Contrast Enhancement In Early Phase Research Articles

An intriguing journey of encapsulated apocrine papillary carcinoma of the breast

BackgroundEncapsulated Apocrine Papillary Carcinoma (EAPC) of the breast are very rare tumors. They usually present as a cystic mass with mural nodule in women aged 44–84 years. Affected patients may be asymptomatic or complain of breast swelling, or nipple discharge. Mammographic features are nonspecific. The tumor appears as a high-density round or oval mass with circumscribed or spiculated margins on mammography. On Ultrasonography (US) a classical lesion appears as predominantly cystic mass with intracystic solid papillary projections and area of vascularity within it. Contrast Enhanced Breast MRI helps to further characterize the lesion by showing intense contrast enhancement in early phase along with washout curve. Histological features of these tumors are similar to those of classical encapsulated papillary neoplasm, in that myoepithelial cells are absent within the papillary structures and at the periphery of the cyst. They show variable degree of cytological atypia and mitotic activity. Such tumors consist of abundant granular eosinophilic cytoplasm and large nuclei with prominent nucleoli and are androgen receptor positive. However, a multidisciplinary approach is crucial for diagnosis and tissue histology is essential to suitably formulate treatment guidelines. Surgical excision is the preferred treating option for these tumors. Little consensus is available about local radiation and adjuvant therapy for the treatment of such tumors, yet they have been reported to have good prognosis.Case presentationThis rare case report describes the intriguing journey towards the diagnosis of an encapsulated intracystic apocrine papillary carcinoma in a 52-year-old premenopausal female who presented with palpable breast swelling in left breast. The patient underwent mammography, breast ultrasound and breast MRI concluding it to be a BIRADS 4A lesion. Then the patient was subjected to trucut core biopsy and finally surgical excision was performed. On Histopathology this lesion was diagnosed as encapsulated apocrine papillary carcinoma with androgen receptor positivity and triple negative hormonal status. At present patient is on regular follow-up.ConclusionsEncapsulated intracystic apocrine papillary carcinoma has a favorable prognosis with low recurrence rate and excellent long-term survival regardless of its invasive nature. Therefore, we present this rare entity to highlight the importance of radiological and histopathology findings in its diagnosis.

The correlation between stroma analysis and MDCT early phase contrast enhancement in small solid lung adenocarcinoma

Objective To evaluate correlations between proportion and distribution of tumor stroma and MDCT early phase enhancement character in solid lung adenocarcinoma, and compare with microvessel density and histological subtypes.

Diagnosis of 26 small hepatocellular carcinoma using incremental dynamic computed tomography.

Hepatocellular carcinoma (HCC) is usually visualized as high density area in early phase of an incremental dynamic computed tomography (ID-CT). Small HCC nodules less than 2 cm in diameter are sometimes, however, showing no contrast enhancement. We examined 26 HCC nodules less than 2 cm in diameter by ID-CT. All HCC nodules examined were originally detected by ultrasonography and diagnosed by fine needle biopsy in histology. We studied the sensitivity of ID-CT in detecting HCC nodules and a possible association between a presence or absence of contrast enhancement and the degree of cell differentiation of HCC nodules. Of the 26 HCC nodules, 22 (84.6%) were detected by ID-CT. Of the 22 detected nodules, 7 were depicted as high density area in early phase of ID-CT, and 5 were moderately differentiated HCC and the other 2 were poorly differentiated HCC in histology. Twelve nodules were low density area in early phase of ID-CT, and all of them were well-differentiated HCC. The other 3 nodules, which were isodense in early phase, were depicted as low density area in late phase, and 2 were well-differentiated HCC and other was moderately differentiated HCC. In this study, most of small and well-differentiated HCC nodules less than 2 cm in diameter showed no contrast enhancement in early phase of ID-CT. Therefore, when ID-CT of intrahepatic nodules less than 2 cm shows low density in early phase without contrast enhancement, well-differentiated HCC are most suspected, and further examinations such as magnetic resonance imaging and needle biopsy are needed.