Contrast enhancement features of tubular adenoma, MRI and contrast enhanced mammography pictorial report

Introduction: Tubular adenomas are rare benign epithelial neoplasms of the breast resembling fibroadenomas on both imaging and pathology. We aimed at characterizing and differentiating these lesions on contrast enhanced mammography and MRI.Material and methods: Out of all percutaneous breast biopsies performed at the Rabin medical center between the years 2010-2019, five cases which also had contrast-based imaging including contrast enhanced mammography and MRI were retrieved. Morphology and enhancement patterns of the lesions were analyzed by two dedicated breast radiologists.Results: The contrast imaging characteristics of all lesions were enhancing masses measuring 4-17 mm. The shape of the lesions was oval, borders well circumscribed, on both CEM and MRI. CEM revealed marked homogenous enhancement. MRI enhancement patterns of the small tumors showed homogenous enhancement, whereas the larger mass showed a more heterogeneous enhancement. Kinetic curves on MRI were of rapid marked enhancement.Conclusion: Tubular adenomas diverge pathologically from known enhancement patterns of fibroadenomas.

Does CSF pleocytosis have a predictive value for disease course in MS?

ObjectiveMS is a demyelinating CNS disorder with a spectrum of clinical patterns regarding course and prognosis. Although several prognostic factors are considered in the initial evaluation of patients, biological markers defining the disease course and guiding treatments are currently lacking. It is unknown whether patients with CSF pleocytosis differ in regard to symptoms, disease course, and prognosis from those without. The aim of this study was to evaluate whether CSF pleocytosis during the initial presentation has an impact on the clinical course and progression of MS.MethodsWe retrospectively evaluated patients attending the MS Clinic at Rabin Medical Center between January 1999 and January 2016 who underwent lumbar puncture (LP) at disease presentation, considering CSF cell count, clinical diagnosis (clinically isolated syndrome [CIS] and relapsing-remitting MS [RRMS]), annualized relapse rate (ARR), paraclinical findings (imaging, CSF oligoclonal bands, and evoked potentials), and disease progression, expressed by the Expanded Disability Status Scale (EDSS).ResultsOne hundred fourteen patients (72 females) underwent LP at disease presentation (RRMS: n = 100, CIS: n = 14). Age at diagnosis was 32.4 ± 12.2 years, and the follow-up time was 9.4 ± 3.8 years. Forty-six patients showed a pleocytic CSF (≥5 cells per μL). Compared with patients with <4 cells per μL, patients with pleocytosis had a higher ARR (0.60 ± 0.09 vs 0.48 ± 0.04; p = 0.0267) and a steeper increase (slope) in the EDSS score throughout the follow-up period (correlation coefficient: r2 = 0.04; p = 0.0251).ConclusionsCSF pleocytosis may be considered a biological unfavorable predictive factor regarding disease course and progression in MS.

Breast Cancer and Sarcoidosis: Case Series and Review of the Literature

Background: Sarcoidosis is a chronic inflammatory disease of unknown etiology, which can involve different organs and systems. Accordingly, sarcoidosis can mimic breast cancer, making the differential diagnosis very difficult. Case Report: 5 patients with a diagnosis of both sarcoidosis and breast cancer followed by the Rabin Medical Center between January 1993 and June 2012 were enrolled in this study. Additionally, a comprehensive literature review which identified 104 patients diagnosed with breast cancer and sarcoidosis was carried out. In both populations reviewed, the average age at diagnosis of sarcoidosis and breast cancer was 57 years. Among the 66 patients with both sarcoidosis and breast cancer, sarcoidosis preceded breast cancer in 31 cases, followed it in 23 cases, and appeared concurrently in 10 cases. Conclusion: Based on our clinical cases and literature review, a histological study is recommended over imaging if sarcoidosis or breast cancer may be present. Furthermore, breast cancer is rarely associated with sarcoidosis or sarcoidosis-like reaction.