Breast cancer recurrence after mastectomy: diagnosis with mammography and US.

The authors reviewed mammograms and/or ultrasound (US) scans of 76 lesions (67 patients) suspected of being recurrent breast cancer. All patients had previously undergone mastectomy. Sixty-one cases were malignant disease and 15 were benign. Mammography and US were complementary to clinical examination in evaluating palpable lesions at the mastectomy site. Both imaging methods revealed nonpalpable recurrences. The sensitivity of US was 91%, whereas the sensitivities of clinical examination and mammography were 79% and 45%, respectively. US was the best imaging method for evaluating tumors in the chest wall far from the scar and in the axilla, as these could not be visualized on mammograms. Most recurrent cancers were seen as circumscribed masses at mammography and as hypoechoic lesions at US. Hyperechoic recurrences could not be differentiated from benign lesions. The value of early detection of recurrences with imaging methods remains to be seen.

Sonographic follow-up of ethanolamine oleate sclerotherapy for hydrocele.

Sclerotherapy has gained increasing popularity during the last few years as a treatment for hydrocele. Little is known of the natural course of intrascrotal changes, however, nor of their timetable after therapy. In the present trial scrotal ultrasonography was performed before the sclerotherapy and during the follow-up examination in the case of 70 symptomatic consecutive outpatients ranging in age from 19 to 85 years (mean, 58 years) with 71 hydroceles treated by ethanolamine oleate sclerotherapy. Posttreatment sonographic findings typically included heterogeneously echogenic extratesticular masses, cystic areas with peritesticular hyperechoic lines, and a thickened scrotal wall. All the lesions showed improvement. Sonography proved to be useful for differentiating hydroceles from spermatoceles and for evaluating the need for a renewed treatment during follow-up. Ethanolamine oleate was effective as a sclerosant, as 86% of cases were cured or significantly improved. Complications were mild and uncommon, and no intratesticular or epididymal changes were observed. Ethanolamine oleate sclerotherapy can be recommended as a treatment of choice for hydrocele.

Ultrasound follow-up of ethanolamine oleate sclerotherapy for spermatoceles.

Although sclerotherapy as a treatment for hydroceles has gained in popularity during the last few years, there is no consensus on whether it can also be adopted for the treatment of spermatoceles. We examine here the efficacy and safety of ethanolamine oleate sclerotherapy in cases of spermatocele using ultrasound (US) before treatment and during follow-up. Thirty-seven consecutive outpatients aged 36-84 years (mean 61) with symptoms of 40 spermatoceles (1-3 chambers) treated by sclerotherapy were included in the series. It is concluded that US allows multilocular spermatoceles to be differentiated from hydroceles. Post-treatment US findings are typical, including heteroechoic masses with cystic areas extratesticularly, hyperechoic lines peritesticularly (thickened tunicas) and a thickened scrotal wall. All lesions are reversible, however. US is helpful when assessing the need for resclerotherapy. Ethanolamine oleate proved to be effective as a sclerosant, as 83% of the cases were cured or became significantly better. Complications were few and there were no changes in the epididymis. Ethanolamine oleate sclerotherapy can be recommended as an alternative treatment to surgery, especially in older patients with spermatoceles consisting of 1-3 chambers.

Wire localized biopsy of breast lesions: a review of 425 cases found in screening or clinical mammography.

A total of 425 wire localized biopsies for non-palpable breast lesions found by screening (n = 169) or clinical (n = 256) mammography between 1986-1990 are reviewed with reference to the biopsy success rate with different localization techniques, the positive predictive value of the mammographic findings and the staging and treatment of carcinomas in the clinical and screening groups. Specimen radiographs were available for review in 371 cases and confirmed the removal of the lesion in 90.6%, were indeterminate in 4.8% and were negative in 4.6%. Some 95% of the failures occurred in mammography-guided localizations using the Kopans hookwire. In later years this wire was replaced with th Homer retractable needle/wire system, with a 99% success rate. The Kopans wire was found to be accurate in ultrasound (US)-guided procedures, which were tolerated very well with no complications, as compared with a 10.2% rate of vasovagal reactions in mammography-guided procedures. The success rate of the localizations performed under general anaesthesia was 93.7%, as compared with 80.2% of the localizations performed under local anaesthesia. A more clearcut improvement of the success rate (from 66.7% in 1986-1987 to 99% in 1990) was seen over the years with growing experience and the development of teamwork between radiologists, surgeons and pathologists. The histological diagnosis was malignant in 27% of cases. The positive predictive value for malignancy improved from 21% to 32% from 1986 to 1990, due mainly to an increase in the screening group. A total of 71% of the carcinomas found were of stage 0 (TisN0M0) or I (TIN0M0) indicating a good prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Intrascrotal adenomatoid tumors and their ultrasound findings.

Adenomatoid tumors are regarded as uncommon neoplasms of the paratesticular tissues, probably of mesothelial origin, and the majority of cases reported have involved the epididymis. Ultrasonography is the method of choice for imaging scrotal pathology, but there are very few data on ultrasound findings in cases of adenomatoid tumors. We report our experience and ultrasound findings regarding 8 intrascrotal adenomatoid tumors--3 cases of a testicular tunica albuginea tumor and 5 cases of epididymal origin. Ultrasonography is recommended as the preoperative imaging method for excluding the possibility of a cystic lesion and for determining the location of the tumor. Local excision is regarded as the treatment of choice. The clinical course of all these tumors was benign, without recurrences.

Ethanolamine oleate sclerotherapy for hydroceles and spermatoceles: a survey of 158 patients with ultrasound followup.

Sclerotherapy with 5% ethanolamine oleate was used to treat 102 hydroceles in 100 patients and 63 spermatoceles in 58 patients. Scrotal ultrasound examination was performed before the sclerotherapy and at each followup visit. Of the hydroceles 98% were cured completely and 68% were cured after only 1 sclerosant instillation, while 60% of the spermatoceles resolved completely and 33% partially, with 7% failures. No hydroceles recurred during an average followup of 43 months, whereas spermatocele recurred in 4 patients more than 1 year after successful treatment, with a mean followup of 46 months. Approximately half of the patients experienced pain after treatment, 3 had infection and 2 had hematoma. No changes in the structure or size of the testicles were found by ultrasound during followup. Ethanolamine oleate sclerotherapy is a safe, effective and economical form of outpatient therapy that can be recommended as primary treatment for hydroceles in adults and as an alternative to surgery for spermatoceles with 1 to 3 cysts in elderly men in whom fertility is not important.

Cysts of the tunica albuginea--more common testicular masses than previously thought?

Cysts of the tunica albuginea have been considered very rare. Their clinical significance lies in their presentation as discrete testicular masses often diagnosed as malignancies prior to removal. We report our experience with 6 cases of cysts of the tunica albuginea over a 12-year period and review the relevant literature. It is obvious that these cysts can be both of epithelial and of mesothelial origin. Our material includes a cyst lined by a transitional-like epithelium, of a kind to our knowledge not reported previously. All of the cysts were found by palpation and they constituted 6% of the testicular tumours examined over the same period. High-resolution ultrasound examination can distinguish them from solid testicular masses, as in 2 cases here, thus enabling unnecessary operations to be avoided.

Intrascrotal adenomatoid tumors.

Adenomatoid tumors are regarded as uncommon neoplasms of the paratesticular tissues, probably of mesothelial origin. The majority of cases reported have involved the epididymis. We report our experience with 8 cases of testicular tumors and 11 of epididymal adenomatoid tumors during a 13-year period, and review the relevant literature. The incidence of adenomatoid tumors relative to all tumors in the testis was 6.9% (8 of 116), exceeding that of Leydig cell tumors, which were previously believed to be the most common benign testicular neoplasms. The adenomatoid tumors included 38% epididymal tumors (11 of 29). The clinical course of the tumors was benign, without recurrences. Local excision is regarded as the treatment of choice for epididymal and testicular adenomatoid tumors.

Polyorchidism with normal spermatogenesis, diagnosed preoperatively by ultrasound. A case report.

Polyorchidism is a rare urological anomaly with less than 60 cases reported in the literature. We report a case of right-sided polyorchidism with normal spermatogenesis diagnosed preoperatively by ultrasound imaging. Because of the high accuracy of ultrasound, surgical explorations are unnecessary if there are no signs of testicular torsion or other anomalies requiring operation.