Indistinct Margins Research Articles

Bronchiectasis is one of the indicators of severe coronavirus disease 2019 pneumonia.

Bronchiectasis is one of the indicators of severe coronavirus disease 2019 pneumonia.

Ultrasound evaluation of ductal carcinoma in situ of the breast.

To assess the role of ultrasound (US) in detecting and characterizing ductal carcinoma in situ (DCIS) of the breast and to investigate the correlation between ultrasonographic and biological features of DCIS. In total, 171 patients (mean age 44; range 39-62) with 178 lesions were retrospectively evaluated by two independent radiologists searching for US mass or non-mass lesions. Immunohistochemistry analysis was performed to determine estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression. The US detection rate and pattern distribution among the lesion types were evaluated. The χ2 test was used to evaluate the correlation between the US findings and the biological factors. Statistical significance was indicated by p values < 0.05. Inter-observer agreement was calculated by Kohen's k test. US detected 35% (63/178) of all lesions. Fifty-two (83%) lesions were classified as mass lesions, and 11 (17%) as non-mass lesions (p < 0.0001). Among the mass lesions, the most common shape was irregular (79%; p < 0.0001), with 45 (87%) lesions having indistinct margins. Hypoechogenicity was the most common echo pattern (49 cases, 94%; p < 0.0001). Microcalcifications were found in 23 cases (37%; p = 0.004) and were associated with mass lesions in 15 cases (65%) and with non-mass lesions in 8 cases (35%) (p = 0.21). An almost perfect inter-observer agreement (k = 0.87) was obtained between the two radiologists. A significant ER expression was found in mass lesions (83%; p < 0.0001), with no significant PR (p = 0.89) or HER2 expression (p = 0.81). Among the lesions with microcalcifications, only 7 out of 23 cases (30%) were positive for HER2 (p = 0.09). DCIS represents a heterogeneous pathological process with variable US appearance (mass-like, non-mass-like, or occult). The most common US finding is represented by mass-type, hypoechogenic lesions with indistinct margins. A significant ER expression exists among mass-type lesions, while microcalcifications seem not to be associated with HER2 expression.

Primary breast MALT lymphoma: a case report

A 42-year-old woman, with no history of autoimmune diseases or risk factors for cancer, sought a private medical clinic for undergoing breast imaging tests, noticing the presence of a solid nodule with indistinct margins — BI-RADS 4 — in the left breast. An ultrasound-guided core biopsy was performed and complemented by histopathological and immunohistochemical studies, confirming the diagnosis of primary small B-cell MALT lymphoma. After treatment with radiotherapy, the patient evolved with remission, maintaining annual follow-up with a specialist physician. The importance of routine screening for pathologies that affect the breasts is highlighted, aiming at their early diagnosis. In addition, radiotherapy has good prognostic results at the expense of surgical treatment.

Imaging Protocol and Criteria for Evaluation of Axillary Lymph Nodes in the NAUTILUS Trial.

Axillary ultrasonography (US) is the most commonly used imaging modality for nodal evaluation in patients with breast cancer. No Axillary Surgical Treatment in Clinically Lymph Node-Negative Patients after Ultrasonography (NAUTILUS) is a prospective, multicenter, randomized controlled trial investigating whether sentinel lymph node biopsy (SLNB) can be safely omitted in patients with clinically and sonographically node-negative T1–2 breast cancer treated with breast-conserving therapy. In this trial, a standardized imaging protocol and criteria were established for the evaluation of axillary lymph nodes. Women lacking palpable lymph nodes underwent axillary US to dismiss suspicious nodal involvement. Patients with a round hypoechoic node with effaced hilum or indistinct margins were excluded. Patients with T1 tumors and a single node with a cortical thickness ≥ 3 mm underwent US-guided biopsy. Finally, patients with negative axillary US findings were included. The NAUTILUS axillary US nodal assessment criteria facilitate the proper selection of candidates who can omit SLNB.Trial RegistrationClinicalTrials.gov Identifier: NCT04303715

A Rare Case of Granular Cell Tumor of the Urethra Provoking Urinary Retention

A 44-year-old woman was referred to urologist for urinary retention due to a urethral mass. Magnetic resonance imaging (MRI) showed a round mass that surrounded the urethra completely. The regional lymph nodes were normal and no other lesions were identified. Biopsy was performed revealing a tumor that was composed of large polygonal cells with eosinophilic and periodic acid-Schiff (PAS) - positive granular cytoplasm, indistinct cell margins and small round central nuclei. Immunohistochemical staining for S100 protein, vimentin, calretinin and inhibin Α was positive, indicating a granular cell tumor. Excision of the tumor including the urethra and an umbilical catheterized stoma using Mitrofanoff principle was performed.

Mammographic and Sonographic Features of Breast Cancer in Women Before 30 Years of Age.

Breast cancer uncommonly occurs in young women, but, tends to be diagnosed at a later stage and have a poorer prognosis than in older women. Standard screening guidelines for this age group are not established and the radiologic features of breast cancer in young women are not fully studied yet, because of the low incidence. To investigate the imaging findings for breast cancer in women aged 30 years or younger and to correlate them with clinicopathologic features and immunohistochemical subtypes. The study included 52 women with surgically confirmed breast cancer. The medical records of the patients were retrospectively reviewed and the mammographic and ultrasonographic findings were evaluated according to the fifth edition of the ACR BI-RADS lexicon. Most of the tumors in this study were presented as a self-detected mass (42/52, 80.8%) and were of histologic grade III (31/43 invasive carcinoma, 72.1%) and the estrogen receptorpositive subtype (32/52, 61.5%). The most common mammographic finding was an irregular (19/24, 79.2%), indistinct (16/24, 66.7%), and hyperdense (20/24, 83.3%) mass. The ultrasonographic findings were of an irregular (32/47, 68.1%), indistinct (19/47, 40.4%), and hypoechoic/ heterogeneous (40/47, 85.1%) mass with no posterior features (34/47, 72.3%). An oval/round-shaped mass on ultrasonography was also correlated with triple-negative cancer (p=0.011). On mammography and ultrasonography, breast cancer in young women usually presents as a mass with irregular shape and indistinct margin. Some radiologic findings could be used to predict the molecular phenotype of the tumor.

Metastases to the Breast from Extramammary Nonhematological Malignancies: Case Series.

ObjectiveThis article aims to provide a better understanding of ultrasonography and immunohistochemistry of secondary nonhematological tumors of breast.MethodsThe study reviewed the ultrasound findings and immunohistochemical features of nonhematological metastatic breast tumor cases found in patients of West China Hospital, Sichuan University from 2007 to 2019. Each case was categorized as secondary breast malignancy using histopathological results.ResultsFourteen cases were identified from West China Hospital database. Ten cases originated in the lung, 2 cases in the stomach, 1 case in the ovary and 1 case of neuroendocrine carcinomas. Fourteen masses were evaluated. Ultrasound findings showed that tumors were hypoechoic (14/14), irregular (13/14), indistinct margin (13/14), along a long axis parallel to the skin (11/14), lacked vascularity via color doppler flow imaging (9/14). Eight cases showed no posterior features. Calcification was found in 1 case of lung adenocarcinoma that had metastasized to the breast. Abnormal axillary lymph nodes were detected in 5 cases. Immunohistochemical analysis showed that estrogen receptor (ER) and progesterone receptor (PR) were both negative in 11 cases, including gastric and lung cancer metastasis. One case of ovarian metastasis was positive for ER and negative for PR. Six patients were positive for cytokeratin 7 (CK7) and negative for cytokeratin 20 (CK20), including lung and ovarian carcinoma metastasis. Thyroid transcription factor-1 (TTF-1) was positive in 9 of 10 pulmonary carcinoma metastases. The patient of ovarian metastasis was positive for Wilms’ tumour 1 (WT-1) and carbohydrate antigen 125 (CA125). Two cases from gastric metastasis were positive for caudal-type homeobox 2 (CDX2).ConclusionAlthough breast ultrasound is not useful in distinguishing metastases from primary breast cancer, it is helpful in diagnosing breast lesions as oncological diseases and provide evidence for further examination of patients. Immunohistochemistry plays an important role in distinguishing secondary breast cancer from primary, especially in patients without tumor history.

Successful Laparoscopic Radiofrequency Ablation (Lap RFA) of 10 Cm Adenoma with 2 Year Stability

Study Objective To present successful off-label treatment of symptomatic mega Adenoma with Lap RFA for patient desiring to maintain fertility and to present durable 2-year symptom relief and lesion stability post treatment. Design Case Report. Setting Private Practice TX. Patients or Participants 41-year-old African American female G1P0010who originally presented, in May, 2017 as a referral from a fertility specialist for treatment of large adenoma. Pt complained of severe dysmenorrhea and menorrhagia. She had previously undergone several unsuccessful rounds of Clomid. MRI imaging showed an anterior 9.5cm full thickness anterior uterine wall adenoma, with indistinct margins involving the junctional zone. The uterus measured 14cm in total length. There were 3 smaller fibroids noted. She had seen multiple other gyn physicians who had counseled her for hysterectomy, or extensive myomectomy, neither of which would have rendered her able to safely carry a pregnancy. Interventions In July, 2017, after counseling on off label use of Lap RFA for future fertility and off label use on adenoma, the patient received a concomitant procedure including Laparoscopic Radiofrequency ablation with Acessa system and myomectomy. Lap RFA was used to ablate the large anterior adenoma and myomectomy was performed on several smaller pedunculated fibroids. Measurements and Main Results 3 months after the Laparoscopic Radiofrequency Ablation, ultrasound imaging was performed which demonstrated successful shrinkage of the adenoma by 60%. By 6 months, the ultrasound demonstrated 75% reduction in the size of the lesion with sharp margins. Two years later, the area is stable and the patient is pursuing pregnancy. Conclusion For this patient, the off label use of laparoscopic radiofrequency ablation on an adenoma and the off label use for a fertility patient allowed successful treatment of an otherwise untreatable large anterior adenoma involving the entire anterior uterine wall. She is stable 2 years post-op and pursuing fertility. To present successful off-label treatment of symptomatic mega Adenoma with Lap RFA for patient desiring to maintain fertility and to present durable 2-year symptom relief and lesion stability post treatment. Case Report. Private Practice TX. 41-year-old African American female G1P0010who originally presented, in May, 2017 as a referral from a fertility specialist for treatment of large adenoma. Pt complained of severe dysmenorrhea and menorrhagia. She had previously undergone several unsuccessful rounds of Clomid. MRI imaging showed an anterior 9.5cm full thickness anterior uterine wall adenoma, with indistinct margins involving the junctional zone. The uterus measured 14cm in total length. There were 3 smaller fibroids noted. She had seen multiple other gyn physicians who had counseled her for hysterectomy, or extensive myomectomy, neither of which would have rendered her able to safely carry a pregnancy. In July, 2017, after counseling on off label use of Lap RFA for future fertility and off label use on adenoma, the patient received a concomitant procedure including Laparoscopic Radiofrequency ablation with Acessa system and myomectomy. Lap RFA was used to ablate the large anterior adenoma and myomectomy was performed on several smaller pedunculated fibroids. 3 months after the Laparoscopic Radiofrequency Ablation, ultrasound imaging was performed which demonstrated successful shrinkage of the adenoma by 60%. By 6 months, the ultrasound demonstrated 75% reduction in the size of the lesion with sharp margins. Two years later, the area is stable and the patient is pursuing pregnancy. For this patient, the off label use of laparoscopic radiofrequency ablation on an adenoma and the off label use for a fertility patient allowed successful treatment of an otherwise untreatable large anterior adenoma involving the entire anterior uterine wall. She is stable 2 years post-op and pursuing fertility.

Encapsulated Papillary Carcinoma of the Breast: Imaging Features with Histopathologic Correlation.

Encapsulated papillary carcinoma (EPC) is a rare, clinically indolent breast malignancy most common in postmenopausal women. Absence of myoepithelial cells at the periphery is a characteristic feature. Mammographically, EPC typically presents as a mostly circumscribed, noncalcified, dense mass that can have focally indistinct margins when there is associated frank invasive carcinoma. Ultrasound shows a circumscribed solid or complex cystic and solid mass, and occasional hemorrhage in the cystic component may produce a fluid-debris level; the solid components typically show intense washout enhancement on MRI. Color Doppler may demonstrate a prominent vascular pedicle and blood flow within solid papillary fronds. Encapsulated papillary carcinoma can exist in pure form; however, EPC is often associated with conventional ductal carcinoma in-situ and/or invasive ductal carcinoma, no special type. Adjacent in-situ and invasive disease may be only focally present at the periphery of EPC and potentially unsampled at core-needle biopsy. In order to facilitate diagnosis, the mass wall should be included on core-needle biopsy, which will show absence of myoepithelial markers. Staging and prognosis are determined by any associated frankly invasive component, with usually excellent long-term survival and rare distant metastases.

Clinical and endoscopic features of esophageal tuberculosis: a 20-year retrospective study

Background Tuberculosis of the esophagus is a rare clinical entity. There is a paucity of data on esophageal tuberculosis. This study aims to analyze the clinical and endoscopic features of esophageal tuberculosis over the last 20 years. Methods We retrospectively analyzed the data of 14 patients with esophageal tuberculosis between January 1999 to January 2019 at Nanfang Hospital. Tuberculosis was considered diagnostic if histopathological results showing epithelioid granuloma with or without caseous necrosis. Records of clinical features, imaging findings, endoscopic features and outcome of antitubercular treatment were evaluated. Results A total of 14 patients with definite esophageal tuberculosis were included. 7 patients (50%) presented with dysphagia, followed by 6 patients (42.86%) had retrosternal pain and another had cough (7.14%). On endoscopy, involvement of esophagus was observed at mid-segment mostly and findings included bulging lesions in 10 patients (71.43%), ulcer in 3 patients (21.43%), and tracheoesophageal fistula in 1 patient (7.14%). Endoscopic ultrasound showed a heterogeneous hypoechoic lesion with indistinct margins or interruption of the five layers structure of esophageal wall. Endoscopic ultrasound demonstrated mediastinal lymphadenopathy adjacent to esophageal pathology in 7/11(63.64%). Antitubercular treatment resulted in a good response with complete remission in all patients. Conclusions Esophageal tuberculosis is rare and frequently misdiagnosed due to the lack of diagnostic signs. There needs to be a high index of clinical suspicion among patients with dysphagia or retrosternal pain. Endoscopic biopsy and endoscopic ultrasound-guided FNA can help in achieving the correct diagnosis in esophageal tuberculosis.

Unilateral multifocal choroiditis following EBV-positive mononucleosis responsive to immunosuppression: a case report

BackgroundMultifocal choroiditis (MFC) is a relatively uncommon bilateral inflammatory chorioretinopathy affecting Caucasian young women with myopia. We present images from a case of completely unilateral multifocal choroiditis following EBV-positive mononucleosis that demonstrated a dramatic clinical response to immunosuppression.Case presentationA 20-year-old woman with bilateral high myopia (−6D) and a documented normal prior retinal examination presented with visual loss in the right eye 2 months following confirmed Epstein-Barr virus (EBV) positive mononucleosis. Ophthalmoscopic examination showed completely unilateral placoid lesions of variable age. The left eye was unaffected. Fluorescein angiography revealed active leakage, especially in the parafovea. Spectral domain optical coherence tomography (SD-OCT) demonstrated sub-retinal pigment epithelial nodular deposits, some of which were confluent with overlying intra-retinal fluid and indistinct margins. Upon treatment with the immunosuppressant azathioprine there was significant resolution of the lesions in her right eye along with improvement in vision.ConclusionThis is a rare case of completely unilateral MFC following an episode of EBV positive mononucleosis that showed a dramatic response to immunosuppression.

False-negative results on computer-aided detection software in preoperative automated breast ultrasonography of breast cancer patients

PurposeThe purpose of this study was to measure the cancer detection rate of computer-aided detection (CAD) software in preoperative automated breast ultrasonography (ABUS) of breast cancer patients and to determine the characteristics associated with false-negative outcomes.MethodsA total of 129 index lesions (median size, 1.7 cm; interquartile range, 1.2 to 2.4 cm) from 129 consecutive patients (mean age±standard deviation, 53.4±11.8 years) who underwent preoperative ABUS from December 2017 to February 2018 were assessed. An index lesion was defined as a breast cancer confirmed by ultrasonography (US)-guided core needle biopsy. The detection rate of the index lesions, positive predictive value (PPV), and false-positive rate (FPR) of the CAD software were measured. Subgroup analysis was performed to identify clinical and US findings associated with false-negative outcomes.ResultsThe detection rate of the CAD software was 0.84 (109 of 129; 95% confidence interval, 0.77 to 0.90). The PPV and FPR were 0.41 (221 of 544; 95% CI, 0.36 to 0.45) and 0.45 (174 of 387; 95% CI, 0.40 to 0.50), respectively. False-negative outcomes were more frequent in asymptomatic patients (P<0.001) and were associated with the following US findings: smaller size (P=0.001), depth in the posterior third (P=0.002), angular or indistinct margin (P<0.001), and absence of architectural distortion (P<0.001).ConclusionThe CAD software showed a promising detection rate of breast cancer. However, radiologists should judge whether CAD software-marked lesions are true- or false-positive lesions, considering its low PPV and high FPR. Moreover, it would be helpful for radiologists to consider the characteristics associated with false-negative outcomes when reading ABUS with CAD.

Abstract P4-12-24: Evaluation of partial breast irradiation suitability in early stage breast cancer patients

Abstract Purpose: Partial Breast Irradiation (PBI) treats the tumor bed plus a margin in low risk early stage breast cancers, reducing exposure to organs at risk. Randomized trials have shown that PBI with external beam radiotherapy is non-inferior to whole breast irradiation in terms of local control with fewer late normal tissue adverse events. We aimed to determine the proportion of women with early stage breast cancer suitable for external beam PBI at our institution using adapted ASTRO guidelines for accelerated PBI whereby both clinical-pathological factors and visualization of the tumor bed/cavity on planning scans were determined to quantify PBI eligibility. Methods: Patients were identified retrospectively from January 1, 2013 to November 1, 2018 based on age (≥55), tumor size (≤2cm invasive, ≤2.5cm DCIS), nodal negativity and grade (1 or 2). Cases identified were unifocal, lymphovascular invasion negative, ER positive, HER2 negative, with margins ≥2mm (invasive) and ≥3mm (DCIS), no chemotherapy, non-lobular, no extensive intraductal component, no previous/ bilateral cancers and endocrine therapy optional. Planning scans were reviewed to assess for presence of surgical clips and assigned cavity visualization scores (CVS); CVS 1=cavity not visualized, CVS 2=cavity visualized with indistinct margins, CVS 3=cavity visualised with some distinct margins and heterogeneous appearance, CVS 4= cavity visualised with mostly distinct margins and mildly heterogeneous appearance, CVS 5= all cavity margins clearly defined and homogeneous appearance. These features were used to determine if cases were considered radiologically suitable for PBI. Results: Thirty-seven percent (1051/2824) of cases identified were deemed eligible based on age, grade and T1N0/Tis. Of the 1051, 306 (29%) met all the pathologic criteria; the main reasons for exclusion were previous breast cancer, lobular histology, or multifocality. Median age of eligible cases was 65 years (range 55-88 years). The majority (254) had invasive disease (T1mi: 6, T1a: 17, T1b: 98, T1c: 133); 52 had DCIS. There were 169 right-sided and 137 left-sided cases. Endocrine therapy was documented in 55% of cases. CVS (1-5) were: 11%, 22%, 30%, 29%, 8%. Overall, 66% (201/306) of cases were considered radiologically suitable for PBI (of the 201 cases, 97% had CVS ≥3). Seventy-two cases (72/306; 24%) had tumor bed clips, of which, 34 were considered suitable for PBI (91% CVS ≥3; 9% CVS 2). Conclusions: Overall, a low proportion of all patients were eligible for PBI based on clinical features, but two-thirds of eligible cases were suitable for PBI based on CVS score alone. In contrast, the suitability for PBI within the cohort with surgical clip placement was low. Visualization of the tumor bed is essential to safely deliver PBI and is guided by identification of the cavity seroma and/or surgical clips. Development of standard practice guidelines for surgical clip positioning to identify the tumor bed will potentially assist in increasing the proportion of early stage breast cancer patients suitable to receive PBI, even if the CVS is less favorable. Citation Format: Christine Anne Koch, Gemma Corey, Kathy Han, Grace Lee, Tom Purdie, Chris McIntosh, Patricia Lindsay, Fei-Fei Liu, Anthony Fyles, Wilf Levin, Jennifer Croke, Aisling Barry, Danielle Rodin, Nhu Tram Nguyen, Tatiana Conrad. Evaluation of partial breast irradiation suitability in early stage breast cancer patients [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-12-24.

Primary Neuroendocrine Carcinoma of the Breast: Mammographic, Ultrasound, and Magnetic Resonance Imaging Findings

Objective: The purpose of this study was to investigate the mammography, ultrasound (US), magnetic resonance imaging (MRI) features that characterise primary neuroendocrine breast carcinomas (NEBC) to improve the awareness of the disease. Materials and Methods: The mammography, sonography, MRI and pathologic features in a total of 54 pathologically proven NEBC cases at Fudan University Cancer Hospital from January 2003 to January 2013 were retrospectively analysed. All 54 patients were women with a mean age of 65 years old (ranging from 35 to 80 years). Results: The 54 NEBC patients had a total of 63 lesions. Pathological diagnosis included endocrine ductal carcinoma in situ (E-DCIS) in 20 lesions, E-DCIS with microinvasion in 17 and invasive solid neuroendocrine carcinoma in 26 lesions. The imaging characteristics of NEBC is a high-density round mass (64.1%) with obscured or indistinct margins on mammograms. All masses without malignant calcifications are the most frequent appearances. A hypoechoic mass (78.4%) with irregular shape and circumscribed margins on sonograms; and lobular or irregular shaped mass with spiculated margins, associated with homogeneous or heterogeneous enhancement on MR images. The highest positive predictive value (PPV) for BI-RADS (Breast Imaging Reporting and Data System) 4, and 5 categories was seen by MRI (0.67 [4/6]). In total, 5 patients (9.2%) had axillary lymph node metastasis. 52 (82.5%) lesions were estrogen receptor-positive and 52 (82.5%) progesterone receptor-positive. 45 (71.4%) lesions were negative for HER2/neu. Thirty patients bearing NEBC received hormone therapy; 5 of these patients underwent radiotherapy and/or chemotherapy. Compared with pure NEBC, NEBC with invasive showed larger size of the lesion (t = –2.41, P = 0.024). Conclusion: MRI may have a role in early detection of NEBC. No calcification is a notable mammographic feature that differ from invasive mammary carcinoma. Positive estrogen and progesterone receptor results and negative Her2/neu results have been linked more frequently to NEBC especially in elderly woman with a palpable lump or nipple discharge.

Skin Metastasis in Breast Cancer Patients; a Case Series.

Breast cancer is the most common malignancy in women. It frequently metastasizes to bones, lungs and liver. Although rare, skin metastasis may also take place. It may also be the presenting feature of initial or recurrent breast cancer. The assessment of recurrent metastatic disease involving skin after mastectomy can be challenging because of the benign-appearing clinical presentation. The purpose of this case series was to explore the clinical and radiological presentation of skin metastasis in patients of breast cancer. This is a retrospective case series of breast cancer patients with skin lesions on chest and abdomen at the time of initial presentation, or post-treatment such as, after mastectomy or breast conservation therapy; who underwent various radiological investigations including mammography, ultrasound scan, computed tomography (CT) scan and magnetic resonance imaging from 1 May 2018 to 30 September 2019 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan. A total of eight cases were identified, out of which seven were females. The most common presentation consisted of the presence of metastatic nodules which were seen in 62.5% (five out of eight) of the patients. Other features consisted of erythematous or plaque-like skin thickening on clinical examination, increased density with indistinct margins seen on a mammogram and diffuse oedematous changes in the skin with small irregular mass or infiltration into subcutaneous tissues were visualised on ultrasound and CT studies. Skin metastasis from breast cancer most commonly presents as nodules, although rarely they may present as plaques or diffuse skin thickening. Awareness of diverse manifestations of skin metastasis is of utmost importance in early diagnosis and management.

Imaging Characteristics of Breast Lymphoma; a Case Series.

Breast involvement by lymphoma is rare. It can occur as a primary breast tumour or as an extranodal manifestation of the systemic disease. The imaging features of breast lymphoma (BL) are not characteristic. Biopsy is necessary for diagnosis due to non-specific imaging features. A retrospective electronic medical chart review was conducted of patients diagnosed with lymphoma of breast that underwent diagnostic radiological procedures (including mammography, ultrasound breast, computed tomography (CT) scan and positron emission tomography (PET/CT) scan from 1 July 2018 to 31 March 2019 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan. Four patients were identified. On mammogram, the most common finding consisted of the presence of high-density masses with circumscribed or indistinct margins. On ultrasound, hypoechoic masses and indistinct diffuse infiltrative patterns were observed. PET/CT and CT were helpful in detecting extramammary sites of disease and for classifying the disease into primary or secondary BL. The early diagnosis of the BL is important. The radiologists should include lymphoma in the differential diagnosis when there is the absence of microcalcifications or spiculated margins on mammography and ultrasound.

Long-Term Follow-Up Ultrasonographic Findings of Intrathyroidal Thymus in Children.

ObjectiveTo analyze long-term follow-up sonographic findings of intrathyroidal thymus in children.Materials and MethodsAmong 1259 patients with congenital hypothyroidism under 15 years of age who underwent thyroid ultrasonography (US), 41 patients were diagnosed with an intrathyroidal thymus based on US criteria, i.e., hypoechoic solid lesion with punctate and linear echogenicity. In 26 patients aged one to 14 years old, the last follow-up US was performed after 6 to 132 months and compared with the initial US. The lesion was considered to decrease in size if there was a change of more than 2 mm in any dimension. The margin change was divided into well-defined and indistinct, blurred. When the echogenicity changed to a hyperechoic from a characteristic thymic echogenicity pattern, the pattern was considered a hyperechogenic. The changes in size were compared with the changes in shape, margin, and echogenicity pattern. The changes in size, shape, margin, and echogenicity were analyzed the association with the age of last follow-up. Statistical analysis was conducted using the chi-squared test and logistic regression.ResultsFifteen (57.7%) cases were stable in size, and 11 (42.3%) decreased in size, including one that disappeared. Ten (38.5%) cases changed to indistinct margins from initially well-defined margins including one case of initially indistinct margin. Six (23.1%) changed to hyperechogenic, from initially characteristic thymic echogenicity patterns. When follow-up change was compared, decreases in size were significantly associated with lesion changes to indistinct margins (p = 0.004). The age at last follow-up was significantly associated with change to hyperechogenicity (odd ratio, 2.141; 95% confidence interval, 1.144–4.010, p = 0.017).ConclusionOn follow-up US, an intrathyroidal thymus may be decreased in size, with indistinct margins, or show changes to a hyperechoic mass. Decreases in size may be associated with changing to indistinct margins, and changes to hyperechogenicity may be associated with increasing age.

Can Combined Screening of Ultrasound and Elastography Improve Breast Cancer Identification Compared with MRI in Women with Dense Breasts-a Multicenter Prospective Study.

Objectives: To assess the performance of elastography (ES) and ultrasound (US) in predicting the malignancy of breast lesions and to compare their combined diagnostic value with that of magnetic resonance imaging (MRI).Materials and Methods: The study prospectively enrolled 242 female patients with dense breasts treated in 35 heath care facilities in China between November 2018 and October 2019. Based on conventional US and elastography, radiologists classified the degree of suspicion of breast lesions according to the US Breast Imaging Reporting and Data System (BI-RADS) criteria. The diagnostic value was compared between US BI-RADS and MRI BI-RADS, with pathological results used as the reference standard.Results: The results demonstrated that irregular tumor shape, a nonparallel growth orientation, indistinct margins, angular contours, microcalcifications, color Doppler flow and ES score on US imaging were significantly related to breast cancer in dense breasts (P=0.001; P=0.001; P=0.008; P<0.001; P=0.019; P=0.008; P=0.002, respectively). The sensitivity, specificity, PPV, NPV, accuracy and AUC of US BI-RADS category were 94.7%, 90.7%, 95.8%, 88.0%, 93.4% and 0.93 (95%CI, 0.88-0.97), respectively, while those of MRI BI-RADS category were 98.2%, 57.5%, 84.3%, 83.3%, 86.0% and 0.78 (95%CI, 0.71-0.85), respectively. MRI BI-RADS showed a significantly higher sensitivity than US BI-RADS (98.2% vs 94.7%, P=0.043), whereas US BI-RADS showed significantly higher specificity (90.7% vs 57.5%, P<0.001). US BI-RADS showed better diagnostic efficiency in differentiating nodules in dense breasts than MRI BI-RADS (AUC 0.93 vs 0.78, P<0.001).Conclusion: By combining the use of ES and conventional US, US BI-RADS had better diagnostic efficiency in differentiating nodules in dense breasts than MRI. For the diagnosis of malignant tumors in patients with dense breasts, MRI and US BI-RADS can be used as supplemental diagnostic tools to detect lesions, with US BI-RADS considered the preferred adjunctive resource.

Elevated Lipase Associated With COVID-19 Possibly due to Acute Pancreatitis in a Pediatric Patient: A Case Report

As the global pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) advances, the challenge of understanding its wide spectrum of symptoms and sequelae continues to be a priority in the medical world. There are not many case reports on the atypical presenting features of coronavirus disease 2019 (COVID-19), especially in the pediatric population. Discussed here is a case of acute pancreatitis in a 14-year-old male who presented with abdominal pain without any other typical COVID-19 symptoms. Workup was significant for positive SARS-CoV-2 polymerase chain reaction (PCR), elevated lipase, and computed tomography of the abdomen and pelvis with oral and intravenous contrast showed an indistinct margin of the pancreatic tail and left upper quadrant ascites, supportive of early pancreatitis. Clinical and laboratory improvement was noted after treatment with bowel rest, intravenous fluids, and antibiotics. This case highlights the concern that acute pancreatitis may be a complication associated with COVID-19. Identifying its signs may enable earlier diagnosis and treatment. Int J Clin Pediatr. 2020;9(4):125-129 doi: https://doi.org/10.14740/ijcp401

TRACHEOBRONCHIAL MELANOSIS

SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: “Black bronchoscopy,” i.e., black pigmentation seen in the tracheobronchial tree, may be caused by a variety of conditions, some of which are uncommon or rare. We present a case of tracheobronchial melanosis, an uncommon cause of black bronchoscopy, in an elderly woman. CASE PRESENTATION: A 78-year-old female with past history of squamous cell carcinoma of the lung status post radiation treatment and chronic obstructive pulmonary disease was admitted for pneumonia. X-ray and computed tomography of the chest (Figure 1) were consistent with bilateral pneumonia. Flexible bronchoscopy (Figure 2) showed extrinsic compressions of the bilateral bronchial tree, non-inflamed bronchial mucosa, and numerous melanotic areas with indistinct margins distal to secondary and tertiary carinas, consistent with tracheobronchial melanosis. Bronchoalveolar lavage specimens were negative for malignant cells or bacterial, fungal, mycobacterial, or viral pathogens. DISCUSSION: The main differential diagnoses for black bronchoscopy include tracheobronchial melanosis, endobronchial pigment-producing infections, healed endobronchial tuberculosis, melanoma and other neoplasms, carbon, silica or silver exposure, burn injury, amiodarone, charcoal aspiration, and thermal ablation of endobronchial lesions. While not common, tracheobronchial melanosis is typically seen as an incidental finding on bronchoscopy. The lesions consist of areas of black pigmentation with indistinct margins, mostly adjacent to secondary and tertiary carinas [1]. Tracheobronchial melanosis is usually discovered in the absence of other mucosal abnormalities, and its clinical significance has not been determined. However, it is mostly considered to be a benign congenital variant resulting from abnormal production of melanin pigments in the tracheobronchial mucosa [2]. CONCLUSIONS: In addition to understanding common pathologic and normal bronchoscopy findings, it is important for pulmonologists, especially those in training, to be familiar with uncommon findings, normal variants, and lesions with unknown clinical significance, such as tracheobronchial melanosis. Reference #1: Tunsupon, P, Panchabhai TS, Khemasuwan D, Mehta A. Black bronchoscopy. CHEST 2013; 144 (5): 1696-1706. Reference #2: Pagliaccio L, Mehta AC. Endobronchial melanosis: occurrence and possible significance [abstract]. CHEST 1989; 96: 222S. DISCLOSURES: No relevant relationships by Elizabeth Nielsen, source=Web Response No relevant relationships by Thamer Sartawi, source=Web Response No relevant relationships by Keivan Shalileh, source=Web Response no disclosure on file for Rajagopal Sreedhar