Harmful mutations of the BRCA tumor suppressor genes result in a greater lifetime risk for malignancy-breast and ovarian cancers in particular. An increased risk for male breast, fallopian tube, primary peritoneal, pancreatic, prostate, and colon cancers also has been reported. The BRCA gene is inherited in an autosomal dominant pattern and tends to be highly penetrant; thus, there is an increased incidence of these cancers in affected families. Compared with sporadic tumors, BRCA-associated malignancies have unique manifestations, clinical features, and pathologic profiles. Manifestation at an early patient age, high-grade tumors, and an aggressive clinical course are common features of BRCA-associated malignancies. Understanding the behavior of these cancers aids in identification of affected individuals and families, who can then make informed decisions regarding their future health. Enhanced screening, prophylactic surgery, and chemoprevention are options for managing cancer risk factors in these individuals. Imaging has an important role in the screening, evaluation, staging, and follow-up of BRCA-associated malignancies. Supplemental screening of BRCA mutation carriers often begins at an early age and is critical for early and accurate cancer diagnoses. The authors review the etiopathogenesis and imaging features of BRCA-associated malignancies, the importance of a multidisciplinary approach to determining the diagnosis, and the treatment of patients who have these mutations to improve their outcomes. RSNA, 2017.
77-year-old man with diabetes presented with a four-day history of fever and worsening left-sided neck and shoulder pain accompanied by numbness and paresthesias in the fingers of the hand on the same side. Physical examination revealed severely restricted neck movement and marked palpable neck tenderness over the fourth, fifth, sixth, and seventh cervical vertebrae. The patient underwent integrated positron-emission tomographic and computed tomographic scanning because a pacemaker was present and magnetic resonance imaging could not be performed. The scans (Panels A and B) demonstrated an intense focal area of abnormal hypermetabolism confined to the left aspect of the fourth cervical vertebral body (arrow, Panel A) that was consistent with the presence of an infection. A blood culture grew Enterococcus faecalis that was sensitive to ampicillin. The patient received intravenous gentamicin and ampicillin and had prompt resolution of fever, followed by a steady decrease in pain.
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