[Unilateral gigantomastia of pregnancy: case-report of a giant breast hamartoma]. / Gigantomastie unilatérale gravidique: à propos d'un cas d'hamartome géant.

Breast hamartoma is a benign tumour consisting of fat, fibrous and glandular tissue. A young woman in her 19th week of pregnancy underwent exceptional surgery for a unilateral gigantomastia secondary to a rapid-growth giant hamartoma during her second pregnancy. Rigourous clinical and ultrasonographic examinations were performed followed by multiple biopsies. The decision to perform surgery was guided by the risk to skin integrity and of tumour infarct. Our report provides detailed information on gestational benign breast tumours, on the specificities of medical imaging and breast surgery in pregnant patients.

[MRI-guided breast microbiospy or macrobiopsy: which is the best option for a small tumor?]. / Micro- ou macrobiopsie mammaire guidée par IRM : quel est le meilleur choix pour une petite tumeur ?

The choice of the optimum therapeutic strategy for breast cancer depends on the histological diagnosis of the sample obtained by biopsy. The microbiopsy is the preferred method as it provides an accurate diagnosis of the histological type as well as the main prognostic factors, whilst being simple, fast and inexepensive. However, some infraclinic breast tumors are not accessible by conventional guidance due to excessive depth inside the breast, their small size or technical inability to image them by mammography or ultrasonography. In those cases, the MRI guidance may help to perform the biopsy. Most MRI biopsies are made by large-core needle that are known to alter the histological structure of the tumor and to disturb the anatomopatholgical analysis (size and surgical margin). Those are very important elements to know before treatment. Our case report details an original technique of MRI microbiopsy of a deep 4mm opacity found on the occasion of a patient's mammography. The operative specimen revealed an invasive ductal carcinoma of 4mm diameter which scored III on the Elston and Ellis scale (oestrogen and progesterone receptors tested negative and HER-2 was over-expressed). It was associated with a high grade in situ ductal carcinoma. No systemic treatment was prescribed due to the small size of the carcinoma. The development of partially or totally amagnetic microbiopsy pistols would help perform microbiopses guided by MRI.

Scaphotrapezial ligament: normal arthro-CT and arthro-MRI appearance with anatomical and clinical correlation.

The purpose of our study was to demonstrate and describe the MR and arthro-CT anatomic appearance of the scaphotrapezial ligament and illustrate some of the pathologies involving this structure. This ligament consists of two slips that originate from the radiopalmar aspect of the scaphoid tuberosity and extend distally, forming a V shape. The ulnar fibers, which are just radial to the flexor carpi radialis sheath, inserted along the trapezial ridge. The radial fibers were found to be thinner and inserted at the radial aspect of the trapezium. Twelve fresh cadaver wrists were dissected, with close attention paid to the scaphotrapezio-trapezoidal (STT) joint. An osseoligamentous specimen was dissected with removal of all musculotendinous structures around the STT joint and was performed with high-resolution acquisition in a 128-MDCT scanner. Samples of the wrist area were collected from two fetal specimens. A retrospective study of 55 patients with wrist pain that were submitted to arthrography, arthro-CT, and arthro-MRI imaging was performed (10 patients on a 3-T superconducting magnet and 45 patients on a 1.5-T system). Another ten patients had high-resolution images on a 3-T superconducting magnet without arthrographic injection. MR arthrography and arthro-CT improved visualization and provided detailed information about the anatomy of the scaphotrapezial ligament. Knowledge of the appearance of this normal ligament on MRI allows accurate diagnosis of lesions and will aid when surgery is indicated or may have a role in avoiding unnecessary immobilization.