Neoplastic degeneration in Paget's disease is a rare complication (approximately 1% of cases) and, despite the treatment, presents a poor prognosis. The authors report a case of a male, 82-year-old patient with long standing Paget's disease who presented imaging findings of malignant degeneration in the calcaneus histopathologically diagnosed as sarcomatous degeneration.

Keywords: Paget's disease, Sarcoma, Sarcomatous degeneration, Calcaneus, Osteitis deformans

OBJECTIVE: To determine the relationship between mammography findings and pathology results in patients with breast tumors associated with round calcifications. MATERIALS AND METHODS: We analyzed 16 patients with malignant breast tumors whose mammograms showed round calcifications as the sole finding. The histological types, number of calcifications and the most frequent distribution patterns were studied. RESULTS: The most common histological type of these tumors was cribriform carcinoma in 42.9% of the cases, followed by micropapillary carcinoma (23.8%), comedo (19%) and infiltrating ductaI carcinoma (9.5%). Association of two or more histological types was seen in five cases in a total of 21 tumors. Uncharacteristic distribution pattern was observed in 56% of the cases, ductal pattern in 31.5% and lobular pattern in 12.5%. Regarding the number of calcifications, more than 20 calcifications were seen in 75% of the cases, between 10 and 20 calcifications in 12.5%, and less than 10 calcifications in 12.5%. CONCLUSION: Malignant breast tumors may present round calcifications as the sole mammographic finding. These calcifications may present a lobular, ductal or uncharacteristic pattern of distribution.

Keywords: Round calcifications, Mammography, Malignant breast tumors

Laser-induced thermoablation has been used as a reliable method for producing coagulation necrosis in hepatic tumors in patients who are not suitable for surgical treatment. The procedure can be performed percutaneously, using image-guiding methods, by open laparotomy or laparoscopy. We review the current literature and discuss the principles, indications, complications and clinical results as well as the potential limitations and contraindications of this novel technique.

Keywords: Laser, Thermoablation, Liver, Liver tumors, Metastases

Recent advances in ultrasound have optimized the detection of liver tumors and helped to improve the prognosis of patients with this condition as newly developed and improved therapeutic modalities have been established. The authors review important Doppler findings which may help in the identification and characterization of some hepatic tumors through the evaluation of color Doppler, pulsed Doppler and power Doppler features. New imaging methods such as the use of harmonics imaging are also reviewed.

Keywords: Liver, Liver tumors, Doppler

Although rare, transitional cell carcinoma of the urinary tract is the second most common tumor of the kidneys. We studied retrospectively the computed tomography images of 10 patients with confirmed transitional cell carcinoma of the urinary tract. There was involvement of the bladder in 60% of the cases whereas the calyceal system and the ureters were involved in 60% and 10% of the cases, respectively. Concomitant tumors were present in 40% of the cases. The findings were sessile masses, ureteral wall thickening and renal infiltrative lesions. Calcified tumors were seen in two patients and a transitional cell tumor arising from a bladder diverticulum was identified in another patient. Local tumor dissemination was observed in 80% of the patients and distant dissemination in 20% of the patients. Computed tomography allowed the detection of local and distant tumor dissemination, thus allowing a selected group of patients to be treated conservatively.

Keywords: Transitional cell carcinoma, Computed tomography, Renal tumors

Vascular tumors encompass a spectrum of lesions, which may vary from benign hemangiomas to malignant angiosarcomas. Hemangioendotheliomas can be considered intermediary between these two types of lesions. We report a case of hepatic hemangioendothelioma in a newborn female and review the most important aspects of this disease.

Keywords: Hemangioendotheliomas, Hepatic tumors, Vascular tumors, Computed tomography

Systemic diseases, primary orbital diseases and extraorbital lesions extending into the orbit may lead to ocular proptosis. Eleven patients with ocular proptosis caused by non previously treated extraorbital malignant tumors were studied with computed tomography. Nonepithelial neoplasms were the most common tumors (82%) including three rabdomyosarcomas (27%), three non-Hodgkin's lymphomas (27%), and other sarcomas in two patients (18%). Squamous cell carcinoma (9%), Burkitt's lymphoma (9%) and poorly differentiated carcinoma (9%) were also identified. The most common primary sites of the tumors were the sinonasal cavities (nine cases; 82%), particularly the ethmoidal sinus (five cases). Ocular proptosis was the only ophthalmic sign in four patients (36%) whereas one patient had bilateral ocular proptosis as the only sign of disease. Seventeen orbits were involved due to six patients had bilateral tumor extension into the orbits. Tumor extension into the orbits was mainly through the orbital bone (16 orbits; 94%). There was involvement of all compartments in most of the orbits (59%). The tumor was extraconal in 16 orbits. Computed tomography revealed ocular proptosis in 15 of the 17 orbits (88%), which was bilateral in four cases (eight orbits). Grade 2 ocular proptosis was observed in seven patients (47%). Forty-four regions of the face and skull were involved, excluding the orbits and the primary site of the tumor, indicating extensive loco-regional disease at the time of the diagnosis.

Keywords: Ocular proptosis, Malignant tumors, Orbital extension

The authors studied seven patients with gingival carcinoma attended at the Head and Neck Surgery and Otorrhinolaryngology Service and the Diagnostic Imaging Service of "Complexo Hospitalar Heliópolis", São Paulo, SP, Brazil, between 1985 and 1996. Squamous cell type carcinomas were identified in all cases. All patients were male (100%) aged 48-72 years. Computed tomography was performed in six patients (85.6%). Four patients (57.1%) had not received any treatment before imaging examination whereas three patients (42.8%) had already been submitted to surgery or radiotherapy. The authors analyzed the primary site of the tumor and its extension to the mandible (5/7 cases; 71.4%), the floor of the mouth (3/7 cases; 42.8%), the floor of the maxillary sinus (1/7 cases; 14.2%) and the retromolar trigonum (1/7 cases; 14.2%). Metastatic lymph nodes were observed in five patients (71.4%). Diagnosis was confirmed by biopsy and histopathological examination in all cases. Comparison with surgical findings was possible in five cases (71.4%).

Keywords: Gingiva, Malignant tumors, Gingiva

Sarcomatoid renal carcinoma is an aggressive neoplasm with clinical and radiological features similar to those of clear cell renal sarcomas. The tumor is formed by layers of malignant spindle cells that show immunohistochemical and ultrastructural characteristics of both stromal and epithelial cells, and may also contain mixoid areas of osteoclast-like giant cells, rhabdomyoblast-like pleomorphic cells as well as other rare sarcomatoid components. The authors report a case of sarcomatoid renal carcinoma in a 54-year-old male patient presenting with the classic clinical triad seen on patients with renal cell carcinomas. The typical macroscopic and microscopic features, imaging findings and differential diagnosis with true renal sarcomas are discussed.

Keywords: Renal cell carcinoma, Sarcomatoid renal carcinoma, Tumor metaplasia, Computed tomography, Ultrasonography

Choroid plexus mass lesions encompass a broad and heterogeneous group of diseases and their simulators. Tumors, infections, congenital anomalies, hemorrhage, cysts and degenerative diseases are some examples of mass lesions affecting the choroid plexus. In this article we review the current literature, describing the imaging findings and illustrating choroid plexus mass lesions with some cases diagnosed at our facility. Despite the inexistence of pathognomonic signs, a careful and systematic evaluation of the imaging characteristics may suggest many etiologies.

Keywords: Choroid plexus, Tumors, Mass lesions

Pseudoaneurysms are considered rare conditions. The authors describe the rarity of the occurrence of a pseudoaneurysm secondary to traumatic injury of the common carotid artery in association with a femoral osteochondroma. The importance of imaging methods, particularly computed tomography angiography, in the diagnosis of vascular pathologies are emphasized, and the literature is reviewed.

Keywords: Pseudoaneurysm, Carotid, Osteochondroma, Computed tomography angiography

The authors present a case of a patient with primary pancreatic leiomyosarcoma and describe the ultrasound findings during intraoperative ultrasonography. Although ultrasound, computed tomography and magnetic resonance features of primary pancreatic leiomyosarcomas have been previously described, there is no report on the ultrasonographic appearance of these tumors during intraoperative ultrasonography. The authors also stress the importance of intraoperative ultrasonography in establishing vascular invasion by the tumor.

Keywords: Intraoperative ultrasonography, Pancreas, Pancreatic tumors, Pancreatic leiomyosarcoma

We reviewed 22 cases of patients with parasellar meningiomas evaluated with magnetic resonance imaging (MRI) in private clinics of the cities of Niterói and Rio de Janeiro, RJ, Brazil. Our aim was to characterize the imaging findings in this type of tumor. MRI scanners with 0.5 and 1.0 Tesla magnets were used for the acquisition of multiplanar T1-weighted (pre- and post-gadolinium administration) and T2-weighted images. The main symptoms observed were headache and visual disturbances. Hyperprolactinemia was observed in only one patient. The most frequent imaging finding was a parasellar mass which appeared hypointense on T1-weighted and hyperintense on T2-weighted images, and enhanced intensively after gadolinium administration. MRI is useful to demonstrate the lesion and to assess the damage to adjacent structures, particularly when the patient presents visual disturbances due to involvement of the cavernous sinuses.

Keywords: Parasellar meningiomas. Brain tumors. Magnetic resonance imaging.

We reviewed 95 cases of patients with pituitary microadenomas diagnosed by magnetic resonance imaging in two institutions: "Hospital Santa Cruz/Beneficência Portuguesa de Niterói" and "Clínica X-Labs/Rio de Janeiro". Our aim was to establish the main type of pituitary microadenoma, incidence and proximity to the hypophisial stalk, and correlate these findings with clinical and laboratorial data. A Philips Gyroscan T5 III (0.5 Tesla), a GE Vectra (0.5 Tesla) and a GE Signa (1.0 Tesla) scanners were used to scan the patients with rapid sequences before and after intravenous administration of paramagnetic contrast medium (gadolinium). There was a predominance of women with prolactinomas associated to galactorrhea and hyperprolactinemia. In contrast to the current literature, we observed that the pituitary stalk was centered in most cases. Contrast medium injection immediately before scanning is essential to identify microadenomas. The use of half of the preconized dose of gadolinium is recommended.

Keywords: Pituitary microadenomas. Sellar tumors. Magnetic resonance imaging.

In the literature, there is no evidence of relationship between primary bone lymphoma and osteochondroma or of coexistence of both of them in a single bone. The present report describes an uncommon case of primary bone lymphoma occurring simultaneously with osteochondroma in the proximal third of the tibia. In the present case, magnetic resonance imaging signs simulated the presence of sarcomatous degeneration.

Keywords: Primary bone lymphoma; Osteochondroma; Sarcomatous degeneration; Bone tumors.