Assessment of malignant risk stratification for microcalcifications interpreted as “amorphous” morphology on mammography: A study based on the 5th edition of breast Imaging Reporting and Data System

PURPOSE

To investigate the malignant risk stratification of microcalcifications interpreted as amorphous morphology on mammography according to the coexistence of punctate microcalcifications based on the 5th edition of the Breast Imaging Reporting and Data System.

METHOD

Between March 2013 and September 2020, 367 microcalcifications interpreted as amorphous morphology on mammography with surgical biopsies were included. The amorphous microcalcifications were classified into a predominantly punctate group (A, <50% of amorphous), a predominantly amorphous group (B, >50% of amorphous), and an only amorphous group (C, 100% of amorphous). The distribution was classified into diffuse, regional, grouped, and linear/segmental. The reference standard was the pathology. The positive predictive values (PPV) were calculated and compared using the Chi-square's test or Fisher's exact test and Kruskal-Wallis test.

RESULTS

The overall PPV of microcalcifications interpreted as having an amorphous morphology was 5.2%. The PPV across groups significantly increased in proportion to the amorphous morphology, with 1.0% in group A, 5.6% in group B, and 23.3% in group C (p <.001). Furthermore, the PPV between group A and groups B plus C (10.1%) and groups A plus B (2.8%) and group C were significantly different (p <.001). The PPV of distribution was 0% for diffuse, 4.9% for regional, 5.0% for grouped, and 11.1% for linear/segmental distributions, without statistical significance.

CONCLUSIONS

Pure amorphous microcalcifications are suitable for category 4B. However, when they coexist with punctate morphology, the malignant risk decreases suitable for category 4A or lower. When amorphous microcalcifications coexist with a predominantly punctate morphology, follow-up should be considered.

Portal Vein Gas in Neonates: Predicting Clinical Treatment Outcomes From Ultrasound Findings

OBJECTIVES

To identify sonographic findings that predict clinical outcomes in neonates with portal vein gas.

METHODS

This retrospective study included neonates with portal vein gas detected using ultrasound (US). The US images were reviewed by a pediatric radiologist. US findings included the extent and amount of portal vein gas, mesenteric vein gas, intramural gas, bowel wall thickening or thinning, focal discontinuity of the bowel wall, ascites, free intra-abdominal gas, pseudocyst, gas in the other solid organs, and bowel distension. The imaging findings and demographic factors between survivors and non-survivors were statistically compared.

RESULTS

The mortality rate was 26% (39 survivors, 14 non-survivors) when iatrogenic and idiopathic causes were excluded. The causes of portal vein gas were determined to be necrotizing enterocolitis (n = 33), bowel distension or obstruction (n = 12), fetal hydrops (n = 4), pneumothorax (n = 3), immediate postoperative state for bowel perforation (n = 1), and umbilical vein catheterization (n = 9) based on surgical findings (n = 20) and clinical information (n = 46). Gas within the mesenteric vein and the other solid organs, gestational age, and birth weight were significantly different between survivors and those who succumbed (P < .05).

CONCLUSION

Gas within the mesenteric vein and other solid organs is a US finding that may predict poor outcomes in neonates with portal vein gas.

Comparison of Computed Diffusion-Weighted Imaging b2000 and Acquired Diffusion-Weighted Imaging b2000 for Detection of Prostate Cancer

Purpose

To compare the sensitivity of tumor detection and inter-observer agreement between acquired diffusion-weighted imaging (aDWI) b2000 and computed DWI (cDWI) b2000 in patients with prostate cancer (PCa).

Materials and Methods

Eighty-eight patients diagnosed with PCa by radical prostatectomy and having undergone pre-operative 3 Tesla-MRI, including DWI (b, 0, 100, 1000, 2000 s/mm2), were included in the study. cDWI b2000 was obtained from aDWI b0, b100, and b1000. Two independent reviewers performed a review of the aDWI b2000 and cDWI b2000 images in random order at 4-week intervals. A region of interest was drawn for the largest tumor on each dataset, and a Prostate Imaging-Reporting and Data System (PI-RADS) score based on PI-RADS v2.1 was recorded. Histologic topographic maps served as the reference standard.

Results

The study population's Gleason scores were 6 (n = 16), 7 (n = 53), 8 (n = 9), and 9 (n = 10). According to the reviewers, the sensitivities of cDWI b2000 and aDWI b2000 showed no significant differences (for reviewer 1, both 94% [83/88]; for reviewer 2, both 90% [79/88]; p = 1.000, respectively). The kappa values of cDWI b2000 and aDWI b2000 for the PI-RADS score were 0.422 (95% confidence interval [CI], 0.240-0.603) and 0.495 (95% CI, 0.308-0.683), respectively.

Conclusion

cDWI b2000 showed comparable sensitivity with aDWI b2000, in addition to sustained moderate inter-observer agreement, in the detection of PCa.

Sonographic Features of Palpable Breast and Axillary Lesions in Adult Male Patients: A Pictorial Essay

The male breast is a non-functional and rudimentary organ, but similarly to the female breast, it can be affected by various diseases. In contrast to female breast cancer, male breast cancer has a low incidence, and there is no established breast cancer screening program for male patients. Therefore, the diagnostic evaluation is usually performed in male patients with symptoms such as palpability or pain in the breasts. Furthermore, most adult male patients who visit breast clinics sometimes present with not only breast symptoms but also axillary symptoms, and both the breast and axilla are usually examined during breast ultrasonography in daily clinical practice. The purpose of this pictorial essay was to present the sonographic features of various palpable breast and axillary lesions in adult male patients.

An Unusual Presentation of Extensive Ductal Carcinoma in Situ Accompanying Invasive Ductal Carcinoma on MRI: A Case Report

The incidence of ductal carcinoma in situ has increased with the rise in screening mammography; currently, ductal carcinoma in situ constitutes 20%-25% of all breast cancers, and up to half of them may become invasive. Its early detection is critical in improving the cure rate. Moreover, MRI has higher sensitivity for its detection than mammography. Herein, we report an unusual case of ductal carcinoma in situ presenting as a continuous, serpentine, linear enhancement with regional distribution on MRI.

Sonographic findings of total colonic aganglionosis in a neonate with Haddad syndrome: A case report

Haddad syndrome is a rare congenital disorder characterized by congenital central hypoventilation syndrome and Hirschsprung disease. Total colonic aganglionosis is a rare and long-segment form of Hirschsprung disease, which is primarily diagnosed using contrast enemas. However, the diagnostic performance of contrast enemas is relatively low, making the diagnosis of total colonic aganglionosis challenging. In neonates, ultrasound may be used as an additional imaging modality for the diagnosis of Hirschsprung disease. We describe the unique sonographic findings of total colonic aganglionosis in a term neonate with failure to pass meconium and respiratory distress, who was subsequently diagnosed with Haddad syndrome.

Bilateral axillary pseudoangiomatous stromal hyperplasia in a premenopausal woman: A case report with imaging findings

Pseudoangiomatous stromal hyperplasia is a benign proliferative mesenchymal lesion of the breast. To date, only a few cases of axillary pseudoangiomatous stromal hyperplasia with imaging findings have been reported in the literature. Herein, we report a rare case of pseudoangiomatous stromal hyperplasia in both axillae in a previously healthy 46-year-old woman and describe the imaging findings, including ultrasonography and computed tomography findings.

Breast Cancer Metastasis to the Parotid: A Case Report with Imaging Findings

Patient: Female, 59-year-old

Final Diagnosis: Breast cancer metastasis to the parotid

Symptoms: Growing mass in the parotid gland

Medication:—

Clinical Procedure: —

Specialty: Radiology

Angiosarcoma of the Breast and Spleen: A Case Report with Imaging and Pathologic Findings

Angiosarcoma of the breast is a rare malignant sarcoma of endovascular origin that presents with various radiological findings. We encountered a case of angiosarcoma of the breast presenting as an irregular indistinct hyperechoic mass on ultrasonography, with a large single angiosarcoma of the spleen in a previously healthy 36-year-old female. Herein, we report the imaging and pathologic findings and review the literature.

Sonographic features of anterior chest wall lesions detected on breast sonography in women: A pictorial essay

Although anterior chest wall lesions rarely occur and the associated imaging findings are nonspecific, various disease processes can affect the chest wall. It is important for radiologists to understand the anatomic relationship between the chest wall and breast and differentiate the tumor origin. This pictorial essay presents the sonographic features of various anterior chest wall lesions that were detected on breast ultrasonography.

Intrathyroid metastasis of breast cancer: Sonographic findings

Metastasis of ductal carcinoma of the breast to the thyroid gland is uncommon and usually detected at autopsy. The incidences of metastases to the thyroid have been reported at 3%, and the most common primary malignancy is renal cell carcinoma. We report a rare case of intrathyroid metastatsis of breast ductal carcinoma in a patient who was treated for breast cancer 15 years earlier.

Bilateral Breast Cancer in a Patient with Neurofibromatosis Type 1: A Case Report

Neurofibromatosis type 1 (NF1) is a rare neuroectodermal disease that is associated with an increased risk of malignancy. Here, we report a rare case of bilateral breast cancer in a 49-year-old woman with NF1 that presented as a microlobulated oval hypoechoic mass and a complex cystic solid mass on sonography. She underwent bilateral mastectomy. The masses were diagnosed as invasive ductal carcinoma, ductal carcinoma in situ, and a malignant peripheral nerve sheath tumor. We describe the imaging findings, including ultrasonography, CT, and 18F-fluorodeoxyglucose PET.

Clinical applicability of shear wave elastography for the evaluation of medial epicondylitis

OBJECTIVES

To evaluate the ability of shear wave elastography (SWE) in diagnosing medial epicondylitis and to compare the diagnostic performance of SWE with that of grey-scale ultrasound (GSU) and strain elastography (SE).

METHODS

GSU, SE, and SWE were performed on 61 elbows of 54 patients from March 2018 to April 2019. An experienced radiologist evaluated the GSU findings (swelling, cortical irregularity, hypoechogenicity, calcification, and tear), colour Doppler findings (hyperaemia), SE findings (strain ratio [SR]), and SWE findings (stiffness and shear wave velocity [SWV]). Participants were divided in two groups: patients with clinically diagnosed medial epicondylitis and patients without medial elbow pain. Findings from the two groups were compared, and the receiver operating characteristic (ROC) curves were calculated for significant features.

RESULTS

Of the 54 patients, 25 patients with 28 imaged elbows were clinically diagnosed with medial epicondylitis and 29 patients with 33 imaged elbows had no medial elbow pain. Cortical irregularity, hypoechogenicity, calcification, hyperaemia, SR, stiffness, and SWV were significantly different between the two groups. The areas under the ROC curves were 0.838 for hypoechogenicity, 0.948 for SR, 0.999 for stiffness, and 0.999 for SWV. The diagnostic performances of SR, stiffness, and SWV were significantly superior compared to that of hypoechogenicity. However, there were no significant differences among SR, stiffness, and SWV.

CONCLUSIONS

SWE can obtain both stiffness and SWV, which are valuable diagnostic tools in the diagnosis of medial epicondylitis. The diagnostic performance of SWE and SE is similar in detecting medial epicondylitis.

KEY POINTS

• Shear wave elastography providing stiffness and shear wave velocity showed excellent performance in the diagnosis of medial epicondylitis. • There was no significant difference in the ability of SE and SWE for diagnosing medial epicondylitis.

Ultrasound Features and Rate of Upgrade to Malignancy in Atypical Apocrine Lesions of the Breast

OBJECTIVES

To evaluate the ultrasound (US) features and rate of upgrade to malignancy in atypical apocrine lesions (AALs) of the breast, diagnosed on percutaneous needle biopsy.

METHODS

This retrospective study included 17 AALs diagnosed by needle biopsy in 15 patients. For 16 of the 17 AALs, subsequent surgical excision (n = 14) or 8-gauge vacuum-assisted biopsy (n = 2) was performed. Ultrasound features were retrospectively analyzed according to the American College of Radiology Breast Imaging Reporting and Data System lexicon.

RESULTS

Of 17 AALs, 13 (76.5%) were atypical apocrine hyperplasia; 3 (17.6%) were atypical apocrine adenosis; and 1 (5.9%) was combined atypical apocrine hyperplasia and atypical apocrine adenosis on needle biopsy. Subsequently, 4 of 16 AALs (25%) were upgraded to malignancy at surgical excision. On US imaging, all 17 lesions presented as masses, which were mainly irregular and noncircumscribed (n = 8) or oval/round and noncircumscribed (n = 7) with isoechogenicity or hypoechogenicity. Rarely, an AAL would show complex cystic and solid echogenicity (n = 1) or appear as a hypoechoic mass with oval shape and a circumscribed margin (n = 1).

CONCLUSIONS

Atypical apocrine lesions of the breast often showed suspicious malignant features on US imaging. Given the high upgrade rate (25%), the diagnosis of an AAL by needle biopsy warrants subsequent surgical excision.

Recurrent Primary Pleomorphic Liposarcoma of the Breast: A Case Report with Imaging Findings

Primary pleomorphic liposarcoma of the breast is rare, and only a few cases in the literature have reported imaging findings. Herein, we report a rare case of primary pleomorphic liposarcoma of the breast in a 38-year-old woman and describe the imaging findings including mammography, ultrasonography, computed tomography, magnetic resonance imaging, and ¹⁸F-Fluorodeoxyglucose-positron emission tomography. Although most fat-containing breast masses are benign, malignancy can occur. Magnetic resonance imaging can be helpful for further evaluation of breast masses.

Intraobserver and interobserver reliability in sonographic size measurements of gallbladder polyps

OBJECTIVES

To evaluate the intraobserver and interobserver reliability of gallbladder polyp measurements using transabdominal US and the factors that affect reliability.

METHODS

From November 2017 to February 2018, two radiologists measured the maximum diameter of 91 gallbladder polyps using transabdominal US. Intraobserver and interobserver agreement were determined using 95% Bland-Altman limits of agreement and intraclass correlation coefficients (ICCs). The effects of image settings, polyp location, and polyp size were evaluated by comparing ICCs using z tests.

RESULTS

The intraobserver agreement rates were 0.960 (95% confidence interval [CI], 0.939-0.973) for observer 1 and 0.962 (95% CI, 0.943-0.975) for observer 2. The ICCs between the two observers were 0.963 (95% CI, 0.926-0.979) for the first measurement and 0.973 (95% CI, 0.950-0.984) for the second measurement. The 95% limits of agreement on repeated measurements were 22.3-25.2% of the mean, and those between the two observers were 25.5-34.2% of the mean. ICCs for large polyps (≥ 5 mm) were significantly higher than those for small polyps (< 5 mm). There were no significant differences in the ICCs between image settings and polyp location.

CONCLUSIONS

Polyp size measurements using transabdominal US are highly repeatable and reproducible. Polyp size significantly affects the reliability of measurement. Diameter changes of approximately less than 25% may fall within the measurement error; this should be considered while interpreting the change in size during follow-up US, especially for small polyps.

KEY POINTS

• Gallbladder polyp size measurement using transabdominal US is highly repeatable and reproducible. • Diameter changes of approximately less than 25% should be interpreted carefully, especially in small polyps.

Abstract P1-08-21: Association of depression and anxiety disorder with the risk of mortality in breast cancer: A national health insurance service study in South Korea

PURPOSE: To examine whether depression, anxiety disorder and their co-occurrence would increase the risk of mortality in patients with breast cancer, and whether antidepressant treatment would reduce the same.

PATIENTS AND METHODS: Data were retrieved from the database of the Korean National Health Insurance Service. Of 145,251 patients diagnosed with breast cancer between 2007 and 2014, 20,870 patients diagnosed with depression or anxiety disorder one year before breast cancer diagnosis were excluded. Thus, data of 124,381 patients were included in this study.

RESULTS: Anxiety disorder was more prevalent than depression in patients with breast cancer, and similar factors were associated with both depression and anxiety disorder. Overall, female sex, older age, residence in metropolitan areas, lower income, higher comorbidity, carcinoma in situ, and the receipt of any type of cancer therapies were associated with an increased risk of depression or anxiety disorder. Depression and anxiety disorder were associated with an increased risk of mortality (Hazard Ratio (HR) = 1.26, 95% CI=1.18–1.36; HR=1.14, 95% CI=1.08–1.22, respectively) and their co-occurrence further increased the risk (HR=1.38, 95% CI=1.24–1.54). Antidepressant treatment was related to a reduced risk of mortality. Compared to patients with no depression, among those with depression, the risk of mortality was 2.18 times higher (95% CI=1.69–2.81) in patients who did not receive antidepressant treatment and 1.25 times higher (95% CI =1.17–1.32) in those who received antidepressant treatment.

CONCLUSION: The current findings suggest that psychiatric comorbidities are markers of increased mortality risk in patients with breast cancer. This underscores the need for screening and treating depression and anxiety disorders to improve survival in breast cancer.

Citation Format: Kim YS, Shim E-J, Lee JW, Cho J, Jung HK, Kim NH, Lee JE, Min J, Noh WC, Park S-H. Association of depression and anxiety disorder with the risk of mortality in breast cancer: A national health insurance service study in South Korea [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-21.

Incidentally detected breast lesions on chest CT with US correlation: a pictorial essay

With the increasing use of computed tomography (CT), incidental breast lesions are detected more frequently. When interpreting chest CT findings, it is important for radiologists to carefully review the breast to recognize any abnormal findings that could affect patient management. The purpose of this study is to discuss incidental breast lesions on chest CT with ultrasonography correlation that may be encountered in routine clinical practice.

Interpretations of diffusion-weighted MR imaging by radiology residents in the emergency department: is diagnostic performance influenced by the level of residency training?

BACKGROUND

To evaluate the diagnostic performance of radiology residents' interpretations for diffusion-weighted MR imaging (DWI) in the emergency department at different levels of residency training.

METHOD AND MATERIALS

A total of 160 patients who underwent DWI with acute neurologic symptoms were included in this retrospective study with an institutional review board approval. Four radiology residents with different training years and one attending neuroradiologist independently assessed the DWI results. Discordances between the results of residents and attending neuroradiologist were classified as follows: false positive (FP) and false negative (FN). We also evaluated the diagnostic performance of four residents according to the reference standard.

RESULTS

Overall, the concordance rate was 84.8 %, with a 15.2 % overall discordance rate. There were 83 FN results. The most common misses were small vessel disease (n = 55), acute focal infarction (n = 10), diffuse axonal injury (n = 6), solitary mass (n = 5), extraaxial hemorrhages (n = 3), posterior reversible encephalopathy syndrome (n = 2), and postictal change (n = 2). Fourteen FP results were interpreted as hemorrhage and acute infarction. The 4th year resident exhibited the highest diagnostic performance, and the level of training had a significant influence on the rates of concordance (P < 0.05). Interobserver reliability was good between the interpretations of the residents and the final interpretations of the attending neuroradiologists.

CONCLUSION

The level of resident training had a significant effect on their diagnostic performance, and good interobserver reliability was noted between the results of the residents and attending neuroradiologist.

Apparent diffusion coefficient for lymph node characterization after chemoradiation therapy for locally advanced rectal cancer

BACKGROUND

Because further treatment plans depends on lymph node (LN) status after neoadjuvant chemoradiation therapy (CRT), the accurate characterization of LN is important.

PURPOSE

To evaluate the diagnostic performance of apparent diffusion coefficient (ADC) for LN characterization after CRT and to compare the performance with that of LN size.

MATERIAL AND METHODS

Fifty-three patients (36 men, 17 women; mean age, 58 years; age range, 34-79 years) who underwent CRT and subsequent surgery were included. All patients underwent 1.5-T magnetic resonance imaging (MRI). Each regional LN on post-CRT MRI was identified in consensus by two radiologists after reviewing the pre-CRT MRI. The ADC value and size in each LN was measured. To compare the mean ADC values and sizes of the metastatic and non-metastatic LNs after CRT, the t-test was used. To calculate the performance, a ROC curve analysis was performed. The histopathological examinations served as the reference standard.

RESULTS

A total of 115 LNs (29 metastatic and 86 non-metastatic) were matched and analyzed. The mean ADC of the metastatic LNs was significantly higher than that of the non-metastatic LNs (1.36 ± 0.27 × 10(-3)mm(2)/s; 1.13 ± 0.23 × 10(-3)mm(2)/s, P < 0.0001). The mean size of the metastatic LNs was also significantly larger than that of the non-metastatic LNs (5.6 ± 3.1; 3.9 ± 1.2, P = 0.0078). There was no significant difference between the areas under the curve of the ADC and size (0.742 [95% CI, 0.652-0.819]; 0.680 [0.586-0.764], respectively, P = 0.4090).

CONCLUSION

The performance of ADC for LN characterization after CRT was comparable to that of LN size.

Mammographic and sonographic features of triple-negative invasive carcinoma of no special type

The aim of this study was to compare the mammography, ultrasound (US) and histologic features of triple-negative (TN) invasive carcinoma of no special type (NST) to non-TN invasive carcinoma of NST. The second aim was to assess whether the distinct imaging characteristics of TN breast cancer would persist after controlling for the histologic features. A total of 344 invasive carcinomas of NST in 337 patients from January 2007 to February 2008 were included in this study. Two radiologists retrospectively reviewed the mammography and US findings using the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) lexicon and our institution's criteria. On mammography, TN invasive carcinoma of NST most commonly presented as a mass with round shape and non-spiculated margin. On US, it was more likely to have internal hypoechogenicity, an abrupt boundary and posterior acoustic enhancement. TNBC lacked major suspicious imaging findings such as an irregular shape, spiculated margin and calcification.

Imaging findings of variable axillary mass and axillary lymphadenopathy

The axilla is a triangular space that contains mesenchymal tissues such as fat, vessels, nerves and lymph nodes, from which various diseases can develop. This article describes axillary masses and axillary lymphadenopathies using imaging findings from techniques such as ultrasonography, mammography, computed tomography and magnetic resonance imaging. Awareness of the characteristic imaging findings of disease entities that cause axillary masses and various axillary lymphadenopathies will help in the accurate diagnosis of axillary lesions.

Benign core biopsy of probably benign breast lesions 2 cm or larger: correlation with excisional biopsy and long-term follow-up

Purpose:

To evaluate the accuracy of benign core biopsy of probably benign breast lesions (category 3) 2 cm or larger on the basis of excisional biopsy and long-term follow-up.

Methods:

We retrospectively reviewed 146 category 3 lesions in 146 patients 2 cm or larger which were diagnosed as benign by ultrasound (US)-guided core biopsy. Patients were initially diagnosed as benign at core needle biopsy and then followed up with excisional biopsy (surgical excision, n=91; US-guided vacuum assisted excision, n=35) or breast ultrasonography (n=20).

Results:

Of the 126 patients who underwent surgical excision or US-guided vacuum-assisted excision, 114 patients were diagnosed with benign lesions, 10 patients with borderline lesions (benign phyllodes tumor), and two patients with malignant phyllodes tumors. The probabilities of lesions being benign, borderline and malignant were 91.8% (134/146), 6.8% (10/146), and 1.4% (2/146), respectively. Of 13 patients who had growing masses on follow-up ultrasonography, three (23.1%) were non-benign (two benign phyllodes tumors and one malignant phyllodes tumor).

Conclusion:

US-guided core needle biopsy of probably benign breast mass 2 cm or larger was accurate (98.6%) enough to rule out malignancy. But, it was difficult to rule out borderline lesions even when they were diagnosed as benign.

Thyroid hemangiomas diagnosed on sonography

Primary thyroid hemangiomas are extremely rare, and only a few cases have been previously reported. Primary hemangiomas are developmental anomalies resulting from the inability of the angioblastic mesenchyme to form canals. Thyroid hemangiomas are generally considered difficult to diagnose preoperatively because of their low incidence and nonspecific imaging findings. Here we report 2 cases of thyroid hemangiomas that were diagnosed correctly on preoperative sonography. Our cases showed similar sonographic findings, such as well-circumscribed hypoechoic lesions with internal channel-like linear lines, and bloody content was aspirated during fine-needle aspirations. Our report shows that thyroid hemangiomas can be diagnosed correctly by sonography with or without confirmation of bloody content in the lesions by fine-needle aspiration.

Nonmasslike lesions on breast sonography: comparison between benign and malignant lesions

OBJECTIVES

To compare the imaging and clinical features of benign and malignant nonmasslike lesions in the breast.

METHODS

During a 2-year period at a single institution, 186 nonmasslike lesions in 158 women were pathologically confirmed through surgery or sonographically guided biopsy. The sonographic patterns (mottled, geographic, and indistinct) and distributions (focal and regional) were compared between benign and malignant lesions. The presence of sonographically visible calcifications, amount of color Doppler signals, presence of positive findings on mammography, and presence of symptoms were also compared between the two groups.

RESULTS

A total of 156 lesions (84%) were confirmed as benign and 30 (16%) as malignant. On sonography, malignant nonmasslike lesions more frequently had mottled and geographic patterns and regional distribution than benign lesions (P < .0001). Malignant lesions also more frequently had sonographically visible calcifications (40% versus 0%; P < 0.0001) and a greater amount of color Doppler signals than benign lesions (P < .0001). On mammography, malignant lesions more frequently had densities and calcifications than benign lesions (30.4% versus 7.1%; P = 0.0052; 73.9% versus 6.1%; P < .0001, respectively). Clinically, malignant lesions were more frequently palpable and accompanied by localized pain than benign lesions (50% versus 2.6%; P< .0001; 13.3% versus 0.6%; P = .0025).

CONCLUSIONS

The imaging and clinical features of malignant nonmasslike lesions differed significantly from those of benign nonmasslike lesions.

Sclerosing lymphocytic lobulitis manifesting as suspicious microcalcifications with Hashimoto's thyroiditis in a young woman

Sclerosing lymphocytic lobulitis (SLL) is a rare inflammatory disorder, which is also known as fibrous mastopathy and lymphocytic mastitis. It is commonly associated with autoimmune disorders, particularly type 1 diabetes and thyroiditis. We report the case of a 28-year-old woman diagnosed as SLL with Hashimoto's thyroiditis, but without diabetes. She presented suspicious microcalcifications without palpable mass in routine mammograms in both breasts. She had been diagnosed as Hashimoto's thyroiditis several years before and had been followed up in endo-clinics.

Diffuse sclerosing variant of papillary thyroid carcinoma: sonography and specimen radiography

The purpose of this pictorial essay is to show the limitations of sonography and complementary usefulness of specimen radiography in detecting microcalcifications of the diffuse sclerosing variant of papillary thyroid carcinoma, which mostly manifests as diffusely scattered microcalcifications in the thyroid gland.

Fat-forming variant of solitary fibrous tumour of the pleura: CT findings

The fat-forming variant of solitary fibrous tumour (SFT) was previously called lipomatous haemangiopericytoma and is a rare variant of solitary fibrous tumour. It predominantly occurs in the deep soft tissues of the retroperitoneum and thigh. Only a handful of cases involving the perineum, spine, thoracic wall and pelvic cavity have been reported in the radiological literature and the fat-forming variant of SFT involving the pleura has not been previously reported. Herein, we report the CT findings of a case of the fat-forming variant of SFT involving the pleura that was treated by excision. Chest CT showed a large lobulated heterogeneous fatty mass with a multifocal enhancing soft-tissue component in the left lower hemithorax. Although rare, the fat-forming variant of SFT of the pleura should be added to the differential diagnosis of fat-containing pleural soft-tissue tumours.

Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk

PURPOSE

To develop a practical thyroid imaging reporting and data system (TIRADS) with which to categorize thyroid nodules and stratify their malignant risk.

MATERIALS AND METHODS

The institutional review board approved this retrospective study, and the requirement to obtain informed consent for the review of images and records was waived. From May to December 2008, ultrasonographically (US)-guided fine-needle aspiration biopsy (FNAB) was performed in 3674 focal thyroid nodules in 3414 consecutive patients. The study included the 1658 thyroid nodules (≥1 cm in maximum diameter at US) in 1638 patients (1373 women, 265 men) for which pathologic diagnosis or follow-up findings were available. Univariate and multivariate analyses with generalized estimating equations were performed to investigate the relationship between suspicious US features and thyroid cancer. A score for each significant factor was assigned and multiplied by the β coefficient obtained for each significant factor from multivariate logistic regression analysis. Scores for each significant factor were then added, resulting in an equation that fitted the probability of malignancy in thyroid nodules. The authors evaluated the fitted probability by using a regression equation; the risk of malignancy was determined according to the number of suspicious US features.

RESULTS

The following US features showed a significant association with malignancy: solid component, hypoechogenicity, marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, and taller-than-wide shape. As the number of suspicious US features increased, the fitted probability and risk of malignancy also increased. Positive predictive values according to the number of suspicious US features were significantly different (P < .001).

CONCLUSION

Risk stratification of thyroid malignancy by using the number of suspicious US features allows for a practical and convenient TIRADS.

Effect of glycolic acid on UVB-induced skin damage and inflammation in guinea pigs

OBJECTIVES

Recently the use of glycolic-acid-containing cosmetics has received increased public interest in their supposed ability to reduce wrinkles, roughness, age spots and other skin damage. However, the safety of such products when used excessively or chronically, especially by photosensitive people, is being questioned. The purpose of this study was to examine the effects of glycolic acid alone or in combination with UVB on skin damage and inflammatory response.

METHOD

Guinea pigs were treated with glycolic acid (from 1 to 7 mg/cm(2)) alone or in combination with UVB (0.4 or 3 J/cm(2)) for 14 days. Skin damage was evaluated by scoring the skin irritation value by the method of Draize and by histopathological observations. Cyclooxygenase 2 (COX-2) expression and prostaglandin E(2) (PGE(2)) production were also assessed.

RESULTS

Glycolic acid caused an increase in the level of skin damage in a dose- and time-dependent manner. Lower doses (1 and 3 mg/cm(2)) of glycolic acid mostly caused erythema and eschar, and these consequently formed scales, whereas higher doses (5 and 7 mg/cm(2)) of glycolic acid caused redness, edema and necrotic ulceration. Glycolic acid also increased the thickness of the epidermal layer, reduced the organization of the stratum corneum and eventually destroyed some parts of the epidermal layer at 7 mg/cm(2). UVB (0.4 and 3 J/cm(2)) caused redness and edema as well as reduced the integrity of the stratum corneum. Glycolic acid enhanced the UVB-induced skin damage. The magnitude of the damage caused by combined UVB and glycolic acid treatment was much greater than that caused by glycolic acid or UVB alone. Moreover, partial destruction of the epidermal layer was observed in skin treated with 3 J/cm(2) UVB and 3 mg/cm(2) glycolic acid. However, glycolic acid did not change the basal and UVB-induced PGE(2) production and COX-2 protein expression.

CONCLUSION

These results show that glycolic acid causes skin damage in a dose- and time-dependent manner and that it enhances UVB-induced skin damage without accompanying PGE(2) production or COX-2 protein expression. Therefore, caution should be exercised by those using glycolic acid on a chronic basis or excessively. Moreover, those with photosensitive skins and those more exposed to the sun should be particularly careful.

Association between polymorphisms of ethanol-metabolizing enzymes and susceptibility to alcoholic cirrhosis in a Korean male population

Alcohol is oxidized to acetaldehyde by alcohol dehydrogenase (ADH) and cytochrome P-4502E1 (CYP2E1), and then to acetate by aldehyde dehydrogenase (ALDH). Polymorphisms of these ethanol-metabolizing enzymes may be associated with inter-individual difference in alcohol metabolism and susceptibility to alcoholic liver disease. We determined genotype and allele frequencies of ALDH2, CYP2E1, ADH2, and ADH3 in male Korean patients with alcoholic cirrhosis (n=56), alcoholics without evidence of liver disease (n=52), and nondrinkers (n=64) by using PCR or PCR-directed mutagenesis followed by restriction enzyme digestion. The prevalences of heterozygous ALDH2*1/*2 plus homozygous ALDH2*2/*2 in patients with alcoholic cirrhosis (7.1%) and alcoholics without evidence of liver disease (3.8%) were significantly lower than that in nondrinkers (45.3%). The c2 allele frequencies of the CYP2E1 in alcoholic cirrhosis, alcoholics without evidence of liver disease, and nondrinkers were 0.21, 0.20, and 0.20, respectively. Allele frequencies of ADH2*2 in the three groups were 0.78, 0.74, and 0.77 and those of ADH3*1 were 0.94, 0.98, and 0.95. Therefore, we confirmed the observation that the ALDH2*2 gene protects against the development of alcoholism. However, the development of cirrhosis in Korean alcoholic patients was not associated with polymorphisms of ethanol-metabolizing enzymes.

Reactive oxygen species activity, mucosal lipoperoxidation and glutathione in Helicobacter pylori-infected gastric mucosa

BACKGROUND AND AIM

Helicobacter pylori is considered as the major pathogen in Helicobacter pylori-associated gastroduodenal disease, but the mechanism of its action has not been fully explained. This study was performed to assess the reactive oxygen species activity and the damage in Helicobacter pylori-infected gastric mucosa.

METHODS

Gastric biopsy specimens were obtained from 308 patients undergoing endoscopy. Gastric mucosal damage was assessed by using luminol enhanced chemiluminescence, thiobarbituric acid-reactive substance, and mucosal glutathione.

RESULTS

The chemiluminescence and thiobarbituric acid-reactive substance-equivalent levels in the mucosa of patients with Helicobacter pylori-positive gastric mucosa (43.8 +/- 134.9 c.p.m./microg tissue, 157.0 +/- 96.2 nmol/g tissue, respectively) were significantly higher than in those with Helicobacter pylori-negative mucosa (6.8 +/- 20.3 c.p.m./microg tissue, 110.0 +/- 51.6 nmol/g tissue, respectively; P=0.000, P=0.016, respectively). The glutathione levels in the mucosa of patients with Helicobacter pylori-positive gastric mucosa (159.3 +/- 76.6 nmol/microg tissue) were significantly lower than in those with Helicobacter pylori-negative gastric mucosa (212.3 +/- 134.3 nmol/microg tissue; P=0.008). After the data were divided according to the presence of Helicobacter pylori, there were no significant differences in chemiluminescence, thiobarbituric acid-reactive substance, and glutathione among the different macroscopic findings within Helicobacter pylori-positive and -negative gastric mucosa.

CONCLUSIONS

Helicobacter pylori infection plays a pathological role in many gastrointestinal diseases through excessive mucosal-reactive oxygen species production, pronounced membrane damage, and the depletion of gastric anti-oxidants.

Microcytic adenoma coexistent with low-grade malignant islet cell tumor of the pancreas

We report a case of microcystic (glycogen-rich) adenoma of the whole pancreas with coexistent pancreatic low-grade malignant islet cell tumor in a 29-year-old woman. She complained of nausea, vomiting, and growing abdominal mass. Abdominal computed tomography showed multiple cysts in the whole pancreas and a calcified solid mass in the pancreatic head. A Whipple's operation and total pancreatectomy with splenectomy was performed to treat pancreatic cystic neoplasm. The pancreas was entirely replaced by variable-sized, multilocular cysts, which were lined by a flattened-to-cuboidal glycogen-rich epithelium. Furthermore, in the head of the pancreas, a focal yellowish solid mass showed a positive reaction for chromogranin A and neuron-specific enolase. Careful examination of the pancreas is warranted in cases of microcystic adenoma to rule out a possible coexistent pancreatic malignancy.

Dynamic elastic constants of anisotropic materials by resonant ultrasound spectroscopy

Resonant ultrasound spectroscopy (RUS) has been applied to the anisotropic elastic stiffness determination of SiC/Al composites and highly textured Zr-2.5 Nb alloys. To determine the elastic stiffness of anisotropic materials, the resonant frequencies of a rectangular parallelepiped specimen were measured and compared with the calculated frequencies based on the input data of the estimated stiffness, dimensions, and density. The initial estimates of the elastic stiffness of SiC/Al composites were calculated using the Mori-Tananka (MT) theory and the concept of effective aspect ratio of reinforcements. For highly textured Zr-2.5 Nb alloy, the initial estimates were obtained from its orientation distribution function, determined by X-ray diffraction, and the reported elastic stiffness of a single crystal zirconium. Through a comparison of calculated frequencies with those measured by RUS, elastic stiffness values have been determined very accurately by iteration and convergence processes.

Protective effect of chlormethiazole, a sedative, against acetaminophen-induced liver injury in mice

OBJECTIVES

The hepatotoxicity of acetaminophen is not a result of the parent compound but is mediated by its reactive metabolite N-acetyl-p-benzoquinone imine. Cytochrome P4502E1 (CYP2E1) is the principal enzyme of this biotransformation, which accounts for approximately 52% of the bioactivation in human microsomes. Recently, chlormethiazole a sedative drug, is reported to be an efficient inhibitor of CYP2E1 activity in human beings. In this study we wished to evaluate whether chlormethiazole, an inhibitor of CYP2E1, could prevent acetaminophen-induced liver injury in mice.

METHODS

Acetaminophen, at doses ranging from 200 to 600 mg/kg, was injected into the peritoneum of female C57BL/6 inbred mice fasted for four hours. Chlormethiazole (60 mg/kg) or 5% dextrose water was given 30 min before or 2 h after acetaminophen. Serum aminotransferase activities, histologic index score, survival rate and hepatic malondialdehyde levels were compared.

RESULTS

Pretreatment with chlormethiazole 30 min before 400 mg/kg of acetaminophen completely inhibited acetaminophen-induced liver injury (median 118.5 U/L, range 75 to 142 vs. 14,070 U/L, range 5980 to 27,680 for AST; 49 U/L, range 41 to 64 vs. 15,330 U/L, range 13,920 to 15,940 for ALT). In mice receiving chlormethiazole 2 h after acetaminophen, the mean AST and ALT levels were also less elevated, reaching only 20% of the value of acetaminophen-only group. These protective effects were confirmed histologically. Whereas more than 50% of mice died at 500 mg/kg of acetaminophen, all the mice pretreated with chlormethiazole survived at the same dose.

CONCLUSION

Chlormethiazole effectively reduces acetaminophen-induced liver injury in mice. Further studies are needed to assess its role in humans.

Identification of serotype by use of serologic assay and detection of the enterotoxin gene of Escherichia coli by means of a polymerase chain reaction assay for isolates from pigs, chickens, and cows

OBJECTIVE

To serotype an enterotoxin gene from Escherichia coli isolated from cows, pigs, and chickens in Korea.

SAMPLE POPULATION

Isolates from 37 cows with mastitis, 51 diarrheic pigs, and 5 diarrheic chickens.

PROCEDURE

Serogroups and serotypes were identified by slide agglutination testing, using pathogenic E coli sera. Detection of E coli enterotoxins by use of reversed passive latex agglutination and ELISA was compared by proving existence of the gene by polymerase chain reaction (PCR) analysis.

RESULTS AND CONCLUSIONS

Detection of E. coli enterotoxin by either method was positive for 1 strain (O20:H10; heat-labile enterotoxin [LT+], heat-stable enterotoxin [STa+]; isolation rate, 2%) and 3 other strains (O111:H10, O119:H9, and O125:H6, STa+; isolation rate, 5.9%) isolated from fecal specimens obtained from diarrheic pigs. The E coli enterotoxin genes were identified by use of PCR analysis in 1 strain containing the 417- and 163-base pair (bp) genes (LT+, Sta+; O20:H10) and in 3 strains containing only the 163-bp gene (STa+; O111:H10, O119:H9, and O125:H6).

CLINICAL RELEVANCE

Serotyping of E coli enterotoxin may be used to analyze patterns of transmission among species of domestic animals.

Potentiation of hydrogen peroxide, nitric oxide, and cytokine production in RAW 264.7 macrophage cells exposed to human and commercial isolates of Bifidobacterium

Bifidobacteria have been previously shown to stimulate immune function and this may be mediated by macrophages. The RAW 264.7 cell line was used here as a macrophage model to assess the effects of human and commercial Bifidobacterium isolates on the production nitric oxide (NO), hydrogen peroxide (H2O2) and the cytokines IL-6 and tumor necrosis factor (TNF)-alpha. Thirty three Bifidobacterium strains differentially stimulated the production of H2O2 NO, TNF-alpha, and IL-6 in a dose-dependent manner in 24-h cultures. In the presence of lipopolysaccharide (LPS) the effects of bifidobacteria on NO and H2O2 were masked and were less pronounced at the later stage of incubation. Co-stimulation of macrophages with both LPS and Bifidobacterium increased the production of IL-6 synergistically. In contrast, LPS reduced the ability of the bifidobacteria-induced macrophages to produce TNF-alpha. Our results demonstrated that both human and commercial Bifidobacterium strains can stimulate H2O2, NO, TNF-alpha, and IL-6 production, and this effect was strain-dependent. The in vitro approaches employed here should be useful in further characterization of the effects of bifidobacteria on gastrointestinal and systemic immunity.

The fidelity of DNA polymerase beta during distributive and processive DNA synthesis

During base excision repair, DNA polymerase beta fills 1-6-nucleotide gaps processively, reflecting a contribution of both its 8- and 31-kDa domains to DNA binding. Here we report the fidelity of pol beta during synthesis to fill gaps of 1, 5, 6, or >300 nucleotides. Error rates during distributive synthesis by recombinant rat and human polymerase (pol) beta with a 390-base gap are similar to each other and to previous values with pol beta purified from tissues. The base substitution fidelity of human pol beta when processively filling a 5-nucleotide gap is similar to that with a 361-nucleotide gap, but "closely-spaced" substitutions are produced at a rate at least 60-fold higher than for distributive synthesis. Base substitution fidelity when filling a 1-nucleotide gap is higher than when filling a 5-nucleotide gap, suggesting a contribution of the 8-kDa domain to the dNTP binding pocket and/or a difference in base stacking or DNA structure imposed by pol beta. Nonetheless, 1-nucleotide gap filling is inaccurate, even generating complex substitution-addition errors. Finally, the single-base deletion error rate during processive synthesis to fill a 6-nucleotide gap is indistinguishable from that of distributive synthesis to fill a 390-nucleotide gap. Thus the mechanism of processivity by pol beta does not allow the enzyme to suppress template misalignments.

The consensus motif for phosphorylation by cyclin D1-Cdk4 is different from that for phosphorylation by cyclin A/E-Cdk2

Cyclin D-Cdk4/6 and cyclin A/E-Cdk2 are suggested to be involved in phosphorylation of the retinoblastoma protein (pRB) during the G1/S transition of the cell cycle. However, it is unclear why several Cdks are needed and how they are different from one another. We found that the consensus amino acid sequence for phosphorylation by cyclin D1-Cdk4 is different from S/T-P-X-K/R, which is the consensus sequence for phosphorylation by cyclin A/E-Cdk2 using various synthetic peptides as substrates. Cyclin D1-Cdk4 efficiently phosphorylated the G1 peptide, RPPTLS780PIPHIPR that contained a part of the sequence of pRB, while cyclins E-Cdk2 and A-Cdk2 did not. To determine the phosphorylation state of pRB in vitro and in vivo, we raised the specific antibody against phospho-Ser780 in pRB. We confirmed that cyclin D1-Cdk4, but not cyclin E-Cdk2, phosphorylated Ser780 in recombinant pRB. The Ser780 in pRB was phosphorylated in the G1 phase in a cell cycle-dependent manner. Furthermore, we found that pRB phosphorylated at Ser780 cannot bind to E2F-1 in vivo. Our data show that cyclin D1-Cdk4 and cyclin A/E Cdk2 phosphorylate different sites of pRB in vivo.

A case of massive cisplatin overdose managed by plasmapheresis

OBJECTIVES

Accidental cisplatin overdose occurs with increasing frequency despite the safeguards taken in prescription and administration, since cisplatin has been used increasingly for the treatment of numerous malignancies. Accidentally, a 59-year-old male received massive cisplatin overdose of 300mg/m2.

METHODS

Laboratory documentation included measurement of cisplatin concentrations by flameless atomic absorption spectroscopy (Varian, Spectra AA 300).

RESULTS

Toxicities included severe emesis, myelosuppression, renal failure, mental deterioration with hallucination, dim vision and hepatic toxicity. Plasmapheresis was effective in lowering the platinum concentration from greatest 2979 ng/ml to 185 ng/ml and appeared to be of clinical benefit. Granulocyte-macrophage colony stimulating factor (GM-CSF) was used to ameliorate myelosuppression. The patient's renal function was restored 3 months later and partial response of esophageal cancer was obtained.

CONCLUSIONS

Plasmapheresis was effective in lowering the platinum concentration in massive cisplatin overdose. This case heightens awareness to the possibility of accidental cisplatin overdose and the benefits of prompt management.

Escherichia coli mraR gene involved in cell growth and division

The mraR gene, which has a coding frame of 363 bp and lies close to and upstream of the ftsI gene of Escherichia coli, is involved in both cell division and cell lysis. It is thought to function in regulating the two distinct steps of the cell cycle, as two different one-base mutations in this unique gene caused different phenotypical changes in the cell. Comparison of nucleotide sequences of the mutant type mraR DNAs with the wild type suggested that filamentation of the cell was caused by a mutation in the putative start codon, whereas lysis of the cell was caused by a mutation which led to a change of one internal glutamate residue to lysine.

The Escherichia coli mraY gene encoding UDP-N-acetylmuramoyl-pentapeptide: undecaprenyl-phosphate phospho-N-acetylmuramoyl-pentapeptide transferase

Amplification of the mraY gene, previously called open reading frame Y (ORF-Y, 1,080 bp), at 2 min in the chromosome map of Escherichia coli enhanced the activity of UDP-N-acetylmuramoyl-pentapeptide: undecaprenyl-phosphate phospho-N-acetylmuramoyl-pentapeptide transferase (EC 2.7.8.13). This enzyme catalyzes the formation of undecaprenyl-pyrophosphoryl-N-acetylmuramoyl-pentapeptide from UDP-N-acetylmuramoyl-pentapeptide and undecaprenyl-phosphate, the first step in the lipid cycle reactions in biosynthesis of bacterial cell wall peptidoglycans. The enhanced enzyme activity was sensitive to tunicamycin, and the amino tunicamycin-sensitive N-acetylglucosamine-1-phosphate transferase of Saccharomyces cerevisiae. Very probably mraY is the structural gene for the above enzyme.

Structural similarity among Escherichia coli FtsW and RodA proteins and Bacillus subtilis SpoVE protein, which function in cell division, cell elongation, and spore formation, respectively

The Escherichia coli cell division gene ftsW (2 min) was cloned and sequenced. It encodes a hydrophobic protein(s) with 414 and/or 384 amino acid residues. The deduced amino acid sequence and the hydropathy profile of the protein showed high homology with those of the E. coli RodA protein functioning in determination of the cell shape and the Bacillus subtilis SpoVE protein functioning in spore formation. Probably similar functional membrane proteins are involved in these three cell cycle process.