Ultrasound findings in subcutaneous plantar vein thrombosis: retrospective analysis of seven patients

Background Several disorders may result in forefoot pain. An uncommon cause of forefoot pain is subcutaneous plantar veins thrombosis (SCPVT) involving veins superficial to the plantar fascia. Purpose To describe the ultrasound (US) appearance of SCPVT, which has been described only once in the radiological literature. Material and Methods We performed a retrospective search of our PACS system from 2016 to 2020 to collect all cases of US-diagnosed SCPVT. We collected data on seven patients. Two radiologists analyzed the US images retrieved. All US examinations were performed with a multifrequency linear probe (frequencies in the range of 5–17 MHz). Results A localized plantar nodule was palpable in 86% of patients. The subcutaneous thrombosed vein appeared in all patients as a round or ovoid nodule located in the subcutaneous tissues that corresponded in four patients (4/5, 80%) to the painful palpable nodule. The size was in the range of 4–7 mm (mean = 5.4 mm). The thrombosed vein presented a connection with adjacent patent veins, appeared enlarged, and almost filled with hypo-isoechoic material, and in two patients (2/7, 29%), a thin peripheral fluid component surrounding the thrombus was detectable. Continuous scanning demonstrated slow blood movements inside the peripheral component due to blood circulation. Failure to compress the lumen of the thrombosed vein during the real-time US was evident in all patients. Conclusion SCPVT is a rare or underreported condition. Sonologists must know the US appearance of SCPVT to exclude other conditions and avoid unnecessary invasive studies.

The Role of Core Biopsy versus Vacuum-Assisted Breast Biopsy In Primary Breast Angiosarcoma

We report the case of a 45-year-old woman with a slow-growing palpable nodule on the left breast, confirmed as a well-defined opacity on mammography, corresponding to a 5 cm hyperechoic lesion on ultrasound, and considered, on the basis of clinical examination and radiological findings, to be consistent with a lipoma. One year later, the patient represented with an enlarged left breast mass and underwent further imaging investigation with subsequent diagnosis of primary breast angiosarcoma obtained via a Vacuum-Assisted Breast Biopsy. The patient developed metastatic disease and succumbed to the disease one year after definitive diagnosis. Primary breast angiosarcoma is a rare malignant vascular neoplasia, characterized by aggressive patterns, poor prognosis, and absence of pathognomonic radiological features. Currently, there are no evidence-based guidelines regarding treatment, even though wide surgical resection followed by chemo- and radiotherapy appears to improve survival.

The clinicopathological features of epithelioid undifferentiated sarcoma with TFE3 amplification: one case report and literature review

Background: Strong nuclear expression of TFE3 protein resulting from gene fusion has been reported in some neoplasms. TFE3 amplification has been proven to be a novel mechanism leading to increased protein level only in several cases of perivascular epithelioid cell tumor and renal cell carcinoma. Such rare genetic alteration might be associated with poor prognosis or aggressive course. Herein, we first reported a case of undifferentiated sarcoma with epithelioid features harboring TFE3 amplification. Case presentation: A 66-year-old woman with a history of chronic lymphocytic leukemia and chemotherapy presented with a 4 cm palpable nodule in the left lower leg. Magnetic resonance imaging revealed an oval juxtacortical lesion to the anterolateral left tibia. Microscopically, the large epithelioid cells with marked pleomorphism and the small round cells intermingled with each other in a diffuse sheet or a hemangiopericytoma-like vascular growth pattern. Myxoid stromal change was evident focally, imparting a hypocellular appearance. Atypical mitotic figures and lymph node metastasis were identified while tumor necrosis was absent. Immunohistochemically, the tumor was positive for vimentin, TFE3, CD68 and CD34. TFE3 gene amplification was identified by fluorescence in situ hybridization. Surgical resection was performed. The patient was alive without recurrence 8 month after surgery.Conclusions: The present case might represent a novel entity. Our report expands the scope of tumors carrying TFE3 amplification, and raises more attention to this rare genetic alteration and its association with potential aggressive behavior of the tumor.

Paratesticular colon cancer metastasis in an area of remote trauma

A 53-year-old man with a history of colon adenocarcinoma and remote scrotal trauma resulting in a palpable nodule. Gradual increase in the size of this lesion over the year prior to his presentation to our clinic prompted scrotal ultrasound that demonstrated a 1.1 cm solid lesion, which appeared to arise from the right epididymal tail. Subsequent positron emission tomography (PET) scan showed intense focal uptake at the base of the right testicle, suspicious for epididymitis versus underlying neoplasm. Scrotal exploration through an inguinal approach revealed a paratesticular mass. Frozen section from an excisional biopsy was positive for adenocarcinoma. Radical orchiectomy was completed. Final pathology returned as metastatic adenocarcinoma involving soft tissue; testis and spermatic cord were without diagnostic abnormalities and surgical margins were not involved. Subsequent analysis was consistent with colorectal origin. The patient recovered well from surgery and is continuing treatment of metastatic colon cancer per the medical oncology team.

Idiopathic granulomatous mastitis: Literature review and retrospective analysis of the sample at hospital federal da lagoa from 2013 to 2017

Introduction: Idiopathic Granulomatous Mastitis (IGM) is a benign inflammatory, rare and chronic condition. It constitutes about 24% of all breast inflammatory diseases, and its recurrence ranges from 16% to 50%. Its etiology was not completely elucidated. Breastfeeding and local trauma can be present. Other hypotheses include the use of oral contraceptives, hyperprolactinemia, smoking, infection, autoimmune diseases and alpha 1 antitrypsin deficiency. Objectives: To analyze data from patients in Hospital Federal da Lagoa diagnosed with IGM, and compare the results with the literature. METHOD: We conducted a retrospective analysis of the medical charts in Hospital da Lagoa, Rio de Janeiro, between 2013 and 2017, and identified 15 women, aged between 21 and 76 years, with IGM. RESULT: Of the 15 patients, 14 (93.3%) were tested for mastitis caused by common germs and Koch’s bacillus. Thoracic x-ray, PPD and culture were performed, and one patient tested positive for BK. Of the 14 patients with negative result for secondary infection, one was pregnant, one had HIV, and the other 12 (85.7%) did not present any specificities. At physical examination, 10 women (66.6%) had ulcer, 9 (60%) had a palpable nodule. Eleven patients (73.3%) had undergone an ultrasound, 5 (45.4%) with BIRADS 4; 4 (36.3%) with BIRADS 3; one patient (9%), BIRADS 2, and two (18.1%), BIRADS 1. In the mammography of the first appointment, 7 (46.6%) had records int he medical chart. Three (42.8%) with BIRADS zero; 2 (28.5%), BIRADS 3; one (14.3%), BIRADS 4, and another one (14.3%), BIRADS. Six patients were submitted to some surgical treatment (40%); regarding medicine treatment, 10 patients had records. One (10%) received RIP scheme; 4 (40%) received antibiotic therapy; two (20%), a combination of antibiotics and corticoids (oral); one (10%), a combination of methotrexate with topic and oral corticoid; two (20%, topic corticoid. Conclusion: By comparing the medical charts’ review with the literature, the results regarding clinical presentation, diagnosis and treatment are similar. The histopathological study is gold standard for diagnostic confirmation, and the medicinal conduct with regular follow-up is the best treatment.

Breast mucinous cystadenocarcinoma – case report

Introduction: Mucinous cystadenocarcinoma (MCC) is a rare primary breast tumor, first described in 1998. It was removed from the WHO classification in 2012, due to lack of consensus about its definition. To our knowledge, only 25 cases have been published in the literature. Objective: Case report and discussion of a case of breast MCC diagnosed in Centro de Doenças da Mama in Curitiba. Case report: Premenopausal 51 year-old patient, complaining of pain and nodule in the left breast. Physical examination showed a palpable nodule of approximately 2 cm, in the UOQ of the left breast. The ultrasound showed a 2.3 cm nodule, BI-RADS 5, submitted to core-needle biopsy with diagnosis of carcinoma with mucinous differentiation, positive for estrogen receptor (ER). The PET-Scan did not show extramammary site capture. Conserving surgery and sentinel lymph node were performed, with breast reconstruction using the geometric compensation technique. Macroscopy showed a cystic and solid mass, of mucinous content, measuring 4.0x3.5 cm. The histological status was suggestive of MCC, with 2 negative sentinel lymph nodes. The IQ showed mammaglobin expression, CK7 and ER, negative expression of c-erbB-2, CK20 and CK5/6. The patient was submitted to radiotherapy and hormone therapy. Discussion: The primary breast MCC needs to be distinguished from ovarian and pancreatic metastasis. The IQ for CK7 and CK20 can be useful, considering that the pancreatic and ovarian MCC have concomitant expression of CK7 and CK20; the breast MCC expresses only CK7. In the 26 cases described in the literature, including this study, mean age was 62 years (41‒96), and the tumor size was variable (0.8–19 cm). Only 4 cases presented positive lymph nodes. Most described cases did not express ER. The reported cases were associated with good prognosis. Conclusion: A consensus on the histological nomenclature and longer follow-up time are necessary to better understand this variant.

Endométriose cicatricielle sur incision de Pfannenstiel: à propos d’un cas et revue de la literature

Scar endometriosis is a rare form of extrapelvic endometriosis that is usually confused with other surgical or dermatological conditions leading to delays in diagnosis. We report a case of a 37-year-old woman presenting with a palpable nodule adjacent to her cesarean scar. Complete excision with clear margins was done and sent for histopathological examination confirming the diagnosis of endometriosis. Increasing awareness of this uncommon condition among clinicians can help in early diagnosis and treatment with gratifying results.

TRIGGER THUMB IN CHILDREN

The natural course of the condition in pediatric trigger thumb is still controversial, and accordingly, the recommendations for treatment vary considerably and there are no clear and broadly accepted guidelines. In this paper, we tried to provide a current literary overview of the disease progression and diagnostic and therapeutic abilities with an emphasis on the ultimate outcome of the treatment. Trigger thumb represents one of the most common pediatric hand conditions, mostly seen in preschool children. As a result of anatomic size mismatch between the flexor pollicis longus tendon and its sheath, disrupted tendon gliding is characteristic. The interphalangeal joint of the affected thumb fixed in a flexion contracture presents typical clinical finding. The first description of trigger thumb is attributed to Notta, and the palpable nodule at the volar aspect of the interphalangeal joint flexion crease still bears his name. Medical history and physical examination are used to diagnose this deformity with ultrasound as a potential early diagnostic tool. It is possible to misdiagnose a fracture, dislocation of the thumb or thumb-in-palm deformity. Clinical investigation has improved our understanding of the natural history and its benignancy. Therapeutic treatment depends on parent and physician preference. It can be either conservative, consisting of splint therapy and passive stretching exercises, or surgical, releasing of the A1 pulley that reliably restores thumb interphalangeal joint motion. Although it may take several years for spontaneous resolution, families willing to wait are given an opportunity to avoid hospitalization stress and surgical intervention.

Metastasis of the epididymis and spermatic cord from pancreatic adenocarcinoma: A rare entity. Description of a case and revision of literature

Introduction: Metastatic epididymal and spermatic cord adenocarcinoma from epithelial tumors are a rare condition. The most frequent primary cancers are prostate, lung, kidney, gastrointestinal tumors and breast. In literature, there are very low number of cases reporting metastasis from pancreatic cancer to epididymis and spermatic cord. Case description: We report a case of 70-years old man with history of left orchiectomy for undescended testicle, who presented to our department with a palpable nodule in the right scrotum. Scrotal ultrasound revealed an inhomogeneous hypoechoic nodule of epididymis and/or spermatic cord. Neoplastic markers showed high levels of CEA (carcinoembryonic antigen) and bHCG (beta Human Chorionic Gonadotropin). The patient underwent right surgical scrotal exploration with orchifunicolectomy. Pathologic examination revealed pathologic tissue showing rare glandular structures. Immunohistochemistry profile was compatible with malign epithelial neoplasm with glandular differentiation. Total body CT-scan revealed pathologic tissue in pancreas between head and body and a suspect pathologic lesion in liver and 18-FDG PET-scan confirmed the pancreatic neoplastic mass and a suspect secondary hepatic lesion. Biopsy of pancreatic pathologic area was positive for ductal pancreatic adenocarcinoma. The patient was sent to oncologic evaluation and started chemotherapy. Conclusions: Malignancies of epididymis and spermatic cord are rare entities and, in literature, very low number of cases of metastasis from pancreatic carcinoma to epididymis and spermatic cord are described. Early differential diagnosis is fundamental mostly in those patients with age range unusual for testis cancers.