Irregular Mass Research Articles

Calcifying Odontogenic Cyst: An Enigma

The calcifying odontogenic cyst (COC), discovered in 1962, is a rare developmental odontogenic cyst clinically present as slow-growing swelling mainly in the anterior portion of the jaws, generally present in the second and sixth decades of life. It accounts for 0.3%–0.8% of odontogenic cysts. COC showed variations in clinical and radiographic features that are not pathognomic, whereas histomorphology forms exist in 3 patterns: benign cystic, solid (neoplastic), and aggressive (malignant) forms. The radiograph shows well-defined radiolucency with irregular masses, while the histopathologic features include a cystic lining with characteristic “Ghost” cells and immunohistochemical reactions positive for various enamel proteins.

A Curious Case of IgG4-Related Disease Masquerading As an Occult Abdominal Malignancy

Introduction IgG4-related disease is an autoimmune, fibroinflammatory disorder involving multiple organ systems in the body. Diagnosis is often suggested by strong IgG4-positive stain on tissue biopsy. Patients respond well to steroids; and in cases of relapse, steroid-sparing agents like rituximab, azathioprine or cyclosporine can be used. Case Presentation Here we present the case of a 77 year-old African-American female with a past medical history significant for cerebrovascular accident, chronic hepatitis C infection status post treatment with antivirals, left chronic dacryoadenitis and chronic iron-deficiency anemia. She presented to the hematology office for a follow-up visit for chronic anemia and complained of new onset right upper quadrant pain and unexplained weight loss. Subsequent abdominal and pelvic imaging showed hypoechoic lesion in pancreatic head along with multiple epigastric, omental and gastro-hepatic nodules/lymph nodes suspicious for malignancy. This was followed by esophagogastroduodenoscopy (EGD) with endoscopic ultrasound (EUS) which revealed gastric body/antral erosions along with multiple enlarged abdominal lymph nodes and heterogeneous, hypoechoic irregular mass in the pancreatic head/neck, all of which were biopsied. While awaiting biopsy results, due to high suspicion for malignancy, PET-FDG was performed which showed hypermetabolic lesions corresponding to the EUS findings and a FDG-avid right paravertebral mid thoracic soft tissue mass favored to represent a neurogenic tumor, unrelated to abdominal disease. Laboratory work-up was significant for elevated IgG levels with particularly high titres of IgG subclass 4. Biopsy results from EUS showed no evidence of malignant cells, no clonal proliferation on flow cytometry in either the lymph nodes or pancreatic tissue. Cytology of pancreatic tissue biopsy revealed lymphoid infiltration, extensive edema and fibrosis with no malignant cells. Immunohistochemistry studies revealed strong positive stain for IgG4 suggestive of IgG4-related disease. Of note, the patient had been following up with ophthalmology for a few years for chronic inflammatory dacryoadenitis of the left eye, which can likely be attributed to IgG4-related disease. After shared-decision making with the patient regarding treatment options, treatment was initiated with a plan of rituximab for 4 cycles along with corticosteroid. As of this abstract submission, the patient received one dose of rituximab, pending assessment of response to treatment. Discussion Heterogeneous pancreatic masses on abdominal imaging should be considered malignant until otherwise proven. In cases where these masses are associated with diffuse abdominal and pelvic lymphadenopathy, definitive diagnosis is made through obtaining biopsies from the easily accessible sites. A benign, auto-immune, fibroinflammatory condition which mimics this presentation is IgG4-related disease, whose treatment is far less complicated than a metastatic carcinoma. It often involves lacrimal glands. A high index of suspicion backed by the biopsy results showing strong stain affinity to IgG4 and elevated blood IgG4 levels are required. Treatment involves initiation of steroids followed by steroid-sparing agents like azathioprine, cyclosporine or rituximab in cases of relapse after steroid induction. However, as in our case, combination therapy of simultaneous use of steroids with rituximab can be used after shared decision making with patients.

Adenoid cystic carcinoma of head and neck: Summary and review of imaging findings

PurposeCurrent reports of adenoid cystic carcinoma of the head and neck (ACC) are all case reports, and there is no basilar summary of its imaging findings. This study aims to summarise ACC's computed tomography (CT) and magnetic resonance imaging (MRI) findings to improve radiologists' knowledge of this disease. MethodsWe collected clinical and imaging data of patients with ACC during the last decade, and two radiologists retrospectively analysed the imaging characteristics. ResultsOf the 16 patients included, six were able to self-perceive bulkiness, and 11 had regional pain. Tumour morphology was regular in six cases, with clear borders in 11 cases, invasion of the surrounding bony mass in 12 cases, and invasion of peripheral nerves in 15 cases. CT mostly shows an irregular soft-tissue density mass with mild-to-moderate enhancement after contrast medium administration. On MRI, the ACC showed isointense or hypointense signals on T1-weighted images (T1WI) and hyperintense or slightly hyperintense signals on T2-weighted images (T2WI). All signals were markedly enhanced after gadolinium enhancement. ConclusionsACC often has an irregular morphology, sometimes with a cystic component, enhancement on enhancement scans, easy destruction of adjacent bone, and invasion of peripheral nerves. The diagnosis should be considered when these features are encountered in clinical practice.

A Case of Orbital Rhabdomyosarcoma with Intracranial Extension in an Adult: Diagnostic and Management Challenges

Purpose: To report a rare case of orbital rhabdomyosarcoma with intracranial extension in an adult and the challenges in managing this case.
 Methodology: Research design was through a case report, while data was collected through observation, analysis of medical records and individual interviews. Interpretation of data was through the qualitative method of data analysis.
 Findings: A 34-year-old female meat seller was referred to our center with a rapidly progressive protrusion of the right eye of one month duration. She had a previous history of a penetrating injury to the right globe with bone fragment retention. She had had evisceration. Two weeks post-surgery, she noticed pain and a progressively worsening swelling around the right orbit. In our center, an initial diagnosis of orbital cellulitis post-evisceration was entertained. Orbito-cranial CT scan and MRI done showed a large homogenous irregular soft tissue mass occupying the right orbital cavity with extension to the right lateral rectus, lacrimal gland, cavernous sinus, optic nerve and brain parenchyma; findings were suggestive of orbital rhabdomyosarcoma with intracranial extension. The patient was discharged against medical advice. She re-presented 7 weeks later with a much larger mass which had multiple friable bleeding sites. With much assurance by the oncologists, she had several blood transfusions and 6 courses of chemotherapy. Tumour regression was very impressive. Incisional biopsy and histology confirmed rhabdomyosarcoma with chemotherapeutic changes. The patient was stable and so referred to another tertiary center for External Beam Radiation Therapy (EBRT), but this was delayed due to financial constraints. Two months from her referral for EBRT, colleagues reported she died of intractable seizures
 Recommendations: This study is based on suggestions that therapeutic success for rhabdomyosarcoma is better in children with survival rates reaching 75% unlike in adults where prognosis is poor.1 In this report, remission was observed soon after commencement of treatment. Therefore, it is recommended that early diagnosis be done to improve outcomes. Secondly, combination drugs should be used in all rhabdomyosarcoma cases. Lastly, government policies geared towards universal health coverage should be made and implemented.

SAT535 ANKRD26-RET Fusion Positive Metastatic Papillary Thyroid Carcinoma - Advanced Presentation of a Rare Mutation

Abstract Disclosure: H. Hashmi: None. A. Ankireddypalli: None. L. Burmeister: None. A. Nelson: None. K. Amin: None. Background: While rearranged during transfection (RET) protooncogene mutations have been commonly associated with thyroid malignancy, ankyrin repeat domain containing protein 26 (ANKRD26) has been primarily linked to hematologic malignancy. Exon 29 of ANKRD26 (Chromosome [Chr] 10p12.1) has been shown to fuse with exon 12 of RET (Chr 10q11.21), resulting in a genetic fusion mutation ANKRD26:RET. This is a rare genetic mutation in papillary thyroid cancer with only one previously reported case. We report the first case in the US of this novel genetic mutation with a unique clinical presentation. Clinical Presentation: A 48-year-old, male patient presented with lower back pain radiating to the lower extremities of one year duration. MRI lumbar spine revealed an irregular mass lesion in the L1 vertebral body with extraosseous soft tissue extension, L1 compression fracture and extension into the T12 body. CT CAP revealed a 4.8 x 3.6 cm, heterogenous right thyroid lobe with tracheal compression and sub centimeter pulmonary nodules in the left lower and right middle lobes. Biopsy of the L1 paravertebral mass was diagnostic for metastatic thyroid carcinoma of a follicular pattern. Molecular testing with a next generation sequencing fusion profile assay was positive for ANKRD26:RET gene rearrangement. Thyroid ultrasound was notable for a solid, hypoechoic, 3.2 x 3.1 x 2.9 cm right lobe nodule with echogenic foci and level 4 lymph nodes with loss of reniform shape and fatty hilum. FNA of the nodule and right level 4 lymph node was suspicious for follicular neoplasm. The patient was admitted for acute cord compression necessitating extensive laminectomy, vertebral reconstruction and resection of the L1 paraspinal tumor. Pathology was positive for metastatic, follicular variant, papillary thyroid carcinoma. Total thyroidectomy, central and right modified radical neck dissection was performed. Pathology demonstrated a 4.2 cm papillary carcinoma, follicular type with tall cell variant; confined to the thyroid. Extensive angioinvasion (≥ 4 vessels) and lymphatic invasion was present. 10/32 positive lymph nodes. TNM grading was T3aN1bM1. Summary: The only other case of ANKRD26-RET fusion positive papillary thyroid cancer in the literature was reported by Staubitz et al in Germany in 2019. They reported a case of a 78-year-old male with follicular variant papillary thyroid carcinoma (pT3,pN0,M0). To our knowledge, our case is the second worldwide and the first to be reported in the United States of this rare fusion protein positive thyroid cancer. Such an aggressive presentation with distant osseous metastases has to our knowledge not been previously described. Conclusion: The clinical and therapeutic implications of this rare genetic mutation are not currently well elucidated. We present this case with the intent to expand the existing literature and increase recognition of this rare genetic mutation. Presentation Date: Saturday, June 17, 2023

Synchronous occurrence of small cell lung cancer and primary rectal dedifferentiated liposarcoma with osteosarcomatous differentiation: A rare case report.

Rectal dedifferentiated liposarcoma (DDL) and DDL with osteosarcomatous differentiation both are extremely unwonted. In addition, there are no reports of simultaneous DDL with osteosarcoma differentiation with small cell lung cancer (SCLC) to date. Therefore, it is imperative to alert clinicians and pathologists to this extremely rare and instructive synchronous tumor. The patient was a 63-year-old male who presented with intermittent hematochezia and a swelling in the anus. Irregular masses were found on computed tomography (CT) examinations of the chest and abdomen respectively. The final diagnosis of synchronous occurrence of SCLC and primary rectal DDL with osteosarcomatous differentiation was established by radiological, histological, immunohistochemical and molecular findings. The patient underwent a puncture biopsy of the right lung mass and a complete resection of the rectal mass. The patient abandoned treatment, and multiple SCLC metastases appeared multiple metastasis 8 months after the operation. In the end, he expired suddenly due to severe cerebral hemorrhage caused by brain SCLC metastasis. DDL with osteosarcoma differentiation is infrequent, and its accurate diagnosis is based on morphology, immunohistochemistry and the necessary molecular tests. In rare cases, DDL occurs concurrently with other malignancies and and will be a challenge for pathologists and clinicians at this time. Accordingly, a comprehensive examination to identify possible synchronous tumors is very important in clinical practice.

Synchronous colorectal cancer: a case report

Synchronous colorectal cancer (CRCs) refers to more than 1 primary CRCs detected in a single patient simultaneously or within 6 months of the initial diagnosis. A 76-year-old men presented with persistent constipation since 1 month ago. Abdominal computed tomography (CT) showed an irregular mass in the right lower middle abdomen. Intraoperatively, the synchronous CRCs was found, therefore a subtotal colectomy was performed and the diagnosis was confirmed by histopathological examination. Synchronous CRCs is relatively rare. The CT can detect tumor, node, and metastasis (TNM) staging of colon cancer. Extensive resection was performed taking into account the patients preferences, number and location of tumors and postoperative plan. Surgeons should be familiar with all standard colorectal tumor surgical procedures, to avoid technical difficulties when surgical plans are changed for incidentaloma resection. Failure to identify synchronous colorectal carcinoma before surgery can lead to inadequate therapeutic procedures.

Radiological characteristics of invasive micropapillary carcinoma of the breast

To analyse the various imaging features of invasive micropapillary carcinoma (IMPC), a distinct variant of breast cancer, by mammography, ultrasound, and contrast-enhanced mammography. This study included 68 female patients with histopathologically proven invasive micropapillary carcinoma who underwent mammography, ultrasound, and contrast-enhanced mammography examinations. The findings encountered by each imaging tool were analysed using the Breast Imaging Reporting and Data System (BI-RADS) lexicon. In this retrospective study, 64.7% of cases were of the pure form of IMPC. Most of the cases showed an aggressive clinical course, with lymphovascular invasion noted in 76.5% of cases, while 60.3% of cases showed associated pathological lymphadenopathy. The N3 stage was reported in 25% of cases. On analysing the mammographic and ultrasound imaging findings, a significant association between irregular shape and a non-circumscribed margin with IMPC was found. Associated calcification was noted in 47% of cases. Pathological enhancement of moderate or marked conspicuity was noted in cases that underwent contrast-enhanced mammography, with the most commonly encountered finding being enhancing irregular and non-circumscribed masses. The mammographic and ultrasound imaging features of IMPC are indistinguishable from other aggressive types of breast cancer. At contrast-enhanced mammography examination, pathological enhancement of moderate to marked conspicuity was shown in all cases. The observed strong association of IMPC with lymphovascular invasion and lymph node metastasis with higher nodal stage in this study mandate meticulous sonographic examination of the axilla, as well as the infra, and supraclavicular regions if pathological axillary lymphadenopathy was noted.

Osteosarcoma in a free-living yellow armadillo (Euphractus sexcinctus)

An adult male free-living yellow armadillo (Euphractus sexcinctus) was found by hunters and referred for clinical evaluation because of a tumour-like lesion on the carapace. The animal was lethargic and weak with severe dehydration, enophthalmos and cachexia, and was euthanized because of its very poor clinical condition. Necropsy revealed a whitish, exophytic, irregular and moist mass (7 × 6.5 × 1.5 cm) in the caudal third of the carapace. On cut section, the mass was hard, compact, irregular and whitish. Histopathology revealed a densely cellular, expansive, poorly delimited neoplasm composed of malignant mesenchymal cells arranged in islands and cords, interspersed by numerous areas of irregularly mineralized osteoid matrix. Neoplastic cells were intensely immunolabelled for vimentin. The diagnosis of a high-grade osteosarcoma of osteoblastic subtype was based on the clinical, gross, histopathological and immunohistochemical findings. This first report of an osteosarcoma in an armadillo expands the list of armadillo diseases and will assist the management of these animals by veterinarians.

Numerical Simulation of Failure Modes in Irregular Columnar Jointed Rock Masses under Dynamic Loading

The mechanical properties and failure characteristics of columnar jointed rock mass (CJRM) are significantly influenced by its irregular structure. Current research on CJRMs is mainly under static loading, which cannot meet the actual needs of engineering. This paper adopts the finite element method (FEM) to carry out numerical simulation tests on irregular CJRMs with different dip angles under different dynamic stress wave loadings. The dynamic failure modes of irregular CJRMs and the influence law of related stress wave parameters are obtained. The results show that when the column dip angle α is 0°, the tensile-compressive-shear failure occurs in the CJRMs; when α is 30°, the CJRMs undergo tensile failure and a small amount of compressive shear failure, and an obvious crack-free area appears in the middle of the rock mass; when α is 60°, tensile failure is dominant and compressive shear failure is minimal and no crack area disappears; and when α is 90°, the rock mass undergoes complete tensile failure. In addition, in terms of the change law of stress wave parameters, the increase in peak amplitude will increase the number of cracks, promote the development of cracks, and increase the proportion of compression-shear failure units for low-angle rock mass. The changes in the loading and decay rate only affect the degree of crack development in the CJRMs, but do not increase the number of cracks. Meanwhile, the simulation results show that the crack expansion velocity of the CJRMs increases with the increase in dip angle, and the CJRMs with dip angle α = 60° are the most vulnerable to failure. The influence of the loading and decay rate on the rock mass failure is different with the change in dip angle. The results of the study provide references for related rock engineering.

779 Endoscopic Repair of a Chronic Duodenal Perforation Complicated by a Contained Collection: A Case Report

Abstract Duodenal perforations are a surgical emergency with high mortality. Most perforations require open or laparoscopic surgical repair, whereby the ulcer is oversewn, sometimes using a Graham patch. However, surgery is not without complications. We report the case of a 70-year-old man with a chronic, perforated duodenal ulcer that was repaired endoscopically. The patient presented with a 1-month history of epigastric abdominal pain, exacerbated by eating, and associated with a weight loss of 3.5 stones. Examination revealed a hard, irregular mass in the epigastrium. CT imaging showed a 6.8cm x 5.2cm x 4.1cm collection with an air-fluid level communicating with the D2 duodenum and extravasation of contrast into the collection. The collection was unable to be drained under radiological guidance due to difficulty in visualising and accessing it. Surgical intervention was deemed difficult to due to the site and chronicity of the perforation. The patient underwent endoscopic repair. Two interrupted sutures were placed using an Apollo overstitch system. APC was applied to the edges of the perforation and an OVESCO clip was placed ontop. Repeat CT imaging did not show any evidence of recurrent perforation. Endoscopic repairs have mainly been performed as an adjunct to surgical repair or during ERCP procedures, primarily using endoclips. We present a case where endoscopic repair alone was successful in sealing a duodenal perforation whilst leaving the collection intact. We believe this case is interesting and with advances in endoscopy, endoscopic repair could provide a minimal invasive option for managing duodenal perforations, especially complicated, chronic ones.

411. SINGLE-PORT THORACOSCOPIC RESECTION FOR THE SPINDLE CELL TUMOR OF ESOPHAGUS

Abstract Backgroud Single-port thoracoscopic for the huge spindle cell tumor of esophagusis is one of the most challenging surgeries. Here we reported a rare case of huge spindle cell tumor of esophagusis to explore the application of single-port thoracoscopic in esophageal resection. Methods A 61-year-old female was admitted due to swallow obstruction with breath tight for 1 month. The enhanced CT showed an irregular mass in the right posterior superior mediastinum close to the cephalic trunk, superior vena cava, right superior pulmonary artery and azygos vein, with tracheal and esophageal displacement. The differential diagnosis is potentially large, including lymphoma, lung cancer, bronchial cysts, esophageal tumors, etc. Ultimately we decided to use single-port thoracoscopic surgery for a biopsy or a complete resection of the tumor based on the intraoperative conditions. Results During the operation, we found that the tumor was located in the right posterior superior mediastinum and originated from the intrinsic muscular layer of the esophagus. The spindle cell tumor of esophagus resection by single-port thoracoscopic approach was carried out successfully. Pathological examination revealed esophageal leiomyoma. Conclusion The single-port thoracoscopic resection for the spindle cell tumor of esophagus is feasible and comprehensive.

Male breast cancer: a case report

Objective: This article aims to report a case of breast cancer in a male patient, who also had tumor lysis syndrome and suspected metastasis to the cranial vault. Case details: The present study reports the case of a male patient, 77 years old, with no family history of cancer, who presented with gynecomastia and an irregular mass in the infra-axillary region, with central cystic degeneration, classified as BIRADS IV-A. The patient evolved with tumor lysis syndrome and also had multiple lytic bone lesions scattered throughout the skull, with the possibility of secondary neoplastic involvement. Final considerations: Breast cancer in men is usually diagnosed in more advanced stages and is usually managed according to the procedures recommended for female breast cancer. It is important to understand the disease and its clinical manifestations, as well as to raise awareness about this type of cancer in men. In addition, further studies on specific therapeutic options for male breast cancer are needed to establish an evidence-based standard of care for this population.

Duodenal Metastasis from Colorectal Cancer: A Case Report

Background: The occurrence of metastatic colon lesions in various organs has been documented extensively in the literature. The liver, lungs, and bones are the most frequently affected sites. Metastasis in the duodenum due to colon cancer is an infrequent occurrence. Case Presentation: We present a detailed case report of a 65-year-old female patient diagnosed with metastatic colon cancer to the duodenum. The patient initially underwent extended right hemicolectomy for stage III low-grade adenocarcinoma of the colon. Adjuvant chemotherapy was administered, resulting in a period of apparent remission. However, in 2020, the patient experienced elevated tumor marker levels, prompting further investigations. Endoscopy revealed an irregular mass infiltrating the muscle layer in the duodenum, confirming malignant involvement. The patient underwent curative distal gastric duodenectomy, with pathology results indicating a colonic origin of the tumor. The patient received first-line palliative chemotherapy with FOLFOX rechallenge and the addition of AVASTIN. Several cycles of chemotherapy were completed, with satisfactory tumor response observed in follow-up PET scans. Maintenance therapy was initiated after achieving disease-free status on CT scans. However, in October 2022, the patient exhibited increasing tumor marker levels and new findings on PET scan, leading to the initiation of second-line palliative therapy with FOLFIRI and ramucirumab. The patient has received multiple cycles of second-line therapy, with the most recent PET scan in February 2023 showing a favorable treatment response, including a decrease in the size of existing nodes and no identification of new lesions. Conclusion: In conclusion, this case exemplifies the journey of a patient with stage 3 colon cancer who initially responded well to surgery and adjuvant chemotherapy, but experienced subsequent relapse in the duodenum. Despite surgical intervention and palliative chemotherapy, the patient developed metastasis in the liver, lung, and multiple lymph nodes.

Pancreatic ductal adenocarcinoma arising from the pancreatic parenchyma compressed by a huge pancreatic lipoma: a case report

BackgroundPancreatic lipomas (PLs) arising from the adipose tissue in the pancreatic parenchyma are rare among pancreatic tumors. Coexisting pancreatic ductal adenocarcinoma (PDAC) and PLs have not been previously reported. Herein, we report a case of PDAC arising from the pancreatic parenchyma with chronic pancreatitis compressed by a large PL.Case presentationThe patient was a 69-year-old male. He had been diagnosed with a PL using computed tomography (CT) 12 years previously. The tumor had been slowly growing and was followed up carefully because of the possibility of well-differentiated liposarcoma. During follow-up, laboratory data revealed liver damage and slightly elevated levels of inflammatory markers. Contrast-enhanced CT revealed the previously diagnosed 12 cm pancreatic head tumor and an irregular isodensity mass at the upper margin of the tumor that invaded and obstructed the distal common bile duct. Magnetic resonance cholangiopancreatography demonstrated no specific findings in the main pancreatic duct. Based on these imaging findings, the patient underwent endoscopic retrograde biliary drainage and bile duct brushing cytology, which revealed indeterminate findings. The differential diagnosis of the tumor at that time was as follows: (1) pancreatic liposarcoma (focal change from well-differentiated to dedifferentiated, not lipoma), (2) distal cholangiocarcinoma, and (3) pancreatic cancer. After the cholangitis improved, a pancreatoduodenectomy was performed. Histologically, hematoxylin–eosin staining revealed moderately differentiated PDAC compressed by proliferating adipose tissue. The adipose lesion showed homogeneous adipose tissue with no evidence of sarcoma, which led to a diagnosis of lipoma. Additionally, extensive fibrosis of the pancreatic parenchyma and atrophy of the acinar cells around the lipoma was suggestive of chronic pancreatitis. The pathological diagnosis was PDAC (pT2N0M0 pStage Ib) with chronic pancreatitis and PL. The postoperative course was uneventful, and the patient was discharged on the 15th day after surgery. The patient received adjuvant chemotherapy and has remained recurrence-free for more than 6 months.ConclusionsPL may be associated with the development of PDAC in the surrounding inflammatory microenvironment of chronic pancreatitis. In cases of growing lipomas, careful radiologic surveillance may be needed not only for the possibility of liposarcoma but also for the coincidental occurrence of PDAC.

Dynamic contrast-enhanced magnetic resonance imaging features and apparent diffusion coefficient value of HER2-positive/HR-negative breast carcinoma.

According to hormone receptor (HR) status, human epidermal growth factor 2 positive (HER2+) breast carcinoma can be divided into HR- and HR+, with different treatment and prognosis. We analyzed the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) findings, apparent diffusion coefficient (ADC) value and the combination of DCE-MRI and ADC value of HER2+/HR- breast carcinoma. Totally 259 cases (96 HR-, 163 HR+) of pathologically verified HER2+ breast carcinoma were collected. Patients underwent DCE-MRI and diffusion weighted imaging (DWI). The morphological characteristics, internal enhancement characteristics, early enhancement rate (EER), and time-signal intensity curves (TIC) were recorded, and ADC values were measured. The relationship between each feature and HER2+/HR- breast cancer was analyzed. Area under the cures (AUC) was used to compare diagnostic performance of DCE-MRI, ADC value and the combination of DCE-MRI and ADC value. HER2+/HR- breast cancer presented as non-mass enhancement (NME), mass with NME, whereas HER2+/HR+ breast cancer presented as mass (P<0.001). HR- cases showed a round or oval shape with circumscribed margins, whereas HR+ cases showed an irregular mass with irregular or spiculated margins (P=0.001, P=0.028). The size of the mass, the internal enhancement characteristics, EER, and TIC did not differ significantly between the two HER2+ breast carcinomas. The ADC values for HR- and HR+ breast cancers were [1.2 (1.14, 1.33)] ×10-3 mm2/s and [1.0 (0.89, 1.11)] ×10-3 mm2/s, respectively, which were statistically significant (Z=-9.119, P<0.001). The ADC value can be used for diagnosing HER2+/HR- breast carcinoma, with the threshold value of 1.095×10-3 mm2/s [negative predictive value (NPV) of 89.8%, sensitivity of 86.5% and specificity of 70.6%]. The AUCs of ADC value, DCE-MRI, and DCE-MRI combined with ADC value were 0.839, 0.689 and 0.860, respectively. AUC of the DCE-MRI combined with ADC value was significantly higher than DCE-MRI alone (P<0.0001). The diagnostic performance of the DCE-MRI combined with ADC value was good in diagnosing HER2+/HR- breast cancers. MRI is an effective tool in diagnosing HER2+/HR- breast carcinoma, which will help select the clinical treatment plan and determine the prognosis.

Elucidation of Substantial Differences in Ring-Opening Polymerization Outcomes from Subtle Variation of Glucose Carbonate-Based Monomer Substitution Patterns and Substituent Types.

The substituents present upon five-membered bicyclic glucose carbonate monomers were found to greatly affect the reactivities and regioselectivities during ring-opening polymerization (ROP), which contrast in significant and interesting ways from previous studies on similar systems, while also leading to predictable effects on the thermal properties of the resulting polycarbonates. Polymerization behaviors were probed for a series of five five-membered bicyclic 2,3-glucose-carbonate monomers having 4,6-ether, -carbonate, or -sulfonyl urethane protecting groups, under catalysis with three different organobase catalysts. Irrespective of the organobase catalyst employed, regioregular polycarbonates were obtained via ROP of monomers with ether substituents, while the backbone connectivities of polymers derived from monomers with carbonate protecting groups suffered transcarbonylation reactions, resulting in irregular backbone connectivities and broad molar mass distributions. The sulfonyl urethane-protected monomers were unable to undergo organobase-catalyzed ROP, possibly due to the acidity of the proton in urethane functionality. The thermal behaviors of polycarbonates with ether and carbonate pendant groups were investigated in terms of thermal stability and glass transition temperature (Tg). A two-stage thermal decomposition was observed when tert-butyloxycarbonyl (BOC) groups were employed as protecting side chains, while all other polycarbonates presented high thermal stabilities with a single-stage thermal degradation. Tg was greatly affected by side-chain bulkiness, with values ranging from 39 to 139 °C. These fundamental findings of glucose-based polycarbonates may facilitate the development of next-generation sustainable highly functional materials.

Follicular cholangitis mimicking a common bile duct cancer: a case report

BackgroundFollicular cholangitis (FC) is a benign bile duct disease that was first reported 2003. Pathologically, it is characterized by lymphoplasmacytic infiltration with multiple lymphoid follicle formations under the mucosal layer of the biliary tract. However, as this disease is extremely rare, little is known about its etiology and pathogenesis.Case presentationA 77-year-old woman was diagnosed with middle bile duct stenosis and potential increases in alkaline phosphatase (ALP) and γ-glutamyl transpeptidase levels (γ-GTP). Carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and IgG4 levels were all within the normal limits. Contrast-enhanced computed tomography (CE-CT) and magnetic resonance imaging (MRI) revealed bile duct dilation from intrahepatic to upper common bile duct and an irregular mass lesion in distal bile duct. Additionally, multiple overlapping leaf-like folds were detected. 18F-fluorodeoxyglucose positron emission tomography–computed tomography (18F-FDG-PET/CT) did not demonstrate fluorodeoxyglucose uptake. Subtotal stomach-preserving pancreaticoduodenectomy with regional lymph node dissection was performed because common bile duct cancer could not be ruled out. The resected specimen showed diffuse homogeneous middle bile duct wall thickening. Microscopically, the lesion exhibited thick fibrosis with several invaded lymphoplasmacytic cells, and lymphoid follicle formations were detected under the mucosal layer. Immunohistochemical staining (IHC) revealed positive for CD3, CD4, CD20 and CD79a, and these findings led to a final diagnosis of FC. The patient has not experienced recurrence to date (42 months postoperatively).ConclusionsCurrently, accurate preoperative diagnosis of FC is difficult. More cases must be accumulated to generate additional knowledge on its precise diagnosis and proper treatment.

Lung cancer with breast metastasis: a case report and review of the literature.

In this article, we present a rare case of breast metastasis of lung cancer. Chest computed tomography (CT) for a woman in her early 50s indicated right lung malignancy, multiple bone metastases, and an irregular mass in her right breast. Further inquiry into the case history revealed that the patient had been aware of the breast mass for 3 years, without respiratory symptoms. Biopsy of the breast mass suggested estrogen receptor (ER) (+), progesterone receptor (PR) (-), and human epidermal growth factor receptor 2 (HER2) (+ +) breast cancer. The patient was initially diagnosed with breast cancer with lung and bone metastasis. However, comprehensive breast cancer treatment was ineffective, and thyroid transcription factor-1 (TTF-1), napsin A, and cytokeratin 7 (CK7) were evaluated to better understand the origin of the cancer. To the best of our knowledge, this patient had the longest reported disease course from presentation with a breast lump as the first symptom to the final diagnosis of breast metastasis of lung cancer. To provide a better reference for differential diagnosis of ambiguous tumors, we also performed a systematic literature review.

Presence of Bilateral Rectus Sternalis Muscles in an 88-Year-Old White Female Donor

The rectus sternalis muscle is a rare anatomical variant present in the anterior chest wall of humans. This study presents a case of rectus sternalis muscles found in an 88-year-old White female donor during an anatomy course. The embryology and function of this vestigial muscle remain unclear. The muscle has clinical significance in breast augmentation surgery and mammography. In surgery, the muscle can be used to improve the end quality of breast augmentations. In mammography, the rectus sternalis muscle can mimic irregular masses in the breast, leading to misdiagnosis. Advanced imaging techniques such as magnetic resonance imaging and computed tomography scans can confirm the presence of rectus sternalis muscle. Lack of awareness of this muscle can result in surgical complications and unnecessary procedures. Physicians should be aware of this anatomical variation to ensure accurate diagnosis and appropriate surgical planning.