Follicular dendritic cell sarcoma with atypical features surrounding undescended testis: description of a rare case.

Dendritic cell tumors are extremely rare neoplasms and occur both in nodal and extranodal sites. We report a case of an intra-abdominal follicular dendritic cell sarcoma (FDCS). The aim of this study is to describe histological, immunohistochemical, and ultrastructural features of FDCS in order to better define an abdominal mass with unusual immunophenotype and atypical clinical and radiological presentation.

Huge malignant phyllodes breast tumor: a real entity in a new era of early breast cancer.

Phyllodes tumor is an extremely rare tumor of the breast. It occurs in females in the third and fourth decades. The difficulty in distinguishing between phyllodes tumors and benign fibroadenoma may lead to misdiagnosis. Lymph node involvement is rarely described in phyllodes tumors; for this reason, sentinel node biopsy may be warranted. We present a case of a 33-year-old woman affected by huge tumor of the right breast with ulceration in the skin with a rapid tumor growth and with omolateral axillary metastasis.

Underestimation rate of lobular intraepithelial neoplasia in vacuum-assisted breast biopsy.

OBJECTIVES: To evaluate the underestimation rate and clinical relevance of lobular neoplasia in vacuum-assisted breast biopsy (VABB). METHODS: A total of 161 cases of LN were retrieved from 6,435 VABB. The histological diagnosis was ALH (atypical lobular hyperplasia) in 80 patients, LCIS (lobular carcinoma in situ) in 69 patients and PLCIS (pleomorphic lobular carcinoma in situ) in 12 patients. Seventy-six patients were operated on within 2 years after VABB and 85 were clinically and radiologically monitored. The mean follow-up was 5.2 years, and the prevalence of malignancy was evaluated in the group of 85 patients. RESULTS: The clinico-pathological characteristics significantly favouring surgery were larger lesions, occurrence of a residual lesion following VABB and histological LCIS and PLCIS subtypes. The VABB underestimation rate as compared to surgery was 7.1% for ALH, 12% for LCIS and 50% for PLCIS. Overall, 11 of the 148 patients included in this survival analysis developed an ipsilateral tumour. CONCLUSION: Although obtained retrospectively in a relatively small series of patients, our data suggest that only patients with a diagnosis of PLCIS in VABB should be treated with surgery, whereas patients with ALH and LCIS could be monitored by clinical and radiological examinations. KEY POINTS: • The treatment of ALH and LCIS in VABB is still debated • Some authors favour radical treatment and others a more conservative approach • Only patients with PLCIS in VABB should be treated by surgery.

Surgical sentinel lymph node biopsy in early breast cancer. Could it be avoided by performing a preoperative staging procedure? A pilot study.

BACKGROUND: The aim of this pilot trial was to study the feasibility of sentinel node percutaneous preoperative gamma probe-guided biopsy as a valid preoperative method of assessment of nodal status compared to surgical sentinel lymph node biopsy. MATERIAL/METHODS: This prospective study enrolled 10 consecutive patients without evidence of axillary lymph node metastases at preoperative imaging. All patients underwent sentinel node occult lesion localization (SNOLL) using radiotracer intradermic injection that detected a "hot spot" corresponding to the sentinel node in all cases. Gamma probe over the skin detection with subsequent ultrasonographically guided needle biopsy of the sentinel node were performed. The percutaneous needle core histopathological diagnosis was compared to the results of the surgical biopsy. RESULTS: Preoperative sentinel node identification was successful in all patients. CONCLUSIONS: The combination of preoperative gamma probe sentinel node detection and ultrasound-guided biopsy could represent a valid alternative to intraoperative sentinel node biopsy in clinically and ultrasonographically negative axillary nodes, resulting in shorter duration of surgery and lower intraoperative risks.

Pulmonary nodules: Contrast-enhanced volumetric variation at different CT scan delays.

OBJECTIVE: The purpose of this study was to assess the effects of IV contrast medium and different CT scan delays on volumetric measurements of pulmonary nodule. MATERIALS AND METHODS: Automated volumes of 35 pulmonary nodules were calculated with two dedicated software packages (designated as software A and software B) for each unenhanced and contrast-enhanced CT scan at 30-, 60-, 120-, 180-, and 300-second delays (injection protocol, 2 mL/s and 2 mL/kg). Nodule attenuation was also determined. Differences between unenhanced and contrast-enhanced volumes were analyzed by Wilcoxon's signed rank test. Contrast-enhanced volume ratio was calculated as the ratio between contrast-enhanced and unenhanced nodule volume. RESULTS: Contrast-enhanced volumes were significantly larger than unenhanced volumes (p < 0.05) for all the timing delays except at 30 seconds for software A, and no significant differences were found among volumes measured with both software programs at different contrast-enhanced delays. Median volume ratios between contrast-enhanced and unenhanced volumes were 1.04-1.07 for software A and 1.04-1.06 for software B, and median volume ratios within different contrast-enhanced delays were 0.99-1.03 for software A and 0.99-1.04 for software B. We did not find any significant association between contrast-enhanced volume ratio and nodule diameter, site, shape, unenhanced density, or contrast-enhanced density ratio (p > 0.05). CONCLUSION: We recommend comparing volume of pulmonary nodules obtained from CT examinations only if they are all performed with or without contrast material, whereas nodule volumes obtained by use of enhanced CT performed with different scan delays are comparable.

How we provided appropriate breast imaging practices in the epicentre of the COVID-19 outbreak in Italy.

Italy has one of the highest COVID-19 clinical burdens in the world and Lombardy region accounts for more than half of the deaths of the country. Since COVID-19 is a novel disease, early impactful decisions are often based on experience of referral centres.We report the re-organisation which our institute (IEO, European Institute of Oncology), a cancer referral centre in Lombardy, went through to make our breast-imaging division pandemic-proof. Using personal-protective-equipment and innovative protocols, we provided essential breast-imaging procedures during COVID-19 pandemic without compromising cancer outcomes.The emergency management and infection-control-measures implemented in our division protected both the patients and the staff, making this experience useful for other radiology departments dealing with the pandemic.

Pseudoangiomatous stromal hyperplasia - a benign and rare tumor of the breast in an adolescent: a case report.

BACKGROUND: Pseudoangiomatous stromal hyperplasia is an uncommon mesenchymal breast neoplasm. CASE PRESENTATION: Here we present a case of an 11-year old hispanic girl affected by bilateral mammary nodular pseudoangiomatous stromal hyperplasia, an uncommon breast disease, with a review of the literature related to diagnostic workup, differential diagnosis, and management. A rapidly growing mass in the breast may be stressful for both parents and child as the suspicion of malignancy arises. Multiple wide excisions of both breasts were performed. CONCLUSIONS: The purpose of this case report is to draw attention to the fact that most emerging lesions of the breast in girls during puberty are benign diseases.

Primary breast leiomyosarcoma and synchronous homolateral lung cancer: a case report.

Radiological and histological features of breast leiomyosarcoma can mimic a wide variety of other breast lesions, such as mesenchymal tumors, breast lymphomas, poorly differentiated carcinomas and metaplastic breast carcinomas. The authors present the case of a 62-year-old woman with a primary breast leiomyosarcoma with synchronous ipsilateral lung adenocarcinoma. The latter was an incidental finding during pre-surgical staging examinations. Clinicopathological, immunophenotypic and imaging features cancer are described. A brief review of the literature on imaging findings and management of breast leiomyosarcoma is presented. The authors discuss the differential diagnoses in breast imaging and of the extra-mammary incidental findings. Surgical resection remains the cornerstone of treatment, while radiation therapy and chemotherapy remain to be defined on a single-patient basis.

A very elderly lung cancer patient: case report of a long disease free survival.

Despite the fact that non-small-cell lung cancer (NSCLC) is very common in the older population, these patients are frequently underrepresented in clinical and surgical trials and thus it is difficult to reach evidence-based recommendations for this special population. We present a case of a surgical treatment of asymptomatic lung cancer in a very elderly patient. The patient had no recurrence for 4 years after a complete resection.

Spinal cord compression: an unusual presentation of malignant pleural mesothelioma. A case report and review of the literature.

Pleural malignant mesothelioma is a locally invasive tumor that tends to progress due to direct extension of the tumor into the pulmonary parenchyma, the chest wall, the mediastinum, or the abdominal cavity via the diaphragm. In the later stages of the disease, distant metastases can occur. Metastases to the nervous system are rare, and clinical signs of nervous system involvement typically appear between 2 months and 6 years after the primary diagnosis. However, the case presented here manifested as neurological impairment without any respiratory symptoms.