[Idiopathic granulomatous mastitis and breast carcinoma: What difference on elastography?] / Mastite granulomateuse idiopathique et carcinome mammaire : quelle différence à l'élastographie ?

OBJECTIVES: To determine the elastographic characteristics of idiopathic granulomatous mastitis compared to breast carcinoma. MATERIALS AND METHODS: Retrospective study of 63 breast masses. Ultrasound B mode and strain elastography were performed for each mass. Qualitative criteria (strain score) and semi-quantitative criteria (strain and length ratio) of strain elastography were studied. The pathological findings were used as the reference standard. RESULTS: Sixty-three breast masses, there were 15 idiopathic granulomatous mastitis and 48 breast carcinomas. The mean strain ratio of idiopathic granulomatous mastitis was significantly lower than that of breast carcinoma, respectively 3.34±2.50 and 21.22±20.57 (P<0.0001). However, there was no significant difference between the mean length ratio of idiopathic granulomatous mastitis and breast carcinoma, respectively 1.17±0.18 and 1.22±0.23 (P=0.381). CONCLUSION: Breast elastography helps to differentiate idiopathic granulomatous mastitis from breast carcinoma.

[Accuracy of CT-guided chest biopsy for benign lesions]. / Performance de la biopsie transthoracique et lésions bénignes.

PURPOSE: To demonstrate that CT-guided chest biopsy can effectively prevent surgery for patients with benign tumors. PATIENTS AND METHODS: We present a cohort of patients who underwent CT-guided biopsy for a chest lesion where diagnosis could not be achieved through other means. The gold standard was defined, based on availability, by surgery or imaging and clinical follow-up over a 2-year period. RESULTS: From a total of 114 biopsied lesions, 101 were malignant and 13 were benign. Sensitivity and specificity values for benign lesions were 92.1 and 92.3% respectively with PPV and NPV of 60 and 98.9%. Sensitivity and specificity values for malignant lesions were 86.1 and 100% respectively with PPV and NPV of 100 and 48%. No statistically significant correlation could be established between the groups with concordant and discordant results. CONCLUSION: The diagnosis of specific benign lesion on CT-guided biopsy, all sizes and sites included, may effectively prevent unnecessary surgery.

Association of Budd-Chiari syndrome and celiac disease.

BACKGROUND AND AIMS: An association between Budd-Chiari syndrome (BCS) and celiac disease (CD) is uncommon. The aims of our study were to investigate the etiology of BCS and to search for a particular HLA Ag pattern among patients. PATIENTS AND METHODS: BCS diagnosis was based on Doppler ultrasound and CD diagnosis on duodenal biopsy, transglutaminase (TGAb) and gliadin antibodies (GAb). Patients were screened for prothrombotic disorders and seven had a PCR-SSO test for HLA genotypes. Patients were treated with anticoagulants and gluten-free diet. RESULTS: Nine patients were included; mean age 27 years (20-42); sex ratio (F/M) 2; mean follow-up duration 31 months (6-54). All patients had endoscopic and histological features of CD. GAb/TGAb were found in 78 % (n=7). Ag HLA found were HLA DQß1(*)02 (n=6) and DQß1(*)03 (n=3). Prothrombotic conditions identified were latent myeloproliferative disorder (n=1), protein C deficiency (n=1), probable factor V Leiden (n=1) and oral contraceptive use (n=1). No prothrombotic state could be identified in the five other patients. CONCLUSION: The BCS-CD association is relatively frequent in our country. Underlying prothrombotic conditions were absent in more than 50 % of cases, suggesting CD plays a role in the occurrence of thrombosis. HLA alleles found are strongly associated with CD, without any particular pattern for the BCS-CD association.

The sella turcica in Sheehan's syndrome: computerized tomographic study in 54 patients.

A CT scan study of the sella turcica and its contents was conducted in patients with Sheehan's syndrome with a search for correlation between the radiological data and the degree of endocrine insufficiency on one hand, and the time course of the disease on the other. Fifty-four patients with Sheehan's syndrome were included: 32 with complete anterior hypopituitarism, 22 with at least one spared pituitary function. Subgroups of equal size were obtained with a cut-off of 9 years evolution. The CT scan appearance of the pituitary was never normal in Sheehan's syndrome. The sella turcica was totally empty in 39 patients. A pituitary remnant was visible in 15 patients, more frequently in those with incomplete hypopituitarism (p less than 0.005) and those with short evolution (p less than 0.025). The size of this pituitary residue never exceeded one third of the normal pituitary gland. The pituitary stalk was always visualized. On the other hand, the size of the fossa was significantly (p less than 0.001) smaller in the patients, as compared to a 12-female control group, matched for age and number of pregnancies. Among the patients there was no difference when considering the disease duration nor the degree of hypopituitarism. An empty or partially empty sella of normal or reduced size is a constant feature of Sheehan's syndrome. The presence of a pituitary remnant is inversely correlated to the duration and extension of the disease. Arachnoid herniation alone does not induce a dilatation of the fossa.