Synchronous bilateral neuroendocrine ductal carcinoma in situ.

Neuroendocrine ductal carcinoma in situ (NE-DCIS) is a breast malignancy that has characteristic clinicopathological features and can, therefore, be regarded as a distinct variant of DCIS. The patient was a 54-year-old premenopausal woman with hemorrhagic nipple discharge in her left breast. Magnetic resonance imaging and ultrasound (US) images of the left breast showed mass-like lesions, while concurrent images of the right breast showed non-mass-like lesions. These findings suggested the presence of both benign and malignant tumors. Pathological findings from US-guided core-needle biopsy of the left mass were highly suspicious of a malignant tumor. Excisional biopsy of both breasts was performed. We could define the diagnosis of breast cancer by the second opinion on pathological diagnosis. The tumor cells showed histological characteristics of NE-DCIS. Bilateral breast lesions had histopathological similarities and were composed of predominantly solid growth of carcinoma cells, frequently with well-developed vascular structures, in mammary ducts and ductules. Carcinoma cells were polygonal or occasionally spindle shaped and had fine-granular, relatively eosinophilic cytoplasm. The nuclei of these cells showed round to ovoid in shape and fine-granular chromatin pattern. There was not any invasive component, as confirmed by careful histological examination. Thus, additional immunohistochemical stainings for NE markers (chromogranin A and synaptophysin) were performed. Staining statuses of these markers were positive in almost all tumor cells from both breasts. Both tumors were therefore diagnosed as NE-DCIS. To our knowledge, this case is the first report of NE-DCIS diagnosed synchronously in both breasts.

Epidermoid cyst originating from an intrapancreatic accessory spleen.

We report a rare case of an epidermoid cyst originating from an intrapancreatic accessory spleen, in a 40-year-old Japanese man with no clinical symptoms. A cystic tumor in the pancreatic tail was detected incidentally by abdominal ultrasonography. The patient was referred to the KKR Tachikawa Hospital for further examination of the tumor. Preoperative imaging findings suggested that the tumor was an epidermoid cyst originating from an intrapancreatic accessory spleen. On both pre-and post-contrast computed tomography and magnetic resonance images, the solid compartment of the tumor had the same X-ray attenuation and intensity as the spleen. Upon surgical excision, the mass consisted of solid and cystic components that were macroscopically evident on the preoperative images. Microscopic analysis revealed that the solid component was an accessory spleen in the pancreatic tail, whereas the cystic component was lined with stratified epithelium representative of an epidermoid cyst. This is the thirteenth report (in English) of an epidermoid cyst originating from an intrapancreatic accessory spleen, and the first case to be diagnosed prior to surgery.

The role of contrast enhanced MRI in the diagnosis of non-mass image-forming lesions on breast ultrasonography.

BACKGROUND: Although non-mass lesions on breast ultrasonography have become relatively common, they remain very difficult to diagnose. The purpose of this study was to evaluate the usefulness of contrast enhanced magnetic resonance imaging (MRI) in managing non-mass lesions. METHODS: A total of 82 cases of non-mass lesions visible on breast ultrasonography who were subjected to contrast enhanced MRI (CE-MRI) were available for assessment. These lesions were evaluated in terms of the association between the enhancement pattern on contrast enhanced MRI and the pathological or cytological diagnosis. RESULTS: Thirty-three of 82 (40.2%) non-mass image-forming lesions were seen as enhanced lesions on CE-MRI, of which 32 revealed non-masslike enhancements. Of the 19 breast cancers detected as non-mass image-forming lesions, 18 (94.7%) had an enhancement pattern not suggestive of a mass, so breast cancers comprised 56.3 % (18/32) of the lesions. Most of the breast cancers tended to emerge in a setting of duct dilatation with internal echoes (45.5%; 5/11) or low echo areas with indistinct margins (32.4%; 11/34). Morphologically, segmental (57.9%; 11/19) and regional (21.1%; 4/19) enhancements were common patterns of breast cancer which showed up as non-mass image-forming lesions. On the other hand, 49 of 82 (59.8%) non-mass image-forming lesions were not enhanced and 28 of 49 cases underwent pathological examination. Only one case was breast cancer with category 5 microcalcifications and although about half of the remaining 21 cases were followed for at least 12 months, no breast cancers were found. CONCLUSION: Contrast enhanced MRI was useful for detecting breast cancer in cases of non-mass image-forming lesions. On the other hand, except for cases in which mammography was suspicious for malignancy, lesions showing no enhanced areas may be safely followed, because the possibility of breast cancer is minute.

Isolated splenic vein thrombosis secondary to splenic metastasis: a case report.

A 49-year-old, previously healthy woman sought treatment for abdominal pain. Colonoscopy revealed ascending colon cancer. Computed tomography and angiography showed splenic metastasis and thrombosis extending from the splenic vein to the portal vein. She underwent right hemicolectomy, splenectomy, and distal pancreatomy. Histological findings showed no malignant cell in the splenic vein which was filled with organizing thrombus. We postulate the mechanism of splenic vein thrombosis in our case to be secondary to the extrinsic compression of the splenic vein by the splenic metastasis or by the inflammatory process produced by the splenic metastasis. In conclusion, we suggest that splenic metastasis should be added to the list of differential diagnosis which causes splenic vein thrombosis. In the absence of other sites of neoplastic disease, splenectomy seems to be the preferred therapy because it can be performed with low morbidity and harbors the potential for long-term survival.

An uncommon case of diabetic mastopathy in type II non-insulin dependent diabetes mellitus.

Diabetic mastopathy is an uncommon tumor-like proliferation of fibrous tissue of the breast that usually occurs in a patient who has suffered from type I diabetes mellitus of long duration. Here we report a rare case of diabetic mastopathy that occurred in type II non-insulin dependent diabetes mellitus. This patient was a 63-year-old postmenopausal woman. Mammography, ultrasonography and MR imaging could not distinguish it from breast cancer. Although the core needle biopsy specimen showed fibrosis without evidence of malignancy, excisional biopsy was performed. Histological findings demonstrated typical diabetic mastopathy with keloid-like fibrosis, perivascular lymphocytic infiltration, and lymphocytic lobulitis without evidence of malignancy. These lymphocytes were composed predominantly of B-cells. Five months after surgical biopsy, a nodular formation approximately 4 cm in diameter recurred adjacent to the resected end of the biopsy.