In Yong Whang

Ultrasonographic Findings of Medullary Thyroid Carcinoma: a Comparison with Papillary Thyroid Carcinoma

Objective This study was designed to evaluate the ultrasonographic (US) findings of medullary thyroid carcinoma (MTC) as compared to findings for papillary thyroid carcinoma (PTC). Materials and Methods The study included 21 cases of MTC that were surgically diagnosed between 2002 and 2007 and 114 cases of PTC that were diagnosed in 2007. Two radiologists reached a consensus in the evaluation of the US findings. The US findings were classified as recommended by the Thyroid Study Group of the Korean Society of Neuroradiology and Head and Neck Radiology (KSNHNR) and each nodule was identified as suspicious malignant, indeterminate or probably benign. The findings of medullary and papillary carcinomas were compared with use of the chi-squared test. Results The common US findings for MTCs were solid internal content (91%), an ovoid to round shape (57%), marked hypoechogenicity (52%) and calcifications (52%). Among the 21 cases of MTC nodules, 17 (81%) were classified as suspicious malignant nodules. The mean size (longest diameter) of MTC nodules was 19 ± 13.9 mm and the mean size (longest diameter) of PTC nodules was 11 ± 7.4 mm; this difference was statistically significant (p < 0.05). An ovoid to round shape was more prevalent for MTC lesions than for PTC lesions (p < 0.05). Conclusion The US criteria for suspicious malignant nodules as recommended by the Thyroid Study Group of the KSNHNR correspond to most MTC cases. The US findings for MTC are not greatly different from PTC except for the prevalence of an ovoid to round shape.

Imaging features of invasive lobular carcinoma: comparison with invasive ductal carcinoma

PurposeThe aim of this study was to evaluate the imaging findings of invasive lobular carcinoma (ILC) compared to those of invasive ductal carcinoma (IDC).Materials and methodsThe study included ILCs (n = 27) and IDCs (n = 85). Imaging findings were retrospectively evaluated, according to the BI-RADS lexicon. We compared the imaging findings, multiplicity, and magnetic resonance imaging (MRI) detection accuracy of ILC with those of IDC.ResultsAt mammography, normal findings and mass lesions were more frequent with ILCs (14.8% and 59.2%, respectively) than with IDCs (1.2% and 44.7%, respectively) (P = 0.009). With ultrasonography (US), posterior acoustic shadowing was more frequently seen in ILCs (59.2%) than in IDCs (15.8%) (P < 0.001). With MRI, both ILCs and IDCs most commonly appeared as a heterogeneously enhancing, irregular mass with a spiculated border. Multifocality was more frequently associated with ILCs (40.7%) than with IDCs (14.1% 1% 0.002). However, multicentricity and bilaterality were not different between the two groups. The sensitivity and specificity of MRI for the detection of multiplicity were 91.6% and 73.3%, respectively, for ILCs and 83.3% and 80.3%, respectively, for IDCs.ConclusionNormal findings, mass lesions on mammography, and posterior acoustic shadowing on US were more frequently associated with ILCs than with IDCs. Multifocality was more prevalent with ILCs than with IDCs.

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.

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.

A huge necrotic liver mass in a 45-year-old woman: delayed hepatic metastasis of a gastrointestinal stromal tumor.

A 45-year-old woman was referred with a huge mass of the liver. She complained of a vague abdominal discomfort that had persisted for 1 month. She had no history of liver disease, and physical examination revealed mild abdominal distension. Pertinent laboratory test results were unremarkable. She had a history of small intestinal resection for a gastrointestinal stromal tumor (GIST) 11 years prior (Fig. 1A). Computed tomography (CT) showed a heterogeneous hypervascular tumor with central necrosis, occupying left hemiliver and right paramedian sector of the liver, measuring 20 × 13 cm (Fig. 1B). Positron emission tomography-CT using 18F-fluorodeoxyglucose showed intense hypermetabolic activity (maximum standardized uptake value 8.2) along the peripheral solid portion of the tumor with central photon defect area representing necrosis (Fig. 1C). A tumor biopsy revealed small round/ spindle-shaped cells surrounded by fibrous tissue. Immunohistochemical stainings revealed vimentin reactivity, as well as CD117 reactivity. On c-kit A huge necrotic liver mass in a 45-year-old woman: delayed hepatic metastasis of a gastrointestinal stromal tumor

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

Power Doppler needle-induced fremitus for breast localization

PurposeWe attempted to identify the preoperative, sonography-guided breast localization technique which can be used in cases in which surgeons require the shortest incision route or exact localization of a lesion.Materials and methodsWe performed a phantom study using a lesion-in-breast model, investigating the concept that the flash artifact is induced at the tip of the vibrating needle on power Doppler images, before attempting any clinical applications. In view of the results achieved in the phantom study, we applied this technique to patients referred to our department over a 2-year period.ResultOf the 312 breast localizations in which we used this technique in 289 patients, all procedures were successfully performed without serious complications.ConclusionThe vertical approach with the power Doppler needle-induced fremitus technique indicates the shortest incision route to and the exact localization of a breast lesion.

PTEN Mutation Identified in Patient Diagnosed with Simultaneous Multiple Cancers

PTEN hamartoma tumor syndrome is a spectrum of disorders characterized by unique phenotypic features including multiple hamartomas caused by mutations of the tumor suppressor gene PTEN. Cowden syndrome and Bannayan–Riley–Ruvalcaba syndrome are representative diseases, and both have several common clinical features and differences. Because PTEN mutations are associated with an increased risk of malignancy including breast, thyroid, endometrial, and renal cancers, cancer surveillance is an important element of disease management. We report a germline mutation of the PTEN (c.723dupT, exon 7) identified in a young woman with a simultaneous occurrence of breast cancer, dermatofibrosarcoma protuberans, and follicular neoplasm. This case suggests that it is critical for clinicians to recognize the phenotypic features associated with these syndromes to accurately diagnose them and provide preventive care.