Enhancement patterns and parameters of breast cancers at contrast-enhanced US: correlation with prognostic factors.

PURPOSE: To investigate the correlation between enhancement patterns and parameters of contrast material-enhanced ultrasonography (US) with prognostic factors in breast cancers. MATERIALS AND METHODS: The study was approved by the institutional ethics committee, and written informed consent was obtained. Surgical resection specimens of 74 malignant breast lesions in 74 women (mean age, 55 years; age range, 32-78 years) who had undergone contrast-enhanced US were included. Different contrast enhancement patterns (enhancement degree, order, and margin; internal homogeneity; perfusion defect; and radial or penetrating vessels) and parameters (wash-in time, peak intensity, time to peak, area under the time-intensity curve, ascending slope, and descending slope) were evaluated. Pathologic prognostic factors, including histologic grade, lymph node status, tumor diameter, microvessel density (MVD), estrogen and progesterone receptor status, and c-erb-B2, p53, and Ki-67 expression were determined. Correlation of enhancement patterns and parameters with prognostic factors was analyzed with the Pearson χ2 test, Spearman rank correlation test, and logistic regression analysis. RESULTS: Some enhancement features were associated, albeit not significantly, with prognostic factors. Perfusion defect was the most accurate enhancement criterion for higher histologic grade (grade III) (P=.016), negative estrogen receptor expression (P=.006), positive c-erb-B2 expression (P=.013), larger tumor diameter (≥2 cm) (P=.016), and increased MVD (P=.019). Radial or penetrating vessels were associated with lymph node status (P=.010). Hyperenhancement may be useful in reflecting increased MVD (P=.008) and positive p53 expression (P=.037). For contrast enhancement parameters, ascending slope was the best discrimination criterion for proliferative activity (P=.003). CONCLUSION: Enhancement patterns and parameters of contrast-enhanced US may be useful in the noninvasive prediction of prognostic factors of breast cancers.

[Three-step sperm retrieval for 73 non-obstructive azoospermia patients].

OBJECTIVE: To investigate the value and clinical application of the Three-Step Sperm Retrieval method in improving the sperm retrieval rate for non-obstructive azoospermia (NOA) patients. METHODS: Seventy-three NOA patients underwent Three-Step Sperm Retrieval in the following order of procedures: testicular fine needle aspiration (TFNA), testicular sperm extraction (TSE), and microdissection testicular sperm extraction (MD-TSE). The testicular tissue obtained from each step was observed for spermatozoa under the 400-fold inverted microscope. If spermatozoa were found in one step, the operation would be stopped; otherwise, the next step would be carried out. The testicular tissue was subjected to pathological examination. RESULTS: Spermatozoa was found in the testicular tissue in 38.4% of the cases (28/73) at TFNA as the first step, in 52.1% (38/73) at TFNA and TSE, and in 64.4% (47/73) at TFNA, TSE and MD-TSE. Pathological examination showed 25 of the cases to be Sertoli cell-only syndrome, 21 to be sperm maturation arrest and the other 27 to be hypospermatogenesis, in which spermatozoa were found in 10, 14 and 23 cases, respectively. CONCLUSION: The Three-Step Sperm Retrieval method can significantly improve the sperm retrieval rate for NOA patients. And the sperm retrieval rate is associated with the pathological type of the testicular tissue, a higher rate with hypospermatogenesis.

Value of contrast-enhanced sonography with micro flow imaging in the diagnosis of prostate cancer.

BACKGROUND: To evaluate the effectiveness of contrast-enhanced sonographic micro flow imaging (MFI) in the diagnosis of prostate cancer. METHODS: A total of 74 patients referred for prostate biopsy were prospectively evaluated with MFI. The abnormalities were categorized into four patterns: pattern 1: indistinct separation between the inner and outer gland; pattern 2: asymmetrical or focally increased enhancement in the outer gland; pattern 3: enhancement with focal defect; pattern 4: enhancement in the outer gland equal to that of the inner gland. The findings were correlated with Gleason scores. RESULTS: Prostate cancer was detected in 264 sites in 41 patients. The sensitivity, specificity, accuracy, and positive and negative predictive values for MFI were 81.1%, 84.3%, 83.3%, 68.6%, and 91.3%, respectively. Positive predictive values for the four patterns were 46.0 (pattern 1), 53.6 (pattern 2), 94.3 (pattern 3), and 95.4 (pattern 4). Gleason scores of cancers with patterns 3 (7.09) or 4 (7.51) were significantly higher than those with patterns 1 (6.17) or 2 (6.59) (p = 0.001, p = 0.005, p < 0.001, p < 0.001). CONCLUSIONS: Some MFI patterns had high positive predictive values and were associated with more aggressive cancers. This could be used to reduce the number of biopsy sites and detect clinically significant cancers.

Differential diagnosis of azoospermia and etiologic classification of obstructive azoospermia: role of scrotal and transrectal US.

PURPOSE: To evaluate the usefulness of scrotal and transrectal ultrasonography (US) in the differential diagnosis of azoospermia and the etiologic classification of obstructive azoospermia. MATERIALS AND METHODS: This study was approved by the institutional ethics committee, and all patients provided written informed consent. Between April 2006 and November 2008, 100 infertile men (mean age, 32 years; range, 22-51 years) with azoospermia were evaluated at scrotal and transrectal US, with an emphasis on abnormal US findings of the seminal tract and measurement of testicular volume. On the basis of the results of percutaneous epididymal sperm aspiration, testicular fine-needle aspiration cytology, or testicular biopsy, 97 patients with azoospermia were divided into obstructive or nonobstructive groups. The remaining three patients had Klinefelter syndrome and did not undergo testicular biopsy. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of different indexes for discrimination between obstructive and nonobstructive azoospermia. Cases of obstructive azoospermia were further classified according to obstructive causes. RESULTS: Seminal tract abnormalities were more common in obstructive (92.2% [59 of 64 patients]) than in nonobstructive (2.8% [one of 36 patients]; P < .001) azoospermia. Testicular volume was significantly larger for obstructive (median, 16.0 mL; range, 8.4-27.5 mL) than for nonobstructive (median, 8.6 mL; range, 0.9-21.0 mL; P < .001) azoospermia. The area under the ROC curve for discrimination between the groups through combined assessment of the seminal tract and testicular volume at scrotal and transrectal US was 0.96. Sensitivity, specificity, and accuracy for combined assessment in discriminating between obstructive and nonobstructive azoospermia were 95.3% (61 of 64 patients), 97.2% (35 of 36), and 96.0% (96 of 100), respectively. CONCLUSION: Scrotal US and transrectal US are effective imaging modalities for distinguishing obstructive from nonobstructive azoospermia and can provide meaningful diagnostic information for determining the etiologic classification of obstructive azoospermia.

[Desmoplastic small round-cell tumor of the paratesticular region: a case report and review of the literature].

OBJECTIVE: To investigate the clinical and pathological features of paratesticular desmoplastic small round cell tumor (DSRCT), and to improve the diagnosis and treatment of the disease. METHODS: One case of paratesticular DSRCT was studied retrospectively and a considerable amount of related literature from Medline and Chinese journals reviewed. The patient was a 27-year-old man presenting with a painless testicular mass in the left hemiscrotum. On physical examination, a cystic mass was palpable while the testis was not in the left hemiscrotum. RESULTS: During the operation the paratesticular area was found full of multiple nodular tumor masses of various sizes ranging from 0.5 cm to 1.5 cm in diameter. Pathological examination showed the characteristic histological pattern of nests of small undifferentiated cells embedded in a dense fibrous stroma. The tumor presented an immunohistochemical feature of epithelial, mesenchymal as well as neural multidirectional differentiation. Following testicular tumor orchiectomy, chemotherapy was performed with DDP, VP16, ifosfamide and EPI. Three years follow-up found no tumor recurrence. CONCLUSION: Desmoplastic small round cell tumor has a specific clinicopathologic stigmata, usually occurring in young males, for which surgical resection with chemotherapy is the treatment of choice. DSRCT located in the paratesticular region may have a better prognosis than its more frequently abdominal counterpart.

Brunner's gland adenoma of duodenum: a case report and literature review.

AIM: To analyze the clinicopathological features of Brunner's gland adenoma of the duodenum. METHODS: A rare case of Brunner's gland adenoma of the duodenum was described and related literature was reviewed. RESULTS: Brunner's gland adenoma of the duodenum appeared to be nodular hyperplasia of the normal Brunner's gland with an unusual admixture of normal tissues, including ducts, adipose tissue and lymphoid tissue. We suggested that it might be designated as a duodenal hamartoma rather than a true neoplasm. CONCLUSION: The most common location of the lesion is the posterior wall of the duodenum near the junction of its first and second portions. It can result in gastrointestinal hemorrhage and duodenal obstruction. Endoscopic polypectomy is a worthy treatment for benign Brunner's gland adenomas, as malignant changes in these tumors have never been proven.

[Dynamic observation of vascular endothelial growth factor (VEGF)/VEGF-receptors expression in acute leukemia].

OBJECTIVE: To investigate the expression of vascular endothelial growth factor (VEGF)/VEGF-receptors and its relation to bone marrow angiogenesis in acute leukemia patients before and after chemotherapy. METHODS: Bone marrow biopsies from 122 cases with different stages of human acute leukemia were immunostained with anti-vascular endothelial growth factor, anti-fms-like tyrosine kinase (Flt-1) and anti- kinase-domain insert containing receptor (KDR) antibodies with envision two-step immunohistochemical staining method. RESULTS: The expression of VEGF and KDR protein in remission patients was 5.3 (3.3 - 9.0) and 2.0 (1.0 - 4.0) being significantly lower than newly diagnosed untreated patients 6.0 (3.3 - 12.0) and 5.3 (3.3 - 8.0) (P < 0.05, 0.01). However nonsignificant decrease was shown among non-remission patients. In relapsed patients the expression of VEGF and KDR was significantly increased as compared with that in newly diagnosed patients. Flt-1 staining levels were in the same range between the newly diagnosed untreated patients and control group (P > 0.05), but significantly increased in remission or relapse patients, being 3.3 (1.7 - 5.3) in the remission group and 3.3 (2.0 - 5.3) in the relapse group (P < 0.01). Expression of VEGF and KDR protein was significantly higher in patients with a high degree of bone marrow microvessel counts as compared with those with a low degree and the expression correlated well with microvessel counts (P < 0.01). There was a positive correlation of the percentage of bone marrow blasts with VEGF and KDR expression in AML patients (r = 0.429, 0.359; P = 0.005, 0.02), and with VEGF expression in ALL patients (r = 0.522; P = 0.03). CONCLUSION: VEGF and its two specific cellular receptors are expressed in both haematopoietic cells and endothelial cells. VEGF may be a autocrine factor and modulates the angiogenic reaction in bone marrow as a paracrine factor. VEGF and its cellular receptor KDR may constitute promising targets for antiangiogenic and antileukemic treatment strategies.