MR imaging during intracavitary brachytherapy of vaginal and cervical cancer: preliminary results.

Intracavitary brachytherapy is an effective treatment for gynecologic cancers. Twelve magnetic resonance (MR) imaging studies were performed during intracavitary brachytherapy (10 initial studies and two during repeat brachytherapy) in 10 patients with clear cell adenocarcinoma (n = 9) or epithelioma (n = 1). Fifty percent of the vaginal lesions did not demonstrate high signal intensity on T2-weighted images. Individually tailored molded applicators allowed easy detection of abnormal vaginal parietal thickening on T1-weighted images: Results in seven cases were concordant with results of clinical examination, and there were no false-negative results. MR imaging was useful in controlling the relationships between the tumor and the applicator and facilitated treatment planning, since the radiation dose to the tumor volume and adjacent critical organs could be calculated accurately. Limitations of MR imaging were underestimation of superficial vaginal tumors and the inability to differentiate between tumor and inflammation after recent surgery or repeat intracavitary brachytherapy. MR imaging during intracavitary brachytherapy appears to be a useful adjunct to clinical examination.

The pattern of glomerular disease in New Caledonia: preliminary findings.

Two hundred and two renal biopsies from 181 patients in New Caledonia were classified into either primary glomerulonephritis or glomerulopathy associated with systemic disease. These were then compared with 670 similar biopsies from 634 in-patients at Sydney's Royal Prince Alfred Hospital (RPAH). The most prevalent primary glomerular disease among the New Caledonian cases was focal segmental glomerulosclerosis, compared with IgA disease among the RPAH cases. Mesangiocapillary glomerulonephritis, post-infectious glomerulonephritis and minimal lesion nephropathy were all relatively commoner among the New Caledonian biopsies, but the numbers were small. The most prevalent systemic glomerulopathy in the New Caledonian cases were amyloidosis. This was the least common among our RPAH group. Diabetes mellitus and lupus nephritis were also slightly more common in the New Caledonian group. Focal necrotizing/crescentic glomerulonephritis was unusual in the New Caledonian samples, while it was the most common systemic glomerulopathy among the RPAH group.

The role of low dose rate brachytherapy in the treatment of cervix carcinoma. Experience of the Gustave-Roussy Institute on 1245 patients.

From 1974 to 1992, 1245 patients with cervix carcinoma were treated at the Institut Gustave-Roussy using several treatment protocols all of which included LDR brachytherapy. We present and discuss the results of our experience.

Focal areas of increased opacity in ductal carcinoma in situ of the comedo type: mammographic-pathologic correlation.

PURPOSE: To determine a histopathologic explanation for focal areas of increased opacity on mammograms of ductal carcinoma in situ of the comedo type (comedocarcinoma). MATERIALS AND METHODS: From January 1991 to January 1993, mammograms from 36 patients with comedocarcinomas were reviewed. Each mammogram was screened for microcalcifications and/or any focal area of increased opacity. The presence or absence of infiltrating components was confirmed at pathologic examination, with particular emphasis placed on the search for any stromal reaction. RESULTS: The clinical examination revealed a palpable tumor in five patients (14%) and a bloody discharge from the nipple in two (5%). Isolated clusters of microcalcifications were seen at mammography in 24 patients (67%). Nine patients (25%) had clusters associated with focal areas of increased opacity; three patients (8%) had no microcalcifications. Histologic analysis demonstrated an intense, periductal, inflammatory reaction in all 12 patients with focal areas of increased opacity. CONCLUSION: Focal areas of increased opacity are not always indicative of an infiltrating component and may merely represent intense stromal reaction.

Head and neck rhabdomyosarcomas in children: value of clinical and CT findings in the detection of loco-regional relapses.

Between 1984 and 1990, 16 children who had been treated for a histologically proven head and neck rhabdomyosarcoma developed 19 local recurrences. Fourteen relapses discovered in 11 children (group 1) were based on clinical data acquired 3 to 52 months after completion of treatment. Clinical symptoms (12 patients) or examination (2 patients) led to suspicion of a relapse. The clinical presentation of relapses and that of primary tumour were identical in eight cases. CT scans performed prior to recurrence revealed a stable 'post-therapeutic residue' without mass effect at the original site (12 patients) or was normal (2 patients). Six of these 11 children died at 1 to 15 months and five are alive 12 to 36 months after treatment of recurrence. Five relapses were discovered on CT studies 3 to 15 months after completion of treatment in the remaining five children (group 2). Clinical examination was normal in all cases. CT scans performed 3 months before recurrence showed a stable 'post-therapeutic residue' (4 patients) or was normal (1 patient). All of these five children died 3 to 23 months after the relapse.

Nonpalpable breast tumors: diagnosis with contrast-enhanced subtraction dynamic MR imaging.

PURPOSE: To determine the accuracy of contrast material-enhanced subtraction dynamic magnetic resonance (MR) imaging in the diagnosis of nonpalpable breast tumors. MATERIALS AND METHODS: One hundred forty-three patients underwent surgical biopsy of a nonpalpable breast lesion. Their mammograms showed microcalcifications (n = 80), opacity (n = 52), architectural distortion (n = 10), or asymmetric density (n = 1). All patients underwent a preoperative gadolinium tetraazacyclododecanetetraacetic acid-enhanced subtraction dynamic study. Any early contrast enhancement in the breast parenchyma was considered pathologic. RESULTS: At histologic analysis, 27 intraductal carcinomas, 37 invasive carcinomas, and 79 benign lesions were found. Dynamic MR studies showed early contrast enhancement in 61 of 64 breast cancers (sensitivity, 95%) and in 37 of 79 benign lesions (specificity, 53%). Two invasive lobular carcinomas and one tubular carcinoma showed no early contrast enhancement. CONCLUSION: Subtraction dynamic MR imaging may be helpful to rule out malignancy in nonpalpable breast tumors.

Locally advanced breast cancer: contrast-enhanced subtraction MR imaging of response to preoperative chemotherapy.

PURPOSE: To determine the value of contrast material-enhanced subtraction magnetic resonance (MR) imaging in assessment of response to chemotherapy in locally advanced breast cancer. MATERIALS AND METHODS: Eighteen women treated with chemotherapy because of locally advanced breast cancer underwent preoperative MR examination including both routine and dynamic MR sequences after injection of gadolinium tetraazacyclododecanetetraacetic acid. Any early contrast enhancement, concomitant with early vascular enhancement during the dynamic MR study, was considered pathologic. RESULTS: Dynamic MR studies showed early contrast enhancement in all women with residual tumor except one with nodular residual tumor. Histopathologic analysis and dynamic MR images of contrast-enhanced lesions correlated well, but in one patient, intraductal extension was not seen on MR images, and in another, additional isolated tumor cells were seen in the histologic specimen. Subtraction images always facilitated visualization of vascular and pathologic contrast enhancement. CONCLUSION: Dynamic MR contrast-enhanced subtraction studies are useful in assessment of residual tumor after chemotherapy.

Apocrine carcinoma: clinical and mammographic features.

PURPOSE: To describe the mammographic features of apocrine carcinoma and assess the patterns of calcifications associated with these lesions. MATERIALS AND METHODS: Clinical and mammographic features from 17 patients with apocrine carcinoma were retrospectively reviewed. Special attention was paid to the presence of mixed form, diffusely scattered microcalcifications on mammograms. RESULTS: Patients were referred for clinical (n = 10), mammographic (n = 2), or both clinical and mammographic (n = 5) abnormalities. Findings at clinical examination included a palpable breast mass (n = 12), multiple breast masses (n = 1), and bloody nipple discharge (n = 2); two patients had normal findings. Fourteen patients had opacities at mammography. These opacities were associated with microcalcifications in 10 cases. Three patients had microcalcifications without opacities; one of those three patients exhibited a mixed form of diffusely scattered calcifications. CONCLUSION: Clinical and mammographic features of apocrine carcinoma do not differ from those of invasive ductal carcinoma.

Aggressive fibrous dysplasia of the maxillary sinus.

Fibrous dysplasia is usually a slowly progressive, benign disease that develops over several years and presents with deformity or mild symptomatology. Five of 34 patients (ages 4-21 years), who were subsequently diagnosed histologically as having fibrous dysplasia of the maxillary sinus, rapidly developed soft tissue masses of the malar region over a period of less than 4 months with accompanying pain (2 patients) and nasal obstruction and exophthalmos (2 patients). Each was clinically suspected of having a sarcoma; two had been thought to have an "osteofibrosarcoma" on initial biopsy at outside hospitals. After resection, all lesions developed regrowth. At histopathologic examination, both initial and recurrent masses proved to be typical fibrous dysplasia with spicules of woven bone in cellular, sometimes vascular, fibrous tissue. No malignant degeneration was found. On conventional radiography, aggressive fibrous dysplasia produced opacification and expansion of the maxillary sinus and apparent disruption of its wall with an associated soft tissue mass. Computed tomography (CT) demonstrated voluminous heterogeneous masses with "ground glass appearance", calcifications, areas of enhancement, low attenuation, cystic areas, and a thinned, sometimes interrupted, maxillary wall. Despite the aggressive clinical course for both initial and recurrent lesions, the CT findings of a "ground glass" mass with calcifications surrounded by a maxillary sinus wall, even if incomplete, can suggest the diagnosis of aggressive fibrous dysplasia.

Assessment of breast cancer recurrence with contrast-enhanced subtraction MR imaging: preliminary results in 26 patients.

Local relapse was suspected in 26 women treated conservatively for breast cancer. All women underwent routine magnetic resonance (MR) imaging and a dynamic MR subtraction study after injection of gadolinium-tetraazacyclododecanetetra-acetic acid. Twelve women had no local relapse. Surgical biopsy enabled confirmation of recurrence in 14 patients. Routine MR imaging did not allow differentiation of recurrence from glandular or scar tissue. Except for one case of fat necrosis, patients without local relapse showed no contrast enhancement 1 minute 34 seconds after injection. At dynamic MR imaging, all recurrences showed contrast enhancement 1 minute 34 seconds after injection. Nodular enhancement (n = 11) was found in invasive carcinoma, whereas linear enhancement was seen in intraductal carcinoma (n = 3). Subtraction of precontrast from postcontrast images always allowed better visualization of contrast enhancement. Contrast-enhanced subtraction dynamic MR imaging may prove to be accurate in diagnosis of local relapses of breast cancer.

Case report: clear cell adenocarcinoma of the vagina: MR features.

Clear cell adenocarcinoma (CCA) of the vagina and the cervix is a rare tumour. Since 1971 its increased incidence has been ascribed to intrauterine exposure to diethylstilboestrol (DES) and as a consequence the US Food and Drug Administration has banned the use of all DES-type medications during pregnancy. We report a case of CCA demonstrated by magnetic resonance imaging.

Combined radio-surgical treatment in early invasive cervix carcinoma according to prognostic factors. Experience of the Gustave-Roussy Institute.

In the Gustave-Roussy Institute the standard protocol of limited stages (IB, proximal II) of cervix carcinoma, combines endocavitary brachytherapy (low dose rate) and surgery (BSOH + lymphadenectomy) are eventually followed by external beam irradiation. According to age of patients and to prognostic factors adaptations of this combined treatment are discussed: young patient (40 years) with small tumor, large volume of primary tumor (4 cm), lymphatic node involvement. Analysis of the results in 2 series of patients entirely treated at the Gustave-Roussy Institute: survival, local control, metastases, complications.

Aneurysmal bone cysts of the jaws: CT and MR findings.

Two cases of aneurysmal bone cyst of the jaws, one in the mandible and the other in the maxilla, are reported in young girls 7 and 15 years old. One was a primary lesion; the other was associated with fibrous dysplasia. In both cases CT and MR demonstrated characteristic fluid-fluid levels. The diagnosis was confirmed after biopsy and surgical resection of the lesions.

Importance of a post-therapeutic residue in the prognosis of head and neck rhabdomyosarcoma in children.

Enhanced contrast computed tomography (CT) was performed in 23 children treated for head and neck rhabdomyosarcoma (RMS). The CT studies were retrospectively reviewed by two senior radiologists. Analysis of these CT studies revealed to separate groups of patients. One group (12 patients) had a post-therapeutic residue defined as soft tissue thickening at the original site, which remained stable over a period of 3 months and caused no mass effect on adjacent structures. Of these 12, eight showed enhancement at the area of thickening. Nine of these 12 patients relapsed. The other group (11 patients) demonstrated no post-therapeutic residue; only three of these patients relapsed. In this study the presence of a post-therapeutic residue was significantly associated with a poor prognosis, using a Fischer's test (P = 0.04).

[Evaluation of the role of MRI at 1.5 T in the staging of the initial extension of cancer of the uterine cervix]. / Evaluation du rôle de la RM à 1,5 T dans le bilan d'extension initial des cancers du col utérin.

To evaluate the sensibility and specificity of MRI in the initial staging of carcinoma of the uterine cervix, a retrospective study of 41 patients (48 MR scans) was undertaken. The sensitivity of T2-weighted images in the detection and determination of tumor location was 90% and specificity was 100%. On T2-weighted images, the signal intensity of the tumor was high in 64%. Determination of tumor size was correct in 80%. The ability of MRI to demonstrate the extension to the uterine corpus was acceptable with a sensitivity of 63% and a specificity of 100%. The extra-uterine extension was difficult to appreciate especially for parametrial, vaginal and bladder involvement with a sensitivity of 38%, 43 and 67% respectively. Concerning the lymph nodes involvement, the sensitivity was 38%. The results of this study point out the ability of MRI to evaluate the size and location of the tumor. The accuracy of MRI to appreciate the involvement of the parameters, vagina and bladder is disappointing.

[Imaging of cancer of the uterine cervix]. / Imagerie des cancers du col utérin.

Recently, magnetic resonance imaging (MRI) and transrectal or transvaginal ultrasound (TRUS, TVUS) had an important place in imaging techniques of cervical carcinomas and raise the question of modifying the imaging strategies. For the diagnosis of primitive tumor, those techniques cannot take the place of clinical examination and gross examination. In the assessment of parametrial involvement, TRUS which has better accuracy than clinical examination, and MRI which is considered as the most accurate technique, have an important role to play. In the follow-up and the detection of recurrences, MRI is actually considered as the best imaging technique. The authors, according to recent data in literature and their own experience, present basic concepts of imaging strategies for staging and follow-up of cervical carcinomas.

[Phalangette metastases of cancer of the mouth. An uncommon mode of propagation]. / Métastases aux phalangettes des cancers de la cavité buccale. Un mode de propagation inhabituel.

The direct propagation of a cancer of the buccal cavity or oropharynx to the bone of a distal phalanx is demonstrated in two patients suffering from onychophagy. This exceptional way of cancer propagation must be searched for if an unusual site of metastasis is encountered.