Hungarian Radiology

[Atypical breast cyst: problems of differential diagnosis]

PAPP László, KOVÁCS Zsolt, SZABÓ Éva, MINIK Károly, ANTALFI Bálint, BENDE Sándor

JUNE 20, 2006

Hungarian Radiology - 2006;80(03-04)

[INTRODUCTION - Cystic breast masses detected by ultrasound can be devided into several groups upon their morphology. One of them is the group of progressive atypical cysts. CASE REPORT - A young female patient presented multiple palpable nodules in the central part and in the upper-medial quadrant of the left breast. Ultrasound examination showed cystic lesions of middle size and with smooth walls. The cytological results of two consecutive punctures of the cyst was C2, consistent with acute inflammatory hemorrhagic cystic content. The patient was followed up by ultrasound, which 4-6 months later demonstrated considerable progression in size and morphological changes of the cysts. The presence of intracystic nodules and the pericystic solid lesions made the use of MRI examination justified but it couldn’t exclude the possibility of multicentric malignancy. The breast team decided the excision of the cystic lesions, at first. The biopsy revealed multiple intraductal and intracystic papilloma surrounded by normal breast tissue. CONCLUSION - Considering the problems of differential diagnosis which raised the suspicion of similar morphological histological entities (intracystic papillar carcinoma, adenoid cystic carcinoma, DCIS) surgery was justified. According to the authors’s suggestion, despite of the frightening morphological, radiological and clinical status, the less radical surgery should be performed.]

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[PURPOSE - The aim of this paper is to demonstrate morphological changes of Crohn’s disease observed by CT enteroclysis and also to evaluate the role of the method in the diagnosis and the follow up of patients with known or suspected Crohn’s disease. PATIENTS AND METHODS - We evaluated retrospectively 50 typical cases who were examined earlier. Crohns’s disease was diagnosed in 42 patients before CT enteroclysis. Histological confirmation was available in 36 cases after colonoscopy and in six cases after surgery. In eight patients had a high suspicion of the disease, histological examination was not performed. CT enteroclysis findings were read by two radiologist independently and results were compared. RESULTS - CT enteroclysis showed typical signs of Crohn’s disease in all patients. Different degree of wall thickening was seen in all cases, pathological enhancement of small bowel wall (in cases 35), multilayered appearance (n=29), fibrofatty proliferation (n=33), enlarged lymph nodes (n=37), entero-enteric fistula (n=6), entero-cutan fistula n (=5), mesenteric abscess (n=5) was found. CONCLUSION - CT enteroclysis is an accurate method to detect mural and extramural abnormalities in patients with Crohn’s disease. CT enteroclysis proved highly accurate in detecting small bowel involvement and it also provides an estimation of clinical activity of the disease. CT enetroclysis can be considered as the first imaging method in patients with clinical signs of Crohn’s diseases and also in the follow up of patients with known disease.]

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