Multiple Myeloma

Multiple myeloma is a cancer in which abnormal cells called myeloma cells collect in the bone marrow and form tumors. If only one single tumor forms within the bone this is referred to as a plasmacytoma. Multiple myeloma occurs when these cells collect in multiple bones and forming more than one tumor. This type of disease generally affects patients above the age of 60. Symptoms may include back pain and kidney dysfunction. MRI scans are utilized for diagnosing multiple myeloma. Typical multiple myeloma appearance is low signal intensity on a T1 weighted image. On a T2 weighted image signal intensity is high. Multiple myeloma lesions some what enhance post injection of gadolinium injections. Mulitple myeloma may present in MRI's as other musculosketal tumors so other blood tests and or bone marrow aspirations will have to be utilized for proper diagnosis. Treatment may include chemotherapy and radiation therapy. The prognosis of patients with multiple myeloma are dependant upon success of treatment and how extensive the disease has progressed.

Schmorl's Nodes

I chose Schmorl's nodes since I do MRI and have clinically seen this pathology. Schmorl's nodes are believed to be associated with trauma but a possible congenital origin of a vertebrae end plate defect can not be ruled out. A Schmorl's node is a herniation to the nucleus pulposus of the intravertebral disk through the vertebral end plate. Most patients present with back pain and usually at the thoracolumbar junction. Most patients seem to be able to recall a time when they experienced trauma or a twinge of pain in their back during some type of movement. The injury may have occurred during a sport, exercising, or even moving something while twisting their back. Some Schmorl's nodes may show up on radiographs, but CT and MRI of the spine are the modality of choice. Once diagnosed, patients may be told to take an anti-inflammatory and told to stay away from strenuous activity. Rest will aid in the repair of the disk. Traction and newer developments of non surgical spinal decompression may also be utilized. Prognosis for most patients is very good. Patients may become for susceptible to this same type of pathology in the future.

Cervical Discitis

Discitis is when the vertebral disc space becomes inflamed often related to infection. Vertebral osteomyelitis may also occur due to the fact this condition share much of the same symptoms and treatment. An infection usually does not originate with in the vertebra, but rather through the blood stream spreading from other sites. Pneumonia and urinary tract infections are just a couple of known infections which may spread to the vertebral disc space. Discitis from surgical procedures is very rare, but may occur. Symptoms include neck or back pain. Some patients may present with a fever. Discitis may be detected on x-rays, CT scans, or MRI images. MRI is the modality of choice, since an MRI is able to demonstrate the narrowing of the disk space and the edema associated with the infection. IV antibiotics are used for treatment. If left untreated, death may be the outcome.

Carotid Body Tumor

I chose to write about carotid body tumors because it is a pathology I have not seen clinically. Carotid body tumors are also called paragangilomas or chemodectomas. These particular tumors are found at the branching of the carotid artery and may occur bilaterally. Symptoms of a carotid body tumor may be painless neck masses or hoarseness with in the throat located laterally to the hyoid bone. MRI/CT angiography imaging is utilized with diagnosis of these particular tumors. Patients diagnosed with these tumors have a good prognosis. They may be aggressive, so surgical removal is the patients best option. Prior to surgery some patients might endure a trans catheter embolization. Surgeons utilize this procedure to reduce the blood supply to the tumor. Radiation therapy may also be utilized in treatment.

Carcinoma of the Tongue

Tongue cancer is more common in patients older than 40. Most patients are heavy drinkers and or smokers. Some patients with chronic viral infections may develop into any type of head and neck cancer. Oral exams performed by a dentist may be utilized to diagnosis carcinomas of the tongue. Soft tissue neck MRI's may be used to determine any lymph node involvement and size of tumor. Biopsy will also be needed to diagnosis tumors. Surgery to remove the carcinomas may result in difficulties in swallowing and speech. Radiation therapy may also be utilized. Early diagnosis is key. If caught early, patients may likelihood of developing metastatic disease decreases.

Trigeminal Neuralgia

I am very familiar with this certain pathology because we run extra scans post contrast with our head protocols if patients present with facial pain. The reason they stick out in my mind so much is because these extra scans take at least eight minutes each so I am always set back on my schedule. :) Trigeminal neuralgia is swelling or inflammation of the nerve that delivers feeling to the face. Symptoms may include pain on one side of the face. Sharp spasms may also occur. Pain may also occur while chewing, drinking, shaving, or brushing teeth. No causes can be found, however abnormal blood vessels have been linked to trigeminal neuralgia. MRI is the best modality for diagnosis. Fine cuts are ran from C3 to inferior aspect of the orbit post contrast with fat saturation. Medications may be used but many patients have had a hard time with the long term. Surgery may be utilized to relieve pressure on the nerve. Patients who are not likely candidates for surgery may undergo radiation treatment to the nerve root.

Sinusitis

Sinusitis is when your sinuses become inflamed or infected. Acute sinusitis usually starts out with a common cold. Common colds can inflame the sinuses. If the symptoms do not go away after a few weeks the inflammation caused by the cold may result in swelling of the lining of the sinuses. Trapped mucous in the sinuses becomes ideal conditions for bacteria to grow. In chronic sinusitis the membranes are always thickened because the are constantly inflamed. Most people with chronic sinusitis also have asthma and allergies. Also, people with deviated septum may also develop chronic sinusitis. Symptoms may include headaches, jaw and tooth aches, facial swelling, stuffed up nose, ear aches, cough, and sore throat. CT scans are utilized to diagnose sinusitis based on fluid and air levels seen. Treatment for sinusitis may include antibiotics, nasal steroid spray, and pain relievers. When medicine does not work patients may have surgery. The surgeon will reduce the the blockage of the nasal passages and improve sinus drainage.

Orbital Meningiomas

Orbital Meningiomas are slow growing neoplasms. They can affect the cavernous sinus, optic nerve, and the intraorbital contents. Orbital meningiomas may also invade adjacent orbital tissue, bone, dura and muscle. These meningiomas are more common in adults and are rarely seen with children. Symptoms may include proptosis, visual disturbances, diplopia, and headaches. CT may be utilized for diagnosis, but a MRI is the modality of choice. Thinner slices of the orbits are utilized along with contrast to demonstrate the hyperintense tumor. The treatment plan depends on the age of the patient. With older patients follow up MRI's are utilized. With older patients these meningiomas tend to grow at a much slower rate. Younger patients usually under the age of 40 seem to have more aggresive lesions and should be removed surgically. A side effect from surgery may be visual loss due to the origin of the meningioma and size. After surgical removing, patients' prognosis is great with recurrences being very rare.

Prolactinoma

Prolactinomas produce an excessive amount of the hormone prolactin. Prolactin is a hormone produced by the pituitary gland which aids in breast milk production. Some of the symptoms for women may include the production of breast milk without giving birth, irregular or loss of menstrual cycle, and decrease in libido. Men's symptoms may include gynecomastia. With large pituitary adenomas also called macroadenomas symptoms may also include headache, vision impairment, and pituitary failure. A MRI with thinner slices though the pituitary gland can adequately diagnose prolactinomas. Treatment plans for patients with small prolactinomas include medication to regulate prolactin levels. With medication the prolactinoma may be reduced in size. When medication is not affective, surgery is considered. These adenomas may be removed by transphenoidal surgery. Radiation is also an option for treatment. Prognosis for patients with smaller prolactinomas is great. Larger adenomas need aggressive treatment otherwise they may continue to grow. Follow up pituitary MRI scans are also recommended.

Squamous Cell Cancer of the Middle Ear

Squamous cell tumors of the middle ear are very uncommon. Most patients who present with squamous cell tumors are known to have chronic ear infections. The correlation between the infections and tumors is still undetermined. Symptoms include pain, hearing loss, facial paralysis, and bleeding for an extended time. The only way to diagnose these tumors is by a biopsy of the tissue. Once the biopsy report comes back positive for malignancy, a MRI or CT must be attained before surgery may be performed. These modalities allow the surgeon to know the extent of the tumor. A MRI can be used to see the extent of the tumor into soft tissues. More importantly the parotid gland and the dura of the brain. Once the tumor has spread to the dura, chances of curing squamous cell cancer are not promising. CT scans can show the extensive damage to the surrounding bones. The prognosis for patients depends on how invasive the cancer has become. Squamous cell cancer of the middle ear can be fatal if left untreated. Once diagnosed patients are rushed into surgery. The treatment plan will also include radiation therapy.

Glioblastomas

I decided to write about glioblasotomas. Hearing about Ted Kennedy passing away, and my experience with patients who come in for MRI scans, made me want to learn more about them. Glioblastomas are the most aggressive type of primary brain tumor. Symptoms are directly related to the location of the tumor. Most brain tumors are asymptomatic until they have grown. Symptoms may include but are not limited too seizures, progressive memory loss, headache, and personality changes. MRI is the modality of choice when it comes to diagnosing glioblastomas. These tumors appear as ring enhancing lesions post contrast. Multiple scelerosis, absessess, and metastatic cancer also display ring like enhancement post contrast, so a biopsy is needed. Surgery is the first option due to the fact most patients need relief from what structure the tumor is pressing on. Radiation and chemotherapy are also utilized during the treatment plan. Unfortunately glioblastomas often grow back within or near the original site of the brain. With that being said the prognosis for patients with glioblastomas are not favorable. Patients who choose to not have any treatments have a survival rate of about five months. Patients who choose to have surgery, radiation, and chemotherapy may live up to fifteen months. Obviously with any type of cancer, early or late detection, patients age, health and size of tumor may change these outcomes listed above.