Occult breast cancer in a female with benign lesions.

Occult breast cancer is a carcinoma discovered by the presence of axillary lymph node metastases without the detection of the primary breast tumor. The incidence of this very rare pathology is 0.3%-1.0%. The limited number of these cases does not allow for the precise management of this rare pathology and often, the breast cancer manifestation can take many years to become obvious. We report the case of a 35-year-old woman who presented to our department for annual breast screening examination, without any symptoms. At the time of visit, there were two right and one left tumefactions; unfixed and palpable. Ultrasonography examination confirmed the lesions to be benign. One year later, a palpable hypoechoic axillary left lesion appeared: a lymph node with doubtful morphology. On cytological examination, a biopsy was performed for the axillary left mass which showed irregular masses of large malignant cells with pleomorphism and mitotic figures that suggested a carcinoma. The management of this case is suggestive for cancer of unknown primary syndrome.

Quantitative Assessment of Abdominal Aortic Calcifications Using Lateral Lumbar Radiograph, Dual-Energy X-ray Absorptiometry, and Quantitative Computed Tomography of the Spine.

Abdominal aortic calcifications (AACs) represent an independent determinant of cardiovascular events and are strongly associated with cardiovascular disease. To our knowledge, a comparison between lateral lumbar radiography, lateral spine dual-energy x-ray absorptiometry (DXA), and quantitative computed tomography (QCT) in the assessment of AAC has not been performed. Our objective was to compare those methods in the detection and quantification of AAC using a simplified 8-point score system (AAC-8). Three hundred twenty-three postmenopausal women underwent lateral lumbar radiography, lateral spine DXA, and QCT for osteoporosis screening and were scored for AAC using the AAC-8. Lateral lumbar radiographs, lateral spine DXA, and QCT detected AAC in 58%, 55%, and 60% of the subjects, respectively. The nonparametric intraclass correlation coefficient between lateral lumbar radiograph and lateral spine DXA and lateral lumbar radiograph and QCT were 0.699 (95% confidence interval [CI]: 0.638-0.752) and 0.829 (95% CI: 0.783-0.865). Area under operating curve (receiver operating characteristic [ROC]) for lateral spine DXA was 0.826 (95% CI: 0.764-0.888), whereas for QCT was 0.948 (95% CI: 0.922-0.974) considering lateral lumbar radiograph as gold standard. AAC has been shown to be a significant predictive marker of overall cardiovascular disease. DXA may be a screening tool among asymptomatic patients with low radiation exposure to identify an important cardiovascular disease risk factor. QCT represents a reliable technique that may be applied as a future standard to facilitate the detection of abdominal aortic calcification as well as to provide more accurate measurement of bone densitometry.

Persistent Haglund's disease after conventional treatments: the innovative role of radiotherapy.

Haglund's disease, an inflammation of the retrocalcaneal bursa and a bone enlargement on the back of the heel, is a painful syndrome mainly caused by the exostotic prominence of the posterior calcaneus. Conventional treatment consists of rest, shoewear modification, medical therapy and, in selected cases, surgery. We report the case of a 59-year-old male with a history of severe atraumatic monolateral heel pain treated with foot orthotics, rest and surgery with partial regression of symptoms. Owing to the persistent heel pain and physical impairment after surgery, the patient underwent radiotherapy, which was successful in relieving his symptoms.

Early diagnosis of vertebral fractures.

Vertebral fractures are a common clinical entity, caused by trauma or related to osteoporosis (benign). Their recognition is especially important in the post-menopausal female population but also important is their differentiation from pathological (malignant) fractures (1). A vertebral fracture is evidenced by vertebral body deformity or reduction in vertebral body height beyond a certain threshold value in the absence of bone discontinuity. For prognosis and treatment it is extremely important to recognize the cause of the fracture. In contrast to fractures that occur in other locations, vertebral fractures often go unrecognized in the acute phase as the pain may be transient and radiographic and evaluation of the spine may be difficult (2). Objective measurement of the vertebral deformity provides invaluable information to the interpreting physician and helps grade fracture severity. The recognition and diagnosis of vertebral fractures can be performed using additional diagnostic tools.