The purpose of this study was to correlate the clinicoradiologic and pathologic features of thyroid lymphoma and to identify the most useful diagnostic method for thyroid lymphoma as the first line.Our study population included 16 patients with a diagnosis of thyroid lymphoma by fine-needle aspiration, core biopsy, or surgery from 1995 to 2010. We retrospectively reviewed imaging and medical records. Sonographic findings were correlated with histopathologic results.Of the 16 patients, primary lymphomas were found in 13 and secondary in 3. The mean ages of the patients with primary and secondary lymphomas were 60.8 and 42.7 years, respectively. Most patients with primary lymphomas had symptoms of rapid neck swelling or a mass sensation. All primary lymphomas revealed non-Hodgkin B-cell lymphoma, and secondary lymphomas included a B-cell origin in 2 and a T-cell origin in 1. On sonography, 10 (77%) of 13 primary lymphomas showed diffuse heterogeneous hypoechoic parenchyma with intervening echogenic septa-like structures, whereas all secondary lymphomas showed markedly hypoechoic nodules. Markedly hypoechoic parenchyma was correlated with lymphoepithelial lesions and neoplastic cells, whereas the intervening echogenic septa-like structures were consistent with fibrosis on pathologic examination. The exact diagnosis of thyroid lymphoma was possible with core biopsy in all 9 cases (100%) but with fine-needle aspiration in only 3 of 10 (30%), which included 7 under sonographic guidance and 3 under palpation (P = .0030).Diffuse hypoechoic parenchyma with intervening echogenic septa on sonography under the impression of a primary thyroid lymphoma, particularly in the setting of a rapidly enlarging mass, should prompt core biopsy rather than fine-needle aspiration.
To show the results of an audit of screening breast ultrasound (US) in women with negative mammography in a single institution and to analyze US-detected cancers within a year and interval cancers.During the year of 2006, 1974 women with negative mammography were screened with US in our screening center, and 1727 among them had pathologic results or any follow up breast examinations more than a year. We analyzed the distribution of Breast Imaging Reporting and Data System (BI-RADS) category and the performance outcome through follow up.Among 1727 women (age, 30-76 years, median 49.5 years), 1349 women (78.1%) showed dense breasts on mammography, 762 (44.1%) had previous breast US, and 25 women (1.4%) had a personal history of breast cancers. Test negatives were 94.2% (1.627/1727) [BI-RADS category 1 in 885 (51.2%), 2 in 742 (43.0%)]. The recall rate (=BI-RADS category 3, 4, 5) was 5.8%. Eight cancers were additionally detected with US (yield, 4.6 per 1000). The sensitivity, specificity, and positive predictive value (PPV1, PPV2) were 88.9%, 94.6%, 8.0%, and 28.0%, respectively. Eight of nine true positive cancers were stage I or in-situ cancers. One interval cancer was stage I cancer from BI-RADS category 2.Screening US detected 4.6 additional cancers among 1000. The recall rate was 5.8%, which is in lower bound of acceptable range of mammography (5-12%), according to American College of Radiology standard.
A petrous apex cephalocele is a rare lesion of the petrous apex. It can be discovered incidentally or can cause a suite of clinical problems, such as trigeminal neuralgia or cerebrospinal fluid leakage. Although this lesion can be misinterpreted as a pathologic lesion, the characteristic radiologic features can provide the diagnostic clue for distinguishing these two lesions and avoid unnecessary treatment. Here we present CT and MRI finding of petrous apex cephalocele in two patients with review of the literature.
Background Parathyroid carcinomas (PTC) are very rare. There have been a few studies on the contribution of ultrasound (US) in the diagnosis of PTC compared with parathyroid adenomas (PTA). Purpose To identify the differences between US findings of PTC and PTA in patients with primary hyperparathyroidism (PHPT). Material and Methods We enrolled seven patients with PTC and 32 consecutive patients with PTA whose diagnoses were confirmed by surgery at our institution between March 1994 and June 2015. We retrospectively compared the US features of the two groups, as well as the demographic, clinical, and biochemical characteristics (age, gender, palpability, and serum ionized calcium and parathyroid hormone [PTH] levels). Results The patients with PTC and PTA did not exhibit significant differences in terms of mean age (59.0 years versus 51.1 years; P = 0.2063), sex distribution (male:female, 4:3 versus 1:3; P = 0.1716), mean PTH levels (2855.0 pg/mL versus 1821.5 pg/mL; P = 0.2067), and mean ionized calcium levels (1.7 mMol/L versus 1.5 mMol/L; P = 0.1585) except palpability ( P < 0.0001). On US images, the PTCs were significantly larger (3.5 cm versus 1.9 cm; P = 0.0133) and exhibited higher incidences of heterogeneous echotexture ( P = 0.0002), irregular shape ( P < 0.0001), non-circumscribed margin ( P < 0.0001), intra-nodular calcifications ( P = 0.014), and local invasion ( P = 0.0004) compared to the PTAs. Conclusion In preoperative patients with PHPT, PTCs are differentiated from PTAs by their palpability and significant US features: large size, heterogeneous echotexture, irregular shape, non-circumscribed margin, intra-nodular calcifications, and local invasion.
Background Morphologic and kinetic characteristics of breast lesions are regarded as a major criterion for their differential diagnosis in dynamic magnetic resonance imaging (MRI). However, there have not been well-reported MRI findings of microinvasive ductal carcinoma. Purpose To evaluate MRI characteristics of microinvasive ductal carcinoma of the breast and to compare MRI findings in patients with microinvasive ductal carcinoma and pure ductal carcinoma in situ (DCIS). Material and Methods Eighty-one patients with pathologically confirmed microinvasive ductal carcinomas ( n = 37) or pure DCIS ( n = 44) were included in this study. The MRI findings were analyzed without knowledge of the pathologic and conventional imaging findings. For all the lesions detected on MRI, morphologic and kinetic analyses were performed according to the Breast Imaging Reporting and Data System. For the non-mass lesions, the presence of clustered ring enhancement was also analyzed. Statistical analyses were performed using Student's t test, χ 2 test, and Fisher's exact test. Results In total 35 cases of microinvasive ductal carcinoma and 39 cases of DCIS were detected on MRI. The most common and dominant MRI findings of microinvasive ductal carcinoma and DCIS were non-mass lesions with heterogeneous enhancement. However, the spiculated margin of the mass-type lesion ( P = 0.022), the segmental distribution ( P = 0.023), and clustered ring enhancement ( P = 0.006) of the non-mass-type lesion, and the enhancement kinetics showing strong initial enhancement ( P = 0.004) with subsequent wash-out ( P = 0.001) were significantly more frequent in microinvasive ductal carcinoma than in DCIS. Conclusion Non-mass lesions with segmental distribution, heterogeneous enhancement, and strong initial enhancement with a wash-out curve were the dominant MRI findings of microinvasive ductal carcinoma. Compared with DCIS, microinvasive ductal carcinoma showed more suspicious imaging characteristics. For the non-mass lesions, clustered ring enhancement was also a characteristic finding of microinvasion on MRI.
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