Angiolipoma of the breast with microcalcification. Mammographic, sonographic, and histologic appearances

Angiolipoma of the breast is a rare benign fatty tumor that can be mammographically confused with breast carcinoma. We herein report such a case presenting as a partial obscured mass with microcalcification on mammogram. Sonogram revealed an encapsulated hyperechoic nodule with homogeneous internal echo. Microscopic evaluation revealed abundant adipose tissues with evidence of proliferating vessels and intravascular hyaline thrombi. To our knowledge, angiolipomas of the breast containing microcalcification secondary to intravascular thrombi had not been previously reported.     

Ablative zone size created by radiofrequency ablation with and without chemoembolization in small hepatocellular carcinomas

Purpose

We retrospectively evaluated whether combined use of chemoembolization expands ablative zone sizes created by radiofrequency (RF) ablation in patients with small hepatocellular carcinomas (HCCs).

Materials and methods

Fifty-seven patients treated with single RF ablation for solitary HCC measuring ??2?cm were assessed. RF ablation alone was done in nine patients and in 48 patients following chemoembolization, with an interval of 0?days in 6, 1?C14?days in 27, 15?C28?days in 6, and ??4?weeks in 9. Ablative zone sizes, disappearance of tumor enhancement, and creation of sufficient ablative margins (>5?mm) were evaluated on contrast-enhanced computed tomography (CT) images.

Results

Both mean long-axis (4.2?C4.7 vs. 3.6?±?0.4?cm, p?p?p?Conclusion Ablative zones created by RF ablation with chemoembolization become larger than RF ablation alone, leading to secure ablative margins.     

伴有侵袭征象的脊柱良性病变的X线、CT与MRI对比研究

目的 探讨脊柱良性病变在影像学上出现的侵袭性征象及其对诊断的影响.方法 回顾性分析影像学上具有侵袭性征象并经病理证实的脊柱良性病变139例,包括骨母细胞瘤(OB)18例,动脉瘤样骨囊肿(ABC) 12例,骨软骨瘤(OC)14例,朗格汉斯细胞组织细胞增生症(LCH) 19例,血管瘤(HA)15例,脊柱结核(TS) 34例,化脓性脊柱炎(PS) 27例,均行X线检查,119例行CT平扫,75例行MRI平扫,3种检查方法齐全者57例.计算3种影像学方法对各病例的良恶性误诊率及诊断与病理的符合率,并进行统计学分析.结果 椎体后缘膨隆ＯB 2例,ABC 1例,LCH 3例,OC 1例,HA 6例,TS 6例,PS 2例;病理性压缩骨折OB 6例,ABC10例,LCH 16例,HA4例,TS 21例,PS 16例;边界不清ＯB 3例,HA8例,TS 34例,PS 27例;异常椎周软组织影OB 6例,ABC2例,LCH 15例,TS 10例,PS 15例;周围骨髓及软组织水肿ＯB 5例,ABC 4例,LCH 10例,HA 4例,TS 30例,PS 27例.良恶性误诊率MR高于CT(P＜0.05),病理符合率CT高于MRI(P＜ 0.05),3种影像学方法综合应用明显提高诊断符合率(P＜0.05).结论 脊柱良性病变影像表现多样,可伴发侵袭性征象.联合应用3种影像学方法综合判断是避免误诊的最简便且有效的方法.     

Occult malignant breast lesions in 114 patients: relationship to age and the presence of microcalcifications

This study evaluates the mammographic findings in 352 patients, aged 30-85 years, who underwent spot localization and biopsy for evaluation of nonpalpable breast abnormalities. Malignancy was found at biopsy in 114 cases. The mammographic appearance (specifically, whether grouped microcalcifications, mass, or both were present) was correlated with patient age and histologic findings (specifically, whether the pathologic changes were infiltrating or noninfiltrating in nature). The prevalence of malignant conditions increased directly with age. The presence of grouped microcalcifications as the sole indicator of malignancy was seen in 100% (seven of seven) of the patients in the 30-39-year age group, 64% (18 of 28) in the 40-49-year age group, 37% (11 of 30) in the 50-59-year age group, 30% (seven of 23) in the 60-69-year age group, and 23% (six of 26) in the 70-85-year age group. Of the 49 tumors that were manifested solely as microcalcifications, 34 (69%) were noninfiltrating. The finding of grouped microcalcifications should be aggressively investigated, since it may indicate noninfiltrating carcinoma in an early stage, when the potential for cure is greatest.     

睾丸良恶性肿块的CT、MRI表现及鉴别诊断

目的：探讨睾丸良恶性肿块的CT、MRI表现及鉴别诊断价值。方法：回顾性分析31例经病理证实的睾丸肿块患者的CT、MRI资料，其中21例行MRI平扫及增强扫描，9例行CT平扫及增强扫描，1例同时行CT及MRI平扫及增强扫描。根据病理结果分为良性13例、恶性18例，对比观察良恶性病变的形态、密度/信号和强化表现，并采用Fisher检验进行统计学分析。结果：31例中，恶性病变18例（精原细胞瘤9例，胚胎性癌3例，恶性混合性生殖细胞瘤2例，弥漫大B细胞淋巴瘤2例，高分化脂肪肉瘤1例，间质细胞瘤1例）；良性病变13例（腺样腺瘤2例，表皮样囊肿2例，畸胎瘤1例，平滑肌瘤1例，血肿1例，炎性肿块6例）；在睾丸良恶性病变CT、MRI表现中，浅分叶、密度/信号混杂、T₂WI呈低信号、周边强化、间隔强化、延迟强化征象的出现率差异均有统计学意义（均P<0.05）。结论：睾丸良恶性肿块的CT、MRI表现有一定特征，多种影像学方法联合应用结合临床资料综合分析，有助于睾丸良恶性病变的鉴别诊断。     

The limitations of gallium scintigraphy in the differentiation between benign and malignant salivary gland mass lesions

The aim of this study was to evaluate the ability of gallium scintigraphy to differentiate between benign and malignant salivary gland mass lesions and to identify what types of lesions surpass its diagnostic utility. By considering the uptake of 67Ga, 193 salivary gland masses were graded visually as negative, weakly positive, moderately positive or strongly positive in comparison to the uptake in the nasal cavity and the liver. The uptake was compared with histopathological findings. Among 39 malignant tumours, uptake was positive in 31 (79%) (strongly positive in 18, moderately positive in seven and weakly positive in six) and uptake was negative in eight (21%). Adenoid cystic carcinoma was the most common malignant tumour in our study (11/39), and uptake was negative in five (45%) of these tumours. Malignant tumours did not differ significantly in size despite differences in uptake. Among 154 benign lesions, uptake was negative in 101 (66%) and positive in 53 (34%) (strongly positive in 12, moderately positive in 19 and weakly positive in 22). Out of 88 pleomorphic adenomas, 41 (47%) showed positive uptake. Sensitivity, specificity and accuracy for gallium study were 80%, 66% and 68%, respectively, when the malignancy criterion was weakly positive uptake. Accuracy was greatest (83%) when the criterion was strongly positive uptake, but this criterion failed to detect more than a half of malignant tumours (46% sensitivity). In conclusion, gallium scintigraphy had limitations in differentiating between benign and malignant salivary gland mass lesions. Adenoid cystic carcinomas and pleomorphic adenomas were the principal sources of false negative and false positive results, respectively.     

Early diagnosis of malignant pulmonary lesions. Importance of tumor size and growth rate.

The prognosis of peripheral lung cancer and the possibilities of an early diagnosis are discussed on the basis of a unique case of a small bronchogenic carcinoma which was followed with routine radiography over an eight year period. The tumor growth rate as reflected by volume doubling time is utilized for determination of the earliest possible visibility and evolution time. Certain conclusions are drawn about the importance of an early diagnosis and therapy for the prospective chances of a radical cure.     

Sonographic differentiation of invasive and intraductal carcinomas of the breast

The purpose of this study is to evaluate the diagnostic ability of ultrasound and define the sonographic features of symptomatic intraductal and invasive breast carcinoma. To achieve this the ultrasound features of 488 invasive carcinomas and 65 non-screening detected intraductal carcinomas were compared retrospectively. The features included size, AP/W (anteroposterior diameter/width) ratio, shape, margin, internal echogenicity, internal echotexture, posterior acoustic transmission, bilateral edge shadowing sign and calcifications. The sensitivity and specificity of the detection of calcifications by ultrasound in comparison with mammography were also studied. The accuracy of ultrasound diagnosis is 92.0% for invasive carcinoma of breast and 84.8% for intraductal carcinoma. Differentiation of ultrasound features of intraductal and invasive carcinoma can be based on the internal hypoechogenicity, loss of bilateral edge shadowing, posterior acoustic transmission, irregular shape and non-uniform internal echotexture with odds ratio of 0.3, 0.3, 0.4, 0.5 and 0.5, respectively. Internal echogenicity was the only significant differentiating factor on multiple logistic regression analysis. Non-comedo type ductal carcinoma in situ can be differentiated from comedo type by irregular shape with odds ratio of 0.3. The sensitivity, specificity and accuracy rate for the detection of calcifications in invasive carcinomas by ultrasound were 65.1%, 61.9% and 63.2%; in comedo type intraductal carcinoma 62.5%, 66.7% and 63.6%, and in non-comedo type intraductal carcinoma 30.0%, 86.7% and 64.0%, respectively. The ultrasound appearance of non-screening detected intraductal carcinoma is relatively isoechoic in comparison with invasive carcinoma. More than 60% of microcalcifications in comedo type intraductal carcinoma can be accurately demonstrated by ultrasound. However, the role of ultrasound in detecting symptomatic intraductal carcinoma warrants further study.     

Smaller cerebellar volumes in very preterm infants at term-equivalent age are associated with the presence of supratentorial lesions

BACKGROUND AND PURPOSE: Traditionally cerebellar functions are thought to be related to control of tone, posture, gait, and coordination of skilled motor activity. However, there is an increasing body of evidence implicating the cerebellum in cognition, language, memory, and motor learning. Preterm infants are at increased risk of neurodevelopmental delay, cognitive dysfunction, and behavioral and emotional disturbances. The role of the cerebellum in these adverse outcomes is unclear. OBJECTIVE: The objective of this study was to determine whether absolute cerebellar volumes differ between term-equivalent preterm infants and term-born control infants and to assess whether cerebellar volume is influenced by any possible antenatal, perinatal, and postnatal factors. METHODS: The study compared the MR imaging cerebellar volume by using a manual quantification program of 113 preterm infants at term-equivalent age and 15 term-born control infants. RESULTS: The median cerebellar volume of preterm at term-equivalent age was 25.4 cm3 and that of term-born control infants was 26.9 cm3. On initial analysis, there was a significant median difference of 2.0 cm3 (95% CI, 1.2 cm3 to 2.7 cm3) (2-sided P < .0001). However multiple regression analysis of perinatal variables showed that only infants with supratentorial lesions (P = .003) were significantly associated with the reduction in cerebellar volumes. The median cerebellar volumes were the following: supratentorial lesions, 18.9 cm3; no supratentorial lesions, 26.1 cm3; and term infants, 26.9 cm3 (analysis of variance, P < .0001). Hence, there was no significant difference in cerebellar volumes of preterm infants at term-equivalent age in the absence of supratentorial lesions. The median vermal volumes were 0.7 cm3 and were significantly related to cerebellar volumes both in preterm infants with and without lesions and in term-control infants. CONCLUSION: Premature infants at term-equivalent age have similar total cerebellar and vermal volumes compared with term infants in the presence of normal brain imaging. Reduced cerebellar volume in preterm infants at term-equivalent age is seen in association with supratentorial pathology such as hemorrhagic parenchymal infarction, intraventricular hemorrhage with dilation, and periventricular leukomalacia.     

Sonographic criteria for differentiation of benign and malignant solid breast lesions: size is of value

PURPOSE: The purpose of this study was to evaluate whether lesion size may influence the value of sonographic findings in the differential diagnosis between benign or malignant breast lesions. MATERIALS AND METHODS: Sonographic features of 256 histologically confirmed (148 benign, 108 malignant) breast lesions were retrospectively and independently reviewed by three radiologists unaware of mammographic findings and pathology results. Each lesion was assessed for several sonographic features and assigned a level of suspicion. Logistic modelling defined the predictive value of each sonographic feature per se and in relation to lesion size. The k statistic (k) evaluated interobserver agreement in lesion classification. The accuracy of breast sonography in characterising solid lesions was also evaluated. RESULTS: Analysis of the sonographic features predictive of malignant disease, taken as a whole, showed that only irregular margins and marked hypoechogenicity maintain their predictive value independent of lesion size. When lesion size is considered, the other features remain significant only for lesions larger than 7 mm. Interobserver agreement for sonographic suspicion, when calculated not taking into account lesion size, was good or excellent whereas it was reduced for lesions smaller than 7 mm. Accuracy of breast sonography improved when evaluating lesions larger than 7 mm. CONCLUSIONS: Lesion size influences the value of sonographic findings in distinguishing benign from malignant lesions. The usually adopted criteria in sonography have a significantly lower accuracy in characterisation of small lesions.     

Kinetic analysis of lesions without mass effect on breast MRI using manual and computer-assisted methods

Objective  

To analyse the kinetic characteristics of lesions without mass effect in dynamic breast MRI using manual and computer assisted methods.     

用手动选取和计算机辅助的方法分析乳腺MRI中没有占位效应的病灶的动态强化特性

目的用手动选取和计算机辅助的方法分析动态乳腺MRI中没有占位效应的病灶的动态强化特性。方法在乳腺MRI中用手动放置感兴趣区(ROI)的方法评估82例经组织病理学证实的没有占位效应的病灶(36例恶性,46例良性)的增强模式。用商业性可应用的电脑分析软件来自动评     

多层CT评价健康志愿者用力呼气时的气管萎陷

目的应用多层螺旋CT评价健康志愿者用力呼气时气管萎陷情况，结果与现行的气管软化症诊断标准进行对照。材料与方法本研究经学术审核委员会批准．符合健康医疗保险要求。获得知情同意书后，51例肺活量正常、无吸烟史或其他可能导致气管软化危险因素的健康志愿者（年龄25～57岁）纳入本前瞻性研究。     

Characterization of lesions of the breast with proton MR spectroscopy: comparison of carcinomas, benign lesions, and phyllodes tumors

OBJECTIVE: Proton MR spectroscopy is a recently described technique with high sensitivity and specificity for differentiating breast carcinoma from benign lesions. We evaluated the possible relationship between spectroscopy results and the tumor proliferative index, angiogenesis, and HER2/neu oncogene overexpression. SUBJECTS AND METHODS. We prospectively evaluated 19 breast carcinomas, 21 benign breast lesions (including 18 fibroadenomas, one fibrocystic change, one hamartoma, and one papilloma), and six phyllodes tumors (four benign, two of borderline malignancy) using proton MR spectroscopy. All lesions were larger than 1.5 cm. Tumor Ki-67 proliferative index, tumor angiogenesis, and HER2/neu oncogene overexpression were evaluated by immunohistochemistry of the histologic material. RESULTS: Spectroscopy findings were positive in 17 (89%) of 19 carcinomas but negative for all benign lesions and phyllodes tumors (sensitivity, 89%; specificity, 100%). Significantly higher levels were obtained for all biologic parameters in carcinomas compared with benign lesions and phyllodes tumors. HER2/neu oncogene overexpression was present in 37% of carcinomas but not in other lesions. The two false-negative findings of breast carcinoma showed similar Ki-67 proliferative index and microvessel density compared with the remaining carcinomas, but both cases were negative for HER2/neu overexpression. CONCLUSION: Proton MR spectroscopy is useful in the in vivo characterization of breast masses when the lesion exceeds 1.5 cm in maximal dimension. Spectroscopy is unable to reveal benign breast lesions and phyllodes tumors of benign and borderline malignancy. We suggest that a false-negative spectroscopic result may be related to an absence of HER2/neu overexpression in carcinoma of the breast.