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ABSTRACT: The patient is a 20-year-old man with glycogen storage disease type I (GSD-type I). In his teens, multiple focal hepatic masses were detected on abdominal ultrasonography (US), which were diagnosed as multiple hepatocellular adenomas from the imaging. During follow-up, these masses had shown intermittent growth in size. In the evaluation of Gd-EOB-DTPA (gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid) MR imaging, these masses showed various signal intensities from hypo- to hyperintense during the hepatocyte-specific phase. Intermittent growth and elevation of serum PIVKA-II levels indicate the potential for malignant transformation, so the patient underwent partial hepatectomy. The resected masses were all consistent with benign hepatocellular adenomas histopathologically.
Abdominal Imaging 03/2011; 37(2):239-43. · 1.73 Impact Factor
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ABSTRACT: We correlate findings from magnetic resonance (MR) imaging and pathology in a 55-year-old woman with spindle cell carcinoma of the breast. Pathological examination showed a fibrous capsule at the margins and abundant fibromyxoid stroma within the mass. Spindle cell carcinoma may be included in the differential diagnosis of expanding round masses with internal components that demonstrate rapid initial enhancement with high signal intensity on T(2)-weighted images in postmenopausal women.
Magnetic Resonance in Medical Sciences 01/2011; 10(2):133-7. · 0.97 Impact Factor
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ABSTRACT: A fragile or non-fibrotic pancreas increases the risk of postoperative pancreatic fistula (POPF) after pancreatic head resection, whereas pancreatic fibrosis decreases the risk. The degree of pancreatic fibrosis can be estimated using the time-signal intensity curve (TIC) of the pancreas, obtained with dynamic magnetic resonance imaging (MRI). We have investigated whether trainee surgeons can perform pancreatic anastomosis safely, without the occurrence of POPF, when patients are selected carefully based on a preoperative assessment of pancreatic fibrosis.
Seventy-two consecutive patients who underwent pancreatic head resection were enrolled in this prospective trial. Dynamic contrast-enhanced MRI of the pancreas was performed preoperatively in all patients who, based on their pancreatic TIC profile, were then allocated to one of two groups: Group A comprised patients with type I pancreatic TIC, signifying a normal pancreas without fibrosis (n = 46); Group B comprised patients with type II or III pancreatic TIC, signifying a fibrotic pancreas (n = 26). An end-to-side duct-to-mucosa pancreaticojejunostomy was performed in all patients, with all patients in Group A operated on by two experienced surgeons, and all patients in Group B operated on by one of eight trainee surgeons at various stages of training.
There was no operative mortality. POPF developed in 19 patients: 12 patients with grade A POPF and seven with grade B. All except one of the POPF occurred in Group A patients. The POPF in the one patient from Group B was grade A (p < 0.001).
A trainee surgeon can perform a secure pancreatic anastomosis without the occurrence of POPF in patients with a pancreas displaying a fibrotic pancreatic TIC on dynamic MRI scans.
Journal of hepato-biliary-pancreatic sciences. 11/2010; 17(6):831-8.
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ABSTRACT: We assessed the usefulness and limitations of utilizing apparent diffusion coefficient (ADC) values on diffusion-weighted imaging (DWI) for the differential diagnosis of benign and malignant non-mass-like breast lesions. We retrospectively reviewed 27 such lesions (16 malignant, 11 benign) detected on magnetic resonance (MR) imaging and analyzed the enhancing patterns of dynamic contrast-enhanced DCE-MRI (distribution and internal enhancement), kinetic curve patterns, and ADC values. All images were obtained with a 1.5-tesla MR unit, with patients supine. On DCE-MRI, malignant lesions tended to show either segmental or branching-ductal distribution, and when lesions with these patterns were considered malignant, sensitivity was 68.8%; specificity, 63.6%; positive predictive value (PPV), 73.3%; negative predictive value (NPV), 58.3%; and accuracy, 66.7%. Kinetic curve analysis did not reliably differentiate benign and malignant non-mass-like lesions. There was no significant difference between the mean ADC value of the malignant lesions, 0.968 × 10(-3) mm(2)/s at b=1000 s/mm(2), and that of benign lesions, 1.207 × 10(-3) mm(2)/s (P=0.109). Receiver operating characteristic (ROC) analysis revealed the most effective threshold of ADC value for differentiating tumors as 1.1 × 10(-3) mm(2)/s; values lower than this were observed more often in malignant than benign lesions (P=0.054). Us of this threshold yielded sensitivity of 68.8%; specificity, 72.7%; PPV, 78.6%; NPV, 61.5%; and accuracy, 70.4%. Combining the ADC value criteria with the analysis of DCE-MRI pattern increased sensitivity to 93.8%, negative predictive value (NPV) to 85.7%, and accuracy to 77.8% but decreased specificity to 54.5%. Use of ADC values does not adequately improve DCE-MRI performance for differential diagnosis of non-mass-like breast lesions, but adding the ADC value criteria to the DCE-MRI pattern analysis improves sensitivity, NPV, and accuracy.
Magnetic Resonance in Medical Sciences 01/2010; 9(4):217-25. · 0.97 Impact Factor
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ABSTRACT: A retrospective study was conducted to demonstrate the potential role of dynamic contrast enhanced magnetic resonance imaging (DCEMRI) in the detection of breast lesions in 15 patients with nipple discharge. The DCEMRI findings were compared and correlated with the findings of ultrasonography and mammography. The results revealed that the character of the nipple discharge was mostly bloody and in few cases were serous. The imaging findings revealed that DCEMRI is highly sensitive and specific in the detection of breast canner and the histopathological correlation in such detection was highly significant (p < 0.001) as compared to ultrasonography and mammography finding.
Bangladesh Medical Research Council Bulletin 09/2008; 34(2):44-7.
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ABSTRACT: The time-signal intensity curve (TIC) of the pancreas obtained from dynamic contrast-enhanced magnetic resonance imaging closely reflects the histological degree of pancreatic fibrosis.
Seventy-six patients who had undergone a pancreatic TIC analysis prior to receiving a pancreaticoduodenectomy for various reasons were subjected to a yearly monitoring with pancreatic TIC for the pancreatic remnants. The pancreatic TIC profiles were classified into 3 types: type I, indicating a normal pancreas without fibrosis; and types II and III indicating fibrotic pancreas.
The preoperative pancreatic TICs were type-I in 51 patients, type-II in 20, and type-III in 5, and the corresponding pancreatic fibrosis ratios were proved histologically to be 4.1%, 13.3%, and 21.2%, respectively. The mean postoperative follow-up period was 40.2 mo. A type-I changed to type-II in 16 patients, by 32.3 mo after surgery. In these patients, the exocrine remnant pancreatic function was preserved at the time of TIC conversion, but it significantly deteriorated thereafter. Pancreatic anastomotic leakage was found to be a significant risk factor predisposing a patient to undergo postoperative TIC conversion. In contrast, a preoperative type-II or III showed a postoperative conversion to type-I or II in 6 patients. In this group, the exocrine pancreatic function was noted to show a good recovery. In 35 patients who had a type-I TIC throughout the study, the remnant pancreatic function was well maintained.
Pancreatic TIC analysis has the ability to detect an early fibrotic change that precedes a functional deterioration of the pancreatic remnant after a pancreaticoduodenectomy. Following a pancreaticoduodenectomy, some patients show an improvement in pancreatic fibrosis, but they may also experience remnant pancreatic fibrosis when pancreatic anastomotic leakage occurs after surgery.
Journal of Surgical Research 09/2008; 158(1):61-8. · 2.25 Impact Factor
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ABSTRACT: To evaluate the ability of the time-signal intensity curve (TIC) of the pancreas obtained from dynamic contrast-enhanced magnetic resonance imaging (MRI) for differentiation of focal pancreatic masses, especially pancreatic carcinoma coexisting with chronic pancreatitis and tumor-forming pancreatitis.
Forty-eight consecutive patients who underwent surgery for a focal pancreatic mass, including pancreatic ductal carcinoma (n=33), tumor-forming pancreatitis (n=8), and islet cell tumor (n=7), were reviewed. Five pancreatic carcinomas coexisted with longstanding chronic pancreatitis. The pancreatic TICs were obtained from the pancreatic mass and the pancreatic parenchyma both proximal and distal to the mass lesion in each patient, prior to surgery, and were classified into 4 types according to the time to a peak: 25 s and 1, 2, and 3 min after the bolus injection of contrast material, namely, type-I, II, III, and IV, respectively, and were then compared to the corresponding histological pancreatic conditions.
Pancreatic carcinomas demonstrated type-III (n=13) or IV (n=20) TIC. Tumor-forming pancreatitis showed type-II (n=5) or III (n=3) TIC. All islet cell tumors revealed type-I. The type-IV TIC was only recognized in pancreatic carcinoma, and the TIC of carcinoma always depicted the slowest rise to a peak among the 3 pancreatic TICs measured in each patient, even in patients with chronic pancreatitis.
Pancreatic TIC from dynamic MRI provides reliable information for distinguishing pancreatic carcinoma from other pancreatic masses, and may enable us to avoid unnecessary pancreatic surgery and delays in making a correct diagnosis of pancreatic carcinoma, especially, in patients with longstanding chronic pancreatitis.
World Journal of Gastroenterology 03/2007; 13(6):858-65. · 2.47 Impact Factor
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Mariko Morishita,
Akira Ohtsuru,
Tomayoshi Hayashi, Ichiro Isomoto,
Noriaki Itoyanagi,
Shigeto Maeda,
Sumihisa Honda,
Hiroshi Yano,
Tatsuya Uga,
Takeshi Nagayasu,
Takashi Kanematsu,
Shunichi Yamashita
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ABSTRACT: Mammographic density reflects comprehensive changes in the mammary gland. The condition of the tumour microenvironment is a possible factor affecting tumour progression, as well as a tumour risk factor. This study aimed to determine whether mammographic density correlates with tumour clinicopathological features and prognosis in breast cancer patients. The analysis involved 163 Japanese women who underwent surgery for breast cancer between 1999 and 2003 in the Nagasaki University Hospital, Japan. Mammographic density was classified according to the breast imaging reporting and data system (BI-RADS) categories 1-4. Age, tumour size, axillary lymph node involvement, steroid receptor (SR) status, histological grade and Nottingham prognostic index (NPI) were analysed by density category and tested for statistically significant differences across categories. A significant difference (P<0.05) by breast-density category was found only for age. SR-negative tumours had significantly worse NPI scores than SR-positive tumours in breast-density categories 2 (P=0.03) and 4 (P<0.001). A high distant-metastasis frequency was observed in category 4 SR negatives (44%) versus category 4 SR positives (4.3%). These findings reveal that although the BI-RADS breast-density category alone is not associated with prognosis in breast cancer, patients who are both category 4 and SR negative have an extremely poor prognosis.
International Journal of Oncology 05/2005; 26(5):1307-12. · 2.40 Impact Factor
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ABSTRACT: The purpose of this study was to correlate strongly hyperintense areas(SHI) in breast lesions on FS-T2WI with histopathology and to evaluate the usefulness of the distribution patterns of SHI in the differentiation of benign and malignant breast lesions. MR imaging with pathological correlation was available in 157 breast lesions of 153 patients. The distribution patterns of SHI were classified into seven types. SHI on FS-T2WI was identified in 36 of 157 breast lesions. The irregular and inhomogenous types corresponded to various histological features and were only seen in malignant lesions. The central type corresponded to central necrosis and was only seen in 2 solid-tubular carcinomas. The crescent type corresponded to peripheral fluid collection in the intracystic tumor. The septal type corresponded to fibromyxoid stroma with fibrous septations in the lesions except for one cavernous hemangioma, and was only seen in benign lesions. The smooth type corresponded to mucinous pool, fibromyxoid stroma, and ductal dilatation and did not contribute to differentiation between benign and malignant lesions only on FS-T2WI. SHI in breast lesions on FS-T2WI pathologically corresponded to mucin, fibromyxoid change, necrosis, and ductal dilatation. Evaluation of patterns of SHI is useful in differentiating between benign and malignant lesions.
Nihon Igaku Hoshasen Gakkai zasshi. Nippon acta radiologica 04/2004; 64(3):99-106.
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ABSTRACT: We report a case of sarcoidosis of the breast in a 31-year-old woman who presented with a palpable breast mass. The mammography showed a spiculated mass without any microcalcifications. Ultrasonogram showed a hypoechoic mass. Computed tomography showed a spiculated nodule. T2-weighted MR images with fat-suppression technique showed a mass with irregular border that appeared to be an accumulation of small nodules. Gadolinium-enhanced dynamic study showed gradually increasing signal intensity. She underwent excisional biopsy and the pathological findings were consistent with that of sarcoidosis. The MRI findings were well correlated with histopathological appearance.
European Radiology 01/2003; 12 Suppl 3:S105-8. · 3.22 Impact Factor
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ABSTRACT: We report the clinical findings in a 36-year-old woman with diabetic mastopathy. The lesion showed heterogeneous segmental enhancement on magnetic resonance imaging (MRI), resembling a malignant lesion, but diffusion-weighted imaging (DWI) showed no abnormalities and the apparent diffusion coefficient value did not decrease. This case emphasizes the utility of DWI for differentiating diabetic mastopathy from malignant breast lesions. The value of DWI lies in its ability to exclude the possibility of malignant breast lesions and thus to avoid unnecessary biopsy.
Clinical imaging 33(2):146-9. · 0.73 Impact Factor
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Mariko Morishita,
Tomayoshi Hayashi,
Shigeto Maeda,
Hiroshi Yano, Ichiro Isomoto,
Kuniko Abe,
Megumi Matsumoto,
Masanobu Anami,
Akira Ohtsuru,
Shunichi Yamashita,
Takeshi Nagayasu,
Takashi Kanematsu
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ABSTRACT: Breast cancer has emerged as the most frequent malignant neoplasm among Japanese women in recent years, raising awareness in society of the issue of breast cancer, including good screening and therapies. In fact, the establishment of breast cancer screening program with mammography in the United States and Western Europe has contributed to improve the diagnosis of breast cancer at early stage, and proper management, including various options of evidence-based treatment has not only reduced mortality but also enhanced patients' quality of life. However, the mortality rate due to breast cancer in Japan has continued to increase, and the number of patients is also increasing rapidly. It is therefore very urgent to develop a good system of breast care in all medical facilities as well as the provision of a national scheme in Japan. In this report, we review the situations of breast surgery at Nagasaki University Hospital from 1975 to 2004 and current management practices for breast disease, and evaluate the possibility of establishing a better system for breast care at our hospital, which could then act as a core medical institute in Nagasaki
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ABSTRACT: Epidermoid cysts of the spleen are relatively rare. Usually occurring in children and young adults, they are most often asymptomatic, though large cysts can cause symptoms. A 9-year-old Japanese girl was found to have proteinuria and microscopic hematuria by routine school urine testing. She was incidentally found to have an abdominal mass. On abdominal magnetic resonance imaging, a cyst measuring 12.7 cm × 12.6 cm × 14.7 cm was found in her left upper abdomen. The cyst was too large for nonoperative treatment. Given the patient's age, concerns over the risk of septicemia after splenectomy led to laparoscopic marsupialization surgery. On pathology, the lumen of the cyst was found to be lined with stratified squamous epithelium. A small area of epithelium was positive for Alcian blue and HBME-1, indicating its mesothelial origin. Markers that were present in a high concentration, such as CA125 in the serum and cystic fluid, and CEA in the cystic fluid, stained positively in the epithelium. This supported the idea that these markers were produced by the lining epithelium. Six months since the operation, the cyst has gradually increased in size to 11.9 cm × 8 cm. However, since the cyst is asymptomatic, the patient is under outpatient-follow-up without further treatment
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Chieko Taneda,
Tomayoshi Hayashi,
Terumitsu Sawai, Ichiro Isomoto,
Kuniko Abe,
Naoe Kinoshita,
Masanobu Anami,
Satoshi Nakashima,
Kohei Kotera,
Hideaki Masuzaki,
Takeshi Nagayasu
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ABSTRACT: A 41-year-old Japanese woman who presented with right lower abdominal pain underwent partial omental resection with tumor excision, leaving no residual tumor. The tumor was diagnosed as a myxoid leiomyosarcoma that apparently originated in the greater omentum. A recurrent omental tumor was excised at 4.5 months after the first operation, and then at 5.5 months after this, CT revealed metastatic sarcoma at the surface of the liver (S7) and the left upper abdomen. She died 20 months after the last operation despite treatment of the metastases with MAID therapy (mesna, adriamycin, ifosfamide, dacarbazine). A literature review revealed that this tumor mainly occurs in the uterus, soft tissue, and cardiovascular system, with a preponderance among middle-aged to elderly women. The present report is the first description of primary omental myxoid leiomyosarcoma
