Occurrence of synchronous invasive lobular breast carcinoma and poorly differentiated ovarian carcinoma in a single peritoneal deposit.

The synchronous occurrence of breast and ovarian cancers within individual omental metastases has not been reported in the available medical literature. We report such a finding in a patient with previously diagnosed invasive lobular carcinoma of the right breast. After 5 years of surveillance and disease-free interval, there was development of ovarian cancer, ascites and peritoneal metastases. Ultrasound-guided biopsy of a peritoneal metastasis confirmed dual histology from breast and ovarian carcinoma. Despite the presence of a prolonged disease-free survival from the primary breast cancer, the subsequent finding of advanced ovarian cancer highlights the potential diagnostic and therapeutic dilemmas which persist in the management of these patients.

Alveolar hydatid disease of the liver: computed tomography and transabdominal ultrasound with histopathological correlation.

The appearances of alveolar hydatid disease of the liver (AHDL) on computed tomography (CT) and ultrasound (US) were retrospectively compared with histopathological appearances in 67 patients with 100 separate lesions. The radiological features were correlated directly with the pathological specimens obtained from each patient. We conclude that the CT appearances are more specific, but that US has a role to play in mass screening in endemic areas, and intraoperatively.

[Ultrasonography as a supplemental technique for the diagnosis of adhesion and invasion of abdominal tumors].

Diagnostic capability of ultrasonography (US) concerning with adhesion and/or invasion of the tumors to the surrounding tissues in the abdominal region including pelvis was evaluated in 54 patients with comparison to that of CT. All the lesions reached the surface of the organ and whether the adhesion or invasion of the lesion to the surrounding organ or tissue was a problem. All the patients underwent US and CT. US was performed not only in the usual real-time manner, but with "supplemental" techniques: respiration, drinking water, rectal infusion and bimanual examination. Accuracy of US reached 72% with one or some of those four US supplemental techniques, while accuracy of CT which yields only stable image was 30% (p less than 0.005 by chi 2 test). US with suitable supplemental techniques should be applied to those cases with suspected adhesion or invasion of the tumor in the abdomen, and when CT is not reliable to judge this problem.

[CT in staging gastric cancer].

CT pictures of 26 cases of advanced gastric cancer were reviewed. All the cases of gastric cancer were staged surgically and also histologically. 1) Gastric cancer was enhanced intensely. 2) About the diagnosis of the extension of the tumor, there were many problems to be solved in the future, but the result of final staging was satisfactory. 3) With further advent of technology and methodology in the field of CT, CT will play an important role in staging diagnosis of gastric cancer.

[Ultrasonography of the extremities: nontumor lesions].

Ultrasonographic imagings of non-tumor disorders in extremities were reviewed and discussed. All cases underwent surgery. In our retrospective evaluation, US was found to be effective in cases of tendon injuries, articular osteochondritis, tenosynovitis and the displacement of chondral navicula in infantile club foot, etc.

[Cystic papillary carcinoma of the thyroid--sonographic-pathologic correlation].

Ultrasonographic findings of 13 patients with cystic papillary carcinoma (CPC) of the thyroid gland were reviewed retrospectively correlating with pathologic findings. A 4-6 cm oval cystic structure with a 2-3 cm pedunculated projection of mass into the lumen was the characteristic sonographic findings of CPC. However, other sonographic findings of CPC simulated adenoma, nodular goiter or follicular carcinoma. Pathological investigation revealed that malignant cells tended more to be located in intracystic pedunculated mass and/or pericystic region than in the cyst wall. In most of the cases cyst walls were chiefly composed of granulomatous tissue with scattered malignant cells. These findings indicate that the needle biopsy should be done under ultrasonographic guidance to obtain sufficient material for accurate cytologic and/or pathologic diagnosis, thereby reducing the number of false negative cases.

[Cystic thyroid masses: ultrasonographic and pathologic correlation].

Forty-nine patients with 63 cystic thyroid masses who had undergone preoperative sonography were retrospectively reviewed. 52 lesions (83%) were benign and others (17%) were malignant. Among various sonographic findings of cystic thyroid masses, oval cystic lesions with polyp or dome like solid component projecting into the lumen were all diagnosed adenomatous goiter. Irregular cystic structures with more than 2 cm finger like pedunculated mass extended into and/or out of the lumen were all diagnosed papillary carcinoma. Small oval cysts (less than or equal to 1 cm) with strong echo were all diagnosed colloid goiter. The other sonographic type of cystic thyroid masses had somewhat malignancy (12-30%), not having characteristics which differentiate benign from malignant lesions. Pathologic findings of malignant lesions showed that cancer cells existed rather in pericystic portion than in cyst wall except for finger like solid component projecting into the lumen which was papillary carcinoma itself. Ultrasonically guided needle biopsy should be performed to get samples of above portions.

[CT of pulmonary eosinophilic granuloma].

CT findings of four cases of pulmonary eosinophilic Granuloma were discussed. In three cases, multiple nodular shadows or multiple cavitary lesions were observed in upper and middle lung field predominant. However, in one patient who had history of recurrent pneumothorax, CT revealed a honeycomb appearance and some bullous change as well. These findings seemed to represent a far advanced state of the disease. X-ray CT is excellent in demonstrating such pathological changes, and is indispensable in the diagnosis and follow up study of pulmonary eosinophilic granuloma.

Significant reduction of the echogenicity of the compressed cavernous hemangioma.

Eleven hyperreflective hepatic nodules in eight patients were examined by means of intraoperative ultrasonography (US) with the transducer placed on the liver surface. The nodules included four cavernous hemangiomas, four hepatocellular carcinomas, one metastatic tumor, and two regenerative nodules in cirrhotic livers. When the relevant part of the liver was compressed during US observation, the echogenicity was reduced only in the case of cavernous hemangioma. This phenomenon is considered to be unique to cavernous hemangioma.

[An analysis of needle biopsy under ultrasonography of the thyroid gland].

A multivariate analysis of 47 thyroid nodules and 34 diffuse goiters has been employed to determine the cause of failure in thyroid biopsy under ultrasonography. In the thyroid nodule cases, 30 percent were found to have been misdiagnosed or judged to be an inappropriate sampling. The most important factor leading to failure is a size of tumor. Only one fourth of the small tumors of less than 1 cm were correctly diagnosed and, in cases of a relatively large cystic tumor or a peripherally located nodule, an exact diagnosis was difficult, though 90 percent of the diffuse goiters were difficult, though 90 percent of the diffuse goiters were correctly diagnosed by this method. This result indicates that needle biopsy of the thyroid gland is reliable in cases of a diffuse goiter but problems remain to be resolved in cases of small or cystic tumors and peripherally located nodules.