The Usefulness of Scoring System Distinguishing between Benign and Malignant Breast Masses on Ultrasonogram

PURPOSE: To evaluate a scoring system based on ultrasonographic findings as a means of distinguishing between benign and malignant solid breast masses. MATERIALS AND METHODS: Histopathologically confirmed benign (n=102) and malignant (n=73) breast masses which ultrasonographic findings of histopathologic masses were reviewed for shape, border, internal echo, boundary echo, posterior echo, lateral echo, and ratio of transverse to anteroposterior diameter. There were statistically significant (p < 0.001 ; chi-square test) differences in each feature for benign and malignant lesions. The findings suggesting benignancy, equivocality, and malignancy of the masses were scored as 0, 1, and 2 respectively. The scores for all features were summed for each lesion. An ROC curve was obtained. RESULTS: When the score was 6, five benign and seven malignant cases were found. Scores of 0 and 1 indicated benign masses and a score above 11, malignancy. The turning point was a score of 6, so a score above 7 suggests malignancy. CONCLUSION: A ultrasonographic scoring system can be used to characterise breast masses. A score of a mass above 7 suggests probable malignancy and a score below 5 suggests benignancy.

Anatomical variation of the Main and Right Portal Vein on Indirect Portogram: Correlated with CT and Hepatic Angiogram

PURPOSE: To describe variations of the main and right portal veins as visualized by indirect portograms and to examine the surgical implications of these findings. MATERIALS AND METHODS: A retrospective review was conducted of 632 indirect portograms of 632 patients in whom third-order branches were visualized. All patientsalso underwent dynamic CT and AP and oblique hepatic angiography. RESULTS: Variations of the main portal veinwere found in 165 patients(26.1%) and involved an immediate trifurcation of the main portal vein in 102 patients(16.1%), early division of the right posterior portal vein in 53(8.4%), simultaneous division into fourbranches in three (0.5%), five branches in two (0.3%), a replaced P4 originating from the right portal vein in two(0.3%), and an accessory P6 originating from the main portal vein, a replaced P6 originating from the main portalvein, or a replaced left lateral portal vein originating from the right portal vein in one (0.2%), respectively.Of 468 patients who had a common right portal vein, absence of the right posterior portal vein was seen in 26 patients(5.6%) and an accessory subsegmental branch originating from the right portal vein in 17 patients(3.6%). CONCLUSIONS: Recognition of such variations of the portal vein assists in the localization and appreciation ofthe hepatic segmental anatomy, in preoperative evaluations for hepatic resections, and in radiologic interventional procedures through the portal vein.

Primary Hepatic Leiomyosarcoma: A Case Report

Primary hepatic leiomyosarcoma is an extremely rare neoplasm, with fewer than 60 previously reported cases. Apatient was admitted with pain and palpable mass in the right upper abdomen. An ultrasonogram showed a largecystic mass with irregular thick wall in the right lobe of the liver. On a CT scan, the mass showed irregular enhancement along its wall, but central portion was not enhanced. A celiac angiogram revealed a large hypervascular mass with abundant abnormal vascularities in its peripheral portion. Right hepatectomy was undertaken, and histologic examination, revealed hepatic leiomyosarcoma.

Radiologic Characteristics of Hepatocellular Carcinoma with Intrabile Duct Tumor Growth and Extension

PURPOSE: To determine the radiologic characteristics of the hepatocellular carcinoma with intrabile ducttumor growth and extension. MATERIALS AND METHODS: We analyzed the arterial-dominant phase(ADP) CT scans, hepaticangiograms and cholangiograms in nine cases of hepatocellular carcinomas with intrabile duct tumor growth andextension confirmed by tumor thrombectomy. RESULTS: The gross types were nodular in three cases and massive infive. Two masses were larger than 6cm, four were between 3 and 6cm, and three were less than 3cm. Among six casesof ADP-CT scan, dense contrast enhancement was observed in four, minimal enhancement in one, and no enhancement inone. In one case we were unable to find a primary mass. With regard to tumor staining on hepatic arteriograms, five cases were hypervascular, one case was hypovascular, and the remaing one was not found. All tumor thrombi were seen as filling defects which were dilating the bile duct on cholangiograms. Among five intrabile ducttumors, thrombi were detected on ADP-CT scan(n=6), dense contrast enhancement was observed in one case, minimalenhancement in two cases and no enhancement in two cases. CONCLUSION: Intrabile duct tumor growth and extensionin hepatocellular carcinoma(HCC) does not correlate with location, mass size or tumor vascularity. It was concluded that tumor thrombi were formed through the direct invasion by a tumor of a branch of the intrahepaticduct, its growth in the distal direction in the biliary tree and subsequent extension to the common bile duct. Thrombi were more hypovascular than primary mass.