CT values of contrast-enhanced CBBCT: A useful diagnostic tool for benign and malignant breast lesions.

BACKGROUND: Computed tomography (CT) value studies of cone-beam breast CT (CBBCT) mainly focus on the enhancement value or enhancement rate, and there has been no study on the CT value (Hounsfield units [HU]) of the lesion itself. PURPOSE: To investigate the CT values under contrast-enhanced CBBCT (CE-CBBCT) and non-contrast-enhanced CBBCT (NC-CBBCT) in scanning for the differential diagnosis of benign and malignant breast lesions. MATERIAL AND METHODS: A retrospective analysis was performed on 189 cases of mammary glandular tissues that underwent NC-CBBCT and CE-CBBCT examination. The qualitative CT values of the lesions, standardized Δ(L-A), standardized Δ*(L - G), standardized Δ(L-A) (Post 1st-Pre), and standardized Δ*(L-G) (Post 2nd-Post 1st) between the benign and malignant groups were compared. Prediction performance was evaluated using receiver operating characteristic (ROC) curves. RESULTS: In total, 58 cases were included in the benign group, 79 cases were included in the malignant group, and 52 cases were included in the normal group. The best diagnostic thresholds of CT values for L (Post 1st-Pre), Δ(L-A) (Post 1st-Pre), and Δ*(L-G) (Post 1st-Pre) were 49.5, 44, and 64.8 HU, respectively. The Δ(L-A) Post-1st rate values of CBBCT had medium diagnostic efficacy (AUC = 0.74, sensitivity = 76.6%, specificity = 69.4%). CONCLUSION: CE-CBBCT can improve the diagnostic efficiency of breast lesions compared with NC-CBBCT. The CT values (HU) of lesions do not need to be standardized with fat and can be directly used in clinical differential diagnosis. The first contrast phase (60 s) is recommended to reduce the radiation exposure.

Giant bilateral scrotal lipoma with abnormal somatic fat distribution: A case report.

BACKGROUND: Scrotal lipoma is exceedingly rare, so its origin is still unknown. Injury is suggested as a potential factor, but the cause remains unclear. It is difficult to determine the origin of these tumours. Previous studies have suggested that these tumours may be congenital or that they originate from small fatty particles around the cord. Other studies have suggested that these tumours originate from testicles or the tunica. CASE SUMMARY: A 66-years elderly male with giant scrotal mass. B-ultrasound, computed tomography and magnetic resonance imaging examinations are typical lipoma-like changes, which were confirmed by postoperative pathological analysis. Abnormal somatic fat distribution was confirmed by images. no recurrence after follow-up for 2 years. Previously published English-language literature was reviewed, and a history of inguinal or pelvic surgery was reported in 6 studies (total 21 cases). To our knowledge, this is the heaviest bilateral scrotal lipoma in the English-language literature, and it has the longest postoperative follow-up time. More importantly, the origin of these tumours is reviewed and discussed. CONCLUSION: Giant bilateral scrotal lipoma in elderly may as part of the symptoms of abnormal somatic fat distribution.

CRMP4 CpG Hypermethylation Predicts Upgrading to Gleason Score ≥ 8 in Prostate Cancer.

Background: This study determined the predictive value of CRMP4 promoter methylation in prostate tissues collected by core needle biopsies for a postoperative upgrade of Gleason Score (GS) to ≥8 in patients with low-risk PCa. Method: A retrospective analysis of the clinical data was conducted from 631 patients diagnosed with low-risk PCa by core needle biopsy at multiple centers and then underwent Radical Prostatectomy (RP) from 2014-2019. Specimens were collected by core needle biopsy to detect CRMP4 promoter methylation. The pathologic factors correlated with the postoperative GS upgrade to ≥8 were analyzed by logistic regression. The cut-off value for CRMP4 promoter methylation in the prostate tissues collected by core needle biopsy was estimated from the ROC curve in patients with a postoperative GS upgrade to ≥8. Result: Multivariate logistic regression showed that prostate volume, number of positive cores, and CRMP4 promoter methylation were predictive factors for a GS upgrade to ≥8 (OR: 0.94, 95% CI: 0.91-0.98, P=0.003; OR: 3.16, 95% CI: 1.81-5.53, P<0.001; and OR: 1.43, 95% CI: 1.32-1.55, P<0.001, respectively). The positive predictive rate was 85.2%, the negative predictive rate was 99.3%, and the overall predictive rate was 97.9%. When the CRMP4 promoter methylation rate was >18.00%, the low-risk PCa patients were more likely to escalate to high-risk patients. The predictive sensitivity and specificity were 86.9% and 98.8%, respectively. The area under the ROC curve (AUC) was 0.929 (95% CI: 0.883-0.976; P<0.001). The biochemical recurrence (BCR)-free survival, progression-free survival (PFS), and cancer-specific survival (CSS) were worse in patients with CRMP4 methylation >18.0% and postoperative GS upgrade to ≥8 than in patients without an upgrade (P ≤ 0.002). Conclusion: A CRMP4 promoter methylation rate >18.00% in prostate cancer tissues indicated that patients were more likely to escalate from low-to-high risk after undergoing an RP. We recommend determining CRMP4 promoter methylation before RP for low-risk PCa patients.

Sarcomatoid carcinoma of the prostate with bladder invasion shortly after androgen deprivation: Two case reports.

BACKGROUND: To summarize the imaging, morphological and biological characteristics of sarcomatoid carcinoma (SC) of the prostate with bladder invasion not long after castration. CASE SUMMARY: Our two cases were initially diagnosed with adenocarcinoma of the prostate due to dysuria. However, prostate SC was diagnosed after transurethral resection of the prostate (TURP) and castration after only 5 and 10 mo, respectively. Distinctive liver-like tissues appeared in the second TURP procedure in case 1, while a white, fish flesh-like, narrow pedicled soft globe protruded from the prostate to the bladder in case 2. CONCLUSION: The sarcomatoid component of SC may arise from one of the specific groups of cancer cells that are resistant to hormonal therapy. Morphological characteristics of SCs can present as "red hepatization" and "fish flesh". SCs grow rapidly and have a poor prognosis, and thus, extensive TURP plus radiation may be the treatment of choice.

A rare life-threatening disease: unilateral kidney compressed by huge chronic spontaneous retroperitoneal hemorrhage.

OBJECTIVES: To study an uncommon life-threatening disease, spontaneous retroperitoneal and perirenal hemorrhage. CASE DESCRIPTIONS: A 69-year-old male presented with pain in the left waist and back of 1 month duration. The renal abscess was suspected by magnetic resonance imaging before operation. The perirenal hematoma was cleaned by operation. In another case, the patient had a functional solitary left kidney compressed by a huge retroperitoneal mass and uropenia appeared. RESULTS: The first patient died of adult respiratory distress syndrome after surgery. The second patient died of cardiac insufficiency and pulmonary embolism on the second day after evacuation of retroperitoneal hematoma. CONCLUSION: Conservative surgery, such as selective arterial embolization, is a reasonable approach in patients with chronic spontaneous retroperitoneal and perirenal space hemorrhage and with poor general condition. We strongly recommend drainage or interventional therapy, but not a major surgery, in patients with poor condition.

Perfusion computed tomography evaluation of partial hepatic ischemia reperfusion in a rabbit model.

RATIONALE AND OBJECTIVES: An animal model of partial hepatic ischemia/reperfusion injury (I/R) has benefits for decision making and clinical management after liver transplantation or massive hepatic resection. The aim of this study was to evaluate the change in perfusion parameters after partial hepatic I/R in rabbits using multislice computed tomography perfusion imaging. MATERIALS AND METHODS: Thirty rabbits underwent 60 minutes of left hepatic lobar ischemia followed by 0.5, 2, 6, 12, and 24 hours of reperfusion (six rabbits were used for each reperfusion interval). An additional six rabbits served as sham-operated controls. The perfusion indices of hepatic arterial perfusion, hepatic portal perfusion, total liver perfusion, and hepatic perfusion index were measured. Levels of serum aspartate transaminase and alanine transaminase and liver histopathology at different time points were also examined. RESULTS: Hepatic microvascular flow patterns showed heterogeneity in the 6-hour, 12-hour, and 24-hour groups. Computed tomographic perfusion parameters were significantly different between infarcted liver tissue and viable liver tissue. In poorly enhancing tissues in the 6-hour, 12-hour, and 24-hour groups, hepatic portal perfusion and total liver perfusion were lower compared to the sham group, but hepatic arterial perfusion of poorly enhancing tissues significantly increased in the 6-hour group and then decreased slightly from 12 to 24 hours after reperfusion. The hepatic perfusion index was always higher compared to that of the sham group. Hepatic arterial perfusion, hepatic portal perfusion, total liver perfusion, and hepatic perfusion index in the noninfarcted areas decreased slowly from 6 to 24 hours after reperfusion. The levels of alanine transaminase and aspartate transaminase in the I/R groups significantly increased after reperfusion and were correlated with the computed tomographic perfusion indices of infarcted liver tissue. CONCLUSIONS: Computed tomographic perfusion can dynamically monitor the pathologic processes of liver I/R and reveal the underlying microvascular disorder, improving clinical management after liver surgery.