Distribution of the Mr 52,000 estrogen-regulated protein in benign breast diseases and other tissues by immunohistochemistry.

A secreted glycoprotein with a molecular weight of 52,000 is induced by estrogen in breast cancer cells and has been purified to prepare monoclonal antibodies. The protein has been detected in some breast cancers but not in normal breast and uterus. In order to study its potential value as a marker, we have tested by immunohistochemistry frozen sections of several normal and malignant tissues and of benign mastopathies. Among different tissues tested, the Mr 52,000 protein was detected only in liver, sweat glands, and some sebaceous glands, and in malignant melanomas and some breast tumors. Other estrogen-responsive tissues (ovary, placenta, endometrium, etc.) gave negative results. Immunoradiometric assay of the Mr 52,000 protein in biological fluid revealed an elevated concentration in cyst fluid (0.5 to 7.4 micrograms/ml), pleural effusions of certain metastatic breast cancer, and sweat. By immunohistochemistry, the Mr 52,000 antigen was also detected in 42% of 129 benign mastopathies. Gynecomastia, fibrous disease, fibroadenoma, and adenosis were mainly negative, whereas ductal hyperplasia and cysts were positive. The Mr 52,000 protein was found mostly in proliferative ducts and in cysts but not in lobular hyperplasia and nonproliferative lesions without cyst. More Mr 52,000 protein was found in postmenopausal patients than in premenopausal patients. We conclude that the Mr 52,000 protein is a marker associated with mammary cysts and proliferative ducts. On the basis of the increased risk of breast cancer in proliferative mastopathies, we suggest that the Mr 52,000 protein is useful for predicting high-risk mastopathies acting as a marker associated with the proliferation of ductal tissue.

Herault breast screening programme: results after 30 months of a mobile French schedule.

Breast screening in the Herault Department (France) has been carried out since July 1990. As with other French programmes, it is a population-based screen, whose main features are related to its organization in that: (a) it is performed by a specific unit (the 'Institut Montpelliérain d'Imagerie Medico-Biologique'); and (b) the group of women targeted is those aged 40-70 years. The two-view mammography is performed every 2 years in mobile units. This paper presents the results after 30 months: 26,026 participants were screened from a target population of 52,617 women, giving a participation rate of 49%. The recall rate and the biopsy rate observed were 7% and 1.5%, respectively. The predictive positive value was 8.4% for a positive test while it was 35% for the biopsy; the values increased with age. 137 cancers were observed giving a detection rate of 5.3%, of which 82% were in situ. Small (< or = to 10 mm) tumours represented 41.5%, and 71.5% of the cancers were node negative. The surgical treatment was conservative for 66% of them.

Sensitivity of magnetic resonance imaging of the wrist in very early rheumatoid arthritis.

The aim of this study was to evaluate magnetic resonance images (MRI) of soft tissue abnormalities in the wrist of RA patients in the early stage of the disease. We performed magnetic resonance imaging of the wrist in 15 patients with early rheumatoid arthritis according to ACR criteria, of less than 10 months duration (mean duration 4.8 months). None of the patients had carpal bone erosions on standard radiography. MRI demonstrated abnormality of the soft tissue in 13 of the 15 cases. On coronal MRI, the sites of involvement of the synovitis were the recess of the distal ulnar (9 pts.), the distal radioulnar joint (4 pts.) and the radiocarpal joint (7 pts.). On axial MRI, tendon sheath effusion of the digital flexor was present in 3 patients. Carpal bone lacunae were present in only 4 patients. Disease activity was not associated with the extent of the synovitis on wrist MRI. Our study suggests that MRI is a sensitive method for the detection of synovitis in early RA.

The use of Gd-DOTA in magnetic resonance imaging of experimentally induced mammary tumors.

Gd-DOTA contrast enhancement of MR images was evaluated on induced mammary tumors in female rats. A single intravenous injection of the carcinogenic N-nitrosourea ENU was administered to Wistar rats; this simple treatment led to a high percentage of mammary tumors without causing death. All the induced tumors were adenocarcinoma and their heterogeneousness depended on their size. The induced tumors did not have intra- or extravascular inflammatory spaces caused by heterotopic lesions, as is the case with implanted tumors. Before injection of Gd-DOTA, appearance of the patchy internal structure was clearly demonstrated on spin-echo images performed with long repetition times. Three doses of the paramagnetic contrast agent (0.1, 0.2, and 0.5 mmol/kg) were evaluated on two different T1-weighted MR sequences. Images were recorded before and repeatedly after intravenous injection of Gd-DOTA, and signal intensities and relaxation times were measured. On images acquired with the spin-echo 500/28 as well as the inversion-recovery 928/26/300 sequences, the results showed that 0.2 mmol/kg Gd-DOTA was the optimal dose for contrast enhancement and for clear visualization of the heterogeneousness of the mammary tumor.

Efficiency of different radiodiagnostic techniques in pancreatic disorders.

Using figures from the literature and from our own case material, the diagnostic efficiency of the barium meal, computerized tomography, angiography, ERPC and biopsy have been compared in acute and chronic pancreatitis, pancreatic and papillary carcinoma and islet cell tumour. In acute pancreatitis, CT is the method of choice. In chronic pancreatitis, ERPC has the highest diagnostic accuracy. Furthermore, it is capable of giving an indication for operative intervention, and facilitating the choice of operative method. In pancreatic carcinoma, combination of ERPC, angiography and/or biopsy provides the highest diagnostic accuracy. Angiography and ERPC can provide early diagnosis, and angiography and CT can predict the operability of a tumour. CT is also the most important of the non-invasive diagnostic techniques. Carcinoma of the papilla is easily and reliably recognized by endoscopy. For islet cell tumours, angiography still remains the method of choice.

The results of angiographic studies of abdominal masses.

This study reveals the continuing great viability of angiography in the investigation of abdominal masses. It is a fundamentally important procedure within the context of presurgical evaluation. Certain points should be underlined. - The radiological definition of the histological nature of an abdominal mass during angiography remains difficult, practically impossible in certain regions. - Borrowed vascularizations still pose complex diagnostic problems at different levels. - The benefit of angiography should be compared with other modern radiodiagnostic methods, especially the less aggressive ones. - The importance of each of these points has led us to develop them separately: - The diagnostic reliability of angiography in abdominal masses (from anatomico-radiological correlations). To be published - The borrowed vascularisation of abdominal masses. To be published - The tomodensitometry of abdominal masses. To be published - Diagnostic strategy in case of an abdominal mass. To be published.

The parasitic blood supply of abdominal masses.

Many lesions, and particularly hyper-vascularized ones, acquire an aberrant blood supply. These parasitic vascular supplies are defined as tumour vascularizations derived from neighbouring organs or structures, and supplement the normal blood supply of the diseased organ. Their existence is essential for the angiography of abdominal masses. We selected 35 cases of abdominal masses with parasitic vascular networks. Twenty-four belonged to an initial review of 117 angiographic studies of abdominal masses. Eleven have been added in accordance with the theme of this work. Parasitic circulations should be taken into account because of their effects on the angiographic technique, their diagnostic possibilities and limitations, and their importance in the management of the patient.

A method for the characterization of the echostructures of normal and pathological breast tissues.

Since a valid macroscopic investigation fundamentally cannot exist without its basis in microscopy, we are seeking to identify characteristic echo structures by means of acoustical microscopy at frequencies of 600 MHZ and 1 GHZ in order to better understand ultrasonography in everyday practice and to determine reliable and specific imaging characteristics of the different components of breast tissues. We have studied slices of mammary tissue 5-10 microns thick which had been removed during surgery. Acoustical imaging has to be performed in transmission mode as well as reflection mode. The intrinsic acoustic contrast is more than sufficient to obtain good visualization of different tissue components of the mammary gland. We noted, however, that even if the microscopic acoustic images were of good quality--often as good as light microscopy--certain tissue components such as the epithelium are irregularly visualized. It appears that the effective visualization of a structure depends entirely upon this acoustical environment.

Breast pathology in MRI. First results.

The authors present the first results of the assessment of MRI (0.35 T) with adapted surface reel in the exploration of mammary pathology in 90 cases. On a morphological level, MRI permits a new analysis of signs of dystrophy. As far as MRI is concerned, no specific sign of mammary neoplasia seems to exist. A classification is suggested, taking into account morphology and parameters of relaxation.

Ideal imaging in MR: contrast-enhancing pharmaceuticals. Evaluation of tempo carboxylic acid as nitroxide diagnostic agent.

The meglumine salt of TCA, a piperidinyl nitroxide stable free radical derivative, was tested as an NMR contrast enhancer. This report of its use in animals indicates its usefulness in the enhancement of signal intensity of the kidney and bladder.

Electropotential evaluation as a new technique for diagnosing breast lesions.

A new approach, termed the Biofield test, may have the potential to augment the process of diagnosing breast cancer. This technique is based on the analysis of skin surface electrical potentials measured by an array of specially designed sensors which are placed on the breasts. Measurements are recorded noninvasively and then analyzed using pattern recognition algorithms to produce an immediate and objective assessment of breast tissue in vivo. Initial clinical trials suggests that the test can achieve a sensitivity of approximately 90% and a specificity of 40-50%, which indicates that the test might be useful for excluding cancer when it is, in fact, absent. Although research to date has focused on the differential diagnosis of suspicious breast lesions, future applications could include breast cancer screening, close surveillance and diagnosis of recurrent cancers in breasts previously treated with conservative therapy, and monitoring the effectiveness of breast cancer therapies. Improvements and new applications are expected to occur as additional research and validation in actual clinical settings is performed.

Amyloidosis-related cauda equina compression in long-term hemodialysis patients. Three case reports.

STUDY DESIGN: These case reports illustrate the neurologic manifestations due to beta 2 microglobulin amyloid deposition at the lumbar spine level in long-term hemodialysis patients. OBJECTIVE: Radiologic investigations suggested the amyloid origin of extradural soft tissue deposition, which was confirmed by histologic examination after surgical excision. SUMMARY OF BACKGROUND DATA: Although cervical myelopathy is a recently recognized complication of long-term dialysis-related beta 2 microglobulin amyloidosis, neurologic manifestations due to amyloid deposition at the lumbar spine level have rarely been reported. METHODS: Three case reports of cauda equina compression in long-term hemodialysis patients are presented. Follow-up radiography, computed tomography, and magnetic resonance imaging were performed and patients underwent surgical decompression of the thecal sac. RESULTS: In two patients, the compression resulted from the development of a destructive spondylarthropathy, and from the infiltration of extradural spaces and ligaments by an abnormal soft tissue. The third patient had lumbar spinal stenosis due to multiple disc protrusion and to hypertrophy of facet joints and ligamentum flavum. Multilevel laminectomies enabled excision of an abnormal fibrous tissue responsible for the thecal sac compression. Histologic examination of the excised fibrous tissues disclosed amyloid deposits in intervertebral discs, apophysial joints, and ligaments. CONCLUSIONS: In long-term hemodialysis patients, cauda equina compression may develop as the consequence of beta 2 microglobulin amyloid deposition in lumbar intervertebral discs, facet joints, and ligaments. Magnetic resonance imaging is well suited to show the extent of the compression and supports the argument for the amyloid origin of extradural soft tissue.

[Cauda equina syndrome disclosing adenocarcinoma of the ethmoid]. / Syndrome de la queuè de cheval révélateur d'un adénocarcinome de l'ethmoïde.

Cauda equina metastases have been exceptionally described in sinusal neoplasms. MRI with gadolinium injection show up the primitive lesion and its neurologic extension. We report a case of cauda equina syndrome in which, only MRI, had show up intradural metastases and localised the ethmoïd sinus carcinoma.

[Proposal for a radiologic classification of disorders of the pelvi-rectal angle based on measurement of the posterior rectal inclination. Value of dynamic digitalized rectography]. / Proposition d'une classification radiologique des troubles de la statique pelvirectale basée sur la mesure de l'inclinaison rectale postérieure. Intérêt de la rectographie dynamique numérisée.

The difficulties for evaluation of the perineal descent have always been linked to the choice of references and mostly with the incertitude of the measurement of length on the radiographic film. This present study was carried out to evaluate the perineal descent on the choice of an angular measurement: the posterior rectal inclination. The dynamic digitalized rectography was used to investigate the pelvic floor status of 134 women: 115 patients complaining of idiopathic constipation, and 19 healthy volunteers. Results have shown 3 populations with an increasing graduation of perineal impairment and led to propose a radiologic classification of pelvic floor impairment: stage I, or solid perineum, stage II, or descending perineum and stage III or descended perineum. This study has brought up that the first sign of a pelvic floor abnormality may be increased descent during straining, only later followed by perineal descent at rest. The relationship linking abnormal perineal descent and excessive opening of the ano-rectal angle suggested logically that fecal incontinence may be the end complication of the Descending Perineum Syndrom.

[An experimental study to evaluate mineralization of vertebral bone by computerized tomography (author's transl)]. / Evaluation de la minéralisation osseuse vertébrale par tomographie computérisée. Etude expérimentale.

Computerized tomography ("tomodensitometry") should, in principle, be able to calculate the linear attenuation coefficient of a compact or spongy bone volume. This coefficient is related to the amount of mineralization, enabling the use of the Scanner X to measure the density of the bone. Thirty vertebrae from the vertebral columns of 14 subjects who died after acute infections were examined by C.T. and by standard methods, and then calcinified. The correlation between ashes weight-Houns-field number was positive but only moderate (r = 0.54), and lower than the result obtained (r = 0.84) with standard methods. Errors occur with presently used apparatuses which are related to: polychromatism, too high an energy of the beam, artefacts, and the effects of "partial volume". Futhermore, the mineral concentration by unit of vertebral volume is very low, and large variations must occur for it to be detectable. Finally, considerable errors arise from the intravertebral bone fat. Suggestions are made with the objective of improving the quality of C.T. as a measuring instrument.

[Pseudotumoral retroperitoneal tuberculosis. Apropos of a case]. / Tuberculose pseudo-tumorale rétropéritonéale. A propos d'un cas.

A case is reported of pseudotumoral retroperitoneal tuberculosis with invasion of left supraclavicular glands. Relative diagnostic efficacy of ultrasound and CT scan imaging is discussed as well as the differential diagnosis of this exceptional lesion. Exploratory procedures suggested with this type of picture are ultrasonography. CT scanning and possibly guided needle puncture biopsy to avoid surgical exploration. The value of the scanner for follow up review of results of antituberculosis treatment is emphasized.

[Muscular metastases. Uncommon manifestation of cystadenocarcinoma of the pancreas]. / Métastases musculaires. Révélation exceptionnelle d'un cystadénocarcinome du pancréas.

The authors report the detection of a cystadenocarcinoma of the caudal pancreas developed by muscular metastasis. They insist on the rarity of that type of localization to distinguish from the lesions of steatonecrosis. In the check-up of the developing metastasis, this observation bears out the interest of the C.T. of first meaning which allows an approach of lesional characterization owing to the analogies of structure existing between the causal pancreatic lesion and its muscular and hepatic metastasis.

[Computerized x-ray tomographic aspects of calcifying hepatic metastases. Incidence of cancer of colorectal origin]. / Aspects tomodensitométriques des métastases hépatiques à forme calcifiante. Incidence des cancers d'origine colorectale.

A total of 24 patients with liver metastases of the calcifying type were detected during CT scan imaging for cancer of different primary origin (colorectal, ovarian, mammary, gastric, prostatic, melanoma). These calcifying metastases represented 27% of the 89 liver metastases cases detected, and the incidence of a colorectal origin for these calcifying lesions (20% of cases) appears to be highly significant, their number being relatively larger than reported in previous studies. Identification of liver calcifications of possible diagnostic importance requires a two-stage CT scan investigation, before and after bolus. Paraclinical examinations should be directed selectively towards the digestive tract when the primary tumor is unknown.

[X-ray computed tomography and recent injuries of the abdomen]. / Scanographie X et traumatismes récents de l'abdomen.

Computed tomography was performed in 38 patients with a recent abdominal trauma. Results of this procedure are presented in lesions of the spleen (4 cases), liver (15 cases), pancreas (6 cases), gastrointestinal tract (2 cases), kidney (15 cases). Indications of computed tomography in emergency are only limited by the small number of units. Computed tomography should play an important role in the management of patients with a severe abdominal trauma.

[Calcifying muscular metastases of colonic origin. Apropos of a case localized in the psoas muscle]. / Les métastases calcifiantes musculaires d'origine colique. A propos d'un cas localisé au psoas.

A case is reported of calcifying metastases of colon origin localized to psoas muscle. Emphasis is placed on the effectiveness of CT scan and MR imaging and the rarity of this localization. The presence of intra-lesional calcifications as described in hepatic metastases raises the question of the etiopathogenic mechanism and the predictive value of the detection of a calcified mass during the course of colon adenocarcinoma.