Breast Implant-Associated Anaplastic Large Cell Lymphoma: A Case Report about a Male Patient with Pectoral Implants.

Introduction: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is still a rare extralymphatic lymphoma. As of March 1, 2023, approximately 1,355 cases of BIA-ALCL have been reported worldwide. However, no such case has yet been described with pectoral implants in male patients. Most patients with BIA-ALCL present with nonspecific implant-associated symptoms such as late-onset seroma, swollen breasts, and deformation of implants. Case Presentation: Here, we describe BIA-ALCL in a 76-year-old male patient who presented with a late-onset seroma in order to raise awareness for BIA-ALCL also in men after esthetic chest surgery with silicone pectoral implants. The patient had undergone augmentation of the pectoralis muscle with implants for esthetic reasons 9 years before. First cytological specimens showed no malignancy. A repeated cytological assessment after 6 weeks from recurring seroma showed characteristic CD30+ T-cell clones. Surgery with complete bilateral capsulectomy and implant removal was performed. Due to the early-stage ALCL being limited only to the capsule and no evidence of systemic disease, adjuvant systemic treatment was not considered necessary. Conclusion: Any persisting late-onset seroma also in male patients with pectoral implants should raise suspicion of ALCL as differential diagnosis and should be assessed with cytological examination.

Intraindividual comparison of image quality using retrospective and prospective respiratory gating for the acquisition of thin sliced four dimensional multidetector CT of the thorax in a porcine model.

PURPOSE: To intraindividually compare image quality and anatomical depiction of the lung and mediastinum using retrospective and prospective respiratory gating techniques for the acquisition of 4D-multidetector computed tomography (MDCT) of the chest in a porcine model. MATERIALS AND METHODS: Twelve trachealy intubated domestic pigs underwent 64-row MDCT of the thorax. For retrospective and prospective gating the automated respiratory frequency was adjusted to 10, 14, 18, and 22 respiratory cycles per minute. Further, free breathing MDCT scans of the lung were performed at the same respiratory settings. A breathhold scan was acquired which served as the reference standard. Three reviewers independently analyzed the MDCT data applying a 4-point-grading scale regarding the degree of artifacts observed and anatomical depiction (1, excellent, no artifacts; 4, nondiagnostic due to severe artifacts). For statistical analysis the Wilcoxon matched pairs and Chi-square test were used. RESULTS: Breathhold imaging allowed for the highest image quality (mean value: trachea, 1.00; bronchi, 1.10; lung parenchyma, 1.08; diaphragm, 1.00; pericardium, 1.80). Retrospective gating proved to be of superior image quality compared to prospective gating for all respiratory frequencies. With the respiratory frequency set to 14/min retrospective gating even enabled an identical image quality score as at breathhold. Performing image acquisition during continuous breathing lead to a severe decrease in image quality. CONCLUSIONS: High image quality can be acquired using respiratory gating techniques for 4D-MDCT of the thorax. Retrospective is superior to prospective gating and can be of an equivalent image quality as standard breathhold imaging, but at the cost of a significantly higher radiation dose.

In vitro influence of ultrasonic stress, removal force preload and thermocycling on the retrievability of implant-retained crowns.

OBJECTIVES: The main goals of this in vitro study were to evaluate the influence of thermocycling, ultrasonic stress and the removal force preload on the retrievability of cemented implant crowns using a clinical removal device (Coronaflex) and evaluating the tensile strength using a universal testing machine (UTM). METHODS: Thirty-six crowns were cast from a Co-Cr alloy for 36 tapered titanium abutments (5° taper, 4.3 mm diameter, 6 mm height, Camlog, Germany). The crowns were cemented with a glass-ionomer (Ketac Cem) or a polycarboxylate (Durelon) cement, followed by 3 days of storage in ionized water without thermocycling or 150 days of storage with 37,500 thermal cycles between 5°C and 55°C. Before removal, the crowns were subjected to ultrasonic stress for 0, 5 or 10 min with a contact pressure of either 50 or 500 g. The Coronaflex was used with a removal force preload of 50 or 400 cN, respectively, applied on the point of loading. Scanning electronic microscopy (SEM) was used to evaluate the impact of the removal on the abutment screws. RESULTS: Crowns cemented with the glass-ionomer cement were significantly easier to remove with the Coronaflex or the UTM than crowns cemented with the polycarboxylate cement (P≤0.05). Ultrasonic stress showed no significant impact on the retrievability regardless of the contact pressure or duration applied (P>0.05). No significant differences could be found for both cements when removed with the Coronaflex or the UTM (P>0.05) after thermocycling was applied. A removal force preload of 400 cN resulted in significantly reduced removal attempts in comparison with 50 cN for both cements (P≤0.05). CONCLUSIONS: Ultrasound and thermal cycling did not result in reduced cement strength, but to retrieve the crowns, the full impact of a removal instrument has to be applied. Ketac Cem can be used as a "semipermanent" solution, whereas Durelon might serve for permanent cementation. None of the abutment screws showed signs of wear caused by the removal process.

Diffusion-weighted MR-imaging for the detection of pulmonary nodules at 1.5 Tesla: intraindividual comparison with multidetector computed tomography.

INTRODUCTION: To investigate the feasibility of diffusion-weighted imaging (DWI) MRI for detecting pulmonary nodules at 1.5 Tesla in comparison with standard multidetector computed tomography (MDCT). METHODS: Twenty patients with disseminated cancer disease in which MDCT had assured the presence of at least one pulmonary nodule were examined using a respiratory-gated DWI MR-sequence. Grey scale inverted source images and coronal maximum intensity projection (MIP) images were consensually analysed by two experienced radiologists. Size and location of any nodule detected were assessed. Additionally, the readers evaluated each hemithorax for the presence of at least one nodule and applied a four-point conspicuity scale (1-hemithorax definitely affected; 4-hemithorax definitely not affected). MDCT data served as reference. RESULTS: At MDCT, a total of 71 pulmonary noduIes was found (size 3-5mm, n=16; 6-9mm, n=22; ≥10mm, n=33). For the DWI MR-sequence, a sensitivity of 86.4% was calculated for nodules ranging 6-9mm and 97% for nodules ≥10mm. In contrast, only 43.8% of lesions ≤5mm was detected. The separate analysis of each hemithorax for the presence of at least one pulmonary nodule revealed a specificity rate, PPV and NPV of DWI-MR of 92.3%, 96% and 80%, respectively. CONCLUSIONS: The presented study is the first to confirm the diagnostic potential of DWI-MR in the detection of solid lung nodules. This technique allows for the detection of nodules ≥6mm with reasonably high sensitivity rates (>86%). The observation of false positive findings decreases the accuracy of this approach compared with MDCT.