A series of 11 malignant lymphomas of the breast (6 primary non-Hodgkin lymphomas, 4 secondary non-Hodgkin lymphomas, 1 Hodgkin's disease) is reported. Mammography, performed in 10 cases, revealed an ill-defined density (total or partial) (6 cases), a well-defined mass with multicyclic contours (2 cases), a mass with spiculations (1 case) and a false negative (1 case). The sonographic patterns analysed for 7 patients were non-specific, showing a higly hypoechoic, heterogenous mass with marginal irregularity in all cases. There was no correlation between the radiological appearances and the sonographic patterns; the latter were similar for both primary and secondary lesions. In contrast to mammography, ultrasonography has never been used in large literature series for diagnosis of these exceptional sites of lymphoma. Ultrasound also appears useful for patient follow-up to evaluate the response to treatment.

Laterocervical septated lesions are infrequent in adults, and their etiological diagnosis is difficult. The authors report about four cases in which an exploration with imaging and an anatomical control were performed. Two etiologies are specially interesting, either because of their remarkable features with imaging (cystic lymphangioma) or because they require formal identification (metastatic adenopathy from thyroid or ovarian papillary carcinomas). While modern imaging can confirm the diagnosis, and sometimes define the treatment (cystic lymphangioma), the surgical exeresis of such lesions remains imperative in all cases of atypical appearances, in order to avoid leaving a prevailing lymph node metastasis unrecognized.

Duodenal lipoma is a rare, often asymptomatic tumor; the circumstances of its discovery have become more frequent as CT examinations are more commonly performed. The merits of a CT examination for this condition is to allow both a positive diagnosis and the follow-up of these fatty tumors which have very few clinical expressions, thus avoiding complementary examinations or even useless laparotomies. The authors describe three cases of incidental discovery of duodenal lipomas.

Sixteen cases of anaplasic thyroid carcinoma have been reviewed. In 13 cases out of 16, a diffuse invasion of one or both thyroid lobes and of the isthm associated with calcifications (50%) and necrosis (62%) was present. In 6 cases out of 8, CT Scan with contrast media injection has detected an extension into surrounding tissues. Twelve of the 16 patients presented cervical lymph nodes on the ultrasound examination and 4 of 8 patients presented mediastinal lymph nodes on the CT Scan. In 3 cases out of 16, the anaplasic carcinoma of the thyroid presented as a localized, hypoechoic nodule associated with a cervical lymph node in 1 case.

Clinical, radiographic (mammograms) and ultrasonographic data were compared retrospectively for 171 patients to evaluate the utility of ultrasound for the follow-up of breast cancer patients treated medically or by conservative surgery. When used to follow-up patients treated medically by induction or exclusive chemotherapy, ultrasonography accurately quantified tumor and nodal regression. After conservative surgery, sonograms are an ideal means to diagnose (and sometimes to treat) early complications (hematoma, lymphocele, abscess). Ultrasonography was more sensitive than mammography for the detection of recurrent disease (95.5% sensitivity for radiography versus 90% for ultrasonography). After radical surgery and breast reconstruction, ultrasonography is the only procedure required to follow-up of patients with breast implants, because it can determine the size and penetration of cutaneous recurrences. The fact that 30% of patients treated by lumpectomy and irradiation ultimately develop malignant or benign abnormalities justifies systematic ultrasonography for the follow-up of treated breast cancers. All sonographically demonstrable abnormalities warrant ultrasound-guided puncture biopsy.

The authors report three cases of extrahepatic lipiodol enhancement: two fortuitous discoveries of gastric and duodenal leiomyomas during the management of malignant hepatic lesion and a pancreatic surgical detection of an insulinoma which had not been detected with conventional techniques. The principles of the technique are described. The basis of its application to the pancreatic region is purposed and the future developments of pancreatic studies are discussed.

The splenic cysts are rare diseases and the diagnosis is now easier with modern imaging modalities. The authors report two cases of asymptomatic splenic cysts. The spontaneous involution in less than 3 years has been followed by CT Scan. This possible evolution which has never been described, the improvements of the splenic surgery and the risk of serious infectious complications after splenectomy, must modify the indications of the treatment. A US or CT follow up can be purposed for non symptomatic cyst and a partial splenectomy when these lesions are clinically symptomatic.

The non functional extraperitoneal paragangliomas are rare tumors (less than 50 cases reported). We report a case with ultrasound and CT scan imaging. The tumor is usually large with important necrotic areas leading to a cystic aspect. The malignant tumors more frequent than the benign tumors present with a regional extension and delayed metastasis.

Clinical, radiographic (mammograms), and ultrasonographic data were compared retrospectively for 171 patients to evaluate the utility of ultrasound for the follow-up of breast cancer patients treated medically or by conservative surgery. When used to follow patients treated medically by induction or exclusive chemotherapy, ultrasonography accurately quantified tumor and nodal regression. After conservative surgery, sonograms are ideal to diagnose (and sometimes to treat) early complications such as hematoma, lymphocele, and abscess. Ultrasonography was more sensitive than mammography for the detection of late complications and benign lesions, but was insufficient for the detection of recurrent disease (95.5% sensitivity for radiography vs 90% for ultrasonography). After radical surgery and breast reconstruction, ultrasonography is the only procedure required for follow-up of patients with breast implants because it can determine the size and penetration of cutaneous recurrences. The fact that 30% of patients treated by lumpectomy and irradiation ultimately develop malignant or benign abnormalities justifies systematic ultrasonography for the follow-up of treated breast cancers. All sonographically demonstrable abnormalities warrant ultrasound-guided puncture biopsy.

The authors present the results of CT studies for 19 patients with cerebral lymphoma (including 12 primary tumors). CT appearances varied considerably, because 5 of the 12 primary lymphomas presented as multifocal lesions, and lesion sites included the corpus callosum (3 cases), the central caudate nucleus (4 cases), the posterior fossa (3 cases), and the cerebral hemispheres (6 cases). These findings are in agreement with literature data. Although a solitary, hyperdense and homogeneous lesion in the corpus callosum or the central caudate nucleus is indicative of cerebral lymphoma, numerous other aspects are possible and owing to the increasing frequency of this pathology should suggest this diagnosis. There is no specific appearance for secondary lymphomas, but diagnosis is often facilitated by concomitant systemic involvement.

Delayed hepatic CT (DH-CT) was studied in 250 patients without any major bile duct pathology. One hundred thirty-five of these patients had liver metastases. All patients were administrated 76 grams of iodine. Tolerance of the examination was good. Six hours after injection, average contrast enhancement in the normal liver was 24 HU (greater than 1.3 g/kg iodine), 22 HU (1 to 1.3 g/kg) and 14 HU (1 g/kg). Comparison of scans taken before, immediately after, and 6 hours post-injection revealed the frequent superiority of postinjection scans for diagnosis of liver metastases. Focal steatosis is the only benign pathology to benefit from DH-CT, because of the parallelism in the difference in density between the normal and steatotic tissue regardless of the time of scanning. Aside from isolated tumors requiring exploration by conventional CT (pre- and post-contrast studies), the workup of liver metastases can be optimized by postcontrast and DH-CT scans.

Seventeen cases of muscular lymphoma are reported (5 primary non-Hodgkin lymphoma, 11 secondary NHL, 1 secondary Hodgkin's disease). The psoas or gluteus muscle was involved in 10 cases, and the lower limb was affected in the remaining 7 cases. Nine cases of muscular extension of bone NHL are also reported. On sonograms these lesions were always large and less echogenic than adjacent structures, with no signs of necrosis before treatment. US and CT patterns were comparable for both primary and secondary lesions, regardless of the type of lymphoma or whether or not there was any previous bone lesion. Associated lymphomatous lesions were observed in 14 cases. On angiograms, muscular lymphomatous involvement presented a hypovascular pattern. While ultrasonography is an excellent monitoring technique for soft tissue lymphomas (specially for the lower limbs), a major contribution of CT is the detection and the follow-up of deep or thoracic wall lesions.

Three hundred cases of cervical adenopathies were reviewed in connection with head and neck cancers (205 patients) and lymphoma (95 patients). Overall, physical examination failed to detect such adenopathies in 83 cases. The echostructure of the cervical node was less echoic than that of the muscles in 111 cases (58 cases of lymphoma, 53 cases of metastasis), more echoic than the muscles in 185 cases (35 cases of lymphoma, 150 cases of metastasis), and nucrotic in 4 cases (2 cases of lymphoma and 2 cases of metastasis). Jugular vein thrombosis was noted in 78 cases (75 cases of metastasis, 3 cases of lymphoma); jugular vein compression without thrombosis was observed in 65 cases (35 cases of metastasis, 30 cases of lymphoma). Before histologic proof is obtained, jugular thrombosis suggests a diagnosis of metastasis, regardless of node size. The presence of nodular intraparotid lesions (12 cases) suggests lymphoma. By contrast, neither node size nor echostructure suggest the etiology of cervical adenopathies.