Search

Leiomyosarcoma is a malignant mesenchymal tumour of smooth muscle origin. It is extremely rare as a primary thyroid cancer with only 33 cases previously described in the literature. We present the case of a 69-year-old Caucasian man who presented with a 5-month history of left cervical lymphadenopathy and a suspicious mass in the left thyroid lobe on ultrasound scan. Left hemithyroidectomy confirmed the diagnosis of leiomyosarcoma. A review of current understanding and approaches to management of this rare condition are discussed.

Objective To determine the incidence of tuberculous lymphadenitis (TBL) and other pathologies in cervical lymphadenopathies in Somalia and accompanying radiological findings. Methods In this hospital-based retrospective study, the demographic characteristics, pathology results and radiological findings of 263 patients who underwent ultrasound (US)-guided cervical lymph node biopsy between January 2016 and February 2020 were analyzed. Results Of 241 patients 118 men and 123 women (mean age 27.9 ± 18.1 years) included in the study, 46.1% (n = 111) were diagnosed as necrotizing granulomatous lymphadenitis (caseified, consistent with TBL) and 21.6% (n = 12, atypical lymphoid cells and n = 40, metastases) as malignancy. The most common type of metastasis was squamous cell cancer (n = 31), and the primary source of most of them was esophageal cancer (16/31, 51.6%). The age of patients with TBL was significantly lower than that of non-TBL (21.9 ± 14.6 vs. 41.9 ± 24.6, P = 0.003) and the incidence of TBL in pediatric patients was statistically higher (58.0% vs. 21.5%, P = 0.019). The rate of patients with TBL being localized at level 4 and level 5 was significantly more than non-TBL patients (18.0% vs. 10.0% and 23.4% vs. 10.8%, respectively, P = 0.01). Half of patients with TBL who have chest radiography had pathological findings; consolidation and bronchopneumonia were present in 52.6% of them. There were 2 patients with paravertebral abscess and one patient with gastrointestinal tuberculosis. Conclusion In Somalia, in the presence of cervical lymphadenopathy, after diagnosis by using US-guided biopsy; primarily considering of TBL and malignancy, thoracic involvement should be investigated, and esophageal carcinoma must be excluded in terms of metastatic lymph node.

BACKGROUND: Kikuchi disease (KD) is a rare and generally benign condition of uncertain etiology that presents with nonspecific symptoms including fever and cervical lymphadenopathy. Clinical presentations can vary. Here, we present an atypical case of KD in a 10-year-old girl, as well as an updated literature review of the clinical presentation, laboratory features and management of KD in children. METHODS: Studies (published up until February 2020) were identified through searches of PubMed using the following search items: Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis or Kikuchi disease. Our primary search resulted in 1117 publications. A total of 34 publications with a total of 670 patients were included in the final analysis. RESULTS: All children present with lymphadenopathy. Almost all (96.3%) have cervical lymphadenopathy. Fever is recorded in the majority of children (77.1%). Analysis of laboratory features found that the majority of children have leukopenia (56.0%) and a raised erythrocyte sedimentation rate (56.0%). Over 30% have a raised C-reactive protein and anemia. Other features such as leukocytosis, thrombocytopenia and antinuclear antibodies positivity are less common. KD is mostly self-limiting, but steroids, hydroxychloroquine and intravenous immunoglobulin are used in protracted courses. Their efficacy has yet to be established in clinical trials. CONCLUSIONS: The presentation of KD is variable, and there is no specific set of symptoms or laboratory features that reliably establishes the diagnosis. Thus, histopathology is crucial. Definitive evaluation and establishment of effective treatments will require future prospective research studies for a more comprehensive description of the clinical course and effects of treatment. Given the rarity of the disease, this will have to be performed in collaborative consortia.

Thyroid nodules are common in the general population, with higher prevalence in women and with advancing age. Approximately 5% of thyroid nodules are malignant; the majority of this subset represents papillary thyroid cancer. Ultrasonography is the standard technique to assess the underlying thyroid parenchyma, characterize the features of thyroid nodules, and evaluate for abnormal cervical lymphadenopathy. Various risk stratification systems exist to categorize the risk of malignancy based on the ultrasound appearance of a thyroid nodule. Nodules are selected for fine-needle aspiration biopsy on the basis of ultrasound features, size, and high-risk clinical history. Cytology results are classified by the Bethesda system into six categories ranging from benign to malignant. When cytology is indeterminate, molecular testing can further risk-stratify patients for observation or surgery. Surveillance is indicated for nodules with benign cytology, indeterminate cytology with reassuring molecular testing, or non-biopsied nodules without a benign sonographic appearance. Expected final online publication date for the Annual Review of Medicine, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Introduction. Significant polymorphism of clinical manifestations of infectious mononucleosis, multisystemic lesions, frequent lack of clear clinical and paraclinical criteria and delayed results of available laboratory tests, and sometimes impossibility of their execution complicate the diagnosis of the disease in prehospital stage and on admission to hospital. Objective of the study: to optimize the diagnosis and treatment of infectious mononucleosis in children by examining current features of the course and analyzing the diagnostic value of clinical and instrumental parameters in the verification of the disease. Materials and methods. On the basis of infectious boxed unit of respiratory infections of Municipal Healthcare Institution «Regional Children’s Hospital» (Chernivtsi), there were examined 65 children with infectious mononucleosis, who were hospitalized in the period of 2014–2015. The first clinical group (I) consisted of 42 children, the final clinical diagnosis of the disease in them was verified on the basis of comprehensive clinical and hematological criteria, the second (II) clinical group included 23 patients with serologically confirmed infectious mononucleosis. In terms of the main clinical signs, the observation groups were not significantly different. Results. It was found that for children with infectious mononucleosis, such clinical features are typical: sudden onset of the disease (in 93.8 %) with fever higher than 37.5 °C (80 %), the presence of exudative tonsillitis (81.6 %), submandibular and cervical lymphadenopathy (in 90.7 %), difficulty in nasal breathing (in 78.4 %), and nasal voice (in 73.8 %). In confirmation of Epstein-Barr virus infectious mononucleosis, phenomena of exudative tonsillitis and lymphadenopathy were highly sensitive (90 and 95 %, respectively), but with a high proportion of false positive results. Conclusion. Thus, given the lack of diagnostic value of clinical-anamnestic and sonographic parameters in identifying Epstein-Barr virus infectious mononucleosis in children, as evidenced by low values of the likelihood ratio and risk indicators, their use is expedient only in the combination.

Kikuchi disease is a rare, benign condition of unknown aetiology, which usually involves young women and is characterised by cervical lymphadenopathy and fever. Herein, we are reporting a case of a young Asian woman, who presented with fever and lymphadenopathy raising possibility of either infection or malignancy but after appropriate clinical investigations including lymph node biopsy, it turned out to be Kikuchi disease. She made an uneventful complete recovery with only symptomatic treatment.

Composite hemangioendothelioma (CHE) displaying neuroendocrine differentiation is a rare histologic variant that is often mistaken for angiosarcoma, having a predilection for visceral locations and being associated with an aggressive clinical course. Their pathogenesis is still evolving, with only 2 cases to date from separate studies reporting a recurrent PTBP1-MAML2 fusion. Herein, we report two new cases of neuroendocrine CHE harboring PTBP1-MAML2 fusions occurring in two elderly patients (70-year-old male and 71-year-old female), both involving neck lymph nodes. The first case presented with multifocal cervical lymphadenopathy, while the second case occurred unifocally in an enlarged neck lymph node. Histologically, the tumors displayed heterogenous architectural patterns with areas reminiscent of benign cavernous hemangioma, retiform hemangioendothelioma, epithelioid hemangioendothelioma, and angiosarcoma. Cytologically, the cells were monotonous with round to ovoid nuclei, open to fine chromatin, scant to moderate cytoplasm, and frequent vacuolization. In addition, the first case showed focal solid areas of large epithelioid cells with severe nuclear atypia, enlarged nuclei and prominent nucleoli, resembling epithelioid angiosarcoma. Tumor cells were diffusely positive for vascular markers and focally positive for synaptophysin. In both cases, a next-generation sequencing fusion panel confirmed an in-frame fusion between PTBP1 exon 10 and MAML2 exon 2. One case with clinical follow-up showed stable recurrent disease and metastatic lung deposits following treatment. Both patients were alive at 3 months and one year following initial diagnosis. Our findings lend further support to classifying CHE with PTBP1-MAML2 fusions as a distinct variant of CHE with unique clinicopathologic features, including neuroendocrine features. This article is protected by copyright. All rights reserved.

Chronic-lymphocytic-leukemia (CLL) is the most prevalent leukemia in developed countries, caused by monoclonal proliferation of CD5+ B-cells and accumulation of mature-appearing-neoplastic lymphocytes in blood, bone marrow, and secondary lymphoid organs. Oral manifestations of CLL are infrequent and rarely reported in literature. We report a new case of a 67-year old man who presented with the complaints of tooth mobility and gingival swelling. Extra-oral examination was remarkable for cutaneous pallor and bilateral cervical lymphadenopathy involving the submandibular, and deep cervical lymph nodes on both sides of the neck. Complete blood count revealed normal red blood cell count (4.25 × 106/μl), normal platelet count (136 × 103/μl) and increased white blood cell count (25.3 × 103/μl). Differential white blood cell count showed marked lymphocytosis (88%), and blood film revealed the presence of leukocytosis, with small mature-looking lymphocytes, and mild thrombocytopenia. A flow cytometry immune-phenotyping revealed that 55% of peripheral blood cells were monoclonal B-lymphocytes expressing CD19, CD20, CD23, CD200, CD22, CD5, CD38, CD11c, sIgD and Kappa light chain confirming the diagnosis of CLL. Oral healthcare professionals should consider systemic causes, such as CLL, in the differential diagnosis of generalized tooth mobility and gingival swelling, particularly in patients with associated symptoms such as lymphadenopathy, fever, weight loss, and general fatigue.

Background: The accuracy of individual symptoms, signs, and several easily obtainable hematologic parameters for diagnosing infectious mononucleosis (IM) still needs to be confirmed. Improving the diagnosis of IM based on the clinical findings could prompt physicians to identify better which patients need a diagnostic test for IM. This study performed a systematic review to determine the accuracy of symptoms, signs, and hematologic parameters in patients with suspected IM that used heterophile antibody test or viral capsid antigen tests as the reference standard. Methods: The PubMed database was searched for all relevant articles. Two reviewers reviewed all studies in parallel and assessed the quality of the selected studies using the quality assessment of diagnostic accuracy studies 2 (QUADAS-2) criteria. The pooled measures of diagnostic performance were calculated by bivariate meta-analysis for each clinical finding, which included sensitivity, specificity, likelihood ratios, the diagnostic odds ratios, and the area under the receiver operating characteristic curve. Results: Seventeen studies were included in our final analysis. The prevalence of IM ranged from 2.1% to 80% among prospective cohort studies. The presence of splenomegaly (positive likelihood ratio [LR+], 2.39; 95% confidence interval [CI], 1.11-5.51), palatal petechiae (LR+, 1.32-11.40), posterior cervical lymphadenopathy (LR+, 3.16; 95% CI, 1.45-5.20), and axillary or inguinal cervical lymphadenopathy (LR+, 3.05; 95 CI, 1.85-4.70) were moderately useful for ruling in IM. The most helpful hematologic parameters for ruling in IM include lymphocytes greater than 4 × 109/L and greater than 40% to 50%, or atypical lymphocytes greater than 40%. A combination of lymphocytes greater than 50% and atypical lymphocytes greater than 10% (LR+, 50.40; 95% CI, 8.43-162) was also found to be helpful to rule in disease. Most of the clinical findings have limited diagnostic value in ruling out the disease when absent. Conclusions: Although most symptoms and signs were unhelpful, the likelihood of IM is appreciably increased by several examination findings. Hematologic parameters were more accurate than symptoms and signs. Since most clinical findings have limited diagnostic value in ruling out the disease, physicians should not rely on the absence of any individual symptom or clinical sign for ruling out IM.

Rosai–Dorfman disease (RDD) is also known as Sinus Histiocytosis with Massive Lymphadenopathy. It is a rare, benign, self-limiting disease of phagocytic histiocytes presenting with massive painless cervical lymphadenopathy. RDD can present as a nodal disease and also extra-nodal involvement with episodes of exacerbation and remissions and relapses after treatment. Its etiology remains poorly understood and is highly variable in its clinical presentation and response to treatment. Its treatment is poorly defined but the prognosis is usually fair. Here we are reporting a rare, unusual clinical presentation of infraorbital soft tissue mass diagnosed as RDD with cyto-histopathological correlation. Only a few such cases have been reported in the literature.

The study aimed to determine the clinical manifestations and epidemiology of extrapulmonary tuberculosis (EPTB) of the head and neck in the otorhinolaryngeal regions. There is an increase in the incidence of EPTB in recent years because of increase in immunocompromised states and development of resistant bacteria. The clinical symptoms and signs of EPTB of the otorhinolaryngeal regions overlap with that of malignancies and other diseases in otorhinolaryngology thereby requiring correct early diagnosis so as to avoid unnecessary surgeries and procedures with initiation of appropriate anti tuberculous treatment under RNTCP. Our prospective study was done on 45 patients who attended the ENT OPD at a tertiary care centre in Southern India over a period of 18 months with diagnosed EPTB of the otorhinolaryngeal regions. The study included 29 (64.4%) patients who presented with cervical lymphadenopathy, 11 (24.4%) patients with tuberculous laryngitis, 3 (6.6%) patients with tuberculous otitis media and 1 each with nasal and oral cavity tuberculosis. In our study 6 (13.3%) patients had co-existing pulmonary tuberculosis, 8 (18%) had diabetes, 5 (11%) had past history of tuberculosis and 7 (16%) had contact with patient with tuberculosis. A high index of suspicion of EPTB must be kept among patients where (i) the clinical symptoms are out of proportion to the signs, (ii) common treatment fails or (iii) there is persistence or recurrence of symptoms despite therapy. The challenge is in confirming diagnosis which requires histopathological examination (HPE) of the tissue specimen. The timely diagnosis and initiation of anti tuberculous treatment (ATT) as per RNTCP helps in complete recovery thereby reducing morbidity.

Background: Thyroid cancer is the most common endocrine carcinoma, as it accounts for almost 90% of all endocrine malignancies. Our objective was to determine prevalence of thyroid cancer in patients underwent thyroidectomyin Suez Canal University Hospital. Patients and Methods: Cross-sectional descriptive study was conducted on 81 patients attending to our surgical oncology outpatient who were candidate for total thyroidectomy or hemithyroidectomy. Patients were subjected toclinical examination including multinodular goiter or solitary nodule, complaint of patient: pressure manifestations, cosmetic disfigurement and thyrotoxicosis and cervical lymphadenopathy. Neck ultrasonography was done for cervical lymphadenopathy, solitary nodule or multi nodular, assessment by TI-RADS and size of nodule. Specimens were sent to our pathology department. Results: Mean age of the patients was 48.83±11.01 years.75% were females. The chief complaint was neck lump (46.9%) and pressure symptoms (45.7%). Fifty percent of the patients had thyroid nodular size 1–4cm and 69.2% of were multi-nodular.69.2% of the patients had total thyroidectomy while 30.8% had hemi-thyroidectomy. Incidence of thyroid carcinoma was 26% as: papillary (18.5%), follicular carcinoma (3.7%), medullary carcinoma (2.5%) and anaplastic (1.2%). Thyroid carcinoma was associated with solitary nodule (55%), in the left lobe (42.8%), cervical lymph node (30%) and TIRADS 5 (42.8%). Conclusion: Incidence of thyroid carcinoma in Suez Canal University hospital is 26%. The most frequent histopathology type is papillary carcinoma. Females were the most affected. The pressure symptom was the most complaint in benign nodules while neck lump was the most common in malignant nodules. TIRADS 5 was the most frequent in all malignant nodules.

Background: Enlarged cervical nodes are very common presentation in radiology department. The accurate diagnosis of the cervical lymphadenopathy is very crucial for further management. The aim of this study was to evaluate the cervical lymphadenopathy by sonography and see the effec­tiveness of B mode ultrasound and color Doppler ultrasound in differentiation between the benign and malignant lymph nodes. Methods: A retrospective study was conducted in the Department of Radiology, College of Medical sci­ences, Bharatpur from 2019 to 2021 among 40 patients with clinically palpable cervical nodes. The so­nographic findings and FNAC/biopsy correlation were done with calculation of the p value, sensitivity, specificity, positive and negative predictive values. SPSS 20.0 and Microsoft Excel were used for the data analysis and presentation. Results: Among 40 patients the most common diagnosis was tuberculosis nodes followed by reactive nodes, metastatic nodes and lymphomatous nodes. The sensitivity and specificity for reactive nodes is very high 92% and 89% respectively for B-mode and for color Doppler ultrasound it is 82% and 90%. For TB nodes and metastatic nodes B-mode and color Doppler ultrasound has low sensitivity and high specificity 72% and 71% sensitivity for TB and metastatic nodes respectively and 91% and 94% specificity for TB and metastatic nodes respectively. Conclusions: B mode and color Doppler sonography is very helpful to accurately diagnose the cause of cervical lymphadenopathy with high specificity and sensitivity. However, the differentiation between the tubercular, metastatic and lymphomatous nodes by sonography is very difficult and requires FNAC/biopsy correlation.

ObjectivePatients with coronavirus disease vaccine associated lymphadenopathy are increasingly being referred to healthcare services. This work is the first to report on the incidence, clinical course and imaging features of coronavirus disease vaccine associated cervical lymphadenopathy, with special emphasis on the implications for head and neck cancer services.MethodsThis was a retrospective cohort study of all patients referred to our head and neck cancer clinics between 16 December 2020 and 12 March 2021. The main outcomes measured were the proportion of patients with vaccine-associated cervical lymphadenopathy, and the clinical and imaging characteristics.ResultsThe incidence of vaccine-associated cervical lymphadenopathy referrals was 14.8 per cent (n = 13). Five patients (38.5 per cent) had abnormal-looking enlarged and rounded nodes with increased vascularity. Only seven patients (53.9 per cent) reported full resolution within an average of 3.1 ± 2.3 weeks.ConclusionCoronavirus disease vaccine associated cervical lymphadenopathy can mimic malignant lymphadenopathy and therefore might prove challenging to diagnose and manage correctly. Healthcare services may encounter a significant increase in referrals.

Background: Due to their low prevalence and variable clinical presentation, oral metastatic tumours present a diagnostic challenge to the clinician. This case describes the presentation of a mandibular metastatic tumour in an apparently healthy patient, initially managed as dento-alveolar infection by her general dental practitioner (GDP). Case description: A 56-year-old female attended her GDP with a small intraoral swelling buccal and lingual to the lower left incisors, canine and first premolar. Radiographic examination revealed gross caries in the lower left anterior dentition and periapical bone loss in the region. A week's course of antibiotics had no effect. The swelling increased rapidly and the involved teeth were extracted by the GDP before referral to Oral Surgery. The patient offered no history of weight loss, febrility or breathlessness. Her medical history was unremarkable. She smoked and did not consume alcohol. Histological examination revealed a poorly differentiated metastatic carcinoma. A computerized tomography scan of the neck showed a 4 cm mass in the left anterior mandible with adjacent bony destruction. There was bilateral cervical lymphadenopathy and a large right-sided upper lobe lung mass with metastasis to the contralateral upper lobe of the lung, the right adrenal gland and brain. A diagnosis of poorly differentiated non-small cell carcinoma of the lung was made, staged T4 N3 M1c. Nine weeks after her initial presentation to the GDP, the patient suffered a seizure and passed away. Conclusion: This case demonstrates an uncommon presentation of mandibular metastatic tumour as the first indicator of advanced malignant disease. The presentation of such tumours can often mimic more common, benign processes, making diagnosis challenging. At a time of increased remote assessment of patients due to the COVID-19 pandemic, it is particularly important for clinicians to consider the possibility of malignancy when faced with any unusual case of swelling. © 2021 British Association of Oral Surgeons and John Wiley & Sons Ltd.

This is the first case of follicular T-cell lymphoma (FTCL) presenting as methotrexate-associated lymphoproliferative disorders (MTX-LPDs). A 69-year-old man treated rheumatoid arthritis with methotrexate presented with cervical swelling, hoarseness and fever. Imaging studies revealed multiple lymphadenopathy and lymphoma was suspected. Lymph node biopsy was performed to confirm the diagnosis. Pathologically, the lymph node was composed of atypical lymphocytes with a follicular growth pattern and area of necrosis. Immunohistochemical examination showed the atypical lymphocytes were positive for CD3, CD4, programmed cell death protein 1, and inducible T-cell co-stimulator. These findings are consistent with FTCL. During hospitalization, the patient's fever subsided and cervical lymphadenopathy improved, probably due to discontinuation of MTX. Here we presented the first case of FTCL presenting as MTX-LPDs. The T-cell phenotype MTX-LPDs are relatively rare and accounts for only 3.4%-6.3% of all MTX-LPD cases. Therefore, detailed clinicopathological features have not been clarified sufficiently. It is hoped that similar cases should be accumulated and studied to better understand the clinical and pathological features of this condition.

Background Kawasaki disease (KD), which was first described by Tomisaku Kawasaki in 1967, is a syndrome that results in acute systemic vasculitis, affecting mainly infants and children, and is a major cause of acquired heart disease in developed countries. KD is diagnosed based on certain characteristic symptoms and echocardiogram results. It has been reported that neck and abdominal ultrasound is also reliable diagnostic method. Nevertheless, abdominal ultrasound is not a routine procedure in KD. Moreover, dilatation of the common bile duct (CBD) has been rarely reported in previous cases. Case presentation: A 4-year-old boy presented with fever and markedly high transaminase level (AST, 5,323 U/L, ALT, 1,554 U/L). The patient was diagnosed as having KD based on characteristic symptoms and echocardiogram findings. Neck and abdominal ultrasound revealed dilatation of the CBD as well as cervical lymphadenopathy resembling a cluster of grapes, thickening of the gallbladder wall, and increased periportal echogenicity throughout the liver parenchyma. The patient received initial treatment with intravenous immunoglobulin (IVIG) at day 4 of fever, following which, transaminase level decreased. The patient received second-line treatment with IVIG and prednisolone because of recurrent fever on day 6. Dilatation of the CBD was improved from 6.6 mm on day 4 to 3.1 mm on day 8. Although re-dilatation was observed, it gradually diminished and normalized (4.3 mm on day 28, 4.0 mm on day 63, 3.3 mm on day 105, and 2.8 mm on day 182). Conclusion This case highlights the usefulness of abdominal ultrasound and the importance of considering dilatation of the CBD as one of the complications of KD. Because abdominal ultrasound is not a routine procedure in KD, it is possible that dilatation of the CBD in KD is quite latent if not investigated thoroughly. Further prospective studies to support these findings are warranted.

The aim of this study is to study the incidence of occult nodal micrometastases (ONM) in the contralateral neck and compare it to the laterality of the primary tumor. Retrospective analysis of the medical records of patients with locally advanced supraglottic squamous cell carcinoma and Clinically negative contralateral neck (cN0-CLN) - who had concurrent total laryngectomy and bilateral neck dissection as their primary treatment at the Otolaryngology Department, Al Kas Al Ainy School of Medicine-Cairo University between 2015 and 2020 - was conducted. Patients were divided into 3 groups according to the extent of the primary tumor. 28 patients met the inclusion criteria. Patients with well-lateralized tumors were 14 (Group A), tumors abutting the midline were 4 (Group B) and tumors significantly involving the contralateral side were 14 (Group C). There was no statistically significant difference in age of patients among the three groups. Eleven patients had cervical lymphadenopathy in the final pathology reports. Seven patients had ONM, all of whom were among group C patients (7/14; 50%). The degree of tumor differentiation was not associated with the presence of ONM. Treatment of the cN0-CLN is justified in locally advance supraglottic carcinoma significantly crossing the midline. The total number of patients with ONM in the cN0-CLN exceeds the threshold for observation, however the authors could not recommend or refute the practice of routine prophylactic treatment of the cN0-CLN as none of the patients-in this study-with well-lateralized tumors or tumors just abutting the midline showed ONM.

Background: Malignant cervical lymphadenopathy in the setting of lung cancer represents N3 disease, and neck ultrasound (NUS) with sampling is described in the Royal College of Radiologists ultrasound training curriculum for the non-radiologists. This study reviews the incorporation of NUS +/− biopsy in the routine practice of a lung cancer fast-track clinic in the UK. Methods: We retrospectively assessed 29 months of activity of a lung cancer fast-track clinic. Systematic focused NUS was conducted in suspected thoracic malignancy, sampling nodes with a ≥5-mm short axis, under real-time US using a linear probe (5–12 Mhz). Fine-needle aspirations (FNAs) with or without 18 Ga core biopsies were taken. Results: Between August 2017 and December 2019, of 152 peripheral lymph nodes (LNs)/deposits sampled, 98 (64.5%) were supraclavicular fossa LNs with median [IQR] size 12 [8–18] mm. Core biopsies were performed in 54/98 (55%) patients, while all patients had FNAs. No complications occurred. The representative yield was 90/95 (94.7%) in cases with suspected cancer. No difference was seen between FNA versus core biopsy (p = 0.44). Of the 5 non-diagnostic samples, one was FNA only. The commonest diagnosis was lung cancer in 66/98 (67.3%). PDL-1 was sufficient in 35/36 tested (97.2%). ALK-FISH was successful in 24/25 (96%) cases. EGFR mutation analysis was successful in 28/31 (90.3%) cases. Median time from clinic to initial diagnosis was 7 [5–10] days. Computed tomography (CT) scans reported no significant lymphadenopathy in 18/96 (18.7%) cases, yet 10/18 (55.5%) cases were positive for malignancy. Conclusion: Neck nodal sampling by respiratory physicians was safe, timely, with a high diagnostic yield and suitability for molecular testing. Neck US can provide a timely diagnosis in cases that may be missed by CT alone.

BACKGROUND Rosai–Dorfman disease (RDD) is a rare histiocytic proliferation of unknown etiology commonly found in children and adolescents. The common manifestation of RDD is massive and painless bilateral cervical lymphadenopathy with extranodal disease. While extranodal involvement in RDD is common, the spleen is an infrequent site of disease. CASE SUMMARY We report a 10-mo-old female infant with RDD presenting multiple splenic masses without cervical lymphadenopathy. She had fever, and blood tests showed leukocytosis, anemia, and elevated erythrocyte sedimentation rate and C-reactive protein. Ultrasound, computed tomography, and magnetic resonance images demonstrated multiple splenic masses. Despite antibiotic therapy, her symptoms were not relived. She underwent diagnostic splenectomy and was discharged with recovery. CONCLUSION In pediatric patients with refractory infectious symptoms or hematological abnormalities, clinicians should suspect RDD, even in patients without significant lymphadenopathy.

In this study, we report case studies of two infants diagnosed with Kawasaki disease with pulmonary nodules. The typical symptoms of Kawasaki disease include changes to the lips and oral cavity, including reddening of the lips and strawberry tongue, the diffuse injection of oral and pharyngeal mucosa, a rash (including redness at the site of the Bacille Calmette-Guerin inoculation), and changes to peripheral extremities, which in the initial stage include the reddening of palms and soles and edema, and in the convalescent stage include periungual desquamation and non-suppurative cervical lymphadenopathy. One of the patients had mild, transient bilateral conjunctival redness, and the other patient had a fever. However, chest imaging revealed multiple lung nodules, and echocardiography revealed coronary artery dilatation. Based on the symptoms, the laboratory indicators and echocardiography, diagnoses of incomplete Kawasaki disease were confirmed. The physicians provided treatments to the patients that significantly alleviated their conditions, including intravenous immunoglobulin (IVIG) and aspirin. The coronary arteries of the two infants returned to normal, and the lung nodules of the two infants disappeared. We conducted a literature search and identified publications in which nine children reported pulmonary nodules associated with Kawasaki disease. At present, lung damage remains a challenge in diagnosing and differential diagnosis of Kawasaki disease and incomplete Kawasaki disease.

Kawasaki disease (KD) is an acute systemic vascular disease that affects mostly medium sized and small vessels. The most serious of which is coronary artery disease. Vasculitis involves proliferative granulomatous inflammation and resolves by cicatrization if not treated. It is generally a self-limited disease and its highest incidence is in children under five years. The diagnostic criteria include the presence of fever for at least 5 days along with four of five other clinical features (rash, mucositis, conjunctival injection, cervical lymphadenopathy or extremity changes). Atypical Kawasaki disease includes patients who meet only 2 or 3 of the 5 criteria for diagnosis. We here report a 4- year old male patient who presented with fever, mucositis, perineal rash and evidence of de novo femoral vasculitis leading to spontaneously leaking femoral arteritis. His complete blood count revealed thrombocytopenia. The patient fulfilled the criteria for the diagnosis of atypical Kawasaki Disease. He received intravenous immunoglobulins and aspirin in anti-inflammatory doses and his condition improved. We report this unusual presentation of Kawasaki disease with spontaneous femoral artery leak, rash and thrombocytopenia. Diagnosis of atypical Kawasaki disease is very challenging but essential as initiation of specific management is life-saving.

Background Burkitt lymphoma (BL) is an aggressive B-cell lymphoma with three variants (endemic, sporadic, and immunodeficiency-associated), presenting with specific epidemiological and clinical features. Burkitt lymphoma affects the head and neck region (BLHN) in approximately 10% of cases. The aim of this study was to undertake a comparative analysis of the clinicopathologic and immunohistochemical (IHC) features of BLHN diagnosed in patients from Africa, Guatemala, and Brazil. Methods Cases diagnosed as BLHN were collected from the files of six oral pathology laboratory services (Brazil, South Africa, and Guatemala), and one Brazilian pediatric oncology hospital from 1986 to 2020. Clinicopathological and IHC data, and Epstein-Barr virus (EBV) status by in situ hybridization data for each case were reviewed and described. Results Of the 52 cases, BLHN was predominant in pediatric patients [43 (82.69%)] and males [43 (82.69%)], with a mean age of 11.26 ± 9.68 years (range, 1-39 years). Neck and cervical lymph nodes [14 (26.92%)], and involvement of both maxilla and mandible [8 (15.38%)], were the most common anatomical sites. Clinically, tumor/swelling [40 (31.25%)], cervical lymphadenopathy [14 (10.94%)], pain [12 (9.38%)], and bone destruction [12 (9.38%)] were frequent findings. All cases showed typical morphological characteristics of BL. IHC profiles included positivity for CD20 [52 (100%)], CD10 [38 (79.17%)], Bcl6 [29 (87.88%)], and c-Myc protein [18 (81.82%)]. EBV was positive in 18 cases (62.07%). The Ki-67 index ranged from 90-100%. Conclusion The clinicopathological and EBV profile of BLHN in South African, Guatemalan and Brazilian patients is similar.

Background Rosai-Dorfman disease (RDD) is a rare benign proliferative disease whose etiology is not clear and may be related to infection or unexplained immune dysfunction. The authors present a case of RDD with lung involvement in a 10-year-old patient. Case summary A 10-year-old girl found that her left cervical lymph nodes were enlarged for more than 7 mo, and the largest range was about 6.5 cm × 5.9 cm × 8.1 cm. Cervical magnetic resonance imaging showed multiple masses in the left neck, with low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. A malignant tumor, with a high possibility of lymph node metastasis, was initially considered. At the same time, lung computed tomography showed multiple nodules of different sizes scattered on both sides of the lung, with uniform internal density. Thus, a possible metastatic tumor was considered. Finally, RDD was diagnosed by pathology and immunohistochemistry. According to the antibiogram, clindamycin was administered for 2 wk, and prednisone acetate was administered for 7 wk. Nine months later, the ulcer in the left neck was better than before, but the imaging showed that the lesion was not controlled. Conclusion The diagnosis of RDD cannot be made by a single tool and its treatment is a long-term exploratory process. Follow-up is necessary.

Background The aim of this study is to explore the characteristics of Kawasaki disease (KD) and concurrent pathogens due to a stay-at-home isolation policy during coronavirus disease 2019 (COVID-19) epidemic. Methods All patients with KD admitted between February and April in 2015–2020, were classified into before (group 1, in 2015–2019) and after (group 2, in 2020) isolation groups. A total of 4742 patients [with KD (n = 98) and non-KD (n = 4644)] referred to Mycoplasma pneumoniae (MP) and virus detection were analyzed in 2020. Clinical characteristics, laboratory data, and 13 pathogens were analyzed retrospectively. Results Group 2 had a significantly increased incidence of KD (0.11%) with 107 patients compared to that of group 1 (0.03%) with 493 patients. The comparisons of oral mucosal change, strawberry tongue, desquamation of the fingertips, cervical lymphadenopathy and neutrophil percentage decreased in group 2 compared to group 1. The infection rate of MP increased significantly in group 2 (34.7%) compared to group 1 (19.3%), while the positive rate of viruses decreased significantly in group 2 (5.3%) compared to group 1 (14.3%). In 2020, the positive rate of MP infection increased significantly in patients with KD compared to the increase in patients with non-KD. The infection rate of MP for younger children aged less than 3 years old was higher in group 2 than in group 1. Conclusion Compared with the characteristics of KD from 2015 to 2019 years, the incidence of KD was increased in 2020 and was accompanied by a high incidence of MP infection, especially in younger children (less than 3 years old) during the isolation due to COVID-19 pandemic.

Objective: To determine the complications associated various types of tumors of advanced stage of thyroid disease at tertiary care hospital. Study Design: Descriptive study. Place and Duration: Two years study from April 2018 to March 2020 was conducted in Liaquat University of Medical and health sciences Jamshoro. Patients and Methods: All patients were admitted from Outpatient department (OPD) with advance stage of tumor of thyroid and either of gender were included. The patients were evaluated fully after history and clinical examinations berries sign and specific investigations of thyroid profile (T3,T4,TSH), ultrasound of thyroid, fine-needle aspiration cytology FNAC, image guided biopsy, frozen section biopsy for confirmation of diagnosis, indirect laryngoscopy, x - Ray neck and MRI. All the patients were assessed for pre-operative evaluation (complications) with advanced stage of thyroid tumors. All the data regarding developed complications was recorded via study proforma. Data was analyzed by using the SPSS version 20. Results: Most of the patients were found with age groups of 20 to 34 years and 35 to 55 years. Out of all, 25 patients were diagnosed papillary carcinoma, 12 patients were diagnosed as follicular carcinoma, 7 patients had Anaplastic carcinoma, 4 patients were diagnosed lymphoma and 2 patients were diagnosed as medullary carcinoma. As per complications of advanced disease 23 patients had thyroid swelling with cervical lymphadenopathy and pain, 13 patients had thyroid swelling with change of voice, 7 patients had thyroid swelling with dyspnea and dysphagia, 5 patients were presented with thyroid swelling with bony pain, weight loss and pathological fractures, 2 patients were presented with thyroid swelling with diarrhea. Conclusion: Various complications such as swelling, pain, hemorrhage, cervical lymphadenopathy, change in voice, weight loos, pathological fracture, dyspnea and dysphagia were frequently seen in patients presented with advanced stage of thyroid disease.

Medullary thyroid carcinomas make up 9,4% of all cancers of the thyroid gland [1]. We can divide them into sporadic and familial form. Sporadic forms are most common. The rest of medullary thyroid carcinomas are familial forms which in most cases are associated with MEN2a and MEN2b syndromes. If neoplasm is associated with MEN2a or MEN2b syndromes, other tumors can occur: pheochromocytoma or adenomas of parathyroids glands. Medullary thyroid carcinoma typically occurs as a solid tumor in the thyroid region of the neck. It can produce also: pain in thyroid region, dysphagia, hoarseness, cervical lymphadenopathy. These symptoms are caused by infiltration of adjacent tissues by neoplasm and by metastases to cervical lymph nodes. It is very rare that there is no tumor in the thyroid region, when a patient complains about signs associated with infiltration of the tumor, but in some cases lymphadenopathy can be the first sign of medullary thyroid carcinoma [2]. Rarer than that there is no tumor in thyroid gland visualized in CT scans when there are signs of cervical lymphadenopathy. In this case report we present the patient with metastases of the medullary thyroid carcinoma to the neck and no other findings in physical examination and additional testing.

Syphilis has received its classical designation as one of “the great imitators,” reflecting a wide variety of symptoms and presentations, which can cause difficulties in diagnosis. Here we report an unusual case of secondary syphilis in a person with acute necrotizing tonsillitis and Sweet syndrome. A 33-year-old female presented with fever, bilateral cervical lymphadenopathy, tonsillar enlargements with ulcerated pus-filled lesions on the right tonsil, and multiple pseudovesicular, mammillated, edematous plaques on her neck, face, and extremities. Syphilis serology was positive and a skin biopsy demonstrated a neutrophil-rich dermatitis characteristic of Sweet syndrome. The association of Treponema pallidum infection with Sweet syndrome may be a coincidence; nevertheless, our case serves as a reminder that secondary syphilis should remain in the differential diagnosis of the acute febrile neutrophilic dermatosis.

Nivolumab is a monoclonal antibody targeting programmed cell death-1 (PD-1) that has been recently shown to exhibit clinical efficacy in patients with gastric cancer. However, various degrees of immune-related adverse events (irAEs) have been reported. We report the case of a 71-year-old male patient diagnosed with gastric cancer with peritoneal metastases. He was treated with nivolumab as third-line chemotherapy. On the 10(th) day after completing seven cycles of nivolumab treatment, he urgently visited the hospital because of mild left cervical lymphadenopathy. We suspected it to be due to inflammation and initiated treatment with levofloxacin hydrate. However, 3 days later, he was admitted to the emergency room due to exacerbation of his lymphadenopathy. A diagnosis of nivolumab-induced lymphadenopathy was made as the antibiotics were ineffective, and the patient was administered prednisolone (PSL) 20 mg. One day after admission, the pain and swelling of the lymph node greatly lessened, and the following day, the pain gradually disappeared; thereafter, the PSL dose was tapered and nivolumab treatment was resumed. The patient again developed cervical lymphadenopathy approximately 4–5 days after nivolumab was reintroduced, which disappeared 1 week later. During each episode of lymphadenopathy, he received a dose of 20 mg of PSL for 4 days, which would be eventually tapered to 10 mg without antibiotics and NSAIDs. After 2 months, cervical lymphadenopathy completely disappeared while 10 mg of PSL was continued, which was also eventually tapered off. To our knowledge, this is the first case report of nivolumab-induced lymphadenopathy in a patient with gastric cancer. This case suggested that we should keep in mind that various irAEs may occur during treatment with immune checkpoint inhibitors. It is necessary to ensure the absence of infection and metastasis before treatment and to promptly administer systemic corticosteroids to address them.

Objectives The cause of cervical lymphadenopathy varies from inflammation to malignancy. Accurate and prompt diagnosis is crucial as delayed detection of malignant lymph node can lead to a worse prognosis. To improve the diagnostic accuracy of metastatic lymph node, electrical spectroscopy was employed to study human normal and metastatic lymph nodes using a hypodermic needle with fine interdigitated electrodes on its tip (EoN). Subjects and Methods The electrical impedance of samples collected from 8 patients were analyzed in the sweeping frequency range from 1 Hz to 1 MHz. To align the impedance level data of the patients, normalized impedance was employed. Results The optimal frequency exhibiting the best discrimination results between the normal and cancerous tissues was introduced based on a discrimination index. A high sensitivity (86.2%) and specificity (88.9%) were obtained, which implied that the EoN holds the potential to improve the in vivo diagnostic accuracy of metastatic lymph node during biopsy and surgery. Conclusion EoN has a promising potential to be utilized in real-time in actual clinical trials without a need for any pre/post-treatment during FNA or surgery. We believe that the EoN could reduce unnecessary operations with its associated morbidity.

Thyroid cancer is very rare in children and papillary thyroid carcinoma (PTC) represents the most common type. Patients are frequently in the second decade of life and complain of painless enlargement of the gland. Pediatric PTC has unique clinicopathologic characteristics that make it different from the adult counterpart. The biologic behavior tends to be aggressive and patients frequently present with advanced disease. Herein, we report a case with an unusual presentation. A 5-year-old child manifested with fever, night sweats, cervical lymphadenopathy, and weight loss for 2 months. He also complained of mild cough and shortness of breath. Clinical suspicion of tuberculosis or lymphoma was raised, but laboratory workup was unremarkable. Cervical lymph node excision was done, and the histopathologic examination showed metastatic PTC. The patient underwent surgical and radioactive therapy and remained in complete remission for 5 years. Unfortunately, the disease ultimately relapsed with disseminated metastasis and the patient passed away.

BackgroundKawasaki disease (KD) as an acute, systemic vasculitis is the leading cause of acquired heart disease in children under the age of 5 years.MethodsA 10-year cross-sectional retrospective study was designed to assess 190 Iranian children with KD during 2008–2018. Demographic data, clinical and laboratory manifestations from the onset of symptoms to diagnosis, clinical signs and symptoms, and subsequent treatments were evaluated to predict hospitalization stay, complications, and response to treatment.ResultsChildren with KD had a male-to-female ratio of 1.18:1 and an average age of 36 months. There was an insignificantly more incidence of KD in cold seasons. The most frequent symptoms were fever (92.6%), oral mucus membrane changes (75.8%), bilateral bulbar conjunctival injection (73.7%), polymorphous skin rash (73.2%), peripheral extremity changes (63.7%), and cervical lymphadenopathy (60.0%). The rate of gastrointestinal, cardiac, joint, and hepatic complications was determined to be 38.4, 27.9, 6.8, and 4.2%, respectively. 89.5% of patients received intravenous immunoglobulin (IVIG) plus aspirin as the first line of treatment, while, 16.3% of them needed an extra second line of treatment. Significantly low serum sodium levels and high platelet counts were detected in KD patients with cardiac complications. Cardiac complications often were more encountered in patients who did not respond to the first line of treatment. Higher platelet count, lower serum sodium amount, and C-reactive protein (CRP) level were significantly associated with a need for an additive second line of treatment. A significant relationship between hospitalization stay and hemoglobin level was found.ConclusionAs most of the clinical manifestations and complications were following other reports released over the past few years, such data can be confidently used to diagnose KD in Iran. Seasonal incidence and a positive history of recent infection in a notable number of patients may provide clues to understand possible etiologies of KD. Laboratory markers can successfully contribute to health practitioners with the clinical judgment of the need for additional treatments, possible complications, and hospitalization duration.

We report a case of Kikuchi-Fujimoto disease (KFD) in an 18-year-old African American female who presents with a high-grade fever, sweating, and painful right-sided cervical lymphadenopathy. Lab analysis showed leukopenia, thrombocytopenia, and an elevated C-reactive protein. The remaining infectious and autoimmune work-up was negative. Given her clinical presentation, an infectious etiology was suspected, and broad-spectrum antibiotics were empirically started. Bicytopenia in the setting of lymphadenopathy raised the suspicion for lymphoma with bone marrow infiltration. An excisional biopsy was performed, and a histological exam of the lymph nodes showed necrotizing histiocytic lymphadenitis consistent with KFD. She was discharged on Naproxen and Tylenol with a referral to Rheumatology. This case highlights the rarity of bicytopenia in KFD and the importance of early and prompt diagnosis in order to avoid unnecessary testing and inappropriate treatment.

Objective: To determine the clinical presentation of carcinoma of thyroid and its treatment modalities at tertiary care Hospital. Study Design: Prospective observational study. Place and Duration: This study was conducted in Liaquat university of Medical and health sciences Jamshoro/Hyderabad, Pakistan, during two years from July 2017 to June 2020. Patients and Methods: All the patients with age range between 20 to 80 years having swelling in front of neck according to clinical examination with hard inconsistency along with change of voice lymphadenopathy, difficulty in swallowing and breathing, patients diagnosis with malignancy according to FNAC and CT, and either of gender were included. FNAC was done in each patient except toxic goiter, diffuse goiter and multinodular goiter with dominant nodules. Patients those were diagnosed with stage I and II, underwent surgical treatment and remaining were referred to oncology department for new adjuvant therapy and then surgeries were done if possible. All the data was recorded in study proforma and data analysis was done by using SPSS data analysis software version 20. Results: Out of all cases of suspicious of carcinoma thyroid, 70% were females. Neck swelling was in all of the cases, followed by pain, cervical lymphadenopathy, recurrent laryngeal nerve palsy with change of voice, swallowing difficulty, cyanosis and pathological fracture. According to tumor staging, most of the cases were found with benign tumor, followed by 5 cases with stage I, three cases with stage II, three patients presented with stage IV and one was seen with secondary’s from malignant melanoma. Most of the cases 70.0% underwent subtotal and near total thyroidectomies Eight patients were initially operated having stage I and II of malignancy and remaining 7 patients of stage III and IV were referring to oncology department for further management. Conclusion: In the conclusion of this study the neck swelling was the commonest clinical presentation. Surgical decision making and the operative planning is one of the new challenges. Mostly patients underwent subtotal and near total thyroidectomies having benign presentation and patients those had stage I and II of malignancy were initially operated, while patients of stage III and IV including secondary were referred to oncology.

Presentation with cervical lymphadenopathy would usually have an aetiology of neoplasm, infection or reactive cause. Dual pathology of regional metastasis with simultaneous occurrence of tuberculous lymphadenopathy is rather rare. Herein the authors present a case of primary occult carcinoma and tuberculous lymphadenopathy in an unfortunate patient. The reliability of fine-needle aspiration cytology as a first-line investigation, with alternative methods in approaching cervical lymphadenopathy, was further dissected.

PURPOSE To determine the rate of cytologic and diagnostic adequacy and identify features associated with suboptimal tissue sampling in ultrasound-guided fine-needle aspiration (US-FNA) of suspected nodal disease in thyroid cancer patients. METHODS A single-institution pathology database was queried for lymph node FNA reports in thyroid cancer patients from 2014 to 2019. Charts were reviewed for demographics, body mass index (BMI), prior thyroidectomy, cancer type, and subsequent surgery. Ultrasound images were retrospectively reviewed for location, size, depth from skin, cystic components, macrocalcification, echogenic foci, and internal vascularity score. Pathology reports were categorized as cellular and diagnostic, hypocellular/acellular but diagnostic with abnormal cells or thyroglobulin levels, or hypocellular and nondiagnostic. Correlation and multivariate regression analyses were performed. RESULTS Initial query yielded 552 lesions in 343 subjects. Following exclusion, 377 lesions in 255 subjects were included. Mean patient age was 48.5 years (14-90), BMI 28.5, and 66.7% female and 33.3% male. The majority (95.3%) had papillary thyroid carcinoma (PTC); and 65.5% had prior thyroidectomy. 17.7% of lesions were hypocellular/acellular (suboptimal), and 5.6% nondiagnostic. Patient factors had no association (P >.05). Right-sidedness and hypovascularity were associated with hypocellularity (P

We present a case of middle-aged woman whose health problems began 3 months after a registered tick bite in endemic area of Lyme borreliosis. First symptoms included fatigue, chills, cervical lymphadenopathy, neck pain and stiffness. Patient was afebrile. Lyme disease was excluded due to lack of erythema migrans and negative enzyme immunoassay test results for anti-Borrelia antibodies. During the next few months, her condition was getting worse and symptoms were accompanied with brain fog, dizziness, palpitations, irregular menstrual cycles, insomnia, panic attacks, headaches, and muscle aches. This led to multiple medical tests and examinations, but the diagnosis failed to be established. Finally, after occurrence of paresthesia and weakness of leg muscles, clinical diagnosis of disseminated Lyme borreliosis with nervous system involvement was suspected and antibiotic therapy was initiated. After the second dose of ceftriaxone, patient got fever and her condition worsened. However, ceftriaxone therapy was continued for a total of 5 days and was followed by 4 weeks of doxycycline therapy. Upon completion of antibiotic therapy, high specific anti-Borrelia antibodies were detected by Western blot and SeraSpot. Appearance of anti-Borrelia antibodies, in contrast to negative test results performed immediately before the therapy started, indicated seroconversion. 18 months after the therapy, patient was completely without the symptoms. This paper emphasizes importance of clinical evaluation of Lyme disease and shows a unique case of seroconversion in patient with symptoms of disseminated Lyme disease. Seroconversion was likely triggered by release of lipoproteins and other immunogenic molecules from Borrelia once the bacterial die-off began due to antibiotic therapy.

Follicular helper T-cell-derived peripheral T-cell lymphoma (TFH-derived PTCL) initially present in the Waldeyer's ring is a rare condition with a challenging diagnosis. This study aimed to evaluate the clinicopathological characteristics and diagnosis of Waldeyer's ring TFH-derived PTCL and raise awareness of this type of lymphoma. A series of 13 cases of Waldeyer's ring TFH-derived PTCL were retrospectively analyzed. Clinically, most patients presented with localized manifestations, such as painless cervical lymphadenopathy (7/13), pharyngalgia (6/13), and nasal obstruction (3/13), and systemic symptoms were uncommon. Macroscopically, plump mass (9/13) and nodular lesions (3/13) covered with intact and tense mucosa were the main findings on fiberoptic laryngoscopy examination. Pathologically, diffuse infiltration with atypical lymphocytes in the lamina propria (10/13) was the most common growth pattern. Clear cells (9/13) and vascular proliferation (11/13) within a polymorphic inflammatory background (11/13) were frequently observed. All cases expressed at least two TFH markers: PD-1 in 92.3% (12/13), BCL6 in 69.2% (9/13), CXCL13 in 53.8% (7/13), and CD10 in 46% (6/13). Targeted next-generation sequencing analysis identified frequent mutations, including TET2 (10/11), RHOA (6/11), DNMT3A (3/11), and IDH2 (2/11). The overall survival rate at 2 years was 35.5%, and survival analysis revealed that patients with localized disease showed better overall survival (P = 0.022). In conclusion, careful morphological observation combined with immunohistochemistry and molecular analysis would help in diagnosis of TFH-derived PTCL involving the Waldeyer's ring, which is a rare condition that frequently presents with atypical clinical manifestations.

Introduction The diagnostic approach to patients with isolated asymptomatic cervical lymphadenopathy varies between excisional biopsy and follow-up. When the anamnesis, physical examination, laboratory and imaging findings are not sufficient to identify the etiology, an excisional biopsy is performed for the differential diagnosis between early-stage lymphoma and infectious or reactive causes. If the excisional biopsy, which may have some complications, is not performed, it may delay the diagnosis of lymphoma. This diagnostic challenge could be avoided by predictive markers. Objectives This study was planned to determine the predictive value of neutrophil/lymphocyte ratio in the diagnosis of Hodgkin and non-Hodgkin limphoma in patients with asymptomatic, isolated cervical limphadenopathy and underwent excisional biopsy. Methods A total of 90 patients between the years 2016 − 2019 admitted to our clinics due to asymptomatic isolated cervical lymphadenopathy, present in at least 4 weeks with lympho nodes in pathological dimensions persisting in the cervical region, were included to our study. An excisional lympho node biopsy was performed in all 90 patients. Results Of the 90 patients who underwent excisional biopsy; 34 were diagnosed as reactive lymphadenopathy 30 were non-Hodgkin linphoma, and 26 were Hodgkin linphoma. A total of 56 (62.2%) patients were diagnosed as lymphoma, either Hodgkin or non-Hodgkin, while 34 patients (38.8%) were diagnosed as reactive lymphadenopathy. The median age, total whiteblood count, neutrophil count of the lymphoma groups were significantly higher than reactive lymphadenopathy group, whereas the lymphocyte count was significantly lower in the lymphoma patients. The median neutrophil/ lymphocyte ratio was 1.7 in the reactive lymphadenopathy group, 3.5 in the non-Hodgkin limphoma group, and 3.0 in the Hodgkin limphoma group (p Conclusion According to the results of our study, neutrophil/lymphocyte ratio was significantly higher in patients who were admitted with isolated asymptomatic lymphadenopathy and were diagnosed with lymphoma, and who were diagnosed with early-stage Hodgkin and non- Hodgkin lymphoma compared to those who were found to have reactive lymphadenopathy. Neutrophil/lymphocyte ratio, which is a low-cost, fast and easy-to-access test, has a predictive value in the diagnosis of lymphoma in patients with asymptomatic lymphadenopathy.

Background Cervical lymphadenopathy is commonly seen in general practice, and its etiology is diverse. Establishing the diagnostic strategy for lymphadenopathy would be desirable to avoid overlooking neoplasms or other critical conditions. This study aims to identify the useful laboratory parameters for cervical lymphadenopathy that require clinical observation or intervention. Methods The participants were outpatients presenting cervical swelling or cervical lymph node (LN) pain who consulted the General Internal Medicine department from 2010 to 2016. We evaluated the characteristics, physical findings, and laboratory parameters with final diagnoses by multivariate logistic regression analysis. We categorized the final diagnoses as “Clinical Intervention Required Group (CIRG)” including necrotizing lymphadenitis, hematologic neoplasms, metastatic lymphadenopathy, tuberculous lymphadenitis, bacterial infectious diseases, infectious mononucleosis, autoimmune diseases, and other abnormal conditions or “No‐CIRG” not requiring further clinical observation or intervention. Results We evaluated 409 participants, with 130 (31.8%) diagnosed as belonging to the CIRG. There was an association between CIRG and various parameters: age ≥60 years old (adjusted odds ratio [AOR], 2.70; 95% confidence interval [CI], 1.48‐4.90), having a referral (AOR, 1.83; 95% CI, 1.12‐3.00), diameter of LN ≥ 2 cm (AOR, 1.91; 95% CI, 1.05‐3.48), fixed LNs (AOR, 2.74; 95% CI, 1.02‐7.37), and lactate dehydrogenase (LD) ≥400 U/L (AOR, 3.78; 95% CI, 1.46‐9.77). Eighty‐two percent of LD ≥ 400 cases in the CIRG were infectious mononucleosis or necrotizing lymphadenitis. Conclusions Besides the clinical indicators reported previously, we may apply an elevated LD level as a useful indicator of cervical lymphadenopathy that requires further clinical observation or intervention., We evaluated 409 participants presenting cervical swelling or cervical lymph node pain to identify useful physical findings or laboratory parameters for cervical lymphadenopathy that require clinical observation or intervention. The risk factors associated with that by multivariate analysis were age ≥60 years, having a referral, diameter of cervical LN ≥2 cm, fixed cervical LNs, and LD ≥400 U/L.

Purpose Significant numbers of children and teenagers with COVID-19 have developed a severe inflammatory condition with a Kawasaki-like disease. Some needed intensive care unit admission, and others recovered quickly. We aimed to summarize the clinical and laboratory features of patients with Kawasaki-like features diagnosed during the COVID-19 pandemic. Methods A literature search in Web of Science, PubMed, Scopus, and Science Direct up to June 30, 2020. The mean or untransformed proportion and 95%CI were estimated. Results Analysis of 15 articles (318 COVID-19 patients) revealed that the mean age was 9.10 years. Although many presented with typical Kawasaki-like features; fever (82.4%), polymorphous maculopapular exanthema (63.7%), oral mucosal changes (58.1%), conjunctival injections (56.0%), edematous extremities (40.7%), and cervical lymphadenopathy (28.5%), atypical gastrointestinal (79.4%) and neurocognitive symptoms (31.8%) were also common. They had elevated LDH, D-dimer, CRP, procalcitonin, interleukin-6, troponin I levels, and lymphopenia. Nearly 77.0% developed hypotension, and 68.1% went into shock, while 41.1% had acute kidney injury. Intensive care was needed in 73.7% of cases, 13.2% were intubated, and 37.9% required mechanical ventilation, with only one reported fatality case. Intravenous immunoglobulins and steroids were given in 87.7% and 56.9% of the patients, and anticoagulants were utilized in 67.0%. Pediatric patients were discharged after a hospital stay of, on average, 6.77 days (95%CI:4.93-8.6). Conclusion Recognizing the typical and atypical presentation of pediatric COVID-19 patients has important implications in identifying children at risk. Monitoring cardiac and renal decompensation and early interventions in patients with “multisystem inflammatory syndrome” is critical to prevent further morbidity.

Case Presentation A 72-year-old Chinese man presented with a 5-month history of chronic dry cough, weight loss, and progressive dyspnea. There was no associated hemoptysis, hoarseness, epistaxis, or fever on systemic review. He was a nonsmoker and had no family history of malignancy. He was treated for pulmonary TB 40 years ago. A chest radiograph ( Fig 1 ) showed mass-like consolidation in the right midzone with loss of the right hilar border, a small right pleural effusion, and bi-apical scarring. On physical examination, he was afebrile and normotensive, and he had pulse oxygen saturation of 97%. Examination of the chest was remarkable only for reduced breath sounds over the right chest. He did not have digital clubbing, distended neck veins, or cervical lymphadenopathy.

Rhabdomyosarcoma (RMS) is the most common soft tissue malignancy in children and adolescents. Its occurrence in patients more than 18 years of age is rare. Subtypes of rhabdomyosarcoma include embryonal RMS, alveolar RMS, pleomorphic RMS and spindle/sclerosing RMS.Herein, we report the case of a 42-year-old female patient who presented with bilateral cervical lymphadenopathy of two-month duration. Clinical and radiological examination showed no other significant lesions. Fine needle aspiration cytology and biopsy of lymph node showed diffusely arranged atypical round cells. The clinical findings and morphology pointed to a hematolymphoid malignancy. On immunohistochemical examination, the atypical cells were negative for CD45, CD20, CD3, PAX5 and CD30. The cells showed patchy moderate positivity for cytokeratin, focal weak positivity for synaptophysin and were negative for chromogranin, CD56 and TTF1. On further evaluation, patchy strong positivity for desmin, myogenin and myo D1 were noted. Correlating the morphology and immunoprofile, diagnosis of rhabdomyosarcoma was given.Multiple peripheral lymph node enlargement without an obvious primary lesion is a rare presentation of alveolar RMS, with only a few cases reported in literature. Unusual clinical presentation complicated with aberrant expression of epithelial markers may make the diagnosis of alveolar RMS difficult. This case demonstrates the importance of considering extensive differential diagnosis for neck masses with poorly differentiated morphology.

Research focusing on COVID-19-associated complications has become a growing area of importance. One such complication is multisystem inflammatory syndrome, a rare immune-mediated condition that most commonly presents with Kawasaki-like symptoms in the pediatric population. Potential complications include myocarditis, renal impairment, and cytokine storm. Here we describe the first reported case of multisystem inflammatory syndrome in the West Texas region, presenting in a Hispanic 5-year-old female with a recent history of COVID-19. The patient arrived to the hospital with a 4 day history of high fever, a 2 day history of diffuse maculopapular rash, and complaints of fatigue, generalized body aches, decreased appetite, headache, and abdominal pain. Further physical exam revealed hepatosplenomegaly and cervical lymphadenopathy, while labs revealed elevated inflammatory markers, lymphopenia, left shift with bandemia and immature cells, thrombocytopenia, hypoalbuminemia, and transaminitis. The patient was admitted to the pediatric intensive care unit with a suspected Kawasaki-like illness and started on high dose aspirin and IV immunoglobulin. She was placed on methylprednisolone, albumin, and acetaminophen on hospital day 3. By hospital day 4, the patient defervesced, inflammatory markers decreased, and clinical symptoms improved. The patient was discharged on hospital day 10 with absent fever and improvement of clinical symptoms for 6 consecutive days. No complications were detected upon follow-up 2 weeks later. A low threshold of suspicion for this illness is required in any child with a history of SARS-CoV-2 infection, as the presentation is vague and early identification is necessary to prevent further complications.

Objective: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare cause of cervical lymphadenopathy. It is a potentially life-threatening hypersensitivity reaction, commonly characterized by fever, rash, hematological abnormalities, and multi-organ involvement. Its association with agranulocytosis is even rarer, with fewer than 10 cases describing the coexistence of DRESS with agranulocytosis reported in the English literature. Case Summary: An otherwise well 40-year-old female presented with a sore throat and cervical lymphadenopathy, with investigations revealing DRESS and agranulocytosis secondary to carbamazepine. Conclusion: DRESS and agranulocytosis are serious, potentially life-threatening adverse drug reactions which can initially present as cervical lymphadenopathy. As carbamazepine is considered first-line therapy for certain chronic neuropathic conditions such as trigeminal neuralgia, clinicians should be aware of the varying clinical presentations of both conditions.

We herein report a rare coincidence and a possible association between laryngotracheal fungal infection and spindle cell carcinoma of the larynx (SpCC). A 79-year-old gentleman presented to the Emergency Department with manifestations of airway obstruction. Flexible nasendoscopy showed pooling of saliva around the larynx and his neck palpation did not show cervical lymphadenopathy. Further imaging showed bilateral transglottic mass mainly in the subglottis along with right pulmonary nodularity. Percutaneous tracheostomy, panendoscopy and biopsy of the laryngeal mass confirmed a diagnosis of SpCC. A few days later, he was admitted and aspergillus fumigatus was found in a biopsy of his tracheal tissue. To the best of our knowledge, the possible correlation between laryngotracheal aspergillosis and such a rare type of cancer larynx (SpCC) has not been highlighted in the literature.

Objective To investigate the diagnostic performance of 18F-FDG PET/computed tomography (CT) for the detection of occult primary tumors in patients with squamous cell carcinoma of unknown primary (SCCUP) in the head and neck. Patients From March 2016 to January 2020, 37 patients diagnosed as SCCUP before PET/CT were retrospectively reviewed. The diagnosis of SCCUP was made when an overt primary tumor location could not be found for histologically proven squamous cell cervical lymphadenopathy after a complete diagnostic workup which includes full medical history, physical examinations, flexible rhinolaryngoscopy and CT or MRI. The PET/CT images were visually assessed by two nuclear medicine radiologists. Histopathological investigations after the PET scan served as the reference standard. Results The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET/CT for SCCUP were 71.4, 43.8, 62.5, 53.9 and 59.5%, respectively. PET/CT allowed identification of previously undetected lesions in 40.5% of the SCCUP patients. A total of 24 PET/CT scans indicated a positive result. Among them, nine were categorized into false-positive because of negative results from subsequent targeted and random biopsies. There were 13 PET/CT scans with a negative result, six of which, however, were revealed to have a primary site by subsequent random biopsies. Conclusion 18F-FDG PET/CT was shown to be useful in detecting a primary tumor for SCCUP, but had limitations in terms of both false-positive cases and false-negative cases. Therefore, histopathological investigations such as targeted and random biopsy should be viewed as necessary practice irrespective of PET/CT results.

Objective: to study the activity of HSV 1,2, EBV, CMV, HHV6, HHV7 in children of different age groups, to determine the frequency of various symptoms and syndromes in the examined children depending on hhv7 monoinfection and combined herpetic infection in the age aspect.Materials and methods: 56 children aged 2 to 18 years were examined at the state MEDICAL research Institute named after Prof. A. F. Agafonov in Kazan, at the BIOMED medical and diagnostic center in Kazan and at the LUCH children’s clinic in Naberezhnye Chelny (boys accounted for 62.5% of cases, girls-37.5%). Verification of the diagnosis and evaluation of the dynamics of etiological markers of the infectious process in all observed children was performed by PCR. Blood and saliva were examined to detect markers of human herpes virus type 7 (in qualitative PCR), and blood, oropharyngeal flushing, and urine were examined in semiquantitative PCR to determine other viruses from the herpes family (HHV6, CMV, EBV). In enzyme immunoassay is determined At the same time, we studied options for combining laboratory markers of herpesvirus activity and changes in the main laboratory parameters used in routine practice. We studied the dynamics of the observed parameters against the background of complex antiviral therapy for the next 3 months after the initial examination. The frequency of occurrence of various symptoms and syndromes was determined depending on the activity of various representatives of the herpes family, their combination, and the age of the subjects.Results of the study: HHV7-monoinfection is more typical for the age group of 7-14 years. The significance of mixed HHV6+HHV7 infection decreased with age. The combination of activity of 4 herpesviruses was more often registered in the age categories 2-7 years and 14-18 years. More often, patients had tonsillitis, generalized cervical lymphadenopathy, periodic temperature rise to subfebrile or febrile numbers, pharyngitis, recurrent ARI, rhinitis, which allows us to consider them as the main manifestations of HHV7 infection.Conclusion: HHV7 infection is significant in the modern pathology of the child. The presence of such syndromes as recurrent tonsillitis, cervical lymphadenopathy or isolated enlargement of submandibular lymph nodes, periodic fever, pharyngitis, recurrent ARI in combination with hepato - and/ or splenomegaly, fatigue, and headache is often associated with HHV7. HHV7-viremia is relatively rare, despite obvious clinical and laboratory signs of inflammation indicating the presence of a viral disease, which, apparently, and is the cause of underdiagnosis and lack of proper attention to this infection.

Fine Needle Aspiration Cytology (FNAC) is a quick, reliable, minimally invasive and cost effective diagnostic modality for evaluation of superficial lymph nodes and has been accepted as a first line investigation in most centres. The aim of the study was to identify the patterns of pathologies in aspiration cytology of lymph nodes in a tertiary care hospital located in Uttar Pradesh, India. The study was undertaken as a retrospective study using data in the Department of Pathology, G.S Medical College and Hospital, Uttar Pradesh, India. 235 lymph node FNACs that were performed during the two year span of 2018-19 were analysed. Females comprised 59.6% of the total patients who underwent lymph node FNAC procedure, 95 (40.4%) were males. The youngest patient was a 3 month old and the oldest happened to be 78 years. Lymph node enlargement was traced to malignant processes exclusively above 40 years of age. Uptill that age, tuberculosis seems to be the major cause underlying lymphadenopathy, mostly presenting as granulomatous lymphadenitis. Out of all cases which showed granulomatous or necrotic features, 27% showed the presence of AFB, hence confirming tuberculosis. A vast majority of the FNACs were performed for cervical lymphadenopathy (92.8%). 42.1% of the FNACs revealed reactive morphology. This diagnosis was closely followed by granulomatous lymphadenitis in 29.4% patients. Together with a definite diagnosis of tuberculous lymphadenitis, patients with granulomatous lymphadenitis comprised 42.6% of all diagnoses. 12 patients received a diagnosis of suppurative lymphadenitis, 9 received necrotizing lymphadenitis. 12 patients were diagnosed as metastatic carcinoma and 1 was suggestive of lymphoma. Most of the lymph nodes whose sizes were under 1 cm were reactive on cytology. Lymphadenopathy due to malignant etiology presented with lymph nodes measuring at least 2 cm. Granulomatous/tuberculous lymphadenitis presented in lymph nodes of varying sizes, from as small as 0.5 cm to larger ones.

Aim and Objective: To study incidence of cervical lymphadenopathy between age, sex and disease. Methodology: A review of 100 cases of cervical lymphadenopathy from Shadan Institute of Medical Sciences, Hyderabad were used for analysis and discussion. Results: Tuberculous cervical lymphadenitis is the commonest disease affecting the cervical lymphnodes 50% followed by secondaries from various primaries 39%, non-specific 5%, Hodgkins lymphoma 4% and non Hodgekins lymphoma 2% were diseases commonly found to be effecting cervical lymphonodes in the study conducted above, we had no cases of cat scratch disease or toxoplasma gondi or other in the group. Heigher incidence of tuberculous cervical lymphadenitis in the age group between 11-40 years. The youngest in the series was 11 years, oldest its 66 years. Average age is 35 years. The male: female ratio is 1:1 in present series. Tuberculosis is a disease of the poor still holds good. In the present study 71% of patients belong to socioeconomically low income groups. Hindus were more commonly affected than Muslim which usually vice versa is explained due to the fact that Hindu population is more than Muslim population in the area when this study was conducted. Distribution of disease is more in rural area 67%. According to the present series, this could be due to increase the awareness of the disease and improvement in living condition of the population living in the urban area. Conclusion: There is very high incidence of tubercular cervical lymphadenitis in patients with enlarged neck nodes in developing countries like India. Cervical lymph node adenopathy constitutes the most common presentation of extra pulmonary form of tuberculosis. However, it mimics other pathological conditions like metastasis from other primary sites, reactive lymphadenitis, chronic non-specific lymphadenitis, lymphoma etc. Therefore, it is important that otolaryngologists are aware of tuberculosis in the head and neck region which can aid in early diagnosis with the help of simple investigations and subsequently patients can be managed promptly without delay.