Axillary disorders originate from an axillary lymph node, subcutaneous fat layer, accessory breast, nerve, vessel and muscle. The most common causes of a palpable axillary mass are a lymph node pathology containing a benign axillary lymphadenopathy, and malignant lymph nodes such as a metastatic lymphadenopathy from breast cancer and a malignant lymphoma. For the detection of masses in the axilla, mammography and sonography are the imaging modalities of choice. We present a spectrum of various axillary masses with correlative radiological imaging and pathological findings in this pictorial essay. Knowledge of the radiological findings of various axillary disorders is useful for a differential diagnosis and for preventing unnecessary invasive procedures.
Animals ; Axilla ; Breast Neoplasms ; Breast* ; Diagnosis, Differential ; Lymph Nodes ; Lymphatic Diseases ; Lymphatic Metastasis ; Lymphatic System ; Lymphoma ; Mammary Neoplasms, Animal ; Mammography ; Neoplasm Metastasis* ; Pathology ; Radiography ; Subcutaneous Fat ; Ultrasonography

We report the sonographic features of an intracystic papillary carcinoma of the breast presenting as recurrent hemorrhagic cysts following trauma. A 56-year-old woman presented with palpable breast masses after a traumatic event; sonography showed multiple, well-defined, hemorrhagic cysts. Hemorrhagic fluid was evacuated by fine needle aspiration with no residual lesions. Cytology was negative for malignancy. Five months later, the mass reappeared; sonography demonstrated multiple cysts with solid nodules. US-guided core biopsy and surgery revealed invasive papillary carcinoma. We suggest close follow-up of cystic masses, even with negative cytology, and performance of surgical excisional biopsy in cases of rapid refilling after aspiration.
Ultrasonography, Mammary/methods ; Recurrence ; Middle Aged ; Mammography/methods ; Lymphatic Metastasis ; Humans ; Hemorrhage/*diagnosis/ultrasonography ; Female ; Diagnosis, Differential ; Cysts/*diagnosis/ultrasonography ; Carcinoma, Papillary/*diagnosis/ultrasonography ; Breast Neoplasms/*diagnosis/ultrasonography

Objective To explore the value of trans-lymphatic contrast-enhanced ultrasound(CEUS)in the diagnosis of cervical lymph node metastasis of thyroid cancer. Methods The patients with suspected thyroid cancer underwent conventional ultrasound and trans-lymphatic CEUS examinations before the biopsy.The differences in ultrasound and CEUS characteristics of cervical lymph nodes between the metastatic group and the non-metastatic group were compared,and pathological results were regarded as the golden standard. Results Twenty patients had thyroid cancer,including 12 cases with lymph node metastasis and 8 cases without metastasis.The diagnostic sensitivity(91.7%
Contrast Media ; Humans ; Lymph Nodes/diagnostic imaging* ; Lymphatic Metastasis/diagnostic imaging* ; Thyroid Neoplasms/diagnostic imaging* ; Ultrasonography

OBJECTIVE: To investigate the value of lymphatic contrast-enhanced ultrasound (LCEUS) with intra-glandular injection of contrast agent for diagnosis of central compartment lymph node metastasis of thyroid cancer. METHODS: From November, 2020 to May, 2022, the patients suspected of having thyroid cancer and scheduled for biopsy at our center received both conventional ultrasound and LCEUS examinations of the central compartment lymph nodes before surgery. All the patients underwent surgical dissection of the lymph nodes. The perfusion features in LCEUS were classified as homogeneous enhancement, heterogeneous enhancement, regular/irregular ring, and non-enhancement. With pathological results as the gold standard, we compared the diagnostic ability of conventional ultrasound and LCEUS for identifying metastasis in the central compartment lymph nodes. RESULTS: Forty-nine patients with 60 lymph nodes were included in the final analysis. Pathological examination reported metastasis in 34 of the lymph nodes, and 26 were benign lymph nodes. With ultrasound findings of heterogeneous enhancement, irregular ring and non-enhancement as the criteria for malignant lesions, LCEUS had a diagnostic sensitivity, specificity and accuracy of 97.06%, 92.31% and 95% for diagnosing metastatic lymph nodes, respectively, demonstrating its better performance than conventional ultrasound (P < 0.001). Receiver-operating characteristic curve analysis showed that LCEUS had a significantly greater area under the curve than conventional ultrasound for diagnosing metastatic lymph nodes (94.7% [0.856-0.988] vs 78.2% [0.656-0.878], P=0.003). CONCLUSION LCEUS can enhance the display and improve the diagnostic accuracy of the central compartment lymph nodes to provide important clinical evidence for making clinical decisions on treatment of thyroid cancer.
Humans ; Lymphatic Metastasis/diagnostic imaging* ; Thyroid Neoplasms/pathology* ; Ultrasonography/methods* ; Lymph Nodes/pathology* ; ROC Curve

PURPOSE: Ovarian epithelial tumors of borderline malignancy belong to a disease entity distnct from that ofbenign and overt malignant tumors, and the younger age of patients and earlier stage at diagnosis compared withinvasive ovarian cancers makes conservative surgery an important issue. The purpose of this study was to evaluatewhether there are any characteristic radiologic findings to suggest the presence of these tumors. MATERIALS AND METHODS: In 20 pathologically proven tumors of ovarian borderline malignancy, the findings of ultrasonography (n= 17) (with color Doppler ultrasonography in two cases), computed tomography (n = 8), or magnetic resonanceimaging (n = 6) were compared with pathologic findings and, were retrospectively reviewed and analyzed. Imageswere evaluated for size, loculation, thickness and regularity of wall and septum, endocystic vegetation, solidportion, calcification, local invasion and distant metastasis. RESULTS: Among 20 unilateral tumors, 18 weremucinous and two were serous; 19 (95%) were at stage I, and one was at stage II (local invasion of uterus, leftpara-aortic lymphadenopathy, and malignant ascites). Tumor size ranged from 10 - 40 cm in the largest diameter(mean, 21 cm). Radiologic findings of thick, irregular wall or septum were notified in 14 tumors (70%), endocysticvegetation in 12 (60%), enhancing solid portion in 11 (55%), and calcification in two (10%). Of 18 mucinoustumors, 17 (94%) were multilocular. One serous tumor was unilocular and one was multilocular. Color Dopplerultrasonography of two mucinous tumors revealed blood flow signals in the wall, septum, solid portion orendocystic vegetation, and resistive indices were 0.5 and 0.4, respectively. CONCLUSION: When ovarian tumors arepresent - especially in young females and at a lower stage -, radiologic findings of a thick, irregular wall orseptum, endocystic vegetation, and a small enhanced solid component, for example, indicate the possibility ofovarian epithelial tumors of borderline malignancy.
Diagnosis ; Female ; Humans ; Lymphatic Diseases ; Mucins ; Neoplasm Metastasis ; Ovarian Neoplasms ; Retrospective Studies ; Ultrasonography ; Ultrasonography, Doppler, Color ; Uterus

PURPOSE: Hepatoid adenocarcinoma of the stomach is a variant of gastric carcinoma with both adenocarcinoma and hepatocellular carcinomatous differentiations. Until recently, few reports had been published. The purpose of this study was to evaluate the radiologic characteristics of eleven hepatoid adenocarcinomas of the stomach aswell as patterns of metastasis. MATERIALS AND METHODS: Eleven pathologically proven cases of hepatoidadeno carcinoma of the stomach were retrospectively reviewed. Radiologic studies available were CT in eight patients, abdominal ultrasonography in ten, upper GI series in seven, and hepatic angiography in two. Pathologicand radiologic characteristics of these lesions, patterns of metastasis, if present, and labolatory data(AFP andCEA) were evaluated. RESULTS: Tumors were seen in the antrum and body in five patients, in the antrum in five, and in the body of the stomach in one. Six tumors were classified as Borrmann type 3, four as Borrmann type 2, andone as Borrmann type 4. Nine cases showed hepatic metastasis. Portal vein thrombosis was present in three cases ;two were accompanied by multiple liver metastasis and the other had portal venous thrombosis. Lymph nodemetastasis was identified in 11 cases ; N1 in five, N2 in five, and extensive retroperitoneal paraaortic and left supraclavicular lymphadenopathy in one. Angiography showed hypervascular metastatic liver masses in two cases.There was no evidence of metastasis to the mesentery, omentum, and peritoneum. Serum AFP was elevated in tencases(mean : 24752.2 ; median : 4230 ng/ml). CONCLUSION: Radiologic findings of hepatoid adenocarcinoma of thestomach appear similar to those of non-hepatoid adenocarcinoma. However, elevation of AFP and early liver metastasis without peritoneal metastasis is suggestive of hepatoid adenocarcinoma of the stomach.
Adenocarcinoma* ; Angiography ; Humans ; Liver ; Lymphatic Diseases ; Mesentery ; Neoplasm Metastasis ; Omentum ; Peritoneum ; Retrospective Studies ; Stomach* ; Ultrasonography ; Venous Thrombosis

Metastatic foci to the breast resulting from extramammary malignant neoplasm are rare and multiple myeloma involved the breast are extremely rare. A 53 year old woman with a history of multiple myeloma, diagnosed 4 years previously, was admitted with a lump in her right breast. A multiple course of chemotherapy was administered. Examination revealed a palpable mass in the upper outer quadrant of the right breast. The firm and mobile mass measured 3X2 cm. There was no palpable axillary lymphadenopathy. Two echo-poor solid masses were present on breast ultrasound and there was evidence of neovascularization on color Doppler. A mammogram revealed a circumscribed spheroid shadow without evidence of microcalcification, spiculation or any other signs of desmoplastic response. A core biopsy revealed immature plasma cell infiltration showing kappa light chain restriction, consistent with multiple myeloma involving the breast. Another case of breast metastasis of multiple myeloma origin is described and a review of the literature is discussed.
Biopsy ; Breast* ; Drug Therapy ; Female ; Humans ; Lymphatic Diseases ; Middle Aged ; Multiple Myeloma* ; Neoplasm Metastasis ; Plasma Cells ; Ultrasonography

Cervical nodal metastases are common in patients with head and neck cancers. Early assessment is important for treatment planning and prognosis. Ultrasound has been widely used in the evaluation of neck lymph nodes, with common parameters including location, size, shape, boundary, hilus, echogenicity, vascular pattern, and resistance index. The diagnostic accuracy has been dramatically improved along with the introduction of new techniques including contrast-enhanced ultrasound, elastography, and ultrasound-guided fine needle aspiration biopsy. Neck ultrasound has became an important tool in preoperative assessment and postoperative follow-up for patients with head and neck cancers.
Head and Neck Neoplasms ; pathology ; Humans ; Lymph Nodes ; diagnostic imaging ; pathology ; Lymphatic Metastasis ; diagnostic imaging ; pathology ; Neck ; diagnostic imaging ; pathology ; Ultrasonography

OBJECTIVETo prepare a lymph node-targeted ultrasound/fluorescence bi-functional imaging contrast agents, and observe its effectiveness both on contrast-enhanced ultrasound (CEUS) and vivo near infrared fluorescence (NIR) imaging through animal experiments.

METHODSThe chimeric lymph node-targeted ligand (phosphatidylserine) and near-infrared fluorescent substance were assembled to form bi-functional contrast microbubbles. The morphology and size distribution were detected by optical microscope and Malvern potential tests. Five normal New Zealand white rabbits were subcutaneously injected with the prepared contrast agent in bilateral footpads, and the imaging effectiveness of lymph nodes and lymphatic vessel were observed by CEUS and NIR technique. Then blue dye was subcutaneously injected at the same site, and the rabbits were sacrificed for lymph nodes pathological examination.

RESULTSLipid ultrasound microbubbles,with a mean size of 3-5 Μm in diameter, appeared to be uniform in distribution and regular in configuration. The images of inflow lymphatic vessel and relevant lymph node were quickly showed up after the subcutaneous injection by CEUS, which was identical to the result detected by NIR. Biopsy confirmed that all the blue-stained lymph nodes could be displayed by NIR.

CONCLUSIONSThe self-made bi-functional contrast agent has a good imaging ability in CEUS and NIR imaging. It may be a better agent as lymph node tracer.

Animals ; Contrast Media ; chemistry ; Fluoresceins ; chemistry ; Lymph Nodes ; anatomy & histology ; diagnostic imaging ; Lymphatic Metastasis ; pathology ; Male ; Rabbits ; Ultrasonography

Objective To evaluate the efficacy of ultrasound and computed tomography (CT) in diagnosing cervical lymph node metastasis (CLNM) of papillary thyroid carcinoma (PTC). Methods The patients with PTC treated by surgery in the Chinese PLA General Hospital from January 2016 to January 2021 were selected for analysis.All the patients underwent preoperative ultrasound and CT examinations,the diagnostic values of which for CLNM were retrospectively analyzed. Results A total of 322 PTC patients were enrolled in this study,including 242 with CLNM and 80 with non-CLNM.The CLNM group and non-CLNM group had significant differences in age,tumor size,and maximum size of lateral CLNM (χ²=20.34,27.34,and 4.30,respectively,all P<0.001).For the central compartment,lateral compartment,and overall compartment,ultrasound diagnosis showed higher sensitivity (χ ²=82.26,P<0.001;χ²=114.01,P<0.001;χ²=82.26,P<0.001) and accuracy (χ²=20.27,P<0.001;χ²=15.56,P<0.001;χ²=44.00,P<0.001) than CT,and had no significant differences from ultrasound combined with CT (all P>0.05).However,ultrasound diagnosis had lower specificity than CT (χ²=17.01,P<0.001;χ²=21.29,P<0.001) in the central compartment and lateral compartment.Receiver operating characteristic curve analysis showed that in the central compartment,lateral compartment,and overall compartment,ultrasound diagnosis had larger AUC than CT (Z=2.99,P=0.003;Z=3.86,P<0.001;Z=4.47,P<0.001) and had no significant difference from ultrasound combined with CT (Z=1.87,P=0.062;Z=1.68,P=0.093;Z=1.61,P=0.107). Conclusions Ultrasound and CT have their own advantages in the diagnosis of central and lateral CLNM.In general,ultrasound has better performance than CT in the diagnosis of CLNM.
Humans ; Lymphatic Metastasis/diagnostic imaging* ; Retrospective Studies ; Thyroid Cancer, Papillary/pathology* ; Thyroid Neoplasms/surgery* ; Tomography, X-Ray Computed ; Ultrasonography/methods*