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In patients with well-differentiated papillary thyroid carcinoma (PTC), late recurrence is very rare. It is unusual that 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (PET/CT) shows hypermetabolic lesions in patients with well-differentiated PTC metastases. We demonstrate an exceptional case exhibiting a first relapse 37 years after hemithyroidectomy to treat PTC. Recurrent metastasis of a PTC should be considered as a differential diagnosis even if the elapsed time from the initial treatment is great. A left cervical lymphadenopathy, which exceptionally exhibited a hypermetabolic lesion on PET/CT, should be considered a metastatically well-differentiated PTC.

Cervical lymphadenopathy is a clinical feature of vast spectrum of diseases. It includes infections, malignancy, lymphoma, and connective tissue diseases. All cases need to be evaluated in detail with proper laboratory investigations and a tissue cytology/biopsy to unmask the etiology. Here, we present a young woman who was admitted for multiple painful neck swellings associated with fever for 3 months. She was primarily investigated to rule out infectious causes. The patient was evaluated in detail including blood investigations and biopsy and finally turned out to be systemic lupus erythematosus (SLE)-associated lymphadenopathy. This case shows that painful neck nodes can be a presenting feature of SLE and needs to be considered as one of the differential diagnosis in patients presenting with lymphadenopathy along with constitutional symptoms.

Multi Inflammatory Syndrome (MIS-C) associated with Corona Virus Disease (COVID) in children and young adults presents with a varied clinical spectrum; from that mimicking Kawasaki disease (KD), Incomplete Kawasaki disease to even Hemophagocytic Lymphohistiocytosis. A 14-year-old girl, presented to us, with headache, fever, bilateral uveitis, unilateral cervical lymphadenopathy, oral mucosal changes and abdominal pain. A disproportionate increase in inflammatory markers and Interleukin – 6, in the setting of a negative COVID real-time reverse transcription polymerase chain reaction (RTPCR) and significantly elevated COVID antibody titre confirmed our diagnosis. She was treated with intravenous Immunoglobulin and oral steroids with which she recovered. We want to highlight considering the possibility of MIS-C in children presenting with uveitis at a time when COVID-19 has been conquering the world with community spread.

The patients with leukemia have a high risk of venous thromboembolism and rarely, multiple bone sites can be involved to present as multifocal osteomyelitis. A four year old child had cellulitis, multifocal osteomyelitis, left pneumonia with pleural effusion, cervical lymphadenopathy, hepatomegaly and left internal jugular vein thrombosis, finally diagnosed as acute myeloid leukemia. A timely bone marrow biopsy study should be considered in a child with deep vein thrombosis along with multifocal osteomyelitis to diagnose and intervene acute myeloid leukemia early.

Tonsillar carcinoma is not easily diagnosed on [18F] fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan; normal, inflamed, and infected tonsils also exhibit increased tracer uptake. We present a case of a 68-year-old male with colon and prostate carcinomas who was referred for a PET/CT scan. He presented with right cervical lymphadenopathy which, on fine-needle biopsy, was found to have atypical cells suspicious for malignancy. On PET/CT, the right cervical lymph nodes appeared hypermetabolic; subsequent excision biopsy revealed metastatic poorly differentiated carcinoma. Increased metabolic activity was also seen in the tonsils, the right more than the left, which was initially ascribed to be inflammatory or physiologic. On magnetic resonance imaging follow-up, however, a more prominent and more enhancing right palatine tonsil was observed, which on histopathology was consistent with squamous cell carcinoma. Determining the maximum standard uptake value ratio between the two tonsils could have been helpful in differentiating squamous cell tonsillar carcinoma from benign asymmetric FDG uptake in this case. On a background of enlarged cervical lymph nodes and known primary carcinomas, uptake in the tonsils should be thoroughly assessed before interpreting it as an inflammatory or physiologic variant, especially if there is asymmetry in FDG uptake.

Aims and Objectives: To substantiate the use of ultrasonography in diagnosis of cervical lymphadenopathy in oral malignancies and to assess if ultrasonographic examination done prior to lymph node (LN) biopsy can yield important information regarding the diagnosis. Materials and Methods: Twenty subjects with histopathologically confirmed oral malignant lesions with clinically palpable and untreated cervical LNs included into study. These patients were subjected to clinical examination (number of LNs, shape, size, location, overlying temperature, overlying skin, tenderness, consistency, and fixity to the underlying structures), and ultrasonographic evaluation (number of LNs, shape, size (mm), location, borders, matting, peripheral halo, hilum, calcification, necrosis, reticulation, and echogenicity) of the LNs, and finally, histological assessment was done after surgical excision during the course of treatment. Results: Predominantly male (65%) patients were having with malignant LN involvement with age group of 60–69 years, i.e., 35%. Ultrasonogram is superior to clinical examination as it detected additional 49 nodes. Malignant nodes tend to have longest axial diameter (17 mm with standard deviation of 8.7 mm). Over all 52 malignant nodes were round, whereas 35 nodes were oval in shape. Most of the nodes were detected in submandibular region. Around 61 (70.9%) nodes had sharp borders and 26 (29.9%) had smooth borders. Loss of echogenic hilus is a common feature of malignancy showing 70% sensitivity and 67% specificity. Most of malignant nodes were hypoechoic. Around 51 (58.6%) of nodes showed intranodal necrosis, whereas it was absent in 36 (41.4%) nodes. Matting and edema were present 25 (28.7%) nodes. Intranodal calcification was present in 37 nodes. Sensitivity of USG was 90%, whereas specificity was 100%. Conclusion: Ultrasonographic examination of cervical LNs can yield important information regarding the diagnosis. Ultrasound examination should be done prior to FNAC and ideally an ultrasound-guided FNAC.

Cervical lymph node enlargement as the first and sole manifestation of IgG4-related disease (IgG4-RD) is rare and is often difficult to distinguish from lymphoma. Here, we report a case of a 63-year-old man initially presenting with bilateral posterior neck masses. Ultrasonography revealed multiple matted, ovoid, homogenous, hypoechoic, and enlarged lymph nodes below the right parotid gland. In addition, there was heterogeneous echotexture with small and indistinct hypoechoic nodules over bilateral parotid and submandibular glands which suggested sclerosing sialadenitis. Pathology of the tissues obtained by core needle biopsy revealed reactive hyperplasia, but a diagnosis of lymphoma could not be excluded. Subsequently, excisional biopsy and serological tests were done. The diagnosis of IgG4-RD was confirmed due to marked elevation of serum IgG4 levels and pathological evidence of IgG+ and IgG4+ plasma cell infiltration in the lymph node specimen. The patient's neck masses subsided gradually after 1 week of oral steroid therapy. The differential diagnosis of IgG4-RD should always be considered when sclerosing sialadenitis is presented with cervical lymphadenopathy.

Background: Fine-needle aspiration cytology (FNAC) is a first-line investigation modality for the evaluation of cervical lymphadenopathy. Aim: This study was undertaken to assess the utility and diagnostic efficacy of FNAC in the evaluation of cervical lymphadenopathy. Materials and Methods: A total number of 497 lymph node FNACs were retrieved and evaluated retrospectively between March 2012 and August 2015. Of these, 188 cases had subsequent histopathological follow-up. Their FNAC diagnoses were compared and correlated. Results: Among 188 FNAC cases, 157 (83.5%) were benign, 14 (7.4%) were suspicion of malignancy, and 17 (9.1%) were malignant. On correlation of subsequent histopathology, 151 cases were confirmed as benign (true negative) and 28 cases were confirmed as malignant (true positive). There were three false positive and six false negative results. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive values of FNAC were 82.4%, 98.1%, 95.2%, 90.3%, and 96.2%, respectively. Conclusion: Our study concluded that FNAC in the diagnosis of cervical lymphadenopathy was sensitive, specific, and accurate. FNAC is a useful and reliable diagnostic tool that also appears to be a safe and minimally invasive procedure that provides preoperative information for the appropriate management.

Sebaceous carcinoma (SC) of the eyelid is an aggressive, rare tumor of epidermal appendages, accounting for

Background: To evaluate the efficacy of color Doppler ultrasound (CDUS) in differentiating benign and malignant cervical lymph nodes by detecting differences in blood flow patterns. Materials and Methods: In this cross-sectional prospective study, 25 untreated patients with clinical evidence of cervical lymphadenopathy were evaluated. CDUS was performed for 80 cervical lymph nodes. The gray scale parameters of the lymph node and intranodal perfusion sites were the key CDUS features used to differentiate between reactive and metastatic lymph nodes. Histopathological confirmations were obtained and compared with the results of CDUS. Results: Initially, 53 cervical lymph nodes were evaluated by clinical examination. Twenty-seven additional lymph nodes (53 + 27 = 80) were discovered by CDUS evaluation. Gray scale parameters for lymph nodes such as size of lymph node, shape of lymph node, and presence or absence of hilum revealed highly significant results (P < 0.0001). Color Doppler flow signals revealed that central/hilar flow was characteristic for benign nodes whereas peripheral/mixed flow was characteristic for malignant nodes, the findings were highly significant (P < 0.0001). Gray scale and color Doppler features are used to differentiate benign and malignant nodes. Conclusion: Within the limitations of this study, CDUS evaluation was found to be highly significant with a high sensitivity and specificity over clinical evaluation CDUS examination provides a prospect to reduce the need for biopsy/fine needle aspiration cytology in reactive nodes.

Kimura's disease is a rare, chronic inflammatory disorder of unknown cause. It is endemic in Asia, affecting more number of males than females, with a ratio of 3:1. The typical clinical manifestations include a triad of painless unilateral cervical lymphadenopathy or subcutaneous masses predominantly in the head and neck region, blood and tissue eosinophilia, and an elevated serum immunoglobulin E (IgE) levels. Variable conditions both benign and malignant may mimic Kimura's disease both clinically and on fine needle aspirates. The confirmatory diagnosis is established only by histopathological examination. We report a case of Kimura's disease in a patient who underwent multiple investigations in view of her past history and family history of pulmonary Koch's. Fine needle aspiration cytology (FNAC) was performed thrice with consistently similar result of reactive lymphadenitis with numerous histiocytes and eosinophilia. The final diagnosis of Kimura's disease could finally be established only on histopathological examination.

Kawasaki disease (KD) is a systemic vasculitis that mostly affects children below the age of 5. The vasculitis involves arteries of medium size, especially the coronaries. Various etiologies have been proposed including association with micro-organisms, bacterial superantigens, and genetic factors, however, the exact cause remains unknown. There is no specific laboratory test for KD. Diagnosis is clinical and depends upon the presence of fever for ≥5 days and 4 or more of five principal features, viz. polymorphous exanthem, extremity changes, mucosal changes involving the lips and oral cavity, bilateral bulbar conjunctival injection, and unilateral cervical lymphadenopathy. The term "incomplete KD" refers to the presence of fever and less than four principal clinical features. Recognition of this group of patients is important because it is usually seen in infants and risk of coronary abnormalities is increased probably because of delays in diagnosis. However, what appears to be "incomplete" at a given point of time may not actually be so because some of the features may have already subsided and others may evolve over time. Hence, a detailed dermatological examination is warranted in all cases, especially in incomplete KD, to ensure timely diagnosis. Although KD is a self-limiting disease in most patients, coronary artery abnormalities (CAAs) including coronary dilatations and aneurysms may develop in up to 25% of untreated patients. CAAs are the most common cause of morbidity and mortality in patients with KD. Treatment is aimed at reducing inflammation and consists of intravenous immunoglobulin (IVIG) along with aspirin. Despite treatment, some patients may still develop CAAs, and hence, long-term follow up is of utmost importance.

Rosai-Dorfman disease is a benign, self-limited non-Langerhans cell histiocytosis of unknown etiology. Its most common clinical feature is extraordinary massive painless cervical lymphadenopathy. This entity may be limited to the lymph nodes; however, more than 40% of patients have extranodal involvement, with the skin being the most frequently affected site. Cutaneous disease without the presence of lymphadenopathy is extremely rare but has been reported. We report the intriguing case of exclusively cutaneous Rosai-Dorfman disease in an 80-year-old African-American woman.

Kikuchi-Fujimoto disease (KFD) is a benign but self-limiting disorder. However, KFD is often misdiagnosed as a malignant disease. Although 18F-fludeoxyglucose (FDG) uptake on dual-time-point imaging (DTPI) positron emission tomography (PET)/computed tomography (CT) is useful in distinguishing malignant from benign disease, the latter sometimes mimics malignancy on DTPI PET/CT, resulting in a misdiagnosis. Here, we describe the case of a 30-year-old woman who complained of cervical lymphadenopathy. PET showed increased FDG uptake in multiple lymph nodes, with a maximum standardized uptake value (SUVmax) of 19.0 in the early phase to 21.8 in the late phase. A biopsy was performed, and pathological examination revealed KFD. KFD with FDG uptake in lymph nodes on DTPI PET/CT is rare and difficult to be distinguished from a malignant disease.

Background: Thyroid nodules are common. They can be either benign or malignant. Solitary thyroid nodules (STN) have a high likelihood of being malignant. They should be characterized properly for optimum management. Materials and Methods: In this study, we have analyzed our departmental data over a period of 5 years. All the patients who presented to the outpatient department with a clinically detected STN were included in the study group. Our approach was individualized. Preoperative ultrasonography (USG) and fine-needle aspiration cytology were planned in all these patients. Hemi thyroidectomy and total thyroidectomy with and without neck dissection were performed wherever appropriate. Results: There were 162 cases of clinically detected STN. USG findings were available in 146 cases. Postoperative histopathology was reported as malignant in 58 cases. Malignant STN was more likely in males. Ultrasonographically detected solid STN were more prone for malignancy as compared to multinodular goiter (P = 0.000) Presence of micro calcification and cervical lymphadenopathy were more commonly noted in malignant thyroid swellings. Conclusion: Solitary thyroid nodules do have a high likelihood of harboring a malignancy. Solid echogenicity, micro calcification and cervical lymphadenopathy on USG were seen more frequently in malignant nodules.

Thyroid hemiagenesis (THG) is a rare congenital anomaly in which one lobe of thyroid gland fails to develop. Agenesis may be unilateral, total or isthmic. Left thyroid lobe is commonly involved than right lobe in hemiagenesis. Clinically patients can be euthyroid, hypothyroid or hyperthyroid. Often it is diagnosed as an incidental finding during ultrasonography (USG) study of neck, which easily diagnose this condition. Actual incidence of THG is unknown, most cases are diagnosed in patients admitted for thyroid scan or thyroid surgery because of suspicion of other thyroid abnormalities. This explains high frequency of association of hemiagenesis with other thyroid abnormalities such as multinodular goiter, adenoma, hyperthyroidism, hypothyroidism, chronic thyroiditis, and carcinoma. We report a case of 58-year-old male patient detected to have hemiagenesis of left thyroid lobe and isthmus when USG neck was performed for carcinoma right buccal mucosa with metastatic cervical lymphadenopathy.

Kikuchi-Fujimoto disease (KFD) is a rare, self-limiting disease of unknown aetiology presenting with cervical lymphadenopathy, fever, vomiting, weight loss, night sweats and chills. Familial occurrence of KFD is reported very rarely in literature. We report two cases from the same family presenting with KFD. The two non-twin sisters presented with symptoms of fever, cervical lymphadenopathy, weight loss, nausea, vomiting, night sweats and chills 6 months apart. The elder sibling with KFD also manifested mononeuritis multiplex. Laboratory evaluation revealed raised erythrocyte sedimentation rate, C-reactive protein levels and leucopenia. Anti-nuclear antibody and anti-double stranded deoxyribonucleic acid antibody were negative. Histopathological findings were suggestive of Kikuchi -Fujimoto’s disease. The patients responded well to oral corticosteroid treatment.

Kikuchi-Fujimoto disease (KFD) is an under-recognized disease most commonly presenting with cervical lymphadenopathy, fever, and cytopenias in young females. Bilateral parotid enlargement is usually caused by infections (e.g., mumps) and autoimmune conditions (e.g., Sjogren syndrome). Parotid enlargement, inguinal lymphadenopathy, and pyrexia of unknown origin are uncommon presenting features of KFD and should be suspected in the appropriate setting.

We report the case of a 60-year-old male presented with axillary swelling of 18 months duration with ulceration and cervical lymphadenopathy of 3 months duration with a clinical diagnosis of scrofuloderma. Histopathology showed dermis infiltrated by sheets, nests, and clusters of polygonal cells with markedly pleomorphic mitotically active nuclei suggestive of a more sinister condition, poorly differentiated cutaneous adenocarcinoma either primary or metastasis from breast. The condition is reported for its rarity from male breast and the need to consider it as a differential diagnosis in similar clinical presentation.

We present a rare case of Kikuchi disease in a young lady presenting with fever and cervical lymphadenopathy. Clinically, the disease mimics tuberculosis and lymphoma. Lymph node biopsy is diagnostic and treatment is symptomatic. Although tuberculosis is endemic, clinicians should be aware of uncommon conditions as early recognition of the disease will minimize unnecessary evaluation and treatment.

Epithelial-myoepithelial carcinoma (EMC) is a low-grade malignant tumor of the salivary glands. It is extremely rare neoplasm accounting for

Background: Cervical lymphadenopathy is a common clinical problem that confronts us in daily clinical practice. The causes vary from simple treatable infections to malignancies that require highly specialized institutional management. It therefore needs to be speedily investigated. Fine needle aspiration cytology (FNAC) is simple, quick, inexpensive and minimally invasive technique that can be used as an outpatient procedure to diagnose them. Aims and Objectives: To assess the various causes of cervical lymphadenopathy through FNAC, and to see the distribution of lesions with respect to age and gender . Material and Methods: A retrospective study was conducted over a period of 10 months in a major laboratory. The cyto-morphologic features seen in the aspirates were critically analyzed and correlated with their aetiology. Results: In this study, 214 cases of cervical lymphadenopathy were analyzed. The age of the patients ranged from 9 months to 84 years of which 59% were males and 41% were females. Maximum incidence of cervical lymphadenopathy was observed in the age group of 21 to 40 years. The maximum numbers of patients (47.67%) were diagnosed as tuberculous lymphadenitis, followed by reactive lymphadenitis (44.39%), lymphomas (4.2%) malignant metastatic deposits (2.8%), and granulomatous lymphadenitis (0.94%). Conclusion: Our study concluded that FNAC is simple, quick, minimally invasive, and inexpensive technique to diagnose cervical lymphadenopathy. It can differentiate a neoplastic from a non-neoplastic process and therefore influence patient management preventing patient from being subjected to unnecessary surgery.

Background: Presently it is difficult to differentiate malignancy for thyroid nodules by palpation, ultrasonography and fine-needle aspiration cytology (FNAC) at the outpatient department, especially for solitary thyroid nodule (STN). So a great emphasis should be placed on the STN. AIms: The objective of this study was to investigate the predictive clinicopathological risk factors for malignancy in patients with STN and further to provide an appropriate clinical management. Materials and Methods: The records were reviewed from 265 patients with STN who had undergone thyroidectomy in our hospital. All cases were classified as two independent groups in terms of the final pathological results to assess the independent risk factors using a multinomial logistic regression analysis. Results: A multinomial logistic analysis revealed that the male gender, microcalcification and cervical lymphadenopathy were independent risk factors related to malignancy in patients with STN. The incidence of malignancy in patients with 0,1,2,3 risks was 10.71%, 26.6%, 61.43%, and 100%, respectively. Conclusions: Male gender, microcalcification and lymphadenopathy were independent risk factors for predicting the malignancy in patients with STN. Patients with more than two of those risk factors should be subjected to further examination or thyroidectomy. The findings may provide a simple and reasonable management for the STN.

Background: Prospective observation analysis to evaluate the cure in tuberculous cervical lymphadenopathy with directly observed treatment short course category III (DOTS CAT III) treatment as per revised national tuberculosis control program (RNTCP) at a tertiary care hospital in AP, India, from October 2007 to September 2009. These cases were followed up for period of 22 months. Materials and Methods: Total 1521 tuberculous cases were screened in KIMS both pulmonary and extra pulmonary cases out of which 146 cases were tuberculous lymphadenitis. Fifty cases of tuberculous cervical lymphadenopathy were included after diagnostic and treatment algorithm and fine needle biopsy or excision biopsy. Patients below 5 yrs, immunocompromised, having diabetes mellitus, pulmonary tuberculosis and with other co-morbid conditions were excluded from the study. All patients were put on DOTS CAT III as per RNTCP guidelines. Follow-up was done every 2 months till 6 months for 1) Constitution symptoms 2) Weight gain or loss 3) Appetite gain or loss 4) Regression of lymph nodes or increase 5) Compliance 6) Side effects 7) Failures by demonstration of organism by direct smear, culture or histopathological examination. Results: In this study, lymph node regression was found in 78% at the end of 2 months, 94% at the end of 4 months and 96% at the end of 6 months, 9 patients had regression in size though the nodes were palpable, 2 had no regression but fresh lymph nodes appeared on the same side and sinus discharge was present, culture was negative in these cases. Two cases had immune reconstitution syndrome, constitutional symptoms disappeared and showed clinical improvement. Four cases were subjected for surgical intervention. Conclusion: DOTS CAT III is effective in the treatment of tuberculous cervical lymphadenopathy. Compliance was good with minimal, minor side effects, only two had immune reconstitution syndrome and two had sinus formation; they were referred for surgical intervention, and follow-up of 22 months did not show any relapses.

Virus associated hemophagocytic syndrome is a non-neoplastic, generalized histiocytic proliferation with prominent hemophagocytosis associated with a systemic viral infection. We report a case of cytomegalovirus (CMV) associated hemophagocytic syndrome in a 2 month old male child presenting with rashes, fever, hepatosplenomegaly, cervical lymphadenopathy and pancytopenia. Fine needle aspiration cytology and biopsy from cervical lymph nodes revealed prominent hemophagocytosis. Serology for CMV IgM was positive in both the mother and the child, suggesting recent infection. Possibly there was intrauterine transmission of the infection.

Human immunodeficiency virus (HIV) and M. tuberculosis are two intracellular pathogens that interact with each other at both clinical and cellular levels. A known HIV positive case, presentingwith vague pulmonary symptoms followed by bilateral cervical lymphadenopathy, is reported here. The condition was treated as asthma, based on lung symptoms. Cytology revealed acute purulent lymphadenitis. Only Z. N. staining and culture of sputum and lymphnode aspirate could diagnose tuberculosis. Patient responded well to the standard anti tuberculosis treatment.

Serous borderline tumor (SBT) involving a cervical lymph node is extremely rare. In addition, fine needle aspiration (FNA) cytology of the involved cervical lymph node shares tremendous morphologic similarity with other low-grade papillary carcinomas. Thus, it can be easily misdiagnosed as metastatic carcinoma. A 42-year-old female had a history of bilateral SBT and postbilateral salpingo-oophorectomy. She presented with left cervical lymphadenopathy 6 months later. FNA cytology showed a low-grade papillary neoplasm with psammoma bodies. Needle core biopsy along with immunostains was diagnostic of cervical lymph node involvement (LNI) of SBT. although extremely rare, cervical LNI can be found in patients with SBTs. FNA cytology, sometimes, is indistinguishable from metastatic papillary adenocarcinoma. Cell block or needle core biopsy is essential to make the correct diagnosis.