Metastatic carcinoma to the male and female breast.
Muttarak M. Nimmonrat A. Chaiwun B.
Department of Radiology, Maharaj Nakorn Chiang Mai Hospital, Thailand. email@example.com
Metastases to the female breast are rare and those to the male breast are even rarer. Differentiating primary from metastatic breast carcinoma is important for rational therapy and avoidance of unnecessary radical surgery. Data on five women and two men with metastases to the breast are presented here. The primary tumours in these seven cases were as follows: three bronchogenic carcinoma and one each from papillary adenocarcinoma of the ovary, adenocarcinoma of the colon, squamous cell carcinoma of the nasal cavity and squamous cell carcinoma of the cervix. In both men (who had primary lung carcinoma), mammograms showed dense glandular tissue occupying nearly the entire breast. All five women had multiple nodules. Two of these cases were unilateral and three were bilateral. The metastatic nodules were round, with slightly irregular or ill-defined margins and calcification in the single case from metastatic papillary adenocarcinoma of the ovary. Ultrasonograms demonstrated well-circumscribed low-echoic masses in all cases. In a patient with known extramammary malignancy and a breast mass, mammograms and ultrasonograms should be undertaken to exclude a primary breast carcinoma and for proper management.
Routine chest radiography following endoscopic oesophageal dilatation for benign peptic oesophageal strictures.
Department of Radiology, Princess of Wales Hospital, Bridgend, UK.
Endoscopic oesophageal dilatation is a well-established procedure for management of patients with benign oesophageal strictures. The most important complication of the procedure is perforation with a recorded incidence of approximately 1%. Patients undergoing the procedure require close observation after dilatation. Routine chest radiographs are advisable following the procedure.
Postoperative adjuvant radiotherapy and 5-fluorouracil chemotherapy for rectal carcinoma.
Chao MW. Byram D. Bell R. Bond R. Vaughan S. McLennan R. Lim-Joon M. Wada M. Joseph D.
Division of Radiation Oncology, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia.
Postoperative combined modality therapy with radiotherapy and 5-fluorouracil (5FU) chemotherapy is an effective adjuvant approach that reduces locoregional and distant metastatic disease in patients with high-risk rectal carcinoma. However, this approach results in a treatment regimen of at least 6 months' duration. The present prospective study investigates the integration of radiotherapy and 5FU chemotherapy in a protocol designed to minimize toxicity and reduce the overall treatment time. A total of 40 patients with TNM stage II or III disease received postoperative radiotherapy at four fractions per week with weekly 5FU bolus injections delivered on the fifth non-radiotherapy day. Patients also received systemic chemotherapy with leucovorin both before and after pelvic irradiation, with the total treatment duration extending for only 18 weeks. Patients were able to complete radiotherapy in 90% of cases, while the delivery of full-dose chemotherapy was achievable in the vast majority. The incidence of haematologic and gastrointestinal toxicities requiring the cessation of treatment was acceptable. With a median follow-up of 20.9 months among surviving patients, the estimated progression-free and overall survival at 2 years were 71% and 79%, respectively.
Late effects of radiation therapy for prostate carcinoma: the patients perspective of bladder, bowel and sexual morbidity.
Franklin CI. Parker CA. Morton KM.
Queensland Radium Institute, Herston, Australia. firstname.lastname@example.org
The patients' perceptions of the late effects of radiation therapy for carcinoma of the prostate on bladder, bowel and sexual function were determined by using a self-administered questionnaire which was posted in June 1996 to patients who had been treated for carcinoma of the prostate between February 1993 and April 1994 at the Herston centre of the Queensland Radium Institute. The questions were based on the SOMA-LENT subjective scales. Moderate bladder morbidity was reported by 15% of patients, with 2% reporting major morbidity. Moderate bowel morbidity was reported by 19% of patients with 2% reporting major morbidity, the major symptoms being bowel urgency and mucus discharge. Sexual function was a problem, with 72% of patients reporting dissatisfaction with their current level of sexual activity.
Adult duodenal web.
Mani S. Maniar A. Rananavare R.
An 18-year-old male presented with persistent vomiting and epigastric fullness of 8 months' duration. Barium examination revealed an abrupt cutoff at the third part of the duodenum. Duodenotomy revealed a web at the third part of the duodenum. Following web excision, the patient experienced marked symptomatic relief and remains well 6 months after surgery.
Primary pleomorphic sarcoma of the liver.
Mani S. Naik L. Shet T. Vora IM. Rananavare R.
Department of Radiology, BYL Nair Hospital, Bombay, India.
A 35-year-old woman presented with abdominal distension and a palpable liver mass. Ultrasonography and computed tomography revealed a large well-delineated liver mass with bilobar involvement. Based on autopsy and immunohistochemical findings, a final diagnosis of primary pleomorphic liver sarcoma with myogenic differentiation was established.
Spontaneous intramural haematoma of the oesophagus: CT and MRI appearances.
Yuen EH. Yang WT. Lam WW. Kew J. Metreweli C.
Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
A 64-year-old man with history of ischaemic heart disease and coronary artery bypass graft surgery, but no history of peptic ulcer or liver disease, presented with retrosternal pain and coffee-ground vomitus. Endoscopy revealed a long column of bluish discolouration with normal mucosa interpreted as a grade IV oesophageal varix. Computed tomography showed a non-enhancing low-density submucosal columnar lesion in the mid- and lower oesophagus consistent with a submucosal haematoma. This resolved on follow-up at 10 days. The magnetic resonance features of intermediate signal intensity on T1-weighted images and hyperintense signal on T2-weighted images of this lesion are also highlighted.
Dysphagia: a rare presentation of tuberculous mediastinal lymphadenitis.
Department of Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences, Delhi, India.
Mediastinal lymphadenitis as the only presentation of adult tuberculosis is rare. Rarer still is dysphagia as the only presenting symptom of mediastinal tuberculous lymphadenitis. Here is the report of such a case.
Pedunculated hepatic haemangioma with arterioportal shunt: treated with angio-embolization and surgery.
Srivastava DN. Sharma S. Yadav S. Nundy S. Berry M.
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India. Deep@medinst.ernet.in
A case of symptomatic cavernous haemangioma of the liver with an unusual arterio-portal shunting, which was treated by pre-operative angiographic embolization, is described. The arterio-portal shunting has been reported previously in only two cases.
Incidental computed tomography diagnosis of a giant oesophageal leiomyosarcoma.
Van Gelderen WF. Cheng KS.
Department of Radiology, Wanganui Base Hospital, New Zealand.
Leiomyosarcoma of the oesophagus is a very unusual tumour; only 53 cases have been reported in the English-language literature. A case is reported here of a patient with a giant leiomyosarcoma, without any symptoms of dysphagia. The diagnosis was made incidentally during CT examination of the chest for detection of possible pulmonary metastases from a coexisting carcinoma of the bladder. This was confirmed by a barium swallow, oesophagoscopy and tissue diagnosis. The literature pertaining to this most uncommon tumour is reviewed.