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Granular cell tumors are also referred to as granular cell neuromas, Abrikossoffs tumors, or granular cell myoblastomas. These rare and mostly benign neoplasms originate from Schwann cells of peripheral nerves. In 5 -6% of cases, the lesion is located inside the breast where it may mimic the clinical and imaging features of invasive breast cancer. We report on a 52-year-old patient who palpated a firm mass in the sternocostal region of her left breast during breast self-examination. The suspicious area did not reveal any mammographic anomalies. The character of the lesion was not assessable by ultrasonography. Ultrasound-guided core biopsy did not reveal the diagnosis either. Breast MRI was most compatible with breast cancer. Histopathologic analysis after diagnostic excision revealed a granular cell tumor. We discuss pathological and clinical features including diagnostic imaging, management, and prognosis of this rare condition.

Objective The use of GnRH agonists instead of hCG to trigger ovulation seems to be an effective way to prevent subsequent hCG induced ovarian hyperstimulation in cases of polyfollicular development. But conflicting results are reported on the efficiency of subsequent luteal support using hCG and/or progesterone supplementation. Study design We investigated the efficiency and safety of different luteal support regimes in low dose gonadotropin stimulation non-ivf cycles. A risk for an imminent ovarian hyperstimulation was assumed if preovulatory estradiol levels rose up higher than 700 pg/ml and more than 12 intermediate sized follicles (8–14 mm) were observed. Thirty-six women received 0.5 mg Triptorelin subcutaneously to trigger the ovulation inducing LH surge. After randomization, luteal support regimes started on day 2 after the Triptorelin administration with injections every second day five times in all. Group (a) received 5 × 1000 IU hCG, group (b) received 5 × 500 IU hCG, and group (c) received 5 × 250 mg progesterone, intramuscularly. The monitoring of the ovulation period and the subsequent luteal phase included sonographic measurement of ovarian diameter and estimation of LH, FSH, estradiol and progesterone levels 10 and 34 h as well as 8 days after Triptorelin administration. Results We could prove ovulation in all women and did not find symptoms of ovarian hyperstimulation in any case. Midluteal controls showed extremely low gonadotropins in all groups indicating a long lasting pituitary down regulation after one injection of 0.5 mg Triptorelin. We found high normal sex steroid levels in both hCG groups. The progesterone group displayed a marked luteal phase defect with low levels of progesterone and estradiol in all cases. Conclusion The use of GnRH agonist in cases of polyfollicular development is capable to induce ovulation without a subsequent ovarian enlargement and/or any sign of hyperstimulation syndrome. Luteal support by low dose hCG does not counteract the benefit of GnRH agonist in preventing an ovarian hyperstimulation syndrome, but seems to remedy at least in part the possible deleterious effects of GnRH agonists on luteal functionality.

Aim: This study aims to evaluate the correlation between ultrasonographic and histologic sizing of benign and malignant breast lesions. Ultrasonography is an important adjunct, because palpatory findings are insufficient to decide about the surgical management, e.g. tissue-sparing resection versus mastectomy. Neither does the physical examination suffice to determine if to proceed with surgery or primary chemotherapy. Method: Over a two-year period, breast ultrasonographic and the corresponding histologic sizing data were prospectively collected. The largest measurement obtained for each lesion was entered into the analysis. Results: Among a total number of 281 lesions, 152 (54.1%) were benign and 129 (45.9%) malignant. Measured by ultrasonography, 74.6% of tumors up to 10 mm are benign. Both ultrasonographic and histologic size data were available in 199 cases. Seven patients had received neoadjuvant chemotherapy, leaving 192 lesions for final analysis. By ultrasonography, lesions measured between 3 and 86 mm (mean 18.1 mm) in size. The average size of benign lesions was 15.3 mm, the average size of malignant lesions 21.4 mm. All lesions larger than 50 mm were malignant. There is a trend toward slight overestimation of the size of malignant and underestimation of the size of benign lesions by ultrasonography. In 33.9% (n = 65) of all 192 cases, ultrasonographic and histologic measurements agreed to within 2 mm. Conclusion: Due to precise lesion sizing, breast ultrasonography possesses a significant potential as a preoperative staging tool.

Acellular dermal matrix is increasingly used as caudolateral coverage for breast implants in immediate breast reconstruction after skin-sparing mastectomy or in the correction of implant-associated breast deformities. Matrices of human, bovine, and porcine origin are available. The purpose of this retrospective multicenter study was to report experiences with porcine acellular dermal matrices, as only limited data can be found in the literature.In the hospital databases of five institutions, 127 patients were identified who underwent breast reconstructions in 156 breasts using an acellular porcine dermal matrix. Medical records were reviewed. Patients were divided into three groups: immediate expander-implant or direct to implant reconstructions (n = 98), delayed expander-implant reconstructions (n = 14), and revision surgery for implant-associated breast deformities (n = 44).With a mean follow-up of 19.6 months, total major complication rate was 7.1 %: implant loss (3.2 %), skin flap necrosis (2.6 %), delayed skin healing (2.6 %), hematoma (1.9 %), seroma (1.3 %), infection (0.6 %), and capsular contracture (0.6 %). Total minor complication rate was 22.9 %, with seroma being the most frequent complication (19.2 %). In the group of immediate breast reconstructions, 20.4 % of the breasts had received radiotherapy in the past. These patients exhibited a significantly higher rate of seroma than patients without prior radiotherapy (35.0 vs. 14.9 %, p = 0.031).Complication rates using porcine acellular dermal matrix in breast reconstruction are comparable to complication rates reported in studies using human acellular dermal matrices. Thus, porcine acellular dermal matrices can safely be applied in breast reconstructive surgery.

The aim of this study was to evaluate the quality standard of the nationwide breast ultrasound training program of the German Society of Ultrasound in Medicine (DEGUM) through objective parameters.10 quality criteria, based on the recommendations of The National Association of Statutory Health Insurance Physicians (KBV), were defined for this study. All training units of the DEGUM received a questionnaire. The questionnaires and training material were analyzed.All units met the required criteria pertaining to the trainer's qualification, duration per training course and the maximum number of participants per ultrasound machine. Only 1 course did not fulfill the required 50 % practical training time. The requirements to participate in the graduate course (200 self-made and documented cases) were not clearly conceived and a defined training log could be improved.DEGUM breast ultrasound training offers trainees a high level of education based on the requirements of the KBV. Despite the high quality of training, the content of course announcements could be improved and an official and structured educational index could be meaningful.

The technical part of these Guidelines and Recommendations, produced under the auspices of EFSUMB, provides an introduction to the physical principles and technology on which all forms of current commercially available ultrasound elastography are based. A difference in shear modulus is the common underlying physical mechanism that provides tissue contrast in all elastograms. The relationship between the alternative technologies is considered in terms of the method used to take advantage of this. The practical advantages and disadvantages associated with each of the techniques are described, and guidance is provided on optimisation of scanning technique, image display, image interpretation and some of the known image artefacts.

This retrospective study aimed to assess the diagnostic value of mammography, breast ultrasonography, and palpation in diagnosing fibroadenomas, making consistent use of the BI-RADS classification. The impact of breast density, patient age, and the size and palpability of the mass will be evaluated.Between January 2000 and December 2009, a total of 339 fibroadenomas suitable for inclusion in this study were diagnosed and histologically verified at our institution. Based on their BI-RADS or BI-RADS analog classification, all lesions were categorized as benign or malignant. These results were compared to the corresponding histopathological findings. Specificities were calculated for each of the abovementioned parameters. Chi-square test results with p-values 0.05 were considered significant. Congruence between mammography and ultrasonography was assessed based on Cohen's kappa.Palpation had a specificity of 100 %, mammography 83.9 %, and ultrasonography 88.2 %. Considering the parameters under investigation, ultrasonography is superior to mammography. The specificity of the ultrasonographic assessment "benign" vs. "malignant" varied with patient age and palpability of the lesion (p = 0.001 and p = 0.025). Mammography and ultrasonography were most congruent for lesions rated ACR 1 - 2 and for lesions 1.9 cm (κ = 0.464, κ = 0.444).For diagnosing fibroadenomas, ultrasonography is more specific than mammography when all examined variables are taken into account. Ultrasonography should therefore be favored, especially in younger patients. One needs to be aware of the effects of palpability and patient age on the ultrasonographic differentiation "malignant" vs. "benign". In some cases, mammography should be considered as an adjunct.

Background To investigate the diagnostic reliability of selective microdochectomy after direct ductoscopic wire marking of suspect lesions in patients with pathological nipple discharge. Methods Selective microdochectomy due to pathological discharge was performed in 33 patients with mean age of 51.7 years. Ductoscopes of 0.9 and 1.1 mm in diameter with a channel for wire marking were used. Only patients without sonographic or mammographic correlation for the discharge were included. The pathologic mammary duct was wire marked and extirpated under direct visual guidance via the ductoscope. The histological results were compared with cytology, galactography and ductoscopy. Results In 24 out of 33 cases (72%) an intraductal, epithelial proliferation was found histologically. The following sensitivities for intraductal, epithelial proliferations could be determined: cytology 4%, galactography 74%, and ductoscopy 78%. Conclusion The method allows selective microdochectomy of the pathological duct and the intraductal proliferation under visual guidance. The resection volume can be reduced in contrast to the unselective ductectomy after injection of methylene blue.

Asparagus spears collected from a total of six commercial plantings in Austria during the main harvest periods in May and June of 2003 and 2004 were examined for endophytic colonization byFusarium spp., particularlyF. proliferatum. Potentially toxigenic fungi such asF. proliferatum were isolated and identified by morphological characteristics using light microscopy. Fumonisin B1 inF. proliferatum-infected asparagus spears was detected with IAS-HPLC-FLD or HPLC-MS/MS. The identity of endophytic fungi colonizing of a total of 816 individual spears was determined. The incidence of infection byF. proliferatum and otherFusarium spp. was highly dependent on location and sampling date. The dominantFusarium species among the endophytic microflora wasF. oxysporum. Other frequently isolated species includedF. proliferatum, F. sambucinum, F. culmorum, F. avenaceum andF. equiseti. The incidence ofF. proliferatum-infected asparagus spears was less than 10% at four of the six sampling locations. At the two remaining locations, 20-47% of the spears examined were infected withF. proliferatum. Further exploration of FB1 generation in asparagus is required because the low levels of FB1 (10-50 (μg/kg) detected in harvested spears in 2003 and 2004 cannot be explained by the results of this study.

This prospective double-blind study was designed to assess (i) if primary breast screening by ultrasonography is capable of detecting breast cancer independent of tissue density and (ii) if the rate of unnecessary biopsies remains acceptable when diagnostics are based on ultrasonography.Bilateral breast ultrasonography was performed in 448 asymptomatic women as the initial diagnostic method. Sonograms were interpreted using a set of standardized diagnostic criteria. Subsequently, mammograms were obtained. The radiologists reading the mammograms were blinded to the sonographic results.Overall, 3 non-palpable breast cancers were detected by ultrasound and mammography. All 3 ultrasonographically detected breast cancers were smaller than 1 cm (0.7, 0.7, 0.6 cm). All 3 carcinomas were correctly detected by both methods. For ultrasonography, the false positive rate was 1.1% (n=5) and for mammography 0.6% (n=3). When both methods were combined, the rate of unnecessary open biopsies was 1.6% (n=7). The ratio of benign to malignant lesions was 3.7/1.Without prior mammography, primary high-resolution breast ultrasonography is capable of detecting non-palpable breast carcinomas in asymptomatic women at an early stage. The rate of unnecessary open biopsies is low and the ratio of benign to malignant biopsies acceptable.

This article reviews the role, diagnosis and treatment of Ureaplasma infections in human reproduction.

We report on a 45-year-old patient who presented with a 7 cm palpable right breast mass which had been classified as a cyst by ultrasonography. Multiple aspiration cytologies revealed no evidence of malignancy. Repeat sonography in our institution showed a lesion at 1 o'clock, 1 cm deep, and 3-8 cm from the nipple. The lesion contained a solitary cystic component measuring 3.9 x 4.1 x 4.4 cm. A 3.1 x 2.6 x 2.5 cm solid, inhomogeneous mass with irregular margins was found at the lateral border of the cyst. This mass raised suspicion of an intracystic carcinoma. Histopathologic analysis of 5 high-speed biopsy tissue cores demonstrated an invasive large-cell ductal carcinoma (G2-3). Final histopathologic assessment subsequent to breast-preserving resection and axillary node dissection confirmed the initial diagnosis: keratinizing intracystic squamous cell carcinoma (G2-3, pT2, pN0 (0/15)). The search for a remote primary squamous cell carcinoma included a chest X-ray, cystoscopy, colposcopy and PAP smear, esophago-gastroscopy, ENT consultation (laryngoscopy), and did not reveal any extramammary cancer. The postoperative management consisted of a total of 6 cycles of chemotherapy (Cisplatinum 75 mg/m (2) BSA and Paclitaxel 175 mg/m (2) BSA every 21 days) and subsequent percutaneous radiotherapy. In accordance with published reports, the diagnostic and therapeutic management was analogous to that of adenocarcinoma of the breast. However, some authors recommend the same chemotherapy as used for squamous cell carcinomas of other organs. It remains difficult to make any statements regarding the adjuvant therapy and prognosis, since this type of tumor is so infrequent, especially as an intracystic lesion.

Breast cancer is the most frequent gynecological tumor. The HER-2/neu oncogene may play a role in the prognosis and management of patients with breast cancer. In a retrospective study on 100 patients, we correlated the expression of this oncogene with the classic clinical and pathological factors. 32 % of patients exhibited overexpression of HER-2/neu. There was no significant correlation with classic parameters. This finding could indicate that HER-2/neu expression is a new independent prognostic factor. Prospective studies correlating HER-2/neu overexpression with prognosis might provide additional data.

Benign tumours in pregnancy are often "lactating adenomas". The differentiation against malignant processes is sometimes difficult. In this case report we demonstrate the diagnostic and therapeutic procedure in an 18-year old woman with multiple nodes in the right and left breast. Pregnancy makes it difficult to examine the breast with the usual methods. Because of suspect clinical and ultrasonic findings we made a core biopsy already during pregnancy. With nodes in the breast during pregnancy, ultrasound is the diagnostic method of choice. Histology by core biopsy must be made. As long as the histology corresponds with the ultrasound findings, controls are sufficient if the findings are benign. Otherwise, diagnostic exstirpation will be necessary even though the patient is pregnant. Ultrasound and biopsy are the only significant examinations in pregnancy and lactation. Mammography is contraindicated because of radiation. Assessment by palpation and NMR is problematic during pregnancy.

We report a fetal bilateral renal agenesis in a woman suffering from insulin-dependent diabetes mellitus. Early diagnosis of this lethal congenital anomaly allows well-timed termination of pregnancy. Transvaginal sonography in combination with color flow mapping render possible an accurate diagnosis of bilateral renal agenesis. Sonographic and color flow mapping features of the above described malformation as well as invasive diagnostic possibilities and causes of renal agenesis in maternal IDDM are discussed.