Aortic Angiosarcoma Manifesting as Multiple Musculoskeletal Metastases: A Case Report.

Aortic angiosarcomas are rare. Due to its rarity and metastatic presentation, it is difficult to diagnose metastatic aortic angiosarcoma. We describe the clinicopathological and radiologic features of a metastatic aortic angiosarcoma presenting as musculoskeletal metastases. A 59-year-old male patient presented with left thigh pain. Plain radiographs revealed multifocal osteolytic lesions in the left femur shaft. Abdominopelvic computed tomography showed a lobulated osteolytic lesion in the left iliac bone. Magnetic resonance images revealed multifocal soft tissue lesions in the thigh musculature. A positron emission tomography/computed tomography (PET/CT) scan demonstrated multiple foci of increased uptake in the left femur bone, pelvis, left thigh, and calf musculature. Focal increased uptake in the lower abdominal aorta was newly detected. Pelvis biopsy showed tumor cell nests of epithelioid cells. The tumor cells showed vasoformative features. Immunohistochemically, the tumor cells showed positivity for vimentin, CD31, and ERG. The pathologic diagnosis of epithelioid angiosarcoma was established. The origin of the tumor was presumed to be the aorta. This case underscores the importance of PET scans in identifying primary lesions. In terms of the histopathologic diagnosis of biopsy samples with tumor cells exhibiting epithelioid neoplastic morphology, employing appropriate ancillary techniques such as immunocytochemistry with vascular markers may assist in accurately diagnosing metastatic angiosarcoma.

Devising a deep neural network based mammography phantom image filtering algorithm using images obtained under mAs and kVp control.

We study whether deep neural network based algorithm can filter out mammography phantom images that will pass or fail. With 543 phantom images generated from a mammography unit, we created VGG16 based phantom shape scoring models (multi-and binary-class classifiers). Using these models we designed filtering algorithms that can filter failed or passed phantom images. 61 phantom images obtained from two different medical institutions were used for external validation. The performances of the scoring models show an F1-score of 0.69 (95% confidence interval (CI) 0.65, 0.72) for multi-class classifiers and an F1-score of 0.93 (95% CI 0.92, 0.95) and area under the receiver operating characteristic curve of 0.97 (95% CI 0.96, 0.98) for binary-class classifiers. A total of 42 of the 61 phantom images (69%) were filtered by the filtering algorithms without further need for assessment from a human observer. This study demonstrated the potential to reduce the human workload from mammographic phantom interpretation using the deep neural network based algorithm.

The Design, Characterization and Antibacterial Activity of Heat and Silver Crosslinked Poly(Vinyl Alcohol) Hydrogel Forming Dressings Containing Silver Nanoparticles.

The prompt treatment of burn wounds is essential but can be challenging in remote parts of Africa, where burns from open fires are a constant hazard for children and suitable medical care may be far away. Consequently, there is an unmet need for an economical burn wound dressing with a sustained antimicrobial activity that might be manufactured locally at low cost. This study describes and characterizes the novel preparation of a silver nitrate-loaded/poly(vinyl alcohol) (PVA) film. Using controlled heating cycles, films may be crosslinked with in situ silver nanoparticle production using only a low heat oven and little technical expertise. Our research demonstrated that heat-curing of PVA/silver nitrate films converted the silver to nanoparticles. These films swelled in water to form a robust, wound-compatible hydrogel which exhibited controlled release of the antibacterial silver nanoparticles. An optimal formulation was obtained using 5% (w/w) silver nitrate in PVA membrane films that had been heated at 140 °C for 90 min. Physical and chemical characterization of such films was complemented by in vitro studies that confirmed the effective antibacterial activity of the released silver nanoparticles against both gram positive and negative bacteria. Overall, these findings provide economical and simple methods to manufacture stable, hydrogel forming wound dressings that release antibiotic silver over prolonged periods suitable for emergency use in remote locations.

Clinical outcome and predictive factors for docetaxel and epirubicin neoadjuvant chemotherapy of locally advanced breast cancer.

BACKGROUND/AIMS: We evaluated the efficacy of docetaxel and epirubicin as neoadjuvant chemotherapy in locally advanced breast cancer and assessed the predictive factors for response to neoadjuvant chemotherapy and prognostic factors related to relapse-free survival. METHODS: Forty patients who received docetaxel and epirubicinas neoadjuvant chemotherapy for locally advanced breast cancer were evaluated retrospectively. Neoadjuvant chemotherapy consisted of intravenous injection of 75 mg/m2 docetaxel and 60 mg/m2 epirubucin on day 1, every 21 days, and two to six cycles. RESULTS: Twenty-five (62.5%) patients showed a partial response, and 15 (37.5%) patients showed a stable disease in the first response evaluation after two or three cycles of neoadjuvant chemotherapy. In the second response evaluation of nine patients who received six cycles of neoadjuvant chemotherapy, one patient achieved a complete response, but two patients with hormone receptor-negative, human epidermal growth factor receptor 2-positive breast cancer experienced disease progression. Twenty-five (62.5%) patients experienced downstaging after neoadjuvant chemotherapy. Patients with > 20% pretreatment Ki-67 and decrease of Ki-67 between pre- and post-neoadjuvant chemotherapy showed a trend for better response. In multivariate analysis, advanced pathological stage showed a significant negative effect on relapse-free survival. CONCLUSION: Docetaxel and epirubicin neoadjuvant chemotherapy showed a good response in locally advanced breast cancer. Pretreatment Ki-67 and change of Ki-67 may play a role as predictive factor for response to neoadjuvant chemotherapy.

Hypofractionated Radiation Therapy for Progressive Heterotopic Ossification: The Relationship between Dose and Efficacy.

PURPOSE: We sought to evaluate treatment outcomes after hypofractionated short-course radiation therapy (RT) for progressive heterotopic ossification (HO). METHODS AND MATERIALS: Nine consecutive patients were treated between January 2016 and December 2018. None had received previous preventive RT. RT was performed to prevent further HO progression with one of the following dose-fractionation regimens: 7 Gy × 2 fractions, 9 Gy × 1 fraction, 6 Gy × 2 fractions, 6 Gy × 3 fractions, 8 Gy × 2 fractions, or 7 Gy × 3 fractions. RESULTS: All patients were male, with a median age of 30 years (range, 16-55). Eight patients presented with grade III Brooker classification. The most commonly involved site was the hip, followed by femur and knee. With a median assessment time of 7.1 (range, 5.1-23.1) months, eight patients achieved decreased HO, with five showing a dramatic (≥50%) reduction. Among the five excellent responders, a 21 Gy with 7 Gy per fraction schedule was used in four patients. HO status was maintained at the final median follow-up of 11.6 months (range, 6.2-36.1), and Brooker's grade was improved in three patients. No significant RT-related toxicity was noted. CONCLUSIONS: The current RT scheme was effective for the management of progressive HO. It is speculated that higher RT doses could result in the superior efficacy of progressive HO.

PTEN Mutation Identified in Patient Diagnosed with Simultaneous Multiple Cancers.

PTEN hamartoma tumor syndrome is a spectrum of disorders characterized by unique phenotypic features including multiple hamartomas caused by mutations of the tumor suppressor gene PTEN. Cowden syndrome and Bannayan-Riley-Ruvalcaba syndrome are representative diseases, and both have several common clinical features and differences. Because PTEN mutations are associated with an increased risk of malignancy including breast, thyroid, endometrial, and renal cancers, cancer surveillance is an important element of disease management. We report a germline mutation of the PTEN (c.723dupT, exon 7) identified in a young woman with a simultaneous occurrence of breast cancer, dermatofibrosarcoma protuberans, and follicular neoplasm. This case suggests that it is critical for clinicians to recognize the phenotypic features associated with these syndromes to accurately diagnose them and provide preventive care.

Comparison of osteoconductivity and absorbability of beta-tricalcium phosphate and hydroxyapatite in clinical scenario of opening wedge high tibial osteotomy.

The purpose of this study was to compare the osteoconductivity, and absorbability of hydroxyapatite or beta-tricalcium phosphate in clinical scenario of opening wedge high tibial osteotomy Total 41 knees of 40 patients with follow up period of more than 1 year were enrolled. These patients were divided into two groups, Group I (22 knees, 21 patients) used hydroxyapatite and Group II (19 knees, 19 patients) used beta-tricalcium phosphate as a substitute in the opening gap. According to proven method, the osteoconductivity was assessed radiographically by the extent of new bone formation at osteotomy space and absorbability was evaluated by measuring the area occupied by substitute at immediate postoperative, postoperative 6 months and 1 year. Regarding preoperative demographic data, no significant differences were found between two groups. No statistically significant differences were found between two groups regarding lower limb alignment (mechanical femorotibial angle, weight-bearing line%) and posterior tibial slope at postoperative and final follow up radiographs. Concerning the osteoconductivity, there were no significant differences between two groups in any zone. However, the absorption rate was significantly greater in the Group II than in Group I at 6 months (Group I: 13.7 ± 6.8, group II: 35.3 ± 15.8, P = 0.001) and 1 year (Group I: 24.2 ± 6.3, Group II: 49.6 ± 14.3, P < 0.0001). The complications related to bone substitutes were not observed. Both hydroxyapatite and beta-tricalcium phosphate showed satisfactory gap healing without complications and can be successfully used as alternative healing materials in opening wedge high tibial osteotomy. Our study showed that beta-tricalcium phosphate has superior absorbability than hydroxyapatite. But osteoconductivity showed no significant difference.

Sonography of Invasive Apocrine Carcinoma of the Breast in Five Cases.

OBJECTIVE: To evaluate the sonographic features of invasive apocrine carcinoma (IAC) of the breast. MATERIALS AND METHODS: This study included five pathologically proven cases of IAC, and their sonographic features were retrospectively analyzed according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon. RESULTS: All five lesions involved the left breast and were seen as irregularly shaped masses. All lesions, except one, had a parallel orientation to the chest wall. All five lesions showed noncircumscribed margins and heterogeneous echotexture; however, they showed various posterior features. One lesion had edema as an associated feature. Sonographic assessments were classified as BI-RADS category 4 in all five cases. CONCLUSION: Invasive apocrine carcinoma sonographic findings are difficult to differentiate from those of invasive ductal carcinoma of no special type.

Who could benefit the most from using a computer-aided detection system in full-field digital mammography?

BACKGROUND: The computer-aided detection (CAD) system on mammography has the potential to assist radiologists in breast cancer screening. The purpose of this study is to evaluate the diagnostic performance of the CAD system in full-field digital mammography for detecting breast cancer when used by dedicated breast radiologist (BR) and radiology resident (RR), and to reveal who could benefit the most from a CAD application. METHODS: We retrospectively chose 100 image sets from mammographies performed with CAD between June 2008 and June 2010. Thirty masses (15 benign and 15 malignant), 30 microcalcifications (15 benign and 15 malignant), and 40 normal mammography images were included. The participating radiologists consisted of 7 BRs and 13 RRs. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for total, normal plus microcalcification and normal plus mass both with and without CAD use for each reader. We compared the diagnostic performance values obtained with and without CAD use for the BR and RR groups, respectively. The reading time reviewing one set of 100 images and time reduction with CAD use for the BR and RR groups were also evaluated. RESULTS: The diagnostic performance was generally higher in the BR group than in the RR group. Sensitivity improved with CAD use in the BR and RR groups (from 81.10 to 84.29% for BR; 75.38 to 77.95% for RR). A tendency for improvement in all diagnostic performance values was observed in the BR group, whereas in the RR group, sensitivity improved but specificity, PPV, and NPV did not. None of the diagnostic performance parameters were significantly different. The mean reading time was shortened with CAD use in both the BR and RR groups (111.6 minutes to 94.3 minutes for BR; 135.5 minutes to 109.8 minutes for RR). The mean time reduction was higher for the RR than that in the BR group. CONCLUSIONS: CAD was helpful for dedicated BRs to improve their diagnostic performance and for RRs to improve the sensitivity in a screening setting. CAD could be essential for radiologists by decreasing reading time without decreasing diagnostic performance.

Band-like interposing fat along large vessels: ultrasonographic pseudolesions of the breast.

OBJECTIVE: The aim of this study is to evaluate the clinical characteristics and ultrasonographic findings of band-like interposing fat as well as to identify additional approaches for its diagnosis. MATERIALS AND METHODS: This study included 26 confirmed cases of band-like interposing fat from June 2008 to June 2010. A retrospective analysis was performed to evaluate the clinical characteristics and ultrasonographic findings in these cases. Five radiologists analyzed the ultrasonographic findings, which correlated with the mammographic and MRI findings when available, according to Breast Imaging Reporting and Data System classification. RESULTS: None of the 26 patients had any symptoms. In 92.3% of the patients, the lesion was located in the upper outer quadrant of the breast. The mean distance of the lesion from the nipple was 2.4 ± 0.7 cm (1.1-4.5). The mean depth of the lesion from the skin was 1.3 ± 0.3 cm (0.8-2.1). The mean maximal length of the lesion was 0.8 ± 0.4 cm (0.3-1.8). The following were the most frequent ultrasonographic findings of lesions: irregular shape, not parallel orientation, indistinct margins, abrupt interface, hypoechogenicity, no posterior feature, no calcification, and presence of vascularity. The most frequent BI-RADS category was 4a. There were no suspicious findings on the mammography or MRI. CONCLUSION: Ultrasonographic findings may lead to misclassification of band-like interposing fat as a malignancy. A better understanding of the clinical and ultrasonographic characteristics of band-like interposing fat would facilitate its differentiation from a true mass.

Primary neuroendocrine tumor of the breast: imaging features.

Focal neuroendocrine differentiation can be found in diverse histological types of breast tumors. However, the term, neuroendocrine breast tumor, indicates the diffuse expression of neuroendocrine markers in more than 50% of the tumor cell population. The imaging features of neuroendocrine breast tumor have not been accurately described due to extreme rarity of this tumor type. We present a case of a pathologically confirmed, primary neuroendocrine breast tumor in a 42-year-old woman, with imaging findings difficult to be differentiated from that of invasive ductal carcinoma.

Imaging features of invasive lobular carcinoma: comparison with invasive ductal carcinoma.

PURPOSE: The aim of this study was to evaluate the imaging findings of invasive lobular carcinoma (ILC) compared to those of invasive ductal carcinoma (IDC). MATERIALS AND METHODS: The study included ILCs (n = 27) and IDCs (n = 85). Imaging findings were retrospectively evaluated, according to the BI-RADS lexicon. We compared the imaging findings, multiplicity, and magnetic resonance imaging (MRI) detection accuracy of ILC with those of IDC. RESULTS: At mammography, normal findings and mass lesions were more frequent with ILCs (14.8% and 59.2%, respectively) than with IDCs (1.2% and 44.7%, respectively) (P = 0.009). With ultrasonography (US), posterior acoustic shadowing was more frequently seen in ILCs (59.2%) than in IDCs (15.8%) (P < 0.001). With MRI, both ILCs and IDCs most commonly appeared as a heterogeneously enhancing, irregular mass with a spiculated border. Multifocality was more frequently associated with ILCs (40.7%) than with IDCs (14.1% 1% 0.002). However, multicentricity and bilaterality were not different between the two groups. The sensitivity and specificity of MRI for the detection of multiplicity were 91.6% and 73.3%, respectively, for ILCs and 83.3% and 80.3%, respectively, for IDCs. CONCLUSION: Normal findings, mass lesions on mammography, and posterior acoustic shadowing on US were more frequently associated with ILCs than with IDCs. Multifocality was more prevalent with ILCs than with IDCs.

Cystic hypersecretory ductal carcinoma of the breast: a rare cause of cystic breast mass.

We present the case of a surgically confirmed, invasive, cystic hypersecretory ductal carcinoma (CHDC) of the breast in a 43-year-old woman. The initial sonography showed a complex cyst, which required a core biopsy; however, the diagnosis was delayed as the patient refused to undergo the biopsy and the cyst decreased in size, as seen on follow-up sonography. Excision biopsy was performed, and invasive CHDC was diagnosed after regrowth of the cystic lesion. Meticulous sonographic evaluation of a cystic breast mass is always important, and pathology confirmation must be considered if the lesion shows features suspicious for malignancy, as a CHDC could be the cause of a cystic breast mass.

Diffuse infiltrative lesion of the breast: clinical and radiologic features.

The purpose of this paper is to show the clinical and radiologic features of a variety of diffuse, infiltrative breast lesions, as well to review the relevant literature. Radiologists must be familiar with the various conditions that can diffusely involve the breast, including normal physiologic changes, benign disease and malignant neoplasm.

Correlation between breast arterial calcification detected on mammography and cerebral artery disease.

PURPOSE: This study was carried out to determine the relationship between breast arterial calcification (BAC) and cerebral artery disease. MATERIALS AND METHODS: We investigated the relationship between BAC on mammography and cerebral artery-origin T2-hyperintensity on brain MRI and which is associated with an increased risk for stroke. A total of 168 women, ages 40-78 years, who underwent both mammography and brain MRI, were enrolled in this study. BAC was counted as positive if it was found on more than one view a breast. The T2-hyperintensity was systemically defined and graded as follows: punctuate; patchy; and confluent white-matter hyperintensity (WMH); caps; bands; and irregular periventricular hyperintensity (PVH). Patchy and confluent WMH and irregular PVH were considered as positive findings for cerebral artery disease. We also obtained data regarding cardiovascular risk factors that might function as confounding factors. Statistical analysis was performed for association of the BAC and positive MRI findings. RESULT: The presence of BAC showed a strong correlation with the positive MRI findings (Odds ratios, adjusted with statically significant cardiovascular factors of 6.86 for positive WMH and 9.04 for positive PVH, p < 0.05). CONCLUSION: The mammographic finding of BAC, which may be a useful marker of women at higher risk for stroke, should receive more of clinicians' attention and its presence should never be omitted from the report.

Rapidly growing bilateral pseudoangiomatous stromal hyperplasia of the breast.

A tumoral pseudoangiomatous stromal hyperplasia (PASH) that causes huge breast enlargement is very rare. Only two cases of huge tumoral PASHs have been reported in the English medical literature. We report here on a surgically confirmed case of bilateral huge tumoral PASH in a 47-year-old woman, and we present the imaging and histopathology findings. We also review the relevant medical literature.

The clinical and imaging characteristics of breast cancers in patients with interstitial mammoplasty.

PURPOSE: The aims of this study are to demonstrate the clinical characteristics and various imaging findings of breast cancers in patients with interstitial mammoplasty. METHODS: A total of six patients, who had breast cancer and had received liquid silicone or paraffin injection for augmentation, were included in this study. Mammography, ultrasonography, dynamic breast MRI, and PET/CT were performed for 5, 3, 6, and 2 patients, respectively. The clinical course was reviewed, and the imaging findings were retrospectively evaluated according to the ACR BI-RADS atlas. RESULTS: The mean maximal diameter of the detected breast cancers on enhanced breast MRI was 5.5 cm (range 4.8-7.1 cm). Although the breast cancers were all of a large size, subjective breast symptoms exhibited in only four of six patients. Mammographic examinations exhibited variable associate findings such as skin thickening, ipsilateral volume increase, and increase densities, but could not demonstrate main breast masses. A few sonographic examinations exhibited masses with associate findings such as skin thickening. On breast MRI, enhancing breast cancers with associate findings were detected in all the patients. On PET-CT, breast cancers and distant metastases were detected. CONCLUSIONS: Breast cancers in these patients were detected at the advanced stage. Dynamic breast MRI was useful for detecting breast cancer in these patients. Mammography failed to demonstrate the breast cancer, but cancer detection was facilitated by associated findings: skin thickening, asymmetric volume increase, and increased density.