An unusual case of mammary Paget’s disease in a woman with psoriasis.

Mammary Paget’s disease (MPD) is a malignant breast tumor, which is characterized by intraepidermal infiltration from malignant glandular epithelial cells. Often it may include an underlying ductal carcinoma in situ or an invasive ductal carcinoma. Clinically it appears as an erythematous patch, moist or crusted, with or without desquamation that in some cases becomes ulcerated, causing infiltration and inversion of the nipple. We report the clinical case of a 60-year-old woman, treated in our department for psoriasis, presenting with erythema of nipple and areola with nipple erosion, ulceration and poor secretion. Suspecting Paget’s disease of the nipple, radiological exams (mammography and breast MRI) were performed. A biopsy for histological examination was carried out and confirmed the diagnosis of mammary Paget’s disease. MPD is sometimes difficult to diagnose both clinically and radiologically, therefore it is important to distinguish from other conditions: in literature MPD is reported in differential diagnosis with psoriasis given its similar clinical features, and in some cases MPD has been treated with topical and systemic steroids due to a wrong diagnosis. However, the concomitance, in the same individual, of mammary Paget’s disease and psoriasis has never been described.

[The ankle and hindfoot of rheumatoid arthritis patients: study with computerized tomography]. / La caviglia e il retropiede nei pazienti con artrite reumatoide: studio mediante Tomografia Computerizzata.

To study ankle and hindfoot involvement, we used Computed Tomography (CT) in 38 rheumatoid arthritis (RA) patients (32 women, 6 men, mean age: 56.3 +/- 10.1 years, mean disease duration: 9.9 +/- 6 years) all presenting a definite clinical disease of these joints. The scans were performed on 3rd generation CT equipment (GE ProSpeed SX), with coronally oriented scans 3 mm thick. Bone erosions and joint space narrowing (present/absent) of both talocrural and posterior talocalcaneal joints were assessed and heel valgus angle was measured. Ankle changes (erosion plus joint narrowing) were observed in 15 patients (39.5%, 17 of 76 lower limbs), talocalcaneal changes in 18 (47.4%, 31 lower limbs) and valgus deformity of the hindfoot in 22 (57.9%, 40 lower limbs). Involvement of talocrural and talocalcaneal joints as well as alignment abnormalities were symmetrical in 13.3%, 77.8% and 81.8% of the cases, respectively. All the CT findings were significantly related to disease duration (p = 0.02) and hindfoot injuries to Ritchie index too (p < 0.05). No relationship with seropositivity was observed. Our study confirms that radiographic changes do not entirely mirror clinical evidence and shows that CT does not represent a routine examination for RA patients, but could be reserved to those with prolonged disease or severe heel deformity to plan surgery.

[Density-mask spiral computed tomography in patients who are candidates for a lung-volume-reduction intervention: a preliminary study]. / La Tomografia Computerizzata spirale con maschera della densità nei pazienti candidati a intervento di riduzione del volume polmonare: studio preliminare.

PURPOSE: To investigate the usefulness of helical CT with multiplanar reconstructions and density mask in emphysematous patients candidate for lung volume reduction surgery (LVRS), in order to assess the feasibility of surgery and for surgical planning. MATERIAL AND METHODS: Twenty emphysematous patients (5 women and 15 men; age range: 55-67 years, mean: 61) candidate for LVRS were submitted to isotope perfusion scanning, chest radiography during maximal inspiration and expiration and Helical CT with the low volume contrast technique, multiplanar reconstructions and density mask. RESULTS: Only 8 of the 20 patients examined were submitted to LVRS. They had irregular distribution of emphysema at isotope perfusion scanning and density mask CT. Surgery consisted in an atypical resection of the upper lobe portions which appeared most damage with both techniques. Six of the remaining 12 nonsurgical patients were excluded because of homogeneous distribution of emphysema at both CT and perfusion scanning, which was incompatible with surgery. Lung transplant was considered for 4 of these patients, but only 2 of them actually received it. Three patients were excluded from LVRS because of excessive diaphragm excursion during expiration at chest radiography and of multiple confluent areas of emphysema in both lung at CT and perfusion scanning. One patient with a large area of emphysema in the right upper lobe at CT and perfusion scanning was excluded due to associated severe interstitial disease. Another patient with emphysema mainly involving the lower lobes, as clearly depicted with both techniques, was excluded because the emphysema was secondary to alpha 1-antitrypsin deficiency, a condition known to have a less favorable surgical outcome. Finally, one patient was excluded due to a previous upper transverse laryngectomy, although CT and perfusion scanning patterns were compatible with surgery. CONCLUSIONS: In our opinion, density mask helical CT yields more accurate and clearer images than perfusion scanning, and allows the patients candidate for surgery to undergo a single examination to evaluate the extent and distribution of emphysema and to detect other possible pathological conditions. Though ours was a small series, the results suggest that perfusion scanning be integrated with density mask helical CT, the latter a very important technique for surgical planning.

[Behavior of T1 relaxation time in normal and neoplastic pulmonary tissue. An in vitro study]. / Comportamento del tempo di rilassamento T1 nel tessuto polmonare normale e neoplastico. Studio in vitro.

The aim of the study was to look for a difference between normal and neoplastic lung tissue by means of Magnetic Resonance Spectroscopy in vitro. A 2.1 Tesla intensity spectrometer was used. From 23 pneumonectomized patients, two samples from the lung were taken immediately after surgery: one from the center of the neoplasm, one from the healthy surrounding tissue; on each of them T1 relaxation time was measured. Twenty patients out of 23 had a higher T1 relaxation time in the pathologic tissue than in the healthy surrounding tissue; only in 3 cases the T1 of neoplastic tissue was lower than that of the healthy tissue. A correlation was also sought between the T1 value and the histologic type of the neoplasm. In epidermoid carcinoma, the T1 relaxation time increased with the malignity of the neoplasm.

Pancreatic exocrine involvement in primary Sjögren's syndrome.

Exocrine pancreatic involvement of primary Sjögren's syndrome (SS) was studied. Pancreatic enzyme levels (total amylase, pancreatic isoamylase and immunoreactive trypsin) along with anti-ductuli antibodies (Ab) were studied in 77 patients with primary SS. In 10 patients with normal and 10 with abnormal enzyme levels pancreatic CT scans were also obtained. All enzyme levels were significantly increased in comparison to the control group. Immunoreactive trypsin was found to be the most frequently increased enzyme (35.3% of pSS patients). Anti-ductuli Ab were not found in any patient. Pancreatic CT scans were normal in all subjects with enzymatic increase, whereas 2 abnormal scans were demonstrated in patients without enzyme changes. Our study suggests that exocrine pancreatic involvement is frequent when measured by enzyme levels. Nevertheless, we were unable to demonstrate any morphological lesion by CT scan.