Notes on the history of the radiological study of Egyptian mummies: from X-rays to new imaging techniques.

A few centuries after the practice of mummification was finally abolished in the seventh century A.D., mummies began to capture the collective imagination, exerting a mysterious fascination that continues to this day. From the beginning, the radiological study of Egyptian mummies permitted the collection not only of medical data but also of anthropological and archaeological evidence. The first radiological study of an Egyptian mummy was performed by Flinders Petrie shortly after the discovery of X-rays in 1895, and since then, radiology has never stopped investigating these special patients. By the end of the 1970s, computed tomography (CT) scanning permitted more in-depth studies to be carried out without requiring the mummies to be removed from their cartonnage. CT images can be used to obtain a three-dimensional reconstruction of the mummy that provides important new information, in part thanks to the virtual endoscopy technique known as "fly through". Moreover, starting from CT data and using sophisticated graphics software, one can reconstruct an image of the face of the mummified individual at the time of his or her death. The history of imaging, from its origins until now, from the simplest to the most sophisticated technique, allows us to appreciate why these studies have been, and still are, fundamental in the study of Egyptian mummies.

Salivary gland stones: US evaluation in shock wave lithotripsy.

PURPOSE: To assess the usefulness of ultrasonography (US) in the selection and monitoring of patients with sialolithiasis to be treated with extracorporeal electromagnetic shock wave lithotripsy. MATERIALS AND METHODS: US was performed in 80 symptomatic outpatients who were to undergo shock wave lithotripsy because they were not candidates for endoral extraction of calculi. The location and diameter of stones and the condition of the affected gland and duct were determined. RESULTS: Swollen and sclerotic glands and dilated ducts were the most frequently observed characteristics. After lithotripsy, stone clearance or a residual fragment of less than 2 mm in diameter was seen at US in 37 of 56 patients with submandibular gland calculi and in all 24 patients with parotid gland calculi. Favorable outcome after lithotripsy was associated with smaller (less than 7 mm) stone diameter (P < .001) and, in the case of submandibular gland stones, with intraductal location (P < .05). A return to a normal parenchymal echotexture was seen in all patients in whom the stone was completely eliminated; a limited reduction in swelling was observed in patients with residual fragments. CONCLUSION: US is useful in the selection of candidates for extracorporeal electromagnetic shock wave lithotripsy and in monitoring the progress of treatment.

Phyllode tumor of the breast: mammographic experience in 99 cases.

The clinically variable course of phyllode tumor with its complex histological picture--ranging from benign to malignant--poses problems for the preoperative diagnosis and, in particular, the therapeutic approach. Mammograms of 99 patients with this disease, observed and treated from 1975 to 1989, were reviewed to determine mammographic/histologic correlations useful for early diagnosis. Opacity, size, shape, margin characteristics, the presence of calcifications and radiolucent halo were determined from the mammograms. The most useful characteristics were opacity and the character of the tumor's margins. However, mammographic features alone could not distinguish phyllode tumor from fibroadenoma.

[Nonpalpable breast lesions. General considerations and a review of the literature in the light of the authors' own experience with 344 cases located preoperatively]. / Lesioni mammarie non palpabili. Considerazioni generali e revisione della letteratura alla luce della esperienza personale su 344 casi di localizzazione preoperatoria.

The widespread use of mammography in breast cancer screening has increased the number of non-palpable breast lesions being detected in which the differential diagnosis between benign and malignant cases requires surgical biopsy. In order to remove these mammographically identified lesions the surgeon must be guided, which is why the techniques guiding the surgeon during lesions ablation have become most important. Accurate preoperative lesion localization must be done so that the excision can be complete and with the best cosmetic result. In this report we discuss localization methods, from the simplest to the most complicated ones. The commonest method has the advantage of employing no special instruments, and it is very simple, safe and fast. It requires a skilled hand and a little training. Instrumental methods are then discussed, from the simple dedicated compressor to the stereotactic techniques and, finally, the role of ultrasonography both in preoperative localization and in cytologic biopsy. The importance of mammographic examination of the surgical specimen is also stressed.

Preoperative localization and surgical approach in 344 cases of non-palpable breast lesions.

From June 1985 to August 1989, 344 cases of mammographic non-palpable breast lesions were operated on at the National Cancer Institute in Milan. The mammographic findings consisted of clusters of microcalcifications in 162 cases (42.1%), suspicious opacities with irregular borders in 116 cases (37.7%) and opacities containing microcalcifications in 66 cases (19.2%). The mean age of the patients was 51 years (range 31-77 years). In all patients localization was performed 1 day before the operation, introducing a self-retaining anchor wire into the mammary parenchyma. The histological findings showed benign breast disease in 184 cases (53.4%); proliferative dysplasia without atypia in 150 cases (81.5%); proliferative dysplasia with atypia in 22 cases (12%); fibroadenoma in nine and papilloma in three cases. Of 160 patients with carcinoma, 37 had non-infiltrating carcinoma: 28 of these cases (17.5%) had non-infiltrating ductal carcinoma and nine cases (5.6%) had lobular carcinoma in situ. In the 123 cases with infiltrating breast cancer the histological types were ductal infiltrating carcinoma (32.5%), lobular infiltrating carcinoma (9.8%), and 34.1% of the cases an associated or prevalent intraductal carcinoma was found. In 138 cases (85.6%) a conservative surgical procedure (quadrantectomy or more limited excision) was done, and in 22 (14.4%) cases a total mastectomy was necessary because of the extent of the disease. Axillary dissection was performed in 116 of the 123 patients with histological invasive carcinoma. Nodal metastases were found in 24 cases (20.7%), and only one node was involved in nine of the cases (37.5%), two to three nodes in nine cases (37.5%) and four to ten nodes in six cases (25%).

[Mammography in the diagnosis of phyllodes tumors of the breast. Analysis of 99 cases]. / La mammografia nella diagnosi di tumore fillode della mammella. Analisi di 99 casi.

The clinical history of the phyllodes tumor and its rather complex histologic patterns, ranging from benignity to malignity, often make both preoperative diagnostic procedures and the therapeutic approach very difficult to apply strictly. We reviewed the mammographic examinations of 99 patients observed and treated at the Istituto Nazionale Tumori of Milan, 1975 to 1989, looking for a mammographic-histologic correlation useful for both an unquestionable and early diagnosis and adequate excision. Many parameters were considered for each histologic type of phyllodes tumor (65 benign, 20 borderline, and 14 malignant), such as opacity, size, shape and borders of the tumor, presence/absence of calcifications inside, and radiolucent halo. The lesion was evident in all 3 projections in 85 cases (85.5%). Tumor contour was rounded in 45 instances and polycyclic in 54. Margins were distinct or mostly distinct in 81 instances (81.8%), indistinct in 11 (11.1%), and irregular in 7 (7%). The radiolucent halo was complete in 11 cases (11.1%), incomplete in 50 (50.5%), and absent in 38 (38.4%). In our experience, the most useful and characterizing mammographic parameters were tumoral borders and opacity.

Ultrasonographic evaluation of palpable breast masses: analysis of 134 cases.

Sonography has become a helpful adjunct to mammography mainly for a differential diagnosis between simple cysts and solid masses. The authors examined by ultrasound 134 palpable masses in the breast which had been previously evaluated by clinical examination and mammography and then submitted to biopsy or fine needle aspiration. The exact diagnosis of a simple cyst was made in 94.1% of the cases, whereas the diagnosis of fibroadenoma was made in 80% of the cases. Ultrasound examination proved to be useful in patients with dense breasts: in this group, 82.1% of the patients with a histologic diagnosis of benign status had a correct ultrasound diagnosis. In agreement with other authors, we believe that breast sonography has no part in screening programs.

Small sized phyllodes tumor of the breast.

From 1970 to 1988, 106 women (aged 13-63 years) suffering from phyllodes tumor of the breast underwent surgery at the Day Hospital in the Istituto Nazionale Tumori, Milan. Treatment consisted of enucleation in 57, enucleoresection in 42 and wide resection in seven. Ninety-two cases (86.8%) were benign, 12 (11.3%) borderline and two malignant. All the borderline and malignant tumors were submitted to wider resection as inpatients. The 12 borderline cases underwent wide resection while a subcutaneous mastectomy was performed in the two malignant cases. A mean follow-up of 49 months was carried out on 85 patients (range 1-186). The relapses, all in the benign group (6 cases; 6.52%), were much lower than reported by other authors (20-33%). This may be related to neoplasia size (less than 40 mm in 85.3%) and not to type of limited surgery. Although limited surgery was performed in 93.4% of cases (pre-operative diagnosis being unknown) the number of relapses was so low that re-operation with wider resection in healthy glandular tissue was not justified. However it is still performed in borderline and malignant phyllodes. The natural history of this tumor requires a prolonged follow-up since relapses may occur many months after operation (in our series 52).