Renovascular hypertension in a 12 month old boy: what can the radiologist do?

We report a clinical case of renovascular disease, probably linked to fibromuscular dysplasia, in a 12 months old boy with severe arterial hypertension with target-organ damage, highlighting the radiological approach. Initial investigation included renal ultrasound that showed normal sized kidneys, with normal cortical echogenicity on the right and focally increased echogenicity of the posterior aspect of the left kidney, forming a mass-like lesion. Magnetic resonance imaging excluded renal tumor, which was confirmed by ultrasound guided biopsy. A doppler ultrasonography was also performed suggesting a right renal artery stenosis and decreased flow to the posterior aspect of the left kidney. Angiography with diagnostic and therapeutic intention was performed: right renal artery stenosis was detected and transluminal ballon dilation was performed; the left renal artery bifurcated precociously and the branch that irrigated the posterior part of the kidney had a stenosis which was also successfully dilated. After the intervention good blood pressure control with antihypertensive drugs was achieved, which was not possible before the angiographic procedure. The authors underline various methods of imaging used to accurately diagnose renovascular disease and the usefulness of interventional radiology treatment for this disease in very young children.

Primary gastric choriocarcinoma: A rare case

Introduction Primary gastric choriocarcinoma accounts for 0.08% of all gastric cancers. It is a rapidly growing, widely metastatic and β-HCG-producing tumour of trophoblastic cells. Presentation of case A 69-year-old white man presented to the hospital with symptomatic anaemia. An upper gastrointestinal endoscopy showed an ulcer of the cardia and lesser curvature, whose biopsy specimens proved to be malignant (carcinoma cells, non-specified). The patient underwent total gastrectomy with D2 lymphadenectomy. A histologic evaluation revealed a choriocarcinoma admixed with adenocarcinoma cells without lymph node metastases. The patient died from haemorrhagic shock, due to rupture of liver metastases and a massive haemoperitoneum, within 2 months of the initial presentation. Discussion Primary gastric choriocarcinoma characteristics resemble those of gastric primary adenocarcinoma. The dedifferentiation theory is the most widely accepted theory to explain the pathogenesis of PGC. It is essential to rule out other possible primary lesions such as testicular tumour. The optimal treatment is not yet well established due to very few reported cases. Conclusion Primary gastric choriocarcinoma is a rare tumour with an aggressive behaviour and very poor prognosis.