Hanna P. Mäkäräinen

Intrascrotal adenomatoid tumors.

Adenomatoid tumors are regarded as uncommon neoplasms of the paratesticular tissues, probably of mesothelial origin. The majority of cases reported have involved the epididymis. We report our experience with 8 cases of testicular tumors and 11 of epididymal adenomatoid tumors during a 13-year period, and review the relevant literature. The incidence of adenomatoid tumors relative to all tumors in the testis was 6.9% (8 of 116), exceeding that of Leydig cell tumors, which were previously believed to be the most common benign testicular neoplasms. The adenomatoid tumors included 38% epididymal tumors (11 of 29). The clinical course of the tumors was benign, without recurrences. Local excision is regarded as the treatment of choice for epididymal and testicular adenomatoid tumors.

Ethanolamine Oleate Sclerotherapy for Hydroceles and Spermatoceles: A Survey of 158 Patients with Ultrasound Followup

Sclerotherapy with 5% ethanolamine oleate was used to treat 102 hydroceles in 100 patients and 63 spermatoceles in 58 patients. Scrotal ultrasound examination was performed before the sclerotherapy and at each followup visit. Of the hydroceles 98% were cured completely and 68% were cured after only 1 sclerosant instillation, while 60% of the spermatoceles resolved completely and 33% partially, with 7% failures. No hydroceles recurred during an average followup of 43 months, whereas spermatocele recurred in 4 patients more than 1 year after successful treatment, with a mean followup of 46 months. Approximately half of the patients experienced pain after treatment, 3 had infection and 2 had hematoma. No changes in the structure or size of the testicles were found by ultrasound during followup. Ethanolamine oleate sclerotherapy is a safe, effective and economical form of outpatient therapy that can be recommended as primary treatment for hydroceles in adults and as an alternative to surgery for spermatoceles with 1 to 3 cysts in elderly men in whom fertility is not important.

Diffuse Renal Disease Diagnosis by Ultrasound-Guided Cutting Needle Biopsy

The results of ultrasound (US)-guided renal parenchymal cutting needle biopsies in 101 consecutive patients were reviewed. The biopsies were done with the automated Biopty device mounted with a 2.0-mm needle. One or 2 needle passes yielded sufficient material for histologic analysis in 94% (95/101). Three or more passes were required in 6% (6/101) to obtain an adequate specimen. Mesangio-proliferative glomerulonephritis, IgA-nephropathy, nephrosclerosis, diabetic nephropathy, secondary amyloidosis, lupus nephritis, minimal change glomerulonephritis and interstitial nephritis accounted for 79% of the final histologic diagnoses. The high quality and quantity of the tissue specimens yielded a definitive histologic diagnosis in renal parenchymal diseases of unknown etiology. Four major complications occurred, but no deaths or loss of kidney function were recorded. US proved useful as a guide to suitable biopsy site and in the detection of clinically significant complications. Prebiopsy screening of coagulation variables did not seem to prevent complications. Special attention should be paid to post-biopsy clinical observation.

Mammography and Ultrasound in the Diagnosis of Contralateral Breast Cancer

Forty-nine (5%) of 956 women referred for follow-up imaging after breast cancer treatment had a malignancy in both breasts. The mammograms and ultrasonograms or US reports, and histologic slides or pathologic reports of 31 of these patients were reviewed. Mammography was more sensitive than clinical examination or US in detecting contralateral breast cancer, the sensitivity of mammography being 81%. Thirty-nine percent of the contralateral cancers were nonpalpable, and all were first detected at mammography. No cancers were depicted by US alone. US provided complementary information about palpable masses in 50% of the cases in which the mammographic finding was difficult to interpret. The mammographic appearance and the difficulties in detecting a contralateral cancer were similar to those known to be characteristic for first primaries. Distinguishing a new primary from a metastasis from the first breast cancer was not always possible by means of mammography or US.

Polyorchidism With Normal Spermatogenesis, Diagnosed Preoperatively by Ultrasound

Polyorchidism is a rare urological anomaly with less than 60 cases reported in the literature. We report a case of right-sided polyorchidism with normal spermatogenesis diagnosed preoperatively by ultrasound imaging. Because of the high accuracy of ultrasound, surgical explorations are unnecessary if there are no signs of testicular torsion or other anomalies requiring operation.

Ultrasound-guided fine needle aspiration biopsy in the diagnosis of breast cancer recurrence after mastectomy

Purpose: to define the accuracy and clinical impact of fine needle aspiration biopsy (FNAB) in diagnosing recurrent breast cancer after mastectomy. Material and Methods: the results of ultrasonography (US) and US-guided FNAB of 175 lesions located at the mastectomy site or in the ipsilateral axilla were reviewed. the final diagnosis was recurrent cancer in 77 cases and benign lesion in 98 cases, as verified by histological examination (n=77) or follow-up (n=98). Results: FNAB yielded a representative aspirate in 92.6% of cases. the sensitivity, specificity and overall accuracy of FNAB cytology were 96.1%, 89.8% and 92.6% respectively. US and FNAB cytology were complementary methods in recurrent cancer diagnosis. the cytologic examination increased the specificity of US. the only recurrent tumor which appeared benign both sonographically and cytologically was removed because of a suspicious finding at palpation. FNAB cytologic diagnosis was found to have a clinical impact in 92.2% of the recurrent cases. Conclusion: US-guided FNAB provided an accurate adjunct to clinical examination and mammography for diagnosing and excluding breast cancer recurrence after mastectomy.

Cervical ultrasound combined with parathyroid hormone assay prior to parathyroid exploration

The purpose of this study was to analyse ultrasound (US) findings and US-guided fine needle aspirations (FNAs) for parathyroid hormone (PTH) in pre-operative evaluation prior to parathyroid exploration. Thirteen patients with primary hyperparathyroidism (pHTP) underwent cervical US combined with FNAs. Fourteen suspected lesions were aspirated and the patients were operated on. The US examinations were performed with a real-time scanner using a 7.5-MHz transducer and the direct contact method. The aspiration method was modified according to Doppman et al. (1983), the main differences being that US instead of CT-guidance was used and an immunoradiometric assay was performed for the direct quantitative determination of intact PTH instead of a mid-region specific radioimmunoassay. The freehand technique was employed, using needles with an outer diameter of 0.55–0.6 mm, and the aspirated material (1–2 drops of blood) was dissolved in 1 ml saline. Ice was used to freeze the sample immediately.Normal serum PTH (s-PTH) varies from 10 to 55 ng/l, while the s-PTH of these 13 patients varied from 86 to 188 ngl/. The values for PTH in the suspect parathyroid lesions varied from 6 to 78,400 ng/l. Of the 14 lesions aspirated, there were 11 true positive, two true negative, and one false negative findings. The diagnostic accuracy of this method was 93%, its sensitivity 92% and its specificity 100%.US combined with FNA for PTH assay is the primary imaging method of choice prior to parathyroid re-exploration, prior to more invasive imaging methods, prior to sclerotherapy and before primary parathyroid exploration in selected problem cases.

Spermatic Cord Liposarcoma: Ultrasound for Diagnosis and Follow-Up

A case of spermatic cord liposarcoma is described in a 48-year-old man. Following local excision, the tumour recurred after 3 years, leading to funiculoorchiectomy. The case is presented, the literature reviewed and the role of ultrasound in the diagnosis discussed.

Ultrasound follow-up of ethanolamine oleate sclerotherapy for spermatoceles.

Although sclerotherapy as a treatment for hydroceles has gained in popularity during the last few years, there is no consensus on whether it can also be adopted for the treatment of spermatoceles. We examine here the efficacy and safety of ethanolamine oleate sclerotherapy in cases of spermatocele using ultrasound (US) before treatment and during follow-up. Thirty-seven consecutive outpatients aged 36-84 years (mean 61) with symptoms of 40 spermatoceles (1-3 chambers) treated by sclerotherapy were included in the series. It is concluded that US allows multilocular spermatoceles to be differentiated from hydroceles. Post-treatment US findings are typical, including heteroechoic masses with cystic areas extratesticularly, hyperechoic lines peritesticularly (thickened tunicas) and a thickened scrotal wall. All lesions are reversible, however. US is helpful when assessing the need for resclerotherapy. Ethanolamine oleate proved to be effective as a sclerosant, as 83% of the cases were cured or became significantly better. Complications were few and there were no changes in the epididymis. Ethanolamine oleate sclerotherapy can be recommended as an alternative treatment to surgery, especially in older patients with spermatoceles consisting of 1-3 chambers.