Diffusion-weighted imaging (DWI) has been proven to be effective in detecting breast malignancies and has been widely implemented for breast imaging. However, the exact association between certain DWI biomarkers and well-known prognostic factors remains to be fully elucidated. By studying the association between the apparent diffusion coefficient (ADC) and prognostic factors, the present study aimed to explore the diagnostic value and prognostic potential of the ADC in breast lesions. The study included 539 female subjects with histopathologically confirmed breast lesions who underwent DWI of the breast tissue. The diagnoses comprised 307 subjects with malignant breast tumors and 232 with benign breast tumors. The maximum ADC and mean ADC (ADC mean ) values of the breast lesions were calculated. For malignant tumors, the association between ADC and major prognostic factors, including histological grade, nuclear grade and lymph node status, as well as estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2) and proliferation marker protein Ki-67.(Ki-67) status, were evaluated. The ADC mean demonstrated the best diagnostic performance in distinguishing between malignant and benign lesions. With the optimum cut-off value at 1.30×10 −3 mm 2 /sec, ADC mean had a sensitivity and specificity of 84.1 and 90.2%, respectively. In those patients with malignant breast lesions, a decreased ADC was associated with breast lesions with high nuclear and histological grades, and lymph node-positive, ER-negative, PR-negative and HER-2-negative status, and Ki-67 ≥14%. In conclusion, the ADC is a useful imaging biomarker for differentiating between benign and malignant breast tumors. The marked association between the ADC and prognostic factors also demonstrated its value in evaluating the malignancy of breast lesions.

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Ureteropelvic junction obstruction (UPJO) is a common congenital malformation of the urinary system, which is mostly unilateral and frequently combined with hydronephrosis and kidney stones. The incidence of kidney stones is ~20%, which markedly increases the difficulty and risk of surgery. The present report describes a rare case of bilateral UPJO combined with bilateral renal stones. Laparoscopy and ureteroscopy one-stage surgery was performed creatively. CT urography demonstrated that the hydronephrosis was markedly reduced after the surgery, the ureteropelvic junction was patent without stone residue and the surgical outcome was ideal.

Rationale: Mediastinal non-seminomatous germ cell tumors (MNSGCTs) are rare malignancies. Chemotherapy followed by surgical resection has been regarded as the standard management, but treatment options for chemotherapy-refractory patients or those with unresectable tumors are limited, resulting in a very poor prognosis.Patient concerns: An 18-year-old female presented with symptoms of cough, chest tightness, and shortness of breath for 2 months, and the symptoms gradually worsened.Diagnosis: Computed tomography (CT) revealed a large mediastinal mass invading the pericardium and great blood vessels. Serum human chorionic gonadotropin (HCG) and a-fetoprotein (AFP) levels were normal. Histopathological examination of biopsy specimens revealed mixed MNSGCT with embryonal carcinoma and immature teratoma components. Interventions:The patient achieved complete remission (CR) and long-term survival after multimodal therapy comprising chemotherapy, positron emission tomography/CT (PET/CT)-guided volumetric-modulated arc therapy (VMAT), and anti-angiogenic targeted therapy.Outcomes: The patient was followed up for more than 4 years without recurrence, metastasis, or treatment-related adverse effects.Lessons: The case presented here highlights the importance of multidisciplinary diagnosis and treatment, providing evidence that radiotherapy and anti-angiogenic therapy may play an important role in unresectable or residual tumors after failure of conventional treatments of MNSGCT. Percutaneous biopsy is necessary for diagnosis if the tumor is unresectable, and serum AFP and HCG levels are normal. Additionally, PET/CT is an effective method for evaluation of efficacy and radiotherapy guidance for patients with MNSGCTs. Abbreviations: AFP = a-fetoprotein, CA125 = carbohydrate antigen 125, CR = complete remission, CTV = clinical target volume, DVH = dose volume histogram, GCT = germ cell tumor, GTV = gross tumor volume, HCG = human chorionic gonadotropin, ISRT = involved-site radiation therapy, LDH = lactate dehydrogenase, MGCT = mediastinal germ cell tumor, MNSGCT = mediastinal nonseminomatous germ cell tumor, NSE = neuron-specific enolase, PET/CT = positron emission tomography/computed tomography, PASP = pulmonary artery systolic pressure, PR = partial response, ProGRP = pro-gastrin-releasing peptide, PTV = planning target volume, SD = stable disease, VEGFR = vascular endothelial growth factor receptor, VMAT = volumetric-modulated arc therapy.