Background Neoadjuvant chemotherapy (NAC) is an important step in the treatment of various types of breast cancer by downsizing the tumor to make it operable. Determining disease extent after NAC is essential for accurate surgical planning. MRI has been the gold standard for detecting tumors that are usually difficult to detect on ultrasound or mammography. However, the use of MRI after NAC is controversial. Therefore, we aimed to evaluate the diagnostic accuracy of post-NAC MRI in the detection of residual disease preoperatively and to investigate the factors associated with pathological complete response (pCR). Methodology This retrospective review study was approved by the institutional review board with waiving of the informed consent. A total of 90 charts between January 2016 and January 2019 were reviewed. Baseline lesion size was measured as the maximal diameter in a single dimension by pretreatment MRI. To assess the diagnostic accuracy of MRI in detecting residual disease, we used two different definitions of pCR in the breast. The first is the resolution of both invasive disease and ductal carcinoma in situ. The second is the resolution of the invasive disease only. As a secondary objective of the study, we assessed the association between different patients’ characteristics and both MRI and pathologic response using univariate and multivariate analysis. Results A total of 52 women (mean age: 47.4 years; range: 28-74) with 56 breast masses were eligible for the study. Complete MRI response was noted in 22 (39%) masses. pCR was achieved in 14 (25%) and 25 (44.6%) masses using the first and second pCR definitions, respectively. The negative predictive value (NPV) and overall accuracy of MRI for detecting residual disease were 50% and 75%, respectively, using the first pCR definition. With the second pCR definition, NPV and accuracy were 77.3% and 76.8%, respectively. Positive axillary lymph nodes were the only significant factor associated with incomplete MRI and pathological responses. Conclusions MRI NPV for residual disease was higher with the second pCR definition; however, overall accuracy was not different. MRI accuracy in detecting residual disease after NAC is not adequate to replace pathological assessment.

A 19-year-old male patient presented to the emergency department (ED) with pain in the right iliac fossa. Computed tomography (CT) scan of the abdomen and pelvis revealed signs of acute appendicitis, as a result of a metallic foreign body beyond the appendiceal orifice. Upon further questioning, the patient gave a history of ball bearing (BB) gun bullet ingestion in the past. Although rare, foreign body appendicitis occurs. A radiologist should be mindful to reporting such cases especially bizarre foreign bodies for example bullets as it may warrant psychiatric consultation or alter surgical management.

Mucocele of the appendix (MA) is a rare disease characterized by chronic accumulation of mucin within an appendix. Although MA can be an asymptomatic finding, some patients with MA may present with right lower quadrant (RLQ) pain, pelvic pain, or even hernias. The later presentation is usually related to rupture of the mucin-filled appendix, a condition referred to as pseudomyxoma peritonei (PMP). Herein, we present a case of ruptured MA presenting as an irreducible paraumbilical hernia, where the patient presented with a lump to the surgical clinic. computed tomography (CT) of the abdomen revealed an RLQ lesion extending through the hernial neck. Further characterization of the lesion was performed with magnetic resonance imaging (MRI), revealing an appendiceal origin of the lesion. The patient underwent an exploratory laparotomy during which an omental sample was taken. Histopathology confirmed the diagnosis of metastasizing low-grade appendiceal mucinous neoplasm. We believe that our case is unique due to the rarity of ruptured MA as well as the rarity of it presenting as a paraumbilical hernia.

No abstract

A 32-year-old male patient presented to the emergency department with colicky peri-umbilical abdominal pain and nausea for two days. On examination, there was generalized lower abdominal tenderness with no fever. A computed tomography scan of the abdomen and pelvis revealed signs of acute appendicitis. Upon further questioning, the patient gave a history of appendectomy that took place eight years ago. Although rare, stump appendicitis can occur. A radiologist should always consider stump appendicitis in the differential diagnosis of right lower quadrant pain.