The evaluation of common breast problems

The most common breast problems for which women consult a physician are breast pain, nipple discharge and a palpable mass. Most women with these complaints have benign breast disease. Breast pain alone is rarely a presenting symptom of cancer, and imaging studies should be reserved for use in women who fall within usual screening guidelines. A nipple discharge can be characterized as physiologic or pathologic based on the findings of the history and physical examination. A pathologic discharge is an indication for terminal duct excision. A dominant breast mass requires histologic diagnosis. A breast cyst can be diagnosed and treated by aspiration. The management of a solid mass depends on the degree of clinical suspicion and the patient's age.     

乳腺影像学的现状与使命

乳腺癌是女性最常见的恶性肿瘤。乳腺影像学在乳腺癌的诊断、治疗方案的选择、疗效的评估及治疗后随诊监测中均具有重要作用。该文以国内外大量文献作为依据,对乳腺影像学常用检查方法（乳腺X线摄影、乳腺超声检查、乳腺MRI、PET-CT及其他乳腺影像技术）其临床应用的现状进行了较为全面而简要的阐述,作者结合自己的临床实践,针对乳腺影像学未来的发展趋势及使命提出了自己的见解。     

三阴乳腺癌磁共振成像研究

三阴性乳腺癌(TNBC)具有特殊的生物学和临床病理学特征。由于侵袭性强,缺乏有效的靶向治疗和内分泌治疗,预后差。目前磁共振成像是诊断乳腺癌最准确的影像学检查方法,可协助诊断和预后评估。三阴性乳腺癌典型MRI表现为单一病灶,呈肿块型,形态不规则,边缘光滑,在T2WI上病变中心呈高信号。进一步的工作是研究磁共振成像的临床应用,动态增强磁共振成像(DCE-MRI)、DWI、MR波谱(MRS)等。     

Pancreatic metastasis from squamous cell lung cancer: computed tomography and magnetic resonance imaging findings

Metastatic lesions of the pancreas are uncommon. The incidence of pancreatic involvement with squamous cell carcinoma is the lowest among the different histological subtypes of lung cancer. We present the clinical data, pathological findings, and imaging features of two cases of pancreatic metastasis from squamous cell lung cancer with a literature review. A 75-year-old man and a 67-year-old man were both diagnosed with metastatic pancreatic tumors from squamous cell lung cancer during a multidisciplinary team discussion. Both patients were misdiagnosed as having a neuroendocrine tumor of the pancreas by imaging examination before surgery. Squamous cell lung cancer metastasis to the pancreas is extremely rare, and the atypical clinical and radiological presentations make it difficult to distinguish metastatic tumors from primary pancreatic tumors.     

肺炎性肌纤维母细胞瘤误诊中央型肺癌1例分析并文献复习

目的 探讨肺炎性肌纤维母细胞瘤的临床诊断和治疗.方法 对1例肺炎性肌纤维母细胞瘤的治疗及预后进行回顾性分析,并复习相关文献.结果 报告1例肺炎性肌纤维母细胞瘤,男性,54岁,表现为咳嗽伴右胸痛,初步诊断右肺中央型肺癌,行右全肺切除治疗,术后病理及免疫组化结果证实为肺炎性肌纤维母细胞瘤,术后恢复顺利,康复出院,随访1 a,无肿瘤复发及转移.结论 肺炎性肌纤维母细胞瘤的诊断需综合术前临床表现、胸部影像学检查,术中所见,术后常规病理学检查、免疫组化结果.手术切除惟一有效的治疗措施.     

Secretory carcinoma of the breast

Secretory carcinoma of the breast is a rare but histologically distinct variant of invasive ductal carcinoma that has an indolent growth pattern and a more favorable prognosis than that of typical ductal carcinoma. We present the imaging and histopathologic findings of a case of this tumor that initially manifested as a palpable mass in the left breast of a 31-year-old woman. It appeared sonographically as a round, well-circumscribed but microlobulated hypoechoic solid mass. Secretory carcinoma of the breast may resemble other well-circumscribed breast carcinomas as well as some benign masses, including fibroadenomas. Breast imagers should be aware of this rare tumor's nonspecific imaging features and clinical implications when making a differential diagnosis of solid breast masses.     

乳腺炎性肌纤维母细胞瘤临床病理观察

目的 探讨乳腺炎性肌纤维母细胞瘤的临床病理特征和鉴别诊断.方法 对1例乳腺炎性肌纤维母细胞瘤进行临床、组织学和免疫组化观察,并复习相关文献.结果 患者女性,62岁.左乳腺扪及一肿块8个月,边界尚清.组织学显示,黏液背景下瘤细胞以梭形细胞为主,细胞无异型性,核分裂象少见.间质内见大量淋巴细胞,浆细胞浸润,血管丰富,局部有胶原化.免疫组化:梭形细胞vimentin中等(+),SMA、actin和ALK(+);CK、34βE12、S-100、myogenin、MBP和CD34(-).结论 炎性肌纤维母细胞瘤是一种特殊类型的间叶性肿瘤,罕见于乳腺,应与梭形细胞癌、纤维瘤病、瘢痕、结节性筋膜炎等相鉴别.     

Asymptomatic gastric adenomyoma and heterotopic pancreas in a patient with pancreatic cancer: A case report and review of the literature

BACKGROUNDGastric adenomyoma (GA) is a rare submucosal benign neoplasm that occurs mostly in the gastric antrum and is often misdiagnosed. No standard treatment has been established for this disease in cases of malignancy.CASE SUMMARYA 75-year-old woman with a 10-year history of hypertension was admitted to the Emergency Department of our hospital complaining of paroxysmal exacerbation of acute abdominal pain for 1 d with no apparent cause. Enhanced computed tomography and magnetic resonance imaging indicated a mass in the caudal pancreas, cholecystitis, and cholecystic polypus. Gastrointestinal endoscopy showed a mass arising from the gastric antrum. Due to the imaging findings, pancreatic cancer (PC), gastric lesion, cholecystitis, and cholecystic polypus were our primary consideration. Radical pancreatectomy, splenectomy, and cholecystectomy were performed successfully, and the gastric tumor was locally resected. Postoperative paraffin specimens confirmed the diagnosis of caudal PC, GA, and heterotopic pancreas (HP). Unfortunately, the patient died 13 mo later due to PC metastases to the liver, lung, and adrenal glands.CONCLUSIONGA is a rare benign disease, especially when occurring with HP. It may stem from the same origin as HP. This is the first case report to date of a patient suffering from the simultaneous occurrence of GA, HP, and PC. GA is a lesion that can mimic other benign or malignant gastrointestinal diseases; thus, a definitive diagnosis depends on postoperative pathological biopsy. Although GA and HP are both benign lesions, they should be resected because there is a chance of malignancy. Additional research should be conducted to better understand these submucosal lesions.     

The role of 2-deoxy-2-[(18)F]fluoro-D-glucose positron emission tomography/computed tomography in monitoring the immunosuppressive therapy response of inflammatory myofibroblastic tumor.

PURPOSE: To compare the pre and post treatment 2-deoxy-2-[(18)F]fluoro-D-glucose (FDG)-positron emission tomography (PET)/computed tomography (CT) imaging findings of an inflammatory myofibroblastic tumor (IMT) with its clinical response to immunosuppressive therapy. PROCEDURE: Forty-nine-year-old female presented with dyspnea, chest pain, and weight loss and underwent an FDG-PET/CT scan before and after mediastinal biopsy and treatment with dexamethasone and thalidomide. RESULTS: FDG-PET/CT scan demonstrated a hypermetabolic mediastinal mass. The biopsy of the lesion was consistent with IMT. Following immunosuppressive therapy, the patient's clinical findings resolved, and PET/CT showed a significant decrease in the FDG uptake and the size of the mass. CONCLUSION: Pre-treatment imaging features and post-treatment imaging characteristics of IMT correlate with clinical findings and suggest that FDG-PET/CT may be useful as an adjunct to clinical evaluation in monitoring of immunosuppressive therapy of IMT.     

The role of mammography in male patients with breast symptoms

OBJECTIVE: To determine the contribution of mammography to the comprehensive clinical evaluation of men with breast symptoms. PATIENTS AND METHODS: We retrospectively reviewed the records of all men who underwent mammography between January 1, 2001, and December 31, 2004, at the Mayo Clinic In Jacksonville, Fla. Medical history, mammographic findings, and breast cancer diagnoses were assessed. RESULTS: A total of 198 men had 212 mammograms. Nine mammograms (from 9 different men) (4%) showed suspicious findings. Eight men underwent biopsy, which yielded a breast cancer diagnosis in 2 (1%). Of the 212 mammograms, 203 (96%) showed benign findings, including gynecomastia on 132 (62%). One patient with a benign-appearing mammogram later underwent breast biopsy, and malignant disease was diagnosed. All the men with breast cancer had a dominant mass on clinical examination and other findings suggestive of breast cancer. Of the 132 mammograms showing gynecomastia, 110 (83%) were from men who had taken predisposing medications or who had predisposing medical conditions. CONCLUSIONS: Mammography added little information to the initial patient evaluation. Breast cancer may be suspected by the presence of a dominant mass. Gynecomastia can be predicted on the basis of the patient's symptoms or preexisting condition. Patients with suspicious findings on examination warrant appropriate clinical management regardless of mammographic findings. Mammography in men may be of benefit only for image guidance of percutaneous biopsy of a suspicious mass.     

E-Cigarette or Vaping Product Use–Associated Lung Injury: A Case Study and Review of the Literature

E-cigarette or vaping product use–associated lung injury (EVALI) has caused significant morbidity in the US population, including in many young patients. It is critical for all health-care providers to recognize symptoms and imaging findings associated with lung injury secondary to e-cigarette and vaping use. Nurses, both inpatient and outpatient, are in a unique position to be able to assess patients for vaping and e-cigarette use and educate patients on the dangers of continued use. Here, we describe the case of a 16-year-old male with a history of vaping presenting with clinical and radiographic features consistent with EVALI. We review the current literature on pathophysiology, diagnosis, management, and nursing implications of vaping-related lung disease.     

妊娠相关性乳腺癌临床诊治专家共识(2020版)

妊娠相关性乳腺癌(PABC)约占所有乳腺癌患者的0.2%~3.8%。PABC和非妊娠相关性乳腺癌具有共同的乳腺癌生物学特性,但因妊娠、哺乳的生理改变以及诊疗措施可能对胎儿产生影响等因素,PABC在临床诊断、治疗和预后等方面具有独特性。为规范并提高PABC临床诊治水平,中华医学会外科学分会乳腺外科学组在复习文献的基础上,针对PABC的诊断及治疗方案进行深入讨论,充分考虑到我国PABC患者的临床特点及可行性,提出PABC临床诊治共识意见,旨在为国内乳腺外科医师的临床工作提供参考借鉴。     

炎性肌纤维母细胞瘤影像学表现与病理学分析

目的：探讨炎性肌纤维母细胞瘤（IMT）的影像学表现及病理学特征。方法：回顾性分析手术病理证实的12例炎性肌纤维母细胞瘤患者,3例行CT平扫,10例平扫后行多期增强扫描,2例行MR检查,1例行食道钡餐检查。结果：病变位于乳突窦1例,肺部2例,纵隔2例,鼻咽1例,鼻窦1例,食道1例,胃窦1例,肝脏1例,腹膜后1例,膀胱1例,影像学表现为实性肿块8例,囊实性肿块5例,大部分病例边界清楚,增强扫描肿瘤呈均匀或不均匀中度到明显强化,发生在头颈部及腹膜后的肿瘤及1例纵隔肿瘤影像表现具有侵袭性。病理示瘤组织由梭形纤维细胞及炎细胞组成,免疫组化染色肌源性蛋白阳性表达。结论：IMT是一种少见的肿瘤,影像学表现无特异性,但能为其提供准确的解剖部位等信息,在定性诊断方面有一定价值,最后确诊有赖于组织病理学及免疫组化检查,其免疫组化染色肌源性蛋白阳性表达是诊断IMT的重要依据。     

肺炎性肌纤维母细胞瘤的CT表现

目的:探讨肺炎性肌纤维母细胞瘤的CT表现,提高对该病的认识。材料与方法:收集本院2009年10月至2011年10月经病理确诊的8例肺原发性肌纤维母细胞瘤,回顾性分析患者术前的肺部CT表现。结果:8例肺炎性肌纤维母细胞瘤中,2例(2/8)位于近肺门区,6例(6/8)位于肺周边部;1例(1/8)增强扫描呈轻度强化,7(7/8)呈明显强化,5例(5/8)强化均匀;6例(6/8)边缘较清晰,1例(1/8)发生远处转移。结论:肺炎性肌纤维母细胞瘤虽然有较典型的CT表现,较易诊断,但必须对其转移的可能性提高警惕。     

Radiologic Advances in the Diagnosis of Breast Cancer

Breast cancer is the leading cause of cancer in females between the age of 15 and 54, and the second leading cause of death in women in the United States. Diagnosis begins with detection by breast examination (clinical breast examination or breast self-examination) or by radiologic studies, such as mammography. Many advances in the diagnosis of breast cancer have taken place in the past 20 years. This article reviews the history of radiologic advances in the diagnosis of breast cancer. Use of technological advancements in digital radiography, magnetic resonance imaging, and ultrasound in breast cancer diagnosis are presented. Advantages and disadvantages of these diagnostic interventions compared with older, traditional X-ray films are discussed. It is important for radiology nurses to be well informed about these varied diagnostic modalities, and appreciate the fact that advances in radiologic imaging technologies can yield improved outcomes for breast cancer patients.     

Technical advances in breast ultrasound imaging.

Breast sonography plays an integral role in breast imaging. The technical advances in the field have made breast sonography an essential component of the breast imaging evaluation. In its clinical nascence, the role of breast sonography was primarily to differentiate cysts from solid masses. Technical advances such as compound imaging and harmonics have resulted in improved lesion characterization. Other technical advances such as Doppler imaging, extended field-of-view, fremitus imaging, intravenous contrast, computer-aided diagnosis, and elastography have also expanded the clinical applications of breast sonography. While some of these technical advances are still in the research phase, many are available today for clinical use. We will review these technical advances and examine their roles in clinical breast imaging today.     

Contrast-enhanced ultrasound of breast fibromatosis: a case report

We herein present a rare case of breast fibromatosis, the contrast-enhanced ultrasonography (CEUS) findings of which we believe have never been described. The high similarity between the clinical and imaging manifestations of breast cancer makes its differential diagnosis difficult. In this report, we describe the CEUS findings of a less common type of fibromatosis, discuss the potential value of CEUS to differentiate it from malignant breast lesions, and briefly review the literature.     

超声和MRI影像学及影像组学在乳腺癌中的研究进展

乳腺癌是全球女性最常见的恶性肿瘤之一,发病率和致死率居癌症首位,早期诊断和早期治疗可以提高疾病预后效果,降低疾病相关死亡率。超声和MRI影像学是乳腺癌诊疗指南推荐对原发肿瘤评估无创检查方式,随着科技的发展,越来越多的影像学新技术应用于临床实践,乳腺癌检出率和诊断准确率都有了很大提高。人工智能的出现,拓展了影像组学的应用,推动了乳腺癌精准医疗的发展。本文针对超声和MRI影像学及影像组学在乳腺癌临床诊疗中的应用进展进行了综述。      

钼靶X线摄影对乳腺积乳囊肿的诊断价值

目的：分析乳腺积乳囊肿的影像学特点,探讨钼靶X线摄影对其诊断与鉴别诊断的价值。材料与方法：结合临床对30例病理证实的乳腺积乳囊肿的X线平片进行回顾性分析。结果：哺乳期乳腺23例,致密型乳腺3例,分叶型乳腺2例,团块型乳腺1例,斑点型乳腺1例。X线均显示为类圆形块影。其中高密度型6例,低密度型11例,混杂密度型13例。边界清晰21例,边界部分清晰6例,边界模糊不清3例。结论：乳腺X线摄影结合穿刺抽液对乳腺积乳囊肿的诊断与鉴别诊断颇有价值。     

超声成像新技术在乳腺癌诊断中的应用进展

乳腺癌是女性发病率最高的恶性肿瘤,超声成像是乳腺癌检测和诊断的常用方式。该文就超声弹性成像,超声造影,三维超声等乳腺癌超声成像技术在临床中的应用及其进展进行分析并综述。