Unusual subcutaneous localisation of a dermatofibrosarcoma protuberans of the female breast: a case report

Dermatofibrosarcoma protuberans (DFSP) is a slow growing soft tissue neoplasm of dermal fibroblastic origin characterised by local invasion and a high propensity for local recurrence. We report a 31-year-old woman with subcutaneous DFSP of the breast, which is an unusual localisation. Diagnostic work-up comprised clinical examination, mammography and ultrasound. Definitive diagnosis was not possible prior to histological analysis of the lesion. Wide excision of the tumour was performed, which is the therapy of choice in DFSP. Ultrasound played an important role in histological diagnosis before definitive surgery and might be helpful in follow-up of patients with DFSP of the breast.

[Mammography screening]

Exclusive biannual mammography screening for women ages 50-69 years reduces the mortality from breast cancer among participants by 35%. Compared with 50% of clinically detected cancers, only 20% of carcinomas detected in screening have nodal metastases, and up to 55% of screening carcinomas are in the T1 stage of "minimal cancer." In many European countries (including Sweden, Norway, the Netherlands, and Great Britain), mammography screening programmes have been established for more than 10 years. In Germany, the aim is to establish, by 2008, a nationwide organised programme on the basis of the European Guidelines for Quality Assurance. This goal requires 80-100 mammography screening units. The first screening units went into use in 2005. Women between 50 and 69 years are invited to participate in 2-year intervals.

Clinical evaluation of bone-subtraction CT angiography (BSCTA) in head and neck imaging

Fifty-one patients were examined with bone subtraction CT angiography (BSCTA). Data were acquired on 4-and 64-slice spiral CT systems. The post-processing method is based on fully automatic registration of non-enhanced and contrast-enhanced CT data and subsequent selective bone removal. Vascular structures and brain tissue are retained with the original CTA noise level. Image quality and delineation of the pathologic process were assessed and artifacts introduced by the bone removal process recorded. The bone subtraction algorithm worked successfully in all examinations. The processing time was 6 min on average. Image quality was rated excellent in 20 (39%), good in 26 (51%) and acceptable in 5 (10%) patients. Ophthalmic arteries were visible in 12 (24%) patients bilaterally, in 13 (25%) patients unilaterally and in 26 (51%) patients at least at the origin. BSCTA improved visualization of the infraclinoid ICA and the vertebral arteries. The depiction of stenosis of the extracranial ICA and supraclinoid aneurysms was not significantly improved. In patients with suspicion of sinus thrombosis, BSCTA and conventional CTA yielded similar results. To conclude, BSCTA improves the visualization of vessels with close contact to bone and can improve the diagnostic accuracy and therapy planning of infraclinoid aneurysms.

CTA der A.�carotis mit unterschiedlichen CT-Ger�ten

Noninvasive modalities like CTA are increasingly replacing selective angiography in the evaluation of carotid artery stenosis. Dedicated scan protocols and contrast injection techniques are mandatory for the morphological assessment of carotid artery stenosis. These protocols need to be adapted to different scanner types. The delineation of plaque components and the residual lumen is improved with high resolution scan protocols and dedicated reconstruction algorithms. The exact delineation of in-stent stenosis remains limited. Standardization of postprocessing is crucial in order to attain reproducible results. Multislice spiral CT allows reliable grading of carotid artery stenosis. Relevant venous opacification and pulsation artifacts have to be expected with 4-slice scanners, the short scan time of the latest CT scanners minimize these problems.