Evaluation of Tumor Elasticity and Clinicopathologic Factors Affecting Neoadjuvant Chemotherapy Response in Patients with Breast Cancer

Purpose@#This study aimed to determine the clinicopathologic factors, including tumor elasticity, affecting neoadjuvant chemotherapy response in breast cancer. @*Methods@#Among 95 patients who received neoadjuvant chemotherapy for clinical stage IIa-IIIc primary breast cancer, 75 underwent strain elastography assessments. The patients were divided into soft and hard tumor groups based on the Tsukuba elasticity scoring system. Pathologic factors, including tumor cellularity and stromal characteristics, were evaluated using core needle biopsy specimens collected before neoadjuvant chemotherapy. Pathologic complete response (pCR) was defined as the absence of invasive carcinoma in the breast and axillary lymph nodes. Residual cancer burden (RCB) was also calculated in 79 cases. @*Results@#Twenty-two patients achieved pCR (23.2%). The rates of estrogen receptor (ER) negativity (p=0.04), progesterone receptor (PR) negativity (p=0.03), and nuclear grade 3 (p=0.03) were higher in patients with pCR than those in patients without pCR. The rates of PR negativity (p=0.03), nuclear grade 3 (p=0.01), and high tumor-infiltrating lymphocyte (TIL) levels (p=0.04) were significantly higher in the favorable RCB group (RCB-0 and I) than those in the unfavorable RCB group (RCB-II and III). No significant difference in tumor elasticity was observed between the groups (p=0.30). Hormone receptor (HR) negativity was an independent predictor of favorable RCB in the multivariate analysis (p=0.04). @*Conclusion@#Tumor elasticity was not associated with pCR or RCB. HR negativity was an independent predictor of favorable RCB.

Evaluation of Tumor Elasticity and Clinicopathologic Factors Affecting Neoadjuvant Chemotherapy Response in Patients with Breast Cancer

Purpose@#This study aimed to determine the clinicopathologic factors, including tumor elasticity, affecting neoadjuvant chemotherapy response in breast cancer. @*Methods@#Among 95 patients who received neoadjuvant chemotherapy for clinical stage IIa-IIIc primary breast cancer, 75 underwent strain elastography assessments. The patients were divided into soft and hard tumor groups based on the Tsukuba elasticity scoring system. Pathologic factors, including tumor cellularity and stromal characteristics, were evaluated using core needle biopsy specimens collected before neoadjuvant chemotherapy. Pathologic complete response (pCR) was defined as the absence of invasive carcinoma in the breast and axillary lymph nodes. Residual cancer burden (RCB) was also calculated in 79 cases. @*Results@#Twenty-two patients achieved pCR (23.2%). The rates of estrogen receptor (ER) negativity (p=0.04), progesterone receptor (PR) negativity (p=0.03), and nuclear grade 3 (p=0.03) were higher in patients with pCR than those in patients without pCR. The rates of PR negativity (p=0.03), nuclear grade 3 (p=0.01), and high tumor-infiltrating lymphocyte (TIL) levels (p=0.04) were significantly higher in the favorable RCB group (RCB-0 and I) than those in the unfavorable RCB group (RCB-II and III). No significant difference in tumor elasticity was observed between the groups (p=0.30). Hormone receptor (HR) negativity was an independent predictor of favorable RCB in the multivariate analysis (p=0.04). @*Conclusion@#Tumor elasticity was not associated with pCR or RCB. HR negativity was an independent predictor of favorable RCB.

Sparganosis of the Breast that Mimicked Metastasis: A Case Report

Sparganosis of the breast is a rare parasitic infection of humans. If the breast is involved, then this condition presents as soft tissue masses that mimic breast cancer. We report here on the radiologic feature of sparganosis in a patient with gastric cancer and this mimicked metastasis. We also briefly review the relevant literature.

The Pathologic Splenic Rupture of a Patient with Scrub Typhus: A Case Report

A pathologic splenic rupture is rare, occurring primarily in a spleen affected by infective, hematological, and neoplastic disease. To the best of our knowledge, no prior reports of a pathologic splenic rupture due to scrub typhus exist. Intrasplenic pseudoaneurysms and focal infarctions are visible on an initial CT scan. Moreover, the spontaneous splenic rupture occurred a week later. We report a case of nontraumatic-splenic rupture in a patient with scrub typhus.

CT and (18F)FDG PET/CT Findings of Esophageal Squamous Cell Papillomatosis: A Case Report

Esophageal squamous cell papillomatosis is a rare disorder that is usually found incidentally on an upper gastrointestinal endoscopy examination or autopsy. A 70-year-old woman presented with a two-month history of dysphagia and abdominal discomfort. A chest CT scan showed diffuse marked thickening of the esophageal wall along the entire length and multiple small enhancing polypoid projections in the distal esophagus. Diffuse circumferential FDG uptake in the entire esophagus was seen on [18F] FDG PET/CT. Squamous papillomatosis was diagnosed by an endoscopic biopsy. We report a case of extensive esophageal papillomatosis with imaging features on CT and [18F] FDG PET/CT, with a review of the clinical literature.

Recurring Fibromatosis of Breast Following Tumorectomy: A Case Report

A fibromatosis or desmoid tumor of the breast is an extremely rare benign tumor, which is often presented clinically and radiologically as a malignant tumor. Although benign, fibromatosis or desmoid tumors can grow aggressively in local infiltrating patterns. The recurrence is relatively common; hence a wide excision with a clear margin around the tumor is necessary. We report a case of a young female patient with a recurring fibromatosis of the breast after a local excision.

Multiple Myeloma of the Male Breast: A Case Report

Breast involvement of multiple myeloma is very rare, expecially in men. We describe the mammographic and sonographic findings of multiple myeloma involving the male breast.

Mass Forming Pseudoangiomatous Stromal Hyperplasia of the Breast: Sonographic Features

PURPOSE: The object of this study was to describe the sonographic findings of mass-forming pseudoangiomatous stromal hyperplasia. MATERIALS AND METHODS: A retrospective review of ten patients with breast sonography and five patients with mammography who had pseudoangiomatous stromal hyperplasia presenting as a breast mass. All cases were confirmed by surgical biopsy. RESULTS: The mean age of the 10 patients was 41 years old (21 -51) and the mean mass size was 4.7 cm (2.5-10). On sonography, all lesions were oval shaped and well circumscribed, hypoechoic masses. Nine of the ten lesions presented with homogeneous internal echogenicity and one lesion with a complex heterogeneous pattern with a small internal cyst. A mammogram was performed in five patients and all lesions were oval, well circumscribed, high density masses. CONCLUSION: Sonographic findings of mass-forming pseudoangiomatous stromal hyperplasia of the breast were similar with those of other benign breast masses, so biopsy should be performed for diagnosis.

Congenital Cytomegalovirus Infection of the Brain: MR Imaging and Ultrasonographic Findings of Paraventricular Cysts

PURPOSE: Although the neuroradiological findings of congenital cytomegalovirus (CMV) infection are well known, little has been reported concerning the imaging findings of paraventricular cysts occurring in patients with cytomegalovirus infection involving the brain. The purpose of this study is to describe the features of paraventricular cysts observed at MRI and ultrasonography. MATERIALS AND METHODS: MR and ultrasonographic studies of ten patients with congenital cytomegalovirus infections involving the brain were retrospectively reviewed. Diagnosis was confirmed by positive culture of the virus in urine (n=4), the presence of CMV Ig G antibody (n=4), or positive CMV Ig M antibody (n=2), and on the basis of characteristic MR imaging findings. Initial MRI in all patients and initial ultrasonography in four of five with paraventricular cysts were performed. Three patients underwent follow-up MRI and ultrasonography for the evaluation of cystic change, and the size, location, bilaterality and morphology of the cysts were evaluated. RESULTS: Bilateral paraventricular cysts averaging 15 (range. 10-23) mm in size were found in five of the ten patients (50%). They were adjacent to the foramen of Monro in three cases, the occipital horn in one, and the temporal horn in one. MR imaging showed that the fluid content of all cysts was of similar signal intensity to cerebrospinal fluid (T1-WI, hypointense; T2-WI, hyperintense). The ultrasonographic findings varied: there was one pure cyst and one with a thick wall and septations, and two contained complex fluid. In three patients, follow up MRI and ultrasonography showed that the cysts disappeared after 4-23 months. CONCLUSION: Although paraventricular cysts may appear at MRI to be purely cystic, ultrasonography may indicate that their contents are more complex, or that septations are present.

Primary Serous Papillary Carcinoma of the Peritoneum: A Case Report

Primary serous papillary carcinoma of the peritoneum is a rare neoplasm arising from the mesothelium. Histologically it is indistinguisable from ovarian serous papillary carcinoma, but it should be free of tumor or involved only superficially with the ovary. Radiologically its common findings are peritoneal and omental masses with ascites, and it is indistinguisable from peritoneal carcinomatosis or malignant mesothelioma. We report a case of surgically proven primary serous papillary carcinoma of the peritoneum in a 63-year-old woman.

Hepatocellular Carcinoma with Internal Extensive Coagulation Necrosis: Carefulness of Preoperative Imaging Diagnosis and Comparison with Surgical Specimen

PURPOSE: The aim of this study is to correlate the non-characteristic dual-phase CT imaging findings of hepato-cellular carcinoma with the observed characteristics of surgical specimens. MATERIALS AND METHODS: We studied four cases in which homogeneous low attenuation was observed during the arterial and delayed phases of dynamic CT scanning and in which hepatocellular carcinoma with coagulation necrosis above 95% was pathologically confirmed. We compared the findings of dual phase CT scanning, ultrasonography, angiography and Lipiodol CT scanning with the observed features of surgical specimens. RESULTS: Nodules were 30-50 (mean, 41) mm in size, and were round in three cases and oval in one. In all four cases, a low density lesion was observed during the arterial and delayed phases of dual-phase CT scanning. Ultrasonography demonstrated internal echo and the presence of a hypoechoic halo, implying that in all cases a capsule was present. At angiography and LiCT, minimal peripheral and central tumor staining or lipiodol up-take was observed. In all surgical specimens a complete capsule was visible, and histologic structures were mainly of the trabecular type, Edmondson grade II or III was recorded, and the mass had undergone extensive coagulation necrosis (above 95%). CONCLUSION: In cirrhotic liver which is hepatitis B-antigen positive, clear sonographic findings of internal echo and a capsule, rather than a simple cyst, indicate the possibility of hepatocellular carcinoma with extensive coagulation necrosis. This is so even if the arterial and delayed phases of dual-phase CT scanning indicate the presence of a low-density lesion, and in such cases additional work-up is therefore required.

Coil Embolizaton of Mycotic Pulmonary Artery Aneurysm: A Case Report

Aneurysms of the pulmonary artery are rare, with mycotic aneurysms occurring most frequently. This latter type may also occur in association with a lung abscess or septicemia, particularly in drug addicts. As far as we are aware, the radiologic findings of mycotic aneurysm of the pulmonary artery have not been reported in Korea. We present the simple chest radiographs, as well as the CT and angiographic findings ,of a case of aneurysm of the pulmonary artery which was successfully embolized using a coil.

Diffusion-weighted MR Imaging of Bone Marrow in the Spine: Differentiations of Metastatic Compression Fracture,Benign Compression Fracture, & Spondylitis

PURPOSE: To determine the findings of diffusion-weighted magnetic resonance (MR) imaging of acute and chronic benign compression fracture, metastatic compression fracture, and spondylitis, and to differentiate between them. MATERIALS AND METHODS: Forty-nine cases with vertebral compression fractures (17 metastatic, 16 acute osteo-porotic, 11 old osteoporotic, 5 acute traumatic) and seven with spondylitis (4 tuberculous, 3 pyogenic) underwent MR imaging. All cases were classified as belonging to one of four groups: A: acute osteoporotic and traumatic, B: metastatic, C: old osteoporotic, or D: spondylitic. For MR imaging, a 1.5-T scanner (Magnetom Vision, Siemens, Erlangen, Germany) was used, and the diffusion-weighted imaging sequence was based on reversed fast imaging with steady-state precession (PSIF) and a relatively low b value of about 150 sec/mm 2. Signal intensity characteristics were evaluated in terms of the contrast ratio (CR) and signal-to-noise ratio (SNR) of bone marrow. RESULTS: Diffusion-weighted MR imaging showed that signal intensity in group A was hypointense to adjacent normal vertebral bodies, but in group B, hyperintensity was noted. In group C, signal intensity was variable, while in group D, hyperintensity was again noted. Diffusion-weighted imaging revealed that in group A, bone marrow CR had a negative value, while in groups B and D, this value was positive (p .01). CONCLUSION: Diffusion-weighted MR imaging revealed that the signal intensity of metastatic compression fracture and spondylitis was hyperintense to adjacent normal vertebral bodies, that of acute benign compression fracture was hypointense, and that of chronic benign compression fracture was variable. This modality is therefore useful for differentiating between metastatic compression fracture, spondylitis and acute benign compression fracture.

Screening Examination of Breast Cancer: Review of the Recommended Guidelines / 영남의대학술지

BACKGROUND: Delays in breast cancer diagnosis may occur in young women due to a low index of suspicion. The purpose of this study was to compare mammography and breast sonography in detection of breast cancer and to suggest a reasonable guideline for breast cancer screening examination. MATERIALS AND MATHODS: Among 820 patients, 102 patients were under 35 years and 122 patients were above 60 years of age. We reviewed medical records, mammograms and/or ultrasonography of 49 patients under 35 years and 48 patients above 60 years of age with pathologically-proven breast cancer. Pathological reports were as follows: Invasive ductal carcinoma(IDC) was present 61.2% of patients in the young age group and ductal carcinoma in situ(DCIS) in 16.3%. IDC was present in 66.6% of the patients in the old age group, and DCIS in 8.33%. We analyzed mammography and ultrasonography to evaluate their usefullness in detecting breast cancer in patients under 35 years and over 60 years of age. RESULTS: The mammographic results are as follows: 1) detection rate of lesion: 83.8%(under 35yrs), 100%(over 60yrs) 2) sensitivity of cancer: 67.6%(under 35yrs), 91.2%(over 60yrs) The ultrasonographic results are as follows: 1) detection rate of lesion: 100% 2) sensitivity of cancer: 87.2%(under 35yrs), 96.7%(over 60yrs) The breas cancer detection rate in women under 35 years old was comparable to that of women above 60 years old in our study. CONCLUSION: A striking histologic finding in the two groups was a higher incidence of nuclear Grade II and III tumors. This finding correlates with the reported increased incidence of high grade tumors inyoung women and may correlae with the poorer prognosis of breast cancer in young patients. We conclude that early screening examination is helpful for early detection of breast cancer in women under age 35.

Mammographic Findings Corresponding to Histologic Subtypes of Ductal Carcinoma in Situ

PURPOSE: To compare the mammographic features and histologic subtypes of ductal carcinoma in situ(DCIS) of the breast. MATERIALS AND METHODS: Mammograms of 34 patients with DCIS of the breast detected between January 1992 and November 1998 were retrospectively analyzed. Histologic subtypes were classified as either comedo or noncomedo. Mammographic findings were classified in one of four ways : microcalcification only, microcalcification with mass, mass or asymmetrical density only, or normal. Microcalcifications was classified as either predominantly casting or granular. We also determined whether microcalcification was multifocal. RESULTS: Histologic examination revealed the comedo type in eight patients and the noncomedo type in 26. Among the eight comedo-type cases, mammography demonstrated microcalcification only in five and micro-calcification with mass in three. Among 26 noncomedo-type cases, microcalcifications only was seen in ten, microcalcification with mass in two, mass or asymmetrical density only in six, and normal features in eight. Six of the comedo type were predominantly casting and two were predominantly granular. Predominantly casting calcification was present in four of 12 cases of the noncomedo type and predominatly granular was in eight. Multifocality was seen in four comedo-type cases, but in none of those that were of the noncomedo type. CONCLUSION: We conclude that the comedo subtype of DCIS of the breast is more likely than the noncomedo subtype to be accompanied by microcalcification of the predominantly casting type. Multifocally located microcalcification is a more frequent feature of the comedo subtype than of the noncomedo subtype.

Calcifying Fibrous Pseudotumor of the Retroperitoneum: A Case Report

Calcifying Fibrous Pseudotumor of the Retroperi We report a case of calcifying fibrous pseudotumor in theretroperitoneum. This is a rare soft tissue mass le-sion with specific radiologic and pathologic findings, and itis the first reported case arising in the retroperi-toneum. The CT, MR and angiographic findings are described.

Medical Treatment of Infantile Hypertrophic Pyloric Stenosis Using Intravenous Atropine Sulfate

Infantile hypertrophic pyloric stenosis(IHPS) is one of the most common causes of nonbilious vomiting in early infancy, and is caused by hypertrophied pyloric muscle but its exact etiology and pathogenesis are still unknown. Fredet-Ramstedt pyloromyotomy has been accepted as the treatment of choice for IHPS. Atropine is a cholinergic blocking agent with potent antimuscarinic activity that decreases peristaltic contractions by relaxing smooth muscles. We treated a case of IHPS in a 33-day-old male infant by administering atropine sulfate intravenously. One day after atropine sulfate administration, he did not vomit any more. Ultrasonograms of the pyloric canal which were done on eight days and three weeks after atropine treatment revealed no limitation in the passage of gastric content, and no changes in the muscle thickness and length of the pyloric canal. Thereafter, he did not show up at follow ups, we received his mother's answer through phone that he did not suffer from vomiting and he was growing well at 5 months of age.

MRI Findings of Neuro-Behcet' Disease / 영남의대학술지

MR findings in nine patients(three female, six male) with neuroBehcet's disease were retrospectively analyzed. NeuroBehcet's disease was diagnosed on the basis of typical clinical symptoms. Involved site, pattern, signal intensity, and contrast enhancement pattern on MRI were evaluated. In addition, follow up MR imaging was performed in four patients. The midbrain(7/9), internal capsule(7/9), pons(6/9), thalamus(6/9), basal ganglia(5/9), middle cerebella peduncle(4/9), medulla oblongata(2/9), and subcortical white matter(2/9) are involved on MRI. The size of lesions were 1cm to 3cm and their margin was ill-defined and patchy. Inhomogeneous high signal intensity on the T2-weighted images and low signal intensity on T1-weighted images was seen respectvely. In four of nine cases, there was focal enhancement. On follow up MR imaging, improvement or recurrance of the lesions was found. Also in two cases of follow up cases there was artophy in brainstem and/or middle cerebellar peduncles. In conclusion, MR imaging with systemic clinical symptoms is useful for diagnosing neuro-Behcet's disease.

Radiologic Findings of Uncommon Breast Cancer / 영남의대학술지

We analyzed the mammographic (n=21) findings (location, margin, shape, cluster microcalcifications, size, multiplicity) and ultrasonographic (n=12) findings (shape, border, internal echo, boundary echo, posterior echo, lateral echo, width/depth ratio) to evaluate specific radiologic findings of histopathologically proved uncommon breast cancer. The mammographic findings (n=21) are as follow; 1) single; 16, multiple; 5 2) margin (smooth; 13, irregular; 4, spiculated; 4) 3) shape (round and ovoid; 9, lobulated; 8, irregular; 4) 4) cluster microcalcifications (abscent; 20, present; 1) 5) size (1-3cm; 18, 3-5cm; 2, 5cm> ; 1) 6) location (UOQ; 13, UIQ; 4, LIQ; 3, LOQ; 1). The ultrasonographic findings (n=12) are as follow; 1) shape (round to oval; 5, lobulated; 5, irregular; 2) 2) border (smooth even; 9, rough uneven; 3) 3) internal echo (fine homogeneous; 5, coarse heterogeneous; 7) 4) boundary echo (regular fine; 4, irregular thick; 8) 5) posterior echo (enhanced; 11, no change; 1) 6) lateral echo (marked; 7, nonexistent; 5) 7) width/depth ratio (1.5> 1, 1.0-1.5; 7, 1.0< ; 4). Uncommon breast cancer show benign nature on mammogram, but malignant nature on ultrasonogram (especially boundary echo, internal echo, width/depth ratio)

Correlation of Posterior Echo Patterns and Histopathologic Features in Invasive Ductal Carcinoma of Breast / 영남의대학술지

No abstract available.