表皮囊肿的超声诊断

目的：探讨表皮囊肿的超声声像图特点。方法：回顾分析15例经病理证实的表皮囊肿的超声图像资料。结果：9例皮下表皮囊肿表现为低回声至中等回声，边界清晰，有包膜，内部多见管道样结构，压迫后有形变，放松后复原。3例睾丸表皮囊肿中2例表现为低回声光团，内部见散在高回声，1例表现为睾丸内实质不均质光团，高低回声相间(洋葱征)。3例深部表皮囊肿表现为液性暗区或低回声型。彩超显示表皮囊肿内无彩色血流。结论：表皮囊肿具有一定的超声声像图特征，尤其对睾丸表皮囊肿的声像图认识，有助于避免不必要的睾丸切除术。     

Sonographic findings of fibrous pseudotumor of the tunica vaginalis

We report the sonographic findings in a case of fibrous pseudotumor of the tunica vaginalis. Scrotal gray-scale sonography revealed a well-margined, hypoechoic mass with an onion ring appearance and central calcifications in the left scrotum. Color Doppler sonography showed no blood flow within the mass. The pathological examination revealed a fibrous pseudotumor with a paucicellular and fibroblastic proliferation of cells within a hyalinized collagenous stroma.     

Malignant non-Hodgkin's lymphoma mimicking a benign parotid tumor: sonographic findings.

We report the case of an extranodal non-Hodgkin's lymphoma mimicking a benign tumor in the left parotid gland of a 71-year-old woman. The clinical presentation of the painless, mobile mass was suggestive of a benign parotid tumor such as an adenoma. The intraglandular tumor appeared sonographically as a well-circumscribed, hypoechoic, homogeneous, lobulated mass with mild distal sound enhancement. Power Doppler sonography showed marked intratumoral vascularization. The tumor was resected by lateral lobectomy of the parotid gland and was found histopathologically to be a diffuse large B-cell lymphoma.     

Sonographic features of mammary oil cysts.

Mammographic lesions that are pathognomonic for oil cysts require no further evaluation. Oil cysts, however, may first be discovered by ultrasonography. Between 1988 and 1995, we performed sonography of 26 oil cysts in 15 patients. Sonography was used to evaluate a palpable finding when an oil cyst was not initially perceived on the mammogram (47%) or as an initial evaluation of a palpable lump (33%); in addition, oil cysts were identified incidentally in 20% of cases. Retrospective review showed that the sonographic appearance of oil cysts is highly variable; only 8% mimic simple apocrine cysts. Twelve percent mimic an intracystic mass. Most have smooth walls (88%), are hypoechoic (65%), and have neither enhancement or shadowing (50%). The sonographic appearance of oil cysts can be suggestive of a pathologic lesion such as an intracystic carcinoma. Unnecessary biopsy can be avoided using directed mammography.     

Sonography of the low transverse incision, cesarean section: a prospective study

Using sonography, the uterine incision site was prospectively studied in 36 asymptomatic patients, two days after cesarean section. The findings were compared with those seen in 21 symptomatic, postcesarean patients. In the asymptomatic patients, the incision site was visualized as an oval symmetric region of distinct echogenicity interposed between the lower uterine segment and the posterior wall of the urinary bladder. In eight of the 36 asymptomatic patients, a small (less than 1.5 cm) round hypoechoic mass was present in or adjacent to the uterine incision and distinct from the normal incision. These probably represented insignificant hematomas. Of the 21 symptomatic patients, 17 had either a subfascial hematoma, a bladder-flap hematoma, or endometritis. Two were sonographically normal, and one showed a hematoma in the paracolic gutter. In the remaining patient, there was a 5-mm asymmetrically placed hypoechoic mass representing an insignificant hematoma. Significant bladder-flap hematomas were characteristically round, greater than 2 cm masses asymmetrically placed in or adjacent to the uterine incision. Using sonography, the normal appearance of the lower uterine incision can be distinguished from significant hematomas.     

Pancreatic arteriovenous malformation presenting as cysts: Doppler sonographic diagnosis

A 50-year-old man presented with multiple lesions resembling cysts throughout the pancreas on gray-scale sonography. Pulsatile blood flow detected within the lesions on color Doppler sonography led to the diagnosis of pancreatic arteriovenous malformation (PAVM). Most previously reported PAVMs have been described as having a poorly defined, reticular, or mosaic-like hypoechoic appearance on gray-scale sonography; the cystic appearance of the PAVM seen in our case is unusual.     

Sonographic findings in a patient with cystic hypersecretory duct carcinoma of the breast

In this report, we describe a case of a rare form of intraductal carcinoma of the breast known as cystic hypersecretory duct carcinoma in a 49-year-old woman with a palpable mass and no history of breast disease. Mammography showed heterogeneous dense breast tissue with no definite abnormally increased density or microcalcifications. Gray-scale sonography detected multiple small aggregated, anechoic cysts with good through-transmission in the upper outer quadrant of the left breast, corresponding to the location of the palpable mass. The patient underwent an excision biopsy, and histopathologic examination of the surgical specimen revealed multiple cysts of different size containing an eosinophilic material resembling thyroid colloid. The locations of the cysts corresponded to those of the anechoic cysts detected on sonography. The epithelium lining the cysts showed micropapillary growth consistent with a diagnosis of cystic hypersecretory duct carcinoma. The mammographic and sonographic findings in this case differed somewhat from those reported previously for this rare form of breast carcinoma. Because the imaging findings and low-power microscopic appearance of the mass in our patient's case closely resembled those of some benign breast lesions, we recommend careful differentiation of this type of lesion using high-power microscopy during histopathologic evaluation.     

Calcified epidermoid cyst in the testis: an unusual finding on ultrasound.

Epidermoid cysts of the testis are uncommon, benign testicular tumours. They are often seen on ultrasound as rounded, hypoechoic lesions due to high keratin contents. Calcification within epidermoid cysts is rare. We report a case of prominent calcifications within an epidermoid cyst. If a possible epidermoid cyst is identified with ultrasound, testis-sparing surgery should be considered.     

Sonographic features of breast hamartomas

The sonographic features of ten breast hamartomas are reported. Four masses were clinically palpable. The mammographic appearance was characteristic of hamartomas in five cases. In the remaining five lesions, because the radiographic appearance was not pathognomonic, surgical excision was required for pathologic confirmation of the diagnosis. A wide spectrum of sonographic appearances was identified, the most frequent was that of a moderate to well-circumscribed, solid, hypoechoic mass with posterior acoustic shadowing. Two isoechoic hamartomas were very difficult to visualize on sonography. We conclude that ultrasound has a minimal role in the diagnosis of breast hamartomas, in view of their wide sonographic variability.     

Metastatic malignant pleural mesothelioma to the breast

A 51-year-old woman suffered from dyspnea for several days before she came to an outside clinic for help. Pleura biopsy was performed and the histologic diagnosis was malignant mesothelioma. Sixteen months later, a palpable left breast lump was noted. Physical examination revealed a firm mass in the breast, measuring about 4 x 3.5 cm in size. Breast sonography showed a hypoechoic mass about 3 x 2 x 1.5 cm in size with irregular border in the middle part of the left breast. A mammogram revealed a speculated mass. Chest computed tomography was also performed, which revealed a large pleural mesothelioma and an irregular breast lesion. Incisional biopsy of the left breast lump was performed and histologic examination revealed an infiltrative growth of neoplastic polygonal cells bearing hyperchromatic and pleomorphic nuclei and a small amount of pale, pinkish cytoplasm. Further immunohistochemical study was performed and the tumor cells were positive for low and high molecular weight cytokeratin, thrombomodulin and focally positive for CEA. The final histologic diagnosis was metastatic malignant mesothelioma.     

Endorectal sonographic appearances of rectal MALT lymphoma, its response to therapy, and local recurrence

Endorectal sonography may significantly help to evaluate rectal lymphoma. We report the sonographic findings in a case of rectal non-Hodgkin's MALT (mucosa-associated lymphoid tissue) lymphoma, including the monitoring of response to therapy and confirmation of recurrence, in a 45-year-old man. On endorectal sonography of the rectal wall, the mucosa was markedly thickened to 1.1 cm and was diffusely hypoechoic and risen into multiple polypoid folds. The submucosa and muscularis propria appeared normal. Multiple lymph nodes were visualized in the perirectal fat; they were homogeneously hypoechoic, were round or oval, and ranged from 1.0 cm to 2.6 cm. Endoscopic biopsies revealed a grade I non-Hodgkin's MALT lymphoma. Following chemotherapy, endorectal sonography showed that the surface of the rectal mucosa had a smoother appearance and near-normal thickness, but lymph nodes, although smaller, remained visible in the perirectal fat. Four months later, endorectal sonography demonstrated a local relapse of disease, with significant thickening of the rectal mucosa and multiple lymph nodes visible in the perirectal fat. Following high-dose chemotherapy for the recurrence, endorectal sonography demonstrated a near-normal appearance of the rectal mucosa.     

Bilateral epidermoid cysts of the testis: sonographic and MRI findings

Epidermoid cysts of the testis are rare benign lesions, without malignant potential, that can be managed conservatively with cyst enucleation and testis-sparing surgery. Bilateral epidermoid cysts in the testes have been reported very infrequently. We report the sonographic and MRI findings in a patient who presented with a palpable nodule in only 1 testis, but in whom sonography showed bilateral lesions. On sonography, the cysts had an internal "onion-ring" structure; color Doppler signals were absent. On MRI, the cysts had a laminated appearance, with alternating low- and high-signal-intensity areas on T2-weighted images. These imaging findings and the negative results of laboratory tests for tumor markers suggested the correct diagnosis, and testis-sparing surgery could be performed.     

Epidermoid cyst of the testis: An atypical sonographic appearance

Epidermoid cysts are rare. They represent the most common benign tumor of the testis. The sonographic appearances of testicular epidermoid cysts usually include avascular, mostly lamellated, heterogeneous internal echotexture, with hypoechoic and hyperechoic concentric rings, accounting for the typical onion‐ring appearance. On MRI, epidermoid cysts show a low‐signal‐intensity center, with internal concentric rings of alternating high‐ and low‐signal intensity on T2‐weighted images, which correlates with the onion‐ring appearance. We report a patient with testicular epidermoid cyst with atypical ultrasound and MRI appearances that led to the erroneous initial diagnosis of “burned‐out” tumor. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44 :448–451, 2016;     

睾丸表皮样囊肿的MRI诊断

目的探讨睾丸表皮样囊肿(TEC)的MRI表现。方法回顾性分析8例经手术病理证实的TEC的MRI资料,8例均采用MRI平扫及增强扫描,并结合文献讨论。结果 8例TEC在T_1WI、T_2WI上边缘部有低信号环,即"黑环征",厚度均匀,约1~2 mm。T_1WI上5例病灶内部呈等低或等高信号;1例在T_1WI见"靶征";在T_2WI上6例病灶内部有"洋葱皮征";1例病灶内部"洋葱皮征"显示不清;另1例TEC最大径达4.8 cm,但内部无典型"洋葱皮征"。8例TEC MRI增强均无强化。结论睾丸实质内TEC的MR征象有一定特点,有助于明确诊断。     

Sonographic demonstration of a pharyngoesophageal diverticulum

We report a case of pharyngoesophageal (Zenker's) diverticulum in a 91-year-old woman. Sonography of the thyroid gland showed diffuse enlargement of the gland and a well-defined, heterogeneous hyperechoic mass that appeared to be in the posterior left lobe. The mass had a smooth hypoechoic wall with a layered appearance anteriorly. Real-time sonography performed during the patient's ingestion of water showed transient changes in the size, margins, and echogenicity of the lesion, which subsequently reverted to its original appearance.     

Imaging findings in a case of epidermal inclusion cyst arising within the breast parenchyma

Epidermal inclusion cysts rarely occur in the breast, but when they do, the consequences can be severe. Here, we report the case of a 23-year-old woman who presented with a palpable mass in the right breast. The mass had persisted for 4 years and had been causing pain for 1 month at the time of the patient's presentation. We examined the mass by means of mammography and sonography. Sonographic examination revealed a well-circumscribed solid, avascular mass suggestive of an epidermal inclusion cyst. Excision was performed at the patient's request. Histopathologic examination of the mass after excision confirmed the diagnosis of epidermal inclusion cyst and its localization within the breast parenchyma. To our knowledge, reports on epidermal inclusion cysts within the breast parenchyma are rare.     

Lymphoma of the testis and epididymis mimics chronic inflammation upon sonography

We report the sonographic findings in a case of lymphoma, which mimicked chronic inflammation. Scrotal gray-scale sonography revealed an irregularly margined, hypoechoic mass in the right testis and epididymis. Color Doppler sonography showed increased blood flow within the hypoechoic lesions in both testis and epididymis. Pathologic examination revealed a diffuse involvement of the testis and epididymis.     

Neuroblastoma with spermatic cord metastasis in a child: sonographic findings.

We report a case of neuroblastoma in a patient who had no involvement of the spermatic cord at diagnosis but who developed spermatic cord metastasis 2 months later. The metastasis appeared on sonography as a hypoechoic, highly vascular, fusiform, hard, 14x10x7 mm mass located in the right inguinal canal and extending into the scrotum. The diagnosis of spermatic cord metastasis was confirmed by resection and histopathologic examination. We recommend that the scrotum and spermatic cord be evaluated by high-resolution sonography in children with neuroblastoma, both at the time of diagnosis and during follow-up.     

Secretory carcinoma of the breast: sonographic features.

OBJECTIVE: The purpose of this series was to evaluate the sonographic features of secretory carcinoma of the breast. METHODS: Between 1994 and 2006, 9 patients had histologically confirmed secretory carcinoma of the breast in our institution, and 6 of them underwent breast sonography. We retrospectively evaluated the sonographic findings of the patients in correlation with other available images and reviewed the clinical records. RESULTS: Clinical manifestations were a palpable mass (n=3), a bloody nipple discharge (n=1), and screening-detected abnormalities (n=2). Breast sonograms showed masses with a round or oval (n=5) or tubular (n=1) shape, with relatively well-circumscribed (n=2) or partially microlobulated (n=4) margins, and with a hypoechoic (n=4) or an isoechoic (n=2) internal echo texture. Most lesions were single nodules (n=3) or groups of nodules (n=2) measuring 1 cm or smaller, except 1 mass measuring 3.5 cm with axillary lymph node metastasis. Two cases had associated ductectasia. Sonographic assessments were classified as Breast Imaging Reporting and Data System category 3 in 2 cases, category 4A in 3 cases, and category 4B in 1 case. CONCLUSIONS: Secretory carcinoma of the breast is frequently shown as a small benign-looking nodule or group of nodules or sometimes as an intraductal lesion with a low clinical stage on sonography. Although secretory carcinoma is a rare breast malignancy, awareness of its sonographic features will be helpful for the differential diagnosis.