH and LRN can have distinct clinical presentations and imaging appearances. LRN often result in enhancing liver nodules, whereas NRH usually does not. Clinical and imaging information enables the distinction of LRN and NRH in many cases.

Objective: To access concordance between radiological severity of aphthae and the more advanced features of Crohn's disease., Patients and Methods: In 75 patients with an established diagnosis of Crohn's disease, we evaluated the radiological severity of colonic aphthae by meticulous double-contrast radiography. The degree of aphthae was defined as follows: AE0 = no lesions; AE1 = small nodules without barium flecks (lymphoid hyperplasia); AE2 = minute barium flecks < or = 1 mm in size with a translucent halo (umbilical or eroded lymphoid hyperplasia); AE3 = barium flecks varying from 2 mm to 5 mm in size (typical aphthoid ulcerations). We compared the degree of the lesions to the disease activity, and reviewed these sequential changes during a mean interval of 10 months., Results: AE3 lesions were more prevalent than AE1 or AE2 lesions in patients with active colitis. AE1 or AE2 lesions were found regardless of the involved bowel sites or the disease activity. Of 44 patients receiving a nutritional diet, 26 patients showed regression of the lesions although most of the patients still exhibited AE1 or AE2 lesions. In two of eight patients without the treatment, the lesions progressed., Conclusion: In Crohn's disease, development of aphthoid ulcers is associated with disease activity; lymphoid hyperplasia may exist independently of disease activity.

In the first round of the National Health Service Breast Screening Programme, 35,533 women attended for screening at the two breast screening units served by St Bartholomew's Hospital. Further assessment was necessary in 2212 women (6.2%), of whom 412 (1%) subsequently underwent surgical biopsy. Of these 137 had benign lesions. The predominant mammographic abnormality leading to biopsy was microcalcification in 55, a mass in 48, parenchymal asymmetry in 18 and architectural distortion in 16. Histology revealed fibrocystic change in 66, fibroadenoma in 27, radial scar/complex sclerosing lesion in 23, atypical ductal hyperplasia only in eight, and a variety of unusual benign lesions in 13. In an attempt to determine criteria which would minimize unnecessary biopsy of benign lesions in future, the mammographic and cytological features of these benign lesions were reviewed and compared with the final histology. The most common diagnostic problems were clustered and variable microcalcification, the radial scar/complex sclerosing lesion, and mammographic features shown to be atypical hyperplasia on histology.

The aim of this study was to test the hypothesis that diffuse non-metastatic enlargement of the adrenal glands occurs in patients with malignant disease. Measurements of the adrenal glands were obtained from computed tomographic (CT) images in two groups of patients with malignant disease (47 patients with lymphoma and 144 patients with other primary tumours) and a control group consisting of 55 patients without malignant disease. Patients with conditions known to affect the adrenal glands were excluded. Adrenal glands with focal mass lesions, as judged by CT, were also excluded. The following measurements were obtained: the maximum width perpendicular to the long axis of the gland; and maximum width of the medial and lateral limbs. There was a statistically significant difference in all measurements between the control group and the groups with lymphoma and other tumours. No significant difference was demonstrated in the size of the adrenal glands in patients with different stages of malignancy. We have shown that the adrenal glands are enlarged in patients with malignant tumours, including lymphoma. We believe that this enlargement is due to adrenal hyperplasia rather than to metastatic neoplasm.

Two cases of localized unilateral increase in mammographic density are described in women who had commenced hormone replacement therapy (HRT) just before or within several weeks of their first normal screening mammogram. The increase in density at a subsequent screen required recall to an assessment clinic to exclude cancer in the affected breast. The relationship of HRT to mammographic density is discussed.

This study analyses 7 years of data relating to congenital diaphragmatic herniation in the Northern Region. Ninety-nine confirmed cases were notified to the Northern Region Fetal Abnormality Survey between 1985 and 1991, which is an incidence of 0.35 per 1000 births. A specific diagnosis of CDH was made by antenatal ultrasound in 21 fetuses. The rate of detection improved from 6% to 41% but this had no impact on survival; severe pulmonary hypoplasia was found in the majority dying in the first 48 h. Another structural abnormality occurred in 29% and was the primary antenatal scan diagnosis in 11 fetuses. No other reliable indicator of outcome was identified, including the gestation when detected. The incidence of chromosomal abnormality was 5% and Fryns' syndrome 4%.

Two children with biliary atresia are described in whom focal nodular hyperplasia of the liver occurred following portoenterostomy. The lesions were low-or iso-dense on unenhanced CT and became hypodense post-contrast enhancement. There was normal 99mTc phytate on hepatic colloid scintigraphy. On T2-weighted spin echo MR images, there was increased signal intensity within the masses, and the surrounding liver parenchyma was divided by linear septa in one of the two cases.

Radionuclide skeletal scintigraphy has been successfully used in the assessment of mandibular condylar hyperplasia (condylar hyperplasia) causing mandibular asymmetry to identify the presence of continued active growth in the condylar region. This study reviews 14 cases of mandibular asymmetry and concludes that symmetrical radionuclide uptake in the condylar regions on the bone scintigram excludes a continuing asymmetrical growth focus. Unilateral increased radionuclide uptake may often indicate an abnormally active condylar growth focus but false positive results may be encountered in patients with associated temporo-mandibular joint disease.

Six patients with the variable immunodeficiency syndrome and associated nodular lymphoid hyperplasia of the intestine were studied. Contrary to earlier reports, the nodules were found to be widespread in the large bowel and occurred in all six patients. Nodules were also present in the small bowel in all cases and these were seen predominantly distally. The full significance of the lesions is as yet undetermined but their presence should at least raise the possibility of an immunodeficiency. The importance of employing accurate radiological techniques using a combination of the double contrast enema and small bowel enteroclysis is stressed.

We report a case of Addison's disease with pituitary enlargement which could easily have been misinterpreted as a pituitary adenoma or other pituitary disease. Serial computed tomography following replacement therapy was essential to confirm the diagnosis.