The utility of radiographic assessment of the internal mammary arteries in chest wall irradiated patients.

PURPOSE: The internal mammary arteries (IMA's) are historically recognized to be protected against atherosclerosis. Whether chest wall-irradiation for breast cancer leads to significant IMA damage remains unclear. The utility of computed tomography (CT) and mammography to detect radiation-induced damage to the IMA's and its branches is not known. The objective of this study is to assess the susceptibility of IMA's to radiation-induced atherosclerosis, and the utility of CT scan and mammography in the assessment of IMA and its branches. METHODS: A retrospective analysis of breast cancer patients who received chest wall-radiotherapy was performed. Patients with CT scans and/or mammograms ≥5 years post-radiotherapy were included. Baseline characteristics, coronary artery calcification (CAC), the presence of IMA damage assessed by CT scan, and IMA branch calcifications by mammography were recorded. RESULTS: None of the 66 patients with CT scans post-radiotherapy revealed IMA atherosclerosis. There were 28 (42.4%) patients with CAC, of which four (14.3% of CAC subgroup or 6.1% of the total cohort) had calcifications on either side on mammogram (Chi-square test, p = 0.74). Out of the 222 patients with mammograms, 36 (16.2%) had IMA branch calcifications. Two hundred and ten patients received unilateral radiotherapy, and 27 (12.9%) of these patients had calcifications on the irradiated side, and 26 patients (12.4%) had calcifications on the contralateral side (OR = 1.0). CONCLUSION: IMA's do not exhibit signs of radiation-induced atherosclerosis when evaluated by CT scan. In addition, there is no association between radiotherapy for breast cancer and the presence of IMA branch calcification on mammograms.

Retroperitoneal fibrosis due to B-cell non-Hodgkin lymphoma: Responding to rituximab!

Retroperitoneal fibrosis is a rare disease manifesting as chronic soft tissue fibrosis in the retroperitoneum, with potential anatomic and/or functional compromise of adjacent organs. It can be primary (idiopathic) or secondary to other conditions such as cancers, autoimmune disorders, or drugs. We report herein a 66-year-old patient with symptomatic retroperitoneal fibrosis leading to bilateral hydronephrosis and renal failure, in whom, after a complex diagnostic work-up and protracted clinical course, a B-cell non-Hodgkin lymphoma in the retroperitoneal space and several vertebral bodies was identified. The patient was treated with radiation therapy and weekly rituximab infusions, with resolution of hydronephrosis and lower back pain. We include a thorough literature review on etiopathogenesis, diagnosis, therapy, and prognosis of retroperitoneal fibrosis. A meticulous search for malignancy is necessary in this rare condition that, if positive, may have significant therapeutic and prognostic implications.

An unusual presentation of Kikuchi-Fujimoto disease.

Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare, self-limited disease of unknown etiology. This condition is most commonly encountered in Asian and Caucasian females of childbearing age who usually present with cervical lymphadenopathy and fever. Though rarely, KFD has been described in younger African-American females as well. It often mimics more serious conditions such as lymphoma, metastatic solid malignancy, HIV infection, tuberculosis, sarcoidosis, or systemic lupus erythematosus. Although its etiopathogenesis has not been fully elucidated, literature suggests viral or possibly autoimmune components to play a role. We describe a 34-year-old African-American female who presented with constitutional symptoms and polyadenopathy on clinical examination and imaging, of which the portacaval and portahepatis lymph nodes were most prominent. An extensive workup was otherwise unremarkable, and biopsy showed histiocytic necrotizing lymphadenitis. Initially, her clinical condition improved spontaneously, and she required only a short course of oral steroids. Three months later, she relapsed with bilateral cervical adenopathy and constitutional symptoms and was successfully managed again with steroids. Our case is unique with respect to (a) portahepatis and portacaval node enlargement as the dominant adenopathy and (b) her underlying conditions of fibromyalgia and chronic fatigue syndrome.

Collision tumors: pancreatic adenocarcinoma and mantle cell lymphoma.

CONTEXT: Collision tumors are very rare entities composed of two or more distinct tumor components, each separated by normal tissue. Perhaps due to technical advances in the last decade, the incidence of collision tumors has been on the rise. To the best of our knowledge, collision tumors featuring mantle cell lymphoma and pancreatic adenocarcinoma have not been previously described in the scientific literature. CASE REPORT: For the first time, we describe herein the clinical course of a collision tumor between pancreatic adenocarcinoma and mantle cell lymphoma. DISCUSSION: We hypothesize several aspects in the pathogenesis of a such event and review the existing literature on collision tumors.

Dual-source cardiac computed tomographic technique, anatomy, and normal variants.

The advent of fast multislice computed tomography (CT) has ushered in a new era in the noninvasive evaluation of the heart. Cardiac structures can now be quickly evaluated with exquisite detail in a noninvasive manner. Cardiac CT is increasingly being used for the noninvasive evaluation of coronary arteries, procedural planning, and evaluating chest pain in certain clinical situations. Dual-source CT is a recent technological development that has helped improve spatial and temporal resolution for cardiac CT imaging. It is one of many "next generation" CT technologies that are now pushing image quality to new levels. The interpreting radiologist must now be familiar with detailed cardiac anatomy that is routinely imaged with these next generation units. Understanding normal cardiac anatomy, including normal variants, is key to distinguishing pathology from normal structures.

Radiation myelopathy visualized as increased FDG uptake on positron emission tomography.

A woman with a history of desmoid tumor involving the T9-T10 vertebrae was treated with local irradiation. After treatment, she developed tingling sensations in both legs. An FDG PET study demonstrated focally increased activity posterior to the vertebral bodies at the levels of T9-T10, which was vertical in orientation, corresponding to the location of the spinal cord at this level. This finding is consistent with the clinical suspicion of radiation myelopathy.