Preoperative Ultrasound Images Research Articles

A case of cystadenocarcinoma of the ectopic salivary gland: comparison of pre-operative ultrasound, CT and MR images with the pathological specimen

Cystadenocarcinoma is a rare salivary gland tumour. Only a few case studies have provided pre-operative images of these tumours. This report demonstrates the case of a 28-year-old male with cystadenocarcinoma arising from an ectopic salivary gland with lymph node metastasis in the right upper neck. Ultrasound including Doppler images showed two masses with scant vascular flow. One was a hyperechoic mass enclosed within a low echoic cystic lesion and the other was a solid hypoechoic mass. Contrast enhancement CT scans demonstrated a ring enhanced mass and weakly homogeneous enhanced masses in the right upper neck. Dynamic studies showed increased enhancement in delayed phase CT that was the same as that in other malignant salivary gland tumours. Moderate to slightly high signal intensity was seen on T(1) weighted MR images and axial T(2) weighted MR images showed one heterogeneous mass in a high signal lesion and a moderate to high signal intensity mass. The authors discuss the pre-operative findings of ultrasound with Doppler imaging of this neoplasm, and CT findings including dynamic study images and MRI, comparing the findings with the post-operative pathological features of the tumour.

Invasive Micropapillary Carcinoma of the Breast: Mammographic, Sonographic and MR Imaging Findings

Purpose : We performed this study to investigate the characteristic imaging and clinicopathologic features of invasive micropapillary carcinoma of the breast. Materials and Methods: Among the 47 women with surgically confirmed invasive micropapillary carcinoma between 2005 and 2009, 32 patients (mean age, 50 years; range, 37-69 years) had all preoperative mammography, ultrasound (US) and MR images. Two radiologists retrospectively assessed the imaging findings, clinical presentation and histological results of the patients. Results: On mammography, 29 of 32 patients had suspicious findings. Among them, a mass (or focal asymmetry) with calcifications was the most common findings (15/32, 65%). The calcifications were noted in 20 patients (63%) and the shape of calcifications was frequently amorphous or punctate (n = 12, 60%). On US and MR imaging, all lesions had suspicious findings. The most common US findings were single (n = 20) or multiple (n = 10) irregular hypoechoic mass (es). The mass was frequently hypoechoic (n = 29, 97%). On MR imaging, the type of lesions was a mass or masses in 23 (72%), a mass combined with non-mass in six patients, and non-mass lesions in three patients. Histologically, axillary lymph nodes metastasis were very common (25/32, 78%). Asymptomatic clinical presentation was not usual (9/32, 28%). Conclusion: The imaging features of invasive micropapillary carcinomas strongly suggest malignancy. Microcalcifications on mammography, marked hypoechogenicity on US and an irregular mass, often combined with non-mass on MR are common. Axillary lymph node metastasis is commonly associated. Index words : Breast∙Carcinoma∙Invasive micropapillary carcinoma∙MR imaging∙Sonography

Cystic Parathyroid Adenoma: Sonographic Features and Correlation With 99mTc-Sestamibi SPECT Findings

The purpose of this study was to describe the typical ultrasound features of cystic parathyroid adenoma. A review of a surgical database and electronic medical records from 2006 to 2009 identified the cases of 15 patients who underwent preoperative cervical sonography for primary hyperparathyroidism with subsequent resection of pathologically proven parathyroid adenoma with predominantly cystic components. Two radiologists retrospectively evaluated the preoperative ultrasound images and assessed for cyst complexity, size, location, and color Doppler vascularity. Technetium-99m-sestamibi SPECT findings, surgical and pathologic reports, and the results of parathyroid hormone assay of the cyst fluid also were reviewed. Most of the cystic adenomas (14/15, 93%) were deep or inferolateral to the adjacent thyroid. The same percentage were elongated and had peripheral nodular components. An echogenic border separating the adenoma from the overlying thyroid was identified in 9 of 15 patients (60%). Color Doppler examination of 14 patients showed feeding vessels with internal color flow to the solid components in 10 patients (71%). Six of 14 patients underwent preoperative or intraoperative sampling of cyst fluid, and the assay showed the parathyroid hormone levels ranged from 1,198 to greater than 5,000 pg/mL. Fourteen of 15 patients underwent preoperative sestamibi SPECT, and the adenoma was definitively localized in four patients (29%). The accuracy of preoperative localization improved to 79% (11/14) when sestamibi SPECT scans were interpreted in correlation with cervical ultrasound images. Awareness of typical sonographic features (location, color Doppler vascularity) may aid radiologists in preoperative localization of parathyroid adenomas, even when cystic degeneration occurs. In cases in which imaging or clinical features are equivocal, the results of cyst fluid sampling and parathyroid hormone assay are confirmatory.

OP17.03: Variation in the morphological appearance of ovarian mature cystic teratomas: Implications for diagnosis and management

Objectives: Mature cystic teratomas (MCT) or Dermoid cysts of the ovary account for approximately 25% of all ovarian tumours. The wide range of tissue types found in these tumours give rise to a highly varied appearance on ultrasound examination. The aim of this study was to assess the frequency of different morphological features in order to improve the accuracy of ultrasound diagnosis and aid in management planning. Methods: Our gynaecology ultrasound database and the histopathology department were retrospectively searched for MTCs. All women with a histological diagnosis of MCT and preoperative ultrasound images were included in the study. The images were reviewed by a single observer who recorded the presence and extent of common and rare features of MCTs. Results: A total of 133 cysts were found in 117 women. 15/117 (12.8%) had bilateral MCTs. Hyperechoic cyst contents consistent with sebum were present in 94.7% of cysts. Other common ultrasound features included hair (91.7%), acoustic shadowing (83.5%), and healthy ovarian tissue seen at one edge of the cyst (‘‘the ovarian crescent sign’’) 75.9%. The amount of sebum within the cyst was significantly higher in older women and it was inversely proportional to the size of the cyst (P < 0.05). Conclusions: Sebum and hair are present in more than 90% of MCTs, which facilitates a correct pre-operative diagnosis on ultrasound scan. The amount of sebum within the cyst can be used to estimate the potential of the cyst to grow and require surgical intervention in the future.

Enlarged Thyroid Gland with Normal Thyroid Function Tests

A 41-year-old woman had a 1-to 2-cm asymptomatic thyroid mass, which had been monitored by an endocrinologist for several years with serial sonography. Noting that it had enlarged in the face of normal thyroid function tests, the endocrinologist ordered a fine-needle aspiration biopsy, which showed a cellular follicular lesion. Although some of the nuclear changes seen in papillary carcinoma were present, the cells did not fulfill all of the cytologic criteria for that diagnosis. The patient was referred to Baylor University Medical Center for surgery; she brought with her two ultrasound images (Figure ​(Figure11) and a chest x-ray that showed a minimal leftward deviation of the trachea. Figure 1 The two preoperative thyroid ultrasound images showing a well-cir-cumscribed, solid lesion with heterogeneous echotexture. The mass was 2.4 cm (longitudinal) × 1.9 cm (anteroposterior) × 1.9 cm (transverse). A thyroidectomy was performed in the patient, and 15 lymph nodes in her neck were dissected from the central compartment of the neck. The excised mass was like a small rock (Figure ​(Figure22). The patient's surgery was uneventful, and she was discharged home. She had no postoperative complications and has been started on a replacement dose of levothyroxine. She has resumed all normal activities. Figure 2 Gross features of a hyalinizing trabecular tumor of the thyroid. It has a delicately lobulated cut surface, with a yellow cast and gaping vessels. Pathological evaluation showed a 2.0 cm encapsulated nodule in the right lobe with a distinctly trabecular pattern, elongated tumor cells with enlarged nuclei with longitudinal grooves, occasional intranuclear cytoplasmic intrusions, and eosinophilic hyalin stroma. The features were strongly in favor of a hyalinizing trabecular tumor (HTT). There was advanced lymphocytic thyroiditis in the nonneoplastic right lobe parenchyma and in the left lobe (Figure ​(Figure33). The resected lymph nodes revealed no metastatic disease. The differential diagnosis of HTT is chiefly medullary thyroid carcinoma and papillary thyroid carcinoma, since several histologic features are shared with these two entities. Immunohistochemical studies were positive for thyroglobulin and thyroid transcription factor-1 and negative for calcitonin, confirming the follicular cell origin of the tumor and excluding medullary thyroid carcinoma. An immunostain for the tumor proliferation marker MIB-1 demonstrated a distinctive cell membrane pattern that has been described in HTT but not in papillary carcinoma (Figure ​(Figure44). A test for the mesothelial cell surface protein recognized by monoclonal antibody HBME-1 was invalid, as it demonstrated patchy staining of the tumor and the nonneoplastic thyroid tissue in this case. Cytokeratin 19 was negative in the tumor cells. Figure 3 Hyalinizing trabecular tumor (“adenoma”). (a) A distinctive trabecular pattern is seen from low power in this encapsulated tumor. (b) Eosinophilic hyaline material is seen surrounding the tumor cells in many areas. (c) The nuclei are enlarged ... Figure 4 MIB-1 staining in the specimen demonstrates a very low proliferative index; the rare positive nuclei in this field are endothelial cell nuclei—no tumor cells are staining. DIAGNOSIS: Hyalinizing trabecular tumor.

Overlapping sphincteroplasty: does preservation of the scar influence immediate outcome?

BACKGROUND: The importance of the overlapping scar in an anterior sphincteroplasty is often emphasized. The aim of this study was to identify the tissue type used in overlapping sphincter repair based upon ultrasound images, and to correlate these results with the immediate clinical outcome. METHODS: Data were collected prospectively on all patients with faecal incontinence who underwent anterior overlapping sphincteroplasty between June 1998 and May 1999. Continence was assessed by a standardized incontinence score ranging from 0 to 20. Pre-operative ultrasound images were compared to intraoperative ultrasound findings for each patient. In each case the surgeon performed an overlap of what was grossly felt to represent scar after which a single blinded observer performed intraoperative ultrasound. The degree of overlap was measured and classified as hyperechoic over hyperechoic (muscle over muscle; Type 1), hyperechoic over or under hypoechoic (muscle over or under scar; Type 2), hypoechoic over hypoechoic (scar over scar; Type 3). The patient follow-up included incontinence score that was obtained by telephone interview; suboptimal outcome was considered as an incontinence score >/= 6. Statistical analysis was performed using the Mann-Whitney test and Wilcoxon matched-pairs test. RESULTS: Fourteen female patients with a mean age of 51.6 (range 28-79) years were evaluated. The mean pre-operative incontinence score was 17.1 (range 7-20) and 13 of the 14 (93%) patients had an incontinence score >/= 15. All pre-operative ultrasound images were hypoechoic which correlated with the surgeon's intraoperative findings of scar. The operative appearance included two Type 1, four Type 2, and eight Type 3 images. Larger pre-operative ultrasound image defects were statistically significantly related to intraoperative Type 3 ultrasound images. At a mean follow up of 7.5 (range 2-16) months the mean postoperative incontinence score was 4.5 (range 0-12). In patients with Type 1 and Type 2 images, the mean postoperative score was 8.6 (range 4-12) whereas in patients with Type 3 it was 1.3 (range 0-5) (P < 0.003); 7 of the 8 patients in Type 3 (87.5%) had an incontinence score </= 2. CONCLUSION: These preliminary results show a significant immediate benefit to the overlap of scar over scar, however, such overlapping may not always be achieved despite the surgeon's intent. Furthermore, larger pre-operative defects may predispose to more extensive anterior scarring and thus a better chance of achieving this desired overlap.

Morphology of congenital intrahepatic portacaval shunts in dogs and cats

The preoperative ultrasound images and biplanar operative mesenteric portograms of 28 dogs and six cats with congenital intrahepatic portacaval shunts were reviewed retrospectively. On the basis of the combined surgical,...