Dilek Kosehan

Invasive lobular carcinoma with extracellular mucin as a distinct variant of lobular carcinoma: a case report

The differences between invasive lobular and ductal carcinomas affect the diagnostic and therapeutic management for patients with breast cancer. In most cases, this can be accomplished because of distinct histomorphologic features. However, occasionally, this task may become quite difficult, in particular when dealing with the variants of infiltrating lobular carcinoma. Lobular carcinoma has been considered a variant of mucin-secreting carcinoma with only intracytoplasmic mucin. The presence of extracellular mucin is a feature of ductal carcinoma. Herein is presented a case of lobular carcinoma with extracellular and intracellular mucin in a 43-year-old female patient, and confirmed by immunohistochemistry. Up to the present, infiltrating lobular carcinoma displaying extracellular mucin has not been described in the literature except two case.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1839906067716744

Anatomic evaluation of the xiphoid process with 64-row multidetector computed tomography.

ObjectiveThe aim of this study was to evaluate the interindividual variations of the xiphoid process in a wide adult group using 64-row multidetector computed tomography (MDCT).Materials and methodsIncluded in the study were 500 consecutive patients who underwent coronary computed tomography angiography. Multiplanar reconstruction (MPR), maximum intensity projection (MIP) images on coronal and sagittal planes, and three-dimensional volume rendering (VR) reconstruction images were obtained and used for the evaluation of the anatomic features of the xiphoid process.ResultsThe xiphoid process was present in all patients. The xiphoid process was deviated ventrally in 327 patients (65.4%). In 11 of these 327 patients (2.2%), ventral curving at the end of the xiphoid process resembled a hook. The xiphoid process was aligned in the same axis as the sternal corpus in 166 patients (33.2%). The tip of the xiphoid process was curved dorsally like a hook in three patients (0.6%). In four patients (0.8%), the xiphoid process exhibited a reverse S shape. Xiphoidal endings were single in 313 (62.6%) patients, double in 164 (32.8%), or triple in 23 (4.6%). Ossification of the cartilaginous xiphoid process was fully completed in 254 patients (50.8 %). In total, 171 patients (34.2%) had only one xiphoidal foramen and 45 patients (9%) had two or more foramina. Sternoxiphoidal fusion was present in 214 of the patients (42.8%).ConclusionsSignificant interindividual variations were detected in the xiphoid process. Excellent anatomic evaluation capacity of MDCT facilitates the detection of variations of the xiphoid process as well as the whole ribcage.

Cerebral sinovenous thrombosis associated with MTHFR A1298C mutation in the newborn: a case report

Although cerebral sinovenous thrombosis (CSVT) is a rare condition in the neonatal period, high rates of morbidity and mortality necessitate the establishment of an early diagnosis. Methylenetetrahydrofolate reductase (MTHFR) plays a central role in the folate cycle and mutations of MTHFR are associated with vascular disease. While the C677T common missense mutation is the most well-defined MTHFR polymorphism, another common missense mutation, A1298C also exists. There has been no reported case of CSVT associated with MTHFR A1298C mutation in the neonatal period. Herein, we report a neonate with CSVT who was found to have MTHFR A1298C homozygosity.

Interatrial shunt: diagnosis of patent foramen ovale and atrial septal defect with 64-row coronary computed tomography angiography

PurposeThe aim of this study was to investigate the frequency with which interatrial shunts are found during routine coronary computed tomography (CT) angiography and to describe imaging characterizations of patent foramen ovale (PFO), atrial septal defect (ASD), and atrial septal aneurysm (ASA).Materials and methodsA total of 1081 adult patients were evaluated retrospectively for interatrial shunting; 77 were excluded from the study. CT diagnosis of PFO was defined as (1) a channel-like appearance of the interatrial septum (IAS) and (2) a contrast agent jet flow from the left atrium (LA) to the right atrium (RA). ASD was defined as (1) the IAS resembling a membrane with a hole and (2) a contrast jet flow between the two atria. ASA was identified by detecting a minimum 10-mm protrusion of the LA beyond the IAS into the RA.ResultsAmong 1004 patients, 86 patients (8.6%) were diagnosed to have PFO. Another 23 patients (2.3%) had a hole in the IAS and were diagnosed as having ASD: 21 with an ostium secundum-type ASD and 2 with the sinus venosus type. ASA accompanied ASD in three patients.ConclusionElectrocardiography-gated CT using the saline-chaser contrast injection technique that is routinely used for coronary arterial imaging can be used to detect interatrial shunts. The technique can also serve as a method for differentiating PFO, ASD, and ASA.

Incidentally found retroperitoneal ganglioneuroma in an adult.

The ganglioneuroma is a very rare tumor arising from sympathetic nerve system. An asymptomatic retroperitoneal ganglioneuroma was found incidentally in a 35-year-old woman. Ultrasonography, computed tomography, and magnetic resonance imaging showed a retroperitoneal mass extending to the left adrenal gland, and surrounding abdominal aorta, celiac axis, left renal and adrenal arteries, and veins. The tumor was resected and histologic examination showed ganglioneuroma.

Spontaneous urinary extravasation: detection rate with 64-row multidetector computed tomography in patients presenting with acute abdomen

The aim of this study was to detect the rate of spontaneous urinary extravasation (SUE) with computed tomography (CT) in patients presenting with acute abdomen. Seven hundred thirteen abdominal CT examinations with i.v. contrast media requested mainly from the emergency department and urology clinics for sudden onset abdominal pain, flank pain, nonspecific abdominal pain with nausea and vomiting, and renal colic between September 2007 and August 2011 were retrospectively reviewed. Only adult patients were included in the study. Three patients with SUE were detected. One had a mid-ureteral stone while the etiology for the other two patients was unknown. Two of the patients were treated conservatively; one was treated with stenting with a double-j catheter. SUE should be considered in the differential diagnosis of patients presenting with acute abdomen and perinephric–periureteral fluid collection inconsistent with stone size and who are occasionally stone free. Early and precise diagnosis of SUE plays an important role in the management protocol of patients presenting with acute abdomen.

Inborn Errors of Metabolism Presenting in Childhood

Neurodegenerative and neurometabolic disorders may cause significant morbidity and mortality in children. Imaging is important in early diagnosis of metabolic disorders and in determining the extent of brain injury. Especially after the development of new techniques such as diffusion‐weighted magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS), neuroimaging plays more important role in the diagnosis and management of these disorders. In these disorders, usually a mutation causes a clinically significant block in one or more metabolic pathways. This blockage usually results in either a deficiency of the product or in an accumulation of substrate with damage induced by either storage or toxicity. The presenting symptoms are usually nonspecific. In some of the metabolic disorders, long‐term dietary or medical treatment options are available, and to make an early diagnosis in these disorders is important before the brain damage occurs. Prompt diagnosis, particularly in treatable disorders, is crucial to prevent neurological sequelae or death. If treatment is indeed available, neuroimaging also provides a baseline in evaluation of the efficacy of treatment. Therefore, the neuroradiologist should be aware of these disorders to prevent devastating results of delayed diagnosis. Metabolic disorders affecting the central nervous system, both gray and white matter can be classified by involvement of the primary cellular organelle as lysosomal, peroxisomal, mitochondrial disorders, or biochemical classification can be made as amino acid and organic acid metabolism defects or primary white matter disorders. This article presents the neuroimaging features of relatively more common metabolic disorders.

Diagnosis and percutaneous treatment of partial subclavian steal: Doppler ultrasonography and phase contrast magnetic resonance angiography findings and a brief review of the literature

A 66-year-old woman presented with back pain and arm claudication. Severe stenosis of the left proximal subclavian artery was detected incidentally by thorax computed tomography. Doppler ultrasonography and phase contrast magnetic resonance angiography (PCMRA) evaluation revealed partial subclavian steal. The stenosis was successfully treated with percutaneous stenting. Imaging findings are described and a brief review of the literature emphasizing the role of PCMRA in diagnosing partial steal is discussed.

Growth of the lateral ventricle in normal second-trimester fetuses: Is a nomogram practical?

The purpose of this study was to determine the growth of lateral ventriclar size of fetuses between 15 and 25 weeks of gestation. A prospective study of normal singleton pregnancies was evaluated consecutively. Measurement of the lateral ventricle was performed by transabdominal sonography as a part of routine obstetric examination in 338 fetuses. The mean size of the lateral ventricular atrial diameter for the 338 fetuses was 6.65 ± 0.95 mm. A weak correlation was found between gestational age and lateral ventricle width (R2 = 0.03, P

Neuroimaging in Metabolic Disorders

Although genetic and chemical studies are most helpful for the diagnosis of metabolic disorders of the brain, there is a role for neuroimaging to quantify the degree of brain involvement and the response to therapy. Also, in some instances the imaging pattern can guide in the selection of genes or gene products to be studied.