Diffuse sclerosing variant of papillary carcinoma of the thyroid: ultrasound features with histopathological correlation.

AIM: To evaluate the ultrasound (US) features of the diffuse sclerosing variant of papillary carcinoma (DSVPC) of the thyroid, with histopathological correlations. MATERIALS AND METHODS: The US and histopathological findings of six patients with surgically proven DSVPC of the thyroid were retrospectively assessed. RESULTS: Most of cases showed diffuse, scattered microcalcifications with or without associated masses and underlying heterogeneous hypoechogenicity at the site of the DSVPC in the thyroid. At ultrasound, scattered microcalcifications and heterogeneous hypoechogenicity seen in the DSVPC correlated to psammoma bodies and lymphocytic infiltration at histopathological review. CONCLUSION: DSVPC of the thyroid usually manifested as diffuse scattered microcalcifications and associated suspicious mass on ultrasound. These findings are not specific for the DSVPC of the thyroid. However, in relatively young patients with suspicious masses associated with underlying diffuse scattered microcalcifications on US, the possibility of DSVPC should be included in differential diagnosis.

Intraoperative examination of sentinel lymph nodes by immunohistochemical staining in patients with breast cancer.

AIM: To performed a prospective investigation of the relative merits of rapid cytokeratin immunohistochemical (CK-IHC) staining of the SLN removed during the operation of breast cancer patients. STUDY DESIGN: Between December 2002 and March 2004, 62 patients with T1 and T2 breast cancer were enrolled after undergoing successful sentinel lymph node biopsy. Eighty-nine sentinel lymph nodes (mean number, 1.44) were biopsied and first examined by hematoxylin-eosin (H&E) stained frozen section. All the tumour free sentinel lymph nodes by H&E stained frozen section were immunostained for cytokeratin using a rapid immunohistochemical assay (Cytokeratin (PAN), 1:50, Novocastra Lab., Newcastle, UK) during the operations. RESULTS: Rapid IHC staining revealed seven positive sentinel lymph nodes that were negative for metastasis by H&E staining. This study showed a sensitivity of 92.86%, a specificity of 100%, an accuracy of 98.9%, and a negative predictive value of 98.7%. CONCLUSIONS: The intraoperative examination of sentinel lymph nodes is an accurate and effective way of predicting the axillary lymph node status of patients with breast cancers.

Migrated foreign body granulomas on mammography after injection in the cervicofacial area.

AIM: The purpose of this study was to describe the mammographic findings of localized foreign body granulomas in women who were injected with a foreign body in the cervicofacial area to flatten wrinkles. MATERIALS AND METHODS: The teaching files of our institutions were searched, and nine mammograms of migrated foreign body granulomas located. The mammograms were analysed, including the location, shape, size, distribution and depth of the high-density nodules. All these cases had undergone sonography. RESULTS: The migrated foreign body granulomas appeared bilateral (n = 6) or unilateral (n = 3), as oval or round high-density nodules, in the upper inner and/or upper central locations. The average size of the lesions was less than 5 mm in all cases. All nine sonograms showed multiple, round cystic nodules, less than 5 mm in size, with strong posterior shadowing from far upper central to the upper inner breast. Sonography of the lower neck revealed the anatomy could not be visualized due to the strong posterior shadowing in the skin and subcutaneous fat layer. CONCLUSION: Migrated foreign body granulomas appeared on mammograms as localized, multiple oval or round high-density nodules, less than 0.5 cm in size, in the upper inner and/or upper central breast. Breast sonography, including the sonography of the suspected cervicofacial area, is helpful in verifying migrated foreign body granulomas.

Imaging findings of metastatic disease to the breast.

The purpose of this study was to evaluate imaging findings of metastatic disease to the breast. We analyzed 15 cases that had been previously examined by radiographic study (comprising a total of 11 mammograms, 13 ultrasounds and 3 chest CT). Primary malignancies included the following: 6 breast cancers, 5 stomach cancers, 2 melanomas, 1 cervical cancer, and 1 lung cancer. Radiologic findings were analyzed and the 15 cases were divided into two groups: hematogeneous and lymphangitic metastasis. Eleven cases were classified as lymphangitic metastasis (73.3%) and 4 cases were hematogeneous metastasis (26.7%). Multiple masses were shown in 13 cases (86.7%), and 12 cases displayed unilateral lesions (80%). There was no evidence of calcification. In the 11 cases with available mammogram, 7 cases (63.6%) revealed multiple masses with well-defined (2 cases, 28.6%) or ill-defined margin (5 cases, 71.4%) and 6 cases (54.5%) showed diffuse increased density and skin thickening. Among the 11 cases that revealed mass lesions on ultrasound, 2 cases showed a well-defined margin (18.2%) and 9 cases showed an ill-defined margin (81.8%). Posterior shadowing of the mass was seen in only 1 case. Four cases (36.3%) showed a minimal echogenic boundary around the mass. Eight cases showed diffuse skin thickening (53.3%). Three cases with chest CT showed multiple masses and/or diffuse skin and trabecular thickening of the breast. In conclusion, the characteristic imaging findings of metastatic disease to the breast are multiple ill-defined masses with a lack of desmoplastic reaction and no calcification, as compared to primary breast carcinoma. The diffuse lesions without evidence of breast mass on mammogram and US could be distinguishable from inflammatory carcinoma of breast origin.

Sonographic findings of metastatic disease to the thyroid.

The goal of this study was to evaluate the sonographic findings of thyroid metastases arising from non-thyroid primaries. The study over a 5-year period comprised nine patients who had histopathologically proven metastatic disease to the thyroid. Ultrasonography was available in all cases. Ultrasound-guided needle aspiration was performed on 10 suspected nodules as determined by ultrasound. The Ultrasonographic findings were analyzed in two different ways. The first analysis included only those nodules biopsed, and the second analysis included all the nodules, biopsed and non-biopsed. The primary neoplasms were breast carcinoma (n=6), uterine leiomyosarcoma (n=1), cervical carcinoma (n=1), and nasopharyngeal carcinoma (n=1). Excluding 2 nodules, the 8 remaining metastatic nodules exhibited ill-defined hypoechoic character with heterogeneous texture. The other two nodules showed relatively circumscribed iso- or hypo-echoic character with cystic portion. From the analysis of ultrasonographic findings including all thyroid nodules irrespective of pathologic proof, 7 cases - excluding the 2 cases from the 9 cases - showed unilateral or bilateral multiple nodules suspected of metastasis. There was no evidence of microcalcification in any thyroid nodules. In conclusion, the sonographic findings of the thyroid metastatic nodules were not specific, but unilateral or bilateral multiple suspected thyroid nodules without evidence of microcalcification may be suggestive of metastatic nodules among patients with a known primary non-thyroidal tumor.

Radiologic findings of metastatic signet ring cell carcinoma to the breast from stomach.

Two Korean women (41 and 23-years of age) presented with painful breast enlargement and redness. The involved breast was confirmed as metastatic signet ring cell carcinoma. Although metastatic signet ring cell carcinoma of the breast shows similar clinical symptoms to inflammatory breast cancer, the difference between the two is that this malignancy showed no microcalcifications or mass on radiographic findings (mammograms and US). Therefore, after the confirmation of signet ring cell carcinoma of the breast has been made, metastatic signet ring cell carcinoma should be considered if there are no microcalcifications or masses evident on radiographic findings.

Granular cell tumor of the breast.

We report a case of granular cell tumor of the breast presenting as a spiculated lesion mimicking carcinoma on mammography and ultrasonography (US).

Lobular carcinoma in situ in sclerosing adenosis.

The initial presentation of breast malignancy as noninvasive carcinoma in an area of sclerosing adenosis is unusual. Especially, lobular carcinoma in situ in sclerosing adenosis sometimes can be a potential source of confusion with invasive lobular carcinoma. We report a case of lobular carcinoma in situ presenting in adenosis exhibiting patterns akin to invasive lobular carcinoma, thus leading to potential misdiagnosis. Overall architecture of the lesion as seen at lower power and immunohistochemistry can be useful to distinguish between sclerosing adenosis with lobular carcinoma in situ and infiltrating lobular carcinoma.

Significance of follow-up mammography in estimating the effect of tamoxifen in breast cancer patients who have undergone surgery.

OBJECTIVE: We evaluated mammographic changes to assess the effect of tamoxifen in breast cancer patients who had undergone surgery. MATERIALS AND METHODS: We reviewed the mammograms of 102 breast cancer patients treated with tamoxifen (20 mg per day); these patients were subgrouped into tamoxifen-only patients and patients treated with tamoxifen in combination with another therapy (chemotherapy, radiotherapy, or both). The control group was made up of 50 breast cancer patients who did not undergo tamoxifen therapy and 20 healthy women who had an age distribution and menstruation status similar to those of the breast cancer patients. Two radiologists evaluated parenchymal patterns on mammograms of the contralateral breast in the breast cancer patients and of the left breast in the healthy women. Parenchymal changes before and after surgery were also analyzed. RESULTS: Follow-up mammography showed decreased breast parenchyma in 59.8% of the tamoxifen group, 87.0% of the premenopausal tamoxifen-treated women, 36.0% of the nontamoxifen patients, and 10.0% of the healthy women. CONCLUSION: On follow-up mammography of breast cancer patients, breast parenchyma was shown to be decreased after tamoxifen therapy. Mammography can be a useful method for evaluating breast parenchymal changes after tamoxifen treatment.

Imaging of tuberculous disease involving breast.

The aim of our study was to evaluate radiologic findings of the tuberculosis involving breast. We evaluated the radiologic features of 17 patients (18 lesions) with tuberculous disease involving the breast. The radiologic examinations, including mammography (16 patients), ultrasonography (12 patients), and Gd-DTPA-enhanced dynamic MRI (6 patients), were analyzed. Mammographic findings included mass (12 of 17 lesions), calcification (3 of 17 lesions), asymmetric density with spiculated margin (5 of 17 lesions), and axillary lymph node enlargement (8 of 17 lesions). On ultrasonography, a smooth bordered mass (7 of 13 lesions) with thin boundary (7 of 13 lesions) and heterogeneous, intermediate internal echoes (9 of 13 lesions) were most commonly demonstrated. On Gd-DTPA-enhanced dynamic MRI, 3 lesions showed significant enhancement at the first minute after injection (3 of 7 lesions). The maximum enhancing amount was greater than 500 normalized units, and the enhancing pattern was smooth or irregular ring appearance. Breast involvement with tuberculosis is rare but should be considered in the differential diagnosis of a woman living in an endemic area or when extramammary foci of tuberculosis are present. A multimodality imaging approach with clinical evaluation will help to establish the diagnosis of tuberculosis involving breast.

Breast conserving therapy in stage I & II breast cancer in Korea.

A randomized clinical study of 187 patients with T1, T2 breast cancer was performed, in order to compare the effects of modified radical mastectomy (MRM) and breast conserving therapy (BCT) on breast recurrence, overall survival, and disease-free survival. One hundred eighty seven patients with T1, T2 breast cancer, admitted at Yongdong Severance Hospital from April 1991 to August 1994, were randomized into two different treatment groups. Of the 187 patients, 111 patients had received MRM and 76 had received BCT. In any of the variables considered with the exceptions of age and menopausal status, patient characteristics such as tumor size, incidence of axillary lymph node metastasis, histologic grading, and estrogen and progesterone receptor positive rate were not significantly different between the two groups (p < 0.05). Using the Kaplan-Meier Product-limit method and log-rank test, the difference of locoregional recurrence, and overall and disease-free survival, between these comparable groups was analyzed. Average follow-up period was 37.6 months. Two out of 111 MRM patients and two out of 76 BCT patients had locoregional recurrence. Only one patient who had MRM was found to have a recurrence in her opposite breast. The overall survival rates in MRM and BCT patients were, respectively 93.7% and 94.1%. Furthermore, the disease-free survival rates were, respectively, 89.2% and 93.9%. This result indicates that there were no significant differences between two groups in locoregional recurrence, and overall and disease-free survival. Having gained a better cosmetic appearance, the conservative treatment group was satisfied with the BCT. In this study, we conclude that BCT is a good alternative surgical treatment modality for T1, T2 Korean breast cancer patients, which could substitute for the more traditional MRM. However, further follow-up will be needed for long-term results.

Mucoepidermoid carcinoma of the salivary gland--a clinico-pathologic and immunohistochemical study for c-erbB-2 oncoprotein.

Twenty-five cases of mucoepidermoid carcinoma of the salivary glands were studied with respect to clinico-pathologic features, prognostic factors, and c-erbB-2 oncoprotein expression. Fourteen cases were located in parotid glands, 2 in submandibular glands and 9 in minor salivary glands. Fourteen patients were confirmed to have local recurrences, 6 patients manifested systemic metastases, and 10 patients died of the disease. They were histologically graded as I in 5, II in 12 and III in 8 cases respectively, and the histologic grade was significantly correlated with disease-free interval and overall survival of the patients. c-erbB-2 overexpression was observed in 9 cases (36%), with a trend to be associated with the higher grade, but was not evaluated as a significant survival-related factor in this series. Larger size and major gland location of the tumors were correlated with more frequent regional lymph node metastases. The present study showed that c-erbB-2 overexpression was not uncommonly present in mucoepidermoid carcinoma of the salivary glands, especially of higher grade, and the histologic grade was the most important and handy prognostic indicator.

Partial mastectomy with axillary lymph node dissection and radiotherapy as a new treatment modality of breast cancer (I).

This is the first preliminary report among two consecutive papers. Partial mastectomy(PM), axillary lymph node dissection(AD) and radiotherapy (RT) were performed on seventeen operable breast cancer patients who had been admitted from April 1991 to March 1992 to the department of surgery, Yongdong Severance Hospital for improved cosmetic appearance and better survival rate. Of seventeen patients, 47% were T1 lesion and 76% were stage I and II. Extensive intraductal component(EIC) within or around the tumor was also analyzed. Twenty nine per cent of the patients were EIC positive. The mean number of axillary lymph nodes was 21.5 after PM with AD and 20.5 after mastectomy. For radiotherapy, 4,500 rad was delivered to the breast parenchyma and 1,600 rad of boost to the primary tumor site using the electron beam method after surgery. All patients have since been living well without any local recurrence and were satisfied with breast preservation for the one-year follow-up period. We concluded that the PM, AD and RT can be another surgical treatment modality of breast cancer. A longer follow-up data will be followed on the second paper.

Congenital glioblastoma multiforme--report of an autopsy case.

A congenital neoplasm arising in the central nervous system is rarely encountered, and the majority of case reports that have dealt with intracranial tumors have been divided almost equally between teratomas and various gliomas. We experienced a rare case of congenital glioblastoma multiforme encountered in a three day-old male infant who presented with hydrocephalus since birth. Post-mortem examination revealed that the tumor seemed to have originated from the right thalamic region extending centrifugally to the cerebral cortex and through the brain-stem down to the cerebellum.

The role of mammography on breast cancer patients in a hospital setting.

From Oct. 1, 1983 to May 31, 1988, 6198 mammograms were taken and 443 mastectomies were performed at the Yonsei University Hospital, Seoul, Korea. Of these, 191 cases had preoperative mammography performed prior to surgery (study group) and 252 cases underwent mastectomies without preoperative mammography (control group). There were no significant differences between the two groups in pathological stages, axillary lymph node metastasis and size of the tumor, suggesting that little benefit is derived from the preoperative mammography in the hospital setting. However, there were a number of other findings, including a 14% incidence of multiple foci and localization of non-palpable cancer in 3% of cases, that could help us to make therapeutic plans and strategies for these patients.

Combined modality therapy in Stage III and Stage IIIE diffuse large cell lymphomas.

Combined modality therapy consisting of CHOP-Bleo (cyclophosphamide, Adriamycin [doxorubicin], vincristine (Oncovin), prednisone, and bleomycin) and limited-field radiotherapy was given to 47 patients with Stage III and IIIE diffuse large cell lymphomas. Overall 5-year survival and disease-free survival figures are 64% and 53%, respectively. Twenty-nine patients achieved and maintained a complete remission during treatment; 92% of these patients are alive at 5 years, and 87% are disease-free. Prognostic factors were assessed for the entire group. Age, "B" symptoms, extranodal involvement, and extensive abdominal involvement had little effect on survival. However, the presence of mediastinal involvement and extensive abdominal involvement was associated with a poor response rate and survival.