RESUMO
OBJECTIVE: To compare and determine discriminative magnetic resonance imaging (MRI) findings of idiopathic granulomatous mastitis (IGM) and breast cancer (BC) that present as non-mass enhancement. MATERIALS AND METHODS: This retrospective study includes 68 IGM and 75 BC cases that presented with non-mass enhancement on breast MRI. All patients with a previous history of breast surgery, radiotherapy, or chemotherapy due to BC or a previous history of mastitis were excluded. On MRI images, presence of architectural distortion skin thickening, edema, hyperintense ducts containing protein, dilated fat-containing ducts and axillary adenopathies were noted. Cysts with enhancing walls, lesion size, lesion location, fistulas, distribution, internal enhancement pattern and kinetic features of non-mass enhancement were recorded. Apparent diffusion coefficient (ADC) values were calculated. Pearson chi-square test, Fisher's exact test, independent t test and Mann-Whitney U test were used as needed for statistical analysis and comparison. Multivariate logistic regression model was used to determine the independent predictors. RESULTS: IGM patients were significantly younger than BC patients (p < 0.001). Cysts with thin (p < 0.05) or thick walls (p = 0.001), multiple cystic lesions, (p < 0.001), cystic lesions draining to the skin (p < 0.001), and skin fistulas (p < 0.05) were detected more often in IGM. Central (p < 0.05) and periareolar (p < 0.001) location and focal skin thickening (p < 0.05) were significantly more common in IGM. Architectural distortion (p = 0.001) and diffuse skin thickening (p < 0.05) were associated with BC. Multiple regional distribution was more common in IGM, whereas diffuse distribution and clumped enhancement were more common in BC (p < 0.05). In kinetic analysis, persistent enhancement was more common in IGM, whereas plateau and wash-out types were more common in BC (p < 0.001). Independent predictors for BC were age, diffuse skin thickening and kinetic curve types. There was no significant difference in the diffusion characteristics. Based on these findings, MRI had a sensitivity, specificity and accuracy of 88%, 67.65%, and 78.32%, respectively, in differentiating IGM from BC. CONCLUSIONS: In conclusion, for non-mass enhancement, MRI can rule out malignancy with a considerably high sensitivity; however, specificity is still low, as many IGM patients have overlapping findings. Final diagnosis should be complemented with histopathology whenever necessary.
RESUMO
BACKGROUND: Ingestion of foreign objects is a common problem in children. Ingestion of one more magnets may require surgical intervention because of risk of perforation. METHODS: A 4-year-old girl was admitted to our department with complaints of abdominal pain and bilious vomiting. She had been treated at another clinic with repeated abdominal X-rays because of ingestion of a magnet 5 days ago. Physical examination revealed diffuse abdominal tenderness and bilious drainage from the nasogastric tube. The magnet was observed by radiopaque imaging in the right epigastric region of the upright abdomen but there was no free air. The magnet was presumed to be in the duodenum and exploratory laparotomy was performed. RESULTS: During the operation, a perforation was found between the pylorus and duodenum due to the magnet. The foreign body was found to be two magnets adherent to each; the interposed and compressed tissue was necrotized and perforated between the two magnets. The necrotized segment was excised and primary anastomosis was made. The postoperative period of the patient was uneventful and she was discharged on the seventh postoperative day. CONCLUSIONS: Ingestion of foreign objects such as one more magnets may cause intestinal perforation in early stages. If the object stays in the same location shown by repeated X-rays, surgical intervention should not be delayed.
