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VRU 2007 Flashcards

1
Q

What are the top breeds for skeletal histiocytic sarcoma? And age?

A

Goldens

Rotties

Over 5 years of age

History of lameness or neurologic deficits

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2
Q

Where does skeletal histiocytic sarcoma like to be located?

A

Periarticular - most common!

Vertebral

Proximal humerus - Differential for primary bone tumor

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3
Q

Most skeletal histiocytic sarcomas have what associated with the bony destruction?

A

Soft tissue mass

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4
Q

Periarticular histiocytic sarcoma likely involves multiple periarticular bones or just one?

A

Multiple. It is likely the histiocytes come from the synovium.

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5
Q

What two characteristics are associated with diseeminated histiocytic sarcoma disease?

A
  1. Rotties - All rotties had disseminated disease
  2. Bony involvement.

Disseminated is multiple organs while local is one organ with LN involvement.

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6
Q

Rose et al: Standing myelogram in horse: What contrast was used?

A

iohexol - non-ionic Monomer

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7
Q

Rose et al: Standing myelogram in horse: Why did the other advise against a cervical approach?

A

Lack of consistently good flow.

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8
Q

What should be the cutoff days for letting cats go (in days) be after I131 treatment due to Surface containation (from licking (saliva) and urination).

A

7 days

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9
Q

Marolf et al: Tracheal collapse and bronchiectasis in dogs: How much more times are dogs with tracheal collapse likely to have bronchiectasis?

A

6x more likely.

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10
Q

Marolf et al: Tracheal collapse and bronchiectasis in dogs: Why are dogs with tracheal collapse predisposed to bronchiectasis?

A

Tracheal collapse is related to chronic inflammation and mucosal congestion hindering the mucociliary clearance

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11
Q

Marolf et al: Tracheal collapse and bronchiectasis in dogs: What percentage of dogs had bronchiectasis in just one lobe vs multiple? which lobe was most affected?

A

50/50 with the cranial lung lobes being most affected.

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12
Q

Kinns et al: Malignant LN and US hetterogeneity: What was the percentage of heterogeneous LN that were malignant in dogs and cats, and was this significant?

A

Dogs: 91% of heterogenous LN were malignant - Yes significance

Cats: 63% of heter LN were malignant - NO significance - LIKELY do to most of cat neoplasia is lymphoma

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13
Q

Martinez et al: Hypoechoic renal subcapsular thickening and lymphoma in cats: What was the PPV, NPV sensitivity and specificity of renal hypoechoic subcapsular thickening being lymphosarcoma?

A

PPV: 81%

NPV: 67%

Sensitivity: 61%

Specificity: 85%

This means that if you have it it is likely lymphoma… if you don’t have it…still could be lymphoma!

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14
Q

Martinez et al: Hypoechoic renal subcapsular thickening and lymphoma in cats: Renal lymphoma represents what percentage of all lymphomas in cats?

A

5-20%

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15
Q

Martinez et al: Hypoechoic renal subcapsular thickening and lymphoma in cats: What was the most common appearance? Crescent shaped or rim-like?

A

Crescent shaped.

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16
Q

Martinez et al: Hypoechoic renal subcapsular thickening and lymphoma in cats: Uncommon differentials for this finding?

A

Different types of neoplasia

Chronic active nephritis from FIP.

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17
Q

Ohlerth et al: Contrast harmonic normal dog spleen: What was the peak intensity and time to peak enhancement?

A
  1. 6dB
  2. 6s
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18
Q

Ohlerth et al: Contrast harmonic normal dog spleen: Was there a significant difference between weight groups in peak intensity, time to peak or AUC?

A

No.. no associatation found with CBC differences, blood pressure, HR, age, gender… NOTHING.

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19
Q

Cole et al: CECT auditory tube: Explain the procedure?

A

Dog in lateral recumbency

Myringotomy was made

Contrast infused into the ear canal and middle ear with a balloon-tip catheter (1:1 ratio of water to Contrast)

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20
Q

Contrast ear canalography with 1:1 iohexol showed what type of adverse reactions?

A

NONE: but they flushed after.

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21
Q

Iseri et al: Pancreatic CECT in dogs: What was the normal arterial and pancreatic times for enhancement? What was the normal enhancement values of the pancreas?

A

15s arterial

28s pancreatic

118+/- 16 HU for pancreas.

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22
Q

Iseri et al: Pancreatic CECT in dogs: when was the highest difference between the insulinoma HU and normal pancreatic HU?

A

The arterial phase!

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23
Q

What is the most common canine pancreatic endocrine tumor?

A

Insulinoma.

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24
Q

Van der et al: Dynamic CT for Pituitary gland: What is the best protocol for pituitary gland scanning?

A

1 mm slices

pitch of 2.

Differentiates neuro from adenohypophysis.

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25
Q

Thomason et al: Changes in dorasl acetabular ridge and rotation of hips; Ventral rotation will cause the acetabulum to look smaller or larger?

A

Smaller

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26
Q

O’Brien: Detection of hepatic hemangio mets CEUS; What were the appearance of the nodules after CE?

A

Hypoechoic — lack of normal blood architechture.

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27
Q

Hecht et al: Pancreatic neoplasia and nodular hyperplasia cats; What was the only unique imaging finding in malignant pancreatic tumors?

A

Single pancreatic nodule

Mass exceeding 2 cm

Nodular hyperplasia had lymphadenopathy, abdominal effusion, and mass effect on rads.

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28
Q

Hecht et al: Pancreatic neoplasia and nodular hyperplasia cats; What was the most common radiographic finding of pancreatic nodular hyperplasia? Neoplasia?

A

Mass effect. - nodular hyperplasia

Mass effect and abdominal effusion - neoplasia

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29
Q

Can US and rads replace cytology when dealing with neoplasia vs nodular hyperplasia of the pancreas in a cat?

A

NO

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30
Q

Kneissl et al: MRI features of orital inflammation: What canals were used for intracranial extension? Which one was most common?

A

Optic canal

Orbital fissure — most common

Alar canal

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31
Q

Kneissl et al: MRI features of orital inflammation: What sequences were most helpful?

A

Transverse- T2

Dorsal - STIR

Trans or dorsal - Post contrast

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32
Q

Holloway et al: Perirenal effusion in dogs and cats with AKI: Was the volume of the perirenal fluid associated with severity of renal dysfunction?

A

No.

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33
Q

Holloway et al: Perirenal effusion in dogs and cats with AKI: How is perirenal fluid developed?

A

Ultrafiltrate that backs up into the renal interstitium from the tubules that then overwhelms the lymphatics

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34
Q

Holloway et al: Perirenal effusion in dogs and cats with AKI: Common renal changes associated with perirenal effusion?

A

Pyelectasia

Increase renal echogenicity

Change in size (mostly increased)

Ureteral or renal calculi.

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35
Q

Thoracic histiocytic sarcoma characteristics are?

A

Lymphadenopathy, pleural effusion.

Right middle lung lobe.

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36
Q

Cole et al: Transsplenic portal scintigraphy 99mTc -Mebrofenin: What was the time to peak liver activity and 1/2 life of hepatic excretion? Visulaization of defined biliary activity?

A

2-4min - Peak activity

6-11 min - biliary tree visualization

13-26min- 1/2 of hepatic excretion

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37
Q

Cole et al: Transsplenic portal scintigraphy 99mTc -Mebrofenin: Why could transit times not be calculated like with 99mTc - pertech?

A

Due to the large amount of hepatic extraction of mebrofenin.

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38
Q

What is the normal hepatic extraction efficiency of 99mtc-mebrofenin? What would be seen if hepatic failure?

A

>90%

Blood pooliing and cardiac activity. (lack of extraction)

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39
Q

Trasch et al: US of canine mastitis: What was the characteristics of infected mammary gland tissue?

A

Loss of distinct layering

Reuced echogenicity

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40
Q

Trasch et al: US of canine mastitis: What might be able to predict outcomes of mastitis?

A

Doppler - Reduced blood vessel density centrally

B-Mode was not able to do this.

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41
Q

H van et al: CT of the pituitary gland in healthy dogs; Which portion of the pituitary gland enhances first?

A

Neurohypophysis.. which is more caudal (posterior)

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42
Q

H van et al: CT of the pituitary gland in healthy dogs; Where does the neurohypophysis originate from and where does the adenohypophysis originated from?

A

Neurohypohysis = neuro diencephalon tissue

Adenohypophysis = roof of nasal cavity.

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43
Q

Seiler et al: CT features of skull osteomyelitis in dogs: Osteomyelitis was most commonly caused by what?

A

Trauma or bite wounds with Staph aureus being the most common pathogen.

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44
Q

Seiler et al: CT features of skull osteomyelitis in dogs: Where are the common sites for osteomyelitis and why?

A

Long bones and vertebrae of growing animals

Bacteria migrate to metaphyses and epiphyses where sluggish and turbulent blood flow in the venous sinusoids in the growing bone facilitates bacterial seeding.

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45
Q

Seiler et al: CT features of skull osteomyelitis in dogs: What are the radiographic appearances of osteomyelitis?

A

Multifocal bone lysis

Poorly defined margins

Sclerosis

Irregular periosteal reacion

Sequestra

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46
Q

Seiler et al: CT features of skull osteomyelitis in dogs: The features in this studyy were aggressive or subtle?

A

Very aggressive with extensive bone lysis, proliferation and soft tissue thickening.

Juvenile neoplasia: Osteosarc, lymphoma, Ewing’s Sarcoma are hard to destinugish

Osteomyeolitis is commonly more sclerosis and periosteal reaction and not lysis

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47
Q

Taeymans et al: US of hypothyroid dogs: What first presentation charactistics of the thyroid gland (if all 5 combined) gave a 94% sensitivity in detection of acquired hypothroidism?

A

Decreased echogenicity - 77% sensitive by itself

Inhomogeneity - 65%

Irregualr capsule delineation - 71%

Abnormal lobe shape - 65%

Decreased relative thyroid volume - 47%

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48
Q

Taeymans et al: US of hypothyroid dogs: What is the advocated cut-off for normal volume of a canine thyroid gland?

A

0.05ml/kg0.75

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49
Q

Schultz et al: MRI of Trigem disorders: What were the two histopath diagnosis?

A

Neuritis (2/6)

Nerve sheath tumor (4/6)

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50
Q

Schultz et al: MRI of Trigem disorders: What was the main difference between neuritis and Nerve shealth tumors?

A

Neuritis - hyperintense on T2, diffuse enlargment of the nerve

NST- Isointense on T2, Focal mass (picture)

51
Q

Schultz et al: MRI of Trigem disorders: What was the clinical sign seen in all dogs with neuritis and nerve shealth tumors?

A

Masticatory muscle atrophy. T1 hyperintensity in the muscle.

Decreased facial and corneal sensation

52
Q

Smith et al: US intestinal hyperechoic mucosal striations in dogs: What do they hyperechoic striation mean on US?

A

Lacteal dilation

53
Q

Smith et al: US intestinal hyperechoic mucosal striations in dogs: What is lacteal dilation frequently associated with?

A

Mucosal inflammation (91%) and PLE (78%)

54
Q

Smith et al: US intestinal hyperechoic mucosal striations in dogs: What are common additional US findings in dogs with hyperechoic mucosal striations?

A

Mild jejunal and duodenal thickening

Mucosal speckles

abdominal effusion (87%)

One dog had a focal lymphangiectasia mass - looked like neoplasia

55
Q

Kraft et al: PNST in dogs on MRI: What two types of PNST morphology is there?

A

Diffuse nerve thickening

Circumscribed mass

56
Q

Kraft et al: PNST in dogs on MRI: Characteristics of PNST?

A

T2 hyperintense to muscle

T1 isointense to muscle

Most heterogeneously contrast enhanced.

57
Q

Kraft et al: PNST in dogs on MRI: What type of FOV was recommended? What was a small FOV used for?

A

Large to compare both axillary regions.

Small FOV was used to see nerve root or spinal invasion. - important*** cause they have a poor outcome.

58
Q

Kraft et al: PNST in dogs on MRI: What type of dogs were these?

A

Medium to large breed— all over 20kg

Some dogs just had cervical pain only.

59
Q

Kraft et al: PNST in dogs on MRI: where does the brachial plexus arise from?

A

Last 3 cervical and first two thoracic spinal nerves

60
Q

Kraft et al: PNST in dogs on MRI: What were the most helpful sequences?

A

T2 and T1 (pre and post), STIR

PD sucked.

T1 contrast was CRITICAL in detecting subtle involvment and identifying full extent

61
Q

Pollard et al: Pharyngeal constriction ratio dogs: What are common additional conditions with pharyngeal dysphagic dogs?

A

Lar Par

Myositis (4/5 were boxers)

Difficultly opening mouth.

62
Q

Pollard et al: Pharyngeal constriction ratio dogs: Significant differences between dogs with poor pharyngeal contraction and criopharyngeal dysynchrony, and normal dogs?

A

Pharyngeal contriction ratio: 0.6 mean for poor contraction and crioco dys

0.15 mean for normal dogs

There was some overlap

63
Q

Pollard et al: Pharyngeal constriction ratio dogs: Significant differences between dogs with just poor pharyngeal contraction vs criopharyngeal dysynchrony?

A

Time to upper esphageal schincter opening

poor pharyngeal contraction - 0.7 mean (like normal)

criopharyngeal dysynchrony - 0.28 mean

Hard pharygneal

64
Q

Pollard et al: Pharyngeal constriction ratio dogs: Is movement of the larynx associated with degree of pharyngeal contractions in dogs?

A

NO— not like humans.

65
Q

Pollard et al: Pharyngeal constriction ratio dogs: How to tell dysnchrony apart from reduced pharyngeal contractions?

A

Both have elevated PCRatios (C)

But dsynchrony will have long time to opening of the UES (D).

Why this is important? Because Dysnchrony will have a good outcome if just by itself with surgery.

66
Q

Cole et al: Equine mast cell tumor: What are the characteristics of a mast cell tumor on a horse?

A

Benign

Solitary

No bony involvement

Head, neck, truck or limbs

Next to joints

Well-circumscribed ST mass with granular mineralization

67
Q

Cole et al: Equine mast cell tumor: What breed is overrepresented?

A

Arabian.

68
Q

Cole et al: Equine mast cell tumor: What other ddx are there, though less likely?

A

Calcinosis circumscripta

Mineralizing granuloma.

69
Q

Hugues et al: US cats CBD obstruction: What is the cutoff for a dilated CBD in a cat?

A

5mm

70
Q

Hugues et al: US cats CBD obstruction: What was the most common cause of CBD obstruction?

A

Neoplasia (12/30) - 50% biliary tract carcinoma

Inflammation 11/30 - panc, duodenum or CBD

Cholelith 7/30

No significant mortality rate difference between all three

71
Q

Hugues et al: US cats CBD obstruction: Did degree of dilation help in differentiating the cause of the obstruction?

A

NO.

72
Q

Hugues et al: US cats CBD obstruction: What are important US characteristics that make you think obstruction?

A

Intrahepatic and/or extrahepatic duct dilation - 90% of cats had these

Gallbladder distension was less than reliable 43% only

73
Q

Hugues et al: US cats CBD obstruction: What etiology was more prone to acute onset of clinical signs?

A

Cholelith

74
Q

Hugues et al: US cats CBD obstruction: What two etiologies could not be differentiated from each other?

A

Inflammation and neoplasia.

75
Q

Mareschal et al: US kidney to aorta ratio: What are the low and high cutoff proposed?

A

Low: <5.5

High: >9.1

76
Q

Benigni et al: US of the canine sciatic nerve: What are the two components of the sciatic nerve and when are the visualized?

A

Common peroneal (smaller and more cranial)

Tibial nerve

The are seen through the entire length of the nerve until they branch.

77
Q

Benigni et al: US of the canine sciatic nerve: What side of the hind leg is the sciatice nerve on?

A

Lateral

78
Q

Marin et al: VHS racing greyhounds, What is the greyhounds VHS?

A

10.5 +/- 0.1

This is stats bigger than Rotties and other dog breeds.

79
Q

Novellas et al: Sedation Midaz and butorpahol effects on RI and PI: What does this sedation do to the normal RI and PI?

A

Increase them.

80
Q

Compouding imaging in US reduces what artifact?

A

Speckle and clutter

81
Q

What trochlearr ridge in dogs is easier to miss OCD lesions?

A

Lateral

82
Q

How much of the trochlear ridge can be seen on US?

A

75% - including the most common OCD sites

83
Q

What is the definition of a bone bruise?

A

Acute traumatic microfracture of trabecular bone with hemorrhage and edema in the marrow that may occur without grossly visible disruption of the adjacent cortices or overlying cartilage

84
Q

Winegardener et al: MRI of subarticular bone marrow lesions dog in stifle: What sequence was used and what was commonly seen?

A

High intensity STIR

At the intercondylar eminence of the tibia

Intercondylar fossa of the femur.

85
Q

Winegardener et al: MRI of subarticular bone marrow lesions dog in stifle: What were the common etiologies that caused this STIR change?

A

CCL tear *** most common

CCL partial tear

Synovitis

86
Q

Winegardener et al: MRI of subarticular bone marrow lesions dog in stifle: What is the most common meniscus to be injuried?

A

Caudal portion of the medial meniscus.

87
Q

Whatmoughh et al: US compounding: What are the two types of compounding?

A

Frequency compounding: Sends out slightly different frequencies and receives them back, overlaps them and creates a better picture

Spatial compounding: Sends out diffferent angled beams and recieves them to make a picture.

88
Q

Whatmoughh et al: US compounding: What does compounding accomplish?

A

Reduced speckle

Reduction in clutter, shadowing, echo drop-out

Increase contrast resolution

Increase visibility of lesion margins

89
Q

Whatmoughh et al: US compounding: What type of probe is needed for an aperture-based (spatial) compounding?

A

Wide footprint - Linear or curvilinear probe.

90
Q

Whatmoughh et al: US compounding: Harmonics or compounding causes better lateral resolution?

A

Harmonics!

91
Q

Whatmoughh et al: US compounding: Observers judged what to be the best quality in compounding?

A

Combination of transmit and recieve (spatial and frequency).

92
Q

Martig et al: MRI characteristics of bone marrow lesions in dogs with experimentally induced osteoarthritis: Where were lesions commonly seen after CCL was transected?

A

Epiphyseal and metaphayseal region of the tibial eminence.

93
Q

Martig et al: MRI characteristics of bone marrow lesions in dogs with experimentally induced osteoarthritis: What did the hyperintense lesions represent on histopathology in dogs with OA of the stifle?

A

Edema - but not always

Cellular infiltrates as well such as hematopoietic cellls

94
Q

Scrivani et al: Assessing asymmetry during pertechnetate scan in hyperthyroid cats: What was this study about?

A

Wanted to see if Thyroid:tthyroid ratio was more accurate than visual inspection when assessing asymmetry in a cat. Also, does asymmetry confirm hyperthryoid.

95
Q

Scrivani et al: Assessing asymmetry during pertechnetate scan in hyperthyroid cats: What is the cut off for Thyroid:thyroid ratio (T:T) and what is it used for?

A

Cut off is 1.5

Used to judge asymmetry in the thyroids.

96
Q

Scrivani et al: Assessing asymmetry during pertechnetate scan in hyperthyroid cats: What was the conclusion in this?

A

T:T ratio can be helpful by increasing specificity

Thyroid asymetry is seen more commonly in hyperthyroid cats but are also seen in euthyroid cats as well. SO CAUTION.

97
Q

Drum et al: Histopath vs CT Bone density in the distal MC3 in horses: There is a strong correlation between CT density and histopath lesions of the distal MC3. T/F?

A

False.. not a good correlation.

Talking about POD lesions

98
Q

Brokken et al: MRI features of MC3 and MT3 injuries in horses: Features of proximal suspensory lig and accessory lig of the DDFT injuries include?

A

High signal

Enlargement

Alteration in shape

99
Q

Brokken et al: MRI features of MC3 and MT3 injuries in horses: How many horse were able to return to work?

A

80% if proximal suspensory lig in the frontlimb

69% if proximal suspensory lig in the hindlimb

63% if accessory ligament of the DDFT

So a fair number.

100
Q

Brokken et al: MRI features of MC3 and MT3 injuries in horses: What are the BIG ddx of injury to the proximal MC3 or MT3?

A

Avulsion of the suspensory

Cortical stress fractures

Suspesory desmitis

Acessory lig of the DDFT desmitis

Fracture of the proximal splints

SDFT or DDFT tendonitis

101
Q

Brokken et al: MRI features of MC3 and MT3 injuries in horses: The accessory ligament of the DDF (AKA distal check lig) is a continuation of what ligament of the carpus?

A

Common palmar ligament.

102
Q

Brokken et al: MRI features of MC3 and MT3 injuries in horses: Low signal on MRI means what?

A

Sclerosis

Necrosis (if surrounded by hyperintensity)

103
Q

Where is the most common place for OC fragments to be in the carpus?

A

The dorsal aspect (but not all the time)

In the palmar side it is most common in the palmar lateral pouch - between the ulnar carpal bone and the 4th carpal bone (pic)

104
Q

The lateral intercarpal ligament attaches what bones? Can it been seen from a lateral pouch approach of the carpus?

A

Ulnar carpal and 3rd carpal.

Yes it can.. proximal part.

105
Q

Gorgas et al: Sacroiliac joint radiographs: What is abdominal blurring and what does it do?

A

Increased ventilation to cause motion of the abdomen and then take a long exposure (5s). This allows better visualization of the bony structures of the sacroiliac joint.

106
Q

Gorgas et al: Sacroiliac joint radiographs: what was a common abnormality in the horse radiographs and what sex prediclect did it have?

A

Caudal sacral bony proliferation

Males had significantly larger.

107
Q

Bailey et al: Focal uptake in dorsoproximal P1 in horses: What horses was it most commonly seen and what limbs?

A

Older Heavy warmblood, show jumpers and dressage

Forelimbs more common

Usually bilateral and NOT associated with lameness.

108
Q

Focal photopenic areas on scintigraphy. DDX?

A

Necrosis

Abscess

Infarct/thrombosis (see pic of laminitic thrombosis)

Sequestrum

109
Q

Dyson et al: Scintigraphy of the stifle in horses: What was the normal uptake pattern in a mature horse?

A

Highest uptake: Patella and caudoproximal tibia

110
Q

Dyson et al: Scintigraphy of the stifle in horses: What was the normal uptake pattern in an immature horse?

A

Highest uptake: Caudoproxiaml and cranioproximal tibia

111
Q

Dyson et al: Scintigraphy of the stifle in horses: What was the change in the up of the stifle in horses with front limb lameness?

A

No difference!

112
Q

Dyson et al: Scintigraphy of horses with prox suspensory desmitis: Most of the horse with prox. suspensory desmitis had what kind of uptake in the prox MT/C3?

A

Normal uptake.

113
Q

Dyson et al: Scintigraphy of horses with prox suspensory desmitis: There was a greater uptake in plantar images in lame limbs compared to nonlame limbs on ROI. T/F

A

True

114
Q

Dyson et al: Scintigraphy of horses with prox suspensory desmitis: There was an association between radiopharm uptake and US grade in both legs. T/F?

A

False— just in the hind legs

115
Q

What are the US changes in cows with pyelonephritis and what are the two most common bacteria?

A

US changes: Enlarged kidneys, echogenic material, dilated renal sinus, poor cortical medullary differentiation

Corynebacterium renale and E. coli.

116
Q

Sampson et al: MRI of oblique and straight distal sesamoidean desmitis; What ligaments are most commonly effected?

A

Oblique by a lot

117
Q

Sampson et al: MRI of oblique and straight distal sesamoidean desmitis; Where do the obliques and the straights attach and originate?

A

Oblique

Originate = Base of the prox sesamoid bones

Attach= Mid/Distal P1 (roughened area)

Straight (pictured with lesion)

Originate = Base of the prox sesamoid bones AND inter sesamoidean lig

Attach= P2 scutum (along with the SDF and axial/abaxial lig of the prox interphalangeal joint)

118
Q

Sampson et al: MRI of oblique and straight distal sesamoidean desmitis; what is the role of the straight and oblique distal sesamoidean ligaments?

A

Hold the proximal sesamoid bones to P1 and P2

119
Q

Sampson et al: MRI of oblique and straight distal sesamoidean desmitis; US is a useful tool when assessing the Distal sesamoidean ligamnets?

A

NO.. lesions were not visible on 25/27 horses.

120
Q

Common location of an intracranial epidermoid cyst?

A

Cerebellopontine angle or 4th ventricle —– this are slowly progressing and therefore

121
Q

How do you differentiate an epidermoid cyst from an arachnoid cyst?

A

You FLAIR out the arachnoid but you can’t to the epidermoid.

122
Q

Why might epidermoid cysts be T1 hyperintense?

A

They contain cholesterol - CAN’T tell the difference from this and a dermoid cyst.

123
Q

Differentials for epidermoid cyst?

A

Dermoid cyst

Archnoid diverticulum

Abscess

Cystic or necrotic tumor.

124
Q

Ddx for articular process masses in the spine?

A

Synovial cyst

STS

Myxosarcoma

Granuloma

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