Synovial sarcoma is an uncommon malignant tumor, most frequent in the lower extremity, predominantly in young males. The authors review the clinical history, the different radiographic manifestations and MR appearance of the entity. The MR findings cannot be considered specific for synovial sarcoma. A heterogeneous septated mass located close to a joint, a tendon or a bursa is most indicative of the tumor. The radiographic features of a soft tissue mass with associated calcifications and bony erosions in the lower extremity should suggest a synovial sarcoma. The most likely differential diagnoses are discussed.
We compared the detection of clustered microcalcifications by means of conventional mammograms and by means of secondary digitized images with a spatial resolution of 2048 x 1684 pixels and a contrast resolution of 12 bit. A Receiver Operating Characteristic (ROC) study was carried out using a cadaver breast showing phantom microcalcifications. A set of 100 mammograms was evaluated by two experienced senior radiologists. The ROC scores obtained with the digital images were 10% lower than those obtained with the conventional images. This difference however does not reach statistical significance. The use of a digital zoom function based on pixel duplication is also investigated. This zoom function does not produce a change in the diagnostic accuracy of the digital method. Attention is also paid to the advantages and disadvantages encountered by the radiologists when working on the digital viewing system. The most important drawback seems to be that it is considerably more time consuming than the conventional procedure, and this is especially due to the long loading time of the images and to the absence of window and level preselections.
In a series of 260 consecutive X-ray mammography examinations in symptomatic patients, 25 patients proved to have breast cancer, and 41 had various benign breast conditions. In the 66 patients with abnormal mammograms a real-time ultrasound examination with a 7.5 MHz linear array transducer and a fluid offset pad was performed. This paper focuses on the ultrasound aspect of the skin and the subcutaneous fat layer in various benign and malignant breast conditions. In most of the malignant tumors studied as well as in cases of fat necrosis and breast abscesses, the following ultrasound signs were encountered: discontinuity of the sharp echogenic subcutaneous specular reflector, thickening of the skin, and locally increased echogenicity of the subcutaneous fat layer. In breast cancer these signs were seen in some patients with small tumors, in deeply located tumors as well as in patients with no skin retraction on clinical examination. The differential diagnosis between cancer and benign breast tumors cannot be based upon the ultrasound aspect of the skin and subcutaneous fat layer alone. X-ray mammography as well as clinical criteria and anamnestic factors should be used for the diagnosis of breast abscesses (calor, rubor, tumor, dolor) and for the diagnosis of fat necrosis (surgery, trauma).