Removing silicone artifacts in diffusion-weighted breast MRI by means of shift-resolved spatiotemporally encoding

PURPOSE

Evaluate the usefulness of diffusion-weighted spatiotemporally encoded (SPEN) methods to obtain apparent diffusion coefficient (ADC) maps of fibroglandular human breast tissue, in the presence of silicone implants.

METHODS

Seven healthy volunteers with breast augmentation were scanned at 3 Tesla (T) using customized SPEN sequences yielding separate silicone and water (1) H images in one scan, together with their corresponding diffusion-weightings.

RESULTS

SPEN's ability to deliver multiple spectrally resolved images in a single scan, coupled to the method's substantial robustness to magnetic field heterogeneities, served to acquire ADC maps that could be freed from contributions that did not belong to fibroglandular tissue.

CONCLUSION

SPEN-based sequences incorporating spectral discrimination and diffusion-weighting enable the acquisition of reliable ADC maps despite the presence of dominant signals from silicone implants, thereby opening new screening possibilities for the identification of malignancies in breast augmented patients.

[Acute rectal bleeding from malignant stromal tumor]

Stromal tumors of the rectum are rare. The most common symptoms are rectal bleeding, pain, constipation and obstruction. A case report of a 61 years old female admitted with acute bleeding due to malignant stromal tumor of the rectum is described. Upon admission the clinical and laboratory findings necessitance blood transfusion. Preoperative assessments revealed a large tumor located in the rectal wall with extension to the adjacent tissues. The histologic features of needle biopsy was compatible with gastrointestinal stromal tumor. Abdominoperineal excision of the rectum was performed. The definitive histological examination showed a gastrointestinal stromal tumor (GISTs), spindle cell type with mucosal invasion, vast necrosis and highly mitotic activity. The tumor cells coexpressed CD34 and smooth muscle actin and were negative for staining desmin and S-100 protein. Adjuvant chemotherapy was given. The patient died 7 months after the operation due to widespread metastases. We decided to describe a rare malignant stromal tumor of the rectum with uncommon clinical presentation.

[The history of Schimmelbusch's disease]

In 1982, Curt Schimmelbusch published a paper named "Cystadenoma of the breast", describing the clinical & pathological criteria of Schimmelbusch's disease. For many years this condition was one variant of fibrocystic mastopathy. Today, Schimmelbuuschs disease can be classified as part of ANDI-Aberration of normal development and iInvolution, The histopathological description is synonymous to adenosis. This is a short survey of the history of Schimmelbusch's Disease.

Extensive necrotizing soft tissue infection of the perineum

Synergistic necrotizing fasciitis of the penis and scrotum was first described by Fournier, and remains a rare, but life-threatening disease. The reported mortality rates in different series range between 22 and 60%. We present a study of 20 patients treated over a 9 year period by early aggressive excision. Four of the treated patients (20%) died. A high index of suspicion, combined with early radical surgical intervention, is the key to effective treatment. Delayed diagnosis and treatment were the primary factors responsible for death.

[Amplification of protooncogenes and expression of the HER2/neu oncogene in invasive breast cancer]

The protooncogene HER2/neu was analyzed in 27 women with invasive breast cancer and in 26 with benign breast conditions. Gene amplification was found in 3 patients, 1 in stage 3 and 2 in stage 4. In 3 patients in stage 2 overexpression of protein was found. Although amplification of the gene was found to be a significant predictor of clinical outcome (p < 0.05), high expression of the gene did not correlate with prognosis. In women with benign breast conditions there were no alterations of HER2/neu amplification may become a molecular marker in some malignancies. It should be noted that since few tumors show amplification, examination of a small series may not reveal clinical association with these alterations. Therefore, our conclusions require confirmation on a larger scale with long-term clinical follow-up.

[Combined intrapleural and low epidural anesthesia for upper abdominal surgery]

Intrapleural administration of local anesthetics to achieve postoperative analgesia was recently described by Kvalheim and Reiestad. It has been stated that the intrapleural technique provides analgesia, but not surgical anesthesia. However, this method has been used recently for anesthesia during minor surgical procedures. We describe the use of combined, bilateral intrapleural and low epidural anesthesia in a woman with severe impairment of cardiopulmonary function who underwent combined splenectomy and cholecystectomy.

[Gastrointestinal lipoma]

During the years 1975-1990 we treated 6 patients, 52-70 years old, with lipomas of the gastrointestinal tract. In 4 cases the diagnosis was made preoperatively. In 5 the tumor was located in the colon and in 1 in the stomach. 4 were treated surgically and 2, with relatively small lesions, were followed for 24 and for 52 months, respectively. A lipoma situated in the alimentary tract may lead to a variety of symptoms. Awareness of this phenomenon and the use of advanced diagnostic modalities may allow definitive clinical diagnosis.

Radiation-induced Cerebellar Glioblastoma Multiforme Subsequent to Treatment of an Astrocytoma of the Cervical Spinal Cord

A cerebellar glioblastoma multiforme was diagnosed in a 22-year-old woman. This originated in the zone adjacent to a field irradiated 14 years earlier after the removal of a noncontiguous astrocytoma of the spinal cord. The accepted criteria for radiation-induced tumors of the central nervous system are discussed.

Radiation-induced cerebellar glioblastoma multiforme subsequent to treatment of an astrocytoma of the cervical spinal cord

A cerebellar glioblastoma multiforme was diagnosed in a 22-year-old woman. This originated in the zone adjacent to a field irradiated 14 years earlier after the removal of a noncontiguous astrocytoma of the spinal cord. The accepted criteria for radiation-induced tumors of the central nervous system are discussed.

[Hidradenitis suppurativa involving the perineal region]

Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the skin and subcutaneous tissue. It may occur anywhere in skin containing apocrine sweat glands, but it most often affects the skin of the axilla and the inguinoperineal region. HS of the perineal region is frequently misdiagnosed as other inflammatory conditions, resulting in inappropriate treatment. The best treatment is excision of all the affected skin and subcutaneous tissue. We describe 3 patients with extensive HS and the results of their treatment.