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Objective: Mesenteric panniculitis (MP) and sclerosing mesenteritis is an umbrella term used to describe a rare, chronic, and frequently benign fibrosing inflammatory disease that affects the adipose tissue of the mesentery. The diagnosis is usually based on imaging (computed tomography [CT] or magnetic resonance imaging) findings and is confirmed by biopsy. We report the unusual case of a patient with MP with typical CT findings and diabetes mellitus (DM).Methods: A 48-year-old male presented for symptomatic new onset DM. An abdominal CT scan revealed a well-defined mesenteric mass compatible with MP. The combination of insulin degludec and sitagliptin/metformin resulted in a decrease of HbA1c; however, this was followed by a subsequent gradual increase in HbA1c and positive glutamic acid decarboxylase auto-antibodies.Results: The patient developed auto-immune DM that was confirmed by the presence of auto-antibodies.Conclusion: Panniculitis has been infrequently reported in patients with type 2 DM. This is the first report of a patient with MP correlated with auto-immune DM. The possible pathophysiologic mechanisms are discussed.Abbreviations: CT computed tomography DM diabetes mellitus HbA1c hemoglobin A1c MP mesenteric panniculitis SM sclerosing mesenteritis

The wide availability of cross-sectional imaging is responsible for the increased detection of small, usually asymptomatic renal masses. More than 50 % of renal cell carcinomas (RCCs) represent incidental findings on noninvasive imaging. Multimodality imaging, including conventional US, contrast-enhanced US (CEUS), CT and multiparametric MRI (mpMRI) is pivotal in diagnosing and characterizing a renal mass, but also provides information regarding its prognosis, therapeutic management, and follow-up. In this review, imaging data for renal masses that urologists need for accurate treatment planning will be discussed. The role of US, CEUS, CT and mpMRI in the detection and characterization of renal masses, RCC staging and follow-up of surgically treated or untreated localized RCC will be presented. The role of percutaneous image-guided ablation in the management of RCC will be also reviewed.

To evaluate the difference in apparent diffusion coefficient (ADC) measurements at diffusion-weighted (DW) magnetic resonance imaging of differently shaped regions-of-interest (ROIs) in testicular germ cell neoplasms (TGCNS), the diagnostic ability of differently shaped ROIs in differentiating seminomas from nonseminomatous germ cell neoplasms (NSGCNs) and the interobserver variability.Thirty-three TGCNs were retrospectively evaluated. Patients underwent MR examinations, including DWI on a 1.5-T MR system. Two observers measured mean tumor ADCs using four distinct ROI methods: round, square, freehand and multiple small, round ROIs. The interclass correlation coefficient was analyzed to assess interobserver variability. Statistical analysis was used to compare mean ADC measurements among observers, methods and histologic types.All ROI methods showed excellent interobserver agreement, with excellent correlation (P0.001). Multiple, small ROIs provided the lower mean ADC in TGCNs. Seminomas had lower mean ADC compared to NSGCNs for each ROI method (P0.001). Round ROI proved the most accurate method in characterizing TGCNS.Interobserver variability in ADC measurement is excellent, irrespective of the ROI shape. Multiple, small round ROIs and round ROI proved the more accurate methods for ADC measurement in the characterization of TGCNs and in the differentiation between seminomas and NSGCNs, respectively.

Purpose To investigate the role of proton magnetic resonance spectroscopy. (1H-MRS) in the assessment of the biochemical environment of testes in infertile men with clinical varicocele. Methods In this prospective IRB approved study, 13 infertile men with clinical varicocele and 11 age-matched controls were assessed. 1H-MRS was performed using a single voxel point-resolved spectroscopy (PRESS) sequence with TR/TE: 2000/25 ms. Normalized metabolite concentrations, defined as ratios of the calculated metabolite concentrations relative to total creatine (tCr) concentration were compared between infertile testes with clinical varicocele and normal testes using nonparametric statistical tests. Logistic regression analysis was performed to assess the most significant predictor for the diagnosis of varicocele. Results Several metabolic peaks were found in both infertile testes with clinical varicocele and normal testes. Most prominent peaks were the following: total choline (tCho), tCr, myo-inositol (mI), Glx, and total lipids and macromolecules resonating at 0.9 ppm (TLM09), 1.3 ppm (TLM13) and 2.0 ppm (TLM20). Lower normalized concentrations of tCho (P = 0.001), mI (P = 0.012), Glx (P = 0.011), TLM09 (P = 0.027), TLM13 (P = 0.035) and TLM20 (P = 0.021) were found in infertile testes with clinical varicocele compared with normal men. Total Cho proved the most significant predictor for the diagnosis of clinical varicocele (P = 0.001). Conclusions 1H-MR spectra of infertile testes with clinical varicocele showed decrease in normalized concentrations of tChol, ml, Glx and lipids. 1H-MRS of the testes might be used as a noninvasive marker of deranged spermatogenesis in infertile men with clinical varicocele.

Highlights • Pancreatic undifferentiated carcinomas with OGCs are very rare neoplasms that may have an atypical clinical presentation. • Less than a hundred cases have been described until today. • Early diagnosis and aggressive surgical treatment is the only way to prolong survival., Introduction Undifferentiated head of pancreas carcinoma with osteoclast-like giant cells (UC-OGC) is a rare neoplasm, with less than a hundred cases reported. We present such a case, in which the UC-OGC presented atypically as a cystic lesion following acute pancreatitis and led to late diagnosis. Presentation of case A 75-year-old female patient, who had suffered acute pancreatitis three years ago, was referred with a diagnosis of osteoclast-like giant cell (OGC) tumor of the head of pancreas. She had suffered acute pancreatitis three years ago. Two years ago she developed abdominal pain, steatorrhea and weight loss. Abdominal computed tomography imaging showed a cystic mass in the head of the pancreas (maximum diameter 4 cm). The initial diagnosis was pancreatic pseudocyst; however as the mass gradually increased in size and the patient continued to be symptomatic, a CT-guided biopsy was performed. Histological examination revealed an OGC pancreatic tumor. In laparotomy a large (9 cm) encapsulated heterogeneous mass was found with partial involvement of the common hepatic artery. Pancreaticoduodenectomy was performed and the involved part of the common hepatic artery was replaced with a homologous graft from the major saphenous vein. Post-operative course was uneventful. Histology revealed an undifferentiated pancreatic adenocarcinoma with OGCs. She survived 10 months after the operation. Discussion Pancreatic undifferentiated carcinomas with OGCs are very rare neoplasms and can present with an atypical clinical picture. Conclusions A symptomatic cystic lesion of the pancreas, which is growing in size, should be investigated promptly in order to exclude the presence of malignancy.

Magnetic resonance (MR) imaging of the scrotum has been used as a valuable supplemental diagnostic modality in evaluating scrotal pathology, mostly recommended in cases of inconclusive sonographic findings. Because of the advantages of the technique, MR imaging of the scrotum may provide valuable information in the detection and characterization of various scrotal diseases. The technique may accurately differentiate intratesticular from extratesticular mass lesions and provide important information in the preoperative characterization of the histologic nature of scrotal masses. An accurate estimation of the local extent of testicular carcinomas in patients for whom testis-sparing surgery is planned is possible.

Primary small cell carcinoma of the endometrium (SCCE) is an uncommon and aggressive neoplasm, occurring in perimenopausal and postmenopausal women. We report the multidetector CT and MR imaging findings in a case of SCCE in a 63-year-old woman, referred to the Gynecology clinic for a sonographically detected pelvic tumor. A large, heterogeneously enhancing uterine mass was revealed, accompanied by bulky pelvic and retroperitoneal lymphadenopathy and peritoneal metastases. Based on the cross-sectional imaging findings the accurate preoperative characterization of the histologic type of the neoplasm was difficult. The patient underwent exploratory laparotomy with hysterectomy, bilateral salpingooophorectomy, lymphadenectomy and omenectomy. Histology revealed a small cell neuroendocrine carcinoma of the endometrium and the tumor was surgically staged as IIIC. The patient received systematic chemotherapy and showed minimal disease on follow-up CT examination, 9 months after surgery.

OBJECTIVE: The aim of our study was to evaluate the accuracy of multidetector computed tomography (MDCT) on a 16-row CT scanner in the detection and differentiation of adnexal masses. METHODS: We prospectively examined 102 consecutive women with clinically or sonographically detected adnexal masses. Preoperative CT examination was performed, including scanning of the abdomen during the portal phase, using a detector collimation of 16 x 0.75 mm and a pitch of 1.2. Multiplanar reformatted images were evaluated for the presence of an adnexal mass and differentiation between benign and malignant ones, using the surgical and pathologic results as standard of reference. CT findings used to diagnose malignancy were: diameter greater than 4 cm, presence of masses bilaterally, cystic-solid mass, necrosis in a solid lesion, cystic lesion with thick, irregular walls or septa and/or with papillary projections. Presence of ascites, peritoneal metastases and lymphadenopathy was used to confirm malignancy. Multiple logistic regression analysis of the MDCT findings was performed to determine those more predictive of malignancy. RESULTS: Histopathologic examination demonstrated 143 adnexal mass lesions, 96 (67%) of which were benign and 47 (33%) malignant. Multidetector CT detected 129 (90%) of the 143 adnexal masses, with an overall accuracy for the diagnosis of malignancy of 89.15%. The MDCT findings that found more predictive of malignancy were the presence of papillary projections in a cystic lesion, necrosis in solid mass and peritoneal metastases. CONCLUSION: Multidetector computed tomography on a 16-row CT scanner proved accurate in the detection and characterization of adnexal masses. Gynecol Oncol

Isolated granulomatous orchitis is a rare chronic testicular inflammation, which should be differentiated from testicular malignancies on scrotal imaging. We present a case of a 33-year-old man, with a diffuse pattern of granulomatous orchitis, confirmed by means of testicular biopsy. MR imaging of the scrotum revealed the presence of two small-sized intratesticular lesions, hypointense on T2-weighted images, not enhancing after gadolinium administration suggesting the diagnosis of benignity.