Treatment Response to Acute Total Ophthalmoplegia in Primary Pituitary Lymphoma: A Case Report and Review of the Literature.

Primary pituitary lymphoma (PPL) is an extremely rare localized lymphoma without systemic involvement. The most common clinical presentations of PPL are hypopituitarism, headaches, and ophthalmoplegia. Diagnosing PPL without a biopsy is almost impossible. There is no study that has specifically investigated and reviewed treatment responses to the ophthalmological symptoms of PPL patients. Herein, we present a 66-year-old female patient who had acute-onset total ophthalmoplegia and headache as admission symptoms, which was diagnosed as PPL after subtotal resection. In the present study, we discussed the response of ophthalmological symptoms to treatment with a review of the literature. Only 18 reported cases had postoperative ophthalmological examination, and in 94.4% of these cases, ophthalmoplegia resolves after surgery and chemotherapy. The complete resection rate of the PPL in the literature was found to be as low as 12.3% in this region because of the hard and adhesive nature of the tumor. Our review unveiled that complete recovery of ophthalmoplegia can be achieved even in the late phase of the symptoms. In the present case, ophthalmoplegia resolved completely following subtotal resection and rituximab, high-dose methotrexate, and cytarabine treatment.

Comparison between body composition parameters and response to neoadjuvant chemotherapy by using pre-treatment PET CT in locally advanced breast cancer.

PURPOSE: To compare the adipose and muscle tissue areas in patients who responded differently to neoadjuvant chemotherapy. METHODS: One hundred and eighty six patients diagnosed with breast cancer who underwent neoadjuvant chemotherapy between January 2015- October 2019 and were operated after the treatment were retrospectively included in the study. Pathological results were divided into five groups using the Miller-Payne grading systems. Grade 1 indicating no significant reduction in malignant cells; Grade 2: a minor loss of malignant cells (≤ 30 %); Grade 3: reduction in malignant cells between 30 % and 90 %; Grade 4: disappearance of malignant cells >90 %; Grade 5: no malignant cells identifiable. Pre-treatment PET CT scans were evaluated, and calculation of body composition parameters were performed on a single axial section passing through the L3 vertebrae. Spearman's correlation test was used to analyze the correlation between SAT, VAT, MT parameters and pathological responses. RESULTS: There was no strong correlation between the 5 groups separated according to neoadjuvant chemotherapy treatment response and tissue distributions. However, that there was a very low correlation found between superficial adipose tissue and pathological response (r=, 156). CONCLUSION: In conclusion, our results have provided a very low correlation between SAT and more than 30 % response. More research is required to evaluate the role of the body fat and muscle parameters in response to neoadjuvant chemotherapy in larger patient populations.

Quantification of the Asymmetry between Right and Left Cerebral Lateral Ventricles by Indexing Methods.

PURPOSE: To retrospectively analyze hydrocephalus and lateral ventricular asymmetry by measuring the midline shift, Evans index, right and left semi-Evans index, Right and left semi-callosal angles, superior ophthalmic vein (SOV) diameters, and to compare these findings with the control group. METHODS: The study included 93 cases with hydrocephalus, 80 cases with asymmetrical lateral ventricles (ALV) and 83 control cases with normal findings who had cranial magnetic resonance imaging (MRI) in our institute between the years 2011 and 2016. A senior and junior radiologist analyzed the images and performed the measurements, and the results were compared. RESULTS: The cut-off points for the Evans index and right and left semi-Evans indexes for differentiating hydrocephalus and ALV were calculated as 28.68%, 30.77%, and 30.88%, respectively. The septum shift degree was significantly higher in the ALV group compared to the control group (P = 0.010; P < 0.05). ALV or hydrocephalus were not found to be associated with SOV enlargement. The SOVs were not found to be enlarged ipsilateral to asymmetrically enlarged lateral ventricle. CONCLUSION: Lower Evans and right and left semi-Evans indices are seen in ALV. Despite some limitations, the Evans index could still be used to differentiate hydrocephalus and ALV. Mild ALV is mostly associated with an off-midline septum. SOV diameter and enlargement are not indicators of hydrocephalus or ALV.

Unexpected Finding on Mammography and MRI due to Accumulation of Iron Oxide Particles Used for Sentinel Lymph Node Detection.

We present a case with imaging artefacts on mammography and Magnetic Resonance Imaging (MRI) caused by iron oxide particles. After being diagnosed with the medullary cancer of the breast, the female patient had a breast conserving surgery on right breast. Iron oxide particles were used for the detection of the sentinel lymph node during operation. On follow ups, a de novo density on mammography, which was initially thought to be a new tumour, was found. MR images proved that the lesion is an artefact caused by iron oxide accumulation. Our aim in this case study is to underline and discuss the imaging artefacts caused by these particles and raise awareness.

Case Report: presentation of pleomorphic liposarcoma arising in a borderline phyllodes tumor.

INTRODUCTION: The stromal component of Phyllodes tumors represents the neoplastic portion of the lesion. A variety of associated malignancies can arise from PTs, with its dual population of cells. PRESENTATION OF CASE: We share a very rare case of "borderline"breast phillodes tumour with a 75% liposarcoma component. A 48-year-old woman presented at the surgical clinic with a mass in the left breast. On mammograms, the lesion was dense with radiolucent areas inside which were thought to be compatible with fat. The mass was assumed to be breast imaging-reporting and data system (BIRADS) 3 on sonography as it was well contoured. The needle biopsy was reported to be consistent with a fibroadenomatous lesion. The lesion was completely excised. On microscopic examination, the lesion has benign mammary duct epithelium lining the slit-like spaces. The stroma composed of fibrous and adipous tissue. The fibrous part was cellular, and several cells appeared bizarre. Adipous tissue replaced most of the stroma and was diagnosed as pleomorphic liposarcoma. DISCUSSION: According to the 3 tiered grading criteria of PTs, our case normally suits in borderline category, without liposarcoma component. Heterologous sarcomatous elements usually accompany high grade PTs. Rare cases of benign and borderline PTs with sarcoma component have been reported. CONCLUSION: The presence of a malignant heterologous component places the tumour into the malignant category regardless of other histological features.

Background parenchymal enhancement: is it just an innocent effect of estrogen on the breast?

PURPOSE: We aimed to retrospectively analyze whether background parenchymal enhancement (BPE) on breast magnetic resonance imaging (MRI) correlates with menarche, menopause, reproductive period, menstrual cycle, gravidity-parity, family history of breast cancer, and the Breast Imaging-Reporting and Data System (BI-RADS) category of the patient. METHODS: The study included 126 pre- and 78 postmenopausal women who underwent breast MRI in our institute between 2011 and 2016. Patients had filled a questionnaire form before the MRI. Two radiologists blinded to patient history graded the BPEs and the results were compared and analyzed. RESULTS: The BPE was correlated with patient age and the day of menstrual cycle (P < 0.01 for both). No correlation was found with menarche age, menopause age, total number of reproductive years, and family history of breast cancer. In the moderate BPE group, only 1 out of 35 patients and in the marked BPE group only 1 out of 13 patients were postmenopausal and had BI-RADS scores of 4 and 5, respectively. CONCLUSION: Increased symmetrical BPE is mainly due to current hormonal status in the premenopausal women. High-grade BPE, whether symmetrical or not, is rarely seen in postmenopausal women; hence, these patients should be further investigated or closely followed up.

Complication of non-US guided procedure of aquafilling breast gel.

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Internal Mammary Artery Anastomoses in Patients without Breast Lesions (BIRADS 1) and in Patients with Malignant Breast Lesions (BIRADS 6) on Magnetic Resonance Imaging (MRI).

BACKGROUND: We aimed to compare the frequency of IMA (internal mammarian artery) anastomoses in right and left breasts in patients without breast lesions and in patients with malignant breast lesions. MATERIAL/METHODS: A total of 100 patients with no breast lesions and a total of 100 patients with malignant breast lesions were included in the study. The anastomoses of IMA of right and left breasts were evaluated on MIP and post-contrast T1-weighted magnetic resonance imaging (MRI) sequences. Breast MRI scans were read by a radiologist. RESULTS: In patients with no breast lesions, IMA anastomoses were found in 45% of cases, and in patients with malignant breast lesions, IMA anastomoses were found in 58% cases. In four patients with malignant lesions, ipsilateral IMA was rudimentary, and the lesion was feeding from the contralateral IMA. CONCLUSIONS: No statistically significant difference was found between patients without any breast lesions and patients with malignant breast lesions with respect to the frequency of IMA anastomoses in right and left breasts. The frequencies were higher than expected in both groups.

Sonographically Unusual Breast Carcinomas, 2 Case Reports.

BACKGROUND: For infiltrative breast lesions; sonography might not always be as helpful as mammography and MRI (magnetic resonance imaging). For higher sensitivity and specificity, these 3 imaging methods should be carried out together. Radiologists should be aware of the patient's history and complaints. Patients who have a specific history like a long-term drug treatment or a palpable tumour should be approached differently. CASE REPORT: We would like to present 2 cases with atypical sonographic findings. The first case is an infiltrative breast cancer with occult sonography findings in a patient with a history of a long-term immunosuppressive drug treatment due to kidney transplantation and the second case is a malignant breast tumour which is hyperechogenic on sonography. CONCLUSIONS: Overall breast sonography should always be correlated with mammography in patients over 40 years old and the images should be interpreted along with the patient's history and clinical status.

Diagnostic accuracy of metastatic axillary lymph nodes in breast MRI.

PURPOSE: The most important prognostic variable for early stage breast cancer is the status of axillary lymph nodes. The aim of this study was to evaluate the diagnostic accuracy of preoperative magnetic resonance imaging (MRI) for metastatic axillary lymph node in breast cancer cases with post-operative sentinel lymph node biopsy (SLNB) results. MATERIALS AND METHODS: Women aged between 21 and 73 years who were diagnosed with malignant mass lesion of the breast between 2013 and 2015 were included in this study. The preoperative MR images of patients with diagnosis of breast cancer was evaluated to determine axillary lymph node status. Axillary lymph node size, long axis to short axis ratio, lymph node contours, cortical thickness to anteroposterior diameter ratio, the presence of a fatty hilum and contrast enhancement patterns (homogenous or heterogenous) was noted. Additionally, the presence of comet tail sign which a tail extending from an enhancing breast lesion into the parenchyma and might represent ductal infiltration on post-contrast series was also noted. All data obtained from this evaluation was compared with postoperative SLNB results. RESULTS: Metastatic nodes were found to have a longer short axis when compared to reactive nodes (p = 0.042; p < 0.05). The long axis to short axis ratio was notably lower in metastatic nodes when compared to reactive nodes. Cortical thickness was higher in metastatic nodes when compared to reactive nodes (p = 0.024; p < 0.05). Comet sign was observed in 15 of metastatic nodes (73.3 %) and in one (5 %) reactive node. This difference was statistically significant (p = 0.001; p < 0.01). While fatty hilum was seen in 40 % of metastatic nodes (n = 6), it was seen in all (n = 20) reactive nodes. This difference was statistically significant (p = 0.001; p < 0.01). CONCLUSIONS: MRI is a non invasive sensitive and specific imaging modality for evaluating the axilla. We have shown that with the help of comet tail sign and status of fatty hilum contrast enhanced MRI has the highest sensitivity of 84.7 % for detecting axillary lymph node metastases (Singletary et al. in Semin Surg Oncol 21(1):53-59, 2003).

Diffusion Weighted MR Imaging of Breast and Correlation of Prognostic Factors in Breast Cancer.

BACKGROUND: Through Diffusion Weighted Imaging (DWI), information related to early molecular changes, changes in the permeability of cell membranes, and early morphologic and physiologic changes such as cell swelling can be obtained. AIMS: We investigated the correlation between the prognostic factors of breast cancer and apparent diffusion coefficient (ADC) in DWI sequences of malignant lesions. STUDY DESIGN: Retrospective cross-sectional study. METHODS: Patients who were referred to our clinic between September 2012 and September 2013, who underwent dynamic breast MRI before or after biopsy and whose biopsy results were determined as malignant, were included in our study. Before the dynamic analysis, DWI sequences were taken. ADC relationship with all prognostic factors was investigated. Pearson correlation test was used to compare the numerical data, while Spearman correlation and Fisher exact tests were used to compare the categorical data. The advanced relationships were evaluated with linear regression analysis and univariate analysis. The efficiency of the parameters was evaluated using ROC analysis. The significance level (P) was accepted as 0.05. RESULTS: In total, 41 female patients with an average age of 49.4 years (age interval 21-77) and 44 lesions were included into the study. In the Pearson correlation test, no statistically significant difference was determined between ADC and the patient's age and tumor size. In the Spearman correlation test, a statistically significant difference was determined between nuclear grade (NG) and ADC (r=-0.424, p=0.04); no statistically significant correlation was observed between the other prognostic factors with each other and ADC values. In the linear regression analysis, the relationship of NG with ADC was found to be more significant alone than when comparing all parameters (corrected r2=0.196, p=0.005). Further evaluations between the NG and ADC correlation were carried out with ROC analysis. A statistically significant difference was determined when NG 1 separately was compared with NG 2 and 3 (p=0.03). A statistically significant difference was also determined (p=0.05) in the comparison of NG 1 with only NG 3. No statistically significant difference was determined when NG 2 separately was compared with NG 1 and NG 3 and when NG 3 separately was compared with NG 1 and 2 (p=0.431, p=0.097). CONCLUSION: We found that ADC values obtained by breast DWI showed a higher correlation with the NG of breast cancer, which is an important factor in the patient's treatment. Predictions can be made about NG by analyzing the ADC values. Additional studies are needed, however, and the ADC value of the lesion can be used as a prognostic factor proving the aggressiveness.

A pictorial essay of breast implant imaging and implant complications.

Nowadays as more breast conserving surgeries and mastectomies are being performed, more breast implants are being used. Follow-up of these patients is as important as treatment. We, radiologists should be aware of normal imaging appearance of implants during follow ups. We should also be aware of complications which we may encounter during controls. In our essay, we aim to show the normal and pathological appearence of implants by sharing ultrasound, mammography and MR images from our clinic. KEY WORDS: Breast, Implants, MRI, Rupture.

MRI of Residual Red Bone Marrow in the Distal Femur of Healthy Subjects.

BACKROUND: The purpose of our study is to examine the correlation of the residual red bone marrow areas of distal femoral metaphysis with the age, gender, weight and hemoglobin (hgb) values; evaluate the results, and comprehend the importance of these residual areas in the light of the results. MATERIAL/METHODS: 140 nonsmoking patients between the ages of 26 and 72 (92 women, 48 men) who had knee MR examinations were included in the study. The residual red bone marrow areas in the distal femoral metaphysis in MR images were examined by a radiologist. The areas were separated into grades according to their sizes. The hemoglobin values of the cases were measured. The size of the residual red bone marrow area and the age, gender, weight and hemoglobin values of the cases were compared by using the Tukey and Chi-Square Tests. RESULTS: Although no significant differences were observed between the mean ages, weights and hemoglobin values of the grades, a significant difference was detected between the gender distribution The male group had less residual red bone marrow in the distal femoral metaphysis than the female group (p=0.003). CONCLUSIONS: We observed that the hypointensities due to residual red bone marrow observed in the T1WS of the distal femoral metaphysis are not related with the age, weight and hemoglobin values. No grade 2 and grade 3 patient was detected in male group. We observed that these hypointense areas showed difference according to the gender variable; however, were not affected by the hemoglobin values over certain levels.

Computed tomography imaging findings of craniofacial fibrous dysplasia.

INTRODUCTION: The purpose of this study was to retrospectively describe demographic characteristics and computed tomography (CT) imaging findings of craniofacial fibrous dysplasia (FD). PATIENTS AND METHODS: Between February 2010 and February 2013, we retrospectively studied 64 patients described as FD at CT imaging. Site of involvement and CT imaging findings of craniofacial FD were recorded for each patient. RESULTS: Our patients are described as FD at CT imaging with the following findings: expansion, ground glass density, expansion and sclerosis, expansion with sclerosis and lytic appearance, expansion and lytic appearance, and only sclerosis. Expansion was the main feature which was seen with other findings (85%). The most common finding was ground glass density and the least appearance was expansion with lytic areas and only sclerosis. DISCUSSION: Our study has shown that it is very effective to know about CT findings and localizations of craniofacial FD to reduce unnecessary biopsy rates and increase the true diagnosis.

Liver trauma grading and biochemistry tests.

Among solid organ blunt traumas, the liver and spleen are mostly subject to injury. In addition, the liver is also commonly injured in penetrating traumas because of its size, location, and the ease of injury to the "Glisson Capsule". Several enzymes are known to be elevated following trauma. In our study, we evaluated the correlation between the levels of serum aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and gamma-glutamyl transpeptidase in 57 patients with blunt trauma to the liver and compared these values to the American Association for the Surgery of Trauma trauma grading system. Additionally, we compared the enzyme level elevations in these patients to the enzyme levels of 29 healthy subjects. As expected, we found significant elevations in enzyme levels of trauma patients compared to the control group. The calculated point estimates were not significantly different between grades 1 and 2 trauma. However, grade 3 trauma group showed a significant increase in enzyme levels.