A Case of Primary Breast Lymphoma with Brain Metastasis Detected during Pregnancy

Primary breast lymphoma (PBL) is a rare clinical presentation of localized non-Hodgkin’s lymphoma (NHL), and it makes up 0.04～1.1% of all breast tumors and it is 0.38～0.7% of all NHLs. The prognosis and patterns of relapse of PBL are still not clearly defined. The clinical features of PBL are different from those of breast carcinoma and the usual form of lymphoma. These features are a rapidly enlarging breast mass, multiple lesions, the absence of nipple discharge and retraction, and softer axillary lymph nodes as compared to the metastatic lymph nodes from breast carcinoma. B symptoms are unusual in PBL. A 30-year-old pregnant woman was admitted due to dysarthria and right side weakness that she had experienced for 7 days. She had several medical problems: intrauterine pregnancy at 34 weeks, some neurologic deficits and enlargement of both breasts. A biopsy from the breast and a brain magnetic resonance image (MRI) revealed diffuse large B cell lymphoma and multiple brain metastases, respectively. After delivery of a healthy, premature infant by Cesarean section, whole brain radiation therapy and combination chemotherapy (rituximab, cyclophosphamide, adriamycin, vincristine and prednisone) were started. She showed good response to therapy. We report here on this unusual case and we review the related literature.ope

Galactoceles mimicking suspicious solid masses on sonography

OBJECTIVE: The purpose of this study was to evaluate the sonographic appearance of a galactocele that can sonographically mimic a suspicious solid mass and to differentiate between a galactocele and a solid mass. METHODS: From September 2002 to February 2004, 33 galactoceles classified as Breast Imaging Reporting and Data System category 4 were included. They were all confirmed by sonographically guided core biopsies. Their sonographic imaging and clinical findings were reviewed retrospectively. RESULTS: The lesions had a round or irregular shape in 26 patients (78.8%), a noncircumscribed margin in 31 (93.9%), a nonparallel orientation in 22 (66%), and posterior shadowing in 13 (39.4%). Twenty-five nodules (75.8%) had internal hypoechogenicity or mixed echogenicity. Twenty-nine (87.9%) of 33 lesions showed a relatively sharp convex echogenic rim on the anterior or posterior wall. CONCLUSIONS: Galactoceles have various sonographic findings, many of which are similar to those of suspicious solid breast masses. However, there is a tendency for a galactocele to appear as a small, round hypoechoic nodule with an indistinct or microlobulated margin and mild posterior shadowing. It is helpful to search for a partial anterior or posterior echogenic rim to identify a galactocele.ope

Application of the Breast Imaging Reporting and Data System Final Assessment System in Sonography of Palpable Breast Lesions and Reconsideration of the Modified Triple Test

OBJECTIVE: The purpose of our study was to evaluate the utility of the American College of Radiology's Breast Imaging Reporting and Data System (BI-RADS) sonographic final assessment system and palpation-guided fine-needle aspiration (FNA) for evaluation of palpable breast lesions. METHODS: Our computerized database identified 160 palpable lesions of the breast in which follow-up palpation-guided FNA, targeted sonography, and pathologic confirmation were performed. We used BI-RADS sonographic data on all lesions. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of malignancy were calculated for sonography and palpation-guided FNA. Two-sample binomial proportion tests were used as the statistical analysis (P<.05). RESULTS: The FNA results were defined as benign, atypical cells, suspicious for malignancy, malignancy, and insufficiency. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 90.9%, 82.7%, 84.3%, 57.7%, and 97.2%, respectively, on sonography and 75.8% to 90.9%, 82.7% to 98.4%, 84.3% to 94.4%, 57.7% to 92.6%, and 93.9% to 97.2% on FNA. There was no statistically significant difference for sensitivity and negative predictive value between the two examinations. CONCLUSIONS: The diagnostic accuracy of sonography was similar to that of palpation-guided FNA for not missing the malignancy. Clinical application of FNA results can be difficult, especially when the result is insufficiency or atypical cells. Moreover, FNA is invasive and overlaps other procedures. Therefore, we conclude that sonography can replace palpation-guided FNA for diagnosis of palpable lesions of the breast when the BI-RADS sonographic final assessment system is used appropriately.ope

Application of Power Doppler Vocal Fremitus Sonography in Breast Lesions

OBJECTIVE: The purpose of this study was to illustrate the method and use of power Doppler vocal fremitus (PDVF) sonography in the detection and diagnosis of breast lesions. METHODS: One case was evaluated by various sonographic parameters and equipment to determine how the VF images were affected. Cases illustrative of a broad range of breast conditions were also collected. Each image pair consisted of B-mode and VF images to maintain an identical projection and to illustrate the influence of PDVF sonography. RESULTS: With B-mode and PDVF sonography, we evaluated and compared various breast conditions, including normal anatomic structures and abnormal lesions. We found that PDVF sonography is useful for distinguishing abnormal masses from normal tissue, such as differentiating between isoechoic tumors and isoechoic glandular tissues, and discriminating entrapped fat lobules from isoechoic tumors. Furthermore, PDVF sonography was useful for determining whether intracystic echoes are attached to the cyst wall. CONCLUSIONS: Power Doppler VF imaging is a valuable adjunct tool to B-mode sonography in the evaluation of breast lesions.ope

The Benefit of Sonography in Pregnancy-associated Breast Cancer

PURPOSE : To evaluate the sonographic, mammographic and MRI features of pregnancy-associated breast cancer with the major focus on the sonographic benefit in a diagnosis of pregnancyassociated breast cancer. MATERIALS and METHODS : From 1998 to 2002, sonography was performed on a total 7 patients (age 23 to 38 years), who were pathologically diagnosed with breast cancer during pregnancy. Six of those patients underwent mammography. Five patients underwent a breast MRI, preoperatively. The radiological findings were evaluated retrospectively. Six patients underwent surgery and 1 patient underwent a core biopsy and chemotherapy. The histological, nuclear grading and pathological staging were evaluated. RESULTS : The sonographic findings showed a mass with irregular shapes (n=6), irregular margins (n=6), a non-parallel orientation (n=5), complex echo patterns (n=5). Associated findings could be observed in 3 patients, including Cooper’s ligament thickening (n=2), edema (n=2), skin thickening (n=1) and axillary lymphadenopathy (n=3). The sonographic findings were positive and showed masses in 6 patients. All the patients had a dense breast in mammography. The mammographic findings included masses (n=4), masses with microcalcifications (n=2), masses with axillary lymphadenopathy (n=3), calcifications alone (n=1), an asymmetric density alone (n=1), extremely dense breasts with negative findings (n=2). A breast MRI showed an irregular shaped mass (n=4) with a rim-like enhancement (n=3), linear ductal enhancement without a mass (n= 1), and the time intensity cure revealed the typical pattern and level of enhancement in the carcinoma. CONCLUSION : Sonography is a valuable tool for diagnosing pregnancy-associated breast cancer. However, mammography should be performed if there is a suspicious lesion on sonography in order to confirm the pregnancy-associated breast cancer. Mammography has a lower sensitivity during pregnancy due to the physiologic changes in the breasts. However, calcifications and associated findings are helpful in confirming pregnancy-associated breast cancer. physicians should not consider a rapidly growing lump in the breast during pregnancy to be benign and should perform radiological examinations and imaging-guided biopsies.ope

Variable Breast Conditions: Comparison of Conventional and Real-time Compound Ultrasonography

OBJECTIVES: To illustrate and compare the appearances of variable breast conditions by conventional and real-time spatial compound images. METHODS: Cases illustrative of a broad range of breast conditions were collected. Each image pair consisted of conventional and real-time compound images with a stationary probe to maintain an identical projection. RESULTS: The various breast conditions, including normal anatomic structures and abnormal lesions, were evaluated and compared by conventional and real-time compound images. The real-time compound images revealed more realistic and clear images with reduced artifacts. CONCLUSIONS: Real-time compound images are superior to conventional images of normal and abnormal breast conditions. Real-time compound imaging is a good technique for evaluating the breast state.ope

Recurrence of adenoid cystic carcinoma in the breast after lumpectomy and adjuvant therapy

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Metastatic Breast Lesion From Thymic Carcinoma

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Pharyngoesophageal (Killian-Jamieson) Diverticulum Mimicking Thyroid Nodule on Ultrasonography: A Case Report

Pharyngoesophageal or Killian-Jamieson diverticulum is due to herniation of the mucosa and submucosa of the pharynx through a potentially weak area of the pharyngeal wall. It originates on the anterolateral wall just below the cricopharyngeous. It can be detected incidentally during thyroid ultrasonography (US). We present here a case report of pharyngoesophageal (Killian-Jamieson) diverticulum mimicking a thyroid nodule on US. We discuss the image findings that might be useful for the differential diagnose and to prevent invasive procedures such as needle aspiration biopsy.ope

Imaging findings of chest wall lesions on breast sonography

OBJECTIVE: The purpose of this presentation is to illustrate the sonographic findings of chest wall lesions that were depicted on breast sonography. METHODS: Chest wall lesions detected during breast sonography were collected and reviewed retrospectively. RESULTS: The sonographic findings of normal chest walls and various pathologic chest wall lesions, including inflammatory lesions, benign neoplasms, and malignant neoplasms, are discussed. CONCLUSIONS: Familiarity with normal sonographic anatomy and chest wall lesions could be helpful in differentiating a chest wall lesion from a breast lesion and in showing whether the origin of any palpable breast lump is in the breast parenchyma or the chest wall on breast sonographyope