Silicone-Induced Granuloma of Breast Implant Capsule (SIGBIC): Histopathology and Radiological Correlation.

Currently, attention has been given to complications related to breast implants, especially due to the presence of anaplastic large cell lymphoma (ALCL) related to silicone implants. Many manuscripts attempt to associate silicone presence with clinical complaints reported by patients, while others try to demonstrate the mechanisms of silicone bleeding by permeability loss of breast implant surfaces. There also are reports of foreign body type reactions from implant fibrous capsule to silicone corpuscles. However, there seems to be no study that correlates the clinical, radiological, and histological correlations of these lesions. The objective of this review is to correlate radiological findings of silicone-induced granuloma of breast implant capsule (SIGBIC) from breast MRI (BMRI) scans and complementary findings of ultrasound (US) and positron emission tomography (PET) scan, and its histology originated from surgical breast implant capsulectomy. To make this correlation possible, we divided SIGBIC into three radiological findings: (1) intracapsular SIGBIC, (2) SIGBIC with extracapsular extension, and (3) mixed SIGBIC associated with seroma. Our experience demonstrates histological-radiological correlation in SIGBIC diagnosis. Knowledge of these findings may demonstrate its real importance in terms of public health and patient management. We believe that SIGBIC is currently underdiagnosed by lack of training, guidance, and management in our clinical practice.

Polyacrylate/nanosilica causes pleural and pericardial effusion, and pulmonary fibrosis and granuloma in rats similar to those observed in exposed workers.

Nanomaterials offer great benefit as well as potential damage to humans. Workers exposed to polyacrylate coatings have pleural effusion, pericardial effusion, and pulmonary fibrosis and granuloma, which are thought to be related to the high exposure to nanomaterials in the coatings. The study aimed to determine whether polyacrylate/silica nanoparticles cause similar toxicity in rats, as observed in exposed workers. Ninety male Wistar rats were randomly divided into five groups with 18 rats in each group. The groups included the saline control group, another control group of polyacrylate only, and low-, intermediate-, and high-dose groups of polyacrylate/nanosilica with concentrations of 3.125, 6.25, and 12.5 mg/kg. Seventy-five rats for the 1-week study were terminated for scheduled necropsy at 24 hours, 3 days, and 7 days postintratracheal instillation. The remaining 15 rats (three males/group) had repeated ultrasound and chest computed tomography examinations in a 2-week study to observe the pleural and pericardial effusion and pulmonary toxicity. We found that polyacrylate/nanosilica resulted in pleural and pericardial effusions, where nanosilica was isolated and detected. Effusion occurred on day 3 and day 5 post-administration of nanocomposites in the 6.25 and 12.5 mg/kg groups, it gradually rose to a maximum on days 7-10 and then slowly decreased and disappeared on day 14. With an increase in polyacrylate/nanosilica concentrations, pleural effusion increased, as shown by ultrasonographic qualitative observations. Pulmonary fibrosis and granuloma were also observed in the high-dose polyacrylate/nanosilica group. Our study shows that polyacrylate/nanosilica results in specific toxicity presenting as pleural and pericardial effusion, as well as pulmonary fibrosis and granuloma, which are almost identical to results in reported patients. These results indicate the urgent need and importance of nanosafety and awareness of toxicity of polyacrylate/nanosilica.

Outcome of incidentally detected airway nodules.

Low-dose chest computed tomography (LDCT) screening increased detection of airway nodules. Most nodules appear to be secretions, but pathological lesions may show similar findings. The National Comprehensive Cancer Network (NCCN) recommends repeating LDCT after 1 month and proceeding to bronchoscopy if the nodules persist. However, no reports exist about incidentally detected airway nodules. We investigated the significance of airway nodules detected by LDCT screening.We screened patients with incidental airway nodules detected by LDCT in the Seoul National University Hospital group. The characteristics of computed tomography, bronchoscopy, pathology and clinical findings were analysed.Among 53 036 individuals who underwent LDCT screening, 313 (0.6%) had airway nodules. Of these, 186 (59.4%) were followed-up with chest computed tomography and/or bronchoscopy. Seven (3.8%) cases had significant lesions, including leiomyoma (n=2), endobronchial tuberculosis (n=2), chronic inflammation (n=1), hamartoma (n=1) and benign granuloma (n=1). The remaining 179 lesions were transient, suggesting that they were secretions.The use of LDCT for lung cancer screening demonstrated the low incidence of airway lesions. Most lesions were transient secretions. True pathological lesions were rare, and no malignant lesion was found. The current recommendation of the NCCN guideline is a reasonable approach that can avoid unnecessary bronchoscopy.

Surgical Outcomes in a Large, Clinical, Low-Dose Computed Tomographic Lung Cancer Screening Program.

BACKGROUND: Lung cancer screening with low-dose computed tomography is proven to reduce lung cancer mortality among high-risk patients. However, critics raise concern over the potential for unnecessary surgical procedures performed for benign disease as a result of screening. We reviewed our outcomes in a large clinical lung cancer screening program to assess the number of surgical procedures done for benign disease, as we believe this is an important quality metric. METHODS: We retrospectively reviewed our surgical outcomes of consecutive patients who underwent low-dose computed tomography lung cancer screening from January 2012 through June 2014 using a prospectively collected database. All patients met the National Comprehensive Cancer Network lung cancer screening guidelines high-risk criteria. RESULTS: There were 1,654 screened patients during the study interval with clinical follow-up at Lahey Hospital & Medical Center. Twenty-five of the 1,654 (1.5%) had surgery. Five of 25 had non-lung cancer diagnoses: 2 hamartomas, 2 necrotizing granulomas, and 1 breast cancer metastasis. The incidence of surgery for non-lung cancer diagnosis was 0.30% (5 of 1,654), and the incidence of surgery for benign disease was 0.24% (4 of 1,654). Twenty of 25 had lung cancer, 18 early stage and 2 late stage. There were no surgery-related deaths, and there was 1 major surgical complication (4%) at 30 days. CONCLUSIONS: The incidence of surgical intervention for non-lung cancer diagnosis was low (0.30%) and is comparable to the rate reported in the National Lung Screening Trial (0.62%). Surgical intervention for benign disease was rare (0.24%) in our experience.

Rectal submucosal tumor-like lesion originating from intestinal tuberculosis.

We present the case of a 55-year-old man who underwent transsacral local excision for a rectal submucosal tumor-like lesion suspected to originate from tuberculosis. The lesion, 2 cm in size, was found incidentally in the posterior wall of the lower rectum during anal fistulectomy. The lesion was apart from the primary crypt of the anal fistula. Barium enema and colonoscopy revealed a protuberant submucosal growth with a shallow depression of the overlying mucosa. Although computed tomography and magnetic resonance imaging showed a well defined round mass within the rectal wall, digital rectal examination suggested extramural origin. Since repeated endoscopic biopsies were negative, we selected the transsacral approach for excisional biopsy to achieve histological diagnosis. The lesion was confined to the rectal wall and the full-thickness rectal wall was excised. Histologically, a foreign-body granuloma with acute inflammation was the main component of the lesion. Caseating granulomas and Langhans' giant cells, consistent with tuberculosis, were also found.

Xanthogranulomatous cholecystitis: a radiological study of 12 cases and a review of the literature.

BACKGROUND: Twelve cases of xanthogranulomatous cholecystitis (XGC) are presented, and their radiologic appearance is described. METHODS: Four men and eight women, aged 31-82 years old, with XGC were reviewed. Abdominal ultrasound (US) was performed in all patients. Computed tomography (CT) was performed in five patients, barium enema examination in two, and percutaneously CT-guided fine-needle aspirative biopsy of the gallbladder in one. RESULTS: Barium enema examination showed an indentation of the hepatic flexure. Cholelithiasis was present in all patients, and sludge was present in six. The gallbladder wall was thickened in all patients, irregular in nine, and could not be properly differentiated from surrounding liver parenchyma or from other adjacent structures in most patients. A curvilinear halo, hypoechoic on US and with low attenuation on CT, within the gallbladder wall was found in three patients and pericholecystic fluid in two others. On CT, the pericholecystic fat had streaky soft tissue densities in three cases. Percutaneously CT-guided fine-needle aspirative biopsy of the gallbladder was nondiagnostic. The diagnosis of gallbladder carcinoma was considered preoperatively in three patients. CONCLUSION: Despite the characteristic histologic appearance of XCG, radiologic findings are nonspecific, varying from signs observed in other forms of cholecystitis to the appearance of a gallbladder neoplasm.

MIBG and radiolabeled octreotide in neuroendocrine tumors.

Two newly developed radiopharmaceuticals, [131I]metaiodobenzylguanidine (MIBG) and 111In-pentetreotide, are currently used for the diagnosis and therapy of neural crest tumors. They interact with characteristic features of these tumors, such as the active uptake-1 mechanism at the cell membrane and vesicles or neurosecretory granules in the cytoplasm, as well as the presence of specific receptors at the cell membrane. The role of MIBG and Somatostatin analogues in the management of neural crest tumors is reviewed. Other uses of these radiopharmaceuticals are mentioned. It is concluded that both 111In-pentetreotide and 123I/[131]MIBG are sensitive indicators of neural crest tumors, which have a complementary role. Unlike MIBG, 111In-pentetreotide is not specific for neural crest tumors, as scintigraphy is also positive in many other tumors, granulomas and autoimmune diseases. [131I]MIBG is effectively used for the therapy of several neural crest tumors; the biodistribution of 111In-pentetreotide at present does not allow radionuclide therapy using a beta emitting label. However, as an indicator of somatostatin receptors, 111In-pentetreotide scintigraphy may be a predictor of the response to palliative treatment with unlabelled octreotide. Recommendations for the use of these procedures are given.

Diagnostic significance of epithelioid granulomas in Crohn's disease in children. Multicenter Paediatric Crohn's Disease Study Group.

Out of 528 children with Crohn's disease in a Multicenter Paediatric Crohn's Disease Study Group, 37 cases had epithelioid granulomas but did not fulfill defined radiographic criteria of the disease. Follow-up studies including clinical, biochemical, radiological, endoscopic, and histological investigations were done in these patients. Initially, all patients showed clinical symptoms and 27 of them had biochemical signs of chronic inflammation. After a mean follow-up of 3 years, all 37 children treated for Crohn's disease got a complete upper gastrointestinal series with small bowel followthrough and 8 children in addition had barium enemas. Colonoscopies were done in 23 patients. Radiographic examination revealed Crohn's disease in 14 and endoscopy additionally confirmed Crohn's disease in 8 further cases. One child was diagnosed as having chronic granulomatous disease. Thirteen children still remained unclassified after these follow-up studies including radiographs and endoscopy. An interval of 3 years may in some cases be too short to express the complete radiographic pattern of Crohn's disease. Our studies demonstrate that in addition to initial radiological, endoscopic, and histological investigations, a thorough follow-up is necessary in early diagnosed patients. In these children, epithelioid granulomas are of high diagnostic validity preceding radiological changes of Crohn's disease often for years.

Xanthogranulomatous abscess of a mullerian duct remnant. A rare lesion of the rectum and anus.

A rare example of xanthogranulomatous inflammatory mass and abscess of a Mullerian duct remnant involving the anorectal area is reported. A barium enema showed a bilobed precoccygeal mass of moderate size involving the posterior aspect of the distal rectum. Computed tomography (CT) showed two nonfatty, round masses, one of which contained a small central cystic area. The other mass had a homogeneous appearance and was believed to be in the wall of the rectum. The pathologic specimen showed organizing abscesses and a chronic xanthogranulomatous inflammation in tissue compatible with urogenital tissue, presumably a Mullerian duct remnant. This is the first documented report of anorectal xanthogranulomatous abscess in a Mullerian duct remnant with radiologic findings and histopathologic correlation. Though rare, this lesion should be considered in the differential diagnosis of extrinsic and intramural rectal masses seen on barium enema and CT examinations.

[Contribution of radiology to the postoperative after care of patients with colorectal tumors]. / Der Beitrag der Radiologie zur postoperativen nachsorge von Patienten mit colorectalen Tumoren.

The prognosis of local recurrences after surgery for colorectal cancer is better than in recurrences of many other tumor sites. Since in most cases secondary tumor growth takes place as local recurrence and distant metastases are infrequent, there is a good chance of detecting the recurrence early in a curable state. This offers good conditions for a radical second operation. Following excision of tumors, double-contrast enema permits a very detailed assessment of the anastomosis, allowing detection of small local recurrences and recognition of postoperative changes or sequelae of delayed healing at the site of the anastomosis. Following amputation of the rectum, computed tomography permits better control of the presacral space than other conventional radiodiagnostic procedures. In both situations, however, integration of both methods is necessary in a consequent time schedule of clinical follow-up with suitable intervals.

Rectal balloons: complications, causes, and recommendations.

Nine previously unreported rectal injuries caused by barium-enema examinations have been reviewed. In each case, the injury occurred in conjunction with inflation of a rectal balloon. Analysis of the clinical material suggested that certain mechanical properties of balloon catheter tips might transfer mechanical stress to the rectal wall and contribute to the observed injuries. Careful manometric evaluation of in vivo rectal balloons suggest that significant anatomic differences in patients may be clinically important. Further experimental bench studies revealed undesirable mechanical properties in many commercially available rectal balloon catheters. These mechanical problems include low compliance, asymmetrical inflation, strong lateral and anterior displacement of a firm catheter tip into the restraining wall, and self-obstruction of the balloon deflation outlet by the inflated baloon. Many of these problems were clinically confirmed by careful in vivo observations and by evidence collected from the nine cases of rectal injury. A series of practical prophylactic procedures are recommended.