Pedro J. Grases

Assessment of breast cancer size: Sonographic and pathologic correlation

Accurate presurgical assessment of tumor size in breast cancer is important for choosing appropriate treatment. We retrospectively compared presurgical sonographic measurements of tumor size with postsurgical measurements of size and other variables.

Fibroadenoma phyllodes arising in vulvar supernumerary breast tissue : report of two cases

Ectopic breast tissue, found along the mammary line or sometimes outside it, can exhibit pathologic changes similar to those of the eutopic mammary gland. Fibroadenoma phyllodes, an unusual variant of mammary phyllodes tumor with stromal cellularity similar to a conventional fibroadenoma, rarely arises outside of breast. Its histogenesis is unclear; although some cases suggest an origin in cutaneous adnexa, the presence of normal breast tissue surrounding other tumors favors an ectopic mammary origin. Two cases of fibroadenoma phyllodes arising in ectopic vulvar breast tissue are described.

Tumor Size and Lymph Node Status in Multifocal Breast Cancer

Abstract:  Tumor size correlates with lymph node metastasis in breast cancer. In multifocal lesions there is controversy about considering the summation of the largest diameter of each tumor. A total of 122 patients with multifocal breast cancer were compared in a retrospective study with 177 patients with unifocal tumors, correlating tumor size with lymph node metastasis. In multifocal tumors, two sizes were considered: the diameter of the largest tumor and the combined diameter of all lesions. Relationship was established by three different logistic models using variables such as age, number of lesions, histologic type, and grade. At a same size of the largest diameter of a unifocal or multifocal lesions and the combined diameter of a multifocal lesion, the latter shows less probability of nodal metastasis indicating that combined diameter is an overestimation of the lesion size. Our results indicate that in multifocal breast cancer, only the diameter of the largest tumor breast cancer has relationship with lymph node metastasis.

Role of Color Doppler Ultrasonography in the Diagnosis of Endometriotic Cyst

We studied the role of color Doppler ultrasonography in the distinction between endometriomas and other adnexal masses. Three hundred and fifty‐two ovarian lesions were studied, comparing sonographic diagnosis with pathologic findings. On color Doppler sonography, an endometriotic cyst usually appeared as a cystic lesion with diffuse internal echoes and low vascularization. The sensitivity and specificity of color Doppler transvaginal sonography in detecting endometriotic cysts were 91.8% and 95.3%, respectively. The positive and negative predictive values were 95.5% and 91.5%, respectively. In our experience, transvaginal sonography with color Doppler interrogation is a useful technique in the diagnosis of pathologic ovarian conditions, including cystic endometriosis.

Congenital plate-like osteoma cutis of the forehead: an atypical presentation form

Cutaneous ossifications or osteoma cutis can be found in many syndromes. Primary osteoma cutis, present since birth or the first months of life, in the absence of metabolic disorders or trauma, is found in congenital plate-like osteoma cutis and progressive osseous heteroplasia, coexisting in the latter with deep connective tissue ossifications. This report documents the case of a 7-year-old female with a plate-like cutaneous ossification of the forehead causing aesthetic deformities. Other dermal ossifications in the inguinal and preauricular region, as well as the left hand and a small focus in the extraocular muscles of the left orbit, were also present. These lesions did not show progression, and most of them were present since birth. The lesion of forehead was treated surgically. The lack of progression and the fact that the orbital lesion was solitary still fits the criteria for the diagnosis of plate-like osteoma cutis. Plate-like osteoma cutis and progressive osseous heteroplasia may represent varieties of the same disorder.

Endometrial hyperplasia with secretory changes

OBJECTIVE Secretory changes in endometrial hyperplasia are uncommon. The aim of this study is to review the morphologic and clinical findings of 24 cases of endometrial hyperplasia with secretory changes. METHODS In 24 patients diagnosed with endometrial hyperplasia with secretory changes during 6 years, clinical characteristics such as menopausal status and hormone treatment were correlated with morphological features. A matched age control group of 24 women with conventional endometrial hyperplasia was used to compare the hormonal effect. RESULTS Nineteen patients were premenopausal. Nine women showed simple hyperplasia without atypia and 15 complex hyperplasia, 7 of them with atypia. Seventeen women were under hormonal treatment at the time of diagnosis, 10 of them with progestins. In 7 patients endometrial adenocarcinoma could be seen, 5 coexisting with endometrial hyperplasia with secretory changes and in 2 appearing after 1 and 4 months. In control group only 2 patients were undergoing progestin hormonal treatment. CONCLUSIONS Secretory changes can be found in hyperplastic endometrium, particularly in premenopausal women under hormonal treatment with progestins, with the risk of misdiagnosis.

Myometrial trophoblastic implant as a complication of surgically induced first‐trimester termination of pregnancy

Persistent trophoblastic tissue has been described in the abdominal cavity after surgical treatment of tubal ectopic pregnancy. More infrequently the cause of the ectopic trophoblast is linked to uterine perforation due to surgically induced termination of pregnancy (TOP). Ultrasonographic images may suggest an ectopic pregnancy. A case of myometrial trophoblastic tissue implantation following surgically induced first‐trimester TOP is described. Copyright

Ultrasonographic findings for in vitro detection of metastatic breast cancer in axillary lymph nodes.

To the Editor: We have read with interest the report of Tateishi and coworkers1 of their experience with some previously described ultrasonographic findings for in vitro detection of metastatic breast cancer in axillary lymph nodes.2,3 These criteria are the lymph node shape (expressed by the ratio of the long axis to short axis), the characteristics of the hilus, and the preservation or distribution of the cortex. The authors mention lymph node size as a criterion for malignancy, concluding that nodes measuring 10 mm or more will probably be malignant. In our in vitro study of 158 axillary lymph nodes from patients with breast cancer,3 we did not find statistically significant differences in the percentage of metastatic lymph nodes when they were smaller than 10 mm (12 of 45, 26%) or 10 mm larger (33 of 113, 29%), but we found that the 10 mm cutoff in size was very useful for increasing the sensitivity, specificity, and positive predictive value (PPV) when considering other sonographic criteria of malignancy such as shape, absence of hilus, and cortical disruption. Size and shape are two parameters closely related; thus smaller lymph nodes tend to be round, and larger ones are usually oval. The absence of the hilus in our study proved to be the most specific sign of malignancy, but the ultrasonographic features of the hilus are dependent on the amount of fatty tissue and vessels found in that location. We observed that nodes with few large vessels in the hilus were more hypoechoic than those with numerous small vessels in that zone. In nodes with minimal vascularization and adipose involution of the medulla, the hilus appeared hypoechoic, being erroneously diagnosed as malignant. In many of these cases a thin hyperechoic band, which we called the T-line, distinguishes the hilus from the C-shaped rim of the cortex. The presence of this line is a sign of benignity.4 Finally, cortical disruption is a very important sign to disclose micrometastasis in those lymph nodes in which the hilus is preserved. In our study, when one or more of the criteria for malignancy, indicated by changes in shape, hilus, and cortex, were present, the sensitivity was 84.1% (95% confidence interval: 69.9–93.0), the specificity of 84.4% (75.7–90.0), and the PPV of 67.9% (53.9–79.4), but when these criteria were applied to the lymph nodes of 10 mm or larger, the specificity raised to 88.8% (79.2–94.4) and the PPV to 75.7% (58.4–87.6). Ultrasonography can be an important tool in the presurgical staging for breast cancer by assessing nodal status, permitting the detection of lymph nodes suggestive of malignancy as a guide for cytologic study of samples obtained by fine needle aspiration.

P387: Usefulness of color doppler transvaginal ultrasonography in the diagnosis of early stage ovarian cancer

Clinical evaluation of the tumors of lower and higher stage is reliable. Accuracy of transvaginal ultrasonography in evaluation and staging of cervical cancer in comparison to MRI volumetry has been revised in our study. 21 patients with cervical cancer finally staged as IA2-IB2 and treated accordingly by laparoscopically assisted lymphadenectomy and trachelectomy, primary radical hysterectomy or neoadjuvant chemotherapy followed by radical hysterectomy. All patients were evaluated by transvaginal ultrasonography as well as MRI volumetry. Patients were blinded for the examinations. Staging was accurate in 96% of ultrasound exams in comparison with the MRI volumetry. Tumors staged IB1 were distributed into two categories: small tumors less than 2 cm in diameter and bulky tumors more than 2 cm in the largest diameter. Ultrasound results agreed with MRI findings in small tumors less than 2 cm in 100% of cases. The agreement in bulky tumors staged IB1 2–4 cm was 87%. Transvaginal ultrasound appears to be a useful method for the pretreatment assessment of small cervical tumors with accuracy close to that of MRI volumetry.

Early diagnosis in ovarian cancer: role of transvaginal ultrasound

Purpose:  To evaluate the efficiency of transvaginal ultrasound in the early diagnosis of ovarian cancer.