Hyperechoic Lesions on Breast Ultrasound: All Things Bright and Beautiful?

Ultrasound (US) lexicon of the Breast Imaging Reporting and Data System (BI-RADS) defines an echogenic breast mass as a lesion that is hyperechoic in comparison with subcutaneous adipose tissue. However, at sonography, only 0.6 to 5.6% of breast masses are echogenic and the majority of these lesions are benign. approximately, 0.5% of malignant breast lesions appear hyperechoic. The various benign pathologic entities that appear echogenic on US are lipoma, hematoma, seroma, fat necrosis, abscess, pseudoangiomatous stromal hyperplasia, galactocele, etc. The malignant diagnoses that may present as hyperechoic lesions on breast US are invasive ductal carcinoma, invasive lobular carcinoma, metastasis, lymphoma, and angiosarcoma. Echogenic breast masses need to be correlated with mammographic findings and clinical history. Lesions with worrisome features such as a spiculated margin, interval enlargement, interval vascularity, or association with suspicious microcalcifications on mammography require biopsy. In this article, we would like to present a pictorial review of patients who presented to our department with echogenic breast masses and were subsequently found to have various malignant as well as benign etiologies on histopathology.

Unusual involvement of scalp and bilateral kidneys in an aggressive mediastinal diffuse large B cell lymphoma: documentation by FDG-PET imaging.

In the present communication, an unusual combination of scalp soft tissue and underlying brain involvement with intact skull bone coupled with bilateral renal involvement from a mediastinal diffuse large B cell lymphoma (DLBL) is presented. A 45-year-old man, a diagnosed case of mediastinal DLBL with bilateral lung involvement, was treated with conventional 6 cycles of chemotherapy and local external radiotherapy with initial good treatment response evidenced by considerable regression in mass size and regression in pulmonary lesions. Three months later, he returned with complaints of soft tissue swelling over the scalp; one of them in the high parietal bone and the other over the occipital region. A whole body FDG-PET at this time showed 2 moderate-sized foci in the scalp (with preservation of both tables of skull bone) and corresponding large foci in the brain parenchyma beneath, a superior mediastinal focus, a few foci in the apical and lower zone of left lung, extensive irregular uptake in the right pleura and the right lung parenchyma coupled with a loculated effusion in its lower zone and studded foci of hypermetabolism throughout the bilaterally enlarged kidneys. CT of the head confirmed the FDG-PET findings and histopathology of the biopsy from the scalp swelling was suggestive of DLBL. Ultrasound imaging of the abdomen showed lobulated bilaterally enlarged kidneys with multiple hypoechoic areas within them. The patient underwent palliative local external radiotherapy to the brain and systemic chemotherapy with poor clinical results with raised serum beta-2 microglobulin and serum LDH levels and deranged renal function. The patient died within a month after the FDG-PET study. The event of scalp and bilateral renal involvement from DLBL is rare in lymphoma literature and this report highlights that such unusual events can occur as part of widespread dissemination and underscores the importance of whole-body imaging with FDG-PET.

Ruptured degenerated uterine fibroid diagnosed by imaging.

BACKGROUND: We report a ruptured uterine leiomyoma presenting as an acute abdomen. We document computed tomography and magnetic resonance imaging features of a ruptured uterine fibroid. CASE: A woman with a large anterior wall uterine fibroid underwent a dilation and curettage for a threatened abortion. She had an uneventful recovery. Three weeks later, she presented with peritonitis. Computed tomography and magnetic resonance imaging optimally depicted the ruptured fibroid and excluded other causes of acute abdomen. Exploratory laparotomy and myomectomy confirmed the diagnosis. CONCLUSION: This is a report of a ruptured degenerated fibroid causing acute abdomen outside of pregnancy. Computed tomography and magnetic resonance imaging aided in correctly establishing the diagnosis and optimizing the management of this patient.

Malignant mesenchymoma of the chest wall in an adult.

Mesenchymoma (hamartoma) of the chest wall is an extremely rare tumour presenting in early infancy or fetal life. Pleural, pulmonary, and lymph node metastases developed in a young man with malignant mesenchymoma of the chest wall. The tumour had several characteristics that differ from the mesenchymoma reported from the other parts of the body.

Schistosoma mansoni infections in neonatal Biomphalaria glabrata snails.

In areas endemic for schistosomiasis, the population dynamics of the snail intermediate hosts have a direct effect on parasite transmission. The present study focused on the potential for neonatal Biomphalaria glabrata snails to become infected with Schistosoma mansoni and to produce cercariae under various conditions. It was found that snails as small as 0.74 mm in shell diameter could survive miracidial penetration and could release cercariae when as small as 1.6 mm in diameter. Cercariae produced by small snails were equally infectious for mice when compared with those shed by larger snails. Likewise, histological examination of neonatally exposed snails revealed normally developing parasites at all stages of infection. It was found that in 2 snail populations expressing either high or low susceptibility to the parasite, peak susceptibility occurred at 25 days of age in both groups. Daily cercarial production for neonatally exposed snails was initially low but increased dramatically as the snails grew, eventually reaching values as high as 2,100 cercariae/snail/day. A moderate to high percentage of snails infected as neonates was eventually capable of simultaneously producing both eggs and cercariae. These studies emphasize the potential importance of neonatal and preadult snails in helping to maintain foci of S. mansoni infection in endemic areas.

Role of sonography in trichobezoars.

Three cases of trichobezoar (12/F, 5/F, and 35/M) are reported. All patients presented with an epigastric mass and the diagnosis was not suspected clinically. They were referred for sonography which revealed a hyperechoic curvilinear dense strip at the anterior margin of the lesion associated with marked acoustic shadowing and no through transmission. Similar findings were noted in all three cases. In vitro ultrasound scans performed on the operated specimen in one case confirmed that the sonographic findings were the result of the trichobezoar mass. Diagnosis was confirmed in all the cases by barium meal and surgery.