Staging Malignancies in the Radiology Lounge
The following images from the Internet provide an overview of the diagnostic methodology of this service.
Click on the link to view the image.
Case courtesy of Ian Bickle
The most obvious T4 is the masticator space, i.e., involvement of the medial pterygoid muscle. The presence of infratemporal fossa involvement and carotid space involvement due to occlusion of the left internal jugular vein by tumor invasion may also be a factor for T4.
The presence of bilateral supraclavicular fossa lymph node metastases is also a factor in determining the diagnosis as N3.
Case courtesy of Bruno Di Muzio
An irregularly shaped tumor in the left upper lobe, which appears to be a lung carcinoma, is widely contiguous with the interlobar space, and there is pleural thickening contiguous with the tumor, which raises the suspicion of visceral pleural invasion.
In addition, a large lymph node is found under the aorta, which raises the suspicion of ipsilateral mediastinal lymph node metastasis (N2).
Case courtesy of Ahmed Abdrabou
An early phase, poorly contrasted tumor in the head of the pancreas is thought to be pancreatic cancer, and the upstream main pancreatic duct is noticeably dilated. Dorsal invasion into the surrounding tissues is seen and is at least T3. Soft tissue contiguous with the tumor is seen around the celiac artery and superior mesenteric artery, giving the impression that there is at least some plexus invasion, and some of the soft tissue appears to be circumferential in nature, a finding that cannot be ruled out as invasion. As for the portal vein, it is difficult to determine whether it is only a compression deformity or invasion.
As for lymph node metastasis, there are only small localized lymph nodes, and they are probably N1 or smaller.
Case courtesy of Hidayatullah Hamidi
The low contrast area from the uterine lumen to the myometrium appears to be endometrial carcinoma, and the uterine body retains a strong contrast effect of the normal myometrium, confirming that it remains within the myometrium. On the other hand, the lesion is contrasted to the right side of the cervical myometrium with limited diffusion and is diagnosed as stage II or higher with cervical invasion.
Bilateral pelvic findings with undeniable lymph node metastasis may lead to stage IIIC1.
Case courtesy of Joachim Feger
T2-weighted T2-weighted images show a low-signal tumor in the left lobe of the extraprostatic gland with diffusion limitation, which is suspicious for prostate cancer, with a slightly irregular capsular surface and undeniable perineural invasion, and a clear seminal vesicle line, leading to a diagnosis of T3b.
Click on the link to view the image.
Head & Neck
(https://radiopaedia.org/cases/59376/studies/67000?lang=us)
Case courtesy of Ian Bickle
The most obvious T4 is the masticator space, i.e., involvement of the medial pterygoid muscle. The presence of infratemporal fossa involvement and carotid space involvement due to occlusion of the left internal jugular vein by tumor invasion may also be a factor for T4.
The presence of bilateral supraclavicular fossa lymph node metastases is also a factor in determining the diagnosis as N3.
Lung Cancer
(https://radiopaedia.org/cases/59871/studies/67325?lang=us&source_of=https%3A%2F%2Fradiopaedia.org%2Farticles%2Flung-cancer- staging-iaslc-8th-edition#images)Case courtesy of Bruno Di Muzio
An irregularly shaped tumor in the left upper lobe, which appears to be a lung carcinoma, is widely contiguous with the interlobar space, and there is pleural thickening contiguous with the tumor, which raises the suspicion of visceral pleural invasion.
In addition, a large lymph node is found under the aorta, which raises the suspicion of ipsilateral mediastinal lymph node metastasis (N2).
Pancreatic Cancer
(https://radiopaedia.org/cases/24322/studies/24601?lang=us&source_of=https%3A%2F%2Fradiopaedia.org%2Farticles%2Fpancreatic-cancer- staging#images)Case courtesy of Ahmed Abdrabou
An early phase, poorly contrasted tumor in the head of the pancreas is thought to be pancreatic cancer, and the upstream main pancreatic duct is noticeably dilated. Dorsal invasion into the surrounding tissues is seen and is at least T3. Soft tissue contiguous with the tumor is seen around the celiac artery and superior mesenteric artery, giving the impression that there is at least some plexus invasion, and some of the soft tissue appears to be circumferential in nature, a finding that cannot be ruled out as invasion. As for the portal vein, it is difficult to determine whether it is only a compression deformity or invasion.
As for lymph node metastasis, there are only small localized lymph nodes, and they are probably N1 or smaller.
Endometrial carcinoma
(https://radiopaedia.org/cases/83136/studies/97507?lang=us&source_of=https%3A%2F%2Fradiopaedia.org%2Farticles%2Fendometrial- carcinoma-staging-2)Case courtesy of Hidayatullah Hamidi
The low contrast area from the uterine lumen to the myometrium appears to be endometrial carcinoma, and the uterine body retains a strong contrast effect of the normal myometrium, confirming that it remains within the myometrium. On the other hand, the lesion is contrasted to the right side of the cervical myometrium with limited diffusion and is diagnosed as stage II or higher with cervical invasion.
Bilateral pelvic findings with undeniable lymph node metastasis may lead to stage IIIC1.
Prostate Cancer
(https://radiopaedia.org/cases/73245/studies/83978?lang=us)Case courtesy of Joachim Feger
T2-weighted T2-weighted images show a low-signal tumor in the left lobe of the extraprostatic gland with diffusion limitation, which is suspicious for prostate cancer, with a slightly irregular capsular surface and undeniable perineural invasion, and a clear seminal vesicle line, leading to a diagnosis of T3b.