Chiara Iacconi

Ultrasonographic appearance of breast implant complications.

In the last 20 years, we have observed a large diffusion of breast implants used for cosmetic reasons (augmentation mammoplasty) or for reconstructing breast after mastectomy. At the same time, there has been also an increased request for the instrumental evaluation of implants. Clinical examination remains the first approach to symptomatic patients. Mammography is not considered the ideal tool for studying breast implant because of low sensitivity in the detection of implant rupture. According to literature data, the diagnostic accuracy of ultrasonography is debated; in fact, it has a very high sensitivity if it is performed by a skilled radiologist. Currently, magnetic resonance (MR) is considered the gold standard, with a sensitivity higher than 90%. However, in our experience in early complications (acute or subacute bleeding and local infection), ultrasonography represents an useful diagnostic tool both for diagnosis and for interventional procedures such as positioning drain. Interventionist ultrasonography reduces the number of reoperations, allowing a fast problem solution and a reduction of costs. In our experience, ultrasonography may be helpful also for the evaluation of late complications (capsular contractures, intracapsular and extracapsular rupture) that are related to the time elapsed since implant inclusion (more frequent after 8–13 years). The purpose of this study is to evaluate the diagnostic accuracy of ultrasounds and to evaluate if MR is always necessary in the study of breast implants.

Neck lesions mimicking thyroid pathology

IntroductionNodular lesions within the neck may origin from several structures. A misdiagnosed origin may expose the surgeon to inappropriate procedures. These lesions are paradoxically frequent in high specialised centre for endocrine surgery.Patients and methodsIn the year 2006, three patients were first admitted to our department with a diagnosis of thyroid nodule (1) or lymphatic metastases of thyroid carcinoma (2). The first patient had ultrasound (US) and Tc-99-m scan orienting for thyroid nodule. The two other patients, presented with lateral neck lesion in ipsilateral sincronous and previous diagnosis of papillary thyroid carcinoma, respectively, with US and computed tomography scan confirmed lesion but with a FNA cytology negative for tumoural cells.ResultsAll three patients underwent surgical exploration. In the first two cases, a whitish tender nodule (4 and 4.5cm), cleavable from surrounding structures, was removed with final histology of Schwannoma and Paraganglioma, respectively. Both patients experienced Bernard Horner Syndrome. In the last patients, a firm grey nodule of 5cm strictly adherent to muscular planes was removed with diagnosis of Castleman’s Disease.ConclusionsNodular neck lesions mimicking a thyroid pathology (thyroid nodules or metastatic lymph nodes) are rare but can represent a tough challenge for surgeons who might fall into incorrect surgical approaches, resulting in high morbidity. Pre-operative work-up would help the surgeon to obtain the correct diagnosis, thus, to follow the better surgical approach. Nevertheless, a careful approach would be used for that neurogenic tumour amenable of resection without jeopardising nervous structures.

Ileal invaginated Meckel's diverticulum: Imaging diagnosis (2004:9b)

We describe an uncommon case of severe anemia in an adult man. The patient was evaluated with esophagogastroduodenoscopy, colonoscopy, barium enema and abdominal US, which all proved normal. Abdominal CT showed a nonspecific intraluminal mass. Small-bowel follow-through revealed a polypoid mass with a club-like appearance typical for an invaginated Meckels diverticulum. Our diagnosis was confirmed by surgery.

Magnetic resonance (MR) features in triple negative breast cancer (TNBC) vs receptor positive cancer (nTNBC)

Few reports in literature describe triple negative breast cancer (TNBC) imaging findings. Aim of the study is to determine MR-features of TNBC compared to receptor positive cancer (nTNBC). From May 2014 to May 2015, we retrospectively enrolled 31 consecutive patients with histological diagnosis of TNBC and a control group of 31 consecutive nTNBC observed in the same period, out of 602 cancer, diagnosed in our department in the same year. Histopathological analysis and MR-features of TNBC (31 patients) were compared to nTNBC (31 patients). MR-features included dimension, fibroglandular tissue (FGT), background parenchimal enhancement (BPE), mass shape, margins, presence of rim, intratumoral signal intensity in T2w, uni-multifocality, kinetic curves. All patients were examined with MR 1,5T (Magnetom Simphony Tim, Siemens Healthcare) performing T2w fat-sat and contrast enhanced high temporal and spatial resolution T1w before and after injection of Gadolinium. 62 staging MR were reviewed. Median age was 50 (30-78ys) with a standard deviation of 10,9. TNBC showed 3 MR features in concordance with current literature: rim enhancement, hyperintensity in T2 sequence and unifocality. Rim enhancement was shown in 67.7% of TNBC (21/31) and 29% of nTNBC (9/31). Higher T2w values were shown in 83.9% of TNBC (26/31) and 58.1% of nTNBC (18/31). Cancer was multifocal in 7/31 (22.6%) of TNBC and 19/31 (61.3%) nTNBC. No correlation was found for dimension (p=0.12), FGT (p=0.959), BPE (p=0.596), homogeneity of enhancement (p=0.43), margins (p=0.671) and kinetic (p=0.37). Multivariate analysis demonstrated that rim enhancement and unifocality correlated independently with TNBC group. Area under ROC curve of our model is 0.835. Furthermore, we evaluated the clinical outcome of all 31 TNBC patients in a follow-up time ranging from 24months to 36months separating them in a free-survival group (23 women) and a recurrence group (8 women with local recurrence or distant metastasis): only kinetic curves resulted to be significantly higher in recurrence group (p=0.042).

Diagnosis of an Unusual Case of Castleman's Disease

Castleman disease (CD) is a benign angiofollicular lymph node hyperplasia usually found in the mediastinum, but the pelvis is rarely affected. Descriptions of the pelvic CD mainly involve computed tomography (CT) features and focal well-defined masses, while descriptions based on magnetic resonance imaging (MRI) patterns and infiltrating masses are rare. Through a case of a pelvic CD, unusual in its radiological appearance, the authors analyse imaging features as suggested by CT and MRI in order to improve the recognition of this rare disease. 2011 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Massive upper gastrointestinal bleeding from a pancreatic pseudocyst rupture: a case report

IntroductionBleeding from pancreatic pseudocysts rupture into adjacent organs is a rare, but potentially fatal, complication of chronic pancreatitis requiring quick management. Timing of the rupture is unpredictable; early diagnosis and correct management is essential in preventing the bleeding.Case presentationWe describe the case of a 53 years old male patient successfully treated with emergency surgery for massive hematemesis due to a rupture of a bleeding pseudocyst into the stomach. Patient underwent emergency laparotomy and suture of the bleeding vessel. At 5 years follow-up patient is in healthy condition.ConclusionThis case shows to surgeons that pancreatic pseudocyst cannot be managed strictly with one rule and prompt surgical treatment is mandatory in case of haemodinamic instability.

Unexpected histological findings of lesions diagnosed in the adrenal region in a series of 420 patients submitted to adrenal surgery. Review of our experience

Introduction: The incidence of adrenal incidentalomas is reported to be up to 30% in the current literature; nevertheless, in some patients undergoing surgery, a final diagnosis of non-adrenal origin of the mass is performed. In this paper we present our experience of 13 patients with unexpected histological findings of lesions diagnosed in the adrenal region. Patients and methods: From June 1986 to December 2004, 420 patients underwent adrenalectomy in our Department. Since the introduction of videolaparoscopic technique in 1993, 228 adrenalectomies have been performed videolaparoscopically. Pre-operative diagnosis was: incidentaloma (34.0% of patients), Conn’s adenoma (29.0%), Cushing’s adenoma (13.9%), pheochromocytoma (8.8%), suspicious metastasis (7.3%), Cushing’s disease (6.0%), other (1.0%). Results: Final histology revealed an unexpected diagnosis of non-adrenal origin of the mass in 13 patients (3.1%). Histology demonstrated a benign neurogenic tumor in 10 patients. In the other 3 patients diagnosis was respectively of lymphnode, hemangioma and a gastric metastasis of melanoma. Five patients out of 7 had a successful laparoscopic resection of the lesion. Mean operative time in this group was higher compared to laparoscopic resection for adrenal lesion (95.3 min vs 73.2 min). Conclusion: A small percentage of our patients (3.1%) demonstrated unexpected findings of the lesion pre-operatively misinterpreted as an adrenal mass. Despite a complete pre-operative assessment, adrenal lesions might reveal a different origin, increasing the surgical challenge as well as the morbidity for the patient.