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We study whether deep neural network based algorithm can filter out mammography phantom images that will pass or fail. With 543 phantom images generated from a mammography unit, we created VGG16 based phantom shape scoring models (multi-and binary-class classifiers). Using these models we designed filtering algorithms that can filter failed or passed phantom images. 61 phantom images obtained from two different medical institutions were used for external validation. The performances of the scoring models show an F1-score of 0.69 (95% confidence interval (CI) 0.65, 0.72) for multi-class classifiers and an F1-score of 0.93 (95% CI 0.92, 0.95) and area under the receiver operating characteristic curve of 0.97 (95% CI 0.96, 0.98) for binary-class classifiers. A total of 42 of the 61 phantom images (69%) were filtered by the filtering algorithms without further need for assessment from a human observer. This study demonstrated the potential to reduce the human workload from mammographic phantom interpretation using the deep neural network based algorithm.

Purpose We sought to evaluate treatment outcomes after hypofractionated short-course radiation therapy (RT) for progressive heterotopic ossification (HO). Methods and Materials Nine consecutive patients were treated between January 2016 and December 2018. None had received previous preventive RT. RT was performed to prevent further HO progression with one of the following dose-fractionation regimens: 7 Gy × 2 fractions, 9 Gy × 1 fraction, 6 Gy × 2 fractions, 6 Gy × 3 fractions, 8 Gy × 2 fractions, or 7 Gy × 3 fractions. Results All patients were male, with a median age of 30 years (range, 16-55). Eight patients presented with grade III Brooker classification. The most commonly involved site was the hip, followed by femur and knee. With a median assessment time of 7.1 (range, 5.1-23.1) months, eight patients achieved decreased HO, with five showing a dramatic (≥50%) reduction. Among the five excellent responders, a 21 Gy with 7 Gy per fraction schedule was used in four patients. HO status was maintained at the final median follow-up of 11.6 months (range, 6.2-36.1), and Brooker’s grade was improved in three patients. No significant RT-related toxicity was noted. Conclusions The current RT scheme was effective for the management of progressive HO. It is speculated that higher RT doses could result in the superior efficacy of progressive HO.

PTEN hamartoma tumor syndrome is a spectrum of disorders characterized by unique phenotypic features including multiple hamartomas caused by mutations of the tumor suppressor gene PTEN. Cowden syndrome and Bannayan–Riley–Ruvalcaba syndrome are representative diseases, and both have several common clinical features and differences. Because PTEN mutations are associated with an increased risk of malignancy including breast, thyroid, endometrial, and renal cancers, cancer surveillance is an important element of disease management. We report a germline mutation of the PTEN (c.723dupT, exon 7) identified in a young woman with a simultaneous occurrence of breast cancer, dermatofibrosarcoma protuberans, and follicular neoplasm. This case suggests that it is critical for clinicians to recognize the phenotypic features associated with these syndromes to accurately diagnose them and provide preventive care.

The aim of this study was to evaluate the imaging findings of invasive lobular carcinoma (ILC) compared to those of invasive ductal carcinoma (IDC). The study included ILCs (n = 27) and IDCs (n = 85). Imaging findings were retrospectively evaluated, according to the BI-RADS lexicon. We compared the imaging findings, multiplicity, and magnetic resonance imaging (MRI) detection accuracy of ILC with those of IDC. At mammography, normal findings and mass lesions were more frequent with ILCs (14.8% and 59.2%, respectively) than with IDCs (1.2% and 44.7%, respectively) (P = 0.009). With ultrasonography (US), posterior acoustic shadowing was more frequently seen in ILCs (59.2%) than in IDCs (15.8%) (P < 0.001). With MRI, both ILCs and IDCs most commonly appeared as a heterogeneously enhancing, irregular mass with a spiculated border. Multifocality was more frequently associated with ILCs (40.7%) than with IDCs (14.1% 1% 0.002). However, multicentricity and bilaterality were not different between the two groups. The sensitivity and specificity of MRI for the detection of multiplicity were 91.6% and 73.3%, respectively, for ILCs and 83.3% and 80.3%, respectively, for IDCs. Normal findings, mass lesions on mammography, and posterior acoustic shadowing on US were more frequently associated with ILCs than with IDCs. Multifocality was more prevalent with ILCs than with IDCs.

This study was carried out to determine the relationship between breast arterial calcification (BAC) and cerebral artery disease.We investigated the relationship between BAC on mammography and cerebral artery-origin T2-hyperintensity on brain MRI and which is associated with an increased risk for stroke. A total of 168 women, ages 40-78 years, who underwent both mammography and brain MRI, were enrolled in this study. BAC was counted as positive if it was found on more than one view a breast. The T2-hyperintensity was systemically defined and graded as follows: punctuate; patchy; and confluent white-matter hyperintensity (WMH); caps; bands; and irregular periventricular hyperintensity (PVH). Patchy and confluent WMH and irregular PVH were considered as positive findings for cerebral artery disease. We also obtained data regarding cardiovascular risk factors that might function as confounding factors. Statistical analysis was performed for association of the BAC and positive MRI findings.The presence of BAC showed a strong correlation with the positive MRI findings (Odds ratios, adjusted with statically significant cardiovascular factors of 6.86 for positive WMH and 9.04 for positive PVH, p0.05).The mammographic finding of BAC, which may be a useful marker of women at higher risk for stroke, should receive more of clinicians' attention and its presence should never be omitted from the report.

It is challenging to diagnose epidermoid cysts on ultrasonography; except in typical, benign-appearing cases. The purpose of this study was to include epidermoid cysts in the differential diagnosis of diverse subcutaneous lesions, especially malignancy-mimicking lesions, as seen on ultrasonography.We reviewed 19 cases of pathologically confirmed epidermoid cysts in 19 patients (male, 8; female, 11). Three radiologists, who were blinded to the pathology data, classified (by consensus) these epidermoid cysts as benign or malignancy-mimicking lesions, according to generally accepted ultrasonographic criteria, including the margin, shape, echotexture, and transitional zone with surrounding tissue, and also including the growth pattern and adjacent tissue change. The ultrasonographic data were then correlated with the pathology results regarding the ruptured or unruptured status of the cysts.Epidermoid cysts have been noted as showing a wide-spectrum of findings on ultrasonography. Twelve of our cases showed benign ultrasonographic features: six cases had typical, benign ultrasonographic features with unruptured status; two cases with ruptured status did not have clear ultrasonographic features, although we decided by consensus that there were benign ultrasonographic features; and four cases with unruptured status had peculiar internal echogenicities, described as "internal rod-like contents", that could be considered to be a variation of the typical ultrasonographic finding of epidermoid cysts. Seven cases showed malignancy-mimicking ultrasonographic features; all seven of these had ruptured status.The diagnosis of ruptured epidermoid cysts should be included in the differential diagnosis of malignancy-mimicking subcutaneous lesions. The internal rod-like contents can be regarded as another typical ultrasonographic finding of epidermoid cysts.

Epidermal inclusion cyst of the breast is an uncommon benign lesion and it is usually located in the skin layer. We report here on two cases of ruptured epidermal inclusion cysts in the subareolar area, which is a very unusual location for these cysts and these lesions can be mistaken for breast malignancies.

We report a galactocele as changing axillary lumps in both axillae. 36-year-old woman visited to our hospital for her axillary lump. The diagnosis could be made under ultrasound examination and her recent pregnancy history. However, sonography-guided aspiration was done for confirmation. We could confirm the galactocele arising in axillary accessory breast tissue. Clinical information indicating that such a palpable mass is associated with pregnancy as well as its sonography features along with adjunctive diagnostic aspiration, can help to correctly diagnose this rare entity.

Objective To evaluate the sonographic features of invasive apocrine carcinoma (IAC) of the breast. Materials and Methods This study included five pathologically proven cases of IAC, and their sonographic features were retrospectively analyzed according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon. Results All five lesions involved the left breast and were seen as irregularly shaped masses. All lesions, except one, had a parallel orientation to the chest wall. All five lesions showed noncircumscribed margins and heterogeneous echotexture; however, they showed various posterior features. One lesion had edema as an associated feature. Sonographic assessments were classified as BI-RADS category 4 in all five cases. Conclusion Invasive apocrine carcinoma sonographic findings are difficult to differentiate from those of invasive ductal carcinoma of no special type.

We investigated the mechanism of mitomycin C (MMC)-induced apoptosis in SNU-16 human gastric adenocarcinoma cells. Caspase-8 and caspase-3 were activated in MMC-treated cells whereas caspase-1 was not activated, and cytochrome c was released from mitochondrial membrane to cytosol suggesting that caspase-9 was activated during the MMC-induced apoptotic process. Protein kinase C (PKC) δ was cleaved to its characteristic 40 kDa fragment in a caspase-3-dependent manner; on the other hand PKC ζ was cleaved to approximately 40 kDa independently of caspase-3 in the drug-induced apoptosis of the cells. Incubation with z-DEVD-fmk and benzyloxycarbonyl-Val-Ala-Asp-fluoromethylketone (z-VAD-fmk) almost completely abrogated MMC-induced DNA fragmentation, indicating that activation of these caspases was crucially involved in MMC-induced apoptosis. Activation of caspase-8 in response to Fas triggering by recruitment of caspase-8 to the Fas has also been found, however, MMC did not induce FasL and Fas expression, as evidenced by reverse transcriptase-polymerase chain reaction and Western blotting. Taken together, these findings indicate that MMC-induced apoptosis in SNU-16 cells was mediated by caspase-8, caspase-9, and caspase-3 activation independently of FasL/Fas interactions.

We present the case of a surgically confirmed, invasive, cystic hypersecretory ductal carcinoma (CHDC) of the breast in a 43-year-old woman. The initial sonography showed a complex cyst, which required a core biopsy; however, the diagnosis was delayed as the patient refused to undergo the biopsy and the cyst decreased in size, as seen on follow-up sonography. Excision biopsy was performed, and invasive CHDC was diagnosed after regrowth of the cystic lesion. Meticulous sonographic evaluation of a cystic breast mass is always important, and pathology confirmation must be considered if the lesion shows features suspicious for malignancy, as a CHDC could be the cause of a cystic breast mass.

We attempted to identify the preoperative, sonography-guided breast localization technique which can be used in cases in which surgeons require the shortest incision route or exact localization of a lesion.We performed a phantom study using a lesion-in-breast model, investigating the concept that the flash artifact is induced at the tip of the vibrating needle on power Doppler images, before attempting any clinical applications. In view of the results achieved in the phantom study, we applied this technique to patients referred to our department over a 2-year period.Of the 312 breast localizations in which we used this technique in 289 patients, all procedures were successfully performed without serious complications.The vertical approach with the power Doppler needle-induced fremitus technique indicates the shortest incision route to and the exact localization of a breast lesion.

Tumor development or growth is accompanied by impaired immune responses, such as a poor proliferative response or down-regulated cytolytic T lymphocyte activity. Although recent reports have suggested that modification of the signal-transducing molecule is responsible for impaired immune responses in tumor-bearing hosts, the causes of defective immune function are not yet completely understood. Furthermore, the clinical significance of the findings is not yet clear. In this study, we investigated the alteration of several signal-transducing molecules in peripheral blood T lymphocytes (T-PBL) as well as in tumor-infiltrating lymphocytes (TIL) from human colorectal carcinoma patients and their relationship with the impaired host immune responses. A greater reduction in CD3ζ chain level was observed in TIL than in T-PBL from tumor-bearing hosts. CD3ζ chain reduction in T-PBL correlated with the clinicopathological stage of a tumor, especially with the status of lymph node metastasis. The levels of p56 lck and p59 fyn protein tyrosine kinase in T-PBL were also compared between tumor-bearing hosts and normal healthy volunteers. In T-PBL from tumor-bearing hosts, expression of protein tyrosine kinase p59 fyn was significantly lower than that of p56 lck . However, the level of CD3ζ chain expression did not correlate with T lymphocyte functions such as T lymphocyte proliferative response or allogeneic target cell lysis.

6063 Background: NPC is highly curable in early stages but 70% of NPC patients are diagnosed with advanced disease due to lack of effective screening. Genetic and epigenetic alterations involved in the pathogenesis of NPC are known. The higher order chromosomal structures reflecting aberrant transcriptional states of these genes can be measured via techniques such as chromosome conformation capture. Detection of these changes in peripheral blood may provide an accurate test for the early cancer detection. Methods: Blood samples have been collected from 84 patients with histologically confirmed NPC and 100 matched controls. Samples from 45 NPC patients and 68 controls have been analyzed. Fourteen genes known to be dysregulated in NPC were investigated. Potential higher order juxtaposition sites in the candidate genes were predicted using pattern recognition software. PCR primer sets were designed around the chosen sites to screen potential markers. Twenty-two markers showing predictability between NPC and control samples were analysed for optimal reproducibility using alternative primer sets. The optimal sets of markers were then tested amongst the complete set of samples. The dataset was processed by re-sampling using the synthetic minority oversampling technique. The overall sample was split into two groups (66% training set and 34% test set) in the classification. Results: Sixteen markers from 7 candidate genes were found to be optimal in differentiating between NPC and control samples in the first 103 samples. Using the multilayer perceptron (MLP) classification, the following results were obtained: Sensitivity 88.9%, 95% CI (79.2% - 98.6%); Specificity 72.7%, 95% CI (58.9% - 86.5%); PPV 72.7%, 95% CI (58.9% - 86.5%); NPV 88.9%, 95% CI (79.2% - 98.6%). The accuracy of the test was similar in detection of stage I and II NPC versus that of stage III or IV NPC. Conclusions: Using a PCR-based method to detect alterations in the cancer epigenome, the feasibility of developing a blood test of potential utility in early diagnosis of NPC was demonstrated. Analysis of larger numbers of patient samples and optimization of markers are ongoing. The performance characteristics of the test in the total population of 184 samples will be presented.

Focal neuroendocrine differentiation can be found in diverse histological types of breast tumors. However, the term, neuroendocrine breast tumor, indicates the diffuse expression of neuroendocrine markers in more than 50% of the tumor cell population. The imaging features of neuroendocrine breast tumor have not been accurately described due to extreme rarity of this tumor type. We present a case of a pathologically confirmed, primary neuroendocrine breast tumor in a 42-year-old woman, with imaging findings difficult to be differentiated from that of invasive ductal carcinoma.

Intestinal malrotation is an uncommon cause of abdominal pain in adults. More so, reversed intestinal rotation is one of the least common malrotation anomalies. A few cases of reversed intestinal rotation have been reported only in surgical and internal medicine literatures. To the best of our knowledge, MDCT findings concerning reversed intestinal rotation had never been reported. We present a 38-year-old man with retroarterial reversed intestinal rotation with MDCT findings.

The purpose of this paper is to show the clinical and radiologic features of a variety of diffuse, infiltrative breast lesions, as well to review the relevant literature. Radiologists must be familiar with the various conditions that can diffusely involve the breast, including normal physiologic changes, benign disease and malignant neoplasm.

A tumoral pseudoangiomatous stromal hyperplasia (PASH) that causes huge breast enlargement is very rare. Only two cases of huge tumoral PASHs have been reported in the English medical literature. We report here on a surgically confirmed case of bilateral huge tumoral PASH in a 47-year-old woman, and we present the imaging and histopathology findings. We also review the relevant medical literature.

Recently, we found and analyzed vitamin B(12) in some Korean traditional plant foods which had not reported, yet. This study was to investigate vitamin B(12) intake and its dietary sources and the vitamin B(12) status in the very old elderly Koreans. We measured serum vitamin B(12) level and estimated the amounts of vitamin B(12) intake from different dietary sources in female elderly Koreans aged 85 and over who had consumed a relatively low animal traditional diet for the whole life. The average age of the subjects (n = 127) was 98.0 years (85-108 years). The assessment on energy and nutrient intake involved a one-day 24-hour recall, and serum vitamin B(12) concentration was measured by radioimmunoassay. Overall diet pattern was not different between the 85-99 yr-old group and centenarians, except centenarians were taking more dairy product. The average ratio of plant food to animal food consumption was 87.5:12.5 in weight. The average vitamin B(12) intake of our subjects was 3.2 microg/day, and 52.7% of subjects consumed under estimated average requirement, 2.0 microg/day. On dietary source, 67.3% of dietary vitamin B(12) was from meat, eggs and fishes and 30.6% was from plant foods, such as soybean-fermented foods, seaweeds, and kimchi. The average serum vitamin B(12) concentration was 450.5 pg/mL, and low serum vitamin B(12) (200 pg/mL) was found in 9.6% of subjects. Dietary vitamin B(12) intake was significantly lower in subjects with low serum vitamin B(12) (0.79 microg/day) than those with normal serum vitamin B(12) (3.47 microg/day). There were no significant difference in vitamin B(12) intake and its dietary sources and serum vitamin B(12) level between the 85-99 yr-old group and centenarians. In conclusion, several plant-origin foods including seaweed, soybean-fermented foods, and kimchi, may contribute significantly to good vitamin B(12) status in very old elderly Koreans.

Objective This study was designed to evaluate the ultrasonographic (US) findings of medullary thyroid carcinoma (MTC) as compared to findings for papillary thyroid carcinoma (PTC). Materials and Methods The study included 21 cases of MTC that were surgically diagnosed between 2002 and 2007 and 114 cases of PTC that were diagnosed in 2007. Two radiologists reached a consensus in the evaluation of the US findings. The US findings were classified as recommended by the Thyroid Study Group of the Korean Society of Neuroradiology and Head and Neck Radiology (KSNHNR) and each nodule was identified as suspicious malignant, indeterminate or probably benign. The findings of medullary and papillary carcinomas were compared with use of the chi-squared test. Results The common US findings for MTCs were solid internal content (91%), an ovoid to round shape (57%), marked hypoechogenicity (52%) and calcifications (52%). Among the 21 cases of MTC nodules, 17 (81%) were classified as suspicious malignant nodules. The mean size (longest diameter) of MTC nodules was 19 ± 13.9 mm and the mean size (longest diameter) of PTC nodules was 11 ± 7.4 mm; this difference was statistically significant (p < 0.05). An ovoid to round shape was more prevalent for MTC lesions than for PTC lesions (p < 0.05). Conclusion The US criteria for suspicious malignant nodules as recommended by the Thyroid Study Group of the KSNHNR correspond to most MTC cases. The US findings for MTC are not greatly different from PTC except for the prevalence of an ovoid to round shape.

Aggressive angiomyxoma is a rare benign tumor that originates in the pelvic or perineal organs of women. We report a case of an aggressive angiomyxoma as a huge vulvar mass, and present its clinical and image characteristics with a review of the literatures.

Leiomyomas most frequently occur in the genitourinary and gastrointestinal system. This report describes the clinical and imaging findings of a leiomyoma originating in the prevesical space, a rare location. The mass abutted the fundus of the uterus, but after the correct identification of feeding vessels from the right iliac artery, prevesical leiomyoma was diagnosed radiologically.