Tumoral Pseudoangiomatous Stromal Hyperplasia of Male Breast: A Case Report

Tumoral form of pseudoangiomatous stromal hyperplasia (PASH) of male breast is a rare disease entity. We report on a case of PASH that presented as a palpable subareolar breast mass in a 46-year-old male who has been on hemodialysis due to chronic renal failure. To the best of our knowledge, no case of PASH in a male with chronic renal failure has yet been reported. We describe its mammographic and sonographic findings with correlative histopathologic features, confirmed by surgical excision.

Klebsiella Pneumoniae Multi-organ Abscesses not Accompanied by Liver Abscesses: A Case Report

A Klebsiella pneumoniae infection has a tendency to spread to multiple organs. It is most commonly seen in patients with liver abscesses, but infection in more than three organs without liver abscesses is unusual. We report one case of a K. pneumoniae infection that presented acute pyelonephritis with left perirenal, anterior pararenal, left psoas, and prostate abscesses without liver abscesses in a diabetic patient. With effective antibiotics and ultrasound-guided percutaneous drainage, the patient recovered without significant sequelae.

A case of primary malignant uterine cervical Non-Hodgkin's lymphoma with breast involvement / 대한내과학회지

Primary lymphoma arising from the uterine cervix has been rarely encountered, and breast involvement is rare because of the relative paucity of lymphoid tissue in the breast. A 32-year-old woman with a primary malignant lymphoma of the uterine cervix and breast involvement is reported. The patient presented with post-coital vaginal bleeding, and punch biopsy of the cervix revealed the diffuse large B cell type of malignant lymphoma. PET-scan was done for staging, and abnormal FDP uptakes were detected in a uterine cervical mass and breast nodule. Ultrasonography-guided needle biopsy was done for the breast mass, and 2 biopsied nodules revealed fibroadenoma and diffuse large B cell lymphoma. The patient (Ann Arbor stage IV) was treated with 6 cycles of combination chemotherapy with CHOP plus rituximab. The patient went into complete remission. Thereafter, 4500cGy pelvic irradiation was done for adjuvant therapy.

Spectrum of Axillary Disorders (Excluding Metastasis from Breast Cancer): Radiological and Pathological Correlation: A Pictorial Essay

Axillary disorders originate from an axillary lymph node, subcutaneous fat layer, accessory breast, nerve, vessel and muscle. The most common causes of a palpable axillary mass are a lymph node pathology containing a benign axillary lymphadenopathy, and malignant lymph nodes such as a metastatic lymphadenopathy from breast cancer and a malignant lymphoma. For the detection of masses in the axilla, mammography and sonography are the imaging modalities of choice. We present a spectrum of various axillary masses with correlative radiological imaging and pathological findings in this pictorial essay. Knowledge of the radiological findings of various axillary disorders is useful for a differential diagnosis and for preventing unnecessary invasive procedures.

Huge Endometrioma Mimicking Mucinous Cystadenoma on MR: A Case Report

Endometriosis is a relatively common gynecologic disease affecting women during their reproductive years. For its diagnosis, magnetic resonance imaging has been shown to have greater specificity than other modalities. Although lesions may show variable signal intensity due to numerous stages of bleeding, the characteristic finding of endometrioma which distinguishes it from other ovarian cystic masses is relatively high signal intensity on T1-weighted images and heterogeneous signal intensity with prominent shading on T2-weighted images. We report an atypical case involving a huge endometrioma. Because of varying signal intensity on T1- and T2-weighted images and scanty shading on T2-weighted images, the findings were misinterpreted and mucinous cystadenoma was diagnosed.

Acinic Cell Carcinoma Arising from Unusual Location: 3 Case Reports

Most acinic cell carcinomas arise within the parotid gland: extraparotid origin is rare. We encountered three cases of extraparotid acinic cell carcinoma arising in the buccal or palatal region, or the submandibular gland. All three tumors presented as a painless, slow-growing mass. CT imaging indicated that they were well defined, homogeneously enhanced, round masses. In one case, sonography demonstrated relatively homogeneous low echogenicity.

An Experimental Study on the Effect of Mixture of Absolute Ethanol and Lipiodol Injected into Normal Liver ofRabbit: CT Features and Histopathologic Changes

PURPOSE: To investigate the safety and usefulness of Lipiodol-percutaneous transhepatic ethanolinjection(L-PEI) and to determine the appropriate concentration of Lipiodol during L-PEI. This was achieved byevalvating CT findings and histopathologic changes according to the concentration of Lipiodol, amount of ethanol,and the time interval after injection into normal rabbit liver. MATERIALS AND METHODS: This experimental studyinvolved 18 New Zealand rabbits under US guidance. They were divided into five groups according to injectedmaterials; two rabbits with 0.4cc of normal saline(group I), six with 0.4cc of ethanol in the left hepaticlobe(group II), and 0.4cc of Lipiodol in the right hepatic lobe(group III), five rabbits with 5%Lipiodol-ethanol(5% vol. of Lipiodol+95% vol. of ethanol), 0.2cc in the right hepatic lobe, and 0.4cc in theleft(group IV); and five rabbits with 10% Lipiodol-ethanol as per group IV(group V). CT was performed immediately,one week, two weeks, and three-four weeks after injection, and pathologic specimens were obtained on the thirdday(acute phase) and during the third or fourth week(chronic phase) after injection. RESULTS: On CT, intrahepaticlocalization of the L-PEI injection site was well demonstrated as a focal high attenuated area which graduallydecreased in attenuation on follow up CT. The opacification of the inferior vena cava by Lipiodol, the lineardistribution of Lipiodol along portal veins or fissures, and peritoneal leakage were clearly demonstrated ingroups III-V, though the effects gradually disappeared during follow-up CT. There was no remarkable difference ingross CT attenuation between group IV and group V. The main pathologic findings during the acute phase of group IIwere coagulation necrosis surrounded by macrophage, inflammatory reaction, and early periportal and subcapsularfibrosis. The findings in group IV and V were similar to those in group II and additional fat vacuoleaccumulations in the necrotic area were also seen. During the chronic phase of group II, areas of necrosis wereabsent or smaller and were surrounded or replaced by more organized fibrosis, macrophage or multinucleated giantcell infiltration. Periportal, subcapsular fibrosis was also found. In group IV and V, the findings were similarto those of group II, though additional fat vacuoles in fibrotic or necrotic areas, foreign body reaction to fatvacuole, regenerating nodule and calcification were also observed. CONCLUSION: L-PEI is more useful for thedetection by CT of an injection site than PEI alone, and with regard to CT and histopathologic findings, there wasno significant difference between the 5% and 10% Lipiodol-ethanol groups. Compared to PEI, L-PEI provoked nosighificant additional hepatic injury; only fatty change and foreign body reaction were noted. Thus, L-PEI is moreuseful than PEI for the management of HCC.

Dynamic Enhanced MR Imaging is Necessary in the Diagnosis and Staging of Uterine Cervical Cancer?

PURPOSE: To compare the sensitivity and staging accuracy of dynamically enhanced MR imaging(hereafter, DEI)and turbo spin-echo(TSE) T2-weighted imaging(hereafter, T2WI) in cases of cervical carcinoma. MATERIALS AND METHODS: MR images(T2WI and DEI) of 25 cervical carcinoma patients, diagnosed during surgery, were reviewed by tworadiologists. T2WI employed the TSE technique; dynamic MR imaging, the FLASH technique in the axial plane. DEimages were obtained immediately and at 30, 60, 120, and 180 seconds after rapid injection of Gd-DTPA. The degreeof visualization of the tumor, and its invasiveness, were graded as good, fair, or poor. By correlating thehistopathologic results, the accuracy of the two MR imaging techniques was compared. RESULTS: For tumorvisualization, T2WI was good in 13/25 cases (52%), fair in 3/25(12%), and poor in 9/25(36%); DEI was good in5/25(20%), fair in 7/25(28%), and poor in 13/25 cases (52%). CONCLUSION: For the detection and staging of cervicalcarcinoma, T2WI is superior to DEI. For the diagnosis and staging of cervical carcinoma, DEI is thereforeunnecessary.

Lung Cancer With CT-Bronchus Sign: Correlation with CT-findings and the Yield of Bronchoscopic Biopsy

PURPOSE: To determine the CT factors which predict positive results of bronchoscopic biopsy in cases of lung cancer with CT-bronchus sign. MATERIALS AND METHODS: In 30 patients who on CT showed a lung mass with CT-bronchus sign and who had undergone bronchoscopic biopsy, lung cancer was confirmed histopathologically and/or clinically. The CT findings were evaluated for the location, nature and size of the mass, and the type of CT-bronchus sign, and the diagnostic rate of bronchoscopic biopsy and of CT findings was compared. RESULTS: Seventeen of 30 patients (56.7%) were diagnosed by bronchoscopic biopsy and their diagnostic rates according to the location were as follows: 100% (10/10) in cases involving the lobar bronchus; 60% (6/10) in cases involving the proximal segmental bronchus and 10% (1/10) in cases involving the distal segmental bronchus. In 20 cases of peripheral lung cancer, 16.7% (1/6) of masses with less than 3cm in diameter, 44.4% (4/9) of masses with more than 3cm and less than 6cm, and 40.0% (2/5) of masses with more than 6cm were diagnosed bronchoscopically. In addition, 57.1% (4/7) of cases with abrupt bronchial obstruction, 33.3% (3/9) with a patent bronchus within the mass, 0% (0/3) with bronchial displacement or a marginally located bronchus and 0% (0/1) with tapered bronchial obstruction were diagnosed on bronchoscopic biopsy. One of two cases with perilesional lymphangitic spread and two of four cases with a large cavity were diagnosed bronchoscopically. CONCLUSION: In cases of lung cancer, bronchoscopic biopsy is a useful initial diagnostic method where the mass is located in 1cm proximal to segmental bronchial bifurcation and is more than 3cm in diameter, there is CT-bronchus sign with abrupt bronchial obstruction or a patent bronchus within the mass, and associated perilesional lymphangitic spread or large air-cavity. In most cases where there is peripheral lung mass less than 3cm in diameter, however, bronchoscopic biopsy alone is not adequate, and the use of a further diagnostic modality is required.

Differential Diagnosis of Tuberculous Pleural Effusion and Malignant Pleural Effusion: CT Accuracy and Findings

PURPOSE: To evaluate the diagnostic accuracy of CT in the differential diagnosis of tuberculous and malignant pleural effusion whether or not lung lesions are present, and to investigate the CT findings used for this differential diagnosis. MATERIALS AND METHODS: This study involved 30 patients with tuberculous pleural effusion (mean age, 44.6 years; M:F=19:11) and 20 with malignant pleural effusion (mean age, 57.2 years; M:F=10:10). All 50 patients underwent enhanced CT chest scans, and the respective conditions were pathologically confirmed. Two radiologists unaware of the pathologic results and distribution of patients reviewed these scans retrospectively and independently. They recorded the presence or absence of helpful lung lesions, CT findings of pleural effusions, their diagnoses, and the degree of confidence of their diagnoses. RESULTS: Among the total of 100 answeres, helpful long lesions were found in 57 cases. Fifty-three of 57 diagnoses (93%) were correct and 26 cases (46%) were diagnosed with a high degree of confidence. Thirty-two of 43 cases (74%) without helpful lung lesions were correct and 11(26%) were diagnosed with a high degree of confidence. All diagnoses made with a high degree of confidence were correct, even in cases without helpful lung lesions. Frequent CT findings in tuberculous pleural effusion included diffuse pleural thickening, enhancement of pleura, deposition of extrapleural fat, and pleural calcification; in malignant pleural effusion, nodular pleural thickening, pleural thickening over 1cm and associated lymphadenopathy were frequent. Mediastinal and circumferential pleural, as well as fissural involvement, were seen in both effusions; there were no statistical differences. CONCLUSION: In most cases, CT provided correct differential diagnosis between tuberculous and malignant pleural effusion. It can help determine the nature of associated lung and pleural lesions, and specific findings of the latter, and can accurately differentiate tuberculous and malignant pleural effusion.

Pulmonary Involvement of Hypereosinophilic Syndrome: High-Resolution CT Findings in Three Patients

Hypereosinophilic syndrome is a rare entity of eosinophilic lung disease characterized by idiopathic prolongedeosinophilia of marked degree and variable organ involvement. Pulmonary involvement of hypereosinophilic syndromeoccurs in up to 40% of patients. We report HRCT findings of three patients with pulmonary involement of hypereosinophilic syndrome diagnosed by clinical manifestation, bronchoalveolar lavage and transbronchial lungbiopsy. On HRCT, several small nodules were seen in both lungs, especially in peripheral lung areas of the three patients. One had nodules with ground-glass attenuation halo and also focal areas of ground-glass attenuation inthis area.

High-Resolution CT Appearance of Pulmonary Parenchymal Abnormalities Associated with Bronchiectasis: Correlation with Pulmonary Function Tests

PURPOSE: The purpose of this study was to evaluate the high-resolution CT(HRCT) appearance of abnormalities of small airways and lung parenchyma associated with bronchiectasis and to correlate HRCT appearance and the results of pulmonary function tests. MATERIALS AND METHODS: The author retrospectively reviewed medical recordsand HRCT scans of 33 patients with bronchiectasis. Abnormalities of small airways and lung parenchyma in lobeswith bronchiectasis were assessed on HRCT scan. The findings on HRCT were correlated with the results of pulmonary function tests in 20 patients. In two specimens obtained at lobectomy, histologic examinations were conducted to determine the pathologic basis for CT findings of disease of small airways. RESULTS: Patchy areas of low attenuation(n=27), centrilobular nodules or branching opacities(n=20), irregular hyper attenuation(n=16), and areasof ground-glass attenuation(n=4) were observed on HRCT scans. In the lobar evaluation, areas of low attenuation were observed in 66(76%) of the 87 lobes with bronchiectasis. Areas of low attenuation were also identified inseven(9%) of the 75 lobes without bronchiectasis. On expiratory HRCT, the lung parenchyma with areas of low attenuation did not show a normal increase in CT attenuation and remained more lucent than surrounding normallung, which suggested that air was trapped in the lung parenchyma. Of the 20 patients who underwent pulmonary function tests, six showed an obstructive pattern. These six had more lobes with bronchiectasis and with areas oflow attenuation than the other 14 patients, who did not have an obstructive pulmonary function pattern(p<.01). Intwo patients who had undergone lobectomy, pathologic examination showed bronchiolities obliterans in small airway speripheral to the dilated bronchi. CONCLUSION: In bronchiectasis, areas of low attenuation and centrilobular nodules or branching opacities are commonly observed in the lung parenchyma peripheral to the dilated bronchi on HRCT. These HRCT findings correspond pathologically to bronchiolitis obliterans and to lung parenchyma with trapped air. The number of loves with bronchiectasis and with areas of low attenuation correlate significantly with an obstructive pattern on pulmonary function tests.

Hemodynamic Change by Portal Tumor Thrombus in Hepatocellular Carcinoma: Evaluation by Combined Spiral CT Hepatic Arteriography and CT Arterial Portography

PURPOSE: To evaluate the hemodynamic change by portal tumor thrombus in hepatocellular carcinoma(HCC). MATERIALS AND METHODS: We reviewed 35 cases of combined spiral CTHA and CTAP in 25 HCC patients with portal tumorthrombus from April 1993 to October 1994, regarding to portal tumor thrombus, the involved area of arterioportal(AP) shunt and the development of cavernous transformation of portal vein, in comparison with hepaticand superior mesenteric arteriography. RESULTS: Spiral CTHA showed hyperattenuating tumor, portal tumor thrombus and hyperattenuating peritumoral parenchymal area. Spiral CTAP showed perfusion defect area including tumor, portal tumor thrombus and peritumoral area distal to portal vein obstruction. In 15 cases, portal tumor thrombus showed intraluminal and marginal hyperattenuating linear structures on CTHA due to transvasal AP shunt and tumor feeding arteries, which were corresponding to thread and streaks sign on hepatic arteriography. Cavernous transformation of portal vein was demonstrated in 15 cases as irregular periportal hyperattenuating collateral vessels on spiral CTAP. In 32 cases, portal vein was visualized on CTHA due to AP shunt. And according to shunt amount, we classified AP shunt into 4 grades. Grade I means only the presence of portal tumor thrombus without AP shunt, grade II with segmental AP shunt, grade III with one lobar AP shunt, and grade IV with both lobar AP shuntor the presence of cavernous transformation of portal vein. Grade I was seen in 3, grade II in 4, grade III in 13 and grade IV in 15 cases. CONCLUSION: Variable CTHA and CTAP findings were shown in HCC patients with portal tumor thrombus according to the amount of AP shunt and the presence of cavernous transformation of portal vein. Combined CTHA and CTAP are useful to differentiate the tumor thrombus from simple thrombus and are very sensitive method for detecting AP shunt. Understanding these findings related with portal tumor thrombus is important topredict patient}s prognosis and to decide treatment method.

CT Evaluation of Postoperative Neck Dissection

PURPOSE: To evaluate CT findings of normal anatomic alteration after neck dissection. MATERIALS AND METHODS: The postoperative CT findings were retrospectively reviewed in 40 patients with neck dissection, comparing to preoperative CT. There were 28 patients with radical neck dissection and 12 patients with modified radical neck dissection or selective neck dissection. In addition to the neck dissection, 10 patients had undergone pectoralis major myocutaneous flap reconstruction, 20 patients taken laryngectomy, and 25 patients treated with radiotherapy. RESULTS: The typical CT findings of radical neck dissection were non-visualization of internal jugular vein and sternocleidomastoid muscle(28/28), ipsilateral neck flattening(26/28), and trapezius muscular atrophy(12/28). The other non-specific findings were tissue plane eftacement, subcutaneous reticular pattern, platysma muscle thickening, and adjacent soft tissue contrast enhancement which was the only evidence of previous operation in the cases of modified radical neck dissection or selective neck dissection. Reconstruction with myocutaneous flap was shown as ipsilateral bulk of fat and muscle(10/10). In cases with radiation therapy there was much increased density of submandibular gland(12/25). 15 patients showed recurrence on follow up CT scan, including regional metastasis in 10, stomal recurrence in two, and residual mass at primary site in three patients. CONCLUSION: CT is useful in evaluation of patients with neck dissection and in whom postoperative change impese diagnostic problem.

Evaluation of Hepatic Atrophy after Transcatheter Aterial Embolization

PURPOSE: Hepatic atrophy has been recognized as a complication of hepatic and biliary disease but we have often found it in follow up CT after transcatheter arterial embolization {TACE). The purpose of this study is to evaluate the characteristics of hepatic atrophy after TACE. MATERIAL AND METHODS: Of 53 patients who had TACE, We evaluated the relationship between the incidence of hepatic atrophy and the number of TACE, and also evaluated the average number of TACE in patients with hepatic atrophy. Of 20 patients who had received more than average number of TACE for development of hepatic atrophy (2 times with portal vein obstruction, 2.7 times without portal vein obstruction in this study), we evaluated the relationship between the tipiodol uptake pattern of tumor and the incidence of hepatic atrophy. RESULTS: There were 8 cases of hepatic atrophy (3 with portal vein obstruction, 5 without portal vein obstruction), average number for development of hepatic atrophy were 2.5 times. As the number of TACE were increased, the incidence of hepatic atrophy were also increased. Of 20 patients who received more than average number of TACE for development of hepatic atrophy, we noted 6 cases of hepatic atrophy in 11 patients with dense homogenous lipiodol uptake pattern of tumor and noted only 1 case of hepatic atrophy in 9 patient with inhomogenous lipiodol uptake pattern. CONCLUSION: Hepatic atrophy was one of the CT findings after TACE even without portal vein obstruction. Average number of TACE was 2.5 times and risk factors for development of hepatic atrophy were portal vein obstruction, increased number of TACE, and dense homogenous lipiodol uptake pattern of tumor.

Pleural Calcification as a Manifestation of Paragonimiasis: A Report of Two Cases

Pleural involvement in paragonimiasis is relatively common, either unilateral or bilateral, and may occur without pulmonary parenchymal infiltrates. Common radiologic findings of pleural paragonimiasis are pleural effusion, pneumothorax, hydropneumothorax, empyema and pleural thickening. However, pleural calcification as a manifestation of paragonimiasis is a rare condition. We report two cases of paragonimiasis manifested only as pleural calcifications which were confirmed pathologically.

A Case of Cutaneous Epithelioid Angiosarcoma / 대한피부과학회지

The epithelioid angiosarcoma is recently described ns a variant of ang-osarcoma based on its pathological feature, which is characterized by the epithelioid or histiocytoid morphology af the malignant tumor cells. The existence of vascular endothelial tumor with an epithelioid feature has been accepted for many years, most notablyn the forms of epithelioid hemangioma and epithelioid hemangioendo thelioma. In recent years, cutaneous angiosarcoma with epitheloid morphology have been reported as a cutaneos epithelioid angiosarcoma in the literatures. A 60-year-old man presente with a mild tender erythematous 2 x 2 x 2.5cm sized soft fluctuating single nodule with dark hemorrhagic crust on the left forehead for 3 months. He had had an abrasion wound on the lesion site of the forehead by an accidental trauma 5 month before the lesion appeared. Histopathological findings revealed that the tumor mass was chiefly composed of solid sheets of poorly differentiated malignant cells with an epithelioid feature. The characteristics of classical angiosarcoma such as primitive vascular spaces and clefts with malignat cells, and proliferating vessels were also found in some areas. The immunohistochemical stain wi.h the factor VIII related antigen ivas focally reactive in the tumor cells. Unfortunately he refused further treatment and expired 7 months after discharge at home without knowing the direct cause of his health. We report herein an interesting and rare case of the cutaneous epitheioid angiosarcoma which had typical clinical and histopathological findings and suggested as a case with a very aggressive course.