Biomedical subjects
Publications and source records attributed to L Kalisher.
Stress fractures of the proximal fibula are uncommon, but do occur in the distal fibula in long-distance runners. A case is presented of a 71-year-old jogger who presented with a 2-month history of left knee pain. Radiographs showed an apparent destructive lesion of the proximal fibula which resembled a malignant bone lesion. Excision revealed a healing fracture.
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A metastasis from a bronchial carcinoid tumor presented as an isolated breast mass in a 58-year-old female. A review of the English literature revealed four cases of metastatic carcinoid to the breast that presented as an isolated breast mass. In each case, radical mastectomy was performed after the lesion had been interpreted clinically and pathologically as a primary carcinoma. When the primary tumor was excised, all cases had either regional lymph node or liver involvement. A mass was the usual presenting sign of the metastatic deposit. No metastasis was reported to be greater than 2 cm in diameter. No axillary lymph nodes were reported to contain tumor. Frozen section preparations may not be adequate to differentiate a primary carcinoma of the breast from a metastatic carcinoid tumor, thereby necessitating permanent sections, special stains, review of previously resected neoplasms, or electron microscopy. The first mammogram of a metastatic carcinoid to the breast is reported with this case.
Seventeen patients with lymphedema were treated with intermittent external pneumatic compression. Two patients with hemodynamically significant venous obstruction showed no response to therapy. The response of the remaining fifteen patients varied with the degree of subcutaneous tissue fibrosis. Xeroradiographic estimates of tissue compressibility provided valuable prognostic information. Intermittent external pneumatic compression is an effective nonsurgical method of treatment in patients selected by xeroradiography.
The value of mammography in evaluating the asymptomatic patient has been clearly demonstrated by the HIP program, as well as the National Cancer Institute's breast demonstration projects. A one-third reduction in mortality from breast cancer in mammographically screened women has been substantiated. Nonetheless, questions concerning the long-term effects of repeated radiation exposure associated with mammography have been raised, and for this reason judicious selection of women is urged. In general, women who are asymptomatic or at high risk for breast carcinoma should be evaluated with a planned regimen. Mammographic guidelines and recommendations for attaining the greatest benefit at the lowest possible risk are suggested.
A total of 42 women with proved minimal (14) or occult (28) breast carcinoma were evaluated for up to 48 months (mean = 28 months). Bone scans, radiographs, blood chemistries, enzyme levels, and operative findings demonstrated metastases only in those 6 patients (14%) who presented with symptomatic metastases from an unknown primary source. The other 36 women are free of metastases. Preoperative radionuclide bone scans may not be necessary for women with minimal and asymptomatic occult breast cancers.
An investigation of the relationship between breast parenchymal patterns and breast cancer prevalence in a large referral population is presented. Mammograms were assigned to one of four categories according to our interpretation of Wolfe's classification. Cancer prevalence for the four patterns was similar when uncorrected for age,, and was very high compared to that in the general population. Under age 50, the prominent duct pattern (P2) was associated with a very high relative cancer risk and DY carried a smaller increased risk. After age 50, prevalences for the patterns were nearly equal. Relationship between these findings and epidemiology of breast cancer are discussed and suggestions made for utilizing parenchymal patterns to guide examination frequency.
The radiologic and pathologic manifestations of epithelioid sarcoma are presented based on an analysis of five cases, and the literature is reviewed. This rare entity tends to orginate in the extremities and metastasizes primarily via the lymphatics. Although the lesion grows slowly, it recurs with high frequency. Males are affected three times as often as females. The differential diagnosis includes both malignant and benign entities. The natural history and methods of treatment are reported.
Two cases of Paget's disease of bone with radiographic manifestation of extramedullary hematopoiesis are described. While extramedullary hematopoiesis usually occurs as compensatory phenomenon in response to anemia, this was not the case in our patients. We believe pathologic fractures led to extrusion of hematopoietic marrow and resultant tumorous extramedullary hematopoiesis.
Metastatic lesions to the breast are unusual. We add 21 cases to the previously reported 131 clinical cases. The most common sources are malignant melanomas and the lymphoma/leukemia group. Metastatic lesions to the breast tend to be painless discrete lumps that are generally small at the time of discovery. They usually occur in the upper outer quadrant and are commonly associated with axillary adenopathy. Occasionally, they are the initial manifestation of an occult extramammary primary cancer. Prognosis is poor but appears slightly improved since availability of more refined chemo- and immunotherapeutic regimens. The clinical, pathologic, and radiographic features of this problem are described.
This paper reemphasizes that xeromammographic changes in the skin, parenchyma, and vascular structures of the breast may be manifestations of a host of systemic diseases. Xeromammographic examples of such diseases as congestive heart failure, diabetes mellitus, collagen vascular diseases, and endocrine diseases are presented and discussed.
A patient with an epithelial inclusion cyst of the distal phalanx has been presented. The radiographic and clinical findings have been described and are felt to be pathognomonic. The importance of recognizing its benign nature has been stressed.
In response to recent public demand for mammographic examination after the discovery of breast cancer in two women of national prominence, the Ad Hoc Committee on Mammography of the Massachusetts Radiological Society reviewed the present indications, benefits, and risks of radiologic technics used in the detection of neoplastic breast disease. Either low-dose film mammography or xeromammography can provide diagnostic information with minimal radiation hazard, and thermography is a sensitive though nonspecific technic for interim follow-up observations and for screening of large groups of well patients. Mammographic examination should be performed before contemplated breast operations and in women at high risk for the development of breast cancer, especially those who have had previous neoplastic breast disease. Routine mammographic studies on well women may be initiated after the age of 35 years, the frequency of periodic re-examination being determined by clinical and mammographic findings.
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Xeroradiographic evaluation of the axilla is useful in the presence of mammary carcinoma, as radiographic examination of this area can be highly accurate in predicting its malignant involvement if certain strict criteria are employed. The ability to diagnose nodal metastases with near certainty has important implications for treatment planning and prognostication.
A case is reported of an extra-abdominal desmoid tumor presenting as an axillary tail breast mass. This represents the third reported case and the first description of the roentgenographic findings of this entity. That this tumor can be confused with carcinoma of the breast is emphasized.
The normal axial relationship of 360 wrists was measured. The results differ from those previously published in the radiological literature. The difference may be explained by the small series' size or inadequate technical criteria used in previous studies.
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