Hurthle cell neoplasms of the thyroid: sonographic appearance and histologic characteristics

OBJECTIVE: The purpose of this study was to determine the sonographic features of Hürthle cell neoplasms (HCNs) of the thyroid. METHODS: We retrospectively analyzed the sonographic appearance of 15 histologically proven HCNs in 15 patients aged 16 to 70 years (mean age, 44 years). Sonographic features that were reviewed included the size and echogenicity of the tumors, the presence of cystic areas or calcifications, and detectable blood flow on color Doppler imaging. Correlation of sonographic findings with pathologic results was performed. RESULTS: The tumors ranged from 0.4 to 7 cm in diameter, but most were less than 3 cm in diameter. Four (27%) of the 15 tumors were homogeneously hypoechoic. Two tumors (13%) were predominantly hypoechoic with isoechoic areas to thyroid parenchyma. Two (13%) neoplasms were isoechoic to thyroid parenchyma. Four (27%) tumors were predominantly isoechoic, containing hypoechoic areas, and 3 (20%) tumors were hyperechoic. Three neoplasms contained cystic components. None of the tumors contained calcifications. One tumor was avascular on Doppler examination. One neoplasm showed only peripheral blood flow. Thirteen tumors showed internal vascularity, 7 of them with peripheral blood flow. Twelve HCNs were benign, and 3 were malignant on pathologic examination. CONCLUSIONS: Hürthle cell neoplasms show a spectrum of sonographic appearances from predominantly hypoechoic to hyperechoic lesions and from peripheral blood flow with no internal flow to extensively vascularized lesions. Pathologic criteria differentiating benign and malignant HCNs (absence or presence of a capsular breach, vascular or extrathyroidal tissue invasion, nodal involvement, and distant metastasis) are beyond the resolution of sonography and fine-needle aspiration biopsy and require removal of the entire lesion. This precludes diagnosis and characterization of HCNs by sonography.     

Eleven Patients With Testicular Leydig Cell Tumors

We present the sonographic and magnetic resonance imaging findings of Leydig cell tumors in a series of patients, along with a brief review of the literature. We evaluated the sonographic features of 11 cases of Leydig cell tumors, including echogenicity, size, margins, and patterns of vascularity. The magnetic resonance imaging characteristics of 9 patients were also assessed, with special attention to the appearance of the tumors on T2-weighted imaging and postcontrast T1-weighted imaging. Seven tumors were hypoechoic, and 4 were almost isoechoic. Ten patients showed various patterns of hypervascularity in the tumors, combined in some cases with feeding vessels. One case presented with a single feeding vessel. The tumors showed homogeneous or heterogeneous low signal intensity on T2-weighted imaging and marked enhancement on postcontrast T1-weighted imaging. The small size of these tumors, the various patterns of vascularity on color and power Doppler sonography, and the marked enhancement on postcontrast T1-weighted imaging are considered valuable but generally nonspecific for identification of these tumors.     

High-resolution and color doppler sonography in the evaluation of skin metastases.

OBJECTIVE: To evaluate high-resolution sonography in differentiating cutaneous metastases from other benign dermatologic diseases with the final objective of proposing high-resolution sonography in the diagnostic protocol for asymptomatic patients and those with neoplasms who have 1 or more rapidly growing skin nodules. METHODS: We selected 57 patients (24 women and 33 men; mean age +/- SD, 53 +/- 25 years) who underwent high-resolution and color Doppler sonography because they recently noticed 1 or more superficial nodules. Patients were mostly asymptomatic, but 15 had previously diagnosed malignancies. Each nodule was classified by measurement of fundamental sonographic parameters (major diameter, shape, borders, echo texture, and homogeneity) and by assessment of vascularity (presence or absence of flow and vascular pattern) with color Doppler sonography. All nodules were ablated and histologically examined. RESULTS: Of 68 nodules, 23 were malignant (21 metastases and 2 B-cell lymphomas), and 45 were benign (22 sebaceous cysts, 18 granulomas of different origins, 3 fibromas, and 2 neurofibromas). The nodules were all localized in the subcutaneous space, had clearly demarcated borders, and were hypoechoic; a circular or oval shape was predominant, but 7 metastases had an irregular, polycyclic shape. On color Doppler sonography, none of the benign nodules or B-cell lymphomas showed signs of vascularity, whereas the metastatic nodules were all vascularized, with 1 or more peripheral poles (21 of 21 nodules) and internal vessels (11 of 21 nodules). CONCLUSIONS: A polycyclic shape and hypervascularity, with multiple peripheral poles and, eventually, internal vessels, should be considered the most indicative signs of metastasis.     

彩色多普勒超声鉴别甲状腺结节良恶性价值的再探讨

目的探讨彩色多普勒超声在甲状腺结节良恶性鉴别中的价值。方法回顾性分析857个以实性及实性为主的甲状腺结节,评估每个结节的彩色多普勒超声特征,包括血管模式和血供程度。根据结节大小及结节内部回声又各分成2个亚组(≤1cm组和>1cm组、极低/低回声组和中等/高回声组)。所有结节根据病理结果分成良性组和恶性组。经统计学检验,分析彩色多普勒超声特征在鉴别甲状腺良恶性方面的作用。结果 857个实性及实性为主的结节中,良恶性结节均以混合血管型为主,良性结节以高血供为主,恶性结节则以低血供为主。根据结节大小分组,恶性结节在≤1cm组和>1cm组中均以低血供为主,但结节变大,高血供所占比例上升;良性结节在≤1cm组中以低血供为主,在>1cm组中以高血供为主。根据内部回声分组,恶性结节在极低/低回声组和中等/高回声组中均以低血供为主;良性结节在极低/低回声组中以低血供为主,在中等/高回声组中以高血供为主。结论不同分组的血管模式和血供程度在良恶性结节中存在一定的重叠性,对鉴别甲状腺结节的良恶性意义有限。     

Subcutaneous angioleiomyomas: gray-scale and color Doppler sonographic appearances

PURPOSE: To describe the gray-scale Doppler and sonographic features of a series of subcutaneous angioleiomyomas. METHODS: The sonographic appearances of 10 pathologically proven angioleiomyomas were retrospectively reviewed; 4 in women and 6 in men, with an age range from 33 to 77 years. We evaluated size, shape, echo pattern, margins, location, relationships with adjacent structures, and vascularity. Examinations were performed using a multifrequency linear array transducer (9-11 MHz) connected to a Logiq 500 scanner (GE, Milwaukee, Wl). RESULTS: All tumors were subcutaneous and located in the extremities (7 in the lower extremities, 3 in the upper extremities). The sizes ranged from 0.6 to 6.4 cm, with an average size of 2 cm. All of the lesions were hypoechoic with well-defined margins, and 9 were oval. Intratumoral calcifications were observed in two patients. Vascularity was easily detected in all of them, and 4 tumors had a clear vascular pedicle. The spectral Doppler analysis performed in 5 cases, revealing a low-resistance arterial waveform in 4 patients. CONCLUSIONS: Although angioleiomyomas are uncommon soft tissue tumors, the presence of a well-defined, hypoechoic, vascular subcutaneous tumor in the extremities should raise the possibility of such a diagnosis.     

Common and uncommon sonographic features of papillary thyroid carcinoma.

OBJECTIVE: To determine the relative frequency of various sonographic findings in papillary carcinoma of the thyroid. METHODS: We retrospectively analyzed the sonographic features in 55 patients with proven papillary carcinoma of the thyroid. Sonographic features analyzed were echo texture, cystic change, margin, contour, presence of a peripheral halo, vascularity, and calcification pattern. Features were classified as common (> or = 35% of cases) or uncommon (< 10% of cases). Combinations of features were also analyzed. RESULTS: Common sonographic features of papillary carcinoma included hypoechoic texture (86%), microcalcifications (42%) or no calcifications (47%), well-defined margins (47%), and intrinsic hypervascularity (69%). Uncommon features included hyperechoic or mixed echo texture, cystic elements, irregular margins, hypovascularity, and coarse or peripheral calcifications. Of the 29 lesions that had calcifications, 20 (69%) had microcalcifications; 5 (17%) had coarse calcifications; and 1 had peripheral calcifications. In total, 54% of cases had at least 1 uncommon feature, and 11% had 2 or more uncommon features. Cystic carcinomas were rare and accounted for only 6% of lesions; all had hypervascular solid components. No carcinomas in our series were completely avascular. CONCLUSIONS: There is a broad spectrum of sonographic findings in papillary carcinoma of the thyroid. Half of the lesions in this series had at least 1 uncommon sonographic feature.     

腱鞘巨细胞瘤的高频彩色多普勒超声表现特征

目的总结腱鞘巨细胞瘤的声像图特征，探讨高频彩以多普勒超声对腱鞘巨胞瘤的诊断价值。方法总结分析了37例经手术病理证实的腱鞘巨细胞瘤的二维和彩色多普勒超声特征。结果腱鞘巨细胞瘤声像图及血流图特征：1、指、趾等关节或肌腱旁实性低回声肿块，大部分回声均匀，少部分可见钙化及液化，巨方回声增强：2、肿瘤无包膜回声，与周围组织分界清晰；可压迫骨质和健及关切囊；3、多数瘤体内可探及丰富血流信号。结论 高频彩色普勒超声可作为腱鞘巨细胞瘤的首选检查手段之一。     

颈动脉体瘤的超声诊断

目的探讨彩色多普勒超声在颈动脉体瘤中的应用价值,分析超声仪器及超声医生经验与诊断的相关性.方法总结21例手术后病理证实的颈动脉体瘤患者的超声表现,用SPSS 10.0统计学软件分析超声仪器及超声医生经验与诊断的相关性.结果颈动脉体瘤表现为颈动脉分叉处低回声肿物,边界清晰有包膜,常包绕颈内、外动脉及颈内静脉等周围血管.颈内、外动脉受挤压可使两血管之间角度增大出现"金杯"征,肿瘤内部血流信号非常丰富.结论超声医生的经验及彩色多普勒超声仪器可显著提高诊断水平.     

Sonographic findings of dermatofibrosarcoma protuberans with pathologic correlation.

OBJECTIVE: The purpose of this series was to describe the sonographic features of dermatofibrosarcoma protuberans (DP) and correlate them with the pathologic findings of this condition. METHODS: The echogenicity and marginal contour of DP in 4 patients were observed on sonography, and these features were then correlated with the cellular components and histologic grading of pathologic specimens. Additionally, color Doppler sonography was conducted to evaluate the distribution of blood flow signals in the tumors. RESULTS: All lesions were located in the subcutaneous fat layer, abutted against the skin, and had a wide base. Two of the cases of DP observed on the sonograms were hypoechoic, and 2 had mixed echogenicity; however, the mixed echogenic tumors were primarily echoic. The margin was focally lobulated but well defined in the hypoechoic tumors; however, the margin appeared as an irregular pseudopodialike protrusion in the mixed echogenic tumors. Color Doppler sonography showed 2 different blood flow patterns: 1 in which profuse blood flowed through the entire tumor and 1 in which only a small amount of blood flowed through the peripheral portions of the tumor. The 2 blood flow patterns were observed in 1 of each type of tumor. Pathologically, samples corresponding to hypoechoic DP were composed primarily of tumor cells, and samples corresponding to mixed echogenic DP were composed of tumor cells and fibrous tissues. CONCLUSIONS: If a sonogram reveals an oval mass in the subcutaneous tissue that is abutting against the skin and has a focal lobulated margin with hypoechogenicity or an irregular margin with mixed echogenicity, a diagnosis of DP should be considered.     

超声诊断隆突性皮肤纤维肉瘤

目的 探讨隆突性皮肤纤维肉瘤(DFSP)的超声表现.方法 回顾性分析12例经手术病理证实的隆突性皮肤纤维肉瘤的分布、超声图像特征及彩色多普勒血流成像特点.结果 12例隆突性皮肤纤维肉瘤患者中,11例(91.67%)为单发,直径0.9～8.0 cm;分布在躯干66.67(8/12)、四肢近端16.67%(2/12)、头颈部16.67%(2/12);83.33%(10/12)肿瘤出现在躯干及四肢近端的皮肤与皮肤下层.91.67%(11/12)肿瘤呈不均匀弱回声,66.67%(8/12)边界清楚,形态规则,肿瘤内部无液化或钙化且不伴有局部淋巴结转移;91.67%(11/12)肿瘤内彩色多普勒显示有丰富彩色血流信号.结论 患者躯干及四肢近端的皮肤与皮下层肿块,边界清楚、形态规则、内部呈不均匀弱回声、内部血流较丰富、无局部淋巴结肿大是隆突性皮肤纤维肉瘤的超声表现.     

应用彩色多普勒超声诊断桥本甲状腺炎

目的 探讨二维及彩色多普勒超声对桥本甲状腺炎的诊断价值。方法本组28例桥本甲状腺炎病人，根据二维超声及彩色多普勒血流特点分为弥漫肿大型、结节肿大型及局限性桥本病三型。结果 桥本甲状腺炎的甲状腺体积增大(局限性桥本病除外)，内部回声减低，呈网络样改变，病变部位血流信号丰富。结论 二维及彩色多普勒超声可以对桥本甲状腺炎正确分型，对各型桥本病进行鉴别诊断。     

Color Doppler Sonography of Merkel Cell Carcinoma

We illustrate the color Doppler sonographic findings in primary cutaneous Merkel cell carcinoma. Eight cases (4 female and 4 male; mean age, 75.4 years) were collected. The most common affected regions were the face (63%) and the hip/buttock (25%). The mean transverse diameter and thickness were 21 and 14 mm, respectively. Fifty percent were oval, and 50% were dome shaped. All lesions were hypoechoic, with variable degrees of heterogeneity. All but 2 lesions were poorly defined. An acoustic reinforcement artifact was present in 3 and epidermal thickening in 2. All tumors had prominent and chaotic hypervascularity with arterial vessels (mean peak velocity, 11 cm/s; mean resistive index, 0.57).     

Hypoechoic normal renal sinus and renal pelvis tumors: sonographic differentiation.

OBJECTIVE: To evaluate the sonographic findings of an unusually hypoechoic renal sinus that mimics a tumor in the renal pelvis or renal sinus. METHODS: Sonographic scans of 7 patients with an unusually hypoechoic portion in the renal sinus were reviewed retrospectively. Computed tomography, excretory urography, or both confirmed all sinuses as normal. Five consecutive cases of renal pelvis tumors, which were detected on sonography initially in same period, were also reviewed to determine the differences between the 2 conditions. All cases were transitional cell carcinomas of the renal calyces. The images were analyzed for location, shape, margin, presence of posterior sonic attenuation, and associated findings such as caliectasis. RESULTS: Sonographic findings noted in patients with hypoechoic normal renal sinuses were irregular and poorly defined margins (n = 7), a central and symmetric location in the renal sinus (n = 6), the presence of posterior sonic attenuation with nonvisualization of the posterior border of the lesion (n = 7), an unaffected peripheral hyperechoic renal sinus (n = 7), and traversing hilar vessels in the lesion on color Doppler sonography (n = 7). In contrast, renal pelvis tumors had a relatively well-defined margin (n = 4), an eccentric location in the renal sinus (n = 2), a partially or completely obliterated hyperechoic renal sinus (n = 2), a visible posterior margin (n = 5), no posterior shadowing (n = 5), vessel displacement by the mass on color Doppler sonography (n = 5), and associated caliectasis (n = 1). CONCLUSIONS: By being familiar with the sonographic characteristics of a hypoechoic renal sinus, it can be differentiated from renal pelvis tumors, and unnecessary diagnostic workups can be avoided.     

Sonographic Findings of Acute Vasitis

Objective. The purpose of this study was to describe the sonographic findings of acute vasitis. Methods. This was a retrospective analysis of 12 cases of acute vasitis. The following gray scale and color Doppler sonographic features were analyzed: location, echogenicity of the lesion, presence of hydrocele, epididymal involvement, and blood flow within the lesion. Results. Of the 12 patients, 10 had acute vasitis in the scrotal segment; 1 had acute vasitis in the suprascrotal segment; and 1 had acute vasitis in both the scrotal and suprascrotal segments. The sonographic finding for acute vasitis of the scrotal segment was a heterogeneously hypoechoic appearance of the vas deferens (n = 11). The vas deferens was thickened (6.4 mm in diameter) in the 2 patients with suprascrotal involvement; it was heterogeneously hypoechoic in 1 and had a normal appearance in the other. On color Doppler sonography, the degree of blood flow was increased in all of the cases. Of the 12 patients, 11 had inflammation of the epididymis. Conclusions. Acute vasitis usually presents with infection combined with acute epididymitis, and it usually appears as a heterogeneously hypoechoic lesion in the scrotal segment, suprascrotal segment, or both.     

乳腺癌肝转移的超声特点及穿刺活检的价值

目的探讨超声引导下穿刺活检在乳腺癌肝转移诊断中的应用价值及乳腺癌肝转移的超声声像图特点。方法对105例乳腺癌肝转移患者的超声特点及穿刺活检结果进行回顾性分析。按转移灶最大径3cm和≤3cm分为两组进行声像图比较。结果 105例乳腺癌肝转移灶超声特点为实性结节或肿块,多数为低回声(91例,86.7%),≤3cm组的肝转移灶形态多规则(48例,88.9%),边界清晰(37例,68.5%),内部回声多分布均匀(40例,74.1%);3cm组肝转移灶形态多不规则(36例,70.6%),边界不清晰(34例,66.7%),内部回声多分布不均匀(38例,74.6%),两组肝转移灶形态、边界、内部回声均匀性的检出率比较差异均有统计学意义(P均0.01)。105例肝转移灶彩色多普勒可探及血流信号56例(53.3%),3cm组肝转移灶可探及血流信号48例(94.1%)。超声引导下穿刺活检1次穿刺确诊率为99.0%(104/105)。超声引导下穿刺活检后均无严重并发症发生。结论乳腺癌肝转移灶超声表现多为低回声结节或肿块,不同大小的转移灶声像图各有特点,彩色多普勒超声引导下穿刺活检术操作安全、简便、快速,成功率高,并发症少,是乳腺癌肝转移定性诊断的首选方法。     

Bronchioloalveolar carcinoma: sonographic pattern of 'pneumonia'.

BACKGROUND: the sonographic pattern of bacterial pneumonia is predominantly well known and characterized by an air bronchogram, a marked vascularity on color Doppler sonography, and a high-impedance arterial flow pattern on Doppler spectral analysis. METHODS: in a retrospective study the sonographic findings in seven patients with peripheral BAC on X-ray examination were evaluated in relation to number, size, margins, echomorphology and sonographic arterial flow patterns of the lesions. RESULTS: the following sonomorphologic characteristics were found: multiple foci (n=4), single foci (n=3), smooth margins (n=5), irregular margins (n=2) and maximal diameter of size (range 5-15 cm). The echomorphology of the lesions was homogenously hypoechoic (n=1) or showed airbronchograms (n=6). Color Doppler sonography revealed a vascular tree pattern (n=5) or a marked presence of blood vessels (n=2). Doppler flow spectral analysis of arteries in investigated patients (n=5) demonstrates a high impedance (triphasic) flow pattern in four patients and a low impedance (monophasic) flow pattern in one patient. CONCLUSIONS: these findings indicate that BAC frequently shows a sonographic pattern of 'pneumonia'.     

低回声型肝血管瘤的彩色多普勒超声检测

目的　探讨彩色多普勒超声在诊断低回声型血管瘤中的应用价值。方法　应用二维超声、彩色多普勒血流图 (CDFI)、彩色能量多普勒血流图 (PDI) ,结合脉冲多普勒频谱对 18例共 2 2个低回声型肝血管瘤进行研究。结果　 CDFI对低回声型肝血管瘤内血流显示率 2 7.2 7% ,PDI对低回声型肝血管瘤血流显示率 90 .91%。动脉血流检出率为 2 2 .73%。“病灶染色” 9个 (40 .91% )。低回声型肝血管瘤血流呈低速 ,阻力指数 (RI) <0 .6(6 0 % )。结论　彩色多普勒超声对低回声型肝血管瘤的诊断和鉴别诊断有重要价值。     

Sonographic features of phyllodes tumors of the breast.

OBJECTIVE: The aim of this study was to examine the sonographic features of phyllodes tumors of the breast. METHODS: Retrospective analysis of prospectively recorded sonographic features was performed on 2268 patients with phyllodes tumors or fibroadenomas during 1995-98. Data from 110 phyllodes tumors (76 benign, 11 borderline, 23 malignant) and 2204 fibroadenomas were analyzed. RESULTS: The patients with phyllodes tumors were older than the patients with fibroadenoma (mean +/- standard error, 39.7 +/- 1.1 years vs. 33.4 +/- 0.3 years; P < 0.0001). Sixty-four percent of patients with phyllodes tumors were aged 31-50 years, while 68.5% of those with fibroadenoma were aged 21-40 years. Phyllodes tumors were larger than fibroadenomas (5.90 +/- 0.43 cm vs. 1.95 +/- 0.03 cm; P < 0.0001). The ratio of length to anteroposterior diameter of phyllodes tumors was smaller than the ratio of length to anteroposterior diameter of fibroadenomas (1.72 +/- 0.06 vs. 1.89 +/- 0.02; P = 0.0105). Seventy-seven percent of phyllodes tumors were lobulated and 79.5% of fibroadenomas were oval. Lobulated shape of the tumor, heterogeneous echo pattern and absence of microcalcification are significant independent sonographic features in multiple logistic regression analysis to distinguish between phyllodes tumors and fibroadenoma. Benign, borderline and malignant phyllodes tumors displayed no significant differences in tumor size or the ratio of length to anteroposterior diameter. CONCLUSIONS: There is a substantial overlap in the sonographic characteristics between phyllodes tumors and fibroadenoma of the breast. If lobulation and heterogeneous hypoechoic internal echoes are observed and calcifications are absent, a diagnosis of phyllodes tumors should be considered. Sonography cannot distinguish between malignant, borderline and benign phyllodes tumors.     

Differential diagnosis of focal epididymal lesions with gray scale sonographic, color Doppler sonographic, and clinical features.

OBJECTIVE: To determine whether focal epididymal lesions can be differentiated on gray scale sonographic, color Doppler sonographic, and clinical features. METHODS: This was a retrospectiveanalysis of 60 focal epididymal lesions in 57 patients. Focal epididymal lesions were classified into 3 groups: nonspecific epididymitis (n = 43), tuberculous epididymitis (n = 10), and benign epididymal masses (n = 7). The following gray scale sonographic, color Doppler sonographic, and clinical features were analyzed: size, location, echogenicity, and heterogeneity of the lesion; hypoechoic or hyperechoic rim presence; hydrocele presence; degree of blood flow in the lesion; patient's age; duration of symptoms; and scrotal tenderness. RESULTS: Lesions were larger in patients with tuberculous epididymitis than in those with either nonspecific epididymitis (P = .007) or benign epididymal masses (P = .0017). The hypoechoic or hyperechoic rim of the lesion was more common in patients with benign epididymal masses than in those with nonspecific epididymitis (P = .002). The degree of blood flow in the lesion was greater in patients with nonspecific epididymitis than in those with either tuberculous epididymitis (P = .0019) or benign epididymal masses (P < .001). The duration of symptoms was shorter in patients with nonspecific epididymitis than in those with either tuberculous epididymitis (P < .001) or benign epididymal masses (P = .0092). The frequency of scrotal tenderness was higher in patients with nonspecific epididymitis than in those with either tuberculous epididymitis (P < .001) or benign epididymal masses (P < .001). CONCLUSIONS: Gray scale sonographic, color Doppler sonographic, and some clinical features may be helpful for differential diagnosis of focal epididymal lesions.     

高频彩色多普勒超声对腹壁纤维瘤病的诊断价值

目的总结腹壁纤维瘤病的声像图特征，探讨超声对腹壁纤维瘤病的诊断价值。方法分析总结了12例经手术及穿刺活检病理证实的腹壁纤维瘤病的二维和彩色多普勒超声特征。结果腹壁纤维瘤病声像图及血流图特征，腹肌内长条形实性低回声包块，无包膜，边界欠清，周边及内部见少许血流信号。结论高频彩色多普勒超声对腹壁纤维瘤病的诊断与鉴别诊断具有重要价值，可为临床诊断及治疗提供可靠的信息。