Jun-ichi Sanuki

Breast carcinomas with strong high-signal intensity on T2-weighted MR images: pathological characteristics and differential diagnosis.

To investigate the histopathological characteristics of breast carcinomas with strong high‐signal intensity (SHi) on T2‐weighted (T2W) MR images (T2‐SHi), and discuss the differential diagnosis between T2‐SHi breast carcinomas and T2‐SHi fibroadenomas.

Volume replacement with polyglycolic acid mesh for correcting breast deformity after endoscopic conservative surgery.

From April 2002 to August 2003, 60 patients (41 patients undergoing quadrantectomy and 19 patients undergoing wide excision) with early-stage breast cancer underwent endoscopic breast-conserving surgery and volume replacement with absorbable materials. The average volume of resected tissue was 75 mL (range, 15-145 mL). The absorbable materials consisted of polyglycolic acid mesh (Dexon Mesh DMS#4 10 × 12) folded and wrapped in oxidized regenerated cellulose, which just fit into the dead space. We expected that the polyglycolic acid mesh would help induce granulation and fibrous tissue with reactive tissue fluid and that oxidized regenerated cellulose would prevent adhesion between the skin and the polyglycolic acid mesh (Figure 1). The absorbable materials were gently inserted into the dead space, and the wound was closed in 3 layers. We used 1 sheet of polyglycolic acid mesh and 1 sheet of oxidized regenerated cellulose if the volume loss was 70 mL. The cosmetic outcome was evaluated with a 4-point scoring system of breast cosmesis judged by breast surgeons.1 The scores of breast cosmesis were evaluated every 1 or 2 months at a clinic. The average evaluation time was 6.1 months after surgery (range, 2-12 months). A favorable cosmetic outcome (excellent) was obtained in 83% of patients (77% of patients undergoing quadrantectomy and 91% of patients undergoing wide excision). Dynamic contrast-enhanced magnetic resonance mammography and ultrasonography were performed routinely 3 months after the operation. The images showed that the dead space was lined by granulated scar tissue and filled with fluid. Deformity was almost completely prevented, and the symmetric images helped us to detect local recurrence. In 1 patient, multiple cancers were detected by pathologic examination after conservative breast surgery. Total mastectomy was performed 1 month after the previous operation, and the resected tissue in which polyglycolic acid mesh had been inserted was examined pathologically. Pathologic examination showed that the peripheral part of the dead space was encapsulated by granulation and fibrous tissue, and the mesh was decomposed and phagocytosed by macrophages. Complications of the film-screen mammography (FSM) method were inflammation and overproduction of fluid induced by the polyglycolic acid mesh. These findings were observed in 3 cases that had been diagnosed by open biopsy before surgery. We believe that the open biopsy procedure induced inflammation and overproduction of fluid in these patients. We now regard a history of open biopsy to be a contraindication for the FSM method. It is likely that polyglycolic acid mesh helps to promote granulation and to fill the reactive fluid space in the encapsulating scar. The FSM method is a simple and useful procedure for preventing breast deformity after conservative surgery.

Axillary mass suspected to be occult breast carcinoma: a case study of skipped axillary lymph node metastasis from endometrial carcinoma in which core-needle biopsy was useful for diagnosis

A 55-year-old Japanese woman presented with metrorrhagia and was diagnosed with endometrial carcinoma. Chest computed tomography (CT), ultrasonography (US) and magnetic resonance imaging (MRI) showed a left axillary mass. Regarding the diagnosis of the axillary mass, lymph node metastasis from the uterus was first suspected. Metastasis from the breast, lung, thyroid or stomach was considered next. On a general search including positron emission tomography (PET)-CT, there was no abnormality except endometrial carcinoma and the left axillary mass. Skipped axillary lymph node metastasis of endometrial carcinoma is extremely rare, with a reported incidence of 0.03% of endometrial carcinoma cases. The differential diagnosis was double carcinoma of the uterus and breast. We carried out US-guided core needle biopsy (CNB) of the axillary mass, and the histopathological findings suggested axillary lymph node metastasis from endometrioid carcinoma. US-guided CNB is a valid method for accurate diagnosis of an axillary mass.