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International Journal of Surgical... Dec 2023Vascular lesions of the breast are uncommon, however, these are increasingly encountered now due to more frequent use of magnetic resonance imaging. They comprise a... (Review)
Review
Vascular lesions of the breast are uncommon, however, these are increasingly encountered now due to more frequent use of magnetic resonance imaging. They comprise a spectrum of lesions including benign, atypical, and malignant tumors. The prototype is a hemangioma, which is most often nonpalpable and is detected on routine screening. Different histopathologic subtypes of hemangioma have been described, including perilobular, venous, cavernous, and capillary hemangioma. Other benign vascular lesions include anastomosing hemangioma, a well-circumscribed proliferation of anastomosing blood vessels with lobular or diffuse growth pattern which affects a large segment of the breast, presenting as a painless slow enlarging palpable mass. Recent data suggest that benign vascular lesions diagnosed on core needle biopsy with concordant radiologic and pathologic findings do not require excision and have an excellent prognosis, except angiomatosis, which can be locally aggressive and may recur. The main focus of this study is to present the radiographic, gross, and histopathologic characteristics of benign vascular lesions of the breast and their differential diagnoses.
Topics: Humans; Female; Neoplasm Recurrence, Local; Breast; Hemangioma; Biopsy, Large-Core Needle; Angiomatosis; Breast Neoplasms
PubMed: 37032453
DOI: 10.1177/10668969231160254 -
Journal of Clinical Ultrasound : JCU Oct 2023Breast conservative treatment (BCT) is currently accepted as the standard treatment option for breast cancer. Targeted ultrasound helps detect recurrent lesions,... (Review)
Review
Breast conservative treatment (BCT) is currently accepted as the standard treatment option for breast cancer. Targeted ultrasound helps detect recurrent lesions, postoperative changes, and scarring tissue. In this pictorial essay, we review the ultrasound features of benign (seroma, hematoma, fat necrosis, traumatic neuroma, fibrosis/scarring) and malignant (recurrence, new primary cancer) causes of palpable lumps after BCT and provide images from our patients to illustrate some typical findings of common pathologies. Ultrasound, especially as an adjunct to mammography, can make a specific diagnosis in most cases.
PubMed: 37526634
DOI: 10.1002/jcu.23524 -
World Journal of Clinical Cases Dec 2023Snapping triceps syndrome (STS) is a rare disease, while occurrence of bilateral STS is extremely rare. It is usually accompanied by dislocation of the ulnar nerve and...
BACKGROUND
Snapping triceps syndrome (STS) is a rare disease, while occurrence of bilateral STS is extremely rare. It is usually accompanied by dislocation of the ulnar nerve and double snapping is a clinically important feature. However, to the best of our knowledge, there has been no report of bilateral STS in young active patient.
CASE SUMMARY
A 23-year-old male presented with a complaint of discomfort and snapping on the medial side of both elbows while performing push-ups. On physical examination, two distinct snaps that were both palpable and audible were detected on additional clinical examination. Dynamic ultrasonography showed that the ulnar nerve and the medial head of the triceps were dislocated anteriorly over the medial epicondyle of the elbow during flexion motion. Finally, he was diagnosed as dislocation of the ulnar nerve and STS. Staged anterior subcutaneous transposition of the ulnar nerve combined with partial resection of the snapping portion of the triceps was performed. The patient's pain and snapping symptoms were resolved immediately after surgery. Three months later, the patient was completely asymptomatic and returned to normal activity.
CONCLUSION
STS should be included in the differential diagnosis for active young patients who present with painful snapping on the medial side of the elbow joint, particularly when dislocation of the ulnar nerve is detected. Dynamic sonography is used to assist in accurate diagnosis and differentiation between isolated dislocation of the ulnar nerve and STS.
PubMed: 38130777
DOI: 10.12998/wjcc.v11.i34.8228 -
Cureus Dec 2023Fibroadenomas of the breast are common benign lesions that predominantly affect young women. This review provides a comprehensive overview of fibroadenoma management,... (Review)
Review
Fibroadenomas of the breast are common benign lesions that predominantly affect young women. This review provides a comprehensive overview of fibroadenoma management, encompassing their definition, clinical presentation, diagnostic tools, surgical management, clinicopathological correlations, treatment outcomes, complications, and emerging research. Fibroadenomas typically present as palpable breast lumps, often with no associated nipple discharge, and their diagnosis relies on a combination of clinical examination, breast imaging, and pathological confirmation. Surgical interventions, including excisional biopsy and lumpectomy, offer symptom relief and favorable long-term outcomes. Minimally invasive techniques and ongoing research into genomics and molecular aspects hold promise for the future of fibroadenoma management. Multidisciplinary collaboration among healthcare providers is paramount, ensuring accurate diagnosis, personalized treatment decisions, and holistic patient care. As research advances, the management of fibroadenomas is poised to evolve, providing improved diagnostic accuracy, minimally invasive treatments, and enhanced patient outcomes.
PubMed: 38288219
DOI: 10.7759/cureus.51329 -
Mayo Clinic Proceedings May 2024Sclerosing mesenteritis (SM), an idiopathic nonneoplastic condition affecting 0.18% to 3.14% of the population, is characterized by chronic fat necrosis, inflammation,... (Review)
Review
Sclerosing mesenteritis (SM), an idiopathic nonneoplastic condition affecting 0.18% to 3.14% of the population, is characterized by chronic fat necrosis, inflammation, and fibrosis most commonly of the mesentery of the small intestine. Sclerosing mesenteritis typically presents in the fifth or sixth decade of life, where patients with a history of abdominal surgery and/or autoimmune disease may be at higher risk. While many patients are asymptomatic, clinical features and complications are related to the mass effect resulting from the inflammation and fibrosis involved in the pathogenesis of SM. When present, common signs, symptoms, and complications include abdominal pain, weight loss, diarrhea, palpable abdominal mass on examination, bowel obstruction, chylous ascites, and mesenteric vessel thrombosis. Although SM was historically diagnosed predominantly by biopsy, current practice has shifted away from this to computed tomography imaging of the abdomen, given the invasive nature of biopsy. However, certain conditions, including mesenteric neoplasia (lymphoma, metastatic carcinoid tumor, desmoid tumor, mesenteric carcinomatosis), can mimic SM on imaging, and if clinical suspicion is equivocal, a biopsy may be warranted for definitive diagnosis. Asymptomatic patients do not require treatment. For patients with pronounced symptoms or complicated SM, the combination of tamoxifen 10 mg twice daily and prednisone 40 mg daily is the first-line pharmacotherapy; no randomized controlled trial of this regimen has been performed. Rarely, surgery may be necessary in cases of persistent bowel obstruction refractory to medical management. Sclerosing mesenteritis has an overall benign course in most cases, but disease progression and fatal outcomes have been reported.
Topics: Humans; Panniculitis, Peritoneal; Diagnosis, Differential
PubMed: 38702129
DOI: 10.1016/j.mayocp.2024.01.019 -
Cureus Nov 2023Granulomatosis with polyangiitis (GPA), formerly Wegener's granulomatosis, is a small- and medium-vessel vasculitis with characteristic cutaneous morphologic...
Granulomatosis with polyangiitis (GPA), formerly Wegener's granulomatosis, is a small- and medium-vessel vasculitis with characteristic cutaneous morphologic presentation and systemic involvement. Most patients have palpable purpura at some point in their disease course, but this is not always the presenting manifestation. This autoimmune disorder can affect a range of organs, with the upper and lower respiratory tract, kidneys, and nervous system being commonly implicated, while gastrointestinal and cardiac involvement is less frequent. This is a 44-year-old female presenting to the emergency department (ED) with polyarthralgia and palpable purpura. Palpable purpura was distributed on the oral palate, elbow, and lower back, and a punch biopsy revealed leukocytoclastic vasculitis (LCV). While this was an atypical distribution for leukocytoclastic vasculitis, the skin biopsy provided the necessary evidence to diagnose GPA. This case characterizes non-specific and atypical signs and symptoms of GPA that all providers should be aware of in order to diagnose the condition early in its disease course.
PubMed: 38116340
DOI: 10.7759/cureus.49056 -
Journal of Digital Imaging Aug 2023The objective of this study is to develop a radiomic signature constructed from deep learning features and a nomogram for prediction of axillary lymph node metastasis...
The objective of this study is to develop a radiomic signature constructed from deep learning features and a nomogram for prediction of axillary lymph node metastasis (ALNM) in breast cancer patients. Preoperative magnetic resonance imaging data from 479 breast cancer patients with 488 lesions were studied. The included patients were divided into two cohorts by time (training/testing cohort, n = 366/122). Deep learning features were extracted from diffusion-weighted imaging-quantitatively measured apparent diffusion coefficient (DWI-ADC) imaging and dynamic contrast-enhanced MRI (DCE-MRI) by a pretrained neural network of DenseNet121. After the selection of both radiomic and clinicopathological features, deep learning signature and a nomogram were built for independent validation. Twenty-three deep learning features were automatically selected in the training cohort to establish the deep learning signature of ALNM. Three clinicopathological factors, including LN palpability (odds ratio (OR) = 6.04; 95% confidence interval (CI) = 3.06-12.54, P = 0.004), tumor size in MRI (OR = 1.45, 95% CI = 1.18-1.80, P = 0.104), and Ki-67 (OR = 1.01; 95% CI = 1.00-1.02, P = 0.099), were selected and combined with radiomic signature to build a combined nomogram. The nomogram showed excellent predictive ability for ALNM (AUC 0.80 and 0.71 in training and testing cohorts, respectively). The sensitivity, specificity, and accuracy were 65%, 80%, and 75%, respectively, in the testing cohort. MRI-based deep learning radiomics in patients with breast cancer could be used to predict ALNM, providing a noninvasive approach to structuring the treatment strategy.
Topics: Humans; Female; Lymphatic Metastasis; Breast Neoplasms; Deep Learning; Retrospective Studies; Magnetic Resonance Imaging; Lymph Nodes
PubMed: 36973631
DOI: 10.1007/s10278-023-00818-9 -
Urologie (Heidelberg, Germany) Apr 2024A 9-year-old boy presented to the emergency department after noticing a painless mass on the right testicle during self-examination in the shower. On physical...
A 9-year-old boy presented to the emergency department after noticing a painless mass on the right testicle during self-examination in the shower. On physical examination, both testes were mobile and painless, with the right testis twice as big as the left and exhibiting palpable resistance. Sonographic examination revealed a uniformly demarcated mass with a ventral protrusion on the right testis. Tumor markers and blood tests were normal. The testis was exposed inguinally and the tumor was enucleated, which revealed a dermoid cyst. The testicle could thus be preserved. Final histology confirmed complete excision of the benign dermoid cyst (mature teratoma). As testicular tumors in prepubertal boys are rare and usually benign, an organ-preserving procedure with perioperative biopsy should be aimed for. Due to the rarity of studies on recurrence after organ-preserving testicular surgery, we recommended regular ultrasound examinations during the first year after surgery, followed by annual examinations for a period of 5 years.
PubMed: 38568330
DOI: 10.1007/s00120-024-02313-7 -
Current Problems in Pediatric and... Sep 2023A palpable pulse on organizational culture is imperative for allowing senior leadership to understand the current state and use this as a starting point to measure the...
A palpable pulse on organizational culture is imperative for allowing senior leadership to understand the current state and use this as a starting point to measure the gap between the current state and where the organization should be to meet strategic goals related to quality and safety. Knowledge gleaned from causal analysis and coding of safety events provides the organization with that information. Our organization was unknowingly making decisions on a small quantity of coded and classified events, which led to mistakes on our journey to becoming a high-reliability organization. To remedy this, the Quality and Safety Team improved the user interface of the event reporting system and created standard work for all frontline staff, physicians, area managers and senior leaders. After several interventions, we reduced the time between reported events and documented resolution by 15.28% and increased the quantity of coded and classified safety events tenfold. These changes improved our organization's ability to make better informed decisions and plot a more precise course on the journey to becoming a high-reliability organization.
Topics: Humans; Quality Improvement; Reproducibility of Results; Delivery of Health Care; Organizational Culture; Decision Making; Leadership
PubMed: 37980236
DOI: 10.1016/j.cppeds.2023.101464