A unique case of lymphoepithelioma-like HCC with osteoclast-like giant cells: CT imaging features with pathologic correlations.

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver, with several histological variants being reported in literature. Hereby, we describe a case of a 77-year-old man with chronic liver disease referred to our department for performing a computed tomography (CT) due to a liver mass discovered at an abdominal ultrasound follow-up. At CT, a large, ill-defined lesion in the third hepatic segment was detected, characterized by progressive and delayed enhancement with minimal retraction of the hepatic capsule, associated with perihepatic adipose tissue inhomogeneity, mimicking a cholangiocarcinoma. At histopathological evaluation, the lesion turned out to be an HCC with lymphoepithelioma-like component and osteoclastic-like giant cells. This report focuses on the clinicopathological and radiological features of this unique case.

Practical Challenges of DBT-Guided VABB: Harms and Benefits, from Literature to Clinical Experience.

Vacuum-assisted breast biopsy (VABB) guided by digital breast tomosynthesis (DBT) represents one of the best instruments to obtain a histological diagnosis of suspicious lesions with no ultrasound correlation or those which are visible only on DBT. After a review of the literature, we retrospectively analyzed the DBT-guided VABBs performed from 2019 to 2022 at our department. Descriptive statistics, Pearson's correlation and χ2 test were used to compare distributions of age, breast density (BD) and early performance measures including histopathology. We used kappa statistics to evaluate the agreement between histological assessment and diagnosis. Finally, we compared our experience to the literature to provide indications for clinical practice. We included 85 women aged 41-84 years old. We identified 37 breast cancers (BC), 26 stage 0 and 11 stage IA. 67.5% of BC was diagnosed in women with high BD. The agreement between VABB and surgery was 0.92 (k value, 95% CI: 0.76-1.08). We found a statistically significant inverse correlation between age and BD. The post-procedural clip was correctly positioned in 88.2%. The post-procedural hematoma rate was 14.1%. No infection or hemorrhage were recorded. When executed correctly, DBT-guided VABB represents a safe and minimally invasive technique with high histopathological concordance, for detecting nonpalpable lesions without ultrasound correlation.

Breast Density Evaluation According to BI-RADS 5th Edition on Digital Breast Tomosynthesis: AI Automated Assessment Versus Human Visual Assessment.

BACKGROUND: The assessment of breast density is one of the main goals of radiologists because the masking effect of dense fibroglandular tissue may affect the mammographic identification of lesions. The BI-RADS 5th Edition has revised the mammographic breast density categories, focusing on a qualitative evaluation rather than a quantitative one. Our purpose is to compare the concordance of the automatic classification of breast density with the visual assessment according to the latest available classification. METHODS: A sample of 1075 digital breast tomosynthesis images from women aged between 40 and 86 years (58 ± 7.1) was retrospectively analyzed by three independent readers according to the BI-RADS 5th Edition. Automated breast density assessment was performed on digital breast tomosynthesis images with the Quantra software version 2.2.3. Interobserver agreement was assessed with kappa statistics. The distributions of breast density categories were compared and correlated with age. RESULTS: The agreement on breast density categories was substantial to almost perfect between radiologists (κ = 0.63-0.83), moderate to substantial between radiologists and the Quantra software (κ = 0.44-0.78), and the consensus of radiologists and the Quantra software (κ = 0.60-0.77). Comparing the assessment for dense and non-dense breasts, the agreement was almost perfect in the screening age range without a statistically significant difference between concordant and discordant cases when compared by age. CONCLUSIONS: The categorization proposed by the Quantra software has shown a good agreement with the radiological evaluations, even though it did not completely reflect the visual assessment. Thus, clinical decisions regarding supplemental screening should be based on the radiologist's perceived masking effect rather than the data produced exclusively by the Quantra software.

A rare case of bilateral testicular metastasis from ileocecal NET: multiparametric US detection.

Testicular metastasis are rare findings and bilateral metastasis of testes are extremely rare. Here we are describing for the first time a case of bilateral testicular metastasis in a patient with a known ileocecal valve NET using an in-depth ultra-sound studying including microvascular flow imaging (MV-flow), ultra-sound new technique, able to detect small vessel slow-signal.

Giant malignant sacrococcygeal germ cell tumor in a newborn: A rare case report.

Malignant germ cell tumors constitute about 3%-4% of all neoplasms occurring before the age of 15. They arise in the ovaries, the testes, and in several other locations, including the lower back, the chest, the brain, and the abdomen. In infants and young children, the sacrococcygeal region is the most common site for extragonadal germ cell tumors, and teratomas account for the vast majority of sacrococcygeal germ cell tumors. Neonatal sacrococcygeal teratomas are usually benign and rarely they may contain a malignant component that is predominantly a yolk sac tumor. In this article, we describe a rare case of a male newborn with a giant sacrococcygeal mixed germ cell tumor composed of grade 3 immature teratoma and malignant yolk sac elements.

Chest CT in COVID-19 patients: Structured vs conventional reporting.

PURPOSE: To assess clinician satisfaction with structured (SR) and conventional (CR) radiological reports for chest CT exams in coronavirus disease 2019 (COVID-19) patients, objectively comparing both reporting strategies. METHOD: We retrospectively included 68 CTs (61 patients) with COVID-19. CRs were collected from the digital database while corresponding SRs were written by an expert radiologist, including a sign checklist, severity score index and final impressions. New CRs were prepared for a random subset (n = 10) of cases, to allow comparisons in reporting time and word count. CRs were analyzed to record severity score and final impressions inclusion. A random subset of 40 paired CRs and SRs was evaluated by two clinicians to assess, using a Likert scale, readability, comprehensiveness, comprehensibility, conciseness, clinical impact, and overall quality. RESULTS: Overall, 19/68 (28 %) and 9/68 (13 %) of CRs included final impressions and severity score, respectively. SR writing required significantly (p < 0.001) less time (mean = 308 s; SD ± 60 s) compared to CRs (mean = 458 s; SD ± 72 s). On the other hand, word count was not significantly different (p = 0.059, median = 100 and 106, range = 106-139 and 88-131 for SRs and CRs, respectively). Both clinicians expressed significantly (all p < 0.01) higher scores for SRs compared to CRs in all categories. CONCLUSIONS: Our study supports the use of chest CT SRs in COVID-19 patients to improve referring physician satisfaction, optimizing reporting time and provide a greater amount and quality of information within the report.