Renal cell carcinoma is a potentially lethal cancer with aggressive behavior and a propensity for metastatic spread. Due to the fact that the patterns of metastases from renal cell carcinomas are not clearly defined, there have been several reports of cases of renal cell carcinoma associated with rare metastatic sites and atypical presenting symptoms. The present review focuses on these atypical rare clinical presentations of renal cell carcinomas both at the time of diagnosis of the primary tumor but also in the years after radical nephrectomy.

The introduction of minimally invasive endourologic procedures for upper urinary stone disintegration has closed the curtain on the era of open surgery for upper urinary tract stones in which complete stone eradication was the rule. This shift to minimally invasive procedures has led to the introduction of new terminology, such as stone-free rates and residual stone fragments, the presence of which after treatment was considered an acceptable therapeutic end point. Percutaneous nephrolithotomy (PCNL) is currently considered the procedure of choice for large renal stones. Its use has been greatly facilitated by the favorable profile of multidetector CT with regard to its sensitivity in detecting small stones. Despite the fact that CT is considered essential for the diagnosis and exact localization of stones and has been used for the creation of percutaneous tracts in PCNL, however, its routine use for the post-PCNL detection of residual stones has not been established. There is evidence that routine application of post-PCNL CT provides additional advantages compared with other imaging modalities-namely, the identification of the presence and location of even small residual fragments, which has been shown to cause significant trouble and necessitate secondary procedures in a significant cohort of patients after PCNL. On the other hand, the issues of cost, availability of CT scanners, and radiation exposure along with the acceptable sensitivity, cost, and availability of other imaging studies has raised doubts as to whether CT should be the routine imaging study after PCNL. The present review will discuss the concept of clinically significant residual fragments and comment on the advantages and drawbacks of different imaging studies used for the detection of residual stones after PCNL. This review also aims to clarify the indications in which CT should routinely be performed or could be omitted in the follow-up after PCNL.

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Objectives: The imaging features of Mucoepidermoid carcinoma (MEC) of the breast are unfamiliar to the breast radiologists due to its rarity. In this paper, we aimed to review the literature, do an analysis and find a common pattern of those lesions that could potentially give a better understanding of this entity. Methods: A review is performed with searching keywords “mucoepidermoid carcinoma breast”, without limitations in the dates or the article types, in the PubMed database. Information about the number of cases, the age of the patients, the presenting symptom, the time-interval between the onset of the symptoms and the time of diagnosis, the diagnostic approach, the imaging, the treatment and the outcome have been reviewed and tabulated. Results: We identified 40 cases. The mean age of the patients was 57. The commonest symptom was a palpable mass, few months to up to 37 years, prior to the diagnosis, with the size ranging 5-82 mm. On US, the lesions appeared as irregular masses or had cystic benign features. The majority underwent a radical/modified radical mastectomy with a form of axillary lymph node procedure. 15 cases were Highgrade, 3 Intermediate-grade, and 19 Low-grade MEC. No chemotherapy was administered in most cases and in a mean follow-up time of 30 months, 5 died because of metastasis. Conclusion: Due to its rarity, the diagnostic and therapeutic approach of MEC in the breast is not welldocumented, causing challenges in daily practice, even at experienced Breast Centers. Review of the published cases is essential for multidisciplinary team meetings to plan treatment strategies.

Objective: In the UK RCR 5-point breast imaging system (UKS), radiologists grade mammograms from 1 to 5 according to suspicion for malignancy, however unlike BI-RADS, no lexicon of descriptors is published. The aim of this study was to determine whether strict categorisation of microcalcifications (MCC) according to BI-RADS was a better predictor of malignancy than the UKS and whether these descriptors could be used within the UKS. Methods: A retrospective review of 241 cases, with MCC on mammography, who underwent biopsy was performed. Morphology, distribution, extent, UKS score, BI-RADS category and pathology were recorded. The positive predictive value (PPV) of each classification system for malignancy was calculated. Results: 28.6% were diagnosed with DCIS/IDC. The PPV for malignancy using the UKS was 18.9%, 69.4%, 100% for M3-5 respectively (p < 0.001) and using ΒI-RADS morphology was amorphous: 7.1%, coarse heterogeneous: 33.3%, fine pleomorphic: 48.1% and fine linear/fine linear branching: 85.2% (p < 0.001). The PPV based on distribution was grouped: 14.2%, regional: 32.3%, diffuse: 33.3% and linear/segmental: 77.8% (p < 0.001). Combining all cases of benign-appearing, amorphous and grouped coarse heterogenous and grouped fine pleomorphic MCC gave a PPV of 12.8%. Combining regional, linear or segmental coarse heterogenous and fine pleomorphic and all fine linear/branching MCC resulted in a PPV of 83.3% for malignancy. Conclusion: Combining morphology and distribution of MCC is accurate in malignancy prediction. Use of BI-RADS descriptors could help standardise reporting within the UKS and an algorithm using these within the UKS is proposed. Better prediction would enable more appropriate counselling and help to identify discrepancies. Advances in knowledge: No guidance exists on scoring of suspicious MCC in the UK breast imaging system. Use of BI-RADS morphologic/distribution descriptors can aid malignancy prediction. Findings other than morphology of MCC are important in malignancy prediction. An algorithm for use by the UK radiologist when evaluating MCC is provided.