2, lateral resolution 0.25; 10 MHz linear probe: axial resolution 0.154, lateral 0.187; 13 MHz linear probe: axial resolution 0.188, lateral resolution 0.144; 18 MHz linear probe: axial resolution 0.085, lateral resolution 0.104; 20 MHz annular array: axial resolution 0.077, lateral MG-132 order resolution 0.094. In our study, we have reviewed 32 series of images obtained from high-frequency ultrasound units and have found 5 sonographic patterns to differentiate

PM from other subcutaneous tumours. In particular, Type 1 and 2 of our classification correspond to the two typical hypoechoic solid nodules, fully calcified and partially calcified respectively, already described in literature. These lesions normally present EPZ-6438 mw a hypoechoic peripheral rim in a significant number of cases, and rarely, vascular signals with colour Doppler. In our series, 22 lesions exhibited the solid and calcified patterns of type 1 (10 cases) and 2 (12 cases), and diagnosis was confirmed at histopathology. Eight cases (25%) of our series showed internal fluid areas with a thick-wall: 6 complex lesions (type 3) and 2 pseudo-cystic (type 4). Type 4 fluid areas were larger than type 3 and showed a

good transmission of the ultrasound wave, without enhancement of the posterior wall. Histologically, the pseudo-cystic lesions showed huge groups of ghost cells, without stroma, clearly correlated to the sonographic features. Lim et al. [20] described 2 cases out of 17 with little endotumoural liquid-like areas, which the author, and, more recently, Choo et al. [30], considered to be related to degenerative phenomena. We are the first to report the occurrence of real ultrasonographic cystic areas in PM. As pointed

out by some dermatopathologists [31], the tumour originates from a cystic formation of the follicle matrix, with more or less thick walls, depending on the neoplasia evolvement, and with consequential formation of an internal mass of shadow cells, with low vascularisation Y-27632 2HCl and almost absent stroma. Generally, calcifications and signs of inflammation appear belatedly. The homogeneity of pseudo-cystic fluid areas, the lack of internal interfaces and of fibrous support structures, the absence of internal signs with colour Doppler, but without enhancement of the posterior wall, might address the operator to an erroneous diagnosis. The resemblance of sonographic features to so-called sebaceous cysts (epidermal or trichilemmal cysts), might result from the very high frequency probes that we first used in this particular type of dermopathology. Two cases, with a tumour-like pattern (type 5), were indistinguishable from an aggressive neoplasia of the superficial structures; in both patients, the lesions were significantly old and, histologically, displayed chronic flogistic phenomena and fibrosis. Conclusion Based on the above, some remarks can be drawn: 1 -Using very high frequency probes, we have identified five different ultrasound patterns of PM.