Conventional magnetic resonance (MR) imaging has an established role in gynecologic imaging. However, increasing clinical demand for improved lesion characterization and disease mapping to optimize patient management has resulted in the incorporation of newer sequences, such as diffusion-weighted (DW) imaging, into routine protocols for pelvic MR imaging. DW imaging provides functional information about the microenvironment of water in tissues, hence augmenting the morphologic information derived from conventional MR images. It can depict shifts of water from extracellular to intracellular compartments, altered cell membrane permeability, disruption of cell membrane depolarization, and increased cellular density. Such changes may be associated with tumors. DW imaging has emerged as an important cancer biomarker and takes the role of the radiologist from the level of mere macroscopic diagnosis to more active participation in determining patient prognosis and management through a better understanding of the tumor microenvironment. With the growing acknowledgment of DW imaging as a pivotal tool in the radiologist's armamentarium, radiologists must be familiar with the appearances of various gynecologic tumors at DW imaging and understand the implications of this sequence for improving diagnostic accuracy and predicting and monitoring treatment response. Although positron emission tomography/computed tomography is extremely useful for detecting tumor recurrence in cervical and ovarian carcinomas, it has a limited specificity in the immediate posttreatment setting. DW imaging may aid in detection of residual or recurrent tumors in such situations. DW imaging is a potentially useful adjunct to conventional MR imaging for evaluation of gynecologic tumors, thus improving overall diagnostic accuracy, tumor staging, prediction of response to therapy, and treatment follow-up.
Papillary breast lesions encompass a wide spectrum of pathologies ranging from benign lesions, such as solitary intraductal papilloma, to the uncommon papillary carcinoma. These lesions have various clinical presentations and diverse radiological features. Differentiating benign and malignant papillary lesions based on imaging features may often be difficult. Other benign and malignant pathologies can also mimic papillary lesions on imaging, and tissue diagnosis is essential. Imaging plays an important role in lesion identification, assessment of extent, tissue sampling, and follow-up. Surgical excision has been recommended for all papillary lesions due to an increased incidence of high-risk lesions and neoplasia even with percutaneous, biopsy-proven benign papillomas. This review looks at papillary breast lesions from the radiologists' standpoint and discusses the clinical, imaging, and pathological features of these lesions, as well as the role of imaging in their evaluation. P apillary lesions in the breast are uncommon but arise from a wide range of pathologies and have diverse clinical and imaging features. A papillary lesion is characterized by an arborescent structure composed of fibrovascular stalks covered by a layer of epithelial cells with or without an intervening myoepithelial cell layer (1). Overlapping features make differentiation of benign and malignant papillary lesions difficult on imaging, and a tissue diagnosis is essential. Definitive histopathologic diagnosis on core biopsy can occasionally be difficult. Additionally, even those lesions shown by percutaneous biopsy to be benign papillomas are associated with an increased likelihood of high-risk lesions and neoplasia. Due to nonspecific findings on imaging and histopathology, as well as varying malignant potential, papillary lesions present significant diagnostic and management challenges for the radiologists, pathologists, and surgeons. We briefly review the types of papillary lesions, multimodality imaging findings, and the radiologist's role in their evaluation. The types and clinical features of papillary lesionsPapillary lesions can be broadly categorized as benign or malignant. Benign papillary lesions include a solitary intraductal papilloma, multiple intraductal papillomas, and atypical ductal hyperplasia (ADH) within a papilloma. Malignant papillary lesions include ductal carcinoma in situ (DCIS) arising in a papilloma, papillary DCIS, intracystic or encapsulated papillary carcinoma, solid papillary carcinoma, invasive papillary carcinoma arising in an intracystic papillary carcinoma, and invasive papillary carcinoma (1). Intraductal papillomaSolitary papillomas arise from a large central duct, are more common in perimenopausal women, and present with nipple discharge. Multiple papillomas are peripheral lesions arising from the terminal duct lobular unit. These are less common, usually affect a younger age group, and present as a palpable mass. Both can be associated with proliferative and high-risk lesions, such as radial ...
Invasive lobular carcinoma (ILC) has a greater tendency to metastasize to the peritoneum, retroperitoneum, and gastrointestinal (GI) tract as compared to invasive carcinoma of no special type (NST). Like primary ILC in the breast, ILC metastases are frequently infiltrative and hypometabolic, rather than mass forming and hypermetabolic in nature. This renders them difficult to detect on conventional and metabolic imaging studies. As a result, intra-abdominal ILC metastases are often detected late, with patients presenting with clinical complications such as liver failure, hydronephrosis, or bowel obstruction. In patients with known history of ILC, certain imaging features are very suggestive of infiltrative metastatic ILC. These include retroperitoneal or peritoneal nodularity and linitis plastica appearance of the bowel. Recognition of linitis plastica on imaging should prompt deep or repeat biopsies. In this pictorial review, the authors aim to familiarize readers with imaging features and pitfalls for evaluation of intra-abdominal metastatic ILC. Awareness of these will allow the radiologist to assess these patients with a high index of suspicion and aid detection of metastatic disease. Also, this can direct histopathology and immunohistochemical staining to obtain the correct diagnosis in suspected metastatic disease.
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