Low-grade mucosa-associated lymphoma of the breast: radiological–pathological correlation

Primary breast lymphoma generally is a rare disease. We present a case of a low-grade mucosa-associated (MALT) lymphoma of the breast in a 32-year-old woman, a distinctive type of localized non-Hodgkin's lymphoma (NHL), which is very seldom located in the breast. We performed differential diagnosis and radiological-pathological correlation with regard to typical microscopic criteria and clinical relevance that apply for that special entity.     

A cavernous haemangioma of breast in male: radiological–pathological correlation

Vascular tumours of the breast are especially rare in men, and a majority of them are angiosarcomas. In fact, we found only four cases of haemangioma in males in the literature. We present a case of cavernous haemangioma in a male aged 48 years, and which commenced as a palpable mass. We performed differential diagnosis and radiological–pathological correlation. We established the correct classification of this case histologically, and decided on the definitive therapeutic approach. Received: 11 February 2000/Revised: 19 June 2000/Accepted: 20 June 2000     

T1ρ is superior to T2 mapping for the evaluation of articular cartilage denaturalization with osteoarthritis: Radiological–pathological correlation after total knee arthroplasty

Purpose

We compared the diagnostic performance of T1ρ and T2 mappings in the evaluation of denatured articular cartilage with osteoarthritis of the knee.

Materials and methods

2D-Sagittal T1ρ and T2 mappings of the knee were obtained from 16 patients before total knee arthroplasty. After surgery, specimens of the femur and tibia were regionally segmented according to a 5-point scale of the severity of denaturalization. The T1ρ and T2 values in the full thickness of the articular cartilage in each region were measured by two observers. The two mappings were compared for their ability to differentiate between normal and denatured articular cartilage and also for their usefulness in grading the severity of the denaturalization using the area under receiver operating characteristic curves (Az). A p < 0.05 was considered significant for each analysis.

Results

The T1ρ mapping showed a significantly higher Az value than the T2 mapping for the differentiation between normal and denatured articular cartilage (p < 0.05). Regarding the assessment of the severity of denaturalization, T1ρ mapping could differentiate between normal and mild denaturalization (p < 0.05), but T2 mapping could not. However, there were no significant differences between the two mappings in the discrimination of mild versus moderate denaturalization or of moderate versus severe denaturalization. The two observers showed good agreement in the results (intraclass correlation coefficient = 0.81 for T1ρ and 0.92 for T2).

Conclusion

T1ρ mapping is superior to T2 mapping for the evaluation of denatured articular cartilage with osteoarthritis of the knee.     

Myomatous hepatic angiomyolipoma: imaging findings in 14 cases with radiological–pathological correlation and review of the literature

Objective:

To display and analyse the imaging features of myomatous hepatic angiomyolipomas (MHAMLs).

Methods:

The imaging features (CT = 9; MRI = 10; ultrasound = 10; contrast-enhanced ultrasound = 4) of 14 patients with pathologically proven MHAMLs were reviewed retrospectively.

Results:

MHAMLs were surgically resected in the 14 patients (10 females and 4 males; age, 27–64 years; mean, 45 years), all of whom had negative hepatitis markers and were positive for the immunohistochemical stain homatropine methylbromide-45. The tumours were solitary and well defined, and ranged in size from 1.9 to 9.1 cm (mean, 5.7 cm). On dynamic contrast-enhanced CT, MRI and ultrasound scans, all tumours showed fast strong enhancement in the arterial phase and moderate washout in the portal venous and delayed phases, and the greater portions of the tumours were slightly lower than the surrounding hepatic parenchyma. In some cases, a small area of prolonged or increasing enhancement in the tumour was recognized in the delayed phase. Early draining vessels to the portal vein or hepatic vein could be seen in some cases. However, no capsular signs could be confidently identified in the delayed phase. Haemorrhagic cavities were recognized in two cases, and nodular low-intensity areas in the tumours on T₂ weighted imaging that showed slow and faint enhancement on dynamic scans were seen in two cases. However, no necrosis was identified.

Conclusion:

Dynamic enhanced imaging studies revealed some specific features of MHAMLs that distinguish them from other hypervascular hepatic tumours, especially when combined with clinical features. Familiarity with imaging and clinical features of MHAMLs could avoid unnecessary surgical resection of these generally benign tumours.

Advances in knowledge:

This article systematically describes the imaging features of MHAMLs.Angiomyolipoma (AML) is considered a mesenchymal neoplasm and was classified under the group of perivascular epithelioid cell tumours in the World Health Organization classification of tumours in 2002.¹ The tumour consists of three components: smooth muscle cells (SMCs), adipose tissue and vessels. SMCs that are positive on homatropine methylbromide-45 (HMB-45) staining are considered a key component of the histological diagnosis of AMLs, as they have been postulated to be neoplastic mesenchymal cells. Hepatic AML (HAML) was first described by Ishak² in 1976 and was categorized into four subtypes: mixed (the most common type), lipomatous (>70% fat), myomatous (<10% fat) and angiomatous.^3,4 HAML is generally managed as a benign tumour clinically, although malignant cases are occasionally reported.^5–8 If the diagnosis of HAML can be comfortably made on imaging examinations, the tumour can be followed up using imaging modalities and an ultrasound-guided biopsy could be suggested. Surgical resection would then only be necessary in patients with symptoms, in those at risk of rupture or haemorrhage and in those with signs of malignancy.Both the mixed and lipomatous types of HAMLs are relatively easy to diagnose with modern imaging techniques such as CT, MRI and ultrasound because of the mature fatty components of the tumour. The angiomatous type is also relatively easy to diagnose because of the malformed vascular components. However, the myomatous type of HAML (MHAML), which is rare, is often confused with other hypervascular tumours, such as hepatocellular carcinomas (HCCs), focal nodular hyperplasia (FNH) and adenomas, and an imprecise diagnosis could lead to unnecessary surgical resections. Some authors have described the imaging features of this rare benign tumour. For example, Jeon et al⁹ reported that the presence of early venous draining vessels, vein connections with prominent tumour vessels and absent capsular enhancement in contrast-enhanced triple-phase CT images were highly related to a diagnosis of MHAMLs. Therefore, familiarity with the imaging and clinical features of MHAMLs could facilitate a correct diagnosis and avoid unnecessary surgical resections. In this article, we describe our observations of 14 pathologically proven cases of MHAML.     

Ganglioneuromas of the sacrum–a report of two cases with radiologic–pathologic correlation

Ganglioneuromas are rare, benign, well-differentiated, slow-growing tumors, composed of ganglion cells and Schwann cells. Ganglioneuromas are derived from the neural crest cells and can arise anywhere from the base of the skull to the pelvis. We present and discuss the clinicopathologic and radiographic features of two patients with ganglioneuroma arising from the sacrum, a rare anatomic location.     

Fleischner recommendations for the management of subsolid pulmonary nodules: high awareness but limited conformance – a survey study

Objectives

The aim of this study was to assess awareness and conformance to the Fleischner society recommendations for the management of subsolid pulmonary nodules (SSN) in clinical practice.

Methods

An online questionnaire with four imaging cases was sent to 1579 associates from the European Respiratory Society and 757 from the European Society of Thoracic Imaging. Each respondent was asked to choose from several options which one they thought was the indicated management for the nodule presented. Awareness and conformance to the Fleischner recommendations (FR) were assessed and correlated to respondents characteristics.

Results

In total, 119 radiologists (response rate 16.0 %) and 243 pulmonologists (response rate 16.5 %) were included. Awareness of the FR was higher in radiologists than in pulmonologists (93 % vs. 70 %, p?<?0.001), as was implementation in daily practice (66 % vs. 47 %, p?<?0.001). Radiologists conformed to FR in rates of 31, 69, 68, and 82 %, and pulmonologists in 12, 43, 70, and 75 % for cases 1 to 4, respectively. Overmanagement was common. Conformance in SSN management was associated with awareness, working in an academic practice, larger practice size, teaching residents, and higher SSN exposure.

Conclusions

Although awareness of the Fleischner recommendations for SSN management is widespread, management choices in clinical practice show large heterogeneity.

Key points

? Guideline awareness among clinicians is widespread, but conformance shows large heterogeneity.? Awareness and conformance is significantly higher among radiologists than pulmonologists.? Overmanagement is common, which may lead to avoidable financial and physical burden.

     

A validation study of the Nucleix DSI-Semen kit—a methylation-based assay for semen identification

The detection of semen can assist in reconstructing the events of a sexual assault and impact the outcome of legal dispositions. Many methods currently are used for detecting the presence of semen, but they all have limitations with regards to specificity, sample degradation/consumption, stability of biomolecule assayed, and/or incompatibility with downstream individual identification assays. DNA is routinely collected at sexual assault crime scenes and is widely used for individual identification. The DNA also carries methylation patterns that are tissue specific. To date, however, assays designed to exploit methylation patterns suffer from complex chemistries and unwieldy analyses. DSI-Semen? kit uses a novel approach involving CpG methylation-sensitive restriction endonuclease digestion coupled to a multiplexed polymerase chain reaction (PCR) to generate an amplicon profile that makes it possible to determine whether the tissue source of a DNA sample was semen or non-semen. The assay returned an appropriate positive result for semen with neat semen, semen stains, and semen/non-semen tissue mixtures. The assay is robust and reliable, with a positive result for semen given as little as 31 pg of template DNA input. Low levels of semen were detected in mixtures of semen and other body fluids. UV-exposed samples and those in the presence of limited concentrations of known PCR inhibitors were typeable. The DSI-Semen? kit provides a reliable tool for the determination of DNA being derived from semen.     

Thermal ablation of thyroid nodules: are radiofrequency ablation,microwave ablation and high intensity focused ultrasound equally safe and effective methods?

Objectives

This study compares volume reduction of benign thyroid nodules three months after Radiofrequency Ablation (RFA), Microwave Ablation (MWA) or High Intensity Focused Ultrasound (HIFU) to evaluate which of these methods is the most effective and safe alternative to thyroidectomy or radioiodine therapy.

Material and Methods

Ninety-four patients (39 male, 55 female) with a total of 118 benign, symptomatic thyroid nodules were divided into three subgroups. HIFU was applied to 14 patients with small nodules. The other 80 patients were divided up into two groups of 40 patients each for RFA and MWA in the assumption that both methods are comparable effective. The pre-ablative and post-ablative volume was measured by ultrasound.

Results

RFA showed a significant volume reduction of nodules of 50 % (p<0.05), MWA of 44 % (p<0.05) and HIFU of 48 % (p<0.05) three months after ablation. None of the examined ablation techniques caused serious or permanent complications.

Conclusion

RFA, MWA and HIFU showed comparable results considering volume reduction. All methods are safe and effective treatments of benign thyroid nodules.

Key Points

? Thermal Ablation can be used to treat benign thyroid nodules ? Thermal Ablation can be an alternative to thyroidectomy or radioiodine therapy ? Radiofrequency Ablation, Microwave Ablation, High Intensity Focused Ultrasound are safe and effective