Patient: Female, 52Final Diagnosis: Cholesterol granuloma of the breastSymptoms: Follow upMedication: —Clinical Procedure: Surgical excisionSpecialty: RadiologyObjective:Rare diseaseBackground:Cholesterol granuloma is a benign condition that can be misdiagnosed as breast cancer on mammographic and ultrasound imaging. A case of concomitant cholesterol granuloma with invasive ductal carcinoma of the left breast was imaged with ultrasound elastography and magnetic resonance imaging (MRI) methods, including T1-weighted dynamic contrast-enhanced MRI (DCE-MRI), before biopsy and histopathology.Case Report:A 52-year-old woman, with a previous history of intraduct papillomas in both breasts, underwent six-monthly follow-up breast imaging. The most recent breast mammogram showed a progressively enlarging oval mass in the upper inner quadrant (UIQ) of the left breast, and an adjacent irregular mass with microcalcifications. Virtual Touch IQ (VTIQ) shear wave elastography was used with ultrasound of the breast lesions. T1-weighted fat saturation (T1WFS) MRI, T2-weighted short-tau inversion recovery (STIR) MRI, and T1-weighted DCE-MRI were used to image the left breast. T1-weighted DCE-MRI showed that the oval lesion had a high T1-weighted signal and mild progressive enhancement, with a Type I (benign) time-signal intensity curve; the second, irregular, mass showed rapid, intense enhancement with a washout pattern or Type III (malignant) time-signal intensity curve. Histopathology confirmed that the oval mass was a cholesterol granuloma, and the irregular mass was an invasive ductal carcinoma.Conclusions:A case of concomitant cholesterol granuloma with invasive ductal carcinoma of the left breast, showed that ultrasound with shear wave elastography and T1-weighted DCE-MRI could distinguish between cholesterol granuloma and invasive ductal carcinoma.

Patient: Male, 66Final Diagnosis: Nonbifurcating carotid arterySymptoms: No symptomsMedication: —Clinical Procedure: —Specialty: NeurologyObjective:Congenital defects/diseasesBackground:Vascular anomalies of the carotid vessels can be attributed to false embryogenesis. A rare variant called a nonbifurcating carotid artery (NBCA) exists, where typical carotid bifurcation is not recognizable with its typical branches of the external carotid artery (ECA) and internal carotid artery (ICA). This paper describes a case of this anomaly and reviews the embryogenesis of the carotid arteries for explanation.Case Report:A 66-year-old man received a routine health examination at our hospital. Initial carotid ultrasound indicated an absence of bifurcation in the right cervical carotid artery, and magnetic resonance imaging of the brain indicated an absence of the proximal cervical segment of the right ICA, with a remnant arterial stump at the expected bifurcation level. No evidence of the carotid bulb was identified. The common carotid artery seemed to continue cranially in the trunk of the ECA, where it exhibited extracranial branches. After distributing these branches, the carotid artery coursed medially at the C2 level, where it ascended into the carotid canal to become the petrosal segment of the ICA. This carotid anomaly was labelled an NBCA. No aberrant intracranial arteries were derived from the NBCA in this case.Conclusions:In this case, the arterial stump was considered a remnant from agenesis of the right ICA. We assumed that the NBCA most likely developed because of false regression of the third embryogenic aortic arch with persistence of the second aortic arch.

Primary thyroid lymphoma (PTL) is a rare disease which responds well to rituximab-based chemotherapy. Here, we describe a case who was diagnosed through core needle biopsy as having diffuse large B-cell lymphoma in the right lobe of thyroid gland. Positron emission tomography computed tomography (PET-CT) revealed no other foci of hot spots, so PTL was considered. She was treated with rituximab plus bendamustine for three cycles, and color Doppler ultrasound revealed significant reduction of blood flow signals in the tumor but no significant decrease of its size (<25% extent). Then, the chemotherapy regimen was adjusted to rituximab, cyclophosphamide, vincristine, prednisone (R–COP), and complete remission was noted on ultrasound and PET-CT after three cycles of R–COP treatment. This case is reported to tell that color Doppler ultrasound, in addition to PET-CT, is useful to evaluate chemotherapeutic effect on PTLs.

A 32-year-old woman without any systemic disease presented for a workup of a palpable mass in the right breast. She had identified this abnormality through self-examination 9 months prior. At the 6 o′clock position of the right breast, a lobulated smooth mobile mass was discovered. She went to a local hospital, where she underwent sonography and mammography. Sonography identified a 2.4-cm mass with an obscure margin and mixed echogenicity at the 6 o′clock position of the right breast ( Figure 1). Mammography disclosed unremarkable findings. She was thus followed clinically, and the mass was initially considered benign.Because of the gradual enlargement of the palpable abnormality, the patient received core needle biopsy 6 months later, at which point the mass had enlarged to 5.7 cm in diameter. Histopathology of the core-biopsy specimen determined it to be a benign vascular tumor, and the patient decided to receive a wide excision of the tumor. The surgical pathology reported a well-differentiated angiosarcoma, but the surgical margin was not free of tumors. Follow-up mammography revealed a focal asymmetry over the 6 o′clock position of the right breast and no associated features (Figure 2). She was subsequently referred to our hospital for breast-conserving surgery (BCS) on her right breast. The final pathology identified a welldifferentiated low-grade angiosarcoma with free resection margin. After the operation, adjuvant chemotherapy was not administered to the patient. She was examined through breast sonography every 6 months after the operation. However, an infiltrative lesion was discovered at the 6 o′clock position of the right breast 9 months after BCS. Magnetic resonance (MR) imaging revealed a large confluent mass over the right breast. The mass presented slight hypointensity on T1-weighted images and vivid hyperintensity on T2-weighted images. Rapid and persistent enhancement was also apparent on the dynamic contrast-enhanced images (Figure 3). Additionally, an enlarged lymph node in the ipsilateral axilla was identified. The MR findings of the tumor were consistent with low-grade breast angiosarcomas with recurrence that have been reported in the literature. She subsequently received total mastectomy of the right breast with ipsilateral axillary lymph node dissection. The pathology proved recurrent angiosarcoma of the breast. Primary angiosarcoma of the breast is an extremely rare disease that is easily misdiagnosed using imaging tests. Diagnostic mammography offers limited information, whereas sonography and MR imaging are recommended for its diagnosis. In dynamic MR images, high-grade breast angiosarcomas exhibit typical malignant dynamic features with a rapid washout pattern, whereas low-grade tumors exhibit persistent enhancement on delayed images. Breast angiosarcomas have the least favorable prognosis of all breast malignancies; F I G U R E 1 Gray-scale sonography shows mixed echogenicity of the breast lump in the breast parenchyma [Color figure can be viewed at wileyonlinelibrary.com]