Mammographic and Sonographic Features of Breast Cancer in Women Before 30 Years of Age

Background: Breast cancer uncommonly occurs in young women, but, tends to be diagnosed at a later stage and have a poorer prognosis than in older women. Standard screening guidelines for this age group are not established and the radiologic features of breast cancer in young women are not fully studied yet, because of the low incidence. Objectives: To investigate the imaging findings for breast cancer in women aged 30 years or younger and to correlate them with clinicopathologic features and immunohistochemical subtypes. Methods: The study included 52 women with surgically confirmed breast cancer. The medical records of the patients were retrospectively reviewed and the mammographic and ultrasonographic findings were evaluated according to the fifth edition of the ACR BI-RADS lexicon. Results: Most of the tumors in this study were presented as a self-detected mass (42/52, 80.8%) and were of histologic grade III (31/43 invasive carcinoma, 72.1%) and the estrogen receptorpositive subtype (32/52, 61.5%). The most common mammographic finding was an irregular (19/24, 79.2%), indistinct (16/24, 66.7%), and hyperdense (20/24, 83.3%) mass. The ultrasonographic findings were of an irregular (32/47, 68.1%), indistinct (19/47, 40.4%), and hypoechoic/ heterogeneous (40/47, 85.1%) mass with no posterior features (34/47, 72.3%). An oval/round-shaped mass on ultrasonography was also correlated with triple-negative cancer (p=0.011). Conclusion: On mammography and ultrasonography, breast cancer in young women usually presents as a mass with irregular shape and indistinct margin. Some radiologic findings could be used to predict the molecular phenotype of the tumor.

A Prospective Study to Evaluate the Reliability of Thyroid Imaging Reporting and Data System in Differentiation between Benign and Malignant Thyroid Lesions

Objectives: To evaluate diagnostic reliability of the daily use of thyroid imaging reporting and data system (TIRADS) classification proposed by Kwak et al., in differentiating between a benign and a malignant thyroid lesion, to calculate inter-observer variability in the interpretation of each of the TIRADS ultrasound features and to evaluate role of TIRADS system in reducing unnecessary biopsies of benign lesions. Materials and Methods: Three hundred and sixty-five patients with clinically suspected thyroid lesions during the period from November 1, 2011, to August 31, 2015, were prospectively scanned on gray-scale and Doppler imaging by six radiologists separately. We used GE VOLUSON 730 PRO machine (GE healthcare, Milwaukee, USA) equipped with a 7.5–12 MHz high-frequency linear array transducer with color and power Doppler capability. We evaluated five sonological features: Internal composition, echogenicity, margins, presence and type of calcification, and shape of the lesion. Based on the TIRADS proposed by Kwak et al., we determined categories of the thyroid lesions. The diagnostic performance of TIRADS classification system was evaluated by comparison with the fine-needle aspiration cytology (FNAC) reports which were subsequently obtained after taking informed consent from the patients. All follicular neoplasms on FNAC were further followed up with excision biopsy and histology. The cytopathological report was used as the standard final diagnosis for comparison. The P value and odds ratio were determined to quantify how strongly the presence or absence of a particular ultrasound feature was associated with benignity or malignancy in the study population. The risk of malignancy was stratified for each TIRADS category-based on the total number of benign and malignant lesions in that category. Cervical lymph nodes were also evaluated for their size, loss of the central, echogenic hilum, presence of irregular and indistinct margin, microcalcification, and necrotic changes. Cohen's Kappa coefficient was determined separately for each of the five TIRADS malignant features to study the inter-observer agreement. Furthermore, the percentage of benign cases that were accurately determined by TIRADS which could have avoided unnecessary FNAC was determined. Results: The risk of malignancy in TIRADS categories 1 and 2 was found to be 0%, 0.64% in category 3, 4.76% in category 4A, 66.67% in category 4B, 83.33% in category 4C, and 100% in category 5. Out of the five suspicious sonological features, irregular margins showed the highest positive predictive value (95.45%) for malignancy followed by taller than wide shape (92.86%), microcalcifications (66.67%), marked hypoechogenicity (54.55%), and solid composition (48.15%). The specificity of three sonological features (completely cystic structure, hyperechogenicity, and macrocalcification) in classifying a nodule as benign was 100%. Loss of central echogenic hilum, presence of an irregular and indistinct margin, microcalcification and necrosis were found to have sensitivity of 100%, 63.63%, 27.27%, and 9.09%, respectively and specificity of 95.7%, 98.5%, 100%, and 100%, respectively for cervical lymph node to be malignant. The Kappa value for taller than wide shape, microcalcification, marked hypoechogenicity, solid composition, and irregular margins was 1.0 (95% confidence interval [CI]: 1–1), 1.0 (95% CI: 1–1), 0.90 (95% CI: 0.82–1), 0.88 (95% CI: 0.77–0.92), and 0.82 (95% CI: 0.64–1), respectively. The estimated decrease in unnecessary FNACs was found to be 43.83–86.30%. Conclusions: TIRADS proposed by Kwak et al., combined with evaluation for sonological features of malignant lymph nodes is a valuable, safe, widely available, and easily reproducible imaging tool to stratify the risk of a thyroid lesion and helps in precluding unnecessary FNACs in a significant number of patients. TIRADS features convincingly show comparable results in the interpretation of TIRADS features more so, in the hands of radiologists experienced in thyroid imaging.

CERCOSPORA BRUNFELSIICOLA (FUNGI, MYCOSPHAERELLACEAE), A NEW TROPICAL CERCOSPOROID FUNGUS ON BRUNFELSIA UNIFLORA

Cercospora brunfelsiicola on Brunfelsia uniflora is proposed as a new species based on a combination of molecular phylogenetic and morphological data analyses. The molecular phylogenetic analysis based on combined multilocus analyses of the Internal Transcribed Spacer (ITS), part of the elongation factor 1–a gene (EF1–a), and part of the calmodulin (CAL) gene regions showed that C. brunfelsiicola is phylogenetically distinguishable from other Cercospora species, including members of the C. apii s. lat. complex. Morphologically, C. brunfelsiicola differs from other closely related Cercospora species, in particular C. acaciae-mangii, by forming lesions with indistinct margin, larger stromata [(32) 48.5 ± 10.6 (68) ?m diam.], and filiform to narrowly obclavate conidia [(45) 59 ± 9.1 (72) × (2.5) 2.5 ± 0.2 (3) ?m].

Imaging findings for malignancy-mimicking nodular fasciitis of the breast and a review of previous imaging studies

We report a case of nodular fasciitis of the breast mimicking malignant tumor. A 41-year-old female patient with a palpable mass in the upper center of the left breast present for 1 week visited our hospital. A mammogram showed an oval isodense with a partially indistinct margin. Ultrasonography demonstrated a hypoechoic mass, 8 × 11 mm in size. Breast cancer could not be excluded based on mammographic and ultrasonographic (US) findings. A core needle biopsy and excisional biopsy were performed. Histopathologic examination revealed a diagnosis of nodular fasciitis of the breast. The mammographic and US findings of nodular fasciitis in the breast is reviewed.

Ascochyta sorghi. [Descriptions of Fungi and Bacteria].

A description is provided for Ascochyta sorghi. Information is included on the disease caused by the organism, its transmission, geographical distribution, and hosts. HOSTS: Sorghum bicolor and wild sorghums. DISEASE: Rough leaf spot of sorghum. On leaves symptoms appear as small circular to oblong light coloured spots with well defined reddish margin. Older lesions become broadly elliptic, greyish to yellow brown or purplish red, reaching 4-9 × 8-14 mm. Lesions often merge with one another to form large irregular necrotic areas up to 12.5 × 2.5 cm and the whole leaves may be killed. The variety of host plant mostly determines whether the leaf spots have a distinct red margin or an indistinct margin (Tarr, 1962; Edmunds & Zummo, 1975). Lesions may also occur on leaf sheaths and sometimes on leaf stalks. The disease appears to be severe on young plants whilst older plants have been reported to be resistant to attack (13, 746). GEOGRAPHICAL DISTRIBUTION: Africa (Eritrea, Gambia, Ghana, Nigeria, Senegal, Sudan, Tanzania, Zaire); Asia (Burma, India); Europe (Italy); N. America (USA, Alabama, Georgia); USSR. TRANSMISSION: Infection has been claimed to be spread by air-borne conidia in wet weather or heavy dews and also by insects (Singh et al., 1951; Tarr, 1962; Edmunds & Zummo, 1975). The fungus has been reported to be carried over on crop residues of sorghum and debris in the soil (Singh et al., 1951; Edmunds & Zummo, 1975).