This report presents the clinical features of 78 cases of the chronic Budd-Chiari syndrome encountered over a period of 13 years. The diagnosis of hepatic venous outflow obstruction was confirmed by venographic studies in all cases. In 20 patients there was hepatic vein occlusion without inferior vena caval (IVC) obstruction (Group A). In 17 patients there was constriction of the IVC above the drainage site of the right hepatic vein which was patent (Group B). In 13 patients there was short segmental obstruction of the hepatic segment of the IVC along with blockage of the hepatic venous orifices (Group C). In 28 patients there was hepatic venous obstruction with long segment involvement of the IVC extending to varying lengths of the infrahepatic segment (Group D). Of particular interest are the operative findings in 12 of 17 patients of Group B of hour glass constriction of the IVC, which can be labelled as 'coarctation of the IVC'. Dorsal cavoatrial bypass using a polytetra fluoroethylene graft has proved useful in Group B. Interesting histopathological findings of the liver in some of the cases are also described; The possible aetiology of the Group B cases is discussed.
This article reports our experience using the advanced breast biopsy instrument (ABBI) system for excisional biopsy of mammographically visible nonpalpable breast lesions. Patients with nonpalpable mammographically detected breast lesions were evaluated as potential ABBI candidates. Selection criteria included noncystic lesions for which complete removal or large sampling was indicated, compressed thickness of the breast of more than 25 mm, and the patient's ability to lie prone for at least 1 hour. During the period August 1997-April 2000 (33 months), 284 patients were found to be potential ABBI candidates. Sixteen patients were subsequently excluded. Biopsies using the ABBI system were performed in 268 cases, yielding an overall technical success rate of 94.4%. The mammographic abnormalities included mass in 125 cases (46.6%), mass with calcifications in 63 cases (23.5%), and microcalcifications without a mass in 80 cases (29.8%). Histologically 56 specimens (20.9%) were malignant (mass in 30 cases, mass with calcifications in 12, and microcalcifications in 14) and 212 (79.1%) were benign. Carcinoma in situ was found in 17 cases (30.4%), invasive carcinoma in 35 cases (62.5%), tubular carcinoma in 2 cases (3.6%), metastatic intramammary lymph node of previously unknown malignant melanoma in 1 case, and malignant lymphoma in 1 case. Open reexcision was performed in 54 cases with primary breast cancer. The histologic investigation revealed that in 26 (48.15%) cases the mammographic lesion was completely excised and in 28 (51.85%) cases the margins involved malignant residue and/or other foci of carcinoma. There were complications in 17 cases: wound infection in 2, ecchymosis in 9, seroma in 5, and a large immediate hematoma in 1 patient. Only the latter patient required immediate revision and drainage; the remainder underwent successful conservative treatment. Most nonpalpable breast lesions, if selected properly, are accessible for ABBI procedure. The biopsy causes minimal complications and minimal distortion of the breast architecture. Should relumpectomy be needed after the ABBI procedure, the tunnel of the cannula path is easily recognized, leaving no need for needle localization.
A giant mass of the breast with discoloration
of the overlying skin during pregnancy requires
investigation to rule out the possibility of breast malignancy.
The aim of this paper is to report a case of rapidly
growing hamartoma in a pregnant patient mimicking advanced
breast cancer and to discuss the usefulness of
sonography and core needle biopsy in the diagnosis.
Case Report: A 24-year-old woman in her 16th week of
pregnancy presented with a very enlarged and painful
breast. The overlying skin was edematous, brown to red,
with severely dilated and congested veins. A huge mass
was palpated and easily separated from the main breast.
Results: Sonography and needle core biopsy were consistent
with benign lesion but inadequate to exclude malignancy.
At surgery, a giant (1,600 g) well-defined, ovoid
mass was enucleated under general anesthesia. Gross
and microscopic sections of this tumor were consistent
with hamartoma with a central area of infarction. Clinical
and histological features of this tumor are briefly discussed.
Conclusion: Inability to exclude malignancy in
case of symptomatic giant breast tumor during pregnancy
should be an indication for early surgical excision.
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