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A 70-year-old woman was diagnosed with a moderately differentiated invasive lobular breast carcinoma (pT3, pN1 biii (2/14), M0, ER negative, PR negative) and underwent tumor excision of the left upper outer lobe and lymph node excision of the left axilla 8.5 years ago, followed by re-surgery of the breast 1 month after the first operation because of microscopic residual tumor. The second surgery was followed by four chemotherapy cycles with doxorubicin and cyclophosphamide. Adjuvant percutaneous radiotherapy was performed in fractions of 2 Gy with a total dose of 50 Gy of the left breast and with a total dose of 56 Gy of the left axillar region.Eight years after the initial presentation, the patient noted a skin discoloration that she referred to minor trauma to the breast. Five months later, the patient was seen for routine checkup and physical examination revealed a blue-reddish-colored induration of the skin located at the lower outer and inner quadrant of her left breast, measuring 16 9 7 cm (6.3 9 2.8 inches; Fig. 1).The patients routine mammogram revealed a progressive circular thickening of the skin when compared to previous mammograms (last time performed 1 year before), showing no skin abnormalities. Breast tissue postlumpectomy showed no evidence of tumor recurrence (Fig. 2).Magnetic resonance imaging (MRI) of the left breast demonstrated-in correlation with the mammogram-a circular edematous thickening of the skin. After intravenous (i. v.) injection of contrast medium (CM), heterogeneous enhancement of the cutis was seen, without any infiltration of subcutaneous or breast tissue ( Fig. 3-transversal T1 fat-suppressed post i. v. CM). There was no evidence of local tumor recurrence in the breast tissue by MRI.Tumor biopsy was performed and subsequent histologic analysis confirmed the diagnosis of angiosarcoma in all specimens, based on the vasoformative features on light microscopy and on immunoreactivity for Figure 1. Erythematous lesion affecting the lower medial and lateral quadrant of the left breast.

Resection of the manubrium including both sternoclavicular joints is occasionally performed in the case of sternal tumours. Sternoclavicular joints are the only true joints connecting the axial skeleton to the upper extremity. Therefore, they play an important role in shoulder function. However, data on their reconstruction are lacking. Here, we described the case of a sternal reconstruction including both sternoclavicular joints using a mesh-bone cement sandwich. The mechanical properties of the construct mimicked those of the original sternoclavicular joints and could therefore restore shoulder strength allowing the patient to perform overhead work.

Background: mpMRI assesses prostate lesions through their PI-RADS score. The primary goal of this prospective study was to demonstrate the correlation of PI-RADS v2 score and the volume of a lesion with the presence and clinical significance of prostate cancer (PCa). The secondary goal was to determine the extent of additionally PCa in inconspicuous areas. Methods: All 157 patients underwent a perineal MRI/TRUS-fusion prostate biopsy. Targeted biopsies as well as a systematic biopsy were performed. The presence of PCa in the probes was specified by the ISUP grading system. Results: In total, 258 lesions were biopsied. Of the PI-RADS 3 lesions, 24% were neoplastic. This was also true for 36.9% of the PI-RADS 4 lesions and for 59.5% of the PI-RADS 5 lesions. Correlation between PI-RADS v2 scores and lesion volume was significant (p < 0.00001). In the non-suspicious mpMRI areas carcinoma was revealed in 19.7% of the patients. Conclusions: The study shows that the PI-RADS v2 score and the lesion volume correlate with the presence and clinical significance of PCa. However, there are two major points to consider: First, there is a high number of false positive findings. Second, inconspicuous mpMRI areas revealed PCa.

A bizarre parosteal osteochondromatous proliferation (BPOP), also known as a Nora lesion, is a rare benign bone formation. It emanates mainly from the intact cortex of the metaphysis of short tubular bones (hands or feet). Conventional radiographs should be complemented using cross-sectional imaging modalities (CT/MRI). In the absence of symptoms a non-operative regime with radiological and clinical controls is possible. If symptomatic, excision biopsy is the treatment of choice, though a high recurrence rate has been reported. Histopathological examination confirms the diagnosis and typically shows an endochondral ossification zone and an unusually mineralized cartilaginous matrix referred to as "blue bone".

Objective:The on-going discussion about extent and best template for pelvic lymph dissection (PLND) motivated us to analyse pre-prostatic tissue (PPT) for lymph nodes and metastases.Materials and Methods:From December 2010 to August 2011 PPT was sent for histopathological evaluation during 80 robotic assisted radical prostatectomies (RARP) and one extended staging lymph node dissection. All patients had either a limited (lPLND, n = 44) or an extended lymph node dissection (ePLND, n = 36). Clinical data were retrospectively analyzed and compared to histopathological findings.Results:Lymph nodes were found in PPT in 10/80 (12.5%) patients after RARP and in the one patient after staging ePLND. Mean number of lymph nodes detected in PPT of them was 1.2 (range 1-3). Clinically no differences were found between patients with or without lymph nodes in PPT. In the standard template of either ePLND or lPLND the average number of lymph nodes was 13 (range 2-56). Herein metastases were found in 10 (12.5%) patients after RARP and in the patient after staging ePLND. A metastasis in PPT was only found after staging ePLND.Conclusions:Pre-prostatic tissue might contain lymph nodes that potentially harbour metastases. In the intention to perform the most accurate staging this tissue should be considered for histopathological evaluation.

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