Faculty Bibliography

A 62-year-old woman had proptosis of the right eye, decreased visual acuity of the left eye, and no other focal neurologic deficits. She had a grand mal seizure 1 month before admission. The CT and MR studies showed extensive bone destruction of the margins of the right orbit, the floor of the middle cranial fossa, the right cavernous sinus, and much of the calvaria. There was considerable dural disease and tumor in the right orbit, paranasal sinuses, and scalp, as well as mucoceles of the left ethmoidal sinus with desiccated secretions. The diagnosis was adenosquamous carcinoma, an aggressive tumor related to both squamous cell carcinoma and adenocarcinoma.

A 16-year-old male with a history of neonatal myotonic dystrophy had a painless enlarging left retroauricular mass. Computed tomography showed an enlarged frontal sinus, thickened apparently normal bone in the anterior left clinoid process, doresum sellae, and all portions of the temporal bones. In particular, there was bone production in the left retroauricular region and along the margins of the left internal auditory canal. The left temporomandibular joint was also dislocated. This is the first case report to document the dynamic aspect of the bone changes in this dystrophy.

An expansile temporal bone lesion above the temporomandibular joint (TMJ) in a 55-year-old woman was initially diagnosed as pigmented villonodular tenosynovitis. Preoperative embolization of the tumor had resulted in excessive tumoral hemorrhagic pigment. The surgical and CT findings suggested that the TMJ was not involved, and a final diagnosis of giant cell tumor was made.

A case is described of an elderly woman who presented with headaches, hypopituitarism, and visual disturbances and was found to have idiopathic granulomatous hypophysitis, a rare lesion of the pituitary gland. Preoperative magnetic resonance imaging demonstrated a well-circumscribed lesion, which was isointense on both T1- and T2-weighted imaging and enhanced uniformly with administration of gadolinium contrast enhancement, not unlike a macroadenoma. The present case and 12 other cases from the literature are reviewed.

OBJECTIVE: To present two cases of probable lymphoepithelial cysts of the submandibular glands in patients who were human immunodeficiency virus (HIV) positive and who also had lymphoepithelial cysts of the parotid glands. MATERIALS AND METHODS: Computed tomography and MRI of two HIV positive patients with lymphoepithelial cysts of the parotid glands and cysts in the submandibular glands were correlated with the histories and the possible presence of other known causes of submandibular gland multiple cysts. RESULTS: Because of the present treatment philosophy regarding HIV positive patients with major salivary gland cysts, surgical resection of these glands was not performed. All other known causes of multiple submandibular gland cysts were excluded by either history or laboratory data. CONCLUSION: Computed tomography and MRI on two patients with known HIV infection and bilateral parotid lymphoepithelial cysts are presented. Both patients also had bilateral multiple submandibular gland cysts and no evidence of obstructive glandular disease, autoimmune disease, or other organ system cysts. These cases of presumed submandibular gland lymphoepithelial cysts are rare in the literature. They are presented in the hope that other radiologists will be stimulated to document the occurrence of this entity.

A patient is presented in whom iophendylate (Pantopaque) within the basal cisterns closely resembled the appearance on MRI of thrombosed aneurysms of the middle cerebral arteries. The sometimes subtle differences between the appearances on MRI of Pantopaque and aneurysmal clot are discussed to permit accurate diagnosis without resorting to more invasive diagnostic tests, such as cerebral angiography.

We describe an unusual salivary neoplasm, an epithelial-myoepithelial carcinoma (EMEC) of the parotid gland, that occurred in a 64-year-old man. A CT scan showed a fairly well defined heterogeneous lesion with smooth margins and slight enhancement. MR images showed a lesion with intermediate T1-weighted signal intensity and a relatively high T2-weighted signal intensity. Although the imaging characteristics of EMEC on both CT and MR studies are nonspecific, clinicians and radiologists must be aware of its high local recurrence rate, which has been reported to approach 50% in some series, and thus the need for periodic postoperative imaging to detect early recurrence.

CT showed egg shell calcification in the cervical lymph nodes in a patient with sinus histiocytosis with massive lymphadenopathy treated for 1 year with interferon. CT scans before interferon treatment had shown no nodal calcification.

The purpose of this report is to examine the computed tomography scans, magnetic resonance images, and pathologic findings in 44 patients, 42 of whom had inclusion-type cysts of the parotid and parapharyngeal space of varying etiologies. Two additional cases of cystic changes in the benign lymphoepithelial lesion (BLEL) of Sjogren's syndrome are highlighted here, since they had unusually large cystic components mimicking acquired immunodeficiency syndrome-related parotid cysts (ARPCs). A retrospective examination identified 18 ARPCs, 3 lymphoepithelial cysts (LECs), 13 cystic Warthin's tumors, 8 branchial cysts, and 2 cases of cysts in patients with Sjogren's syndrome (BLEL), all of whom had imaging studies and pathologic confirmation. There were 30 men and 14 women with an age range of 25 to 72 years (median, 46.82 years). Any similarities in the imaging appearances were noted, as were any differences in pathologic detail. On imaging, only the cystic Warthin's tumors had any focal wall nodularity; the other cysts had smooth walls. When multiple parotid cysts were present, the distinguishing feature between ARPCs and cysts in BLEL (and some cystic Warthin's tumors) was the presence of diffuse cervical adenopathy in patients with ARPCs. Imaging usually could not differentiate between a solitary parotid LEC, a branchial cyst, and some cystic Warthin's tumors. Extraparotid lesions were either branchial cysts or cystic Warthin's tumors. Physicians should be aware of the variety of different inclusion-type cysts that may occur in the parotid gland and parapharyngeal space, all of which may have similar imaging appearances. Although imaging clearly identifies these cysts and may suggest a specific diagnosis, it must always be remembered that the precise diagnosis remains in the province of the pathologist.

Measurements of intermediate end points in the carcinogenic process may reduce uncertainty in human risk assessment from bioassay data, by identifying sources of interspecies variation and dose nonlinearity. This paper describes desirable properties of such markers: persistence, predictive power, temporal relevance, and consistency across dose rate and species. We illustrate these properties by evaluating markers for squamous cell nasal carcinoma in rodents exposed to formaldehyde. We also discuss design issues for bioassays that evaluate markers and tumors simultaneously at necropsy.