Accuracy and Clinical Impact of Persistent Disease Diagnosed on Diffusion-Weighted Imaging and Accuracy of Pelvic Nodal Assessment on Magnetic Resonance Imaging for Squamous Cell Carcinoma of the Anus in the 6-Month Interval Post Chemoradiotherapy.

PURPOSE: To evaluate the diagnostic performance of diffusion-weighted imaging (DWI) in the 6-month interval post chemoradiation therapy (CRT) in determining persistent disease and whether persistent diffusion restriction on DWI at 6 months is associated with overall survival; and secondarily, to investigate the accuracy of pelvic lymph node assessment on T2-weighted imaging and DWI in the 6-month interval post CRT, in patients with squamous cell carcinoma of the anus. METHODS AND MATERIALS: This retrospective study included patients with squamous cell carcinoma of the anus who underwent CRT followed by restaging rectal MRI from January 2010 to April 2020, with ≥1 year of follow-up after CRT. DW images were qualitatively evaluated by 2 junior and 2 senior abdominal radiologists to determine anal persistent disease. The reference standard for anal persistent disease was digital rectal examination/endoscopy and histopathology. Diagnostic performance was estimated using sensitivity, specificity, negative predictive value, and positive predictive value. Survival outcomes were evaluated via Kaplan-Meier analysis, and associations between survival outcomes and DWI status were tested for significance using the log-rank test. Additionally, DW and T2-weighted images were evaluated to determine lymph node status. RESULTS: Among 84 patients (mean age, 63 ± 10.2 years; 64/84 [76%] female), 14 of 84 (17%) had confirmed persistent disease. Interreader agreement on DWI between all 4 radiologists was moderate (Light's κ = 0.553). Overall, DWI had a sensitivity of 71.4%, specificity of 72.1%, positive predictive value of 34.5%, and negative predictive value of 92.5%. Patients with a negative DWI showed better survival than patients with a positive DWI (3-year overall survival of 92% vs 79% and 5-year overall survival of 87% vs 74%), although the difference did not reach statistical significance (P = .063). All patients with suspicious lymph nodes (14/14, 100%) showed negative pathology or decreased size during follow-up. CONCLUSIONS: At 6 months post CRT, DWI showed value in excluding anal persistent disease. Persistent diffusion restriction on DWI was not significantly associated with overall survival. Pelvic nodal assessment on DWI and T2-weighted imaging was limited in predicting persistent nodal metastases.

Follicular lymphoma presenting as a seminal vesicle mass: Diagnostic path from prostate MRI to 18F-FDG PET/CT.

A 73-year-old man with biopsy-proven Gleason 3+3 prostate cancer presented with a new mass centered in the seminal vesicles with invasion of the base of the prostate on surveillance prostate MRI. Targeted biopsy showed atypical lymphoid proliferation, suspicious for lymphoma. The patient was referred to the nuclear medicine department for [18F]fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT). Multisite 18F-FDG-avid lymphadenopathy observed, as well as FDG uptake in the new mass. Core biopsy from dominant mesenteric mass revealed follicular lymphoma.

Extracolonic findings at CT colonography in an oncological hospital setting and why they matter.

PURPOSE: To evaluate the frequency and clinical outcome of unknown extracolonic findings in patients with cancer who underwent CT colonography (CTC). METHODS: Consecutive patients who underwent CTC from February 2000-April 2016 for any indication were retrospectively included. One radiologist blinded to clinical data determined C-RADS classification for all extracolonic findings on CTC reports as follows: E1: normal examination or anatomic variant, E2: clinically unimportant, E3: likely unimportant, incompletely characterized, and E4: potentially important. Another radiologist performed an unblinded review of medical records and determined if E4 findings were previously known or new, and classified new E4 findings as clinically important or unimportant on follow-up. RESULTS: Of 855 patients, 686/855 (80.2%) had a normal examination or clinically unimportant extracolonic findings (E1 and E2) and 169/855 (19.8%) had E3-E4 extracolonic findings [99/855 (11.6%) patients had known E4 findings and 102/855 (11.9%) patients had new E4 findings]. On follow-up, among new E4 findings, 71/855 (8.3%) patients had clinically important findings, 66/855 (7.7%) had a malignant outcome previously unknown by the referring physician, and 5/855 (0.6%) had other complications, including bowel obstruction and cirrhosis. Regarding new oncological findings, new extracolonic primary tumors were detected in 13/855 (1.5%) patients, corresponding to 12.7% (13/102) of the new E4 findings. The proportion of new E4 findings on CTC with and without intravenous contrast was not significantly different [41/320 (12.8%) vs 61/535 (11.4%), p = 0.612]. CONCLUSION: Among oncological patients, detection of new significant E4 extracolonic findings at CTC occurred in 8.3% of all cases, including unknown cancers in 1.5%.

Can Hounsfield Unit Density Accurately Predict Recurrent Cholestatoma in Previously Operated Ears?

The objective of the study was to determine whether Hounsfield Unit density would differentiate between cholesteatoma and other causes of opacification, such as granulation tissue in previously operated ears. Temporal bone computer tomography (CT) scans of 47 patients, who had revision mastoid surgeries, were evaluated retrospectively. A circular 5 mm2 region of interest (ROI) was placed at aditus ad antrum to measure Hounsfield Unit (HU) density. There was no statistically significant difference between cholesteatoma and non-cholesteatoma groups in terms of HU densities. Intraclass correlation coefficient test showed an intraclass correlation of 0.41 between measurements done by radiologists and otorhinolaryngologists, which showed poor reliability. Contrary to previous studies in unoperated ears, in operated ears HU density at aditus level cannot be a reliable diagnostic adjunct. Moreover, when it is considered that interrater reliability was poor between radiologists' and otolaryngologists' measurements, a need for further studies arise to solidify findings in this study. Key Words: Cholesteatoma diagnostic imaging, Middle ear surgery, Revision mastoidectomy.

Male Breast Cancer with Radiological and Histopathological Findings.

OBJECTIVES: We aimed to remind and emphasize the importance of male breast cancer with radiological and histopathological results of the patients diagnosed in our institution. METHODS: Men who had proven breast cancer by histopathological analysis between February 2010-April 2018 were reviewed retrospectively. The mammographic, ultrasonographic, magnetic resonance and positron-emission-tomography imaging features and histopathological results of the masses were noted. RESULTS: Twenty-five men were included in this study. Mean age of the patients was 62.9 (min:42; max: 82) with a mean size of lesions was 26.4 mm (min:10 mm; max: 70 mm). All the lesions were presented as a palpable mass. According to imaging features of the five patients who had mammography, all the four patients were presented as a mass but one patient as asymmetrical density. According to imaging features of the 20 patients who had an ultrasound, 16 (80%) lesions were presented as hypoechoic solid masses with irregular margins, while four (20%) were presented as complex-cystic masses with irregular margins. All the patients were diagnosed as invasive ductal cancer with luminal subtype by histopathological analysis. CONCLUSION: Even at young ages, the palpable lesion may be the only symptom of male breast cancer. Male breast cancer is generally presented as retroareolar mass and detected in advanced stages, probably due to low awareness and lack of screening programme. Invasive ductal cancer is the most common type of male breast cancer with the luminal subtype.

Radiologic Findings of Scapular Langerhans Cell Histiocytosis Successfully Treated with CT-Guided Corticosteroid Injection.

Although Langerhans cell histiocytosis (LCH) may arise from any bone, flat bones (skull, ribs, scapula, clavicle, and mandible) are more commonly involved.The overall reported incidence of scapular involvement by LCH is nearly 3% in the literature. Intra-lesional corticosteroid injection can be given for lesions that cause pain or postural deformity. We, herein, report a 26-year male with scapular LCH who was suffering from right shoulder pain and right arm weakness. The patient received intra-lesional methylprednisolone under CT-guidance for treatment. On follow-up imaging, almost total regression was observed. We suggest that percutaneous CT-guided intra-lesional steroid injection is an efficient method for the treatment of LCH located in bone. Key Words: Bone, Langerhans cell histiocytosis, Local treatment, Corticosteroid.

Computed Tomography-guided Transthoracic Core Needle Biopsy of Lung Masses: Technique, Complications and Diagnostic Yield Rate.

OBJECTIVES: Computed tomography-guided core needle biopsy has an important role in the accurate histopathological diagnosis of lung masses. The present study aims to share our results of computed tomography-guided percutaneous core needle biopsy of lung masses. METHODS: A total of 117 patients had computed tomography-guided percutaneous core needle biopsy for lung masses between January 2017-September 2019 in our institution. In this study, these patients' post-procedural complications, diagnostic-yield-rates and radiological-histopathological correlations were evaluated retrospectively. RESULTS: Complications occurred in 23 (20%) patients (20 (17%) of pneumothorax; 3 (3%) of hemorrhage). Chest-tube-drainage was needed in five (4%) of all patients. No significant difference was found between complication rates and patient gender/age, tumor volume/localization or needle-path-length (p>0.05). In 77 of the 85 (91%) primary-lung-cancer-cases radiological and pathological diagnostic results were correlated. CONCLUSION: Computed tomography-guided core needle biopsy has a high diagnostic yield rate with acceptable complication rates in the diagnosis of lung masses.

Primary Intra-articular and Extra-articular Synovial Chondromatosis in a Child: A Rare Cause of Shoulder Pain in Children.

Synovial chondromatosis is a rare condition with chondroid metaplasia of the synovial membrane and multinodular proliferation of the synovial membrane of the joints, tendons and bursae without any certain etiology. The disease generally presents in monoarticular form; and the most commonly involved joint is the knee. It commonly occurs in third and fifth decades of life. Synovial chondromatosis of the shoulder in children is extremely rare; and up to now, only two cases have been reported in the literature. Herein, we report synovial chondromatosis of the shoulder joint in a child with both intraarticular and extraarticular involvement. To the best of the authors' knowledge, this is the first case in the literature with both intra- and extra-articular involvement of synovial chondromatosis of the shoulder joint in children. Key Words: Synovial chondromatosis, Metaplasia, Children.