Hiperplasia estromal pseudoangiomatosa de la mama (HEPA): estudio clínico, radiológico y patológico de 4 casos / Pseudoangiomatous stromal hyperplasia of the breast: a clinical, radiologic and pathological study of 4 cases

Generalmente afecta a mujeres en edad reproductiva, aunque se ha descrito en pacientes entre 12 y 75 años. Suele presentarse como un hallazgo incidental en el estudio histológico tras cirugía por patología benigna o maligna, aunque ocasionalmente su presentación clínica es como una tumoración mamaria indolora, simulando un fibroadenoma. La biopsia percutánea ecoguiada permite detectar la naturaleza de la lesión y descartar patología maligna, como el angiosarcoma de bajo grado. La hiperplasia estromal pseudoangiomatosa (HEPA) es una lesión mamaria poco frecuente, de carácter benigno. Se caracteriza por un sobrecrecimiento benigno de tejido conectivo fibroso que produce numerosos espacios que semejan estructuras vasculares. Se describe una serie de cuatro casos con diferente presentación clínica. Los dos primeros se manifestaron como una tumoración mamaria palpable, única e indolora, el tercero fue un hallazgo histopatológico en la pieza quirúrgica de una cuadrantectomía, realizada como tratamiento de un carcinoma intraductal mamario y el cuarto caso fue en un varón diagnosticado de ginecomastia unilateral (AU)

Pseudoangiomatous stromal hyperplasia (PASH) is a rare benign breast lesion, characterized by a benign overgrowth of fibrous connective tissue of the breast, which produces numerous spaces resembling vascular structures. This entity most commonly affects premenopausal women but cases have been described at all ages ranging from 12 to 75 years. PASH is usually an incidental histological finding after surgery for benign or malignant tumors but may also present as a mass or painless nodule mimicking fibroadenoma. Ultrasound-guided percutaneous biopsy allows the type of lesion to be determined and malignancies, such as low grade angiosarcoma, to be excluded. We report four new cases of PASH with distinct clinical presentations. The first two cases presented as a single painless breast mass, the third as anincidental finding in the surgical specimen from a quadrantectomy performed for an intraductal breast carcinoma, and the fourth case occurred in a man with unilateral gynecomastia (AU)

[Study of neurovascular contact in essential hemifacial spasm: an example of CISS sequence and magnetic resonance angiography]. / Estudio por resonancia magnética del contacto neurovascular en el espasmo hemifacial esencial: empleo de secuencia CISS y angiografía por resonancia magnética.

BACKGROUND AND PURPOSE: The purpose of this article is to assess the validity of the magnetic resonance imaging (MRI) CISS 3D sequence associated with 3D time of flight (TOF) angiographic sequence in order to detect neurovascular contact (NVC) between the facial nerve and neighbouring arteries in patients with essential hemifacial spasm (HFS) and to determine the relationship between HFS symptoms and NVC and NVC image features (type, number and site). MATERIALS AND METHODS: We prospectively enrolled 120 cerebellopontine angle (CPA) MRI studies, 44 cases with HFS symptoms and 76 which were asymptomatic (controls), using axial T2-weighted (CISS) and axial 3D TOF series with associated Maximal intensity (MIP) reconstructions. Prior TOF angiographic studies were available for 56 cases without associated CISS images and the results obtained from that study were compared with the results of the current study. RESULTS: The diagnostic values obtained significantly favoured the protocol used in this study, which demonstrated a sensitivity of 77.27% and a specificity of 75%. There was a statistically significant relationship between the presence of NVC and HFS symptoms (p<0.0001). Only one statistically significant relationship was found between facial nerve displacement (in type of NVC) and HFS symptoms (p=0.019). CONCLUSIONS: The proposed MRI protocol is sensitive and valid for detecting NVC in patients with HFS. The results of our study support a relationship between NVC and HFS symptoms. It is not a simple relationship, however. It may be influenced by other factors, such as displacement of the facial nerve due to NVC.

Estudio por resonancia magnética del contacto neurovascular en el espasmo hemifacial esencial: empleo de secuencia CISS y angiografía por resonancia magnética / Study of neurovascular contact in essential hemifacial spasm: an example of CISS sequence and magnetic resonance angiography

Objetivos: Evaluar la validez de la secuencia CISS 3D de resonancia magnética (RM) en relación con secuencias angiográficas TOF 3D para la detección del contacto neurovascular (CNV) entre el nervio facial y las arterias vecinas en pacientes con espasmo hemifacial esencial (EHE) y determinar la asociación entre la presencia de síntomas de EHE y el CNV y las características de imagen del CNV (tipo, número y localización).Material y métodos: Se han estudiado prospectivamente 120 ángulos pontocerebelosos (APC), 44 con clínica de EHE y 76 asintomáticos (controles), mediante el empleo de una serie axial potenciada en T2 (CISS) y una serie axial con técnica angiográfica TOF 3D con reconstrucciones MIP; 56 de estos APC tenían un estudio angiográfico TOF previo y se compararon sus resultados con los del estudio actual.Resultados: Los valores diagnósticos obtenidos fueron significativos a favor del protocolo del presente trabajo que mostró una sensibilidad del 77,27% y una especificidad del 75%. Se demostró una asociación estadísticamente significativa entre la presencia de CNV y la clínica de EHE (p<0,0001). Entre las características del CNV estudiadas, únicamente se halló una asociación estadísticamente significativa entre el desplazamiento del nervio facial (dentro de tipo de CNV) y la clínica de EHE (p=0,019). Conclusiones: El protocolo de RM propuesto es sensible y válido para detectar CNV en pacientes con EHE. Los resultados de nuestro estudio apoyan la asociación entre el CNV y la clínica de EHE, si bien no se trata de una asociación simple, sino que puede estar influida por otros factores, como el desplazamiento del nervio facial producido por el CNV (AU)

Background and purpose: The purpose of this article is to assess the validity of the magnetic resonance imaging (MRI) CISS 3D sequence associated with 3D time of flight (TOF) angiographic sequence in order to detect neurovascular contact (NVC) between the facial nerve and neighbouring arteries in patients with essential hemifacial spasm (HFS) and to determine the relationship between HFS symptoms and NVC and NVC image features (type, number and site).Materials and methods: We prospectively enrolled 120 cerebellopontine angle (CPA) MRI studies, 44 cases with HFS symptoms and 76 which were asymptomatic (controls), using axial T2-weighted (CISS) and axial 3D TOF series with associated Maximal intensity (MIP) reconstructions. Prior TOF angiographic studies were available for 56 cases without associated CISS images and the results obtained from that study were compared with the results of the current study. Results: The diagnostic values obtained significantly favoured the protocol used in this study, which demonstrated a sensitivity of 77.27% and a specificity of 75%. There was a statistically significant relationship between the presence of NVC and HFS symptoms (p<0,0001). Only one statistically significant relationship was found between facial nerve displacement (in type of NVC) and HFS symptoms (p=0.019).Conclusions: The proposed MRI protocol is sensitive and valid for detecting NVC in patients with HFS. The results of our study support a relationship between NVC and HFS symptoms. It is not a simple relationship, however. It may be influenced by other factors, such as displacement of the facial nerve due to NVC (AU)