Computer-Aided Detection with Automated Breast Ultrasonography for Suspicious Lesions Detected on Breast MRI

PURPOSE: The aim of this study was to evaluate the diagnostic performance of a computer-aided detection (CAD) system used with automated breast ultrasonography (ABUS) for suspicious lesions detected on breast MRI, and CAD-false lesions. MATERIALS AND METHODS: We included a total of 40 patients diagnosed with breast cancer who underwent ABUS (ACUSON S2000) to evaluate multiple suspicious lesions found on MRI. We used CAD (QVCAD™) in all the ABUS examinations. We evaluated the diagnostic accuracy of CAD and analyzed the characteristics of CAD-detected lesions and the factors underlying false-positive and false-negative cases. We also analyzed false-positive lesions with CAD on ABUS. RESULTS: Of a total of 122 suspicious lesions detected on MRI in 40 patients, we excluded 51 daughter nodules near the main breast cancer within the same quadrant and included 71 lesions. We also analyzed 23 false-positive lesions using CAD with ABUS. The sensitivity, specificity, positive predictive value, and negative predictive value of CAD (for 94 lesions) with ABUS were 75.5%, 44.4%, 59.7%, and 62.5%, respectively. CAD facilitated the detection of 81.4% (35/43) of the invasive ductal cancer and 84.9% (28/33) of the invasive ductal cancer that showed a mass (excluding non-mass). CAD also revealed 90.3% (28/31) of the invasive ductal cancers measuring larger than 1 cm (excluding non-mass and those less than 1 cm). The mean sizes of the true-positive versus false-negative mass lesions were 2.08 ± 0.85 cm versus 1.6 ± 1.28 cm (P < 0.05). False-positive lesions included sclerosing adenosis and usual ductal hyperplasia. In a total of 23 false cases of CAD, the most common (18/23) cause was marginal or subareolar shadowing, followed by three simple cysts, a hematoma, and a skin wart. CONCLUSION: CAD with ABUS showed promising sensitivity for the detection of invasive ductal cancer showing masses larger than 1 cm on MRI.

Metastasis of Rhabdomyosarcoma to the Male Breast: a Case Report with Magnetic Resonance Imaging Findings

Metastasis of rhabdomysarcoma to the breast is a very rare manifestation in adult males. Herein, we report a case of metastasis from embryonal rhabdomyosarcoma in the left hypothenar muscle that presented as a breast mass in a 38-year-old man, who four months later expired because of multiple bone metastases related to pancytopenia. We describe the various imaging findings, including mammograms, ultrasonography, computerized tomography (CT), positron emission tomography-computed tomography (PET-CT), and magnetic resonance imaging (MRI) of this rare disease. The various imaging findings of this lesion could be helpful for future diagnosis of male breast lesions.

Differential Cell Count and CRP Level in Blood as Predictors for Middle East Respiratory Syndrome Coronavirus Infection in Acute Febrile Patients during Nosocomial Outbreak

A case-control study was performed to identify clinical predictors for Middle East respiratory syndrome coronavirus (MERS-CoV) infection among patients with acute febrile illness during the nosocomial outbreak. Patients with MERS-CoV were more likely to have monocytosis with normal white blood cell (WBC) count and lower C-reactive protein (CRP) level. Simple laboratory data such as complete blood counts (CBC) with differential count could be a useful marker for the prediction of MERS and triage at the initial presentation of acute febrile patients in outbreak setting.

Ultrasonographic findings of low-grade endometrial stromal sarcoma of the uterus with a focus on cystic degeneration

PURPOSE: The goal of this study was to perform a retrospective analysis of the ultrasonographic findings associated with low-grade endometrial stromal sarcoma. METHODS: Ten pathologically confirmed cases of low-grade endometrial stromal sarcoma at our institution from January 2007 to April 2014 were retrospectively reviewed. All patients underwent a preoperative transvaginal ultrasound. Two radiologists came to a consensus regarding the location, size, margin, and echogenicity of the tumor, as well as the presence of intratumoral cystic degeneration and its extent and configuration. RESULTS: Low-grade endometrial stromal sarcoma manifested as an intramural mass protruding into the endometrial cavity (n=6) or as a purely intramural mass (n=4). The maximal diameter of the lesion ranged from 4 to 9.1 cm (mean, 6.2 cm). The imaging features of low-grade endometrial stromal sarcoma were variable: six cases involved predominantly solid masses containing cystic degeneration, one was a predominantly unilocular cystic mass, two were ill-defined infiltrative solid masses, and one was a well-defined solid mass. Among the seven cases with internal cystic degeneration, five patients showed a multiseptated cystic area or a cystic area with multiple small clusters, while a unilocular cystic area within the tumor was found in two patients. CONCLUSION: Low-grade endometrial stromal sarcoma is associated with variable ultrasonographic findings with regard to the location, margin, and configuration of the lesion. Multiseptated cystic areas and multiple small areas of cystic degeneration are common.

A Case of Light Chain Deposition Disease in a Patient with Diabetes and Nodular Glomerulosclerosis / 대한내과학회지

A 50 year-old male with a 10-year history of diabetes was admitted to the hospital for edema and foamy urine. At the time of admission, serum creatinine was 1.99 mg/dL and 24 h urine protein levels were 4.0 g/day. Renal biopsy showed nodular glomerulosclerosis. Immunofluorescence demonstrated the presence of kappa light chains along the glomerular and tubular basement membrane. Electron microscopy showed granular electron-dense deposits along the glomerular subendothelium and tubular basement membrane. Serum protein electrophoresis was negative for a monoclonal spike; however, urine protein electrophoresis demonstrated a monoclonal spike. Bone marrow examination was compatible with multiple myeloma and the patient was diagnosed with light-chain deposition disease associated with multiple myeloma. This report stresses the significant challenges that occur when diagnosing light-chain deposition disease in kidneys of patients with long standing diabetes, and discusses previously reported cases of light-chain deposition disease in Korea.

Delayed Perforation Occurring after Endoscopic Submucosal Dissection for Early Gastric Cancer

Delayed perforation is a very rare complication of endoscopic submucosal dissection (ESD), with a reported incidence of 0.1% to 0.45%. Few reports exist on the clinical features and outcomes of delayed perforation after ESD, and it is unclear whether the optimal management strategy is emergency surgery or endoscopic closure with conservative treatment. Here, we report two cases of delayed perforation occurring after ESD for early gastric cancer. In both cases, lesions were located in the antrum, and tumor depths were confined to the mucosal layer. Total procedure times for ESD were 25 and 45 minutes, respectively. Because delayed perforation may be associated with excessive thermal damage and necrosis of the muscle layer, treatment with emergency surgery should be used instead of conservative management in cases of delayed perforation after ESD.

A functioning adrenal adenoma and pheochromocytoma in the same adrenal gland: two discrete adrenal incidentalomas

No abstract available.

Survey on the Endoscopic Diagnosis of Chronic Gastritis

BACKGROUND/AIMS: Endoscopic classification of chronic gastritis has not been standardized yet. Patterns of endoscopic classification in the real clinical practice are not defined. MATERIALS AND METHODS: From July 2013 to September 2013, a questionnaire consisting of eight questions on endoscopic gastritis was surveyed. The correct answer for endoscopic diagnosis of chronic gastritis was defined by an advisory group, including professors of gastroenterology. A total of 189 physicians, most of them primary care physicians, participated in the survey. RESULTS: The overall agreement with standard endoscopic diagnoses was 56 percent. The correct answer for each question was 56 percent for erosive gastritis, 58 percent for hypertrophic gastritis, 60 percent for atrophic gastritis, 52 percent for metaplastic gastritis, respectively. In the superficial gastritis case, the ratio of correct answer was 24 percent, which was lowest among all the questions. Forty-four percent of all participants answered superficial gastritis as hemorrhagic gastritis. These results reveal that hemorrhagic gastritis is diagnosed inappropriately and needs further attention to prevent patients from unnecessary worries and misunderstandings. The correct answer for nodular gastritis was 42 percent, which is relatively low as well. Considering the significance of nodular gastritis as a risk factor for gastric cancer, education for endoscopist to detect nodular gastritis is indispensable. CONCLUSIONS: There was significant discrepancy on the endoscopic diagnosis of chronic gastritis. Further studies to develop a new standardized guideline for diagnosis of gastritis should be accompanied.

Membranous Nephropathy Concurrent with Interstitial Nephritis after Allogenic Hematopoietic Stem Cell Transplantation in a Patient with Acute Lymphoblastic Leukemia / 대한수혈학회지

Kidney is rarely an involved organ of graft-versus-host disease (GVHD). Here, we report on a case of membranous nephropathy and interstitial nephritis after allogenic hematopoietic stem cell transplantation (HSCT) in a 44-year-old female patient with acute lymphoblastic leukemia. The patient received GVHD prophylaxis with low dose steroid, cyclosporin, and short course methotrexate. Cyclosporine was tapered out 17 months after allogeneic HSCT. Thereafter, the patient developed kidney impairment and nephrotic range proteinuria. Kidney biopsy revealed membranous nephropathy concurrent with interstitial nephritis.