Hyun Kyung Jung

Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk.

PURPOSE To develop a practical thyroid imaging reporting and data system (TIRADS) with which to categorize thyroid nodules and stratify their malignant risk. MATERIALS AND METHODS The institutional review board approved this retrospective study, and the requirement to obtain informed consent for the review of images and records was waived. From May to December 2008, ultrasonographically (US)-guided fine-needle aspiration biopsy (FNAB) was performed in 3674 focal thyroid nodules in 3414 consecutive patients. The study included the 1658 thyroid nodules (≥1 cm in maximum diameter at US) in 1638 patients (1373 women, 265 men) for which pathologic diagnosis or follow-up findings were available. Univariate and multivariate analyses with generalized estimating equations were performed to investigate the relationship between suspicious US features and thyroid cancer. A score for each significant factor was assigned and multiplied by the β coefficient obtained for each significant factor from multivariate logistic regression analysis. Scores for each significant factor were then added, resulting in an equation that fitted the probability of malignancy in thyroid nodules. The authors evaluated the fitted probability by using a regression equation; the risk of malignancy was determined according to the number of suspicious US features. RESULTS The following US features showed a significant association with malignancy: solid component, hypoechogenicity, marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, and taller-than-wide shape. As the number of suspicious US features increased, the fitted probability and risk of malignancy also increased. Positive predictive values according to the number of suspicious US features were significantly different (P < .001). CONCLUSION Risk stratification of thyroid malignancy by using the number of suspicious US features allows for a practical and convenient TIRADS.

Localized bilateral paranasal mucormycosis: a case in an immunocompetent patient

Mucormycosis of the nasal cavity and paranasal sinuses is an uncommon opportunistic fungal infection, which often has an aggressive, life-threatening course. Patients who have this condition are generally diabetic or immunosuppressed. However, mucormycosis can also occur in immunocompetent individuals. The most effective treatment consists of reversal of the source of immunocompromise, immediate surgical debridement and administration of systemic amphotericin B. No consensus has been reached regarding the appropriate surgical treatment or the total dose of amphotericin B. We present the case of a patient suffering from localized bilateral paranasal mucormycosis who was treated by means of endoscopic sinus surgery and administration of systemic amphotericin B. We suggest that endoscopic sinus surgery is the choice of treatment for localized paranasal mucormycosis in an immunocompetent patient, and that the total dose of amphotericin B can be determined by the extent of disease and the postoperative endoscopic findings.

Cervical Lymph Node Imaging Reporting and Data System for Ultrasound of Cervical Lymphadenopathy: A Pilot Study

OBJECTIVE The objective of our study was to compare ultrasound (US) and real-time elastography (RTE) features of benign and malignant cervical lymphadenopathies and propose a structured reporting system for lymph nodes. MATERIALS AND METHODS The study population for this retrospective study consisted of 291 consecutive patients who underwent US-guided biopsies for cervical lymphadenopathy between 2013 and 2014. The following imaging features were analyzed: shape, margin, echogenicity, echogenic hilum, gross necrosis, calcification, matting, intranodal vascular pattern, elasticity scores (four categories), and strain ratio. A score was assigned for each significant factor from a logistic regression analysis and was multiplied by the beta coefficient. The fitted probability of malignancy was calculated. The risk of malignancy was determined on the basis of the number of suspicious features. Interobserver agreement of the imaging features was retrospectively analyzed using a coefficient of interrater agreement. RESULTS The imaging features that were significantly associated with malignant lymphadenopathy were round shape, noncircumscribed margin, hyperechogenicity, absence of hilum, gross necrosis, calcification, peripheral or mixed vascularity, high elasticity scores, and high level of strain ratio (p < 0.05). The fitted probability and risk of malignancy increased as the number of suspicious features increased. The risk of malignancy according to the Cervical Lymph Node Imaging Reporting and Data System categories was as follows: category 1, 3.3%; category 2, 10.9%; category 3, 26.7%; category 4, 51.8-74.4%; and category 5, 90.6-98.8%. An analysis of the overall interobserver agreement revealed that interobserver agreement was moderate to good. CONCLUSION We propose the Cervical Lymph Node Imaging Reporting and Data System, which uses the number of suspicious US and RTE features to assess the risk of malignancy in cervical lymph nodes.

Fibromatosis Associated with Silicone Breast Implant: Ultrasonography and MR Imaging Findings

Desmoid type fibromatosis is an uncommon benign disease entity of which its etiology is currently unknown. It constitutes 0.3% of all solid neoplasms, but it is rarely seen in the breast and even more scarcely reported to develop in association with breast implant. We present ultrasonography and magnetic resonance imaging findings of a 29‐year‐old female patient with fibromatosis after breast implant surgery. Knowledge of imaging findings of breast fibromatosis associated with implant will be helpful for accurate diagnosis and appropriate management.

Mammographic and Sonographic Features of Triple-Negative Invasive Carcinoma of No Special Type

The aim of this study was to compare the mammography, ultrasound (US) and histologic features of triple-negative (TN) invasive carcinoma of no special type (NST) to non-TN invasive carcinoma of NST. The second aim was to assess whether the distinct imaging characteristics of TN breast cancer would persist after controlling for the histologic features. A total of 344 invasive carcinomas of NST in 337 patients from January 2007 to February 2008 were included in this study. Two radiologists retrospectively reviewed the mammography and US findings using the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) lexicon and our institutions criteria. On mammography, TN invasive carcinoma of NST most commonly presented as a mass with round shape and non-spiculated margin. On US, it was more likely to have internal hypoechogenicity, an abrupt boundary and posterior acoustic enhancement. TNBC lacked major suspicious imaging findings such as an irregular shape, spiculated margin and calcification.

Nonmasslike lesions on breast sonography: comparison between benign and malignant lesions.

To compare the imaging and clinical features of benign and malignant nonmasslike lesions in the breast.

Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma Sonography and Specimen Radiography

The purpose of this pictorial essay is to show the limitations of sonography and complementary usefulness of specimen radiography in detecting microcalcifications of the diffuse sclerosing variant of papillary thyroid carcinoma, which mostly manifests as diffusely scattered microcalcifications in the thyroid gland.

Lymphoepithelial carcinoma of the maxillary sinus with orbital invasion.

Lymphoepithelial carcinoma (LEC) of the maxillary sinus is a very rare neoplasm that shares some characteristics with nasopharyngeal carcinoma. Epstein-Barr virus (EBV) has been reported to be associated with LEC located outside of the nasopharynx in Asian populations. A case report of a 64-year-old Asian female with right-sided cheek mass which was diagnosed preoperatively as a maxillary mass by paranasal sinus computed tomography scan is presented. Because maxillary sinus cancer with orbital invasion was considered, she underwent surgical removal of a mass. Final pathology revealed LEC, which is presented in our report. However, in situ hybridization assays returned negative results for Epstein-Barr virus. The patient underwent postoperative chemoradiotherapy, and has remained disease-free during 3-year follow-up. Although a few cases in the maxillary LEC have been reported, this is the first report describing the diagnosis and treatment of LEC occurred in the maxillary sinus. Surgical removal and adjuvant chemoradiotherapy may be useful in the treatment of more advanced maxillary LEC.

Expression of cyclooxygenase-2 and 5-lipoxygenase in nasal polyps associated with interleukin-4 promoter polymorphism -590.

OBJECTIVE: To evaluate expression of cyclooxygenase (COX)-2 and 5-lipoxygenase (5-LO) associated with interleukin (IL)-4 promoter polymorphism -590 in nasal polyp tissues. STUDY DESIGN AND SETTING: A prospective controlled study. A venous blood sample was taken to determine the genotype in 61 nasal polyp subjects. The C-590T variant was determined by the polymerase chain reaction-restriction fragment length polymorphism method. The expression of 5-LO and COX-2 was determined with immunohistochemical staining in 37 nasal polyp tissues associated with genotype. RESULTS: The genotype frequencies at position -590 of the IL-4 gene in the patients with nasal polyp were C/C (8.20%), C/T (40.98%), and T/T (50.82%). There was no significantly increased expression of COX-2 among genotypes. The 5-LO expression was significantly increased in C/C compared with C/T and T/T. CONCLUSION: We suggested that the IL-4 promoter polymorphism -590 C/C is associated with the expression of 5-LO in the patients with nasal polyp.

Merkel Cell Carcinoma of the Axilla and Adrenal Gland: A Case Report with Imaging and Pathologic Findings

Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine carcinoma of the skin. MCC is characterized by a high incidence of locoregional recurrence, and distant metastasis, and often requires short-term follow-up after treatment. In this present paper, we describe a rare case of MCC, which presented as a palpable axillary mass and an incidental adrenal mass, and report on the ultrasonography, computed tomography, and 18F-fluorodeoxyglucose-positron emission tomography findings. The patient underwent surgery and adjuvant radiation therapy. Seven months after the initial diagnosis, distant metastasis was detected during a follow-up examination.