Granulomatous diseases of the breast and axilla: radiological findings with pathological correlation.

OBJECTIVES: This article reviews our experience and describes the literature findings of granulomatous diseases of the breast and axilla. METHODS: After approval of the Institutional Review Board was obtained, the surgical pathological records from January 2000 to January 2017 were searched for the keyword granulomatous. Clinical, imaging and histology findings were reviewed by both a fellowship-trained radiologist and a breast-imaging consultant radiologist, reviewing 127 patients (age range, 32-86 years; 126 women and 1 man). RESULTS: Most common causes of granulomatous lesions of the breast and axilla included silicone granulomas 33% (n = 42), fat necrosis 29% (n = 37) and suture granulomas 11% (n = 14). In 16% (n = 20), no cause could be found and clinical history was consistent with idiopathic granulomatous mastitis. Other granulomatous aetiologies included granulomatous infections, sarcoidosis and Sjögren's syndrome. Causes of axillary granulomatous disease were similar to the breast; however, a case of cat-scratch disease was found that only involved the axillary lymph nodes. They can have a variable appearance on imaging and may mimic malignancy with irregular masses seen on mammography, ultrasound and magnetic resonance imaging. Fistulas to the skin and nipple retraction can suggest chronicity and a granulomatous aetiology. Combination of clinical history, laboratory and imaging findings can be diagnostic. CONCLUSIONS: Granulomatous processes of the breast are rare. The diagnosis can, however, be made if there is relevant history (prior trauma, silicone breast implants, lactation), laboratory (systemic or infectious processes) and imaging findings (fistula, nipple retraction). Recognising these entities is important for establishing pathological concordance after biopsy and for preventing unnecessary treatment. TEACHING POINTS: Breast granulomatous are rare but can mimic breast carcinoma on imaging Imaging with clinical and laboratory findings can correctly diagnosis specific granulomatous breast diseases Recognition of the imaging findings allows appropriate pathological concordance and treatment.

Imaging Features of AlloDerm(®) Used in Postmastectomy Breast Reconstructions.

The purpose of this pictorial essay is to demonstrate the imaging features (ultrasound, mammogram, and magnetic resonance imaging (MRI)) of AlloDerm(®)(LifeCell Corp.; Branchburg, NJ), an acellular dermal matrix sometimes used in both primary and reconstructive breast surgeries. AlloDerm(®) is derived from cadaveric dermis and provides an immunologically inert scaffold in tissue reconstruction. Since there is little literature on the imaging of this substance, radiologists may be unfamiliar with its appearance in breast imaging. For this manuscript, ex vivo and in vivo images of AlloDerm(®) in postmastectomy patients were evaluated using different imaging modalities. The appearance of AlloDerm(®) can vary based on length of time postsurgery and incorporation into the host. AlloDerm(®) appears as an isodense to glandular tissue on a mammogram and isoechoic to glandular tissue on ultrasound imaging. On MRI, in comparison with normal breast parenchyma, AlloDerm(®) is hyperintense on T2-weighted imaging and isointense on T1-weighted imaging and demonstrates mild enhancement. To the best of the authors' knowledge, this is the first multimodality imaging description of AlloDerm(®) used in postmastectomy patients. The conformation of AlloDerm(®) at surgical placement and the degree of host cell migration and neoangiogenesis are factors to take into consideration when performing diagnostic evaluations; and, familiarity with the various imaging appearances of AlloDerm(®) can be helpful to exclude residual or recurrent disease.

Semiquantitative analysis of brain metabolism in patients with paraneoplastic neurologic syndromes.

PURPOSE: The objective of this study was to evaluate brain metabolism with F-FDG-PET in patients with definite or possible paraneoplastic neurologic syndromes (PNS) using qualitative assessment and semiquantitative measurements with subsequent correlation with MRI. METHODS: The institutional review board approved this Health Insurance Portability and Accountability Act-compliant study. A prospective PET database of patients referred for PNS between 2001 and 2010 was queried retrospectively and identified 102 patients who met the diagnostic criteria for PNS, had PET brain imaging, and lacked clinical or MRI evidence of an alternative diagnosis.Qualitative and semiquantitative evaluation of brain metabolism was obtained by 3-dimensional stereotactic surface projection and region-based analysis. Qualitative and semiquantitative assessment was performed blinded to clinical data. RESULTS: PET/CT demonstrated that 67 patients had abnormal brain glucose metabolism. Six categories of brain hypometabolism were identified: diffuse (36/67), cerebellar (10/67), basal ganglia (10/67), frontal (9/67), temporal (1/67), and occipital (1/67). The mean Z score of the cerebral cortex in diffuse hypometabolism was 1.65 (range, 0.25-3.46). For cerebellar hypometabolism, the mean Z score of the cerebellum was 2.31 (range, 0.52-4.54). In basal ganglia hypometabolism, the mean Z score was 2.53 (range, 1.78-3.89), and in frontal lobe hypometabolism, the mean Z score was 2.11 (range, 1.39-4.45). The majority (39/67, 62.9%) with abnormal glucose metabolism on PET had a normal MR. CONCLUSIONS: Patients with PNS frequently have abnormal brain metabolism on semiquantitative PET/CT. With semiquantitative analysis, we defined 6 common patterns of abnormalities, which often correlated with clinical symptoms. Both qualitative and semiquantitative analyses of brain glucose metabolism may be helpful in evaluating PNS, especially in patients with a normal MRI.

Percutaneous ultrasound-guided thrombin injection of a post-traumatic pancreatic pseudoaneurysm in a pediatric patient.

Non-operative management for blunt injuries to the proximal pancreas has become increasingly common. A bleeding pseudoaneurysm in the setting of a traumatic pancreatic pseudocyst presents a morbid operation. We present the case of a 15-year old with a grade V pancreatic injury that developed a bleeding pseudoaneurysm successfully treated with percutaneous ultrasound-guided thrombin injection.