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Abstract Background Primary prevention of breast cancer through prophylactic mastectomy can reduce the risk of malignancy in high-risk individuals. No type of mastectomy completely removes all breast tissue, but a subcutaneous mastectomy leaves more tissue in situ than does a simple mastectomy. Case presentation We report a case of invasive breast cancer in a BRCA2-positive woman 33 years after bilateral subcutaneous mastectomy. To our knowledge, only one case of primary breast cancer after prophylactic mastectomy in a BRCA1-positive patient has been reported in the literature and none in BRCA2-positive individuals. Conclusion Careful documentation and long follow-up is essential to fully assess the benefits and risks of preventive surgical procedures in BRCA1 and BRCA2 mutation carriers.

Most of male breast masses are benign with gynecomastia being the most common entity encountered. Primary male breast cancer accounts for less than 1% of the total number of breast cancer. Male breast can be affected by a variety of conditions affecting the female breast with less frequency due to the lack of hormonal influence and consequent glandular sub-development. Imaging features of male breast masses are quite similar to the female breast. Therefore, using the knowledge of the female breast and applying it may help in the diagnosis and management of male breast abnormalities. In this article, we aim to review a variety of unusual male breast masses. We discuss the demographics of male breast tumors, describe the diagnostic algorithm for evaluating male breast masses, and review the imaging features of rare breast masses and mimickers of male breast cancer. [ABSTRACT FROM AUTHOR]

Objective: To review the imaging features of invasive lobular carcinoma (ILC) seen on digital breast tomosynthesis (DBT) in comparison with invasive ductal carcinoma (IDC), and to evaluate whether DBT could improve conspicuity and tumour size assessment of ILC in comparison with digital mammography (DM). Methods: Institutional review board with waiver of informed consent was obtained for this retrospective study. Patients with ILC or IDC who underwent DBT and DM at the time of diagnosis were included. DM and DBT images were reviewed in consensus by two breast radiologists in order to assess imaging features, conspicuity and maximum tumour diameter of ILC and IDC. Pathology on the surgical specimen was considered the standard of reference for assessment of tumour size. Results: 43 patients (20 patients with ILC and 23 patients with IDC) were included. On DBT, compared with IDC, ILC presented less frequently as masses (40% vs 78%) (p = 0.01) and more frequently as isolated distortion (20% vs 0%) (p = 0.03). ILC presented more often as asymmetries (60%) than masses (20%) on DM (p = 0.02) but not on DBT (35% vs 40%; p = 1.00). Conspicuity of ILC was significantly higher on DBT than on DM (p = 0.002), while the difference between the two techniques was not significant for IDC (p = 0.2). Regarding ILC, concordance in tumour size measurement between DBT and pathology was fair (intraclass correlation coefficient = 0.24). Conclusion: ILC rarely presented as dense masses but frequently demonstrated architectural distortion on DBT. DBT increased lesion conspicuity but failed to accurately assess tumour size of ILC. [ABSTRACT FROM AUTHOR]

Breast Ultrasound (US) is an important tool for both screening and diagnostic examinations. Although breast US has benefitted from significant recent technical improvements, its use for the retroareolar region is known to be more challenging than for other locations. The retroareolar location was defined by Giess et al. in 1998 as the region where any lesion is situated at less than two cm from the nipple and/or involves the nipple-areolar complex on mammogram. Understanding of the complex anatomy and physiology of the nipple-areolar region is important to avoid misinterpretation and misdiagnosis. The ability for the breast imager to manage difficulties related to the retroareolar area is paramount by adjusting settings (compounding, frequency, Doppler) and utilizing specific manoeuvers. Cases illustrating difficulties encountered in diagnosis of retroareolar carcinomas are presented. [ABSTRACT FROM AUTHOR]

Purpose: To review breast magnetic resonance imaging (MRI) features of radial scar (RS) with and without associated atypia/malignancy. Methods: Twenty-eight (mean age 56.8) patients diagnosed with 30 biopsy-proven RS (n = 25, ultrasound-guided 14-gauge, n = 5, stereotactically guided 9-gauge) subsequently underwent breast MRI followed by surgery. Magnetic resonance imaging protocol included axial T1, axial fat sat T2, and postgadolinium in axial and sagittal planes. Two radiologists reviewed the mammographic and MRI findings in consensus according to the Breast Imaging Reporting and Data System lexicon. Results: Of the 30 RSs excised surgically, 14 (14/30, 47.7%) were not associated with atypia/malignancy while atypia/malignancy was found in 16 (16/30, 53.3%) RSs. Three (3/30, 10%) RS lesions did not enhance on dynamic MR. Mean lesion size on MRI was 1.4 cm (range, 0.5-5 cm). Seventeen (17/30, 56.7%) lesions presented as nonmass enhancement and 9 (9/30, 30%) as masses. Nonmass lesions showed focal distribution (13/17, 76.5%) and heterogeneous enhancement (15/17, 88.2%). Masses showed irregular shape and margins (6/9, 67%) and heterogeneous enhancement (8/9, 89%). Multivariate analysis did not show any significant difference in MRI presentation between RS only and RS associated with atypia/malignancy. Conclusion: Breast MRI does not help differentiate between RS with or without associated atypia/malignancy. [ABSTRACT FROM AUTHOR]

Purpose: Verify whether there is a difference in likelihood of developing pulmonary embolism (PE) between pregnant women, nonpregnant women of reproductive age, and postpartum (up to 6 weeks) women, by comparing their outcomes on computed tomography pulmonary angiography (CTPA) done for suspicion of PE. Materials and Methods: Retrospective cohort study of 1463 CTPA done for suspicion of PE in females of reproductive age (18-40 years), nonpregnant, pregnant (antepartum), and postpartum, from 2 tertiary-care academic hospitals between October 2006 and September 2015. Primary outcome was diagnosis of PE on imaging. Additional assessment was made of technical adequacy of the studies and method of delivery for the postpartum cohort (vaginal vs caesarean birth). Twenty-nine technically nondiagnostic studies were excluded. The effect of any potential variable on PE status was tested using univariate logistic regression. Subgroup analysis was performed after excluding patients with independent risk factors for PE. Results: The rate of CTPA positive for PE was less among pregnant patients compared to early postpartum and nonpregnant women of similar age, 2.9% vs 11.5% and 10.3%, respectively. Pregnancy was associated with statistically significant decreased odds ratio of developing a PE on CTPA, 0.23 (0.09-0.89), P value =.004. After excluding patients with additional independent risk factors for PE, there was no statistically significant odds ratio association between presence of PE on CTPA and pregnancy 0.41 (0.13-1.34), P value =.14. Conclusion: Rate of CTPA positive for PE in pregnant women was lower than in nonpregnant and early postpartum women. Pregnancy was statistically significantly less likely to be associated with positive PE on a CTPA study. The common perception that pregnancy (antepartum state) is associated with an increased risk of PE may require a thorough critical reappraisal. [ABSTRACT FROM AUTHOR]

Objectives Gonadal vein thrombosis is an uncommon but serious condition that can be fatal if it goes unnoticed. Up to 80% of cases occur in patients after delivery, hysterectomy, or lymphadenectomy for gynecological neoplasms. The objective of this study was to determine the incidence of gonadal vein thrombosis using computed tomography (CT) imaging at our center and to describe associated risk factors. Methods A retrospective, single-center, observational study was conducted at King Abdulaziz Medical City in Jeddah, Saudi Arabia. Data were collected for all patients diagnosed with incidental gonadal-vein-thrombosis using contrast-enhanced computed tomography imaging of the abdomen and pelvis between January 2005 and December 2017. We included all patients with incidental findings of gonadal vein thrombosis and excluded those with incomplete data. Results In total, 58/68,268 (0.08%) patients were included. Fifty-seven patients were females, and only one was male. The mean age (years) of the patients was 50.0±15.0 (range 4-87). Thirty-four patients (59%) had right gonadal vein thrombosis, 20 (34%) had thrombosis on the left side, and four (7%) had bilateral thrombosis. Nineteen patients (33%) had undergone pelvic surgery previously. Forty-four patients (76%) had a malignancy at the time of diagnosis. Forty-two patients (72%) were treated with anticoagulants after the diagnosis. Conclusion Gonadal vein thrombosis is a rare clinical entity with vague clinical presentation. The incidence in the oncology population is similar to the reported incidence in the obstetric population. Initiation of anticoagulation therapy is important to treat this condition and limit complications., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Alsharif et al.)

Objectives: Recent investigations have shown that serotonergic antidepressant (SAd) use may increase the risk of peri-operative bleeding events. Our objective was to evaluate the possibility of a similar association in patients undergoing radiologic breast biopsies., Methods: We used data from 3890 patients undergoing 6300 biopsy procedures between January 2011 and October 2014 in the Breast Clinic of McGill University Health Centre, Montreal, Canada. In this case-control study, cases were patients reported to have abnormal bleeding during their biopsy by board-certified radiologists. A control group of nonbleeders was selected using matching according to age and type of biopsy. The correlation between abnormal bleeding and SAd use was assessed using bivariate and multivariate statistical analyses., Results: There were 97 patients with abnormal bleeding and 137 matched controls; 10 bleeders (cases) were on SAds (7 citalopram, 3 paroxetine) while only 1 nonbleeder (control group) was on a SAd (low-dose sertraline, 25 mg/day). SAds were significantly associated with increased bleeding risk (10.3% versus 0.7%, Fisher's Exact p = 0.001). Moreover, after adjusting for confounding factors (age, type of biopsy, size of biopsy, needle caliber, pathology result and nonsteroidal anti-inflammatory drug use, multivariate logistic regression confirmed that SAds were associated with elevated bleeding risk (16.2, 95% confidence interval 1.87-140.1, p = 0.01)., Conclusions: This is the first study demonstrating increased bleeding events in breast biopsy patients using SAds. Clinicians should be aware that SAds may be associated with peri-operative bleeding risk, even in relatively minor procedures such as breast biopsies.

Purpose: To retrospectively evaluate interobserver variability between breast radiologists when describing abnormal enhancement on breast MR examinations and assigning a BI-RADS category using the Breast Imaging Reporting and Data System (BI-RADS) terminology., Materials and Methods: Five breast radiologists blinded to patients' medical history and pathologic results retrospectively and independently reviewed 257 abnormal areas of enhancement on breast MRI performed in 173 women. Each radiologist described the focal enhancement using BI-RADS terminology and assigned a final BI-RADS category. Krippendorff's α coefficient of agreement was used to asses interobserver variability., Results: All radiologists agreed on the morphology of enhancement in 183/257 (71%) lesions, yielding a substantial agreement (Krippendorff's α=0.71). Moderate agreement was obtained for mass descriptors - shape, margins and internal enhancement - (α=0.55, 0.51 and 0.45 respectively) and NME (non-mass enhancement) descriptors - distribution and internal enhancement - (α=0.54 and 0.43). Overall substantial agreement was obtained for BI-RADS category assignment (α=0.71). It was however only moderate (α=0.38) for NME compared to mass (α=0.80)., Conclusion: Our study shows good agreement in describing mass and NME on a breast MR examination but a better agreement in predicting malignancy for mass than NME., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: The aims of our study were to determine the frequency of malignancy after surgical excision of biopsy-proven lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia (ALH) lesions, to assess any difference between pure LCIS and pure ALH lesions regarding their radiologic presentation and the malignancy upgrade rate after surgical excision, and to evaluate the outcome of lesions that were not excised surgically but were followed up., Materials and Methods: Radiologic and pathologic records of 14,435 imaging-guided needle biopsies of the breast performed between 2004 and 2008 in three different institutions were retrospectively reviewed. A total of 126 patients (0.9%) had biopsy-proven LCIS or ALH, or both, as the highest-risk lesion. Among the 126 patients, 89 (71%) continued to surgery, and 14 were followed up for more than 24 months. The Mantel-Haensel chi-square test was used for statistical analysis., Results: Cancer upgrade was documented in 17 of the 43 LCIS (40%), 11 of the 40 ALH (27%), and two of the six combined ALH and LCIS lesions (33%) surgically excised, for a total malignancy upgrade rate of 34% (30/89). Both LCIS and ALH lesions presented mammographically in most cases as microcalcifications (p = 0.078). None of the 14 patients followed up for a mean period of 51 months showed development of malignancy., Conclusion: No statistically significant difference was found between mammographic presentation and postsurgical outcome of LCIS versus ALH lesions. Surgical excision of these lesions is recommended as long as no evident criteria are provided to differentiate those that might be associated with an underlying malignancy.

Objectives: This study is a single institution retrospective evaluation of imaging findings of small bowel obstruction (SBO) after retrocolic antegastric Roux-en-Y gastric bypass surgery for morbid obesity., Methods: The radiological database of 490 patients who underwent gastric bypass surgery for morbid obesity from January 2001-2005 at the Royal Victoria Hospital McGill University Health Center was searched for SBO complications related to the procedure. There were 22 cases of small bowel obstruction related to the procedure. Ten patients had abdominal and pelvic computed tomography (CT) scans, 12 patients had upper gastrointestinal (UGI) and small bowel follow through (SBFT)., Results: Among 22 cases of SBO, 14 cases were due to anastomotic stenosis or adhesion, 7 due to internal hernia and one to jejuno-jejunal intussusception. Among the 14 patients with SBO related to adhesion and anastomotic narrowing, 11 patients were managed medically and 3 cases managed surgically. CT scans correctly diagnosed 4 out of 5 cases including the 3 patients managed surgically and UGI and SBFT examinations diagnosed the remaining 9 cases that were managed medically. Among the 7 patients with internal hernias, CT scans correctly diagnosed 2 out of 4 cases, while UGI and SBFT examinations correctly diagnosed 1 out of 3. The jejuno-jejunal intussusception was correctly diagnosed by CT scan., Conclusion: The most frequent cause of SBO is anastomotic narrowing or adhesion. CT scan remains the most appropriate imaging modality in diagnosing acute presentation of SBO caused by internal hernia or adhesion/anastomotic narrowing. UGI and SBFT appear more appropriate for diagnosing the subacute insidious presentation of adhesive partial SBO.