Radiologic features of papillary adenoma and papillomatosis of the biliary tract

BACKGROUND

The purpose of this study was to describe the imaging findings of papillary adenoma of the bile ducts.

METHODS

Imaging modalities including sonography, computed tomography, cholangiography, and endoscopic sonography obtained in five patients with papillary adenoma of the bile duct were retrospectively reviewed and correlated with pathologic findings.

RESULTS

In four cases, imaging findings were a dilatation of the bile ducts due to a protruding mass within the lumen of the common bile duct. In one case, the biliary tract obstruction was not due to the mass but to mucus secretion that was detected at sonography, endoscopic sonography, and cholangiography. Multiple lesions were observed in two cases at pathology and not detected preoperatively. All the lesions contained foci of in situ carcinoma or mild dysplasia.

CONCLUSION

Imaging is useful in detecting bile duct tumors. Hypersecretion of mucus is rare but highly characteristic of bile duct adenoma.

Positron emission tomographic imaging of head and neck lesions

Positron emission tomography (PET) produces images that reflect the rate and distribution of biochemical and physiological processes in tissue in vivo. This has been observed with many types of neoplasm not evident when using such anatomical imaging techniques as computed tomography or magnetic resonance imaging. We evaluated the feasibility of 2-18F-2-deoxy-D-glucose (FDG) PET studies in diagnosing and assessing the effects of treatment on lesions of the tongue, maxillary sinus and nasopharynx. FDG-PET imaging was performed 45 times in 17 patients with tumors before treatment. Ten patients with malignant lesions also underwent imaging after treatment. The differential absorption ratio (DAR) of the isotope was calculated at 55 min and the time activity curve (TAC) was obtained by dynamic emission scans for 0-55 min following injection of FDG. FDG-PET images, DAR and TAC were evaluated in all lesions. Findings showed that FDG-PET images could be used to diagnose malignant tumors and evaluate treatment when the DAR was > 4.0 and TAC was steep upward. Images suggestive of benign lesions had low DAR values (< 4.0) and mildly upward or flat TACs.

[Diagnosis of nodal mastopathy: present-day views]

The concept of nodal mastopathy is accumulative. Both fibrotic segments and fibroadenomas, cysts, lipomas and other formations with atypical manifestations may serve as a substrate for forming a node. In addition to the clinical method, a diagnostic set should involve mammography that detects the true nature of a formation in 75-91% of cases, traditional sonography providing additional information in cysts in 88% of cases, Doppler sonography suspecting enhanced proliferative processes by the higher blood flow velocity and defining indications for surgical treatment, as well as new puncture bioptic procedures yielding better information materials by 25-30%. The comprehensive assessment of non-specific manifestations of nodal mastopathies from the data obtained by diagnostic techniques enables a more exact preoperative diagnosis to be made.

[Morphometry by analysis of microcalcifications and histopathological diagnosis: a new approach to the diagnosis of impalpable lesions of the breast detected by mammography]

A series of 104 impalpable breast lesions detected by mammograms containing microcalcifications was studied. Intraoperative radiographs of intact and sliced specimens were assessed, followed by microscopic diagnostic on frozen sections of areas containing microcalcifications. Microcalcification detected on mammograms and on radiographs of the specimens were digitized and evaluated according morphometric parameters including the mean surface, shape factor, bend energy, the envelope surface and the total surface, the total number and the concentration of the microcalcifications. Benign disorders, atypical hyperplasia and carcinomas accounted for 47.2%, 4.8% and 48% of the tissue lesions respectively, but disorders were most often heterogeneous and mixed. Most but not all parameters were significantly correlated in the three types of radiographs, although radiographs of the sliced specimens provided for images of the best quality. Only two parameters, the mean size and the bend energy were significantly (p = 0.008, p. = 0.036) different in benign and malignant lesions. It is concluded that image analysis of digitized microcalcifications in radiographs may provide a quantitative basis helpful for mammograms interpretation.

CT findings of malignant change in recurrent respiratory papillomatosis

Recurrent respiratory papillomatosis is a chronic disease of children and young adults associated with various complications, one of which is malignant change. We report CT findings of malignant change in a case of recurrent respiratory papillomatosis.

Surgical office-based ultrasound of the breast

How surgical office-based ultrasound (US) influences the management of nonpalpable, new or increasing size, mammogram-detected breast masses was evaluated. Ninety-seven patients had diagnostic US only; of these, 67 had their mass diagnosed as a simple cyst, and 30 had a negative US. Fifty-three additional patients underwent US-guided aspiration and/or biopsy (US-GAB) of their breast mass after diagnostic US. Of 12 patients with diagnostic US of "simple cyst," US-GAB confirmed each to be cysts. Of five patients with diagnostic US of "fibroadenoma," four had fibroadenomas and one had insufficient tissue on US-GAB. In all five cases a fibroadenoma was diagnosed at open biopsy. Of 27 patients with diagnostic US of "indeterminate" (cyst versus solid/complex cyst), 15 had cysts, one had a fibroadenoma, and one had a papilloma on US-GAB; the latter two were confirmed on open biopsy. Ten of these 27 patients had fibrocystic change identified on US-GAB; six were benign on open biopsy, and four had no change on follow-up mammogram. Of nine patients with diagnostic US of "suspicious," three had carcinomas, five had fibrocystic change, and one had insufficient tissue on US-GAB; three cancers were confirmed, and the remaining six were benign on open biopsy. There were no false positives and no false negatives among those patients undergoing US-GAB. In conclusion, office-based ultrasound of the breast performed by surgeons can accurately diagnose nonpalpable simple cysts and can accurately guide needle aspiration and/or biopsy of probable fibroadenomas, indeterminate, or suspicious masses for diagnosis of cystic, benign solid, or malignant lesions.

[Esophageal squamous cell papilloma. Report of 3 cases. Diagnostic aspects]

Dysphagia is not always present in patients with esophageal squamous cell papilloma, and it can be an incidental finding during gastrointestinal endoscopy of an asymptomatic patient.

PURPOSE

Three cases of squamous cell papilloma of the esophagus and aspects regarding diagnosis and association with human papillomavirus are presented. CASUISTIC: Two cases are male and one female what is consistent with a higher incidence showed in the literature in males. The three patients were submitted to upper gastrointestinal endoscopy: in one case the tumor was unusually large and in all patients it was located in the mid and lower esophagus. Chromoscopy was performed in one case and the lesion was not stained. We were unable to identify human papillomavirus using DNA-hybridization techniques. Our results are similar to those reported in the review of the literature.

RESULTS

There is no other case published in the Brazilian literature and this is the first report on the use of chromoscopy.

CONCLUSION

We were not able to show an association between esophageal squamous papilloma and human papillomavirus.

[Galactography]

Spontaneous single duct discharge is the main indication for galactography. This abnormality has in most cases a benign aetiology (> 90%). With a meticulous technique and sufficient experience, the ducts can be cannulated in 95% of the cases. A nipple adenoma with a blood stained discharge is seldom to pass for cannulation. Because cytology of the nipple discharge is not always positive in case of intraductal proliferations, microdochectomy must be used to obtain the differential diagnosis. Galactography shows multiple normal duct variations, depending on age, surrounding tissue, and a possible history of lactation. Pathologic images can be seen in dystrophic breasts, solitary papillomas, (juvenile) papillomas or (intraductal) carcinomas. In addition to high frequency ultrasonography (> or = 10 MHz), which is able to visualise the retro-areolar and superficial ducts, galactography can give a more detailed and better overview of the pathology.

Metachromatic leukodystrophy and coincidental finding of papillomatosis of the gallbladder. A case report

In this case report we describe the coincidental finding of polyps in the gallbladder by ultrasound investigation in a six-year-old girl, known to have metachromatic leukodystrophy. The investigation was carried out because of suspicion of abdominal trauma after falling down the stairs and finding elevated serum amylase.

Prenatal sonographic diagnosis of a third ventricle choroid plexus papilloma

We report a case of fetal hydrocephalus secondary to a third ventricle choroid plexus papilloma detected by ultrasound at 33 weeks' gestation. The prenatal sonographic and colour flow Doppler findings of this rare fetal intracranial tumour are discussed.

Clinical and radiological features in three cases of pulmonary involvement from recurrent respiratory papillomatosis

Clinical case reports of 3 children with recurrent respiratory papillomatosis who developed lung dissemination of the disease are presented. The radiological features of the primary pulmonary disease included papillomata in the distal airway and multiple, nodular lung lesions, both solid and cavitated. Changes secondary to pulmonary papillomatosis included atelectasis, infection and bronchiectasis. Respiratory papillomatosis involving pulmonary parenchyma is associated with a poor prognostic outcome. Early detection of such involvement and aggressive treatment of secondary infection are required to limit parenchymal damage.

Adult-onset disseminated tracheobronchial papillomatosis: CT features

The high resolution CT (HRCT) findings in an adult with disseminated tracheobronchial papillomatosis are discussed. In addition to polypoid masses within the trachea and main bronchi, diffuse ill-defined parenchymal centrilobular opacities were present; these reflect lesions within the small airways. Some of the nodules showed central cavitation. In a patient with centrilobular opacities, some of which cavitate, on HRCT and concomitant endobronchial or endotracheal abnormality, disseminated papillomatosis should be considered in the differential diagnosis, particularly if there is a history of hoarseness or laryngeal disease.

[Color Doppler flow data of breast tumors]

The recent development of high-quality colour Doppler instruments allows flow detection in small vessels below the resolution of B-mode imaging. Therefore, Doppler is now frequently used for flow detection in tumours. For breast examinations, CW Doppler has been in use for many years, which allows a sufficient definition of diagnostic criteria. Nevertheless, it is surprising that new studies using colour Doppler try to define different diagnostic criteria. To characterise the vascularity of breast lesions by colour Doppler we investigated 127 symptomatic patients. In 54 carcinomas the average flow velocity was 32 cm/s and 12.6 cm/s in 73 benign conditions (p > 0.0001). Total tumour vascularisation was characterised by a new parameter: the sum of all flow velocities in all tumour vessels. In carcinomas the mean total flow as 197.9 cm/s, and 52.7 cm/s in benign pathologies (p > 0.0001). Mean RI (resistance index) and PI (pulsatility index) were calculated to describe the flow profiles. The wide variation did not allow for a differentiation between benign and malignant lesions.

Isotretinoin therapy for recurrent respiratory papillomatosis

Retinoic acid has been advocated for use in several premalignant and malignant epithelial lesions of the head and neck, including benign recurrent respiratory papillomatosis, with varying results. We describe a 24-year-old man with extensive tracheoesophageal and bronchoalveolar papillomatosis that degenerated into squamous cell carcinoma. Multiple endoscopic carbon dioxide laser excisions, at one point performed on a weekly basis, as well as a prolonged trial of interferon, failed to control the progression of his disease. Isotretinoin (13-cis-retinoic acid) therapy (1 mg/kg per day) was instituted, with dramatic clinical, radiographic, and functional improvement. The patient experienced no significant toxic effects and required no endoscopic procedures over a 6-month period. We propose that isotretinoin may be an effective adjuvant therapy for aggressive respiratory papillomatosis.

[A new cases of transitional cell papilloma of the bladder, inverted type]

We report on a 75-year-old male patient with inverted transitional cell papilloma located on the right side of the bladder, behind the prostate lobe. It was a large (4 x 4 x 0.9 cm) exophytic, papillary tumor with a wide base and all the gross features of a typical transitional cell tumor of the bladder. The presenting symptom was gross hematuria and treatment was by transurethral resection. The literature is briefly reviewed.

Stasis papillomatosis. Clinical features, etiopathogenesis and radiological findings

Stasis papillomatosis can be divided into localized and widespread forms. Ten patients with this disease are discussed with emphasis on their clinical and lymphoradiological findings. Using isotope lymphography we were able to find an overall lymphostasis in only four patients. In all patients, local lymphatic disturbances were detected by means of indirect lymphography with intradermal lymph cysts as the most specific sign. Local dermal lymphostasis seems to be the common final pathogenesis in spite of different etiologies (ie, primary lymphedema, chronic venous insufficiency, trauma recurrent erysipelas, and local lymphangiodysplasia of unknown origin). A maximum variant was seen, following en-bloc resection of subcutaneous tissue in a patient suffering from congenital lymphedema.

Fat-suppressed three-dimensional MR imaging of the breast

Rotating delivery of excitation off-resonance (RODEO) is a new magnetic resonance (MR) imaging pulse sequence that uses a jump return sine excitation on fat resonance to produce fat-suppressed, T1-weighted images. New three-dimensional MR imaging techniques were used to examine 57 women with abnormalities suspicious for breast cancer. MR imaging findings were compared with those of mammography in all cases and with those of other imaging techniques when appropriate. Thirty-five specimens obtained at mastectomy were analyzed with rigorous pathologic examination that included imaging of the entire breast at 5-mm incremental sections. Histologic confirmation was obtained in 76 lesions in 47 patients. MR imaging helped detect 100% of malignant lesions, whereas mammography produced 33% false-negative findings. The use of RODEO in breast imaging is in the early investigational phases, but it has potential for supplementing mammography in the diagnosis of breast cancer.

Epithelial tumors of the paranasal sinuses and nasal cavity

This article addresses the various epithelial tumors of the nasal cavity and paranasal sinuses. It emphasizes the radiologic evaluation of patients with these tumors and the radiologic findings of importance. The advantages and disadvantages of the use of computed tomographic (CT) and magnetic resonance (MR) imaging in this evaluation are stressed.

Evaluation of an improved dot-immunobinding assay for carcinoembryonic antigen determination in nipple discharge in early breast cancer: results of a multicenter study

We have previously reported carcinoembryonic antigen (CEA) measurement in nipple discharge to be a useful adjunct in the diagnosis of non-palpable breast cancer. We have now developed a "microdot-immunobinding assay" using a specially constructed device to screen efficiently large numbers of patients with nipple discharge for non-palpable breast cancer. The method is as follows: a sample of nipple discharge is placed on a solid phase monoclonal anti-CEA antibody and, if CEA is present in the discharge, it will be detected by a second monoclonal anti-CEA antibody conjugated with alkaline phosphatase. The use of bromochloroindolyl phosphate as a chromogen results in a stable color reaction that can be semiquantitatively analyzed with the naked eye. CEA levels determined by this microdot assay correlated well with those determined using the earlier Elmotec assay. To determine the accuracy of the method, a collaborative study involving 11 institutes in Japan was organized. The CEA levels in nipple discharges from 77 patients undergoing surgery, 44 of whom were diagnosed as having breast cancer, were assayed. The results were that 17 of the 23 patients with palpable breast cancer, and 16 of the 21 patients with non-palpable breast cancer exhibited CEA values > 400 ng/ml, a cut-off value determined in a previous study. The overall accuracy (78%) of this test for diagnosing non-palpable breast cancer was higher than that obtained from ductography or cytology. The system may thus be of use in the screening of early breast cancer.

Solitary breast papilloma: comparison of mammographic, galactographic, and pathologic findings

OBJECTIVE

Our purpose was to determine the mammographic/galactographic features of solitary breast papillomas and to correlate these features with the pathologic findings.

MATERIALS AND METHODS

Retrospective review of pathology files revealed 72 women in whom breast biopsy reports described a solitary papilloma. All patients with additional pathologic abnormalities were excluded from this study. Patients meeting the pathologic criteria and for whom mammograms, galactograms, or both were available and had been obtained within 6 months before biopsy were included. Twenty-four women met these criteria and form the basis of this study. Presenting clinical signs and symptoms were reviewed. Abnormal mammographic/galactographic findings were correlated with pathologic features.

RESULTS

Nipple discharge was present in 21 (88%) of 24 patients, two (8%) of 24 patients had abnormal findings on screening mammography, and one patient had a palpable mass that was visible on mammograms. Eight (42%) of 19 mammograms had abnormal findings, including dilated duct(s) in five cases (26%), nodules in two cases (11%), and microcalcifications in one case (5%). All technically adequate galactograms (13/15) had abnormal findings, with 12 (92%) of 13 showing an intraluminal filling defect. The other technically adequate galactogram (8%) showed only a solitary obstructed duct. Ductal dilatation was greatest at or central to the papilloma on 12 (92%) of 13 galactograms. Imaging features correlated well with the histologic findings.

CONCLUSION

Patients with solitary papillomas most commonly have nipple discharge, normal mammographic findings, and a galactographic filling defect. Galactography is useful for localizing papillomas.

[Ultrasonographic diagnosis of tumors of the gallbladder]

The role of echography in the diagnosis of gallbladder tumors was investigated. Benign tumors (papilloma and adenoma) were diagnosed in 2 patients and carcinoma in 18 subjects. This technique failed to diagnose carcinoma in 2 patients. Two more procedures had false-positive results (in one patient multiple clots in the dramatically enlarged bladder were taken for the tumor while ++post-inflammatory granulation in the other patient was mistaken for the tumor as well). Echographical signs of gallbladder tumors were presented, as were the criteria permitting one to differentiate carcinoma from other pathological formations in the gallbladder (echogenic bile, cholesterol polyps, cholecystitis, adenomyomatosis). High informative value of echographic investigation in the diagnosis of gallbladder tumors was noted.