Ewa J. Białek

Pleomorphic adenoma and adenolymphoma in ultrasonography.

OBJECTIVE The aim of the study was to define ultrasonographic morphologic features characteristic of pleomorphic adenoma and adenolymphoma (Warthins tumor). METHODS Documentation of 31 ultrasonographic examinations of 20 pleomorphic adenomas and 10 Warthins tumors in 28 patients was analysed. All cases were confirmed by fine needle aspiration biopsy or/and histopathological examination. Estimated ultrasound criteria were: borders (well-defined, predominantly well-defined, ill-defined), shape (lobulated, oval, irregular), echogenicity (increased, decreased), structure (homogeneous, slightly inhomogeneous, inhomogeneous) and presence of irregular anechoic areas within a tumor. RESULTS 100% of the lesions were hypoechoic. 80.6% of all tumors were well-defined. The remaining 19.4% had predominantly well-defined borders. 55% of pleomorphic adenomas had a lobulated shape. Almost equal percentages of Warthins tumors were lobulated, had an oval and irregular shape. Irregular echolucent areas were present in six of 11 examinations of Warthins tumors and in one pleomorphic adenoma. CONCLUSIONS Ultrasonography is a useful method for the evaluation of pleomorphic adenomas and Warthins tumors and sometimes it might allow to suggest the nature of a tumor if a certain sonographic pattern is present.

US-appearance of a Küttner tumour resembling a malignant lesion: US-histopathologic correlation

We present a case of unilateral Küttner tumour in the right submandibular gland. Its clinical course and ultrasound features inclined us to include a malignant lesion in the differential diagnosis. US-histopathologic correlation explained the ultrasound appearance of the lesion.

Mistakes in ultrasound examination of salivary glands

Ultrasonography is the first imaging method applied in the case of diseases of the salivary glands. The article discusses basic mistakes that can be made during an ultrasound examination of these structures. The reasons for these mistakes may be examiner-dependent or may be beyond their control. The latter may include, inter alia, difficult conditions during examination (technical or patient-related), similarity of ultrasound images in different diseases, the lack of clinical and laboratory data as well as the lack of results of other examinations, their insufficient number or incorrectness. Doctor-related mistakes include: the lack of knowledge of normal anatomy, characteristics of ultrasound images in various salivary gland diseases and statistical incidence of diseases, but also attaching excessive importance to such statistical data. The complex anatomical structures of the floor of the oral cavity may be mistaken for benign or malignant tumors. Fragments of correct anatomical structures (bones, arterial wall fibrosis, air bubbles in the mouth) can be wrongly interpreted as deposits in the salivary gland or in its excretory duct. Correct lymph nodes in the parotid glands may be treated as pathologic structures. Lesions not being a simple cyst, e.g. lymphoma, benign or malignant tumors of the salivary glands or metastatic lymph nodes, can be mistaken for one. The image of disseminated focal changes, both anechoic and solid, is not pathognomonic for specific diseases in the salivary glands. However, in part, it occurs typically and requires an extended differential diagnosis. Small focal changes and infiltrative lesions pose a diagnostic problem because their etiology cannot be safely suggested on the basis of an ultrasound examination itself. The safest approach is to refer patients with abnormal focal changes for an ultrasoundguided fine-needle aspiration biopsy.

The role of ultrasound and lymphoscintigraphy in the assessment of axillary lymph nodes in patients with breast cancer.

Breast cancer is the most common malignancy and the leading cause of death due to cancer in European women. Mammography screening programs aimed to increase the detection of early cancer stages were implemented in numerous European countries. Recent data show a decrease in mortality due to breast cancer in many countries, particularly among young women. At the same time, the number of sentinel node biopsy procedures and breast-conserving surgeries has increased. Intraoperative sentinel lymph node biopsy preceded by lymphoscintigraphy is used in breast cancer patients with no clinical signs of lymph node metastasis. Due to the limited sensitivity and specificity of physical examination in detecting metastatic lesions, developing an appropriate diagnostic algorithm for the preoperative assessment of axillary lymph nodes seems to be a challenge. The importance of ultrasound in patient qualification for sentinel lymph-node biopsy has been discussed in a number of works. Furthermore, different lymphoscintigraphy protocols have been compared in the literature. The usefulness of novel radiopharmaceuticals as well as the methods of image acquisition in sentinel lymph node diagnostics have also been assessed. The aim of this article is to present, basing on current guidelines, literature data as well as our own experience, the diagnostic possibilities of axillary lymph node ultrasound in patient qualification for an appropriate treatment as well as the role of lymphoscintigraphy in sentinel lymph node biopsy.

Zastosowanie ultrasonografii w laryngologii – krótka informacja ☆ ☆☆

Summary Modern ultrasound with high resolution transducers, and sensitive power Doppler and color Doppler modes, and other options, such as panoramic and 3D imaging, allows for detailed imaging of many anatomical structures and pathologic lesions of the head and neck. Only the structures situated in the sonographic acoustic shadow: behind bones, calcified cartilages, stones, and behind organs containing gas (f.e. trachea and larynx) can not be visualized. Ultrasound is widely regarded as the first imaging method in the diseases of the thyroid, salivary glands (parotid gland, submandibular gland and sublingual gland), lymph nodes, muscles, soft tissues of the head and neck, and as an valuable adjunct in some laryngeal pathologies. Real time ultrasound examination allows for dynamic assessment of organs and lesions, lets the examiner check the susceptibility of tumors for pressure, which is inaccessible in other imaging methods. Tumors and congenital lesions, inflammation, abscesses, abnormal lymph nodes, cysts, muscle hypertrophy and posttraumatic conditions may be well evaluated with ultrasound. However, most neck tumors (f.e. in the thyroid, salivary glands, and soft tisses) as well as equivocal lymph nodes demand fine needle aspiration biopsy to determine their benign or malignant nature. This paper presents application of ultrasound examination in the head and neck area including limitations of ultrasound diagnostics in many clinical cases. Data taken from Polish and foreign literature and authors experience are included in this paper.

Color-SieScape imaging of carotid and vertebral arteries ☆

OBJECTIVE The aim of this study was to estimate the feasibility and limitations of Color-SieScape imaging of carotid and vertebral arteries in healthy subjects. METHODS extended field of view procedure was applied during the examination of 80 carotid and 80 vertebral arteries in 40 healthy volunteers. RESULTS visualisation of a common carotid artery together with a proximal segment of both an internal (ICA) and external carotid artery (ECA) in one Color-SieScape image was possible in nine cases. Clear presentation of a common carotid artery in one Color-SieScape image with a segment of an ICA or ECA of varying length was possible in 49 cases. In 22 cases, visualisation of an ICA was possible only on a minimal length, with major artefacts or completely impossible. Color-SieScape images of vertebral arteries were good or very good in 34 cases and poor or very poor in 46 cases. Artefacts arose due to the pulsatile movements of the arterial wall, especially in vessels lying close to the skin and in the proximal part of a common carotid artery. Tracing a tortuous vessel and ICA coming from common carotid artery at an angle close to 90 degrees produced significant artefacts. CONCLUSIONS Color-SieScape images of carotid and vertebral arteries of good quality are usually possible to obtain.

Vascular patterns in superficial lymphomatous lymph nodes: A detailed sonographic analysis().

PURPOSE To identify the vascular patterns found in superficial lymph nodes with histologically confirmed lymphomatous involvement and to determine their value in the sonographic diagnosis of lymphadenopathy. METHODS AND MATERIALS The study involved the prospective classification of vascular patterns observed during power Doppler and/or color Doppler studies of superficial lymph nodes scheduled for resection. Forty patients (27 men and 13 women, aged 22-84 years; mean age: 58 years) with pathologically proven lymphoma were selected for this study (26 cervical, 13 axillary and 1 inguinal). RESULTS A longitudinal vessel with or without branches (pattern I) was found in 14 lymphomatous nodes. Six contained short vessel segments distributed in the hilum area or centrally (pattern II), five had multiple vessels, partially branching, entering the node in a few rows from its longitudinal side (pattern III), seven presented multiple vessels that branched irregularly or chaotically with avascular areas (pattern IV), and eight had a peripheral vessel distribution (pattern V). Therefore, 50% of the lymphomatous nodes had vascular patterns regarded as characteristic of reactive lymph nodes (patterns I and II), and 37.5% had patterns normally described in lymph nodes with metastatic involvement (patterns IV and V); other lymphomatous lymph nodes had ambiguous vascular patterns that have not been previously classified (pattern III). CONCLUSION The angioarchitecture of superficial lymphomatous lymph nodes varies widely and is difficult to classify. It may resemble that reported in normal or reactive lymph nodes or patterns that are associated with metastases. The finding of a normal or benign vascular pattern in a lymph node with suspected lymphomatous involvement does not eliminate the need for a diagnostic biopsy.