Late fracture of Groshong ports: A report of the three cases.

BACKGROUND: Totally implantable venous access devices are valuable tools for total parenteral nutrition, chemotherapy, and long-term intravenous therapy. However, late catheter fracture is a well-known complication of totally implantable venous access device, particularly in Groshong silicone catheter. Recently, a specific type of totally implantable venous access device made with Groshong silicone has been introduced to facilitate power injection of contrast medium for enhanced computed tomography. CASES DESCRIPTION: We reported three cases of catheter fracture in power-injectable Groshong silicone totally implantable venous access device. From May 2012 to August 2014, 66 patients underwent power-injectable Groshong silicone totally implantable venous access device implantation at our institution, with a median follow-up of 20.1 (range 0.2-58.1) months. The catheters in all patients were inserted into the internal jugular vein under ultrasound guidance and were connected to the port implanted in the upper chest through the subcutaneous tunnel. Chemotherapy was administered using these routes. Fractures of all three cases specifically showed a torn catheter section: smooth surface on one side, and a rough edge on the other side of the catheter, suggesting that long-term repeated stretch force may be related with the mechanism of fracture. CONCLUSION: Totally implantable venous access devices with Groshong silicone catheters, if inserted via the internal jugular vein, have a potential risk for late catheter fracture.

Magnetic resonance imaging of intraductal papillomas of the breast.

PURPOSE: To conduct magnetic resonance imaging (MRI) studies of intraductal papillomas of the breast and to establish correlations with pathologic features. MATERIALS AND METHODS: Magnetic resonance images of the breast from 32 patients identified with surgically resected intraductal papillomas were retrospectively analyzed. were obtained. Interpretation of the MRI findings was based on evaluation of the configuration, internal signal intensity, contrast enhancement, type of the time-intensity curve, and presence or absence of dilated ducts associated with the lesion. Intraductal papillomas of our series were classified into several MR types and were compared to each of the surgically resected specimens. RESULTS: Intraductal papillomas of the breast were classified into 4 MR types: oval nodule in 14 patients; irregular nodule in 6, solid and cystic mass in 8; and occult lesion in 4. Each of the MR types reflected its unique pathologic features: oval nodule composed of papillary fronds surrounded by narrow luminal space inside the duct; irregular nodule of papillary fronds entirely filling up the luminal space and adhering to the duct wall, with irregular margins surrounded by fibrosis or collagenization of fibroglandular stroma; solid and cystic mass of solid nodular protrusion of papillary fronds attached to the dilated cystic duct wall; and occult lesion of 1 to 2 mm in diameter with dilated ducts. They showed various contrast enhancements and time-intensity curves. Dilated ducts associated with the lesions were recognized in 20 patients. CONCLUSION: Classifying the MR images of intraductal papillomas could be useful for understanding their pathologic background.

MR imaging of medullary carcinoma of the breast.

PURPOSE: To examine the magnetic resonance imaging (MRI) findings of medullary carcinoma of the breast and to correlate them with histopathologic features. MATERIALS AND METHODS: Eight patients were retrospectively evaluated with pathologically confirmed medullary carcinoma of the breast. T1-weighted fat-saturated, T2-weighted fast spine echo, and gadolinium-enhanced fat-saturated fast spoiled gradient-echo images were obtained. Interpretation of the MRI findings was based on evaluation of the configuration, internal signal intensity, contrast enhancement, and type of the time-intensity curve. RESULTS: Medullary carcinoma showed a lobular shape and a smooth margin, either homogenous or heterogeneous enhancement and delayed peripheral enhancement in the late phase on contrast-enhanced MRI, and either a plateau or washout type with rapid initial rise on the time-intensity curve of the dynamic study. CONCLUSION: Although the MRI findings showed a close relationship with histopathologic features of medullary carcinoma, it was difficult to differentiate medullary carcinoma from other histologic types of invasive breast carcinomas.

Granulocyte-colony stimulating factor- and interleukin 6-producing diffuse deciduoid peritoneal mesothelioma.

An autopsy case of granulocyte colony-stimulating factor (G-CSF)- and interleukin-6 (IL-6)-producing diffuse deciduoid peritoneal mesothelioma is reported. The patient was a 70-year-old man with abdominal distension and weight loss in the year prior to his death. Laboratory data suggested severe inflammation with marked leukocytosis, thrombocytosis and elevated serum levels of C-reactive protein, G-CSF and IL-6. Imaging studies showed an expansive mass occupying the entire abdomen and pelvic cavity. Histological diagnosis of tissue taken by needle biopsy was difficult due to the unusual sarcomatoid-appearance of the tumor. In addition, there was severe infiltration of numerous neutrophilic leukocytes. An autopsy revealed that the diffuse peritoneal tumor had a fresh fishmeat-like appearance with focal mucinous degeneration and entirely encased the abdominal organs. Histological examination showed a sheet-like proliferation of tumor cells with large ovoid or polygonal cytoplasm, large atypical nuclei and obvious nucleoli. The tumor cells showed abundant glycogen and hyaluronic acid, and were immunoreactive to cytokeratin, calretinin, epithelial membrane antigen (EMA), CA-125, and focally to vimentin. The tumor cells were immunoreactive to G-CSF and IL-6. Electron microscopy revealed long, slender microvilli on the tumor cell surface. This tumor was diagnosed as a G-CSF- and IL-6-producing, diffuse deciduoid mesothelioma. We report this case with special reference to the differential diagnosis of deciduoid peritoneal mesothelioma with paraneoplastic syndrome.

Acute eosinophilic pneumonia associated with intravesical bacillus Calmette-Guérin therapy of carcinoma in situ of the bladder.

A 71-year-old man with a history of rheumatoid arthritis was treated with intravesical bacillus Calmette-Guérin (BCG) instillation of 80 mg once-a-week for carcinoma in situ. He developed low-grade fever followed by dyspnea and severe hypoxemia. Radiological and laboratory studies revealed bilateral diffuse reticulonodular infiltrates and hypereosinophilia. A lymphocyte stimulation test for BCG was strongly positive. From these findings, a pulmonary hypersensitivity reaction to immunotherapy was suspected, and therefore, methylprednisolone (500 mg per day) was started. After that, the fever and dyspnea disappeared, the hypereosinophilia was normalised and chest radiography results were clear. The present case is the first reported case of eosinophilic pneumonia following intravesical BCG therapy.