Eun Deok Chang

Small Bowel Volvulus Induced by Mesenteric Lymphangioma in an Adult: a Case Report

Mesenteric lymphangiomas are rare abdominal masses that are seldom associated with small bowel volvulus, and especially in adult patients. We report here on an unusual case of small bowel volvulus that was induced by a mesenteric lymphangioma in a 43-year-old man who suffered from repeated bouts of abdominal pain. At multidetector CT, we noticed whirling of the cystic mesenteric mass and the adjacent small bowel around the superior mesenteric artery. Small bowel volvulus induced by the rotation of the mesenteric lymphangioma was found on exploratory laparotomy. Lymphangioma should be considered as a rare cause of small bowel volvulus in adult patients.

Rapidly Growing Bilateral Pseudoangiomatous Stromal Hyperplasia of the Breast

A tumoral pseudoangiomatous stromal hyperplasia (PASH) that causes huge breast enlargement is very rare. Only two cases of huge tumoral PASHs have been reported in the English medical literature. We report here on a surgically confirmed case of bilateral huge tumoral PASH in a 47-year-old woman, and we present the imaging and histopathology findings. We also review the relevant medical literature.

Parenchymal Neurocutaneous Melanosis in Association with Intraventricular Dermoid and Dandy-Walker Variant: A Case Report

Neurocutaneous melanosis (NCM) is a rare congenital disease that is characterized by the presence of large or multiple congenital melanocytic nevi and melanotic lesions of the central nervous system. We report here on the CT and MR imaging findings of an unusual case of NCM that was associated with intraventricular dermoid and Dandy-Walker malformation.

Primary Acinic Cell Carcinoma of the Breast: A Case Report with an Immunohistochemical and Ultrastructural Studies

Acinic cell carcinoma (ACC) of the breast is extremely rare and is characterized by widespread acinar cell-like differentiation. We report of a 39-year-old woman presented with a palpable breast mass with significant morphological, immunohistochemical and ultrastructural findings. Histologically, ACC showed a diffuse glandular infiltrative pattern, with small acinar or glandular structures mixed with solid nests. Neoplastic cells were monotonous proliferation of cells with a granular or clear cytoplasm, resembling acinar cells of the salivary glands or Paneth cells. Both glandular and solid tumor cell populations were strongly positive for lysozyme and α-1-antitrypsin.

Pseudocirrhosis of Breast Cancer Metastases to the Liver Treated by Chemotherapy

Pseudocirrhosis refers to a condition that shows changes in hepatic contour that mimic cirrhosis radiographically in the absence of the typical histopathological findings of cirrhosis. This condition has been observed in patients with cancer metastatic to the liver, both in those who have undergone prior systemic chemotherapy and those who have not. Pseudocirrhosis may cause difficulty in interpretation of the response to chemotherapy and hepatic decompression and complication of portal hypertension have a negative effect on the prognosis. We report on a case of breast cancer with liver metastases that showed cirrhotic changes during disease progression. Progression of liver metastases was confirmed by F18 fluorodeoxyglucose positron emission tomography/computed tomography (PET-CT). We also performed ultrasound-guided liver biopsy and confirmed tumor infiltration with severe desmoplastic fibrosis. This case suggests the pathogenesis of pseudocirrhosis through histopathological findings and the role of PET-CT in evaluation of the response to chemotherapy in patients with pseudocirrhosis.

Primary neuroendocrine tumor of the breast: imaging features.

Focal neuroendocrine differentiation can be found in diverse histological types of breast tumors. However, the term, neuroendocrine breast tumor, indicates the diffuse expression of neuroendocrine markers in more than 50% of the tumor cell population. The imaging features of neuroendocrine breast tumor have not been accurately described due to extreme rarity of this tumor type. We present a case of a pathologically confirmed, primary neuroendocrine breast tumor in a 42-year-old woman, with imaging findings difficult to be differentiated from that of invasive ductal carcinoma.

Cystic hypersecretory ductal carcinoma of the breast: a rare cause of cystic breast mass

We present the case of a surgically confirmed, invasive, cystic hypersecretory ductal carcinoma (CHDC) of the breast in a 43-year-old woman. The initial sonography showed a complex cyst, which required a core biopsy; however, the diagnosis was delayed as the patient refused to undergo the biopsy and the cyst decreased in size, as seen on follow-up sonography. Excision biopsy was performed, and invasive CHDC was diagnosed after regrowth of the cystic lesion. Meticulous sonographic evaluation of a cystic breast mass is always important, and pathology confirmation must be considered if the lesion shows features suspicious for malignancy, as a CHDC could be the cause of a cystic breast mass.

Sonography of Invasive Apocrine Carcinoma of the Breast in Five Cases

Objective To evaluate the sonographic features of invasive apocrine carcinoma (IAC) of the breast. Materials and Methods This study included five pathologically proven cases of IAC, and their sonographic features were retrospectively analyzed according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon. Results All five lesions involved the left breast and were seen as irregularly shaped masses. All lesions, except one, had a parallel orientation to the chest wall. All five lesions showed noncircumscribed margins and heterogeneous echotexture; however, they showed various posterior features. One lesion had edema as an associated feature. Sonographic assessments were classified as BI-RADS category 4 in all five cases. Conclusion Invasive apocrine carcinoma sonographic findings are difficult to differentiate from those of invasive ductal carcinoma of no special type.

Primary papillary serous carcinoma of the peritoneum diagnosed by video-assisted thoracoscopic surgery: Report of a case

A 53-year-old woman who had end-stage renal disease and hypertension presented with back pain. Chest radiographs and chest computed tomography (CT) showed right pleural effusion with bilateral pleural masses. The patient underwent video-assisted thoracoscopic surgery (VATS) for a biopsy of the right pleural mass and for an evaluation of pleural effusion. A frozensection specimen suggested a papillary adenocarcinoma, which was confirmed to be metastatic primary papillary serous carcinoma of the peritoneum by immunohistochemistry, an elevated serum cancer antigen (CA-125) level, and abdominal CT findings. We found that the patient had been unfortunately misdiagnosed to have advanced colon cancer 11 years previously and thus had undergone a right hemicolectomy which was followed by six cycles of 5-fluorouracil chemotherapy. Despite this, she survived more than 10 years and was later correctly diagnosed by VATS of the pleural lesions and based on a review of the previous pathology. The patient was transferred to an oncologist to receive the proper chemotherapy with paclitaxel and carboplatin.

Dermatofibrosarcoma Protuberans of the Breast

A 14-year-old female presented with a lump in her right breast and which she had been aware of for 1 week. On physical examination, an approximately 4cm, firm, and movable lump was palpated in the upper mid-portion of her right breast. No regional skin changes were seen, and there was no apparent axillary lymphadenopathy. Mammography showed a hyperdense mass with a posterior, obscured margin in the 12 o’clock direction of the right breast. No microcalcification was detected on mammography (Fig. 1). Targeted sonography of the right breast revealed longitudinal dimension of 4.1-cm, oval-shaped, circumscribed, hypoechoic mass with posterior enhancement. The orientation was parallel to the chest wall, and a gentle lobulation was noted on the posterior wall of mass. Narrow, hyperechoic, band-like echoes were noted in the hypoechoic background of the mass. On color Doppler scanning, increased vascular flow was noted in the periphery of the mass. The mass was located between the sub-dermis and the chest wall, however, it was not possible to identify the tumor origin due to the relatively large mass size compared to the breast thickness (Fig. 2). The mass was categorized as BIRADS 4. The patient underwent a 14-G core biopsy. The initial pathology suggested sarcoma of the breast. Wide excision of the right breast was subsequently performed and revealed high cellularity with slender, spindle cells arranged in a distinct storiform pattern. The tumor cells showed strong immunoreactivity to CD34 (Fig. 3). The final histological diagnosis was dermatofibrosarcoma protuberans (DFSP) of the breast. DFSP is a rare, cutaneous malignancy. DFSP cells are typically positive for CD34 which indicates a close link between this neoplasm and normal, CD34-positive, dermic dendritic cells. The incidence of DFSP is approximately five cases per 1 million persons per year. Most commonly, DFPS involves the trunk and