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...
Chemotherapy induced cholangitis is caused when intra-arterial chemotherapy is introduced to treat liver metastases. This causes strictures of the common hepatic duct and main ducts, but spares distal and proximal (i.e. common bile duct and intrahepatic ducts).
Unfortunately the paediatric population is susceptible to malignancies. The most common entities, in overall order of frequency, are 1-4:
leukaemia/lymphoma: ~35% *
acute lymphoblastic leukaemia: 23%
Hodgkin disease: 5%
acute myelogenous leukaemia: 4%
central nervous system malignancies: ~2...
Use only the size of the tumor during evaluation of response to chemotherapy has some pitfalls and limitations, especially when the estimated response for specific tumors such as gastrointestinal stromal tumour (GIST).
The Choi response criteria for GIST proposed that tumour attenuation could p...
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).
Choledochal cysts represent congenital cystic dilatations of the biliary tree. Diagnosis relies on the exclusion of other conditions (e.g. tumour, gallstone, inflammation) as a cause of biliary duct dilatation.
Choledochal cysts are rare, with an incidence of 1:100,000-150,000. Al...
Choriocarcinoma is an aggressive, highly vascular tumour. When it is associated with gestation, it is often considered part of the spectrum of gestational trophoblastic disease; it is then termed gestational choriocarcinoma. When it occurs in the absence of preceding gestation, it is termed non-...
Choroid plexus malignancies can be classified as primary or secondary neoplasms of the choroid plexus:
choroid plexus papilloma (CPP)
WHO Grade I, and WHO Grade II when atypical
choroid plexus carcinoma (CPC)
WHO Grade III
Chronic myelomonocytic leukaemia (CMML) is a relatively rare clonal haematologic disorder. It is sometimes classified as a type of myelodysplastic syndrome (MDS) but also has features of myeloproliferative disease (MPD).
Can be variable but many patients tend to present w...
The circumferential resection margin (CRM) is a term used in rectal carcinoma excision surgery (such as total mesorectal excision (TME)).
Pathologic evaluation of the resection margin on the excised rectum has been considered important for determining the risk of local recurrence. A margin of ≤...
Clavicle tumours may be malignant or benign.
osteoma: uncommon, sclerotic, hamartomatous surface lesion
enchondroma: rare, geographic, intramed...
Clear cell meningiomas are a histological variant of meningioma with poorer prognosis and a higher rate of recurrence. They are therefore considered WHO grade 2 tumours, regardless of mitotic index, cellular atypia/anaplasia, or presence of brain invasion.
Clear cell meningiomas ...
Clear cell renal cell carcinoma is the most common type of renal cell carcinoma.
The average age of onset of sporadic clear cell renal carcinoma is 61 years-old. In cases associated with Von Hippel-Lindau disease the average age of onset is 37 years 1.
Clear cell sarcomas of the kidney (CCSK) are a rare mesenchymal renal tumour that account for ~5% of primary renal neoplasms in the paediatric population 1.
Clear cell sarcoma of the kidney is the second most common primary malignant paediatric renal neoplasm after Wilms tumour, ...
Clear cell tumours of the lung are rare benign pulmonary neoplasms that contain an abundant amount of glycogen. It is often classified under the spectrum of perivascular epithelioid cell tumours (PEComas).
Usually seen as a rounded, smooth-walled, and peripheral parenchym...
CNS capillary telangiectasiae(s) are small, asymptomatic low flow vascular lesions of the brain.
As these lesions are asymptomatic, diagnosis usually matches the age of first imaging with MRI, and as such are most frequently found in middle-aged and elderly adults. Their inciden...
Coarsened hepatic echotexture is a sonographic descriptor where there uniform smooth hepatic echotexture of the liver is lost. This can occur due to number of reasons which include:
conditions that cause hepatic fibrosis 1
various types of hepatitis 3
Coeliac plexus block under image guidance is an easy and safe percutaneous procedure with good outcomes for pain palliation in patients who have chronic abdominal pain related to the coeliac ganglia.
This usually includes patients with advanced cancers, especially from upper abdominal viscera,...
Colon polyps are mucosal outgrowths of the colon wall. They are of interest to physicians and radiologists because of the accepted progression of adenomatous polyps to colon carcinoma.
adenomatous colon polyps
villous colon polyps
This is a basic article for medical students and other non-radiologists
Colorectal cancer, also called 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...
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%.
Computed tomography texture analysis (or CTTA) is a method to obtain new useful biomarkers that provide objective and quantitative assessment of tumour heterogeneity by analysing the differences and patterns within the pixel values of an image. CTs can be worked with as a matrix of numbers, corr...
With the advent of echocardiography, and cardiac CT and MRI, the role of chest x-rays 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 diagnosis ca...
A congenital neuroblastoma is defined as neuroblastoma identified within a month of birth, and is divided into :
In most cases they present as stage 1, 2 or 4S (see neuroblastoma staging).
In 90% of cases fetal neuroblastomas ar...
A handy mnemonic to recall cortically-based brain tumours is:
P: pleomorphic xanthoastrocytoma
D: dysembryoplastic neuroepithelial tumour (DNET); desmoplastic infantile astrocytoma and ganglioglioma
The CT angiogram sign refers to vessels appearing prominent during a contrast enhanced CT as they traverse an airless low attenuation portion of consolidated lung. Although initially thought to be specific for bronchoalveolar carcinoma, it has now been recognised as a generic appearance provided...
CT guided thoracic biopsy is usually performed for the diagnosis of suspicious lung, pleural or mediastinal lesions. It can be performed as an outpatient where patient monitoring and complications support are available. A small percentage of lung and pleural biopsies may be performed under ultr...
The curtain sign (or draped curtain sign) in neuroimaging refers to the appearance of a vertebral body mass that extends to the anterior epidural space.
The posterior longitudinal ligament is strongly attached to the posterior vertebral body cortex in the midline and is more loosely attached la...
Cutaneous and subcutaneous metastases are not uncommon, occurring in ~5% (range 0.7-10.4%) of internal malignancies, and representing 2% of skin cancers. The Sister Mary Joseph nodule is a well known cutaneous metastasis.
These metastases can come from haematogenous or lymphatic spre...
Cystic adrenal neoplasms are uncommon and only account for a minority of cystic adrenal lesions 3. They may be represented several histological types:
adrenal adenoma 1
adrenal cortical carcinoma 1,2
adrenal epithelioid angiosarcoma 2
teratoma (paediatric population) 4
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...
The differential for cystic lesions of the pancreas includes:
intraductal papillary mucinous neoplasm (IPMN)
serous cystadenoma uncommonly uni/macrolocular
simple pancreatic cyst
pancreatic cysts occur in association with
von Hippel Lindau syndrome
The term cystic meningioma is applied to both meningiomas with intratumoral degenerative cyst formation as well as those with peritumoral arachnoid cysts or reactive intraparenchymal cysts.
They should not be confused with microcystic meningiomas, a distinct variant, in which the cysts are mic...
Cystic or necrotic appearing lymph nodes can be caused by a number of infectious, inflammatory or malignant conditions:
squamous cell carcinoma metastases
plasmacytoid T-cell leukemia
acute myeloid leukemia
herpes simplex lymphadenit...
Cystic pulmonary metastases are atypical morphological form on pulmonary metastases where lesions manifest as distinct cystic lesions. It is slightly different form the term cavitating pulmonary metastases in that the lesions are extremely thin walled.
It has been reported with many ...
The Deauville five-point scale (Deauville 5ps) is an internationally-recommended scale for routine clinical reporting and clinical trials using FDG-PET/CT in the initial staging and assessment of treatment response in Hodgkin lymphoma (HL) and certain types of non-Hodgkin lymphomas (NHL).
The deep inguinal nodes are located within the femoral sheath, medial to the femoral vein. They receive afferent lymphatic drainage from the deep lymphatics of the distal lower extremity and perineum (e.g. glans penis / clitoris), and drain proximally into external iliac lymph nodes via channels...
The dense hilum sign suggests a pathological process at the hilum or in the lung anterior or posterior to the hilum. Malignancy, especially lung cancer, should be suspected.
On a well-centred chest posteroanterior (PA) radiograph the density of the hilum is comparable on ...
Dermatofibrosarcoma protuberans (DFSP) is a low-grade malignant tumour arising from dermal and subcutaneous tissues, and is the most common cutaneous sarcoma (although overall still quite rare). It is most commonly found at the trunk and proximal extremities 6.
Its behaviour is notable for a hi...
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...
Desmoid tumours are benign, non-inflammatory fibroblastic tumours (see WHO 2002 classification of soft tissue tumours) with a tendency for local invasion and recurrence but without metastasis.
The terms desmoid tumour and aggressive fibromatosis are occasionally used synonymously b...
Desmoplastic fibromas are extremely rare bone tumours that do not metastasise but may be locally aggressive. They are considered to be a bony counterpart of soft tissue desmoid tumours and are histologically identical.
Incidence is ~0.3%. The most common areas of involve...
Desmoplastic small round cell tumours are a rare and highly aggressive primary peritoneal malignancy.
They are usually seen in young adolescents and has male predominance with a mean survival of 2-3 years.
It usually presents with a palpable abdominal mass ...
Diabetic mastopathy is a condition characterised by the presence of a benign tumour like breast masses in women with long-standing type 1 or type 2 insulin-dependent diabetes. The condition has also been reported in men. A similar condition is lymphocytic mastitis but this occurs in non-diabetic...
A gas filled focal collection in the right upper upper quadrant on plain film can occur from a number of pathologies. Things to consider are
entero biliary fistula : common types include cholecysto-duodenal fistula and cholecysto-colic fistula and. Can occur with
gallstone ileus (majority of ...
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...
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...
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)
Diffuse brainstem gliomas, also known as diffuse intrinsic brainstem glioma (DIBG), is a term used to describe infiltrating astrocytomas, no longer recognised as a distinct entity in the 2016 update to the WHO classification of CNS tumours. It encompassed a variety of tumours, ranging from WHO g...
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)
Distal appendicular skeletal metastases, especially distal to the knee and elbow joints, are uncommon.
Localised pain and swelling, along with pathological fractures, are the most common 3.
Malignancies that most commonly spread to appendicular ske...
Drash syndrome, also known as the Denys-Drash syndrome, is associated with an abnormal WT1 gene (Wilms tumour gene) and consists of:
A ductal adenoma of the breast is a benign glandular tumour of the breast that usually fills and distends the ductal lumen.
They may occur in women of all ages, although the majority of patients are 60 years of age or greater 3.
Ductal adenomas usually pres...
Duodenal filling defects may be caused by a wide variety of duodenal pathology which may be divided by their location and pathological process.
common bile duct impression
Note: please refer to duodenal mucosal nodular fill...
Dural or pachymeningeal metastases are a relatively common cause of dural masses, although they are less common than brain metastases and meningiomas. They can occur both within the spine and intracranially - this article is focussed on intracranial dural masses.
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...
Dysplastic liver nodules are focal nodular regions (≥1 mm) without definite evidence of malignancy.
They have been found in cirrhotic patients with a prevalence of 14% (size >1.0 cm) to 37% (size >0.5 cm) 2.
Epstein-Barr virus-associated smooth muscle tumours (EBV-SMT) are rare and encountered in immunocompromised individuals.
These tumours are generally exceedingly rare, and only seen with any frequency in the setting of immunosuppression, particularly in HIV/AIDS patients, but also ...
The Eastern Cooperative Oncology Group (ECOG) is one of the largest clinical cancer research organizations in the United States and conducts clinical trials in all types of adult cancers.
The ECOG performance status is a scale used to assess how a patient's disease is progressing, assess how th...
Elevated vitamin B12 (also known as hypervitaminosis B12 or hypercobalaminaemia) is most important as a diagnostic and prognostic marker for malignant disease 1,3. Very high serum levels of vitamin B12 do not seem to have any observable deleterious effects 2.
Endometrial carcinoma is generally considered the most common gynaecological malignancy 1,5. It frequently presents with vaginal bleeding. Both ultrasound and pelvic MRI are useful modalities for evaluation.
Endometrial carcinoma is the most common gynaecological malignancy, with ...
Endometrial hyperplasia is abnormal proliferation of the endometrial glands and stroma, defined as diffuse smooth thickening >10 mm 13. One of the main concerns is the potential malignant transformation of the endometrial hyperplasia to endometrial carcinoma.
Endosteal scalloping refers to the focal resorption of the inner layer of the cortex (i.e. the endosteum) of bones, most typically long bones, due to slow-growing medullary lesions.
It is important to note that although it is evidence of a slow non-infiltrative lesion, it does not equate to ben...
Engraftment syndrome (ES) refers to a potential early complication of haematopoetic stem cell transplantation. It is thought to be related to increased capillary permeability and comprises of a combination of symptoms and signs which include
erythrodermatous skin rash
Eosinophils (or less commonly acidophiles) are myeloid granulocytes and form one of the main types of white blood cells. Their counts are routinely measured as part of a full blood count. They have important roles in fighting parasitic infections, but it is increasingly recognised that they have...
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...
Ewing sarcoma is the second most common highly malignant primary bone tumour of childhood after osteosarcoma, typically arising from medullary cavity with invasion of Haversian system. They usually present as moth-eaten destructive permeative lucent lesions in the shaft of long bones with large ...
Exophytic is a descriptive term used by radiologists/pathologists to describe solid organ lesions arising from the outer surface of the organ of origin.
Literally exophytic only refers to those lesions arising from the outer surface, however radiologists and pathologists use the term to include...
Extramedullary haematopoiesis is a response to the failure of erythropoiesis in the bone marrow.
This article aims to a general approach on the condition, for a dedicated discussion for a particularly involved organ, please refer to the specific articles on:
extramedullary haematopoiesis in t...
Extramedullary haematopoiesis in the spleen represents a physiologic compensatory event that may be seen in many haematologic diseases leading to chronic anaemia. The liver and the spleen are the most common site of extramedullary haematopoiesis, both usually manifesting on imaging as organomega...
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.
Familial adenomatous polyposis syndrome (FAPS) is characterised by the presence of hundreds of adenomatous polyps in the colon. It is the most common of the polyposis syndromes.
Familial polyposis coli, attenuated familial adenomatous polyposis and Gardner syndrome are all variants...
Fascicular sign is a finding on T2-weighted MRI images that suggests a lesion of neurogenic origin. It is characterised by multiple small ring-like structures with peripheral hyperintensity representing the fascicular bundles within the nerves.
It is found in various neurogenic tumours, includi...
Fetal cardiac tumours refer to primary cardiac tumours that can present in the in utero population.
Fetal cardiac tumours are rare; the prevalence, reported from autopsy studies of patients of all ages, varies from 0.0017-0.28 % 2.
Known cardiac tumour types that pres...
Fibrinous pericarditis results from fine granular roughening of the pericardium.
Pericardial friction rub may be heard.
acute rheumatic fever
myocardial infarction: Dressler syndrome
chronic renal fail...
Fibrolamellar hepatocellular carcinoma is a distinct histological variant of hepatocellular carcinoma characterised on microscopy by laminated fibrous layers between the tumour cells. It is important as it has different demographics and risk factors compared to 'standard' hepatocellular carcinom...
Fibrosarcoma of the breast is a type of malignant stromal sarcoma that rarely occurs as a primary tumour within the breast.
A fibrosarcoma is composed of immature mesenchymal elements surrounded by a collagenous substance. It is a type of breast sarcoma with a predominant “herringbo...
The FIGO staging systems are determined by the International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d’Obstétrique).
In general, there are five stages:
stage 0: carcinoma in situ (common in cervical, vaginal, and vulval cancer)
stage I: confined to...
Finger clubbing, also called "drumstick fingers", is a common clinical sign in patients with heart or lung disease. The term is used to describe an enlargement of the distal phalanges of the fingers, giving them a drumstick or club-like appearance.
Finger clubbing presen...
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 ...
Fluid-fluid levels in bone tumours is a commonly encountered finding, both in benign as well as malignant bone tumours, and can be used to differentiate between the two.
Method of assessment
On the sagittal T2W image:
measure the length of the largest fluid-fluid level (A)
measure the maximu...
Fluorine-18-labeled sodium fluoride (also known as 18F-NaF or sodium fluoride) is a PET radiotracer used primarily for skeletal imaging.
Fluorine-18-labeled sodium fluoride is an ionic compound comprised of a single sodium atom bound to a positron-emitting isotope of fluorine.
Focal fatty sparing of the liver is the localised absence of increased intracellular hepatic fat, in a liver otherwise fatty in appearance i.e. diffuse hepatic steatosis. Recognition of this finding is important to prevent the erroneous belief that the region of sparing is itself a mass.
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
Follicular lymphoma is the most common subtype of non-Hodgkin lymphoma (NHL)
Estimated to account for ~45% of all NHL cases 1. Higher rates in North America and Europe 4.
Nodal effacement by closely packed follicles containing small cleaved cells without nucleoli (cen...
Follicular thyroid carcinoma (FTC) is the second most frequent malignancy of the thyroid gland after papillary cancer and accounts for ≈10-20% of all thyroid neoplasms.
It typically occurs in women and in an older age group than papillary (i.e. 40-60 years of age).
Fukuoka consensus guidelines, also referred to as the Tanaka criteria, is a classification system for intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs).
The prior international consensus guidelines (2006) were referred to as the Sendai criteria, which later ...
68Ga-DOTATATE is a PET radiotracer that is useful for evaluating primary and metastatic well-differentiated neuroendocrine tumours. It is a form of somatostatin-receptor (SSTR) functional imaging and most often combined with cross-sectional imaging in the form of PET/CT.
Gallbladder carcinomas are usually asymptomatic until they reach an incurable stage. As such, early incidental detection is important, if the occasional patient is to be successfully treated. The majority (90%) are adenocarcinomas, and the remainder is squamous cell carcinomas.
Gallbladder metastases are rare and usually represent an advanced and end-stage of malignancy.
They represent <5% of all gallbladder cancers 1.
Most patients with gallbladder metastases are asymptomatic, and the metastases are detected on surveillance or st...
Gangliogliomas are uncommon, usually low-grade, CNS tumours. Epilepsy is a common clinical presentation and this tumour has a typical occurrence in the temporal lobes, although they have been described in all parts of the central nervous system.
Their appearance on imaging is very variable: fro...
Gastric adenocarcinoma, commonly referred to as gastric cancer, refers to a primary malignancy arising from the gastric epithelium. It is the most common gastric malignancy.
Gastric cancer is rare before the age of 40, but its incidence steadily climbs after that and peaks in the...
This is a basic article for medical students and other non-radiologists
Gastric cancer, also known as stomach cancer or gastric carcinoma, refers to a cancer that arises from the mucosal lining of the stomach. It is the commonest gastric malignancy.
This is a summary article...