A Case of Solitary Fibrous Tumor Presenting as Lower Neck Mass

Solitary fibrous tumor (SFT) is rare mesenchymal tumor usually arising from pleura. SFT can be found at all anatomic site in our body but incidence of SFT is much lower in head and neck region especially at lower neck area. We found a case of SFT that presented as a lower neck mass in a 41-year old woman. Ultrasonography showed a 3×1cm sized hypoechoic mass in the intermuscular fat plane of left lower neck, and computed tomography showed a well circumscribed, low-density mass with contrast enhancement. Fine needle aspiration showed no malignant cells with abundant red blood cells, but it was not possible to completely rule out malignant tumors or nodules clinically. Surgery was performed to make a definitive diagnosis and histopathology showed tightly packed, round to fusiform cells with staghorn shaped vessels at microscopic examination. The tumor cell were positive for CD34 but negative for CD31 and S-100 protein.

Visible Pancreatic Neuroendocrine Tumor after Water Intake and Position Change

Most pancreatic neuroendocrine tumors (NETs) are detected incidentally and arise in the endocrine tissues. NETs can secrete hormones and result in clinical syndromes. However, between 50 and 75 percent of pancreatic NETs are nonfunctioning. Ultrasonography shows a well-circumscribed mass with a smooth margin and round or oval hypoechoic shape. A 38-year-old woman visited our hospital with mild upper abdominal discomfort. We visualized an oval hypoechoic mass with inner hyperechogenicity after water intake in the stomach and position change. The patient underwent surgery, and the mass was diagnosed as pancreatic NET.

A Rare Case of Undifferentiated Pleomorphic Sarcoma of the Pancreas and Literature Review

BackgroundPrimary undifferentiated pleomorphic sarcoma (UPS) of the pancreas is an exceedingly rare malignant tumor, with only 15 cases have been reported in the medical literature. At present, clinicians have poor recognition of the tumor, the epidemiology, diagnosis and treatment of this disease have yet not been established. Case presentationIn this report, we depict the clinical and imaging characteristics of a 37-year-old man presenting with a primarily cystic UPS. The patient complained of epigastric pain and distention over 20 days. Abdominal CT and pancreatic magnetic resonance imaging revealed cystic and cystic solid masses in the pancreatic body and tail. An abdominal ultrasound echogram revealed the mass in the body of the pancreas to be cystic with separation echo inside, and the wall was thick, not smooth. Besides, a hypoechoic mass was seen in the tail area of the pancreas with an inhomogeneous echoic pattern, containing small patches of no echo zone in the central. Microscopically, spindle fibroblast-like cells are arranged in a characteristic storiform pattern with pleomorphic and multinucleated cells. Immunohistochemically, tumor cells were positive for CD68 and vimentin. Seven months postoperatively, he was diagnosed with pulmonary lymph node metastasis and died five months later. Combined with this case report, we also reviewed the literature regarding UPS of the pancreas. ConclusionsAs we know, this is the first report on ultrasonography findings of pancreatic UPS. Despite there are no distinctive manifestation of UPS, a solid cystic lesion on ultrasonography or a hypodense area in the lesion on T2-weighted imaging, should be considered for differential diagnosis with pancreatic UPS. We believe this article may add some ideas into the diagnosis and therapy of patients with this tumor.

Hidden breast cancer after breast augmentation, not presenting as a hypoechoic mass lesion, diagnosed using colour Doppler ultrasound

The main concern after breast augmentation with silicone injection is that silicone granulomas make it difficult to detect breast cancer. A case of breast cancer was diagnosed using colour Doppler ultrasound (CD) to detect an non-palpable mass not presenting as a hypoechoic mass lesion. An 83-year-old woman was incidentally found to have a lesion in her right breast, which was injected with silicone, showing 18F-fluorodeoxyglucose (FDG) uptake; the lesion was suspected to be breast cancer or silicone granuloma. A mass at the FDG uptake site was not detected on ultrasonography (US); however, observation using CD revealed a slightly hypoechoic area with hypervascularity. Core needle biopsy showed invasive ductal carcinoma. Patients in whom US does not reveal lesions after breast augmentation with silicone injection should undergo CD to detect hypervascularised tissue. To prevent false-negative biopsy results, CD is essential to detect cancer at suspected sites.

Role of ultrasound in the diagnosis of primary and recurrent dermatofibrosarcoma protuberans

Background Dermatofibrosarcoma protuberans (DFSP) is a rare, low- to intermediate-grade sarcoma, which represents a diagnostic imaging challenge. This study aimed to analyze the clinical and ultrasound features of primary and recurrent DFSP to improve the diagnosis. Methods Clinical, imaging, and pathological data from a total of 58 patients (23 patients with primary DFSP and 35 patients with recurrent DFSP) were retrospectively reviewed. Results There was no statistically significant difference in age, sex, tumor size, or echogenicity between the two groups. Most of the primary DFSP lesions involved the overlying dermis and hypodermis, while most of the recurrent DFSP lesions were fixated to more deeply seated structures at the original surgical incision. Red nodules on the skin were found more frequently in the primary group. There were statistically significant differences in the type of lesion and ultrasound tumor morphology (p < 0.050). The lesions in the primary group showed more tentacle-like projections or a “claw” sign, while the lesions in the recurrent group were more commonly oval, lobulated, and irregularly shaped. Hypervascularity was common in both groups. Conclusions For primary DFSP, a slow-growing, red nodule on the skin involving the overlying dermis and hypodermis, more frequently a hypoechoic mass with tentacle-like projections or a “claw” sign, was observed. For recurrent DFSP, palpable subcutaneous nodules or subcutaneous masses at the original surgical incision and oval, lobulated, and irregularly shaped lesions were more commonly observed. This may be useful for improving diagnostic accuracy.

Solitary intrascrotal neurofibroma in a child: A case report

Background: Neurofibroma (NF) remains a rare entity among various scrotal masses in the pediatric age group. We report a case of solitary intrascrotal extra testicular plexiform neurofibroma in a 6-year-old child with the clinical management of this rare entity and review of the literature. Case Summary: A 6-year-old male presented with incidentally noticed intrascrotal swelling. Clinical examination confirmed the presence of solitary intrascrotal swelling with normal testis. Radiological imaging showed the presence of a hypoechoic mass in the left hemiscrotum with normal both testes. Surgical exploration showed the presence of unencapsulated soft tissue mass and histopathological examination (HPE) confirmed the diagnosis of plexiform neurofibroma. Thorough evaluation ruled out features of neurofibromatosis 1 thus confirming the diagnosis of solitary intrascrotal extratesticular plexiform neurofibroma. Complete surgical excision resulted in satisfactory recovery with no recurrence on follow-up Conclusion: Neurofibroma although rare should be considered as a differential in the diagnosis of an intrascrotal mass in the pediatric age group. The benign nature of the lesion and extratesticular origin usually makes testis sparing surgical excision feasible which remains the treatment of choice with excellent prognosis and minimal chances of recurrence. A thorough histopathological examination is mandatory to rule out neurofibromatosis.

A Huge Hemorrhagic Epidermoid Cyst of the Perineum with Hypoechoic Semisolid Ultrasonographic Feature Mimicking Scar Endometriosis

Epidermoid cysts are small, solitary, and slow-growing lesions that rarely appear in the perineum and mostly arise because of trauma. This study examined a huge perineal epidermoid cyst that slowly grew over eight years in a premenopausal woman. Ultrasonography showed that the hemorrhage in the cyst was a semisolid hypoechoic mass, which mimicked endometrioma, and was tentatively diagnosed as scar endometriosis in the perineum after vaginal delivery. This case study highlights the importance of wide surgical excision and histopathologic diagnosis, even with typical ultrasonography and surgical findings.

Radiological Red Flags of Triple Negative Breast Cancer on Mammography and Ultrasonography: A Case-control Study

Introduction: Breast cancer is the most common cause of cancer related mortality in Indian women. Aim: To evaluate the imaging characters of Triple Negative Breast Cancer (TNBC) on Mammography and Ultrasonography (USG), with the major goal of identifying imaging predictors of TNBC. Materials and Methods: The present retrospective case-control study was conducted at AIIMS, Rishikesh, Uttarakhand, India, over a period of one year from September 2018 to August 2019. The imaging findings of 50 cases of histopathologically proven TNBC were retrospectively evaluated by two breast radiologists. This was compared with 50 age matched blindly chosen cases of non-TNBC. The statistically significant imaging characters of TNBC were identified by Chi-square test. The imaging predictors of TNBC were identified by regression analysis. Results: The most common mammographic presentation of TNBC was mass without calcification (64%) with round/oval shape (54%) and lobulated margins (38%). The most common ultrasonographic presentation was hypoechoic mass (76%) with round/oval shape (52%) and lobulated margins (44%) with Posterior Acoustic Enhancement (PAE) (54%). PAE (p<0.0001: Area Under Curve (AUC): 0.6200) on USG was the single strongest imaging predictor of TNBC, followed by lobulated margins on mammography (p<0.001: AUC: 0.6300). On multivariate analysis, a lobulated, hypoechoic mass with PAE was found to be the most statistically confident predictor of TNBC on imaging. Conclusion: TNBC has specific imaging features on both mammography and USG which may be used as utility tools in early diagnosis. A round, lobulated mass on both modalities with hypoechogenicity and PAE on USG are definite red flags for TNBC on imaging.

B-cell lymphoma presenting as acute pancreatitis symptoms in a child

Lymphoma which has a wide range of manifestations is the third malignancy in pediatrics. Nearly, 50% of patients have extranodal involvement. Pancreas can be affected secondarily more than primarily. A 10-year-old boy with recurrent abdominal pain in the epigastric region for six weeks was referred to Amirkola Children's Hospital, affiliated to Babol University of medical sciences (north of Iran). The patient was icteric with elevated levels of amylase and lipase. A hypoechoic mass near the head of the pancreas was detected by ultrasound examination. Pathology of stomach polyps revealed small blue round-cell tumor compatible with a lymphoma. In children with acute pancreatitis symptoms and palpable abdominal mass, the non-Hodgkin lymphomas (NHL) should be considered as an important, though rare possible cause.