Pinar Balci

Mammographic and sonographic findings in the diagnosis of idiopathic granulomatous mastitis

Abstract. The aim of this study was to describe the mammographic and sonographic findings of idiopathic granulomatous mastitis which is a rare inflammatory disease of the breast of unknown etiology. The clinical, radiologic, and pathologic features of 12 cases with idiopathic granulomatous mastitis were retrospectively reviewed. Mammography was performed in all cases, 8 of which showed a focal asymmetric density, 3 had a mass with irregular margins, and 1 had no abnormality. Sonography was performed in 10 cases, and a focal area with inhomogeneous and hypoechoic pattern was depicted in 6 cases, 4 of which were associated with internal tubular hypoechoic structures. One case revealed a hypoechoic mass consistent with malignancy. In 1 case sonography showed an edematous pattern involving nearly the entire breast. Two patients had normal sonograms. If a focal asymmetric density is seen in mammography and inhomogeneous hypoechogenity with internal hypoechoic tubular structures accompany ultrasonographically, these findings should suggest the possibility of idiopathic granulomatous mastitis; however, very often idiopathic granulomatous mastitis mimics a breast carcinoma clinically and the final diagnosis should be reached histopatologically due to high false-positive and false-negative mammographic appearances.

Breast mass contour segmentation algorithm in digital mammograms

Many computer aided diagnosis (CAD) systems help radiologist on difficult task of mass detection in a breast mammogram and, besides, they also provide interpretation about detected mass. One of the most crucial information of a mass is its shape and contour, since it provides valuable information about spread ability of a mass. However, accuracy of shape recognition of a mass highly related with the precision of detected mass contours. In this work, we introduce a new segmentation algorithm, breast mass contour segmentation, based on classical seed region growing algorithm to enhance contour of a mass from a given region of interest with ability to adjust threshold value adaptively. The new approach is evaluated over a dataset with 260 masses whose contours are manually annotated by expert radiologists. The performance of the method is evaluated with respect to a set of different evaluation metrics, such as specificity, sensitivity, balanced accuracy, Yassnoff and Hausdorrf error distances. The results obtained from experimentations shows that our method outperforms the other compared methods. All the findings and details of approach are presented in detail.

Invasive micropapillary carcinoma of the breast: a clinicopathologic study of 103 cases of an unusual and highly aggressive variant of breast carcinoma.

Invasive micropapillary carcinoma (IMPC) of the breast is an uncommon, highly aggressive breast cancer that may occur in pure and mixed forms. Our aim in this study is to investigate the relationship between clinical, histopathologic, and immunohistochemical features of pure and mixed IMPC cases diagnosed and treated at our institution. One hundred and three IMPC cases diagnosed at our institution over a period of 19 years have been selected. Clinical, histopathologic features, as well as hormone status and c‐erb‐B2 overexpression of tumors were re‐evaluated. Mann–Whitney U, chi‐squared, Kaplan–Meier, and Fishers exact tests were used for statistical analyses. Results were considered to be significant at p < 0.05. Twenty cases (19.4%) were pure, and 83 cases (80.6%) were mixed IMPC. The most common nonmicropapillary invasive carcinoma component in mixed cases was invasive ductal carcinoma (IDC; 78.3%). Progesterone receptor was significantly less positive in pure IMPC cases (p = 0.031). There was no statistically significant difference between the two groups, in terms of mean age of the patients (53.0 versus 52.8), mean tumor size (26.6 mm versus 27.7 mm), presence of high‐grade tumor (p = 0.631), presence of sentinel lymph node (SN) metastasis (p = 1.000), axillary lymph node metastasis (p = 1.000), lymphatic invasion (p = 1.000) and blood vessel invasion (p = 0.475), c‐erbB‐2 overexpression of tumor cells (p = 0.616), distant metastasis (p = 0.549), or overall survival (p = 0.759). The local recurrence rate of the two groups was not statistically significant either (16.7% versus 4.3%). However, local recurrence was detected 12% more commonly (p = 0.100), and ~8 months earlier (p = 0.967) in pure IMPC cases, compared to mixed cases. In addition, presence of local recurrence was found to be statistically significantly associated with estrogen receptor (ER) status (p = 0.004), progesterone receptor (PR) status (p = 0.001), and c‐erb‐B2 overexpression (p = 0.016) in all patients. Overall survival rate was significantly associated with ER staining of the tumor (log‐rank = 0.028). Our findings suggest that hormone receptor negativity may explain the more aggressive behavior of pure IMPC compared to mixed cases. Besides, longer survival period of patients with ER positivity, and the relationship of hormone status and c‐erb‐B2 overexpression and local recurrence further support favorable prognostic value of hormone receptors in invasive breast cancer.

Metastasis of giant cell tumor to the breast : Case report and review of the literature

Breast cancer is the most common type of malignancy in women. Of all breast cancers, 0.5–3% involve metastasis of a non-breast malignancy to the breast. Metastasis of soft tissue tumors to the breast is rarely seen. In particular, metastasis of a giant cell tumor to the breast has never been reported in the literature. We present here a case of breast metastasis in a 44-year-old woman with a diagnosis of malignant giant cell tumor originating from the distal radius and metastatic to the lung, who had been treated with radiotherapy, surgery and chemotherapy.

Aneurysmal bone cyst secondary to infantile cartilaginous hamartoma of rib

Abstract We report the first case, in a 4-month-old girl, of an aneurysmal bone cyst secondary to infantile cartilaginous hamartoma of the rib. Infantile cartilaginous hamartoma of the rib (benign mesenchymoma) is a large, expansile tumour that is characterised by cartilaginous, vascular and primitive-appearing stromal and mesenchymal elements. Most cases are diagnosed at less than 1 year of age and may even be congenital. Aneurysmal bone cyst may be a secondary lesion to pre-existing tumours such as giant cell tumours, osteoblastomas, angiomas and chondroblastomas. This unique case is presented with radiological and pathological findings.

The coexistence of invasive ductal carcinoma and malignant phyllodes tumor with liposarcomatous and chondrosarcomatous differentiation in the same breast in a post-osteosarcoma case.

Malignant phyllodes tumors of the breast are rare biphasic neoplasms, the stromal component of which may show homologous and heterologous sarcomatous elements. Malignant epithelial transformation is rare. It has been reported in a few cases of in situ and infiltrating ductal or lobular carcinoma. Rarely, breast carcinomas and phyllodes tumors may also develop in the same breast independent of each other. To our knowledge, this is the first case of two different types of tumor occurring in the same breast at the same time in a post-osteosarcoma case.

A Case of Benign Schwannoma of the Breast: Mammographic, Ultrasonographic and Color Doppler Ultrasonographic Findings

A 61-year-old asymptomatic postmenopausal woman presented to the radiology department for a screening mammogram. The patient’s medical history was noncontributory and her physical examination was within normal limits. Her prior mammogram, 3 years earlier, was normal. The mammogram showed that both breasts were almost entirely composed of fat (Breast Imaging Reporting and Data System [BIRADS] category 1: almost entirely fat breast composition). There was 20 · 10 mm, lobular, circumscribed, high-density mass without microcalcification on one-third posterior of the upper–lower outer quadrant of her left breast (Fig. 1). On ultrasonography, the lesion was well-circumscribed, parallel in orientation, hypoechoic, slightly inhomogeneous, and solid with moderate acoustic enhancement (Fig. 2). On color Doppler sonography, the mass was hypovascular (Fig. 3). No enlarged axillary or supraclavicular lymph nodes were noted. The right breast was normal. Although the mammography and ultrasonography findings indicated that the mass was benign, the patient’s age, hyperdensity of the lesion, and normal prior mammogram were considered as suspicious for malignancy (BIRADS category 4A: a low suspicion for malignancy); thus, a biopsy was recommended. After mammography-guided wire localization, excision was performed. Macroscopically, the excised specimen was measured 4 · 2.5 · 2 cm. The size of the tumor was 1.2 · 1 · 0.5 cm. The tumor was grown in an expansile fashion and was encapsulated. The cut surface was homogenous, gray and tan with irregular yellow areas. Microscopically, the tumor was well encapsulated by the existing epineurium and composed of two main patterns termed Antoni A and Antoni B (Fig 4). The Antoni A pattern consisted of fascicles of fusiform cells with elongate nuclei and indistinct cytoplasmic borders. These cells were often arranged in a palisading pattern and in some areas, bizonal arrangement of such

Ontology-based mammography annotation and Case-based Retrieval of breast masses

This paper describes ontology-based annotation of mammography and a Case-based Retrieval approach for breast masses from digital mammography archive. We first present our Mammography Annotation Ontology focusing on its main concepts and relationships, as well as the annotation tool. Then, we propose a model for similarity calculation between breast masses based on their high, mid and low-level features. We use Semantic Query-enhanced Web Rule Language (SQWRL) to process retrieval of similar masses from annotated mammography collection in OWL. We give both retrieving process and results we obtained from experimentations, in detail.

PHYLLODES TUMOR OF THE BREAST IN AN ADOLESCENT GIRL

Phyllodes tumor (PT) is an uncommon tumor in adolescent girls and young women. A case of PT in a 14-year-old girl is reported. The clinical examination showed a painless tumor that had grown during 10 months. Total excision of the mass with wide margin was performed. The diagnosis, behavior, and treatment of this rare tumor are discussed.

Detection of Bilateral Multifocal Breast Cancer Using Tc-99m Sestamibi Imaging: The Role of Delayed Imaging

PURPOSE Early determination that breast cancer is bilateral and multifocal can change therapy strategy and, subsequently, mortality and morbidity rates. The authors present a case with bilateral, multifocal breast cancer detected only by Tc-99m sestamibi imaging. METHODS Early and delayed Tc-99m sestamibi imaging and dynamic MRI were performed in a patient with a right-sided lesion shown on mammography. RESULTS Although early Tc-99m sestamibi imaging detected bilateral breast cancer foci, both dynamic MRI and mammography missed the lesion in the left breast. Additional lesions seen on delayed Tc-99m sestamibi images of the left breast, which were initially thought to be benign, completely disappeared after concomitant chemotherapy and radiotherapy, suggesting multifocal malignant lesions in the left breast. CONCLUSION This case suggests that Tc-99m sestamibi may be useful for detecting bilateral cancer, and delayed imaging may give additional information regarding the possible multifocal nature of the disease.