Both endocrine and exocrine tumours of the pancreas are now staged by a single pancreatic staging system.
Staging of pancreatic ductal adenocarcinoma is with the TNM system, and as a majority of tumours are not-resectable, this is mostly achieved with imaging (typically CT scan) although laparo...
Thyroid-associated orbitopathy (TAO) is the most common cause of proptosis in adults and is most frequently associated with Graves disease.
On imaging, it is characterised by enlargement of the extraocular muscles' bellies (frequently: inferior rectus > medial rectus > superior rectus) sparing...
Optic nerve meningiomas are benign tumours arising from the arachnoid cap cells of the optic nerve sheath, and represent ~20% of all orbital meningiomas, the majority of which are direct extensions from intracranial meningiomas.
These tumours typically appear as masses within the optic nerve, ...
Tolosa-Hunt syndrome (THS) is an idiopathic inflammatory condition that involves the cavernous sinus and orbital apex, and is essentially a clinical diagnosis of exclusion.
Clinically it refers to the presence of a painful ophthalmoplegia secondary to surrounding cavernou...
The small bowel is the most common site of carcinoid tumours, accounting for 42% of gastrointestinal carcinoid tumours 1. Within the small bowel, the most common site is at the terminal ileum 2.
Small bowel carcinoid are slow growing and may present with vague symptoms 1,3:
As expected there are a number of different staging systems for hepatoblastoma.
PRETEXT grouping system of paediatric liver tumours
not specific to hepatoblastoma; used in all paediatric liver tumours
Intergroup staging system
specific for hepatoblastoma (see below)
Cannonball metastases refer to large, well circumscribed, round pulmonary metastases that appear, well, like cannonballs. The French term "envolée de ballons" which translates to "balloons release" is also used to describe this same appearance.
Metastases with such an appearance are classically...
Adenosquamous cell carcinoma (ASC) of the cervix is a rare histological subtype of cervical carcinoma.
It has components of both cervical adenocarcinoma and cervical squamous cell carcinoma.
An adenosquamous histology appears to be an independent predictor of poor outcome...
Ischaemic colitis refers to inflammation of the colon secondary to vascular insufficiency and ischaemia. It is sometimes considered under the same spectrum as intestinal ischaemia. The severity and consequences of the disease are highly variable.
Ischaemic bowel is typically a dis...
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The bright rim sign has been described in dysembryoplastic neuroepithelial tumours (DNETs) and is seen, as the name so aptly describes, as a rim of high signal around the DNET on FLAIR sequences.
Pancreatic ductal adenocarcinoma makes up the vast majority (~90%) of all pancreatic neoplasms and remains a disease with a very poor prognosis and high morbidity.
On imaging, it usually presents as a hypodense mass on CT that is poorly marginated, which may encase vessels and the common biliar...
Cervical lymph node staging is important in a variety of tumours, especially squamous cell carcinoma of the head and neck.
TNM nodal staging
Nodal staging is the same for squamous cell carcinomas of most regions of the upper aerodigestive tract of the head and neck, including those of the of t...
Bat's wing or butterfly pulmonary opacities refer to a pattern of bilateral perihilar shadowing. It is classically described on a frontal chest radiograph but can also refer to appearances on chest CT 3-4.
Bat's wing pulmonary opacities can be caused by:
Dermatofibrosarcoma protuberans (DFSP) is an uncommon exophytic, slow growing, low grade, spindle cell tumour arising in the dermal and subcutaneous tissues, particularly of the trunk region with excellent outcome after complete surgical resection.
The tumour occurs in patients of...
A handy mnemonic to recall cortically-based brain tumours is:
P: pleomorphic xanthoastrocytoma
D: dysembryoplastic neuroepithelial tumour (DNET); desmoplastic infantile astrocytoma and ganglioglioma
Convenient mnemonics for the causes of cerebral ring enhancing lesions are:
MAGIC DR or DR MAGIC
DR MAGIC L
MAGIC DR or DR MAGIC
I: infarct (subacute phase)
D: demyelinating disease
R: radiation necrosis or re...
Malignant uveal melanomas, also referred as choroidal melanomas, are the most common primary tumour of the adult eye 3.
Malignant melanoma of the uvea is the most common primary intraocular malignancy and is predominantly seen in Caucasians 5. The incidence of these tumours incre...
The ivory vertebra sign refers to diffuse and homogeneous increase in opacity of a vertebral body that otherwise retains its size and contours, and with no change in the opacity and size of adjacent intervertebral discs.
The cause for an ivory vertebra depends on the age o...
Lymphangitic carcinomatosis, or lymphangitis carcinomatosa, is the term given to tumour spread through the lymphatics of the lung and is most commonly seen secondary to adenocarcinoma.
The demographics will reflect that of the underlying malignancy (see below).
Diffuse astrocytomas, also referred to as low-grade infiltrative astrocytomas, are designated as WHO II tumours of the brain. The term diffuse infiltrating means there is no identifiable border between the tumour and normal brain tissue, even though the borders may appear well-marginated on imag...
Solitary bone plasmacytomas (SBP) may involve any bone, but they have a predisposition for the red marrow-containing axial skeleton:
spinal disease is observed in ~50% (range 34-72%) of cases
the thoracic vertebrae are most commonly involved, followed by lumbar, sacral, and cervical vertebrae
Synonyms, located below references when in edit mode, are used in a number of scenarios.
To view a YouTube screencast tutorial please click here.
What is a synonym?
A synonym is essentially a 'redirect' to an article. This enables links created to article A to pass to article B, provided ar...
Inverted papillomas are a type of Schneiderian papilloma. They are uncommon with distinctive pathological and imaging features.
The term inverted papilloma is also used to describe a urothelial lesion. For a discussion of that entity, please refer to inverted papilloma of the urin...
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare haematological malignancy. It was previously termed as blastic natural-killer lymphoma or agranular CD4+ natural killer cell leukemia.
It only represent a wel small propotion (around 0.44%) of all haematological malign...
Facial nerve schwannoma (FNS), also known as facial nerve neuroma/neurilemoma, is a schwannoma that arises from the facial nerve. They are generally uncommon, and when involving the temporal bone, make up less than 1% of all temporal bone tumours.
FNS is a rare tumour 2.
Response evaluation criteria in solid tumours or RECIST refers to a set of published rules used to assess tumour burden in order to provide an objective assessment of response to therapy. They were initially introduced in 2000 and have undergone subsequent revision in 2009 (RECIST 1.1).
Radial scar, or complex sclerosing lesion, is a rosette-like proliferative breast lesion. It is not related to surgical scarring. Some authors, however, reserve the latter term to lesions over 1 cm 5.
It is an idiopathic process with sclerosing ductal hyperplasia.
Its significance is that it...
Solid lesions with enhancement is by far the most commonly encountered appearance of pituitary region masses. The differential includes :
by far the most common entity
typically enhances less vividly than other entities
elevates the dura of the diaphragma sella (as the origin i...
Serum CA-125 is well recognised as an ovarian cancer-associated marker and is an antigen determinant on a high-molecular-weight glycoprotein. The normal range of CA-125 is 0-35 U/mL.
Serum CA-125 levels can also be used to monitor the response to treatment as well as a prognostic indicator sinc...
Ameloblastomas are locally aggressive benign tumours that arise from the mandible, or, less commonly, from the maxilla. Usually present as a slowly but continuously growing hard painless lesion near the angle of the mandible in the 3rd to 5th decades of life, which can be severely disfiguring if...
Autosomal dominant polycystic kidney disease (ADPKD), also sometimes more vaguely referred to as "adult polycystic kidney disease", is as the name would suggest, a hereditary form of adult cystic renal disease.
Autosomal dominant polycystic kidney disease is one of the most commo...
RASopathies are a class of developmental disorders caused by germline mutations in genes that encode for components or regulators of the Ras/mitogen activated protein kinase (MAPK) pathway.
As a group, RASopathies represent one of the most common malformation syndromes, with an in...
Mnemonics for the differential diagnosis of lucent/lytic bone lesions include:
They are anagrams of each other and therefore include the same components. They are by no means exhaustive lists, but are a good start for remembering a differential for a lucent/lytic bone...
An incidentaloma is a radiological neologism to denote a mass lesion found incidentally and of dubious clinical significance. Although it can refer to any incidental lesion (e.g. pituitary 3, thyroid 4), it is most often used to denote an incidental adrenal lesion, which is commonly an adrenal a...
Adrenal haemangiomas are rare benign tumours that are usually incidentally identified (one example of an adrenal incidentaloma). Its significance mainly relates to the difficulty in differentiation from other malignant lesions.
Although these can be found at any age, they are mos...
Adrenal calcification is not a rare finding in healthy asymptomatic people and is usually the result of previous haemorrhage or tuberculosis. Addison's disease patients only occasionally have calcification.
sepsis: Waterhouse-Friderichsen syndrome
Adrenal metastases are the most common malignant lesions involving the adrenal gland. Metastases are usually bilateral but may also be unilateral. Unilateral involvement is more prevalent on the left side (ratio of 1.5:1).
They are present at autopsy in up to 27% of patients with ...
Pheochromocytomas are an uncommon tumour of the adrenal gland, with characteristic clinical, and to a lesser degree, imaging features. The tumours are said to follow a 10% rule:
~10% are extra-adrenal
~10% are bilateral
~10% are malignant
~10% are found in children
~10% are familial
Perineural spread of tumour is a form of local invasion in which primary tumours cells spread along the tissues of the nerve sheath. It is a well-recognised phenomenon in head and neck cancers.
An important distinction has to be made between perineural invasion (PNI) and Perineural spread (PNS...
A popular mnemonic to help remember causes of focal sclerotic bony lesions is:
H: healed NOF
E: Ewing sarcoma
I: infection or infarct
F: fibrous dysplasia
Salivary gland tumours are variable in location, origin, and malignant potential.
In general, the ratio of benign to malignant tumours is proportional to the gland size; i.e. the parotid gland tends to have benign neoplasms, the submandibular gland 50:50, and the sublingual glands a...
Useful mnemonics for remembering causes of diffuse bony sclerosis include:
3 M's PROOF
Regular Sex Makes Occasional Perversions Much More Pleasurable And Fantastic 1
3 M's PROOF
metastases (osteoblastic metastases)
Intraventricular meningiomas are rare intracranial tumours that represent an uncommon subtype of the more classical extra-axial meningioma and represent between 0.5 and 2% of all meningiomas. Despite its rarity, they represent one of the commonest adult intraventricular neoplasms 4.
Mnemonics to help remember common causes of bony sequestrum include:
E: eosinophilic granuloma
I: infection (Brodie abscess)
L: lymphoma (skeletal)
M: malignant fibrous histiocytoma or metastasis (especially from breast carcinoma)
Burkitt lymphoma (BL) is an aggressive B-cell lymphoma that predominantly affects children.
Burkitt lymphoma is the most common (40%) type of non-Hodgkin lymphoma in childhood. The median age of Burkitt lymphoma is eight years, and it has a male predominance (M:F = 4:1) 1. It is l...
Vertebral metastases represent the secondary involvement of the vertebral spine by haematogenously-disseminated metastatic cells. They must be included in any differential diagnosis of a bone lesion in a patient older 40 years.
This article will focus only on the metastasis involving the bony s...
The differential for tracheal masses can be rather wide.
For a single mass consider:
direct invasion from adjacent organ (lung, thryoid,esophagus)
distant metastsis ( such as melanoma)
squamous cell carcinoma: commonest primary tracheal malignancy 2 ~50 %
Multiple myeloma is the most common primary malignant bone neoplasm in adults. It arises from red marrow due to monoclonal proliferation of plasma cells and manifests in a wide range of radiographic abnormalities. Multiple myeloma remains incurable.
Four main patterns are recognise...
The skeleton is the most commonly involved organ system in Langerhans cell histiocytosis (LCH) and is by far the most common location for single-lesion LCH, often referred to as eosinophilic granuloma (EG) (the terms are used interchangeably in this article). For a general discussion of this dis...
Tamoxifen has pro-oestrogenic effects on the endometrium and thus is associated with an increased prevalence of:
endometrial polyps: occurs in ~8-36% of women in treated 8
endometrial hyperplasia: occurs in ~1-20% of women treated ref
cystic endometrial atrophy
There are a number of lymphoma staging systems for both Hodgkin lymphoma and non-Hodgkin lymphoma including the Ann Arbor classification, Cotswolds-modified Ann Arbor classification, and the most current, Lugano classification.
Evolution of lymphoma staging and treatment response evaluation cr...
Cervical lymphadenopathy in an adult can result from a vast number of conditions. They include:
from head and neck tumours
other neoplastic lesions
Ependymomas represent a relatively broad group of glial tumours most often arising from the lining the ventricles of the brain or the central canal of the spinal cord. They account for ~5% of all neuroepithelial neoplasms, ~10% of all paediatric brain tumours and up to 33% of brain tumours occur...
Many patients, particularly in developing countries, present late with giant breast masses. They may be single or multiple and either benign or malignant. Many of these conditions are indistinguishable on physical examination alone. Some of these lesions require mastectomy while others can be tr...
Squamous cell carcinoma (SCC) is one of the non-small cell carcinomas of the lung, overtaken by adenocarcinoma of the lung as the most commonly encountered lung cancer.
Squamous cell carcinoma accounts for ~30-35% of all lung cancers and in most instances are due to heavy smoking...
Dermatomyositis is an autoimmune inflammatory myositis.
There is a recognised female predilection. It has a bimodal age of presentation depending on the variant:
juvenile dermatomyositis (JDM): affects children and tends to be more severe
adult dermatomyositis (ADM): typically a...
Spinal astrocytomas are the second most common spinal cord tumour overall, representing 40% of intramedullary tumours 3. They account for 60% of paediatric intramedullary tumours, making them the most common spinal cord tumour in children 6.
This article specifically relates to spinal astrocyto...
Adenocarcinoma of the lacrimal glands is rare, with few cases reported in the literature since it was first described in 1996 1. Primary adenocarcinoma of the lacrimal gland is extremely rare; only 9 cases have been reported in the literature 1,2. It can be classified into high- and low-grade ma...
Leptomeningeal enhancement refers to a diffuse or focal gyriform or serpentine enhancement that can be seen in the following conditions:
tuberculous meningitis (can also be focal)
CNS cryptococcal infection
coccidioidal meningitis (c...
Typhlitis, also called caecitis or neutropaenic colitis, is a necrotising inflammatory condition which typically involves the caecum and, sometimes, can extend into the ascending colon or terminal ileum.
Typhlitis was first described in children with leukaemia and severe neutropae...
Granulocytic sarcoma (also called myeloid sarcoma and chloroma) is a rare neoplasm comprised of myeloid precursor cells.
It can occur in association with:
acute myeloid leukaemia (AML)
chronic myeloid leukaemia (CML)
other myeloproliferative disorders such as
myelofibrosis with myeloid meta...
Endometrial hyperplasia refers to an increased proliferation of the endometrial glands relative to the stroma. One of the main concerns is the potential malignant transformation of the endometrial hyperplasia to the endometrial carcinoma.
Endometrial hyperplasia affects women of a...
The anatomy curriculum is one of our curriculum articles and aims to be a collection of articles that represent the core anatomy knowledge for radiologists and imaging specialists.
Head and neck anatomy
Abdominal and pelvic anatomy
Borderline ovarian serous cystadenomas lie in the intermediate range in the spectrum of ovarian serous tumours and represent approximately 15% of all serous tumours.
They present at a younger age group 1-2 than the more malignant serous cystadenocarcinomas with a peak age of prese...
Cystic glioblastoma is a descriptive term for one form of glioblastoma that contains a large cystic component, rather than being a pathological subtype.
Please refer to the main article on glioblastoma for a broad discussion on this tumour.
The main challenge in discri...
Haemangioblastomas are tumours of vascular origin and occur both sporadically and in patients with von Hippel Lindau (vHL). They are WHO grade I tumours that can occur in the central nervous system or elsewhere in the body, including kidneys, liver, and pancreas.
These tumours generally present...
The appearance of multiple, well-defined lytic lesions (punched out lesions) of various size scattered throughout the skull constitutes the raindrop skull appearance of multiple myeloma. This term is applied as an analogy to rain hitting a surface and splashing, where it leaves a random pattern ...
Dysembryoplastic neuroepithelial tumours (DNET) are benign (WHO Grade I) slow growing glioneuronal tumours arising from either cortical or deep grey matter. The vast majority are centred in cortical grey matter, arise from secondary germinal layers, and are frequently associated with cortical dy...
Cholangiohepatoma refers to a synchronous cholangiocarcinoma and hepatocellular carcinoma. It is a rare and aggressive primary hepatic tumour. The origin of cholangiohepatoma is closely linked to the origin of cholangiocarcinoma rather than hepatocellular carcinoma (HCC).
Von Hippel-Lindau (vHL) disease is characterised by the development of numerous benign and malignant tumours in different organs (at least 40 types 1) due to mutations in the VHL tumour suppressor gene on chromosome 3.
The disease is rare with an estimated prevalence of 1:35,000-5...
Breast angiosarcomas are a rare vascular breast malignancy.
As primary tumours of the breast, they account for ~0.04% 2 of all breast cancers and tend to occur in younger women, in their 3rd to 4th decades. Secondary angiosarcoma has an estimated incidence of ~0.09-0.16% and occur...
Pseudomyxoma peritonei refers to the intraperitoneal accumulation of a gelatinous ascites secondary to rupture of a mucinous tumour. The most common cause is a ruptured mucinous tumour of the appendix/appendiceal mucocoele 10.
Occasionally, mucinous tumours of the colon, rectum, stomach, panc...
Abnormal nodular enhancement of the pituitary stalk can be seen in:
granular cell tumour of the pituitary (a.k.a. pituitary choristoma)
pilocytic astrocytoma of the neurohypophysis (a.k.a. infundibuloma)
Secondary involvement of the bone with lymphoma, also referred as secondary bone lymphoma, is much more common than primary bone lymphoma, occurring in ~15% of disseminated lymphomas.
Secondary bone lymphoma is defined as lymphoma involving the bone with nodal disease occurring wit...
HIV-associated neoplasms are numerous and can be broadly divided into two groups:
associated but not AIDS defining malignancies
The development of these malignancies in HIV affected individuals generally implies progression to AIDS 4:
Tuberculosis of the central nervous system can result from either haematogenous spread from distant systemic infection (e.g. pulmonary tuberculosis) or direct extension from local infection (e.g. tuberculous otomastoiditis).
Intracranial manifestations of tuberculosis are protean and can affect...
Duodenal adenocarcinoma is the most common primary malignancy of the duodenum.
Adenocarcinoma is the most common primary malignant neoplasm of the duodenum. It represents 0.3% of all gastrointestinal malignancies and accounts for 50-70% of small bowel adenocarcinomas occurring ei...
Pulmonary manifestations of scleroderma are demonstrated histologically in 90% of patients with scleroderma. It is a leading cause of mortality and at autopsy. The lung is reportedly involved in close to 100% of cases. However, only 25% of patients will present with respiratory symptoms or demon...
Anal cancer is a relatively uncommon malignancy. It accounts for less than 2% of large bowel malignancies and 1-6% of anorectal tumours (~1.5% of all gastrointestinal tract malignancies in the United States 14).
There may be a slight male predilection where its incidence has been...
Pulmonary metastases are common and the result of metastatic spread from a variety of primary tumours via blood or lymphatics.
This article describes haematogenous pulmonary metastases with lymphangitis carcinomatosis discussed separately.
The epidemiology will match that of the ...
Head and neck squamous cell carcinomas (HNSCC) refer to SCCs of the aerodigestive tract of the head and neck rather than cutaneous SCCs. SCC is the most common tumour of the mucosa of the upper aerodigestive tract, and can occur anywhere there is squamous cell mucosa.
Epidemiology, risk factor...
Assessment of thyroid lesions is commonly encountered in radiological practice.
hyperplastic / colloid nodule / nodular hyperplasia: 85%
papillary: 60-80% of carcinomas
MRI protocols are a combination of various MRI sequences, designed to optimally assess a particular region of the body and/or pathological process.
There are some general principles of protocol design for each area. However, the specifics of a protocol are dependent on MRI hardware and software...
A hyperechoic liver lesion on ultrasound can arise from a number of entities, both benign and malignant. A benign hepatic haemangioma is the most common entity encountered, but in patients with atypical findings or a risk for malignancy, other entities must be considered.
Colorectal carcinoma (CRC) is the most common cancer of the gastrointestinal tract and the second most frequently diagnosed malignancy in adults. CT and MRI are the modalities most frequently used for staging. Surgical resection may be curative although five-year survival rate is 40-50%.
Cardiac myxomas, although uncommon are one of commonest primary cardiac tumours and account for ~50% primary benign cardiac tumours.
Cardiac myxomas are the most common primary cardiac tumour in adults but are relatively infrequent in childhood, where cardiac rhabdomyomas are mor...
Lymphoma is a malignancy arising from lymphocytes or lymphoblasts. Lymphoma can be restricted to the lymphatic system or can arise as extranodal disease. This, along with variable aggressiveness results in a diverse imaging appearance.
Lymphoma accounts for ~4% of all cancers 4. T...
The ventricular system of the brain plays host to a variety of unique tumours, as well as tumours that are more frequently seen elsewhere (e.g. meningiomas). Besides, some intra-axial (parenchymal) masses can be mostly exophytic and thus appear mostly intraventricular. A systematic approach taki...
With the advent of echocardiography, and cardiac CT and MRI, the role of chest radiographs in evaluating congenital heart disease has been largely been relegated to one of historical and academic interest, although they continue to crop up in radiology exams. In most instances a definite diagnos...
Flare phenomenon or osteoblastic flare phenomenon refers to interval visualisation of lesions with a sclerotic rim around an initially lytic lesion or sclerosis of lesions previously undetected on radiograph or CT in the setting of follow-up of an oncological patient with other signs of partial ...
An anterosuperior mediastinal mass can be caused by neoplastic and non-neoplastic pathology. As their name suggests, they are confined to the anterior mediastinum, that portion of the mediastinum anterior to the pericardium and below the level of the clavicles.
The differential diagnosis for a...
A diffuse homogeneous bone marrow FDG uptake usually reflects hyperplastic bone marrow which can be seen in the following conditions:
granulocyte colony stimulating factor (G-CSF)