Eight of 9 subjects with the same P51S mutation in the COCH gene showed similar radiologic lesions, affecting the PSCC in the majority of the cases. These radiologic abnormalities occurred in more advanced stages of the otovestibular deterioration, supporting the hypothesis that these lesions might represent the end phase of a low-grade chronic inflammation or protein deposition. A new phenotypic and characteristic radiologic feature of DFNA9 has been discovered.

We report an unusual case concerning encephalitis following Mycoplasma pneumonia. This interpretation corner case showed an unusual pattern of lesion distribution, resembling primary nervous system angiitis. The distribution of the lesions according to the perivascular spaces suggests a predominant leptomeningeal infiltration.

Objective: The primary aim was to determine whether 3D video-head-impulse-test vestibulo-ocular reflex (vHIT VOR)gains correlate with computed tomography (CT) and magnetic resonance (MR) lesions in a series of carriers of the p.(Pro51Ser)-variant (P51S) in the COCH-gene (DFNA9). Secondary aim was to compare routine imaging with second peer review radiologic lecture. Study Design: Analytical cross-sectional study. Setting: Secondary referral center. Patients: Twenty-four p.P51S carriers with MR and CT images. Eighteen carriers were selected of whom both 3D-vHIT and imaging data were available within a time interval of 24 months. Interventions: All imaging data were reassessed by two independent neuroradiologists. vHIT VOR-gains were correlated with semi-circular canal (SCC) lesions. Main Outcome Measures: Correlation between vHIT VORgains and SCC lesions, and additional lesions detected during scientific lecture of imaging data. Results: The average gain of the ipsilateral labyrinth was significantly lower when positive CT (0.3215; p ¼ 0.0122) and MR results (0.3215; p ¼ 0.0134). 92% of ears presented MR lesions on at least one SCC, whereas this was 75% on CT. The posterior SCC is the most frequently affected on MR and CT. Second lecture led to nine additional MR and 16 CT lesions. Conclusions: Significant correlation was observed between radiological lesions at any SCC and lower average gain of the three ipsilateral SCC. The substantially larger number of lesions during scientific assessment stresses the need to fully inform radiologists concerning differential diagnosis to facilitate accurate diagnosis when planning imaging. Focal sclerosis and narrowing of SCC in DFNA9 represent a possible biomarker of advanced stages of otovestibular deterioration.

We report the use of gadolinium-based contrast agent for both diagnostic and interventional subclavian angiography in two azotemic patients, presenting with an asymptomatic, high-grade stenosis of the left subclavian artery, ipsilateral to the site of choice for native fistula creation. Angiographic imaging performed with diluted gadolinium-based contrast material was clear enough to perform successful subclavian artery stenting, resulting in normalization of the arterial blood pressure in the afferent artery of the dialysis fistula. Clinically, no decrease in residual renal function and no other complication were noted immediately or a longer period after the interventional treatment.

Metastatic extramammary breast lesions are rare. Differential diagnosis with primary breast lesions may be difficult. The following case describes the clinical course of a woman with a breast lesion as initial presentation of a renal cell carcinoma. Case reportA 83-year-old caucasian woman developed a ductal breast carcinoma in the right breast (pT2 N0 M0) in 1995. She underwent a tumorectomy and a right axillary lymph node dissection followed by radiotherapy. She had been treated with tamoxifen during five years.The patient had 11 years of followup of her breast carcinoma without severe abnormalities apart from 2 clinically palpable lumps of scar tissue in the right breast which were twice biopsied and histologically negative.In June 2007, the patient was examined and found to be in a good general condition on a routine gynaecological consultation. Clinically, she had a satisfying heart and lung auscultation. Clinical breast examination remained normal. Her laboratory work-up only demonstrated an elevated lactate dehydroge-Mammography in June 2007 demonstrated a single well-marginated opacity in the axillary tail of the right breast with a diameter of 6 mm (Fig. 1A,B) and a similar lesion of 7 mm and calcifications (Le Gal type 2) in the left breast ( Fig. 2A,B). pathologies could not be made. Metastasis of the former breast cancer could not be ruled out. Core needle biopsy (CNB) was performed on the lesion in the right breast.In July 2007 CNB (Fig. 4) showed morphologically a metastasis of a renal cell carcinoma (RCC). Immunohistological characterisation indicated a positive staining for CD 10 suggestive of RCC of the clear cell type (Fig. 5) and a negative for cytokeratine CK7 and CK 20.Next, computer tomography (CT) of the thorax and the abdomen illustrated several lung metastasis and a large hypervascular mass in the left kidney, suggestive of RCC (Fig. 6). Due to the patient's age, the significant comorbidity, and the Ultrasound investigation (Fig. 3) visualised a regular circumscribed nodular hyporeflective lesion in the axillary tail of the right breast. The lesion was evaluated with fine needle aspiration cytology (FNAC). The left side only showed some lymph nodes.On FNAC epithelial cell populations were found. A differentiation between benign and malignant JBR-BTR, 2011, 94: 330-332. Metastatic extramammary breast tumours are uncommon and differential diagnosis with primary breast carcinoma may prove to be difficult. We report a case of a metastasis of a renal cell cancer in the breast in a woman with a history of primary breast cancer. On follow-up of her breast carcinoma, a lump was detected via mammography and ultrasound. Core needle biopsy revealed a metastatic extramammary lesion originating from an asymptomatic renal cell carcinoma. We conclude that the diagnosis of metastasis to the breast from extramammary tumours is important to avoid unnecessary surgery and insure proper treatment of the primary disease. METASTATIC RENAL CELL CARCINOMA PRESENTING AS A BREAST MASS IN A WOMAN WITH HISTORY OF PR...