Invasive Lobular Cancer Arising in a Surgical Scar From Lumpectomy for a Previous Invasive Ductal Cancer of the Breast.

We describe a case of pathology-proven invasive lobular breast cancer (ILC) arising in a scar over 15 years after lumpectomy for previous invasive ductal carcinoma (IDC). The tumor was detected on screening mammography as a new focal asymmetry at the scar site and confirmed at diagnostic mammography. Ultrasound demonstrated an irregular, shadowing, hypoechoic mass at the scar site. Ultrasound-guided biopsy revealed poorly differentiated invasive lobular carcinoma. MRI and CT showed an irregular mass with pectoralis muscle invasion. Multimodality imaging findings are described. This is the first case to our knowledge reporting multimodality imaging findings of a breast cancer developing at the site of a surgical scar that is histologically different from the originally resected cancer.

Colonic lipomas revisited on CT colonography.

PURPOSE: CT colonography (CTC) is growing in its utilization as a nationally approved colorectal cancer screening test. After colonic polyps, lipomas are the second most common colonic lesions and their accurate and rapid recognition are important. METHODS: This retrospective Institutional Review Board approved study was performed at two large academic university-based institutions. 1044 patients underwent CTC at Institution A from 2010 to 2018 and 1094 patients underwent CTC at Institution B from 2003 to 2015. All CTC examinations with at least one colonic lipoma in their report were evaluated by a fellowship-trained abdominal imaging radiologist. 47 CTC examinations containing 59 colonic lipomas were detected and included. Segmental location, sessile versus pedunculated morphology, multiplicity, average attenuation, and largest lesion diameter were evaluated. A review of the current literature on colonic lipomas is entailed. RESULTS: The overall incidence of colonic lipoma was 2.2% in women and 2.3% in men. Mean age for detection of colonic lipomas on CTC was 66.9 years. Segmental locations of colonic lipomas include ascending colon (39%), transverse colon (19%), ileocecal valve (12%), cecum (12%), descending colon (10%), and rectosigmoid (8%). 9% of colonic lipomas were multiple, 42% were pedunculated, and 58% were sessile. The mean (range) size of detected lipomas was 19 (6-59) mm. The mean (range) attenuation was - 132 (- 41 to - 258) HU. CONCLUSION: Most colonic lipomas are located in the ascending colon. Although they are typically solitary, just under 10% are multiple, and although they are most often sessile, slightly under half are pedunculated mimicking polyps. CTC detects smaller lipomas than optical colonoscopy.

Image-guided Microinvasive Percutaneous Treatment of Breast Lesions: Where Do We Stand?

Treatment of breast lesions has evolved toward the use of less-invasive or minimally invasive techniques. Minimally invasive treatments destroy focal groups of cells without surgery; hence, less anesthesia is required, better cosmetic outcomes are achieved because of minimal (if any) scarring, and recovery times are shorter. These techniques include cryoablation, radiofrequency ablation, microwave ablation, high-intensity focused US, laser therapy, vacuum-assisted excision, and irreversible electroporation. Each modality involves the use of different mechanisms and requires specific considerations for application. To date, only cryoablation and vacuum-assisted excision have received U.S. Food and Drug Administration approval for treatment of fibroadenomas and have been implemented as part of the treatment algorithm by the American Society of Breast Surgeons. Several clinical studies on this topic have been performed on outcomes in patients with breast cancer who were treated with these techniques. The results are promising, with more data for radiofrequency ablation and cryoablation available than for other minimally invasive methods for treatment of early-stage breast cancer. Clinical decisions should be made on a case-by-case basis, according to the availability of the technique. MRI is the most effective imaging modality for postprocedural follow-up, with the pattern of enhancement differentiating residual or recurrent disease from postprocedural changes. ©RSNA, 2021.

Oral contraceptive use is associated with smaller hypothalamic and pituitary gland volumes in healthy women: A structural MRI study.

The effects of hormonal contraceptives on structural features of the hypothalamus and pituitary are incompletely understood. One prior study reported microstructural changes in the hypothalamus with oral contraceptive pill (OCP) use. However, effects on hypothalamic volume have not been reported. One prior study reported volumetric changes in the pituitary. However, this study was limited by including participants evaluated for neurological symptoms. We sought to determine if OCP use is associated with alteration of hypothalamic or pituitary volume. High-resolution 3T MRI was performed for a prospective cohort of 50 healthy women from 2016 to 2018, which comprised 21 OCP users (age, 19-29) and 29 naturally cycling women (age, 18-36). Participants were excluded if they were pregnant or had significant medical conditions including neurological, psychiatric, and endocrine disorders. After confirming reliability of the image analysis techniques, 5 raters independently performed manual segmentation of the hypothalamus and semi-automated intensity threshold-based segmentation of the pituitary using ITK-SNAP. Total intracranial volume was estimated using FreeSurfer. A general linear model tested the association of OCP use with hypothalamic and pituitary volumes. Hypothalamic (B = -81.2 ± 24.9, p = 0.002) and pituitary (B = -81.2 ± 38.7, p = 0.04) volumes in OCP users were smaller than in naturally cycling women. These findings may be related to interference with known trophic effects of sex hormones and suggest a structural correlate of central OCP effects.

The role of diffusion weighted imaging as supplement to dynamic contrast enhanced breast MRI: Can it help predict malignancy, histologic grade and recurrence?

RATIONALE AND OBJECTIVES: To evaluate the value of adding Diffusion Weighted Imaging (DWI) with Apparent Diffusion Coefficient (ADC) mapping to dynamic contrast enhanced (DCE-MRI) to distinguish benign from malignant pathology subtypes and tumor recurrence. METHOD AND MATERIALS: In this retrospective IRB approved study, 956 consecutive patients underwent bilateral breast MRI between 1/2015 and 12/2015, with 156 BIRADS 4, 5, or 6 lesions detected in 111 patients. DWI imaging at B0, B100, B600, B1000 was performed with DCE-MRI. Values for diffusion and ADC images were recorded by two fellowship-trained breast radiologists. Mean ADC and signal intensity (SI) values were correlated with histology, tumor grade, hormone receptors (ER, PR, and HER-2)and Oncotype DX scores, when available. p ≤ 0.05 was considered significant. RESULTS: Of 156 lesions, there were 59 (38%) benign lesions, 24 (15%) Ductal Carcinoma In-Situ, 47 (30%) Invasive Ductal Carcinoma (IDC), 15 (10%) Invasive Lobular Carcinoma (ILC) and 2 (2%) Mucinous carcinoma (MC), five (5%) mixed IDC and ILC, and four (4%) other, including tubular and rare types of malignancy. Mean ADC values for malignancy were significantly lower than for benign lesions (1085 ± 343 × 10-6 vs 1481 ± 276 × 10-6 mm2/s), which is highly predictive (area under curve = 0.82). In addition, tumors with PR negativity and Oncotype score ≥18 (intermediate to high risk for recurrence) demonstrated significantly lower ADC values. SI at B100 and B600 was helpful in distinguishing benign versus IDC. There was no significant correlation between ADC values and tumor grade or ER/HER2 status. CONCLUSION: ADC value is important factor in distinguishing malignancy, differentiating tumors with higher Oncotype score, and PR negativity. Therefore, it can be used as an important tool to assist appropriate treatment selection.

Estimating the prevalence and disease characteristics of rheumatoid arthritis in Tehran: A WHO -ILAR COPCORD Study (from Iran COPCORD study, Urban Study stage 1).

BACKGROUND: To estimate the prevalence and characteristics of Rheumatoid Arthritis (RA) in an urban area of Tehran. METHODS: A total of 50 clusters were randomly selected in Tehran and 10291 subjects completed the COPCORD Core Questionnaire during 2004 and 2005. Patients with rheumatic complaints were examined and diagnosed by subspecialty fellows in rheumatology. Laboratory and radiology tests were also performed if required. RESULTS: A total of 35 subjects (5 men and 30 women) were diagnosed with RA, with a prevalence of 0.33% (95% CI: 0.22-0.46). Our results demonstrated that RA was six times more common in women than men. The mean age (± SD) of patients was 52.3 (± 17.6) years. Morning stiffness > 1 hour was reported in 37.1% of patients. Rheumatic signs were commonly found in wrist (60%), knee (60%), metacarpophalangeal (48.6%) and proximal interphalangeals of hand (40%). Approximately 46% of patients had difficulty carrying out daily activities. CONCLUSION: According to our study, the prevalence of RA in Iran seems to be lower than western countries. However, the prevalence of RA in Iran seems to be approximately in the middle point comparing the APLAR region (from 0.7% in Australia (rural) to 0.12% in Thailand).

Association of the CTLA-4 1722TC polymorphism and systemic lupus erythematosus: a systematic review and meta analysis.

BACKGROUND: Cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) is an important negative regulator of Tcell responses. The -1722TC polymorphism of the CTLA-4 gene may be associated with systemic lupus erythematosus (SLE) risk, but related results from previous studies have been inconsistent. We carried out a metaanalysis to assess this association more precisely. METHODS: A systematic search through PubMed, Science Direct, and OVID, Iran doc, Iranmedex and SID (Scientific Information Database) databases was performed with the last search updated on December 30, 2011. The odds of ratio (OR) and its 95% confidence interval (95%CI) were used to assess the strength of the association. We evaluated both fixed and random effect models, depending on the presence of between-study heterogeneity. The analyses were conducted using STATA software, version 11.0. RESULTS: A total of 9 independent studies on the CTLA-4 gene -1722TC polymorphism and SLE, including 1422 cases and 1417 controls were used in this meta-analysis. In the present meta-analysis, we found a significant association between -1722TC polymorphism and SLE risk in the overall analysis (TT versus TC/CC: OR=1.18, 95%CI 0.84-1.66, p= 0.32; TT/TC versus CC: OR = 2.06, 95%CI 1.07-3.99, p= 0.03; TT versus CC: OR = 2.32, 95%CI 1.62-3.32, p< 0.001; TC versus CC: OR = 1.99, 95%CI 1.42-2.78, p<0.001; TT versus TC: OR = 1.2, 95%CI 0.86-1.66,p= 0.28; T versus C: OR = 1.22, 95%CI 0.91-1.64,p= 0.16). In the subgroup analysis by ethnicity, -1722TC polymorphism was significantly associated with SLE risk in Asian population. CONCLUSION: This meta-analysis suggests a significant association between -1722TC polymorphism and SLE susceptibility. Large-scale and well-designed case-control studies are necessary to validate the risk identified in the present meta-analysis.

Clinical features and severity of psoriasis: a comparison of facial and nonfacial involvement in Iran.

BACKGROUND: Facial involvement in psoriasis is accomplished with poor prognosis. In this study, clinical features and severity of psoriasis were compared between facial and nonfacial psoriasis involvement groups in Iran. It also evaluated these characteristics in different subtypes of facial psoriasis. METHODS: One hundred and thirty- eight psoriatic patients having referred to our clinic entered in this cross- sectional study in 2006 - 2007. Medical information, whole body and scalp Psoriasis Area and Severity Index (PASI) scores were obtained. Variables were compared between the facial and nonfacial involvement groups and also in different subtypes of the former including peripherofacial (PF), centrofacial (CF), and mixedfacial (MF). A P-value of < 0.05 was considered as significant. RESULTS: We found 55.0% facial involvement in Iranian psoriatic patients. MF (52.6%), CF (28.9%), and PF (18.4%), respectively were the common forms of facial involvement. The median whole body and scalp PASI scores, the number of male participants, and tongue involvement were significantly higher in patients with facial involvement. Comparing different subtypes of facial psoriasis, whole body PASI and scalp PASI scores were significantly higher in MF subtype and lower in CF subtype. Despite the least severity in the latter subtype, psoriatic arthritis and geographic tongue were shown to be more common in this subtype. Moreover, relapse history was correlated with PF subtype. CONCLUSIONS: Facial involvement in psoriasis had significantly higher whole body and scalp PASI scores in Iran which may be an indication of more severe disease. This difference was more prominent in MF subtype.

A new formula for estimating fetal weight: The impression of biparietal diameter, abdominal circumference, mid-thigh soft tissue thickness and femoral length on birth weight.

BACKGROUND: Abdominal circumference (AC), biparietal diameters (BPD) and femoral length (FL) are now the main parameters used to obtain estimated fetal weight (EFW). Although the role of soft tissue parameters in determining fetal weight was proved but clinical attention to mid-thigh soft tissue thickness (STT) is limited. OBJECTIVE: To find the impression of STT on birth weight (BW) and represent a new predictive formula. MATERIALS AND METHODS: One hundred and fourteen normal singleton term (36-42w) pregnancies with delivery within 72 hours were randomly selected to participate in this prospective cohort study. Variables measured by ultrasonography before birth included: AC, BPD, FL and STT. The actual neonatal BW was also measured after birth. Linear regression model was used and R square and p-value were reported. RESULTS: The mean (SD) of BW was 3406 (405) gr. R square was best fit for the model that STT was added to AC, BPD, FL (r(2): 0.77). R square for the model using BPD, AC, FL and model using BPD, STT, FL was the same (r(2): 0.7). Best fit formula was Log (BW)= 2.461+0.003BPD+0.001AC+0.007STT+0.005FL. AC (R: 0.67, p<0.001), STT (R: 0.50, p<0.001), BPD (R: 0.59, p<0.001), FL (R: 0.66, p<0.001) were significantly correlated with birth weight. AC had also significant correlation with STT (p=0.001) CONCLUSION: This study showed adding STT to other variables in predictive models of fetal weight would provide a nice estimation (r(2)=0.77) and in cases that measuring AC is suboptimal STT may be a good replacement.