Cystic Mass Research Articles

Thyroglossal Tract Cyst in the Elderly Subject: About Two Cases

SUMMARY: Introduction: Thyroglossal tract cysts (TTCs) are the most common congenital cysts of the neck. Approximately 50% of cases are detected in the first 2 decades of life, but may also appear later in adulthood. Clinical cases: A 62-year-old patient with no particular pathological history and a cervical mass that had been evolving for more than 30 years. Clinical examination revealed a cervical mass opposite the left lateral hyoid bone, measuring 3.5cm long, firm in consistency, regular in contour, painless, immobile on swallowing, with healthy skin and no signs of compression. and a 72-year-old patient with no particular pathological history, presenting with a cervical mass that had been evolving for over 5 years, with no signs of compression of adjacent organs. Clinical examination revealed a mass in the anterior cervical region at the level of the hyoid bone, measuring 2.2cm in long axis, firm in consistency, regular in contour, painless, immobile on swallowing, with healthy skin and no signs of compression. On CT scan, the appearance was suggestive of a left median and paramedian cystic formation, embedded in the homolateral infra-hyoid muscle, abutting the thyroid cartilage without lysis opposite, and fusing at the level of the HTE lodge corresponding to a cyst of the sub-hyoid thyreoglossal tract. Exploratory cervicotomy in both patients revealed a cystic mass of the subhyoid thyreoglossal tract. Exploratory cervicotomy in both patients revealed a superficial cystic mass, adherent to the body of the hyoid bone, raising strong suspicion of a thyroglossal tract cyst. Surgical excision was performed using the Sistrunk technique, removing the cyst en bloc with the body of the hyoid bone. The surgical specimen was sent for histological examination, which confirmed the diagnosis of a KTT. Conclusion: Thyroglossal tract cyst is a frequent pathology in children, but remains rare in adults. The key to its management is to be aware of it when faced with a cervical mass.

Beyond Belief: A Rare Encounter with Eye Teratoma

A 7-year-old boy presented with progressive swelling in left eye since childhood. Examination revealed a soft cystic mass in the medial aspect of the left orbit. Rudimentary eye structures were present in left eye. There was no evidence of any exposure keratitis. A clinical diagnosis of congenital cystic eyeball was made and patient underwent cystic fluid aspiration followed by intralesional steroid injection followed by enucleation. Histopathology showed mature neuroglial tissue, fibro collagenous and vascular proliferation with mature cartilage suggestive of congenital mature teratoma. This case report tends to highlight the features of this rare case of congenital mature teratoma of eye.

Diagnostic Accuracy of Fine Needle Aspiration Cytology, Triple Test and Tru-cut Biopsy in the Detection of Breast Lesion

Background: The majority of breast illnesses manifest as a palpable mass. The vast majority of breast lesions are not malignant, and the vast majority of benign lesions do not progress to cancer; however, the accuracy of diagnosis can be improved by a combination of preoperative tests such as physical examination, mammography, fine-needle aspiration cytology (FNAC), and Trucut needle biopsy (TCNB) or core needle biopsy (CNB). FNAC has gained in popularity and is now the primary treatment performed after a history and clinical examination to diagnose solid and cystic breast masses. This study was designed to assess the accuracy of FNAC in comparison to Triple Test and TCNB for the diagnosis of breast masses. Methodology: From January 2023 through May 2023, this study was conducted in the Tezpur Medical College and Hospital. The research included all female patients over the age of 20 with clinically palpable lumps. Palpable breast lumps need a complete clinical breast examination, imaging, and tissue sample for a clear diagnosis to rule out cancer.The Ultrasonography/Mammography, FNAC and tru-cut biopsy procedures were performed concurrently in the same region, and the results were compared to final histopathology as the gold standard. Result: The majority of the patients in the study were in age group of > 60 years. In our study Left breast was involved in 41 (58.5%) patients and right breast in 29 (41.4%) patients. The most frequent site involved was upper outer quadrant in 38 (54.2%). The overall sensitivity of FNAC in our study was 93.75%, tru-cut biopsy is 100% and that of triple test is 100% and specificity for malignancy was 91.6%, 93.6 and 95.6% for FNAC, tru-cut biopsy and triple test respectively. Conclusion: All three techniques have advantages and disadvantages. Core Needle Biopsy cannot be used in place of FNAC, and it is not required to identify all breast lesions. It can be utilised as an adjuvant in circumstances when cytology is definitive and biomarker tests are required. triple test and trucut were more accurate than FNAC in our testing.Trucut biopsy was able to provide histological diagnosis, and the findings were 100% consistent with the final histopathology report.

Obstructive jaundice as a rare complication of multiple pancreaticoduodenal artery aneurysms due to median arcuate ligament syndrome: a case report and review of the literature

BackgroundObstructive jaundice has various causes, and one of the rarest is pancreaticoduodenal artery aneurysm (PDAA), which is often associated with celiac axis stenosis caused by median arcuate ligament syndrome (MALS).Case presentationThe patient was a 77-year-old Azeri woman who presented with progressive jaundice, vague abdominal pain, and abdominal distension from 6 months ago. The intra- and extrahepatic bile ducts were dilated, the liver's margin was slightly irregular, and the echogenicity of the liver was mildly heterogeneous in the initial ultrasound exam. A huge cystic mass with peripheral calcification and compressive effect on the common bile duct (CBD) was also seen near the pancreatic head, which was connected to the superior mesenteric artery (SMA) and had internal turbulent blood flow on color Doppler ultrasound. According to the computed tomography angiography (CTA) findings, the huge mass of the pancreatic head was diagnosed as a true aneurysm of the pancreaticoduodenal artery caused by MALS. Two similar smaller aneurysms were also present at the huge aneurysm's superior margin. Due to impending rupture signs in the huge aneurysm, the severe compression effect of this aneurysm on CBD, and the patient's family will surgery was chosen for the patient to resect the aneurysms, but unfortunately, the patient died on the first day after the operation due to hemorrhagic shock.ConclusionIn unexpected obstructive jaundice due to a mass with vascular origin in the head of the pancreas, PDAA should be considered, and celiac trunk should be evaluated because the main reason for PDAA is celiac trunk stenosis or occlusion by atherosclerosis or MALS. The treatment method chosen (including transarterial embolization, open surgery, or combined method) depends on the patient's clinical status and radiological findings, but transarterial embolization would be safer and should be used as a first-line method.

Role of Contrast-Enhanced Ultrasound in Evaluation of Cystic Renal Mass.

Contrast-enhanced ultrasound (CEUS) allows excellent delineation of perfusion in septa and nodules without exposure to ionizing radiation or nephrotoxic contrast media. The aim of our study was to evaluate the role of CEUS for the assessment of cystic renal masses and compare its diagnostic performance with that of CECT. Exactly 40 patients diagnosed to have cystic renal masses on CECT scan were prospectively evaluated with CEUS and were assigned a Bosniak class. Based on results of final histopathology and clinical follow-up, internal validity of both CEUS and CECT was evaluated, including agreement between these two modalities. Out of the 40 patients (mean size 3.1 ± 2.5 cm), 23 patients had benign lesions and 17 patients had malignant lesions. For CEUS, the sensitivity and negative predictive value was 100%, the specificity and positive predictive value was 73.9%. For CECT, the sensitivity and negative predictive value were 88.2 and 83.3%, respectively, whereas the specificity and positive predictive value was 87 and 90.9%, respectively. Both imaging modalities had similar accuracy with fair to good agreement with the final diagnosis (Κ = 0.71 and 0.75 for CEUS and CECT, respectively). Concordance between CEUS and CECT was seen in 29 patients (72.5%) with fair agreement between the two modalities (K = 0.66). CEUS has comparable accuracy with CECT and could be used as screening modality to rule out the presence of complex cystic renal masses without exposure of nephrotoxic contrast media and ionizing radiation.

Contrast enhanced ultrasound diagnosis of complex cystic renal mass: Interobserver variability based on different Bosniak classification systems

The diagnostic value of Bosniak classification based on contrast enhanced ultrasound (CEUS) on complex cystic renal mass (CRM) was compared among different observers. From 2012 to 2022, 212 complex CRMs, confirmed by pathology or at least 1-year imaging follow-up, were enrolled. The CEUS images of CRM were retrospectively analyzed by two reviewers with different experience in kidney CEUS examination, and each lesion was given the categorizations according the Bosniak ver. 2015 and ver. 2019, respectively. There was good inter-observer agreement (k = 0.689; p < 0.05) for Bosniak ver. 2019. With Bosniak ver. 2019, senior and junior reviewer correctly classified 44 (83.02%), 40 (75.47%) benign lesions as low grade (Ⅰ ∼ ⅡF), and 94 (94.95%), 80 (80.81%) malignant tumors as high grade (Ⅲ or Ⅳ), respectively. Meanwhile, the combination of Bosniak 2019 and senior reviewer demonstrated the highest area under the receiver operating characteristic curve (Az: 0.875, all p < 0.05) than other groups, with the highest specificity (81.10%) and sensitivity (93.90%) among all the groups (95% CI, 0.807–0.943; p < 0.05), respectively. Overall, the senior reviewer combined with Bosniak ver. 2019 was the best choice for the diagnosis of complex CRM.

Ultrasonography in Children With Congenital Pyriform Sinus Fistula: Analysis of 31 Cases.

Congenital pyriform sinus fistula (CPSF) is a rare disease that can be easily misdiagnosed. This study investigates the value of ultrasonography in the early diagnosis and treatment of CPSF in children. Clinical features and ultrasonography images of 31 CPSF pediatric patients confirmed by operation were retrospectively analyzed, different sonographic features during the infection period and the quiescence period were summarized and the consistency test of ultrasonic recognition and diagnosis between observers was conducted. In this study, 25 CPSF children had thick-walled cystic masses during the infection period, and cystic masses of 8 cases showed gas echo inside; after the modified valsalva maneuver, gas echo was found in another 5 cases. The detection rate of gas can be enhanced through the modified valsalva maneuver and infants' cry so as to provide an important basis for the diagnosis of pyriform sinus fistula. During the quiescent period of inflammation of 6 cases, fistula can be completely shown, and the wall structure has not been completely destroyed, so that the running position of fistula can be clearly seen. Ultrasonography boasted a good inter-observer consistency in identification and determination (Kappa:0.799-0.857; P<0.001). Ultrasonography could clearly reveal the position and direction of CPSF fistula. Different ultrasonic characteristics in different periods could provide relevant information for the selection of clinical operation timing and evaluate the post-operative effects.

Ultrasound diagnosis and treatment of branchial cleft cyst and preoperative management.

The ultrasonic diagnosis of cervical and facial cystic masses, as well as cases of missed diagnosis and misdiagnosis, was examined, to improve the diagnosis of branchial cleft anomalies. A retrospective analysis was conducted on 17 patients with branchial cleft cyst anomalies, including 11 males and 6 females, aged 12-53years, with an average age of 33 ± 2years, were unilateral single. All patients who underwent an ultrasound examination and image storage for retrospective analysis, and both longitudinal and transverse sections were scanned to observe the shape, size, boundary, peripheral relationship, and blood flow signal of the masses. All cases were examined with an enhanced CT scan, and pathological reports were generated. Among the 17 cases of branchial cleft anomalies, 15 cases were branchial cleft cysts, while one case involved fistula formation and one case involved sinus tract formation. Based on the type of branchial cleft, the first, second, and third cysts were classified in 4, 12, and 1 case, respectively. The sensitivity rate and specificity of ultrasonic diagnosis were 14/17 (82.4%) and 4/6 (66.7%), respectively. Ultrasonic characteristic analysis for the masses can be found in simple cystic masses or hypoechoic masses, most of them are of a regular shape and have a distinct boundary, and almost no blood flow signal. All patients who were misdiagnosed exhibited blood flow signals, including 1 patient with an abundant blood flow signal, 1 patient suspected of having ectopic thyroid with an abnormal function due to the rat-tail sign, 2 patients misdiagnosed as local inflammatory focus, and 1 patient misdiagnosed with tuberculous lymphadenitis. Ultrasound has a detection rate of up to 100% for cervical and facial masses, providing a fundamental determination of lesion characteristics and specific guidance for preoperative diagnosis. If the blood flow signals can be identified and carefully considered their peripheral relationship, the diagnostic rate can be improved.

Applicability of Bosniak 2019 for renal mass classification on portal venous phase at the era of spectral CT imaging using rapid kV-switching dual-energy CT.

To evaluate the applicability of Bosniak 2019 criteria on a monophasic portal venous phase using rapid kilovoltage-switching DECT (rsDECT). One hundred twenty-seven renal masses assessed on rsDECT were included, classified according to Bosniak 2019 classification using MRI as the reference standard. Using the portal venous phase, virtual monochromatic images at 40, 50, and 77keV; virtual unenhanced (VUE) images; and iodine map images were reconstructed. Changes in attenuation values between VUE and 40keV, 50keV, and 77keV measurements were computed and respectively defined as ∆HU40keV, ∆HU50keV, and ∆HU77keV. The values of ∆HU40keV, ∆HU50keV, and ∆HU77keV thresholds providing the optimal diagnostic performance for the detection of internal enhancement were determined using Youden index. Population study included 25 solid renal masses (25/127, 20%) and 102 cystic renal masses (102/127, 80%). To differentiate solid to cystic masses, the specificity of the predefined 20 HU threshold reached 88% (95%CI: 82, 93) using ∆HU77keV and 21% (95%CI: 15, 28) using ∆HU40keV. The estimated optimal threshold of attenuation change was 19 HU on ∆HU77keV, 69 HU on ∆HU50eV, and 111 HU on ∆HU40eV. The rsDECT classification was highly similar to that of MRI for solid renal masses (23/25, 92%) and for Bosniak 1 masses (62/66, 94%). However, 2 hyperattenuating Bosniak 2 renal masses (2/26, 8%) were classified as solid renal masses on rsDECT. DECT is a promising tool for Bosniak classification particularly to differentiate solid from Bosniak I-II cyst. However, known enhancement thresholds must be adapted especially to the energy level of virtual monochromatic reconstructions. DECT is a promising tool for Bosniak classification; however, known enhancement thresholds must be adapted according to the types of reconstructions used and especially to the energy level of virtual monochromatic reconstructions. • To differentiate solid to cystic renal masses, predefined 20 HU threshold had a poor specificity using 40keV virtual monochromatic images. • Most of Bosniak 1 masses according to MRI were also classified as Bosniak 1 on rapid kV-switching dual-energy CT (rsDECT). • Bosniak 2 hyperattenuating renal cysts mimicked solid lesion on rsDECT.

A Rare Case of Fetal Hydrocolpos Secondary to Low Vaginal Atresia

AbstractFemale urogenital anomalies are often difficult to evaluate by ultrasonography, especially in late gestation. We report a case of fetal hydrocolpos detected by a fetal medicine scan at 33 weeks of gestation. Antenatal ultrasound by the fetal medicine unit showed a singleton fetus with a huge retrovesical cystic mass extending from the mid-abdomen to the perineum. Bilateral hydronephrosis was noted. Postnatal ultrasound showed the findings of a markedly dilated vagina containing thick echogenic fluid that was extended up to the umbilical level displacing the urinary bladder upwards and anteriorly and rectum posteriorly, suggesting hydrocolpos. Bilateral hydronephrosis was also noted. Postnatal examination of the neonate showed a distended abdomen with a well-defined mass arising from the pelvis extended to the umbilicus. External genitalia were of a normal female. There were no other dysmorphic features. Hydrocolpos was secondary to low vaginal atresia. Aspiration of the mass was performed on the first postnatal day.

Two Cases of Laryngomalacia With Congenital Vallecular Cyst Treated by Supraglottoplasty

Vallecular cyst consisted of a unilocular cystic mass of variable size arising from the lingual surface of the epiglottis and containing clear fluid is a rare occurrence in children. Although a cyst is benign, it may cause serious airway obstruction and even death if not treated appropriately. Also, laryngomalacia is the most common congenital anomaly that causes inspiratory stridor and airway obstruction in the newborn. Symptoms typically begin to appear at around 2 to 3 weeks of age and become worse between 4 and 8 months. With a review of literature, we report two cases of vallecular cyst with symptomatic laryngomalacia in a 1-month-old female and a 2-month-old male. Both patients experienced symptom relief after undergoing endoscopic supraglottoplasty.

Herlyn-Werner-Wunderlich syndrome: Challenges in diagnosis and management.

Herlyn-Werner-Wunderlich syndrome (HWWS), also known as OHVIRA syndrome (obstructed hemivagina and ipsilateral renal anomaly) is a complex congenital malformation characterized by a triad including uterine didelphys, hemivaginal obstruction, and ipsilateral renal agenesis. In this case report, we present a case of HWWS along with the challenges in diagnosis and multi-step treatment processes. A 25-year-old woman presented to Dr. Zainoel Abidin Hospital in Banda Aceh, Indonesia with a chief complaint of lower back pain for the past six months (two months after the marriage). The patient also complained of late menstruation, followed by thick yellow vaginal discharge resembling malodorous pus occurring after menstruation. Additionally, a history of fever and pain during intercourse was reported. Vaginal examination revealed purulent fluid emerging from a pinpoint hole on the right vaginal wall. Vaginal palpation revealed a two-branched uterus, along with a palpable cystic mass on the right vaginal wall. Ultrasound examination indicated the presence of the right and left hemi-uteri, measuring 4.7x1.35 cm and 5.7x1.26 cm in size, respectively with both ovaries appearing normal. Fluid accumulation was observed in the right hemivagina, while the left kidney exhibited normal features, and the right kidney showed signs of hypoplasia. The patient was diagnosed with uterus didelphys, fluid accumulation in the hemivagina, and right kidney hypoplasia. Magnetic resonance imaging (MRI) confirmed uterus didelphys and revealed narrowing of the right hemivagina, suggestive of HWWS. Hysteroscopy was performed to resect the vaginal septum with laparoscopic guidance, along with drainage of hematocolpos, pyocolpos and placement of an intracervical mold. Despite HWWs having conservative gradual management, it was opted to perform vaginal septum resection, hematocolpos and pyocolpos drainage and placement of an intracervical mould in this case, in order to relieve symptoms and restore the reproductive and sexual functions.

Primary papillary carcinoma in a thyroglossal duct cyst: A case report

Background: Thyroglossal duct cyst(TDC)is the most common congenital disorder of the thyroid gland. Seventy five percent of midline neck masses in children are (TDC). Occurrence of malignancy in (TDC) is very rare event, and include 1% of all cases of (TDC). Here in this report, we describe a rare case of primary papillary carcinoma which arises in a (TDC). Case report: Our case is a 42-year-old woman who presented with a hard painless solid and cystic mass in front of the neck above of thyroid cartilage. After initial physical examination and ultrasonography, the mass identified. Radiologist performed a core needle biopsy of the cyst and mass which show a papillary cell carcinoma. The patient underwent near total thyroidectomy, excision of lymph node and surgical excision of the thyroglossal duct cyst (the Sistrunk's procedure). Histopathology of the specimen revealed a thyroglossal duct cyst which showed a primary invasive papillary carcinoma that infiltrated the cyst wall. The thyroid gland was normal, cervical lymph node was not involved. Conclusions: Primary papillary carcinoma of thyroglossal duct cyst is a rare disease which presents in patients with cystic midline neck masses. Surgery and radical excision is the optimal patient management with radioactive iodine therapy which improve the survival.

870 Benign Cystic Mesothelioma- a Rare Intra-Abdominal Tumour

Abstract Introduction Benign cystic mesothelioma is a rare intra-abdominal tumour affects primarily women who are in reproductive. Since this pathology has a rare occurrence, a similar presentation, and similar imaging features, the diagnosis is based on histologic findings and there is no current standard treatment for this condition. Presentation of case In this case report, a 40-year-old female patient presented in the Emergency Department with a five-day history of right-sided, migratory, abdominal pain. She was systemically well, and her inflammatory markers were unremarkable. The patient was investigated for appendicitis, with a CT scan showing a multi-loculated cystic structure below the liver. Her case was discussed with the Basingstoke Peritoneal Malignancy Institute who felt this may demonstrate benign cystic peritoneal mesothelioma. As per their advice, and the thoughts of the local MDT team, the patient underwent a diagnostic laparoscopy, and the cystic mass was removed. The diagnosis of benign cystic peritoneal mesothelioma was then confirmed by histology. Discussion Based on literature, this is a rare and asymptomatic form of mesothelioma.Imaging is able to provide suspicion of this type of benign mesothelium, but only histological examination can provide a definitive diagnosis. Additionally, on review there are no guidelines regarding management and no standard treatment for this condition. The only effective treatment for a benign cystic mesothelioma is surgery, but no evidence-based strategies exist. Conclusions It is critical to publish more case reports on this condition once it is diagnosed in order to formulate guidelines and to advance towards a possible effective treatment solution.

198 Clinical and Radiological Features of Cardiac Hydatid Cysts: A Case Series

Abstract Aim Hydatid cyst disease is a pathology caused by tapeworm Echinococcus. The cardiac involvement is rare, so the aim of this study is to highlight its clinical polymorphism and different radiological features. Method This is a retrospective study of 7 patients diagnosed with cardiac hydatid cysts who were admitted to our department in a 5-year duration. Results We see that most affected individuals were women (4 out of 7), the revealing symptoms were mostly chest pain and dyspnea, only one case presented AV block with faintness. Concerning the localizations: 2 patients had pericardial cysts, 2 had intramyocardial cysts, 2 others had both pericardial and intramyocardial cysts and the last one presented an interventricular septum cyst. Six patients were diagnosed through transthoracic echocardiography (TTE) and one patient with CT of the chest. In all cases, TTE described a cystic mass except one case that presented multivesicular aspect. The diameter of the cysts ranged between 20 and 88 mm. Two patients had associated liver hydatid cyst and one had pulmonary hydatid cyst. All these patients underwent open-heart surgery for conservative treatment under cardiopulmonary bypass. Only one patient presented recurrence which was treated with albendazole with good results. No patient benefited from pre-operative medication with anthelmintic. Conclusions Cardiac hydatic cysts are rare and usually discovered after dyspnea or chest pain. TTE is the most efficient method of diagnosis. Due to life-threatening complications that these cysts can cause, surgery is the main modality of treatment.

1212 Actinomycosis of the Middle Ear Mimicking Cholesteatoma – a Case Report and Literature Review

Abstract Introduction Actinomycosis, a rare infection of the middle ear, has less than 50 documented cases worldwide. Actinomyces are an anaerobic, filamentous bacterium causing granuloma formation and suppurative infection. Case We present a young male with a nine-month history of unilateral, yellow coloured otorrhoea and hearing loss. Swabs showed no growth, with infection not responding to oral or topical antibiotics. CT temporal bones was consistent with cholesteatoma and ossicular disruption. Surgical exploration revealed a yellow, cystic mass within the middle ear. Cortical mastoidectomy and washout were performed. Histological diagnosis confirmed actinomyces clusters with positive Gram stain. Discussion Actinomyces typically presents as chronic otitis media. It likely reaches the middle ear via the Eustachian tube. It is often misdiagnosed due to culture insensitivity; however clinical suspicion can aid labs in providing an optimum culture environment. Tympanomastoidectomy allows for histopathological diagnosis. Surgical resection should be followed by a prolonged course of antibiotics.

Infiltrative solid papillary carcinoma of the breast with axillary lymph node metastasis: a case report

BackgroundSolid papillary carcinoma (SPC) is a rare breast papillary tumor variant. The main histological features of SPC consist of neoplastic cell-rich nodules with thin fibrovascular cores, often accompanied by mucous secretion and neuroendocrine differentiation. Infiltrative solid papillary carcinoma (ISPC) tumor cells have an invasive, map-like growth pattern with serrated irregular growth. Due to its unique clinicopathological features, SPC is classified as two pathological tissue types based on the 2019 WHO classification of breast tumors: SPC in situ and ISPC.Case presentationWe report a case of a 55-year-old female patient who was admitted to the hospital due to a painless left breast mass that had persisted for two years. Mammography suggested a mass in the left upper outer quadrant (BI-RADS 4B), and ultrasound of the breast demonstrated a cystic mass of the left breast (US_BI_RADS 4 C) with multiple enlarged lymph nodes in the left axilla. Postoperative pathology revealed ISPC with one lymph node metastasis in the left breast. Modified radical mastectomy was performed on the left breast. Subsequently, the patient received letrozole endocrine therapy, epirubicin hydrochloride and cyclophosphamide chemotherapy, and radiotherapy of the left chest wall and left upper and lower clavicular regions. After 17 months of follow-up, there was no evidence of recurrence or distant metastasis.ConclusionsSPC is a group of heterogeneous tumors. SPC in situ has a good prognosis. In contrast, ISPC has a unique histological morphology and growth pattern with invasive biological behavior that can lead to lymph node and distant metastases.

Euterpe oleracea extract (açaí) exhibits cardioprotective effects after chemotherapy treatment in a breast cancer model.

Açaí, a Brazilian native fruit, has already been demonstrated to play a role in the progress of breast cancer and cardiotoxicity promoted by chemotherapy agents. Thus, the present study aimed to evaluate the combined use of açaí and the FAC-D chemotherapy protocol in a breast cancer model in vivo. Mammary carcinogenesis was induced in thirty female Wistar rats by subcutaneous injection of 25mg/kg 7,12-dimethylbenzanthracene (DMBA) in the mammary gland. After sixty days, the rats were randomized into two groups: treated with 200mg/kg of either açaí extract or vehicle, via gastric tube for 45 consecutive days. The FAC-D protocol was initiated after 90 days of induction by intraperitoneal injection for 3 cycles with a 7-day break each. After treatment, blood was collected for haematological and biochemical analyses, and tumours were collected for macroscopic and histological analyses. In the same way, heart, liver, and kidney samples were also collected for macroscopic and histological analyses. Breast cancer was found as a cystic mass with a fibrotic pattern in the mammary gland. The histological analysis showed an invasive carcinoma area in both groups; however, in the saline group, there was a higher presence of inflammatory clusters. No difference was observed regarding body weight, glycaemia, aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, and urea in either group. However, açaí treatment decreased creatine kinase (CK), creatine kinase MB (CKMB), troponin I and C-reactive protein levels and increased the number of neutrophils and monocytes. Heart histopathology showed normal myocardium in the açaí treatment, while the saline group presented higher toxicity effects with loss of architecture of cardiac tissue. Furthermore, the açaí treatment presented greater collagen distribution, increased hydroxyproline concentration and lower H2AX immunostaining in the heart samples. Açaí decreased the number of inflammatory cells in the tumor environment and exhibited protection against chemotherapy drug cardiotoxicity with an increased immune response in animals. Thus, açaí can be considered a promising low-cost therapeutic treatment that can be used in association with chemotherapy agents to avoid heart damage.

Ultrasound diagnosis of renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion in children and adolescents.

Many studies have reported Xp 11.2 translocation renal cancer in radioimaging,but there is little literature on the evaluation of Xp11.2 translocation renal cell carcinoma by ultrasound. To investigate the ultrasonographic features and diagnostic value of renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion in children and adolescents. The clinical and ultrasonographic data of 10 patients with renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion confirmed by pathology in our hospital were analyzed retrospectively. The age ranged from 3 to 18 years old, including 7 males and 3 females. The tumor location, size, boundary, echo, hemorrhage, cystic change, calcification, blood flow, lymph node status and metastasis were mainly observed, and the results were compared with the pathological results. There were 10 masses in 10 cases of renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion, including 4 in the right kidney and 6 in the left kidney; the maximum diameter line is 5-23cm; 9 cases had clear mass boundary (90%); 9 masses (90%) showed mixed cystic and solid masses with high echo of solid components, and 1 mass (10%) showed huge multilocular cystic mass with multiple septations; necrosis and cystic changes were seen in all 10 masses (100%); calcification in 5 masses (50%); blood flow signals were seen in the solid components of the mass (100%). Renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion in children and adolescents are mostly large cystic and solid mixed echo masses, with high echo of solid components, and often accompanied by cystic changes and calcification. Its ultrasonic manifestations have certain characteristics. Color Doppler ultrasound has a certain diagnostic value for this disease.

Cystic Renal Masses: characterization with Diffusion- Weighted Imaging versus ContrastEnhanced Magnetic Resonance Imaging

Purpose To compare the diagnostic performance of magnetic resonance imaging (MRI), and MRI with diffusion-weighted imaging (DWI) in the characterization of cystic renal lesions. Materials and Methods Thirty-six adult patients underwent MRI (at 1.5 T), and DWI (at b-values of 0, 400 and 800 s/mm2) for characterization of 63 cystic renal lesions. There were 16 malignant renal cystic lesions (9 cystic clear cell RCC, 4 cystic papillary RCC, 3 massively necrotic RCC) opposite to 37 benign renal cystic lesions, 6 renal abscesses and 4 renal hemorrhagic cysts. A composite reference standards including histology, typical imaging criteria, and follow-up imaging was employed. To determine the diagnostic performance of imaging modalities, area-under-curve (AUC) was calculated by receiver-operating-characteristic analysis and compared. Fisher's exact test was used to compare the diagnostic accuracies and confidence levels with MRI, and MRI + DWI. Furthermore, DWI-ADC cutoff point to detect malignant cystic renal lesions, had been estimated and its diagnostic performance had been tested in term of sensitivity and specificity, PPD and NPV as compared to that of CE-MRI Results AUC for CE-MRI (0.915) and DW-MRI (0.834) in the differentiation between benign and malignant lesions (among all study cases) were within corresponding 95% confidence interval (CI) (P &amp;gt; 0.5), furthermore A cutoff ADC point of ≤ 2.26 x10 − 3 mm2/s can be considered as diagnostic threshold for malignant cystic renal lesion lesions (among all study cases) with 87.5% sensitivity, 87.2% specificity, 70.0% PPV, 95.3% NPV, opposite to 100% sensitivity, 82.9% specificity, 66.7% PPV, 100% NPV for the CE-MRI. AUC for CE-MRI (0.976) and DW-MRI (0.917) in the differentiation between benign and malignant lesions (after exclusion of renal abscess and renal hemorrhagic cysts from study cases) were within corresponding 95% confidence interval (CI) (P = &amp;gt;0.5), A cutoff ADC point of ≤ 2.84 x10 − 3 mm2/s could be considered as diagnostic threshold for malignant cystic renal lesion lesions (after exclusion of renal abscess and renal hemorrhagic cysts from study cases) with 93.7% sensitivity, 91.9% specificity, 83.3 PPV, 97.1 NPV, opposite to 100% sensitivity, 95.12% specificity, 88.9% PPV, 100% NPV for the CE-MRI. Conclusions Our study showed that malignant cystic renal masses had tendency toward restricted diffusivity and significant lower ADCs in comparison to benign ones, and diagnostic performance of DWI-ADC at b-value of 0-400-800 s/mm2 appeared as efficient as that of CE-MRI in differential between benign and malignant cystic lesions, especially when usage of contrast medium is contraindicated, however there is noticeable ADC overlapping among some malignant and benign lesions, specifically for renal carcinomas versus renal abscesses as well as for renal cell carcinoma versus renal hemorrhagic cysts, For such situation we need to consider clinical data, follow up notes, and correlates with findings of conventional MRI to optimize the characterization of cystic renal lesion before establishment of proper management plan.