Hepatosplenic γδ T-cell lymphoma (HSTCL) is a very rare peripheral T-cell lymphoma characterized by extranodal infiltration of mature malignant post-thymic T-lymphocytes into sinusoids of the liver and spleen without lymphadenopathy and significant cytopenias. It is an aggressive form of lymphoma, resistant to the conventional chemotherapy. We report a case of HSTCL in pregnancy. Because this condition is an extremely aggressive and rare entity, data from these cases can help confirm the most suitable treatment regimen and timing of initiation. The role of ultrasound and magnetic resonance imaging in the diagnosis has been discussed. HSTCL is a rare entity of T-cell lymphoma, uncommon in female patients and very rarely reported during pregnancy.
33 Background: The purpose of the study is to differentiate benign and malignant breast lesions based on very early enhancement of the lesion on time-resolved gadolinium-enhanced MR imaging. Methods: 100 women with breast lesions were examined at 1.5 T (Siemens, Erlangen, Germany), by fast T1-weighted GRE images every 5 s for 1 min after injection of Gd-DOTA (Dotarem, Guerbet, France), followed by 5 spacially-resolved MR image series every 30 s. Images were subtracted; maximum-intensity-projection images were obtained; and images were randomized and reviewed by two blinded readers, who reviewed only the spacially-resolved MR images and gave BIRADS diagnosis. After one month, they evaluated only the time-resolved MR images and noted the time of first appearance of enhancement. Results: The patients had 249 enhancing lesions: 66 malignant on histopathology and 183 benign on basis of histopathology or 1-year imaging follow-up. On time-resolved MR imaging, 15 lesions enhanced at 0-5 s (all malignant), 23 at 5-10 s (21 malignant, 2 benign), 34 at 10-15 s (28 malignant, 6 benign), and 117 at 15-20 s (2 malignant, 115 benign). All malignant lesions enhanced before 20 s. Taking 15s as the cut-off point, early enhancement had sensitivity of 96.9%, specificity of 95.6%, positive predictive value of 88.8%, negative predictive value of 98.8%, and accuracy of 95.9% for diagnosis of carcinoma. Enhancement before 15 s corrected BIRADS diagnosis of the spacially-resolved MR imaging in 14 lesions (5.6%). Conclusions: Lesion enhancement in the first 15s on time-resolved MR imaging is a useful sign for the diagnosis of breast carcinoma.
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