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Ultrasonography (US) is the primary imaging modality for the evaluation of pediatric scrotal disease. The ability to obtain exceptional anatomical detail and testicular perfusion information without ionizing radiation makes it the essential tool for evaluating scrotal pain and palpable masses. Challenges arise in both the performance and interpretation of scrotal US in the child. Optimizing imaging parameters and recognizing key differentiating US features help minimize misinterpretations that can lead to poor patient outcomes. Key pearls and pitfalls in pediatric scrotal ultrasound methods and diagnoses are reviewed. Knowledge of what is normal for the various ages of childhood from neonate through adolescence is necessary for accurate US analysis. Imaging evaluation of key causes of the acute painful scrotum including testicular appendage torsion, epididymitis, and testicular torsion are discussed. Sonographic features for the diagnosis of benign and malignant scrotal masses, microlithiasis, and cryptorchidism are reviewed.

Background We analyzed the clinical and imaging characteristics of patients with breast ductal carcinoma in situ with microinvasion (DCISM) and breast ductal carcinoma in situ (DCIS). Methods We analyzed the records of 40 patients diagnosed with DCISM and 61 patients with DCIS who were hospitalized at Shengjing Hospital (Shenyang, China) from January 2009 to June 2016. The size, hardness, and degree of calcification of tumors were determined by mammography and ultrasonography. Results In all, 37 DCISM patients and 45 DCIS patients showed clinical palpable masses (92.5% vs 73.77%, P = 0.018). Mammography showed that the mean size of tumor was larger in DCISM patients than that of DCIS patients (3.13 ± 1.51 vs 2.68 ± 1.77, P = 0.030). Ultrasound examination revealed calcification shadows in the solid tumor mass in 17 DCISM cases and 11 DCIS patients (42.5 vs 18.03%, P = 0.007). Furthermore, estrogen receptor positivity and progesterone receptor positivity were more common in DCIS patients (32.5% vs 54.10%, P = 0.033; 22.5% vs 45.90%, P = 0.017), and the percentage of menopausal patients were higher in DCISM patients than that of DCIS patients (70.00% vs 47.54%, P = 0.026). Conclusion Clinically palpable and calcified tumor masses on sonography are more commonly encountered in DCISM lesions.

Due to postoperative changes, imaging evaluation of patients with palpable masses after mastectomy can be challenging. There is considerable overlap between the imaging characteristics of recurrent disease and benign postoperative findings in patients with or without breast reconstruction. US is the initial modality of choice for evaluating palpable masses in most patients after mastectomy. In cases where US findings are not classic, however, other modalities are useful in problem solving, including both mammography and MRI. It is imperative that radiologists are educated about benign and malignant imaging characteristics, further workup considerations, and appropriate management. In cases where findings are not characteristic across multiple imaging modalities, biopsy may be warranted.

Palpable lesions of the scalp and face are common in clinical practice. They are usually small and benign, and the lesions tend to be treated simply according to the clinical symptoms. However, radiologic evaluation is often performed to determine the exact type and location of a lesion to ensure appropriate management. Ultrasonography is useful as a primary and definitive modality for evaluating small superficial lesions. CT and MRI are better for characterizing soft tissue features and provide superior soft tissue resolution. This article discusses various lesions and their imaging findings of the scalp and face that may present as superficially palpable masses.

Case summary A 16-year-old neutered female Korat cat presented with chronic vomiting, mild azotaemia and mild hypercalcaemia. Physical examination revealed bilateral palpable masses on each side of the trachea. Laboratory results were consistent with primary hyperparathyroidism, diagnostic imaging findings with cystic thyroid or parathyroid masses, and fine-needle aspiration cytology with thyroid hyperplasia or adenoma. In order to confirm whether one or two of the masses were the cause of the hyperparathyroidism, cystic fluid was aspirated from both for parathyroid hormone concentration measurement. The concentration was shown to exceed that of the serum manyfold in both samples, confirming both masses to be functional and of parathyroid origin. A total parathyroidectomy and thyroidectomy were performed on the right side, and a subtotal thyroidectomy and a subtotal to total parathyroidectomy on the left, without any major postoperative complications. Histopathology was consistent with bilateral parathyroid carcinoma. Relevance and novel information To our knowledge, this report is the first to describe a rare case of bilateral parathyroid cystic carcinoma in a cat. It highlights the usefulness of determining parathyroid hormone concentration in the cystic fluid of a suspected neoplastic parathyroid mass preoperatively. It also demonstrates that it may be possible to remove most of the cervical parathyroid and thyroid tissue of a cat without causing any clinically relevant hypocalcaemia or iatrogenic hypothyroidism. However, serum concentrations of ionised calcium, thyroxine and creatinine should be closely monitored in the postoperative period in order to detect and control possible complications.

Background and objective As a chronic inflammatory disease of an unknown origin, the treatment of granulomatous mastitis has always been controversial. According to some researchers, surgical treatment and certain medications, especially steroids, are more effective in treating the disease. This study aimed at evaluating the results of treatment in a group of patients with granulomatous mastitis. Materials and methods This longitudinal cohort study evaluated the treatment outcomes of 87 patients with pathology-confirmed granulomatous mastitis referred to the surgical clinic of Central Hospital in Sari, Iran. Demographic, clinical, and pathological information, treatment methods and results, and the recurrence rate were analyzed. Findings A total of 87 female patients with granulomatous mastitis aged 22–52 years with a mean age of 34 years were evaluated. All patients had palpable masses; the breast masses were painful in 48.3% of patients, and 55.2% of patients suffered from erythema and inflammation, and8% had fistulas and ulcers at the inflammation site. The patients were followed-up for an average duration of 26 months (8–48 months) after treatment and recovery. The overall recurrence rate was 24.1%, and the recurrence rate was 29.4% in patients underwent surgery, 34.8% in patients received high-dose prednisolone, and 17% in those received low-dose prednisolone together with drainage (p Conclusions According to the results, the low-dose prednisolone plus drainage was more effective with a lower recurrence rate than only surgical excision or high-dose prednisolone. In fact, the use of minimally invasive methods such as drainage plus low-dose steroids is a more effective method with fewer side effects than the other two methods.

Major and minor salivary gland malignancies come in various shapes and sizes. They can present as palpable masses or can be detected incidentally when imaging patients for other indications. A complete evaluation of salivary gland malignancies requires knowledge of the anatomy and various routes of spread of neoplasias. Computed tomography (CT) and MR imaging are complementary tools in this respect and offer useful information to the proceduralist. Advanced imaging (diffusion-weighted imaging and PET-CT) and other modalities (eg, ultrasound) help with characterization, although biopsy or excision is often needed for definitive tissue diagnosis.

There is a myriad of potential mass lesions that occur in the popliteal fossa, which present as palpable masses or are found incidentally on imaging. With a thorough knowledge and understanding of the appearances and locations of these different entities, one can narrow the differential diagnoses in the majority of cases. This will eliminate unnecessary additional investigations and enable a more rapid management. We present a review of frequently encountered and less common entities using an anatomical sieve, with the aim of providing a diagnostic approach to popliteal fossa masses.

Thread-lifting is as a minimally invasive procedure with limited scarring, rapid recovery, and fewer complications compared with the standard incisional surgery for facial rejuvenation. Using absorbable thread-like polydioxanone is a relatively simple procedure that is also performed by nonmedical professionals in Korea. Although several acute or delayed complications after using nonabsorbable thread types were also reported, it is uncommon to find cellulitis caused by a delayed complication after thread-lifting. A 41-year-old woman presented to our clinic with inflamed multiple palpable masses. She underwent 3 courses of acupoint embedding therapy at a Korean oriental medical clinic. She was treated with combination antibiotic therapy; however, the inflammation did not subside. Consequently, excisional biopsy was performed under local anesthesia. During the procedure, threads were detected and removed. Dimpling, thread exposure, alopecia, under-correction, asymmetry, and parotid gland injury also can occur as early complications of the procedure. Fortunately, these reactions are predominantly mild to moderate in intensity, and can be corrected by a relatively simple procedure. Chronic inflammatory reactions in the thread-lifting area, as identified in the authors' case, are an infrequent complication. It is recommended to consult with experts in the field for the implementation of this procedure. In addition, experts also need to notify the above side effects and solutions in advance to ensure safe and satisfactory procedures for their patients.

INTRODUCTION The American College of Radiology's Breast Imaging Reporting and Data System (BI-RADS) was developed to guide imaging-based surgical treatment in patients with breast cancer. Studies confirming the BI-RADS did not include adolescents. To evaluate the validity of this classification system in adolescents, we aim to investigate the relationship between the BI-RADS and pathology findings in adolescents. METHODS The medical data of 67 female adolescent patients, aged 12 to 18, referred to our clinic for breast-related complaints between 2013 and 2016 were reviewed retrospectively for demographic data and the results of radiologic and surgical pathologies. RESULTS The main underlying reasons for the visit at the clinic were fullness, tenderness, pain, and palpable masses. Of the 67 patients, 46 were enrolled in the study. After breast ultrasonography, patients whose complaints had diminished were subtracted from the follow-up. The mean age of the patients was 16 years (12 to 18 y). The mean mass diameter size was 3.69 cm (0.9 to 15 cm), and the mean clinical follow-up was 65.3 days (11 to 1095 d). All the patients who were surgically intervened had benign pathology. Of the 21 surgically intervened patients with BI-RADS levels of ≥3, most had fibroadenomas. CONCLUSIONS The BI-RADS classification-based treatment algorithm may not be valid in adolescents. In the present study, all patients with lesions with BI-RADS ≥3 levels had revealed benign pathologies. The BI-RADS classification may show an increased risk. However, to determine the need for a biopsy in adolescents, there is a need for larger-scale pediatric and adolescent studies using the BI-RADS classification.

Fine Needle Aspiration (FNA) is a routine diagnostic procedure essential to both medical and veterinary practices. It consists of the percutaneous aspiration of cells and/or microorganisms from palpable masses, organs or effusions (fluid accumulation in a body cavity) using a thin needle similar to the regular needle used for the venous puncture. The material collected by FNA is in general highly cellular, and the retrieved aspirate is then smeared, air dried, wet-fixed, stained and observed under a microscope. In the clinical context, FNA is an important diagnostic tool that serves as a guide to the appropriate therapeutic management. Because it is simple, fast, minimally invasive and requires limited investment in the laboratory and human resources, it is extensively used by veterinary practitioners, mostly in domestic, but also in farm animals. In studies using animal models, FNA has the advantage that it can be performed repeatedly in the same animal, enabling longitudinal studies through the collection of cells from tumors and organs/tissues over the course of the disease. In addition to routine microscopy, retrieved material can also be used for immunocytochemistry, electron microscopy, biochemical analysis, flow cytometry, molecular biology or in vitro assays. FNA has been used to identify the protozoan parasite Trypanosoma brucei in the gonads of infected mice, opening the possibility for a future diagnosis in cattle.

Objective Palpable breast abnormalities in women warrant diagnostic evaluation. Contrast-enhanced spectral mammography (CESM) is a novel technique which has demonstrated early promising results in the diagnostic imaging setting. The purpose of this study was to evaluate the role of CESM for imaging of palpable breast abnormalities and compare it to the current routine imaging work-up. Materials and methods This retrospective study included women with palpable breast masses who underwent diagnostic CESM and ultrasound between 2012 and 2019. Diagnostic parameters for low-energy images, CESM and targeted ultrasound were calculated and compared. Analysis was performed at the lesion level. Additional incidental findings were reported separately. Results Included in this study were 138 women with 147 palpable breast abnormalities, of which 38 were cancers. Standard 2D mammography revealed 36/38 cancers (sensitivity 94.7%). All 38 cancers (100%) were detected at CESM and at targeted ultrasound. Negative predictive value for 2D mammography was 97.8% (91/93), and 100% for both ultrasound (74/74) and for CESM (80/80). None of the palpable masses that were negative at CESM but positive at ultrasound (n = 13) were malignant. Two additional incidental cancers were detected with CESM at the contralateral breast to the palpable lump. Conclusion CESM could be useful for assessment of palpable breast abnormalities, potentially decreasing the number of unnecessary benign biopsies performed.

A wide range of congenital or acquired conditions, some pretty rare, may affect the vulva and vagina in children. Swelling, visible or palpable masses and abnormal discharges are common symptoms of conditions affecting the vulva and/or the lower genital tract. The majority of these diseases are benign. Ultrasonography is pivotal to elucidate the anatomical origin of these conditions and make the diagnosis. Magnetic resonance imaging can be relevant to improve diagnostic confidence and, if needed, to plan more accurate surgical treatment. The aim of this pictorial essay is to review the related imaging findings to help make radiologists familiar with these conditions.

Wilms' tumor is the most common primary malignant renal tumor. It is paradigm for comprehensive treatment of malignant solid tumors in children. Typically, children with this disorder are initially seen with abdominal distention, palpable masses or due to fever of unknown origin. Atypical tumor symptoms can be caused by complications, making it difficult to diagnose the disease. We present three clinical cases of Wilms' tumor in young children. Emergency multidetector computed tomography and magnetic resonance imaging provided the surgeon with sufficient information to perform an urgent radical resection.

Although some breast cancers present as palpable masses or with other clinical findings, many are detected at screening. Most screening is currently done with digital mammography, but high-risk patients or those with dense breast tissue may undergo additional screening examinations with magnetic resonance imaging or ultrasound. Additionally, digital breast tomosynthesis, contrast-enhanced mammography, and molecular breast imaging are newer technologies available at some sites. Optimal usage of breast imaging technologies remains controversial, both in screening and diagnostic settings following a new diagnosis of breast cancer. This article will review well established and newer, alternative breast imaging technologies as well as recent data regarding their role in optimizing patient care.

Background: Historically frenotomy was performed at newborn babies’ baptism for healthy breast-feeding over many centuries. Although it was necessary for nursing babies, its application was denied subjectively without clinical observation since the early 20th century. As a result solutions for breastfeeding and breast problems are confused now. Methods: We studied changes in breastfeeding and mothers’ breasts before and one month after the surgeries for ADEL by standards for healthy breastfeeding and breasts. Results: With regard to suckling, before the surgeries 24% of babies opened their eyes during breastfeeding, while after surgeries 76% opened eyes while nursing. 30% of the babies latched onto the mother’s breast with a wide-open mouth. After surgeries, 84% properly latched on. 73% of the babies had calluses on the upper lip before surgeries, and no calluses were observed after surgeries. 27% of babies before surgeries moved the jaws during breast-feeding, but after surgeries 88% moved the jaws while nursing. White debris was on the dorsum tongue in 70% of babies prior to surgeries. After surgeries, 22% were with debris. 67% of mothers experienced nipple pain before their babies’ surgeries while 6% had pain after the surgeries. Flattened nipples were observed in 55% of mothers before the infants’ surgeries, 7% after surgeries. 23% of mothers had breast pain before the surgeries, and 4% had breast pain after the surgeries. Mastitis was also reduced from 9% to 1% after surgeries. 73% of women had palpable breast masses, and after the surgeries 25% had palpable masses. Summary: Remarkable improvements in breastfeeding and in women’s breasts were achieved after their infants underwent operations for ADEL. These results indicate the necessity of surgical interventions in babies with ADEL for healthy breastfeeding and breasts (279).

Introduction Fine-needle aspirations (FNAs) of palpable masses are often performed by cytopathologists without ultrasound (US) guidance. Nonetheless, variations in the actual depth of palpable masses lead to occasional challenges. US guidance allows cytopathologists to visualize the mass and guide needle placement. This study retrospectively addressed the utility of US by comparing FNAs performed by cytopathologists on palpable masses with and without US guidance. Materials and methods Cytopathologist-performed FNAs with and without US guidance from March 1, 2013 to July 1, 2014 were identified. The number of passes, location of lesions, and interpretations were recorded. Available slides were reviewed to determine the proportion of passes that contained diagnostic cellular material and cases in which diagnostic material was present on the first needle pass. Results In this study, 134 palpation-guided FNAs and 118 US-guided FNAs were analyzed. The percentage of nondiagnostic cases was significantly lower for US-guided FNAs (2.5%) than for palpation-guided FNAs (12.7%; P = 0.004). The average number of needle passes was significantly lower for US-guided FNAs (2.9) than for palpation-guided FNAs (3.6; P = 0.0002). Twenty-two of 118 of US-guided FNAs (18.6%) and 6 of 134 palpation-guided FNAs (4.5%) were completed after only a single pass ( P = 0.0008). The percentage of passes with diagnostic material was significantly higher for US-guided FNAs (73.6% versus 60%; P = 0.0002). Conclusions For palpable masses, US-guidance adds value to cytopathologists in obtaining diagnostic cellular material more often on the first pass and with fewer passes overall than by palpation alone. This has a potentially beneficial impact on patient care owing to the increased precision and accuracy of needle guidance with ultrasonography.

A variety of diffuse diseases affect the calvaria. They may be identified clinically as palpable masses or incidentally in radiologic examinations. The purpose of this study is to illustrate the main diffuse calvarial lesions starting from a case report of fibrous dysplasia of the cranial vault. A 68-year-old male patient who presented with a history of right otalgia and bloody otorrhea was diagnosed to have fibrous dysplasia based on the radiological features. Most diffuse diseases of the calvaria are benign non-neoplastic lesions of unknown origin. The radiologist has a long list of differential diagnosis and their true etiology may be puzzling when the medical evaluation is based only on imaging findings.

Breast biopsies are common surgical specimens to search for possible cancer via evaluation of palpable masses, radiologic lesions, or nipple discharge. It is crucial for the pathologist to have the knowledge of all the breast specimens that could be received, and the best manner to process them, in order to provide accurate information about the diagnosis, prognostic factors (e.g., tumor staging, histologic type, precursor lesions, etc.) and assessment of treatment response. Appropriate grossing of breast specimens is indeed a cornerstone for achieving a quality diagnosis. We also must consider that grossing of breast specimens has been evolving over the past few decades. As image-guided core-needle biopsy has gradually replaced surgical biopsy in the initial assessment of breast lesions, most patients have a definitive diagnosis at the time of excision.

Hydatid cysts is most often characterized by hepatic and pulmonary involvement, but it also rarely involves other body parts and systems. Axillary involvement by hydatid cysts is considerably rare in countries with endemic hydatid cyst manifestation, and cases from countries like Turkey are still widely reported. A young woman aged 24 years was seen at our clinic for a painful axillary mass. She was detected by a thoracoabdominal tomographic examination to have a localized multilocular cystic mass in her left axillary region; the mass showed little soft tissue invasion at its periphery but no hepatic or pulmonary involvement at all. It was excised from its stalks and totally removed. The diagnosis of hydatid cyst was made by macroscopic and microscopic examination. It was highlighted by this case report that the differential diagnosis of palpable masses in axillary region should include hydatid cyst, particularly in areas where the disease is endemic.

An eight-year-old male neutered boxer and a 10-year-old female neutered lurcher were presented with palpable masses in the region of the right parotid salivary gland. In both cases, fine needle aspirates yielded adipose cells, normal salivary epithelium and some blood contamination. CT images showed a mixed fat attenuating mass in the region of the right parotid salivary gland, without a normal ipsilateral parotid salivary gland. Surgical excision was performed in both cases and histopathology was consistent with sialolipoma. Neither mass has recurred 7 and 16 months after surgery. Sialolipoma should therefore be considered as a differential in dogs with a mass in this location. Fine needle aspirates showing salivary epithelium and adipose cells should not be dismissed as non-diagnostic. To the authors’ knowledge, these are the two first reported cases of sialolipomas of the parotid salivary gland in dogs and the first description of cross-sectional imaging of sialolipomas.

Nodular fasciitis of the breast is a rare, benign, proliferative disease characterized by sudden onset and rapid growth. It can clinically and radiologically mimic breast cancer. We present imaging findings from two cases of nodular fasciitis that initially manifested as palpable masses. Sonographically, they appeared as irregular, not-circumscribed hypoechoic nodules. The diagnosis of nodular fasciitis was made by US-guided core needle biopsies. US-guided vacuum-assisted excision was subsequently performed in the first case, while the second resolved via spontaneous regression.

Tuberkuloz, sternumu nadiren tutmaktadir. Erken donemde en sik gorulen semptomlar gogus agrisi ve sternum uzerinde ele gelen kitlelerdir. Tanisi gecikmis olgularda kutanoz fistuller, sternumda spontan kirik ve sternum disi yayilim gorulebilmektedir. Bu yazida, bir aydir devam eden gogus agrisi ve sternum alt ucunda ele gelen kitleler ile basvuran ve histopatolojik ve mikrobiyolojik olarak sternum tuberkulozu tanisi kesinlesen 53 yasinda bir erkek olgu sunuldu. Kitleler iki aylik antituberkuloz tedavisi ile kuculdu. Dokuz aylik tedavi sureci, herhangi bir yan etki gorulmeden tatminkar sonuclar verdi. Anah tar soz cuk ler: Osteomiyelit; sternum; tuberkuloz. Tuberculosis involving the sternum is rare. The most common symptoms at the early stage are chest pain and palpable masses on the sternum. Cutaneous fistulas, spontaneous fracture of sternum and extrasternal spread may develop in cases with late diagnosis. In this article, we report a 53-yearold male case admitted with a one-month history of chest pain and two palpable masses on his lower sternal part of chest in whom the diagnosis of sternal tuberculosis was confirmed by histopathologically and microbiologically. The masses were reduced in size with two-month anti-tubercular therapy. The nine-month duration of the therapy produced satisfactory results without any adverse reactions.

Palpable mass is a common complaint presented to the breast surgeon. It is very uncommon for patients to report breast mass associated with palpable masses in other superficial structures. When these masses are related to systemic granulomatous diseases, the diagnosis and initiation of specific therapy can be challenging. The purpose of this paper is to report a case initially assessed by the breast surgeon and ultimately diagnosed as granulomatous variant of T-cell lymphoma, and discuss the main systemic granulomatous diseases associated with palpable masses involving the breast.

An 18-year-old female complains of weakness and decreased bulk of her right thigh. This started 2 years ago with decreased strength of her knee extension. She progressively noticed loss of muscle mass in her thigh as well as weakness in her hip flexors. She also has numbness on the inner aspect of the right leg but no pain. PMH significant for asthma. FH positive for spinal stenosis in her father, type 2 diabetes in the paternal grandmother and “a nerve problem” in 2 aunts. Examination reveals significant atrophy of the right quadriceps, with 4/5 strength, right iliopsoas 4/5, and an absent right knee jerk. Sensation is decreased to light touch on the medial aspect of the leg (saphenous n distribution). There is no Tinel’s sign or palpable masses.

Ideally, scrotal ultrasound should distinguish between tumorous and non-tumorous lesions and – in the former category – between benign and malignant tumours. Most testicular tumours present as a palpable mass, but not all palpable masses are malignant tumours, nor are all testicular lesions palpable.

We report the case of an 80-year-old woman, presented to our department for an Intestinal obstruction due to postoperative adhesions from an anterior exploratory laparotomy. Preoperative imaging showed a downward elongation of the liver, ending at the level of the iliac crest. Originally reported in 1888 by a German Surgeon named Carl Ludwig Riedel in seven female patients who had palpable masses, they were all confirmed by surgical exploration. The potential complications are rare and include torsion, mass effect morbidity and laparoscopic associated difficulty during different surgical procedures. Unnecessary imaging can be avoided with the knowledge of this normal variant of the right lobe of the liver.

Introduction The purpose of this work is to present 8 minilaparoscopic-assisted transvaginal appendectomies using rigid instruments in patients with acute appendicitis. Material and methods Eight minilaparoscopic-assisted transvaginal appendectomies were performed from the 10th of August 2009 to the 30th of June 2010. The inclusion criteria were women between 18 and 65 years of age with a diagnosis of acute appendicitis. The exclusion criteria were palpable masses, appendicular abscesses, ASA III and IV; morbid obesity (BMI>35); gynaecological infections; virgin patients and pregnant women. The surgical intervention was performed with rigid instruments. Surgical time, the need for post-operative analgesics, and post-surgical complications. Results The age range varied between 18 and 42 years, with a mean of 29.6 years. The mean surgical time was 48.3 min (37–75 min). Analgesics were given to 2 patients after surgery (1 parenteral and 1 oral). Five patients were discharged before 24 h and 3 at 48 h. There were no post-operative complications. Conclusions Minilaparoscopic-assisted transvaginal appendectomy with rigid instruments, in selected women is a feasible and safe method, and with better aesthetic results than laparoscopic appendectomy, but future studies will be required that can demonstrate its advantages.

To evaluate the clinical presentation and surgical management of adult patients who were presented with renal cancer, and to compare it with findings in the international studies as to give recommendations regarding future management in Saudi Arabia. 124 adult patients were included in the study. The data were reviewed for all patients. All data were entered and analyzed; the statistics obtained were the minimum values, maximum values, mean value and standard deviations. The age of the patients varied between 27 86 years old with a mean age of 54.08 (±10.75) years, 96 (77.42%) patients were males while 28 (22.58%) were females. For clinical presentation, 32 (25.8%) patients were asymptomatic diagnosed during a general check up, 44 (35.5%) patients presented with gross hematuria, 14 (11.29%) patients presented with palpable masses, and 42 (33.87%) patients presented with flank pain. Among all renal tumor histological subtypes, conventional clear cell cancer was found in 66 (53.22%) patients, while transitional cell cancer was documented in 8 (6.45%) patients. Renal cancer is not a common disease. This study demonstrated the presence of some different clinical and pathological presentation than what has been reported in the literature. Multicenter national studies are needed to improve the outcomes for the management of renal cancer.

Calvarial lesions often present themselves as clinically silent findings on skull radiographs or as palpable masses that may cause localized pain or soreness. This review aims to explore the radiographic, computed tomography (CT), and magnetic resonance imaging (MRI) characteristics of calvarial neoplastic, inflammatory, and congenital lesions that are common in adults in order to facilitate a structured approach to their diagnosis and limit the differential diagnosis. In addition to reviewing the literature, we reviewed the records of 141 patients of the Montreal Neurological Institute and Hospital with radiologically documented calvarial lesions between 2001 and June 2009. CT is ideal for detecting bony lesions and is helpful in precisely localizing a lesion pre-surgically. MRI is best at identifying intradiploic lesions before they affect the cortical tables and is able to establish extraosseous involvement, especially when paramagnetic contrast is employed.

A total of 1170 rats comprised of 65 male and 65 female Han Wistar rats per group were exposed for 2 h/day, 5 days/ week for up to 104 weeks to GSM or DCS wireless communication signals at three nominal SARs of 0.44, 1.33 and 4.0 W/kg. A preliminary study confirmed that the highest exposure level was below that which was capable of causing a measurable increase in the core temperature of the rat. Additional groups for each modulation were sham exposed, and there was also an unrestrained, unexposed (cage) control group. Fifteen male and 15 female rats per group were killed after 52 weeks. From the remaining 50 male and 50 female rats per group, surviving animals were killed after 104 weeks. Evaluations during the study included mortality rate, clinical signs, recording of palpable masses, body weight, food consumption, ophthalmoscopic examination, and clinical pathological investigations. Terminal investigations included organ weight measurement and macroscopic and microscopic pathology examinations. There was no adverse response to the wireless communication signals. In particular, there were no significant differences in the incidence of primary neoplasms, the number of rats with more than one primary neoplasm, the multiplicity and latency of neoplasms, the number of rats with metastases, and the number of benign and malignant neoplasms between the rats exposed to wireless communication signals and rats that were sham exposed.

Head and neck lumps are common and a significant proportion are malignant.Quick Early Diagnosis is best achieved in the setting of a “One Stop Clinic”.A relevant clinical history is frequently critical to narrowing the differential diagnosis or establishing the significance of radiological findings.Ultrasound±fine needle aspiration cytology (FNAc) will make the diagnosis in the majority of cases.Distinguishing normal structures from lymphadenopathy and non-nodal pathologies is an important step in differential diagnosis.Additional cross-sectional imaging may be required to characterize deep seated disease, markedly inflammatory or infiltrative processes, and stage malignancy. High-resolution ultrasound is now the imaging modality of choice for the assessment of the vast majority of palpable swellings in the head and neck. In experienced hands, it is frequently the only imaging technique required for diagnosis, as it can be performed rapidly, safely and permits accurate tissue sampling. A systematic approa...

Background and aim The use of conventional needle core biopsy for palpable masses and vacuum-assisted needle core biopsy for microcalcifications has significantly increased the preoperative diagnosis rate, but the strategy for those patients with lesions of uncertain malignant potential (B3) still remains controversial. The aim of this study was to evaluate the positive predictive value (PPV) of the malignancy of B3 lesions in order to establish their correct management in the setting of a multidisciplinary care pathway. Methods Data from all patients who had a Needle Core Biopsy (NCB) or a Vacuum-Assisted Needle Core Biopsy (VANCB) between 2005 and 2014 were retrospectively collected and analyzed. The B3 patients were discussed by the Multidisciplinary Team (MDT) deciding for surgery or for follow-up, based on a score in which clinical-instrumental factors and environmental factors were considered. The PPV of malignancy of all surgically excised B3 lesions was calculated. Results One hundred and seventy-eight B3 NCBs were included in the study and Atypical Epithelial Proliferation of Ductal Type (AEDPT) was the most represented subcategory. The final histopathology report of the 128 patients operated on showed 94 benign and 34 malignant lesions. The PPV of B3 patients referred to surgery was 26.5%. Conclusion B3 patients should be evaluated by a breast MDT in order to make the right therapeutic decision, in particular for patients with contrasting clinical/diagnostic findings. Larger prospective studies are required to assess the definitive PPV of each B3 subcategory.

Groups of Crl:CD-1 (ICR) mice (60/group/sex) were fed 0 (2 control groups), 5000, 20,000, or 40,000 ppm of enzymatically sourced (2R,4R)-monatin salt ("R,R-monatin") in the diet for up to two years. There were no adverse effects on survival, incidence of palpable masses and tumors, feed consumption, hematology or serum chemistry parameters, organ weights, or ophthalmic, macroscopic, and microscopic examinations. The only notable effect was statistically significantly lower mean body weights and body weight gains in all treated groups, which generally occurred throughout the study and were most likely a result of caloric dilution of the test diets and not considered adverse. There were no test article-related changes in the incidence or occurrence of neoplastic diseases in mice on this study. The no-observed-effect-level (NOEL) for carcinogenicity of R,R-monatin fed to mice for 24 months was 40,000 ppm, the highest dietary concentration tested, which was equivalent to approximately 6502 and 7996 mg/kg bw/day in males and females, respectively.

Ultrasound use should be considered in most instances of a palpable breast finding, particularly in young women. A primary advantage is the ability to directly correlate the physical exam finding with imaging. Ultrasound is useful in characterizing palpable masses as well as detecting cancer in women with negative mammograms. The negative-predictive value of imaging for cancer in the evaluation of a palpable lump is very high, which may reassure women with low-suspicion palpable findings. Short-term follow-up of a palpable mass with benign features may be feasible, though further study is needed to establish criteria. A suspicious dominant palpable finding should be further evaluated even if imaging is negative.

A 63-year old lady attended the Accident and Emergency Department with a history of having fallen on to her left knee and landing on her handbag. Initial examination revealed a small transverse laceration measuring about 1 cm just above the level of the tibia tuberosity of her injured knee (Fig. 1). The patient was able to fully weight bear and had full range of movement of her injured knee with some pain only during flexion. There were no palpable masses or any evidence of the presence of a foreign body. There was a small puncture hole in her handbag which inside was stained with ink. The patient

A 66-year-old woman presented with complaint of palpable masses throughout her body. A contrast-enhanced, electrocardiogram-gated CT angiogram of the heart using a 256-channel scanner showed a large mass arising from the tricuspid valve. A biopsy of a mass in the patient's breast showed diffuse large B-cell lymphoma. Cardiac lymphoma usually presents as part of widespread disease. Involvement of the right atrium is typical, but the valves are usually spared, making this case atypical. On CT, cardiac lymphoma often manifests as an infiltrating, ill-defined epicardial or myocardial mass.

he most important prognostic factor in cancer of thehead and neck is the status of the cervical lymphnodes. For this reason, surgical therapy of the neck is anessential part of the treatment and prognostic evaluationof these malignancies.The grandfather of neck dissection in North America isGeorge Crile of the Cleveland Clinic. By 1906, stronglyinfluenced by Halsted, Crile believed that if the necklymphatics could be removed in a “radical” manner anden bloc, more cures could be accomplished.Head and neck surgery made little progress in theensuing decades in North America. The various surgi-cal groups interested in head and neck cancer acknowl-edged a need for a more focused effort. To this goal, ahead and neck service was established by Henry Jane-way at the Memorial Hospital in New York City in1914. Hayes Martin had a profound influence on thedirection and dogma of head and neck surgery. Theradical operation was standard. The radical operation’soncologic premise was “the bigger the operation thebetter the chance for cure.”It soon became evident to all those involved in themanagement of patients with head and neck cancer thatthe radical operation was reasonable for the treatment oflarge palpable masses, but excessive for patients withoutpalpable nodes with a high risk of cervical metastasis andfor some patients with small palpable nodes. It was alsonoteworthy that radical neck dissection was not practicalas a simultaneous bilateral procedure.At the beginning of the second part of the century,there were rumors about an operation called “functionalneck dissection” that was performed by an Argentineannamed Osvaldo Sua´rez. He was on the staff of the Depart-ment of Otolaryngology, and also worked at the Depart-ment of Anatomy under the direction of Pedro Ara. Pro-fessor Ara was known as the “Spanish anatomist,” and hewas very popular in Argentina for having embalmed thecorpse of Eva Pero´n. His dual projection as an anatomistand otolaryngologist conferred Sua´rez a privileged posi-tion. As an otolaryngologist, he had a thorough knowl-edge of head and neck cancer, especially cancer of thelarynx. Functional neck dissection was designed to re-move the lymphatic tissue of the neck and preserve theremaining neck structures. However, the operation wasnotappealingforthefollowingtworeasons:(1)Itwaslessthan the accepted dogma of the time, ie, radical neckdissection; and (2) the name suggested a dangerous ap-proachtocancer.Howcanaterriblediseaselikecancerbetreated with a mild “functional” operation? (Rememberthat Halstedian principles were still leading the world ofoncology at that time.) As an anatomist, he was veryfamiliar with all anatomic details concerning neck dissec-tion. The operation, as performed by Sua´rez, was clean,systematic, comprehensive, and easy to understand andteach.Themaingoalofthe“functional”approachtoneckdissection proposed by Sua´rez was removal of all lym-phatic tissue in the neck and preservation of the remain-ing neck structures. This is achieved by using the fascialplanes of the neck that surround most cervical structuresandseparatethemfromadjacentlymphatictissue.Apply-ing the technical details of functional neck dissectionwithout understanding the spirit of the procedure resultsinalargenumberofdifferentoperations,betheyselectiveoperations, modified procedures, or limited neck dissec-tions (or any other name). This is in part what happenswith most neck dissection classifications currently usedin the literature. On the other hand, understanding thespirit of the procedure but using the wrong techniquesproduces a messy operation that is difficult to understandand teach.What is not clear, on a statistically supported basis, iswhat dissection is appropriate for which clinical scenario.The question of whether many of the modifications makeany clinical difference in terms of survival, morbidity, orany other measure of value has not been answered. Onlyempirical assumptions are offered as a basis for theserecommendations. It is unlikely that statistical data willbe forthcoming in the immediate future because thewhole issue of neck dissection type is being overshad-owed by the issues surrounding neck treatment whenconcomitant chemotherapy–radiation programs are usedas initial treatment for both the primary site and neckmetastases.

Objective: To describe clinical and imaging findings of distended scapulothoracic bursitis without scapular snapping, which is often confused with a soft tissue tumor. Methods: Nine patients (6 male, 3 female; age range: 50-73 years; mean age = 67 years) with distended scapulothoracic bursitis diagnosed by clinical and magnetic resonance (MR) imaging findings were studied. The results of a histologic examination were available in 1 case. Results: All patients presented with painless palpable masses below the scapula, and the initial diagnoses were soft tissue tumors. On MR images, the lesions were 5.5 to 12 cm in maximum diameter (mean = 7.7 cm) and well-demarcated cystic masses situated in the subscapular region between the serratus anterior and the chest wall. There was no solid portion on the cyst walls. The findings of hemorrhage within the bursae were present in all cases. Every mass regressed in size spontaneously after a few to several weeks, and no lesions revealed any malignant findings of sarcomas. Conclusions: Distended scapulothoracic bursae without scapular snapping resemble soft tissue tumors. They have some specific MR findings; therefore, precise recognition of these findings is important to avoid misdiagnoses and unnecessary treatments.

The purpose of this study was to assess the MR imaging appearance of palpable fatty masses and to propose terminology for palpable subcutaneous fatty masses that are nonencapsulated on MR imaging.We searched the past 7 years of our institution's radiology database for reports of MR images containing the word "lipoma." Medical records were reviewed to identify patients with palpable masses corresponding to fat. Two radiologists retrospectively reviewed the MR images for the presence of an encapsulated or nonencapsulated fatty mass in the region of the palpable abnormality. Pathologic specimens, when available, were also reviewed.Between 1995 and 2001, 184 palpable subcutaneous fatty masses were evaluated on MR imaging. Of these, 46% (85/184) were encapsulated lipomas and 54% (99/184) were nonencapsulated fatty masses on MR imaging. Four masses (three encapsulated and one nonencapsulated) were surgically resected and had pathology consistent with lipomas.Many palpable fatty masses do not have definable capsules on MR imaging. We propose that a palpable mass that corresponds to a nonencapsulated prominence of subcutaneous fat on MR imaging should be reported as a nonencapsulated lipoma. More definitive reporting of this relatively common lesion will assure the referring clinician of the benign nature.

Clinical images emphasizing on magnetic resonance imaging (MRI) characteristics of silicone-injected breasts with microscopic correlation were presented. A total of 16 patients with a history of silicone injection breast augmentation received MRI examinations due to palpable masses were reviewed. MRI enables the demonstration of the characteristic MR intensities in silicone-injected breasts. Four breast cancers were accurately detected by the enhancement technique including the cancers admixing within the fibrosis and silicone granuloma. This article can document the excellent ability of MRI with high microscopic correlation in examining these clinical, mammographic and ultrasonographic difficult cases. Understanding the MRI features is helpful to approach these patients. On the other hand, these illustrations indicated the importance of enhancement technique in detecting the cancers and in differentiating the angiogenic lesions from nonenhanced silicone granulomas.

To evaluate the ability of shear-wave elastography (SWE) to distinguish between benign and malignant palpable masses of the adult male breast.Clinical examination, mammography, B-mode and Doppler ultrasound findings and SWE quantitative parameters were compared in 50 benign lesions (including 40 gynaecomastias) and 15 malignant lesions (invasive ductal carcinomas) from 65 patients who were consecutively addressed for specialized advice at our comprehensive cancer centre. Mean elasticity (El mean), maximum elasticity (El max), El mean of the surrounding fatty tissue and lesion to fat ratio (El ratio) were reported for each patient.Malignant masses displayed significantly higher El mean (p0.0001), El max (p0.0001) and El ratio (p0.0001) compared to benign masses without overlap of values between the two groups. By adding SWE to clinical examination, mammography and ultrasound, all the lesions would have been retrospectively correctly diagnosed as benign or malignant. One false positive could have been downstaged, 14/65 undetermined masses could have been correctly reclassified as 4 malignant and 10 benign lesions, for which biopsies could have consequently been avoided.Evaluation of male breast palpable masses by SWE demonstrates that malignant masses are significantly stiffer lesions and may improve diagnostic management when clinical examination, mammography and conventional ultrasound are doubtful. Advances in knowledge: Quantitative SWE is feasible in male breast and could be of great interest to help classify doubtful lesions after classical clinical and radiological evaluations, probably because of different anatomy and different tumours epidemiology compared with female breast.

Peroneal intraneural ganglion cystsusually occur in adult male population and may cause neurological symptoms. Most patients complain of pain and palpable mass located near the lateral part of the fibular neck where peroneal nerve passes through.Most of the patients share complaints of pain and palpable masses located near the lateral part of the fibular neck where peroneal nerve passes through. We would like to present the case of a 14-year-old girl who presented in our clinic with pain and mass at the lateral side of her knee and drop foot due to a peroneal intraneural ganglion cyst, a rare cause of lower extremity paralysis. In order to regain best possible recovery, quick diagnosis and immediate treatment are essential in such cases. Magnetic resonance imaging (MRI) provides reliable and proper information and while also shedding light on therapeutic approaches. Key words: Ganglion Cyst; Peroneal Nerve; Superior Tibiofibular Joint; Magnetic Resonance Imaging., Peroneal intranöral ganglion kisti, genelde erişkin yaşta erkeklerde ortaya çıkar ve nörolojik bulgulara yol açabilir. Hastaların çoğunda peroneal sinirin geçtiği fibula boynu laterali komşuluğunda ele gelen şişlik ve ağrı şikayeti ile karşılaşılmaktadır. Tanıda elektromiyografi ve radyolojik görüntüleme yöntemleri kullanılmaktadır. Biz burada dizinin dış yan tarafında ağrılı şişlik ve düşük ayak klinik tablosu ile başvuran 14 yaşında kız hastada alt ekstremite paralizisinin nadir nedenlerinden biri olan peroneal sinir yerleşimli intranöral ganglion kisti olgusunu sunduk. Sinir fonksiyonlarının geri kazanılabilmesi için mümkün olan en kısa zamanda cerrahi müdahale yapılmalıdır. Manyetik rezonans görüntülemesi (MRG) bu lezyonun hızlı ve doğru tanısına katkı sağlamakta ve tedavi yaklaşımlarına ışık tutmaktadır. Anahtar kelimeler: Ganglion Kisti; Peroneal Sinir; Süperior Tibyofibular Eklem; Manyetik Rezonans Görüntülemesi.