Breast pilomatrixoma manifested as microcalcifications on mammography: report of two cases

Pilomatricoma is a benign tumor of hair follicule origin corresponding to a firm subcutaneous nodule requiring histology for diagnosis. Only few breast pilomatricomas have been reported, with imaging showing well defined nodules with microcalcifications. We report two cases of intra-mammary pilomatricomas presenting as ACR BI-RADS 4 and 5 microcalcifications, suspicious for malignant tumors. Percutaneous biopsy confirmed the histological diagnosis. Malignant pilomatricomas have been reported, suggesting that all pilomatricomas should be resected.     

Paraffin tissue block radiography: adjunct to breast specimen radiography

Radiography of specimens is an essential step in confirming excision of nonpalpable breast lesions. On occasion, however, the pathologist may not identify the lesion histologically. The authors report five cases in which suspicious microcalcifications were included in the excised tissue but were not identified by the pathologist. In all five, paraffin tissue block radiography enabled identification of the specific blocks containing the microcalcifications. The correct tissue blocks were then sectioned again, and the microcalcifications were identified histopathologically. In one case, the initial diagnosis of intraductal hyperplasia was changed to intraductal carcinoma with focal invasion. When the pathologist cannot identify the calcifications on initial histopathologic sections, this technique may assist in identification of the mammographic abnormality.     

Myofibroblastoma of male breast: report of three cases and review of the literature

We report three cases of male breast myofibroblastoma. This uncommon benign tumor arises from breast mesenchyma and is more frequently seen in adult men. Mammographic findings consist of a well-delimited, round to oval dense mass, variable in size but usually 1–4 cm in diameter. No microcalcifications were observed. Ultrasonography confirms the solid nature of the lesion, showing a well-circumscribed, homogeneous, hypoechoic mass, compressible with pressure. Although FNA cytology may support the diagnosis, surgical biopsy should be performed. Tumorectomy is the treatment of choice. To our knowledge, no more than 40 cases of breast myofibroblastoma have been reported. This is the first report in the literature which emphasizes the mammographic and ultrasonographic features of this tumor. Received: 30 April 1996; Revision received: 22 August 1996; Accepted: 30 September 1996     

POEMS syndrome: unusual radiographic, scintigraphic and CT features

POEMS syndrome is a multisystemic disorder related to a plasma cell dyscrasia. Radiologically, this syndrome is characterized by sclerotic focal bone lesions with a normal radionuclide bone scan. We report a case of POEMS syndrome with an expansile lytic lesion in the sternum showing periosteal reaction and soft tissue mass, which revealed locally increased uptake of radiotracer in bone scintigraphy. These unusual findings and the differential diagnosis are discussed. Received 8 March 1996; Revision received 6 September 1996; Accepted 28 April 1997     

Radiologic-pathological correlation of punctate hyperechoic foci by ultrasound in stereotactic vacuum-assisted breast biopsy samples

Purpose

To correlate punctate hyperechoic foci (PHF) on ultrasound (US) with microcalcifications detected by mammography (MMG) and at histopathology.

Materials and methods

Forty-eight subjects who underwent stereotactic vacuum-assisted breast biopsy (SVABB) for evaluation of breast microcalcifications between April and December 2008 were evaluated for 191 lesions obtained after SVABB. The concordance between PHF on US with microcalcifications detected on MMG and histopathology was therefore evaluated for 191 lesions. Values for sensitivity and specificity were determined against histopathology as the reference standard.

Results

In 154 of 191 samples (80.6%), the PHF on US corresponded with microcalcifications on MMG and histopathology. The overall sensitivity and specificity were 85.3% and 80.0%, respectively, for US, and 89.7% and 90.7%, respectively, for MMG. There were no significant differences between values for US and MMG. At US, 12 PHF did not correlate with any microcalcifications at MMG or histopathology. Histopathology revealed collagen fibers in fatty tissue in 5 of 12 lesions and collagenization in 2 of 12 lesions.

Conclusion

There was a general concordance between PHF on US and microcalcifications detected at MMG. However, in addition to microcalcifications, collagen fibers in fatty tissue and collagenization may account for some PHF. This possibility should be considered when interpreting US findings.     

Subcutaneous implantation metastasis of a cholangiocarcinoma of the bile duct after percutaneous transhepatic biliary drainage (PTBD)

Percutaneous transhepatic biliary drainage (PTBD) is the basis for most biliary interventional procedures. We recently observed the occurrence of a subcutaneous implantation metastasis after PTBD in a patient with incurable cholangiocarcinoma. Although tumor cell seeding along the catheter tract is a very rare complication, we think that PTBD should be avoided when curative resection is planned. Received: 6 December 1995; Revision received 18 March 1996; Accepted 11 April 1996     

Benign hyperplasia in ectopic prostatic tissue: a rare cause of pelvic mass

Four cases of a pelvic mass due to the development of benign hyperplasia within ectopic prostatic tissue are reported. They presented a hypoechoic homogeneous or heterogeneous pattern on transrectal ultrasonography and a high signal intensity on T2-weighted spin-echo sequences on MR. On CT the density was similar to that of prostatic tissue. No recent imaging findings of this rare entity have been described in the literature. Possible aetiologies are discussed. Even if it is a rare event, the correct diagnosis can be reached. It is important for radiologists to consider the presence of this lesion because of its benign nature. Received 27 December 1995; Revision received 22 March 1996; Accepted 30 March 1996     

Tossed on the horn of humerus: a legal case report

Radiological cases constituted 2 % of the total number of legal cases in Sweden during 1996. The young man in this report accused a radiologist of having missed a fracture 7 years earlier based on a new radiology examination and report. In reality the latter report was incorrect and the patient had a rare exostosis that explained the clinical signs and symptoms. The alleged fracture was an epiphyseal line to a non-unified ossification centre at the tip of the unique exostosis. Received 30 January 1998; Revision received 17 March 1998; Accepted 23 March 1998     

Incidental finding of a mucinous carcinoma of the breast by dynamic MRI in a patient with a history of breast trauma (horse bite): incidental mucinous carcinoma after breast trauma

Occasional reports on the coincidence of previous trauma of the breast and the development of invasive breast cancer have been published. Furthermore, traumatic changes of the breast tissue can clinically and radiographically mimic malignant breast disease. We report of a 52-year-old female presenting with increasing mammographic microcalcifications after a trauma of the breast due to a horse bite. Dynamic MRI was able to exclude malignancy at the site of the trauma but did detect a clinically and radiographically nonsymptomatic mucinous carcinoma of the breast.     

Role of high magnification specimen radiography in surgical and core biopsies of the breast

The clinical relevance of a high magnification specimen radiography (HMSR) system in breast biopsies was evaluated and compared with conventional specimen radiography with a mammography system (SRM). 100 surgical biopsies of 72 patients and 248 core biopsies of 30 patients were examined in (a) maximal 20-fold HMSR in combination with storage phosphors and (b) 1.8-fold SRM using a film-screen system. Detection of calcifications/soft tissue lesions and the impact on management were evaluated. In surgical biopsies, SRM could detect only 22% of individual microcalcifications, 39% of calcified lesions and 67% of soft tissue lesions identified with HMSR. Calcifications down to 10 microns were identified with HMSR. In five biopsies, peripheral calcifications leading to additional resection were recognized only with HMSR; in three of these they were indicative of malignant tissue. In core biopsies, only 12% of individual microcalcifications seen with HMSR were identified with SRM. 52% and 16% of all cores were calcified on HMSR and SRM, respectively. Microcalcifications within cores were found only with HMSR in 41% of patients with calcified lesions. In conclusion, the better detectability of microcalcifications with HMSR led to justified additional tissue resections in surgical patients and reduced the number of core biopsies required in interventional patients.     

Origin of metallic particles resembling microcalcifications on mammograms after use of abrasive cautery-tip cleaning pads during breast surgery: experimental demonstration

PURPOSE: To determine if the act of cleaning a cautery tip with an abrasive pad dislodges radiopaque particles that can be transferred to breast tissue during surgery, thereby mimicking microcalcifications at mammography. MATERIALS AND METHODS: Mock breast surgery was performed by cauterizing bovine liver or fresh, normal, human breast tissue. The cautery tip was rubbed against a cleaning pad five to 20 times in the manner used intraoperatively and was touched on separate breast tissue specimens two to six times. Specimen radiography was then performed. Thirty-six breast specimens were used in three experiments, including 28 used for the experimental conditions and eight control specimens. RESULTS: Particles collected from the cleaning pads resembled microcalcifications. After cauterization of liver, breast tissue, or both, in series, particles transferred from the cautery tip to breast tissue specimens could be identified on specimen radiographs. Transfer of particles after cautery of breast tissue occurred with increased numbers of rubs and specimen contacts. CONCLUSION: Radiopaque aluminum oxide particles from abrasive cautery-tip cleaning pads can be dislodged and transferred to breast tissue during surgery. Scrutiny of high-detail, spot-compression, magnification mammograms will help identify these particles. Simple measures to mitigate particle transfer during breast surgery can prevent this problem and obviate a potential second procedure to remove particles mistaken for microcalcifications.     

Breast specimen microcalcifications: radiographic validation and pathologic-radiologic correlation.

A prospective analysis of specimens from location and biopsy of mammographically suspect microcalcifications in 108 patients was carried out to determine if microcalcifications were lost during histopathologic processing and the clinical relevance of such loss. Nine hundred sixty-eight paraffin blocks were prepared from 425 gross tissue slices containing calcifications identified at radiography of the specimens. Calcium was apparently lost both during preparation of the blocks (13.6%) and after slide preparation (12.6%), for a total possible loss of 26.2%. All specimens demonstrated calcification histologically. One pathology report was amended because of information obtained after recuts, but all cancers were detected on original slides whether or not calcifications were identified initially. The results indicate that, by following the suggestions offered to ensure adequate histopathologic sampling of calcification seen at mammography, most if not all of the calcification present can be detected on the original slide.     

Mucinous breast carcinoma showing as a cluster of suspicious microcalcifications on mammography

We report a case of mucinous breast carcinoma whose mammographic features consisted of a suspicious cluster of microcalcifications as the unique sign of malignancy. The lesion was non-palpable and measured approximately 2 cm at the greatest diameter. The microcalcifications showed several morphologies: round, pleomorphic, and fine shapes were identified. The total number of microcalcifications was > 30 and the number per square centimeter varied from 10 to 20. The histological calcifications showed good correlation with the mammographic ones and were localized predominantly at the periphery of the tumor inside ducts with ductal carcinoma in situ or in the acellular mucin. Two types were observed: psammomatous and gross-irregular calcifications. To our knowledge, only one case with similar findings has been reported previously. Received 10 November 1997; Revision received 3 April 1998; Accepted 2 June 1998     

MRI in carcinomatous encephalitis

We report a rare case of miliary brain metastases presenting with symptoms similar to encephalitis (“carcinomatous encephalitis”). Contrast-enhanced MRI demonstrated miliary metastases more distinctly than other imaging methods and reproduced the pathological features. Received: 28 March 1996 Accepted: 29 April 1996     

Heat-stroke-induced cerebellar atrophy: clinical course, CT and MRI findings

We report the clinical course and CT and MRI findings in a case of heat-stroke-induced cerebellar atrophy. Although the cerebellar syndrome was severe concomitant with the onset of heat stroke, no abnormality was observed on brain CT in the first 2 weeks following the event. Cerebellar atrophy was first noted after 10 weeks on MRI; it was progressive during a 1-year follow-up. Received: 30 November 1995 Accepted: 1 March 1996     

Vascular rupture complicating transluminal angioplasty applied on a failed dialysis vascular access in a patient under chronic steroid therapy

We report a case of venous rupture complicating percutaneous transluminal angioplasty (PTA) applied on a failed dialysis vascular access (VA) in a patient on chronic steroid therapy. This complication resulted in a rapidly growing hematoma which was successfully controlled by a prolonged reinflation of the balloon catheter at the angioplasty site. The absence of oversizing of the balloon catheter and the low inflation pressure at which the perforation occurred suggest a vessel fragility which was probably induced by a long-standing steroid therapy. In dialysis patients in whom steroid therapy does not represent an infrequent therapeutic modality, this potential risk of vascular rupture should be carefully weighted while treating VA stenoses with the use of PTA. Received 10 January 1996; Revision received 18 March 1996; Accepted 23 July 1996     

Aberrant pancreas in the gallbladder wall

We present three cases of heterotopic pancreas in the gallbladder wall. The patients (all female) presented with abdominal pain. Ultrasonography revealed polypoid tumor with coexistence of lithiasis in two cases. All patients underwent cholecystectomy. Microscopy revealed chronic cholecystitis and cholesteatosis and heterotopic pancreatic tissue. Heterotopic pancreas in the gallbladder wall is a rare heterotopia, with 23 cases reported in the international literature. Received 21 March 1996; Revision received 4 September 1996; Accepted: 9 December 1996     

Mature teratoma of the posterior mediastinum

The vast majority of germ cell tumors in the thorax arise at or near the thymus. We report a case of a 41-year-old man with mature teratoma of the posterior mediastinum. He was asymptomatic and was incidentally found to have a posterior mediastinal mass. Computed tomography was helpful in suggesting a diagnosis of mature teratoma by demonstrating the presence of fat and calcification. The differential diagnosis included neurogenic tumors, liposarcoma, and extramedullary hematopoiesis. Received 27 December 1996; Revision received 6 March 1997; Accepted 11 March 1997     

Microcalcifications of breast tissue: appearance on synchrotron radiation imaging with 6-microm resolution

OBJECTIVE: The purpose of this study was to use synchrotron radiation imaging with 6-microm resolution to evaluate amorphous and pleomorphic breast tissue microcalcifications. CONCLUSION: Synchrotron radiation imaging depicted microcalcifications as small as 24 microm. Imaging with this technique revealed that most amorphous and pleomorphic calcifications on conventional mammograms are clusters of fine specks and that in addition to the shape or density of a speck, the distribution density of clustered specks is a factor determining the apparent shape.     

Characterization and guided-procedures of breast suspicious microcalcifications: can MicroPure ultrasound do it?

Objective

To assess the diagnostic value of high-frequency (MicroPure) ultrasound in evaluating suspicious microcalcifications and to determine its capability in biopsy guidance.

Subjects and methods

Sixty-two cases with suspicious microcalcifications detected on mammographic examination had been re-evaluated by MicroPure US. The studied cases underwent true cut tissue/surgical excision biopsy. Histopathology revealed 25 benign and 37 malignant lesions and was considered the gold standard of reference.

Results

Malignant microcalcifications were easier to be visible at MicroPure US, as they were detected in 86.5% (n = 32/39) compared to only 68% (n = 17/25) of the benign lesions. US depicted more breast masses associated with malignant microcalcifications in 78% (n = 29/37) than those associated with benign ones seen in 36% (n = 9/25).Visibility of suspicious microcalcifications at US was aided by preliminary mammogram. Given known mammography location of these microcalcifications had made their visualization accessible by MicroPure US in 79% (n = 49) of the cases.

Conclusion

MicroPure ultrasound cannot discriminate benign from malignant breast microcalcifications. MicroPure can be useful in detecting clustered microcalcifications that are not accessible by B-mode ultrasound; provided knowledge of their mammographic location and thus can provide better guidance for pre-surgical wire localization and ultrasound-guided biopsies.