Invasive mucinous carcinoma of the breast and response patterns after neoadjuvant chemotherapy (NAC).

AIMS: Neoadjuvant chemotherapy (NAC) is often used to treat localised invasive breast cancer. Invasive mucinous carcinoma (IMC) is considered to be an indolent form of invasive breast cancer, and is rarely treated with NAC. We report the largest series of IMCs treated with NAC, and report a characteristic, but not well recognised, pattern of pathological response. METHODS AND RESULTS: Our series included seven patients with IMC treated with NAC. Three patients presented with locally advanced disease, three patients had tumours that were HER-2/neu-positive, and four patients had tumours with admixed mucinous and micropapillary features. Clinical and imaging assessment of response showed persistent and, in some cases, progressive disease, despite evidence of significant pathological response in these cases. Pathological assessment after NAC demonstrated marked reduction in tumour cellularity, but persistent space-occupying mucin pools, showing acellular mucin in one case, <1% tumour cellularity in three cases, and 5-10% cellularity in three cases in both the treated breast and axillary lymph nodes. CONCLUSIONS: Persistent mass-forming low-cellular or acellular mucin pools can result in discordant clinical, imaging and pathological findings in IMC treated with NAC.

Applications of 3-Dimensional Ultrasonography in the Neck, Excluding the Thyroid.

Ultrasonography (US) of the neck is an accepted, useful imaging modality for many applications beyond its usefulness in thyroid disease. Two-dimensional US has been effectively used for evaluation of many types of neck conditions, and now, 3-dimensional US can be added to the imaging armamentaria. Three-dimensional US is useful in the evaluation of cervical lymph nodes, recurrent/residual thyroid neoplasia, parathyroid glands, parotid and submandibular glands, as well as thyroglossal duct cysts and other assorted palpable and visible abnormalities because of its unique capabilities, including multiplanar reconstruction, accessibility of the coronal view, volume calculation, and regularly spaced incremental slice evaluation.

Sensitivity of 3-Dimensional Sonography in Preoperative Evaluation of Parathyroid Glands in Patients With Primary Hyperparathyroidism.

OBJECTIVES: Preoperative localization of parathyroid adenomas in patients with primary hyperparathyroidism facilitates targeted surgery. We assessed the sensitivity of 3-dimensional (3D) sonography for preoperative localization of abnormal parathyroid glands. METHODS: We conducted a retrospective review of patients who underwent parathyroidectomy for primary hyperparathyroidism at a single site at our institution. We compared preoperative 2-dimensional (2D) sonography, 3D sonography, and sestamibi scans with final gland localization at surgery. Two readers reviewed the sonograms to assess inter-reader variability. RESULTS: From January 2010 through April 2015, 52 patients underwent parathyroidectomy after preoperative 2D sonography, 3D sonography, and sestamibi scans. Three-dimensional sonography had sensitivity of 88-92% compared with 69-71% for 2D sonography for gland localization. In patients in whom sonography and sestamibi scans localized abnormalities to the same side, the sensitivities were 100% (43 of 43) for 3D sonography and 96% (48 of 50) for 2D sonography. Three-dimensional sonography had significantly higher sensitivity for localization of glands smaller than 500 mg compared with 2D sonography (88% versus 58%; P = .012). There was better inter-reader agreement between the radiologists when using 3D sonography (κ = 0.65) compared with 2D sonography (κ = 0.41). CONCLUSIONS: We found a significantly higher sensitivity and better inter-reader agreement for 3D sonography compared with 2D sonography for preoperative identification of abnormal parathyroid glands, especially among smaller glands.

Three-Dimensional Sonography of Axillary Lymph Nodes in Patients With Breast Cancer.

Sonography is useful in the evaluation of axillary lymph nodes in patients with breast cancer. In this pictorial essay, we review the range of grayscale and Doppler appearances of abnormal axillary lymph nodes on 2-dimensional and 3-dimensional imaging.

Three-dimensional sonography in the evaluation of primary hyperparathyroidism.

Three-dimensional sonography is useful in the preoperative evaluation of patients with primary hyperparathyroidism. In this pictorial essay, we review the characteristic spectrum of grayscale and Doppler appearances of parathyroid glands on 2-dimensional sonography and demonstrate the additional benefits of 3-dimensional scanning.

Diabetic mastopathy, a clinicopathological correlation of 34 cases.

Diabetic mastopathy (DM) is an unusual fibrous disease of the breast. We report 34 cases with clinicopathological correlation and follow-ups. Patients mean age was 57 years and 24 had histories of diabetes mellitus. The DM presented as a palpable breast mass in 85.3% of the cases clinically. Image findings were often as an irregular hypoechoic mass (44.4%) on ultrasound and negative or non-specific density (67.6%) on mammogram. Histologically, we found that the majority of DM occurred in the upper outer/central part of the breast (76%) and the size ranged from 0.5 to 3.7 cm. All cases showed lymphocytic lobulitis and vasculitis, keloidal fibrosis, lobular atrophy and varying degree of epithelioid fibroblasts. Examining the surrounding normal tissue of the excision specimens revealed that the margins of DM were often poorly circumscribed and irregularly demarcated from the sounding breast tissue. Vascular calcifications were identified in 10 of 24 excisional specimens, suggesting a hypothesis that vascular damage and scar/wounding healing process could contribute to the pathogenesis of DM. Twenty-one cases had repeated procedures for uncertain descriptive diagnosis. This is the largest study of diabetic mastopathy to date with clinical and imagining correlation. Recognition of this benign entity is important to better understanding the pathogenesis and to avoid unnecessary procedures.

Core Biopsy of Vascular Neoplasms of the Breast: Pathologic Features, Imaging, and Clinical Findings.

Vascular lesions (VLs) of the breast present a diagnostic challenge on breast core biopsy (BCBx). We report on 27 VLs presenting on BCBx. The mean patient age was 60 years, and mean size was 7.5 mm (range, 1.6 to 16 mm). Presentation included palpable mass in 6 (22%), incidental in 6 (22%), and an imaging abnormality in 15 (56%) cases. Imaging impression included hematoma (24%), lymph node (10%), fat necrosis (10%), tortuous vessel (5%), and not provided in 52%. The lesions were classified on the basis of BCBx or BCBx and excision (available in 16 pts) as follows: 1 low-grade angiosarcoma, 8 angiolipomas, 6 capillary hemangiomas, 4 cavernous hemangiomas, 2 hemangiomas (not otherwise specified), 1 papillary endothelial hyperplasia, and 5 perilobular hemangiomas. The angiosarcoma was 9 mm, detected incidentally by magnetic resonance imaging, and showed dissection of stromal collagen, infiltration of glands, high cellularity, moderate cytologic atypia, scant mitotic activity, and Ki-67 reactivity of 10%. Among the 26 benign VLs, worrisome histologic features were noted in 14 on BCBx, including anastomosing vascular channels in 9, moderate cytologic atypia in 4, high cellularity in 2, Ki-67>10% in 2, mitotic activity in 1, and infiltration of glands in 1. Of the 12 VLs without worrisome features, the lesion extended to edge of core in 8, precluding complete evaluation. BCBx of VLs presents diagnostic challenges due to overlapping clinicopathologic and radiologic features with low-grade angiosarcoma. If completeness of removal is documented on BCBx, and cytoarchitectural changes are not worrisome, follow-up could be considered rather than excision. However, only 4 of these cases fulfilled those criteria.

Computed tomography screening for lung cancer: preliminary results in a diverse urban population.

PURPOSE: The purpose of this study was to describe the baseline characteristics and results of the initial 18 months of our clinical computed tomography (CT) lung cancer screening program in an ethnically diverse, poor, predominantly overweight, and obese population, which differs dramatically from the National Lung Screening Trial population. MATERIALS AND METHODS: All patients had a physician referral for CT lung cancer screening and met National Lung Screening Trial eligibility criteria. Infrastructure developed for the program included a standardized results report [Bronx score of 1 to 5 (modeled on BI-RADS)] for the electronic medical record and a dedicated bilingual screening coordinator. If the patient's insurance did not cover CT screening, a fee of $75 was charged. RESULTS: A total of 320 patients [54% (174) men, mean age 64 y] underwent initial CT lung cancer screening from December 18, 2012 to July 3, 2014. The median pack-years was 47, and 68% (218) were current smokers. Twenty-six percent (84) were white, and 70% (223) were overweight (101) or obese (122). The lung cancer prevalence was 2.2% (7/320). Seventy-eight percent (7/9) of patients with CT findings positive for lung cancer (score 5a, 5b) had proven lung cancer; 1 had stage 1 (1B) disease, and 6 had stage IIA or higher disease. The false-positive rate for a Bronx score ≥3 was 19% (60). Medicare and Medicaid insure 80% of the institution's overall population but only 38% (121) of the CT screening patients. CONCLUSIONS: CT screening is feasible in a diverse inner-city population with the support of a robust infrastructure. Further study is needed to determine whether CT screening will confer a mortality benefit in this population.

A case report: lobular carcinoma in situ in a male patient with subsequent invasive ductal carcinoma identified on screening breast MRI.

Lobular carcinoma in situ is a form of in situ neoplasia that develops within the terminal lobules of the breast. It is an extremely rare finding in males due to the lack of lobular development in the male breast. The authors herein report an unusual case of incidentally discovered lobular carcinoma in situ in a male patient with recurrent bilateral gynecomastia who was subsequently diagnosed with invasive ductal carcinoma of the left breast. The pathology of lobular carcinoma in situ in a male as well as screening MRI surveillance of male patients at high risk for breast cancer are discussed, emphasizing the importance of screening and imaging follow up in men who are at high risk for breast cancer.

Calcifications associated with lactational changes of the breast: mammographic findings with histologic correlation.

OBJECTIVE: We sought to describe the mammographic appearance of calcifications associated with histologically confirmed lactational changes of the breast. CONCLUSION: Calcifications associated with lactational changes of the breast may have a suspicious appearance on mammography. These calcifications may be identified on a patient's original screening mammogram or may be a new finding on an annual screening examination. Correlating a clinical history of recent lactation or a postpartum state is important in establishing a concordance between the mammographic and histologic findings. However, despite the benign nature of these calcifications, biopsy is recommended because of their suspicious morphologic features.