Jack E. Meyer

The Utility of Ultrasonographically Guided Large-Core Needle Biopsy Results From 500 Consecutive Breast Biopsies

Five hundred ultrasonographically guided large‐core needle breast biopsies of solid masses were performed in 446 women. Histopathologic results were correlated with imaging findings. Ultrasonographically guided large‐core needle biopsy resulted in diagnosis of malignancy (n = 124) or severe atypical ductal hyperplasia (n = 4) in 128 lesions (26%). In the remaining 372 lesions (74%), ultrasonographically guided large‐core needle biopsy yielded benign pathologic results. Follow‐up of more than 1 year (n = 225), results of surgical excision (n = 50), or both were obtainable in 275 (74%) of the benign lesions. No malignancies were discovered at surgical excision or during follow‐up of this group of benign lesions. There were no complications related to large‐core needle biopsy that required additional treatment. Ultrasonographically guided large‐core needle biopsy is a safe and accurate method for evaluating breast lesions that require tissue sampling.

CT appearance of clival chordomas

Computed tomography of 30 patients with chordomas arising from the clivus was reviewed. All examinations demonstrated bone destruction with a soft tissue mass and varying degrees of encroachment on the adjacent brain. Other CT findings included contrast enhancement, soft tissue calcification and well defined areas of low attenuation.

Radiotherapeutic management of carcinoma of the nasopharynx: An analysis of 170 patients

A study of 170 patients with carcinoma of the nasopharynx was made. Aggressive radiation therapy remains the treatment of choice. The overall 5‐year survival was 39% and the disease‐free rate 31%. For patients with T1N0 lesions, 69% lived for 5 or more years, and 58% had no disease at 5 years. Patients with unilateral nodal disease had a 5‐year survival rate of 38% and a disease‐free rate of 31%. Those with extensive local disease and/or with bilateral or fixed cervical nodes generally had a poor prognosis. This study seems to indicate that there have been some radio‐therapeutic advances in the past 15 years. Improvements in prognosis were observed in patients with unilateral nodal disease (N1 group) and with massive soft‐tissue disease (T3), and a slight improvement was noted in patients with very early lesions (T1No group) and those with far‐advanced nodal lesions (N2, N3 group).

MR imaging in acute cervical spine trauma.

Fourteen patients with cervical spine injuries, 12 with resultant neurological deficits, were scanned with magnetic resonance (MR) imaging within 7 days following injury. Useful information concerning the status of the spinal canal and disks was obtained in most cases. In addition, MR was able to suggest the nature of the pathological changes within the spinal cord, as well as hemorrhage and edema in the extraspinal soft tissues. These observations indicate that following acute cervical spine trauma, MR is a valuable technique in assessing injury to the spinal cord, surrounding soft tissues, vertebra, and disks.

Relationship between mammographic and histologic features of breast tissue in women with benign biopsies

Mammograms and histologic slides of a group of 320 women who had breast symptoms and a biopsy without cancer being found were reviewed. The mammographic features assessed were the parenchymal pattern and extent of nodular and homogeneous densities. In addition to the pathologic diagnosis, the histologic features assessed included epithelial hyperplasia and atypia, intralobular fibrosis, and extra‐lobular fibrosis. Among premenopausal women, those with marked intralobular fibrosis were more likely to have large (3+ mm) nodular densities on the mammogram. Among postmenopausal women, epithelial hyperplasia or atypia was related to having nodular densities in at least 40% of the breast volume. In both groups, marked extralobular fibrosis was related to the presence of homogeneous density on the mammogram. We conclude that mammographic nodular densities may be an expression of lobular characteristics, whereas homogeneous density may reflect extralobular connective tissue changes.

Diffuse large cell (Histiocytic) lymphoma of the spleen: clinical and pathologic characteristics of ten cases

Ten patients with diffuse large cell (histiocytic) lymphoma of the spleen had a characteristic clinical presentation and pathologic findings. Patients presented with left upper quadrant pain, fever, weight loss, and an elevated sedimentation rate. Imaging studies revealed an enlarged spleen with a discrete mass in all cases. Moderate to massive splenomegaly (average weight, 1025 g) was found at laparotomy; a single large mass or multiple confluent nodules with extensive central necrosis replaced 85% to 90% of the parenchyma. The tumor transgressed the splenic capsule in nine of ten cases, and either invaded or was adherent to the diaphragm, stomach, pancreas, or abdominal wall. Lymph nodes in the splenic hilum or retroperitoneum were frequently involved. Seven patients were in Ann Arbor Stage II, and three were in Stage I. Eight of the ten lymphomas were subclassified as centroblastic (large noncleaved cell) and two were immunoblastic. The B‐cell lineage of six tumors was established by the presence of monoclonal immunoglobulin. Despite combination chemotherapy, with or without radiation, three of the seven patients whose follow‐up was adequate died in less than 2 years; four are alive at 7, 12, 12, and 81 months, respectively, the last two with recurrent lymphoma. Large cell lymphoma of the spleen is a likely diagnosis in patients who present with left upper quadrant pain, fever, and radiographic evidence of a splenic mass.

Solitary myeloma of bone: a review of 12 cases.

The clinical course and treatment of 12 patients with presumed solitary myeloma of bone are reviewed. These patients who presented with solitary lesions showed a rather protracted clinical course, often over many years, before disseminated myeloma became apparent. Three patients have been followed 5, 12, and 19 years respectively without definite evidence of multiple myeloma, although the latter patient has shown multiple solitary lesions. The eventual development of disseminated myeloma in the other 9 patients was preceded by a disease‐free interval of from 2 to 10 years following treatment of the solitary lesion.

Carcinoma of the Nasopharynx: Factors Influencing Results of Therapy

Six factors affecting the survival of 170 patients with nasopharyngeal carcinoma are discussed: extent of the primary lesion, status of cervical lymph node metastases, histological classification, age, sex, and effect of recurrence after initial treatment. The survival period decreased with increasing primary lesion size and with more extensive lymph node metastasis. Transitional-cell carcinoma was the most favorable histological variety and squamous-cell carcinoma was the least favorable. Young patients had better survival rates than old patients; females survived better than males. Patients whose disease recurred two years after initial treatment had better survival rates than did those with earlier recurrence.

Fatal Complications of Percutaneous Lung Biopsy

Abstract A case is reported of mortality probably secondary to tracheal aspiration of blood following performance of percutaneous needle biopsy under fluoroscopic guidance. Radiologists should be aware of this potential complication.

Radiographic evaluation of metastatic melanoma

Malignant melanoma can potentially involve any organ system in the body once it metastasizes beyond the regional lymph nodes. A survey of the radiographic and associated clinical manifestations of metastatic melanoma is presented. The findings from 74 autopsies of patients who died of metastatic melanoma are included.