Deuk Lin Choi

Magnetic Resonance Imaging of Breast Cancer and Correlation with Prognostic Factors

Background: Prognostic factors of breast cancer have been used for the prediction of clinical outcome or selection of patients for complementary treatment. Some of the imaging features of breast cancer, e.g. magnetic resonance imaging (MRI), are associated with these prognostic factors. Purpose: To evaluate the relationship between dynamic enhanced MR features and prognostic factors of clinical outcome of breast cancer. Material and Methods: A total of 136 patients with 151 breast cancers underwent 1.5T dynamic MR imaging with the use of a dynamic T1-weighted three-dimensional fast low-angle shot (FLASH) subtraction imaging technique. Morphological and kinetic analyses of MR features were evaluated using the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) MRI lexicon. Pathological prognostic factors were correlated with MR imaging characteristics, including tumor size, histological grade, lymph node status, expression of estrogen receptor (ER), expression of progesterone receptor (PR), expression of c-erbB2, determination of Ki-67 index, and microvascular density (MVD), using univariate and multivariate statistical analyses. Results: Based on univariate and multivariate analyses, spiculated tumor margins correlated significantly with lower histological grade (I–II) and positive PR expression. Rim enhancement was significantly correlated with high histological grade, presence of axillary lymph node metastasis, large tumor size, increased Ki-67 index, and increased MVD. Early peak enhancement, as seen on the first scan after contrast medium injection, was correlated with negative ER expression. Conclusion: The presence of a lesion with a spiculated margin may predict a relatively good prognosis, and the presence of a lesion with rim enhancement may predict a relatively poor prognosis.

Acute Diffuse Phlegmonous Esophagogastritis: A Case Report

Acute phlegmonous infection of the gastrointestinal tract is characterized by purulent inflammation of the submucosa and muscular layer with sparing of the mucosa. The authors report a rare case of acute diffuse phlegmonous esophagogastritis, which was well diagnosed based on the typical chest computed tomographic (CT) findings and was successfully treated. A 48-yr-old man presented with left chest pain and dyspnea for three days. Chest radiograph on admission showed mediastinal widening and bilateral pleural effusion. The patient became febrile and the amount of left pleural effusion is increased on follow-up chest radiograph. Left closed thoracostomy was performed with pus drainage. A CT diagnosis of acute phlegmonous esophagogastritis was suggested and a surgery was decided due to worsening of clinical condition of the patient and radiologic findings. Esophageal myotomies were performed and the submucosal layer was filled with thick, cheesy materials. The patient was successfully discharged with no postoperative complication.

Tumor detection and serosal invasion of bladder cancer: role of three-dimensional volumetric reconstructed US.

BackgroundAccurate evaluation of local extent in bladder cancer is important to determine the optimal therapeutic strategy and to predict the outcome of treatment. The purpose of this study is to evaluate the accuracy of 3D volumetric reconstructed US in the assessment of tumor detection and serosal invasion in patients with bladder cancer.MethodsA total of 14 patients with findings of bladder cancer determined with the use of cystoscopy was examined with the use of bladder two-dimensional (2D) US and subsequent 3D US. US findings were compared with cystoscopy findings and the pathological stage after a TURB or a radical cystectomy in a double-blinded manner.ResultsThe sensitivity of preoperative tumor staging was 67.9% for 2D US and sensitivity was 78.6% for 3D US. 3D US was superior sensitivity than 2D US (Pxa0<xa00.05). The accuracy for serosal invasion in staging of bladder cancer was demonstrated for 88.9% in 2D US and for 100% in 3D US.ConclusionsThe accuracy for serosal invasion (T3b) in the staging of bladder cancer was demonstrated for 88.9% in 2D US and for 100% in 3D US. 3D volumetric reconstructed US is a non-invasive and accurate technique for tumor detection of bladder cancer.

Endovascular Management of Immediate Procedure-Related Complications of Failed Hemodialysis Access Recanalization

Endovascular procedures are becoming the standard type of care for the management of hemodialysis vascular access dysfunction. As with any type of medical procedure, these techniques can result in procedure-related complications, although the expected number of complications is low. The clinical extent of these complications varies from case to case. Management of these cases depends on the clinical presentation. Major complications such as vein rupture, arterial embolism, remote site bleeding or hematoma, symptomatic pulmonary embolism and puncture site complications necessitating treatment require major therapy. Minor complications such as non-flow compromising small puncture site hematoma or pseudoaneurysms require little or no therapy. It is essential that the interventionist be prepared to manage these complications appropriately when they arise.

Spontaneous intratumoral hemorrhage into hepatocellular carcinoma during transcatheter arterial embolization: a case report.

Spontaneous extrahepatic rupture of hepatocellular carcinoma (HCC) is a rare but serious complication that occurs with an incidence of between 5 and 15% of patients with HCC. It is thought to be preceded by rapid expansion due to intratumoral bleed-ing. Extrahepatic rupture of HCC has been reported as a rare complication of tran-scatheter arterial embolization (TAE). Although there have been reports of extrahepatic rupture of HCC after TAE, but there is no report regarding intratumoral hemor-rhage into HCC during TAE. We report a unique case of intratumoral hemorrhage into HCC during TAE presumably triggered by TAE. Although a rare complication, intratumoral hemorrhage into HCC after TAE should be considered in any patient with TAE due to HCC.

Bilateral Breast Enlargement: An Unusual Presentation of Superior Vena Cava Obstruction in a Hemodialysis Patient with Fibrosing Mediastinitis

A 67-year-old woman with end-stage renal disease presented with profound edema of both breasts. The presence of a patent hemodialysis basilic transposition fistula and superior vena cava obstruction (SVC), due to fibrosing mediastinitis, was demonstrated by the use of fistulography. Endovascular treatment with a balloon and stent caused immediate resolution of the breast edema.

Spontaneous Partial Regression of Cerebral Arteriovenous Malformation

Arteriovenous malformation (AVM) of the brain is one of the important pathologic conditions which cause intracerebral or subarachnoid hemorrhage, epilepsy, or chronic cerebral ischemia. The spontaneous regression of cerebral AVM is reported to be very rare and more likely to occur when the AVM is small, is accompanied by hemorrhage, and has fewer arterial feeders. We report a case of right occipital AVM which at follow-up angiography performed four years later showed near-complete spontaneous regression.