Cutaneous metastasis in hypopharyngeal carcinoma: a case report.

Background: Occurrence of cutaneous metastasis in hypopharyngeal carcinoma is an extremely rare event reported in the literature, with an incidence of only 0.8%-1.3%. Early diagnosis of cutaneous metastasis would have a positive impact on treatment response and disease prognosis with diagnosis mainly dependent on physical examination and radiological imaging (ultrasonography, computed tomography scan or PET-CT). Palliative care is, however, the mainstay of treatment for cutaneous metastasis. Case presentation: We report a middle-aged female patient, with known case of hypopharyngeal squamous cell carcinoma, who initially showed partial response to chemoradiotherapy but developed cutaneous nodules in the region of the right axilla and bilateral lateral chest wall posterior to the posterior axillary fold. Excision biopsy of one of these nodules showed metastatic squamous cell carcinoma. The patient was again referred to the Oncology Department of INMOL Hospital and her chemotherapy was planned for cutaneous metastasis. Conclusion: Being uncommon, the occurrence of cutaneous lesions in a patient with hypopharyngeal carcinoma should prompt detailed evaluation to rule out metastasis. Early detection will help in improving disease prognosis and median survival.

Idiopathic Scrotal Calcinosis: A Case Report.

Idiopathic scrotal calcinosis is formation of calcium deposits in the dermal layers of the scrotum. It results in the formation of single or multiple nodular calcifications that vary in size and number. First reported in 1883, this condition is common in the third decade of life. The presenting complaints range from disfigurement to itching, leading to decreased quality of life. The diagnosis is usually made on a clinical basis and can be confirmed by the histopathology of the excised nodules. Surgical removal of the nodules is the generally recommended treatment. The surgery aims to eradicate the nodules leaving the scrotal skin enough for scrotoplasty. We present a case of idiopathic scrotal calcinosis in a 37 years old male who came for radiological examination.

Diagnostic value of strain elastography and shear wave elastography in differentiating benign and malignant breast lesions.

BACKGROUND: Conventional B-mode breast ultrasonography, though the primary modality to determine benign or malignant nature of a solid breast lesion, sometimes encounters overlapping sonographic morphological features in a single lesion. Elastography leads to improvement by evaluating the structural aspects and characterization of the lesion as benign or malignant on the basis of multi-parametric assessment. OBJECTIVE: Determine the role of strain elastography (SE) and shear wave elastography (SWE) in differentiating benign and malignant breast lesions. DESIGN: Cross sectional SETTING: Radiology department of hospital PATIENTS AND METHODS: Patients meeting inclusion criteria referred to our hospital for ultrasonography followed by biopsy or surgical excisions were examined with B-mode ultrasonography and by both strain and shear wave elastography. MAIN OUTCOME MEASURES: Mean values of SE and SWE in benign and malignant breast lesions, determination of cutoff using AUC curves and sensitivity and specificity of both techniques. SAMPLE SIZE: One hundred breast lesions from 95 consecutive patients. RESULTS: The mean (SD) strain elastography ratio in the overall patient population was 4.1 (2.0). Cutoff for benign vs. malignant lesions was 2.86 on the ROC curve. The AUC was 0.911 (95%CI; 0.835-0.988: SE, 0.039) with a sensitivity of 95.8% and a specificity of 89.3%. For the SWE kPa values, the ROC curve showed the AUC was 0.929 (95% CI, 0.870-0.988; SE: 0.030, P<.001). Assigning 45.3 as a cut off value provided a sensitivity of 95.8% with a specificity of 85.7%; the positive predictive value was 94.5% and the negative predictive value was 89.6%. The Breast Imaging Reporting and Data System (BI-RADS) category alone was able to differentiate between benign and malignant lesions with a sensitivity of 91.7% and a specificity 100% keeping the cut off value between 4a and 4b. The area under the ROC curve was 0.979. Combining the three (BI-RADS + SE + SWE) distinguished benign vs. malignant lesions with a sensitivity up to 100% and specificity up to 96.3%. CONCLUSION: Combining SE and SWE as a complementary tool with conventional B-mode ultrasonography has a significant potential for better characterization of solid breast lesions and decreasing unnecessary biopsies of BI-RADS IVa lesions. LIMITATIONS: Single institution study. CONFLICT OF INTEREST: None.

Strain Elastography for Differentiation between Benign and Malignant Thyroid Nodules.

OBJECTIVE: To find out the diagnostic accuracy of strain elastography in differentiating between benign and malignant thyroid nodules taking cytology as a gold standard. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Radiology Department, Institute of Nuclear Medicine and Oncology (INMOL), Lahore, Pakistan, from February to July 2019. METHODOLOGY: A total of 110 patients aged 18-80 years of either gender having one or more solid nodules, in thyroid lobe on conventional ultrasound examination, were included. Patients with cystic nodules, nodules that constitute more than 75% volume of thyroid lobe and thyroid nodules with peripheral calcification were excluded. All the patients then underwent strain ultrasound elastography with high-resolution unit equipped with a linear array probe which was centered at 7.5 MHz. Sonoelastographic findings were correlated with cytology. RESULTS: Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of sonoelastography in differentiating between benign and malignant thyroid nodules taking cytology as gold standard was 90.0%, 90.0%, 91.53%, 88.24% and 90.0%, respectively. Optimal cutoff to differentiate between malignant and benign nodules for elasticity strain using ROC curve was 2.57. Area under the curve (AUC) was found to be 0.933 (0.879-0.987) p<0.001. CONCLUSION: Sonoelastography is the non-invasive modality of choice with high diagnostic accuracy in differentiating between malignant and benign nodules. Key Words: Sonoelastography, Strain elastography, Thyroid nodule, Benign, Malignant, Sensitivity, Specificity.

Sonographically guided metalic clip placement for tumour localization in early breast cancer patients undergoing neoadjuvant chemotherapy.

OBJECTIVE: To determine the outcome of sonographically-guided indigenous low-cost metallic clip placement for tumour localisation in patients of early breast cancer undergoing neoadjuvant chemotherapy. . METHODS: The prospective analytical study was conducted at the Institute of Nuclear Medicine and Oncology, Lahore, Pakistan, from May 2016 to December 2017, and comprised biopsy-proven breast cancer cases. Under sonographic guidance, metallic clips were placed as markers within the lesions before their scheduled preoperative neoadjuvant chemotherapy. The procedure was performed using an 18 gauge lumbar puncture needle and 25 gauge needle by a locally devised simple and cost-effective technique. Post-procedure mammography was performed to confirm the location of clips within the lesions and to evaluate its role in imaging assessment of treatment response after neo adjuvant chemotherapy. SPSS 20 was used for data analysis. RESULTS: There were 30 women with a mean age of 40.43+11.35 years (range: 21-60 years). These women had 32 lesions with a mean size of 26.72+9.85mm (range: 8-58mm). Breast conserving surgery was performed on 28(87.5%) lesions and negative margins were achieved in all these cases. Modified radical mastectomy was performed on 4(12/5%) non-responding lesions. No complication was noted in association with metallic clip placement, and the clips were easily visualised on mammograms without causing any interference with treatment response. CONCLUSIONS: Sonographically-guided metallic clip placement by a simple indigenously devised technique before neoadjuvant chemotherapy was found to be a well-tolerated, safe and cost-effective method for accurate preoperative localisation of tumour bed and to assess response to therapy.

Isolated Dorsal Pancreatic Agenesis.

Developmental anomalies of the pancreas have been reported; but among these, agenesis of dorsal pancreas is an extremely rare congenital pancreatic anomaly. It may be asymptomatic and incidentally detected on imaging or may be associated with diabetes mellitus or attacks of pancreatitis. We report a rare case of agenesis of dorsal pancreas that was detected incidentally on imaging and there was no other co-existing anomaly.

Plexiform neurofibroma of uterus: a rare manifestation of neurofibromatosis 1.

Neurofibromatosis type 1 (NF1) rarely affects the female genital system. Plexiform neurofibromas are congenital lesions that occur exclusively in patients with neurofibromatosis type I. The vulva is the most frequent genital organ to be affected, whereas vaginal, cervical, uterine, and ovarian neurofibromas have also been reported only rarely. We present an 8 years old girl with plexiform neurofibroma primarily involving genital system.

Detection and characterization of intracranial aneurysms: magnetic resonance angiography versus digital subtraction angiography.

OBJECTIVE: To compare magnetic resonance angiography (MRA) with Intra-arterial digital subtraction angiography (IA-DSA) in detection and characterization of intracranial aneurysms. STUDY DESIGN: Comparative cross-sectional study. PLACE AND DURATION OF STUDY: Department of Diagnostic Imaging, Lahore General Hospital, Lahore, from January to June 2007. METHODOLOGY: Thirty patients presented with aneurysmal subarachnoid haemorrhage (SAH) and focal neurological signs were selected by convenience sampling. Three dimensional time of flight (3D TOF) MRA using maximum intensity projection (MIP) was performed on all patients along with DSA. Results of 3D TOF MRA were compared with those of IA-DSA taking IA-DSA as Gold standard. RESULTS: Out of 30 patients 14 (46.7%) were males and 16 (53.3%) were females with mean age of 41±14.1 years. MRA detected 29 out of 30 aneurysmal lesions with sensitivity of 96.7%. Regarding characterization of aneurysms results of MRA were comparable to those of IA-DSA. CONCLUSION: 3D TOF MRA technique showed a high sensitivity in this study. This technique can be used as a non-invasive screening test for intracranial aneurysms and as a suitable alternative primary examination to IA-DSA prior to aneurysmal surgery.