Intraductal Mass Research Articles

A novel presentation of tubular adenoma of the breast as an intraductal mass: Diagnostic considerations and pathologic correlation.

A novel presentation of tubular adenoma of the breast as an intraductal mass: Diagnostic considerations and pathologic correlation.

A Rare Plug in the Pipe: Intraductal Tubular Adenoma of the Pancreas

Background: Intraductal lesions of the pancreas are uncommon but increasingly recognized because of advances in radiological technology. Intraductal tubular (IT) adenoma are extremely rare and are incompletely understood. These lesions have similar clinical, and radiological presentations and therefore a definitive histological diagnosis is crucial for appropriate management, surveillance and outcomes. Case: A 79-year-old man presented with abdominal discomfort. Contrast CT of the abdomen revealed a 1.7x2.2 cm pancreatic body mass with upstream ductal dilation concerning for a pancreatic neoplasm. Endoscopic ultrasound demonstrated a 1.8 cm x 2.1 cm intraductal mass in the body of the pancreas with upstream ductal dilation suspicious for a main duct IPMN with mural nodularity. FNA revealed ductal epithelium without dysplasia or malignant cells. Extracellular mucin was present. He underwent a distal pancreatectomy and splenectomy. Surgical pathology (Image 3) was consistent with IT adenoma, pyloric gland type with mild dysplasia and a minor component of IPMN with focal moderate dysplasia. His postoperative course was unremarkable. Discussion: Pancreatic intraductal tumors are divided into IPMNs and IT neoplasms. IT neoplasms are further divided into IT adenoma and IT carcinoma as based on histological epithelial atypia that is present. IT adenomas have no gender predilection and the lesions occur in those within the 5th to 7th decade of life. Most patients are asymptomatic or have nonspecific symptoms. Imaging can show a dilated duct with filling defect and varying amounts of mucin. EUS may show a protruding/nodular mass, which is regarded as a malignant feature in lesions like IPMN. Grossly, they appear polyploid, often occluding the lumen resulting in cystic dilation of the duct. Histologically, ITAs have epithelial lining, which is columnar with apical mucin and basally oriented nuclei, which show low-grade cytological atypia. ITAs share similarities with IPMN. They have similar Mucinex brush and profiles, which include MUC6 and MUC5AC. They may also share common mutations of GNAS and KRAS. However, there is a difference, which may help to differentiate ITA from IPMN. ITA pyloric type lesions tend to occur in the main pancreatic duct whereas gastric type IPMNs are mainly in the branch ducts. Limited information exists on intraductal lesions such as IPMNs, ITAs and ITCs. Appropriate workup will help with accurate diagnosis, management and surviellance.Figure 1

Assessing the Potential of Thermal Imaging in Recognition of Breast Cancer

Breast cancer is a common disorder in women, constituting one of the main causes of death all over the world. The purpose of this study was to determine the diagnostic value of the breast tissue diseases by the help of thermography. In this paper, we applied non-contact infrared camera, INFREC R500 for evaluating the capabilities of thermography. The study was conducted on 60 patients suspected of breast disease, who were referred to Imam Khomeini Imaging Center. Information obtained from the questionnaires and clinical examinations along with the obtained diagnostic results from ultrasound images, biopsies and thermography, were analyzed. The results indicated that the use of thermography as well as the asymmetry technique is useful in identifying hypoechoic as well as cystic masses. It should be noted that the patient should not suffer from breast discharge. The accuracy of asymmetry technique identification is respectively 91/89% and 92/30%. Also the accuracy of the exact location of identification is on the 61/53% and 75%. The approach also proved effective in identifying heterogeneous lesions, fibroadenomas, and intraductal masses, but not ISO-echoes and calcified masses. According to the results of the investigation, thermography may be useful in the initial screening and supplementation of diagnostic procedures due to its safety (its non-radiation properties), low cost and the good recognition of breast tissue disease.

Intrabiliary Hepatic Metastasis of Colorectal Carcinoma Mimicking Primary Cholangiocarcinoma: A Case Report and Review of the Literature.

Intrabiliary metastasis from colorectal carcinoma (CRC) growing within or invading bile ducts is not a very common pattern. However, accurate diagnosis of metastatic lesions is very important for selection of adjuvant therapy and prognosis. We report a case of 71-year-old male who developed painless jaundice due to hepatobiliary obstruction. MRI demonstrated 1.4 cm intraductal mass at hepatic hilum with severe intrahepatic ductal dilation, consistent with cholangiocarcinoma. ERCP (endoscopic retrograde cholangiopancreatography) showed intraductal segmental biliary stricture. Biopsy from the lesion showed adenocarcinoma favoring primary cholangiocarcinoma due to the papillary morphology and location of the mass. His past history was significant for rectosigmoid carcinoma (pT1N0) ten years ago and liver resection for metastatic CRC four years ago. He subsequently underwent central hepatectomy with resection of common bile duct. Grossly, there was a 1.2 cm intraductal mass at the bifurcation of bile ducts with multiple nodules in liver parenchyma. Microscopic examination revealed intraductal carcinoma with papillary architecture colonizing bile duct epithelium with resultant dilation and tortuosity. Occasional liver parenchymal nodules show classical metastatic pattern resembling CRC. Because of two distinct morphologic patterns and patient's past history, immunostains were performed. CK7 stained uninvolved bile duct epithelium with no staining in intrabiliary metastatic growth. CK20 and CDX2 were positive, thus confirming intrabiliary growth as metastatic growth from CRC. In summary, findings from our case indicate that intrabiliary growth of metastatic CRC can easily be overlooked with major duct involvement. Pathologic evaluation with use of immunohistochemical stains is very important to achieve correct diagnosis.

Biliary Intraductal Papillary Neoplasm

The intraductal papillary neoplasm of the bile duct (IPNB) is a rare, little-known entity, regarded as the biliary equivalent of intraductal papillary mucinous neoplasm of the pancreas (IPMN-P). It is considered a premalignant lesion, which progresses in a multistep fashion towards invasive cholangiocarcinoma. IPNB can occur in any segment of the bile duct, presenting multiple foci and a variety of symptoms including abdominal pain, dyspepsia, jaundice, repetition cholangitis and weight loss. Between 5% and 29% of patients are asymptomatic. The most common radiological findings are dilatation of the bile duct and the presence of intraductal masses. Free margin resection is the treatment of choice for IPNB regardless of size, location, and initial benign status, since recurrent episodes of cholangitis and obstructive jaundice caused by mucin production may cause serious clinical problems. In patients who are not candidates for surgery, treatment is mainly limited to the creation of a biliary bypass to relieve jaundice and/or cholangitis.

Value of MR imaging in the diagnosis of intraductal papillary neoplasm of the bile duct

To analyze the value of MR imaging in diagnosis of intraductal papillary neoplasm of the bile duct (IPN-B). Fourteen patients with intraductal papillary neoplasms of the bile duct confirmed by surgical pathology were included in this study. The patients underwent MR routine plain scanning and enhancement scanning (including T1WI, T2WI with fat suppression, FALSH T1WI, and three-phase enhancement scanning), diffusion weighted imaging(DWI) and magnetic resonance cholangiopancreatography (MRCP) before operation. The imaging data were reviewed and analyzed retrospectively in comparison with the surgical and pathological results. In these patients, 7 cases had tumors located in the left lobe, 2 cases had tumors in both the left and right lobes, 2 cases in the hepatic hilum, 2 cases in the common bile duct, and 1 case in both the right lobe and the common bile duct. Solitary or multiple intraductal masses could be found in 12 cases, with 11 cases appeared as papillary masses and one case as flat mass. In the other two cases the tumor was not visible (one case had too many stones, and in another case the tumor was too small). The tumors in the 12 cases showed hypointensity on T1WI and hyperintensity on T2WI. On the dynamic contrast-enhanced MRI, 11 cases showed mild and one showed moderate enhancement in arterial phase, and all the cases showed mildly and gradually delayed enhancement. On DWI, the lesion areas showed high signal intensity in all the cases, and the ADC value of the tumor area (1.697×10(-3)mm(2)/s) was significantly lower than that of the normal bile (3.973×10(-3)mm(2)/s) (t = -10.94, P < 0.05). Twelve cases demonstrated filling defects on primary MRCP coronary thin section images. On 3D-reconstruction MRCP images, 7 cases exhibited diffuse bile duct dilatation with the tumor areas more prominent, 3 cases exhibited aneurysmal bile dilatation, while the rest 4 cases exhibited segmental or lobar bile duct dilatation ( including 2 with invisible tumors ). In the 3 cases with aneurysmal bile dilatation, the multiple directions of MRCP images helped to find the communication between the aneurysmal dilatation and the bile duct. All the cases showed significant proximal bile duct dilatation (the extent of dilatation >100%), and 9 cases also showed distal bile duct dilatation. Bile duct stones were noted in 6 cases, 4 at the tumor area, and the other 2 away from the tumor area. No adjacent tissue invasion and no distal tissue or lymph node metastasis were observed. Intraductal papillary neoplasms of the bile ducts have characteristic imaging appearances on MRI, and MRI is an important method helpful to making correct diagnosis.

Unusual cause of obstructive jaundice revealed by endoscopic ultrasound guided fine-needle aspiration of mediastinal lymph node.

A 65-year-old male presented to us with jaundice of 2-month duration. His liver function tests were suggestive of cholestatic jaundice with serum bilirubin of 28 mg/dL. Ultrasound of the abdomen revealed dilated intrahepatic biliary radicles with a suspicion of intra-ductal mass lesion at the hilum. Contrast-enhanced computed tomography (CT) and magnetic resonance cholangiopancreatography of the abdomen showed a soft tissue lesion in the common bile duct (CBD) extending into the right ductal system as well as distal bile duct with bilobar biliary radical dilatation [Figures 1 and 2 respectively]. Positron emission tomography CT detected a non-fl ourodeoxyglucose (non-FDG) avid mass in the bile duct along with a moderately FDG avid (SUV

Ultrasound Findings of Intraductal Papillary Neoplasm in Bile Duct and the Added Value of Contrast-Enhanced Ultrasound.

To investigate the imaging features of intraductal papillary neoplasm in bile duct (IPNB) on baseline ultrasound and contrast-enhanced ultrasound (CEUS). The imaging features on baseline ultrasound and CEUS in 16 pathologically proven IPNB lesions in 15 patients were retrospectively analyzed. Real-time contrast specific modes and contrast agent of SonoVue were used for CEUS. Bile duct dilation was present in all patients. The mean lengths for the intraductal papillary adenomas and adenocarcinomas were 2.5 ± 1.1 (range, 1.2 - 4.2 cm) and 5.6 ± 2.0 cm (range, 3.3 - 9.8 cm) (P = 0.004). Three imaging types of IPNB on ultrasound were depicted: bile duct dilation with intraductal mass (n = 8), bile duct dilation without intraductal mass (n = 3), and cystic-solid mixed type (n = 5). On CEUS, solid components of 13 lesions appeared hyper- (n = 12) or iso-enhancement (n = 1) in the arterial phase whereas all showed hypo-enhancement in the portal and late phases. For 3 lesions of bile duct dilation without intraductal mass, CEUS showed non-enhancement during all phases. Pre-surgical CEUS and conventional ultrasound made correct diagnoses in 12 (75.0 %) and 5(31.3 %) of 16 IPNBs respectively (P = 0.04). For CECT, correct diagnosis was also achieved in 12 (75.0 %) of 16 lesions (P = 1.00, in comparison with CEUS). IPNB should be taken into consideration when intraductal mass or cystic-solid mass with bile duct dilation, or remarkable bile duct dilation without intraductal mass, are found on US. Intraductal mass length > 3.0 cm is more commonly found in malignant IPNB. CEUS might facilitate the diagnosis of IPNB by easily excluding the possibility of commonly found sludge, nonshadowing stones, or blood clots.

Abstracts and Case Studies From the College of American Pathologists 2014 Annual Meeting (CAP '14)

Abstracts and Case Studies From the College of American Pathologists 2014 Annual Meeting (CAP '14)

Intraductal papillary neoplasms of the bile duct.

Intraductal papillary neoplasm of the bile duct (IPNB) is a rare variant of bile duct tumors characterized by papillary growth within the bile duct lumen and is regarded as a biliary counterpart of intraductal papillary mucinous neoplasm of the pancreas. IPNBs display a spectrum of premalignant lesion towards invasive cholangiocarcinoma. The most common radiologic findings for IPNB are bile duct dilatation and intraductal masses. The major treatment of IPNB is surgical resection. Ultrasonography, computed tomography, magnetic resonance image, and cholangiography are usually performed to assess tumor location and extension. Cholangioscopy can confirm the histology and assess the extent of the tumor including superficial spreading along the biliary epithelium. However, pathologic diagnosis by preoperative biopsy cannot always reflect the maximum degree of atypia, because IPNBs are often composed of varying degrees of cytoarchitectural atypia. IPNBs are microscopically classified into four epithelial subtypes, such as pancreatobiliary, intestinal, gastric, and oncocytic types. Most cases of IPNB are IPN with high-grade intraepithelial neoplasia or with an associated invasive carcinoma. The histologic types of invasive lesions are either tubular adenocarcinoma or mucinous carcinoma. Although several authors have investigated molecular genetic changes during the development and progression of IPNB, these are still poorly characterized and controversial.

Magnetic resonance imaging features of papillary breast lesions

PurposeThis study was aimed to assess the role of magnetic resonance imaging (MRI) in the evaluation of the papillary lesions of the breast and their morphological relationship with the mammary ducts. The potential diagnostic contributory role of ductal oriented protocols to conventional dynamic magnetic resonance examination was also explored. Materials and methodsRetrospective data were collected from 46 patients who had been diagnosed with papillary breast lesions and undergone magnetic resonance examination.The presence of dilated ducts and their morphological relation with the lesion were recorded. Lesions were classified as follows: papilloma, papillomatosis and malignant papillary lesion. Statistical difference between groups was studied for each morphological and dynamic lesion characteristic. ResultsDilated ducts and characteristics of intraductal material can be identified by magnetic resonance imaging. Certain MRI findings such as a mass with crescentic peripheral fluid or focal intraductal mass on T2 weighted images may suggest the presence of an intraductal/papillary lesion. In this respect, non-fatsat T2 weighted images appear particularly useful. There was a significant difference between papilloma and papillomatosis with regard to segmental and heterogeneous contrast enhancement (p<0.05 for both comparisons). In addition, there was a significant difference between papillomas and carcinomas with regard to homogenous, heterogeneous and segmental contrast enhancement (p<0.05 for all). On the other hand, papillomatosis and carcinoma did not differ significantly in terms of any of the morphological or dynamical MR criteria compared. ConclusionPapillary lesions can be detected by MRI. Despite some overlaps in MRI findings between carcinoma, papilloma and papillomatosis, MRI may help differentiate these lesions. Major benefit of retroareolar imaging appears to arise from its ability to demonstrate ductal relation and extension of contrast enhanced regions.

Intraductal Mass on Breast Ultrasound: Final Outcomes and Predictors of Malignancy

The purpose of this study was to retrospectively investigate the final outcomes of intraductal masses on breast ultrasound and determine the clinical and radiologic variables associated with malignancy. A database search (2006-2008) was performed to find patients who had an intraductal mass on breast ultrasound. Histopathologic or ultrasound follow-up (> 24 months) data were available from 147 women (mean age, 49.8 years) with 163 intraductal masses. Clinical and radiologic variables (age, symptom, personal and family history, lesion size, and distance from the nipple) and pathologic results were collected. Ultrasound features of the intraductal masses were reviewed by two radiologists in consensus and classified into three morphologic types: mass incompletely filling the duct, mass completely filling the duct, and mass extending outside the duct. Involvement of a branch duct was also analyzed. Associations between variables and final outcomes were analyzed using chi-square tests and Student t tests. Thirteen (8%) of the 163 intraductal masses were malignant (10 ductal carcinomas in situ and three invasive ductal carcinomas). Malignancy was significantly associated with symptoms (p = 0.008) and personal history of breast cancer (p < 0.007). Malignant intraductal masses were larger than benign intraductal masses (1.4 cm vs 0.9 cm, p = 0.02). Malignant intraductal masses tended to fill the duct more completely or extend outside the duct (p < 0.001), and they more frequently involved the branch duct (p < 0.001) than did the benign intraductal masses. Our study showed that 8% of intraductal masses are malignant. Symptoms, personal history, lesion size, and ultrasound features can be possible predictors of malignancy.

Intraductal papillary neoplasm of the bile duct

Intraductal papillary neoplasm of the bile duct (IPNB) is a variant of bile duct carcinoma that is characterized by intraductal growth and better outcomes compared with common cholangiocarcinoma. IPNBs are mainly found in patients from Far Eastern areas, where hepatolithiasis and clonorchiasis are endemic. According to the immunohistochemical profiles of the mucin core proteins, IPNBs are classified into four types: pancreaticobiliary, intestinal, gastric, and oncocytic. Approximately 40%-80% of IPNBs contain a component of invasive carcinoma or tubular or mucinous adenocarcinoma, suggesting that IPNB is a disease with high potential for malignancy. It is difficult to make an accurate preoperative diagnosis because of IPNB's low incidence and the lack of specificity in its clinical manifestation. The most common abnormal preoperative imaging findings of IPNB are intraductal masses and the involvement of bile duct dilation. Simultaneous proximal and distal bile duct dilation can be detected in some cases, which has diagnostic significance. Cholangiography and cholangioscopy are needed to confirm the pathology and demonstrate the extent of the lesions. However, pathologic diagnosis by biopsy cannot reflect the actual stage in many cases because different foci may be of different stages and because mixed pathologic findings may exist in the same lesion. Surgical resection is the major treatment. Systematic cholangioscopy with staged biopsies and frozen sections is recommended during resection to ensure that no minor tumors are left and that curative resection is achieved. Staging, histologic subtype, curative resection and lymph node metastasis are factors affecting long-term survival.

Abstract P1-03-03: milk deposition in women's mammary duct has been a potential risk factor of breast tumor

Abstract Background: According to the pathology and general resection specimens, so many patients have breast tumors together with deposited milk. Therefore, we performed this retrospective study to determine the distribution and characteristics of breast diseases in women undergoing mammary ductoscopy and explore the clinical values and implications of mammary ductoscopy in the management of the breast diseases. Materials &amp; Methods: Total of 10,082 women(20,082 breasts) with a mean age of 39.2 years old (ranging from 12 to 84 years old) underwent mammary ductoscopy from 2002 to 2011. We studied NSND in contrast with SND duct, specially focused on the situation of duct with intraductal mass. Comparing with the pathology, we studied the relationship between duct milk deposition and epithelial hyperplasia. Results: From this study we concluded that duct milk deposition was a common disease in 25–59 years old women, it occupied 42.89% cases of the mammary ductal disease and almost 46% are NSND. The character of deposited milk became solid from liquid with the age growing up. Duct milk deposition 476/1431(33.26%)was mostly associated with intraductal masses(total 1431 cases), followed by duct dilatation 517/1431(36.13%). Pathology of patients diagnosed by FDS for duct milk deposition are epithelial hyperplasia(100%), adenosis(86.5%), chronic inflammation(8.8%), metaplasia(16.9), florid hyperplasia(10.8%), tumor-like hyperplasia (57.2%), intraductal tumor or fibroadenoma (27.8%), dysplasia (3.0%), breast cancer (11.7%). Discussion: Diagnosis of duct milk deposition, which may not necessarily presented by nipple discharge, is the most common finding and associated with proliferation and thus intraductal mass, etc. we should noticed 30–50 years old women groups, cause they have have stopped breast-feeding for years but still had yellow or brown, liquid or solid milk-like things in their lactiferous ducts. We predict duct milk deposition may be related with breast carcinogenesis. It is a kind of long time mechanical stimulation in the duct, both the physico-chemical properties and the acid-alkaline environment had changes by years. Still, the deposited milk would be a best medium for microbial and virus, which would cause the genesis of hyperplasia even breast cancer. Therefore, we should go on the research of deposited milk and the changes of the microenvironment of the duct to find the pathogenesis of breast disease. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-03-03.

Breast MR for intraductal masses

Unilateral, bloody or serous nipple discharge is associated with an increased risk of malignancy. The cancer risk is 5–28% and 3–35% for bloody and serous respectively. However, the most common tumor in patients presenting with this symptom is a benign intraductal papilloma with and incidence of 40–78% for bloody and 41–59% for serous [1]. While breast MR has been shown to be effective in demonstration of malignancy in women with nipple discharge symptoms, the diagnosis of intraductal masses often still requires galactography [2–4]. In this paper, MR methods are described that can accurately depict ductal anatomy for the improved differentiation of intraductal papillomas from malignancy.

Imaging Approaches to Diagnosis and Management of Common Ductal Abnormalities

Ductal disease is an important, often overlooked, and poorly understood issue in breast imaging that results in delays in diagnosis and patient care. The differential diagnosis for an intraductal mass is broad and includes inspissated secretions, infection, hemorrhage, solitary or multiple papillomas, and malignancy. Each breast is composed of eight or more ductal systems, with most disease arising in the terminal ductal-lobular unit. Imaging evaluation of the ductal system usually entails a combination of mammography, galactography, ultrasonography (US), and in some cases magnetic resonance (MR) imaging. The most common finding with all modalities is ductal dilatation with a focal or diffuse abnormality. Benign diseases of the ducts include duct ectasia, blocked ducts, inflammatory infiltrates, periductal mastitis, apocrine metaplasia, intraductal papillomas, and papillomatosis. Malignant diseases of the ducts include ductal carcinoma in situ, invasive ductal carcinoma, and Paget disease. Most commonly performed with US or MR imaging guidance, percutaneous biopsy methods are helpful in diagnosis and management of ductal findings. Because most findings are smaller than 1 cm, located within a duct, and thus sometimes not visible after a single pass, vacuum-assisted devices help improve the accuracy of sampling.

The T1W Hyperintense Signal on the Surface of Distal Segment of Bile Duct Tumor Thrombi and Its Significance

To evaluate the magnetic resonance (MR) findings of bile duct tumor thrombi (BDTT) and intraductal growing-type cholangiocarcinoma (IDG-type CC), especially focusing on the distal segment of intrabiliary tumors. Twenty-nine cases of hepatocellular carcinoma with BDTT and 17 cases of IDG-type CC were available for retrospective review. The following MR findings were evaluated: presence of necrosis and T1-weighted (T1W) hyperintense signal on the surface of the distal segment of intrabiliary tumors, bile duct wall thickening adjacent to the tumor, dilation of bile duct of the tumor-bearing segment, location and maximum diameter of intraductal mass, and presence of a hepatic parenchymal mass. There was significant difference in T1W hyperintense signal on the surface of the distal segment of intrabiliary tumors between BDTT and IDG-type CC (P < .05). The T1W hyperintense signal detected in BDTT was identified as bile layering (9/25) or hemobilia (16/25) pathologically. For the diagnosis of BDTT, the sensitivity and specificity of T1W hyperintense signal was 86.2% and 100%, respectively. There was significant difference in necrosis at the distal end of intrabiliary tumors and presence of hepatic parenchymal mass between BDTT and IDG-type CC (P < .05). However, no statistical significance was found in bile duct dilation, the absence of wall thickening, the location of intraductal mass, or the maximum diameter of intrabiliary mass between the two groups (P > .05). The T1W hyperintense signal on the distal segment of intrabiliary mass was because of concentrated bile deposits or hemobilia. The sign of T1W hyper signal on the distal segment is valuable to differentiate BDTT and IDG-type CC.

CT findings of intraductal papillary neoplasm of the bile duct: Assessment with multiphase contrast-enhanced examination using multi-detector CT

To evaluate multi-detector computed tomography (MDCT) findings of intraductal papillary neoplasm of the bile duct (IPNB), a neoplasm that is considered to be the biliary counterpart of pancreatic intraductal papillary mucinous neoplasm. Two radiologists retrospectively evaluated multiphase contrast-enhanced CT images with 0.5 or 1mm collimation in 37 consecutive patients with resected IPNB diagnosed by a single pathologist. The CT findings were correlated with the pathological findings concerning invasion of the surrounding organs and vessels. All patients showed bile duct dilatation. An intraductal mass was detected in 36 patients and the following findings were observed: extensive infiltration along the bile duct more than 20mm (n=32), compared with normal hepatic parenchyma, isodense or hyperdense during the late arterial phase (n=31), not hyperdense during the portal-venous and delayed phases (n=36), and intense enhancement rim at the base of the mass during the portal-venous or delayed phase (n=27). Parenchymal invasion of the surrounding organs was seen in eight of 16 tumours showing irregular or bulging margins. Vascular invasion was false positive in four of eight tumours. IPNB exhibits relatively characteristic findings with multiphase contrast-enhanced examination using MDCT. A tendency to overestimate invasion of the surrounding organs and vessels was seen.

Nonfunctioning pancreatic endocrine tumor with extension into the main pancreatic duct: Report of a case

Pancreatic endocrine tumors (PETs) rarely involve the main pancreatic duct. We report a case of malignant nonfunctioning pancreatic endocrine tumor (NFPET) with prevalent intraductal growth. A 47-year-old woman was referred to us after ultrasonography at a routine health check showed diffuse swelling of the pancreas. Preoperative imaging showed a solid mass in the tail of the pancreas and a bulging intraductal mass in the main pancreatic duct. We performed total pancreatectomy because the tumor occupied almost the entire lumen of the main pancreatic duct. Histological examination confirmed well-differentiated endocrine carcinoma. We review reported cases of the intraductal growth of NFPETs and discuss the pathogenesis of these unusual tumors.

Intraductal papilloma of the breast in association with preoncogenic gene of breast cancer

We reported a case of an African American woman who went to the hospital with palpable right breast lump with bloody nipple discharge at University of Texas Medical Branct at Galvestion. The modalities of breast imagings included mammography and ultrasongraphy. The method used for viral identification was Linear Array HPV genotyping test. Intraductal papilloma revealed as high density tubular or rounded lobular masses with partially circumscribed, obscured margins and clustered punctate microcalcifications on mammograms. Ultrasound showed as intraductal masses with dilated ducts. The core biopsy demonstrated duct filled with papillary lesion and post excision revealed intraductal papilloma. HPV DNA types 16, 33, 58 and 71 were detected after use of Linear Array HPV genotyping test.